An Account of the Sore Throat Attended With Ulcers / A Disease Which Hath of Late Years Appeared in This City, and in Several Parts of the Nation

by John Fothergill

It is necessary that the Patient should keep in Bed as much as may be, tho' the Disease should seem to be slight: It has happen'd, for want of Care in this Respect, that a Purging has come on, the Redness of the Skin disappeared, and a Disorder, which with Confinement alone would probably have gone off in twice 24 Hours, has been render'd tedious and difficult.

If we are called in at the first, while the Sickness or Vomiting continues, it will be of Use to promote this Discharge, by giving an Infusion of Green Tea, Chamomile-Flowers, Carduus, or a few Grains of Ipecacuanha. In some Instances, where the Attack has been severe, and this Method practised, the Disorder has gone off with more Ease than was at first apprehended.

If these Symptoms don't abate with the Operation of the Emetic, small Draughts of Mint-Tea, with a sixth Part of red Port added to it, may be given frequently; together with some grateful and warm aromatic, cordial Medicine, every four or six Hours. The Pulvis Contrayervæ simp.—comp. Confect. cardiac.—Raleigh. Spec. arom. Vinum croceum; Aq. Menth. spirit. Aq. Alex. spirit. cum Aceto; with others of the like Nature, may be used for this Purpose.

In this Disease it is at all times necessary to attend very carefully to the Diarrhœa. For the most part it ceases with the Vomiting, in less than twelve Hours from the first Attack: If it continues longer than this Period, it is necessary to check it, otherwise it occasions great Faintness, sinks the Strength, and in the End produces very dangerous Consequences. The aromatic Cordials above-mention'd, if they are given plentifully, commonly take off this Symptom, as well as the Vomiting; but if they prove ineffectual, Recourse must be had to Astringents and Anodynes, in proportion to the Exigence of the Case; such as the Confectio Fracastorii, or Elect. e Scordio cum Opio, dissolved in small Cinnamon-water, and given post singulas sedes.

It is common for the Redness, so often mention'd, to appear upon the Skin, as these Discharges abate: It has happen'd that this Colour has gone off sometimes, and the Patient has been brought into imminent Danger, upon giving a mild Cathartic: Which Circumstances, as they point out a close Connexion between them, indicate the Use of a warm Regimen, notwithstanding the Heat and other Symptoms might seem to forbid it.

A Girl about 9 Years old, of a slender Make, but healthy and active, was seized with this Disorder. The Sickness and Vomiting went off, and the Redness of the Skin appeared soon after: The Apothecary who attended her, judging it an inflammatory Case, as she complained of her Throat, bled her, gave her a cooling Purge the next Day, and afterwards some nitrous Draughts. A plentiful Efflorescence which cover'd the Face, Neck, and Arms, suddenly disappeared; a Diarrhœa came on, she grew restless, faint, and insensible. In this Condition I first saw her on the third Day of the Disease; she frequently sigh'd, her Pulse was quick, small and hard, without any remarkable Colour upon her Skin; and the Swelling on each Side the Neck large: It was not possible to examine the Fauces, as she lay in a comatous helpless Condition, her Stools and Urine coming away insensibly. A warm cordial Mixture was frequently given her, upon which the Diarrhœa soon abated; and the next Day the Efflorescence again appeared upon her Face and Arms. From this time she continued to recover, tho' slowly, and was for some time attended with a Cough and hectic Heats.

Another Symptom which requires our Attention in the Cure of this Disease, is an excessive Faintness: Of this they generally complain soon after they are taken ill, and continue to do so, if sensible, till the Distemper begins to abate: The Urgency of this Symptom seems to indicate the Degree of Danger: It is more or less violent, as the Disease is mild or malignant; and an Abatement of it may be look'd upon as a sure Presage of Recovery.

Warm aromatic and gently stimulating Medicines, such as have, been already mention'd, as the most effectual to suppress the Vomiting, and check the Looseness attending this Disease, have likewise been found useful in removing the present Complaint: And tho' the Degree of Heat, and Quickness of the Pulse, would be enough to dissuade a Person who has not seen the Disease, from giving them in so liberal a manner as Necessity requires; yet we are not to be governed so much by these Symptoms, as by the Faintness, Depression of the Pulse, and Increase of Putrescency in the Fauces. One Drachm of the Confectio Raleighana has been given to a Youth not quite 15 Years of Age, every four Hours, which was soon follow'd by a sensible Amendment, and the Decrease of the Patient's Restlessness, Faintness, and Heat.

Some of the Italian Physicians forbad the Use of Wine in the Cure of this Disease, and the Warmth of that Climate might perhaps make this Caution necessary; but as it is a generous Cordial, and at the same time antiseptic, it seems to be in no respect improper here; and, besides in Whey, I have allow'd it to be given, in small Quantities, mixed with Mint, Baum, or Sage-Tea, Barley-Water, Gruel, Panada, Sago, and suchlike; and alone, where the Faintness has been excessive; the Age, the former Way of Life, and the Symptoms, affording the necessary Rules as to Quantity and Kind. Chicken-Water, or thin Broth, may also be allow'd; which is frequently very acceptable to the Patient. And I don't remember to have observed so general and early an Inclination after solid Food, in any acute Disease, as in this: For at a time when one would imagine, both from the Condition of the Fauces, and the Degree of Heat, that Liquids would be the most acceptable, it is not uncommon to find Children, who have this Disease, extremely desirous of Chicken, and chearfully complying with Directions, in hopes of being gratified in this respect.

Blisters are likewise of Use to relieve the Faintness. At first I was in Doubt, lest the Flies, by their Acrimony, should increase the putrescent Disposition, and consequently aggravate the Disorder they were intended to remove: but no such Effect having appeared from their Use, I have order'd them to be applied, and I think with Advantage, both to the usual Parts, and to the Neck on each Side from below the Ear almost to the Clavicle, as Occasion required.