SECT. I.

Of the Cynanche Tonsillaris.

301. This is an inflammation of the mucous membrane of the fauces, affecting especially that congeries of mucous follicles which forms the tonsils, and spreading from thence along the velum and uvula, so as frequently to affect every part of the mucous membrane.

302. The disease appears by some tumour, sometimes considerable, and by a redness of the parts; is attended with a painful and difficult de glutition; with a pain sometimes shooting into the ear; with a troublesome clamminess of the mouth and throat; with a frequent, but difficult excretion of mucus; and the whole is accompanied with a pyrexia.

303. This species of quinsy is never contagious. It terminates frequently by resolution, sometimes by suppuration, but hardly ever by gangrene; although, in this disease, some sloughy spots, commonly supposed to be forerunners of gangrene, sometimes appear upon the fauces.

304. This disease is commonly occasioned by cold externally applied, particularly about the neck.

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It affects especially the young and sanguine, and a disposition to it is often acquired by habit; so that, from every considerable application of cold to any part of the body, this disease is readily induced. It occurs especially in spring and autumn, when vicissitudes of heat and cold frequently take place. The inflammation and tumour are commonly at first most considerable in one tonsil; and afterwards, abating in that, increase in the other.

305. In the cure of this inflammation, some bleeding may be proper; but large general bleedings will seldom be necessary. The opening of the ranular veins seems to be an insignificant remedy; and leeches set upon the external fauces are of more efficacy.

206. At the beginning of the disease, full vomiting has been frequently found to be of great service.

307. This inflammation may be often relieved by moderate astringents, and particularly by acids applied to the inflamed parts. In many cases, however, nothing has been found to give more relief than the vapour of warm water received into the fauces by a proper apparatus.

308. The other remedies of this disease are rubefacient or blistering medicines, applied externally to the neck; and, with these, the employ

ment of antiphlogistic purgatives, as well as every part of the antiphlogistic regimen, excepting the application of cold.

309. This disease as we have said, often terminates by resolution frequently accompanied with sweating; which is therefore to be prudently favoured and encouraged.

310. When this disease shall have taken a tendency to suppuration, nothing will be more useful, than the frequent taking into the fauces the steams of warm water. When the abscess is attended with much swelling, if it break not spontaneously, it should be opened by a lancet; and this does not require much caution, as even the inflammatory state may be relieved by some scarification of the tonsils. I have never had occasion to see any case requiring bronchotomy.

SECT. II.

Of the Cynanche Maligna.

311. This is a contagious disease, seldom sporadic, and commonly epidemic. It attacks persons of all ages, but more commonly those in a young and infant state. It attacks persons of every constitution when exposed to the contagion, but most readily the weak and infirm.

312. This disease is usually attended with a con siderable pyrexia; and the symptoms of the accession of this, such as frequent cold shiverings, sickness, anxiety, and vomiting, are often the first appearances of the disease. About the same time, a stiffness is felt in the neck, with some uneasiness in the internal fauces, and some hoarseness of the voice. The internal fauces, when viewed, appear of a deep red colour, with some tumour; but this last is seldom considerable, and deglutition is seldom difficult or painful. Very soon a number of white or ash-coloured spots appear upon the inflamed parts. These spots spread and unite, covering almost the whole fauces with thick sloughs; which falling off, discover ulcerations. While these symptoms proceed in the fauces, they are generally attended with a coryza, which pours out a thin acrid and fetid matter, excoriating the nostrils and lips. There is often also, especially in infants, a frequent purging; and a thin acrid matter flows from the anus, excoriating this and the neighbouring parts.

313. With these symptoms, the pyrexia proceeds with a small, frequent, and irregular pulse; and there occurs à manifest exacerbation every evening, and some remission in the mornings. A great debility appears in the animal functions; and the sensorium is affected with delirium, frequently with coma.

314. On the second day, or sometimes later, efflorescences appear upon the skin, which are sometimes in small points hardly eminent; but, for the most part, in patches of a red colour, spreading and uniting so as to cover the whole skin. They appear first about the face and neck, and in the course of some days spread by degrees to the lower extremities. The scarlet redness is often considerable on the hands and extremities of the fingers, which feel stiff and swelled. This eruption is often irregular, as to the time of its appearance, as to its steadiness, and as to the time of its duration. It usually continues four days, goes off by some desquamation of the cuticle; but, neither on its first appearance, nor on its desquamation, does it always produce a remission of the pyrexia, or of the other symptoms.

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315. The progress of the disease depends on the state of the fauces and of the pyrexia. When the ulcers on the fauces, by their livid and black colour, by the fetor of the breath, and by many marks of acrimony in the fluids, shew a tendency to gangrene, this takes place to a considerable degree; and, the symptoms of a putrid fever constantly increasing, the patient dies, often on the third day, sometimes later, but for the most part before the seventh. The acrimony poured out from the diseased fauces must necessarily, in part, pass into the pharynx, and there spread the infec