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i
Attended with ULCERS;
A Disease which hath of late Years
appeared in THIS CITY, and the
PARTS ADJACENT.
By John Fothergill, M. D.
LONDON:
Printed for C. Davis, over-against
Gray's-Inn Gate, Holborn.
MDCCXLVIII.
PREFACE.
iii
A simple Inflammation of the Tonsils,
or of other Parts about the Fauces,
from its frequently happening
without any considerable Hazard attending
it, is commonly look'd upon as a troublesome,
rather than a dangerous Disease: And every
one, how little soever conversant in the
Practice of Physic, thinks himself qualified
to conduct the Patient thro' it with Safety.
If a Person complains of Pain in his
Throat upon swallowing, with the Symptoms
of a Fever, nothing is thought more expedient,
or more frequently order'd, than Bleeding,
Purging, and such Medicines as are
daily observed to remove Inflammations in
general: And in simple Inflammations this
Method is warranted to be just, by Reason
and Experience.
But a Disease hath of late Years appeared
in this City, in many of the neighbouring
Villages, and according to the best Informamation
ivI have been able to procure, in several
other Parts of this Nation; which, tho' it
may be taken for a common Sore Throat, or
a simple Inflammation of the Tonsils, by those
who are unacquainted with it, is of a very
different Nature from the common one, and
requires to be treated in as different a Method:
For it has been found by Experience,
that those Measures, which seldom fail of
answering the Prescriber's Expectation in
this Case, frequently produce the most unhappy
Consequences in the other, and render
a Disease almost certainly fatal, which of
itself is not often so, in this Country.
Some Instances of Mistakes in this respect
have not long since fallen under my Observation;
and there is still a Possibility of the
like happening, as the same Disorder continues
amongst us: It seems therefore necessary,
that some Endeavours should be used
to prevent them; and that such a Description
of the Disease should be made public,
as might enable Practitioners, who have not
seen or known it, to distinguish it from that
to which it bears some Resemblance; together
with an Account of the Method of treating
it, which hath in general been attended
with Success.
There are several of the Faculty, who, I
readily acknowledge, have it more in theirvPower to give the Public Satisfaction on
this Subject, than I have, but their constant
Engagements in the Duties of their Profession,
will probably hinder those who are
most equal to the Task, from executing it so
speedily as public Utility requires: Wherefore,
as some Information relative to it seems
immediately wanted in several Places, the
following, tho' less perfect, will perhaps in
the mean time be neither unacceptable, nor
wholly useless.
If any thing in these Sheets should appear,
to those who may be better acquainted with
the Subject to be inaccurate, or premature;
if some Things of little Weight should seem
too largely insisted on, whilst others of more
Consequence are neglected, this Apology will,
I hope, be admitted; viz. that to have delay'd
the Publication of this Essay, till it
had received those Advantages that further
Observations might have added, would
have frustrated my Design; which was, to
prevent, as much as possible, the Mistakes
that might happen in relation to this Disease,
by speedily communicating the Remarks,
which the Instances I had seen had afforded.
As this Disease appears to be the same
with that which raged in Spain, Italy, and
the neighbouring Countries, somewhat morevithan a Century ago; it may not be improper,
in the first place, to give some Account
of it, from such of the Authors who then
wrote upon it, as have come to my Hands,
previous to a Description of the same
distemper, as it now appears in this
Country.
'Tis said, that a similar, if not the same
Disease hath long been in some of our American
Colonies, and the West-India Islands,
but as I have met with no Accounts of it
from such as were competent Judges, it must
be left to Time, and further Inquiries, to
determine the Truth or Falsity of the Report.
London, Dec. 1. 1748.
OF THE SORE THROAT Attended with ULCERS;
1
As it appeared in Spain, Italy, Sicily, &c.
The Disease which was called by the
SpaniardsGarrotillo[1], by the
Italians, and other Nations, Morbus
strangulatorius, Pestilens Faucium
Affectus, Epidemica Gutturis Lues, and by
divers other Appellations[2], is said to have
appeared first in Spain about the Year 1608,
to have spread from thence to Malta, Sicily,
Otranto, Apulia, Calabria, and the Campagnia,
in the Space of a few Years; and to
have broke out at Naples in 1618, where it
continued upwards of 20 Years ravaging the
different Parts of that Kingdom[3].
2It is not certainly known how much longer
it remained in these Countries, or to what
others it was communicated at that time, its
Declension being as obscure as the Causes it
sprung from. That it wholly disappeared in
these Parts, soon after the Time above-mention'd,
seems probable, from the Silence of
those Physicians, who have published their
Observations made in the Places, which had
so severely felt the Effects of this Distemper.
Several Writers, as Wierus[4], Forrestus[5],
Ramazzini[6], and others, take notice of
epidemic Affections of the Throat, in some
respects resembling the Disease here described;
but a little Attention to the Symptoms of each,
will, I think, discover an essential Difference
between them. The same may be said of the
Sore Throat and Scarlet Fever, which shew'd
itself at Edinburgh in 1733[7].
3Tournefort, in his Voyage to the Levant[8],
seems to have found the Disease we are treating
of in the Islands of the Archipelago; at
least as far as one can judge from the imperfect
Description we have of it. His Account
is as follows.
"When we were in this Island (Milo),
there raged a terrible Distemper, not uncommon
in the Levant: It carries off Children
in twice 24 Hours: It is a Carbuncle
or Plague-Sore in the Bottom of the Throat,
attended with a violent Fever. This Malady,
which may be called the Child's
Plague, is epidemical, tho' it spares adult
People. The best way to check the Progress
of it, is to vomit the Child the Moment
he complains of a sore Throat, or
that he is perceived to grow heavy-headed.
4This Remedy must be repeated, according
as there is Occasion, in order to evacuate
a sort of Aqua fortis, that discharges itself
on the Throat. It is necessary to support
the Circulation of the Juices, and the
Strength of the Patient, with spirituous
Things; such as the Theriaca, Spir. vol.
oleos. aromat. and the like. The Solution
of Liquid Styrax in Brandy is an excellent
Gargarism upon this Occasion. Tho' it is
a Case that requires the greatest Dispatch,
the Levantines are seldom much in Haste
in the Cure of any Disease."
This Account does not disagree in general
with that which has been left us of the Morbus
strangulatorius; only he is singular in affecting
it to arise from a kind of Aqua fortis
discharged upon the Parts: But his favourite
Study had engrossed his Attention, and to this
we must impute both the present Mistake,
and his Want of sufficient Accuracy and Precision,
when he treats upon medical Subjects.
When it first broke out in the Countries
above-mention'd, it soon engaged the Physicians
of those Times, as well to observe its
Nature and Effects, with whatever might
contribute to its Cure, as to vindicate their
respective Systems and Opinions, which some
5of them did with a great deal of Warmth.
Out of such of the Tracts that were then published
as I have had an Opportunity of perusing,
and which indeed are not so many as I
could wish, the following Account has been
collected. I shall here mention the Authors
to whom I am principally indebted for it.
Johannes Andreas Sgambatus, a Physician
of Naples, who published a Treatise upon
this Subject in 1620[9]. He gives us a methodical
and pretty exact History of the Symptoms
of this Disease, and the Method of Cure
both general and topical, together with a
summary View of the Disputes which at that
time were managed with sufficient Heat and
Acrimony in relation to its Name, Cause, and
Nature; about which they were as much divided
as they were about the Method of
Cure; each Party appealing to Hippocrates,
Galen, Avicenna, &c. for the Support of
their Opinions concerning a Disease, which it
is not certain that those whom they appeal to
ever saw.
6Johannes Baptista Cortesius, in his Miscellanea
medica[10] takes notice of this Disease,
and describes its principal Symptoms, in a Letter
to Jo. Anton. Anguilloni, Physician in chief
to the Maltese Gallies. He considers it indeed
as a different Distemper from that which infested
Naples, and other Parts of Italy; tho',
from his own Account of it, there appears
little Reason to question the Identity. He
seems to have been led into this Mistake, by
considering the Disease he treats of as contagious
only in a certain limited Sense, whilst
the Italians declared theirs to be pestilential
and contagious without Restriction. He allows,
that the Breath of a Person affected
might convey the contagious Effluvia to another
near at hand; and gives an Instance of
one who got the Disease, and died of it, by
trying, at his Friend's Request, who then
labour'd under this Disease, if his Breath was
affected[11]: for from this Circumstance they
guessed at the Degree of Danger attending
them.
7In 1636, Ætius Cletus, of Signia in Italy,
published his Treatise De Morbo strangulatorio[12].
He mentions some Facts relating
to it, that had escaped Sgambatus and Cortesius,
which will be taken notice of hereafter.
Marcus Aurelius Severinus, Professor of
Anatomy and Surgery, and Physician to the
Hospital of Incurables at Naples, wrote a
Dissertation upon this Disease, under the Title
of 'Pædanchone Loimodes, seu de pestilente ac
præfocante Pueros Abscessu'; and annexed it
to the second Edition of his Book De recondita
Abscessuum Natura, which was printed
8in 1643[13]. From a Person of his Capacity,
and furnished with the best Opportunities of
seeing the Disease in every Stage and Condition,
we might reasonably expect such
Observations as would enable one to form a
just Idea of this Distemper; but we meet with
very little of this kind in his Performance. He
has indeed mention'd some Circumstances relating
to its History, not taken notice of by the
other Writers I have seen, and his Method of
Cure is different from the rest; but he refers us
to others for an Account of the Symptoms, and
contents himself with reciting and commenting
upon Aretæus's Description of the Ulcera
Syriaca, which he takes for granted to be the
same with the Disease he treats upon; yet
does not put it in our Power to compare
them, by giving a candid Relation of the
Symptoms.
9One might justly expect some curious Observations
upon this Disease, from a Person so
well qualified for it as Thomas Bartholine:
He was in Italy whilst it raged there, and
it might be supposed, would be attentive
to the minutest Circumstance relating to it,
and be inquisitive enough to know what Men
of Character had said upon it. But the Treatise
which he wrote upon this Disease, and
publish'd in 1646[14], contains so little to the
Purpose, that it is difficult to conceive for
what End it was wrote, unless to compliment
his Master Severinus, which he does very liberally.
According to the Accounts which have
been left us by these Authors, it appears, that
the Disease which they describe was most
particularly fatal to Children; tho' Adults, if
they were much conversant about the Sick,
were very often seized with it; yet more of
these recover'd in proportion than of Children;
and it was observed, that more Boys
got well through the Disease than Girls; some
thought, that such of this Sex as had black
Eyes suffer'd more from it than others.
10As it was sometimes observ'd to carry off
whole Families together, and to spread to
those Places first, where the Communication
with the Country affected by it was most frequent;
and also that Children sent away in
order to avoid it, escaped whilst they remained
there, but had it on their Return, if the Disease
was not extinguished; it was almost universally
allow'd to be contagious[15].
Those who were Seized with it, first complained
of a Pain in the Throat, with a Stiffness
of the Neck, an Uneasiness upon Motion,
and a Difficulty in Swallowing their usual
Nourishment. On Inspection, the Uvula,
the Tonsils, Pharynx, and the whole Fauces,
appeared of a remarkably florid red Colour,
like that attending an Erysipelas: This Colour
was not uniformly intense, but Some Parts
Seemed to be of a deeper Dye than others.
The Parts above-mention'd were swell'd more
or less, tho' seldom so much as to affect Respiration,
as in a common Angina; but the Sick
could not Swallow without Pain. An acute
Fever came on at the same time, which in
Some was accompanied with small Pimples
and Eruptions like Flea-bites. Several had
Vomitings, according to an Observation of
Severinus[16].
On the same Day, or the Day following,
such Parts of the Fauces as at first seem'd to
be of a deeper Colour than the rest, turn'd
white; this did not proceed from any Crust or
Matter superinduced upon the Parts, but from
a gangrenous Colliquation, the Substance itself
being mortified.
11The Voice was hoarse and obscure; not as
in a common Cold, but as it is in those People
who have venereal Ulcers in the Throat:
So that, from this Circumstance alone, some
were able to guess at the Disease.
The Neck and Throat soon after began to
swell externally; the Tumour was of a soft
œdematous kind, and increased in Magnitude
as the Disease advanced. All the Symptoms
were commonly aggravated during the Night.
If the Patients had any Interval of Quiet, it
was commonly in the Day-time[17]. About
the fourth Day this Tumour was generally
grown very large, and the white Places in the
Fauces began to turn black; the Breath grew
extremely offensive; Respiration, hitherto
not much affected, now became difficult, and
the Patient expired in a very short time.
12Tho' this was the common Progress of the
Disease, where it terminated unhappily, yet it
often varied from this Type, and was attended
with very different Symptoms. Some had a
Difficulty of breathing almost from the first;
some had a violent Cough; some were comatous;
others had a Delirium; some died in a
lethargic Stupor; others bled to Death at the
Nose; whilst others again had none of these
Symptoms, but were carried off suddenly by
an instantaneous Suffocation. The Oesophagus
in some was sphacelated to the Stomach; the
Aspera Arteria, in others, to the Lungs: As
these could only breathe in an erect Position;
so those could swallow nothing when the
Parts were so affected. The Nostrils discharged
a fetid pituitous Ichor, sometimes
mixed with Blood; and sometimes Blood
alone, without Mixture. This bleeding at the
Nose seem'd at first, in one Case, to give
Relief; but the Patient soon after died[18].
These were the Symptoms in general, and
they judged of the Event by the Mildness of
their Progress, or the contrary: Tho' it was
agreed, that nothing could be more fallacious
than this Disease; and that the most Experienced
were often deceived in their Prognostic.
13If the Redness above described, which appeared
at the first being seized, was succeeded
by an Ulceration, without any of that Whiteness
(which for the future I shall call Sloughs),
if the Swelling about the Neck and Throat
was not large, if the Patient discharged by
the Mouth considerable Quantities of thin pituitous
Matter, if the Breath was not fetid,
and the Patient had no Disgust to his Food, if
the Eyes retain'd their proper Lustre, all was
judged to be secure.
On the other hand, if this Lustre was in
any degree faded[19], if the external œdematous
Tumour was very large, if the Breath
stunk, if the Fauces were livid or black, with
a Coma, or Delirium, if with these the Patient
had an Aversion to his Nourishment,
and his Breathing became difficult or laborious,
the Danger was judged to be extreme.
14It was not observed that the Disease had
any stated Crisis; or that the Signs of Recovery,
or Death, appeared on any certain Day.
Some died on the first, others on the second,
third, and on every Day, to the seventh.
Those who survived the fourteenth, were
thought to be out of Danger, at least from the
Disease itself[20]; tho' some dropp'd off unexpectedly,
after a much longer Reprieve[21].
The Consequences of this Disease were often
felt a long time after it had ceased: An
excessive Languor and Weakness continued
for many Months; and the Voice or Deglutition
was frequently affected, so as to be perceivable
in some almost a Year after[22].
It was however observed, that notwithstanding
the Disease most frequently was accompanied
with Symptoms of pestilential Malignity,
yet it sometimes appeared with a
much more favourable Aspect; its Progress
not being so quick, nor its Symptoms so violent
and dangerous, as hath here been described
to be the Case in general[23]. At its
first breaking out in any Place it was commonly
the most severe; it then spared no Age or
Sex, but swept off Adults together with Infants:
By degrees it became less violent, and
at length either wholly disappeared, or was
of so little Consequence as to be disregarded.
15We are directed, by most of the Authors
I have seen, to begin the Cure of this Distemper
with Evacuations; the chief whereof
are Bleeding and Purging; tho' which of the
two ought to precede was not a little disputed.
Purging was in general preferr'd;
and they commonly made use of Manna, Rhubarb,
Senna, and Agaric, for this Purpose.
Cortesius directs six Ounces of Manna to be
given to Adults in a Decoction of Tamarinds.
Bleeding, tho' commonly directed at the first,
hath been used more sparingly in this, than
most other acute Cases[24]. Severinus, who
was by no means a timid Operator, directs
from four to eight Ounces to be taken away;
which, considering the common Practice in
those Countries, is a very small Quantity[25],
But it may not be improper here to give
a short Sketch of this Author's Practice,
as he differs in several Respects from most
others.
16He orders an antimonial Vomit to be given
at the first Attack, and a cooling gently astringent
Gargle to be used Night and Day.
He then directs a Clyster, takes away some
Blood from the Jugular, and gives from xv
to xxi Grains of Bezoar Mineral twice a Day;
or oftener, as Occasion requires, with thin
diluting Liquors, in order to raise and promote
a moderate Sweat. He gives five or six
Grains of the same Medicine to Children at the
Breast, and commends it highly. He scarifies
the discolour'd Parts in the Fauces, in order to
let out the corrosive Virus; a Practice, which,
though it was countenanced by some of the
Spaniards, was disliked and condemned by the
most eminent Italians. He, as well as Zacutus
Lusitanus[26], used the Arsenicum album
in Gargles in very small Quantities, but with
how much Advantage to the Patient is nowhere
so fully proved, as to induce one to
follow their Example.
17Cupping, with Scarification, was universally
approved, and commonly practised.
Leeches were also applied, by way of Revulsion,
to different Parts.
Considerable Benefit was expected from
Ligatures made on the Extremities, and from
chafing the Limbs with the Hand or a Cloth;
also from Cupping without Scarification; apprehending
that a Revulsion from the Parts
affected was by this means procured; and that
some Portion of the morbific Matter, was
carried off by the Pores of the Skin.
18Some of the Spanish Physicians recommended
Vesicatories of Cantharides to be
laid on each Side the Neck: The Italians
seem not to have been fond of them; and
urge it as a Reason against their Use, that
the Progress of the Disease was too quick
to be relieved by any Discharge they could
make.
The internal Medicines they used were
such as they deemed Alexipharmics. Armenian
Bole, Bezoar both animal and mineral,
Pearls, and, according to the Philosophy of
those Times, the precious Stones. The Theriaca
was excepted against for Children, as
Galen had condemned its Use in such young
Subjects. But after they had lessened, as they
thought, the Plethora by Bleeding, and the
Cacochemy, as they stiled it, by a Cathartic;
as they found, from Experience, that no Concoction
of Humours was to be waited for in
this Case[27], without laying much Stress upon
Internals, they seem chiefly to have applied
themselves to Topics; considering the Disease
as local, and a peculiar morbid Affection of
the Fauces.
19In this Part of their Directions they have
been more particular; and some of them, in
order to point out their Applications with
more Propriety, have divided the Course of
this Disease into four different Periods[28].
The first is the State of Inflammation. In
this Repellents were thought necessary; such
as Vinegar in Barley-water, Syrup of Roses,
Mulberries, and Purslain.
The second, is that wherein the white
Sloughs begin to appear, which is a Step towards
a gangrenous Colliquation. In this
State they order'd mild Abstergents, of which
Honey of Roses was esteemed the chief.
In the third, the Fauces begin to look
black, and a real Mortification is come on,
sometimes penetrating to a considerable Depth,
with great Putrefaction. Here the mild Abstergents
were deem'd ineffectual, and Caustics
were recommended; such as Alum with Honey,
Alum-Water, Oil of Sulphur, and Oil of
Vitriol. These were used both to check the Putrefaction,
and to destroy the mortified Flesh.
20Sometimes the Oil of Vitriol was dextrously
applied to the Part affected by an arm'd Probe;
but it was oftener mix'd with Syrup of Roses,
and in Children pour'd into the Mouth. Bole
dissolv'd in Treacle-Water, and the Juice of
Wood-Sorrel, was used by some for the like
Purposes.
In the fourth Stage the Putrefaction is supposed
to be extinguished, the mortified Parts
cast off, and an Ulcer only remains. In this
Case, the Fume of white Amber thrown on
live Coals, and received into the Mouth, as a
Suffitus, was advised; also the Vinum Myrrhites,
a Decoction of Guaiacum, Roses, Balaustines,
Pomegranate-Peels by way of Gargle;
Medicines that were supposed to dry with
some Degree of Astringency.
Such was the general Appearance of this
Disease at its first being taken notice of in
Europe; and such, as far as I can collect,
the Methods that were pursued in treating it,
by the most eminent Practitioners at that
time.
The Disease which is described in the following
Pages, seems to be the same with this
Angina maligna, or strangulatory Affection
of the Fauces, and seems only to differ from
21it in Degree; in which, as it is much more
favourable and mild with us in general, than
it was with them, we have greatly the Advantage.
OF THE SORE THROAT Attended with ULCERS; — FOOTNOTES:
22
As it hath appeared in This City,
and Parts adjacent.
About twelve Years ago, two Children,
in a Family of Distinction, and some
others in the same Part of the Town, being
carried off suddenly, and their principal Complaints
having been of a Soreness in their
Throats, it occasion'd a Suspicion, that the
Morbus strangulatorius was broke out amongst
us: But as very few Cases occurred after these,
or pass'd unobserv'd, the Disease and the
Remembrance of it seemed to vanish together.
It began however to shew itself again about
4 or 5 Years ago, but not very frequently: And
tho' some of the Faculty met with it now-and-then,
it remained unknown to Practitioners in
general, till within these two or three Years:
Since which Time its Appearance has been
23more frequent, both in Town, and the Villages
adjacent.
In the Winter of 1746, so many Children
died, and so suddenly, at Bromley near Bow in
Middlesex, of a Disease that seem'd to yield to
no Remedies or Applications, that the Inhabitants
began to be alarmed with Apprehensions
that the Plague was broke out amongst them;
some losing all, and others the greater Part of
their Children, after a few Days Indisposition.
Some others of the neighbouring Places
were affected at the same time, tho' in a
less Degree, with the same Disease; which,
from all the Accounts I have met with, from
those who attended the Sick, was the Disease
here treated of.——It still continues in this
City, and sometimes shews itself in the
Villages about it, though at present with
so mild an Aspect, as seldom to prove fatal;
unless the Subject is very unfavourable, or the
Disease hath been neglected, or improperly
treated at the Beginning; which Circumstances,
tho' of Moment in all Cases, yet are
very much so in this, as a wrong Step at
the first, may put it out of the Power of Art
to afford Relief.
It is observed here, as well as in those
Countries where the Angina maligna was
first taken notice of, that Children and young
24People are more exposed to it than Adults:
A greater Number of Girls have it than Boys;
more Women than Men; and the infirm of
either Sex suffer more from it than the healthy
and vigorous.
If it breaks out in a Family, all the Children
are commonly affected with it, if the
healthy are not kept apart from the sick;
and such Adults as are frequently with them,
and receive their Breath near at hand, often
undergo the same Disease.
It generally comes on with a Chilness or
Shivering like that of an Ague-Fit: This is
soon follow'd by great Heat; and these interchangeably
succeed each other during some
Hours, till at length the Heat becomes constant
and intense. The Patient complains at the same
time of an acute Pain in the Head, of Heat
and Soreness in the Throat, commonly of great
Sickness, with Vomiting, Purging, or both.
The Face soon after looks red and swell'd, the
Eyes inflam'd and watry; with Restlessness,
Anxiety, and Faintness.
This Disease frequently seizes the Patient
in the fore Part of the Day: As Night approaches,
the Heat and Restlesness increase,
till towards Morning; when after a short
disturbed Slumber (the only Repose they often
25have during several Nights), a Sweat
breaks out; which mitigates the Heat and
Restlessnes, and gives the Disease sometimes
the Appearance of an Intermittent.
If the Mouth and Throat be examin'd
soon after the first Attack, the Uvula and
Tonsils appear swell'd; and these Parts, together
with the Velum Pendulum Palati, the
Cheeks on each Side near the Entrance into
the Fauces, and as much of them and the
Pharynx behind as can be seen, appear of a
florid red Colour. This Colour is commonly
most observable on the posterior Edge
of the Palate, in the Angles above the Tonsils,
and upon the Tonsils themselves. Instead of
this Redness, a broad Spot or Patch of an
irregular Figure, and of a pale white Colour, is
sometimes to be seen, surrounded with a florid
Red; which Whiteness commonly appears like
that of the Gums immediately after having
been pressed with the Finger, or as if Matter
ready to be discharged was contained underneath.
Generally on the second Day of the Disease,
the Face, Neck, Breast, and Hands to the Fingers
Ends, are become of a deep erysipelatous
Colour, with a sensible Tumefaction; the
Fingers are frequently tinged in so remarkable
26a manner, that, from seeing them only, It
has not been difficult to guess at the Disease.
A great Number of small Pimples, of a
Colour distinguishably more intense than that
which surrounds them, appear on the Arms,
and other Parts. They are larger, and more
prominent in those Subjects, and in those Parts
of the same Subject, where the Redness is
least intense; which is generally on the Arms,
the Breast, and lower Extremities.
As the Skin acquires this Colour, the Sickness
commonly goes off, the Vomiting and
Purging cease of themselves, and rarely continue
after the first Day.
The Appearance in the Fauces continues to
be the same; except that the white Places
become of a more opake White; and it is
now discoverable, that what at first might
have been taken for the superficial Covering
of a suppurated Tumor, is really a Slough, concealing
an Ulcer of the same Dimensions.
All the Parts of the Fauces above-mention'd
are liable to these Ulcerations; but
they generally are first discernible in the Angles
above the Tonsils, or on the Tonsils
themselves; though they are often to be
seen in the Arch form'd by the Uvula,
27and one of the Tonsils; also on the Pharynx
behind, on the Inside of the Cheeks, and
the Bale of the Tongue, which they cover in
the manner of a thick Fur. Instead of these
Sloughs, where the Disorder is mild, a superficial
Ulcer of an irregular Figure appears in
one or more of these Parts, scarce to be distinguish'd
from the sound, but by the Inequality
of Surface they occasion.
Towards Night, the Heat and Restlessness
increase, and a Delirium frequently comes
on. This Symptom, which appears in some
even on the first Night, seems to differ considerably
from the like Affection in other Diseases.
They commonly answer the Questions
put to them properly, but with an unusual
Quickness; they talk to themselves incoherently
when left alone, and frequently betray
the first Tendency to this Disorder, by
affecting too great a Composure: This for the
most part happens to those who sleep but little;
for some are comatous and stupid, and
take little notice of any thing that passes.
In this manner they continue during two,
three, or more Days; they commonly grow
hot and restless towards Evening: which
Symptoms increase as Night comes on; a
Sweat more or less profuse breaks out towards
Morning; and from this time they are easier
28during some Hours; a Faintness only continuing,
of which they frequently complain more
than of the rest of their Sufferings.
The Disease seems to have no stated Period
which can properly be called its Ἀκμὴ or
Height. Some grow easier from the first Day
of the Attack; but, in general, the Symptoms
of Recovery appear on the third, fourth, or
fifth Day, and proceed in the following
manner:
First, the Redness of the Skin disappears;
the Heat grows less; the Pulse, which was hitherto
very quick, becomes slower; the external
Swellings of the Neck subside; the
Sloughs in the Fauces cast off; the Ulcerations
fill up; the Patient sleeps without Confusion,
is composed when awake, and his Appetite
begins to return towards more solid
Nourishment, than has hitherto been allow'd
him.
The parotid Glands on each Side, and the
Parts about them, are commonly swell'd, and
painful to the Touch; and if the Disease is
violent, the Neck and Throat are surrounded
with a large œdematous Tumor; which, by
straitening the Fauces, increases the Danger.
The Pulse, during the whole Course of this
Disease, is generally very quick; frequently
29120 Strokes or more in a Minute: In some
it is hard and small; in others soft and full;
but without that Strength and Firmness which
usually accompany equal Quickness and Heat
in genuine inflammatory Disorders.
If a Vein is open'd soon after the Distemper
is come on, the Blood generally appears
of a fresh florid Red; the Crassamentum is
rather of a lax gelatinous Texture, than
dense or compact; the Serum yellow, and
in a large Proportion.
The Urine is at first crude, and of a pale
Whey-Colour: As the Disease advances, it
turns yellower, as if Bile was diluted in it
and soon after the Patient shews any Marks
of Recovery, it commonly grows turbid, and
deposits a farinaceous Sediment.
They seldom have any Stools, if the Symptoms
are favourable, from the Time when
the Purging, which generally attends the Accession,
ceases. This Discharge is frequently
bilious, and without any Pain: Tho' these
Circumstances differ in different Habits.
They complain less of Thirst in this than in
other acute Diseases. The Tongue is generally
moist, and not often furr'd: In some nevertheless
it is cover'd with a thick white Coat or Fur,
30and those who are so affected, often complain
of Soreness about the Root of the
Tongue.
The Uvula and Tonsils, tho' they are sometimes
so much swell'd, as to leave but a very
narrow Entrance into the Gullet, and this Entrance
frequently surrounded with Ulcers or
Sloughs; yet the Patients often swallow with
much less Difficulty and Pain than might be
expected under such Circumstances.
They frequently complain, soon after they
are taken ill, of an offensive putrid Smell, affecting
their Throats and Nostrils, which oft
occasions Sickness before any Ulcerations appear.
In those who have this Disease in a
severe manner, the Inside of the Nostrils, as
high up as can be seen, frequently appears of
a deep red, or almost livid Colour: After a
Day or two, a thin corrosive Sanies, or with
it a white putrid Matter of a thicker Consistence,
flows from them, which is so acrid,
as to excoriate the Part it lies upon any considerable
time. This is most observable in
Children, or in young and very tender Subjects,
whose Lips likewise are frequently
of the Colour above-mention'd, and cover'd
on the Inside with Vesicles containing a thin
31Ichor, which excoriates the Angles of their
Mouths, and the Cheeks where it touches
them.
It is probable, that Part of the same acrid
Matter passes with the Nourishment into
the Stomach; especially in Children; and
it is perhaps owing to this Cause in part,
that they suffer much more from this Distemper
than Adults; this corrosive Fluid
without Doubt producing the same Effects
on the Stomach and Bowels, as it does
when applied to the much less sensible Skin
of the Face; i. e. it excoriates the Parts it
touches; which in fact seems to be the
Case: For, if they get over the Disease, a
Purging sometimes succeeds it, attended with
the Symptoms of Ulcerations in the Bowels,
and after enduring great Pain and Misery,
perhaps some Weeks, they at length die
emaciated: And I have been inform'd, that
some Children have had the Parts about the
Anus also excoriated; the Sanies retaining
its Virulency thro' the whole Tract of the
Intestines.
The Sick sometimes bleed at the Nose towards
the Beginning of the Disease; and the
Menses very often appear in those of the Female
Sex, who are of Age to have them, soon
after they are seized, notwithstanding the regular
32Period is at a considerable Distance: If
they are taken ill about the usual Season, the
Discharge is commonly large and expensive.
Some young Persons, who never had the least
Appearance of them, have had this Evacuation
during their Illness.
In strong and full Habits, these Evacuations
are seldom attended with much Benefit,
or manifest ill Effects, unless they are very
copious; for in this Case they occasion great
Faintness, and an Increase of the other Symptoms,
in proportion to the Excess. In tender
weak Subjects, they are often prejudicial.
It has happen'd in this Disease, that Hæmorrhages
from the Nose and Mouth have
suddenly carried off the Patient. I have
heard of the like Accident from Bleeding at
the Ear: But these fatal Discharges most commonly
happen after the Patient has been ill
several Days; and it seems more probable,
that they proceed from the Separation of
some Slough from the Branch of an Artery,
rather than from a Fulness of the Vessels, or
an Effort of Nature to relieve herself by a
salutary Crisis.
Bleeding in this Disease has in general been
observed to be prejudicial: Some indeed admit
of it without any sensible Inconvenience;
33but a Repetition of it, even where the Disease
is mild and favourable, seldom fails to
aggravate the Symptoms; and in some Cases it
appears to have occasion'd very dangerous Consequences.
The Heat, Restlessness, and Delirium,
which this Evacuation commonly prevents
or mitigates in other Cases, in this are
increased by it; nor does the Swelling of the
Tonsils, Fauces, &c. seem to receive the least
Benefit from it: On the contrary, tho' the
Fullness of these Parts decreases, yet the
Sloughs thicken, the external Tumor grows
large, and the Spitting commonly diminishes.
Nor has Purging been observed to be more
beneficial: Gentle Cathartics have brought on
very dangerous Symptoms. Upon procuring
a few Stools with Manna, the Redness of the
Skin has disappeared, and the Flux to the
Throat has been surprisingly increased: If it
happens that the Discharge by Stool continues,
the Swelling of the Neck commonly
grows larger, the Fauces become flaccid, dry,
and livid; and the Patient in a few Hours after
this expires: So that Purgatives seem to have
no better Effects in diminishing the Tumor,
and abating the supposed Inflammation, than
Bleeding.
Nitrous cooling Medicines frequently produce
the like Effects; they increase that Faintness
which accompanies this Disease, and
34either dispose the Patient to copious sinking
Sweats, or to Stools.
Upon the whole, it appears, that all Evacuations
which tend to lessen the natural Strength
of the Constitution, are in this Disease injurious;
and that those Persons in common are in the
greatest Danger, if attacked with it, who
have been previously indisposed or have had
their Strength impair'd by Grief, or any other
Accident. Of which it may not perhaps be
improper to relate an Instance or two in this
Place, as it will also tend to explain the usual
Progress of the Symptoms in the worst Cases
we meet with.
A young Gentlewoman about 26 Years of
Age, of a pale lax Habit, but of an active chearful
Disposition, had enjoy'd a pretty good Share
of Health in common, till a Year or two before
her last Illness; about that time she unhappily
made use of some external and empirical
Application to remove a Redness attended
with Pimples, which now-and-then
broke out in her Face. She was soon relieved
from this Complaint by the Medicine she used;
but was quickly after seized with Sickness,
Vomiting, Loss of Appetite, and either obstinate
Costiveness, or a troublesome Diarrhœa;
the Menses were pale, and in small Quantities,
and her Health in general greatly impaired.
35She had scarce recover'd from this weak
State, when the Loss of a near Relation
brought her almost into the same Circumstances;
from which she was slowly recruiting,
when she married. Her Sickness, Vomiting,
and Loss of Appetite, soon return'd; which
she conceal'd as much as possible.
Under these Disadvantages, she was seized
with this Distemper, a Day or two after she
had visited an Acquaintance labouring under
the same Disorder: It came on with a Coldness
and Trembling like that of an Ague-Fit,
great Faintness, and an acute Pain in her Head,
with a Vomiting more violent than she was
usually affected with, and a Purging. Towards
Evening she grew very hot and restless,
complained of a Soreness in her Throat, and
the Discharges abated. Her Face, Neck, and
Hands were intensely red; she frequently
sigh'd, and from her Aspect and Gestures there
was Reason to suspect a Delirium approaching.
She slept little that Night; and next Morning
her Pulse, which before was very quick and
small, seemed to be somewhat more full, but not
sensibly slower; and she complained of Faintness
and Anxiety. The Parts about the Fauces
were much relax'd, and very red, in
some Places almost livid, with a kind of glossy
Dryness upon them. She continued in this
36Manner without any remarkable Increase of
Symptoms till Night, when the Looseness return'd,
and in a very short time exhausted
her Strength to a great Degree: The Redness
upon the Skin disappeared, the Extremities
grew cold, her Eyes became dim, her
Pulse scarce perceptible, she breath'd with
Difficulty, and expired in the Morning, on
the third Day of the Disease.
Another young Woman, who frequently
visited, and sometimes assisted a Relation,
who had this Disease, was attack'd with
it in the usual manner. She was about 17,
of a pale and somewhat bloated lax Habit,
naturally inactive, averse to Exercise, and was
thought to have indulged some painful Solicitude,
to the Prejudice of her Health, and
making way for an obstinate Chlorosis.
Under these Circumstances she was seized
with the usual Complaints, but in a violent
manner. The Purging continued till the Day
following; when it yielded for the present to
Opiates, but constantly return'd when their
Effects were over. The other Symptoms,
such as Heat, Restlessness, Anxiety, and
Faintness, increased with the Purging; the
Pulse was small, quick, and hard; a Difficulty
of breathing came on, the small Remains
of Lustre in the Eye perish'd, and
37she died early on the fourth Day of the Distemper.
No Marks of any Sloughs in the Throat appeared
in either of these Cases; but the Redness
became daily more intense, and approached
nearer to Lividness, whilst the Fauces could
be inspected; which, from the great Difficulty
they had in breathing, was impracticable
several Hours before the Patients expired.
Warm aromatic Cordials, and anodyne Astringents,
were administred assiduously, with
suitable Nourishment, and Vesicatories applied
successively to the Neck on each Side, the
Shoulders and Arms, but without Effect.
If the Purging therefore continues long
after the first Exacerbation of the Disease, it
may be look'd upon as a dangerous Symptom;
for though it be sometimes restrain'd for the
present by Opiates or Astringents, yet it commonly
returns with more Vehemence, when
their Efficacy ceases, and in a short time exhausts
the small Degree of Strength remaining.
In this Case they generally spit very little;
the Fauces appear dry, glossy, and livid;
the external Tumor grows large; they void
their Excrements without perceiving it, and
fall into profuse Sweats; Respiration becomes
difficult and laborious; the extreme
38Parts grow cold, and Death in a few Hours
closes the Scene; and in no Disease that I
have seen is the Eye so early deprived of
its Lustre as in this; for it is sometimes
opake and glassy several Hours before Death;
and, as Ætius Cletus hath observed, is a fatal
Presage of its Approach.
A copious Flux of pituitous Matter to the
Glands, and other Parts about the Fauces,
seem'd to be the Cause of sudden Death, in a
Girl about 12 Years old. She was seized in
the common Way, with Shivering, Headach,
Sickness, Vomiting, and Purging. The
Discharges abated in a few Hours, and were
succeeded by great Heat, Redness of the Skin,
and a sore Throat; the Uvula, Tonsils, and,
contiguous Parts were red, and so swell'd
in eight or ten Hours, as to touch each
other, and seem d to close the Entrance into
the Pharynx. She breath'd without much
Difficulty, swallow'd with less Pain than
could be imagin'd, and spit up large Quantities
of Phlegm. About six in the Evening
she was seized with a Difficulty of breathing,
as if strangled: Those about her rais'd her up,
thinking she was in a Fit; she recover'd herself
a little, but expired upon being again laid
down in Bed; in somewhat less than 24 Hours
from the first Attack. A large Quantity of viscid
Phlegm, with which, after she was dead, her
39Mouth appear to be fill'd, together with the tumefied
Uvula, Tonsils, and Velum Palati,
had perhaps jointly closed the Rima Glottidis,
and put a Stop to Respiration.
By a Fall in her Infancy she was reduced to
the Necessity of using Crutches. She was
big-bon'd, had a good Appetite, and for want
of that Exercise, which Persons at her Age
commonly enjoy, seem'd to be plethoric.
These Circumstances perhaps might contribute
to this speedy and unhappy Event.
Accidents of the like kind seem not to
have been uncommon while this Disease continued
in Italy, according to a Remark of
Cortesius[29].
40From the preceding Account of the Sore
Throat attended with Ulcers, it will, I believe,
appear, that this Disease is widely different
from a common Sore Throat, or simple Inflammation
of any of the Parts about the
Fauces; both as to the Subject commonly
affected by it, the Manner of its Attack,
the Progress of the Symptoms, and its
Conclusion: For the sore Throat with Ulcers
generally attacks Children; and of these Girls
more frequently than Boys, as hath been observ'd:
If Adults are seized with it, they are
commonly such as have been very much conversant
with the Sick, or else are weak and
infirm: And it seems to affect those Adults
in the severest manner, who have been previously
indisposed, or whose Strength has been
reduced by unseasonable or immoderate Evacuations.
On the contrary, the common Angina, or
an Inflammation of the Tonsils, most frequently
attacks the healthy, the vigorous, and
robust; the weak, the delicate, and infirm,
are less exposed to it, at least suffer less from
it, than the former.
As both Diseases are attended with a Fever,
and as most Fevers come on with Shivering
or Chilness, this Symptom may at least
appear equivocal: But if Sickness, or Vomiting,
or Purging, or an acute Head-ach, towards
the back Parts or Top especially, or
if all these, come on in the Space of a very
few Hours, which they generally do, where
the Disease is vehement, it may justly be
esteem'd of the malignant or putrefactive
kind: But if an erysipelatous Redness discovers
itself in the Fauces, or if any Ulcerations
41or white Sloughs appear in them, the Disease
is evident.
In some Cases, the Symptoms have been
so obscure, that it was difficult to determine
to which Class they properly belonged: But in
these Circumstances the Disorder was so favourable,
that, supposing it not to be of the
ulcerated kind, no other Inconvenience seemed
likely to ensue from treating it as such, than
a Suppuration; which is often an Event rather
to be chosen than avoided.
The Redness of the Skin in the Face,
Neck, Breast, and Hands, is another obvious
and distinguishing Characteristic, which in
Children and young People especially, seldom
fails to accompany this Disorder.
In the common sore Throat, a local Inflammation
is the Disease: All the Symptoms
are derived from this Source: An acute
throbbing Pain, greatly increased upon swallowing
even Liquids, is the principal Grievance.
In the other, the whole Habit suffers,
as if by a Stimulus of a peculiar Nature
and although the Throat is always more
or less affected, yet it is sometimes the least
Part of the Patient's Complaint; and Instances
have occurr'd to me of considerable Sloughs
42being formed, before any Soreness or Pain in
the Fauces hath been mention'd.
Again, this Disease is accompanied with
a greater Tendency to a Delirium, than either
a common Angina, or almost any other Disease
we are acquainted with. To have this
Symptom appear in the Disease we are
treating of on the first Night, is not uncommon;
and on the second, frequent. A
Girl about eight Years of Age, whom I
attended, was scarce known to be indisposed,
till she alarmed the Family, by appearing
to be light-headed. She had made no
Complaint of her Throat, nor was this Part
thought to be affected, till, upon Examination,
I found it so; being led to suspect it
by the Colour of her Hands, and the Delirium.
She got well through the Disease,
tho' its Progress, at first, appear'd to be very
swift.
A common Sore Throat, if the Patient recovers,
either goes off by Resolution, or suppurates,
or becomes hard and scirrhous.
In that attended with Ulcers, none of these
Circumstances happen; for it terminates in a
superficial Ulceration of some of the Parts about
the Fauces, with little Appearance of any
Sloughs, if the Disease is very mild; and with
43large and deep ones, of a white, cineritious, livid,
or black Colour, if it is more violent.
It will not perhaps be difficult, from this
comparative View of the Disease, to distinguish
it from a common Sore Throat, or an
inflammatory Affection of those Parts: But
there is another no less certain Criterion,
tho' too often a fatal one, which is, the constant
Increase of Symptoms upon Bleeding,
Purging, and the liberal Use of cooling antiphlogistic
Medicines; an Instance whereof I
think evidently appeared in the following Case.
A Youth of about 14 Years old, of a brisk
lively Disposition, who had enjoyed a good
Share of Health, saving that, for a few Years
past, a cutaneous Disease, akin to a Leprosy,
had sometimes appeared on his Head
and Arms, was seized one Morning with a
general Uneasiness, and a Disposition to vomit;
he was put to Bed, and a severe Shivering
ensued; his Sickness increased, he
vomited up every thing, had several purging
Stools that Day, and complained much of
his Head, with some Soreness in his Throat.
He was order'd to be blooded, and had an
Emetic given him: This operated but little;
he grew hot and restless, a deep Redness
spread itself over his Face, Hands, and Arms,
with a plentiful Eruption of small Pimples,
44which induced those about him to apprehend
it was a Scarlet Fever.
The next Day, which was the second of the
Disease, his Throat continuing sore, and the
feverish Symptoms increasing, a Purge of
Manna was given him, which operated gently;
and at Night his Head and Throat being more
uneasy, his Heat still continuing, with a Tendency
to Delirium; a Blister was applied.
On the third, the Symptoms not abating, he
lost about ten Ounces of Blood. He had taken
a cooling nitrous Powder every four Hours;
this was now changed for one more cordial.
At Night he grew delirious, his Fever increased,
and he had some loose Stools, which
were rather encouraged than restrain'd, as it
was hoped they might relieve him. Blisters
were applied to his Head and Arms.
On the fourth in the Morning I was sent
for: I found him delirious, with convulsive
Twitchings; his Hands in constant Motion,
gathering the Bed-cloaths; his Pulse quick
and weak; his Tongue parched. With some
Difficulty I looked into the Fauces; they
seemed to be pale in some Places, intensely
red or livid in others, with a glossy Brightness:
His Excrements came away involuntarily;
his Eyes were languid, and somewhat
45opake; he breath'd with Difficulty, and
died in a few Hours after.
In some of the first Cases I met with,
the Quickness of the Pulse, the Degree of
Heat, the apparent inflammatory Redness of
the Eyes and Face, and Pain in the Head,
some times urged me to order Bleeding, especially
if there were any Marks of a Plethora;
but in these Cases it did not appear to have
any advantageous Effects: So that, notwithstanding
the Urgency of the Symptoms above-mention'd,
it seems proper in general to omit
this Evacuation.
Cupping with Scarification has been applied
to the Shoulders and Back of the Head, in
order to remove an acute Pain of this Part,
which is often complain'd of, but, as far as I
have been able to observe, without much Benefit.
It is necessary that the Patient should keep
in Bed as much as may be, tho' the Disease
should seem to be slight: It has happen'd, for
want of Care in this Respect, that a Purging
has come on, the Redness of the Skin disappeared,
and a Disorder, which with Confinement
alone would probably have gone off in
twice 24 Hours, has been render'd tedious
and difficult.
46If we are called in at the first, while the
Sickness or Vomiting continues, it will be of
Use to promote this Discharge, by giving an
Infusion of Green Tea, Chamomile-Flowers,
Carduus, or a few Grains of Ipecacuanha. In
some Instances, where the Attack has been
severe, and this Method practised, the Disorder
has gone off with more Ease than
was at first apprehended.
If these Symptoms don't abate with the
Operation of the Emetic, small Draughts
of Mint-Tea, with a sixth Part of red
Port added to it, may be given frequently;
together with some grateful and warm aromatic,
cordial Medicine, every four or six
Hours. The Pulvis Contrayervæ simp.—comp.
Confect. cardiac.—Raleigh. Spec.
arom. Vinum croceum; Aq. Menth. spirit.
Aq. Alex. spirit. cum Aceto; with others of
the like Nature, may be used for this Purpose.
In this Disease it is at all times necessary
to attend very carefully to the Diarrhœa. For
the most part it ceases with the Vomiting, in less
than twelve Hours from the first Attack: If it
continues longer than this Period, it is necessary
to check it, otherwise it occasions great Faintness,
47sinks the Strength, and in the End produces
very dangerous Consequences. The
aromatic Cordials above-mention'd, if they
are given plentifully, commonly take off
this Symptom, as well as the Vomiting; but
if they prove ineffectual, Recourse must be
had to Astringents and Anodynes, in proportion
to the Exigence of the Case; such as
the Confectio Fracastorii, or Elect. e Scordio
cum Opio, dissolved in small Cinnamon-water,
and given post singulas sedes.
It is common for the Redness, so often
mention'd, to appear upon the Skin, as these
Discharges abate: It has happen'd that this
Colour has gone off sometimes, and the Patient
has been brought into imminent Danger, upon
giving a mild Cathartic: Which Circumstances,
as they point out a close Connexion between
them, indicate the Use of a warm Regimen,
notwithstanding the Heat and other Symptoms
might seem to forbid it.
A Girl about 9 Years old, of a slender
Make, but healthy and active, was seized
with this Disorder. The Sickness and Vomiting
went off, and the Redness of the Skin
appeared soon after: The Apothecary who attended
her, judging it an inflammatory Case,
as she complained of her Throat, bled her,
gave her a cooling Purge the next Day,
48and afterwards some nitrous Draughts. A
plentiful Efflorescence which cover'd the Face,
Neck, and Arms, suddenly disappeared; a
Diarrhœa came on, she grew restless, faint,
and insensible. In this Condition I first saw
her on the third Day of the Disease; she frequently
sigh'd, her Pulse was quick, small and
hard, without any remarkable Colour upon
her Skin; and the Swelling on each Side the
Neck large: It was not possible to examine
the Fauces, as she lay in a comatous helpless
Condition, her Stools and Urine coming
away insensibly. A warm cordial Mixture
was frequently given her, upon which the
Diarrhœa soon abated; and the next Day the
Efflorescence again appeared upon her Face
and Arms. From this time she continued to
recover, tho' slowly, and was for some time
attended with a Cough and hectic Heats.
Another Symptom which requires our
Attention in the Cure of this Disease, is an
excessive Faintness: Of this they generally
complain soon after they are taken ill, and
continue to do so, if sensible, till the Distemper
begins to abate: The Urgency of
this Symptom seems to indicate the Degree
of Danger: It is more or less violent, as the
Disease is mild or malignant; and an Abatement
of it may be look'd upon as a sure
Presage of Recovery.
49Warm aromatic and gently stimulating
Medicines, such as have, been already mention'd,
as the most effectual to suppress the
Vomiting, and check the Looseness attending
this Disease, have likewise been found useful
in removing the present Complaint: And tho'
the Degree of Heat, and Quickness of the
Pulse, would be enough to dissuade a Person
who has not seen the Disease, from giving
them in so liberal a manner as Necessity requires;
yet we are not to be governed so much
by these Symptoms, as by the Faintness, Depression
of the Pulse, and Increase of Putrescency
in the Fauces. One Drachm of the
Confectio Raleighana has been given to a Youth
not quite 15 Years of Age, every four Hours,
which was soon follow'd by a sensible Amendment,
and the Decrease of the Patient's Restlessness,
Faintness, and Heat.
Some of the Italian Physicians forbad the
Use of Wine in the Cure of this Disease, and
the Warmth of that Climate might perhaps
make this Caution necessary; but as it is a generous
Cordial, and at the same time antiseptic,
it seems to be in no respect improper
here; and, besides in Whey, I have allow'd
it to be given, in small Quantities, mixed
with Mint, Baum, or Sage-Tea, Barley-Water,
Gruel, Panada, Sago, and suchlike;
50and alone, where the Faintness has been
excessive; the Age, the former Way of Life,
and the Symptoms, affording the necessary
Rules as to Quantity and Kind. Chicken-Water,
or thin Broth, may also be allow'd;
which is frequently very acceptable to the
Patient. And I don't remember to have
observed so general and early an Inclination
after solid Food, in any acute Disease,
as in this: For at a time when one
would imagine, both from the Condition of
the Fauces, and the Degree of Heat, that
Liquids would be the most acceptable, it is
not uncommon to find Children, who have
this Disease, extremely desirous of Chicken,
and chearfully complying with Directions, in
hopes of being gratified in this respect.
Blisters are likewise of Use to relieve the
Faintness. At first I was in Doubt, lest the
Flies, by their Acrimony, should increase the
putrescent Disposition, and consequently aggravate
the Disorder they were intended to
remove: but no such Effect having appeared
from their Use, I have order'd them to be applied,
and I think with Advantage, both to
the usual Parts, and to the Neck on each Side
from below the Ear almost to the Clavicle, as
Occasion required.
51The Ulcers in the Throat demand our early
and constant Attention, as a considerable Loss
of Substance cannot here be suffer'd without
immediate Danger to Life itself, or the most
pernicious Consequences to the future Action
of the Parts, if the Patient survives.
Where the Disease is of the mildest kind,
a superficial Ulceration only is observable;
which may easily escape the Notice of a Person
unacquainted with it. A thin, pale, white
Slough seems to accompany the next Degree:
A thick, opake, or ash-colour'd one is a further
Advance: And if the Parts have a livid
or black Aspect, the Case is still worse.
These Sloughs are not formed of any foreign
Matter covering the Parts affected as
a Crust or Coat, but are real Mortifications
of the Substance; since when they come off
spontaneously, or are separated by Force,
they leave an Ulcer of a greater or less Depth,
as the Sloughs were superficial or penetrating.
When the Tendency to Putrefaction is
stopp'd, these Sloughs in most Cases come off
spontaneously; or their Separation may be
promoted by suitable Remedies and Applications:
But it seems by no means adviseable
to attempt it by Scarification, scraping them
52off with the Fingers or Instruments, as Severinus
proposes; since the Experiment has
been tried, but with such unhappy Consequences[30],
as are sufficient to discourage one
from persisting in this Method.
In a Case where I was concerned, previous
to my being called in, a Surgeon had endeavour'd
to separate the Sloughs by the Assistance
of his Probe: He succeeded in his Attempt
without much Difficulty; but was surprised
to see the same Parts cover'd the next
Day with thick, dark, ash-colour'd Sloughs,
penetrating deep into the Substance, with an
Increase of every Symptom.
53It is true, the Sloughs have been sometimes
scarified, from an Apprehension, that
Matter was lodg'd underneath them, without
any manifest Inconvenience; but as there
are Instances of fatal Mortifications having
ensued, it seems most prudent to decline
the Practice.
From under these Sloughs, and from every
Part of the Ulcers which they cover, a thin
corrosive Ichor is discharged, so acrid as to excoriate
the external Parts upon which it is suffer'd
to remain. This is sometimes observable
in Adults, when the Parts above the Fauces
are affected; the Ichor in these Cases flows
thro' the Nostrils, and frequently raises Pimples
on the Skin of the upper Lip; but it is
most obvious in Children, who often have this
Part, the Corners of the Mouth, the Cheek
of that Side on which they most commonly lie,
blister'd or excoriated.
It is probable, as hath been already hinted,
that Part of the same virulent Matter, passing
down the Oesophagus into the Stomach and
Intestines, acts upon them as it does upon
the Skin, when applied to it externally; it
frets and corrodes the Parts it touches, and
produces that Sickness, Vomiting, Purging,
and Faintness, which sometimes accompany
54this Disease in different Parts of its Progress.
In Children, and very young Subjects, the
Symptoms arising from this Cause are yet
more dangerous: The natural Softness and
Laxity of the Parts liable to be affected, disposes
them to suffer by it much more than
Adults: At the same time they are commonly
alike incapable of promoting the Discharge of
this Matter themselves, and of admitting
Assistance from others, being generally, if the
Distemper is acute, either comatous and stupid,
or delirious and untractable. If Gargles are
injected, they either prevent them from
reaching the Seat of the Disorder, by their
Tongues, or they swallow them, and the
putrid Taint of the Ulcers, together; the Mischief
spreads beyond the Power of Art to restrain
it; violent Purgings ensue, or fatal
Hæmorrhages from the penetrating Gangrene.
And to this, perhaps, it may in part be owing,
that Children suffer so much more from
this kind of Sore Throat, than Adults.
That this corrosive Matter produces these
Effects, is farther confirm'd, by observing,
that those whose Throats are severely affected,
if they have a plentiful Discharge from the
Fauces, are seldom attended with Sickness,
Vomiting, or excessive Faintness; though,
55after longer Sleeps than ordinary, or a Neglect
of encouraging this Evacuation, they have
complain'd of Sickness, and have had Reachings
come on: Likewise, that in such Cases, where
little or no Discharge of this kind appears, the
Symptoms are commonly the most dangerous.
From hence it is obvious that great Advantages
may be expected from the constant Use
of gently stimulating aromatic Gargles; as they
promote the Discharge of the pituitous Matter
flowing to the Fauces, and, doubtless, with
it, of some Part of the corrosive Fluid above-mention'd:
To which if we add Antiseptics and
Detergents, in order to check the Progress of
the Mortification, and cleanse the sordid Ulcers
it produces, every Indication is provided for.
Where the Disease is mild, the Symptoms
favourable, the Sloughs superficial, or scarce
perceptible, it may be sufficient to order a
Gargle of Sage-Tea with a few Rose-Leaves
added in the Infusion; three or four Spoonfuls
of Vinegar may be mixed with half a Pint
of the Tea, and as much Honey put to it, as
will leave it agreeably acid.
But where the Symptoms are urgent, the
Tendency, to Putrefaction great, the Sloughs
large and thick, and the Breath offensive, Recourse
must be had to more efficacious Remedies:
56A Composition like the following,
varied only as the Patient's Age and the Circumstances
of the Disease required, has in general
been attended with very good Effects. The
Proportion here given may be used for Adults,
and the more active Parts lessen'd for
younger Subjects.
℞ Decoct. Pectoral. ℥ xij. cui inter coquendum
add. Rad. Contrayerv. contus. ℥ ss.
Liquori colato admisce Acet. Vin. Alb. ℥ ij.
Tinct. Myr. ℥ i. Mel. opt. ʒ vi. f. Gargarisma.
As the Parts about the Gullet are frequently
so much affected, as to render it
painful or impracticable for the Sick themselves
to make use of the Gargle so freely as
they ought, it is commonly order'd, that a few
Spoonfuls of this Liquor, made somewhat
warm, should be very often injected into the
Fauces with a small Syringe; and especially
before the Patient swallows any thing, in
order to wash off as much as possible the putrid
Sordes adhering to the Ulcers, and prevent
it from passing into the Stomach and
Bowels. In young Subjects this Method is
the more necessary, as they don't always know
how to manage a Gargle to any Purpose, did
the Soreness of the Parts permit them to
do it.
57If the Sloughs are large, and cast off slowly,
they may be touched with Mel Ægyptiacum,
by means of an armed Probe; or it the Condition
of the Fauces is such, that this cannot
conveniently be done, a Spoonful of the following
Mixture may be injected, and retain'd
in the Throat, as long as the Patient can endure
it; the Parts may then be washed two
or three times with the Gargle alone.
℞ Gargarism. præscript. ℥ ij. Mel Ægypt.
ʒ j. m.
By the constant and regular Use of these
Applications, if the Patient is kept warm,
and the Method of treating him in other Respects
is observed, agreeable to what has been
mention'd above, it seldom happens but that
the febrile Symptoms disappear, the Sloughs
come off, and the Ulcers are disposed to heal
in a few Days; unless it be where Mismanagement
at first, Malignity of the Infection,
or an unfavourable Constitution, have one or
all contributed to increase the Disease, and to
render its Consequences more lasting and mischievous.
What Effects improper Treatment produces
in this Case has already been observed.
With regard to the Matter of Contagion, or
Nature of that Cause which so suddenly
brings on such a Train of Symptoms as hath
been described, little can be said with any
58Degree of Certainty: Thus much, however,
seems to be true in Fact, that in some Cases
the Disease appears to be of so mild a Nature,
and so benign, as to require but little
Assistance from Art: Persons even recover
from it under the Disadvantages of unskilful
and injurious Management; whilst in others,
the Progress of the Symptoms is so rapid,
and the Tendency to Corruption so strong, that
nothing seems able to oppose it. Just as it happens
in the Small-Pox; the benign and distinct
sort bears ill Treatment without Injury;
in the malignant flux Kind, the utmost Art
and Experience are too often insufficient to
conduct the Distemper to a happy Issue. Whether
this Diversity in the Sore Throat we are
speaking of, is owing to a Difference of
Constitutions, or of Seasons, to the different
Quality or Quantity of the Contagion,
or the Manner of receiving it; or whether
there are in Reality distinct Species of it;
may perhaps hereafter be more certainly determined.
With respect to Constitution, it may be
further observed, that in soft, lax, leucophlegmatic
Habits, and languid inactive Dispositions,
every thing else being equal, the
Disease seems to proceed more slowly, to go
off more irregularly, and to leave behind it
more lasting Effects. In some Persons of the
Temperament described, tho' the Fever has
grown less, and all the Symptoms abated in
59four or five Days, yet the Sloughs in the
Throat have continued almost a Week longer;
whilst in the opposite Constitution, tho' the
Disease has been much more acute, yet the
Symptoms have no sooner abated, than the
Sloughs have cast off, and the Ulcers healed
of their own Accord.
A copious Hæmorrhage from the Nose,
Mouth, or Ears, the last especially, coming
on after the Disease has continued three or
four Days, or longer, is a dangerous Phænomenon:
For at this time of the Distemper,
it most probably proceeds from the Branch of
an Artery destroy'd by the Mortification, and
laid open by the Separation of the Slough.
If the Vessel is therefore large, the Bleeding
may prove fatal to the Patient in a very short
time; or if he escapes for the present, the
Loss of a considerable Quantity of Blood at
this time of the Disease, will occasion various
ill Consequences.
It is therefore absolutely necessary to endeavour
to stop this Discharge with all the
Expedition possible. If the Patient is costive,
it will be of Use to procure Relief in this
respect, by Clysters or Suppositories as soon
as can be done: To apply Vinegar, by the
means of Tents or otherwise, as near to the
Orifice of the Vessel as we can: To convey
the Steam of it into the Fauces and Nostrils
60plentifully: To keep the Patient in a
sitting Posture, or his Head raised as high as
may be, and his upper Parts moderately
cool: If these Methods don't immediately
take Effect, Recourse must be had to the most
efficacious Remedies, amongst which we may
rank the Bark and Opium.
It is not uncommon for hectic Heats,
Night Sweats, Want of Appetite, and Dejection
of Spirits to attend those a considerable
time, who have had the Disease in a
severe manner. Asses Milk commonly relieves
them, or a Decoction of the Bark, and
Elix. Vitriol if the Case is more obstinate.
Having thus related, as concisely as I
could, the most material Circumstances that
have occurr'd to me in respect to the Symptoms,
Progress, and Event of this Distemper,
the Juvantia, Lædentia, and the Accidents
chiefly to be regarded in its Cure; in such
a manner as I hope will enable those who
have not seen or known it, to distinguish it
from a common Sore Throat and to treat it
with some Degree of Propriety and Success,
I shall conclude with observing;
1. That the Sore Throat attended with Ulcers
seems to be accompanied with a strong
Disposition to Putrefaction, which affects the
Habit in general, but the Fauces, and the
61Parts contiguous in particular. And it seems
not unreasonable to suppose,
2. That the Cause of this Disposition or
Tendency is a putrid Virus, or Miasma sui
generis, introduced into the Habit by Contagion,
principally by means of the Breath of
the Person, from whom it is received.
3. That this Virus, or contagious Matter,
produces Effects more or less pernicious, according
to the Quantity and Nature of the
Infection, and as the Subject is disposed to
receive or suffer by it.
4. That putrefactive and malignant Diseases,
in common, admit of the most sensible
and secure Relief, from Discharges of the
peccant Matter, either upon the Skin in general,
or on particular Parts of the Body.
5. That the Redness, and cutaneous Efflorescence
in the present Case may be consider'd
as an Eruption of the like Nature; and
therefore to be promoted by such Methods
as have proved successful in similar Diseases.
6. That a cordial, alexipharmac, warm
Regimen has been found by Experience to
be of the most Use in such Cases; and that
Bleeding, Purging, Antiphlogistics, liberally
employed, either retard, or wholly prevent
these Discharges.
62Therefore, as to expel the morbific Matter
(3) seems to be the Design of Nature;
to promote this Design by the Measures that
are approved by Experience in analogous
Disorders, is the Duty of the Physician.
It may likewise be remarked, that, though
this Disease has now been amongst us several
Years, and has consequently survived
the different Seasons, and all the Variety
of Weather to which we are exposed,
yet it seems to shew itself most frequently
in Autumn and the Beginning of
Winter; at least I have met with many more
Cases from September to December, inclusive,
than in all the other Months together;
having not yet seen any who had it in the
Spring, and very few in the Summer.
It may likewise be remark'd, that the
Summers of 1747 and 1748 were dry, with
some Days in each uncommonly hot, for
this Climate; the Mercury in Fahrenheit's
Thermometer rising in the Shade, and within-door,
one Day to 78, and during several to 75
and 6. The Autumns of the same Years
as unusually temperate and warm; the Wind
continuing longer in the Southerly Points
than has often been known at this Season.
FINIS.
1. Ab Hispanis Garrotillo appellatur, ut eadem patiantur
Angina laborantes, quæ facinorosi homines, cum
injecto circa collum sune strangulantur. Epist. R. Moreau
ad Th. Barth. Epist. Med. Cent. i. p. 336.
8. Tournefort's Voyage to the Levant, vol. i. p. 133.
9. De pestilente faucium affectu Neapoli sæviente,
opusculum, auctore Jo. Andrea Sgambato, phylosopho ac
medico Neapolitano, et academico otioso. Neapoli excudebat
Tarquinius Longus, 1620, in 4to.
10. Joannis Baptistæ Cortesii, medici ac philosophi, in
Messanensi academia praxim ordinariam e prima sede interpretantis,
Miscellaneorum Medicinalium Decades Denæ.
Messanæ 1625. in fol.
11. Divi Francisci Custos, vir doctrina et moribus insignis,
hac lue obsessus, tonsillas solummodo et gargareonem
inflammatione læsa habebat, et continuo querebatur
se percipere in ore fætorem quendam; et ut hac de re
certior redderetur, ad se vocavit baccalaureum quendam
sibi amicissimum, qui maximo affectu assistebat, rogavitque
ut vellet olfacere, percipereque naribus, an verum esset
talem fætorem emittere, an ab ejus imaginatione prodiret:
olfecit baccalaureus me (scil. Cortesio) præsente, et multis
aliis, at statim non multis elapsis horis decubuit sola
faucium et glandularum inflammatione vexatus, absque
aliqua manifesta corruptione partium, omnibusque præsidiis
ex arte factis, quarto die suffocatus periit; et
tamen Custodem non tetigerat, sed solo olfactu aerem
ab ore prodeuntem naribus traxerat: quare ab hujusmodi
exemplo veni in sententiam hunc morbum non esse absque
aliqua contagione. Cort. Miscel.p. 698.
12. De morbo strangulatorio, opus Ætii Cleti Signini,
doctoris medici et philosophi. Romæ 1636. 8vo.
13. De recondita abscessuum natura, libri 8. Marci
Aurelii Severini Tharsiensis, philosophi et medici, regio in
gymnasio Neapolitano anatomes et chirurgiæ professoris.
Editio secunda, Francofurti ad Mænum 1643. And again
printed with Bartholine's Exercitationes, as a Commentary
upon it, with Villani's Therapeuta Neapolitanus seu Veni
mecum Consultor. Neapoli 1653.
19. Hoc unum salutis est indicium vel interitus: dum
oculorum nitor adservatur, salutis spes semper adest; quo
tempore hic deperiit, in propinquo mors est. Ætii
Cleti Op.
21. Quinimo post xxx dies, et xl. jam prærepti morbi
furoribus, præter omnium opinionem ex improviso sunt
extincti. Adeo scil. latitans et recondita veneni vis est.
Severin, p. 440.
24. In hoc sacro igne non mittendus est sanguis in ea
quantitate ac in angina exquisita.—Placuit quibusdam in
hoc morbo fecare venas sub lingua; alii admoverunt hirudines
collo: mihi nulla istarum evacuationum unquam
probari potuit. Nam cum tumor superveniens ex sanguine
non oritur, frustra adhibentur ea auxilia quæ ad
sanguinem ex parte affecta evacuandum excogitata fuerunt.
Sgambat. de Pest. Faucium Affect.
26. Zacut. Lusitan. de praxi medic. admiranda lib i.
observ. 99. where he mentions this Disease, and relates
an unhappy Instance of its Effects in the following Terms.
In his partibus (scil. faucibus) ex humoris virulenti
affluxu gignuntur carbunculosæ inflammationes, quæ pestis
diræ, aut veneni promptissimi instar, contagio quodam,
pueros et adultos corripiunt; et sævis maleficentissimisque
stipatæ symptomatis citissimam necem inferre solent.
Malum in Hispania non multis abhinc annis frequens,
vulgus medicorum Hispano sermone Garrotillo nuncupat;
de cujus essentia, periculo, brevitate, et complicatione
ustivi et ulcerosi tumoris, ac deleteria corruptione, laconice
dicam. Hoc fuit pressus biennis infans, sanguineus
et obesus. Primo die ex catarrhosa defluxione in suffocationem
pene incurrit, difficulter respirabat, et lac deglutiebat,
et febri acuta affectus, nec plorare poterat. In
parte gutturis dextra externa glandulosus apparuit tumor
cum dolore multo. Secundo die intra fauces ulcus visum
est ad nigrum vergens, quod putrilago et mollities multa
comitabantur; at ab ore fætor horribilis prodibat, magnum
certe corruptionis completæ indicium. Tertio die
nullis adjutus auxiliis strangulatus, est extinctus.
29. —Ad prædictarum partium (Uvulae, Tonsillarum)
inflammationem subsequebatur interdum materia quædam
pituitosa a capite tam repente et inopinato descendens, ut
miseri ægrotantes subito suffocarentur. Cortes. Miscell.
p. 697.
30. Si quis tamen vel digitis, vel aliquo instrumento
levi ipsam (materiam aliam) auferre tentâsset, quamvis
operatio hæc fieret absque dolore, ea tamen ablata brevissimo
tempore peribant ægrotantes; quod præ cæteris in
Petro Soprano genero meo observatum est, cui cum hujusmodi
mortificatio apparuisset in suprema superficie dictarum
glandularum faucium, et palati, ita ut videretur esse
maximo respirationi et deglutitioni impedimento, chirurgus
existimans posse facillimo negotio a subjectis partibus
eam separari solis digitis, levissime quidem eam abstulit;
quæ ablata, tantum abest ut juverit deglutitionem aut respirationem,
ut utraque potius actio læsa magis fuerit, unde
brevissimo tempore miser, meo cum maximo dolore, mortem
oppetiit; id quod etiam in aliis quamplurimis pueris
sæpius observavi, et præfertim in ejusdem Petri filiolo
nepoti ex filia, quinque annorum, mihi carissima, qui post
paucos dies eodem modo, quo pater, vitam cum morte
mutavit. Cortes. Miscel. Med, p. 697.
Transcriber's Notes.
The original spelling and punctuation has been retained.
This Book is 300 years old and the advice given has been superceded
by more modern methods and is of historical value only.
