vi A MODEL OF CLINICAL DESCRIPTION 51 



FothergilTs account of the symptoms and treatment of 

 the disorder is fitly called by the late Dr. J. F. Payne " a 

 model of clinical description." He describes in simple 

 language what he has himself observed, and out of -a wealth 

 of experience puts forward his conclusions cautiously, without 

 dogmatism, recognising the limitations of his knowledge. 

 Hence he has written very little which later research would 

 lead us to reject. His style may be contrasted with the turgid 

 and obscure diction still employed by many of his medical 

 contemporaries. At the close he sums up his conclusions : 

 that the sore throat attended with ulcers is a disorder of 

 putrefaction, which affects the fauces in particular and the 

 habit in general ; that it is due to a putrid virus, or miasma 

 sui generis, which is introduced by contagion, principally by 

 the breath ; that the effects of the virus vary according to its 

 nature and quantity, and the predisposition of the subject ; 

 that the disease is most effectually relieved by discharge of 

 the peccant matter on the skin or other parts ; that the 

 eruption is therefore to be promoted ; that a cordial alexi- 

 pharmac, warm regimen is used with advantage, and that 

 bleeding, purging and antiphlogistics are injurious. 1 



An attentive study of Fothergill's paper leads to the 

 conclusion that he is describing a definite disorder, and not, 

 as has been suggested, a mixture of cases of several different 

 types. The same disorder was described by Dr. Cotton of 

 St. Albans in I749, 2 by Dr. J. Wall of Worcester in I75I, 3 by 

 Dr. Huxham in 1757,* and especially by Dr. Withering, 5 who 

 studied it closely in Birmingham and wrote upon it at intervals 

 from 1766 to 1793. Withering, who had known Fothergill 

 well, became at length convinced that the " ulcerated sore 

 throat " of the latter was the same disease as the Scarlatina 

 Anginosa of Sauvage* (1763). Heberden, 6 writing in 1782, 

 considered it highly probable that the malignant sore throat 

 was a form of scarlet fever. And this must be our verdict 

 to-day : that Fothergill's disorder was one type of that 

 variable infectious disease, which we know as Scarlatina ; of 

 which a slight form was defined by Sydenham as Febris 



1 Alexipharmac is a term applied to remedies against poisons, antidotes. 

 Fothergill's enlightened views on contagion and isolation are illustrated by a 

 letter to his brother about 1749, with directions how to deal with an outbreak 

 of cattle plague. Tuke, p. 23. 



2 Quoted by Withering. 



3 Gent. Mag. Nov. 1751, p. 497. 



* Dissertation on the Malignant Ulcerous Sore Throat. 

 5 Account of the Scarlet Fever and Sore Throat, 1793. 

 8 Commentaries, c. 7. 



