Fothergill’s Sore-throat with Ulcers, 1746-48.
Meanwhile we have to overtake Fothergill’s history of the ulcerous sore-throat in or near London[1271]. It broke out at Bromley, near Bow, Middlesex, in the winter of 1746 (Short says that it was in Sheffield in 1745). So many children died suddenly, some losing all and others the greater part of their families, that people were reminded of the plague.
It began with a chill and rigor, followed by heat. The throat became sore, and there were nausea, vomiting and purging. The face turned red and swollen, the eyes were inflamed and watery, the patient was restless, anxious and prostrated. The seizure was often in the forenoon, and in all cases the symptoms became much worse towards night, to be relieved by a sweat in the morning, as in an intermittent fever. The uvula, tonsils, velum, inside of the cheeks, and the pharynx, were florid red, with a broad spot or patch, irregular in figure, of pale white colour like the blanched appearance of the gums when they have been pressed by the finger. Usually on the second day of the disease, the face, neck, breast and hands to the tips of the fingers became of a deep erysipelatous colour with perceptible swelling, the fingers in particular being often of so characteristic a tint as at once to suggest an examination of the throat. A great number of small pimples, of a deeper red than the skin around 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. With the coming out of this rash, the sickness, vomiting and purging cease. The white spot or spots on the throat are now seen to be sloughs; they come first usually in the angles above the tonsils. They are not formed of any foreign matter covering the parts but are real mortifications of substance leaving an ulcer with corrosive discharge behind. The nocturnal exacerbation now takes the form of delirium and incoherent talking. The parotids are commonly swelled and painful; and if the disease be violent, the neck and throat are surrounded with a large oedematous tumour threatening suffocation. The pulse is 120, perhaps hard and small. The urine is at first crude and pale like whey; afterwards it is more yellow, as if from bile; and towards recovery it is turbid and deposits a “farinaceous” sediment. The initial purging having ceased, the bowels become irregular. The disease had no crisis, but in general, if the patient were to recover, the amendment began on the third, fourth or fifth day, when the redness disappeared and the sloughs in the throat were cast off.
Such is the main outline; the following symptoms have less general value.
At the outset, the patient complained of a putrid smell in the throat and nostrils, which caused nausea. The nostrils were often inflamed, yielding a sanies, and the inside of the lips covered with vesicles filled with an excoriating ichor. Some had the parts about the anus excoriated. Fothergill was inclined to think that either the excoriations or the ichor from them extended down the whole intestinal tract, and accounted for the purging, with other bowel symptoms, which sometimes remained for weeks after the primary disease and caused death by emaciation[1272]. In some there was bleeding at the nose, or mouth, which might be fatal; in one case there was a like accident from the ear. Several cases are given in which there were no sloughs of the throat, but a dry glossy redness or lividity; in these cases, there was a general brawny swelling of the neck, a coldness of the hands and feet, involuntary evacuations, a glassy eye and certain death. Three of Fothergill’s five briefly reported cases are of that variety. In one of them, a boy of 14 years, he says there was “deep redness of the face, hands and arms, with a plentiful eruption of small pimples, which induced those about him to apprehend it was a scarlet fever.”
That is the only reference to a possible diagnosis of scarlet fever in the whole essay. In the New England throat-distemper of 1735, “scarlet fever” was in like manner the name given by the laity, and disapproved by the profession. Fothergill, adopting the erudition of Letherland, identified the ulcerous or gangrenous sore-throat of London in 1746-48 with the garrotillo of Spain in the 16th and 17th centuries, the famous throat-plague of Naples and other places in Italy and Sicily from 1618 onwards, and the “plague in the throat” mentioned by a traveller, Tournefort, in 1701 as occurring among children in the island of Milo, (Douglass having already identified the Levantine plague in the throat with the throat-distemper of New England in 1735.)
After the outbreak at Bromley and Bow in the winter of 1746, the ulcerous, or putrid or gangrenous angina continued in London and the villages near until the date of Fothergill’s writing (1748). By credible accounts, he says, it was also “in several other parts of this nation.” Short, of Rotherham, a professed epidemiologist, says that the malignant angina “never left Sheffield entirely since the year 1745[1273].” Fothergill himself, in his monthly accounts of the weather and diseases of London from 1751 to 1755, refers to the sore-throat once or twice; thus, in October, 1751: “epidemic sore-throat, in both children and adults”; and again, in July, 1755: “The ulcerated sore-throat likewise appears in many families, with the greatest part of its usual symptoms, but gives way without much difficulty, if no improper evacuations have been made, to the method heretofore recommended (XXI. 497)[1274].”