Fowle's New Hampshire Gazette And General Advertiser

The following Observations and Remarks on the putrid malignant SORE THROAT, which has prevailed for three years past in many parts of the country, and now in this town, being much approved of by the Faculty, is with pleasure handed to the public.

At a time when a most pestilential and contagious disease is making its progress through a country, marking its way with the most calamitous circumstances, any attempt to investigate the real nature of the disorder, to mitigate its violence, and if possible, to prevent its destructive effects, is not only in itself laudable, but a duty highly incumbent on those who have the lives of their nearest connections, friends, and neighbours, committed to their care: This consideration alone, has produced the following observations and remarks. They were thrown together at a late hour, after the fatigues of a busy day, as well for the author's own satisfaction, as the purpose of adopting some concise and regular method of treating a disease that is so rapidly spreading, and in all probability will become general, amongst us: They were shown to some medical friends, at whose pressing solicitations they are now, with the utmost diffidence, submitted to public inspection.

The author is not unaware that he has laid himself open to criticism and censure; but he will as patiently bear the one as be regardless of the other, should he stimulate those of superior abilities, and more extensive medical knowledge to improve on these imperfect hints, and favour the public with their opinion, that from the united endeavours of all, some effectual method may be obtained to mitigate the violence of so distressing a disease.

The present putrid malignant Sore Throat, as far as we are able to learn, first made its appearance in Sanford, Coxhall, and several other new settled towns in the upper part of the county of York, & commonwealth of Massachusetts, in the fall of the year 1784, since which it has been slowly spreading, though more rapidly in the back towns than toward the sea-coast.

The three last years have not been marked with any remarkable circumstances as to the weather, or state of the air; the two last winters were not uncommonly severe, and the summers have been remarkably temperate, nor has any great degree of dry or moist weather prevailed, a foggy day or night has scarcely been known in any part of the seasons, and more general health never prevailed through the country, excepting in the summer of 1784; when puerperal fevers were remarkably common through the country in general, and proved fatal to a great number of women.

Whatever then may be the remote or predisposing cause of the present disease, must remain one of those mysteries that baffle human researches. Blindly to puzzle for peccant causes, is oftentimes as futile and absurd, as prescription founded on prejudice and conjecture are unjustifiable.

The author has had an opportunity of seeing a considerable number under the present disease, he has most attentively marked the symptoms, compared them with the disorders that he thought similar, as described by a number of authors; he has taken the opinion of some aged, and formerly eminent practitioners, and on the whole he is persuaded that the present contagious disorder, is a disease, sui generis: it differs from that destructive disorder that formerly prevailed in this country known by the name of the Throat-Distemper, this was a dreadful disease indeed! much more mortal than the present one, often destroying in a few hours after the attack, while the innocent victim was diverting with its toys, and its fond parents unsuspicious of danger. Many were suddenly carried off, when no marks of the disease appeared, more than a superficial pustule or small inflamed ulcer, on a finger or toe: he has not seen, or heard, of any like effects in the present disease; however it may not be improbable, that the former malignant disease may associate with the present one, as they are both disorders of a highly putrid nature, the disposing cause in the air, and constitutional disposition in the habit, may produce them both in the same season; yet out of a very considerable number he has seen, not more than one or two have appeared to have had the real Throat-Distemper. Nor is the present disorder that which often prevails, and is commonly called the Scarlet-Fever this is most evident, from numbers that are now under the present disease, who heretofore have had the Scarlet-Fever, a disorder that has not been known to attack the same persons a second time, besides, an efflorescence always appears in the Scarlet-Fever: indeed, it is a characteristic of this disease, but in the present disorder one third, at least, are free from every appearance of eruption.

The ulcerous Sore Throat of Doctor Huxham, the cynanche-maligna of Doctor Cullen, are in many cases a good description of the present disease, the putrid Sore Throat of Doctor Brooks, more accurate: the Scarlatina Anginosa, of Doctor Withering, he has not seen. The present putrid sore throat is contagious, more so with children, frequently with those from twenty to thirty years of age, and those of more advanced life do not always escape. It is a disease of a highly putrid nature; this is most evident from the appearance of the sloughs and ulcers in the throat--the offensive putrid smell of the breath so soon after the patient begins to complain; the petechial spots which, in many cases, are dispersed over different parts of the body.

The attack is often sudden, and the symptoms increase very rapidly; persons have been perfectly well at noon, in the evening in the most disagreeable circumstances; a most violent fever, pain, and stiffness in the neck; the uvula, and tonsils, so swelled as almost to close up the throat; in others the symptoms advance more slowly, beginning with slight rigors, and sickness, but in all, sooner or later, there is great increased heat, restlessness, difficulty of breathing, with an exceeding full and quick pulse: and very soon the uvula, and tonsils, and in some the whole inside of the throat will be covered with white, or ash-coloured spots, these enlarge and become thick sloughs; the tongue exceedingly foul at the basis, and in young subjects, a remarkable drowsiness; --all these Symptoms increase, and are greatly aggravated towards the evening; on the second or third day an efflorescence of a deep erysipelatous colour appears, more especially on the face, neck, breast, and hands, all which appear to be a little swelled, the fingers more evidently so, and, in many, tinged in a remarkable manner;-- if these parts be accurately viewed, an infinite number of small pimples, of an intense scarlet colour, will be perceived:--But here, different from other eruptive disorders, the patient gains no relief, nor are the symptoms the least extenuated by this large depumation on the skin, on the contrary, the pain, heat, and anxiety increase; at night a delirium frequently comes on, which generally goes off in the morning, with an abatement of the other symptoms, but returns again with equal violence towards the evening. The tongue and mouth become more foul; the sloughs in the throat increase so as almost to prevent breathing, these are frequently thrown off in large flakes, and leave deep, painful, and sometimes bleeding ulcers, behind them; from the inside of the nostrils, especially in children, is discharged large quantities of a thin, putrid matter, of a most corrosive nature, excoriating whatever it touches;--in infants this virulent matter often passes down the œsophagus into the stomach and intestines, bringing on sickness, vomiting, and violent purgings; the fine membrane that lines the pharynx is corroded off, the epiglottis loses its action, by which every thing the child endeavours to swallow passes the wrong way (as the common phrase is) strangles, and flies back through the nose; a hoarseness and whooping (which by the by is generally a fatal symptom, however mild and favourable other appearances may be) comes on, suffocation and death suddenly take place; about the 5th day, sometimes sooner, and sometimes a day later, all the symptoms become more and more aggravated; the heat, restlessness, difficulty of breathing, and delirium constant;--the pulse small, but excessive quick; the sloughs in the throat thicken, and change to a dark livid colour; the foetor from the breath intolerable; the efflorescence on the skin disappears, or becomes of a dark crimson colour, with petechial spots dispersed about on the legs, thighs, and sometimes other parts of the Body; the difficulty of breathing increases; the patient falls into a stupor, and death suddenly closes the scene.-

Those that have the disease more favourable, generally have an abatement of all the symptoms on the 4th day: the efflorescence on those that have it) for as was before observed, one third of the patients have no appearance of eruption) disappears; the sloughs in the throat separate and come off; and leave ulcers that readily heal;-- in some a hardness and tumefaction of the parotid glands remain, in others a dry hoarse cough, these however soon give way to proper remedies.

(To be continued)