§ 187. Angina maligna, gangraenosa, putrida, diphterica.

This disease is frequently attended with violent typhoid symptoms of the whole organism, affects the mucous membrane of the fauces, and frequently that of the larynx, at first forming circumscribed, afterwards confluent, whitish or grayish pseudo-membranous scurfs on the tonsils, uvula, palate, root of the tongue; they frequently turn black, occasion a fetid smell from the mouth, with discharge of patches, and often spread to the larynx, terminating fatally. This kind of angina is a disease of a peculiar kind, commencing with apparently slight symptoms, and becoming more dangerous as it develops itself.

The disease is frequently attended with a kind of eruptive fever, consisting of general malaise, chilliness, flushes of heat, restlessness, peevishness, with heat on the third day, pain, roughness of the throat, difficulty of swallowing, dots or spots of livid, purple, or at all events not very bright redness, considerable swelling of the cervical glands, bloated face, lachry-mation. In a few days the red spots change to the above named white or ash-gray lardaceous spots, which rapidly multiply and run into each other, and consist of a pulpous, cheesy, thick substance, exuding from the livid or dark-red mucous membrane, from which it can be drawn off. The affection spreads to the Schneider-ian membrane as well as to the oesophagus and larynx; in the latter case the affection resembles an angina polyposa.

The patient recovers in from 7 to 20 days. This angina is generally epidemic and contagious, or sets in by metastasis in epidemic scarlatina, generally affects feeble, scrofulous children, and is most frequent in the fall and in damp weather. Whether a metastatic or primary disease, it always sets in suddenly after deceitful precursory symptoms.

§ 188. Nux is most suitable for this kind of angina. Belladonna will be found serviceable when the inner parts of the mouth and fauces, and particularly the edges of the tongue, exhibit a bright, vivid, less dark, livid redness. Acidum sulph. is another useful remedy in this affection; the spots which characterize angina gangraenosa, resemble those which mineral acids occasion in the mucous membrane. Secale corn, and Kreasotum are likewise suitable. If the disease should extend to the larynx, it takes the form of an angina polyposa, and should be treated with Spongia, Iodium, Hep. sulph. Other remedies are Sulphur, Mang. acet. and Sepia. Mercurius should never be employed in angina maligna.