52 THE MALIGNANT SORE THROAT CHAF 



Scarlatina; which occurred in severer forms epidemically, 

 both then and often since ; forms which we now regard as 

 manifestations of the same disease. Quasi - diphtheritic 

 symptoms indeed attended Fothergill's disorder, as they 

 occur in severe types of scarlatina at this day. But these 

 symptoms were exceptional, and the evidence shows that the 

 disease denned by Bretonneau in 1821 as diphtheria was 

 hardly known in Fothergill's time, at any rate in its pharyngeal 

 form. Yet in the opinion of medical historians it had occurred 

 previously, and the epidemics of angina in Spain and Italy 

 which were the subject of Letherland's and Fothergill's 

 researches were in fact diphtheritic. 1 The complaint already 

 called " croup " was better known and sometimes epidemic, 

 but it was a laryngeal disorder, and thus clearly distinguished 

 from other forms of angina. 



Scarlatina, as has been said, occurred in Fothergill's time 

 in occasional epidemics of varying type. In the succeeding 

 century it became a more common disease, of greater average 

 severity and mortality, with a tendency to epidemic prevalence 

 every few years. Outbreaks of aberrant types of tonsillitis, in 

 which some cases assumed a scarlatinal, others a diphtherial 

 aspect, were common in England a generation ago. These 

 facts suggest that certain diseases of the fauces were in Fother- 

 gill's time less fully developed than they are now, that indeed 

 new diseases were in course of formation. It is well to 

 remember what we mean by a disease. What we call a 

 disease is strictly the reaction of the human organism to a 

 morbific cause. In common usage we combine the symptoms 

 of the reaction with the cause itself, and call the whole a 

 disease. The reaction varies with numerous factors, extrinsic 

 and intrinsic. The cause, which Fothergill called in the 

 language of his day a virus or miasma, we are accustomed in 

 the case of many diseases to identify with a micro-organism, 

 although the actual part played in the production of disease 

 by the organism (in its possible transmutations) or by its 

 toxins, or ferments, or by " secondary invaders," is not yet 

 determined. When, however, such a cause has acted (it 

 may be through countless generations of micro-organisms) 

 upon many subjects, and has found a favourable environment 



1 Bretonneau, Memoirs on Diphtheria, New Syd. Soc. pp. 31-37 ; Hirsch, 

 Geog. and Hist. Pathology, iii. 76, 77. An outbreak of diphtheria (?) in the 

 American colonies is described by Dr. Cadwallader Golden in a letter to 

 Fothergill in 1753 : Med. Obs. & Inq. i. 211. See also Dr. James Sims, 

 Scarlatina Anginosa in 1786, Mem. Med. Soc. Land. i. 388 ; Lettsom, 1793, 

 Idem, iv. 280 ; and Fagge, Medicine, 3rd ed. i. 256. 



