INFLAMMATIONS. S'J 



CCCX. When this disease shall have taken a tendency to 

 suppuration, nothing will be more useful than the frequent tak- 

 ing into the fauces the steams of warm water. When the ab- 

 scess is attended with much swelling, if it break not spontane- 

 ously, 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. 



CCCXI. 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 per- 

 sons of every constitution when exposed to the contagion, but 

 most readily the weak and infirm. 



CCCXII. The disease is usually attended with a considera- 

 ble 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 tu- 

 mour ; 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, ex- 

 coriating 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. 



" When the disease is epidemic, we especially judge of its 

 approach by the vomiting. In Cynanche tonsillaris the affec- 

 tion extends to the adjacent muscles and membranes ; in Cy- 

 nanche maligna it seems more erysipelatous, and does not go so 

 deep. I have seen this disease attended with coma, so that we 



