In this Case they generally spit very little; the Fauces appear dry, glossy, and livid; the external Tumor grows large; they void their Excrements without perceiving it, and fall into profuse Sweats; Respiration becomes difficult and laborious; the extreme Parts grow cold, and Death in a few Hours closes the Scene; and in no Disease that I have seen is the Eye so early deprived of its Lustre as in this; for it is sometimes opake and glassy several Hours before Death; and, as Ætius Cletus hath observed, is a fatal Presage of its Approach.
A copious Flux of pituitous Matter to the Glands, and other Parts about the Fauces, seem'd to be the Cause of sudden Death, in a Girl about 12 Years old. She was seized in the common Way, with Shivering, Headach, Sickness, Vomiting, and Purging. The Discharges abated in a few Hours, and were succeeded by great Heat, Redness of the Skin, and a sore Throat; the Uvula, Tonsils, and, contiguous Parts were red, and so swell'd in eight or ten Hours, as to touch each other, and seem d to close the Entrance into the Pharynx. She breath'd without much Difficulty, swallow'd with less Pain than could be imagin'd, and spit up large Quantities of Phlegm. About six in the Evening she was seized with a Difficulty of breathing, as if strangled: Those about her rais'd her up, thinking she was in a Fit; she recover'd herself a little, but expired upon being again laid down in Bed; in somewhat less than 24 Hours from the first Attack. A large Quantity of viscid Phlegm, with which, after she was dead, her Mouth appear to be fill'd, together with the tumefied Uvula, Tonsils, and Velum Palati, had perhaps jointly closed the Rima Glottidis, and put a Stop to Respiration.
By a Fall in her Infancy she was reduced to the Necessity of using Crutches. She was big-bon'd, had a good Appetite, and for want of that Exercise, which Persons at her Age commonly enjoy, seem'd to be plethoric. These Circumstances perhaps might contribute to this speedy and unhappy Event.
Accidents of the like kind seem not to have been uncommon while this Disease continued in Italy, according to a Remark of Cortesius[[29]].
From the preceding Account of the Sore Throat attended with Ulcers, it will, I believe, appear, that this Disease is widely different from a common Sore Throat, or simple Inflammation of any of the Parts about the Fauces; both as to the Subject commonly affected by it, the Manner of its Attack, the Progress of the Symptoms, and its Conclusion: For the sore Throat with Ulcers generally attacks Children; and of these Girls more frequently than Boys, as hath been observ'd: 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 both Diseases are attended with a Fever, and as most Fevers come on with Shivering or Chilness, this Symptom may at least appear equivocal: But if Sickness, or Vomiting, or Purging, or an acute Head-ach, towards the back Parts or Top especially, or if all these, come on in the Space of a very few Hours, which they generally do, where the Disease is vehement, it may justly be esteem'd of the malignant or putrefactive kind: But if an erysipelatous Redness discovers itself in the Fauces, or if any Ulcerations or 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.
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.
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 being formed, before any Soreness or Pain in the Fauces hath been mention'd.