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and swelling appear, in colour and bulk approaching to the state of these symptoms in the cynanche tonsillaris; but, in the scarlatina, there is always more or less of sloughs, which seldom appear in the cynanche tonsillaris, and the sloughs are com monly whiter than those in the cynanche maligna.
While these appearances are discovered in the fauces, upon the third or fourth day a scarlet eruption appears on the skin, in the same form as described in 314. This eruption is commonly more considerable and universal than in the cynanche; but it seldom produces a remission of the fever. The eruption for the most part remains till the third or fourth day after its first appearance; but then goes off, ending in a meally de. squamation. At this time the fever usually subsides ; and generally, at the same time, some degree of sweat comes on.
The sloughs on the fauces, which appeared early in the disease, continue for some days, but then falling off, discover the swelling abated, and an ulcer formed on one or both tonsils shewing a laud. able pus; and soon after the fever has subsided, these ulcers heal up entirely. For the most part, this disease has much less of coryza' attending it than the cynanche maligna ; and, when there is a coryza attending the scarlatina, the matter discharged is less acrid, and has not the fetid smell which it has in the other disease.
In the Scarlatina, when the eruption has entire. ly disappeared, it frequently happens, that, in a few days after, the whole body is affected with an anasarcous swelling; which, however, in a few days more, gradually subsides.
We have thus described the most common circumstances of the Scarlatina Anginosa; and have only to add, that, during the time of its being epidemic, and especially upon its first setting in, there are always a few cases in which the circumstances of the disease approach very nearly to those of the cynanche maligna ;, and it is only in these instances that the disease is attended with any danger, i .
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657. With respect to the cure of this disease, when the symptoms of it are nearly the same with those of the cynanche maligna, it requires exactly, the same treatment as directed in 317.
658. When the scarlet fever appears, without any affection of the throat, the treatment of it is very simple, and is delivered by Dr. Sydenham. An antiphlogistic regimen is commonly all that is requisite; avoiding, on one hand, the application of cold air; and, on the other, any increase of external heat,
659. In the ordinary state of the Scarlatina Anginosa, the same treatment is, in most cases, sufa ficient ; but as here the fever. is commonly more considerable, and there is likewise an affection of the throat, some remedies may be often neces. sary.
660. When there is a pretty high degree of fe. ver, with a full pulse, and a considerable swelling of the tonsils, bleeding is very proper, especially in adults; and it has been frequently practised with advantage: but as, even in the cynanche tonsillaris, much bleeding is seldom necessary (305); só, in the scarlatina, when the state of the fever and the appearances of the fauces render the nature of the disease ambiguous, bleeding may be omitted ; and, if not altogether avoided, it should at least not be large, and ought not to be repeated.
661. Vomiting, and especially nauseating doses of emetics, notwithstanding the inflamed state of the fauces, have been found very useful in this disease. An open belly is proper in every form of this disease; and when the nauseating doses of emetics operate a little downwards, they are more serviceable.
662. In every form of the Scarlatina Anginosa, through the whole course of it, detergent gargles should be employed, and more or less as the quan tity of sloughs and the viscid mucus in the fauces may seem to require.
663. Even in the milder states of the Scarlatina Anginosa, it has been common with practitioners to exhibit the Peruvian bark through the whole course of the disease; but we are assured, by much experience, that in such cases it may be safely omitted, though in cases anywise ambiguous it may not be prudent to neglect this remedy.
664. The anasarcous swelling, which frequently follows the Scarlatina Anginosa, seldom requires any remedy; and, at least, the purgatives so much inculcated, and so commonly exhibited, soon take off the anasarca.
OF THE PLAGUE.
Of the Phenomena of the Plague.
665. THE Plague is a disease which always arises from contagion ; which affects many persons about the same time; proves fatal to great numbers; generally produces fever; and, in most persons, is attended with buboes or carbuncles.
. 666. These are the circumstances which, taken together, give the character of the disease; but it is accompanied with many symptoms almost peculiar to itself, that, in different persons, are greatly diversified in number and degree, and should be particularly studied. I would wish to lay a foundation for this, but think it unfit for a person who has never seen the disease to attempt its particular history. For this, therefore, I must refer to the authors who have written on the subject; but allowing those only to be consulted, who have themselves seen and treated the disease in all its different forms.
.667. From the accounts of such authors, it appears to me, that the circumstances which parti. cularly distinguish this disease, and especially the more violent and dangerous states of it, are, . 1st, The great loss of strength in the animal functions, which often appears early in the disease.
2dly, The stupor, giddiness, and consequent staggering, which resembles drunkenness, or the headach and various delirium ; which are all of them symptoms denoting a great disorder in the functions of the brain.
3dy, The anxiety, palpitation, syncope, and especially the weakness and irregularity of the pulse, which denote a considerable disturbance in the action of the heart. in
4thly, The nausea and vomiting, particularly