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

In the Winter of 1746, so many Children died, and so suddenly, at Bromley near Bow in Middlesex, of a Disease that seem'd to yield to no Remedies or Applications, that the Inhabitants began to be alarmed with Apprehensions that the Plague was broke out amongst them; some losing all, and others the greater Part of their Children, after a few Days Indisposition. Some others of the neighbouring Places were affected at the same time, tho' in a less Degree, with the same Disease; which, from all the Accounts I have met with, from those who attended the Sick, was the Disease here treated of.——It still continues in this City, and sometimes shews itself in the Villages about it, though at present with so mild an Aspect, as seldom to prove fatal; unless the Subject is very unfavourable, or the Disease hath been neglected, or improperly treated at the Beginning; which Circumstances, tho' of Moment in all Cases, yet are very much so in this, as a wrong Step at the first, may put it out of the Power of Art to afford Relief.

It is observed here, as well as in those Countries where the Angina maligna was first taken notice of, that Children and young People are more exposed to it than Adults: A greater Number of Girls have it than Boys; more Women than Men; and the infirm of either Sex suffer more from it than the healthy and vigorous.

If it breaks out in a Family, all the Children are commonly affected with it, if the healthy are not kept apart from the sick; and such Adults as are frequently with them, and receive their Breath near at hand, often undergo the same Disease.

It generally comes on with a Chilness or Shivering like that of an Ague-Fit: This is soon follow'd by great Heat; and these interchangeably succeed each other during some Hours, till at length the Heat becomes constant and intense. The Patient complains at the same time of an acute Pain in the Head, of Heat and Soreness in the Throat, commonly of great Sickness, with Vomiting, Purging, or both. The Face soon after looks red and swell'd, the Eyes inflam'd and watry; with Restlessness, Anxiety, and Faintness.

This Disease frequently seizes the Patient in the fore Part of the Day: As Night approaches, the Heat and Restlesness increase, till towards Morning; when after a short disturbed Slumber (the only Repose they often have during several Nights), a Sweat breaks out; which mitigates the Heat and Restlessnes, and gives the Disease sometimes the Appearance of an Intermittent.

If the Mouth and Throat be examin'd soon after the first Attack, the Uvula and Tonsils appear swell'd; and these Parts, together with the Velum Pendulum Palati, the Cheeks on each Side near the Entrance into the Fauces, and as much of them and the Pharynx behind as can be seen, appear of a florid red Colour. This Colour is commonly most observable on the posterior Edge of the Palate, in the Angles above the Tonsils, and upon the Tonsils themselves. Instead of this Redness, a broad Spot or Patch of an irregular Figure, and of a pale white Colour, is sometimes to be seen, surrounded with a florid Red; which Whiteness commonly appears like that of the Gums immediately after having been pressed with the Finger, or as if Matter ready to be discharged was contained underneath.

Generally on the second Day of the Disease, the Face, Neck, Breast, and Hands to the Fingers Ends, are become of a deep erysipelatous Colour, with a sensible Tumefaction; the Fingers are frequently tinged in so remarkable a manner, that, from seeing them only, It has not been difficult to guess at the Disease.

A great Number of small Pimples, of a Colour distinguishably more intense than that which surrounds them, appear on the Arms, and other Parts. They are larger, and more prominent in those Subjects, and in those Parts of the same Subject, where the Redness is least intense; which is generally on the Arms, the Breast, and lower Extremities.

As the Skin acquires this Colour, the Sickness commonly goes off, the Vomiting and Purging cease of themselves, and rarely continue after the first Day.

The Appearance in the Fauces continues to be the same; except that the white Places become of a more opake White; and it is now discoverable, that what at first might have been taken for the superficial Covering of a suppurated Tumor, is really a Slough, concealing an Ulcer of the same Dimensions.