“There was also among infants and children during the month of January [1796], an epidemic catarrh attended with a watery discharge from the eyes and nostrils, a frequent though slight cough, a shortness of breath, or rather panting, a flushing of the cheeks, great languor with disposition to sleep, and a quick small irregular pulse.... It was succeeded in February by the hooping cough.”
“There was also among infants and children during the month of January [1796], an epidemic catarrh attended with a watery discharge from the eyes and nostrils, a frequent though slight cough, a shortness of breath, or rather panting, a flushing of the cheeks, great languor with disposition to sleep, and a quick small irregular pulse.... It was succeeded in February by the hooping cough.”
Measles, which is usually a catarrhal malady, has undoubtedly been followed by whooping-cough in many individual cases and in epidemics as a whole; and it may be that there is a closer association of whooping-cough with measles than with any otherinfectious disease. In the table on p. 647, the deaths by whooping cough in London from 1731 to 1830 have been reduced to ratios per cent. of the deaths from all causes, in a parallel column with the ratios of measles; it will be seen that the increase of both is equally remarkable towards the end of the table. But the Glasgow ratios abstracted by Watt show no such decided increase of whooping-cough from 1783 to 1812, side by side with the astonishing increase of measles; while his annual bills for the same period show that there were many deaths from whooping-cough in Glasgow for years before measles began to replace smallpox or to divide the mortality with it. The first high monthly mortalities from whooping-cough in Watt’s bills were from November, 1785, to the end of 1786; but there had been so little measles for twenty-four months before that epidemic began, that only one death from it is recorded all the time. Again, the great measles epidemic of 1808 in Glasgow was indeed followed by many deaths from whooping-cough in 1809; but, while the height of the measles epidemic was in May and June, 1808, it was not until April, 1809, that whooping-cough began to cause many deaths.
Glasgow: Deaths by measles and whooping-cough.
Whatever correspondence or relation there may be between measles and whooping-cough, (and it has been remarked by many in the ordinary way of experience), it eludes the methodof statistics[1244]. As for the catarrhs of infants and children other than those which are part of the actual attack of measles or influenza, they are so common from year to year, and even from month to month, (perhaps coincident with teething, or with chicken-pox or other slight febrile disturbance), that a statistical study of whooping-cough in relation to them could lead only to an empirical, and possibly bewildering, result. It may be more useful to consider the antecedent probability of some such relationship, arising out of the pathology of the convulsive cough.
Whooping-cough is not only a paroxysmal cough coming on in convulsive fits at intervals, but the paroxysms, as they recur for many weeks, or, as they say in Japan, “for a hundred days,” have none of the obvious occasions of coughing, such as catarrh of the mucous membrane, congestion of the lungs from hot or close air, irritation of the bronchial tubes from dusty particles or vapours, or the presence of tubercles in the substance of the lungs. Such irritants can, indeed, produce whooping-cough, as in the following instance of “artificial chincough” related by Watt:
Two children having quarelled in their play, one of them thrust a handful of sawdust into the mouth of the other. Some of the sawdust passed into the windpipe. After a short time the child began to have violent convulsive fits of coughing, in which the whoop was very distinctly formed. Expectoration in the course of a few hours removed all the irritation, and the coughing thereupon ceased.
Two children having quarelled in their play, one of them thrust a handful of sawdust into the mouth of the other. Some of the sawdust passed into the windpipe. After a short time the child began to have violent convulsive fits of coughing, in which the whoop was very distinctly formed. Expectoration in the course of a few hours removed all the irritation, and the coughing thereupon ceased.
But in natural or ordinary whooping-cough there is no mechanical irritation, there is nothing to cough up, the reflex action, violent and paroxysmal though it be, has apparently no motive. I have, in another work, offered an original explanation of the paroxysmal cough of children as being the deferred reaction, the postponed liability, the stored-up memory, of some past catarrhal or otherwise irritated state of the respiratory organs, to which I refer without attempting to summarize it here[1245].
The epidemicity of whooping-cough presents no more difficulty if the malady be viewed as the sequel or dregs of something else than if it be taken for an independent primary affection. The many infants and children that suffer from it together may have equally been suffering together from one or other of the various things of which it is assumed to be the sequel—influenza, measles, sore-throat, the bronchitis of rickets, simple bronchial catarrh of the winter, simple coryza. Again, it may be a secondary or residual affection with many, but a communicable disease to others. Much of the whooping-cough of an epidemic is believed by good authorities, such as Bouchut and Struges[1246], to be simply mimetic, or a habit of coughing acquired by hearing other children coughing in a particular way, just as chorea is sometimes acquired in schools or hospital-wards through the mere spectacle of it. But it may be doubted whether much of the whooping-cough which swells the bills of mortality is acquired in that way. The children that die of it are probably most of them such as had only escaped dying of the measles or other infective disease, or of the non-specific catarrh, which had preceded the whooping-cough.
SCARLATINA AND DIPHTHERIA.
Scarlatina and diphtheria have to be taken together in a historical work for the reason that certain important epidemics of the 18th century, both in Britain and in the American colonies, which were indeed the first of the kind in modern English experience, cannot now be placed definitely under the one head or the other, nor divided between the two. It may be that this ambiguity lies actually in the complex or undifferentiated nature of the throat-distemper at that time, or that it arises out of the contemporary manner of making and recording observations upon the prevalent maladies of seasons. The older or Hippocratic method was not unlike the mason’s rule of lead, said to have been in use in the island of Lesbos for measuring uneven stones; it took account of gradations, modifications, affinities, being careless of symmetry, of definitions or clean-cut nosological ideas, or the dividing lines of a classification. Sydenham was the great English exponent of this method; but, in one of his more discursive passages, he sketched out another method of describing diseases as if they were species or natural kinds[1247]. He did no more than indicate this analogy, at the same time declining to put it in practice; so that Sauvages correctly described his great Nosology of 1763 as being constructed “juxta Sydenhami mentem et Botanicorum ordinem.” The identification of scarlatina in its modern sense, including scarlatina simplex and scarlatina anginosa, falls really in the time of the nosologies in the generation following the work of Sauvages, although both the name and definition in the modernsense were used in England as early as 1749. On the other hand, the name and definition of diphtheria were little known until about the years 1856-59, when the form of throat-distemper which is now quite definitely joined to that name became suddenly common, having been almost unheard of for at least two generations before. The only English writer who has attempted to unravel the accounts of the 18th century epidemics of throat-disease was Dr Willan in his unfinished work on Cutaneous Diseases, 1808; he swept the whole of those epidemic types into the species of scarlatina, to which also he reduced the great Spanish epidemics of “garrotillo” in the 16th and 17th centuries. Whether he would have used so summary a method if he had seen the sudden return of diphtheria in 1856, may well be doubted; at all events the German writers who brought their erudition to bear upon the question of identity some thirty years ago have discovered true diphtheria among the 18th century throat-distempers, although no two of them agree as to which of these should be called diphtheria and which scarlatina anginosa. It is one advantage of a historical method that the complexities of things may be stated just as they are, with due criticism, naturally, of the matters of fact and of the relative credit of observers. The result is more an impression than a logical conclusion,—an impression which will take a colour from the pre-existing views or theoretical preferences of individual readers on such points as fixity of type or the incompetence of the earlier observers. An author who has puzzled over these difficulties in detail can hardly help having a tolerably definite impression of the real state of the case; and I do not seek to conceal mine, namely, that scarlatina anginosa and diphtheria were not in nature so sharply differentiated in the 18th century as they have been since 1856.
The significant name ofpestis gutturuosaor plague of the throat is given by the St Albans chronicler to the great pestilence, or some part of it, in 1315-16, during one of the worst periods of famine and murrain in the whole English history. But those two words being all that we have to base upon, there is no use speculating whether the disease was scarlatina anginosa, or diphtheria, or something different from either. This is perhaps the only reference to an epidemic throat-distemper in England for several centuries in which bubo-plague was the grand infection. In the popular medicalhandbooks of the Tudor period one naturally looks for scarlatina among the diseases of children. In Elyot’sCastel of Health(1541), “the purpyles” is mentioned among children’s maladies in company with smallpox and measles, and the same name is in the London bills of mortality from their beginning in 1629, although it does not appear whether the deaths assigned to it were of children or adults. Perhaps the most common use of purples in the 17th and 18th centuries was for a form of childbed fever often attended with discoloured miliary vesicles. In Scotland, according to Sibbald (1684), “the fevers called purple” were any fevers, even measles or smallpox, in which livid or dark spots occurred as an occasional thing. Unless a few scarlatinal deaths are included under “purples” in the London bills (they could not have been many in any case), there is no other evidence of their existence until 1703, when the entry of scarlet fever appears for the first time, with seven deaths to it in the year. The heading remains in the bills until 1730 (the deaths never more than one figure), after which it is merged with fevers in general. The same indications of the insignificance of scarlatina among the causes of death in the 17th century may be got from the medical writers in London.
Sydenham introduced into the third edition (1675) of hisObservationes Medicaea short chapter entitled “Febris Scarlatina[1248].” It was a disease that might occur at any time of the year, but occurred mostly in the end of summer, sometimes infesting whole families, the children more than the elders. It began with a rigor, as other fevers did, the malaise being but slight. Then the whole skin became interspersed with small red spots, more numerous, broader, redder and less uniform than in measles; they persisted for two or three days and then vanished, and, as the cuticle returned to its natural state, there were successive desquamations of fine branny scales, which he compares elsewhere to those following the measles of 1670. Sydenham took it to be a moderate effervescence of the blood from the heat of the summer just over, or from some such excitement. It was a mild affair, not calling for blood-letting nor cardiac remedies, and requiring no other regimen than abstinence from flesh and spirituous liquors, and that the patient should keep in doors, but not all day in bed. The disease, he says, amounted to hardly more than a name (hoc morbi nomen,vix enim altius assurgit); but it appears that it was sometimes fatal; and in those cases Sydenham was inclined, after his wont, to blame the fussiness of the medical attendant (nimia medici diligentia). If convulsions or coma preceded the eruption, a large epispastic should be applied to the back of the neck and paregoric administered. Whether Sydenham was describing true scarlatina simplex, or a “scarlatiniform variety of contagious roseola,” it is from him that we derive the name of scarlatina by continuous usage to the present time[1249].
A few years after Sydenham had thus described scarlatina, Sir Robert Sibbald, physician and naturalist of Edinburgh, professed to have discovered the same as a new species of disease. “Just as the luxury of men,” he says, “increases every day, so there grow up new diseases, if not unknown to former generations, yet untreated of by them. Nor is this surprising, since new depravations of the humours arise from unwonted diets and from various mixtures of the same. Among the many diseases which owe their origin to this age, there has been most recently (nuperrime) observed a fever which is calledScarlatina, from the carmine colour (named by our people in the vernacularscarlet) with which almost the whole skin is tinged. Of this disease the observations are not so many that an accurate theory can be delivered or a method of cure constructed.” He proceeds to append one case—a child of eight, daughter of one of the senators of the College of Justice, who fell ill with redness of the face (thought at first to indicate smallpox coming on), became delirious and restless, then had the redness all over, which disappeared and left the child well about the fifth day. He had heard from some of his colleagues that the scarlet rash was sometimes interspersed with vesicles—perhaps themiliariaso much in evidence a generation or two later. In adults, Sibbald had seen the cuticle fall from nearly the whole body. But extremely few (paucissimi) had died of this fever. Like Sydenham, he omits to mention sore-throat and dropsy[1250].
Another 17th century reference is by Morton, who practised in London, in Newgate Street, from about 1667 to the end of the century, and was frequently called to consult with apothecaries or other physicians in cases of sickness in middle-class families. In the second volume of hisPyretologia, published in 1694, he has a chapter “De Morbillis et Febre Scarlatina,” and a separate chapter “De Febre Scarlatina.” His position towards scarlet fever is peculiar. He uses the name, he says, in deference to the common consent of physicians, but, for his own part, he thinks scarlatina different from measles only in the form of the rash, so-called scarlatina being confluent measles just as there is a confluent smallpox. Except in that sense he sees no reason for retaining scarlatina in the catalogue of diseases. Both arise from the same cause, both have hacking cough, heaviness of the brain, sneezing, diarrhoea; the single difference is that in scarlatina the rash is continuous. He gives eleven cases, most of which are clearly enough cases of measles; but the fourth case, that of his own daughter, Marcia, aged seven, in 1689, “in quo febris dicta Scarlatina, tempore praesertim aestivo, quadantenus publice grassabatur,” had no cough, nor redness of the eyes, nor diarrhoea, nor any other catarrhal symptoms (such as her sister had in 1685), but on the fourth day a continuous scarlet rash over the whole skin, which ended, not in a desquamation of fine branny scales, but in parchment-like peeling. The eleventh instance is complex enough to show that Morton had some reason, at that early stage in the history of scarlatina, for hesitating to make the disease a distinct type under a name of its own.
About midsummer, 1689, he was called to the house of his friend Mr Hook, merchant, of Pye Alley, Fenchurch Street, and found the whole household, three young girls, one little boy, and their aunt Mrs Barnardiston, a matron aged seventy, all suffering from the effects of some infection of as deleterious a kind as synochus, the symptoms being hacking cough, coma, delirium, and other signs of malignity. But on the 4th, 5th, or 6th day, each had a scarlatinal rash all over the skin, which lasted until the 7th, 8th or 10th day. Two of the girls, and the boy, had “on the 4th or 5th day of the efflorescence” extensive parotid swellings, difficulty of swallowing, vibrating arteries, and other urgent symptoms, for which they were blooded. The parotid abscesses burst, and discharged a copious acrid, corrosive pus by the nostrils, ears and throat, for the space of thirty days, during which the patients gradually got well. The third girl had, on the 3rd or 4th day of the rash, a painful swelling in the left armpit, not unlike a bubo; she also was blooded, and recovered completely, the swelling having broken and discharged pus for many days. The case of the aunt, aged seventy, was somewhat different; she neglected her medicines, acquired a “carcinoma”or slough over the pubes, which became gangrenous, recovered with difficulty, and lived three years longer.
About midsummer, 1689, he was called to the house of his friend Mr Hook, merchant, of Pye Alley, Fenchurch Street, and found the whole household, three young girls, one little boy, and their aunt Mrs Barnardiston, a matron aged seventy, all suffering from the effects of some infection of as deleterious a kind as synochus, the symptoms being hacking cough, coma, delirium, and other signs of malignity. But on the 4th, 5th, or 6th day, each had a scarlatinal rash all over the skin, which lasted until the 7th, 8th or 10th day. Two of the girls, and the boy, had “on the 4th or 5th day of the efflorescence” extensive parotid swellings, difficulty of swallowing, vibrating arteries, and other urgent symptoms, for which they were blooded. The parotid abscesses burst, and discharged a copious acrid, corrosive pus by the nostrils, ears and throat, for the space of thirty days, during which the patients gradually got well. The third girl had, on the 3rd or 4th day of the rash, a painful swelling in the left armpit, not unlike a bubo; she also was blooded, and recovered completely, the swelling having broken and discharged pus for many days. The case of the aunt, aged seventy, was somewhat different; she neglected her medicines, acquired a “carcinoma”or slough over the pubes, which became gangrenous, recovered with difficulty, and lived three years longer.
Morton calls these cases a veritablepestisor plague; and he goes on in the same context to say: “what swellings have I seen of the uvula, fauces, nares, and how protracted! At other times, what turgid lips, covered with sordid crusts and ulcerated!”—instancing the child of Mr Blaney, who had these symptoms long after the efflorescence, together with fever and coma[1251]. These cases, all given under the eleventh history illustrating the chapter on Scarlatina, are perhaps not different from those which Huxham, next in order, described in 1735, but not under the same name. It would appear from a reference in Hamilton’s essay on Miliary Fever, published in 1710, that scarlet fever continued to be seen in London: “If, in a scarlet fever, miliary pustules should arise, dying away with a red colour, they promise safety[1252].”
Several of the annalists of epidemic constitutions agree as to fatal anginas in the year 1727, with an exanthem of the miliary kind. Wintringham, of York, mentions the two things apart—in one place a putrid fever with cutaneous eruptions of a fuscous colour, sometimes dry, sometimes filled with a clear serum; in another place, “about this time many anginas were prevalent, attended with extreme suffocation, which proved fatal unless they were speedily relieved.” He mentions the same putrid fever in the summer of 1728, and again anginae. Hillary, who was then at Ripon, gives the same fever in 1727 (or perhaps in 1726) with miliary eruption, and chronicles “a fatal suffocative quinsey” in the winter of 1727-28, of which many died, especially those that had been reduced by the fever. Huxham’s account of an epidemic malady of the throat and neck at Plymouth in January and February, 1728, might relate to mumps (which Hillary and an Edinburgh observer describe clearly enough under 1731); and under October, 1728, he describes an erysipelatous and petechial fever, often relieved by an eruption of red miliary vesicles accompanied by sweats, the same miliary fever being again common in the autumn of 1729. This associationof “putrid” fever with sore-throat became still more notable in the period 1750-60.
These anginas of 1727-28 are unimportant compared with the outbreak a few years later. We hear first from Edinburgh in June, 1733, of scarlet fever and sore throats frequent in several parts of the country near the city, and continuing all through the summer into the winter and spring of 1734[1253]. Then in April, 1734, begins a series of important notes by Huxham at Plymouth[1254]. In that month, he says, there began a certain anginose fever (“for so I shall call it”), raging more and more every day. It mostly affected children and young people. Among other symptoms were vomiting and diarrhoea, pain and swelling of the fauces, languor, anxiety, delirium or stupor, a favourable issue being attended with sweats and red pustules. In May it was raging worse, with more severe angina and most troublesome “aphthae.” In June it was now miliary-pustular, and not seldom erysipelatous, while the throat was “less oppressed.” On the 6th or 7th day the cuticle looked rough and broken as if thickly sprinkled with bran; at length the whole desquamated—sometimes the entire skin of the sole of the foot coming off. The more copious the rash, the better the chance for life. It was contagious, affecting several in the same house. In July it cut off several within six days of the onset. Huxham’s references to this putrid miliary fever in Devon and Cornwall go on for some time, without farther mention of the throat complication. In April, 1735, “raro nunc adest strangulans faucium dolor, paucaeque nunc erumpunt pustulae.” But, in September, 1736, he enters again, “febres miliares, scarlatinae, pustulosae,” often attended with swelling of the parotid glands and of the fauces, and with profuse sweats.
The most important scene of fatal angina with rash in the same period (1734-35) was the North American colonies. Before coming to that remarkable outburst, I shall mention one curious coincident outbreak in the island of Barbados. Dr Warren, who occupies his pen chiefly with yellow fever, says[1255]: “In this space of time [1734 to 1738], there arose here a few other diseases, that were really epidemical and of the contagious kind too, few escaping them in families where they had once gota footing. The first was an obstinate and ill-favour’d erysipelatous quinsey. The second a very anomalous scarlet fever, in which almost all the skin, even of the hands and feet, peeled off,”—just as Huxham described for Devonshire.
It is beyond our purpose to include the evidence from foreign countries; but it may be noted in this context that Le Cat, in tracing the antecedents of the great Rouen fever in his paper of 1754, refers to many fatal anginas in that city about twenty years before[1256]. Thus we find about the year 1735 evidence of the beginning of a remarkable “constitution” of throat-disease both in the old world and in the new. But the facts in America stand out with peculiar prominence, and shall be given on the threshold of the subject as fully as possible.
The accounts of the great wave of “throat-distemper” that spread over the towns and villages of New England in 1735 are singularly clear and even numerically precise. The arrival of this sickness is one of the most definite incidents in the whole history of epidemics; it was hardly possible for the common belief, whether popular or professional, to have been mistaken about it. Just a hundred years had passed since the first settlement of the Puritans on Massachusetts Bay and along the Connecticut river; Boston had grown to a town of some 12,000 inhabitants, and many small towns and townships had sprung up along the coast and in the interior. The population was still sparse, although it was growing rapidly from within; it is difficult to believe that even the largest towns could then have deserved the strictures which Noah Webster passed upon them two generations later[1257].
In the mother country at that time, smallpox was the great infectious malady of infancy and childhood. It was not unknown in the colonies, Boston having had epidemics in 1721,1730 and 1752, and Charleston an epidemic in 1738 after an almost free interval of thirty years. Even in the chief cities of the colonies such epidemics were only occasional, affecting adults and adolescents perhaps more than infants and as much as children; while in such a town as Hampton, for which the register was well kept from 1735, it is known that there were no smallpox deaths in the twenty years following, or until the period 1755-63, when four died of the disease, and that only one death from it occurred in the next recorded period of ten years, 1767 to 1776. It was in these circumstances of a growing population, almost untouched, at least in the inland towns, by the great infantile infectious malady of the old country, that the throat-distemper broke out and raged in the manner now to be described.
The disease “did emerge,” as Douglass says, on the 20th of May, 1735, at Kingston township, some fifty miles to the east of Boston[1258]. The first child seized died in three days; in about a week after three children in a family some four miles distant were successively seized, and all died on the third day; it continued to spread through the township, and Douglass was informed that of the first forty cases none recovered. It was vulgarly called the “throat illness” or “plague in the throat.” Some died quickly as if from prostration, but most had “a symptomatic affection of the fauces or neck: that is, a sphacelation or corrosive ulceration in the fauces, or an infiltration and tumefaction in the chops and forepart of the neck, so turgid as to bring all upon a level between the chin and sternum, occasioning a strangulation of the patient in a very short time.” In August it was at Exeter, a town six miles distant, but it did not appear at Chester, six miles to the westward, until October. After the first fatal outburst in Kingston township it became somewhat milder; but in the country districts of New Hampshire it was fatal to 1 in 3, or 1 in 4 of the sick, and in scarce any place to less than 1 in 6. This average was made up by its excessive fatality in some families; Boynton of Newbury Falls lost his eight children; at Hampton Falls twenty-seven died in five families. The following table, compiled by Fitch, minister of Portsmouth, shows the deaths from it in varioustowns and townships of New Hampshire during fourteen months from May, 1735, to 26 July, 1736, with the ages[1259]:
Deaths from the throat-distemper in 14 months, 1735-36(Fitch).
The meaning of these figures in the townships of New Hampshire will appear from the case of Hampton. In the year 1736 its burials from all causes were 69, and its baptisms 50; while the throat-distemper alone, during fourteen months of that and the previous year, cut off 55. As we have seen, Hampton had no smallpox to ravage its children; but the throat-disease of 1735-36 had almost the same effect as the occasional disastrous epidemics of smallpox had upon English towns of a corresponding population or annual average of births.
This plague in the throat attacked the children of the most sequestered houses, especially those situated near rivers or lakes. It was least fatal to those who lived well, both Douglass and Colden assigning the salt diet, and other things likely to producepsora, as the reason of its greater severity. In the country districts or townships, in which the fatalities were most numerous, it would appear that an eruption, scarlet or other, was not only not the rule but even something of a rarity. Douglass, who was familiar with the exanthem in the Boston cases, assigns its absence in the country to a mistaken evacuant treatment, by which “the laudable and salutary cuticular eruption has been so perverted as to be noticeable only in a few, and in these it was called a scarlet fever.”
When the disease broke out in due course at Boston it proved much less malignant than in the country. The first case, on the 20th August, had white specks in the throat and an efflorescence of the skin. A few more soon followed in the same locality, of which none were fatal; they had soreness in the throat, the tonsils swelled and speckt, the uvula relaxed, a slight fever, a flush in the face and an erysipelas-like efflorescence on the neck and extremities. The first death was not until October, the disease becoming more frequent and more fatal in November, and reaching its worst in the second week of March, when the burials from all causes rose to 24, the average per week in an ordinary season being 10. The fatalities in Boston were so few for the enormous number of cases that many could scarce be persuaded that it was the same disease as in the Townships. In the corresponding weeks (1 Oct. to 11 May) of eight ordinary years preceding, the average deaths were 268, whites and slaves; during this sickness they were 382, or an excess of 114, which were probably all due to the throat-distemper, as many as 76 fatal cases having come to the knowledge of Douglass himself. He estimates the whole number of attacks at 4000, giving a ratio of one death in thirty-five cases; but it is clear that very slight cases of sore-throat were counted in.
The fatal cases in Boston seem to have shown a great range of malignant symptoms: “We have anatomically inspected persons who died of it with so intense a foetor from the violence of the disease that some practitioners could not continue in the room.” Among the bad symptoms were the coming and going of the miliary eruption, dark livid colour of the same, the vesicles large, distinct and pale, like crystalline smallpox; an ichorous discharge from the nose; many mucous linings expectorated, resembling the cuticle raised by blisters; pus brought up where no sloughs could be seen in the fauces; extension to the bronchi, with symptoms of a New England quinsey (? croup); in some children, spreading ulcers behind the ears; the tongue throwing off a complete slough with marks of the papillae. Among the after-effects in severe cases were anasarca or dropsy of the skin, haemorrhages, urtications, serpiginous eruptions chiefly in the face, purulent pustules, boils, or imposthumations in the groins, armpits and other parts of the body, indurations of the front of the neck (the same by which many in the country were suffocated, and a few in Boston), hysteric symptoms in women, and epileptic fits.Douglass gives special attention to the eruption, which he calls miliary in his title-page. Some had a sore-throat without any eruption, and a very few had an eruption with no affection of the throat beyond the tonsils and uvula swollen. In some the eruption preceded the soreness of the throat, in some the two came together, but in the general case the eruption was a little later than the affection in the throat. The ordinary course was a chill and shivering, spasmodic wandering pains, vomiting or at least nausea, pain, swelling and redness of the tonsils and uvula, with some white specks: then followed a flush in the face, with some miliary eruptions,attended by a benign mild fever; soon after, the miliary efflorescence appears on the neck, chest and extremities; on the third or fourth day the rash is at its height and well defined, with fair intervals; the flushing goes off gradually with a general itching, and in a day or two more the cuticle scales or peels off, especially in the extremities. At the same time the cream-coloured sloughs or specks on the fauces become loose and are cast off, and the swelling goes down. Where the miliary eruptions were considerable the extremities peeled in scraps or strips likeexuviae; in one or two, the nails of the fingers and toes were shed. Some who had little or no obvious eruption underwent a scaling or peeling of the cuticle.
The fatal cases in Boston seem to have shown a great range of malignant symptoms: “We have anatomically inspected persons who died of it with so intense a foetor from the violence of the disease that some practitioners could not continue in the room.” Among the bad symptoms were the coming and going of the miliary eruption, dark livid colour of the same, the vesicles large, distinct and pale, like crystalline smallpox; an ichorous discharge from the nose; many mucous linings expectorated, resembling the cuticle raised by blisters; pus brought up where no sloughs could be seen in the fauces; extension to the bronchi, with symptoms of a New England quinsey (? croup); in some children, spreading ulcers behind the ears; the tongue throwing off a complete slough with marks of the papillae. Among the after-effects in severe cases were anasarca or dropsy of the skin, haemorrhages, urtications, serpiginous eruptions chiefly in the face, purulent pustules, boils, or imposthumations in the groins, armpits and other parts of the body, indurations of the front of the neck (the same by which many in the country were suffocated, and a few in Boston), hysteric symptoms in women, and epileptic fits.
Douglass gives special attention to the eruption, which he calls miliary in his title-page. Some had a sore-throat without any eruption, and a very few had an eruption with no affection of the throat beyond the tonsils and uvula swollen. In some the eruption preceded the soreness of the throat, in some the two came together, but in the general case the eruption was a little later than the affection in the throat. The ordinary course was a chill and shivering, spasmodic wandering pains, vomiting or at least nausea, pain, swelling and redness of the tonsils and uvula, with some white specks: then followed a flush in the face, with some miliary eruptions,attended by a benign mild fever; soon after, the miliary efflorescence appears on the neck, chest and extremities; on the third or fourth day the rash is at its height and well defined, with fair intervals; the flushing goes off gradually with a general itching, and in a day or two more the cuticle scales or peels off, especially in the extremities. At the same time the cream-coloured sloughs or specks on the fauces become loose and are cast off, and the swelling goes down. Where the miliary eruptions were considerable the extremities peeled in scraps or strips likeexuviae; in one or two, the nails of the fingers and toes were shed. Some who had little or no obvious eruption underwent a scaling or peeling of the cuticle.
The epidemic having spent its force upon the New England towns from the autumn of 1735 until the summer of 1736, gradually travelled westward, and was two years in reaching the Hudson River, distant only two hundred miles in a straight line from Kingston, where it first appeared in May, 1735. It continued its progress, with some interruptions, until it spread over the colonies from Pemaquid in 44°N. latitude to Carolina; and as Douglass, writing in 1736, had heard that “it is in our West India Islands,” it was probably the same disease that Warren recorded for Barbados in the same years under the names of “an obstinate and ill-favour’d erysipelatous quinsey,” and “a very anomalous scarlet fever”; and the same as the epidemic “sore-throats” that another records for the Virgin Islands in 1737[1260].
Although it usually attacked several children in the same house, it did not seem to be communicable, like smallpox, from person to person or by the medium of infected clothes. The Boston physicians held a consultation on the point, and published their opinion that it proceeded entirely from “some occult quality of the air.”
This was the first appearance of sore-throat with efflorescence of the skin among the English colonists of North America. For at least two generations after, the disease remained in the country, breaking out unaccountably from time to time at one place or another and often cutting off many children, but never so malignantly as at first[1261]. Colden, writing from near New York in 1753, says:[1262]