As the former kind of distemper afflicts the whole neck, so there is another common one equally dangerous and acute, the seat of which is in the fauces. Our authors call it angina: amongst the Greeks the name varies according to the species. For sometimes there appears neither any redness nor tumour; but the body is dry, the breath is fetched with difficulty, the limbs are relaxed. This they call [ CK ]synanche(11). Sometimes the tongue and fauces are red and swelled, the voice is stopped, the eyes are turned, the face is pale, and there is a hiccough. That is called quasi synanche[ CL ]. These symptoms are common to both: the patient is not able to swallow either food or drink; his breathing is obstructed. It is more slight, when there is only a swelling and redness, and the rest of the symptoms do not follow. That they call parasynanche[ CM ].

Whatever species it be, if the patient’s strength will allow, blood must be let, although there is not a plethora; the next thing is to give a clyster. A cucurbital also is properly applied below the chin, and about the fauces, in order to evacuate the suffocating matter. Then there is a necessity for moist fomentations. For dry ones cut the breath. Therefore it is fit to apply sponges, which are better dipped now and then in warm oil, than in warm water. And it is of great efficacy in this case too, to put on salt in warm bags. Then it is convenient to make a decoction of hyssop, or cat mint, or thyme, or wormwood, or even bran, or dry figs, in hydromel, and use it as a gargarism; after that to touch the palate either with ox-gall, or the medicine, which is composed of mulberries. Fine flour of pepper is also proper to sprinkle upon it.

If from these things there is little benefit, the last remedy is to make pretty deep incisions under the jaws above the neck, and in the palate about the uvula, or to open the veins, that lie under the tongue, that the distemper may be discharged through these wounds. If this method don’t relieve the patient, we may be assured, that the distemper has got the better of him. But if the disorder is mitigated by them, and his throat is capable of admitting meat and drink, health will be easily recovered again. And sometimes nature assists too, if the disorder passes from a more contracted place to a larger. For this reason, when a redness and swelling begins in the præcordia, it is a sign that the malady has begun to leave the throat.

Whatever has relieved it, he must begin with a moist diet, and especially hydromel; then take soft food, and not acrid, till the fauces return to their former soundness. It is a vulgar opinion, that if a person eats a young swallow, he will be in no danger of an angina for the whole year: and that if it be preserved in salt, to burn it, and powder the coal of it, and give it to drink in hydromel, does service in this distemper. And as this is confidently reported by men of good credit among the common people, and the practice can be attended with no danger, although I have not read of it in medical treatises, yet I thought fit to give it a place in this work.

There is also a disorder about the fauces, which amongst the Greeks has different names, according to its different degrees. The whole consists in a difficulty of breathing: but while it is moderate, and does not wholly suffocate, it is called dyspnœa[ CN ]; when it is more severe, that the patient cannot breath without a noise, and quick fetches, asthma[ CO ]; when the difficulty is so great, that respiration cannot be performed, unless the neck be kept erect, orthopnœa[ CP ]. The first of these may be of long continuance without endangering life: the two following are commonly acute. These symptoms are common to them all, that by the straitness of the passage, through which the breath comes, a wheezing is occasioned; there is a pain in the breast and præcordia, sometimes also in the shoulders, and that goes and comes; besides these there is a slight cough.

Now the remedy, unless there be some contra-indication, is letting of blood. Nor is that sufficient; but goat’s milk must be given warm to the patient fasting, and if he has no fever, his belly must be opened(12); and sometimes purged; and sometimes a clyster must be given, by which means the body being extenuated, the patient begins to breathe more freely. The head also ought to be placed high on the bed, and the thorax assisted with fomentations, and hot cataplasms, either dry or moist; and after that a malagma applied, or a cerate of the cyprine ointment, or that of iris. Then the patient must drink fasting either hydromel, or a decoction of hyssop, or bruised caper-roots in water. It is proper also to give nitre, or cresses, or garlick, toasted, and then ground and mixed with honey: another medicine is thus prepared, honey, galbanum, resin, and turpentine are boiled up together: and when they have come to a consistence, the bigness of a bean is put every day in the mouth, and suffered to lie under the tongue, till it be dissolved: or p. *. & a quadrans of crude sulphur, and p. *. of southernwood are powdered, and mixed in a cyathus of wine, and that is supped warm. And it is not an idle opinion, that a fox’s liver dried ought to be beat, and the powder of it sprinkled upon the drink; or that the lungs of the same animal should be eaten roasted as soon as possible after he is killed, but nothing of iron used in the dressing. Besides these, gruels and light food must be used, sometimes also small austere wine, and sometimes a vomit taken. Whatever is diuretic, is also good; but nothing more so, than walking slowly almost to lassitude, much friction, especially of the lower parts, either in the sun or at the fire, and both by the patient himself and by others, till he sweat.

In the internal part of the fauces there sometimes happens an exulceration. In this case most people make use of hot cataplasms externally, and moist fomentations. They advise also the warm vapour to be received by the mouth: by which, others say these parts are rendered softer, and more fit to afford entertainment to the disorder, that already possesses them. But if the distemper can be prevented by these methods, those remedies are safe: if there is reason to fear it is already begun, they are improper. It is undoubtedly dangerous to rub the fauces, for it ulcerates them. Neither are diuretics good: because as they pass, they may possibly attenuate the phlegm of the part affected, which it is better to repel.

Asclepiades, to whom we are indebted for many useful discoveries, in which I have also followed him, recommends the sipping of very strong vinegar, and asserts, that this without any danger suppresses the ulcers. That may possibly prevent a flux of blood, but cannot heal the ulcers. A more proper application is lycium(13), which the same author also equally approves; or the juice of leek, or horehound, or sweet almonds rubbed with tragacanth, and mixed with passum, or lint-seed bruised, and mixed with sweet wine. The exercise also of walking and running is necessary. And smart friction is to be used from the breast downwards to all the inferior parts.

The food ought to be neither too acrid, nor rough: honey, lentils, tragum, milk, ptisan, fat flesh, and especially leeks, and whatever is mixed with the latter. The drink ought to be as little as possible, water may be given, either pure, or boiled to a decoction with a quince or dates. Also mild gargarisms: but if these are not successful, repellent ones are good.

This disease is not acute, and yet may not continue long: but requires a speedy cure, lest it turn very severe and tedious.

A cough, which is contracted in many different ways, is generally a troublesome concomitant of an exulceration of the fauces; and in this case, when the fauces are cured, the cough ceases. Yet it is sometimes found by itself without any other distemper: and when it becomes inveterate, it is hardly possible to remove it entirely. And sometimes it is dry, sometimes it either generates or discharges phlegm.

In this it is proper to drink hyssop every other day; to keep in the breath and run, but by no means in dusty places; and to read aloud, which at first is obstructed by the cough, but afterwards overcomes it; then to walk; then to use also those exercises that employ the hands, and to rub the breast for a long time: after these to eat three ounces of the mellowest figs stewed over the fire.

Besides if it be moist, strong frictions are good with some heating medicines, the head being briskly rubbed at the same time; also cucurbitals used to the breast, mustard applied to the external part of the fauces, till it be a little ulcerated; the drink may be prepared from mint, and sweet almonds, and starch; and beginning with dry bread he may proceed to any other light food.

But if it be a dry cough, when it is most severe, taking a cyathus of austere wine relieves; provided that be not oftener done than three or four times after proper intervals. It is likewise necessary to swallow a little of the best laser, to take the juice of leeks or horehound, to lick squils, to sup vinegar of squills, or at least sharp vinegar, or two cyathi of wine with a clove of bruised garlick infused in it.

In every cough it does service to take journies, long voyages, and to live near the sea, and to swim. The diet must be sometimes soft, as mallows and nettles; sometimes acrid, as milk boiled with garlick; gruels, to which laser has been added, or such as have had leeks boiled in them, till they have lost all their verdure. A sorbile egg also with an addition of sulphur may be supped; for drink warm water may be taken first, then alternately, some days water, and other days wine.

A spitting of blood may strike a greater terror. But that sometimes is less, and sometimes more dangerous. For it issues sometimes from the gums, sometimes from the mouth; and indeed from the latter very plentifully at times, but without a cough, without an ulcer, or any distemper of the gums, and without expectorating any thing; but breaks out from the mouth in the same manner, as from the nose. And sometimes pure blood is discharged, at other times something like water, in which fresh meat has been washed. Sometimes it comes from the upper part of the fauces, which may happen by means of an exulceration in that part; or when it is not ulcerated, either from the mouth of some vein opened, or tubercles rising there, and discharging the blood. When this is the case, neither meat nor drink do harm, nor is any thing expectorated, as from an ulcer. But sometimes, when the throat and wind-pipe are ulcerated, a frequent cough forces out blood too. Neither is it uncommon for it to come either from the lungs, or the breast, or the side, or the liver. Women, whose menses are suppressed, often have these spittings. And medical writers say, that blood is discharged either by the erosion, or the rupture of some part, or the dilatation of the mouth of some vein. The first they call diabrosis[ CQ ], the second rhegmochasmus[ CR ], the third anastomosis[ CS ]. The last does least hurt; the first is most dangerous. And it often happens, that the blood is followed by pus.

Now sometimes stopping the blood is alone sufficient to effect a cure. But if ulcers have followed, if pus, if there be a cough, diseases are formed, which differ in nature and danger according to the parts they possess. If blood only is discharged, both the remedy is easier, and the termination of the distemper quicker. And we ought not to be ignorant, that a moderate discharge of blood, is not hurtful to those, who are accustomed to hæmorrhages, or such, whose spine or hips are pained, or to any after violent walking or running, provided there be no fever: and that passing off in the urine, it removes even the lassitude. And that it is not terrible in the case of a person, who has fallen from a height, if nothing else appears uncommon in his urine. That neither is a vomiting of blood dangerous, although it return, if opportunity has been allowed to strengthen and fill up the body beforehand: and in general that no such discharge can hurt, when it happens in a strong body, and is neither excessive, nor raises a cough, nor heat. These observations are universal. Now I shall return to those particular places, which I have mentioned.

If it comes from the gums, it is sufficient to chew purslane; if from the mouth, to hold pure wine in it; if that is not effectual, vinegar. If notwithstanding these it breaks out with violence, because it may waste a person, it is most proper to divert its force by applying a cucurbital to the back of the head, and making an incision in the skin; if this happens to a woman, whose menses are stopped, to apply the cucurbital to her groin, with scarification.

But if it has proceeded from the fauces, or the more internal parts, there is more to be feared, and greater care must be taken in the cure. Blood must be let: and if notwithstanding that, it breaks out from the mouth, the operation must be repeated a second, and a third time, and every day a little taken away: the patient ought immediately to sup either vinegar, or the juice of plantain, or leek with frankincense(14): and some sordid wool dipped in vinegar and squeezed, should be applied externally upon the place, which is diseased, and it must be cooled now and then with a sponge. Erasistratus made many ligatures in the legs, and thighs, and arms of such patients. Asclepiades was so far from thinking this useful, that he even judged it hurtful. But a number of experiments gives proof of its often answering very well.

Nevertheless there is not a necessity for making ligatures in many places: but it is sufficient to do it below the groin, and above the ancles, and near the top of the shoulders, and fore arms. Then if the patient have a fever, gruel must be given; and for drink some astringent decoction. But if there is no fever, either washed alica, or bread dipped in cold water, and a soft egg too may be given; and for drink either what was above-mentioned, or sweet wine, or cold water. But in the allowance of drink we must remember, that thirst is serviceable in this disorder.

Besides these, rest, security from apprehensions, and silence are necessary. The patient’s head, when he lies, should also be high, and it is proper to clip it close. The face is to be often bathed with cold water. But wine, the bath, venery, oil amongst meat, all acrid things, warm fomentations, a hot and close room, many cloaths thrown upon the body, are all prejudicial; also frictions, unless when bleedings have entirely ceased. Then indeed he may begin with the arms and legs, but not touch the chest. In this case he should reside near the sea-coast in the winter time, and in the inland places in the summer.