CYNANCEIE MALIGNA. 
365 
The malignant sore throat has existed in this town for 
upwards of a year and a half. It was at first confined to 
the town; at length it appeared in the neighbouring villages, 
but not to any great extent. 
I cannot say precisely what proportion of deaths to reco- 
veries have taken place. At first, in the most malignant 
form, more than half the cases proved fatal; in the milder 
cases, most recovered. 
The disease begins with an ash-coloured spot on one or 
both tonsils, which rapidly spreads, and involves the velum 
and uvula. In the worst cases, it runs speedily into a gan- 
grenous condition of these parts, and then, of course is 
attended with great fetor, &c. The cervical glands become 
enlarged, and frequently there is an acrid, fetid discharge 
from the nares. Deglutition is of course difficult, from the 
enlarged tonsils. The pharynx has more rarely been impli- 
cated. In a few cases croupal symptoms have arisen from 
the disease attacking the larynx, but it is not true croup, but 
only a complication of a secondary character. At first, the 
pulse is more or less accelerated, but it soon becomes feeble 
and sinks in frequency even below the natural standard. 
Delirium is rare. There are no symptoms of the respiratory 
organs, below the larynx, being implicated, nor is the larynx 
but very seldom. We have had no post-mortem examinations. 
The worst forms are quickly followed by great prostration, 
and even the milder cases are frequently attended with pro- 
tracted debility. I scarcely know whether you wished for 
this detail of symptoms. 
The disease is not true croup . Secondary croup has been a 
complication in a few cases. 
The disease has not been unfrequently accompanied by 
sloughing of the tonsils and adjoining parts, shown by the dead 
parts coming away, and excavations left behind. I am not 
clear, therefore, that the disease is the diphtherite of Bre- 
tonneau. 
It is a new disease here, not, I incline to think, altogether 
independent of the scarlatinal poison in a modified form. 
Scarlet fever has existed more or less during the prevalence 
of the complaint. I have sometimes called the disease 
cynanche maligna, from the view T I have that the poison 
which enters the system may be a modification of that of 
scarlet fever. This, however, is not fully proved though I 
have seen cases of both diseases in the same house. 
This epidemic is eminently contagious. The blood is 
poisoned, and the poison kills in most instances rather by 
its general than by its local effects 
