176 TllACTICE OF PHYSIC. 



the Cynanche maligna, most of the instances terminate fatally, 

 while, on the other hand, that is the event of very few of 

 the cases of the Scarlatina anginosa. 



DCLV. From these considerations, though it may ap- 

 pear that there is some affinity between the Cynanche maligna 

 and Scarlatina anginosa, it will still remain probable that the 

 two diseases are specifically different. I have been at some 

 pains to establish this opinion : fof, from all my experience, I 

 find, that those two diseases require a different treatment ; and 

 I therefore now proceed to mention more particularly the cir- 

 cumstances of the Scarlatina anginosa. 



DCLVI. This disease commonly appears about the begin- 

 ning of winter, and continues throughout the season. 



66 1 have followed Sydenham in assigning particular times of the 

 year to the appearance of diseases depending on a specific conta- 

 gion. But I have seen the measles beginning in summer. Scarlet 

 fever also has begun in summer this year (1782.). Almost every 

 epidemic is obliterated by a long-continued frost in winter, but 

 sometimes returns after the frost. Epidemics seem to decline 

 by degrees, after having exhausted the persons liable to be af- 

 fected." 



It comes on with some cold shivering, and other symptoms of 

 the fever which usually introduces the other exanthemata. But 

 here there is no cough, nor the other catarrhal symptoms which 

 attend the measles; nor is there that anxiety and vomiting 

 which commonly introduce the confluent smallpox, and which 

 more certainly introduce the Cynanche maligna. 



Early in the disease, some uneasiness is felt in the throat ; 

 and frequently the deglutition is difficult, generally more so than 

 in the Cynanche maligna. Upon looking into the fauces, a 

 redness and swelling appear, in colour and bulk approaching to 

 the state of these symptoms in the cynanche tonsillaris ; but in 

 the Scarlatina, there is always more or less of sloughs, which 

 seldom appear in the Cynanche tonsillaris ; and the sloughs are 

 commonly whiter than those in the Cynanche maligna. 



While these appearances are discovered in the fauces, upon 

 the third or fourth day a scarlet eruption appears on the skin, 

 in the same form as described in CCCXIV. This eruption is 

 commonly more j considerable and universal| than in the Cy- 



1 



