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 Pharmacopœia 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.

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.

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.”

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.

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.

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.

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.

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.

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.

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.

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 diarrhœa, 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.

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].

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.

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].

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.

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].

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.

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].

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 Diarrhœa, 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].

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.

FOOTNOTES:

[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.”

[2] Observations on the Diseases of the Army, part III. chap. vii. sect. 3. third Edition, 1761.

[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.

[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.

[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.

[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.

[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.

[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.

[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.

[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.

[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.

[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.

[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.

[19] Ibid.

[20] Pringle’s Observations on the Diseases of the Army, Part III. chap. vii.

[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.

[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.

[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.

[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.

[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.

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].

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].

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].

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.

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].

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.

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.

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.

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.

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.

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.

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.

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.

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.

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].

FOOTNOTES:

[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.

[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.

[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.

[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.

[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.

[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.

[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.

[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. ℞ 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.

[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.

[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. ℞. 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.

[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.

[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.

[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.

[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.

[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 Diarrhœa’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.

[45] Many other Medicines have been used for the Cure of old Dysenteries,—The Conessi Bark, recommended as a Specific in Diarrhœas, 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.

Dr. Sydenham[49] trusts principally to drinking freely of Chicken Broth, and throwing up Clysters of the same, and afterwards giving Opiates.

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.

FOOTNOTES:

[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.

[49] Processus integ. de Cholera.

[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.

FOOTNOTES:

[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].

FOOTNOTES:

[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].

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.

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.

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.

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.

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.

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 fœtida, 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.

FOOTNOTES:

[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.

[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.

[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.

[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.

[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.

[58] Sect. x. de Febrib. lentis sive Hecticis.

[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.