240 
PATHOLOGY. 
fauces and neck. This appears firft as a glandular move- 
able tumour at the corner of the lower jaw ; but the 
fwelling foon becomes uniformly diffufed over a great 
part of the neck, fometimes on one fide only, but more 
commonly on both. The fwelling continues to increafe 
till the fourth day ; but, from that period it declines, 
and in a few days more paffes off entirely. As the fwell¬ 
ing of the fauces recedes, fome tumour affefts the tefti- 
cles in the male fex, or the breafts in the female. Thefe 
tumours are fometimes large, hard, and fomewhat pain¬ 
ful ; but, in this climate, are feldom either very painful 
or of long continuance. The fever attending this dif- 
eafe is commonly flight, and recedes with the fwelling 
of the fauces 5 but fometimes, when the fwelling of the 
teflicle does not fucceed to that of the fauces, or when the 
one or the other has been fuddenly repreffed, the fever 
becomes more confiderable, is often attended with deli¬ 
rium, and has fometimes proved fatal. As this difeafe 
commonly runs its courfe without either dangerous or 
troublefome fymptoms, fo it hardly requires any remedies. 
An antiphlogiftic regimen, and avoiding cold, are all 
that will be Commonly neceffary. But when, upon the 
receding of the fwelling of the teflicles in males, or of 
the breafts in females, the fever comes to be confiderable 
and threatens an affeftion of the brain, it will be pro¬ 
per, by warm fomentations, to bring back the fwelling; 
and, by vomiting, bleeding, or bliftering, to obviate the 
confequences of its abfence. 
4. Emprefma parifthmitis, (Cynanche, Cull. Angina, 
Au 6 l. Lat .) Squinancy, or quinfy. Rednefs and fwelling 
of the fauces with painful and impeded deglutition. 
This fpecies contains three varieties. 
a. P. tonfillaris, or common quinfy. It is an inflam¬ 
mation of the mucous membrane lining the throat, and 
affefting efpecially the tonfils, and fpreading from thence 
along the velum and uvula. The difeafe is marked by a 
rednefs of the parts, accompanied by fwelling, which is 
fometimes confiderable, fo as to render the aft of fwal¬ 
lowing painful and difficult, or even to impede it almoft 
entirely. There is alfo a troublefome clamminefs of the 
mouth and throat, with a frequent but difficult excre¬ 
tion of mucus ; there is often a pain (hooting into the 
ear: the voice is altered, and articulation rendered in- 
diftinft. A degree of fever is generally prefent. This 
kind of quinfy is not contagious. It terminates fre¬ 
quently by refolution, fometimes by fuppuration, but 
hardly ever by gangrene. The progrefs of the inflamma¬ 
tion to fuppuration, is fometimes, indeed, very rapid ; at 
other times there are feveral fmall abfceffes, which break 
one after another, and the difeafe is tedious. Occafionally 
the tonfils become enlarged and hard after this inflam¬ 
mation, and remain fo for years. When a large impof- 
thume breaks, there is generally fudden relief from the 
pain, difficulty of breathing, fwallowing, and fpeaking ; 
although often no matter is thrown up, but paffes down 
the oefophagus. 
The difeafe is commonly traced to expofure to cold. 
It affefts the young and fanguine, and is very liable to 
return, in fome conftitutions, upon the application of 
cold to any part of the body, fo as to become.almoft ha¬ 
bitual. It occurs, efpecially in fpringand autumn, when 
viciffitudes of heat and cold frequently take place. The 
inflammation and fwelling often begin mod violently in 
one tonfil, and afterwards, abating in that, increafe in 
the other. The remedies for inflammation, and the an¬ 
tiphlogiftic regimen, are to be employed for the cure of 
this complaint. It is greatly aggravated by heating diet 
and ftimulating medicines. General blood-letting is 
feldom neceflary; but leeches to the neck and external 
fauces are very ufeful. Blifters, when early applied to the 
fame parts, are alfo highly beneficial, and have often had 
the effeft of curing by refolution a violent inflammation 
of the throat. When fuppuration is begun, they can be 
of little ufe. Purgatives, repeated occafionally, are of ef- 
fential benefit. The inflammation is often relieved by 
topical refrigerants, particularly acids ; hence the ufe of 
gargles containing vinegar, lemon-juice, or the mineral 
acids, and rendered palatable by means of honey or fy- 
rup. Thefe acids moreover coagulate the mucus w’hich 
adheres about the parts, and cleanfe the paffages. In 
many cafes, however, no application has afforded more 
relief than the vapour of warm water received into the 
fauces by means of Mudge’s inhaler. 
P. maligna; crimfon rednefs of the mucous mem¬ 
brane of the fauces and tonfils ; ulcerations covered with 
mucous and fpreading floughs, of an affi or whitifti hue; 
fever a typhus. This difeafe is of great danger and im¬ 
portance. We give the following account of its nature 
on the authority of Dr. Parr. It attacks like a flight in¬ 
flammatory fore throat, though fometimes only a languor 
infidioufly creeps on, with a little difficulty of fwallow¬ 
ing; and, in the worft cafes, even this is abfent. The 
ftrength, however, rapidly finks, the features fall, aghaft- 
ly palenefs comes on, and death quickly follows. In 
(lighter kinds, the courfe is not very different from that 
of the inflammatory fpecies, though feemingly flight, 
with alternate chills and heats, pain in the head, 82c. till 
the debility appears, when every other bad fymptom im¬ 
mediately follows. Every fore throat ffiould, therefore, 
be carefully examined. 
In the moft aftive inflammations of the throat, white 
fpecks will fometimes appear on the velum pendulum or 
tonfils. If the inflammation is florid, the conftitution 
robuft, and the pulfe firm, thefe fpots may be difregard- 
ed. On the contrary, in fome inftances of the molt ma¬ 
lignant kind, no floughs can be obferved. The diftinc- 
tion muft be taken from the colour of the inflammation. 
In the true malignant fore throat, the colour approaches 
rather to the crimfon and the pink than the red ; and 
fometimes a (hade of brown, not far diftant from the cin¬ 
namon, is mixed. The pain in fwallowing is flight in 
proportion to the degree of inflammation ; languor, lift- 
leffnefs, and indifference, are very confpicuous ; and the 
features difplay the fame want of fulnefs and tone : the 
eyes are red and watery. At this time the pulfe will be 
fometimes apparently ltrong, but a flight attention (hows 
that the ftrength of the ftroke is apparent only : it throbs 
with a kind of convulfive weaknefs, rather than beats 
with a fteady firmnefs. The tongue grows brown, the 
breath offenfive ; and delirium, at night, comes on ; by 
day, a wandering is only obfervable. When there are 
floughs on the throat, the edges are of a dark pink red; 
they are obferved to cover, and fometimes they conceal, 
a confiderable lofs of fubftance : they enlarge, become 
deeper, and the edges black. An ichor, or a thin acrid 
matter, is difcharged from the nofe or ears ; the (tools 
are thin and highly offenfive. The fever is faid to remit 
in the morning, but the remiffion is inconsiderable, and 
will never affilt in the diftinftion, though it will fome* 
times lead to an infidious fecurity. Sometimes, from the 
beginning, exanthemata appear ; and the putrid fore 
throat is frequently, if not conftantly, an attendant on 
Scarlatina: thefe foon affume a darker hue, and appear 
livid. The breath in the earlier periods is not aftefte.d, 
but a wheezing noife fupervenes if neglefted; and this, 
in the worft kinds, is fucceeded by a (hrill barking found. 
It evidently arifes from the eryfipelatous inflammation 
extending to the larynx, and is generally a fatal fymp¬ 
tom. The eruptions have been erroneoufly defcribed as 
favourable and critical, In a difeafe which runs -its 
courfe generally in lefs than five, always in feven days, no 
prognoftic is to be depended on but a more florid appear¬ 
ance in the throat, and a more healthy afpeft of the edges 
of the fores. 
The difeafe is epidemic, and attacks the aftive and 
robuft as well as the infirm. The treatment muft in its 
early ftages be ft rift ly antiphlogiftic; but it is faid that, 
when the floughs are formed, fuch meafures are injurious. 
It feems to us, however, that in this refpeft we lhould 
be guided by the ftate of the pulfe, &c. rather than adopt 
a line 
