Excerpt from The Principles and Practice of Medicine: Founded on the Most Extensive Experience in Public Hospitals and Private Practice; And Developed in a Course of Lectures Delivered at University College, London

The predisposing causes of the disease are, in the first place, a peculiar constitution, and disposition to it. There are some people who, in whatever way they may be exposed to the general causes of inflammation, continually get a sore throat. Whenever they are exposed to the vicissitudes of temperature, coldness, and moisture, they are sure to have inflammation of the throat; and this will run in families, so as to be constitutional. It certainly is predisposed to by mercury. When persons have been much under the influence of mercury, they are very liable (as I formerly mentioned, when speak ing of inflammation in general) to take cold from the vicissitudes of temperature; and the throat is certainly particularly liable to inflammation from this cause. The youthful period of life appears more liable to tonsillitis than old age; for we see far more cases of inflammatory sore-throat in the young, than in the old. Perhaps, among the predisposing causes, I might mention the season of the year - spring. Cases of this description certainly occur (from cold and wet) more frequently in the spring, than at any other period of the year. The exciting causes of the disease are, especially, cold and wet - whether applied to the body at large, or to the feet only. Cold applied in any way, is sufficient to produce the disease.

With regard to the treatment, it is rarely necessary to take blood from the arm; but leeches around the throat, are particularly useful. I do not know that it is necessary to apply them internally to the fauces. I think that, applied externally, they answer every purpose they can; and that a free application of leeches, is far superior to blistering. As a general rule, in the treatment of inflammation, we must be upon our guard never to let blistering take the place of the removal of blood. If the inflammation be at all severe, you only harass a patient (in any disease whatever) by blistering, if there be a necessity to take away blood; and, in this disease, blistering is a very painful remedy. A blister produces great anguish, when applied to the throat; and does not, by any means, answer so good a purpose as leeches - the frequent application of leeches externally, under the lower jaw, followed by poultices. The application of poultices not only tends' to encourage the bleeding, but is a constant fomentation - a mode of relaxing the parts, and causing perspira tion there. If the patient be too weak for you to apply leeches, a blister then will be proper; or, if you have applied leeches as much as you think advisable, and still it is requisite to do more before the disease can be controlled, then blisters may be used with advantage. It must be remembered, however, that when a patient can bear leeches, you will find them the most useful.

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