Chapter V: Part 5

Sec. 101. Two Medicines greatly esteemed in this Disease among the Peasantry, and even extolled by some Physicians, are the Blood of a wild He Goat, and the [24] Soot in an Egg. I do not contest the Cure or Recovery of many Persons, who have taken these Remedies; notwithstanding it is not less true, that both of them, as well as the Egg in which the Soot is taken, are dangerous: For which Reason it is prudent, at least, never to make use of them; as there is great Probability, they may do a little Mischief; and a Certainty that they can do no Good. The _Genipi_, or [25] Wormwood of the Alps, has also acquired great Reputation in this Disease, and occasioned many Disputes between some very zealous Ecclesiastics, and a justly celebrated Physician. It seems not difficult however to ascertain the proper Use of it. This Plant is a powerful Bitter; it heats and excites Sweat: it seems clear, that, from such Consequences, it should never be employed in a Pleurisy, while the Vessels are full, the Pulse hard, the Fever high, and the Blood inflamed. In all such Circumstances it must aggravate the Disease; but towards the Conclusion of it, when the Vessels are considerably emptied, the Blood is diluted, and the Fever abated, it may then be recurred to; but with a constant Recollection that it is hot, and not to be employed without Reflection and Prudence. [26]

[24] This, with great Probability, means that small black Substance
often visible in a rotten Egg, which is undoubtedly of a violent,
or even poisonous Quality. Dr. _Tissot_ terms it expressly--_la
suie dans un Oeuf_. K.

[25] Dr. _Lewis_, who has not taken Notice of this Species of Wormwood
in his Improvement of _Quincy's_ Dispensatory, has mentioned it in
his late _Materia Medica_. K.

[26] This being a proper Place for directing the Seneka Rattle Snake
Root, I shall observe, that the best Way of exhibiting it is in
Decoction, by gradually simmering and boiling two Ounces of it in
gross Powder, in two Pints and a half of Water, to a Pint and a
quarter; and then giving three Spoonfuls of it to a grown Person,
every six Hours. If the Stitch should continue, or return, after
taking it, Bleeding, which should be premised to it, must be
occasionally repeated; though it seldom proves necessary, after a
few Doses of it. It greatly promotes Expectoration, keeps the Body
gently open, and sometimes operates by Urine and by Sweat; very
seldom proving at all emetic in Decoction. The Regimen of Drinks
directed here in Pleurisies are to be given as usual. Dr.
_Tennant_, the Introducer of this valuable Medicine, confided
solely in it, in Bastard Peripneumonies, without Bleeding,
Blistering, or any other Medicines. _K._

__Chapter VI.__

_Of the Diseases of the Throat._

__Sect.__ 102.

The Throat is subject to many Diseases: One of the most frequent and the most dangerous, is that Inflammation of it, commonly termed a Quinsey. This in Effect is a Distemper of the same Nature with an Inflammation of the Breast; but as it occurs in a different Part, the Symptoms, of Course, are very different. They also vary, not a very little, according to the different Parts of the Throat which are inflamed.

Sec. 103. The general Symptoms of an Inflammation of the Throat are, the Shivering, the subsequent Heat, the Fever, the Head-ach, red high-coloured Urine, a considerable Difficulty, and sometimes even an Impossibility, of swallowing any thing whatever. But if the nearer Parts to the _Glottis_, that is, of the Entrance into the Windpipe, or Conduit through which we breathe, are attacked, Breathing becomes excessively difficult; the Patient is sensible of extreme Anguish, and great Approaches to Suffocation; the Disease is then extended to the _Glottis_, to the Body of the Wind-pipe, and even to the Substance of the Lungs, whence it becomes speedily fatal.

The Inflammation of the other Parts is attended with less Danger; and this Danger becomes still less, as the Disease is more extended to the outward and superficial Parts. When the Inflammation is general, and seizes all the internal Parts of the Throat, and particularly the Tonsils or Almonds, as they are called, the _Uvula_, or Process of the Palate, and the _Basis_, or remotest deepest Part of the Tongue, it is one of the most dangerous and dreadful Maladies. The Face is then swelled up and inflamed; the whole Inside of the Throat is in the same Condition; the Patient can get nothing down; he breathes with a Pain and Anguish, which concur, with a Stuffing or Obstruction in his Brains, to throw him into a kind of furious _Delirium_, or Raving. His Tongue is bloated up, and is extended out of his Mouth; his Nostrils are dilated, as tho' it were to assist him in his Breathing; the whole Neck, even to the Beginning of the Breast, is excessively tumified or swelled up; the Pulse is very quick, very weak, and often intermits; the miserable Patient is deprived of all his Strength, and commonly dies the second or third Day. Very fortunately this Kind, or Degree of it, which I have often seen in _Languedoc_, happens very rarely in _Swisserland_, where the Disease is less violent; and where I have only seen People die of it, in Consequence of its being perniciously treated; or by Reason of some accidental Circumstances, which were foreign to the Disease itself. Of the Multitude of Patients I have attended in this Disorder, I have known but one to fail under it, whose Case I shall mention towards the Close of this Chapter.

Sec. 104. Sometimes the Disease shifts from the internal to the external Parts: the Skin of the Neck and Breast grows very red, and becomes painful, but the Patient finds himself better.

At other Times the Disorder quits the Throat; but is transferred to the Brain, or upon the Lungs. Both these Translations of it are mortal, when the best Advice and Assistance cannot be immediately procured; and it must be acknowledged, that even the best are often ineffectual.

Sec. 105. The most usual kind of this Disease is that which affects only the Tonsils (the Almonds) and the Palate; or rather its Process, _commonly called_ the Palate. It generally first invades one of the Tonsils, which becomes enlarged, red and painful, and does not allow the afflicted to swallow, but with great Pain. Sometimes the Disorder is confined to one Side; but most commonly it is extended to the _Uvula_, (the Palate) from whence it is extended to the other Tonsil. If it be of a mild kind, the Tonsil first affected is generally better, when the second is attacked. Whenever they are both affected at once, the Pain and the Anguish of the Patient are very considerable; he cannot swallow, but with great Difficulty and Complaint; and the Torment of this is so vehement, that I have seen Women affected with Convulsions, as often as they endeavoured to swallow their Spittle, or any other Liquid. They continue, even for several Hours sometimes, unable to take any thing whatever; all the upper inward Part of the Mouth, the Bottom of the Palate, and the descending Part of the Tongue become lightly red, or inflamed.

A considerable Proportion of Persons under this Disease swallow Liquids more difficultly than Solids; by Reason that Liquids require a greater Action of some Part of the Muscles, in order to their being properly directed into their Conduit or Chanel. The Deglutition (the Swallowing) of the Spittle is attended with still more Uneasiness than that of other Liquids, because it is a little more thick and viscid, and flows down with less Ease. This Difficulty of swallowing, joined to the Quantity thence accumulated, produces that almost continual hawking up, which oppresses some Patients so much the more, as the Inside of their Cheeks, their whole Tongue, and their Lips are often galled, and even flead as it were. This also prevents their Sleeping, which however seems no considerable Evil; Sleep being _sometimes_ but of little Service in Diseases attended with a Fever; and I have often seen those, who thought their Throats almost entirely well in the Evening, and yet found them very bad after some Hours Sleep.

The Fever, in this Species of the Disease, is sometimes, very high; and the Shivering often endures for many Hours. It is succeeded by considerable Heat, and a violent Head-ach, which yet is sometimes attended with a Drowsiness. The Fever is commonly pretty high in the Evening, though sometimes but inconsiderable, and by the Morning perhaps there is none at all.

A light Invasion of this Disease of the Throat often precedes the Shivering; though most commonly it does not become manifest 'till after it, and at the same Time when the Heat comes on.

The Neck is sometimes a little inflated, or puffed up; and many of the Sick complain of a pretty smart Pain in the Ear of that Side, which is most affected. I have but very seldom observed that they had it in both.

Sec. 106. The Inflammation either disappears by Degrees, or an Abscess is formed in the Part which was chiefly affected. It has never happened, at least within my Knowledge, that this Sort of the Disease, prudently treated, has ever terminated either in a Mortification, or a Scirrhus: but I have been a Witness to either of these supervening, when Sweating was extorted in the Beginning of it, by hot Medicines.

It is also very rare to meet with those highly dangerous Translations of this Disease upon the Lungs, such as are described in that Species of it from Sec. 103, 104. It is true indeed it does not occur more frequently, even in that Species, whenever the Disease is thrown out upon the more external Parts.

Sec. 107. The Treatment of the Quinsey, as well as of all other inflammatory Diseases, is the same with that of an Inflammation of the Breast.

The Sick is immediately to be put upon a Regimen; and in that Sort described Sec. 103, Bleeding must be repeated four or five Times within a few Hours; and sometimes there is a Necessity to recur still oftner to it. When it assaults the Patient in the most vehement Degree, all Medicines, all Means, are very generally ineffectual; they should be tried however. We should give as much as can be taken of the Drinks No. 2 and 4. But as the Quantity they are able to swallow is often very inconsiderable; the Glyster No. 5 should be repeated every three Hours; and their Legs should be put into a Bath of warm Water, thrice a Day.

Sec. 108. Cupping Glasses, with Scarification, applied about the Neck, after bleeding twice or thrice, have often been experienced to be highly useful. In the most desperate Cases, when the Neck is excessively swelled, one or two deep Incisions made with a Razor, on this external Tumour, have sometimes saved a Patient's Life.

Sec. 109. In that kind, and those Circumstances, of this Disease described Sec. 105 we must have very frequent Recourse to Bleeding; and it should never be omitted, when the Pulse is very perceivably hard and full. It is of the utmost Consequence to do it instantaneously; since it is the only Means to prevent the Abscess, which forms very readily, if Bleeding has been neglected, only for a few Hours. Sometimes it is necessary to repeat it a second Time, but very rarely a third.

This Disease is frequently so gentle and mild, as to be cured without Bleeding, by the Means of much good Management. But as many as are not Masters of their own Time, nor in such an easy Situation, as to be properly attended, ought, without the least Hesitation, to be bled directly, which is sometimes sufficient to remove the Complaint; especially if, after Bleeding, the Patient drinks plentifully of the Ptisan No. 2.

In this light Degree of the Disease, it may suffice to bathe the Legs, and to receive a Glyster, once a Day each; the first to be used in the Morning, and the last in the Evening. Besides the general Remedies against Inflammations, a few particular ones, calculated precisely for this Disease, may be applied in each kind or Degree of it. The best are, first the emollient Poultices, No. 9, laid over the whole Neck. [27] Some have highly extolled the Application of Swallows Nests in this Disease; and though I make no Objection to it, I think it certainly less efficacious than any of those which I direct.

[27] The _English_ avail themselves considerably, in this Disease, of a
Mixture of equal Parts of Sallad Oil, and Spirit of Sal Ammoniac;
or of Oil and Spirit of Hartshorn, as a Liniment and Application
round the Neck. This Remedy corresponds with many Indications; and
deserves, perhaps, the first Place amongst local Applications
against the inflammatory Quinsey. _E. L._

2. Of the Gargarisms (No. 19) a great Variety may be prepared, of pretty much the same Properties, and of equal Efficacy. Those I direct here are what have succeeded best with me and they are very simple. [28]

[28] Dr. _Pringle_ is apprehensive of some ill Effects from Acids in
Gargarisms [_which is probably from their supposed repelling
Property_] and prefers a Decoction of Figs in Milk and Water, to
which he adds a small Quantity of Spirit of Sal Ammoniac. _E. L._

3. The Steam of hot Water, as directed Sec. 55, should be repeated five or six Times a Day; a Poultice should be constantly kept on, and often renewed; and the Patient should often gargle.

There are some Persons, besides Children, who cannot gargle themselves: and in fact the Pain occasioned by it makes it the more difficult. In such a Case, instead of gargling, the same Gargarism (No. 19) may be injected with a small Syringe. The Injection reaches further than Gargling, and often causes the Patient to hawk up a considerable Quantity of glarey Matter (which has grown still thicker towards the Bottom of the Throat) to his sensible Relief. This Injection should be often repeated. The little hollowed Pipes of Elder Wood, which all the Children in the Country can make, may be conveniently employed for this Purpose. The Patient should breathe out, rather than inspire, during the Injection.

Sec. 110. Whenever the Disease terminates without Suppuration, the Fever, the Head-ach, the Heat in the Throat, and the Pain in swallowing, begin to abate from the fourth Day, some times from the third, often only from the fifth; and from such Period that Abatement increases at a great Rate; so that at the End of two, three, or four Days, on the sixth, seventh, or eighth, the Patient is entirely well. Some few however continue to feel a light Degree of Pain, and that only on one Side, four or five Days longer, but without a Fever, or any considerable Uneasiness.

Sec. 111. Sometimes the Fever and the other Symptoms abate, after the Bleeding and other Remedies; without any subsequent Amendment in the Throat, or any Signs of Suppuration. In such Cases we must chiefly persist in the Gargarisms and the Steams; and where an experienced and dexterous Surgeon can be procured, it were proper he should scarify the inflamed Tonsils. These discharge, in such Cases, a moderate Quantity of Blood; and this Evacuation relieves, very readily, as many as make use of it.

Sec. 112. If the Inflammation is no ways disposed to disperse, so that an Abscess is forming, which almost ever happens, if it has not been obviated at the Invasion of the Disease; then the Symptoms attending the Fever continue, though raging a little less after the fourth Day: the Throat continues red, but of a less florid and lively Redness: a Pain also continues, though less acute, accompanied sometimes with Pulsations, and at other Times intirely without any; of which it is proper to take Notice: the Pulse commonly grows a little softer; and on the fifth or sixth Day, and sometimes sooner, the Abscess is ready to break. This may be discovered by the Appearance of a small white and soft Tumour, when the Mouth is open, which commonly appears about the Centre or Middle of the Inflammation. It bursts of itself; or, should it not, it must be opened. This is effected by strongly securing a Lancet to one End of a small Stick or Handle, and enveloping, or wrapping up the whole Blade of it, except the Point and the Length of one fourth or a third of an Inch, in some Folds of soft Linnen; after which the Abscess is pierced with the Point of this Lancet. The Instant it is opened, the Mouth is filled with the Discharge of a Quantity of _Pus_, of the most intolerable Savour and Smell. The Patient should gargle himself after the Discharge of it with the detersive, or cleansing Gargarism No. 19. It is surprising sometimes to see the Quantity of Matter discharged from this Imposthumation. In general there is but one; though sometimes I have seen two of them.

Sec. 113. It happens, and not seldom, that the Matter is not collected exactly in the Place, where the Inflammation appeared, but in some less exposed and less visible Place: whence a Facility of swallowing is almost entirely restored; the Fever abates; the Patient sleeps; he imagines he is cured, and that no Inconvenience remains, but such as ordinarily occurs in the earliest Stage of Recovery. A Person who is neither a Physician, nor a Surgeon, may easily deceive himself, when in this State. But the following Signs may enable him to discover that there is an Abscess, viz. A certain Inquietude and general Uneasiness; a Pain throughout the Mouth; some Shiverings from Time to Time; frequently sharp, but short and transient, Heat: a Pulse moderately soft, but not in a natural State; a Sensation of Thickness and Heaviness in the Tongue; small white Eruptions on the Gums, on the Inside of the Cheek, on the Inside and Outside of the Lips, and a disagreeable Taste and Odour.

Sec. 114. In such Cases Milk or warm Water should frequently be retained in the Mouth; the Vapour of hot Water should be conveyed into it; and emollient Cataplasms may be applied about the Neck. All these Means concur to the softening and breaking of the Abscess. The Finger may also be introduced to feel for its Situation; and when discovered, the Surgeon may easily open it. I happened once to break one under my Finger, without having made the least Effort to do it. Warm Water may be injected pretty forcibly, either by the Mouth or the Nostrils: this sometimes occasions a kind of Cough, or certain Efforts which tend to break it. I have seen this happen even from laughing. As to the rest, the Patient should not be too anxious or uneasy about the Event. I never saw a single Instance of a Person's dying of a Quinsey of this kind, after the Suppuration is truly effected; neither has it happened perhaps after the Time it is forming for Suppuration.

Sec. 115. The glairy Matter with which the Throat is over-charged, and the very Inflammation of that Part, which, from its Irritation, produces the same Effect, as the Introduction of a Finger into it, occasions some Patients to complain of incessant Propensities to vomit. We must be upon our Guard here, and not suppose that this Heart-Sickness, as some have called it, results from a Disorder of, or a Load within, the Stomach, and that it requires a Vomit for its Removal. The giving one here would often prove a very unfortunate Mistake. It might, in a high Inflammation, further aggravate it; or we might be obliged (even during the Operation of the Vomit) to bleed, in order to lessen the Violence of the Inflammation. Such Imprudence with its bad Consequences, often leaves the Patient, even after the Disease is cured, in a State of Languor and Weakness for a considerable Time. Nevertheless, there are some particular Disorders of the Throat, attended with a Fever, in which a Vomit may be prudently given. But this can only be, when there is no Inflammation, or after it is dispersed; and there still remains some putrid Matter in the first Passages. Of such Cases I shall speak hereafter. [29]

[29] In Diseases of the Throat, which have been preceded by such
Excesses in Food or strong Drink, as occur too often in many
Countries, when the Patient has very strong Reachings to vomit, and
the Tongue is moist at the same Time; we should not hesitate, after
appeasing the first Symptoms of the Inflammation [by sufficient
Bleedings, &c.] to assist the Efforts of Nature, and to give a
small Dose of Tartar emetic, dissolved in some Spoonfuls of Water.
This Remedy in this Case, promotes the Dispersion of the
Inflammation, beyond any other. _E. L._

Sec. 116. We often see in _Swisserland_ a Disorder different from these of the Throat, of which we have just treated; though, like these, attended with a Difficulty of swallowing. It is termed in French the _Oreillons_, and often the _Ourles_, or swelled Ears. It is an Overfulness and Obstruction of those Glands and their Tubes, which are to furnish the _Saliva_ or Spittle; and particularly of the two large Glands which lie between the Ear and the Jaw; which are called the _Parotides_; and of two under the Jaw, called the _Maxillares_. All these being considerably swelled in this Disease, do not only produce a great Difficulty of swallowing; but also prevent the Mouth from opening; as an Attempt to do it is attended with violent Pain. Young Children are much more liable to this Disease than grown Persons. Being seldom attended with a Fever, there is no Occasion for Medicines: It is sufficient to defend the Parts affected from the external Air; to apply some proper Poultice over them; to lessen the Quantity of their Food considerably, denying them Flesh and Wine; but indulging them plentifully in some light warm Liquid, to dilute their Humours and restore Perspiration. I cured myself of this Disorder in 1754, by drinking nothing, for four Days, but Balm Tea, to which I added one fourth part Milk, and a little Bread. The same _Regimen_ has often cured me of other light Complaints of the Throat.

Sec. 117. In the Spring of 1761, there were an astonishing Number of Persons attacked with Disorders of the Throat, of two different Kinds. Some of them were seized with that common Sort which I have already described. Without adding any thing more particularly, in Respect to this Species, it happened frequently to grown Persons, who were perfectly cured by the Method already recited. The other Species, on which I shall be more particular in this Place (because I know they have abounded in some Villages, and were very fatal) invaded Adults, or grown Persons also, but especially Children, from the Age of one Year, and even under that, to the Age of twelve or thirteen.

The first Symptoms were the same with those of the common Quinsey, such as the Shivering, the ensuing Heat or Fever, Dejection, and a Complaint of the Throat: but the following Symptoms distinguished these from the common inflammatory Quinseys.

1. The Sick had often something of a Cough, and a little Oppression.

2. The Pulse was quicker, but less hard, and less strong, than generally happens in Diseases of the Throat.

3. The Patients were afflicted with a sharp, stinging and dry Heat, and with great Restlessness.

4. They spat less than is usual in a common Quinsey; and their Tongues were extremely dry.

5. Though they had some Pain in swallowing, this was not their principal Complaint, and they could drink sufficiently.

6. The Swelling and Redness of the Tonsils, of the Palate, and of its Process were not considerable; but the parotid and maxillary Glands, and especially the former, being extremely swelled and inflamed, the Pain they chiefly complained of, was this outward one.

7. When the Disease proved considerably dangerous, the whole Neck swelled; and sometimes even the Veins, which return the Blood from the Brain, being overladen, as it were, the Sick had some Degree of Drowsiness, and of a _Delirium_, or Raving.

8. The Paroxysms, or Returns, of the Fever were considerably irregular.

9. The Urine appeared to be less inflamed, than in other Diseases of the Throat.

10. Bleeding and other Medicines did not relieve them, as soon as in the other kind; and the Disease itself continued a longer Time.

11. It did not terminate in a Suppuration like other Quinsies, but sometimes the Tonsils were ulcerated.

12. [30] Almost every Child, and indeed a great many of the grown Persons assaulted with this Disease, threw out, either on the first Day, or on some succeeding one, within the first six Days, a certain Efflorescence, or Eruptions, resembling the Measles considerably in some, but of a less lively Colour, and without any Elevation, or rising above the Skin. It appeared first in the Face, next in the Arms, and descended to the Legs, Thighs and Trunk; disappearing gradually at the End of two or three Days, in the same Order it had observed in breaking out. A few others (I have seen but five Instances of it) suffered the most grievous Symptoms before the Eruption; and threw out the genuine _purpura_, or white miliary Eruption.

[30] This seems to have been the same kind of Quinsey, of which Drs.
_Huxham_, _Fothergil_, _Cotton_ and others wrote, though under
different Appellations. _K._

13. As soon as these Efflorescences or Eruptions appeared, the Sick generally found themselves better. That, last mentioned, continued four, five, or six Days, and frequently went off by Sweats. Such as had not these Ebullitions, which was the Case of many Adults, were not cured without very plentiful Sweats towards the Termination of the Disease: those which occurred at the Invasion of it being certainly unprofitable, and always hurtful.

14. I have seen some Patients, in whom the Complaint of the Throat disappeared entirely, without either Eruptions or Sweats: but such still remained in very great Inquietude and Anguish, with a quick and small Pulse. I ordered them a sudorific Drink, which being succeeded by the Eruption, or by Sweating, they found themselves sensibly relieved.

15. But whether the Sick had, or had not, these external Rednesses or Eruptions, every one of them parted with their Cuticle or Scarf Skin, which fell off, in large Scales, from the whole Surface of the Body: so great was the Acrimony or Sharpness of that Matter, which was to be discharged through the Skin.

16. A great Number suffered a singular Alteration in their Voice, different from that which occurs in common Quinsies, the Inside of their Nostrils being extremely dry.

17. The Sick recovered with more Difficulty after this, than after the common Quinsies: and if they were negligent or irregular, during their Recovery; particularly, if they exposed themselves too soon to the Cold, a Relapse ensued, or some different Symptoms; such as a Stuffing with Oppression, a Swelling of the Belly, windy Swellings in different Parts; Weakness, Loathings, Ulcerations behind the Ears, and something of a Cough and Hoarseness.

18. I have been sent for to Children, and also to some young Folks, who, at the End of several Weeks, had been taken with a general Inflammation of the whole Body, attended with great Oppression, and a considerable Abatement of their Urine, which was also high-coloured and turbid, or without Separation. They seemed also in a very singular State of Indifference, or Disregard, with Respect to any Object, or Circumstance. I recovered every one of them entirely by Blisters, and the Powder No. 25. The first Operation of this Medicine was to vomit them: to this succeeded a Discharge by Urine, and at last very plentiful Sweating, which compleated the Cure. Two Patients only, of a bad Constitution, who were a little ricketty, and disposed to glandular Scirrhosity or Knottiness, relapsed and died, after being recovered of the Disease itself for some Days.

Sec. 118. I have bled some adult Persons, and made Use of the cooling Regimen, as long as there was an evident Inflammation: it was necessary after this to unload the first Passages; and at last to excite moderate Sweats. The same Powders No. 25 have often effected both these Discharges, and with entire Success. In other Cases I have made Use of Ipecacuanha, as directed No. 35.

In some Subjects there did not appear any inflammatory Symptom; and the Distemper resulted solely from a Load of putrid Matter in the first Passages. Some Patients also discharged Worms. In such Cases I never bled; but the Vomit had an excellent Effect, at the very Onset of the Disease; it produced a perceivable Abatement of all the Symptoms; Sweating ensued very kindly and naturally, and the Patient recovered entirely a few Hours after.

Sec. 119. There were some Places, in which no Symptom or Character of Inflammation appeared; and in which it was necessary to omit Bleeding, which was attended with bad Consequences.

I never directed Infants to be bled. After opening the first Passages, Blisters and diluting Drinks proved their only Remedies. A simple Infusion of Elder Flowers, and those of the Lime Tree, has done great Service to those who drank plentifully of it.

Sec. 120. I am sensible that in many Villages a great Number of Persons have died, with a prodigious Inflation or Swelling of the Neck. Some have also died in the City, and among others a young Woman of twenty Years of Age, who had taken nothing but hot sweating Medicines and red Wine, and died the fourth Day, with violent Suffocations, and a large Discharge of Blood from the Nose. Of the great Number I have seen in Person, only two died. One was a little Girl of ten Months old. She had an Efflorescence which very suddenly disappeared: at this Time I was called in; but the Humour had retreated to the Breast, and rendered her Death inevitable. The other was a strong Youth from sixteen to seventeen Years old, whose sudden Attack from the Disease manifested, from the very Beginning, a violent Degree of it. Nevertheless, the Symptoms subsiding, and the Fever nearly terminating, the Sweats which approached would probably have saved him. But he would not suffer them to have their Course, continually stripping himself quite naked. The Inflammation was immediately repelled upon the Lungs, and destroyed him within the Space of thirty Hours. I never saw a Person die with so very dry a Skin. The Vomit affected him very little upwards, and brought on a purging. His own bad Conduct seems to have been the Occasion of his Death; and may this serve as one Example of it.

Sec. 121. I chose to expatiate on this Disease, as it may happen to reach other Places, where it may be useful to have been apprized of its Marks, and of its Treatment, which agrees as much with that of putrid Fevers, of which I shall speak hereafter, as with that of the inflammatory Diseases I have already considered: since in some Subjects the Complaint of the Throat has evidently been a Symptom of a putrid Fever, rather than of the chiefly apparent Disease, a Quinsey. [31]

Sec. 122. Disorders of the Throat are, with Respect to particular Persons, an habitual Disease returning every Year, and sometimes oftner than once a Year. They may be prevented by the same Means, which I have directed for the Preservation from habitual Pleurisies Sec. 100; and by defending the Head and the Neck from the Cold; especially after being heated by Hunting, or any violent Exercise, or even by singing long and loud, which may be considered as an extraordinary Exercise of some of the Parts affected in this Disease.

[31] I reserve some other interesting Reflections on this Disease, for
the second Edition of my Treatise on Fevers; and the Editor at
_Paris_ has very well observed, that it has some Relation to the
gangrenous sore Throat, which has been epidemical these twenty
Years past, in many Parts of _Europe_.----This Note is from Dr.
_Tissot_ himself.

__Chapter VII.__

_Of Colds._

__Sect.__ 123.

There are many erroneous Prejudices, with Regard to Colds, all of which may be attended with pernicious Consequences. The first is, that a Cold is never dangerous; an Error which daily destroys the Lives of many. I have already complained of it for many Years past; and I have since beheld a Multitude of such Examples of it, as have but too sufficiently warranted my Complaints.

No Person however, it is certain, dies merely of a Cold, as long as it is nothing but a Cold simply; but when, from Inattention and Neglect, it is thrown upon, and occasions Distempers of the Breast, it may, and often does, prove mortal. _Colds destroy more than Plagues_, was the Answer of a very sagacious and experienced Physician to one of his Friends, who, being asked, how he was in Health, replied, Very well, I have nothing but a Cold.

A second erroneous Prejudice is, that Colds require no Means, no Medicines, and that they last the longer for being nursed, or tampered with. The last Article may be true indeed, with Respect to the Method, in which the Person affected with them treats them; but the Principle itself is false. Colds, like other Disorders, have their proper Remedies; and are removed with more or less Facility, as they are conducted better or worse.

Sec. 124. A third Mistake is, that they are not only considered as not dangerous, but are even supposed wholesome too. Doubtless a Man had better have a Cold than a more grievous Disease; though it must be still better to have neither of them. The most that can reasonably be said and admitted on this Point, is, that when a checked, or an obstructed Perspiration becomes the Cause of a Distemper, it is fortunate that it produces rather a Cold, than any very dreadful Disease, which it frequently does: though it were to be wished, that neither the Cause, nor its Effect existed. A Cold constantly produces some Disorder or Defect in the Functions of some Part or Parts of the Body, and thus becomes the Cause of a Disease. It is indeed a real Disorder itself, and which, when in a violent Degree, makes a very perceivable Assault upon our whole Machine. Colds, with their Defluxions, considerably weaken the Breast, and sooner or later considerably impair the Health. Persons subject to frequent Colds are never robust or strong; they often sink into languid Disorders; and a frequent Aptitude to take Cold is a Proof, that their Perspiration may be easily checked and restrained; whence the Lungs become oppressed and obstructed, which must always be attended with considerable Danger.

Sec. 125. We may be convinced of the Weakness and Fallacy of these Prejudices, by considering attentively the Nature of Colds; which are nothing else than the very Diseases already described in the three preceding Chapters, though in their greatest Degree only.

A Cold in Truth is almost constantly an inflammatory Disease; a light Inflammation of the Lungs, or of the Throat; of the Membrane or very thin Skin, which lines the Nostrills, and the Inside of certain Cavities in the Bones of the Cheeks and Forehead. These Cavities communicate with the Nose, in such a Manner, that when one Part of this Membrane is affected with an Inflammation, it is easily communicated to the other Parts.

Sec. 126. It is scarcely necessary to describe the Symptoms of a Cold, and it may be sufficient to remark, 1. That their chief Cause is the same with that, which most commonly produces the Diseases already treated of, that is, an obstructed Perspiration, and a Blood somewhat inflamed. 2. That whenever these Diseases affect great Numbers, many Colds prevail at the same Time. 3. That the Symptoms which manifest a violent Cold, greatly resemble those which precede or usher in these Diseases. People are rarely attacked by great Colds, without a shivering and Fever; which last sometimes continues for many Days. There is a Cough, a dry Cough, for some Time; after which some Expectoration ensues; which allays the Cough, and lightens the Oppression; at which Time the Cold may be said to be maturated, or ripe. There are pretty often slight Stitches, but unfixed or flying about, with a little Complaint of the Throat. When the Nostrills happen to be the Seat of the Disorder, which is then very improperly termed a Cold of the Brain, it is often attended with a vehement Head-ach; which sometimes depends on an Irritation of the Membrane, that lines the Cavities in the Bone of the Forehead, or the maxillary Sinusses, that is, the Cavities in the Jaws: At first the Running from the Nose is very clear; thin and sharp; afterwards, in Proportion to the Abatement of the Inflammation, it becomes thicker; and the Consistence and Colour of it resemble those of what others cough up. The Smell, the Taste and the Appetite are commonly impaired by it.

Sec. 127. Colds seem to be of no certain Duration or Continuance. Those of the Head or Brain generally last but a few Days; of the Breast longer. Some Colds nevertheless terminate in four or five Days. If they extend beyond this Term they prove really hurtful. 1. Because the Violence of the Cough disorders the whole Machine; and particularly, by forcing up the Blood to the Head. 2. By depriving the Person afflicted of his usual Sleep, which is almost constantly diminished by it. 3. By impairing the Appetite, and confusing the Digestion, which is unavoidably lessened by it. 4. By weakening the very Lungs, by the continual Agitations from Coughing; whence all the Humours being gradually determined towards them, as the weakest Part, a continual Cough subsists. Hence also they become overcharged with Humours, which grow viscid there; the Respiration is overloaded and oppressed; a slow Fever appears; Nutrition almost ceases; the Patient becomes very weak; sinks into a Wasting; an obstinate Wakefulness and Anguish, and often dies in a short Time. 5. By Reason that the Fever, which almost constantly accompanies great Cold, concurs to wear the body down.

Sec. 128. Wherefore, since a Cold is a Disease of the same kind with Quinsies, Peripneumonies and Inflammations of the Breast, it ought to be treated in the same Manner. If it is a violent one, Blood should be taken from the Arm, which may considerably shorten its Duration: and this becomes most essentially necessary, whenever the Patient is of a sanguineous ruddy Complexion, abounds with Blood, and has a strong Cough, and great Head-ach. The Drinks No. 1, 2, 3, 4, should be very plentifully used. It is advantagious to bathe the Feet in warm Water every Night at going to Bed. [32] In a Word, if the Patient is put into a Regimen, the Cure is very speedily effected.

[32] It frequently happens, that the Bathings alone remove the Head-ach,
and the Cough too, by relaxing the lower Parts, and the entire
Surface of the Body. If the Patient is costive, he should receive
Glysters of warm Water, in which some Bran has been boiled, with
the Addition of a little common Soap or Butter. _E. L._

Sec. 129. The Disorder indeed, however, is often so very slight, that it may be thought to require very little, if any, medical Treatment, and may be easily cured without Physick, by abstaining from Flesh, Eggs, Broth, and Wine; from all Food that is sharp, fat and heavy; and by dieting upon Bread, Pulse, Fruit, and Water; particularly by eating little or no Supper; and drinking, if thirsty, a simple Ptisan of Barley, or an Infusion of Elder Flowers, with the Addition of a third or fourth Part of Milk. Bathing the Feet, and the Powder No. 20 contribute to dispose the Patient to sleep. Five Tea-Cups of an Infusion of the Red, or wild Poppy Leaves may also be ventured on safely.

Sec. 130. When the Fever, Heat and Inflammation wholly disappear; when the Patient has kept to his Regimen for some Days, and his Blood is well diluted, if the Cough and Want of Sleep still continues, he may take in the Evening a Dose of Storax [33] Pill, or of Venice Treacle with Elder Flower Tea, after bathing his Feet. These Remedies by stilling the Cough, and restoring Perspiration, frequently cure the Cold in the Space of one Night. I confess at the same Time, I have seen bad Consequences from such Opiates, when given too early in the Complaint. It is also necessary, when they are given, that the Patient should have supt but very moderately, and that his Supper should be digested.

[33] Under these Circumstances of a tickling Cough from a Cold, without
a Fever, and with very little Inflammation, I have known great and
very frequent Success, from a Dose of _Elixir paregoricum_, taken
at Bed-time, after a very light thin Supper. If the Patient be
sanguine, strong and costive, Bleeding in a suitable Quantity, and
a gently opening Potion, or purging Glyster, may be prudently
premised to it. Grown Persons may take from 30 to 80, or even 100
Drops of it, in Barley Water, or any other pectoral Drink; and
Children in the Chincough from five to twenty Drops; half an Ounce
of it by Measure containing about one Grain of Opium, which is the
Quantity contained in less than quite six Grains of the Storax
Pill; this last being a very available pectoral Opiate too in
Coughs from a Distillation, in more adult Bodies, who may also
prefer a Medicine in that small Size, and Form. _K._

Sec. 131. An immense Number of Remedies are cried up for the Cure of Colds; such as Ptisans of Apples or Pippins, of Liquorice, of dry Raisins, of Figs, of Borage, of Ground-Ivy, of _Veronica_ or Speedwell, of Hysop, of Nettles, _&c. &c._ I have no Design to depreciate them; as all of them may possibly be useful: But unfortunately, those who have seen any particular one of them succeed in one Case, readily conclude it to be the most excellent of them all; which is a dangerous Error, because no one Case is a sufficient Foundation to decide upon: which besides none are qualified to do, who have not often seen a great Number of such Cases; and who do not so attentively observe the Effects of different Medicines, as to determine on those which most frequently agree with the Disorder; and which, in my Judgment, are those I have just enumerated. I have known a Tea or Infusion of Cherry Stalks, which is not a disagreeable Drink, to cure a very inveterate Cold.

Sec. 132. In Colds of the Head or Brain, the Steam of warm Water alone, or that in which Elder Flowers, or some other mild aromatic Herbs, have been boiled, commonly afford a pretty speedy Relief. These are also serviceable in Colds fallen on the Breast. See Sec. 55.

It has been a Practice, though of no very long standing, to give the Fat of a Whale in these Cases; but this is a very crude indigestible kind of Fat, and greasy oily Medicines seldom agree with Colds. Besides, this Whales' Fat is very disagreeable and rancid, that is rank; so that it were better to forbear using it: I have sometimes seen ill Effects from it, and rarely any good ones. [34]

[34] This seems but too applicable to the very popular Use of
_Spermaceti_, &c. in such Cases, which can only grease the Passage
to the Stomach; must impair its digestive Faculty, and cannot
operate against the Cause of a Cold; though that Cure of it, which
is effected by the Oeconomy of Nature in due Time, is often
ascribed to such Medicines, as may rather have retarded it. _K._

Sec. 133. Such Persons as abate nothing of the usual Quantity of their Food, when seized with a Cold, and who swallow down large Quantities of hot Water, ruin their Health. Their Digestion ceases; the Cough begins to affect the Stomach, without ceasing to afflict the Breast; and they incur a Chance of sinking into the Condition described Sec. 127, No. 4.

Burnt Brandy and spiced Wine are very pernicious in the Beginning of Colds, and the Omission of them must be a very prudent Omission. If any good Effects have ever been known to attend the Use of them, it has been towards the going off of the Cold; when the Disorder maintained its Ground, solely from the Weakness of the Patient. Whenever this is the Case, there is not the least Room for farther Relaxation; but the Powders No. 14, should be taken every Day in a little Wine; and should the Humours seem likely to be thrown upon the Lungs, Blisters ought to be applied to the fleshy Part of the Legs.

Sec. 134. Drams, or _Liqueurs_, as they are called in _French_, agree so very little in this last State, that frequently a very small Quantity of them revives a Cold that was just expiring. There really are some Persons who never drink them without taking Cold, which is not to be wondered at, as they occasion a light Inflammation in the Breast, which is equivalent to a Cold or Distillation.

Nevertheless, People in this Disorder should not expose themselves to violent cold Weather, if there is a Possibility of avoiding it: though they should equally guard too against excessive Heat. Those, who inclose themselves in very hot Rooms, never get quite cured; and how is it possible they should be cured in such a Situation? Such Rooms, abstracted from the Danger of coming out of them, produce Colds in the same Manner that Drams do, by producing a light inflammation in the Breast.

Sec. 135. Persons subject to frequent Colds, which Habits are sometimes termed _fluxionary_, or liable to Distillations, imagine, they ought to keep themselves very hot. This is an Error which thoroughly destroys their Health. Such a Disposition to take Cold arises from two Causes; either because their Perspiration is easily impaired; or sometimes from the Weakness of the Stomach or the Lungs, which require particular Remedies. When the Complaint arises from the Perspiration's being easily disturbed and lessened, the hotter they keep themselves, the more they sweat, and increase their Complaint the more. This incessantly warm Air lets down and weakens the whole Machine, and more particularly the Lungs; where the Humours finding less Resistance, are continually derived, and are accumulated there. The Skin, being constantly bathed in a small Sweat, becomes relaxed, soft, and incapable of compleating its Functions: from which Failure the slightest Cause produces a total Obstruction of Perspiration; and a Multitude of languid Disorders ensue.

These Patients thus circumstanced, redouble their Precautions against the Cold, or even the Coolness of the Air, while their utmost Cautions are but so many effectual Means to lower their Health; and this the more certainly, as their Dread of the free Air necessarily subjects them to a sedentary Life, which increases all their Symptoms; while the hot Drinks they indulge in, compleat their Severity. There is but one Method to cure People thus situated; that is, by accustoming them gradually to the Air; to keep them out of hot Chambers; to lessen their Cloathing by Degrees; to make them sleep cool; and to let them eat or drink nothing but what is cold, Ice itself being wholesome in their Drink: to make them use much Exercise; and finally, if the Disorder be inveterate, to give them for a considerable Time the Powder No. 14, and make them use the cold Bath. This Method succeeds equally too with those, in whom the Disease originally depended on a Weakness of the Stomach, or of the Lungs: and in fact, at the End of a certain Period, these three Causes are always combined. Some Persons who have been subject, for many Years, to catch Colds throughout the Winter; and who, during that Season, never went out, and drank every thing warm, have been evidently the better, during the Winter of 1761, and 1762, for the Direction I have given here. They now walk out every Day; drink their Liquids cold; and by this Means entirely escape Colds, and enjoy perfect Health.

Sec. 136. It is more customary indeed in Town, than in the Country, to have different Troches, and Compositions in the Mouth. I am not for excluding this Habit; though I think nothing is so efficacious as Juice of Liquorice; and provided a sufficient Dose be taken, it affords certain Relief. I have taken an Ounce and a half in one Day, and have felt the good Consequences of it very remarkably.

__Chapter VIII.__

_Of Diseases of the Teeth._

__Sect.__ 137.

The Diseases of the Teeth, which are sometimes so tedious and so violent, as to cause obstinate Wakefulness, a considerable Degree of Fever, Raving, Inflammations, Abscesses, Rottenness of the Bones, Convulsions and Faintings, depend on three principal Causes. 1. On a _Caries_ or Rottenness of the Teeth. 2. On an Inflammation of the Nerves of the Teeth, or of the Membrane which invests and covers them; and which affects the Membrane of the Gums. 3. A cold Humour or Defluxion that is determined to the Teeth, and to their Nerves and Membrane.

Sec. 138. In the first of these Cases, the _Caries_ having eat down to, and exposed the naked Nerve, the Air, Food and Drink irritate, or, as it were sting it; and this irritation is attended with Pain more or less violent. Every thing that increases the Motion or Action of the affected Part, as Exercise, Heat or Food, will be attended with the same Consequence.

When the Tooth is greatly decayed, there is no other Cure besides that by extracting it, without which the Pain continues; the Breath becomes very offensive; the Gum is eat down; the other Teeth, and sometimes even the Jaw-bone, are infected with the Rottenness: besides, that it prevents the Use of the other Teeth, which are infected with a kind of tartarous Matter, and decay.

But when the Disorder is less considerable, the Progress of it may sometimes be restrained, by burning the Tooth with a hot Iron, or by filling it with Lead, if it is fitted to receive and to retain it. Different corroding Liquids are sometimes used on these Occasions, _Aqua fortis_ itself, and Spirit of Vitriol: but such Applications are highly dangerous, and ought to be excluded. When the Patients, from Dread, reject the Operations just mentioned, a little Oyl of Cloves may be applied, by introducing a small Pellet of Cotton, dipt in it, to the rotten hollow Tooth; which often affords considerable Ease, and Respite. Some make use of a Tincture of Opium, or Laudanum, after the same Manner; and indeed these two Medicines may be used together in equal Quantities. I have often succeeded with _Hoffman's_ mineral anodyne Liquor; which seemed indeed, for a few Moments, to increase the Pain; but Ease generally ensues after spitting a little Time. A Gargarism made of the Herb _Argentina_; that is Silver-weed or wild Tansey, in Water, frequently appeases the Pain that results from a _Caries_ of the Teeth: and in such Cases many People have found themselves at Ease, under a constant Use of it. It certainly is an Application that cannot hurt, and is even beneficial to the Gums. Others have been relieved by rubbing their Faces over with Honey.

Sec. 139. The second Cause is the Inflammation of the Nerve within the Substance, or of the Membrane on the Outside, of the Tooth. This is discovered by the Patient's Temperament, Age and Manner of living. They who are young, sanguine, who heat themselves much, whether by Labour, by their Food, their Drink, by sitting up late, or by any other Excess: they who have been accustomed to any Discharges or Eruptions of Blood, whether natural or artificial, and who cease to have them as usual, are much exposed to the Tooth-ach, from this Cause.

This Pain, or rather Torment, if in an acute Degree, commonly happens very suddenly, and often after some heating Cause. The Pulse is strong and full; the Countenance considerably red; the Mouth extremely hot: there is often a pretty high Fever, and a violent Head-ach. The Gums, or some Part of them, become inflamed, swelled, and sometimes an Abscess appears. At other times the Humours throw themselves upon the more external Parts; the Cheek swells, and the Pain abates. When the Cheek swells, but without any Diminution of the Pain, it then becomes an Augmentation, but no essential Change, of the Disorder.