An Account of the Diseases which were most frequent in the British military hospitals in Germany
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Title: An Account of the Diseases which were most frequent in the British military hospitals in Germany
Author: Donald Monro
Release date: February 21, 2010 [eBook #31338]
Language: English
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*** START OF THE PROJECT GUTENBERG EBOOK AN ACCOUNT OF THE DISEASES WHICH WERE MOST FREQUENT IN THE BRITISH MILITARY HOSPITALS IN GERMANY ***
Produced by Irma Spehar and the Online Distributed
Proofreading Team at http://www.pgdp.net (This file was
produced from images generously made available by The
Internet Archive/Canadian Libraries)
AN
ACCOUNT
OF THE
DISEASES
Which were most frequent in the
BRITISH MILITARY HOSPITALS
in Germany,
From January 1761 to the Return of the Troops
to England in March 1763.
To which is added,
An ESSAY on the Means of Preserving the Health
of Soldiers, and conducting Military Hospitals.
By DONALD MONRO, M.D.
PHYSICIAN to his MAJESTY'S ARMY, and to
ST. GEORGE's Hospital.
LONDON:
Printed for A. MILLAR, D. WILSON, and T. DURHAM,
in the Strand; and T. PAYNE, at the Mews-Gate.
MDCCLXIV.
TO THE KING.
May it please Your MAJESTY,
To permit me to lay at your Feet the following Sheets, published with
a View to be useful to those, who hereafter may have the Care of the
Health of your MAJESTY's Troops.
YOUR MAJESTY's particular Inquiries into the State of Your Military
Hospitals, in every Quarter of the World, in the Time of the late
glorious and successful War; Your Concern for every Officer and
Soldier who suffered either by Sickness or by Wounds in the Cause of
their King and Country; and Your Solicitude to procure them every
possible Assistance and Relief, cannot fail to excite the highest
Admiration of Your MAJESTY's Goodness in the Breast of every Subject,
and the warmest Gratitude in the Heart of every Soldier.
The Knowledge of these Circumstances induced me to flatter myself,
that a Work of this Kind would be agreeable to Your MAJESTY; and
should this Attempt towards pointing out the Means of alleviating
those Miseries, which necessarily attend a Military Life in the Time
of Service, be acceptable, I shall obtain the utmost of my Wishes; it
being the greatest Ambition of my Heart ever so to act as to merit
Your MAJESTY's Approbation, and to subscribe myself,
May it please Your MAJESTY,
Your MAJESTY's most dutiful Subject,
And most faithful
and humble Servant,
DONALD MONRO.
THE PREFACE.
Among the numerous Authors of Observations in the Art of Physick,
there are but few who have expressly written on the Treatment of those
Distempers, most generally incident to an Army in the Field: The
following Work, therefore, seems to have a fair Claim to be acceptable
to the Publick, having been compiled during the Author's Attendance on
the _British_ Military Hospitals in _Germany_ in the late War; and in
order to render it of still further Use, he has occasionally added, by
Way of Note, the Practice of some of the most eminent Physicians in
similar Diseases, as well as a few Histories of Cases which passed
under his own Care at _St. George_'s Hospital, _London_.
To avoid the Repetition of the Composition of particular Medicines,
and the Interruption that would be given by their being inserted in
the Body of the Work, a small Pharmacopoeia is added, to which his
Practice in the Army Hospitals was chiefly confined.
In a commercial Country like our own, where Numbers of Hands are
constantly wanted for the carrying on our Manufactories, we have a
strong political Argument to add to that drawn from the Dictates of
Humanity, why the Life of every individual should be most carefully
attended to.
The Preservation of the Lives of Soldiers is then with us a Matter of
the highest Importance, in order to make as low as possible the Number
of Recruits who must be perpetually drawn off for the Service of War.
The Author has, therefore, in this Treatise, endeavoured to point out
the Means most likely to keep Men healthy when employed in different
Services; and also the Manner in which Military Hospitals ought to be
fitted up, and conducted.--As he was never in any of the warm
Climates, nor ever at Sea along with Troops aboard of Transports,
whatever is mentioned relative to such Situations, is to be understood
as taken from printed Accounts of these Subjects, or collected from
the Conversation of physical Gentlemen, who were employed on such
Services during the two last Wars.
It is but Justice here to observe, that the Marquis of _Granby_,
Commander in Chief of the _British_ Troops in _Germany_, as well as
the Rest of the General Officers employed on the _German_ Service,
always paid the greatest Attention to the Soldiers when sick in
Hospitals; and were particularly ready in giving Orders for all such
Things as were necessary or proper for them.
JERMYN-STREET,
April 15, 1764.
CONTENTS.
PAGE.
Of the Malignant and Petechial Fever, 1
Of the Dysentery, 57
Of the Cholera Morbus, 97
Of the Inflammatory Fever, 104
Of the Angina, 109
Of the Pleurisy, 111
Of the Peripneumony, 115
Of the Cough and Consumption, 124
Of the Epidemical Catarrhal Fever of _April_ 1762, 137
Of the Rheumatism, 141
Of the Autumnal Remitting Fever, 154
Of the Intermitting Fever, or Ague, 179
Of the Jaundice, 206
Of Tumours of the Breast, 216
Of Paralytic Complaints, 219
Of an Incontinency of Urine, 223
Of a Stoppage of Urine, 227
Of the Epilepsy, 237
Of the Small-Pox, 243
Of Erisypilatous Swellings, 245
Of the Scurvy, 250
Of the Itch, 265
Table of Diet used in the _British_ Military Hospitals in _Germany_, 273
PHARMACOPOEIA in usum Nosocomii militaris regii Britannici 1761, 275
OF THE MEANS of Preserving the Health of Soldiers on Service, 309
---- in Winter, and in cold Climates, 313
---- aboard of Transport Ships, 323
---- in warm Climates, 331
Of healthful and unhealthful Grounds for the Encampment of Troops, 338
Of keeping Camps clean, 344
Of supplying an Army with Straw and with Provisions, and obliging
the Soldiers to buy a certain Quantity of Meat daily, 346
Of Water, and the Means of correcting its bad Qualities in Camps, 348
Of vinous and spirituous Liquors, 350
Of keeping Men healthful in Quarters after an active Campaign, 354
Of MILITARY HOSPITALS, 355
Of the Manner in which the Antients disposed of their Sick
and Wounded, 356
Of the Hospitals wanted for an Army acting on a Continent, 357
Of the Houses most fit for Hospitals, 361
Of fitting them up, and distributing the Sick in them, 363
Of preventing infectious Disorders from being generated or
spreading among the Sick, 366
Of the Diet of Military Hospitals, 372
Of providing the Flying Hospital, 380
Of Hospitals on Expedition Service, 380
Of a Guard for Hospitals, 382
Of the Nurses and Patients, and Orders for them, 383
Of a convalescent Hospital, 389
Of the Physicians, Surgeons, Apothecaries, and Mates, 393
Of the Direction of Military Hospitals, 394
Of the Purveyor or Commissary of the Hospital, 396
Orders for the Mates, 397
Of Precautions for guarding against infectious Disorders, 400
Of a Military Inspector and Officers on convalescent Duty, 403
ERRATA CORRIGENDA.
Page 13, line 11, for _Pleuretic_, read _Pleuritic_.
18, 10, of Notes, for _Acadamy_, read _Academy_.
28, 22, for _Cinamon_, read _Cinnamon_.
35, 5, of Notes, for _Calomile_, read _Calomel_.
51, 12, dele _used in this Way_.
166, 12, of Notes, for _which almost depend_, read _which almost
always depend_.
207, 13, of Notes, for _Vena postarum_, read _Vena portarum_.
259, 4, for _appeared_, read _appear_.
261, 1, of Notes, for _became_, read _become_.
280, 20, for _Chamamel_, read _Chamæmel_.
290, 4, for _3tis 4tiis_, read _3tiis 4tis_.
293, 13, for _Mithridatum_, read _Mithridatium_.
336, 12 & 13, for _bathe themselves as often_, read _bathe early
in the Morning as often_.
352, 7, for _in Bilanders_, read _and were to go in Bilanders_.
353, 2, for _the least Appearance of the Malignant Fever_, read
_the Malignant Fever appearing_.
OF THE MALIGNANT and PETECHIAL FEVER.
A Malignant Fever, and Fluxes, began to appear among the Soldiers in
Autumn, 1760, while the Allied Army remained encamped about
_Warbourg_, from the Beginning of _August_ till the 13th of
_December_, when they went into Cantonments. During that Time, there
had been a continued Rain for some Months, and the Camp and
neighbouring Fields, and Villages, were not only filled with the
Excrements of such a numerous Army, but likewise with infinite Numbers
of dead Horses, and other dead Animals, which had died in doing the
necessary military Duties, and in bringing Forage, Provisions, and
other Necessaries, to the Camp: besides this, the Field where there
had been an Action on the 31st of _July_, and where many of the Dead
were scarce covered with Earth, was in the Neighbourhood of the Camp.
Not only the Soldiers, but the Inhabitants of the Country, who were
reduced to the greatest Misery and Want, were infected with the
Malignant Fever, and whole Villages almost laid waste by it.
Such a Number of Soldiers was sent to _Paderborn_ as crowded the
Hospitals there, and increased the Malignancy of the Distempers so
that a great many died.
When I arrived at _Paderborn_, in the Beginning of _January_ 1761, the
Fever was upon the Decline in the General Hospitals, though it was
still rife; but by sending off a Party of Convalescents to
_Hervorden_, which thinned the Hospitals, it became less frequent, and
but few died. The Guards marched upon the Expedition into _Hesse_, on
the eleventh of _February_, which gave us full Room for billetting all
our Convalescents, and thinning the Wards; by which Means the Fever
almost entirely ceased in all the Hospitals we had before they went
away; though there still remained about four hundred sick.
When the Guards marched out of _Paderborn_, they left the Care of
their Sick to us, who belonged to the General Hospital: the first
Regiment of Guards left sixty sick; the second, twenty-nine; the
third, twenty-eight; and the Granadiers, fifteen, in their regimental
Infirmaries; who were mostly ill of the Malignant Fever: amongst whom
the Infection was so very strong, that, although I procured the Sick
new airy Houses for Hospitals, which were kept as clean and well-aired
as possible, and procured clean Bedding, and clean Linen for every
Man, and had the Sick laid thin, yet several died, and it was some
Time before we got entirely free of the Infection. The first and third
Regiments suffered most, owing to all the Sick of each Regiment being
put into a particular Hospital by themselves, which kept up the
Infection, so that they lost one-third of those left ill of this
Fever; and many of the Nurses, and People who attended them, were
seized with it. But not being able to procure particular Houses for
the Sick of the _Coldstream_ or Second Regiment, and for the
Granadiers, I distributed them through the different Hospitals we had
then in Town, where the Contagion had ceased; and by their being thus
scattered, while they were kept very clean, and at as great a Distance
as possible, from the other Patients in the Wards where they were put,
they lost few in Proportion to the first and third Regiments, and the
Disorder did not spread.
About the End of _May_, the Weather was very warm at _Osnabruck_; when
this Fever began to make its Appearance in the Corner of a large Ward,
which was next to one kept for salivating venereal Patients; and only
divided from it by means of a few thin Deals. Perceiving a strong
Smell in this Place, I suspected that the Fever arose from the foul
Steams coming from the next Ward, and therefore ordered the salivating
Ward to be thinned, and removed all the Sick from the Places near that
Ward; and ordered those that had catched the Fever to be put into
large airy Places; by which means the Infection spread no further,
and only one, out of six or seven who had got the Fever, died.
At the End of _June_, the Weather was very hot at _Bilifield_, and the
Fever began to shew itself by the Hospital being overcrowded, by a
greater Number of Sick being sent from the Army than we had proper
Places to put them in; but it was put a Stop to in a few Days, by the
Removal of the Hospital. Seventy Sick were left behind to the Care of
a Mate, most of them ill of the Fever, of whom twelve died.
In the Beginning of _August_, a few Men were taken ill of the same
Fever at _Munster_, in one of the Hospitals which was too much
crowded; but its further Progress was stopped by sending a Number of
recovered Men to Billet.
In _November_ and _December_ 1761, and _January_, _February_, and
_March_ 1762, we had several Men sent from Quarters in the Town of
_Bremen_ to the Hospital, sick of the Petechial Fever: they were
quartered on the Ground-floors of low damp Houses, and fresh Meat and
Vegetables so dear that they could not afford to buy them; but were
obliged to live mostly on salt Provisions. I was told likewise that
the spotted Fever was frequent among the lower Class of the
Inhabitants. Some few were seized with this Fever in the Hospital
itself; yet as the House was not crowded, and we had a Number of small
airy Wards, the Infection did not spread; and we had but one or two
who died of this Fever during the Winter, in the Hospital I attended.
In Summer 1762, we had only ten or eleven ill of this Fever in the
Hospital at _Natzungen_, and only one died.
When the Troops marched from their Cantonments, in _December_ 1762,
towards the Borders of _Holland_, the twentieth and twenty-fifth
Regiments of Foot left behind them, at _Osnabruck_, thirty sick; five
of whom had Symptoms of the Hospital Fever, though no Petechiæ
appeared; three recovered, and two died suddenly, being lodged in
large open Wards (the only Places we had to put them in) with the
Windows all broke, in very cold frosty Weather.
In _January_ 1763, we had only three Patients in this Fever, with the
Petechiæ upon them, who all recovered. After this we had none taken
ill of it at _Osnabruck_, while I remained there, which was till the
twenty-fifth of _March_.
This Malignant Fever begun variously in different Subjects; for the
most part with Cold and Shivering, Pain in the Head, and other
Symptoms, commonly described as peculiar to this Fever. In some, it
begun with a sharp Pain of the Side, or other Parts, attended with
acute inflammatory Symptoms; in others, it put on the Appearance of
the common, low, or nervous Fever, for a Day or two. Blood drawn in
the Beginning from some Patients did not seem much altered; from
others it threw up a strong inflammatory Buff[1]; but where the Fever
had continued some time, it was commonly of a loose Texture, and of a
livid Colour; unless when the Sick were accidentally seized with
pleuritic Stitches, or other Disorders of this kind.
[1] Dr. _Huxham_, in his _Treatise on the ulcerous sore
Throat_, p. 36, says, "I have very often met with this buffy
or sizy Appearance of the Blood in the Beginning of Malignant
Fevers; and yet, Blood drawn two or three Days afterwards,
from the same Persons, hath been quite loose, dissolved, and
sanious as it were." And in his _Essay on Fevers_, chap.
viii. p. 108. says, "The first Blood frequently appears
florid; what is drawn twenty four Hours after, is commonly
livid, black, and too thin; a third quantity, livid,
dissolved, and sanious. I have sometimes observed the Crasis
of the Blood so broke as to deposite a black Powder, like
Soot, at the Bottom, the superior Part being either a livid
Gore, or a dark green, and exceedingly soft Jelly."
The Reason of this Difference of Symptoms in the Beginning, and of
these different Appearances of the Blood, seemed to be, that such
Patients as laboured under Pleurisies, low or other Fevers, being
brought into Hospitals where the Malignant Fever was frequent, had
their original Disorders changed into this Fever by breathing a foul
infected Air, and by their Communication with those ill of the Fever,
and of Fluxes; at other Times, a mere Acrimony of the Blood, set in
Motion by a supervening Fever, determined the Disorder to be of this
kind: and I always observed, that those Men were most apt to catch
this Fever, whose Constitutions had been broke down by previous
Disorders.
The Fever appeared in different Forms. Some had only a Quickness of
the Pulse, attended with a slight Head-ach and Sickness, Whiteness of
the Tongue and Thirst, and a Lowness and Languor; which continued for
a Week or more, and then went off, either insensibly, or with a
profuse Sweat, succeeded by a plentiful Sediment in the Urine. Most of
those who fell into profuse kindly-warm Sweats recovered, the Sweat
carrying off the Fever. These profuse Sweats continued for twelve or
twenty-four Hours, and sometimes for two, three, or four Days. In
those who had the Fever in this slight Degree, the Petechiæ seldom
appeared; and it was only known to be this sort of Fever by the other
Symptoms, and the Malignant Fever being frequent at that time in the
Hospitals. Dr. _Pringle_[2] very justly observes, "That these low
Degrees of this Fever are hardly to be characterised, and are only to
be discovered, in full Hospitals, by observing Men languish; though
the Nature of the Illness, for which they come in, should seem to
admit of a speedier Cure."
[2] _Observations on the Diseases of the Army_, part III.
chap. vii. sect. 3. third Edition, 1761.
For the most Part the Fever appeared with more violent Symptoms, the
Tongue became more parched and dry, more or less of a Delirium came
on, attended with the other Symptoms commonly described as peculiar to
this Fever.
When the Petechiæ appeared, they came out on the fourth, fifth, sixth,
or seventh Day; seldom after the eleventh or twelfth[3]. They appeared
mostly on the Breast, Back, Arms, and Legs, and sometimes, tho'
rarely, on the Face. They had exactly the Appearance described by Dr.
_Pringle_, either like small distinct Spots of a reddish Colour, or
the Skin looked sometimes as if it had been marbled, or variegated as
in the Measles, but of a Colour more dull and lured. As they began to
disappear, they inclined to a dun or brown Colour, and looked like so
many dirty Spots. I never saw them rise above the Skin; nor did I once
see any miliary Eruptions in this Fever; which agreed exactly with
what Dr. _Pringle_ had observed in the former War, and in the
Beginning of this; however, we ought not to conclude from thence that
miliary Eruptions are never observed in Fevers of this kind; for Dr.
_Huxham_[4], Dr. _Hasenohrl_[5] and Dr. _Lind_[6], besides many other
good Practitioners, mention their having seen them.
[3] _Ramazini_, in his Treatise _De Constitutionibus
annorum_, 1692, 3, 4, _in Mutinensi civitate_, Sect. 19.
mentions the Petechial Fever which had been frequent the
three foregoing Years; in which the Petechiæ appeared
commonly on the fourth or seventh Days, and almost all those
died in whom they appeared on the first Day. These Spots came
out first on the Neck, the Back and Breast; and it was
observed that none escaped unless these Spots extended
themselves as far as the Nails of the Toes, vanishing by
Degrees on the upper Parts. He tells us likewise, that this
Fever was attended with an Inflammation of the Throat, which,
about the Height of this Disorder, terminated in a white
ulcerous Crust. This sore Throat should seem to be the same
which we now call _the malignant ulcerous sore Throat_, which
I never once saw while I was with the Troops in _Germany_.
[4] Dr. _Huxham_, in his _Essay on Fevers_, ch. viii. p. 97,
tells us, that sometimes, about the eleventh or twelfth Day,
on the coming on of profuse Sweats, the Petechiæ disappear,
and vast Quantities of small white miliary pustules break
out.
[5] Dr. _Hasenohrl_, in his Treatise _De Febre Petechiali_,
cap. i. p. 12. relates a very particular Case, where the
Petechiæ appeared on the fourth, and the white miliary
Eruptions on the seventeenth Day of the Fever.
[6] Dr. _Lind_, in his _second Paper on Fevers_, p. 105.
mentions Spots which rise above the Surface of the Skin, and
are of the miliary kind, as common in contagious Fevers, as
he observed among the _French_ Prisoners in _Winchester_
Castle, in the Beginning of the Year 1761.
Many had no Petechiæ through the whole Course of the Disorder; but in
all who were very bad, the Countenance looked bloated, and the Eyes
reddish and somewhat inflamed; and though the Skin was commonly dry,
yet the _Perspiration from the Lungs_ was strong. By these
Circumstances one might frequently discover that the Patient laboured
under the malignant Fever, without asking any Questions.
* * * * *
When Men were taken ill of a Fever, which we suspected to be of the
malignant kind, our first Care was to lay them in airy Places,
separate as much as possible from the other Men, and to keep them
extremely clean; and they were put on low Diet, and allowed as much
Barley or Rice-water as they chose to drink, which was commonly
ordered to be acidulated with the _Spiritus Vitrioli_.
For the first two or three Days we could seldom distinguish, with
Certainty, that the Fever was of the malignant kind, though we had
often Reason to suspect it. The Pain of the Head, the Fulness and
Quickness of the Pulse, and other Symptoms, led us commonly to take
away more or less Blood, which the Patient bore easily, and for the
most part it gave Relief[7]. We seldom repeated this Evacuation where
we suspected the Fever to be of the malignant kind, unless a pleuritic
Stitch, an acute Pain of the Bowels, or some other accidental Symptom,
required it; or the Patient was strong, and there were evident
Symptoms of Fullness immediately before we intended giving the Bark,
as shall be mentioned afterwards; for under other Circumstances, if
the Blooding was repeated, and other Evacuations used freely, I always
observed that it did Harm, and was apt to sink the Patient too much;
as Dr. _Huxham_, Dr. _Pringle_, and other good Practitioners, have
remarked.
[7] Dr. _Huxham_, tho' he says "yet Bleeding to some Degree
is most commonly requisite, nay necessary, in the strong and
plethoric;" yet he afterwards makes the following Remark:
"Besides, the Pulse in these Cases sinks oftentimes
surprisingly after a second Bleeding, nay sometimes after the
first, and that even where I thought I had sufficient
Indications from the Pulse to draw Blood a second time." See
his _Essay on Fevers_, chap. viii. And Dr. _Pringle_
observes, that in the second Stage of the Disorder large
Bleedings have generally proved fatal, by sinking the Pulse,
and bringing on a Delirium. _Observations on the Diseases of
the Army_, part III. chap. vii. sect. V.
After Bleeding, if the Patient was costive, or complained of Gripes,
he had a Dose of Rhubarb, or Salts, or a laxative Clyster; but where
there was much Sickness of the Stomach, we gave a gentle Emetic[8] in
the Evening, and the Purge next Morning. And if in the Course of the
Disorder the Sickness and Nausea returned, attended with Griping and
Costiveness, or very fetid loose Stools, these Medicines were
repeated, and a gentle Opiate given in the Evening after their
Operation.
[8] Dr. _Pringle_ advises giving a Vomit, by way of
Prevention, on the first Appearance of the Symptoms, and at
Night to force a Sweat, by giving a Drachm of Theriac with
ten Grains _Sal volat. Corn. cervi_, and some Draughts of
Vinegar-whey, and to repeat the same the following Night; and
says, he has often seen those Symptoms removed which he
apprehended to be Forerunners of this Fever received by
Contagion; but previous to Vomits, or Sweats, if the Person
be plethoric, it will be necessary to take away some Blood.
_Observ._ part III. ch. vii. sect. 5. Dr. _Lind_, in his
_second Paper on Fevers_, p. 66. says, "To all who are
supposed to be infected by Fevers, during this Stage of
Rigours, a gentle Vomit is immediately to be exhibited before
the Fever be formed, and before the Fulness or Hardness of
the Pulse renders its Operation dangerous. If the Vomit be
delayed too long, and especially if Bleeding must precede it,
the most certain and favourable Opportunity of procuring
Safety for the Patient is past.--That he has found it equally
serviceable in preventing Relapses, when it is given at the
Return of the Shiverings." A loose Stool, or two, should be
procured by the Emetic or Clysters, and he advises Sweating
immediately after, in the manner recommended by Dr.
_Pringle_. At other times "he gave five Grains of Camphire
every four Hours, with large Draughts of Vinegar-whey. Eight
Persons in ten, he says, got quite well by this Treatment."
I have never had sufficient Opportunities of trying this
Method of Prevention, to determine any thing certain about
it; but it may be worth while to practise it.
After Evacuations, if the Pulse kept up, we commonly gave nothing but
the saline Draughts, with the _Pulvis contrayervæ_, or some temperate
Medicine, for the first Day or two. As soon as we could distinguish
the Fever to be of the malignant kind, and that the Pulse rather sunk,
we joined some of the Cordials to the saline Medicines, and allowed
the Patient more or less Wine, according to the Degree of the Fever.
Dr. _De Haen_ has found Fault with Dr. _Pringle_ and Dr. _Huxham_, for
administering cordial Medicines and Wine in the low State of this
Fever; but nothing answered so well with us as these Remedies under
such Circumstances; and I have frequently seen every Symptom changed
for the better by their Use; and even when I gave the Bark, in the
Manner recommended by _De Haen_, I often found it necessary to join
the free Use of Wine[9], Cordials and Blisters[10], in order to
support the Patient's Strength.
[9] _Petrus a Castro_, in his Account of a Petechial Fever,
which was frequent at _Verona_, tells us, that the Sick had a
great Thirst, and an Aversion to Meat, but all of them had
the strongest Desire for Wine, and were perpetually asking
for it, even those who at other Times used to be very
temperate; and that this proceeded from an Instinct of
Nature, which wanted something to support the Strength. _De
Feb. Malig._ sect. iii. chap. 26. Dr. _Huxham_, in his _Essay
on Fevers_, has the following very judicious Remark on the
Use of Wine: "In this View, and in those above-mentioned, I
cannot but recommend a generous red Wine as a most noble,
natural sub-astringent Cordial, and perhaps Art can scarce
supply a better. Of this I am confident, that sometimes at
the State, and more frequently in the Decline of putrid
Malignant Fevers, it is of the highest Service, especially
when acidulated with Juice of _Seville_ Orange or Lemon. It
may be also impregnated with some Aromatics, as Cinnamon,
_Seville_ Orange Rhind, red Roses, or the like, as may be
indicated, and a few Drops of _Elix. Vitrioli_ may be added.
Rhenish and French White Wines, diluted, make a most salutary
Drink in several Kinds of Fevers, and generous Cyder is
little inferior to either. The _Asiatics_, and other Nations,
where pestilential Disorders are much more rife than with us,
lay more Stress on the Juice of Lemons in these Fevers than
on the most celebrated _Alexipharmac._" Chap, viii. second
Edit. p. 123, 4.
Acid and acescent Liquors have very justly been recommended
and used by most late Practitioners, in this as well as in
other malignant Diseases. Vinegar-whey, Barley-water
acidulated with Lemon-juice, and such other Liquors, make
good Drinks for the Sick; but we were obliged, for the most
part, to use the vitriolic Acid for acidulating the Patient's
Drink, as it was the easiest procured and carried about with
the Flying Hospital.
[10] If the preventive Method does not succeed, Dr. _Lind_
advises to have recourse to Blisters; and says, that sixteen
out of twenty will next Morning be free of the Fever. But
adds, this is said, provided the Source of their Infection be
not so highly poisonous as it was in the Garland Ship, or in
other such violent Contagions. Dr. _Pringle_ mentions his
having applied Blisters early, but without relieving the
Head, or preventing any of the usual Symptoms. I have often
ordered Blisters pretty early in the Disorder; and though I
have frequently found them of use in keeping up the Pulse,
and relieving the Head, and other Symptoms, yet I never saw
them have such an immediate Effect as Dr. _Lind_ mentions.
After reading the Treatises of Dr. _De Haen_ and Dr. _Hasenohrl_, on
this Fever, I resolved on giving the Bark[11] in large Quantities, and
found it to answer the Recommendations given by these Gentlemen; and
shall relate here two or three Cases, out of above a hundred and
fifty, in which I gave it.
[11] It is long since the _Peruvian_ Bark has been used by
Practitioners in Malignant Disorders, though I do not know
that any body gave it in this Fever to the Amount of an Ounce
per Day, before Dr. _Haen_ and Dr. _Hasenohrl_. Dr.
_Ramazini_ mentions its having been tried in the Petechial
Fever, in the Years 1692, 3, 4. And in a Treatise on the
Plague in the _Ucrane_, published at _Petersburgh_, in the
Year 1750, we are told, that in the _French_ Translation of
the Philosophical Transactions for the Year 1732, there is a
Note to p. 264, telling, that Mr. _Amyand_ informed the
Academy of Surgery at _Paris_, that Mr. _Rushworth_, Surgeon,
had wrote to Sir _Hans Sloane_, on the 23d of _May_ 1723,
that when he was Surgeon to a Ship, in the Year 1694, he had
cured some Men ill of the Malignant Fever, attended with
pestilential Buboes, by means of the _Peruvian_ Bark. Dr.
_Huxham_ has recommended a Tincture of the Bark; and Dr.
_Pringle_, a strong Decoction of it, with some of the
Tincture, in these Malignant Fevers.
I. _Robert Wilson_, of the Second Regiment of Foot Guards, on the 19th
of _February_ 1761, was seized with a Shivering and Coldness,
succeeded with Heat, Thirst, a short dry Cough, Difficulty of
Breathing, Head-ach, and slight Stitches in his Breast; some Blood was
taken away, which was sizy, and he was ordered two Ounces of the
_Sperma Ceti_ Mixture, with the _spiritus mindereri_, every two or
three Hours. He continued without any manifest Alteration in the
Symptoms, till the 21st, when a Number of dun Petechiæ appeared all
over his Body, particularly on his Breast. The Stitches and Cough were
then much easier, and he had his Medicines as before. On the 22d, he
was seized with a Delirium, and was somewhat comatose; when he was
ordered a Drachm of the Bark every six Hours. The 23d, the comatose
Symptoms had increased, and he had slight Twitchings of the Tendons, a
dry brown-coloured Tongue, and a Faultering in his Speech. The Bark
was continued, with the Addition of two Spoonfuls of Mountain Wine
every two Hours. On the 24th, he had several loose Stools. The 25th,
he was still loose, and went on as before, with the Addition of six
Grains of the _Pilulæ saponaceæ_ in the Evening. The 26th, the
Petechiæ were not so apparent as before, but he had still the nervous
Symptoms, and his Breathing grew more difficult; and therefore a
Blister was applied between his Shoulders, and his Medicines
continued; as they were likewise on the 27th, without any Alteration
in the Symptoms. On the 28th, his Tongue became moister, and the
Pulse, which had been low and quick the four preceding Days, became
fuller and slower. On the 29th, he was much more sensible, his Tongue
more moist, and the Twitchings of the Tendons much less; and in the
Evening he fell into a profuse Sweat, which lasted all the 30th. On
the 1st of _March_, his feverish Symptoms were much abated, his Pulse
was calmer, his Skin moist, his Drought less, and his Urine dropt a
plentiful Sediment. On the 2d, his Fever was almost entirely gone, but
he had still a Cough, and spit up a viscid Matter. He was ordered to
go on as before, with the Addition of two Spoonfuls of the _Sperma
Ceti_ Mixture, and the _Spiritus Mindereri_, when his Cough was
troublesome. He followed this Course till the 7th, when, his Cough and
Fever being gone, he was ordered a Dose of Tincture of Rhubarb; after
which he recruited his Strength daily, without the Assistance of any
more Medicines.
II. On the 5th of _March_ 1761, _Thomas Stagg_, of the Second Regiment
of Foot Guards, was seized with the same Symptoms as _Robert Wilson_
had been in the Beginning of his Fever, but in a more violent Degree.
He was blooded to about twelve Ounces, and was ordered a saline
Draught every six Hours. On the 6th, the Blood, which had been drawn
the Day before, had thrown up a slight Buff; it appeared to contain
but a small Proportion of Serum, and the Crassamentum was of a loose
Texture. The feverish Symptoms had increased, with the Addition of a
Delirium: pergat. On the 7th, the Delirium was grown more violent, so
that he could scarce be kept in Bed; his Breathing was difficult, his
Eyes red and florid: A Blister was applied to his Back, and the saline
Mixture continued. On the 8th, there was no Alteration in the Course
of that Day; but being lower towards Night, Blisters were applied to
his Legs, and he was ordered to have a Pint of Wine allowed him in
twenty-four Hours. On the 9th, the Petechiæ appeared over his whole
Body, of a broad dunnish kind; his Breathing became easier, and his
Pulse stronger, though the Delirium was still as bad as before: He was
ordered a Drachm of the Bark every fourth Hour in a saline Draught. On
the 10th, the Bark gave him several loose Stools, but the Petechiæ
were of a more florid Colour; the Delirium was less, and his Tongue
moist, and therefore he was ordered to continue the same Medicines as
the Day before, with the Addition of ten Grains of the _Pilulæ
saponaceæ_ in the Evening. The 11th Day, he fell into a fine breathing
Sweat, his Pulse became fuller and slower, and the Delirium abated: p.
The 12th, his Pulse was regular, and the Delirium gone, and he was
much inclined to sleep. The 13th, after a calm Sleep, which had lasted
twelve or fourteen Hours, he became quite free of Fever. After this he
continued the Use of his Medicines for some Days, and recovered his
Health and Strength daily.
III. On the 23d of _May_ 1761, _Lionel Thompson_, of the First
Regiment of Foot Guards, was seized with all the Symptoms of a
Peripneumony, attended with a high Fever, for which he was ordered to
be blooded. After losing eight Ounces of Blood, he fell into a
fainting Fit; on recovering out of which, his Breathing being still
much affected, he had a Mixture made of four Ounces of the _Lac
Ammoniacum_, and one of the _spiritus mindereri_, of which he was
desired to take two Spoonfuls every four Hours. The 24th, the Symptoms
the same: He complained of having had no Stool for some Days, and took
half an Ounce of the _sal catharticum amarum_, which gave him two
loose Stools. On the 25th, his Pulse was small and quick, his
Breathing difficult; he was low, and had a slight Delirium: A large
Blister was applied between his Shoulders, and the Medicines
continued. On the 26th, in the Morning, the Petechiæ appeared, and his
Breathing was freer: He was ordered a Drachm of the Bark, in a saline
Draught, every four Hours. The 27th, the Pulse better: p. The 28th,
was more sensible, and had a kindly warm Moisture all over the Skin.
The 29th, the Fever was much abated, and his Tongue, which was before
parched and dry, became moist and white: He continued the Use of the
Cortex for three Days more, which removed the Fever; and being
costive, he took a Dose of the Tincture of Rhubarb. After this he used
the Bark for a few Days longer, and got perfectly well.
After giving the Bark[12] with Success, in the two first of the Cases
mentioned, and to two young Gentlemen, Mates of the Hospital, who had
caught the Fever from their Attendance on the Sick, I gave it to above
a hundred and fifty at _Paderborn_, and elsewhere, during my
Attendance in the Military Hospitals in _Germany_; and although it did
not answer in every Case, yet it was found to have a better Effect
than any other Remedy that was tried. We joined different Medicines
with it, according to the State of the Patient. We gave the _Confectio
cardiaca_, _Rad. serpent. Virg._ and other cordial Medicines, and
Wine, when the Pulse was low; _Oxymel scilliticum_, and other
Pectorals, when the Breathing was difficult; Opiates, where the
Patient was inclined to be too loose; the _spiritus mindereri_, and
other Diaphoretics, when we wanted to promote a free Perspiration; and
we applied Blisters as Occasion required.
[12] The _Peruvian_ Bark has not only been found useful in
this Malignant Fever, but has likewise been recommended in
the Plague. See _Morton Oper. Append. secund. Exercitat.
Hist. Febr. Ann. 1658, ad. an. 1691. complexa_. In the Small
Pox, see _Medical Essays_, vol. V. art. x. and has been found
serviceable in the putrid Disorders of the _West Indies_, as
taken Notice of by Dr. _Hillary_; and in the malignant
ulcerous sore Throat in this Country, as Dr. _Wall_ and
others have observed. And in thirty-five Cases of the
malignant ulcerous sore Throat, in which I gave it, joined
with Cordials, and the Use of Acids, I did not lose one
Patient. Nine of them were strong People, and had plethoric
Symptoms, and were blooded in the Beginning; and seven of
them were costive, and took a Dose of gentle laxative Physic
before taking the Bark. The rest had no Symptoms which seemed
to require these Evacuations. However, it ought to be
observed, that this is a Disorder of the malignant kind; and
that although some well-timed gentle Evacuations may be
serviceable in the Beginning, before giving the Bark; yet too
free, or even gentle Evacuations, injudiciously made, will
sink the Patient, and infallibly do Mischief.
The free Use of the Bark has long been found serviceable in
Mortifications and foul Sores, where the Juices tend too much
to the Putrescent; and has been strongly recommended by Mr.
_Ranby_, Serjeant Surgeon to his Majesty, in the Cure of
Gunshot Wounds. See his _Treatise on Gunshot Wounds_.
When the Patient was strong, the Pulse quick and full, the Eyes looked
red, and the Breathing was difficult, after the Petechiæ appeared; I
took away more or less Blood before giving the Bark. Most
Practitioners of late Years have been against Bleeding in this Stage
of the Disorder; but trusting to the Assurances given by Dr.
_Hasenohrl_ of its being safe, nay of Advantage to bleed at this Time,
if the Symptoms required it, I ventured upon it, and found it to be of
the greatest Service, in many Cases, in the Hospitals at _Paderborn_
and elsewhere; and particularly in two Cases at _Bremen_, and one at
_Osnabruck_, where it gave immediate Relief, and seemed to shorten the
Disease much. One of the Patients at _Bremen_, _Robert Ellis_,
belonged to an Independant Company; the other, _Francis Hamstan_, of
the 24th Regiment, had formerly had his Skull fractured, and took the
Fever, while he was in the Hospital, for violent Head-achs, which he
had been subject to, at times, ever after his Skull had been
fractured. The Case at _Osnabruck_ was a Nurse of the Hospital, whose
Name was ---- _Andrews_, a Woman about twenty-five Years of Age, who,
after attending a Dragoon in the Small Pox, and suckling at the same
time her own Child, then in the same Disorder, was, on the 18th of
_January_ 1763, attacked with a Fever. I saw her for the first time on
the 20th, and found her Pulse quick, full, and strong. She complained
of a violent Head-ach; for which she was blooded, and took the saline
Mixture, with Nitre and Contrayerva. Next Day, the 21st, her Blood
appeared very sizy, and she complained of having been costive for some
Days. We gave her immediately an Ounce of the _sal catharticum
amarum_, which operated well. She continued much in the same Way the
22d, and had some loose Stools that Day. Being still inclined to be
loose the 23d, instead of her former Medicines, she was ordered the
_spiritus mindereri_ Mixture, with Mithridate. This checked the
Purging, but did not stop it entirely. The Fever went on, without any
remarkable Change, till the 27th; at which time the Petechiæ appeared
all over her Body, attended with a Redness of the Eyes, and a violent
Oppression and Pain of her Head, and a quick Pulse. I ordered six
Ounces of Blood to be taken away immediately, and a large Blister to
be applied to her Back, and, at the same time, ordered her a cordial
Mixture, with half an Ounce of the Extract of the Bark in it, to be
taken every twenty-four Hours. The 28th, her Pulse was not so hard,
her Head was much easier, the Redness of her Eyes was much less, and
the Petechiæ had begun to die away. The Blood which was taken away the
Day before, had a thin Buff at the Top, but the _Crassamentum_
underneath was of a dark Colour, and of a loose Texture: p. On the
29th, she told me that she had had two or three loose Stools, and she
was lower than the Day before; and therefore a Drachm of Mithridate,
and two Drachms of the Tincture of Cinnamon, were added to her cordial
Mixture, with the Cortex; and she was allowed half a Pint of Red Wine,
mulled with Cinnamon, _per_ Day. 30th, Her Tongue rather moister than
the Day before; and she not so low, but she was still inclined to be
loose; and therefore was ordered the anodyne Draught at Nights, and to
continue the other Medicines. 31st, She was still inclined to be
loose; but her Pulse kept up, her Tongue was moister, and she found
herself pretty easy: p. _Feb._ 1st, Her Pulse pretty strong, and she
found herself much cooler, and freer from the Fever, and complained of
a Dullness of Hearing. On the 2d, in the Morning, she felt a warm
Moisture all over her Skin, which, about Noon, broke out into a
profuse Sweat, and continued till the 4th; when it went off, and her
Urine let fall a copious whitish Sediment. She had then little or no
Fever. The Dullness of Hearing still continued, though it was much
less than before. After this the Deafness went gradually away. She
continued the Use of the cordial Mixture, with the Cortex, till the
12th, and recovered Strength daily. After this, she had no other
Medicine, except two Doses of the Tincture of Rhubarb, and was soon
in good Health, and able to discharge her Duty as a Nurse.
However, it ought to be observed, that we must not bleed so freely, in
this or any other Stage of the Malignant Fever, as in acute
inflammatory Disorders, otherwise we shall sink the Patient, and hurry
him to his Grave; and that Bleeding can only take place with Safety
and Advantage, under the Circumstances above-mentioned, immediately
before giving the Bark freely; or where some accidental sharp Pain in
the Breast, or Bowels, or some other violent Symptom, may require it.
They err equally, who recommend Bleeding freely in this Fever, with
those who entirely forbid its Use.
Although we found the Bark to be in general the best Remedy in this
malignant Petechial Fever, yet it did not answer in every Case; for in
some we found other Remedies had a better Effect: And therefore, when
we observed that, notwithstanding the Use of the Bark, the Patient
sunk, and the Symptoms grew worse, we did not persist obstinately in
its Use, but tried the Effect of other Medicines.
Towards the End of _May_ 1761, two Soldiers in the Hospital, at
_Osnabruck_, were taken ill of this Fever; who, after using the Bark
freely, and being allowed a Pint of Red Wine _per_ Day, for some Days
together, began to sink, and had a Delirium and other bad Symptoms
hastening on: upon which I laid aside the Use of the Bark, and ordered
each of them a Blister to the Back, and to take a cordial Draught,
with fifteen Grains of Musk in it, every four Hours; and to have their
Wine mulled with Cinnamon; and although at that Time they were both so
low that I scarce imagined they would live twenty-four Hours, yet next
Day I found them greatly mended; and they had a kindly warm Moisture
all over their Skin, and the Pulse had rose considerably in both. By
the Continuance of the same Medicine the feverish Symptoms gradually
abated, and they both got well.
About the same time, having given the Bark freely for some Days, and
applied a Blister, to another Patient, after the Petechiæ had
appeared, I found him one Morning so low that his Pulse could scarce
be felt. He could not speak; he had a Delirium, and rather a Tremor
than a _subsultus tendinum_, and he had all the Appearance of a dying
Man. However, as he still swallowed whatever was put in his Mouth, I
changed the Bark Mixture for Draughts, which contained a Scruple of
the _confectio cardiaca_, and seven Grains of the _sal vol. corn.
cerv._[13] each, and ordered one to be given immediately, and
afterwards to be repeated every four Hours; and, in the Intervals, to
give him frequently a Tea-cup full of Red Wine, mulled with Cinnamon;
and to apply two large Blisters to his Legs. Next Day, his Pulse had
rose; and by the Continuance of the same Remedies it became gradually
fuller and stronger, and the third Day after he recovered his Voice;
and a warm kindly Moisture which ended in a profuse Sweat coming on,
the feverish Symptoms went off soon after, and he recovered his
Health.
[13] Dr. _Huxham_, in his _Treatise on the ulcerous sore
Throat_, p. 54, &c. condemns the Use of the volatile alcaline
Salts, in Fevers of the putrid, pestilential, or petechial
kind, as being apt to heat too much, and to hasten the
Dissolution and consequent Putrefaction of the Blood.
However, I cannot help thinking that they are the best
Remedies we can use on some particular Occasions, even in
this Fever; for we have no Remedy which gives such a sudden
and brisk _Stimulus_ to the Fibres as they do. And I have
known many Cases of Patients who were extremely low, and
whose Pulse was scarce to be felt, and others who were apt to
fail into fainting Fits, who have been preserved by large and
repeated Doses of these Salts, and the free Use of Wine, and
acescent Liquors, to correct their alcaline Acrimony in the
Blood. Though as soon as such Patients had recovered from
this low State, I laid these Medicines aside; because I
cannot help agreeing with the Doctor in the Belief, that
their continued Use will produce the Effects he mentions. For
although it be true, that these Salts, when mixed with
putrescent Liquors, or with dead animal Substances, resist
Putrefaction, and, like ardent Spirits and Vinegar (the other
Products of Fermentation) check and put a Stop to that very
Process which produced them: Yet it is also true, that, when
mixed with the Blood of living Animals, they stimulate the
Vessels, and increase the Heat and _Momentum_ of the Blood,
and dissolve it; and therefore I cannot but disapprove the
continuing their Use longer than is immediately necessary.
At _Bremen_ there were two Men, one in _January_, and the other in
_February_ 1762, on whom the Cortex had but little Effect, who
recovered by the free Use of Mixtures, with the _confectio cardiaca_
and _rad. serpentariæ_, and of Wine, with the Application of large
Blisters. Several Cases of this kind occurred in the Hospitals, where
the Bark did not answer.
There is one thing to be observed with respect to Malignant Fevers,
which is, that if ever they appear in large crowded Hospitals, unless
we can thin the Wards, and procure a free Circulation of Air, and keep
the Hospital and Sick extremely clean, the Fevers will continue to
spread, and great Numbers will die; and even the most efficacious
Remedies will have little or no Effect. And that when once the
Infection is grown strong, it requires the greatest Care, and some
Time, before it can be entirely got the better of. And that if a great
number of Men, ill of this Fever, be kept in the same Ward, they will
help to keep up the Infection; and therefore it is always proper, when
it can possibly be done, to lay but a few of them in one Ward; not
above one-third of the Number generally admitted.
Many of the Patients, towards the Height of this Fever, sooner or
later, had a Purging, which seldom proved critical; and some were
seized with the Flux. A gentle _diarrhoea_, such as did not sink the
Patient, was commonly of Service; but when violent, or a Dysentery
came on, the Case was always dangerous; for whatever stopped the Flux
increased the Fever; and, if the Purging or Flux continued, it sunk
the Patient. Such Fluxes we treated in the Manner to be mentioned
afterwards, when we come to the History of the Dysentery.
In this Fever, it was common for Patients to vomit Worms[14], or to
pass them by Stool, or, what was more frequent, to have them come up
into their Throat and Mouth, or sometimes into their Nostrils, while
they were asleep in Bed, and to pull them out with their Fingers. The
same Thing happened to most of the _British_ Soldiers, brought to the
Hospitals for other feverish Disorders as well as this. Dr.
_Pringle_[15] when he mentions Worms being observed in this Fever,
seems to embrace _Lancisius_'s Opinion; and believes that these Worms
are not the Cause of the Fever; but being lodged in the Intestines,
before the Fever comes on, they are annoyed by the Increase of the
Heat, and the Corruption of the Humours, in the Cavity of the
Intestines of Persons labouring under Fevers, especially of the putrid
Kind; and so they begin to move and struggle to get out. This seemed
evidently to be the Case with many of the Patients we had; though in
some the Worms seemed to have given Rise to the Fever, which the bad
State of the Patient's Humours, or the infected Air of Hospitals,
determined to be of this Kind. In many, the Fever lessened, or went
off entirely, soon after; and they were no more affected with Symptoms
of Worms. But some notwithstanding were subject to frequent Sickness,
Pain of the Stomach, and Uneasiness in the Bowels, and discharged some
Worms from Time to Time. Others had frequent Relapses into Fevers,
which seemed to be owing to the Irritation of these Insects.
[14] Some Men passed only one Worm; others, two or three;
some, six or seven; and one Man, of the Guards, in _January_
1763, after passing three by Stools in the Course of a Fever
of this Kind, discharged fourteen more upon taking a Dose of
Rhubarb and Calomel after the Fever was over.
[15] _Observations on the Diseases of the Army_, part iii.
chap. iv. Note to p. 213. third Edition.
It is no Wonder that Worms of the round Kind should be productive of
troublesome Symptoms, and occasion these Relapses; since we know that
they have sometimes perforated the Intestines, and been found in the
Cavity of the Abdomen[16].
[16] See _Hoffman_'s Works, vol. III. chap. x. _River.
Observ. commun._ Obs. 13. _of Observations found in a
Library._ _Bonetus's Sepulchret. anatom._ tom. II. _Gualther
van Doeveren's Inaugural Dissertation de Vermibus
intestinalibus_, published at _Leyden_, 1753; and _Lancisi_'s
Works; for Cases where the internal Coats of the Stomach, and
Intestines, have been eroded, and all the Coats perforated by
Worms of the round Kind.
As soon as we observed a Patient to be troubled with Worms, if his
present Situation did not prevent it, we gave twenty-five or thirty
Grains of Rhubarb, with five or six Grains of Calomel; and if there
was much Sickness, we likewise gave an Emetic; which, in more than one
Case, brought up two or three Worms of the round Kind, and gave great
Relief. But where the Fever was violent, we were obliged to neglect
this Symptom of Worms for the present; and when the Fever was over, if
there still remained any Symptoms of Worms, we gave the purgative
Medicine once or oftener, and in the Intervals gave the _pulvis
stanni_, or an Infusion of Camomile Flowers; and in some Cases, oily
Medicines. By these Means most of the Patients got well and recovered
their Health, and seemed to be freed, at least for the present, from
these troublesome Insects; though a few continued to complain of
Sickness, and other Symptoms of Worms, for some Time afterwards.
What was the Cause of the Army's being so much troubled with Worms of
the round Kind, is not easy to ascertain; unless it was owing to the
great Quantity of crude Vegetables, and Fruits, which the Soldiers eat
in the Course of the Summer and Autumn, and to the bad Water they were
often obliged to drink.
In the Malignant Fever at _Paderborn_, many complained of a Dysuria,
and some of a Suppression of Urine, especially towards the Decline of
the Fever; and others, of a Scalding and Pain in making Water, though
they had no venereal Complaint. These Symptoms appeared in other
Places, but not near so frequently as at _Paderborn_. Decoctions of
Gum Arabic, with some of the _spiritus nitri dulcis_, and oily
Mixtures, and Opiates, commonly gave immediate Relief, and soon
removed this Complaint.
One of the first salutary Symptoms which most generally appeared in
those who recovered, was a Dullness of Hearing, or Deafness[17]; which
came on about the Height of the Fever, and continued a longer or
shorter Time, generally till the Fever was entirely gone; and
sometimes for a considerable Time afterwards. For the most Part we
did nothing for this Complaint, and it went off as the Patient
recovered his Strength. When it continued long, Blisters applied
behind the Ears, or on the Neck, and washing the _meatus auditorius_
with the emollient Decoction, in which a small Quantity of Soap was
dissolved, proved of Service.
[17] _Riverius_ tells us, that, according to _Hippocrates_'s
Doctrine, Deafness is a very dangerous Symptom in the
Beginning of acute Disorders, though it be a good Omen, and
portends Health, when it does not appear till the Height of
Fevers, especially those of a malignant Kind; and adds, that
he himself has a thousand Times observed, that those
labouring under this Fever have recovered, when this Symptom
of Deafness came on at the Height (_in statu_) though the
other Symptoms threatened much Danger. _Prax. Medic._ lib.
XVII. sect. iii. cap. i. p. 451.
This Symptom of Deafness occurs in other Fevers as well as in
this, and often proves a good Symptom in them likewise, as I
have frequently observed. Two remarkable Examples of which I
had under my Care in St. _George_'s Hospital, in the Year
1759. On the 17th of _January_ 1759, _James Donaldson_, a
young Man of nineteen Years of Age, was admitted into the
Hospital for a Fever, attended with a Stupor and a Delirium,
a parched dry Tongue, and other Symptoms of a Fever of the
inflammatory Kind, for which he had been blooded, and used
other Evacuations. On the 19th, after the Application of a
Blister, he was seized with almost an entire Deafness; after
which, all his other Symptoms became milder, and he mended
daily, and was entirely free from the Fever by the 30th. On
the 10th of _April_ 1759, a Youth, _John Young_, fifteen
Years of Age, was admitted into the same Hospital for a
Fever, which had already continued fourteen Days. His Speech
was affected, and he had entirely lost the Use of his Limbs,
was delirious, and had other bad Symptoms. On the 12th, his
Hearing became exceedingly dull, and he recovered daily
afterwards, and was discharged, cured, the 2d of _May_,
having recovered the Use of his Legs as well as got free of
the Fever.
Swellings of the parotid Glands appeared in many Subjects, towards the
Decline of the Fever, which came to Suppuration, and proved critical.
In two only, out of those I attended while in _Germany_, they came on
early in the Fever, but did not suppurate. Both Patients died; all
the rest recovered, except one old Man, an Invalid at _Bremen_; who,
after having one Swelling appear on the right Side, which came to
Suppuration, and seemed critical, relapsed into the Fever; and another
formed on the other Side, which came likewise to Suppuration, and the
Fever ceased, after having reduced him very low; but the great
Discharge from the Sores wasted him gradually, and he died hectic in
about a Month after the Fever had left him[18].
[18] But although these parotid Swellings were in general so
favourable with us, we are not to imagine that this will
always be the Case: for _Riverius_, though he speaks of these
Swellings proving for the most part critical; yet he tells
us, that, in the Year 1623, this Fever was epidemic at
_Montpelier_, and that almost one half of the Sick died; and
particularly, that most of those who had Swellings of the
parotid Glands appearing about the 9th or 11th Day, were
carried off within two Days of their Appearance. Having
attended several who died from the Swellings not coming to
Suppuration, he began to consider in his own Mind, what might
be the Cause of their Death, and concluded, that it was owing
to there being a greater Quantity of morbid Matter in the
Blood than the Part was able to contain, and that Evacuations
by blooding and purging were the only Remedies which were
likely to give Relief; and therefore, in the first Case of
this Kind, in which he was afterwards consulted, he ordered
three Ounces of Blood to be taken away, notwithstanding the
Patient was so low that the Surgeon was afraid he would have
died in the Operation: The Pulse rose on bleeding, and he
ordered four Ounces more to be taken in three or four Hours
afterwards: The Pulse rose still more, and he ordered a Dose
of Sena and Rhubarb to be taken next Day, and the Patient
recovered. And he adds, that all those who were treated in
this manner got well. _Prax. Med. Lib._ XVII. _sect._ iii.
_cap._ 1.
As soon as these Swellings of the parotid Glands appeared, we
endeavoured to bring them forward to Suppuration, by the Application
of emollient Cataplasms, or of gummous Plaisters; and had them opened
as soon as a Fluctuation of Matter was to be felt, and afterwards
treated them as common Abscesses. _Riverius_[19] very justly observes,
that when such Tumours encrease in such a Manner as to endanger
Suffocation, they ought to be opened before they come to Maturation;
and Dr. _Pringle_[20] desires us not to wait for a Fluctuation of
Matter, but to open the Abscess as soon as it can be supposed to have
formed.
[19] Ibid.
[20] _Pringle's Observations on the Diseases of the Army_,
Part III. chap. vii.
In _February_ 1761, three Patients in the Decline of this Fever had
Buboes formed in the Groin, which proved critical. At first, on
observing them, I suspected them to be venereal; but on examining the
Patients, they obstinately denied their having any Reason to suspect
any such Cause; and the favourable Manner in which they healed without
the Appearance of any other venereal Symptom, made me believe what
they asserted to be true; especially as such People are not shy in
owning Complaints of that Kind. The first Patient I saw who had a Bubo
in the Decline of one of these Malignant Fevers, was a Woman, Wife to
a Soldier of the thirty-seventh Regiment of Foot; she had a Child at
her Breast, and her Husband was living with her at the Time she was
taken ill of the Fever, and neither of them had the least venereal
Complaint. In a few Days afterwards, two Soldiers in other Hospitals,
towards the Decline of very bad Petechial Fevers, had likewise Buboes
formed in the Groin, without any Suspicion of a venereal Taint. Except
in these three, I did not see any critical Buboes appear in this Fever
while I was with the Troops in _Germany_; tho' Mr. _Lovet_, who
served as a Mate to the Hospitals, and who was at _Hoxter_, where we
had another Hospital established, while I was at _Paderborn_, told me,
that, in the Beginning of the Year 1761, they had several Men in the
Hospital ill of this Fever, who had critical Buboes formed in the
Groins and Armpits[21].
[21] This Symptom of Buboes is taken Notice of by Authors,
but does not seem to be so frequent as many of them would
make us believe. Neither Dr. _Huxham_ nor Dr. _Pringle_
mention their having seen such Buboes; and Dr. _Lind_ says,
that he never saw them till the Beginning of the Year 1763.
About the same Time that these Buboes appeared, severals towards the
Decline of this Fever complained of a Pain all along the Spermatic
Chord; and soon after a Swelling of the Testicle appeared[22].
However, this Complaint was not peculiar to those who had the Fever;
for others recovering from Fluxes, and other Disorders, were likewise
affected with such Swellings. I did not observe any Symptom of this
Kind in Fevers while I was with the Troops in _Germany_, except in
_January_, _February_, _March_, and _April_ 1761. By Bleeding, and
applying emollient Fomentations and Cataplasms, and bathing the Parts
with _spiritus mindereri_ on the first Attack of the Pain, the
Swelling of the Testicle was prevented; but where no Mention was made
of this Pain till the Swelling had already begun, it commonly ended in
a Suppuration of the Scrotum or Testicle, which healed very kindly. We
had no Reason to suspect any venereal Taint in any of them.
[22] _Hippocrates_ takes Notice of Swellings of the Testicles
in Fevers. He tells us, that a Man from Alcibiades had his
left Testicle swell before the Crisis of a Fever. _See his
Second Book on Epidemics_, sect. ii. And he mentions this
Symptom as a Crisis in the ardent Fever. _See his Book on
Crises_, sect. xi.--And Dr. _Antonio Lizzari_, in a Treatise
which he published on the _Acute Diseases which were frequent
at Venice, and all over Italy, in the Years 1761, 62_, tells
us, that Abscesses of the Scrotum and Testicles frequently
followed the Measles.
Many, while recovering from this Fever, were seized with an
Ophthalmia, or Inflammation of the Eye; for the most part of one Eye
only, sometimes of both. When the Patients were strong, they were
blooded, and had Blisters applied behind the Ears; and sometimes,
where the Pain was great, had Poultices of Bread and Milk applied to
the inflamed Eye; which, with the Assistance of some cooling Physick,
commonly removed this Complaint; tho' in some obstinate Cases we were
obliged to repeat the Evacuations, to apply Leeches to the Temples;
and after the acute State of the Disorder was passed, to order the Eye
to be washed frequently with the Collyrium vitriolicum, or Collyrium
Saturninum, before we got the better of this Complaint. However, it
ought to be observed, that if these astringent Collyria were used too
soon, they did hurt. When these Ophthalmias were neglected in the
Beginning, the Inflammation frequently rose to a great Height, and
left an Obscurity or Philm over the Cornea, which remained an
Impediment to the Sight not to be removed.
Towards the Decline of these Fevers, and very often during the Course
of them, many complained of Pains in their Feet and Toes, which
sometimes ended in Mortifications, especially where the Patients lay
in very cold Wards. For the most Part, the Mortification extended no
further than the Ends of the Toes, tho' in some it spread over the
Feet, and in two or three advanced up the Leg. Several lost one or
more Toes; and in _February_ 1761, one Man lost Half of each Foot;
another lost both Feet, and Part of each Leg. Both got the better of
the Fever, tho' the Man who lost both Feet languished a long time
afterwards. These Pains of the Feet and Toes, and the Mortifications
which followed, were for the most part owing to the Patients being
exposed to too much Cold while they were very weak, the Circulation
languid, and the Juices vitiated by a putrid Distemper; by which means
the Vessels were rendered incapable of carrying on the Circulation in
their extreme Branches[23].
[23] These Pains and Mortifications of the Feet and Toes were
not confined to those who were brought low by malignant
Fevers; for, during the very hard Frost in the Beginning of
the Year 1763, many of the Patients who lay in very large
open Wards in the Hospital at _Osnabruck_, were affected in
the same Way. One Man had both Feet, and Part of each Leg,
compleatly mortified, and died in about nine Days after the
first Appearance of the Mortification. One lost half of one
Foot, and some Toes of the other; and the third lost the
first Joint of some of his Toes, and the Ends of others.
As soon as the Sick began to complain of these Pains of the Toes and
Feet, I found the best Remedy to be, the Bathing of the Feet in warm
Water, or in warm aromatic Fomentations; and, after keeping the Feet
for some time in these warm Liquors, to dry them well, and then rub
them with the _linimentum saponaceum_, or _linimentum volatile_, and
wrap them up in Flannel. And if ever any Lividness or Redness appeared
on the Parts, we gave plentifully of the Cortex and Cordials, if not
contra-indicated by the other Symptoms. When Vesicles arose on the
Part, and a Gangrene formed, we directed the Parts to be scarified,
and proper Dressings to be applied, while warm aromatic Fomentations
and Cataplasms were used.
In _January_ 1762, one Patient, ill of the Petechial Fever at
_Bremen_, had a Lividness and Blackness, threatning a Mortification,
which appeared at the End of his Nose. I expected for some Days, that,
if he recovered, he would lose Part of his Nose; but, by giving him
large and repeated Doses of the _cortex_ and _confectio cardiaca_, in
a Mindereri Mixture, and allowing him the free Use of Wine, its
further Progress was prevented; and as the Patient got clear of the
Fever, the Nose recovered its natural Colour, and only the scarf Skin
peeled off from the End of it.
When the Fever continued long, and reduced the Patients low, it was
very common for the Back, and Parts on which the Weight of the Body
rested, to mortify. As soon as any thing of this Kind was observed, we
ordered such Parts to be covered with proper Dressings, and gave the
Bark and Cordials freely; and took care to make the Patient change his
Posture; and by Pillows prevented as much as possible the Weight of
the Body from resting on that Part. By this Treatment, many recovered,
where the Fever was on the Decline, and the Strength not too much
exhausted; even tho' a very large Surface of the Skin had mortified;
but where the Patients were very low, and the Fever still continued,
or where it was complicated with a Flux, which kept them perpetually
nasty, and exhausted the Strength, it generally proved fatal.
Patients, who were reduced very low by this Fever, or by repeated
Relapses, were subject to oedematous Swellings; especially of the
Feet, towards the Evening, after sitting up all the Day. These
Swellings generally went away as the Sick recovered their Strength;
but in some Cases they continued obstinate, and ascended towards the
Thighs; and in some spread all over the Body, and terminated in an
universal Anasarca.
When these Swellings were recent, and confined to the Feet and Legs,
commonly the Bark joined to the lixivial Salts, or the Oxymel of
Squills, or other Diuretics, and a Purgative once or twice a Week,
removed them. In some, an Infusion of Horse-radish had a good Effect;
in others, Sweats brought out by means of _Dover_'s Powder, or of the
_guttæ antimoniales anodynæ_.
Sometimes these Swellings were very obstinate, and resisted the Force
of all internal Remedies. In such Cases, Punctures made in the Feet,
or lower Part of the Legs, which furnished a Drain for the Water, had
a good Effect. Blisters applied to the Legs were of Service to some.
When the Punctures were made, or the Blisters applied, before the
Patient's Strength was exhausted, provided that he laboured under no
other Disorder but these oedematous Swellings, which proceeded from
Weakness, I never observed any bad Effects from them; tho' I used them
both repeatedly in a Variety of Cases. But if the Patient was very
weak; or had a Hectic Fever or Purging; or other Disorders, and the
oedematous Swellings large; then oftentimes the great Discharge
exhausted his Strength, and a Gangrene and Death were the Consequence.
One of the most remarkable Instances of the good Effects of Blisters,
was in the Case of a Soldier at _Paderborn_; _Thomas Hope_, of the
Second Regiment of Foot Guards, after a Fever of this Kind, was
swelled all over, especially about the Face and Neck, and had a
Difficulty of Breathing: after having tried Variety of Medicines for
this Complaint, without any Effect, he had a large Blister applied to
his Back, and took the Cortex in a Mixture, with the Oxymel of
Squills. As soon as the Blister began to discharge, the Swellings
decreased; and were afterwards entirely removed by the Help of one or
two Doses of Physic, and the continued Use of the Medicines before
prescribed. Three other Men in the Hospital at _Osnabruck_, in _May_
1761, having oedematous Swellings of the Feet and Legs, which yielded
to no internal Remedies, had Blisters applied to their Legs, used the
Cortex, with the lixivial Salts, two or three Times a Day, and a Purge
every fourth Day; which removed the Swellings in a short Time.
Some of the Soldiers, who had repeated Hospital Fevers, had their
Blood so much broke down, as to be subject to profuse Hæmorrhages from
the Nose; and some of them passed Blood likewise by Stool; which
reduced them to a very low State, sometimes attended with imminent
Danger. In such Cases we found nothing to answer so well as to give
freely of the Bark; to acidulate their Drinks with the _spiritus
vitrioli_; to allow them as much Red Wine as the Strength and present
Circumstances could bear; and at the same Time to support the
Patient's Strength by a mild Diet, of light Digestion; as Water or
Rice Gruel, Panado, weak Broth, and the like. When there was a
Tendency to a Diarrhoea, we were obliged to add some of the
_electuarium diascordii_ to the Cortex, and frequently to give an
Opiate in the Evening. One Case, where this Method of Cure had a very
remarkable good Effect, I had under my Care at _Paderborn_. A Soldier
who lay in one of the lower Wards of the Jesuits Hospital, after a
Malignant Fever, attended with a Flux, used to bleed at the Nose, to
four, five, or six Ounces at a Time; and once or twice lost near a
Pint of Blood, of a dark Colour, very thin and watery, and of so loose
a Texture, that the grumous Part scarcely coagulated. This Evacuation
brought him so low, that he could scarce turn himself in Bed; and his
Pulse might be said rather to flutter than beat: By the continued Use
of the Bark, and of Cordials, and Drinks acidulated with _spiritus
vitrioli_, and some Spoonfulls of mulled Red Wine every two or three
Hours, he was restored to Health and Strength. The only Accident which
happened during the Cure, was a Threatening of a Looseness, and the
Return of his Flux; which however was stopt by a Dose of the
_tinctura rhei_; by joining some of the _electuarium diascordii_ with
the Bark, and giving an Opiate in the Evening.
* * * * *
Putrid Malignant Fevers, attended with Eruptions, are taken Notice of
by _Hippocrates_[24], and other antient Authors[25]; but whether they
meant that particular Sort of Eruption which we now call Petechiæ, is
uncertain; as their Descriptions are not clear enough to distinguish
it from the Miliary and other Kinds. But since the Year 1500, we have
had many accurate Accounts of Fevers of this Kind, which have appeared
in different Parts of the World: from all which it appears that such
Fevers generally take their Rise either from some antecedent Acrimony
of the Blood; or, what is more frequent, from some Source of
Corruption or Contagion; from the Use of putrescent animal Food, and a
Want of fresh Vegetables and acescent Liquors; from the putrid Steams
of corrupted animal Substances; from the moist putrid Vapour of low
marshy Places in Summer, where there is stagnating Water, which
corrupts by the Heat; from the foul Air of crowded Hospitals, Jails,
and Ships; and from such like Causes[26].
[24] _Hippocrat._ lib ii. popul. sect. iii. text. 2.
[25] _Aetius Tetrab._ ii. sect. i. cap. 129. _Actuar._ lib.
i. cap. 23.
[26] See these Causes mentioned by _Riverius_, and since more
fully explained by Dr. _Pringle_, _Observations on the
Diseases of the Army_, part iii. chap. vii.
When once this Fever begins, it is observed to be of a contagious
Nature, and (if proper Care is not taken) to affect those who attend
the Sick, or who live in the same Room, and breathe the same Air with
them.
Many Authors have reckoned the Malignant, Petechial, and Pestilential,
to be distinct Species of Fevers; and have treated each of them under
a particular Head. But _Riverius_[27] has very justly observed, that
they all belong to the same pestilential Tribe, and only differ from
one another in the Degree of Infection, and the Violence of the
Symptoms[28]; and that they are to be cured by the same general
Treatment, and the same Medicines.
[27] _River. Prax. Med._ lib. xvi. sect. iii. Præfat.
[28] The Malignant or Hospital Fever, and Petechial, seemed
to me to be entirely the same Disorder, and the Petechial
Spots to be only a Symptom which appeared sometimes, but not
always. And _Riverius_ says, the Petechiæ do not always
appear; but when they do, it is a most certain Sign of a
Pestilential Fever. See his _Prax. Med._ cap. xvi. sect. iii.
OF THE DYSENTERY.
The Dysentery generally began to appear soon after the Army took the
Field; and became frequent about the End of _July_, and continued so
till the Army went into Winter-Quarters; and through the Winter, many
of those, who had this Disorder in Autumn, relapsed, upon returning to
their Duty; or by drinking too freely of spirituous Liquors, and being
irregular in their Living.
It is now generally agreed upon, that this Disorder is entirely
produced by such Causes as make the Juices become too putrescent, and
turn the Flow of Humours to the Bowels; and in the Camp it seemed to
arise principally from an obstructed Perspiration caused by the Men's
lying in the Field, and doing the necessary Military Duties in all
Sorts of Weather; at the same Time being often exposed to the putrid
Steams of dead Horses, of the Privies, and of other corrupted Animal
or Vegetable Substances[29], after their Juices had been highly
exalted by the Heat of Summer.
[29] The Dysentery has been long alledged to arise from a
putrescent Cause in Camps; from the Smell of corrupted dead
Animals, and of Excrements, during the Heat of Summer.
_Ramazini_, in his Chapter on Camp-Diseases, informs us, that
Dr. G. _Erric Barnstorff_, Physician to the Duke of
_Brunswick_, who served five Campaigns with the _Brunswick_
and _Lunenburg_ Troops in _Hungary_, told him, that the Camp
Diseases, particularly the Malignant Fever and Dysentery,
took their Rise from the Troops remaining long encamped on
the same Ground, and being exposed to the corrupted Steams of
the Bodies of dead Men, Horses, and other Animals, which lay
unburied; and of Excrements, which were not covered with
Earth. And these Causes have since been particularly taken
notice of by Dr. _Pringle_, in his _Observation on the
Diseases of the Army_.
Many have imputed the Cause of this Disorder to the eating of
Fruit in excess, because it generally appears about the
Middle of Summer, the Time the Fruit begins to be in Season,
and continues through the Autumn. But from later Observations
this should seem to be a vulgar Error. Dr. _Pringle_ (part i.
ch. iii. p. 20.) tells us, that, in the Year 1743, this
Sickness began and raged before any Fruit was in Season,
except Strawberries, (which from their high Price the Men
never tasted) and ended about the Time the Grapes were ripe;
which growing in open Vineyards were freely eat by every
body. And Dr. _Tissot_, in a Treatise which he published,
called _Avis au Peuple sur la Santé_, in his Chapter on the
_Dysentery_, § 320, says, that ripe Fruit, especially the
Summer-Fruits, are so far from being the Cause of the
Disorder, that they are the great Preservatives against it:
he says, that, in the Years which the Fruit is most
plentiful, the Dysentery is least frequent; and he relates
several Instances where the Use of ripe Grapes proved a Cure
for the Disorder. Eleven People were attacked by the
Dysentery, nine eat Fruit, and all recovered; the other two,
a Grandmother and Child, from Prejudice, eat none, and both
died. A Regiment of _Swiss_ Soldiers, in Garrison in the
South of _France_, had the Dysentery very frequent among
them. The Captains purchased some Acres of a Vineyard, and
carried the sick Soldiers to the Field, and gave them the
Grapes to eat; and ordered the Men in Health to live upon
them chiefly. After this not one Person died, nor was any one
seized with the Distemper.--In an Account of a Treatise on
the Dysentery, published at _Hamburg_ in 1753, which was
epidemical the Year before, in _August_ and _September_, we
are told, that it did not proceed, as is commonly believed,
from the eating of Fruit; for it was observed, that those who
eat Fruit freely escaped better than those who abstained from
it altogether. _Vide Comment. de Rebus in Hist. Nat. &
Medecin. Gestis_, vol. II. par. iv. sect. v.
Generally in _August_ and _September_ we have People admitted
into _St. George_'s Hospital for the Dysentery; who have
certainly not catched the Disorder from eating of Fruit, but
from working in the Fields, and being exposed to Causes
similar to those which produce the Dysentery in Camps.
At the Time the Petechial Fever was frequent at _Paderborn_ in
_January_, _February_, and _March_ 1761, the Flux frequently
accompanied it; and we had in the Hospitals likewise a Number of old
Cases of this Kind, the Remains of the preceding Campaign about
_Warbourg_; besides some Men who had relapsed during the Winter, and
were sent to us when the Troops marched, upon the Winter-Expedition,
into the Country of _Hesse_. In _May_ and _June_, what Fluxes we had
at _Osnabruck_, were the remaining old Cases of the Hospitals of
_Munster_, _Paderborn_, _Hoxter_, and _Niehms_. Some few recent ones
were sent to _Bilifield_ about the End of _June_, and above 300 to
_Munster_, in _July_ and _August_. Those sent to _Bremen_, in
_November_ and _December_, had continued for some time before they
reached us; but a good many of the Soldiers in the Garrison were taken
ill of this Disorder, and sent immediately to the Hospital. In the
Beginning of _May_ we had but four ill of this Complaint in the
Hospital I attended; and there were not above six or seven, among the
Sick sent down from the Army, in the Middle of this Month. In _June_
there were but two sent to the Hospital at _Minden_; and not above ten
among the Sick sent to _Natzungen_ in the Beginning of _July_; tho'
towards the Middle of this Month they began to be more frequent; and
continued to be more so in _August_ and _September_; and in the
Hospital at _Osnabruck_ we had not above five or six ill of this
Disorder, in _December_ 1762, and in _January_, _February_ and _March_
1763.
The Dysentery commonly begun with Sickness and Gripes, succeeded by a
Purging, and attended with more or less Fever. Very soon the Gripes
became more severe, attended with a Flatulency in the Bowels, and
often with a Tenesmus. The Stools were chiefly composed of Mucus,
mixed with Bile, and more or less Blood: tho' sometimes no Blood could
be observed in them; and then the Soldiers used to say they had the
White Flux.
After eight, ten, or twelve, Days, if the Disorder was not complicated
with any other, there remained little or no Fever, unless where some
Accident supervened; tho' in Cases which terminated fatally, towards
the latter End came on a Fever of a low malignant Kind, attended with
black fetid Stools, Lientery, Hiccup, Stupor, and other bad Symptoms.
It often happened, that, after the Dysentery had continued for some
Time, the Sick complained for a Day or two of severe Gripes; and then
discharged along with the Stools little Pieces of hardened Excrements;
at other Times, tho' more rarely, little Pieces of white Stuff like
Tallow or Suet: Frequently small Filaments, and little Pieces of
Membranes, were found floating in the Stools; and it was very common
for the Sick to vomit up Worms of the round Kind, or discharge them by
Stool[30].
[30] Most Authors, who treat of the Dysentery, mention this
Symptom of Worms; and Dr. _Huxham_ tells us, that, in some
Seasons, he has seen round Worms in the Stools of most of the
Dysenteric Patients. _De Aere_, vol. II. p. 98.
In the Course of the Disorder, the Men often complained of a violent
Pain of the Rectum, near the Fundament, which was most excruciating
when they went to Stool; it continued for some Days, sometimes for a
Week or more; and then they passed more or less of a Yellow Pus with
their Excrements, and the violent Pain ceased. Mr. _A. Tough_, one of
the Apothecaries to the Military Hospital in _Germany_, was the first
who told me that I should find Pus mixed with the Stools: on my
mentioning a Case of this Kind, which had been relieved by Bleeding,
and Clysters often repeated; he told me he had observed it frequently
at _Gibraltar_; and was at a Loss to understand the Nature of the
Symptom, till he observed the Matter in the Stools; which at once
shewed him that it had been originally an acute Inflammation of the
Part, and pointed out to him the proper Method of Cure.
Oftentimes the Bilious and Malignant Fevers terminated in the
Dysentery; or were accompanied with it, when it might be looked upon
as a Symptom of these Fevers.
The Appearances we found after Death in the Bodies of some Patients,
who died of old Fluxes at _Bremen_, were: In all of them the Rectum
was inflamed, and partly gangrened, especially the internal Coat. In
two the lower Part of the Colon was inflamed, and there were several
livid Spots on its great Arcade. In one whose Body was much emaciated,
and who had been seized with a violent Pain of the Bowels two Days
before his Death, all the small Guts were red and inflamed; and in
another there were livid gangrened Spots on the Stomach[31].
[31] From the Accounts we have in Authors, of the Dissection
of the Bodies of Persons who died of the Dysentery, it would
appear; that there is no Part of the alimentary Canal which
has not some time or other been found inflamed, or in a state
of Suppuration or Gangrene; and the Liver, Spleen, and other
Viscera, have likewise been found diseased, but the Rectum
and Colon have almost in all been more or less affected. The
following Account I had, in the Year 1748, from the late Dr.
_L. Fraser_, who afterwards practised in the Island of
_Nevis_, two Days after the Patient died. _Mary Reid_, a
Woman thirty Years of Age, was taken ill of a Dysentery,
which in Three Weeks Time killed her. In her Life-time she
complained, more than ordinary, of Gripes in her Belly,
especially in her Left Side. Her Body was opened in Presence
of Dr. _Dundas_, who had attended her, during her Illness.
All the Intestines and Mesentery were inflamed, especially
the Colon and Rectum; the internal Side of which was quite in
a mortified State, and contained little Vesicles full of a
putrid fetid Liquor, Numbers of which she had evacuated by
Stool some Days before her Death.
There was no Disorder we were more successful in the Cure of, than
recent Fluxes; but after they had continued for Weeks, and were become
in a manner chronic, they often foiled all our Endeavours, and a great
Number died[32].
[32] While this Sheet was in the Press, I received Dr.
_Pringle_'s 4th Edition of his _Observations on the Diseases
of the Army_, and Dr. _Baker_'s Treatise on the _Dysentery
which was epidemic in London in the Year 1762_. Both these
Gentlemen give an Account of the Dissection of the Bodies of
some People who died of the Dysentery; where, besides the
common Appearances of the inner Surface of the Rectum and
Colon being covered with a bloody Slime, and their internal
Coats being inflamed, gangrened, or in a putrid State, there
were observed on the Inside of the lower Part of the Colon,
and upper Part of the Rectum, a Number of little Tubercles,
or Excrescences, which resembled the Small Pox, of a flat
Sort at the Height of the Disorder; but differed from them in
this, that they were of a firm Consistence, without any
Cavity: they were believed to take their Rise from the
cellular Membrane, which lies immediately above the villous
Coat. Perhaps such Tubercles might have been found in the
Colon and Rectum of those Bodies we opened; but not looking
for them, they may have passed unobserved.
_Morgagni_, in his Book lately published, _de Sede & Causis
Morborum_, epist. xxxi. is of Opinion, that the Filaments,
and Pieces of Membranes, which are frequently observed in the
Stools, are often formed of inspissated Mucus and Lymph, and
other Liquors; and not the Fibres, or Pieces of the villous
Coat of the Intestines, as alledged by many Authors.
Upon my first being employed in the Military Hospitals in _Germany_,
I was surprised to see so many of the old Dysenteric Cases end
fatally; and imagined I had not fallen upon the Right Method of
treating them: but upon consulting the other Physical People[33]
employed in the same Service, I found them as unsuccessful, as myself,
after having tried a Variety of Remedies: And at last, I was
convinced, that when once the Flux had continued long, and injured the
Structure of the Intestines to a certain Length, a Gangrene will
often form by slow Degrees; and the Disorder end fatally,
notwithstanding the Use of what are esteemed the most efficacious
Remedies; and that, when this Disorder is violent, the Cure
principally depends upon an early and speedy Application of proper
Remedies, before the Strength be exhausted, or the Structure of the
Bowels too much hurt. The bad Success we had in treating these old
Cases, may perhaps surprise those who have never practised except in
healthful Cities, where the Disease is commonly mild, and People apply
soon for Advice. But all those Gentlemen who have had the Care of
Military Hospitals, where the Dysentery has been frequent, and where
the Sick have been often sent a great Way, before they reached the
Hospitals, must be convinced of the Truth of what is here asserted.
[33] Mr. _Cleghorn_, in his _Account of the Diseases of the
Island of Minorca_, says, "That almost all the Dysenteries
which fell under my Observation, unless they were speedily
cured in the Beginning, at best proved obstinate, and too
frequently fatal, in spite of the many boasted Specificks for
this Distemper." chap. v. p. 228.--The physical Gentlemen
employed on the _American_ Service have told me, that the old
Flux Cases were as fatal in _America_, as we found them in
_Germany_. I would not from thence have it believed, that
every old Flux was to be looked on as a lost Case; and for
that Reason given up, and no Attempts be made to cure it; for
many, by great Care, and Strength of Constitution, have
gradually surmounted the Disorder, and recovered their
Health; especially when they got over the Winter, and lived
till the warm Weather began.
In the Treatment of this Disorder, as well as of the Malignant Fever,
nothing contributed more to the Cure, than keeping the Sick as clean
as possible, and in large airy Wards.
Most of the recent Fluxes, which I saw, were at first attended with a
good deal of Fever, and Pain in the Bowels; and required more or less
Blood to be taken away, according to the Strength of the Patient, and
the Violence of the Symptoms.
When the Patients were strong, and complained of sharp Pain of the
Bowels, attended with a Fever, we used the Lancet freely, nor were we
discouraged from bleeding in the Beginning by the low quick Pulse
which often attended the Disorder; and we frequently found the Pulse
rise as the Blood flowed from the Vein. But when the Sick were low and
weak, without much Pain or Fever, and the Pulse was soft, we were more
sparing of the vital Fluid[34].
[34] Although Bleeding, in the Beginning, has been
recommended by _Sydenham_, _Huxham_, _Pringle_, and other
Practitioners; yet it has been reckoned unnecessary in this
Disorder by some late Authors. But in most of the recent
Cases I saw, it was extremely necessary, and contributed
greatly to the Relief as well as the Cure of the Patient;
indeed where the Disorder had already continued some time,
and the Fever was gone off before the Patient was sent to us;
and the Disorder had become in a manner chronic, and the
Patient low, then bleeding was unnecessary, and would have
probably done Hurt. Mr. _Francis Russel_ told me, that when
the Dysentery was epidemical at _Gibraltar_, in Summer 1756,
he found that by bleeding such Patients as he met with at the
first coming on of the Symptoms, and by giving them
immediately a Vomit, and afterwards a sudorific Draught, the
Disorder was rendered mild, and few of those died.
As the Disorder was for the most part attended with Sickness in the
Beginning, we gave a Vomit after bleeding; which not only discharged
the Contents of the Stomach, and a Quantity of Bile, but relieved the
Sickness, and frequently threw the Patient into a breathing Sweat; and
made the Purgatives which were given next Day operate more freely, and
with more evident good Effects than where no Vomit had been
administered.--If in the Course of the Disease the Sickness returned,
the Emetic was repeated; and we often observed, when the Flux was
obstinate, that well-timed Vomits greatly promoted the Cure.--The
Vomit we commonly employed was the Powder of Ipecacuana, which we gave
from ten to twenty Grains; and where the Patient was strong, and we
wanted to make a free Evacuation, we added one, two, or three Grains
of the Tartar Emetic; which encreased the Strength of the Vomit, and
commonly operated likewise by Stool[35], as Dr. _Pringle_ has
observed.
[35] Mr. _W. Russel_, who was with the Hospital at
_Martinico_, told me, that, when he was there, he found the
Vomit with the Tartar Emetic to be far preferable to any
other, in all Cases where there was much putrid Bile lodged
in the alimentary Canal; as it speedily carried off those
corrupt Humours, which were often productive of the greatest
Mischiefs, if they remained, but for a short Time, pent up
within the Bowels.
Next Day we ordered a Purge to empty the other Parts of the alimentary
Canal. The Purgative, that at first was most employed for this
Purpose, was Rhubarb; but upon repeated Trials we did not find, that,
in general, it answered so well, in this first Stage of the Disorder,
as the _sal catharticum amarum_, with Manna and Oil; which operated
without griping or disturbing the Patient, procured a freer
Evacuation, and gave greater Relief than any other purgative Medicine
we tried. Mr. _Francis Russel_, Surgeon to the _British_ Military
Hospital in _America_, who was formerly Surgeon to the Island of
_Minorca_, was the first Person who informed me (in the Year 1757) of
the Use of the _sal catharticum amarum_ in the Dysentery; he told me,
that the Year before (1756) the Dysentery had been very frequent and
very fatal at _Gibraltar_; and, after trying Variety of Medicines, he
had found nothing give more Relief, or contribute more to the Cure,
than repeated Doses of these Salts.
As a great Part of the Cure depended on the frequent Use of gentle
Purges[36] in the Beginning, to carry off the corrupted Humours; the
Purgative was repeated every second, third, or fourth Day, as the Case
required; the Operation of the former Purge, and the Symptoms,
determining the Frequency of the Repetition. It was surprising with
how little Loss of Strength the Sick bore the Operation of these
Purges; I have sometimes given them to strong People every Day, for
two, three, or four Days successively; and observed that the Patient,
instead of being weakened, seemed stronger, and more brisk and lively,
after the Operation of each, from the Relief it gave; by evacuating
those putrid, corrupted Humours, which kept him perpetually sick and
uneasy, while they remained within the Bowels.
[36] Variety of Medicines have been recommended to answer
this Purpose.
The _vitrum ceratum antimonii_ proved often too rough a
Medicine, and therefore we laid it almost entirely aside.
Repeated small Doses of the Ipecacuana, from four to six
Grains, operated both as an Emetic, and kept up a Purging;
but they made the Men so sick, that we could not prevail upon
them to continue their Use. Mr. _Francis Russel_ told me,
that, in the Year 1756, he found a few Grains of Rhubarb
added to each Dose, made it operate more as a Purgative, and
did not make the Men so sick.--Dr. _Akenside_ proposes giving
the Ipecacuana in so small Doses as one or two Grains every
six Hours, in a Draught made of Mint-water, and Half a Drachm
of _confectio cardiaca_; and, after bleeding and vomiting
once, seems to depend almost entirely on the Use of this
Medicine for the Cure of the Dysentery. See his _Comment. de
Dysenteria_, cap. 2.
The watery Tincture of Rhubarb, recommended by _Degnerus_, we
tried in some Cases at Bremen; and found it to be a good mild
Purge, but not to answer so well as the Salts and Manna in
recent Cases. Mr. _William Russel_ told me that they found
this watery Tincture of Rhubarb to answer better in _America_
than any other of the Preparations of Rhubarb.
Calomel has been recommended by many as a Purge in
Dysenteries; and Dr. _Huxham_ (_de Aere_, Vol. II. P. 100)
assures us, that he has often experienced the good Effects of
it, especially when the Patient at the same time had Worms;
in such Cases we joined it to Rhubarb as mentioned in the
Text, or gave a Calomel Bolus over Night, and a Purge next
Morning. Dr. _Duncan_, Physician to his Majesty, told me,
that he found the following Method of Cure always successful
in the Dysentery, which was epidemic in _London_ in the Year
1762.
If the Patient was Plethoric, or had much Fever, he ordered
more or less Blood to be taken away; and then gave four
Ounces of the following Julep, every Half Hour, till it both
vomited and purged. Rx _Tartar. emetic. gr._ iij _Mannæ elect.
Unc._ ij _solve in Aq. hordeat. Lib._ 1.--The next Day, and
for five or six Days more, the Patient took so much of a
Decoction, of Manna, Tamarinds, and soluble Tartar, as kept
up a free Discharge by Stool.--If the Irritation and Griping
were severe, he found that a Solution of Manna, in the common
Almond Emulsion, was sufficient.
When the Pain, or Tenesmus, was violent, a Clyster, of
Chicken Broth, or of an Infusion of Linseed, with an Ounce or
two of Oil of sweet Almonds dissolved in the Yolk of an Egg,
injected once or twice a Day, was of great Use.
Upon the whole, he was always pleased when he saw large
excrementitious Stools come away; and when that could be
procured by a gentle Method, he was the more pleased.
This Disorder was very often cured in a few Days, and in that
Case he dropt the further Use of Medicines; but when it
exceeded the Period of six or seven Days, he then added
thirty or forty Drops of the _tinctura thebaica_ to the
Clysters; and ordered a Scruple of the Extract of the Logwood
to be taken thrice a Day in some proper Vehicle.
The Patient's Diet was Rice-Gruel, Sago, Panado, and such
like; no Animal Food, not so much as Chicken-Broth, was
allowed in the Beginning of the Distemper, nor even Oil,
Butter, or Fat of any Kind. The common Drink was Almond
Emulsion, Rice-Water, or Barley-Water with Gum Arabic.
Dr. _Duncan_ lost but one Patient out of Eighty, whom he had
under his Care that Season; and he was delirious, had a high
Fever, and a _subsultus tendinum_ before the Doctor was
called to him, and he died the next Day.
The late Dr. _Young_, of _Edinburgh_, seems to have had a
very just Notion of this Disorder, and of the proper Method
of treating it; for, in his Treatise on Opium, sect. vii. he
says, "I am convinced from Experience, that most of the
Dysenteries I have hitherto met with, might have been cured
by purging mildly, but constantly; and at the same time
abating the Acrimony in the great Guts by emollient Clysters,
and in the small ones by Plenty of Absorbents, and a Diet of
Chicken Broth: But it must be observed with regard to
Purgatives, that Manna agrees best with some, Rhubarb with
others, Jalap, Mercury, and toasted Rhubarb with others;
while others are sooner cured by emollient Clysters. I use
Opium only when the Disease is mild, or after its Violence is
abated by Evacuants and Emollients."
Scammony, Aloes, and the other strong resinous and hydragogue
Purges, are hurtful, and occasion Pain. I always observed,
that those Purges answered best which made the freest
Evacuation, and acted with the greatest Ease to the Patient;
of which the Salts and Manna answered best of any I have
hitherto used.
Though Rhubarb did not answer so well in the Beginning as the saline
Purges; yet afterwards in the Course of the Distemper, when the
Patient did not complain much of Gripes, half a Drachm of Rhubarb,
either by itself or in a saline Draught, proved a good gentle Purge;
and given with six or seven Grains of Calomel, was found to be a good
Medicine, when the Disorder was attended with Worms.
In the Evening, after the Operation of the Purge, we gave an Opiate;
and repeated it at Nights, in the Intervals between the Purges; but
were obliged to be very sparing of the Dose, while the Disorder
continued in its acute State; the Opiate was only given in a Quantity
sufficient to mitigate the Pain, and to procure Rest, but never so as
to stupify the Patient, or prevent a due Discharge by Stool; though we
were often obliged to encrease the Dose, as Use made it familiar to
the Patient.
In the Intervals between the Purges, we gave in the Day, the Mindereri
Draughts with the Mithridate; or the saline Draughts with the Addition
of four Drops of the _tinctura thebaica_; or some such mild
diaphoretic, every four or six Hours; which helped to keep up a free
Perspiration, without any Danger of stopping the Purging; and for the
most part answered much better than the Diascord, or Philonium, or
other strong Astringents and Opiates commonly prescribed for this
Purpose; which were always liable to check the Purging too much, and
bring on severe Gripes attended with Heat and Fever[37]; and therefore
we seldom made Use of them in this first Stage of the Disorder.
[37] _Sydenham_, _Huxham_, and all good Practitioners, have
taken Notice of the bad Effects of the too free Use of
Astringents, and given Cautions against it.
If the Patient was attacked with severe Gripes[38], and a Tenesmus,
which the Purgatives and gentle Opiates did not relieve, we ordered
the Abdomen to be fomented with warm Stupes; and the Patient to drink
freely of warm Barley or Rice-water, or of weak Broth[39], or an
Infusion of Camomile Flowers, as recommended by Dr. _Pringle_; and
ordered first Clysters of large Quantities of the plain emollient
Decoction to be given; and if the Gripes still continued, to be
repeated in small Quantities, with the Addition of a Drachm or two of
the _tinctura thebaica_; for we observed that Opiate Clysters often
gave more Relief, than Anodynes administered in any other Way; and
sometimes, when a Tenesmus was very troublesome, the common oily
Clyster, with a little Diascord, and _tinctura thebaica_, or the
Starch Clyster, gave more Ease than any other.--In some Cases, where
the Pain was sharp, attended with a Fever, we were obliged to take
away more or less Blood; and sometimes also to apply a Blister to that
Part of the Abdomen where the Patient felt most Pain.
[38] If the Patient was suddenly attacked with sharp Pain of
the Bowels and Gripes, on a Day in which he had not Physic, a
Dose of the Salts and Manna was commonly given immediately,
to empty thoroughly the first Passages.
[39] Mr. _W. Russel_ told me, that he and Dr. _Huck_ found
the free Use of the following Emulsion, made of Bees Wax, to
be of great Use after Evacuations, where there was much Pain
of the Bowels, in recent Cases of Fluxes in the Hospitals in
_America_. Rx. Ceræ alb. vel flavæ drachmes tres. Sapon. alb.
Hispan. drachmam unam. Aquæ fontanæ, unciam unam, liquefiant
super ignem in vase ferreo, agitando spatula, & dein infunde
in mortarium marmoreum, & adde paulatim aq. fontanæ, libras
duas syrupi sacchari. spiritus vini gallici tenuis, vel aquæ
alicujus spirituosæ ana unciam unam, terendo optime ut fiat
emulsio.
This Method of dissolving Bees Wax, in a Watery Liquor, is
entirely new; for before this we knew of no Way of making it
miscible with Water.
During this Course, the Patients used the common low Diet of the
Hospital; when they loathed the Rice-Gruel, they had Panado with a
little Red Wine and Sugar; or Water-gruel, when it could be got, in
its Place.--Their common Drink was Barley or Rice-water; of which it
was recommended to them to drink plentifully; as nothing contributed
more to the Cure than the free Use of such Liquors, to dilute and
blunt the Acrimony of the Fluids[40]. In some Cases, when the Purging
was violent, and not accompanied with the malignant Fever, the
_decoctum album_ was found to be a good Drink; and we added
occasionally a few Drops of the _tinctura thebaica_.
[40] Dr. _Huxham_ (_de Aere_, Vol. II. p. 107.) says, there
is no Disorder in which a diluting, sweetening Drink is more
necessary than in this; that he has done great Service among
the Poor by luke-warm Water; that, after emptying the Bowels
thoroughly, he has sometimes cured this Disorder by the Use
of pure Water, and a small Quantity of Opium. And _Baglivi_
(_Prax. Med._ lib. i.) tells us, that the drinking of common
Whey, and throwing up frequent Clysters of it, had cured
many, and that this was looked upon as a Specific, and kept a
Secret by some.
Such were the chief Remedies we used in the first Stage of this
Disorder; but after some Weeks, when the Fever had abated, and free
Evacuations had been made, and the Complaint become in a manner
chronic, we were obliged to try other Methods; and found that the best
Way of treating this Disorder, was, to endeavour to brace and restore
the Tone of the Intestines, by means of the corroborating and gentle
astringent Medicines, mixed with Opiates; while mild Purgatives were
given at proper Intervals.
The Patients were kept to the same low Diet as before, with the
Addition of a little Wine or Brandy. They were allowed from a Gill to
a Pint of red Wine _per_ Day, which was commonly mulled before it was
given them; when the Wine griped them, which it frequently did, they
took in its Stead Half a Gill or a Gill of Brandy, mixed with a Pint
or a Quart of Barley or Rice-water, or of the _decoctum album_.
In this Stage of the Disorder we found, that the same Medicines would
not answer with all, and therefore we were obliged to try Variety[41];
and indeed, unless where the Violence of the Disorder had abated by
the Use of Evacuations, the Event was always very doubtful; for when
the Complaint had continued long and become chronic, and the Structure
of the Intestines was much hurt, before the Sick were sent to us; or
when it continued obstinate, and yielded but little to Evacuations,
and the other Methods used in the first Stage, even Remedies esteemed
the most efficacious oftentimes proved unsuccessful, and at length
the Patient died.
[41] Dr. _Pringle_, in the _fourth Edition of his
Observations_, just published, in treating of the third or
last Stage of the Dysentery, remarks, that this is the Time
for Astringents, which ought not to be given sooner, or at
least very sparingly. And he tells us, that, in the former
Editions of his Work, he mentioned those Compositions which
he had most frequently used, but that he had now laid most of
them aside; and at present trusts to Vomits, and to a Milk
Diet, for the perfect Cure.
He says, "Whenever therefore the Patient is in this State,
and especially when his Pulse is quick, and he complains of
inward Heat, I began with giving him a Scruple of Ipecacuana;
and the next Day I put him upon the Milk-Diet; which I
continue till all the hectic Symptoms are gone, and till the
Bowels have recovered their Tone. During this Course I have
seldom had Occasion for any other Medicine, excepting the
Chalk Julep mentioned before, which I use for correcting that
strong Acid so incident to relaxed Stomachs. Sometimes also I
add an Opiate to procure Rest at Night; but after a few Days
these are likewise laid aside. All that I require (which
indeed is often hard to obtain) is a strict Perseverance in
the low Diet: and now and then a Repetition of the Vomit,
upon any new Disorder of the Stomach, or great Laxity of the
Bowels.
"Whilst the Patient continues in this Course, I forbid all
animal Food and fermented Liquors; and besides Milk, I allow
only the Preparations of Grain, Sago and Salop." See Part
iii. ch. vi. p. 289, 290.
A Spoonful of the _mixtura fracastorii_, taken after every loose
Stool; and an anodyne Draught at Night, had a good Effect with
some--Repeated Doses of the _philonium Londinense_ answered better
with others, who were low, and required a Remedy that was warm and
cordial--And others found more Benefit from the Mindereri Draughts,
with Mithridate, or the _confectio cardiaca_, or the Theriac anodyne
Boluses.
The _mixtura Campechensis_, both alone and with _tinctura thebaica_,
checked the Purging, and gave Relief sometimes; and the Addition of
some of the Extract of Bark and Tincture of Cinnamon, seemed to
encrease its Efficacy in one or two old Cases, at _Bremen_; but it
afterwards occasioned such Sickness, that we did not continue its Use.
In other inveterate Dysenteries, where we thought that a strong
Astringent was wanted, we added a small Proportion of Allum to the
_Campechense_ Julep, which on first using seemed to be serviceable;
but at other Times it occasioned a Tenesmus and Gripes; and therefore
we were obliged to be very cautious how we used it.
Equal Parts of the _electuarium diascordii_ and _electuarium
corticis_, taken in the Quantity of a Drachm twice or thrice a Day,
was of Use in many old Fluxes[42], though it made other Patients so
sick, that they were obliged to lay it aside.
[42] I had lately a very remarkable Instance of the Effects
of this Medicine, in the Case of one _Gilchrist_, a
middle-aged Man, by Trade a Taylor; who was admitted into
_St. George_'s Hospital the 20th of _July_, 1763, for an old
Flux, which had continued above six Months, and reduced him
very low: He had taken a great many Medicines without any
Effect. After giving him a Vomit and two Doses of Tincture of
Rhubarb, I gave him four Grains of the Powder of Ipecacuana
with Opium three Times a Day; but that having no Effect,
after using it for above a Fortnight, I ordered him the
Electuary of Diascord and Cortex; from the Time he began to
use this Medicine, he mended daily; and was dismissed in good
Health the 26th of _September_.
We tried likewise in this Stage of the Disorder, repeated small Doses
of the Ipecacuana; but it occasioned such Sickness, that we did not
persist in its Use.
In other Cases, we gave from two to five Grains of the Ipecacuana,
mixed with Opium, in different Proportions (from three Grains to ten
of the Ipecacuana to one of the Opium), every four or six Hours; it
gave sometimes a little present Ease, at other Times it occasioned
Sickness; we often continued its Use for ten, twelve, or fourteen
Days; but it seldom produced any remarkable Change for the better, and
we were obliged to have Recourse to other Remedies.
_Dover_'s Powder was given in large Doses, from one Scruple to two;
and proved a good Sudorific and Anodyne in some Cases; though in
others it made the Patients sick, without producing any good
Effect.--It commonly answered better, when used occasionally as a
Sudorific, than when constantly continued.
During the Use of these Remedies, it was necessary to repeat the
Purgatives from Time to Time; or to mix them occasionally with the
other Medicines, in order to carry off any corrupted Humours, or
Excrements that might be lodged In the Cavity of the Intestines; for
when this was neglected, the Patients were often seized with Sickness
and Gripes, and a more violent Purging than before:--And if at any
Time they complained of Gripes, and passed little Pieces of hardened
Excrements, it was mostly a certain Sign that a Purge was indicated;
and, on such Occasions, it generally gave Relief; and when attended
with Sickness, a Vomit was given before the Purge.--Clysters were used
as in recent Cases, where the Sick were low, or had much Pain of the
Bowels[43], or complained of a Tenesmus.
[43] On the 21st of _November_, 1759, _Hanah Meredith_, a
middle-aged Woman, was admitted into _St. George_'s Hospital
for a Flux, which she had six or seven Weeks; she had no
Fever, but complained much of Sickness and Gripes, and her
Disorder had reduced her very low. During the two first Weeks
of her being in the Hospital, she had two Vomits of
Ipecacuana and four Doses of Rhubarb; and in the Intervals
anodyne and astringent Medicines, which made no Alteration in
her Complaints. On the 2d of _December_, she told me, that
two Years before she had had a Flux for above three Months,
which had yielded to no Remedies till she was ordered
repeated Clysters, and that they had made a Cure in a short
Time. I then ordered an emollient Clyster with a drachm of
the _electuarium diascordii_, and a Scruple of the _tinctura
thebaica_, to be given twice a Day, which gave her almost
immediate Relief; and with the Assistance of some Doses of
Rhubarb, and one or two Vomits and occasional Opiates,
removed her Disorder by the Middle of _January_; though she
remained long weak, and troubled at Times with Gripes; but
these Complaints were at last got the better of by her taking
some Doses of Rhubarb, and drinking daily a Pint of Lime
Water mixed with Half a Pint of Milk.
_Sarah Spencer_, a middle-aged Woman, was admitted into _St.
George_'s Hospital the 9th of _November_, 1763, for a Flux,
which had continued for two Months, and reduced her very low.
She complained much of Sickness and Gripes; her Stools were
mostly composed of Mucus and Blood; her Pulse was low, and
she had no Fever, but a Whiteness of the Tongue, and
complained of Thirst.--The first Day she had a Vomit, and
next Day a Dose of the purging saline oily Draught.--She was
ordered to have an emollient Clyster, with a Drachm of
Diascord, and as much _tinctura thebaica_, given her every
Evening; and to have a Dose of the saline oily Purge twice a
Week, and Opiates occasionally; by following this Course, and
drinking at Times the Chalk Julep, her Disorder was removed,
and she was discharged the Hospital on the 30th of the same
Month.
In some old Dysenteries, where the villous Coat of the Intestines was
much injured, I gave the Cordial Draughts, with the Addition of Half a
Drachm of the _balsamum copaivi_, a Scruple of the Extract of the
Bark, and five Drops of the _tinctura thebaica_, three Times a Day.
At first, this Medicine seemed to promise much, particularly in the
Case of an old Invalid, _William Brookes_; who had been long ill of a
Flux, attended with Gripes and a Tenesmus. He had used Variety of
Remedies, without receiving any Benefit. For the first Fortnight,
after he began the Use of this Medicine, he rested well, and found
great Relief; and seemed to be in a fair Way of doing well. But the
Disorder being too far advanced before he began to use it, he
relapsed, and died. On opening his Body, the inner Coats of the Rectum
and the lower Part of the Colon seemed to be reduced almost to a
gelatinous Substance, and the other Coats were black, approaching to a
Gangrene.--The same Medicine gave Relief in other Cases, but they were
too far advanced before it was administered. In these Cases, when the
villous Coat of the Intestines was inflamed and very irritable, the
mucilaginous Medicines, the _pulvis e tragacantha_, and such others,
were of Service; and frequently Starch Clysters and Anodynes gave
Relief, when other Remedies had little Effect. Flower, boiled with
Milk, and sweetened with Sugar, and given for Breakfast, as mentioned
by Dr. _Pringle_, proved a good Palliative to some; and the Starch and
Gum Arabic, dissolved in Water, a good Drink to others.--Lime Water
and Milk, drank to the Quantity of a Pint or a Quart a Day, was of use
to a few, though it did not agree with all.
It was very common for Patients bad in the malignant Fever to be
seized likewise with the Flux. Such Cases were always extremely
dangerous; and when the Fever was bad, we were often obliged to
neglect the Flux, and only attend to the Fever.--When the Purging was
violent, and appeared very early in the Fever, it often sunk the
Patients, and soon carried them off: but where it was moderate, and
did not appear till towards the Height or the Decline of the Fever, it
often proved a Crisis to the Disorder.
When such Fluxes appeared early attended with sharp Pain of the
Bowels, and Signs of Inflammation; if the Patient was strong, we
began the Cure with opening a Vein, which the Patient bore easily, and
it gave Relief; but when the Symptoms were mild, without any acute
Pain, the Bleeding was omitted.--Commonly the Bowels were loaded with
corrupted Humours, when this Symptom appeared; and, therefore, we
found it of Advantage to give a Dose of the Salts with Manna and Oil,
or some other gentle Purge, to carry them off; and in the Evening an
Opiate to ease the Pain and procure the Patient Rest.
After this we gave the Mindereri Draughts with Mithridate; and as soon
as the Petechiæ appeared, or we observed any Remissions in the Fever,
the Patient took every four or six Hours, a Drachm of an Electuary,
composed of equal Parts of the _electuarium corticis_ and the
_electuarium diascordii_[44]; or Half a Drachm of the Powder of the
Bark, or a Scruple of the Extract, in the Mindereri Draughts, with
four or five Drops of the _tinctura thebaica_; and we repeated the
Opiate in the Evening, always proportioning the Quantity of it to the
Effects of the former Dose, and the Violence of the Purging.
[44] This Practice of giving the Cortex with Opiates in the
Dysentery is not new; for Dr. R. _Morton_, in his Appendix to
his second Exercise on the Fevers, which appeared from 1658
to 1691, observes, that after the Plague of 1666 had ceased,
a Fever from a milder Poison, attended with Gripes and
Dysentery, began to make its Appearance. As the common
Methods of Cure proved unsuccessful, and Dr. _Morton_
observed Exacerbations and Remissions, he resolved to give
the Bark mixed with Laudanum; and found it answer his
Expectation. The first Patient to whom he gave it, was a man
in _Long Lane_, who laboured under a Tertian Dysentery; upon
observing a Remission, he ordered a Drachm of the Bark, mixed
with a Grain of Opium, to be given every four Hours for six
Times; and this removed both the Fever and Dysentery.--He
says, he afterwards gave it, with equal Success, in the
Quotidian Dysenteries, where he observed Exacerbations or
Remissions; and he adds, that he does not doubt but that it
will answer as well in Epidemical Diarrhoea's, and Camp Fevers
attended with such Symptoms.
Dr. _Whytt_ of _Edinburgh_ has given with Success a strong
Decoction of the Bark, mixed with the _confectio japonica_ of
the _Edinburgh_ Dispensatory, in the bad State of the
Dysentery, when the Mouth and alimentary Canal were
threatened with Aphthæ, and even sometimes after they had
appeared. And Dr. _Pringle_ mentions his having given the
Decoction of the Bark, with Snake-Root and some Drops of
Laudanum, in the Dysentery complicated with the malignant
Fever. See _Note to Page 245 of his third Edition on the
Diseases of the Army_.
On the second or third Day, we repeated the Purge; or, if the Patient
was weak, ordered a Clyster to be administered in its Place; in order
to prevent the putrid Fluids and Excrements from being accumulated in
the Bowels:--In other respects we treated it as when the Disorder was
not complicated with the malignant Fever.
This Method, though it did not succeed with all, yet it answered
better than any other I tried;--and it ought to be remarked, that
although it had such a good Effect in Cases attended with the
malignant Fever, or where the Fever inclined to the intermittent Kind,
it did not answer so well in other recent Cases, but often made the
Patient sick.
In military Hospitals, Fluxes are liable to be complicated with other
Disorders, as well as with the malignant Fever; especially with
Coughs, and pleuritic and peripneumonic Symptoms, when the Weather
begins to be cold, in _October_ and _November_.--In such Cases, when
the Patients were strong, we were often obliged to bleed freely, to
apply Blisters, and in the Beginning treat the Disorder as
inflammatory; having at the same Time an Eye towards the Flux, in the
other Medicines we prescribed.
Patients, who have had the Flux long, are apt to have their Legs swell
at Nights; or to swell all over as soon as the Flux has stopped. Such
oedematous or anasarcous Swellings, we treated nearly in the same
Manner as those which followed the petechial Fever; only that we durst
not at first be so free with the Use of Purgatives; for as the Bowels
remained weak and easily irritated, such Medicines were apt to bring
back the Flux; and therefore, in the Beginning, we were for the most
part obliged to attempt the Cure by Diuretics and Diaphoretics; and to
be sparing of the Use of Purgatives, especially of those of the
hydragogue Kind; though if the Swellings continued for some Time after
the Flux was gone off, and the Patients were strong, we then ventured
to give Purges at proper Intervals:--And Blisters and Scarifications
removed them in several Instances both at _Paderborn_ and
_Osnabruck_.
In _December_, 1761, we had a Case of this Kind where the _oxymel
scilliticum_ was of remarkable Service. A Soldier, belonging to the
Guards, after a Flux, swelled all over, and made but a very small
Quantity of Water. He took Medicines of different Sorts for some
Weeks, but received no Benefit till we gave him the Oxymel Mixture;
after taking a few Doses he made Water very freely, and in large
Quantities, and the Swellings of his Body and Scrotum began
immediately to subside; and by continuing its Use for a Fortnight, the
Swellings entirely disappeared, and he recovered his Health and
Strength.--The Oxymel, at the same Time that it promoted a Flow of
Urine, kept his Body gently open, but did not occasion any Return of
the Flux.
At the Beginning of _January_, 1762, one _Carter_, a Soldier of the
Eleventh Regiment of Foot, laboured under an universal Anasarca; which
about two Months before had succeeded a Flux. He made but very little
Water, and that of a high red Colour. He took Variety of Medicines,
as Purges, Vomits, _Dover_'s Powder, lixivial and neutral Salts with
Opiates, Infusions of Horse-Radish, all without Effect; till he was
ordered small Doses of Calomel, three Grains Morning and Evening.
After the third Dose he began to make Water freely; and by the 24th of
_January_ the Swellings were all gone, and he was shipped off for
_England_ the 8th of _February_; having been discharged from his
Regiment. The Ship, he went aboard of, was detained in the River
_Weser_ for above six Weeks, and the malignant Fever broke out aboard
the Transport: He took the Distemper, and got well of it; but towards
the Decline was seized with a Return of the Flux, which carried him
off.
When these oedematous Swellings came after the Purging was stopt, if
the Patient's Strength was not much exhausted, and he laboured under
no other Disorder, he commonly got the better of it:--But when the
Strength was gone before the Swellings appeared, the Disorder often
ended in a confirmed Dropsy, and at last in Death; and when the
Swellings were universal over the Body, while the Flux yet continued,
it was a Sign of great Weakness, and they did not survive it long[45].
[45] Many other Medicines have been used for the Cure of old
Dysenteries,--The _Conessi Bark_, recommended as a Specific
in Diarrhoeas, cured a Dysentery which had yielded nothing to
a Variety of Medicines. _Edinburgh Medical Essays_, _Vol._
III. _Art._ iv.--The _cortex eleutheriæ vel cascarillæ_ is
much recommended for the Cure of Dysenteries in the _Memoir.
de L'Academie des Sciences a Paris_ 1719, and is still in
great Repute among the _Germans_.--The Decoction of the
_semiruba_ Bark was found to have a good Effect in the
Dysentery, where the Patient continued to void Blood with his
Stools; and when the Stools were only liquid, without a
Mixture of Blood, some of the Cascarilla added to the
Decoction encreased its Efficacy. See _Degnerus_'s Treatise
_de Dysenteria_, _cap._ iii. _sect._ 55. These and many other
Remedies have been tried in obstinate Dysenteries.
From what I have observed myself, and from the Accounts of
others, I am now convinced, that such Cases as are not
already too far gone, are most likely to be cured,
1. By keeping the Patients on a low Diet, composed
principally of Milk, Sago, Rice, Salop, and such other Things
as are recommended by Dr. _Pringle_; allowing weak Broths,
and a small Quantity of white Meat, as they recover their
Strength. The common Drink to be Barley or Rice-Water, Toast
and Water, _Bristol_ Water, Almond Emulsion, and such
like.--By making them wear some additional Cloathing, and
guarding carefully against catching cold.--Errors of Diet and
Exposure to Cold being the most frequent Causes of Relapses
into this Disorder.
2. By giving from Time to Time a Dose of some mild Purge;
such as a little Manna and Salts; a Solution of Manna in
Almond Emulsion; twenty or thirty Grains of Rhubarb, in a
saline Draught, or such like; and occasionally gentle
Emetics.
3. By the Use of some of the mild Astringents and
Corroborants.--The Bark, with Astringents and Opiates,
agreeing best with some--Decoctions of the Semiruba with
others--Chalk in Electuaries, or Juleps, with others--anodyne
and astringent Clysters with others--while others receive
more Benefit from other Remedies--and severals find
themselves better when they use no Medicines of this Kind.
4. And by the occasional Use of Opiates, and a free Air: And
by moderate Exercise on Horseback, or in a Machine in the
convalescent State.
I ought not to omit mentioning, that I have seen some Cases
where Evacuations had been used in the Beginning, which,
after they had continued for some Time, were cured by a
regular Diet of Broths, and white Meats; riding daily on
Horseback; and drinking a generous good Claret Wine. However,
it ought to be remarked, that this Method only succeeded
where the Disorder was mild, and its Violence had abated by
previous Evacuations.
OF THE CHOLERA MORBUS.
The Cholera Morbus, or a sudden and violent Vomiting and Purging, was
very frequent in _July_ and _August_ 1701; and several were attacked
with it at _Munster_.--It was attended with great Sickness, with Pain,
and Inflation of the Abdomen, Thirst, and a small quick Pulse: Some
had it in a pretty violent Degree, but in general it was mild; and
although the Sickness, Vomiting, and Purging, continued, in one or two
Cases, for above a Day; yet none of those died whom I saw.
This Disorder weakens the Patient much, in a short Space of Time; and
sometimes, when violent, kills in less than twenty-four Hours. It is
always most frequent in Summer and the Beginning of Autumn; and is
taken Notice of by _Hippocrates_, _Aretæus_, _Celsus_, and other
antient Authors; and is very accurately described by many of them.--It
is of the bilious Kind; and the Cure principally depends upon the free
Use of warm mild Liquors in the Beginning; to dilute and blunt the
Acrimony of the Bile, and other Fluids, and to promote their
Discharge; and afterwards of gentle Cordials to support the Strength;
and warm Fomentations to allay the Pain when violent; and mild Opiates
to procure Rest; and if the Sickness or Griping remains next Day after
the Cholera is stopt, to give a Dose of Physic and an Opiate in the
Evening.
An Officer, who had been wounded on the 15th of _July_, at the Battle
of _Fillinghausen_, began afterwards to live very freely, and was on
the 4th of _August_ seized in the Night with the Cholera.--About ten
o'Clock next Day I was sent for; and found him in violent Agony, with
sharp Pain in the Bowels, Reachings, and Strainings to Vomit, and
Spasms and Cramps in the Bowels, Legs, and Arms.--He had large red
Blotches on his Extremities, and no Pulse was to be felt at the Wrist,
and rather a Fluttering than a Beating at the Heart.--He had vomited
and purged much in the Night before I saw him, but the Purging had
begun to abate.--I immediately ordered him an emollient Clyster, and a
saline Draught, with the _confectio cardiaca_, and five Drops of
liquid Laudanum; which, if he vomited up, was to be repeated soon
after; if not, only once in four Hours: And he was directed to drink
freely of weak Chicken Broth, warm.--Two Hours afterwards we found him
in the same Situation; still no Pulse to be felt, which prevented us
from bleeding him; and the violent Pain of the Stomach and Bowels, and
the Cramps, continued. We then ordered Flannels, dipped in a warm
emollient Decoction, to be kept constantly applied to his Belly,
dipping them in the warm Decoction as soon as they began to grow cool;
his Clyster to be repeated with the Addition of a Drachm of the
_electuarium e baccis lauri_, and Half a Drachm of the _tinctura
thebaica_; a Scruple of Castor, and Half a Drachm of Spirit of
Lavender, to be added to each of his Draughts; and a Blister to be
prepared, in case these Medicines gave no Relief.--Soon after,
beginning to use the Fomentations, the Cramps and Pains began to
abate; about four o'Clock in the Afternoon we could perceive a
Fluttering of the Pulse at the Wrist, and all the Pains and Cramps
were much easier; so that there was no occasion for the Blister.--Next
Morning he was very easy, but low, and inclined to be sick; for which
his Cordial Draughts were repeated every six Hours.--The third Day, as
he complained of a little Griping in the Bowels, we ordered him a Dose
of Tincture of Rhubarb, and an Opiate in the Evening, which entirely
removed these Complaints, and he was abroad and well next Day.
One Soldier, who had a good deal of Fever, and complained of acute
Pain in the Bowels, along with the Vomiting and Purging, was blooded;
and drank freely of warm Barley-Water while the Vomiting
continued.--After throwing up a Quantity of green bilious Matter, the
Vomiting ceased; and the Gripes and Purging became less violent.--In
an Hour after, being able to retain some very weak Broth in his
Stomach, he drank plentifully of it through the Day; and the Purging
being abated towards Night, he took an anodyne Draught; and next Day,
having still a little Sickness remaining, had a Dose of Physic and an
Opiate at Night, which removed all his Complaints.
The Rest, who were attacked with the Cholera at _Munster_, were
treated much in the same Way; only as they had not such acute Pain and
Fever as this Man, it was thought unnecessary to bleed them.
The Antients[46] recommended drinking freely of warm Water in the
Beginning, and the Use of both cold and hot Fomentations of the
Stomach and Belly;--and in the low State, the Use of Wine, mixed with
Water, and Polenta[47]; and to apply Rue, with Vinegar, and other
strong smelling Things, to the Nostrils; besides Variety of other
Remedies.--When Convulsions happen, _Celsus_[48] advises to anoint the
Belly with warm Oil; and if that does not remove them, to apply
Cupping-Glasses or Mustard to the Stomach; and, after sleeping, to
abstain the second Day from Drink; and the third, to go into the Bath;
and if any thing of a Fever remains after the Cholera is suppressed,
to give a Purge.
[46] See _Aretæus_, Lib. ii. Cap. 4. and _Celsus_, Lib. iv.
Cap. 11.
[47] The Polenta seems to have been nothing but toasted
Barley Meal. See _Plinii Hist. Natural._ Lib. xxii. Cap. 25.
[48] _Celsus loco citato._
Dr. _Sydenham_[49] trusts principally to drinking freely of Chicken
Broth, and throwing up Clysters of the same, and afterwards giving
Opiates.
[49] _Processus integ. de Cholera._
Dr. _Ayton Douglas_, in the sixth Volume of the _Edinburgh_ Medical
Essays[50], recommends a Decoction of Oat Bread, baked without Leaven
or Yest, and carefully toasted as brown as Coffee, but not burnt; as a
Remedy very grateful to the Stomach, and useful in stopping the
Vomiting, and sometimes the Purging too: And he relates several Cases
where it had a good Effect. After the Vomiting was stopped, he added
the Use of mild Opiates; and, where the Patient was low, Wine and
other Cordials.
[50] Art. 65.
OF THE INFLAMMATORY FEVER.
On the Return of the Troops from the Winter Expedition into the
Country of _Hesse_, in the Year 1761, we had several Men seized with
Inflammatory Fevers without any topical Inflammation; and at the
Opening of each Campaign had always Numbers sent to the Hospitals ill
of this Disorder. Towards the End of the Campaigns, and throughout the
Winter, many were seized with Inflammatory Fevers; but these were
mostly complicated, with pleuritic, or peripneumonic Symptoms, or
other topical Inflammations, or with rheumatic Complaints.
In the Inflammatory Fever, the Sick were seized at first with cold and
hot Fits, succeeded by Pain in the Head and all over the Body. The
Pulse was strong and quick, and the Blood sizy; attended with other
Appearances commonly observed in such Fevers.
As the Summer advanced, this Fever was often accompanied with bilious
Symptoms, with Sickness, and vomiting of bilious Matter, and very
frequently with a Purging: Towards the End of Summer it ceased, and
was succeeded by the bilious remittent Fever.--And it was no uncommon
Thing to see those Fevers, which originally were entirely of an
inflammatory Nature, after the sick had been some Days in a crowded
Hospital, partake a good deal of the Nature of the Malignant Fever, or
be changed entirely into it.
We treated these Fevers in the common antiphlogistic Method.--We
blooded freely in the Beginning; gave the saline Draughts with Nitre
and other cooling Medicines; and made the Patients drink plentifully
of small Liquors:--And when they were inclined to be costive, gave
mild Purges, or emollient laxative Clysters. We afterwards applied
Blisters; and if the Pulse began to sink, gave Cordials, Wine, and
other Remedies commonly employed in such Cases;--and towards the
Decline of the Fever endeavoured to promote such Evacuations as were
pointed out by Nature, and likely to prove critical.
When the Case was complicated with bilious Symptoms in the Beginning,
we were obliged to have particular Regard to the first Passages. If
the Patient complained much of Sickness, we gave a gentle Vomit in the
Evening, after bleeding; and a Purge next Day, to carry off any
bilious or corrupted Humours that might be lodged in the Stomach or
Intestines; and we found that these Evacuations gave Relief, and
generally mitigated all the Symptoms.
If at any Time during the Fever a Looseness came on, especially when
attended with Gripes, we gave a Dose of some gentle Physic, which made
a free Evacuation; and an Opiate in the Evening after its Operation;
and afterwards we found it answer better to attempt rather to
moderate, than wholly stop the Purging by strong Astringents, and
Opiates; unless where the Evacuation by Stool was so great as to be in
Danger of sinking the Patient.
The _pulvis antimonialis_, composed of ten Parts of the _pulvis e
chelis_, and one Part of the Tartar emetic, given in small Doses, was
serviceable in many of these Fevers, after free Evacuations had been
made.
Two Patients, one a Soldier of the Twentieth Regiment, the other a
_German_ Waggoner, were taken ill of this Fever about the 25th of
_December_, 1762: They were both blooded freely, and had a Dose of
Physic in the Beginning; and the saline Draughts with Nitre and other
cooling Remedies; and had Blisters applied without producing any
considerable Change in their Disorder.--On the 5th of _January_, 1763,
they both complained much of Thirst, and were inclined to be costive;
their Tongues were parched, their Pulses quick and small, and their
Skins dry; they were restless at Nights, and the Soldier had a slight
Delirium.--I ordered each of them four Grains of the _pulvis
antimonialis_ every four Hours.
6th. Next Day the Soldier told me, he had had four loose Stools; his
Senses were much clearer, the Pulse calmer and slower, and he said he
found himself lighter and easier, and less feverish, than he had been
since he was first taken ill. The Medicine was continued, with the
Addition of an anodyne Draught at Night.--7th. I found him in a fine
breathing Sweat, and he told me he had slept well in the Night:
p.--8th. The Sweat continued till this Morning, and on going off his
Urine let fall a copious white Sediment, and left him free from the
Fever; after which he mended daily.
The Waggoner, after taking the third Dose of the Powders, had a warm
Moisture upon the Skin.--On the 6th was cooler and without much Fever,
and had had one Stool.--7th. The warm Moisture ended in a profuse
Sweat, which carried off the Fever, and he continued to recover
daily.
OF THE ANGINA; OR, SORE THROAT.
Many of the Soldiers during the Campaign were seized with
Inflammations of the Throat, especially when the Nights were cold and
moist after warm Days; and when they did Duty in cold wet Nights in
the Winter Season.--All of them I saw in _Germany_ were of the
inflammatory Kind; I did not observe any that were malignant.
They were treated in the antiphlogistic Method.--The Patients were
blooded liberally in the Beginning--took the cooling nitrous and
saline Medicines--gentle Diaphoretics and Purgatives--and used
frequent Gargarisms.
Sometimes a Flannel rubbed with camphorated Oil, or the _linimentum
volatile_, and applied round the Neck, was of Service.--And frequently
after bleeding sufficiently, where the Breathing or Swallowing was
difficult, the Application of a large Blister to the Neck gave speedy
Relief.
OF THE PLEURISY.
The Pleurisy, or an acute Inflammation of the Side, was most frequent
among the Soldiers towards the latter End of the Campaigns; though
some were attacked with it at all Times of the Year, from doing Duty
in all Sorts of Weather.
We followed the antiphlogistic Method of Cure; and ordered plentiful
Bleeding in the Beginning, till the Violence of the Pain began to
abate, or the Patient grew faint;--and the Side to be fomented with
Flannels dipped in warm emollient Decoctions, and afterwards rubbed
with volatile Liniments: At the same Time the Patient drank freely of
warm diluting Liquors, as Barley Water, the pectoral Decoction, and
such like; and took the saline and other cooling Medicines, mixed
occasionally with Sperma Ceti, or some other soft Pectorals, if there
was a tickling Cough.--When the Patient was costive, we gave a Dose of
Salts, or some other mild Physic, or laxative Clysters.
If the Pain continued very acute, we repeated the Bleeding as often as
Necessity seemed to require, and the Pulse could bear; and immediately
after the second Bleeding ordered a large Blister to be applied to the
Part affected.
Physicians formerly used to forbid Bleeding after the fourth Day, if
it had been omitted so long; but when no Symptoms of Suppuration had
already appeared, on whatever Day of the Disorder it happened, I
ordered plentiful Bleeding, the same as in recent Cases; and never
found any Disadvantage, but often great Service from this Practice.
When the Sharpness of the Pain was gone, and the Pulse became soft,
very often a dull Pain remained for some Time in the Part.--In some
Cases a brisk Purge removed it;--in others, cupping above the Part,
and afterwards rubbing it with the volatile Liniments, did
Service;--in others, gentle Opiates at Night, especially where there
was a tickling Cough;--and in one or two Cases, this Pain did not go
away, till the Patient was ordered to drink every Day for some Time, a
Quart of the Decoction of Sarsaparilla with the antimonial Wine.
In the Course of this Disorder, if a kindly Moisture broke out on the
Skin, which gave Relief, this was encouraged by the Use of mild warm
Liquors; or if the Patient began to spit up a viscid or yellowish
Mucus, we endeavoured to keep up the Expectoration by the Use of mild
Pectorals; and if a Purging came on, we were careful not to check it
too soon, unless it was so violent as to be in Danger of sinking the
Patient.
When an Inflammation of the Side came to Suppuration, which happened
in one or two Cases at _Osnabruck_, in _May_ 1761; as soon as a
Fluctuation of Matter was to be felt, an Incision was was made in the
Part, and the Matter discharged; after which the Sore healed kindly,
and the Patients recovered[51]. I am persuaded, was this Operation
oftener performed, many would recover who die consumptive.
[51] Dr. _Mead_ advises, where the Lungs and Pleura grow
together, and an Abscess forms, to open it with Caustic; and
afterwards to keep the Ulcer open during the Patient's Life:
For he says, he has often seen, where such Sores were healed
up, that the Patient died soon after by an Efflux of Matter
upon the Breast. _Monita Medica_, Cap. i. Sect. 7.
OF THE PERIPNEUMONY.
The Soldiers were subject at all Times to the Peripneumony, or
Inflammation of the Lungs, from doing Duty in cold wet Weather, and
from their irregular Way of living; but more particularly towards the
End of the Campaigns, and in Winter.
This Disorder was much more dangerous and fatal than the Pleurisy,
especially when neglected in the Beginning; for then Bleeding had
seldom any Effect; the Difficulty of Breathing encreased, the Patient
was seized with an Orthopnea, and such an Anxiety and Sense of
Suffocation, that he could not sleep; and the Pulse sunk; and in these
Cases Death only afforded Relief. This we experienced in many Men who
had lain neglected in Quarters, for two, three, four, or five Days,
before they were brought to the Hospital.
In most of the Bodies of those who died of this Disorder, and were
opened after Death; we found the Lungs violently inflamed, with livid
or gangrenous Spots on their Surface; and more or less of a watery
Serum extravasated into the Cavity of the Chest.
Three had Suppurations in the Lungs. In one, who had lain sick in
Quarters for ten Days or upwards, before he was sent to the Hospital,
the right Cavity of the Thorax was found full of a watery Serum; and
the Lobes of the Lungs on the same Side almost entirely wasted; and
what remained seemed as it were composed of thickened Membranes,
resembling those formed by the coagulable Lymph, or what is called by
some (though improperly) the fibrous Part of the Blood. The Lobes in
the left Side seemed to be in a sound State, or at most but slightly
inflamed. From the right Lobes of the Lungs being so much wasted, I
suspected that the Patient had probably laboured long under some
Disorder of the Breast; but I could not from Enquiry obtain any
Information in this Particular; nor did he ever mention such a Thing
during the few Days he lived after being brought into the Hospital; he
said, he had only been ill for eight or ten Days before; but Soldiers
afflicted with chronic Distempers, when they are seized with violent
Symptoms, or acute Diseases, are apt to reckon the Beginning of their
Disorder, only from the Time they are taken ill in a violent Manner;
and never to take any Notice of their former Complaints.
Another Soldier, about the Middle of _February_, 1762, remained in
Quarters five Days after being taken ill with a Pain of the Breast,
and a Difficulty of Breathing; the sixth Day he was brought to the
Hospital in the Morning, and I saw him about eleven o'Clock; he then
had all the Symptoms of the true Peripneumony, attended with a strong
hard Pulse. He was immediately blooded as freely as his Pulse would
bear, had Blisters applied, and other Remedies used; notwithstanding
which, on the eighth Day from that Time, he began to throw up a
purulent Matter in great Quantity, attended with a constant hectic
Heat, and Fever; which sunk him so fast, that he died the tenth Day,
after he first began to expectorate.
On the 2d of _March_, a Soldier, of the Fifty-first Regiment of Foot,
was brought to the Hospital, with a violent Pain in the left Side, and
a great Difficulty of Breathing. Upon examining him, he told me, that
about two Years before he had had a violent Stitch in his left Side,
towards the lower Part of the Thorax; that ever since he had been
subject to a Difficulty of Breathing; and at Times to a Pain in the
Side; but that he had only been seized with the violent Pain and
Difficulty of Breathing he then complained of, about five Days before,
occasioned by catching Cold, on being billeted in a low, cold, and
damp House.--His Pulse was quick, the Pain of his Side and Difficulty
of Breathing so great, that he could not sleep, nor lie down, but was
obliged to sit constantly in an erect Posture; his Tongue was white
and furred, and he had had no Stools for three Days: He was ordered to
be blooded immediately; and to take a Dose of Salts; and his Side to
be rubbed with the _linimentum volatile_. 3d. His Breathing and Pain
of the Side were easier; he had slept a little in the Night, and could
lie on his right side, but not on his left. He was ordered the Squill
Mixture. 4th. His Breathing was worse; he was blooded a second Time;
had a large Blister applied to his Side, and was ordered to continue
the Use of the Squill Mixture. On the 5th, 6th, and 7th, he seemed
easier, though the Breathing was still much affected, and his Pulse
quick and low, attended with a hectic Heat. On the 8th, he told me
that his left Side was swelled: On examining, I observed a Fullness in
that Side of the Thorax; and on pressing with my Fingers between the
Ribs, I thought I felt an obscure Fluctuation of a deep-seated Fluid.
From these Appearances, and the History of the Case, I judged that
there was a Collection of some Fluid within the Cavity of the Chest;
and that the only Means left to give Relief, was to make an Opening
into the Cavity, and so evacuate the Fluid. I therefore proposed to
him the Operation of the Empyema, to be performed immediately; which
he several Times obstinately refused to submit to: He allowed a Seton
to be put in his Side, but that did not answer the End proposed: He
languished six Days longer; and died the 14th of _March_. Next Day an
Opening was made in the Thorax, in the Part where the Operation was
proposed to have been performed; as soon as the Pleura was cut
through, some Quarts of Water rushed out. We then opened the Thorax,
and found still some Water in the left Cavity. The Pericardium was
thickened, and slightly inflamed, and adhered to the Diaphragm; which
was likewise a little thickened and inflamed in the adhering Part; the
Lungs on that Side were much compressed, and contracted by the
Pressure of the Water; but on being inflated and cut, seemed in a
sound State, except that they were slightly inflamed. The Lungs of
the left Side adhered every-where firmly to the Thorax, but seemed
otherwise sound; having no Tubercles, Suppuration, or other Disorder,
that we could observe in cutting them. The Heart and Blood Vessels
were sound, and no other polypous Concretions were observed within
their Cavities, but such as we find in most dead Bodies; which seem to
be formed of the coagulable Lymph in _articulo mortis_. The Viscera of
the Abdomen were in a sound State.
We treated the Peripneumony nearly as the Pleurisy. We bled freely in
the Beginning, till the Breathing became easier, or the Pulse began to
sink; taking Care not to be deceived by a low oppressive Pulse, which
generally rose upon Bleeding. We applied large Blisters; gave the mild
Pectorals freely, and plenty of warm diluting Liquors, Barley Water,
the pectoral Decoction, and such like; which afforded more Relief than
any other Medicines. We gave too saline Purges, and laxative Clysters
occasionally; and in some Cases ordered the Steams of warm emollient
Decoctions with Vinegar to be drawn into the Lungs.
By this Treatment most of them, who applied early for Relief, got the
better of the Disorder.
When the Expectoration began, the Patient continued the free Use of
the mild Pectorals, and diluting Liquors; and no Medicines were given
that might in the least tend to stop it; other Evacuations were
omitted, unless where the Pain of the Breast, or the Difficulty of
Breathing increased; in which Case, if the Pulse kept up, I ordered a
Vein to be opened, and a suitable Quantity of Blood to be taken away;
no other Remedy affording any Relief, till this Evacuation was made.
Where the Patient was costive, we frequently ordered laxative
Clysters, or a mild Purge, and found them beneficial: But where no
such Symptoms occurred, it was best, for the most part, to omit all
Evacuations of this Kind, after a free Expectoration had begun, and to
trust to it for carrying off the Disorder.
In some Cases, where the Expectoration stopt suddenly after bleeding,
we gave with Advantage a gentle Vomit, as recommended by Dr.
_Huxham_[52].
[52] Some late Authors seem to look upon the _Pleurisy_ and
_Peripneumony_ as the same Disorder: However, though it be
true, that when the _Pleura_ is inflamed, the Surface of the
contiguous Lungs is generally in the same State; and that,
when the _Lungs_ are inflamed, the Pleura is often affected;
yet as I have frequently seen the true Peripneumony without
that sharp Pain of the Side which characterizes the Pleurisy;
and upon opening the Bodies of People who have died of the
Peripneumony, have found the Lungs violently inflamed and
livid, and so filled with Blood as to sink in Water, without
the Pleura being much diseased; and upon opening the Thorax
of others who died of the Pleurisy, have found the
intercostal Muscles and Pleura violently inflamed with livid
Spots, and only a small Portion of the Surface of the
contiguous Lungs affected; I cannot help still looking upon
them as distinct Disorders; though they require nearly the
same Treatment, and are often complicated together.
OF THE COUGH and CONSUMPTION.
Coughs were very frequent during the Winter, and when the Weather was
wet and cold. They were often accompanied with Pains of the Breast;
and, when neglected, Obstructions, Tubercles, and Suppurations, were
apt to form in the Lungs, and the Disease to end in a Consumption, or
_Phthisis Pulmonalis_.
When Coughs were slight, guarding against further Cold, and the Use of
mild Pectorals and warm Drinks, removed them. But when the Patient
complained of a Pain and Tightness about the Breast, it was always
necessary to take away more or less Blood; and after Bleeding to give
some of the mild Pectorals, such as the Sperma Ceti or oily Mixtures;
and, if a Fever attended, to join the Use of Nitre, or of the saline
or mindereri Draughts; and, if a tickling Cough was troublesome, to
give frequently a Tea Spoonful of the oily Linctus, acidulated either
with the Spirit of Vitriol, or the _oxymel scilliticum_. The mild
Diaphoretics, such as the mindereri Draughts, given along with warm
Drinks, to promote a free Perspiration, or Sweat, were used with
Advantage; when the Patients kept in Bed, and lay in Wards which had
Stoves in them.
If the Cough and Pain of the Breast were not relieved by these Means,
the Patient was bled a second Time, and a Blister applied to the Side
immediately after; which often removed most of the Complaints. When it
did not, we gave the pectoral Decoction for common Drink; and if there
was a Shortness or Difficulty of Breathing, the squill Mixture, or
_lac ammoniacum_, with Oxymel; and occasionally gentle Purges: And if
at any Time of the Disorder the Tightness and Pain of the Breast
returned violent, we took away some Blood, no other Remedy affording
Relief.
When there was little or no Fever, and a thin Rheum kept up a tickling
Cough, nothing had a better Effect than to add some Drops of the
_tinctura thebaica_, or some of the _elixir paregoricum_, to the
oleagenous or squill Mixtures; or to give an Opiate Draught or Pill at
Bed-Time, which eased the Cough, and procured the Patient Rest.
At all Times it was necessary, when the Cough was violent, attended
with Pains of the Breast, to keep the Patients on low Diet; and in as
free and pure Air as the Nature of the Hospitals would admit of; for
we often found that those Men who had laboured long under obstinate
Coughs, which threatened Consumptions in small crowded Wards,
recovered surprisingly on being removed to a freer Air; of which we
had a remarkable Instance in the Hospital at _Bremen_, in _January_
1762; upon removing some Men, afflicted with very bad Coughs, out of
small Wards, which were damp, into one large one, which was dry and
airy.
When the Weather was good, we made the Patients walk out a little in
the Day-Time; for we observed, that remaining always in the Hospital,
and breathing nothing but a foul Air, helped to encrease the
Disorder.--When we knew the Men to be sober, and not apt to commit
Irregularities, we used to procure them good Billets, and make them
come daily to the Hospital for their Medicines.
Equal Parts of Lime-Water and Milk, drank to the Quantity of a Quart a
Day, was of Use to some; and the _infusum amarum_, and other gentle
Bitters, taken to the Quantity of an Ounce or two, Morning and
Evening, to others[53].
[53] Asses Milk, and _Bristol_ and _Seltzer_ Waters, which
are found so serviceable in pulmonic Disorders, could not be
had in the military Hospitals; and riding on Horseback was
too expensive a Remedy for a Soldier.
In chronic Cases, where we suspect Obstructions and Tubercles
to be formed in the Lungs, which have not already come to
Suppuration, Dr. _Russel_ recommends the Use of Sea Water for
resolving them; but we were at too great a Distance from the
Sea to try this Remedy. See his _Treatise on Sea Water_, Page
17.
A Decoction of the Cortex removed some Coughs which had continued for
a considerable Time. In one or two of these Cases, slight hectic
Symptoms had already appeared[54]. However, for the most part,
where-ever Obstructions of the Lungs were confirmed, or there were
evident hectic Symptoms without a free Discharge of purulent Matter,
the Bark did no Service; but rather heated and increased the Fever,
and made the Sick more restless and uneasy.--It was of most Use where
there seemed to be no confirmed Obstructions, but the Vessels much
relaxed; which we judged to be the Case from the Patients having no
fixed Pain, nor the Breathing much affected. If the Sick were
plethoric, or in the least feverish, we ordered a little Blood to be
taken away, before we began the Use of this Medicine.
[54] _Mary Shepperd_, a Woman twenty-six Years of Age, was
admitted into _St. George_'s Hospital the 6th of _June_,
1759, for a Cough; attended with a constant hectic Fever and
Night Sweats, which had begun in the Month of _April_, after
the Measles. She complained likewise of having the _fluor
albus_, and she had been blooded more than once before she
came to the Hospital.--I at first gave her some of the mild
Pectorals; and a Solution of White Vitriol in Water, _utenda
pro inject. uterina_. After a Week, finding no Alteration in
her Complaints, I advised her to become an Out-patient; and
to go down to her Friends in the Country, to live upon a Milk
Diet; to take gentle Exercise, and continue the Use of her
Medicines; which she did, but without any Alteration in her
Disorder, till the 6th of _July_, when I ordered her to take
thrice a Day two Ounces of the Decoction of the Cortex, along
with a saline Draught. Immediately, on beginning to use this
Medicine, her Disorder began to take a favourable Turn; her
Fever and Night Sweats left her, her Cough became easier, and
she recovered Health and Strength daily. She came to the
Hospital the 15th of _August_, seemingly in good Health, to
return Thanks for her Cure.
In similar Cases, I have sometimes observed good Effects from the Use
of the Balsam _Copaivy_, or _Peru_; given either in Juleps or made up
into an Electuary, as in the _electuarium e spermate ceti cum
balsamo_; but in whatever Form they were given, if there were
confirmed Obstructions of the Lungs, they rather heated and inflamed,
than did any real Service.
When Coughs continued long, attended with Pain in the Side, Difficulty
of Breathing, and Hectic Fever and Night Sweats, we always had Reason
to suspect, that the Disorder would terminate in a confirmed
Consumption. When this was threatened, we found, that the principal
Thing to be done, was to keep the Patients cool; and to endeavour to
allay the hectic Heat and Fever; and to retard, as much as possible,
the Progress of the Disorder. When the Case was recent, we were
sometimes so lucky as to make a Cure; but after it was confirmed, it
for the most part ended fatally.
We kept the Patients upon a low Diet; and where-ever Milk was to be
got easily, we allowed them a Pint a Day[55]; which was either mixed
with Water and given for Drink, or they took it to Breakfast or
Supper.--Their common Drink was either Barley Water or the pectoral
Decoction; which was occasionally acidulated with a few Drops of
Spirit of Vitriol; and we gave at the same Time the cooling
Medicines, such as Nitre, the saline or mindereri Draughts, mixed at
Times with Sperma Ceti, or some other of the mild Pectorals.
[55] In private Practice, at this Stage of the Disorder, the
Use of Asses Milk, and drinking the _Bristol_ Water at the
_Bristol_ Wells, and riding on Horseback daily, are justly
ranked amongst the most efficacious Remedies; and going into
the more southern Climates, as the South of _France_,
_Portugal_, or _Italy_, where the Air is warmer, more
constant, and dry, than in _England_, has often been found to
produce good Effects.
The opening a Vein, and taking away from four to eight Ounces of
Blood[56], whenever the Pain of the Breast was troublesome, or the
Patient was hot and restless at Nights from the Hectic Fever, gave the
greatest Relief of any Thing we tried; and these repeated small
Bleedings were so far from wasting the Patient's Strength, that they
rather seemed to prevent its being exhausted so fast as otherwise it
would have been, by allaying the Force of the Hectic Fever.
[56] This Practice has been strongly recommended by Dr.
_Mead_, in his _Monita Medica_, Sect. x. and by an anonymous
Author in the _Edinburgh Medical Essays_, Vol. IV. Art. 28.
and Dr. _Mead_ says, when Things have not been quite
desperate, he has seen good Success from it.
At this Stage of the Disorder, we put in Setons, or ordered Issues, to
serve as a Drain to carry off the Matter, and found them of Advantage
in some Cases. When the Patients complained of any fixed Pain, we
always made the Issues as near the Part affected as possible[57]. On
the 5th of _May_, 1762, a Man, belonging to the Eighty-eighth Regiment
of Foot, was sent to the Hospital at _Bremen_ for an Hæmoptoe,
attended with a constant hectic Heat and Fever.--After being blooded,
and using the cooling Remedies without Success, he had four Pea Issues
made in his Back; and had a slight Decoction of the Cortex, acidulated
with Spirit of Vitriol. As soon as the Issues began to discharge
freely, the hectic Heat, Fever, and Spitting of Blood, diminished
daily; and he recovered his Health and Strength in a short Time.
However, it ought to be observed, that although these Drains are
sometimes efficacious, yet, when the Disease is far advanced, the
Mischief is generally too deep rooted for them to be of any Service.
[57] In _June_, 1748, a Servant Girl came to ask my Advice
for a Cough, attended with a constant Hectic Fever and Night
Sweats, which had begun some Months before, on catching Cold.
The Matter she spit up was yellow, and had the Appearance of
Pus; and she complained of a Pain in the left Side of the
Thorax. I ordered her the saline Mixture with Sperma Ceti to
be taken thrice a Day, to lose a little Blood, to drink an
Infusion of Linseed sweetened with Honey, and to have a Seton
put in her Side at the Part where she complained of Pain;
advising her to go home to her Father, who was a Farmer in
the Country, and to live upon a Milk and Vegetable Diet, and
ride on Horseback whenever she could conveniently. She seemed
so far gone in a Consumption, that I scarce expected to see
her again; but, in the Month of _December_, she came to
return me Thanks for her Cure, seeming then to be in good
Health. She told me, that, as soon as the Seton began to
discharge freely, she found Relief; and mended afterwards
daily, by following the Directions I had given her.
The Bark, and natural Balsams, for the most part were prejudicial, and
encreased the Hectic Heat and Fever; except in one or two Cases, where
the Disorder seemed to depend on a Vomica of the Lungs, and the
Patient coughed up the Matter freely.--In one Case they were of
considerable Service; the Patient was very low, and had the Night
Sweats, but coughed up the Matter freely: On using the Decoction of
the Bark, and the _electuarium e spermate ceti cum balsamo_, the
Matter expectorated became thicker, and of a more balmy Consistence,
without any Increase of Heat or Fever; after which the Symptoms became
gradually milder, and the Patient recovered.
In the Course of this Disorder the Patients often became very hot and
restless, and were troubled with Gripes, succeeded by a Purging: These
Symptoms were most readily removed by a Dose of Rhubarb, or of some
other mild Purge; for they generally proceeded from corrupted Humours
lodged in the Intestines. In the Evening, after the Operation of the
Purge, we gave an Opiate to procure the Patient Rest.--When the first
Dose of Physic did not stop the Purging, we repeated the Opiates at
Nights, and in a Day or two gave another Purge; and if there was much
Sickness, or Load at the Stomach, gave likewise a gentle Emetic.
If the Purging still continued, we were obliged to join the Use of
Astringents along with the Opiates. In some Cases, I found good
Effects from equal Parts of Milk and Water boiled with Rose Leaves,
Pomegranate Bark, Balaustine Flowers, and Cinnamon, as recommended by
Dr. _Mead_ in his _Monita Medica_[58]; it served both for Food and
Medicine.--When Opiates and Astringents were given to stop the Purging
at its first Appearance, before the Bowels were emptied, they always
did Mischief; and increased the Heat and Fever: And although they
stopt the Purging for a few Hours, it always broke out with greater
Violence afterwards.
[58] _Sect._ x. _de Febrib. lentis sive Hecticis._
When the Sick were attacked with a Shortness and Difficulty of
Breathing, which was not relieved by Evacuations, and the Use of
cooling Medicines, and Pectorals, and Blisters, nothing gave so much
Ease, or had such a good Effect, as a gentle Vomit; for it often
removed the immediate Oppression from the Breast, and helped to pump
up the Matter from the Lungs.
In the advanced State of the Consumption, the Cough was always very
troublesome; and the Sick found no Relief but from Opiate Medicines,
which, in such Cases, cannot be expected to do more than give a little
present Ease.--As they were apt to obstruct the free Expectoration, we
generally mixed them with some _oxymel scilliticum_, or _tinctura
foetida_, which took off a good deal of their suffocating Quality.
Dr. _Barry_[59] advises for the Cure of a Consumption, to make an
Incision or Aperture into the Side; where-ever there is a fixed Pain
attended with a Weight, a Hectic Fever, and other Symptoms of an
evident Suppuration: He says the Pleura is thickened, and the Lungs
adhere at the Part where they are exulcerated; and that by the
Operation the Pus may be evacuated, and a Cure made; and he gives
several Instances of the Success of the Operation, when performed in
Time.
[59] _Treatise on the Digestions_, p. 410.
OF THE Epidemical CATARRHAL FEVER Of APRIL, 1762; CALLED, THE
INFLUENZA.
After a very cold severe Winter at _Bremen_, the Weather, from being
very cold, became of a sudden extremely hot, about the 10th of
_April_. In a few Days after, many People were seized with a violent
Catarrhal Disorder. It often began with such a Cold and Shivering,
that many imagined at first that they were going to have Agues; but
soon after they were attacked with a Cough, and a Difficulty of
Breathing, and Pain of the Breast, with a Head-Ach, and Pains all over
the Body, especially in the Limbs.--The first Nights they commonly had
profuse Sweats.--In several, it had the Appearance of a remitting
Fever, for the two or three first Days.--Many had a slight
Inflammation of the Throat, and a Hoarseness. In all it was attended
with an acute Fever in the Beginning, and the Urine was of a high
Colour; and when the Disorder had put on the Appearance of a Remittent
Fever in the Beginning, it dropt a Sediment towards Morning after the
second Day; and did the same in all, when the Disorder was going
off.--Some had a Purging, but the greater Number were rather inclined
to be costive.--The Cough in many was very violent; and the Patients,
after each Fit of Coughing, had Reachings, or Strainings to vomit,
exactly resembling those which come after violent Fits of the Hooping
Cough.--At first the Patients spit up only a little Phlegm; but in the
Decline of the Disorder, they expectorated freely.--The violent Cough
and Feverishness generally continued for four, five, or six Days;
with others it continued longer; and some had a Cough for two or three
Weeks after the Fever left them.
This Catarrhal Fever seized most of the People of the Town of
_Bremen_; and there were very few of the _British_ who escaped it; at
the same Time, it was epidemical in most Countries in _Europe_.
We treated it entirely as an inflammatory Disorder, and none died who
applied early for Relief.--Most People recovered by one plentiful
Bleeding, and taking the mild cooling Medicines, such as the _mixtura
e spermate ceti cum nitro_, the saline or mindereri Draughts, or such
like. When the Fever and Difficulty of Breathing continued after the
first Bleeding, in a Day or two a Vein was opened a second Time; and
immediately after a Blister was applied to the Back, which commonly
removed the Fever, and relieved the Breathing.--When the Patients were
inclined to be costive, a Dose of Physic was of Service.
None of the _British_ died, except one or two of the Soldiers, who
remained in Quarters after being taken ill; and, instead of bleeding
and living low, indulged in the Use of spirituous Liquors; and were
not brought to the Hospital, till they were in the last Stage of a
Peripneumony.--Many of the Inhabitants of the Town died of this
Disorder, which was probably owing to Want of Care.
OF THE RHEUMATISM.
The Rheumatism is one of the Disorders most generally to be met with
in military Hospitals. There were at all Times some Men in our
Hospitals labouring under Rheumatic Fevers, or other rheumatic
Complaints; though we never had at any one Time a great Number; owing
probably to the Weather being very favourable in both the Campaigns of
1761 and 1762.--It was always most frequent when the Weather was wet
and cold; both during the Campaign, and when we were in Winter
Quarters.
It commonly began either, 1. With an acute Fever, and Pains all over
their Body: or, 2. With Pains in particular Parts, as the Shoulders,
Legs, Arms, Knees, and sometimes of the Side, attended with some
Degree of a Fever.--The first was the most common Form it assumed,
when Men were attacked with it in the Field or in Garrison; owing to
their doing Duty in cold wet Weather.--The other Causes generally took
place when they had been formerly subject to rheumatic Complaints, and
had caught Cold; or after they had been weakened and reduced low by
Fevers, Fluxes, or other Disorders.
We had but very few Rheumatisms accompanied with Swelling, Pain, and
Inflammation of the Joints of the Knees and Wrists, &c. which are so
common in our Hospitals about _London_. I did not meet with above a
Dozen Cases, of this Kind, whilst in _Germany_ with the Army.
When the Rheumatism began with Pains all over the Body, attended with
a High Fever, we treated it at first entirely as an Inflammatory
Fever[60]. We blooded freely, and repeated this Evacuation often[61],
if the Blood continued sizy, and the Pains violent; provided the Pulse
was strong. When the Pleura, the Lungs, or any other of the Viscera
were affected, we blooded as freely as we should have done in acute
Inflammations of these Parts: We gave the saline Draughts with
Nitre[62]; and Plenty of Barley Water and other weak diluting Liquors;
and gentle Physic once or twice a Week; and afterwards applied
Blisters, which often relieved both the Pains and Fever.
[60] _Sydenham_, in treating of this Disease, orders
Bleeding, and that to be repeated next Day; and afterwards
every other Day, two, three, or four Times, or more, as the
Patients Strength can bear it; and on the intermediate Days
to give a purgative Clyster. But in young People, and those
who have lived regularly, he says, that a very low Diet will
cure as effectually as Bleeding and Medicines; That the
Patients must live four Days on Whey alone, but after this
may eat Bread for Dinner; and on the last Days for Supper
also; and when the Symptoms begin to abate, he allows them to
eat boiled Chicken, or other light Food; but says they must
live every third Day on Whey, till their Strength returns.
_Precess. Integr. de Rheumatismo_.
[61] A Remark of Dr. _Huxham_'s deserves to be taken Notice
of here: He tells us, that there are some Kinds of
Rheumatisms, _viz._ those which come from a sharp serous
Rheum, which do not bear the free Use of the Lancet; that
plentiful Bleeding does more Hurt than Good; and that, in
such Cases, the Medicines which bring out breathing Sweats,
and at the same Time correct the Acrimony of the Blood,
joined with gentle Opiates, have a much better Effect. _De
Aere_, Vol. II. p. 185.
[62] Dr. _Brocklesby_, in his _Observations on military
Diseases_, recommends the Use of large Quantities of Nitre
dissolved in Water Gruel, or Sage Tea, (in the Proportion of
two Drachms of the Nitre to a Quart of the Liquor) in acute
Rheumatisms. He says, "I am assured from numberless
Instances, that in stout young Men, by taking six hundred
Grains (ten Drachms) daily, for four or five Days
successively, and diluting plentifully, as before
recommended, plain Nitre proves the most powerful and best
Sudorific, in such Complaints, that I have ever tried; and
this Quantity, and even more, may be retained in the Stomach,
and pass through the Course of the Circulation, by only
diluting properly with those thin attenuating Beverages as
before recommended. Such Quantities, in three or four Days,
seldom failed wonderfully to relieve the Patient, and very
often to cure him entirely, by the most plentiful and profuse
Sweats." _See from p. 116, to p. 124._
I have never hitherto given Nitre in such large Quantities as
here recommended by Dr. _Brocklesby_.
After some Days, if the Pains still remained, we continued the saline
Draughts with Nitre throughout the Day; and in the Evening endeavoured
to promote a free Perspiration by Means of the mild Diaphoretics,
such as the mindereri Draughts with Mithridate, in Doses frequently
repeated; at the same Time, the Patient kept in Bed, and drank freely
of mild diluting Liquors. Sometimes we gave twenty, thirty, or forty
Drops of Spirits of Hartshorn, in repeated Draughts of warm Barley
Water: or a like Quantity of the Antimonial Wine, used in the same
Manner: or from sixty to a hundred Drops of the Antimonial Wine, mixed
with one-fourth Part of the _tinctura thebaica_, in a large Draught of
some warm Liquor; which I have observed, in many Cases, to have a
better Effect, than most other Medicines used for this Purpose; as it
acts both as an Opiate in easing the Pain, and procuring Rest; at the
same Time that it promotes a free Perspiration, or gentle Sweat, to
carry off the Distemper.
But it should be observed, that, in the Beginning of Rheumatic Fevers,
forced Sweats generally did Hurt, and often increased both the Pain
and Fever; and that in general we had greater Success, and made
speedier Cures, when we did not attempt to promote Sweating, till
after other Evacuations had been sufficiently made, and the Fever had
begun to abate; and that in this Fever, when we did attempt to procure
Sweats, the milder Diaphoretics, with Plenty of weak diluting Liquors,
answered better than those of a more heating Nature; though after the
Fever was gone, and the Pains still continued, sometimes the stronger
Sudorifics, such as G. Guaiac, and its volatile Tincture, _Dover_'s
Powder, and the like, best answered the Purpose, and carried off the
Distemper, when the milder ones had little Effect.
I have often observed, where Sweating made no Change in the Distemper,
that keeping up a free Perspiration by Means of the Decoction of the
Sarsaparilla with the Antimonial Wine, or small Doses of the _pulvis
antimonialis_ (_gr._ v.), given twice or thrice a Day, removed
Rheumatisms, which had resisted the Force of other Remedies.
Sometimes the cold Bath[63] removed Pains which had not yielded to
internal Medicines; but it ought to be observed, that when Patients
went into the cold Bath while the Feverishness still remained, and the
Blood continued sizy, or before free Evacuations had been made,
oftentimes, instead of giving Relief, it made the Disorder worse, and
more obstinate[64].
[63] I have frequently ordered the warm Bath with Advantage
in Rheumatic Cases in _St. George_'s Hospital; but we had no
Convenience of this Kind with the flying Hospital in
_Germany_.
[64] This I have seen many Instances of, particularly in the
Case of _Ann Walker_, a Woman of twenty three Years of Age,
who was under my Care in _St. George_'s Hospital, in _May_,
1759. Before she came to the Hospital, she had been blooded,
and had gone into the cold Bath four Times, which, she told
me, had increased her Pains to a violent Degree; in which
State she had continued for some Weeks before she came to the
Hospital; but by being blooded, and taking the cooling saline
Medicines, with gentle Purges, and mild Diaphoretics, she got
well in a Month's Time.
When the Rheumatism was confined to a particular Part, attended with
Fever, we treated it as the acute Rheumatism. Fomenting the Part with
warm emollient Decoctions, and rubbing it afterwards with the
volatile, or saponaceous Liniments, often gave Ease; and the
Application of Cupping-Glasses and Blisters frequently removed the
Disorder. In some Cases, where the first Blister did not relieve, the
Application of a second, and afterwards keeping up a Discharge from
the Part by Means of the Epispastic Ointment, carried off the Pain. In
others, where the mild Diaphoretics were ineffectual, Sweating, with
the G. Guaiac, or _Dover_'s Powder, and such other Medicines, after
the Fever was gone, removed the Complaints[65].
[65] Warm Water, pumped upon the Part, often removes such
rheumatic Pains as have resisted the Force of internal and
other Remedies. On the 29th of _August_, 1759, _Mary Ward_
was admitted into _St. George_'s Hospital for rheumatic Pains
of the Arms, Legs, and Knees, attended with Fever, which all
yielded to Evacuations, and the Use of cooling Medicines,
mild Diaphoretics, and of the warm Bath, except the Pain of
the Knee; which, after it had resisted the Course
above-mentioned, was at last removed by pumping warm Water on
the Part, three Times a Week; joined to the Use of
Fomentations and volatile Liniments.
When the Rheumatism was attended with Inflammation and Swelling of the
Joints, we blooded freely, gave cooling Purges, and the saline
Draughts with Nitre, along with Plenty of weak diluting Liquors, and
prescribed a cool low Diet.
After the Violence of the Fever and Inflammation was abated, fomenting
the Parts, and rubbing them with the saponaceous or volatile
Liniments, sometimes hastened the Discussion of the Swelling; as did
likewise the Application of Blisters[66], after the Inflammation was
entirely gone; but it ought to be noticed, that if volatile Liniments
or Blisters are used too soon, they will sometimes occasion violent
Inflammation and Pain[67].
[66] _Ann Ragen_, a Woman about thirty-three Years of Age,
was admitted into _St. George_'s Hospital the 17th of
_January_, 1759, for rheumatic Pains of her Legs and Arms,
and a Swelling of her right Knee. Free Evacuations, and the
Use of cooling Medicines, and mild Diaphoretics, removed all
her other Complaints, except the Swelling of the Knee, by the
Middle of _February_, when I ordered a Blister to be applied
to it; after which the Swelling gradually decreased, and she
was discharged, cured, the 20th of _March_.--_Rachael Hyde_,
a Woman twenty-four Years of Age, was admitted into _St.
George_'s Hospital the 9th of _May_, 1759, for similar
Complaints, which were removed by the same Means, all except
the Swelling of the Knee. A Blister was applied, and most of
the Swelling went away, but returned soon after: It was at
last removed by the Use of the warm Pump three Times a Week,
and drinking a Pint of the Guaiac Decoction daily.
[67] I have sometimes ordered Leetches to be applied to such
Swellings (as recommended by Dr. _Pringle_), and found them
to be of Service; and, at other Times, I have applied
emollient Fomentations and Poultices, which have given great
Ease to the Patient.--I have seen Setons or Issues, made near
the Part affected, afford considerable Relief.
Rheumatic Cases of this Kind are often very obstinate, and require a
considerable Length of Time before they are got the better of; and
frequently more or less of the Swelling, especially of the Wrists and
Joints of the Fingers, remains ever after; and Patients, who have once
had the Rheumatism in this violent Degree, are always subject to
Relapses; as are even those who have had the Rheumatism but slightly.
Mercury[68] has been recommended in the Cure of Rheumatisms; but I
never found it do any Service by itself, except in Cases complicated
with venereal Symptoms; though I have often given it, and even
sometimes gone so far as to raise a Salivation, where the Pains were
most severe in the Night; and the Patient, at the same Time, thought
he had some Reason to suspect a venereal Taint, though no external
Symptom appeared. However, many good Practitioners have recommended
small Doses of Calomel to be given at Nights, and next Morning a
Purge; in which Way, I think, I have observed good Effects from its
Use.
[68] Dr. _Musgrave_, in his Treatise _de Arthritide
Symptomat._ p. 30, cap. ii. sect. 10, says, he has known a
Salivation, raised by Mercury, cure the Rheumatism.
The Bark was frequently of Use in restoring the Strength, and removing
those rheumatic Pains which remained after Fevers, and other
Disorders; but, in other Cases, it had little Effect.
When the Rheumatism continues long, and has taken deep Root,
_Sydenham_[69] advises to bleed from Time to Time, at some Weeks
Distance; which, he says, will either entirely remove the Disease, or
bring it to that Condition, that the Remains of it will be easily
extirpated by an Issue; and giving some of the volatile Salts in
_Canary_ Wine, Morning and Evening. I have always observed in
rheumatic Cases, which continued long, that, after free Evacuations,
the Patients received more Benefit from a mild low Diet, continued for
some Time, and the Use of diluting Decoctions with mild Diaphoretics,
while they took gentle Purges once or twice a Week, than from any
other Remedies.
[69] Vide _Sydenham. Opera._ sect. vi. cap. 5.
I have given Half an Ounce of Soap a Day, for a considerable Time, in
some old rheumatic Cases, in the Manner recommended by the late Dr.
_John Clerk_ of _Edinburgh_, as mentioned by Dr. _Pringle_; and, I
think, with Advantage; but have not had sufficient Trials to ascertain
the Merits of this Medicine.
Dr. _Sydenham_, in treating of the Rheumatism, which he calls
scorbutic, says; that after it had resisted Bleeding, Purging, low
Diet, and other Remedies, he has cured it by giving thrice a Day two
Drachms of an Electuary made of _conserv. cochlear. horten. recent.
unc._ ij. _lujul. unc._ i. _pulv. ar. comp. drachm_ vi. _cum syrup.
aurant._ q. s. drinking after it three Ounces of a Water drawn from
_Brunswick_ Beer, and some of the antiscorbutic Plants.
There is no Disorder which Soldiers are so apt to counterfeit as the
Rheumatism, when ever the Duty in the Field is severe; but while there
is no Fever or Size in the Blood, or other evident Marks of the
Distemper, and the Men look healthy, there is always Reason to suspect
Imposture.
OF THE Autumnal Remitting Fever.
The Remitting Autumnal Fever, called by the Antients [Greek: synechês],
was also one of the most frequent Disorders during the Campaign.
This Fever is observed in most Countries, after the Juices have been
highly exalted by the Heat of Summer; and People are exposed to the
Heats of Mid-Day, and to the cold Damps of the Night. We observe it
every Year in the Neighbourhood of _London_, especially among the
labouring People, who work in the Fields, towards the End of Summer,
and in Autumn; but it is generally in a milder Degree than in Armies,
where Men are more exposed to the Vicissitudes of the Weather.
As we go further towards the South, this, as well as other bilious
Disorders, becomes more frequent.
This Fever is reckoned the endemic Distemper of the _West Indies_, of
the Coast of _Guinea_, and other Places in the Torrid Zone; but in
those warm Countries it appears in a more violent Degree; makes a much
more rapid Progress; and proves far more fatal than in our cooler and
more temperate Climate. And it is observed to be always most frequent
and most fatal where a Country is covered with Wood, or is marshy; and
where there are frequent Fogs, and much stagnating Water, which
corrupts by the Heat of Summer.
In _January_, _February_, and _March_ 1761, we had none of those
Remitting Fevers at _Paderborn_. In _April_, some few of the Soldiers,
on their Return from the Winter-Expedition into _Hesse-Cassel_, had
Fevers attended with bilious Symptoms; but they were rather of the
continued, inflammatory Kind, and tending to malignant, than such as
could be called remitting.
The first Time that I saw much of this Fever, was among the Sick sent
to _Bilifield_ in the End of _June_ 1761; soon after the Army took the
Field. The Remissions were short, and it partook much of the Nature of
the common Inflammatory Fever; and most of them were cured by the
antiphlogistic Method. A Day or two before we left this Place, it
began to change into the Malignant Hospital Fever, from the Sick being
too much crowded.
In the Middle of _July_, about Twelve Hundred Sick were sent to the
Hospital at _Munster_; and about one-third Part were ill of this
Remitting Fever. It did not partake near so much of the inflammatory
Nature as at _Bilifield_; the Remissions became much more evident; and
it was attended much oftener in the Beginning with bilious Vomiting
and Purging; and in some few the Disorder turned to a Dysentery. About
eight or nine had it changed into the Hospital Fever, from the Wards
in one of the Hospitals being too much crowded; and in some few the
Disorder terminated in regular Agues. In _November_ severals were
taken ill of it in the Garrison of _Bremen_, which mostly ended in a
regular Intermittent, the endemic Distemper of the Place. Towards the
End of _December_ we had none of these Remitting Fevers, the Disorders
turning more to the inflammatory Kind.
In _June_ 1762, this Fever began to appear again among the Sick, sent
from the Army, to the Hospital at _Natzungen_; and it continued to be
frequent through the Summer and Autumn; and the greatest Part of these
Fevers this Year terminated in regular Agues, mostly in Tertians, and
were cured by the Bark; whereas the Year before very few terminated
this Way.
This Disorder in the Beginning had commonly the Appearance of a
continued Fever; and many had a Sickness and Vomiting, and threw up a
Quantity of yellow Bile, mixed with the Contents of the Stomach. In a
few Days, especially after Bleeding, the Remissions became clear; tho'
on its first Appearance in _June_ 1761 they were short, and rather
obscure; and it seemed still to partake a good deal of the Nature of
the common Inflammatory Fever, the Blood being very sizy; but as the
Season advanced, the Remissions became more evident, and the Paroxysms
more like those of an Ague; and the Blood less sizy, tho' at all
Seasons of the Year it had some Appearance of an inflammatory Buff in
this Disorder. The Sick were restless and uneasy at Night; but
commonly felt themselves cooler and lighter in the Day-Time: and
although they had no cold Fit, as the Fever came on at Nights, and
many of them no Breathing Sweat, as they became cooler and freer from
the Fever in the Morning; yet the Fits were so remarkable, that many
of the Patients used to say they had a regular Fit of an Ague every
Night, or towards the Morning; and some few, that they had the Fit
every second Night. As the Season advanced, the Remissions appeared
more distinct. However, there was always a good Number in whom the
Fever went on in a continued Form, through its whole Course, without
any Signs of Remission; tho' they had all the other Symptoms of this
Fever. In a few Instances the Fever, after it came to remit, changed
again into a continued Form.
The Heat in the Time of the Paroxysms rose high, and several were
delirious during its Continuance[70]; but were quite sensible in the
Intervals, though never wholly without the Fever.
[70] I did not see the Delirium rise so high, nor the
Paroxysms so severe, as in the Marsh Fever described by Dr.
_Pringle_.
At the End of _July_ 1761, four or five were attacked with a Bleeding
at the Nose, in the Time of the Paroxysms, and became cooler
afterwards; but it did not prove a Crisis in any of them.
The Urine in the Beginning was commonly of a high Colour, though
sometimes it was pale and limpid: At first it deposited no Sediment;
but when the Fever came to remit, there was often a small Sediment
after each Paroxysm; and as the Fever was going off, it let fall a
Sediment in all[71].
[71] Dr. _Hillary_ says the Symptoms of this Fever in
_Barbadoes_ were much the same as those of the [Greek: synechês],
or continued Remitting Fever in England; except only that the
Urine in this hot Climate never deposits any lateritious
Sediment, nor very rarely in any intermitting or any other
Fever, except when a Crisis happens that Way. _Observations
on the Diseases of Barbadoes_, p. 23.
Some at first were inclined to be costive; others had a Sickness and
Purging; and several of those who were costive in the Beginning, were
in the Course of the Disorder attacked with a Purging; and others,
after some previous Complaint of the Stomach, were seized with both
Vomiting and Purging. In general, after the Sick continued some Days
in the Hospital, they were inclined to be loose; which was a
favourable Circumstance, when this Evacuation was not so great as to
be in Danger of sinking the Patient. Some were attacked with a
Dysentery.
In this, as well as in most other Fevers, the Sick frequently passed
by Stool Worms of the round Kind; and sometimes they vomited them up,
or the Worms came up into their Mouth or Nostrils while they lay
asleep in Bed; and some towards the Height were afflicted with
Deafness, which was commonly a favourable Symptom.
Most of those ill of this Disorder had a yellowish Colour of the
Countenance, which went off with the Fever. It was more observable in
some than in others; in general, it was slight; some few became yellow
all over[72]; particularly one Man, in the Hospital at _Munster_, who,
after being seized with violent Vomiting and Purging, Convulsions, and
Twitchings of the Tendons, and Hiccup, became yellow, as in the
deepest Jaundice. This Symptom of Yellowness arises from a Redundancy
and Absorption of Bile; and is sometimes observed in other Fevers as
well as this[73]; for while we were at _Paderborn_ in _February_
1761, two Men were brought to the Hospital in Fevers, attended with
this Symptom. They were both delirious, with parched dry Tongues,
slight Twitchings of the Tendons, and other bad Symptoms; and one of
them had a continual Vomiting and Purging. They both died, and the
Body of him who had the Purging was opened. All the Bowels, especially
the Colon, were tinged with a yellow Bile, and had a slight Degree of
Inflammation all over their Surface; the Gall-Bladder was distended
with a very dark-coloured Bile; but no Concretions were found in its
Cavity, or in the bilious Ducts; nor Mucus, or any other Thing
obstructing these Passages. The Surface of the Lungs seemed slightly
inflamed; and there was a small Quantity of greenish Serum in the
Cavities of the Thorax. I could not learn the Histories of these two
Mens Disorders, before they were brought to the Hospital; but, from
the Symptoms, was inclined to believe, that the Fevers had been of the
malignant or petechial Kind; and that the yellow Colour was only an
accidental Symptom of it; for on one of the Men we could perceive
obscure Traces of dun petechial Spots on his Breast and Arms; and the
malignant Fever was frequent at this Time among the Troops, and the
bilious autumnal Fevers had ceased long before.
[72] Dr. _Pringle_ takes Notice of this yellow Colour or
Jaundice. He says, "some grow yellow, as in the Jaundice.
This was found more frequent during the first Campaign than
afterwards; it was an unfavourable, but not a mortal
Symptom." _Observ._ part iii. ch. 4.--_Hippocrates_ mentions
the Jaundice occurring in Fevers, _Aphor._ iv. § 62 & 64; and
he reckons it a favourable Symptom in ardent Fevers, where it
happens on the seventh Day. See _Book on Crises_'s, sect. 3.
[73] Does this Fever, when accompanied with this universal
Yellowness of the Skin, approach to the Nature of the yellow
Fever of the _West Indies_? As I had so few Cases of this
Kind under my Care, I cannot determine any thing about it
from my own Experience; but, from the Accounts of others, I
should believe them to be very different Disorders.--In the
yellow Fever of the _West Indies_, the Blood appears quite
loose and dissolved, without the least Appearance of Size,
even on the first Day; and the general Yellowness appears on
the third or fourth, with Signs of a total Dissolution, and
gangrenous Diathesis of the Blood: Whereas, in the Remitting
Fever of _Jamaica_, Mr. _Nasmith_ tells us, (See Dr. _Lind_'s
first Paper on Fevers), there is always an inflammatory
Diathesis of the Blood. The Yellowness in both depends on a
Redundancy and Absorption of Bile; but in the yellow Fever of
the _West Indies_, the Bile is in a much more putrescent
State, and a great Part of the Cure depends on the early and
speedy Evacuation of it.--In the yellow Fevers which appeared
in _Haslar_ Hospital, which are taken Notice of by Dr.
_Lind_, in his _Two Papers on Fevers_, the Blood was in quite
a different State from what it is in the Yellow Fever of the
_West Indies_; the Blood drawn from two of these Patients
became covered with a thick yellow Gluten, and the Serum was
of the Consistence of a thin Syrup, and of a deep yellow
Tinge, and tasted bitter; and in another who was bled two
Days before his Death, it threw up the same thick yellow
Gluten, tho' the red Part below was quite loose.
I could not observe any certain critical Days, or Periods, when this
Disorder terminated.--Some, who had it slightly, got well in a few
Days; with others, it continued longer: Some continued long feverish,
and would seem cooler and freer from Fever for a Day or two, and then
grow worse again; and many had repeated Relapses.
Neither could I observe any regular Crisis in this Fever. Sweat was
the Discharge which oftenest proved critical. Many seemed to be
relieved by a Purging; but as the greater Part had a Looseness after
some Days, which continued often through the Disorder, without
producing any very sudden Change in the Symptoms, it seemed to be a
favourable Circumstance; though it seldom carried off the Fever so
suddenly as to be manifestly critical. The Urine broke, and dropt a
Sediment, for the most part, as the Fever took a favourable Turn.
When this Fever proved mortal, it commonly assumed a continued Form;
the Tongue became parched and dry, the Patient delirious, with
Twitchings of the Tendons, Hiccup, and other fatal Presages; while
others were seized with a violent Diarrhoea, or Dysentery, which sunk
them irrecoverably.
In the Beginning, it was absolutely necessary to bleed the Patients
freely; and frequently to repeat the Evacuation, where the Symptoms
required it. The Blood was of a florid Colour, and commonly threw up
more or less of an inflammatory Buff.
In these Fevers, we were obliged to have particular Regard to the
first Passages, especially in the Beginning of the Disorder; for they
were generally loaded with bilious Humours[74]; which, if suffered to
remain in the Bowels; were either absorbed, and increased the Heat
and Fever, or brought on a violent Diarrhoea; and therefore, after
Bleeding, we gave a Vomit in the Evening, and next Day a Dose of some
gentle Purge, as Rhubarb or Salts; to carry off these putrid, bilious
Humours: And afterwards, in the Course of the Disorder, if the Patient
was costive, and grew hot, restless, and uneasy, we either repeated
the Purge, or gave laxative Clysters, which generally removed these
Symptoms.--Frequently after the Operation of the Emetic, the Patient
had some loose Stools, from the Gall Bladder's being emptied in the
Strainings to vomit. Such Stools were always bilious, as were commonly
those procured by purgative Medicines.
[74] According to Dr. _Hillary_'s Account of the Yellow Fever
in the _West Indies_, which is attended with bilious
Vomiting, it bears bleeding once or twice, but not a third
Time, before the third Day, but not at all after that Time;
and after Bleeding a great Part of the Cure depends on
carrying off as much of the putrid Bile as expeditiously and
safely as possible, which he says is to be done by making the
Patients drink freely of warm Water (sometimes mixed with a
little simple Oxymel or Green Tea) so as to vomit seven or
eight Times; and then to give a grain, or a Grain and a half
of Opium, to procure Rest, and to settle the Stomach; to make
the Patient take nothing for two Hours after; and then, if he
has not had a Stool, to give a laxative Clyster; after six
Hours Rest, to give a gentle Purge, to carry off as much as
possible of the bilious corrupted Humours; and in the Course
of the Disorder to repeat the Purge, as often as the Patient
is attacked with an Anxiety, and a painful burning Heat about
the Præcordia; which almost always depend on bilious
corrupted Humours pent up within the Bowels; and to endeavour
to support the Patient's Strength, and stop the putrescent
Diathesis of the Fluids by suitable Antiseptics, of which he
found a watery Infusion of Snake Root, mixed with _Madeira_
Wine and Syrup of Poppies, to answer the best of any Thing he
tried, and to sit easiest on the Stomach; and to this he
added the Use of Cordials, and of strong Wine Whey as the
Patient became lower.
Dr. _Hillary_'s Purge was: Rx. Mannæ sescunc. vel unc. ij.
Tamarind. cond. unc. i. Tartar vitriolat. gr. x. solve in
seri lactis præparat. cum Vin. Maderiens. unc. vi. Colaturæ
adde Tinct. Senæ unciam dimidiam. Divide in Partes quatuor, &
capt. æger unam omni hora donec laxetur alvus.
His Infusion of Snake-Root was prepared in the following
Manner:
Rx. Rad. Serpent. Virgin. drachm. ij. Croci Angl. drachmam
dimidiam, infunde per horam vase clauso in aq. bull. q. s. &
dein unc. vi. Colaturæ, adde aq. Menth. simp. unc. ij. Vin.
Maderiensis, unc. iv. Syrup. Croci vel Syr. e Mecon. unc. i.
Elix. Vitriol. acid. q. s. ad gratum saporem M. capiat æger
cochlear. ij. vel iij. omni hora vel secunda quaq; hora vel
sæpius pro re nata.
The Stomach is so irritable in the Beginning of this
Disorder, as to reject the saline Draughts, Nitre, and such
other Medicines. Nor will
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