The Ulcers in the Throat demand our early and constant Attention, as a considerable Loss of Substance cannot here be suffer'd without immediate Danger to Life itself, or the most pernicious Consequences to the future Action of the Parts, if the Patient survives.
Where the Disease is of the mildest kind, a superficial Ulceration only is observable; which may easily escape the Notice of a Person unacquainted with it. A thin, pale, white Slough seems to accompany the next Degree: A thick, opake, or ash-colour'd one is a further Advance: And if the Parts have a livid or black Aspect, the Case is still worse. These Sloughs are not formed of any foreign Matter covering the Parts affected as a Crust or Coat, but are real Mortifications of the Substance; since when they come off spontaneously, or are separated by Force, they leave an Ulcer of a greater or less Depth, as the Sloughs were superficial or penetrating.
When the Tendency to Putrefaction is stopp'd, these Sloughs in most Cases come off spontaneously; or their Separation may be promoted by suitable Remedies and Applications: But it seems by no means adviseable to attempt it by Scarification, scraping them off with the Fingers or Instruments, as Severinus proposes; since the Experiment has been tried, but with such unhappy Consequences[[30]], as are sufficient to discourage one from persisting in this Method.
In a Case where I was concerned, previous to my being called in, a Surgeon had endeavour'd to separate the Sloughs by the Assistance of his Probe: He succeeded in his Attempt without much Difficulty; but was surprised to see the same Parts cover'd the next Day with thick, dark, ash-colour'd Sloughs, penetrating deep into the Substance, with an Increase of every Symptom.
It is true, the Sloughs have been sometimes scarified, from an Apprehension, that Matter was lodg'd underneath them, without any manifest Inconvenience; but as there are Instances of fatal Mortifications having ensued, it seems most prudent to decline the Practice.
From under these Sloughs, and from every Part of the Ulcers which they cover, a thin corrosive Ichor is discharged, so acrid as to excoriate the external Parts upon which it is suffer'd to remain. This is sometimes observable in Adults, when the Parts above the Fauces are affected; the Ichor in these Cases flows thro' the Nostrils, and frequently raises Pimples on the Skin of the upper Lip; but it is most obvious in Children, who often have this Part, the Corners of the Mouth, the Cheek of that Side on which they most commonly lie, blister'd or excoriated.
It is probable, as hath been already hinted, that Part of the same virulent Matter, passing down the Oesophagus into the Stomach and Intestines, acts upon them as it does upon the Skin, when applied to it externally; it frets and corrodes the Parts it touches, and produces that Sickness, Vomiting, Purging, and Faintness, which sometimes accompany this Disease in different Parts of its Progress.
In Children, and very young Subjects, the Symptoms arising from this Cause are yet more dangerous: The natural Softness and Laxity of the Parts liable to be affected, disposes them to suffer by it much more than Adults: At the same time they are commonly alike incapable of promoting the Discharge of this Matter themselves, and of admitting Assistance from others, being generally, if the Distemper is acute, either comatous and stupid, or delirious and untractable. If Gargles are injected, they either prevent them from reaching the Seat of the Disorder, by their Tongues, or they swallow them, and the putrid Taint of the Ulcers, together; the Mischief spreads beyond the Power of Art to restrain it; violent Purgings ensue, or fatal Hæmorrhages from the penetrating Gangrene. And to this, perhaps, it may in part be owing, that Children suffer so much more from this kind of Sore Throat, than Adults.
That this corrosive Matter produces these Effects, is farther confirm'd, by observing, that those whose Throats are severely affected, if they have a plentiful Discharge from the Fauces, are seldom attended with Sickness, Vomiting, or excessive Faintness; though, after longer Sleeps than ordinary, or a Neglect of encouraging this Evacuation, they have complain'd of Sickness, and have had Reachings come on: Likewise, that in such Cases, where little or no Discharge of this kind appears, the Symptoms are commonly the most dangerous.
From hence it is obvious that great Advantages may be expected from the constant Use of gently stimulating aromatic Gargles; as they promote the Discharge of the pituitous Matter flowing to the Fauces, and, doubtless, with it, of some Part of the corrosive Fluid above-mention'd: To which if we add Antiseptics and Detergents, in order to check the Progress of the Mortification, and cleanse the sordid Ulcers it produces, every Indication is provided for.