Sec Aretaeus, Coelius Aurelianus, Hildanus, Trallia-nus, Hoffman, Boerhaave, Le Dran's Operations, Wal-lis's Sydenham, and Fordyce's Elements, part. ii. Cul-len's First Lines, i. 279. edit. 4.

Angina aquosa oedematosa. Boerhaavii Aphor. 791. This is a species of dropsy, arranged by Dr. Cullen under anasarca, the second species, which arises from obstruction, occasioned by compression of the veins; see Anasarca oppilata. It is called Lowe-riana, being produced upon a dog by Lower's tying up the jugular veins, which brought on the angina aquosa that occasioned suffocation; see Sauvages" Nos. Meth. vol. i. p. 678.

Angina gangraenosa, called also garotillo, angina maligna, epidemica gangraenosa, ulcerosa, ulcusculosa, suffocativa, erysipelatous, ulcerated, malignant, or putrid sore throat; cynanche maligna of Dr. Cullen.

This is a disease of great danger and importance. It is probably not a new one; but its nature and proper treatment were seemingly obscured by the too common term of pestilential, and the farrago-of remedies adapted to a name. The history is very accurately detailed in Dr. Cullen's Synopsis, where a chronological list of the authors who have treated of it is inserted.

It attacks like a slight inflammatory sore throat, though sometimes only a languor insidiously creeps on, with a little difficulty of swallowing; and, in the worst cases, even this is absent. The strength, however, rapidly sinks, the features fall, a ghastly paleness comes on, and death quickly follows. In slighter kinds, the course is not very different from that of the inflammatory species, though seemingly slight, with alternate chills and heats, pain in the head, etc. till the debility appears, when every other bad symptom immediately follows. Every sore throat, should, therefore, be carefully examined.

In the most active inflammations of the throat, white specks will sometimes appear on the velum pendulum or tonsils. If the inflammation is florid, the constitution robust, and the pulse firm, these spots may be disregarded. On the contrary, in some instances of the most malignant kind, no sloughs can be observed. The distinction must be taken from the colour of the inflammation. In the true malignant sore throat, the colour approaches rather to the crimson and the pink than the red; and sometimes a shade of brown, not far distant from the cinnamon, is mixed. The pain in swallowing is slight in proportion to the degree of inflammation; languor, listlessness, and indifference, are very conspicuous; and the features display the same want of fulness and tone: the eyes are red and watery. At this time the pulse will be sometimes apparently strong, but a slight attention shows that the strength of the stroke is apparent only: it throbs with a kind of convulsive weakness, rather than beats with a steady firmness. The tongue grows brown, the breath offensive, and delirium, at night, comes on: by day, a wandering is only observable. When there are sloughs on the throat, the edges are of a dark pink red; they are observed to cover, and sometimes they conceal a considerable loss of substance; they enlarge, become deeper, and the edges black. An ichor, or a thin acrid matter, is discharged from the nose or ears; the stools are thin and highly offensive. The fever is said to remit in the morning, but the remission is inconsiderable, and will never assist in the distinction, though it will sometimes lead to an insidious security.

Sometimes, from the beginning, exanthemata appear; and the putrid sore throat is frequently, if not constantly, an attendant on scarlatina: these soon assume a darker hue, and appear livid. The breath in the earlier periods is not affected, but a wheezing noise supervenes if neglected; and this, in the worst kinds, is succeeded by the shrill barking sound which has occasioned the Spaniards to give it the name of garotillo. It evidently arises from the erysipelatous inflammation extending to the larynx, and is generally a fatal symptom. The eruptions have been described as favourable and critical: we have generally found them accidental, and only of use as an index of amendment, or of the disease increasing in violence and malignancy. In a disease which runs its course generally in less than five, always in seven days, no prognostic is to be depended on but a more florid appearance in the throat, and a more healthy aspect of the edges of the sores. '

The disease is epidemic, and attacks the active and robust as well as the infirm. We have not found the number of its victims greatly disproportioned in any period of life, in any situation or time of year. It is certainly infectious, though the infection is not active, or its influence very extended.

All evacuations are highly injurious; and an emetic, with which we are often directed to begin, sometimes operates with such violence as to debilitate greatly. If a stool or two be necessary, a clyster, or a very mild, quickly operating laxative, is alone admissible. After this the bark is to be given in active doses, with aroma-tics. Half a dram of the bark, with ten grains of aromatic species, should be exhibited every two hours. If it seems to produce strictures on the skin, and rigor, five or six grains of camphor, and three or four of true James's powder, (guarded by a little opium,) should be added to each dose. These may be washed down with a strong decoction of bark, sharply acidulated with either of the mineral acids. We may, however, remark, that in this disease the bark seldom disagrees.

The action of these remedies is greatly assisted by diet and gargles. Port wine should be given freely: it should indeed enter into every part of the food, and be drunk alone, cold. Even sleep is less necessary than bark and port wine; and should it continue above three hours, the patient must be awakened, for the loss of time cannot be regained. The quantity of the medicine and the wine must be regulated by the effect. If we gain nothing in the first thirty-six hours, we may depend on a fatal event: if we lose ground in twenty-four, our hopes will be inconsiderable. We have known women unaccustomed to wine drink two bottles within twenty-four hours, for more than a fortnight. The gargles should be of a strong decoction of bark, very sharply acidulated with mineral acids or with the strongest Cayenne vinegar, or some Cayenne in substance should be added; and they should be frequently used, or, as the patient is languid, injected with a syringe. Pepper-corns constantly bitten, and the saliva swallowed, we have often found highly useful.