MEDICINE. 
witli assiduity. There appear to be two 
varieties of this complaint; the one just 
now described, which may be termed the 
inflammatory, and the spasmodic; which, 
from their different requisite mode of treat- 
ment, it will be necessary to discriminate. 
The inflammatory Cynanche commonly at- 
tacks the patient in a gradual manner, and 
is generally preceded for a few days by 
slight symptoms of pyrexy ; it never, when 
completely formed, intermits so as to lose 
its distinguishing mark, particularly in 
coughing: the heat, frequency of the pulse, 
and other symptoms of pyrexy, are in a 
much greater degree in this than in the 
spasmodic species. The spasmodic Cynanche 
always attacks the patient in a sudden man- 
ner, and usually in the night-time : it often 
intermits, and in the intervals both the res- 
piration and cough, if any exists, are free 
from the characteristic sound of the above 
disease ; it must, of course, be treated with 
antispasmodics, as the musk, camphor, asa- 
foetida, the warm bath, and similar reme- 
dies. 
C. maligna, malignant, or putrid sore 
throat. This disease, whether primary or 
symptomatic, is marked by frequent cold 
shiverings, alternating with fits of heat, gid- 
diness, lassitude, anxiety, depression of 
spirits, nausea, and vomiting : these symp- 
toms seldom continue long, before the pa- 
tient complains of a sense of stiffness in the 
neck, some uneasiness in the internal fauces, 
and hoarseness ; the internal fauces, when 
viewed, appear of a dark red colour, are but 
little, or not at all swollen, and deglutition 
is seldom attended with difficulty or pain. 
In a short time, a number of white, ash-co- 
loured, or brown .spots, make tlieir ai)pear- 
ance upon the inflamed parts ; these spread, 
run together, and cover the greatest part of 
the fauces with thick sloughs, which, upon 
falling off, discover deep ulcerations. As 
the disease advances, these symptoms are 
generally attended with a coryza, which 
pours out a thin, acrid, and fetid matter, 
which excoriates the nostrils, lips, and some- 
times every part it touches; in infants diarr- 
hoea is a more frequent occurrence than in 
adults, and the thin acrid matter evacuated 
excoriates the anus and neighbouring parts. 
The fever increases with the other symp- 
toms ; the skin is dry, parched, and accom- 
panied with a biting heat; the eyes become 
red, heavy, and watery ; the countenance 
is either full and bloated, or pale, shrunk, 
and dejected, and the patient frequently 
pomplains of an unusual sense of oppression 
and debility ; the pulse is small, frequent, 
and Irregular ; the respiration is more or 
less hurried, and as the disease advances, 
the breath becomes very fetid, and is often 
disagreeable to the patient himself; and 
there is generally a considerable discharge 
of a sanious-like matter from the fauces; 
the voice is frequently very much altered, 
and when the inflammation has attacked 
the organs of respiration, it assumes a 
wheezing or ringing sound, the respiration 
becomes difficult, and the patient is teased 
with a troublesome cough; the fever suf- 
fers an evident exacerbation in the evening, 
during which some rattling is perceived in 
the breathing, and there is generally a re- 
mission in the morning ; great debility, pros- 
tration of strength, and restlessness, accom- 
panied with frequent sighing, as in the Ty- 
phus Gravior, supervene, and, if neither de- 
lirium nor coma appeared at an early period, 
they generally come on in the progress of 
the complaint. On the second or third, 
rarely later than the fourth day, an eruption 
appears upon the skin, which, for the most 
part, in the first instance, shews itself upon 
the neck and breast; it comes out in blot- 
ches of a dark purple or raspberry hue, and 
gradually spreads over the trunk and extre- 
mities ; the scarlet redness is often consi- 
derable on the hands and extremities of the 
fingers, which feel stiff and swelled; the 
stains, when nearly inspected, appear to be 
composed of small prominences, which may 
sometimes, although rarely, be distinguished 
by the eye, more frequently by the touch 
only; the eruption is as irregular in its ap- 
pearance as it is in its steadiness and conti- 
nuance; it generally, however, disappears 
about the fourth day, and a desquamation 
of the cuticle fakes place : but neither on 
its first appearance, nor on its desquamation, 
does it always produce a remission of the 
fever or of the other symptoms, except the 
vomiting, which generally abates on its first 
appearance. As the disease advances, the 
ulcers on the fauces become of a livid or 
black colour, the pulse becomes more de- 
pressed, and the symptoms attending the 
latter stages of the Typhus Gravior come 
on, and the patient is generally cut off 
either by a diarrhoea, or by a profuse h®- 
morrliage from the intestinal canal, nose, 
mouth, or ears, often on the third day, 
sometimes later, but for the, most part be- 
fore the seventh. The complaint some- 
times spreads into the trachea ; the parotid 
and the other lymphatic glands also in the 
vicinity of the fauces, in consequence of the 
