CHAPTER XIV.

OF THE QUINSY, OR INFLAMMATION OF THE THROAT.

THIS disease is very common in Britain, and is frequently attended with great danger. It prevails in the winter and spring, and is most fatal to young people of a sanguine temperature.

CAUSES.—In general, it proceeds from the same causes as other inflammatory disorders, viz. an obstructed perspiration, or whatever heats and inflames the blood. An inflammation of the throat is often occasioned by omitting some part of the covering usually worn about the neck, by drinking cold liquor when the body is warm, by riding or walking against a cold northerly wind, or any thing that greatly cools the throat, and parts adjacent. It may likewise proceed from the neglect of bleeding, purging, or any customary evacuation.

Singing, speaking aloud and long, or whatever strains the throat, may likewise cause an inflammation of that organ. I have often known the quinsy prove fatal to jovial companies, who, after sitting long in a warm room, drinking hot liquors, and singing with vehemence, were so imprudent as to go abroad in the cold night air. Sitting with wet feet, or keeping on wet clothes, are very apt to occasion this malady. It is likewise frequently occasioned by continuing long in a moist place, sitting near an open window, sleeping in a damp bed, sitting in a room that has been newly plastered, &c. I know people who never fail to have a sore throat, if they sit even but a short time in a room that has been lately washed.

Acrid or irritating food may likewise inflame the throat, and occasion a quinsy. It may also proceed from bones, pins, or other sharp substances, sticking in the throat, or from the caustic fumes of metals or minerals, as arsenic, antimony, &c. taken in by the breath. This disease is sometimes epidemical and infectious.

SYMPTOMS.—The inflammation from the throat is evident from inspection, the parts appearing red and swelled; besides, the patient complains of pains in swallowing. His pulse is quick and hard, with other symptoms of a fever. If blood be let, it is generally covered with a tough coat of a whitish colour, and the patient spits a tough phlegm. As the swelling and inflammation increase, the breathing and swallowing become more difficult, the pain affects the ears, the eyes generally appear red, and the face swells. The patient is often obliged to keep himself in an erect posture, being in danger of suffocation; there is a constant nausea or inclination to vomit, and the drink, instead of passing into the stomach, is often returned by the nose. The patient is sometimes starved at last, merely from an inability to swallow any kind of food.

When the breathing is laborious, with straitness of the breast and anxiety, the danger is great. Though the pain in swallowing be very great, yet while the patient breathes easy, there is not so much danger. An external swelling is no unfavourable symptom; but if it suddenly falls, and the disease affects the breast, the danger is very great. When a quinsy is the consequence of some other disease, which has already weakened the patient, his situation is dangerous. A frothing at the mouth, with a swelled tongue, a pale ghastly countenance, and coldness of the extremities, are fatal symptoms.

REGIMEN.—The regimen in this disease is in all respects the same as in the pleurisy. The food must be light and in small quantities, and the drink plentiful, weak, and diluting, mixed with acids.

It is highly necessary that the patient be kept easy and quiet. Violent affections of the mind, or great efforts of the body, may prove fatal. He should not even attempt to speak but in a low voice. Such a degree of warmth as to promote a constant gentle sweat is proper. When the patient is in bed, his head ought to be raised a little higher than usual.

It is particularly necessary that the neck be kept warm, for which purpose several folds of soft flannel may be wrapt round it. That alone may often remove a slight complaint of the throat, especially if applied in due time. We cannot here omit observing the propriety of a custom which prevails among the peasants of this country. When they feel any uneasiness of the throat, they wrap a stocking about it all night. So effectual is this remedy, that in many places it passes for a charm, and the stocking is applied with particular ceremonies; the custom however is undoubtedly a good one, and should never be neglected. When the throat has been thus wrapped up all night, it must not be exposed to the cold air through the day, but a handkerchief or a piece of flannel be kept about it till the inflammation be removed.

The jelly of black currants is a medicine very much in esteem for complaints in the throat, and indeed it is of some use. It should be almost constantly kept in the mouth, and swallowed down leisurely. It may likewise be mixed with the patient’s drink, or taken any other way. When it cannot be obtained, the jelly of red currants, or of mulberries, may be used in stead.

Gargles for the throat are very beneficial. They may be made of sage-tea, with a little vinegar and honey, or by adding to half an English pint of pectoral decoction, two or three spoonsful of honey, and the same quantity of currant-jelly. This may be used three or four times a day; and, if the patient be troubled with tough viscid phlegm, the gargle may be rendered more sharp and cleansing, by adding to it a tea-spoonful of the spirit of sal ammoniac. Some recommend gargles made of the decoction of the leaves or bark of the black currant-bush; but where the jelly can be had, these are unnecessary.

There is no disease wherein the benefit of bathing the feet and legs in luke-warm water is more apparent: that practice ought therefore never to be neglected. If people were careful to keep warm, to wrap up their throats with flannel, to bathe their feet and legs in warm water, and to use a spare diet, with diluting liquors, at the beginning of this disease, it would seldom proceed to a great height, or be attended with any danger; but when these precautions are neglected, and the disease becomes violent, more powerful medicines are necessary.

MEDICINE.—An inflammation of the throat being a most acute and dangerous distemper, which sometimes takes off the patient very suddenly, it will be proper, as soon as the symptoms appear, to bleed in the arm, or rather in the jugular vein, and to repeat the operation if circumstances require.

The body should likewise be kept gently open. This may either be done, by giving the patient for his ordinary drink a decoction of figs and tamarinds, or small doses of rhubarb and nitre. These may be increased according to the age of the patient, and repeated till they have the desired effect.

I have often known very good effects from a bit of sal prunel, or purified nitre, held in the mouth, and swallowed down as it melted. This promotes the discharge of saliva, by which means it answers the end of a gargle, while at the same time it abates the fever, by promoting the discharge of urine.

The throat ought likewise to be rubbed twice or thrice a day with a little of the volatile liniment. This seldom fails to produce some good effects. At the same time the neck ought to be carefully covered with wool or flannel, to prevent the cold from penetrating the skin, as this application renders it very tender. Many other external applications are recommended in this disease, as a swallow’s nest, poultices made of the fungus called Jews’ ear, album Græcum, &c. But as we do not look upon any of these to be preferable to a common poultice of bread and milk, we shall take no farther notice of it.

Some recommend the gum guaiacum as a specific in this disease. Half a drachm of the gum in powder may be made into an electuary with the rob of elder-berries, or the jelly of currants, for a dose, and repeated occasionally.

Blistering upon the neck or behind the ears, in violent inflammations of the throat, is very beneficial; and in bad cases it will be necessary to lay a blistering-plaster quite across the throat, so as to reach from ear to ear. After the plasters are taken off, the parts ought to be kept running by the application of issue-ointment, till the inflammation is gone; otherwise, upon their drying, up, the patient will be in danger of a relapse.

When the patient has been treated as above, a suppuration seldom happens. This however is sometimes the case, in spite of all endeavours to prevent it. When the inflammation and swelling continue, and it is evident that a suppuration will ensue, it ought to be promoted by drawing the steam of warm water into the throat through a tunnel, or the like. Soft poultices ought likewise to be applied outwardly, and the patient may keep a roasted fig constantly in his mouth.

It sometimes happens, before the tumour breaks, that the swelling is so great, as entirely to prevent any thing from getting down into the stomach. In this case, the patient must inevitably perish, unless he can be supported in some other way. This can only be done by nourishing clysters of broth, or gruel, with milk, &c. Patients have often been supported by these for several days, till the tumour has broke; and afterwards they have recovered.

Not only the swallowing but the breathing, is often prevented by the tumour. In this case, nothing can save the patient’s life, but opening the trachœa or wind-pipe. As that has been often done with success, no person, in such desperate circumstances, ought to hesitate a moment about the operation; but as it can only be performed by a surgeon, it is not necessary here to give any direction about it.

When a difficulty of swallowing is not attended with an acute pain or inflammation, it is generally owing to an obstruction of the glands about the throat, and only requires that the part be kept warm, and the throat frequently gargled with something that may gently stimulate the glands, as a decoction of figs with vinegar and honey; to which may be added a little mustard, or a small quantity of spirits. But this gargle is never to be used where there are signs of an inflammation.

Those who are subject to inflammations of the throat, in order to avoid that disease, ought to live temperately. Such as do not choose to observe this rule, must have frequent recourse to purging and other evacuations, to discharge the superfluous humours. They ought likewise to beware of catching cold, and should abstain from aliment and medicines of an astringent or stimulating nature.

I have often known persons, who had been subject to sore throats, entirely freed from that complaint by only wearing a ribband, or a piece of flannel, constantly about their necks, or by wearing thicker shoes, a flannel waistcoat, or the like. These may seem trifling, but they have great effect. There is danger indeed in leaving them off after persons have been accustomed to them; but surely the inconvenience of using such things for life is not to be compared with the danger which may attend the neglect of them.

Sometimes, after an inflammation, the glands of the throat continue swelled, and become hard and callous. This complaint is not easily removed, and is often rendered dangerous by the too frequent application of strong stimulating and styptic medicines. The best method is to keep it warm, and to gargle it twice a-day with a decoction of figs sharpened a little with the elixir or spirit of vitriol.