John Fothergill

“ 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 ”

“ 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 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ MDCCXLVIII.
iii PREFACE. 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. ”

“ 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 ”

“ 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 ”

“ 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. ”

“ 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. ”

“ 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 ”

“ 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. ”

“ 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 ”

“ 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 ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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 ”