Quinsy: A Classic Example of Regency Ignorance

My previous blog post addressed the practice of “medical moonshine” during the Regency era. In Jane Austen’s day miasma — the foul, noxious, polluted air arising from swampy ground or cesspools — was believed to cause most diseases. For chemists and glass-makers and those who worked in foundries and smithies, breathing polluted air was, in fact, responsible for causing certain diseases, particularly those of the lung. But in most cases doctors believed miasma was the culprit. When a patient did not appear to have been exposed to a harmful miasma, doctors looked elsewhere for a cause. For example, obstructing the normal body functions of urinating and sweating was believed to cause disease.

In truth, the causes of disease as they were understood during the Regency era had nothing to do with miasma or interfering with bodily functions and everything to do with Fracastoro’s “disease seeds” and van Leeuwenhoek’s “animalcules” — which today we call germs or pathogens. Only look at what was known about quinsy two hundred years ago to see why Regency doctors practiced medical moonshine — they simply didn’t know better.

What Regency Doctors Believed Caused Quinsy

Quinsy (also spelled quinsey or quincy) was quite common in Regency England. This inflammation of the throat occurred frequently in winter and spring and could be fatal, especially among young people. According to Dr. William Buchan — who published several editions of his practical medical guide titled Domestic Medicine — the main causes of quinsy were the same as for other inflammatory conditions: an “obstructed perspiration” — that is, something that interfered with sweating or that inflamed or heated the blood. Dr. Buchan described the following causes of quinsy’s chief symptom, the inflamed throat:¹

• not wearing a scarf or cloth around the neck if used to doing so
• drinking cold water when the body is warm
• walking or riding against a strong northerly wind
• neglecting any customary bleeding, purging or evacuation (the latter refers to a bowel movement)
• straining the throat by singing or speaking loudly — Dr. Buchan knew of fatal cases of quinsy arising from “jovial companions” laughing, singing, talking loudly and drinking warm liquors and then going out into a cold night (sounds like a pub scene to me)
• wearing wet clothes or having wet feet
• sitting near an open window
• sleeping in a damp bed
• irritating foods (not defined) or inhaling noxious agents such as arsenic, antimony and the like
• violent exercise or running, which overheats the blood²

Symptoms of Quinsy

Doctors diagnosed quinsy by observing the patient’s inflamed throat, which appeared red and swollen.¹ Patients with quinsy often had trouble swallowing; displayed a quick, hard pulse; and showed signs of a fever. As the throat mass swelled and became inflamed, the difficulty of swallowing increased, the ears hurt, the eyes appeared red and the face swelled. When patients took on a ghastly tone, frothed at the mouth and had a swollen tongue, the case nearly always proved fatal.

Regency-era Treatment for Quinsy

On the medicine side Dr. Buchan recommended bleeding from the arm or, even better, from the jugular vein as soon as quinsy symptoms appeared.³ The patient’s body should be kept open — that is, the bowels should be stimulated to work properly — by giving the patient a decoction of figs and tamarinds or doses of rhubarb and nitre. The throat ought to be rubbed with a volatile liniment two or three times daily. In cases of violent throat inflammations, blistering of the neck or behind the ears was thought to be beneficial. (Poor patient, to be in such pain both inside and out!) If the quinsy swelled sufficiently large to make breathing or eating nearly impossible, then the only recourse for saving the patient was having a surgeon open the wind pipe or trachea.

As a general regimen Dr. Buchan recommended light meals, plenty of weak drinks, and peace and quiet. Strong stimulants of any kind should be avoided, so no spicy food, loud friends or lively family members. The patient should lie in bed with her head elevated and her neck kept warm by the application of soft flannel. She should consume the jelly of black currants (or red currants or mulberries if black currants weren’t available) by holding the jelly in her mouth and swallowing in a leisurely manner. A gargle of sage tea mixed with vinegar and honey was also useful three or four times daily. Of great importance was bathing the feet and legs in warm water daily.⁴

Quinsy in the Twenty-first Century

In this, the 21st century, quinsy is understood to be a peritonsillar abscess. It arises as a complication of tonsillitis and consists of an abscess containing pus that sits near the tonsils in the throat. The infection is caused by bacteria, including Streptococcus and Staphylococcus. It is treated with surgery to drain the pus and antibiotics to cure the infection.

Miasma or walking in the wind or sitting near an open window or obstructing perspiration had nothing to do with it. Of course, Regency doctors could not know that: at the time there was no germ theory of disease.

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Sources:

¹Buchan, William. Domestic Medicine (Boston, 1811), p. 199-200.
²Ibid., p. 203.
³Ibid., pp. 201-202.
⁴Ibid., pp. 200-201.