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

As it appeared in Spain, Italy, Sicily, &c.

The Disease which was called by the Spaniards _Garrotillo_[1], by the Italians, and other Nations, Morbus strangulatorius, Pestilens Faucium Affectus, Epidemica Gutturis Lues, and by divers other Appellations[2], is said to have appeared first in Spain about the Year 1608, to have spread from thence to Malta, Sicily, Otranto, Apulia, Calabria, and the Campagnia, in the Space of a few Years; and to have broke out at Naples in 1618, where it continued upwards of 20 Years ravaging the different Parts of that Kingdom[3].

It is not certainly known how much longer it remained in these Countries, or to what others it was communicated at that time, its Declension being as obscure as the Causes it sprung from. That it wholly disappeared in these Parts, soon after the Time above-mention'd, seems probable, from the Silence of those Physicians, who have published their Observations made in the Places, which had so severely felt the Effects of this Distemper.

Several Writers, as _Wierus_[4], _Forrestus_[5], _Ramazzini_[6], and others, take notice of epidemic Affections of the Throat, in some respects resembling the Disease here described; but a little Attention to the Symptoms of each, will, I think, discover an essential Difference between them. The same may be said of the Sore Throat and Scarlet Fever, which shew'd itself at Edinburgh in 1733[7].

Tournefort, in his Voyage to the _Levant_[8], seems to have found the Disease we are treating of in the Islands of the Archipelago; at least as far as one can judge from the imperfect Description we have of it. His Account is as follows.

"When we were in this Island (Milo), there raged a terrible Distemper, not uncommon in the Levant: It carries off Children in twice 24 Hours: It is a Carbuncle or Plague-Sore in the Bottom of the Throat, attended with a violent Fever. This Malady, which may be called the Child's Plague, is epidemical, tho' it spares adult People. The best way to check the Progress of it, is to vomit the Child the Moment he complains of a sore Throat, or that he is perceived to grow heavy-headed.

This Remedy must be repeated, according as there is Occasion, in order to evacuate a sort of Aqua fortis, that discharges itself on the Throat. It is necessary to support the Circulation of the Juices, and the Strength of the Patient, with spirituous Things; such as the Theriaca, Spir. vol. oleos. aromat. and the like. The Solution of Liquid Styrax in Brandy is an excellent Gargarism upon this Occasion. Tho' it is a Case that requires the greatest Dispatch, the Levantines are seldom much in Haste in the Cure of any Disease."

This Account does not disagree in general with that which has been left us of the Morbus strangulatorius; only he is singular in affecting it to arise from a kind of Aqua fortis discharged upon the Parts: But his favourite Study had engrossed his Attention, and to this we must impute both the present Mistake, and his Want of sufficient Accuracy and Precision, when he treats upon medical Subjects.

When it first broke out in the Countries above-mention'd, it soon engaged the Physicians of those Times, as well to observe its Nature and Effects, with whatever might contribute to its Cure, as to vindicate their respective Systems and Opinions, which some of them did with a great deal of Warmth. Out of such of the Tracts that were then published as I have had an Opportunity of perusing, and which indeed are not so many as I could wish, the following Account has been collected. I shall here mention the Authors to whom I am principally indebted for it.

Johannes Andreas Sgambatus, a Physician of Naples, who published a Treatise upon this Subject in 1620[9]. He gives us a methodical and pretty exact History of the Symptoms of this Disease, and the Method of Cure both general and topical, together with a summary View of the Disputes which at that time were managed with sufficient Heat and Acrimony in relation to its Name, Cause, and Nature; about which they were as much divided as they were about the Method of Cure; each Party appealing to Hippocrates, Galen, Avicenna, &c. for the Support of their Opinions concerning a Disease, which it is not certain that those whom they appeal to ever saw.

Johannes Baptista Cortesius, in his _Miscellanea medica_[10] takes notice of this Disease, and describes its principal Symptoms, in a Letter to Jo. Anton. Anguilloni, Physician in chief to the Maltese Gallies. He considers it indeed as a different Distemper from that which infested Naples, and other Parts of Italy; tho', from his own Account of it, there appears little Reason to question the Identity. He seems to have been led into this Mistake, by considering the Disease he treats of as contagious only in a certain limited Sense, whilst the Italians declared theirs to be pestilential and contagious without Restriction. He allows, that the Breath of a Person affected might convey the contagious Effluvia to another near at hand; and gives an Instance of one who got the Disease, and died of it, by trying, at his Friend's Request, who then labour'd under this Disease, if his Breath was affected[11]: for from this Circumstance they guessed at the Degree of Danger attending them.

In 1636, Ætius Cletus, of Signia in Italy, published his Treatise _De Morbo strangulatorio_[12]. He mentions some Facts relating to it, that had escaped Sgambatus and Cortesius, which will be taken notice of hereafter.

Marcus Aurelius Severinus, Professor of Anatomy and Surgery, and Physician to the Hospital of Incurables at Naples, wrote a Dissertation upon this Disease, under the Title of '_Pædanchone Loimodes, seu de pestilente ac præfocante Pueros Abscessu_'; and annexed it to the second Edition of his Book De recondita Abscessuum Natura, which was printed

in 1643[13]. From a Person of his Capacity, and furnished with the best Opportunities of seeing the Disease in every Stage and Condition, we might reasonably expect such Observations as would enable one to form a just Idea of this Distemper; but we meet with very little of this kind in his Performance. He has indeed mention'd some Circumstances relating to its History, not taken notice of by the other Writers I have seen, and his Method of Cure is different from the rest; but he refers us to others for an Account of the Symptoms, and contents himself with reciting and commenting upon Aretæus's Description of the Ulcera Syriaca, which he takes for granted to be the same with the Disease he treats upon; yet does not put it in our Power to compare them, by giving a candid Relation of the Symptoms.

One might justly expect some curious Observations upon this Disease, from a Person so well qualified for it as Thomas Bartholine: He was in Italy whilst it raged there, and it might be supposed, would be attentive to the minutest Circumstance relating to it, and be inquisitive enough to know what Men of Character had said upon it. But the Treatise which he wrote upon this Disease, and publish'd in 1646[14], contains so little to the Purpose, that it is difficult to conceive for what End it was wrote, unless to compliment his Master Severinus, which he does very liberally.

ACCORDING to the Accounts which have been left us by these Authors, it appears, that the Disease which they describe was most particularly fatal to Children; tho' Adults, if they were much conversant about the Sick, were very often seized with it; yet more of these recover'd in proportion than of Children; and it was observed, that more Boys got well through the Disease than Girls; some thought, that such of this Sex as had black Eyes suffer'd more from it than others.

As it was sometimes observ'd to carry off whole Families together, and to spread to those Places first, where the Communication with the Country affected by it was most frequent; and also that Children sent away in order to avoid it, escaped whilst they remained there, but had it on their Return, if the Disease was not extinguished; it was almost universally allow'd to be contagious[15].

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.