50 THE MALIGNANT SORE THROAT CHAP. 



ichor flowed from them, and sometimes through the nostrils 

 also. There was swelling of the parotid glands and neck ; 

 and regurgitation of fluids sometimes took place through the 

 nose. Insomnia and delirium were common. In those cases 

 which ended fatally death took place by exhaustion, especially 

 from persistent diarrhoea, or in some cases from suffocation, 

 and generally before the fourth day of the disease ; but some 

 patients dropped off unexpectedly after thirty or even forty 

 days. 



The diagnosis from a common angina depends, in Fother- 

 gill's view, upon the severity of the initial symptoms, the 

 vomiting or purging, acute headache, and the erysipelatous 

 redness of the fauces with ulceration or sloughs ; also upon 

 the skin eruption, seldom absent in children. But some 

 cases are difficult to discriminate. He thinks the disorder is 

 a general one, as contrasted with angina which is purely local. 



As regards the treatment, he has found bleeding prejudicial 

 and purging also ; all evacuations which tend to lessen the 

 strength are injurious. Let the patient be kept warm in bed ; 

 promote the early vomiting ; give aromatic cordials (contra- 

 yerva, confectio cardiaca, saffron wine) ; check any continuing 

 diarrhoea ; recession of the skin eruption, which is dangerous, 

 is to be met by warmth and cordials ; a tendency to faintness 

 to be watched against ; wine whey, chicken broth, barley 

 water, etc., to be given ; blisters, on occasion, to be applied 

 to the neck ; the sloughs on the tonsils not to be forcibly 

 separated or scarified, but a free discharge of the corrosive 

 matter to be encouraged by the use of stimulating antiseptic 1 

 gargles sage tea, decoctum perforate (a warm decoction of 

 barley, raisins, figs, and liquorice), vinegar, myrrh, etc. with 

 which in severe cases the fauces should be very often and 

 sedulously syringed, and especially before the swallowing of 

 food ; large sluggish sloughs to be touched with the mel 

 cegyptiacum (caustic copper acetate). For haemorrhage he 

 uses clysters, vinegar applied by means of tents or in steam, 

 also bark and opium. Asses' milk, bark and the elixir vitrioli 

 (aromatic sulphuric acid) are useful in the debility of con- 

 valescence. In later editions of his book he lays stress upon 

 " free air," cleanliness and liquid nutriment ; bark in an 

 enema with broth has, he thinks, saved many lives. 



1 The term antiseptic (anti-putrescent) follows Bacon's earlier thought 

 (Nat. Hist., Cent. IV.) and was employed by Boerhaave. It was becoming 

 current at this period in English medicine. Fothergill's use of the word in 

 1748 is earlier than the first example given in Murray's Dictionary. See also 

 Pringle's paper before the Royal Society, 1750. 



