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diff --git a/old/54911-0.txt b/old/54911-0.txt deleted file mode 100644 index d85d381..0000000 --- a/old/54911-0.txt +++ /dev/null @@ -1,1936 +0,0 @@ -The Project Gutenberg EBook of An Account of the Sore Throat Attended With -Ulcers, by John Fothergill - -This eBook is for the use of anyone anywhere in the United States and most -other parts of the world at no cost and with almost no restrictions -whatsoever. You may copy it, give it away or re-use it under the terms of -the Project Gutenberg License included with this eBook or online at -www.gutenberg.org. If you are not located in the United States, you'll have -to check the laws of the country where you are located before using this ebook. - - - -Title: 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 - -Author: John Fothergill - -Release Date: June 15, 2017 [EBook #54911] - -Language: English - -Character set encoding: UTF-8 - -*** START OF THIS PROJECT GUTENBERG EBOOK ACCOUNT OF THE SORE THROAT *** - - - - -Produced by readbueno and the Online Distributed -Proofreading Team at http://www.pgdp.net (This file was -produced from images generously made available by The -Internet Archive) - - - - - - - - - - AN - ACCOUNT - OF THE - SORE THROAT - - Attended with ULCERS; - - A DISEASE which hath of late Years - appeared in THIS CITY, and the - PARTS ADJACENT. - - By JOHN FOTHERGILL, _M. D._ - -[Illustration] - - _LONDON_: - - Printed for C. DAVIS, over-against - _Gray's-Inn Gate, Holborn_. - - MDCCXLVIII. - - - - - PREFACE. - - -_A simple Inflammation of the Tonsils, or of other Parts about the_ -Fauces, _from its frequently happening without any considerable Hazard -attending it, is commonly look'd upon as a troublesome, rather than a -dangerous Disease: And every one, how little soever conversant in the -Practice of Physic, thinks himself qualified to conduct the Patient -thro' it with Safety_. - -_If a Person complains of Pain in his Throat upon swallowing, with the -Symptoms of a Fever, nothing is thought more expedient, or more -frequently order'd, than Bleeding, Purging, and such Medicines as are -daily observed to remove Inflammations in general: And in simple -Inflammations this Method is warranted to be just, by Reason and -Experience._ - -_But a Disease hath of late Years appeared in this City, in many of the -neighbouring Villages, and according to the best Informamation I have -been able to procure, in several other Parts of this Nation; which, tho' -it may be taken for a common Sore Throat, or a simple Inflammation of -the Tonsils, by those who are unacquainted with it, is of a very -different Nature from the common one, and requires to be treated in as -different a Method: For it has been found by Experience, that those -Measures, which seldom fail of answering the Prescriber's Expectation in -this Case, frequently produce the most unhappy Consequences in the -other, and render a Disease almost certainly fatal, which of itself is -not often so, in this Country._ - -_Some Instances of Mistakes in this respect have not long since fallen -under my Observation; and there is still a Possibility of the like -happening, as the same Disorder continues amongst us: It seems therefore -necessary, that some Endeavours should be used to prevent them; and that -such a Description of the Disease should be made public, as might enable -Practitioners, who have not seen or known it, to distinguish it from -that to which it bears some Resemblance; together with an Account of the -Method of treating it, which hath in general been attended with -Success._ - -_There are several of the Faculty, who, I readily acknowledge, have it -more in their_ _Power to give the Public Satisfaction on this Subject, -than I have, but their constant Engagements in the Duties of their -Profession, will probably hinder those who are most equal to the Task, -from executing it so speedily as public Utility requires: Wherefore, as -some Information relative to it seems immediately wanted in several -Places, the following, tho' less perfect, will perhaps in the mean time -be neither unacceptable, nor wholly useless._ - -_If any thing in these Sheets should appear, to those who may be better -acquainted with the Subject to be inaccurate, or premature; if some -Things of little Weight should seem too largely insisted on, whilst -others of more Consequence are neglected, this Apology will, I hope, be -admitted;_ viz. _that to have delay'd the Publication of this Essay, -till it had received those Advantages that further Observations might -have added, would have frustrated my Design; which was, to prevent, as -much as possible, the Mistakes that might happen in relation to this -Disease, by speedily communicating the Remarks, which the Instances I -had seen had afforded._ - -_As this Disease appears to be the same with that which raged in_ Spain, -Italy, _and the neighbouring Countries, somewhat more_ _than a Century -ago; it may not be improper, in the first place, to give some Account of -it, from such of the Authors who then wrote upon it, as have come to my -Hands, previous to a Description of the same distemper, as it now -appears in this Country._ - -_'Tis said, that a similar, if not the same Disease hath long been in -some of our_ American _Colonies, and the_ West-India _Islands, but as I -have met with no Accounts of it from such as were competent Judges, it -must be left to Time, and further Inquiries, to determine the Truth or -Falsity of the Report._ - - _London_, Dec. 1. 1748. - - - - - OF THE - - SORE THROAT - - Attended with ULCERS; - - 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. - -If the Redness above described, which appeared at the first being -seized, was succeeded by an Ulceration, without any of that Whiteness -(which for the future I shall call Sloughs), if the Swelling about the -Neck and Throat was not large, if the Patient discharged by the Mouth -considerable Quantities of thin pituitous Matter, if the Breath was not -fetid, and the Patient had no Disgust to his Food, if the Eyes retain'd -their proper Lustre, all was judged to be secure. - -On the other hand, if this Lustre was in any degree faded[19], if the -external œdematous Tumour was very large, if the Breath stunk, if the -_Fauces_ were livid or black, with a Coma, or Delirium, if with these -the Patient had an Aversion to his Nourishment, and his Breathing became -difficult or laborious, the Danger was judged to be extreme. - -It was not observed that the Disease had any stated Crisis; or that the -Signs of Recovery, or Death, appeared on any certain Day. Some died on -the first, others on the second, third, and on every Day, to the -seventh. Those who survived the fourteenth, were thought to be out of -Danger, at least from the Disease itself[20]; tho' some dropp'd off -unexpectedly, after a much longer Reprieve[21]. - -The Consequences of this Disease were often felt a long time after it -had ceased: An excessive Languor and Weakness continued for many Months; -and the Voice or Deglutition was frequently affected, so as to be -perceivable in some almost a Year after[22]. - -It was however observed, that notwithstanding the Disease most -frequently was accompanied with Symptoms of pestilential Malignity, yet -it sometimes appeared with a much more favourable Aspect; its Progress -not being so quick, nor its Symptoms so violent and dangerous, as hath -here been described to be the Case in general[23]. At its first breaking -out in any Place it was commonly the most severe; it then spared no Age -or Sex, but swept off Adults together with Infants: By degrees it became -less violent, and at length either wholly disappeared, or was of so -little Consequence as to be disregarded. - -We are directed, by most of the Authors I have seen, to begin the Cure -of this Distemper with Evacuations; the chief whereof are Bleeding and -Purging; tho' which of the two ought to precede was not a little -disputed. Purging was in general preferr'd; and they commonly made use -of Manna, Rhubarb, Senna, and Agaric, for this Purpose. _Cortesius_ -directs six Ounces of Manna to be given to Adults in a Decoction of -Tamarinds. Bleeding, tho' commonly directed at the first, hath been used -more sparingly in this, than most other acute Cases[24]. _Severinus_, -who was by no means a timid Operator, directs from four to eight Ounces -to be taken away; which, considering the common Practice in those -Countries, is a very small Quantity[25], But it may not be improper here -to give a short Sketch of this Author's Practice, as he differs in -several Respects from most others. - -He orders an antimonial Vomit to be given at the first Attack, and a -cooling gently astringent Gargle to be used Night and Day. He then -directs a Clyster, takes away some Blood from the Jugular, and gives -from _xv_ to _xxi_ Grains of Bezoar Mineral twice a Day; or oftener, as -Occasion requires, with thin diluting Liquors, in order to raise and -promote a moderate Sweat. He gives five or six Grains of the same -Medicine to Children at the Breast, and commends it highly. He scarifies -the discolour'd Parts in the _Fauces_, in order to let out the corrosive -_Virus_; a Practice, which, though it was countenanced by some of the -_Spaniards_, was disliked and condemned by the most eminent _Italians_. -He, as well as _Zacutus Lusitanus_[26], used the _Arsenicum album_ in -Gargles in very small Quantities, but with how much Advantage to the -Patient is nowhere so fully proved, as to induce one to follow their -Example. - -Cupping, with Scarification, was universally approved, and commonly -practised. Leeches were also applied, by way of Revulsion, to different -Parts. - -Considerable Benefit was expected from Ligatures made on the -Extremities, and from chafing the Limbs with the Hand or a Cloth; also -from Cupping without Scarification; apprehending that a Revulsion from -the Parts affected was by this means procured; and that some Portion of -the morbific Matter, was carried off by the Pores of the Skin. - -Some of the _Spanish_ Physicians recommended Vesicatories of -_Cantharides_ to be laid on each Side the Neck: The _Italians_ seem not -to have been fond of them; and urge it as a Reason against their Use, -that the Progress of the Disease was too quick to be relieved by any -Discharge they could make. - -The internal Medicines they used were such as they deemed Alexipharmics. -_Armenian_ Bole, Bezoar both animal and mineral, Pearls, and, according -to the Philosophy of those Times, the precious Stones. The _Theriaca_ -was excepted against for Children, as _Galen_ had condemned its Use in -such young Subjects. But after they had lessened, as they thought, the -Plethora by Bleeding, and the Cacochemy, as they stiled it, by a -Cathartic; as they found, from Experience, that no Concoction of Humours -was to be waited for in this Case[27], without laying much Stress upon -Internals, they seem chiefly to have applied themselves to Topics; -considering the Disease as local, and a peculiar morbid Affection of the -_Fauces_. - -In this Part of their Directions they have been more particular; and -some of them, in order to point out their Applications with more -Propriety, have divided the Course of this Disease into four different -Periods[28]. - -The first is the State of Inflammation. In this Repellents were thought -necessary; such as Vinegar in Barley-water, Syrup of Roses, Mulberries, -and Purslain. - -The second, is that wherein the white Sloughs begin to appear, which is -a Step towards a gangrenous Colliquation. In this State they order'd -mild Abstergents, of which Honey of Roses was esteemed the chief. - -In the third, the _Fauces_ begin to look black, and a real Mortification -is come on, sometimes penetrating to a considerable Depth, with great -Putrefaction. Here the mild Abstergents were deem'd ineffectual, and -Caustics were recommended; such as Alum with Honey, Alum-Water, Oil of -Sulphur, and Oil of Vitriol. These were used both to check the -Putrefaction, and to destroy the mortified Flesh. - -Sometimes the Oil of Vitriol was dextrously applied to the Part affected -by an arm'd Probe; but it was oftener mix'd with Syrup of Roses, and in -Children pour'd into the Mouth. Bole dissolv'd in Treacle-Water, and the -Juice of Wood-Sorrel, was used by some for the like Purposes. - -In the fourth Stage the Putrefaction is supposed to be extinguished, the -mortified Parts cast off, and an Ulcer only remains. In this Case, the -Fume of white Amber thrown on live Coals, and received into the Mouth, -as a _Suffitus_, was advised; also the _Vinum Myrrhites_, a Decoction of -Guaiacum, Roses, Balaustines, Pomegranate-Peels by way of Gargle; -Medicines that were supposed to dry with some Degree of Astringency. - -Such was the general Appearance of this Disease at its first being taken -notice of in _Europe_; and such, as far as I can collect, the Methods -that were pursued in treating it, by the most eminent Practitioners at -that time. - -The Disease which is described in the following Pages, seems to be the -same with this _Angina maligna_, or strangulatory Affection of the -_Fauces_, and seems only to differ from it in Degree; in which, as it is -much more favourable and mild with us in general, than it was with them, -we have greatly the Advantage. - - - - - OF THE - SORE THROAT - Attended with ULCERS; - - - As it hath appeared in THIS CITY, - and PARTS adjacent. - - -About twelve Years ago, two Children, in a Family of Distinction, and -some others in the same Part of the Town, being carried off suddenly, -and their principal Complaints having been of a Soreness in their -Throats, it occasion'd a Suspicion, that the _Morbus strangulatorius_ -was broke out amongst us: But as very few Cases occurred after these, or -pass'd unobserv'd, the Disease and the Remembrance of it seemed to -vanish together. - -It began however to shew itself again about 4 or 5 Years ago, but not -very frequently: And tho' some of the Faculty met with it now-and-then, -it remained unknown to Practitioners in general, till within these two -or three Years: Since which Time its Appearance has been more frequent, -both in Town, and the Villages adjacent. - -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. - -All the Parts of the _Fauces_ above-mention'd are liable to these -Ulcerations; but they generally are first discernible in the Angles -above the Tonsils, or on the Tonsils themselves; though they are often -to be seen in the Arch form'd by the _Uvula_, and one of the Tonsils; -also on the _Pharynx_ behind, on the Inside of the Cheeks, and the Bale -of the Tongue, which they cover in the manner of a thick Fur. Instead of -these Sloughs, where the Disorder is mild, a superficial Ulcer of an -irregular Figure appears in one or more of these Parts, scarce to be -distinguish'd from the sound, but by the Inequality of Surface they -occasion. - -Towards Night, the Heat and Restlessness increase, and a _Delirium_ -frequently comes on. This Symptom, which appears in some even on the -first Night, seems to differ considerably from the like Affection in -other Diseases. They commonly answer the Questions put to them properly, -but with an unusual Quickness; they talk to themselves incoherently when -left alone, and frequently betray the first Tendency to this Disorder, -by affecting too great a Composure: This for the most part happens to -those who sleep but little; for some are comatous and stupid, and take -little notice of any thing that passes. - -In this manner they continue during two, three, or more Days; they -commonly grow hot and restless towards Evening: which Symptoms increase -as Night comes on; a Sweat more or less profuse breaks out towards -Morning; and from this time they are easier during some Hours; a -Faintness only continuing, of which they frequently complain more than -of the rest of their Sufferings. - -The Disease seems to have no stated Period which can properly be called -its Ἀκμὴ or Height. Some grow easier from the first Day of the Attack; -but, in general, the Symptoms of Recovery appear on the third, fourth, -or fifth Day, and proceed in the following manner: - -First, the Redness of the Skin disappears; the Heat grows less; the -Pulse, which was hitherto very quick, becomes slower; the external -Swellings of the Neck subside; the Sloughs in the _Fauces_ cast off; the -Ulcerations fill up; the Patient sleeps without Confusion, is composed -when awake, and his Appetite begins to return towards more solid -Nourishment, than has hitherto been allow'd him. - -The parotid Glands on each Side, and the Parts about them, are commonly -swell'd, and painful to the Touch; and if the Disease is violent, the -Neck and Throat are surrounded with a large œdematous Tumor; which, by -straitening the _Fauces_, increases the Danger. - -The Pulse, during the whole Course of this Disease, is generally very -quick; frequently 120 Strokes or more in a Minute: In some it is hard -and small; in others soft and full; but without that Strength and -Firmness which usually accompany equal Quickness and Heat in genuine -inflammatory Disorders. - -If a Vein is open'd soon after the Distemper is come on, the Blood -generally appears of a fresh florid Red; the _Crassamentum_ is rather of -a lax gelatinous Texture, than dense or compact; the _Serum_ yellow, and -in a large Proportion. - -The Urine is at first crude, and of a pale Whey-Colour: As the Disease -advances, it turns yellower, as if Bile was diluted in it and soon after -the Patient shews any Marks of Recovery, it commonly grows turbid, and -deposits a farinaceous Sediment. - -They seldom have any Stools, if the Symptoms are favourable, from the -Time when the Purging, which generally attends the Accession, ceases. -This Discharge is frequently bilious, and without any Pain: Tho' these -Circumstances differ in different Habits. - -They complain less of Thirst in this than in other acute Diseases. The -Tongue is generally moist, and not often furr'd: In some nevertheless it -is cover'd with a thick white Coat or Fur, and those who are so -affected, often complain of Soreness about the Root of the Tongue. - -The _Uvula_ and _Tonsils_, tho' they are sometimes so much swell'd, as -to leave but a very narrow Entrance into the Gullet, and this Entrance -frequently surrounded with Ulcers or Sloughs; yet the Patients often -swallow with much less Difficulty and Pain than might be expected under -such Circumstances. - -They frequently complain, soon after they are taken ill, of an offensive -putrid Smell, affecting their Throats and Nostrils, which oft occasions -Sickness before any Ulcerations appear. - -In those who have this Disease in a severe manner, the Inside of the -Nostrils, as high up as can be seen, frequently appears of a deep red, -or almost livid Colour: After a Day or two, a thin corrosive _Sanies_, -or with it a white putrid Matter of a thicker Consistence, flows from -them, which is so acrid, as to excoriate the Part it lies upon any -considerable time. This is most observable in Children, or in young and -very tender Subjects, whose Lips likewise are frequently of the Colour -above-mention'd, and cover'd on the Inside with Vesicles containing a -thin _Ichor_, which excoriates the Angles of their Mouths, and the -Cheeks where it touches them. - -It is probable, that Part of the same acrid Matter passes with the -Nourishment into the Stomach; especially in Children; and it is perhaps -owing to this Cause in part, that they suffer much more from this -Distemper than Adults; this corrosive Fluid without Doubt producing the -same Effects on the Stomach and Bowels, as it does when applied to the -much less sensible Skin of the Face; _i. e._ it excoriates the Parts it -touches; which in fact seems to be the Case: For, if they get over the -Disease, a Purging sometimes succeeds it, attended with the Symptoms of -Ulcerations in the Bowels, and after enduring great Pain and Misery, -perhaps some Weeks, they at length die emaciated: And I have been -inform'd, that some Children have had the Parts about the _Anus_ also -excoriated; the _Sanies_ retaining its Virulency thro' the whole Tract -of the Intestines. - -The Sick sometimes bleed at the Nose towards the Beginning of the -Disease; and the _Menses_ very often appear in those of the Female Sex, -who are of Age to have them, soon after they are seized, notwithstanding -the regular Period is at a considerable Distance: If they are taken ill -about the usual Season, the Discharge is commonly large and expensive. -Some young Persons, who never had the least Appearance of them, have had -this Evacuation during their Illness. - -In strong and full Habits, these Evacuations are seldom attended with -much Benefit, or manifest ill Effects, unless they are very copious; for -in this Case they occasion great Faintness, and an Increase of the other -Symptoms, in proportion to the Excess. In tender weak Subjects, they are -often prejudicial. - -It has happen'd in this Disease, that Hæmorrhages from the Nose and -Mouth have suddenly carried off the Patient. I have heard of the like -Accident from Bleeding at the Ear: But these fatal Discharges most -commonly happen after the Patient has been ill several Days; and it -seems more probable, that they proceed from the Separation of some -Slough from the Branch of an Artery, rather than from a Fulness of the -Vessels, or an Effort of Nature to relieve herself by a salutary Crisis. - -Bleeding in this Disease has in general been observed to be prejudicial: -Some indeed admit of it without any sensible Inconvenience; but a -Repetition of it, even where the Disease is mild and favourable, seldom -fails to aggravate the Symptoms; and in some Cases it appears to have -occasion'd very dangerous Consequences. The Heat, Restlessness, and -Delirium, which this Evacuation commonly prevents or mitigates in other -Cases, in this are increased by it; nor does the Swelling of the -Tonsils, _Fauces_, &c. seem to receive the least Benefit from it: On the -contrary, tho' the Fullness of these Parts decreases, yet the Sloughs -thicken, the external Tumor grows large, and the Spitting commonly -diminishes. - -Nor has Purging been observed to be more beneficial: Gentle Cathartics -have brought on very dangerous Symptoms. Upon procuring a few Stools -with Manna, the Redness of the Skin has disappeared, and the Flux to the -Throat has been surprisingly increased: If it happens that the Discharge -by Stool continues, the Swelling of the Neck commonly grows larger, the -_Fauces_ become flaccid, dry, and livid; and the Patient in a few Hours -after this expires: So that Purgatives seem to have no better Effects in -diminishing the Tumor, and abating the supposed Inflammation, than -Bleeding. - -Nitrous cooling Medicines frequently produce the like Effects; they -increase that Faintness which accompanies this Disease, and either -dispose the Patient to copious sinking Sweats, or to Stools. - -Upon the whole, it appears, that all Evacuations which tend to lessen -the natural Strength of the Constitution, are in this Disease injurious; -and that those Persons in common are in the greatest Danger, if attacked -with it, who have been previously indisposed or have had their Strength -impair'd by Grief, or any other Accident. Of which it may not perhaps be -improper to relate an Instance or two in this Place, as it will also -tend to explain the usual Progress of the Symptoms in the worst Cases we -meet with. - -A young Gentlewoman about 26 Years of Age, of a pale lax Habit, but of -an active chearful Disposition, had enjoy'd a pretty good Share of -Health in common, till a Year or two before her last Illness; about that -time she unhappily made use of some external and empirical Application -to remove a Redness attended with Pimples, which now-and-then broke out -in her Face. She was soon relieved from this Complaint by the Medicine -she used; but was quickly after seized with Sickness, Vomiting, Loss of -Appetite, and either obstinate Costiveness, or a troublesome Diarrhœa; -the _Menses_ were pale, and in small Quantities, and her Health in -general greatly impaired. - -She had scarce recover'd from this weak State, when the Loss of a near -Relation brought her almost into the same Circumstances; from which she -was slowly recruiting, when she married. Her Sickness, Vomiting, and -Loss of Appetite, soon return'd; which she conceal'd as much as -possible. - -Under these Disadvantages, she was seized with this Distemper, a Day or -two after she had visited an Acquaintance labouring under the same -Disorder: It came on with a Coldness and Trembling like that of an -Ague-Fit, great Faintness, and an acute Pain in her Head, with a -Vomiting more violent than she was usually affected with, and a Purging. -Towards Evening she grew very hot and restless, complained of a Soreness -in her Throat, and the Discharges abated. Her Face, Neck, and Hands were -intensely red; she frequently sigh'd, and from her Aspect and Gestures -there was Reason to suspect a Delirium approaching. She slept little -that Night; and next Morning her Pulse, which before was very quick and -small, seemed to be somewhat more full, but not sensibly slower; and she -complained of Faintness and Anxiety. The Parts about the _Fauces_ were -much relax'd, and very red, in some Places almost livid, with a kind of -glossy Dryness upon them. She continued in this Manner without any -remarkable Increase of Symptoms till Night, when the Looseness return'd, -and in a very short time exhausted her Strength to a great Degree: The -Redness upon the Skin disappeared, the Extremities grew cold, her Eyes -became dim, her Pulse scarce perceptible, she breath'd with Difficulty, -and expired in the Morning, on the third Day of the Disease. - -Another young Woman, who frequently visited, and sometimes assisted a -Relation, who had this Disease, was attack'd with it in the usual -manner. She was about 17, of a pale and somewhat bloated lax Habit, -naturally inactive, averse to Exercise, and was thought to have indulged -some painful Solicitude, to the Prejudice of her Health, and making way -for an obstinate _Chlorosis_. - -Under these Circumstances she was seized with the usual Complaints, but -in a violent manner. The Purging continued till the Day following; when -it yielded for the present to Opiates, but constantly return'd when -their Effects were over. The other Symptoms, such as Heat, Restlessness, -Anxiety, and Faintness, increased with the Purging; the Pulse was small, -quick, and hard; a Difficulty of breathing came on, the small Remains of -Lustre in the Eye perish'd, and she died early on the fourth Day of the -Distemper. - -No Marks of any Sloughs in the Throat appeared in either of these Cases; -but the Redness became daily more intense, and approached nearer to -Lividness, whilst the _Fauces_ could be inspected; which, from the great -Difficulty they had in breathing, was impracticable several Hours before -the Patients expired. - -Warm aromatic Cordials, and anodyne Astringents, were administred -assiduously, with suitable Nourishment, and Vesicatories applied -successively to the Neck on each Side, the Shoulders and Arms, but -without Effect. - -If the Purging therefore continues long after the first Exacerbation of -the Disease, it may be look'd upon as a dangerous Symptom; for though it -be sometimes restrain'd for the present by Opiates or Astringents, yet -it commonly returns with more Vehemence, when their Efficacy ceases, and -in a short time exhausts the small Degree of Strength remaining. - -In this Case they generally spit very little; the _Fauces_ appear dry, -glossy, and livid; the external Tumor grows large; they void their -Excrements without perceiving it, and fall into profuse Sweats; -Respiration becomes difficult and laborious; the extreme Parts grow -cold, and Death in a few Hours closes the Scene; and in no Disease that -I have seen is the Eye so early deprived of its Lustre as in this; for -it is sometimes opake and glassy several Hours before Death; and, as -_Ætius Cletus_ hath observed, is a fatal Presage of its Approach. - -A copious Flux of pituitous Matter to the Glands, and other Parts about -the _Fauces_, seem'd to be the Cause of sudden Death, in a Girl about 12 -Years old. She was seized in the common Way, with Shivering, Headach, -Sickness, Vomiting, and Purging. The Discharges abated in a few Hours, -and were succeeded by great Heat, Redness of the Skin, and a sore -Throat; the _Uvula_, Tonsils, and, contiguous Parts were red, and so -swell'd in eight or ten Hours, as to touch each other, and seem d to -close the Entrance into the _Pharynx_. She breath'd without much -Difficulty, swallow'd with less Pain than could be imagin'd, and spit up -large Quantities of Phlegm. About six in the Evening she was seized with -a Difficulty of breathing, as if strangled: Those about her rais'd her -up, thinking she was in a Fit; she recover'd herself a little, but -expired upon being again laid down in Bed; in somewhat less than 24 -Hours from the first Attack. A large Quantity of viscid Phlegm, with -which, after she was dead, her Mouth appear to be fill'd, together with -the tumefied _Uvula_, Tonsils, and _Velum Palati_, had perhaps jointly -closed the _Rima Glottidis_, and put a Stop to Respiration. - -By a Fall in her Infancy she was reduced to the Necessity of using -Crutches. She was big-bon'd, had a good Appetite, and for want of that -Exercise, which Persons at her Age commonly enjoy, seem'd to be -plethoric. These Circumstances perhaps might contribute to this speedy -and unhappy Event. - -Accidents of the like kind seem not to have been uncommon while this -Disease continued in _Italy_, according to a Remark of _Cortesius_[29]. - -From the preceding Account of the Sore Throat attended with Ulcers, it -will, I believe, appear, that this Disease is widely different from a -common Sore Throat, or simple Inflammation of any of the Parts about the -_Fauces_; both as to the Subject commonly affected by it, the Manner of -its Attack, the Progress of the Symptoms, and its Conclusion: For the -sore Throat with Ulcers generally attacks Children; and of these Girls -more frequently than Boys, as hath been observ'd: If Adults are seized -with it, they are commonly such as have been very much conversant with -the Sick, or else are weak and infirm: And it seems to affect those -Adults in the severest manner, who have been previously indisposed, or -whose Strength has been reduced by unseasonable or immoderate -Evacuations. - -On the contrary, the common _Angina_, or an Inflammation of the Tonsils, -most frequently attacks the healthy, the vigorous, and robust; the weak, -the delicate, and infirm, are less exposed to it, at least suffer less -from it, than the former. - -As both Diseases are attended with a Fever, and as most Fevers come on -with Shivering or Chilness, this Symptom may at least appear equivocal: -But if Sickness, or Vomiting, or Purging, or an acute Head-ach, towards -the back Parts or Top especially, or if all these, come on in the Space -of a very few Hours, which they generally do, where the Disease is -vehement, it may justly be esteem'd of the malignant or putrefactive -kind: But if an erysipelatous Redness discovers itself in the _Fauces_, -or if any Ulcerations or white Sloughs appear in them, the Disease is -evident. - -In some Cases, the Symptoms have been so obscure, that it was difficult -to determine to which Class they properly belonged: But in these -Circumstances the Disorder was so favourable, that, supposing it not to -be of the ulcerated kind, no other Inconvenience seemed likely to ensue -from treating it as such, than a Suppuration; which is often an Event -rather to be chosen than avoided. - -The Redness of the Skin in the Face, Neck, Breast, and Hands, is another -obvious and distinguishing Characteristic, which in Children and young -People especially, seldom fails to accompany this Disorder. - -In the common sore Throat, a local Inflammation is the Disease: All the -Symptoms are derived from this Source: An acute throbbing Pain, greatly -increased upon swallowing even Liquids, is the principal Grievance. In -the other, the whole Habit suffers, as if by a _Stimulus_ of a peculiar -Nature and although the Throat is always more or less affected, yet it -is sometimes the least Part of the Patient's Complaint; and Instances -have occurr'd to me of considerable Sloughs being formed, before any -Soreness or Pain in the _Fauces_ hath been mention'd. - -Again, this Disease is accompanied with a greater Tendency to a -Delirium, than either a common _Angina_, or almost any other Disease we -are acquainted with. To have this Symptom appear in the Disease we are -treating of on the first Night, is not uncommon; and on the second, -frequent. A Girl about eight Years of Age, whom I attended, was scarce -known to be indisposed, till she alarmed the Family, by appearing to be -light-headed. She had made no Complaint of her Throat, nor was this Part -thought to be affected, till, upon Examination, I found it so; being led -to suspect it by the Colour of her Hands, and the Delirium. She got well -through the Disease, tho' its Progress, at first, appear'd to be very -swift. - -A common Sore Throat, if the Patient recovers, either goes off by -Resolution, or suppurates, or becomes hard and scirrhous. - -In that attended with Ulcers, none of these Circumstances happen; for it -terminates in a superficial Ulceration of some of the Parts about the -_Fauces_, with little Appearance of any Sloughs, if the Disease is very -mild; and with large and deep ones, of a white, cineritious, livid, or -black Colour, if it is more violent. - -It will not perhaps be difficult, from this comparative View of the -Disease, to distinguish it from a common Sore Throat, or an inflammatory -Affection of those Parts: But there is another no less certain -Criterion, tho' too often a fatal one, which is, the constant Increase -of Symptoms upon Bleeding, Purging, and the liberal Use of cooling -antiphlogistic Medicines; an Instance whereof I think evidently appeared -in the following Case. - -A Youth of about 14 Years old, of a brisk lively Disposition, who had -enjoyed a good Share of Health, saving that, for a few Years past, a -cutaneous Disease, akin to a Leprosy, had sometimes appeared on his Head -and Arms, was seized one Morning with a general Uneasiness, and a -Disposition to vomit; he was put to Bed, and a severe Shivering ensued; -his Sickness increased, he vomited up every thing, had several purging -Stools that Day, and complained much of his Head, with some Soreness in -his Throat. He was order'd to be blooded, and had an Emetic given him: -This operated but little; he grew hot and restless, a deep Redness -spread itself over his Face, Hands, and Arms, with a plentiful Eruption -of small Pimples, which induced those about him to apprehend it was a -Scarlet Fever. - -The next Day, which was the second of the Disease, his Throat continuing -sore, and the feverish Symptoms increasing, a Purge of Manna was given -him, which operated gently; and at Night his Head and Throat being more -uneasy, his Heat still continuing, with a Tendency to Delirium; a -Blister was applied. - -On the third, the Symptoms not abating, he lost about ten Ounces of -Blood. He had taken a cooling nitrous Powder every four Hours; this was -now changed for one more cordial. At Night he grew delirious, his Fever -increased, and he had some loose Stools, which were rather encouraged -than restrain'd, as it was hoped they might relieve him. Blisters were -applied to his Head and Arms. - -On the fourth in the Morning I was sent for: I found him delirious, with -convulsive Twitchings; his Hands in constant Motion, gathering the -Bed-cloaths; his Pulse quick and weak; his Tongue parched. With some -Difficulty I looked into the _Fauces_; they seemed to be pale in some -Places, intensely red or livid in others, with a glossy Brightness: His -Excrements came away involuntarily; his Eyes were languid, and somewhat -opake; he breath'd with Difficulty, and died in a few Hours after. - -In some of the first Cases I met with, the Quickness of the Pulse, the -Degree of Heat, the apparent inflammatory Redness of the Eyes and Face, -and Pain in the Head, some times urged me to order Bleeding, especially -if there were any Marks of a _Plethora_; but in these Cases it did not -appear to have any advantageous Effects: So that, notwithstanding the -Urgency of the Symptoms above-mention'd, it seems proper in general to -omit this Evacuation. - -Cupping with Scarification has been applied to the Shoulders and Back of -the Head, in order to remove an acute Pain of this Part, which is often -complain'd of, but, as far as I have been able to observe, without much -Benefit. - -It is necessary that the Patient should keep in Bed as much as may be, -tho' the Disease should seem to be slight: It has happen'd, for want of -Care in this Respect, that a Purging has come on, the Redness of the -Skin disappeared, and a Disorder, which with Confinement alone would -probably have gone off in twice 24 Hours, has been render'd tedious and -difficult. - -If we are called in at the first, while the Sickness or Vomiting -continues, it will be of Use to promote this Discharge, by giving an -Infusion of Green Tea, Chamomile-Flowers, Carduus, or a few Grains of -_Ipecacuanha_. In some Instances, where the Attack has been severe, and -this Method practised, the Disorder has gone off with more Ease than was -at first apprehended. - -If these Symptoms don't abate with the Operation of the Emetic, small -Draughts of Mint-Tea, with a sixth Part of red Port added to it, may be -given frequently; together with some grateful and warm aromatic, cordial -Medicine, every four or six Hours. The _Pulvis Contrayervæ simp._—_comp. -Confect. cardiac._—_Raleigh. Spec. arom. Vinum croceum_; _Aq. Menth. -spirit. Aq. Alex. spirit. cum Aceto_; with others of the like Nature, -may be used for this Purpose. - -In this Disease it is at all times necessary to attend very carefully to -the Diarrhœa. For the most part it ceases with the Vomiting, in less -than twelve Hours from the first Attack: If it continues longer than -this Period, it is necessary to check it, otherwise it occasions great -Faintness, sinks the Strength, and in the End produces very dangerous -Consequences. The aromatic Cordials above-mention'd, if they are given -plentifully, commonly take off this Symptom, as well as the Vomiting; -but if they prove ineffectual, Recourse must be had to Astringents and -Anodynes, in proportion to the Exigence of the Case; such as the -_Confectio Fracastorii_, or _Elect. e Scordio cum Opio_, dissolved in -small Cinnamon-water, and given _post singulas sedes_. - -It is common for the Redness, so often mention'd, to appear upon the -Skin, as these Discharges abate: It has happen'd that this Colour has -gone off sometimes, and the Patient has been brought into imminent -Danger, upon giving a mild Cathartic: Which Circumstances, as they point -out a close Connexion between them, indicate the Use of a warm Regimen, -notwithstanding the Heat and other Symptoms might seem to forbid it. - -A Girl about 9 Years old, of a slender Make, but healthy and active, was -seized with this Disorder. The Sickness and Vomiting went off, and the -Redness of the Skin appeared soon after: The Apothecary who attended -her, judging it an inflammatory Case, as she complained of her Throat, -bled her, gave her a cooling Purge the next Day, and afterwards some -nitrous Draughts. A plentiful Efflorescence which cover'd the Face, -Neck, and Arms, suddenly disappeared; a Diarrhœa came on, she grew -restless, faint, and insensible. In this Condition I first saw her on -the third Day of the Disease; she frequently sigh'd, her Pulse was -quick, small and hard, without any remarkable Colour upon her Skin; and -the Swelling on each Side the Neck large: It was not possible to examine -the _Fauces_, as she lay in a comatous helpless Condition, her Stools -and Urine coming away insensibly. A warm cordial Mixture was frequently -given her, upon which the Diarrhœa soon abated; and the next Day the -Efflorescence again appeared upon her Face and Arms. From this time she -continued to recover, tho' slowly, and was for some time attended with a -Cough and hectic Heats. - -Another Symptom which requires our Attention in the Cure of this -Disease, is an excessive Faintness: Of this they generally complain soon -after they are taken ill, and continue to do so, if sensible, till the -Distemper begins to abate: The Urgency of this Symptom seems to indicate -the Degree of Danger: It is more or less violent, as the Disease is mild -or malignant; and an Abatement of it may be look'd upon as a sure -Presage of Recovery. - -Warm aromatic and gently stimulating Medicines, such as have, been -already mention'd, as the most effectual to suppress the Vomiting, and -check the Looseness attending this Disease, have likewise been found -useful in removing the present Complaint: And tho' the Degree of Heat, -and Quickness of the Pulse, would be enough to dissuade a Person who has -not seen the Disease, from giving them in so liberal a manner as -Necessity requires; yet we are not to be governed so much by these -Symptoms, as by the Faintness, Depression of the Pulse, and Increase of -Putrescency in the _Fauces_. One Drachm of the _Confectio Raleighana_ -has been given to a Youth not quite 15 Years of Age, every four Hours, -which was soon follow'd by a sensible Amendment, and the Decrease of the -Patient's Restlessness, Faintness, and Heat. - -Some of the _Italian_ Physicians forbad the Use of Wine in the Cure of -this Disease, and the Warmth of that Climate might perhaps make this -Caution necessary; but as it is a generous Cordial, and at the same time -antiseptic, it seems to be in no respect improper here; and, besides in -Whey, I have allow'd it to be given, in small Quantities, mixed with -Mint, Baum, or Sage-Tea, Barley-Water, Gruel, Panada, Sago, and -suchlike; and alone, where the Faintness has been excessive; the Age, -the former Way of Life, and the Symptoms, affording the necessary Rules -as to Quantity and Kind. Chicken-Water, or thin Broth, may also be -allow'd; which is frequently very acceptable to the Patient. And I don't -remember to have observed so general and early an Inclination after -solid Food, in any acute Disease, as in this: For at a time when one -would imagine, both from the Condition of the _Fauces_, and the Degree -of Heat, that Liquids would be the most acceptable, it is not uncommon -to find Children, who have this Disease, extremely desirous of Chicken, -and chearfully complying with Directions, in hopes of being gratified in -this respect. - -Blisters are likewise of Use to relieve the Faintness. At first I was in -Doubt, lest the Flies, by their Acrimony, should increase the putrescent -Disposition, and consequently aggravate the Disorder they were intended -to remove: but no such Effect having appeared from their Use, I have -order'd them to be applied, and I think with Advantage, both to the -usual Parts, and to the Neck on each Side from below the Ear almost to -the Clavicle, as Occasion required. - -The Ulcers in the Throat demand our early and constant Attention, as a -considerable Loss of Substance cannot here be suffer'd without immediate -Danger to Life itself, or the most pernicious Consequences to the future -Action of the Parts, if the Patient survives. - -Where the Disease is of the mildest kind, a superficial Ulceration only -is observable; which may easily escape the Notice of a Person -unacquainted with it. A thin, pale, white Slough seems to accompany the -next Degree: A thick, opake, or ash-colour'd one is a further Advance: -And if the Parts have a livid or black Aspect, the Case is still worse. -These Sloughs are not formed of any foreign Matter covering the Parts -affected as a Crust or Coat, but are real Mortifications of the -Substance; since when they come off spontaneously, or are separated by -Force, they leave an Ulcer of a greater or less Depth, as the Sloughs -were superficial or penetrating. - -When the Tendency to Putrefaction is stopp'd, these Sloughs in most -Cases come off spontaneously; or their Separation may be promoted by -suitable Remedies and Applications: But it seems by no means adviseable -to attempt it by Scarification, scraping them off with the Fingers or -Instruments, as _Severinus_ proposes; since the Experiment has been -tried, but with such unhappy Consequences[30], as are sufficient to -discourage one from persisting in this Method. - -In a Case where I was concerned, previous to my being called in, a -Surgeon had endeavour'd to separate the Sloughs by the Assistance of his -Probe: He succeeded in his Attempt without much Difficulty; but was -surprised to see the same Parts cover'd the next Day with thick, dark, -ash-colour'd Sloughs, penetrating deep into the Substance, with an -Increase of every Symptom. - -It is true, the Sloughs have been sometimes scarified, from an -Apprehension, that Matter was lodg'd underneath them, without any -manifest Inconvenience; but as there are Instances of fatal -Mortifications having ensued, it seems most prudent to decline the -Practice. - -From under these Sloughs, and from every Part of the Ulcers which they -cover, a thin corrosive _Ichor_ is discharged, so acrid as to excoriate -the external Parts upon which it is suffer'd to remain. This is -sometimes observable in Adults, when the Parts above the _Fauces_ are -affected; the _Ichor_ in these Cases flows thro' the Nostrils, and -frequently raises Pimples on the Skin of the upper Lip; but it is most -obvious in Children, who often have this Part, the Corners of the Mouth, -the Cheek of that Side on which they most commonly lie, blister'd or -excoriated. - -It is probable, as hath been already hinted, that Part of the same -virulent Matter, passing down the _Oesophagus_ into the Stomach and -Intestines, acts upon them as it does upon the Skin, when applied to it -externally; it frets and corrodes the Parts it touches, and produces -that Sickness, Vomiting, Purging, and Faintness, which sometimes -accompany this Disease in different Parts of its Progress. - -In Children, and very young Subjects, the Symptoms arising from this -Cause are yet more dangerous: The natural Softness and Laxity of the -Parts liable to be affected, disposes them to suffer by it much more -than Adults: At the same time they are commonly alike incapable of -promoting the Discharge of this Matter themselves, and of admitting -Assistance from others, being generally, if the Distemper is acute, -either comatous and stupid, or delirious and untractable. If Gargles are -injected, they either prevent them from reaching the Seat of the -Disorder, by their Tongues, or they swallow them, and the putrid Taint -of the Ulcers, together; the Mischief spreads beyond the Power of Art to -restrain it; violent Purgings ensue, or fatal Hæmorrhages from the -penetrating Gangrene. And to this, perhaps, it may in part be owing, -that Children suffer so much more from this kind of Sore Throat, than -Adults. - -That this corrosive Matter produces these Effects, is farther confirm'd, -by observing, that those whose Throats are severely affected, if they -have a plentiful Discharge from the _Fauces_, are seldom attended with -Sickness, Vomiting, or excessive Faintness; though, after longer Sleeps -than ordinary, or a Neglect of encouraging this Evacuation, they have -complain'd of Sickness, and have had Reachings come on: Likewise, that -in such Cases, where little or no Discharge of this kind appears, the -Symptoms are commonly the most dangerous. - -From hence it is obvious that great Advantages may be expected from the -constant Use of gently stimulating aromatic Gargles; as they promote the -Discharge of the pituitous Matter flowing to the _Fauces_, and, -doubtless, with it, of some Part of the corrosive Fluid above-mention'd: -To which if we add Antiseptics and Detergents, in order to check the -Progress of the Mortification, and cleanse the sordid Ulcers it -produces, every Indication is provided for. - -Where the Disease is mild, the Symptoms favourable, the Sloughs -superficial, or scarce perceptible, it may be sufficient to order a -Gargle of Sage-Tea with a few Rose-Leaves added in the Infusion; three -or four Spoonfuls of Vinegar may be mixed with half a Pint of the Tea, -and as much Honey put to it, as will leave it agreeably acid. - -But where the Symptoms are urgent, the Tendency, to Putrefaction great, -the Sloughs large and thick, and the Breath offensive, Recourse must be -had to more efficacious Remedies: A Composition like the following, -varied only as the Patient's Age and the Circumstances of the Disease -required, has in general been attended with very good Effects. The -Proportion here given may be used for Adults, and the more active Parts -lessen'd for younger Subjects. - - ℞ [prescription] _Decoct. Pectoral. ℥ [ounce] xij. cui inter - coquendum add. Rad. Contrayerv. contus. ℥ [ounce] ss. Liquori - colato admisce Acet. Vin. Alb. ℥ [ounce] ij. Tinct. Myr. ℥ - [ounce] i. Mel. opt. ʒ [dram] vi. f. Gargarisma._ - -As the Parts about the Gullet are frequently so much affected, as to -render it painful or impracticable for the Sick themselves to make use -of the Gargle so freely as they ought, it is commonly order'd, that a -few Spoonfuls of this Liquor, made somewhat warm, should be very often -injected into the _Fauces_ with a small Syringe; and especially before -the Patient swallows any thing, in order to wash off as much as possible -the putrid _Sordes_ adhering to the Ulcers, and prevent it from passing -into the Stomach and Bowels. In young Subjects this Method is the more -necessary, as they don't always know how to manage a Gargle to any -Purpose, did the Soreness of the Parts permit them to do it. - -If the Sloughs are large, and cast off slowly, they may be touched with -_Mel Ægyptiacum_, by means of an armed Probe; or it the Condition of the -_Fauces_ is such, that this cannot conveniently be done, a Spoonful of -the following Mixture may be injected, and retain'd in the Throat, as -long as the Patient can endure it; the Parts may then be washed two or -three times with the Gargle alone. - - ℞ [prescription] _Gargarism. præscript. ℥ [ounce] ij. Mel Ægypt. - ʒ [dram] j. m._ - -By the constant and regular Use of these Applications, if the Patient is -kept warm, and the Method of treating him in other Respects is observed, -agreeable to what has been mention'd above, it seldom happens but that -the febrile Symptoms disappear, the Sloughs come off, and the Ulcers are -disposed to heal in a few Days; unless it be where Mismanagement at -first, Malignity of the Infection, or an unfavourable Constitution, have -one or all contributed to increase the Disease, and to render its -Consequences more lasting and mischievous. - -What Effects improper Treatment produces in this Case has already been -observed. With regard to the Matter of Contagion, or Nature of that -Cause which so suddenly brings on such a Train of Symptoms as hath been -described, little can be said with any Degree of Certainty: Thus much, -however, seems to be true in Fact, that in some Cases the Disease -appears to be of so mild a Nature, and so benign, as to require but -little Assistance from Art: Persons even recover from it under the -Disadvantages of unskilful and injurious Management; whilst in others, -the Progress of the Symptoms is so rapid, and the Tendency to Corruption -so strong, that nothing seems able to oppose it. Just as it happens in -the Small-Pox; the benign and distinct sort bears ill Treatment without -Injury; in the malignant flux Kind, the utmost Art and Experience are -too often insufficient to conduct the Distemper to a happy Issue. -Whether this Diversity in the Sore Throat we are speaking of, is owing -to a Difference of Constitutions, or of Seasons, to the different -Quality or Quantity of the Contagion, or the Manner of receiving it; or -whether there are in Reality distinct Species of it; may perhaps -hereafter be more certainly determined. - -With respect to Constitution, it may be further observed, that in soft, -lax, leucophlegmatic Habits, and languid inactive Dispositions, every -thing else being equal, the Disease seems to proceed more slowly, to go -off more irregularly, and to leave behind it more lasting Effects. In -some Persons of the Temperament described, tho' the Fever has grown -less, and all the Symptoms abated in four or five Days, yet the Sloughs -in the Throat have continued almost a Week longer; whilst in the -opposite Constitution, tho' the Disease has been much more acute, yet -the Symptoms have no sooner abated, than the Sloughs have cast off, and -the Ulcers healed of their own Accord. - -A copious Hæmorrhage from the Nose, Mouth, or Ears, the last especially, -coming on after the Disease has continued three or four Days, or longer, -is a dangerous _Phænomenon_: For at this time of the Distemper, it most -probably proceeds from the Branch of an Artery destroy'd by the -Mortification, and laid open by the Separation of the Slough. If the -Vessel is therefore large, the Bleeding may prove fatal to the Patient -in a very short time; or if he escapes for the present, the Loss of a -considerable Quantity of Blood at this time of the Disease, will -occasion various ill Consequences. - -It is therefore absolutely necessary to endeavour to stop this Discharge -with all the Expedition possible. If the Patient is costive, it will be -of Use to procure Relief in this respect, by Clysters or Suppositories -as soon as can be done: To apply Vinegar, by the means of Tents or -otherwise, as near to the Orifice of the Vessel as we can: To convey the -Steam of it into the _Fauces_ and Nostrils plentifully: To keep the -Patient in a sitting Posture, or his Head raised as high as may be, and -his upper Parts moderately cool: If these Methods don't immediately take -Effect, Recourse must be had to the most efficacious Remedies, amongst -which we may rank the _Bark_ and _Opium_. - -It is not uncommon for hectic Heats, Night Sweats, Want of Appetite, and -Dejection of Spirits to attend those a considerable time, who have had -the Disease in a severe manner. Asses Milk commonly relieves them, or a -Decoction of the _Bark_, and _Elix. Vitriol_ if the Case is more -obstinate. - - * * * * * - -Having thus related, as concisely as I could, the most material -Circumstances that have occurr'd to me in respect to the Symptoms, -Progress, and Event of this Distemper, the _Juvantia_, _Lædentia_, and -the Accidents chiefly to be regarded in its Cure; in such a manner as I -hope will enable those who have not seen or known it, to distinguish it -from a common Sore Throat and to treat it with some Degree of Propriety -and Success, I shall conclude with observing; - -1. That the Sore Throat attended with Ulcers seems to be accompanied -with a strong Disposition to Putrefaction, which affects the Habit in -general, but the _Fauces_, and the Parts contiguous in particular. And -it seems not unreasonable to suppose, - -2. That the Cause of this Disposition or Tendency is a putrid _Virus_, -or _Miasma sui generis_, introduced into the Habit by Contagion, -principally by means of the Breath of the Person, from whom it is -received. - -3. That this _Virus_, or contagious Matter, produces Effects more or -less pernicious, according to the Quantity and Nature of the Infection, -and as the Subject is disposed to receive or suffer by it. - -4. That putrefactive and malignant Diseases, in common, admit of the -most sensible and secure Relief, from Discharges of the peccant Matter, -either upon the Skin in general, or on particular Parts of the Body. - -5. That the Redness, and cutaneous Efflorescence in the present Case may -be consider'd as an Eruption of the like Nature; and therefore to be -promoted by such Methods as have proved successful in similar Diseases. - -6. That a cordial, alexipharmac, warm Regimen has been found by -Experience to be of the most Use in such Cases; and that Bleeding, -Purging, Antiphlogistics, liberally employed, either retard, or wholly -prevent these Discharges. - -Therefore, as to expel the morbific Matter (3) seems to be the Design of -Nature; to promote this Design by the Measures that are approved by -Experience in analogous Disorders, is the Duty of the Physician. - -It may likewise be remarked, that, though this Disease has now been -amongst us several Years, and has consequently survived the different -Seasons, and all the Variety of Weather to which we are exposed, yet it -seems to shew itself most frequently in Autumn and the Beginning of -Winter; at least I have met with many more Cases from _September_ to -_December_, inclusive, than in all the other Months together; having not -yet seen any who had it in the Spring, and very few in the Summer. - -It may likewise be remark'd, that the Summers of 1747 and 1748 were dry, -with some Days in each uncommonly hot, for this Climate; the Mercury in -_Fahrenheit_'s Thermometer rising in the Shade, and within-door, one Day -to 78, and during several to 75 and 6. The Autumns of the same Years as -unusually temperate and warm; the Wind continuing longer in the -Southerly Points than has often been known at this Season. - - - _FINIS._ - ------ - - - - - FOOTNOTES: - - -Footnote 1: - - Ab Hispanis _Garrotillo_ appellatur, ut eadem patiantur Angina - laborantes, quæ facinorosi homines, cum injecto circa collum sune - strangulantur. Epist. _R. Moreau_ ad _Th. Barth_. Epist. Med. Cent. i. - _p._ 336. - -Footnote 2: - - Affectus suffocatorius, Carbunculus anginosus, Phlegmone anginosa, - Angina pestilentialis, Epidemica Gutturis Lues, Morbus Gulæ, Morbus - Puerorum, Pestilens ac præfocans pueros abscessus, Tonsillae - pestilentes, Ἀγχόνη λοιμώδης, Aphthæ malignæ, Passio angìnosa, Laqueus - Gutturis, _&c._ _Vide Cortes. Miscel. Med._ _p._ 696. _Severin. Epist. - Ren. Moreau ad Th. Barthol. de Laryngotomia._ - -Footnote 3: - - _Severin._ de recondita Abscessuum natur. _p._ 446. - -Footnote 4: - - _Joh. Wieri_ Observat. lib. i. de Angina pestilenti Epidemica, Oper. - _p._ 910. - -Footnote 5: - - _Pet. Forrest._ Observat. lib. vi. de Febribus publice grassantibus, - p. m. 150. - -Footnote 6: - - _Bern. Ramazzini_ Constitutiones Epidem. Oper. _p._ 195, & seq. - -Footnote 7: - - Medical Essays, vol. iii. p. 26. - -Footnote 8: - - _Tournefort's_ Voyage to the _Levant_, vol. i. p. 133. - -Footnote 9: - - De pestilente faucium affectu Neapoli sæviente, opusculum, auctore - _Jo. Andrea Sgambato_, phylosopho ac medico Neapolitano, et academico - otioso. Neapoli excudebat Tarquinius Longus, 1620, in _4to._ - -Footnote 10: - - _Joannis Baptistæ Cortesii_, medici ac philosophi, in Messanensi - academia praxim ordinariam e prima sede interpretantis, Miscellaneorum - Medicinalium Decades Denæ. _Messanæ_ 1625. in fol. - -Footnote 11: - - Divi Francisci Custos, vir doctrina et moribus insignis, hac lue - obsessus, tonsillas solummodo et gargareonem inflammatione læsa - habebat, et continuo querebatur se percipere in ore fætorem quendam; - et ut hac de re certior redderetur, ad se vocavit baccalaureum quendam - sibi amicissimum, qui maximo affectu assistebat, rogavitque ut vellet - olfacere, percipereque naribus, an verum esset talem fætorem emittere, - an ab ejus imaginatione prodiret: olfecit baccalaureus me (scil. - _Cortesio_) præsente, et multis aliis, at statim non multis elapsis - horis decubuit sola faucium et glandularum inflammatione vexatus, - absque aliqua manifesta corruptione partium, omnibusque præsidiis ex - arte factis, quarto die suffocatus periit; et tamen Custodem non - tetigerat, sed solo olfactu aerem ab ore prodeuntem naribus traxerat: - quare ab hujusmodi exemplo veni in sententiam hunc morbum non esse - absque aliqua contagione. _Cort. Miscel._ _p. 698._ - -Footnote 12: - - De morbo strangulatorio, opus Ætii Cleti Signini, doctoris medici et - philosophi. _Romæ_ 1636. _8vo._ - -Footnote 13: - - De recondita abscessuum natura, libri 8. Marci Aurelii Severini - Tharsiensis, philosophi et medici, regio in gymnasio Neapolitano - anatomes et chirurgiæ professoris. Editio secunda, _Francofurti ad - Mænum_ 1643. And again printed with _Bartholine_'s _Exercitationes_, - as a Commentary upon it, with _Villani_'s _Therapeuta Neapolitanus seu - Veni mecum Consultor_. Neapoli 1653. - -Footnote 14: - - _Thomæ Bartholini_ de Angina Puerorum Campaniæ Siciliæque epidemica - exercitationes. _Lut. Parisior._ 1646. - -Footnote 15: - - Quod ad contagium attinet, hoc turn communi omnium consensu atque - experimento evincitur, tum etiam comprobatur ratione. _Severin._ p. - 442. - -Footnote 16: - - Ibid. - -Footnote 17: - - Idem ibid. - -Footnote 18: - - Idem, _p. 440_. - -Footnote 19: - - Hoc unum salutis est indicium vel interitus: dum oculorum nitor - adservatur, salutis spes semper adest; quo tempore hic deperiit, in - propinquo mors est. _Ætii Cleti_ Op. - -Footnote 20: - - _Ætii Cleti_ Op. de Morbo Strangulatorio. - -Footnote 21: - - Quinimo post xxx dies, et xl. jam prærepti morbi furoribus, præter - omnium opinionem ex improviso sunt extincti. Adeo scil. latitans et - recondita veneni vis est. _Severin_, p. 440. - -Footnote 22: - - _Æt. Clet._ - -Footnote 23: - - _Severin._ p. - -Footnote 24: - - In hoc sacro igne non mittendus est sanguis in ea quantitate ac in - angina exquisita.—Placuit quibusdam in hoc morbo fecare venas sub - lingua; alii admoverunt hirudines collo: mihi nulla istarum - evacuationum unquam probari potuit. Nam cum tumor superveniens ex - sanguine non oritur, frustra adhibentur ea auxilia quæ ad sanguinem ex - parte affecta evacuandum excogitata fuerunt. _Sgambat._ de Pest. - Faucium Affect. - -Footnote 25: - - _Severin._ ubi supra. _Cort._ Miscel. _p. 697_. - -Footnote 26: - - _Zacut. Lusitan._ de praxi medic. admiranda _lib_ i. observ. 99. where - he mentions this Disease, and relates an unhappy Instance of its - Effects in the following Terms. - - In his partibus (scil. faucibus) ex humoris virulenti affluxu - gignuntur carbunculosæ inflammationes, quæ pestis diræ, aut veneni - promptissimi instar, contagio quodam, pueros et adultos corripiunt; et - sævis maleficentissimisque stipatæ symptomatis citissimam necem - inferre solent. Malum in Hispania non multis abhinc annis frequens, - vulgus medicorum Hispano sermone _Garrotillo_ nuncupat; de cujus - essentia, periculo, brevitate, et complicatione ustivi et ulcerosi - tumoris, ac deleteria corruptione, laconice dicam. Hoc fuit pressus - biennis infans, sanguineus et obesus. Primo die ex catarrhosa - defluxione in suffocationem pene incurrit, difficulter respirabat, et - lac deglutiebat, et febri acuta affectus, nec plorare poterat. In - parte gutturis dextra externa glandulosus apparuit tumor cum dolore - multo. Secundo die intra fauces ulcus visum est ad nigrum vergens, - quod putrilago et mollities multa comitabantur; at ab ore fætor - horribilis prodibat, magnum certe corruptionis completæ indicium. - Tertio die nullis adjutus auxiliis strangulatus, est extinctus. - -Footnote 27: - - _Cortes._ Miscel. _p. 703_. - -Footnote 28: - - _Sgambat._ de Affectu Faucium pestilente. - -Footnote 29: - - —Ad prædictarum partium (Uvulae, Tonsillarum) inflammationem - subsequebatur interdum materia quædam pituitosa a capite tam repente - et inopinato descendens, ut miseri ægrotantes subito suffocarentur. - _Cortes. Miscell._ p. 697. - -Footnote 30: - - Si quis tamen vel digitis, vel aliquo instrumento levi ipsam (materiam - aliam) auferre tentâsset, quamvis operatio hæc fieret absque dolore, - ea tamen ablata brevissimo tempore peribant ægrotantes; quod præ - cæteris in _Petro Soprano_ genero meo observatum est, cui cum - hujusmodi mortificatio apparuisset in suprema superficie dictarum - glandularum faucium, et palati, ita ut videretur esse maximo - respirationi et deglutitioni impedimento, chirurgus existimans posse - facillimo negotio a subjectis partibus eam separari solis digitis, - levissime quidem eam abstulit; quæ ablata, tantum abest ut juverit - deglutitionem aut respirationem, ut utraque potius actio læsa magis - fuerit, unde brevissimo tempore miser, meo cum maximo dolore, mortem - oppetiit; id quod etiam in aliis quamplurimis pueris sæpius observavi, - et præfertim in ejusdem _Petri_ filiolo nepoti ex filia, quinque - annorum, mihi carissima, qui post paucos dies eodem modo, quo pater, - vitam cum morte mutavit. _Cortes. Miscel. Med_, p. 697. - - - - ------------------------------------------------------------------------- - - - - - Transcriber's Notes. - -The original spelling and punctuation has been retained. - -This Book is 300 years old and the advice given has been superceded by -more modern methods and is of historical value only. - -Italicized words and phrases are presented by surrounding the text with -underscores. - -The symbols for the Apothecaries Measures have been replaced with the -full word in Square brackets for yor information, in some cases it has -not been possible to replace the symbol with a unicode character. 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