From the month of June, 1778, until the 1st September, 1779, there were treated 146 cases of “ulcerated sore-throat,” of which 18 were fatal. The epidemic was at its height in September and October. The ages were: under ten years, 98, ten to twenty, 25, twenty to thirty, 18, above thirty, 5. Dropsy followed in 23; 75 were mild scarlatina and sore-throat, 33 were angina maligna. During the ten years following, until 1789, only 57 more cases were treated from the Newcastle Dispensary, of which 8 were fatal[1304].
History of Scarlatina after the Epidemic of 1778.
In London, according to Dr James Sims, scarlatina with sore-throat occasioned a great mortality in the latter half of 1786. The bills of mortality assign only 19 deaths to sore-throat, while they give 793 for the year to measles. But Sims says that “measles were not present in London during the whole year; at least I saw none, and I saw about two thousand cases in private and at the General Dispensary.”
The deaths from scarlet fever, he thinks, had been given under measles and also under “fevers,” which were a large total for the year. The epidemic was very virulent, going through families; many lost two children, some a larger number; many adults fell victims to it who were supposed to die of common fever.
Sims’ first case was of a youth at Camberwell, in March, with scarlet rash and sloughs of the throat. He saw no more cases for several weeks, and then, on 1 May, he was called to a case of sore-throat in a school at Hampstead; the illness was slight, and there was no efflorescence; but in June there occurred in the same school an explosion of scarlatina, twenty of the girls being seized within a short time. It was in other suburban villages in the summer, but did not enter London until August, after which Sims saw three hundred cases of it; of some two hundred treated by him in a certain way, only two died. The symptoms of the epidemic were the usual ones of scarlet fever with ulcerated or sloughing throat. In November and December, swelling attacked the face and extremities, which were painful but not oedematous. The parotids were swollen. Several had the angina without the rash; others the rash without the angina[1305].
The same epidemic in London was one of the early medical experiences of Dr Robert Willan, who gave some account of it in the volume ‘On Cutaneous Diseases’ which he published in 1808, shortly before his death[1306]. It began in the autumn of 1785, was superseded by measles for a time, and revived again in 1786, to last into 1787. It was most malignant in the narrow courts, alleys and close crowded streets of London, but existed also in the villages near. While admitting the existence of measles in the winter of 1785-86, he confirms Sims in saying that it was not measles (as in the Bills) but scarlatina that caused the high mortality in 1786: “The cases of scarlatina during the year 1786 exceeded in number the sum of all other febrile diseases within the same period.” The deaths were mostly between the seventh and eighteenth day of the fever. The following is his classification of over two hundred cases seen by himself:
1786
| Scarlatina simplex | Scarlatina anginosa | Scarlatina maligna | Sore-throat without eruption | |||||
| April | — | 3 | — | — | ||||
| May | 6 | 10 | 2 | — | ||||
| June | 4 | 12 | 1 | 4 | ||||
| July | 2 | 11 | 1 | 3 | ||||
| August | 1 | 17 | 4 | 4 | ||||
| Sept. | 2 | 29 | 9 | 12 | ||||
| Oct. | 3 | 24 | 5 | 7 | ||||
| Nov. | 0 | 38 | 12 | 10 | ||||
| Dec. | 0 | 8 | 5 | 2 | ||||
| 18 | 152 | 39 | 42 | |||||
The infirmary book of the Foundling Hospital has long lists of patients sick of “scarlet fever with sore-throat” in August and September, 1787, as many as 76 being under treatment in one week, the next week 39 sick of scarlet fever, besides 45 recovering from it. This is the first unambiguous entry of an epidemic of scarlet fever in the Foundling Hospital records[1307]. Under the same year, 1787, Barker, of Coleshill, records “scarlet fever, smallpox, and chincough” in a neighbouring city, as well as pestilential sore-throats “epidemical everywhere in the terrible foul weather of winter.” His next entry of “scarlet fever and sore-throat” is under the year 1791[1308].
An account by Dr Denman, of London, dated 28 November, 1790, of “a disease lately observed in infants,” but otherwise unnamed, appears to relate to diphtheria. Eight cases in young infants were seen, one per month from April to October, of which six proved fatal. The signs were “thrush in the nose,” fulness of the throat and neck, the tonsils red, swelled, and covered by ash-coloured sloughs or extensive ulcerations. The skin sloughed at places where blisters were applied. Nothing is said of a scarlet rash[1309].