It was once more described, for New York city, by Dr Samuel Bard in 1771[1264]. He identifies it with the disease described by Douglass in 1735, and gives an account of it on the whole like Colden’s.
It was “uncommon and very dangerous,” mostly a malady of children under ten. They drooped for several days, had a watery eye, then a bloated livid countenance, and a few red eruptions here and there on the face. This went on for three or four days, the throat meanwhile showing white specks on the tonsils. Sudden and great prostration ensued, with a peculiar hollow cough and tone of voice, or loss of voice, constant fever, especially nocturnal, and a degree of drowsiness. In fatal cases there was great restlessness and tossing of the limbs towards the end. In one family all the seven children took it one after another; three died out of the four elder; the three younger recovered, having had ulceration behind the ears, which continued for several weeks and rendered an acrid, corrosive ichor. Many other children had these ulcerations behind the ears, sometimes with swelling of the parotid and sublingual glands. The same ulcerations might occur also “in different parts of the body.” Sloughs of the fauces and epiglottis extended as a membranous exudation into the trachea. Two cases occurred in women, one of them having assisted to lay out two children dead of the distemper.
The last time of its general spreading (within the period covered by Belknap’s History of New Hampshire, 1791) was in 1784-85-86 and -87. It was first seen at Sandford in the county of York, and thence diffused itself very slowly through most of the towns of New England; but its virulence and the mortality which it caused were comparatively small[1265].
Angina maligna in England from 1739.
Although there had been an extensive prevalence of angina with miliary or scarlet or erysipelatous rash in Devon and Cornwall in 1734 and following years, a slight amount of sore-throat with scarlet fever in and near Edinburgh in 1733, a great prevalence of throat-distemper with scarlet or miliary rash in the North American colonies in 1735-37, and an ill-favoured erysipelatous quinsy as well as an anomalous scarlet fever in Barbados, St Christopher, &c., during the same period, yet it was not until the end of the year 1739 that cases more or less similar occurred in London. The incident that first drew attention to the throat-distemper in the capital was the death of the two sons of Henry Pelham, the colleague of his relative the Duke of Newcastle in the premiership[1266]. Horace Walpole, writing twenty years after concerning similar calamities in the family of the Earl of Bessborough, says that not only Mr Pelham’s two sons, but also two daughters and a daughter of the Duke of Rutland all died together. Chandler, writing in 1761, says that he well remembered the disease at the end of 1739. Early in 1740 he had in his own practice as an apothecary two cases of children sick in one family; the first died, and as he was at a loss to account for the death, there being “something in the whole of the case quite new and unknown to me,” he called in Dr Letherland to see the other, who declared that the child would die also, as it did. Letherland then spoke to Chandler of the death of the two Pelhams shortly before, “of the alarm it caused all over this great city, both from its novelty and fatality,” and of his own care and pains in turning over ancient and modern writers to see if he could trace any footsteps of this remarkable and terrible disease: at last, after long search, he had been so happy as to discover the identical disease circumstantially described in the Spanish writers[1267].
The identification of the English throat-distemper of the 18th century with the garrotillo of Spain in the 16th and 17th centuries was thus undoubtedly due to Letherland, so far as English learning was concerned, and he received due credit for it in the Harveian Oration at the College of Physicians on the first occasion after his death[1268].
Chandler thus described the state of the disease at its first breaking out in 1739:
“The first and common appearances are feverishness, sickness, vomiting or purging; the proper and diagnostic signs which follow are an ulcerous slough in some part of the fauces, discharging a fœtid matter.... The nostrils are glandered.... From the absorption of the fœtid pus, the blood is contaminated; crimson efflorescences and small putrid pustules break out on the skin of the neck and breast, a quick depressed pulse, with a tendency rather to stupor than violent perturbations accompanying all, and, if not relieved, terminate in delirium, languor, clammy sweats and death.”
Fothergill, whose name is so closely associated with the outbreak of gangrenous sore-throat a few years after, makes little of the earlier epidemic in London; besides the cases in the Pelham family and some others in the same part of the town, there were, he says, very few observed, so that “the disease and the remembrance of it”—including Letherland’s priority—“seemed to vanish altogether.” The winter of 1739-40, in which these cases had occurred, was one of intense frost and the beginning of a two years’ sickly period in which typhus in Britain, dysentery and typhus in Ireland, reached a height unprecedented in the 18th century.