Again, this Disease is accompanied with a greater Tendency to a Delirium, than either a common Angina, or almost any other Disease we are acquainted with. To have this Symptom appear in the Disease we are treating of on the first Night, is not uncommon; and on the second, frequent. A Girl about eight Years of Age, whom I attended, was scarce known to be indisposed, till she alarmed the Family, by appearing to be light-headed. She had made no Complaint of her Throat, nor was this Part thought to be affected, till, upon Examination, I found it so; being led to suspect it by the Colour of her Hands, and the Delirium. She got well through the Disease, tho' its Progress, at first, appear'd to be very swift.
A common Sore Throat, if the Patient recovers, either goes off by Resolution, or suppurates, or becomes hard and scirrhous.
In that attended with Ulcers, none of these Circumstances happen; for it terminates in a superficial Ulceration of some of the Parts about the Fauces, with little Appearance of any Sloughs, if the Disease is very mild; and with large and deep ones, of a white, cineritious, livid, or black Colour, if it is more violent.
It will not perhaps be difficult, from this comparative View of the Disease, to distinguish it from a common Sore Throat, or an inflammatory Affection of those Parts: But there is another no less certain Criterion, tho' too often a fatal one, which is, the constant Increase of Symptoms upon Bleeding, Purging, and the liberal Use of cooling antiphlogistic Medicines; an Instance whereof I think evidently appeared in the following Case.
A Youth of about 14 Years old, of a brisk lively Disposition, who had enjoyed a good Share of Health, saving that, for a few Years past, a cutaneous Disease, akin to a Leprosy, had sometimes appeared on his Head and Arms, was seized one Morning with a general Uneasiness, and a Disposition to vomit; he was put to Bed, and a severe Shivering ensued; his Sickness increased, he vomited up every thing, had several purging Stools that Day, and complained much of his Head, with some Soreness in his Throat. He was order'd to be blooded, and had an Emetic given him: This operated but little; he grew hot and restless, a deep Redness spread itself over his Face, Hands, and Arms, with a plentiful Eruption of small Pimples, which induced those about him to apprehend it was a Scarlet Fever.
The next Day, which was the second of the Disease, his Throat continuing sore, and the feverish Symptoms increasing, a Purge of Manna was given him, which operated gently; and at Night his Head and Throat being more uneasy, his Heat still continuing, with a Tendency to Delirium; a Blister was applied.
On the third, the Symptoms not abating, he lost about ten Ounces of Blood. He had taken a cooling nitrous Powder every four Hours; this was now changed for one more cordial. At Night he grew delirious, his Fever increased, and he had some loose Stools, which were rather encouraged than restrain'd, as it was hoped they might relieve him. Blisters were applied to his Head and Arms.
On the fourth in the Morning I was sent for: I found him delirious, with convulsive Twitchings; his Hands in constant Motion, gathering the Bed-cloaths; his Pulse quick and weak; his Tongue parched. With some Difficulty I looked into the Fauces; they seemed to be pale in some Places, intensely red or livid in others, with a glossy Brightness: His Excrements came away involuntarily; his Eyes were languid, and somewhat opake; he breath'd with Difficulty, and died in a few Hours after.
In some of the first Cases I met with, the Quickness of the Pulse, the Degree of Heat, the apparent inflammatory Redness of the Eyes and Face, and Pain in the Head, some times urged me to order Bleeding, especially if there were any Marks of a Plethora; but in these Cases it did not appear to have any advantageous Effects: So that, notwithstanding the Urgency of the Symptoms above-mention'd, it seems proper in general to omit this Evacuation.
Cupping with Scarification has been applied to the Shoulders and Back of the Head, in order to remove an acute Pain of this Part, which is often complain'd of, but, as far as I have been able to observe, without much Benefit.