Zoonomia; Or, the Laws of Organic Life, Vol. II

by Erasmus Darwin

Tonsillitis interna. Inflammation of the internal tonsil. When the swelling is so considerable as to produce difficulty of breathing, the size of the tonsil should be diminished by cutting it with a proper lancet, which may either give exit to the matter it contains, or may make it less by discharging a part of the blood. This kind of angina is frequently attended with irritated fever besides the sensitive one, which accompanies all inflammation, and sometimes requires venesection. An emetic should be given early in the disease, as by its inducing the retrograde action of the vessels about the fauces during the nausea it occasions, it may eliminate the very cause of the inflammation; which may have been taken up by the absorbents, and still continue in the mouths of the lymphatics or their glands. The patient should then be induced to swallow some aperient liquid, an infusion of senna, so as to induce three or four evacuations. Gargles of all kinds are rather hurtful, as the action of using them is liable to give pain to the inflamed parts; but the patients find great relief from frequently holding warm water in their mouths, and putting it out again, or by syringing warm water into the mouth, as this acts like a warm bath or fomentation to the inflamed part. Lastly, some mild stimulant, as a weak solution of salt and water, or of white vitriol and water, may be used to wash the fauces with in the decline of the disease, to expedite the absorption of the new vessels, if necessary, as recommended in ophthalmy.

Tonsillitis superficialis. Inflammation of the surface of the tonsils. As the tonsils and parts in their vicinity are covered with a membrane, which, though exposed to currents of air, is nevertheless constantly kept moist by mucus and saliva, and is liable to diseases of its surface like other mucous membranes, as well as to suppuration of the internal substance of the gland; the inflammation of its surface is succeeded by small elevated pustules with matter in them, which soon disappears, and the parts either readily heal, or ulcers covered with sloughs are left on the surface.

This disease is generally attended with only sensitive fever, and therefore is of no danger, and may be distinguished with great certainty from the dangerous inflammation or gangrene of the tonsils at the height of the small-pox, or scarlet fever, by its not being attended with other symptoms of those diseases. One emetic and a gentle cathartic is generally sufficient; and the frequent swallowing of weak broth, or gruel, both without salt in them, relieves the patient, and absolves the cure. When these tumours of the tonsils frequently return I have sometimes suspected them to originate from the absorption of putrid matter from decaying teeth. See Class [I. 2. 3. 21]. and [II. 2. 2. 1].

Tonsillitis inirritata. Inflammation of the tonsils with sensitive inirritated fever is a symptom only of contagious fever, whether attended with scarlet eruption, or with confluent small-pox, or otherwise. The matter of contagion is generally diffused, not dissolved in the air; and as this is breathed over the mucaginous surface of the tonsils, the contagious atoms are liable to be arrested by the tonsil; which therefore becomes the nest of the future disease, like the inflamed circle round the inoculated puncture of the arm in supposititious small-pox. This swelling is liable to suffocate the patient in small-pox, and to become gangrenous in scarlet fever, and some other contagious fevers, which have been received in this manner. The existence of inflammation of the tonsil previous to the scarlet eruption, as the arm inflames in the inoculated small-pox, and suppurates before the variolous eruption, should be a criterion of the scarlet fever being taken in this manner.

M. M. All the means which strengthen the patient, as in the sensitive inirritated fever, Class [II. 1. 2. 1]. As it is liable to continue a whole lunation or more, great attention should be used to nourish the patient with acidulous and vinous panada, broth with vegetables boiled in it, sugar, cream, beer; all which given frequently will contribute much to moisten, clean, and heal the ulcuscles, or sloughs, of the throat; warm water and wine, or acid of lemon, should be frequently applied to the tonsils by means of a syringe, or by means of a capillary syphon, as described in Class [II. 1. 3. 1]. A slight solution of blue vitriol, as two grains to an ounce, or a solution of sugar of lead of about six grains to an ounce, may be of service; especially the latter, applied to the edges of the sloughs, drop by drop by means of a small glass tube, or small crow-quill with the end cut off, or by a camel's-hair pencil or sponge; to the end of either of which a drop will conveniently hang by capillary attraction; as solutions of lead evidently impede the progress of erysipelas on the exterior skin, when it is attended with feeble pulse. Yet a solution of alum injected frequently by a syringe is perhaps to be preferred, as it immediately removes the fetor of the breath, which must much injure the patient by its being perpetually received into the lungs by respiration.

[4]. Parotitis. Mumps, or branks, is a contagious inflammation of the parotis and maxillary glands, and has generally been classed under the word Cynanche or Angina, to which it bears no analogy. It divides itself into two kinds, which differ in the degree of fever which attends them, and in the method of cure.

Parotitis suppurans. The suppurating mumps is to be distinguished by the acuteness of the pain, and the sensitive, irritated, or inflammatory fever, which attends it.

M. M. Venesection. Cathartic with calomel three or four grains repeatedly. Cool air, diluents. This antiphlogistic treatment is to be continued no longer than is necessary to relieve the violence of the pain, as the disease is attended with contagion, and must run through a certain time, like other fevers with contagion.

Parotitis mutabilis. Mutable parotitis. A sensitive fever only, or a sensitive irritated fever, generally attends this kind. And when the tumor of the parotis and maxillary glands subsides, a new swelling occurs in some distant part of the system; as happens to the hands and feet, at the commencement of the secondary fever of the small-pox, when the tumor of the face subsides. This new swelling in the parotitis mutabilis is liable to affect the testes in men, and form a painful tumor, which should be prevented from suppuration by very cautious means, if the violence of the pain threaten such a termination; as by bathing the part with coldish water for a time, venesection, a cathartic; or by a blister on the perinæum, or scrotum, or a poultice.

When women are affected with this complaint, after the swelling of the parotis and maxillary glands subsides, a tumor with pain is liable to affect their breasts; which, however, I have never seen terminate in suppuration.