Dr. Huxham, of Plymouth, 1751 to 1753,1 "The disease began in various ways, but commonly with chills and heats, pressure and pain in the head, soreness of throat and hoarseness, some cough, sickness of the stomach, frequent vomiting and purging. These symptoms occurred more frequently in children, and were then very severe; in adults they were less emphatically expressed. From the beginning, there were in all a great dejection of spirits, very sudden weakness, great heaviness on the breast, and faintness. The pulse was generally quick, small and fluttering, though sometimes heavy and undose. The urine, commonly pale, thin, and crude, was, however, in many grown persons, scanty and high-colored, or like turbid whey. The eyes were heavy, reddish, and weeping; the countenance very often full, flushed and bloated, though sometimes pale and sunk.

"How slight soever the disorder might appear in daytime, at night the symptoms became greatly aggravated, and the feverish habit very much increased; sometimes even delirium appeared on the very first night, and this exacerbation constantly returned in the evening, through the whole course of the disease. Indeed, when it was considerably on the decline, I have been often surprised to find a patient had passed the whole night in a frenzy, whom I had left tolerably cool and sedate in the day. Some few hours after the seizure, and sometimes cotemporaneously with it, a swelling and soreness of the throat were perceived, and the tonsils became tumid and inflamed; and many times, even at the beginning of the attack, the parotid and maxillary glands swelled so greatly and suddenly as to threaten strangulation. The fauces also very soon appeared of a high florid red, or rather of a bright crimson color, very shining and glossy; and com. monly on the uvula, tonsils, velum palatinum, and back part of the pharynx, several whitish or ash-colored spots appeared

diphtheritic deposit, such as we have witnessed very frequently in Philadelphia.

1 Dissertation on the Maglignant Ulcerous Sore Throat, by John Huxham, M.D. London, 1759.

T. P. Wilson, M. D.

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DIPHTHERIA IN THE EIGHTEENTH CENTURY.

scattered up and down, which oftentimes increased very fast, soon covering one or both the tonsils, uvula, etc. These eventually proved to be the sloughs of superficial ulcers, (which sometimes, however, ate very deep into the parts.) The tongue at this time, though only white and moist at the top, was very foul at the root, and covered with a thick yellowish or brown coat. The breath also now began to be very nauseous; the offensive smell increased hourly, and in some instances became quite intolerable, even to the patients themselves.

"By the second or third day, the sloughs were much enlarged, and of a darker color, and the surrounding parts tended much more to a livid hue. The breathing became more difficult, with a kind of rattling stertor, as if the patient was actually strangling,—the voice being exceedingly hoarse and hollow, exactly resembling that from venereal ulcers in the fauces. This noise in speaking and breathing was so peculiar that any person in the least conversant with the disease might easily know it by this symptom alone; whence, indeed, the Spanish physicians named the disease garrotillo, expressing the noise made by those who are being strangled with a rope. I never observed in one of them the shrill, barking noise that we frequently hear in inflammatory quinsies. The breath of the diseased was very nauseous, of some insufferably fetid, especially in the advance of the distemper to a crisis; and many, about the fourth or fifth day, spit up a vast quantity of stinking, purulent mucus, tinged sometimes with blood, and sometimes quite livid. The nostrils likewise in many were greatly inflamed and excoriated, continually dripping down a most sharp ichor, or sanious matter, so excessively acrid that it not only corroded the lips, cheeks and hands of the children that labored under the disease, but even the fingers and arms of the very nurses that attended them. Not only the nostrils, fauces, etc., were greatly affected by this extremely acrid matter, but the windpipe itself was sometimes much corroded by it, and pieces of its internal membrane were spit up, with much blood and corruption. At

length the patient died tabid; though there were more frequent instances of the disease falling suddenly and violently on the lungs and killing in a peripneumonic manner."

Dr. Wall, of Worcester, 1751.1 "Aphthous ulcers and sloughs on the tonsils and parts about the pharynx. Very few patients had the scarlet efflorescence on the skin, which was rather an accidental than an essential symptom; but in some persons the skin was covered with petechia and purple spots; and in one or two, when the disease was far advanced, large black spots appeared on the tonsils." (Our malignant cases.)

"The complaint was evidently infectious and very liable to return. If they who had it were at any time afterwards. seized with a fever of a putrid kind, they seldom failed to have this complaint likewise. I have frequently known the parts very much swelled and covered with thick sloughs, though the sick person made little complaint of the soreness, and swallowed nearly as well as in perfect health.”

Mr. Rumsey, Chisham, 1793 and 1794.2 Diphtheritic Croup. "It was not confined to the town, which lies in a valley, but appeared with equal violence upon the neighboring hills, at a distance of five or six miles. The subjects were children from the first to the fourteenth year of their age, and it attacked many fine, healthy, robust children, as well as the pale, phlegmatic and delicate. The illness crept on imperceptibly at first, the patient appearing to be in good health, the countenance not altered, and, excepting at intervals, the appetite and spirits unimpaired; but it sometimes happened, that symptoms which had appeared trifling for two or three days, suddenly increased, and the disease then advanced so rapidly as to prove fatal before many hours had elapsed."

Mr. Rumsey met with about forty cases of this croup. The disease rarely proved fatal earlier than the fourth or fifth day;

1 Gentleman's Magazine, November, 1751.

2 Transactions of a Society for the Improvement of Medical and Chirurgical Knowledge, vol. ii. London, 1800.

often later. Two or more children in a family were sometimes seized with it, whilst on other occasions, when it proved fatal to one or two children, several others escaped without any particular pains being taken to keep the healthy apart from the sick. Many children suffered from erysipelatous inflammation behind the ears, in the groins, in the labia of girls, or wherever the skin folded, attended with very acrid discharge.

"At first the cough was dry, but in the course of the disease, by the third day or sooner, the passage of air was obstructed by viscid matter in the trachea, some of which was occasionally thrown up by cough or retching; and according to the quantity thrown up, respiration was more or less relieved. Several children brought up portions of a film or membrane of a whitish color, resembling the coagulated matter which was found in the trachea of those children whose bodies were opened. This was thrown off by violent coughing or retching, and the efforts made to dislodge it were often so distressing, that the child appeared almost in a state of strangulation. This was succeeded by an abatement of all the symptoms, until a fresh quantity of the same substance was formed, when the distress recurred as before.

'Most of the cases which occurred in November and afterwards, were attended with inflammation and swelling of the tonsils, uvula, and velum pendulum palati, and frequently large films of a white substance were formed on the tonsils. The swallowing was usually less impeded than might have been expected from the degree of disease which was observed in the throat."

Ghisi, Cremona, 1747 and 1748.1 "Deglutition was frequently free and unimpaired; there was great thirst; the countenance was pale, and there was a dry, harsh cough. Respiration was difficult, and the larynx almost always affected

1 Journal Général de Médicine, tom. xxxvii., p. 227. 1810.

by pain or a sense of pricking. The voice was shrill, pulse feeble and generally irregular, and the external fever scarcely observable. By and by these symptoms were followed by others of a more alarming nature; the pulse became extremely irregular and intermittent, the skin dry, and the extremities cold. There was excessive restlessness, so that even his bed became insupportable to the patient, and the respiration was most difficult and attended by agonizing efforts. The sufferers generally died on the third, fourth, or fifth day; sometimes, but rarely, as early as the second or as late as the seventh day. Although the cough was generally dry, the patient often, in the act of coughing, detached from the airpassages a substance very like the buffy coat of the blood or the pseudo-polypous substance met with in the heart or larger vessels after death. Many patients who had this tracheal form of angina continued to speak with a nasal voice, and to reject food through the nostrils for some time after recovery."

FRANCE.

Chomel, 1748. "At first the uvula was elongated; there was slight heat in the throat, accompanied by some pain; the tongue was more or less swelled, and there was generally a little fever. Insensibly and within the first twenty-four hours, one or other of the tonsils became covered with a white, aphthous spot, which, extending in every direction, reached the uvula, descended towards the pharynx, and ascended to the pituitary membrane. These symptoms were fully developed within two or three days.

"About the third day, an aggravation of the illness was manifested by an increase of fever, a faint unpleasant odor, observable on approaching the sick, and by a whitish eschar, which, without extending much farther, grew thicker, became a crust, and seemed disposed to loosen, but was either still

1 Dissertation Historique sur l'Espèce de Mal de Gorge gangréneux, qui a regné parmi les Enfants l'année dernière. Paris, 1749.