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An Account of the Diseases which were most frequent in the British military hospitals in Germany
by Donald Monro
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AN ACCOUNT OF THE DISEASES

Which were most frequent in the

BRITISH MILITARY HOSPITALS

in Germany,

From January 1761 to the Return of the Troops to England in March 1763.

To which is added,

An ESSAY on the Means of Preserving the Health of Soldiers, and conducting Military Hospitals.

By DONALD MONRO, M.D.

PHYSICIAN to his MAJESTY'S ARMY, and to ST. GEORGE's Hospital.

LONDON:

Printed for A. MILLAR, D. WILSON, and T. DURHAM, in the Strand; and T. PAYNE, at the Mews-Gate.

MDCCLXIV.



TO THE KING.

May it please Your MAJESTY,

To permit me to lay at your Feet the following Sheets, published with a View to be useful to those, who hereafter may have the Care of the Health of your MAJESTY's Troops.

YOUR MAJESTY's particular Inquiries into the State of Your Military Hospitals, in every Quarter of the World, in the Time of the late glorious and successful War; Your Concern for every Officer and Soldier who suffered either by Sickness or by Wounds in the Cause of their King and Country; and Your Solicitude to procure them every possible Assistance and Relief, cannot fail to excite the highest Admiration of Your MAJESTY's Goodness in the Breast of every Subject, and the warmest Gratitude in the Heart of every Soldier.

The Knowledge of these Circumstances induced me to flatter myself, that a Work of this Kind would be agreeable to Your MAJESTY; and should this Attempt towards pointing out the Means of alleviating those Miseries, which necessarily attend a Military Life in the Time of Service, be acceptable, I shall obtain the utmost of my Wishes; it being the greatest Ambition of my Heart ever so to act as to merit Your MAJESTY's Approbation, and to subscribe myself,

May it please Your MAJESTY,

Your MAJESTY's most dutiful Subject,

And most faithful

and humble Servant,

DONALD MONRO.



THE PREFACE.

Among the numerous Authors of Observations in the Art of Physick, there are but few who have expressly written on the Treatment of those Distempers, most generally incident to an Army in the Field: The following Work, therefore, seems to have a fair Claim to be acceptable to the Publick, having been compiled during the Author's Attendance on the British Military Hospitals in Germany in the late War; and in order to render it of still further Use, he has occasionally added, by Way of Note, the Practice of some of the most eminent Physicians in similar Diseases, as well as a few Histories of Cases which passed under his own Care at St. George's Hospital, London.

To avoid the Repetition of the Composition of particular Medicines, and the Interruption that would be given by their being inserted in the Body of the Work, a small Pharmacopoeia is added, to which his Practice in the Army Hospitals was chiefly confined.

In a commercial Country like our own, where Numbers of Hands are constantly wanted for the carrying on our Manufactories, we have a strong political Argument to add to that drawn from the Dictates of Humanity, why the Life of every individual should be most carefully attended to.

The Preservation of the Lives of Soldiers is then with us a Matter of the highest Importance, in order to make as low as possible the Number of Recruits who must be perpetually drawn off for the Service of War. The Author has, therefore, in this Treatise, endeavoured to point out the Means most likely to keep Men healthy when employed in different Services; and also the Manner in which Military Hospitals ought to be fitted up, and conducted.—As he was never in any of the warm Climates, nor ever at Sea along with Troops aboard of Transports, whatever is mentioned relative to such Situations, is to be understood as taken from printed Accounts of these Subjects, or collected from the Conversation of physical Gentlemen, who were employed on such Services during the two last Wars.

It is but Justice here to observe, that the Marquis of Granby, Commander in Chief of the British Troops in Germany, as well as the Rest of the General Officers employed on the German Service, always paid the greatest Attention to the Soldiers when sick in Hospitals; and were particularly ready in giving Orders for all such Things as were necessary or proper for them.

JERMYN-STREET, April 15, 1764.



CONTENTS.

PAGE.

Of the Malignant and Petechial Fever, 1

Of the Dysentery, 57

Of the Cholera Morbus, 97

Of the Inflammatory Fever, 104

Of the Angina, 109

Of the Pleurisy, 111

Of the Peripneumony, 115

Of the Cough and Consumption, 124

Of the Epidemical Catarrhal Fever of April 1762, 137

Of the Rheumatism, 141

Of the Autumnal Remitting Fever, 154

Of the Intermitting Fever, or Ague, 179

Of the Jaundice, 206

Of Tumours of the Breast, 216

Of Paralytic Complaints, 219

Of an Incontinency of Urine, 223

Of a Stoppage of Urine, 227

Of the Epilepsy, 237

Of the Small-Pox, 243

Of Erisypilatous Swellings, 245

Of the Scurvy, 250

Of the Itch, 265

Table of Diet used in the British Military Hospitals in Germany, 273

PHARMACOPOEIA in usum Nosocomii militaris regii Britannici 1761, 275

OF THE MEANS of Preserving the Health of Soldiers on Service, 309

—— in Winter, and in cold Climates, 313

—— aboard of Transport Ships, 323

—— in warm Climates, 331

Of healthful and unhealthful Grounds for the Encampment of Troops, 338

Of keeping Camps clean, 344

Of supplying an Army with Straw and with Provisions, and obliging the Soldiers to buy a certain Quantity of Meat daily, 346

Of Water, and the Means of correcting its bad Qualities in Camps, 348

Of vinous and spirituous Liquors, 350

Of keeping Men healthful in Quarters after an active Campaign, 354

Of MILITARY HOSPITALS, 355

Of the Manner in which the Antients disposed of their Sick and Wounded, 356

Of the Hospitals wanted for an Army acting on a Continent, 357

Of the Houses most fit for Hospitals, 361

Of fitting them up, and distributing the Sick in them, 363

Of preventing infectious Disorders from being generated or spreading among the Sick, 366

Of the Diet of Military Hospitals, 372

Of providing the Flying Hospital, 380

Of Hospitals on Expedition Service, 380

Of a Guard for Hospitals, 382

Of the Nurses and Patients, and Orders for them, 383

Of a convalescent Hospital, 389

Of the Physicians, Surgeons, Apothecaries, and Mates, 393

Of the Direction of Military Hospitals, 394

Of the Purveyor or Commissary of the Hospital, 396

Orders for the Mates, 397

Of Precautions for guarding against infectious Disorders, 400

Of a Military Inspector and Officers on convalescent Duty, 403

ERRATA CORRIGENDA.

Page 13, line 11, for Pleuretic, read Pleuritic.

18, 10, of Notes, for Acadamy, read Academy.

28, 22, for Cinamon, read Cinnamon.

35, 5, of Notes, for Calomile, read Calomel.

51, 12, dele used in this Way.

166, 12, of Notes, for which almost depend, read which almost always depend.

207, 13, of Notes, for Vena postarum, read Vena portarum.

259, 4, for appeared, read appear.

261, 1, of Notes, for became, read become.

280, 20, for Chamamel, read Chamaemel.

290, 4, for 3tis 4tiis, read 3tiis 4tis.

293, 13, for Mithridatum, read Mithridatium.

336, 12 & 13, for bathe themselves as often, read bathe early in the Morning as often.

352, 7, for in Bilanders, read and were to go in Bilanders.

353, 2, for the least Appearance of the Malignant Fever, read the Malignant Fever appearing.



OF THE MALIGNANT and PETECHIAL FEVER.

A Malignant Fever, and Fluxes, began to appear among the Soldiers in Autumn, 1760, while the Allied Army remained encamped about Warbourg, from the Beginning of August till the 13th of December, when they went into Cantonments. During that Time, there had been a continued Rain for some Months, and the Camp and neighbouring Fields, and Villages, were not only filled with the Excrements of such a numerous Army, but likewise with infinite Numbers of dead Horses, and other dead Animals, which had died in doing the necessary military Duties, and in bringing Forage, Provisions, and other Necessaries, to the Camp: besides this, the Field where there had been an Action on the 31st of July, and where many of the Dead were scarce covered with Earth, was in the Neighbourhood of the Camp.

Not only the Soldiers, but the Inhabitants of the Country, who were reduced to the greatest Misery and Want, were infected with the Malignant Fever, and whole Villages almost laid waste by it.

Such a Number of Soldiers was sent to Paderborn as crowded the Hospitals there, and increased the Malignancy of the Distempers so that a great many died.

When I arrived at Paderborn, in the Beginning of January 1761, the Fever was upon the Decline in the General Hospitals, though it was still rife; but by sending off a Party of Convalescents to Hervorden, which thinned the Hospitals, it became less frequent, and but few died. The Guards marched upon the Expedition into Hesse, on the eleventh of February, which gave us full Room for billetting all our Convalescents, and thinning the Wards; by which Means the Fever almost entirely ceased in all the Hospitals we had before they went away; though there still remained about four hundred sick.

When the Guards marched out of Paderborn, they left the Care of their Sick to us, who belonged to the General Hospital: the first Regiment of Guards left sixty sick; the second, twenty-nine; the third, twenty-eight; and the Granadiers, fifteen, in their regimental Infirmaries; who were mostly ill of the Malignant Fever: amongst whom the Infection was so very strong, that, although I procured the Sick new airy Houses for Hospitals, which were kept as clean and well-aired as possible, and procured clean Bedding, and clean Linen for every Man, and had the Sick laid thin, yet several died, and it was some Time before we got entirely free of the Infection. The first and third Regiments suffered most, owing to all the Sick of each Regiment being put into a particular Hospital by themselves, which kept up the Infection, so that they lost one-third of those left ill of this Fever; and many of the Nurses, and People who attended them, were seized with it. But not being able to procure particular Houses for the Sick of the Coldstream or Second Regiment, and for the Granadiers, I distributed them through the different Hospitals we had then in Town, where the Contagion had ceased; and by their being thus scattered, while they were kept very clean, and at as great a Distance as possible, from the other Patients in the Wards where they were put, they lost few in Proportion to the first and third Regiments, and the Disorder did not spread.

About the End of May, the Weather was very warm at Osnabruck; when this Fever began to make its Appearance in the Corner of a large Ward, which was next to one kept for salivating venereal Patients; and only divided from it by means of a few thin Deals. Perceiving a strong Smell in this Place, I suspected that the Fever arose from the foul Steams coming from the next Ward, and therefore ordered the salivating Ward to be thinned, and removed all the Sick from the Places near that Ward; and ordered those that had catched the Fever to be put into large airy Places; by which means the Infection spread no further, and only one, out of six or seven who had got the Fever, died.

At the End of June, the Weather was very hot at Bilifield, and the Fever began to shew itself by the Hospital being overcrowded, by a greater Number of Sick being sent from the Army than we had proper Places to put them in; but it was put a Stop to in a few Days, by the Removal of the Hospital. Seventy Sick were left behind to the Care of a Mate, most of them ill of the Fever, of whom twelve died.

In the Beginning of August, a few Men were taken ill of the same Fever at Munster, in one of the Hospitals which was too much crowded; but its further Progress was stopped by sending a Number of recovered Men to Billet.

In November and December 1761, and January, February, and March 1762, we had several Men sent from Quarters in the Town of Bremen to the Hospital, sick of the Petechial Fever: they were quartered on the Ground-floors of low damp Houses, and fresh Meat and Vegetables so dear that they could not afford to buy them; but were obliged to live mostly on salt Provisions. I was told likewise that the spotted Fever was frequent among the lower Class of the Inhabitants. Some few were seized with this Fever in the Hospital itself; yet as the House was not crowded, and we had a Number of small airy Wards, the Infection did not spread; and we had but one or two who died of this Fever during the Winter, in the Hospital I attended.

In Summer 1762, we had only ten or eleven ill of this Fever in the Hospital at Natzungen, and only one died.

When the Troops marched from their Cantonments, in December 1762, towards the Borders of Holland, the twentieth and twenty-fifth Regiments of Foot left behind them, at Osnabruck, thirty sick; five of whom had Symptoms of the Hospital Fever, though no Petechiae 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 Petechiae upon them, who all recovered. After this we had none taken ill of it at Osnabruck, while I remained there, which was till the twenty-fifth of March.

This Malignant Fever begun variously in different Subjects; for the most part with Cold and Shivering, Pain in the Head, and other Symptoms, commonly described as peculiar to this Fever. In some, it begun with a sharp Pain of the Side, or other Parts, attended with acute inflammatory Symptoms; in others, it put on the Appearance of the common, low, or nervous Fever, for a Day or two. Blood drawn in the Beginning from some Patients did not seem much altered; from others it threw up a strong inflammatory Buff[1]; but where the Fever had continued some time, it was commonly of a loose Texture, and of a livid Colour; unless when the Sick were accidentally seized with pleuritic Stitches, or other Disorders of this kind.

[1] Dr. Huxham, in his Treatise on the ulcerous sore Throat, p. 36, says, "I have very often met with this buffy or sizy Appearance of the Blood in the Beginning of Malignant Fevers; and yet, Blood drawn two or three Days afterwards, from the same Persons, hath been quite loose, dissolved, and sanious as it were." And in his Essay on Fevers, chap. viii. p. 108. says, "The first Blood frequently appears florid; what is drawn twenty four Hours after, is commonly livid, black, and too thin; a third quantity, livid, dissolved, and sanious. I have sometimes observed the Crasis of the Blood so broke as to deposite a black Powder, like Soot, at the Bottom, the superior Part being either a livid Gore, or a dark green, and exceedingly soft Jelly."

The Reason of this Difference of Symptoms in the Beginning, and of these different Appearances of the Blood, seemed to be, that such Patients as laboured under Pleurisies, low or other Fevers, being brought into Hospitals where the Malignant Fever was frequent, had their original Disorders changed into this Fever by breathing a foul infected Air, and by their Communication with those ill of the Fever, and of Fluxes; at other Times, a mere Acrimony of the Blood, set in Motion by a supervening Fever, determined the Disorder to be of this kind: and I always observed, that those Men were most apt to catch this Fever, whose Constitutions had been broke down by previous Disorders.

The Fever appeared in different Forms. Some had only a Quickness of the Pulse, attended with a slight Head-ach and Sickness, Whiteness of the Tongue and Thirst, and a Lowness and Languor; which continued for a Week or more, and then went off, either insensibly, or with a profuse Sweat, succeeded by a plentiful Sediment in the Urine. Most of those who fell into profuse kindly-warm Sweats recovered, the Sweat carrying off the Fever. These profuse Sweats continued for twelve or twenty-four Hours, and sometimes for two, three, or four Days. In those who had the Fever in this slight Degree, the Petechiae seldom appeared; and it was only known to be this sort of Fever by the other Symptoms, and the Malignant Fever being frequent at that time in the Hospitals. Dr. Pringle[2] very justly observes, "That these low Degrees of this Fever are hardly to be characterised, and are only to be discovered, in full Hospitals, by observing Men languish; though the Nature of the Illness, for which they come in, should seem to admit of a speedier Cure."

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

For the most Part the Fever appeared with more violent Symptoms, the Tongue became more parched and dry, more or less of a Delirium came on, attended with the other Symptoms commonly described as peculiar to this Fever.

When the Petechiae appeared, they came out on the fourth, fifth, sixth, or seventh Day; seldom after the eleventh or twelfth[3]. They appeared mostly on the Breast, Back, Arms, and Legs, and sometimes, tho' rarely, on the Face. They had exactly the Appearance described by Dr. Pringle, either like small distinct Spots of a reddish Colour, or the Skin looked sometimes as if it had been marbled, or variegated as in the Measles, but of a Colour more dull and lured. As they began to disappear, they inclined to a dun or brown Colour, and looked like so many dirty Spots. I never saw them rise above the Skin; nor did I once see any miliary Eruptions in this Fever; which agreed exactly with what Dr. Pringle had observed in the former War, and in the Beginning of this; however, we ought not to conclude from thence that miliary Eruptions are never observed in Fevers of this kind; for Dr. Huxham[4], Dr. Hasenohrl[5] and Dr. Lind[6], besides many other good Practitioners, mention their having seen them.

[3] Ramazini, in his Treatise De Constitutionibus annorum, 1692, 3, 4, in Mutinensi civitate, Sect. 19. mentions the Petechial Fever which had been frequent the three foregoing Years; in which the Petechiae 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 Petechiae 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 Petechiae appeared on the fourth, and the white miliary Eruptions on the seventeenth Day of the Fever.

[6] Dr. Lind, in his second Paper on Fevers, p. 105. mentions Spots which rise above the Surface of the Skin, and are of the miliary kind, as common in contagious Fevers, as he observed among the French Prisoners in Winchester Castle, in the Beginning of the Year 1761.

Many had no Petechiae through the whole Course of the Disorder; but in all who were very bad, the Countenance looked bloated, and the Eyes reddish and somewhat inflamed; and though the Skin was commonly dry, yet the Perspiration from the Lungs was strong. By these Circumstances one might frequently discover that the Patient laboured under the malignant Fever, without asking any Questions.

* * * * *

When Men were taken ill of a Fever, which we suspected to be of the malignant kind, our first Care was to lay them in airy Places, separate as much as possible from the other Men, and to keep them extremely clean; and they were put on low Diet, and allowed as much Barley or Rice-water as they chose to drink, which was commonly ordered to be acidulated with the Spiritus Vitrioli.

For the first two or three Days we could seldom distinguish, with Certainty, that the Fever was of the malignant kind, though we had often Reason to suspect it. The Pain of the Head, the Fulness and Quickness of the Pulse, and other Symptoms, led us commonly to take away more or less Blood, which the Patient bore easily, and for the most part it gave Relief[7]. We seldom repeated this Evacuation where we suspected the Fever to be of the malignant kind, unless a pleuritic Stitch, an acute Pain of the Bowels, or some other accidental Symptom, required it; or the Patient was strong, and there were evident Symptoms of Fullness immediately before we intended giving the Bark, as shall be mentioned afterwards; for under other Circumstances, if the Blooding was repeated, and other Evacuations used freely, I always observed that it did Harm, and was apt to sink the Patient too much; as Dr. Huxham, Dr. Pringle, and other good Practitioners, have remarked.

[7] Dr. Huxham, tho' he says "yet Bleeding to some Degree is most commonly requisite, nay necessary, in the strong and plethoric;" yet he afterwards makes the following Remark: "Besides, the Pulse in these Cases sinks oftentimes surprisingly after a second Bleeding, nay sometimes after the first, and that even where I thought I had sufficient Indications from the Pulse to draw Blood a second time." See his Essay on Fevers, chap. viii. And Dr. Pringle observes, that in the second Stage of the Disorder large Bleedings have generally proved fatal, by sinking the Pulse, and bringing on a Delirium. Observations on the Diseases of the Army, part III. chap. vii. sect. V.

After Bleeding, if the Patient was costive, or complained of Gripes, he had a Dose of Rhubarb, or Salts, or a laxative Clyster; but where there was much Sickness of the Stomach, we gave a gentle Emetic[8] in the Evening, and the Purge next Morning. And if in the Course of the Disorder the Sickness and Nausea returned, attended with Griping and Costiveness, or very fetid loose Stools, these Medicines were repeated, and a gentle Opiate given in the Evening after their Operation.

[8] Dr. Pringle advises giving a Vomit, by way of Prevention, on the first Appearance of the Symptoms, and at Night to force a Sweat, by giving a Drachm of Theriac with ten Grains Sal volat. Corn. cervi, and some Draughts of Vinegar-whey, and to repeat the same the following Night; and says, he has often seen those Symptoms removed which he apprehended to be Forerunners of this Fever received by Contagion; but previous to Vomits, or Sweats, if the Person be plethoric, it will be necessary to take away some Blood. Observ. part III. ch. vii. sect. 5. Dr. Lind, in his second Paper on Fevers, p. 66. says, "To all who are supposed to be infected by Fevers, during this Stage of Rigours, a gentle Vomit is immediately to be exhibited before the Fever be formed, and before the Fulness or Hardness of the Pulse renders its Operation dangerous. If the Vomit be delayed too long, and especially if Bleeding must precede it, the most certain and favourable Opportunity of procuring Safety for the Patient is past.—That he has found it equally serviceable in preventing Relapses, when it is given at the Return of the Shiverings." A loose Stool, or two, should be procured by the Emetic or Clysters, and he advises Sweating immediately after, in the manner recommended by Dr. Pringle. At other times "he gave five Grains of Camphire every four Hours, with large Draughts of Vinegar-whey. Eight Persons in ten, he says, got quite well by this Treatment."

I have never had sufficient Opportunities of trying this Method of Prevention, to determine any thing certain about it; but it may be worth while to practise it.

After Evacuations, if the Pulse kept up, we commonly gave nothing but the saline Draughts, with the Pulvis contrayervae, or some temperate Medicine, for the first Day or two. As soon as we could distinguish the Fever to be of the malignant kind, and that the Pulse rather sunk, we joined some of the Cordials to the saline Medicines, and allowed the Patient more or less Wine, according to the Degree of the Fever. Dr. De Haen has found Fault with Dr. Pringle and Dr. Huxham, for administering cordial Medicines and Wine in the low State of this Fever; but nothing answered so well with us as these Remedies under such Circumstances; and I have frequently seen every Symptom changed for the better by their Use; and even when I gave the Bark, in the Manner recommended by De Haen, I often found it necessary to join the free Use of Wine[9], Cordials and Blisters[10], in order to support the Patient's Strength.

[9] Petrus a Castro, in his Account of a Petechial Fever, which was frequent at Verona, tells us, that the Sick had a great Thirst, and an Aversion to Meat, but all of them had the strongest Desire for Wine, and were perpetually asking for it, even those who at other Times used to be very temperate; and that this proceeded from an Instinct of Nature, which wanted something to support the Strength. De Feb. Malig. sect. iii. chap. 26. Dr. Huxham, in his Essay on Fevers, has the following very judicious Remark on the Use of Wine: "In this View, and in those above-mentioned, I cannot but recommend a generous red Wine as a most noble, natural sub-astringent Cordial, and perhaps Art can scarce supply a better. Of this I am confident, that sometimes at the State, and more frequently in the Decline of putrid Malignant Fevers, it is of the highest Service, especially when acidulated with Juice of Seville Orange or Lemon. It may be also impregnated with some Aromatics, as Cinnamon, Seville Orange Rhind, red Roses, or the like, as may be indicated, and a few Drops of Elix. Vitrioli may be added. Rhenish and French White Wines, diluted, make a most salutary Drink in several Kinds of Fevers, and generous Cyder is little inferior to either. The Asiatics, and other Nations, where pestilential Disorders are much more rife than with us, lay more Stress on the Juice of Lemons in these Fevers than on the most celebrated Alexipharmac." Chap, viii. second Edit. p. 123, 4.

Acid and acescent Liquors have very justly been recommended and used by most late Practitioners, in this as well as in other malignant Diseases. Vinegar-whey, Barley-water acidulated with Lemon-juice, and such other Liquors, make good Drinks for the Sick; but we were obliged, for the most part, to use the vitriolic Acid for acidulating the Patient's Drink, as it was the easiest procured and carried about with the Flying Hospital.

[10] If the preventive Method does not succeed, Dr. Lind advises to have recourse to Blisters; and says, that sixteen out of twenty will next Morning be free of the Fever. But adds, this is said, provided the Source of their Infection be not so highly poisonous as it was in the Garland Ship, or in other such violent Contagions. Dr. Pringle mentions his having applied Blisters early, but without relieving the Head, or preventing any of the usual Symptoms. I have often ordered Blisters pretty early in the Disorder; and though I have frequently found them of use in keeping up the Pulse, and relieving the Head, and other Symptoms, yet I never saw them have such an immediate Effect as Dr. Lind mentions.

After reading the Treatises of Dr. De Haen and Dr. Hasenohrl, on this Fever, I resolved on giving the Bark[11] in large Quantities, and found it to answer the Recommendations given by these Gentlemen; and shall relate here two or three Cases, out of above a hundred and fifty, in which I gave it.

[11] It is long since the Peruvian Bark has been used by Practitioners in Malignant Disorders, though I do not know that any body gave it in this Fever to the Amount of an Ounce per Day, before Dr. Haen and Dr. Hasenohrl. Dr. Ramazini mentions its having been tried in the Petechial Fever, in the Years 1692, 3, 4. And in a Treatise on the Plague in the Ucrane, published at Petersburgh, in the Year 1750, we are told, that in the French Translation of the Philosophical Transactions for the Year 1732, there is a Note to p. 264, telling, that Mr. Amyand informed the Academy of Surgery at Paris, that Mr. Rushworth, Surgeon, had wrote to Sir Hans Sloane, on the 23d of May 1723, that when he was Surgeon to a Ship, in the Year 1694, he had cured some Men ill of the Malignant Fever, attended with pestilential Buboes, by means of the Peruvian Bark. Dr. Huxham has recommended a Tincture of the Bark; and Dr. Pringle, a strong Decoction of it, with some of the Tincture, in these Malignant Fevers.

I. Robert Wilson, of the Second Regiment of Foot Guards, on the 19th of February 1761, was seized with a Shivering and Coldness, succeeded with Heat, Thirst, a short dry Cough, Difficulty of Breathing, Head-ach, and slight Stitches in his Breast; some Blood was taken away, which was sizy, and he was ordered two Ounces of the Sperma Ceti Mixture, with the spiritus mindereri, every two or three Hours. He continued without any manifest Alteration in the Symptoms, till the 21st, when a Number of dun Petechiae 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 Pilulae saponaceae in the Evening. The 26th, the Petechiae 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 Petechiae 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 Petechiae 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 Pilulae saponaceae 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 Petechiae appeared, and his Breathing was freer: He was ordered a Drachm of the Bark, in a saline Draught, every four Hours. The 27th, the Pulse better: p. The 28th, was more sensible, and had a kindly warm Moisture all over the Skin. The 29th, the Fever was much abated, and his Tongue, which was before parched and dry, became moist and white: He continued the Use of the Cortex for three Days more, which removed the Fever; and being costive, he took a Dose of the Tincture of Rhubarb. After this he used the Bark for a few Days longer, and got perfectly well.

After giving the Bark[12] with Success, in the two first of the Cases mentioned, and to two young Gentlemen, Mates of the Hospital, who had caught the Fever from their Attendance on the Sick, I gave it to above a hundred and fifty at Paderborn, and elsewhere, during my Attendance in the Military Hospitals in Germany; and although it did not answer in every Case, yet it was found to have a better Effect than any other Remedy that was tried. We joined different Medicines with it, according to the State of the Patient. We gave the Confectio cardiaca, Rad. serpent. Virg. and other cordial Medicines, and Wine, when the Pulse was low; Oxymel scilliticum, and other Pectorals, when the Breathing was difficult; Opiates, where the Patient was inclined to be too loose; the spiritus mindereri, and other Diaphoretics, when we wanted to promote a free Perspiration; and we applied Blisters as Occasion required.

[12] The Peruvian Bark has not only been found useful in this Malignant Fever, but has likewise been recommended in the Plague. See Morton Oper. Append. secund. Exercitat. Hist. Febr. Ann. 1658, ad. an. 1691. complexa. In the Small Pox, see Medical Essays, vol. V. art. x. and has been found serviceable in the putrid Disorders of the West Indies, as taken Notice of by Dr. Hillary; and in the malignant ulcerous sore Throat in this Country, as Dr. Wall and others have observed. And in thirty-five Cases of the malignant ulcerous sore Throat, in which I gave it, joined with Cordials, and the Use of Acids, I did not lose one Patient. Nine of them were strong People, and had plethoric Symptoms, and were blooded in the Beginning; and seven of them were costive, and took a Dose of gentle laxative Physic before taking the Bark. The rest had no Symptoms which seemed to require these Evacuations. However, it ought to be observed, that this is a Disorder of the malignant kind; and that although some well-timed gentle Evacuations may be serviceable in the Beginning, before giving the Bark; yet too free, or even gentle Evacuations, injudiciously made, will sink the Patient, and infallibly do Mischief.

The free Use of the Bark has long been found serviceable in Mortifications and foul Sores, where the Juices tend too much to the Putrescent; and has been strongly recommended by Mr. Ranby, Serjeant Surgeon to his Majesty, in the Cure of Gunshot Wounds. See his Treatise on Gunshot Wounds.

When the Patient was strong, the Pulse quick and full, the Eyes looked red, and the Breathing was difficult, after the Petechiae 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 Petechiae 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 Petechiae 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 Petechiae had appeared, I found him one Morning so low that his Pulse could scarce be felt. He could not speak; he had a Delirium, and rather a Tremor than a subsultus tendinum, and he had all the Appearance of a dying Man. However, as he still swallowed whatever was put in his Mouth, I changed the Bark Mixture for Draughts, which contained a Scruple of the confectio cardiaca, and seven Grains of the sal vol. corn. cerv.[13] each, and ordered one to be given immediately, and afterwards to be repeated every four Hours; and, in the Intervals, to give him frequently a Tea-cup full of Red Wine, mulled with Cinnamon; and to apply two large Blisters to his Legs. Next Day, his Pulse had rose; and by the Continuance of the same Remedies it became gradually fuller and stronger, and the third Day after he recovered his Voice; and a warm kindly Moisture which ended in a profuse Sweat coming on, the feverish Symptoms went off soon after, and he recovered his Health.

[13] Dr. Huxham, in his Treatise on the ulcerous sore Throat, p. 54, &c. condemns the Use of the volatile alcaline Salts, in Fevers of the putrid, pestilential, or petechial kind, as being apt to heat too much, and to hasten the Dissolution and consequent Putrefaction of the Blood. However, I cannot help thinking that they are the best Remedies we can use on some particular Occasions, even in this Fever; for we have no Remedy which gives such a sudden and brisk Stimulus to the Fibres as they do. And I have known many Cases of Patients who were extremely low, and whose Pulse was scarce to be felt, and others who were apt to fail into fainting Fits, who have been preserved by large and repeated Doses of these Salts, and the free Use of Wine, and acescent Liquors, to correct their alcaline Acrimony in the Blood. Though as soon as such Patients had recovered from this low State, I laid these Medicines aside; because I cannot help agreeing with the Doctor in the Belief, that their continued Use will produce the Effects he mentions. For although it be true, that these Salts, when mixed with putrescent Liquors, or with dead animal Substances, resist Putrefaction, and, like ardent Spirits and Vinegar (the other Products of Fermentation) check and put a Stop to that very Process which produced them: Yet it is also true, that, when mixed with the Blood of living Animals, they stimulate the Vessels, and increase the Heat and Momentum of the Blood, and dissolve it; and therefore I cannot but disapprove the continuing their Use longer than is immediately necessary.

At Bremen there were two Men, one in January, and the other in February 1762, on whom the Cortex had but little Effect, who recovered by the free Use of Mixtures, with the confectio cardiaca and rad. serpentariae, and of Wine, with the Application of large Blisters. Several Cases of this kind occurred in the Hospitals, where the Bark did not answer.

There is one thing to be observed with respect to Malignant Fevers, which is, that if ever they appear in large crowded Hospitals, unless we can thin the Wards, and procure a free Circulation of Air, and keep the Hospital and Sick extremely clean, the Fevers will continue to spread, and great Numbers will die; and even the most efficacious Remedies will have little or no Effect. And that when once the Infection is grown strong, it requires the greatest Care, and some Time, before it can be entirely got the better of. And that if a great number of Men, ill of this Fever, be kept in the same Ward, they will help to keep up the Infection; and therefore it is always proper, when it can possibly be done, to lay but a few of them in one Ward; not above one-third of the Number generally admitted.

Many of the Patients, towards the Height of this Fever, sooner or later, had a Purging, which seldom proved critical; and some were seized with the Flux. A gentle diarrhoea, such as did not sink the Patient, was commonly of Service; but when violent, or a Dysentery came on, the Case was always dangerous; for whatever stopped the Flux increased the Fever; and, if the Purging or Flux continued, it sunk the Patient. Such Fluxes we treated in the Manner to be mentioned afterwards, when we come to the History of the Dysentery.

In this Fever, it was common for Patients to vomit Worms[14], or to pass them by Stool, or, what was more frequent, to have them come up into their Throat and Mouth, or sometimes into their Nostrils, while they were asleep in Bed, and to pull them out with their Fingers. The same Thing happened to most of the British Soldiers, brought to the Hospitals for other feverish Disorders as well as this. Dr. Pringle[15] when he mentions Worms being observed in this Fever, seems to embrace Lancisius's Opinion; and believes that these Worms are not the Cause of the Fever; but being lodged in the Intestines, before the Fever comes on, they are annoyed by the Increase of the Heat, and the Corruption of the Humours, in the Cavity of the Intestines of Persons labouring under Fevers, especially of the putrid Kind; and so they begin to move and struggle to get out. This seemed evidently to be the Case with many of the Patients we had; though in some the Worms seemed to have given Rise to the Fever, which the bad State of the Patient's Humours, or the infected Air of Hospitals, determined to be of this Kind. In many, the Fever lessened, or went off entirely, soon after; and they were no more affected with Symptoms of Worms. But some notwithstanding were subject to frequent Sickness, Pain of the Stomach, and Uneasiness in the Bowels, and discharged some Worms from Time to Time. Others had frequent Relapses into Fevers, which seemed to be owing to the Irritation of these Insects.

[14] Some Men passed only one Worm; others, two or three; some, six or seven; and one Man, of the Guards, in January 1763, after passing three by Stools in the Course of a Fever of this Kind, discharged fourteen more upon taking a Dose of Rhubarb and Calomel after the Fever was over.

[15] Observations on the Diseases of the Army, part iii. chap. iv. Note to p. 213. third Edition.

It is no Wonder that Worms of the round Kind should be productive of troublesome Symptoms, and occasion these Relapses; since we know that they have sometimes perforated the Intestines, and been found in the Cavity of the Abdomen[16].

[16] See Hoffman's Works, vol. III. chap. x. River. Observ. commun. Obs. 13. of Observations found in a Library. Bonetus's Sepulchret. anatom. tom. II. Gualther van Doeveren's Inaugural Dissertation de Vermibus intestinalibus, published at Leyden, 1753; and Lancisi's Works; for Cases where the internal Coats of the Stomach, and Intestines, have been eroded, and all the Coats perforated by Worms of the round Kind.

As soon as we observed a Patient to be troubled with Worms, if his present Situation did not prevent it, we gave twenty-five or thirty Grains of Rhubarb, with five or six Grains of Calomel; and if there was much Sickness, we likewise gave an Emetic; which, in more than one Case, brought up two or three Worms of the round Kind, and gave great Relief. But where the Fever was violent, we were obliged to neglect this Symptom of Worms for the present; and when the Fever was over, if there still remained any Symptoms of Worms, we gave the purgative Medicine once or oftener, and in the Intervals gave the pulvis stanni, or an Infusion of Camomile Flowers; and in some Cases, oily Medicines. By these Means most of the Patients got well and recovered their Health, and seemed to be freed, at least for the present, from these troublesome Insects; though a few continued to complain of Sickness, and other Symptoms of Worms, for some Time afterwards.

What was the Cause of the Army's being so much troubled with Worms of the round Kind, is not easy to ascertain; unless it was owing to the great Quantity of crude Vegetables, and Fruits, which the Soldiers eat in the Course of the Summer and Autumn, and to the bad Water they were often obliged to drink.

In the Malignant Fever at Paderborn, many complained of a Dysuria, and some of a Suppression of Urine, especially towards the Decline of the Fever; and others, of a Scalding and Pain in making Water, though they had no venereal Complaint. These Symptoms appeared in other Places, but not near so frequently as at Paderborn. Decoctions of Gum Arabic, with some of the spiritus nitri dulcis, and oily Mixtures, and Opiates, commonly gave immediate Relief, and soon removed this Complaint.

One of the first salutary Symptoms which most generally appeared in those who recovered, was a Dullness of Hearing, or Deafness[17]; which came on about the Height of the Fever, and continued a longer or shorter Time, generally till the Fever was entirely gone; and sometimes for a considerable Time afterwards. For the most Part we did nothing for this Complaint, and it went off as the Patient recovered his Strength. When it continued long, Blisters applied behind the Ears, or on the Neck, and washing the meatus auditorius with the emollient Decoction, in which a small Quantity of Soap was dissolved, proved of Service.

[17] Riverius tells us, that, according to Hippocrates's Doctrine, Deafness is a very dangerous Symptom in the Beginning of acute Disorders, though it be a good Omen, and portends Health, when it does not appear till the Height of Fevers, especially those of a malignant Kind; and adds, that he himself has a thousand Times observed, that those labouring under this Fever have recovered, when this Symptom of Deafness came on at the Height (in statu) though the other Symptoms threatened much Danger. Prax. Medic. lib. XVII. sect. iii. cap. i. p. 451.

This Symptom of Deafness occurs in other Fevers as well as in this, and often proves a good Symptom in them likewise, as I have frequently observed. Two remarkable Examples of which I had under my Care in St. George's Hospital, in the Year 1759. On the 17th of January 1759, James Donaldson, a young Man of nineteen Years of Age, was admitted into the Hospital for a Fever, attended with a Stupor and a Delirium, a parched dry Tongue, and other Symptoms of a Fever of the inflammatory Kind, for which he had been blooded, and used other Evacuations. On the 19th, after the Application of a Blister, he was seized with almost an entire Deafness; after which, all his other Symptoms became milder, and he mended daily, and was entirely free from the Fever by the 30th. On the 10th of April 1759, a Youth, John Young, fifteen Years of Age, was admitted into the same Hospital for a Fever, which had already continued fourteen Days. His Speech was affected, and he had entirely lost the Use of his Limbs, was delirious, and had other bad Symptoms. On the 12th, his Hearing became exceedingly dull, and he recovered daily afterwards, and was discharged, cured, the 2d of May, having recovered the Use of his Legs as well as got free of the Fever.

Swellings of the parotid Glands appeared in many Subjects, towards the Decline of the Fever, which came to Suppuration, and proved critical. In two only, out of those I attended while in Germany, they came on early in the Fever, but did not suppurate. Both Patients died; all the rest recovered, except one old Man, an Invalid at Bremen; who, after having one Swelling appear on the right Side, which came to Suppuration, and seemed critical, relapsed into the Fever; and another formed on the other Side, which came likewise to Suppuration, and the Fever ceased, after having reduced him very low; but the great Discharge from the Sores wasted him gradually, and he died hectic in about a Month after the Fever had left him[18].

[18] But although these parotid Swellings were in general so favourable with us, we are not to imagine that this will always be the Case: for Riverius, though he speaks of these Swellings proving for the most part critical; yet he tells us, that, in the Year 1623, this Fever was epidemic at Montpelier, and that almost one half of the Sick died; and particularly, that most of those who had Swellings of the parotid Glands appearing about the 9th or 11th Day, were carried off within two Days of their Appearance. Having attended several who died from the Swellings not coming to Suppuration, he began to consider in his own Mind, what might be the Cause of their Death, and concluded, that it was owing to there being a greater Quantity of morbid Matter in the Blood than the Part was able to contain, and that Evacuations by blooding and purging were the only Remedies which were likely to give Relief; and therefore, in the first Case of this Kind, in which he was afterwards consulted, he ordered three Ounces of Blood to be taken away, notwithstanding the Patient was so low that the Surgeon was afraid he would have died in the Operation: The Pulse rose on bleeding, and he ordered four Ounces more to be taken in three or four Hours afterwards: The Pulse rose still more, and he ordered a Dose of Sena and Rhubarb to be taken next Day, and the Patient recovered. And he adds, that all those who were treated in this manner got well. Prax. Med. Lib. XVII. sect. iii. cap. 1.

As soon as these Swellings of the parotid Glands appeared, we endeavoured to bring them forward to Suppuration, by the Application of emollient Cataplasms, or of gummous Plaisters; and had them opened as soon as a Fluctuation of Matter was to be felt, and afterwards treated them as common Abscesses. Riverius[19] very justly observes, that when such Tumours encrease in such a Manner as to endanger Suffocation, they ought to be opened before they come to Maturation; and Dr. Pringle[20] desires us not to wait for a Fluctuation of Matter, but to open the Abscess as soon as it can be supposed to have formed.

[19] Ibid.

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

In February 1761, three Patients in the Decline of this Fever had Buboes formed in the Groin, which proved critical. At first, on observing them, I suspected them to be venereal; but on examining the Patients, they obstinately denied their having any Reason to suspect any such Cause; and the favourable Manner in which they healed without the Appearance of any other venereal Symptom, made me believe what they asserted to be true; especially as such People are not shy in owning Complaints of that Kind. The first Patient I saw who had a Bubo in the Decline of one of these Malignant Fevers, was a Woman, Wife to a Soldier of the thirty-seventh Regiment of Foot; she had a Child at her Breast, and her Husband was living with her at the Time she was taken ill of the Fever, and neither of them had the least venereal Complaint. In a few Days afterwards, two Soldiers in other Hospitals, towards the Decline of very bad Petechial Fevers, had likewise Buboes formed in the Groin, without any Suspicion of a venereal Taint. Except in these three, I did not see any critical Buboes appear in this Fever while I was with the Troops in Germany; tho' Mr. Lovet, who served as a Mate to the Hospitals, and who was at Hoxter, where we had another Hospital established, while I was at Paderborn, told me, that, in the Beginning of the Year 1761, they had several Men in the Hospital ill of this Fever, who had critical Buboes formed in the Groins and Armpits[21].

[21] This Symptom of Buboes is taken Notice of by Authors, but does not seem to be so frequent as many of them would make us believe. Neither Dr. Huxham nor Dr. Pringle mention their having seen such Buboes; and Dr. Lind says, that he never saw them till the Beginning of the Year 1763.

About the same Time that these Buboes appeared, severals towards the Decline of this Fever complained of a Pain all along the Spermatic Chord; and soon after a Swelling of the Testicle appeared[22]. However, this Complaint was not peculiar to those who had the Fever; for others recovering from Fluxes, and other Disorders, were likewise affected with such Swellings. I did not observe any Symptom of this Kind in Fevers while I was with the Troops in Germany, except in January, February, March, and April 1761. By Bleeding, and applying emollient Fomentations and Cataplasms, and bathing the Parts with spiritus mindereri on the first Attack of the Pain, the Swelling of the Testicle was prevented; but where no Mention was made of this Pain till the Swelling had already begun, it commonly ended in a Suppuration of the Scrotum or Testicle, which healed very kindly. We had no Reason to suspect any venereal Taint in any of them.

[22] Hippocrates takes Notice of Swellings of the Testicles in Fevers. He tells us, that a Man from Alcibiades had his left Testicle swell before the Crisis of a Fever. See his Second Book on Epidemics, sect. ii. And he mentions this Symptom as a Crisis in the ardent Fever. See his Book on Crises, sect. xi.—And Dr. Antonio Lizzari, in a Treatise which he published on the Acute Diseases which were frequent at Venice, and all over Italy, in the Years 1761, 62, tells us, that Abscesses of the Scrotum and Testicles frequently followed the Measles.

Many, while recovering from this Fever, were seized with an Ophthalmia, or Inflammation of the Eye; for the most part of one Eye only, sometimes of both. When the Patients were strong, they were blooded, and had Blisters applied behind the Ears; and sometimes, where the Pain was great, had Poultices of Bread and Milk applied to the inflamed Eye; which, with the Assistance of some cooling Physick, commonly removed this Complaint; tho' in some obstinate Cases we were obliged to repeat the Evacuations, to apply Leeches to the Temples; and after the acute State of the Disorder was passed, to order the Eye to be washed frequently with the Collyrium vitriolicum, or Collyrium Saturninum, before we got the better of this Complaint. However, it ought to be observed, that if these astringent Collyria were used too soon, they did hurt. When these Ophthalmias were neglected in the Beginning, the Inflammation frequently rose to a great Height, and left an Obscurity or Philm over the Cornea, which remained an Impediment to the Sight not to be removed.

Towards the Decline of these Fevers, and very often during the Course of them, many complained of Pains in their Feet and Toes, which sometimes ended in Mortifications, especially where the Patients lay in very cold Wards. For the most Part, the Mortification extended no further than the Ends of the Toes, tho' in some it spread over the Feet, and in two or three advanced up the Leg. Several lost one or more Toes; and in February 1761, one Man lost Half of each Foot; another lost both Feet, and Part of each Leg. Both got the better of the Fever, tho' the Man who lost both Feet languished a long time afterwards. These Pains of the Feet and Toes, and the Mortifications which followed, were for the most part owing to the Patients being exposed to too much Cold while they were very weak, the Circulation languid, and the Juices vitiated by a putrid Distemper; by which means the Vessels were rendered incapable of carrying on the Circulation in their extreme Branches[23].

[23] These Pains and Mortifications of the Feet and Toes were not confined to those who were brought low by malignant Fevers; for, during the very hard Frost in the Beginning of the Year 1763, many of the Patients who lay in very large open Wards in the Hospital at Osnabruck, were affected in the same Way. One Man had both Feet, and Part of each Leg, compleatly mortified, and died in about nine Days after the first Appearance of the Mortification. One lost half of one Foot, and some Toes of the other; and the third lost the first Joint of some of his Toes, and the Ends of others.

As soon as the Sick began to complain of these Pains of the Toes and Feet, I found the best Remedy to be, the Bathing of the Feet in warm Water, or in warm aromatic Fomentations; and, after keeping the Feet for some time in these warm Liquors, to dry them well, and then rub them with the linimentum saponaceum, or linimentum volatile, and wrap them up in Flannel. And if ever any Lividness or Redness appeared on the Parts, we gave plentifully of the Cortex and Cordials, if not contra-indicated by the other Symptoms. When Vesicles arose on the Part, and a Gangrene formed, we directed the Parts to be scarified, and proper Dressings to be applied, while warm aromatic Fomentations and Cataplasms were used.

In January 1762, one Patient, ill of the Petechial Fever at Bremen, had a Lividness and Blackness, threatning a Mortification, which appeared at the End of his Nose. I expected for some Days, that, if he recovered, he would lose Part of his Nose; but, by giving him large and repeated Doses of the cortex and confectio cardiaca, in a Mindereri Mixture, and allowing him the free Use of Wine, its further Progress was prevented; and as the Patient got clear of the Fever, the Nose recovered its natural Colour, and only the scarf Skin peeled off from the End of it.

When the Fever continued long, and reduced the Patients low, it was very common for the Back, and Parts on which the Weight of the Body rested, to mortify. As soon as any thing of this Kind was observed, we ordered such Parts to be covered with proper Dressings, and gave the Bark and Cordials freely; and took care to make the Patient change his Posture; and by Pillows prevented as much as possible the Weight of the Body from resting on that Part. By this Treatment, many recovered, where the Fever was on the Decline, and the Strength not too much exhausted; even tho' a very large Surface of the Skin had mortified; but where the Patients were very low, and the Fever still continued, or where it was complicated with a Flux, which kept them perpetually nasty, and exhausted the Strength, it generally proved fatal.

Patients, who were reduced very low by this Fever, or by repeated Relapses, were subject to oedematous Swellings; especially of the Feet, towards the Evening, after sitting up all the Day. These Swellings generally went away as the Sick recovered their Strength; but in some Cases they continued obstinate, and ascended towards the Thighs; and in some spread all over the Body, and terminated in an universal Anasarca.

When these Swellings were recent, and confined to the Feet and Legs, commonly the Bark joined to the lixivial Salts, or the Oxymel of Squills, or other Diuretics, and a Purgative once or twice a Week, removed them. In some, an Infusion of Horse-radish had a good Effect; in others, Sweats brought out by means of Dover's Powder, or of the guttae antimoniales anodynae.

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 Haemorrhages from the Nose; and some of them passed Blood likewise by Stool; which reduced them to a very low State, sometimes attended with imminent Danger. In such Cases we found nothing to answer so well as to give freely of the Bark; to acidulate their Drinks with the spiritus vitrioli; to allow them as much Red Wine as the Strength and present Circumstances could bear; and at the same Time to support the Patient's Strength by a mild Diet, of light Digestion; as Water or Rice Gruel, Panado, weak Broth, and the like. When there was a Tendency to a Diarrhoea, we were obliged to add some of the electuarium diascordii to the Cortex, and frequently to give an Opiate in the Evening. One Case, where this Method of Cure had a very remarkable good Effect, I had under my Care at Paderborn. A Soldier who lay in one of the lower Wards of the Jesuits Hospital, after a Malignant Fever, attended with a Flux, used to bleed at the Nose, to four, five, or six Ounces at a Time; and once or twice lost near a Pint of Blood, of a dark Colour, very thin and watery, and of so loose a Texture, that the grumous Part scarcely coagulated. This Evacuation brought him so low, that he could scarce turn himself in Bed; and his Pulse might be said rather to flutter than beat: By the continued Use of the Bark, and of Cordials, and Drinks acidulated with spiritus vitrioli, and some Spoonfulls of mulled Red Wine every two or three Hours, he was restored to Health and Strength. The only Accident which happened during the Cure, was a Threatening of a Looseness, and the Return of his Flux; which however was stopt by a Dose of the tinctura rhei; by joining some of the electuarium diascordii with the Bark, and giving an Opiate in the Evening.

* * * * *

Putrid Malignant Fevers, attended with Eruptions, are taken Notice of by Hippocrates[24], and other antient Authors[25]; but whether they meant that particular Sort of Eruption which we now call Petechiae, is uncertain; as their Descriptions are not clear enough to distinguish it from the Miliary and other Kinds. But since the Year 1500, we have had many accurate Accounts of Fevers of this Kind, which have appeared in different Parts of the World: from all which it appears that such Fevers generally take their Rise either from some antecedent Acrimony of the Blood; or, what is more frequent, from some Source of Corruption or Contagion; from the Use of putrescent animal Food, and a Want of fresh Vegetables and acescent Liquors; from the putrid Steams of corrupted animal Substances; from the moist putrid Vapour of low marshy Places in Summer, where there is stagnating Water, which corrupts by the Heat; from the foul Air of crowded Hospitals, Jails, and Ships; and from such like Causes[26].

[24] Hippocrat. lib ii. popul. sect. iii. text. 2.

[25] Aetius Tetrab. ii. sect. i. cap. 129. Actuar. lib. i. cap. 23.

[26] See these Causes mentioned by Riverius, and since more fully explained by Dr. Pringle, Observations on the Diseases of the Army, part iii. chap. vii.

When once this Fever begins, it is observed to be of a contagious Nature, and (if proper Care is not taken) to affect those who attend the Sick, or who live in the same Room, and breathe the same Air with them.

Many Authors have reckoned the Malignant, Petechial, and Pestilential, to be distinct Species of Fevers; and have treated each of them under a particular Head. But Riverius[27] has very justly observed, that they all belong to the same pestilential Tribe, and only differ from one another in the Degree of Infection, and the Violence of the Symptoms[28]; and that they are to be cured by the same general Treatment, and the same Medicines.

[27] River. Prax. Med. lib. xvi. sect. iii. Praefat.

[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 Petechiae do not always appear; but when they do, it is a most certain Sign of a Pestilential Fever. See his Prax. Med. cap. xvi. sect. iii.



OF THE DYSENTERY.

The Dysentery generally began to appear soon after the Army took the Field; and became frequent about the End of July, and continued so till the Army went into Winter-Quarters; and through the Winter, many of those, who had this Disorder in Autumn, relapsed, upon returning to their Duty; or by drinking too freely of spirituous Liquors, and being irregular in their Living.

It is now generally agreed upon, that this Disorder is entirely produced by such Causes as make the Juices become too putrescent, and turn the Flow of Humours to the Bowels; and in the Camp it seemed to arise principally from an obstructed Perspiration caused by the Men's lying in the Field, and doing the necessary Military Duties in all Sorts of Weather; at the same Time being often exposed to the putrid Steams of dead Horses, of the Privies, and of other corrupted Animal or Vegetable Substances[29], after their Juices had been highly exalted by the Heat of Summer.

[29] The Dysentery has been long alledged to arise from a putrescent Cause in Camps; from the Smell of corrupted dead Animals, and of Excrements, during the Heat of Summer. Ramazini, in his Chapter on Camp-Diseases, informs us, that Dr. G. Erric Barnstorff, Physician to the Duke of Brunswick, who served five Campaigns with the Brunswick and Lunenburg Troops in Hungary, told him, that the Camp Diseases, particularly the Malignant Fever and Dysentery, took their Rise from the Troops remaining long encamped on the same Ground, and being exposed to the corrupted Steams of the Bodies of dead Men, Horses, and other Animals, which lay unburied; and of Excrements, which were not covered with Earth. And these Causes have since been particularly taken notice of by Dr. Pringle, in his Observation on the Diseases of the Army.

Many have imputed the Cause of this Disorder to the eating of Fruit in excess, because it generally appears about the Middle of Summer, the Time the Fruit begins to be in Season, and continues through the Autumn. But from later Observations this should seem to be a vulgar Error. Dr. Pringle (part i. ch. iii. p. 20.) tells us, that, in the Year 1743, this Sickness began and raged before any Fruit was in Season, except Strawberries, (which from their high Price the Men never tasted) and ended about the Time the Grapes were ripe; which growing in open Vineyards were freely eat by every body. And Dr. Tissot, in a Treatise which he published, called Avis au Peuple sur la Sante, in his Chapter on the Dysentery, Sec. 320, says, that ripe Fruit, especially the Summer-Fruits, are so far from being the Cause of the Disorder, that they are the great Preservatives against it: he says, that, in the Years which the Fruit is most plentiful, the Dysentery is least frequent; and he relates several Instances where the Use of ripe Grapes proved a Cure for the Disorder. Eleven People were attacked by the Dysentery, nine eat Fruit, and all recovered; the other two, a Grandmother and Child, from Prejudice, eat none, and both died. A Regiment of Swiss Soldiers, in Garrison in the South of France, had the Dysentery very frequent among them. The Captains purchased some Acres of a Vineyard, and carried the sick Soldiers to the Field, and gave them the Grapes to eat; and ordered the Men in Health to live upon them chiefly. After this not one Person died, nor was any one seized with the Distemper.—In an Account of a Treatise on the Dysentery, published at Hamburg in 1753, which was epidemical the Year before, in August and September, we are told, that it did not proceed, as is commonly believed, from the eating of Fruit; for it was observed, that those who eat Fruit freely escaped better than those who abstained from it altogether. Vide Comment. de Rebus in Hist. Nat. & Medecin. Gestis, vol. II. par. iv. sect. v.

Generally in August and September we have People admitted into St. George's Hospital for the Dysentery; who have certainly not catched the Disorder from eating of Fruit, but from working in the Fields, and being exposed to Causes similar to those which produce the Dysentery in Camps.

At the Time the Petechial Fever was frequent at Paderborn in January, February, and March 1761, the Flux frequently accompanied it; and we had in the Hospitals likewise a Number of old Cases of this Kind, the Remains of the preceding Campaign about Warbourg; besides some Men who had relapsed during the Winter, and were sent to us when the Troops marched, upon the Winter-Expedition, into the Country of Hesse. In May and June, what Fluxes we had at Osnabruck, were the remaining old Cases of the Hospitals of Munster, Paderborn, Hoxter, and Niehms. Some few recent ones were sent to Bilifield about the End of June, and above 300 to Munster, in July and August. Those sent to Bremen, in November and December, had continued for some time before they reached us; but a good many of the Soldiers in the Garrison were taken ill of this Disorder, and sent immediately to the Hospital. In the Beginning of May we had but four ill of this Complaint in the Hospital I attended; and there were not above six or seven, among the Sick sent down from the Army, in the Middle of this Month. In June there were but two sent to the Hospital at Minden; and not above ten among the Sick sent to Natzungen in the Beginning of July; tho' towards the Middle of this Month they began to be more frequent; and continued to be more so in August and September; and in the Hospital at Osnabruck we had not above five or six ill of this Disorder, in December 1762, and in January, February and March 1763.

The Dysentery commonly begun with Sickness and Gripes, succeeded by a Purging, and attended with more or less Fever. Very soon the Gripes became more severe, attended with a Flatulency in the Bowels, and often with a Tenesmus. The Stools were chiefly composed of Mucus, mixed with Bile, and more or less Blood: tho' sometimes no Blood could be observed in them; and then the Soldiers used to say they had the White Flux.

After eight, ten, or twelve, Days, if the Disorder was not complicated with any other, there remained little or no Fever, unless where some Accident supervened; tho' in Cases which terminated fatally, towards the latter End came on a Fever of a low malignant Kind, attended with black fetid Stools, Lientery, Hiccup, Stupor, and other bad Symptoms.

It often happened, that, after the Dysentery had continued for some Time, the Sick complained for a Day or two of severe Gripes; and then discharged along with the Stools little Pieces of hardened Excrements; at other Times, tho' more rarely, little Pieces of white Stuff like Tallow or Suet: Frequently small Filaments, and little Pieces of Membranes, were found floating in the Stools; and it was very common for the Sick to vomit up Worms of the round Kind, or discharge them by Stool[30].

[30] Most Authors, who treat of the Dysentery, mention this Symptom of Worms; and Dr. Huxham tells us, that, in some Seasons, he has seen round Worms in the Stools of most of the Dysenteric Patients. De Aere, vol. II. p. 98.

In the Course of the Disorder, the Men often complained of a violent Pain of the Rectum, near the Fundament, which was most excruciating when they went to Stool; it continued for some Days, sometimes for a Week or more; and then they passed more or less of a Yellow Pus with their Excrements, and the violent Pain ceased. Mr. A. Tough, one of the Apothecaries to the Military Hospital in Germany, was the first who told me that I should find Pus mixed with the Stools: on my mentioning a Case of this Kind, which had been relieved by Bleeding, and Clysters often repeated; he told me he had observed it frequently at Gibraltar; and was at a Loss to understand the Nature of the Symptom, till he observed the Matter in the Stools; which at once shewed him that it had been originally an acute Inflammation of the Part, and pointed out to him the proper Method of Cure.

Oftentimes the Bilious and Malignant Fevers terminated in the Dysentery; or were accompanied with it, when it might be looked upon as a Symptom of these Fevers.

The Appearances we found after Death in the Bodies of some Patients, who died of old Fluxes at Bremen, were: In all of them the Rectum was inflamed, and partly gangrened, especially the internal Coat. In two the lower Part of the Colon was inflamed, and there were several livid Spots on its great Arcade. In one whose Body was much emaciated, and who had been seized with a violent Pain of the Bowels two Days before his Death, all the small Guts were red and inflamed; and in another there were livid gangrened Spots on the Stomach[31].

[31] From the Accounts we have in Authors, of the Dissection of the Bodies of Persons who died of the Dysentery, it would appear; that there is no Part of the alimentary Canal which has not some time or other been found inflamed, or in a state of Suppuration or Gangrene; and the Liver, Spleen, and other Viscera, have likewise been found diseased, but the Rectum and Colon have almost in all been more or less affected. The following Account I had, in the Year 1748, from the late Dr. L. Fraser, who afterwards practised in the Island of Nevis, two Days after the Patient died. Mary Reid, a Woman thirty Years of Age, was taken ill of a Dysentery, which in Three Weeks Time killed her. In her Life-time she complained, more than ordinary, of Gripes in her Belly, especially in her Left Side. Her Body was opened in Presence of Dr. Dundas, who had attended her, during her Illness. All the Intestines and Mesentery were inflamed, especially the Colon and Rectum; the internal Side of which was quite in a mortified State, and contained little Vesicles full of a putrid fetid Liquor, Numbers of which she had evacuated by Stool some Days before her Death.

There was no Disorder we were more successful in the Cure of, than recent Fluxes; but after they had continued for Weeks, and were become in a manner chronic, they often foiled all our Endeavours, and a great Number died[32].

[32] While this Sheet was in the Press, I received Dr. Pringle's 4th Edition of his Observations on the Diseases of the Army, and Dr. Baker's Treatise on the Dysentery which was epidemic in London in the Year 1762. Both these Gentlemen give an Account of the Dissection of the Bodies of some People who died of the Dysentery; where, besides the common Appearances of the inner Surface of the Rectum and Colon being covered with a bloody Slime, and their internal Coats being inflamed, gangrened, or in a putrid State, there were observed on the Inside of the lower Part of the Colon, and upper Part of the Rectum, a Number of little Tubercles, or Excrescences, which resembled the Small Pox, of a flat Sort at the Height of the Disorder; but differed from them in this, that they were of a firm Consistence, without any Cavity: they were believed to take their Rise from the cellular Membrane, which lies immediately above the villous Coat. Perhaps such Tubercles might have been found in the Colon and Rectum of those Bodies we opened; but not looking for them, they may have passed unobserved.

Morgagni, in his Book lately published, de Sede & Causis Morborum, epist. xxxi. is of Opinion, that the Filaments, and Pieces of Membranes, which are frequently observed in the Stools, are often formed of inspissated Mucus and Lymph, and other Liquors; and not the Fibres, or Pieces of the villous Coat of the Intestines, as alledged by many Authors.

Upon my first being employed in the Military Hospitals in Germany, I was surprised to see so many of the old Dysenteric Cases end fatally; and imagined I had not fallen upon the Right Method of treating them: but upon consulting the other Physical People[33] employed in the same Service, I found them as unsuccessful, as myself, after having tried a Variety of Remedies: And at last, I was convinced, that when once the Flux had continued long, and injured the Structure of the Intestines to a certain Length, a Gangrene will often form by slow Degrees; and the Disorder end fatally, notwithstanding the Use of what are esteemed the most efficacious Remedies; and that, when this Disorder is violent, the Cure principally depends upon an early and speedy Application of proper Remedies, before the Strength be exhausted, or the Structure of the Bowels too much hurt. The bad Success we had in treating these old Cases, may perhaps surprise those who have never practised except in healthful Cities, where the Disease is commonly mild, and People apply soon for Advice. But all those Gentlemen who have had the Care of Military Hospitals, where the Dysentery has been frequent, and where the Sick have been often sent a great Way, before they reached the Hospitals, must be convinced of the Truth of what is here asserted.

[33] Mr. Cleghorn, in his Account of the Diseases of the Island of Minorca, says, "That almost all the Dysenteries which fell under my Observation, unless they were speedily cured in the Beginning, at best proved obstinate, and too frequently fatal, in spite of the many boasted Specificks for this Distemper." chap. v. p. 228.—The physical Gentlemen employed on the American Service have told me, that the old Flux Cases were as fatal in America, as we found them in Germany. I would not from thence have it believed, that every old Flux was to be looked on as a lost Case; and for that Reason given up, and no Attempts be made to cure it; for many, by great Care, and Strength of Constitution, have gradually surmounted the Disorder, and recovered their Health; especially when they got over the Winter, and lived till the warm Weather began.

In the Treatment of this Disorder, as well as of the Malignant Fever, nothing contributed more to the Cure, than keeping the Sick as clean as possible, and in large airy Wards.

Most of the recent Fluxes, which I saw, were at first attended with a good deal of Fever, and Pain in the Bowels; and required more or less Blood to be taken away, according to the Strength of the Patient, and the Violence of the Symptoms.

When the Patients were strong, and complained of sharp Pain of the Bowels, attended with a Fever, we used the Lancet freely, nor were we discouraged from bleeding in the Beginning by the low quick Pulse which often attended the Disorder; and we frequently found the Pulse rise as the Blood flowed from the Vein. But when the Sick were low and weak, without much Pain or Fever, and the Pulse was soft, we were more sparing of the vital Fluid[34].

[34] Although Bleeding, in the Beginning, has been recommended by Sydenham, Huxham, Pringle, and other Practitioners; yet it has been reckoned unnecessary in this Disorder by some late Authors. But in most of the recent Cases I saw, it was extremely necessary, and contributed greatly to the Relief as well as the Cure of the Patient; indeed where the Disorder had already continued some time, and the Fever was gone off before the Patient was sent to us; and the Disorder had become in a manner chronic, and the Patient low, then bleeding was unnecessary, and would have probably done Hurt. Mr. Francis Russel told me, that when the Dysentery was epidemical at Gibraltar, in Summer 1756, he found that by bleeding such Patients as he met with at the first coming on of the Symptoms, and by giving them immediately a Vomit, and afterwards a sudorific Draught, the Disorder was rendered mild, and few of those died.

As the Disorder was for the most part attended with Sickness in the Beginning, we gave a Vomit after bleeding; which not only discharged the Contents of the Stomach, and a Quantity of Bile, but relieved the Sickness, and frequently threw the Patient into a breathing Sweat; and made the Purgatives which were given next Day operate more freely, and with more evident good Effects than where no Vomit had been administered.—If in the Course of the Disease the Sickness returned, the Emetic was repeated; and we often observed, when the Flux was obstinate, that well-timed Vomits greatly promoted the Cure.—The Vomit we commonly employed was the Powder of Ipecacuana, which we gave from ten to twenty Grains; and where the Patient was strong, and we wanted to make a free Evacuation, we added one, two, or three Grains of the Tartar Emetic; which encreased the Strength of the Vomit, and commonly operated likewise by Stool[35], as Dr. Pringle has observed.

[35] Mr. W. Russel, who was with the Hospital at Martinico, told me, that, when he was there, he found the Vomit with the Tartar Emetic to be far preferable to any other, in all Cases where there was much putrid Bile lodged in the alimentary Canal; as it speedily carried off those corrupt Humours, which were often productive of the greatest Mischiefs, if they remained, but for a short Time, pent up within the Bowels.

Next Day we ordered a Purge to empty the other Parts of the alimentary Canal. The Purgative, that at first was most employed for this Purpose, was Rhubarb; but upon repeated Trials we did not find, that, in general, it answered so well, in this first Stage of the Disorder, as the sal catharticum amarum, with Manna and Oil; which operated without griping or disturbing the Patient, procured a freer Evacuation, and gave greater Relief than any other purgative Medicine we tried. Mr. Francis Russel, Surgeon to the British Military Hospital in America, who was formerly Surgeon to the Island of Minorca, was the first Person who informed me (in the Year 1757) of the Use of the sal catharticum amarum in the Dysentery; he told me, that the Year before (1756) the Dysentery had been very frequent and very fatal at Gibraltar; and, after trying Variety of Medicines, he had found nothing give more Relief, or contribute more to the Cure, than repeated Doses of these Salts.

As a great Part of the Cure depended on the frequent Use of gentle Purges[36] in the Beginning, to carry off the corrupted Humours; the Purgative was repeated every second, third, or fourth Day, as the Case required; the Operation of the former Purge, and the Symptoms, determining the Frequency of the Repetition. It was surprising with how little Loss of Strength the Sick bore the Operation of these Purges; I have sometimes given them to strong People every Day, for two, three, or four Days successively; and observed that the Patient, instead of being weakened, seemed stronger, and more brisk and lively, after the Operation of each, from the Relief it gave; by evacuating those putrid, corrupted Humours, which kept him perpetually sick and uneasy, while they remained within the Bowels.

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