C. malign, malignant, or putrid sore throat. This disease, whether primary or symptomatic, is marked by frequent cold shiverings, alternating with fits of heat, giddiness, lassitude, anxiety,depres thon of spirits, nausea, and vomiting : these symptoms seldom continue long, before the patient complains of a sense of stiffness in the neck, some uneasiness in the internal fauces, and hoarseness; the internal fauces, when viewed; appear of a dark red colour, are but little or not at all swollen, and deglutition is seldom attended with difficulty or pain. in a short time, a number of white, ash-co loured, or brown spots make their ap pearance upon the inflamed parts ; these spread, run together, and cover the greatest part of the fauces with thick sloughs, which, upon falling off, discover deep ulcerations. As the disease advan ces, these symptoms are generally at tended with a coryza, which pours out a thin, acrid, and fetid matter, which exco riates the nostrils, lips, and sometimes every part it touches; in infants diarrhcea is a more frequent occurrence than in adults, and the thin acrid matter evacuat ed excoriates the anus and neighbouring parts. The fever increases with the other symptoms ; the skin is dry, parched, and accompanied with a biting heat ; the eyes become red, heavy, and watery ; the countenance is either full and bloated, or pale, shrunk:, and dejected, and the pa. ticnt frequently complains of an unusual sense of oppression and debility ; the pulse is small, frequent and irregular ; the respiration is more or less hurried ; and as the disease advances, the breath becomes very fetid, and is often disagree able to the patient himself; and there is generally a considerable discharge of a sanious-like matter from the fauces; the voice is frequently very much' altered, and when the inflammation has attacked the organs of respiration, it assumes a wheezing or ringing sound, the respira tion becomes difficult, and the patient is teased with a troublesome cough ; the fever suffers an evident exacerbation in the evemng, during which some rattling is perceived in the breathing, and there is generally a remission in the morning ; great debility, prostration of strength and restlessness, accompanied with fre quent sighing, as in the Typhus Gravior, supervene, and, if neither delirium nor coma appeared at an early period, they generally come on in the progress of the complaint. On the second or third, rare= ly later than the fourth day, an eruption appears upon the skin, which, for the most part, in the first instance, shews it self upon the neck and breast . it comes out in blotches of a dark purple or rasp berry hue, and gradually spreads over the trunk and extremities; the scarlet redness is often considerable on the hands and extremities of the fingers, which feel stiff and swelled; the stains, when nearly inspected, appear to be composed of small prominences, which may sometimes, although rarely, be dis tinguished by the eye, more frequently by the touch only ; the eruption is as ir regular in its appearance as it is in its steadiness and continuance ; it generally, however, disappears about the fourth day. and a desquamation of the cuticle takes place ; but neither on its first ap pearance, nor on its desquamation does it always produce a remission of the fever or of the other symptoms, except the vomiting, which generally abates on its first appearance. As the disease advan ces, the ulcers on the fauces become of a livid or black colour, the pulse becomes more depressed, and the symptoms at tending the latter stages of the Typhus Gravior come on, and the patient is gene rally cut off; either by a diarrhcea, or by a profuse hemorrhage from the intesti nal canal, nose, mouth, or ears, often on the third day, sometimes later, but for the most part before the seventh. The complaint sometimes spreads into the trachea ; the parotid and the other lym phatic glands also in the vicinity of the fauces, in consequence of the absorption of the putrescent matter, are sometimes so much swollen as to endanger or induce suffocation.
Cause:. This disease is produced by a specific contagion, and those will be more liable to be attacked by it who are of a sickly habit of body, and who have been exposed to the remote causes of the Ty phus Gravior. It has been frequently ob served of this, as of most other epidemics, that it is most fatal on its first appearance, gradually becoming milder till towards the end, when it is attended with scarce any danger ; at the same time, other com plaints seldom prevail much while it rages, or, if they do, are generally cate nated with its symptoms.
nvaiment. In the management of this often fatal and insidious disease, we must keep its tendency to depression of strength and gangrene constantly in view, and at the samo time attend to certain troublesome symptoms which frequently accompany this disease. Emetics. at the
commencement, must on no account be dispensed with ; but as in this species of Cynanche there is so great a tendency to diarrhoea, they should in general consist of ipecacuanha only : sometimes, how ever, a small portion of Dr. James's pow der may be added with advantage. The intestinal canal must be evacuated by the most gentle laxatives, for which purpose the mercurial carthartics are particularly recommended ; in the more advanced stages of the disease they will be impro per, as there is generally a spontaneous diarrhea : the regular expulsion of the fauces should be solicited by clysters only; but towards the termination, when the bowels are loaded with putrid sordes, accumulated in them during the disease, which protracts the fever and impairs the appetite, gentle cathartics will b e service able : even in this case we must not ven ture to employ them, unless the fauces have a healthy appearance, and there is a considerable abatement of the febrile symptoms. Small repeated blisters should be applied to the external fauces: rube facients, however, may in general be em ployed with equal advantage and more safety. The fauces must be preserved from the effects of the acrid matter dis charged from the ulcers by the diligent use of antiseptic, tar rather stimulating gargles, as the decoction of bark with muriatic or sulphuric acid, or the hark in port wine, a small quantity of which should be frequently employed or inject ed into the fauces by means of a syringe : a small quantity of a gargle, composed of alum, in the proportion of an ounce to a pint of water, is recommended to be fre. quently injected into the fauces, which is said to remove the fetor from the ul cers. But the most powerful gargle is prepared by mixing a tea-spoonful or two of the capsicum Romano, or Guinea pep per, and a tea-spoonful of sea-salt, with three ounces of distilled vinegar, and the same quantity of boiling water, a small quantity of which is advised to be taken into the fauces every two hours, so as to produce and keep up a moderate degree of excitement on the tonsils, uvula, and fauces. Wine, opium, bark, mineral acids, and the other remedies recom mended in the treatment of the Typhus Gravior, must be employed with assidui ty. As children can rarely he prevailed upon to take the necessary medicines in sufficient quantities, the bark and cor dials should be exhibited by clysters.
Diarrhoea is to be checked by opiates anti astringents, excepting it arise as a salu tary crisis towards the close of the disease, in which case rhubarb in gentle doses is the very best moderating remedy Rheurnatirmur, Rheumatism. Of this disease, there are two species, the Acute and the Chronic. The former generally commences with the usual symptoms of fever, preceded or succeeded by acute and pungent pains in the joints : the pain is not, however, confined to the joints ; but it frequently shoots along the mus cles from one joint to another : the parts Most commonly affected are the hips, knees, shoulders, and elbows, more rare ly the ankles and wrists : the pain is much increased upon the slightest mo tion, or even by the heat of the bed : there is some degree of swelling and red ness in the parts most affected, which are painful to the touch : the pulse is fre quent, full, and hard : generally costive : the urine at the commencement of the disease is high•coloured, and generally without sediment; but on the remission of the symptoms it deposits a lateritious one, and there is a tendency to sweating in the course of the disease, which rarely brings relief: an exacerbation of the fe brile symptoms takes place every even ing, and a remission towards morning, and the pains are most severe and most apt to shift their place in the night-time. Dr. Darwin suspects that rheumatism is not a primary disease, but the conse quence of the translation of morbid ac tion from one part of the system to ano ther, •• hich idea, he observes, is counte. nanced by the frequent change of place in rheumatic inflammation, and from its attacking two similar parts at the same time, as both ankles and both wrists, and these attacks being in succession to each other • and he further remarks, that this accounts for rheumatic inflammation so very rarely terminating in suppuration, as the original cause is not in the in flamed part ; but, instead of suppuration, a quantity of mucus or coagulable lymph, is formed on the inflamed membrane, which is re-absorbed, or lies on it, producing pains on motion long af ter the termination of the inflamma tion.