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THERE are two forms of quinsey. The one is attended with heat, and great inflammation of the tonsils, and swelling outwardly; moreover, the tongue, uvula, and all the parts there, are raised up into a swelling. The other is a collapse of these parts, and compression inwardly, with greater sense of suffocation, so that the inflammation appears to be determined to the heart. In it, then, particularly, we must make haste to apply our remedies, for it quickly proves fatal.

If, then, it proceed from taking too much food and wine, we must inject the bowels on the day of the attack, and that with two clysters: the one a common clyster, so as to bring off the feculent matters; and the other for the purpose of producing revulsion of the humours from the tonsils and chest.

It will therefore be, but not undiluted . . . . . . . and the decoctions of centaury and hyssop; for these medicines also bring off phlegm. And if the patient has been on a restricted diet, we open the vein at the elbow, and make a larger incision than usual, that the blood may flow with impetuosity and in large quantity; for such a flow is sufficient to mitigate the heat most speedily, is able to relieve the strangulation, and reduce all the bad symptoms. It is no bad practice, likewise, to bring the patient almost to fainting, and yet not so as that he should faint altogether, for some from the shock have died of the fainting . . . . . . . . or binding them with ligatures above the ankles and knees. It is a very good thing, likewise, to apply ligatures to the forearms above the wrists, and above the forearms to the arms. And if deglutition be easy, we are to give elaterium with honeyed-water, and the whey of milk, as much as will be sufficient to purge the patient. In these cases, elaterium is preferable to all other cathartics; but cneoros and mustard are also suitable, for both these purge the bowels. If the inflammations do not yield to these means, having bent the tongue back to the roof of the mouth, we open the veins in it; and if the blood flow freely and copiously, it proves more effectual than all other means. Liquid applications to the inflamed parts, at first of an astringent nature, so as to dispel the morbid matters: unwashed wool, then, with hyssop, moistened in wine, and the ointment from the unripe olive. But the cataplasms are similar to the liquid applications,--dates soaked in wine, and levigated with rose-leaves. But in order that the cataplasm may be rendered glutinous and soft, let flour or linseed, and honey and oil be added, to produce the admixture of all the ingredients. But if it turn to a suppuration, we are to use hot things, such as those used in the other form of synanche. Let fenugreek be the powder, and manna and resin the substances which are melted; and let the hair of poley be sprinkled on it, and a hot fomentation

be made with sponges of the decoction of the fruit of the bay and of hyssop. And the powdered dung of pigeons or of dogs, sifted in a sieve, is most efficacious in producing suppuration, when sprinkled on the cataplasm. As gargles, honeyed-water, with the decoction of dried lentil, or of hyssop, or of roses, or of dates, or of all together. We are also to smear the whole mouth, as far as the internal fauces, either with Simples, such as the juice of mulberries, or the water of pounded pomegranates, or the decoction of dates; or with Compound preparations, such as that from mulberries, or that from besasa,1 or that from the juice of pomegranates, and that from swallows. But if the ulcers proceed from eschars, these gargles, and washes for the mouth, the decoction of hyssop in honeyed-water, or of fat figs in water, and along with them starch dissolved in honeyed-water, or the juice of ptisan, or of tragus (spelt?).

But in the species of synanche attended with collapse, we are to make a general determination from within outwardly, of the fluids, of the warmth, and of all the flesh, so that the whole may swell out. Let the liquid applications then be of a hot nature, with rue and dill, natron being sprinkled upon them; and along with them the cataplasms formerly mentioned. It is a good thing also to apply a cerate with natron and mustard for inducing heat; for heat determined outwardly is the cure of such complaints; and thus swelling takes place in the neck, and an external swelling rescues from peripneumonia; but in cases of synanche, the evil when inwardly is of a fatal nature. But those who, in order to guard against suffocation in quinsey, make an incision in the trachea for the breathing, do not appear to me to have proved the practicability of the thing by actual experiment; for the heat of the inflammation is increased by the wound, and thus contributes to the suffocation and cough. And, moreover, if by any means they should escape the danger, the lips of the

wound do not coalesce; for they are both cartilaginous, and not of a nature to unite.2 * * * * * * * * * * * * * * * * * * * * * * * * * *

1 The wild rue, or Peganum harmala. See Dioscorides, iii. 46.

2 On the Ancient History of Laryngotomy, see Paulus Ægineta, t. ii., pp. 301--303, Syd. Soc. Edit. I would avail myself of the present opportunity of bringing into the notice of my learned readers the very accurate and elegant edition of the Sixth Book of Paulus Ægineta, lately published in Paris by Dr. RO・Brian. As regards the text, it is everything that could be desired; and the translation which accompanies it is generally correct.

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