glands or muscles of the mouth and throat; but the blood-veffels were turged every where with a thick blood. This disease, however rare, is defcribed by Hippocrates. "Of quinfies," fays he, thofe are "the worst, and fooneft fatal, which fhew nothing "remarkable either in the fauces or neck; and yet 66 bring on very much pain and difficulty of breathing." Thefe forts are all very dangerous, and require fome difference in the treatment. I remember, that the watery quinfy reigned fome years ago like an epidemic fever in Wales, especially in places near the fea, and carried off a great number of people in two or three days from their feizure. Whereupon, being confulted by a physician residing there, I wrote him this advice: To bleed plentifully as foon as poffible, and empty the first passages by a clyfter, or, if practicable, by a gentle purge; and then to apply blifters under the chin, and on the fides of the neck and if this courfe did not fucceed, to fcarify the palate pretty deeply about the uvula and fublingual veins, in order to give vent to the matter of the difeafe. In the mean time, to carry off the fever, I recommended a powder made up of equal parts of the compound powder of contrayerva, and very pure nitre. And this method faved very many lives. : In the gangrene of the tonfils, after bleeding and clyfters, the only remedy is, to make three or four pretty deep incifions in thefe glands, which are to be dreffed with honey of rofes, mixed with a fmall quantity of Egyptian honey and at the fame time, the mouth and throat are to be gargled with a decoction Prognoftic. of of barley and figs. But it is to be observed, that all this is to be done in the beginning of the disease: for in two or three days the gangrene fpreads to the gullet, and is mortal. I have feen fome patients faved by this method, and others die, in whofe cafes it was either neglected, or applied too late while the attending phyficians were of opinion, because the fe ver feemed abated, that all was fafe, and the patient out of danger; whereas, they ought to have confidered, that his fluttering pulse, great inquietude, and cold fweats fucceeding each other, were forerunners of Speedy death. This disease chiefly feizes children; and Aretæus * has, in his ufual manner, given an accurate defcription of it; which Severinus + has illuftrated with a learned comment, calling it the peftilential quinfy of children, and commending the method of cure above described; as the Latin Hippocrates + had done long before him. The ftrangulation of the fauces, which I have called the third pernicious fpecies of quinfies, if it can be forefeen, ought to be prevented by evacuations of all kinds; I mean, by bleeding, purging, bliftering, iffues, and diuretics. And it will be of fervice to practise abstinence, that is, moderation in eating and drinking. * De caufis et fignis morborum acutorum, lib. i. сар. 9. + Diatriba de peftilente ac præfocante pueros abfceffu, annexed to his book, De recondita abfceffuum natura, Francfort, 1643. Celfus, lib. vi. cap. 10. CHAP. CHA P. V. Of the difeafes of the breaft. Of the Afthma. Ifficulty of breathing arifes from many and very Diff different caufes. For whatsoever occafions the ambient air to enter the lungs with lefs freedom than ufual, brings on this disease. Now, for performing refpiration, first the thorax must be dilated; which is effected by the actions of the diaphragm, and intercóftal and abdominal mufcles. Next, the air must be received into the afpera arteria; and therefore whenfoever this duct or its ramifications are obftructed, either by a tumour, or by vifcid humours, a difficulty of breathing must enfue. Then, the air itfelf comes in for a partial caufe; for if it be much heavier or lighter than ufual, it does not diftend the veficles of the lungs with fufficient force. Likewife the tendernefs of the very lungs fometimes occafions this diftemper. For I have known fome perfons, who breathed well enough in the thick air of the town; but upon going into the country, the clear air, which is beneficial to most afthmatic patients, threw them into a very great difficulty of breath. In fine, the difficult paffage of the blood through the lungs may be reckoned among the impediments of refpiration. Now, it is manifeft, that this may happen feveral ways; that is, through fome defect in the heart, or in the blood itfelf. When the heart is weak, it does not fufficiently drive the blood forward; and if the blood chance to be too thick, it is not fo easily moved; and in fome measure measure stagnating in its vessels, disturbs and retards the office of the air. We could enumerate several other caufes of this difeafe, but thefe are principal ones; and they are more or lefs fatal, according to their greater or leffer combinations. As this diftemper is owing to different causes, so it requires different methods of cure. However, in every fpecies of it, blood-letting is ufeful, unless there be fome particular contra-indication. But that alone. will not fuffice; vomits too, and those often repeated, are very proper, if the lungs or ftomach be loaded with tough phlegm. The body must be kept open, but by no means with violent cathartics: for the most part pills, made up of equal parts of Rufus's pills and gum-ammoniac, and given every night, will an fwer that end. The patient is to be forbid the use of all flatulent food and drink; and to be ordered to use exercise till he is almost tired, and frictions, of the lower parts especially, both by himself and others, till he is pretty near fweating. In the fits, the breath is to be eased as much as poffible. In the case of vifcid and tough humours, this is effected by a mixture of oxymel of fquills and fimple cinnamon-water; or garlic either raw or preferved. But if the fault lie in the nervous juice, all the strong-smelling gums are proper, especially the milk of gum-ammoniac. But it ought to be remembered, that anodynes, which are poifons in the preceding cafe, are very serviceable in this, if joined with volatile falts or fpirits: but of all this tribe, I know no better medicine than the paregoric elixir. Now, as fome conftitutions, through fome defect of the folids or fluids, are apt to relapfe into this dif cafe ease upon every occafion; it is proper to give directions how to prevent it. Wherefore regard is to be had here, both to the conftitution of the patient, and the nature of the difeafe. If he be of a hot conftitution, coolers and acids, of the milder fort, are indicated; the best of which are vinegar and the oxymels but if it be cold, fome warm medicines are ferviceable; fuch as the roots of elecampane and zedoary, fagapenum, myrrh, and the like. In both cafes it is proper to give a vomit now and then; and to keep the body open with gentle cathartics, as Glauber's falt. Water with little wine is the most convenient drink. : But whereas every kind of this disease is attended with more or lefs of effervefcence in the blood, the best way to obviate this symptom is to give the bark, efpecially about the ufual time of the return of the paroxyfm. And I have known fome instances, where it has done vaft fervice, mixed with cinnabar of anfimony. Laftly, I muft not omit, that iffues above the fhoulder-blades are good in all asthmatic cafes; and it is very probable, that their benefit in this and fome other diftemper's lies, not only in giving vent to the humours, but likewife in leffening the over-great tenfion of the nerves. Yet all these things are to be managed with caution. From the too frequent ufe of blood-letting a dropfy is to be apprehended. Drinking too much water is hurtful to old folks. Violent exercise causes fhortness of breath; and fo does the over-free use of acids by conftringing the nervous fibres. So neceffary is moderation even in medicine! VOL. III. I But |