In Ireland the dysenteries, typhus and relapsing fevers, attendant on and following the famine, were hardly over when the plague of the throat began among the children. It was seen first in the summer of 1743 (an influenza having preceded in May and June), it raged through the autumn and winter, and was not extinct for many years after. There were but few instances of it in Dublin, but it was prevalent in the adjoining counties, and exceedingly so in Wicklow, Carlow, Queen’s County, Kilkenny, Cavan, Roscommon, Leitrim, Sligo “and perhaps many others, carrying off incredible numbers, and sweeping away the children of whole villages in a few days.” The country doctors, who knew most of it, were not apt to record their experiences; so that the following account, which Rutty extracted from Dr Molloy, is all the record that remains of an epidemic concerning which one would wish to have known more[1269]:
“It is peculiar to children, and those chiefly of from a month to three, four, five, six, eight or nine years old. They commonly for a day or two, or more, had a little hoarseness, sometimes a little cough; then in an instant they were seized with a great suffocation lasting a minute or two, and their face became livid; they have frequent returns of these fits of suffocation like asthmatic persons. The said suffocation is ever followed by one symptom which continues till they die, viz. a prodigious rattling in the upper part of the aspera arteria [windpipe] resembling that sound which attends colds when there is phlegm that cannot be got up. It is scarce sensible when they are awake but very great when they are asleep.”
While there is little in this account to suggest the malignant sore-throat, and no mention of a miliary or scarlet rash, yet Rutty made no doubt that it was the malignant angina, comparing it rather to that described by Starr for Cornwall in 1748 than to that of Fothergill’s description. He adds, from some other source of information, that children had generally clammy sweats upon them, with foetor of the breath. Many died in twenty-four hours; none lived above five days. Some had tumours behind the ears, which mortified. Many had a prodigious weeping behind the ears, which was very corrosive. A case is given of a child recovering after a profuse sweat, which suggested diaphoretic treatment by warm baths and sack-whey. Swellings of the tonsils and uvula were not observed.
It will be convenient to give here what remains to be said of the 18th century history of sore-throat in Ireland. In 1744 Rutty enters “mortal anginas” in Dublin. In March, 1751, tumours of the face, jaws, and throat, following an epidemic among horses in December, 1750. In the spring of 1752 “the pestilential angina” made great havoc among children. In the spring of 1755, “the gangrenous sore-throat” (same as in 1743) was fatal to some children. In the winter of 1759-60 he records “scarlet fever,” and a singular form of the same in May, 1762, noticed under Influenza (p. 356). This must serve for the Irish experiences, although it is far from satisfactory. But it should be added that Dr James Sims, of Tyrone, who came to London afterwards and there wrote on the Scarlatina Anginosa (1786), says in an account of his Irish practice: “During all my practice here I have not seen one instance of the malignant ulcerous sore-throat as described by authors” (op. cit. 1773, p. 86).
Malignant Sore-throat in Cornwall, 1748.
Dr Starr, of Liskeard, calls the Cornish throat-disease the Morbus Strangulatorius. Writing in January, 1750, he said it had raged in several parts of Cornwall “within a few years,” with great severity[1270]: “Many parishes have felt its cruelty, and whole families of children been swept off: few, very few, have escaped.” Cases given by himself belong to the year 1748; and Huxham, who did not meet with it at Plymouth until 1750-51, says that it had been raging with great fatality for a year or two before in and about Lostwithiel, St Austel, Fowey and Liskeard. In the account of the Cornish epidemic the emphasis falls upon the affection of the larynx and trachea; while there are so many other symptoms enumerated, including eruptions and brawny swelling of the neck, that it is clearly impossible to distinguish between exanthematous fever with sore-throat and laryngeal diphtheria pure and simple. Starr says: “Dr Fothergill’s sore-throat with ulcers and Dr Cotton’s St Albans scarlet fever are, in my opinion, but its shadows.”
The symptoms generally pointed to the glottis.
Agonized breathing for a time was followed by the spitting up of jelly-like, glairy and somewhat transparent matter, mixed with white opaque thready matter, which might resemble more or less a rotten body or slough. The paroxysm returned, and the patient either died suddenly or sank away gradually, and died worn out, with or without convulsions. A plate is given of a whitish membrane loosened from the velum by means of hydrochloric acid on a silver probe; it was not a slough, but a strong tenacious membrane which would bear handling and stretching without breaking. In the same case, the child’s father afterwards pulled from the mouth a complete cast of the trachea including the bifurcation of the bronchi, of which a figure is given: “what sweated from it was as sticking as bird-lime”; he lived twenty-one hours after this second cast was drawn from him and died somewhat suddenly in his perfect senses. Such formations Starr clearly believed to be the essence of the disease; but he gives many variations of it. The train of symptoms was not the same in every subject: “Some, I am informed, have had corrosive pustules in the groin and about the anus, eating quick and deep, and threatening a mortification even in the beginning [as Colden described for the sore-throat in New York State]. Others after a few days’ illness have had numbers of the worst and deepest petechiae break out in various parts of their body: such I have not seen.” But he gives cases of his own at Liskeard in 1748: “A child here and there had red pustules which broke out in the nape of the neck and threw off a surprising quantity of thin transparent ichor”; these pustules sloughed when poulticed; in another case sloughs followed where blisters had been applied to the neck and arm. Many had swelling of the tonsils, parotids, submaxillary and sublingual glands. A few had oedema from the chin to the thyroid, and up the side of the face. In one case, a tumour of the fauces broke and yielded some ounces of coffee-coloured foetid matter, to the patient’s relief and ultimate recovery. Not a few had gangrenous sloughs in the mouth, which formed quickly. Some had foetor of the breath as an early symptom, but others had it not. Some were merely feverish and hoarse.
When Huxham came to describe the disease at Plymouth a year or two later, he laid the emphasis on other symptoms than those mostly dwelt upon by Starr, describing really a sloughing sore-throat with rash. But he has this also: “The windpipe itself was sometimes much corroded by it, and pieces of its internal membrane were spit up, with much blood and corruption; and the patients lingered on for a considerable time, and at length died tabid.”