Angina, or Quinsey.

I. WHether a Vein should be opened in eve∣ry Quinsey? The Negative seems pro∣bable according to the Opinion of Mesue, who some∣times orders a Purge before Bloud-letting, especi∣ally when the matter peccant is also Cholerick or Phlegmatick; because the Cholerick matter boils and ferments higher, when the Bloud is taken away, and the Phlegmatick matter usually causeth greater crudity. Nay, if what Avicenna saith be true, That it is better the strength should remain in the Body, and that the peccant Matter should be taken away by Evacuation; it of neces∣sity follows, that in a Quinsey, caused by a Cho∣lerick or a Phlegmatick Inflammation, Bloud must not be let in the beginning, seeing by this means faintness follows, and Choler or Phlegm are not first purged, which certainly indicate Purging of the Mat∣ter rather than Bloud-letting. But we defend the contrary with the greater number, scil. That in eve∣ry Quinsey, whether the Bloud offend with Choler or Phlegm, or alone, we must begin with Bloud-let∣ting, if nothing hinder; because in the beginning a Man must presently take care to stop the afflux of Humours to the part affected, which may conveni∣ently be done by letting of Bloud, which draws back the affluent Matter from the part affected: For as in other Inflammations Bloud is let,* not in respect of that Matter, which hath already actually caused an Imposthume in any part, but for Preservation's sake, in respect of the Matter yet affluent and in∣creasing the Inflammation; so here we prescribe Bloud-letting in the beginning, lest the Inflammati∣on should be increased by the affluent Humours, and there should be imminent danger of present Suffocation.

II. Seeing a Quinsey is a most acute Disease, and that sometime it takes a Man away in one day; the Great Remedies are to be used with huge Care and Diligence. Therefore, at what hour of the day soever a Physician is called, let him take away Bloud presently, from the same side the part grieved is on, to one pound, a pound and an half, or two pounds, as the Patient can bear it: For the principal hope of safety must rely on this Remedy. Yet so great a Quantity of Bloud must not be taken at once,* lest the Patient fall in a swoon, whereby his life would greatly be indangered; but at several times, that is, once in three or four hours.

III. If you meet with a Woman in a Quinsey, who has her Months stopt, or is in daily expectati∣on of them, or actually has them, what must then be done? I would not have you follow them that breathe the upper Veins; for at this time you must breathe the lower. Trallianus teacheth this, lib. 4. c. 1. And Reason teacheth it: For in this kind of Bloud-letting there is not onely Revulsion,* but also an Evacuation of the accustomed natural Purgation, which hugely helps the Inflammation. But if Strang∣ling perplex you, when you have opened the lower Veins, you may with safety open a Vein under the Tongue: For this Bloud-letting draws not from the Womb, nor from the whole Body; but onely evacuates the Part affected.

IV. A Man of Fifty newly fallen sick, was taken about Midnight with so violent a Quinsey, that he was not able to speak one word.* A Surgeon was called, who let him Bloud under the Tongue, and in a short time he recovered. Saxonia Writes, that the opening of the Sublingual Veins should not be onely once, but repeated twice or thrice, as neces∣sity requires, and Suffocation is urgent.

V. The Ancients in a desperate Quinsey opened the Jugular Veins, which Remedy, although it be ap∣proved by most of the Moderns, is grown quite out of use in our times, because it is accounted dangerous, but erroneously. Trallianus, l. 4. c. 1. saith, He Cured several of the Quinsey by opening these Veins. ¶ I had under my Cure, Anno 1675. in the Month of May, Mr. Dennis Bordier of Geneva, a lusty Man, taken with a Quinsey and an acute Fever, although his Breathing and Swallowing were easie enough; I bled him in the Arm, the Bloud run very pure, but without any ease; I bled him under the Tongue also without any Benefit: But when I opened the Jugular on that side, where was most Pain, very Putrid Bloud ran out like a Rivulet, to his sudden and manifest Ease. Although this Ail ended in a Page  13 Peripneumony, from which he shortly recovered by repeated Bloud-letting and Expectoration.

VI. A Matron of Fifty had a Phlegmatick Quin∣sey all over her Throat, within and without; the Swelling appeared great outwardly, her Swallow∣ing and Speech were hindered: When I touched the place, I found Matter lye deep; wherefore I knew that she would be choaked before the Impost∣hume would break, either inwards or outwards; and feeling of it with my fingers,* I found ripe Mat∣ter gathered more between her Chin and the Epiglot∣tis, than any where else, and avoiding the Nerves and Vessels, I made a deep Wound in that place, out of which I took a good share of the Matter, leaving much behind. Then she took her Breath better, and the Fear of Death abated, &c.

VII. The Wife of N. being Plethorick, underwent most exquisite pains in her Jaws, her Tonsills were so swelled, that she could not swallow one drop, but threw whatever she took out at her Nostrils. I ordered Bloud-letting, I used Cataplasms and Gar∣garisms, and the fourth day of the Disea•e, as I was searching the Sore with a Probe,* I saw the Abscess suppurated: I was resolved to treat her somewhat Inhumanely, I broke the Abscess with the very same Probe; upon which, when she presently grew bet∣ter, she Laught, and commended my honest Cheat.

VIII. Benivenius, when a Man was almost strangled by a latent Quinsey, and given up for Dead, cut the place with deep Gashes under the Jaws, and on the Throat also, out of which there run much Corrup∣tion, and so rais'd the Man from Death to Life.

IX. Cutting the Windpipe is seldom put in pra∣ctice, for fear of Disgrace, if when the Operation is perform'd, the Patient should Dy: Besides, in a ve∣ry dangerous Quinsey, the Lungs are often afflicted and stuffed with Humours, which choak Men; in which Case this Operation is practised to no pur∣pose. Yet Examples are not wanting of those that have had good success in it. Famous Renatus Moreau used it in a Gardiner and a Souldier, both which re∣covered of their Disease and Wound, onely in the latter there remained a little hoarseness in his voice. The celebrated Tulpius, obs. 50. l. 1. shews, that Wounds of this nature heal quickly. Things that were never tried seem terrible, which, after they have been once practised, are used as confident∣ly as they are perform'd easily. This is confirm'd by the Opening of the Jugular Veins, now very usual, and by Cutting for the Stone. The way of performing the Operation is thus; Let the Pa∣tient be set in a Chair, with his Head leaning ba•k as much as he well can: let the Servant standing be∣hind him, take up the skin on each side of the fore∣part of the Neck, and the Surgeon must cut the Skin length-ways with the Muscles under it, just against the Aspera Arteria, not far from the pit of the Throat, and with a broad Lancet he must divide the Space between the Cartilages, and having made a hole, he must put in a Silver Pipe,* a little crooked with Legs: By this way the Breath goes and comes to the Lungs, till the Inflammation be either dispers∣ed, or brought to Suppuration, and a passage for breathing by the Mouth be restored.

X. In that sort of Quinsey, where the Muscles of the Larynx are inflamed, called, The Dog Quinsey, Breath may be restored to the Choaking Patient, by the help of Laryngotomy, an Operation less ha∣zardous than the Disease. Nevertheless here great Circumspection must be used, lest, if other parts al∣so, as the Pleura, Lungs, Gullet, &c. be inflamed, or full of Matter, the labour be in vain, and so give oc∣casion for Reproach. All things therefore well con∣sidered, the Operation may be gone about in this manner; Let the Head be bent back a little, that the Trachaea may come more in sight, and the Cartila∣ginous Rings may part the wider one from another: Let the Skin of the Wind-pipe be cut length-ways to the Pit: Let it be drawn asunder by the Servant's fingers on each side, that the Surgeon may see the Sternothyreoides Muscles, which are to be parted one from another with a Wooden or Ivory Knife: After the Windpipe shews it self, Section must be made with a Lancet, in the middle space, between the third and fourth Cartilaginous Ring, taking diligent care that the Cartilages themselves be not hurt. When the Wind comes out, take away your Instru∣ment, and fasten a Silver Pipe in the Wound: Care must be taken that it be not over long, nor touch the back-part of the Windpipe,* for then it would cause continual Coughing. When the danger of Choaking is over, which usually comes to pass in three or four days, the Pipe must be taken away, and the Wound cured the ordinary way according to Art: for it differs not from other Wounds.

XI. When the Imposthume is opened,* care must be taken that the Corruption fall not on the Lungs, nor into the Stomach, for fear of another Disease; but it must carefully be cast up at the Mouth, and then a Gargarism of Hydromel used often is good for Detersion, &c.

XII. One had been sick of a Bastard Quinsey, and he often Relapsed: Because some thin Matter al∣way flow'd to the foresaid par•s,* I therefore order∣ed him an Issue in one of his Arms, which we tri∣ed as the last Remedy; and by God's Assistence we restored the Patient to perfect Health.

XIII. There are some, who in that sort of Quin∣sey, which is caused by a Vertebra of the Neck slipt in∣wards, use Cupping-glasses, thinking by that means they may draw the dislocated Vertebra outwards again, which Hippocrates expresly forbids, lib. de Articulis. But it is great weakness to think to draw out the Verticles slipt in∣ward, by applying Cupping Glasses: for they rather drive for∣ward than backward, nor do those that set them on, take no∣tice of this: for by how much faster they set them on, so much the more crooked are they made to whom they are applied; be∣cause they shrink the outer skin together.

XIV. When the Patient has bled enough, he may be purged the day following,* never waiting for the Coction of the Humours, because the Disease gives no Truce: Nay, if that it be very violent, you may Bleed and Purge the same day, which Trallianus saith he did, l. 4. c. 1. But it must be done with gentle Medicines, because of the Inflammation. ¶ After the Patient has been let Bloud, the next morn∣ing, if the Fever and Pain be any thing abated, I presently give him a gentle Purge, which, after Bloud-letting, is the best thing can be done, and by often experience I have found it highly neces∣sary. If afterwards, which seldom happens,* the Fe∣ver and other Symptoms invade him, they must be en∣counter'd with repeated Bloud-letting as before. Through the whole course of this Disease, I order every morning a Cooling emollient Clyster, except the day allotted for Purging.

XV. There are some that prescribe Gargarisms of some sower and bitter things, that are not very ingratefull to the Taste, for repelling the Humour: Yet I suspect the use of these things in this case, because the Parts Inflamed should be quiet; but the Throat and Jaws are moved by Gargling: Therefore I would either have them not used at all, or held in the Mouth without stirring,* lying on ones back, that they may come to the Part af∣fected. Then I prescribe the following Gargarism, not to be used the common way, but to be kept in the Mouth without Gargling, till it be hot,* then to be spit out, and more taken. Take of Water of Plantain, Red Roses, and Frog Spawn, each four ounces, three Whites of Eggs beaten to water, of White Sugar-Candy three Drachms, make a Gargarism.

XVI. Galen and his followers, in all sorts of Quin∣seys, from the Beginning, use cold and astringent Gargarisms, contrary to the Precept of Hippocrates 4. de rat. vict. in acut. vers. 72. who prescribes Gargarisms actually hot. They mistake, not considering how such Medicines cause certain and speedy Suffocation Page  14 in the Quinsey, which depen•• on Phlegmatick Mat∣ter, seeing it gives not place to Repellents, but be∣ing thickned and more-setled in the Part, it is ren∣dred more unfit for Discussion, and readier for Suf∣focation: and in that which comes of sharp and thin Matter, although they be not so pernicious, yet they may doe more hurt than good; for since they cannot repell upwards the Matter descending from the Head, when it is forced either to the i•ner parts of the Muscles of the Throat, or upon the Lungs; they may make the Disease more dangerous Hippocrates his Advice is better, whom all the Ancients follow'd (as you may see, 6. de comp. Med.) while he thinks good in all sorts of Quinseys, and at all times, to abstain from Repellents, and always to use Rarefiers and Dis∣cutients, that the Matter may more easily be raised by Spittle, and be driven outward and discuss'd. Nor is there any fear the Flux should increase, seeing it may be prevented by Bleeding and Purging, and other Remedies respecting the Matter fluent.* And if at any time he would have some Astringents mixt with the foresaid Medicines, when the Matter is thin, he does it not because he would repell, but that by their drying virtue, he might avoid too great laxity of the Part, and that he might lessen the Swelling: Therefore he approves the use of them rather in the Beginning, than at another Time, as appears from lib. 2. de morb. sect. 1. vers. 24.

XVII. Humours sticking in the Flesh, which are wholly extravasated, cannot run because of the thick∣ness: Therefore the Physician must make them flux¦ile with hot Medicines: If one taken with a Quin∣sey, do, in the beginning of the Disease, Gargle himself with Spirit of Wine,* all Inflammation of the Throat will cease in three hours time.

XVIII. Whether a Swallow's Nest be of use? Some disapprove it, as Mercurialis, because the Vir∣tue lies not in the Nest, but in the Bird: But grant the Bird be endowed with such a peculiar Virtue, yet it ought not be denied the Nest, because the Nest may have it from the Excrements of the young ones, which are full of Salt. Neither ought it to be rejected for the repellent virtue of the Earth, as Pereda doth, because all Earth hath not a Repulsive Virtue; nor is it desired alone, but for the sake of the Dung mixt with it, which is sharp and Discuti∣ent, whose sharpness the Earth qualifies. There∣fore it is a Remedy most proper to discuss Tumours, chiefly of the Jaws and Throat; especially if the Bird have a peculiar virtue against the Quinsey. If the Quinsey be Phlegmatick, Swallow's Dung used inwardly and outwardly is good: But a bilious one is exasperated by the use of sharp Medicines: It concocts and discusses Phlegmatick Humours, and dries up the superfluous Moisture.

XIX. J. Tiengius had a Nun under Cure, that had an Imposthume in her Throat, which was Twenty days before it broke, or she could swallow any Food: He ordered now and then a Clyster of sweet Milk boild with Yelks of Eggs.*Amatus teaches the same, when the Quinsey is upon the Windpipe and Gullet, that Broths given by way of Clyster are able to nourish: Celsus and others affirm the same. We kept a Reli∣gious Woman alive in a Quinsey for nine days one∣ly with Clysters, and she recovered of her Sickness. Brassavolus comm. ad aphor. 15. Sect. 2.

XX. In a Quinsey Symptomatick of a Malignant Fever, we must doe nothing before the great Heat be laid, the Body evacuated and altered, and the Parts be preserved against the Poyson.

*XXI. Then Sleep, as in all inward Inflammations, so in this likewise, must be avoided, to our utmost power; for, according to the Prince of Physicians, in sleep the Bloud retires inwards; therefore the De∣fluxion of the Humours to the part affected may be increased.

XXII. A Learned Man of a Sanguine Temper, in∣clining to adust, was taken with a Bastard Quinsey without a Fever, he swallowed difficultly, and found some straitness about his Jaws: He tried many things to quiet his troublesome Disease, supposing it came of a Defluxion from the Brain, although there were more signs that that was dry: He Purged his Head often with Pills, he prescribed to himself (for he was a Physician) a Drying and Sweating Diet, he endeavoured to dry his Head with Bags, Plasters, &c. he used Apophlegmatisms, Sneezing, yea, and made an Issue behind in his Head; all in vain. At that time I was following my Studies at Paris, he sent me a Description of his Disease, to shew it to some famous Physicians. I consulted severally with Monsieur Carolus Buvardus, Chief Physician to Lewis XIII. with Monsieur Curaeus de la Chambre, Physician to the High Chancellour, and with Monsieur Hurduy∣nus de S. Jaques, Physician to the Hospital of Charity: They well considering the Constitution of the Patient, declared, The Disease was Sympathick, arising from Fumes ascending from the Hypochondria, affecting the Top of the Chimney, i. e. the Gullet, and that the tempering and exclusion of Melancholick Humours must be lookt after; they prescribed him Spaw Waters, the use of Chalybeates, an Issue in each Leg, and stopt up that in his head; they order'd Leeches to the Haemorrhoids, and other things to conquer the Melancholick Humours. The Patient consented, who a little after was rid both of his Melancholy and his Quinsey.

XXIII. In this Controversie I think we must take great notice, whether the Body abound with Bloud, either naturally, or because of the manner of living, or of some accustomed Evacuation stopt; for then I think we should bleed in the Ham or the Ancle; and the same day, if the Disease be urgent, or the next, to Breathe the Jecorary, or Cephalick Vein; and if the Disease abate not, we must proceed to Bleed under the Tongue. But if there be no such great plenty of Bloud,* I think it better not to meddle with the Veins of the lower parts; but presently to open a Vein in the Arm, and afterwards to bleed in the upper Veins.

XXIV. But Bloud-letting in the Arm must be re∣peated, not onely because it makes better Revulsi∣on, and causeth less weakness; but because it is of∣ten observed, that there is new afflux to the Part affected, either from some other Part transfusing Matter,* that it may ease it self of the burthen where∣with it is oppressed; or by the Part affected draw∣ing, by reason of its pain and heat.

XXV. And seeing some either in the Working of their Physick, or that they naturally abhor it, are apt to vomit it up again; it is better always to give Potions than Pills or Bolus's: for if they should happen to Vomit either a Bolus or Pills, when they are suddenly and with great Violence forced to the Passage straitned with the Inflammation,* there is no small danger of Strangling.

XXVI. Bags that are made up with drying Pow∣ders, to discuss in Inflammations of other parts, must never be made use of in the Quinsey, because by thickning the outer Skin,* they rather hinder the Cure; Therefore we must rather work with Moist∣ners.