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

Those who were Seized with it, first complained of a Pain in the Throat, with a Stiffness of the Neck, an Uneasiness upon Motion, and a Difficulty in Swallowing their usual Nourishment. On Inspection, the Uvula, the Tonsils, Pharynx, and the whole Fauces, appeared of a remarkably florid red Colour, like that attending an Erysipelas: This Colour was not uniformly intense, but Some Parts Seemed to be of a deeper Dye than others. The Parts above-mention'd were swell'd more or less, tho' seldom so much as to affect Respiration, as in a common Angina; but the Sick could not Swallow without Pain. An acute Fever came on at the same time, which in Some was accompanied with small Pimples and Eruptions like Flea-bites. Several had Vomitings, according to an Observation of Severinus[^[16]].

On the same Day, or the Day following, such Parts of the Fauces as at first seem'd to be of a deeper Colour than the rest, turn'd white; this did not proceed from any Crust or Matter superinduced upon the Parts, but from a gangrenous Colliquation, the Substance itself being mortified.

The Voice was hoarse and obscure; not as in a common Cold, but as it is in those People who have venereal Ulcers in the Throat: So that, from this Circumstance alone, some were able to guess at the Disease.

The Neck and Throat soon after began to swell externally; the Tumour was of a soft œdematous kind, and increased in Magnitude as the Disease advanced. All the Symptoms were commonly aggravated during the Night. If the Patients had any Interval of Quiet, it was commonly in the Day-time[^[17]]. About the fourth Day this Tumour was generally grown very large, and the white Places in the Fauces began to turn black; the Breath grew extremely offensive; Respiration, hitherto not much affected, now became difficult, and the Patient expired in a very short time.

Tho' this was the common Progress of the Disease, where it terminated unhappily, yet it often varied from this Type, and was attended with very different Symptoms. Some had a Difficulty of breathing almost from the first; some had a violent Cough; some were comatous; others had a Delirium; some died in a lethargic Stupor; others bled to Death at the Nose; whilst others again had none of these Symptoms, but were carried off suddenly by an instantaneous Suffocation. The Oesophagus in some was sphacelated to the Stomach; the Aspera Arteria, in others, to the Lungs: As these could only breathe in an erect Position; so those could swallow nothing when the Parts were so affected. The Nostrils discharged a fetid pituitous Ichor, sometimes mixed with Blood; and sometimes Blood alone, without Mixture. This bleeding at the Nose seem'd at first, in one Case, to give Relief; but the Patient soon after died[^[18]].

These were the Symptoms in general, and they judged of the Event by the Mildness of their Progress, or the contrary: Tho' it was agreed, that nothing could be more fallacious than this Disease; and that the most Experienced were often deceived in their Prognostic.

If the Redness above described, which appeared at the first being seized, was succeeded by an Ulceration, without any of that Whiteness (which for the future I shall call Sloughs), if the Swelling about the Neck and Throat was not large, if the Patient discharged by the Mouth considerable Quantities of thin pituitous Matter, if the Breath was not fetid, and the Patient had no Disgust to his Food, if the Eyes retain'd their proper Lustre, all was judged to be secure.

On the other hand, if this Lustre was in any degree faded[^[19]], if the external œdematous Tumour was very large, if the Breath stunk, if the Fauces were livid or black, with a Coma, or Delirium, if with these the Patient had an Aversion to his Nourishment, and his Breathing became difficult or laborious, the Danger was judged to be extreme.

It was not observed that the Disease had any stated Crisis; or that the Signs of Recovery, or Death, appeared on any certain Day. Some died on the first, others on the second, third, and on every Day, to the seventh. Those who survived the fourteenth, were thought to be out of Danger, at least from the Disease itself[^[20]]; tho' some dropp'd off unexpectedly, after a much longer Reprieve[^[21]].

The Consequences of this Disease were often felt a long time after it had ceased: An excessive Languor and Weakness continued for many Months; and the Voice or Deglutition was frequently affected, so as to be perceivable in some almost a Year after[^[22]].