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+The Project Gutenberg EBook of An Account of the Diseases which were most
+frequent in the British military hospitals, by Donald Monro
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: An Account of the Diseases which were most frequent in the British military hospitals in Germany
+
+Author: Donald Monro
+
+Release Date: February 21, 2010 [EBook #31338]
+
+Language: English
+
+Character set encoding: UTF-8
+
+*** START OF THIS PROJECT GUTENBERG EBOOK BRITISH MILITARY HOSPITALS ***
+
+
+
+
+Produced by Irma Spehar and the Online Distributed
+Proofreading Team at http://www.pgdp.net (This file was
+produced from images generously made available by The
+Internet Archive/Canadian Libraries)
+
+
+
+
+
+
+                                  AN
+                                ACCOUNT
+                                OF THE
+                               DISEASES
+
+                    Which were most frequent in the
+
+                      BRITISH MILITARY HOSPITALS
+
+                              in Germany,
+
+             From January 1761 to the Return of the Troops
+                       to England in March 1763.
+
+                          To which is added,
+
+            An ESSAY on the Means of Preserving the Health
+            of Soldiers, and conducting Military Hospitals.
+
+
+                         By DONALD MONRO, M.D.
+
+                PHYSICIAN to his MAJESTY’S ARMY, and to
+                        ST. GEORGE’s Hospital.
+
+
+                                LONDON:
+
+           Printed for A. MILLAR, D. WILSON, and T. DURHAM,
+            in the Strand; and T. PAYNE, at the Mews-Gate.
+
+                               MDCCLXIV.
+
+
+
+
+TO THE KING.
+
+
+May it please Your MAJESTY,
+
+To permit me to lay at your Feet the following Sheets, published with
+a View to be useful to those, who hereafter may have the Care of the
+Health of your MAJESTY’s Troops.
+
+YOUR MAJESTY’s particular Inquiries into the State of Your Military
+Hospitals, in every Quarter of the World, in the Time of the late
+glorious and successful War; Your Concern for every Officer and
+Soldier who suffered either by Sickness or by Wounds in the Cause of
+their King and Country; and Your Solicitude to procure them every
+possible Assistance and Relief, cannot fail to excite the highest
+Admiration of Your MAJESTY’s Goodness in the Breast of every Subject,
+and the warmest Gratitude in the Heart of every Soldier.
+
+The Knowledge of these Circumstances induced me to flatter myself,
+that a Work of this Kind would be agreeable to Your MAJESTY; and
+should this Attempt towards pointing out the Means of alleviating
+those Miseries, which necessarily attend a Military Life in the Time
+of Service, be acceptable, I shall obtain the utmost of my Wishes; it
+being the greatest Ambition of my Heart ever so to act as to merit
+Your MAJESTY’s Approbation, and to subscribe myself,
+
+      May it please Your MAJESTY,
+
+    Your MAJESTY’s most dutiful Subject,
+
+        And most faithful
+
+          and humble Servant,
+
+      DONALD MONRO.
+
+
+
+
+THE PREFACE.
+
+Among the numerous Authors of Observations in the Art of Physick,
+there are but few who have expressly written on the Treatment of those
+Distempers, most generally incident to an Army in the Field: The
+following Work, therefore, seems to have a fair Claim to be acceptable
+to the Publick, having been compiled during the Author’s Attendance on
+the _British_ Military Hospitals in _Germany_ in the late War; and in
+order to render it of still further Use, he has occasionally added, by
+Way of Note, the Practice of some of the most eminent Physicians in
+similar Diseases, as well as a few Histories of Cases which passed
+under his own Care at _St. George_’s Hospital, _London_.
+
+To avoid the Repetition of the Composition of particular Medicines,
+and the Interruption that would be given by their being inserted in
+the Body of the Work, a small 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.
+
+                                                                      PAGE.
+
+Of the Malignant and Petechial Fever,                                    1
+
+Of the Dysentery,                                                       57
+
+Of the Cholera Morbus,                                                  97
+
+Of the Inflammatory Fever,                                             104
+
+Of the Angina,                                                         109
+
+Of the Pleurisy,                                                       111
+
+Of the Peripneumony,                                                   115
+
+Of the Cough and Consumption,                                          124
+
+Of the Epidemical Catarrhal Fever of _April_ 1762,                     137
+
+Of the Rheumatism,                                                     141
+
+Of the Autumnal Remitting Fever,                                       154
+
+Of the Intermitting Fever, or Ague,                                    179
+
+Of the Jaundice,                                                       206
+
+Of Tumours of the Breast,                                              216
+
+Of Paralytic Complaints,                                               219
+
+Of an Incontinency of Urine,                                           223
+
+Of a Stoppage of Urine,                                                227
+
+Of the Epilepsy,                                                       237
+
+Of the Small-Pox,                                                      243
+
+Of Erisypilatous Swellings,                                            245
+
+Of the Scurvy,                                                         250
+
+Of the Itch,                                                           265
+
+Table of Diet used in the _British_ Military Hospitals in _Germany_,   273
+
+
+PHARMACOPOEIA in usum Nosocomii militaris regii Britannici 1761,       275
+
+
+OF THE MEANS of Preserving the Health of Soldiers on Service,          309
+
+---- in Winter, and in cold Climates,                                  313
+
+---- aboard of Transport Ships,                                        323
+
+---- in warm Climates,                                                 331
+
+Of healthful and unhealthful Grounds for the Encampment of Troops,     338
+
+Of keeping Camps clean,                                                344
+
+Of supplying an Army with Straw and with Provisions, and obliging
+  the Soldiers to buy a certain Quantity of Meat daily,                346
+
+Of Water, and the Means of correcting its bad Qualities in Camps,      348
+
+Of vinous and spirituous Liquors,                                      350
+
+Of keeping Men healthful in Quarters after an active Campaign,         354
+
+
+Of MILITARY HOSPITALS,                                                 355
+
+Of the Manner in which the Antients disposed of their Sick
+  and Wounded,                                                         356
+
+Of the Hospitals wanted for an Army acting on a Continent,             357
+
+Of the Houses most fit for Hospitals,                                  361
+
+Of fitting them up, and distributing the Sick in them,                 363
+
+Of preventing infectious Disorders from being generated or
+  spreading among the Sick,                                            366
+
+Of the Diet of Military Hospitals,                                     372
+
+Of providing the Flying Hospital,                                      380
+
+Of Hospitals on Expedition Service,                                    380
+
+Of a Guard for Hospitals,                                              382
+
+Of the Nurses and Patients, and Orders for them,                       383
+
+Of a convalescent Hospital,                                            389
+
+Of the Physicians, Surgeons, Apothecaries, and Mates,                  393
+
+Of the Direction of Military Hospitals,                                394
+
+Of the Purveyor or Commissary of the Hospital,                         396
+
+Orders for the Mates,                                                  397
+
+Of Precautions for guarding against infectious Disorders,              400
+
+Of a Military Inspector and Officers on convalescent Duty,             403
+
+
+ERRATA CORRIGENDA.
+
+Page 13, line 11, for _Pleuretic_, read _Pleuritic_.
+
+     18,      10, of Notes, for _Acadamy_, read _Academy_.
+
+     28,      22, for _Cinamon_, read _Cinnamon_.
+
+     35,       5, of Notes, for _Calomile_, read _Calomel_.
+
+     51,      12, dele _used in this Way_.
+
+    166,      12, of Notes, for _which almost depend_, read _which almost
+                  always depend_.
+
+    207,      13, of Notes, for _Vena postarum_, read _Vena portarum_.
+
+    259,       4, for _appeared_, read _appear_.
+
+    261,       1, of Notes, for _became_, read _become_.
+
+    280,      20, for _Chamamel_, read _Chamæmel_.
+
+    290,       4, for _3tis 4tiis_, read _3tiis 4tis_.
+
+    293,      13, for _Mithridatum_, read _Mithridatium_.
+
+    336,      12 & 13, for _bathe themselves as often_, read _bathe early
+                       in the Morning as often_.
+
+    352,       7, for _in Bilanders_, read _and were to go in Bilanders_.
+
+    353,       2, for _the least Appearance of the Malignant Fever_, read
+                  _the Malignant Fever appearing_.
+
+
+
+
+OF THE MALIGNANT and PETECHIAL FEVER.
+
+
+A Malignant Fever, and Fluxes, began to appear among the Soldiers in
+Autumn, 1760, while the Allied Army remained encamped about
+_Warbourg_, from the Beginning of _August_ till the 13th of
+_December_, when they went into Cantonments. During that Time, there
+had been a continued Rain for some Months, and the Camp and
+neighbouring Fields, and Villages, were not only filled with the
+Excrements of such a numerous Army, but likewise with infinite Numbers
+of dead Horses, and other dead Animals, which had died in doing the
+necessary military Duties, and in bringing Forage, Provisions, and
+other Necessaries, to the Camp: besides this, the Field where there
+had been an Action on the 31st of _July_, and where many of the Dead
+were scarce covered with Earth, was in the Neighbourhood of the Camp.
+
+Not only the Soldiers, but the Inhabitants of the Country, who were
+reduced to the greatest Misery and Want, were infected with the
+Malignant Fever, and whole Villages almost laid waste by it.
+
+Such a Number of Soldiers was sent to _Paderborn_ as crowded the
+Hospitals there, and increased the Malignancy of the Distempers so
+that a great many died.
+
+When I arrived at _Paderborn_, in the Beginning of _January_ 1761, the
+Fever was upon the Decline in the General Hospitals, though it was
+still rife; but by sending off a Party of Convalescents to
+_Hervorden_, which thinned the Hospitals, it became less frequent, and
+but few died. The Guards marched upon the Expedition into _Hesse_, on
+the eleventh of _February_, which gave us full Room for billetting all
+our Convalescents, and thinning the Wards; by which Means the Fever
+almost entirely ceased in all the Hospitals we had before they went
+away; though there still remained about four hundred sick.
+
+When the Guards marched out of _Paderborn_, they left the Care of
+their Sick to us, who belonged to the General Hospital: the first
+Regiment of Guards left sixty sick; the second, twenty-nine; the
+third, twenty-eight; and the Granadiers, fifteen, in their regimental
+Infirmaries; who were mostly ill of the Malignant Fever: amongst whom
+the Infection was so very strong, that, although I procured the Sick
+new airy Houses for Hospitals, which were kept as clean and well-aired
+as possible, and procured clean Bedding, and clean Linen for every
+Man, and had the Sick laid thin, yet several died, and it was some
+Time before we got entirely free of the Infection. The first and third
+Regiments suffered most, owing to all the Sick of each Regiment being
+put into a particular Hospital by themselves, which kept up the
+Infection, so that they lost one-third of those left ill of this
+Fever; and many of the Nurses, and People who attended them, were
+seized with it. But not being able to procure particular Houses for
+the Sick of the _Coldstream_ or Second Regiment, and for the
+Granadiers, I distributed them through the different Hospitals we had
+then in Town, where the Contagion had ceased; and by their being thus
+scattered, while they were kept very clean, and at as great a Distance
+as possible, from the other Patients in the Wards where they were put,
+they lost few in Proportion to the first and third Regiments, and the
+Disorder did not spread.
+
+About the End of _May_, the Weather was very warm at _Osnabruck_; when
+this Fever began to make its Appearance in the Corner of a large Ward,
+which was next to one kept for salivating venereal Patients; and only
+divided from it by means of a few thin Deals. Perceiving a strong
+Smell in this Place, I suspected that the Fever arose from the foul
+Steams coming from the next Ward, and therefore ordered the salivating
+Ward to be thinned, and removed all the Sick from the Places near that
+Ward; and ordered those that had catched the Fever to be put into
+large airy Places; by which means the Infection spread no further,
+and only one, out of six or seven who had got the Fever, died.
+
+At the End of _June_, the Weather was very hot at _Bilifield_, and the
+Fever began to shew itself by the Hospital being overcrowded, by a
+greater Number of Sick being sent from the Army than we had proper
+Places to put them in; but it was put a Stop to in a few Days, by the
+Removal of the Hospital. Seventy Sick were left behind to the Care of
+a Mate, most of them ill of the Fever, of whom twelve died.
+
+In the Beginning of _August_, a few Men were taken ill of the same
+Fever at _Munster_, in one of the Hospitals which was too much
+crowded; but its further Progress was stopped by sending a Number of
+recovered Men to Billet.
+
+In _November_ and _December_ 1761, and _January_, _February_, and
+_March_ 1762, we had several Men sent from Quarters in the Town of
+_Bremen_ to the Hospital, sick of the Petechial Fever: they were
+quartered on the Ground-floors of low damp Houses, and fresh Meat and
+Vegetables so dear that they could not afford to buy them; but were
+obliged to live mostly on salt Provisions. I was told likewise that
+the spotted Fever was frequent among the lower Class of the
+Inhabitants. Some few were seized with this Fever in the Hospital
+itself; yet as the House was not crowded, and we had a Number of small
+airy Wards, the Infection did not spread; and we had but one or two
+who died of this Fever during the Winter, in the Hospital I attended.
+
+In Summer 1762, we had only ten or eleven ill of this Fever in the
+Hospital at _Natzungen_, and only one died.
+
+When the Troops marched from their Cantonments, in _December_ 1762,
+towards the Borders of _Holland_, the twentieth and twenty-fifth
+Regiments of Foot left behind them, at _Osnabruck_, thirty sick; five
+of whom had Symptoms of the Hospital Fever, though no Petechiæ
+appeared; three recovered, and two died suddenly, being lodged in
+large open Wards (the only Places we had to put them in) with the
+Windows all broke, in very cold frosty Weather.
+
+In _January_ 1763, we had only three Patients in this Fever, with the
+Petechiæ upon them, who all recovered. After this we had none taken
+ill of it at _Osnabruck_, while I remained there, which was till the
+twenty-fifth of _March_.
+
+This Malignant Fever begun variously in different Subjects; for the
+most part with Cold and Shivering, Pain in the Head, and other
+Symptoms, commonly described as peculiar to this Fever. In some, it
+begun with a sharp Pain of the Side, or other Parts, attended with
+acute inflammatory Symptoms; in others, it put on the Appearance of
+the common, low, or nervous Fever, for a Day or two. Blood drawn in
+the Beginning from some Patients did not seem much altered; from
+others it threw up a strong inflammatory Buff[1]; but where the Fever
+had continued some time, it was commonly of a loose Texture, and of a
+livid Colour; unless when the Sick were accidentally seized with
+pleuritic Stitches, or other Disorders of this kind.
+
+    [1] Dr. _Huxham_, in his _Treatise on the ulcerous sore
+    Throat_, p. 36, says, “I have very often met with this buffy
+    or sizy Appearance of the Blood in the Beginning of Malignant
+    Fevers; and yet, Blood drawn two or three Days afterwards,
+    from the same Persons, hath been quite loose, dissolved, and
+    sanious as it were.” And in his _Essay on Fevers_, chap.
+    viii. p. 108. says, “The first Blood frequently appears
+    florid; what is drawn twenty four Hours after, is commonly
+    livid, black, and too thin; a third quantity, livid,
+    dissolved, and sanious. I have sometimes observed the Crasis
+    of the Blood so broke as to deposite a black Powder, like
+    Soot, at the Bottom, the superior Part being either a livid
+    Gore, or a dark green, and exceedingly soft Jelly.”
+
+The Reason of this Difference of Symptoms in the Beginning, and of
+these different Appearances of the Blood, seemed to be, that such
+Patients as laboured under Pleurisies, low or other Fevers, being
+brought into Hospitals where the Malignant Fever was frequent, had
+their original Disorders changed into this Fever by breathing a foul
+infected Air, and by their Communication with those ill of the Fever,
+and of Fluxes; at other Times, a mere Acrimony of the Blood, set in
+Motion by a supervening Fever, determined the Disorder to be of this
+kind: and I always observed, that those Men were most apt to catch
+this Fever, whose Constitutions had been broke down by previous
+Disorders.
+
+The Fever appeared in different Forms. Some had only a Quickness of
+the Pulse, attended with a slight Head-ach and Sickness, Whiteness of
+the Tongue and Thirst, and a Lowness and Languor; which continued for
+a Week or more, and then went off, either insensibly, or with a
+profuse Sweat, succeeded by a plentiful Sediment in the Urine. Most of
+those who fell into profuse kindly-warm Sweats recovered, the Sweat
+carrying off the Fever. These profuse Sweats continued for twelve or
+twenty-four Hours, and sometimes for two, three, or four Days. In
+those who had the Fever in this slight Degree, the Petechiæ seldom
+appeared; and it was only known to be this sort of Fever by the other
+Symptoms, and the Malignant Fever being frequent at that time in the
+Hospitals. Dr. _Pringle_[2] very justly observes, “That these low
+Degrees of this Fever are hardly to be characterised, and are only to
+be discovered, in full Hospitals, by observing Men languish; though
+the Nature of the Illness, for which they come in, should seem to
+admit of a speedier Cure.”
+
+    [2] _Observations on the Diseases of the Army_, part III.
+    chap. vii. sect. 3. third Edition, 1761.
+
+For the most Part the Fever appeared with more violent Symptoms, the
+Tongue became more parched and dry, more or less of a Delirium came
+on, attended with the other Symptoms commonly described as peculiar to
+this Fever.
+
+When the Petechiæ appeared, they came out on the fourth, fifth, sixth,
+or seventh Day; seldom after the eleventh or twelfth[3]. They appeared
+mostly on the Breast, Back, Arms, and Legs, and sometimes, tho’
+rarely, on the Face. They had exactly the Appearance described by Dr.
+_Pringle_, either like small distinct Spots of a reddish Colour, or
+the Skin looked sometimes as if it had been marbled, or variegated as
+in the Measles, but of a Colour more dull and lured. As they began to
+disappear, they inclined to a dun or brown Colour, and looked like so
+many dirty Spots. I never saw them rise above the Skin; nor did I once
+see any miliary Eruptions in this Fever; which agreed exactly with
+what Dr. _Pringle_ had observed in the former War, and in the
+Beginning of this; however, we ought not to conclude from thence that
+miliary Eruptions are never observed in Fevers of this kind; for Dr.
+_Huxham_[4], Dr. _Hasenohrl_[5] and Dr. _Lind_[6], besides many other
+good Practitioners, mention their having seen them.
+
+    [3] _Ramazini_, in his Treatise _De Constitutionibus
+    annorum_, 1692, 3, 4, _in Mutinensi civitate_, Sect. 19.
+    mentions the Petechial Fever which had been frequent the
+    three foregoing Years; in which the Petechiæ appeared
+    commonly on the fourth or seventh Days, and almost all those
+    died in whom they appeared on the first Day. These Spots came
+    out first on the Neck, the Back and Breast; and it was
+    observed that none escaped unless these Spots extended
+    themselves as far as the Nails of the Toes, vanishing by
+    Degrees on the upper Parts. He tells us likewise, that this
+    Fever was attended with an Inflammation of the Throat, which,
+    about the Height of this Disorder, terminated in a white
+    ulcerous Crust. This sore Throat should seem to be the same
+    which we now call _the malignant ulcerous sore Throat_, which
+    I never once saw while I was with the Troops in _Germany_.
+
+    [4] Dr. _Huxham_, in his _Essay on Fevers_, ch. viii. p. 97,
+    tells us, that sometimes, about the eleventh or twelfth Day,
+    on the coming on of profuse Sweats, the Petechiæ disappear,
+    and vast Quantities of small white miliary pustules break
+    out.
+
+    [5] Dr. _Hasenohrl_, in his Treatise _De Febre Petechiali_,
+    cap. i. p. 12. relates a very particular Case, where the
+    Petechiæ appeared on the fourth, and the white miliary
+    Eruptions on the seventeenth Day of the Fever.
+
+    [6] Dr. _Lind_, in his _second Paper on Fevers_, p. 105.
+    mentions Spots which rise above the Surface of the Skin, and
+    are of the miliary kind, as common in contagious Fevers, as
+    he observed among the _French_ Prisoners in _Winchester_
+    Castle, in the Beginning of the Year 1761.
+
+Many had no Petechiæ through the whole Course of the Disorder; but in
+all who were very bad, the Countenance looked bloated, and the Eyes
+reddish and somewhat inflamed; and though the Skin was commonly dry,
+yet the _Perspiration from the Lungs_ was strong. By these
+Circumstances one might frequently discover that the Patient laboured
+under the malignant Fever, without asking any Questions.
+
+       *       *       *       *       *
+
+When Men were taken ill of a Fever, which we suspected to be of the
+malignant kind, our first Care was to lay them in airy Places,
+separate as much as possible from the other Men, and to keep them
+extremely clean; and they were put on low Diet, and allowed as much
+Barley or Rice-water as they chose to drink, which was commonly
+ordered to be acidulated with the _Spiritus Vitrioli_.
+
+For the first two or three Days we could seldom distinguish, with
+Certainty, that the Fever was of the malignant kind, though we had
+often Reason to suspect it. The Pain of the Head, the Fulness and
+Quickness of the Pulse, and other Symptoms, led us commonly to take
+away more or less Blood, which the Patient bore easily, and for the
+most part it gave Relief[7]. We seldom repeated this Evacuation where
+we suspected the Fever to be of the malignant kind, unless a pleuritic
+Stitch, an acute Pain of the Bowels, or some other accidental Symptom,
+required it; or the Patient was strong, and there were evident
+Symptoms of Fullness immediately before we intended giving the Bark,
+as shall be mentioned afterwards; for under other Circumstances, if
+the Blooding was repeated, and other Evacuations used freely, I always
+observed that it did Harm, and was apt to sink the Patient too much;
+as Dr. _Huxham_, Dr. _Pringle_, and other good Practitioners, have
+remarked.
+
+    [7] Dr. _Huxham_, tho’ he says “yet Bleeding to some Degree
+    is most commonly requisite, nay necessary, in the strong and
+    plethoric;” yet he afterwards makes the following Remark:
+    “Besides, the Pulse in these Cases sinks oftentimes
+    surprisingly after a second Bleeding, nay sometimes after the
+    first, and that even where I thought I had sufficient
+    Indications from the Pulse to draw Blood a second time.” See
+    his _Essay on Fevers_, chap. viii. And Dr. _Pringle_
+    observes, that in the second Stage of the Disorder large
+    Bleedings have generally proved fatal, by sinking the Pulse,
+    and bringing on a Delirium. _Observations on the Diseases of
+    the Army_, part III. chap. vii. sect. V.
+
+After Bleeding, if the Patient was costive, or complained of Gripes,
+he had a Dose of Rhubarb, or Salts, or a laxative Clyster; but where
+there was much Sickness of the Stomach, we gave a gentle Emetic[8] in
+the Evening, and the Purge next Morning. And if in the Course of the
+Disorder the Sickness and Nausea returned, attended with Griping and
+Costiveness, or very fetid loose Stools, these Medicines were
+repeated, and a gentle Opiate given in the Evening after their
+Operation.
+
+    [8] Dr. _Pringle_ advises giving a Vomit, by way of
+    Prevention, on the first Appearance of the Symptoms, and at
+    Night to force a Sweat, by giving a Drachm of Theriac with
+    ten Grains _Sal volat. Corn. cervi_, and some Draughts of
+    Vinegar-whey, and to repeat the same the following Night; and
+    says, he has often seen those Symptoms removed which he
+    apprehended to be Forerunners of this Fever received by
+    Contagion; but previous to Vomits, or Sweats, if the Person
+    be plethoric, it will be necessary to take away some Blood.
+    _Observ._ part III. ch. vii. sect. 5. Dr. _Lind_, in his
+    _second Paper on Fevers_, p. 66. says, “To all who are
+    supposed to be infected by Fevers, during this Stage of
+    Rigours, a gentle Vomit is immediately to be exhibited before
+    the Fever be formed, and before the Fulness or Hardness of
+    the Pulse renders its Operation dangerous. If the Vomit be
+    delayed too long, and especially if Bleeding must precede it,
+    the most certain and favourable Opportunity of procuring
+    Safety for the Patient is past.--That he has found it equally
+    serviceable in preventing Relapses, when it is given at the
+    Return of the Shiverings.” A loose Stool, or two, should be
+    procured by the Emetic or Clysters, and he advises Sweating
+    immediately after, in the manner recommended by Dr.
+    _Pringle_. At other times “he gave five Grains of Camphire
+    every four Hours, with large Draughts of Vinegar-whey. Eight
+    Persons in ten, he says, got quite well by this Treatment.”
+
+    I have never had sufficient Opportunities of trying this
+    Method of Prevention, to determine any thing certain about
+    it; but it may be worth while to practise it.
+
+After Evacuations, if the Pulse kept up, we commonly gave nothing but
+the saline Draughts, with the _Pulvis contrayervæ_, or some temperate
+Medicine, for the first Day or two. As soon as we could distinguish
+the Fever to be of the malignant kind, and that the Pulse rather sunk,
+we joined some of the Cordials to the saline Medicines, and allowed
+the Patient more or less Wine, according to the Degree of the Fever.
+Dr. _De Haen_ has found Fault with Dr. _Pringle_ and Dr. _Huxham_, for
+administering cordial Medicines and Wine in the low State of this
+Fever; but nothing answered so well with us as these Remedies under
+such Circumstances; and I have frequently seen every Symptom changed
+for the better by their Use; and even when I gave the Bark, in the
+Manner recommended by _De Haen_, I often found it necessary to join
+the free Use of Wine[9], Cordials and Blisters[10], in order to
+support the Patient’s Strength.
+
+    [9] _Petrus a Castro_, in his Account of a Petechial Fever,
+    which was frequent at _Verona_, tells us, that the Sick had a
+    great Thirst, and an Aversion to Meat, but all of them had
+    the strongest Desire for Wine, and were perpetually asking
+    for it, even those who at other Times used to be very
+    temperate; and that this proceeded from an Instinct of
+    Nature, which wanted something to support the Strength. _De
+    Feb. Malig._ sect. iii. chap. 26. Dr. _Huxham_, in his _Essay
+    on Fevers_, has the following very judicious Remark on the
+    Use of Wine: “In this View, and in those above-mentioned, I
+    cannot but recommend a generous red Wine as a most noble,
+    natural sub-astringent Cordial, and perhaps Art can scarce
+    supply a better. Of this I am confident, that sometimes at
+    the State, and more frequently in the Decline of putrid
+    Malignant Fevers, it is of the highest Service, especially
+    when acidulated with Juice of _Seville_ Orange or Lemon. It
+    may be also impregnated with some Aromatics, as Cinnamon,
+    _Seville_ Orange Rhind, red Roses, or the like, as may be
+    indicated, and a few Drops of _Elix. Vitrioli_ may be added.
+    Rhenish and French White Wines, diluted, make a most salutary
+    Drink in several Kinds of Fevers, and generous Cyder is
+    little inferior to either. The _Asiatics_, and other Nations,
+    where pestilential Disorders are much more rife than with us,
+    lay more Stress on the Juice of Lemons in these Fevers than
+    on the most celebrated _Alexipharmac._” Chap, viii. second
+    Edit. p. 123, 4.
+
+    Acid and acescent Liquors have very justly been recommended
+    and used by most late Practitioners, in this as well as in
+    other malignant Diseases. Vinegar-whey, Barley-water
+    acidulated with Lemon-juice, and such other Liquors, make
+    good Drinks for the Sick; but we were obliged, for the most
+    part, to use the vitriolic Acid for acidulating the Patient’s
+    Drink, as it was the easiest procured and carried about with
+    the Flying Hospital.
+
+    [10] If the preventive Method does not succeed, Dr. _Lind_
+    advises to have recourse to Blisters; and says, that sixteen
+    out of twenty will next Morning be free of the Fever. But
+    adds, this is said, provided the Source of their Infection be
+    not so highly poisonous as it was in the Garland Ship, or in
+    other such violent Contagions. Dr. _Pringle_ mentions his
+    having applied Blisters early, but without relieving the
+    Head, or preventing any of the usual Symptoms. I have often
+    ordered Blisters pretty early in the Disorder; and though I
+    have frequently found them of use in keeping up the Pulse,
+    and relieving the Head, and other Symptoms, yet I never saw
+    them have such an immediate Effect as Dr. _Lind_ mentions.
+
+After reading the Treatises of Dr. _De Haen_ and Dr. _Hasenohrl_, on
+this Fever, I resolved on giving the Bark[11] in large Quantities, and
+found it to answer the Recommendations given by these Gentlemen; and
+shall relate here two or three Cases, out of above a hundred and
+fifty, in which I gave it.
+
+    [11] It is long since the _Peruvian_ Bark has been used by
+    Practitioners in Malignant Disorders, though I do not know
+    that any body gave it in this Fever to the Amount of an Ounce
+    per Day, before Dr. _Haen_ and Dr. _Hasenohrl_. Dr.
+    _Ramazini_ mentions its having been tried in the Petechial
+    Fever, in the Years 1692, 3, 4. And in a Treatise on the
+    Plague in the _Ucrane_, published at _Petersburgh_, in the
+    Year 1750, we are told, that in the _French_ Translation of
+    the Philosophical Transactions for the Year 1732, there is a
+    Note to p. 264, telling, that Mr. _Amyand_ informed the
+    Academy of Surgery at _Paris_, that Mr. _Rushworth_, Surgeon,
+    had wrote to Sir _Hans Sloane_, on the 23d of _May_ 1723,
+    that when he was Surgeon to a Ship, in the Year 1694, he had
+    cured some Men ill of the Malignant Fever, attended with
+    pestilential Buboes, by means of the _Peruvian_ Bark. Dr.
+    _Huxham_ has recommended a Tincture of the Bark; and Dr.
+    _Pringle_, a strong Decoction of it, with some of the
+    Tincture, in these Malignant Fevers.
+
+I. _Robert Wilson_, of the Second Regiment of Foot Guards, on the 19th
+of _February_ 1761, was seized with a Shivering and Coldness,
+succeeded with Heat, Thirst, a short dry Cough, Difficulty of
+Breathing, Head-ach, and slight Stitches in his Breast; some Blood was
+taken away, which was sizy, and he was ordered two Ounces of the
+_Sperma Ceti_ Mixture, with the _spiritus mindereri_, every two or
+three Hours. He continued without any manifest Alteration in the
+Symptoms, till the 21st, when a Number of dun Petechiæ appeared all
+over his Body, particularly on his Breast. The Stitches and Cough were
+then much easier, and he had his Medicines as before. On the 22d, he
+was seized with a Delirium, and was somewhat comatose; when he was
+ordered a Drachm of the Bark every six Hours. The 23d, the comatose
+Symptoms had increased, and he had slight Twitchings of the Tendons, a
+dry brown-coloured Tongue, and a Faultering in his Speech. The Bark
+was continued, with the Addition of two Spoonfuls of Mountain Wine
+every two Hours. On the 24th, he had several loose Stools. The 25th,
+he was still loose, and went on as before, with the Addition of six
+Grains of the _Pilulæ saponaceæ_ in the Evening. The 26th, the
+Petechiæ were not so apparent as before, but he had still the nervous
+Symptoms, and his Breathing grew more difficult; and therefore a
+Blister was applied between his Shoulders, and his Medicines
+continued; as they were likewise on the 27th, without any Alteration
+in the Symptoms. On the 28th, his Tongue became moister, and the
+Pulse, which had been low and quick the four preceding Days, became
+fuller and slower. On the 29th, he was much more sensible, his Tongue
+more moist, and the Twitchings of the Tendons much less; and in the
+Evening he fell into a profuse Sweat, which lasted all the 30th. On
+the 1st of _March_, his feverish Symptoms were much abated, his Pulse
+was calmer, his Skin moist, his Drought less, and his Urine dropt a
+plentiful Sediment. On the 2d, his Fever was almost entirely gone, but
+he had still a Cough, and spit up a viscid Matter. He was ordered to
+go on as before, with the Addition of two Spoonfuls of the _Sperma
+Ceti_ Mixture, and the _Spiritus Mindereri_, when his Cough was
+troublesome. He followed this Course till the 7th, when, his Cough and
+Fever being gone, he was ordered a Dose of Tincture of Rhubarb; after
+which he recruited his Strength daily, without the Assistance of any
+more Medicines.
+
+II. On the 5th of _March_ 1761, _Thomas Stagg_, of the Second Regiment
+of Foot Guards, was seized with the same Symptoms as _Robert Wilson_
+had been in the Beginning of his Fever, but in a more violent Degree.
+He was blooded to about twelve Ounces, and was ordered a saline
+Draught every six Hours. On the 6th, the Blood, which had been drawn
+the Day before, had thrown up a slight Buff; it appeared to contain
+but a small Proportion of Serum, and the Crassamentum was of a loose
+Texture. The feverish Symptoms had increased, with the Addition of a
+Delirium: pergat. On the 7th, the Delirium was grown more violent, so
+that he could scarce be kept in Bed; his Breathing was difficult, his
+Eyes red and florid: A Blister was applied to his Back, and the saline
+Mixture continued. On the 8th, there was no Alteration in the Course
+of that Day; but being lower towards Night, Blisters were applied to
+his Legs, and he was ordered to have a Pint of Wine allowed him in
+twenty-four Hours. On the 9th, the Petechiæ appeared over his whole
+Body, of a broad dunnish kind; his Breathing became easier, and his
+Pulse stronger, though the Delirium was still as bad as before: He was
+ordered a Drachm of the Bark every fourth Hour in a saline Draught. On
+the 10th, the Bark gave him several loose Stools, but the Petechiæ
+were of a more florid Colour; the Delirium was less, and his Tongue
+moist, and therefore he was ordered to continue the same Medicines as
+the Day before, with the Addition of ten Grains of the _Pilulæ
+saponaceæ_ in the Evening. The 11th Day, he fell into a fine breathing
+Sweat, his Pulse became fuller and slower, and the Delirium abated: p.
+The 12th, his Pulse was regular, and the Delirium gone, and he was
+much inclined to sleep. The 13th, after a calm Sleep, which had lasted
+twelve or fourteen Hours, he became quite free of Fever. After this he
+continued the Use of his Medicines for some Days, and recovered his
+Health and Strength daily.
+
+III. On the 23d of _May_ 1761, _Lionel Thompson_, of the First
+Regiment of Foot Guards, was seized with all the Symptoms of a
+Peripneumony, attended with a high Fever, for which he was ordered to
+be blooded. After losing eight Ounces of Blood, he fell into a
+fainting Fit; on recovering out of which, his Breathing being still
+much affected, he had a Mixture made of four Ounces of the _Lac
+Ammoniacum_, and one of the _spiritus mindereri_, of which he was
+desired to take two Spoonfuls every four Hours. The 24th, the Symptoms
+the same: He complained of having had no Stool for some Days, and took
+half an Ounce of the _sal catharticum amarum_, which gave him two
+loose Stools. On the 25th, his Pulse was small and quick, his
+Breathing difficult; he was low, and had a slight Delirium: A large
+Blister was applied between his Shoulders, and the Medicines
+continued. On the 26th, in the Morning, the Petechiæ appeared, and his
+Breathing was freer: He was ordered a Drachm of the Bark, in a saline
+Draught, every four Hours. The 27th, the Pulse better: p. The 28th,
+was more sensible, and had a kindly warm Moisture all over the Skin.
+The 29th, the Fever was much abated, and his Tongue, which was before
+parched and dry, became moist and white: He continued the Use of the
+Cortex for three Days more, which removed the Fever; and being
+costive, he took a Dose of the Tincture of Rhubarb. After this he used
+the Bark for a few Days longer, and got perfectly well.
+
+After giving the Bark[12] with Success, in the two first of the Cases
+mentioned, and to two young Gentlemen, Mates of the Hospital, who had
+caught the Fever from their Attendance on the Sick, I gave it to above
+a hundred and fifty at _Paderborn_, and elsewhere, during my
+Attendance in the Military Hospitals in _Germany_; and although it did
+not answer in every Case, yet it was found to have a better Effect
+than any other Remedy that was tried. We joined different Medicines
+with it, according to the State of the Patient. We gave the _Confectio
+cardiaca_, _Rad. serpent. Virg._ and other cordial Medicines, and
+Wine, when the Pulse was low; _Oxymel scilliticum_, and other
+Pectorals, when the Breathing was difficult; Opiates, where the
+Patient was inclined to be too loose; the _spiritus mindereri_, and
+other Diaphoretics, when we wanted to promote a free Perspiration; and
+we applied Blisters as Occasion required.
+
+    [12] The _Peruvian_ Bark has not only been found useful in
+    this Malignant Fever, but has likewise been recommended in
+    the Plague. See _Morton Oper. Append. secund. Exercitat.
+    Hist. Febr. Ann. 1658, ad. an. 1691. complexa_. In the Small
+    Pox, see _Medical Essays_, vol. V. art. x. and has been found
+    serviceable in the putrid Disorders of the _West Indies_, as
+    taken Notice of by Dr. _Hillary_; and in the malignant
+    ulcerous sore Throat in this Country, as Dr. _Wall_ and
+    others have observed. And in thirty-five Cases of the
+    malignant ulcerous sore Throat, in which I gave it, joined
+    with Cordials, and the Use of Acids, I did not lose one
+    Patient. Nine of them were strong People, and had plethoric
+    Symptoms, and were blooded in the Beginning; and seven of
+    them were costive, and took a Dose of gentle laxative Physic
+    before taking the Bark. The rest had no Symptoms which seemed
+    to require these Evacuations. However, it ought to be
+    observed, that this is a Disorder of the malignant kind; and
+    that although some well-timed gentle Evacuations may be
+    serviceable in the Beginning, before giving the Bark; yet too
+    free, or even gentle Evacuations, injudiciously made, will
+    sink the Patient, and infallibly do Mischief.
+
+    The free Use of the Bark has long been found serviceable in
+    Mortifications and foul Sores, where the Juices tend too much
+    to the Putrescent; and has been strongly recommended by Mr.
+    _Ranby_, Serjeant Surgeon to his Majesty, in the Cure of
+    Gunshot Wounds. See his _Treatise on Gunshot Wounds_.
+
+When the Patient was strong, the Pulse quick and full, the Eyes looked
+red, and the Breathing was difficult, after the Petechiæ appeared; I
+took away more or less Blood before giving the Bark. Most
+Practitioners of late Years have been against Bleeding in this Stage
+of the Disorder; but trusting to the Assurances given by Dr.
+_Hasenohrl_ of its being safe, nay of Advantage to bleed at this Time,
+if the Symptoms required it, I ventured upon it, and found it to be of
+the greatest Service, in many Cases, in the Hospitals at _Paderborn_
+and elsewhere; and particularly in two Cases at _Bremen_, and one at
+_Osnabruck_, where it gave immediate Relief, and seemed to shorten the
+Disease much. One of the Patients at _Bremen_, _Robert Ellis_,
+belonged to an Independant Company; the other, _Francis Hamstan_, of
+the 24th Regiment, had formerly had his Skull fractured, and took the
+Fever, while he was in the Hospital, for violent Head-achs, which he
+had been subject to, at times, ever after his Skull had been
+fractured. The Case at _Osnabruck_ was a Nurse of the Hospital, whose
+Name was ---- _Andrews_, a Woman about twenty-five Years of Age, who,
+after attending a Dragoon in the Small Pox, and suckling at the same
+time her own Child, then in the same Disorder, was, on the 18th of
+_January_ 1763, attacked with a Fever. I saw her for the first time on
+the 20th, and found her Pulse quick, full, and strong. She complained
+of a violent Head-ach; for which she was blooded, and took the saline
+Mixture, with Nitre and Contrayerva. Next Day, the 21st, her Blood
+appeared very sizy, and she complained of having been costive for some
+Days. We gave her immediately an Ounce of the _sal catharticum
+amarum_, which operated well. She continued much in the same Way the
+22d, and had some loose Stools that Day. Being still inclined to be
+loose the 23d, instead of her former Medicines, she was ordered the
+_spiritus mindereri_ Mixture, with Mithridate. This checked the
+Purging, but did not stop it entirely. The Fever went on, without any
+remarkable Change, till the 27th; at which time the Petechiæ appeared
+all over her Body, attended with a Redness of the Eyes, and a violent
+Oppression and Pain of her Head, and a quick Pulse. I ordered six
+Ounces of Blood to be taken away immediately, and a large Blister to
+be applied to her Back, and, at the same time, ordered her a cordial
+Mixture, with half an Ounce of the Extract of the Bark in it, to be
+taken every twenty-four Hours. The 28th, her Pulse was not so hard,
+her Head was much easier, the Redness of her Eyes was much less, and
+the Petechiæ had begun to die away. The Blood which was taken away the
+Day before, had a thin Buff at the Top, but the _Crassamentum_
+underneath was of a dark Colour, and of a loose Texture: p. On the
+29th, she told me that she had had two or three loose Stools, and she
+was lower than the Day before; and therefore a Drachm of Mithridate,
+and two Drachms of the Tincture of Cinnamon, were added to her cordial
+Mixture, with the Cortex; and she was allowed half a Pint of Red Wine,
+mulled with Cinnamon, _per_ Day. 30th, Her Tongue rather moister than
+the Day before; and she not so low, but she was still inclined to be
+loose; and therefore was ordered the anodyne Draught at Nights, and to
+continue the other Medicines. 31st, She was still inclined to be
+loose; but her Pulse kept up, her Tongue was moister, and she found
+herself pretty easy: p. _Feb._ 1st, Her Pulse pretty strong, and she
+found herself much cooler, and freer from the Fever, and complained of
+a Dullness of Hearing. On the 2d, in the Morning, she felt a warm
+Moisture all over her Skin, which, about Noon, broke out into a
+profuse Sweat, and continued till the 4th; when it went off, and her
+Urine let fall a copious whitish Sediment. She had then little or no
+Fever. The Dullness of Hearing still continued, though it was much
+less than before. After this the Deafness went gradually away. She
+continued the Use of the cordial Mixture, with the Cortex, till the
+12th, and recovered Strength daily. After this, she had no other
+Medicine, except two Doses of the Tincture of Rhubarb, and was soon
+in good Health, and able to discharge her Duty as a Nurse.
+
+However, it ought to be observed, that we must not bleed so freely, in
+this or any other Stage of the Malignant Fever, as in acute
+inflammatory Disorders, otherwise we shall sink the Patient, and hurry
+him to his Grave; and that Bleeding can only take place with Safety
+and Advantage, under the Circumstances above-mentioned, immediately
+before giving the Bark freely; or where some accidental sharp Pain in
+the Breast, or Bowels, or some other violent Symptom, may require it.
+They err equally, who recommend Bleeding freely in this Fever, with
+those who entirely forbid its Use.
+
+Although we found the Bark to be in general the best Remedy in this
+malignant Petechial Fever, yet it did not answer in every Case; for in
+some we found other Remedies had a better Effect: And therefore, when
+we observed that, notwithstanding the Use of the Bark, the Patient
+sunk, and the Symptoms grew worse, we did not persist obstinately in
+its Use, but tried the Effect of other Medicines.
+
+Towards the End of _May_ 1761, two Soldiers in the Hospital, at
+_Osnabruck_, were taken ill of this Fever; who, after using the Bark
+freely, and being allowed a Pint of Red Wine _per_ Day, for some Days
+together, began to sink, and had a Delirium and other bad Symptoms
+hastening on: upon which I laid aside the Use of the Bark, and ordered
+each of them a Blister to the Back, and to take a cordial Draught,
+with fifteen Grains of Musk in it, every four Hours; and to have their
+Wine mulled with Cinnamon; and although at that Time they were both so
+low that I scarce imagined they would live twenty-four Hours, yet next
+Day I found them greatly mended; and they had a kindly warm Moisture
+all over their Skin, and the Pulse had rose considerably in both. By
+the Continuance of the same Medicine the feverish Symptoms gradually
+abated, and they both got well.
+
+About the same time, having given the Bark freely for some Days, and
+applied a Blister, to another Patient, after the Petechiæ had
+appeared, I found him one Morning so low that his Pulse could scarce
+be felt. He could not speak; he had a Delirium, and rather a Tremor
+than a _subsultus tendinum_, and he had all the Appearance of a dying
+Man. However, as he still swallowed whatever was put in his Mouth, I
+changed the Bark Mixture for Draughts, which contained a Scruple of
+the _confectio cardiaca_, and seven Grains of the _sal vol. corn.
+cerv._[13] each, and ordered one to be given immediately, and
+afterwards to be repeated every four Hours; and, in the Intervals, to
+give him frequently a Tea-cup full of Red Wine, mulled with Cinnamon;
+and to apply two large Blisters to his Legs. Next Day, his Pulse had
+rose; and by the Continuance of the same Remedies it became gradually
+fuller and stronger, and the third Day after he recovered his Voice;
+and a warm kindly Moisture which ended in a profuse Sweat coming on,
+the feverish Symptoms went off soon after, and he recovered his
+Health.
+
+    [13] Dr. _Huxham_, in his _Treatise on the ulcerous sore
+    Throat_, p. 54, &c. condemns the Use of the volatile alcaline
+    Salts, in Fevers of the putrid, pestilential, or petechial
+    kind, as being apt to heat too much, and to hasten the
+    Dissolution and consequent Putrefaction of the Blood.
+    However, I cannot help thinking that they are the best
+    Remedies we can use on some particular Occasions, even in
+    this Fever; for we have no Remedy which gives such a sudden
+    and brisk _Stimulus_ to the Fibres as they do. And I have
+    known many Cases of Patients who were extremely low, and
+    whose Pulse was scarce to be felt, and others who were apt to
+    fail into fainting Fits, who have been preserved by large and
+    repeated Doses of these Salts, and the free Use of Wine, and
+    acescent Liquors, to correct their alcaline Acrimony in the
+    Blood. Though as soon as such Patients had recovered from
+    this low State, I laid these Medicines aside; because I
+    cannot help agreeing with the Doctor in the Belief, that
+    their continued Use will produce the Effects he mentions. For
+    although it be true, that these Salts, when mixed with
+    putrescent Liquors, or with dead animal Substances, resist
+    Putrefaction, and, like ardent Spirits and Vinegar (the other
+    Products of Fermentation) check and put a Stop to that very
+    Process which produced them: Yet it is also true, that, when
+    mixed with the Blood of living Animals, they stimulate the
+    Vessels, and increase the Heat and _Momentum_ of the Blood,
+    and dissolve it; and therefore I cannot but disapprove the
+    continuing their Use longer than is immediately necessary.
+
+At _Bremen_ there were two Men, one in _January_, and the other in
+_February_ 1762, on whom the Cortex had but little Effect, who
+recovered by the free Use of Mixtures, with the _confectio cardiaca_
+and _rad. serpentariæ_, and of Wine, with the Application of large
+Blisters. Several Cases of this kind occurred in the Hospitals, where
+the Bark did not answer.
+
+There is one thing to be observed with respect to Malignant Fevers,
+which is, that if ever they appear in large crowded Hospitals, unless
+we can thin the Wards, and procure a free Circulation of Air, and keep
+the Hospital and Sick extremely clean, the Fevers will continue to
+spread, and great Numbers will die; and even the most efficacious
+Remedies will have little or no Effect. And that when once the
+Infection is grown strong, it requires the greatest Care, and some
+Time, before it can be entirely got the better of. And that if a great
+number of Men, ill of this Fever, be kept in the same Ward, they will
+help to keep up the Infection; and therefore it is always proper, when
+it can possibly be done, to lay but a few of them in one Ward; not
+above one-third of the Number generally admitted.
+
+Many of the Patients, towards the Height of this Fever, sooner or
+later, had a Purging, which seldom proved critical; and some were
+seized with the Flux. A gentle _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.
+
+    [14] Some Men passed only one Worm; others, two or three;
+    some, six or seven; and one Man, of the Guards, in _January_
+    1763, after passing three by Stools in the Course of a Fever
+    of this Kind, discharged fourteen more upon taking a Dose of
+    Rhubarb and Calomel after the Fever was over.
+
+    [15] _Observations on the Diseases of the Army_, part iii.
+    chap. iv. Note to p. 213. third Edition.
+
+It is no Wonder that Worms of the round Kind should be productive of
+troublesome Symptoms, and occasion these Relapses; since we know that
+they have sometimes perforated the Intestines, and been found in the
+Cavity of the Abdomen[16].
+
+    [16] See _Hoffman_’s Works, vol. III. chap. x. _River.
+    Observ. commun._ Obs. 13. _of Observations found in a
+    Library._ _Bonetus’s Sepulchret. anatom._ tom. II. _Gualther
+    van Doeveren’s Inaugural Dissertation de Vermibus
+    intestinalibus_, published at _Leyden_, 1753; and _Lancisi_’s
+    Works; for Cases where the internal Coats of the Stomach, and
+    Intestines, have been eroded, and all the Coats perforated by
+    Worms of the round Kind.
+
+As soon as we observed a Patient to be troubled with Worms, if his
+present Situation did not prevent it, we gave twenty-five or thirty
+Grains of Rhubarb, with five or six Grains of Calomel; and if there
+was much Sickness, we likewise gave an Emetic; which, in more than one
+Case, brought up two or three Worms of the round Kind, and gave great
+Relief. But where the Fever was violent, we were obliged to neglect
+this Symptom of Worms for the present; and when the Fever was over, if
+there still remained any Symptoms of Worms, we gave the purgative
+Medicine once or oftener, and in the Intervals gave the _pulvis
+stanni_, or an Infusion of Camomile Flowers; and in some Cases, oily
+Medicines. By these Means most of the Patients got well and recovered
+their Health, and seemed to be freed, at least for the present, from
+these troublesome Insects; though a few continued to complain of
+Sickness, and other Symptoms of Worms, for some Time afterwards.
+
+What was the Cause of the Army’s being so much troubled with Worms of
+the round Kind, is not easy to ascertain; unless it was owing to the
+great Quantity of crude Vegetables, and Fruits, which the Soldiers eat
+in the Course of the Summer and Autumn, and to the bad Water they were
+often obliged to drink.
+
+In the Malignant Fever at _Paderborn_, many complained of a Dysuria,
+and some of a Suppression of Urine, especially towards the Decline of
+the Fever; and others, of a Scalding and Pain in making Water, though
+they had no venereal Complaint. These Symptoms appeared in other
+Places, but not near so frequently as at _Paderborn_. Decoctions of
+Gum Arabic, with some of the _spiritus nitri dulcis_, and oily
+Mixtures, and Opiates, commonly gave immediate Relief, and soon
+removed this Complaint.
+
+One of the first salutary Symptoms which most generally appeared in
+those who recovered, was a Dullness of Hearing, or Deafness[17]; which
+came on about the Height of the Fever, and continued a longer or
+shorter Time, generally till the Fever was entirely gone; and
+sometimes for a considerable Time afterwards. For the most Part we
+did nothing for this Complaint, and it went off as the Patient
+recovered his Strength. When it continued long, Blisters applied
+behind the Ears, or on the Neck, and washing the _meatus auditorius_
+with the emollient Decoction, in which a small Quantity of Soap was
+dissolved, proved of Service.
+
+    [17] _Riverius_ tells us, that, according to _Hippocrates_’s
+    Doctrine, Deafness is a very dangerous Symptom in the
+    Beginning of acute Disorders, though it be a good Omen, and
+    portends Health, when it does not appear till the Height of
+    Fevers, especially those of a malignant Kind; and adds, that
+    he himself has a thousand Times observed, that those
+    labouring under this Fever have recovered, when this Symptom
+    of Deafness came on at the Height (_in statu_) though the
+    other Symptoms threatened much Danger. _Prax. Medic._ lib.
+    XVII. sect. iii. cap. i. p. 451.
+
+    This Symptom of Deafness occurs in other Fevers as well as in
+    this, and often proves a good Symptom in them likewise, as I
+    have frequently observed. Two remarkable Examples of which I
+    had under my Care in St. _George_’s Hospital, in the Year
+    1759. On the 17th of _January_ 1759, _James Donaldson_, a
+    young Man of nineteen Years of Age, was admitted into the
+    Hospital for a Fever, attended with a Stupor and a Delirium,
+    a parched dry Tongue, and other Symptoms of a Fever of the
+    inflammatory Kind, for which he had been blooded, and used
+    other Evacuations. On the 19th, after the Application of a
+    Blister, he was seized with almost an entire Deafness; after
+    which, all his other Symptoms became milder, and he mended
+    daily, and was entirely free from the Fever by the 30th. On
+    the 10th of _April_ 1759, a Youth, _John Young_, fifteen
+    Years of Age, was admitted into the same Hospital for a
+    Fever, which had already continued fourteen Days. His Speech
+    was affected, and he had entirely lost the Use of his Limbs,
+    was delirious, and had other bad Symptoms. On the 12th, his
+    Hearing became exceedingly dull, and he recovered daily
+    afterwards, and was discharged, cured, the 2d of _May_,
+    having recovered the Use of his Legs as well as got free of
+    the Fever.
+
+Swellings of the parotid Glands appeared in many Subjects, towards the
+Decline of the Fever, which came to Suppuration, and proved critical.
+In two only, out of those I attended while in _Germany_, they came on
+early in the Fever, but did not suppurate. Both Patients died; all
+the rest recovered, except one old Man, an Invalid at _Bremen_; who,
+after having one Swelling appear on the right Side, which came to
+Suppuration, and seemed critical, relapsed into the Fever; and another
+formed on the other Side, which came likewise to Suppuration, and the
+Fever ceased, after having reduced him very low; but the great
+Discharge from the Sores wasted him gradually, and he died hectic in
+about a Month after the Fever had left him[18].
+
+    [18] But although these parotid Swellings were in general so
+    favourable with us, we are not to imagine that this will
+    always be the Case: for _Riverius_, though he speaks of these
+    Swellings proving for the most part critical; yet he tells
+    us, that, in the Year 1623, this Fever was epidemic at
+    _Montpelier_, and that almost one half of the Sick died; and
+    particularly, that most of those who had Swellings of the
+    parotid Glands appearing about the 9th or 11th Day, were
+    carried off within two Days of their Appearance. Having
+    attended several who died from the Swellings not coming to
+    Suppuration, he began to consider in his own Mind, what might
+    be the Cause of their Death, and concluded, that it was owing
+    to there being a greater Quantity of morbid Matter in the
+    Blood than the Part was able to contain, and that Evacuations
+    by blooding and purging were the only Remedies which were
+    likely to give Relief; and therefore, in the first Case of
+    this Kind, in which he was afterwards consulted, he ordered
+    three Ounces of Blood to be taken away, notwithstanding the
+    Patient was so low that the Surgeon was afraid he would have
+    died in the Operation: The Pulse rose on bleeding, and he
+    ordered four Ounces more to be taken in three or four Hours
+    afterwards: The Pulse rose still more, and he ordered a Dose
+    of Sena and Rhubarb to be taken next Day, and the Patient
+    recovered. And he adds, that all those who were treated in
+    this manner got well. _Prax. Med. Lib._ XVII. _sect._ iii.
+    _cap._ 1.
+
+As soon as these Swellings of the parotid Glands appeared, we
+endeavoured to bring them forward to Suppuration, by the Application
+of emollient Cataplasms, or of gummous Plaisters; and had them opened
+as soon as a Fluctuation of Matter was to be felt, and afterwards
+treated them as common Abscesses. _Riverius_[19] very justly observes,
+that when such Tumours encrease in such a Manner as to endanger
+Suffocation, they ought to be opened before they come to Maturation;
+and Dr. _Pringle_[20] desires us not to wait for a Fluctuation of
+Matter, but to open the Abscess as soon as it can be supposed to have
+formed.
+
+    [19] Ibid.
+
+    [20] _Pringle’s Observations on the Diseases of the Army_,
+    Part III. chap. vii.
+
+In _February_ 1761, three Patients in the Decline of this Fever had
+Buboes formed in the Groin, which proved critical. At first, on
+observing them, I suspected them to be venereal; but on examining the
+Patients, they obstinately denied their having any Reason to suspect
+any such Cause; and the favourable Manner in which they healed without
+the Appearance of any other venereal Symptom, made me believe what
+they asserted to be true; especially as such People are not shy in
+owning Complaints of that Kind. The first Patient I saw who had a Bubo
+in the Decline of one of these Malignant Fevers, was a Woman, Wife to
+a Soldier of the thirty-seventh Regiment of Foot; she had a Child at
+her Breast, and her Husband was living with her at the Time she was
+taken ill of the Fever, and neither of them had the least venereal
+Complaint. In a few Days afterwards, two Soldiers in other Hospitals,
+towards the Decline of very bad Petechial Fevers, had likewise Buboes
+formed in the Groin, without any Suspicion of a venereal Taint. Except
+in these three, I did not see any critical Buboes appear in this Fever
+while I was with the Troops in _Germany_; tho’ Mr. _Lovet_, who
+served as a Mate to the Hospitals, and who was at _Hoxter_, where we
+had another Hospital established, while I was at _Paderborn_, told me,
+that, in the Beginning of the Year 1761, they had several Men in the
+Hospital ill of this Fever, who had critical Buboes formed in the
+Groins and Armpits[21].
+
+    [21] This Symptom of Buboes is taken Notice of by Authors,
+    but does not seem to be so frequent as many of them would
+    make us believe. Neither Dr. _Huxham_ nor Dr. _Pringle_
+    mention their having seen such Buboes; and Dr. _Lind_ says,
+    that he never saw them till the Beginning of the Year 1763.
+
+About the same Time that these Buboes appeared, severals towards the
+Decline of this Fever complained of a Pain all along the Spermatic
+Chord; and soon after a Swelling of the Testicle appeared[22].
+However, this Complaint was not peculiar to those who had the Fever;
+for others recovering from Fluxes, and other Disorders, were likewise
+affected with such Swellings. I did not observe any Symptom of this
+Kind in Fevers while I was with the Troops in _Germany_, except in
+_January_, _February_, _March_, and _April_ 1761. By Bleeding, and
+applying emollient Fomentations and Cataplasms, and bathing the Parts
+with _spiritus mindereri_ on the first Attack of the Pain, the
+Swelling of the Testicle was prevented; but where no Mention was made
+of this Pain till the Swelling had already begun, it commonly ended in
+a Suppuration of the Scrotum or Testicle, which healed very kindly. We
+had no Reason to suspect any venereal Taint in any of them.
+
+    [22] _Hippocrates_ takes Notice of Swellings of the Testicles
+    in Fevers. He tells us, that a Man from Alcibiades had his
+    left Testicle swell before the Crisis of a Fever. _See his
+    Second Book on Epidemics_, sect. ii. And he mentions this
+    Symptom as a Crisis in the ardent Fever. _See his Book on
+    Crises_, sect. xi.--And Dr. _Antonio Lizzari_, in a Treatise
+    which he published on the _Acute Diseases which were frequent
+    at Venice, and all over Italy, in the Years 1761, 62_, tells
+    us, that Abscesses of the Scrotum and Testicles frequently
+    followed the Measles.
+
+Many, while recovering from this Fever, were seized with an
+Ophthalmia, or Inflammation of the Eye; for the most part of one Eye
+only, sometimes of both. When the Patients were strong, they were
+blooded, and had Blisters applied behind the Ears; and sometimes,
+where the Pain was great, had Poultices of Bread and Milk applied to
+the inflamed Eye; which, with the Assistance of some cooling Physick,
+commonly removed this Complaint; tho’ in some obstinate Cases we were
+obliged to repeat the Evacuations, to apply Leeches to the Temples;
+and after the acute State of the Disorder was passed, to order the Eye
+to be washed frequently with the Collyrium vitriolicum, or Collyrium
+Saturninum, before we got the better of this Complaint. However, it
+ought to be observed, that if these astringent Collyria were used too
+soon, they did hurt. When these Ophthalmias were neglected in the
+Beginning, the Inflammation frequently rose to a great Height, and
+left an Obscurity or Philm over the Cornea, which remained an
+Impediment to the Sight not to be removed.
+
+Towards the Decline of these Fevers, and very often during the Course
+of them, many complained of Pains in their Feet and Toes, which
+sometimes ended in Mortifications, especially where the Patients lay
+in very cold Wards. For the most Part, the Mortification extended no
+further than the Ends of the Toes, tho’ in some it spread over the
+Feet, and in two or three advanced up the Leg. Several lost one or
+more Toes; and in _February_ 1761, one Man lost Half of each Foot;
+another lost both Feet, and Part of each Leg. Both got the better of
+the Fever, tho’ the Man who lost both Feet languished a long time
+afterwards. These Pains of the Feet and Toes, and the Mortifications
+which followed, were for the most part owing to the Patients being
+exposed to too much Cold while they were very weak, the Circulation
+languid, and the Juices vitiated by a putrid Distemper; by which means
+the Vessels were rendered incapable of carrying on the Circulation in
+their extreme Branches[23].
+
+    [23] These Pains and Mortifications of the Feet and Toes were
+    not confined to those who were brought low by malignant
+    Fevers; for, during the very hard Frost in the Beginning of
+    the Year 1763, many of the Patients who lay in very large
+    open Wards in the Hospital at _Osnabruck_, were affected in
+    the same Way. One Man had both Feet, and Part of each Leg,
+    compleatly mortified, and died in about nine Days after the
+    first Appearance of the Mortification. One lost half of one
+    Foot, and some Toes of the other; and the third lost the
+    first Joint of some of his Toes, and the Ends of others.
+
+As soon as the Sick began to complain of these Pains of the Toes and
+Feet, I found the best Remedy to be, the Bathing of the Feet in warm
+Water, or in warm aromatic Fomentations; and, after keeping the Feet
+for some time in these warm Liquors, to dry them well, and then rub
+them with the _linimentum saponaceum_, or _linimentum volatile_, and
+wrap them up in Flannel. And if ever any Lividness or Redness appeared
+on the Parts, we gave plentifully of the Cortex and Cordials, if not
+contra-indicated by the other Symptoms. When Vesicles arose on the
+Part, and a Gangrene formed, we directed the Parts to be scarified,
+and proper Dressings to be applied, while warm aromatic Fomentations
+and Cataplasms were used.
+
+In _January_ 1762, one Patient, ill of the Petechial Fever at
+_Bremen_, had a Lividness and Blackness, threatning a Mortification,
+which appeared at the End of his Nose. I expected for some Days, that,
+if he recovered, he would lose Part of his Nose; but, by giving him
+large and repeated Doses of the _cortex_ and _confectio cardiaca_, in
+a Mindereri Mixture, and allowing him the free Use of Wine, its
+further Progress was prevented; and as the Patient got clear of the
+Fever, the Nose recovered its natural Colour, and only the scarf Skin
+peeled off from the End of it.
+
+When the Fever continued long, and reduced the Patients low, it was
+very common for the Back, and Parts on which the Weight of the Body
+rested, to mortify. As soon as any thing of this Kind was observed, we
+ordered such Parts to be covered with proper Dressings, and gave the
+Bark and Cordials freely; and took care to make the Patient change his
+Posture; and by Pillows prevented as much as possible the Weight of
+the Body from resting on that Part. By this Treatment, many recovered,
+where the Fever was on the Decline, and the Strength not too much
+exhausted; even tho’ a very large Surface of the Skin had mortified;
+but where the Patients were very low, and the Fever still continued,
+or where it was complicated with a Flux, which kept them perpetually
+nasty, and exhausted the Strength, it generally proved fatal.
+
+Patients, who were reduced very low by this Fever, or by repeated
+Relapses, were subject to oedematous Swellings; especially of the
+Feet, towards the Evening, after sitting up all the Day. These
+Swellings generally went away as the Sick recovered their Strength;
+but in some Cases they continued obstinate, and ascended towards the
+Thighs; and in some spread all over the Body, and terminated in an
+universal Anasarca.
+
+When these Swellings were recent, and confined to the Feet and Legs,
+commonly the Bark joined to the lixivial Salts, or the Oxymel of
+Squills, or other Diuretics, and a Purgative once or twice a Week,
+removed them. In some, an Infusion of Horse-radish had a good Effect;
+in others, Sweats brought out by means of _Dover_’s Powder, or of the
+_guttæ antimoniales anodynæ_.
+
+Sometimes these Swellings were very obstinate, and resisted the Force
+of all internal Remedies. In such Cases, Punctures made in the Feet,
+or lower Part of the Legs, which furnished a Drain for the Water, had
+a good Effect. Blisters applied to the Legs were of Service to some.
+When the Punctures were made, or the Blisters applied, before the
+Patient’s Strength was exhausted, provided that he laboured under no
+other Disorder but these oedematous Swellings, which proceeded from
+Weakness, I never observed any bad Effects from them; tho’ I used them
+both repeatedly in a Variety of Cases. But if the Patient was very
+weak; or had a Hectic Fever or Purging; or other Disorders, and the
+oedematous Swellings large; then oftentimes the great Discharge
+exhausted his Strength, and a Gangrene and Death were the Consequence.
+
+One of the most remarkable Instances of the good Effects of Blisters,
+was in the Case of a Soldier at _Paderborn_; _Thomas Hope_, of the
+Second Regiment of Foot Guards, after a Fever of this Kind, was
+swelled all over, especially about the Face and Neck, and had a
+Difficulty of Breathing: after having tried Variety of Medicines for
+this Complaint, without any Effect, he had a large Blister applied to
+his Back, and took the Cortex in a Mixture, with the Oxymel of
+Squills. As soon as the Blister began to discharge, the Swellings
+decreased; and were afterwards entirely removed by the Help of one or
+two Doses of Physic, and the continued Use of the Medicines before
+prescribed. Three other Men in the Hospital at _Osnabruck_, in _May_
+1761, having oedematous Swellings of the Feet and Legs, which yielded
+to no internal Remedies, had Blisters applied to their Legs, used the
+Cortex, with the lixivial Salts, two or three Times a Day, and a Purge
+every fourth Day; which removed the Swellings in a short Time.
+
+Some of the Soldiers, who had repeated Hospital Fevers, had their
+Blood so much broke down, as to be subject to profuse Hæmorrhages from
+the Nose; and some of them passed Blood likewise by Stool; which
+reduced them to a very low State, sometimes attended with imminent
+Danger. In such Cases we found nothing to answer so well as to give
+freely of the Bark; to acidulate their Drinks with the _spiritus
+vitrioli_; to allow them as much Red Wine as the Strength and present
+Circumstances could bear; and at the same Time to support the
+Patient’s Strength by a mild Diet, of light Digestion; as Water or
+Rice Gruel, Panado, weak Broth, and the like. When there was a
+Tendency to a 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].
+
+    [24] _Hippocrat._ lib ii. popul. sect. iii. text. 2.
+
+    [25] _Aetius Tetrab._ ii. sect. i. cap. 129. _Actuar._ lib.
+    i. cap. 23.
+
+    [26] See these Causes mentioned by _Riverius_, and since more
+    fully explained by Dr. _Pringle_, _Observations on the
+    Diseases of the Army_, part iii. chap. vii.
+
+When once this Fever begins, it is observed to be of a contagious
+Nature, and (if proper Care is not taken) to affect those who attend
+the Sick, or who live in the same Room, and breathe the same Air with
+them.
+
+Many Authors have reckoned the Malignant, Petechial, and Pestilential,
+to be distinct Species of Fevers; and have treated each of them under
+a particular Head. But _Riverius_[27] has very justly observed, that
+they all belong to the same pestilential Tribe, and only differ from
+one another in the Degree of Infection, and the Violence of the
+Symptoms[28]; and that they are to be cured by the same general
+Treatment, and the same Medicines.
+
+    [27] _River. Prax. Med._ lib. xvi. sect. iii. Præfat.
+
+    [28] The Malignant or Hospital Fever, and Petechial, seemed
+    to me to be entirely the same Disorder, and the Petechial
+    Spots to be only a Symptom which appeared sometimes, but not
+    always. And _Riverius_ says, the Petechiæ do not always
+    appear; but when they do, it is a most certain Sign of a
+    Pestilential Fever. See his _Prax. Med._ cap. xvi. sect. iii.
+
+
+
+
+OF THE DYSENTERY.
+
+
+The Dysentery generally began to appear soon after the Army took the
+Field; and became frequent about the End of _July_, and continued so
+till the Army went into Winter-Quarters; and through the Winter, many
+of those, who had this Disorder in Autumn, relapsed, upon returning to
+their Duty; or by drinking too freely of spirituous Liquors, and being
+irregular in their Living.
+
+It is now generally agreed upon, that this Disorder is entirely
+produced by such Causes as make the Juices become too putrescent, and
+turn the Flow of Humours to the Bowels; and in the Camp it seemed to
+arise principally from an obstructed Perspiration caused by the Men’s
+lying in the Field, and doing the necessary Military Duties in all
+Sorts of Weather; at the same Time being often exposed to the putrid
+Steams of dead Horses, of the Privies, and of other corrupted Animal
+or Vegetable Substances[29], after their Juices had been highly
+exalted by the Heat of Summer.
+
+    [29] The Dysentery has been long alledged to arise from a
+    putrescent Cause in Camps; from the Smell of corrupted dead
+    Animals, and of Excrements, during the Heat of Summer.
+    _Ramazini_, in his Chapter on Camp-Diseases, informs us, that
+    Dr. G. _Erric Barnstorff_, Physician to the Duke of
+    _Brunswick_, who served five Campaigns with the _Brunswick_
+    and _Lunenburg_ Troops in _Hungary_, told him, that the Camp
+    Diseases, particularly the Malignant Fever and Dysentery,
+    took their Rise from the Troops remaining long encamped on
+    the same Ground, and being exposed to the corrupted Steams of
+    the Bodies of dead Men, Horses, and other Animals, which lay
+    unburied; and of Excrements, which were not covered with
+    Earth. And these Causes have since been particularly taken
+    notice of by Dr. _Pringle_, in his _Observation on the
+    Diseases of the Army_.
+
+    Many have imputed the Cause of this Disorder to the eating of
+    Fruit in excess, because it generally appears about the
+    Middle of Summer, the Time the Fruit begins to be in Season,
+    and continues through the Autumn. But from later Observations
+    this should seem to be a vulgar Error. Dr. _Pringle_ (part i.
+    ch. iii. p. 20.) tells us, that, in the Year 1743, this
+    Sickness began and raged before any Fruit was in Season,
+    except Strawberries, (which from their high Price the Men
+    never tasted) and ended about the Time the Grapes were ripe;
+    which growing in open Vineyards were freely eat by every
+    body. And Dr. _Tissot_, in a Treatise which he published,
+    called _Avis au Peuple sur la Santé_, in his Chapter on the
+    _Dysentery_, § 320, says, that ripe Fruit, especially the
+    Summer-Fruits, are so far from being the Cause of the
+    Disorder, that they are the great Preservatives against it:
+    he says, that, in the Years which the Fruit is most
+    plentiful, the Dysentery is least frequent; and he relates
+    several Instances where the Use of ripe Grapes proved a Cure
+    for the Disorder. Eleven People were attacked by the
+    Dysentery, nine eat Fruit, and all recovered; the other two,
+    a Grandmother and Child, from Prejudice, eat none, and both
+    died. A Regiment of _Swiss_ Soldiers, in Garrison in the
+    South of _France_, had the Dysentery very frequent among
+    them. The Captains purchased some Acres of a Vineyard, and
+    carried the sick Soldiers to the Field, and gave them the
+    Grapes to eat; and ordered the Men in Health to live upon
+    them chiefly. After this not one Person died, nor was any one
+    seized with the Distemper.--In an Account of a Treatise on
+    the Dysentery, published at _Hamburg_ in 1753, which was
+    epidemical the Year before, in _August_ and _September_, we
+    are told, that it did not proceed, as is commonly believed,
+    from the eating of Fruit; for it was observed, that those who
+    eat Fruit freely escaped better than those who abstained from
+    it altogether. _Vide Comment. de Rebus in Hist. Nat. &
+    Medecin. Gestis_, vol. II. par. iv. sect. v.
+
+    Generally in _August_ and _September_ we have People admitted
+    into _St. George_’s Hospital for the Dysentery; who have
+    certainly not catched the Disorder from eating of Fruit, but
+    from working in the Fields, and being exposed to Causes
+    similar to those which produce the Dysentery in Camps.
+
+At the Time the Petechial Fever was frequent at _Paderborn_ in
+_January_, _February_, and _March_ 1761, the Flux frequently
+accompanied it; and we had in the Hospitals likewise a Number of old
+Cases of this Kind, the Remains of the preceding Campaign about
+_Warbourg_; besides some Men who had relapsed during the Winter, and
+were sent to us when the Troops marched, upon the Winter-Expedition,
+into the Country of _Hesse_. In _May_ and _June_, what Fluxes we had
+at _Osnabruck_, were the remaining old Cases of the Hospitals of
+_Munster_, _Paderborn_, _Hoxter_, and _Niehms_. Some few recent ones
+were sent to _Bilifield_ about the End of _June_, and above 300 to
+_Munster_, in _July_ and _August_. Those sent to _Bremen_, in
+_November_ and _December_, had continued for some time before they
+reached us; but a good many of the Soldiers in the Garrison were taken
+ill of this Disorder, and sent immediately to the Hospital. In the
+Beginning of _May_ we had but four ill of this Complaint in the
+Hospital I attended; and there were not above six or seven, among the
+Sick sent down from the Army, in the Middle of this Month. In _June_
+there were but two sent to the Hospital at _Minden_; and not above ten
+among the Sick sent to _Natzungen_ in the Beginning of _July_; tho’
+towards the Middle of this Month they began to be more frequent; and
+continued to be more so in _August_ and _September_; and in the
+Hospital at _Osnabruck_ we had not above five or six ill of this
+Disorder, in _December_ 1762, and in _January_, _February_ and _March_
+1763.
+
+The Dysentery commonly begun with Sickness and Gripes, succeeded by a
+Purging, and attended with more or less Fever. Very soon the Gripes
+became more severe, attended with a Flatulency in the Bowels, and
+often with a Tenesmus. The Stools were chiefly composed of Mucus,
+mixed with Bile, and more or less Blood: tho’ sometimes no Blood could
+be observed in them; and then the Soldiers used to say they had the
+White Flux.
+
+After eight, ten, or twelve, Days, if the Disorder was not complicated
+with any other, there remained little or no Fever, unless where some
+Accident supervened; tho’ in Cases which terminated fatally, towards
+the latter End came on a Fever of a low malignant Kind, attended with
+black fetid Stools, Lientery, Hiccup, Stupor, and other bad Symptoms.
+
+It often happened, that, after the Dysentery had continued for some
+Time, the Sick complained for a Day or two of severe Gripes; and then
+discharged along with the Stools little Pieces of hardened Excrements;
+at other Times, tho’ more rarely, little Pieces of white Stuff like
+Tallow or Suet: Frequently small Filaments, and little Pieces of
+Membranes, were found floating in the Stools; and it was very common
+for the Sick to vomit up Worms of the round Kind, or discharge them by
+Stool[30].
+
+    [30] Most Authors, who treat of the Dysentery, mention this
+    Symptom of Worms; and Dr. _Huxham_ tells us, that, in some
+    Seasons, he has seen round Worms in the Stools of most of the
+    Dysenteric Patients. _De Aere_, vol. II. p. 98.
+
+In the Course of the Disorder, the Men often complained of a violent
+Pain of the Rectum, near the Fundament, which was most excruciating
+when they went to Stool; it continued for some Days, sometimes for a
+Week or more; and then they passed more or less of a Yellow Pus with
+their Excrements, and the violent Pain ceased. Mr. _A. Tough_, one of
+the Apothecaries to the Military Hospital in _Germany_, was the first
+who told me that I should find Pus mixed with the Stools: on my
+mentioning a Case of this Kind, which had been relieved by Bleeding,
+and Clysters often repeated; he told me he had observed it frequently
+at _Gibraltar_; and was at a Loss to understand the Nature of the
+Symptom, till he observed the Matter in the Stools; which at once
+shewed him that it had been originally an acute Inflammation of the
+Part, and pointed out to him the proper Method of Cure.
+
+Oftentimes the Bilious and Malignant Fevers terminated in the
+Dysentery; or were accompanied with it, when it might be looked upon
+as a Symptom of these Fevers.
+
+The Appearances we found after Death in the Bodies of some Patients,
+who died of old Fluxes at _Bremen_, were: In all of them the Rectum
+was inflamed, and partly gangrened, especially the internal Coat. In
+two the lower Part of the Colon was inflamed, and there were several
+livid Spots on its great Arcade. In one whose Body was much emaciated,
+and who had been seized with a violent Pain of the Bowels two Days
+before his Death, all the small Guts were red and inflamed; and in
+another there were livid gangrened Spots on the Stomach[31].
+
+    [31] From the Accounts we have in Authors, of the Dissection
+    of the Bodies of Persons who died of the Dysentery, it would
+    appear; that there is no Part of the alimentary Canal which
+    has not some time or other been found inflamed, or in a state
+    of Suppuration or Gangrene; and the Liver, Spleen, and other
+    Viscera, have likewise been found diseased, but the Rectum
+    and Colon have almost in all been more or less affected. The
+    following Account I had, in the Year 1748, from the late Dr.
+    _L. Fraser_, who afterwards practised in the Island of
+    _Nevis_, two Days after the Patient died. _Mary Reid_, a
+    Woman thirty Years of Age, was taken ill of a Dysentery,
+    which in Three Weeks Time killed her. In her Life-time she
+    complained, more than ordinary, of Gripes in her Belly,
+    especially in her Left Side. Her Body was opened in Presence
+    of Dr. _Dundas_, who had attended her, during her Illness.
+    All the Intestines and Mesentery were inflamed, especially
+    the Colon and Rectum; the internal Side of which was quite in
+    a mortified State, and contained little Vesicles full of a
+    putrid fetid Liquor, Numbers of which she had evacuated by
+    Stool some Days before her Death.
+
+There was no Disorder we were more successful in the Cure of, than
+recent Fluxes; but after they had continued for Weeks, and were become
+in a manner chronic, they often foiled all our Endeavours, and a great
+Number died[32].
+
+    [32] While this Sheet was in the Press, I received Dr.
+    _Pringle_’s 4th Edition of his _Observations on the Diseases
+    of the Army_, and Dr. _Baker_’s Treatise on the _Dysentery
+    which was epidemic in London in the Year 1762_. Both these
+    Gentlemen give an Account of the Dissection of the Bodies of
+    some People who died of the Dysentery; where, besides the
+    common Appearances of the inner Surface of the Rectum and
+    Colon being covered with a bloody Slime, and their internal
+    Coats being inflamed, gangrened, or in a putrid State, there
+    were observed on the Inside of the lower Part of the Colon,
+    and upper Part of the Rectum, a Number of little Tubercles,
+    or Excrescences, which resembled the Small Pox, of a flat
+    Sort at the Height of the Disorder; but differed from them in
+    this, that they were of a firm Consistence, without any
+    Cavity: they were believed to take their Rise from the
+    cellular Membrane, which lies immediately above the villous
+    Coat. Perhaps such Tubercles might have been found in the
+    Colon and Rectum of those Bodies we opened; but not looking
+    for them, they may have passed unobserved.
+
+    _Morgagni_, in his Book lately published, _de Sede & Causis
+    Morborum_, epist. xxxi. is of Opinion, that the Filaments,
+    and Pieces of Membranes, which are frequently observed in the
+    Stools, are often formed of inspissated Mucus and Lymph, and
+    other Liquors; and not the Fibres, or Pieces of the villous
+    Coat of the Intestines, as alledged by many Authors.
+
+Upon my first being employed in the Military Hospitals in _Germany_,
+I was surprised to see so many of the old Dysenteric Cases end
+fatally; and imagined I had not fallen upon the Right Method of
+treating them: but upon consulting the other Physical People[33]
+employed in the same Service, I found them as unsuccessful, as myself,
+after having tried a Variety of Remedies: And at last, I was
+convinced, that when once the Flux had continued long, and injured the
+Structure of the Intestines to a certain Length, a Gangrene will
+often form by slow Degrees; and the Disorder end fatally,
+notwithstanding the Use of what are esteemed the most efficacious
+Remedies; and that, when this Disorder is violent, the Cure
+principally depends upon an early and speedy Application of proper
+Remedies, before the Strength be exhausted, or the Structure of the
+Bowels too much hurt. The bad Success we had in treating these old
+Cases, may perhaps surprise those who have never practised except in
+healthful Cities, where the Disease is commonly mild, and People apply
+soon for Advice. But all those Gentlemen who have had the Care of
+Military Hospitals, where the Dysentery has been frequent, and where
+the Sick have been often sent a great Way, before they reached the
+Hospitals, must be convinced of the Truth of what is here asserted.
+
+    [33] Mr. _Cleghorn_, in his _Account of the Diseases of the
+    Island of Minorca_, says, “That almost all the Dysenteries
+    which fell under my Observation, unless they were speedily
+    cured in the Beginning, at best proved obstinate, and too
+    frequently fatal, in spite of the many boasted Specificks for
+    this Distemper.” chap. v. p. 228.--The physical Gentlemen
+    employed on the _American_ Service have told me, that the old
+    Flux Cases were as fatal in _America_, as we found them in
+    _Germany_. I would not from thence have it believed, that
+    every old Flux was to be looked on as a lost Case; and for
+    that Reason given up, and no Attempts be made to cure it; for
+    many, by great Care, and Strength of Constitution, have
+    gradually surmounted the Disorder, and recovered their
+    Health; especially when they got over the Winter, and lived
+    till the warm Weather began.
+
+In the Treatment of this Disorder, as well as of the Malignant Fever,
+nothing contributed more to the Cure, than keeping the Sick as clean
+as possible, and in large airy Wards.
+
+Most of the recent Fluxes, which I saw, were at first attended with a
+good deal of Fever, and Pain in the Bowels; and required more or less
+Blood to be taken away, according to the Strength of the Patient, and
+the Violence of the Symptoms.
+
+When the Patients were strong, and complained of sharp Pain of the
+Bowels, attended with a Fever, we used the Lancet freely, nor were we
+discouraged from bleeding in the Beginning by the low quick Pulse
+which often attended the Disorder; and we frequently found the Pulse
+rise as the Blood flowed from the Vein. But when the Sick were low and
+weak, without much Pain or Fever, and the Pulse was soft, we were more
+sparing of the vital Fluid[34].
+
+    [34] Although Bleeding, in the Beginning, has been
+    recommended by _Sydenham_, _Huxham_, _Pringle_, and other
+    Practitioners; yet it has been reckoned unnecessary in this
+    Disorder by some late Authors. But in most of the recent
+    Cases I saw, it was extremely necessary, and contributed
+    greatly to the Relief as well as the Cure of the Patient;
+    indeed where the Disorder had already continued some time,
+    and the Fever was gone off before the Patient was sent to us;
+    and the Disorder had become in a manner chronic, and the
+    Patient low, then bleeding was unnecessary, and would have
+    probably done Hurt. Mr. _Francis Russel_ told me, that when
+    the Dysentery was epidemical at _Gibraltar_, in Summer 1756,
+    he found that by bleeding such Patients as he met with at the
+    first coming on of the Symptoms, and by giving them
+    immediately a Vomit, and afterwards a sudorific Draught, the
+    Disorder was rendered mild, and few of those died.
+
+As the Disorder was for the most part attended with Sickness in the
+Beginning, we gave a Vomit after bleeding; which not only discharged
+the Contents of the Stomach, and a Quantity of Bile, but relieved the
+Sickness, and frequently threw the Patient into a breathing Sweat; and
+made the Purgatives which were given next Day operate more freely, and
+with more evident good Effects than where no Vomit had been
+administered.--If in the Course of the Disease the Sickness returned,
+the Emetic was repeated; and we often observed, when the Flux was
+obstinate, that well-timed Vomits greatly promoted the Cure.--The
+Vomit we commonly employed was the Powder of Ipecacuana, which we gave
+from ten to twenty Grains; and where the Patient was strong, and we
+wanted to make a free Evacuation, we added one, two, or three Grains
+of the Tartar Emetic; which encreased the Strength of the Vomit, and
+commonly operated likewise by Stool[35], as Dr. _Pringle_ has
+observed.
+
+    [35] Mr. _W. Russel_, who was with the Hospital at
+    _Martinico_, told me, that, when he was there, he found the
+    Vomit with the Tartar Emetic to be far preferable to any
+    other, in all Cases where there was much putrid Bile lodged
+    in the alimentary Canal; as it speedily carried off those
+    corrupt Humours, which were often productive of the greatest
+    Mischiefs, if they remained, but for a short Time, pent up
+    within the Bowels.
+
+Next Day we ordered a Purge to empty the other Parts of the alimentary
+Canal. The Purgative, that at first was most employed for this
+Purpose, was Rhubarb; but upon repeated Trials we did not find, that,
+in general, it answered so well, in this first Stage of the Disorder,
+as the _sal catharticum amarum_, with Manna and Oil; which operated
+without griping or disturbing the Patient, procured a freer
+Evacuation, and gave greater Relief than any other purgative Medicine
+we tried. Mr. _Francis Russel_, Surgeon to the _British_ Military
+Hospital in _America_, who was formerly Surgeon to the Island of
+_Minorca_, was the first Person who informed me (in the Year 1757) of
+the Use of the _sal catharticum amarum_ in the Dysentery; he told me,
+that the Year before (1756) the Dysentery had been very frequent and
+very fatal at _Gibraltar_; and, after trying Variety of Medicines, he
+had found nothing give more Relief, or contribute more to the Cure,
+than repeated Doses of these Salts.
+
+As a great Part of the Cure depended on the frequent Use of gentle
+Purges[36] in the Beginning, to carry off the corrupted Humours; the
+Purgative was repeated every second, third, or fourth Day, as the Case
+required; the Operation of the former Purge, and the Symptoms,
+determining the Frequency of the Repetition. It was surprising with
+how little Loss of Strength the Sick bore the Operation of these
+Purges; I have sometimes given them to strong People every Day, for
+two, three, or four Days successively; and observed that the Patient,
+instead of being weakened, seemed stronger, and more brisk and lively,
+after the Operation of each, from the Relief it gave; by evacuating
+those putrid, corrupted Humours, which kept him perpetually sick and
+uneasy, while they remained within the Bowels.
+
+    [36] Variety of Medicines have been recommended to answer
+    this Purpose.
+
+    The _vitrum ceratum antimonii_ proved often too rough a
+    Medicine, and therefore we laid it almost entirely aside.
+
+    Repeated small Doses of the Ipecacuana, from four to six
+    Grains, operated both as an Emetic, and kept up a Purging;
+    but they made the Men so sick, that we could not prevail upon
+    them to continue their Use. Mr. _Francis Russel_ told me,
+    that, in the Year 1756, he found a few Grains of Rhubarb
+    added to each Dose, made it operate more as a Purgative, and
+    did not make the Men so sick.--Dr. _Akenside_ proposes giving
+    the Ipecacuana in so small Doses as one or two Grains every
+    six Hours, in a Draught made of Mint-water, and Half a Drachm
+    of _confectio cardiaca_; and, after bleeding and vomiting
+    once, seems to depend almost entirely on the Use of this
+    Medicine for the Cure of the Dysentery. See his _Comment. de
+    Dysenteria_, cap. 2.
+
+    The watery Tincture of Rhubarb, recommended by _Degnerus_, we
+    tried in some Cases at Bremen; and found it to be a good mild
+    Purge, but not to answer so well as the Salts and Manna in
+    recent Cases. Mr. _William Russel_ told me that they found
+    this watery Tincture of Rhubarb to answer better in _America_
+    than any other of the Preparations of Rhubarb.
+
+    Calomel has been recommended by many as a Purge in
+    Dysenteries; and Dr. _Huxham_ (_de Aere_, Vol. II. P. 100)
+    assures us, that he has often experienced the good Effects of
+    it, especially when the Patient at the same time had Worms;
+    in such Cases we joined it to Rhubarb as mentioned in the
+    Text, or gave a Calomel Bolus over Night, and a Purge next
+    Morning. Dr. _Duncan_, Physician to his Majesty, told me,
+    that he found the following Method of Cure always successful
+    in the Dysentery, which was epidemic in _London_ in the Year
+    1762.
+
+    If the Patient was Plethoric, or had much Fever, he ordered
+    more or less Blood to be taken away; and then gave four
+    Ounces of the following Julep, every Half Hour, till it both
+    vomited and purged. ℞ _Tartar. emetic. gr._ iij _Mannæ elect.
+    Unc._ ij _solve in Aq. hordeat. Lib._ 1.--The next Day, and
+    for five or six Days more, the Patient took so much of a
+    Decoction, of Manna, Tamarinds, and soluble Tartar, as kept
+    up a free Discharge by Stool.--If the Irritation and Griping
+    were severe, he found that a Solution of Manna, in the common
+    Almond Emulsion, was sufficient.
+
+    When the Pain, or Tenesmus, was violent, a Clyster, of
+    Chicken Broth, or of an Infusion of Linseed, with an Ounce or
+    two of Oil of sweet Almonds dissolved in the Yolk of an Egg,
+    injected once or twice a Day, was of great Use.
+
+    Upon the whole, he was always pleased when he saw large
+    excrementitious Stools come away; and when that could be
+    procured by a gentle Method, he was the more pleased.
+
+    This Disorder was very often cured in a few Days, and in that
+    Case he dropt the further Use of Medicines; but when it
+    exceeded the Period of six or seven Days, he then added
+    thirty or forty Drops of the _tinctura thebaica_ to the
+    Clysters; and ordered a Scruple of the Extract of the Logwood
+    to be taken thrice a Day in some proper Vehicle.
+
+    The Patient’s Diet was Rice-Gruel, Sago, Panado, and such
+    like; no Animal Food, not so much as Chicken-Broth, was
+    allowed in the Beginning of the Distemper, nor even Oil,
+    Butter, or Fat of any Kind. The common Drink was Almond
+    Emulsion, Rice-Water, or Barley-Water with Gum Arabic.
+
+    Dr. _Duncan_ lost but one Patient out of Eighty, whom he had
+    under his Care that Season; and he was delirious, had a high
+    Fever, and a _subsultus tendinum_ before the Doctor was
+    called to him, and he died the next Day.
+
+    The late Dr. _Young_, of _Edinburgh_, seems to have had a
+    very just Notion of this Disorder, and of the proper Method
+    of treating it; for, in his Treatise on Opium, sect. vii. he
+    says, “I am convinced from Experience, that most of the
+    Dysenteries I have hitherto met with, might have been cured
+    by purging mildly, but constantly; and at the same time
+    abating the Acrimony in the great Guts by emollient Clysters,
+    and in the small ones by Plenty of Absorbents, and a Diet of
+    Chicken Broth: But it must be observed with regard to
+    Purgatives, that Manna agrees best with some, Rhubarb with
+    others, Jalap, Mercury, and toasted Rhubarb with others;
+    while others are sooner cured by emollient Clysters. I use
+    Opium only when the Disease is mild, or after its Violence is
+    abated by Evacuants and Emollients.”
+
+    Scammony, Aloes, and the other strong resinous and hydragogue
+    Purges, are hurtful, and occasion Pain. I always observed,
+    that those Purges answered best which made the freest
+    Evacuation, and acted with the greatest Ease to the Patient;
+    of which the Salts and Manna answered best of any I have
+    hitherto used.
+
+Though Rhubarb did not answer so well in the Beginning as the saline
+Purges; yet afterwards in the Course of the Distemper, when the
+Patient did not complain much of Gripes, half a Drachm of Rhubarb,
+either by itself or in a saline Draught, proved a good gentle Purge;
+and given with six or seven Grains of Calomel, was found to be a good
+Medicine, when the Disorder was attended with Worms.
+
+In the Evening, after the Operation of the Purge, we gave an Opiate;
+and repeated it at Nights, in the Intervals between the Purges; but
+were obliged to be very sparing of the Dose, while the Disorder
+continued in its acute State; the Opiate was only given in a Quantity
+sufficient to mitigate the Pain, and to procure Rest, but never so as
+to stupify the Patient, or prevent a due Discharge by Stool; though we
+were often obliged to encrease the Dose, as Use made it familiar to
+the Patient.
+
+In the Intervals between the Purges, we gave in the Day, the Mindereri
+Draughts with the Mithridate; or the saline Draughts with the Addition
+of four Drops of the _tinctura thebaica_; or some such mild
+diaphoretic, every four or six Hours; which helped to keep up a free
+Perspiration, without any Danger of stopping the Purging; and for the
+most part answered much better than the Diascord, or Philonium, or
+other strong Astringents and Opiates commonly prescribed for this
+Purpose; which were always liable to check the Purging too much, and
+bring on severe Gripes attended with Heat and Fever[37]; and therefore
+we seldom made Use of them in this first Stage of the Disorder.
+
+    [37] _Sydenham_, _Huxham_, and all good Practitioners, have
+    taken Notice of the bad Effects of the too free Use of
+    Astringents, and given Cautions against it.
+
+If the Patient was attacked with severe Gripes[38], and a Tenesmus,
+which the Purgatives and gentle Opiates did not relieve, we ordered
+the Abdomen to be fomented with warm Stupes; and the Patient to drink
+freely of warm Barley or Rice-water, or of weak Broth[39], or an
+Infusion of Camomile Flowers, as recommended by Dr. _Pringle_; and
+ordered first Clysters of large Quantities of the plain emollient
+Decoction to be given; and if the Gripes still continued, to be
+repeated in small Quantities, with the Addition of a Drachm or two of
+the _tinctura thebaica_; for we observed that Opiate Clysters often
+gave more Relief, than Anodynes administered in any other Way; and
+sometimes, when a Tenesmus was very troublesome, the common oily
+Clyster, with a little Diascord, and _tinctura thebaica_, or the
+Starch Clyster, gave more Ease than any other.--In some Cases, where
+the Pain was sharp, attended with a Fever, we were obliged to take
+away more or less Blood; and sometimes also to apply a Blister to that
+Part of the Abdomen where the Patient felt most Pain.
+
+    [38] If the Patient was suddenly attacked with sharp Pain of
+    the Bowels and Gripes, on a Day in which he had not Physic, a
+    Dose of the Salts and Manna was commonly given immediately,
+    to empty thoroughly the first Passages.
+
+    [39] Mr. _W. Russel_ told me, that he and Dr. _Huck_ found
+    the free Use of the following Emulsion, made of Bees Wax, to
+    be of great Use after Evacuations, where there was much Pain
+    of the Bowels, in recent Cases of Fluxes in the Hospitals in
+    _America_. ℞. Ceræ alb. vel flavæ drachmes tres. Sapon. alb.
+    Hispan. drachmam unam. Aquæ fontanæ, unciam unam, liquefiant
+    super ignem in vase ferreo, agitando spatula, & dein infunde
+    in mortarium marmoreum, & adde paulatim aq. fontanæ, libras
+    duas syrupi sacchari. spiritus vini gallici tenuis, vel aquæ
+    alicujus spirituosæ ana unciam unam, terendo optime ut fiat
+    emulsio.
+
+    This Method of dissolving Bees Wax, in a Watery Liquor, is
+    entirely new; for before this we knew of no Way of making it
+    miscible with Water.
+
+During this Course, the Patients used the common low Diet of the
+Hospital; when they loathed the Rice-Gruel, they had Panado with a
+little Red Wine and Sugar; or Water-gruel, when it could be got, in
+its Place.--Their common Drink was Barley or Rice-water; of which it
+was recommended to them to drink plentifully; as nothing contributed
+more to the Cure than the free Use of such Liquors, to dilute and
+blunt the Acrimony of the Fluids[40]. In some Cases, when the Purging
+was violent, and not accompanied with the malignant Fever, the
+_decoctum album_ was found to be a good Drink; and we added
+occasionally a few Drops of the _tinctura thebaica_.
+
+    [40] Dr. _Huxham_ (_de Aere_, Vol. II. p. 107.) says, there
+    is no Disorder in which a diluting, sweetening Drink is more
+    necessary than in this; that he has done great Service among
+    the Poor by luke-warm Water; that, after emptying the Bowels
+    thoroughly, he has sometimes cured this Disorder by the Use
+    of pure Water, and a small Quantity of Opium. And _Baglivi_
+    (_Prax. Med._ lib. i.) tells us, that the drinking of common
+    Whey, and throwing up frequent Clysters of it, had cured
+    many, and that this was looked upon as a Specific, and kept a
+    Secret by some.
+
+Such were the chief Remedies we used in the first Stage of this
+Disorder; but after some Weeks, when the Fever had abated, and free
+Evacuations had been made, and the Complaint become in a manner
+chronic, we were obliged to try other Methods; and found that the best
+Way of treating this Disorder, was, to endeavour to brace and restore
+the Tone of the Intestines, by means of the corroborating and gentle
+astringent Medicines, mixed with Opiates; while mild Purgatives were
+given at proper Intervals.
+
+The Patients were kept to the same low Diet as before, with the
+Addition of a little Wine or Brandy. They were allowed from a Gill to
+a Pint of red Wine _per_ Day, which was commonly mulled before it was
+given them; when the Wine griped them, which it frequently did, they
+took in its Stead Half a Gill or a Gill of Brandy, mixed with a Pint
+or a Quart of Barley or Rice-water, or of the _decoctum album_.
+
+In this Stage of the Disorder we found, that the same Medicines would
+not answer with all, and therefore we were obliged to try Variety[41];
+and indeed, unless where the Violence of the Disorder had abated by
+the Use of Evacuations, the Event was always very doubtful; for when
+the Complaint had continued long and become chronic, and the Structure
+of the Intestines was much hurt, before the Sick were sent to us; or
+when it continued obstinate, and yielded but little to Evacuations,
+and the other Methods used in the first Stage, even Remedies esteemed
+the most efficacious oftentimes proved unsuccessful, and at length
+the Patient died.
+
+    [41] Dr. _Pringle_, in the _fourth Edition of his
+    Observations_, just published, in treating of the third or
+    last Stage of the Dysentery, remarks, that this is the Time
+    for Astringents, which ought not to be given sooner, or at
+    least very sparingly. And he tells us, that, in the former
+    Editions of his Work, he mentioned those Compositions which
+    he had most frequently used, but that he had now laid most of
+    them aside; and at present trusts to Vomits, and to a Milk
+    Diet, for the perfect Cure.
+
+    He says, “Whenever therefore the Patient is in this State,
+    and especially when his Pulse is quick, and he complains of
+    inward Heat, I began with giving him a Scruple of Ipecacuana;
+    and the next Day I put him upon the Milk-Diet; which I
+    continue till all the hectic Symptoms are gone, and till the
+    Bowels have recovered their Tone. During this Course I have
+    seldom had Occasion for any other Medicine, excepting the
+    Chalk Julep mentioned before, which I use for correcting that
+    strong Acid so incident to relaxed Stomachs. Sometimes also I
+    add an Opiate to procure Rest at Night; but after a few Days
+    these are likewise laid aside. All that I require (which
+    indeed is often hard to obtain) is a strict Perseverance in
+    the low Diet: and now and then a Repetition of the Vomit,
+    upon any new Disorder of the Stomach, or great Laxity of the
+    Bowels.
+
+    “Whilst the Patient continues in this Course, I forbid all
+    animal Food and fermented Liquors; and besides Milk, I allow
+    only the Preparations of Grain, Sago and Salop.” See Part
+    iii. ch. vi. p. 289, 290.
+
+A Spoonful of the _mixtura fracastorii_, taken after every loose
+Stool; and an anodyne Draught at Night, had a good Effect with
+some--Repeated Doses of the _philonium Londinense_ answered better
+with others, who were low, and required a Remedy that was warm and
+cordial--And others found more Benefit from the Mindereri Draughts,
+with Mithridate, or the _confectio cardiaca_, or the Theriac anodyne
+Boluses.
+
+The _mixtura Campechensis_, both alone and with _tinctura thebaica_,
+checked the Purging, and gave Relief sometimes; and the Addition of
+some of the Extract of Bark and Tincture of Cinnamon, seemed to
+encrease its Efficacy in one or two old Cases, at _Bremen_; but it
+afterwards occasioned such Sickness, that we did not continue its Use.
+
+In other inveterate Dysenteries, where we thought that a strong
+Astringent was wanted, we added a small Proportion of Allum to the
+_Campechense_ Julep, which on first using seemed to be serviceable;
+but at other Times it occasioned a Tenesmus and Gripes; and therefore
+we were obliged to be very cautious how we used it.
+
+Equal Parts of the _electuarium diascordii_ and _electuarium
+corticis_, taken in the Quantity of a Drachm twice or thrice a Day,
+was of Use in many old Fluxes[42], though it made other Patients so
+sick, that they were obliged to lay it aside.
+
+    [42] I had lately a very remarkable Instance of the Effects
+    of this Medicine, in the Case of one _Gilchrist_, a
+    middle-aged Man, by Trade a Taylor; who was admitted into
+    _St. George_’s Hospital the 20th of _July_, 1763, for an old
+    Flux, which had continued above six Months, and reduced him
+    very low: He had taken a great many Medicines without any
+    Effect. After giving him a Vomit and two Doses of Tincture of
+    Rhubarb, I gave him four Grains of the Powder of Ipecacuana
+    with Opium three Times a Day; but that having no Effect,
+    after using it for above a Fortnight, I ordered him the
+    Electuary of Diascord and Cortex; from the Time he began to
+    use this Medicine, he mended daily; and was dismissed in good
+    Health the 26th of _September_.
+
+We tried likewise in this Stage of the Disorder, repeated small Doses
+of the Ipecacuana; but it occasioned such Sickness, that we did not
+persist in its Use.
+
+In other Cases, we gave from two to five Grains of the Ipecacuana,
+mixed with Opium, in different Proportions (from three Grains to ten
+of the Ipecacuana to one of the Opium), every four or six Hours; it
+gave sometimes a little present Ease, at other Times it occasioned
+Sickness; we often continued its Use for ten, twelve, or fourteen
+Days; but it seldom produced any remarkable Change for the better, and
+we were obliged to have Recourse to other Remedies.
+
+_Dover_’s Powder was given in large Doses, from one Scruple to two;
+and proved a good Sudorific and Anodyne in some Cases; though in
+others it made the Patients sick, without producing any good
+Effect.--It commonly answered better, when used occasionally as a
+Sudorific, than when constantly continued.
+
+During the Use of these Remedies, it was necessary to repeat the
+Purgatives from Time to Time; or to mix them occasionally with the
+other Medicines, in order to carry off any corrupted Humours, or
+Excrements that might be lodged In the Cavity of the Intestines; for
+when this was neglected, the Patients were often seized with Sickness
+and Gripes, and a more violent Purging than before:--And if at any
+Time they complained of Gripes, and passed little Pieces of hardened
+Excrements, it was mostly a certain Sign that a Purge was indicated;
+and, on such Occasions, it generally gave Relief; and when attended
+with Sickness, a Vomit was given before the Purge.--Clysters were used
+as in recent Cases, where the Sick were low, or had much Pain of the
+Bowels[43], or complained of a Tenesmus.
+
+    [43] On the 21st of _November_, 1759, _Hanah Meredith_, a
+    middle-aged Woman, was admitted into _St. George_’s Hospital
+    for a Flux, which she had six or seven Weeks; she had no
+    Fever, but complained much of Sickness and Gripes, and her
+    Disorder had reduced her very low. During the two first Weeks
+    of her being in the Hospital, she had two Vomits of
+    Ipecacuana and four Doses of Rhubarb; and in the Intervals
+    anodyne and astringent Medicines, which made no Alteration in
+    her Complaints. On the 2d of _December_, she told me, that
+    two Years before she had had a Flux for above three Months,
+    which had yielded to no Remedies till she was ordered
+    repeated Clysters, and that they had made a Cure in a short
+    Time. I then ordered an emollient Clyster with a drachm of
+    the _electuarium diascordii_, and a Scruple of the _tinctura
+    thebaica_, to be given twice a Day, which gave her almost
+    immediate Relief; and with the Assistance of some Doses of
+    Rhubarb, and one or two Vomits and occasional Opiates,
+    removed her Disorder by the Middle of _January_; though she
+    remained long weak, and troubled at Times with Gripes; but
+    these Complaints were at last got the better of by her taking
+    some Doses of Rhubarb, and drinking daily a Pint of Lime
+    Water mixed with Half a Pint of Milk.
+
+    _Sarah Spencer_, a middle-aged Woman, was admitted into _St.
+    George_’s Hospital the 9th of _November_, 1763, for a Flux,
+    which had continued for two Months, and reduced her very low.
+    She complained much of Sickness and Gripes; her Stools were
+    mostly composed of Mucus and Blood; her Pulse was low, and
+    she had no Fever, but a Whiteness of the Tongue, and
+    complained of Thirst.--The first Day she had a Vomit, and
+    next Day a Dose of the purging saline oily Draught.--She was
+    ordered to have an emollient Clyster, with a Drachm of
+    Diascord, and as much _tinctura thebaica_, given her every
+    Evening; and to have a Dose of the saline oily Purge twice a
+    Week, and Opiates occasionally; by following this Course, and
+    drinking at Times the Chalk Julep, her Disorder was removed,
+    and she was discharged the Hospital on the 30th of the same
+    Month.
+
+In some old Dysenteries, where the villous Coat of the Intestines was
+much injured, I gave the Cordial Draughts, with the Addition of Half a
+Drachm of the _balsamum copaivi_, a Scruple of the Extract of the
+Bark, and five Drops of the _tinctura thebaica_, three Times a Day.
+At first, this Medicine seemed to promise much, particularly in the
+Case of an old Invalid, _William Brookes_; who had been long ill of a
+Flux, attended with Gripes and a Tenesmus. He had used Variety of
+Remedies, without receiving any Benefit. For the first Fortnight,
+after he began the Use of this Medicine, he rested well, and found
+great Relief; and seemed to be in a fair Way of doing well. But the
+Disorder being too far advanced before he began to use it, he
+relapsed, and died. On opening his Body, the inner Coats of the Rectum
+and the lower Part of the Colon seemed to be reduced almost to a
+gelatinous Substance, and the other Coats were black, approaching to a
+Gangrene.--The same Medicine gave Relief in other Cases, but they were
+too far advanced before it was administered. In these Cases, when the
+villous Coat of the Intestines was inflamed and very irritable, the
+mucilaginous Medicines, the _pulvis e tragacantha_, and such others,
+were of Service; and frequently Starch Clysters and Anodynes gave
+Relief, when other Remedies had little Effect. Flower, boiled with
+Milk, and sweetened with Sugar, and given for Breakfast, as mentioned
+by Dr. _Pringle_, proved a good Palliative to some; and the Starch and
+Gum Arabic, dissolved in Water, a good Drink to others.--Lime Water
+and Milk, drank to the Quantity of a Pint or a Quart a Day, was of use
+to a few, though it did not agree with all.
+
+It was very common for Patients bad in the malignant Fever to be
+seized likewise with the Flux. Such Cases were always extremely
+dangerous; and when the Fever was bad, we were often obliged to
+neglect the Flux, and only attend to the Fever.--When the Purging was
+violent, and appeared very early in the Fever, it often sunk the
+Patients, and soon carried them off: but where it was moderate, and
+did not appear till towards the Height or the Decline of the Fever, it
+often proved a Crisis to the Disorder.
+
+When such Fluxes appeared early attended with sharp Pain of the
+Bowels, and Signs of Inflammation; if the Patient was strong, we
+began the Cure with opening a Vein, which the Patient bore easily, and
+it gave Relief; but when the Symptoms were mild, without any acute
+Pain, the Bleeding was omitted.--Commonly the Bowels were loaded with
+corrupted Humours, when this Symptom appeared; and, therefore, we
+found it of Advantage to give a Dose of the Salts with Manna and Oil,
+or some other gentle Purge, to carry them off; and in the Evening an
+Opiate to ease the Pain and procure the Patient Rest.
+
+After this we gave the Mindereri Draughts with Mithridate; and as soon
+as the Petechiæ appeared, or we observed any Remissions in the Fever,
+the Patient took every four or six Hours, a Drachm of an Electuary,
+composed of equal Parts of the _electuarium corticis_ and the
+_electuarium diascordii_[44]; or Half a Drachm of the Powder of the
+Bark, or a Scruple of the Extract, in the Mindereri Draughts, with
+four or five Drops of the _tinctura thebaica_; and we repeated the
+Opiate in the Evening, always proportioning the Quantity of it to the
+Effects of the former Dose, and the Violence of the Purging.
+
+    [44] This Practice of giving the Cortex with Opiates in the
+    Dysentery is not new; for Dr. R. _Morton_, in his Appendix to
+    his second Exercise on the Fevers, which appeared from 1658
+    to 1691, observes, that after the Plague of 1666 had ceased,
+    a Fever from a milder Poison, attended with Gripes and
+    Dysentery, began to make its Appearance. As the common
+    Methods of Cure proved unsuccessful, and Dr. _Morton_
+    observed Exacerbations and Remissions, he resolved to give
+    the Bark mixed with Laudanum; and found it answer his
+    Expectation. The first Patient to whom he gave it, was a man
+    in _Long Lane_, who laboured under a Tertian Dysentery; upon
+    observing a Remission, he ordered a Drachm of the Bark, mixed
+    with a Grain of Opium, to be given every four Hours for six
+    Times; and this removed both the Fever and Dysentery.--He
+    says, he afterwards gave it, with equal Success, in the
+    Quotidian Dysenteries, where he observed Exacerbations or
+    Remissions; and he adds, that he does not doubt but that it
+    will answer as well in Epidemical 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_.
+
+On the second or third Day, we repeated the Purge; or, if the Patient
+was weak, ordered a Clyster to be administered in its Place; in order
+to prevent the putrid Fluids and Excrements from being accumulated in
+the Bowels:--In other respects we treated it as when the Disorder was
+not complicated with the malignant Fever.
+
+This Method, though it did not succeed with all, yet it answered
+better than any other I tried;--and it ought to be remarked, that
+although it had such a good Effect in Cases attended with the
+malignant Fever, or where the Fever inclined to the intermittent Kind,
+it did not answer so well in other recent Cases, but often made the
+Patient sick.
+
+In military Hospitals, Fluxes are liable to be complicated with other
+Disorders, as well as with the malignant Fever; especially with
+Coughs, and pleuritic and peripneumonic Symptoms, when the Weather
+begins to be cold, in _October_ and _November_.--In such Cases, when
+the Patients were strong, we were often obliged to bleed freely, to
+apply Blisters, and in the Beginning treat the Disorder as
+inflammatory; having at the same Time an Eye towards the Flux, in the
+other Medicines we prescribed.
+
+Patients, who have had the Flux long, are apt to have their Legs swell
+at Nights; or to swell all over as soon as the Flux has stopped. Such
+oedematous or anasarcous Swellings, we treated nearly in the same
+Manner as those which followed the petechial Fever; only that we durst
+not at first be so free with the Use of Purgatives; for as the Bowels
+remained weak and easily irritated, such Medicines were apt to bring
+back the Flux; and therefore, in the Beginning, we were for the most
+part obliged to attempt the Cure by Diuretics and Diaphoretics; and to
+be sparing of the Use of Purgatives, especially of those of the
+hydragogue Kind; though if the Swellings continued for some Time after
+the Flux was gone off, and the Patients were strong, we then ventured
+to give Purges at proper Intervals:--And Blisters and Scarifications
+removed them in several Instances both at _Paderborn_ and
+_Osnabruck_.
+
+In _December_, 1761, we had a Case of this Kind where the _oxymel
+scilliticum_ was of remarkable Service. A Soldier, belonging to the
+Guards, after a Flux, swelled all over, and made but a very small
+Quantity of Water. He took Medicines of different Sorts for some
+Weeks, but received no Benefit till we gave him the Oxymel Mixture;
+after taking a few Doses he made Water very freely, and in large
+Quantities, and the Swellings of his Body and Scrotum began
+immediately to subside; and by continuing its Use for a Fortnight, the
+Swellings entirely disappeared, and he recovered his Health and
+Strength.--The Oxymel, at the same Time that it promoted a Flow of
+Urine, kept his Body gently open, but did not occasion any Return of
+the Flux.
+
+At the Beginning of _January_, 1762, one _Carter_, a Soldier of the
+Eleventh Regiment of Foot, laboured under an universal Anasarca; which
+about two Months before had succeeded a Flux. He made but very little
+Water, and that of a high red Colour. He took Variety of Medicines,
+as Purges, Vomits, _Dover_’s Powder, lixivial and neutral Salts with
+Opiates, Infusions of Horse-Radish, all without Effect; till he was
+ordered small Doses of Calomel, three Grains Morning and Evening.
+After the third Dose he began to make Water freely; and by the 24th of
+_January_ the Swellings were all gone, and he was shipped off for
+_England_ the 8th of _February_; having been discharged from his
+Regiment. The Ship, he went aboard of, was detained in the River
+_Weser_ for above six Weeks, and the malignant Fever broke out aboard
+the Transport: He took the Distemper, and got well of it; but towards
+the Decline was seized with a Return of the Flux, which carried him
+off.
+
+When these oedematous Swellings came after the Purging was stopt, if
+the Patient’s Strength was not much exhausted, and he laboured under
+no other Disorder, he commonly got the better of it:--But when the
+Strength was gone before the Swellings appeared, the Disorder often
+ended in a confirmed Dropsy, and at last in Death; and when the
+Swellings were universal over the Body, while the Flux yet continued,
+it was a Sign of great Weakness, and they did not survive it long[45].
+
+    [45] Many other Medicines have been used for the Cure of old
+    Dysenteries,--The _Conessi Bark_, recommended as a Specific
+    in 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.
+
+    [46] See _Aretæus_, Lib. ii. Cap. 4. and _Celsus_, Lib. iv.
+    Cap. 11.
+
+    [47] The Polenta seems to have been nothing but toasted
+    Barley Meal. See _Plinii Hist. Natural._ Lib. xxii. Cap. 25.
+
+    [48] _Celsus loco citato._
+
+Dr. _Sydenham_[49] trusts principally to drinking freely of Chicken
+Broth, and throwing up Clysters of the same, and afterwards giving
+Opiates.
+
+    [49] _Processus integ. de Cholera._
+
+Dr. _Ayton Douglas_, in the sixth Volume of the _Edinburgh_ Medical
+Essays[50], recommends a Decoction of Oat Bread, baked without Leaven
+or Yest, and carefully toasted as brown as Coffee, but not burnt; as a
+Remedy very grateful to the Stomach, and useful in stopping the
+Vomiting, and sometimes the Purging too: And he relates several Cases
+where it had a good Effect. After the Vomiting was stopped, he added
+the Use of mild Opiates; and, where the Patient was low, Wine and
+other Cordials.
+
+    [50] Art. 65.
+
+
+
+
+OF THE INFLAMMATORY FEVER.
+
+
+On the Return of the Troops from the Winter Expedition into the
+Country of _Hesse_, in the Year 1761, we had several Men seized with
+Inflammatory Fevers without any topical Inflammation; and at the
+Opening of each Campaign had always Numbers sent to the Hospitals ill
+of this Disorder. Towards the End of the Campaigns, and throughout the
+Winter, many were seized with Inflammatory Fevers; but these were
+mostly complicated, with pleuritic, or peripneumonic Symptoms, or
+other topical Inflammations, or with rheumatic Complaints.
+
+In the Inflammatory Fever, the Sick were seized at first with cold and
+hot Fits, succeeded by Pain in the Head and all over the Body. The
+Pulse was strong and quick, and the Blood sizy; attended with other
+Appearances commonly observed in such Fevers.
+
+As the Summer advanced, this Fever was often accompanied with bilious
+Symptoms, with Sickness, and vomiting of bilious Matter, and very
+frequently with a Purging: Towards the End of Summer it ceased, and
+was succeeded by the bilious remittent Fever.--And it was no uncommon
+Thing to see those Fevers, which originally were entirely of an
+inflammatory Nature, after the sick had been some Days in a crowded
+Hospital, partake a good deal of the Nature of the Malignant Fever, or
+be changed entirely into it.
+
+We treated these Fevers in the common antiphlogistic Method.--We
+blooded freely in the Beginning; gave the saline Draughts with Nitre
+and other cooling Medicines; and made the Patients drink plentifully
+of small Liquors:--And when they were inclined to be costive, gave
+mild Purges, or emollient laxative Clysters. We afterwards applied
+Blisters; and if the Pulse began to sink, gave Cordials, Wine, and
+other Remedies commonly employed in such Cases;--and towards the
+Decline of the Fever endeavoured to promote such Evacuations as were
+pointed out by Nature, and likely to prove critical.
+
+When the Case was complicated with bilious Symptoms in the Beginning,
+we were obliged to have particular Regard to the first Passages. If
+the Patient complained much of Sickness, we gave a gentle Vomit in the
+Evening, after bleeding; and a Purge next Day, to carry off any
+bilious or corrupted Humours that might be lodged in the Stomach or
+Intestines; and we found that these Evacuations gave Relief, and
+generally mitigated all the Symptoms.
+
+If at any Time during the Fever a Looseness came on, especially when
+attended with Gripes, we gave a Dose of some gentle Physic, which made
+a free Evacuation; and an Opiate in the Evening after its Operation;
+and afterwards we found it answer better to attempt rather to
+moderate, than wholly stop the Purging by strong Astringents, and
+Opiates; unless where the Evacuation by Stool was so great as to be in
+Danger of sinking the Patient.
+
+The _pulvis antimonialis_, composed of ten Parts of the _pulvis e
+chelis_, and one Part of the Tartar emetic, given in small Doses, was
+serviceable in many of these Fevers, after free Evacuations had been
+made.
+
+Two Patients, one a Soldier of the Twentieth Regiment, the other a
+_German_ Waggoner, were taken ill of this Fever about the 25th of
+_December_, 1762: They were both blooded freely, and had a Dose of
+Physic in the Beginning; and the saline Draughts with Nitre and other
+cooling Remedies; and had Blisters applied without producing any
+considerable Change in their Disorder.--On the 5th of _January_, 1763,
+they both complained much of Thirst, and were inclined to be costive;
+their Tongues were parched, their Pulses quick and small, and their
+Skins dry; they were restless at Nights, and the Soldier had a slight
+Delirium.--I ordered each of them four Grains of the _pulvis
+antimonialis_ every four Hours.
+
+6th. Next Day the Soldier told me, he had had four loose Stools; his
+Senses were much clearer, the Pulse calmer and slower, and he said he
+found himself lighter and easier, and less feverish, than he had been
+since he was first taken ill. The Medicine was continued, with the
+Addition of an anodyne Draught at Night.--7th. I found him in a fine
+breathing Sweat, and he told me he had slept well in the Night:
+p.--8th. The Sweat continued till this Morning, and on going off his
+Urine let fall a copious white Sediment, and left him free from the
+Fever; after which he mended daily.
+
+The Waggoner, after taking the third Dose of the Powders, had a warm
+Moisture upon the Skin.--On the 6th was cooler and without much Fever,
+and had had one Stool.--7th. The warm Moisture ended in a profuse
+Sweat, which carried off the Fever, and he continued to recover
+daily.
+
+
+
+
+OF THE ANGINA; OR, SORE THROAT.
+
+
+Many of the Soldiers during the Campaign were seized with
+Inflammations of the Throat, especially when the Nights were cold and
+moist after warm Days; and when they did Duty in cold wet Nights in
+the Winter Season.--All of them I saw in _Germany_ were of the
+inflammatory Kind; I did not observe any that were malignant.
+
+They were treated in the antiphlogistic Method.--The Patients were
+blooded liberally in the Beginning--took the cooling nitrous and
+saline Medicines--gentle Diaphoretics and Purgatives--and used
+frequent Gargarisms.
+
+Sometimes a Flannel rubbed with camphorated Oil, or the _linimentum
+volatile_, and applied round the Neck, was of Service.--And frequently
+after bleeding sufficiently, where the Breathing or Swallowing was
+difficult, the Application of a large Blister to the Neck gave speedy
+Relief.
+
+
+
+
+OF THE PLEURISY.
+
+
+The Pleurisy, or an acute Inflammation of the Side, was most frequent
+among the Soldiers towards the latter End of the Campaigns; though
+some were attacked with it at all Times of the Year, from doing Duty
+in all Sorts of Weather.
+
+We followed the antiphlogistic Method of Cure; and ordered plentiful
+Bleeding in the Beginning, till the Violence of the Pain began to
+abate, or the Patient grew faint;--and the Side to be fomented with
+Flannels dipped in warm emollient Decoctions, and afterwards rubbed
+with volatile Liniments: At the same Time the Patient drank freely of
+warm diluting Liquors, as Barley Water, the pectoral Decoction, and
+such like; and took the saline and other cooling Medicines, mixed
+occasionally with Sperma Ceti, or some other soft Pectorals, if there
+was a tickling Cough.--When the Patient was costive, we gave a Dose of
+Salts, or some other mild Physic, or laxative Clysters.
+
+If the Pain continued very acute, we repeated the Bleeding as often as
+Necessity seemed to require, and the Pulse could bear; and immediately
+after the second Bleeding ordered a large Blister to be applied to the
+Part affected.
+
+Physicians formerly used to forbid Bleeding after the fourth Day, if
+it had been omitted so long; but when no Symptoms of Suppuration had
+already appeared, on whatever Day of the Disorder it happened, I
+ordered plentiful Bleeding, the same as in recent Cases; and never
+found any Disadvantage, but often great Service from this Practice.
+
+When the Sharpness of the Pain was gone, and the Pulse became soft,
+very often a dull Pain remained for some Time in the Part.--In some
+Cases a brisk Purge removed it;--in others, cupping above the Part,
+and afterwards rubbing it with the volatile Liniments, did
+Service;--in others, gentle Opiates at Night, especially where there
+was a tickling Cough;--and in one or two Cases, this Pain did not go
+away, till the Patient was ordered to drink every Day for some Time, a
+Quart of the Decoction of Sarsaparilla with the antimonial Wine.
+
+In the Course of this Disorder, if a kindly Moisture broke out on the
+Skin, which gave Relief, this was encouraged by the Use of mild warm
+Liquors; or if the Patient began to spit up a viscid or yellowish
+Mucus, we endeavoured to keep up the Expectoration by the Use of mild
+Pectorals; and if a Purging came on, we were careful not to check it
+too soon, unless it was so violent as to be in Danger of sinking the
+Patient.
+
+When an Inflammation of the Side came to Suppuration, which happened
+in one or two Cases at _Osnabruck_, in _May_ 1761; as soon as a
+Fluctuation of Matter was to be felt, an Incision was was made in the
+Part, and the Matter discharged; after which the Sore healed kindly,
+and the Patients recovered[51]. I am persuaded, was this Operation
+oftener performed, many would recover who die consumptive.
+
+    [51] Dr. _Mead_ advises, where the Lungs and Pleura grow
+    together, and an Abscess forms, to open it with Caustic; and
+    afterwards to keep the Ulcer open during the Patient’s Life:
+    For he says, he has often seen, where such Sores were healed
+    up, that the Patient died soon after by an Efflux of Matter
+    upon the Breast. _Monita Medica_, Cap. i. Sect. 7.
+
+
+
+
+OF THE PERIPNEUMONY.
+
+
+The Soldiers were subject at all Times to the Peripneumony, or
+Inflammation of the Lungs, from doing Duty in cold wet Weather, and
+from their irregular Way of living; but more particularly towards the
+End of the Campaigns, and in Winter.
+
+This Disorder was much more dangerous and fatal than the Pleurisy,
+especially when neglected in the Beginning; for then Bleeding had
+seldom any Effect; the Difficulty of Breathing encreased, the Patient
+was seized with an Orthopnea, and such an Anxiety and Sense of
+Suffocation, that he could not sleep; and the Pulse sunk; and in these
+Cases Death only afforded Relief. This we experienced in many Men who
+had lain neglected in Quarters, for two, three, four, or five Days,
+before they were brought to the Hospital.
+
+In most of the Bodies of those who died of this Disorder, and were
+opened after Death; we found the Lungs violently inflamed, with livid
+or gangrenous Spots on their Surface; and more or less of a watery
+Serum extravasated into the Cavity of the Chest.
+
+Three had Suppurations in the Lungs. In one, who had lain sick in
+Quarters for ten Days or upwards, before he was sent to the Hospital,
+the right Cavity of the Thorax was found full of a watery Serum; and
+the Lobes of the Lungs on the same Side almost entirely wasted; and
+what remained seemed as it were composed of thickened Membranes,
+resembling those formed by the coagulable Lymph, or what is called by
+some (though improperly) the fibrous Part of the Blood. The Lobes in
+the left Side seemed to be in a sound State, or at most but slightly
+inflamed. From the right Lobes of the Lungs being so much wasted, I
+suspected that the Patient had probably laboured long under some
+Disorder of the Breast; but I could not from Enquiry obtain any
+Information in this Particular; nor did he ever mention such a Thing
+during the few Days he lived after being brought into the Hospital; he
+said, he had only been ill for eight or ten Days before; but Soldiers
+afflicted with chronic Distempers, when they are seized with violent
+Symptoms, or acute Diseases, are apt to reckon the Beginning of their
+Disorder, only from the Time they are taken ill in a violent Manner;
+and never to take any Notice of their former Complaints.
+
+Another Soldier, about the Middle of _February_, 1762, remained in
+Quarters five Days after being taken ill with a Pain of the Breast,
+and a Difficulty of Breathing; the sixth Day he was brought to the
+Hospital in the Morning, and I saw him about eleven o’Clock; he then
+had all the Symptoms of the true Peripneumony, attended with a strong
+hard Pulse. He was immediately blooded as freely as his Pulse would
+bear, had Blisters applied, and other Remedies used; notwithstanding
+which, on the eighth Day from that Time, he began to throw up a
+purulent Matter in great Quantity, attended with a constant hectic
+Heat, and Fever; which sunk him so fast, that he died the tenth Day,
+after he first began to expectorate.
+
+On the 2d of _March_, a Soldier, of the Fifty-first Regiment of Foot,
+was brought to the Hospital, with a violent Pain in the left Side, and
+a great Difficulty of Breathing. Upon examining him, he told me, that
+about two Years before he had had a violent Stitch in his left Side,
+towards the lower Part of the Thorax; that ever since he had been
+subject to a Difficulty of Breathing; and at Times to a Pain in the
+Side; but that he had only been seized with the violent Pain and
+Difficulty of Breathing he then complained of, about five Days before,
+occasioned by catching Cold, on being billeted in a low, cold, and
+damp House.--His Pulse was quick, the Pain of his Side and Difficulty
+of Breathing so great, that he could not sleep, nor lie down, but was
+obliged to sit constantly in an erect Posture; his Tongue was white
+and furred, and he had had no Stools for three Days: He was ordered to
+be blooded immediately; and to take a Dose of Salts; and his Side to
+be rubbed with the _linimentum volatile_. 3d. His Breathing and Pain
+of the Side were easier; he had slept a little in the Night, and could
+lie on his right side, but not on his left. He was ordered the Squill
+Mixture. 4th. His Breathing was worse; he was blooded a second Time;
+had a large Blister applied to his Side, and was ordered to continue
+the Use of the Squill Mixture. On the 5th, 6th, and 7th, he seemed
+easier, though the Breathing was still much affected, and his Pulse
+quick and low, attended with a hectic Heat. On the 8th, he told me
+that his left Side was swelled: On examining, I observed a Fullness in
+that Side of the Thorax; and on pressing with my Fingers between the
+Ribs, I thought I felt an obscure Fluctuation of a deep-seated Fluid.
+From these Appearances, and the History of the Case, I judged that
+there was a Collection of some Fluid within the Cavity of the Chest;
+and that the only Means left to give Relief, was to make an Opening
+into the Cavity, and so evacuate the Fluid. I therefore proposed to
+him the Operation of the Empyema, to be performed immediately; which
+he several Times obstinately refused to submit to: He allowed a Seton
+to be put in his Side, but that did not answer the End proposed: He
+languished six Days longer; and died the 14th of _March_. Next Day an
+Opening was made in the Thorax, in the Part where the Operation was
+proposed to have been performed; as soon as the Pleura was cut
+through, some Quarts of Water rushed out. We then opened the Thorax,
+and found still some Water in the left Cavity. The Pericardium was
+thickened, and slightly inflamed, and adhered to the Diaphragm; which
+was likewise a little thickened and inflamed in the adhering Part; the
+Lungs on that Side were much compressed, and contracted by the
+Pressure of the Water; but on being inflated and cut, seemed in a
+sound State, except that they were slightly inflamed. The Lungs of
+the left Side adhered every-where firmly to the Thorax, but seemed
+otherwise sound; having no Tubercles, Suppuration, or other Disorder,
+that we could observe in cutting them. The Heart and Blood Vessels
+were sound, and no other polypous Concretions were observed within
+their Cavities, but such as we find in most dead Bodies; which seem to
+be formed of the coagulable Lymph in _articulo mortis_. The Viscera of
+the Abdomen were in a sound State.
+
+We treated the Peripneumony nearly as the Pleurisy. We bled freely in
+the Beginning, till the Breathing became easier, or the Pulse began to
+sink; taking Care not to be deceived by a low oppressive Pulse, which
+generally rose upon Bleeding. We applied large Blisters; gave the mild
+Pectorals freely, and plenty of warm diluting Liquors, Barley Water,
+the pectoral Decoction, and such like; which afforded more Relief than
+any other Medicines. We gave too saline Purges, and laxative Clysters
+occasionally; and in some Cases ordered the Steams of warm emollient
+Decoctions with Vinegar to be drawn into the Lungs.
+
+By this Treatment most of them, who applied early for Relief, got the
+better of the Disorder.
+
+When the Expectoration began, the Patient continued the free Use of
+the mild Pectorals, and diluting Liquors; and no Medicines were given
+that might in the least tend to stop it; other Evacuations were
+omitted, unless where the Pain of the Breast, or the Difficulty of
+Breathing increased; in which Case, if the Pulse kept up, I ordered a
+Vein to be opened, and a suitable Quantity of Blood to be taken away;
+no other Remedy affording any Relief, till this Evacuation was made.
+Where the Patient was costive, we frequently ordered laxative
+Clysters, or a mild Purge, and found them beneficial: But where no
+such Symptoms occurred, it was best, for the most part, to omit all
+Evacuations of this Kind, after a free Expectoration had begun, and to
+trust to it for carrying off the Disorder.
+
+In some Cases, where the Expectoration stopt suddenly after bleeding,
+we gave with Advantage a gentle Vomit, as recommended by Dr.
+_Huxham_[52].
+
+    [52] Some late Authors seem to look upon the _Pleurisy_ and
+    _Peripneumony_ as the same Disorder: However, though it be
+    true, that when the _Pleura_ is inflamed, the Surface of the
+    contiguous Lungs is generally in the same State; and that,
+    when the _Lungs_ are inflamed, the Pleura is often affected;
+    yet as I have frequently seen the true Peripneumony without
+    that sharp Pain of the Side which characterizes the Pleurisy;
+    and upon opening the Bodies of People who have died of the
+    Peripneumony, have found the Lungs violently inflamed and
+    livid, and so filled with Blood as to sink in Water, without
+    the Pleura being much diseased; and upon opening the Thorax
+    of others who died of the Pleurisy, have found the
+    intercostal Muscles and Pleura violently inflamed with livid
+    Spots, and only a small Portion of the Surface of the
+    contiguous Lungs affected; I cannot help still looking upon
+    them as distinct Disorders; though they require nearly the
+    same Treatment, and are often complicated together.
+
+
+
+
+OF THE COUGH and CONSUMPTION.
+
+
+Coughs were very frequent during the Winter, and when the Weather was
+wet and cold. They were often accompanied with Pains of the Breast;
+and, when neglected, Obstructions, Tubercles, and Suppurations, were
+apt to form in the Lungs, and the Disease to end in a Consumption, or
+_Phthisis Pulmonalis_.
+
+When Coughs were slight, guarding against further Cold, and the Use of
+mild Pectorals and warm Drinks, removed them. But when the Patient
+complained of a Pain and Tightness about the Breast, it was always
+necessary to take away more or less Blood; and after Bleeding to give
+some of the mild Pectorals, such as the Sperma Ceti or oily Mixtures;
+and, if a Fever attended, to join the Use of Nitre, or of the saline
+or mindereri Draughts; and, if a tickling Cough was troublesome, to
+give frequently a Tea Spoonful of the oily Linctus, acidulated either
+with the Spirit of Vitriol, or the _oxymel scilliticum_. The mild
+Diaphoretics, such as the mindereri Draughts, given along with warm
+Drinks, to promote a free Perspiration, or Sweat, were used with
+Advantage; when the Patients kept in Bed, and lay in Wards which had
+Stoves in them.
+
+If the Cough and Pain of the Breast were not relieved by these Means,
+the Patient was bled a second Time, and a Blister applied to the Side
+immediately after; which often removed most of the Complaints. When it
+did not, we gave the pectoral Decoction for common Drink; and if there
+was a Shortness or Difficulty of Breathing, the squill Mixture, or
+_lac ammoniacum_, with Oxymel; and occasionally gentle Purges: And if
+at any Time of the Disorder the Tightness and Pain of the Breast
+returned violent, we took away some Blood, no other Remedy affording
+Relief.
+
+When there was little or no Fever, and a thin Rheum kept up a tickling
+Cough, nothing had a better Effect than to add some Drops of the
+_tinctura thebaica_, or some of the _elixir paregoricum_, to the
+oleagenous or squill Mixtures; or to give an Opiate Draught or Pill at
+Bed-Time, which eased the Cough, and procured the Patient Rest.
+
+At all Times it was necessary, when the Cough was violent, attended
+with Pains of the Breast, to keep the Patients on low Diet; and in as
+free and pure Air as the Nature of the Hospitals would admit of; for
+we often found that those Men who had laboured long under obstinate
+Coughs, which threatened Consumptions in small crowded Wards,
+recovered surprisingly on being removed to a freer Air; of which we
+had a remarkable Instance in the Hospital at _Bremen_, in _January_
+1762; upon removing some Men, afflicted with very bad Coughs, out of
+small Wards, which were damp, into one large one, which was dry and
+airy.
+
+When the Weather was good, we made the Patients walk out a little in
+the Day-Time; for we observed, that remaining always in the Hospital,
+and breathing nothing but a foul Air, helped to encrease the
+Disorder.--When we knew the Men to be sober, and not apt to commit
+Irregularities, we used to procure them good Billets, and make them
+come daily to the Hospital for their Medicines.
+
+Equal Parts of Lime-Water and Milk, drank to the Quantity of a Quart a
+Day, was of Use to some; and the _infusum amarum_, and other gentle
+Bitters, taken to the Quantity of an Ounce or two, Morning and
+Evening, to others[53].
+
+    [53] Asses Milk, and _Bristol_ and _Seltzer_ Waters, which
+    are found so serviceable in pulmonic Disorders, could not be
+    had in the military Hospitals; and riding on Horseback was
+    too expensive a Remedy for a Soldier.
+
+    In chronic Cases, where we suspect Obstructions and Tubercles
+    to be formed in the Lungs, which have not already come to
+    Suppuration, Dr. _Russel_ recommends the Use of Sea Water for
+    resolving them; but we were at too great a Distance from the
+    Sea to try this Remedy. See his _Treatise on Sea Water_, Page
+    17.
+
+A Decoction of the Cortex removed some Coughs which had continued for
+a considerable Time. In one or two of these Cases, slight hectic
+Symptoms had already appeared[54]. However, for the most part,
+where-ever Obstructions of the Lungs were confirmed, or there were
+evident hectic Symptoms without a free Discharge of purulent Matter,
+the Bark did no Service; but rather heated and increased the Fever,
+and made the Sick more restless and uneasy.--It was of most Use where
+there seemed to be no confirmed Obstructions, but the Vessels much
+relaxed; which we judged to be the Case from the Patients having no
+fixed Pain, nor the Breathing much affected. If the Sick were
+plethoric, or in the least feverish, we ordered a little Blood to be
+taken away, before we began the Use of this Medicine.
+
+    [54] _Mary Shepperd_, a Woman twenty-six Years of Age, was
+    admitted into _St. George_’s Hospital the 6th of _June_,
+    1759, for a Cough; attended with a constant hectic Fever and
+    Night Sweats, which had begun in the Month of _April_, after
+    the Measles. She complained likewise of having the _fluor
+    albus_, and she had been blooded more than once before she
+    came to the Hospital.--I at first gave her some of the mild
+    Pectorals; and a Solution of White Vitriol in Water, _utenda
+    pro inject. uterina_. After a Week, finding no Alteration in
+    her Complaints, I advised her to become an Out-patient; and
+    to go down to her Friends in the Country, to live upon a Milk
+    Diet; to take gentle Exercise, and continue the Use of her
+    Medicines; which she did, but without any Alteration in her
+    Disorder, till the 6th of _July_, when I ordered her to take
+    thrice a Day two Ounces of the Decoction of the Cortex, along
+    with a saline Draught. Immediately, on beginning to use this
+    Medicine, her Disorder began to take a favourable Turn; her
+    Fever and Night Sweats left her, her Cough became easier, and
+    she recovered Health and Strength daily. She came to the
+    Hospital the 15th of _August_, seemingly in good Health, to
+    return Thanks for her Cure.
+
+In similar Cases, I have sometimes observed good Effects from the Use
+of the Balsam _Copaivy_, or _Peru_; given either in Juleps or made up
+into an Electuary, as in the _electuarium e spermate ceti cum
+balsamo_; but in whatever Form they were given, if there were
+confirmed Obstructions of the Lungs, they rather heated and inflamed,
+than did any real Service.
+
+When Coughs continued long, attended with Pain in the Side, Difficulty
+of Breathing, and Hectic Fever and Night Sweats, we always had Reason
+to suspect, that the Disorder would terminate in a confirmed
+Consumption. When this was threatened, we found, that the principal
+Thing to be done, was to keep the Patients cool; and to endeavour to
+allay the hectic Heat and Fever; and to retard, as much as possible,
+the Progress of the Disorder. When the Case was recent, we were
+sometimes so lucky as to make a Cure; but after it was confirmed, it
+for the most part ended fatally.
+
+We kept the Patients upon a low Diet; and where-ever Milk was to be
+got easily, we allowed them a Pint a Day[55]; which was either mixed
+with Water and given for Drink, or they took it to Breakfast or
+Supper.--Their common Drink was either Barley Water or the pectoral
+Decoction; which was occasionally acidulated with a few Drops of
+Spirit of Vitriol; and we gave at the same Time the cooling
+Medicines, such as Nitre, the saline or mindereri Draughts, mixed at
+Times with Sperma Ceti, or some other of the mild Pectorals.
+
+    [55] In private Practice, at this Stage of the Disorder, the
+    Use of Asses Milk, and drinking the _Bristol_ Water at the
+    _Bristol_ Wells, and riding on Horseback daily, are justly
+    ranked amongst the most efficacious Remedies; and going into
+    the more southern Climates, as the South of _France_,
+    _Portugal_, or _Italy_, where the Air is warmer, more
+    constant, and dry, than in _England_, has often been found to
+    produce good Effects.
+
+The opening a Vein, and taking away from four to eight Ounces of
+Blood[56], whenever the Pain of the Breast was troublesome, or the
+Patient was hot and restless at Nights from the Hectic Fever, gave the
+greatest Relief of any Thing we tried; and these repeated small
+Bleedings were so far from wasting the Patient’s Strength, that they
+rather seemed to prevent its being exhausted so fast as otherwise it
+would have been, by allaying the Force of the Hectic Fever.
+
+    [56] This Practice has been strongly recommended by Dr.
+    _Mead_, in his _Monita Medica_, Sect. x. and by an anonymous
+    Author in the _Edinburgh Medical Essays_, Vol. IV. Art. 28.
+    and Dr. _Mead_ says, when Things have not been quite
+    desperate, he has seen good Success from it.
+
+At this Stage of the Disorder, we put in Setons, or ordered Issues, to
+serve as a Drain to carry off the Matter, and found them of Advantage
+in some Cases. When the Patients complained of any fixed Pain, we
+always made the Issues as near the Part affected as possible[57]. On
+the 5th of _May_, 1762, a Man, belonging to the Eighty-eighth Regiment
+of Foot, was sent to the Hospital at _Bremen_ for an Hæmoptoe,
+attended with a constant hectic Heat and Fever.--After being blooded,
+and using the cooling Remedies without Success, he had four Pea Issues
+made in his Back; and had a slight Decoction of the Cortex, acidulated
+with Spirit of Vitriol. As soon as the Issues began to discharge
+freely, the hectic Heat, Fever, and Spitting of Blood, diminished
+daily; and he recovered his Health and Strength in a short Time.
+However, it ought to be observed, that although these Drains are
+sometimes efficacious, yet, when the Disease is far advanced, the
+Mischief is generally too deep rooted for them to be of any Service.
+
+    [57] In _June_, 1748, a Servant Girl came to ask my Advice
+    for a Cough, attended with a constant Hectic Fever and Night
+    Sweats, which had begun some Months before, on catching Cold.
+    The Matter she spit up was yellow, and had the Appearance of
+    Pus; and she complained of a Pain in the left Side of the
+    Thorax. I ordered her the saline Mixture with Sperma Ceti to
+    be taken thrice a Day, to lose a little Blood, to drink an
+    Infusion of Linseed sweetened with Honey, and to have a Seton
+    put in her Side at the Part where she complained of Pain;
+    advising her to go home to her Father, who was a Farmer in
+    the Country, and to live upon a Milk and Vegetable Diet, and
+    ride on Horseback whenever she could conveniently. She seemed
+    so far gone in a Consumption, that I scarce expected to see
+    her again; but, in the Month of _December_, she came to
+    return me Thanks for her Cure, seeming then to be in good
+    Health. She told me, that, as soon as the Seton began to
+    discharge freely, she found Relief; and mended afterwards
+    daily, by following the Directions I had given her.
+
+The Bark, and natural Balsams, for the most part were prejudicial, and
+encreased the Hectic Heat and Fever; except in one or two Cases, where
+the Disorder seemed to depend on a Vomica of the Lungs, and the
+Patient coughed up the Matter freely.--In one Case they were of
+considerable Service; the Patient was very low, and had the Night
+Sweats, but coughed up the Matter freely: On using the Decoction of
+the Bark, and the _electuarium e spermate ceti cum balsamo_, the
+Matter expectorated became thicker, and of a more balmy Consistence,
+without any Increase of Heat or Fever; after which the Symptoms became
+gradually milder, and the Patient recovered.
+
+In the Course of this Disorder the Patients often became very hot and
+restless, and were troubled with Gripes, succeeded by a Purging: These
+Symptoms were most readily removed by a Dose of Rhubarb, or of some
+other mild Purge; for they generally proceeded from corrupted Humours
+lodged in the Intestines. In the Evening, after the Operation of the
+Purge, we gave an Opiate to procure the Patient Rest.--When the first
+Dose of Physic did not stop the Purging, we repeated the Opiates at
+Nights, and in a Day or two gave another Purge; and if there was much
+Sickness, or Load at the Stomach, gave likewise a gentle Emetic.
+
+If the Purging still continued, we were obliged to join the Use of
+Astringents along with the Opiates. In some Cases, I found good
+Effects from equal Parts of Milk and Water boiled with Rose Leaves,
+Pomegranate Bark, Balaustine Flowers, and Cinnamon, as recommended by
+Dr. _Mead_ in his _Monita Medica_[58]; it served both for Food and
+Medicine.--When Opiates and Astringents were given to stop the Purging
+at its first Appearance, before the Bowels were emptied, they always
+did Mischief; and increased the Heat and Fever: And although they
+stopt the Purging for a few Hours, it always broke out with greater
+Violence afterwards.
+
+    [58] _Sect._ x. _de Febrib. lentis sive Hecticis._
+
+When the Sick were attacked with a Shortness and Difficulty of
+Breathing, which was not relieved by Evacuations, and the Use of
+cooling Medicines, and Pectorals, and Blisters, nothing gave so much
+Ease, or had such a good Effect, as a gentle Vomit; for it often
+removed the immediate Oppression from the Breast, and helped to pump
+up the Matter from the Lungs.
+
+In the advanced State of the Consumption, the Cough was always very
+troublesome; and the Sick found no Relief but from Opiate Medicines,
+which, in such Cases, cannot be expected to do more than give a little
+present Ease.--As they were apt to obstruct the free Expectoration, we
+generally mixed them with some _oxymel scilliticum_, or _tinctura
+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.
+
+    [59] _Treatise on the Digestions_, p. 410.
+
+
+
+
+OF THE Epidemical CATARRHAL FEVER Of APRIL, 1762; CALLED, THE
+INFLUENZA.
+
+
+After a very cold severe Winter at _Bremen_, the Weather, from being
+very cold, became of a sudden extremely hot, about the 10th of
+_April_. In a few Days after, many People were seized with a violent
+Catarrhal Disorder. It often began with such a Cold and Shivering,
+that many imagined at first that they were going to have Agues; but
+soon after they were attacked with a Cough, and a Difficulty of
+Breathing, and Pain of the Breast, with a Head-Ach, and Pains all over
+the Body, especially in the Limbs.--The first Nights they commonly had
+profuse Sweats.--In several, it had the Appearance of a remitting
+Fever, for the two or three first Days.--Many had a slight
+Inflammation of the Throat, and a Hoarseness. In all it was attended
+with an acute Fever in the Beginning, and the Urine was of a high
+Colour; and when the Disorder had put on the Appearance of a Remittent
+Fever in the Beginning, it dropt a Sediment towards Morning after the
+second Day; and did the same in all, when the Disorder was going
+off.--Some had a Purging, but the greater Number were rather inclined
+to be costive.--The Cough in many was very violent; and the Patients,
+after each Fit of Coughing, had Reachings, or Strainings to vomit,
+exactly resembling those which come after violent Fits of the Hooping
+Cough.--At first the Patients spit up only a little Phlegm; but in the
+Decline of the Disorder, they expectorated freely.--The violent Cough
+and Feverishness generally continued for four, five, or six Days;
+with others it continued longer; and some had a Cough for two or three
+Weeks after the Fever left them.
+
+This Catarrhal Fever seized most of the People of the Town of
+_Bremen_; and there were very few of the _British_ who escaped it; at
+the same Time, it was epidemical in most Countries in _Europe_.
+
+We treated it entirely as an inflammatory Disorder, and none died who
+applied early for Relief.--Most People recovered by one plentiful
+Bleeding, and taking the mild cooling Medicines, such as the _mixtura
+e spermate ceti cum nitro_, the saline or mindereri Draughts, or such
+like. When the Fever and Difficulty of Breathing continued after the
+first Bleeding, in a Day or two a Vein was opened a second Time; and
+immediately after a Blister was applied to the Back, which commonly
+removed the Fever, and relieved the Breathing.--When the Patients were
+inclined to be costive, a Dose of Physic was of Service.
+
+None of the _British_ died, except one or two of the Soldiers, who
+remained in Quarters after being taken ill; and, instead of bleeding
+and living low, indulged in the Use of spirituous Liquors; and were
+not brought to the Hospital, till they were in the last Stage of a
+Peripneumony.--Many of the Inhabitants of the Town died of this
+Disorder, which was probably owing to Want of Care.
+
+
+
+
+OF THE RHEUMATISM.
+
+
+The Rheumatism is one of the Disorders most generally to be met with
+in military Hospitals. There were at all Times some Men in our
+Hospitals labouring under Rheumatic Fevers, or other rheumatic
+Complaints; though we never had at any one Time a great Number; owing
+probably to the Weather being very favourable in both the Campaigns of
+1761 and 1762.--It was always most frequent when the Weather was wet
+and cold; both during the Campaign, and when we were in Winter
+Quarters.
+
+It commonly began either, 1. With an acute Fever, and Pains all over
+their Body: or, 2. With Pains in particular Parts, as the Shoulders,
+Legs, Arms, Knees, and sometimes of the Side, attended with some
+Degree of a Fever.--The first was the most common Form it assumed,
+when Men were attacked with it in the Field or in Garrison; owing to
+their doing Duty in cold wet Weather.--The other Causes generally took
+place when they had been formerly subject to rheumatic Complaints, and
+had caught Cold; or after they had been weakened and reduced low by
+Fevers, Fluxes, or other Disorders.
+
+We had but very few Rheumatisms accompanied with Swelling, Pain, and
+Inflammation of the Joints of the Knees and Wrists, &c. which are so
+common in our Hospitals about _London_. I did not meet with above a
+Dozen Cases, of this Kind, whilst in _Germany_ with the Army.
+
+When the Rheumatism began with Pains all over the Body, attended with
+a High Fever, we treated it at first entirely as an Inflammatory
+Fever[60]. We blooded freely, and repeated this Evacuation often[61],
+if the Blood continued sizy, and the Pains violent; provided the Pulse
+was strong. When the Pleura, the Lungs, or any other of the Viscera
+were affected, we blooded as freely as we should have done in acute
+Inflammations of these Parts: We gave the saline Draughts with
+Nitre[62]; and Plenty of Barley Water and other weak diluting Liquors;
+and gentle Physic once or twice a Week; and afterwards applied
+Blisters, which often relieved both the Pains and Fever.
+
+    [60] _Sydenham_, in treating of this Disease, orders
+    Bleeding, and that to be repeated next Day; and afterwards
+    every other Day, two, three, or four Times, or more, as the
+    Patients Strength can bear it; and on the intermediate Days
+    to give a purgative Clyster. But in young People, and those
+    who have lived regularly, he says, that a very low Diet will
+    cure as effectually as Bleeding and Medicines; That the
+    Patients must live four Days on Whey alone, but after this
+    may eat Bread for Dinner; and on the last Days for Supper
+    also; and when the Symptoms begin to abate, he allows them to
+    eat boiled Chicken, or other light Food; but says they must
+    live every third Day on Whey, till their Strength returns.
+    _Precess. Integr. de Rheumatismo_.
+
+    [61] A Remark of Dr. _Huxham_’s deserves to be taken Notice
+    of here: He tells us, that there are some Kinds of
+    Rheumatisms, _viz._ those which come from a sharp serous
+    Rheum, which do not bear the free Use of the Lancet; that
+    plentiful Bleeding does more Hurt than Good; and that, in
+    such Cases, the Medicines which bring out breathing Sweats,
+    and at the same Time correct the Acrimony of the Blood,
+    joined with gentle Opiates, have a much better Effect. _De
+    Aere_, Vol. II. p. 185.
+
+    [62] Dr. _Brocklesby_, in his _Observations on military
+    Diseases_, recommends the Use of large Quantities of Nitre
+    dissolved in Water Gruel, or Sage Tea, (in the Proportion of
+    two Drachms of the Nitre to a Quart of the Liquor) in acute
+    Rheumatisms. He says, “I am assured from numberless
+    Instances, that in stout young Men, by taking six hundred
+    Grains (ten Drachms) daily, for four or five Days
+    successively, and diluting plentifully, as before
+    recommended, plain Nitre proves the most powerful and best
+    Sudorific, in such Complaints, that I have ever tried; and
+    this Quantity, and even more, may be retained in the Stomach,
+    and pass through the Course of the Circulation, by only
+    diluting properly with those thin attenuating Beverages as
+    before recommended. Such Quantities, in three or four Days,
+    seldom failed wonderfully to relieve the Patient, and very
+    often to cure him entirely, by the most plentiful and profuse
+    Sweats.” _See from p. 116, to p. 124._
+
+    I have never hitherto given Nitre in such large Quantities as
+    here recommended by Dr. _Brocklesby_.
+
+After some Days, if the Pains still remained, we continued the saline
+Draughts with Nitre throughout the Day; and in the Evening endeavoured
+to promote a free Perspiration by Means of the mild Diaphoretics,
+such as the mindereri Draughts with Mithridate, in Doses frequently
+repeated; at the same Time, the Patient kept in Bed, and drank freely
+of mild diluting Liquors. Sometimes we gave twenty, thirty, or forty
+Drops of Spirits of Hartshorn, in repeated Draughts of warm Barley
+Water: or a like Quantity of the Antimonial Wine, used in the same
+Manner: or from sixty to a hundred Drops of the Antimonial Wine, mixed
+with one-fourth Part of the _tinctura thebaica_, in a large Draught of
+some warm Liquor; which I have observed, in many Cases, to have a
+better Effect, than most other Medicines used for this Purpose; as it
+acts both as an Opiate in easing the Pain, and procuring Rest; at the
+same Time that it promotes a free Perspiration, or gentle Sweat, to
+carry off the Distemper.
+
+But it should be observed, that, in the Beginning of Rheumatic Fevers,
+forced Sweats generally did Hurt, and often increased both the Pain
+and Fever; and that in general we had greater Success, and made
+speedier Cures, when we did not attempt to promote Sweating, till
+after other Evacuations had been sufficiently made, and the Fever had
+begun to abate; and that in this Fever, when we did attempt to procure
+Sweats, the milder Diaphoretics, with Plenty of weak diluting Liquors,
+answered better than those of a more heating Nature; though after the
+Fever was gone, and the Pains still continued, sometimes the stronger
+Sudorifics, such as G. Guaiac, and its volatile Tincture, _Dover_’s
+Powder, and the like, best answered the Purpose, and carried off the
+Distemper, when the milder ones had little Effect.
+
+I have often observed, where Sweating made no Change in the Distemper,
+that keeping up a free Perspiration by Means of the Decoction of the
+Sarsaparilla with the Antimonial Wine, or small Doses of the _pulvis
+antimonialis_ (_gr._ v.), given twice or thrice a Day, removed
+Rheumatisms, which had resisted the Force of other Remedies.
+
+Sometimes the cold Bath[63] removed Pains which had not yielded to
+internal Medicines; but it ought to be observed, that when Patients
+went into the cold Bath while the Feverishness still remained, and the
+Blood continued sizy, or before free Evacuations had been made,
+oftentimes, instead of giving Relief, it made the Disorder worse, and
+more obstinate[64].
+
+    [63] I have frequently ordered the warm Bath with Advantage
+    in Rheumatic Cases in _St. George_’s Hospital; but we had no
+    Convenience of this Kind with the flying Hospital in
+    _Germany_.
+
+    [64] This I have seen many Instances of, particularly in the
+    Case of _Ann Walker_, a Woman of twenty three Years of Age,
+    who was under my Care in _St. George_’s Hospital, in _May_,
+    1759. Before she came to the Hospital, she had been blooded,
+    and had gone into the cold Bath four Times, which, she told
+    me, had increased her Pains to a violent Degree; in which
+    State she had continued for some Weeks before she came to the
+    Hospital; but by being blooded, and taking the cooling saline
+    Medicines, with gentle Purges, and mild Diaphoretics, she got
+    well in a Month’s Time.
+
+When the Rheumatism was confined to a particular Part, attended with
+Fever, we treated it as the acute Rheumatism. Fomenting the Part with
+warm emollient Decoctions, and rubbing it afterwards with the
+volatile, or saponaceous Liniments, often gave Ease; and the
+Application of Cupping-Glasses and Blisters frequently removed the
+Disorder. In some Cases, where the first Blister did not relieve, the
+Application of a second, and afterwards keeping up a Discharge from
+the Part by Means of the Epispastic Ointment, carried off the Pain. In
+others, where the mild Diaphoretics were ineffectual, Sweating, with
+the G. Guaiac, or _Dover_’s Powder, and such other Medicines, after
+the Fever was gone, removed the Complaints[65].
+
+    [65] Warm Water, pumped upon the Part, often removes such
+    rheumatic Pains as have resisted the Force of internal and
+    other Remedies. On the 29th of _August_, 1759, _Mary Ward_
+    was admitted into _St. George_’s Hospital for rheumatic Pains
+    of the Arms, Legs, and Knees, attended with Fever, which all
+    yielded to Evacuations, and the Use of cooling Medicines,
+    mild Diaphoretics, and of the warm Bath, except the Pain of
+    the Knee; which, after it had resisted the Course
+    above-mentioned, was at last removed by pumping warm Water on
+    the Part, three Times a Week; joined to the Use of
+    Fomentations and volatile Liniments.
+
+When the Rheumatism was attended with Inflammation and Swelling of the
+Joints, we blooded freely, gave cooling Purges, and the saline
+Draughts with Nitre, along with Plenty of weak diluting Liquors, and
+prescribed a cool low Diet.
+
+After the Violence of the Fever and Inflammation was abated, fomenting
+the Parts, and rubbing them with the saponaceous or volatile
+Liniments, sometimes hastened the Discussion of the Swelling; as did
+likewise the Application of Blisters[66], after the Inflammation was
+entirely gone; but it ought to be noticed, that if volatile Liniments
+or Blisters are used too soon, they will sometimes occasion violent
+Inflammation and Pain[67].
+
+    [66] _Ann Ragen_, a Woman about thirty-three Years of Age,
+    was admitted into _St. George_’s Hospital the 17th of
+    _January_, 1759, for rheumatic Pains of her Legs and Arms,
+    and a Swelling of her right Knee. Free Evacuations, and the
+    Use of cooling Medicines, and mild Diaphoretics, removed all
+    her other Complaints, except the Swelling of the Knee, by the
+    Middle of _February_, when I ordered a Blister to be applied
+    to it; after which the Swelling gradually decreased, and she
+    was discharged, cured, the 20th of _March_.--_Rachael Hyde_,
+    a Woman twenty-four Years of Age, was admitted into _St.
+    George_’s Hospital the 9th of _May_, 1759, for similar
+    Complaints, which were removed by the same Means, all except
+    the Swelling of the Knee. A Blister was applied, and most of
+    the Swelling went away, but returned soon after: It was at
+    last removed by the Use of the warm Pump three Times a Week,
+    and drinking a Pint of the Guaiac Decoction daily.
+
+    [67] I have sometimes ordered Leetches to be applied to such
+    Swellings (as recommended by Dr. _Pringle_), and found them
+    to be of Service; and, at other Times, I have applied
+    emollient Fomentations and Poultices, which have given great
+    Ease to the Patient.--I have seen Setons or Issues, made near
+    the Part affected, afford considerable Relief.
+
+Rheumatic Cases of this Kind are often very obstinate, and require a
+considerable Length of Time before they are got the better of; and
+frequently more or less of the Swelling, especially of the Wrists and
+Joints of the Fingers, remains ever after; and Patients, who have once
+had the Rheumatism in this violent Degree, are always subject to
+Relapses; as are even those who have had the Rheumatism but slightly.
+
+Mercury[68] has been recommended in the Cure of Rheumatisms; but I
+never found it do any Service by itself, except in Cases complicated
+with venereal Symptoms; though I have often given it, and even
+sometimes gone so far as to raise a Salivation, where the Pains were
+most severe in the Night; and the Patient, at the same Time, thought
+he had some Reason to suspect a venereal Taint, though no external
+Symptom appeared. However, many good Practitioners have recommended
+small Doses of Calomel to be given at Nights, and next Morning a
+Purge; in which Way, I think, I have observed good Effects from its
+Use.
+
+    [68] Dr. _Musgrave_, in his Treatise _de Arthritide
+    Symptomat._ p. 30, cap. ii. sect. 10, says, he has known a
+    Salivation, raised by Mercury, cure the Rheumatism.
+
+The Bark was frequently of Use in restoring the Strength, and removing
+those rheumatic Pains which remained after Fevers, and other
+Disorders; but, in other Cases, it had little Effect.
+
+When the Rheumatism continues long, and has taken deep Root,
+_Sydenham_[69] advises to bleed from Time to Time, at some Weeks
+Distance; which, he says, will either entirely remove the Disease, or
+bring it to that Condition, that the Remains of it will be easily
+extirpated by an Issue; and giving some of the volatile Salts in
+_Canary_ Wine, Morning and Evening. I have always observed in
+rheumatic Cases, which continued long, that, after free Evacuations,
+the Patients received more Benefit from a mild low Diet, continued for
+some Time, and the Use of diluting Decoctions with mild Diaphoretics,
+while they took gentle Purges once or twice a Week, than from any
+other Remedies.
+
+    [69] Vide _Sydenham. Opera._ sect. vi. cap. 5.
+
+I have given Half an Ounce of Soap a Day, for a considerable Time, in
+some old rheumatic Cases, in the Manner recommended by the late Dr.
+_John Clerk_ of _Edinburgh_, as mentioned by Dr. _Pringle_; and, I
+think, with Advantage; but have not had sufficient Trials to ascertain
+the Merits of this Medicine.
+
+Dr. _Sydenham_, in treating of the Rheumatism, which he calls
+scorbutic, says; that after it had resisted Bleeding, Purging, low
+Diet, and other Remedies, he has cured it by giving thrice a Day two
+Drachms of an Electuary made of _conserv. cochlear. horten. recent.
+unc._ ij. _lujul. unc._ i. _pulv. ar. comp. drachm_ vi. _cum syrup.
+aurant._ q. s. drinking after it three Ounces of a Water drawn from
+_Brunswick_ Beer, and some of the antiscorbutic Plants.
+
+There is no Disorder which Soldiers are so apt to counterfeit as the
+Rheumatism, when ever the Duty in the Field is severe; but while there
+is no Fever or Size in the Blood, or other evident Marks of the
+Distemper, and the Men look healthy, there is always Reason to suspect
+Imposture.
+
+
+
+
+OF THE Autumnal Remitting Fever.
+
+
+The Remitting Autumnal Fever, called by the Antients συνεχης, was also
+one of the most frequent Disorders during the Campaign.
+
+This Fever is observed in most Countries, after the Juices have been
+highly exalted by the Heat of Summer; and People are exposed to the
+Heats of Mid-Day, and to the cold Damps of the Night. We observe it
+every Year in the Neighbourhood of _London_, especially among the
+labouring People, who work in the Fields, towards the End of Summer,
+and in Autumn; but it is generally in a milder Degree than in Armies,
+where Men are more exposed to the Vicissitudes of the Weather.
+
+As we go further towards the South, this, as well as other bilious
+Disorders, becomes more frequent.
+
+This Fever is reckoned the endemic Distemper of the _West Indies_, of
+the Coast of _Guinea_, and other Places in the Torrid Zone; but in
+those warm Countries it appears in a more violent Degree; makes a much
+more rapid Progress; and proves far more fatal than in our cooler and
+more temperate Climate. And it is observed to be always most frequent
+and most fatal where a Country is covered with Wood, or is marshy; and
+where there are frequent Fogs, and much stagnating Water, which
+corrupts by the Heat of Summer.
+
+In _January_, _February_, and _March_ 1761, we had none of those
+Remitting Fevers at _Paderborn_. In _April_, some few of the Soldiers,
+on their Return from the Winter-Expedition into _Hesse-Cassel_, had
+Fevers attended with bilious Symptoms; but they were rather of the
+continued, inflammatory Kind, and tending to malignant, than such as
+could be called remitting.
+
+The first Time that I saw much of this Fever, was among the Sick sent
+to _Bilifield_ in the End of _June_ 1761; soon after the Army took the
+Field. The Remissions were short, and it partook much of the Nature of
+the common Inflammatory Fever; and most of them were cured by the
+antiphlogistic Method. A Day or two before we left this Place, it
+began to change into the Malignant Hospital Fever, from the Sick being
+too much crowded.
+
+In the Middle of _July_, about Twelve Hundred Sick were sent to the
+Hospital at _Munster_; and about one-third Part were ill of this
+Remitting Fever. It did not partake near so much of the inflammatory
+Nature as at _Bilifield_; the Remissions became much more evident; and
+it was attended much oftener in the Beginning with bilious Vomiting
+and Purging; and in some few the Disorder turned to a Dysentery. About
+eight or nine had it changed into the Hospital Fever, from the Wards
+in one of the Hospitals being too much crowded; and in some few the
+Disorder terminated in regular Agues. In _November_ severals were
+taken ill of it in the Garrison of _Bremen_, which mostly ended in a
+regular Intermittent, the endemic Distemper of the Place. Towards the
+End of _December_ we had none of these Remitting Fevers, the Disorders
+turning more to the inflammatory Kind.
+
+In _June_ 1762, this Fever began to appear again among the Sick, sent
+from the Army, to the Hospital at _Natzungen_; and it continued to be
+frequent through the Summer and Autumn; and the greatest Part of these
+Fevers this Year terminated in regular Agues, mostly in Tertians, and
+were cured by the Bark; whereas the Year before very few terminated
+this Way.
+
+This Disorder in the Beginning had commonly the Appearance of a
+continued Fever; and many had a Sickness and Vomiting, and threw up a
+Quantity of yellow Bile, mixed with the Contents of the Stomach. In a
+few Days, especially after Bleeding, the Remissions became clear; tho’
+on its first Appearance in _June_ 1761 they were short, and rather
+obscure; and it seemed still to partake a good deal of the Nature of
+the common Inflammatory Fever, the Blood being very sizy; but as the
+Season advanced, the Remissions became more evident, and the Paroxysms
+more like those of an Ague; and the Blood less sizy, tho’ at all
+Seasons of the Year it had some Appearance of an inflammatory Buff in
+this Disorder. The Sick were restless and uneasy at Night; but
+commonly felt themselves cooler and lighter in the Day-Time: and
+although they had no cold Fit, as the Fever came on at Nights, and
+many of them no Breathing Sweat, as they became cooler and freer from
+the Fever in the Morning; yet the Fits were so remarkable, that many
+of the Patients used to say they had a regular Fit of an Ague every
+Night, or towards the Morning; and some few, that they had the Fit
+every second Night. As the Season advanced, the Remissions appeared
+more distinct. However, there was always a good Number in whom the
+Fever went on in a continued Form, through its whole Course, without
+any Signs of Remission; tho’ they had all the other Symptoms of this
+Fever. In a few Instances the Fever, after it came to remit, changed
+again into a continued Form.
+
+The Heat in the Time of the Paroxysms rose high, and several were
+delirious during its Continuance[70]; but were quite sensible in the
+Intervals, though never wholly without the Fever.
+
+    [70] I did not see the Delirium rise so high, nor the
+    Paroxysms so severe, as in the Marsh Fever described by Dr.
+    _Pringle_.
+
+At the End of _July_ 1761, four or five were attacked with a Bleeding
+at the Nose, in the Time of the Paroxysms, and became cooler
+afterwards; but it did not prove a Crisis in any of them.
+
+The Urine in the Beginning was commonly of a high Colour, though
+sometimes it was pale and limpid: At first it deposited no Sediment;
+but when the Fever came to remit, there was often a small Sediment
+after each Paroxysm; and as the Fever was going off, it let fall a
+Sediment in all[71].
+
+    [71] Dr. _Hillary_ says the Symptoms of this Fever in
+    _Barbadoes_ were much the same as those of the συνεχης, or
+    continued Remitting Fever in England; except only that the
+    Urine in this hot Climate never deposits any lateritious
+    Sediment, nor very rarely in any intermitting or any other
+    Fever, except when a Crisis happens that Way. _Observations
+    on the Diseases of Barbadoes_, p. 23.
+
+Some at first were inclined to be costive; others had a Sickness and
+Purging; and several of those who were costive in the Beginning, were
+in the Course of the Disorder attacked with a Purging; and others,
+after some previous Complaint of the Stomach, were seized with both
+Vomiting and Purging. In general, after the Sick continued some Days
+in the Hospital, they were inclined to be loose; which was a
+favourable Circumstance, when this Evacuation was not so great as to
+be in Danger of sinking the Patient. Some were attacked with a
+Dysentery.
+
+In this, as well as in most other Fevers, the Sick frequently passed
+by Stool Worms of the round Kind; and sometimes they vomited them up,
+or the Worms came up into their Mouth or Nostrils while they lay
+asleep in Bed; and some towards the Height were afflicted with
+Deafness, which was commonly a favourable Symptom.
+
+Most of those ill of this Disorder had a yellowish Colour of the
+Countenance, which went off with the Fever. It was more observable in
+some than in others; in general, it was slight; some few became yellow
+all over[72]; particularly one Man, in the Hospital at _Munster_, who,
+after being seized with violent Vomiting and Purging, Convulsions, and
+Twitchings of the Tendons, and Hiccup, became yellow, as in the
+deepest Jaundice. This Symptom of Yellowness arises from a Redundancy
+and Absorption of Bile; and is sometimes observed in other Fevers as
+well as this[73]; for while we were at _Paderborn_ in _February_
+1761, two Men were brought to the Hospital in Fevers, attended with
+this Symptom. They were both delirious, with parched dry Tongues,
+slight Twitchings of the Tendons, and other bad Symptoms; and one of
+them had a continual Vomiting and Purging. They both died, and the
+Body of him who had the Purging was opened. All the Bowels, especially
+the Colon, were tinged with a yellow Bile, and had a slight Degree of
+Inflammation all over their Surface; the Gall-Bladder was distended
+with a very dark-coloured Bile; but no Concretions were found in its
+Cavity, or in the bilious Ducts; nor Mucus, or any other Thing
+obstructing these Passages. The Surface of the Lungs seemed slightly
+inflamed; and there was a small Quantity of greenish Serum in the
+Cavities of the Thorax. I could not learn the Histories of these two
+Mens Disorders, before they were brought to the Hospital; but, from
+the Symptoms, was inclined to believe, that the Fevers had been of the
+malignant or petechial Kind; and that the yellow Colour was only an
+accidental Symptom of it; for on one of the Men we could perceive
+obscure Traces of dun petechial Spots on his Breast and Arms; and the
+malignant Fever was frequent at this Time among the Troops, and the
+bilious autumnal Fevers had ceased long before.
+
+    [72] Dr. _Pringle_ takes Notice of this yellow Colour or
+    Jaundice. He says, “some grow yellow, as in the Jaundice.
+    This was found more frequent during the first Campaign than
+    afterwards; it was an unfavourable, but not a mortal
+    Symptom.” _Observ._ part iii. ch. 4.--_Hippocrates_ mentions
+    the Jaundice occurring in Fevers, _Aphor._ iv. § 62 & 64; and
+    he reckons it a favourable Symptom in ardent Fevers, where it
+    happens on the seventh Day. See _Book on Crises_’s, sect. 3.
+
+    [73] Does this Fever, when accompanied with this universal
+    Yellowness of the Skin, approach to the Nature of the yellow
+    Fever of the _West Indies_? As I had so few Cases of this
+    Kind under my Care, I cannot determine any thing about it
+    from my own Experience; but, from the Accounts of others, I
+    should believe them to be very different Disorders.--In the
+    yellow Fever of the _West Indies_, the Blood appears quite
+    loose and dissolved, without the least Appearance of Size,
+    even on the first Day; and the general Yellowness appears on
+    the third or fourth, with Signs of a total Dissolution, and
+    gangrenous Diathesis of the Blood: Whereas, in the Remitting
+    Fever of _Jamaica_, Mr. _Nasmith_ tells us, (See Dr. _Lind_’s
+    first Paper on Fevers), there is always an inflammatory
+    Diathesis of the Blood. The Yellowness in both depends on a
+    Redundancy and Absorption of Bile; but in the yellow Fever of
+    the _West Indies_, the Bile is in a much more putrescent
+    State, and a great Part of the Cure depends on the early and
+    speedy Evacuation of it.--In the yellow Fevers which appeared
+    in _Haslar_ Hospital, which are taken Notice of by Dr.
+    _Lind_, in his _Two Papers on Fevers_, the Blood was in quite
+    a different State from what it is in the Yellow Fever of the
+    _West Indies_; the Blood drawn from two of these Patients
+    became covered with a thick yellow Gluten, and the Serum was
+    of the Consistence of a thin Syrup, and of a deep yellow
+    Tinge, and tasted bitter; and in another who was bled two
+    Days before his Death, it threw up the same thick yellow
+    Gluten, tho’ the red Part below was quite loose.
+
+I could not observe any certain critical Days, or Periods, when this
+Disorder terminated.--Some, who had it slightly, got well in a few
+Days; with others, it continued longer: Some continued long feverish,
+and would seem cooler and freer from Fever for a Day or two, and then
+grow worse again; and many had repeated Relapses.
+
+Neither could I observe any regular Crisis in this Fever. Sweat was
+the Discharge which oftenest proved critical. Many seemed to be
+relieved by a Purging; but as the greater Part had a Looseness after
+some Days, which continued often through the Disorder, without
+producing any very sudden Change in the Symptoms, it seemed to be a
+favourable Circumstance; though it seldom carried off the Fever so
+suddenly as to be manifestly critical. The Urine broke, and dropt a
+Sediment, for the most part, as the Fever took a favourable Turn.
+
+When this Fever proved mortal, it commonly assumed a continued Form;
+the Tongue became parched and dry, the Patient delirious, with
+Twitchings of the Tendons, Hiccup, and other fatal Presages; while
+others were seized with a violent Diarrhœa, or Dysentery, which sunk
+them irrecoverably.
+
+In the Beginning, it was absolutely necessary to bleed the Patients
+freely; and frequently to repeat the Evacuation, where the Symptoms
+required it. The Blood was of a florid Colour, and commonly threw up
+more or less of an inflammatory Buff.
+
+In these Fevers, we were obliged to have particular Regard to the
+first Passages, especially in the Beginning of the Disorder; for they
+were generally loaded with bilious Humours[74]; which, if suffered to
+remain in the Bowels; were either absorbed, and increased the Heat
+and Fever, or brought on a violent Diarrhœa; and therefore, after
+Bleeding, we gave a Vomit in the Evening, and next Day a Dose of some
+gentle Purge, as Rhubarb or Salts; to carry off these putrid, bilious
+Humours: And afterwards, in the Course of the Disorder, if the Patient
+was costive, and grew hot, restless, and uneasy, we either repeated
+the Purge, or gave laxative Clysters, which generally removed these
+Symptoms.--Frequently after the Operation of the Emetic, the Patient
+had some loose Stools, from the Gall Bladder’s being emptied in the
+Strainings to vomit. Such Stools were always bilious, as were commonly
+those procured by purgative Medicines.
+
+    [74] According to Dr. _Hillary_’s Account of the Yellow Fever
+    in the _West Indies_, which is attended with bilious
+    Vomiting, it bears bleeding once or twice, but not a third
+    Time, before the third Day, but not at all after that Time;
+    and after Bleeding a great Part of the Cure depends on
+    carrying off as much of the putrid Bile as expeditiously and
+    safely as possible, which he says is to be done by making the
+    Patients drink freely of warm Water (sometimes mixed with a
+    little simple Oxymel or Green Tea) so as to vomit seven or
+    eight Times; and then to give a grain, or a Grain and a half
+    of Opium, to procure Rest, and to settle the Stomach; to make
+    the Patient take nothing for two Hours after; and then, if he
+    has not had a Stool, to give a laxative Clyster; after six
+    Hours Rest, to give a gentle Purge, to carry off as much as
+    possible of the bilious corrupted Humours; and in the Course
+    of the Disorder to repeat the Purge, as often as the Patient
+    is attacked with an Anxiety, and a painful burning Heat about
+    the Præcordia; which almost always depend on bilious
+    corrupted Humours pent up within the Bowels; and to endeavour
+    to support the Patient’s Strength, and stop the putrescent
+    Diathesis of the Fluids by suitable Antiseptics, of which he
+    found a watery Infusion of Snake Root, mixed with _Madeira_
+    Wine and Syrup of Poppies, to answer the best of any Thing he
+    tried, and to sit easiest on the Stomach; and to this he
+    added the Use of Cordials, and of strong Wine Whey as the
+    Patient became lower.
+
+    Dr. _Hillary_’s Purge was: ℞. Mannæ sescunc. vel unc. ij.
+    Tamarind. cond. unc. i. Tartar vitriolat. gr. x. solve in
+    seri lactis præparat. cum Vin. Maderiens. unc. vi. Colaturæ
+    adde Tinct. Senæ unciam dimidiam. Divide in Partes quatuor, &
+    capt. æger unam omni hora donec laxetur alvus.
+
+    His Infusion of Snake-Root was prepared in the following
+    Manner:
+
+    ℞. Rad. Serpent. Virgin. drachm. ij. Croci Angl. drachmam
+    dimidiam, infunde per horam vase clauso in aq. bull. q. s. &
+    dein unc. vi. Colaturæ, adde aq. Menth. simp. unc. ij. Vin.
+    Maderiensis, unc. iv. Syrup. Croci vel Syr. e Mecon. unc. i.
+    Elix. Vitriol. acid. q. s. ad gratum saporem M. capiat æger
+    cochlear. ij. vel iij. omni hora vel secunda quaq; hora vel
+    sæpius pro re nata.
+
+    The Stomach is so irritable in the Beginning of this
+    Disorder, as to reject the saline Draughts, Nitre, and such
+    other Medicines. Nor will the Bark, which might be judged a
+    very proper Medicine in the second Stage of the Disorder, lie
+    upon the Stomach, but is thrown up immediately, in whatever
+    Form it is given. However, a Gentleman who had practised long
+    in the _West Indies_ told me, that although the Patient could
+    not retain it in his Stomach, yet that he had found great
+    Service, after the Bowels were emptied, from the Bark used
+    freely in Clysters.
+
+    Dr. _Hillary_ disapproves of the Use of Blisters in the
+    advanced State of these Fevers.
+
+After emptying the Bowels, we gave the cooling, and mild Diaphoretics,
+such as the saline and mindereri Draughts, joined occasionally with
+Nitre, or the Contrayerva Powders; while we made the Patient drink
+plentifully of warm diluting Liquors; which we found to answer in
+general better than any other Remedies: They brought the Remissions to
+be more evident, and the Paroxysms to be milder, at the same Time that
+they kept up a free Perspiration, as a Means to carry off the
+Distemper.
+
+In some Cases we gave the Antimonial Powder, made of one Part of
+Tartar Emetic, and ten of the _pulvis e chelis_, in small Doses, from
+two to four Grains every four or six Hours. The first Doses of this
+Powder sometimes made the Patient sick, and acted as a Purgative, and
+kept up a free Perspiration; at other Times, it produced no visible
+Effect. In some Cases, where it was given early, it operated both by
+Stool, and as a Diaphoretic, and removed the Fever[75]; and it was of
+Use in others, towards the Decline of the Fever; but we were often
+obliged to lay it aside; for it either acted too roughly, or produced
+no visible Effect or Alteration in the Disorder.
+
+    [75] Dr. _Millar_, one of the Physicians to the Army, told me
+    in _Germany_, that he had given this antimonial Powder with
+    great Success in the Remitting Fever, while the Eighth
+    Regiment of Foot (to which he was formerly Surgeon) lay in
+    _England_.--Dr. _Pringle_, in his fourth Edition of his
+    _Observations_, Part iii. ch. iv. tells us, that having given
+    a mild Purge immediately after Bleeding, he next Morning,
+    when there was almost always a Remission, gave a Grain of the
+    Tartar Emetic, with twelve Grains of Crabs-Eyes, and repeated
+    the Dose in two Hours, if the first had little or no Effect;
+    at any Rate, in four Hours. This Medicine not only vomited,
+    but generally opened the Body, and raised a Sweat. By these
+    Evacuations, the Fever was sometimes quite removed, but
+    always became easier.--This Medicine he usually repeated the
+    second or third Day; if not, he opened the Body with some
+    mild Laxative, or a Clyster; and continued this Medicine,
+    till the Fever went gradually off, or intermitted.--Dr.
+    _Pringle_ says, that Dr. _Huck_ treated this Fever in a
+    Method similar to this, both in _North America_ and in the
+    _West Indies_. In the Beginning he let Blood; and in the
+    first Remission, gave four or five Grains of Ipecacuana, with
+    Half a Grain of Tartar Emetic: This Medicine he repeated in
+    two Hours, taking Care that the Patient should not drink
+    before the second Dose; for by that Means the Medicine passed
+    more readily into the Bowels, before it operated by vomiting.
+    If, after two Hours more, the Operation either Way was small,
+    he gave a third Dose; which commonly had a good Effect in
+    carrying off the Bile; and then the Fever either went quite
+    off, or intermitted so far as to admit the Bark. On the
+    Continent he found no Difficulty after the Intermission; but
+    in the Islands, unless he gave the Bark upon the first
+    Intermission, though imperfect, the Fever was apt to assume a
+    continual and dangerous Form. Dr. _Huck_ never varied this
+    Method, but upon a stronger Indication to purge, than to
+    vomit. In which Case he made an eight Ounce Decoction, with
+    Half an Ounce of _Tamarinds_, two Ounces of _Manna_, and two
+    Grains of _Emetic Tartar_; and dividing this into four Parts,
+    he gave one every Hour, till the Medicine operated by Stool.
+
+When the Fever came to remit, we were obliged, for the most part, to
+continue the Use of the mild Diaphoretics, as before; for, although
+the Disorder put on a remitting Form, the Bark had very little Effect
+in stopping it[76], unless where the Fever changed into a regular
+Quotidian or Tertian Ague.--In the Year 1761, very few of these Fevers
+turned to regular Intermittents; but, in the Year 1762, the greater
+Part of them terminated in regular Agues, and were cured by the
+Bark[77].
+
+    [76] Dr. _Hillary_, in mentioning the Remitting Fever of the
+    Island of _Barbadoes_, says: In those who were blooded, and
+    took an Emetic afterwards, and then the saline Draughts, the
+    Fever was generally carried quite off by a critical Sweat on
+    the seventh or ninth Day; in some few it came to intermit
+    regularly after that Time; and was soon cured by the _cortex
+    Peruviana_, given with the saline Draughts, and seldom
+    effectually without them; though these irregular ingeminated
+    Fevers often remitted, and sometimes seemed to intermit; yet
+    if the _cortex Peruviana_ was given too soon in the Disease,
+    before it intermitted regularly (as I have more than once
+    seen, where it had been injudiciously given), it generally
+    caused the Fever to become continual and malignant.
+    _Observat. on the epidemic Diseases of Barbadoes_, p. 22.
+
+    [77] Mr. _Cleghorn_, after giving a very accurate Account of
+    Tertian Fevers, as they appeared in their various Forms of
+    true, of double, and triple Tertians, and of Semi-Tertians,
+    in the Island of _Minorca_, tells us, that he first attempted
+    the Cure by profuse Evacuations; but afterwards learnt from
+    Experience, that they were unnecessary; and that Bleeding and
+    Purging once or twice in the Beginning, was all that was in
+    general requisite; and if on the fifth Day the third
+    Revolution was not attended with more threatening Symptoms
+    than the second, and the Patient bore it easily, he
+    frequently trusted the whole Business to Nature; which
+    commonly terminated the Fever about the fourth or fifth
+    Revolution; and for the most part with an Increase of some
+    natural Evacuation.--But if the Paroxysm on the fifth Day was
+    the longest and most severe that happened, attended with any
+    doubtful or dangerous Symptom, he ordered two Scruples of the
+    Cortex to be given every two or three Hours; so that five or
+    six Drachms may be taken before next Day at Noon; lest, if
+    this Interval escaped, he should not have found a favourable
+    Opportunity of giving a sufficient Quantity of the Medicine
+    afterwards; as the Fits about this Period are wont to become
+    double, subintrant, or continual.--This did not always put an
+    immediate Stop to the Fever, but it invigorated the Powers of
+    the Body, and prevented or removed the dangerous Symptoms.
+    Having given the Bark on the fifth Day, if a Fit came on the
+    sixth, and declined the same Evening, he gave some more Doses
+    of the Bark to mitigate the Fit on the seventh; yet sometimes
+    this Fit of the sixth united with that of the seventh, and
+    the Patient had the Heat, Restlessness, Raving, and other
+    Complaints, greatly augmented, and the Case seemed more
+    desperate than ever; which, however, were more dangerous in
+    Appearance than Reality, and went off with a profuse Sweat
+    next Morning; after which he gave the Bark freely as before;
+    and this either stopt the Fits, or made them so moderate, as
+    that they yielded quickly to the same Sort of Management.--By
+    this Method, when Assistance is called timely, Mr. _Cleghorn_
+    says, the most formidable Intermitting and Remitting
+    Tertians, may be certainly and speedily brought to a happy
+    Conclusion about the End of the first Week, or Beginning of
+    the second. See _Observ. on the epidemic Diseases in
+    Minorca_, chap. iii. p. 187, &c.
+
+In the Year 1761, we tried the Bark in various Forms in many Cases,
+where the Patient had been blooded and purged in the Beginning, and
+used the cooling Medicines; and where the Remissions were very clear:
+Yet it had no Effect in removing the Disorder, except in two or three
+Cases at _Munster_, where the Paroxysms assumed a tertian Form; for
+the most part, it made the Patients more hot and feverish, and we were
+obliged to leave off using it, as it was in Danger of changing the
+remittent into a continued Fever. However, it was of Service after the
+Fever came to a Crisis, and was going off; and Dr. _Pringle_ has very
+justly observed, that it hastened the Recovery, and that those who
+used it were less subject to Relapses than such as did not; and
+therefore we commonly gave it in a convalescent State.--Before giving
+the Bark, I always found it of Advantage to give a Dose of Rhubarb, or
+of some other Purgative, or to mix some Rhubarb with the first Doses,
+so as to procure the Patient some loose Stools.
+
+When either the Fever went on without Intermission, or changed into a
+continued Form, or the Patient continued hot and feverish through the
+Day, with a Head-Ach, and other feverish Symptoms, nothing answered
+better, after free Evacuations had been made, than to apply a large
+Blister to the Back; and to make the Patient drink freely of cooling
+diluting Liquors; which generally relieved the Head, and abated the
+Violence of the other Symptoms.
+
+When a Purging came on in the Course of this Disorder, if there was
+much Fever, with a strong throbbing Pulse, Gripes and Pain of the
+Bowels, some Blood was taken away; and immediately after the Patient
+took a Dose of Salts and Manna, or of Rhubarb; and an Opiate in the
+Evening after its Operation: But if there was little or no Fever, or
+sharp Pain, Bleeding was omitted; and if the Patient complained of
+Sickness, a few Grains of Ipecacuana were given previous to the Purge.
+
+After this, if the Purging was moderate, and did not sink the Patient,
+we did nothing to stop it; but if it was violent, we gave the
+mindereri Draughts with Mithridate, and the Chalk Julep in the Day,
+and an Opiate at going to Rest; and occasionally used the emollient
+and anodyne Clyster; and, if necessary, repeated the Emetic and Purge.
+
+The Hiccup seldom appeared in this Fever till the Patient was reduced
+very low, and was commonly the Forerunner of Death. Some few, who had
+a Purging and Vomiting, were taken with a Hiccup, attended with
+Sickness, and Load at the Stomach, which seemed to depend on bilious
+Humours lodged in the Stomach and Bowels. This induced me to give a
+few Grains of the Ipecacuana; and to make the Patients drink an
+Infusion of Camomile Flowers till they vomited freely, and afterwards
+to take some mild Purge, or use laxative Clysters; after which they
+found themselves easier, and an anodyne Draught, with twenty or
+twenty-five Drops of the _tinctura thebaica_, put an End to the
+Hiccup. Others required the Use of Cordial Draughts, mixed with
+Opiates; and repeated Clysters and Fomentations, before they found
+Relief.--The Application of a Blister removed the Hiccup in one,
+after the above Remedies had proved ineffectual; as did the Musk Julep
+with Opium, and the Application of an aromatic Plaister to the
+Stomach, in another Patient.
+
+Several of them complained of a burning Heat and Pain in making Water;
+which commonly went off by drinking freely of the Gum Arabic
+Decoction, with the dulcified Spirit of Nitre, and the Use of oily
+Draughts; though in some it required the Assistance of Opiates, and of
+Fomentations and Clysters, before it was got the better of.
+
+The Symptom of Worms we were often obliged to neglect till the Fever
+was over, and then we treated it as formerly mentioned.
+
+The Deafness, though not near so frequent in this as the Malignant
+Fever, was rather a favourable Symptom, and mostly went away of
+itself; though in a few Cases, where it continued long, we applied
+Blisters behind the Ears, or to the Neck, with Advantage.
+
+Many, especially those who were brought low, complained, after the
+Crisis of the Fever, of Restlessness, and Want of Sleep; which,
+however, went off as their Strength returned: Where it fatigued them
+much, and kept them low, we gave a Cordial anodyne Draught at Night;
+and if that did not answer, commonly the Addition of a few Glasses of
+Wine in the Afternoon had the desired Effect.
+
+Others, in their convalescent State, complained of such a Giddiness,
+and Lightness of the Head, that they could neither walk nor stand;
+others, of a Dimness of the Eyes. These Symptoms, for the most part,
+went off as the Patients gathered Strength: The Use of the Bark, with
+now and then a Glass of Wine, hastened the Cure; and in two or three
+Cases we were obliged to give a Dose or two of some gentle Physic, and
+to apply a Blister, before the Patient got the better of them.
+
+As the Sick were recovering, it was common for them to complain of
+Pains of the Shoulders, Arms, and Legs, which also left them as they
+recovered their Strength; where they did not, the saline Draughts, and
+a low Diet, generally had a good Effect; and where it had not, we
+treated them as rheumatic Complaints.
+
+When the yellowish Colour of the Countenance remained after the Fever,
+we kept the Patient on a low Diet; and his Body open by Means of the
+saline Draughts, with a few Grains of Rhubarb, or by giving Half a
+Drachm, or two Scruples of the Soap Pills with Rhubarb daily; which,
+for the most part, removed the Yellowness soon. Two only had a
+Jaundice remain after the Fever, and both were cured in a short Time.
+
+In other Respects, the Treatment of this Fever, when it degenerated
+into a continued Form, had nothing particular in it; nor differed from
+the common Practice of giving cooling Medicines when the Fever was
+high, and supporting Nature by the Use of Cordials and Wine, and the
+Application of Blisters, &c. when low; and promoting such Evacuations
+as Nature pointed out for a Crisis.
+
+
+
+
+OF THE Intermitting Fever, or Ague.
+
+
+This Disorder belongs to the same Tribe of Diseases as the Remitting
+Fever. We call it an Intermitting Fever, or Ague, when the Paroxysms
+are distinct, begin with a cold and hot Fit, and go off with a Sweat;
+and the Patient is cool, and free from the Fever in the Intervals
+between the Fits.
+
+Many have been the Causes alledged to produce this Disorder. The great
+Quantity of Bile that is often thrown up in the Fit, has caused it to
+be ranked among the bilious Diseases; and the Seasons of the Year in
+which it is most frequent, and the low moist Situation of the Places
+where it is endemic, have made Practitioners suspect, that an
+obstructed Perspiration, and a Tendency in the Juices to the
+Putrescent, are the Cause of it.
+
+But whatever Cause we may suppose to give Rise to the first feverish
+Fit, it is difficult from hence to account for the regular Returns of
+the Paroxysms and Intermissions: For my own Part, after considering
+Intermittents, which observed a regular _Type_ in the Course of a
+Salivation[78]; their being so easily stopt by the Bark without any
+sensible Evacuation; their being sometimes put away by a Stimulus
+externally applied[79], or by a Fright, or sudden Plunge into cold
+Water[80]; their returning after slight Errors in Diet, and sometimes
+by the Operation of a Purge, or of Bleeding; their attacking sometimes
+only particular Parts, and many such Accidents in these Fevers, I must
+confess, that I am unable to form any Idea, either of their Origin,
+Seat, or Cause[81].
+
+    [78] See _Van Swieten_, Vol. II. p. 537.
+
+    [79] A Gentleman told me, that he was once cured of an Ague
+    in the Country, by applying a Poultice of Garlic to his
+    Wrists, and letting it lie on till it inflamed and blistered
+    the Part.--I have seen Blisters cure an Ague.--In the
+    _Edinburgh Med. Essays_, Vol. II. Art. v. we have an Account
+    of Agues being cured by the Application of Poultices of
+    recent Erigerum (Groundsel) applied to the Stomach on the
+    Days free from the Paroxysm, which caused strong Vomiting.
+
+    [80] See an Account of an Ague being cured by the Patient
+    being pushed into a Pool of Water without any previous
+    Notice, and being much frightened, in _Mason’s Account of
+    Agues_, p. 222.
+
+    [81] The common Account given of the Cause of Agues, and of
+    the regular Return of their Paroxysms, has been: That the
+    Ague takes its Rise from some Sort of Matter, bilious, or
+    whatever it may be, either mixed with the Blood, or lodged in
+    the Bowels, or in some other Part of the Body; that a great
+    Part of this Matter is thrown out of the Body, in the Time of
+    the Paroxysm; but that so much remains as serves by Way of a
+    Ferment to assimilate other Particles to its own Nature;
+    which, when collected in a certain Quantity, produce a new
+    Fit; and, according to the Time that it takes to produce this
+    Quantity, the Disorder assumes the Form of a Quotidian,
+    Tertian, or Quartan Ague.
+
+The Soldiers were subject to this Disorder, particularly in Spring, if
+they took the Field soon, and in Autumn: The Frequency of it was in a
+great Measure determined by the Nature of the Ground on which they
+were encamped, or the Situation of the Garrison or Town in which they
+were quartered; for the lower and moister the Camp or Garrison, and
+the more moist the Season, the more subject an Army is to Agues; and
+the drier the Situation of the Camp or Garrison, and the finer and
+drier the Weather is, the freer they are from Disorders of this Kind.
+
+In Winter 1761, we had but very few Agues in the Hospitals; but on the
+Return of the Troops from the Expedition into _Hesse-Cassel_, and
+during the Spring, some (though not many) were attacked with Quotidian
+and Tertian Agues, and but very few with Quartans.--In _July_ and
+_August_ they were more frequent, and accompanied with more bilious
+Symptoms. At _Bremen_, during the latter End of Autumn, and throughout
+the Winter and Spring 1762, we had Agues of all Sorts, and many
+inveterate Cases; and all this Spring, and during the Summer and
+Autumn, the Ague was the epidemic Disorder all over _Westphalia_, as
+well as among the Troops.
+
+In Spring 1761, what Agues we had were mostly Tertian, some Quotidian,
+and but two or three of the Quartan Kind. They were, for the most
+part, mild, and yielded to the Bark.--Some of them began in the Form
+of a continued Fever; but after Bleeding, and the Use of the cooling
+Medicines for a few Days, they began to remit, and at last ended in
+regular Quotidian or Tertian Agues: Others, at first, appeared in Form
+of Remittent Fevers, attended with a strong throbbing Pulse; but
+changed to regular Intermittents by pursuing the antiphlogistic Method
+of Cure; and some from the Beginning assumed the Type of Quotidian or
+Tertian Agues, but often attended with a good deal of Fever, for the
+first two or three Days; and some had a slight Delirium in the Time of
+the Paroxysms, and the Pulse was not quite settled in the Intervals.
+In such Cases, where the Patient was strong, nothing answered so well
+as to take away some Blood; and to give the saline Draughts with Nitre
+till the Fever was moderated, before we gave the Bark.
+
+In general, there is a Prejudice against bleeding in Agues, after they
+become regular; but I have always observed, both in _England_ and in
+_Germany_, that where Patients are strong and plethoric, and the
+Fever in the Paroxysms rises high, or the Pulse remains quick in the
+Intervals, that taking away more or less Blood, and giving the
+antiphlogistic Medicines in the Beginning, eased the Patient,
+moderated the Fever, and made it safer to give the Bark soon; and I
+never saw the least Inconvenience from the Practice; but, on the
+contrary, have seen several Intermittent Fevers change into continued
+ones from the Neglect of this Evacuation; and have seen Cases where
+the Bark, instead of stopping the Ague, rather increased the Fever,
+till the Patient was blooded, and had pursued the antiphlogistic
+Method for some Time; after which the Bark had its proper Effect, and
+put an End to the Disorder.
+
+As soon as these Agues became regular, and the Patient was quite cool,
+and free from any Fever in the Intervals, we gave the Bark; which soon
+put a Stop to the Paroxysms, without the least bad Consequences; but,
+before giving the Bark, we always took Care to empty the first
+Passages by the Use of Emetics and Purgatives, where there was no
+Symptom to forbid their Use: In Cases where the Patient was weak, and
+the Fits so violent as to make it necessary to stop the Ague, before
+we had Time to administer Emetics or Purgatives, we added so much
+Rhubarb to the first Doses of the Bark as procured the Patient some
+loose Stools, as recommended by Dr. _Mead_[82]; which did not prevent
+its stopping the Ague, at the same Time that it answered the End
+proposed of carrying off any putrid Humours that might be lodged in
+the Intestines.
+
+    [82] Mr. _Cleghorn_, while at _Minorca_, after Evacuations,
+    gave the Bark at the End of the third Period, as we observed
+    before; but where the Fever had been neglected till about the
+    third or fourth Period, or badly treated in the Beginning,
+    and the Bowels were inflamed or overcharged with corrupted
+    Gall, he was obliged to endeavour to palliate the most
+    pressing Complaints, and to watch Evening, Night, and Morning
+    for a Remission, and then immediately to fly to the Bark, as
+    the only Remedy that could avert the Danger. If the Patient
+    was strong, he gave Half an Ounce of the Bark, with six
+    Drachms of the _sal catharticum amarum_, divided into four
+    equal Parts, of which the Patient took one every two Hours;
+    the Effect of which was, that the next Fit was mitigated, and
+    an Intermission commonly ensued, in which the Bark was
+    repeated without the Purgative, to finish the Cure.--But
+    where the Patient was excessively feeble, and there was a
+    manifest Risk of his dying in next Fit, he gave Cordials with
+    the Bark, instead of the _sal catharticum_; and endeavoured
+    to throw in six or seven Drachms in the Space of ten or
+    twelve Hours; he having found by Experience, that if a
+    smaller Quantity is given, the Paroxysms come on earlier than
+    usual, and make all Attempts to preserve Life unsuccessful.
+    See his _Account of the epidemic Diseases of Minorca_, cap.
+    iii. 2d edit. p. 192.
+
+In _England_, Vernal, Quotidian, and Tertian Agues, frequently go off
+after Bleeding, and taking some Emetics and Purges, and the saline
+Draughts, and cooling Medicines, for some Time, without the Use of the
+Bark; but in _Germany_ very few yielded to this Treatment, and we were
+obliged to give the Bark[83] before we could put a Stop to them.
+
+    [83] Sometimes, when Patients are reduced low by Agues, the
+    Stomach becomes so squeamish as to reject the Bark in every
+    Shape it can be given; in such Cases, when the Ague cannot be
+    stopped by other Means, it may be administered with great
+    Advantage in Clysters, of which the following is a very
+    remarkable Instance.--_William Hadderell_, a Lad seventeen
+    Years of Age, in the End of the Year 1761, was attacked with
+    a severe Tertian Ague, in which a Mortification came on his
+    left Foot, and one-half of it dropt off; notwithstanding, his
+    Ague continued to attack him every second Day, and the Sore
+    continued running on the 12th of _October_ 1763, when he was
+    admitted into _St. George_’s Hospital. He was reduced
+    extremely low; and the Sore of his Foot looked so bad, that
+    it was at first imagined he must lose his Leg. He was ordered
+    some Vomits, and a Purge, and cooling Medicines, and
+    afterwards to take the Bark freely; but his Stomach rejected
+    it, in whatever Form it was given. Other Means were then
+    tried to stop his Ague, but with no Effect, till the 7th of
+    _November_, that I ordered two Drachms of the Powder of the
+    Bark to be given him twice a Day in an emollient Clyster,
+    with Half a Drachm of the _tinctura thebaica_, which stopt
+    his Ague in three Days; and he had had no Return of it on the
+    28th of _January_ 1764, and had recruited his Health and
+    Strength, and the Sore of his Foot was greatly lessened. Dr.
+    _Harvey_ (who teaches Midwifery in _London_) told me, that he
+    has cured Children of Agues by Bark Clysters, after the Bark
+    Waistcoats, and other Means used, had proved unsuccessful.
+
+In the End of _July_, and Beginning of _August_, the aguish Cases we
+had at _Munster_ continued to be of the Quotidian or Tertian Kind. The
+greatest Part of them began in the Form of continued Fevers, tending
+more to the bilious Kind than the preceding Months, and many of the
+Sick had bilious Vomitings in the cold Fits; and the Agues we had in
+Spring, and during the Campaign 1762, were of the same Nature, and
+required the same Treatment.
+
+Those Cases, which began in the Form of continued Fevers, were
+treated as such till they began to have regular Intermissions; they
+then yielded to the Bark.
+
+Some were attended with the Dysentery; and the Purging and Gripes were
+most severe on the Days of the aguish Paroxysms. In such Cases, we
+were frequently obliged at first to neglect the Ague, and to treat the
+Disorder entirely as a Flux. Where there was much Fever, the Patient
+strong, and the Pains in the Bowels acute, we ordered Bleeding; and
+after it a gentle Emetic, and some Doses of the saline oily Purge, or
+of Rhubarb; and gentle Opiates in the Evening, and other Medicines
+proper in the Dysentery, till its Violence was abated, before we gave
+the Bark: though in some Cases, where the aguish Paroxysms were very
+severe, and helped to increase the Purging, and the Patient was in
+Danger of sinking, we gave the Bark, notwithstanding the Flux still
+continued; and the Method we followed was the same as that I formerly
+mentioned, where it was complicated with the Malignant Fever; which
+was to give the Bark, mixed with Diascord, and Opiates, or other
+Medicines proper for the Dysentery, in the Intervals between the
+Purges.
+
+By this Treatment, very often both the Flux and Ague went off.
+However, it ought to be observed, that unless the aguish Paroxysms
+were severe, and in Danger of sinking the Patient, or that the
+Disorder had continued for some Time, and the Paroxysms were distinct,
+we seldom gave the Bark till the Violence of the Flux was abated: And
+where-ever much Griping and Pain in the Bowels attended the Flux and
+Ague, there Bleeding as well as Purgatives were necessary, before
+exhibiting the Bark; which seldom or ever agreed with them, till there
+was an evident _Apurexia_, or Absence of Fever in the Intervals
+between the Fits. Where these Cautions were neglected, the Bark
+generally made the Patients worse; and we were obliged to omit it,
+till the Violence of the Purging was over.
+
+Some Agues were accompanied with the Jaundice, though not in such a
+high Degree as in the confirmed State of that Disorder; and commonly
+in the Beginning the Pulse continued rather quick, in the Intervals
+between the Paroxysms; and the Patients complained of some Degree of
+Sickness for the first two or three Days. With those the Bark always
+disagreed, till the Feverishness between the aguish Paroxysms was
+gone; and we found, that the best Method of treating them, was to
+bleed in the Beginning, if there was much Fever; and then to give a
+Vomit and Purge, and to repeat them, if necessary; and where there was
+no Purging, to give the saline Draughts, and other cooling Medicines;
+and to add a few Grains of Rhubarb, or to give so much of the _pilulæ
+saponacæ cum rheo_, daily, as procured one or two loose Stools.
+
+After the Ague had regular Intermissions, and the Patient was quite
+cool, and without Fever in the Intervals, if the Disorder did not
+yield to the above Treatment, which it seldom did, we then gave the
+Bark freely; even though the slight icteric Symptoms still remained;
+and it put an End to the Ague, and removed the Jaundice at the same
+Time, without the least Inconvenience to the Patient. In such Cases,
+we generally used to add a few Grains of Rhubarb to the first Doses of
+the Bark; or gave the Bark made up into Pills with Soap, and added
+occasionally a few Grains of Rhubarb.
+
+Several of those who had the icteric Symptoms along with the Ague, had
+bilious Vomitings in the Time of the cold Fit; they found themselves
+sick, with a bitter Taste in their Mouth, before the Approach of the
+aguish Paroxysm; and many of them, though they took Emetics, which
+operated freely at this Time, yet did not vomit up the Bile; but the
+Sickness and bitter Taste continued till the cold Fit came on, when
+they vomited Bile in large Quantities. In such Cases, after the Use of
+Emetics and Purges, and the Ague was brought to have regular
+Paroxysms, with free Intermissions, the Bark, given as just now
+mentioned, removed the Ague and icteric Symptoms, without the least
+bad Consequences.
+
+Many Practitioners of great Repute have been prejudiced against the
+Bark; and tell us, that the free Use of this Medicine often lays the
+Foundation of Obstructions in the abdominal Viscera, especially when
+it has been given where there was an icteritious Colour in the Eyes
+and Countenance; and that, in such Cases, we ought not to give the
+Bark till these Icteric Symptoms are gone. At first, I was very
+cautious of giving it under such Circumstances; till meeting with some
+Cases where the Paroxysms were severe, and became more frequent, while
+the Patient was so low, as to be in Danger of sinking under the
+Disorder, I gave the Bark freely, as the only Remedy capable of
+preserving Life; which not only stopt the Ague, but carried off the
+icteritious Symptoms[84], and restored the Patients to perfect Health.
+
+    [84] This agrees with what Mr. _Cleghorn_ remarks of Tertian
+    Fevers in his _Observations on the epidemic Diseases of the
+    Island of Minorca_, who says, “where there is an icteritious
+    Colour of the Eyes, we are likewise told, that the Cortex
+    should not be administered; though, in my Opinion, it is for
+    the most part dangerous to delay it, after the first
+    Appearance of that Symptom.” Chap. iii. 2d edit. p. 205.
+
+After this I gave it freely, in the Manner above mentioned, to some
+Hundreds, with great Success; and I never saw any Mischief follow from
+using it: Indeed sometimes, where it was given rather too soon, it did
+not sit easy on the Stomach; and made the Patients hot and restless;
+but, by laying it aside, these Effects immediately ceased; and
+generally, after a little Time, the Paroxysms became milder and more
+distinct, when the Bark was again administered, agreed with the
+Stomach, and put an End to the Disorder; and I am now convinced, from
+Experience, that the Cases in which the Bark has done Mischief, or
+given Rise to Obstructions of the abdomenal Viscera, are but very
+rare; and that these Mischiefs mostly arise from the Obstinacy of the
+Disorder, and not from the Use of this Drug; for I have oftener
+observed these Obstructions where little or no Bark had been used,
+than where it was given freely[85]. What probably has given Rise to
+the Belief of the Bark’s doing so much Mischief, is, that in
+_Holland_, and other low fenny Countries, where Agues are endemic,
+they are oftentimes extremely obstinate, and yield hardly to any
+Remedies; and if they are stopt by the Bark, they often return soon
+after, and by their long Continuance give Rise to Obstructions of the
+abdomenal _viscera_, which have been attributed to the Use of this
+Specific.
+
+    [85] Dr. _Pringle_ takes Notice, that these Obstructions
+    happened as often without as with the Bark; and therefore
+    seemed to depend on the long Continuance and Obstinacy of the
+    Intermittent. _Observ._ part iii. chap. iv. sect. 2. p. 179.
+    3d Edit.
+
+In some few Cases a Purging accompanied these icteric Symptoms, which
+we treated much in the same Manner as when the Ague was complicated
+with the Flux; we gave Emetics and Purgatives; and the mindereri
+Draughts with Mithridate, throughout the Day, and Opiates at Night, if
+the Purging was violent; if it continued, accompanied with regular
+aguish Fits, the Bark, with Astringents, generally removed both.
+
+In the latter Part of the Year 1761, and during Spring 1762, we had
+at _Bremen_ many Patients in Agues of all Sorts; as Quotidians,
+Tertians, Quartans, and irregular Agues of a very obstinate Nature.
+The Town of _Bremen_ is large and well built, situated in a low sandy
+Plain, with the _Weser_ dividing the old from the new Town; generally
+a considerable Part of the Environs is covered with Water in the
+Winter, and frequently the _Weser_ breaks down some of the Dikes, and
+overflows all the Country round; and every Time the River overflows
+its Banks, the Cellars of all the new Town, and of that Part of the
+old Town next the River, are filled with Water. All the Year round, on
+digging two or three Feet deep into the Ground, you come at Water.
+
+Agues are endemic in this Place, and great Numbers of the lower Class
+of People are afflicted with them at all Times of the Year, especially
+in Spring and Autumn.
+
+Some of the Sick sent down from the Army were bad of Agues; but the
+greatest Number we had in Hospitals was composed of such as took it
+in Town; either from doing Duty on the Ramparts, or from lying in bad
+Quarters, or getting drunk and exposing themselves to Wet and Cold;
+and many Men of the invalid Companies who had come from _Embden_
+brought with them old inveterate tertian and quartan Agues.
+
+Most of the recent Cases were easily cured by the Methods already
+mentioned; though they often continued longer, required a greater
+Quantity of the Bark to stop them, and a longer Continuance of its Use
+to make a Cure, than at other Places, which were more dry, and higher
+situated.
+
+The most obstinate of the recent Cases were the irregular
+Intermittents, which had regular Paroxysms, but where the Pulse was
+not settled in the Intervals; which we were obliged to treat as
+Remitting Fevers till the Paroxysms became quite distinct, and the
+Patient was cool and free from any Fever in the Intervals; after which
+they commonly yielded to the Bark.
+
+But many of those Agues which had continued for some Time, especially
+with those Invalids who came from _Embden_, or who had brought on
+frequent Relapses by their own Irregularities, were very obstinate.
+With many the Bark had no Effect; and its Use persisted in seeming
+rather to exasperate the Paroxysms, and to do Hurt. Nor had almost any
+Remedy we tried a better Effect. We gave the following Medicines to
+divers Patients; the saline Draughts and cooling Medicines; Infusions
+of Camomile Flowers and of other Bitters; Dr. _Morton_’s Powders of
+Camomile Flowers, Salt of Wormwood, and diaphoretic Antimony; Dr.
+_Mead_’s Powders of Camomile Flowers, Salt of Wormwood, Myrrh, and
+Alum; Alum and Nutmeg; large Doses of _sal ammoniac_; large Quantities
+of Spirits of Hartshorn; the antimonial Drops and Powders; to some we
+gave Emetics, both in the Intervals and immediately before the Fits.
+In some we tried to promote Sweats before the Approach of the Fits, by
+making them drink freely of warm Liquors while they kept in Bed, and
+took diaphoretic Medicines; and to others we applied Blisters.--But
+all did not put a Stop to some of those Agues.
+
+With some the Disorder continued till it broke down the Crasis of the
+Blood, and brought on a general Relaxation of the Fibres; and the
+Patients became cachectic, and fell into Dropsies, or were seized with
+Diarrhœas, of which they died. Some had Obstructions formed in the
+Liver or Spleen, or other _viscera_, and fell into the Jaundice and
+Dropsies, which carried them off.--In the Bodies, of several whom we
+opened, we found Indurations of the Liver and Spleen--in two of them
+Suppurations of the Liver--and in one, who had had the Ague at
+_Embden_, and had long complained of one of those Swellings towards
+the left Side of the _abdomen_, called the _Ague Cake_[86], the Spleen
+was so much enlarged as to weigh above four Pounds.
+
+    [86] I have seen the dead Bodies of four People opened, who
+    had those Swellings of the left Side, commonly called the
+    _Ague Cake_, which had come after Agues; and in all the
+    Swelling was owing to an Enlargement of the Spleen.
+
+Some, whose Constitutions were worn out by these obstinate Agues, fell
+into Consumptions and other pulmonic Disorders in the Winter, of which
+they died. One Man died in the cold Fit[87].
+
+    [87] The cold Fit is the most dangerous Time of the Paroxysm,
+    and the greatest Part of those who die of Agues die at this
+    Time; one or two Instances of which I saw in the Military
+    Hospital at _Edinburgh_ in the Year 1746.--_Van Swieten_ says
+    he has seen the trembling and shaking so great in the Time of
+    the cold Fit of Quartans, that the Teeth have dropt out of
+    the Head. _Comment. in sect._ 749. _Aphorism. Boerhaav._ vol.
+    II. p. 511.
+
+Where-ever the Ague continued long, and the Bark had no Effect, we
+were obliged to lay it aside, and to try other Remedies adapted to the
+present Circumstances of the Patient.
+
+The mild Methods succeeded best; giving the saline Draughts and gentle
+cooling Medicines to such as were strong and plethoric, and had the
+aguish Paroxysms violent; and the gentle Aromatics and Bitters, or
+Chalybeats, to those of a weakly Habit, or whose Fibres had been much
+relaxed, and their Constitutions greatly injured by this or any other
+preceding Disorder.
+
+During these Courses, we gave at Times gentle Emetics; and if the
+Patient complained of Gripes and Purging, which they frequently did,
+in the Course of this Disorder, we gave a Dose of Rhubarb, or of some
+other mild Purge; and after it other Medicines proper for this
+Complaint.
+
+By these Methods frequently the aguish Paroxysms became gradually
+milder, and at last vanished. At other Times, after they had continued
+for five or six Weeks, we again gave the Bark, and found it to have
+the proper Effect. With others they continued thro’ the Winter, and
+went off of themselves in the Spring. With others they still
+continued; and as no Medicines nor Time seemed to have any Effect in
+that Country, we recommended their being sent over to _England_ for
+Change of Air, as the only Means likely to remove the Disorder.
+
+Two Agues which had resisted the Use of the Bark were cured by Powder
+of Camomile-Flowers, Salt of Wormwood, and diaphoretic Antimony; and
+one by the Use of the aluminous Powders, with Myrrh.--One Invalid, who
+had long been ill of an obstinate Tertian, on catching Cold, was
+seized with an Inflammation of his Throat, for which he was blooded,
+and took a mild Purge; next Day there appeared a Swelling of one of
+the parotid Glands, which we endeavoured to bring to Maturation, by
+the Application of emollient Cataplasms; after some Days it went
+entirely away, without coming to Suppuration; but as there remained
+still a Confusion of the Head, and a Quickness of the Pulse, a large
+Blister was applied to the Back, which continued running for some
+Days; after it dried up he fell into a Fit resembling that of an
+Epilepsy, and next Day had another Fit of the same kind; from the Time
+the Swelling first appeared till the Time he had the first Fit, he had
+no Ague, but it returned the second Day after the second epileptic
+Fit; another Blister was applied, and he had no Return of the
+epileptic Fits, though his Ague continued obstinate till _March_, at
+which Time he was sent to _England_[88].--About the same Time the
+aguish Fits of two others were stopt by the Application of Blisters,
+though they returned in both soon after.
+
+    [88] On the 29th of _August_ 1759, a Man (_Murdoch Brinnen_)
+    about thirty Years of Age, was admitted into _St. George_’s
+    Hospital for a very large Swelling of the parotid Glands and
+    neighbouring Parts, which had come three Days before, after a
+    Fit of the Tertian Ague, which did not return afterwards. The
+    Swelling was discussed by the Application of emollient
+    Cataplasms, which were intended to have brought it to
+    Suppuration. He had no Return of the Ague, nor did any bad
+    Consequence follow the Discussion of the Tumour, and the Cure
+    was completed by a few Doses of Physic, and a Decoction of
+    the Bark, which restored him to his Strength, and carried off
+    the little Heat and Feverishness which remained.
+
+Excepting in these few Cases, I found no Medicines effectual in
+stopping those Agues, which had resisted the Bark when properly given,
+though we tried a vast Variety in different Cases. The _cortex
+cascarillæ_, or _eleutheriæ_, was given freely, both in Decoction and
+Substance, in four Cases, which had not yielded to the Bark, but
+without producing any good Effect; we had not an Opportunity of
+trying this Bark in more Cases of this kind, nor in Fluxes, the small
+Quantity of it which had come from _England_ being all expended.
+
+A Soldier of one of the Regiments of Guards, who was admitted into the
+Hospital for œdematous Legs, and the Remains of a very bad Flux, which
+he had had ever since the preceding Autumn; after being cured of the
+Flux, and most of the œdematous Swellings, was seized with an
+intermitting Complaint in _February_. He had no regular hot and cold
+Fits; but every second Day, after a slight Shivering and Cold, he was
+seized with Gripes and a Purging. In one or two of the Fits his Pulse
+was very quick, and the Pain of the Bowels very acute and severe;
+which obliged us to blood him, and give him a Dose of the saline oily
+Purge; after which we treated the Disorder as a Flux complicated with
+the Ague, and gave the Bark mixed with Diascord, and gentle Opiates at
+Nights, and at Times gentle Purgatives; the Ague and Diarrhœa stopt
+very soon, and in a few Weeks he got free of all Complaints, though he
+still continued weak, till he was sent to _England_, about the
+Beginning of _April_.
+
+Many, especially those whose Constitution had been shaken by this or
+some other Disorder, complained of flatulent Swellings of the Stomach
+and Bowels, which affected them either while the Ague continued, or
+soon after it was stopped, and were very troublesome and uneasy. For
+the most part, these Swellings were removed by the Use of cordial
+Medicines mixed with the Bark, or a Course of Bitters, and some Doses
+of Rhubarb given at proper Intervals. In some Cases, where they were
+attended with Sickness, and the Stomach seemed to be loaded, a Vomit
+gave Relief. Very often these Symptoms continued for Weeks after the
+Ague had left them, and did not go entirely off, till the Patient
+recovered his Strength.
+
+In _February_, _March_, and _April_, 1761, severals of the Soldiers in
+the Hospital at _Paderborn_ complained of periodical Head-Achs, which
+returned in most, every Day; in others, only every second; and
+afterwards Cases of this Kind occurred at different Times as long as
+the Army continued in _Germany_. These Head-Achs generally began in
+the Forenoon, were very violent while they lasted, and confined the
+Patient to his Bed for some Hours. During the Pain, the Pulse was
+quick; but in the Intervals the Patients were quite cool, and without
+Fever. Sometimes, tho’ not always, the Urine deposited a little
+Sediment as the Head-Ach was going off. Commonly the Pain was all over
+the Head, but most severe in the Forehead; though sometimes it was
+confined to one Side only.
+
+These Head-Achs we treated entirely as Agues of the same Type. When
+the Patient was strong, some Blood was taken away, and afterwards we
+prescribed an Emetic and Purge, and then gave the Bark liberally,
+which generally put an End to the Complaint, without any bad
+Consequences attending.
+
+
+
+
+OF THE JAUNDICE.
+
+
+The Jaundice, or a yellow Colour of the Eyes and Skin, occasioned by
+an Absorption of Bile into the Blood, was another Distemper which
+appeared towards the End of each Campaign.
+
+This Disorder, for the most part, takes its Rise[89] from Calculi
+lodged in the biliary Ducts[90]; and sometimes from a viscid Mucus or
+Pituita obstructing those Passages[91]; and it may be brought on by a
+Tumour, or any other Cause[92], compressing these Ducts, so as to
+prevent the free Flow of the Bile into the Cavity of the Intestines.
+
+    [89] Obstructions and Scirrhi of the Liver have been assigned
+    as the Cause of the Jaundice; but as we have so many Cases of
+    this Kind related where no Jaundice appeared, it is now much
+    doubted, whether such Obstructions, which do not affect the
+    Ducts, are capable of producing this Disorder.
+
+    [90] We have numerous Cases in _Bonetus_, and other physical
+    Observations, where Calculi have been found in the Gall
+    Bladder, and Ducts of People who have died of the Jaundice;
+    and I have frequently found two, three, and sometimes twelve,
+    fifteen, or twenty, such bilious Calculi in these Cavities.
+
+    [91] Viscid Mucus or Pituita, or viscid Bile, has been
+    observed frequently to obstruct the Ducts. Dr. _Coe_ says,
+    sometimes icteric Patients discharge very thick Bile, almost
+    as viscid as Bird-Lime. See his _Treatise on biliary
+    Concretions_, chap. ii. where he has collected a great Number
+    of icteric Cases, in which the Bile has been found quite
+    viscid after Death.
+
+    [92] See the Case of a Jaundice in _Bonetus’s Sepulchretum
+    Anatomicum_, tom. II. p. 326, where the Sides of the common
+    biliary Duct were compressed by an Enlargement of the Glands
+    about the _vena portarum_; and we sometimes meet with a
+    Jaundice in pregnant Women which goes off after Delivery, and
+    seems to have been caused by the Pressure of the Uterus and
+    indurated Fœces in the Colon. _Van Swieten_ says, he has seen
+    this very frequently, vol. III. sect. 918, p. 95.
+
+The yellow Colour, or Jaundice, observed in the Ague, and some other
+bilious Disorders, seems to arise sometimes from Spasms of the Ducts;
+or from too great a Quantity of Bile secreted and absorbed into the
+Blood, which seems evidently to be the Case where large Quantities of
+Bile are either vomited or discharged by Stool; a Proof that the
+biliary Ducts are clear, and free from Obstructions.
+
+In the End of the Campaign of 1760, after a continued Rain for many
+Weeks, the Jaundice had been very frequent, and in a Manner
+epidemical, among the Troops, for some Time before they left the
+Field; and in passing thro’ _Munster_, about the End of _December_, I
+observed several ill of that Distemper in Hospitals, and met with a
+few Cases of this Kind in the Hospitals at _Paderborn_ in _January_
+1761; but during the Spring and Summer, we had only one or two now and
+then sent to the Hospitals for this Complaint; though towards the End
+of the Campaign it became more frequent, and several were sent down to
+_Bremen_; and some of the Garrison were likewise affected with it.
+During the Winter not above four or five were sent to the Hospitals I
+attended, and but a few to the flying Hospital, during the Campaign
+1762. It frequently appeared in dropsical Cases, depending on
+obstructed Viscera.
+
+Those in whom the Jaundice was the original Disorder, and not
+complicated with any other, generally got well soon; but where it
+appeared in dropsical Cases, depending on obstructed Viscera, it was
+commonly fatal.
+
+In the Beginning of this Disease, Patients usually complained of
+Sickness, Heat, Thirst, and other feverish Symptoms; and some had a
+Vomiting, and Pain of the Stomach, for a Day or two before the
+Jaundice appeared; the Urine was always of a deep Colour from the
+first; and about the second or third Day the Skin, and the Whites of
+the Eyes, began to be tinged with a yellow Colour, attended with the
+common Symptoms of this Disorder.
+
+Such was the Manner in which the Jaundice began in those who were
+taken ill in Garrison; but those sent us from the Army could seldom
+give any accurate Account of their own Cases.
+
+In the Course of this Disorder, the Sick were inclined to be costive,
+though some few had a Diarrhœa; several, who had been reduced by
+Fevers, or other Complaints, before the Jaundice appeared, were
+attacked with violent Hæmorrhages from the Nose; and two had like to
+have died of them before the Bleeding was stopped. The Hæmorrhages did
+not prove critical, but seemed to depend on a dissolved State of the
+Blood.
+
+On the Patient’s being first taken ill, if he was plethoric or
+feverish, or complained of Pain, attended with Sickness and Vomiting,
+some Blood was taken away. Next Day we gave twenty-five or thirty
+Grains of Rhubarb in a saline Draught, and afterwards the common
+saline and other cooling Medicines, till the Fever was abated. If the
+Pain and Fever did not abate, a Vein was opened a second Time, and a
+few Drops of the _tinctura thebaica_ were added to the saline
+Draughts, while emollient Clysters were frequently administered, and
+the Stomach and Belly fomented with Flannels dipped in warm emollient
+Decoctions.
+
+When the Pain and Fever were gone, we then gave a gentle Vomit in the
+Evening, and next Day a Dose of Rhubarb; and afterwards so much of
+the _pilulæ saponaceæ cum rheo_ daily as kept the Body open; or the
+saline Draughts with five or six Grains of Rhubarb in each, or such a
+Quantity as answered the same Purpose as the Pills; and from Time to
+Time repeated the Emetic[93] and Purge.
+
+    [93] Vomits are reckoned amongst the most efficacious
+    Remedies in this Disorder, and I have often seen good Effects
+    follow their Use.--_Janet Crags_, a Woman thirty Years of
+    Age, was, on the 21st of _December_ 1758 admitted into _St.
+    George_’s Hospital for a Jaundice of some Months Continuance.
+    Her Eyes and Skin were not of the common icteric Colour, but
+    of a dark livid yellow, for which Reason both she and the
+    Nurses termed her Disorder the Black Jaundice. She at first
+    complained of a Difficulty of Breathing, and a Weight and
+    Oppression about the Region of the Liver, for which she was
+    blooded, took some Doses of Physick, and the Soap Pills with
+    Rhubarb; but these produced no Change in her Complaints. On
+    the 29th she had a Cough, and complained much of Sickness and
+    Difficulty of Breathing, for which she was ordered a Vomit,
+    and afterwards to take the Squill Draught Morning and
+    Evening, which occasioned a Purging and Gripes. On the 5th of
+    _January_ 1759, the Looseness still continuing, I ordered her
+    to leave off the Use of the Squill Draughts, and to take only
+    some Rhubarb in an oily Draught every Night at Bed-Time. On
+    the 8th, tho’ the Purging had increased, I did not chuse to
+    check it, as I suspected it would prove a Crisis to the
+    Disorder, and therefore only ordered her the Cordial Draughts
+    and Wine to support her Strength. The Looseness continued
+    till the 15th, when most of the icteric Symptoms were gone,
+    and by the 30th they entirely disappeared. However, she
+    continued low, and subject to Flatulencies for some Months
+    afterwards, which were at last removed by the continued Use
+    of Cordials, gentle Bitters, a nourishing Diet, and repeated
+    Doses of Rhubarb; and on the 2d of _May_ she was discharged
+    in a firm State of Health.
+
+    Dr. _Coe_ says, “I have more Reason to be satisfied of the
+    Effect of Vomits in dislodging these Calculi, than of any
+    other, or indeed of all other Medicines.” _Treatise on
+    biliary Concretions_, chap. ii. p. 253. Besides viscid
+    Humours, which Vomits bring away from the biliary Passages,
+    how often are Gall Stones likewise found in the Stools after
+    the Operation of a Vomit? _Ibid._ p. 256.
+
+Most of the icteric Cases we had, which were not complicated with
+other Disorders, yielded to the above Treatment in about twelve or
+fourteen Days. Two or three remained obstinate for a longer Time. To
+one I ordered a Quart of the pectoral Decoction, made with Parsly
+Roots instead of the Linseed, to be drunk daily along with the Soap
+Pills; and the Jaundice disappeared in about eight or ten Days. One
+who had the Disease more obstinate than the rest, and complained for
+some Time of a Tension and Uneasiness about the Liver, was ordered to
+have the right Side fomented Morning and Evening, and to rub it for
+some Time after with the _linimentum saponaceum_ and to drink the
+Decoction of Sarsaparilla after the Soap Pills; and by continuing this
+Course for about three Weeks, the Disorder went off[94].
+
+    [94] Sometimes the warm Bath has a good Effect after other
+    Remedies have afforded no Relief. In the Year 1743, a young
+    Gentleman, a Student of Physic at _Edinburgh_, had a Jaundice
+    for which he had taken Variety of Medicines, and rode daily
+    on Horseback for some Weeks, without receiving any Benefit:
+    At last, by my Father’s Advice, he took a brisk Dose of
+    Physic, and before it began to operate had a large Quantity
+    of warm Whey thrown up by way of a Clyster, and went
+    immediately into the warm Bath. In the Bath he was taken with
+    a violent Inclination to go to Stool; and after coming out,
+    had a great Number of bilious Stools that Day, and next
+    Morning was still inclined to be loose; and in a few Days all
+    the icteric Symptoms vanished. On the 20th of _July_ 1763, a
+    middle aged Woman, _Elizabeth Hosier_, was admitted into _St.
+    George_’s Hospital for a Jaundice, which came about a
+    Fortnight before. She had been blooded, and had taken some
+    Medicines, before I saw her. I ordered her a Vomit and Purge,
+    and to take too Scruples of the Soap Pills and Rhubarb daily;
+    and four Days afterwards the Vomit and Purge were repeated,
+    but without making any Change in her Disorder. On the 29th
+    she went into the warm Bath, and took a Vomit immediately on
+    coming out. After the Vomit she had some loose Stools, and
+    the icteric Symptoms went all off in a few Days. She
+    continued well for some Months; but I have been told, that
+    she has since relapsed.
+
+    When the Jaundice continues obstinate, there is hardly any
+    Thing has often a better Effect than the continued Use of
+    Decoctions of the Juices of succulent Plants, of Whey in the
+    Spring, Soap, and such like Medicines. The Baron _Van
+    Swieten_ tells us, that he has cured many obstinate Jaundices
+    by making the Patients drink daily a Pint or two Pints of a
+    Decoction of Grass, Dandelion, Fumaria, Succory, and such
+    like, prepared in Whey; to each Pint of which he added Half
+    an Ounce of _sal polychrest_, and an Ounce or two of Syrup of
+    the five aperient Roots; and by ordering them to drink the
+    Spa Water in Summer, and take freely of Soap, along with a
+    Decoction of the aperient Roots, in Winter. In those who were
+    cured by these Remedies, he says, Stones, or a kind of a
+    grumous calculous Matter, were always found in the Stools, as
+    the Jaundice was going off. He relates one very particular
+    Case of a Lady of sixty Years of Age, who had had a black
+    Jaundice for twelve Years, and was cured by continuing the
+    Use of these Medicines for eighteen Months; during the last
+    six Months of which she had a Looseness, and constantly
+    discharged by Stool a fetid granulated Matter of the Colour
+    of Clay;--and another singular Case of a Man who was cured by
+    living mostly upon Grass, and a Decoction of it, for two
+    Years together. The Man came at last to devour such
+    Quantities of it, and could distinguish the good Sort from
+    the bad so well, that the Farmers often used to drive him out
+    of their Fields. Vol. III. §. 950.
+
+    _Glisson_ tells us, that Cattle are subject to bilious
+    Concretions in Winter, which are dissolved and evacuated in
+    the Spring, when they begin to move much about, and to eat
+    the new Grass, which purges them. _Oper._ vol. II. _Anat.
+    Hepat._ chap. vii. p. 104.
+
+    Dr. _Russel_ greatly recommends the Use of Sea Water along
+    with the saponaceous Medicines. See his _Treatise on the Use
+    of Sea Water_.
+
+The Hæmorrhage from the Nose commonly stopped soon. Where it was
+violent, we kept the Patient cool, and applied Cloths dipped in
+Vinegar and Water to the Nose.--In two Cases, one at _Munster_, the
+other at _Bremen_, the Patients were hot and feverish, and a Vein was
+opened, and eight or ten Ounces of Blood taken away; and in one Case
+nothing took Effect till we gave repeated Doses of the _tinctura
+saturnina_ in a common acid Julep.
+
+
+
+
+OF TUMOURS of the BREAST.
+
+
+In _May_ 1761, a great many of the Patients, who had been in Hospitals
+the preceding Winter, had Tumours formed on the external Part of the
+Breast, which they shewed me at _Osnabruck_. They began in the Form of
+indolent Tumours, and came slowly to Suppuration. For the most part,
+the Suppuration was only partial, and the Tumour, on being opened,
+discharged a very small Quantity of Matter. Some of them, though they
+felt soft, and seemed to contain Matter, yet, upon being opened,
+discharged only a small Quantity of black Blood. None of them melted
+down entirely into Pus, or came fully to Suppuration, and healed
+kindly as Abscesses which succeed acute Inflammations. But after a
+small Quantity of Matter was discharged, for the most part, there
+still remained a hard Tumour, which felt as if it was a Swelling of
+the Bone, or Cartilage below; and in some the Surface of the Bone was
+found rough at the Bottom of the Abscess.
+
+These Tumours seldom rose high, and were most of them situated at the
+lower Part of the Sternum, or a little to one Side of it, commonly on
+the left Side, above the _cartilago ensiformis_. Some Patients had
+only one, others two, and some three such Tumours. The first of them I
+saw was on the left Side, which, on being felt, gave exactly the same
+Sensation as when the Cartilages of the Sternum are begun to be raised
+by an Aneurism of the Aorta; only no Pulsation was to be perceived;
+and most of them had the same Appearance.
+
+The Patients, who had such Tumours, commonly complained of Pains of
+their Breast. One or two, after these Tumours came to Suppuration,
+seemed to recover their Health, and to feel no Uneasiness, tho’ some
+of the Swelling remained: But many of them were inclined to be
+hectic, and seemed likely to grow consumptive.
+
+Being ordered up to the flying Hospital in _June_, and the Sick going
+down to _Bremen_, I had no Opportunity of seeing the Event of these
+Tumours, or of examining the Bodies of those who died with them. One I
+accidentally met with the following Winter at _Bremen_, who died of a
+Consumption and Diarrhœa. He had a large Abscess, which penetrated
+into the Cavity of the Chest, and discharged a great Quantity of very
+fetid Matter, at the Part where one of these Tumours had been seated,
+and the Sternum and Ribs were carious all round the Abscess.
+
+
+
+
+OF PARALYTIC COMPLAINTS.
+
+
+Some of the Soldiers, from lying out in the Nights on the wet Ground,
+and from doing Duty in cold rainy Weather, were seized with a Pain and
+Numbness all over, and lost the Use of their Limbs, which in some was
+succeeded with a Palsy of these Parts: But the greatest Number of
+those afflicted with Paralytic Symptoms were seized with them either
+in Fevers, or after feverish and other Disorders. The Number, who were
+attacked with Complaints of this Kind, were but few.
+
+When Men were suddenly taken with Pain and Numbness all over, we found
+that the best Method of treating them was to put them to Bed, and give
+them Plenty of mild warm diluting Liquors for Drink; and if there was
+much of a Fever, to open a Vein, to give the cooling antiphlogistic
+Medicines, and apply Blisters; and if these Complaints still remained,
+to endeavour to promote a breathing Sweat, by means of Diaphoretics
+and warm Drinks. Several who were brought to the Hospital, soon after
+being seized in this Manner, got well; but in some few, one or other
+of the Limbs would begin to waste, and remain paralytic afterwards.
+
+Those who had the true confirmed Palsy seldom remained long enough
+with us to be cured. Two or three received Benefit from Blisters
+applied to the Parts, and from Issues; drinking at the same time the
+Decoction of the Woods, or of Sarsaparilla, and taking the volatile
+Tincture of Guaiac or Valerian[95], and being sweated by the Use of
+_Dover_’s Powder, or other Diaphoretics.
+
+    [95] On _Wednesday_ the 1st of _February_ 1764, _Margaret
+    Julion_, a Woman between fifty and sixty Years of Age, was
+    admitted into _St. George_’s Hospital for an entire Loss of
+    Speech, which seemed to depend on a paralytic Disorder of the
+    Parts about the Larynx. The Account her Friends who came with
+    her to the Hospital gave of her Case was, that she had been
+    for five Months troubled at Times with Pains of her Bowels,
+    and a Purging; that on _Sunday_ se’night before coming to the
+    Hospital, she had suddenly lost the Use of her Speech, and
+    had not spoke since that Time, though she seemed to hear and
+    understand whatever was said to her. I asked her some
+    Questions, which she answered distinctly by Signs. She had no
+    paralytic Complaint of her Face, Arms, Legs, or any other
+    Part of her Body, and swallowed both Fluids and Solids with
+    Ease. She had no Fever, and seemed to complain of nothing but
+    the Loss of Speech.--A Blister was applied to her Neck, and
+    she was ordered the saline Draughts, with a Scruple of Powder
+    of Valerian in each, to be taken three Times a-day, and a
+    Dose of sacred Tincture, to be taken twice a-Week. She
+    followed this Course for a Fortnight, when another Blister
+    was applied to the Fore-part of the Neck, and the Powder of
+    Valerian in the Draughts was changed for two Drachms of the
+    _tinctura valeriana volatilis_. At the End of three Weeks she
+    could pronounce the two Words _Why_, _What_. She continued
+    the same Course till this Day, the 16th of _March_, and can
+    now pronounce many Words and short Sentences.
+
+One Man of the 51st Regiment of Foot, after doing Duty in very cold
+wet Weather, in the Beginning of the Year 1762, was seized with a
+Palsy of one Side of his Face, which prevented him from speaking
+distinctly, and was an Impediment to his eating. He mended much after
+being blooded, and having a large Blister to his Neck, kept open for
+some time by means of the epispastic Ointment.
+
+
+
+
+OF AN INCONTINENCY of URINE.
+
+
+An Incontinency of Urine was another Complaint frequent among the
+Soldiers; but it seemed to me to be counterfeited by many. All, who
+had it, said that they had received some Hurt[96] or Sprain of the
+Back, or a Kick from a Horse, or that a Carriage had run over them.
+
+    [96] A Soldier in the Hospital at _Paderborn_ used to
+    discharge his Water involuntarily, and mixed with Pus, which
+    came from some violent Blows he had received on the Back.
+
+    _John Pearce_, a young Man about eighteen Years of Age, was
+    admitted into _St. George_’s Hospital, the 10th of _April_
+    1759, for a Pain of his Side, and a Complaint of the Bladder.
+    The Account which he gave of his own Case was, that, some
+    Months before, he had received a violent Blow with a
+    Cricket-Bat on the left Side, on the Region of the Kidney;
+    and that ever since he had had a sharp Pain in that Part, and
+    sometimes had a Stoppage of Urine, and at other Times it came
+    away insensibly. His Pulse was rather quick, but low, and he
+    had a feverish Heat. He at first took some cooling Medicines;
+    but on the 20th, being low and faint, he had some of the
+    fœtid Julep. On the 23d he was attacked with a sharp Pain in
+    the Belly and Side, had a Stoppage in making Water, a quick
+    and full Pulse, and most of the Symptoms of the Stone. He was
+    ordered to be blooded immediately, to take the saline
+    Draughts every four Hours; and as he was inclined to be
+    costive, to take as much lenitive Electuary as to procure him
+    a loose Stool; and it was recommended that he should be
+    sounded as soon as the Violence of the Fever was over. On the
+    25th he continued much in the same Way, and had made some
+    Water, which was intolerably fœtid. Half a Drachm of the
+    dulcified Spirit of Nitre, and five Drops of the _tinctura
+    thebaica_, were added to each of his Draughts, as the Pain
+    and Difficulty of making Water had increased. On the 26th his
+    Pulse rose, and became very hard and quick; the Pain in his
+    Side, and the Dysuria, became more violent; and about Twelve
+    o’Clock he had a convulsive Fit, resembling that of an
+    Epilepsy; after coming out of the Fit, as the Fever and Pain
+    had increased, he was blooded; the Belly was fomented and
+    embrocated, and he took the oily Draughts four Times a-Day;
+    his Blood immediately threw up a very thick Buff. He remained
+    pretty easy the rest of the Day; but about the same Time next
+    Day, he had another convulsive Fit, and died.
+
+    On opening his Body, we found about two or three Pints of a
+    dark-coloured fœtid Water in the Abdomen; on cutting through,
+    and squeezing the right Kidney, there came out a thin
+    purulent Matter every where from its Substance, though it
+    appeared sound; on raising and cutting through the
+    Peritoneum, covering the left Kidney, there was a Discharge
+    of about a Pint of black and very fœtid Water, which had
+    every where surrounded this Kidney; and there were six
+    mortified Spots on its Surface, as large as the End of one’s
+    Finger, with a Depression in each about a Quarter or Half an
+    Inch deep; most of the Substance of this Kidney seemed
+    diseased, and it was full of Suppurations. The Bladder was
+    contracted and thickened, and contained a rough Stone, which
+    weighed three Ounces. The rest of the _viscera_ were sound.
+    This Stone had certainly been in the Bladder long before the
+    young Fellow received the Blow with the Cricket-Bat; but the
+    Injury done the Kidney had probably aggravated the Symptoms.
+
+    I do not remember ever to have seen convulsive Fits, such as
+    this young Man had, in acute Diseases, except in one Case of
+    a slow Fever, which came by taking Cold after a Salivation,
+    and which I attended, along with Dr. _Pringle_. The Gentleman
+    had three Fits exactly of the same kind as this young Man, at
+    twenty-four Hours Distance from one another, and he died of
+    the third.
+
+Those who really had the Disorder seemed to have received such an
+Injury of the Bladder, or Kidneys as required a considerable Space of
+Time to get the better of; and by reason of the short Time we had them
+under our Care at the flying Hospital, they seldom received much
+Benefit. One or two thought they grew better on taking the Bark and
+Balsam of _Peru_; at the same Time they bathed Morning and Evening the
+lower Part of the Abdomen and Perinæum, with Flannels dipped in gentle
+astringent Liquors, applied cold. Blisters applied to the _os sacrum_
+had no Effect.
+
+
+
+
+OF A STOPPAGE of URINE.
+
+
+We formerly mentioned, that in acute Diseases many complained of a
+Stoppage or Difficulty of making Water; and others had this Complaint
+from Strictures of the Urethra, or Disorders of the Bladder or
+Kidneys[97].
+
+    [97] It is often very difficult to judge of the Cause, or to
+    be able to determine exactly the Seat of these Disorders
+    before Death; as the following Cases will shew.
+
+    _John Waden_, a middle-aged Man, was admitted into _St.
+    George_’s Hospital the 10th of _April_ 1759, for a Swelling
+    of the Abdomen, and a Difficulty of making Water, which he
+    said begun about two Months before, with a violent Pain in
+    his Back and Belly, occasioned by his being employed in
+    making of Cyder in a very cold Cellar. He had not had a Stool
+    for some Days: at first he took a Dose of Physic, and some of
+    the saline Draughts; but in a Day or two complained that his
+    Belly had grown to a monstrous Size, and that he had not made
+    Water for above twenty-four Hours; on examining, we found the
+    Bladder so much distended as to reach up to the Navel; and
+    upon a Catheter’s being introduced, above two Quarts of Water
+    were drawn off, and the Swelling immediately subsided; but in
+    the Afternoon was as large as before, the Bladder seeming to
+    be in a paralytic State. During the Months of _May_ and
+    _June_, his Water was drawn off twice a-Day; he had his Belly
+    fomented with emollient, astringent, and other Decoctions,
+    and embrocated with Liniments; was blooded once when
+    feverish, took Cordials, the Bark, Myrrh, and a Variety of
+    Medicines, without any Effect. On the 3d of _July_, a
+    flexible Catheter was introduced into the Bladder, and left
+    there, in order that the Urine might drain away as fast as it
+    was secreted, and the Bladder be allowed to contract, and
+    recover its Tone. The Catheter gave him no Pain, and he
+    thought himself much easier by the Bladder’s never being too
+    much stretched; but on taking out the Catheter some Days
+    after, he had the same Stoppage of Water as before. On
+    consulting with Dr. _Batt_ and the other Physicians, it was
+    agreed to give two Grains of the Powder of Cantharides, with
+    three Grains of Camphor and ten of Sugar, rubbed well
+    together in a Mortar, twice a-Day; and to continue the Use of
+    the flexible Catheter. He found no Uneasiness or Strangury
+    from the Use of the Cantharides, and thought he passed his
+    Water more freely, when the Catheter was taken out; but after
+    fourteen Days, finding no Change for the better, and being
+    free from any Fever, he was ordered into the cold Bath; the
+    two first Days he found himself more lively and brisk; but
+    the third Day was chilly and cold after coming out of it, and
+    therefore was desired to leave it off; some Days after he
+    became hectic, and I observed Pus in his Water, which he said
+    he had passed with his Urine for above three Months; after
+    this he languished for near a Month, and died upon the 25th
+    of _August_.--Upon examining his Body next Day, we found the
+    thoracic Viscera in a sound State, except that the Lungs
+    adhered a little on the right Side. Both Kidneys were
+    diseased; they were inflamed, and seemed enlarged; and on
+    cutting them, had Tubercles dispersed every where through
+    their Substance, which had come to Suppuration, and contained
+    a good deal of Matter; the lower Part of the left Kidney was
+    mortified, and contained two or three Ounces of a black fœtid
+    Liquor. The Bladder of Urine was contracted, and its Coats
+    greatly thickened, and the internal Coat much inflamed; and
+    there was a Cyst full of Matter, about Half the Size of a
+    Walnut, between the muscular and villous Coats, towards the
+    lower Part of the right Side of the Bladder; and there were
+    two large Cysts, containing a small Quantity of Matter,
+    though capable of containing near two Ounces each; one
+    situated between the _vesiculæ seminales_ and Rectum, the
+    other between the _vesiculæ_ and Bladder, which opened into
+    the Urethra by one common Orifice, capable of admitting a
+    large Quill, at the Side of the _caput galinaginis_. The rest
+    of the Viscera were in a sound State.
+
+    _Mary Hibbard_, a Woman twenty-four Years of Age, was
+    admitted into _St. George_’s Hospital, the 6th _June_ 1759,
+    for a Complaint of her Bladder. The Account she gave of
+    herself was, that, about _Christmas_ 1758, she had parted
+    with some Gravel; and about fourteen Days before coming to
+    the Hospital, she was seized with a violent Pain in her Back
+    and Loins, attended with a Sickness and Nausea; and very soon
+    after complained of a violent Pain in the lower Part of her
+    Belly, and with a perpetual Inclination to make Water, though
+    she felt a sharp Pain and Difficulty in doing it; and that
+    these Complaints still remained. Her Pulse was quick and
+    strong, and she was inclined to be costive. She was
+    immediately blooded, took the oily Draughts three Times
+    a-Day, the _decoctum furfuris_ for common Drink, and so much
+    lenitive Electuary as procured her a Stool next Day. As there
+    was a strong Suspicion of her having a Stone, she was
+    sounded; but nothing at all was to be felt in the Bladder.
+    Her Medicines eased her Pain in making Water, but not the
+    Pain in her Back. On the 16th her Water was thick and turbid,
+    and deposited a brown Sediment; and the Difficulty in making
+    Water still remained; instead of the lenitive Electuary she
+    was ordered the Rhubarb oily Draught to be taken every Night.
+    On the 18th, there being no Change in her Disorder, she had
+    Draughts made of an Ounce and a Half of simple Mint Water,
+    Half a Drachm of the dulcified Spirit of Nitre, and five
+    Drops of the _tinctura thebaica_, and Syrup three Times
+    a-Day; but on the 22d she complained, that since she left off
+    the oily Medicines, her Pain and Difficulty in making Water
+    had grown worse; she was therefore ordered the saline and
+    oily Draughts alternately, and to take the Rhubarb oily
+    Draught occasionally when costive, which removed these
+    Complaints; and they did not return while she remained in the
+    House; but on the 4th of _July_, the Day before she was to
+    have been discharged as cured, she was attacked with a sharp
+    Pain in her Hip and Loins, and about the _os coccygis_; which
+    increased till the 9th, and extended itself all along the
+    Outside of the right Thigh; it was most acute about the _os
+    coccygis_; but on examining, nothing was to be observed
+    externally: This Pain continued more or less all that Month,
+    and till the End of the next, and so obstinate as not to be
+    altered by bleeding, and the Use of Liniments, Blisters,
+    cooling Medicines, Opiates, warm Baths, and other Remedies.
+    On the 20th of _August_, a strengthening Plaister was applied
+    to her Back, which gave immediate Relief, and she was
+    discharged cured the 29th. She continued well till _October_,
+    when she was attacked with a violent Fever at _Hounslow_, and
+    was brought to the Hospital on the 24th of that Month, and
+    the tenth Day of the Fever. She died the 3d of _November_.
+    During the Course of the Fever, she only complained once of a
+    Difficulty of making Water.--After Death I had her Body
+    opened, when the only Thing particular which we could
+    observe, was the urinary Bladder about four times the natural
+    Size; it seemed to be flaccid, and in a State of Relaxation;
+    the Kidneys were sound, and no Signs of any Distemper could
+    be observed about the Uterus or Rectum, or near the _os
+    coccygis_.--When she was first in the Hospital, I desired her
+    always to examine her Urine; but she never observed that she
+    passed any Sand, Gravel, or any thing of that kind.
+
+    _Thomas Jacey_, an elderly Man, was admitted into _St.
+    George_’s Hospital the 14th of _March_ 1759, for a Pain in
+    his Back, and a Difficulty and Pain in making Water, which
+    was often mixed with grumous Blood; but he had never observed
+    any Sand or Gravel in it. His Pulse was quick and full,
+    attended with Heat and Thirst; and he was inclined to be
+    costive; he was at first blooded, and took a Dose of laxative
+    Mixture, and two Ounces of the Tincture of Roses, four Times
+    a Day, and the _decoctum malvæ_ for common Drink. At first he
+    seemed relieved, and passed no grumous Blood for some Days;
+    but on the 26th, as he complained much of a Pain in making
+    Water, the Tincture of Roses was changed for the oily
+    Draughts, and he was ordered the Rhubarb oily Draught
+    occasionally. On the 9th of _April_ he fell suddenly into a
+    comatose Way, and remained so till the 12th, when he died,
+    notwithstanding the Use of divers Remedies.--Upon examining
+    his Body, both Kidneys were found in a sound State; the
+    Intestines covered with slight inflammatory Spots, the
+    Bladder of Urine quite contracted, schirrhous, and greatly
+    thickened; and its internal Surface rough and eroded, with
+    one or two black Spots on it, and some grumous Blood lying on
+    its Surface. The other viscera were sound.
+
+    In Ulcers of these Organs, the natural Balsams, mixed with
+    soft Things, are often of great Service; of which the
+    following Case is an Example.--_William Lumley_, a Boy nine
+    Years of Age, was admitted into _St. George_’s Hospital, the
+    6th of _September_ 1759, for a Pain in the Bladder, and a
+    Difficulty in making Water, which was always more or less
+    mixed with Matter. At first there was a Suspicion of his
+    having the Stone; but on sounding, none was to be found. From
+    the Symptoms, it appeared as if there was an Ulcer in the
+    Bladder near to its Neck; the Boy had a Cough, was very low,
+    and inclined to be costive; at first he took three Spoonfuls
+    of the Sperma Ceti Mixture four Times a-Day, and a Dose of
+    Physic; but the Symptoms still remaining, on the 2d of
+    _October_ he was ordered to take a Scruple of the
+    _electuarium e spermate ceti_ three or four Times a Day, and
+    to have the Gum-Arabic Decoction for his common Drink. By
+    continuing the Use of these Things, and taking some opiate
+    and laxative Medicines occasionally, he mended by slow
+    Degrees, and all his Symptoms went off; and he recovered his
+    Health and Strength, and returned Thanks for his Cure the
+    18th of _January_ 1760.
+
+    The following Account of a remarkable Suppression of Urine I
+    had in a Letter, dated the 25th of _November_ 1757, from Mr.
+    _Pearson_, one of the Surgeons to his Majesty’s Military
+    Hospitals, who then served as a Mate.
+
+    _James Ruffendal_, aged Twenty, of a delicate Habit, was, in
+    the Middle of _July_ last, seized with a violent Pain in both
+    Kidneys, which extended along the Ureters to the Bladder, and
+    remained in the same Situation for about three Weeks; during
+    which Period his Urine began to decrease in Quantity, and the
+    voiding of it was attended with acute Pain about the Neck of
+    the Bladder. The Secretion then totally stopt; he remained
+    for upwards of five Weeks in the Hospital at _Dorchester_,
+    and made no Water; at the End of which Time I first visited
+    him along with Mr. _Adair_. He complained then of a slight
+    Pain in his Kidneys, and told us he had a tolerable Appetite,
+    sweated little, and voided every Day four or five Liquid
+    Stools. He was ordered Boluses of Camphor, and _sal. vol. c.
+    cervi_, and every Night a Dose of _tinctura cantharidum_;
+    which he continued to take for a Fortnight without receiving
+    the least Benefit. I then blooded him to the Quantity of ten
+    Ounces, and gave him an Emetic of six Drachms of the _vinum
+    ipecacoanhæ_, and two Ounces of the Oxymel of Squills, which
+    operated very well; and afterwards ordered him to take one of
+    the following Boluses every four Hours. ℞ Sapon. dur. Hispan.
+    drachm. i. Sal. Absynth. gr. vi. Calc. Viv. gr. x. Balsam.
+    Peruv. q. s. ut fiat Bolus. These he continued to take for
+    twelve Days. On the Morning of the 14th of _October_, he was
+    suddenly seized with an acute Pain in both Kidneys, and about
+    Noon voided upwards of Half a Pint of straw-coloured Urine,
+    which let fall a clay-coloured Sediment. As he was feverish,
+    I took away twelve Ounces of Blood, and ordered him
+    Barley-Water with Nitre for Drink. He was easy in the Night,
+    and made upwards of two Pints of Urine, which deposited a
+    Sediment of a gelatinous Consistence. Next Morning the Pain
+    increased, especially in his Right Side, and ten Ounces more
+    of Blood was taken away. This lowered the Pulse, and
+    considerably abated the Pain. Both this and the Blood taken
+    away the Day before threw up an inflammatory Buff. He was
+    ordered to continue the Use of the Barley Water with Nitre,
+    and to take three Spoonfuls of a Mixture with _spiritus
+    mindereri_ every two Hours. He had an easy Night, and was
+    next Day free from Fever; but complained of an Uneasiness in
+    his Stomach and Nausea. He was ordered a Scruple of the
+    Powder of Ipecacoanha, which vomited him, and procured him a
+    Stool. He was easy in the Night; but in the Morning was hot,
+    and complained of a Pain in his Right Kidney, and all over
+    his Bones, as he expressed it. I then gave him a Mixture,
+    with _spiritus mindereri_, and the _pulvis contrayerva comp._
+    of which I desired him to take some Spoonfuls frequently.
+    This procured him a plentiful Sweat, which removed the Fever
+    and Pain: these Symptoms returned next Day, but were removed
+    by the same Means. I remained at _Dorchester_ for a Week
+    after, and he recovered his Strength and Appetite as much as
+    could be expected in so short a Time; but he still complained
+    of Pain in his Right Kidney, tho’ he made Water freely. By a
+    Letter I received from the Gentleman whose Care I left him
+    under, I understood he had a Relapse, which he has since got
+    the better of.
+
+    I forgot to inform you, that his Father died of the same
+    Complaints, after being six Months without secreting a Drop
+    of Urine; and his Brother died of the same in about ten
+    Weeks.
+
+Where it depended on Strictures of the Urethra, Bougies introduced
+into that Passage, and worn for some Time, were of great Service. The
+Patients were at the same time ordered to live on a cool Diet, and to
+drink the _decoctum Arabicum_, or an Infusion of Linseed, or such
+other mild mucilaginous Liquors; and to take oily Medicines and
+Opiates occasionally, and gentle Laxatives, to keep the Body open;
+which Method of Treatment generally gave Relief. Where the Patients
+were plethoric, or complained of Pain, or the Disorder was attended
+with a Fever, Bleeding was often necessary.
+
+When the Stoppage of Urine seemed to arise from an Inflammation of
+the Kidneys or Bladder, or other Diseases of these Parts, we treated
+it accordingly; and where the Fever was considerable, we made
+Evacuations, and gave plenty of diluting Liquors, and the cooling
+saline Medicines, and afterwards those of the soft, mucilaginous, and
+oily Nature, and mild Diuretics and Opiates.
+
+When the Disorder, in its Progress, became chronical, the Sick were
+commonly sent down to the fixed Hospital, so that we had no
+Opportunity of examining the Bodies of such as might die of this
+Complaint.
+
+
+
+
+OF THE EPILEPSY.
+
+
+The Epilepsy, or Falling Sickness, attacked a Number of Men, from the
+severe Duty of long Marches in hot Weather, and afterwards lying out
+on the cold Ground, exposed to the Damps of the Night[98].
+
+    [98] I saw above twenty Men, while I was in _Germany_, who
+    attributed the Epileptic Fits they were attacked with to
+    these Causes, and said they had never had the Epilepsy
+    before; besides others, who had been formerly subject to
+    these Fits, who declared, that the Disorder was brought back
+    by the same Means.
+
+It was very seldom that Men were cured of this Disorder in the
+military Hospitals. We had some few Instances, indeed, where Relief
+seemed to be obtained by Rest, a regular Diet, gentle Evacuations,
+and Issues[99]; but even those Men generally relapsed as soon as they
+were sent to their Regiments, and began to do Duty. All who had these
+Fits after being some Time with their Regiments, were at last
+discharged, and sent home. However, before Men are discharged for
+Fits, they should be watched very narrowly for some Time; for there is
+no Disorder which Soldiers are more apt to counterfeit than this.
+
+    [99] _William Wilson_, a Boy fourteen Years of Age, was
+    admitted into _St. George_’s Hospital, _Sept._ 20, 1758, for
+    Epileptic Fits, which he had been subject to for some Time,
+    and which generally seized him three or four Times a Week. He
+    took Variety of Medicines without any Effect till the 6th of
+    _November_, when I ordered him to take eight Grains of the
+    _pilulæ fœtidæ_ Morning and Evening, and Physic twice a Week,
+    and a Seton to be made in his Neck. After the Seton began to
+    run, he had but three or four slight Fits in _November_, and
+    none the following Month; and he was discharged the Hospital
+    the 3d of _January_ 1759, seemingly in good Health, with
+    Directions to keep the Seton running at least for some Months
+    after he went home, and to come again to the Hospital if he
+    should have any Return of his Fits; but we never heard more
+    of him.
+
+    _Mary Hacket_, a Girl of nineteen Years of Age, was admitted
+    into _St. George_’s Hospital the 14th of _February_ 1759, for
+    Fits. The Account she gave of her Case, was, that about five
+    Years before she was seized with the first Fit, after a
+    Fright; three Years afterwards she had a second Fit, and for
+    some Time after had a Fit commonly once a Month, about the
+    Time of the full Moon; and since had them more frequently;
+    that the Fits began with a Trembling and Shaking of the right
+    Foot, and she had frequent pricking Pains in the right Thigh,
+    and what she called convulsive Tremors in the right Leg and
+    Foot. She was regular in her menstrual Discharge. At the Time
+    she came into the Hospital, she was feverish, and complained
+    much of a sharp Pain in the right Thigh: She was blooded, and
+    took some cooling Medicine, and had no Fit till the 9th of
+    _March_: She then took the fetid Pills and camphorated Julep
+    twice a Day; but still the Fits returned frequently. She then
+    had the Bark, Valerian and Purging Doses successively, and
+    used the warm Bath; but without any Effect. On the 7th of
+    _May_ a Blister was applied to her right Foot, which was
+    intended to be kept open; but an Inflammation coming on that
+    Leg and Foot, it was suffered to dry up, and an Issue made in
+    the same Leg. From the Time the Blister was applied, she had
+    no Fit while she remained in the Hospital. She was discharged
+    the 15th of _July_, seemingly in good Health; though during
+    that Period she had some little Tremors in her Foot, and was
+    subject to be low and faintish, which was always relieved by
+    cordial anodyne Medicines. After going out of the Hospital,
+    she remained in good Health for seven or eight Months, when I
+    was told her Disease had returned as violent as ever.
+
+It is no Wonder that Soldiers, during the Time of Service, should
+seldom be cured of these Fits; for in Adults it is not often cured
+even in private Practice, with all the Conveniencies and Advantages
+to be wished for; and generally the few that do get well, require a
+considerable Length of Time to accomplish the Cure; and we find from
+daily Experience, as well as from examining the Records of Medicine,
+that the Cures that have been made, have mostly been performed either
+by a Change of Air, such as going from a cold to a hot Climate[100],
+by some remarkable Change of Life[101], or some accidental
+Disorder;[102] or by Issues or Drains[103]; or by the Removal of some
+acrid or irritating Substance, or such like[104]; or by preventing
+the Cause[105]; and that those Medicines called Specifics have in
+general had but little Share in the Cure.
+
+    [100] _Hippocrates_ lays the chief Stress of the Cure upon
+    Change of Air, Aphor. 4, 5, sect. ii. The Baron _Van Swieten_
+    says, he has known a great Number cured by going to the _East
+    Indies_; many of whom have remained well ever after, while
+    others had a Return of the Disorder when they came back to
+    _Holland_. _Comment._ vol. III. p. 436. sect. 1080.
+
+    [101] _Celsus_ has long ago observed, that the Appearance of
+    the Menses in Girls, and of Puberty in Boys, often removes
+    this Disorder, lib. iii. cap. xxiii.--On the 22d of
+    _November_ 1758, _Mary Evans_, a Girl of eighteen Years of
+    Age, was admitted into _St. George_’s Hospital for Fits. She
+    had never had the Menstrua; but, for above two Years, found
+    regularly, once a Month, a Fulness in her Breasts, and had a
+    slight Head Ach, and other Symptoms which generally precede
+    this Discharge; and were succeeded with violent Epileptic
+    Fits, which continued returning frequently for two or three
+    Days, and then went off; and she had no more Symptoms of
+    them, till about the same Time next Month. She was ordered to
+    take ten Grains of the _pilulæ fœtidæ_ Morning and Evening,
+    and a Dose of Physic twice a Week; and as I found that she
+    became plethoric near the Time her Fits used to return, I
+    began to imagine, that both the Fits and Stoppage of the
+    Menstrua were owing to too great a Fullness of the Vessels,
+    which prevented the Heart and vascular System from having
+    such free Play, as to drive the Blood through the extreme
+    uterine Vessels: I therefore ordered seven Ounces of Blood to
+    be taken away from her immediately. In three Days Time the
+    menstrual Discharge began to make its Appearance; and on the
+    10th of _January_ she was discharged the Hospital, seemingly
+    in good Health, after the menstrual Discharge had returned
+    for two regular Periods, without any Appearance of Epileptic
+    Fits. She was desired to come back to the Hospital, if the
+    Fits returned; but I never heard more of her.
+
+    [102] _William Glen_, a Patient in the _Royal Infirmary_ at
+    _Edinburgh_ in _September_ 1747, was freed from Epileptic
+    Fits, which used to return ten or twelve Times a Day, for a
+    Quarter of a Year, by a Diarrhœa coming on; but they
+    afterwards returned.
+
+    _A Man_ subject to the Epilepsy was cured of it by a Quartan
+    Ague, and had afterwards no Return of the Disorder. _Miscell.
+    Curios. Dec. 3. Ann. 3._ p. 34.
+
+    [103] There are numerous Instances of the good Effects of
+    Issues and Drains in diverse Authors. _Tulpius_, _Van
+    Swieten_, &c.
+
+    [104] _La Motte_ gives one Instance of a Person being cured
+    of the Epilepsy by voiding five Stones, _Chirurg._ vol. II.
+    p. 20; and of another who died of the Fits from a triangular
+    Stone remaining in the Kidneys, _ibid._ p. 416. Dr. _Short_
+    cured a Woman of an Epilepsy of twelve Years standing, by
+    extirpating a cartilagenous Substance, about the Bigness of a
+    large Pea, seated on the gastronemei Muscles, above a Nerve
+    which he cut asunder. _Edin. Medic. Essays_, vol. IV. Art.
+    27.
+
+    [105] _Galen_, tells us, of his having prevented the
+    Epileptic Fits in a Boy, who used to have one whenever he was
+    hungry, by making him carry Bread in his Pocket, and eat a
+    little as soon as he found the least Symptoms of Hunger. _De
+    Loc. Affect._ lib. v. cap. vi.--And _Van Swieten_ mentions
+    how he cured a Boy, who had a Fit every full Moon; whose
+    under Lip used to fall a Trembling before it began (a Symptom
+    which, he says, often precedes Vomiting); by giving a Vomit
+    every Month, for six Months successively, three Days before
+    the full Moon, and an Opiate in the Evening after its
+    Operation; and by putting him under a Course of strengthening
+    Medicines. It was observeable, that if he vomited in the Time
+    of the Paroxysm, it was soon at an End. See his _Comment._
+    vol. III. p. 439. sect. 1050.
+
+
+
+
+OF THE SMALL-POX.
+
+
+The Small-Pox appeared at _Paderborn_ in the Spring 1761, and five had
+the distinct Kind, who recovered. Six or seven had them at _Osnabruck_
+in _May_ and _June_, and one Man and a Child died of the confluent
+Kind. Four had the distinct Kind at _Munster_ in _July_ and _August_
+who all did well. During the Winter, we had sixteen in the Hospital I
+attended at _Bremen_; ten had the distinct Kind, and all recovered;
+five had the confluent Kind, of whom two died; as did also one who was
+brought to the Hospital with all the Symptoms of the most malignant
+Kind. Two were sent to _Natzungen_ in _July_, both ill of the
+confluent Kind; the one died two Hours after his Arrival; the other
+recovered: And we had only two in the Hospital at _Osnabruck_ in
+Winter 1762-63, and both did well.
+
+There was nothing particular either in the Course or Treatment of this
+Disorder, different from what we meet with in daily Practice; only as
+the Soldiers, who were attacked with it, were strong, and in full
+Health, they required Bleeding and gentle Evacuations, and a cooling
+Regimen, on the first Appearance of the Symptoms.
+
+The malignant Kind required the Use of Acids, and the Bark; which
+last, could often only be administered by Way of Clyster, as the Sick
+could not swallow it: In short, we treated the Patients much in the
+same Way as in the malignant Fever, Allowance only being made for the
+present Circumstances.
+
+Luckily this Disorder never spread much in the Army, while I was in
+_Germany_.
+
+
+
+
+OF ERISYPILATOUS SWELLINGS.
+
+
+In _January_ 1762, several Patients in the Hospitals I had the Care of
+at _Bremen_, had shining watery Swellings of the Face, or Extremities;
+which came suddenly, and were attended with a slight Degree of
+Inflammation, and watery Blisters rising above the Skin, and some
+Degree of Fever. The Blisters were not small, round, and angry, as in
+_St. Antony_’s Fire; but larger, and of an irregular Figure,
+resembling those raised when People are scalded by boiling Water. The
+Swellings did not pit on being pressed, as the oedematous Swellings
+commonly do: They gave Pain when pressed, but the Inflammation was not
+in that high Degree as it is in the common Phlegmon: The Blood was
+sizy, and the Water of a high Colour. The Disorder seemed to be a
+Species of the Erisypelas.
+
+Between the 9th and 12th of _January_, three Patients were seized with
+such Swellings.
+
+The first was a Dragoon, who had just recovered from a Flux, and a bad
+Cough. On the 9th, he was suddenly seized in the Night with a large
+Swelling of his Face, Hands, and Arms, which had a shining oedematous
+Appearance, with a small Degree of Redness, and was painful when
+pressed; and he had two or three watery Blisters rose on the Back of
+each Hand above the Division of the Fingers, attended with a quick
+full Pulse, a feverish Heat and Thirst, a Cough, and somewhat of a
+Difficulty of Breathing, and high-coloured Water; and he was inclined
+to be costive. He was immediately blooded, had a saline Mixture with
+Contrayerva and Nitre, and was ordered to take a Purge in the Morning.
+Next Day the Blood had thrown up an inflammatory Buff, the Fever was
+abated, and the Breathing easier; but the Cough and Swelling still
+remained. He then took a Julep made of equal Parts of the Saline and
+Sperma Ceti Mixtures, which eased the Cough. The fourth Day the Pulse
+was soft, and the Swellings still in the same Situation, and the
+Breathing a little affected. A large Blister was applied to his Back,
+which discharged plentifully, relieved the Breathing, and lessened the
+Swellings considerably. The Cough and some Degree of Swelling still
+remained; but were removed by the Use of the Sperma Ceti Mixture with
+Oxymel, gentle Opiates, and some Doses of Physic.
+
+The second was a Man of the Twentieth Regiment of Foot, who had been
+some Months in the Hospital for a hectic Complaint; he was taken ill,
+the same Night as the Dragoon, with a Swelling of his whole Face,
+particularly the Lips, which had a shining watery Appearance, and a
+slight Degree of Redness, attended with a strong Fever; and was cured
+by Bleeding, Purging, the Use of the saline Medicines, and the
+Application of a Blister.
+
+The third was an Invalid, who had been admitted for a pleuritic
+Complaint, which he had got the better of. He was attacked, the second
+Night after the other two, with a shineing, watery, reddish Swelling,
+of his right Hand and Arm, up as far as the Joint of the Shoulder;
+four large watery Bladders likewise appeared on the fore Part of his
+Arm, above the Joint of the Elbow. Bleeding, with the cooling
+Medicines, and two Doses of Salts, carried off the Fever, and lessened
+the Swelling, in about seven Days Time; but a little of it, with a
+Stiffness, still remained; which at last was removed by the Use of
+aromatic Fomentations, rubbing with the _linimentum saponaceum_, and
+taking two Doses of Physic.
+
+Within less than a Fortnight, five or six more were seized with
+Swellings of the same Kind on some of the Extremities, and all got
+well by nearly the same Treatment; excepting one Man, who was in a
+very low State, and had a large deep Ulcer on his Hip, where there had
+been a Mortification from his lying on that Part in a Fever. The
+Swelling at first seemed to give Way; but on the third or fourth Day,
+having got a severe Cough, the Swelling increased, and the
+Inflammation began to look livid, and the Discharge from the Sore to
+look bad; and, notwithstanding various Means were used, a
+Mortification of the Part came on, and he died the seventh Day.
+
+
+
+
+OF THE SCURVY.
+
+
+The true Scurvy, attended with spungy fetid Gums of a livid Colour,
+with livid Blotches, and Ulcers of the Legs, and other Symptoms, began
+to shew itself at _Bremen_ in _January_ 1762; tho’ we had not the
+least Appearance of this Disorder in the Hospitals at any other Place,
+while I was with the Troops in _Germany_.
+
+A great Variety of Disorders have been called by the Name of Scurvy:
+and the Disease has been divided into hot and cold; into the Acid, the
+Alcaline; and the Muriatic, according to the different Fancies of
+Authors, and the Causes they imagined it took its Rise from; but, from
+later and more accurate Observations, Dr. _Lind_ has justly remarked,
+that the true Scurvy has been found to be the same in all the
+different Parts of the Globe, and to take its Rise from similar
+Causes; from Cold and Moisture, and living much upon salted
+Provisions, joined to a Want of fresh Vegetables, and of good generous
+fermented Liquors; and hence it is most frequent in low marshy Places
+in northern Climates, where there is a Scarcity of fresh Vegetables;
+and where the Inhabitants live much upon salted Provisions in Winter;
+and aboard of Ships in long Voyages or Cruizes, especially in the
+northern Seas; and hence this Disorder was so frequent at _Quebec_ the
+first Winter it was in our Possession; and in some of the other Forts
+in _North America_, which were taken so late in the Year, that the
+Troops had not sufficient Time to lay in a Stock of Vegetables, and of
+fresh Meat to be preserved by the Frost[106]; but were obliged to live
+mostly on Ship Provisions.
+
+    [106] In _Quebec_, and other northern Parts of _North
+    America_, as soon as the Frost sets in, they kill their Meat
+    intended for their Winter Store, and hang it up: It soon
+    freezes, and will keep in this Manner all through the Winter.
+    They preserve Vegetables in the same Way; and when they
+    intend to make Use of either, they put so much as they want
+    into cold Water for some Time, which draws the Frost out of
+    it; and then they boil or roast it, as they think proper.
+
+It is observed, both at Sea and Land, that where the Scurvy rages,
+those People are least subject to it who are well cloathed; who live
+in dry Habitations, or lie in dry Births; who take proper Exercise,
+without being too much exposed to the Inclemency of the Weather; and
+who live well, and drink good Beer, Cyder, or Wine; as has been
+remarked by Dr. _Pringle_, Dr. _Lind_, and others.
+
+At _Bremen_ the Disorder was only observed among the Soldiers; not one
+of the Gentlemen belonging to the Hospital, or to the Commissariate,
+nor one of the military Officers, not even of the Serjeants, having
+the least Symptom of it. The Reason of its being frequent among the
+Soldiers was, that the Place is situated on a Plain naturally very
+damp; and the Soldiers were quartered in very low damp Houses; at the
+same Time, no Vegetables or Greens were to be bought in the Market;
+and fresh Meat, and other fresh Provisions, were at so high a Price,
+that the Soldiers could not afford to buy them; but were obliged to
+live on salted Meat, and salted Herrings, during the Winter; and what
+little Money they had remaining, they laid out on spirituous Liquors,
+which were sold cheap.
+
+The Cure of this Disorder requires--living in a dry comfortable
+Place--good Cloathing--light Food of easy Digestion, such as good
+Bread, Panado, Milk, Whey, Broths made of fresh Meats--white Meats,
+with Greens, or other Vegetable, &c.--the Use of Liquors of the acid
+or acescent Kind, or the moderate Use of Beer, Cyder, good Wine, or
+weak Punch[107]--And, by Way of Medicine, gentle Purges, mild
+Diaphoretics; the free Use of acid or acescent Fruits, Lemons,
+Oranges, Apples, Pears, Currans, Grapes, &c. and of the antiscorbutic
+Plants and their Juices, as Succory, Endive, Water-Cresses,
+Scurvy-Grass[108], &c. on which a great Part of the Cure principally
+depends; and the Use of some of the strengthening Bitters[109], of
+which the Bark is not the least efficacious.
+
+    [107] The free Use of raw Spirits is found to be very
+    prejudicial; but a moderate Quantity of these Spirits,
+    diluted with Water, and acidulated with Lemons or Oranges (or
+    with Cream of Tartar, or Tamarinds, when the former cannot be
+    got), and made into Punch, is found to be a good
+    Antiscorbutic.
+
+    [108] Most ripe Fruits, particularly Lemons and Oranges, and
+    esculent Herbs, and many Kinds of Roots, such as
+    Horse-Radish, Onions, Leeks, and many others, have been found
+    the most useful Remedies in the Cure of the Scurvy.
+    Decoctions and Infusions of Fir-Tops, of Spruce, and of other
+    Species of the Pine-Tree; and Beer made of these Infusions,
+    by fermenting them with Molasses, are approved
+    Antiscorbutics: and when such Remedies cannot be got,
+    Infusions of the common Bitters, and weak Punch, made with
+    Tamarinds or Cream of Tartar, have proved serviceable; and
+    where these Acids cannot be had, the Mineral Acids may be
+    used for acidulating the Drink. However, it ought always to
+    be remembered, that fresh Vegetables and Fruits, and
+    vegetable Acids, produce much better Effects in the Scurvy,
+    than any other Sorts of Remedies; and ought always to be
+    used, when they can be got.
+
+    [109] Most of the common Bitters have been strongly
+    recommended in this Disorder, Gentian, Trifoil, Wormwood,
+    &c.--as likewise aromatic Bitters and Aromatics; such as
+    _calamus aromaticus_, Carvi Seeds, Winters Bark, Cinnamon,
+    and many others.
+
+Bleeding is seldom requisite, except where there is much Heat or
+Fever; or a sharp Pain of the Side, or Difficulty of Breathing, or
+some Symptom of the like Kind; it is then sometimes necessary to take
+away some Blood: And in obstinate Cases, it is often found of Use to
+promote Sweats, by making the Patient, while in Bed, drink freely of
+warm Whey, or Sack Whey, mixed with the scorbutic Juices; or warm
+Barley Water, or the like, mixed with a small Quantity of the
+Antimonial Wine, or some other mild Diaphoretic.
+
+And where the Patient is strong, and there is no Danger of
+Hæmorrhages, warm aromatic Baths have sometimes been found
+serviceable; but they are not to be used where the Patient is weak.
+
+The first Time I saw this Disorder at _Bremen_, was in an old Invalid,
+_James Long_, who had come from _Bristol_ to _Embden_, and from thence
+to _Bremen_. He was some Weeks in the Hospital before I discovered his
+Disorder to be the Scurvy. He at first complained only of great
+Weakness, and such a Giddiness, when he got out of Bed, that he could
+not walk, and of what he called flying rheumatic Pains of his Legs.
+He had no other visible Complaint; all which, I imagined, proceeded
+from Old-Age, and being worn out in the Service. At last, on the 25th
+of _January_, he complained of his Gums being sore; and, on examining
+him, I found his Breath fetid, his Gums swelled, soft, and spungy, his
+Legs covered with scorbutic Blotches, and other Symptoms, which
+evidently proved his Disorder to be the true Scurvy.
+
+Upon which, I ordered him a low Diet, with the Addition of Greens for
+Dinner, and a Quart of Lemonade, with a Gill of Brandy in it, _per_
+Day, for his common Drink; and, by Way of Medicine, a Decoction of the
+Bark, with the Elixir of Vitriol; and, at the same Time, ordered his
+Gums to be scarified, where they were most swelled and spungy; and to
+be washed frequently with an astringent Gargle; and to be rubbed now
+and then with burnt Alum[110]. By these Means, in a Fortnight’s Time,
+his Gums became firmer, and his scorbutic Symptoms decreased. During
+that Course he took cold, and had a Stitch in his Side, for which he
+was blooded. The Blood threw up a very thin Buff, which was not of a
+firm Consistence[111]; the Crassamentum below was of a blackish
+Colour and of a loose Texture, and the Serum in a large Proportion. By
+the 2d of _March_ his Gums had recovered their natural Firmness and
+Texture, and the scorbutic Spots and Pains of the Legs were gone, and
+he had recovered his Strength; the only remaining Complaint was a
+little Swelling about the Ankles, for which he continued the same
+Course, and took a Dose or two of Physic. By the 16th of _March_ all
+these Symptoms were gone, and he was dismissed the Hospital free from
+all Complaints. I saw him well the last Week in _May_; and he told me,
+he had had no scorbutic Symptom since he left the Hospital.
+
+    [110] Dr. _Lind_, who has wrote one of the best Treatises on
+    this Disorder, and who had a great Deal of Practice himself,
+    says, “When first the Patient complains of an Itching and a
+    Spunginess of the Gums, with loose Teeth, either a Tincture
+    of the Bark in Brandy, or aluminous Medicines, will be found
+    serviceable in putting a Stop to the Beginning Laxity of
+    these Parts.” When the Putrefaction increases, he recommends
+    the Use of some of the mineral Acids. See his _Treatise on
+    the Scurvy_, part ii. chap. v. p. 201.--_Van Swieten_ says,
+    he never found any Thing answer better than a Gargle made of
+    four Ounces of Elder or Rose Water, acidulated with a Drachm
+    of the Spirit of Sea Salt; and where the Gums were very
+    putrid and gangrened, he has been obliged to touch them
+    slightly with the pure Acid Spirit, and some Hours after to
+    have them washed with the Gargle just mentioned. Vide
+    _Comment._ vol. III. p. 629, sect. 1163.
+
+    If the Spunginess of the Gums sprout out into a luxuriant
+    Fungus, it is sometimes requisite to cut such Funguses away,
+    and to wash the Sores frequently with gentle astringent or
+    acid Liquors.
+
+    [111] Dr. _Huxham_ observes, that, after the Disease has
+    continued some Time, the Blood appears a mere Gore as it
+    were, not separating into Serum and Crassamentum as usual,
+    but remaining an uniform half-coagulated Mass, generally of a
+    more livid or darker Colour than common; though sometimes it
+    continues long very florid; but it always putrifies soon. See
+    his _Essay on Fevers_, chap. v.
+
+    There is something very particular in the Nature of this
+    Disorder, according to an Observation of Dr. _Lind_’s; who
+    says, “That the Scurvy is a Disease in its Nature very
+    opposite to that of a Fever; insomuch, that even an Infection
+    is long resisted by a scorbutic Habit; and those of a
+    scorbutic Habit being seized with the Fever, was a Proof of
+    its proceeding entirely from Infection.” See his _First Paper
+    on Fevers_, p. 4.
+
+In the Beginning of _February_, another of the Invalids, who had been
+in the Hospital for a Fever and rheumatic Complaints, had Blotches
+appear on his Legs, complained of great Weakness, and fainted away in
+attempting to walk; which made me suspect his Disorder to be the
+Scurvy; and, on examining him, I found his Gums soft and spongy,
+attended with the other Symptoms of the true Scurvy. I put him nearly
+on the same Course as in the last-mentioned Case: He used a low Diet,
+with the Addition of Greens for Dinner, which he eat with a little
+Butter and Vinegar; and he had a Quart of Lemonade, with two Ounces of
+Brandy, for his common Drink during the Day; and, by Way of Medicine,
+a Decoction of the Bark, with two Drachms of the _confectio cordiaca_
+to each Half Pint, which he took by Spoonfuls. Next Day he complained
+of a Pain in his Leg; and, on examining it more particularly, I found
+a large livid Blotch, yellow all round the Edges, on the fore Part,
+and a Tension all over that Leg. As he was so extremely low, as to be
+in Danger of fainting whenever he sat up, I was afraid lest a
+Mortification should ensue; and therefore ordered his Leg to be bathed
+Morning and Evening with a warm aromatic Fomentation, and a Poultice
+of Theriaca to be applied after it; and desired him to take as much of
+the Decoction of the Bark with the Cordial as possible; and allowed
+him a Glass of Mountain Wine every two or three Hours. By the
+Continuance of this Course for some Weeks, the livid Blotches, Pain,
+and Stiffness of his Leg, and most of the other scorbutic Symptoms,
+went away; his Gums were restored to their natural Firmness; and he
+recovered his Strength so much as to be able to sit up all Day long;
+though he still remained very weak when he was sent to _England_, in
+_March_.
+
+In _February_ and _March_, seven or eight more scorbutic Patients were
+sent to the Hospital I attended, who were all treated in the same
+Manner; and all did well. About the Middle of _February_ this
+Distemper began to shew itself in the other Hospital attended by Dr.
+_Miller_, who treated the Patients nearly in the same Way, and they
+all recovered.
+
+On the 5th of _April_, a young Man, belonging to the Eighth Regiment
+of Foot, came to the Hospital with all the Symptoms of the true
+Scurvy; his Gums were spungy and fœtid; he had livid Blotches on his
+Legs, and Contractions of the Hams, and a Stiffness and Hardness in
+the Calves of both Legs[112]. By following the same Course as the
+others, and the Use of frequent Fomentations, and rubbing the
+contracted Parts with soft Liniments, he mended daily; and, after
+taking a Dose or two of Physic, was dismissed perfectly recovered on
+the 10th of _May_. At his first Admission into the Hospital, he was
+taken with a severe Cough, attended with Pain of the Breast, and a
+Spitting of Blood for a Day or two, for which he was blooded. His
+Blood threw up a little Buff; the Crassamentum was of a blackish
+Colour and of a loose Texture, with a good Proportion of a yellowish
+Serum. This Bleeding relieved the Complaints of his Breast, and he had
+no Return of them while he remained in the Hospital.
+
+    [112] If the Swellings become large, stiff, and painful, Dr.
+    _Lind_ recommends that the Legs should be frequently bathed
+    and fomented; or, what he has found preferable, to be exposed
+    to their Steams, after being well covered with Blankets.
+    After this Operation, he advises the Limb to be rubbed with
+    some mild Oil, such as _oleum palmæ_, or Salad Oil; and if
+    the Swellings resist both the general Cure and these
+    Applications, the Limbs to be sweated with Spirits. See his
+    _Treatise on the Scurvy_, part ii, chap. v.
+
+The first Week in _May_ four Invalids were admitted into the Hospital
+for this Disorder. The first had spungy Gums, a fœtid Breath, his Legs
+swelled and hard, and of a deep purple Colour. The second was a Case
+at first of a more doubtful Kind; there were no spungy Gums, though an
+offensive Breath; his Ancles and Feet were swelled, attended with Pain
+and Uneasiness, and a great Weakness and Lassitude; but no Fever, nor
+any livid Blotches. The Swelling of the Feet and Ancles seemed at
+first Sight rather gouty or rheumatic, than of the scorbutic Kind; but
+from the Man’s Way of Life, and the Disorder being so frequent, we
+discovered it to be the Scurvy. The third had a very fœtid Breath and
+spungy Gums, livid Spots and fungous Ulcers[113] on his Legs, with
+Pains and Weakness all over. The fourth had also spungy Gums and a
+fœtid Breath, Pains of the Legs and Arms, livid Blotches on his Legs,
+great Hardness and Contraction of the right Ham, and a livid hard
+Swelling on the Outside of the left Thigh, immediately above the Knee.
+
+    [113] “Ulcers on the Legs, or any other Part of the Body,
+    require pretty much the same Treatment, _viz._ very gentle
+    Compression, in order to keep under the Fungus, and such
+    antiseptic Applications as have been recommended for putrid
+    Gums, _viz. mel rosat._ acidulated with _spiritus vitrioli_,
+    _ung. Ægiptiacum_, &c. but nothing will avail where the
+    Patient cannot have Vegetables and Fruits.” _Dr. Lind’s
+    Treatise on Scurvy_, part ii. chap. v. p. 204. And he
+    recommends, if the Swellings and Ulcers of the Legs neither
+    yield to the general Cure nor to the Methods here proposed,
+    that a slow and gentle Course of Mercury should be tried,
+    after the scorbutic Taint is a good deal removed, and the
+    Gums are sufficiently firm; and to give along with it a
+    Decoction of the Woods, or of Sarsaparilla; but this Method
+    ought not to be attempted till the Gums have acquired a
+    proper Firmness. See _ibid._ part ii. chap. v.
+
+We treated them all four in the Method above-mentioned, adding a Mess
+of Greens to Dinner, giving Lemonade for Drink, and the Bark, with
+Elixir of Vitriol, by Way of Medicine. The Parts that were hard and
+swelled, were fomented, and rubbed with soft Liniments, and Poultices
+were applied to the hard Swelling on the Outside of the left Thigh;
+and the Ulcers of the Legs dressed with Digestives, and occasionally
+washed with spirituous Tinctures, and touched with Escharotics. Before
+I left _Bremen_, the first Week in _June_, the first and second
+Patients were perfectly recovered, and the third and fourth almost
+well. All of them had had the Disorder some Months before they came to
+the Hospital.
+
+
+
+
+OF THE ITCH.
+
+
+There was no Disorder so common in the military Hospitals as the Itch.
+It is of an infectious Nature, and now most commonly believed to be
+entirely owing to little Insects lodged in the Skin, which many
+Authors affirm they have seen in the Pustules by the Help of a
+Microscope; and that the Disorder is entirely communicated by
+Infection, and does not arise from any Fault in the Fluids or Solids.
+
+It has been found by Experience, that internal Medicines have little
+or no Effect in removing this Disorder; and that only external
+Remedies, which come immediately in contact with the Parts affected,
+are capable of making a Cure; which has been brought as a farther
+Proof, that the Itch is owing to Animalcules or Insects; as it is
+alledged, that no Remedies will cure the Distemper, but such as are
+capable of killing them.
+
+The Medicines, which are most commonly used for the Cure, are
+_Mercury_, _White Helebore_, and _Sulphur_.
+
+Mercurial Frictions on the Part are often made use of, and sometimes
+with Success, though they are by no Means to be depended upon for a
+Cure; besides that, they are liable to throw the Patients into a
+Salivation, as I have seen happen more than once; for which Reasons I
+would never recommend this Method where the Patient labours under no
+other Disorder which requires the Use of Mercury, and would confine it
+entirely to Cases where Patients, having the Itch, labour, at the same
+Time, under the _Lues venerea_, and require the free Use of mercurial
+Frictions; under such Circumstances the mercurial Ointment may be as
+well rubbed on the Parts affected with the Itch as upon any other.
+
+The Powder of the Root of _White Helebore_, made up into an Ointment
+with Hogs Lard, or a strong Decoction of it in Water, rubbed on the
+Parts, will often cure the Itch; but it is a sharp Medicine, and
+generally smarts, and sometimes inflames the Parts on which it is
+rubbed; and therefore it is not so commonly used, as we know a much
+surer and milder Remedy. Though I have cured some People with the
+Helebore Lotion without any Inconvenience, who would not use the
+Sulphur on Account of its Smell.
+
+_Sulphur_ is the most certain and easy Cure for the Itch of any we
+know, and perhaps is more certain in the Cure of this Disorder than
+almost any other Medicine in any other Disorder whatever. We used it
+in Form of the Sulphur Ointment of the _London Dispensatory_, of which
+one, two, or more Drachms were rubbed in every Night, in Proportion to
+the Extent of the Parts affected. These Unctions were continued from
+four or five to ten or twelve Nights, according to the Violence and
+Continuance of the Disorder. Most were cured in a few Days; others
+required a longer Time. As the sulphureous Unctions tend to obstruct
+the Perspiration, we generally ordered a Purge to be given before
+rubbing the Sulphur Ointment, and in full Habits sometimes ordered a
+little Blood to be taken away; and put them all under a low Diet.
+After the Disorder seemed to be removed, they took another Dose or two
+of Physic to carry off any Impurities that might have been thrown upon
+the Bowels, during the Use of the Sulphur Ointment. In inveterate
+Cases, the Sulphur was given internally at the same Time that the
+Patient rubbed with the Ointment.
+
+It is generally believed (though denied by some) that Sulphur, taken
+internally, enters the Blood; and its Steams are thrown off by the
+perspiratory Vessels, and assists more effectually to destroy the
+Insects and their Ovula, which give Rise to the Itch; but whether this
+Effect be true or not, I found it to answer another very good Purpose;
+which was to keep the Belly rather loose, while the Patient used the
+Unction; and by this Way it carried off those Humours, which ought to
+have passed off by the Skin; and for that Reason, when it had not that
+Effect, we joined some Lenitive Electuary to it.
+
+There is one Thing to be observed with regard to sulphureous Unctions,
+which is, that we ought not to use them too soon with People
+recovering out of Fevers, or other Disorders which bring them low;
+otherwise there will be Danger of bringing on a Relapse, which I have
+often observed to happen in military Hospitals, where the Itch has
+appeared as the Patients were recovering from Fevers and other
+Disorders, and the Unctions were used too soon: But whether these
+Relapses were owing to the sulphureous Unction’s stopping up the Pores
+of the Skin, and obstructing a free Perspiration, or to the Patient’s
+being more apt to take Cold while they used the Sulphur Ointment, than
+at any other Time, is what I cannot determine; but to me it seems most
+probable, that these Unctions rather obstruct the Perspiration; and
+that when they are used too soon with People recovering from Fevers,
+especially those of the putrid Kind, they prevent those Particles
+from passing off by the Skin, which it was necessary should be
+evacuated, in order to free the Body from the Seeds of the Fever, or
+other Disorders the Patients laboured under. But however this be,
+Experience has shewn, that we ought not to attempt the Cure of the
+Itch, in Patients so circumstanced, till their Strength be in a great
+Measure re-established, otherwise there will be Danger of a Relapse;
+and likewise, that Patients using Sulphur externally, ought to be
+particularly on their Guard against Cold.
+
+This Observation of Peoples being so apt to relapse after Fevers by
+the too early Use of sulphureous Unction, is a strong Proof of the
+Usefulness of keeping the Body open during the Time of Rubbing and of
+Purging the Patient afterwards; as by these Means we may carry off by
+the Bowels those Particles which could not pass by the Skin; and I
+think, so far as I have been able to observe, those People have been
+less subject to relapse into Fevers where this Caution has been used,
+than where it has been neglected.
+
+That Species of the Itch where it forms small Ulcers or Pustules in
+the Skin, is the worst Kind, and most contagious, and seems to take
+its Rise from the common Itch continuing long, and making its Way
+deeper into the Skin. The Cure is the same, only this requires more
+frequent Unctions, and those to be continued longer, than before the
+Disorder has taken such deep Root.
+
+It is no uncommon Thing to see the Itch appear again, some Weeks after
+it has seemingly been cured by the Use of sulphureous Unctions; which
+most commonly happened to those who were in too great a Hurry to get
+well, and left off the Use of the Unctions too soon. Such Returns of
+the Itch were generally cured by the Repetition of the same Treatment
+as before.
+
+
+
+
+TABLE of DIET.
+
+
+The following is a Copy of the Table of Diet which was used in the
+Hospital all the Time I was with the Troops in _Germany_:
+
+                     _Breakfast._     |   _Dinner._      |   _Supper._
+                                      |                  |
+               One Pint of Rice       |                  |
+               Gruel; made with two   |                  |
+               Ounces of Rice, one    |                  |
+  Full Diet,   Spoonful of fine       | One Pound of     | As Breakfast.
+               Flower, a little       | Meat.            |
+               common Salt, and fine  |                  |
+               Sugar.                 |                  |
+  ______________________________________________________________________
+                                      | One Pint of      |
+  Middle Diet, As above.              | Broth, Half a    | As above.
+                                      | Pound of Meat.   |
+  ______________________________________________________________________
+                                      | One Pint of      |
+                                      | Broth; or Half   |
+               As above, or           | a Pint of        |
+               according to           | Panado, with two |
+  Low Diet,    the Patient’s          | Spoonfuls of     | As Breakfast.
+               Stomach or             | Wine, and a      |
+               Indisposition.         | Quarter of an    |
+                                      | Ounce of fine    |
+                                      | Sugar.           |
+
+The daily Allowance of Bread was a Pound to those on full and middle
+Diet, and Half a Pound to those on low Diet, or a Pound, if so ordered
+by the Physician.
+
+Those on full and middle Diet were allowed daily three Pints of Barley
+or Rice Water; to each Pint of which were added two Spoonfuls of
+Brandy, and a Quarter of an Ounce of Lump Sugar. Small Beer was
+mentioned in the Diet Table; but this we could never have good; and
+therefore was not used.
+
+Those on low Diet were allowed Barley or Rice Water; to which some
+Wine or Brandy was occasionally added, if ordered so by the Physician.
+
+Besides this, the Physician might order an additional Quantity of
+Wine, Brandy, or Milk, or Water Gruel, or any other Articles which he
+thought proper for the Sick under his Care, and which could be got
+easily.
+
+
+
+
+PHARMACOPŒIA IN USUM
+
+Nosocomii Regii Militaris Britanici.
+
+MDCCLXI.
+
+
+
+
+PHARMACOPŒIA IN USUM
+
+Nosocomii Regii Militaris.
+
+Ann. MDCCLXI.
+
+
+AQUÆ SIMPLICES ET SPIRITUOSÆ.
+
+    AQUA Alexeteria.
+    ---- Bacc. Juniperi.
+    ---- Cinnamomi.
+    ---- Menthæ vulgaris.
+    ---- Menthæ piperitidis.
+    ---- Nucis moschatæ.
+    ---- Pulegii.
+    ---- Rutæ.
+
+    Vel aliæ aquæ hujus generis præparari possint, terendo in
+    mortario vitreo elaeosacchara præparata, cum oleis
+    essentialibus, et sacchari albi 12la quantitate; et dein
+    addendo aquæ fontanæ vel spiritus vini tenuis quantitatem
+    sufficientem[114].
+
+    [114] Such _Elaeosacchara_ (as they are called), made by
+    rubbing the essential Oils with twelve Times the Quantity of
+    Sugar, may at all Times be prepared at the fixed Hospital,
+    and carried about with the flying Hospital, much more
+    conveniently than the simple or compound Waters themselves.
+
+Aqua calcis simp. Ph. Lond.
+
+    Dosis a lib. i. ad lib. ij. in die.
+
+Aqua Hordeata. Ph. Lond.
+
+    Utenda pro potu.
+
+
+BOLUS.
+
+Bolus anodynus astringens.
+
+    ℞ Theriacæ andromachi, drachm. dimid. opii, gr. i. M. pro
+    dosi semel vel bis die.
+
+Bolus e rheo cum mercurio.
+
+    ℞ Pulv. rhei, gr. xxv. calomel, gr. v. syrup sacchari, q. s.
+
+Bolus e calomel.
+
+    ℞ Calomel gr. v. conserv. rosar. scrup. i. M.
+
+Bolus mercurialis.
+
+    ℞ Argenti vivi, gr. x. extingue in balsam copaivi, q. s. et
+    adde conserv. rosar. q. s.
+
+Bolus e scordio cum rheo.
+
+    ℞ Elect. e scordio, scrup. i. pulv. Rhei, gr. x. syrup, q. s.
+    ut fiat bolus sumendus semel, bis, terve die.
+
+
+COLLYRIA.
+
+Collyrium saturninum.
+
+    ℞ Sacchari saturni, salis ammoniaci crudi ana gr. vi. solve
+    in aq. fontanæ, unc. xij. adde pro re nata tinct. thebaicæ,
+    drachm. i.
+
+Collyrium vitriolicum.
+
+    ℞ Vitrioli albi, drachm. ss. solve in aq. fontanæ, lib. i.
+
+Confectio cardiaca. Ph. Lond.
+
+Conserva cynosbat. Ph. Lond.
+
+Conserva rosar. Ph. Lond.
+
+
+DECOCTA.
+
+Decoctum album. Ph. Lond. utendum pro potu.
+
+Decoctum arabicum.
+
+    ℞ Gum. arabici, unc. dimid. coque in aq. hordeatæ bullientis,
+    lib. ij. ad solutionem Gummi. utend. pro potu.--addi possit
+    pro re nata spirit. nitri dulcis, drachm. ij.
+
+Dococtum corticis Peruviani.
+
+    ℞ Cort. Peruv. crass. pulv. unc. i. coque in aq. fontan. lib.
+    iij. ad lib. ij. Colaturæ adde tinct. cort. Peruv. unc. i.
+    spirit vini Gallici sescunc. Dosis ab uncia i. ad unc. iv.
+    bis ter. quaterve die.
+
+Decoctum cort. cum serpentaria.
+
+    Fit addendo decocto cort. Peruv. sub sinem coctionis, rad.
+    serpentariæ virgin. contus. unc. dimid. Dosis ab unc. i. ad
+    unc. iij. ter quaterve die.
+
+Decoct. commun. pro clyster.
+
+    ℞ Flor. vel herb. chamæmel. unc. i. coque in aq. fontan. lib.
+    i.ss. ad lib. i. & cola.
+
+Decoctum ligni guaiaci.
+
+    ℞ Ligni guaiaci ras. lib. ss. aq. fontanæ bullientis, cong.
+    ij. macera per noctem; mane coque ad congium. i. & cola;
+    Capiat a lib. ss. ad lib. ij. die.
+
+Decoctum nitrosum.
+
+    ℞ Coccinel. scrupul. i. coque in aq. fontan. lib. ijss. ad
+    lib. ij. & dein adde salis nitri, unc. i. sacchar. albi
+    sescunc. Colaturæ addi possit pro re nata aq. alicujus
+    spirit. unc. ij. Dosis ab unc. i. ad unc. iv. 4tis vel 6tis
+    horis.
+
+Decoctum pectorale.
+
+    ℞ Fol. herb. malvæ, unc. ij. feminum lini, unc. dimid. coque
+    in aq. fontan. lib. ivss. ad lib. iv. addendo sub finem
+    coctionis rad glycyrrhiz sescunc. vel mellis optimi, unc. i.
+    Cola pro potu.--Adde pro re nata aceti, sescunc.
+
+Decoctum rad. sarsaparillæ.
+
+    ℞ Rad. sarsaparillæ, unc. iij. coque in aq. fontan. lib. iij.
+    ad lib. ij. adde sub finem coctionis ligni sasafras, drachm.
+    i. rad. glycyrrhizæ, drachm. ij. Colaturæ capiat a lib. i.
+    ad lib. ij. in die.--Adde pro re nata vini antimonialis,
+    drachm. ij.
+
+
+ELECTARIA.
+
+Elect. astringens balsamicum.
+
+    ℞ Specier. e scordio, pulv. e tragacanth. comp. ana unc. i.
+    tincturæ thebaicæ, drachm. ij. syrup sacchari, q. s. ut fiat
+    elect. Dosis ad molem N. M. bis, ter. quaterve in die.
+
+Elect. corticis Peruviani.
+
+    ℞ Pulv. cort. Peruv. unc. iv. syrup sacchari, q. s. Dosis a
+    scrup. i. ad drachm. unam, bis, ter, 4r. 6ties. vel decies
+    die.
+
+Elect. corticis anodynum.
+
+    ℞ Elect. cort. Peruv. unc. 1nam. elect. e scordio unciam
+    dimidiam, vel tinct. thebaicæ scrup. ij.
+
+Elect. corticis astringens.
+
+    ℞ Elect. cort. Peruv. semunc. pulv. rad. tormentil, lapidis
+    cancror. ppt. singulorum, drachm. i. syrup, q. s.
+
+Elect. cort. cum serpentaria.
+
+    ℞ Elect. cort. Peruv. unc. i. pulv. rad. serpentar. virgin.
+    cort. canel. alb. ana, drachm ij. syrup. q. s.
+
+Elect. cort. cum sale ammoniac.
+
+    ℞ Elect. cort. Peruv. sescunciam. sal. ammon. crud. drachm. i.
+
+Elect. e baccis lauri. Ph. Lond.
+
+Elect. lenitiv. Ph. Lond.
+
+Elect. lenitivum cum sulphure.
+
+    ℞ Elect. lenitiv. lib. ss. flor. sulphuris, unc. ij. Dosis,
+    moles, N. M. vel ad semunc. pro re nata.
+
+Elect. lenitivum compositum.
+
+    ℞ Elect. lenitiv. lib. i. pulv. jalap. unc. i. sal. nitri,
+    drachm. ij. syrup. q. s. Dosis a drach. i. ad drach. iv. pro
+    r. n.
+
+Elect. lenitivum balsamicum.
+
+    ℞ Elect. lenitiv. comp. unc. ij. bals. copaiv. unc. i. gum
+    guaiac. unc. ss. M. Dosis, cochleare theæ, h. s. vel mane &
+    vesperi.
+
+Electuar. e scordio vel diascordium. Ph. Lond.
+
+Elect. e spermat. ceti.
+
+    ℞ Balsam Peruv. unc. im. misce optime cum mucilag. gum arab.
+    sescunciam & adde spermat. ceti, conserv. rosar. ana unc.
+    xij. syrup sacchar. q. s. dosis, a dimidiâ drachma bis die ad
+    drachm. im. quater vel sexties die.
+
+Elect. stomachicum.
+
+    ℞ Conserv. cynosbat. unc. iv. pulv. rad. zinziber. drachm.
+    ij. canell. alb. unc. i. rubigin. martis, drachm. ij. syrup.
+    q. s. dosis a scrup. i. bis terve die ad semidrach. 4tis
+    horis.
+
+Elect. e scammon. Ph. Lond.
+
+
+ELIXIR.
+
+Elix. aloes. Ph. Lond.
+
+Elix. paregoricum. Ph. Lond.
+
+Elix. vitrioli acid. Ph. Lond.
+
+
+ENEMATA.
+
+Enema commune laxativ.
+
+    ℞ Aq. fontan. calid. unc. xij. elect. lenitiv. semunc. sal.
+    cathartici amari, unc. i. M.
+
+Enema commun. oleos.
+
+    ℞ Aq. fontan. bullient. unc. x. mucilag. gum arabic. unc. im.
+    olei olivar. unc. ij. adde pro re nata elect. e scord.
+    drachm. ij. vel. tinct. thebaic. drachm. i.
+
+Enema ex amylo.
+
+    ℞ Aq. fontan. calid. unc. iv. gelatin. amyli, unc. v. elect.
+    e scord. drachm. i. M.
+
+Enema terebinth.
+
+    ℞ Terebinth commun. drachm. vi. solve in vitello ovi & adde
+    enemat. oleos. unc. x.
+
+Emplastrum vesicatorium. Ph. Lond.
+
+
+FOTUS.
+
+Fotus communis.
+
+    ℞ Fol. malv. flor. chamæmel. singulorum, m. i. coque in aq.
+    fontan. q. s.
+
+Fotus commun. spirit.
+
+    ℞ Fotus commun. lib. ij. aceti, lib. i. spirit. vini tenuis,
+    lib. ss. M. pro fotu.
+
+Fotus cum sale ammoniac.
+
+    ℞ Fotus commun. lib. ij. sal ammoniac crud. unc. i.
+
+Fotus volatilis.
+
+    ℞ Fotus commun. q. s. asperge panno statim ante applicationem
+    spiritus sal. ammoniac, q. s.
+
+
+GARGARISMATA.
+
+Gargarisma commune.
+
+    ℞ Aq. hordeat. unc. xij. sal. nitri, drachm. i. mellis
+    semunc. M. adde pro re nata spirit. vin. unciam i.
+
+Gargarisma acidum.
+
+    ℞ Aq. hordeat. unc. xij. spirit. vini gallici, unc. i. aceti
+    sescunc. tinct. myrrhæ, drachm. ij. M.
+
+Gargarisma volatile.
+
+    ℞ Aq. hordeat. unc. xij. spirit. vin gallic. unc. ij. sal.
+    vol. ammoniaci, drachm. i. M.
+
+
+GUTTÆ ANTIMONIALES ANODYNÆ.
+
+    ℞ Vini antimonialis, unc. im tinct. thebaic. drachm. ij.
+    dosis a gutt. 30 ad 40 bis terve die, vel a gutt. 60 ad 140,
+    h. s. in potu tepido.
+
+
+HAUSTUS.
+
+Haustus simplex.
+
+    ℞ Aq. fontan. sescunc. spirit. vini gallici drachm. i. ss.
+    sacchar alb. drachm. dimidiam M.--Haustus præparari possit
+    aqua aliqua simp. et spirit. loco aq fontan. & spirit. vini
+    gallici pro re nata.
+
+Haustus anodynus.
+
+    ℞ Haust. simp. sescunc. tinct. thebaic. gutt. xx. M.
+
+Haustus camphoratus.
+
+    ℞ Camphoræ, gr. iij. tere in mortario cum sacchar. alb.
+    drach. dimid. & dein adde mucilag. gum arabici, drachm. ij.
+    haust. simp. sescunciam. M. s. a. Dosis repetenda, 4ta vel
+    6ta. quaque hora.
+
+Haust. emetic. antimonialis.
+
+    ℞ Vini antimonialis semunciam. Dari possit ad drachm. x. pro r. n.
+
+Haust. emeticus scilliticus.
+
+    ℞ Oxymel. scillit. drachm. x. aq. fontan. semunc. pulv. rad.
+    ipecacoan. gr. vi.
+
+Haustus cardiacus.
+
+    ℞ Haust. simp. sescunciam confect. cardiac. scrup. im. M. f.
+    haustus repetendus 4tis. vel 6tis. horis--adde pro re nata
+    sp. lavend. comp. dr. i.
+
+Haustus cardiacus oleosus.
+
+    ℞ Ol. essential. menth. gutt. ij. tere in mortario vitreo cum
+    sacchar. alb. drachm. dimid. & adde haust. simplicis sescunc.
+    tinct. stomachic. drachm. i. M.--adde pro re nata tinctur.
+    thebaic. gutt. x.
+
+Haustus lixiviosus anodynus.
+
+    ℞ Haust. simp. sescunciam, lixivii tartari, drachmam dimidiam
+    tincturæ thebaicæ, gutt. xx. cap. h. s. vel mane & vesperi.
+
+Haustus e mithridatio.
+
+    ℞ Haust. simp. sescunc. mithridat. scrup. i. aceti vin.
+    drachm. iij. dosis repetenda 4tis. vel 6tis. horis.
+
+Haustus oleosus communis.
+
+    ℞ Mucilagin. gum arabici, drachm, iv. ol. olivar, drachm. v.
+    misce s. a. & adde haust. simp. sescunciam. Repet. 4tis. vel
+    6tis. horis.
+
+Haustus oleosus cum rheo.
+
+    ℞ Haust. oleos. communis, unc. ij. tinct. rhei sescunc. vel
+    pulv. rhei, gr. xxv. tinct. thebaic. gutt. xv. M. fiat
+    haustus sumendus vel h. s. vel primo mane.
+
+Haustus purgans.
+
+    ℞ Infus. senæ. unc. iij. sal. glauber. drachm. iij. spirit.
+    vin. gallici, drachm. ij. sacchar. alb. drachm. dimid. capiat mane.
+
+Haustus salinus communis.
+
+    ℞ Aceti vinosi vel succ. limonum semunciam, sal. absynth.
+    scrup. i. vel ad saturationem, haust. simp. sescunciam adde
+    pro re nata pulv. contrayerv. comp. scrup. i. vel pulv.
+    contrayerv. cum nitro, scrup. ij.--Haustus præparari possit
+    cum salis diuretici drachma dimid. loco acidi & salis
+    absynthii. Dosis repetend. 3tiis. 4tis. vel 6tis.
+    horis--Eodem modo sit haustus cum spirit. mindereri uncia
+    dimidiâ.
+
+Haust. salin. cum confect. cardiaca.
+
+    ℞ Haust. salin. commun. unc. ij. confect. cardiac. scrup. i.
+    M. repet. 4tis. vel 6tis. horis.
+
+Haust. salin. cum mithridatio.
+
+    ℞ Haust. salin. commun. unc. ij. mithridatii, scrup. i. M.
+    sumend. 4tis. vel 6tis. horis.
+
+Haustus salin. cum rheo.
+
+    ℞ Haust. salin. com. uncias ij. pulv. rhei, gr. xxv. M.
+    capiat mane.
+
+Haustus salin. cum phu.
+
+    ℞ Haust. salin. commun. unc. ij. pulv. rad. valerian.
+    sylvestris, scrup. ij. Dosis repetend. 2dis. 4tis. vel 6tis.
+    horis.
+
+Haust. salinus succinatus.
+
+    ℞ Haust. salin. commun. unc. ij. sal succini, pulv. castorei
+    singulorum, gr. x. H. repetend. 4tis. vel 6tis. horis.
+
+Haust. salinus purg. oleosus.
+
+    ℞ Mannæ opt. semunc. olei olivar. drachm. vi. vitelli ovi q.
+    s. tere in mortario, addendo paulatim sal cathartici amari,
+    unc. i. solutam in aq. fontan. calid. unc. iij. spirit. vini
+    gallici vel aq. alicujus spirituosæ, drachm. iij. M. s. a pro
+    dosi matutino.
+
+Haustus volatilis.
+
+    ℞ Haust. simp. sescunciam sal. vol. c. cervi, gr. x. M. H.
+    repet. 4tis. vel 6tis. horis.
+
+
+INFUSA.
+
+    Infusum amarum. Ph. Lond. Addi possit pro re nata in
+    præparando spirit. vini tenuis, lib. ss. ad lib. ij. infusi.
+    Dosis ab unc. ina. bis die ad unc. ij. ter. die.
+
+Infusum raphani rusticani.
+
+    ℞ Rad. raphani rusticani, unc. ij. baccar. juniper, unc.
+    inam. cort. canell. alb. drachm. ij. aq. fontan. bullient,
+    lib. iv. infunde per noctem leni calore. Colaturæ adde
+    spirit. vini gallici unc. iv. Dosis ab. unc. i. bis terve die
+    ad unc. iv. 6tis. horis.
+
+Infusum senæ commun. Ph. Lond.
+
+
+JULEPUM E MOSCHO.
+
+    ℞ Mosch. drachmam im. tere optime in mortario cum sacchar.
+    alb. drachm. iij. & adde mucilagin. gum arab. dr. iv. Haust.
+    simp. unc. vi. Dosis unc. ij. 4tis. vel 6tis. horis.
+
+
+LINCTUS.
+
+    ℞ Conserv. cynosbat. unc. iv. ol. olivar. syrup. sacchari vel
+    mellis ana unc. ij. adde pro re nata spirit. vitrioli tenuis,
+    drachm. iv. Dosis cochleare theæ urgente tussi.
+
+
+LINIMENTA.
+
+Liniment. saponaceum. Ph. Lond.
+
+Linimentum camphoratum.
+
+    ℞ Olei olivar. unc. ij. camphoræ, drachm. ij. M.
+
+Linimentum volatile. Ph. Lond.
+
+Linimentum volatile commune.
+
+    ℞ Olei olivar. unc. iij. spiritus salis ammoniaci, dr. vi. M.
+
+
+MELLA.
+
+Mel cum borace.
+
+    ℞ Mellis optimi, unc. i. pulv. subtilissim. boracis, dr. i. M.
+
+Mel Ægyptiacum. Ph. Lond.
+
+Mel rosaceum. Ph. Lond.
+
+MITHRIDATIUM. Ph. Lond.
+
+
+MIXTURÆ.
+
+Mixtura acida communis.
+
+    ℞ Haust. simp. unc: viij. spirit. vitrioli tenuis, scrup. ij.
+    vel ad gratam aciditatem. Dosis ab. unc. ij. ad unc iv. 4tis.
+    vel 6tis. horis.
+
+Mixtura ammoniaca.
+
+    ℞ Gum ammoniaci, drachm. i. solve in haust. simp. unc. vi.
+    Dosis ab. unc. i. ad unc. ij. bis terve in die.
+
+Mixtura ammon. cum oxymel.
+
+    ℞ Mixt. ammoniac. unc. vi. oxymel scillit. drachm. vi. Dosis
+    a cochlear. i. ad unc. ii. ter. 4rve. die.
+
+Mixtura ammoniac. anodyna.
+
+    ℞ Mixt. ammoniac. cum oxymel. unc. vi. tinct. thebaic.
+    drachm. dimid. Dosis a cochlear. i. ad iv. 4tis. vel 6tis.
+    horis.
+
+Mixtura Campechensis.
+
+    ℞ Extract. ligni Campechensis, drachm. iij. solve in haust.
+    simplic. unc. vi. adde pro re nata tinct. thebaic. gutt. xxx.
+    vel Philon. Londinen. drachm. i. Dosis ab. unc. i. ad unc.
+    iij. bis, ter, 4rve. die.
+
+Mixtura fætida.
+
+    ℞ G. asafætid. drachm. i. solve in haust. simp. unc. vi.
+    Dosis ab. unc. i. ad unc. iij. 4r. die.
+
+Mixtura fætida volatilis.
+
+    ℞ Mixt. fætid. unc. vi. spirit. volat. sal. ammon. drachm. i.
+    Dosis ab. unc. i. ad unc. ij. bis, ter, 4rve. die.
+
+Mixtura fracastorii.
+
+    ℞ Haust. simp. unc. viij. Elect. e scordio, drachm. iv. Dosis
+    ab. unc. i. ad unc. ij. 4tis. vel 6tis. horis.
+
+Mixtura japonica.
+
+    ℞ Haust. simp. unc. vi. Tinct. japonic. unc. i. adde pro re
+    nata tinct. thebaic. dr. i.
+
+Mixtura laxativa.
+
+    ℞ Elect. lenitiv. unc. i. Mannæ semunc. coque in aq fontan.
+    unc. xvi. ad unc. xij. Colaturæ adde sal. cathartici amari.
+    sescunciam. spirit. vini gallici, unc. i. Dosis ab. unc. ij.
+    ad unc. xij.
+
+Mixtura purg. antimonial.
+
+    ℞ Elect. lenitiv. sescunc. mannæ semunc. coque in aq. fontan.
+    unc. xx. ad unc. xvi. & dein solve tartar. emetici, gr. x.
+    Colaturæ dosis ab. unc. i. ad unc. iv. omni hora vel omni
+    2da. vel 3tia. vel 4ta. hora, donec laxetur alvus.
+
+Mixtura oleosa volatilis.
+
+    ℞ Haust. simp. unc. vi. ol. olivar. unc. iij. spirit.
+    volatil. salis ammoniaci drachmam inam. M. Dosis ab. unc. i.
+    ad unc. iij. 3tiis. vel 4tis. horis.
+
+Mixtura scillitica.
+
+    ℞ Haust. simp. unc. vi. oxymel scillitic. drachm. vi. Dosis a
+    drachm. iv. ad unc. ij. bis, ter, 4rve. die.
+
+Mixtura e spermat. ceti.
+
+    ℞ Spermat. ceti, drachm. ij. solve in vitello ovi & adde
+    haust. simp. unc. vi. adde, pro re nata, tinct. thebaic.
+    scrup. ij. Dosis ab. unc. i. ad unc. ij. 4tis. vel 6tis.
+    horis.
+
+Mixtura e spermat. ceti cum balsamo.
+
+    ℞ Balsam. copaiv. drachm. ij. tere in mortario cum mucilag.
+    gum arabici, drachm. iij. & dein adde mixtur. e spermat.
+    ceti, unc. vi. Dosis ab. unc. i. ad unc. iij. 4tis. vel 6tis.
+    horis.
+
+
+MUCILAGO. G. ARABICI.
+
+    ℞ G. arabici pulv. unc. iv. solve in aq. puræ bullient. unc. x.
+
+Oxymel scillit. Ph. Lond.
+
+Philonium Londinen. Ph. Lond.
+
+
+PILULÆ.
+
+Pilulæ fætidæ.
+
+    ℞ Gum asafætid. myrrh. ana drachm. i. sapon. alb. hispan.
+    drachm. ij. Tinct. fuliginis q. s. Dosis a gr. x. ad drachm.
+    dimid. bis terve die.
+
+Pilulæ guaiac.
+
+    ℞ Sapon. albi hispanici semunc. gum guaiac, scrup. iv. syrup.
+    q. s. Dosis a scrup. i. ad drachmam dimidiam bis terve die.
+
+Pilulæ gummosæ. Ph. Lond.
+
+Pilulæ mercuriales.
+
+    ℞ Argenti vivi semunc. extingue in balsam. copaiv. q. s. &
+    adde pulv. glycyrrhiz. gum guaiac. singulorum, drachm. vi.
+    syrup. q. s. ut fiat massa. Dosis a scrup. ss. ad drachmam
+    dimidiam semel vel bis die.
+
+Pilulæ rufi. Ph. Lond.
+
+Pilulæ saponaceæ. Ph. Lond.
+
+Pilulæ saponaceæ cum rheo.
+
+    ℞ Sapon. alb. hispanici, drachm. vi. pulv. rhei, drachm. ij.
+    syrup. sacchari q. s. Dosis a scrup. i. ad scrup. ij. bis
+    terve die.
+
+Pilulæ scilliticæ.
+
+    ℞ Pulv. glycyrhiz. rad. scill. exsiccat ana drachm. dimid.
+    rad. zinziber. drachm. i. sapon. alb. hispan. drachm. ij.
+    syrup. q. s. Dosis a gr. iv. ad. gr. xvi. bis terve die.
+
+Pilulæ stomachicæ.
+
+    ℞ Pulv. canell. alb. drachm. ij. extract. rad. gentian. dr.
+    i. mucilag. gum arabici q. s. Dosis a scrup. i. ad drachmam
+    dimid. bis die--adde pro re nata rubigin. martis drachmam
+    dimid.
+
+
+PULVERES.
+
+Pulvis astringens.
+
+    ℞ Pulv. canell. alb. rad. tormentill. singulorum, drachm. i.
+    M. Dosis a scrup. i. ad drachm. i.
+
+Pulvis aluminosus.
+
+    ℞ Alumin. crud. terræ japonicæ ana partes æquales dosis a gr.
+    viij. ad drachmam dimidiam.
+
+Pulv. anodynus Doveri.
+
+    ℞ Sal. nitri, tartari vitriolati singulorum, unc. iv. in
+    crucibulum candens injice, agitetur donec deflagratio &
+    scintillatio desinat, & adde opii concisi, unc. i. & in
+    pulverem redige addendo rad. glycyrrhiz. ipecacoanhæ
+    subtilissime pulver. ana, unc. i. & dein probe misceantur
+    omnia. Dosis a gr. x. ad scrup. ij. vel ad drachmam 1nam.
+
+Pulvis antimonialis.
+
+    ℞ Pulv. e chel. cancror. drachm. x. tartari emetici, dr. i.
+    M. fiat pulv. subtilissimus. Dosis a gr. iij. ad gr. x. 4ta.
+    vel 6ta. quaque hora.
+
+Pulvis cardiacus.
+
+    ℞ Pulv. canell. alb. drachm. i. rad. zedoariæ, drachm. ij.
+    rad. serpentar. drachm. i. M. dosis a scrup. i. ad drachm. i.
+    4tis. vel 6tis. horis.
+
+Pulvis chamæmelinus.
+
+    ℞ Pulv. flor. chamæmel. drachm. iij. aluminis, g. myrrh. ana
+    drachm. i. Dosis a scrup. i. ad scrup. ij.
+
+Pulv. contrayerv. comp. Ph. Lond.
+
+Pulv. contrayerv. cum nitro.
+
+    ℞ Pulv. contrayerv. comp. unc. iv. salis nitri, drachm. i. M.
+    Dosis a scrup. i. ad drachm. i. 4tis. vel 6tis. horis.
+
+Pulvis emeticus.
+
+    ℞ Pulv. ipecacoanhæ, scrup. i. tartar emetici, gr. ij. Dosis
+    a gr. xi. ad gr. xxii.
+
+Hiera picra. Ph. Lond.
+
+Pulv. Ipecacuanhæ cum opio.
+
+    ℞ Pulv. rad. ipecacoan. gr. x. opii, gr. ij. dosis a gr. iij.
+    ad gr. xij.
+
+Pulv. e jalapio.
+
+    ℞ Pulv. rad. jalapii, drachm. vi. rad. zinzib. drachm. ij.
+    Dosis a scrup. i. ad scrup. ij.
+
+Pulv. jalapii cum nitro.
+
+    ℞ Pulv. rad. jalap. drachm. iv. salis nitri drachm. im. Dosis
+    a scrup. i. ad scrup. ij.
+
+Magnesia alba.
+
+Pulv. nitrosus.
+
+    ℞ Pulv. e chel. cancror. drachm. iij. nitri, drachm. i. M.
+    Dosis a scrup. i. ad scrup. ij. vel ad drachmam. i.
+
+Pulv. nitrosus camphoratus.
+
+    ℞ Pulv. nitros, scrup. ij. camphoræ, gr. v. M. Dosis a scrup.
+    i. ad scrup. ij.
+
+Pulv. nitrosus cum gum guaiac.
+
+    ℞ Sal. nitri, drachm. ij. gum guaiac. drachm. dimid. Dosis a
+    gr. v. ad drachm. dimid.
+
+Pulv. plummeri.
+
+    ℞ Calomel, sulph. aurat antimonii ana dr. ij. tere in
+    mortario ut fiat pulv. subtilissimus. Dosis a gr. ij. ad gr.
+    x. vel ad scrup. im.
+
+Pulvis stanni. Ph. Lond.
+
+Pulv. e spermat. ceti cum nitro.
+
+    ℞ Spermat. ceti, drachm. ij. sacchar. albi sal. nitri ana
+    unc. im. Dosis a scrup. dimid. ad drachmam i.
+
+Pulv. e tragacanth. Ph. Lond.
+
+
+SALES ACIDI.
+
+                                                     PRÆPARATIONES.
+                  Spir. vitrioli fortis |                       |
+  Acida           ---- tenuis           |Spir. vitrioli dulcis  |
+  mineralis       Spiritus nitri        |Spir. nitri dulcis     | Æther.
+                  Spir. salis marini    |Spir. salis dulcis.    |
+
+  Varietat. acid. Acetum.
+  vegit.          Spiritus aceti vel acetum distillatum.
+                  Succus limonum.
+                  Chrystalli tartari.
+
+  Acid. anomal.   Sal. succini.
+                  Sal. sedativus Hombergeri.
+
+
+SALES ALCALINI.
+
+  Alcal. vegit.  Sal. absynthii.
+                 Sal. tartari.
+
+  Alcal. min.    Sal. alcali mineral. seu soda, seu natrum.
+
+  Alcal. vol.    Sal. volatilis c. cervi.
+                 Sal. volatilis sal. ammoniaci.
+
+
+SALES NEUTRI.
+
+SALES NEUTRI, qui fiunt        ex ALCALI            et ACIDO.
+
+            Tartarus vitriol.  | vegetab.      |
+            Sal. glauberi      | minerali      | vitrioli.
+            Sal. am. vitrioli  | volatili      |
+
+            Sal. nit. com.     | vegetab.      |
+            Nit. cubicum       | mineral.      | nitri.
+            Sal. am. nitrosum  | volatili.     |
+
+            Sal. digest. sylvii| vegetabil.    |
+            ---- marin. com.   | minerali      | Sal. marini.
+            ---- ammon. com.   | volatili      |
+
+Varietates  Sal. diureticus    | vegetab.      | aceti.
+salis       Tartar. tartar.    | veget.        | chryst. tartar.
+neutri                         |   tartari     |
+comp. ex    Sal. citratus com. | veget.        | succ. limonum.  Vegetabil.
+alcal. &                       |   absynth.    |
+acid.       Sal. de seignette  | minerali      | chryst. tartar.
+vegitab.    Spir. mindereri.   | volatili      | acet. distillat.
+
+Hi omnes sales neutri præparari possint pro usu medico admiscendo
+Alcali & acidum ad saturationem; alii vero in crystallos redacti, s.
+a. commodius circumferuntur pro usu militari; alii ut _sal. citratus
+comm._ et _spiritus mindereri_ facilius præparantur ad miscendo alcali
+& acidum ad saturationem pro re nata[115].
+
+    [115] This Table of neutral Salts is nearly the same as one I
+    have seen, which was said to be a Copy of that given yearly
+    by Dr. _Cullen_, Professor of Chymistry in the University of
+    _Edinburgh_, to his Pupils; and as that published by Dr.
+    _Vogel_, in his _Institutiones Chymiæ_, sect. 629. These
+    neutral Salts are likewise taken Notice of by _Macquer_, in
+    his _Elemens de Chymie_, and other late chymical Authors.
+
+Solutio mercurii corrosivi sublimati.
+
+    ℞ Mercur. corrosiv. sublimat. gr. vi. spir. vini gallici,
+    unc. xii. M. fiat solutio. Dosis a semunc ad unc. i. die.
+
+    Species aromaticæ. Ph. Lond.
+    ---- e scordio. Ph. Lond.
+
+Tartar. emetic. Ph. Lond.
+
+Theriaca andromachi. Ph. Lond.
+
+
+TINCTURÆ.
+
+    Tinctura amara.
+    ---- corticis Puruv.
+    ---- martis in sp. sal.
+    ---- japonica.
+    ---- melampodii.          Pharm. Lond.
+    ---- myrrhæ.
+    ---- sacra.
+    ---- saturnina.
+    ---- serpentariæ.
+    ---- thebaica.
+
+Tinctura rhei.
+
+    ℞ Pulv. rad. rhei, unc. ij. semin. cardamom minor. decortic.
+    semunc. vini alb. hisp. lib. ij. sp. vini gallici, unc. viij.
+    digere sine calore & cola. Dosis ab. unc. i. ad unc. iij.
+
+Tinctura stomachica.
+
+    ℞ Cort. canell. alb. semunc. cort. aurantior. unc. i. semin.
+    cardam. minor. decort. drachm. ij. spirit. vini gallici lib.
+    ij. digere sine calore & cola. Dosis a semunc ad unc. i. bis
+    terve die.--Adde pro re nata vin alb. hisp. lib. i.
+
+
+UNGUENTA.
+
+Unguenta cærulea vel mercurial. Ph. Lond.
+
+Unguentum sulphuratum. Ph. Lond.
+
+
+VINA.
+
+    Vinum amarum.
+    ---- antimoniale.   Pharm. Lond.
+    ---- chalybeatum.
+
+
+VITRUM CERATUM ANTIMONII.
+
+
+
+
+AN ESSAY ON THE MEANS of Preserving the Health of SOLDIERS on SERVICE.
+AND Conducting MILITARY HOSPITALS.
+
+
+
+
+OF THE Means of Preserving the Health of Soldiers on Service.
+
+
+The Life of _British_ Soldiers on Service, in Time of War, is so very
+different from what they lead in Time of Peace, as to subject them to
+many Inconveniences and Diseases.
+
+In Time of Peace, Soldiers are quartered either in Towns or Garrisons,
+where they are under the Eye of their Officers, who take Care that
+they keep themselves clean, and provided with Necessaries; they lie
+either in private Houses or in Barracks, where they have a good Bed,
+regular Meals of wholesome Provisions, and enjoy most of the other
+Necessaries of Life in common with the lower Class of People, their
+Duty is easy, they mount Guard but seldom, and in other Nights enjoy
+an undisturbed Rest.
+
+Whereas, during the Time of an active Campaign, they are seldom in
+Houses; they lie in Tents upon the Ground, which is often bare, and at
+best covered only with Straw and a Blanket; and sometimes they are
+obliged, after fatiguing Marches in wet Weather, to lie on the bare
+Ground, without even a Tent to cover them; they must stand Centinel,
+and be upon Pikets and other Out-Posts in the Night, during all Kinds
+of Weather; besides performing long fatiguing Marches, and other
+military Duties; and when near an Enemy, they are perhaps on Duty
+every second or third Night, besides working Parties, and other Duties
+of Fatigue; and what Rest they have is interrupted by frequent Alarms.
+They have often but little Time or Convenience to make themselves
+clean. Provisions are sometimes scarce, and frequently on long Marches
+they have no Opportunity of dressing what they can get: Water is
+sometimes difficult to be come at, and what is to be got, is bad. And
+it frequently happens, that neither Beer, Wine, nor Spirits, can be
+purchased for Money. In fixed Camps, they are often exposed to the
+putrid Effluvia of dead Bodies, of dead Horses, and other Animals, and
+of the Privies and Dung of the Horses[116]; and, in some Encampments,
+likewise to the unwholesome Vapours of marshy Ground, and of corrupt
+stagnating Water: All which, joined to the other Hardships and
+Inconveniences unavoidably attending a military Life in Time of
+Service, often give Rise to numerous Diseases, which weaken an Army in
+a most surprising Manner; and therefore Commanders ought to use every
+Means in their Power, consistent with the necessary military
+Operations, to preserve the Health of the Soldiers.
+
+    [116] In the Year 1760, the Men, who remained in the fixed
+    Camp about _Warbourg_, were very unhealthy; while the
+    Regiments who were detached to the _Lower Rhine_, under the
+    Command of the Hereditary Prince of _Brunswick_, enjoyed a
+    much better State of Health; and notwithstanding their great
+    Fatigues, and the Loss they sustained at the Affair of
+    _Kampen_, were much stronger when they rejoined the Army to
+    go upon the Winter Expedition into the Country of _Hesse_,
+    than those Regiments which had remained in the fixed Camp.
+
+Diseases are more or less frequent in Armies according as the Season
+is hot or cold, wet or dry; according to the Nature of the Climate,
+and the Time of the Year in which military Operations are carried on;
+the Nature of the Ground on which the Army is encamped, or the
+Situation of the Towns or Villages in which they are cantonned; the
+Cleanness, Neatness, and Dryness of the Camp, and of the Tents or
+Houses in which the Soldiers are lodged; according as the Men are
+supplied with Provisions, and good Water, good Beer, Wine, or other
+fermented Liquors; or are well cloathed, and well furnished with Straw
+and Blankets; in proportion as the Duty is more or less severe; and to
+the Care taken of such as are attacked with Sickness.
+
+Soldiers generally enjoy good Health in cold dry Weather, even during
+the Time of severe Frost; if they be kept in Exercise, be well
+cloathed, and well supplied with Provisions and good Liquors, and
+with Wood; as the Troops, both in _Germany_ and _North America_,
+experienced during the late War; but Cold joined to Moisture was
+observed always to be productive of Diseases.
+
+Nor is mere Heat of itself such an Enemy to Health[117] as is
+generally apprehended; but when joined to Moisture, is observed to
+give Rise to the most fatal Disorders in the warm Climates.
+
+    [117] This Dr. _Pringle_ takes Notice of; and Mr. _Naesmith_
+    says, he observed it in Voyages to the _East Indies_, which
+    afford the fairest Trials of this Kind. See Dr. _Lind’s Essay
+    on the Means of Preserving the Health of Seamen_, 2d edit.
+    note to page 5.
+
+In our northern Climates the Winters are cold, and the Weather
+variable; sometimes it is cold and rainy, at other Times thick and
+foggy; sometimes we have fair Weather and Sunshine, at other Times
+Frost and Snow; and sometimes it happens that we have all these
+different Sorts of Weather in the same Day. During this Season,
+Soldiers are subject to Coughs, Pleurisies, Peripneumonies,
+Rheumatisms, and other Disorders of the inflammatory Kind. And in
+very intense Frost, they are liable to have their Limbs benumbed with
+Cold, and their Extremities Frost bit (as it is called).
+
+And where there is a Want of fresh Provisions, and they are obliged to
+live on salted Meat, and cannot have Greens, Pot Herbs, Roots, or
+other fresh Vegetables, nor be properly supplied with Beer, Cyder,
+Wine, or other generous fermented Liquors, they, as well as Sailors,
+are subject to the Scurvy[118]; especially if they be encamped or
+quartered in low damp Places.
+
+    [118] Dr. _Joh. Valint. Willius_, Army Physician to the King
+    of _Denmark_, in his Treatise on Camp Diseases, says, you
+    scarce find a Camp in these northern Countries in which the
+    true Scurvy, attended with stinking Breath and eroded Gums,
+    is not to be observed. _Cap._ iii. _sect._ iii.
+
+The best Means of guarding against inflammatory Disorders, and other
+Mischiefs arising from Cold, whether in Camp or in Quarters, is, to
+take Care that the Soldiers be well cloathed; that they lie dry, and
+be well provided with Straw and Blankets, and with Wood; and to
+prevent, as much as possible, their exposing themselves to sudden
+changes from Heat to Cold.
+
+In these northern Climates, it would be right to allow every Soldier
+on Service a Flannel Waistcoat, a Pair of worsted Gloves, and a warm
+woollen Stock, or a Neckcloth, to wear when on Duty in cold and wet
+Weather, as soon as the Winter begins to set in[119]. Dr. _Pringle_
+mentions the Advantage the Troops received from the Flannel
+Waistcoats supplied by the Quakers, in the Winter Campaign of 1745-6,
+in _Britain_; and those Regiments who had them for their Men towards
+the End of the Campaigns in _Germany_, found that they contributed
+greatly to keep the Men in Health. Officers ought to take particular
+Care that the Men be well provided with good strong Shoes and
+Stockings; and where the Troops remain late in the Field, if the
+Government allowed a Pair or two extraordinary of each to every Foot
+Soldier, it would be of great Use to the Service.
+
+    [119] A Flannel Waistcoat, worsted Gloves, and woollen Stock,
+    or a Neckcloth, may be purchased for about Half a Crown _per_
+    Man, and would contribute to preserve the Lives of many; the
+    recruiting of others, to supply whose Places, if they die,
+    will cost the Government a great deal more than the Price of
+    the Articles mentioned; which for a Regiment of nine hundred
+    Men, at the Rate of two Shillings and Six-Pence _per_ Man,
+    comes only to 112_l._ 10_s._ _per Ann._ Every Recruit sent
+    from _England_ to the Army in _Germany_, cost the Government
+    at least twenty Guineas before he joined his Regiment; and
+    every sick Man sent to the general Hospital, cost the
+    Government at least sixteen Pence _per_ Day, which is ten
+    Pence above his Pay; so that, if we suppose the extraordinary
+    Cloathing here mentioned would preserve only the Lives of
+    nine Men to each Regiment yearly, and keep forty in Health
+    who would otherwise be sick, we see what great Gainers the
+    Government will be in Point of Money at the Year’s End;
+    besides preserving the Lives and Health of so many Men.
+
+Blankets ought to be provided for each Tent, and those carried along
+with the Regiment, so as to be always ready for the Men when they come
+to their Ground. During the late War in _Germany_, a Couple of
+Blankets were allowed for each Tent of the _British_ Troops, and each
+Company carried their Blankets covered with an Oil Cloth on a Horse;
+so that they were always up with the Regiments when they came to their
+Ground.
+
+Each Regiment ought to be provided with a Number of Watch Coats
+sufficient to serve the Centinels who are to be on Camp Duty, or
+general Guards, in very cold and wet Weather. Some of the Regiments in
+_Germany_ had such Coats, and found great Service from them.
+
+In Winter Quarters, Soldiers are apt to make the Rooms in which they
+sit, and their Guard Rooms, as hot as possible; especially in
+_Germany_, where the Inhabitants use close Stoves, instead of open
+Fires; and continue in these warm Rooms till they are called out on
+Duty, when, by being exposed to sudden Cold, they are apt to be seized
+with Inflammations of the Breast; and therefore Officers ought to
+examine carefully the Quarters and Guard Rooms allotted for their Men,
+and chuse them dry and comfortable, if possible[120]; but never to
+allow the Men to keep them as hot as Ovens, by Means of close Stoves,
+or other such Contrivances; but to depend more on good warm Cloathing,
+and dry Quarters, for guarding against Diseases, than upon artificial
+Heat. Many of the Regiments in _Germany_ made the People in whose
+Houses their Men were quartered, take down their Stoves, and use only
+open Fires; when there was no Danger of the Soldiers making their
+Quarters too warm, as Wood was difficult to be got.
+
+    [120] Dr. _Pringle_ has very justly observed, that upper
+    Stories are preferable to Ground Floors; and that all
+    uninhabited large damp Houses ought to be rejected.
+    _Observat. on Diseases of the Army_, part ii. chap. iii.
+    sect. 2.
+
+    If Necessity obliges Officers to put up with such Places for
+    their Men, Care ought to be taken to clean them well, and to
+    air and dry them by Means of Fires, before the Soldiers go
+    into them; and to supply well the Men who are to lodge in
+    them with Straw and Blankets, and with Wood or Turf.
+
+But although close Stoves are prejudicial in small Rooms, yet when a
+Town is much crowded, and Men are obliged to be lodged, in Winter, in
+large Barns or Churches, or other large open Places, the _German_
+Stoves may be used with great Advantage in airing and drying such
+Places, and keeping them of a moderate Heat; especially if there be a
+Place in them for an open Fire, or if they be of that Kind which the
+_Germans_ call _wynd Stoves_, which have a Door opening into the
+Chamber where the People are lodged; or if there be broken Windows, or
+any other Opening by which a free Circulation of Air can be kept up
+in the Men’s Apartments.
+
+In Winter, when the Weather is very cold or wet, a Glass of Brandy, or
+of the spirituous Tincture of the Bark, given to the Men as they went
+upon Duty, especially in the Night, has been found to be of great
+Use[121]. Dr. _Pringle_ has very justly observed, that the Times of
+standing Centinel, and being upon Out-posts, ought, if possible, to be
+shortened at such Seasons; and that Fires in the Rear of the Camp, for
+Men coming off Duty to warm and dry themselves at, were found to be of
+great Service.
+
+    [121] Dr. _Pringle_ has taken Notice, that it would be a
+    right Measure to make an Allowance of Spirits to the Infantry
+    on Service; which certainly would be of great Use, and save
+    many Mens Lives; and might be done at a small Expence to the
+    Government, if properly managed; as it would only be
+    requisite to make such an Allowance when the Troops are in
+    the Field, and to such Men as mount Guard in cold wet
+    Weather, or at Nights in Garrison Towns, during the Winter.
+    If ever such an Allowance be made, what Spirits are given to
+    the Men ought to be mixed with five or six Times the Quantity
+    of Water; except when Men are to stand Centinels, or to be
+    upon Out-Posts, in a frosty Season, or in cold wet Weather;
+    at which Time a small Glass of pure Spirits may be given them
+    in Presence of the Officer or Serjeant of the Guard.
+
+In Spring, and the latter End of Autumn, the Days are sometimes
+extremely hot, and the Nights cold and damp, and the Men exposed to
+these sudden Changes; at such Times, the Men who go upon Duty in the
+Night, ought to put on their Flannel Waistcoats, and be warmer
+cloathed than in the Day; and use many of the Precautions practised in
+Winter for the Preservation of their Health.
+
+In _North America_, when the Men were in the Field in very hard frosty
+Weather, Fires were lighted at the Ends of the Tents, and Centinels
+set over them to prevent their doing Mischief; and both in _Germany_
+and _North America_, when the Troops were in the Field without Tents,
+they cut down Wood and made large Fires, and the Soldiers lay down and
+slept round these Fires, with their Feet next to them; and Fires were
+lighted at all Out-posts, where it could be done with Safety.
+
+In _Germany_, when the Weather set in rainy or cold towards the End of
+the Campaigns, and the Army was in a fixed Position, his Serene
+Highness Prince _Ferdinand_ constantly ordered the Army to Hutt;
+which was done either by thatching their Tents, or building Hurdles,
+or digging Pitts, and covering and thatching them over. The Officers
+either built Hutts with Fire Places, or had Chimnies built to their
+Tents.
+
+If, notwithstanding all Precautions, Men upon Out-posts should be
+benumbed with Cold, or Frost bit, as soon as they are brought into
+Camp or Quarters, their Extremities ought to be rubbed with Snow, or
+put into cold Water[122]; and afterwards well dried, and wrapt up in
+Blankets; and warm mild Liquors given them to drink, and afterwards
+Cordials; and, after some Time, they may be brought near the Fire, or
+put to Bed. Dr. _Lind_[123] mentions one Caution to be used when Men
+are found in this Condition; which is, not to give them immediately
+strong spirituous Liquors, for that those often prove instantaneously
+fatal; but to put them to Bed, and give warm Water Gruel, or some
+other mild diluting Liquor, to drink; after which, he says, a Glass of
+Spirits will prove less dangerous and more beneficial.
+
+    [122] _Hildanus_ relates a very remarkable Instance of the
+    good Effects of this Treatment. A Man was found quite stiff
+    and frozen all over. He was put into cold Water, and
+    immediately the icy Spicula were discharged from all Parts of
+    his Body, so that he seemed covered with an icy Crust. He was
+    then put into a warm Bed, and took a Cordial Draught, and a
+    plentiful Sweat followed; after which he recovered with the
+    Loss of the last Joints of his Fingers and Toes. _De
+    Gangræna_, cap. xiii. People who are benumbed with Cold in
+    frosty Weather ought never to be brought immediately near a
+    Fire; for that has been found either to cause immediate Death
+    or Gangrenes of the Extremities; and even Apples and other
+    Fruits which have been frozen, if brought immediately near a
+    Fire, turn soft and rot; but if put into cold Water, throw
+    out the icy Spicula, and recover, so as to be almost as good
+    as before they were frozen.
+
+    [123] _Means of Preserving the Health of Seamen_, 2d edition,
+    page 19.
+
+When Men are quartered or cantonned in Towns or Villages, whose
+Situation is low and damp, and where fresh Meat and Vegetables are
+scarce in Winter, and the Scurvy frequent among the lower Class of
+People; Commanding Officers, at the Approach of Winter, ought to use
+their Endeavours to provide a Store of Potatoes, Onions, Cabbages,
+sour Crout; of pickled Cabbages, and other pickled Vegetables; of
+Apples and other Fruits, preserved in different Forms, to be laid up,
+and sold out to the Men at a cheap Rate during the Winter. They
+should contract, if possible, with Butchers to furnish the Men with
+fresh Meat[124], and endeavour to procure good small Beer, or Cyder or
+Wine in the Wine or Cyder Countries; or Spirits to be mixed with
+Water, and a small Proportion of Cream of Tartar or Vinegar; or some
+other wholesome fermented Liquor for their Drink[125]; and to put
+their Men into as dry comfortable Quarters as possible.
+
+    [124] The Regiments in _Germany_ who kept their Butchers in
+    Winter, and made Stoppages of the Mens Pay, and obliged them
+    to take a certain Quantity of Meat daily, were much more
+    healthy than those who used no Precaution of this Kind.
+
+    [125] In Places where the Articles here mentioned are at too
+    high a Price for a Soldier’s Pay, a small Allowance, from the
+    Government, of such Things would contribute much to the
+    Preservation of the Mens Health in unwholesome Garrisons.
+
+In Times of War, when Men are sent upon Expeditions into warm
+Climates, great Care ought to be taken to embark such only as are in
+good Health; particular Regard ought to be paid to those who are
+picked up in the Streets, or have been taken out of the _Savoy_, or
+other Jails. All dirty Rags from off such People ought to be thrown
+away or burnt; and the Men, after being well washed, and new cloathed,
+ought to be kept for a Fortnight or three Weeks in some Garrison Town,
+or with their Regiments, in open airy Places, that it may be
+ascertained that they have no infectious Disorder before they be put
+aboard the Transports.
+
+All Ships allotted for Transports ought to be well aired and purified,
+and every Thing fitted up properly, before the Men are embarked. They
+ought to be provided with Ventilators, or Wind Sails, to make a free
+Circulation of Air through the Vessel[126]; and they ought never to be
+crowded; but full Room allowed for each Man, in Proportion to the
+Length of the Voyage[127].
+
+    [126] See Dr. _Lind’s Treatise on the Means of Preserving the
+    Health of Seamen in the Royal Navy_, where he takes Notice of
+    most of the Articles here mentioned with regard to Transport
+    Ships in treating of Ships of War.
+
+    [127] When Ships are too much crowded with Men, if they meet
+    with a tedious Passage, and hot moist close Weather, they are
+    often attacked with Diseases which prove very fatal. Dr.
+    _Lind_, talking of Ships of War, says it is a Mistake
+    destructive to the Men to crowd too many of them together in
+    a southern Voyage, or in a hot Climate; as the Ship will be
+    found, before the End of the Voyage, in more Distress for
+    Want of Men, than she would have been, had she at first
+    carried out only her proper Compliment. An additional Number
+    is made, in order to supply an expected Mortality; but they
+    generally increase that Mortality to double or triple their
+    own Number. _Ibid. note to p. 48._
+
+In military Expeditions, Soldiers are put upon Ships Allowance;
+which, Dr. _Lind_ very justly observes, ought not, in Voyages to the
+warm Climates, be made up so much of salted Beef and salted Pork
+(which always tend to the Putrescent), as is the common Practice of
+the Navy; but that a greater Share of Biscuit, Flour, Oatmeal, Goarts,
+Rice, and other Stores of that Kind, ought to be laid in; and a
+greater Proportion of them, and a Less of the salted Meat, distributed
+among the Men: And he is certainly in the Right, when he says, that a
+full Animal Diet, and tenacious Malt Liquors, are well adapted to the
+Constitution of our own, and of other northern Climates; and that
+Sailors who visit the _Greenland_ Seas, and are remarkable for a
+voracious Appetite, and a strong Digestion of hard salted Meat, and
+the coarsest Fare, when sent to the _West Indies_, soon become
+sensible of a Decay of Appetite, and find a full gross salted Diet
+pernicious to Health. “Instinct (he says) has taught the Natives
+between the Tropics to live chiefly on a Vegetable Diet, of Grains,
+Roots, and subacid Fruits, with Plenty of diluting Liquors[128].”
+
+    [128] The following is the Diet established for the Seamen of
+    his Majesty’s Navy.
+
+    Every Man is allowed a Pound of Biscuit, _Averdupoiz Weight_,
+    and a Gallon of Beer, _Wine Measure_, _per_ Day.
+
+    On _Sunday_ and _Thursday_, one Pound of Pork, and Half a
+    Pint of Peas, _Winchester Measure_.
+
+    On _Monday_, _Wednesday_, and _Friday_, one Pint of Oatmeal,
+    two Ounces of Butter, and four Ounces of Cheese.
+
+    On _Tuesday_ and _Saturday_ two Pounds of Beef.
+
+    It is left to the Commanders of Squadrons to shorten the
+    aforesaid Allowance of Provisions according to the Exigence
+    of the Service, taking Care that the Men be punctually paid
+    for the same. As it is thought for the Benefit of the Service
+    to alter some of the foregoing Particulars of Provisions in
+    Ships employed on foreign Voyages, it is to be observed, that
+
+    A Pint of Wine, or Half a Pint of Rum, Arrack, or Brandy,
+    hold Proportion to a Gallon of Beer.
+
+    Four Pounds of Flour, or three Pounds of the same with a
+    Pound of Raisins, Half a Pound of Currans, or Half a Pound of
+    Beef Suet pickled, are equal to a four Pound Piece of Beef,
+    or two Pound Piece of Pork with Peas.
+
+    Half a Pound of Rice is equal to a Pint of Oatmeal.
+
+    A Pint of Olive Oil is equal to a Pound of Butter, or two
+    Pounds of _Cheshire_ Cheese.
+
+    And Two-thirds of a Pound of _Cheshire_ Cheese is equal to a
+    Pound of _Suffolk_.
+
+    If Soldiers are sent as Passengers on board of King’s Ships,
+    or on board of Transports, their Allowance is generally but
+    Two-thirds of the above.
+
+A Store of Vegetables, such as Mustard Seed, Garlick, Onions,
+Potatoes, pickled Cabbages and other pickled Vegetables, sour Crout
+and other Things of that Kind, which can be purchased at a cheap Rate,
+and preserved for some Months, ought to be laid in; which may be mixed
+with the Soops prepared for the Men, or given them to eat along with
+their salted Provisions.
+
+A Quantity of Beer, Cyder, or Wine, ought to be put aboard, and a
+certain Allowance distributed to each Man daily. When, for Want of
+these, Men are reduced to an Allowance of Spirits, they ought to be
+mixed with seven or eight Times the Quantity of Water, or made into
+Punch, by the Mixture of Water and Molosses, and the Juice of Lemons,
+before they are given to the Men; and, if Lemons cannot be got, Cream
+of Tartar, or Vinegar, ought to supply their Place; and it ought to be
+a Duty of one of the military Officers on board to see the Punch made,
+and distributed among the Men daily.
+
+It would be right, on all Expeditions into warm Climates, to send some
+Sloops of War, or other armed Vessels, before the grand Fleet, to take
+up a Quantity of Wine that will keep, either at the _Madeira_, or
+other Wine Countries; and afterwards to go to any of our Settlements
+that are nearest the Place of Destination, and to take in a Quantity
+of Limes, Lemons, Oranges, and other Fruits, and Vegetables which will
+keep for some little Time; and of Spirits, live Stock, and other
+Provisions proper for the Army; and then to meet the Fleet at the
+general Rendezvous. When once a Landing is made good, these Vessels,
+after having unloaded their Cargoes, may either be employed on other
+Services, or kept constantly going and coming for whatever Stores or
+Provisions are wanted for the Army or Fleet.
+
+A sufficient Quantity of Vinegar ought to be put on board of each
+Transport, both for the Men to eat with their Victuals, and likewise
+for fumigating and washing between Decks occasionally. And a Quantity
+of Molosses, or coarse brown Sugar, and of Lemons, or their
+inspissated Juice, or Cream of Tartar, ought to be allowed for making
+the Punch, as well as for other Purposes.
+
+If the Water become fœtid, the Quantity to be used in the Day ought to
+be sweetened by Means of the Ventilator contrived by the ingenious Dr.
+_Hales_[129] for that Purpose.
+
+    [129] This Ventilator is no more than a long Tube, with a Tin
+    Box, about six Inches wide and four high, with a Number of
+    Holes at the Top, fixed at one End; and this Box is put down
+    to the Bottom of the Water, and the Nose of a Pair of Bellows
+    fixed to the other End of the Tube, which is above the Water;
+    by working the Bellows, fresh Air is driven through the whole
+    Body of Water, the putrid Effluvia are evaporated and
+    dispersed, and the Water becomes sweet in a very short Time.
+
+The Men ought to be brought upon Deck, and Roll called two or three
+Times a Day; they should be made to comb their Hair, and wash their
+Hands and Face every Day, and to shift themselves sometimes, if
+possible; and in every respect keep themselves as clean as the Nature
+of the Service will admit; and proper Exercises should be contrived,
+to keep them in Health.
+
+All the Parts of the Ship ought to be kept very neat and clean; and
+the Hold, and all between Decks, ought to be scraped and swept daily;
+and every Morning, in fair Weather, ought likewise to be washed, and
+afterwards sprinkled or washed with warm Vinegar, while the Men are
+upon Deck[130].
+
+    [130] This ought always to be done in the Morning, that all
+    the Parts of the Ship may have Time to dry before the Men go
+    to rest in their Births at Night; but it ought never to be
+    done after Sun-set.
+
+When the Weather will permit, Fires of dried Wood may be lighted in
+Iron Kettles between Decks, and Centinels set over them, and the Fires
+sprinkled with Rosin or Bits of Rope dipt in Tar, or with some cheap
+Aromatic; and these Fires may be carried into all the Parts of the
+Ship that Safety will permit, in order to dry and purify the Air[131].
+After this Operation all the Ports and Hatchways should be opened,
+and the Air in all the Parts of the Ship often renewed by working the
+Ventilators.
+
+    [131] It has been proposed, that the Air in Ships of War
+    should be purified in this Way both by Dr. _Lind_ and by
+    Mons. _de Hamel de Monceau_.
+
+The Mens Hammocks and Beds ought to be brought up upon Deck in fair
+Weather, and well aired, and afterwards put in their Places, and Fires
+lighted below Decks.
+
+When Troops, sent on an Expedition into warm Climates, arrive at the
+Place of their Destination, particular Care should be taken to guard
+them against the Diseases peculiar to such Climates, which are
+different from those common to our more northern Latitudes.
+
+Dr. _Lind_ says, that People coming first from a cold into a hot
+Climate are apt to have plethoric Symptoms; a Pain of the Head,
+Giddiness, a Sense of Weight, and Fulness of the Breast, and a slight
+Inflammation of the _tunica conjunctiva_; and that some are apt to be
+seized with ardent Fevers and Diarrhœas. And all Practitioners have
+observed, that New-Comers into warm Climates are at first liable to
+Fevers tending to the Ardent, and are very subject to Fevers of the
+remitting and intermitting Kind, which are the Endemics of all warm
+Countries at certain Seasons of the Year; and after some Time they are
+apt to fall into Fluxes, the Yellow Fever, and other Diseases
+depending on a putrescent State of the Juices. In military Expeditions
+these Disorders are liable to be complicated with Fevers of the
+Malignant or Hospital Kind, if Care is not taken to prevent it. And
+nothing has been found to be more productive of Diseases in those warm
+Climates, than indulging freely in the Use of Spirits and other strong
+fermented Liquors; exposing one’s self to the Damps, especially lying
+on the Ground after the Dews fall; and working hard, or using violent
+Exercise in the Heat of the Day.
+
+The best Preservatives against Diseases in warm Climates have been
+found to be,--1. Temperance; a Diet of light and easy Digestion,
+composed more of vegetable than of animal Food; such as a small
+Portion of fresh Meat, joined with a sufficient Quantity of
+Vegetables; Rice, _Indian_ Corn, and other Grains, and Roots of
+various Kinds, prepared in different Forms; well baked Bread; the
+moderate Use of ripe Fruits; and the free Use of mild cooling subacid
+Liquors, joined with a small Proportion of vinous or spirituous
+Liquors; carefully avoiding the too liberal Use of Wine, Spirits, or
+other strong fermented Liquors.--2. Great Care not to expose one’s
+self to the Damps of the Night, nor lie down to sleep on the Grass, or
+in woody moist Places, in the Day; and to avoid all violent Exercise
+in the Heat of the Sun.--3. Such Means as tend to support the Spirits;
+for Chearfulness has been observed to contribute as much to the
+Preservation of Health, as Fear and Dejection of Spirits to the
+Production of Diseases.--4. Keeping the Body clean, and bathing
+frequently in the Sea, or in a River, in the Morning.
+
+And therefore, in warm Climates, Officers ought to be particularly
+careful to keep their Men sober and temperate; to procure them good
+Bread, and Plenty of Vegetables and fresh Meat, if possible; and
+where no other but salted Meat can be got, to make them boil a small
+Proportion of it in their Camp Kettles, along with Onions, Goarts,
+Rice, Carrots, Turnips, Greens, or any other wholesome Roots or Herbs
+which the Country affords, or they can get, and of these to prepare a
+good wholesome Soop for themselves; and where there is Plenty of the
+ripe acescent Fruits, which are reckoned wholesome, to distribute a
+moderate Quantity among the Soldiers daily, which will both help to
+preserve their Health, and prevent them from privately stealing and
+eating large Quantities to the Prejudice of their Health.--To
+encourage their Men, and keep up their Spirits.
+
+They should also prevent, as much as possible, the too free Use of
+Wine, Spirits, or other strong fermented Liquors; and in Wine
+Countries give every Man a daily Allowance of Wine, to be mixed with
+Water for his common Drink; and in Countries where nothing but Spirits
+can be got, make the Spirit be mixed with Water, or made into a very
+weak Punch, before it is given to the Men, as Lemons, Oranges, Limes,
+and other Fruits proper for this Purpose, are generally to be had in
+most warm Countries.
+
+They should be careful not to march their Men in the Heat of the Day,
+nor order them upon Duty where they must stand exposed to the Dews and
+Damps of the Night, unless where the military Operations absolutely
+require it.
+
+They should endeavour to make the Bottom of the Tents be covered with
+Straw, or dried Leaves of Trees, or dried Reeds, and with
+Blankets[132], for the Men to lie upon.
+
+    [132] A sufficient Store of Blankets has often been neglected
+    to be carried out in Expeditions into warm Climates; but
+    Blankets are no-where more necessary, as it is very
+    prejudicial to the Health of Soldiers to be obliged to lie
+    down on the bare Ground; and Straw, dried Reeds, and other
+    such Things, are often difficult to be got in the warm
+    Climates.
+
+The Time of standing Centinel, and being upon Out-posts, if possible,
+should be short, where Men are exposed to the scorching Heat of the
+Sun; and when Men are upon Out-posts in the Night, it should be
+recommended to them to lie down on the Ground as little as possible;
+and if they do it, to chuse a dry Place; and, where it can be done,
+to have it covered with Straw or a Blanket, and to have some light
+Covering to defend them from the Dews.
+
+The Tents should be covered with Boughs of Trees, and the Men should
+be ordered sometimes to strike them in the Middle of the Day, and air
+well every Thing within them.
+
+The Men should be obliged to keep themselves neat and clean; to comb
+their Hair, and change their Linen often; and if the Camp be near the
+Sea, or a large River, they ought to bathe early in the Morning as
+often as the Nature of the Service will permit. However the following
+Caution, mentioned by Dr. _Lind_, ought to be observed, which is, not
+to go into the cold Bath when overheated with Work or Liquor, or when
+the Stomach is full, or when a critical Eruption, called the prickly
+Heat, appears on the Skin[133].
+
+    [133] Dr. _Lind_ says, the Use of the cold Bath, either in
+    Tubs under the Forecastle, or to dip in the Sea early in the
+    Morning, has been found extremely beneficial in warm Weather
+    and hot Countries; and that he can affirm, from his own
+    Experience in hot Climates, that many Diarrhœas and other
+    Complaints, the pure and sole Effect of an unusual and great
+    Heat (relaxing the System of the Solids, and occasioning a
+    Colliquation of the Animal Juices), have not only been cured
+    by cold Bathing; but their Return, and even the Attack of
+    such Diseases, effectually prevented by it. _Ibid._ p. 44,
+    &c.
+
+When Men are seized with inflammatory Symptoms on entering into warm
+Climates, they may be blooded freely: Afterwards they do not easily
+bear such copious Evacuations, but rather require to have them made in
+smaller Quantities, and very early and frequent, as Inflammations make
+a rapid Progress in warm Countries. Dr. _Lind_ says, many
+Practitioners disapprove of Blood-letting in the Countries lying under
+the Torrid Zone, on a Supposition that the Blood is too much
+dissolved; but he thinks that this Rule will admit of many Exceptions;
+and that Sailors (_and consequently Soldiers_), being strong and
+robust, and exposed to greater Vicissitudes of Heat and Cold, and more
+Excesses, and other Accidents in general, bear freer Bleeding than any
+other Set of People.
+
+After some Time, the Diseases in these warm Climates tend to the
+putrid Kind, and must be treated as such.
+
+In all Countries, and in all Climates, great Care ought to be taken in
+chusing the Ground on which Men are to encamp. Dry high Grounds,
+exposed to the Winds, where there is a free Current of Air, and which
+lie at a Distance from Marshes, stagnating Water, and large Woods, are
+generally healthful in very different Climates[134]. But Places
+situated low, where, on digging two or three Feet below the Surface of
+the Earth, you come to Water[135], and marshy Grounds, and Places
+surrounded with corrupt stagnating Water, are almost always the
+contrary, and very unhealthful; as are often those Grounds which are
+subject to be overflowed by large Rivers, and low Places covered with
+Wood, where there is no free Circulation of Air. However, it ought to
+be observed, that it is not the Neighbourhood of Water alone which is
+prejudicial, but the watery Vapours which keep the Air perpetually
+moist, and the Exhalations of corrupt Effluvia, which render such
+Places unwholesome; for the Neighbourhood of Rivers, and of the Sea,
+where the Tide ebbs and flows freely, has no such Effect, where the
+Situation is dry and airy; and those very unhealthy marshy Grounds
+often continue healthy in cold Weather, when their Waters are
+refreshed with Rains[136], and little or no moist putrid Exhalations
+rise from them; though, as Dr. _Pringle_ observes, in Summer and
+Autumn, when their Waters begin to corrupt, and the Exhalation is
+strong, they are always exposed to Diseases; and it is for this
+Reason that such Places are always very unhealthy in warm Climates.
+
+    [134] Mr. _du Hamel_ says, that the Air of the Island of _St.
+    Domingo_ is very fatal to _Europeans_; but it is observed
+    that those People who inhabit the rising Grounds are much
+    less exposed to Diseases than those who live in the Vallies.
+    _Sur la santé des Equipages_, art. i. p. 16.
+
+    [135] Ground may seem very dry and healthful, and yet be
+    quite the contrary, as Dr. _Pringle_ remarks is the Case in
+    the Neighbourhood of _Bois le Duc_, in _Flanders_, where
+    Water is found every where at the Depth of two or three Feet
+    from the Surface.
+
+    [136] Mr. _du Hamel_ remarks, that Places which were formerly
+    very subject to Diseases have become healthful when the Water
+    which surrounded them was refreshed by opening a
+    Communication with the Sea. _Ibid._ art. i. p. 18.
+
+Hence, where the military Operations will permit, Commanders, if
+possible, ought to chuse a dry Ground, whose Situation is high, and
+which admits a free Current of Air, such as on the Banks of Rivers,
+where there is generally a Stream of fresh Air, and Plenty of fresh
+Water to supply the Camp[137]; taking Care to avoid the Neighbourhood
+of low marshy Grounds, and corrupt stagnating Waters, especially in
+Summer, and in hot Climates.
+
+    [137] Dr. _Pringle_ observes, that where Grounds are equally
+    dry, that the Camps are always most healthful on the Banks of
+    large Rivers; because in the hot Season Situations of this
+    Kind have a Stream of fresh Air from the Water, tending to
+    carry off both the moist and putrid Exhalations.--And in
+    Cantonments we are not only to seek Villages removed from
+    marshy Grounds, but such as are least choaked with
+    Plantations, and stand highest above subterraneous Water. See
+    his _Observat. on Diseases of the Army_, 3d edit. p. 99.
+
+When Necessity obliges Commanders to take Post, or encamp in a wet or
+marshy Ground, they should endeavour to make it as dry as possible, by
+ordering Trenches to be cut for Drains across the Field and round the
+Mens Tents; to see that the Ground within the Tents be well covered
+with Straw; to order the Tents to be struck at Mid-Day, in dry warm
+Weather, and the Men to dry and air the Straw, and change it
+frequently; to have a proper Supply of Blankets for the Men, and to
+take Care that they be well cloathed, especially those who go upon
+Duty in the Nights; and, in the northern Climates, to have Fires in
+proper Places for warming the Men and drying their Cloaths, and for
+correcting the Dampness of the Air[138].
+
+    [138] The Negroes on the Coast of _Guinea_, and some of the
+    _Indians_, both of whom sleep on the Ground, have constantly
+    a Fire producing a little Smoak burning in the Hutts where
+    they sleep, which corrects the Moisture of the Night, and
+    renders the Damp of the Earth less noxious; and during the
+    Time of the very unwholesome Fogs on the Coast of _Guinea_,
+    called Harmattans, which lay waste whole Negroe Towns, the
+    Smoak of Wood, of pitched Staves, and such Things, are found
+    to be the best Correctors of this thick Air. See Dr. _Lind’s
+    Means of preserving the Health of Seamen_.
+
+In Countries lying under the Torrid Zone, the Parts near the Sea Shore
+are often marshy, or close and covered with Wood, or have swampy
+Beaches, and are very unwholesome; and therefore where Soldiers aboard
+of Transports keep their Health, Commanders ought to be very careful
+not to allow them to land, till they come to the Place of their
+Destination. Dr. _Lind_ observes, that Men commonly live more healthy
+in warm Climates at Sea, where the Air is dry and serene, and the Heat
+moderated by refreshing Breezes, than when they arrive in Harbours, or
+get within Reach of the noxious Vapours which arise from many Parts of
+the Land[139].
+
+    [139] Dr. _Lind_ says, that it is constantly observed in
+    unhealthy Harbours, that the Boats Crews employed in wooding
+    and watering the Ships, who are obliged to lie on Shore,
+    suffer most. _Ibid._ p. 72.
+
+When Necessity requires Parties to be landed for Wood or Water, or on
+other Duties, they should always be obliged to return and lie aboard
+at Night; and if that cannot be done, they should be cautioned to
+avoid lying down to sleep on the Grass, where the Air is fresh, or
+they are exposed to the Dews; and to pitch their Tents on a rising
+Ground, covered with Straw or dried Reeds, and a Blanket; and to use
+the other Precautions necessary for encamping in these warm Climates;
+for where this Care has been neglected, the Consequences have
+frequently proved fatal[140].
+
+    [140] A very remarkable Instance of this we have related by
+    Dr. _Lind_. In the Year 1739, in _Mahon_ Harbour, a Party of
+    Men were sent with the Coopers from Admiral _Haddock_’s Fleet
+    to refit and fill the Water Casks, who, finding an artificial
+    Cave dug out of a soft sandy Stone, put their bedding into
+    it; every one who slept in this damp Place was infected with
+    the Tertian Fever, then epidemic in _Minorca_, and not one in
+    eight recovered. At the same Time the Men aboard the Ships
+    continued healthy; and others, who were afterwards sent on
+    the same Duty, enjoyed perfect Health by being obliged to
+    sleep in their respective Ships. He says, he has known a
+    whole Boat’s Crew seized next Morning with bad Fevers by
+    sleeping near the Mangroves, with which the Sides of the
+    Rivers are frequently planted in the Torrid Zone. _Ibid._ p.
+    74, 75.
+
+On unhealthful Coasts, the noxious Land Vapours often affect the Crews
+of Ships that run up into Rivers or Harbours, and cause great
+Sickness; and therefore in such Places Ships should anchor at as great
+a Distance from the Shore as can well be done, that they may be
+exposed to the Sea Breezes, and as much to the Windward of the Woods
+and Marshes as possible; and if the Anchorage is safe, one should
+prefer the open Sea to running up into Rivers or Creeks[141].
+
+    [141] The higher that Ships sail up the Rivers upon the Coast
+    of _Guinea_, the more sickly they become: Such, however, as
+    keep at Sea beyond the Reach of the Land Breezes (that is,
+    two or three Leagues at Sea), are for the most part healthy.
+    _Lind_, _ibid._ p. 65. The Malignity of these Land Vapours
+    often does not extend itself to any considerable Distance, as
+    we know by manifold Experience. The Troops in _Zealand_ were
+    very unhealthy when Admiral _Mitchel_’s Squadron, which lay
+    but a little Way from the Shore, enjoyed perfect Health.--Dr.
+    _Pringle’s Observat. on the Diseases of the Army_, p. 1.
+    chap. vii.--In _July_ and _August_ 1744, two Ships, belonging
+    to Admiral _Long_’s Squadron in the _Mediterranean_, lying
+    near the Mouth of the River _Tyber_, began to be affected,
+    while others, though at a very small Distance, but further
+    out at Sea, had not a Man sick. _Lind_, _ibid._ p. 66.
+
+Cleanness and Neatness in the Camp is another Article that ought to be
+particularly regarded. _Portius_, _Ramazini_, and most other Authors
+who treat of Camp Diseases, attribute those of the putrid Kind in a
+great Measure to the Stench and putrid Effluvia arising from the
+Excrements of Men and Beasts, and from the dead Bodies of Men, Horses,
+and other Animals, lying unburied in the Neighbourhood of Camps, and
+have in a particular Manner mentioned the Necessity of burying such
+putrid Substances. Dr. _Pringle_ has very justly recommended the
+Digging of Deep Pits for Privies in Camp, and covering the Excrements
+with Earth daily[142] till the Pits are near full, and then to fill
+them up with Earth, and dig new ones; and to punish every Person who
+shall ease himself any where in Camp but in the Privies: And he
+remarks, that when the Camp begins to turn unhealthy, that often the
+only Means that will preserve the Health of the Men, is to change the
+Ground, and to leave behind all the Filth and Nastiness which gave
+Rise to those putrid Disorders.
+
+    [142] The divine Lawgiver _Moses_ has enjoined Cleanliness in
+    the Camp to the _Jews_ in a particular Manner, when he says,
+
+    “Thou shalt have a Place also without the Camp, whither thou
+    shalt go forth abroad; and thou shalt have a Paddle upon thy
+    Weapon, and it shall be when thou wilt ease thyself abroad
+    thou shalt dig therewith, and shalt turn back and cover that
+    which cometh from thee. For the Lord thy God walketh in the
+    Midst of thy Camp; therefore shall thy Camp be holy, that he
+    see no unclean Thing in thee, and turn away from thee.”
+    _Deuteronomy_, chap. xxiii. verses 12, 13, 14.
+
+In fixed Camps, the striking the Tents at Mid-Day in fair Weather,
+and turning and airing the Straw, and changing it often, as
+recommended by Dr. _Pringle_, will contribute much to preserve the
+Health of the Men; and making the Men wash themselves daily, and
+change their Linen often, and keep themselves otherwise clean, ought
+never to be omitted by the Officers.
+
+All military Authors have recommended to Commanders always to have
+Straw for their Men when they come to their Ground, if possible; and
+to have the Army well supplied with Provisions; giving proper
+Encouragement to the Country People, and to Suttlers and Merchants of
+all Sorts, to bring in every Kind of Provisions and other Necessaries
+to Camp; and preventing, as much as possible, the Soldiers from
+moroding. And the Commanders of every Corps ought to take Care that
+their Men form themselves into Messes, and that Stoppages be made for
+buying them Provisions.
+
+In _Germany_ every Regiment of the _British_ Troops contracted with a
+Butcher, who was obliged to carry along with them, at all Times, a
+certain Number of live Sheep and Oxen to kill when wanted, and to sell
+the Meat at a fixed Price. Every Soldier was obliged to take a certain
+Quantity, which was paid for by Stoppages made in his Pay; and this
+Meat was boiled in the Camp Kettles, with such Roots and Greens as
+could be got; by which Means the Men, whenever they could use their
+Kettles, had always a good warm Soop, as well as Meat, to refresh them
+after their Fatigues, which, along with their Ammunition Bread, made a
+good wholesome Food.
+
+In Countries where Fruit is plentiful, a certain Quantity of what is
+fully ripe, distributed to the Men in warm Weather, and in hot
+Climates, will contribute to preserve their Health, though the Abuse
+of it will prove prejudicial; but unripe and acrid Fruits are always
+hurtful[143].
+
+    [143] The _British_ Soldiers in _Germany_ used sometimes to
+    hurt their Health by eating great Quantities of raw unripe
+    Apples, Plumbs, and other unripe Fruits; but the foreign
+    Troops had a much better Method of using such Fruits: They
+    commonly boiled or stewed them, and eat them with Bread, or
+    with their Meat, which in a great Measure corrected their bad
+    Qualities.
+
+    The Orders in the _French_ Camp, prohibiting the Men from
+    eating unripe Fruit, were strictly complied with every-where
+    in _Germany_ during the late War.
+
+Water is another Article which Commanders endeavour to have their Camp
+well supplied with, and therefore they generally encamp near Rivers or
+Rivulets. Where the Stream is small, Care ought to be taken that its
+Course be not interrupted, and that no Filth or Nastiness, or any
+Thing that will spoil or corrupt the Water, be thrown into it.
+
+When there are no Rivers or Rivulets near a Camp, and the Men are
+supplied from Wells, if the Water is not pure, very often the digging
+of deep Pits, and covering the Bottom and Sides with large Stones, and
+over these a Lay of Sand, Gravel, or Chalk, will make the Water pure
+in a few Hours.
+
+In fixed Camps, where the Water is bad, _Portius_[144] proposes
+straining it thro’ Sand, and has given Figures of Machines to be used
+for that Purpose; but the Method proposed by Dr. _Lind_ is still more
+simple, which is, to get a broad Cask with one End struck out; then
+put a longer Cask, with both Ends struck out, in the Middle of it;
+fill the short Cask one-third with Sand, and the inner longer Cask
+above one-half; fill the Rest of the inner Cask with the Water, which
+will filter through the Sand, and rise above the Sand in the outer
+Cask, where it may be allowed to run off into Vessels placed to
+receive it, by Means of a Cock, put into the Side of the outer Cask,
+fifteen or twenty Inches above the Level of the Sand.
+
+    [144] See the Treatise published by Dr. _Luc. Anton. Portius_
+    in 1686, _de Militis in castris sanitate tuenda_, _part._ ii.
+    _cap._ vi. In this Book we have many useful Things mentioned
+    relative to the Health of Soldiers.
+
+Where there are no such Conveniences for purifying the Water, what is
+used for Drink ought to be mixed with a small Proportion of Spirits,
+or Wine, or with Vinegar, or Cream of Tartar, when neither of the
+other two can be got; and if the Water be previously boiled, it will
+be so much the better.
+
+In Expeditions into warm Countries, where fresh Water is difficult to
+be had, a few Stills, with a proper Apparatus, ought to be carried
+out; and after a Landing is made, the Stills ought to be set to work
+for distilling fresh Water from Sea Water in the Manner mentioned by
+Dr. _Lind_[145]; and although a sufficient Quantity cannot be
+distilled for serving the whole Army, yet enough may be got in this
+Way for the Use of the Sick.
+
+    [145] Dr. _Lind_ relates a Number of Experiments of his
+    having distilled Sea Water in different Manners, as
+    recommended by others; and concludes, that the best Way of
+    getting fresh Water from Salt, is to distil the Sea Water by
+    itself, without any Mixture; and he proposes having a Still
+    Head to the Coppers or Iron Pots in which the Meat is dressed
+    aboard a Ship. _Ibid. note to p. 84_, &c.
+
+When Men are very warm, after long Marches, and other hard Duties, in
+Summer; Officers should endeavour to prevent their swallowing
+immediately great Quantities of cold Water, and persuade them to wait
+a little till they cool; and at such Times, if Spirits can be got
+easily, to order a small Quantity to be mixed with the Water in each
+Man’s Canteen.
+
+Though the Abuse of vinous and spirituous Liquors is very destructive
+to the Constitution, yet these same Liquors, given in Moderation to
+Soldiers on Service, during the Times of great Fatigues, are some of
+the best Preservatives of Health. Spirits, for common Use, ought to
+be mixed with Water; and in the hot Climates made into Punch; though
+in very cold and wet Weather, and in damp Nights, a Glass of pure
+Spirits, given to the Men going on Duty, is of great Service; for it
+is always observed, that Men are much less apt to catch Diseases from
+being wet when they are upon a March, or at hard Work, than when they
+stand Centinels, or are upon Out-Posts where they move but little, or
+when they lie down in their wet Cloaths; and that they are less liable
+to be affected by the Weather after a hearty Meal, or drinking a Glass
+of Spirits, or some generous Liquor, than when their Stomachs are
+empty.
+
+An Infusion of Bark or other Bitters, and of Garlick, in Spirits, has
+been found to encrease their Efficacy as Preservatives both against
+the Effects of Cold and malignant Distempers. Dr. _Lind_ has
+recommended an Infusion of Garlick in Spirits as one of the best
+Stomachics and Diaphoretics he knows in cold wet Weather. And many
+have recommended a Tincture of the Bark[146]: Towards the End of the
+Year 1743, Mr. _Tough_, one of the Apothecaries to the _British_
+military Hospital in the late War, then a Mate to a marching Regiment,
+was ordered to go down the _Rhine_ with a Party of Sick, who had the
+Seeds of the Hospital Fever among them, and were to go in Bilanders,
+from _Germany_ to _Flanders_. Having had a Cask or two of Brandy put
+aboard as Part of the Stores for the Sick, he was afraid lest the Men
+should make too free with the Spirits; to prevent which he threw in a
+Quantity of Bark into each Cask, and gave the Men regularly, Morning
+and Evening, a Glass of this bitter Tincture. At the same Time, the
+Men were kept extremely clean. By these Means most of the Sick mended
+upon the Passage, without the Malignant Fever appearing again amongst
+them; whereas, Dr. _Pringle_, who takes Notice of the other Parties
+who came from the same Hospitals in _Germany_, tells us, that the
+Malignant Fever broke out in a violent Degree, and Half the Number
+died by the Way, and federal others soon after their Arrival[147].
+
+    [146] During the Campaign in _Hungary_, in the Year 1717,
+    Count _Boneval_ preserved both himself and Family from
+    Disorders, by taking himself, and making all his Domesticks
+    take, two or three Times a Day, a small Quantity of Brandy,
+    in which Bark had been infused, at a Time when all the Rest
+    of the Army were infected with malignant Disorders. A
+    Regiment in _Italy_ continued healthy by the Use of the Bark,
+    when the Rest of the _Austrian_ Army, who did not pursue the
+    same Method, were greatly annoyed with Sickness. See
+    _Kramer._ quoted by Dr. _Lind_.
+
+    [147] _Observat._ part. i. chap. iii.
+
+Commanding Officers ought always to endeavour to proportion the Time
+the Men are to be upon Duty to the Weather and the Nature of the
+Climate. The Time of standing Centinel in very hard Frost, and in cold
+wet Weather, or in the Heat of the Day in Summer, when the Weather is
+very warm, and in hot Climates, ought to be shorter than when the
+Weather is dry and more temperate.
+
+The Marches of Troops ought, if possible, during the Time of very hot
+Weather, to be made either very early in the Morning, in the Evening,
+or at Night; and Officers, during the Course of an active Campaign,
+ought to spare their Men as much as possible.
+
+And when they are in Quarters, and have nothing to do, they should
+narrowly inspect into their Manner of living; and have them out daily,
+when the Weather will permit, and exercise them, or march them two or
+three _English_ Miles a-Day, in order to prevent their falling sick
+for want of Exercise; for Soldiers left to themselves are very subject
+to Diseases when they come into Quarters after an active Campaign, by
+leading too indolent a Life, if Officers do not take Care to prevent
+it. However, at such Times, the Exercise ought to be moderate, and the
+Men should not be brought out in wet Weather.
+
+
+
+
+OF MILITARY HOSPITALS.
+
+
+Whenever Men are seized with Distempers, they ought immediately to be
+separated from those in Health, and either sent to the Regimental[148]
+or General Hospital.
+
+    [148] Some of the regimental Surgeons in _Germany_, when they
+    took the Field, had always some spare Tents carried along
+    with their Medicine Chests; and when any of their Men fell
+    sick in Camp, and they could get no House for a regimental
+    Hospital in Villages, they ordered these Tents to be pitched,
+    and had the Ground within well covered with Straw and
+    Blankets, and then put the Sick into them, and there took
+    Care of them till they found an Opportunity of sending them
+    to the Flying Hospital.
+
+There is no Part of the Service that requires more to be regarded than
+the Choice of proper Places for Hospitals, and the right Management
+of them, on which the Health and Strength of an Army often depends;
+for in wet unwholesome Seasons, if infectious Disorders get into the
+Hospitals, which possibly might have been prevented by proper Care,
+they often weaken an Army in a very short Time far more than the Sword
+of the Enemy.
+
+We have no Account of the particular Manner in which the Antients took
+Care of their Sick and Wounded in Times of War; for although we read
+in _Homer_[149] of Surgeons or Physicians attending the _Grecian_
+Camp, and in _Xenophon_[150] of _Cyrus_’s having appointed Physicians
+to his Army; and we learn from _Tacitus_[151] and _Livy_[152], that
+the wounded _Romans_ were received into the Houses of the Nobility,
+and had Physicians to attend them, and were furnished with
+Fomentations and other proper Remedies; and from _Justin_[153], that
+the _Lacedemonians_ followed the same Method: yet these Authors make
+no Mention of the particular Oeconomy or Manner in which these
+Hospitals were conducted.
+
+    [149] _Homer_ mentions _Podalirius_ and _Machaon_, sons of
+    _Æsculapius_, as two excellent Physicians or Surgeons in the
+    _Grecian_ Army. Vid. _Iliad_, lib. ii. Physic and Surgery
+    were antiently exercised by the same Persons.
+
+    [150] Vid. _Xenophon. de Institut. Cyri._ lib. i. et viii.
+
+    [151] _Tacitus_, after giving an Account of 50,000 People
+    being killed by the Fall of an Amphitheatre at _Fidena_,
+    during the Time of a Shew of Gladiators, has these Words:
+    “Ceterum post recentem cladem, patuere procerum domus,
+    fomenta & medici passim præbiti; suit urbs per illos dies,
+    quanquam mæsta facie veterum institutis similis, qui magna
+    post prælia saucios largitione & cura sustentabant.” _Vid.
+    lib._ iv. _Annal._ § 63.
+
+    [152] In _Livy_ we find the following Passage: “Neque immemor
+    ejus quod initio consulatus imbiberat, conciliandi animos
+    plebis, saucios milites curandos dividit patribus. Fabiis
+    plurimi dati, nec alibi majore cura habiti.” _Vid. lib._ ii.
+    cap. xlvii.
+
+    [153] _Justin_ mentions the same Thing of the _Spartans_
+    after their Defeat at _Sellasia_--“Patentibus omnes domibus
+    saucios excipiebant, vulnera curabant, lapsos reficiebant.”
+    _Vid. lib._ xxviii. cap. iv.
+
+The Hospitals commonly wanted for an Army acting on the Continent,
+are,
+
+1. One in the Rear, to follow their Motions, so as to be always ready
+to receive the Sick from Camp, which is called the Moveable or Flying
+Hospital. 2. One or more, at some Distance, in Towns, to receive such
+of the Sick as can be moved from the Flying Hospital, when they are
+obliged to go from one Place to another; or when a greater Number of
+Sick is sent to them than they can easily take Care of[154].
+
+    [154] When Parties of Sick or Wounded are to be sent from
+    Camp, or from one Hospital to another, Care ought to be taken
+    that they are placed properly in the Waggons; that they have
+    proper physical People, Nurses, &c. to attend them; as well
+    as Provisions, and other Necessaries, so as to be in no
+    Danger of wanting any Thing while they are on their Journey.
+
+Each of the Hospitals ought to be provided with Physicians, Surgeons
+Mates, Purveyors, or Commissaries, and others, to attend and take Care
+of the Sick.
+
+Besides the physical People who attend the Hospital, one or two
+Physicians ought to go along with the Army to attend the Commander in
+Chief, and the General and Staff Officers, in Case of Sickness; and an
+Apothecary, provided with a small Chest of Medicines, ought to attend
+at Head Quarters to make up the Prescriptions of the Physicians.
+
+A Number of Hospital Surgeons also, with Mates, ought to attend the
+Army, to be ready in Case of an Action. These ought to be attached to
+the Suite of the Commanders of the different Corps or Brigades, and to
+be quartered or encamped with them. And each Surgeon should be
+provided with a Waggon or some Horses loaded with a proper chirurgical
+Apparatus, as Instruments, Bandages, Lint, and other Things necessary
+for taking Care of the Wounded.
+
+A small Quantity of Medicines, some Wine, Rice, portable Soop, &c. and
+Utensils for a small Hospital, and two, three, or four hundred Sets of
+Bedding, should be carried about with the Army, in Case of an Action,
+for the Use of the Wounded, till they have Time to receive Assistance
+from the Flying Hospital. Some of the Bedding ought to be carried on
+Horseback, so as to be at Hand when any of the Surgeons are sent with
+Detachments that are going upon an Attack.
+
+To prevent crowding the General Hospitals in Winter Quarters, every
+Regiment ought to take Care of their own Sick, and to have proper
+Hospitals fitted up for them.
+
+Dr. _Pringle_ has laid down some very good Directions with regard to
+the Choice of Places fit for Hospitals, and the Method of preventing
+infectious Disorders in them; and we find many excellent Hints of this
+Kind in Dr. _Lind_ and Mons. _du Hamel_’s Treatises on the Means of
+Preserving the Health of Seamen, and some likewise in Dr.
+_Brocklesby_’s late Treatise on military Disorders.
+
+In the Time of Service the Commander in Chief generally orders the
+Hospitals to be established in Towns or Villages that least interfere
+with the military Operations, to which the Sick and Wounded can most
+easily be conveyed; and which he can best protect from the Insults of
+the Enemy[155].
+
+    [155] The _Roman_ Generals seem to have sent their Sick and
+    Wounded into Towns, in the same Manner as is done by those of
+    the present Time. For we read in _Cæsar’s Commentaries_ of
+    this Method having been practised on more Occasions than one.
+    In the sixty-second Chapter of the third Book, _de Bello
+    Civili_, we have the following Passage: “Itaque nulla
+    interposita mora, sauciorum modo & ægrorum habita ratione,
+    impedimenta omnia silentio prima nocte ex castris _Apolloniæ_
+    præmisit, ac conquiescere ante iter confectum vetuit. His una
+    legio missa præsidio est.”--And immediately after, in chap.
+    lxv. “Itaque præmissis nunciis ad Cn. Domitium Cæsar
+    scripsit, & quid fieri vellet ostendit: præsidioque
+    _Apolloniæ_ cohortibus iv. _Lissi_ i. tres _Orici_ relictis;
+    quique erant ex vulneribus ægri depositis; per Epirum atque
+    Arcarniam iter facere cæpit.”
+
+    And in the twentieth chapter, _de Bello Africano_, we read:
+    “_Labienus_ saucios suos, quorum numerus maximus fuit, jubet
+    in plaustris deligatos _Adrumentum_ deportari.”
+
+    It would be a right Measure, in the Beginning of every War,
+    to settle by a Cartel that military Hospitals on both Sides
+    should be considered as Sanctuaries for the Sick, and
+    mutually protected; as was agreed upon between the late Earl
+    of _Stairs_, who commanded the _British_ Troops, and the Duke
+    _de Noailles_, who commanded the _French_ in the Campaign in
+    _Germany_ in the year 1743. See _Dr. Pringle’s Preface_.
+
+In Towns, the Places fittest for Hospitals are public Buildings, which
+have large dry airy Apartments, situated on a high Ground, where there
+is a free Draught of Air, and a Command of Water.
+
+In Winter, those Houses, which have open Fire Places in the Rooms, are
+always preferable to such as have close Stoves, or no Fire Place at
+all; for an open Fire Place serves to keep up a free Circulation of
+Air in a Room, as well as to keep it warm. And for the same Reason,
+where nothing but Stoves can be got to warm the Wards, the Wynd
+Stoves, which open into the Room or Ward, are vastly preferable to the
+close ones.
+
+Where there are no public Buildings, private Houses answering nearest
+to the above Description are most proper for Hospitals. In general,
+Houses with small Rooms make but bad Hospitals; and very Damp and
+close Places ought by all Means to be avoided.
+
+In Summer, when the Moveable or Flying Hospital is ordered into
+Villages, large Barns, and the largest airy Houses, are the best.
+
+Churches, situated on a dry high Ground, make good Summer Hospitals;
+and in Winter, when Necessity obliged us sometimes to use them in
+_Germany_ for this Purpose, they were found to answer very well, when
+we had Bedsteads or Cradles for the Men to lie upon, and the Wynd
+Stoves to keep them of a moderate Heat.
+
+In making Choice of Houses for Hospitals, particular Regard ought to
+be had to the Privies or Necessaries; because, where their Smell is
+offensive, there is always Danger of infectious Disorders. If,
+therefore, there be no proper Conveniencies of this Kind about an
+Hospital, such ought to be contrived so as to prevent any Danger from
+their putrid Effluvia. If there be a River near the Hospital, the
+Necessaries may be made above it at a Place where there is a rapid
+Stream below. In Villages deep Pits may be dug in the Ground behind
+the Hospital, and Seats made over them, as in Camp; and a thick Lay of
+Earth be thrown above the Fœces every Morning, till the Pits are near
+full, and then they must be filled up, and others dug to supply their
+Place.
+
+When once the Places are fixed upon for Hospitals, every Ward ought to
+be made perfectly sweet and clean; first, by scraping and washing with
+Soap and Water, and afterwards with warm Vinegar; and then they ought
+to be fumigated with the Smoke of wetted Gunpowder and of Aromatics,
+and afterwards well dried and aired by lighting Fires, and opening
+the Windows, before any Sick are admitted.
+
+After this the Beds ought to be laid; in doing of which great Care
+should be taken not to crowd the Wards too much, as nothing corrupts
+the Air so much, or so soon brings on infectious Disorders. Dr.
+_Pringle_ says, the Beds ought to be laid so thin, that a Person
+unacquainted with the Danger of bad Air, might imagine there was Room
+for double or triple the Number. In high lofty Apartments, and in
+Churches, and other large Places, the Beds may be laid much closer
+together than in Rooms with low Cielings. In Churches, or such Places,
+thirty-six square Feet, or a Square of six Feet by six, may be allowed
+for each Man; but in common Wards we must allow from forty-two square
+Feet, _i. e._ six by seven Feet, to sixty-four square Feet, or eight
+by eight, according to the Height of the Cieling, the Airyness of the
+Place, and the Nature of the Diseases of the Patients.
+
+The Bedding most fit for Hospitals, is Palliasses and Bolsters filled
+with Straw, Sheets, and Blankets, as they can easily be washed.
+Feather Beds and Matrasses are apt to retain Infection, and cannot be
+easily cleansed. In the fixed Hospitals, Bedsteads or Cradles may be
+set up for laying the Bedding on: But in the Moveable or Flying
+Hospital the Bedding must be, for the most part, laid on the Floor.
+
+When once the Beds are laid, and the Sick arrive, some of the
+Gentlemen belonging to the physical Department ought to attend, to
+distribute the Sick properly through the Hospitals.
+
+All the Surgery Patients, such as have Wounds, Ulcers, Sores, the
+Venereal Disease, &c. should be separated from the Rest, and put
+either into particular Wards by themselves, or into an Hospital fitted
+up for that Purpose under the Direction of the Surgeons.
+
+Those labouring under infectious Fevers and Fluxes, should each of
+them be placed in good airy Wards by themselves, where the Beds are
+laid much thinner than in the other Wards of the Hospital. If the Flux
+Wards have a Privy near them, where the Men can ease themselves,
+without being offensive either to their own Ward, or any other Part of
+the Hospital, they are so much the fitter for such Patients. In the
+Hospital I attended at _Bremen_, the Flux Ward had a Necessary that
+opened into the River _Weser_, and at _Natzungen_ a deep Pit was dug
+in the Field about twenty Yards from the Barn where the Flux Men lay,
+which kept these Wards always sweet.
+
+Patients that have got the Itch, or any other infectious Distemper,
+ought likewise to be put into separate Wards by themselves; and at all
+Times a Place should be set apart for those who may be taken ill of
+the Measles or Small-Pox. A House separated from the other Hospitals,
+with a distinct Set of Nurses and other Attendants, bids fairest to
+prevent the Infection from spreading.
+
+When once the Sick are properly ranged, the next Care must be to
+prevent infectious and malignant Disorders from being generated, and
+from spreading amongst the Sick; which is principally to be effected
+by keeping the Sick and the Hospital extremely clean and well-aired,
+and the Wards as sweet, and free from putrid and offensive Smells, as
+possible.
+
+Every sick Man, as soon as he arrives at an Hospital, should be washed
+with warm Water, or if there is a warm Bath, or bathing Tub, to be put
+into it; and afterwards be supplied with a clean Shirt[156] well-aired
+before he be put to Bed; and his own dirty Linen should be immediately
+carried to the Wash-House: And every Morning each Nurse ought to carry
+a Bucket full of warm Water, and a Piece of Soap and a Towel, round to
+each of her Patients, and make them wash their Hands and Face, and
+their Feet, when dirty.
+
+    [156] Every military Hospital ought to have a Number of
+    Shirts belonging to it, for the Use of the Sick who arrive
+    without having clean Linen with them. As soon as their own
+    Shirts are washed and dried, or that new ones are provided by
+    their Regiments, the Hospital Shirts ought to be taken from
+    them.
+
+Every Morning all the Wards ought to be scraped and swept, and
+afterwards sprinkled with warm Vinegar; and when dirty, they ought to
+be washed after the Fires are lighted.
+
+Every Thing in the Wards, and about the Sick, should be kept as clean
+as possible; the Chamber-Pots and Close-Stools ought to be carried
+away as soon as used, and immediately emptied and washed before they
+be brought back.
+
+The Windows of the Wards ought to be kept open to admit fresh Air
+Morning and Evening, for a longer or shorter Time, according as the
+Weather will permit.
+
+If the Wards are close, and the Cieling too low, Dr. _Pringle_ advises
+to remove some Part of them, and to open the Garret Story to the
+Tiles[157]; and if the Opening of the Windows is not sufficient to
+air the Wards, Ventilators of different Kinds, such as those mentioned
+by Dr. _Hales_ and Dr. _Pringle_, may be used, especially when the
+Weather is hot.
+
+    [157] In Wards which are too close, it has been found that
+    one or two square Holes (of about six or eight, or ten Inches
+    diameter), cut in the Cieling, and a Tube made of Wood fitted
+    to it, and carried up into the Chimney of the Ward above, so
+    as to enter above the Grate, is one of the best Contrivances
+    for procuring a free Circulation of Air; as the foul Air,
+    which is lightest, and occupies the highest Part of the Ward,
+    finds a free Exit by these Tubes: We have such Tubes now
+    fixed in several of the Wards in _St. George_’s Hospital. A
+    Hole cut above the Door of the Ward, or in the upper Part of
+    the Windows, and one of what are called the _Chamber
+    Ventilators_ fixed in it, will answer, where Holes cannot be
+    conveniently cut in the Cieling.
+
+In Winter, Fires should be lighted in all the Wards where it can be
+done.
+
+In foreign Countries, when we meet with Hospitals where there are no
+Places for open Fires, but only close Stoves, different Contrivances
+may be used to renew the Air. Ventilators of different Kinds may be
+used, or Openings made in the Doors and Windows. In Winter 1761-62,
+some of the Wards in the Hospital at _Bremen_ which I attended had
+such Stoves. In order to keep up a free Circulation of Air in those
+Wards, I directed large Holes to be cut in the lower Part of the Door
+in each Ward, and two Grooves to be made on the Outside of the Door,
+above and below the Hole, parallel to each other, in which a Board
+slided; by means of which, the Hole could be either quite covered or
+only in Part, or left entirely open; and I directed a Casement, about
+eight or nine Inches square, to be made in the upper Corner of each
+Window. After the Fires were lighted, upon removing the Board which
+covered the Hole in the Door, and opening the little square Windows, a
+Current of fresh cool Air rushed into the Ward by the Door, while the
+heated foul Air found an Exit by the Windows. In very cold Weather,
+the Opening of the small Windows was sufficient; but in mild Weather,
+and in Summer, it was necessary to keep both open.
+
+The Wards should be daily fumigated by Means of Aromatics, or wetted
+Gunpowder thrown on burning Coals, put in an Iron Pot or Chaffern, or
+with the Steams of warm Vinegar placed in the Middle of the Ward. Dr.
+_Lind_ says, that although Cleanliness and a pure Air contribute much
+to prevent infectious Disorders, or to check them, yet that they of
+themselves are not always sufficient; but that he seldom or never knew
+a proper Application of Fire and Smoke to be unsuccessful in producing
+the happy Consequence of effectually purifying all tainted Places,
+Materials, and Substances[158].
+
+    [158] Dr. _Lind_ tells us, that the Ships of War in his
+    Majesty’s Service are purified by Fire and Smoke, and gives
+    the Process by which it is done; and he says, that he never
+    heard of any Ship, which, after being carefully and properly
+    smoked, did not immediately become healthy for the Men.--See
+    _First Paper on Fevers and Infection_.--And he observes, that
+    these Steams and Smoke, which are inoffensive to the Lungs,
+    besides correcting the bad Quality of the Air, produce
+    another good Effect; which is, to make both the Patients and
+    Nurses desirous of opening the Doors and Windows for the
+    Admission of fresh Air. _Ibid._ p. 51.
+
+In all Military Hospitals, at least in the fixed ones, one Ward ought
+to be always kept empty; and whenever a malignant Fever, or any other
+infectious Disorder, breaks out in any Ward, the Men ought to be
+removed into this empty one; and the foul Ward purified, by washing
+and cleaning it well with Soap and Water, and then with warm Vinegar;
+and afterwards purifying it with Smoke, in the same Manner as is
+practised in his Majesty’s Ships of War; and Fires should be lighted
+daily, and the Windows kept open for some Time, before any Sick be
+again admitted into it.
+
+As soon as any Patient dies, the Body ought to be removed to the Dead
+House; and the Bedding he lay upon should be carried away immediately,
+and not used again till it has been smoked, well-aired, and washed.
+
+All the Linen of Patients in Fevers, Fluxes, and other infectious
+Disorders, ought to be changed often; and all the foul Linen and foul
+Bedding of the Hospital should be smoked with the Fumes of Brimstone,
+or of wetted Gunpowder, in a Place set apart for that Purpose; and Dr.
+_Lind_ advises to steep them first in cold Water, or cold Soap Lees,
+before putting them in warm Water; as it is dangerous for any Person
+to receive the Steam that may at first arise, where this Precaution is
+not used.
+
+All the Cloaths, of Soldiers who die in Hospitals, ought to be sent to
+the Smoke House, and be well fumigated, and afterwards aired, before
+they are put up in the Store-House.
+
+The next Thing to be considered about a Military Hospital is the Diet
+of the Patients, which should consist of good wholesome Provisions,
+that can be purchased easily, and at a cheap Rate[159].
+
+    [159] The _French_, and many other Nations, give their
+    Patients Meat Soops in acute Diseases, and after capital
+    Operations; and they allow them but little Bread or other
+    Preparations of Vegetable Substances: But these Meat Soops
+    without Bread do not nourish the Patient sufficiently, and
+    tend too much to the Putrescent; and this is one Reason why
+    more Sick die in the _French_ than in the _British_
+    Hospitals.
+
+Good Bread[160] is a standing Article of Provisions for an Hospital in
+all Countries and in all Climates; and a certain Quantity of it ought
+to be distributed to each Man daily.
+
+    [160] On Expeditions where a Siege is expected, a Quantity of
+    Flour ought to be carried out, and a Number of portable Ovens
+    for baking bread for the Sick, which may be put up after the
+    Troops have made good their Landing.
+
+The Breakfast and Supper in most Military Hospitals must be made of
+Water Gruel or Rice Gruel; as either Rice or Oatmeal can be got in
+most Places, and are very portable.--Water Gruel is in general
+preferable to the Rice Gruel, because most Patients nauseate the Rice
+Gruel, after eating it for some Days, but not the Water Gruel, as
+every Person, who has attended the Military Hospitals, must have
+experienced. Where both Rice and Oatmeal can be had, Rice Gruel may
+be used two or three Times a Week by Way of Variety.
+
+But although Rice Gruel is not so proper for constant Use, yet Rice
+should always make an Article among the Stores for an Hospital, as it
+is useful for making Rice Water for Drink; and it can be boiled or
+ground, and made into a light Pudding, and in short may be used in a
+Variety of Forms to make a good and wholesome Food for the Sick.
+
+Oatmeal is cheaper than Rice, and can be procured almost every-where
+in _Europe_, where Armies make Campaigns; as Oats make such a great
+Article in the Forage for Horses. And a sufficient Quantity can at any
+Time be ground into Meal for the Use of the Sick, at the Mills which
+are employed for making Flour for the Bakery, if there be none nearer
+the Hospital.
+
+In Countries where neither Oatmeal nor Rice can be had, _Indian_ or
+some other Corn, which is known to be wholesome, and which the Country
+affords, may be employed in their Place.
+
+When fresh Meat can be got, the Men who are on full Diet, and the
+Nurses and other Servants about the Hospital, should have Meat for
+Dinner; and the Meat that is boiled for them ought to make Broth for
+the Sick who are kept on a low or middle Diet. Some Barley or Rice
+should be added to the Broth; and a small Quantity of Carrots,
+Turnips, or other Vegetables, boiled along with them, will make it
+more agreeable to the Taste.
+
+On Expeditions where nothing but salted Meat can be had, a Quantity of
+portable Soop should always be carried out for the Use of the Sick;
+which with Water and some Barley, and fresh Vegetables, when they can
+be got, will make a good Soop or Broth. On such Occasions, the Dinner
+ought to consist of Soop and Bread, or of light Puddings made of Flour
+or of Rice, of boiled Rice or Barley, or of Panado, &c.
+
+Nurses and recovered Men may be allowed salted Meat twice or thrice a
+Week.
+
+The common Drink of Military Hospitals ought to be Rice and Barley
+Water, with a small Proportion of Spirits and Sugar. Small Beer is a
+good Drink where it can be easily procured; as is Wine and Water, or a
+very small Negus, or very weak Punch in warm Climates.
+
+Besides this Diet, extraordinary Indulgences may be occasionally
+allowed to particular Patients, as Wine, Brandy, Sugar, Milk. And the
+Physicians and Surgeons ought to have a discretionary Power to order a
+Vegetable or any other proper Diet for Patients in the Scurvy, or any
+other particular Complaints.
+
+
+The Established Diet of a Military Hospital may be,
+
+                _Breakfast._         _Dinner._       _Supper._
+             One Pint of Water  |                |
+             or Rice Gruel.     |                |
+                                |                |
+             Water Gruel made   |                |
+             with 3 or 4 Ounces |                |
+             of Oatmeal, a      |                |
+             little common Salt,|One Pound       |
+             and with or without|of boiled fresh |
+  Full Diet, a little           |Meat.           |  As Breakfast.
+             Sweet Oil, and     |                |
+             two Spoonfuls of   |                |
+             Wine.              |                |
+                                |                |
+             Rice Gruel made    |                |
+             with two Ounces of |                |
+             Rice, one Spoonful |                |
+             of fine Flour, a   |                |
+             little             |                |
+             common Salt and    |                |
+             Sugar.             |                |
+  -----------------------------------------------------------------
+                                |One Pint of     |
+                                |Broth, half     |
+  Middle Diet, Ditto.           |Pound of boiled |  Ditto.
+                                |Meat.           |
+  -----------------------------------------------------------------
+                                |One Pint of     |
+                                |Broth, or       |
+  Low Diet,  Ditto, or according|half a Pint of  |
+             to the Patient’s   |Panado, with    |
+             Appetite.          |two Spoonfulls  |  Ditto.
+                                |of Wine,        |
+                                |and a Quarter   |
+                                |of an Ounce     |
+                                |of Sugar.       |
+
+
+The daily Allowance of Bread to be one Pound to each Man.
+
+The common Drink for those on full and middle Diet to be Rice or
+Barley Water, with two Spoonfuls of Brandy to each Pint, and a Quarter
+of an Ounce of Lump Sugar; small Beer, or very weak Punch; or Wine and
+Water, two Ounces of Wine to a Pint of Water, and a Quarter of an
+Ounce of Sugar. The Quantity not to exceed three Pints _per_ Day.
+
+Those on low Diet to have Rice or Barley Water as above, with or
+without Wine or Brandy.
+
+
+The Diet Boards hung up in the Hospitals may be made with the
+following Columns, nearly as they were with us in _Germany_.
+
+  Regiments.|Mens  |  Diet  |Wine.     |Brandy.|Milk.     |Sugar. |
+            |Names.|F.|M.|L.|½ Pints.  |Ounces.|½ Pints.  |Ounces.|
+  ----------+------+--+--+--+----------+-------+----------+-------+
+            |      |  |  |  |          |       |          |       |
+            |      |  |  |  |          |       |          |       |
+            |      |  |  |  |          |       |          |       |
+            |      |  |  |  |          |       |          |       |
+            |      |  |  |  |          |       |          |       |
+            |      |  |  |  |          |       |          |       |
+            |      |  |  |  |          |       |          |       |
+            |      |  |  |  |          |       |          |       |
+            |      |  |  |  |          |       |          |       |
+            |      |  |  |  |          |       |          |       |
+            |      |  |  |  |          |       |          |       |
+  ----------+------+--+--+--+----------+-------+----------+-------+
+
+When such Diet Boards are kept in an Hospital, and the Mens Names and
+Regiments are once wrote down, the Patients may with very little
+Trouble be put upon the full, middle, or low Diet, with so much of the
+above-mentioned Extraordinaries as may be judged proper.
+
+If any Thing else be wanted for the Sick, the Physician ought to give
+a particular Order in Writing for it, the Columns here marked being
+only for such Things as are most frequently wanted.
+
+It should be a general Rule in all Military Hospitals, that, when a
+Party of Sick arrives, every Man may have immediately a Mess of Water
+Gruel given him, and afterwards be put on low Diet till it is ordered
+otherwise by the Physician or Surgeon who attends him.
+
+It is not to be supposed that the Diet here mentioned can be strictly
+kept to in all Parts of the World; for it must often be varied
+according to the Difference of the Climates, and to the Provision of
+the Countries where the Scene of War may be.
+
+Whenever a Moveable or Flying Hospital is to attend an Army, a
+Quantity of Bedding, and of all Utensils for forming an Hospital,
+ought to be put up in the Waggons, together with Provisions of
+different Kinds, such as Oatmeal, Rice, Sago, Brandy, Wine, Sugar, &c.
+A Butcher with a Stock of live Cattle, and a Baker with a proper
+Quantity of Flour for making Bread ought constantly to attend; and a
+Number of empty Waggons should likewise be always in Readiness, to
+transport the Sick when the Hospital moves, or when a Party is to be
+sent to the fixed Hospitals.
+
+When Troops go upon an Expedition, besides the common Hospital Ships,
+another Ship ought to be properly fitted up for the Reception of sick
+Officers[161]; and every Hospital Ship ought to be supplied with all
+Sorts of Provisions, and other Necessaries fit for forming an
+Hospital, before they leave _England_.--And one or more armed Vessels
+loaded with Provisions, Wine, and all Sorts of Necessaries for the
+Sick, ought to attend them; or if the Expedition be intended for the
+warm Climates, these Vessels ought to go before the Fleet to take up
+Wine and Fruits, such as Lemons, Oranges, &c. Vegetables of different
+Kinds, and a live Stock for the Use of the Sick.
+
+    [161] If there be no Ship fitted up for the Reception of sick
+    Officers, those who are taken ill on Expeditions must be in a
+    most miserable Situation; as there is no Place to receive
+    them in the common Hospital Ships, they must remain almost
+    without Assistance in a crowded Cabin amongst People in
+    Health; as was the Case in some of our Expeditions during the
+    late War.
+
+All Hospitals attending Expeditions should carry out among their
+Stores a Number of large Tents for lodging the Sick and Wounded
+immediately on making good their Landing. Where a Siege is expected
+which will take up Time, and where no Accommodations for the Sick can
+be had till the Siege is over, a Ship or two, with Boards, and other
+Necessaries for building large Sheds, or temporary Hutts, for the
+Sick, as proposed by Dr. _Brocklesby_, ought to go along with the
+Fleet, or meet them at the Place of their Destination. Such thatched
+Sheds, or Hutts, are very necessary in the warm Climates, as the
+perpendicular Rays of the Sun, beating upon Canvass, make Tents
+intolerably hot. When any of our own Settlements happen to be near the
+Place attacked, a fixed Hospital may be established there; either in
+Houses, if proper ones can be found; or in temporary Sheds or Hutts
+erected for that Purpose; and some Vessels, properly fitted up, may be
+kept going with the Sick and Wounded, and bringing back the recovered
+Men.
+
+At every Military Hospital a Serjeant’s Guard ought to mount; and
+Centinels be placed at the Doors of the Hospital, 1. To prevent all
+Visitors, who have not proper Leave, from coming into the Hospitals;
+as such People oftentimes crowd the Wards, disturb the Sick, and are
+apt to catch infectious Distempers, and to spread them among the
+Troops. 2. To take Care the Patients do not go out of the Hospital
+without having a Ticket[162] of Leave for that Purpose, signed by the
+Physician, Surgeon, or Apothecary, belonging to the Hospital. 3. To
+prevent spirituous Liquors, or other Things of that Kind, being
+clandestinely carried into the Hospital.
+
+    [162] At every Hospital there ought to be a Number of printed
+    Tickets lying ready to be filled up and signed by the
+    Physicians and Surgeons, and no Man ought to be allowed to go
+    out without a Ticket so signed.
+
+The Serjeant of the Guard, attended by the Ward Master, ought, every
+Morning, to go round the Wards to call a Roll, and see that every Man
+is in his Ward; and to do the same at Night before the Hospital Doors
+are shut, and at this Time to order every Person out of the Hospital
+who does not belong to it. And the Serjeant, every Morning, ought to
+report to the Physician, Surgeon, or Apothecary, every Man’s Name who
+was found to be absent at Roll-calling; and whether he found every
+Thing regular and in good Order in going his Rounds.
+
+Every large Military Hospital ought to have one Head Nurse, and a
+sufficient Number of other Nurses, to attend and take Care of the
+Sick.
+
+Orders to the following Purport, hung up in every Military Hospital,
+would serve to shew the Nurses and Patients what their Duty is, and
+to maintain Regularity and good Order through the whole Hospital.
+
+
+_Matron, or Head Nurse._
+
+Every Matron, or Head Nurse, is to go round all the Wards of the
+Hospital at least twice a Day, Morning and Evening; to see that the
+Nurses keep their Wards clean; that they behave themselves soberly and
+regularly, and give due Attendance to their Patients; and to examine
+the Diet of the Patients, and see that it is good and well dressed;
+and if she finds any Thing amiss, to report the same to the Physician,
+Surgeon, or Apothecary, of the Hospital.
+
+
+_Common Nurses._
+
+1. The Nurses are to give due Attendance to their Patients; and to
+keep them always as neat and clean, as the Nature of their Distempers
+will admit of; to give them their Diet regularly; to be particularly
+careful to see them take the Medicines ordered by the Physicians,
+according to the Directions given; to report to the Physician,
+Surgeon, or Apothecary, any Faults or Irregularities which any of
+their Patients may have committed; and to acquaint the Ward Matter and
+Head Nurse of the Death of any of their Patients as soon as it
+happens, that proper Care may be taken of their Cloaths and Effects.
+
+2. They are to keep their Wards extremely clean, to sprinkle them
+every Morning with Vinegar, and to fumigate them with the Smoke of
+wetted Gunpowder, or of Frankincense, or any other Aromatics that may
+be thought proper; in fair Weather to keep open the Windows of their
+Wards, twice or thrice a Day; for a longer or shorter Time, as the
+Weather will permit; to attend at the Steward’s Room for the
+Provisions of the Patients at the Hours appointed for that Purpose;
+and to pay implicit Obedience to the Matron, or Head Nurse, in what
+relates to their Duty; and punctually to obey all Orders they receive
+from the Physician, Surgeon, or Apothecary, of the Hospital.
+
+3. They are to keep themselves clean and decently dressed, and to
+observe the strictest Rules of Sobriety; remembering, that if any one
+is found intoxicated with Liquor, that she is immediately to be sent
+to the Guard, and afterwards discharged.
+
+4. They are not to absent themselves from their Wards, unless when
+employed in the Discharge of their Duty; nor to go out of the Hospital
+to which they belong, without having a Ticket of Leave signed by the
+Physician, Surgeon, Apothecary, or Head Nurse, belonging to the
+Hospital.
+
+5. They are not to throw Nastiness of any Kind out at the Windows, but
+to carry it to the common Necessaries, and to empty the Chamber Pots
+and Close-stools as soon as used, and be careful to wash them before
+they bring them back.
+
+6. They are not, upon any Pretence whatever, to alter the Diet ordered
+by the Physicians or Surgeons to the Patients on the Diet Boards; nor
+to suffer their Patients to use any other Diet than what is allowed by
+the Hospital; nor are they to bring, or allow others to bring, Meat,
+spirituous Liquors, or other Things of that Kind, into their Wards,
+except what is allowed by the Physicians or Surgeons. Whenever any
+Thing of this Kind is found in any of the Wards, it ought immediately
+to be thrown into the common Necessary; and if it be found in the
+Custody of a Nurse, she ought to be confined in the Guard, or
+discharged.
+
+7. Nurses guilty of great Neglect of Duty, or of getting drunk and
+using their Patients ill, or of stealing, or concealing or taking away
+the Effects of Men who die in the Hospital, are to be immediately sent
+to the Guard, and reported to the Commanding Officer of the Place,
+that they may be tried by a Court-Martial, and be confined, whipped,
+or otherwise punished, as the military Law directs; all Followers of
+Armies on foreign Service being equally subject to the military Law as
+the Soldiers themselves.
+
+
+_Patients._
+
+1. All sick Soldiers, on their Arrival at a Military Hospital, are to
+be washed all over with warm Water, or to go into a warm Bath; and
+afterwards to wash their Face and Hands every Morning, and their Feet
+occasionally, with warm Water and Soap, brought round every Morning by
+the Nurses for that Purpose; and they ought to comb their Head every
+Day. If they be too weak to wash and comb themselves, it is to be done
+by their Nurses.
+
+2. Every Patient is to be shaved and have clean Linen twice a Week, or
+oftener if requisite.
+
+3. They are punctually to obey the Directions given them, and to take
+the Medicines ordered by the Physician; and none to be allowed to go
+out of the Hospital without a Ticket of Leave signed by the Physician,
+Surgeon, or Apothecary, of the Hospital.
+
+4. They must commit no Disorder or Riot, but in all Respects behave
+themselves well.
+
+5. If any Man disobeys the Orders he receives from the Physicians or
+Surgeons, or is irregular in Conduct, gets drunk, and commits Riots in
+the Hospital, or is found guilty of Theft or other Crimes, the same
+is to be reported to the Commanding Officer of the Place, and he to be
+tried by a Court-Martial, and punished as soon as his Strength will
+permit.
+
+In conducting the Military Hospitals, we found that it was always
+right to discharge the Patients from the sick Hospitals as soon as
+they were recovered, and to send them either to Billet, or to a
+convalescent Hospital; because recovered Men are always the most
+riotous; besides they crowded the Hospitals, and were in Danger of
+catching fresh Disorders from those who were sick; and therefore the
+recovering Men in every Hospital ought to be reviewed once or twice a
+Week by the Physician or Surgeon, and the Names of such Men as are
+well enough, to be marked; in order that they may be sent the next Day
+to the convalescent Hospital, or to Billet. A Return of those marked
+for Billet ought immediately to be sent to the Officers on
+convalescent Duty.
+
+When a convalescent Hospital is established, it ought to be put under
+proper Regulations; the following are those which I drew up for that
+established at _Osnabruck_ in _April_ 1761, and which were found to
+answer the Purpose intended.
+
+
+_Regulations for a Convalescent Hospital._
+
+1. That this Hospital be entirely occupied by such Men as are
+recovered from Diseases; that no Men be sent there but those whose
+Names are returned to the Purveyor’s Office by the Physician or
+Surgeon of the Hospital.
+
+2. That all the Patients shall be upon full Diet, unless in particular
+Cases it be ordered otherwise by the Physician or Surgeon.
+
+3. That all the Patients shall breakfast, dine, and sup, at regular
+stated Hours, in the Hall appointed for that Purpose: Breakfast to be
+ready at nine, Dinner at one, and Supper at seven o’Clock in the
+Evening.
+
+4. That no Patient shall carry up any Victuals into the Wards
+appointed for sleeping in; and if any Patient does not attend at the
+regular Hours of Meals, no Allowance of Victuals shall be made him in
+the Place of such Meals, unless he has been absent on Hospital
+Business, or been confined to Bed by Sickness.
+
+5. That as soon as the Men are come down Stairs to Breakfast, the
+Wards in which they sleep shall be cleaned out and sprinkled with
+Vinegar, and the Windows opened to air them.
+
+6. That the Doors of this Hospital shall be locked every Night at
+eight o’Clock, and no Man be allowed to come in or go out after that
+Time. The Doors to be opened again at seven o’Clock in the Morning.
+
+7. That the said Hospital is to be visited two or three Times a Week
+by the Physician, Surgeon, and Apothecary, who are to see that the
+above Orders are complied with; to examine the Diet, and take Care
+that every Thing is carried on properly; and to prescribe for any
+little Disorders the Men may be affected with.
+
+8. That one of the Hospital Mates be appointed to visit this Hospital
+daily, to administer any Medicines which may have been prescribed by
+the Physician; to apply any Dressings ordered by the Surgeon; and to
+acquaint the Physician or Surgeon if any of the Men be so bad as to
+require their Attendance, or to be sent back again to the Sick
+Hospital.
+
+9. That for the better executing these Regulations, orderly Serjeants
+or Corporals be appointed for the Care of the Men; who shall mount a
+Guard of six or more of such of the Patients of the said Hospital as
+are fit for this Duty--That the Serjeants are to call a Roll of all
+the Patients regularly three Times a Day, before Breakfast, Dinner,
+and Supper; to see that the Men behave themselves soberly and
+decently; and that they keep themselves clean, and commit no Riots;
+and to confine in the Guard such as commit Riots and other
+Irregularities, or whom they find drunk, or who stay out all Night;
+and to report the same to the Officer on Duty.
+
+10. That an Officer on convalescent Duty do visit the said Hospital
+daily at the Times of Roll-calling, to see that every Thing be carried
+on properly; and to receive the Reports from the Serjeants, and give
+what Orders he may think proper for the better regulating the said
+Hospital.
+
+11. That if at any Time it should happen that there are more
+Convalescents than the Hospital can hold conveniently, a Review be
+made of all the Patients, and the strongest and most healthy be sent
+to Billet.
+
+12. That a Review be always made, when any Party is going to join the
+Army, to pick out the Men who are fit to join their Regiments.
+
+The Physical Officers employed in the Military Hospitals, are
+Physicians, Surgeons, and Apothecaries.
+
+No Person ought to be appointed a Physician to the Army, or Military
+Hospitals, without previously undergoing the same Examination at the
+College of Physicians, as those do who enter Fellows and Licentiates
+of the College, that none but proper Persons may be employed. On such
+Examinations the Physician General to the Army ought to be allowed to
+sit as one of the Censors of the College.
+
+The Surgeons are all obliged to pass an Examination at Surgeons Hall
+before they are appointed, and the Apothecaries ought in like Manner
+to pass an Examination at Apothecaries Hall.
+
+The Mates employed in the Service ought, previous to their
+Appointment, to be examined both in Surgery and Pharmacy, as the
+Service commonly requires their acting in both Branches.
+
+The Direction of all Military Hospitals ought always to be committed
+to the Physicians, who have the immediate Care of Hospitals.
+
+When an Army is acting on a Continent, and there is a Number of
+Hospitals in different Places, the Physician who attends the Commander
+in Chief ought to be made Physician General and Director of the
+Hospitals, with proper Appointments; and all Orders from Head Quarters
+ought to go immediately thro’ this Channel.
+
+Every other Physician at the different Hospitals ought to direct every
+Thing about the Hospital which he attends, and his Orders ought to be
+punctually obeyed; and he ought to keep up a constant Correspondence
+with the Physician General; acquainting him from Time to Time with the
+State of the Hospital, and what is wanted for it; and he ought
+punctually to obey whatever Orders he receives from the Physician
+General.
+
+If there be separate Hospitals for the Surgery Patients, the eldest
+Surgeon ought to direct every Thing in the Hospital he attends; and
+when any Thing is wanted for his Hospital, to report the same to the
+Physician General.
+
+The directing and purveying Branches ought never to be entrusted to
+the same Person, as the Temptation of accumulating Wealth has at all
+Times, and in all Services, given Rise to the grossest Abuses, which
+have been a great Detriment to the Service, as well as to the poor
+wounded and sick Soldiers, and has occasioned the Loss of many Lives.
+And therefore neither the Physician General, nor any of the Physicians
+or Surgeons of the Army, or any other Person concerned in the
+Direction of the Military Hospitals, ought ever to act as Purveyor or
+Commissary; nor ought they ever to have any Thing to do with the
+Accounts, Contracts, or any other Money Affairs relating to the
+Hospital; and if ever they be found to intermeddle in these Affairs,
+they ought to be immediately dismissed the Service.
+
+The purveying or commissariate Branch ought to be entirely distinct
+from the physical. The Purveyors or Commissaries ought punctually to
+obey whatever Orders they receive from the Physicians or Surgeons; to
+provide every Thing for the Hospital; to keep regular Accounts of all
+the Men who come into, or go out of the Hospitals; and from Time to
+Time to make Returns to Head Quarters of all the Men in Hospitals; and
+their Accounts ought to be controuled by such Persons as the
+Government may think proper.
+
+Every Physician and Surgeon of a Military Hospital ought to visit the
+Sick at regular stated Hours, and the Mates to attend and go round
+with them, and receive and execute their Orders.
+
+Every Mate ought to have a certain Number of Patients allotted him,
+for whom he is to make up all Medicines, dress all Sores, and execute
+whatever Orders he receives from the Physician, Surgeon, or
+Apothecary. That the Mates may know and execute their Duty, proper
+Orders in Writing should be hung up in the Apothecaries Shop for that
+Purpose. The following are those which I gave out at all the Hospitals
+I attended in _Germany_.
+
+
+_Orders for the Mates._
+
+1. That all the Gentlemen do attend at the Apothecaries Shop every
+Morning at eight o’Clock, to assist in making up the common Medicines
+of the Day, and afterwards to go round the Hospitals with the
+Physicians and Surgeons.
+
+2. That every Mate have a Book for writing the Prescriptions of the
+Physicians in, which is to be kept in the following Order.--First, to
+mark the Patient’s Name and Regiment; then the Day of his Entry into
+the Hospital and his Disorder; then the Prescriptions of the
+Physician; and after all the Day of his Discharge, or of his Death.
+_Ex. gr._
+
+     _John Clarke_, 20th Regiment. _Jan._ 1. Fever.
+
+     _Jan._ 1. V. S. unc. x.--H. salin. cum pulv. contrayerv.
+     4r. die.--2. Emplast. vesicat. dorso, &c.
+
+       Discharged or dead _Jan._ 28.
+
+3. That every Mate make up himself the Physician’s Prescriptions for
+his own Patients, and afterwards go round and administer them, or give
+them to his Patients with proper Directions; that he bleed his own
+Patients, and dress any slight Sores they may have, which do not
+require their being sent to the Surgery Hospital.
+
+4. That every Mate go round amongst his Patients in the Evening, to
+see that every Thing is well conducted, and to report to the Physician
+or Apothecary if any Thing extraordinary happens.
+
+5. That two of the Mates attend all Day at the Apothecary’s Shop to
+receive any Sick that may arrive, and to place them properly; to make
+up what Medicines they may immediately want; to order each of them a
+Mess of Water Gruel; and if any Thing extraordinary occurs, to send an
+orderly Man to acquaint the Physician or Apothecary with the same. The
+orderly Mates to make up likewise for Officers, or others, all
+Prescriptions sent to the Apothecary’s Shop through the Day.
+
+A Joint of Meat, roasted or boiled, for Dinner, and a Bottle of Wine,
+was allowed to the orderly Mates, by Lord _Granby_’s Order, that they
+might not absent themselves from their Duty.--Where there was
+Conveniency for it, a Mate lodged in the Hospital.
+
+The Apothecary ought to take Care of the Medicines; to go round the
+Hospitals in the Morning before the Time of the Physician’s visiting;
+to see that the Wards are in proper Order; that the Nurses and other
+Servants have done their Duty; to examine into the State of the Sick,
+and to see that the Provisions are good; and make a faithful Report
+of all these Things to the Physician when he arrives.--To take Care
+that the Mates prepare in the Morning the Medicines that are commonly
+wanted for the Day; and that they afterwards make up faithfully the
+Prescriptions of the Physician; to go round the Hospital again in the
+Evening, to see that the Sick have got their Medicines regularly; and
+to make the same Enquiries as in the Morning.
+
+The Apothecary should always be lodged near the Hospital, to assist in
+Case of any Accidents happening, or of Sick arriving at the Hospital.
+
+When there are any strong infectious Disorders in Military Hospitals,
+the physical Gentlemen may use the following Precautions to guard
+themselves against Infection.
+
+1. Never to visit the Sick with an empty Stomach; but to eat Breakfast
+before they go into the Hospital.
+
+2. To have a Suit of Cloaths reserved for visiting the Hospital, and a
+waxed Linen Coat to wear above them in going round the Wards; and as
+soon as they have come out of the Hospital, to wash and change their
+Linen and Cloaths.
+
+3. Before they go into the Wards, to order that they be well cleaned
+out, and sprinkled with Vinegar, and afterwards fumigated, and aired
+by opening the Windows, or by Working the Ventilators.
+
+4. If the Infection be very strong, to take a Glass of the spirituous
+Tincture of the Bark just before they go into the Hospital.
+
+5. To put small Rolls of Lint, dipped in camphorated Spirits, up the
+Nostrils, and to direct a Vessel, with warm camphorated Vinegar, to be
+carried round, and held near the Patients they are examining.
+
+6. In examining Patients affected with the Petechial Fever, or any
+other malignant Distempers, to stand at some little Distance, and ask
+what Questions they may think proper; and when they come near, to feel
+the Pulse, and examine the Skin, not to inspire while their Head is
+near the Patient’s Body; but after being fully satisfied in these
+Points, to retire a little, and ask what other Questions may be
+necessary.
+
+It would be right to establish some military Rank for every
+commissioned Officer of the Hospital on Service, and to settle the
+same Subordination in the physical as in the military Department. By
+these Means, the Service would be carried on with greater Order, and
+more Advantage to the Sick.
+
+And it would be right, in Times of War, to add a Clause in the Mutiny
+Bill to allow any military Officer on convalescent Duty to call in the
+commissioned physical Officers to assist in making up a Court-Martial,
+when there are not a sufficient Number of military Officers in a
+Place, to try convalescent Soldiers guilty of Crimes. For in Times of
+Service, very often a sufficient Number of military Officers cannot be
+spared to be on Duty at the different Military Hospitals; and at all
+such Places the Convalescents are generally very disorderly, when they
+know that there is not a sufficient Number of Officers to form a
+Court-Martial for punishing them. Where-ever there are a sufficient
+Number of military Officers, no physical Officer ought ever to be
+called upon as a Member of a Court-Martial.
+
+Men, in Time of Service, are often apt to saunter in and about
+Hospitals, and there learn all Manner of Debaucheries, and lose all
+Sense of Discipline; and therefore, to keep up Order and Decorum,
+there ought to be, at every Fixed and every large Military Hospital, a
+military Inspector or Commander, an Officer of known Activity and
+Probity; and a Number of Officers on convalescent Duty sufficient to
+form a Court-Martial whenever required.
+
+The Duty of the Military Inspector, or Commander, should be, to take
+Care of all Convalescents on Billet; to see that the Officers under
+him do their Duty, and maintain the same Regularity and Discipline
+among the Men belonging to their respective Corps, as if they were
+with their Regiments; and that the Men attend the Parade and
+Roll-calling; and that they always appear neat and clean.
+
+He ought, from Time to Time, to visit the Hospitals; to see if they
+are kept clean; to enquire if the Men behave well, if the Diet is
+good, and the Officers, Nurses, and Servants, do their Duty; and if he
+finds any Thing amiss, to report the same to the Physicians and
+Surgeons of the Hospital, or to the Purveyor or Commissary, or others,
+under whose Department it may be, that the same may be immediately
+rectified; and if he finds that the superior Officers of the Hospital
+overlook such Abuses, notwithstanding his Representations, to report
+the same immediately to the Head Quarters.
+
+He ought to order one of the Officers on convalescent Duty to visit
+the Hospitals daily, to make the Enquiries above-mentioned, and to
+give him a Report of the same in Writing.
+
+The Purveyor or Commissary ought to make a Return to him twice or
+thrice a Week of every Man admitted into, or discharged from, the
+Hospitals, or who dies in them; marking in the Return the Name of
+every Man, and the Company and Regiment he belongs to; that he may
+report the same to the Officers of the different Brigades or
+Regiments.
+
+The Military Inspector ought to have the Power of providing Billets
+for all Officers and Soldiers about Hospitals; and the Names of all
+Men to be discharged from Hospitals should be sent to him the Day
+before they are discharged, that he may provide Billets for them; and
+next Day the Men ought to march from the Hospitals to the Parade, to
+receive their Billets, and the Orders of the Military Inspector, and
+of the Officers of the Corps they belong to.
+
+The Military Inspector ought to see that the Arms of the sick Men, and
+the Arms and Cloaths of those who die and are lodged in the Magazines,
+be properly taken Care of; and that the Stores of the different
+Regiments be properly looked after.
+
+As the Service often makes it necessary at Military Hospitals, where
+the Number of Sick is great, to employ the convalescent Soldiers[163]
+as orderly Men and Servants about Hospitals, all Men thus employed
+ought to have a special Leave from the Military Inspector for so
+doing; and no Man should be employed in any Capacity as a Servant
+about an Hospital, who at that Time is on the Books as a Patient. And
+all Men employed about the Hospital ought to be reviewed once a Week
+by the Military Inspector, and likewise whenever a Party of
+Convalescents is going to join the Army, or their Regiments; that no
+Man may be allowed to remain with the Hospital, after he is fit to do
+Duty in his Regiment.
+
+    [163] In the _French_ Hospitals there are always a Number of
+    Men who attend their Sick who belong to the Hospital, so that
+    they have no Occasion to employ their Convalescents, as we
+    are often obliged to do, where the Sick are attended by
+    Nurses, who are commonly Soldiers Wives, and not so capable
+    of doing such laborious Work as the Men.
+
+When the Military Inspector is absent, the eldest Officer on
+convalescent Duty ought to act in his Place.
+
+Every Officer sent on convalescent Duty ought, as soon as he arrives
+at the Place where the Hospital is, to wait on the Commandant, or
+Military Inspector; to acquaint him of his Arrival, and to receive his
+Commands. He ought then to go to the Purveyor or Commissary’s Office,
+to get a List of all the Soldiers who are in or about the Hospital,
+and belong to the Regiment or Brigade he is employed for, wherein
+those on Billet are distinguished from those in Hospitals. The next
+Day he ought to parade all those marked on Billet, to see if the
+Number of Men agrees with the List given him, and to examine in what
+State each Man is, and how he is employed; and then he ought to go
+round the Hospitals, attended by an orderly Serjeant, to see all the
+Men in the Hospitals, and to know if the List given him at the
+Purveyor’s Office was right; and afterwards he ought to send every Day
+a Serjeant or Corporal to see the Men in Hospitals, and to report to
+him when any Men are discharged or die.--And he ought to procure from
+the Military Inspector a Return of all the Men of his Corps, who are
+either admitted into, or discharged from Hospitals, on the Days when
+such Returns are made. He ought to make all his Men on Billet appear
+regularly on the Parade at Roll-calling, and to oblige them to keep
+themselves clean and their Arms in good Order, and to endeavour to
+preserve the same Regularity and Discipline as when they are with
+their Regiments. And whenever a Party is to be sent to join their
+Regiments, he ought to have all his Men particularly examined; and
+those Men who are found to be perfectly recovered, should be sent to
+their Regiments.
+
+If every Officer on convalescent Duty conform to these Directions, no
+Man can ever be detained without his Knowledge in or about Hospitals,
+as he must always know where every Man is, in what State of Health,
+and how he is employed; and may at any Time be able to make a Return
+to the Brigade or Regiment for which he is employed, of every Man who
+is admitted, discharged, or dies in the Hospital.
+
+
+FINIS.
+
+
+
+
+
+End of the Project Gutenberg EBook of An Account of the Diseases which were
+most frequent in the British military, by Donald Monro
+
+*** END OF THIS PROJECT GUTENBERG EBOOK BRITISH MILITARY HOSPITALS ***
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+The Project Gutenberg EBook of An Account of the Diseases which were most
+frequent in the British military hospitals in Germany, by Donald Monro
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: An Account of the Diseases which were most frequent in the British military hospitals in Germany
+
+Author: Donald Monro
+
+Release Date: February 21, 2010 [EBook #31338]
+
+Language: English
+
+Character set encoding: ISO-8859-1
+
+*** START OF THIS PROJECT GUTENBERG EBOOK BRITISH MILITARY HOSPITALS ***
+
+
+
+
+Produced by Irma Spehar and the Online Distributed
+Proofreading Team at http://www.pgdp.net (This file was
+produced from images generously made available by The
+Internet Archive/Canadian Libraries)
+
+
+
+
+
+
+                                  AN
+                                ACCOUNT
+                                OF THE
+                               DISEASES
+
+                    Which were most frequent in the
+
+                      BRITISH MILITARY HOSPITALS
+
+                              in Germany,
+
+             From January 1761 to the Return of the Troops
+                       to England in March 1763.
+
+                          To which is added,
+
+            An ESSAY on the Means of Preserving the Health
+            of Soldiers, and conducting Military Hospitals.
+
+
+                         By DONALD MONRO, M.D.
+
+                PHYSICIAN to his MAJESTY'S ARMY, and to
+                        ST. GEORGE's Hospital.
+
+
+                                LONDON:
+
+           Printed for A. MILLAR, D. WILSON, and T. DURHAM,
+            in the Strand; and T. PAYNE, at the Mews-Gate.
+
+                               MDCCLXIV.
+
+
+
+
+TO THE KING.
+
+
+May it please Your MAJESTY,
+
+To permit me to lay at your Feet the following Sheets, published with
+a View to be useful to those, who hereafter may have the Care of the
+Health of your MAJESTY's Troops.
+
+YOUR MAJESTY's particular Inquiries into the State of Your Military
+Hospitals, in every Quarter of the World, in the Time of the late
+glorious and successful War; Your Concern for every Officer and
+Soldier who suffered either by Sickness or by Wounds in the Cause of
+their King and Country; and Your Solicitude to procure them every
+possible Assistance and Relief, cannot fail to excite the highest
+Admiration of Your MAJESTY's Goodness in the Breast of every Subject,
+and the warmest Gratitude in the Heart of every Soldier.
+
+The Knowledge of these Circumstances induced me to flatter myself,
+that a Work of this Kind would be agreeable to Your MAJESTY; and
+should this Attempt towards pointing out the Means of alleviating
+those Miseries, which necessarily attend a Military Life in the Time
+of Service, be acceptable, I shall obtain the utmost of my Wishes; it
+being the greatest Ambition of my Heart ever so to act as to merit
+Your MAJESTY's Approbation, and to subscribe myself,
+
+      May it please Your MAJESTY,
+
+    Your MAJESTY's most dutiful Subject,
+
+        And most faithful
+
+          and humble Servant,
+
+      DONALD MONRO.
+
+
+
+
+THE PREFACE.
+
+Among the numerous Authors of Observations in the Art of Physick,
+there are but few who have expressly written on the Treatment of those
+Distempers, most generally incident to an Army in the Field: The
+following Work, therefore, seems to have a fair Claim to be acceptable
+to the Publick, having been compiled during the Author's Attendance on
+the _British_ Military Hospitals in _Germany_ in the late War; and in
+order to render it of still further Use, he has occasionally added, by
+Way of Note, the Practice of some of the most eminent Physicians in
+similar Diseases, as well as a few Histories of Cases which passed
+under his own Care at _St. George_'s Hospital, _London_.
+
+To avoid the Repetition of the Composition of particular Medicines,
+and the Interruption that would be given by their being inserted in
+the Body of the Work, a small Pharmacopoeia is added, to which his
+Practice in the Army Hospitals was chiefly confined.
+
+In a commercial Country like our own, where Numbers of Hands are
+constantly wanted for the carrying on our Manufactories, we have a
+strong political Argument to add to that drawn from the Dictates of
+Humanity, why the Life of every individual should be most carefully
+attended to.
+
+The Preservation of the Lives of Soldiers is then with us a Matter of
+the highest Importance, in order to make as low as possible the Number
+of Recruits who must be perpetually drawn off for the Service of War.
+The Author has, therefore, in this Treatise, endeavoured to point out
+the Means most likely to keep Men healthy when employed in different
+Services; and also the Manner in which Military Hospitals ought to be
+fitted up, and conducted.--As he was never in any of the warm
+Climates, nor ever at Sea along with Troops aboard of Transports,
+whatever is mentioned relative to such Situations, is to be understood
+as taken from printed Accounts of these Subjects, or collected from
+the Conversation of physical Gentlemen, who were employed on such
+Services during the two last Wars.
+
+It is but Justice here to observe, that the Marquis of _Granby_,
+Commander in Chief of the _British_ Troops in _Germany_, as well as
+the Rest of the General Officers employed on the _German_ Service,
+always paid the greatest Attention to the Soldiers when sick in
+Hospitals; and were particularly ready in giving Orders for all such
+Things as were necessary or proper for them.
+
+  JERMYN-STREET,
+    April 15, 1764.
+
+
+
+
+CONTENTS.
+
+                                                                      PAGE.
+
+Of the Malignant and Petechial Fever,                                    1
+
+Of the Dysentery,                                                       57
+
+Of the Cholera Morbus,                                                  97
+
+Of the Inflammatory Fever,                                             104
+
+Of the Angina,                                                         109
+
+Of the Pleurisy,                                                       111
+
+Of the Peripneumony,                                                   115
+
+Of the Cough and Consumption,                                          124
+
+Of the Epidemical Catarrhal Fever of _April_ 1762,                     137
+
+Of the Rheumatism,                                                     141
+
+Of the Autumnal Remitting Fever,                                       154
+
+Of the Intermitting Fever, or Ague,                                    179
+
+Of the Jaundice,                                                       206
+
+Of Tumours of the Breast,                                              216
+
+Of Paralytic Complaints,                                               219
+
+Of an Incontinency of Urine,                                           223
+
+Of a Stoppage of Urine,                                                227
+
+Of the Epilepsy,                                                       237
+
+Of the Small-Pox,                                                      243
+
+Of Erisypilatous Swellings,                                            245
+
+Of the Scurvy,                                                         250
+
+Of the Itch,                                                           265
+
+Table of Diet used in the _British_ Military Hospitals in _Germany_,   273
+
+
+PHARMACOPOEIA in usum Nosocomii militaris regii Britannici 1761,       275
+
+
+OF THE MEANS of Preserving the Health of Soldiers on Service,          309
+
+---- in Winter, and in cold Climates,                                  313
+
+---- aboard of Transport Ships,                                        323
+
+---- in warm Climates,                                                 331
+
+Of healthful and unhealthful Grounds for the Encampment of Troops,     338
+
+Of keeping Camps clean,                                                344
+
+Of supplying an Army with Straw and with Provisions, and obliging
+  the Soldiers to buy a certain Quantity of Meat daily,                346
+
+Of Water, and the Means of correcting its bad Qualities in Camps,      348
+
+Of vinous and spirituous Liquors,                                      350
+
+Of keeping Men healthful in Quarters after an active Campaign,         354
+
+
+Of MILITARY HOSPITALS,                                                 355
+
+Of the Manner in which the Antients disposed of their Sick
+  and Wounded,                                                         356
+
+Of the Hospitals wanted for an Army acting on a Continent,             357
+
+Of the Houses most fit for Hospitals,                                  361
+
+Of fitting them up, and distributing the Sick in them,                 363
+
+Of preventing infectious Disorders from being generated or
+  spreading among the Sick,                                            366
+
+Of the Diet of Military Hospitals,                                     372
+
+Of providing the Flying Hospital,                                      380
+
+Of Hospitals on Expedition Service,                                    380
+
+Of a Guard for Hospitals,                                              382
+
+Of the Nurses and Patients, and Orders for them,                       383
+
+Of a convalescent Hospital,                                            389
+
+Of the Physicians, Surgeons, Apothecaries, and Mates,                  393
+
+Of the Direction of Military Hospitals,                                394
+
+Of the Purveyor or Commissary of the Hospital,                         396
+
+Orders for the Mates,                                                  397
+
+Of Precautions for guarding against infectious Disorders,              400
+
+Of a Military Inspector and Officers on convalescent Duty,             403
+
+
+ERRATA CORRIGENDA.
+
+Page 13, line 11, for _Pleuretic_, read _Pleuritic_.
+
+     18,      10, of Notes, for _Acadamy_, read _Academy_.
+
+     28,      22, for _Cinamon_, read _Cinnamon_.
+
+     35,       5, of Notes, for _Calomile_, read _Calomel_.
+
+     51,      12, dele _used in this Way_.
+
+    166,      12, of Notes, for _which almost depend_, read _which almost
+                  always depend_.
+
+    207,      13, of Notes, for _Vena postarum_, read _Vena portarum_.
+
+    259,       4, for _appeared_, read _appear_.
+
+    261,       1, of Notes, for _became_, read _become_.
+
+    280,      20, for _Chamamel_, read _Cham�mel_.
+
+    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 Petechi�
+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
+Petechi� 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 Petechi� 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 Petechi� 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 Petechi� 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 Petechi� 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
+    Petechi� 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 Petechi� 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 contrayerv�_, 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 Petechi� 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 _Pilul� saponace�_ in the Evening. The 26th, the
+Petechi� 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 Petechi� 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 Petechi�
+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 _Pilul�
+saponace�_ 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 Petechi� 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 Petechi� 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 Petechi� 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 Petechi� 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 Petechi� 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. serpentari�_, 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
+_gutt� antimoniales anodyn�_.
+
+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 H�morrhages 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 Petechi�, 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. Pr�fat.
+
+    [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 Petechi� 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 Sant�_, in his Chapter on the
+    _Dysentery_, � 320, says, that ripe Fruit, especially the
+    Summer-Fruits, are so far from being the Cause of the
+    Disorder, that they are the great Preservatives against it:
+    he says, that, in the Years which the Fruit is most
+    plentiful, the Dysentery is least frequent; and he relates
+    several Instances where the Use of ripe Grapes proved a Cure
+    for the Disorder. Eleven People were attacked by the
+    Dysentery, nine eat Fruit, and all recovered; the other two,
+    a Grandmother and Child, from Prejudice, eat none, and both
+    died. A Regiment of _Swiss_ Soldiers, in Garrison in the
+    South of _France_, had the Dysentery very frequent among
+    them. The Captains purchased some Acres of a Vineyard, and
+    carried the sick Soldiers to the Field, and gave them the
+    Grapes to eat; and ordered the Men in Health to live upon
+    them chiefly. After this not one Person died, nor was any one
+    seized with the Distemper.--In an Account of a Treatise on
+    the Dysentery, published at _Hamburg_ in 1753, which was
+    epidemical the Year before, in _August_ and _September_, we
+    are told, that it did not proceed, as is commonly believed,
+    from the eating of Fruit; for it was observed, that those who
+    eat Fruit freely escaped better than those who abstained from
+    it altogether. _Vide Comment. de Rebus in Hist. Nat. &
+    Medecin. Gestis_, vol. II. par. iv. sect. v.
+
+    Generally in _August_ and _September_ we have People admitted
+    into _St. George_'s Hospital for the Dysentery; who have
+    certainly not catched the Disorder from eating of Fruit, but
+    from working in the Fields, and being exposed to Causes
+    similar to those which produce the Dysentery in Camps.
+
+At the Time the Petechial Fever was frequent at _Paderborn_ in
+_January_, _February_, and _March_ 1761, the Flux frequently
+accompanied it; and we had in the Hospitals likewise a Number of old
+Cases of this Kind, the Remains of the preceding Campaign about
+_Warbourg_; besides some Men who had relapsed during the Winter, and
+were sent to us when the Troops marched, upon the Winter-Expedition,
+into the Country of _Hesse_. In _May_ and _June_, what Fluxes we had
+at _Osnabruck_, were the remaining old Cases of the Hospitals of
+_Munster_, _Paderborn_, _Hoxter_, and _Niehms_. Some few recent ones
+were sent to _Bilifield_ about the End of _June_, and above 300 to
+_Munster_, in _July_ and _August_. Those sent to _Bremen_, in
+_November_ and _December_, had continued for some time before they
+reached us; but a good many of the Soldiers in the Garrison were taken
+ill of this Disorder, and sent immediately to the Hospital. In the
+Beginning of _May_ we had but four ill of this Complaint in the
+Hospital I attended; and there were not above six or seven, among the
+Sick sent down from the Army, in the Middle of this Month. In _June_
+there were but two sent to the Hospital at _Minden_; and not above ten
+among the Sick sent to _Natzungen_ in the Beginning of _July_; tho'
+towards the Middle of this Month they began to be more frequent; and
+continued to be more so in _August_ and _September_; and in the
+Hospital at _Osnabruck_ we had not above five or six ill of this
+Disorder, in _December_ 1762, and in _January_, _February_ and _March_
+1763.
+
+The Dysentery commonly begun with Sickness and Gripes, succeeded by a
+Purging, and attended with more or less Fever. Very soon the Gripes
+became more severe, attended with a Flatulency in the Bowels, and
+often with a Tenesmus. The Stools were chiefly composed of Mucus,
+mixed with Bile, and more or less Blood: tho' sometimes no Blood could
+be observed in them; and then the Soldiers used to say they had the
+White Flux.
+
+After eight, ten, or twelve, Days, if the Disorder was not complicated
+with any other, there remained little or no Fever, unless where some
+Accident supervened; tho' in Cases which terminated fatally, towards
+the latter End came on a Fever of a low malignant Kind, attended with
+black fetid Stools, Lientery, Hiccup, Stupor, and other bad Symptoms.
+
+It often happened, that, after the Dysentery had continued for some
+Time, the Sick complained for a Day or two of severe Gripes; and then
+discharged along with the Stools little Pieces of hardened Excrements;
+at other Times, tho' more rarely, little Pieces of white Stuff like
+Tallow or Suet: Frequently small Filaments, and little Pieces of
+Membranes, were found floating in the Stools; and it was very common
+for the Sick to vomit up Worms of the round Kind, or discharge them by
+Stool[30].
+
+    [30] Most Authors, who treat of the Dysentery, mention this
+    Symptom of Worms; and Dr. _Huxham_ tells us, that, in some
+    Seasons, he has seen round Worms in the Stools of most of the
+    Dysenteric Patients. _De Aere_, vol. II. p. 98.
+
+In the Course of the Disorder, the Men often complained of a violent
+Pain of the Rectum, near the Fundament, which was most excruciating
+when they went to Stool; it continued for some Days, sometimes for a
+Week or more; and then they passed more or less of a Yellow Pus with
+their Excrements, and the violent Pain ceased. Mr. _A. Tough_, one of
+the Apothecaries to the Military Hospital in _Germany_, was the first
+who told me that I should find Pus mixed with the Stools: on my
+mentioning a Case of this Kind, which had been relieved by Bleeding,
+and Clysters often repeated; he told me he had observed it frequently
+at _Gibraltar_; and was at a Loss to understand the Nature of the
+Symptom, till he observed the Matter in the Stools; which at once
+shewed him that it had been originally an acute Inflammation of the
+Part, and pointed out to him the proper Method of Cure.
+
+Oftentimes the Bilious and Malignant Fevers terminated in the
+Dysentery; or were accompanied with it, when it might be looked upon
+as a Symptom of these Fevers.
+
+The Appearances we found after Death in the Bodies of some Patients,
+who died of old Fluxes at _Bremen_, were: In all of them the Rectum
+was inflamed, and partly gangrened, especially the internal Coat. In
+two the lower Part of the Colon was inflamed, and there were several
+livid Spots on its great Arcade. In one whose Body was much emaciated,
+and who had been seized with a violent Pain of the Bowels two Days
+before his Death, all the small Guts were red and inflamed; and in
+another there were livid gangrened Spots on the Stomach[31].
+
+    [31] From the Accounts we have in Authors, of the Dissection
+    of the Bodies of Persons who died of the Dysentery, it would
+    appear; that there is no Part of the alimentary Canal which
+    has not some time or other been found inflamed, or in a state
+    of Suppuration or Gangrene; and the Liver, Spleen, and other
+    Viscera, have likewise been found diseased, but the Rectum
+    and Colon have almost in all been more or less affected. The
+    following Account I had, in the Year 1748, from the late Dr.
+    _L. Fraser_, who afterwards practised in the Island of
+    _Nevis_, two Days after the Patient died. _Mary Reid_, a
+    Woman thirty Years of Age, was taken ill of a Dysentery,
+    which in Three Weeks Time killed her. In her Life-time she
+    complained, more than ordinary, of Gripes in her Belly,
+    especially in her Left Side. Her Body was opened in Presence
+    of Dr. _Dundas_, who had attended her, during her Illness.
+    All the Intestines and Mesentery were inflamed, especially
+    the Colon and Rectum; the internal Side of which was quite in
+    a mortified State, and contained little Vesicles full of a
+    putrid fetid Liquor, Numbers of which she had evacuated by
+    Stool some Days before her Death.
+
+There was no Disorder we were more successful in the Cure of, than
+recent Fluxes; but after they had continued for Weeks, and were become
+in a manner chronic, they often foiled all our Endeavours, and a great
+Number died[32].
+
+    [32] While this Sheet was in the Press, I received Dr.
+    _Pringle_'s 4th Edition of his _Observations on the Diseases
+    of the Army_, and Dr. _Baker_'s Treatise on the _Dysentery
+    which was epidemic in London in the Year 1762_. Both these
+    Gentlemen give an Account of the Dissection of the Bodies of
+    some People who died of the Dysentery; where, besides the
+    common Appearances of the inner Surface of the Rectum and
+    Colon being covered with a bloody Slime, and their internal
+    Coats being inflamed, gangrened, or in a putrid State, there
+    were observed on the Inside of the lower Part of the Colon,
+    and upper Part of the Rectum, a Number of little Tubercles,
+    or Excrescences, which resembled the Small Pox, of a flat
+    Sort at the Height of the Disorder; but differed from them in
+    this, that they were of a firm Consistence, without any
+    Cavity: they were believed to take their Rise from the
+    cellular Membrane, which lies immediately above the villous
+    Coat. Perhaps such Tubercles might have been found in the
+    Colon and Rectum of those Bodies we opened; but not looking
+    for them, they may have passed unobserved.
+
+    _Morgagni_, in his Book lately published, _de Sede & Causis
+    Morborum_, epist. xxxi. is of Opinion, that the Filaments,
+    and Pieces of Membranes, which are frequently observed in the
+    Stools, are often formed of inspissated Mucus and Lymph, and
+    other Liquors; and not the Fibres, or Pieces of the villous
+    Coat of the Intestines, as alledged by many Authors.
+
+Upon my first being employed in the Military Hospitals in _Germany_,
+I was surprised to see so many of the old Dysenteric Cases end
+fatally; and imagined I had not fallen upon the Right Method of
+treating them: but upon consulting the other Physical People[33]
+employed in the same Service, I found them as unsuccessful, as myself,
+after having tried a Variety of Remedies: And at last, I was
+convinced, that when once the Flux had continued long, and injured the
+Structure of the Intestines to a certain Length, a Gangrene will
+often form by slow Degrees; and the Disorder end fatally,
+notwithstanding the Use of what are esteemed the most efficacious
+Remedies; and that, when this Disorder is violent, the Cure
+principally depends upon an early and speedy Application of proper
+Remedies, before the Strength be exhausted, or the Structure of the
+Bowels too much hurt. The bad Success we had in treating these old
+Cases, may perhaps surprise those who have never practised except in
+healthful Cities, where the Disease is commonly mild, and People apply
+soon for Advice. But all those Gentlemen who have had the Care of
+Military Hospitals, where the Dysentery has been frequent, and where
+the Sick have been often sent a great Way, before they reached the
+Hospitals, must be convinced of the Truth of what is here asserted.
+
+    [33] Mr. _Cleghorn_, in his _Account of the Diseases of the
+    Island of Minorca_, says, "That almost all the Dysenteries
+    which fell under my Observation, unless they were speedily
+    cured in the Beginning, at best proved obstinate, and too
+    frequently fatal, in spite of the many boasted Specificks for
+    this Distemper." chap. v. p. 228.--The physical Gentlemen
+    employed on the _American_ Service have told me, that the old
+    Flux Cases were as fatal in _America_, as we found them in
+    _Germany_. I would not from thence have it believed, that
+    every old Flux was to be looked on as a lost Case; and for
+    that Reason given up, and no Attempts be made to cure it; for
+    many, by great Care, and Strength of Constitution, have
+    gradually surmounted the Disorder, and recovered their
+    Health; especially when they got over the Winter, and lived
+    till the warm Weather began.
+
+In the Treatment of this Disorder, as well as of the Malignant Fever,
+nothing contributed more to the Cure, than keeping the Sick as clean
+as possible, and in large airy Wards.
+
+Most of the recent Fluxes, which I saw, were at first attended with a
+good deal of Fever, and Pain in the Bowels; and required more or less
+Blood to be taken away, according to the Strength of the Patient, and
+the Violence of the Symptoms.
+
+When the Patients were strong, and complained of sharp Pain of the
+Bowels, attended with a Fever, we used the Lancet freely, nor were we
+discouraged from bleeding in the Beginning by the low quick Pulse
+which often attended the Disorder; and we frequently found the Pulse
+rise as the Blood flowed from the Vein. But when the Sick were low and
+weak, without much Pain or Fever, and the Pulse was soft, we were more
+sparing of the vital Fluid[34].
+
+    [34] Although Bleeding, in the Beginning, has been
+    recommended by _Sydenham_, _Huxham_, _Pringle_, and other
+    Practitioners; yet it has been reckoned unnecessary in this
+    Disorder by some late Authors. But in most of the recent
+    Cases I saw, it was extremely necessary, and contributed
+    greatly to the Relief as well as the Cure of the Patient;
+    indeed where the Disorder had already continued some time,
+    and the Fever was gone off before the Patient was sent to us;
+    and the Disorder had become in a manner chronic, and the
+    Patient low, then bleeding was unnecessary, and would have
+    probably done Hurt. Mr. _Francis Russel_ told me, that when
+    the Dysentery was epidemical at _Gibraltar_, in Summer 1756,
+    he found that by bleeding such Patients as he met with at the
+    first coming on of the Symptoms, and by giving them
+    immediately a Vomit, and afterwards a sudorific Draught, the
+    Disorder was rendered mild, and few of those died.
+
+As the Disorder was for the most part attended with Sickness in the
+Beginning, we gave a Vomit after bleeding; which not only discharged
+the Contents of the Stomach, and a Quantity of Bile, but relieved the
+Sickness, and frequently threw the Patient into a breathing Sweat; and
+made the Purgatives which were given next Day operate more freely, and
+with more evident good Effects than where no Vomit had been
+administered.--If in the Course of the Disease the Sickness returned,
+the Emetic was repeated; and we often observed, when the Flux was
+obstinate, that well-timed Vomits greatly promoted the Cure.--The
+Vomit we commonly employed was the Powder of Ipecacuana, which we gave
+from ten to twenty Grains; and where the Patient was strong, and we
+wanted to make a free Evacuation, we added one, two, or three Grains
+of the Tartar Emetic; which encreased the Strength of the Vomit, and
+commonly operated likewise by Stool[35], as Dr. _Pringle_ has
+observed.
+
+    [35] Mr. _W. Russel_, who was with the Hospital at
+    _Martinico_, told me, that, when he was there, he found the
+    Vomit with the Tartar Emetic to be far preferable to any
+    other, in all Cases where there was much putrid Bile lodged
+    in the alimentary Canal; as it speedily carried off those
+    corrupt Humours, which were often productive of the greatest
+    Mischiefs, if they remained, but for a short Time, pent up
+    within the Bowels.
+
+Next Day we ordered a Purge to empty the other Parts of the alimentary
+Canal. The Purgative, that at first was most employed for this
+Purpose, was Rhubarb; but upon repeated Trials we did not find, that,
+in general, it answered so well, in this first Stage of the Disorder,
+as the _sal catharticum amarum_, with Manna and Oil; which operated
+without griping or disturbing the Patient, procured a freer
+Evacuation, and gave greater Relief than any other purgative Medicine
+we tried. Mr. _Francis Russel_, Surgeon to the _British_ Military
+Hospital in _America_, who was formerly Surgeon to the Island of
+_Minorca_, was the first Person who informed me (in the Year 1757) of
+the Use of the _sal catharticum amarum_ in the Dysentery; he told me,
+that the Year before (1756) the Dysentery had been very frequent and
+very fatal at _Gibraltar_; and, after trying Variety of Medicines, he
+had found nothing give more Relief, or contribute more to the Cure,
+than repeated Doses of these Salts.
+
+As a great Part of the Cure depended on the frequent Use of gentle
+Purges[36] in the Beginning, to carry off the corrupted Humours; the
+Purgative was repeated every second, third, or fourth Day, as the Case
+required; the Operation of the former Purge, and the Symptoms,
+determining the Frequency of the Repetition. It was surprising with
+how little Loss of Strength the Sick bore the Operation of these
+Purges; I have sometimes given them to strong People every Day, for
+two, three, or four Days successively; and observed that the Patient,
+instead of being weakened, seemed stronger, and more brisk and lively,
+after the Operation of each, from the Relief it gave; by evacuating
+those putrid, corrupted Humours, which kept him perpetually sick and
+uneasy, while they remained within the Bowels.
+
+    [36] Variety of Medicines have been recommended to answer
+    this Purpose.
+
+    The _vitrum ceratum antimonii_ proved often too rough a
+    Medicine, and therefore we laid it almost entirely aside.
+
+    Repeated small Doses of the Ipecacuana, from four to six
+    Grains, operated both as an Emetic, and kept up a Purging;
+    but they made the Men so sick, that we could not prevail upon
+    them to continue their Use. Mr. _Francis Russel_ told me,
+    that, in the Year 1756, he found a few Grains of Rhubarb
+    added to each Dose, made it operate more as a Purgative, and
+    did not make the Men so sick.--Dr. _Akenside_ proposes giving
+    the Ipecacuana in so small Doses as one or two Grains every
+    six Hours, in a Draught made of Mint-water, and Half a Drachm
+    of _confectio cardiaca_; and, after bleeding and vomiting
+    once, seems to depend almost entirely on the Use of this
+    Medicine for the Cure of the Dysentery. See his _Comment. de
+    Dysenteria_, cap. 2.
+
+    The watery Tincture of Rhubarb, recommended by _Degnerus_, we
+    tried in some Cases at Bremen; and found it to be a good mild
+    Purge, but not to answer so well as the Salts and Manna in
+    recent Cases. Mr. _William Russel_ told me that they found
+    this watery Tincture of Rhubarb to answer better in _America_
+    than any other of the Preparations of Rhubarb.
+
+    Calomel has been recommended by many as a Purge in
+    Dysenteries; and Dr. _Huxham_ (_de Aere_, Vol. II. P. 100)
+    assures us, that he has often experienced the good Effects of
+    it, especially when the Patient at the same time had Worms;
+    in such Cases we joined it to Rhubarb as mentioned in the
+    Text, or gave a Calomel Bolus over Night, and a Purge next
+    Morning. Dr. _Duncan_, Physician to his Majesty, told me,
+    that he found the following Method of Cure always successful
+    in the Dysentery, which was epidemic in _London_ in the Year
+    1762.
+
+    If the Patient was Plethoric, or had much Fever, he ordered
+    more or less Blood to be taken away; and then gave four
+    Ounces of the following Julep, every Half Hour, till it both
+    vomited and purged. Rx _Tartar. emetic. gr._ iij _Mann� elect.
+    Unc._ ij _solve in Aq. hordeat. Lib._ 1.--The next Day, and
+    for five or six Days more, the Patient took so much of a
+    Decoction, of Manna, Tamarinds, and soluble Tartar, as kept
+    up a free Discharge by Stool.--If the Irritation and Griping
+    were severe, he found that a Solution of Manna, in the common
+    Almond Emulsion, was sufficient.
+
+    When the Pain, or Tenesmus, was violent, a Clyster, of
+    Chicken Broth, or of an Infusion of Linseed, with an Ounce or
+    two of Oil of sweet Almonds dissolved in the Yolk of an Egg,
+    injected once or twice a Day, was of great Use.
+
+    Upon the whole, he was always pleased when he saw large
+    excrementitious Stools come away; and when that could be
+    procured by a gentle Method, he was the more pleased.
+
+    This Disorder was very often cured in a few Days, and in that
+    Case he dropt the further Use of Medicines; but when it
+    exceeded the Period of six or seven Days, he then added
+    thirty or forty Drops of the _tinctura thebaica_ to the
+    Clysters; and ordered a Scruple of the Extract of the Logwood
+    to be taken thrice a Day in some proper Vehicle.
+
+    The Patient's Diet was Rice-Gruel, Sago, Panado, and such
+    like; no Animal Food, not so much as Chicken-Broth, was
+    allowed in the Beginning of the Distemper, nor even Oil,
+    Butter, or Fat of any Kind. The common Drink was Almond
+    Emulsion, Rice-Water, or Barley-Water with Gum Arabic.
+
+    Dr. _Duncan_ lost but one Patient out of Eighty, whom he had
+    under his Care that Season; and he was delirious, had a high
+    Fever, and a _subsultus tendinum_ before the Doctor was
+    called to him, and he died the next Day.
+
+    The late Dr. _Young_, of _Edinburgh_, seems to have had a
+    very just Notion of this Disorder, and of the proper Method
+    of treating it; for, in his Treatise on Opium, sect. vii. he
+    says, "I am convinced from Experience, that most of the
+    Dysenteries I have hitherto met with, might have been cured
+    by purging mildly, but constantly; and at the same time
+    abating the Acrimony in the great Guts by emollient Clysters,
+    and in the small ones by Plenty of Absorbents, and a Diet of
+    Chicken Broth: But it must be observed with regard to
+    Purgatives, that Manna agrees best with some, Rhubarb with
+    others, Jalap, Mercury, and toasted Rhubarb with others;
+    while others are sooner cured by emollient Clysters. I use
+    Opium only when the Disease is mild, or after its Violence is
+    abated by Evacuants and Emollients."
+
+    Scammony, Aloes, and the other strong resinous and hydragogue
+    Purges, are hurtful, and occasion Pain. I always observed,
+    that those Purges answered best which made the freest
+    Evacuation, and acted with the greatest Ease to the Patient;
+    of which the Salts and Manna answered best of any I have
+    hitherto used.
+
+Though Rhubarb did not answer so well in the Beginning as the saline
+Purges; yet afterwards in the Course of the Distemper, when the
+Patient did not complain much of Gripes, half a Drachm of Rhubarb,
+either by itself or in a saline Draught, proved a good gentle Purge;
+and given with six or seven Grains of Calomel, was found to be a good
+Medicine, when the Disorder was attended with Worms.
+
+In the Evening, after the Operation of the Purge, we gave an Opiate;
+and repeated it at Nights, in the Intervals between the Purges; but
+were obliged to be very sparing of the Dose, while the Disorder
+continued in its acute State; the Opiate was only given in a Quantity
+sufficient to mitigate the Pain, and to procure Rest, but never so as
+to stupify the Patient, or prevent a due Discharge by Stool; though we
+were often obliged to encrease the Dose, as Use made it familiar to
+the Patient.
+
+In the Intervals between the Purges, we gave in the Day, the Mindereri
+Draughts with the Mithridate; or the saline Draughts with the Addition
+of four Drops of the _tinctura thebaica_; or some such mild
+diaphoretic, every four or six Hours; which helped to keep up a free
+Perspiration, without any Danger of stopping the Purging; and for the
+most part answered much better than the Diascord, or Philonium, or
+other strong Astringents and Opiates commonly prescribed for this
+Purpose; which were always liable to check the Purging too much, and
+bring on severe Gripes attended with Heat and Fever[37]; and therefore
+we seldom made Use of them in this first Stage of the Disorder.
+
+    [37] _Sydenham_, _Huxham_, and all good Practitioners, have
+    taken Notice of the bad Effects of the too free Use of
+    Astringents, and given Cautions against it.
+
+If the Patient was attacked with severe Gripes[38], and a Tenesmus,
+which the Purgatives and gentle Opiates did not relieve, we ordered
+the Abdomen to be fomented with warm Stupes; and the Patient to drink
+freely of warm Barley or Rice-water, or of weak Broth[39], or an
+Infusion of Camomile Flowers, as recommended by Dr. _Pringle_; and
+ordered first Clysters of large Quantities of the plain emollient
+Decoction to be given; and if the Gripes still continued, to be
+repeated in small Quantities, with the Addition of a Drachm or two of
+the _tinctura thebaica_; for we observed that Opiate Clysters often
+gave more Relief, than Anodynes administered in any other Way; and
+sometimes, when a Tenesmus was very troublesome, the common oily
+Clyster, with a little Diascord, and _tinctura thebaica_, or the
+Starch Clyster, gave more Ease than any other.--In some Cases, where
+the Pain was sharp, attended with a Fever, we were obliged to take
+away more or less Blood; and sometimes also to apply a Blister to that
+Part of the Abdomen where the Patient felt most Pain.
+
+    [38] If the Patient was suddenly attacked with sharp Pain of
+    the Bowels and Gripes, on a Day in which he had not Physic, a
+    Dose of the Salts and Manna was commonly given immediately,
+    to empty thoroughly the first Passages.
+
+    [39] Mr. _W. Russel_ told me, that he and Dr. _Huck_ found
+    the free Use of the following Emulsion, made of Bees Wax, to
+    be of great Use after Evacuations, where there was much Pain
+    of the Bowels, in recent Cases of Fluxes in the Hospitals in
+    _America_. Rx. Cer� alb. vel flav� drachmes tres. Sapon. alb.
+    Hispan. drachmam unam. Aqu� fontan�, unciam unam, liquefiant
+    super ignem in vase ferreo, agitando spatula, & dein infunde
+    in mortarium marmoreum, & adde paulatim aq. fontan�, libras
+    duas syrupi sacchari. spiritus vini gallici tenuis, vel aqu�
+    alicujus spirituos� ana unciam unam, terendo optime ut fiat
+    emulsio.
+
+    This Method of dissolving Bees Wax, in a Watery Liquor, is
+    entirely new; for before this we knew of no Way of making it
+    miscible with Water.
+
+During this Course, the Patients used the common low Diet of the
+Hospital; when they loathed the Rice-Gruel, they had Panado with a
+little Red Wine and Sugar; or Water-gruel, when it could be got, in
+its Place.--Their common Drink was Barley or Rice-water; of which it
+was recommended to them to drink plentifully; as nothing contributed
+more to the Cure than the free Use of such Liquors, to dilute and
+blunt the Acrimony of the Fluids[40]. In some Cases, when the Purging
+was violent, and not accompanied with the malignant Fever, the
+_decoctum album_ was found to be a good Drink; and we added
+occasionally a few Drops of the _tinctura thebaica_.
+
+    [40] Dr. _Huxham_ (_de Aere_, Vol. II. p. 107.) says, there
+    is no Disorder in which a diluting, sweetening Drink is more
+    necessary than in this; that he has done great Service among
+    the Poor by luke-warm Water; that, after emptying the Bowels
+    thoroughly, he has sometimes cured this Disorder by the Use
+    of pure Water, and a small Quantity of Opium. And _Baglivi_
+    (_Prax. Med._ lib. i.) tells us, that the drinking of common
+    Whey, and throwing up frequent Clysters of it, had cured
+    many, and that this was looked upon as a Specific, and kept a
+    Secret by some.
+
+Such were the chief Remedies we used in the first Stage of this
+Disorder; but after some Weeks, when the Fever had abated, and free
+Evacuations had been made, and the Complaint become in a manner
+chronic, we were obliged to try other Methods; and found that the best
+Way of treating this Disorder, was, to endeavour to brace and restore
+the Tone of the Intestines, by means of the corroborating and gentle
+astringent Medicines, mixed with Opiates; while mild Purgatives were
+given at proper Intervals.
+
+The Patients were kept to the same low Diet as before, with the
+Addition of a little Wine or Brandy. They were allowed from a Gill to
+a Pint of red Wine _per_ Day, which was commonly mulled before it was
+given them; when the Wine griped them, which it frequently did, they
+took in its Stead Half a Gill or a Gill of Brandy, mixed with a Pint
+or a Quart of Barley or Rice-water, or of the _decoctum album_.
+
+In this Stage of the Disorder we found, that the same Medicines would
+not answer with all, and therefore we were obliged to try Variety[41];
+and indeed, unless where the Violence of the Disorder had abated by
+the Use of Evacuations, the Event was always very doubtful; for when
+the Complaint had continued long and become chronic, and the Structure
+of the Intestines was much hurt, before the Sick were sent to us; or
+when it continued obstinate, and yielded but little to Evacuations,
+and the other Methods used in the first Stage, even Remedies esteemed
+the most efficacious oftentimes proved unsuccessful, and at length
+the Patient died.
+
+    [41] Dr. _Pringle_, in the _fourth Edition of his
+    Observations_, just published, in treating of the third or
+    last Stage of the Dysentery, remarks, that this is the Time
+    for Astringents, which ought not to be given sooner, or at
+    least very sparingly. And he tells us, that, in the former
+    Editions of his Work, he mentioned those Compositions which
+    he had most frequently used, but that he had now laid most of
+    them aside; and at present trusts to Vomits, and to a Milk
+    Diet, for the perfect Cure.
+
+    He says, "Whenever therefore the Patient is in this State,
+    and especially when his Pulse is quick, and he complains of
+    inward Heat, I began with giving him a Scruple of Ipecacuana;
+    and the next Day I put him upon the Milk-Diet; which I
+    continue till all the hectic Symptoms are gone, and till the
+    Bowels have recovered their Tone. During this Course I have
+    seldom had Occasion for any other Medicine, excepting the
+    Chalk Julep mentioned before, which I use for correcting that
+    strong Acid so incident to relaxed Stomachs. Sometimes also I
+    add an Opiate to procure Rest at Night; but after a few Days
+    these are likewise laid aside. All that I require (which
+    indeed is often hard to obtain) is a strict Perseverance in
+    the low Diet: and now and then a Repetition of the Vomit,
+    upon any new Disorder of the Stomach, or great Laxity of the
+    Bowels.
+
+    "Whilst the Patient continues in this Course, I forbid all
+    animal Food and fermented Liquors; and besides Milk, I allow
+    only the Preparations of Grain, Sago and Salop." See Part
+    iii. ch. vi. p. 289, 290.
+
+A Spoonful of the _mixtura fracastorii_, taken after every loose
+Stool; and an anodyne Draught at Night, had a good Effect with
+some--Repeated Doses of the _philonium Londinense_ answered better
+with others, who were low, and required a Remedy that was warm and
+cordial--And others found more Benefit from the Mindereri Draughts,
+with Mithridate, or the _confectio cardiaca_, or the Theriac anodyne
+Boluses.
+
+The _mixtura Campechensis_, both alone and with _tinctura thebaica_,
+checked the Purging, and gave Relief sometimes; and the Addition of
+some of the Extract of Bark and Tincture of Cinnamon, seemed to
+encrease its Efficacy in one or two old Cases, at _Bremen_; but it
+afterwards occasioned such Sickness, that we did not continue its Use.
+
+In other inveterate Dysenteries, where we thought that a strong
+Astringent was wanted, we added a small Proportion of Allum to the
+_Campechense_ Julep, which on first using seemed to be serviceable;
+but at other Times it occasioned a Tenesmus and Gripes; and therefore
+we were obliged to be very cautious how we used it.
+
+Equal Parts of the _electuarium diascordii_ and _electuarium
+corticis_, taken in the Quantity of a Drachm twice or thrice a Day,
+was of Use in many old Fluxes[42], though it made other Patients so
+sick, that they were obliged to lay it aside.
+
+    [42] I had lately a very remarkable Instance of the Effects
+    of this Medicine, in the Case of one _Gilchrist_, a
+    middle-aged Man, by Trade a Taylor; who was admitted into
+    _St. George_'s Hospital the 20th of _July_, 1763, for an old
+    Flux, which had continued above six Months, and reduced him
+    very low: He had taken a great many Medicines without any
+    Effect. After giving him a Vomit and two Doses of Tincture of
+    Rhubarb, I gave him four Grains of the Powder of Ipecacuana
+    with Opium three Times a Day; but that having no Effect,
+    after using it for above a Fortnight, I ordered him the
+    Electuary of Diascord and Cortex; from the Time he began to
+    use this Medicine, he mended daily; and was dismissed in good
+    Health the 26th of _September_.
+
+We tried likewise in this Stage of the Disorder, repeated small Doses
+of the Ipecacuana; but it occasioned such Sickness, that we did not
+persist in its Use.
+
+In other Cases, we gave from two to five Grains of the Ipecacuana,
+mixed with Opium, in different Proportions (from three Grains to ten
+of the Ipecacuana to one of the Opium), every four or six Hours; it
+gave sometimes a little present Ease, at other Times it occasioned
+Sickness; we often continued its Use for ten, twelve, or fourteen
+Days; but it seldom produced any remarkable Change for the better, and
+we were obliged to have Recourse to other Remedies.
+
+_Dover_'s Powder was given in large Doses, from one Scruple to two;
+and proved a good Sudorific and Anodyne in some Cases; though in
+others it made the Patients sick, without producing any good
+Effect.--It commonly answered better, when used occasionally as a
+Sudorific, than when constantly continued.
+
+During the Use of these Remedies, it was necessary to repeat the
+Purgatives from Time to Time; or to mix them occasionally with the
+other Medicines, in order to carry off any corrupted Humours, or
+Excrements that might be lodged In the Cavity of the Intestines; for
+when this was neglected, the Patients were often seized with Sickness
+and Gripes, and a more violent Purging than before:--And if at any
+Time they complained of Gripes, and passed little Pieces of hardened
+Excrements, it was mostly a certain Sign that a Purge was indicated;
+and, on such Occasions, it generally gave Relief; and when attended
+with Sickness, a Vomit was given before the Purge.--Clysters were used
+as in recent Cases, where the Sick were low, or had much Pain of the
+Bowels[43], or complained of a Tenesmus.
+
+    [43] On the 21st of _November_, 1759, _Hanah Meredith_, a
+    middle-aged Woman, was admitted into _St. George_'s Hospital
+    for a Flux, which she had six or seven Weeks; she had no
+    Fever, but complained much of Sickness and Gripes, and her
+    Disorder had reduced her very low. During the two first Weeks
+    of her being in the Hospital, she had two Vomits of
+    Ipecacuana and four Doses of Rhubarb; and in the Intervals
+    anodyne and astringent Medicines, which made no Alteration in
+    her Complaints. On the 2d of _December_, she told me, that
+    two Years before she had had a Flux for above three Months,
+    which had yielded to no Remedies till she was ordered
+    repeated Clysters, and that they had made a Cure in a short
+    Time. I then ordered an emollient Clyster with a drachm of
+    the _electuarium diascordii_, and a Scruple of the _tinctura
+    thebaica_, to be given twice a Day, which gave her almost
+    immediate Relief; and with the Assistance of some Doses of
+    Rhubarb, and one or two Vomits and occasional Opiates,
+    removed her Disorder by the Middle of _January_; though she
+    remained long weak, and troubled at Times with Gripes; but
+    these Complaints were at last got the better of by her taking
+    some Doses of Rhubarb, and drinking daily a Pint of Lime
+    Water mixed with Half a Pint of Milk.
+
+    _Sarah Spencer_, a middle-aged Woman, was admitted into _St.
+    George_'s Hospital the 9th of _November_, 1763, for a Flux,
+    which had continued for two Months, and reduced her very low.
+    She complained much of Sickness and Gripes; her Stools were
+    mostly composed of Mucus and Blood; her Pulse was low, and
+    she had no Fever, but a Whiteness of the Tongue, and
+    complained of Thirst.--The first Day she had a Vomit, and
+    next Day a Dose of the purging saline oily Draught.--She was
+    ordered to have an emollient Clyster, with a Drachm of
+    Diascord, and as much _tinctura thebaica_, given her every
+    Evening; and to have a Dose of the saline oily Purge twice a
+    Week, and Opiates occasionally; by following this Course, and
+    drinking at Times the Chalk Julep, her Disorder was removed,
+    and she was discharged the Hospital on the 30th of the same
+    Month.
+
+In some old Dysenteries, where the villous Coat of the Intestines was
+much injured, I gave the Cordial Draughts, with the Addition of Half a
+Drachm of the _balsamum copaivi_, a Scruple of the Extract of the
+Bark, and five Drops of the _tinctura thebaica_, three Times a Day.
+At first, this Medicine seemed to promise much, particularly in the
+Case of an old Invalid, _William Brookes_; who had been long ill of a
+Flux, attended with Gripes and a Tenesmus. He had used Variety of
+Remedies, without receiving any Benefit. For the first Fortnight,
+after he began the Use of this Medicine, he rested well, and found
+great Relief; and seemed to be in a fair Way of doing well. But the
+Disorder being too far advanced before he began to use it, he
+relapsed, and died. On opening his Body, the inner Coats of the Rectum
+and the lower Part of the Colon seemed to be reduced almost to a
+gelatinous Substance, and the other Coats were black, approaching to a
+Gangrene.--The same Medicine gave Relief in other Cases, but they were
+too far advanced before it was administered. In these Cases, when the
+villous Coat of the Intestines was inflamed and very irritable, the
+mucilaginous Medicines, the _pulvis e tragacantha_, and such others,
+were of Service; and frequently Starch Clysters and Anodynes gave
+Relief, when other Remedies had little Effect. Flower, boiled with
+Milk, and sweetened with Sugar, and given for Breakfast, as mentioned
+by Dr. _Pringle_, proved a good Palliative to some; and the Starch and
+Gum Arabic, dissolved in Water, a good Drink to others.--Lime Water
+and Milk, drank to the Quantity of a Pint or a Quart a Day, was of use
+to a few, though it did not agree with all.
+
+It was very common for Patients bad in the malignant Fever to be
+seized likewise with the Flux. Such Cases were always extremely
+dangerous; and when the Fever was bad, we were often obliged to
+neglect the Flux, and only attend to the Fever.--When the Purging was
+violent, and appeared very early in the Fever, it often sunk the
+Patients, and soon carried them off: but where it was moderate, and
+did not appear till towards the Height or the Decline of the Fever, it
+often proved a Crisis to the Disorder.
+
+When such Fluxes appeared early attended with sharp Pain of the
+Bowels, and Signs of Inflammation; if the Patient was strong, we
+began the Cure with opening a Vein, which the Patient bore easily, and
+it gave Relief; but when the Symptoms were mild, without any acute
+Pain, the Bleeding was omitted.--Commonly the Bowels were loaded with
+corrupted Humours, when this Symptom appeared; and, therefore, we
+found it of Advantage to give a Dose of the Salts with Manna and Oil,
+or some other gentle Purge, to carry them off; and in the Evening an
+Opiate to ease the Pain and procure the Patient Rest.
+
+After this we gave the Mindereri Draughts with Mithridate; and as soon
+as the Petechi� appeared, or we observed any Remissions in the Fever,
+the Patient took every four or six Hours, a Drachm of an Electuary,
+composed of equal Parts of the _electuarium corticis_ and the
+_electuarium diascordii_[44]; or Half a Drachm of the Powder of the
+Bark, or a Scruple of the Extract, in the Mindereri Draughts, with
+four or five Drops of the _tinctura thebaica_; and we repeated the
+Opiate in the Evening, always proportioning the Quantity of it to the
+Effects of the former Dose, and the Violence of the Purging.
+
+    [44] This Practice of giving the Cortex with Opiates in the
+    Dysentery is not new; for Dr. R. _Morton_, in his Appendix to
+    his second Exercise on the Fevers, which appeared from 1658
+    to 1691, observes, that after the Plague of 1666 had ceased,
+    a Fever from a milder Poison, attended with Gripes and
+    Dysentery, began to make its Appearance. As the common
+    Methods of Cure proved unsuccessful, and Dr. _Morton_
+    observed Exacerbations and Remissions, he resolved to give
+    the Bark mixed with Laudanum; and found it answer his
+    Expectation. The first Patient to whom he gave it, was a man
+    in _Long Lane_, who laboured under a Tertian Dysentery; upon
+    observing a Remission, he ordered a Drachm of the Bark, mixed
+    with a Grain of Opium, to be given every four Hours for six
+    Times; and this removed both the Fever and Dysentery.--He
+    says, he afterwards gave it, with equal Success, in the
+    Quotidian Dysenteries, where he observed Exacerbations or
+    Remissions; and he adds, that he does not doubt but that it
+    will answer as well in Epidemical Diarrhoea's, and Camp Fevers
+    attended with such Symptoms.
+
+    Dr. _Whytt_ of _Edinburgh_ has given with Success a strong
+    Decoction of the Bark, mixed with the _confectio japonica_ of
+    the _Edinburgh_ Dispensatory, in the bad State of the
+    Dysentery, when the Mouth and alimentary Canal were
+    threatened with Aphth�, and even sometimes after they had
+    appeared. And Dr. _Pringle_ mentions his having given the
+    Decoction of the Bark, with Snake-Root and some Drops of
+    Laudanum, in the Dysentery complicated with the malignant
+    Fever. See _Note to Page 245 of his third Edition on the
+    Diseases of the Army_.
+
+On the second or third Day, we repeated the Purge; or, if the Patient
+was weak, ordered a Clyster to be administered in its Place; in order
+to prevent the putrid Fluids and Excrements from being accumulated in
+the Bowels:--In other respects we treated it as when the Disorder was
+not complicated with the malignant Fever.
+
+This Method, though it did not succeed with all, yet it answered
+better than any other I tried;--and it ought to be remarked, that
+although it had such a good Effect in Cases attended with the
+malignant Fever, or where the Fever inclined to the intermittent Kind,
+it did not answer so well in other recent Cases, but often made the
+Patient sick.
+
+In military Hospitals, Fluxes are liable to be complicated with other
+Disorders, as well as with the malignant Fever; especially with
+Coughs, and pleuritic and peripneumonic Symptoms, when the Weather
+begins to be cold, in _October_ and _November_.--In such Cases, when
+the Patients were strong, we were often obliged to bleed freely, to
+apply Blisters, and in the Beginning treat the Disorder as
+inflammatory; having at the same Time an Eye towards the Flux, in the
+other Medicines we prescribed.
+
+Patients, who have had the Flux long, are apt to have their Legs swell
+at Nights; or to swell all over as soon as the Flux has stopped. Such
+oedematous or anasarcous Swellings, we treated nearly in the same
+Manner as those which followed the petechial Fever; only that we durst
+not at first be so free with the Use of Purgatives; for as the Bowels
+remained weak and easily irritated, such Medicines were apt to bring
+back the Flux; and therefore, in the Beginning, we were for the most
+part obliged to attempt the Cure by Diuretics and Diaphoretics; and to
+be sparing of the Use of Purgatives, especially of those of the
+hydragogue Kind; though if the Swellings continued for some Time after
+the Flux was gone off, and the Patients were strong, we then ventured
+to give Purges at proper Intervals:--And Blisters and Scarifications
+removed them in several Instances both at _Paderborn_ and
+_Osnabruck_.
+
+In _December_, 1761, we had a Case of this Kind where the _oxymel
+scilliticum_ was of remarkable Service. A Soldier, belonging to the
+Guards, after a Flux, swelled all over, and made but a very small
+Quantity of Water. He took Medicines of different Sorts for some
+Weeks, but received no Benefit till we gave him the Oxymel Mixture;
+after taking a few Doses he made Water very freely, and in large
+Quantities, and the Swellings of his Body and Scrotum began
+immediately to subside; and by continuing its Use for a Fortnight, the
+Swellings entirely disappeared, and he recovered his Health and
+Strength.--The Oxymel, at the same Time that it promoted a Flow of
+Urine, kept his Body gently open, but did not occasion any Return of
+the Flux.
+
+At the Beginning of _January_, 1762, one _Carter_, a Soldier of the
+Eleventh Regiment of Foot, laboured under an universal Anasarca; which
+about two Months before had succeeded a Flux. He made but very little
+Water, and that of a high red Colour. He took Variety of Medicines,
+as Purges, Vomits, _Dover_'s Powder, lixivial and neutral Salts with
+Opiates, Infusions of Horse-Radish, all without Effect; till he was
+ordered small Doses of Calomel, three Grains Morning and Evening.
+After the third Dose he began to make Water freely; and by the 24th of
+_January_ the Swellings were all gone, and he was shipped off for
+_England_ the 8th of _February_; having been discharged from his
+Regiment. The Ship, he went aboard of, was detained in the River
+_Weser_ for above six Weeks, and the malignant Fever broke out aboard
+the Transport: He took the Distemper, and got well of it; but towards
+the Decline was seized with a Return of the Flux, which carried him
+off.
+
+When these oedematous Swellings came after the Purging was stopt, if
+the Patient's Strength was not much exhausted, and he laboured under
+no other Disorder, he commonly got the better of it:--But when the
+Strength was gone before the Swellings appeared, the Disorder often
+ended in a confirmed Dropsy, and at last in Death; and when the
+Swellings were universal over the Body, while the Flux yet continued,
+it was a Sign of great Weakness, and they did not survive it long[45].
+
+    [45] Many other Medicines have been used for the Cure of old
+    Dysenteries,--The _Conessi Bark_, recommended as a Specific
+    in Diarrhoeas, cured a Dysentery which had yielded nothing to
+    a Variety of Medicines. _Edinburgh Medical Essays_, _Vol._
+    III. _Art._ iv.--The _cortex eleutheri� vel cascarill�_ 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_, _Aret�us_, _Celsus_, and other
+antient Authors; and is very accurately described by many of them.--It
+is of the bilious Kind; and the Cure principally depends upon the free
+Use of warm mild Liquors in the Beginning; to dilute and blunt the
+Acrimony of the Bile, and other Fluids, and to promote their
+Discharge; and afterwards of gentle Cordials to support the Strength;
+and warm Fomentations to allay the Pain when violent; and mild Opiates
+to procure Rest; and if the Sickness or Griping remains next Day after
+the Cholera is stopt, to give a Dose of Physic and an Opiate in the
+Evening.
+
+An Officer, who had been wounded on the 15th of _July_, at the Battle
+of _Fillinghausen_, began afterwards to live very freely, and was on
+the 4th of _August_ seized in the Night with the Cholera.--About ten
+o'Clock next Day I was sent for; and found him in violent Agony, with
+sharp Pain in the Bowels, Reachings, and Strainings to Vomit, and
+Spasms and Cramps in the Bowels, Legs, and Arms.--He had large red
+Blotches on his Extremities, and no Pulse was to be felt at the Wrist,
+and rather a Fluttering than a Beating at the Heart.--He had vomited
+and purged much in the Night before I saw him, but the Purging had
+begun to abate.--I immediately ordered him an emollient Clyster, and a
+saline Draught, with the _confectio cardiaca_, and five Drops of
+liquid Laudanum; which, if he vomited up, was to be repeated soon
+after; if not, only once in four Hours: And he was directed to drink
+freely of weak Chicken Broth, warm.--Two Hours afterwards we found him
+in the same Situation; still no Pulse to be felt, which prevented us
+from bleeding him; and the violent Pain of the Stomach and Bowels, and
+the Cramps, continued. We then ordered Flannels, dipped in a warm
+emollient Decoction, to be kept constantly applied to his Belly,
+dipping them in the warm Decoction as soon as they began to grow cool;
+his Clyster to be repeated with the Addition of a Drachm of the
+_electuarium e baccis lauri_, and Half a Drachm of the _tinctura
+thebaica_; a Scruple of Castor, and Half a Drachm of Spirit of
+Lavender, to be added to each of his Draughts; and a Blister to be
+prepared, in case these Medicines gave no Relief.--Soon after,
+beginning to use the Fomentations, the Cramps and Pains began to
+abate; about four o'Clock in the Afternoon we could perceive a
+Fluttering of the Pulse at the Wrist, and all the Pains and Cramps
+were much easier; so that there was no occasion for the Blister.--Next
+Morning he was very easy, but low, and inclined to be sick; for which
+his Cordial Draughts were repeated every six Hours.--The third Day, as
+he complained of a little Griping in the Bowels, we ordered him a Dose
+of Tincture of Rhubarb, and an Opiate in the Evening, which entirely
+removed these Complaints, and he was abroad and well next Day.
+
+One Soldier, who had a good deal of Fever, and complained of acute
+Pain in the Bowels, along with the Vomiting and Purging, was blooded;
+and drank freely of warm Barley-Water while the Vomiting
+continued.--After throwing up a Quantity of green bilious Matter, the
+Vomiting ceased; and the Gripes and Purging became less violent.--In
+an Hour after, being able to retain some very weak Broth in his
+Stomach, he drank plentifully of it through the Day; and the Purging
+being abated towards Night, he took an anodyne Draught; and next Day,
+having still a little Sickness remaining, had a Dose of Physic and an
+Opiate at Night, which removed all his Complaints.
+
+The Rest, who were attacked with the Cholera at _Munster_, were
+treated much in the same Way; only as they had not such acute Pain and
+Fever as this Man, it was thought unnecessary to bleed them.
+
+The Antients[46] recommended drinking freely of warm Water in the
+Beginning, and the Use of both cold and hot Fomentations of the
+Stomach and Belly;--and in the low State, the Use of Wine, mixed with
+Water, and Polenta[47]; and to apply Rue, with Vinegar, and other
+strong smelling Things, to the Nostrils; besides Variety of other
+Remedies.--When Convulsions happen, _Celsus_[48] advises to anoint the
+Belly with warm Oil; and if that does not remove them, to apply
+Cupping-Glasses or Mustard to the Stomach; and, after sleeping, to
+abstain the second Day from Drink; and the third, to go into the Bath;
+and if any thing of a Fever remains after the Cholera is suppressed,
+to give a Purge.
+
+    [46] See _Aret�us_, Lib. ii. Cap. 4. and _Celsus_, Lib. iv.
+    Cap. 11.
+
+    [47] The Polenta seems to have been nothing but toasted
+    Barley Meal. See _Plinii Hist. Natural._ Lib. xxii. Cap. 25.
+
+    [48] _Celsus loco citato._
+
+Dr. _Sydenham_[49] trusts principally to drinking freely of Chicken
+Broth, and throwing up Clysters of the same, and afterwards giving
+Opiates.
+
+    [49] _Processus integ. de Cholera._
+
+Dr. _Ayton Douglas_, in the sixth Volume of the _Edinburgh_ Medical
+Essays[50], recommends a Decoction of Oat Bread, baked without Leaven
+or Yest, and carefully toasted as brown as Coffee, but not burnt; as a
+Remedy very grateful to the Stomach, and useful in stopping the
+Vomiting, and sometimes the Purging too: And he relates several Cases
+where it had a good Effect. After the Vomiting was stopped, he added
+the Use of mild Opiates; and, where the Patient was low, Wine and
+other Cordials.
+
+    [50] Art. 65.
+
+
+
+
+OF THE INFLAMMATORY FEVER.
+
+
+On the Return of the Troops from the Winter Expedition into the
+Country of _Hesse_, in the Year 1761, we had several Men seized with
+Inflammatory Fevers without any topical Inflammation; and at the
+Opening of each Campaign had always Numbers sent to the Hospitals ill
+of this Disorder. Towards the End of the Campaigns, and throughout the
+Winter, many were seized with Inflammatory Fevers; but these were
+mostly complicated, with pleuritic, or peripneumonic Symptoms, or
+other topical Inflammations, or with rheumatic Complaints.
+
+In the Inflammatory Fever, the Sick were seized at first with cold and
+hot Fits, succeeded by Pain in the Head and all over the Body. The
+Pulse was strong and quick, and the Blood sizy; attended with other
+Appearances commonly observed in such Fevers.
+
+As the Summer advanced, this Fever was often accompanied with bilious
+Symptoms, with Sickness, and vomiting of bilious Matter, and very
+frequently with a Purging: Towards the End of Summer it ceased, and
+was succeeded by the bilious remittent Fever.--And it was no uncommon
+Thing to see those Fevers, which originally were entirely of an
+inflammatory Nature, after the sick had been some Days in a crowded
+Hospital, partake a good deal of the Nature of the Malignant Fever, or
+be changed entirely into it.
+
+We treated these Fevers in the common antiphlogistic Method.--We
+blooded freely in the Beginning; gave the saline Draughts with Nitre
+and other cooling Medicines; and made the Patients drink plentifully
+of small Liquors:--And when they were inclined to be costive, gave
+mild Purges, or emollient laxative Clysters. We afterwards applied
+Blisters; and if the Pulse began to sink, gave Cordials, Wine, and
+other Remedies commonly employed in such Cases;--and towards the
+Decline of the Fever endeavoured to promote such Evacuations as were
+pointed out by Nature, and likely to prove critical.
+
+When the Case was complicated with bilious Symptoms in the Beginning,
+we were obliged to have particular Regard to the first Passages. If
+the Patient complained much of Sickness, we gave a gentle Vomit in the
+Evening, after bleeding; and a Purge next Day, to carry off any
+bilious or corrupted Humours that might be lodged in the Stomach or
+Intestines; and we found that these Evacuations gave Relief, and
+generally mitigated all the Symptoms.
+
+If at any Time during the Fever a Looseness came on, especially when
+attended with Gripes, we gave a Dose of some gentle Physic, which made
+a free Evacuation; and an Opiate in the Evening after its Operation;
+and afterwards we found it answer better to attempt rather to
+moderate, than wholly stop the Purging by strong Astringents, and
+Opiates; unless where the Evacuation by Stool was so great as to be in
+Danger of sinking the Patient.
+
+The _pulvis antimonialis_, composed of ten Parts of the _pulvis e
+chelis_, and one Part of the Tartar emetic, given in small Doses, was
+serviceable in many of these Fevers, after free Evacuations had been
+made.
+
+Two Patients, one a Soldier of the Twentieth Regiment, the other a
+_German_ Waggoner, were taken ill of this Fever about the 25th of
+_December_, 1762: They were both blooded freely, and had a Dose of
+Physic in the Beginning; and the saline Draughts with Nitre and other
+cooling Remedies; and had Blisters applied without producing any
+considerable Change in their Disorder.--On the 5th of _January_, 1763,
+they both complained much of Thirst, and were inclined to be costive;
+their Tongues were parched, their Pulses quick and small, and their
+Skins dry; they were restless at Nights, and the Soldier had a slight
+Delirium.--I ordered each of them four Grains of the _pulvis
+antimonialis_ every four Hours.
+
+6th. Next Day the Soldier told me, he had had four loose Stools; his
+Senses were much clearer, the Pulse calmer and slower, and he said he
+found himself lighter and easier, and less feverish, than he had been
+since he was first taken ill. The Medicine was continued, with the
+Addition of an anodyne Draught at Night.--7th. I found him in a fine
+breathing Sweat, and he told me he had slept well in the Night:
+p.--8th. The Sweat continued till this Morning, and on going off his
+Urine let fall a copious white Sediment, and left him free from the
+Fever; after which he mended daily.
+
+The Waggoner, after taking the third Dose of the Powders, had a warm
+Moisture upon the Skin.--On the 6th was cooler and without much Fever,
+and had had one Stool.--7th. The warm Moisture ended in a profuse
+Sweat, which carried off the Fever, and he continued to recover
+daily.
+
+
+
+
+OF THE ANGINA; OR, SORE THROAT.
+
+
+Many of the Soldiers during the Campaign were seized with
+Inflammations of the Throat, especially when the Nights were cold and
+moist after warm Days; and when they did Duty in cold wet Nights in
+the Winter Season.--All of them I saw in _Germany_ were of the
+inflammatory Kind; I did not observe any that were malignant.
+
+They were treated in the antiphlogistic Method.--The Patients were
+blooded liberally in the Beginning--took the cooling nitrous and
+saline Medicines--gentle Diaphoretics and Purgatives--and used
+frequent Gargarisms.
+
+Sometimes a Flannel rubbed with camphorated Oil, or the _linimentum
+volatile_, and applied round the Neck, was of Service.--And frequently
+after bleeding sufficiently, where the Breathing or Swallowing was
+difficult, the Application of a large Blister to the Neck gave speedy
+Relief.
+
+
+
+
+OF THE PLEURISY.
+
+
+The Pleurisy, or an acute Inflammation of the Side, was most frequent
+among the Soldiers towards the latter End of the Campaigns; though
+some were attacked with it at all Times of the Year, from doing Duty
+in all Sorts of Weather.
+
+We followed the antiphlogistic Method of Cure; and ordered plentiful
+Bleeding in the Beginning, till the Violence of the Pain began to
+abate, or the Patient grew faint;--and the Side to be fomented with
+Flannels dipped in warm emollient Decoctions, and afterwards rubbed
+with volatile Liniments: At the same Time the Patient drank freely of
+warm diluting Liquors, as Barley Water, the pectoral Decoction, and
+such like; and took the saline and other cooling Medicines, mixed
+occasionally with Sperma Ceti, or some other soft Pectorals, if there
+was a tickling Cough.--When the Patient was costive, we gave a Dose of
+Salts, or some other mild Physic, or laxative Clysters.
+
+If the Pain continued very acute, we repeated the Bleeding as often as
+Necessity seemed to require, and the Pulse could bear; and immediately
+after the second Bleeding ordered a large Blister to be applied to the
+Part affected.
+
+Physicians formerly used to forbid Bleeding after the fourth Day, if
+it had been omitted so long; but when no Symptoms of Suppuration had
+already appeared, on whatever Day of the Disorder it happened, I
+ordered plentiful Bleeding, the same as in recent Cases; and never
+found any Disadvantage, but often great Service from this Practice.
+
+When the Sharpness of the Pain was gone, and the Pulse became soft,
+very often a dull Pain remained for some Time in the Part.--In some
+Cases a brisk Purge removed it;--in others, cupping above the Part,
+and afterwards rubbing it with the volatile Liniments, did
+Service;--in others, gentle Opiates at Night, especially where there
+was a tickling Cough;--and in one or two Cases, this Pain did not go
+away, till the Patient was ordered to drink every Day for some Time, a
+Quart of the Decoction of Sarsaparilla with the antimonial Wine.
+
+In the Course of this Disorder, if a kindly Moisture broke out on the
+Skin, which gave Relief, this was encouraged by the Use of mild warm
+Liquors; or if the Patient began to spit up a viscid or yellowish
+Mucus, we endeavoured to keep up the Expectoration by the Use of mild
+Pectorals; and if a Purging came on, we were careful not to check it
+too soon, unless it was so violent as to be in Danger of sinking the
+Patient.
+
+When an Inflammation of the Side came to Suppuration, which happened
+in one or two Cases at _Osnabruck_, in _May_ 1761; as soon as a
+Fluctuation of Matter was to be felt, an Incision was was made in the
+Part, and the Matter discharged; after which the Sore healed kindly,
+and the Patients recovered[51]. I am persuaded, was this Operation
+oftener performed, many would recover who die consumptive.
+
+    [51] Dr. _Mead_ advises, where the Lungs and Pleura grow
+    together, and an Abscess forms, to open it with Caustic; and
+    afterwards to keep the Ulcer open during the Patient's Life:
+    For he says, he has often seen, where such Sores were healed
+    up, that the Patient died soon after by an Efflux of Matter
+    upon the Breast. _Monita Medica_, Cap. i. Sect. 7.
+
+
+
+
+OF THE PERIPNEUMONY.
+
+
+The Soldiers were subject at all Times to the Peripneumony, or
+Inflammation of the Lungs, from doing Duty in cold wet Weather, and
+from their irregular Way of living; but more particularly towards the
+End of the Campaigns, and in Winter.
+
+This Disorder was much more dangerous and fatal than the Pleurisy,
+especially when neglected in the Beginning; for then Bleeding had
+seldom any Effect; the Difficulty of Breathing encreased, the Patient
+was seized with an Orthopnea, and such an Anxiety and Sense of
+Suffocation, that he could not sleep; and the Pulse sunk; and in these
+Cases Death only afforded Relief. This we experienced in many Men who
+had lain neglected in Quarters, for two, three, four, or five Days,
+before they were brought to the Hospital.
+
+In most of the Bodies of those who died of this Disorder, and were
+opened after Death; we found the Lungs violently inflamed, with livid
+or gangrenous Spots on their Surface; and more or less of a watery
+Serum extravasated into the Cavity of the Chest.
+
+Three had Suppurations in the Lungs. In one, who had lain sick in
+Quarters for ten Days or upwards, before he was sent to the Hospital,
+the right Cavity of the Thorax was found full of a watery Serum; and
+the Lobes of the Lungs on the same Side almost entirely wasted; and
+what remained seemed as it were composed of thickened Membranes,
+resembling those formed by the coagulable Lymph, or what is called by
+some (though improperly) the fibrous Part of the Blood. The Lobes in
+the left Side seemed to be in a sound State, or at most but slightly
+inflamed. From the right Lobes of the Lungs being so much wasted, I
+suspected that the Patient had probably laboured long under some
+Disorder of the Breast; but I could not from Enquiry obtain any
+Information in this Particular; nor did he ever mention such a Thing
+during the few Days he lived after being brought into the Hospital; he
+said, he had only been ill for eight or ten Days before; but Soldiers
+afflicted with chronic Distempers, when they are seized with violent
+Symptoms, or acute Diseases, are apt to reckon the Beginning of their
+Disorder, only from the Time they are taken ill in a violent Manner;
+and never to take any Notice of their former Complaints.
+
+Another Soldier, about the Middle of _February_, 1762, remained in
+Quarters five Days after being taken ill with a Pain of the Breast,
+and a Difficulty of Breathing; the sixth Day he was brought to the
+Hospital in the Morning, and I saw him about eleven o'Clock; he then
+had all the Symptoms of the true Peripneumony, attended with a strong
+hard Pulse. He was immediately blooded as freely as his Pulse would
+bear, had Blisters applied, and other Remedies used; notwithstanding
+which, on the eighth Day from that Time, he began to throw up a
+purulent Matter in great Quantity, attended with a constant hectic
+Heat, and Fever; which sunk him so fast, that he died the tenth Day,
+after he first began to expectorate.
+
+On the 2d of _March_, a Soldier, of the Fifty-first Regiment of Foot,
+was brought to the Hospital, with a violent Pain in the left Side, and
+a great Difficulty of Breathing. Upon examining him, he told me, that
+about two Years before he had had a violent Stitch in his left Side,
+towards the lower Part of the Thorax; that ever since he had been
+subject to a Difficulty of Breathing; and at Times to a Pain in the
+Side; but that he had only been seized with the violent Pain and
+Difficulty of Breathing he then complained of, about five Days before,
+occasioned by catching Cold, on being billeted in a low, cold, and
+damp House.--His Pulse was quick, the Pain of his Side and Difficulty
+of Breathing so great, that he could not sleep, nor lie down, but was
+obliged to sit constantly in an erect Posture; his Tongue was white
+and furred, and he had had no Stools for three Days: He was ordered to
+be blooded immediately; and to take a Dose of Salts; and his Side to
+be rubbed with the _linimentum volatile_. 3d. His Breathing and Pain
+of the Side were easier; he had slept a little in the Night, and could
+lie on his right side, but not on his left. He was ordered the Squill
+Mixture. 4th. His Breathing was worse; he was blooded a second Time;
+had a large Blister applied to his Side, and was ordered to continue
+the Use of the Squill Mixture. On the 5th, 6th, and 7th, he seemed
+easier, though the Breathing was still much affected, and his Pulse
+quick and low, attended with a hectic Heat. On the 8th, he told me
+that his left Side was swelled: On examining, I observed a Fullness in
+that Side of the Thorax; and on pressing with my Fingers between the
+Ribs, I thought I felt an obscure Fluctuation of a deep-seated Fluid.
+From these Appearances, and the History of the Case, I judged that
+there was a Collection of some Fluid within the Cavity of the Chest;
+and that the only Means left to give Relief, was to make an Opening
+into the Cavity, and so evacuate the Fluid. I therefore proposed to
+him the Operation of the Empyema, to be performed immediately; which
+he several Times obstinately refused to submit to: He allowed a Seton
+to be put in his Side, but that did not answer the End proposed: He
+languished six Days longer; and died the 14th of _March_. Next Day an
+Opening was made in the Thorax, in the Part where the Operation was
+proposed to have been performed; as soon as the Pleura was cut
+through, some Quarts of Water rushed out. We then opened the Thorax,
+and found still some Water in the left Cavity. The Pericardium was
+thickened, and slightly inflamed, and adhered to the Diaphragm; which
+was likewise a little thickened and inflamed in the adhering Part; the
+Lungs on that Side were much compressed, and contracted by the
+Pressure of the Water; but on being inflated and cut, seemed in a
+sound State, except that they were slightly inflamed. The Lungs of
+the left Side adhered every-where firmly to the Thorax, but seemed
+otherwise sound; having no Tubercles, Suppuration, or other Disorder,
+that we could observe in cutting them. The Heart and Blood Vessels
+were sound, and no other polypous Concretions were observed within
+their Cavities, but such as we find in most dead Bodies; which seem to
+be formed of the coagulable Lymph in _articulo mortis_. The Viscera of
+the Abdomen were in a sound State.
+
+We treated the Peripneumony nearly as the Pleurisy. We bled freely in
+the Beginning, till the Breathing became easier, or the Pulse began to
+sink; taking Care not to be deceived by a low oppressive Pulse, which
+generally rose upon Bleeding. We applied large Blisters; gave the mild
+Pectorals freely, and plenty of warm diluting Liquors, Barley Water,
+the pectoral Decoction, and such like; which afforded more Relief than
+any other Medicines. We gave too saline Purges, and laxative Clysters
+occasionally; and in some Cases ordered the Steams of warm emollient
+Decoctions with Vinegar to be drawn into the Lungs.
+
+By this Treatment most of them, who applied early for Relief, got the
+better of the Disorder.
+
+When the Expectoration began, the Patient continued the free Use of
+the mild Pectorals, and diluting Liquors; and no Medicines were given
+that might in the least tend to stop it; other Evacuations were
+omitted, unless where the Pain of the Breast, or the Difficulty of
+Breathing increased; in which Case, if the Pulse kept up, I ordered a
+Vein to be opened, and a suitable Quantity of Blood to be taken away;
+no other Remedy affording any Relief, till this Evacuation was made.
+Where the Patient was costive, we frequently ordered laxative
+Clysters, or a mild Purge, and found them beneficial: But where no
+such Symptoms occurred, it was best, for the most part, to omit all
+Evacuations of this Kind, after a free Expectoration had begun, and to
+trust to it for carrying off the Disorder.
+
+In some Cases, where the Expectoration stopt suddenly after bleeding,
+we gave with Advantage a gentle Vomit, as recommended by Dr.
+_Huxham_[52].
+
+    [52] Some late Authors seem to look upon the _Pleurisy_ and
+    _Peripneumony_ as the same Disorder: However, though it be
+    true, that when the _Pleura_ is inflamed, the Surface of the
+    contiguous Lungs is generally in the same State; and that,
+    when the _Lungs_ are inflamed, the Pleura is often affected;
+    yet as I have frequently seen the true Peripneumony without
+    that sharp Pain of the Side which characterizes the Pleurisy;
+    and upon opening the Bodies of People who have died of the
+    Peripneumony, have found the Lungs violently inflamed and
+    livid, and so filled with Blood as to sink in Water, without
+    the Pleura being much diseased; and upon opening the Thorax
+    of others who died of the Pleurisy, have found the
+    intercostal Muscles and Pleura violently inflamed with livid
+    Spots, and only a small Portion of the Surface of the
+    contiguous Lungs affected; I cannot help still looking upon
+    them as distinct Disorders; though they require nearly the
+    same Treatment, and are often complicated together.
+
+
+
+
+OF THE COUGH and CONSUMPTION.
+
+
+Coughs were very frequent during the Winter, and when the Weather was
+wet and cold. They were often accompanied with Pains of the Breast;
+and, when neglected, Obstructions, Tubercles, and Suppurations, were
+apt to form in the Lungs, and the Disease to end in a Consumption, or
+_Phthisis Pulmonalis_.
+
+When Coughs were slight, guarding against further Cold, and the Use of
+mild Pectorals and warm Drinks, removed them. But when the Patient
+complained of a Pain and Tightness about the Breast, it was always
+necessary to take away more or less Blood; and after Bleeding to give
+some of the mild Pectorals, such as the Sperma Ceti or oily Mixtures;
+and, if a Fever attended, to join the Use of Nitre, or of the saline
+or mindereri Draughts; and, if a tickling Cough was troublesome, to
+give frequently a Tea Spoonful of the oily Linctus, acidulated either
+with the Spirit of Vitriol, or the _oxymel scilliticum_. The mild
+Diaphoretics, such as the mindereri Draughts, given along with warm
+Drinks, to promote a free Perspiration, or Sweat, were used with
+Advantage; when the Patients kept in Bed, and lay in Wards which had
+Stoves in them.
+
+If the Cough and Pain of the Breast were not relieved by these Means,
+the Patient was bled a second Time, and a Blister applied to the Side
+immediately after; which often removed most of the Complaints. When it
+did not, we gave the pectoral Decoction for common Drink; and if there
+was a Shortness or Difficulty of Breathing, the squill Mixture, or
+_lac ammoniacum_, with Oxymel; and occasionally gentle Purges: And if
+at any Time of the Disorder the Tightness and Pain of the Breast
+returned violent, we took away some Blood, no other Remedy affording
+Relief.
+
+When there was little or no Fever, and a thin Rheum kept up a tickling
+Cough, nothing had a better Effect than to add some Drops of the
+_tinctura thebaica_, or some of the _elixir paregoricum_, to the
+oleagenous or squill Mixtures; or to give an Opiate Draught or Pill at
+Bed-Time, which eased the Cough, and procured the Patient Rest.
+
+At all Times it was necessary, when the Cough was violent, attended
+with Pains of the Breast, to keep the Patients on low Diet; and in as
+free and pure Air as the Nature of the Hospitals would admit of; for
+we often found that those Men who had laboured long under obstinate
+Coughs, which threatened Consumptions in small crowded Wards,
+recovered surprisingly on being removed to a freer Air; of which we
+had a remarkable Instance in the Hospital at _Bremen_, in _January_
+1762; upon removing some Men, afflicted with very bad Coughs, out of
+small Wards, which were damp, into one large one, which was dry and
+airy.
+
+When the Weather was good, we made the Patients walk out a little in
+the Day-Time; for we observed, that remaining always in the Hospital,
+and breathing nothing but a foul Air, helped to encrease the
+Disorder.--When we knew the Men to be sober, and not apt to commit
+Irregularities, we used to procure them good Billets, and make them
+come daily to the Hospital for their Medicines.
+
+Equal Parts of Lime-Water and Milk, drank to the Quantity of a Quart a
+Day, was of Use to some; and the _infusum amarum_, and other gentle
+Bitters, taken to the Quantity of an Ounce or two, Morning and
+Evening, to others[53].
+
+    [53] Asses Milk, and _Bristol_ and _Seltzer_ Waters, which
+    are found so serviceable in pulmonic Disorders, could not be
+    had in the military Hospitals; and riding on Horseback was
+    too expensive a Remedy for a Soldier.
+
+    In chronic Cases, where we suspect Obstructions and Tubercles
+    to be formed in the Lungs, which have not already come to
+    Suppuration, Dr. _Russel_ recommends the Use of Sea Water for
+    resolving them; but we were at too great a Distance from the
+    Sea to try this Remedy. See his _Treatise on Sea Water_, Page
+    17.
+
+A Decoction of the Cortex removed some Coughs which had continued for
+a considerable Time. In one or two of these Cases, slight hectic
+Symptoms had already appeared[54]. However, for the most part,
+where-ever Obstructions of the Lungs were confirmed, or there were
+evident hectic Symptoms without a free Discharge of purulent Matter,
+the Bark did no Service; but rather heated and increased the Fever,
+and made the Sick more restless and uneasy.--It was of most Use where
+there seemed to be no confirmed Obstructions, but the Vessels much
+relaxed; which we judged to be the Case from the Patients having no
+fixed Pain, nor the Breathing much affected. If the Sick were
+plethoric, or in the least feverish, we ordered a little Blood to be
+taken away, before we began the Use of this Medicine.
+
+    [54] _Mary Shepperd_, a Woman twenty-six Years of Age, was
+    admitted into _St. George_'s Hospital the 6th of _June_,
+    1759, for a Cough; attended with a constant hectic Fever and
+    Night Sweats, which had begun in the Month of _April_, after
+    the Measles. She complained likewise of having the _fluor
+    albus_, and she had been blooded more than once before she
+    came to the Hospital.--I at first gave her some of the mild
+    Pectorals; and a Solution of White Vitriol in Water, _utenda
+    pro inject. uterina_. After a Week, finding no Alteration in
+    her Complaints, I advised her to become an Out-patient; and
+    to go down to her Friends in the Country, to live upon a Milk
+    Diet; to take gentle Exercise, and continue the Use of her
+    Medicines; which she did, but without any Alteration in her
+    Disorder, till the 6th of _July_, when I ordered her to take
+    thrice a Day two Ounces of the Decoction of the Cortex, along
+    with a saline Draught. Immediately, on beginning to use this
+    Medicine, her Disorder began to take a favourable Turn; her
+    Fever and Night Sweats left her, her Cough became easier, and
+    she recovered Health and Strength daily. She came to the
+    Hospital the 15th of _August_, seemingly in good Health, to
+    return Thanks for her Cure.
+
+In similar Cases, I have sometimes observed good Effects from the Use
+of the Balsam _Copaivy_, or _Peru_; given either in Juleps or made up
+into an Electuary, as in the _electuarium e spermate ceti cum
+balsamo_; but in whatever Form they were given, if there were
+confirmed Obstructions of the Lungs, they rather heated and inflamed,
+than did any real Service.
+
+When Coughs continued long, attended with Pain in the Side, Difficulty
+of Breathing, and Hectic Fever and Night Sweats, we always had Reason
+to suspect, that the Disorder would terminate in a confirmed
+Consumption. When this was threatened, we found, that the principal
+Thing to be done, was to keep the Patients cool; and to endeavour to
+allay the hectic Heat and Fever; and to retard, as much as possible,
+the Progress of the Disorder. When the Case was recent, we were
+sometimes so lucky as to make a Cure; but after it was confirmed, it
+for the most part ended fatally.
+
+We kept the Patients upon a low Diet; and where-ever Milk was to be
+got easily, we allowed them a Pint a Day[55]; which was either mixed
+with Water and given for Drink, or they took it to Breakfast or
+Supper.--Their common Drink was either Barley Water or the pectoral
+Decoction; which was occasionally acidulated with a few Drops of
+Spirit of Vitriol; and we gave at the same Time the cooling
+Medicines, such as Nitre, the saline or mindereri Draughts, mixed at
+Times with Sperma Ceti, or some other of the mild Pectorals.
+
+    [55] In private Practice, at this Stage of the Disorder, the
+    Use of Asses Milk, and drinking the _Bristol_ Water at the
+    _Bristol_ Wells, and riding on Horseback daily, are justly
+    ranked amongst the most efficacious Remedies; and going into
+    the more southern Climates, as the South of _France_,
+    _Portugal_, or _Italy_, where the Air is warmer, more
+    constant, and dry, than in _England_, has often been found to
+    produce good Effects.
+
+The opening a Vein, and taking away from four to eight Ounces of
+Blood[56], whenever the Pain of the Breast was troublesome, or the
+Patient was hot and restless at Nights from the Hectic Fever, gave the
+greatest Relief of any Thing we tried; and these repeated small
+Bleedings were so far from wasting the Patient's Strength, that they
+rather seemed to prevent its being exhausted so fast as otherwise it
+would have been, by allaying the Force of the Hectic Fever.
+
+    [56] This Practice has been strongly recommended by Dr.
+    _Mead_, in his _Monita Medica_, Sect. x. and by an anonymous
+    Author in the _Edinburgh Medical Essays_, Vol. IV. Art. 28.
+    and Dr. _Mead_ says, when Things have not been quite
+    desperate, he has seen good Success from it.
+
+At this Stage of the Disorder, we put in Setons, or ordered Issues, to
+serve as a Drain to carry off the Matter, and found them of Advantage
+in some Cases. When the Patients complained of any fixed Pain, we
+always made the Issues as near the Part affected as possible[57]. On
+the 5th of _May_, 1762, a Man, belonging to the Eighty-eighth Regiment
+of Foot, was sent to the Hospital at _Bremen_ for an H�moptoe,
+attended with a constant hectic Heat and Fever.--After being blooded,
+and using the cooling Remedies without Success, he had four Pea Issues
+made in his Back; and had a slight Decoction of the Cortex, acidulated
+with Spirit of Vitriol. As soon as the Issues began to discharge
+freely, the hectic Heat, Fever, and Spitting of Blood, diminished
+daily; and he recovered his Health and Strength in a short Time.
+However, it ought to be observed, that although these Drains are
+sometimes efficacious, yet, when the Disease is far advanced, the
+Mischief is generally too deep rooted for them to be of any Service.
+
+    [57] In _June_, 1748, a Servant Girl came to ask my Advice
+    for a Cough, attended with a constant Hectic Fever and Night
+    Sweats, which had begun some Months before, on catching Cold.
+    The Matter she spit up was yellow, and had the Appearance of
+    Pus; and she complained of a Pain in the left Side of the
+    Thorax. I ordered her the saline Mixture with Sperma Ceti to
+    be taken thrice a Day, to lose a little Blood, to drink an
+    Infusion of Linseed sweetened with Honey, and to have a Seton
+    put in her Side at the Part where she complained of Pain;
+    advising her to go home to her Father, who was a Farmer in
+    the Country, and to live upon a Milk and Vegetable Diet, and
+    ride on Horseback whenever she could conveniently. She seemed
+    so far gone in a Consumption, that I scarce expected to see
+    her again; but, in the Month of _December_, she came to
+    return me Thanks for her Cure, seeming then to be in good
+    Health. She told me, that, as soon as the Seton began to
+    discharge freely, she found Relief; and mended afterwards
+    daily, by following the Directions I had given her.
+
+The Bark, and natural Balsams, for the most part were prejudicial, and
+encreased the Hectic Heat and Fever; except in one or two Cases, where
+the Disorder seemed to depend on a Vomica of the Lungs, and the
+Patient coughed up the Matter freely.--In one Case they were of
+considerable Service; the Patient was very low, and had the Night
+Sweats, but coughed up the Matter freely: On using the Decoction of
+the Bark, and the _electuarium e spermate ceti cum balsamo_, the
+Matter expectorated became thicker, and of a more balmy Consistence,
+without any Increase of Heat or Fever; after which the Symptoms became
+gradually milder, and the Patient recovered.
+
+In the Course of this Disorder the Patients often became very hot and
+restless, and were troubled with Gripes, succeeded by a Purging: These
+Symptoms were most readily removed by a Dose of Rhubarb, or of some
+other mild Purge; for they generally proceeded from corrupted Humours
+lodged in the Intestines. In the Evening, after the Operation of the
+Purge, we gave an Opiate to procure the Patient Rest.--When the first
+Dose of Physic did not stop the Purging, we repeated the Opiates at
+Nights, and in a Day or two gave another Purge; and if there was much
+Sickness, or Load at the Stomach, gave likewise a gentle Emetic.
+
+If the Purging still continued, we were obliged to join the Use of
+Astringents along with the Opiates. In some Cases, I found good
+Effects from equal Parts of Milk and Water boiled with Rose Leaves,
+Pomegranate Bark, Balaustine Flowers, and Cinnamon, as recommended by
+Dr. _Mead_ in his _Monita Medica_[58]; it served both for Food and
+Medicine.--When Opiates and Astringents were given to stop the Purging
+at its first Appearance, before the Bowels were emptied, they always
+did Mischief; and increased the Heat and Fever: And although they
+stopt the Purging for a few Hours, it always broke out with greater
+Violence afterwards.
+
+    [58] _Sect._ x. _de Febrib. lentis sive Hecticis._
+
+When the Sick were attacked with a Shortness and Difficulty of
+Breathing, which was not relieved by Evacuations, and the Use of
+cooling Medicines, and Pectorals, and Blisters, nothing gave so much
+Ease, or had such a good Effect, as a gentle Vomit; for it often
+removed the immediate Oppression from the Breast, and helped to pump
+up the Matter from the Lungs.
+
+In the advanced State of the Consumption, the Cough was always very
+troublesome; and the Sick found no Relief but from Opiate Medicines,
+which, in such Cases, cannot be expected to do more than give a little
+present Ease.--As they were apt to obstruct the free Expectoration, we
+generally mixed them with some _oxymel scilliticum_, or _tinctura
+foetida_, which took off a good deal of their suffocating Quality.
+
+Dr. _Barry_[59] advises for the Cure of a Consumption, to make an
+Incision or Aperture into the Side; where-ever there is a fixed Pain
+attended with a Weight, a Hectic Fever, and other Symptoms of an
+evident Suppuration: He says the Pleura is thickened, and the Lungs
+adhere at the Part where they are exulcerated; and that by the
+Operation the Pus may be evacuated, and a Cure made; and he gives
+several Instances of the Success of the Operation, when performed in
+Time.
+
+    [59] _Treatise on the Digestions_, p. 410.
+
+
+
+
+OF THE Epidemical CATARRHAL FEVER Of APRIL, 1762; CALLED, THE
+INFLUENZA.
+
+
+After a very cold severe Winter at _Bremen_, the Weather, from being
+very cold, became of a sudden extremely hot, about the 10th of
+_April_. In a few Days after, many People were seized with a violent
+Catarrhal Disorder. It often began with such a Cold and Shivering,
+that many imagined at first that they were going to have Agues; but
+soon after they were attacked with a Cough, and a Difficulty of
+Breathing, and Pain of the Breast, with a Head-Ach, and Pains all over
+the Body, especially in the Limbs.--The first Nights they commonly had
+profuse Sweats.--In several, it had the Appearance of a remitting
+Fever, for the two or three first Days.--Many had a slight
+Inflammation of the Throat, and a Hoarseness. In all it was attended
+with an acute Fever in the Beginning, and the Urine was of a high
+Colour; and when the Disorder had put on the Appearance of a Remittent
+Fever in the Beginning, it dropt a Sediment towards Morning after the
+second Day; and did the same in all, when the Disorder was going
+off.--Some had a Purging, but the greater Number were rather inclined
+to be costive.--The Cough in many was very violent; and the Patients,
+after each Fit of Coughing, had Reachings, or Strainings to vomit,
+exactly resembling those which come after violent Fits of the Hooping
+Cough.--At first the Patients spit up only a little Phlegm; but in the
+Decline of the Disorder, they expectorated freely.--The violent Cough
+and Feverishness generally continued for four, five, or six Days;
+with others it continued longer; and some had a Cough for two or three
+Weeks after the Fever left them.
+
+This Catarrhal Fever seized most of the People of the Town of
+_Bremen_; and there were very few of the _British_ who escaped it; at
+the same Time, it was epidemical in most Countries in _Europe_.
+
+We treated it entirely as an inflammatory Disorder, and none died who
+applied early for Relief.--Most People recovered by one plentiful
+Bleeding, and taking the mild cooling Medicines, such as the _mixtura
+e spermate ceti cum nitro_, the saline or mindereri Draughts, or such
+like. When the Fever and Difficulty of Breathing continued after the
+first Bleeding, in a Day or two a Vein was opened a second Time; and
+immediately after a Blister was applied to the Back, which commonly
+removed the Fever, and relieved the Breathing.--When the Patients were
+inclined to be costive, a Dose of Physic was of Service.
+
+None of the _British_ died, except one or two of the Soldiers, who
+remained in Quarters after being taken ill; and, instead of bleeding
+and living low, indulged in the Use of spirituous Liquors; and were
+not brought to the Hospital, till they were in the last Stage of a
+Peripneumony.--Many of the Inhabitants of the Town died of this
+Disorder, which was probably owing to Want of Care.
+
+
+
+
+OF THE RHEUMATISM.
+
+
+The Rheumatism is one of the Disorders most generally to be met with
+in military Hospitals. There were at all Times some Men in our
+Hospitals labouring under Rheumatic Fevers, or other rheumatic
+Complaints; though we never had at any one Time a great Number; owing
+probably to the Weather being very favourable in both the Campaigns of
+1761 and 1762.--It was always most frequent when the Weather was wet
+and cold; both during the Campaign, and when we were in Winter
+Quarters.
+
+It commonly began either, 1. With an acute Fever, and Pains all over
+their Body: or, 2. With Pains in particular Parts, as the Shoulders,
+Legs, Arms, Knees, and sometimes of the Side, attended with some
+Degree of a Fever.--The first was the most common Form it assumed,
+when Men were attacked with it in the Field or in Garrison; owing to
+their doing Duty in cold wet Weather.--The other Causes generally took
+place when they had been formerly subject to rheumatic Complaints, and
+had caught Cold; or after they had been weakened and reduced low by
+Fevers, Fluxes, or other Disorders.
+
+We had but very few Rheumatisms accompanied with Swelling, Pain, and
+Inflammation of the Joints of the Knees and Wrists, &c. which are so
+common in our Hospitals about _London_. I did not meet with above a
+Dozen Cases, of this Kind, whilst in _Germany_ with the Army.
+
+When the Rheumatism began with Pains all over the Body, attended with
+a High Fever, we treated it at first entirely as an Inflammatory
+Fever[60]. We blooded freely, and repeated this Evacuation often[61],
+if the Blood continued sizy, and the Pains violent; provided the Pulse
+was strong. When the Pleura, the Lungs, or any other of the Viscera
+were affected, we blooded as freely as we should have done in acute
+Inflammations of these Parts: We gave the saline Draughts with
+Nitre[62]; and Plenty of Barley Water and other weak diluting Liquors;
+and gentle Physic once or twice a Week; and afterwards applied
+Blisters, which often relieved both the Pains and Fever.
+
+    [60] _Sydenham_, in treating of this Disease, orders
+    Bleeding, and that to be repeated next Day; and afterwards
+    every other Day, two, three, or four Times, or more, as the
+    Patients Strength can bear it; and on the intermediate Days
+    to give a purgative Clyster. But in young People, and those
+    who have lived regularly, he says, that a very low Diet will
+    cure as effectually as Bleeding and Medicines; That the
+    Patients must live four Days on Whey alone, but after this
+    may eat Bread for Dinner; and on the last Days for Supper
+    also; and when the Symptoms begin to abate, he allows them to
+    eat boiled Chicken, or other light Food; but says they must
+    live every third Day on Whey, till their Strength returns.
+    _Precess. Integr. de Rheumatismo_.
+
+    [61] A Remark of Dr. _Huxham_'s deserves to be taken Notice
+    of here: He tells us, that there are some Kinds of
+    Rheumatisms, _viz._ those which come from a sharp serous
+    Rheum, which do not bear the free Use of the Lancet; that
+    plentiful Bleeding does more Hurt than Good; and that, in
+    such Cases, the Medicines which bring out breathing Sweats,
+    and at the same Time correct the Acrimony of the Blood,
+    joined with gentle Opiates, have a much better Effect. _De
+    Aere_, Vol. II. p. 185.
+
+    [62] Dr. _Brocklesby_, in his _Observations on military
+    Diseases_, recommends the Use of large Quantities of Nitre
+    dissolved in Water Gruel, or Sage Tea, (in the Proportion of
+    two Drachms of the Nitre to a Quart of the Liquor) in acute
+    Rheumatisms. He says, "I am assured from numberless
+    Instances, that in stout young Men, by taking six hundred
+    Grains (ten Drachms) daily, for four or five Days
+    successively, and diluting plentifully, as before
+    recommended, plain Nitre proves the most powerful and best
+    Sudorific, in such Complaints, that I have ever tried; and
+    this Quantity, and even more, may be retained in the Stomach,
+    and pass through the Course of the Circulation, by only
+    diluting properly with those thin attenuating Beverages as
+    before recommended. Such Quantities, in three or four Days,
+    seldom failed wonderfully to relieve the Patient, and very
+    often to cure him entirely, by the most plentiful and profuse
+    Sweats." _See from p. 116, to p. 124._
+
+    I have never hitherto given Nitre in such large Quantities as
+    here recommended by Dr. _Brocklesby_.
+
+After some Days, if the Pains still remained, we continued the saline
+Draughts with Nitre throughout the Day; and in the Evening endeavoured
+to promote a free Perspiration by Means of the mild Diaphoretics,
+such as the mindereri Draughts with Mithridate, in Doses frequently
+repeated; at the same Time, the Patient kept in Bed, and drank freely
+of mild diluting Liquors. Sometimes we gave twenty, thirty, or forty
+Drops of Spirits of Hartshorn, in repeated Draughts of warm Barley
+Water: or a like Quantity of the Antimonial Wine, used in the same
+Manner: or from sixty to a hundred Drops of the Antimonial Wine, mixed
+with one-fourth Part of the _tinctura thebaica_, in a large Draught of
+some warm Liquor; which I have observed, in many Cases, to have a
+better Effect, than most other Medicines used for this Purpose; as it
+acts both as an Opiate in easing the Pain, and procuring Rest; at the
+same Time that it promotes a free Perspiration, or gentle Sweat, to
+carry off the Distemper.
+
+But it should be observed, that, in the Beginning of Rheumatic Fevers,
+forced Sweats generally did Hurt, and often increased both the Pain
+and Fever; and that in general we had greater Success, and made
+speedier Cures, when we did not attempt to promote Sweating, till
+after other Evacuations had been sufficiently made, and the Fever had
+begun to abate; and that in this Fever, when we did attempt to procure
+Sweats, the milder Diaphoretics, with Plenty of weak diluting Liquors,
+answered better than those of a more heating Nature; though after the
+Fever was gone, and the Pains still continued, sometimes the stronger
+Sudorifics, such as G. Guaiac, and its volatile Tincture, _Dover_'s
+Powder, and the like, best answered the Purpose, and carried off the
+Distemper, when the milder ones had little Effect.
+
+I have often observed, where Sweating made no Change in the Distemper,
+that keeping up a free Perspiration by Means of the Decoction of the
+Sarsaparilla with the Antimonial Wine, or small Doses of the _pulvis
+antimonialis_ (_gr._ v.), given twice or thrice a Day, removed
+Rheumatisms, which had resisted the Force of other Remedies.
+
+Sometimes the cold Bath[63] removed Pains which had not yielded to
+internal Medicines; but it ought to be observed, that when Patients
+went into the cold Bath while the Feverishness still remained, and the
+Blood continued sizy, or before free Evacuations had been made,
+oftentimes, instead of giving Relief, it made the Disorder worse, and
+more obstinate[64].
+
+    [63] I have frequently ordered the warm Bath with Advantage
+    in Rheumatic Cases in _St. George_'s Hospital; but we had no
+    Convenience of this Kind with the flying Hospital in
+    _Germany_.
+
+    [64] This I have seen many Instances of, particularly in the
+    Case of _Ann Walker_, a Woman of twenty three Years of Age,
+    who was under my Care in _St. George_'s Hospital, in _May_,
+    1759. Before she came to the Hospital, she had been blooded,
+    and had gone into the cold Bath four Times, which, she told
+    me, had increased her Pains to a violent Degree; in which
+    State she had continued for some Weeks before she came to the
+    Hospital; but by being blooded, and taking the cooling saline
+    Medicines, with gentle Purges, and mild Diaphoretics, she got
+    well in a Month's Time.
+
+When the Rheumatism was confined to a particular Part, attended with
+Fever, we treated it as the acute Rheumatism. Fomenting the Part with
+warm emollient Decoctions, and rubbing it afterwards with the
+volatile, or saponaceous Liniments, often gave Ease; and the
+Application of Cupping-Glasses and Blisters frequently removed the
+Disorder. In some Cases, where the first Blister did not relieve, the
+Application of a second, and afterwards keeping up a Discharge from
+the Part by Means of the Epispastic Ointment, carried off the Pain. In
+others, where the mild Diaphoretics were ineffectual, Sweating, with
+the G. Guaiac, or _Dover_'s Powder, and such other Medicines, after
+the Fever was gone, removed the Complaints[65].
+
+    [65] Warm Water, pumped upon the Part, often removes such
+    rheumatic Pains as have resisted the Force of internal and
+    other Remedies. On the 29th of _August_, 1759, _Mary Ward_
+    was admitted into _St. George_'s Hospital for rheumatic Pains
+    of the Arms, Legs, and Knees, attended with Fever, which all
+    yielded to Evacuations, and the Use of cooling Medicines,
+    mild Diaphoretics, and of the warm Bath, except the Pain of
+    the Knee; which, after it had resisted the Course
+    above-mentioned, was at last removed by pumping warm Water on
+    the Part, three Times a Week; joined to the Use of
+    Fomentations and volatile Liniments.
+
+When the Rheumatism was attended with Inflammation and Swelling of the
+Joints, we blooded freely, gave cooling Purges, and the saline
+Draughts with Nitre, along with Plenty of weak diluting Liquors, and
+prescribed a cool low Diet.
+
+After the Violence of the Fever and Inflammation was abated, fomenting
+the Parts, and rubbing them with the saponaceous or volatile
+Liniments, sometimes hastened the Discussion of the Swelling; as did
+likewise the Application of Blisters[66], after the Inflammation was
+entirely gone; but it ought to be noticed, that if volatile Liniments
+or Blisters are used too soon, they will sometimes occasion violent
+Inflammation and Pain[67].
+
+    [66] _Ann Ragen_, a Woman about thirty-three Years of Age,
+    was admitted into _St. George_'s Hospital the 17th of
+    _January_, 1759, for rheumatic Pains of her Legs and Arms,
+    and a Swelling of her right Knee. Free Evacuations, and the
+    Use of cooling Medicines, and mild Diaphoretics, removed all
+    her other Complaints, except the Swelling of the Knee, by the
+    Middle of _February_, when I ordered a Blister to be applied
+    to it; after which the Swelling gradually decreased, and she
+    was discharged, cured, the 20th of _March_.--_Rachael Hyde_,
+    a Woman twenty-four Years of Age, was admitted into _St.
+    George_'s Hospital the 9th of _May_, 1759, for similar
+    Complaints, which were removed by the same Means, all except
+    the Swelling of the Knee. A Blister was applied, and most of
+    the Swelling went away, but returned soon after: It was at
+    last removed by the Use of the warm Pump three Times a Week,
+    and drinking a Pint of the Guaiac Decoction daily.
+
+    [67] I have sometimes ordered Leetches to be applied to such
+    Swellings (as recommended by Dr. _Pringle_), and found them
+    to be of Service; and, at other Times, I have applied
+    emollient Fomentations and Poultices, which have given great
+    Ease to the Patient.--I have seen Setons or Issues, made near
+    the Part affected, afford considerable Relief.
+
+Rheumatic Cases of this Kind are often very obstinate, and require a
+considerable Length of Time before they are got the better of; and
+frequently more or less of the Swelling, especially of the Wrists and
+Joints of the Fingers, remains ever after; and Patients, who have once
+had the Rheumatism in this violent Degree, are always subject to
+Relapses; as are even those who have had the Rheumatism but slightly.
+
+Mercury[68] has been recommended in the Cure of Rheumatisms; but I
+never found it do any Service by itself, except in Cases complicated
+with venereal Symptoms; though I have often given it, and even
+sometimes gone so far as to raise a Salivation, where the Pains were
+most severe in the Night; and the Patient, at the same Time, thought
+he had some Reason to suspect a venereal Taint, though no external
+Symptom appeared. However, many good Practitioners have recommended
+small Doses of Calomel to be given at Nights, and next Morning a
+Purge; in which Way, I think, I have observed good Effects from its
+Use.
+
+    [68] Dr. _Musgrave_, in his Treatise _de Arthritide
+    Symptomat._ p. 30, cap. ii. sect. 10, says, he has known a
+    Salivation, raised by Mercury, cure the Rheumatism.
+
+The Bark was frequently of Use in restoring the Strength, and removing
+those rheumatic Pains which remained after Fevers, and other
+Disorders; but, in other Cases, it had little Effect.
+
+When the Rheumatism continues long, and has taken deep Root,
+_Sydenham_[69] advises to bleed from Time to Time, at some Weeks
+Distance; which, he says, will either entirely remove the Disease, or
+bring it to that Condition, that the Remains of it will be easily
+extirpated by an Issue; and giving some of the volatile Salts in
+_Canary_ Wine, Morning and Evening. I have always observed in
+rheumatic Cases, which continued long, that, after free Evacuations,
+the Patients received more Benefit from a mild low Diet, continued for
+some Time, and the Use of diluting Decoctions with mild Diaphoretics,
+while they took gentle Purges once or twice a Week, than from any
+other Remedies.
+
+    [69] Vide _Sydenham. Opera._ sect. vi. cap. 5.
+
+I have given Half an Ounce of Soap a Day, for a considerable Time, in
+some old rheumatic Cases, in the Manner recommended by the late Dr.
+_John Clerk_ of _Edinburgh_, as mentioned by Dr. _Pringle_; and, I
+think, with Advantage; but have not had sufficient Trials to ascertain
+the Merits of this Medicine.
+
+Dr. _Sydenham_, in treating of the Rheumatism, which he calls
+scorbutic, says; that after it had resisted Bleeding, Purging, low
+Diet, and other Remedies, he has cured it by giving thrice a Day two
+Drachms of an Electuary made of _conserv. cochlear. horten. recent.
+unc._ ij. _lujul. unc._ i. _pulv. ar. comp. drachm_ vi. _cum syrup.
+aurant._ q. s. drinking after it three Ounces of a Water drawn from
+_Brunswick_ Beer, and some of the antiscorbutic Plants.
+
+There is no Disorder which Soldiers are so apt to counterfeit as the
+Rheumatism, when ever the Duty in the Field is severe; but while there
+is no Fever or Size in the Blood, or other evident Marks of the
+Distemper, and the Men look healthy, there is always Reason to suspect
+Imposture.
+
+
+
+
+OF THE Autumnal Remitting Fever.
+
+
+The Remitting Autumnal Fever, called by the Antients [Greek: synech�s],
+was also one of the most frequent Disorders during the Campaign.
+
+This Fever is observed in most Countries, after the Juices have been
+highly exalted by the Heat of Summer; and People are exposed to the
+Heats of Mid-Day, and to the cold Damps of the Night. We observe it
+every Year in the Neighbourhood of _London_, especially among the
+labouring People, who work in the Fields, towards the End of Summer,
+and in Autumn; but it is generally in a milder Degree than in Armies,
+where Men are more exposed to the Vicissitudes of the Weather.
+
+As we go further towards the South, this, as well as other bilious
+Disorders, becomes more frequent.
+
+This Fever is reckoned the endemic Distemper of the _West Indies_, of
+the Coast of _Guinea_, and other Places in the Torrid Zone; but in
+those warm Countries it appears in a more violent Degree; makes a much
+more rapid Progress; and proves far more fatal than in our cooler and
+more temperate Climate. And it is observed to be always most frequent
+and most fatal where a Country is covered with Wood, or is marshy; and
+where there are frequent Fogs, and much stagnating Water, which
+corrupts by the Heat of Summer.
+
+In _January_, _February_, and _March_ 1761, we had none of those
+Remitting Fevers at _Paderborn_. In _April_, some few of the Soldiers,
+on their Return from the Winter-Expedition into _Hesse-Cassel_, had
+Fevers attended with bilious Symptoms; but they were rather of the
+continued, inflammatory Kind, and tending to malignant, than such as
+could be called remitting.
+
+The first Time that I saw much of this Fever, was among the Sick sent
+to _Bilifield_ in the End of _June_ 1761; soon after the Army took the
+Field. The Remissions were short, and it partook much of the Nature of
+the common Inflammatory Fever; and most of them were cured by the
+antiphlogistic Method. A Day or two before we left this Place, it
+began to change into the Malignant Hospital Fever, from the Sick being
+too much crowded.
+
+In the Middle of _July_, about Twelve Hundred Sick were sent to the
+Hospital at _Munster_; and about one-third Part were ill of this
+Remitting Fever. It did not partake near so much of the inflammatory
+Nature as at _Bilifield_; the Remissions became much more evident; and
+it was attended much oftener in the Beginning with bilious Vomiting
+and Purging; and in some few the Disorder turned to a Dysentery. About
+eight or nine had it changed into the Hospital Fever, from the Wards
+in one of the Hospitals being too much crowded; and in some few the
+Disorder terminated in regular Agues. In _November_ severals were
+taken ill of it in the Garrison of _Bremen_, which mostly ended in a
+regular Intermittent, the endemic Distemper of the Place. Towards the
+End of _December_ we had none of these Remitting Fevers, the Disorders
+turning more to the inflammatory Kind.
+
+In _June_ 1762, this Fever began to appear again among the Sick, sent
+from the Army, to the Hospital at _Natzungen_; and it continued to be
+frequent through the Summer and Autumn; and the greatest Part of these
+Fevers this Year terminated in regular Agues, mostly in Tertians, and
+were cured by the Bark; whereas the Year before very few terminated
+this Way.
+
+This Disorder in the Beginning had commonly the Appearance of a
+continued Fever; and many had a Sickness and Vomiting, and threw up a
+Quantity of yellow Bile, mixed with the Contents of the Stomach. In a
+few Days, especially after Bleeding, the Remissions became clear; tho'
+on its first Appearance in _June_ 1761 they were short, and rather
+obscure; and it seemed still to partake a good deal of the Nature of
+the common Inflammatory Fever, the Blood being very sizy; but as the
+Season advanced, the Remissions became more evident, and the Paroxysms
+more like those of an Ague; and the Blood less sizy, tho' at all
+Seasons of the Year it had some Appearance of an inflammatory Buff in
+this Disorder. The Sick were restless and uneasy at Night; but
+commonly felt themselves cooler and lighter in the Day-Time: and
+although they had no cold Fit, as the Fever came on at Nights, and
+many of them no Breathing Sweat, as they became cooler and freer from
+the Fever in the Morning; yet the Fits were so remarkable, that many
+of the Patients used to say they had a regular Fit of an Ague every
+Night, or towards the Morning; and some few, that they had the Fit
+every second Night. As the Season advanced, the Remissions appeared
+more distinct. However, there was always a good Number in whom the
+Fever went on in a continued Form, through its whole Course, without
+any Signs of Remission; tho' they had all the other Symptoms of this
+Fever. In a few Instances the Fever, after it came to remit, changed
+again into a continued Form.
+
+The Heat in the Time of the Paroxysms rose high, and several were
+delirious during its Continuance[70]; but were quite sensible in the
+Intervals, though never wholly without the Fever.
+
+    [70] I did not see the Delirium rise so high, nor the
+    Paroxysms so severe, as in the Marsh Fever described by Dr.
+    _Pringle_.
+
+At the End of _July_ 1761, four or five were attacked with a Bleeding
+at the Nose, in the Time of the Paroxysms, and became cooler
+afterwards; but it did not prove a Crisis in any of them.
+
+The Urine in the Beginning was commonly of a high Colour, though
+sometimes it was pale and limpid: At first it deposited no Sediment;
+but when the Fever came to remit, there was often a small Sediment
+after each Paroxysm; and as the Fever was going off, it let fall a
+Sediment in all[71].
+
+    [71] Dr. _Hillary_ says the Symptoms of this Fever in
+    _Barbadoes_ were much the same as those of the [Greek: synech�s],
+    or continued Remitting Fever in England; except only that the
+    Urine in this hot Climate never deposits any lateritious
+    Sediment, nor very rarely in any intermitting or any other
+    Fever, except when a Crisis happens that Way. _Observations
+    on the Diseases of Barbadoes_, p. 23.
+
+Some at first were inclined to be costive; others had a Sickness and
+Purging; and several of those who were costive in the Beginning, were
+in the Course of the Disorder attacked with a Purging; and others,
+after some previous Complaint of the Stomach, were seized with both
+Vomiting and Purging. In general, after the Sick continued some Days
+in the Hospital, they were inclined to be loose; which was a
+favourable Circumstance, when this Evacuation was not so great as to
+be in Danger of sinking the Patient. Some were attacked with a
+Dysentery.
+
+In this, as well as in most other Fevers, the Sick frequently passed
+by Stool Worms of the round Kind; and sometimes they vomited them up,
+or the Worms came up into their Mouth or Nostrils while they lay
+asleep in Bed; and some towards the Height were afflicted with
+Deafness, which was commonly a favourable Symptom.
+
+Most of those ill of this Disorder had a yellowish Colour of the
+Countenance, which went off with the Fever. It was more observable in
+some than in others; in general, it was slight; some few became yellow
+all over[72]; particularly one Man, in the Hospital at _Munster_, who,
+after being seized with violent Vomiting and Purging, Convulsions, and
+Twitchings of the Tendons, and Hiccup, became yellow, as in the
+deepest Jaundice. This Symptom of Yellowness arises from a Redundancy
+and Absorption of Bile; and is sometimes observed in other Fevers as
+well as this[73]; for while we were at _Paderborn_ in _February_
+1761, two Men were brought to the Hospital in Fevers, attended with
+this Symptom. They were both delirious, with parched dry Tongues,
+slight Twitchings of the Tendons, and other bad Symptoms; and one of
+them had a continual Vomiting and Purging. They both died, and the
+Body of him who had the Purging was opened. All the Bowels, especially
+the Colon, were tinged with a yellow Bile, and had a slight Degree of
+Inflammation all over their Surface; the Gall-Bladder was distended
+with a very dark-coloured Bile; but no Concretions were found in its
+Cavity, or in the bilious Ducts; nor Mucus, or any other Thing
+obstructing these Passages. The Surface of the Lungs seemed slightly
+inflamed; and there was a small Quantity of greenish Serum in the
+Cavities of the Thorax. I could not learn the Histories of these two
+Mens Disorders, before they were brought to the Hospital; but, from
+the Symptoms, was inclined to believe, that the Fevers had been of the
+malignant or petechial Kind; and that the yellow Colour was only an
+accidental Symptom of it; for on one of the Men we could perceive
+obscure Traces of dun petechial Spots on his Breast and Arms; and the
+malignant Fever was frequent at this Time among the Troops, and the
+bilious autumnal Fevers had ceased long before.
+
+    [72] Dr. _Pringle_ takes Notice of this yellow Colour or
+    Jaundice. He says, "some grow yellow, as in the Jaundice.
+    This was found more frequent during the first Campaign than
+    afterwards; it was an unfavourable, but not a mortal
+    Symptom." _Observ._ part iii. ch. 4.--_Hippocrates_ mentions
+    the Jaundice occurring in Fevers, _Aphor._ iv. � 62 & 64; and
+    he reckons it a favourable Symptom in ardent Fevers, where it
+    happens on the seventh Day. See _Book on Crises_'s, sect. 3.
+
+    [73] Does this Fever, when accompanied with this universal
+    Yellowness of the Skin, approach to the Nature of the yellow
+    Fever of the _West Indies_? As I had so few Cases of this
+    Kind under my Care, I cannot determine any thing about it
+    from my own Experience; but, from the Accounts of others, I
+    should believe them to be very different Disorders.--In the
+    yellow Fever of the _West Indies_, the Blood appears quite
+    loose and dissolved, without the least Appearance of Size,
+    even on the first Day; and the general Yellowness appears on
+    the third or fourth, with Signs of a total Dissolution, and
+    gangrenous Diathesis of the Blood: Whereas, in the Remitting
+    Fever of _Jamaica_, Mr. _Nasmith_ tells us, (See Dr. _Lind_'s
+    first Paper on Fevers), there is always an inflammatory
+    Diathesis of the Blood. The Yellowness in both depends on a
+    Redundancy and Absorption of Bile; but in the yellow Fever of
+    the _West Indies_, the Bile is in a much more putrescent
+    State, and a great Part of the Cure depends on the early and
+    speedy Evacuation of it.--In the yellow Fevers which appeared
+    in _Haslar_ Hospital, which are taken Notice of by Dr.
+    _Lind_, in his _Two Papers on Fevers_, the Blood was in quite
+    a different State from what it is in the Yellow Fever of the
+    _West Indies_; the Blood drawn from two of these Patients
+    became covered with a thick yellow Gluten, and the Serum was
+    of the Consistence of a thin Syrup, and of a deep yellow
+    Tinge, and tasted bitter; and in another who was bled two
+    Days before his Death, it threw up the same thick yellow
+    Gluten, tho' the red Part below was quite loose.
+
+I could not observe any certain critical Days, or Periods, when this
+Disorder terminated.--Some, who had it slightly, got well in a few
+Days; with others, it continued longer: Some continued long feverish,
+and would seem cooler and freer from Fever for a Day or two, and then
+grow worse again; and many had repeated Relapses.
+
+Neither could I observe any regular Crisis in this Fever. Sweat was
+the Discharge which oftenest proved critical. Many seemed to be
+relieved by a Purging; but as the greater Part had a Looseness after
+some Days, which continued often through the Disorder, without
+producing any very sudden Change in the Symptoms, it seemed to be a
+favourable Circumstance; though it seldom carried off the Fever so
+suddenly as to be manifestly critical. The Urine broke, and dropt a
+Sediment, for the most part, as the Fever took a favourable Turn.
+
+When this Fever proved mortal, it commonly assumed a continued Form;
+the Tongue became parched and dry, the Patient delirious, with
+Twitchings of the Tendons, Hiccup, and other fatal Presages; while
+others were seized with a violent Diarrhoea, or Dysentery, which sunk
+them irrecoverably.
+
+In the Beginning, it was absolutely necessary to bleed the Patients
+freely; and frequently to repeat the Evacuation, where the Symptoms
+required it. The Blood was of a florid Colour, and commonly threw up
+more or less of an inflammatory Buff.
+
+In these Fevers, we were obliged to have particular Regard to the
+first Passages, especially in the Beginning of the Disorder; for they
+were generally loaded with bilious Humours[74]; which, if suffered to
+remain in the Bowels; were either absorbed, and increased the Heat
+and Fever, or brought on a violent Diarrhoea; and therefore, after
+Bleeding, we gave a Vomit in the Evening, and next Day a Dose of some
+gentle Purge, as Rhubarb or Salts; to carry off these putrid, bilious
+Humours: And afterwards, in the Course of the Disorder, if the Patient
+was costive, and grew hot, restless, and uneasy, we either repeated
+the Purge, or gave laxative Clysters, which generally removed these
+Symptoms.--Frequently after the Operation of the Emetic, the Patient
+had some loose Stools, from the Gall Bladder's being emptied in the
+Strainings to vomit. Such Stools were always bilious, as were commonly
+those procured by purgative Medicines.
+
+    [74] According to Dr. _Hillary_'s Account of the Yellow Fever
+    in the _West Indies_, which is attended with bilious
+    Vomiting, it bears bleeding once or twice, but not a third
+    Time, before the third Day, but not at all after that Time;
+    and after Bleeding a great Part of the Cure depends on
+    carrying off as much of the putrid Bile as expeditiously and
+    safely as possible, which he says is to be done by making the
+    Patients drink freely of warm Water (sometimes mixed with a
+    little simple Oxymel or Green Tea) so as to vomit seven or
+    eight Times; and then to give a grain, or a Grain and a half
+    of Opium, to procure Rest, and to settle the Stomach; to make
+    the Patient take nothing for two Hours after; and then, if he
+    has not had a Stool, to give a laxative Clyster; after six
+    Hours Rest, to give a gentle Purge, to carry off as much as
+    possible of the bilious corrupted Humours; and in the Course
+    of the Disorder to repeat the Purge, as often as the Patient
+    is attacked with an Anxiety, and a painful burning Heat about
+    the Pr�cordia; which almost always depend on bilious
+    corrupted Humours pent up within the Bowels; and to endeavour
+    to support the Patient's Strength, and stop the putrescent
+    Diathesis of the Fluids by suitable Antiseptics, of which he
+    found a watery Infusion of Snake Root, mixed with _Madeira_
+    Wine and Syrup of Poppies, to answer the best of any Thing he
+    tried, and to sit easiest on the Stomach; and to this he
+    added the Use of Cordials, and of strong Wine Whey as the
+    Patient became lower.
+
+    Dr. _Hillary_'s Purge was: Rx. Mann� sescunc. vel unc. ij.
+    Tamarind. cond. unc. i. Tartar vitriolat. gr. x. solve in
+    seri lactis pr�parat. cum Vin. Maderiens. unc. vi. Colatur�
+    adde Tinct. Sen� unciam dimidiam. Divide in Partes quatuor, &
+    capt. �ger unam omni hora donec laxetur alvus.
+
+    His Infusion of Snake-Root was prepared in the following
+    Manner:
+
+    Rx. Rad. Serpent. Virgin. drachm. ij. Croci Angl. drachmam
+    dimidiam, infunde per horam vase clauso in aq. bull. q. s. &
+    dein unc. vi. Colatur�, adde aq. Menth. simp. unc. ij. Vin.
+    Maderiensis, unc. iv. Syrup. Croci vel Syr. e Mecon. unc. i.
+    Elix. Vitriol. acid. q. s. ad gratum saporem M. capiat �ger
+    cochlear. ij. vel iij. omni hora vel secunda quaq; hora vel
+    s�pius pro re nata.
+
+    The Stomach is so irritable in the Beginning of this
+    Disorder, as to reject the saline Draughts, Nitre, and such
+    other Medicines. Nor will the Bark, which might be judged a
+    very proper Medicine in the second Stage of the Disorder, lie
+    upon the Stomach, but is thrown up immediately, in whatever
+    Form it is given. However, a Gentleman who had practised long
+    in the _West Indies_ told me, that although the Patient could
+    not retain it in his Stomach, yet that he had found great
+    Service, after the Bowels were emptied, from the Bark used
+    freely in Clysters.
+
+    Dr. _Hillary_ disapproves of the Use of Blisters in the
+    advanced State of these Fevers.
+
+After emptying the Bowels, we gave the cooling, and mild Diaphoretics,
+such as the saline and mindereri Draughts, joined occasionally with
+Nitre, or the Contrayerva Powders; while we made the Patient drink
+plentifully of warm diluting Liquors; which we found to answer in
+general better than any other Remedies: They brought the Remissions to
+be more evident, and the Paroxysms to be milder, at the same Time that
+they kept up a free Perspiration, as a Means to carry off the
+Distemper.
+
+In some Cases we gave the Antimonial Powder, made of one Part of
+Tartar Emetic, and ten of the _pulvis e chelis_, in small Doses, from
+two to four Grains every four or six Hours. The first Doses of this
+Powder sometimes made the Patient sick, and acted as a Purgative, and
+kept up a free Perspiration; at other Times, it produced no visible
+Effect. In some Cases, where it was given early, it operated both by
+Stool, and as a Diaphoretic, and removed the Fever[75]; and it was of
+Use in others, towards the Decline of the Fever; but we were often
+obliged to lay it aside; for it either acted too roughly, or produced
+no visible Effect or Alteration in the Disorder.
+
+    [75] Dr. _Millar_, one of the Physicians to the Army, told me
+    in _Germany_, that he had given this antimonial Powder with
+    great Success in the Remitting Fever, while the Eighth
+    Regiment of Foot (to which he was formerly Surgeon) lay in
+    _England_.--Dr. _Pringle_, in his fourth Edition of his
+    _Observations_, Part iii. ch. iv. tells us, that having given
+    a mild Purge immediately after Bleeding, he next Morning,
+    when there was almost always a Remission, gave a Grain of the
+    Tartar Emetic, with twelve Grains of Crabs-Eyes, and repeated
+    the Dose in two Hours, if the first had little or no Effect;
+    at any Rate, in four Hours. This Medicine not only vomited,
+    but generally opened the Body, and raised a Sweat. By these
+    Evacuations, the Fever was sometimes quite removed, but
+    always became easier.--This Medicine he usually repeated the
+    second or third Day; if not, he opened the Body with some
+    mild Laxative, or a Clyster; and continued this Medicine,
+    till the Fever went gradually off, or intermitted.--Dr.
+    _Pringle_ says, that Dr. _Huck_ treated this Fever in a
+    Method similar to this, both in _North America_ and in the
+    _West Indies_. In the Beginning he let Blood; and in the
+    first Remission, gave four or five Grains of Ipecacuana, with
+    Half a Grain of Tartar Emetic: This Medicine he repeated in
+    two Hours, taking Care that the Patient should not drink
+    before the second Dose; for by that Means the Medicine passed
+    more readily into the Bowels, before it operated by vomiting.
+    If, after two Hours more, the Operation either Way was small,
+    he gave a third Dose; which commonly had a good Effect in
+    carrying off the Bile; and then the Fever either went quite
+    off, or intermitted so far as to admit the Bark. On the
+    Continent he found no Difficulty after the Intermission; but
+    in the Islands, unless he gave the Bark upon the first
+    Intermission, though imperfect, the Fever was apt to assume a
+    continual and dangerous Form. Dr. _Huck_ never varied this
+    Method, but upon a stronger Indication to purge, than to
+    vomit. In which Case he made an eight Ounce Decoction, with
+    Half an Ounce of _Tamarinds_, two Ounces of _Manna_, and two
+    Grains of _Emetic Tartar_; and dividing this into four Parts,
+    he gave one every Hour, till the Medicine operated by Stool.
+
+When the Fever came to remit, we were obliged, for the most part, to
+continue the Use of the mild Diaphoretics, as before; for, although
+the Disorder put on a remitting Form, the Bark had very little Effect
+in stopping it[76], unless where the Fever changed into a regular
+Quotidian or Tertian Ague.--In the Year 1761, very few of these Fevers
+turned to regular Intermittents; but, in the Year 1762, the greater
+Part of them terminated in regular Agues, and were cured by the
+Bark[77].
+
+    [76] Dr. _Hillary_, in mentioning the Remitting Fever of the
+    Island of _Barbadoes_, says: In those who were blooded, and
+    took an Emetic afterwards, and then the saline Draughts, the
+    Fever was generally carried quite off by a critical Sweat on
+    the seventh or ninth Day; in some few it came to intermit
+    regularly after that Time; and was soon cured by the _cortex
+    Peruviana_, given with the saline Draughts, and seldom
+    effectually without them; though these irregular ingeminated
+    Fevers often remitted, and sometimes seemed to intermit; yet
+    if the _cortex Peruviana_ was given too soon in the Disease,
+    before it intermitted regularly (as I have more than once
+    seen, where it had been injudiciously given), it generally
+    caused the Fever to become continual and malignant.
+    _Observat. on the epidemic Diseases of Barbadoes_, p. 22.
+
+    [77] Mr. _Cleghorn_, after giving a very accurate Account of
+    Tertian Fevers, as they appeared in their various Forms of
+    true, of double, and triple Tertians, and of Semi-Tertians,
+    in the Island of _Minorca_, tells us, that he first attempted
+    the Cure by profuse Evacuations; but afterwards learnt from
+    Experience, that they were unnecessary; and that Bleeding and
+    Purging once or twice in the Beginning, was all that was in
+    general requisite; and if on the fifth Day the third
+    Revolution was not attended with more threatening Symptoms
+    than the second, and the Patient bore it easily, he
+    frequently trusted the whole Business to Nature; which
+    commonly terminated the Fever about the fourth or fifth
+    Revolution; and for the most part with an Increase of some
+    natural Evacuation.--But if the Paroxysm on the fifth Day was
+    the longest and most severe that happened, attended with any
+    doubtful or dangerous Symptom, he ordered two Scruples of the
+    Cortex to be given every two or three Hours; so that five or
+    six Drachms may be taken before next Day at Noon; lest, if
+    this Interval escaped, he should not have found a favourable
+    Opportunity of giving a sufficient Quantity of the Medicine
+    afterwards; as the Fits about this Period are wont to become
+    double, subintrant, or continual.--This did not always put an
+    immediate Stop to the Fever, but it invigorated the Powers of
+    the Body, and prevented or removed the dangerous Symptoms.
+    Having given the Bark on the fifth Day, if a Fit came on the
+    sixth, and declined the same Evening, he gave some more Doses
+    of the Bark to mitigate the Fit on the seventh; yet sometimes
+    this Fit of the sixth united with that of the seventh, and
+    the Patient had the Heat, Restlessness, Raving, and other
+    Complaints, greatly augmented, and the Case seemed more
+    desperate than ever; which, however, were more dangerous in
+    Appearance than Reality, and went off with a profuse Sweat
+    next Morning; after which he gave the Bark freely as before;
+    and this either stopt the Fits, or made them so moderate, as
+    that they yielded quickly to the same Sort of Management.--By
+    this Method, when Assistance is called timely, Mr. _Cleghorn_
+    says, the most formidable Intermitting and Remitting
+    Tertians, may be certainly and speedily brought to a happy
+    Conclusion about the End of the first Week, or Beginning of
+    the second. See _Observ. on the epidemic Diseases in
+    Minorca_, chap. iii. p. 187, &c.
+
+In the Year 1761, we tried the Bark in various Forms in many Cases,
+where the Patient had been blooded and purged in the Beginning, and
+used the cooling Medicines; and where the Remissions were very clear:
+Yet it had no Effect in removing the Disorder, except in two or three
+Cases at _Munster_, where the Paroxysms assumed a tertian Form; for
+the most part, it made the Patients more hot and feverish, and we were
+obliged to leave off using it, as it was in Danger of changing the
+remittent into a continued Fever. However, it was of Service after the
+Fever came to a Crisis, and was going off; and Dr. _Pringle_ has very
+justly observed, that it hastened the Recovery, and that those who
+used it were less subject to Relapses than such as did not; and
+therefore we commonly gave it in a convalescent State.--Before giving
+the Bark, I always found it of Advantage to give a Dose of Rhubarb, or
+of some other Purgative, or to mix some Rhubarb with the first Doses,
+so as to procure the Patient some loose Stools.
+
+When either the Fever went on without Intermission, or changed into a
+continued Form, or the Patient continued hot and feverish through the
+Day, with a Head-Ach, and other feverish Symptoms, nothing answered
+better, after free Evacuations had been made, than to apply a large
+Blister to the Back; and to make the Patient drink freely of cooling
+diluting Liquors; which generally relieved the Head, and abated the
+Violence of the other Symptoms.
+
+When a Purging came on in the Course of this Disorder, if there was
+much Fever, with a strong throbbing Pulse, Gripes and Pain of the
+Bowels, some Blood was taken away; and immediately after the Patient
+took a Dose of Salts and Manna, or of Rhubarb; and an Opiate in the
+Evening after its Operation: But if there was little or no Fever, or
+sharp Pain, Bleeding was omitted; and if the Patient complained of
+Sickness, a few Grains of Ipecacuana were given previous to the Purge.
+
+After this, if the Purging was moderate, and did not sink the Patient,
+we did nothing to stop it; but if it was violent, we gave the
+mindereri Draughts with Mithridate, and the Chalk Julep in the Day,
+and an Opiate at going to Rest; and occasionally used the emollient
+and anodyne Clyster; and, if necessary, repeated the Emetic and Purge.
+
+The Hiccup seldom appeared in this Fever till the Patient was reduced
+very low, and was commonly the Forerunner of Death. Some few, who had
+a Purging and Vomiting, were taken with a Hiccup, attended with
+Sickness, and Load at the Stomach, which seemed to depend on bilious
+Humours lodged in the Stomach and Bowels. This induced me to give a
+few Grains of the Ipecacuana; and to make the Patients drink an
+Infusion of Camomile Flowers till they vomited freely, and afterwards
+to take some mild Purge, or use laxative Clysters; after which they
+found themselves easier, and an anodyne Draught, with twenty or
+twenty-five Drops of the _tinctura thebaica_, put an End to the
+Hiccup. Others required the Use of Cordial Draughts, mixed with
+Opiates; and repeated Clysters and Fomentations, before they found
+Relief.--The Application of a Blister removed the Hiccup in one,
+after the above Remedies had proved ineffectual; as did the Musk Julep
+with Opium, and the Application of an aromatic Plaister to the
+Stomach, in another Patient.
+
+Several of them complained of a burning Heat and Pain in making Water;
+which commonly went off by drinking freely of the Gum Arabic
+Decoction, with the dulcified Spirit of Nitre, and the Use of oily
+Draughts; though in some it required the Assistance of Opiates, and of
+Fomentations and Clysters, before it was got the better of.
+
+The Symptom of Worms we were often obliged to neglect till the Fever
+was over, and then we treated it as formerly mentioned.
+
+The Deafness, though not near so frequent in this as the Malignant
+Fever, was rather a favourable Symptom, and mostly went away of
+itself; though in a few Cases, where it continued long, we applied
+Blisters behind the Ears, or to the Neck, with Advantage.
+
+Many, especially those who were brought low, complained, after the
+Crisis of the Fever, of Restlessness, and Want of Sleep; which,
+however, went off as their Strength returned: Where it fatigued them
+much, and kept them low, we gave a Cordial anodyne Draught at Night;
+and if that did not answer, commonly the Addition of a few Glasses of
+Wine in the Afternoon had the desired Effect.
+
+Others, in their convalescent State, complained of such a Giddiness,
+and Lightness of the Head, that they could neither walk nor stand;
+others, of a Dimness of the Eyes. These Symptoms, for the most part,
+went off as the Patients gathered Strength: The Use of the Bark, with
+now and then a Glass of Wine, hastened the Cure; and in two or three
+Cases we were obliged to give a Dose or two of some gentle Physic, and
+to apply a Blister, before the Patient got the better of them.
+
+As the Sick were recovering, it was common for them to complain of
+Pains of the Shoulders, Arms, and Legs, which also left them as they
+recovered their Strength; where they did not, the saline Draughts, and
+a low Diet, generally had a good Effect; and where it had not, we
+treated them as rheumatic Complaints.
+
+When the yellowish Colour of the Countenance remained after the Fever,
+we kept the Patient on a low Diet; and his Body open by Means of the
+saline Draughts, with a few Grains of Rhubarb, or by giving Half a
+Drachm, or two Scruples of the Soap Pills with Rhubarb daily; which,
+for the most part, removed the Yellowness soon. Two only had a
+Jaundice remain after the Fever, and both were cured in a short Time.
+
+In other Respects, the Treatment of this Fever, when it degenerated
+into a continued Form, had nothing particular in it; nor differed from
+the common Practice of giving cooling Medicines when the Fever was
+high, and supporting Nature by the Use of Cordials and Wine, and the
+Application of Blisters, &c. when low; and promoting such Evacuations
+as Nature pointed out for a Crisis.
+
+
+
+
+OF THE Intermitting Fever, or Ague.
+
+
+This Disorder belongs to the same Tribe of Diseases as the Remitting
+Fever. We call it an Intermitting Fever, or Ague, when the Paroxysms
+are distinct, begin with a cold and hot Fit, and go off with a Sweat;
+and the Patient is cool, and free from the Fever in the Intervals
+between the Fits.
+
+Many have been the Causes alledged to produce this Disorder. The great
+Quantity of Bile that is often thrown up in the Fit, has caused it to
+be ranked among the bilious Diseases; and the Seasons of the Year in
+which it is most frequent, and the low moist Situation of the Places
+where it is endemic, have made Practitioners suspect, that an
+obstructed Perspiration, and a Tendency in the Juices to the
+Putrescent, are the Cause of it.
+
+But whatever Cause we may suppose to give Rise to the first feverish
+Fit, it is difficult from hence to account for the regular Returns of
+the Paroxysms and Intermissions: For my own Part, after considering
+Intermittents, which observed a regular _Type_ in the Course of a
+Salivation[78]; their being so easily stopt by the Bark without any
+sensible Evacuation; their being sometimes put away by a Stimulus
+externally applied[79], or by a Fright, or sudden Plunge into cold
+Water[80]; their returning after slight Errors in Diet, and sometimes
+by the Operation of a Purge, or of Bleeding; their attacking sometimes
+only particular Parts, and many such Accidents in these Fevers, I must
+confess, that I am unable to form any Idea, either of their Origin,
+Seat, or Cause[81].
+
+    [78] See _Van Swieten_, Vol. II. p. 537.
+
+    [79] A Gentleman told me, that he was once cured of an Ague
+    in the Country, by applying a Poultice of Garlic to his
+    Wrists, and letting it lie on till it inflamed and blistered
+    the Part.--I have seen Blisters cure an Ague.--In the
+    _Edinburgh Med. Essays_, Vol. II. Art. v. we have an Account
+    of Agues being cured by the Application of Poultices of
+    recent Erigerum (Groundsel) applied to the Stomach on the
+    Days free from the Paroxysm, which caused strong Vomiting.
+
+    [80] See an Account of an Ague being cured by the Patient
+    being pushed into a Pool of Water without any previous
+    Notice, and being much frightened, in _Mason's Account of
+    Agues_, p. 222.
+
+    [81] The common Account given of the Cause of Agues, and of
+    the regular Return of their Paroxysms, has been: That the
+    Ague takes its Rise from some Sort of Matter, bilious, or
+    whatever it may be, either mixed with the Blood, or lodged in
+    the Bowels, or in some other Part of the Body; that a great
+    Part of this Matter is thrown out of the Body, in the Time of
+    the Paroxysm; but that so much remains as serves by Way of a
+    Ferment to assimilate other Particles to its own Nature;
+    which, when collected in a certain Quantity, produce a new
+    Fit; and, according to the Time that it takes to produce this
+    Quantity, the Disorder assumes the Form of a Quotidian,
+    Tertian, or Quartan Ague.
+
+The Soldiers were subject to this Disorder, particularly in Spring, if
+they took the Field soon, and in Autumn: The Frequency of it was in a
+great Measure determined by the Nature of the Ground on which they
+were encamped, or the Situation of the Garrison or Town in which they
+were quartered; for the lower and moister the Camp or Garrison, and
+the more moist the Season, the more subject an Army is to Agues; and
+the drier the Situation of the Camp or Garrison, and the finer and
+drier the Weather is, the freer they are from Disorders of this Kind.
+
+In Winter 1761, we had but very few Agues in the Hospitals; but on the
+Return of the Troops from the Expedition into _Hesse-Cassel_, and
+during the Spring, some (though not many) were attacked with Quotidian
+and Tertian Agues, and but very few with Quartans.--In _July_ and
+_August_ they were more frequent, and accompanied with more bilious
+Symptoms. At _Bremen_, during the latter End of Autumn, and throughout
+the Winter and Spring 1762, we had Agues of all Sorts, and many
+inveterate Cases; and all this Spring, and during the Summer and
+Autumn, the Ague was the epidemic Disorder all over _Westphalia_, as
+well as among the Troops.
+
+In Spring 1761, what Agues we had were mostly Tertian, some Quotidian,
+and but two or three of the Quartan Kind. They were, for the most
+part, mild, and yielded to the Bark.--Some of them began in the Form
+of a continued Fever; but after Bleeding, and the Use of the cooling
+Medicines for a few Days, they began to remit, and at last ended in
+regular Quotidian or Tertian Agues: Others, at first, appeared in Form
+of Remittent Fevers, attended with a strong throbbing Pulse; but
+changed to regular Intermittents by pursuing the antiphlogistic Method
+of Cure; and some from the Beginning assumed the Type of Quotidian or
+Tertian Agues, but often attended with a good deal of Fever, for the
+first two or three Days; and some had a slight Delirium in the Time of
+the Paroxysms, and the Pulse was not quite settled in the Intervals.
+In such Cases, where the Patient was strong, nothing answered so well
+as to take away some Blood; and to give the saline Draughts with Nitre
+till the Fever was moderated, before we gave the Bark.
+
+In general, there is a Prejudice against bleeding in Agues, after they
+become regular; but I have always observed, both in _England_ and in
+_Germany_, that where Patients are strong and plethoric, and the
+Fever in the Paroxysms rises high, or the Pulse remains quick in the
+Intervals, that taking away more or less Blood, and giving the
+antiphlogistic Medicines in the Beginning, eased the Patient,
+moderated the Fever, and made it safer to give the Bark soon; and I
+never saw the least Inconvenience from the Practice; but, on the
+contrary, have seen several Intermittent Fevers change into continued
+ones from the Neglect of this Evacuation; and have seen Cases where
+the Bark, instead of stopping the Ague, rather increased the Fever,
+till the Patient was blooded, and had pursued the antiphlogistic
+Method for some Time; after which the Bark had its proper Effect, and
+put an End to the Disorder.
+
+As soon as these Agues became regular, and the Patient was quite cool,
+and free from any Fever in the Intervals, we gave the Bark; which soon
+put a Stop to the Paroxysms, without the least bad Consequences; but,
+before giving the Bark, we always took Care to empty the first
+Passages by the Use of Emetics and Purgatives, where there was no
+Symptom to forbid their Use: In Cases where the Patient was weak, and
+the Fits so violent as to make it necessary to stop the Ague, before
+we had Time to administer Emetics or Purgatives, we added so much
+Rhubarb to the first Doses of the Bark as procured the Patient some
+loose Stools, as recommended by Dr. _Mead_[82]; which did not prevent
+its stopping the Ague, at the same Time that it answered the End
+proposed of carrying off any putrid Humours that might be lodged in
+the Intestines.
+
+    [82] Mr. _Cleghorn_, while at _Minorca_, after Evacuations,
+    gave the Bark at the End of the third Period, as we observed
+    before; but where the Fever had been neglected till about the
+    third or fourth Period, or badly treated in the Beginning,
+    and the Bowels were inflamed or overcharged with corrupted
+    Gall, he was obliged to endeavour to palliate the most
+    pressing Complaints, and to watch Evening, Night, and Morning
+    for a Remission, and then immediately to fly to the Bark, as
+    the only Remedy that could avert the Danger. If the Patient
+    was strong, he gave Half an Ounce of the Bark, with six
+    Drachms of the _sal catharticum amarum_, divided into four
+    equal Parts, of which the Patient took one every two Hours;
+    the Effect of which was, that the next Fit was mitigated, and
+    an Intermission commonly ensued, in which the Bark was
+    repeated without the Purgative, to finish the Cure.--But
+    where the Patient was excessively feeble, and there was a
+    manifest Risk of his dying in next Fit, he gave Cordials with
+    the Bark, instead of the _sal catharticum_; and endeavoured
+    to throw in six or seven Drachms in the Space of ten or
+    twelve Hours; he having found by Experience, that if a
+    smaller Quantity is given, the Paroxysms come on earlier than
+    usual, and make all Attempts to preserve Life unsuccessful.
+    See his _Account of the epidemic Diseases of Minorca_, cap.
+    iii. 2d edit. p. 192.
+
+In _England_, Vernal, Quotidian, and Tertian Agues, frequently go off
+after Bleeding, and taking some Emetics and Purges, and the saline
+Draughts, and cooling Medicines, for some Time, without the Use of the
+Bark; but in _Germany_ very few yielded to this Treatment, and we were
+obliged to give the Bark[83] before we could put a Stop to them.
+
+    [83] Sometimes, when Patients are reduced low by Agues, the
+    Stomach becomes so squeamish as to reject the Bark in every
+    Shape it can be given; in such Cases, when the Ague cannot be
+    stopped by other Means, it may be administered with great
+    Advantage in Clysters, of which the following is a very
+    remarkable Instance.--_William Hadderell_, a Lad seventeen
+    Years of Age, in the End of the Year 1761, was attacked with
+    a severe Tertian Ague, in which a Mortification came on his
+    left Foot, and one-half of it dropt off; notwithstanding, his
+    Ague continued to attack him every second Day, and the Sore
+    continued running on the 12th of _October_ 1763, when he was
+    admitted into _St. George_'s Hospital. He was reduced
+    extremely low; and the Sore of his Foot looked so bad, that
+    it was at first imagined he must lose his Leg. He was ordered
+    some Vomits, and a Purge, and cooling Medicines, and
+    afterwards to take the Bark freely; but his Stomach rejected
+    it, in whatever Form it was given. Other Means were then
+    tried to stop his Ague, but with no Effect, till the 7th of
+    _November_, that I ordered two Drachms of the Powder of the
+    Bark to be given him twice a Day in an emollient Clyster,
+    with Half a Drachm of the _tinctura thebaica_, which stopt
+    his Ague in three Days; and he had had no Return of it on the
+    28th of _January_ 1764, and had recruited his Health and
+    Strength, and the Sore of his Foot was greatly lessened. Dr.
+    _Harvey_ (who teaches Midwifery in _London_) told me, that he
+    has cured Children of Agues by Bark Clysters, after the Bark
+    Waistcoats, and other Means used, had proved unsuccessful.
+
+In the End of _July_, and Beginning of _August_, the aguish Cases we
+had at _Munster_ continued to be of the Quotidian or Tertian Kind. The
+greatest Part of them began in the Form of continued Fevers, tending
+more to the bilious Kind than the preceding Months, and many of the
+Sick had bilious Vomitings in the cold Fits; and the Agues we had in
+Spring, and during the Campaign 1762, were of the same Nature, and
+required the same Treatment.
+
+Those Cases, which began in the Form of continued Fevers, were
+treated as such till they began to have regular Intermissions; they
+then yielded to the Bark.
+
+Some were attended with the Dysentery; and the Purging and Gripes were
+most severe on the Days of the aguish Paroxysms. In such Cases, we
+were frequently obliged at first to neglect the Ague, and to treat the
+Disorder entirely as a Flux. Where there was much Fever, the Patient
+strong, and the Pains in the Bowels acute, we ordered Bleeding; and
+after it a gentle Emetic, and some Doses of the saline oily Purge, or
+of Rhubarb; and gentle Opiates in the Evening, and other Medicines
+proper in the Dysentery, till its Violence was abated, before we gave
+the Bark: though in some Cases, where the aguish Paroxysms were very
+severe, and helped to increase the Purging, and the Patient was in
+Danger of sinking, we gave the Bark, notwithstanding the Flux still
+continued; and the Method we followed was the same as that I formerly
+mentioned, where it was complicated with the Malignant Fever; which
+was to give the Bark, mixed with Diascord, and Opiates, or other
+Medicines proper for the Dysentery, in the Intervals between the
+Purges.
+
+By this Treatment, very often both the Flux and Ague went off.
+However, it ought to be observed, that unless the aguish Paroxysms
+were severe, and in Danger of sinking the Patient, or that the
+Disorder had continued for some Time, and the Paroxysms were distinct,
+we seldom gave the Bark till the Violence of the Flux was abated: And
+where-ever much Griping and Pain in the Bowels attended the Flux and
+Ague, there Bleeding as well as Purgatives were necessary, before
+exhibiting the Bark; which seldom or ever agreed with them, till there
+was an evident _Apurexia_, or Absence of Fever in the Intervals
+between the Fits. Where these Cautions were neglected, the Bark
+generally made the Patients worse; and we were obliged to omit it,
+till the Violence of the Purging was over.
+
+Some Agues were accompanied with the Jaundice, though not in such a
+high Degree as in the confirmed State of that Disorder; and commonly
+in the Beginning the Pulse continued rather quick, in the Intervals
+between the Paroxysms; and the Patients complained of some Degree of
+Sickness for the first two or three Days. With those the Bark always
+disagreed, till the Feverishness between the aguish Paroxysms was
+gone; and we found, that the best Method of treating them, was to
+bleed in the Beginning, if there was much Fever; and then to give a
+Vomit and Purge, and to repeat them, if necessary; and where there was
+no Purging, to give the saline Draughts, and other cooling Medicines;
+and to add a few Grains of Rhubarb, or to give so much of the _pilul�
+saponac� cum rheo_, daily, as procured one or two loose Stools.
+
+After the Ague had regular Intermissions, and the Patient was quite
+cool, and without Fever in the Intervals, if the Disorder did not
+yield to the above Treatment, which it seldom did, we then gave the
+Bark freely; even though the slight icteric Symptoms still remained;
+and it put an End to the Ague, and removed the Jaundice at the same
+Time, without the least Inconvenience to the Patient. In such Cases,
+we generally used to add a few Grains of Rhubarb to the first Doses of
+the Bark; or gave the Bark made up into Pills with Soap, and added
+occasionally a few Grains of Rhubarb.
+
+Several of those who had the icteric Symptoms along with the Ague, had
+bilious Vomitings in the Time of the cold Fit; they found themselves
+sick, with a bitter Taste in their Mouth, before the Approach of the
+aguish Paroxysm; and many of them, though they took Emetics, which
+operated freely at this Time, yet did not vomit up the Bile; but the
+Sickness and bitter Taste continued till the cold Fit came on, when
+they vomited Bile in large Quantities. In such Cases, after the Use of
+Emetics and Purges, and the Ague was brought to have regular
+Paroxysms, with free Intermissions, the Bark, given as just now
+mentioned, removed the Ague and icteric Symptoms, without the least
+bad Consequences.
+
+Many Practitioners of great Repute have been prejudiced against the
+Bark; and tell us, that the free Use of this Medicine often lays the
+Foundation of Obstructions in the abdominal Viscera, especially when
+it has been given where there was an icteritious Colour in the Eyes
+and Countenance; and that, in such Cases, we ought not to give the
+Bark till these Icteric Symptoms are gone. At first, I was very
+cautious of giving it under such Circumstances; till meeting with some
+Cases where the Paroxysms were severe, and became more frequent, while
+the Patient was so low, as to be in Danger of sinking under the
+Disorder, I gave the Bark freely, as the only Remedy capable of
+preserving Life; which not only stopt the Ague, but carried off the
+icteritious Symptoms[84], and restored the Patients to perfect Health.
+
+    [84] This agrees with what Mr. _Cleghorn_ remarks of Tertian
+    Fevers in his _Observations on the epidemic Diseases of the
+    Island of Minorca_, who says, "where there is an icteritious
+    Colour of the Eyes, we are likewise told, that the Cortex
+    should not be administered; though, in my Opinion, it is for
+    the most part dangerous to delay it, after the first
+    Appearance of that Symptom." Chap. iii. 2d edit. p. 205.
+
+After this I gave it freely, in the Manner above mentioned, to some
+Hundreds, with great Success; and I never saw any Mischief follow from
+using it: Indeed sometimes, where it was given rather too soon, it did
+not sit easy on the Stomach; and made the Patients hot and restless;
+but, by laying it aside, these Effects immediately ceased; and
+generally, after a little Time, the Paroxysms became milder and more
+distinct, when the Bark was again administered, agreed with the
+Stomach, and put an End to the Disorder; and I am now convinced, from
+Experience, that the Cases in which the Bark has done Mischief, or
+given Rise to Obstructions of the abdomenal Viscera, are but very
+rare; and that these Mischiefs mostly arise from the Obstinacy of the
+Disorder, and not from the Use of this Drug; for I have oftener
+observed these Obstructions where little or no Bark had been used,
+than where it was given freely[85]. What probably has given Rise to
+the Belief of the Bark's doing so much Mischief, is, that in
+_Holland_, and other low fenny Countries, where Agues are endemic,
+they are oftentimes extremely obstinate, and yield hardly to any
+Remedies; and if they are stopt by the Bark, they often return soon
+after, and by their long Continuance give Rise to Obstructions of the
+abdomenal _viscera_, which have been attributed to the Use of this
+Specific.
+
+    [85] Dr. _Pringle_ takes Notice, that these Obstructions
+    happened as often without as with the Bark; and therefore
+    seemed to depend on the long Continuance and Obstinacy of the
+    Intermittent. _Observ._ part iii. chap. iv. sect. 2. p. 179.
+    3d Edit.
+
+In some few Cases a Purging accompanied these icteric Symptoms, which
+we treated much in the same Manner as when the Ague was complicated
+with the Flux; we gave Emetics and Purgatives; and the mindereri
+Draughts with Mithridate, throughout the Day, and Opiates at Night, if
+the Purging was violent; if it continued, accompanied with regular
+aguish Fits, the Bark, with Astringents, generally removed both.
+
+In the latter Part of the Year 1761, and during Spring 1762, we had
+at _Bremen_ many Patients in Agues of all Sorts; as Quotidians,
+Tertians, Quartans, and irregular Agues of a very obstinate Nature.
+The Town of _Bremen_ is large and well built, situated in a low sandy
+Plain, with the _Weser_ dividing the old from the new Town; generally
+a considerable Part of the Environs is covered with Water in the
+Winter, and frequently the _Weser_ breaks down some of the Dikes, and
+overflows all the Country round; and every Time the River overflows
+its Banks, the Cellars of all the new Town, and of that Part of the
+old Town next the River, are filled with Water. All the Year round, on
+digging two or three Feet deep into the Ground, you come at Water.
+
+Agues are endemic in this Place, and great Numbers of the lower Class
+of People are afflicted with them at all Times of the Year, especially
+in Spring and Autumn.
+
+Some of the Sick sent down from the Army were bad of Agues; but the
+greatest Number we had in Hospitals was composed of such as took it
+in Town; either from doing Duty on the Ramparts, or from lying in bad
+Quarters, or getting drunk and exposing themselves to Wet and Cold;
+and many Men of the invalid Companies who had come from _Embden_
+brought with them old inveterate tertian and quartan Agues.
+
+Most of the recent Cases were easily cured by the Methods already
+mentioned; though they often continued longer, required a greater
+Quantity of the Bark to stop them, and a longer Continuance of its Use
+to make a Cure, than at other Places, which were more dry, and higher
+situated.
+
+The most obstinate of the recent Cases were the irregular
+Intermittents, which had regular Paroxysms, but where the Pulse was
+not settled in the Intervals; which we were obliged to treat as
+Remitting Fevers till the Paroxysms became quite distinct, and the
+Patient was cool and free from any Fever in the Intervals; after which
+they commonly yielded to the Bark.
+
+But many of those Agues which had continued for some Time, especially
+with those Invalids who came from _Embden_, or who had brought on
+frequent Relapses by their own Irregularities, were very obstinate.
+With many the Bark had no Effect; and its Use persisted in seeming
+rather to exasperate the Paroxysms, and to do Hurt. Nor had almost any
+Remedy we tried a better Effect. We gave the following Medicines to
+divers Patients; the saline Draughts and cooling Medicines; Infusions
+of Camomile Flowers and of other Bitters; Dr. _Morton_'s Powders of
+Camomile Flowers, Salt of Wormwood, and diaphoretic Antimony; Dr.
+_Mead_'s Powders of Camomile Flowers, Salt of Wormwood, Myrrh, and
+Alum; Alum and Nutmeg; large Doses of _sal ammoniac_; large Quantities
+of Spirits of Hartshorn; the antimonial Drops and Powders; to some we
+gave Emetics, both in the Intervals and immediately before the Fits.
+In some we tried to promote Sweats before the Approach of the Fits, by
+making them drink freely of warm Liquors while they kept in Bed, and
+took diaphoretic Medicines; and to others we applied Blisters.--But
+all did not put a Stop to some of those Agues.
+
+With some the Disorder continued till it broke down the Crasis of the
+Blood, and brought on a general Relaxation of the Fibres; and the
+Patients became cachectic, and fell into Dropsies, or were seized with
+Diarrhoeas, of which they died. Some had Obstructions formed in the
+Liver or Spleen, or other _viscera_, and fell into the Jaundice and
+Dropsies, which carried them off.--In the Bodies, of several whom we
+opened, we found Indurations of the Liver and Spleen--in two of them
+Suppurations of the Liver--and in one, who had had the Ague at
+_Embden_, and had long complained of one of those Swellings towards
+the left Side of the _abdomen_, called the _Ague Cake_[86], the Spleen
+was so much enlarged as to weigh above four Pounds.
+
+    [86] I have seen the dead Bodies of four People opened, who
+    had those Swellings of the left Side, commonly called the
+    _Ague Cake_, which had come after Agues; and in all the
+    Swelling was owing to an Enlargement of the Spleen.
+
+Some, whose Constitutions were worn out by these obstinate Agues, fell
+into Consumptions and other pulmonic Disorders in the Winter, of which
+they died. One Man died in the cold Fit[87].
+
+    [87] The cold Fit is the most dangerous Time of the Paroxysm,
+    and the greatest Part of those who die of Agues die at this
+    Time; one or two Instances of which I saw in the Military
+    Hospital at _Edinburgh_ in the Year 1746.--_Van Swieten_ says
+    he has seen the trembling and shaking so great in the Time of
+    the cold Fit of Quartans, that the Teeth have dropt out of
+    the Head. _Comment. in sect._ 749. _Aphorism. Boerhaav._ vol.
+    II. p. 511.
+
+Where-ever the Ague continued long, and the Bark had no Effect, we
+were obliged to lay it aside, and to try other Remedies adapted to the
+present Circumstances of the Patient.
+
+The mild Methods succeeded best; giving the saline Draughts and gentle
+cooling Medicines to such as were strong and plethoric, and had the
+aguish Paroxysms violent; and the gentle Aromatics and Bitters, or
+Chalybeats, to those of a weakly Habit, or whose Fibres had been much
+relaxed, and their Constitutions greatly injured by this or any other
+preceding Disorder.
+
+During these Courses, we gave at Times gentle Emetics; and if the
+Patient complained of Gripes and Purging, which they frequently did,
+in the Course of this Disorder, we gave a Dose of Rhubarb, or of some
+other mild Purge; and after it other Medicines proper for this
+Complaint.
+
+By these Methods frequently the aguish Paroxysms became gradually
+milder, and at last vanished. At other Times, after they had continued
+for five or six Weeks, we again gave the Bark, and found it to have
+the proper Effect. With others they continued thro' the Winter, and
+went off of themselves in the Spring. With others they still
+continued; and as no Medicines nor Time seemed to have any Effect in
+that Country, we recommended their being sent over to _England_ for
+Change of Air, as the only Means likely to remove the Disorder.
+
+Two Agues which had resisted the Use of the Bark were cured by Powder
+of Camomile-Flowers, Salt of Wormwood, and diaphoretic Antimony; and
+one by the Use of the aluminous Powders, with Myrrh.--One Invalid, who
+had long been ill of an obstinate Tertian, on catching Cold, was
+seized with an Inflammation of his Throat, for which he was blooded,
+and took a mild Purge; next Day there appeared a Swelling of one of
+the parotid Glands, which we endeavoured to bring to Maturation, by
+the Application of emollient Cataplasms; after some Days it went
+entirely away, without coming to Suppuration; but as there remained
+still a Confusion of the Head, and a Quickness of the Pulse, a large
+Blister was applied to the Back, which continued running for some
+Days; after it dried up he fell into a Fit resembling that of an
+Epilepsy, and next Day had another Fit of the same kind; from the Time
+the Swelling first appeared till the Time he had the first Fit, he had
+no Ague, but it returned the second Day after the second epileptic
+Fit; another Blister was applied, and he had no Return of the
+epileptic Fits, though his Ague continued obstinate till _March_, at
+which Time he was sent to _England_[88].--About the same Time the
+aguish Fits of two others were stopt by the Application of Blisters,
+though they returned in both soon after.
+
+    [88] On the 29th of _August_ 1759, a Man (_Murdoch Brinnen_)
+    about thirty Years of Age, was admitted into _St. George_'s
+    Hospital for a very large Swelling of the parotid Glands and
+    neighbouring Parts, which had come three Days before, after a
+    Fit of the Tertian Ague, which did not return afterwards. The
+    Swelling was discussed by the Application of emollient
+    Cataplasms, which were intended to have brought it to
+    Suppuration. He had no Return of the Ague, nor did any bad
+    Consequence follow the Discussion of the Tumour, and the Cure
+    was completed by a few Doses of Physic, and a Decoction of
+    the Bark, which restored him to his Strength, and carried off
+    the little Heat and Feverishness which remained.
+
+Excepting in these few Cases, I found no Medicines effectual in
+stopping those Agues, which had resisted the Bark when properly given,
+though we tried a vast Variety in different Cases. The _cortex
+cascarill�_, or _eleutheri�_, was given freely, both in Decoction and
+Substance, in four Cases, which had not yielded to the Bark, but
+without producing any good Effect; we had not an Opportunity of
+trying this Bark in more Cases of this kind, nor in Fluxes, the small
+Quantity of it which had come from _England_ being all expended.
+
+A Soldier of one of the Regiments of Guards, who was admitted into the
+Hospital for oedematous Legs, and the Remains of a very bad Flux, which
+he had had ever since the preceding Autumn; after being cured of the
+Flux, and most of the oedematous Swellings, was seized with an
+intermitting Complaint in _February_. He had no regular hot and cold
+Fits; but every second Day, after a slight Shivering and Cold, he was
+seized with Gripes and a Purging. In one or two of the Fits his Pulse
+was very quick, and the Pain of the Bowels very acute and severe;
+which obliged us to blood him, and give him a Dose of the saline oily
+Purge; after which we treated the Disorder as a Flux complicated with
+the Ague, and gave the Bark mixed with Diascord, and gentle Opiates at
+Nights, and at Times gentle Purgatives; the Ague and Diarrhoea stopt
+very soon, and in a few Weeks he got free of all Complaints, though he
+still continued weak, till he was sent to _England_, about the
+Beginning of _April_.
+
+Many, especially those whose Constitution had been shaken by this or
+some other Disorder, complained of flatulent Swellings of the Stomach
+and Bowels, which affected them either while the Ague continued, or
+soon after it was stopped, and were very troublesome and uneasy. For
+the most part, these Swellings were removed by the Use of cordial
+Medicines mixed with the Bark, or a Course of Bitters, and some Doses
+of Rhubarb given at proper Intervals. In some Cases, where they were
+attended with Sickness, and the Stomach seemed to be loaded, a Vomit
+gave Relief. Very often these Symptoms continued for Weeks after the
+Ague had left them, and did not go entirely off, till the Patient
+recovered his Strength.
+
+In _February_, _March_, and _April_, 1761, severals of the Soldiers in
+the Hospital at _Paderborn_ complained of periodical Head-Achs, which
+returned in most, every Day; in others, only every second; and
+afterwards Cases of this Kind occurred at different Times as long as
+the Army continued in _Germany_. These Head-Achs generally began in
+the Forenoon, were very violent while they lasted, and confined the
+Patient to his Bed for some Hours. During the Pain, the Pulse was
+quick; but in the Intervals the Patients were quite cool, and without
+Fever. Sometimes, tho' not always, the Urine deposited a little
+Sediment as the Head-Ach was going off. Commonly the Pain was all over
+the Head, but most severe in the Forehead; though sometimes it was
+confined to one Side only.
+
+These Head-Achs we treated entirely as Agues of the same Type. When
+the Patient was strong, some Blood was taken away, and afterwards we
+prescribed an Emetic and Purge, and then gave the Bark liberally,
+which generally put an End to the Complaint, without any bad
+Consequences attending.
+
+
+
+
+OF THE JAUNDICE.
+
+
+The Jaundice, or a yellow Colour of the Eyes and Skin, occasioned by
+an Absorption of Bile into the Blood, was another Distemper which
+appeared towards the End of each Campaign.
+
+This Disorder, for the most part, takes its Rise[89] from Calculi
+lodged in the biliary Ducts[90]; and sometimes from a viscid Mucus or
+Pituita obstructing those Passages[91]; and it may be brought on by a
+Tumour, or any other Cause[92], compressing these Ducts, so as to
+prevent the free Flow of the Bile into the Cavity of the Intestines.
+
+    [89] Obstructions and Scirrhi of the Liver have been assigned
+    as the Cause of the Jaundice; but as we have so many Cases of
+    this Kind related where no Jaundice appeared, it is now much
+    doubted, whether such Obstructions, which do not affect the
+    Ducts, are capable of producing this Disorder.
+
+    [90] We have numerous Cases in _Bonetus_, and other physical
+    Observations, where Calculi have been found in the Gall
+    Bladder, and Ducts of People who have died of the Jaundice;
+    and I have frequently found two, three, and sometimes twelve,
+    fifteen, or twenty, such bilious Calculi in these Cavities.
+
+    [91] Viscid Mucus or Pituita, or viscid Bile, has been
+    observed frequently to obstruct the Ducts. Dr. _Coe_ says,
+    sometimes icteric Patients discharge very thick Bile, almost
+    as viscid as Bird-Lime. See his _Treatise on biliary
+    Concretions_, chap. ii. where he has collected a great Number
+    of icteric Cases, in which the Bile has been found quite
+    viscid after Death.
+
+    [92] See the Case of a Jaundice in _Bonetus's Sepulchretum
+    Anatomicum_, tom. II. p. 326, where the Sides of the common
+    biliary Duct were compressed by an Enlargement of the Glands
+    about the _vena portarum_; and we sometimes meet with a
+    Jaundice in pregnant Women which goes off after Delivery, and
+    seems to have been caused by the Pressure of the Uterus and
+    indurated Foeces in the Colon. _Van Swieten_ says, he has seen
+    this very frequently, vol. III. sect. 918, p. 95.
+
+The yellow Colour, or Jaundice, observed in the Ague, and some other
+bilious Disorders, seems to arise sometimes from Spasms of the Ducts;
+or from too great a Quantity of Bile secreted and absorbed into the
+Blood, which seems evidently to be the Case where large Quantities of
+Bile are either vomited or discharged by Stool; a Proof that the
+biliary Ducts are clear, and free from Obstructions.
+
+In the End of the Campaign of 1760, after a continued Rain for many
+Weeks, the Jaundice had been very frequent, and in a Manner
+epidemical, among the Troops, for some Time before they left the
+Field; and in passing thro' _Munster_, about the End of _December_, I
+observed several ill of that Distemper in Hospitals, and met with a
+few Cases of this Kind in the Hospitals at _Paderborn_ in _January_
+1761; but during the Spring and Summer, we had only one or two now and
+then sent to the Hospitals for this Complaint; though towards the End
+of the Campaign it became more frequent, and several were sent down to
+_Bremen_; and some of the Garrison were likewise affected with it.
+During the Winter not above four or five were sent to the Hospitals I
+attended, and but a few to the flying Hospital, during the Campaign
+1762. It frequently appeared in dropsical Cases, depending on
+obstructed Viscera.
+
+Those in whom the Jaundice was the original Disorder, and not
+complicated with any other, generally got well soon; but where it
+appeared in dropsical Cases, depending on obstructed Viscera, it was
+commonly fatal.
+
+In the Beginning of this Disease, Patients usually complained of
+Sickness, Heat, Thirst, and other feverish Symptoms; and some had a
+Vomiting, and Pain of the Stomach, for a Day or two before the
+Jaundice appeared; the Urine was always of a deep Colour from the
+first; and about the second or third Day the Skin, and the Whites of
+the Eyes, began to be tinged with a yellow Colour, attended with the
+common Symptoms of this Disorder.
+
+Such was the Manner in which the Jaundice began in those who were
+taken ill in Garrison; but those sent us from the Army could seldom
+give any accurate Account of their own Cases.
+
+In the Course of this Disorder, the Sick were inclined to be costive,
+though some few had a Diarrhoea; several, who had been reduced by
+Fevers, or other Complaints, before the Jaundice appeared, were
+attacked with violent H�morrhages from the Nose; and two had like to
+have died of them before the Bleeding was stopped. The H�morrhages did
+not prove critical, but seemed to depend on a dissolved State of the
+Blood.
+
+On the Patient's being first taken ill, if he was plethoric or
+feverish, or complained of Pain, attended with Sickness and Vomiting,
+some Blood was taken away. Next Day we gave twenty-five or thirty
+Grains of Rhubarb in a saline Draught, and afterwards the common
+saline and other cooling Medicines, till the Fever was abated. If the
+Pain and Fever did not abate, a Vein was opened a second Time, and a
+few Drops of the _tinctura thebaica_ were added to the saline
+Draughts, while emollient Clysters were frequently administered, and
+the Stomach and Belly fomented with Flannels dipped in warm emollient
+Decoctions.
+
+When the Pain and Fever were gone, we then gave a gentle Vomit in the
+Evening, and next Day a Dose of Rhubarb; and afterwards so much of
+the _pilul� saponace� cum rheo_ daily as kept the Body open; or the
+saline Draughts with five or six Grains of Rhubarb in each, or such a
+Quantity as answered the same Purpose as the Pills; and from Time to
+Time repeated the Emetic[93] and Purge.
+
+    [93] Vomits are reckoned amongst the most efficacious
+    Remedies in this Disorder, and I have often seen good Effects
+    follow their Use.--_Janet Crags_, a Woman thirty Years of
+    Age, was, on the 21st of _December_ 1758 admitted into _St.
+    George_'s Hospital for a Jaundice of some Months Continuance.
+    Her Eyes and Skin were not of the common icteric Colour, but
+    of a dark livid yellow, for which Reason both she and the
+    Nurses termed her Disorder the Black Jaundice. She at first
+    complained of a Difficulty of Breathing, and a Weight and
+    Oppression about the Region of the Liver, for which she was
+    blooded, took some Doses of Physick, and the Soap Pills with
+    Rhubarb; but these produced no Change in her Complaints. On
+    the 29th she had a Cough, and complained much of Sickness and
+    Difficulty of Breathing, for which she was ordered a Vomit,
+    and afterwards to take the Squill Draught Morning and
+    Evening, which occasioned a Purging and Gripes. On the 5th of
+    _January_ 1759, the Looseness still continuing, I ordered her
+    to leave off the Use of the Squill Draughts, and to take only
+    some Rhubarb in an oily Draught every Night at Bed-Time. On
+    the 8th, tho' the Purging had increased, I did not chuse to
+    check it, as I suspected it would prove a Crisis to the
+    Disorder, and therefore only ordered her the Cordial Draughts
+    and Wine to support her Strength. The Looseness continued
+    till the 15th, when most of the icteric Symptoms were gone,
+    and by the 30th they entirely disappeared. However, she
+    continued low, and subject to Flatulencies for some Months
+    afterwards, which were at last removed by the continued Use
+    of Cordials, gentle Bitters, a nourishing Diet, and repeated
+    Doses of Rhubarb; and on the 2d of _May_ she was discharged
+    in a firm State of Health.
+
+    Dr. _Coe_ says, "I have more Reason to be satisfied of the
+    Effect of Vomits in dislodging these Calculi, than of any
+    other, or indeed of all other Medicines." _Treatise on
+    biliary Concretions_, chap. ii. p. 253. Besides viscid
+    Humours, which Vomits bring away from the biliary Passages,
+    how often are Gall Stones likewise found in the Stools after
+    the Operation of a Vomit? _Ibid._ p. 256.
+
+Most of the icteric Cases we had, which were not complicated with
+other Disorders, yielded to the above Treatment in about twelve or
+fourteen Days. Two or three remained obstinate for a longer Time. To
+one I ordered a Quart of the pectoral Decoction, made with Parsly
+Roots instead of the Linseed, to be drunk daily along with the Soap
+Pills; and the Jaundice disappeared in about eight or ten Days. One
+who had the Disease more obstinate than the rest, and complained for
+some Time of a Tension and Uneasiness about the Liver, was ordered to
+have the right Side fomented Morning and Evening, and to rub it for
+some Time after with the _linimentum saponaceum_ and to drink the
+Decoction of Sarsaparilla after the Soap Pills; and by continuing this
+Course for about three Weeks, the Disorder went off[94].
+
+    [94] Sometimes the warm Bath has a good Effect after other
+    Remedies have afforded no Relief. In the Year 1743, a young
+    Gentleman, a Student of Physic at _Edinburgh_, had a Jaundice
+    for which he had taken Variety of Medicines, and rode daily
+    on Horseback for some Weeks, without receiving any Benefit:
+    At last, by my Father's Advice, he took a brisk Dose of
+    Physic, and before it began to operate had a large Quantity
+    of warm Whey thrown up by way of a Clyster, and went
+    immediately into the warm Bath. In the Bath he was taken with
+    a violent Inclination to go to Stool; and after coming out,
+    had a great Number of bilious Stools that Day, and next
+    Morning was still inclined to be loose; and in a few Days all
+    the icteric Symptoms vanished. On the 20th of _July_ 1763, a
+    middle aged Woman, _Elizabeth Hosier_, was admitted into _St.
+    George_'s Hospital for a Jaundice, which came about a
+    Fortnight before. She had been blooded, and had taken some
+    Medicines, before I saw her. I ordered her a Vomit and Purge,
+    and to take too Scruples of the Soap Pills and Rhubarb daily;
+    and four Days afterwards the Vomit and Purge were repeated,
+    but without making any Change in her Disorder. On the 29th
+    she went into the warm Bath, and took a Vomit immediately on
+    coming out. After the Vomit she had some loose Stools, and
+    the icteric Symptoms went all off in a few Days. She
+    continued well for some Months; but I have been told, that
+    she has since relapsed.
+
+    When the Jaundice continues obstinate, there is hardly any
+    Thing has often a better Effect than the continued Use of
+    Decoctions of the Juices of succulent Plants, of Whey in the
+    Spring, Soap, and such like Medicines. The Baron _Van
+    Swieten_ tells us, that he has cured many obstinate Jaundices
+    by making the Patients drink daily a Pint or two Pints of a
+    Decoction of Grass, Dandelion, Fumaria, Succory, and such
+    like, prepared in Whey; to each Pint of which he added Half
+    an Ounce of _sal polychrest_, and an Ounce or two of Syrup of
+    the five aperient Roots; and by ordering them to drink the
+    Spa Water in Summer, and take freely of Soap, along with a
+    Decoction of the aperient Roots, in Winter. In those who were
+    cured by these Remedies, he says, Stones, or a kind of a
+    grumous calculous Matter, were always found in the Stools, as
+    the Jaundice was going off. He relates one very particular
+    Case of a Lady of sixty Years of Age, who had had a black
+    Jaundice for twelve Years, and was cured by continuing the
+    Use of these Medicines for eighteen Months; during the last
+    six Months of which she had a Looseness, and constantly
+    discharged by Stool a fetid granulated Matter of the Colour
+    of Clay;--and another singular Case of a Man who was cured by
+    living mostly upon Grass, and a Decoction of it, for two
+    Years together. The Man came at last to devour such
+    Quantities of it, and could distinguish the good Sort from
+    the bad so well, that the Farmers often used to drive him out
+    of their Fields. Vol. III. �. 950.
+
+    _Glisson_ tells us, that Cattle are subject to bilious
+    Concretions in Winter, which are dissolved and evacuated in
+    the Spring, when they begin to move much about, and to eat
+    the new Grass, which purges them. _Oper._ vol. II. _Anat.
+    Hepat._ chap. vii. p. 104.
+
+    Dr. _Russel_ greatly recommends the Use of Sea Water along
+    with the saponaceous Medicines. See his _Treatise on the Use
+    of Sea Water_.
+
+The H�morrhage from the Nose commonly stopped soon. Where it was
+violent, we kept the Patient cool, and applied Cloths dipped in
+Vinegar and Water to the Nose.--In two Cases, one at _Munster_, the
+other at _Bremen_, the Patients were hot and feverish, and a Vein was
+opened, and eight or ten Ounces of Blood taken away; and in one Case
+nothing took Effect till we gave repeated Doses of the _tinctura
+saturnina_ in a common acid Julep.
+
+
+
+
+OF TUMOURS of the BREAST.
+
+
+In _May_ 1761, a great many of the Patients, who had been in Hospitals
+the preceding Winter, had Tumours formed on the external Part of the
+Breast, which they shewed me at _Osnabruck_. They began in the Form of
+indolent Tumours, and came slowly to Suppuration. For the most part,
+the Suppuration was only partial, and the Tumour, on being opened,
+discharged a very small Quantity of Matter. Some of them, though they
+felt soft, and seemed to contain Matter, yet, upon being opened,
+discharged only a small Quantity of black Blood. None of them melted
+down entirely into Pus, or came fully to Suppuration, and healed
+kindly as Abscesses which succeed acute Inflammations. But after a
+small Quantity of Matter was discharged, for the most part, there
+still remained a hard Tumour, which felt as if it was a Swelling of
+the Bone, or Cartilage below; and in some the Surface of the Bone was
+found rough at the Bottom of the Abscess.
+
+These Tumours seldom rose high, and were most of them situated at the
+lower Part of the Sternum, or a little to one Side of it, commonly on
+the left Side, above the _cartilago ensiformis_. Some Patients had
+only one, others two, and some three such Tumours. The first of them I
+saw was on the left Side, which, on being felt, gave exactly the same
+Sensation as when the Cartilages of the Sternum are begun to be raised
+by an Aneurism of the Aorta; only no Pulsation was to be perceived;
+and most of them had the same Appearance.
+
+The Patients, who had such Tumours, commonly complained of Pains of
+their Breast. One or two, after these Tumours came to Suppuration,
+seemed to recover their Health, and to feel no Uneasiness, tho' some
+of the Swelling remained: But many of them were inclined to be
+hectic, and seemed likely to grow consumptive.
+
+Being ordered up to the flying Hospital in _June_, and the Sick going
+down to _Bremen_, I had no Opportunity of seeing the Event of these
+Tumours, or of examining the Bodies of those who died with them. One I
+accidentally met with the following Winter at _Bremen_, who died of a
+Consumption and Diarrhoea. He had a large Abscess, which penetrated
+into the Cavity of the Chest, and discharged a great Quantity of very
+fetid Matter, at the Part where one of these Tumours had been seated,
+and the Sternum and Ribs were carious all round the Abscess.
+
+
+
+
+OF PARALYTIC COMPLAINTS.
+
+
+Some of the Soldiers, from lying out in the Nights on the wet Ground,
+and from doing Duty in cold rainy Weather, were seized with a Pain and
+Numbness all over, and lost the Use of their Limbs, which in some was
+succeeded with a Palsy of these Parts: But the greatest Number of
+those afflicted with Paralytic Symptoms were seized with them either
+in Fevers, or after feverish and other Disorders. The Number, who were
+attacked with Complaints of this Kind, were but few.
+
+When Men were suddenly taken with Pain and Numbness all over, we found
+that the best Method of treating them was to put them to Bed, and give
+them Plenty of mild warm diluting Liquors for Drink; and if there was
+much of a Fever, to open a Vein, to give the cooling antiphlogistic
+Medicines, and apply Blisters; and if these Complaints still remained,
+to endeavour to promote a breathing Sweat, by means of Diaphoretics
+and warm Drinks. Several who were brought to the Hospital, soon after
+being seized in this Manner, got well; but in some few, one or other
+of the Limbs would begin to waste, and remain paralytic afterwards.
+
+Those who had the true confirmed Palsy seldom remained long enough
+with us to be cured. Two or three received Benefit from Blisters
+applied to the Parts, and from Issues; drinking at the same time the
+Decoction of the Woods, or of Sarsaparilla, and taking the volatile
+Tincture of Guaiac or Valerian[95], and being sweated by the Use of
+_Dover_'s Powder, or other Diaphoretics.
+
+    [95] On _Wednesday_ the 1st of _February_ 1764, _Margaret
+    Julion_, a Woman between fifty and sixty Years of Age, was
+    admitted into _St. George_'s Hospital for an entire Loss of
+    Speech, which seemed to depend on a paralytic Disorder of the
+    Parts about the Larynx. The Account her Friends who came with
+    her to the Hospital gave of her Case was, that she had been
+    for five Months troubled at Times with Pains of her Bowels,
+    and a Purging; that on _Sunday_ se'night before coming to the
+    Hospital, she had suddenly lost the Use of her Speech, and
+    had not spoke since that Time, though she seemed to hear and
+    understand whatever was said to her. I asked her some
+    Questions, which she answered distinctly by Signs. She had no
+    paralytic Complaint of her Face, Arms, Legs, or any other
+    Part of her Body, and swallowed both Fluids and Solids with
+    Ease. She had no Fever, and seemed to complain of nothing but
+    the Loss of Speech.--A Blister was applied to her Neck, and
+    she was ordered the saline Draughts, with a Scruple of Powder
+    of Valerian in each, to be taken three Times a-day, and a
+    Dose of sacred Tincture, to be taken twice a-Week. She
+    followed this Course for a Fortnight, when another Blister
+    was applied to the Fore-part of the Neck, and the Powder of
+    Valerian in the Draughts was changed for two Drachms of the
+    _tinctura valeriana volatilis_. At the End of three Weeks she
+    could pronounce the two Words _Why_, _What_. She continued
+    the same Course till this Day, the 16th of _March_, and can
+    now pronounce many Words and short Sentences.
+
+One Man of the 51st Regiment of Foot, after doing Duty in very cold
+wet Weather, in the Beginning of the Year 1762, was seized with a
+Palsy of one Side of his Face, which prevented him from speaking
+distinctly, and was an Impediment to his eating. He mended much after
+being blooded, and having a large Blister to his Neck, kept open for
+some time by means of the epispastic Ointment.
+
+
+
+
+OF AN INCONTINENCY of URINE.
+
+
+An Incontinency of Urine was another Complaint frequent among the
+Soldiers; but it seemed to me to be counterfeited by many. All, who
+had it, said that they had received some Hurt[96] or Sprain of the
+Back, or a Kick from a Horse, or that a Carriage had run over them.
+
+    [96] A Soldier in the Hospital at _Paderborn_ used to
+    discharge his Water involuntarily, and mixed with Pus, which
+    came from some violent Blows he had received on the Back.
+
+    _John Pearce_, a young Man about eighteen Years of Age, was
+    admitted into _St. George_'s Hospital, the 10th of _April_
+    1759, for a Pain of his Side, and a Complaint of the Bladder.
+    The Account which he gave of his own Case was, that, some
+    Months before, he had received a violent Blow with a
+    Cricket-Bat on the left Side, on the Region of the Kidney;
+    and that ever since he had had a sharp Pain in that Part, and
+    sometimes had a Stoppage of Urine, and at other Times it came
+    away insensibly. His Pulse was rather quick, but low, and he
+    had a feverish Heat. He at first took some cooling Medicines;
+    but on the 20th, being low and faint, he had some of the
+    foetid Julep. On the 23d he was attacked with a sharp Pain in
+    the Belly and Side, had a Stoppage in making Water, a quick
+    and full Pulse, and most of the Symptoms of the Stone. He was
+    ordered to be blooded immediately, to take the saline
+    Draughts every four Hours; and as he was inclined to be
+    costive, to take as much lenitive Electuary as to procure him
+    a loose Stool; and it was recommended that he should be
+    sounded as soon as the Violence of the Fever was over. On the
+    25th he continued much in the same Way, and had made some
+    Water, which was intolerably foetid. Half a Drachm of the
+    dulcified Spirit of Nitre, and five Drops of the _tinctura
+    thebaica_, were added to each of his Draughts, as the Pain
+    and Difficulty of making Water had increased. On the 26th his
+    Pulse rose, and became very hard and quick; the Pain in his
+    Side, and the Dysuria, became more violent; and about Twelve
+    o'Clock he had a convulsive Fit, resembling that of an
+    Epilepsy; after coming out of the Fit, as the Fever and Pain
+    had increased, he was blooded; the Belly was fomented and
+    embrocated, and he took the oily Draughts four Times a-Day;
+    his Blood immediately threw up a very thick Buff. He remained
+    pretty easy the rest of the Day; but about the same Time next
+    Day, he had another convulsive Fit, and died.
+
+    On opening his Body, we found about two or three Pints of a
+    dark-coloured foetid Water in the Abdomen; on cutting through,
+    and squeezing the right Kidney, there came out a thin
+    purulent Matter every where from its Substance, though it
+    appeared sound; on raising and cutting through the
+    Peritoneum, covering the left Kidney, there was a Discharge
+    of about a Pint of black and very foetid Water, which had
+    every where surrounded this Kidney; and there were six
+    mortified Spots on its Surface, as large as the End of one's
+    Finger, with a Depression in each about a Quarter or Half an
+    Inch deep; most of the Substance of this Kidney seemed
+    diseased, and it was full of Suppurations. The Bladder was
+    contracted and thickened, and contained a rough Stone, which
+    weighed three Ounces. The rest of the _viscera_ were sound.
+    This Stone had certainly been in the Bladder long before the
+    young Fellow received the Blow with the Cricket-Bat; but the
+    Injury done the Kidney had probably aggravated the Symptoms.
+
+    I do not remember ever to have seen convulsive Fits, such as
+    this young Man had, in acute Diseases, except in one Case of
+    a slow Fever, which came by taking Cold after a Salivation,
+    and which I attended, along with Dr. _Pringle_. The Gentleman
+    had three Fits exactly of the same kind as this young Man, at
+    twenty-four Hours Distance from one another, and he died of
+    the third.
+
+Those who really had the Disorder seemed to have received such an
+Injury of the Bladder, or Kidneys as required a considerable Space of
+Time to get the better of; and by reason of the short Time we had them
+under our Care at the flying Hospital, they seldom received much
+Benefit. One or two thought they grew better on taking the Bark and
+Balsam of _Peru_; at the same Time they bathed Morning and Evening the
+lower Part of the Abdomen and Perin�um, with Flannels dipped in gentle
+astringent Liquors, applied cold. Blisters applied to the _os sacrum_
+had no Effect.
+
+
+
+
+OF A STOPPAGE of URINE.
+
+
+We formerly mentioned, that in acute Diseases many complained of a
+Stoppage or Difficulty of making Water; and others had this Complaint
+from Strictures of the Urethra, or Disorders of the Bladder or
+Kidneys[97].
+
+    [97] It is often very difficult to judge of the Cause, or to
+    be able to determine exactly the Seat of these Disorders
+    before Death; as the following Cases will shew.
+
+    _John Waden_, a middle-aged Man, was admitted into _St.
+    George_'s Hospital the 10th of _April_ 1759, for a Swelling
+    of the Abdomen, and a Difficulty of making Water, which he
+    said begun about two Months before, with a violent Pain in
+    his Back and Belly, occasioned by his being employed in
+    making of Cyder in a very cold Cellar. He had not had a Stool
+    for some Days: at first he took a Dose of Physic, and some of
+    the saline Draughts; but in a Day or two complained that his
+    Belly had grown to a monstrous Size, and that he had not made
+    Water for above twenty-four Hours; on examining, we found the
+    Bladder so much distended as to reach up to the Navel; and
+    upon a Catheter's being introduced, above two Quarts of Water
+    were drawn off, and the Swelling immediately subsided; but in
+    the Afternoon was as large as before, the Bladder seeming to
+    be in a paralytic State. During the Months of _May_ and
+    _June_, his Water was drawn off twice a-Day; he had his Belly
+    fomented with emollient, astringent, and other Decoctions,
+    and embrocated with Liniments; was blooded once when
+    feverish, took Cordials, the Bark, Myrrh, and a Variety of
+    Medicines, without any Effect. On the 3d of _July_, a
+    flexible Catheter was introduced into the Bladder, and left
+    there, in order that the Urine might drain away as fast as it
+    was secreted, and the Bladder be allowed to contract, and
+    recover its Tone. The Catheter gave him no Pain, and he
+    thought himself much easier by the Bladder's never being too
+    much stretched; but on taking out the Catheter some Days
+    after, he had the same Stoppage of Water as before. On
+    consulting with Dr. _Batt_ and the other Physicians, it was
+    agreed to give two Grains of the Powder of Cantharides, with
+    three Grains of Camphor and ten of Sugar, rubbed well
+    together in a Mortar, twice a-Day; and to continue the Use of
+    the flexible Catheter. He found no Uneasiness or Strangury
+    from the Use of the Cantharides, and thought he passed his
+    Water more freely, when the Catheter was taken out; but after
+    fourteen Days, finding no Change for the better, and being
+    free from any Fever, he was ordered into the cold Bath; the
+    two first Days he found himself more lively and brisk; but
+    the third Day was chilly and cold after coming out of it, and
+    therefore was desired to leave it off; some Days after he
+    became hectic, and I observed Pus in his Water, which he said
+    he had passed with his Urine for above three Months; after
+    this he languished for near a Month, and died upon the 25th
+    of _August_.--Upon examining his Body next Day, we found the
+    thoracic Viscera in a sound State, except that the Lungs
+    adhered a little on the right Side. Both Kidneys were
+    diseased; they were inflamed, and seemed enlarged; and on
+    cutting them, had Tubercles dispersed every where through
+    their Substance, which had come to Suppuration, and contained
+    a good deal of Matter; the lower Part of the left Kidney was
+    mortified, and contained two or three Ounces of a black foetid
+    Liquor. The Bladder of Urine was contracted, and its Coats
+    greatly thickened, and the internal Coat much inflamed; and
+    there was a Cyst full of Matter, about Half the Size of a
+    Walnut, between the muscular and villous Coats, towards the
+    lower Part of the right Side of the Bladder; and there were
+    two large Cysts, containing a small Quantity of Matter,
+    though capable of containing near two Ounces each; one
+    situated between the _vesicul� seminales_ and Rectum, the
+    other between the _vesicul�_ and Bladder, which opened into
+    the Urethra by one common Orifice, capable of admitting a
+    large Quill, at the Side of the _caput galinaginis_. The rest
+    of the Viscera were in a sound State.
+
+    _Mary Hibbard_, a Woman twenty-four Years of Age, was
+    admitted into _St. George_'s Hospital, the 6th _June_ 1759,
+    for a Complaint of her Bladder. The Account she gave of
+    herself was, that, about _Christmas_ 1758, she had parted
+    with some Gravel; and about fourteen Days before coming to
+    the Hospital, she was seized with a violent Pain in her Back
+    and Loins, attended with a Sickness and Nausea; and very soon
+    after complained of a violent Pain in the lower Part of her
+    Belly, and with a perpetual Inclination to make Water, though
+    she felt a sharp Pain and Difficulty in doing it; and that
+    these Complaints still remained. Her Pulse was quick and
+    strong, and she was inclined to be costive. She was
+    immediately blooded, took the oily Draughts three Times
+    a-Day, the _decoctum furfuris_ for common Drink, and so much
+    lenitive Electuary as procured her a Stool next Day. As there
+    was a strong Suspicion of her having a Stone, she was
+    sounded; but nothing at all was to be felt in the Bladder.
+    Her Medicines eased her Pain in making Water, but not the
+    Pain in her Back. On the 16th her Water was thick and turbid,
+    and deposited a brown Sediment; and the Difficulty in making
+    Water still remained; instead of the lenitive Electuary she
+    was ordered the Rhubarb oily Draught to be taken every Night.
+    On the 18th, there being no Change in her Disorder, she had
+    Draughts made of an Ounce and a Half of simple Mint Water,
+    Half a Drachm of the dulcified Spirit of Nitre, and five
+    Drops of the _tinctura thebaica_, and Syrup three Times
+    a-Day; but on the 22d she complained, that since she left off
+    the oily Medicines, her Pain and Difficulty in making Water
+    had grown worse; she was therefore ordered the saline and
+    oily Draughts alternately, and to take the Rhubarb oily
+    Draught occasionally when costive, which removed these
+    Complaints; and they did not return while she remained in the
+    House; but on the 4th of _July_, the Day before she was to
+    have been discharged as cured, she was attacked with a sharp
+    Pain in her Hip and Loins, and about the _os coccygis_; which
+    increased till the 9th, and extended itself all along the
+    Outside of the right Thigh; it was most acute about the _os
+    coccygis_; but on examining, nothing was to be observed
+    externally: This Pain continued more or less all that Month,
+    and till the End of the next, and so obstinate as not to be
+    altered by bleeding, and the Use of Liniments, Blisters,
+    cooling Medicines, Opiates, warm Baths, and other Remedies.
+    On the 20th of _August_, a strengthening Plaister was applied
+    to her Back, which gave immediate Relief, and she was
+    discharged cured the 29th. She continued well till _October_,
+    when she was attacked with a violent Fever at _Hounslow_, and
+    was brought to the Hospital on the 24th of that Month, and
+    the tenth Day of the Fever. She died the 3d of _November_.
+    During the Course of the Fever, she only complained once of a
+    Difficulty of making Water.--After Death I had her Body
+    opened, when the only Thing particular which we could
+    observe, was the urinary Bladder about four times the natural
+    Size; it seemed to be flaccid, and in a State of Relaxation;
+    the Kidneys were sound, and no Signs of any Distemper could
+    be observed about the Uterus or Rectum, or near the _os
+    coccygis_.--When she was first in the Hospital, I desired her
+    always to examine her Urine; but she never observed that she
+    passed any Sand, Gravel, or any thing of that kind.
+
+    _Thomas Jacey_, an elderly Man, was admitted into _St.
+    George_'s Hospital the 14th of _March_ 1759, for a Pain in
+    his Back, and a Difficulty and Pain in making Water, which
+    was often mixed with grumous Blood; but he had never observed
+    any Sand or Gravel in it. His Pulse was quick and full,
+    attended with Heat and Thirst; and he was inclined to be
+    costive; he was at first blooded, and took a Dose of laxative
+    Mixture, and two Ounces of the Tincture of Roses, four Times
+    a Day, and the _decoctum malv�_ for common Drink. At first he
+    seemed relieved, and passed no grumous Blood for some Days;
+    but on the 26th, as he complained much of a Pain in making
+    Water, the Tincture of Roses was changed for the oily
+    Draughts, and he was ordered the Rhubarb oily Draught
+    occasionally. On the 9th of _April_ he fell suddenly into a
+    comatose Way, and remained so till the 12th, when he died,
+    notwithstanding the Use of divers Remedies.--Upon examining
+    his Body, both Kidneys were found in a sound State; the
+    Intestines covered with slight inflammatory Spots, the
+    Bladder of Urine quite contracted, schirrhous, and greatly
+    thickened; and its internal Surface rough and eroded, with
+    one or two black Spots on it, and some grumous Blood lying on
+    its Surface. The other viscera were sound.
+
+    In Ulcers of these Organs, the natural Balsams, mixed with
+    soft Things, are often of great Service; of which the
+    following Case is an Example.--_William Lumley_, a Boy nine
+    Years of Age, was admitted into _St. George_'s Hospital, the
+    6th of _September_ 1759, for a Pain in the Bladder, and a
+    Difficulty in making Water, which was always more or less
+    mixed with Matter. At first there was a Suspicion of his
+    having the Stone; but on sounding, none was to be found. From
+    the Symptoms, it appeared as if there was an Ulcer in the
+    Bladder near to its Neck; the Boy had a Cough, was very low,
+    and inclined to be costive; at first he took three Spoonfuls
+    of the Sperma Ceti Mixture four Times a-Day, and a Dose of
+    Physic; but the Symptoms still remaining, on the 2d of
+    _October_ he was ordered to take a Scruple of the
+    _electuarium e spermate ceti_ three or four Times a Day, and
+    to have the Gum-Arabic Decoction for his common Drink. By
+    continuing the Use of these Things, and taking some opiate
+    and laxative Medicines occasionally, he mended by slow
+    Degrees, and all his Symptoms went off; and he recovered his
+    Health and Strength, and returned Thanks for his Cure the
+    18th of _January_ 1760.
+
+    The following Account of a remarkable Suppression of Urine I
+    had in a Letter, dated the 25th of _November_ 1757, from Mr.
+    _Pearson_, one of the Surgeons to his Majesty's Military
+    Hospitals, who then served as a Mate.
+
+    _James Ruffendal_, aged Twenty, of a delicate Habit, was, in
+    the Middle of _July_ last, seized with a violent Pain in both
+    Kidneys, which extended along the Ureters to the Bladder, and
+    remained in the same Situation for about three Weeks; during
+    which Period his Urine began to decrease in Quantity, and the
+    voiding of it was attended with acute Pain about the Neck of
+    the Bladder. The Secretion then totally stopt; he remained
+    for upwards of five Weeks in the Hospital at _Dorchester_,
+    and made no Water; at the End of which Time I first visited
+    him along with Mr. _Adair_. He complained then of a slight
+    Pain in his Kidneys, and told us he had a tolerable Appetite,
+    sweated little, and voided every Day four or five Liquid
+    Stools. He was ordered Boluses of Camphor, and _sal. vol. c.
+    cervi_, and every Night a Dose of _tinctura cantharidum_;
+    which he continued to take for a Fortnight without receiving
+    the least Benefit. I then blooded him to the Quantity of ten
+    Ounces, and gave him an Emetic of six Drachms of the _vinum
+    ipecacoanh�_, and two Ounces of the Oxymel of Squills, which
+    operated very well; and afterwards ordered him to take one of
+    the following Boluses every four Hours. Rx Sapon. dur. Hispan.
+    drachm. i. Sal. Absynth. gr. vi. Calc. Viv. gr. x. Balsam.
+    Peruv. q. s. ut fiat Bolus. These he continued to take for
+    twelve Days. On the Morning of the 14th of _October_, he was
+    suddenly seized with an acute Pain in both Kidneys, and about
+    Noon voided upwards of Half a Pint of straw-coloured Urine,
+    which let fall a clay-coloured Sediment. As he was feverish,
+    I took away twelve Ounces of Blood, and ordered him
+    Barley-Water with Nitre for Drink. He was easy in the Night,
+    and made upwards of two Pints of Urine, which deposited a
+    Sediment of a gelatinous Consistence. Next Morning the Pain
+    increased, especially in his Right Side, and ten Ounces more
+    of Blood was taken away. This lowered the Pulse, and
+    considerably abated the Pain. Both this and the Blood taken
+    away the Day before threw up an inflammatory Buff. He was
+    ordered to continue the Use of the Barley Water with Nitre,
+    and to take three Spoonfuls of a Mixture with _spiritus
+    mindereri_ every two Hours. He had an easy Night, and was
+    next Day free from Fever; but complained of an Uneasiness in
+    his Stomach and Nausea. He was ordered a Scruple of the
+    Powder of Ipecacoanha, which vomited him, and procured him a
+    Stool. He was easy in the Night; but in the Morning was hot,
+    and complained of a Pain in his Right Kidney, and all over
+    his Bones, as he expressed it. I then gave him a Mixture,
+    with _spiritus mindereri_, and the _pulvis contrayerva comp._
+    of which I desired him to take some Spoonfuls frequently.
+    This procured him a plentiful Sweat, which removed the Fever
+    and Pain: these Symptoms returned next Day, but were removed
+    by the same Means. I remained at _Dorchester_ for a Week
+    after, and he recovered his Strength and Appetite as much as
+    could be expected in so short a Time; but he still complained
+    of Pain in his Right Kidney, tho' he made Water freely. By a
+    Letter I received from the Gentleman whose Care I left him
+    under, I understood he had a Relapse, which he has since got
+    the better of.
+
+    I forgot to inform you, that his Father died of the same
+    Complaints, after being six Months without secreting a Drop
+    of Urine; and his Brother died of the same in about ten
+    Weeks.
+
+Where it depended on Strictures of the Urethra, Bougies introduced
+into that Passage, and worn for some Time, were of great Service. The
+Patients were at the same time ordered to live on a cool Diet, and to
+drink the _decoctum Arabicum_, or an Infusion of Linseed, or such
+other mild mucilaginous Liquors; and to take oily Medicines and
+Opiates occasionally, and gentle Laxatives, to keep the Body open;
+which Method of Treatment generally gave Relief. Where the Patients
+were plethoric, or complained of Pain, or the Disorder was attended
+with a Fever, Bleeding was often necessary.
+
+When the Stoppage of Urine seemed to arise from an Inflammation of
+the Kidneys or Bladder, or other Diseases of these Parts, we treated
+it accordingly; and where the Fever was considerable, we made
+Evacuations, and gave plenty of diluting Liquors, and the cooling
+saline Medicines, and afterwards those of the soft, mucilaginous, and
+oily Nature, and mild Diuretics and Opiates.
+
+When the Disorder, in its Progress, became chronical, the Sick were
+commonly sent down to the fixed Hospital, so that we had no
+Opportunity of examining the Bodies of such as might die of this
+Complaint.
+
+
+
+
+OF THE EPILEPSY.
+
+
+The Epilepsy, or Falling Sickness, attacked a Number of Men, from the
+severe Duty of long Marches in hot Weather, and afterwards lying out
+on the cold Ground, exposed to the Damps of the Night[98].
+
+    [98] I saw above twenty Men, while I was in _Germany_, who
+    attributed the Epileptic Fits they were attacked with to
+    these Causes, and said they had never had the Epilepsy
+    before; besides others, who had been formerly subject to
+    these Fits, who declared, that the Disorder was brought back
+    by the same Means.
+
+It was very seldom that Men were cured of this Disorder in the
+military Hospitals. We had some few Instances, indeed, where Relief
+seemed to be obtained by Rest, a regular Diet, gentle Evacuations,
+and Issues[99]; but even those Men generally relapsed as soon as they
+were sent to their Regiments, and began to do Duty. All who had these
+Fits after being some Time with their Regiments, were at last
+discharged, and sent home. However, before Men are discharged for
+Fits, they should be watched very narrowly for some Time; for there is
+no Disorder which Soldiers are more apt to counterfeit than this.
+
+    [99] _William Wilson_, a Boy fourteen Years of Age, was
+    admitted into _St. George_'s Hospital, _Sept._ 20, 1758, for
+    Epileptic Fits, which he had been subject to for some Time,
+    and which generally seized him three or four Times a Week. He
+    took Variety of Medicines without any Effect till the 6th of
+    _November_, when I ordered him to take eight Grains of the
+    _pilul� foetid�_ Morning and Evening, and Physic twice a Week,
+    and a Seton to be made in his Neck. After the Seton began to
+    run, he had but three or four slight Fits in _November_, and
+    none the following Month; and he was discharged the Hospital
+    the 3d of _January_ 1759, seemingly in good Health, with
+    Directions to keep the Seton running at least for some Months
+    after he went home, and to come again to the Hospital if he
+    should have any Return of his Fits; but we never heard more
+    of him.
+
+    _Mary Hacket_, a Girl of nineteen Years of Age, was admitted
+    into _St. George_'s Hospital the 14th of _February_ 1759, for
+    Fits. The Account she gave of her Case, was, that about five
+    Years before she was seized with the first Fit, after a
+    Fright; three Years afterwards she had a second Fit, and for
+    some Time after had a Fit commonly once a Month, about the
+    Time of the full Moon; and since had them more frequently;
+    that the Fits began with a Trembling and Shaking of the right
+    Foot, and she had frequent pricking Pains in the right Thigh,
+    and what she called convulsive Tremors in the right Leg and
+    Foot. She was regular in her menstrual Discharge. At the Time
+    she came into the Hospital, she was feverish, and complained
+    much of a sharp Pain in the right Thigh: She was blooded, and
+    took some cooling Medicine, and had no Fit till the 9th of
+    _March_: She then took the fetid Pills and camphorated Julep
+    twice a Day; but still the Fits returned frequently. She then
+    had the Bark, Valerian and Purging Doses successively, and
+    used the warm Bath; but without any Effect. On the 7th of
+    _May_ a Blister was applied to her right Foot, which was
+    intended to be kept open; but an Inflammation coming on that
+    Leg and Foot, it was suffered to dry up, and an Issue made in
+    the same Leg. From the Time the Blister was applied, she had
+    no Fit while she remained in the Hospital. She was discharged
+    the 15th of _July_, seemingly in good Health; though during
+    that Period she had some little Tremors in her Foot, and was
+    subject to be low and faintish, which was always relieved by
+    cordial anodyne Medicines. After going out of the Hospital,
+    she remained in good Health for seven or eight Months, when I
+    was told her Disease had returned as violent as ever.
+
+It is no Wonder that Soldiers, during the Time of Service, should
+seldom be cured of these Fits; for in Adults it is not often cured
+even in private Practice, with all the Conveniencies and Advantages
+to be wished for; and generally the few that do get well, require a
+considerable Length of Time to accomplish the Cure; and we find from
+daily Experience, as well as from examining the Records of Medicine,
+that the Cures that have been made, have mostly been performed either
+by a Change of Air, such as going from a cold to a hot Climate[100],
+by some remarkable Change of Life[101], or some accidental
+Disorder;[102] or by Issues or Drains[103]; or by the Removal of some
+acrid or irritating Substance, or such like[104]; or by preventing
+the Cause[105]; and that those Medicines called Specifics have in
+general had but little Share in the Cure.
+
+    [100] _Hippocrates_ lays the chief Stress of the Cure upon
+    Change of Air, Aphor. 4, 5, sect. ii. The Baron _Van Swieten_
+    says, he has known a great Number cured by going to the _East
+    Indies_; many of whom have remained well ever after, while
+    others had a Return of the Disorder when they came back to
+    _Holland_. _Comment._ vol. III. p. 436. sect. 1080.
+
+    [101] _Celsus_ has long ago observed, that the Appearance of
+    the Menses in Girls, and of Puberty in Boys, often removes
+    this Disorder, lib. iii. cap. xxiii.--On the 22d of
+    _November_ 1758, _Mary Evans_, a Girl of eighteen Years of
+    Age, was admitted into _St. George_'s Hospital for Fits. She
+    had never had the Menstrua; but, for above two Years, found
+    regularly, once a Month, a Fulness in her Breasts, and had a
+    slight Head Ach, and other Symptoms which generally precede
+    this Discharge; and were succeeded with violent Epileptic
+    Fits, which continued returning frequently for two or three
+    Days, and then went off; and she had no more Symptoms of
+    them, till about the same Time next Month. She was ordered to
+    take ten Grains of the _pilul� foetid�_ Morning and Evening,
+    and a Dose of Physic twice a Week; and as I found that she
+    became plethoric near the Time her Fits used to return, I
+    began to imagine, that both the Fits and Stoppage of the
+    Menstrua were owing to too great a Fullness of the Vessels,
+    which prevented the Heart and vascular System from having
+    such free Play, as to drive the Blood through the extreme
+    uterine Vessels: I therefore ordered seven Ounces of Blood to
+    be taken away from her immediately. In three Days Time the
+    menstrual Discharge began to make its Appearance; and on the
+    10th of _January_ she was discharged the Hospital, seemingly
+    in good Health, after the menstrual Discharge had returned
+    for two regular Periods, without any Appearance of Epileptic
+    Fits. She was desired to come back to the Hospital, if the
+    Fits returned; but I never heard more of her.
+
+    [102] _William Glen_, a Patient in the _Royal Infirmary_ at
+    _Edinburgh_ in _September_ 1747, was freed from Epileptic
+    Fits, which used to return ten or twelve Times a Day, for a
+    Quarter of a Year, by a Diarrhoea coming on; but they
+    afterwards returned.
+
+    _A Man_ subject to the Epilepsy was cured of it by a Quartan
+    Ague, and had afterwards no Return of the Disorder. _Miscell.
+    Curios. Dec. 3. Ann. 3._ p. 34.
+
+    [103] There are numerous Instances of the good Effects of
+    Issues and Drains in diverse Authors. _Tulpius_, _Van
+    Swieten_, &c.
+
+    [104] _La Motte_ gives one Instance of a Person being cured
+    of the Epilepsy by voiding five Stones, _Chirurg._ vol. II.
+    p. 20; and of another who died of the Fits from a triangular
+    Stone remaining in the Kidneys, _ibid._ p. 416. Dr. _Short_
+    cured a Woman of an Epilepsy of twelve Years standing, by
+    extirpating a cartilagenous Substance, about the Bigness of a
+    large Pea, seated on the gastronemei Muscles, above a Nerve
+    which he cut asunder. _Edin. Medic. Essays_, vol. IV. Art.
+    27.
+
+    [105] _Galen_, tells us, of his having prevented the
+    Epileptic Fits in a Boy, who used to have one whenever he was
+    hungry, by making him carry Bread in his Pocket, and eat a
+    little as soon as he found the least Symptoms of Hunger. _De
+    Loc. Affect._ lib. v. cap. vi.--And _Van Swieten_ mentions
+    how he cured a Boy, who had a Fit every full Moon; whose
+    under Lip used to fall a Trembling before it began (a Symptom
+    which, he says, often precedes Vomiting); by giving a Vomit
+    every Month, for six Months successively, three Days before
+    the full Moon, and an Opiate in the Evening after its
+    Operation; and by putting him under a Course of strengthening
+    Medicines. It was observeable, that if he vomited in the Time
+    of the Paroxysm, it was soon at an End. See his _Comment._
+    vol. III. p. 439. sect. 1050.
+
+
+
+
+OF THE SMALL-POX.
+
+
+The Small-Pox appeared at _Paderborn_ in the Spring 1761, and five had
+the distinct Kind, who recovered. Six or seven had them at _Osnabruck_
+in _May_ and _June_, and one Man and a Child died of the confluent
+Kind. Four had the distinct Kind at _Munster_ in _July_ and _August_
+who all did well. During the Winter, we had sixteen in the Hospital I
+attended at _Bremen_; ten had the distinct Kind, and all recovered;
+five had the confluent Kind, of whom two died; as did also one who was
+brought to the Hospital with all the Symptoms of the most malignant
+Kind. Two were sent to _Natzungen_ in _July_, both ill of the
+confluent Kind; the one died two Hours after his Arrival; the other
+recovered: And we had only two in the Hospital at _Osnabruck_ in
+Winter 1762-63, and both did well.
+
+There was nothing particular either in the Course or Treatment of this
+Disorder, different from what we meet with in daily Practice; only as
+the Soldiers, who were attacked with it, were strong, and in full
+Health, they required Bleeding and gentle Evacuations, and a cooling
+Regimen, on the first Appearance of the Symptoms.
+
+The malignant Kind required the Use of Acids, and the Bark; which
+last, could often only be administered by Way of Clyster, as the Sick
+could not swallow it: In short, we treated the Patients much in the
+same Way as in the malignant Fever, Allowance only being made for the
+present Circumstances.
+
+Luckily this Disorder never spread much in the Army, while I was in
+_Germany_.
+
+
+
+
+OF ERISYPILATOUS SWELLINGS.
+
+
+In _January_ 1762, several Patients in the Hospitals I had the Care of
+at _Bremen_, had shining watery Swellings of the Face, or Extremities;
+which came suddenly, and were attended with a slight Degree of
+Inflammation, and watery Blisters rising above the Skin, and some
+Degree of Fever. The Blisters were not small, round, and angry, as in
+_St. Antony_'s Fire; but larger, and of an irregular Figure,
+resembling those raised when People are scalded by boiling Water. The
+Swellings did not pit on being pressed, as the oedematous Swellings
+commonly do: They gave Pain when pressed, but the Inflammation was not
+in that high Degree as it is in the common Phlegmon: The Blood was
+sizy, and the Water of a high Colour. The Disorder seemed to be a
+Species of the Erisypelas.
+
+Between the 9th and 12th of _January_, three Patients were seized with
+such Swellings.
+
+The first was a Dragoon, who had just recovered from a Flux, and a bad
+Cough. On the 9th, he was suddenly seized in the Night with a large
+Swelling of his Face, Hands, and Arms, which had a shining oedematous
+Appearance, with a small Degree of Redness, and was painful when
+pressed; and he had two or three watery Blisters rose on the Back of
+each Hand above the Division of the Fingers, attended with a quick
+full Pulse, a feverish Heat and Thirst, a Cough, and somewhat of a
+Difficulty of Breathing, and high-coloured Water; and he was inclined
+to be costive. He was immediately blooded, had a saline Mixture with
+Contrayerva and Nitre, and was ordered to take a Purge in the Morning.
+Next Day the Blood had thrown up an inflammatory Buff, the Fever was
+abated, and the Breathing easier; but the Cough and Swelling still
+remained. He then took a Julep made of equal Parts of the Saline and
+Sperma Ceti Mixtures, which eased the Cough. The fourth Day the Pulse
+was soft, and the Swellings still in the same Situation, and the
+Breathing a little affected. A large Blister was applied to his Back,
+which discharged plentifully, relieved the Breathing, and lessened the
+Swellings considerably. The Cough and some Degree of Swelling still
+remained; but were removed by the Use of the Sperma Ceti Mixture with
+Oxymel, gentle Opiates, and some Doses of Physic.
+
+The second was a Man of the Twentieth Regiment of Foot, who had been
+some Months in the Hospital for a hectic Complaint; he was taken ill,
+the same Night as the Dragoon, with a Swelling of his whole Face,
+particularly the Lips, which had a shining watery Appearance, and a
+slight Degree of Redness, attended with a strong Fever; and was cured
+by Bleeding, Purging, the Use of the saline Medicines, and the
+Application of a Blister.
+
+The third was an Invalid, who had been admitted for a pleuritic
+Complaint, which he had got the better of. He was attacked, the second
+Night after the other two, with a shineing, watery, reddish Swelling,
+of his right Hand and Arm, up as far as the Joint of the Shoulder;
+four large watery Bladders likewise appeared on the fore Part of his
+Arm, above the Joint of the Elbow. Bleeding, with the cooling
+Medicines, and two Doses of Salts, carried off the Fever, and lessened
+the Swelling, in about seven Days Time; but a little of it, with a
+Stiffness, still remained; which at last was removed by the Use of
+aromatic Fomentations, rubbing with the _linimentum saponaceum_, and
+taking two Doses of Physic.
+
+Within less than a Fortnight, five or six more were seized with
+Swellings of the same Kind on some of the Extremities, and all got
+well by nearly the same Treatment; excepting one Man, who was in a
+very low State, and had a large deep Ulcer on his Hip, where there had
+been a Mortification from his lying on that Part in a Fever. The
+Swelling at first seemed to give Way; but on the third or fourth Day,
+having got a severe Cough, the Swelling increased, and the
+Inflammation began to look livid, and the Discharge from the Sore to
+look bad; and, notwithstanding various Means were used, a
+Mortification of the Part came on, and he died the seventh Day.
+
+
+
+
+OF THE SCURVY.
+
+
+The true Scurvy, attended with spungy fetid Gums of a livid Colour,
+with livid Blotches, and Ulcers of the Legs, and other Symptoms, began
+to shew itself at _Bremen_ in _January_ 1762; tho' we had not the
+least Appearance of this Disorder in the Hospitals at any other Place,
+while I was with the Troops in _Germany_.
+
+A great Variety of Disorders have been called by the Name of Scurvy:
+and the Disease has been divided into hot and cold; into the Acid, the
+Alcaline; and the Muriatic, according to the different Fancies of
+Authors, and the Causes they imagined it took its Rise from; but, from
+later and more accurate Observations, Dr. _Lind_ has justly remarked,
+that the true Scurvy has been found to be the same in all the
+different Parts of the Globe, and to take its Rise from similar
+Causes; from Cold and Moisture, and living much upon salted
+Provisions, joined to a Want of fresh Vegetables, and of good generous
+fermented Liquors; and hence it is most frequent in low marshy Places
+in northern Climates, where there is a Scarcity of fresh Vegetables;
+and where the Inhabitants live much upon salted Provisions in Winter;
+and aboard of Ships in long Voyages or Cruizes, especially in the
+northern Seas; and hence this Disorder was so frequent at _Quebec_ the
+first Winter it was in our Possession; and in some of the other Forts
+in _North America_, which were taken so late in the Year, that the
+Troops had not sufficient Time to lay in a Stock of Vegetables, and of
+fresh Meat to be preserved by the Frost[106]; but were obliged to live
+mostly on Ship Provisions.
+
+    [106] In _Quebec_, and other northern Parts of _North
+    America_, as soon as the Frost sets in, they kill their Meat
+    intended for their Winter Store, and hang it up: It soon
+    freezes, and will keep in this Manner all through the Winter.
+    They preserve Vegetables in the same Way; and when they
+    intend to make Use of either, they put so much as they want
+    into cold Water for some Time, which draws the Frost out of
+    it; and then they boil or roast it, as they think proper.
+
+It is observed, both at Sea and Land, that where the Scurvy rages,
+those People are least subject to it who are well cloathed; who live
+in dry Habitations, or lie in dry Births; who take proper Exercise,
+without being too much exposed to the Inclemency of the Weather; and
+who live well, and drink good Beer, Cyder, or Wine; as has been
+remarked by Dr. _Pringle_, Dr. _Lind_, and others.
+
+At _Bremen_ the Disorder was only observed among the Soldiers; not one
+of the Gentlemen belonging to the Hospital, or to the Commissariate,
+nor one of the military Officers, not even of the Serjeants, having
+the least Symptom of it. The Reason of its being frequent among the
+Soldiers was, that the Place is situated on a Plain naturally very
+damp; and the Soldiers were quartered in very low damp Houses; at the
+same Time, no Vegetables or Greens were to be bought in the Market;
+and fresh Meat, and other fresh Provisions, were at so high a Price,
+that the Soldiers could not afford to buy them; but were obliged to
+live on salted Meat, and salted Herrings, during the Winter; and what
+little Money they had remaining, they laid out on spirituous Liquors,
+which were sold cheap.
+
+The Cure of this Disorder requires--living in a dry comfortable
+Place--good Cloathing--light Food of easy Digestion, such as good
+Bread, Panado, Milk, Whey, Broths made of fresh Meats--white Meats,
+with Greens, or other Vegetable, &c.--the Use of Liquors of the acid
+or acescent Kind, or the moderate Use of Beer, Cyder, good Wine, or
+weak Punch[107]--And, by Way of Medicine, gentle Purges, mild
+Diaphoretics; the free Use of acid or acescent Fruits, Lemons,
+Oranges, Apples, Pears, Currans, Grapes, &c. and of the antiscorbutic
+Plants and their Juices, as Succory, Endive, Water-Cresses,
+Scurvy-Grass[108], &c. on which a great Part of the Cure principally
+depends; and the Use of some of the strengthening Bitters[109], of
+which the Bark is not the least efficacious.
+
+    [107] The free Use of raw Spirits is found to be very
+    prejudicial; but a moderate Quantity of these Spirits,
+    diluted with Water, and acidulated with Lemons or Oranges (or
+    with Cream of Tartar, or Tamarinds, when the former cannot be
+    got), and made into Punch, is found to be a good
+    Antiscorbutic.
+
+    [108] Most ripe Fruits, particularly Lemons and Oranges, and
+    esculent Herbs, and many Kinds of Roots, such as
+    Horse-Radish, Onions, Leeks, and many others, have been found
+    the most useful Remedies in the Cure of the Scurvy.
+    Decoctions and Infusions of Fir-Tops, of Spruce, and of other
+    Species of the Pine-Tree; and Beer made of these Infusions,
+    by fermenting them with Molasses, are approved
+    Antiscorbutics: and when such Remedies cannot be got,
+    Infusions of the common Bitters, and weak Punch, made with
+    Tamarinds or Cream of Tartar, have proved serviceable; and
+    where these Acids cannot be had, the Mineral Acids may be
+    used for acidulating the Drink. However, it ought always to
+    be remembered, that fresh Vegetables and Fruits, and
+    vegetable Acids, produce much better Effects in the Scurvy,
+    than any other Sorts of Remedies; and ought always to be
+    used, when they can be got.
+
+    [109] Most of the common Bitters have been strongly
+    recommended in this Disorder, Gentian, Trifoil, Wormwood,
+    &c.--as likewise aromatic Bitters and Aromatics; such as
+    _calamus aromaticus_, Carvi Seeds, Winters Bark, Cinnamon,
+    and many others.
+
+Bleeding is seldom requisite, except where there is much Heat or
+Fever; or a sharp Pain of the Side, or Difficulty of Breathing, or
+some Symptom of the like Kind; it is then sometimes necessary to take
+away some Blood: And in obstinate Cases, it is often found of Use to
+promote Sweats, by making the Patient, while in Bed, drink freely of
+warm Whey, or Sack Whey, mixed with the scorbutic Juices; or warm
+Barley Water, or the like, mixed with a small Quantity of the
+Antimonial Wine, or some other mild Diaphoretic.
+
+And where the Patient is strong, and there is no Danger of
+H�morrhages, warm aromatic Baths have sometimes been found
+serviceable; but they are not to be used where the Patient is weak.
+
+The first Time I saw this Disorder at _Bremen_, was in an old Invalid,
+_James Long_, who had come from _Bristol_ to _Embden_, and from thence
+to _Bremen_. He was some Weeks in the Hospital before I discovered his
+Disorder to be the Scurvy. He at first complained only of great
+Weakness, and such a Giddiness, when he got out of Bed, that he could
+not walk, and of what he called flying rheumatic Pains of his Legs.
+He had no other visible Complaint; all which, I imagined, proceeded
+from Old-Age, and being worn out in the Service. At last, on the 25th
+of _January_, he complained of his Gums being sore; and, on examining
+him, I found his Breath fetid, his Gums swelled, soft, and spungy, his
+Legs covered with scorbutic Blotches, and other Symptoms, which
+evidently proved his Disorder to be the true Scurvy.
+
+Upon which, I ordered him a low Diet, with the Addition of Greens for
+Dinner, and a Quart of Lemonade, with a Gill of Brandy in it, _per_
+Day, for his common Drink; and, by Way of Medicine, a Decoction of the
+Bark, with the Elixir of Vitriol; and, at the same Time, ordered his
+Gums to be scarified, where they were most swelled and spungy; and to
+be washed frequently with an astringent Gargle; and to be rubbed now
+and then with burnt Alum[110]. By these Means, in a Fortnight's Time,
+his Gums became firmer, and his scorbutic Symptoms decreased. During
+that Course he took cold, and had a Stitch in his Side, for which he
+was blooded. The Blood threw up a very thin Buff, which was not of a
+firm Consistence[111]; the Crassamentum below was of a blackish
+Colour and of a loose Texture, and the Serum in a large Proportion. By
+the 2d of _March_ his Gums had recovered their natural Firmness and
+Texture, and the scorbutic Spots and Pains of the Legs were gone, and
+he had recovered his Strength; the only remaining Complaint was a
+little Swelling about the Ankles, for which he continued the same
+Course, and took a Dose or two of Physic. By the 16th of _March_ all
+these Symptoms were gone, and he was dismissed the Hospital free from
+all Complaints. I saw him well the last Week in _May_; and he told me,
+he had had no scorbutic Symptom since he left the Hospital.
+
+    [110] Dr. _Lind_, who has wrote one of the best Treatises on
+    this Disorder, and who had a great Deal of Practice himself,
+    says, "When first the Patient complains of an Itching and a
+    Spunginess of the Gums, with loose Teeth, either a Tincture
+    of the Bark in Brandy, or aluminous Medicines, will be found
+    serviceable in putting a Stop to the Beginning Laxity of
+    these Parts." When the Putrefaction increases, he recommends
+    the Use of some of the mineral Acids. See his _Treatise on
+    the Scurvy_, part ii. chap. v. p. 201.--_Van Swieten_ says,
+    he never found any Thing answer better than a Gargle made of
+    four Ounces of Elder or Rose Water, acidulated with a Drachm
+    of the Spirit of Sea Salt; and where the Gums were very
+    putrid and gangrened, he has been obliged to touch them
+    slightly with the pure Acid Spirit, and some Hours after to
+    have them washed with the Gargle just mentioned. Vide
+    _Comment._ vol. III. p. 629, sect. 1163.
+
+    If the Spunginess of the Gums sprout out into a luxuriant
+    Fungus, it is sometimes requisite to cut such Funguses away,
+    and to wash the Sores frequently with gentle astringent or
+    acid Liquors.
+
+    [111] Dr. _Huxham_ observes, that, after the Disease has
+    continued some Time, the Blood appears a mere Gore as it
+    were, not separating into Serum and Crassamentum as usual,
+    but remaining an uniform half-coagulated Mass, generally of a
+    more livid or darker Colour than common; though sometimes it
+    continues long very florid; but it always putrifies soon. See
+    his _Essay on Fevers_, chap. v.
+
+    There is something very particular in the Nature of this
+    Disorder, according to an Observation of Dr. _Lind_'s; who
+    says, "That the Scurvy is a Disease in its Nature very
+    opposite to that of a Fever; insomuch, that even an Infection
+    is long resisted by a scorbutic Habit; and those of a
+    scorbutic Habit being seized with the Fever, was a Proof of
+    its proceeding entirely from Infection." See his _First Paper
+    on Fevers_, p. 4.
+
+In the Beginning of _February_, another of the Invalids, who had been
+in the Hospital for a Fever and rheumatic Complaints, had Blotches
+appear on his Legs, complained of great Weakness, and fainted away in
+attempting to walk; which made me suspect his Disorder to be the
+Scurvy; and, on examining him, I found his Gums soft and spongy,
+attended with the other Symptoms of the true Scurvy. I put him nearly
+on the same Course as in the last-mentioned Case: He used a low Diet,
+with the Addition of Greens for Dinner, which he eat with a little
+Butter and Vinegar; and he had a Quart of Lemonade, with two Ounces of
+Brandy, for his common Drink during the Day; and, by Way of Medicine,
+a Decoction of the Bark, with two Drachms of the _confectio cordiaca_
+to each Half Pint, which he took by Spoonfuls. Next Day he complained
+of a Pain in his Leg; and, on examining it more particularly, I found
+a large livid Blotch, yellow all round the Edges, on the fore Part,
+and a Tension all over that Leg. As he was so extremely low, as to be
+in Danger of fainting whenever he sat up, I was afraid lest a
+Mortification should ensue; and therefore ordered his Leg to be bathed
+Morning and Evening with a warm aromatic Fomentation, and a Poultice
+of Theriaca to be applied after it; and desired him to take as much of
+the Decoction of the Bark with the Cordial as possible; and allowed
+him a Glass of Mountain Wine every two or three Hours. By the
+Continuance of this Course for some Weeks, the livid Blotches, Pain,
+and Stiffness of his Leg, and most of the other scorbutic Symptoms,
+went away; his Gums were restored to their natural Firmness; and he
+recovered his Strength so much as to be able to sit up all Day long;
+though he still remained very weak when he was sent to _England_, in
+_March_.
+
+In _February_ and _March_, seven or eight more scorbutic Patients were
+sent to the Hospital I attended, who were all treated in the same
+Manner; and all did well. About the Middle of _February_ this
+Distemper began to shew itself in the other Hospital attended by Dr.
+_Miller_, who treated the Patients nearly in the same Way, and they
+all recovered.
+
+On the 5th of _April_, a young Man, belonging to the Eighth Regiment
+of Foot, came to the Hospital with all the Symptoms of the true
+Scurvy; his Gums were spungy and foetid; he had livid Blotches on his
+Legs, and Contractions of the Hams, and a Stiffness and Hardness in
+the Calves of both Legs[112]. By following the same Course as the
+others, and the Use of frequent Fomentations, and rubbing the
+contracted Parts with soft Liniments, he mended daily; and, after
+taking a Dose or two of Physic, was dismissed perfectly recovered on
+the 10th of _May_. At his first Admission into the Hospital, he was
+taken with a severe Cough, attended with Pain of the Breast, and a
+Spitting of Blood for a Day or two, for which he was blooded. His
+Blood threw up a little Buff; the Crassamentum was of a blackish
+Colour and of a loose Texture, with a good Proportion of a yellowish
+Serum. This Bleeding relieved the Complaints of his Breast, and he had
+no Return of them while he remained in the Hospital.
+
+    [112] If the Swellings become large, stiff, and painful, Dr.
+    _Lind_ recommends that the Legs should be frequently bathed
+    and fomented; or, what he has found preferable, to be exposed
+    to their Steams, after being well covered with Blankets.
+    After this Operation, he advises the Limb to be rubbed with
+    some mild Oil, such as _oleum palm�_, or Salad Oil; and if
+    the Swellings resist both the general Cure and these
+    Applications, the Limbs to be sweated with Spirits. See his
+    _Treatise on the Scurvy_, part ii, chap. v.
+
+The first Week in _May_ four Invalids were admitted into the Hospital
+for this Disorder. The first had spungy Gums, a foetid Breath, his Legs
+swelled and hard, and of a deep purple Colour. The second was a Case
+at first of a more doubtful Kind; there were no spungy Gums, though an
+offensive Breath; his Ancles and Feet were swelled, attended with Pain
+and Uneasiness, and a great Weakness and Lassitude; but no Fever, nor
+any livid Blotches. The Swelling of the Feet and Ancles seemed at
+first Sight rather gouty or rheumatic, than of the scorbutic Kind; but
+from the Man's Way of Life, and the Disorder being so frequent, we
+discovered it to be the Scurvy. The third had a very foetid Breath and
+spungy Gums, livid Spots and fungous Ulcers[113] on his Legs, with
+Pains and Weakness all over. The fourth had also spungy Gums and a
+foetid Breath, Pains of the Legs and Arms, livid Blotches on his Legs,
+great Hardness and Contraction of the right Ham, and a livid hard
+Swelling on the Outside of the left Thigh, immediately above the Knee.
+
+    [113] "Ulcers on the Legs, or any other Part of the Body,
+    require pretty much the same Treatment, _viz._ very gentle
+    Compression, in order to keep under the Fungus, and such
+    antiseptic Applications as have been recommended for putrid
+    Gums, _viz. mel rosat._ acidulated with _spiritus vitrioli_,
+    _ung. �giptiacum_, &c. but nothing will avail where the
+    Patient cannot have Vegetables and Fruits." _Dr. Lind's
+    Treatise on Scurvy_, part ii. chap. v. p. 204. And he
+    recommends, if the Swellings and Ulcers of the Legs neither
+    yield to the general Cure nor to the Methods here proposed,
+    that a slow and gentle Course of Mercury should be tried,
+    after the scorbutic Taint is a good deal removed, and the
+    Gums are sufficiently firm; and to give along with it a
+    Decoction of the Woods, or of Sarsaparilla; but this Method
+    ought not to be attempted till the Gums have acquired a
+    proper Firmness. See _ibid._ part ii. chap. v.
+
+We treated them all four in the Method above-mentioned, adding a Mess
+of Greens to Dinner, giving Lemonade for Drink, and the Bark, with
+Elixir of Vitriol, by Way of Medicine. The Parts that were hard and
+swelled, were fomented, and rubbed with soft Liniments, and Poultices
+were applied to the hard Swelling on the Outside of the left Thigh;
+and the Ulcers of the Legs dressed with Digestives, and occasionally
+washed with spirituous Tinctures, and touched with Escharotics. Before
+I left _Bremen_, the first Week in _June_, the first and second
+Patients were perfectly recovered, and the third and fourth almost
+well. All of them had had the Disorder some Months before they came to
+the Hospital.
+
+
+
+
+OF THE ITCH.
+
+
+There was no Disorder so common in the military Hospitals as the Itch.
+It is of an infectious Nature, and now most commonly believed to be
+entirely owing to little Insects lodged in the Skin, which many
+Authors affirm they have seen in the Pustules by the Help of a
+Microscope; and that the Disorder is entirely communicated by
+Infection, and does not arise from any Fault in the Fluids or Solids.
+
+It has been found by Experience, that internal Medicines have little
+or no Effect in removing this Disorder; and that only external
+Remedies, which come immediately in contact with the Parts affected,
+are capable of making a Cure; which has been brought as a farther
+Proof, that the Itch is owing to Animalcules or Insects; as it is
+alledged, that no Remedies will cure the Distemper, but such as are
+capable of killing them.
+
+The Medicines, which are most commonly used for the Cure, are
+_Mercury_, _White Helebore_, and _Sulphur_.
+
+Mercurial Frictions on the Part are often made use of, and sometimes
+with Success, though they are by no Means to be depended upon for a
+Cure; besides that, they are liable to throw the Patients into a
+Salivation, as I have seen happen more than once; for which Reasons I
+would never recommend this Method where the Patient labours under no
+other Disorder which requires the Use of Mercury, and would confine it
+entirely to Cases where Patients, having the Itch, labour, at the same
+Time, under the _Lues venerea_, and require the free Use of mercurial
+Frictions; under such Circumstances the mercurial Ointment may be as
+well rubbed on the Parts affected with the Itch as upon any other.
+
+The Powder of the Root of _White Helebore_, made up into an Ointment
+with Hogs Lard, or a strong Decoction of it in Water, rubbed on the
+Parts, will often cure the Itch; but it is a sharp Medicine, and
+generally smarts, and sometimes inflames the Parts on which it is
+rubbed; and therefore it is not so commonly used, as we know a much
+surer and milder Remedy. Though I have cured some People with the
+Helebore Lotion without any Inconvenience, who would not use the
+Sulphur on Account of its Smell.
+
+_Sulphur_ is the most certain and easy Cure for the Itch of any we
+know, and perhaps is more certain in the Cure of this Disorder than
+almost any other Medicine in any other Disorder whatever. We used it
+in Form of the Sulphur Ointment of the _London Dispensatory_, of which
+one, two, or more Drachms were rubbed in every Night, in Proportion to
+the Extent of the Parts affected. These Unctions were continued from
+four or five to ten or twelve Nights, according to the Violence and
+Continuance of the Disorder. Most were cured in a few Days; others
+required a longer Time. As the sulphureous Unctions tend to obstruct
+the Perspiration, we generally ordered a Purge to be given before
+rubbing the Sulphur Ointment, and in full Habits sometimes ordered a
+little Blood to be taken away; and put them all under a low Diet.
+After the Disorder seemed to be removed, they took another Dose or two
+of Physic to carry off any Impurities that might have been thrown upon
+the Bowels, during the Use of the Sulphur Ointment. In inveterate
+Cases, the Sulphur was given internally at the same Time that the
+Patient rubbed with the Ointment.
+
+It is generally believed (though denied by some) that Sulphur, taken
+internally, enters the Blood; and its Steams are thrown off by the
+perspiratory Vessels, and assists more effectually to destroy the
+Insects and their Ovula, which give Rise to the Itch; but whether this
+Effect be true or not, I found it to answer another very good Purpose;
+which was to keep the Belly rather loose, while the Patient used the
+Unction; and by this Way it carried off those Humours, which ought to
+have passed off by the Skin; and for that Reason, when it had not that
+Effect, we joined some Lenitive Electuary to it.
+
+There is one Thing to be observed with regard to sulphureous Unctions,
+which is, that we ought not to use them too soon with People
+recovering out of Fevers, or other Disorders which bring them low;
+otherwise there will be Danger of bringing on a Relapse, which I have
+often observed to happen in military Hospitals, where the Itch has
+appeared as the Patients were recovering from Fevers and other
+Disorders, and the Unctions were used too soon: But whether these
+Relapses were owing to the sulphureous Unction's stopping up the Pores
+of the Skin, and obstructing a free Perspiration, or to the Patient's
+being more apt to take Cold while they used the Sulphur Ointment, than
+at any other Time, is what I cannot determine; but to me it seems most
+probable, that these Unctions rather obstruct the Perspiration; and
+that when they are used too soon with People recovering from Fevers,
+especially those of the putrid Kind, they prevent those Particles
+from passing off by the Skin, which it was necessary should be
+evacuated, in order to free the Body from the Seeds of the Fever, or
+other Disorders the Patients laboured under. But however this be,
+Experience has shewn, that we ought not to attempt the Cure of the
+Itch, in Patients so circumstanced, till their Strength be in a great
+Measure re-established, otherwise there will be Danger of a Relapse;
+and likewise, that Patients using Sulphur externally, ought to be
+particularly on their Guard against Cold.
+
+This Observation of Peoples being so apt to relapse after Fevers by
+the too early Use of sulphureous Unction, is a strong Proof of the
+Usefulness of keeping the Body open during the Time of Rubbing and of
+Purging the Patient afterwards; as by these Means we may carry off by
+the Bowels those Particles which could not pass by the Skin; and I
+think, so far as I have been able to observe, those People have been
+less subject to relapse into Fevers where this Caution has been used,
+than where it has been neglected.
+
+That Species of the Itch where it forms small Ulcers or Pustules in
+the Skin, is the worst Kind, and most contagious, and seems to take
+its Rise from the common Itch continuing long, and making its Way
+deeper into the Skin. The Cure is the same, only this requires more
+frequent Unctions, and those to be continued longer, than before the
+Disorder has taken such deep Root.
+
+It is no uncommon Thing to see the Itch appear again, some Weeks after
+it has seemingly been cured by the Use of sulphureous Unctions; which
+most commonly happened to those who were in too great a Hurry to get
+well, and left off the Use of the Unctions too soon. Such Returns of
+the Itch were generally cured by the Repetition of the same Treatment
+as before.
+
+
+
+
+TABLE of DIET.
+
+
+The following is a Copy of the Table of Diet which was used in the
+Hospital all the Time I was with the Troops in _Germany_:
+
+                     _Breakfast._     |   _Dinner._      |   _Supper._
+                                      |                  |
+               One Pint of Rice       |                  |
+               Gruel; made with two   |                  |
+               Ounces of Rice, one    |                  |
+  Full Diet,   Spoonful of fine       | One Pound of     | As Breakfast.
+               Flower, a little       | Meat.            |
+               common Salt, and fine  |                  |
+               Sugar.                 |                  |
+  ______________________________________________________________________
+                                      | One Pint of      |
+  Middle Diet, As above.              | Broth, Half a    | As above.
+                                      | Pound of Meat.   |
+  ______________________________________________________________________
+                                      | One Pint of      |
+                                      | Broth; or Half   |
+               As above, or           | a Pint of        |
+               according to           | Panado, with two |
+  Low Diet,    the Patient's          | Spoonfuls of     | As Breakfast.
+               Stomach or             | Wine, and a      |
+               Indisposition.         | Quarter of an    |
+                                      | Ounce of fine    |
+                                      | Sugar.           |
+
+The daily Allowance of Bread was a Pound to those on full and middle
+Diet, and Half a Pound to those on low Diet, or a Pound, if so ordered
+by the Physician.
+
+Those on full and middle Diet were allowed daily three Pints of Barley
+or Rice Water; to each Pint of which were added two Spoonfuls of
+Brandy, and a Quarter of an Ounce of Lump Sugar. Small Beer was
+mentioned in the Diet Table; but this we could never have good; and
+therefore was not used.
+
+Those on low Diet were allowed Barley or Rice Water; to which some
+Wine or Brandy was occasionally added, if ordered so by the Physician.
+
+Besides this, the Physician might order an additional Quantity of
+Wine, Brandy, or Milk, or Water Gruel, or any other Articles which he
+thought proper for the Sick under his Care, and which could be got
+easily.
+
+
+
+
+PHARMACOPOEIA IN USUM
+
+Nosocomii Regii Militaris Britanici.
+
+MDCCLXI.
+
+
+
+
+PHARMACOPOEIA IN USUM
+
+Nosocomii Regii Militaris.
+
+Ann. MDCCLXI.
+
+
+AQU� SIMPLICES ET SPIRITUOS�.
+
+    AQUA Alexeteria.
+    ---- Bacc. Juniperi.
+    ---- Cinnamomi.
+    ---- Menth� vulgaris.
+    ---- Menth� piperitidis.
+    ---- Nucis moschat�.
+    ---- Pulegii.
+    ---- Rut�.
+
+    Vel ali� aqu� hujus generis pr�parari possint, terendo in
+    mortario vitreo elaeosacchara pr�parata, cum oleis
+    essentialibus, et sacchari albi 12la quantitate; et dein
+    addendo aqu� fontan� vel spiritus vini tenuis quantitatem
+    sufficientem[114].
+
+    [114] Such _Elaeosacchara_ (as they are called), made by
+    rubbing the essential Oils with twelve Times the Quantity of
+    Sugar, may at all Times be prepared at the fixed Hospital,
+    and carried about with the flying Hospital, much more
+    conveniently than the simple or compound Waters themselves.
+
+Aqua calcis simp. Ph. Lond.
+
+    Dosis a lib. i. ad lib. ij. in die.
+
+Aqua Hordeata. Ph. Lond.
+
+    Utenda pro potu.
+
+
+BOLUS.
+
+Bolus anodynus astringens.
+
+    Rx Theriac� andromachi, drachm. dimid. opii, gr. i. M. pro
+    dosi semel vel bis die.
+
+Bolus e rheo cum mercurio.
+
+    Rx Pulv. rhei, gr. xxv. calomel, gr. v. syrup sacchari, q. s.
+
+Bolus e calomel.
+
+    Rx Calomel gr. v. conserv. rosar. scrup. i. M.
+
+Bolus mercurialis.
+
+    Rx Argenti vivi, gr. x. extingue in balsam copaivi, q. s. et
+    adde conserv. rosar. q. s.
+
+Bolus e scordio cum rheo.
+
+    Rx Elect. e scordio, scrup. i. pulv. Rhei, gr. x. syrup, q. s.
+    ut fiat bolus sumendus semel, bis, terve die.
+
+
+COLLYRIA.
+
+Collyrium saturninum.
+
+    Rx Sacchari saturni, salis ammoniaci crudi ana gr. vi. solve
+    in aq. fontan�, unc. xij. adde pro re nata tinct. thebaic�,
+    drachm. i.
+
+Collyrium vitriolicum.
+
+    Rx Vitrioli albi, drachm. ss. solve in aq. fontan�, lib. i.
+
+Confectio cardiaca. Ph. Lond.
+
+Conserva cynosbat. Ph. Lond.
+
+Conserva rosar. Ph. Lond.
+
+
+DECOCTA.
+
+Decoctum album. Ph. Lond. utendum pro potu.
+
+Decoctum arabicum.
+
+    Rx Gum. arabici, unc. dimid. coque in aq. hordeat� bullientis,
+    lib. ij. ad solutionem Gummi. utend. pro potu.--addi possit
+    pro re nata spirit. nitri dulcis, drachm. ij.
+
+Dococtum corticis Peruviani.
+
+    Rx Cort. Peruv. crass. pulv. unc. i. coque in aq. fontan. lib.
+    iij. ad lib. ij. Colatur� adde tinct. cort. Peruv. unc. i.
+    spirit vini Gallici sescunc. Dosis ab uncia i. ad unc. iv.
+    bis ter. quaterve die.
+
+Decoctum cort. cum serpentaria.
+
+    Fit addendo decocto cort. Peruv. sub sinem coctionis, rad.
+    serpentari� virgin. contus. unc. dimid. Dosis ab unc. i. ad
+    unc. iij. ter quaterve die.
+
+Decoct. commun. pro clyster.
+
+    Rx Flor. vel herb. cham�mel. unc. i. coque in aq. fontan. lib.
+    i.ss. ad lib. i. & cola.
+
+Decoctum ligni guaiaci.
+
+    Rx Ligni guaiaci ras. lib. ss. aq. fontan� bullientis, cong.
+    ij. macera per noctem; mane coque ad congium. i. & cola;
+    Capiat a lib. ss. ad lib. ij. die.
+
+Decoctum nitrosum.
+
+    Rx Coccinel. scrupul. i. coque in aq. fontan. lib. ijss. ad
+    lib. ij. & dein adde salis nitri, unc. i. sacchar. albi
+    sescunc. Colatur� addi possit pro re nata aq. alicujus
+    spirit. unc. ij. Dosis ab unc. i. ad unc. iv. 4tis vel 6tis
+    horis.
+
+Decoctum pectorale.
+
+    Rx Fol. herb. malv�, unc. ij. feminum lini, unc. dimid. coque
+    in aq. fontan. lib. ivss. ad lib. iv. addendo sub finem
+    coctionis rad glycyrrhiz sescunc. vel mellis optimi, unc. i.
+    Cola pro potu.--Adde pro re nata aceti, sescunc.
+
+Decoctum rad. sarsaparill�.
+
+    Rx Rad. sarsaparill�, unc. iij. coque in aq. fontan. lib. iij.
+    ad lib. ij. adde sub finem coctionis ligni sasafras, drachm.
+    i. rad. glycyrrhiz�, drachm. ij. Colatur� capiat a lib. i.
+    ad lib. ij. in die.--Adde pro re nata vini antimonialis,
+    drachm. ij.
+
+
+ELECTARIA.
+
+Elect. astringens balsamicum.
+
+    Rx Specier. e scordio, pulv. e tragacanth. comp. ana unc. i.
+    tinctur� thebaic�, drachm. ij. syrup sacchari, q. s. ut fiat
+    elect. Dosis ad molem N. M. bis, ter. quaterve in die.
+
+Elect. corticis Peruviani.
+
+    Rx Pulv. cort. Peruv. unc. iv. syrup sacchari, q. s. Dosis a
+    scrup. i. ad drachm. unam, bis, ter, 4r. 6ties. vel decies
+    die.
+
+Elect. corticis anodynum.
+
+    Rx Elect. cort. Peruv. unc. 1nam. elect. e scordio unciam
+    dimidiam, vel tinct. thebaic� scrup. ij.
+
+Elect. corticis astringens.
+
+    Rx Elect. cort. Peruv. semunc. pulv. rad. tormentil, lapidis
+    cancror. ppt. singulorum, drachm. i. syrup, q. s.
+
+Elect. cort. cum serpentaria.
+
+    Rx Elect. cort. Peruv. unc. i. pulv. rad. serpentar. virgin.
+    cort. canel. alb. ana, drachm ij. syrup. q. s.
+
+Elect. cort. cum sale ammoniac.
+
+    Rx Elect. cort. Peruv. sescunciam. sal. ammon. crud. drachm. i.
+
+Elect. e baccis lauri. Ph. Lond.
+
+Elect. lenitiv. Ph. Lond.
+
+Elect. lenitivum cum sulphure.
+
+    Rx Elect. lenitiv. lib. ss. flor. sulphuris, unc. ij. Dosis,
+    moles, N. M. vel ad semunc. pro re nata.
+
+Elect. lenitivum compositum.
+
+    Rx Elect. lenitiv. lib. i. pulv. jalap. unc. i. sal. nitri,
+    drachm. ij. syrup. q. s. Dosis a drach. i. ad drach. iv. pro
+    r. n.
+
+Elect. lenitivum balsamicum.
+
+    Rx Elect. lenitiv. comp. unc. ij. bals. copaiv. unc. i. gum
+    guaiac. unc. ss. M. Dosis, cochleare the�, h. s. vel mane &
+    vesperi.
+
+Electuar. e scordio vel diascordium. Ph. Lond.
+
+Elect. e spermat. ceti.
+
+    Rx Balsam Peruv. unc. im. misce optime cum mucilag. gum arab.
+    sescunciam & adde spermat. ceti, conserv. rosar. ana unc.
+    xij. syrup sacchar. q. s. dosis, a dimidi� drachma bis die ad
+    drachm. im. quater vel sexties die.
+
+Elect. stomachicum.
+
+    Rx Conserv. cynosbat. unc. iv. pulv. rad. zinziber. drachm.
+    ij. canell. alb. unc. i. rubigin. martis, drachm. ij. syrup.
+    q. s. dosis a scrup. i. bis terve die ad semidrach. 4tis
+    horis.
+
+Elect. e scammon. Ph. Lond.
+
+
+ELIXIR.
+
+Elix. aloes. Ph. Lond.
+
+Elix. paregoricum. Ph. Lond.
+
+Elix. vitrioli acid. Ph. Lond.
+
+
+ENEMATA.
+
+Enema commune laxativ.
+
+    Rx Aq. fontan. calid. unc. xij. elect. lenitiv. semunc. sal.
+    cathartici amari, unc. i. M.
+
+Enema commun. oleos.
+
+    Rx Aq. fontan. bullient. unc. x. mucilag. gum arabic. unc. im.
+    olei olivar. unc. ij. adde pro re nata elect. e scord.
+    drachm. ij. vel. tinct. thebaic. drachm. i.
+
+Enema ex amylo.
+
+    Rx Aq. fontan. calid. unc. iv. gelatin. amyli, unc. v. elect.
+    e scord. drachm. i. M.
+
+Enema terebinth.
+
+    Rx Terebinth commun. drachm. vi. solve in vitello ovi & adde
+    enemat. oleos. unc. x.
+
+Emplastrum vesicatorium. Ph. Lond.
+
+
+FOTUS.
+
+Fotus communis.
+
+    Rx Fol. malv. flor. cham�mel. singulorum, m. i. coque in aq.
+    fontan. q. s.
+
+Fotus commun. spirit.
+
+    Rx Fotus commun. lib. ij. aceti, lib. i. spirit. vini tenuis,
+    lib. ss. M. pro fotu.
+
+Fotus cum sale ammoniac.
+
+    Rx Fotus commun. lib. ij. sal ammoniac crud. unc. i.
+
+Fotus volatilis.
+
+    Rx Fotus commun. q. s. asperge panno statim ante applicationem
+    spiritus sal. ammoniac, q. s.
+
+
+GARGARISMATA.
+
+Gargarisma commune.
+
+    Rx Aq. hordeat. unc. xij. sal. nitri, drachm. i. mellis
+    semunc. M. adde pro re nata spirit. vin. unciam i.
+
+Gargarisma acidum.
+
+    Rx Aq. hordeat. unc. xij. spirit. vini gallici, unc. i. aceti
+    sescunc. tinct. myrrh�, drachm. ij. M.
+
+Gargarisma volatile.
+
+    Rx Aq. hordeat. unc. xij. spirit. vin gallic. unc. ij. sal.
+    vol. ammoniaci, drachm. i. M.
+
+
+GUTT� ANTIMONIALES ANODYN�.
+
+    Rx Vini antimonialis, unc. im tinct. thebaic. drachm. ij.
+    dosis a gutt. 30 ad 40 bis terve die, vel a gutt. 60 ad 140,
+    h. s. in potu tepido.
+
+
+HAUSTUS.
+
+Haustus simplex.
+
+    Rx Aq. fontan. sescunc. spirit. vini gallici drachm. i. ss.
+    sacchar alb. drachm. dimidiam M.--Haustus pr�parari possit
+    aqua aliqua simp. et spirit. loco aq fontan. & spirit. vini
+    gallici pro re nata.
+
+Haustus anodynus.
+
+    Rx Haust. simp. sescunc. tinct. thebaic. gutt. xx. M.
+
+Haustus camphoratus.
+
+    Rx Camphor�, gr. iij. tere in mortario cum sacchar. alb.
+    drach. dimid. & dein adde mucilag. gum arabici, drachm. ij.
+    haust. simp. sescunciam. M. s. a. Dosis repetenda, 4ta vel
+    6ta. quaque hora.
+
+Haust. emetic. antimonialis.
+
+    Rx Vini antimonialis semunciam. Dari possit ad drachm. x. pro r. n.
+
+Haust. emeticus scilliticus.
+
+    Rx Oxymel. scillit. drachm. x. aq. fontan. semunc. pulv. rad.
+    ipecacoan. gr. vi.
+
+Haustus cardiacus.
+
+    Rx Haust. simp. sescunciam confect. cardiac. scrup. im. M. f.
+    haustus repetendus 4tis. vel 6tis. horis--adde pro re nata
+    sp. lavend. comp. dr. i.
+
+Haustus cardiacus oleosus.
+
+    Rx Ol. essential. menth. gutt. ij. tere in mortario vitreo cum
+    sacchar. alb. drachm. dimid. & adde haust. simplicis sescunc.
+    tinct. stomachic. drachm. i. M.--adde pro re nata tinctur.
+    thebaic. gutt. x.
+
+Haustus lixiviosus anodynus.
+
+    Rx Haust. simp. sescunciam, lixivii tartari, drachmam dimidiam
+    tinctur� thebaic�, gutt. xx. cap. h. s. vel mane & vesperi.
+
+Haustus e mithridatio.
+
+    Rx Haust. simp. sescunc. mithridat. scrup. i. aceti vin.
+    drachm. iij. dosis repetenda 4tis. vel 6tis. horis.
+
+Haustus oleosus communis.
+
+    Rx Mucilagin. gum arabici, drachm, iv. ol. olivar, drachm. v.
+    misce s. a. & adde haust. simp. sescunciam. Repet. 4tis. vel
+    6tis. horis.
+
+Haustus oleosus cum rheo.
+
+    Rx Haust. oleos. communis, unc. ij. tinct. rhei sescunc. vel
+    pulv. rhei, gr. xxv. tinct. thebaic. gutt. xv. M. fiat
+    haustus sumendus vel h. s. vel primo mane.
+
+Haustus purgans.
+
+    Rx Infus. sen�. unc. iij. sal. glauber. drachm. iij. spirit.
+    vin. gallici, drachm. ij. sacchar. alb. drachm. dimid. capiat mane.
+
+Haustus salinus communis.
+
+    Rx Aceti vinosi vel succ. limonum semunciam, sal. absynth.
+    scrup. i. vel ad saturationem, haust. simp. sescunciam adde
+    pro re nata pulv. contrayerv. comp. scrup. i. vel pulv.
+    contrayerv. cum nitro, scrup. ij.--Haustus pr�parari possit
+    cum salis diuretici drachma dimid. loco acidi & salis
+    absynthii. Dosis repetend. 3tiis. 4tis. vel 6tis.
+    horis--Eodem modo sit haustus cum spirit. mindereri uncia
+    dimidi�.
+
+Haust. salin. cum confect. cardiaca.
+
+    Rx Haust. salin. commun. unc. ij. confect. cardiac. scrup. i.
+    M. repet. 4tis. vel 6tis. horis.
+
+Haust. salin. cum mithridatio.
+
+    Rx Haust. salin. commun. unc. ij. mithridatii, scrup. i. M.
+    sumend. 4tis. vel 6tis. horis.
+
+Haustus salin. cum rheo.
+
+    Rx Haust. salin. com. uncias ij. pulv. rhei, gr. xxv. M.
+    capiat mane.
+
+Haustus salin. cum phu.
+
+    Rx Haust. salin. commun. unc. ij. pulv. rad. valerian.
+    sylvestris, scrup. ij. Dosis repetend. 2dis. 4tis. vel 6tis.
+    horis.
+
+Haust. salinus succinatus.
+
+    Rx Haust. salin. commun. unc. ij. sal succini, pulv. castorei
+    singulorum, gr. x. H. repetend. 4tis. vel 6tis. horis.
+
+Haust. salinus purg. oleosus.
+
+    Rx Mann� opt. semunc. olei olivar. drachm. vi. vitelli ovi q.
+    s. tere in mortario, addendo paulatim sal cathartici amari,
+    unc. i. solutam in aq. fontan. calid. unc. iij. spirit. vini
+    gallici vel aq. alicujus spirituos�, drachm. iij. M. s. a pro
+    dosi matutino.
+
+Haustus volatilis.
+
+    Rx Haust. simp. sescunciam sal. vol. c. cervi, gr. x. M. H.
+    repet. 4tis. vel 6tis. horis.
+
+
+INFUSA.
+
+    Infusum amarum. Ph. Lond. Addi possit pro re nata in
+    pr�parando spirit. vini tenuis, lib. ss. ad lib. ij. infusi.
+    Dosis ab unc. ina. bis die ad unc. ij. ter. die.
+
+Infusum raphani rusticani.
+
+    Rx Rad. raphani rusticani, unc. ij. baccar. juniper, unc.
+    inam. cort. canell. alb. drachm. ij. aq. fontan. bullient,
+    lib. iv. infunde per noctem leni calore. Colatur� adde
+    spirit. vini gallici unc. iv. Dosis ab. unc. i. bis terve die
+    ad unc. iv. 6tis. horis.
+
+Infusum sen� commun. Ph. Lond.
+
+
+JULEPUM E MOSCHO.
+
+    Rx Mosch. drachmam im. tere optime in mortario cum sacchar.
+    alb. drachm. iij. & adde mucilagin. gum arab. dr. iv. Haust.
+    simp. unc. vi. Dosis unc. ij. 4tis. vel 6tis. horis.
+
+
+LINCTUS.
+
+    Rx Conserv. cynosbat. unc. iv. ol. olivar. syrup. sacchari vel
+    mellis ana unc. ij. adde pro re nata spirit. vitrioli tenuis,
+    drachm. iv. Dosis cochleare the� urgente tussi.
+
+
+LINIMENTA.
+
+Liniment. saponaceum. Ph. Lond.
+
+Linimentum camphoratum.
+
+    Rx Olei olivar. unc. ij. camphor�, drachm. ij. M.
+
+Linimentum volatile. Ph. Lond.
+
+Linimentum volatile commune.
+
+    Rx Olei olivar. unc. iij. spiritus salis ammoniaci, dr. vi. M.
+
+
+MELLA.
+
+Mel cum borace.
+
+    Rx Mellis optimi, unc. i. pulv. subtilissim. boracis, dr. i. M.
+
+Mel �gyptiacum. Ph. Lond.
+
+Mel rosaceum. Ph. Lond.
+
+MITHRIDATIUM. Ph. Lond.
+
+
+MIXTUR�.
+
+Mixtura acida communis.
+
+    Rx Haust. simp. unc: viij. spirit. vitrioli tenuis, scrup. ij.
+    vel ad gratam aciditatem. Dosis ab. unc. ij. ad unc iv. 4tis.
+    vel 6tis. horis.
+
+Mixtura ammoniaca.
+
+    Rx Gum ammoniaci, drachm. i. solve in haust. simp. unc. vi.
+    Dosis ab. unc. i. ad unc. ij. bis terve in die.
+
+Mixtura ammon. cum oxymel.
+
+    Rx Mixt. ammoniac. unc. vi. oxymel scillit. drachm. vi. Dosis
+    a cochlear. i. ad unc. ii. ter. 4rve. die.
+
+Mixtura ammoniac. anodyna.
+
+    Rx Mixt. ammoniac. cum oxymel. unc. vi. tinct. thebaic.
+    drachm. dimid. Dosis a cochlear. i. ad iv. 4tis. vel 6tis.
+    horis.
+
+Mixtura Campechensis.
+
+    Rx Extract. ligni Campechensis, drachm. iij. solve in haust.
+    simplic. unc. vi. adde pro re nata tinct. thebaic. gutt. xxx.
+    vel Philon. Londinen. drachm. i. Dosis ab. unc. i. ad unc.
+    iij. bis, ter, 4rve. die.
+
+Mixtura f�tida.
+
+    Rx G. asaf�tid. drachm. i. solve in haust. simp. unc. vi.
+    Dosis ab. unc. i. ad unc. iij. 4r. die.
+
+Mixtura f�tida volatilis.
+
+    Rx Mixt. f�tid. unc. vi. spirit. volat. sal. ammon. drachm. i.
+    Dosis ab. unc. i. ad unc. ij. bis, ter, 4rve. die.
+
+Mixtura fracastorii.
+
+    Rx Haust. simp. unc. viij. Elect. e scordio, drachm. iv. Dosis
+    ab. unc. i. ad unc. ij. 4tis. vel 6tis. horis.
+
+Mixtura japonica.
+
+    Rx Haust. simp. unc. vi. Tinct. japonic. unc. i. adde pro re
+    nata tinct. thebaic. dr. i.
+
+Mixtura laxativa.
+
+    Rx Elect. lenitiv. unc. i. Mann� semunc. coque in aq fontan.
+    unc. xvi. ad unc. xij. Colatur� adde sal. cathartici amari.
+    sescunciam. spirit. vini gallici, unc. i. Dosis ab. unc. ij.
+    ad unc. xij.
+
+Mixtura purg. antimonial.
+
+    Rx Elect. lenitiv. sescunc. mann� semunc. coque in aq. fontan.
+    unc. xx. ad unc. xvi. & dein solve tartar. emetici, gr. x.
+    Colatur� dosis ab. unc. i. ad unc. iv. omni hora vel omni
+    2da. vel 3tia. vel 4ta. hora, donec laxetur alvus.
+
+Mixtura oleosa volatilis.
+
+    Rx Haust. simp. unc. vi. ol. olivar. unc. iij. spirit.
+    volatil. salis ammoniaci drachmam inam. M. Dosis ab. unc. i.
+    ad unc. iij. 3tiis. vel 4tis. horis.
+
+Mixtura scillitica.
+
+    Rx Haust. simp. unc. vi. oxymel scillitic. drachm. vi. Dosis a
+    drachm. iv. ad unc. ij. bis, ter, 4rve. die.
+
+Mixtura e spermat. ceti.
+
+    Rx Spermat. ceti, drachm. ij. solve in vitello ovi & adde
+    haust. simp. unc. vi. adde, pro re nata, tinct. thebaic.
+    scrup. ij. Dosis ab. unc. i. ad unc. ij. 4tis. vel 6tis.
+    horis.
+
+Mixtura e spermat. ceti cum balsamo.
+
+    Rx Balsam. copaiv. drachm. ij. tere in mortario cum mucilag.
+    gum arabici, drachm. iij. & dein adde mixtur. e spermat.
+    ceti, unc. vi. Dosis ab. unc. i. ad unc. iij. 4tis. vel 6tis.
+    horis.
+
+
+MUCILAGO. G. ARABICI.
+
+    Rx G. arabici pulv. unc. iv. solve in aq. pur� bullient. unc. x.
+
+Oxymel scillit. Ph. Lond.
+
+Philonium Londinen. Ph. Lond.
+
+
+PILUL�.
+
+Pilul� f�tid�.
+
+    Rx Gum asaf�tid. myrrh. ana drachm. i. sapon. alb. hispan.
+    drachm. ij. Tinct. fuliginis q. s. Dosis a gr. x. ad drachm.
+    dimid. bis terve die.
+
+Pilul� guaiac.
+
+    Rx Sapon. albi hispanici semunc. gum guaiac, scrup. iv. syrup.
+    q. s. Dosis a scrup. i. ad drachmam dimidiam bis terve die.
+
+Pilul� gummos�. Ph. Lond.
+
+Pilul� mercuriales.
+
+    Rx Argenti vivi semunc. extingue in balsam. copaiv. q. s. &
+    adde pulv. glycyrrhiz. gum guaiac. singulorum, drachm. vi.
+    syrup. q. s. ut fiat massa. Dosis a scrup. ss. ad drachmam
+    dimidiam semel vel bis die.
+
+Pilul� rufi. Ph. Lond.
+
+Pilul� saponace�. Ph. Lond.
+
+Pilul� saponace� cum rheo.
+
+    Rx Sapon. alb. hispanici, drachm. vi. pulv. rhei, drachm. ij.
+    syrup. sacchari q. s. Dosis a scrup. i. ad scrup. ij. bis
+    terve die.
+
+Pilul� scillitic�.
+
+    Rx Pulv. glycyrhiz. rad. scill. exsiccat ana drachm. dimid.
+    rad. zinziber. drachm. i. sapon. alb. hispan. drachm. ij.
+    syrup. q. s. Dosis a gr. iv. ad. gr. xvi. bis terve die.
+
+Pilul� stomachic�.
+
+    Rx Pulv. canell. alb. drachm. ij. extract. rad. gentian. dr.
+    i. mucilag. gum arabici q. s. Dosis a scrup. i. ad drachmam
+    dimid. bis die--adde pro re nata rubigin. martis drachmam
+    dimid.
+
+
+PULVERES.
+
+Pulvis astringens.
+
+    Rx Pulv. canell. alb. rad. tormentill. singulorum, drachm. i.
+    M. Dosis a scrup. i. ad drachm. i.
+
+Pulvis aluminosus.
+
+    Rx Alumin. crud. terr� japonic� ana partes �quales dosis a gr.
+    viij. ad drachmam dimidiam.
+
+Pulv. anodynus Doveri.
+
+    Rx Sal. nitri, tartari vitriolati singulorum, unc. iv. in
+    crucibulum candens injice, agitetur donec deflagratio &
+    scintillatio desinat, & adde opii concisi, unc. i. & in
+    pulverem redige addendo rad. glycyrrhiz. ipecacoanh�
+    subtilissime pulver. ana, unc. i. & dein probe misceantur
+    omnia. Dosis a gr. x. ad scrup. ij. vel ad drachmam 1nam.
+
+Pulvis antimonialis.
+
+    Rx Pulv. e chel. cancror. drachm. x. tartari emetici, dr. i.
+    M. fiat pulv. subtilissimus. Dosis a gr. iij. ad gr. x. 4ta.
+    vel 6ta. quaque hora.
+
+Pulvis cardiacus.
+
+    Rx Pulv. canell. alb. drachm. i. rad. zedoari�, drachm. ij.
+    rad. serpentar. drachm. i. M. dosis a scrup. i. ad drachm. i.
+    4tis. vel 6tis. horis.
+
+Pulvis cham�melinus.
+
+    Rx Pulv. flor. cham�mel. drachm. iij. aluminis, g. myrrh. ana
+    drachm. i. Dosis a scrup. i. ad scrup. ij.
+
+Pulv. contrayerv. comp. Ph. Lond.
+
+Pulv. contrayerv. cum nitro.
+
+    Rx Pulv. contrayerv. comp. unc. iv. salis nitri, drachm. i. M.
+    Dosis a scrup. i. ad drachm. i. 4tis. vel 6tis. horis.
+
+Pulvis emeticus.
+
+    Rx Pulv. ipecacoanh�, scrup. i. tartar emetici, gr. ij. Dosis
+    a gr. xi. ad gr. xxii.
+
+Hiera picra. Ph. Lond.
+
+Pulv. Ipecacuanh� cum opio.
+
+    Rx Pulv. rad. ipecacoan. gr. x. opii, gr. ij. dosis a gr. iij.
+    ad gr. xij.
+
+Pulv. e jalapio.
+
+    Rx Pulv. rad. jalapii, drachm. vi. rad. zinzib. drachm. ij.
+    Dosis a scrup. i. ad scrup. ij.
+
+Pulv. jalapii cum nitro.
+
+    Rx Pulv. rad. jalap. drachm. iv. salis nitri drachm. im. Dosis
+    a scrup. i. ad scrup. ij.
+
+Magnesia alba.
+
+Pulv. nitrosus.
+
+    Rx Pulv. e chel. cancror. drachm. iij. nitri, drachm. i. M.
+    Dosis a scrup. i. ad scrup. ij. vel ad drachmam. i.
+
+Pulv. nitrosus camphoratus.
+
+    Rx Pulv. nitros, scrup. ij. camphor�, gr. v. M. Dosis a scrup.
+    i. ad scrup. ij.
+
+Pulv. nitrosus cum gum guaiac.
+
+    Rx Sal. nitri, drachm. ij. gum guaiac. drachm. dimid. Dosis a
+    gr. v. ad drachm. dimid.
+
+Pulv. plummeri.
+
+    Rx Calomel, sulph. aurat antimonii ana dr. ij. tere in
+    mortario ut fiat pulv. subtilissimus. Dosis a gr. ij. ad gr.
+    x. vel ad scrup. im.
+
+Pulvis stanni. Ph. Lond.
+
+Pulv. e spermat. ceti cum nitro.
+
+    Rx Spermat. ceti, drachm. ij. sacchar. albi sal. nitri ana
+    unc. im. Dosis a scrup. dimid. ad drachmam i.
+
+Pulv. e tragacanth. Ph. Lond.
+
+
+SALES ACIDI.
+
+                                                     PR�PARATIONES.
+                  Spir. vitrioli fortis |                       |
+  Acida           ---- tenuis           |Spir. vitrioli dulcis  |
+  mineralis       Spiritus nitri        |Spir. nitri dulcis     | �ther.
+                  Spir. salis marini    |Spir. salis dulcis.    |
+
+  Varietat. acid. Acetum.
+  vegit.          Spiritus aceti vel acetum distillatum.
+                  Succus limonum.
+                  Chrystalli tartari.
+
+  Acid. anomal.   Sal. succini.
+                  Sal. sedativus Hombergeri.
+
+
+SALES ALCALINI.
+
+  Alcal. vegit.  Sal. absynthii.
+                 Sal. tartari.
+
+  Alcal. min.    Sal. alcali mineral. seu soda, seu natrum.
+
+  Alcal. vol.    Sal. volatilis c. cervi.
+                 Sal. volatilis sal. ammoniaci.
+
+
+SALES NEUTRI.
+
+SALES NEUTRI, qui fiunt        ex ALCALI            et ACIDO.
+
+            Tartarus vitriol.  | vegetab.      |
+            Sal. glauberi      | minerali      | vitrioli.
+            Sal. am. vitrioli  | volatili      |
+
+            Sal. nit. com.     | vegetab.      |
+            Nit. cubicum       | mineral.      | nitri.
+            Sal. am. nitrosum  | volatili.     |
+
+            Sal. digest. sylvii| vegetabil.    |
+            ---- marin. com.   | minerali      | Sal. marini.
+            ---- ammon. com.   | volatili      |
+
+Varietates  Sal. diureticus    | vegetab.      | aceti.
+salis       Tartar. tartar.    | veget.        | chryst. tartar.
+neutri                         |   tartari     |
+comp. ex    Sal. citratus com. | veget.        | succ. limonum.  Vegetabil.
+alcal. &                       |   absynth.    |
+acid.       Sal. de seignette  | minerali      | chryst. tartar.
+vegitab.    Spir. mindereri.   | volatili      | acet. distillat.
+
+Hi omnes sales neutri pr�parari possint pro usu medico admiscendo
+Alcali & acidum ad saturationem; alii vero in crystallos redacti, s.
+a. commodius circumferuntur pro usu militari; alii ut _sal. citratus
+comm._ et _spiritus mindereri_ facilius pr�parantur ad miscendo alcali
+& acidum ad saturationem pro re nata[115].
+
+    [115] This Table of neutral Salts is nearly the same as one I
+    have seen, which was said to be a Copy of that given yearly
+    by Dr. _Cullen_, Professor of Chymistry in the University of
+    _Edinburgh_, to his Pupils; and as that published by Dr.
+    _Vogel_, in his _Institutiones Chymi�_, sect. 629. These
+    neutral Salts are likewise taken Notice of by _Macquer_, in
+    his _Elemens de Chymie_, and other late chymical Authors.
+
+Solutio mercurii corrosivi sublimati.
+
+    Rx Mercur. corrosiv. sublimat. gr. vi. spir. vini gallici,
+    unc. xii. M. fiat solutio. Dosis a semunc ad unc. i. die.
+
+    Species aromatic�. Ph. Lond.
+    ---- e scordio. Ph. Lond.
+
+Tartar. emetic. Ph. Lond.
+
+Theriaca andromachi. Ph. Lond.
+
+
+TINCTUR�.
+
+    Tinctura amara.
+    ---- corticis Puruv.
+    ---- martis in sp. sal.
+    ---- japonica.
+    ---- melampodii.          Pharm. Lond.
+    ---- myrrh�.
+    ---- sacra.
+    ---- saturnina.
+    ---- serpentari�.
+    ---- thebaica.
+
+Tinctura rhei.
+
+    Rx Pulv. rad. rhei, unc. ij. semin. cardamom minor. decortic.
+    semunc. vini alb. hisp. lib. ij. sp. vini gallici, unc. viij.
+    digere sine calore & cola. Dosis ab. unc. i. ad unc. iij.
+
+Tinctura stomachica.
+
+    Rx Cort. canell. alb. semunc. cort. aurantior. unc. i. semin.
+    cardam. minor. decort. drachm. ij. spirit. vini gallici lib.
+    ij. digere sine calore & cola. Dosis a semunc ad unc. i. bis
+    terve die.--Adde pro re nata vin alb. hisp. lib. i.
+
+
+UNGUENTA.
+
+Unguenta c�rulea vel mercurial. Ph. Lond.
+
+Unguentum sulphuratum. Ph. Lond.
+
+
+VINA.
+
+    Vinum amarum.
+    ---- antimoniale.   Pharm. Lond.
+    ---- chalybeatum.
+
+
+VITRUM CERATUM ANTIMONII.
+
+
+
+
+AN ESSAY ON THE MEANS of Preserving the Health of SOLDIERS on SERVICE.
+AND Conducting MILITARY HOSPITALS.
+
+
+
+
+OF THE Means of Preserving the Health of Soldiers on Service.
+
+
+The Life of _British_ Soldiers on Service, in Time of War, is so very
+different from what they lead in Time of Peace, as to subject them to
+many Inconveniences and Diseases.
+
+In Time of Peace, Soldiers are quartered either in Towns or Garrisons,
+where they are under the Eye of their Officers, who take Care that
+they keep themselves clean, and provided with Necessaries; they lie
+either in private Houses or in Barracks, where they have a good Bed,
+regular Meals of wholesome Provisions, and enjoy most of the other
+Necessaries of Life in common with the lower Class of People, their
+Duty is easy, they mount Guard but seldom, and in other Nights enjoy
+an undisturbed Rest.
+
+Whereas, during the Time of an active Campaign, they are seldom in
+Houses; they lie in Tents upon the Ground, which is often bare, and at
+best covered only with Straw and a Blanket; and sometimes they are
+obliged, after fatiguing Marches in wet Weather, to lie on the bare
+Ground, without even a Tent to cover them; they must stand Centinel,
+and be upon Pikets and other Out-Posts in the Night, during all Kinds
+of Weather; besides performing long fatiguing Marches, and other
+military Duties; and when near an Enemy, they are perhaps on Duty
+every second or third Night, besides working Parties, and other Duties
+of Fatigue; and what Rest they have is interrupted by frequent Alarms.
+They have often but little Time or Convenience to make themselves
+clean. Provisions are sometimes scarce, and frequently on long Marches
+they have no Opportunity of dressing what they can get: Water is
+sometimes difficult to be come at, and what is to be got, is bad. And
+it frequently happens, that neither Beer, Wine, nor Spirits, can be
+purchased for Money. In fixed Camps, they are often exposed to the
+putrid Effluvia of dead Bodies, of dead Horses, and other Animals, and
+of the Privies and Dung of the Horses[116]; and, in some Encampments,
+likewise to the unwholesome Vapours of marshy Ground, and of corrupt
+stagnating Water: All which, joined to the other Hardships and
+Inconveniences unavoidably attending a military Life in Time of
+Service, often give Rise to numerous Diseases, which weaken an Army in
+a most surprising Manner; and therefore Commanders ought to use every
+Means in their Power, consistent with the necessary military
+Operations, to preserve the Health of the Soldiers.
+
+    [116] In the Year 1760, the Men, who remained in the fixed
+    Camp about _Warbourg_, were very unhealthy; while the
+    Regiments who were detached to the _Lower Rhine_, under the
+    Command of the Hereditary Prince of _Brunswick_, enjoyed a
+    much better State of Health; and notwithstanding their great
+    Fatigues, and the Loss they sustained at the Affair of
+    _Kampen_, were much stronger when they rejoined the Army to
+    go upon the Winter Expedition into the Country of _Hesse_,
+    than those Regiments which had remained in the fixed Camp.
+
+Diseases are more or less frequent in Armies according as the Season
+is hot or cold, wet or dry; according to the Nature of the Climate,
+and the Time of the Year in which military Operations are carried on;
+the Nature of the Ground on which the Army is encamped, or the
+Situation of the Towns or Villages in which they are cantonned; the
+Cleanness, Neatness, and Dryness of the Camp, and of the Tents or
+Houses in which the Soldiers are lodged; according as the Men are
+supplied with Provisions, and good Water, good Beer, Wine, or other
+fermented Liquors; or are well cloathed, and well furnished with Straw
+and Blankets; in proportion as the Duty is more or less severe; and to
+the Care taken of such as are attacked with Sickness.
+
+Soldiers generally enjoy good Health in cold dry Weather, even during
+the Time of severe Frost; if they be kept in Exercise, be well
+cloathed, and well supplied with Provisions and good Liquors, and
+with Wood; as the Troops, both in _Germany_ and _North America_,
+experienced during the late War; but Cold joined to Moisture was
+observed always to be productive of Diseases.
+
+Nor is mere Heat of itself such an Enemy to Health[117] as is
+generally apprehended; but when joined to Moisture, is observed to
+give Rise to the most fatal Disorders in the warm Climates.
+
+    [117] This Dr. _Pringle_ takes Notice of; and Mr. _Naesmith_
+    says, he observed it in Voyages to the _East Indies_, which
+    afford the fairest Trials of this Kind. See Dr. _Lind's Essay
+    on the Means of Preserving the Health of Seamen_, 2d edit.
+    note to page 5.
+
+In our northern Climates the Winters are cold, and the Weather
+variable; sometimes it is cold and rainy, at other Times thick and
+foggy; sometimes we have fair Weather and Sunshine, at other Times
+Frost and Snow; and sometimes it happens that we have all these
+different Sorts of Weather in the same Day. During this Season,
+Soldiers are subject to Coughs, Pleurisies, Peripneumonies,
+Rheumatisms, and other Disorders of the inflammatory Kind. And in
+very intense Frost, they are liable to have their Limbs benumbed with
+Cold, and their Extremities Frost bit (as it is called).
+
+And where there is a Want of fresh Provisions, and they are obliged to
+live on salted Meat, and cannot have Greens, Pot Herbs, Roots, or
+other fresh Vegetables, nor be properly supplied with Beer, Cyder,
+Wine, or other generous fermented Liquors, they, as well as Sailors,
+are subject to the Scurvy[118]; especially if they be encamped or
+quartered in low damp Places.
+
+    [118] Dr. _Joh. Valint. Willius_, Army Physician to the King
+    of _Denmark_, in his Treatise on Camp Diseases, says, you
+    scarce find a Camp in these northern Countries in which the
+    true Scurvy, attended with stinking Breath and eroded Gums,
+    is not to be observed. _Cap._ iii. _sect._ iii.
+
+The best Means of guarding against inflammatory Disorders, and other
+Mischiefs arising from Cold, whether in Camp or in Quarters, is, to
+take Care that the Soldiers be well cloathed; that they lie dry, and
+be well provided with Straw and Blankets, and with Wood; and to
+prevent, as much as possible, their exposing themselves to sudden
+changes from Heat to Cold.
+
+In these northern Climates, it would be right to allow every Soldier
+on Service a Flannel Waistcoat, a Pair of worsted Gloves, and a warm
+woollen Stock, or a Neckcloth, to wear when on Duty in cold and wet
+Weather, as soon as the Winter begins to set in[119]. Dr. _Pringle_
+mentions the Advantage the Troops received from the Flannel
+Waistcoats supplied by the Quakers, in the Winter Campaign of 1745-6,
+in _Britain_; and those Regiments who had them for their Men towards
+the End of the Campaigns in _Germany_, found that they contributed
+greatly to keep the Men in Health. Officers ought to take particular
+Care that the Men be well provided with good strong Shoes and
+Stockings; and where the Troops remain late in the Field, if the
+Government allowed a Pair or two extraordinary of each to every Foot
+Soldier, it would be of great Use to the Service.
+
+    [119] A Flannel Waistcoat, worsted Gloves, and woollen Stock,
+    or a Neckcloth, may be purchased for about Half a Crown _per_
+    Man, and would contribute to preserve the Lives of many; the
+    recruiting of others, to supply whose Places, if they die,
+    will cost the Government a great deal more than the Price of
+    the Articles mentioned; which for a Regiment of nine hundred
+    Men, at the Rate of two Shillings and Six-Pence _per_ Man,
+    comes only to 112_l._ 10_s._ _per Ann._ Every Recruit sent
+    from _England_ to the Army in _Germany_, cost the Government
+    at least twenty Guineas before he joined his Regiment; and
+    every sick Man sent to the general Hospital, cost the
+    Government at least sixteen Pence _per_ Day, which is ten
+    Pence above his Pay; so that, if we suppose the extraordinary
+    Cloathing here mentioned would preserve only the Lives of
+    nine Men to each Regiment yearly, and keep forty in Health
+    who would otherwise be sick, we see what great Gainers the
+    Government will be in Point of Money at the Year's End;
+    besides preserving the Lives and Health of so many Men.
+
+Blankets ought to be provided for each Tent, and those carried along
+with the Regiment, so as to be always ready for the Men when they come
+to their Ground. During the late War in _Germany_, a Couple of
+Blankets were allowed for each Tent of the _British_ Troops, and each
+Company carried their Blankets covered with an Oil Cloth on a Horse;
+so that they were always up with the Regiments when they came to their
+Ground.
+
+Each Regiment ought to be provided with a Number of Watch Coats
+sufficient to serve the Centinels who are to be on Camp Duty, or
+general Guards, in very cold and wet Weather. Some of the Regiments in
+_Germany_ had such Coats, and found great Service from them.
+
+In Winter Quarters, Soldiers are apt to make the Rooms in which they
+sit, and their Guard Rooms, as hot as possible; especially in
+_Germany_, where the Inhabitants use close Stoves, instead of open
+Fires; and continue in these warm Rooms till they are called out on
+Duty, when, by being exposed to sudden Cold, they are apt to be seized
+with Inflammations of the Breast; and therefore Officers ought to
+examine carefully the Quarters and Guard Rooms allotted for their Men,
+and chuse them dry and comfortable, if possible[120]; but never to
+allow the Men to keep them as hot as Ovens, by Means of close Stoves,
+or other such Contrivances; but to depend more on good warm Cloathing,
+and dry Quarters, for guarding against Diseases, than upon artificial
+Heat. Many of the Regiments in _Germany_ made the People in whose
+Houses their Men were quartered, take down their Stoves, and use only
+open Fires; when there was no Danger of the Soldiers making their
+Quarters too warm, as Wood was difficult to be got.
+
+    [120] Dr. _Pringle_ has very justly observed, that upper
+    Stories are preferable to Ground Floors; and that all
+    uninhabited large damp Houses ought to be rejected.
+    _Observat. on Diseases of the Army_, part ii. chap. iii.
+    sect. 2.
+
+    If Necessity obliges Officers to put up with such Places for
+    their Men, Care ought to be taken to clean them well, and to
+    air and dry them by Means of Fires, before the Soldiers go
+    into them; and to supply well the Men who are to lodge in
+    them with Straw and Blankets, and with Wood or Turf.
+
+But although close Stoves are prejudicial in small Rooms, yet when a
+Town is much crowded, and Men are obliged to be lodged, in Winter, in
+large Barns or Churches, or other large open Places, the _German_
+Stoves may be used with great Advantage in airing and drying such
+Places, and keeping them of a moderate Heat; especially if there be a
+Place in them for an open Fire, or if they be of that Kind which the
+_Germans_ call _wynd Stoves_, which have a Door opening into the
+Chamber where the People are lodged; or if there be broken Windows, or
+any other Opening by which a free Circulation of Air can be kept up
+in the Men's Apartments.
+
+In Winter, when the Weather is very cold or wet, a Glass of Brandy, or
+of the spirituous Tincture of the Bark, given to the Men as they went
+upon Duty, especially in the Night, has been found to be of great
+Use[121]. Dr. _Pringle_ has very justly observed, that the Times of
+standing Centinel, and being upon Out-posts, ought, if possible, to be
+shortened at such Seasons; and that Fires in the Rear of the Camp, for
+Men coming off Duty to warm and dry themselves at, were found to be of
+great Service.
+
+    [121] Dr. _Pringle_ has taken Notice, that it would be a
+    right Measure to make an Allowance of Spirits to the Infantry
+    on Service; which certainly would be of great Use, and save
+    many Mens Lives; and might be done at a small Expence to the
+    Government, if properly managed; as it would only be
+    requisite to make such an Allowance when the Troops are in
+    the Field, and to such Men as mount Guard in cold wet
+    Weather, or at Nights in Garrison Towns, during the Winter.
+    If ever such an Allowance be made, what Spirits are given to
+    the Men ought to be mixed with five or six Times the Quantity
+    of Water; except when Men are to stand Centinels, or to be
+    upon Out-Posts, in a frosty Season, or in cold wet Weather;
+    at which Time a small Glass of pure Spirits may be given them
+    in Presence of the Officer or Serjeant of the Guard.
+
+In Spring, and the latter End of Autumn, the Days are sometimes
+extremely hot, and the Nights cold and damp, and the Men exposed to
+these sudden Changes; at such Times, the Men who go upon Duty in the
+Night, ought to put on their Flannel Waistcoats, and be warmer
+cloathed than in the Day; and use many of the Precautions practised in
+Winter for the Preservation of their Health.
+
+In _North America_, when the Men were in the Field in very hard frosty
+Weather, Fires were lighted at the Ends of the Tents, and Centinels
+set over them to prevent their doing Mischief; and both in _Germany_
+and _North America_, when the Troops were in the Field without Tents,
+they cut down Wood and made large Fires, and the Soldiers lay down and
+slept round these Fires, with their Feet next to them; and Fires were
+lighted at all Out-posts, where it could be done with Safety.
+
+In _Germany_, when the Weather set in rainy or cold towards the End of
+the Campaigns, and the Army was in a fixed Position, his Serene
+Highness Prince _Ferdinand_ constantly ordered the Army to Hutt;
+which was done either by thatching their Tents, or building Hurdles,
+or digging Pitts, and covering and thatching them over. The Officers
+either built Hutts with Fire Places, or had Chimnies built to their
+Tents.
+
+If, notwithstanding all Precautions, Men upon Out-posts should be
+benumbed with Cold, or Frost bit, as soon as they are brought into
+Camp or Quarters, their Extremities ought to be rubbed with Snow, or
+put into cold Water[122]; and afterwards well dried, and wrapt up in
+Blankets; and warm mild Liquors given them to drink, and afterwards
+Cordials; and, after some Time, they may be brought near the Fire, or
+put to Bed. Dr. _Lind_[123] mentions one Caution to be used when Men
+are found in this Condition; which is, not to give them immediately
+strong spirituous Liquors, for that those often prove instantaneously
+fatal; but to put them to Bed, and give warm Water Gruel, or some
+other mild diluting Liquor, to drink; after which, he says, a Glass of
+Spirits will prove less dangerous and more beneficial.
+
+    [122] _Hildanus_ relates a very remarkable Instance of the
+    good Effects of this Treatment. A Man was found quite stiff
+    and frozen all over. He was put into cold Water, and
+    immediately the icy Spicula were discharged from all Parts of
+    his Body, so that he seemed covered with an icy Crust. He was
+    then put into a warm Bed, and took a Cordial Draught, and a
+    plentiful Sweat followed; after which he recovered with the
+    Loss of the last Joints of his Fingers and Toes. _De
+    Gangr�na_, cap. xiii. People who are benumbed with Cold in
+    frosty Weather ought never to be brought immediately near a
+    Fire; for that has been found either to cause immediate Death
+    or Gangrenes of the Extremities; and even Apples and other
+    Fruits which have been frozen, if brought immediately near a
+    Fire, turn soft and rot; but if put into cold Water, throw
+    out the icy Spicula, and recover, so as to be almost as good
+    as before they were frozen.
+
+    [123] _Means of Preserving the Health of Seamen_, 2d edition,
+    page 19.
+
+When Men are quartered or cantonned in Towns or Villages, whose
+Situation is low and damp, and where fresh Meat and Vegetables are
+scarce in Winter, and the Scurvy frequent among the lower Class of
+People; Commanding Officers, at the Approach of Winter, ought to use
+their Endeavours to provide a Store of Potatoes, Onions, Cabbages,
+sour Crout; of pickled Cabbages, and other pickled Vegetables; of
+Apples and other Fruits, preserved in different Forms, to be laid up,
+and sold out to the Men at a cheap Rate during the Winter. They
+should contract, if possible, with Butchers to furnish the Men with
+fresh Meat[124], and endeavour to procure good small Beer, or Cyder or
+Wine in the Wine or Cyder Countries; or Spirits to be mixed with
+Water, and a small Proportion of Cream of Tartar or Vinegar; or some
+other wholesome fermented Liquor for their Drink[125]; and to put
+their Men into as dry comfortable Quarters as possible.
+
+    [124] The Regiments in _Germany_ who kept their Butchers in
+    Winter, and made Stoppages of the Mens Pay, and obliged them
+    to take a certain Quantity of Meat daily, were much more
+    healthy than those who used no Precaution of this Kind.
+
+    [125] In Places where the Articles here mentioned are at too
+    high a Price for a Soldier's Pay, a small Allowance, from the
+    Government, of such Things would contribute much to the
+    Preservation of the Mens Health in unwholesome Garrisons.
+
+In Times of War, when Men are sent upon Expeditions into warm
+Climates, great Care ought to be taken to embark such only as are in
+good Health; particular Regard ought to be paid to those who are
+picked up in the Streets, or have been taken out of the _Savoy_, or
+other Jails. All dirty Rags from off such People ought to be thrown
+away or burnt; and the Men, after being well washed, and new cloathed,
+ought to be kept for a Fortnight or three Weeks in some Garrison Town,
+or with their Regiments, in open airy Places, that it may be
+ascertained that they have no infectious Disorder before they be put
+aboard the Transports.
+
+All Ships allotted for Transports ought to be well aired and purified,
+and every Thing fitted up properly, before the Men are embarked. They
+ought to be provided with Ventilators, or Wind Sails, to make a free
+Circulation of Air through the Vessel[126]; and they ought never to be
+crowded; but full Room allowed for each Man, in Proportion to the
+Length of the Voyage[127].
+
+    [126] See Dr. _Lind's Treatise on the Means of Preserving the
+    Health of Seamen in the Royal Navy_, where he takes Notice of
+    most of the Articles here mentioned with regard to Transport
+    Ships in treating of Ships of War.
+
+    [127] When Ships are too much crowded with Men, if they meet
+    with a tedious Passage, and hot moist close Weather, they are
+    often attacked with Diseases which prove very fatal. Dr.
+    _Lind_, talking of Ships of War, says it is a Mistake
+    destructive to the Men to crowd too many of them together in
+    a southern Voyage, or in a hot Climate; as the Ship will be
+    found, before the End of the Voyage, in more Distress for
+    Want of Men, than she would have been, had she at first
+    carried out only her proper Compliment. An additional Number
+    is made, in order to supply an expected Mortality; but they
+    generally increase that Mortality to double or triple their
+    own Number. _Ibid. note to p. 48._
+
+In military Expeditions, Soldiers are put upon Ships Allowance;
+which, Dr. _Lind_ very justly observes, ought not, in Voyages to the
+warm Climates, be made up so much of salted Beef and salted Pork
+(which always tend to the Putrescent), as is the common Practice of
+the Navy; but that a greater Share of Biscuit, Flour, Oatmeal, Goarts,
+Rice, and other Stores of that Kind, ought to be laid in; and a
+greater Proportion of them, and a Less of the salted Meat, distributed
+among the Men: And he is certainly in the Right, when he says, that a
+full Animal Diet, and tenacious Malt Liquors, are well adapted to the
+Constitution of our own, and of other northern Climates; and that
+Sailors who visit the _Greenland_ Seas, and are remarkable for a
+voracious Appetite, and a strong Digestion of hard salted Meat, and
+the coarsest Fare, when sent to the _West Indies_, soon become
+sensible of a Decay of Appetite, and find a full gross salted Diet
+pernicious to Health. "Instinct (he says) has taught the Natives
+between the Tropics to live chiefly on a Vegetable Diet, of Grains,
+Roots, and subacid Fruits, with Plenty of diluting Liquors[128]."
+
+    [128] The following is the Diet established for the Seamen of
+    his Majesty's Navy.
+
+    Every Man is allowed a Pound of Biscuit, _Averdupoiz Weight_,
+    and a Gallon of Beer, _Wine Measure_, _per_ Day.
+
+    On _Sunday_ and _Thursday_, one Pound of Pork, and Half a
+    Pint of Peas, _Winchester Measure_.
+
+    On _Monday_, _Wednesday_, and _Friday_, one Pint of Oatmeal,
+    two Ounces of Butter, and four Ounces of Cheese.
+
+    On _Tuesday_ and _Saturday_ two Pounds of Beef.
+
+    It is left to the Commanders of Squadrons to shorten the
+    aforesaid Allowance of Provisions according to the Exigence
+    of the Service, taking Care that the Men be punctually paid
+    for the same. As it is thought for the Benefit of the Service
+    to alter some of the foregoing Particulars of Provisions in
+    Ships employed on foreign Voyages, it is to be observed, that
+
+    A Pint of Wine, or Half a Pint of Rum, Arrack, or Brandy,
+    hold Proportion to a Gallon of Beer.
+
+    Four Pounds of Flour, or three Pounds of the same with a
+    Pound of Raisins, Half a Pound of Currans, or Half a Pound of
+    Beef Suet pickled, are equal to a four Pound Piece of Beef,
+    or two Pound Piece of Pork with Peas.
+
+    Half a Pound of Rice is equal to a Pint of Oatmeal.
+
+    A Pint of Olive Oil is equal to a Pound of Butter, or two
+    Pounds of _Cheshire_ Cheese.
+
+    And Two-thirds of a Pound of _Cheshire_ Cheese is equal to a
+    Pound of _Suffolk_.
+
+    If Soldiers are sent as Passengers on board of King's Ships,
+    or on board of Transports, their Allowance is generally but
+    Two-thirds of the above.
+
+A Store of Vegetables, such as Mustard Seed, Garlick, Onions,
+Potatoes, pickled Cabbages and other pickled Vegetables, sour Crout
+and other Things of that Kind, which can be purchased at a cheap Rate,
+and preserved for some Months, ought to be laid in; which may be mixed
+with the Soops prepared for the Men, or given them to eat along with
+their salted Provisions.
+
+A Quantity of Beer, Cyder, or Wine, ought to be put aboard, and a
+certain Allowance distributed to each Man daily. When, for Want of
+these, Men are reduced to an Allowance of Spirits, they ought to be
+mixed with seven or eight Times the Quantity of Water, or made into
+Punch, by the Mixture of Water and Molosses, and the Juice of Lemons,
+before they are given to the Men; and, if Lemons cannot be got, Cream
+of Tartar, or Vinegar, ought to supply their Place; and it ought to be
+a Duty of one of the military Officers on board to see the Punch made,
+and distributed among the Men daily.
+
+It would be right, on all Expeditions into warm Climates, to send some
+Sloops of War, or other armed Vessels, before the grand Fleet, to take
+up a Quantity of Wine that will keep, either at the _Madeira_, or
+other Wine Countries; and afterwards to go to any of our Settlements
+that are nearest the Place of Destination, and to take in a Quantity
+of Limes, Lemons, Oranges, and other Fruits, and Vegetables which will
+keep for some little Time; and of Spirits, live Stock, and other
+Provisions proper for the Army; and then to meet the Fleet at the
+general Rendezvous. When once a Landing is made good, these Vessels,
+after having unloaded their Cargoes, may either be employed on other
+Services, or kept constantly going and coming for whatever Stores or
+Provisions are wanted for the Army or Fleet.
+
+A sufficient Quantity of Vinegar ought to be put on board of each
+Transport, both for the Men to eat with their Victuals, and likewise
+for fumigating and washing between Decks occasionally. And a Quantity
+of Molosses, or coarse brown Sugar, and of Lemons, or their
+inspissated Juice, or Cream of Tartar, ought to be allowed for making
+the Punch, as well as for other Purposes.
+
+If the Water become foetid, the Quantity to be used in the Day ought to
+be sweetened by Means of the Ventilator contrived by the ingenious Dr.
+_Hales_[129] for that Purpose.
+
+    [129] This Ventilator is no more than a long Tube, with a Tin
+    Box, about six Inches wide and four high, with a Number of
+    Holes at the Top, fixed at one End; and this Box is put down
+    to the Bottom of the Water, and the Nose of a Pair of Bellows
+    fixed to the other End of the Tube, which is above the Water;
+    by working the Bellows, fresh Air is driven through the whole
+    Body of Water, the putrid Effluvia are evaporated and
+    dispersed, and the Water becomes sweet in a very short Time.
+
+The Men ought to be brought upon Deck, and Roll called two or three
+Times a Day; they should be made to comb their Hair, and wash their
+Hands and Face every Day, and to shift themselves sometimes, if
+possible; and in every respect keep themselves as clean as the Nature
+of the Service will admit; and proper Exercises should be contrived,
+to keep them in Health.
+
+All the Parts of the Ship ought to be kept very neat and clean; and
+the Hold, and all between Decks, ought to be scraped and swept daily;
+and every Morning, in fair Weather, ought likewise to be washed, and
+afterwards sprinkled or washed with warm Vinegar, while the Men are
+upon Deck[130].
+
+    [130] This ought always to be done in the Morning, that all
+    the Parts of the Ship may have Time to dry before the Men go
+    to rest in their Births at Night; but it ought never to be
+    done after Sun-set.
+
+When the Weather will permit, Fires of dried Wood may be lighted in
+Iron Kettles between Decks, and Centinels set over them, and the Fires
+sprinkled with Rosin or Bits of Rope dipt in Tar, or with some cheap
+Aromatic; and these Fires may be carried into all the Parts of the
+Ship that Safety will permit, in order to dry and purify the Air[131].
+After this Operation all the Ports and Hatchways should be opened,
+and the Air in all the Parts of the Ship often renewed by working the
+Ventilators.
+
+    [131] It has been proposed, that the Air in Ships of War
+    should be purified in this Way both by Dr. _Lind_ and by
+    Mons. _de Hamel de Monceau_.
+
+The Mens Hammocks and Beds ought to be brought up upon Deck in fair
+Weather, and well aired, and afterwards put in their Places, and Fires
+lighted below Decks.
+
+When Troops, sent on an Expedition into warm Climates, arrive at the
+Place of their Destination, particular Care should be taken to guard
+them against the Diseases peculiar to such Climates, which are
+different from those common to our more northern Latitudes.
+
+Dr. _Lind_ says, that People coming first from a cold into a hot
+Climate are apt to have plethoric Symptoms; a Pain of the Head,
+Giddiness, a Sense of Weight, and Fulness of the Breast, and a slight
+Inflammation of the _tunica conjunctiva_; and that some are apt to be
+seized with ardent Fevers and Diarrhoeas. And all Practitioners have
+observed, that New-Comers into warm Climates are at first liable to
+Fevers tending to the Ardent, and are very subject to Fevers of the
+remitting and intermitting Kind, which are the Endemics of all warm
+Countries at certain Seasons of the Year; and after some Time they are
+apt to fall into Fluxes, the Yellow Fever, and other Diseases
+depending on a putrescent State of the Juices. In military Expeditions
+these Disorders are liable to be complicated with Fevers of the
+Malignant or Hospital Kind, if Care is not taken to prevent it. And
+nothing has been found to be more productive of Diseases in those warm
+Climates, than indulging freely in the Use of Spirits and other strong
+fermented Liquors; exposing one's self to the Damps, especially lying
+on the Ground after the Dews fall; and working hard, or using violent
+Exercise in the Heat of the Day.
+
+The best Preservatives against Diseases in warm Climates have been
+found to be,--1. Temperance; a Diet of light and easy Digestion,
+composed more of vegetable than of animal Food; such as a small
+Portion of fresh Meat, joined with a sufficient Quantity of
+Vegetables; Rice, _Indian_ Corn, and other Grains, and Roots of
+various Kinds, prepared in different Forms; well baked Bread; the
+moderate Use of ripe Fruits; and the free Use of mild cooling subacid
+Liquors, joined with a small Proportion of vinous or spirituous
+Liquors; carefully avoiding the too liberal Use of Wine, Spirits, or
+other strong fermented Liquors.--2. Great Care not to expose one's
+self to the Damps of the Night, nor lie down to sleep on the Grass, or
+in woody moist Places, in the Day; and to avoid all violent Exercise
+in the Heat of the Sun.--3. Such Means as tend to support the Spirits;
+for Chearfulness has been observed to contribute as much to the
+Preservation of Health, as Fear and Dejection of Spirits to the
+Production of Diseases.--4. Keeping the Body clean, and bathing
+frequently in the Sea, or in a River, in the Morning.
+
+And therefore, in warm Climates, Officers ought to be particularly
+careful to keep their Men sober and temperate; to procure them good
+Bread, and Plenty of Vegetables and fresh Meat, if possible; and
+where no other but salted Meat can be got, to make them boil a small
+Proportion of it in their Camp Kettles, along with Onions, Goarts,
+Rice, Carrots, Turnips, Greens, or any other wholesome Roots or Herbs
+which the Country affords, or they can get, and of these to prepare a
+good wholesome Soop for themselves; and where there is Plenty of the
+ripe acescent Fruits, which are reckoned wholesome, to distribute a
+moderate Quantity among the Soldiers daily, which will both help to
+preserve their Health, and prevent them from privately stealing and
+eating large Quantities to the Prejudice of their Health.--To
+encourage their Men, and keep up their Spirits.
+
+They should also prevent, as much as possible, the too free Use of
+Wine, Spirits, or other strong fermented Liquors; and in Wine
+Countries give every Man a daily Allowance of Wine, to be mixed with
+Water for his common Drink; and in Countries where nothing but Spirits
+can be got, make the Spirit be mixed with Water, or made into a very
+weak Punch, before it is given to the Men, as Lemons, Oranges, Limes,
+and other Fruits proper for this Purpose, are generally to be had in
+most warm Countries.
+
+They should be careful not to march their Men in the Heat of the Day,
+nor order them upon Duty where they must stand exposed to the Dews and
+Damps of the Night, unless where the military Operations absolutely
+require it.
+
+They should endeavour to make the Bottom of the Tents be covered with
+Straw, or dried Leaves of Trees, or dried Reeds, and with
+Blankets[132], for the Men to lie upon.
+
+    [132] A sufficient Store of Blankets has often been neglected
+    to be carried out in Expeditions into warm Climates; but
+    Blankets are no-where more necessary, as it is very
+    prejudicial to the Health of Soldiers to be obliged to lie
+    down on the bare Ground; and Straw, dried Reeds, and other
+    such Things, are often difficult to be got in the warm
+    Climates.
+
+The Time of standing Centinel, and being upon Out-posts, if possible,
+should be short, where Men are exposed to the scorching Heat of the
+Sun; and when Men are upon Out-posts in the Night, it should be
+recommended to them to lie down on the Ground as little as possible;
+and if they do it, to chuse a dry Place; and, where it can be done,
+to have it covered with Straw or a Blanket, and to have some light
+Covering to defend them from the Dews.
+
+The Tents should be covered with Boughs of Trees, and the Men should
+be ordered sometimes to strike them in the Middle of the Day, and air
+well every Thing within them.
+
+The Men should be obliged to keep themselves neat and clean; to comb
+their Hair, and change their Linen often; and if the Camp be near the
+Sea, or a large River, they ought to bathe early in the Morning as
+often as the Nature of the Service will permit. However the following
+Caution, mentioned by Dr. _Lind_, ought to be observed, which is, not
+to go into the cold Bath when overheated with Work or Liquor, or when
+the Stomach is full, or when a critical Eruption, called the prickly
+Heat, appears on the Skin[133].
+
+    [133] Dr. _Lind_ says, the Use of the cold Bath, either in
+    Tubs under the Forecastle, or to dip in the Sea early in the
+    Morning, has been found extremely beneficial in warm Weather
+    and hot Countries; and that he can affirm, from his own
+    Experience in hot Climates, that many Diarrhoeas and other
+    Complaints, the pure and sole Effect of an unusual and great
+    Heat (relaxing the System of the Solids, and occasioning a
+    Colliquation of the Animal Juices), have not only been cured
+    by cold Bathing; but their Return, and even the Attack of
+    such Diseases, effectually prevented by it. _Ibid._ p. 44,
+    &c.
+
+When Men are seized with inflammatory Symptoms on entering into warm
+Climates, they may be blooded freely: Afterwards they do not easily
+bear such copious Evacuations, but rather require to have them made in
+smaller Quantities, and very early and frequent, as Inflammations make
+a rapid Progress in warm Countries. Dr. _Lind_ says, many
+Practitioners disapprove of Blood-letting in the Countries lying under
+the Torrid Zone, on a Supposition that the Blood is too much
+dissolved; but he thinks that this Rule will admit of many Exceptions;
+and that Sailors (_and consequently Soldiers_), being strong and
+robust, and exposed to greater Vicissitudes of Heat and Cold, and more
+Excesses, and other Accidents in general, bear freer Bleeding than any
+other Set of People.
+
+After some Time, the Diseases in these warm Climates tend to the
+putrid Kind, and must be treated as such.
+
+In all Countries, and in all Climates, great Care ought to be taken in
+chusing the Ground on which Men are to encamp. Dry high Grounds,
+exposed to the Winds, where there is a free Current of Air, and which
+lie at a Distance from Marshes, stagnating Water, and large Woods, are
+generally healthful in very different Climates[134]. But Places
+situated low, where, on digging two or three Feet below the Surface of
+the Earth, you come to Water[135], and marshy Grounds, and Places
+surrounded with corrupt stagnating Water, are almost always the
+contrary, and very unhealthful; as are often those Grounds which are
+subject to be overflowed by large Rivers, and low Places covered with
+Wood, where there is no free Circulation of Air. However, it ought to
+be observed, that it is not the Neighbourhood of Water alone which is
+prejudicial, but the watery Vapours which keep the Air perpetually
+moist, and the Exhalations of corrupt Effluvia, which render such
+Places unwholesome; for the Neighbourhood of Rivers, and of the Sea,
+where the Tide ebbs and flows freely, has no such Effect, where the
+Situation is dry and airy; and those very unhealthy marshy Grounds
+often continue healthy in cold Weather, when their Waters are
+refreshed with Rains[136], and little or no moist putrid Exhalations
+rise from them; though, as Dr. _Pringle_ observes, in Summer and
+Autumn, when their Waters begin to corrupt, and the Exhalation is
+strong, they are always exposed to Diseases; and it is for this
+Reason that such Places are always very unhealthy in warm Climates.
+
+    [134] Mr. _du Hamel_ says, that the Air of the Island of _St.
+    Domingo_ is very fatal to _Europeans_; but it is observed
+    that those People who inhabit the rising Grounds are much
+    less exposed to Diseases than those who live in the Vallies.
+    _Sur la sant� des Equipages_, art. i. p. 16.
+
+    [135] Ground may seem very dry and healthful, and yet be
+    quite the contrary, as Dr. _Pringle_ remarks is the Case in
+    the Neighbourhood of _Bois le Duc_, in _Flanders_, where
+    Water is found every where at the Depth of two or three Feet
+    from the Surface.
+
+    [136] Mr. _du Hamel_ remarks, that Places which were formerly
+    very subject to Diseases have become healthful when the Water
+    which surrounded them was refreshed by opening a
+    Communication with the Sea. _Ibid._ art. i. p. 18.
+
+Hence, where the military Operations will permit, Commanders, if
+possible, ought to chuse a dry Ground, whose Situation is high, and
+which admits a free Current of Air, such as on the Banks of Rivers,
+where there is generally a Stream of fresh Air, and Plenty of fresh
+Water to supply the Camp[137]; taking Care to avoid the Neighbourhood
+of low marshy Grounds, and corrupt stagnating Waters, especially in
+Summer, and in hot Climates.
+
+    [137] Dr. _Pringle_ observes, that where Grounds are equally
+    dry, that the Camps are always most healthful on the Banks of
+    large Rivers; because in the hot Season Situations of this
+    Kind have a Stream of fresh Air from the Water, tending to
+    carry off both the moist and putrid Exhalations.--And in
+    Cantonments we are not only to seek Villages removed from
+    marshy Grounds, but such as are least choaked with
+    Plantations, and stand highest above subterraneous Water. See
+    his _Observat. on Diseases of the Army_, 3d edit. p. 99.
+
+When Necessity obliges Commanders to take Post, or encamp in a wet or
+marshy Ground, they should endeavour to make it as dry as possible, by
+ordering Trenches to be cut for Drains across the Field and round the
+Mens Tents; to see that the Ground within the Tents be well covered
+with Straw; to order the Tents to be struck at Mid-Day, in dry warm
+Weather, and the Men to dry and air the Straw, and change it
+frequently; to have a proper Supply of Blankets for the Men, and to
+take Care that they be well cloathed, especially those who go upon
+Duty in the Nights; and, in the northern Climates, to have Fires in
+proper Places for warming the Men and drying their Cloaths, and for
+correcting the Dampness of the Air[138].
+
+    [138] The Negroes on the Coast of _Guinea_, and some of the
+    _Indians_, both of whom sleep on the Ground, have constantly
+    a Fire producing a little Smoak burning in the Hutts where
+    they sleep, which corrects the Moisture of the Night, and
+    renders the Damp of the Earth less noxious; and during the
+    Time of the very unwholesome Fogs on the Coast of _Guinea_,
+    called Harmattans, which lay waste whole Negroe Towns, the
+    Smoak of Wood, of pitched Staves, and such Things, are found
+    to be the best Correctors of this thick Air. See Dr. _Lind's
+    Means of preserving the Health of Seamen_.
+
+In Countries lying under the Torrid Zone, the Parts near the Sea Shore
+are often marshy, or close and covered with Wood, or have swampy
+Beaches, and are very unwholesome; and therefore where Soldiers aboard
+of Transports keep their Health, Commanders ought to be very careful
+not to allow them to land, till they come to the Place of their
+Destination. Dr. _Lind_ observes, that Men commonly live more healthy
+in warm Climates at Sea, where the Air is dry and serene, and the Heat
+moderated by refreshing Breezes, than when they arrive in Harbours, or
+get within Reach of the noxious Vapours which arise from many Parts of
+the Land[139].
+
+    [139] Dr. _Lind_ says, that it is constantly observed in
+    unhealthy Harbours, that the Boats Crews employed in wooding
+    and watering the Ships, who are obliged to lie on Shore,
+    suffer most. _Ibid._ p. 72.
+
+When Necessity requires Parties to be landed for Wood or Water, or on
+other Duties, they should always be obliged to return and lie aboard
+at Night; and if that cannot be done, they should be cautioned to
+avoid lying down to sleep on the Grass, where the Air is fresh, or
+they are exposed to the Dews; and to pitch their Tents on a rising
+Ground, covered with Straw or dried Reeds, and a Blanket; and to use
+the other Precautions necessary for encamping in these warm Climates;
+for where this Care has been neglected, the Consequences have
+frequently proved fatal[140].
+
+    [140] A very remarkable Instance of this we have related by
+    Dr. _Lind_. In the Year 1739, in _Mahon_ Harbour, a Party of
+    Men were sent with the Coopers from Admiral _Haddock_'s Fleet
+    to refit and fill the Water Casks, who, finding an artificial
+    Cave dug out of a soft sandy Stone, put their bedding into
+    it; every one who slept in this damp Place was infected with
+    the Tertian Fever, then epidemic in _Minorca_, and not one in
+    eight recovered. At the same Time the Men aboard the Ships
+    continued healthy; and others, who were afterwards sent on
+    the same Duty, enjoyed perfect Health by being obliged to
+    sleep in their respective Ships. He says, he has known a
+    whole Boat's Crew seized next Morning with bad Fevers by
+    sleeping near the Mangroves, with which the Sides of the
+    Rivers are frequently planted in the Torrid Zone. _Ibid._ p.
+    74, 75.
+
+On unhealthful Coasts, the noxious Land Vapours often affect the Crews
+of Ships that run up into Rivers or Harbours, and cause great
+Sickness; and therefore in such Places Ships should anchor at as great
+a Distance from the Shore as can well be done, that they may be
+exposed to the Sea Breezes, and as much to the Windward of the Woods
+and Marshes as possible; and if the Anchorage is safe, one should
+prefer the open Sea to running up into Rivers or Creeks[141].
+
+    [141] The higher that Ships sail up the Rivers upon the Coast
+    of _Guinea_, the more sickly they become: Such, however, as
+    keep at Sea beyond the Reach of the Land Breezes (that is,
+    two or three Leagues at Sea), are for the most part healthy.
+    _Lind_, _ibid._ p. 65. The Malignity of these Land Vapours
+    often does not extend itself to any considerable Distance, as
+    we know by manifold Experience. The Troops in _Zealand_ were
+    very unhealthy when Admiral _Mitchel_'s Squadron, which lay
+    but a little Way from the Shore, enjoyed perfect Health.--Dr.
+    _Pringle's Observat. on the Diseases of the Army_, p. 1.
+    chap. vii.--In _July_ and _August_ 1744, two Ships, belonging
+    to Admiral _Long_'s Squadron in the _Mediterranean_, lying
+    near the Mouth of the River _Tyber_, began to be affected,
+    while others, though at a very small Distance, but further
+    out at Sea, had not a Man sick. _Lind_, _ibid._ p. 66.
+
+Cleanness and Neatness in the Camp is another Article that ought to be
+particularly regarded. _Portius_, _Ramazini_, and most other Authors
+who treat of Camp Diseases, attribute those of the putrid Kind in a
+great Measure to the Stench and putrid Effluvia arising from the
+Excrements of Men and Beasts, and from the dead Bodies of Men, Horses,
+and other Animals, lying unburied in the Neighbourhood of Camps, and
+have in a particular Manner mentioned the Necessity of burying such
+putrid Substances. Dr. _Pringle_ has very justly recommended the
+Digging of Deep Pits for Privies in Camp, and covering the Excrements
+with Earth daily[142] till the Pits are near full, and then to fill
+them up with Earth, and dig new ones; and to punish every Person who
+shall ease himself any where in Camp but in the Privies: And he
+remarks, that when the Camp begins to turn unhealthy, that often the
+only Means that will preserve the Health of the Men, is to change the
+Ground, and to leave behind all the Filth and Nastiness which gave
+Rise to those putrid Disorders.
+
+    [142] The divine Lawgiver _Moses_ has enjoined Cleanliness in
+    the Camp to the _Jews_ in a particular Manner, when he says,
+
+    "Thou shalt have a Place also without the Camp, whither thou
+    shalt go forth abroad; and thou shalt have a Paddle upon thy
+    Weapon, and it shall be when thou wilt ease thyself abroad
+    thou shalt dig therewith, and shalt turn back and cover that
+    which cometh from thee. For the Lord thy God walketh in the
+    Midst of thy Camp; therefore shall thy Camp be holy, that he
+    see no unclean Thing in thee, and turn away from thee."
+    _Deuteronomy_, chap. xxiii. verses 12, 13, 14.
+
+In fixed Camps, the striking the Tents at Mid-Day in fair Weather,
+and turning and airing the Straw, and changing it often, as
+recommended by Dr. _Pringle_, will contribute much to preserve the
+Health of the Men; and making the Men wash themselves daily, and
+change their Linen often, and keep themselves otherwise clean, ought
+never to be omitted by the Officers.
+
+All military Authors have recommended to Commanders always to have
+Straw for their Men when they come to their Ground, if possible; and
+to have the Army well supplied with Provisions; giving proper
+Encouragement to the Country People, and to Suttlers and Merchants of
+all Sorts, to bring in every Kind of Provisions and other Necessaries
+to Camp; and preventing, as much as possible, the Soldiers from
+moroding. And the Commanders of every Corps ought to take Care that
+their Men form themselves into Messes, and that Stoppages be made for
+buying them Provisions.
+
+In _Germany_ every Regiment of the _British_ Troops contracted with a
+Butcher, who was obliged to carry along with them, at all Times, a
+certain Number of live Sheep and Oxen to kill when wanted, and to sell
+the Meat at a fixed Price. Every Soldier was obliged to take a certain
+Quantity, which was paid for by Stoppages made in his Pay; and this
+Meat was boiled in the Camp Kettles, with such Roots and Greens as
+could be got; by which Means the Men, whenever they could use their
+Kettles, had always a good warm Soop, as well as Meat, to refresh them
+after their Fatigues, which, along with their Ammunition Bread, made a
+good wholesome Food.
+
+In Countries where Fruit is plentiful, a certain Quantity of what is
+fully ripe, distributed to the Men in warm Weather, and in hot
+Climates, will contribute to preserve their Health, though the Abuse
+of it will prove prejudicial; but unripe and acrid Fruits are always
+hurtful[143].
+
+    [143] The _British_ Soldiers in _Germany_ used sometimes to
+    hurt their Health by eating great Quantities of raw unripe
+    Apples, Plumbs, and other unripe Fruits; but the foreign
+    Troops had a much better Method of using such Fruits: They
+    commonly boiled or stewed them, and eat them with Bread, or
+    with their Meat, which in a great Measure corrected their bad
+    Qualities.
+
+    The Orders in the _French_ Camp, prohibiting the Men from
+    eating unripe Fruit, were strictly complied with every-where
+    in _Germany_ during the late War.
+
+Water is another Article which Commanders endeavour to have their Camp
+well supplied with, and therefore they generally encamp near Rivers or
+Rivulets. Where the Stream is small, Care ought to be taken that its
+Course be not interrupted, and that no Filth or Nastiness, or any
+Thing that will spoil or corrupt the Water, be thrown into it.
+
+When there are no Rivers or Rivulets near a Camp, and the Men are
+supplied from Wells, if the Water is not pure, very often the digging
+of deep Pits, and covering the Bottom and Sides with large Stones, and
+over these a Lay of Sand, Gravel, or Chalk, will make the Water pure
+in a few Hours.
+
+In fixed Camps, where the Water is bad, _Portius_[144] proposes
+straining it thro' Sand, and has given Figures of Machines to be used
+for that Purpose; but the Method proposed by Dr. _Lind_ is still more
+simple, which is, to get a broad Cask with one End struck out; then
+put a longer Cask, with both Ends struck out, in the Middle of it;
+fill the short Cask one-third with Sand, and the inner longer Cask
+above one-half; fill the Rest of the inner Cask with the Water, which
+will filter through the Sand, and rise above the Sand in the outer
+Cask, where it may be allowed to run off into Vessels placed to
+receive it, by Means of a Cock, put into the Side of the outer Cask,
+fifteen or twenty Inches above the Level of the Sand.
+
+    [144] See the Treatise published by Dr. _Luc. Anton. Portius_
+    in 1686, _de Militis in castris sanitate tuenda_, _part._ ii.
+    _cap._ vi. In this Book we have many useful Things mentioned
+    relative to the Health of Soldiers.
+
+Where there are no such Conveniences for purifying the Water, what is
+used for Drink ought to be mixed with a small Proportion of Spirits,
+or Wine, or with Vinegar, or Cream of Tartar, when neither of the
+other two can be got; and if the Water be previously boiled, it will
+be so much the better.
+
+In Expeditions into warm Countries, where fresh Water is difficult to
+be had, a few Stills, with a proper Apparatus, ought to be carried
+out; and after a Landing is made, the Stills ought to be set to work
+for distilling fresh Water from Sea Water in the Manner mentioned by
+Dr. _Lind_[145]; and although a sufficient Quantity cannot be
+distilled for serving the whole Army, yet enough may be got in this
+Way for the Use of the Sick.
+
+    [145] Dr. _Lind_ relates a Number of Experiments of his
+    having distilled Sea Water in different Manners, as
+    recommended by others; and concludes, that the best Way of
+    getting fresh Water from Salt, is to distil the Sea Water by
+    itself, without any Mixture; and he proposes having a Still
+    Head to the Coppers or Iron Pots in which the Meat is dressed
+    aboard a Ship. _Ibid. note to p. 84_, &c.
+
+When Men are very warm, after long Marches, and other hard Duties, in
+Summer; Officers should endeavour to prevent their swallowing
+immediately great Quantities of cold Water, and persuade them to wait
+a little till they cool; and at such Times, if Spirits can be got
+easily, to order a small Quantity to be mixed with the Water in each
+Man's Canteen.
+
+Though the Abuse of vinous and spirituous Liquors is very destructive
+to the Constitution, yet these same Liquors, given in Moderation to
+Soldiers on Service, during the Times of great Fatigues, are some of
+the best Preservatives of Health. Spirits, for common Use, ought to
+be mixed with Water; and in the hot Climates made into Punch; though
+in very cold and wet Weather, and in damp Nights, a Glass of pure
+Spirits, given to the Men going on Duty, is of great Service; for it
+is always observed, that Men are much less apt to catch Diseases from
+being wet when they are upon a March, or at hard Work, than when they
+stand Centinels, or are upon Out-Posts where they move but little, or
+when they lie down in their wet Cloaths; and that they are less liable
+to be affected by the Weather after a hearty Meal, or drinking a Glass
+of Spirits, or some generous Liquor, than when their Stomachs are
+empty.
+
+An Infusion of Bark or other Bitters, and of Garlick, in Spirits, has
+been found to encrease their Efficacy as Preservatives both against
+the Effects of Cold and malignant Distempers. Dr. _Lind_ has
+recommended an Infusion of Garlick in Spirits as one of the best
+Stomachics and Diaphoretics he knows in cold wet Weather. And many
+have recommended a Tincture of the Bark[146]: Towards the End of the
+Year 1743, Mr. _Tough_, one of the Apothecaries to the _British_
+military Hospital in the late War, then a Mate to a marching Regiment,
+was ordered to go down the _Rhine_ with a Party of Sick, who had the
+Seeds of the Hospital Fever among them, and were to go in Bilanders,
+from _Germany_ to _Flanders_. Having had a Cask or two of Brandy put
+aboard as Part of the Stores for the Sick, he was afraid lest the Men
+should make too free with the Spirits; to prevent which he threw in a
+Quantity of Bark into each Cask, and gave the Men regularly, Morning
+and Evening, a Glass of this bitter Tincture. At the same Time, the
+Men were kept extremely clean. By these Means most of the Sick mended
+upon the Passage, without the Malignant Fever appearing again amongst
+them; whereas, Dr. _Pringle_, who takes Notice of the other Parties
+who came from the same Hospitals in _Germany_, tells us, that the
+Malignant Fever broke out in a violent Degree, and Half the Number
+died by the Way, and federal others soon after their Arrival[147].
+
+    [146] During the Campaign in _Hungary_, in the Year 1717,
+    Count _Boneval_ preserved both himself and Family from
+    Disorders, by taking himself, and making all his Domesticks
+    take, two or three Times a Day, a small Quantity of Brandy,
+    in which Bark had been infused, at a Time when all the Rest
+    of the Army were infected with malignant Disorders. A
+    Regiment in _Italy_ continued healthy by the Use of the Bark,
+    when the Rest of the _Austrian_ Army, who did not pursue the
+    same Method, were greatly annoyed with Sickness. See
+    _Kramer._ quoted by Dr. _Lind_.
+
+    [147] _Observat._ part. i. chap. iii.
+
+Commanding Officers ought always to endeavour to proportion the Time
+the Men are to be upon Duty to the Weather and the Nature of the
+Climate. The Time of standing Centinel in very hard Frost, and in cold
+wet Weather, or in the Heat of the Day in Summer, when the Weather is
+very warm, and in hot Climates, ought to be shorter than when the
+Weather is dry and more temperate.
+
+The Marches of Troops ought, if possible, during the Time of very hot
+Weather, to be made either very early in the Morning, in the Evening,
+or at Night; and Officers, during the Course of an active Campaign,
+ought to spare their Men as much as possible.
+
+And when they are in Quarters, and have nothing to do, they should
+narrowly inspect into their Manner of living; and have them out daily,
+when the Weather will permit, and exercise them, or march them two or
+three _English_ Miles a-Day, in order to prevent their falling sick
+for want of Exercise; for Soldiers left to themselves are very subject
+to Diseases when they come into Quarters after an active Campaign, by
+leading too indolent a Life, if Officers do not take Care to prevent
+it. However, at such Times, the Exercise ought to be moderate, and the
+Men should not be brought out in wet Weather.
+
+
+
+
+OF MILITARY HOSPITALS.
+
+
+Whenever Men are seized with Distempers, they ought immediately to be
+separated from those in Health, and either sent to the Regimental[148]
+or General Hospital.
+
+    [148] Some of the regimental Surgeons in _Germany_, when they
+    took the Field, had always some spare Tents carried along
+    with their Medicine Chests; and when any of their Men fell
+    sick in Camp, and they could get no House for a regimental
+    Hospital in Villages, they ordered these Tents to be pitched,
+    and had the Ground within well covered with Straw and
+    Blankets, and then put the Sick into them, and there took
+    Care of them till they found an Opportunity of sending them
+    to the Flying Hospital.
+
+There is no Part of the Service that requires more to be regarded than
+the Choice of proper Places for Hospitals, and the right Management
+of them, on which the Health and Strength of an Army often depends;
+for in wet unwholesome Seasons, if infectious Disorders get into the
+Hospitals, which possibly might have been prevented by proper Care,
+they often weaken an Army in a very short Time far more than the Sword
+of the Enemy.
+
+We have no Account of the particular Manner in which the Antients took
+Care of their Sick and Wounded in Times of War; for although we read
+in _Homer_[149] of Surgeons or Physicians attending the _Grecian_
+Camp, and in _Xenophon_[150] of _Cyrus_'s having appointed Physicians
+to his Army; and we learn from _Tacitus_[151] and _Livy_[152], that
+the wounded _Romans_ were received into the Houses of the Nobility,
+and had Physicians to attend them, and were furnished with
+Fomentations and other proper Remedies; and from _Justin_[153], that
+the _Lacedemonians_ followed the same Method: yet these Authors make
+no Mention of the particular Oeconomy or Manner in which these
+Hospitals were conducted.
+
+    [149] _Homer_ mentions _Podalirius_ and _Machaon_, sons of
+    _�sculapius_, as two excellent Physicians or Surgeons in the
+    _Grecian_ Army. Vid. _Iliad_, lib. ii. Physic and Surgery
+    were antiently exercised by the same Persons.
+
+    [150] Vid. _Xenophon. de Institut. Cyri._ lib. i. et viii.
+
+    [151] _Tacitus_, after giving an Account of 50,000 People
+    being killed by the Fall of an Amphitheatre at _Fidena_,
+    during the Time of a Shew of Gladiators, has these Words:
+    "Ceterum post recentem cladem, patuere procerum domus,
+    fomenta & medici passim pr�biti; suit urbs per illos dies,
+    quanquam m�sta facie veterum institutis similis, qui magna
+    post pr�lia saucios largitione & cura sustentabant." _Vid.
+    lib._ iv. _Annal._ � 63.
+
+    [152] In _Livy_ we find the following Passage: "Neque immemor
+    ejus quod initio consulatus imbiberat, conciliandi animos
+    plebis, saucios milites curandos dividit patribus. Fabiis
+    plurimi dati, nec alibi majore cura habiti." _Vid. lib._ ii.
+    cap. xlvii.
+
+    [153] _Justin_ mentions the same Thing of the _Spartans_
+    after their Defeat at _Sellasia_--"Patentibus omnes domibus
+    saucios excipiebant, vulnera curabant, lapsos reficiebant."
+    _Vid. lib._ xxviii. cap. iv.
+
+The Hospitals commonly wanted for an Army acting on the Continent,
+are,
+
+1. One in the Rear, to follow their Motions, so as to be always ready
+to receive the Sick from Camp, which is called the Moveable or Flying
+Hospital. 2. One or more, at some Distance, in Towns, to receive such
+of the Sick as can be moved from the Flying Hospital, when they are
+obliged to go from one Place to another; or when a greater Number of
+Sick is sent to them than they can easily take Care of[154].
+
+    [154] When Parties of Sick or Wounded are to be sent from
+    Camp, or from one Hospital to another, Care ought to be taken
+    that they are placed properly in the Waggons; that they have
+    proper physical People, Nurses, &c. to attend them; as well
+    as Provisions, and other Necessaries, so as to be in no
+    Danger of wanting any Thing while they are on their Journey.
+
+Each of the Hospitals ought to be provided with Physicians, Surgeons
+Mates, Purveyors, or Commissaries, and others, to attend and take Care
+of the Sick.
+
+Besides the physical People who attend the Hospital, one or two
+Physicians ought to go along with the Army to attend the Commander in
+Chief, and the General and Staff Officers, in Case of Sickness; and an
+Apothecary, provided with a small Chest of Medicines, ought to attend
+at Head Quarters to make up the Prescriptions of the Physicians.
+
+A Number of Hospital Surgeons also, with Mates, ought to attend the
+Army, to be ready in Case of an Action. These ought to be attached to
+the Suite of the Commanders of the different Corps or Brigades, and to
+be quartered or encamped with them. And each Surgeon should be
+provided with a Waggon or some Horses loaded with a proper chirurgical
+Apparatus, as Instruments, Bandages, Lint, and other Things necessary
+for taking Care of the Wounded.
+
+A small Quantity of Medicines, some Wine, Rice, portable Soop, &c. and
+Utensils for a small Hospital, and two, three, or four hundred Sets of
+Bedding, should be carried about with the Army, in Case of an Action,
+for the Use of the Wounded, till they have Time to receive Assistance
+from the Flying Hospital. Some of the Bedding ought to be carried on
+Horseback, so as to be at Hand when any of the Surgeons are sent with
+Detachments that are going upon an Attack.
+
+To prevent crowding the General Hospitals in Winter Quarters, every
+Regiment ought to take Care of their own Sick, and to have proper
+Hospitals fitted up for them.
+
+Dr. _Pringle_ has laid down some very good Directions with regard to
+the Choice of Places fit for Hospitals, and the Method of preventing
+infectious Disorders in them; and we find many excellent Hints of this
+Kind in Dr. _Lind_ and Mons. _du Hamel_'s Treatises on the Means of
+Preserving the Health of Seamen, and some likewise in Dr.
+_Brocklesby_'s late Treatise on military Disorders.
+
+In the Time of Service the Commander in Chief generally orders the
+Hospitals to be established in Towns or Villages that least interfere
+with the military Operations, to which the Sick and Wounded can most
+easily be conveyed; and which he can best protect from the Insults of
+the Enemy[155].
+
+    [155] The _Roman_ Generals seem to have sent their Sick and
+    Wounded into Towns, in the same Manner as is done by those of
+    the present Time. For we read in _C�sar's Commentaries_ of
+    this Method having been practised on more Occasions than one.
+    In the sixty-second Chapter of the third Book, _de Bello
+    Civili_, we have the following Passage: "Itaque nulla
+    interposita mora, sauciorum modo & �grorum habita ratione,
+    impedimenta omnia silentio prima nocte ex castris _Apolloni�_
+    pr�misit, ac conquiescere ante iter confectum vetuit. His una
+    legio missa pr�sidio est."--And immediately after, in chap.
+    lxv. "Itaque pr�missis nunciis ad Cn. Domitium C�sar
+    scripsit, & quid fieri vellet ostendit: pr�sidioque
+    _Apolloni�_ cohortibus iv. _Lissi_ i. tres _Orici_ relictis;
+    quique erant ex vulneribus �gri depositis; per Epirum atque
+    Arcarniam iter facere c�pit."
+
+    And in the twentieth chapter, _de Bello Africano_, we read:
+    "_Labienus_ saucios suos, quorum numerus maximus fuit, jubet
+    in plaustris deligatos _Adrumentum_ deportari."
+
+    It would be a right Measure, in the Beginning of every War,
+    to settle by a Cartel that military Hospitals on both Sides
+    should be considered as Sanctuaries for the Sick, and
+    mutually protected; as was agreed upon between the late Earl
+    of _Stairs_, who commanded the _British_ Troops, and the Duke
+    _de Noailles_, who commanded the _French_ in the Campaign in
+    _Germany_ in the year 1743. See _Dr. Pringle's Preface_.
+
+In Towns, the Places fittest for Hospitals are public Buildings, which
+have large dry airy Apartments, situated on a high Ground, where there
+is a free Draught of Air, and a Command of Water.
+
+In Winter, those Houses, which have open Fire Places in the Rooms, are
+always preferable to such as have close Stoves, or no Fire Place at
+all; for an open Fire Place serves to keep up a free Circulation of
+Air in a Room, as well as to keep it warm. And for the same Reason,
+where nothing but Stoves can be got to warm the Wards, the Wynd
+Stoves, which open into the Room or Ward, are vastly preferable to the
+close ones.
+
+Where there are no public Buildings, private Houses answering nearest
+to the above Description are most proper for Hospitals. In general,
+Houses with small Rooms make but bad Hospitals; and very Damp and
+close Places ought by all Means to be avoided.
+
+In Summer, when the Moveable or Flying Hospital is ordered into
+Villages, large Barns, and the largest airy Houses, are the best.
+
+Churches, situated on a dry high Ground, make good Summer Hospitals;
+and in Winter, when Necessity obliged us sometimes to use them in
+_Germany_ for this Purpose, they were found to answer very well, when
+we had Bedsteads or Cradles for the Men to lie upon, and the Wynd
+Stoves to keep them of a moderate Heat.
+
+In making Choice of Houses for Hospitals, particular Regard ought to
+be had to the Privies or Necessaries; because, where their Smell is
+offensive, there is always Danger of infectious Disorders. If,
+therefore, there be no proper Conveniencies of this Kind about an
+Hospital, such ought to be contrived so as to prevent any Danger from
+their putrid Effluvia. If there be a River near the Hospital, the
+Necessaries may be made above it at a Place where there is a rapid
+Stream below. In Villages deep Pits may be dug in the Ground behind
+the Hospital, and Seats made over them, as in Camp; and a thick Lay of
+Earth be thrown above the Foeces every Morning, till the Pits are near
+full, and then they must be filled up, and others dug to supply their
+Place.
+
+When once the Places are fixed upon for Hospitals, every Ward ought to
+be made perfectly sweet and clean; first, by scraping and washing with
+Soap and Water, and afterwards with warm Vinegar; and then they ought
+to be fumigated with the Smoke of wetted Gunpowder and of Aromatics,
+and afterwards well dried and aired by lighting Fires, and opening
+the Windows, before any Sick are admitted.
+
+After this the Beds ought to be laid; in doing of which great Care
+should be taken not to crowd the Wards too much, as nothing corrupts
+the Air so much, or so soon brings on infectious Disorders. Dr.
+_Pringle_ says, the Beds ought to be laid so thin, that a Person
+unacquainted with the Danger of bad Air, might imagine there was Room
+for double or triple the Number. In high lofty Apartments, and in
+Churches, and other large Places, the Beds may be laid much closer
+together than in Rooms with low Cielings. In Churches, or such Places,
+thirty-six square Feet, or a Square of six Feet by six, may be allowed
+for each Man; but in common Wards we must allow from forty-two square
+Feet, _i. e._ six by seven Feet, to sixty-four square Feet, or eight
+by eight, according to the Height of the Cieling, the Airyness of the
+Place, and the Nature of the Diseases of the Patients.
+
+The Bedding most fit for Hospitals, is Palliasses and Bolsters filled
+with Straw, Sheets, and Blankets, as they can easily be washed.
+Feather Beds and Matrasses are apt to retain Infection, and cannot be
+easily cleansed. In the fixed Hospitals, Bedsteads or Cradles may be
+set up for laying the Bedding on: But in the Moveable or Flying
+Hospital the Bedding must be, for the most part, laid on the Floor.
+
+When once the Beds are laid, and the Sick arrive, some of the
+Gentlemen belonging to the physical Department ought to attend, to
+distribute the Sick properly through the Hospitals.
+
+All the Surgery Patients, such as have Wounds, Ulcers, Sores, the
+Venereal Disease, &c. should be separated from the Rest, and put
+either into particular Wards by themselves, or into an Hospital fitted
+up for that Purpose under the Direction of the Surgeons.
+
+Those labouring under infectious Fevers and Fluxes, should each of
+them be placed in good airy Wards by themselves, where the Beds are
+laid much thinner than in the other Wards of the Hospital. If the Flux
+Wards have a Privy near them, where the Men can ease themselves,
+without being offensive either to their own Ward, or any other Part of
+the Hospital, they are so much the fitter for such Patients. In the
+Hospital I attended at _Bremen_, the Flux Ward had a Necessary that
+opened into the River _Weser_, and at _Natzungen_ a deep Pit was dug
+in the Field about twenty Yards from the Barn where the Flux Men lay,
+which kept these Wards always sweet.
+
+Patients that have got the Itch, or any other infectious Distemper,
+ought likewise to be put into separate Wards by themselves; and at all
+Times a Place should be set apart for those who may be taken ill of
+the Measles or Small-Pox. A House separated from the other Hospitals,
+with a distinct Set of Nurses and other Attendants, bids fairest to
+prevent the Infection from spreading.
+
+When once the Sick are properly ranged, the next Care must be to
+prevent infectious and malignant Disorders from being generated, and
+from spreading amongst the Sick; which is principally to be effected
+by keeping the Sick and the Hospital extremely clean and well-aired,
+and the Wards as sweet, and free from putrid and offensive Smells, as
+possible.
+
+Every sick Man, as soon as he arrives at an Hospital, should be washed
+with warm Water, or if there is a warm Bath, or bathing Tub, to be put
+into it; and afterwards be supplied with a clean Shirt[156] well-aired
+before he be put to Bed; and his own dirty Linen should be immediately
+carried to the Wash-House: And every Morning each Nurse ought to carry
+a Bucket full of warm Water, and a Piece of Soap and a Towel, round to
+each of her Patients, and make them wash their Hands and Face, and
+their Feet, when dirty.
+
+    [156] Every military Hospital ought to have a Number of
+    Shirts belonging to it, for the Use of the Sick who arrive
+    without having clean Linen with them. As soon as their own
+    Shirts are washed and dried, or that new ones are provided by
+    their Regiments, the Hospital Shirts ought to be taken from
+    them.
+
+Every Morning all the Wards ought to be scraped and swept, and
+afterwards sprinkled with warm Vinegar; and when dirty, they ought to
+be washed after the Fires are lighted.
+
+Every Thing in the Wards, and about the Sick, should be kept as clean
+as possible; the Chamber-Pots and Close-Stools ought to be carried
+away as soon as used, and immediately emptied and washed before they
+be brought back.
+
+The Windows of the Wards ought to be kept open to admit fresh Air
+Morning and Evening, for a longer or shorter Time, according as the
+Weather will permit.
+
+If the Wards are close, and the Cieling too low, Dr. _Pringle_ advises
+to remove some Part of them, and to open the Garret Story to the
+Tiles[157]; and if the Opening of the Windows is not sufficient to
+air the Wards, Ventilators of different Kinds, such as those mentioned
+by Dr. _Hales_ and Dr. _Pringle_, may be used, especially when the
+Weather is hot.
+
+    [157] In Wards which are too close, it has been found that
+    one or two square Holes (of about six or eight, or ten Inches
+    diameter), cut in the Cieling, and a Tube made of Wood fitted
+    to it, and carried up into the Chimney of the Ward above, so
+    as to enter above the Grate, is one of the best Contrivances
+    for procuring a free Circulation of Air; as the foul Air,
+    which is lightest, and occupies the highest Part of the Ward,
+    finds a free Exit by these Tubes: We have such Tubes now
+    fixed in several of the Wards in _St. George_'s Hospital. A
+    Hole cut above the Door of the Ward, or in the upper Part of
+    the Windows, and one of what are called the _Chamber
+    Ventilators_ fixed in it, will answer, where Holes cannot be
+    conveniently cut in the Cieling.
+
+In Winter, Fires should be lighted in all the Wards where it can be
+done.
+
+In foreign Countries, when we meet with Hospitals where there are no
+Places for open Fires, but only close Stoves, different Contrivances
+may be used to renew the Air. Ventilators of different Kinds may be
+used, or Openings made in the Doors and Windows. In Winter 1761-62,
+some of the Wards in the Hospital at _Bremen_ which I attended had
+such Stoves. In order to keep up a free Circulation of Air in those
+Wards, I directed large Holes to be cut in the lower Part of the Door
+in each Ward, and two Grooves to be made on the Outside of the Door,
+above and below the Hole, parallel to each other, in which a Board
+slided; by means of which, the Hole could be either quite covered or
+only in Part, or left entirely open; and I directed a Casement, about
+eight or nine Inches square, to be made in the upper Corner of each
+Window. After the Fires were lighted, upon removing the Board which
+covered the Hole in the Door, and opening the little square Windows, a
+Current of fresh cool Air rushed into the Ward by the Door, while the
+heated foul Air found an Exit by the Windows. In very cold Weather,
+the Opening of the small Windows was sufficient; but in mild Weather,
+and in Summer, it was necessary to keep both open.
+
+The Wards should be daily fumigated by Means of Aromatics, or wetted
+Gunpowder thrown on burning Coals, put in an Iron Pot or Chaffern, or
+with the Steams of warm Vinegar placed in the Middle of the Ward. Dr.
+_Lind_ says, that although Cleanliness and a pure Air contribute much
+to prevent infectious Disorders, or to check them, yet that they of
+themselves are not always sufficient; but that he seldom or never knew
+a proper Application of Fire and Smoke to be unsuccessful in producing
+the happy Consequence of effectually purifying all tainted Places,
+Materials, and Substances[158].
+
+    [158] Dr. _Lind_ tells us, that the Ships of War in his
+    Majesty's Service are purified by Fire and Smoke, and gives
+    the Process by which it is done; and he says, that he never
+    heard of any Ship, which, after being carefully and properly
+    smoked, did not immediately become healthy for the Men.--See
+    _First Paper on Fevers and Infection_.--And he observes, that
+    these Steams and Smoke, which are inoffensive to the Lungs,
+    besides correcting the bad Quality of the Air, produce
+    another good Effect; which is, to make both the Patients and
+    Nurses desirous of opening the Doors and Windows for the
+    Admission of fresh Air. _Ibid._ p. 51.
+
+In all Military Hospitals, at least in the fixed ones, one Ward ought
+to be always kept empty; and whenever a malignant Fever, or any other
+infectious Disorder, breaks out in any Ward, the Men ought to be
+removed into this empty one; and the foul Ward purified, by washing
+and cleaning it well with Soap and Water, and then with warm Vinegar;
+and afterwards purifying it with Smoke, in the same Manner as is
+practised in his Majesty's Ships of War; and Fires should be lighted
+daily, and the Windows kept open for some Time, before any Sick be
+again admitted into it.
+
+As soon as any Patient dies, the Body ought to be removed to the Dead
+House; and the Bedding he lay upon should be carried away immediately,
+and not used again till it has been smoked, well-aired, and washed.
+
+All the Linen of Patients in Fevers, Fluxes, and other infectious
+Disorders, ought to be changed often; and all the foul Linen and foul
+Bedding of the Hospital should be smoked with the Fumes of Brimstone,
+or of wetted Gunpowder, in a Place set apart for that Purpose; and Dr.
+_Lind_ advises to steep them first in cold Water, or cold Soap Lees,
+before putting them in warm Water; as it is dangerous for any Person
+to receive the Steam that may at first arise, where this Precaution is
+not used.
+
+All the Cloaths, of Soldiers who die in Hospitals, ought to be sent to
+the Smoke House, and be well fumigated, and afterwards aired, before
+they are put up in the Store-House.
+
+The next Thing to be considered about a Military Hospital is the Diet
+of the Patients, which should consist of good wholesome Provisions,
+that can be purchased easily, and at a cheap Rate[159].
+
+    [159] The _French_, and many other Nations, give their
+    Patients Meat Soops in acute Diseases, and after capital
+    Operations; and they allow them but little Bread or other
+    Preparations of Vegetable Substances: But these Meat Soops
+    without Bread do not nourish the Patient sufficiently, and
+    tend too much to the Putrescent; and this is one Reason why
+    more Sick die in the _French_ than in the _British_
+    Hospitals.
+
+Good Bread[160] is a standing Article of Provisions for an Hospital in
+all Countries and in all Climates; and a certain Quantity of it ought
+to be distributed to each Man daily.
+
+    [160] On Expeditions where a Siege is expected, a Quantity of
+    Flour ought to be carried out, and a Number of portable Ovens
+    for baking bread for the Sick, which may be put up after the
+    Troops have made good their Landing.
+
+The Breakfast and Supper in most Military Hospitals must be made of
+Water Gruel or Rice Gruel; as either Rice or Oatmeal can be got in
+most Places, and are very portable.--Water Gruel is in general
+preferable to the Rice Gruel, because most Patients nauseate the Rice
+Gruel, after eating it for some Days, but not the Water Gruel, as
+every Person, who has attended the Military Hospitals, must have
+experienced. Where both Rice and Oatmeal can be had, Rice Gruel may
+be used two or three Times a Week by Way of Variety.
+
+But although Rice Gruel is not so proper for constant Use, yet Rice
+should always make an Article among the Stores for an Hospital, as it
+is useful for making Rice Water for Drink; and it can be boiled or
+ground, and made into a light Pudding, and in short may be used in a
+Variety of Forms to make a good and wholesome Food for the Sick.
+
+Oatmeal is cheaper than Rice, and can be procured almost every-where
+in _Europe_, where Armies make Campaigns; as Oats make such a great
+Article in the Forage for Horses. And a sufficient Quantity can at any
+Time be ground into Meal for the Use of the Sick, at the Mills which
+are employed for making Flour for the Bakery, if there be none nearer
+the Hospital.
+
+In Countries where neither Oatmeal nor Rice can be had, _Indian_ or
+some other Corn, which is known to be wholesome, and which the Country
+affords, may be employed in their Place.
+
+When fresh Meat can be got, the Men who are on full Diet, and the
+Nurses and other Servants about the Hospital, should have Meat for
+Dinner; and the Meat that is boiled for them ought to make Broth for
+the Sick who are kept on a low or middle Diet. Some Barley or Rice
+should be added to the Broth; and a small Quantity of Carrots,
+Turnips, or other Vegetables, boiled along with them, will make it
+more agreeable to the Taste.
+
+On Expeditions where nothing but salted Meat can be had, a Quantity of
+portable Soop should always be carried out for the Use of the Sick;
+which with Water and some Barley, and fresh Vegetables, when they can
+be got, will make a good Soop or Broth. On such Occasions, the Dinner
+ought to consist of Soop and Bread, or of light Puddings made of Flour
+or of Rice, of boiled Rice or Barley, or of Panado, &c.
+
+Nurses and recovered Men may be allowed salted Meat twice or thrice a
+Week.
+
+The common Drink of Military Hospitals ought to be Rice and Barley
+Water, with a small Proportion of Spirits and Sugar. Small Beer is a
+good Drink where it can be easily procured; as is Wine and Water, or a
+very small Negus, or very weak Punch in warm Climates.
+
+Besides this Diet, extraordinary Indulgences may be occasionally
+allowed to particular Patients, as Wine, Brandy, Sugar, Milk. And the
+Physicians and Surgeons ought to have a discretionary Power to order a
+Vegetable or any other proper Diet for Patients in the Scurvy, or any
+other particular Complaints.
+
+
+The Established Diet of a Military Hospital may be,
+
+                _Breakfast._         _Dinner._       _Supper._
+             One Pint of Water  |                |
+             or Rice Gruel.     |                |
+                                |                |
+             Water Gruel made   |                |
+             with 3 or 4 Ounces |                |
+             of Oatmeal, a      |                |
+             little common Salt,|One Pound       |
+             and with or without|of boiled fresh |
+  Full Diet, a little           |Meat.           |  As Breakfast.
+             Sweet Oil, and     |                |
+             two Spoonfuls of   |                |
+             Wine.              |                |
+                                |                |
+             Rice Gruel made    |                |
+             with two Ounces of |                |
+             Rice, one Spoonful |                |
+             of fine Flour, a   |                |
+             little             |                |
+             common Salt and    |                |
+             Sugar.             |                |
+  -----------------------------------------------------------------
+                                |One Pint of     |
+                                |Broth, half     |
+  Middle Diet, Ditto.           |Pound of boiled |  Ditto.
+                                |Meat.           |
+  -----------------------------------------------------------------
+                                |One Pint of     |
+                                |Broth, or       |
+  Low Diet,  Ditto, or according|half a Pint of  |
+             to the Patient's   |Panado, with    |
+             Appetite.          |two Spoonfulls  |  Ditto.
+                                |of Wine,        |
+                                |and a Quarter   |
+                                |of an Ounce     |
+                                |of Sugar.       |
+
+
+The daily Allowance of Bread to be one Pound to each Man.
+
+The common Drink for those on full and middle Diet to be Rice or
+Barley Water, with two Spoonfuls of Brandy to each Pint, and a Quarter
+of an Ounce of Lump Sugar; small Beer, or very weak Punch; or Wine and
+Water, two Ounces of Wine to a Pint of Water, and a Quarter of an
+Ounce of Sugar. The Quantity not to exceed three Pints _per_ Day.
+
+Those on low Diet to have Rice or Barley Water as above, with or
+without Wine or Brandy.
+
+
+The Diet Boards hung up in the Hospitals may be made with the
+following Columns, nearly as they were with us in _Germany_.
+
+  Regiments.|Mens  |  Diet  |Wine.     |Brandy.|Milk.     |Sugar. |
+            |Names.|F.|M.|L.|� Pints.  |Ounces.|� Pints.  |Ounces.|
+  ----------+------+--+--+--+----------+-------+----------+-------+
+            |      |  |  |  |          |       |          |       |
+            |      |  |  |  |          |       |          |       |
+            |      |  |  |  |          |       |          |       |
+            |      |  |  |  |          |       |          |       |
+            |      |  |  |  |          |       |          |       |
+            |      |  |  |  |          |       |          |       |
+            |      |  |  |  |          |       |          |       |
+            |      |  |  |  |          |       |          |       |
+            |      |  |  |  |          |       |          |       |
+            |      |  |  |  |          |       |          |       |
+            |      |  |  |  |          |       |          |       |
+  ----------+------+--+--+--+----------+-------+----------+-------+
+
+When such Diet Boards are kept in an Hospital, and the Mens Names and
+Regiments are once wrote down, the Patients may with very little
+Trouble be put upon the full, middle, or low Diet, with so much of the
+above-mentioned Extraordinaries as may be judged proper.
+
+If any Thing else be wanted for the Sick, the Physician ought to give
+a particular Order in Writing for it, the Columns here marked being
+only for such Things as are most frequently wanted.
+
+It should be a general Rule in all Military Hospitals, that, when a
+Party of Sick arrives, every Man may have immediately a Mess of Water
+Gruel given him, and afterwards be put on low Diet till it is ordered
+otherwise by the Physician or Surgeon who attends him.
+
+It is not to be supposed that the Diet here mentioned can be strictly
+kept to in all Parts of the World; for it must often be varied
+according to the Difference of the Climates, and to the Provision of
+the Countries where the Scene of War may be.
+
+Whenever a Moveable or Flying Hospital is to attend an Army, a
+Quantity of Bedding, and of all Utensils for forming an Hospital,
+ought to be put up in the Waggons, together with Provisions of
+different Kinds, such as Oatmeal, Rice, Sago, Brandy, Wine, Sugar, &c.
+A Butcher with a Stock of live Cattle, and a Baker with a proper
+Quantity of Flour for making Bread ought constantly to attend; and a
+Number of empty Waggons should likewise be always in Readiness, to
+transport the Sick when the Hospital moves, or when a Party is to be
+sent to the fixed Hospitals.
+
+When Troops go upon an Expedition, besides the common Hospital Ships,
+another Ship ought to be properly fitted up for the Reception of sick
+Officers[161]; and every Hospital Ship ought to be supplied with all
+Sorts of Provisions, and other Necessaries fit for forming an
+Hospital, before they leave _England_.--And one or more armed Vessels
+loaded with Provisions, Wine, and all Sorts of Necessaries for the
+Sick, ought to attend them; or if the Expedition be intended for the
+warm Climates, these Vessels ought to go before the Fleet to take up
+Wine and Fruits, such as Lemons, Oranges, &c. Vegetables of different
+Kinds, and a live Stock for the Use of the Sick.
+
+    [161] If there be no Ship fitted up for the Reception of sick
+    Officers, those who are taken ill on Expeditions must be in a
+    most miserable Situation; as there is no Place to receive
+    them in the common Hospital Ships, they must remain almost
+    without Assistance in a crowded Cabin amongst People in
+    Health; as was the Case in some of our Expeditions during the
+    late War.
+
+All Hospitals attending Expeditions should carry out among their
+Stores a Number of large Tents for lodging the Sick and Wounded
+immediately on making good their Landing. Where a Siege is expected
+which will take up Time, and where no Accommodations for the Sick can
+be had till the Siege is over, a Ship or two, with Boards, and other
+Necessaries for building large Sheds, or temporary Hutts, for the
+Sick, as proposed by Dr. _Brocklesby_, ought to go along with the
+Fleet, or meet them at the Place of their Destination. Such thatched
+Sheds, or Hutts, are very necessary in the warm Climates, as the
+perpendicular Rays of the Sun, beating upon Canvass, make Tents
+intolerably hot. When any of our own Settlements happen to be near the
+Place attacked, a fixed Hospital may be established there; either in
+Houses, if proper ones can be found; or in temporary Sheds or Hutts
+erected for that Purpose; and some Vessels, properly fitted up, may be
+kept going with the Sick and Wounded, and bringing back the recovered
+Men.
+
+At every Military Hospital a Serjeant's Guard ought to mount; and
+Centinels be placed at the Doors of the Hospital, 1. To prevent all
+Visitors, who have not proper Leave, from coming into the Hospitals;
+as such People oftentimes crowd the Wards, disturb the Sick, and are
+apt to catch infectious Distempers, and to spread them among the
+Troops. 2. To take Care the Patients do not go out of the Hospital
+without having a Ticket[162] of Leave for that Purpose, signed by the
+Physician, Surgeon, or Apothecary, belonging to the Hospital. 3. To
+prevent spirituous Liquors, or other Things of that Kind, being
+clandestinely carried into the Hospital.
+
+    [162] At every Hospital there ought to be a Number of printed
+    Tickets lying ready to be filled up and signed by the
+    Physicians and Surgeons, and no Man ought to be allowed to go
+    out without a Ticket so signed.
+
+The Serjeant of the Guard, attended by the Ward Master, ought, every
+Morning, to go round the Wards to call a Roll, and see that every Man
+is in his Ward; and to do the same at Night before the Hospital Doors
+are shut, and at this Time to order every Person out of the Hospital
+who does not belong to it. And the Serjeant, every Morning, ought to
+report to the Physician, Surgeon, or Apothecary, every Man's Name who
+was found to be absent at Roll-calling; and whether he found every
+Thing regular and in good Order in going his Rounds.
+
+Every large Military Hospital ought to have one Head Nurse, and a
+sufficient Number of other Nurses, to attend and take Care of the
+Sick.
+
+Orders to the following Purport, hung up in every Military Hospital,
+would serve to shew the Nurses and Patients what their Duty is, and
+to maintain Regularity and good Order through the whole Hospital.
+
+
+_Matron, or Head Nurse._
+
+Every Matron, or Head Nurse, is to go round all the Wards of the
+Hospital at least twice a Day, Morning and Evening; to see that the
+Nurses keep their Wards clean; that they behave themselves soberly and
+regularly, and give due Attendance to their Patients; and to examine
+the Diet of the Patients, and see that it is good and well dressed;
+and if she finds any Thing amiss, to report the same to the Physician,
+Surgeon, or Apothecary, of the Hospital.
+
+
+_Common Nurses._
+
+1. The Nurses are to give due Attendance to their Patients; and to
+keep them always as neat and clean, as the Nature of their Distempers
+will admit of; to give them their Diet regularly; to be particularly
+careful to see them take the Medicines ordered by the Physicians,
+according to the Directions given; to report to the Physician,
+Surgeon, or Apothecary, any Faults or Irregularities which any of
+their Patients may have committed; and to acquaint the Ward Matter and
+Head Nurse of the Death of any of their Patients as soon as it
+happens, that proper Care may be taken of their Cloaths and Effects.
+
+2. They are to keep their Wards extremely clean, to sprinkle them
+every Morning with Vinegar, and to fumigate them with the Smoke of
+wetted Gunpowder, or of Frankincense, or any other Aromatics that may
+be thought proper; in fair Weather to keep open the Windows of their
+Wards, twice or thrice a Day; for a longer or shorter Time, as the
+Weather will permit; to attend at the Steward's Room for the
+Provisions of the Patients at the Hours appointed for that Purpose;
+and to pay implicit Obedience to the Matron, or Head Nurse, in what
+relates to their Duty; and punctually to obey all Orders they receive
+from the Physician, Surgeon, or Apothecary, of the Hospital.
+
+3. They are to keep themselves clean and decently dressed, and to
+observe the strictest Rules of Sobriety; remembering, that if any one
+is found intoxicated with Liquor, that she is immediately to be sent
+to the Guard, and afterwards discharged.
+
+4. They are not to absent themselves from their Wards, unless when
+employed in the Discharge of their Duty; nor to go out of the Hospital
+to which they belong, without having a Ticket of Leave signed by the
+Physician, Surgeon, Apothecary, or Head Nurse, belonging to the
+Hospital.
+
+5. They are not to throw Nastiness of any Kind out at the Windows, but
+to carry it to the common Necessaries, and to empty the Chamber Pots
+and Close-stools as soon as used, and be careful to wash them before
+they bring them back.
+
+6. They are not, upon any Pretence whatever, to alter the Diet ordered
+by the Physicians or Surgeons to the Patients on the Diet Boards; nor
+to suffer their Patients to use any other Diet than what is allowed by
+the Hospital; nor are they to bring, or allow others to bring, Meat,
+spirituous Liquors, or other Things of that Kind, into their Wards,
+except what is allowed by the Physicians or Surgeons. Whenever any
+Thing of this Kind is found in any of the Wards, it ought immediately
+to be thrown into the common Necessary; and if it be found in the
+Custody of a Nurse, she ought to be confined in the Guard, or
+discharged.
+
+7. Nurses guilty of great Neglect of Duty, or of getting drunk and
+using their Patients ill, or of stealing, or concealing or taking away
+the Effects of Men who die in the Hospital, are to be immediately sent
+to the Guard, and reported to the Commanding Officer of the Place,
+that they may be tried by a Court-Martial, and be confined, whipped,
+or otherwise punished, as the military Law directs; all Followers of
+Armies on foreign Service being equally subject to the military Law as
+the Soldiers themselves.
+
+
+_Patients._
+
+1. All sick Soldiers, on their Arrival at a Military Hospital, are to
+be washed all over with warm Water, or to go into a warm Bath; and
+afterwards to wash their Face and Hands every Morning, and their Feet
+occasionally, with warm Water and Soap, brought round every Morning by
+the Nurses for that Purpose; and they ought to comb their Head every
+Day. If they be too weak to wash and comb themselves, it is to be done
+by their Nurses.
+
+2. Every Patient is to be shaved and have clean Linen twice a Week, or
+oftener if requisite.
+
+3. They are punctually to obey the Directions given them, and to take
+the Medicines ordered by the Physician; and none to be allowed to go
+out of the Hospital without a Ticket of Leave signed by the Physician,
+Surgeon, or Apothecary, of the Hospital.
+
+4. They must commit no Disorder or Riot, but in all Respects behave
+themselves well.
+
+5. If any Man disobeys the Orders he receives from the Physicians or
+Surgeons, or is irregular in Conduct, gets drunk, and commits Riots in
+the Hospital, or is found guilty of Theft or other Crimes, the same
+is to be reported to the Commanding Officer of the Place, and he to be
+tried by a Court-Martial, and punished as soon as his Strength will
+permit.
+
+In conducting the Military Hospitals, we found that it was always
+right to discharge the Patients from the sick Hospitals as soon as
+they were recovered, and to send them either to Billet, or to a
+convalescent Hospital; because recovered Men are always the most
+riotous; besides they crowded the Hospitals, and were in Danger of
+catching fresh Disorders from those who were sick; and therefore the
+recovering Men in every Hospital ought to be reviewed once or twice a
+Week by the Physician or Surgeon, and the Names of such Men as are
+well enough, to be marked; in order that they may be sent the next Day
+to the convalescent Hospital, or to Billet. A Return of those marked
+for Billet ought immediately to be sent to the Officers on
+convalescent Duty.
+
+When a convalescent Hospital is established, it ought to be put under
+proper Regulations; the following are those which I drew up for that
+established at _Osnabruck_ in _April_ 1761, and which were found to
+answer the Purpose intended.
+
+
+_Regulations for a Convalescent Hospital._
+
+1. That this Hospital be entirely occupied by such Men as are
+recovered from Diseases; that no Men be sent there but those whose
+Names are returned to the Purveyor's Office by the Physician or
+Surgeon of the Hospital.
+
+2. That all the Patients shall be upon full Diet, unless in particular
+Cases it be ordered otherwise by the Physician or Surgeon.
+
+3. That all the Patients shall breakfast, dine, and sup, at regular
+stated Hours, in the Hall appointed for that Purpose: Breakfast to be
+ready at nine, Dinner at one, and Supper at seven o'Clock in the
+Evening.
+
+4. That no Patient shall carry up any Victuals into the Wards
+appointed for sleeping in; and if any Patient does not attend at the
+regular Hours of Meals, no Allowance of Victuals shall be made him in
+the Place of such Meals, unless he has been absent on Hospital
+Business, or been confined to Bed by Sickness.
+
+5. That as soon as the Men are come down Stairs to Breakfast, the
+Wards in which they sleep shall be cleaned out and sprinkled with
+Vinegar, and the Windows opened to air them.
+
+6. That the Doors of this Hospital shall be locked every Night at
+eight o'Clock, and no Man be allowed to come in or go out after that
+Time. The Doors to be opened again at seven o'Clock in the Morning.
+
+7. That the said Hospital is to be visited two or three Times a Week
+by the Physician, Surgeon, and Apothecary, who are to see that the
+above Orders are complied with; to examine the Diet, and take Care
+that every Thing is carried on properly; and to prescribe for any
+little Disorders the Men may be affected with.
+
+8. That one of the Hospital Mates be appointed to visit this Hospital
+daily, to administer any Medicines which may have been prescribed by
+the Physician; to apply any Dressings ordered by the Surgeon; and to
+acquaint the Physician or Surgeon if any of the Men be so bad as to
+require their Attendance, or to be sent back again to the Sick
+Hospital.
+
+9. That for the better executing these Regulations, orderly Serjeants
+or Corporals be appointed for the Care of the Men; who shall mount a
+Guard of six or more of such of the Patients of the said Hospital as
+are fit for this Duty--That the Serjeants are to call a Roll of all
+the Patients regularly three Times a Day, before Breakfast, Dinner,
+and Supper; to see that the Men behave themselves soberly and
+decently; and that they keep themselves clean, and commit no Riots;
+and to confine in the Guard such as commit Riots and other
+Irregularities, or whom they find drunk, or who stay out all Night;
+and to report the same to the Officer on Duty.
+
+10. That an Officer on convalescent Duty do visit the said Hospital
+daily at the Times of Roll-calling, to see that every Thing be carried
+on properly; and to receive the Reports from the Serjeants, and give
+what Orders he may think proper for the better regulating the said
+Hospital.
+
+11. That if at any Time it should happen that there are more
+Convalescents than the Hospital can hold conveniently, a Review be
+made of all the Patients, and the strongest and most healthy be sent
+to Billet.
+
+12. That a Review be always made, when any Party is going to join the
+Army, to pick out the Men who are fit to join their Regiments.
+
+The Physical Officers employed in the Military Hospitals, are
+Physicians, Surgeons, and Apothecaries.
+
+No Person ought to be appointed a Physician to the Army, or Military
+Hospitals, without previously undergoing the same Examination at the
+College of Physicians, as those do who enter Fellows and Licentiates
+of the College, that none but proper Persons may be employed. On such
+Examinations the Physician General to the Army ought to be allowed to
+sit as one of the Censors of the College.
+
+The Surgeons are all obliged to pass an Examination at Surgeons Hall
+before they are appointed, and the Apothecaries ought in like Manner
+to pass an Examination at Apothecaries Hall.
+
+The Mates employed in the Service ought, previous to their
+Appointment, to be examined both in Surgery and Pharmacy, as the
+Service commonly requires their acting in both Branches.
+
+The Direction of all Military Hospitals ought always to be committed
+to the Physicians, who have the immediate Care of Hospitals.
+
+When an Army is acting on a Continent, and there is a Number of
+Hospitals in different Places, the Physician who attends the Commander
+in Chief ought to be made Physician General and Director of the
+Hospitals, with proper Appointments; and all Orders from Head Quarters
+ought to go immediately thro' this Channel.
+
+Every other Physician at the different Hospitals ought to direct every
+Thing about the Hospital which he attends, and his Orders ought to be
+punctually obeyed; and he ought to keep up a constant Correspondence
+with the Physician General; acquainting him from Time to Time with the
+State of the Hospital, and what is wanted for it; and he ought
+punctually to obey whatever Orders he receives from the Physician
+General.
+
+If there be separate Hospitals for the Surgery Patients, the eldest
+Surgeon ought to direct every Thing in the Hospital he attends; and
+when any Thing is wanted for his Hospital, to report the same to the
+Physician General.
+
+The directing and purveying Branches ought never to be entrusted to
+the same Person, as the Temptation of accumulating Wealth has at all
+Times, and in all Services, given Rise to the grossest Abuses, which
+have been a great Detriment to the Service, as well as to the poor
+wounded and sick Soldiers, and has occasioned the Loss of many Lives.
+And therefore neither the Physician General, nor any of the Physicians
+or Surgeons of the Army, or any other Person concerned in the
+Direction of the Military Hospitals, ought ever to act as Purveyor or
+Commissary; nor ought they ever to have any Thing to do with the
+Accounts, Contracts, or any other Money Affairs relating to the
+Hospital; and if ever they be found to intermeddle in these Affairs,
+they ought to be immediately dismissed the Service.
+
+The purveying or commissariate Branch ought to be entirely distinct
+from the physical. The Purveyors or Commissaries ought punctually to
+obey whatever Orders they receive from the Physicians or Surgeons; to
+provide every Thing for the Hospital; to keep regular Accounts of all
+the Men who come into, or go out of the Hospitals; and from Time to
+Time to make Returns to Head Quarters of all the Men in Hospitals; and
+their Accounts ought to be controuled by such Persons as the
+Government may think proper.
+
+Every Physician and Surgeon of a Military Hospital ought to visit the
+Sick at regular stated Hours, and the Mates to attend and go round
+with them, and receive and execute their Orders.
+
+Every Mate ought to have a certain Number of Patients allotted him,
+for whom he is to make up all Medicines, dress all Sores, and execute
+whatever Orders he receives from the Physician, Surgeon, or
+Apothecary. That the Mates may know and execute their Duty, proper
+Orders in Writing should be hung up in the Apothecaries Shop for that
+Purpose. The following are those which I gave out at all the Hospitals
+I attended in _Germany_.
+
+
+_Orders for the Mates._
+
+1. That all the Gentlemen do attend at the Apothecaries Shop every
+Morning at eight o'Clock, to assist in making up the common Medicines
+of the Day, and afterwards to go round the Hospitals with the
+Physicians and Surgeons.
+
+2. That every Mate have a Book for writing the Prescriptions of the
+Physicians in, which is to be kept in the following Order.--First, to
+mark the Patient's Name and Regiment; then the Day of his Entry into
+the Hospital and his Disorder; then the Prescriptions of the
+Physician; and after all the Day of his Discharge, or of his Death.
+_Ex. gr._
+
+     _John Clarke_, 20th Regiment. _Jan._ 1. Fever.
+
+     _Jan._ 1. V. S. unc. x.--H. salin. cum pulv. contrayerv.
+     4r. die.--2. Emplast. vesicat. dorso, &c.
+
+       Discharged or dead _Jan._ 28.
+
+3. That every Mate make up himself the Physician's Prescriptions for
+his own Patients, and afterwards go round and administer them, or give
+them to his Patients with proper Directions; that he bleed his own
+Patients, and dress any slight Sores they may have, which do not
+require their being sent to the Surgery Hospital.
+
+4. That every Mate go round amongst his Patients in the Evening, to
+see that every Thing is well conducted, and to report to the Physician
+or Apothecary if any Thing extraordinary happens.
+
+5. That two of the Mates attend all Day at the Apothecary's Shop to
+receive any Sick that may arrive, and to place them properly; to make
+up what Medicines they may immediately want; to order each of them a
+Mess of Water Gruel; and if any Thing extraordinary occurs, to send an
+orderly Man to acquaint the Physician or Apothecary with the same. The
+orderly Mates to make up likewise for Officers, or others, all
+Prescriptions sent to the Apothecary's Shop through the Day.
+
+A Joint of Meat, roasted or boiled, for Dinner, and a Bottle of Wine,
+was allowed to the orderly Mates, by Lord _Granby_'s Order, that they
+might not absent themselves from their Duty.--Where there was
+Conveniency for it, a Mate lodged in the Hospital.
+
+The Apothecary ought to take Care of the Medicines; to go round the
+Hospitals in the Morning before the Time of the Physician's visiting;
+to see that the Wards are in proper Order; that the Nurses and other
+Servants have done their Duty; to examine into the State of the Sick,
+and to see that the Provisions are good; and make a faithful Report
+of all these Things to the Physician when he arrives.--To take Care
+that the Mates prepare in the Morning the Medicines that are commonly
+wanted for the Day; and that they afterwards make up faithfully the
+Prescriptions of the Physician; to go round the Hospital again in the
+Evening, to see that the Sick have got their Medicines regularly; and
+to make the same Enquiries as in the Morning.
+
+The Apothecary should always be lodged near the Hospital, to assist in
+Case of any Accidents happening, or of Sick arriving at the Hospital.
+
+When there are any strong infectious Disorders in Military Hospitals,
+the physical Gentlemen may use the following Precautions to guard
+themselves against Infection.
+
+1. Never to visit the Sick with an empty Stomach; but to eat Breakfast
+before they go into the Hospital.
+
+2. To have a Suit of Cloaths reserved for visiting the Hospital, and a
+waxed Linen Coat to wear above them in going round the Wards; and as
+soon as they have come out of the Hospital, to wash and change their
+Linen and Cloaths.
+
+3. Before they go into the Wards, to order that they be well cleaned
+out, and sprinkled with Vinegar, and afterwards fumigated, and aired
+by opening the Windows, or by Working the Ventilators.
+
+4. If the Infection be very strong, to take a Glass of the spirituous
+Tincture of the Bark just before they go into the Hospital.
+
+5. To put small Rolls of Lint, dipped in camphorated Spirits, up the
+Nostrils, and to direct a Vessel, with warm camphorated Vinegar, to be
+carried round, and held near the Patients they are examining.
+
+6. In examining Patients affected with the Petechial Fever, or any
+other malignant Distempers, to stand at some little Distance, and ask
+what Questions they may think proper; and when they come near, to feel
+the Pulse, and examine the Skin, not to inspire while their Head is
+near the Patient's Body; but after being fully satisfied in these
+Points, to retire a little, and ask what other Questions may be
+necessary.
+
+It would be right to establish some military Rank for every
+commissioned Officer of the Hospital on Service, and to settle the
+same Subordination in the physical as in the military Department. By
+these Means, the Service would be carried on with greater Order, and
+more Advantage to the Sick.
+
+And it would be right, in Times of War, to add a Clause in the Mutiny
+Bill to allow any military Officer on convalescent Duty to call in the
+commissioned physical Officers to assist in making up a Court-Martial,
+when there are not a sufficient Number of military Officers in a
+Place, to try convalescent Soldiers guilty of Crimes. For in Times of
+Service, very often a sufficient Number of military Officers cannot be
+spared to be on Duty at the different Military Hospitals; and at all
+such Places the Convalescents are generally very disorderly, when they
+know that there is not a sufficient Number of Officers to form a
+Court-Martial for punishing them. Where-ever there are a sufficient
+Number of military Officers, no physical Officer ought ever to be
+called upon as a Member of a Court-Martial.
+
+Men, in Time of Service, are often apt to saunter in and about
+Hospitals, and there learn all Manner of Debaucheries, and lose all
+Sense of Discipline; and therefore, to keep up Order and Decorum,
+there ought to be, at every Fixed and every large Military Hospital, a
+military Inspector or Commander, an Officer of known Activity and
+Probity; and a Number of Officers on convalescent Duty sufficient to
+form a Court-Martial whenever required.
+
+The Duty of the Military Inspector, or Commander, should be, to take
+Care of all Convalescents on Billet; to see that the Officers under
+him do their Duty, and maintain the same Regularity and Discipline
+among the Men belonging to their respective Corps, as if they were
+with their Regiments; and that the Men attend the Parade and
+Roll-calling; and that they always appear neat and clean.
+
+He ought, from Time to Time, to visit the Hospitals; to see if they
+are kept clean; to enquire if the Men behave well, if the Diet is
+good, and the Officers, Nurses, and Servants, do their Duty; and if he
+finds any Thing amiss, to report the same to the Physicians and
+Surgeons of the Hospital, or to the Purveyor or Commissary, or others,
+under whose Department it may be, that the same may be immediately
+rectified; and if he finds that the superior Officers of the Hospital
+overlook such Abuses, notwithstanding his Representations, to report
+the same immediately to the Head Quarters.
+
+He ought to order one of the Officers on convalescent Duty to visit
+the Hospitals daily, to make the Enquiries above-mentioned, and to
+give him a Report of the same in Writing.
+
+The Purveyor or Commissary ought to make a Return to him twice or
+thrice a Week of every Man admitted into, or discharged from, the
+Hospitals, or who dies in them; marking in the Return the Name of
+every Man, and the Company and Regiment he belongs to; that he may
+report the same to the Officers of the different Brigades or
+Regiments.
+
+The Military Inspector ought to have the Power of providing Billets
+for all Officers and Soldiers about Hospitals; and the Names of all
+Men to be discharged from Hospitals should be sent to him the Day
+before they are discharged, that he may provide Billets for them; and
+next Day the Men ought to march from the Hospitals to the Parade, to
+receive their Billets, and the Orders of the Military Inspector, and
+of the Officers of the Corps they belong to.
+
+The Military Inspector ought to see that the Arms of the sick Men, and
+the Arms and Cloaths of those who die and are lodged in the Magazines,
+be properly taken Care of; and that the Stores of the different
+Regiments be properly looked after.
+
+As the Service often makes it necessary at Military Hospitals, where
+the Number of Sick is great, to employ the convalescent Soldiers[163]
+as orderly Men and Servants about Hospitals, all Men thus employed
+ought to have a special Leave from the Military Inspector for so
+doing; and no Man should be employed in any Capacity as a Servant
+about an Hospital, who at that Time is on the Books as a Patient. And
+all Men employed about the Hospital ought to be reviewed once a Week
+by the Military Inspector, and likewise whenever a Party of
+Convalescents is going to join the Army, or their Regiments; that no
+Man may be allowed to remain with the Hospital, after he is fit to do
+Duty in his Regiment.
+
+    [163] In the _French_ Hospitals there are always a Number of
+    Men who attend their Sick who belong to the Hospital, so that
+    they have no Occasion to employ their Convalescents, as we
+    are often obliged to do, where the Sick are attended by
+    Nurses, who are commonly Soldiers Wives, and not so capable
+    of doing such laborious Work as the Men.
+
+When the Military Inspector is absent, the eldest Officer on
+convalescent Duty ought to act in his Place.
+
+Every Officer sent on convalescent Duty ought, as soon as he arrives
+at the Place where the Hospital is, to wait on the Commandant, or
+Military Inspector; to acquaint him of his Arrival, and to receive his
+Commands. He ought then to go to the Purveyor or Commissary's Office,
+to get a List of all the Soldiers who are in or about the Hospital,
+and belong to the Regiment or Brigade he is employed for, wherein
+those on Billet are distinguished from those in Hospitals. The next
+Day he ought to parade all those marked on Billet, to see if the
+Number of Men agrees with the List given him, and to examine in what
+State each Man is, and how he is employed; and then he ought to go
+round the Hospitals, attended by an orderly Serjeant, to see all the
+Men in the Hospitals, and to know if the List given him at the
+Purveyor's Office was right; and afterwards he ought to send every Day
+a Serjeant or Corporal to see the Men in Hospitals, and to report to
+him when any Men are discharged or die.--And he ought to procure from
+the Military Inspector a Return of all the Men of his Corps, who are
+either admitted into, or discharged from Hospitals, on the Days when
+such Returns are made. He ought to make all his Men on Billet appear
+regularly on the Parade at Roll-calling, and to oblige them to keep
+themselves clean and their Arms in good Order, and to endeavour to
+preserve the same Regularity and Discipline as when they are with
+their Regiments. And whenever a Party is to be sent to join their
+Regiments, he ought to have all his Men particularly examined; and
+those Men who are found to be perfectly recovered, should be sent to
+their Regiments.
+
+If every Officer on convalescent Duty conform to these Directions, no
+Man can ever be detained without his Knowledge in or about Hospitals,
+as he must always know where every Man is, in what State of Health,
+and how he is employed; and may at any Time be able to make a Return
+to the Brigade or Regiment for which he is employed, of every Man who
+is admitted, discharged, or dies in the Hospital.
+
+
+FINIS.
+
+
+
+
+
+End of the Project Gutenberg EBook of An Account of the Diseases which were
+most frequent in the British military hospitals in Germany, by Donald Monro
+
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+<pre>
+
+The Project Gutenberg EBook of An Account of the Diseases which were most
+frequent in the British military hospitals in Germany, by Donald Monro
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: An Account of the Diseases which were most frequent in the British military hospitals in Germany
+
+Author: Donald Monro
+
+Release Date: February 21, 2010 [EBook #31338]
+
+Language: English
+
+Character set encoding: ISO-8859-1
+
+*** START OF THIS PROJECT GUTENBERG EBOOK BRITISH MILITARY HOSPITALS ***
+
+
+
+
+Produced by Irma Spehar and the Online Distributed
+Proofreading Team at http://www.pgdp.net (This file was
+produced from images generously made available by The
+Internet Archive/Canadian Libraries)
+
+
+
+
+
+
+</pre>
+
+
+
+<h1><span style="font-size: 80%">AN</span><br />
+ACCOUNT<br />
+<span style="font-size: 70%">OF THE</span><br />
+<span style="font-size: 90%">DISEASES</span><br />
+<span style="font-size: 50%">Which were most frequent in the</span><br />
+<span class="smcap">British Military Hospitals</span><br />
+<span style="font-size: 80%">in Germany,</span><br />
+<span style="font-size: 70%">From January 1761 to the Return of the Troops</span><br />
+<span style="font-size: 80%">to England in March 1763.</span></h1>
+
+<p class="sub">To which is added,<br />
+An ESSAY on the Means of Preserving the Health<br />
+of Soldiers, and conducting Military Hospitals.</p>
+
+
+<p class="author">By DONALD MONRO, M.D.<br />
+<small><span class="smcap">Physician</span> to his <span class="smcap">Majesty&#8217;s Army</span>, and to</small><br />
+<small><span class="smcap">St. George</span>&#8217;s Hospital.</small></p>
+
+
+<p class="publisher">LONDON:<br /><br />
+Printed for <span class="smcap">A. Millar</span>, <span class="smcap">D. Wilson</span>, and <span class="smcap">T. Durham</span>,<br />
+in the Strand; and <span class="smcap">T. Payne</span>, at the Mews-Gate.<br />
+<br />
+MDCCLXIV.</p>
+
+
+<h2><a name="TO_THE_KING" id="TO_THE_KING"></a>TO THE<span class='pagenum'><a name="Page_iii" id="Page_iii">[iii]</a></span><br />
+<span style="font-size: 150%; letter-spacing: 0.15ex">KING</span>.</h2>
+
+
+<p style="padding-left: 2em; font-size: 80%">May it please Your <span class="smcap">Majesty</span>,</p>
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">T</span>o</span> 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 <span class="smcap">Majesty</span>&#8217;s Troops.<span class='pagenum'><a name="Page_iv" id="Page_iv">[iv]</a></span></p>
+
+<p><span class="smcap">Your Majesty</span>&#8217;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
+<span class="smcap">Majesty</span>&#8217;s Goodness in the<span class='pagenum'><a name="Page_v" id="Page_v">[v]</a></span>
+Breast of every Subject, and the
+warmest Gratitude in the Heart
+of every Soldier.</p>
+
+<p>The Knowledge of these Circumstances
+induced me to flatter
+myself, that a Work of this
+Kind would be agreeable to Your
+<span class="smcap">Majesty</span>; 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;<span class='pagenum'><a name="Page_vi" id="Page_vi">[vi]</a></span>
+it being the greatest Ambition
+of my Heart ever so to act as to
+merit Your <span class="smcap">Majesty</span>&#8217;s Approbation,
+and to subscribe myself,</p>
+
+<p class="sig"><span style="padding-right: 2em">May it please Your <span class="smcap">Majesty</span>,</span><br />
+
+Your <span class="smcap">Majesty</span>&#8217;s most dutiful Subject,<br />
+
+<span style="padding-right: 4em">And most faithful</span><br />
+
+<span style="padding-right: 2em">and humble Servant,</span><br />
+
+<span style="font-size: 130%">DONALD MONRO.</span></p>
+
+
+
+<h2><a name="THE_PREFACE" id="THE_PREFACE"></a>THE<span class='pagenum'><a name="Page_vii" id="Page_vii">[vii]</a></span><br />
+<span style="font-size: 130%; letter-spacing: 0.15ex">PREFACE.</span></h2>
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">A</span>mong</span> 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&#8217;s Attendance on the<span class='pagenum'><a name="Page_viii" id="Page_viii">[viii]</a></span>
+<i>British</i> Military Hospitals in <i>Germany</i>
+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 <i>St. George</i>&#8217;s
+Hospital, <i>London</i>.</p>
+
+<p>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 Pharmacop&#339;ia
+is added, to which his Practice
+in the Army Hospitals was chiefly
+confined.<span class='pagenum'><a name="Page_ix" id="Page_ix">[ix]</a></span></p>
+
+<p>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.</p>
+
+<p>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<span class='pagenum'><a name="Page_x" id="Page_x">[x]</a></span>
+employed in different Services; and
+also the Manner in which Military
+Hospitals ought to be fitted up, and
+conducted.&mdash;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.</p>
+
+<p>It is but Justice here to observe,
+that the Marquis of <i>Granby</i>, Commander
+in Chief of the <i>British</i> Troops
+in <i>Germany</i>, as well as the Rest of the<span class='pagenum'><a name="Page_xi" id="Page_xi">[xi]</a></span>
+General Officers employed on the <i>German</i>
+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.</p>
+
+<p style="font-size: 90%; padding-left: 4em">
+<span class="smcap">Jermyn-Street</span>,<br />
+<span style="padding-left: 2em">April 15, 1764.</span>
+<span class='pagenum'><a name="Page_xii" id="Page_xii">[xii]</a></span></p>
+
+
+
+<h2><a name="CONTENTS" id="CONTENTS"></a><span style="font-size: 130%; letter-spacing: 0.15ex">CONTENTS</span>.<span class='pagenum'><a name="Page_xiii" id="Page_xiii">[xiii]</a></span></h2>
+
+<table summary="contents">
+<tr><td class="ral" colspan="2"><span class="smcap">Page.</span></td></tr>
+
+<tr><td class="lal">Of the Malignant and Petechial Fever,</td><td class="ral"><a href="#Page_1">1</a></td></tr>
+
+<tr><td class="lal">Of the Dysentery,</td><td class="ral"><a href="#Page_57">57</a></td></tr>
+
+<tr><td class="lal">Of the Cholera Morbus,</td><td class="ral"><a href="#Page_97">97</a></td></tr>
+
+<tr><td class="lal">Of the Inflammatory Fever,</td><td class="ral"><a href="#Page_104">104</a></td></tr>
+
+<tr><td class="lal">Of the Angina,</td><td class="ral"><a href="#Page_109">109</a></td></tr>
+
+<tr><td class="lal">Of the Pleurisy,</td><td class="ral"><a href="#Page_111">111</a></td></tr>
+
+<tr><td class="lal">Of the Peripneumony,</td><td class="ral"><a href="#Page_115">115</a></td></tr>
+
+<tr><td class="lal">Of the Cough and Consumption,</td><td class="ral"><a href="#Page_124">124</a></td></tr>
+
+<tr><td class="lal">Of the Epidemical Catarrhal Fever of
+<i>April</i> 1762,</td><td class="ral"><a href="#Page_137">137</a></td></tr>
+
+<tr><td class="lal">Of the Rheumatism,</td><td class="ral"><a href="#Page_141">141</a></td></tr>
+
+<tr><td class="lal">Of the Autumnal Remitting Fever,</td><td class="ral"><a href="#Page_154">154</a></td></tr>
+
+<tr><td class="lal">Of the Intermitting Fever, or Ague,</td><td class="ral"><a href="#Page_179">179</a></td></tr>
+
+<tr><td class="lal">Of the Jaundice,</td><td class="ral"><a href="#Page_206">206</a></td></tr>
+
+<tr><td class="lal">Of Tumours of the Breast,</td><td class="ral"><a href="#Page_216">216</a></td></tr>
+
+<tr><td class="lal">Of Paralytic Complaints,</td><td class="ral"><a href="#Page_219">219</a></td></tr>
+
+<tr><td class="lal">Of an Incontinency of Urine,</td><td class="ral"><a href="#Page_223">223</a><span class='pagenum'><a name="Page_xiv" id="Page_xiv">[xiv]</a></span></td></tr>
+
+<tr><td class="lal">Of a Stoppage of Urine,</td><td class="ral"><a href="#Page_227">227</a></td></tr>
+
+<tr><td class="lal">Of the Epilepsy,</td><td class="ral"><a href="#Page_237">237</a></td></tr>
+
+<tr><td class="lal">Of the Small-Pox,</td><td class="ral"><a href="#Page_243">243</a></td></tr>
+
+<tr><td class="lal">Of Erisypilatous Swellings,</td><td class="ral"><a href="#Page_245">245</a></td></tr>
+
+<tr><td class="lal">Of the Scurvy,</td><td class="ral"><a href="#Page_250">250</a></td></tr>
+
+<tr><td class="lal">Of the Itch,</td><td class="ral"><a href="#Page_265">265</a></td></tr>
+
+<tr><td class="lal" style="padding-bottom: 1em">Table of Diet used in the <i>British</i> Military
+Hospitals in <i>Germany</i>,</td><td class="ral"><a href="#Page_273">273</a></td></tr>
+
+<tr><td class="lal" style="line-height: 250%; border-top: solid black 1px; border-bottom: solid black 1px; padding-top: 0.5em; padding-bottom: 0.5em">
+<span class="smcap">Pharmacopoeia</span> in usum Nosocomii
+militaris regii Britannici 1761,</td><td class="ral" style="line-height: 250%; border-top: solid black 1px; border-bottom: solid black 1px; padding-top: 0.5em; padding-bottom: 0.5em"><a href="#Page_275">275</a></td></tr>
+
+<tr><td class="lal" style="padding-top: 1em"><span class="smcap">Of the Means</span> of Preserving the Health
+of Soldiers on Service,</td><td class="ral"><a href="#Page_309">309</a></td></tr>
+
+<tr><td class="lal">&mdash;&mdash; in Winter, and in cold Climates,</td><td class="ral"><a href="#Page_313">313</a></td></tr>
+
+<tr><td class="lal">&mdash;&mdash; aboard of Transport Ships,</td><td class="ral"><a href="#Page_323">323</a></td></tr>
+
+<tr><td class="lal">&mdash;&mdash; in warm Climates,</td><td class="ral"><a href="#Page_331">331</a></td></tr>
+
+<tr><td class="lal">Of healthful and unhealthful Grounds for
+the Encampment of Troops,</td><td class="ral"><a href="#Page_338">338</a></td></tr>
+
+<tr><td class="lal">Of keeping Camps clean,</td><td class="ral"><a href="#Page_344">344</a></td></tr>
+
+<tr><td class="lal">Of supplying an Army with Straw and with
+Provisions, and obliging the Soldiers to
+buy a certain Quantity of Meat daily,</td><td class="ral"><a href="#Page_346">346</a><span class='pagenum'><a name="Page_xv" id="Page_xv">[xv]</a></span></td></tr>
+
+<tr><td class="lal">Of Water, and the Means of correcting its
+bad Qualities in Camps,</td><td class="ral"><a href="#Page_348">348</a></td></tr>
+
+<tr><td class="lal">Of vinous and spirituous Liquors,</td><td class="ral"><a href="#Page_350">350</a></td></tr>
+
+<tr><td class="lal" style="padding-bottom: 1em">Of keeping Men healthful in Quarters after
+an active Campaign,</td><td class="ral"><a href="#Page_354">354</a></td></tr>
+
+<tr><td class="lal" style="border-top: solid black 1px; padding-top: 1em">
+Of <span class="smcap">Military Hospitals</span>,</td><td class="ral" style="border-top: solid black 1px; padding-top: 1em"><a href="#Page_355">355</a></td></tr>
+
+<tr><td class="lal">Of the Manner in which the Antients disposed
+of their Sick and Wounded,</td><td class="ral"><a href="#Page_356">356</a></td></tr>
+
+<tr><td class="lal">Of the Hospitals wanted for an Army acting
+on a Continent,</td><td class="ral"><a href="#Page_357">357</a></td></tr>
+
+<tr><td class="lal">Of the Houses most fit for Hospitals,</td><td class="ral"><a href="#Page_361">361</a></td></tr>
+
+<tr><td class="lal">Of fitting them up, and distributing the
+Sick in them,</td><td class="ral"><a href="#Page_363">363</a></td></tr>
+
+<tr><td class="lal">Of preventing infectious Disorders from
+being generated or spreading among the Sick,</td><td class="ral"><a href="#Page_366">366</a></td></tr>
+
+<tr><td class="lal">Of the Diet of Military Hospitals,</td><td class="ral"><a href="#Page_372">372</a></td></tr>
+
+<tr><td class="lal">Of providing the Flying Hospital,</td><td class="ral"><a href="#Page_380">380</a></td></tr>
+
+<tr><td class="lal">Of Hospitals on Expedition Service,</td><td class="ral"><a href="#Page_380">380</a></td></tr>
+
+<tr><td class="lal">Of a Guard for Hospitals,</td><td class="ral"><a href="#Page_382">382</a></td></tr>
+
+<tr><td class="lal">Of the Nurses and Patients, and Orders for
+them,</td><td class="ral"><a href="#Page_383">383</a><span class='pagenum'><a name="Page_xvi" id="Page_xvi">[xvi]</a></span></td></tr>
+
+<tr><td class="lal">Of a convalescent Hospital,</td><td class="ral"><a href="#Page_389">389</a></td></tr>
+
+<tr><td class="lal">Of the Physicians, Surgeons, Apothecaries,
+and Mates,</td><td class="ral"><a href="#Page_393">393</a></td></tr>
+
+<tr><td class="lal">Of the Direction of Military Hospitals,</td><td class="ral"><a href="#Page_394">394</a></td></tr>
+
+<tr><td class="lal">Of the Purveyor or Commissary of the
+Hospital,</td><td class="ral"><a href="#Page_396">396</a></td></tr>
+
+<tr><td class="lal">Orders for the Mates,</td><td class="ral"><a href="#Page_397">397</a></td></tr>
+
+<tr><td class="lal">Of Precautions for guarding against infectious
+Disorders,</td><td class="ral"><a href="#Page_400">400</a></td></tr>
+
+<tr><td class="lal" style="border-bottom: solid black 1px; padding-bottom: 1em">Of a Military Inspector and Officers on
+convalescent Duty,</td><td class="ral" style="border-bottom: solid black 1px; padding-bottom: 1em"><a href="#Page_403">403</a></td></tr>
+</table>
+
+
+
+<table summary="errata" class="errata">
+
+<tr><th colspan="5"><span class="smcap">Errata Corrigenda.</span></th></tr>
+
+<tr><td rowspan="15" valign="top">Page</td><td class="rall"><a href="#Page_13">13</a>,</td><td rowspan="15" valign="top">line</td><td class="rall">11,</td><td class="lall">for <i>Pleuretic</i>, read <i>Pleuritic</i>.</td></tr>
+
+<tr><td class="rall"><a href="#Page_18">18</a>,</td><td class="rall">10,</td><td class="lall">of Notes, for <i>Acadamy</i>, read <i>Academy</i>.</td></tr>
+
+<tr><td class="rall"><a href="#Page_28">28</a>,</td><td class="rall">22,</td><td class="lall">for <i>Cinamon</i>, read <i>Cinnamon</i>.</td></tr>
+
+<tr><td class="rall"><a href="#Page_35">35</a>,</td><td class="rall">5,</td><td class="lall">of Notes, for <i>Calomile</i>, read <i>Calomel</i>.</td></tr>
+
+<tr><td class="rall"><a href="#Page_51">51</a>,</td><td class="rall">12,</td><td class="lall">dele <i>used in this Way</i>.</td></tr>
+
+<tr><td class="rall"><a href="#Page_166">166</a>,</td><td class="rall">12,</td><td class="lall">of Notes, for <i>which almost depend</i>, read
+<i>which almost always depend</i>.</td></tr>
+
+<tr><td class="rall"><a href="#Page_207">207</a>,</td><td class="rall">13,</td><td class="lall">of Notes, for <i>Vena postarum</i>, read <i>Vena portarum</i>.</td></tr>
+
+<tr><td class="rall"><a href="#Page_259">259</a>,</td><td class="rall">4,</td><td class="lall">for <i>appeared</i>, read <i>appear</i>.</td></tr>
+
+<tr><td class="rall"><a href="#Page_261">261</a>,</td><td class="rall">1,</td><td class="lall">of Notes, for <i>became</i>, read <i>become</i>.</td></tr>
+
+<tr><td class="rall"><a href="#Page_280">280</a>,</td><td class="rall">20,</td><td class="lall">for <i>Chamamel</i>, read <i>Cham&aelig;mel</i>.</td></tr>
+
+<tr><td class="rall"><a href="#Page_290">290</a>,</td><td class="rall">4,</td><td class="lall">for <i>3<sup>tis</sup> 4<sup>tiis</sup></i>, read <i>3<sup>tiis</sup> 4<sup>tis</sup></i>.</td></tr>
+
+<tr><td class="rall"><a href="#Page_293">293</a>,</td><td class="rall">13,</td><td class="lall">for <i>Mithridatum</i>, read <i>Mithridatium</i>.</td></tr>
+
+<tr><td class="rall"><a href="#Page_336">336</a>,</td><td class="rall">12</td><td class="lall">&amp; 13, for <i>bathe themselves as often</i>, read
+<i>bathe early in the Morning as often</i>.</td></tr>
+
+<tr><td class="rall"><a href="#Page_352">352</a>,</td><td class="rall">7,</td><td class="lall">for <i>in Bilanders</i>, read <i>and were to go in Bilanders</i>.</td></tr>
+
+<tr><td class="rall"><a href="#Page_353">353</a>,</td><td class="rall">2,</td><td class="lall">for <i>the least Appearance of the Malignant Fever</i>,
+read <i>the Malignant Fever appearing</i>.</td></tr>
+</table>
+
+
+
+<h2><a name="OF_THE_FEVER" id="OF_THE_FEVER"></a>OF THE<span class='pagenum'><a name="Page_1" id="Page_1">[1]</a></span><br />
+<span class="smcap">Malignant</span> and <span class="smcap">Petechial</span><br />
+<span style="font-size: 130%; letter-spacing: 0.15ex">FEVER.</span></h2>
+
+
+<p class="newchapter"><span class="dropcap">A</span> Malignant Fever, and Fluxes, began to
+appear among the Soldiers in Autumn,
+1760, while the Allied Army remained encamped
+about <i>Warbourg</i>, from the Beginning
+of <i>August</i> till the 13th of <i>December</i>, 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<span class='pagenum'><a name="Page_2" id="Page_2">[2]</a></span>
+Necessaries, to the Camp: besides this, the
+Field where there had been an Action on the
+31st of <i>July</i>, and where many of the Dead
+were scarce covered with Earth, was in the
+Neighbourhood of the Camp.</p>
+
+<p>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.</p>
+
+<p>Such a Number of Soldiers was sent to
+<i>Paderborn</i> as crowded the Hospitals there, and
+increased the Malignancy of the Distempers
+so that a great many died.</p>
+
+<p>When I arrived at <i>Paderborn</i>, in the
+Beginning of <i>January</i> 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 <i>Hervorden</i>,
+which thinned the Hospitals, it became
+less frequent, and but few died. The
+Guards marched upon the Expedition into
+<i>Hesse</i>, on the eleventh of <i>February</i>, which gave
+us full Room for billetting all our Convalescents,
+and thinning the Wards; by which Means<span class='pagenum'><a name="Page_3" id="Page_3">[3]</a></span>
+the Fever almost entirely ceased in all the Hospitals
+we had before they went away; though
+there still remained about four hundred sick.</p>
+
+<p>When the Guards marched out of <i>Paderborn</i>,
+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<span class='pagenum'><a name="Page_4" id="Page_4">[4]</a></span>
+not being able to procure particular Houses for
+the Sick of the <i>Coldstream</i> 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.</p>
+
+<p>About the End of <i>May</i>, the Weather was
+very warm at <i>Osnabruck</i>; 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,<span class='pagenum'><a name="Page_5" id="Page_5">[5]</a></span>
+and only one, out of six or seven who had got
+the Fever, died.</p>
+
+<p>At the End of <i>June</i>, the Weather was
+very hot at <i>Bilifield</i>, 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.</p>
+
+<p>In the Beginning of <i>August</i>, a few Men
+were taken ill of the same Fever at <i>Munster</i>,
+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.</p>
+
+<p>In <i>November</i> and <i>December</i> 1761, and
+<i>January</i>, <i>February</i>, and <i>March</i> 1762, we
+had several Men sent from Quarters in the
+Town of <i>Bremen</i> 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<span class='pagenum'><a name="Page_6" id="Page_6">[6]</a></span>
+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.</p>
+
+<p>In Summer 1762, we had only ten or
+eleven ill of this Fever in the Hospital at <i>Natzungen</i>,
+and only one died.</p>
+
+<p>When the Troops marched from their Cantonments,
+in <i>December</i> 1762, towards the
+Borders of <i>Holland</i>, the twentieth and twenty-fifth
+Regiments of Foot left behind them, at
+<i>Osnabruck</i>, thirty sick; five of whom had Symptoms
+of the Hospital Fever, though no Petechi&aelig;
+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.<span class='pagenum'><a name="Page_7" id="Page_7">[7]</a></span></p>
+
+<p>In <i>January</i> 1763, we had only three Patients
+in this Fever, with the Petechi&aelig; upon
+them, who all recovered. After this we had
+none taken ill of it at <i>Osnabruck</i>, while I remained
+there, which was till the twenty-fifth
+of <i>March</i>.</p>
+
+<p>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<a name="FNanchor_1_1" id="FNanchor_1_1"></a><a href="#Footnote_1_1" class="fnanchor">[1]</a>; but
+<span class='pagenum'><a name="Page_8" id="Page_8">[8]</a></span>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.</p>
+
+<p>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
+<span class='pagenum'><a name="Page_9" id="Page_9">[9]</a></span>had been broke down by previous
+Disorders.</p>
+
+<p>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 Petechi&aelig; 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. <i>Pringle</i><a name="FNanchor_2_2" id="FNanchor_2_2"></a><a href="#Footnote_2_2" class="fnanchor">[2]</a> very justly
+observes, &#8220;That these low Degrees of this
+Fever are hardly to be characterised, and are
+only to be discovered, in full Hospitals, by
+<span class='pagenum'><a name="Page_10" id="Page_10">[10]</a></span>observing Men languish; though the Nature
+of the Illness, for which they come in, should
+seem to admit of a speedier Cure.&#8221;</p>
+
+<p>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.</p>
+
+<p>When the Petechi&aelig; appeared, they came
+out on the fourth, fifth, sixth, or seventh
+Day; seldom after the eleventh or twelfth<a name="FNanchor_3_3" id="FNanchor_3_3"></a><a href="#Footnote_3_3" class="fnanchor">[3]</a>.
+They appeared mostly on the Breast, Back,
+<span class='pagenum'><a name="Page_11" id="Page_11">[11]</a></span>Arms, and Legs, and sometimes, tho&#8217; rarely,
+on the Face. They had exactly the Appearance
+described by Dr. <i>Pringle</i>, 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. <i>Pringle</i>
+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.
+<i>Huxham</i><a name="FNanchor_4_4" id="FNanchor_4_4"></a><a href="#Footnote_4_4" class="fnanchor">[4]</a>, Dr. <i>Hasenohrl</i><a name="FNanchor_5_5" id="FNanchor_5_5"></a><a href="#Footnote_5_5" class="fnanchor">[5]</a> and Dr. <i>Lind</i><a name="FNanchor_6_6" id="FNanchor_6_6"></a><a href="#Footnote_6_6" class="fnanchor">[6]</a>,
+<span class='pagenum'><a name="Page_12" id="Page_12">[12]</a></span>besides many other good Practitioners, mention
+their having seen them.</p>
+
+<p>Many had no Petechi&aelig; 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
+<i>Perspiration from the Lungs</i> was strong. By
+these Circumstances one might frequently discover
+that the Patient laboured under the malignant
+Fever, without asking any Questions.</p>
+
+
+<p class="break">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 <i>Spiritus Vitrioli</i>.</p>
+
+<p><span class='pagenum'><a name="Page_13" id="Page_13">[13]</a></span></p><p>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<a name="FNanchor_7_7" id="FNanchor_7_7"></a><a href="#Footnote_7_7" class="fnanchor">[7]</a>. 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
+<span class='pagenum'><a name="Page_14" id="Page_14">[14]</a></span>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. <i>Huxham</i>, Dr. <i>Pringle</i>, and
+other good Practitioners, have remarked.</p>
+
+<p>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<a name="FNanchor_8_8" id="FNanchor_8_8"></a><a href="#Footnote_8_8" class="fnanchor">[8]</a>
+in the Evening, and the Purge next Morning.
+<span class='pagenum'><a name="Page_15" id="Page_15">[15]</a></span>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.</p>
+
+<p>After Evacuations, if the Pulse kept up, we
+commonly gave nothing but the saline Draughts,
+with the <i>Pulvis contrayerv&aelig;</i>, 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
+<span class='pagenum'><a name="Page_16" id="Page_16">[16]</a></span>more or less Wine, according to the Degree
+of the Fever. Dr. <i>De Haen</i> has found Fault
+with Dr. <i>Pringle</i> and Dr. <i>Huxham</i>, 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 <i>De Haen</i>, I often
+found it necessary to join the free Use of Wine<a name="FNanchor_9_9" id="FNanchor_9_9"></a><a href="#Footnote_9_9" class="fnanchor">[9]</a>,
+<span class='pagenum'><a name="Page_17" id="Page_17">[17]</a></span>Cordials and Blisters<a name="FNanchor_10_10" id="FNanchor_10_10"></a><a href="#Footnote_10_10" class="fnanchor">[10]</a>, in order to support the
+Patient&#8217;s Strength.</p>
+<p><span class='pagenum'><a name="Page_18" id="Page_18">[18]</a></span></p>
+<p>After reading the Treatises of Dr. <i>De Haen</i>
+and Dr. <i>Hasenohrl</i>, on this Fever, I resolved
+on giving the Bark<a name="FNanchor_11_11" id="FNanchor_11_11"></a><a href="#Footnote_11_11" class="fnanchor">[11]</a> 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.</p>
+
+<p>I. <i>Robert Wilson</i>, of the Second Regiment
+of Foot Guards, on the 19th of <i>February</i> 1761,
+was seized with a Shivering and Coldness, succeeded
+<span class='pagenum'><a name="Page_19" id="Page_19">[19]</a></span>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 <i>Sperma Ceti</i> Mixture, with
+the <i>spiritus mindereri</i>, every two or three
+Hours. He continued without any manifest
+Alteration in the Symptoms, till the 21st,
+when a Number of dun Petechi&aelig; 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 <i>Pilul&aelig; saponace&aelig;</i><span class='pagenum'><a name="Page_20" id="Page_20">[20]</a></span>
+in the Evening. The 26th, the Petechi&aelig;
+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
+<i>March</i>, 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 <i>Sperma Ceti</i>
+Mixture, and the <i>Spiritus Mindereri</i>, when<span class='pagenum'><a name="Page_21" id="Page_21">[21]</a></span>
+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.</p>
+
+<p>II. On the 5th of <i>March</i> 1761, <i>Thomas Stagg</i>,
+of the Second Regiment of Foot Guards,
+was seized with the same Symptoms as <i>Robert
+Wilson</i> 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<span class='pagenum'><a name="Page_22" id="Page_22">[22]</a></span>
+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 Petechi&aelig; 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 Petechi&aelig; 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 <i>Pilul&aelig;
+saponace&aelig;</i> 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<span class='pagenum'><a name="Page_23" id="Page_23">[23]</a></span>
+for some Days, and recovered his Health
+and Strength daily.</p>
+
+<p>III. On the 23d of <i>May</i> 1761, <i>Lionel Thompson</i>,
+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 <i>Lac Ammoniacum</i>,
+and one of the <i>spiritus mindereri</i>,
+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 <i>sal catharticum amarum</i>, 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 Petechi&aelig; appeared, and
+his Breathing was freer: He was ordered a
+Drachm of the Bark, in a saline Draught, every<span class='pagenum'><a name="Page_24" id="Page_24">[24]</a></span>
+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.</p>
+
+<p>After giving the Bark<a name="FNanchor_12_12" id="FNanchor_12_12"></a><a href="#Footnote_12_12" class="fnanchor">[12]</a> with Success, in the
+two first of the Cases mentioned, and to two
+<span class='pagenum'><a name="Page_25" id="Page_25">[25]</a></span>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 <i>Paderborn</i>, and elsewhere, during my
+Attendance in the Military Hospitals in <i>Germany</i>;
+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 <i>Confectio
+cardiaca</i>, <i>Rad. serpent. Virg.</i> and other cordial
+Medicines, and Wine, when the Pulse was low;
+<i>Oxymel scilliticum</i>, and other Pectorals, when
+<span class='pagenum'><a name="Page_26" id="Page_26">[26]</a></span>the Breathing was difficult; Opiates, where the
+Patient was inclined to be too loose; the <i>spiritus
+mindereri</i>, and other Diaphoretics, when
+we wanted to promote a free Perspiration; and
+we applied Blisters as Occasion required.</p>
+
+<p>When the Patient was strong, the Pulse
+quick and full, the Eyes looked red, and the
+Breathing was difficult, after the Petechi&aelig; 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. <i>Hasenohrl</i> 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 <i>Paderborn</i> and elsewhere;
+and particularly in two Cases at <i>Bremen</i>, and
+one at <i>Osnabruck</i>, where it gave immediate Relief,
+and seemed to shorten the Disease much.
+One of the Patients at <i>Bremen</i>, <i>Robert Ellis</i>,
+belonged to an Independant Company; the other,
+<i>Francis Hamstan</i>, of the 24th Regiment, had formerly
+had his Skull fractured, and took the Fever,
+while he was in the Hospital, for violent Head-achs,<span class='pagenum'><a name="Page_27" id="Page_27">[27]</a></span>
+which he had been subject to, at times,
+ever after his Skull had been fractured. The
+Case at <i>Osnabruck</i> was a Nurse of the Hospital,
+whose Name was &mdash;&mdash; <i>Andrews</i>, 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 <i>January</i>
+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 <i>sal catharticum
+amarum</i>, 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 <i>spiritus mindereri</i>
+Mixture, with Mithridate. This checked
+the Purging, but did not stop it entirely. The Fever<span class='pagenum'><a name="Page_28" id="Page_28">[28]</a></span>
+went on, without any remarkable Change,
+till the 27th; at which time the Petechi&aelig; 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 Petechi&aelig;
+had begun to die away. The Blood
+which was taken away the Day before, had a
+thin Buff at the Top, but the <i>Crassamentum</i> 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<span class='pagenum'><a name="Page_29" id="Page_29">[29]</a></span>
+Cinnamon, <i>per</i> 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. <i>Feb.</i> 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,<span class='pagenum'><a name="Page_30" id="Page_30">[30]</a></span>
+and was soon in good Health, and able to discharge
+her Duty as a Nurse.</p>
+
+<p>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.</p>
+
+<p>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.<span class='pagenum'><a name="Page_31" id="Page_31">[31]</a></span></p>
+
+<p>Towards the End of <i>May</i> 1761, two Soldiers
+in the Hospital, at <i>Osnabruck</i>, were taken
+ill of this Fever; who, after using the Bark
+freely, and being allowed a Pint of Red Wine
+<i>per</i> 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.</p>
+
+<p>About the same time, having given the Bark
+freely for some Days, and applied a Blister, to
+another Patient, after the Petechi&aelig; had appeared,
+I found him one Morning so low that his<span class='pagenum'><a name="Page_32" id="Page_32">[32]</a></span>
+Pulse could scarce be felt. He could not speak;
+he had a Delirium, and rather a Tremor than a
+<i>subsultus tendinum</i>, 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 <i>confectio cardiaca</i>,
+and seven Grains of the <i>sal vol. corn. cerv.</i><a name="FNanchor_13_13" id="FNanchor_13_13"></a><a href="#Footnote_13_13" class="fnanchor">[13]</a>
+<span class='pagenum'><a name="Page_33" id="Page_33">[33]</a></span>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.</p>
+
+<p>At <i>Bremen</i> there were two Men, one in <i>January</i>,
+and the other in <i>February</i> 1762, on
+whom the Cortex had but little Effect, who
+recovered by the free Use of Mixtures, with
+the <i>confectio cardiaca</i> and <i>rad. serpentari&aelig;</i>, and
+<span class='pagenum'><a name="Page_34" id="Page_34">[34]</a></span>of Wine, with the Application of large Blisters.
+Several Cases of this kind occurred in
+the Hospitals, where the Bark did not answer.</p>
+
+<p>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.</p>
+
+<p>Many of the Patients, towards the Height
+of this Fever, sooner or later, had a Purging,
+which seldom proved critical; and some were<span class='pagenum'><a name="Page_35" id="Page_35">[35]</a></span>
+seized with the Flux. A gentle <i>diarrh&#339;a</i>, 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.</p>
+
+<p>In this Fever, it was common for Patients to
+vomit Worms<a name="FNanchor_14_14" id="FNanchor_14_14"></a><a href="#Footnote_14_14" class="fnanchor">[14]</a>, 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 <i>British</i>
+Soldiers, brought to the Hospitals for other
+feverish Disorders as well as this. Dr. <i>Pringle</i><a name="FNanchor_15_15" id="FNanchor_15_15"></a><a href="#Footnote_15_15" class="fnanchor">[15]</a>
+<span class='pagenum'><a name="Page_36" id="Page_36">[36]</a></span>when he mentions Worms being observed in
+this Fever, seems to embrace <i>Lancisius</i>&#8217;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&#8217;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.<span class='pagenum'><a name="Page_37" id="Page_37">[37]</a></span></p>
+
+<p>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<a name="FNanchor_16_16" id="FNanchor_16_16"></a><a href="#Footnote_16_16" class="fnanchor">[16]</a>.</p>
+
+<p>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
+<span class='pagenum'><a name="Page_38" id="Page_38">[38]</a></span>remained any Symptoms of Worms, we gave
+the purgative Medicine once or oftener, and in
+the Intervals gave the <i>pulvis stanni</i>, 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.</p>
+
+<p>What was the Cause of the Army&#8217;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.</p>
+
+<p>In the Malignant Fever at <i>Paderborn</i>, 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<span class='pagenum'><a name="Page_39" id="Page_39">[39]</a></span>
+<i>Paderborn</i>. Decoctions of Gum Arabic, with
+some of the <i>spiritus nitri dulcis</i>, and oily Mixtures,
+and Opiates, commonly gave immediate
+Relief, and soon removed this Complaint.</p>
+
+<p>One of the first salutary Symptoms which
+most generally appeared in those who recovered,
+was a Dullness of Hearing, or Deafness<a name="FNanchor_17_17" id="FNanchor_17_17"></a><a href="#Footnote_17_17" class="fnanchor">[17]</a>;
+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
+<span class='pagenum'><a name="Page_40" id="Page_40">[40]</a></span>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 <i>meatus auditorius</i> with
+the emollient Decoction, in which a small Quantity
+of Soap was dissolved, proved of Service.</p>
+
+<p>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 <i>Germany</i>, they came on early in the Fever,
+<span class='pagenum'><a name="Page_41" id="Page_41">[41]</a></span>but did not suppurate. Both Patients died;
+all the rest recovered, except one old Man, an
+Invalid at <i>Bremen</i>; 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<a name="FNanchor_18_18" id="FNanchor_18_18"></a><a href="#Footnote_18_18" class="fnanchor">[18]</a>.</p>
+<p><span class='pagenum'><a name="Page_42" id="Page_42">[42]</a></span></p>
+<p>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. <i>Riverius</i><a name="FNanchor_19_19" id="FNanchor_19_19"></a><a href="#Footnote_19_19" class="fnanchor">[19]</a>
+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.
+<i>Pringle</i><a name="FNanchor_20_20" id="FNanchor_20_20"></a><a href="#Footnote_20_20" class="fnanchor">[20]</a> 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.</p>
+
+<p><span class='pagenum'><a name="Page_43" id="Page_43">[43]</a></span></p><p>In <i>February</i> 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<span class='pagenum'><a name="Page_44" id="Page_44">[44]</a></span>
+<i>Germany</i>; tho&#8217; Mr. <i>Lovet</i>, who served as a Mate
+to the Hospitals, and who was at <i>Hoxter</i>, where
+we had another Hospital established, while I
+was at <i>Paderborn</i>, 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<a name="FNanchor_21_21" id="FNanchor_21_21"></a><a href="#Footnote_21_21" class="fnanchor">[21]</a>.</p>
+
+<p>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<a name="FNanchor_22_22" id="FNanchor_22_22"></a><a href="#Footnote_22_22" class="fnanchor">[22]</a>. However, this Complaint
+was not peculiar to those who had the
+<span class='pagenum'><a name="Page_45" id="Page_45">[45]</a></span>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 <i>Germany</i>, except in <i>January</i>,
+<i>February</i>, <i>March</i>, and <i>April</i> 1761. By Bleeding,
+and applying emollient Fomentations and
+Cataplasms, and bathing the Parts with <i>spiritus
+mindereri</i> 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.</p>
+
+<p>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,<span class='pagenum'><a name="Page_46" id="Page_46">[46]</a></span>
+commonly removed this Complaint; tho&#8217;
+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.</p>
+
+<p>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&#8217; in
+some it spread over the Feet, and in two or
+three advanced up the Leg. Several lost one<span class='pagenum'><a name="Page_47" id="Page_47">[47]</a></span>
+or more Toes; and in <i>February</i> 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&#8217; 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<a name="FNanchor_23_23" id="FNanchor_23_23"></a><a href="#Footnote_23_23" class="fnanchor">[23]</a>.</p>
+
+<p>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
+<span class='pagenum'><a name="Page_48" id="Page_48">[48]</a></span>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 <i>linimentum saponaceum</i>, or <i>linimentum
+volatile</i>, 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.</p>
+
+<p>In <i>January</i> 1762, one Patient, ill of the
+Petechial Fever at <i>Bremen</i>, 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 <i>cortex</i> and <i>confectio cardiaca</i>,
+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,<span class='pagenum'><a name="Page_49" id="Page_49">[49]</a></span>
+and only the scarf Skin peeled off from
+the End of it.</p>
+
+<p>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&#8217; 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.</p>
+
+<p>Patients, who were reduced very low by this
+Fever, or by repeated Relapses, were subject
+to oedematous Swellings; especially of the Feet,<span class='pagenum'><a name="Page_50" id="Page_50">[50]</a></span>
+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.</p>
+
+<p>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 <i>Dover</i>&#8217;s Powder, or of the <i>gutt&aelig; antimoniales
+anodyn&aelig;</i>.</p>
+
+<p>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&#8217;s
+Strength was exhausted, provided that he laboured<span class='pagenum'><a name="Page_51" id="Page_51">[51]</a></span>
+under no other Disorder but these oedematous
+Swellings, which proceeded from
+Weakness, I never observed any bad Effects
+from them; tho&#8217; 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.</p>
+
+<p>One of the most remarkable Instances of the
+good Effects of Blisters, was
+in the Case of a Soldier at <i>Paderborn</i>; <i>Thomas
+Hope</i>, 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<span class='pagenum'><a name="Page_52" id="Page_52">[52]</a></span>
+of Physic, and the continued Use of the Medicines
+before prescribed. Three other Men in
+the Hospital at <i>Osnabruck</i>, in <i>May</i> 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.</p>
+
+<p>Some of the Soldiers, who had repeated
+Hospital Fevers, had their Blood so much broke
+down, as to be subject to profuse H&aelig;morrhages
+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 <i>spiritus vitrioli</i>; to allow them as
+much Red Wine as the Strength and present
+Circumstances could bear; and at the same
+Time to support the Patient&#8217;s Strength by
+a mild Diet, of light Digestion; as Water or
+Rice Gruel, Panado, weak Broth, and the<span class='pagenum'><a name="Page_53" id="Page_53">[53]</a></span>
+like. When there was a Tendency to a Diarrh&#339;a,
+we were obliged to add some of the <i>electuarium
+diascordii</i> 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 <i>Paderborn</i>. 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 <i>spiritus
+vitrioli</i>, 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<span class='pagenum'><a name="Page_54" id="Page_54">[54]</a></span>
+by a Dose of the <i>tinctura rhei</i>; by joining some
+of the <i>electuarium diascordii</i> with the Bark, and
+giving an Opiate in the Evening.</p>
+
+
+<p class="break">Putrid Malignant Fevers, attended with
+Eruptions, are taken Notice of by <i>Hippocrates</i><a name="FNanchor_24_24" id="FNanchor_24_24"></a><a href="#Footnote_24_24" class="fnanchor">[24]</a>,
+and other antient Authors<a name="FNanchor_25_25" id="FNanchor_25_25"></a><a href="#Footnote_25_25" class="fnanchor">[25]</a>; but
+whether they meant that particular Sort of
+Eruption which we now call Petechi&aelig;, 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
+<span class='pagenum'><a name="Page_55" id="Page_55">[55]</a></span>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<a name="FNanchor_26_26" id="FNanchor_26_26"></a><a href="#Footnote_26_26" class="fnanchor">[26]</a>.</p>
+
+<p>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.</p>
+
+<p>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 <i>Riverius</i><a name="FNanchor_27_27" id="FNanchor_27_27"></a><a href="#Footnote_27_27" class="fnanchor">[27]</a>
+has very justly observed, that they all
+belong to the same pestilential Tribe, and only
+differ from one another in the Degree of Infection,
+<span class='pagenum'><a name="Page_56" id="Page_56">[56]</a></span>and the Violence of the Symptoms<a name="FNanchor_28_28" id="FNanchor_28_28"></a><a href="#Footnote_28_28" class="fnanchor">[28]</a>;
+and that they are to be cured by the same general
+Treatment, and the same Medicines.</p>
+
+
+<div class="footnotes"><h3>FOOTNOTES:</h3>
+
+<div class="footnote"><p><a name="Footnote_1_1" id="Footnote_1_1"></a><a href="#FNanchor_1_1"><span class="label">[1]</span></a> Dr. <i>Huxham</i>, in his <i>Treatise on the ulcerous sore Throat</i>,
+p. 36, says, &#8220;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.&#8221; And in his <i>Essay on Fevers</i>,
+chap. viii. p. 108. says, &#8220;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.&#8221;</p></div>
+
+<div class="footnote"><p><a name="Footnote_2_2" id="Footnote_2_2"></a><a href="#FNanchor_2_2"><span class="label">[2]</span></a> <i>Observations on the Diseases of the Army</i>, part III. chap.
+vii. sect. 3. third Edition, 1761.</p></div>
+
+<div class="footnote"><p><a name="Footnote_3_3" id="Footnote_3_3"></a><a href="#FNanchor_3_3"><span class="label">[3]</span></a> <i>Ramazini</i>, in his Treatise <i>De Constitutionibus annorum</i>,
+1692, 3, 4, <i>in Mutinensi civitate</i>, Sect. 19. mentions the Petechial
+Fever which had been frequent the three foregoing
+Years; in which the Petechi&aelig; 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 <i>the malignant
+ulcerous sore Throat</i>, which I never once saw while I was
+with the Troops in <i>Germany</i>.</p></div>
+
+<div class="footnote"><p><a name="Footnote_4_4" id="Footnote_4_4"></a><a href="#FNanchor_4_4"><span class="label">[4]</span></a> Dr. <i>Huxham</i>, in his <i>Essay on Fevers</i>, ch. viii. p. 97, tells
+us, that sometimes, about the eleventh or twelfth Day, on the
+coming on of profuse Sweats, the Petechi&aelig; disappear, and vast
+Quantities of small white miliary pustules break out.</p></div>
+
+<div class="footnote"><p><a name="Footnote_5_5" id="Footnote_5_5"></a><a href="#FNanchor_5_5"><span class="label">[5]</span></a> Dr. <i>Hasenohrl</i>, in his Treatise <i>De Febre Petechiali</i>, cap. i. p.
+12. relates a very particular Case, where the Petechi&aelig; appeared
+on the fourth, and the white miliary Eruptions on the seventeenth
+Day of the Fever.</p></div>
+
+<div class="footnote"><p><a name="Footnote_6_6" id="Footnote_6_6"></a><a href="#FNanchor_6_6"><span class="label">[6]</span></a> Dr. <i>Lind</i>, in his <i>second Paper on Fevers</i>, 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 <i>French</i> Prisoners in <i>Winchester</i> Castle, in the Beginning
+of the Year 1761.</p></div>
+
+<div class="footnote"><p><a name="Footnote_7_7" id="Footnote_7_7"></a><a href="#FNanchor_7_7"><span class="label">[7]</span></a> Dr. <i>Huxham</i>, tho&#8217; he says &#8220;yet Bleeding to some Degree
+is most commonly requisite, nay necessary, in the strong and
+plethoric;&#8221; yet he afterwards makes the following Remark:
+&#8220;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.&#8221; See his <i>Essay on Fevers</i>,
+chap. viii. And Dr. <i>Pringle</i> observes, that in the second
+Stage of the Disorder large Bleedings have generally
+proved fatal, by sinking the Pulse, and bringing on a Delirium.
+<i>Observations on the Diseases of the Army</i>, part III. chap. vii.
+sect. V.</p></div>
+
+<div class="footnote"><p><a name="Footnote_8_8" id="Footnote_8_8"></a><a href="#FNanchor_8_8"><span class="label">[8]</span></a> Dr. <i>Pringle</i> 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
+<i>Sal volat. Corn. cervi</i>, 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. <i>Observ.</i> part III. ch. vii.
+sect. 5. Dr. <i>Lind</i>, in his <i>second Paper on Fevers</i>, p. 66. says,
+&#8220;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.&mdash;That he has found it equally serviceable in
+preventing Relapses, when it is given at the Return of the
+Shiverings.&#8221; 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. <i>Pringle</i>. At
+other times &#8220;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.&#8221;
+</p><p>
+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.</p></div>
+
+<div class="footnote"><p><a name="Footnote_9_9" id="Footnote_9_9"></a><a href="#FNanchor_9_9"><span class="label">[9]</span></a> <i>Petrus a Castro</i>, in his Account of a Petechial Fever,
+which was frequent at <i>Verona</i>, 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. <i>De Feb. Malig.</i> sect. iii. chap.
+26. Dr. <i>Huxham</i>, in his <i>Essay on Fevers</i>, has the following very
+judicious Remark on the Use of Wine: &#8220;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 <i>Seville</i> Orange or
+Lemon. It may be also impregnated with some Aromatics,
+as Cinnamon, <i>Seville</i> Orange Rhind, red Roses, or the like, as
+may be indicated, and a few Drops of <i>Elix. Vitrioli</i> 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 <i>Asiatics</i>, 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 <i>Alexipharmac.</i>&#8221; Chap,
+viii. second Edit. p. 123, 4.
+</p><p>
+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&#8217;s Drink,
+as it was the easiest procured and carried about with the Flying
+Hospital.</p></div>
+
+<div class="footnote"><p><a name="Footnote_10_10" id="Footnote_10_10"></a><a href="#FNanchor_10_10"><span class="label">[10]</span></a> If the preventive Method does not succeed, Dr. <i>Lind</i>
+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. <i>Pringle</i> 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. <i>Lind</i> mentions.</p></div>
+
+<div class="footnote"><p><a name="Footnote_11_11" id="Footnote_11_11"></a><a href="#FNanchor_11_11"><span class="label">[11]</span></a> It is long since the <i>Peruvian</i> 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. <i>Haen</i> and Dr. <i>Hasenohrl</i>. Dr. <i>Ramazini</i>
+mentions its having been tried in the Petechial Fever,
+in the Years 1692, 3, 4. And in a Treatise on the Plague in
+the <i>Ucrane</i>, published at <i>Petersburgh</i>, in the Year 1750, we
+are told, that in the <i>French</i> Translation of the Philosophical
+Transactions for the Year 1732, there is a Note to p. 264,
+telling, that Mr. <i>Amyand</i> informed the Academy of Surgery at
+<i>Paris</i>, that Mr. <i>Rushworth</i>, Surgeon, had wrote to Sir <i>Hans
+Sloane</i>, on the 23d of <i>May</i> 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 <i>Peruvian</i> Bark. Dr. <i>Huxham</i> has recommended a Tincture
+of the Bark; and Dr. <i>Pringle</i>, a strong Decoction of it, with
+some of the Tincture, in these Malignant Fevers.</p></div>
+
+<div class="footnote"><p><a name="Footnote_12_12" id="Footnote_12_12"></a><a href="#FNanchor_12_12"><span class="label">[12]</span></a> The <i>Peruvian</i> Bark has not only been found useful in this
+Malignant Fever, but has likewise been recommended in the
+Plague. See <i>Morton Oper. Append. secund. Exercitat. Hist. Febr.
+Ann. 1658, ad. an. 1691. complexa</i>. In the Small Pox, see <i>Medical
+Essays</i>, vol. V. art. x. and has been found serviceable in the
+putrid Disorders of the <i>West Indies</i>, as taken Notice of by Dr.
+<i>Hillary</i>; and in the malignant ulcerous sore Throat in this
+Country, as Dr. <i>Wall</i> 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.
+</p><p>
+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. <i>Ranby</i>, Serjeant Surgeon to his Majesty, in the Cure of
+Gunshot Wounds. See his <i>Treatise on Gunshot Wounds</i>.</p></div>
+
+<div class="footnote"><p><a name="Footnote_13_13" id="Footnote_13_13"></a><a href="#FNanchor_13_13"><span class="label">[13]</span></a> Dr. <i>Huxham</i>, in his <i>Treatise on the ulcerous sore Throat</i>,
+p. 54, &amp;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 <i>Stimulus</i> 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 <i>Momentum</i> of the Blood, and dissolve
+it; and therefore I cannot but disapprove the continuing their
+Use longer than is immediately necessary.</p></div>
+
+<div class="footnote"><p><a name="Footnote_14_14" id="Footnote_14_14"></a><a href="#FNanchor_14_14"><span class="label">[14]</span></a> Some Men passed only one Worm; others, two or three;
+some, six or seven; and one Man, of the Guards, in <i>January</i>
+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.</p></div>
+
+<div class="footnote"><p><a name="Footnote_15_15" id="Footnote_15_15"></a><a href="#FNanchor_15_15"><span class="label">[15]</span></a> <i>Observations on the Diseases of the Army</i>, part iii. chap.
+iv. Note to p. 213. third Edition.</p></div>
+
+<div class="footnote"><p><a name="Footnote_16_16" id="Footnote_16_16"></a><a href="#FNanchor_16_16"><span class="label">[16]</span></a> See <i>Hoffman</i>&#8217;s Works, vol. III. chap. x. <i>River. Observ.
+commun.</i> Obs. 13. <i>of Observations found in a Library.</i> <i>Bonetus&#8217;s
+Sepulchret. anatom.</i> tom. II. <i>Gualther van Doeveren&#8217;s Inaugural
+Dissertation de Vermibus intestinalibus</i>, published at <i>Leyden</i>,
+1753; and <i>Lancisi</i>&#8217;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.</p></div>
+
+<div class="footnote"><p><a name="Footnote_17_17" id="Footnote_17_17"></a><a href="#FNanchor_17_17"><span class="label">[17]</span></a> <i>Riverius</i> tells us, that, according to <i>Hippocrates</i>&#8217;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 (<i>in statu</i>) though the other Symptoms
+threatened much Danger. <i>Prax. Medic.</i> lib. XVII. sect. iii.
+cap. i. p. 451.
+</p><p>
+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. <i>George</i>&#8217;s Hospital, in the Year 1759.
+On the 17th of <i>January</i> 1759, <i>James Donaldson</i>, 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 <i>April</i>
+1759, a Youth, <i>John Young</i>, 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 <i>May</i>, having recovered the Use of his Legs as
+well as got free of the Fever.</p></div>
+
+<div class="footnote"><p><a name="Footnote_18_18" id="Footnote_18_18"></a><a href="#FNanchor_18_18"><span class="label">[18]</span></a> 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 <i>Riverius</i>, 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 <i>Montpelier</i>, 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. <i>Prax. Med. Lib.</i> XVII. <i>sect.</i>
+iii. <i>cap.</i> 1.</p></div>
+
+<div class="footnote"><p><a name="Footnote_19_19" id="Footnote_19_19"></a><a href="#FNanchor_19_19"><span class="label">[19]</span></a> Ibid.</p></div>
+
+<div class="footnote"><p><a name="Footnote_20_20" id="Footnote_20_20"></a><a href="#FNanchor_20_20"><span class="label">[20]</span></a> <i>Pringle&#8217;s Observations on the Diseases of the Army</i>, Part
+III. chap. vii.</p></div>
+
+<div class="footnote"><p><a name="Footnote_21_21" id="Footnote_21_21"></a><a href="#FNanchor_21_21"><span class="label">[21]</span></a> 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. <i>Huxham</i> nor Dr. <i>Pringle</i>
+mention their having seen such Buboes; and Dr. <i>Lind</i> says,
+that he never saw them till the Beginning of the Year 1763.</p></div>
+
+<div class="footnote"><p><a name="Footnote_22_22" id="Footnote_22_22"></a><a href="#FNanchor_22_22"><span class="label">[22]</span></a> <i>Hippocrates</i> 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. <i>See his Second Book
+on Epidemics</i>, sect. ii. And he mentions this Symptom as a
+Crisis in the ardent Fever. <i>See his Book on Crises</i>, sect. xi.&mdash;And
+Dr. <i>Antonio Lizzari</i>, in a Treatise which he published on
+the <i>Acute Diseases which were frequent at Venice, and all over
+Italy, in the Years 1761, 62</i>, tells us, that Abscesses of the
+Scrotum and Testicles frequently followed the Measles.</p></div>
+
+<div class="footnote"><p><a name="Footnote_23_23" id="Footnote_23_23"></a><a href="#FNanchor_23_23"><span class="label">[23]</span></a> 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 <i>Osnabruck</i>, 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.</p></div>
+
+<div class="footnote"><p><a name="Footnote_24_24" id="Footnote_24_24"></a><a href="#FNanchor_24_24"><span class="label">[24]</span></a> <i>Hippocrat.</i> lib ii. popul. sect. iii. text. 2.</p></div>
+
+<div class="footnote"><p><a name="Footnote_25_25" id="Footnote_25_25"></a><a href="#FNanchor_25_25"><span class="label">[25]</span></a> <i>Aetius Tetrab.</i> ii. sect. i. cap. 129. <i>Actuar.</i> lib. i.
+cap. 23.</p></div>
+
+<div class="footnote"><p><a name="Footnote_26_26" id="Footnote_26_26"></a><a href="#FNanchor_26_26"><span class="label">[26]</span></a> See these Causes mentioned by <i>Riverius</i>, and since more
+fully explained by Dr. <i>Pringle</i>, <i>Observations on the Diseases of
+the Army</i>, part iii. chap. vii.</p></div>
+
+<div class="footnote"><p><a name="Footnote_27_27" id="Footnote_27_27"></a><a href="#FNanchor_27_27"><span class="label">[27]</span></a> <i>River. Prax. Med.</i> lib. xvi. sect. iii. Pr&aelig;fat.</p></div>
+
+<div class="footnote"><p><a name="Footnote_28_28" id="Footnote_28_28"></a><a href="#FNanchor_28_28"><span class="label">[28]</span></a> 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 <i>Riverius</i> says, the Petechi&aelig; do not always appear;
+but when they do, it is a most certain Sign of a Pestilential Fever.
+See his <i>Prax. Med.</i> cap. xvi. sect. iii.</p></div>
+</div>
+
+
+<h2><a name="DYSENTERY" id="DYSENTERY"></a>OF THE<span class='pagenum'><a name="Page_57" id="Page_57">[57]</a></span><br />
+<span style="font-size: 130%; letter-spacing: 0.15ex">DYSENTERY</span>.</h2>
+
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">T</span>he</span> Dysentery generally began to appear
+soon after the Army took the Field;
+and became frequent about the End of <i>July</i>,
+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.</p>
+
+<p>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&#8217;s<span class='pagenum'><a name="Page_58" id="Page_58">[58]</a></span>
+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<a name="FNanchor_29_29" id="FNanchor_29_29"></a><a href="#Footnote_29_29" class="fnanchor">[29]</a>,
+after their Juices had been highly exalted
+by the Heat of Summer.</p>
+<p><span class='pagenum'><a name="Page_59" id="Page_59">[59]</a></span></p>
+<p>At the Time the Petechial Fever was frequent
+at <i>Paderborn</i> in <i>January</i>, <i>February</i>, and
+<i>March</i> 1761, the Flux frequently accompanied
+<span class='pagenum'><a name="Page_60" id="Page_60">[60]</a></span>it; and we had in the Hospitals likewise a Number
+of old Cases of this Kind, the Remains of the
+preceding Campaign about <i>Warbourg</i>; 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 <i>Hesse</i>. In <i>May</i> and <i>June</i>, what Fluxes
+we had at <i>Osnabruck</i>, were the remaining old
+Cases of the Hospitals of <i>Munster</i>, <i>Paderborn</i>,
+<i>Hoxter</i>, and <i>Niehms</i>. Some few recent ones
+were sent to <i>Bilifield</i> about the End of <i>June</i>,
+and above 300 to <i>Munster</i>, in <i>July</i> and <i>August</i>.
+Those sent to <i>Bremen</i>, in <i>November</i> and <i>December</i>,
+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
+<span class='pagenum'><a name="Page_61" id="Page_61">[61]</a></span>Beginning of <i>May</i> 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 <i>June</i> there were but two sent to the
+Hospital at <i>Minden</i>; and not above ten among
+the Sick sent to <i>Natzungen</i> in the Beginning of
+<i>July</i>; tho&#8217; towards the Middle of this Month
+they began to be more frequent; and continued
+to be more so in <i>August</i> and <i>September</i>; and
+in the Hospital at <i>Osnabruck</i> we had not above
+five or six ill of this Disorder, in <i>December</i>
+1762, and in <i>January</i>, <i>February</i> and <i>March</i>
+1763.</p>
+
+<p>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&#8217; sometimes no Blood could be observed
+in them; and then the Soldiers used to
+say they had the White Flux.<span class='pagenum'><a name="Page_62" id="Page_62">[62]</a></span></p>
+
+<p>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&#8217; 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.</p>
+
+<p>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&#8217; 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<a name="FNanchor_30_30" id="FNanchor_30_30"></a><a href="#Footnote_30_30" class="fnanchor">[30]</a>.</p>
+
+<p>In the Course of the Disorder, the Men often
+complained of a violent Pain of the Rectum,
+<span class='pagenum'><a name="Page_63" id="Page_63">[63]</a></span>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. <i>A. Tough</i>, one of the Apothecaries to
+the Military Hospital in <i>Germany</i>, 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 <i>Gibraltar</i>; 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.</p>
+
+<p>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.</p>
+
+<p>The Appearances we found after Death in the
+Bodies of some Patients, who died of old Fluxes<span class='pagenum'><a name="Page_64" id="Page_64">[64]</a></span>
+at <i>Bremen</i>, 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<a name="FNanchor_31_31" id="FNanchor_31_31"></a><a href="#Footnote_31_31" class="fnanchor">[31]</a>.</p>
+
+<p>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<span class='pagenum'><a name="Page_65" id="Page_65">[65]</a></span>
+our Endeavours, and a great Number died<a name="FNanchor_32_32" id="FNanchor_32_32"></a><a href="#Footnote_32_32" class="fnanchor">[32]</a>.</p>
+
+<p>Upon my first being employed in the Military<span class='pagenum'><a name="Page_66" id="Page_66">[66]</a></span>
+Hospitals in <i>Germany</i>, 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<a name="FNanchor_33_33" id="FNanchor_33_33"></a><a href="#Footnote_33_33" class="fnanchor">[33]</a> 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
+<span class='pagenum'><a name="Page_67" id="Page_67">[67]</a></span>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.</p>
+
+<p>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.<span class='pagenum'><a name="Page_68" id="Page_68">[68]</a></span></p>
+
+<p>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.</p>
+
+<p>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<a name="FNanchor_34_34" id="FNanchor_34_34"></a><a href="#Footnote_34_34" class="fnanchor">[34]</a>.</p>
+<p><span class='pagenum'><a name="Page_69" id="Page_69">[69]</a></span></p>
+<p>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.&mdash;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
+<span class='pagenum'><a name="Page_70" id="Page_70">[70]</a></span>greatly promoted the Cure.&mdash;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<a name="FNanchor_35_35" id="FNanchor_35_35"></a><a href="#Footnote_35_35" class="fnanchor">[35]</a>, as Dr. <i>Pringle</i> has observed.</p>
+
+<p>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 <i>sal catharticum amarum</i>, with Manna
+<span class='pagenum'><a name="Page_71" id="Page_71">[71]</a></span>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. <i>Francis Russel</i>,
+Surgeon to the <i>British</i> Military Hospital in <i>America</i>,
+who was formerly Surgeon to the Island of
+<i>Minorca</i>, was the first Person who informed me
+(in the Year 1757) of the Use of the <i>sal catharticum
+amarum</i> in the Dysentery; he told me,
+that the Year before (1756) the Dysentery had
+been very frequent and very fatal at <i>Gibraltar</i>;
+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.</p>
+
+<p>As a great Part of the Cure depended on the
+frequent Use of gentle Purges<a name="FNanchor_36_36" id="FNanchor_36_36"></a><a href="#Footnote_36_36" class="fnanchor">[36]</a> in the Beginning,
+<span class='pagenum'><a name="Page_72" id="Page_72">[72]</a></span>to carry off the corrupted Humours; the
+Purgative was repeated every second, third, or
+fourth Day, as the Case required; the Operation
+<span class='pagenum'><a name="Page_73" id="Page_73">[73]</a></span>of the former Purge, and the Symptoms,
+determining the Frequency of the Repetition.
+<span class='pagenum'><a name="Page_74" id="Page_74">[74]</a></span>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
+<span class='pagenum'><a name="Page_75" id="Page_75">[75]</a></span>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.</p>
+
+<p>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.</p>
+
+<p>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,<span class='pagenum'><a name="Page_76" id="Page_76">[76]</a></span>
+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.</p>
+
+<p>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 <i>tinctura thebaica</i>;
+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<a name="FNanchor_37_37" id="FNanchor_37_37"></a><a href="#Footnote_37_37" class="fnanchor">[37]</a>; and therefore we seldom
+made Use of them in this first Stage of the
+Disorder.</p>
+<p><span class='pagenum'><a name="Page_77" id="Page_77">[77]</a></span></p>
+<p>If the Patient was attacked with severe
+Gripes<a name="FNanchor_38_38" id="FNanchor_38_38"></a><a href="#Footnote_38_38" class="fnanchor">[38]</a>, 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<a name="FNanchor_39_39" id="FNanchor_39_39"></a><a href="#Footnote_39_39" class="fnanchor">[39]</a>, or
+an Infusion of Camomile Flowers, as recommended
+by Dr. <i>Pringle</i>; and ordered first Clysters
+of large Quantities of the plain emollient
+Decoction to be given; and if the Gripes still
+<span class='pagenum'><a name="Page_78" id="Page_78">[78]</a></span>continued, to be repeated in small Quantities,
+with the Addition of a Drachm or two of the
+<i>tinctura thebaica</i>; 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 <i>tinctura thebaica</i>, or the Starch Clyster,
+gave more Ease than any other.&mdash;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.</p>
+
+<p>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.&mdash;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<span class='pagenum'><a name="Page_79" id="Page_79">[79]</a></span>
+and blunt the Acrimony of the Fluids<a name="FNanchor_40_40" id="FNanchor_40_40"></a><a href="#Footnote_40_40" class="fnanchor">[40]</a>. In
+some Cases, when the Purging was violent, and
+not accompanied with the malignant Fever, the
+<i>decoctum album</i> was found to be a good Drink;
+and we added occasionally a few Drops of the
+<i>tinctura thebaica</i>.</p>
+
+<p>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;
+<span class='pagenum'><a name="Page_80" id="Page_80">[80]</a></span>while mild Purgatives were given at proper Intervals.</p>
+
+<p>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 <i>per</i> 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 <i>decoctum album</i>.</p>
+
+<p>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<a name="FNanchor_41_41" id="FNanchor_41_41"></a><a href="#Footnote_41_41" class="fnanchor">[41]</a>;
+<span class='pagenum'><a name="Page_81" id="Page_81">[81]</a></span>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
+<span class='pagenum'><a name="Page_82" id="Page_82">[82]</a></span>the most efficacious oftentimes proved unsuccessful,
+and at length the Patient died.</p>
+
+<p>A Spoonful of the <i>mixtura fracastorii</i>, taken
+after every loose Stool; and an anodyne Draught
+at Night, had a good Effect with some&mdash;Repeated
+Doses of the <i>philonium Londinense</i> answered
+better with others, who were low, and
+required a Remedy that was warm and cordial&mdash;And
+others found more Benefit from the
+Mindereri Draughts, with Mithridate, or the
+<i>confectio cardiaca</i>, or the Theriac anodyne Boluses.</p>
+
+<p>The <i>mixtura Campechensis</i>, both alone and
+with <i>tinctura thebaica</i>, 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 <i>Bremen</i>; but it afterwards
+occasioned such Sickness, that we did not
+continue its Use.</p>
+
+<p>In other inveterate Dysenteries, where we
+thought that a strong Astringent was wanted,
+we added a small Proportion of Allum to the
+<i>Campechense</i> Julep, which on first using seemed<span class='pagenum'><a name="Page_83" id="Page_83">[83]</a></span>
+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.</p>
+
+<p>Equal Parts of the <i>electuarium diascordii</i> and
+<i>electuarium corticis</i>, taken in the Quantity of a
+Drachm twice or thrice a Day, was of Use in
+many old Fluxes<a name="FNanchor_42_42" id="FNanchor_42_42"></a><a href="#Footnote_42_42" class="fnanchor">[42]</a>, though it made other
+Patients so sick, that they were obliged to lay
+it aside.</p>
+
+<p>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.</p>
+<p><span class='pagenum'><a name="Page_84" id="Page_84">[84]</a></span></p>
+<p>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.</p>
+
+<p><i>Dover</i>&#8217;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.&mdash;It commonly answered
+better, when used occasionally as a Sudorific,
+than when constantly continued.</p>
+
+<p>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<span class='pagenum'><a name="Page_85" id="Page_85">[85]</a></span>
+when this was neglected, the Patients were
+often seized with Sickness and Gripes, and a
+more violent Purging than before:&mdash;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.&mdash;Clysters
+were used as in recent Cases,
+where the Sick were low, or had much
+Pain of the Bowels<a name="FNanchor_43_43" id="FNanchor_43_43"></a><a href="#Footnote_43_43" class="fnanchor">[43]</a>, or complained of a
+Tenesmus.</p>
+<p><span class='pagenum'><a name="Page_86" id="Page_86">[86]</a></span></p>
+<p>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 <i>balsamum copaivi</i>, a Scruple
+of the Extract of the Bark, and five Drops of
+<span class='pagenum'><a name="Page_87" id="Page_87">[87]</a></span>the <i>tinctura thebaica</i>, three Times a Day. At
+first, this Medicine seemed to promise much,
+particularly in the Case of an old Invalid, <i>William
+Brookes</i>; 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.&mdash;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 <i>pulvis e tragacantha</i>,
+and such others, were of Service;
+and frequently Starch Clysters and Anodynes<span class='pagenum'><a name="Page_88" id="Page_88">[88]</a></span>
+gave Relief, when other Remedies had little
+Effect. Flower, boiled with Milk, and sweetened
+with Sugar, and given for Breakfast, as
+mentioned by Dr. <i>Pringle</i>, proved a good Palliative
+to some; and the Starch and Gum Arabic,
+dissolved in Water, a good Drink to others.&mdash;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.</p>
+
+<p>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.&mdash;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.</p>
+
+<p>When such Fluxes appeared early attended
+with sharp Pain of the Bowels,
+and Signs of Inflammation; if the Patient<span class='pagenum'><a name="Page_89" id="Page_89">[89]</a></span>
+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.&mdash;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.</p>
+
+<p>After this we gave the Mindereri Draughts
+with Mithridate; and as soon as the Petechi&aelig;
+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 <i>electuarium corticis</i>
+and the <i>electuarium diascordii</i><a name="FNanchor_44_44" id="FNanchor_44_44"></a><a href="#Footnote_44_44" class="fnanchor">[44]</a>; or Half
+<span class='pagenum'><a name="Page_90" id="Page_90">[90]</a></span>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 <i>tinctura
+thebaica</i>; 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.</p>
+
+<p><span class='pagenum'><a name="Page_91" id="Page_91">[91]</a></span></p><p>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:&mdash;In
+other respects we treated it as when the
+Disorder was not complicated with the malignant
+Fever.</p>
+
+<p>This Method, though it did not succeed
+with all, yet it answered better than any other
+I tried;&mdash;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.</p>
+
+<p>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
+<i>October</i> and <i>November</i>.&mdash;In such Cases, when
+the Patients were strong, we were often obliged
+to bleed freely, to apply Blisters, and in the<span class='pagenum'><a name="Page_92" id="Page_92">[92]</a></span>
+Beginning treat the Disorder as inflammatory;
+having at the same Time an Eye towards the
+Flux, in the other Medicines we prescribed.</p>
+
+<p>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:&mdash;And Blisters
+and Scarifications removed them in several Instances
+both at <i>Paderborn</i> and <i>Osnabruck</i>.<span class='pagenum'><a name="Page_93" id="Page_93">[93]</a></span></p>
+
+<p>In <i>December</i>, 1761, we had a Case of this
+Kind where the <i>oxymel scilliticum</i> 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.&mdash;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.</p>
+
+<p>At the Beginning of <i>January</i>, 1762, one
+<i>Carter</i>, 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<span class='pagenum'><a name="Page_94" id="Page_94">[94]</a></span>
+of Medicines, as Purges, Vomits, <i>Dover</i>&#8217;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 <i>January</i> the Swellings were
+all gone, and he was shipped off for <i>England</i>
+the 8th of <i>February</i>; having been discharged
+from his Regiment. The Ship, he went aboard
+of, was detained in the River <i>Weser</i> 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.</p>
+
+<p>When these oedematous Swellings came after
+the Purging was stopt, if the Patient&#8217;s Strength
+was not much exhausted, and he laboured under
+no other Disorder, he commonly got the
+better of it:&mdash;But when the Strength was gone
+before the Swellings appeared, the Disorder
+often ended in a confirmed Dropsy, and at last<span class='pagenum'><a name="Page_95" id="Page_95">[95]</a></span>
+in Death; and when the Swellings were universal
+over the Body, while the Flux yet continued,<span class='pagenum'><a name="Page_96" id="Page_96">[96]</a></span>
+it was a Sign of great Weakness, and they
+did not survive it long<a name="FNanchor_45_45" id="FNanchor_45_45"></a><a href="#Footnote_45_45" class="fnanchor">[45]</a>.</p>
+
+<div class="footnotes"><h3>FOOTNOTES:</h3>
+
+<div class="footnote"><p><a name="Footnote_29_29" id="Footnote_29_29"></a><a href="#FNanchor_29_29"><span class="label">[29]</span></a> 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.
+<i>Ramazini</i>, in his Chapter on Camp-Diseases, informs us,
+that Dr. G. <i>Erric Barnstorff</i>, Physician to the Duke of <i>Brunswick</i>,
+who served five Campaigns with the <i>Brunswick</i> and
+<i>Lunenburg</i> Troops in <i>Hungary</i>, 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. <i>Pringle</i>, in his <i>Observation on the Diseases
+of the Army</i>.
+</p><p>
+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. <i>Pringle</i>
+(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. <i>Tissot</i>, in a Treatise which he published, called <i>Avis
+au Peuple sur la Sant&eacute;</i>, in his Chapter on the <i>Dysentery</i>, &sect; 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 <i>Swiss</i> Soldiers, in Garrison in
+the South of <i>France</i>, 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.&mdash;In an Account of a Treatise
+on the Dysentery, published at <i>Hamburg</i> in 1753, which was
+epidemical the Year before, in <i>August</i> and <i>September</i>, 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.
+<i>Vide Comment. de Rebus in Hist. Nat. &amp; Medecin.
+Gestis</i>, vol. II. par. iv. sect. v.
+</p><p>
+Generally in <i>August</i> and <i>September</i> we have People admitted
+into <i>St. George</i>&#8217;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.</p></div>
+
+<div class="footnote"><p><a name="Footnote_30_30" id="Footnote_30_30"></a><a href="#FNanchor_30_30"><span class="label">[30]</span></a> Most Authors, who treat of the Dysentery, mention this
+Symptom of Worms; and Dr. <i>Huxham</i> tells us, that, in some
+Seasons, he has seen round Worms in the Stools of most of the
+Dysenteric Patients. <i>De Aere</i>, vol. II. p. 98.</p></div>
+
+<div class="footnote"><p><a name="Footnote_31_31" id="Footnote_31_31"></a><a href="#FNanchor_31_31"><span class="label">[31]</span></a> 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.
+<i>L. Fraser</i>, who afterwards practised in the Island of <i>Nevis</i>, two
+Days after the Patient died. <i>Mary Reid</i>, 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. <i>Dundas</i>,
+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.</p></div>
+
+<div class="footnote"><p><a name="Footnote_32_32" id="Footnote_32_32"></a><a href="#FNanchor_32_32"><span class="label">[32]</span></a> While this Sheet was in the Press, I received Dr. <i>Pringle</i>&#8217;s 4th
+Edition of his <i>Observations on the Diseases of the Army</i>, and Dr.
+<i>Baker</i>&#8217;s Treatise on the <i>Dysentery which was epidemic in London
+in the Year 1762</i>. 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.
+</p><p>
+<i>Morgagni</i>, in his Book lately published, <i>de Sede &amp; Causis
+Morborum</i>, 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.</p></div>
+
+<div class="footnote"><p><a name="Footnote_33_33" id="Footnote_33_33"></a><a href="#FNanchor_33_33"><span class="label">[33]</span></a> Mr. <i>Cleghorn</i>, in his <i>Account of the Diseases of the Island of
+Minorca</i>, says, &#8220;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.&#8221;
+chap. v. p. 228.&mdash;The physical Gentlemen employed on the
+<i>American</i> Service have told me, that the old Flux Cases were
+as fatal in <i>America</i>, as we found them in <i>Germany</i>. 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.</p></div>
+
+<div class="footnote"><p><a name="Footnote_34_34" id="Footnote_34_34"></a><a href="#FNanchor_34_34"><span class="label">[34]</span></a> Although Bleeding, in the Beginning, has been recommended
+by <i>Sydenham</i>, <i>Huxham</i>, <i>Pringle</i>, 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. <i>Francis Russel</i>
+told me, that when the Dysentery was epidemical at <i>Gibraltar</i>,
+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.</p></div>
+
+<div class="footnote"><p><a name="Footnote_35_35" id="Footnote_35_35"></a><a href="#FNanchor_35_35"><span class="label">[35]</span></a> Mr. <i>W. Russel</i>, who was with the Hospital at <i>Martinico</i>,
+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.</p></div>
+
+<div class="footnote"><p><a name="Footnote_36_36" id="Footnote_36_36"></a><a href="#FNanchor_36_36"><span class="label">[36]</span></a> Variety of Medicines have been recommended to answer
+this Purpose.
+</p><p>
+The <i>vitrum ceratum antimonii</i> proved often too rough a Medicine,
+and therefore we laid it almost entirely aside.
+</p><p>
+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. <i>Francis Russel</i> 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.&mdash;Dr. <i>Akenside</i> 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 <i>confectio cardiaca</i>; 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 <i>Comment. de Dysenteria</i>,
+cap. 2.
+</p><p>
+The watery Tincture of Rhubarb, recommended by <i>Degnerus</i>,
+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. <i>William Russel</i> told me that they
+found this watery Tincture of Rhubarb to answer better in
+<i>America</i> than any other of the Preparations of Rhubarb.
+</p><p>
+Calomel has been recommended by many as a Purge in Dysenteries;
+and Dr. <i>Huxham</i> (<i>de Aere</i>, 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. <i>Duncan</i>, Physician to his Majesty, told me, that he found
+the following Method of Cure always successful in the Dysentery,
+which was epidemic in <i>London</i> in the Year 1762.
+</p><p>
+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. &#8478; <i>Tartar. emetic. gr.</i> iij <i>Mann&aelig; elect.
+Unc.</i> ij <i>solve in Aq. hordeat. Lib.</i> 1.&mdash;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.&mdash;If the Irritation and Griping were severe,
+he found that a Solution of Manna, in the common Almond
+Emulsion, was sufficient.
+</p><p>
+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.
+</p><p>
+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.
+</p><p>
+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 <i>tinctura thebaica</i> to the Clysters; and
+ordered a Scruple of the Extract of the Logwood to be taken
+thrice a Day in some proper Vehicle.
+</p><p>
+The Patient&#8217;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.
+</p><p>
+Dr. <i>Duncan</i> 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 <i>subsultus tendinum</i> before the Doctor was called
+to him, and he died the next Day.
+</p><p>
+The late Dr. <i>Young</i>, of <i>Edinburgh</i>, 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,
+&#8220;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.&#8221;
+</p><p>
+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.</p></div>
+
+<div class="footnote"><p><a name="Footnote_37_37" id="Footnote_37_37"></a><a href="#FNanchor_37_37"><span class="label">[37]</span></a> <i>Sydenham</i>, <i>Huxham</i>, and all good Practitioners, have taken
+Notice of the bad Effects of the too free Use of Astringents,
+and given Cautions against it.</p></div>
+
+<div class="footnote"><p><a name="Footnote_38_38" id="Footnote_38_38"></a><a href="#FNanchor_38_38"><span class="label">[38]</span></a> 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.</p></div>
+
+<div class="footnote"><p><a name="Footnote_39_39" id="Footnote_39_39"></a><a href="#FNanchor_39_39"><span class="label">[39]</span></a> Mr. <i>W. Russel</i> told me, that he and Dr. <i>Huck</i> 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 <i>America</i>. &#8478;. Cer&aelig;
+alb. vel flav&aelig; drachmes tres. Sapon. alb. Hispan. drachmam
+unam. Aqu&aelig; fontan&aelig;, unciam unam, liquefiant super ignem
+in vase ferreo, agitando spatula, &amp; dein infunde in mortarium
+marmoreum, &amp; adde paulatim aq. fontan&aelig;, libras duas syrupi
+sacchari. spiritus vini gallici tenuis, vel aqu&aelig; alicujus spirituos&aelig;
+ana unciam unam, terendo optime ut fiat emulsio.
+</p><p>
+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.</p></div>
+
+<div class="footnote"><p><a name="Footnote_40_40" id="Footnote_40_40"></a><a href="#FNanchor_40_40"><span class="label">[40]</span></a> Dr. <i>Huxham</i> (<i>de Aere</i>, 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 <i>Baglivi</i>
+(<i>Prax. Med.</i> 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.</p></div>
+
+<div class="footnote"><p><a name="Footnote_41_41" id="Footnote_41_41"></a><a href="#FNanchor_41_41"><span class="label">[41]</span></a> Dr. <i>Pringle</i>, in the <i>fourth Edition of his Observations</i>, 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.
+</p><p>
+He says, &#8220;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.
+</p><p>
+&#8220;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.&#8221; See
+Part iii. ch. vi. p. 289, 290.</p></div>
+
+<div class="footnote"><p><a name="Footnote_42_42" id="Footnote_42_42"></a><a href="#FNanchor_42_42"><span class="label">[42]</span></a> I had lately a very remarkable Instance of the Effects of
+this Medicine, in the Case of one <i>Gilchrist</i>, a middle-aged Man,
+by Trade a Taylor; who was admitted into <i>St. George</i>&#8217;s Hospital
+the 20th of <i>July</i>, 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
+<i>September</i>.</p></div>
+
+<div class="footnote"><p><a name="Footnote_43_43" id="Footnote_43_43"></a><a href="#FNanchor_43_43"><span class="label">[43]</span></a> On the 21st of <i>November</i>, 1759, <i>Hanah Meredith</i>, a middle-aged
+Woman, was admitted into <i>St. George</i>&#8217;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 <i>December</i>, 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 <i>electuarium
+diascordii</i>, and a Scruple of the <i>tinctura thebaica</i>, 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 <i>January</i>; 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.
+</p><p>
+<i>Sarah Spencer</i>, a middle-aged Woman, was admitted into <i>St.
+George</i>&#8217;s Hospital the 9th of <i>November</i>, 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.&mdash;The first Day she had a Vomit, and next
+Day a Dose of the purging saline oily Draught.&mdash;She was ordered
+to have an emollient Clyster, with a Drachm of Diascord,
+and as much <i>tinctura thebaica</i>, 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.</p></div>
+
+<div class="footnote"><p><a name="Footnote_44_44" id="Footnote_44_44"></a><a href="#FNanchor_44_44"><span class="label">[44]</span></a> This Practice of giving the Cortex with Opiates in the
+Dysentery is not new; for Dr. R. <i>Morton</i>, 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. <i>Morton</i> 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 <i>Long Lane</i>,
+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.&mdash;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 Diarrh&#339;a&#8217;s, and Camp Fevers attended with such
+Symptoms.
+</p><p>
+Dr. <i>Whytt</i> of <i>Edinburgh</i> has given with Success a strong Decoction
+of the Bark, mixed with the <i>confectio japonica</i> of the
+<i>Edinburgh</i> Dispensatory, in the bad State of the Dysentery,
+when the Mouth and alimentary Canal were threatened with
+Aphth&aelig;, and even sometimes after they had appeared. And
+Dr. <i>Pringle</i> 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 <i>Note
+to Page 245 of his third Edition on the Diseases of the Army</i>.</p></div>
+
+<div class="footnote"><p><a name="Footnote_45_45" id="Footnote_45_45"></a><a href="#FNanchor_45_45"><span class="label">[45]</span></a> Many other Medicines have been used for the Cure
+of old Dysenteries,&mdash;The <i>Conessi Bark</i>, recommended
+as a Specific in Diarrh&#339;as, cured a Dysentery which had
+yielded nothing to a Variety of Medicines. <i>Edinburgh Medical
+Essays</i>, <i>Vol.</i> III. <i>Art.</i> iv.&mdash;The <i>cortex eleutheri&aelig; vel cascarill&aelig;</i> is
+much recommended for the Cure of Dysenteries in the <i>Memoir.
+de L&#8217;Academie des Sciences a Paris</i> 1719, and is still in great Repute
+among the <i>Germans</i>.&mdash;The Decoction of the <i>semiruba</i> 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 <i>Degnerus</i>&#8217;s Treatise <i>de Dysenteria</i>, <i>cap.</i> iii. <i>sect.</i> 55. These
+and many other Remedies have been tried in obstinate Dysenteries.
+</p><p>
+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,
+</p><p>
+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. <i>Pringle</i>; 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, <i>Bristol</i> Water, Almond Emulsion, and such like.&mdash;By
+making them wear some additional Cloathing, and guarding
+carefully against catching cold.&mdash;Errors of Diet and Exposure
+to Cold being the most frequent Causes of Relapses into this
+Disorder.
+</p><p>
+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.
+</p><p>
+3. By the Use of some of the mild Astringents and Corroborants.&mdash;The
+Bark, with Astringents and Opiates, agreeing best
+with some&mdash;Decoctions of the Semiruba with others&mdash;Chalk in
+Electuaries, or Juleps, with others&mdash;anodyne and astringent
+Clysters with others&mdash;while others receive more Benefit from
+other Remedies&mdash;and severals find themselves better when they
+use no Medicines of this Kind.
+</p><p>
+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.
+</p><p>
+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.</p></div>
+</div>
+
+
+<h2><a name="CHOLERA" id="CHOLERA"></a>OF THE<span class='pagenum'><a name="Page_97" id="Page_97">[97]</a></span><br />
+<span style="font-size: 130%; letter-spacing: 0.15ex">CHOLERA MORBUS</span>.</h2>
+
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">T</span>he</span> Cholera Morbus, or a sudden and
+violent Vomiting and Purging, was
+very frequent in <i>July</i> and <i>August</i> 1701; and
+several were attacked with it at <i>Munster</i>.&mdash;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.</p>
+
+<p>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<span class='pagenum'><a name="Page_98" id="Page_98">[98]</a></span>
+Beginning of Autumn; and is taken Notice of
+by <i>Hippocrates</i>, <i>Aret&aelig;us</i>, <i>Celsus</i>, and other antient
+Authors; and is very accurately described
+by many of them.&mdash;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.</p>
+
+<p>An Officer, who had been wounded on the
+15th of <i>July</i>, at the Battle of <i>Fillinghausen</i>,
+began afterwards to live very freely, and was
+on the 4th of <i>August</i> seized in the Night with
+the Cholera.&mdash;About ten o&#8217;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.&mdash;He had large<span class='pagenum'><a name="Page_99" id="Page_99">[99]</a></span>
+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.&mdash;He had
+vomited and purged much in the Night before
+I saw him, but the Purging had begun to
+abate.&mdash;I immediately ordered him an emollient
+Clyster, and a saline Draught, with the
+<i>confectio cardiaca</i>, 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.&mdash;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 <i>electuarium e baccis
+lauri</i>, and Half a Drachm of the <i>tinctura
+thebaica</i>; a Scruple of Castor, and Half a<span class='pagenum'><a name="Page_100" id="Page_100">[100]</a></span>
+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.&mdash;Soon
+after, beginning to use the Fomentations,
+the Cramps and Pains began to abate;
+about four o&#8217;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.&mdash;Next
+Morning he was very easy, but
+low, and inclined to be sick; for which his
+Cordial Draughts were repeated every six
+Hours.&mdash;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.</p>
+
+<p>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.&mdash;After
+throwing up a Quantity of green bilious Matter,<span class='pagenum'><a name="Page_101" id="Page_101">[101]</a></span>
+the Vomiting ceased; and the Gripes and
+Purging became less violent.&mdash;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.</p>
+
+<p>The Rest, who were attacked with the
+Cholera at <i>Munster</i>, 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.</p>
+
+<p>The Antients<a name="FNanchor_46_46" id="FNanchor_46_46"></a><a href="#Footnote_46_46" class="fnanchor">[46]</a> recommended drinking
+freely of warm Water in the Beginning, and
+the Use of both cold and hot Fomentations of
+the Stomach and Belly;&mdash;and in the low State,
+the Use of Wine, mixed with Water, and Polenta<a name="FNanchor_47_47" id="FNanchor_47_47"></a><a href="#Footnote_47_47" class="fnanchor">[47]</a>;
+and to apply Rue, with Vinegar, and
+<span class='pagenum'><a name="Page_102" id="Page_102">[102]</a></span>other strong smelling Things, to the Nostrils;
+besides Variety of other Remedies.&mdash;When
+Convulsions happen, <i>Celsus</i><a name="FNanchor_48_48" id="FNanchor_48_48"></a><a href="#Footnote_48_48" class="fnanchor">[48]</a> 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.</p>
+
+<p>Dr. <i>Sydenham</i><a name="FNanchor_49_49" id="FNanchor_49_49"></a><a href="#Footnote_49_49" class="fnanchor">[49]</a> trusts principally to drinking
+freely of Chicken Broth, and throwing up
+Clysters of the same, and afterwards giving
+Opiates.</p>
+
+<p>Dr. <i>Ayton Douglas</i>, in the sixth Volume of
+the <i>Edinburgh</i> Medical Essays<a name="FNanchor_50_50" id="FNanchor_50_50"></a><a href="#Footnote_50_50" class="fnanchor">[50]</a>, 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
+<span class='pagenum'><a name="Page_103" id="Page_103">[103]</a></span>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.</p>
+
+<div class="footnotes"><h3>FOOTNOTES:</h3>
+
+<div class="footnote"><p><a name="Footnote_46_46" id="Footnote_46_46"></a><a href="#FNanchor_46_46"><span class="label">[46]</span></a> See <i>Aret&aelig;us</i>, Lib. ii. Cap. 4. and <i>Celsus</i>, Lib. iv. Cap.
+11.</p></div>
+
+<div class="footnote"><p><a name="Footnote_47_47" id="Footnote_47_47"></a><a href="#FNanchor_47_47"><span class="label">[47]</span></a> The Polenta seems to have been nothing but toasted Barley
+Meal. See <i>Plinii Hist. Natural.</i> Lib. xxii. Cap. 25.</p></div>
+
+<div class="footnote"><p><a name="Footnote_48_48" id="Footnote_48_48"></a><a href="#FNanchor_48_48"><span class="label">[48]</span></a> <i>Celsus loco citato.</i></p></div>
+
+<div class="footnote"><p><a name="Footnote_49_49" id="Footnote_49_49"></a><a href="#FNanchor_49_49"><span class="label">[49]</span></a> <i>Processus integ. de Cholera.</i></p></div>
+
+<div class="footnote"><p><a name="Footnote_50_50" id="Footnote_50_50"></a><a href="#FNanchor_50_50"><span class="label">[50]</span></a> Art. 65.</p></div>
+</div>
+
+
+<hr />
+<h2><a name="INFLAMMATORY" id="INFLAMMATORY"></a>OF THE<span class='pagenum'><a name="Page_104" id="Page_104">[104]</a></span><br />
+<span class="smcap" style="font-size: 130%; letter-spacing: 0.15ex">Inflammatory Fever</span>.</h2>
+
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">O</span>n</span> the Return of the Troops from the
+Winter Expedition into the Country of
+<i>Hesse</i>, 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.</p>
+
+<p>In the Inflammatory Fever, the Sick were
+seized at first with cold and hot Fits, succeeded<span class='pagenum'><a name="Page_105" id="Page_105">[105]</a></span>
+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.</p>
+
+<p>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.&mdash;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.</p>
+
+<p>We treated these Fevers in the common
+antiphlogistic Method.&mdash;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:&mdash;And when they were inclined to
+be costive, gave mild Purges, or emollient
+laxative Clysters. We afterwards applied Blisters;<span class='pagenum'><a name="Page_106" id="Page_106">[106]</a></span>
+and if the Pulse began to sink, gave
+Cordials, Wine, and other Remedies commonly
+employed in such Cases;&mdash;and towards
+the Decline of the Fever endeavoured to promote
+such Evacuations as were pointed out by
+Nature, and likely to prove critical.</p>
+
+<p>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.</p>
+
+<p>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<span class='pagenum'><a name="Page_107" id="Page_107">[107]</a></span>
+by strong Astringents, and Opiates; unless
+where the Evacuation by Stool was so great as
+to be in Danger of sinking the Patient.</p>
+
+<p>The <i>pulvis antimonialis</i>, composed of ten
+Parts of the <i>pulvis e chelis</i>, and one Part of the
+Tartar emetic, given in small Doses, was serviceable
+in many of these Fevers, after free
+Evacuations had been made.</p>
+
+<p>Two Patients, one a Soldier of the Twentieth
+Regiment, the other a <i>German</i> Waggoner,
+were taken ill of this Fever about the 25th of
+<i>December</i>, 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.&mdash;On the 5th of <i>January</i>,
+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.&mdash;I
+ordered each of them four Grains of
+the <i>pulvis antimonialis</i> every four Hours.<span class='pagenum'><a name="Page_108" id="Page_108">[108]</a></span></p>
+
+<p>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.&mdash;7th. I found him in a fine breathing
+Sweat, and he told me he had slept well in the
+Night: p.&mdash;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.</p>
+
+<p>The Waggoner, after taking the third Dose
+of the Powders, had a warm Moisture upon
+the Skin.&mdash;On the 6th was cooler and without
+much Fever, and had had one Stool.&mdash;7th. The
+warm Moisture ended in a profuse Sweat,
+which carried off the Fever, and he continued
+to recover daily.</p>
+
+
+
+<h2><a name="ANGINA" id="ANGINA"></a>OF THE<span class='pagenum'><a name="Page_109" id="Page_109">[109]</a></span><br />
+<span style="font-size: 130%; letter-spacing: 0.15ex">ANGINA;</span><br />
+OR,<br />
+<span class="smcap" style="letter-spacing: 0.15ex; font-size: 130%">Sore Throat</span>.</h2>
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">M</span>any</span> 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.&mdash;All of them I saw in <i>Germany</i> were
+of the inflammatory Kind; I did not observe
+any that were malignant.</p>
+
+<p>They were treated in the antiphlogistic
+Method.&mdash;The Patients were blooded liberally<span class='pagenum'><a name="Page_110" id="Page_110">[110]</a></span>
+in the Beginning&mdash;took the cooling nitrous
+and saline Medicines&mdash;gentle Diaphoretics and
+Purgatives&mdash;and used frequent Gargarisms.</p>
+
+<p>Sometimes a Flannel rubbed with camphorated
+Oil, or the <i>linimentum volatile</i>, and applied
+round the Neck, was of Service.&mdash;And
+frequently after bleeding sufficiently, where the
+Breathing or Swallowing was difficult, the Application
+of a large Blister to the Neck gave
+speedy Relief.</p>
+
+
+
+<h2><a name="PLEURISY" id="PLEURISY"></a>OF THE<span class='pagenum'><a name="Page_111" id="Page_111">[111]</a></span><br />
+<span style="letter-spacing: 0.15ex; font-size: 130%">PLEURISY.</span></h2>
+
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">T</span>he</span> 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.</p>
+
+<p>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;&mdash;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<span class='pagenum'><a name="Page_112" id="Page_112">[112]</a></span>
+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.&mdash;When
+the Patient was costive, we gave a Dose
+of Salts, or some other mild Physic, or laxative
+Clysters.</p>
+
+<p>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.</p>
+
+<p>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.</p>
+
+<p>When the Sharpness of the Pain was gone,
+and the Pulse became soft, very often a dull<span class='pagenum'><a name="Page_113" id="Page_113">[113]</a></span>
+Pain remained for some Time in the Part.&mdash;In
+some Cases a brisk Purge removed it;&mdash;in
+others, cupping above the Part, and afterwards
+rubbing it with the volatile Liniments, did Service;&mdash;in
+others, gentle Opiates at Night, especially
+where there was a tickling Cough;&mdash;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.</p>
+
+<p>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.</p>
+
+<p>When an Inflammation of the Side came to
+Suppuration, which happened in one or two
+Cases at <i>Osnabruck</i>, in <i>May</i> 1761; as soon as a
+Fluctuation of Matter was to be felt, an Incision was<span class='pagenum'><a name="Page_114" id="Page_114">[114]</a></span>
+was made in the Part, and the Matter discharged;
+after which the Sore healed kindly,
+and the Patients recovered<a name="FNanchor_51_51" id="FNanchor_51_51"></a><a href="#Footnote_51_51" class="fnanchor">[51]</a>. I am persuaded,
+was this Operation oftener performed, many
+would recover who die consumptive.</p>
+
+<div class="footnotes"><h3>FOOTNOTES:</h3>
+
+<div class="footnote"><p><a name="Footnote_51_51" id="Footnote_51_51"></a><a href="#FNanchor_51_51"><span class="label">[51]</span></a> Dr. <i>Mead</i> 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&#8217;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. <i>Monita Medica</i>, Cap. i. Sect. 7.</p></div>
+</div>
+
+
+<h2><a name="PERIPNEUMONY" id="PERIPNEUMONY"></a>OF THE<span class='pagenum'><a name="Page_115" id="Page_115">[115]</a></span><br />
+<span style="letter-spacing: 0.15ex; font-size: 130%">PERIPNEUMONY.</span></h2>
+
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">T</span>he</span> 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.</p>
+
+<p>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<span class='pagenum'><a name="Page_116" id="Page_116">[116]</a></span>
+Men who had lain neglected in Quarters, for
+two, three, four, or five Days, before they were
+brought to the Hospital.</p>
+
+<p>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.</p>
+
+<p>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<span class='pagenum'><a name="Page_117" id="Page_117">[117]</a></span>
+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.</p>
+
+<p>Another Soldier, about the Middle of <i>February</i>,
+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&#8217;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,<span class='pagenum'><a name="Page_118" id="Page_118">[118]</a></span>
+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.</p>
+
+<p>On the 2d of <i>March</i>, 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.&mdash;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<span class='pagenum'><a name="Page_119" id="Page_119">[119]</a></span>
+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 <i>linimentum volatile</i>.
+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;<span class='pagenum'><a name="Page_120" id="Page_120">[120]</a></span>
+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 <i>March</i>.
+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<span class='pagenum'><a name="Page_121" id="Page_121">[121]</a></span>
+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 <i>articulo
+mortis</i>. The Viscera of the Abdomen were in
+a sound State.</p>
+
+<p>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<span class='pagenum'><a name="Page_122" id="Page_122">[122]</a></span>
+Steams of warm emollient Decoctions with
+Vinegar to be drawn into the Lungs.</p>
+
+<p>By this Treatment most of them, who applied
+early for Relief, got the better of the
+Disorder.</p>
+
+<p>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.<span class='pagenum'><a name="Page_123" id="Page_123">[123]</a></span></p>
+
+<p>In some Cases, where the Expectoration stopt
+suddenly after bleeding, we gave with Advantage
+a gentle Vomit, as recommended by Dr.
+<i>Huxham</i><a name="FNanchor_52_52" id="FNanchor_52_52"></a><a href="#Footnote_52_52" class="fnanchor">[52]</a>.</p>
+
+<div class="footnotes"><h3>FOOTNOTES:</h3>
+
+<div class="footnote"><p><a name="Footnote_52_52" id="Footnote_52_52"></a><a href="#FNanchor_52_52"><span class="label">[52]</span></a> Some late Authors seem to look upon the <i>Pleurisy</i> and
+<i>Peripneumony</i> as the same Disorder: However, though it be
+true, that when the <i>Pleura</i> is inflamed, the Surface of the contiguous
+Lungs is generally in the same State; and that, when
+the <i>Lungs</i> 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.</p></div>
+</div>
+
+
+<h2><a name="COUGH" id="COUGH"></a>OF THE<span class='pagenum'><a name="Page_124" id="Page_124">[124]</a></span><br />
+<span style="letter-spacing: 0.15ex; font-size: 130%"><span class="smcap">Cough</span> and <span class="smcap">Consumption</span>.</span></h2>
+
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">C</span>oughs</span> 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 <i>Phthisis Pulmonalis</i>.</p>
+
+<p>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<span class='pagenum'><a name="Page_125" id="Page_125">[125]</a></span>
+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
+<i>oxymel scilliticum</i>. 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.</p>
+
+<p>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 <i>lac
+ammoniacum</i>, with Oxymel; and occasionally
+gentle Purges: And if at any Time of the
+Disorder the Tightness and Pain of the Breast<span class='pagenum'><a name="Page_126" id="Page_126">[126]</a></span>
+returned violent, we took away some Blood,
+no other Remedy affording Relief.</p>
+
+<p>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 <i>tinctura thebaica</i>, or some of the
+<i>elixir paregoricum</i>, 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.</p>
+
+<p>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
+<i>Bremen</i>, in <i>January</i> 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.<span class='pagenum'><a name="Page_127" id="Page_127">[127]</a></span></p>
+
+<p>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.&mdash;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.</p>
+
+<p>Equal Parts of Lime-Water and Milk,
+drank to the Quantity of a Quart a Day, was
+of Use to some; and the <i>infusum amarum</i>, and
+other gentle Bitters, taken to the Quantity of
+an Ounce or two, Morning and Evening, to
+others<a name="FNanchor_53_53" id="FNanchor_53_53"></a><a href="#Footnote_53_53" class="fnanchor">[53]</a>.</p>
+<p><span class='pagenum'><a name="Page_128" id="Page_128">[128]</a></span></p>
+<p>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<a name="FNanchor_54_54" id="FNanchor_54_54"></a><a href="#Footnote_54_54" class="fnanchor">[54]</a>.
+However, for the most part, where-ever Obstructions
+of the Lungs were confirmed, or
+there were evident hectic Symptoms without
+<span class='pagenum'><a name="Page_129" id="Page_129">[129]</a></span>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.&mdash;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.</p>
+
+<p>In similar Cases, I have sometimes observed
+good Effects from the Use of the Balsam <i>Copaivy</i>,
+or <i>Peru</i>; given either in Juleps or made
+up into an Electuary, as in the <i>electuarium e
+spermate ceti cum balsamo</i>; 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.</p>
+
+<p>When Coughs continued long, attended
+with Pain in the Side, Difficulty of Breathing,
+and Hectic Fever and Night Sweats, we always<span class='pagenum'><a name="Page_130" id="Page_130">[130]</a></span>
+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.</p>
+
+<p>We kept the Patients upon a low Diet; and
+where-ever Milk was to be got easily, we allowed
+them a Pint a Day<a name="FNanchor_55_55" id="FNanchor_55_55"></a><a href="#Footnote_55_55" class="fnanchor">[55]</a>; which was either
+mixed with Water and given for Drink,
+or they took it to Breakfast or Supper.&mdash;Their
+common Drink was either Barley Water or
+the pectoral Decoction; which was occasionally
+acidulated with a few Drops of Spirit of
+<span class='pagenum'><a name="Page_131" id="Page_131">[131]</a></span>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.</p>
+
+<p>The opening a Vein, and taking away from
+four to eight Ounces of Blood<a name="FNanchor_56_56" id="FNanchor_56_56"></a><a href="#Footnote_56_56" class="fnanchor">[56]</a>, 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&#8217;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.</p>
+
+<p>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
+<span class='pagenum'><a name="Page_132" id="Page_132">[132]</a></span>complained of any fixed Pain, we always made
+the Issues as near the Part affected as possible<a name="FNanchor_57_57" id="FNanchor_57_57"></a><a href="#Footnote_57_57" class="fnanchor">[57]</a>.
+On the 5th of <i>May</i>, 1762, a Man,
+belonging to the Eighty-eighth Regiment of
+Foot, was sent to the Hospital at <i>Bremen</i> for
+an H&aelig;moptoe, attended with a constant hectic
+Heat and Fever.&mdash;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
+<span class='pagenum'><a name="Page_133" id="Page_133">[133]</a></span>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.</p>
+
+<p>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.&mdash;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 <i>electuarium e spermate ceti cum
+balsamo</i>, 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.<span class='pagenum'><a name="Page_134" id="Page_134">[134]</a></span></p>
+
+<p>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.&mdash;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.</p>
+
+<p>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. <i>Mead</i> in his <i>Monita Medica</i><a name="FNanchor_58_58" id="FNanchor_58_58"></a><a href="#Footnote_58_58" class="fnanchor">[58]</a>; it served
+<span class='pagenum'><a name="Page_135" id="Page_135">[135]</a></span>both for Food and Medicine.&mdash;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.</p>
+
+<p>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.</p>
+
+<p>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.&mdash;As they were apt to obstruct the free
+Expectoration, we generally mixed them with<span class='pagenum'><a name="Page_136" id="Page_136">[136]</a></span>
+some <i>oxymel scilliticum</i>, or <i>tinctura f&#339;tida</i>,
+which took off a good deal of their suffocating
+Quality.</p>
+
+<p>Dr. <i>Barry</i><a name="FNanchor_59_59" id="FNanchor_59_59"></a><a href="#Footnote_59_59" class="fnanchor">[59]</a> 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.</p>
+
+<div class="footnotes"><h3>FOOTNOTES:</h3>
+
+<div class="footnote"><p><a name="Footnote_53_53" id="Footnote_53_53"></a><a href="#FNanchor_53_53"><span class="label">[53]</span></a> Asses Milk, and <i>Bristol</i> and <i>Seltzer</i> 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.
+</p><p>
+In chronic Cases, where we suspect Obstructions and Tubercles
+to be formed in the Lungs, which have not already come
+to Suppuration, Dr. <i>Russel</i> 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 <i>Treatise on Sea Water</i>,
+Page 17.</p></div>
+
+<div class="footnote"><p><a name="Footnote_54_54" id="Footnote_54_54"></a><a href="#FNanchor_54_54"><span class="label">[54]</span></a> <i>Mary Shepperd</i>, a Woman twenty-six Years of Age,
+was admitted into <i>St. George</i>&#8217;s Hospital the 6th of <i>June</i>,
+1759, for a Cough; attended with a constant hectic Fever and
+Night Sweats, which had begun in the Month of <i>April</i>, after
+the Measles. She complained likewise of having the <i>fluor albus</i>,
+and she had been blooded more than once before she came to
+the Hospital.&mdash;I at first gave her some of the mild Pectorals;
+and a Solution of White Vitriol in Water, <i>utenda pro inject. uterina</i>.
+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 <i>July</i>, 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 <i>August</i>, seemingly in good Health, to return Thanks
+for her Cure.</p></div>
+
+<div class="footnote"><p><a name="Footnote_55_55" id="Footnote_55_55"></a><a href="#FNanchor_55_55"><span class="label">[55]</span></a> In private Practice, at this Stage of the Disorder, the Use
+of Asses Milk, and drinking the <i>Bristol</i> Water at the <i>Bristol</i>
+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 <i>France</i>, <i>Portugal</i>, or
+<i>Italy</i>, where the Air is warmer, more constant, and dry, than
+in <i>England</i>, has often been found to produce good Effects.</p></div>
+
+<div class="footnote"><p><a name="Footnote_56_56" id="Footnote_56_56"></a><a href="#FNanchor_56_56"><span class="label">[56]</span></a> This Practice has been strongly recommended by Dr.
+<i>Mead</i>, in his <i>Monita Medica</i>, Sect. x. and by an anonymous
+Author in the <i>Edinburgh Medical Essays</i>, Vol. IV. Art. 28. and
+Dr. <i>Mead</i> says, when Things have not been quite desperate, he
+has seen good Success from it.</p></div>
+
+<div class="footnote"><p><a name="Footnote_57_57" id="Footnote_57_57"></a><a href="#FNanchor_57_57"><span class="label">[57]</span></a> In <i>June</i>, 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 <i>December</i>, 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.</p></div>
+
+<div class="footnote"><p><a name="Footnote_58_58" id="Footnote_58_58"></a><a href="#FNanchor_58_58"><span class="label">[58]</span></a> <i>Sect.</i> x. <i>de Febrib. lentis sive Hecticis.</i></p></div>
+
+<div class="footnote"><p><a name="Footnote_59_59" id="Footnote_59_59"></a><a href="#FNanchor_59_59"><span class="label">[59]</span></a> <i>Treatise on the Digestions</i>, p. 410.</p></div>
+</div>
+
+
+<h2><a name="INFLUENZA" id="INFLUENZA"></a>OF THE<span class='pagenum'><a name="Page_137" id="Page_137">[137]</a></span><br />
+<span style="letter-spacing: 0.15ex; font-size: 130%">Epidemical <span class="smcap">Catarrhal Fever</span></span><br />
+Of APRIL, 1762;<br />
+CALLED,<br />
+<span class="smcap" style="letter-spacing: 0.15ex; font-size: 130%">The INFLUENZA.</span></h2>
+
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">A</span>fter</span> a very cold severe Winter at
+<i>Bremen</i>, the Weather, from being very
+cold, became of a sudden extremely hot, about
+the 10th of <i>April</i>. 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<span class='pagenum'><a name="Page_138" id="Page_138">[138]</a></span>
+of Breathing, and Pain of the Breast, with
+a Head-Ach, and Pains all over the Body, especially
+in the Limbs.&mdash;The first Nights they
+commonly had profuse Sweats.&mdash;In several, it
+had the Appearance of a remitting Fever, for
+the two or three first Days.&mdash;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.&mdash;Some had a
+Purging, but the greater Number were rather
+inclined to be costive.&mdash;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.&mdash;At
+first the Patients spit up only a little Phlegm;
+but in the Decline of the Disorder, they expectorated
+freely.&mdash;The violent Cough and
+Feverishness generally continued for four, five,<span class='pagenum'><a name="Page_139" id="Page_139">[139]</a></span>
+or six Days; with others it continued longer;
+and some had a Cough for two or three Weeks
+after the Fever left them.</p>
+
+<p>This Catarrhal Fever seized most of the
+People of the Town of <i>Bremen</i>; and there were
+very few of the <i>British</i> who escaped it; at the
+same Time, it was epidemical in most Countries
+in <i>Europe</i>.</p>
+
+<p>We treated it entirely as an inflammatory
+Disorder, and none died who applied early for
+Relief.&mdash;Most People recovered by one plentiful
+Bleeding, and taking the mild cooling Medicines,
+such as the <i>mixtura e spermate ceti cum
+nitro</i>, 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.&mdash;When the Patients
+were inclined to be costive, a Dose of
+Physic was of Service.</p>
+
+<p>None of the <i>British</i> died, except one or two
+of the Soldiers, who remained in Quarters after<span class='pagenum'><a name="Page_140" id="Page_140">[140]</a></span>
+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.&mdash;Many
+of the Inhabitants of the
+Town died of this Disorder, which was probably
+owing to Want of Care.</p>
+
+
+
+<h2><a name="RHEUMATISM" id="RHEUMATISM"></a>OF THE<span class='pagenum'><a name="Page_141" id="Page_141">[141]</a></span><br />
+<span style="letter-spacing: 0.15ex; font-size: 130%">RHEUMATISM.</span></h2>
+
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">T</span>he</span> Rheumatism is one of the Disorders
+most generally to be met with in military
+Hospitals. There were at all Times some
+Men in our Hospitals labouring under Rheumatic
+Fevers, or other rheumatic Complaints;
+though we never had at any one Time a great
+Number; owing probably to the Weather being
+very favourable in both the Campaigns of
+1761 and 1762.&mdash;It was always most frequent
+when the Weather was wet and cold; both
+during the Campaign, and when we were in
+Winter Quarters.<span class='pagenum'><a name="Page_142" id="Page_142">[142]</a></span></p>
+
+<p>It commonly began either, 1. With an
+acute Fever, and Pains all over their Body: or,
+2. With Pains in particular Parts, as the
+Shoulders, Legs, Arms, Knees, and sometimes
+of the Side, attended with some Degree of a
+Fever.&mdash;The first was the most common Form
+it assumed, when Men were attacked with it in
+the Field or in Garrison; owing to their doing
+Duty in cold wet Weather.&mdash;The other Causes
+generally took place when they had been formerly
+subject to rheumatic Complaints, and
+had caught Cold; or after they had been weakened
+and reduced low by Fevers, Fluxes, or
+other Disorders.</p>
+
+<p>We had but very few Rheumatisms accompanied
+with Swelling, Pain, and Inflammation
+of the Joints of the Knees and Wrists, &amp;c.
+which are so common in our Hospitals about
+<i>London</i>. I did not meet with above a Dozen
+Cases, of this Kind, whilst in <i>Germany</i> with the
+Army.</p>
+
+<p>When the Rheumatism began with Pains all
+over the Body, attended with a High Fever, we
+treated it at first entirely as an Inflammatory<span class='pagenum'><a name="Page_143" id="Page_143">[143]</a></span>
+Fever<a name="FNanchor_60_60" id="FNanchor_60_60"></a><a href="#Footnote_60_60" class="fnanchor">[60]</a>. We blooded freely, and repeated
+this Evacuation often<a name="FNanchor_61_61" id="FNanchor_61_61"></a><a href="#Footnote_61_61" class="fnanchor">[61]</a>, if the Blood continued
+sizy, and the Pains violent; provided the
+Pulse was strong. When the Pleura, the
+Lungs, or any other of the Viscera were affected,
+we blooded as freely as we should have
+done in acute Inflammations of these Parts:
+<span class='pagenum'><a name="Page_144" id="Page_144">[144]</a></span>We gave the saline Draughts with Nitre<a name="FNanchor_62_62" id="FNanchor_62_62"></a><a href="#Footnote_62_62" class="fnanchor">[62]</a>;
+and Plenty of Barley Water and other weak
+diluting Liquors; and gentle Physic once or
+twice a Week; and afterwards applied Blisters,
+which often relieved both the Pains and
+Fever.</p>
+
+<p>After some Days, if the Pains still remained,
+we continued the saline Draughts with Nitre
+throughout the Day; and in the Evening endeavoured
+<span class='pagenum'><a name="Page_145" id="Page_145">[145]</a></span>to promote a free Perspiration by
+Means of the mild Diaphoretics, such as the
+mindereri Draughts with Mithridate, in Doses
+frequently repeated; at the same Time, the
+Patient kept in Bed, and drank freely of mild
+diluting Liquors. Sometimes we gave twenty,
+thirty, or forty Drops of Spirits of Hartshorn,
+in repeated Draughts of warm Barley Water:
+or a like Quantity of the Antimonial Wine,
+used in the same Manner: or from sixty to a
+hundred Drops of the Antimonial Wine, mixed
+with one-fourth Part of the <i>tinctura thebaica</i>,
+in a large Draught of some warm Liquor;
+which I have observed, in many Cases,
+to have a better Effect, than most other Medicines
+used for this Purpose; as it acts both as an
+Opiate in easing the Pain, and procuring Rest;
+at the same Time that it promotes a free Perspiration,
+or gentle Sweat, to carry off the Distemper.</p>
+
+<p>But it should be observed, that, in the Beginning
+of Rheumatic Fevers, forced Sweats
+generally did Hurt, and often increased both
+the Pain and Fever; and that in general we<span class='pagenum'><a name="Page_146" id="Page_146">[146]</a></span>
+had greater Success, and made speedier Cures,
+when we did not attempt to promote Sweating,
+till after other Evacuations had been sufficiently
+made, and the Fever had begun to
+abate; and that in this Fever, when we did
+attempt to procure Sweats, the milder Diaphoretics,
+with Plenty of weak diluting Liquors,
+answered better than those of a more heating
+Nature; though after the Fever was gone,
+and the Pains still continued, sometimes the
+stronger Sudorifics, such as G. Guaiac, and its
+volatile Tincture, <i>Dover</i>&#8217;s Powder, and the
+like, best answered the Purpose, and carried off
+the Distemper, when the milder ones had little
+Effect.</p>
+
+<p>I have often observed, where Sweating made
+no Change in the Distemper, that keeping
+up a free Perspiration by Means of the Decoction
+of the Sarsaparilla with the Antimonial
+Wine, or small Doses of the <i>pulvis antimonialis</i>
+(<i>gr.</i> v.), given twice or thrice a Day, removed
+Rheumatisms, which had resisted the Force of
+other Remedies.<span class='pagenum'><a name="Page_147" id="Page_147">[147]</a></span></p>
+
+<p>Sometimes the cold Bath<a name="FNanchor_63_63" id="FNanchor_63_63"></a><a href="#Footnote_63_63" class="fnanchor">[63]</a> removed Pains
+which had not yielded to internal Medicines;
+but it ought to be observed, that when Patients
+went into the cold Bath while the Feverishness
+still remained, and the Blood continued sizy,
+or before free Evacuations had been made,
+oftentimes, instead of giving Relief, it made the
+Disorder worse, and more obstinate<a name="FNanchor_64_64" id="FNanchor_64_64"></a><a href="#Footnote_64_64" class="fnanchor">[64]</a>.</p>
+
+<p>When the Rheumatism was confined to a
+particular Part, attended with Fever, we treated
+it as the acute Rheumatism. Fomenting the
+Part with warm emollient Decoctions, and
+<span class='pagenum'><a name="Page_148" id="Page_148">[148]</a></span>rubbing it afterwards with the volatile, or saponaceous
+Liniments, often gave Ease; and the
+Application of Cupping-Glasses and Blisters
+frequently removed the Disorder. In some
+Cases, where the first Blister did not relieve,
+the Application of a second, and afterwards
+keeping up a Discharge from the Part by
+Means of the Epispastic Ointment, carried off
+the Pain. In others, where the mild Diaphoretics
+were ineffectual, Sweating, with the G.
+Guaiac, or <i>Dover</i>&#8217;s Powder, and such other
+Medicines, after the Fever was gone, removed
+the Complaints<a name="FNanchor_65_65" id="FNanchor_65_65"></a><a href="#Footnote_65_65" class="fnanchor">[65]</a>.</p>
+<p><span class='pagenum'><a name="Page_149" id="Page_149">[149]</a></span></p>
+<p>When the Rheumatism was attended with
+Inflammation and Swelling of the Joints, we
+blooded freely, gave cooling Purges, and the
+saline Draughts with Nitre, along with Plenty
+of weak diluting Liquors, and prescribed a cool
+low Diet.</p>
+
+<p>After the Violence of the Fever and Inflammation
+was abated, fomenting the Parts, and
+rubbing them with the saponaceous or volatile
+Liniments, sometimes hastened the Discussion
+of the Swelling; as did likewise the Application
+of Blisters<a name="FNanchor_66_66" id="FNanchor_66_66"></a><a href="#Footnote_66_66" class="fnanchor">[66]</a>, after the Inflammation was
+<span class='pagenum'><a name="Page_150" id="Page_150">[150]</a></span>entirely gone; but it ought to be noticed, that
+if volatile Liniments or Blisters are used too
+soon, they will sometimes occasion violent Inflammation
+and Pain<a name="FNanchor_67_67" id="FNanchor_67_67"></a><a href="#Footnote_67_67" class="fnanchor">[67]</a>.</p>
+
+<p>Rheumatic Cases of this Kind are often very
+obstinate, and require a considerable Length of
+Time before they are got the better of; and
+frequently more or less of the Swelling, especially
+of the Wrists and Joints of the Fingers,
+remains ever after; and Patients, who have
+once had the Rheumatism in this violent Degree,
+are always subject to Relapses; as are even
+those who have had the Rheumatism but
+slightly.</p>
+
+<p>Mercury<a name="FNanchor_68_68" id="FNanchor_68_68"></a><a href="#Footnote_68_68" class="fnanchor">[68]</a> has been recommended in the
+<span class='pagenum'><a name="Page_151" id="Page_151">[151]</a></span>Cure of Rheumatisms; but I never found it do
+any Service by itself, except in Cases complicated
+with venereal Symptoms; though I have
+often given it, and even sometimes gone so far
+as to raise a Salivation, where the Pains were
+most severe in the Night; and the Patient, at
+the same Time, thought he had some Reason
+to suspect a venereal Taint, though no external
+Symptom appeared. However, many good
+Practitioners have recommended small Doses
+of Calomel to be given at Nights, and next
+Morning a Purge; in which Way, I think,
+I have observed good Effects from its
+Use.</p>
+
+<p>The Bark was frequently of Use in restoring
+the Strength, and removing those rheumatic
+Pains which remained after Fevers,
+and other Disorders; but, in other Cases, it
+had little Effect.</p>
+
+<p>When the Rheumatism continues long, and
+has taken deep Root, <i>Sydenham</i><a name="FNanchor_69_69" id="FNanchor_69_69"></a><a href="#Footnote_69_69" class="fnanchor">[69]</a> advises to
+bleed from Time to Time, at some Weeks
+Distance; which, he says, will either entirely
+<span class='pagenum'><a name="Page_152" id="Page_152">[152]</a></span>remove the Disease, or bring it to that Condition,
+that the Remains of it will be easily extirpated
+by an Issue; and giving some of the
+volatile Salts in <i>Canary</i> Wine, Morning and
+Evening. I have always observed in rheumatic
+Cases, which continued long, that, after free
+Evacuations, the Patients received more Benefit
+from a mild low Diet, continued for some
+Time, and the Use of diluting Decoctions with
+mild Diaphoretics, while they took gentle
+Purges once or twice a Week, than from any
+other Remedies.</p>
+
+<p>I have given Half an Ounce of Soap a Day,
+for a considerable Time, in some old rheumatic
+Cases, in the Manner recommended by the
+late Dr. <i>John Clerk</i> of <i>Edinburgh</i>, as mentioned
+by Dr. <i>Pringle</i>; and, I think, with Advantage;
+but have not had sufficient Trials to ascertain
+the Merits of this Medicine.</p>
+
+<p>Dr. <i>Sydenham</i>, in treating of the Rheumatism,
+which he calls scorbutic, says; that after
+it had resisted Bleeding, Purging, low Diet,
+and other Remedies, he has cured it by giving
+thrice a Day two Drachms of an Electuary<span class='pagenum'><a name="Page_153" id="Page_153">[153]</a></span>
+made of <i>conserv. cochlear. horten. recent. unc.</i> ij.
+<i>lujul. unc.</i> i. <i>pulv. ar. comp. drachm</i> vi. <i>cum syrup.
+aurant.</i> q.&nbsp;s. drinking after it three Ounces
+of a Water drawn from <i>Brunswick</i> Beer, and
+some of the antiscorbutic Plants.</p>
+
+<p>There is no Disorder which Soldiers are so
+apt to counterfeit as the Rheumatism, when
+ever the Duty in the Field is severe; but while
+there is no Fever or Size in the Blood, or other
+evident Marks of the Distemper, and the Men
+look healthy, there is always Reason to suspect
+Imposture.</p>
+
+<div class="footnotes"><h3>FOOTNOTES:</h3>
+
+<div class="footnote"><p><a name="Footnote_60_60" id="Footnote_60_60"></a><a href="#FNanchor_60_60"><span class="label">[60]</span></a> <i>Sydenham</i>, in treating of this Disease, orders Bleeding,
+and that to be repeated next Day; and afterwards every other
+Day, two, three, or four Times, or more, as the Patients
+Strength can bear it; and on the intermediate Days to give a
+purgative Clyster. But in young People, and those who have
+lived regularly, he says, that a very low Diet will cure as effectually
+as Bleeding and Medicines; That the Patients must
+live four Days on Whey alone, but after this may eat Bread for
+Dinner; and on the last Days for Supper also; and when the
+Symptoms begin to abate, he allows them to eat boiled Chicken,
+or other light Food; but says they must live every third Day
+on Whey, till their Strength returns. <i>Precess. Integr. de Rheumatismo</i>.</p></div>
+
+<div class="footnote"><p><a name="Footnote_61_61" id="Footnote_61_61"></a><a href="#FNanchor_61_61"><span class="label">[61]</span></a> A Remark of Dr. <i>Huxham</i>&#8217;s deserves to be taken Notice
+of here: He tells us, that there are some Kinds of Rheumatisms,
+<i>viz.</i> those which come from a sharp serous Rheum, which do
+not bear the free Use of the Lancet; that plentiful Bleeding
+does more Hurt than Good; and that, in such Cases, the Medicines
+which bring out breathing Sweats, and at the same
+Time correct the Acrimony of the Blood, joined with gentle
+Opiates, have a much better Effect. <i>De Aere</i>, Vol. II. p. 185.</p></div>
+
+<div class="footnote"><p><a name="Footnote_62_62" id="Footnote_62_62"></a><a href="#FNanchor_62_62"><span class="label">[62]</span></a> Dr. <i>Brocklesby</i>, in his <i>Observations on military Diseases</i>,
+recommends the Use of large Quantities of Nitre dissolved in
+Water Gruel, or Sage Tea, (in the Proportion of two Drachms
+of the Nitre to a Quart of the Liquor) in acute Rheumatisms.
+He says, &#8220;I am assured from numberless Instances, that in
+stout young Men, by taking six hundred Grains (ten Drachms)
+daily, for four or five Days successively, and diluting plentifully,
+as before recommended, plain Nitre proves the most
+powerful and best Sudorific, in such Complaints, that I have
+ever tried; and this Quantity, and even more, may be retained
+in the Stomach, and pass through the Course of the
+Circulation, by only diluting properly with those thin attenuating
+Beverages as before recommended. Such Quantities,
+in three or four Days, seldom failed wonderfully to relieve
+the Patient, and very often to cure him entirely, by the
+most plentiful and profuse Sweats.&#8221; <i>See from p. 116, to p.
+124.</i>
+</p><p>
+I have never hitherto given Nitre in such large Quantities as
+here recommended by Dr. <i>Brocklesby</i>.</p></div>
+
+<div class="footnote"><p><a name="Footnote_63_63" id="Footnote_63_63"></a><a href="#FNanchor_63_63"><span class="label">[63]</span></a> I have frequently ordered the warm Bath with Advantage
+in Rheumatic Cases in <i>St. George</i>&#8217;s Hospital; but we had no
+Convenience of this Kind with the flying Hospital in <i>Germany</i>.</p></div>
+
+<div class="footnote"><p><a name="Footnote_64_64" id="Footnote_64_64"></a><a href="#FNanchor_64_64"><span class="label">[64]</span></a> This I have seen many Instances of, particularly in the
+Case of <i>Ann Walker</i>, a Woman of twenty three Years of Age,
+who was under my Care in <i>St. George</i>&#8217;s Hospital, in <i>May</i>, 1759.
+Before she came to the Hospital, she had been blooded, and
+had gone into the cold Bath four Times, which, she told me,
+had increased her Pains to a violent Degree; in which State
+she had continued for some Weeks before she came to the Hospital;
+but by being blooded, and taking the cooling saline
+Medicines, with gentle Purges, and mild Diaphoretics, she got
+well in a Month&#8217;s Time.</p></div>
+
+<div class="footnote"><p><a name="Footnote_65_65" id="Footnote_65_65"></a><a href="#FNanchor_65_65"><span class="label">[65]</span></a> Warm Water, pumped upon the Part, often removes such
+rheumatic Pains as have resisted the Force of internal and other
+Remedies. On the 29th of <i>August</i>, 1759, <i>Mary Ward</i> was admitted
+into <i>St. George</i>&#8217;s Hospital for rheumatic Pains of the
+Arms, Legs, and Knees, attended with Fever, which all yielded
+to Evacuations, and the Use of cooling Medicines, mild
+Diaphoretics, and of the warm Bath, except the Pain of the
+Knee; which, after it had resisted the Course above-mentioned,
+was at last removed by pumping warm Water on the
+Part, three Times a Week; joined to the Use of Fomentations
+and volatile Liniments.</p></div>
+
+<div class="footnote"><p><a name="Footnote_66_66" id="Footnote_66_66"></a><a href="#FNanchor_66_66"><span class="label">[66]</span></a> <i>Ann Ragen</i>, a Woman about thirty-three Years of Age,
+was admitted into <i>St. George</i>&#8217;s Hospital the 17th of <i>January</i>,
+1759, for rheumatic Pains of her Legs and Arms, and a Swelling
+of her right Knee. Free Evacuations, and the Use of cooling
+Medicines, and mild Diaphoretics, removed all her other
+Complaints, except the Swelling of the Knee, by the Middle of
+<i>February</i>, when I ordered a Blister to be applied to it; after
+which the Swelling gradually decreased, and she was discharged,
+cured, the 20th of <i>March</i>.&mdash;<i>Rachael Hyde</i>, a Woman
+twenty-four Years of Age, was admitted into <i>St. George</i>&#8217;s Hospital
+the 9th of <i>May</i>, 1759, for similar Complaints, which were
+removed by the same Means, all except the Swelling of the
+Knee. A Blister was applied, and most of the Swelling went
+away, but returned soon after: It was at last removed by the
+Use of the warm Pump three Times a Week, and drinking a
+Pint of the Guaiac Decoction daily.</p></div>
+
+<div class="footnote"><p><a name="Footnote_67_67" id="Footnote_67_67"></a><a href="#FNanchor_67_67"><span class="label">[67]</span></a> I have sometimes ordered Leetches to be applied to such
+Swellings (as recommended by Dr. <i>Pringle</i>), and found them to
+be of Service; and, at other Times, I have applied emollient
+Fomentations and Poultices, which have given great Ease to the
+Patient.&mdash;I have seen Setons or Issues, made near the Part affected,
+afford considerable Relief.</p></div>
+
+<div class="footnote"><p><a name="Footnote_68_68" id="Footnote_68_68"></a><a href="#FNanchor_68_68"><span class="label">[68]</span></a> Dr. <i>Musgrave</i>, in his Treatise <i>de Arthritide Symptomat.</i>
+p. 30, cap. ii. sect. 10, says, he has known a Salivation, raised
+by Mercury, cure the Rheumatism.</p></div>
+
+<div class="footnote"><p><a name="Footnote_69_69" id="Footnote_69_69"></a><a href="#FNanchor_69_69"><span class="label">[69]</span></a> Vide <i>Sydenham. Opera.</i> sect. vi. cap. 5.</p></div>
+</div>
+
+
+<h2><a name="AUTUMNAL" id="AUTUMNAL"></a>OF THE<span class='pagenum'><a name="Page_154" id="Page_154">[154]</a></span><br />
+<span style="letter-spacing: 0.15ex; font-size: 130%">Autumnal Remitting Fever.</span></h2>
+
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">T</span>he</span> Remitting Autumnal Fever, called
+by the Antients &#963;&#965;&#957;&#949;&#967;&#951;&#962;, was also one of
+the most frequent Disorders during the Campaign.</p>
+
+<p>This Fever is observed in most Countries,
+after the Juices have been highly exalted by
+the Heat of Summer; and People are exposed
+to the Heats of Mid-Day, and to the cold
+Damps of the Night. We observe it every
+Year in the Neighbourhood of <i>London</i>, especially
+among the labouring People, who work
+in the Fields, towards the End of Summer,
+and in Autumn; but it is generally in a milder
+Degree than in Armies, where Men are more
+exposed to the Vicissitudes of the Weather.<span class='pagenum'><a name="Page_155" id="Page_155">[155]</a></span></p>
+
+<p>As we go further towards the South, this,
+as well as other bilious Disorders, becomes more
+frequent.</p>
+
+<p>This Fever is reckoned the endemic Distemper
+of the <i>West Indies</i>, of the Coast of <i>Guinea</i>,
+and other Places in the Torrid Zone; but in
+those warm Countries it appears in a more violent
+Degree; makes a much more rapid Progress;
+and proves far more fatal than in our
+cooler and more temperate Climate. And it
+is observed to be always most frequent and
+most fatal where a Country is covered with
+Wood, or is marshy; and where there are frequent
+Fogs, and much stagnating Water,
+which corrupts by the Heat of Summer.</p>
+
+<p>In <i>January</i>, <i>February</i>, and <i>March</i> 1761,
+we had none of those Remitting Fevers at <i>Paderborn</i>.
+In <i>April</i>, some few of the Soldiers,
+on their Return from the Winter-Expedition
+into <i>Hesse-Cassel</i>, had Fevers attended with bilious
+Symptoms; but they were rather of the
+continued, inflammatory Kind, and tending to
+malignant, than such as could be called remitting.<span class='pagenum'><a name="Page_156" id="Page_156">[156]</a></span></p>
+
+<p>The first Time that I saw much of this Fever,
+was among the Sick sent to <i>Bilifield</i> in the
+End of <i>June</i> 1761; soon after the Army took
+the Field. The Remissions were short, and it
+partook much of the Nature of the common
+Inflammatory Fever; and most of them were
+cured by the antiphlogistic Method. A Day
+or two before we left this Place, it began to
+change into the Malignant Hospital Fever,
+from the Sick being too much crowded.</p>
+
+<p>In the Middle of <i>July</i>, about Twelve Hundred
+Sick were sent to the Hospital at <i>Munster</i>;
+and about one-third Part were ill of this Remitting
+Fever. It did not partake near so
+much of the inflammatory Nature as at <i>Bilifield</i>;
+the Remissions became much more evident;
+and it was attended much oftener in the
+Beginning with bilious Vomiting and Purging;
+and in some few the Disorder turned to a Dysentery.
+About eight or nine had it changed
+into the Hospital Fever, from the Wards in
+one of the Hospitals being too much crowded;
+and in some few the Disorder terminated in regular
+Agues. In <i>November</i> severals were taken<span class='pagenum'><a name="Page_157" id="Page_157">[157]</a></span>
+ill of it in the Garrison of <i>Bremen</i>, which
+mostly ended in a regular Intermittent, the endemic
+Distemper of the Place. Towards the
+End of <i>December</i> we had none of these Remitting
+Fevers, the Disorders turning more to the
+inflammatory Kind.</p>
+
+<p>In <i>June</i> 1762, this Fever began to appear
+again among the Sick, sent from the Army, to
+the Hospital at <i>Natzungen</i>; and it continued
+to be frequent through the Summer and Autumn;
+and the greatest Part of these Fevers this
+Year terminated in regular Agues, mostly in
+Tertians, and were cured by the Bark; whereas
+the Year before very few terminated this
+Way.</p>
+
+<p>This Disorder in the Beginning had commonly
+the Appearance of a continued Fever;
+and many had a Sickness and Vomiting, and
+threw up a Quantity of yellow Bile, mixed
+with the Contents of the Stomach. In a few
+Days, especially after Bleeding, the Remissions
+became clear; tho&#8217; on its first Appearance in
+<i>June</i> 1761 they were short, and rather obscure;
+and it seemed still to partake a good deal of the<span class='pagenum'><a name="Page_158" id="Page_158">[158]</a></span>
+Nature of the common Inflammatory Fever,
+the Blood being very sizy; but as the Season advanced,
+the Remissions became more evident,
+and the Paroxysms more like those of an Ague;
+and the Blood less sizy, tho&#8217; at all Seasons of
+the Year it had some Appearance of an inflammatory
+Buff in this Disorder. The Sick were
+restless and uneasy at Night; but commonly
+felt themselves cooler and lighter in the Day-Time:
+and although they had no cold Fit, as
+the Fever came on at Nights, and many of
+them no Breathing Sweat, as they became
+cooler and freer from the Fever in the Morning;
+yet the Fits were so remarkable, that
+many of the Patients used to say they had
+a regular Fit of an Ague every Night, or towards
+the Morning; and some few, that they
+had the Fit every second Night. As the Season
+advanced, the Remissions appeared more
+distinct. However, there was always a good
+Number in whom the Fever went on in a continued
+Form, through its whole Course, without
+any Signs of Remission; tho&#8217; they had all
+the other Symptoms of this Fever. In a few<span class='pagenum'><a name="Page_159" id="Page_159">[159]</a></span>
+Instances the Fever, after it came to remit,
+changed again into a continued Form.</p>
+
+<p>The Heat in the Time of the Paroxysms
+rose high, and several were delirious during
+its Continuance<a name="FNanchor_70_70" id="FNanchor_70_70"></a><a href="#Footnote_70_70" class="fnanchor">[70]</a>; but were quite sensible in
+the Intervals, though never wholly without
+the Fever.</p>
+
+<p>At the End of <i>July</i> 1761, four or five were
+attacked with a Bleeding at the Nose, in the
+Time of the Paroxysms, and became cooler
+afterwards; but it did not prove a Crisis in any
+of them.</p>
+
+<p>The Urine in the Beginning was commonly
+of a high Colour, though sometimes it was
+pale and limpid: At first it deposited no Sediment;
+but when the Fever came to remit,
+there was often a small Sediment after each
+Paroxysm; and as the Fever was going off,
+it let fall a Sediment in all<a name="FNanchor_71_71" id="FNanchor_71_71"></a><a href="#Footnote_71_71" class="fnanchor">[71]</a>.</p>
+
+<p><span class='pagenum'><a name="Page_160" id="Page_160">[160]</a></span></p><p>Some at first were inclined to be costive;
+others had a Sickness and Purging; and several
+of those who were costive in the Beginning,
+were in the Course of the Disorder attacked
+with a Purging; and others, after some previous
+Complaint of the Stomach, were seized
+with both Vomiting and Purging. In general,
+after the Sick continued some Days in the Hospital,
+they were inclined to be loose; which
+was a favourable Circumstance, when this
+Evacuation was not so great as to be in Danger
+of sinking the Patient. Some were attacked
+with a Dysentery.</p>
+
+<p>In this, as well as in most other Fevers, the
+Sick frequently passed by Stool Worms of the
+round Kind; and sometimes they vomited
+them up, or the Worms came up into their
+Mouth or Nostrils while they lay asleep in Bed;
+and some towards the Height were afflicted
+<span class='pagenum'><a name="Page_161" id="Page_161">[161]</a></span>with Deafness, which was commonly a favourable
+Symptom.</p>
+
+<p>Most of those ill of this Disorder had a yellowish
+Colour of the Countenance, which went
+off with the Fever. It was more observable in
+some than in others; in general, it was slight;
+some few became yellow all over<a name="FNanchor_72_72" id="FNanchor_72_72"></a><a href="#Footnote_72_72" class="fnanchor">[72]</a>; particularly
+one Man, in the Hospital at <i>Munster</i>,
+who, after being seized with violent Vomiting
+and Purging, Convulsions, and Twitchings of
+the Tendons, and Hiccup, became yellow,
+as in the deepest Jaundice. This Symptom
+of Yellowness arises from a Redundancy
+and Absorption of Bile; and is sometimes observed
+in other Fevers as well as this<a name="FNanchor_73_73" id="FNanchor_73_73"></a><a href="#Footnote_73_73" class="fnanchor">[73]</a>; for
+<span class='pagenum'><a name="Page_162" id="Page_162">[162]</a></span>while we were at <i>Paderborn</i> in <i>February</i> 1761,
+two Men were brought to the Hospital in Fevers,
+attended with this Symptom. They were
+both delirious, with parched dry Tongues, slight
+<span class='pagenum'><a name="Page_163" id="Page_163">[163]</a></span>Twitchings of the Tendons, and other bad
+Symptoms; and one of them had a continual
+Vomiting and Purging. They both died, and
+the Body of him who had the Purging was
+opened. All the Bowels, especially the Colon,
+were tinged with a yellow Bile, and had
+a slight Degree of Inflammation all over their
+Surface; the Gall-Bladder was distended with
+a very dark-coloured Bile; but no Concretions
+were found in its Cavity, or in the bilious
+Ducts; nor Mucus, or any other Thing obstructing
+these Passages. The Surface of the
+Lungs seemed slightly inflamed; and there
+was a small Quantity of greenish Serum in the
+Cavities of the Thorax. I could not learn the
+Histories of these two Mens Disorders, before
+they were brought to the Hospital; but, from
+the Symptoms, was inclined to believe, that the
+Fevers had been of the malignant or petechial
+Kind; and that the yellow Colour was only
+an accidental Symptom of it; for on one of
+the Men we could perceive obscure Traces of
+dun petechial Spots on his Breast and Arms;
+and the malignant Fever was frequent at this<span class='pagenum'><a name="Page_164" id="Page_164">[164]</a></span>
+Time among the Troops, and the bilious autumnal
+Fevers had ceased long before.</p>
+
+<p>I could not observe any certain critical Days,
+or Periods, when this Disorder terminated.&mdash;Some,
+who had it slightly, got well in a few
+Days; with others, it continued longer: Some
+continued long feverish, and would seem cooler
+and freer from Fever for a Day or two, and
+then grow worse again; and many had repeated
+Relapses.</p>
+
+<p>Neither could I observe any regular Crisis in
+this Fever. Sweat was the Discharge which
+oftenest proved critical. Many seemed to
+be relieved by a Purging; but as the greater
+Part had a Looseness after some Days,
+which continued often through the Disorder,
+without producing any very sudden Change in
+the Symptoms, it seemed to be a favourable
+Circumstance; though it seldom carried off the
+Fever so suddenly as to be manifestly critical.
+The Urine broke, and dropt a Sediment, for
+the most part, as the Fever took a favourable
+Turn.<span class='pagenum'><a name="Page_165" id="Page_165">[165]</a></span></p>
+
+<p>When this Fever proved mortal, it commonly
+assumed a continued Form; the
+Tongue became parched and dry, the Patient
+delirious, with Twitchings of the Tendons,
+Hiccup, and other fatal Presages; while others
+were seized with a violent Diarrh&#339;a, or Dysentery,
+which sunk them irrecoverably.</p>
+
+<p>In the Beginning, it was absolutely necessary
+to bleed the Patients freely; and frequently to
+repeat the Evacuation, where the Symptoms
+required it. The Blood was of a florid Colour,
+and commonly threw up more or less of
+an inflammatory Buff.</p>
+
+<p>In these Fevers, we were obliged to have
+particular Regard to the first Passages, especially
+in the Beginning of the Disorder; for
+they were generally loaded with bilious Humours<a name="FNanchor_74_74" id="FNanchor_74_74"></a><a href="#Footnote_74_74" class="fnanchor">[74]</a>;
+which, if suffered to remain in the
+<span class='pagenum'><a name="Page_166" id="Page_166">[166]</a></span>Bowels; were either absorbed, and increased the
+Heat and Fever, or brought on a violent Diarrh&#339;a;
+and therefore, after Bleeding, we gave
+<span class='pagenum'><a name="Page_167" id="Page_167">[167]</a></span>a Vomit in the Evening, and next Day a Dose
+of some gentle Purge, as Rhubarb or Salts;
+to carry off these putrid, bilious Humours:
+And afterwards, in the Course of the Disorder,
+if the Patient was costive, and grew hot, restless,
+and uneasy, we either repeated the Purge,
+or gave laxative Clysters, which generally removed
+<span class='pagenum'><a name="Page_168" id="Page_168">[168]</a></span>these Symptoms.&mdash;Frequently after the
+Operation of the Emetic, the Patient had some
+loose Stools, from the Gall Bladder&#8217;s being
+emptied in the Strainings to vomit. Such Stools
+were always bilious, as were commonly those
+procured by purgative Medicines.</p>
+
+<p>After emptying the Bowels, we gave the
+cooling, and mild Diaphoretics, such as the
+saline and mindereri Draughts, joined occasionally
+with Nitre, or the Contrayerva
+Powders; while we made the Patient drink
+plentifully of warm diluting Liquors; which
+we found to answer in general better than any
+other Remedies: They brought the Remissions
+to be more evident, and the Paroxysms to
+be milder, at the same Time that they kept up
+a free Perspiration, as a Means to carry off the
+Distemper.</p>
+
+<p>In some Cases we gave the Antimonial
+Powder, made of one Part of Tartar Emetic,
+and ten of the <i>pulvis e chelis</i>, in small Doses,
+from two to four Grains every four or six Hours.
+The first Doses of this Powder sometimes made
+the Patient sick, and acted as a Purgative, and<span class='pagenum'><a name="Page_169" id="Page_169">[169]</a></span>
+kept up a free Perspiration; at other Times,
+it produced no visible Effect. In some Cases,
+where it was given early, it operated both by
+Stool, and as a Diaphoretic, and removed the
+Fever<a name="FNanchor_75_75" id="FNanchor_75_75"></a><a href="#Footnote_75_75" class="fnanchor">[75]</a>; and it was of Use in others, towards
+<span class='pagenum'><a name="Page_170" id="Page_170">[170]</a></span>the Decline of the Fever; but we were often
+obliged to lay it aside; for it either acted too
+roughly, or produced no visible Effect or Alteration
+in the Disorder.</p>
+
+<p>When the Fever came to remit, we were
+obliged, for the most part, to continue the Use
+of the mild Diaphoretics, as before; for, although
+the Disorder put on a remitting Form,
+the Bark had very little Effect in stopping it<a name="FNanchor_76_76" id="FNanchor_76_76"></a><a href="#Footnote_76_76" class="fnanchor">[76]</a>,
+<span class='pagenum'><a name="Page_171" id="Page_171">[171]</a></span>unless where the Fever changed into a regular
+Quotidian or Tertian Ague.&mdash;In the Year
+1761, very few of these Fevers turned to regular
+Intermittents; but, in the Year 1762, the
+greater Part of them terminated in regular
+Agues, and were cured by the Bark<a name="FNanchor_77_77" id="FNanchor_77_77"></a><a href="#Footnote_77_77" class="fnanchor">[77]</a>.</p>
+
+<p><span class='pagenum'><a name="Page_172" id="Page_172">[172]</a></span></p><p>In the Year 1761, we tried the Bark in various
+Forms in many Cases, where the Patient
+had been blooded and purged in the Beginning,
+and used the cooling Medicines; and where
+<span class='pagenum'><a name="Page_173" id="Page_173">[173]</a></span>the Remissions were very clear: Yet it had no
+Effect in removing the Disorder, except in two
+or three Cases at <i>Munster</i>, where the Paroxysms
+assumed a tertian Form; for the most
+part, it made the Patients more hot and feverish,
+and we were obliged to leave off using it,
+as it was in Danger of changing the remittent
+into a continued Fever. However, it was of
+Service after the Fever came to a Crisis, and
+was going off; and Dr. <i>Pringle</i> has very justly
+observed, that it hastened the Recovery, and
+that those who used it were less subject to Relapses
+than such as did not; and therefore we
+commonly gave it in a convalescent State.&mdash;Before
+giving the Bark, I always found it of
+Advantage to give a Dose of Rhubarb, or of
+some other Purgative, or to mix some Rhubarb
+with the first Doses, so as to procure the Patient
+some loose Stools.</p>
+
+<p>When either the Fever went on without
+Intermission, or changed into a continued
+<span class='pagenum'><a name="Page_174" id="Page_174">[174]</a></span>Form, or the Patient continued hot and feverish
+through the Day, with a Head-Ach, and
+other feverish Symptoms, nothing answered
+better, after free Evacuations had been made,
+than to apply a large Blister to the Back; and
+to make the Patient drink freely of cooling diluting
+Liquors; which generally relieved the
+Head, and abated the Violence of the other
+Symptoms.</p>
+
+<p>When a Purging came on in the Course of
+this Disorder, if there was much Fever, with a
+strong throbbing Pulse, Gripes and Pain of
+the Bowels, some Blood was taken away; and
+immediately after the Patient took a Dose of
+Salts and Manna, or of Rhubarb; and an Opiate
+in the Evening after its Operation: But if
+there was little or no Fever, or sharp Pain,
+Bleeding was omitted; and if the Patient complained
+of Sickness, a few Grains of Ipecacuana
+were given previous to the Purge.</p>
+
+<p>After this, if the Purging was moderate, and
+did not sink the Patient, we did nothing to
+stop it; but if it was violent, we gave the mindereri
+Draughts with Mithridate, and the Chalk<span class='pagenum'><a name="Page_175" id="Page_175">[175]</a></span>
+Julep in the Day, and an Opiate at going to
+Rest; and occasionally used the emollient and
+anodyne Clyster; and, if necessary, repeated
+the Emetic and Purge.</p>
+
+<p>The Hiccup seldom appeared in this Fever
+till the Patient was reduced very low, and was
+commonly the Forerunner of Death. Some
+few, who had a Purging and Vomiting, were
+taken with a Hiccup, attended with Sickness,
+and Load at the Stomach, which seemed to depend
+on bilious Humours lodged in the Stomach
+and Bowels. This induced me to give
+a few Grains of the Ipecacuana; and to make
+the Patients drink an Infusion of Camomile
+Flowers till they vomited freely, and afterwards
+to take some mild Purge, or use laxative
+Clysters; after which they found themselves
+easier, and an anodyne Draught, with
+twenty or twenty-five Drops of the <i>tinctura
+thebaica</i>, put an End to the Hiccup. Others
+required the Use of Cordial Draughts, mixed
+with Opiates; and repeated Clysters and Fomentations,
+before they found Relief.&mdash;The
+Application of a Blister removed the Hiccup<span class='pagenum'><a name="Page_176" id="Page_176">[176]</a></span>
+in one, after the above Remedies had
+proved ineffectual; as did the Musk Julep with
+Opium, and the Application of an aromatic
+Plaister to the Stomach, in another Patient.</p>
+
+<p>Several of them complained of a burning
+Heat and Pain in making Water; which
+commonly went off by drinking freely of the
+Gum Arabic Decoction, with the dulcified
+Spirit of Nitre, and the Use of oily Draughts;
+though in some it required the Assistance of
+Opiates, and of Fomentations and Clysters,
+before it was got the better of.</p>
+
+<p>The Symptom of Worms we were often obliged
+to neglect till the Fever was over, and
+then we treated it as formerly mentioned.</p>
+
+<p>The Deafness, though not near so frequent
+in this as the Malignant Fever, was rather a
+favourable Symptom, and mostly went away of
+itself; though in a few Cases, where it continued
+long, we applied Blisters behind the Ears,
+or to the Neck, with Advantage.</p>
+
+<p>Many, especially those who were brought
+low, complained, after the Crisis of the Fever,
+of Restlessness, and Want of Sleep; which,<span class='pagenum'><a name="Page_177" id="Page_177">[177]</a></span>
+however, went off as their Strength returned:
+Where it fatigued them much, and kept them
+low, we gave a Cordial anodyne Draught at
+Night; and if that did not answer, commonly
+the Addition of a few Glasses of Wine in the
+Afternoon had the desired Effect.</p>
+
+<p>Others, in their convalescent State, complained
+of such a Giddiness, and Lightness of the
+Head, that they could neither walk nor stand;
+others, of a Dimness of the Eyes. These
+Symptoms, for the most part, went off as the
+Patients gathered Strength: The Use of the
+Bark, with now and then a Glass of Wine,
+hastened the Cure; and in two or three Cases
+we were obliged to give a Dose or two of some
+gentle Physic, and to apply a Blister, before the
+Patient got the better of them.</p>
+
+<p>As the Sick were recovering, it was common
+for them to complain of Pains of the Shoulders,
+Arms, and Legs, which also left them as
+they recovered their Strength; where they did
+not, the saline Draughts, and a low Diet, generally
+had a good Effect; and where it had not,
+we treated them as rheumatic Complaints.<span class='pagenum'><a name="Page_178" id="Page_178">[178]</a></span></p>
+
+<p>When the yellowish Colour of the Countenance
+remained after the Fever, we kept the
+Patient on a low Diet; and his Body open by
+Means of the saline Draughts, with a few
+Grains of Rhubarb, or by giving Half a
+Drachm, or two Scruples of the Soap Pills
+with Rhubarb daily; which, for the most
+part, removed the Yellowness soon. Two only
+had a Jaundice remain after the Fever, and both
+were cured in a short Time.</p>
+
+<p>In other Respects, the Treatment of this
+Fever, when it degenerated into a continued
+Form, had nothing particular in it; nor differed
+from the common Practice of giving
+cooling Medicines when the Fever was high,
+and supporting Nature by the Use of Cordials
+and Wine, and the Application of Blisters, &amp;c.
+when low; and promoting such Evacuations as
+Nature pointed out for a Crisis.</p>
+
+<div class="footnotes"><h3>FOOTNOTES:</h3>
+
+<div class="footnote"><p><a name="Footnote_70_70" id="Footnote_70_70"></a><a href="#FNanchor_70_70"><span class="label">[70]</span></a> I did not see the Delirium rise so high, nor the Paroxysms
+so severe, as in the Marsh Fever described by Dr.
+<i>Pringle</i>.</p></div>
+
+<div class="footnote"><p><a name="Footnote_71_71" id="Footnote_71_71"></a><a href="#FNanchor_71_71"><span class="label">[71]</span></a> Dr. <i>Hillary</i> says the Symptoms of this Fever in <i>Barbadoes</i>
+were much the same as those of the &#963;&#965;&#957;&#949;&#967;&#951;&#962;, or continued Remitting
+Fever in England; except only that the Urine in this hot
+Climate never deposits any lateritious Sediment, nor very
+rarely in any intermitting or any other Fever, except when a
+Crisis happens that Way. <i>Observations on the Diseases of Barbadoes</i>,
+p. 23.</p></div>
+
+<div class="footnote"><p><a name="Footnote_72_72" id="Footnote_72_72"></a><a href="#FNanchor_72_72"><span class="label">[72]</span></a> Dr. <i>Pringle</i> takes Notice of this yellow Colour or Jaundice.
+He says, &#8220;some grow yellow, as in the Jaundice. This was
+found more frequent during the first Campaign than afterwards;
+it was an unfavourable, but not a mortal Symptom.&#8221;
+<i>Observ.</i> part iii. ch. 4.&mdash;<i>Hippocrates</i> mentions the Jaundice occurring
+in Fevers, <i>Aphor.</i> iv. &sect; 62 &amp; 64; and he reckons it
+a favourable Symptom in ardent Fevers, where it happens on
+the seventh Day. See <i>Book on Crises</i>&#8217;s, sect. 3.</p></div>
+
+<div class="footnote"><p><a name="Footnote_73_73" id="Footnote_73_73"></a><a href="#FNanchor_73_73"><span class="label">[73]</span></a> Does this Fever, when accompanied with this universal
+Yellowness of the Skin, approach to the Nature of the yellow
+Fever of the <i>West Indies</i>? As I had so few Cases of this Kind
+under my Care, I cannot determine any thing about it from my
+own Experience; but, from the Accounts of others, I should
+believe them to be very different Disorders.&mdash;In the yellow Fever
+of the <i>West Indies</i>, the Blood appears quite loose and dissolved,
+without the least Appearance of Size, even on the first
+Day; and the general Yellowness appears on the third or
+fourth, with Signs of a total Dissolution, and gangrenous Diathesis
+of the Blood: Whereas, in the Remitting Fever of <i>Jamaica</i>,
+Mr. <i>Nasmith</i> tells us, (See Dr. <i>Lind</i>&#8217;s first Paper on Fevers),
+there is always an inflammatory Diathesis of the Blood.
+The Yellowness in both depends on a Redundancy and Absorption
+of Bile; but in the yellow Fever of the <i>West Indies</i>, the
+Bile is in a much more putrescent State, and a great Part of
+the Cure depends on the early and speedy Evacuation of it.&mdash;In
+the yellow Fevers which appeared in <i>Haslar</i> Hospital, which
+are taken Notice of by Dr. <i>Lind</i>, in his <i>Two Papers on Fevers</i>,
+the Blood was in quite a different State from what it is in the
+Yellow Fever of the <i>West Indies</i>; the Blood drawn from two
+of these Patients became covered with a thick yellow Gluten,
+and the Serum was of the Consistence of a thin Syrup, and of a
+deep yellow Tinge, and tasted bitter; and in another who was
+bled two Days before his Death, it threw up the same thick
+yellow Gluten, tho&#8217; the red Part below was quite loose.</p></div>
+
+<div class="footnote"><p><a name="Footnote_74_74" id="Footnote_74_74"></a><a href="#FNanchor_74_74"><span class="label">[74]</span></a> According to Dr. <i>Hillary</i>&#8217;s Account of the Yellow Fever
+in the <i>West Indies</i>, which is attended with bilious Vomiting, it
+bears bleeding once or twice, but not a third Time, before
+the third Day, but not at all after that Time; and after
+Bleeding a great Part of the Cure depends on carrying off as
+much of the putrid Bile as expeditiously and safely as possible,
+which he says is to be done by making the Patients drink freely
+of warm Water (sometimes mixed with a little simple Oxymel
+or Green Tea) so as to vomit seven or eight Times; and
+then to give a grain, or a Grain and a half of Opium, to procure
+Rest, and to settle the Stomach; to make the Patient take
+nothing for two Hours after; and then, if he has not had a
+Stool, to give a laxative Clyster; after six Hours Rest, to
+give a gentle Purge, to carry off as much as possible of the
+bilious corrupted Humours; and in the Course of the Disorder
+to repeat the Purge, as often as the Patient is attacked with
+an Anxiety, and a painful burning Heat about the Pr&aelig;cordia;
+which almost always depend on bilious corrupted Humours pent up
+within the Bowels; and to endeavour to support the Patient&#8217;s
+Strength, and stop the putrescent Diathesis of the Fluids by
+suitable Antiseptics, of which he found a watery Infusion of
+Snake Root, mixed with <i>Madeira</i> Wine and Syrup of Poppies,
+to answer the best of any Thing he tried, and to sit easiest on
+the Stomach; and to this he added the Use of Cordials, and
+of strong Wine Whey as the Patient became lower.
+</p><p>
+Dr. <i>Hillary</i>&#8217;s Purge was: &#8478;. Mann&aelig; sescunc. vel unc. ij.
+Tamarind. cond. unc. i. Tartar vitriolat. gr. x. solve in seri
+lactis pr&aelig;parat. cum Vin. Maderiens. unc. vi. Colatur&aelig; adde
+Tinct. Sen&aelig; unciam dimidiam. Divide in Partes quatuor, &amp;
+capt. &aelig;ger unam omni hora donec laxetur alvus.
+</p><p>
+His Infusion of Snake-Root was prepared in the following
+Manner:
+</p><p>
+&#8478;. Rad. Serpent. Virgin. drachm. ij. Croci Angl. drachmam
+dimidiam, infunde per horam vase clauso in aq. bull. q.&nbsp;s. &amp;
+dein unc. vi. Colatur&aelig;, adde aq. Menth. simp. unc. ij. Vin.
+Maderiensis, unc. iv. Syrup. Croci vel Syr. e Mecon. unc. i.
+Elix. Vitriol. acid. q.&nbsp;s. ad gratum saporem M. capiat &aelig;ger
+cochlear. ij. vel iij. omni hora vel secunda quaq; hora vel s&aelig;pius
+pro re nata.
+</p><p>
+The Stomach is so irritable in the Beginning of this Disorder,
+as to reject the saline Draughts, Nitre, and such other Medicines.
+Nor will the Bark, which might be judged a very
+proper Medicine in the second Stage of the Disorder, lie upon
+the Stomach, but is thrown up immediately, in whatever Form
+it is given. However, a Gentleman who had practised long
+in the <i>West Indies</i> told me, that although the Patient could not
+retain it in his Stomach, yet that he had found great Service,
+after the Bowels were emptied, from the Bark used freely in
+Clysters.
+</p><p>
+Dr. <i>Hillary</i> disapproves of the Use of Blisters in the advanced
+State of these Fevers.</p></div>
+
+<div class="footnote"><p><a name="Footnote_75_75" id="Footnote_75_75"></a><a href="#FNanchor_75_75"><span class="label">[75]</span></a> Dr. <i>Millar</i>, one of the Physicians to the Army, told
+me in <i>Germany</i>, that he had given this antimonial Powder with
+great Success in the Remitting Fever, while the Eighth Regiment
+of Foot (to which he was formerly Surgeon) lay in <i>England</i>.&mdash;Dr.
+<i>Pringle</i>, in his fourth Edition of his <i>Observations</i>,
+Part iii. ch. iv. tells us, that having given a mild Purge immediately
+after Bleeding, he next Morning, when there was almost
+always a Remission, gave a Grain of the Tartar Emetic,
+with twelve Grains of Crabs-Eyes, and repeated the Dose in
+two Hours, if the first had little or no Effect; at any Rate, in
+four Hours. This Medicine not only vomited, but generally
+opened the Body, and raised a Sweat. By these Evacuations,
+the Fever was sometimes quite removed, but always became
+easier.&mdash;This Medicine he usually repeated the second or third
+Day; if not, he opened the Body with some mild Laxative, or
+a Clyster; and continued this Medicine, till the Fever went
+gradually off, or intermitted.&mdash;Dr. <i>Pringle</i> says, that Dr. <i>Huck</i>
+treated this Fever in a Method similar to this, both in <i>North
+America</i> and in the <i>West Indies</i>. In the Beginning he let Blood;
+and in the first Remission, gave four or five Grains of Ipecacuana,
+with Half a Grain of Tartar Emetic: This Medicine he
+repeated in two Hours, taking Care that the Patient should not
+drink before the second Dose; for by that Means the Medicine
+passed more readily into the Bowels, before it operated by vomiting.
+If, after two Hours more, the Operation either Way
+was small, he gave a third Dose; which commonly had a good
+Effect in carrying off the Bile; and then the Fever either went
+quite off, or intermitted so far as to admit the Bark. On the
+Continent he found no Difficulty after the Intermission; but
+in the Islands, unless he gave the Bark upon the first Intermission,
+though imperfect, the Fever was apt to assume a continual
+and dangerous Form. Dr. <i>Huck</i> never varied this Method,
+but upon a stronger Indication to purge, than to vomit. In
+which Case he made an eight Ounce Decoction, with Half an
+Ounce of <i>Tamarinds</i>, two Ounces of <i>Manna</i>, and two Grains of
+<i>Emetic Tartar</i>; and dividing this into four Parts, he gave one
+every Hour, till the Medicine operated by Stool.</p></div>
+
+<div class="footnote"><p><a name="Footnote_76_76" id="Footnote_76_76"></a><a href="#FNanchor_76_76"><span class="label">[76]</span></a> Dr. <i>Hillary</i>, in mentioning the Remitting Fever of the
+Island of <i>Barbadoes</i>, says: In those who were blooded, and
+took an Emetic afterwards, and then the saline Draughts, the
+Fever was generally carried quite off by a critical Sweat on the
+seventh or ninth Day; in some few it came to intermit regularly
+after that Time; and was soon cured by the <i>cortex Peruviana</i>,
+given with the saline Draughts, and seldom effectually
+without them; though these irregular ingeminated Fevers often
+remitted, and sometimes seemed to intermit; yet if the <i>cortex
+Peruviana</i> was given too soon in the Disease, before it intermitted
+regularly (as I have more than once seen, where it had
+been injudiciously given), it generally caused the Fever to become
+continual and malignant. <i>Observat. on the epidemic Diseases
+of Barbadoes</i>, p. 22.</p></div>
+
+<div class="footnote"><p><a name="Footnote_77_77" id="Footnote_77_77"></a><a href="#FNanchor_77_77"><span class="label">[77]</span></a> Mr. <i>Cleghorn</i>, after giving a very accurate Account of
+Tertian Fevers, as they appeared in their various Forms of true,
+of double, and triple Tertians, and of Semi-Tertians, in the
+Island of <i>Minorca</i>, tells us, that he first attempted the Cure by
+profuse Evacuations; but afterwards learnt from Experience,
+that they were unnecessary; and that Bleeding and Purging
+once or twice in the Beginning, was all that was in general requisite;
+and if on the fifth Day the third Revolution was not
+attended with more threatening Symptoms than the second, and
+the Patient bore it easily, he frequently trusted the whole Business
+to Nature; which commonly terminated the Fever about
+the fourth or fifth Revolution; and for the most part with an
+Increase of some natural Evacuation.&mdash;But if the Paroxysm on
+the fifth Day was the longest and most severe that happened,
+attended with any doubtful or dangerous Symptom, he ordered
+two Scruples of the Cortex to be given every two or three
+Hours; so that five or six Drachms may be taken before next
+Day at Noon; lest, if this Interval escaped, he should not have
+found a favourable Opportunity of giving a sufficient Quantity
+of the Medicine afterwards; as the Fits about this Period are
+wont to become double, subintrant, or continual.&mdash;This did
+not always put an immediate Stop to the Fever, but it invigorated
+the Powers of the Body, and prevented or removed the
+dangerous Symptoms. Having given the Bark on the fifth
+Day, if a Fit came on the sixth, and declined the same Evening,
+he gave some more Doses of the Bark to mitigate the Fit
+on the seventh; yet sometimes this Fit of the sixth united with
+that of the seventh, and the Patient had the Heat, Restlessness,
+Raving, and other Complaints, greatly augmented, and the
+Case seemed more desperate than ever; which, however, were
+more dangerous in Appearance than Reality, and went off with
+a profuse Sweat next Morning; after which he gave the Bark
+freely as before; and this either stopt the Fits, or made them so
+moderate, as that they yielded quickly to the same Sort of Management.&mdash;By
+this Method, when Assistance is called timely,
+Mr. <i>Cleghorn</i> says, the most formidable Intermitting and Remitting
+Tertians, may be certainly and speedily brought to a happy
+Conclusion about the End of the first Week, or Beginning of
+the second. See <i>Observ. on the epidemic Diseases in Minorca</i>,
+chap. iii. p. 187, &amp;c.</p></div>
+</div>
+
+
+
+<h2><a name="AGUE" id="AGUE"></a>OF THE<span class='pagenum'><a name="Page_179" id="Page_179">[179]</a></span><br />
+<span style="letter-spacing: 0.15ex; font-size: 130%">Intermitting Fever, or Ague.</span></h2>
+
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">T</span>his</span> Disorder belongs to the same Tribe
+of Diseases as the Remitting Fever. We
+call it an Intermitting Fever, or Ague, when
+the Paroxysms are distinct, begin with a cold
+and hot Fit, and go off with a Sweat; and the
+Patient is cool, and free from the Fever in the
+Intervals between the Fits.</p>
+
+<p>Many have been the Causes alledged to produce
+this Disorder. The great Quantity of
+Bile that is often thrown up in the Fit, has
+caused it to be ranked among the bilious Diseases;
+and the Seasons of the Year in which
+it is most frequent, and the low moist Situation
+of the Places where it is endemic, have made
+Practitioners suspect, that an obstructed Perspiration,<span class='pagenum'><a name="Page_180" id="Page_180">[180]</a></span>
+and a Tendency in the Juices to the
+Putrescent, are the Cause of it.</p>
+
+<p>But whatever Cause we may suppose to give
+Rise to the first feverish Fit, it is difficult from
+hence to account for the regular Returns of the
+Paroxysms and Intermissions: For my own
+Part, after considering Intermittents, which
+observed a regular <i>Type</i> in the Course of a
+Salivation<a name="FNanchor_78_78" id="FNanchor_78_78"></a><a href="#Footnote_78_78" class="fnanchor">[78]</a>; their being so easily stopt by the
+Bark without any sensible Evacuation; their
+being sometimes put away by a Stimulus externally
+applied<a name="FNanchor_79_79" id="FNanchor_79_79"></a><a href="#Footnote_79_79" class="fnanchor">[79]</a>, or by a Fright, or sudden
+Plunge into cold Water<a name="FNanchor_80_80" id="FNanchor_80_80"></a><a href="#Footnote_80_80" class="fnanchor">[80]</a>; their returning
+<span class='pagenum'><a name="Page_181" id="Page_181">[181]</a></span>after slight Errors in Diet, and sometimes by
+the Operation of a Purge, or of Bleeding;
+their attacking sometimes only particular Parts,
+and many such Accidents in these Fevers, I
+must confess, that I am unable to form any Idea,
+either of their Origin, Seat, or Cause<a name="FNanchor_81_81" id="FNanchor_81_81"></a><a href="#Footnote_81_81" class="fnanchor">[81]</a>.</p>
+
+<p>The Soldiers were subject to this Disorder,
+particularly in Spring, if they took the Field
+soon, and in Autumn: The Frequency of it was
+in a great Measure determined by the Nature
+of the Ground on which they were encamped,
+or the Situation of the Garrison or Town in
+which they were quartered; for the lower and
+moister the Camp or Garrison, and the more
+<span class='pagenum'><a name="Page_182" id="Page_182">[182]</a></span>moist the Season, the more subject an Army is
+to Agues; and the drier the Situation of the
+Camp or Garrison, and the finer and drier the
+Weather is, the freer they are from Disorders
+of this Kind.</p>
+
+<p>In Winter 1761, we had but very few
+Agues in the Hospitals; but on the Return of
+the Troops from the Expedition into <i>Hesse-Cassel</i>,
+and during the Spring, some (though
+not many) were attacked with Quotidian and
+Tertian Agues, and but very few with Quartans.&mdash;In
+<i>July</i> and <i>August</i> they were more
+frequent, and accompanied with more bilious
+Symptoms. At <i>Bremen</i>, during the latter End
+of Autumn, and throughout the Winter and
+Spring 1762, we had Agues of all Sorts, and
+many inveterate Cases; and all this Spring,
+and during the Summer and Autumn, the
+Ague was the epidemic Disorder all over <i>Westphalia</i>,
+as well as among the Troops.</p>
+
+<p>In Spring 1761, what Agues we had were
+mostly Tertian, some Quotidian, and but two
+or three of the Quartan Kind. They were,
+for the most part, mild, and yielded to the Bark.&mdash;Some<span class='pagenum'><a name="Page_183" id="Page_183">[183]</a></span>
+of them began in the Form of a continued
+Fever; but after Bleeding, and the Use
+of the cooling Medicines for a few Days, they
+began to remit, and at last ended in regular
+Quotidian or Tertian Agues: Others, at first,
+appeared in Form of Remittent Fevers, attended
+with a strong throbbing Pulse; but changed
+to regular Intermittents by pursuing the antiphlogistic
+Method of Cure; and some from the
+Beginning assumed the Type of Quotidian or
+Tertian Agues, but often attended with a good
+deal of Fever, for the first two or three Days;
+and some had a slight Delirium in the Time of
+the Paroxysms, and the Pulse was not quite settled
+in the Intervals. In such Cases, where
+the Patient was strong, nothing answered so
+well as to take away some Blood; and to
+give the saline Draughts with Nitre till the
+Fever was moderated, before we gave the
+Bark.</p>
+
+<p>In general, there is a Prejudice against bleeding
+in Agues, after they become regular; but
+I have always observed, both in <i>England</i> and
+in <i>Germany</i>, that where Patients are strong and<span class='pagenum'><a name="Page_184" id="Page_184">[184]</a></span>
+plethoric, and the Fever in the Paroxysms rises
+high, or the Pulse remains quick in the Intervals,
+that taking away more or less Blood, and
+giving the antiphlogistic Medicines in the Beginning,
+eased the Patient, moderated the Fever,
+and made it safer to give the Bark soon;
+and I never saw the least Inconvenience from
+the Practice; but, on the contrary, have seen
+several Intermittent Fevers change into continued
+ones from the Neglect of this Evacuation;
+and have seen Cases where the Bark, instead of
+stopping the Ague, rather increased the Fever,
+till the Patient was blooded, and had pursued
+the antiphlogistic Method for some Time; after
+which the Bark had its proper Effect, and
+put an End to the Disorder.</p>
+
+<p>As soon as these Agues became regular, and
+the Patient was quite cool, and free from any
+Fever in the Intervals, we gave the Bark;
+which soon put a Stop to the Paroxysms, without
+the least bad Consequences; but, before
+giving the Bark, we always took Care to empty
+the first Passages by the Use of Emetics and
+Purgatives, where there was no Symptom to<span class='pagenum'><a name="Page_185" id="Page_185">[185]</a></span>
+forbid their Use: In Cases where the Patient
+was weak, and the Fits so violent as to make
+it necessary to stop the Ague, before we had
+Time to administer Emetics or Purgatives, we
+added so much Rhubarb to the first Doses of
+the Bark as procured the Patient some loose
+Stools, as recommended by Dr. <i>Mead</i><a name="FNanchor_82_82" id="FNanchor_82_82"></a><a href="#Footnote_82_82" class="fnanchor">[82]</a>; which
+<span class='pagenum'><a name="Page_186" id="Page_186">[186]</a></span>did not prevent its stopping the Ague, at the
+same Time that it answered the End proposed
+of carrying off any putrid Humours that might
+be lodged in the Intestines.</p>
+
+<p>In <i>England</i>, Vernal, Quotidian, and Tertian
+Agues, frequently go off after Bleeding,
+and taking some Emetics and Purges, and the
+saline Draughts, and cooling Medicines, for
+some Time, without the Use of the Bark; but
+in <i>Germany</i> very few yielded to this Treatment,
+and we were obliged to give the Bark<a name="FNanchor_83_83" id="FNanchor_83_83"></a><a href="#Footnote_83_83" class="fnanchor">[83]</a>
+before we could put a Stop to them.</p>
+
+<p><span class='pagenum'><a name="Page_187" id="Page_187">[187]</a></span></p><p>In the End of <i>July</i>, and Beginning of <i>August</i>,
+the aguish Cases we had at <i>Munster</i> continued
+to be of the Quotidian or Tertian Kind.
+The greatest Part of them began in the Form
+of continued Fevers, tending more to the bilious
+Kind than the preceding Months, and many
+of the Sick had bilious Vomitings in the cold
+Fits; and the Agues we had in Spring, and
+during the Campaign 1762, were of the same
+Nature, and required the same Treatment.</p>
+
+<p><span class='pagenum'><a name="Page_188" id="Page_188">[188]</a></span></p><p>Those Cases, which began in the Form of
+continued Fevers, were treated as such till they
+began to have regular Intermissions; they then
+yielded to the Bark.</p>
+
+<p>Some were attended with the Dysentery; and
+the Purging and Gripes were most severe on the
+Days of the aguish Paroxysms. In such Cases,
+we were frequently obliged at first to neglect
+the Ague, and to treat the Disorder entirely as
+a Flux. Where there was much Fever, the
+Patient strong, and the Pains in the Bowels
+acute, we ordered Bleeding; and after it a gentle
+Emetic, and some Doses of the saline oily
+Purge, or of Rhubarb; and gentle Opiates in
+the Evening, and other Medicines proper in
+the Dysentery, till its Violence was abated, before
+we gave the Bark: though in some Cases,
+where the aguish Paroxysms were very severe,
+and helped to increase the Purging, and the Patient
+was in Danger of sinking, we gave the
+Bark, notwithstanding the Flux still continued;
+and the Method we followed was the same
+as that I formerly mentioned, where it
+was complicated with the Malignant Fever;<span class='pagenum'><a name="Page_189" id="Page_189">[189]</a></span>
+which was to give the Bark, mixed with Diascord,
+and Opiates, or other Medicines proper
+for the Dysentery, in the Intervals between
+the Purges.</p>
+
+<p>By this Treatment, very often both the Flux
+and Ague went off. However, it ought to be
+observed, that unless the aguish Paroxysms
+were severe, and in Danger of sinking the Patient,
+or that the Disorder had continued for
+some Time, and the Paroxysms were distinct,
+we seldom gave the Bark till the Violence of
+the Flux was abated: And where-ever much
+Griping and Pain in the Bowels attended the
+Flux and Ague, there Bleeding as well as Purgatives
+were necessary, before exhibiting the
+Bark; which seldom or ever agreed with
+them, till there was an evident <i>Apurexia</i>, or
+Absence of Fever in the Intervals between the
+Fits. Where these Cautions were neglected,
+the Bark generally made the Patients worse;
+and we were obliged to omit it, till the Violence
+of the Purging was over.</p>
+
+<p>Some Agues were accompanied with the
+Jaundice, though not in such a high Degree as<span class='pagenum'><a name="Page_190" id="Page_190">[190]</a></span>
+in the confirmed State of that Disorder; and
+commonly in the Beginning the Pulse continued
+rather quick, in the Intervals between the
+Paroxysms; and the Patients complained of
+some Degree of Sickness for the first two or
+three Days. With those the Bark always disagreed,
+till the Feverishness between the aguish
+Paroxysms was gone; and we found, that
+the best Method of treating them, was to
+bleed in the Beginning, if there was much Fever;
+and then to give a Vomit and Purge, and
+to repeat them, if necessary; and where there
+was no Purging, to give the saline Draughts,
+and other cooling Medicines; and to add a few
+Grains of Rhubarb, or to give so much of the
+<i>pilul&aelig; saponac&aelig; cum rheo</i>, daily, as procured
+one or two loose Stools.</p>
+
+<p>After the Ague had regular Intermissions,
+and the Patient was quite cool, and without
+Fever in the Intervals, if the Disorder did
+not yield to the above Treatment, which
+it seldom did, we then gave the Bark freely;
+even though the slight icteric Symptoms still
+remained; and it put an End to the Ague, and<span class='pagenum'><a name="Page_191" id="Page_191">[191]</a></span>
+removed the Jaundice at the same Time, without
+the least Inconvenience to the Patient. In
+such Cases, we generally used to add a few
+Grains of Rhubarb to the first Doses of the
+Bark; or gave the Bark made up into Pills with
+Soap, and added occasionally a few Grains of
+Rhubarb.</p>
+
+<p>Several of those who had the icteric Symptoms
+along with the Ague, had bilious Vomitings
+in the Time of the cold Fit; they found
+themselves sick, with a bitter Taste in their
+Mouth, before the Approach of the aguish Paroxysm;
+and many of them, though they took
+Emetics, which operated freely at this Time,
+yet did not vomit up the Bile; but the Sickness
+and bitter Taste continued till the cold
+Fit came on, when they vomited Bile in large
+Quantities. In such Cases, after the Use of
+Emetics and Purges, and the Ague was
+brought to have regular Paroxysms, with free
+Intermissions, the Bark, given as just now
+mentioned, removed the Ague and icteric
+Symptoms, without the least bad Consequences.<span class='pagenum'><a name="Page_192" id="Page_192">[192]</a></span></p>
+
+<p>Many Practitioners of great Repute have been
+prejudiced against the Bark; and tell us, that
+the free Use of this Medicine often lays the
+Foundation of Obstructions in the abdominal
+Viscera, especially when it has been given
+where there was an icteritious Colour in the
+Eyes and Countenance; and that, in such
+Cases, we ought not to give the Bark till these
+Icteric Symptoms are gone. At first, I was
+very cautious of giving it under such Circumstances;
+till meeting with some Cases where
+the Paroxysms were severe, and became more
+frequent, while the Patient was so low, as to
+be in Danger of sinking under the Disorder, I
+gave the Bark freely, as the only Remedy capable
+of preserving Life; which not only stopt
+the Ague, but carried off the icteritious Symptoms<a name="FNanchor_84_84" id="FNanchor_84_84"></a><a href="#Footnote_84_84" class="fnanchor">[84]</a>,
+and restored the Patients to perfect
+Health.</p>
+<p><span class='pagenum'><a name="Page_193" id="Page_193">[193]</a></span></p>
+<p>After this I gave it freely, in the Manner
+above mentioned, to some Hundreds, with
+great Success; and I never saw any Mischief
+follow from using it: Indeed sometimes, where
+it was given rather too soon, it did not sit easy
+on the Stomach; and made the Patients hot and
+restless; but, by laying it aside, these Effects
+immediately ceased; and generally, after a little
+Time, the Paroxysms became milder and
+more distinct, when the Bark was again administered,
+agreed with the Stomach, and put an
+End to the Disorder; and I am now convinced,
+from Experience, that the Cases in which
+the Bark has done Mischief, or given Rise to
+Obstructions of the abdomenal Viscera, are but
+very rare; and that these Mischiefs mostly
+arise from the Obstinacy of the Disorder, and
+not from the Use of this Drug; for I have oftener
+observed these Obstructions where little
+or no Bark had been used, than where it was
+given freely<a name="FNanchor_85_85" id="FNanchor_85_85"></a><a href="#Footnote_85_85" class="fnanchor">[85]</a>. What probably has given
+<span class='pagenum'><a name="Page_194" id="Page_194">[194]</a></span>Rise to the Belief of the Bark&#8217;s doing so much
+Mischief, is, that in <i>Holland</i>, and other low
+fenny Countries, where Agues are endemic,
+they are oftentimes extremely obstinate, and
+yield hardly to any Remedies; and if they
+are stopt by the Bark, they often return soon
+after, and by their long Continuance give
+Rise to Obstructions of the abdomenal <i>viscera</i>,
+which have been attributed to the Use of this
+Specific.</p>
+
+<p>In some few Cases a Purging accompanied
+these icteric Symptoms, which we treated
+much in the same Manner as when the Ague
+was complicated with the Flux; we gave
+Emetics and Purgatives; and the mindereri
+Draughts with Mithridate, throughout the
+Day, and Opiates at Night, if the Purging
+was violent; if it continued, accompanied
+with regular aguish Fits, the Bark, with
+Astringents, generally removed both.</p>
+
+<p><span class='pagenum'><a name="Page_195" id="Page_195">[195]</a></span></p><p>In the latter Part of the Year 1761, and
+during Spring 1762, we had at <i>Bremen</i> many
+Patients in Agues of all Sorts; as Quotidians,
+Tertians, Quartans, and irregular Agues of a
+very obstinate Nature. The Town of <i>Bremen</i>
+is large and well built, situated in a low
+sandy Plain, with the <i>Weser</i> dividing the old
+from the new Town; generally a considerable
+Part of the Environs is covered with
+Water in the Winter, and frequently the
+<i>Weser</i> breaks down some of the Dikes, and
+overflows all the Country round; and every
+Time the River overflows its Banks, the Cellars
+of all the new Town, and of that Part
+of the old Town next the River, are filled
+with Water. All the Year round, on digging
+two or three Feet deep into the Ground, you
+come at Water.</p>
+
+<p>Agues are endemic in this Place, and great
+Numbers of the lower Class of People are
+afflicted with them at all Times of the Year,
+especially in Spring and Autumn.</p>
+
+<p>Some of the Sick sent down from the Army
+were bad of Agues; but the greatest Number<span class='pagenum'><a name="Page_196" id="Page_196">[196]</a></span>
+we had in Hospitals was composed of such as
+took it in Town; either from doing Duty on
+the Ramparts, or from lying in bad Quarters,
+or getting drunk and exposing themselves to
+Wet and Cold; and many Men of the invalid
+Companies who had come from <i>Embden</i>
+brought with them old inveterate tertian and
+quartan Agues.</p>
+
+<p>Most of the recent Cases were easily cured
+by the Methods already mentioned; though
+they often continued longer, required a greater
+Quantity of the Bark to stop them, and a
+longer Continuance of its Use to make a Cure,
+than at other Places, which were more dry,
+and higher situated.</p>
+
+<p>The most obstinate of the recent Cases were
+the irregular Intermittents, which had regular
+Paroxysms, but where the Pulse was not
+settled in the Intervals; which we were obliged
+to treat as Remitting Fevers till the Paroxysms
+became quite distinct, and the Patient was
+cool and free from any Fever in the Intervals;
+after which they commonly yielded to the
+Bark.<span class='pagenum'><a name="Page_197" id="Page_197">[197]</a></span></p>
+
+<p>But many of those Agues which had continued
+for some Time, especially with those
+Invalids who came from <i>Embden</i>, or who had
+brought on frequent Relapses by their own
+Irregularities, were very obstinate. With many
+the Bark had no Effect; and its Use persisted
+in seeming rather to exasperate the Paroxysms,
+and to do Hurt. Nor had almost
+any Remedy we tried a better Effect. We
+gave the following Medicines to divers Patients;
+the saline Draughts and cooling Medicines;
+Infusions of Camomile Flowers and
+of other Bitters; Dr. <i>Morton</i>&#8217;s Powders of Camomile
+Flowers, Salt of Wormwood, and
+diaphoretic Antimony; Dr. <i>Mead</i>&#8217;s Powders
+of Camomile Flowers, Salt of Wormwood,
+Myrrh, and Alum; Alum and Nutmeg;
+large Doses of <i>sal ammoniac</i>; large Quantities
+of Spirits of Hartshorn; the antimonial Drops
+and Powders; to some we gave Emetics, both
+in the Intervals and immediately before the
+Fits. In some we tried to promote Sweats
+before the Approach of the Fits, by making
+them drink freely of warm Liquors while<span class='pagenum'><a name="Page_198" id="Page_198">[198]</a></span>
+they kept in Bed, and took diaphoretic Medicines;
+and to others we applied Blisters.&mdash;But
+all did not put a Stop to some of those Agues.</p>
+
+<p>With some the Disorder continued till it
+broke down the Crasis of the Blood, and
+brought on a general Relaxation of the Fibres;
+and the Patients became cachectic, and fell into
+Dropsies, or were seized with Diarrh&#339;as,
+of which they died. Some had Obstructions
+formed in the Liver or Spleen, or other <i>viscera</i>,
+and fell into the Jaundice and Dropsies, which
+carried them off.&mdash;In the Bodies, of several
+whom we opened, we found Indurations of the
+Liver and Spleen&mdash;in two of them Suppurations
+of the Liver&mdash;and in one, who had had
+the Ague at <i>Embden</i>, and had long complained
+of one of those Swellings towards the
+left Side of the <i>abdomen</i>, called the <i>Ague
+Cake</i><a name="FNanchor_86_86" id="FNanchor_86_86"></a><a href="#Footnote_86_86" class="fnanchor">[86]</a>, the Spleen was so much enlarged
+as to weigh above four Pounds.</p>
+<p><span class='pagenum'><a name="Page_199" id="Page_199">[199]</a></span></p>
+<p>Some, whose Constitutions were worn out
+by these obstinate Agues, fell into Consumptions
+and other pulmonic Disorders in the Winter,
+of which they died. One Man died in
+the cold Fit<a name="FNanchor_87_87" id="FNanchor_87_87"></a><a href="#Footnote_87_87" class="fnanchor">[87]</a>.</p>
+
+<p>Where-ever the Ague continued long, and
+the Bark had no Effect, we were obliged to
+lay it aside, and to try other Remedies adapted
+to the present Circumstances of the Patient.</p>
+
+<p>The mild Methods succeeded best; giving
+the saline Draughts and gentle cooling Medicines
+to such as were strong and plethoric,
+and had the aguish Paroxysms violent; and
+the gentle Aromatics and Bitters, or Chalybeats,
+to those of a weakly Habit, or whose
+Fibres had been much relaxed, and their Constitutions
+<span class='pagenum'><a name="Page_200" id="Page_200">[200]</a></span>greatly injured by this or any other
+preceding Disorder.</p>
+
+<p>During these Courses, we gave at Times
+gentle Emetics; and if the Patient complained
+of Gripes and Purging, which they frequently
+did, in the Course of this Disorder,
+we gave a Dose of Rhubarb, or of some other
+mild Purge; and after it other Medicines proper
+for this Complaint.</p>
+
+<p>By these Methods frequently the aguish Paroxysms
+became gradually milder, and at last
+vanished. At other Times, after they had
+continued for five or six Weeks, we again
+gave the Bark, and found it to have the proper
+Effect. With others they continued thro&#8217;
+the Winter, and went off of themselves in the
+Spring. With others they still continued; and
+as no Medicines nor Time seemed to have any
+Effect in that Country, we recommended
+their being sent over to <i>England</i> for Change
+of Air, as the only Means likely to remove
+the Disorder.</p>
+
+<p>Two Agues which had resisted the Use of
+the Bark were cured by Powder of Camomile-Flowers,<span class='pagenum'><a name="Page_201" id="Page_201">[201]</a></span>
+Salt of Wormwood, and diaphoretic
+Antimony; and one by the Use of the aluminous
+Powders, with Myrrh.&mdash;One Invalid,
+who had long been ill of an obstinate Tertian,
+on catching Cold, was seized with an Inflammation
+of his Throat, for which he was blooded,
+and took a mild Purge; next Day there
+appeared a Swelling of one of the parotid
+Glands, which we endeavoured to bring to
+Maturation, by the Application of emollient
+Cataplasms; after some Days it went entirely
+away, without coming to Suppuration;
+but as there remained still a Confusion of the
+Head, and a Quickness of the Pulse, a large
+Blister was applied to the Back, which continued
+running for some Days; after it dried
+up he fell into a Fit resembling that of an Epilepsy,
+and next Day had another Fit of the
+same kind; from the Time the Swelling first
+appeared till the Time he had the first Fit, he
+had no Ague, but it returned the second Day
+after the second epileptic Fit; another Blister
+was applied, and he had no Return of the epileptic
+Fits, though his Ague continued obstinate<span class='pagenum'><a name="Page_202" id="Page_202">[202]</a></span>
+till <i>March</i>, at which Time he was sent
+to <i>England</i><a name="FNanchor_88_88" id="FNanchor_88_88"></a><a href="#Footnote_88_88" class="fnanchor">[88]</a>.&mdash;About the same Time the
+aguish Fits of two others were stopt by the
+Application of Blisters, though they returned
+in both soon after.</p>
+
+<p>Excepting in these few Cases, I found no
+Medicines effectual in stopping those Agues,
+which had resisted the Bark when properly
+given, though we tried a vast Variety in different
+Cases. The <i>cortex cascarill&aelig;</i>, or <i>eleutheri&aelig;</i>,
+was given freely, both in Decoction
+and Substance, in four Cases, which had not
+yielded to the Bark, but without producing
+any good Effect; we had not an Opportunity
+<span class='pagenum'><a name="Page_203" id="Page_203">[203]</a></span>of trying this Bark in more Cases of this kind,
+nor in Fluxes, the small Quantity of it which
+had come from <i>England</i> being all expended.</p>
+
+<p>A Soldier of one of the Regiments of Guards,
+who was admitted into the Hospital for &#339;dematous
+Legs, and the Remains of a very bad
+Flux, which he had had ever since the preceding
+Autumn; after being cured of the Flux,
+and most of the &#339;dematous Swellings, was
+seized with an intermitting Complaint in <i>February</i>.
+He had no regular hot and cold Fits;
+but every second Day, after a slight Shivering
+and Cold, he was seized with Gripes and a Purging.
+In one or two of the Fits his Pulse was
+very quick, and the Pain of the Bowels very
+acute and severe; which obliged us to blood
+him, and give him a Dose of the saline oily
+Purge; after which we treated the Disorder
+as a Flux complicated with the Ague, and
+gave the Bark mixed with Diascord, and gentle
+Opiates at Nights, and at Times gentle Purgatives;
+the Ague and Diarrh&#339;a stopt very
+soon, and in a few Weeks he got free of all
+Complaints, though he still continued weak,<span class='pagenum'><a name="Page_204" id="Page_204">[204]</a></span>
+till he was sent to <i>England</i>, about the Beginning
+of <i>April</i>.</p>
+
+<p>Many, especially those whose Constitution
+had been shaken by this or some other Disorder,
+complained of flatulent Swellings of the
+Stomach and Bowels, which affected them either
+while the Ague continued, or soon after it
+was stopped, and were very troublesome and
+uneasy. For the most part, these Swellings
+were removed by the Use of cordial Medicines
+mixed with the Bark, or a Course of Bitters,
+and some Doses of Rhubarb given at proper
+Intervals. In some Cases, where they were
+attended with Sickness, and the Stomach seemed
+to be loaded, a Vomit gave Relief. Very
+often these Symptoms continued for Weeks
+after the Ague had left them, and did not go
+entirely off, till the Patient recovered his
+Strength.</p>
+
+<p>In <i>February</i>, <i>March</i>, and <i>April</i>, 1761, severals
+of the Soldiers in the Hospital at <i>Paderborn</i>
+complained of periodical Head-Achs,
+which returned in most, every Day; in others,
+only every second; and afterwards Cases of<span class='pagenum'><a name="Page_205" id="Page_205">[205]</a></span>
+this Kind occurred at different Times as long
+as the Army continued in <i>Germany</i>. These
+Head-Achs generally began in the Forenoon,
+were very violent while they lasted, and confined
+the Patient to his Bed for some Hours.
+During the Pain, the Pulse was quick; but in
+the Intervals the Patients were quite cool, and
+without Fever. Sometimes, tho&#8217; not always,
+the Urine deposited a little Sediment as the
+Head-Ach was going off. Commonly the
+Pain was all over the Head, but most severe in
+the Forehead; though sometimes it was confined
+to one Side only.</p>
+
+<p>These Head-Achs we treated entirely as
+Agues of the same Type. When the Patient
+was strong, some Blood was taken away, and
+afterwards we prescribed an Emetic and Purge,
+and then gave the Bark liberally, which generally
+put an End to the Complaint, without
+any bad Consequences attending.</p>
+
+<div class="footnotes"><h3>FOOTNOTES:</h3>
+
+<div class="footnote"><p><a name="Footnote_78_78" id="Footnote_78_78"></a><a href="#FNanchor_78_78"><span class="label">[78]</span></a> See <i>Van Swieten</i>, Vol. II. p. 537.</p></div>
+
+<div class="footnote"><p><a name="Footnote_79_79" id="Footnote_79_79"></a><a href="#FNanchor_79_79"><span class="label">[79]</span></a> A Gentleman told me, that he was once cured of an Ague
+in the Country, by applying a Poultice of Garlic to his Wrists,
+and letting it lie on till it inflamed and blistered the Part.&mdash;I
+have seen Blisters cure an Ague.&mdash;In the <i>Edinburgh Med. Essays</i>,
+Vol. II. Art. v. we have an Account of Agues being cured by
+the Application of Poultices of recent Erigerum (Groundsel)
+applied to the Stomach on the Days free from the Paroxysm,
+which caused strong Vomiting.</p></div>
+
+<div class="footnote"><p><a name="Footnote_80_80" id="Footnote_80_80"></a><a href="#FNanchor_80_80"><span class="label">[80]</span></a> See an Account of an Ague being cured by the Patient
+being pushed into a Pool of Water without any previous Notice,
+and being much frightened, in <i>Mason&#8217;s Account of Agues</i>,
+p. 222.</p></div>
+
+<div class="footnote"><p><a name="Footnote_81_81" id="Footnote_81_81"></a><a href="#FNanchor_81_81"><span class="label">[81]</span></a> The common Account given of the Cause of Agues,
+and of the regular Return of their Paroxysms, has been: That
+the Ague takes its Rise from some Sort of Matter, bilious, or whatever
+it may be, either mixed with the Blood, or lodged in the
+Bowels, or in some other Part of the Body; that a great Part
+of this Matter is thrown out of the Body, in the Time of the
+Paroxysm; but that so much remains as serves by Way of a
+Ferment to assimilate other Particles to its own Nature; which,
+when collected in a certain Quantity, produce a new Fit; and,
+according to the Time that it takes to produce this Quantity,
+the Disorder assumes the Form of a Quotidian, Tertian, or
+Quartan Ague.</p></div>
+
+<div class="footnote"><p><a name="Footnote_82_82" id="Footnote_82_82"></a><a href="#FNanchor_82_82"><span class="label">[82]</span></a> Mr. <i>Cleghorn</i>, while at <i>Minorca</i>, after Evacuations, gave
+the Bark at the End of the third Period, as we observed before;
+but where the Fever had been neglected till about the third or
+fourth Period, or badly treated in the Beginning, and the
+Bowels were inflamed or overcharged with corrupted Gall, he
+was obliged to endeavour to palliate the most pressing Complaints,
+and to watch Evening, Night, and Morning for a Remission,
+and then immediately to fly to the Bark, as the only
+Remedy that could avert the Danger. If the Patient was
+strong, he gave Half an Ounce of the Bark, with six Drachms
+of the <i>sal catharticum amarum</i>, divided into four equal Parts,
+of which the Patient took one every two Hours; the Effect of
+which was, that the next Fit was mitigated, and an Intermission
+commonly ensued, in which the Bark was repeated without the
+Purgative, to finish the Cure.&mdash;But where the Patient was excessively
+feeble, and there was a manifest Risk of his dying in next
+Fit, he gave Cordials with the Bark, instead of the <i>sal catharticum</i>;
+and endeavoured to throw in six or seven Drachms in
+the Space of ten or twelve Hours; he having found by Experience,
+that if a smaller Quantity is given, the Paroxysms come
+on earlier than usual, and make all Attempts to preserve Life
+unsuccessful. See his <i>Account of the epidemic Diseases of Minorca</i>,
+cap. iii. 2d edit. p. 192.</p></div>
+
+<div class="footnote"><p><a name="Footnote_83_83" id="Footnote_83_83"></a><a href="#FNanchor_83_83"><span class="label">[83]</span></a> Sometimes, when Patients are reduced low by Agues,
+the Stomach becomes so squeamish as to reject the Bark in every
+Shape it can be given; in such Cases, when the Ague cannot
+be stopped by other Means, it may be administered with great
+Advantage in Clysters, of which the following is a very remarkable
+Instance.&mdash;<i>William Hadderell</i>, a Lad seventeen Years
+of Age, in the End of the Year 1761, was attacked with a severe
+Tertian Ague, in which a Mortification came on his left
+Foot, and one-half of it dropt off; notwithstanding, his Ague
+continued to attack him every second Day, and the Sore continued
+running on the 12th of <i>October</i> 1763, when he was admitted
+into <i>St. George</i>&#8217;s Hospital. He was reduced extremely
+low; and the Sore of his Foot looked so bad, that it was at
+first imagined he must lose his Leg. He was ordered some
+Vomits, and a Purge, and cooling Medicines, and afterwards
+to take the Bark freely; but his Stomach rejected it, in
+whatever Form it was given. Other Means were then tried to
+stop his Ague, but with no Effect, till the 7th of <i>November</i>,
+that I ordered two Drachms of the Powder of the Bark to
+be given him twice a Day in an emollient Clyster, with Half a
+Drachm of the <i>tinctura thebaica</i>, which stopt his Ague in three
+Days; and he had had no Return of it on the 28th of <i>January</i>
+1764, and had recruited his Health and Strength, and the Sore
+of his Foot was greatly lessened. Dr. <i>Harvey</i> (who teaches
+Midwifery in <i>London</i>) told me, that he has cured Children of
+Agues by Bark Clysters, after the Bark Waistcoats, and other
+Means used, had proved unsuccessful.</p></div>
+
+<div class="footnote"><p><a name="Footnote_84_84" id="Footnote_84_84"></a><a href="#FNanchor_84_84"><span class="label">[84]</span></a> This agrees with what Mr. <i>Cleghorn</i> remarks of Tertian
+Fevers in his <i>Observations on the epidemic Diseases of the Island of
+Minorca</i>, who says, &#8220;where there is an icteritious Colour of the
+Eyes, we are likewise told, that the Cortex should not be administered;
+though, in my Opinion, it is for the most part
+dangerous to delay it, after the first Appearance of that
+Symptom.&#8221; Chap. iii. 2d edit. p. 205.</p></div>
+
+<div class="footnote"><p><a name="Footnote_85_85" id="Footnote_85_85"></a><a href="#FNanchor_85_85"><span class="label">[85]</span></a> Dr. <i>Pringle</i> takes Notice, that these Obstructions happened
+as often without as with the Bark; and therefore seemed
+to depend on the long Continuance and Obstinacy of the Intermittent.
+<i>Observ.</i> part iii. chap. iv. sect. 2. p. 179. 3d Edit.</p></div>
+
+<div class="footnote"><p><a name="Footnote_86_86" id="Footnote_86_86"></a><a href="#FNanchor_86_86"><span class="label">[86]</span></a> I have seen the dead Bodies of four People opened, who
+had those Swellings of the left Side, commonly called the <i>Ague
+Cake</i>, which had come after Agues; and in all the Swelling
+was owing to an Enlargement of the Spleen.</p></div>
+
+<div class="footnote"><p><a name="Footnote_87_87" id="Footnote_87_87"></a><a href="#FNanchor_87_87"><span class="label">[87]</span></a> The cold Fit is the most dangerous Time of the Paroxysm,
+and the greatest Part of those who die of Agues die at
+this Time; one or two Instances of which I saw in the Military
+Hospital at <i>Edinburgh</i> in the Year 1746.&mdash;<i>Van Swieten</i>
+says he has seen the trembling and shaking so great in the
+Time of the cold Fit of Quartans, that the Teeth have dropt
+out of the Head. <i>Comment. in sect.</i> 749. <i>Aphorism. Boerhaav.</i>
+vol. II. p. 511.</p></div>
+
+<div class="footnote"><p><a name="Footnote_88_88" id="Footnote_88_88"></a><a href="#FNanchor_88_88"><span class="label">[88]</span></a> On the 29th of <i>August</i> 1759, a Man (<i>Murdoch Brinnen</i>)
+about thirty Years of Age, was admitted into <i>St. George</i>&#8217;s Hospital
+for a very large Swelling of the parotid Glands and
+neighbouring Parts, which had come three Days before, after
+a Fit of the Tertian Ague, which did not return afterwards.
+The Swelling was discussed by the Application of emollient
+Cataplasms, which were intended to have brought it to Suppuration.
+He had no Return of the Ague, nor did any bad Consequence
+follow the Discussion of the Tumour, and the Cure
+was completed by a few Doses of Physic, and a Decoction of
+the Bark, which restored him to his Strength, and carried off
+the little Heat and Feverishness which remained.</p></div>
+</div>
+
+
+
+<h2><a name="JAUNDICE" id="JAUNDICE"></a>OF THE<span class='pagenum'><a name="Page_206" id="Page_206">[206]</a></span><br />
+<span style="letter-spacing: 0.15ex; font-size: 130%">JAUNDICE.</span></h2>
+
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">T</span>he</span> Jaundice, or a yellow Colour of the
+Eyes and Skin, occasioned by an Absorption
+of Bile into the Blood, was another
+Distemper which appeared towards the End
+of each Campaign.</p>
+
+<p>This Disorder, for the most part, takes its
+Rise<a name="FNanchor_89_89" id="FNanchor_89_89"></a><a href="#Footnote_89_89" class="fnanchor">[89]</a> from Calculi lodged in the biliary
+Ducts<a name="FNanchor_90_90" id="FNanchor_90_90"></a><a href="#Footnote_90_90" class="fnanchor">[90]</a>; and sometimes from a viscid Mucus
+<span class='pagenum'><a name="Page_207" id="Page_207">[207]</a></span>or Pituita obstructing those Passages<a name="FNanchor_91_91" id="FNanchor_91_91"></a><a href="#Footnote_91_91" class="fnanchor">[91]</a>; and it
+may be brought on by a Tumour, or any other
+Cause<a name="FNanchor_92_92" id="FNanchor_92_92"></a><a href="#Footnote_92_92" class="fnanchor">[92]</a>, compressing these Ducts, so as to
+prevent the free Flow of the Bile into the Cavity
+of the Intestines.</p>
+
+<p>The yellow Colour, or Jaundice, observed
+in the Ague, and some other bilious Disorders,
+seems to arise sometimes from Spasms of the
+Ducts; or from too great a Quantity of Bile secreted
+and absorbed into the Blood, which
+seems evidently to be the Case where large
+<span class='pagenum'><a name="Page_208" id="Page_208">[208]</a></span>Quantities of Bile are either vomited or discharged
+by Stool; a Proof that the biliary
+Ducts are clear, and free from Obstructions.</p>
+
+<p>In the End of the Campaign of 1760, after
+a continued Rain for many Weeks, the Jaundice
+had been very frequent, and in a Manner
+epidemical, among the Troops, for some Time
+before they left the Field; and in passing thro&#8217;
+<i>Munster</i>, about the End of <i>December</i>, I observed
+several ill of that Distemper in Hospitals, and
+met with a few Cases of this Kind in the Hospitals
+at <i>Paderborn</i> in <i>January</i> 1761; but during
+the Spring and Summer, we had only one
+or two now and then sent to the Hospitals for
+this Complaint; though towards the End of
+the Campaign it became more frequent, and
+several were sent down to <i>Bremen</i>; and some
+of the Garrison were likewise affected with it.
+During the Winter not above four or five were
+sent to the Hospitals I attended, and but a few
+to the flying Hospital, during the Campaign
+1762. It frequently appeared in dropsical
+Cases, depending on obstructed Viscera.<span class='pagenum'><a name="Page_209" id="Page_209">[209]</a></span></p>
+
+<p>Those in whom the Jaundice was the original
+Disorder, and not complicated with any
+other, generally got well soon; but where it
+appeared in dropsical Cases, depending on obstructed
+Viscera, it was commonly fatal.</p>
+
+<p>In the Beginning of this Disease, Patients
+usually complained of Sickness, Heat, Thirst,
+and other feverish Symptoms; and some had a
+Vomiting, and Pain of the Stomach, for a Day
+or two before the Jaundice appeared; the Urine
+was always of a deep Colour from the first;
+and about the second or third Day the Skin,
+and the Whites of the Eyes, began to be tinged
+with a yellow Colour, attended with the
+common Symptoms of this Disorder.</p>
+
+<p>Such was the Manner in which the Jaundice
+began in those who were taken ill in Garrison;
+but those sent us from the Army could
+seldom give any accurate Account of their own
+Cases.</p>
+
+<p>In the Course of this Disorder, the Sick
+were inclined to be costive, though some few
+had a Diarrh&#339;a; several, who had been reduced
+by Fevers, or other Complaints, before the<span class='pagenum'><a name="Page_210" id="Page_210">[210]</a></span>
+Jaundice appeared, were attacked with violent
+H&aelig;morrhages from the Nose; and two had
+like to have died of them before the Bleeding
+was stopped. The H&aelig;morrhages did not
+prove critical, but seemed to depend on a dissolved
+State of the Blood.</p>
+
+<p>On the Patient&#8217;s being first taken ill, if he
+was plethoric or feverish, or complained of
+Pain, attended with Sickness and Vomiting,
+some Blood was taken away. Next Day we
+gave twenty-five or thirty Grains of Rhubarb
+in a saline Draught, and afterwards the common
+saline and other cooling Medicines, till
+the Fever was abated. If the Pain and Fever
+did not abate, a Vein was opened a second
+Time, and a few Drops of the <i>tinctura thebaica</i>
+were added to the saline Draughts, while
+emollient Clysters were frequently administered,
+and the Stomach and Belly fomented
+with Flannels dipped in warm emollient Decoctions.</p>
+
+<p>When the Pain and Fever were gone, we
+then gave a gentle Vomit in the Evening, and
+next Day a Dose of Rhubarb; and afterwards<span class='pagenum'><a name="Page_211" id="Page_211">[211]</a></span>
+so much of the <i>pilul&aelig; saponace&aelig; cum rheo</i> daily
+as kept the Body open; or the saline Draughts
+with five or six Grains of Rhubarb in each, or
+such a Quantity as answered the same Purpose
+as the Pills; and from Time to Time repeated
+the Emetic<a name="FNanchor_93_93" id="FNanchor_93_93"></a><a href="#Footnote_93_93" class="fnanchor">[93]</a> and Purge.</p>
+<p><span class='pagenum'><a name="Page_212" id="Page_212">[212]</a></span></p>
+<p>Most of the icteric Cases we had, which
+were not complicated with other Disorders,
+yielded to the above Treatment in about twelve
+or fourteen Days. Two or three remained obstinate
+for a longer Time. To one I ordered
+a Quart of the pectoral Decoction, made with
+Parsly Roots instead of the Linseed, to be drunk
+daily along with the Soap Pills; and the Jaundice
+disappeared in about eight or ten Days.
+One who had the Disease more obstinate than
+the rest, and complained for some Time of a
+Tension and Uneasiness about the Liver, was
+<span class='pagenum'><a name="Page_213" id="Page_213">[213]</a></span>ordered to have the right Side fomented Morning
+and Evening, and to rub it for some Time
+after with the <i>linimentum saponaceum</i> and to
+drink the Decoction of Sarsaparilla after the
+Soap Pills; and by continuing this Course for<span class='pagenum'><a name="Page_214" id="Page_214">[214]</a></span>
+about three Weeks, the Disorder went off<a name="FNanchor_94_94" id="FNanchor_94_94"></a><a href="#Footnote_94_94" class="fnanchor">[94]</a>.</p>
+
+<p>The H&aelig;morrhage from the Nose commonly
+stopped soon. Where it was violent, we kept
+<span class='pagenum'><a name="Page_215" id="Page_215">[215]</a></span>the Patient cool, and applied Cloths dipped in
+Vinegar and Water to the Nose.&mdash;In two
+Cases, one at <i>Munster</i>, the other at <i>Bremen</i>,
+the Patients were hot and feverish, and a Vein
+was opened, and eight or ten Ounces of Blood
+taken away; and in one Case nothing took
+Effect till we gave repeated Doses of the <i>tinctura
+saturnina</i> in a common acid Julep.</p>
+
+<div class="footnotes"><h3>FOOTNOTES:</h3>
+
+<div class="footnote"><p><a name="Footnote_89_89" id="Footnote_89_89"></a><a href="#FNanchor_89_89"><span class="label">[89]</span></a> Obstructions and Scirrhi of the Liver have been assigned
+as the Cause of the Jaundice; but as we have so many
+Cases of this Kind related where no Jaundice appeared, it is
+now much doubted, whether such Obstructions, which do not
+affect the Ducts, are capable of producing this Disorder.</p></div>
+
+<div class="footnote"><p><a name="Footnote_90_90" id="Footnote_90_90"></a><a href="#FNanchor_90_90"><span class="label">[90]</span></a> We have numerous Cases in <i>Bonetus</i>, and other physical
+Observations, where Calculi have been found in the Gall Bladder,
+and Ducts of People who have died of the Jaundice; and
+I have frequently found two, three, and sometimes twelve, fifteen,
+or twenty, such bilious Calculi in these Cavities.</p></div>
+
+<div class="footnote"><p><a name="Footnote_91_91" id="Footnote_91_91"></a><a href="#FNanchor_91_91"><span class="label">[91]</span></a> Viscid Mucus or Pituita, or viscid Bile, has been observed
+frequently to obstruct the Ducts. Dr. <i>Coe</i> says, sometimes
+icteric Patients discharge very thick Bile, almost as viscid
+as Bird-Lime. See his <i>Treatise on biliary Concretions</i>, chap. ii.
+where he has collected a great Number of icteric Cases, in
+which the Bile has been found quite viscid after Death.</p></div>
+
+<div class="footnote"><p><a name="Footnote_92_92" id="Footnote_92_92"></a><a href="#FNanchor_92_92"><span class="label">[92]</span></a> See the Case of a Jaundice in <i>Bonetus&#8217;s Sepulchretum Anatomicum</i>,
+tom. II. p. 326, where the Sides of the common biliary
+Duct were compressed by an Enlargement of the Glands
+about the <i>vena portarum</i>; and we sometimes meet with a Jaundice
+in pregnant Women which goes off after Delivery, and
+seems to have been caused by the Pressure of the Uterus and
+indurated F&#339;ces in the Colon. <i>Van Swieten</i> says, he has seen
+this very frequently, vol. III. sect. 918, p. 95.</p></div>
+
+<div class="footnote"><p><a name="Footnote_93_93" id="Footnote_93_93"></a><a href="#FNanchor_93_93"><span class="label">[93]</span></a> Vomits are reckoned amongst the most efficacious Remedies
+in this Disorder, and I have often seen good Effects follow
+their Use.&mdash;<i>Janet Crags</i>, a Woman thirty Years of Age, was,
+on the 21st of <i>December</i> 1758 admitted into <i>St. George</i>&#8217;s Hospital
+for a Jaundice of some Months Continuance. Her Eyes and
+Skin were not of the common icteric Colour, but of a dark
+livid yellow, for which Reason both she and the Nurses termed
+her Disorder the Black Jaundice. She at first complained of a
+Difficulty of Breathing, and a Weight and Oppression about the
+Region of the Liver, for which she was blooded, took some
+Doses of Physick, and the Soap Pills with Rhubarb; but these
+produced no Change in her Complaints. On the 29th she had a
+Cough, and complained much of Sickness and Difficulty of
+Breathing, for which she was ordered a Vomit, and afterwards
+to take the Squill Draught Morning and Evening, which occasioned
+a Purging and Gripes. On the 5th of <i>January</i> 1759,
+the Looseness still continuing, I ordered her to leave off the
+Use of the Squill Draughts, and to take only some Rhubarb in
+an oily Draught every Night at Bed-Time. On the 8th, tho&#8217;
+the Purging had increased, I did not chuse to check it, as I suspected
+it would prove a Crisis to the Disorder, and therefore
+only ordered her the Cordial Draughts and Wine to support
+her Strength. The Looseness continued till the 15th, when
+most of the icteric Symptoms were gone, and by the 30th they
+entirely disappeared. However, she continued low, and subject
+to Flatulencies for some Months afterwards, which were
+at last removed by the continued Use of Cordials, gentle Bitters,
+a nourishing Diet, and repeated Doses of Rhubarb; and
+on the 2d of <i>May</i> she was discharged in a firm State of Health.
+</p><p>
+Dr. <i>Coe</i> says, &#8220;I have more Reason to be satisfied of the
+Effect of Vomits in dislodging these Calculi, than of any
+other, or indeed of all other Medicines.&#8221; <i>Treatise on biliary
+Concretions</i>, chap. ii. p. 253. Besides viscid Humours, which
+Vomits bring away from the biliary Passages, how often are
+Gall Stones likewise found in the Stools after the Operation of
+a Vomit? <i>Ibid.</i> p. 256.</p></div>
+
+<div class="footnote"><p><a name="Footnote_94_94" id="Footnote_94_94"></a><a href="#FNanchor_94_94"><span class="label">[94]</span></a> Sometimes the warm Bath has a good Effect after other
+Remedies have afforded no Relief. In the Year 1743, a young
+Gentleman, a Student of Physic at <i>Edinburgh</i>, had a Jaundice
+for which he had taken Variety of Medicines, and rode daily
+on Horseback for some Weeks, without receiving any Benefit:
+At last, by my Father&#8217;s Advice, he took a brisk Dose of Physic,
+and before it began to operate had a large Quantity of
+warm Whey thrown up by way of a Clyster, and went immediately
+into the warm Bath. In the Bath he was taken with a
+violent Inclination to go to Stool; and after coming out, had
+a great Number of bilious Stools that Day, and next Morning
+was still inclined to be loose; and in a few Days all the icteric
+Symptoms vanished. On the 20th of <i>July</i> 1763, a middle aged
+Woman, <i>Elizabeth Hosier</i>, was admitted into <i>St. George</i>&#8217;s Hospital
+for a Jaundice, which came about a Fortnight before. She
+had been blooded, and had taken some Medicines, before I saw
+her. I ordered her a Vomit and Purge, and to take too Scruples
+of the Soap Pills and Rhubarb daily; and four Days afterwards
+the Vomit and Purge were repeated, but without making
+any Change in her Disorder. On the 29th she went into
+the warm Bath, and took a Vomit immediately on coming out.
+After the Vomit she had some loose Stools, and the icteric
+Symptoms went all off in a few Days. She continued well for
+some Months; but I have been told, that she has since relapsed.
+</p><p>
+When the Jaundice continues obstinate, there is hardly any
+Thing has often a better Effect than the continued Use of Decoctions
+of the Juices of succulent Plants, of Whey in the Spring,
+Soap, and such like Medicines. The Baron <i>Van Swieten</i> tells us,
+that he has cured many obstinate Jaundices by making the Patients
+drink daily a Pint or two Pints of a Decoction of Grass,
+Dandelion, Fumaria, Succory, and such like, prepared in
+Whey; to each Pint of which he added Half an Ounce of <i>sal
+polychrest</i>, and an Ounce or two of Syrup of the five aperient
+Roots; and by ordering them to drink the Spa Water in Summer,
+and take freely of Soap, along with a Decoction of the
+aperient Roots, in Winter. In those who were cured by these
+Remedies, he says, Stones, or a kind of a grumous calculous
+Matter, were always found in the Stools, as the Jaundice was
+going off. He relates one very particular Case of a Lady of
+sixty Years of Age, who had had a black Jaundice for twelve
+Years, and was cured by continuing the Use of these Medicines
+for eighteen Months; during the last six Months of
+which she had a Looseness, and constantly discharged by Stool
+a fetid granulated Matter of the Colour of Clay;&mdash;and another
+singular Case of a Man who was cured by living mostly upon
+Grass, and a Decoction of it, for two Years together. The
+Man came at last to devour such Quantities of it, and could
+distinguish the good Sort from the bad so well, that the Farmers
+often used to drive him out of their Fields. Vol. III. &sect;. 950.
+</p><p>
+<i>Glisson</i> tells us, that Cattle are subject to bilious Concretions
+in Winter, which are dissolved and evacuated in the Spring,
+when they begin to move much about, and to eat the new Grass,
+which purges them. <i>Oper.</i> vol. II. <i>Anat. Hepat.</i> chap. vii.
+p. 104.
+</p><p>
+Dr. <i>Russel</i> greatly recommends the Use of Sea Water along
+with the saponaceous Medicines. See his <i>Treatise on the Use of
+Sea Water</i>.</p></div>
+</div>
+
+
+
+<h2><a name="TUMOURS" id="TUMOURS"></a>OF<span class='pagenum'><a name="Page_216" id="Page_216">[216]</a></span><br />
+<span style="letter-spacing: 0.15ex; font-size: 130%"><span class="smcap">Tumours</span> of the <span class="smcap">Breast</span>.</span></h2>
+
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">I</span>n</span> <i>May</i> 1761, a great many of the Patients,
+who had been in Hospitals the preceding
+Winter, had Tumours formed on the external
+Part of the Breast, which they shewed me at
+<i>Osnabruck</i>. They began in the Form of indolent
+Tumours, and came slowly to Suppuration.
+For the most part, the Suppuration was only
+partial, and the Tumour, on being opened,
+discharged a very small Quantity of Matter.
+Some of them, though they felt soft, and
+seemed to contain Matter, yet, upon being
+opened, discharged only a small Quantity of
+black Blood. None of them melted down
+entirely into Pus, or came fully to Suppuration,
+and healed kindly as Abscesses which succeed<span class='pagenum'><a name="Page_217" id="Page_217">[217]</a></span>
+acute Inflammations. But after a small Quantity
+of Matter was discharged, for the most
+part, there still remained a hard Tumour, which
+felt as if it was a Swelling of the Bone, or Cartilage
+below; and in some the Surface of the
+Bone was found rough at the Bottom of the
+Abscess.</p>
+
+<p>These Tumours seldom rose high, and were
+most of them situated at the lower Part of the
+Sternum, or a little to one Side of it, commonly
+on the left Side, above the <i>cartilago ensiformis</i>.
+Some Patients had only one, others two,
+and some three such Tumours. The first of
+them I saw was on the left Side, which, on
+being felt, gave exactly the same Sensation as
+when the Cartilages of the Sternum are begun
+to be raised by an Aneurism of the Aorta; only
+no Pulsation was to be perceived; and most of
+them had the same Appearance.</p>
+
+<p>The Patients, who had such Tumours, commonly
+complained of Pains of their Breast.
+One or two, after these Tumours came to Suppuration,
+seemed to recover their Health, and
+to feel no Uneasiness, tho&#8217; some of the Swelling<span class='pagenum'><a name="Page_218" id="Page_218">[218]</a></span>
+remained: But many of them were inclined to
+be hectic, and seemed likely to grow consumptive.</p>
+
+<p>Being ordered up to the flying Hospital in
+<i>June</i>, and the Sick going down to <i>Bremen</i>, I
+had no Opportunity of seeing the Event of
+these Tumours, or of examining the Bodies of
+those who died with them. One I accidentally
+met with the following Winter at <i>Bremen</i>,
+who died of a Consumption and Diarrh&#339;a.
+He had a large Abscess, which penetrated
+into the Cavity of the Chest, and discharged
+a great Quantity of very fetid Matter,
+at the Part where one of these Tumours had
+been seated, and the Sternum and Ribs were
+carious all round the Abscess.</p>
+
+
+
+<h2><a name="PARALYTIC" id="PARALYTIC"></a>OF<span class='pagenum'><a name="Page_219" id="Page_219">[219]</a></span><br />
+<span class="smcap" style="letter-spacing: 0.15ex; font-size: 130%">Paralytic Complaints.</span></h2>
+
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">S</span>ome</span> of the Soldiers, from lying out in
+the Nights on the wet Ground, and from
+doing Duty in cold rainy Weather, were seized
+with a Pain and Numbness all over, and lost
+the Use of their Limbs, which in some was succeeded
+with a Palsy of these Parts: But the
+greatest Number of those afflicted with Paralytic
+Symptoms were seized with them either
+in Fevers, or after feverish and other Disorders.
+The Number, who were attacked with Complaints
+of this Kind, were but few.</p>
+
+<p>When Men were suddenly taken with Pain
+and Numbness all over, we found that the best
+Method of treating them was to put them to
+Bed, and give them Plenty of mild warm diluting<span class='pagenum'><a name="Page_220" id="Page_220">[220]</a></span>
+Liquors for Drink; and if there was
+much of a Fever, to open a Vein, to give the
+cooling antiphlogistic Medicines, and apply
+Blisters; and if these Complaints still remained,
+to endeavour to promote a breathing Sweat,
+by means of Diaphoretics and warm Drinks.
+Several who were brought to the Hospital,
+soon after being seized in this Manner, got
+well; but in some few, one or other of the
+Limbs would begin to waste, and remain paralytic
+afterwards.</p>
+
+<p>Those who had the true confirmed Palsy
+seldom remained long enough with us to be
+cured. Two or three received Benefit from
+Blisters applied to the Parts, and from Issues;
+drinking at the same time the Decoction of
+the Woods, or of Sarsaparilla, and taking the
+volatile Tincture of Guaiac or Valerian<a name="FNanchor_95_95" id="FNanchor_95_95"></a><a href="#Footnote_95_95" class="fnanchor">[95]</a>,
+<span class='pagenum'><a name="Page_221" id="Page_221">[221]</a></span>and being sweated by the Use of <i>Dover</i>&#8217;s
+Powder, or other Diaphoretics.</p>
+
+<p>One Man of the 51st Regiment of Foot,
+after doing Duty in very cold wet Weather,
+in the Beginning of the Year 1762, was seized
+with a Palsy of one Side of his Face, which
+<span class='pagenum'><a name="Page_222" id="Page_222">[222]</a></span>prevented him from speaking distinctly, and
+was an Impediment to his eating. He mended
+much after being blooded, and having a
+large Blister to his Neck, kept open for some
+time by means of the epispastic Ointment.</p>
+
+<div class="footnotes"><h3>FOOTNOTES:</h3>
+
+<div class="footnote"><p><a name="Footnote_95_95" id="Footnote_95_95"></a><a href="#FNanchor_95_95"><span class="label">[95]</span></a> On <i>Wednesday</i> the 1st of <i>February</i> 1764, <i>Margaret Julion</i>,
+a Woman between fifty and sixty Years of Age, was admitted
+into <i>St. George</i>&#8217;s Hospital for an entire Loss of Speech,
+which seemed to depend on a paralytic Disorder of the Parts
+about the Larynx. The Account her Friends who came with
+her to the Hospital gave of her Case was, that she had been
+for five Months troubled at Times with Pains of her Bowels,
+and a Purging; that on <i>Sunday</i> se&#8217;night before coming to
+the Hospital, she had suddenly lost the Use of her Speech, and
+had not spoke since that Time, though she seemed to hear and
+understand whatever was said to her. I asked her some Questions,
+which she answered distinctly by Signs. She had no
+paralytic Complaint of her Face, Arms, Legs, or any other
+Part of her Body, and swallowed both Fluids and Solids with
+Ease. She had no Fever, and seemed to complain of nothing
+but the Loss of Speech.&mdash;A Blister was applied to her Neck,
+and she was ordered the saline Draughts, with a Scruple of
+Powder of Valerian in each, to be taken three Times a-day,
+and a Dose of sacred Tincture, to be taken twice a-Week.
+She followed this Course for a Fortnight, when another Blister
+was applied to the Fore-part of the Neck, and the Powder of
+Valerian in the Draughts was changed for two Drachms of the
+<i>tinctura valeriana volatilis</i>. At the End of three Weeks she
+could pronounce the two Words <i>Why</i>, <i>What</i>. She continued
+the same Course till this Day, the 16th of <i>March</i>, and can now
+pronounce many Words and short Sentences.</p></div>
+</div>
+
+
+<h2><a name="INCONTINENCY" id="INCONTINENCY"></a>OF AN<span class='pagenum'><a name="Page_223" id="Page_223">[223]</a></span><br />
+<span style="letter-spacing: 0.15ex; font-size: 130%"><span class="smcap">Incontinency</span> of <span class="smcap">Urine</span>.</span></h2>
+
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">A</span>n</span> Incontinency of Urine was another
+Complaint frequent among the Soldiers;
+but it seemed to me to be counterfeited
+by many. All, who had it, said that they had
+received some Hurt<a name="FNanchor_96_96" id="FNanchor_96_96"></a><a href="#Footnote_96_96" class="fnanchor">[96]</a> or Sprain of the Back,
+<span class='pagenum'><a name="Page_224" id="Page_224">[224]</a></span>or a Kick from a Horse, or that a Carriage
+had run over them.</p>
+
+<p><span class='pagenum'><a name="Page_225" id="Page_225">[225]</a></span></p><p>Those who really had the Disorder seemed
+to have received such an Injury of the Bladder,
+or Kidneys as required a considerable Space of
+Time to get the better of; and by reason of
+the short Time we had them under our Care
+at the flying Hospital, they seldom received
+<span class='pagenum'><a name="Page_226" id="Page_226">[226]</a></span>much Benefit. One or two thought they grew
+better on taking the Bark and Balsam of <i>Peru</i>;
+at the same Time they bathed Morning and
+Evening the lower Part of the Abdomen and
+Perin&aelig;um, with Flannels dipped in gentle
+astringent Liquors, applied cold. Blisters applied
+to the <i>os sacrum</i> had no Effect.</p>
+
+<div class="footnotes"><h3>FOOTNOTES:</h3>
+
+<div class="footnote"><p><a name="Footnote_96_96" id="Footnote_96_96"></a><a href="#FNanchor_96_96"><span class="label">[96]</span></a> A Soldier in the Hospital at <i>Paderborn</i> used to discharge
+his Water involuntarily, and mixed with Pus, which came from
+some violent Blows he had received on the Back.
+</p><p>
+<i>John Pearce</i>, a young Man about eighteen Years of Age,
+was admitted into <i>St. George</i>&#8217;s Hospital, the 10th of <i>April</i>
+1759, for a Pain of his Side, and a Complaint of the Bladder.
+The Account which he gave of his own Case was, that, some
+Months before, he had received a violent Blow with a Cricket-Bat
+on the left Side, on the Region of the Kidney; and that
+ever since he had had a sharp Pain in that Part, and sometimes
+had a Stoppage of Urine, and at other Times it came away
+insensibly. His Pulse was rather quick, but low, and he had
+a feverish Heat. He at first took some cooling Medicines;
+but on the 20th, being low and faint, he had some of the
+f&#339;tid Julep. On the 23d he was attacked with a sharp Pain
+in the Belly and Side, had a Stoppage in making Water,
+a quick and full Pulse, and most of the Symptoms of the
+Stone. He was ordered to be blooded immediately, to take
+the saline Draughts every four Hours; and as he was inclined
+to be costive, to take as much lenitive Electuary as to
+procure him a loose Stool; and it was recommended that he
+should be sounded as soon as the Violence of the Fever was
+over. On the 25th he continued much in the same Way, and
+had made some Water, which was intolerably f&#339;tid. Half a
+Drachm of the dulcified Spirit of Nitre, and five Drops of the
+<i>tinctura thebaica</i>, were added to each of his Draughts, as the
+Pain and Difficulty of making Water had increased. On the
+26th his Pulse rose, and became very hard and quick; the Pain
+in his Side, and the Dysuria, became more violent; and about
+Twelve o&#8217;Clock he had a convulsive Fit, resembling that of an
+Epilepsy; after coming out of the Fit, as the Fever and Pain
+had increased, he was blooded; the Belly was fomented and
+embrocated, and he took the oily Draughts four Times a-Day;
+his Blood immediately threw up a very thick Buff. He remained
+pretty easy the rest of the Day; but about the same
+Time next Day, he had another convulsive Fit, and died.
+</p><p>
+On opening his Body, we found about two or three Pints of
+a dark-coloured f&#339;tid Water in the Abdomen; on cutting
+through, and squeezing the right Kidney, there came out a
+thin purulent Matter every where from its Substance, though
+it appeared sound; on raising and cutting through the Peritoneum,
+covering the left Kidney, there was a Discharge of about
+a Pint of black and very f&#339;tid Water, which had every where
+surrounded this Kidney; and there were six mortified Spots
+on its Surface, as large as the End of one&#8217;s Finger, with a
+Depression in each about a Quarter or Half an Inch deep;
+most of the Substance of this Kidney seemed diseased, and it
+was full of Suppurations. The Bladder was contracted and
+thickened, and contained a rough Stone, which weighed three
+Ounces. The rest of the <i>viscera</i> were sound. This Stone had
+certainly been in the Bladder long before the young Fellow
+received the Blow with the Cricket-Bat; but the Injury done
+the Kidney had probably aggravated the Symptoms.
+</p><p>
+I do not remember ever to have seen convulsive Fits, such as
+this young Man had, in acute Diseases, except in one Case of
+a slow Fever, which came by taking Cold after a Salivation,
+and which I attended, along with Dr. <i>Pringle</i>. The Gentleman
+had three Fits exactly of the same kind as this young
+Man, at twenty-four Hours Distance from one another, and
+he died of the third.</p></div>
+</div>
+
+
+<h2><a name="STOPPAGE" id="STOPPAGE"></a>OF A<span class='pagenum'><a name="Page_227" id="Page_227">[227]</a></span><br />
+<span style="letter-spacing: 0.15ex; font-size: 130%"><span class="smcap">Stoppage</span> of <span class="smcap">Urine</span>.</span></h2>
+
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">W</span>e</span> formerly mentioned, that in acute
+Diseases many complained of a Stoppage
+or Difficulty of making Water; and<span class='pagenum'><a name="Page_228" id="Page_228">[228]</a></span>
+others had this Complaint from Strictures of
+the Urethra, or Disorders of the Bladder or
+Kidneys<a name="FNanchor_97_97" id="FNanchor_97_97"></a><a href="#Footnote_97_97" class="fnanchor">[97]</a>.</p>
+
+<p>Where it depended on Strictures of the Urethra,
+Bougies introduced into that Passage,
+<span class='pagenum'><a name="Page_229" id="Page_229">[229]</a></span>and worn for some Time, were of great Service.
+The Patients were at the same time ordered
+<span class='pagenum'><a name="Page_230" id="Page_230">[230]</a></span>to live on a cool Diet, and to drink the
+<i>decoctum Arabicum</i>, or an Infusion of Linseed,
+or such other mild mucilaginous Liquors;<span class='pagenum'><a name="Page_231" id="Page_231">[231]</a></span>
+and to take oily Medicines and Opiates
+occasionally, and gentle Laxatives, to keep the
+Body open; which Method of Treatment generally<span class='pagenum'><a name="Page_232" id="Page_232">[232]</a></span>
+gave Relief. Where the Patients were
+plethoric, or complained of Pain, or the Disorder<span class='pagenum'><a name="Page_233" id="Page_233">[233]</a></span>
+was attended with a Fever, Bleeding was
+often necessary.</p>
+
+<p>When the Stoppage of Urine seemed to<span class='pagenum'><a name="Page_234" id="Page_234">[234]</a></span>
+arise from an Inflammation of the Kidneys or
+Bladder, or other Diseases of these Parts, we
+treated it accordingly; and where the Fever
+was considerable, we made Evacuations, and<span class='pagenum'><a name="Page_235" id="Page_235">[235]</a></span>
+gave plenty of diluting Liquors, and the cooling
+saline Medicines, and afterwards those of
+the soft, mucilaginous, and oily Nature, and<span class='pagenum'><a name="Page_236" id="Page_236">[236]</a></span>
+mild Diuretics and Opiates.</p>
+
+<p>When the Disorder, in its Progress, became
+chronical, the Sick were commonly sent down
+to the fixed Hospital, so that we had no Opportunity
+of examining the Bodies of such as
+might die of this Complaint.</p>
+
+<div class="footnotes"><h3>FOOTNOTES:</h3>
+
+<div class="footnote"><p><a name="Footnote_97_97" id="Footnote_97_97"></a><a href="#FNanchor_97_97"><span class="label">[97]</span></a> It is often very difficult to judge of the Cause, or to be
+able to determine exactly the Seat of these Disorders before
+Death; as the following Cases will shew.
+</p><p>
+<i>John Waden</i>, a middle-aged Man, was admitted into <i>St.
+George</i>&#8217;s Hospital the 10th of <i>April</i> 1759, for a Swelling of
+the Abdomen, and a Difficulty of making Water, which he
+said begun about two Months before, with a violent Pain in
+his Back and Belly, occasioned by his being employed in making
+of Cyder in a very cold Cellar. He had not had a Stool
+for some Days: at first he took a Dose of Physic, and some of
+the saline Draughts; but in a Day or two complained that his
+Belly had grown to a monstrous Size, and that he had not
+made Water for above twenty-four Hours; on examining, we
+found the Bladder so much distended as to reach up to the Navel;
+and upon a Catheter&#8217;s being introduced, above two
+Quarts of Water were drawn off, and the Swelling immediately
+subsided; but in the Afternoon was as large as before,
+the Bladder seeming to be in a paralytic State. During the
+Months of <i>May</i> and <i>June</i>, his Water was drawn off twice a-Day;
+he had his Belly fomented with emollient, astringent,
+and other Decoctions, and embrocated with Liniments; was
+blooded once when feverish, took Cordials, the Bark, Myrrh,
+and a Variety of Medicines, without any Effect. On the 3d
+of <i>July</i>, a flexible Catheter was introduced into the Bladder,
+and left there, in order that the Urine might drain away as fast
+as it was secreted, and the Bladder be allowed to contract, and
+recover its Tone. The Catheter gave him no Pain, and he
+thought himself much easier by the Bladder&#8217;s never being too
+much stretched; but on taking out the Catheter some Days
+after, he had the same Stoppage of Water as before. On consulting
+with Dr. <i>Batt</i> and the other Physicians, it was agreed
+to give two Grains of the Powder of Cantharides, with three
+Grains of Camphor and ten of Sugar, rubbed well together in
+a Mortar, twice a-Day; and to continue the Use of the flexible
+Catheter. He found no Uneasiness or Strangury from the
+Use of the Cantharides, and thought he passed his Water more
+freely, when the Catheter was taken out; but after fourteen
+Days, finding no Change for the better, and being free from
+any Fever, he was ordered into the cold Bath; the two first
+Days he found himself more lively and brisk; but the third
+Day was chilly and cold after coming out of it, and therefore
+was desired to leave it off; some Days after he became hectic,
+and I observed Pus in his Water, which he said he had passed
+with his Urine for above three Months; after this he languished
+for near a Month, and died upon the 25th of <i>August</i>.&mdash;Upon
+examining his Body next Day, we found the thoracic
+Viscera in a sound State, except that the Lungs adhered a little
+on the right Side. Both Kidneys were diseased; they were
+inflamed, and seemed enlarged; and on cutting them, had
+Tubercles dispersed every where through their Substance,
+which had come to Suppuration, and contained a good deal of
+Matter; the lower Part of the left Kidney was mortified, and
+contained two or three Ounces of a black f&#339;tid Liquor. The
+Bladder of Urine was contracted, and its Coats greatly thickened,
+and the internal Coat much inflamed; and there was a
+Cyst full of Matter, about Half the Size of a Walnut, between
+the muscular and villous Coats, towards the lower Part of the
+right Side of the Bladder; and there were two large Cysts,
+containing a small Quantity of Matter, though capable of containing
+near two Ounces each; one situated between the <i>vesicul&aelig;
+seminales</i> and Rectum, the other between the <i>vesicul&aelig;</i> and
+Bladder, which opened into the Urethra by one common Orifice,
+capable of admitting a large Quill, at the Side of the <i>caput
+galinaginis</i>. The rest of the Viscera were in a sound State.
+</p><p>
+<i>Mary Hibbard</i>, a Woman twenty-four Years of Age, was
+admitted into <i>St. George</i>&#8217;s Hospital, the 6th <i>June</i> 1759, for a
+Complaint of her Bladder. The Account she gave of herself
+was, that, about <i>Christmas</i> 1758, she had parted with some
+Gravel; and about fourteen Days before coming to the Hospital,
+she was seized with a violent Pain in her Back and Loins,
+attended with a Sickness and Nausea; and very soon after
+complained of a violent Pain in the lower Part of her Belly,
+and with a perpetual Inclination to make Water, though she
+felt a sharp Pain and Difficulty in doing it; and that these
+Complaints still remained. Her Pulse was quick and strong,
+and she was inclined to be costive. She was immediately
+blooded, took the oily Draughts three Times a-Day, the <i>decoctum
+furfuris</i> for common Drink, and so much lenitive Electuary
+as procured her a Stool next Day. As there was a strong
+Suspicion of her having a Stone, she was sounded; but nothing
+at all was to be felt in the Bladder. Her Medicines eased her
+Pain in making Water, but not the Pain in her Back. On the
+16th her Water was thick and turbid, and deposited a brown
+Sediment; and the Difficulty in making Water still remained;
+instead of the lenitive Electuary she was ordered the Rhubarb oily
+Draught to be taken every Night. On the 18th, there being no
+Change in her Disorder, she had Draughts made of an Ounce
+and a Half of simple Mint Water, Half a Drachm of the dulcified
+Spirit of Nitre, and five Drops of the <i>tinctura thebaica</i>, and
+Syrup three Times a-Day; but on the 22d she complained, that since
+she left off the oily Medicines, her Pain and Difficulty in making
+Water had grown worse; she was therefore ordered the
+saline and oily Draughts alternately, and to take the Rhubarb
+oily Draught occasionally when costive, which removed these
+Complaints; and they did not return while she remained in
+the House; but on the 4th of <i>July</i>, the Day before she was to
+have been discharged as cured, she was attacked with a sharp
+Pain in her Hip and Loins, and about the <i>os coccygis</i>; which
+increased till the 9th, and extended itself all along the Outside
+of the right Thigh; it was most acute about the <i>os coccygis</i>;
+but on examining, nothing was to be observed externally:
+This Pain continued more or less all that Month, and till
+the End of the next, and so obstinate as not to be altered by
+bleeding, and the Use of Liniments, Blisters, cooling Medicines,
+Opiates, warm Baths, and other Remedies. On the
+20th of <i>August</i>, a strengthening Plaister was applied to her
+Back, which gave immediate Relief, and she was discharged
+cured the 29th. She continued well till <i>October</i>, when she was
+attacked with a violent Fever at <i>Hounslow</i>, and was brought to
+the Hospital on the 24th of that Month, and the tenth Day of
+the Fever. She died the 3d of <i>November</i>. During the Course
+of the Fever, she only complained once of a Difficulty of making
+Water.&mdash;After Death I had her Body opened, when the
+only Thing particular which we could observe, was the urinary
+Bladder about four times the natural Size; it seemed to
+be flaccid, and in a State of Relaxation; the Kidneys were
+sound, and no Signs of any Distemper could be observed about
+the Uterus or Rectum, or near the <i>os coccygis</i>.&mdash;When she was
+first in the Hospital, I desired her always to examine her Urine;
+but she never observed that she passed any Sand, Gravel,
+or any thing of that kind.
+</p><p>
+<i>Thomas Jacey</i>, an elderly Man, was admitted into <i>St. George</i>&#8217;s
+Hospital the 14th of <i>March</i> 1759, for a Pain in his Back, and
+a Difficulty and Pain in making Water, which was often mixed
+with grumous Blood; but he had never observed any Sand or
+Gravel in it. His Pulse was quick and full, attended with Heat
+and Thirst; and he was inclined to be costive; he was at first
+blooded, and took a Dose of laxative Mixture, and two Ounces
+of the Tincture of Roses, four Times a Day, and the <i>decoctum
+malv&aelig;</i> for common Drink. At first he seemed relieved,
+and passed no grumous Blood for some Days; but on the 26th,
+as he complained much of a Pain in making Water, the Tincture
+of Roses was changed for the oily Draughts, and he was
+ordered the Rhubarb oily Draught occasionally. On the 9th
+of <i>April</i> he fell suddenly into a comatose Way, and remained so
+till the 12th, when he died, notwithstanding the Use of divers
+Remedies.&mdash;Upon examining his Body, both Kidneys were
+found in a sound State; the Intestines covered with slight inflammatory
+Spots, the Bladder of Urine quite contracted,
+schirrhous, and greatly thickened; and its internal Surface
+rough and eroded, with one or two black Spots on it, and some
+grumous Blood lying on its Surface. The other viscera were
+sound.
+</p><p>
+In Ulcers of these Organs, the natural Balsams, mixed with
+soft Things, are often of great Service; of which the following
+Case is an Example.&mdash;<i>William Lumley</i>, a Boy nine Years
+of Age, was admitted into <i>St. George</i>&#8217;s Hospital, the 6th of
+<i>September</i> 1759, for a Pain in the Bladder, and a Difficulty in
+making Water, which was always more or less mixed with
+Matter. At first there was a Suspicion of his having the
+Stone; but on sounding, none was to be found. From the
+Symptoms, it appeared as if there was an Ulcer in the Bladder
+near to its Neck; the Boy had a Cough, was very low,
+and inclined to be costive; at first he took three Spoonfuls of
+the Sperma Ceti Mixture four Times a-Day, and a Dose of
+Physic; but the Symptoms still remaining, on the 2d of <i>October</i>
+he was ordered to take a Scruple of the <i>electuarium e
+spermate ceti</i> three or four Times a Day, and to have the Gum-Arabic
+Decoction for his common Drink. By continuing the
+Use of these Things, and taking some opiate and laxative Medicines
+occasionally, he mended by slow Degrees, and all his
+Symptoms went off; and he recovered his Health and Strength,
+and returned Thanks for his Cure the 18th of <i>January</i> 1760.
+</p><p>
+The following Account of a remarkable Suppression of Urine
+I had in a Letter, dated the 25th of <i>November</i> 1757, from Mr.
+<i>Pearson</i>, one of the Surgeons to his Majesty&#8217;s Military Hospitals,
+who then served as a Mate.
+</p><p>
+<i>James Ruffendal</i>, aged Twenty, of a delicate Habit, was, in
+the Middle of <i>July</i> last, seized with a violent Pain in both
+Kidneys, which extended along the Ureters to the Bladder, and
+remained in the same Situation for about three Weeks; during
+which Period his Urine began to decrease in Quantity, and the
+voiding of it was attended with acute Pain about the Neck of the
+Bladder. The Secretion then totally stopt; he remained for upwards
+of five Weeks in the Hospital at <i>Dorchester</i>, and made no Water;
+at the End of which Time I first visited him along with
+Mr. <i>Adair</i>. He complained then of a slight Pain in his Kidneys,
+and told us he had a tolerable Appetite, sweated little,
+and voided every Day four or five Liquid Stools. He was ordered
+Boluses of Camphor, and <i>sal. vol. c. cervi</i>, and every
+Night a Dose of <i>tinctura cantharidum</i>; which he continued to
+take for a Fortnight without receiving the least Benefit. I
+then blooded him to the Quantity of ten Ounces, and gave
+him an Emetic of six Drachms of the <i>vinum ipecacoanh&aelig;</i>, and
+two Ounces of the Oxymel of Squills, which operated very
+well; and afterwards ordered him to take one of the following
+Boluses every four Hours. &#8478; Sapon. dur. Hispan. drachm. i.
+Sal. Absynth. gr. vi. Calc. Viv. gr. x. Balsam. Peruv. q.&nbsp;s.
+ut fiat Bolus. These he continued to take for twelve Days.
+On the Morning of the 14th of <i>October</i>, he was suddenly seized
+with an acute Pain in both Kidneys, and about Noon
+voided upwards of Half a Pint of straw-coloured Urine, which
+let fall a clay-coloured Sediment. As he was feverish, I took
+away twelve Ounces of Blood, and ordered him Barley-Water
+with Nitre for Drink. He was easy in the Night, and made
+upwards of two Pints of Urine, which deposited a Sediment of
+a gelatinous Consistence. Next Morning the Pain increased,
+especially in his Right Side, and ten Ounces more of Blood
+was taken away. This lowered the Pulse, and considerably
+abated the Pain. Both this and the Blood taken away the
+Day before threw up an inflammatory Buff. He was ordered
+to continue the Use of the Barley Water with Nitre, and to
+take three Spoonfuls of a Mixture with <i>spiritus mindereri</i> every
+two Hours. He had an easy Night, and was next Day free
+from Fever; but complained of an Uneasiness in his Stomach
+and Nausea. He was ordered a Scruple of the Powder of Ipecacoanha,
+which vomited him, and procured him a Stool. He
+was easy in the Night; but in the Morning was hot, and complained
+of a Pain in his Right Kidney, and all over his Bones,
+as he expressed it. I then gave him a Mixture, with <i>spiritus
+mindereri</i>, and the <i>pulvis contrayerva comp.</i> of which I desired
+him to take some Spoonfuls frequently. This procured him
+a plentiful Sweat, which removed the Fever and Pain: these
+Symptoms returned next Day, but were removed by the same
+Means. I remained at <i>Dorchester</i> for a Week after, and he recovered
+his Strength and Appetite as much as could be expected
+in so short a Time; but he still complained of Pain in
+his Right Kidney, tho&#8217; he made Water freely. By a Letter I
+received from the Gentleman whose Care I left him under, I understood
+he had a Relapse, which he has since got the better of.
+</p><p>
+I forgot to inform you, that his Father died of the same
+Complaints, after being six Months without secreting a Drop
+of Urine; and his Brother died of the same in about ten
+Weeks.</p></div>
+</div>
+
+
+<h2><a name="EPILEPSY" id="EPILEPSY"></a>OF THE<span class='pagenum'><a name="Page_237" id="Page_237">[237]</a></span><br />
+<span style="letter-spacing: 0.15ex; font-size: 130%">EPILEPSY.</span></h2>
+
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">T</span>he</span> Epilepsy, or Falling Sickness, attacked
+a Number of Men, from the
+severe Duty of long Marches in hot Weather,
+and afterwards lying out on the cold Ground,
+exposed to the Damps of the Night<a name="FNanchor_98_98" id="FNanchor_98_98"></a><a href="#Footnote_98_98" class="fnanchor">[98]</a>.</p>
+
+<p>It was very seldom that Men were cured of
+this Disorder in the military Hospitals. We
+had some few Instances, indeed, where Relief
+seemed to be obtained by Rest, a regular
+<span class='pagenum'><a name="Page_238" id="Page_238">[238]</a></span>Diet, gentle Evacuations, and Issues<a name="FNanchor_99_99" id="FNanchor_99_99"></a><a href="#Footnote_99_99" class="fnanchor">[99]</a>; but
+even those Men generally relapsed as soon as
+<span class='pagenum'><a name="Page_239" id="Page_239">[239]</a></span>they were sent to their Regiments, and began
+to do Duty. All who had these Fits after
+being some Time with their Regiments, were
+at last discharged, and sent home. However,
+before Men are discharged for Fits, they should
+be watched very narrowly for some Time; for
+there is no Disorder which Soldiers are more
+apt to counterfeit than this.</p>
+
+<p>It is no Wonder that Soldiers, during the
+Time of Service, should seldom be cured of
+these Fits; for in Adults it is not often cured
+<span class='pagenum'><a name="Page_240" id="Page_240">[240]</a></span>even in private Practice, with all the Conveniencies
+and Advantages to be wished
+for; and generally the few that do get well,
+require a considerable Length of Time to accomplish
+the Cure; and we find from daily
+Experience, as well as from examining the
+Records of Medicine, that the Cures that have
+been made, have mostly been performed either<span class='pagenum'><a name="Page_241" id="Page_241">[241]</a></span>
+by a Change of Air, such as going from a cold
+to a hot Climate<a name="FNanchor_100_100" id="FNanchor_100_100"></a><a href="#Footnote_100_100" class="fnanchor">[100]</a>, by some remarkable
+Change of Life<a name="FNanchor_101_101" id="FNanchor_101_101"></a><a href="#Footnote_101_101" class="fnanchor">[101]</a>, or some accidental Disorder;<a name="FNanchor_102_102" id="FNanchor_102_102"></a><a href="#Footnote_102_102" class="fnanchor">[102]</a>
+or by Issues or Drains<a name="FNanchor_103_103" id="FNanchor_103_103"></a><a href="#Footnote_103_103" class="fnanchor">[103]</a>; or by the
+Removal of some acrid or irritating Substance,
+or such like<a name="FNanchor_104_104" id="FNanchor_104_104"></a><a href="#Footnote_104_104" class="fnanchor">[104]</a>; or by preventing the
+Cause<a name="FNanchor_105_105" id="FNanchor_105_105"></a><a href="#Footnote_105_105" class="fnanchor">[105]</a>; and that those Medicines called
+Specifics have in general had but little Share in<span class='pagenum'><a name="Page_242" id="Page_242">[242]</a></span>
+the Cure.</p>
+
+<div class="footnotes"><h3>FOOTNOTES:</h3>
+
+<div class="footnote"><p><a name="Footnote_98_98" id="Footnote_98_98"></a><a href="#FNanchor_98_98"><span class="label">[98]</span></a> I saw above twenty Men, while I was in <i>Germany</i>, who
+attributed the Epileptic Fits they were attacked with to these
+Causes, and said they had never had the Epilepsy before; besides
+others, who had been formerly subject to these Fits, who
+declared, that the Disorder was brought back by the same
+Means.</p></div>
+
+<div class="footnote"><p><a name="Footnote_99_99" id="Footnote_99_99"></a><a href="#FNanchor_99_99"><span class="label">[99]</span></a> <i>William Wilson</i>, a Boy fourteen Years of Age, was admitted
+into <i>St. George</i>&#8217;s Hospital, <i>Sept.</i> 20, 1758, for Epileptic
+Fits, which he had been subject to for some Time, and which
+generally seized him three or four Times a Week. He took
+Variety of Medicines without any Effect till the 6th of <i>November</i>,
+when I ordered him to take eight Grains of the <i>pilul&aelig; f&#339;tid&aelig;</i>
+Morning and Evening, and Physic twice a Week, and a
+Seton to be made in his Neck. After the Seton began to run,
+he had but three or four slight Fits in <i>November</i>, and none the
+following Month; and he was discharged the Hospital the 3d
+of <i>January</i> 1759, seemingly in good Health, with Directions to
+keep the Seton running at least for some Months after he went
+home, and to come again to the Hospital if he should have any
+Return of his Fits; but we never heard more of him.
+</p><p>
+<i>Mary Hacket</i>, a Girl of nineteen Years of Age, was admitted
+into <i>St. George</i>&#8217;s Hospital the 14th of <i>February</i> 1759, for Fits.
+The Account she gave of her Case, was, that about five Years
+before she was seized with the first Fit, after a Fright; three
+Years afterwards she had a second Fit, and for some Time after
+had a Fit commonly once a Month, about the Time of the
+full Moon; and since had them more frequently; that the Fits
+began with a Trembling and Shaking of the right Foot, and
+she had frequent pricking Pains in the right Thigh, and what
+she called convulsive Tremors in the right Leg and Foot. She
+was regular in her menstrual Discharge. At the Time she
+came into the Hospital, she was feverish, and complained much
+of a sharp Pain in the right Thigh: She was blooded, and took
+some cooling Medicine, and had no Fit till the 9th of <i>March</i>:
+She then took the fetid Pills and camphorated Julep twice a
+Day; but still the Fits returned frequently. She then had
+the Bark, Valerian and Purging Doses successively, and used
+the warm Bath; but without any Effect. On the 7th of <i>May</i> a
+Blister was applied to her right Foot, which was intended to
+be kept open; but an Inflammation coming on that Leg and
+Foot, it was suffered to dry up, and an Issue made in the same
+Leg. From the Time the Blister was applied, she had no Fit
+while she remained in the Hospital. She was discharged the
+15th of <i>July</i>, seemingly in good Health; though during that
+Period she had some little Tremors in her Foot, and was subject
+to be low and faintish, which was always relieved by cordial
+anodyne Medicines. After going out of the Hospital, she
+remained in good Health for seven or eight Months, when I was
+told her Disease had returned as violent as ever.</p></div>
+
+<div class="footnote"><p><a name="Footnote_100_100" id="Footnote_100_100"></a><a href="#FNanchor_100_100"><span class="label">[100]</span></a> <i>Hippocrates</i> lays the chief Stress of the Cure upon Change
+of Air, Aphor. 4, 5, sect. ii. The Baron <i>Van Swieten</i> says, he has
+known a great Number cured by going to the <i>East Indies</i>; many of
+whom have remained well ever after, while others had a Return
+of the Disorder when they came back to <i>Holland</i>. <i>Comment.</i>
+vol. III. p. 436. sect. 1080.</p></div>
+
+<div class="footnote"><p><a name="Footnote_101_101" id="Footnote_101_101"></a><a href="#FNanchor_101_101"><span class="label">[101]</span></a> <i>Celsus</i> has long ago observed, that the Appearance of the
+Menses in Girls, and of Puberty in Boys, often removes this
+Disorder, lib. iii. cap. xxiii.&mdash;On the 22d of <i>November</i> 1758,
+<i>Mary Evans</i>, a Girl of eighteen Years of Age, was admitted
+into <i>St. George</i>&#8217;s Hospital for Fits. She had never had the
+Menstrua; but, for above two Years, found regularly, once a
+Month, a Fulness in her Breasts, and had a slight Head Ach,
+and other Symptoms which generally precede this Discharge;
+and were succeeded with violent Epileptic Fits, which continued
+returning frequently for two or three Days, and then went
+off; and she had no more Symptoms of them, till about the
+same Time next Month. She was ordered to take ten Grains
+of the <i>pilul&aelig; f&#339;tid&aelig;</i> Morning and Evening, and a Dose of Physic
+twice a Week; and as I found that she became plethoric
+near the Time her Fits used to return, I began to imagine, that
+both the Fits and Stoppage of the Menstrua were owing to too
+great a Fullness of the Vessels, which prevented the Heart and
+vascular System from having such free Play, as to drive the
+Blood through the extreme uterine Vessels: I therefore ordered
+seven Ounces of Blood to be taken away from her immediately.
+In three Days Time the menstrual Discharge began to make its
+Appearance; and on the 10th of <i>January</i> she was discharged
+the Hospital, seemingly in good Health, after the menstrual
+Discharge had returned for two regular Periods, without any
+Appearance of Epileptic Fits. She was desired to come back
+to the Hospital, if the Fits returned; but I never heard more
+of her.</p></div>
+
+<div class="footnote"><p><a name="Footnote_102_102" id="Footnote_102_102"></a><a href="#FNanchor_102_102"><span class="label">[102]</span></a> <i>William Glen</i>, a Patient in the <i>Royal Infirmary</i> at <i>Edinburgh</i>
+in <i>September</i> 1747, was freed from Epileptic Fits, which used to
+return ten or twelve Times a Day, for a Quarter of a Year, by
+a Diarrh&#339;a coming on; but they afterwards returned.
+</p><p>
+<i>A Man</i> subject to the Epilepsy was cured of it by a Quartan
+Ague, and had afterwards no Return of the Disorder. <i>Miscell.
+Curios. Dec. 3. Ann. 3.</i> p. 34.</p></div>
+
+<div class="footnote"><p><a name="Footnote_103_103" id="Footnote_103_103"></a><a href="#FNanchor_103_103"><span class="label">[103]</span></a> There are numerous Instances of the good Effects of
+Issues and Drains in diverse Authors. <i>Tulpius</i>, <i>Van Swieten</i>,
+&amp;c.</p></div>
+
+<div class="footnote"><p><a name="Footnote_104_104" id="Footnote_104_104"></a><a href="#FNanchor_104_104"><span class="label">[104]</span></a> <i>La Motte</i> gives one Instance of a Person being cured of
+the Epilepsy by voiding five Stones, <i>Chirurg.</i> vol. II. p. 20;
+and of another who died of the Fits from a triangular Stone
+remaining in the Kidneys, <i>ibid.</i> p. 416. Dr. <i>Short</i> cured a Woman
+of an Epilepsy of twelve Years standing, by extirpating a
+cartilagenous Substance, about the Bigness of a large Pea, seated
+on the gastronemei Muscles, above a Nerve which he cut
+asunder. <i>Edin. Medic. Essays</i>, vol. IV. Art. 27.</p></div>
+
+<div class="footnote"><p><a name="Footnote_105_105" id="Footnote_105_105"></a><a href="#FNanchor_105_105"><span class="label">[105]</span></a> <i>Galen</i>, tells us, of his having prevented the Epileptic Fits
+in a Boy, who used to have one whenever he was hungry, by
+making him carry Bread in his Pocket, and eat a little as soon
+as he found the least Symptoms of Hunger. <i>De Loc. Affect.</i>
+lib. v. cap. vi.&mdash;And <i>Van Swieten</i> mentions how he cured a
+Boy, who had a Fit every full Moon; whose under Lip used to
+fall a Trembling before it began (a Symptom which, he says,
+often precedes Vomiting); by giving a Vomit every Month,
+for six Months successively, three Days before the full Moon,
+and an Opiate in the Evening after its Operation; and by putting
+him under a Course of strengthening Medicines. It was
+observeable, that if he vomited in the Time of the Paroxysm,
+it was soon at an End. See his <i>Comment.</i> vol. III. p. 439. sect.
+1050.</p></div>
+</div>
+
+
+<h2><a name="SMALLPOX" id="SMALLPOX"></a>OF THE<span class='pagenum'><a name="Page_243" id="Page_243">[243]</a></span><br />
+<span style="letter-spacing: 0.15ex; font-size: 130%">SMALL-POX.</span></h2>
+
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">T</span>he</span> Small-Pox appeared at <i>Paderborn</i>
+in the Spring 1761, and five had the
+distinct Kind, who recovered. Six or seven
+had them at <i>Osnabruck</i> in <i>May</i> and <i>June</i>, and
+one Man and a Child died of the confluent
+Kind. Four had the distinct Kind at <i>Munster</i>
+in <i>July</i> and <i>August</i> who all did well. During
+the Winter, we had sixteen in the Hospital I
+attended at <i>Bremen</i>; ten had the distinct Kind,
+and all recovered; five had the confluent Kind,
+of whom two died; as did also one who was
+brought to the Hospital with all the Symptoms
+of the most malignant Kind. Two were sent
+to <i>Natzungen</i> in <i>July</i>, both ill of the confluent
+Kind; the one died two Hours after his Arrival;<span class='pagenum'><a name="Page_244" id="Page_244">[244]</a></span>
+the other recovered: And we had only
+two in the Hospital at <i>Osnabruck</i> in Winter
+1762-63, and both did well.</p>
+
+<p>There was nothing particular either in the
+Course or Treatment of this Disorder, different
+from what we meet with in daily Practice;
+only as the Soldiers, who were attacked with
+it, were strong, and in full Health, they required
+Bleeding and gentle Evacuations, and a
+cooling Regimen, on the first Appearance of
+the Symptoms.</p>
+
+<p>The malignant Kind required the Use of
+Acids, and the Bark; which last, could often
+only be administered by Way of Clyster, as
+the Sick could not swallow it: In short, we
+treated the Patients much in the same Way as
+in the malignant Fever, Allowance only being
+made for the present Circumstances.</p>
+
+<p>Luckily this Disorder never spread much in
+the Army, while I was in <i>Germany</i>.</p>
+
+
+
+<h2><a name="ERISYPILATOUS" id="ERISYPILATOUS"></a>OF<span class='pagenum'><a name="Page_245" id="Page_245">[245]</a></span><br />
+<span class="smcap" style="letter-spacing: 0.15ex; font-size: 130%">Erisypilatous Swellings</span>.</h2>
+
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">I</span>n</span> <i>January</i> 1762, several Patients in the
+Hospitals I had the Care of at <i>Bremen</i>,
+had shining watery Swellings of the Face, or
+Extremities; which came suddenly, and were
+attended with a slight Degree of Inflammation,
+and watery Blisters rising above the Skin,
+and some Degree of Fever. The Blisters were
+not small, round, and angry, as in <i>St. Antony</i>&#8217;s
+Fire; but larger, and of an irregular Figure,
+resembling those raised when People are scalded
+by boiling Water. The Swellings did not pit
+on being pressed, as the oedematous Swellings
+commonly do: They gave Pain when pressed,
+but the Inflammation was not in that high
+Degree as it is in the common Phlegmon:<span class='pagenum'><a name="Page_246" id="Page_246">[246]</a></span>
+The Blood was sizy, and the Water of a high
+Colour. The Disorder seemed to be a Species
+of the Erisypelas.</p>
+
+<p>Between the 9th and 12th of <i>January</i>, three
+Patients were seized with such Swellings.</p>
+
+<p>The first was a Dragoon, who had just recovered
+from a Flux, and a bad Cough. On
+the 9th, he was suddenly seized in the Night
+with a large Swelling of his Face, Hands, and
+Arms, which had a shining oedematous Appearance,
+with a small Degree of Redness, and
+was painful when pressed; and he had two or
+three watery Blisters rose on the Back of each
+Hand above the Division of the Fingers, attended
+with a quick full Pulse, a feverish Heat
+and Thirst, a Cough, and somewhat of a Difficulty
+of Breathing, and high-coloured Water;
+and he was inclined to be costive. He was
+immediately blooded, had a saline Mixture
+with Contrayerva and Nitre, and was ordered
+to take a Purge in the Morning. Next Day
+the Blood had thrown up an inflammatory
+Buff, the Fever was abated, and the Breathing
+easier; but the Cough and Swelling still remained.<span class='pagenum'><a name="Page_247" id="Page_247">[247]</a></span>
+He then took a Julep made of equal
+Parts of the Saline and Sperma Ceti Mixtures,
+which eased the Cough. The fourth Day the
+Pulse was soft, and the Swellings still in the
+same Situation, and the Breathing a little affected.
+A large Blister was applied to his Back,
+which discharged plentifully, relieved the
+Breathing, and lessened the Swellings considerably.
+The Cough and some Degree of
+Swelling still remained; but were removed
+by the Use of the Sperma Ceti Mixture with
+Oxymel, gentle Opiates, and some Doses of
+Physic.</p>
+
+<p>The second was a Man of the Twentieth
+Regiment of Foot, who had been some
+Months in the Hospital for a hectic Complaint;
+he was taken ill, the same Night as the
+Dragoon, with a Swelling of his whole Face,
+particularly the Lips, which had a shining watery
+Appearance, and a slight Degree of Redness,
+attended with a strong Fever; and was
+cured by Bleeding, Purging, the Use of the
+saline Medicines, and the Application of a
+Blister.<span class='pagenum'><a name="Page_248" id="Page_248">[248]</a></span></p>
+
+<p>The third was an Invalid, who had been admitted
+for a pleuritic Complaint, which he had
+got the better of. He was attacked, the second
+Night after the other two, with a shineing,
+watery, reddish Swelling, of his right
+Hand and Arm, up as far as the Joint of the
+Shoulder; four large watery Bladders likewise
+appeared on the fore Part of his Arm, above
+the Joint of the Elbow. Bleeding, with the
+cooling Medicines, and two Doses of Salts,
+carried off the Fever, and lessened the Swelling,
+in about seven Days Time; but a little of it,
+with a Stiffness, still remained; which at last
+was removed by the Use of aromatic Fomentations,
+rubbing with the <i>linimentum saponaceum</i>,
+and taking two Doses of Physic.</p>
+
+<p>Within less than a Fortnight, five or six
+more were seized with Swellings of the same
+Kind on some of the Extremities, and all got
+well by nearly the same Treatment; excepting
+one Man, who was in a very low State,
+and had a large deep Ulcer on his Hip, where
+there had been a Mortification from his lying
+on that Part in a Fever. The Swelling at first<span class='pagenum'><a name="Page_249" id="Page_249">[249]</a></span>
+seemed to give Way; but on the third or
+fourth Day, having got a severe Cough, the
+Swelling increased, and the Inflammation began
+to look livid, and the Discharge from the
+Sore to look bad; and, notwithstanding various
+Means were used, a Mortification of the Part
+came on, and he died the seventh Day.</p>
+
+
+
+<h2><a name="SCURVY" id="SCURVY"></a>OF THE<span class='pagenum'><a name="Page_250" id="Page_250">[250]</a></span><br />
+<span style="letter-spacing: 0.15ex; font-size: 130%">SCURVY.</span></h2>
+
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">T</span>he</span> true Scurvy, attended with spungy
+fetid Gums of a livid Colour, with livid
+Blotches, and Ulcers of the Legs, and other
+Symptoms, began to shew itself at <i>Bremen</i> in <i>January</i>
+1762; tho&#8217; we had not the least Appearance
+of this Disorder in the Hospitals at any
+other Place, while I was with the Troops in
+<i>Germany</i>.</p>
+
+<p>A great Variety of Disorders have been called
+by the Name of Scurvy: and the Disease has
+been divided into hot and cold; into the Acid,
+the Alcaline; and the Muriatic, according to the
+different Fancies of Authors, and the Causes
+they imagined it took its Rise from; but, from
+later and more accurate Observations, Dr. <i>Lind</i><span class='pagenum'><a name="Page_251" id="Page_251">[251]</a></span>
+has justly remarked, that the true Scurvy has
+been found to be the same in all the different
+Parts of the Globe, and to take its Rise from
+similar Causes; from Cold and Moisture, and
+living much upon salted Provisions, joined to
+a Want of fresh Vegetables, and of good generous
+fermented Liquors; and hence it is most
+frequent in low marshy Places in northern Climates,
+where there is a Scarcity of fresh Vegetables;
+and where the Inhabitants live much
+upon salted Provisions in Winter; and aboard of
+Ships in long Voyages or Cruizes, especially in
+the northern Seas; and hence this Disorder
+was so frequent at <i>Quebec</i> the first Winter it was
+in our Possession; and in some of the other Forts
+in <i>North America</i>, which were taken so late in
+the Year, that the Troops had not sufficient
+Time to lay in a Stock of Vegetables, and of
+fresh Meat to be preserved by the Frost<a name="FNanchor_106_106" id="FNanchor_106_106"></a><a href="#Footnote_106_106" class="fnanchor">[106]</a>; but
+were obliged to live mostly on Ship Provisions.</p>
+<p><span class='pagenum'><a name="Page_252" id="Page_252">[252]</a></span></p>
+<p>It is observed, both at Sea and Land, that
+where the Scurvy rages, those People are least
+subject to it who are well cloathed; who live
+in dry Habitations, or lie in dry Births; who
+take proper Exercise, without being too much
+exposed to the Inclemency of the Weather;
+and who live well, and drink good Beer, Cyder,
+or Wine; as has been remarked by Dr.
+<i>Pringle</i>, Dr. <i>Lind</i>, and others.</p>
+
+<p>At <i>Bremen</i> the Disorder was only observed
+among the Soldiers; not one of the Gentlemen
+belonging to the Hospital, or to the Commissariate,
+nor one of the military Officers, not
+even of the Serjeants, having the least Symptom
+of it. The Reason of its being frequent
+among the Soldiers was, that the Place is situated
+on a Plain naturally very damp; and the
+Soldiers were quartered in very low damp
+Houses; at the same Time, no Vegetables or
+<span class='pagenum'><a name="Page_253" id="Page_253">[253]</a></span>Greens were to be bought in the Market; and
+fresh Meat, and other fresh Provisions, were at
+so high a Price, that the Soldiers could not
+afford to buy them; but were obliged to live
+on salted Meat, and salted Herrings, during the
+Winter; and what little Money they had remaining,
+they laid out on spirituous Liquors,
+which were sold cheap.</p>
+
+<p>The Cure of this Disorder requires&mdash;living
+in a dry comfortable Place&mdash;good Cloathing&mdash;light
+Food of easy Digestion, such as good
+Bread, Panado, Milk, Whey, Broths made of
+fresh Meats&mdash;white Meats, with Greens, or
+other Vegetable, &amp;c.&mdash;the Use of Liquors of
+the acid or acescent Kind, or the moderate Use
+of Beer, Cyder, good Wine, or weak Punch<a name="FNanchor_107_107" id="FNanchor_107_107"></a><a href="#Footnote_107_107" class="fnanchor">[107]</a>&mdash;And,
+by Way of Medicine, gentle Purges,
+mild Diaphoretics; the free Use of acid or acescent
+Fruits, Lemons, Oranges, Apples, Pears,
+<span class='pagenum'><a name="Page_254" id="Page_254">[254]</a></span>Currans, Grapes, &amp;c. and of the antiscorbutic
+Plants and their Juices, as Succory, Endive,
+Water-Cresses, Scurvy-Grass<a name="FNanchor_108_108" id="FNanchor_108_108"></a><a href="#Footnote_108_108" class="fnanchor">[108]</a>, &amp;c. on which
+a great Part of the Cure principally depends;
+and the Use of some of the strengthening Bitters<a name="FNanchor_109_109" id="FNanchor_109_109"></a><a href="#Footnote_109_109" class="fnanchor">[109]</a>,
+of which the Bark is not the least efficacious.</p>
+
+<p>Bleeding is seldom requisite, except where
+there is much Heat or Fever; or a sharp Pain
+<span class='pagenum'><a name="Page_255" id="Page_255">[255]</a></span>of the Side, or Difficulty of Breathing, or some
+Symptom of the like Kind; it is then sometimes
+necessary to take away some Blood: And
+in obstinate Cases, it is often found of Use to
+promote Sweats, by making the Patient, while
+in Bed, drink freely of warm Whey, or Sack
+Whey, mixed with the scorbutic Juices; or
+warm Barley Water, or the like, mixed with a
+small Quantity of the Antimonial Wine, or some
+other mild Diaphoretic.</p>
+
+<p>And where the Patient is strong, and there
+is no Danger of H&aelig;morrhages, warm aromatic
+Baths have sometimes been found serviceable;
+but they are not to be used where the
+Patient is weak.</p>
+
+<p>The first Time I saw this Disorder at <i>Bremen</i>,
+was in an old Invalid, <i>James Long</i>, who
+had come from <i>Bristol</i> to <i>Embden</i>, and from
+thence to <i>Bremen</i>. He was some Weeks in the
+Hospital before I discovered his Disorder to be
+the Scurvy. He at first complained only of
+great Weakness, and such a Giddiness, when
+he got out of Bed, that he could not walk, and
+of what he called flying rheumatic Pains of his<span class='pagenum'><a name="Page_256" id="Page_256">[256]</a></span>
+Legs. He had no other visible Complaint; all
+which, I imagined, proceeded from Old-Age,
+and being worn out in the Service. At last,
+on the 25th of <i>January</i>, he complained of his
+Gums being sore; and, on examining him, I
+found his Breath fetid, his Gums swelled, soft,
+and spungy, his Legs covered with scorbutic
+Blotches, and other Symptoms, which evidently
+proved his Disorder to be the true
+Scurvy.</p>
+
+<p>Upon which, I ordered him a low Diet, with
+the Addition of Greens for Dinner, and a Quart
+of Lemonade, with a Gill of Brandy in it, <i>per</i>
+Day, for his common Drink; and, by Way of
+Medicine, a Decoction of the Bark, with the
+Elixir of Vitriol; and, at the same Time, ordered
+his Gums to be scarified, where they
+were most swelled and spungy; and to be
+washed frequently with an astringent Gargle;
+and to be rubbed now and then with burnt
+Alum<a name="FNanchor_110_110" id="FNanchor_110_110"></a><a href="#Footnote_110_110" class="fnanchor">[110]</a>. By these Means, in a Fortnight&#8217;s
+<span class='pagenum'><a name="Page_257" id="Page_257">[257]</a></span>Time, his Gums became firmer, and his scorbutic
+Symptoms decreased. During that Course
+he took cold, and had a Stitch in his Side, for
+which he was blooded. The Blood threw up
+a very thin Buff, which was not of a firm Consistence<a name="FNanchor_111_111" id="FNanchor_111_111"></a><a href="#Footnote_111_111" class="fnanchor">[111]</a>;
+the Crassamentum below was of
+<span class='pagenum'><a name="Page_258" id="Page_258">[258]</a></span>a blackish Colour and of a loose Texture, and
+the Serum in a large Proportion. By the 2d
+of <i>March</i> his Gums had recovered their natural
+Firmness and Texture, and the scorbutic
+Spots and Pains of the Legs were gone, and he
+had recovered his Strength; the only remaining
+Complaint was a little Swelling about the
+Ankles, for which he continued the same
+Course, and took a Dose or two of Physic.
+By the 16th of <i>March</i> all these Symptoms
+were gone, and he was dismissed the Hospital
+free from all Complaints. I saw him well the
+last Week in <i>May</i>; and he told me, he had
+had no scorbutic Symptom since he left the
+Hospital.</p>
+
+<p><span class='pagenum'><a name="Page_259" id="Page_259">[259]</a></span></p><p>In the Beginning of <i>February</i>, another of
+the Invalids, who had been in the Hospital for
+a Fever and rheumatic Complaints, had Blotches
+appear on his Legs, complained of great
+Weakness, and fainted away in attempting to
+walk; which made me suspect his Disorder
+to be the Scurvy; and, on examining him, I
+found his Gums soft and spongy, attended with
+the other Symptoms of the true Scurvy. I put
+him nearly on the same Course as in the last-mentioned
+Case: He used a low Diet, with the
+Addition of Greens for Dinner, which he eat
+with a little Butter and Vinegar; and he had
+a Quart of Lemonade, with two Ounces of
+Brandy, for his common Drink during the
+Day; and, by Way of Medicine, a Decoction
+of the Bark, with two Drachms of the <i>confectio
+cordiaca</i> to each Half Pint, which he took
+by Spoonfuls. Next Day he complained of a
+Pain in his Leg; and, on examining it more
+particularly, I found a large livid Blotch, yellow
+all round the Edges, on the fore Part,
+and a Tension all over that Leg. As he
+was so extremely low, as to be in Danger of<span class='pagenum'><a name="Page_260" id="Page_260">[260]</a></span>
+fainting whenever he sat up, I was afraid lest
+a Mortification should ensue; and therefore
+ordered his Leg to be bathed Morning and
+Evening with a warm aromatic Fomentation,
+and a Poultice of Theriaca to be applied after
+it; and desired him to take as much of the
+Decoction of the Bark with the Cordial as possible;
+and allowed him a Glass of Mountain
+Wine every two or three Hours. By the
+Continuance of this Course for some Weeks,
+the livid Blotches, Pain, and Stiffness of his
+Leg, and most of the other scorbutic Symptoms,
+went away; his Gums were restored to
+their natural Firmness; and he recovered his
+Strength so much as to be able to sit up all
+Day long; though he still remained very
+weak when he was sent to <i>England</i>, in
+<i>March</i>.</p>
+
+<p>In <i>February</i> and <i>March</i>, seven or eight more
+scorbutic Patients were sent to the Hospital I
+attended, who were all treated in the same
+Manner; and all did well. About the Middle
+of <i>February</i> this Distemper began to shew itself
+in the other Hospital attended by Dr. <i>Miller</i>,<span class='pagenum'><a name="Page_261" id="Page_261">[261]</a></span>
+who treated the Patients nearly in the same
+Way, and they all recovered.</p>
+
+<p>On the 5th of <i>April</i>, a young Man, belonging
+to the Eighth Regiment of Foot, came to
+the Hospital with all the Symptoms of the true
+Scurvy; his Gums were spungy and f&#339;tid; he
+had livid Blotches on his Legs, and Contractions
+of the Hams, and a Stiffness and Hardness
+in the Calves of both Legs<a name="FNanchor_112_112" id="FNanchor_112_112"></a><a href="#Footnote_112_112" class="fnanchor">[112]</a>. By following
+the same Course as the others, and the
+Use of frequent Fomentations, and rubbing the
+contracted Parts with soft Liniments, he mended
+daily; and, after taking a Dose or two of
+Physic, was dismissed perfectly recovered on
+the 10th of <i>May</i>. At his first Admission into
+the Hospital, he was taken with a severe Cough,
+<span class='pagenum'><a name="Page_262" id="Page_262">[262]</a></span>attended with Pain of the Breast, and a Spitting
+of Blood for a Day or two, for which he
+was blooded. His Blood threw up a little
+Buff; the Crassamentum was of a blackish Colour
+and of a loose Texture, with a good Proportion
+of a yellowish Serum. This Bleeding
+relieved the Complaints of his Breast, and he
+had no Return of them while he remained in
+the Hospital.</p>
+
+<p>The first Week in <i>May</i> four Invalids were
+admitted into the Hospital for this Disorder.
+The first had spungy Gums, a f&#339;tid Breath,
+his Legs swelled and hard, and of a deep purple
+Colour. The second was a Case at first of
+a more doubtful Kind; there were no spungy
+Gums, though an offensive Breath; his Ancles
+and Feet were swelled, attended with Pain and
+Uneasiness, and a great Weakness and Lassitude;
+but no Fever, nor any livid Blotches.
+The Swelling of the Feet and Ancles seemed
+at first Sight rather gouty or rheumatic, than of
+the scorbutic Kind; but from the Man&#8217;s Way
+of Life, and the Disorder being so frequent, we
+discovered it to be the Scurvy. The third had<span class='pagenum'><a name="Page_263" id="Page_263">[263]</a></span>
+a very f&#339;tid Breath and spungy Gums, livid
+Spots and fungous Ulcers<a name="FNanchor_113_113" id="FNanchor_113_113"></a><a href="#Footnote_113_113" class="fnanchor">[113]</a> on his Legs, with
+Pains and Weakness all over. The fourth had
+also spungy Gums and a f&#339;tid Breath, Pains of
+the Legs and Arms, livid Blotches on his Legs,
+great Hardness and Contraction of the right
+Ham, and a livid hard Swelling on the Outside
+of the left Thigh, immediately above the
+Knee.</p>
+
+<p>We treated them all four in the Method
+above-mentioned, adding a Mess of Greens to
+<span class='pagenum'><a name="Page_264" id="Page_264">[264]</a></span>Dinner, giving Lemonade for Drink, and the
+Bark, with Elixir of Vitriol, by Way of Medicine.
+The Parts that were hard and swelled,
+were fomented, and rubbed with soft Liniments,
+and Poultices were applied to the hard
+Swelling on the Outside of the left Thigh; and
+the Ulcers of the Legs dressed with Digestives,
+and occasionally washed with spirituous Tinctures,
+and touched with Escharotics. Before
+I left <i>Bremen</i>, the first Week in <i>June</i>, the first
+and second Patients were perfectly recovered,
+and the third and fourth almost well. All of
+them had had the Disorder some Months before
+they came to the Hospital.</p>
+
+<div class="footnotes"><h3>FOOTNOTES:</h3>
+
+<div class="footnote"><p><a name="Footnote_106_106" id="Footnote_106_106"></a><a href="#FNanchor_106_106"><span class="label">[106]</span></a> In <i>Quebec</i>, and other northern Parts of <i>North America</i>, as
+soon as the Frost sets in, they kill their Meat intended for their
+Winter Store, and hang it up: It soon freezes, and will keep
+in this Manner all through the Winter. They preserve Vegetables
+in the same Way; and when they intend to make Use of
+either, they put so much as they want into cold Water for some
+Time, which draws the Frost out of it; and then they boil or
+roast it, as they think proper.</p></div>
+
+<div class="footnote"><p><a name="Footnote_107_107" id="Footnote_107_107"></a><a href="#FNanchor_107_107"><span class="label">[107]</span></a> The free Use of raw Spirits is found to be very prejudicial;
+but a moderate Quantity of these Spirits, diluted with
+Water, and acidulated with Lemons or Oranges (or with Cream
+of Tartar, or Tamarinds, when the former cannot be got), and
+made into Punch, is found to be a good Antiscorbutic.</p></div>
+
+<div class="footnote"><p><a name="Footnote_108_108" id="Footnote_108_108"></a><a href="#FNanchor_108_108"><span class="label">[108]</span></a> Most ripe Fruits, particularly Lemons and Oranges, and
+esculent Herbs, and many Kinds of Roots, such as Horse-Radish,
+Onions, Leeks, and many others, have been found the most
+useful Remedies in the Cure of the Scurvy. Decoctions and
+Infusions of Fir-Tops, of Spruce, and of other Species of the
+Pine-Tree; and Beer made of these Infusions, by fermenting
+them with Molasses, are approved Antiscorbutics: and when
+such Remedies cannot be got, Infusions of the common Bitters,
+and weak Punch, made with Tamarinds or Cream of Tartar,
+have proved serviceable; and where these Acids cannot be had,
+the Mineral Acids may be used for acidulating the Drink.
+However, it ought always to be remembered, that fresh Vegetables
+and Fruits, and vegetable Acids, produce much better
+Effects in the Scurvy, than any other Sorts of Remedies; and
+ought always to be used, when they can be got.</p></div>
+
+<div class="footnote"><p><a name="Footnote_109_109" id="Footnote_109_109"></a><a href="#FNanchor_109_109"><span class="label">[109]</span></a> Most of the common Bitters have been strongly recommended
+in this Disorder, Gentian, Trifoil, Wormwood, &amp;c.&mdash;as
+likewise aromatic Bitters and Aromatics; such as <i>calamus
+aromaticus</i>, Carvi Seeds, Winters Bark, Cinnamon, and many
+others.</p></div>
+
+<div class="footnote"><p><a name="Footnote_110_110" id="Footnote_110_110"></a><a href="#FNanchor_110_110"><span class="label">[110]</span></a> Dr. <i>Lind</i>, who has wrote one of the best Treatises on this
+Disorder, and who had a great Deal of Practice himself, says,
+&#8220;When first the Patient complains of an Itching and a Spunginess
+of the Gums, with loose Teeth, either a Tincture of
+the Bark in Brandy, or aluminous Medicines, will be found
+serviceable in putting a Stop to the Beginning Laxity of
+these Parts.&#8221; When the Putrefaction increases, he recommends
+the Use of some of the mineral Acids. See his <i>Treatise
+on the Scurvy</i>, part ii. chap. v. p. 201.&mdash;<i>Van Swieten</i> says, he
+never found any Thing answer better than a Gargle made of
+four Ounces of Elder or Rose Water, acidulated with a Drachm
+of the Spirit of Sea Salt; and where the Gums were very putrid
+and gangrened, he has been obliged to touch them slightly
+with the pure Acid Spirit, and some Hours after to have them
+washed with the Gargle just mentioned. Vide <i>Comment.</i> vol. III.
+p. 629, sect. 1163.
+</p><p>
+If the Spunginess of the Gums sprout out into a luxuriant
+Fungus, it is sometimes requisite to cut such Funguses away,
+and to wash the Sores frequently with gentle astringent or acid
+Liquors.</p></div>
+
+<div class="footnote"><p><a name="Footnote_111_111" id="Footnote_111_111"></a><a href="#FNanchor_111_111"><span class="label">[111]</span></a> Dr. <i>Huxham</i> observes, that, after the Disease has continued
+some Time, the Blood appears a mere Gore as it were, not separating
+into Serum and Crassamentum as usual, but remaining
+an uniform half-coagulated Mass, generally of a more livid or
+darker Colour than common; though sometimes it continues
+long very florid; but it always putrifies soon. See his <i>Essay on
+Fevers</i>, chap. v.
+</p><p>
+There is something very particular in the Nature of this
+Disorder, according to an Observation of Dr. <i>Lind</i>&#8217;s; who
+says, &#8220;That the Scurvy is a Disease in its Nature very opposite
+to that of a Fever; insomuch, that even an Infection
+is long resisted by a scorbutic Habit; and those of a scorbutic
+Habit being seized with the Fever, was a Proof of its
+proceeding entirely from Infection.&#8221; See his <i>First Paper on
+Fevers</i>, p. 4.</p></div>
+
+<div class="footnote"><p><a name="Footnote_112_112" id="Footnote_112_112"></a><a href="#FNanchor_112_112"><span class="label">[112]</span></a> If the Swellings become large, stiff, and painful, Dr.
+<i>Lind</i> recommends that the Legs should be frequently bathed
+and fomented; or, what he has found preferable, to be exposed
+to their Steams, after being well covered with Blankets.
+After this Operation, he advises the Limb to be rubbed with
+some mild Oil, such as <i>oleum palm&aelig;</i>, or Salad Oil; and if the
+Swellings resist both the general Cure and these Applications,
+the Limbs to be sweated with Spirits. See his <i>Treatise on the
+Scurvy</i>, part ii, chap. v.</p></div>
+
+<div class="footnote"><p><a name="Footnote_113_113" id="Footnote_113_113"></a><a href="#FNanchor_113_113"><span class="label">[113]</span></a> &#8220;Ulcers on the Legs, or any other Part of the Body,
+require pretty much the same Treatment, <i>viz.</i> very gentle
+Compression, in order to keep under the Fungus, and such
+antiseptic Applications as have been recommended for putrid
+Gums, <i>viz. mel rosat.</i> acidulated with <i>spiritus vitrioli</i>,
+<i>ung. &AElig;giptiacum</i>, &amp;c. but nothing will avail where the Patient
+cannot have Vegetables and Fruits.&#8221; <i>Dr. Lind&#8217;s Treatise
+on Scurvy</i>, part ii. chap. v. p. 204. And he recommends,
+if the Swellings and Ulcers of the Legs neither yield to the general
+Cure nor to the Methods here proposed, that a slow and
+gentle Course of Mercury should be tried, after the scorbutic
+Taint is a good deal removed, and the Gums are sufficiently
+firm; and to give along with it a Decoction of the Woods, or
+of Sarsaparilla; but this Method ought not to be attempted till
+the Gums have acquired a proper Firmness. See <i>ibid.</i> part ii.
+chap. v.</p></div>
+</div>
+
+
+<h2><a name="ITCH" id="ITCH"></a>OF THE<span class='pagenum'><a name="Page_265" id="Page_265">[265]</a></span><br />
+<span style="letter-spacing: 0.15ex; font-size: 130%">ITCH.</span></h2>
+
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">T</span>here</span> was no Disorder so common in
+the military Hospitals as the Itch. It
+is of an infectious Nature, and now most commonly
+believed to be entirely owing to little
+Insects lodged in the Skin, which many Authors
+affirm they have seen in the Pustules by
+the Help of a Microscope; and that the Disorder
+is entirely communicated by Infection, and
+does not arise from any Fault in the Fluids or
+Solids.</p>
+
+<p>It has been found by Experience, that internal
+Medicines have little or no Effect in removing
+this Disorder; and that only external
+Remedies, which come immediately in contact
+with the Parts affected, are capable of making a<span class='pagenum'><a name="Page_266" id="Page_266">[266]</a></span>
+Cure; which has been brought as a farther
+Proof, that the Itch is owing to Animalcules or
+Insects; as it is alledged, that no Remedies will
+cure the Distemper, but such as are capable of
+killing them.</p>
+
+<p>The Medicines, which are most commonly
+used for the Cure, are <i>Mercury</i>, <i>White Helebore</i>,
+and <i>Sulphur</i>.</p>
+
+<p>Mercurial Frictions on the Part are often
+made use of, and sometimes with Success,
+though they are by no Means to be depended
+upon for a Cure; besides that, they are liable
+to throw the Patients into a Salivation, as I
+have seen happen more than once; for which
+Reasons I would never recommend this Method
+where the Patient labours under no other
+Disorder which requires the Use of Mercury,
+and would confine it entirely to Cases where
+Patients, having the Itch, labour, at the same
+Time, under the <i>Lues venerea</i>, and require the
+free Use of mercurial Frictions; under such
+Circumstances the mercurial Ointment may be
+as well rubbed on the Parts affected with the
+Itch as upon any other.<span class='pagenum'><a name="Page_267" id="Page_267">[267]</a></span></p>
+
+<p>The Powder of the Root of <i>White Helebore</i>,
+made up into an Ointment with Hogs Lard,
+or a strong Decoction of it in Water, rubbed
+on the Parts, will often cure the Itch; but it is
+a sharp Medicine, and generally smarts, and
+sometimes inflames the Parts on which it is
+rubbed; and therefore it is not so commonly
+used, as we know a much surer and milder
+Remedy. Though I have cured some People
+with the Helebore Lotion without any Inconvenience,
+who would not use the Sulphur on
+Account of its Smell.</p>
+
+<p><i>Sulphur</i> is the most certain and easy Cure
+for the Itch of any we know, and perhaps is
+more certain in the Cure of this Disorder than
+almost any other Medicine in any other Disorder
+whatever. We used it in Form of the
+Sulphur Ointment of the <i>London Dispensatory</i>,
+of which one, two, or more Drachms were
+rubbed in every Night, in Proportion to the
+Extent of the Parts affected. These Unctions
+were continued from four or five to ten or
+twelve Nights, according to the Violence and
+Continuance of the Disorder. Most were cured<span class='pagenum'><a name="Page_268" id="Page_268">[268]</a></span>
+in a few Days; others required a longer Time.
+As the sulphureous Unctions tend to obstruct
+the Perspiration, we generally ordered a Purge
+to be given before rubbing the Sulphur Ointment,
+and in full Habits sometimes ordered a
+little Blood to be taken away; and put them
+all under a low Diet. After the Disorder
+seemed to be removed, they took another Dose
+or two of Physic to carry off any Impurities
+that might have been thrown upon the Bowels,
+during the Use of the Sulphur Ointment. In
+inveterate Cases, the Sulphur was given internally
+at the same Time that the Patient rubbed
+with the Ointment.</p>
+
+<p>It is generally believed (though denied by
+some) that Sulphur, taken internally, enters the
+Blood; and its Steams are thrown off by the
+perspiratory Vessels, and assists more effectually
+to destroy the Insects and their Ovula, which
+give Rise to the Itch; but whether this Effect
+be true or not, I found it to answer another
+very good Purpose; which was to keep the
+Belly rather loose, while the Patient used the
+Unction; and by this Way it carried off those<span class='pagenum'><a name="Page_269" id="Page_269">[269]</a></span>
+Humours, which ought to have passed off by
+the Skin; and for that Reason, when it had
+not that Effect, we joined some Lenitive Electuary
+to it.</p>
+
+<p>There is one Thing to be observed with
+regard to sulphureous Unctions, which is, that
+we ought not to use them too soon with People
+recovering out of Fevers, or other Disorders
+which bring them low; otherwise there
+will be Danger of bringing on a Relapse, which
+I have often observed to happen in military
+Hospitals, where the Itch has appeared as the
+Patients were recovering from Fevers and other
+Disorders, and the Unctions were used too
+soon: But whether these Relapses were owing
+to the sulphureous Unction&#8217;s stopping up the
+Pores of the Skin, and obstructing a free Perspiration,
+or to the Patient&#8217;s being more apt to
+take Cold while they used the Sulphur Ointment,
+than at any other Time, is what I cannot
+determine; but to me it seems most probable,
+that these Unctions rather obstruct the
+Perspiration; and that when they are used too
+soon with People recovering from Fevers, especially<span class='pagenum'><a name="Page_270" id="Page_270">[270]</a></span>
+those of the putrid Kind, they prevent
+those Particles from passing off by the Skin,
+which it was necessary should be evacuated, in
+order to free the Body from the Seeds of the
+Fever, or other Disorders the Patients laboured
+under. But however this be, Experience has
+shewn, that we ought not to attempt the Cure
+of the Itch, in Patients so circumstanced, till
+their Strength be in a great Measure re-established,
+otherwise there will be Danger of a
+Relapse; and likewise, that Patients using Sulphur
+externally, ought to be particularly on
+their Guard against Cold.</p>
+
+<p>This Observation of Peoples being so apt to
+relapse after Fevers by the too early Use of sulphureous
+Unction, is a strong Proof of the Usefulness
+of keeping the Body open during the
+Time of Rubbing and of Purging the Patient
+afterwards; as by these Means we may carry
+off by the Bowels those Particles which could
+not pass by the Skin; and I think, so far as I
+have been able to observe, those People have
+been less subject to relapse into Fevers where
+this Caution has been used, than where it has
+been neglected.<span class='pagenum'><a name="Page_271" id="Page_271">[271]</a></span></p>
+
+<p>That Species of the Itch where it forms
+small Ulcers or Pustules in the Skin, is the
+worst Kind, and most contagious, and seems to
+take its Rise from the common Itch continuing
+long, and making its Way deeper into the
+Skin. The Cure is the same, only this requires
+more frequent Unctions, and those to be continued
+longer, than before the Disorder has taken
+such deep Root.</p>
+
+<p>It is no uncommon Thing to see the Itch
+appear again, some Weeks after it has seemingly
+been cured by the Use of sulphureous Unctions;
+which most commonly happened to those who
+were in too great a Hurry to get well, and left
+off the Use of the Unctions too soon. Such
+Returns of the Itch were generally cured by
+the Repetition of the same Treatment as before.<span class='pagenum'><a name="Page_272" id="Page_272">[272]</a></span></p>
+
+
+
+<h2><span style="letter-spacing: 0.15ex; font-size: 130%"><a name="TABLE_of_DIET" id="TABLE_of_DIET"></a>TABLE of DIET.</span><span class='pagenum'><a name="Page_273" id="Page_273">[273]</a></span></h2>
+
+
+<p class="negative">The following is a Copy of the Table of Diet
+which was used in the Hospital all the Time
+I was with the Troops in <i>Germany</i>:</p>
+
+<table summary="diet" class="diet">
+
+<tr><td>&nbsp;</td><td style="text-align: center"><i>Breakfast.</i></td><td style="text-align: center"><i>Dinner.</i></td><td style="text-align: center"><i>Supper.</i></td></tr>
+
+<tr><td style="width: 12%; border-right: solid black 1px">Full Diet,</td>
+<td style="width: 25%; border-right: solid black 1px">One Pint of Rice Gruel;
+made with two Ounces of
+Rice, one Spoonful of fine
+Flower, a little common
+Salt, and fine Sugar.</td>
+<td style="width: 25%;  border-right: solid black 1px">One Pound of Meat.</td>
+<td style="width: 25%">As Breakfast.</td></tr>
+
+<tr><td colspan="4" style="line-height: 1%; border-bottom: solid black 1px">&nbsp;</td></tr>
+<tr><td colspan="4" style="line-height: 1%">&nbsp;</td></tr>
+
+<tr><td style="width: 12%; border-right: solid black 1px">Middle Diet,</td>
+<td style="width: 25%; border-right: solid black 1px">As above.</td>
+<td style="width: 25%;  border-right: solid black 1px">One Pint of Broth, Half a Pound of Meat.</td>
+<td style="width: 25%">As above.</td></tr>
+
+<tr><td colspan="4" style="line-height: 1%; border-bottom: solid black 1px">&nbsp;</td></tr>
+<tr><td colspan="4" style="line-height: 1%">&nbsp;</td></tr>
+
+<tr><td style="width: 12%; border-right: solid black 1px">Low Diet,</td>
+
+<td style="width: 25%; border-right: solid black 1px">As above, or according to the Patient&#8217;s Stomach or Indisposition.</td>
+
+<td style="width: 25%;  border-right: solid black 1px">One Pint of Broth; or Half a Pint of Panado, with two Spoonfuls of Wine, and a
+Quarter of an Ounce of fine  Sugar.</td>
+
+<td style="width: 25%">As Breakfast.</td></tr>
+</table>
+
+<p>The daily Allowance of Bread was a Pound<span class='pagenum'><a name="Page_274" id="Page_274">[274]</a></span>
+to those on full and middle Diet, and Half a
+Pound to those on low Diet, or a Pound, if so
+ordered by the Physician.</p>
+
+<p>Those on full and middle Diet were allowed
+daily three Pints of Barley or Rice Water;
+to each Pint of which were added two Spoonfuls
+of Brandy, and a Quarter of an Ounce of
+Lump Sugar. Small Beer was mentioned in
+the Diet Table; but this we could never have
+good; and therefore was not used.</p>
+
+<p>Those on low Diet were allowed Barley or
+Rice Water; to which some Wine or Brandy
+was occasionally added, if ordered so by the
+Physician.</p>
+
+<p>Besides this, the Physician might order an
+additional Quantity of Wine, Brandy, or Milk,
+or Water Gruel, or any other Articles which
+he thought proper for the Sick under his Care,
+and which could be got easily.</p>
+
+
+
+<h1 style="padding-top: 2em"><a name="PHARMACOPOEIA" id="PHARMACOPOEIA"></a>PHARMACOP&#338;IA<span class='pagenum'><a name="Page_275" id="Page_275">[275]</a></span><br />
+
+<span style="font-size: 60%">IN USUM</span><br /><br />
+
+Nosocomii Regii Militaris<br />
+Britanici.<br /><br />
+
+<span style="font-size: 50%">MDCCLXI.</span><span class='pagenum'><a name="Page_276" id="Page_276">[276]</a></span></h1>
+
+
+
+<h2><a name="PHARMA" id="PHARMA"></a><span style="font-size: 130%; letter-spacing: 0.15ex">PHARMACOP&#338;IA</span><span class='pagenum'><a name="Page_277" id="Page_277">[277]</a></span><br />
+
+IN USUM<br />
+
+Nosocomii Regii Militaris.<br />
+
+Ann. <span class="smcap">Mdcclxi.</span></h2>
+
+
+<h3>AQU&AElig; SIMPLICES ET SPIRITUOS&AElig;.</h3>
+
+<div class="blockquot">
+<p class="newchapter"><span class="firstword"><span class="dropcap">A</span>qua</span> Alexeteria.<br />
+&mdash;&mdash; Bacc. Juniperi.<br />
+&mdash;&mdash; Cinnamomi.<br />
+<span style="padding-left: 2.4em">&mdash;&mdash; Menth&aelig; vulgaris.</span><br />
+<span style="padding-left: 2.4em">&mdash;&mdash; Menth&aelig; piperitidis.</span><br />
+<span style="padding-left: 2.4em">&mdash;&mdash; Nucis moschat&aelig;.</span><br />
+<span style="padding-left: 2.4em">&mdash;&mdash; Pulegii.</span><br />
+<span style="padding-left: 2.4em">&mdash;&mdash; Rut&aelig;.</span><br />
+</p>
+</div>
+
+<div class="blockquot">
+<p>Vel ali&aelig; aqu&aelig; hujus generis pr&aelig;parari possint,
+terendo in mortario vitreo elaeosacchara
+pr&aelig;parata, cum oleis essentialibus, et sacchari
+albi 12<sub>la</sub> quantitate; et dein addendo aqu&aelig;<span class='pagenum'><a name="Page_278" id="Page_278">[278]</a></span>
+fontan&aelig; vel spiritus vini tenuis quantitatem sufficientem<a name="FNanchor_114_114" id="FNanchor_114_114"></a><a href="#Footnote_114_114" class="fnanchor">[114]</a>.</p>
+</div>
+
+<p class="recipe">Aqua calcis simp. Ph. Lond.</p>
+
+<div class="blockquot"><p>Dosis a lib. i. ad lib. ij. in die.</p></div>
+
+<p class="recipe">Aqua Hordeata. Ph. Lond.</p>
+
+<div class="blockquot"><p>Utenda pro potu.</p></div>
+
+
+<h3>BOLUS.</h3>
+
+<p class="recipe">Bolus anodynus astringens.</p>
+
+<div class="blockquot"><p>&#8478; Theriac&aelig; andromachi, drachm. dimid.
+opii, gr. i.&nbsp;M. pro dosi semel vel bis die.</p></div>
+
+<p class="recipe">Bolus e rheo cum mercurio.</p>
+
+<div class="blockquot"><p>&#8478; Pulv. rhei, gr. xxv. calomel, gr. v. syrup
+sacchari, q.&nbsp;s.</p></div>
+
+<p class="recipe">Bolus e calomel.</p>
+
+<div class="blockquot"><p>&#8478; Calomel gr. v. conserv. rosar. scrup. i.&nbsp;M.</p></div>
+
+<p class="recipe">Bolus mercurialis.<span class='pagenum'><a name="Page_279" id="Page_279">[279]</a></span></p>
+
+<div class="blockquot"><p>&#8478; Argenti vivi, gr. x. extingue in balsam
+copaivi, q.&nbsp;s. et adde conserv. rosar. q.&nbsp;s.</p></div>
+
+<p class="recipe">Bolus e scordio cum rheo.</p>
+
+<div class="blockquot"><p>&#8478; Elect. e scordio, scrup. i. pulv. Rhei, gr.
+x. syrup, q.&nbsp;s. ut fiat bolus sumendus semel,
+bis, terve die.</p></div>
+
+
+<h3>COLLYRIA.</h3>
+
+<p class="recipe">Collyrium saturninum.</p>
+
+<div class="blockquot"><p>&#8478; Sacchari saturni, salis ammoniaci crudi
+ana gr. vi. solve in aq. fontan&aelig;, unc. xij. adde
+pro re nata tinct. thebaic&aelig;, drachm. i.</p></div>
+
+<p class="recipe">Collyrium vitriolicum.</p>
+
+<div class="blockquot"><p>&#8478; Vitrioli albi, drachm. ss. solve in aq. fontan&aelig;,
+lib. i.</p></div>
+
+<div class="blockquot"><p>Confectio cardiaca. Ph. Lond.</p>
+
+<p>Conserva cynosbat. Ph. Lond.</p>
+
+<p>Conserva rosar. Ph. Lond.<span class='pagenum'><a name="Page_280" id="Page_280">[280]</a></span></p></div>
+
+
+<h3>DECOCTA.</h3>
+
+<p class="recipe">Decoctum album. Ph. Lond. utendum pro potu.</p>
+
+<p class="recipe">Decoctum arabicum.</p>
+
+<div class="blockquot"><p>&#8478; Gum. arabici, unc. dimid. coque in aq.
+hordeat&aelig; bullientis, lib. ij. ad solutionem Gummi.
+utend. pro potu.&mdash;addi possit pro re nata
+spirit. nitri dulcis, drachm. ij.</p></div>
+
+<p class="recipe">Dococtum corticis Peruviani.</p>
+
+<div class="blockquot"><p>&#8478; Cort. Peruv. crass. pulv. unc. i. coque in
+aq. fontan. lib. iij. ad lib. ij. Colatur&aelig; adde
+tinct. cort. Peruv. unc. i. spirit vini Gallici sescunc.
+Dosis ab uncia i. ad unc. iv. bis ter.
+quaterve die.</p></div>
+
+<p class="recipe">Decoctum cort. cum serpentaria.</p>
+
+<div class="blockquot"><p>Fit addendo decocto cort. Peruv. sub sinem
+coctionis, rad. serpentari&aelig; virgin. contus.
+unc. dimid. Dosis ab unc. i. ad unc. iij. ter quaterve
+die.</p></div>
+
+<p class="recipe">Decoct. commun. pro clyster.</p>
+
+<div class="blockquot"><p>&#8478; Flor. vel herb. cham&aelig;mel. unc. i. coque
+in aq. fontan. lib. i.ss. ad lib. i. &amp; cola.<span class='pagenum'><a name="Page_281" id="Page_281">[281]</a></span></p>
+</div>
+
+<p class="recipe">Decoctum ligni guaiaci.</p>
+
+<div class="blockquot"><p>&#8478; Ligni guaiaci ras. lib. ss. aq. fontan&aelig; bullientis,
+cong. ij. macera per noctem; mane
+coque ad congium. i. &amp; cola; Capiat a lib. ss.
+ad lib. ij. die.</p></div>
+
+<p class="recipe">Decoctum nitrosum.</p>
+
+<div class="blockquot"><p>&#8478; Coccinel. scrupul. i. coque in aq. fontan.
+lib. ijss. ad lib. ij. &amp; dein adde salis nitri,
+unc. i. sacchar. albi sescunc. Colatur&aelig; addi
+possit pro re nata aq. alicujus spirit. unc.
+ij. Dosis ab unc. i. ad unc. iv. 4<sup>tis</sup> vel 6<sup>tis</sup>
+horis.</p></div>
+
+<p class="recipe">Decoctum pectorale.</p>
+
+<div class="blockquot"><p>&#8478; Fol. herb. malv&aelig;, unc. ij. feminum lini,
+unc. dimid. coque in aq. fontan. lib. ivss. ad
+lib. iv. addendo sub finem coctionis rad glycyrrhiz
+sescunc. vel mellis optimi, unc. i. Cola pro
+potu.&mdash;Adde pro re nata aceti, sescunc.</p></div>
+
+<p class="recipe">Decoctum rad. sarsaparill&aelig;.</p>
+
+<div class="blockquot"><p>&#8478; Rad. sarsaparill&aelig;, unc. iij. coque in aq.
+fontan. lib. iij. ad lib. ij. adde sub finem coctionis
+ligni sasafras, drachm. i. rad. glycyrrhiz&aelig;,<span class='pagenum'><a name="Page_282" id="Page_282">[282]</a></span>
+drachm. ij. Colatur&aelig; capiat a lib. i. ad lib. ij.
+in die.&mdash;Adde pro re nata vini antimonialis,
+drachm. ij.</p></div>
+
+
+<h3>ELECTARIA.</h3>
+
+<p class="recipe">Elect. astringens balsamicum.</p>
+
+<div class="blockquot"><p>&#8478; Specier. e scordio, pulv. e tragacanth.
+comp. ana unc. i. tinctur&aelig; thebaic&aelig;, drachm.
+ij. syrup sacchari, q.&nbsp;s. ut fiat elect. Dosis ad
+molem N.&nbsp;M. bis, ter. quaterve in die.</p></div>
+
+<p class="recipe">Elect. corticis Peruviani.</p>
+
+<div class="blockquot"><p>&#8478; Pulv. cort. Peruv. unc. iv. syrup sacchari,
+q.&nbsp;s. Dosis a scrup. i. ad drachm. unam, bis,
+ter, 4<sup>r</sup>. 6<sup>ties</sup>. vel decies die.</p></div>
+
+<p class="recipe">Elect. corticis anodynum.</p>
+
+<div class="blockquot"><p>&#8478; Elect. cort. Peruv. unc. 1<sup>nam</sup>. elect. e
+scordio unciam dimidiam, vel tinct. thebaic&aelig;
+scrup. ij.</p></div>
+
+<p class="recipe">Elect. corticis astringens.</p>
+
+<div class="blockquot"><p>&#8478; Elect. cort. Peruv. semunc. pulv. rad.
+tormentil, lapidis cancror. pp<sup>t</sup>. singulorum,
+drachm. i. syrup, q.&nbsp;s.<span class='pagenum'><a name="Page_283" id="Page_283">[283]</a></span></p></div>
+
+<p class="recipe">Elect. cort. cum serpentaria.</p>
+
+<div class="blockquot"><p>&#8478; Elect. cort. Peruv. unc. i. pulv. rad. serpentar.
+virgin. cort. canel. alb. ana, drachm ij.
+syrup. q.&nbsp;s.</p></div>
+
+<p class="recipe">Elect. cort. cum sale ammoniac.</p>
+
+<div class="blockquot"><p>&#8478; Elect. cort. Peruv. sescunciam. sal. ammon.
+crud. drachm. i.</p></div>
+
+<p class="recipe">Elect. e baccis lauri. Ph. Lond.</p>
+
+<p class="recipe">Elect. lenitiv. Ph. Lond.</p>
+
+<p class="recipe">Elect. lenitivum cum sulphure.</p>
+
+<div class="blockquot"><p>&#8478; Elect. lenitiv. lib. ss. flor. sulphuris, unc.
+ij. Dosis, moles, N.&nbsp;M. vel ad semunc. pro
+re nata.</p></div>
+
+<p class="recipe">Elect. lenitivum compositum.</p>
+
+<div class="blockquot"><p>&#8478; Elect. lenitiv. lib. i. pulv. jalap. unc. i.
+sal. nitri, drachm. ij. syrup. q.&nbsp;s. Dosis a drach.
+i. ad drach. iv. pro r.&nbsp;n.</p></div>
+
+<p class="recipe">Elect. lenitivum balsamicum.</p>
+
+<div class="blockquot"><p>&#8478; Elect. lenitiv. comp. unc. ij. bals. copaiv.
+unc. i. gum guaiac. unc. ss. M. Dosis, cochleare
+the&aelig;, h.&nbsp;s. vel mane &amp; vesperi.<span class='pagenum'><a name="Page_284" id="Page_284">[284]</a></span></p></div>
+
+<p class="recipe">Electuar. e scordio vel diascordium. Ph. Lond.</p>
+
+<p class="recipe">Elect. e spermat. ceti.</p>
+
+<div class="blockquot"><p>&#8478; Balsam Peruv. unc. i<sup>m</sup>. misce optime
+cum mucilag. gum arab. sescunciam &amp; adde
+spermat. ceti, conserv. rosar. ana unc. xij. syrup
+sacchar. q.&nbsp;s. dosis, a dimidi&acirc; drachma bis
+die ad drachm. i<sup>m</sup>. quater vel sexties die.</p></div>
+
+<p class="recipe">Elect. stomachicum.</p>
+
+<div class="blockquot"><p>&#8478; Conserv. cynosbat. unc. iv. pulv. rad. zinziber.
+drachm. ij. canell. alb. unc. i. rubigin.
+martis, drachm. ij. syrup. q.&nbsp;s. dosis a scrup. i.
+bis terve die ad semidrach. 4<sup>tis</sup> horis.</p></div>
+
+<p class="recipe">Elect. e scammon. Ph. Lond.</p>
+
+
+<h3>ELIXIR.</h3>
+
+<p class="recipe">Elix. aloes. Ph. Lond.</p>
+
+<p class="recipe">Elix. paregoricum. Ph. Lond.</p>
+
+<p class="recipe">Elix. vitrioli acid. Ph. Lond.<span class='pagenum'><a name="Page_285" id="Page_285">[285]</a></span></p>
+
+
+<h3>ENEMATA.</h3>
+
+<p class="recipe">Enema commune laxativ.</p>
+
+<div class="blockquot"><p>&#8478; Aq. fontan. calid. unc. xij. elect. lenitiv.
+semunc. sal. cathartici amari, unc. i.&nbsp;M.</p></div>
+
+<p class="recipe">Enema commun. oleos.</p>
+
+<div class="blockquot"><p>&#8478; Aq. fontan. bullient. unc. x. mucilag. gum
+arabic. unc. i<sup>m</sup>. olei olivar. unc. ij. adde pro re
+nata elect. e scord. drachm. ij. vel. tinct. thebaic.
+drachm. i.</p></div>
+
+<p class="recipe">Enema ex amylo.</p>
+
+<div class="blockquot"><p>&#8478; Aq. fontan. calid. unc. iv. gelatin. amyli,
+unc. v. elect. e scord. drachm. i.&nbsp;M.</p></div>
+
+<p class="recipe">Enema terebinth.</p>
+
+<div class="blockquot"><p>&#8478; Terebinth commun. drachm. vi. solve in
+vitello ovi &amp; adde enemat. oleos. unc. x.</p></div>
+
+<p class="recipe">Emplastrum vesicatorium. Ph. Lond.</p>
+
+
+<h3>FOTUS.</h3>
+
+<p class="recipe">Fotus communis.</p>
+
+<div class="blockquot"><p>&#8478; Fol. malv. flor. cham&aelig;mel. singulorum,
+m.&nbsp;i. coque in aq. fontan. q.&nbsp;s.<span class='pagenum'><a name="Page_286" id="Page_286">[286]</a></span></p></div>
+
+<p class="recipe">Fotus commun. spirit.</p>
+
+<div class="blockquot"><p>&#8478; Fotus commun. lib. ij. aceti, lib. i. spirit.
+vini tenuis, lib. ss. M. pro fotu.</p></div>
+
+<p class="recipe">Fotus cum sale ammoniac.</p>
+
+<div class="blockquot"><p>&#8478; Fotus commun. lib. ij. sal ammoniac crud.
+unc. i.</p></div>
+
+<p class="recipe">Fotus volatilis.</p>
+
+<div class="blockquot"><p>&#8478; Fotus commun. q.&nbsp;s. asperge panno statim
+ante applicationem spiritus sal. ammoniac,
+q.&nbsp;s.</p></div>
+
+
+<h3>GARGARISMATA.</h3>
+
+<p class="recipe">Gargarisma commune.</p>
+
+<div class="blockquot"><p>&#8478; Aq. hordeat. unc. xij. sal. nitri, drachm. i.
+mellis semunc. M. adde pro re nata spirit. vin.
+unciam i.</p></div>
+
+<p class="recipe">Gargarisma acidum.</p>
+
+<div class="blockquot"><p>&#8478; Aq. hordeat. unc. xij. spirit. vini gallici,
+unc. i. aceti sescunc. tinct. myrrh&aelig;, drachm. ij.
+M.</p></div>
+
+<p class="recipe">Gargarisma volatile.</p>
+
+<div class="blockquot"><p>&#8478; Aq. hordeat. unc. xij. spirit. vin gallic.
+unc. ij. sal. vol. ammoniaci, drachm. i.&nbsp;M.<span class='pagenum'><a name="Page_287" id="Page_287">[287]</a></span></p></div>
+
+
+<h3>GUTT&AElig; ANTIMONIALES ANODYN&AElig;.</h3>
+
+<div class="blockquot"><p>&#8478; Vini antimonialis, unc. i<sub>m</sub> tinct. thebaic.
+drachm. ij. dosis a gutt. 30 ad 40 bis terve die,
+vel a gutt. 60 ad 140, h.&nbsp;s. in potu tepido.</p></div>
+
+
+<h3>HAUSTUS.</h3>
+
+<p class="recipe">Haustus simplex.</p>
+
+<div class="blockquot"><p>&#8478; Aq. fontan. sescunc. spirit. vini gallici
+drachm. i. ss. sacchar alb. drachm. dimidiam
+M.&mdash;Haustus pr&aelig;parari possit aqua aliqua simp.
+et spirit. loco aq fontan. &amp; spirit. vini gallici
+pro re nata.</p></div>
+
+<p class="recipe">Haustus anodynus.</p>
+
+<div class="blockquot"><p>&#8478; Haust. simp. sescunc. tinct. thebaic. gutt.
+xx. M.</p></div>
+
+<p class="recipe">Haustus camphoratus.</p>
+
+<div class="blockquot"><p>&#8478; Camphor&aelig;, gr. iij. tere in mortario cum
+sacchar. alb. drach. dimid. &amp; dein adde mucilag.
+gum arabici, drachm. ij. haust. simp. sescunciam.
+M.&nbsp;s. a. Dosis repetenda, 4<sup>ta</sup> vel 6<sup>ta</sup>. quaque
+hora.<span class='pagenum'><a name="Page_288" id="Page_288">[288]</a></span></p></div>
+
+<p class="recipe">Haust. emetic. antimonialis.</p>
+
+<div class="blockquot"><p>&#8478; Vini antimonialis semunciam. Dari possit
+ad drachm. x. pro r.&nbsp;n.</p></div>
+
+<p class="recipe">Haust. emeticus scilliticus.</p>
+
+<div class="blockquot"><p>&#8478; Oxymel. scillit. drachm. x. aq. fontan.
+semunc. pulv. rad. ipecacoan. gr. vi.</p></div>
+
+<p class="recipe">Haustus cardiacus.</p>
+
+<div class="blockquot"><p>&#8478; Haust. simp. sescunciam confect. cardiac.
+scrup. i<sup>m</sup>. M.&nbsp;f. haustus repetendus 4<sup>tis</sup>. vel 6<sup>tis</sup>.
+horis&mdash;adde pro re nata sp. lavend. comp. dr. i.</p></div>
+
+<p class="recipe">Haustus cardiacus oleosus.</p>
+
+<div class="blockquot"><p>&#8478; Ol. essential. menth. gutt. ij. tere in mortario
+vitreo cum sacchar. alb. drachm. dimid. &amp;
+adde haust. simplicis sescunc. tinct. stomachic.
+drachm. i.&nbsp;M.&mdash;adde pro re nata tinctur. thebaic.
+gutt. x.</p></div>
+
+<p class="recipe">Haustus lixiviosus anodynus.</p>
+
+<div class="blockquot"><p>&#8478; Haust. simp. sescunciam, lixivii tartari,
+drachmam dimidiam tinctur&aelig; thebaic&aelig;, gutt.
+xx. cap. h.&nbsp;s. vel mane &amp; vesperi.<span class='pagenum'><a name="Page_289" id="Page_289">[289]</a></span></p></div>
+
+<p class="recipe">Haustus e mithridatio.</p>
+
+<div class="blockquot"><p>&#8478; Haust. simp. sescunc. mithridat. scrup. i.
+aceti vin. drachm. iij. dosis repetenda 4<sup>tis</sup>. vel
+6<sup>tis</sup>. horis.</p></div>
+
+<p class="recipe">Haustus oleosus communis.</p>
+
+<div class="blockquot"><p>&#8478; Mucilagin. gum arabici, drachm, iv. ol.
+olivar, drachm. v. misce s.&nbsp;a. &amp; adde haust.
+simp. sescunciam. Repet. 4<sup>tis</sup>. vel 6<sup>tis</sup>. horis.</p></div>
+
+<p class="recipe">Haustus oleosus cum rheo.</p>
+
+<div class="blockquot"><p>&#8478; Haust. oleos. communis, unc. ij. tinct.
+rhei sescunc. vel pulv. rhei, gr. xxv. tinct. thebaic.
+gutt. xv. M. fiat haustus sumendus vel h.&nbsp;s.
+vel primo mane.</p></div>
+
+<p class="recipe">Haustus purgans.</p>
+
+<div class="blockquot"><p>&#8478; Infus. sen&aelig;. unc. iij. sal. glauber. drachm.
+iij. spirit. vin. gallici, drachm. ij. sacchar. alb.
+drachm. dimid. capiat mane.</p></div>
+
+<p class="recipe">Haustus salinus communis.</p>
+
+<div class="blockquot"><p>&#8478; Aceti vinosi vel succ. limonum semunciam,
+sal. absynth. scrup. i. vel ad saturationem, haust.
+simp. sescunciam adde pro re nata pulv. contrayerv.<span class='pagenum'><a name="Page_290" id="Page_290">[290]</a></span>
+comp. scrup. i. vel pulv. contrayerv. cum
+nitro, scrup. ij.&mdash;Haustus pr&aelig;parari possit cum
+salis diuretici drachma dimid. loco acidi &amp; salis
+absynthii. Dosis repetend. 3<sup>tiis</sup>. 4<sup>tis</sup>. vel 6<sup>tis</sup>.
+horis&mdash;Eodem modo sit haustus cum spirit.
+mindereri uncia dimidi&acirc;.</p></div>
+
+<p class="recipe">Haust. salin. cum confect. cardiaca.</p>
+
+<div class="blockquot"><p>&#8478; Haust. salin. commun. unc. ij. confect.
+cardiac. scrup. i.&nbsp;M. repet. 4<sup>tis</sup>. vel 6<sup>tis</sup>. horis.</p></div>
+
+<p class="recipe">Haust. salin. cum mithridatio.</p>
+
+<div class="blockquot"><p>&#8478; Haust. salin. commun. unc. ij. mithridatii,
+scrup. i.&nbsp;M. sumend. 4<sup>tis</sup>. vel 6<sup>tis</sup>. horis.</p></div>
+
+<p class="recipe">Haustus salin. cum rheo.</p>
+
+<div class="blockquot"><p>&#8478; Haust. salin. com. uncias ij. pulv. rhei, gr.
+xxv. M. capiat mane.</p></div>
+
+<p class="recipe">Haustus salin. cum phu.</p>
+
+<div class="blockquot"><p>&#8478; Haust. salin. commun. unc. ij. pulv. rad.
+valerian. sylvestris, scrup. ij. Dosis repetend.
+2<sup>dis</sup>. 4<sup>tis</sup>. vel 6<sup>tis</sup>. horis.</p></div>
+
+<p class="recipe">Haust. salinus succinatus.</p>
+
+<div class="blockquot"><p>&#8478; Haust. salin. commun. unc. ij. sal succini,<span class='pagenum'><a name="Page_291" id="Page_291">[291]</a></span>
+pulv. castorei singulorum, gr. x.&nbsp;H. repetend.
+4<sup>tis</sup>. vel 6<sup>tis</sup>. horis.</p></div>
+
+<p class="recipe">Haust. salinus purg. oleosus.</p>
+
+<div class="blockquot"><p>&#8478; Mann&aelig; op<sup>t</sup>. semunc. olei olivar. drachm.
+vi. vitelli ovi q.&nbsp;s. tere in mortario, addendo
+paulatim sal cathartici amari, unc. i. solutam in
+aq. fontan. calid. unc. iij. spirit. vini gallici vel
+aq. alicujus spirituos&aelig;, drachm. iij. M.&nbsp;s. a pro
+dosi matutino.</p></div>
+
+<p class="recipe">Haustus volatilis.</p>
+
+<div class="blockquot"><p>&#8478; Haust. simp. sescunciam sal. vol. c. cervi,
+gr. x.&nbsp;M. H. repet. 4<sup>tis</sup>. vel 6<sup>tis</sup>. horis.</p></div>
+
+
+<h3>INFUSA.</h3>
+
+<div class="blockquot"><p>Infusum amarum. Ph. Lond. Addi possit pro
+re nata in pr&aelig;parando spirit. vini tenuis, lib. ss.
+ad lib. ij. infusi. Dosis ab unc. i<sup>na</sup>. bis die ad
+unc. ij. ter. die.</p></div>
+
+<p class="recipe">Infusum raphani rusticani.</p>
+
+<div class="blockquot"><p>&#8478; Rad. raphani rusticani, unc. ij. baccar.
+juniper, unc. i<sup>nam</sup>. cort. canell. alb. drachm. ij.<span class='pagenum'><a name="Page_292" id="Page_292">[292]</a></span>
+aq. fontan. bullient, lib. iv. infunde per noctem
+leni calore. Colatur&aelig; adde spirit. vini gallici
+unc. iv. Dosis ab. unc. i. bis terve die ad unc.
+iv. 6<sup>tis</sup>. horis.</p></div>
+
+<p class="recipe">Infusum sen&aelig; commun. Ph. Lond.</p>
+
+
+<h3>JULEPUM E MOSCHO.</h3>
+
+<div class="blockquot"><p>&#8478; Mosch. drachmam i<sup>m</sup>. tere optime in
+mortario cum sacchar. alb. drachm. iij. &amp; adde
+mucilagin. gum arab. dr. iv. Haust. simp.
+unc. vi. Dosis unc. ij. 4<sup>tis</sup>. vel 6<sup>tis</sup>. horis.</p></div>
+
+
+<h3>LINCTUS.</h3>
+
+<div class="blockquot"><p>&#8478; Conserv. cynosbat. unc. iv. ol. olivar. syrup.
+sacchari vel mellis ana unc. ij. adde pro re nata
+spirit. vitrioli tenuis, drachm. iv. Dosis cochleare
+the&aelig; urgente tussi.</p></div>
+
+
+<h3>LINIMENTA.</h3>
+
+<p class="recipe">Liniment. saponaceum. Ph. Lond.<span class='pagenum'><a name="Page_293" id="Page_293">[293]</a></span></p>
+
+<p class="recipe">Linimentum camphoratum.</p>
+
+<div class="blockquot"><p>&#8478; Olei olivar. unc. ij. camphor&aelig;, drachm.
+ij. M.</p></div>
+
+<p class="recipe">Linimentum volatile. Ph. Lond.</p>
+
+<p class="recipe">Linimentum volatile commune.</p>
+
+<div class="blockquot"><p>&#8478; Olei olivar. unc. iij. spiritus salis ammoniaci,
+dr. vi. M.</p></div>
+
+
+<h3>MELLA.</h3>
+
+<p class="recipe">Mel cum borace.</p>
+
+<div class="blockquot"><p>&#8478; Mellis optimi, unc. i. pulv. subtilissim.
+boracis, dr. i.&nbsp;M.</p></div>
+
+<p class="recipe">Mel &AElig;gyptiacum. Ph. Lond.</p>
+
+<p class="recipe">Mel rosaceum. Ph. Lond.</p>
+
+<p class="recipe">MITHRIDATIUM. Ph. Lond.</p>
+
+
+<h3>MIXTUR&AElig;.</h3>
+
+<p class="recipe">Mixtura acida communis.</p>
+
+<div class="blockquot"><p>&#8478; Haust. simp. unc: viij. spirit. vitrioli tenuis,
+scrup. ij. vel ad gratam aciditatem. Dosis
+ab. unc. ij. ad unc iv. 4<sup>tis</sup>. vel 6<sup>tis</sup>. horis.<span class='pagenum'><a name="Page_294" id="Page_294">[294]</a></span></p></div>
+
+<p class="recipe">Mixtura ammoniaca.</p>
+
+<div class="blockquot"><p>&#8478; Gum ammoniaci, drachm. i. solve in
+haust. simp. unc. vi. Dosis ab. unc. i. ad unc.
+ij. bis terve in die.</p></div>
+
+<p class="recipe">Mixtura ammon. cum oxymel.</p>
+
+<div class="blockquot"><p>&#8478; Mixt. ammoniac. unc. vi. oxymel scillit.
+drachm. vi. Dosis a cochlear. i. ad unc. ii. ter.
+4<sup>rve</sup>. die.</p></div>
+
+<p class="recipe">Mixtura ammoniac. anodyna.</p>
+
+<div class="blockquot"><p>&#8478; Mixt. ammoniac. cum oxymel. unc. vi.
+tinct. thebaic. drachm. dimid. Dosis a cochlear.
+i. ad iv. 4<sup>tis</sup>. vel 6<sup>tis</sup>. horis.</p></div>
+
+<p class="recipe">Mixtura Campechensis.</p>
+
+<div class="blockquot"><p>&#8478; Extract. ligni Campechensis, drachm. iij.
+solve in haust. simplic. unc. vi. adde pro re nata
+tinct. thebaic. gutt. xxx. vel Philon. Londinen.
+drachm. i. Dosis ab. unc. i. ad unc. iij. bis,
+ter, 4<sup>rve</sup>. die.</p></div>
+
+<p class="recipe">Mixtura f&aelig;tida.</p>
+
+<div class="blockquot"><p>&#8478; G. asaf&aelig;tid. drachm. i. solve in haust.
+simp. unc. vi. Dosis ab. unc. i. ad unc. iij.
+4<sup>r</sup>. die.<span class='pagenum'><a name="Page_295" id="Page_295">[295]</a></span></p></div>
+
+<p class="recipe">Mixtura f&aelig;tida volatilis.</p>
+
+<div class="blockquot"><p>&#8478; Mixt. f&aelig;tid. unc. vi. spirit. volat. sal.
+ammon. drachm. i. Dosis ab. unc. i. ad unc.
+ij. bis, ter, 4<sup>rve</sup>. die.</p></div>
+
+<p class="recipe">Mixtura fracastorii.</p>
+
+<div class="blockquot"><p>&#8478; Haust. simp. unc. viij. Elect. e scordio,
+drachm. iv. Dosis ab. unc. i. ad unc. ij. 4<sup>tis</sup>.
+vel 6<sup>tis</sup>. horis.</p></div>
+
+<p class="recipe">Mixtura japonica.</p>
+
+<div class="blockquot"><p>&#8478; Haust. simp. unc. vi. Tinct. japonic.
+unc. i. adde pro re nata tinct. thebaic. dr. i.</p></div>
+
+<p class="recipe">Mixtura laxativa.</p>
+
+<div class="blockquot"><p>&#8478; Elect. lenitiv. unc. i. Mann&aelig; semunc.
+coque in aq fontan. unc. xvi. ad unc. xij. Colatur&aelig;
+adde sal. cathartici amari. sescunciam.
+spirit. vini gallici, unc. i. Dosis ab. unc. ij. ad
+unc. xij.</p></div>
+
+<p class="recipe">Mixtura purg. antimonial.</p>
+
+<div class="blockquot"><p>&#8478; Elect. lenitiv. sescunc. mann&aelig; semunc.
+coque in aq. fontan. unc. xx. ad unc. xvi. &amp;
+dein solve tartar. emetici, gr. x. Colatur&aelig; dosis
+ab. unc. i. ad unc. iv. omni hora vel omni<span class='pagenum'><a name="Page_296" id="Page_296">[296]</a></span>
+2<sup>da</sup>. vel 3<sup>tia</sup>. vel 4<sup>ta</sup>. hora, donec laxetur
+alvus.</p></div>
+
+<p class="recipe">Mixtura oleosa volatilis.</p>
+
+<div class="blockquot"><p>&#8478; Haust. simp. unc. vi. ol. olivar. unc. iij. spirit.
+volatil. salis ammoniaci drachmam i<sup>nam</sup>. M.
+Dosis ab. unc. i. ad unc. iij. 3<sup>tiis</sup>. vel 4<sup>tis</sup>.
+horis.</p></div>
+
+<p class="recipe">Mixtura scillitica.</p>
+
+<div class="blockquot"><p>&#8478; Haust. simp. unc. vi. oxymel scillitic.
+drachm. vi. Dosis a drachm. iv. ad unc. ij.
+bis, ter, 4<sup>rve</sup>. die.</p></div>
+
+<p class="recipe">Mixtura e spermat. ceti.</p>
+
+<div class="blockquot"><p>&#8478; Spermat. ceti, drachm. ij. solve in vitello
+ovi &amp; adde haust. simp. unc. vi. adde, pro re
+nata, tinct. thebaic. scrup. ij. Dosis ab. unc. i.
+ad unc. ij. 4<sup>tis</sup>. vel 6<sup>tis</sup>. horis.</p></div>
+
+<p class="recipe">Mixtura e spermat. ceti cum balsamo.</p>
+
+<div class="blockquot"><p>&#8478; Balsam. copaiv. drachm. ij. tere in mortario
+cum mucilag. gum arabici, drachm. iij. &amp;
+dein adde mixtur. e spermat. ceti, unc. vi. Dosis
+ab. unc. i. ad unc. iij. 4<sup>tis</sup>. vel 6<sup>tis</sup>. horis.<span class='pagenum'><a name="Page_297" id="Page_297">[297]</a></span></p></div>
+
+
+<h3>MUCILAGO. G. ARABICI.</h3>
+
+<div class="blockquot"><p>&#8478; G. arabici pulv. unc. iv. solve in aq. pur&aelig;
+bullient. unc. x.</p></div>
+
+<p class="recipe">Oxymel scillit. Ph. Lond.</p>
+
+<p class="recipe">Philonium Londinen. Ph. Lond.</p>
+
+
+<h3>PILUL&AElig;.</h3>
+
+<p class="recipe">Pilul&aelig; f&aelig;tid&aelig;.</p>
+
+<div class="blockquot"><p>&#8478; Gum asaf&aelig;tid. myrrh. ana drachm. i. sapon.
+alb. hispan. drachm. ij. Tinct. fuliginis q.&nbsp;s.
+Dosis a gr. x. ad drachm. dimid. bis terve die.</p></div>
+
+<p class="recipe">Pilul&aelig; guaiac.</p>
+
+<div class="blockquot"><p>&#8478; Sapon. albi hispanici semunc. gum guaiac,
+scrup. iv. syrup. q.&nbsp;s. Dosis a scrup. i. ad
+drachmam dimidiam bis terve die.</p></div>
+
+<p class="recipe">Pilul&aelig; gummos&aelig;. Ph. Lond.</p>
+
+<p class="recipe">Pilul&aelig; mercuriales.</p>
+
+<div class="blockquot"><p>&#8478; Argenti vivi semunc. extingue in balsam.
+copaiv. q.&nbsp;s. &amp; adde pulv. glycyrrhiz. gum<span class='pagenum'><a name="Page_298" id="Page_298">[298]</a></span>
+guaiac. singulorum, drachm. vi. syrup. q.&nbsp;s. ut
+fiat massa. Dosis a scrup. ss. ad drachmam
+dimidiam semel vel bis die.</p></div>
+
+<p class="recipe">Pilul&aelig; rufi. Ph. Lond.</p>
+
+<p class="recipe">Pilul&aelig; saponace&aelig;. Ph. Lond.</p>
+
+<p class="recipe">Pilul&aelig; saponace&aelig; cum rheo.</p>
+
+<div class="blockquot"><p>&#8478; Sapon. alb. hispanici, drachm. vi. pulv.
+rhei, drachm. ij. syrup. sacchari q.&nbsp;s. Dosis a
+scrup. i. ad scrup. ij. bis terve die.</p></div>
+
+<p class="recipe">Pilul&aelig; scillitic&aelig;.</p>
+
+<div class="blockquot"><p>&#8478; Pulv. glycyrhiz. rad. scill. exsiccat ana
+drachm. dimid. rad. zinziber. drachm. i. sapon.
+alb. hispan. drachm. ij. syrup. q.&nbsp;s. Dosis a
+gr. iv. ad. gr. xvi. bis terve die.</p></div>
+
+<p class="recipe">Pilul&aelig; stomachic&aelig;.</p>
+
+<div class="blockquot"><p>&#8478; Pulv. canell. alb. drachm. ij. extract. rad.
+gentian. dr. i. mucilag. gum arabici q.&nbsp;s. Dosis
+a scrup. i. ad drachmam dimid. bis die&mdash;adde
+pro re nata rubigin. martis drachmam
+dimid.<span class='pagenum'><a name="Page_299" id="Page_299">[299]</a></span></p></div>
+
+
+<h3>PULVERES.</h3>
+
+<p class="recipe">Pulvis astringens.</p>
+
+<div class="blockquot"><p>&#8478; Pulv. canell. alb. rad. tormentill. singulorum,
+drachm. i.&nbsp;M. Dosis a scrup. i. ad
+drachm. i.</p></div>
+
+<p class="recipe">Pulvis aluminosus.</p>
+
+<div class="blockquot"><p>&#8478; Alumin. crud. terr&aelig; japonic&aelig; ana partes
+&aelig;quales dosis a gr. viij. ad drachmam dimidiam.</p></div>
+
+<p class="recipe">Pulv. anodynus Doveri.</p>
+
+<div class="blockquot"><p>&#8478; Sal. nitri, tartari vitriolati singulorum, unc.
+iv. in crucibulum candens injice, agitetur donec
+deflagratio &amp; scintillatio desinat, &amp; adde opii
+concisi, unc. i. &amp; in pulverem redige addendo
+rad. glycyrrhiz. ipecacoanh&aelig; subtilissime pulver.
+ana, unc. i. &amp; dein probe misceantur omnia.
+Dosis a gr. x. ad scrup. ij. vel ad drachmam
+1<sup>nam</sup>.</p></div>
+
+<p class="recipe">Pulvis antimonialis.</p>
+
+<div class="blockquot"><p>&#8478; Pulv. e chel. cancror. drachm. x. tartari
+emetici, dr. i.&nbsp;M. fiat pulv. subtilissimus. Dosis
+a gr. iij. ad gr. x. 4<sup>ta</sup>. vel 6<sup>ta</sup>. quaque hora.<span class='pagenum'><a name="Page_300" id="Page_300">[300]</a></span></p></div>
+
+<p class="recipe">Pulvis cardiacus.</p>
+
+<div class="blockquot"><p>&#8478; Pulv. canell. alb. drachm. i. rad. zedoari&aelig;,
+drachm. ij. rad. serpentar. drachm. i.&nbsp;M. dosis
+a scrup. i. ad drachm. i. 4<sup>tis</sup>. vel 6<sup>tis</sup>. horis.</p></div>
+
+<p class="recipe">Pulvis cham&aelig;melinus.</p>
+
+<div class="blockquot"><p>&#8478; Pulv. flor. cham&aelig;mel. drachm. iij. aluminis,
+g. myrrh. ana drachm. i. Dosis a scrup.
+i. ad scrup. ij.</p></div>
+
+<p class="recipe">Pulv. contrayerv. comp. Ph. Lond.</p>
+
+<p class="recipe">Pulv. contrayerv. cum nitro.</p>
+
+<div class="blockquot"><p>&#8478; Pulv. contrayerv. comp. unc. iv. salis nitri,
+drachm. i.&nbsp;M. Dosis a scrup. i. ad drachm. i.
+4<sup>tis</sup>. vel 6<sup>tis</sup>. horis.</p></div>
+
+<p class="recipe">Pulvis emeticus.</p>
+
+<div class="blockquot"><p>&#8478; Pulv. ipecacoanh&aelig;, scrup. i. tartar emetici,
+gr. ij. Dosis a gr. xi. ad gr. xxii.</p></div>
+
+<p class="recipe">Hiera picra. Ph. Lond.</p>
+
+<p class="recipe">Pulv. Ipecacuanh&aelig; cum opio.</p>
+
+<div class="blockquot"><p>&#8478; Pulv. rad. ipecacoan. gr. x. opii, gr. ij.
+dosis a gr. iij. ad gr. xij.<span class='pagenum'><a name="Page_301" id="Page_301">[301]</a></span></p>
+</div>
+
+<p class="recipe">Pulv. e jalapio.</p>
+
+<div class="blockquot"><p>&#8478; Pulv. rad. jalapii, drachm. vi. rad. zinzib.
+drachm. ij. Dosis a scrup. i. ad scrup. ij.</p></div>
+
+<p class="recipe">Pulv. jalapii cum nitro.</p>
+
+<div class="blockquot"><p>&#8478; Pulv. rad. jalap. drachm. iv. salis nitri
+drachm. i<sup>m</sup>. Dosis a scrup. i. ad scrup. ij.</p></div>
+
+<div class="blockquot"><p>Magnesia alba.</p></div>
+
+<p class="recipe">Pulv. nitrosus.</p>
+
+<div class="blockquot"><p>&#8478; Pulv. e chel. cancror. drachm. iij. nitri,
+drachm. i.&nbsp;M. Dosis a scrup. i. ad scrup. ij.
+vel ad drachmam. i.</p></div>
+
+<p class="recipe">Pulv. nitrosus camphoratus.</p>
+
+<div class="blockquot"><p>&#8478; Pulv. nitros, scrup. ij. camphor&aelig;, gr. v.
+M. Dosis a scrup. i. ad scrup. ij.</p></div>
+
+<p class="recipe">Pulv. nitrosus cum gum guaiac.</p>
+
+<div class="blockquot"><p>&#8478; Sal. nitri, drachm. ij. gum guaiac. drachm.
+dimid. Dosis a gr. v. ad drachm. dimid.</p></div>
+
+<p class="recipe">Pulv. plummeri.</p>
+
+<div class="blockquot"><p>&#8478; Calomel, sulph. aurat antimonii ana dr. ij.<span class='pagenum'><a name="Page_302" id="Page_302">[302]</a></span>
+tere in mortario ut fiat pulv. subtilissimus.
+Dosis a gr. ij. ad gr. x. vel ad scrup. i<sup>m</sup>.</p></div>
+
+<p class="recipe">Pulvis stanni. Ph. Lond.</p>
+
+<p class="recipe">Pulv. e spermat. ceti cum nitro.</p>
+
+<div class="blockquot"><p>&#8478; Spermat. ceti, drachm. ij. sacchar. albi
+sal. nitri ana unc. i<sup>m</sup>. Dosis a scrup. dimid. ad
+drachmam i.</p></div>
+
+<p class="recipe">Pulv. e tragacanth. Ph. Lond.</p>
+
+
+<h3>SALES ACIDI.</h3>
+
+<table class="salts" summary="sales acidi">
+<tr><td>&nbsp;</td><td>&nbsp;</td><td style="text-align: center; line-height: 200%" colspan="2">PR&AElig;PARATIONES.</td></tr>
+
+<tr><td rowspan="4" style="width: 5%; border-right: solid black 1px">Acida mineralis</td><td style="width: 10%; padding-left: 1em; border-right: solid black 1px">Spir. vitrioli fortis</td><td style="width: 8%; border-right: solid black 1px">&nbsp;</td><td rowspan="4" style="width: 5%; padding-left: 1em">&AElig;ther.</td></tr>
+<tr><td style="padding-left: 1em; border-right: solid black 1px; width: 10%">&mdash;&mdash;&mdash;&mdash;&nbsp; tenuis</td><td style="padding-left: 1em; border-right: solid black 1px; width: 8%">Spir. vitrioli dulcis</td></tr>
+<tr><td style="padding-left: 1em; border-right: solid black 1px; width: 10%">Spiritus nitri</td><td style="padding-left: 1em; border-right: solid black 1px; width: 8%">Spir. nitri dulcis</td></tr>
+<tr><td style="padding-left: 1em; border-right: solid black 1px; width: 10%">Spir. salis marini</td><td style="padding-left: 1em; border-right: solid black 1px; width: 8%">Spir. salis dulcis.</td></tr>
+<tr><td colspan="4" style="line-height: 100%">&nbsp;</td></tr>
+<tr><td rowspan="4" style="width: 5%">Varietat. acid. vegit.</td>
+<td colspan="3" style="padding-left: 1em; border-left: solid black 1px">Acetum.</td></tr>
+<tr><td colspan="3" style="padding-left: 1em; border-left: solid black 1px">Spiritus aceti vel acetum distillatum.</td></tr>
+<tr><td colspan="3" style="padding-left: 1em; border-left: solid black 1px">Succus limonum.</td></tr>
+<tr><td colspan="3" style="padding-left: 1em; border-left: solid black 1px">Chrystalli tartari.</td></tr>
+<tr><td colspan="4" style="line-height: 100%">&nbsp;</td></tr>
+<tr><td rowspan="2" style="width: 5%">Acid. anomal.</td>
+<td colspan="3" style="padding-left: 1em; border-left: solid black 1px">Sal. succini.</td></tr>
+<tr><td colspan="3" style="padding-left: 1em; border-left: solid black 1px">Sal. sedativus Hombergeri.</td></tr>
+</table>
+
+
+<h3>SALES ALCALINI.<span class='pagenum'><a name="Page_303" id="Page_303">[303]</a></span></h3>
+
+<table class="salts" style="width: 60%">
+
+<tr><td rowspan="2" style="width: 19%; border-right: solid black 1px">Alcal. vegit.</td>
+<td style="padding-left: 1em">Sal. absynthii.</td></tr>
+<tr><td style="padding-left: 1em">Sal. tartari.</td></tr>
+<tr><td colspan="2" style="line-height: 100%">&nbsp;</td></tr>
+
+<tr><td style="width: 19%; border-right: solid black 1px">Alcal. min.</td>
+<td style="padding-left: 1em">Sal. alcali mineral. seu soda, seu natrum.</td></tr>
+<tr><td colspan="2" style="line-height: 100%">&nbsp;</td></tr>
+
+<tr><td rowspan="2" style="width: 19%; border-right: solid black 1px">Alcal. vol.</td>
+<td style="padding-left: 1em">Sal. volatilis c. cervi.</td></tr>
+<tr><td style="padding-left: 1em">Sal. volatilis sal. ammoniaci.</td></tr>
+</table>
+
+
+<h3>SALES NEUTRI.</h3>
+
+<p><span class="smcap">Sales Neutri</span>, qui fiunt ex <span class="smcap">Alcali</span> et <span class="smcap">Acido</span>.</p>
+
+<table summary="sales neutri" style="width: 70%; margin-bottom: 1em">
+<tr><td>&nbsp;</td><td>Tartarus vitriol.</td><td style="border-right: solid black 1px; border-left: solid black 1px; width: 20%; padding-left: 1em">vegetab.</td><td rowspan="3" style="padding-left: 1em">vitrioli.</td><td>&nbsp;</td></tr>
+<tr><td>&nbsp;</td><td>Sal. glauberi</td><td style="border-right: solid black 1px; border-left: solid black 1px; width: 20%; padding-left: 1em">minerali</td><td>&nbsp;</td></tr>
+<tr><td>&nbsp;</td><td>Sal. am. vitrioli</td><td style="border-right: solid black 1px; border-left: solid black 1px; width: 20%; padding-left: 1em">volatili</td><td>&nbsp;</td></tr>
+
+<tr><td colspan="5" style="line-height: 100%">&nbsp;</td></tr>
+
+<tr><td>&nbsp;</td><td>Sal. nit. com.</td><td style="border-right: solid black 1px; border-left: solid black 1px; width: 20%; padding-left: 1em">vegetab.</td><td rowspan="3" style="padding-left: 1em">nitri.</td><td>&nbsp;</td></tr>
+<tr><td>&nbsp;</td><td>Nit. cubicum</td><td style="border-right: solid black 1px; border-left: solid black 1px; width: 20%; padding-left: 1em">mineral.</td><td>&nbsp;</td></tr>
+<tr><td>&nbsp;</td><td>Sal. am. nitrosum</td><td style="border-right: solid black 1px; border-left: solid black 1px; width: 20%; padding-left: 1em">volatili.</td><td>&nbsp;</td></tr>
+
+<tr><td colspan="5" style="line-height: 100%">&nbsp;</td></tr>
+
+<tr><td>&nbsp;</td><td>Sal. digest. sylvii</td><td style="border-right: solid black 1px; border-left: solid black 1px; width: 20%; padding-left: 1em">vegetabil.</td>
+<td rowspan="3" style="padding-left: 1em">Sal. marini.</td><td>&nbsp;</td></tr>
+<tr><td>&nbsp;</td><td>&mdash;&mdash; marin. com.</td><td style="border-right: solid black 1px; border-left: solid black 1px; width: 20%; padding-left: 1em">minerali</td><td>&nbsp;</td></tr>
+<tr><td>&nbsp;</td><td>&mdash;&mdash; ammon. com.</td><td style="border-right: solid black 1px; border-left: solid black 1px; width: 20%; padding-left: 1em">volatili</td><td>&nbsp;</td></tr>
+
+<tr><td colspan="5" style="line-height: 100%">&nbsp;</td></tr>
+
+<tr><td rowspan="5" style="width: 20%; border-right: solid black 1px">Varietates salis neutri comp. ex alcal. &amp; acid. vegitab.</td>
+<td style="padding-left: 1em">Sal. diureticus</td><td style="border-right: solid black 1px; border-left: solid black 1px; width: 25%; padding-left: 1em">vegetab.</td><td style="padding-left: 1em">aceti.</td>
+<td rowspan="5" style="width: 5%; border-left: solid black 1px; padding-left: 1em">Vegetabil.</td></tr>
+<tr><td style="padding-left: 1em">Tartar. tartar.</td><td style="border-right: solid black 1px; border-left: solid black 1px; width: 25%; padding-left: 1em">veget. tartari</td><td style="padding-left: 1em; width: 20%">chryst. tartar.</td></tr>
+<tr><td style="padding-left: 1em">Sal. citratus com.</td><td style="border-right: solid black 1px; border-left: solid black 1px; width: 25%; padding-left: 1em">veget. absynth.</td><td style="padding-left: 1em">succ. limonum.</td></tr>
+<tr><td style="padding-left: 1em">Sal. de seignette</td><td style="border-right: solid black 1px; border-left: solid black 1px; width: 25%; padding-left: 1em">minerali</td><td style="padding-left: 1em">chryst. tartar.</td></tr>
+<tr><td style="padding-left: 1em">Spir. mindereri.</td><td style="border-right: solid black 1px; border-left: solid black 1px; width: 25%; padding-left: 1em">volatili</td><td style="padding-left: 1em">acet. distillat.</td></tr>
+</table>
+
+<p>Hi omnes sales neutri pr&aelig;parari possint<span class='pagenum'><a name="Page_304" id="Page_304">[304]</a></span>
+pro usu medico admiscendo Alcali &amp;
+acidum ad saturationem; alii vero in crystallos
+redacti, s.&nbsp;a. commodius circumferuntur
+pro usu militari; alii ut <i>sal. citratus comm.</i>
+et <i>spiritus mindereri</i> facilius pr&aelig;parantur ad
+miscendo alcali &amp; acidum ad saturationem pro
+re nata<a name="FNanchor_115_115" id="FNanchor_115_115"></a><a href="#Footnote_115_115" class="fnanchor">[115]</a>.</p>
+
+
+<p class="recipe">Solutio mercurii corrosivi sublimati.</p>
+
+<div class="blockquot"><p>&#8478; Mercur. corrosiv. sublimat. gr. vi. spir.
+vini gallici, unc. xii. M. fiat solutio. Dosis a
+semunc ad unc. i. die.</p></div>
+
+<p class="recipe">Species aromatic&aelig;. Ph. Lond.<br />
+&mdash;&mdash; e scordio. Ph. Lond.</p>
+
+<p class="recipe">Tartar. emetic. Ph. Lond.</p>
+
+<p class="recipe">Theriaca andromachi. Ph. Lond.
+<span class='pagenum'><a name="Page_305" id="Page_305">[305]</a></span></p>
+
+<h3>TINCTUR&AElig;.</h3>
+
+<table summary="tinctur�" style="width: 35%">
+<tr><td>Tinctura amara.</td><td rowspan="10" style="border-left: solid black 1px; padding-left: 1em">Pharm. Lond.</td></tr>
+<tr><td>&mdash;&mdash;&mdash; corticis Puruv.</td></tr>
+<tr><td>&mdash;&mdash;&mdash; martis in sp. sal.</td></tr>
+<tr><td>&mdash;&mdash;&mdash; japonica.</td></tr>
+<tr><td>&mdash;&mdash;&mdash; melampodii.</td></tr>
+<tr><td>&mdash;&mdash;&mdash; myrrh&aelig;.</td></tr>
+<tr><td>&mdash;&mdash;&mdash; sacra.</td></tr>
+<tr><td>&mdash;&mdash;&mdash; saturnina.</td></tr>
+<tr><td>&mdash;&mdash;&mdash; serpentari&aelig;.</td></tr>
+<tr><td>&mdash;&mdash;&mdash; thebaica.</td></tr>
+</table>
+
+<p class="recipe">Tinctura rhei.</p>
+
+<div class="blockquot"><p>&#8478; Pulv. rad. rhei, unc. ij. semin. cardamom
+minor. decortic. semunc. vini alb. hisp. lib. ij.
+sp. vini gallici, unc. viij. digere sine calore &amp;
+cola. Dosis ab. unc. i. ad unc. iij.</p></div>
+
+<p class="recipe">Tinctura stomachica.</p>
+
+<div class="blockquot"><p>&#8478; Cort. canell. alb. semunc. cort. aurantior.
+unc. i. semin. cardam. minor. decort. drachm.
+ij. spirit. vini gallici lib. ij. digere sine calore &amp;
+cola. Dosis a semunc ad unc. i. bis terve die.&mdash;Adde
+pro re nata vin alb. hisp. lib. i.<span class='pagenum'><a name="Page_306" id="Page_306">[306]</a></span></p></div>
+
+
+<h3>UNGUENTA.</h3>
+
+<p class="recipe">Unguenta c&aelig;rulea vel mercurial. Ph. Lond.</p>
+
+<p class="recipe">Unguentum sulphuratum. Ph. Lond.</p>
+
+
+<h3>VINA.</h3>
+
+<table summary="vina" style="width: 30%">
+<tr><td>Vinum amarum.</td><td rowspan="3" style="border-left: solid black 1px; padding-left: 1em; width: 45%">Pharm. Lond.</td></tr>
+<tr><td>&mdash;&mdash;&nbsp;&nbsp; antimoniale.</td></tr>
+<tr><td>&mdash;&mdash;&nbsp;&nbsp; chalybeatum.</td></tr>
+</table>
+
+
+<h3>VITRUM CERATUM ANTIMONII.</h3>
+
+<div class="footnotes"><h3>FOOTNOTES:</h3>
+
+<div class="footnote"><p><a name="Footnote_114_114" id="Footnote_114_114"></a><a href="#FNanchor_114_114"><span class="label">[114]</span></a> Such <i>Elaeosacchara</i> (as they are called), made by rubbing
+the essential Oils with twelve Times the Quantity of Sugar,
+may at all Times be prepared at the fixed Hospital, and
+carried about with the flying Hospital, much more conveniently
+than the simple or compound Waters themselves.</p></div>
+
+<div class="footnote"><p><a name="Footnote_115_115" id="Footnote_115_115"></a><a href="#FNanchor_115_115"><span class="label">[115]</span></a> This Table of neutral Salts is nearly the same as one I
+have seen, which was said to be a Copy of that given yearly
+by Dr. <i>Cullen</i>, Professor of Chymistry in the University of <i>Edinburgh</i>,
+to his Pupils; and as that published by Dr. <i>Vogel</i>, in
+his <i>Institutiones Chymi&aelig;</i>, sect. 629. These neutral Salts are
+likewise taken Notice of by <i>Macquer</i>, in his <i>Elemens de Chymie</i>,
+and other late chymical Authors.</p></div>
+</div>
+
+
+<h1 style="padding-top: 2em"><a name="ESSAY" id="ESSAY"></a><span style="font-size: 60%">AN</span><span class='pagenum'><a name="Page_307" id="Page_307">[307]</a></span><br />
+<span style="letter-spacing: 0.15ex">ESSAY</span><br />
+<span style="font-size: 60%">ON THE</span><br />
+<span class="smcap">Means</span> of Preserving the Health of <span class="smcap">Soldiers</span><br />
+<span style="font-size: 60%">on <span class="smcap">Service</span>.</span><br />
+<span style="font-size: 60%">AND</span><br />
+<span style="font-size: 60%">Conducting <span class="smcap">Military Hospitals</span>.</span><span class='pagenum'><a name="Page_308" id="Page_308">[308]</a></span></h1>
+
+
+
+<h2><a name="MILITARY" id="MILITARY"></a><small>OF THE</small><span class='pagenum'><a name="Page_309" id="Page_309">[309]</a></span><br />
+Means of Preserving the Health<br />
+of Soldiers on Service.</h2>
+
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">T</span>he</span> Life of <i>British</i> Soldiers on Service,
+in Time of War, is so very different
+from what they lead in Time of Peace, as to
+subject them to many Inconveniences and Diseases.</p>
+
+<p>In Time of Peace, Soldiers are quartered
+either in Towns or Garrisons, where they are
+under the Eye of their Officers, who take Care
+that they keep themselves clean, and provided
+with Necessaries; they lie either in private
+Houses or in Barracks, where they have a good
+Bed, regular Meals of wholesome Provisions,
+and enjoy most of the other Necessaries of<span class='pagenum'><a name="Page_310" id="Page_310">[310]</a></span>
+Life in common with the lower Class of People,
+their Duty is easy, they mount Guard but seldom,
+and in other Nights enjoy an undisturbed
+Rest.</p>
+
+<p>Whereas, during the Time of an active Campaign,
+they are seldom in Houses; they lie in
+Tents upon the Ground, which is often bare,
+and at best covered only with Straw and a
+Blanket; and sometimes they are obliged, after
+fatiguing Marches in wet Weather, to lie
+on the bare Ground, without even a Tent to
+cover them; they must stand Centinel, and be
+upon Pikets and other Out-Posts in the Night,
+during all Kinds of Weather; besides performing
+long fatiguing Marches, and other military
+Duties; and when near an Enemy, they are
+perhaps on Duty every second or third Night,
+besides working Parties, and other Duties of
+Fatigue; and what Rest they have is interrupted
+by frequent Alarms. They have often
+but little Time or Convenience to make themselves
+clean. Provisions are sometimes scarce,
+and frequently on long Marches they have no
+Opportunity of dressing what they can get:<span class='pagenum'><a name="Page_311" id="Page_311">[311]</a></span>
+Water is sometimes difficult to be come at, and
+what is to be got, is bad. And it frequently
+happens, that neither Beer, Wine, nor Spirits,
+can be purchased for Money. In fixed Camps,
+they are often exposed to the putrid Effluvia
+of dead Bodies, of dead Horses, and other Animals,
+and of the Privies and Dung of the
+Horses<a name="FNanchor_116_116" id="FNanchor_116_116"></a><a href="#Footnote_116_116" class="fnanchor">[116]</a>; and, in some Encampments, likewise
+to the unwholesome Vapours of marshy
+Ground, and of corrupt stagnating Water: All
+which, joined to the other Hardships and Inconveniences
+unavoidably attending a military
+Life in Time of Service, often give Rise to numerous
+Diseases, which weaken an Army in a
+most surprising Manner; and therefore Commanders
+ought to use every Means in their
+<span class='pagenum'><a name="Page_312" id="Page_312">[312]</a></span>Power, consistent with the necessary military
+Operations, to preserve the Health of the Soldiers.</p>
+
+<p>Diseases are more or less frequent in Armies
+according as the Season is hot or cold, wet or
+dry; according to the Nature of the Climate,
+and the Time of the Year in which military
+Operations are carried on; the Nature of the
+Ground on which the Army is encamped, or
+the Situation of the Towns or Villages in which
+they are cantonned; the Cleanness, Neatness,
+and Dryness of the Camp, and of the Tents
+or Houses in which the Soldiers are lodged;
+according as the Men are supplied with Provisions,
+and good Water, good Beer, Wine, or
+other fermented Liquors; or are well cloathed,
+and well furnished with Straw and Blankets; in
+proportion as the Duty is more or less severe;
+and to the Care taken of such as are attacked
+with Sickness.</p>
+
+<p>Soldiers generally enjoy good Health in cold
+dry Weather, even during the Time of severe
+Frost; if they be kept in Exercise, be well
+cloathed, and well supplied with Provisions and<span class='pagenum'><a name="Page_313" id="Page_313">[313]</a></span>
+good Liquors, and with Wood; as the Troops,
+both in <i>Germany</i> and <i>North America</i>, experienced
+during the late War; but Cold joined to
+Moisture was observed always to be productive
+of Diseases.</p>
+
+<p>Nor is mere Heat of itself such an Enemy
+to Health<a name="FNanchor_117_117" id="FNanchor_117_117"></a><a href="#Footnote_117_117" class="fnanchor">[117]</a> as is generally apprehended; but
+when joined to Moisture, is observed to give
+Rise to the most fatal Disorders in the warm
+Climates.</p>
+
+<p>In our northern Climates the Winters are
+cold, and the Weather variable; sometimes it
+is cold and rainy, at other Times thick and
+foggy; sometimes we have fair Weather and
+Sunshine, at other Times Frost and Snow;
+and sometimes it happens that we have all these
+different Sorts of Weather in the same Day.
+During this Season, Soldiers are subject to
+Coughs, Pleurisies, Peripneumonies, Rheumatisms,
+and other Disorders of the inflammatory
+<span class='pagenum'><a name="Page_314" id="Page_314">[314]</a></span>Kind. And in very intense Frost, they are
+liable to have their Limbs benumbed with
+Cold, and their Extremities Frost bit (as it is
+called).</p>
+
+<p>And where there is a Want of fresh Provisions,
+and they are obliged to live on salted
+Meat, and cannot have Greens, Pot Herbs, Roots,
+or other fresh Vegetables, nor be properly supplied
+with Beer, Cyder, Wine, or other generous
+fermented Liquors, they, as well as Sailors,
+are subject to the Scurvy<a name="FNanchor_118_118" id="FNanchor_118_118"></a><a href="#Footnote_118_118" class="fnanchor">[118]</a>; especially if they
+be encamped or quartered in low damp Places.</p>
+
+<p>The best Means of guarding against inflammatory
+Disorders, and other Mischiefs arising
+from Cold, whether in Camp or in Quarters,
+is, to take Care that the Soldiers be well
+cloathed; that they lie dry, and be well provided
+with Straw and Blankets, and with
+Wood; and to prevent, as much as possible,
+<span class='pagenum'><a name="Page_315" id="Page_315">[315]</a></span>their exposing themselves to sudden changes
+from Heat to Cold.</p>
+
+<p>In these northern Climates, it would be right
+to allow every Soldier on Service a Flannel
+Waistcoat, a Pair of worsted Gloves, and a warm
+woollen Stock, or a Neckcloth, to wear when
+on Duty in cold and wet Weather, as soon as
+the Winter begins to set in<a name="FNanchor_119_119" id="FNanchor_119_119"></a><a href="#Footnote_119_119" class="fnanchor">[119]</a>. Dr. <i>Pringle</i>
+mentions the Advantage the Troops received
+<span class='pagenum'><a name="Page_316" id="Page_316">[316]</a></span>from the Flannel Waistcoats supplied by the
+Quakers, in the Winter Campaign of 1745-6,
+in <i>Britain</i>; and those Regiments who had them
+for their Men towards the End of the Campaigns
+in <i>Germany</i>, found that they contributed
+greatly to keep the Men in Health.
+Officers ought to take particular Care that the
+Men be well provided with good strong Shoes
+and Stockings; and where the Troops remain
+late in the Field, if the Government allowed a
+Pair or two extraordinary of each to every Foot
+Soldier, it would be of great Use to the Service.</p>
+
+<p>Blankets ought to be provided for each Tent,
+and those carried along with the Regiment, so
+as to be always ready for the Men when they
+come to their Ground. During the late War
+in <i>Germany</i>, a Couple of Blankets were allowed
+for each Tent of the <i>British</i> Troops, and
+each Company carried their Blankets covered
+with an Oil Cloth on a Horse; so that they
+were always up with the Regiments when they
+came to their Ground.</p>
+
+<p>Each Regiment ought to be provided with a
+Number of Watch Coats sufficient to serve the<span class='pagenum'><a name="Page_317" id="Page_317">[317]</a></span>
+Centinels who are to be on Camp Duty, or
+general Guards, in very cold and wet Weather.
+Some of the Regiments in <i>Germany</i> had such
+Coats, and found great Service from them.</p>
+
+<p>In Winter Quarters, Soldiers are apt to make
+the Rooms in which they sit, and their Guard
+Rooms, as hot as possible; especially in <i>Germany</i>,
+where the Inhabitants use close Stoves,
+instead of open Fires; and continue in these
+warm Rooms till they are called out on Duty,
+when, by being exposed to sudden Cold, they
+are apt to be seized with Inflammations of the
+Breast; and therefore Officers ought to examine
+carefully the Quarters and Guard Rooms
+allotted for their Men, and chuse them dry and
+comfortable, if possible<a name="FNanchor_120_120" id="FNanchor_120_120"></a><a href="#Footnote_120_120" class="fnanchor">[120]</a>; but never to allow
+<span class='pagenum'><a name="Page_318" id="Page_318">[318]</a></span>the Men to keep them as hot as Ovens, by
+Means of close Stoves, or other such Contrivances;
+but to depend more on good warm
+Cloathing, and dry Quarters, for guarding against
+Diseases, than upon artificial Heat. Many
+of the Regiments in <i>Germany</i> made the People
+in whose Houses their Men were quartered,
+take down their Stoves, and use only open
+Fires; when there was no Danger of the Soldiers
+making their Quarters too warm, as
+Wood was difficult to be got.</p>
+
+<p>But although close Stoves are prejudicial in
+small Rooms, yet when a Town is much
+crowded, and Men are obliged to be lodged, in
+Winter, in large Barns or Churches, or other
+large open Places, the <i>German</i> Stoves may be
+used with great Advantage in airing and drying
+such Places, and keeping them of a moderate
+Heat; especially if there be a Place in
+them for an open Fire, or if they be of that
+Kind which the <i>Germans</i> call <i>wynd Stoves</i>,
+which have a Door opening into the Chamber
+where the People are lodged; or if there be
+broken Windows, or any other Opening by<span class='pagenum'><a name="Page_319" id="Page_319">[319]</a></span>
+which a free Circulation of Air can be kept up
+in the Men&#8217;s Apartments.</p>
+
+<p>In Winter, when the Weather is very cold
+or wet, a Glass of Brandy, or of the spirituous
+Tincture of the Bark, given to the Men as they
+went upon Duty, especially in the Night, has
+been found to be of great Use<a name="FNanchor_121_121" id="FNanchor_121_121"></a><a href="#Footnote_121_121" class="fnanchor">[121]</a>. Dr. <i>Pringle</i>
+has very justly observed, that the Times of standing
+Centinel, and being upon Out-posts, ought, if
+possible, to be shortened at such Seasons; and
+that Fires in the Rear of the Camp, for Men
+coming off Duty to warm and dry themselves
+at, were found to be of great Service.</p>
+<p><span class='pagenum'><a name="Page_320" id="Page_320">[320]</a></span></p>
+<p>In Spring, and the latter End of Autumn,
+the Days are sometimes extremely hot, and the
+Nights cold and damp, and the Men exposed
+to these sudden Changes; at such Times, the
+Men who go upon Duty in the Night, ought
+to put on their Flannel Waistcoats, and be
+warmer cloathed than in the Day; and use
+many of the Precautions practised in Winter for
+the Preservation of their Health.</p>
+
+<p>In <i>North America</i>, when the Men were in
+the Field in very hard frosty Weather, Fires
+were lighted at the Ends of the Tents, and
+Centinels set over them to prevent their doing
+Mischief; and both in <i>Germany</i> and <i>North
+America</i>, when the Troops were in the Field
+without Tents, they cut down Wood and
+made large Fires, and the Soldiers lay down
+and slept round these Fires, with their Feet
+next to them; and Fires were lighted at all
+Out-posts, where it could be done with Safety.</p>
+
+<p>In <i>Germany</i>, when the Weather set in rainy
+or cold towards the End of the Campaigns, and
+the Army was in a fixed Position, his Serene
+Highness Prince <i>Ferdinand</i> constantly ordered<span class='pagenum'><a name="Page_321" id="Page_321">[321]</a></span>
+the Army to Hutt; which was done either by
+thatching their Tents, or building Hurdles, or
+digging Pitts, and covering and thatching them
+over. The Officers either built Hutts with Fire
+Places, or had Chimnies built to their Tents.</p>
+
+<p>If, notwithstanding all Precautions, Men
+upon Out-posts should be benumbed with Cold,
+or Frost bit, as soon as they are brought into
+Camp or Quarters, their Extremities ought to
+be rubbed with Snow, or put into cold Water<a name="FNanchor_122_122" id="FNanchor_122_122"></a><a href="#Footnote_122_122" class="fnanchor">[122]</a>;
+and afterwards well dried, and wrapt
+up in Blankets; and warm mild Liquors given
+<span class='pagenum'><a name="Page_322" id="Page_322">[322]</a></span>them to drink, and afterwards Cordials; and,
+after some Time, they may be brought near
+the Fire, or put to Bed. Dr. <i>Lind</i><a name="FNanchor_123_123" id="FNanchor_123_123"></a><a href="#Footnote_123_123" class="fnanchor">[123]</a> mentions
+one Caution to be used when Men are
+found in this Condition; which is, not to give
+them immediately strong spirituous Liquors, for
+that those often prove instantaneously fatal; but
+to put them to Bed, and give warm Water
+Gruel, or some other mild diluting Liquor, to
+drink; after which, he says, a Glass of Spirits
+will prove less dangerous and more beneficial.</p>
+
+<p>When Men are quartered or cantonned in
+Towns or Villages, whose Situation is low and
+damp, and where fresh Meat and Vegetables
+are scarce in Winter, and the Scurvy frequent
+among the lower Class of People; Commanding
+Officers, at the Approach of Winter, ought
+to use their Endeavours to provide a Store of
+Potatoes, Onions, Cabbages, sour Crout; of
+pickled Cabbages, and other pickled Vegetables;
+of Apples and other Fruits, preserved in
+different Forms, to be laid up, and sold out to
+<span class='pagenum'><a name="Page_323" id="Page_323">[323]</a></span>the Men at a cheap Rate during the Winter.
+They should contract, if possible, with Butchers
+to furnish the Men with fresh Meat<a name="FNanchor_124_124" id="FNanchor_124_124"></a><a href="#Footnote_124_124" class="fnanchor">[124]</a>,
+and endeavour to procure good small Beer, or
+Cyder or Wine in the Wine or Cyder Countries;
+or Spirits to be mixed with Water, and
+a small Proportion of Cream of Tartar or Vinegar;
+or some other wholesome fermented Liquor
+for their Drink<a name="FNanchor_125_125" id="FNanchor_125_125"></a><a href="#Footnote_125_125" class="fnanchor">[125]</a>; and to put their
+Men into as dry comfortable Quarters as possible.</p>
+
+<p>In Times of War, when Men are sent upon
+Expeditions into warm Climates, great Care
+ought to be taken to embark such only as are
+in good Health; particular Regard ought to be
+paid to those who are picked up in the Streets,
+or have been taken out of the <i>Savoy</i>, or other
+<span class='pagenum'><a name="Page_324" id="Page_324">[324]</a></span>Jails. All dirty Rags from off such People
+ought to be thrown away or burnt; and the
+Men, after being well washed, and new cloathed,
+ought to be kept for a Fortnight or three
+Weeks in some Garrison Town, or with their
+Regiments, in open airy Places, that it may be
+ascertained that they have no infectious Disorder
+before they be put aboard the Transports.</p>
+
+<p>All Ships allotted for Transports ought to
+be well aired and purified, and every Thing
+fitted up properly, before the Men are embarked.
+They ought to be provided with
+Ventilators, or Wind Sails, to make a free Circulation
+of Air through the Vessel<a name="FNanchor_126_126" id="FNanchor_126_126"></a><a href="#Footnote_126_126" class="fnanchor">[126]</a>; and
+they ought never to be crowded; but full
+Room allowed for each Man, in Proportion to
+the Length of the Voyage<a name="FNanchor_127_127" id="FNanchor_127_127"></a><a href="#Footnote_127_127" class="fnanchor">[127]</a>.</p>
+
+<p><span class='pagenum'><a name="Page_325" id="Page_325">[325]</a></span></p><p>In military Expeditions, Soldiers are put
+upon Ships Allowance; which, Dr. <i>Lind</i> very
+justly observes, ought not, in Voyages to the
+warm Climates, be made up so much of salted
+Beef and salted Pork (which always tend to the
+Putrescent), as is the common Practice of the
+Navy; but that a greater Share of Biscuit,
+Flour, Oatmeal, Goarts, Rice, and other
+Stores of that Kind, ought to be laid in; and
+a greater Proportion of them, and a Less of the
+salted Meat, distributed among the Men: And
+he is certainly in the Right, when he says, that
+a full Animal Diet, and tenacious Malt Liquors,
+are well adapted to the Constitution of our
+own, and of other northern Climates; and that
+Sailors who visit the <i>Greenland</i> Seas, and are
+<span class='pagenum'><a name="Page_326" id="Page_326">[326]</a></span>remarkable for a voracious Appetite, and a
+strong Digestion of hard salted Meat, and the
+coarsest Fare, when sent to the <i>West Indies</i>,
+soon become sensible of a Decay of Appetite,
+and find a full gross salted Diet pernicious to
+Health. &#8220;Instinct (he says) has taught the
+Natives between the Tropics to live chiefly
+on a Vegetable Diet, of Grains, Roots,
+and subacid Fruits, with Plenty of diluting
+Liquors<a name="FNanchor_128_128" id="FNanchor_128_128"></a><a href="#Footnote_128_128" class="fnanchor">[128]</a>.&#8221;</p>
+
+<p><span class='pagenum'><a name="Page_327" id="Page_327">[327]</a></span></p><p>A Store of Vegetables, such as Mustard
+Seed, Garlick, Onions, Potatoes, pickled Cabbages
+and other pickled Vegetables, sour Crout
+and other Things of that Kind, which can be
+purchased at a cheap Rate, and preserved for
+some Months, ought to be laid in; which may
+be mixed with the Soops prepared for the Men,
+or given them to eat along with their salted
+Provisions.</p>
+
+<p>A Quantity of Beer, Cyder, or Wine, ought
+to be put aboard, and a certain Allowance
+distributed to each Man daily. When, for
+Want of these, Men are reduced to an Allowance
+of Spirits, they ought to be mixed with
+seven or eight Times the Quantity of Water, or
+<span class='pagenum'><a name="Page_328" id="Page_328">[328]</a></span>made into Punch, by the Mixture of Water and
+Molosses, and the Juice of Lemons, before they
+are given to the Men; and, if Lemons cannot
+be got, Cream of Tartar, or Vinegar, ought to
+supply their Place; and it ought to be a Duty of
+one of the military Officers on board to see the
+Punch made, and distributed among the Men daily.</p>
+
+<p>It would be right, on all Expeditions into
+warm Climates, to send some Sloops of War,
+or other armed Vessels, before the grand Fleet,
+to take up a Quantity of Wine that will keep,
+either at the <i>Madeira</i>, or other Wine Countries;
+and afterwards to go to any of our Settlements
+that are nearest the Place of Destination,
+and to take in a Quantity of Limes, Lemons,
+Oranges, and other Fruits, and Vegetables
+which will keep for some little Time; and of
+Spirits, live Stock, and other Provisions proper
+for the Army; and then to meet the Fleet
+at the general Rendezvous. When once a
+Landing is made good, these Vessels, after having
+unloaded their Cargoes, may either be employed
+on other Services, or kept constantly going
+and coming for whatever Stores or Provisions
+are wanted for the Army or Fleet.<span class='pagenum'><a name="Page_329" id="Page_329">[329]</a></span></p>
+
+<p>A sufficient Quantity of Vinegar ought to be
+put on board of each Transport, both for the
+Men to eat with their Victuals, and likewise
+for fumigating and washing between Decks occasionally.
+And a Quantity of Molosses, or
+coarse brown Sugar, and of Lemons, or their
+inspissated Juice, or Cream of Tartar, ought to
+be allowed for making the Punch, as well as
+for other Purposes.</p>
+
+<p>If the Water become f&#339;tid, the Quantity to
+be used in the Day ought to be sweetened by
+Means of the Ventilator contrived by the ingenious
+Dr. <i>Hales</i><a name="FNanchor_129_129" id="FNanchor_129_129"></a><a href="#Footnote_129_129" class="fnanchor">[129]</a> for that Purpose.</p>
+
+<p>The Men ought to be brought upon Deck,
+and Roll called two or three Times a Day;
+they should be made to comb their Hair, and
+wash their Hands and Face every Day, and to
+<span class='pagenum'><a name="Page_330" id="Page_330">[330]</a></span>shift themselves sometimes, if possible; and in
+every respect keep themselves as clean as the Nature
+of the Service will admit; and proper Exercises
+should be contrived, to keep them in Health.</p>
+
+<p>All the Parts of the Ship ought to be kept
+very neat and clean; and the Hold, and all
+between Decks, ought to be scraped and swept
+daily; and every Morning, in fair Weather,
+ought likewise to be washed, and afterwards
+sprinkled or washed with warm Vinegar, while
+the Men are upon Deck<a name="FNanchor_130_130" id="FNanchor_130_130"></a><a href="#Footnote_130_130" class="fnanchor">[130]</a>.</p>
+
+<p>When the Weather will permit, Fires of
+dried Wood may be lighted in Iron Kettles
+between Decks, and Centinels set over them,
+and the Fires sprinkled with Rosin or Bits of
+Rope dipt in Tar, or with some cheap Aromatic;
+and these Fires may be carried into all
+the Parts of the Ship that Safety will permit,
+in order to dry and purify the Air<a name="FNanchor_131_131" id="FNanchor_131_131"></a><a href="#Footnote_131_131" class="fnanchor">[131]</a>. After
+<span class='pagenum'><a name="Page_331" id="Page_331">[331]</a></span>this Operation all the Ports and Hatchways
+should be opened, and the Air in all the Parts
+of the Ship often renewed by working the
+Ventilators.</p>
+
+<p>The Mens Hammocks and Beds ought to
+be brought up upon Deck in fair Weather,
+and well aired, and afterwards put in their
+Places, and Fires lighted below Decks.</p>
+
+<p>When Troops, sent on an Expedition into
+warm Climates, arrive at the Place of their
+Destination, particular Care should be taken to
+guard them against the Diseases peculiar to such
+Climates, which are different from those common
+to our more northern Latitudes.</p>
+
+<p>Dr. <i>Lind</i> says, that People coming first from
+a cold into a hot Climate are apt to have plethoric
+Symptoms; a Pain of the Head, Giddiness,
+a Sense of Weight, and Fulness of the
+Breast, and a slight Inflammation of the <i>tunica
+conjunctiva</i>; and that some are apt to be seized
+with ardent Fevers and Diarrh&#339;as. And all
+Practitioners have observed, that New-Comers
+<span class='pagenum'><a name="Page_332" id="Page_332">[332]</a></span>into warm Climates are at first liable to Fevers
+tending to the Ardent, and are very subject to
+Fevers of the remitting and intermitting Kind,
+which are the Endemics of all warm Countries
+at certain Seasons of the Year; and after
+some Time they are apt to fall into Fluxes,
+the Yellow Fever, and other Diseases depending
+on a putrescent State of the Juices. In military
+Expeditions these Disorders are liable to
+be complicated with Fevers of the Malignant
+or Hospital Kind, if Care is not taken to prevent
+it. And nothing has been found to be
+more productive of Diseases in those warm Climates,
+than indulging freely in the Use of Spirits
+and other strong fermented Liquors; exposing
+one&#8217;s self to the Damps, especially lying on the
+Ground after the Dews fall; and working hard,
+or using violent Exercise in the Heat of the
+Day.</p>
+
+<p>The best Preservatives against Diseases in
+warm Climates have been found to be,&mdash;1.
+Temperance; a Diet of light and easy Digestion,
+composed more of vegetable than of
+animal Food; such as a small Portion of fresh<span class='pagenum'><a name="Page_333" id="Page_333">[333]</a></span>
+Meat, joined with a sufficient Quantity of Vegetables;
+Rice, <i>Indian</i> Corn, and other Grains,
+and Roots of various Kinds, prepared in different
+Forms; well baked Bread; the moderate
+Use of ripe Fruits; and the free Use of mild
+cooling subacid Liquors, joined with a small
+Proportion of vinous or spirituous Liquors;
+carefully avoiding the too liberal Use of Wine,
+Spirits, or other strong fermented Liquors.&mdash;2. Great
+Care not to expose one&#8217;s self to the
+Damps of the Night, nor lie down to sleep on
+the Grass, or in woody moist Places, in the
+Day; and to avoid all violent Exercise in the
+Heat of the Sun.&mdash;3. Such Means as tend to
+support the Spirits; for Chearfulness has been
+observed to contribute as much to the Preservation
+of Health, as Fear and Dejection of Spirits
+to the Production of Diseases.&mdash;4. Keeping
+the Body clean, and bathing frequently in the
+Sea, or in a River, in the Morning.</p>
+
+<p>And therefore, in warm Climates, Officers
+ought to be particularly careful to keep their
+Men sober and temperate; to procure them
+good Bread, and Plenty of Vegetables and fresh<span class='pagenum'><a name="Page_334" id="Page_334">[334]</a></span>
+Meat, if possible; and where no other but
+salted Meat can be got, to make them boil a
+small Proportion of it in their Camp Kettles,
+along with Onions, Goarts, Rice, Carrots, Turnips,
+Greens, or any other wholesome Roots or
+Herbs which the Country affords, or they can
+get, and of these to prepare a good wholesome
+Soop for themselves; and where there is Plenty
+of the ripe acescent Fruits, which are reckoned
+wholesome, to distribute a moderate Quantity
+among the Soldiers daily, which will both help
+to preserve their Health, and prevent them
+from privately stealing and eating large Quantities
+to the Prejudice of their Health.&mdash;To encourage
+their Men, and keep up their Spirits.</p>
+
+<p>They should also prevent, as much as possible,
+the too free Use of Wine, Spirits, or other
+strong fermented Liquors; and in Wine Countries
+give every Man a daily Allowance of
+Wine, to be mixed with Water for his common
+Drink; and in Countries where nothing
+but Spirits can be got, make the Spirit be mixed
+with Water, or made into a very weak Punch,
+before it is given to the Men, as Lemons, Oranges,<span class='pagenum'><a name="Page_335" id="Page_335">[335]</a></span>
+Limes, and other Fruits proper for this Purpose,
+are generally to be had in most warm Countries.</p>
+
+<p>They should be careful not to march their
+Men in the Heat of the Day, nor order them
+upon Duty where they must stand exposed to
+the Dews and Damps of the Night, unless
+where the military Operations absolutely require
+it.</p>
+
+<p>They should endeavour to make the Bottom
+of the Tents be covered with Straw, or dried
+Leaves of Trees, or dried Reeds, and with Blankets<a name="FNanchor_132_132" id="FNanchor_132_132"></a><a href="#Footnote_132_132" class="fnanchor">[132]</a>,
+for the Men to lie upon.</p>
+
+<p>The Time of standing Centinel, and being
+upon Out-posts, if possible, should be short,
+where Men are exposed to the scorching Heat
+of the Sun; and when Men are upon Out-posts
+in the Night, it should be recommended to
+them to lie down on the Ground as little as
+possible; and if they do it, to chuse a dry
+<span class='pagenum'><a name="Page_336" id="Page_336">[336]</a></span>Place; and, where it can be done, to have it
+covered with Straw or a Blanket, and to have
+some light Covering to defend them from the
+Dews.</p>
+
+<p>The Tents should be covered with Boughs
+of Trees, and the Men should be ordered sometimes
+to strike them in the Middle of the Day,
+and air well every Thing within them.</p>
+
+<p>The Men should be obliged to keep themselves
+neat and clean; to comb their Hair, and
+change their Linen often; and if the Camp be
+near the Sea, or a large River, they ought to bathe
+early in the Morning as often as the Nature of the Service
+will permit. However the following Caution,
+mentioned by Dr. <i>Lind</i>, ought to be observed,
+which is, not to go into the cold Bath when
+overheated with Work or Liquor, or when the
+Stomach is full, or when a critical Eruption,
+called the prickly Heat, appears on the
+Skin<a name="FNanchor_133_133" id="FNanchor_133_133"></a><a href="#Footnote_133_133" class="fnanchor">[133]</a>.</p>
+<p><span class='pagenum'><a name="Page_337" id="Page_337">[337]</a></span></p>
+<p>When Men are seized with inflammatory
+Symptoms on entering into warm Climates,
+they may be blooded freely: Afterwards they
+do not easily bear such copious Evacuations,
+but rather require to have them made in
+smaller Quantities, and very early and frequent,
+as Inflammations make a rapid Progress
+in warm Countries. Dr. <i>Lind</i> says, many
+Practitioners disapprove of Blood-letting in
+the Countries lying under the Torrid Zone,
+on a Supposition that the Blood is too much
+dissolved; but he thinks that this Rule will admit
+of many Exceptions; and that Sailors (<i>and
+consequently Soldiers</i>), being strong and robust,
+and exposed to greater Vicissitudes of Heat and
+Cold, and more Excesses, and other Accidents
+in general, bear freer Bleeding than any other
+Set of People.</p>
+
+<p><span class='pagenum'><a name="Page_338" id="Page_338">[338]</a></span></p><p>After some Time, the Diseases in these warm
+Climates tend to the putrid Kind, and must be
+treated as such.</p>
+
+<p>In all Countries, and in all Climates, great
+Care ought to be taken in chusing the Ground
+on which Men are to encamp. Dry high
+Grounds, exposed to the Winds, where there
+is a free Current of Air, and which lie at
+a Distance from Marshes, stagnating Water,
+and large Woods, are generally healthful in
+very different Climates<a name="FNanchor_134_134" id="FNanchor_134_134"></a><a href="#Footnote_134_134" class="fnanchor">[134]</a>. But Places situated
+low, where, on digging two or three Feet
+below the Surface of the Earth, you come to
+Water<a name="FNanchor_135_135" id="FNanchor_135_135"></a><a href="#Footnote_135_135" class="fnanchor">[135]</a>, and marshy Grounds, and Places
+surrounded with corrupt stagnating Water, are
+almost always the contrary, and very unhealthful;
+<span class='pagenum'><a name="Page_339" id="Page_339">[339]</a></span>as are often those Grounds which are subject
+to be overflowed by large Rivers, and low
+Places covered with Wood, where there is no
+free Circulation of Air. However, it ought
+to be observed, that it is not the Neighbourhood
+of Water alone which is prejudicial, but
+the watery Vapours which keep the Air perpetually
+moist, and the Exhalations of corrupt Effluvia,
+which render such Places unwholesome;
+for the Neighbourhood of Rivers, and of the
+Sea, where the Tide ebbs and flows freely,
+has no such Effect, where the Situation is dry
+and airy; and those very unhealthy marshy
+Grounds often continue healthy in cold Weather,
+when their Waters are refreshed with
+Rains<a name="FNanchor_136_136" id="FNanchor_136_136"></a><a href="#Footnote_136_136" class="fnanchor">[136]</a>, and little or no moist putrid Exhalations
+rise from them; though, as Dr. <i>Pringle</i>
+observes, in Summer and Autumn, when their
+Waters begin to corrupt, and the Exhalation is
+strong, they are always exposed to Diseases;
+<span class='pagenum'><a name="Page_340" id="Page_340">[340]</a></span>and it is for this Reason that such Places are
+always very unhealthy in warm Climates.</p>
+
+<p>Hence, where the military Operations will
+permit, Commanders, if possible, ought to
+chuse a dry Ground, whose Situation is high,
+and which admits a free Current of Air, such
+as on the Banks of Rivers, where there is generally
+a Stream of fresh Air, and Plenty of
+fresh Water to supply the Camp<a name="FNanchor_137_137" id="FNanchor_137_137"></a><a href="#Footnote_137_137" class="fnanchor">[137]</a>; taking
+Care to avoid the Neighbourhood of low marshy
+Grounds, and corrupt stagnating Waters,
+especially in Summer, and in hot Climates.</p>
+
+<p>When Necessity obliges Commanders to take
+Post, or encamp in a wet or marshy Ground,
+they should endeavour to make it as dry as
+possible, by ordering Trenches to be cut for
+<span class='pagenum'><a name="Page_341" id="Page_341">[341]</a></span>Drains across the Field and round the Mens
+Tents; to see that the Ground within the
+Tents be well covered with Straw; to order
+the Tents to be struck at Mid-Day, in dry
+warm Weather, and the Men to dry and
+air the Straw, and change it frequently; to
+have a proper Supply of Blankets for the Men,
+and to take Care that they be well cloathed,
+especially those who go upon Duty in the
+Nights; and, in the northern Climates, to have
+Fires in proper Places for warming the Men
+and drying their Cloaths, and for correcting the
+Dampness of the Air<a name="FNanchor_138_138" id="FNanchor_138_138"></a><a href="#Footnote_138_138" class="fnanchor">[138]</a>.</p>
+
+<p>In Countries lying under the Torrid Zone,
+the Parts near the Sea Shore are often marshy,
+<span class='pagenum'><a name="Page_342" id="Page_342">[342]</a></span>or close and covered with Wood, or have
+swampy Beaches, and are very unwholesome;
+and therefore where Soldiers aboard of Transports
+keep their Health, Commanders ought to
+be very careful not to allow them to land, till
+they come to the Place of their Destination.
+Dr. <i>Lind</i> observes, that Men commonly live
+more healthy in warm Climates at Sea, where
+the Air is dry and serene, and the Heat moderated
+by refreshing Breezes, than when they
+arrive in Harbours, or get within Reach of the
+noxious Vapours which arise from many Parts
+of the Land<a name="FNanchor_139_139" id="FNanchor_139_139"></a><a href="#Footnote_139_139" class="fnanchor">[139]</a>.</p>
+
+<p>When Necessity requires Parties to be
+landed for Wood or Water, or on other
+Duties, they should always be obliged to
+return and lie aboard at Night; and if that
+cannot be done, they should be cautioned to
+avoid lying down to sleep on the Grass, where
+the Air is fresh, or they are exposed to the
+Dews; and to pitch their Tents on a rising
+<span class='pagenum'><a name="Page_343" id="Page_343">[343]</a></span>Ground, covered with Straw or dried Reeds,
+and a Blanket; and to use the other Precautions
+necessary for encamping in these warm Climates;
+for where this Care has been neglected, the
+Consequences have frequently proved fatal<a name="FNanchor_140_140" id="FNanchor_140_140"></a><a href="#Footnote_140_140" class="fnanchor">[140]</a>.</p>
+
+<p>On unhealthful Coasts, the noxious Land
+Vapours often affect the Crews of Ships that
+run up into Rivers or Harbours, and cause
+great Sickness; and therefore in such Places
+Ships should anchor at as great a Distance from
+the Shore as can well be done, that they may
+be exposed to the Sea Breezes, and as much to
+<span class='pagenum'><a name="Page_344" id="Page_344">[344]</a></span>the Windward of the Woods and Marshes as
+possible; and if the Anchorage is safe, one
+should prefer the open Sea to running up into
+Rivers or Creeks<a name="FNanchor_141_141" id="FNanchor_141_141"></a><a href="#Footnote_141_141" class="fnanchor">[141]</a>.</p>
+
+<p>Cleanness and Neatness in the Camp is another
+Article that ought to be particularly regarded.
+<i>Portius</i>, <i>Ramazini</i>, and most other
+Authors who treat of Camp Diseases, attribute
+those of the putrid Kind in a great Measure to
+the Stench and putrid Effluvia arising from the
+Excrements of Men and Beasts, and from the
+dead Bodies of Men, Horses, and other Animals,
+<span class='pagenum'><a name="Page_345" id="Page_345">[345]</a></span>lying unburied in the Neighbourhood of
+Camps, and have in a particular Manner mentioned
+the Necessity of burying such putrid Substances.
+Dr. <i>Pringle</i> has very justly recommended
+the Digging of Deep Pits for Privies
+in Camp, and covering the Excrements with
+Earth daily<a name="FNanchor_142_142" id="FNanchor_142_142"></a><a href="#Footnote_142_142" class="fnanchor">[142]</a> till the Pits are near full, and then
+to fill them up with Earth, and dig new ones;
+and to punish every Person who shall ease himself
+any where in Camp but in the Privies:
+And he remarks, that when the Camp begins
+to turn unhealthy, that often the only Means
+that will preserve the Health of the Men, is to
+change the Ground, and to leave behind all the
+Filth and Nastiness which gave Rise to those
+putrid Disorders.</p>
+
+<p>In fixed Camps, the striking the Tents at
+<span class='pagenum'><a name="Page_346" id="Page_346">[346]</a></span>Mid-Day in fair Weather, and turning and
+airing the Straw, and changing it often, as recommended
+by Dr. <i>Pringle</i>, will contribute
+much to preserve the Health of the Men; and
+making the Men wash themselves daily, and
+change their Linen often, and keep themselves
+otherwise clean, ought never to be omitted by
+the Officers.</p>
+
+<p>All military Authors have recommended
+to Commanders always to have Straw for their
+Men when they come to their Ground, if
+possible; and to have the Army well supplied
+with Provisions; giving proper Encouragement
+to the Country People, and to Suttlers
+and Merchants of all Sorts, to bring in every
+Kind of Provisions and other Necessaries to
+Camp; and preventing, as much as possible,
+the Soldiers from moroding. And the Commanders
+of every Corps ought to take Care
+that their Men form themselves into Messes,
+and that Stoppages be made for buying them
+Provisions.</p>
+
+<p>In <i>Germany</i> every Regiment of the <i>British</i>
+Troops contracted with a Butcher, who was
+obliged to carry along with them, at all Times,<span class='pagenum'><a name="Page_347" id="Page_347">[347]</a></span>
+a certain Number of live Sheep and Oxen to
+kill when wanted, and to sell the Meat at a
+fixed Price. Every Soldier was obliged to take
+a certain Quantity, which was paid for by
+Stoppages made in his Pay; and this Meat was
+boiled in the Camp Kettles, with such Roots and
+Greens as could be got; by which Means the
+Men, whenever they could use their Kettles,
+had always a good warm Soop, as well as Meat,
+to refresh them after their Fatigues, which,
+along with their Ammunition Bread, made a
+good wholesome Food.</p>
+
+<p>In Countries where Fruit is plentiful, a certain
+Quantity of what is fully ripe, distributed
+to the Men in warm Weather, and in hot Climates,
+will contribute to preserve their Health,
+though the Abuse of it will prove prejudicial;
+but unripe and acrid Fruits are always hurtful<a name="FNanchor_143_143" id="FNanchor_143_143"></a><a href="#Footnote_143_143" class="fnanchor">[143]</a>.</p>
+<p><span class='pagenum'><a name="Page_348" id="Page_348">[348]</a></span></p>
+<p>Water is another Article which Commanders
+endeavour to have their Camp well supplied
+with, and therefore they generally encamp
+near Rivers or Rivulets. Where the
+Stream is small, Care ought to be taken that its
+Course be not interrupted, and that no Filth or
+Nastiness, or any Thing that will spoil or corrupt
+the Water, be thrown into it.</p>
+
+<p>When there are no Rivers or Rivulets near a
+Camp, and the Men are supplied from Wells,
+if the Water is not pure, very often the digging
+of deep Pits, and covering the Bottom and Sides
+with large Stones, and over these a Lay of
+Sand, Gravel, or Chalk, will make the Water
+pure in a few Hours.</p>
+
+<p>In fixed Camps, where the Water is bad,
+<i>Portius</i><a name="FNanchor_144_144" id="FNanchor_144_144"></a><a href="#Footnote_144_144" class="fnanchor">[144]</a> proposes straining it thro&#8217; Sand, and
+has given Figures of Machines to be used for
+that Purpose; but the Method proposed by
+Dr. <i>Lind</i> is still more simple, which is, to get
+<span class='pagenum'><a name="Page_349" id="Page_349">[349]</a></span>a broad Cask with one End struck out; then
+put a longer Cask, with both Ends struck out,
+in the Middle of it; fill the short Cask one-third
+with Sand, and the inner longer Cask
+above one-half; fill the Rest of the inner Cask
+with the Water, which will filter through the
+Sand, and rise above the Sand in the outer
+Cask, where it may be allowed to run off into
+Vessels placed to receive it, by Means of a Cock,
+put into the Side of the outer Cask, fifteen or
+twenty Inches above the Level of the Sand.</p>
+
+<p>Where there are no such Conveniences for
+purifying the Water, what is used for Drink
+ought to be mixed with a small Proportion of
+Spirits, or Wine, or with Vinegar, or Cream of
+Tartar, when neither of the other two can
+be got; and if the Water be previously boiled,
+it will be so much the better.</p>
+
+<p>In Expeditions into warm Countries, where
+fresh Water is difficult to be had, a few Stills,
+with a proper Apparatus, ought to be carried
+out; and after a Landing is made, the Stills
+ought to be set to work for distilling fresh
+Water from Sea Water in the Manner mentioned<span class='pagenum'><a name="Page_350" id="Page_350">[350]</a></span>
+by Dr. <i>Lind</i><a name="FNanchor_145_145" id="FNanchor_145_145"></a><a href="#Footnote_145_145" class="fnanchor">[145]</a>; and although a sufficient
+Quantity cannot be distilled for serving
+the whole Army, yet enough may be got in
+this Way for the Use of the Sick.</p>
+
+<p>When Men are very warm, after long
+Marches, and other hard Duties, in Summer;
+Officers should endeavour to prevent their
+swallowing immediately great Quantities of
+cold Water, and persuade them to wait a little
+till they cool; and at such Times, if Spirits
+can be got easily, to order a small Quantity to
+be mixed with the Water in each Man&#8217;s Canteen.</p>
+
+<p>Though the Abuse of vinous and spirituous
+Liquors is very destructive to the Constitution,
+yet these same Liquors, given in Moderation to
+Soldiers on Service, during the Times of great
+Fatigues, are some of the best Preservatives of
+<span class='pagenum'><a name="Page_351" id="Page_351">[351]</a></span>Health. Spirits, for common Use, ought to
+be mixed with Water; and in the hot Climates
+made into Punch; though in very cold
+and wet Weather, and in damp Nights, a Glass
+of pure Spirits, given to the Men going on Duty,
+is of great Service; for it is always observed,
+that Men are much less apt to catch Diseases
+from being wet when they are upon a
+March, or at hard Work, than when they stand
+Centinels, or are upon Out-Posts where they
+move but little, or when they lie down in their
+wet Cloaths; and that they are less liable to be
+affected by the Weather after a hearty Meal,
+or drinking a Glass of Spirits, or some generous
+Liquor, than when their Stomachs are
+empty.</p>
+
+<p>An Infusion of Bark or other Bitters, and of
+Garlick, in Spirits, has been found to encrease
+their Efficacy as Preservatives both against the
+Effects of Cold and malignant Distempers.
+Dr. <i>Lind</i> has recommended an Infusion of
+Garlick in Spirits as one of the best Stomachics
+and Diaphoretics he knows in cold wet Weather.
+And many have recommended a Tincture of the<span class='pagenum'><a name="Page_352" id="Page_352">[352]</a></span>
+Bark<a name="FNanchor_146_146" id="FNanchor_146_146"></a><a href="#Footnote_146_146" class="fnanchor">[146]</a>: Towards the End of the Year
+1743, Mr. <i>Tough</i>, one of the Apothecaries
+to the <i>British</i> military Hospital in the late
+War, then a Mate to a marching Regiment,
+was ordered to go down the <i>Rhine</i>
+with a Party of Sick, who had the Seeds
+of the Hospital Fever among them, and were to go in Bilanders,
+from <i>Germany</i> to <i>Flanders</i>. Having had
+a Cask or two of Brandy put aboard as Part of
+the Stores for the Sick, he was afraid lest the
+Men should make too free with the Spirits; to
+prevent which he threw in a Quantity of Bark
+into each Cask, and gave the Men regularly,
+Morning and Evening, a Glass of this bitter
+Tincture. At the same Time, the Men were
+kept extremely clean. By these Means most
+<span class='pagenum'><a name="Page_353" id="Page_353">[353]</a></span>of the Sick mended upon the Passage, without
+the Malignant Fever appearing
+again amongst them; whereas, Dr. <i>Pringle</i>,
+who takes Notice of the other Parties who
+came from the same Hospitals in <i>Germany</i>, tells
+us, that the Malignant Fever broke out in a violent
+Degree, and Half the Number died by
+the Way, and federal others soon after their
+Arrival<a name="FNanchor_147_147" id="FNanchor_147_147"></a><a href="#Footnote_147_147" class="fnanchor">[147]</a>.</p>
+
+<p>Commanding Officers ought always to endeavour
+to proportion the Time the Men are
+to be upon Duty to the Weather and the Nature
+of the Climate. The Time of standing
+Centinel in very hard Frost, and in cold wet
+Weather, or in the Heat of the Day in Summer,
+when the Weather is very warm, and in
+hot Climates, ought to be shorter than when
+the Weather is dry and more temperate.</p>
+
+<p>The Marches of Troops ought, if possible,
+during the Time of very hot Weather, to be
+made either very early in the Morning, in the
+Evening, or at Night; and Officers, during the
+<span class='pagenum'><a name="Page_354" id="Page_354">[354]</a></span>Course of an active Campaign, ought to spare
+their Men as much as possible.</p>
+
+<p>And when they are in Quarters, and have
+nothing to do, they should narrowly inspect
+into their Manner of living; and have them
+out daily, when the Weather will permit, and
+exercise them, or march them two or three
+<i>English</i> Miles a-Day, in order to prevent their
+falling sick for want of Exercise; for Soldiers
+left to themselves are very subject to Diseases
+when they come into Quarters after an active
+Campaign, by leading too indolent a Life, if
+Officers do not take Care to prevent it. However,
+at such Times, the Exercise ought to be
+moderate, and the Men should not be brought
+out in wet Weather.</p>
+
+<div class="footnotes"><h3>FOOTNOTES:</h3>
+
+<div class="footnote"><p><a name="Footnote_116_116" id="Footnote_116_116"></a><a href="#FNanchor_116_116"><span class="label">[116]</span></a> In the Year 1760, the Men, who remained in the fixed
+Camp about <i>Warbourg</i>, were very unhealthy; while the Regiments
+who were detached to the <i>Lower Rhine</i>, under the
+Command of the Hereditary Prince of <i>Brunswick</i>, enjoyed a
+much better State of Health; and notwithstanding their great
+Fatigues, and the Loss they sustained at the Affair of <i>Kampen</i>,
+were much stronger when they rejoined the Army to go upon
+the Winter Expedition into the Country of <i>Hesse</i>, than those
+Regiments which had remained in the fixed Camp.</p></div>
+
+<div class="footnote"><p><a name="Footnote_117_117" id="Footnote_117_117"></a><a href="#FNanchor_117_117"><span class="label">[117]</span></a> This Dr. <i>Pringle</i> takes Notice of; and Mr. <i>Naesmith</i>
+says, he observed it in Voyages to the <i>East Indies</i>, which afford
+the fairest Trials of this Kind. See Dr. <i>Lind&#8217;s Essay on the
+Means of Preserving the Health of Seamen</i>, 2d edit. note to
+page 5.</p></div>
+
+<div class="footnote"><p><a name="Footnote_118_118" id="Footnote_118_118"></a><a href="#FNanchor_118_118"><span class="label">[118]</span></a> Dr. <i>Joh. Valint. Willius</i>, Army Physician to the King of
+<i>Denmark</i>, in his Treatise on Camp Diseases, says, you scarce
+find a Camp in these northern Countries in which the true
+Scurvy, attended with stinking Breath and eroded Gums, is
+not to be observed. <i>Cap.</i> iii. <i>sect.</i> iii.</p></div>
+
+<div class="footnote"><p><a name="Footnote_119_119" id="Footnote_119_119"></a><a href="#FNanchor_119_119"><span class="label">[119]</span></a> A Flannel Waistcoat, worsted Gloves, and woollen Stock,
+or a Neckcloth, may be purchased for about Half a Crown
+<i>per</i> Man, and would contribute to preserve the Lives of many;
+the recruiting of others, to supply whose Places, if they
+die, will cost the Government a great deal more than the
+Price of the Articles mentioned; which for a Regiment of
+nine hundred Men, at the Rate of two Shillings and Six-Pence
+<i>per</i> Man, comes only to 112<i>l.</i> 10<i>s.</i> <i>per Ann.</i> Every Recruit sent
+from <i>England</i> to the Army in <i>Germany</i>, cost the Government at
+least twenty Guineas before he joined his Regiment; and every
+sick Man sent to the general Hospital, cost the Government at
+least sixteen Pence <i>per</i> Day, which is ten Pence above his Pay;
+so that, if we suppose the extraordinary Cloathing here mentioned
+would preserve only the Lives of nine Men to each Regiment
+yearly, and keep forty in Health who would otherwise
+be sick, we see what great Gainers the Government will be in
+Point of Money at the Year&#8217;s End; besides preserving the Lives
+and Health of so many Men.</p></div>
+
+<div class="footnote"><p><a name="Footnote_120_120" id="Footnote_120_120"></a><a href="#FNanchor_120_120"><span class="label">[120]</span></a> Dr. <i>Pringle</i> has very justly observed, that upper Stories
+are preferable to Ground Floors; and that all uninhabited large
+damp Houses ought to be rejected. <i>Observat. on Diseases of the
+Army</i>, part ii. chap. iii. sect. 2.
+</p><p>
+If Necessity obliges Officers to put up with such Places for
+their Men, Care ought to be taken to clean them well, and to
+air and dry them by Means of Fires, before the Soldiers go into
+them; and to supply well the Men who are to lodge in them
+with Straw and Blankets, and with Wood or Turf.</p></div>
+
+<div class="footnote"><p><a name="Footnote_121_121" id="Footnote_121_121"></a><a href="#FNanchor_121_121"><span class="label">[121]</span></a> Dr. <i>Pringle</i> has taken Notice, that it would be a right
+Measure to make an Allowance of Spirits to the Infantry on
+Service; which certainly would be of great Use, and save
+many Mens Lives; and might be done at a small Expence to
+the Government, if properly managed; as it would only be
+requisite to make such an Allowance when the Troops are in
+the Field, and to such Men as mount Guard in cold wet Weather,
+or at Nights in Garrison Towns, during the Winter. If
+ever such an Allowance be made, what Spirits are given to the
+Men ought to be mixed with five or six Times the Quantity of
+Water; except when Men are to stand Centinels, or to be upon
+Out-Posts, in a frosty Season, or in cold wet Weather; at which
+Time a small Glass of pure Spirits may be given them in Presence
+of the Officer or Serjeant of the Guard.</p></div>
+
+<div class="footnote"><p><a name="Footnote_122_122" id="Footnote_122_122"></a><a href="#FNanchor_122_122"><span class="label">[122]</span></a> <i>Hildanus</i> relates a very remarkable Instance of the good
+Effects of this Treatment. A Man was found quite stiff and
+frozen all over. He was put into cold Water, and immediately
+the icy Spicula were discharged from all Parts of his Body, so
+that he seemed covered with an icy Crust. He was then put
+into a warm Bed, and took a Cordial Draught, and a plentiful
+Sweat followed; after which he recovered with the Loss of the
+last Joints of his Fingers and Toes. <i>De Gangr&aelig;na</i>, cap. xiii.
+People who are benumbed with Cold in frosty Weather ought
+never to be brought immediately near a Fire; for that has been
+found either to cause immediate Death or Gangrenes of the
+Extremities; and even Apples and other Fruits which have been
+frozen, if brought immediately near a Fire, turn soft and rot;
+but if put into cold Water, throw out the icy Spicula, and recover,
+so as to be almost as good as before they were frozen.</p></div>
+
+<div class="footnote"><p><a name="Footnote_123_123" id="Footnote_123_123"></a><a href="#FNanchor_123_123"><span class="label">[123]</span></a> <i>Means of Preserving the Health of Seamen</i>, 2d edition,
+page 19.</p></div>
+
+<div class="footnote"><p><a name="Footnote_124_124" id="Footnote_124_124"></a><a href="#FNanchor_124_124"><span class="label">[124]</span></a> The Regiments in <i>Germany</i> who kept their Butchers in
+Winter, and made Stoppages of the Mens Pay, and obliged
+them to take a certain Quantity of Meat daily, were much
+more healthy than those who used no Precaution of this Kind.</p></div>
+
+<div class="footnote"><p><a name="Footnote_125_125" id="Footnote_125_125"></a><a href="#FNanchor_125_125"><span class="label">[125]</span></a> In Places where the Articles here mentioned are at too
+high a Price for a Soldier&#8217;s Pay, a small Allowance, from the
+Government, of such Things would contribute much to the
+Preservation of the Mens Health in unwholesome Garrisons.</p></div>
+
+<div class="footnote"><p><a name="Footnote_126_126" id="Footnote_126_126"></a><a href="#FNanchor_126_126"><span class="label">[126]</span></a> See Dr. <i>Lind&#8217;s Treatise on the Means of Preserving the
+Health of Seamen in the Royal Navy</i>, where he takes Notice of
+most of the Articles here mentioned with regard to Transport
+Ships in treating of Ships of War.</p></div>
+
+<div class="footnote"><p><a name="Footnote_127_127" id="Footnote_127_127"></a><a href="#FNanchor_127_127"><span class="label">[127]</span></a> When Ships are too much crowded with Men, if they
+meet with a tedious Passage, and hot moist close Weather, they
+are often attacked with Diseases which prove very fatal. Dr.
+<i>Lind</i>, talking of Ships of War, says it is a Mistake destructive
+to the Men to crowd too many of them together in a southern
+Voyage, or in a hot Climate; as the Ship will be found, before
+the End of the Voyage, in more Distress for Want of Men,
+than she would have been, had she at first carried out only her
+proper Compliment. An additional Number is made, in order
+to supply an expected Mortality; but they generally increase
+that Mortality to double or triple their own Number. <i>Ibid.
+note to p. 48.</i></p></div>
+
+<div class="footnote"><p><a name="Footnote_128_128" id="Footnote_128_128"></a><a href="#FNanchor_128_128"><span class="label">[128]</span></a> The following is the Diet established for the Seamen of
+his Majesty&#8217;s Navy.
+</p><p>
+Every Man is allowed a Pound of Biscuit, <i>Averdupoiz
+Weight</i>, and a Gallon of Beer, <i>Wine Measure</i>, <i>per</i> Day.
+</p><p>
+On <i>Sunday</i> and <i>Thursday</i>, one Pound of Pork, and Half a
+Pint of Peas, <i>Winchester Measure</i>.
+</p><p>
+On <i>Monday</i>, <i>Wednesday</i>, and <i>Friday</i>, one Pint of Oatmeal,
+two Ounces of Butter, and four Ounces of Cheese.
+</p><p>
+On <i>Tuesday</i> and <i>Saturday</i> two Pounds of Beef.
+</p><p>
+It is left to the Commanders of Squadrons to shorten the
+aforesaid Allowance of Provisions according to the Exigence
+of the Service, taking Care that the Men be punctually paid
+for the same. As it is thought for the Benefit of the Service
+to alter some of the foregoing Particulars of Provisions in Ships
+employed on foreign Voyages, it is to be observed, that
+</p><p>
+A Pint of Wine, or Half a Pint of Rum, Arrack, or Brandy,
+hold Proportion to a Gallon of Beer.
+</p><p>
+Four Pounds of Flour, or three Pounds of the same with
+a Pound of Raisins, Half a Pound of Currans, or Half a
+Pound of Beef Suet pickled, are equal to a four Pound Piece
+of Beef, or two Pound Piece of Pork with Peas.
+</p><p>
+Half a Pound of Rice is equal to a Pint of Oatmeal.
+</p><p>
+A Pint of Olive Oil is equal to a Pound of Butter, or two
+Pounds of <i>Cheshire</i> Cheese.
+</p><p>
+And Two-thirds of a Pound of <i>Cheshire</i> Cheese is equal to a
+Pound of <i>Suffolk</i>.
+</p><p>
+If Soldiers are sent as Passengers on board of King&#8217;s Ships,
+or on board of Transports, their Allowance is generally but
+Two-thirds of the above.</p></div>
+
+<div class="footnote"><p><a name="Footnote_129_129" id="Footnote_129_129"></a><a href="#FNanchor_129_129"><span class="label">[129]</span></a> This Ventilator is no more than a long Tube, with a Tin
+Box, about six Inches wide and four high, with a Number of
+Holes at the Top, fixed at one End; and this Box is put down
+to the Bottom of the Water, and the Nose of a Pair of Bellows
+fixed to the other End of the Tube, which is above the Water;
+by working the Bellows, fresh Air is driven through the whole
+Body of Water, the putrid Effluvia are evaporated and dispersed,
+and the Water becomes sweet in a very short Time.</p></div>
+
+<div class="footnote"><p><a name="Footnote_130_130" id="Footnote_130_130"></a><a href="#FNanchor_130_130"><span class="label">[130]</span></a> This ought always to be done in the Morning, that all
+the Parts of the Ship may have Time to dry before the Men go
+to rest in their Births at Night; but it ought never to be done
+after Sun-set.</p></div>
+
+<div class="footnote"><p><a name="Footnote_131_131" id="Footnote_131_131"></a><a href="#FNanchor_131_131"><span class="label">[131]</span></a> It has been proposed, that the Air in Ships of War should
+be purified in this Way both by Dr. <i>Lind</i> and by Mons. <i>de Hamel
+de Monceau</i>.</p></div>
+
+<div class="footnote"><p><a name="Footnote_132_132" id="Footnote_132_132"></a><a href="#FNanchor_132_132"><span class="label">[132]</span></a> A sufficient Store of Blankets has often been neglected to
+be carried out in Expeditions into warm Climates; but Blankets
+are no-where more necessary, as it is very prejudicial to the
+Health of Soldiers to be obliged to lie down on the bare
+Ground; and Straw, dried Reeds, and other such Things, are
+often difficult to be got in the warm Climates.</p></div>
+
+<div class="footnote"><p><a name="Footnote_133_133" id="Footnote_133_133"></a><a href="#FNanchor_133_133"><span class="label">[133]</span></a> Dr. <i>Lind</i> says, the Use of the cold Bath, either in Tubs
+under the Forecastle, or to dip in the Sea early in the Morning,
+has been found extremely beneficial in warm Weather and hot
+Countries; and that he can affirm, from his own Experience in
+hot Climates, that many Diarrh&#339;as and other Complaints, the
+pure and sole Effect of an unusual and great Heat (relaxing the
+System of the Solids, and occasioning a Colliquation of the
+Animal Juices), have not only been cured by cold Bathing;
+but their Return, and even the Attack of such Diseases, effectually
+prevented by it. <i>Ibid.</i> p. 44, &amp;c.</p></div>
+
+<div class="footnote"><p><a name="Footnote_134_134" id="Footnote_134_134"></a><a href="#FNanchor_134_134"><span class="label">[134]</span></a> Mr. <i>du Hamel</i> says, that the Air of the Island of <i>St. Domingo</i>
+is very fatal to <i>Europeans</i>; but it is observed that those
+People who inhabit the rising Grounds are much less exposed
+to Diseases than those who live in the Vallies. <i>Sur la sant&eacute; des
+Equipages</i>, art. i. p. 16.</p></div>
+
+<div class="footnote"><p><a name="Footnote_135_135" id="Footnote_135_135"></a><a href="#FNanchor_135_135"><span class="label">[135]</span></a> Ground may seem very dry and healthful, and yet be
+quite the contrary, as Dr. <i>Pringle</i> remarks is the Case in the
+Neighbourhood of <i>Bois le Duc</i>, in <i>Flanders</i>, where Water is
+found every where at the Depth of two or three Feet from the
+Surface.</p></div>
+
+<div class="footnote"><p><a name="Footnote_136_136" id="Footnote_136_136"></a><a href="#FNanchor_136_136"><span class="label">[136]</span></a> Mr. <i>du Hamel</i> remarks, that Places which were formerly
+very subject to Diseases have become healthful when the Water
+which surrounded them was refreshed by opening a Communication
+with the Sea. <i>Ibid.</i> art. i. p. 18.</p></div>
+
+<div class="footnote"><p><a name="Footnote_137_137" id="Footnote_137_137"></a><a href="#FNanchor_137_137"><span class="label">[137]</span></a> Dr. <i>Pringle</i> observes, that where Grounds are equally
+dry, that the Camps are always most healthful on the Banks of
+large Rivers; because in the hot Season Situations of this Kind
+have a Stream of fresh Air from the Water, tending to carry
+off both the moist and putrid Exhalations.&mdash;And in Cantonments
+we are not only to seek Villages removed from marshy
+Grounds, but such as are least choaked with Plantations, and
+stand highest above subterraneous Water. See his <i>Observat.
+on Diseases of the Army</i>, 3d edit. p. 99.</p></div>
+
+<div class="footnote"><p><a name="Footnote_138_138" id="Footnote_138_138"></a><a href="#FNanchor_138_138"><span class="label">[138]</span></a> The Negroes on the Coast of <i>Guinea</i>, and some of the
+<i>Indians</i>, both of whom sleep on the Ground, have constantly a
+Fire producing a little Smoak burning in the Hutts where they
+sleep, which corrects the Moisture of the Night, and renders
+the Damp of the Earth less noxious; and during the Time of
+the very unwholesome Fogs on the Coast of <i>Guinea</i>, called Harmattans,
+which lay waste whole Negroe Towns, the Smoak of
+Wood, of pitched Staves, and such Things, are found to be
+the best Correctors of this thick Air. See Dr. <i>Lind&#8217;s Means of
+preserving the Health of Seamen</i>.</p></div>
+
+<div class="footnote"><p><a name="Footnote_139_139" id="Footnote_139_139"></a><a href="#FNanchor_139_139"><span class="label">[139]</span></a> Dr. <i>Lind</i> says, that it is constantly observed in unhealthy
+Harbours, that the Boats Crews employed in wooding and watering
+the Ships, who are obliged to lie on Shore, suffer most.
+<i>Ibid.</i> p. 72.</p></div>
+
+<div class="footnote"><p><a name="Footnote_140_140" id="Footnote_140_140"></a><a href="#FNanchor_140_140"><span class="label">[140]</span></a> A very remarkable Instance of this we have related by
+Dr. <i>Lind</i>. In the Year 1739, in <i>Mahon</i> Harbour, a Party of
+Men were sent with the Coopers from Admiral <i>Haddock</i>&#8217;s Fleet
+to refit and fill the Water Casks, who, finding an artificial Cave
+dug out of a soft sandy Stone, put their bedding into it; every
+one who slept in this damp Place was infected with the Tertian
+Fever, then epidemic in <i>Minorca</i>, and not one in eight recovered.
+At the same Time the Men aboard the Ships continued
+healthy; and others, who were afterwards sent on the same
+Duty, enjoyed perfect Health by being obliged to sleep in their
+respective Ships. He says, he has known a whole Boat&#8217;s Crew
+seized next Morning with bad Fevers by sleeping near the
+Mangroves, with which the Sides of the Rivers are frequently
+planted in the Torrid Zone. <i>Ibid.</i> p. 74, 75.</p></div>
+
+<div class="footnote"><p><a name="Footnote_141_141" id="Footnote_141_141"></a><a href="#FNanchor_141_141"><span class="label">[141]</span></a> The higher that Ships sail up the Rivers upon the Coast
+of <i>Guinea</i>, the more sickly they become: Such, however, as
+keep at Sea beyond the Reach of the Land Breezes (that is, two
+or three Leagues at Sea), are for the most part healthy. <i>Lind</i>,
+<i>ibid.</i> p. 65. The Malignity of these Land Vapours often does
+not extend itself to any considerable Distance, as we know by
+manifold Experience. The Troops in <i>Zealand</i> were very unhealthy
+when Admiral <i>Mitchel</i>&#8217;s Squadron, which lay but a little
+Way from the Shore, enjoyed perfect Health.&mdash;Dr. <i>Pringle&#8217;s
+Observat. on the Diseases of the Army</i>, p. 1. chap. vii.&mdash;In <i>July</i>
+and <i>August</i> 1744, two Ships, belonging to Admiral <i>Long</i>&#8217;s
+Squadron in the <i>Mediterranean</i>, lying near the Mouth of the
+River <i>Tyber</i>, began to be affected, while others, though at a
+very small Distance, but further out at Sea, had not a Man
+sick. <i>Lind</i>, <i>ibid.</i> p. 66.</p></div>
+
+<div class="footnote"><p><a name="Footnote_142_142" id="Footnote_142_142"></a><a href="#FNanchor_142_142"><span class="label">[142]</span></a> The divine Lawgiver <i>Moses</i> has enjoined Cleanliness in
+the Camp to the <i>Jews</i> in a particular Manner, when he says,
+</p><p>
+&#8220;Thou shalt have a Place also without the Camp, whither
+thou shalt go forth abroad; and thou shalt have a Paddle
+upon thy Weapon, and it shall be when thou wilt ease thyself
+abroad thou shalt dig therewith, and shalt turn back and
+cover that which cometh from thee. For the Lord thy God
+walketh in the Midst of thy Camp; therefore shall thy
+Camp be holy, that he see no unclean Thing in thee, and
+turn away from thee.&#8221; <i>Deuteronomy</i>, chap. xxiii. verses 12,
+13, 14.</p></div>
+
+<div class="footnote"><p><a name="Footnote_143_143" id="Footnote_143_143"></a><a href="#FNanchor_143_143"><span class="label">[143]</span></a> The <i>British</i> Soldiers in <i>Germany</i> used sometimes to hurt
+their Health by eating great Quantities of raw unripe Apples,
+Plumbs, and other unripe Fruits; but the foreign Troops had
+a much better Method of using such Fruits: They commonly
+boiled or stewed them, and eat them with Bread, or with their
+Meat, which in a great Measure corrected their bad Qualities.
+</p><p>
+The Orders in the <i>French</i> Camp, prohibiting the Men from
+eating unripe Fruit, were strictly complied with every-where in
+<i>Germany</i> during the late War.</p></div>
+
+<div class="footnote"><p><a name="Footnote_144_144" id="Footnote_144_144"></a><a href="#FNanchor_144_144"><span class="label">[144]</span></a> See the Treatise published by Dr. <i>Luc. Anton. Portius</i>
+in 1686, <i>de Militis in castris sanitate tuenda</i>, <i>part.</i> ii. <i>cap.</i> vi.
+In this Book we have many useful Things mentioned relative
+to the Health of Soldiers.</p></div>
+
+<div class="footnote"><p><a name="Footnote_145_145" id="Footnote_145_145"></a><a href="#FNanchor_145_145"><span class="label">[145]</span></a> Dr. <i>Lind</i> relates a Number of Experiments of his having
+distilled Sea Water in different Manners, as recommended by
+others; and concludes, that the best Way of getting fresh Water
+from Salt, is to distil the Sea Water by itself, without any
+Mixture; and he proposes having a Still Head to the Coppers
+or Iron Pots in which the Meat is dressed aboard a Ship. <i>Ibid.
+note to p. 84</i>, &amp;c.</p></div>
+
+<div class="footnote"><p><a name="Footnote_146_146" id="Footnote_146_146"></a><a href="#FNanchor_146_146"><span class="label">[146]</span></a> During the Campaign in <i>Hungary</i>, in the Year 1717,
+Count <i>Boneval</i> preserved both himself and Family from Disorders,
+by taking himself, and making all his Domesticks take,
+two or three Times a Day, a small Quantity of Brandy, in
+which Bark had been infused, at a Time when all the Rest of
+the Army were infected with malignant Disorders. A Regiment
+in <i>Italy</i> continued healthy by the Use of the Bark, when
+the Rest of the <i>Austrian</i> Army, who did not pursue the same
+Method, were greatly annoyed with Sickness. See <i>Kramer.</i>
+quoted by Dr. <i>Lind</i>.</p></div>
+
+<div class="footnote"><p><a name="Footnote_147_147" id="Footnote_147_147"></a><a href="#FNanchor_147_147"><span class="label">[147]</span></a> <i>Observat.</i> part. i. chap. iii.</p></div>
+</div>
+
+
+<h2><a name="MILITARY_HOSPITALS" id="MILITARY_HOSPITALS"></a><small>OF</small><span class='pagenum'><a name="Page_355" id="Page_355">[355]</a></span><br />
+<span class="smcap">Military Hospitals</span>.</h2>
+
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">W</span>henever</span> Men are seized with
+Distempers, they ought immediately
+to be separated from those in Health, and
+either sent to the Regimental<a name="FNanchor_148_148" id="FNanchor_148_148"></a><a href="#Footnote_148_148" class="fnanchor">[148]</a> or General
+Hospital.</p>
+
+<p>There is no Part of the Service that requires
+more to be regarded than the Choice of proper
+<span class='pagenum'><a name="Page_356" id="Page_356">[356]</a></span>Places for Hospitals, and the right Management
+of them, on which the Health and Strength of
+an Army often depends; for in wet unwholesome
+Seasons, if infectious Disorders get into
+the Hospitals, which possibly might have been
+prevented by proper Care, they often weaken
+an Army in a very short Time far more than
+the Sword of the Enemy.</p>
+
+<p>We have no Account of the particular Manner
+in which the Antients took Care of their
+Sick and Wounded in Times of War; for although
+we read in <i>Homer</i><a name="FNanchor_149_149" id="FNanchor_149_149"></a><a href="#Footnote_149_149" class="fnanchor">[149]</a> of Surgeons or
+Physicians attending the <i>Grecian</i> Camp, and in
+<i>Xenophon</i><a name="FNanchor_150_150" id="FNanchor_150_150"></a><a href="#Footnote_150_150" class="fnanchor">[150]</a> of <i>Cyrus</i>&#8217;s having appointed Physicians
+to his Army; and we learn from <i>Tacitus</i><a name="FNanchor_151_151" id="FNanchor_151_151"></a><a href="#Footnote_151_151" class="fnanchor">[151]</a>
+<span class='pagenum'><a name="Page_357" id="Page_357">[357]</a></span>and <i>Livy</i><a name="FNanchor_152_152" id="FNanchor_152_152"></a><a href="#Footnote_152_152" class="fnanchor">[152]</a>, that the wounded <i>Romans</i> were
+received into the Houses of the Nobility, and
+had Physicians to attend them, and were furnished
+with Fomentations and other proper
+Remedies; and from <i>Justin</i><a name="FNanchor_153_153" id="FNanchor_153_153"></a><a href="#Footnote_153_153" class="fnanchor">[153]</a>, that the <i>Lacedemonians</i>
+followed the same Method: yet
+these Authors make no Mention of the particular
+Oeconomy or Manner in which these
+Hospitals were conducted.</p>
+
+<p>The Hospitals commonly wanted for an Army
+acting on the Continent, are,</p>
+
+<p>1. One in the Rear, to follow their Motions,
+so as to be always ready to receive the Sick
+from Camp, which is called the Moveable or
+Flying Hospital. 2. One or more, at some
+<span class='pagenum'><a name="Page_358" id="Page_358">[358]</a></span>Distance, in Towns, to receive such of the
+Sick as can be moved from the Flying Hospital,
+when they are obliged to go from one
+Place to another; or when a greater Number
+of Sick is sent to them than they can easily
+take Care of<a name="FNanchor_154_154" id="FNanchor_154_154"></a><a href="#Footnote_154_154" class="fnanchor">[154]</a>.</p>
+
+<p>Each of the Hospitals ought to be provided
+with Physicians, Surgeons Mates, Purveyors,
+or Commissaries, and others, to attend and take
+Care of the Sick.</p>
+
+<p>Besides the physical People who attend the
+Hospital, one or two Physicians ought to go
+along with the Army to attend the Commander
+in Chief, and the General and Staff Officers,
+in Case of Sickness; and an Apothecary,
+provided with a small Chest of Medicines,
+ought to attend at Head Quarters to make up
+the Prescriptions of the Physicians.</p>
+<p><span class='pagenum'><a name="Page_359" id="Page_359">[359]</a></span></p>
+<p>A Number of Hospital Surgeons also, with
+Mates, ought to attend the Army, to be ready
+in Case of an Action. These ought to be attached
+to the Suite of the Commanders of the
+different Corps or Brigades, and to be quartered
+or encamped with them. And each Surgeon
+should be provided with a Waggon or some
+Horses loaded with a proper chirurgical Apparatus,
+as Instruments, Bandages, Lint, and
+other Things necessary for taking Care of the
+Wounded.</p>
+
+<p>A small Quantity of Medicines, some Wine,
+Rice, portable Soop, &amp;c. and Utensils for a
+small Hospital, and two, three, or four hundred
+Sets of Bedding, should be carried about
+with the Army, in Case of an Action, for the
+Use of the Wounded, till they have Time to
+receive Assistance from the Flying Hospital.
+Some of the Bedding ought to be carried on
+Horseback, so as to be at Hand when any of
+the Surgeons are sent with Detachments that are
+going upon an Attack.</p>
+
+<p>To prevent crowding the General Hospitals
+in Winter Quarters, every Regiment ought to<span class='pagenum'><a name="Page_360" id="Page_360">[360]</a></span>
+take Care of their own Sick, and to have proper
+Hospitals fitted up for them.</p>
+
+<p>Dr. <i>Pringle</i> has laid down some very good
+Directions with regard to the Choice of Places
+fit for Hospitals, and the Method of preventing
+infectious Disorders in them; and we find
+many excellent Hints of this Kind in Dr. <i>Lind</i>
+and Mons. <i>du Hamel</i>&#8217;s Treatises on the Means
+of Preserving the Health of Seamen, and some
+likewise in Dr. <i>Brocklesby</i>&#8217;s late Treatise on military
+Disorders.</p>
+
+<p>In the Time of Service the Commander in
+Chief generally orders the Hospitals to be established
+in Towns or Villages that least interfere
+with the military Operations, to which the
+Sick and Wounded can most easily be conveyed;
+and which he can best protect from the
+Insults of the Enemy<a name="FNanchor_155_155" id="FNanchor_155_155"></a><a href="#Footnote_155_155" class="fnanchor">[155]</a>.</p>
+<p><span class='pagenum'><a name="Page_361" id="Page_361">[361]</a></span></p>
+<p>In Towns, the Places fittest for Hospitals are
+public Buildings, which have large dry airy
+Apartments, situated on a high Ground, where
+there is a free Draught of Air, and a Command
+of Water.</p>
+
+<p>In Winter, those Houses, which have open
+Fire Places in the Rooms, are always preferable
+to such as have close Stoves, or no Fire
+<span class='pagenum'><a name="Page_362" id="Page_362">[362]</a></span>Place at all; for an open Fire Place serves
+to keep up a free Circulation of Air in a Room,
+as well as to keep it warm. And for the same
+Reason, where nothing but Stoves can be got
+to warm the Wards, the Wynd Stoves, which
+open into the Room or Ward, are vastly preferable
+to the close ones.</p>
+
+<p>Where there are no public Buildings, private
+Houses answering nearest to the above Description
+are most proper for Hospitals. In general,
+Houses with small Rooms make but bad
+Hospitals; and very Damp and close Places
+ought by all Means to be avoided.</p>
+
+<p>In Summer, when the Moveable or Flying
+Hospital is ordered into Villages, large Barns,
+and the largest airy Houses, are the best.</p>
+
+<p>Churches, situated on a dry high Ground,
+make good Summer Hospitals; and in Winter,
+when Necessity obliged us sometimes to use
+them in <i>Germany</i> for this Purpose, they were
+found to answer very well, when we had
+Bedsteads or Cradles for the Men to lie upon,
+and the Wynd Stoves to keep them of a
+moderate Heat.<span class='pagenum'><a name="Page_363" id="Page_363">[363]</a></span></p>
+
+<p>In making Choice of Houses for Hospitals,
+particular Regard ought to be had to the Privies
+or Necessaries; because, where their Smell
+is offensive, there is always Danger of infectious
+Disorders. If, therefore, there be no
+proper Conveniencies of this Kind about an
+Hospital, such ought to be contrived so as to
+prevent any Danger from their putrid Effluvia.
+If there be a River near the Hospital, the Necessaries
+may be made above it at a Place
+where there is a rapid Stream below. In Villages
+deep Pits may be dug in the Ground
+behind the Hospital, and Seats made over
+them, as in Camp; and a thick Lay of Earth
+be thrown above the F&#339;ces every Morning,
+till the Pits are near full, and then they must
+be filled up, and others dug to supply their Place.</p>
+
+<p>When once the Places are fixed upon for
+Hospitals, every Ward ought to be made perfectly
+sweet and clean; first, by scraping and
+washing with Soap and Water, and afterwards
+with warm Vinegar; and then they ought to
+be fumigated with the Smoke of wetted Gunpowder
+and of Aromatics, and afterwards well<span class='pagenum'><a name="Page_364" id="Page_364">[364]</a></span>
+dried and aired by lighting Fires, and opening
+the Windows, before any Sick are admitted.</p>
+
+<p>After this the Beds ought to be laid; in doing
+of which great Care should be taken not to
+crowd the Wards too much, as nothing corrupts
+the Air so much, or so soon brings on infectious
+Disorders. Dr. <i>Pringle</i> says, the Beds
+ought to be laid so thin, that a Person unacquainted
+with the Danger of bad Air, might
+imagine there was Room for double or triple
+the Number. In high lofty Apartments, and
+in Churches, and other large Places, the Beds
+may be laid much closer together than in
+Rooms with low Cielings. In Churches, or
+such Places, thirty-six square Feet, or a Square
+of six Feet by six, may be allowed for each
+Man; but in common Wards we must allow
+from forty-two square Feet, <i>i.&nbsp;e.</i> six by seven
+Feet, to sixty-four square Feet, or eight by
+eight, according to the Height of the Cieling,
+the Airyness of the Place, and the Nature of
+the Diseases of the Patients.</p>
+
+<p>The Bedding most fit for Hospitals, is Palliasses
+and Bolsters filled with Straw, Sheets,<span class='pagenum'><a name="Page_365" id="Page_365">[365]</a></span>
+and Blankets, as they can easily be washed.
+Feather Beds and Matrasses are apt to retain
+Infection, and cannot be easily cleansed. In
+the fixed Hospitals, Bedsteads or Cradles may
+be set up for laying the Bedding on: But in
+the Moveable or Flying Hospital the Bedding
+must be, for the most part, laid on the Floor.</p>
+
+<p>When once the Beds are laid, and the Sick
+arrive, some of the Gentlemen belonging to the
+physical Department ought to attend, to distribute
+the Sick properly through the Hospitals.</p>
+
+<p>All the Surgery Patients, such as have
+Wounds, Ulcers, Sores, the Venereal Disease,
+&amp;c. should be separated from the Rest, and put
+either into particular Wards by themselves, or
+into an Hospital fitted up for that Purpose under
+the Direction of the Surgeons.</p>
+
+<p>Those labouring under infectious Fevers and
+Fluxes, should each of them be placed in good
+airy Wards by themselves, where the Beds are
+laid much thinner than in the other Wards of
+the Hospital. If the Flux Wards have a Privy
+near them, where the Men can ease themselves,<span class='pagenum'><a name="Page_366" id="Page_366">[366]</a></span>
+without being offensive either to their
+own Ward, or any other Part of the Hospital,
+they are so much the fitter for such Patients.
+In the Hospital I attended at <i>Bremen</i>, the Flux
+Ward had a Necessary that opened into the
+River <i>Weser</i>, and at <i>Natzungen</i> a deep Pit was
+dug in the Field about twenty Yards from the
+Barn where the Flux Men lay, which kept
+these Wards always sweet.</p>
+
+<p>Patients that have got the Itch, or any other
+infectious Distemper, ought likewise to be put
+into separate Wards by themselves; and at all
+Times a Place should be set apart for those who
+may be taken ill of the Measles or Small-Pox.
+A House separated from the other Hospitals,
+with a distinct Set of Nurses and other Attendants,
+bids fairest to prevent the Infection from
+spreading.</p>
+
+<p>When once the Sick are properly ranged,
+the next Care must be to prevent infectious
+and malignant Disorders from being generated,
+and from spreading amongst the Sick; which is
+principally to be effected by keeping the Sick<span class='pagenum'><a name="Page_367" id="Page_367">[367]</a></span>
+and the Hospital extremely clean and well-aired,
+and the Wards as sweet, and free from
+putrid and offensive Smells, as possible.</p>
+
+<p>Every sick Man, as soon as he arrives at an
+Hospital, should be washed with warm Water,
+or if there is a warm Bath, or bathing Tub, to
+be put into it; and afterwards be supplied with
+a clean Shirt<a name="FNanchor_156_156" id="FNanchor_156_156"></a><a href="#Footnote_156_156" class="fnanchor">[156]</a> well-aired before he be put to
+Bed; and his own dirty Linen should be immediately
+carried to the Wash-House: And
+every Morning each Nurse ought to carry a
+Bucket full of warm Water, and a Piece of
+Soap and a Towel, round to each of her
+Patients, and make them wash their Hands
+and Face, and their Feet, when dirty.</p>
+
+<p>Every Morning all the Wards ought to be
+scraped and swept, and afterwards sprinkled
+with warm Vinegar; and when dirty, they
+ought to be washed after the Fires are lighted.</p>
+<p><span class='pagenum'><a name="Page_368" id="Page_368">[368]</a></span></p>
+<p>Every Thing in the Wards, and about the
+Sick, should be kept as clean as possible; the
+Chamber-Pots and Close-Stools ought to be
+carried away as soon as used, and immediately
+emptied and washed before they be brought
+back.</p>
+
+<p>The Windows of the Wards ought to be
+kept open to admit fresh Air Morning and
+Evening, for a longer or shorter Time, according
+as the Weather will permit.</p>
+
+<p>If the Wards are close, and the Cieling too
+low, Dr. <i>Pringle</i> advises to remove some Part
+of them, and to open the Garret Story to the
+Tiles<a name="FNanchor_157_157" id="FNanchor_157_157"></a><a href="#Footnote_157_157" class="fnanchor">[157]</a>; and if the Opening of the Windows
+<span class='pagenum'><a name="Page_369" id="Page_369">[369]</a></span>is not sufficient to air the Wards, Ventilators of
+different Kinds, such as those mentioned by Dr.
+<i>Hales</i> and Dr. <i>Pringle</i>, may be used, especially
+when the Weather is hot.</p>
+
+<p>In Winter, Fires should be lighted in all
+the Wards where it can be done.</p>
+
+<p>In foreign Countries, when we meet with
+Hospitals where there are no Places for open
+Fires, but only close Stoves, different Contrivances
+may be used to renew the Air. Ventilators
+of different Kinds may be used, or Openings
+made in the Doors and Windows. In
+Winter 1761-62, some of the Wards in the
+Hospital at <i>Bremen</i> which I attended had
+such Stoves. In order to keep up a free Circulation
+of Air in those Wards, I directed large
+Holes to be cut in the lower Part of the Door
+in each Ward, and two Grooves to be made on
+the Outside of the Door, above and below the
+Hole, parallel to each other, in which a Board
+slided; by means of which, the Hole could be
+either quite covered or only in Part, or left
+entirely open; and I directed a Casement,<span class='pagenum'><a name="Page_370" id="Page_370">[370]</a></span>
+about eight or nine Inches square, to be made
+in the upper Corner of each Window. After
+the Fires were lighted, upon removing the
+Board which covered the Hole in the Door,
+and opening the little square Windows, a Current
+of fresh cool Air rushed into the Ward by
+the Door, while the heated foul Air found an
+Exit by the Windows. In very cold Weather,
+the Opening of the small Windows was sufficient;
+but in mild Weather, and in Summer,
+it was necessary to keep both open.</p>
+
+<p>The Wards should be daily fumigated by
+Means of Aromatics, or wetted Gunpowder
+thrown on burning Coals, put in an Iron Pot
+or Chaffern, or with the Steams of warm Vinegar
+placed in the Middle of the Ward. Dr.
+<i>Lind</i> says, that although Cleanliness and a pure
+Air contribute much to prevent infectious Disorders,
+or to check them, yet that they of
+themselves are not always sufficient; but that
+he seldom or never knew a proper Application
+of Fire and Smoke to be unsuccessful in producing
+the happy Consequence of effectually<span class='pagenum'><a name="Page_371" id="Page_371">[371]</a></span>
+purifying all tainted Places, Materials, and Substances<a name="FNanchor_158_158" id="FNanchor_158_158"></a><a href="#Footnote_158_158" class="fnanchor">[158]</a>.</p>
+
+<p>In all Military Hospitals, at least in the fixed
+ones, one Ward ought to be always kept
+empty; and whenever a malignant Fever, or
+any other infectious Disorder, breaks out in any
+Ward, the Men ought to be removed into this
+empty one; and the foul Ward purified, by
+washing and cleaning it well with Soap and
+Water, and then with warm Vinegar; and afterwards
+purifying it with Smoke, in the same
+Manner as is practised in his Majesty&#8217;s Ships of
+War; and Fires should be lighted daily, and
+the Windows kept open for some Time, before
+any Sick be again admitted into it.</p>
+<p><span class='pagenum'><a name="Page_372" id="Page_372">[372]</a></span></p>
+<p>As soon as any Patient dies, the Body ought
+to be removed to the Dead House; and the
+Bedding he lay upon should be carried away
+immediately, and not used again till it has been
+smoked, well-aired, and washed.</p>
+
+<p>All the Linen of Patients in Fevers, Fluxes,
+and other infectious Disorders, ought to be
+changed often; and all the foul Linen and foul
+Bedding of the Hospital should be smoked
+with the Fumes of Brimstone, or of wetted
+Gunpowder, in a Place set apart for that Purpose;
+and Dr. <i>Lind</i> advises to steep them first
+in cold Water, or cold Soap Lees, before putting
+them in warm Water; as it is dangerous
+for any Person to receive the Steam that may
+at first arise, where this Precaution is not
+used.</p>
+
+<p>All the Cloaths, of Soldiers who die in Hospitals,
+ought to be sent to the Smoke House,
+and be well fumigated, and afterwards aired,
+before they are put up in the Store-House.</p>
+
+<p>The next Thing to be considered about a
+Military Hospital is the Diet of the Patients,
+which should consist of good wholesome Provisions,<span class='pagenum'><a name="Page_373" id="Page_373">[373]</a></span>
+that can be purchased easily, and at a
+cheap Rate<a name="FNanchor_159_159" id="FNanchor_159_159"></a><a href="#Footnote_159_159" class="fnanchor">[159]</a>.</p>
+
+<p>Good Bread<a name="FNanchor_160_160" id="FNanchor_160_160"></a><a href="#Footnote_160_160" class="fnanchor">[160]</a> is a standing Article of Provisions
+for an Hospital in all Countries and in
+all Climates; and a certain Quantity of it
+ought to be distributed to each Man daily.</p>
+
+<p>The Breakfast and Supper in most Military
+Hospitals must be made of Water Gruel or
+Rice Gruel; as either Rice or Oatmeal can be
+got in most Places, and are very portable.&mdash;Water
+Gruel is in general preferable to the
+Rice Gruel, because most Patients nauseate the
+Rice Gruel, after eating it for some Days, but
+not the Water Gruel, as every Person, who has
+attended the Military Hospitals, must have experienced.
+<span class='pagenum'><a name="Page_374" id="Page_374">[374]</a></span>Where both Rice and Oatmeal can
+be had, Rice Gruel may be used two or three
+Times a Week by Way of Variety.</p>
+
+<p>But although Rice Gruel is not so proper
+for constant Use, yet Rice should always make
+an Article among the Stores for an Hospital, as
+it is useful for making Rice Water for Drink;
+and it can be boiled or ground, and made into
+a light Pudding, and in short may be used in a
+Variety of Forms to make a good and wholesome
+Food for the Sick.</p>
+
+<p>Oatmeal is cheaper than Rice, and can be
+procured almost every-where in <i>Europe</i>, where
+Armies make Campaigns; as Oats make such
+a great Article in the Forage for Horses. And
+a sufficient Quantity can at any Time be ground
+into Meal for the Use of the Sick, at the Mills
+which are employed for making Flour for the
+Bakery, if there be none nearer the Hospital.</p>
+
+<p>In Countries where neither Oatmeal nor
+Rice can be had, <i>Indian</i> or some other Corn,
+which is known to be wholesome, and which
+the Country affords, may be employed in their
+Place.<span class='pagenum'><a name="Page_375" id="Page_375">[375]</a></span></p>
+
+<p>When fresh Meat can be got, the Men who
+are on full Diet, and the Nurses and other
+Servants about the Hospital, should have Meat
+for Dinner; and the Meat that is boiled for
+them ought to make Broth for the Sick who
+are kept on a low or middle Diet. Some Barley
+or Rice should be added to the Broth; and
+a small Quantity of Carrots, Turnips, or other
+Vegetables, boiled along with them, will make
+it more agreeable to the Taste.</p>
+
+<p>On Expeditions where nothing but salted
+Meat can be had, a Quantity of portable Soop
+should always be carried out for the Use of the
+Sick; which with Water and some Barley,
+and fresh Vegetables, when they can be
+got, will make a good Soop or Broth. On
+such Occasions, the Dinner ought to consist of
+Soop and Bread, or of light Puddings made of
+Flour or of Rice, of boiled Rice or Barley, or
+of Panado, &amp;c.</p>
+
+<p>Nurses and recovered Men may be allowed
+salted Meat twice or thrice a Week.</p>
+
+<p>The common Drink of Military Hospitals
+ought to be Rice and Barley Water, with a<span class='pagenum'><a name="Page_376" id="Page_376">[376]</a></span>
+small Proportion of Spirits and Sugar. Small
+Beer is a good Drink where it can be easily
+procured; as is Wine and Water, or a very
+small Negus, or very weak Punch in warm
+Climates.</p>
+
+<p>Besides this Diet, extraordinary Indulgences
+may be occasionally allowed to particular Patients,
+as Wine, Brandy, Sugar, Milk. And
+the Physicians and Surgeons ought to have a
+discretionary Power to order a Vegetable or
+any other proper Diet for Patients in the Scurvy,
+or any other particular Complaints.</p>
+
+
+<p class="negative">The Established Diet of a Military Hospital<span class='pagenum'><a name="Page_377" id="Page_377">[377]</a></span>
+may be,</p>
+
+<table summary="diet" class="diet">
+<tr><td>&nbsp;</td><td style="text-align: center"><i>Breakfast.</i></td><td style="text-align: center"><i>Dinner.</i></td><td style="text-align: center"><i>Supper.</i></td></tr>
+
+<tr><td style="width: 14%; border-right: solid black 1px">Full Diet,</td>
+
+<td style="width: 25%; border-right: solid black 1px"><span style="padding-left: 1em">One Pint of Water or Rice Gruel.</span><br />
+<span style="padding-left: 1em">Water Gruel made with 3 or 4 Ounces of Oatmeal, a
+little common Salt, and with or without a little Sweet Oil, and two Spoonfuls of Wine.</span><br />
+<span style="padding-left: 1em">Rice Gruel made with two Ounces of Rice, one Spoonful of fine Flour, a little
+common Salt and Sugar.</span></td>
+
+<td style="width: 25%;  border-right: solid black 1px">One Pound of boiled fresh Meat.</td>
+
+<td style="width: 25%">As Breakfast.</td></tr>
+
+<tr><td colspan="4" style="line-height: 1%; border-bottom: solid black 1px">&nbsp;</td></tr>
+<tr><td colspan="4" style="line-height: 1%">&nbsp;</td></tr>
+
+<tr><td style="width: 14%; border-right: solid black 1px">Middle Diet,</td>
+
+<td style="width: 25%; border-right: solid black 1px">Ditto.</td>
+
+<td style="width: 25%;  border-right: solid black 1px">One Pint of Broth, half Pound of boiled Meat.</td>
+
+<td style="width: 25%">Ditto.</td></tr>
+
+<tr><td colspan="4" style="line-height: 1%; border-bottom: solid black 1px">&nbsp;</td></tr>
+<tr><td colspan="4" style="line-height: 1%">&nbsp;</td></tr>
+
+<tr><td style="width: 14%; border-right: solid black 1px">Low Diet,</td>
+
+<td style="width: 25%; border-right: solid black 1px">Ditto, or according to the Patient&#8217;s Appetite.</td>
+
+<td style="width: 25%;  border-right: solid black 1px">One Pint of Broth, or half a Pint of Panado, with two Spoonfulls of Wine,
+and a Quarter of an Ounce of Sugar.</td>
+
+<td style="width: 25%">Ditto.</td></tr>
+</table>
+
+
+<p>The daily Allowance of Bread to be one
+Pound to each Man.<span class='pagenum'><a name="Page_378" id="Page_378">[378]</a></span></p>
+
+<p>The common Drink for those on full and
+middle Diet to be Rice or Barley Water, with
+two Spoonfuls of Brandy to each Pint, and a
+Quarter of an Ounce of Lump Sugar; small
+Beer, or very weak Punch; or Wine and Water,
+two Ounces of Wine to a Pint of Water,
+and a Quarter of an Ounce of Sugar. The
+Quantity not to exceed three Pints <i>per</i> Day.</p>
+
+<p>Those on low Diet to have Rice or Barley
+Water as above, with or without Wine or
+Brandy.</p>
+
+
+<p class="negative">The Diet Boards hung up in the Hospitals may
+be made with the following Columns, nearly
+as they were with us in <i>Germany</i>.</p>
+
+<table class="boards" summary="Diet Boards">
+<tr><td>Regiments.</td><td>Mens Names.</td><td colspan="3">Diet<br />F.<span style="padding-left: 1em; padding-right: 1em">M.</span>L.</td><td>Wine.<br />&frac12; Pints.</td>
+<td>Brandy.<br />Ounces.</td><td>Milk.<br />&frac12; Pints.</td><td>Sugar.<br />Ounces.</td></tr>
+<tr style="line-height: 1500%"><td>&nbsp;</td><td>&nbsp;</td><td style="width: 1%">&nbsp;</td><td style="width: 1%">&nbsp;</td><td style="width: 1%">&nbsp;</td><td>&nbsp;</td><td>&nbsp;</td>
+<td>&nbsp;</td><td>&nbsp;</td></tr>
+</table>
+
+<p>When such Diet Boards are kept in an Hospital,<span class='pagenum'><a name="Page_379" id="Page_379">[379]</a></span>
+and the Mens Names and Regiments are
+once wrote down, the Patients may with very
+little Trouble be put upon the full, middle, or
+low Diet, with so much of the above-mentioned
+Extraordinaries as may be judged proper.</p>
+
+<p>If any Thing else be wanted for the Sick,
+the Physician ought to give a particular Order
+in Writing for it, the Columns here marked
+being only for such Things as are most frequently
+wanted.</p>
+
+<p>It should be a general Rule in all Military
+Hospitals, that, when a Party of Sick arrives,
+every Man may have immediately a Mess of
+Water Gruel given him, and afterwards be put
+on low Diet till it is ordered otherwise by the
+Physician or Surgeon who attends him.</p>
+
+<p>It is not to be supposed that the Diet here
+mentioned can be strictly kept to in all Parts of
+the World; for it must often be varied according
+to the Difference of the Climates, and to
+the Provision of the Countries where the Scene
+of War may be.<span class='pagenum'><a name="Page_380" id="Page_380">[380]</a></span></p>
+
+<p>Whenever a Moveable or Flying Hospital is
+to attend an Army, a Quantity of Bedding, and
+of all Utensils for forming an Hospital, ought
+to be put up in the Waggons, together with
+Provisions of different Kinds, such as Oatmeal,
+Rice, Sago, Brandy, Wine, Sugar, &amp;c. A Butcher
+with a Stock of live Cattle, and a Baker
+with a proper Quantity of Flour for making
+Bread ought constantly to attend; and a Number
+of empty Waggons should likewise be always
+in Readiness, to transport the Sick when
+the Hospital moves, or when a Party is to be
+sent to the fixed Hospitals.</p>
+
+<p>When Troops go upon an Expedition, besides
+the common Hospital Ships, another Ship
+ought to be properly fitted up for the Reception
+of sick Officers<a name="FNanchor_161_161" id="FNanchor_161_161"></a><a href="#Footnote_161_161" class="fnanchor">[161]</a>; and every Hospital
+Ship ought to be supplied with all Sorts of
+<span class='pagenum'><a name="Page_381" id="Page_381">[381]</a></span>Provisions, and other Necessaries fit for forming
+an Hospital, before they leave <i>England</i>.&mdash;And
+one or more armed Vessels loaded with
+Provisions, Wine, and all Sorts of Necessaries
+for the Sick, ought to attend them; or if the
+Expedition be intended for the warm Climates,
+these Vessels ought to go before the Fleet to
+take up Wine and Fruits, such as Lemons,
+Oranges, &amp;c. Vegetables of different Kinds,
+and a live Stock for the Use of the Sick.</p>
+
+<p>All Hospitals attending Expeditions should
+carry out among their Stores a Number of
+large Tents for lodging the Sick and Wounded
+immediately on making good their Landing.
+Where a Siege is expected which will take up
+Time, and where no Accommodations for the
+Sick can be had till the Siege is over, a Ship or
+two, with Boards, and other Necessaries for
+building large Sheds, or temporary Hutts, for
+the Sick, as proposed by Dr. <i>Brocklesby</i>, ought
+to go along with the Fleet, or meet them at
+the Place of their Destination. Such thatched
+Sheds, or Hutts, are very necessary in the warm
+Climates, as the perpendicular Rays of the Sun,<span class='pagenum'><a name="Page_382" id="Page_382">[382]</a></span>
+beating upon Canvass, make Tents intolerably
+hot. When any of our own Settlements
+happen to be near the Place attacked, a fixed
+Hospital may be established there; either in
+Houses, if proper ones can be found; or in
+temporary Sheds or Hutts erected for that Purpose;
+and some Vessels, properly fitted up,
+may be kept going with the Sick and Wounded,
+and bringing back the recovered Men.</p>
+
+<p>At every Military Hospital a Serjeant&#8217;s Guard
+ought to mount; and Centinels be placed at
+the Doors of the Hospital, 1. To prevent all
+Visitors, who have not proper Leave, from
+coming into the Hospitals; as such People oftentimes
+crowd the Wards, disturb the Sick,
+and are apt to catch infectious Distempers, and
+to spread them among the Troops. 2. To
+take Care the Patients do not go out of the
+Hospital without having a Ticket<a name="FNanchor_162_162" id="FNanchor_162_162"></a><a href="#Footnote_162_162" class="fnanchor">[162]</a> of Leave
+for that Purpose, signed by the Physician, Surgeon,
+<span class='pagenum'><a name="Page_383" id="Page_383">[383]</a></span>or Apothecary, belonging to the Hospital.
+3. To prevent spirituous Liquors, or other
+Things of that Kind, being clandestinely carried
+into the Hospital.</p>
+
+<p>The Serjeant of the Guard, attended by the
+Ward Master, ought, every Morning, to go
+round the Wards to call a Roll, and see that
+every Man is in his Ward; and to do the same
+at Night before the Hospital Doors are shut,
+and at this Time to order every Person out of
+the Hospital who does not belong to it. And
+the Serjeant, every Morning, ought to report
+to the Physician, Surgeon, or Apothecary,
+every Man&#8217;s Name who was found to be absent
+at Roll-calling; and whether he found every
+Thing regular and in good Order in going his
+Rounds.</p>
+
+<p>Every large Military Hospital ought to have
+one Head Nurse, and a sufficient Number of
+other Nurses, to attend and take Care of the
+Sick.</p>
+
+<p>Orders to the following Purport, hung up in
+every Military Hospital, would serve to shew
+the Nurses and Patients what their Duty is,<span class='pagenum'><a name="Page_384" id="Page_384">[384]</a></span>
+and to maintain Regularity and good Order
+through the whole Hospital.</p>
+
+
+<h4><i>Matron, or Head Nurse.</i></h4>
+
+<p>Every Matron, or Head Nurse, is to go
+round all the Wards of the Hospital at least
+twice a Day, Morning and Evening; to see
+that the Nurses keep their Wards clean; that
+they behave themselves soberly and regularly,
+and give due Attendance to their Patients; and
+to examine the Diet of the Patients, and see
+that it is good and well dressed; and if she
+finds any Thing amiss, to report the same to
+the Physician, Surgeon, or Apothecary, of the
+Hospital.</p>
+
+
+<h4><i>Common Nurses.</i></h4>
+
+<p>1. The Nurses are to give due Attendance
+to their Patients; and to keep them always as
+neat and clean, as the Nature of their Distempers
+will admit of; to give them their Diet
+regularly; to be particularly careful to see them
+take the Medicines ordered by the Physicians,<span class='pagenum'><a name="Page_385" id="Page_385">[385]</a></span>
+according to the Directions given; to report to
+the Physician, Surgeon, or Apothecary, any Faults
+or Irregularities which any of their Patients
+may have committed; and to acquaint
+the Ward Matter and Head Nurse of the Death
+of any of their Patients as soon as it happens,
+that proper Care may be taken of their Cloaths
+and Effects.</p>
+
+<p>2. They are to keep their Wards extremely
+clean, to sprinkle them every Morning with
+Vinegar, and to fumigate them with the Smoke
+of wetted Gunpowder, or of Frankincense, or
+any other Aromatics that may be thought proper;
+in fair Weather to keep open the Windows
+of their Wards, twice or thrice a Day;
+for a longer or shorter Time, as the Weather
+will permit; to attend at the Steward&#8217;s Room
+for the Provisions of the Patients at the Hours
+appointed for that Purpose; and to pay implicit
+Obedience to the Matron, or Head Nurse,
+in what relates to their Duty; and punctually
+to obey all Orders they receive from the Physician,
+Surgeon, or Apothecary, of the Hospital.<span class='pagenum'><a name="Page_386" id="Page_386">[386]</a></span></p>
+
+<p>3. They are to keep themselves clean and
+decently dressed, and to observe the strictest
+Rules of Sobriety; remembering, that if any
+one is found intoxicated with Liquor, that she
+is immediately to be sent to the Guard, and
+afterwards discharged.</p>
+
+<p>4. They are not to absent themselves from
+their Wards, unless when employed in the Discharge
+of their Duty; nor to go out of the
+Hospital to which they belong, without having
+a Ticket of Leave signed by the Physician,
+Surgeon, Apothecary, or Head Nurse, belonging
+to the Hospital.</p>
+
+<p>5. They are not to throw Nastiness of any
+Kind out at the Windows, but to carry it to the
+common Necessaries, and to empty the Chamber
+Pots and Close-stools as soon as used, and
+be careful to wash them before they bring
+them back.</p>
+
+<p>6. They are not, upon any Pretence whatever,
+to alter the Diet ordered by the Physicians
+or Surgeons to the Patients on the Diet
+Boards; nor to suffer their Patients to use any
+other Diet than what is allowed by the Hospital;<span class='pagenum'><a name="Page_387" id="Page_387">[387]</a></span>
+nor are they to bring, or allow others to bring,
+Meat, spirituous Liquors, or other Things of
+that Kind, into their Wards, except what is allowed
+by the Physicians or Surgeons. Whenever
+any Thing of this Kind is found in any of
+the Wards, it ought immediately to be thrown
+into the common Necessary; and if it be
+found in the Custody of a Nurse, she ought to
+be confined in the Guard, or discharged.</p>
+
+<p>7. Nurses guilty of great Neglect of Duty,
+or of getting drunk and using their Patients ill,
+or of stealing, or concealing or taking away the
+Effects of Men who die in the Hospital, are to
+be immediately sent to the Guard, and reported
+to the Commanding Officer of the Place, that
+they may be tried by a Court-Martial, and be
+confined, whipped, or otherwise punished, as
+the military Law directs; all Followers of Armies
+on foreign Service being equally subject
+to the military Law as the Soldiers themselves.</p>
+
+
+<h4><i>Patients.</i></h4>
+
+<p>1. All sick Soldiers, on their Arrival at a Military
+Hospital, are to be washed all over with<span class='pagenum'><a name="Page_388" id="Page_388">[388]</a></span>
+warm Water, or to go into a warm Bath;
+and afterwards to wash their Face and
+Hands every Morning, and their Feet occasionally,
+with warm Water and Soap, brought
+round every Morning by the Nurses for that
+Purpose; and they ought to comb their Head
+every Day. If they be too weak to wash and
+comb themselves, it is to be done by their
+Nurses.</p>
+
+<p>2. Every Patient is to be shaved and have
+clean Linen twice a Week, or oftener if requisite.</p>
+
+<p>3. They are punctually to obey the Directions
+given them, and to take the Medicines ordered
+by the Physician; and none to be allowed
+to go out of the Hospital without a Ticket
+of Leave signed by the Physician, Surgeon, or
+Apothecary, of the Hospital.</p>
+
+<p>4. They must commit no Disorder or Riot,
+but in all Respects behave themselves well.</p>
+
+<p>5. If any Man disobeys the Orders he receives
+from the Physicians or Surgeons, or is
+irregular in Conduct, gets drunk, and commits
+Riots in the Hospital, or is found guilty<span class='pagenum'><a name="Page_389" id="Page_389">[389]</a></span>
+of Theft or other Crimes, the same is to be reported
+to the Commanding Officer of the
+Place, and he to be tried by a Court-Martial,
+and punished as soon as his Strength will
+permit.</p>
+
+<p>In conducting the Military Hospitals, we
+found that it was always right to discharge the
+Patients from the sick Hospitals as soon as they
+were recovered, and to send them either to
+Billet, or to a convalescent Hospital; because
+recovered Men are always the most riotous;
+besides they crowded the Hospitals, and were
+in Danger of catching fresh Disorders from
+those who were sick; and therefore the recovering
+Men in every Hospital ought to be reviewed
+once or twice a Week by the Physician
+or Surgeon, and the Names of such Men
+as are well enough, to be marked; in order that
+they may be sent the next Day to the convalescent
+Hospital, or to Billet. A Return of
+those marked for Billet ought immediately to
+be sent to the Officers on convalescent Duty.</p>
+
+<p>When a convalescent Hospital is established,
+it ought to be put under proper Regulations;<span class='pagenum'><a name="Page_390" id="Page_390">[390]</a></span>
+the following are those which I drew
+up for that established at <i>Osnabruck</i> in <i>April</i>
+1761, and which were found to answer the
+Purpose intended.</p>
+
+
+<h4><i>Regulations for a Convalescent Hospital.</i></h4>
+
+<p>1. That this Hospital be entirely occupied
+by such Men as are recovered from Diseases;
+that no Men be sent there but those whose
+Names are returned to the Purveyor&#8217;s Office by
+the Physician or Surgeon of the Hospital.</p>
+
+<p>2. That all the Patients shall be upon full
+Diet, unless in particular Cases it be ordered
+otherwise by the Physician or Surgeon.</p>
+
+<p>3. That all the Patients shall breakfast, dine,
+and sup, at regular stated Hours, in the Hall
+appointed for that Purpose: Breakfast to be
+ready at nine, Dinner at one, and Supper at
+seven o&#8217;Clock in the Evening.</p>
+
+<p>4. That no Patient shall carry up any Victuals
+into the Wards appointed for sleeping in; and
+if any Patient does not attend at the regular
+Hours of Meals, no Allowance of Victuals<span class='pagenum'><a name="Page_391" id="Page_391">[391]</a></span>
+shall be made him in the Place of such Meals,
+unless he has been absent on Hospital Business,
+or been confined to Bed by Sickness.</p>
+
+<p>5. That as soon as the Men are come down
+Stairs to Breakfast, the Wards in which they
+sleep shall be cleaned out and sprinkled with
+Vinegar, and the Windows opened to air
+them.</p>
+
+<p>6. That the Doors of this Hospital shall be
+locked every Night at eight o&#8217;Clock, and no
+Man be allowed to come in or go out after that
+Time. The Doors to be opened again at seven
+o&#8217;Clock in the Morning.</p>
+
+<p>7. That the said Hospital is to be visited two
+or three Times a Week by the Physician, Surgeon,
+and Apothecary, who are to see that the
+above Orders are complied with; to examine
+the Diet, and take Care that every Thing is
+carried on properly; and to prescribe for any
+little Disorders the Men may be affected with.</p>
+
+<p>8. That one of the Hospital Mates be appointed
+to visit this Hospital daily, to administer
+any Medicines which may have been prescribed<span class='pagenum'><a name="Page_392" id="Page_392">[392]</a></span>
+by the Physician; to apply any Dressings
+ordered by the Surgeon; and to acquaint
+the Physician or Surgeon if any of the Men be
+so bad as to require their Attendance, or to be
+sent back again to the Sick Hospital.</p>
+
+<p>9. That for the better executing these Regulations,
+orderly Serjeants or Corporals be appointed
+for the Care of the Men; who shall
+mount a Guard of six or more of such of the
+Patients of the said Hospital as are fit for this
+Duty&mdash;That the Serjeants are to call a Roll of
+all the Patients regularly three Times a Day,
+before Breakfast, Dinner, and Supper; to see
+that the Men behave themselves soberly and
+decently; and that they keep themselves clean,
+and commit no Riots; and to confine in the
+Guard such as commit Riots and other Irregularities,
+or whom they find drunk, or who stay
+out all Night; and to report the same to the
+Officer on Duty.</p>
+
+<p>10. That an Officer on convalescent Duty do
+visit the said Hospital daily at the Times of
+Roll-calling, to see that every Thing be carried
+on properly; and to receive the Reports from<span class='pagenum'><a name="Page_393" id="Page_393">[393]</a></span>
+the Serjeants, and give what Orders he may
+think proper for the better regulating the said
+Hospital.</p>
+
+<p>11. That if at any Time it should happen
+that there are more Convalescents than the
+Hospital can hold conveniently, a Review be
+made of all the Patients, and the strongest and
+most healthy be sent to Billet.</p>
+
+<p>12. That a Review be always made, when
+any Party is going to join the Army, to pick
+out the Men who are fit to join their Regiments.</p>
+
+<p>The Physical Officers employed in the Military
+Hospitals, are Physicians, Surgeons, and
+Apothecaries.</p>
+
+<p>No Person ought to be appointed a Physician
+to the Army, or Military Hospitals, without
+previously undergoing the same Examination
+at the College of Physicians, as those do who
+enter Fellows and Licentiates of the College,
+that none but proper Persons may be employed.
+On such Examinations the Physician General
+to the Army ought to be allowed to sit as one
+of the Censors of the College.<span class='pagenum'><a name="Page_394" id="Page_394">[394]</a></span></p>
+
+<p>The Surgeons are all obliged to pass an Examination
+at Surgeons Hall before they are appointed,
+and the Apothecaries ought in like
+Manner to pass an Examination at Apothecaries
+Hall.</p>
+
+<p>The Mates employed in the Service ought,
+previous to their Appointment, to be examined
+both in Surgery and Pharmacy, as the Service
+commonly requires their acting in both
+Branches.</p>
+
+<p>The Direction of all Military Hospitals
+ought always to be committed to the Physicians,
+who have the immediate Care of Hospitals.</p>
+
+<p>When an Army is acting on a Continent,
+and there is a Number of Hospitals in different
+Places, the Physician who attends the Commander
+in Chief ought to be made Physician
+General and Director of the Hospitals, with
+proper Appointments; and all Orders from
+Head Quarters ought to go immediately thro&#8217;
+this Channel.</p>
+
+<p>Every other Physician at the different Hospitals
+ought to direct every Thing about the<span class='pagenum'><a name="Page_395" id="Page_395">[395]</a></span>
+Hospital which he attends, and his Orders
+ought to be punctually obeyed; and he ought
+to keep up a constant Correspondence with the
+Physician General; acquainting him from Time
+to Time with the State of the Hospital, and
+what is wanted for it; and he ought punctually
+to obey whatever Orders he receives from
+the Physician General.</p>
+
+<p>If there be separate Hospitals for the Surgery
+Patients, the eldest Surgeon ought to direct
+every Thing in the Hospital he attends; and
+when any Thing is wanted for his Hospital,
+to report the same to the Physician General.</p>
+
+<p>The directing and purveying Branches ought
+never to be entrusted to the same Person, as
+the Temptation of accumulating Wealth has at
+all Times, and in all Services, given Rise to the
+grossest Abuses, which have been a great Detriment
+to the Service, as well as to the poor
+wounded and sick Soldiers, and has occasioned
+the Loss of many Lives. And therefore neither
+the Physician General, nor any of the Physicians
+or Surgeons of the Army, or any other
+Person concerned in the Direction of the Military<span class='pagenum'><a name="Page_396" id="Page_396">[396]</a></span>
+Hospitals, ought ever to act as Purveyor
+or Commissary; nor ought they ever to have
+any Thing to do with the Accounts, Contracts,
+or any other Money Affairs relating to
+the Hospital; and if ever they be found to
+intermeddle in these Affairs, they ought to be
+immediately dismissed the Service.</p>
+
+<p>The purveying or commissariate Branch
+ought to be entirely distinct from the physical.
+The Purveyors or Commissaries ought punctually
+to obey whatever Orders they receive
+from the Physicians or Surgeons; to provide
+every Thing for the Hospital; to keep regular
+Accounts of all the Men who come into, or
+go out of the Hospitals; and from Time to
+Time to make Returns to Head Quarters of
+all the Men in Hospitals; and their Accounts
+ought to be controuled by such Persons as the
+Government may think proper.</p>
+
+<p>Every Physician and Surgeon of a Military
+Hospital ought to visit the Sick at regular stated
+Hours, and the Mates to attend and go round
+with them, and receive and execute their Orders.<span class='pagenum'><a name="Page_397" id="Page_397">[397]</a></span></p>
+
+<p>Every Mate ought to have a certain Number
+of Patients allotted him, for whom he is
+to make up all Medicines, dress all Sores, and
+execute whatever Orders he receives from the
+Physician, Surgeon, or Apothecary. That the
+Mates may know and execute their Duty,
+proper Orders in Writing should be hung up
+in the Apothecaries Shop for that Purpose.
+The following are those which I gave out at
+all the Hospitals I attended in <i>Germany</i>.</p>
+
+
+<h4><i>Orders for the Mates.</i></h4>
+
+<p>1. That all the Gentlemen do attend at the
+Apothecaries Shop every Morning at eight
+o&#8217;Clock, to assist in making up the common
+Medicines of the Day, and afterwards to go
+round the Hospitals with the Physicians and
+Surgeons.</p>
+
+<p>2. That every Mate have a Book for writing
+the Prescriptions of the Physicians in,
+which is to be kept in the following Order.&mdash;First,
+to mark the Patient&#8217;s Name and Regiment;
+then the Day of his Entry into the Hospital<span class='pagenum'><a name="Page_398" id="Page_398">[398]</a></span>
+and his Disorder; then the Prescriptions
+of the Physician; and after all the Day of his
+Discharge, or of his Death. <i>Ex. gr.</i></p>
+
+<div class="blockquot">
+<p class="negative"><i>John Clarke</i>, 20th Regiment. <i>Jan.</i> 1. Fever.</p>
+
+<p><i>Jan.</i> 1. V.&nbsp;S. unc. x.&mdash;H. salin. cum pulv.
+contrayerv. 4<sup>r</sup>. die.&mdash;2. Emplast. vesicat. dorso,
+&amp;c.</p>
+
+<p style="padding-left: 2em">Discharged or dead <i>Jan.</i> 28.</p></div>
+
+<p>3. That every Mate make up himself the
+Physician&#8217;s Prescriptions for his own Patients,
+and afterwards go round and administer them,
+or give them to his Patients with proper Directions;
+that he bleed his own Patients, and
+dress any slight Sores they may have, which
+do not require their being sent to the Surgery
+Hospital.</p>
+
+<p>4. That every Mate go round amongst his
+Patients in the Evening, to see that every
+Thing is well conducted, and to report to the
+Physician or Apothecary if any Thing extraordinary
+happens.<span class='pagenum'><a name="Page_399" id="Page_399">[399]</a></span></p>
+
+<p>5. That two of the Mates attend all Day at
+the Apothecary&#8217;s Shop to receive any Sick that
+may arrive, and to place them properly; to
+make up what Medicines they may immediately
+want; to order each of them a Mess of
+Water Gruel; and if any Thing extraordinary
+occurs, to send an orderly Man to acquaint the
+Physician or Apothecary with the same. The
+orderly Mates to make up likewise for Officers,
+or others, all Prescriptions sent to the Apothecary&#8217;s
+Shop through the Day.</p>
+
+<p>A Joint of Meat, roasted or boiled, for
+Dinner, and a Bottle of Wine, was allowed to
+the orderly Mates, by Lord <i>Granby</i>&#8217;s Order,
+that they might not absent themselves from
+their Duty.&mdash;Where there was Conveniency
+for it, a Mate lodged in the Hospital.</p>
+
+<p>The Apothecary ought to take Care of the
+Medicines; to go round the Hospitals in the
+Morning before the Time of the Physician&#8217;s
+visiting; to see that the Wards are in proper
+Order; that the Nurses and other Servants
+have done their Duty; to examine into the
+State of the Sick, and to see that the Provisions<span class='pagenum'><a name="Page_400" id="Page_400">[400]</a></span>
+are good; and make a faithful Report of all
+these Things to the Physician when he arrives.&mdash;To
+take Care that the Mates prepare in the
+Morning the Medicines that are commonly
+wanted for the Day; and that they afterwards
+make up faithfully the Prescriptions of the
+Physician; to go round the Hospital again in
+the Evening, to see that the Sick have got their
+Medicines regularly; and to make the same
+Enquiries as in the Morning.</p>
+
+<p>The Apothecary should always be lodged
+near the Hospital, to assist in Case of any Accidents
+happening, or of Sick arriving at the
+Hospital.</p>
+
+<p>When there are any strong infectious Disorders
+in Military Hospitals, the physical Gentlemen
+may use the following Precautions to guard
+themselves against Infection.</p>
+
+<p>1. Never to visit the Sick with an empty
+Stomach; but to eat Breakfast before they go
+into the Hospital.</p>
+
+<p>2. To have a Suit of Cloaths reserved for
+visiting the Hospital, and a waxed Linen Coat
+to wear above them in going round the Wards;<span class='pagenum'><a name="Page_401" id="Page_401">[401]</a></span>
+and as soon as they have come out of the Hospital,
+to wash and change their Linen and
+Cloaths.</p>
+
+<p>3. Before they go into the Wards, to order
+that they be well cleaned out, and sprinkled
+with Vinegar, and afterwards fumigated, and
+aired by opening the Windows, or by Working
+the Ventilators.</p>
+
+<p>4. If the Infection be very strong, to take a
+Glass of the spirituous Tincture of the Bark
+just before they go into the Hospital.</p>
+
+<p>5. To put small Rolls of Lint, dipped in
+camphorated Spirits, up the Nostrils, and to
+direct a Vessel, with warm camphorated Vinegar,
+to be carried round, and held near the
+Patients they are examining.</p>
+
+<p>6. In examining Patients affected with the
+Petechial Fever, or any other malignant Distempers,
+to stand at some little Distance, and
+ask what Questions they may think proper;
+and when they come near, to feel the Pulse,
+and examine the Skin, not to inspire while
+their Head is near the Patient&#8217;s Body; but
+after being fully satisfied in these Points, to retire<span class='pagenum'><a name="Page_402" id="Page_402">[402]</a></span>
+a little, and ask what other Questions may
+be necessary.</p>
+
+<p>It would be right to establish some military
+Rank for every commissioned Officer of the
+Hospital on Service, and to settle the same Subordination
+in the physical as in the military
+Department. By these Means, the Service
+would be carried on with greater Order, and
+more Advantage to the Sick.</p>
+
+<p>And it would be right, in Times of War,
+to add a Clause in the Mutiny Bill to allow
+any military Officer on convalescent Duty
+to call in the commissioned physical Officers
+to assist in making up a Court-Martial,
+when there are not a sufficient Number of military
+Officers in a Place, to try convalescent
+Soldiers guilty of Crimes. For in Times of
+Service, very often a sufficient Number of military
+Officers cannot be spared to be on Duty
+at the different Military Hospitals; and at all
+such Places the Convalescents are generally
+very disorderly, when they know that there is
+not a sufficient Number of Officers to form a
+Court-Martial for punishing them. Where-ever<span class='pagenum'><a name="Page_403" id="Page_403">[403]</a></span>
+there are a sufficient Number of military
+Officers, no physical Officer ought ever to be
+called upon as a Member of a Court-Martial.</p>
+
+<p>Men, in Time of Service, are often apt to
+saunter in and about Hospitals, and there learn
+all Manner of Debaucheries, and lose all Sense
+of Discipline; and therefore, to keep up Order
+and Decorum, there ought to be, at every
+Fixed and every large Military Hospital, a military
+Inspector or Commander, an Officer of
+known Activity and Probity; and a Number
+of Officers on convalescent Duty sufficient to
+form a Court-Martial whenever required.</p>
+
+<p>The Duty of the Military Inspector, or
+Commander, should be, to take Care of all
+Convalescents on Billet; to see that the Officers
+under him do their Duty, and maintain the
+same Regularity and Discipline among the
+Men belonging to their respective Corps, as if
+they were with their Regiments; and that the
+Men attend the Parade and Roll-calling; and
+that they always appear neat and clean.</p>
+
+<p>He ought, from Time to Time, to visit the
+Hospitals; to see if they are kept clean; to<span class='pagenum'><a name="Page_404" id="Page_404">[404]</a></span>
+enquire if the Men behave well, if the Diet is
+good, and the Officers, Nurses, and Servants,
+do their Duty; and if he finds any Thing
+amiss, to report the same to the Physicians and
+Surgeons of the Hospital, or to the Purveyor or
+Commissary, or others, under whose Department
+it may be, that the same may be immediately
+rectified; and if he finds that the superior
+Officers of the Hospital overlook such Abuses,
+notwithstanding his Representations, to report
+the same immediately to the Head Quarters.</p>
+
+<p>He ought to order one of the Officers on
+convalescent Duty to visit the Hospitals daily,
+to make the Enquiries above-mentioned, and
+to give him a Report of the same in Writing.</p>
+
+<p>The Purveyor or Commissary ought to
+make a Return to him twice or thrice a Week
+of every Man admitted into, or discharged
+from, the Hospitals, or who dies in them;
+marking in the Return the Name of every
+Man, and the Company and Regiment he belongs
+to; that he may report the same to the
+Officers of the different Brigades or Regiments.<span class='pagenum'><a name="Page_405" id="Page_405">[405]</a></span></p>
+
+<p>The Military Inspector ought to have the
+Power of providing Billets for all Officers and
+Soldiers about Hospitals; and the Names of
+all Men to be discharged from Hospitals should
+be sent to him the Day before they are discharged,
+that he may provide Billets for them;
+and next Day the Men ought to march from
+the Hospitals to the Parade, to receive their
+Billets, and the Orders of the Military Inspector,
+and of the Officers of the Corps they belong to.</p>
+
+<p>The Military Inspector ought to see that the
+Arms of the sick Men, and the Arms and
+Cloaths of those who die and are lodged in the
+Magazines, be properly taken Care of; and
+that the Stores of the different Regiments be
+properly looked after.</p>
+
+<p>As the Service often makes it necessary at
+Military Hospitals, where the Number of Sick
+is great, to employ the convalescent Soldiers<a name="FNanchor_163_163" id="FNanchor_163_163"></a><a href="#Footnote_163_163" class="fnanchor">[163]</a>
+<span class='pagenum'><a name="Page_406" id="Page_406">[406]</a></span>as orderly Men and Servants about Hospitals,
+all Men thus employed ought to have a special
+Leave from the Military Inspector for so doing;
+and no Man should be employed in any
+Capacity as a Servant about an Hospital, who
+at that Time is on the Books as a Patient.
+And all Men employed about the Hospital
+ought to be reviewed once a Week by the Military
+Inspector, and likewise whenever a Party
+of Convalescents is going to join the Army, or
+their Regiments; that no Man may be allowed
+to remain with the Hospital, after he is fit to
+do Duty in his Regiment.</p>
+
+<p>When the Military Inspector is absent, the
+eldest Officer on convalescent Duty ought to
+act in his Place.</p>
+
+<p>Every Officer sent on convalescent Duty
+ought, as soon as he arrives at the Place where
+the Hospital is, to wait on the Commandant,
+or Military Inspector; to acquaint him of his
+Arrival, and to receive his Commands. He
+ought then to go to the Purveyor or Commissary&#8217;s
+Office, to get a List of all the Soldiers
+who are in or about the Hospital, and belong to<span class='pagenum'><a name="Page_407" id="Page_407">[407]</a></span>
+the Regiment or Brigade he is employed for,
+wherein those on Billet are distinguished from
+those in Hospitals. The next Day he ought
+to parade all those marked on Billet, to see if
+the Number of Men agrees with the List
+given him, and to examine in what State each
+Man is, and how he is employed; and then
+he ought to go round the Hospitals, attended
+by an orderly Serjeant, to see all the Men in
+the Hospitals, and to know if the List given him
+at the Purveyor&#8217;s Office was right; and afterwards
+he ought to send every Day a Serjeant
+or Corporal to see the Men in Hospitals, and
+to report to him when any Men are discharged
+or die.&mdash;And he ought to procure from the
+Military Inspector a Return of all the Men of
+his Corps, who are either admitted into, or discharged
+from Hospitals, on the Days when
+such Returns are made. He ought to make all
+his Men on Billet appear regularly on the Parade
+at Roll-calling, and to oblige them to
+keep themselves clean and their Arms in good
+Order, and to endeavour to preserve the same
+Regularity and Discipline as when they are<span class='pagenum'><a name="Page_408" id="Page_408">[408]</a></span>
+with their Regiments. And whenever a Party
+is to be sent to join their Regiments, he ought
+to have all his Men particularly examined;
+and those Men who are found to be perfectly
+recovered, should be sent to their Regiments.</p>
+
+<p>If every Officer on convalescent Duty conform
+to these Directions, no Man can ever be
+detained without his Knowledge in or about
+Hospitals, as he must always know where every
+Man is, in what State of Health, and how he
+is employed; and may at any Time be able to
+make a Return to the Brigade or Regiment for
+which he is employed, of every Man who is
+admitted, discharged, or dies in the Hospital.</p>
+
+
+<p class="center" style="letter-spacing: 0.25ex; padding-top: 2em; padding-bottom: 1em; font-size: 130%">FINIS.</p>
+
+<div class="footnotes"><h3>FOOTNOTES:</h3>
+
+<div class="footnote"><p><a name="Footnote_148_148" id="Footnote_148_148"></a><a href="#FNanchor_148_148"><span class="label">[148]</span></a> Some of the regimental Surgeons in <i>Germany</i>, when they
+took the Field, had always some spare Tents carried along with
+their Medicine Chests; and when any of their Men fell sick in
+Camp, and they could get no House for a regimental Hospital
+in Villages, they ordered these Tents to be pitched, and had
+the Ground within well covered with Straw and Blankets, and
+then put the Sick into them, and there took Care of them till
+they found an Opportunity of sending them to the Flying Hospital.</p></div>
+
+<div class="footnote"><p><a name="Footnote_149_149" id="Footnote_149_149"></a><a href="#FNanchor_149_149"><span class="label">[149]</span></a> <i>Homer</i> mentions <i>Podalirius</i> and <i>Machaon</i>, sons of <i>&AElig;sculapius</i>,
+as two excellent Physicians or Surgeons in the <i>Grecian</i>
+Army. Vid. <i>Iliad</i>, lib. ii. Physic and Surgery were antiently
+exercised by the same Persons.</p></div>
+
+<div class="footnote"><p><a name="Footnote_150_150" id="Footnote_150_150"></a><a href="#FNanchor_150_150"><span class="label">[150]</span></a> Vid. <i>Xenophon. de Institut. Cyri.</i> lib. i. et viii.</p></div>
+
+<div class="footnote"><p><a name="Footnote_151_151" id="Footnote_151_151"></a><a href="#FNanchor_151_151"><span class="label">[151]</span></a> <i>Tacitus</i>, after giving an Account of 50,000 People being
+killed by the Fall of an Amphitheatre at <i>Fidena</i>, during the
+Time of a Shew of Gladiators, has these Words: &#8220;Ceterum
+post recentem cladem, patuere procerum domus, fomenta &amp;
+medici passim pr&aelig;biti; suit urbs per illos dies, quanquam
+m&aelig;sta facie veterum institutis similis, qui magna post pr&aelig;lia
+saucios largitione &amp; cura sustentabant.&#8221; <i>Vid. lib.</i> iv. <i>Annal.</i>
+&sect; 63.</p></div>
+
+<div class="footnote"><p><a name="Footnote_152_152" id="Footnote_152_152"></a><a href="#FNanchor_152_152"><span class="label">[152]</span></a> In <i>Livy</i> we find the following Passage: &#8220;Neque immemor
+ejus quod initio consulatus imbiberat, conciliandi animos
+plebis, saucios milites curandos dividit patribus. Fabiis
+plurimi dati, nec alibi majore cura habiti.&#8221; <i>Vid. lib.</i> ii.
+cap. xlvii.</p></div>
+
+<div class="footnote"><p><a name="Footnote_153_153" id="Footnote_153_153"></a><a href="#FNanchor_153_153"><span class="label">[153]</span></a> <i>Justin</i> mentions the same Thing of the <i>Spartans</i> after
+their Defeat at <i>Sellasia</i>&mdash;&#8220;Patentibus omnes domibus saucios
+excipiebant, vulnera curabant, lapsos reficiebant.&#8221; <i>Vid.
+lib.</i> xxviii. cap. iv.</p></div>
+
+<div class="footnote"><p><a name="Footnote_154_154" id="Footnote_154_154"></a><a href="#FNanchor_154_154"><span class="label">[154]</span></a> When Parties of Sick or Wounded are to be sent from
+Camp, or from one Hospital to another, Care ought to be
+taken that they are placed properly in the Waggons; that
+they have proper physical People, Nurses, &amp;c. to attend
+them; as well as Provisions, and other Necessaries, so as to
+be in no Danger of wanting any Thing while they are on their
+Journey.</p></div>
+
+<div class="footnote"><p><a name="Footnote_155_155" id="Footnote_155_155"></a><a href="#FNanchor_155_155"><span class="label">[155]</span></a> The <i>Roman</i> Generals seem to have sent their Sick and
+Wounded into Towns, in the same Manner as is done by those
+of the present Time. For we read in <i>C&aelig;sar&#8217;s Commentaries</i> of
+this Method having been practised on more Occasions than
+one. In the sixty-second Chapter of the third Book, <i>de Bello
+Civili</i>, we have the following Passage: &#8220;Itaque nulla interposita
+mora, sauciorum modo &amp; &aelig;grorum habita ratione, impedimenta
+omnia silentio prima nocte ex castris <i>Apolloni&aelig;</i>
+pr&aelig;misit, ac conquiescere ante iter confectum vetuit. His
+una legio missa pr&aelig;sidio est.&#8221;&mdash;And immediately after, in
+chap. lxv. &#8220;Itaque pr&aelig;missis nunciis ad Cn. Domitium C&aelig;sar
+scripsit, &amp; quid fieri vellet ostendit: pr&aelig;sidioque <i>Apolloni&aelig;</i>
+cohortibus iv. <i>Lissi</i> i. tres <i>Orici</i> relictis; quique erant ex
+vulneribus &aelig;gri depositis; per Epirum atque Arcarniam iter
+facere c&aelig;pit.&#8221;
+</p><p>
+And in the twentieth chapter, <i>de Bello Africano</i>, we read:
+&#8220;<i>Labienus</i> saucios suos, quorum numerus maximus fuit, jubet
+in plaustris deligatos <i>Adrumentum</i> deportari.&#8221;
+</p><p>
+It would be a right Measure, in the Beginning of every War,
+to settle by a Cartel that military Hospitals on both Sides should
+be considered as Sanctuaries for the Sick, and mutually protected;
+as was agreed upon between the late Earl of <i>Stairs</i>,
+who commanded the <i>British</i> Troops, and the Duke <i>de Noailles</i>,
+who commanded the <i>French</i> in the Campaign in <i>Germany</i> in the
+year 1743. See <i>Dr. Pringle&#8217;s Preface</i>.</p></div>
+
+<div class="footnote"><p><a name="Footnote_156_156" id="Footnote_156_156"></a><a href="#FNanchor_156_156"><span class="label">[156]</span></a> Every military Hospital ought to have a Number of
+Shirts belonging to it, for the Use of the Sick who arrive without
+having clean Linen with them. As soon as their own
+Shirts are washed and dried, or that new ones are provided by
+their Regiments, the Hospital Shirts ought to be taken from
+them.</p></div>
+
+<div class="footnote"><p><a name="Footnote_157_157" id="Footnote_157_157"></a><a href="#FNanchor_157_157"><span class="label">[157]</span></a> In Wards which are too close, it has been found that one
+or two square Holes (of about six or eight, or ten Inches diameter),
+cut in the Cieling, and a Tube made of Wood fitted to
+it, and carried up into the Chimney of the Ward above, so as to
+enter above the Grate, is one of the best Contrivances for procuring
+a free Circulation of Air; as the foul Air, which is
+lightest, and occupies the highest Part of the Ward, finds a free
+Exit by these Tubes: We have such Tubes now fixed in several
+of the Wards in <i>St. George</i>&#8217;s Hospital. A Hole cut above
+the Door of the Ward, or in the upper Part of the Windows,
+and one of what are called the <i>Chamber Ventilators</i> fixed in it,
+will answer, where Holes cannot be conveniently cut in the
+Cieling.</p></div>
+
+<div class="footnote"><p><a name="Footnote_158_158" id="Footnote_158_158"></a><a href="#FNanchor_158_158"><span class="label">[158]</span></a> Dr. <i>Lind</i> tells us, that the Ships of War in his Majesty&#8217;s
+Service are purified by Fire and Smoke, and gives the Process
+by which it is done; and he says, that he never heard of any
+Ship, which, after being carefully and properly smoked, did
+not immediately become healthy for the Men.&mdash;See <i>First Paper
+on Fevers and Infection</i>.&mdash;And he observes, that these Steams
+and Smoke, which are inoffensive to the Lungs, besides correcting
+the bad Quality of the Air, produce another good Effect;
+which is, to make both the Patients and Nurses desirous
+of opening the Doors and Windows for the Admission of fresh
+Air. <i>Ibid.</i> p. 51.</p></div>
+
+<div class="footnote"><p><a name="Footnote_159_159" id="Footnote_159_159"></a><a href="#FNanchor_159_159"><span class="label">[159]</span></a> The <i>French</i>, and many other Nations, give their Patients
+Meat Soops in acute Diseases, and after capital Operations;
+and they allow them but little Bread or other Preparations
+of Vegetable Substances: But these Meat Soops without
+Bread do not nourish the Patient sufficiently, and tend too much
+to the Putrescent; and this is one Reason why more Sick die
+in the <i>French</i> than in the <i>British</i> Hospitals.</p></div>
+
+<div class="footnote"><p><a name="Footnote_160_160" id="Footnote_160_160"></a><a href="#FNanchor_160_160"><span class="label">[160]</span></a> On Expeditions where a Siege is expected, a Quantity
+of Flour ought to be carried out, and a Number of portable
+Ovens for baking bread for the Sick, which may be put up
+after the Troops have made good their Landing.</p></div>
+
+<div class="footnote"><p><a name="Footnote_161_161" id="Footnote_161_161"></a><a href="#FNanchor_161_161"><span class="label">[161]</span></a> If there be no Ship fitted up for the Reception of sick
+Officers, those who are taken ill on Expeditions must be in a
+most miserable Situation; as there is no Place to receive them
+in the common Hospital Ships, they must remain almost without
+Assistance in a crowded Cabin amongst People in Health; as
+was the Case in some of our Expeditions during the late War.</p></div>
+
+<div class="footnote"><p><a name="Footnote_162_162" id="Footnote_162_162"></a><a href="#FNanchor_162_162"><span class="label">[162]</span></a> At every Hospital there ought to be a Number of printed
+Tickets lying ready to be filled up and signed by the Physicians
+and Surgeons, and no Man ought to be allowed to go out
+without a Ticket so signed.</p></div>
+
+<div class="footnote"><p><a name="Footnote_163_163" id="Footnote_163_163"></a><a href="#FNanchor_163_163"><span class="label">[163]</span></a> In the <i>French</i> Hospitals there are always a Number of
+Men who attend their Sick who belong to the Hospital, so that
+they have no Occasion to employ their Convalescents, as we
+are often obliged to do, where the Sick are attended by Nurses,
+who are commonly Soldiers Wives, and not so capable of doing
+such laborious Work as the Men.</p></div>
+
+</div>
+
+
+
+
+
+
+
+<pre>
+
+
+
+
+
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+most frequent in the British military hospitals in Germany, by Donald Monro
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+The Project Gutenberg EBook of An Account of the Diseases which were most
+frequent in the British military hospitals in Germany, by Donald Monro
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: An Account of the Diseases which were most frequent in the British military hospitals in Germany
+
+Author: Donald Monro
+
+Release Date: February 21, 2010 [EBook #31338]
+
+Language: English
+
+Character set encoding: ASCII
+
+*** START OF THIS PROJECT GUTENBERG EBOOK BRITISH MILITARY HOSPITALS ***
+
+
+
+
+Produced by Irma Spehar and the Online Distributed
+Proofreading Team at http://www.pgdp.net (This file was
+produced from images generously made available by The
+Internet Archive/Canadian Libraries)
+
+
+
+
+
+
+                                  AN
+                                ACCOUNT
+                                OF THE
+                               DISEASES
+
+                    Which were most frequent in the
+
+                      BRITISH MILITARY HOSPITALS
+
+                              in Germany,
+
+             From January 1761 to the Return of the Troops
+                       to England in March 1763.
+
+                          To which is added,
+
+            An ESSAY on the Means of Preserving the Health
+            of Soldiers, and conducting Military Hospitals.
+
+
+                         By DONALD MONRO, M.D.
+
+                PHYSICIAN to his MAJESTY'S ARMY, and to
+                        ST. GEORGE's Hospital.
+
+
+                                LONDON:
+
+           Printed for A. MILLAR, D. WILSON, and T. DURHAM,
+            in the Strand; and T. PAYNE, at the Mews-Gate.
+
+                               MDCCLXIV.
+
+
+
+
+TO THE KING.
+
+
+May it please Your MAJESTY,
+
+To permit me to lay at your Feet the following Sheets, published with
+a View to be useful to those, who hereafter may have the Care of the
+Health of your MAJESTY's Troops.
+
+YOUR MAJESTY's particular Inquiries into the State of Your Military
+Hospitals, in every Quarter of the World, in the Time of the late
+glorious and successful War; Your Concern for every Officer and
+Soldier who suffered either by Sickness or by Wounds in the Cause of
+their King and Country; and Your Solicitude to procure them every
+possible Assistance and Relief, cannot fail to excite the highest
+Admiration of Your MAJESTY's Goodness in the Breast of every Subject,
+and the warmest Gratitude in the Heart of every Soldier.
+
+The Knowledge of these Circumstances induced me to flatter myself,
+that a Work of this Kind would be agreeable to Your MAJESTY; and
+should this Attempt towards pointing out the Means of alleviating
+those Miseries, which necessarily attend a Military Life in the Time
+of Service, be acceptable, I shall obtain the utmost of my Wishes; it
+being the greatest Ambition of my Heart ever so to act as to merit
+Your MAJESTY's Approbation, and to subscribe myself,
+
+      May it please Your MAJESTY,
+
+    Your MAJESTY's most dutiful Subject,
+
+        And most faithful
+
+          and humble Servant,
+
+      DONALD MONRO.
+
+
+
+
+THE PREFACE.
+
+Among the numerous Authors of Observations in the Art of Physick,
+there are but few who have expressly written on the Treatment of those
+Distempers, most generally incident to an Army in the Field: The
+following Work, therefore, seems to have a fair Claim to be acceptable
+to the Publick, having been compiled during the Author's Attendance on
+the _British_ Military Hospitals in _Germany_ in the late War; and in
+order to render it of still further Use, he has occasionally added, by
+Way of Note, the Practice of some of the most eminent Physicians in
+similar Diseases, as well as a few Histories of Cases which passed
+under his own Care at _St. George_'s Hospital, _London_.
+
+To avoid the Repetition of the Composition of particular Medicines,
+and the Interruption that would be given by their being inserted in
+the Body of the Work, a small Pharmacopoeia is added, to which his
+Practice in the Army Hospitals was chiefly confined.
+
+In a commercial Country like our own, where Numbers of Hands are
+constantly wanted for the carrying on our Manufactories, we have a
+strong political Argument to add to that drawn from the Dictates of
+Humanity, why the Life of every individual should be most carefully
+attended to.
+
+The Preservation of the Lives of Soldiers is then with us a Matter of
+the highest Importance, in order to make as low as possible the Number
+of Recruits who must be perpetually drawn off for the Service of War.
+The Author has, therefore, in this Treatise, endeavoured to point out
+the Means most likely to keep Men healthy when employed in different
+Services; and also the Manner in which Military Hospitals ought to be
+fitted up, and conducted.--As he was never in any of the warm
+Climates, nor ever at Sea along with Troops aboard of Transports,
+whatever is mentioned relative to such Situations, is to be understood
+as taken from printed Accounts of these Subjects, or collected from
+the Conversation of physical Gentlemen, who were employed on such
+Services during the two last Wars.
+
+It is but Justice here to observe, that the Marquis of _Granby_,
+Commander in Chief of the _British_ Troops in _Germany_, as well as
+the Rest of the General Officers employed on the _German_ Service,
+always paid the greatest Attention to the Soldiers when sick in
+Hospitals; and were particularly ready in giving Orders for all such
+Things as were necessary or proper for them.
+
+  JERMYN-STREET,
+    April 15, 1764.
+
+
+
+
+CONTENTS.
+
+                                                                      PAGE.
+
+Of the Malignant and Petechial Fever,                                    1
+
+Of the Dysentery,                                                       57
+
+Of the Cholera Morbus,                                                  97
+
+Of the Inflammatory Fever,                                             104
+
+Of the Angina,                                                         109
+
+Of the Pleurisy,                                                       111
+
+Of the Peripneumony,                                                   115
+
+Of the Cough and Consumption,                                          124
+
+Of the Epidemical Catarrhal Fever of _April_ 1762,                     137
+
+Of the Rheumatism,                                                     141
+
+Of the Autumnal Remitting Fever,                                       154
+
+Of the Intermitting Fever, or Ague,                                    179
+
+Of the Jaundice,                                                       206
+
+Of Tumours of the Breast,                                              216
+
+Of Paralytic Complaints,                                               219
+
+Of an Incontinency of Urine,                                           223
+
+Of a Stoppage of Urine,                                                227
+
+Of the Epilepsy,                                                       237
+
+Of the Small-Pox,                                                      243
+
+Of Erisypilatous Swellings,                                            245
+
+Of the Scurvy,                                                         250
+
+Of the Itch,                                                           265
+
+Table of Diet used in the _British_ Military Hospitals in _Germany_,   273
+
+
+PHARMACOPOEIA in usum Nosocomii militaris regii Britannici 1761,       275
+
+
+OF THE MEANS of Preserving the Health of Soldiers on Service,          309
+
+---- in Winter, and in cold Climates,                                  313
+
+---- aboard of Transport Ships,                                        323
+
+---- in warm Climates,                                                 331
+
+Of healthful and unhealthful Grounds for the Encampment of Troops,     338
+
+Of keeping Camps clean,                                                344
+
+Of supplying an Army with Straw and with Provisions, and obliging
+  the Soldiers to buy a certain Quantity of Meat daily,                346
+
+Of Water, and the Means of correcting its bad Qualities in Camps,      348
+
+Of vinous and spirituous Liquors,                                      350
+
+Of keeping Men healthful in Quarters after an active Campaign,         354
+
+
+Of MILITARY HOSPITALS,                                                 355
+
+Of the Manner in which the Antients disposed of their Sick
+  and Wounded,                                                         356
+
+Of the Hospitals wanted for an Army acting on a Continent,             357
+
+Of the Houses most fit for Hospitals,                                  361
+
+Of fitting them up, and distributing the Sick in them,                 363
+
+Of preventing infectious Disorders from being generated or
+  spreading among the Sick,                                            366
+
+Of the Diet of Military Hospitals,                                     372
+
+Of providing the Flying Hospital,                                      380
+
+Of Hospitals on Expedition Service,                                    380
+
+Of a Guard for Hospitals,                                              382
+
+Of the Nurses and Patients, and Orders for them,                       383
+
+Of a convalescent Hospital,                                            389
+
+Of the Physicians, Surgeons, Apothecaries, and Mates,                  393
+
+Of the Direction of Military Hospitals,                                394
+
+Of the Purveyor or Commissary of the Hospital,                         396
+
+Orders for the Mates,                                                  397
+
+Of Precautions for guarding against infectious Disorders,              400
+
+Of a Military Inspector and Officers on convalescent Duty,             403
+
+
+ERRATA CORRIGENDA.
+
+Page 13, line 11, for _Pleuretic_, read _Pleuritic_.
+
+     18,      10, of Notes, for _Acadamy_, read _Academy_.
+
+     28,      22, for _Cinamon_, read _Cinnamon_.
+
+     35,       5, of Notes, for _Calomile_, read _Calomel_.
+
+     51,      12, dele _used in this Way_.
+
+    166,      12, of Notes, for _which almost depend_, read _which almost
+                  always depend_.
+
+    207,      13, of Notes, for _Vena postarum_, read _Vena portarum_.
+
+    259,       4, for _appeared_, read _appear_.
+
+    261,       1, of Notes, for _became_, read _become_.
+
+    280,      20, for _Chamamel_, read _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.
+
+    [36] Variety of Medicines have been recommended to answer
+    this Purpose.
+
+    The _vitrum ceratum antimonii_ proved often too rough a
+    Medicine, and therefore we laid it almost entirely aside.
+
+    Repeated small Doses of the Ipecacuana, from four to six
+    Grains, operated both as an Emetic, and kept up a Purging;
+    but they made the Men so sick, that we could not prevail upon
+    them to continue their Use. Mr. _Francis Russel_ told me,
+    that, in the Year 1756, he found a few Grains of Rhubarb
+    added to each Dose, made it operate more as a Purgative, and
+    did not make the Men so sick.--Dr. _Akenside_ proposes giving
+    the Ipecacuana in so small Doses as one or two Grains every
+    six Hours, in a Draught made of Mint-water, and Half a Drachm
+    of _confectio cardiaca_; and, after bleeding and vomiting
+    once, seems to depend almost entirely on the Use of this
+    Medicine for the Cure of the Dysentery. See his _Comment. de
+    Dysenteria_, cap. 2.
+
+    The watery Tincture of Rhubarb, recommended by _Degnerus_, we
+    tried in some Cases at Bremen; and found it to be a good mild
+    Purge, but not to answer so well as the Salts and Manna in
+    recent Cases. Mr. _William Russel_ told me that they found
+    this watery Tincture of Rhubarb to answer better in _America_
+    than any other of the Preparations of Rhubarb.
+
+    Calomel has been recommended by many as a Purge in
+    Dysenteries; and Dr. _Huxham_ (_de Aere_, Vol. II. P. 100)
+    assures us, that he has often experienced the good Effects of
+    it, especially when the Patient at the same time had Worms;
+    in such Cases we joined it to Rhubarb as mentioned in the
+    Text, or gave a Calomel Bolus over Night, and a Purge next
+    Morning. Dr. _Duncan_, Physician to his Majesty, told me,
+    that he found the following Method of Cure always successful
+    in the Dysentery, which was epidemic in _London_ in the Year
+    1762.
+
+    If the Patient was Plethoric, or had much Fever, he ordered
+    more or less Blood to be taken away; and then gave four
+    Ounces of the following Julep, every Half Hour, till it both
+    vomited and purged. Rx _Tartar. emetic. gr._ iij _Mannae elect.
+    Unc._ ij _solve in Aq. hordeat. Lib._ 1.--The next Day, and
+    for five or six Days more, the Patient took so much of a
+    Decoction, of Manna, Tamarinds, and soluble Tartar, as kept
+    up a free Discharge by Stool.--If the Irritation and Griping
+    were severe, he found that a Solution of Manna, in the common
+    Almond Emulsion, was sufficient.
+
+    When the Pain, or Tenesmus, was violent, a Clyster, of
+    Chicken Broth, or of an Infusion of Linseed, with an Ounce or
+    two of Oil of sweet Almonds dissolved in the Yolk of an Egg,
+    injected once or twice a Day, was of great Use.
+
+    Upon the whole, he was always pleased when he saw large
+    excrementitious Stools come away; and when that could be
+    procured by a gentle Method, he was the more pleased.
+
+    This Disorder was very often cured in a few Days, and in that
+    Case he dropt the further Use of Medicines; but when it
+    exceeded the Period of six or seven Days, he then added
+    thirty or forty Drops of the _tinctura thebaica_ to the
+    Clysters; and ordered a Scruple of the Extract of the Logwood
+    to be taken thrice a Day in some proper Vehicle.
+
+    The Patient's Diet was Rice-Gruel, Sago, Panado, and such
+    like; no Animal Food, not so much as Chicken-Broth, was
+    allowed in the Beginning of the Distemper, nor even Oil,
+    Butter, or Fat of any Kind. The common Drink was Almond
+    Emulsion, Rice-Water, or Barley-Water with Gum Arabic.
+
+    Dr. _Duncan_ lost but one Patient out of Eighty, whom he had
+    under his Care that Season; and he was delirious, had a high
+    Fever, and a _subsultus tendinum_ before the Doctor was
+    called to him, and he died the next Day.
+
+    The late Dr. _Young_, of _Edinburgh_, seems to have had a
+    very just Notion of this Disorder, and of the proper Method
+    of treating it; for, in his Treatise on Opium, sect. vii. he
+    says, "I am convinced from Experience, that most of the
+    Dysenteries I have hitherto met with, might have been cured
+    by purging mildly, but constantly; and at the same time
+    abating the Acrimony in the great Guts by emollient Clysters,
+    and in the small ones by Plenty of Absorbents, and a Diet of
+    Chicken Broth: But it must be observed with regard to
+    Purgatives, that Manna agrees best with some, Rhubarb with
+    others, Jalap, Mercury, and toasted Rhubarb with others;
+    while others are sooner cured by emollient Clysters. I use
+    Opium only when the Disease is mild, or after its Violence is
+    abated by Evacuants and Emollients."
+
+    Scammony, Aloes, and the other strong resinous and hydragogue
+    Purges, are hurtful, and occasion Pain. I always observed,
+    that those Purges answered best which made the freest
+    Evacuation, and acted with the greatest Ease to the Patient;
+    of which the Salts and Manna answered best of any I have
+    hitherto used.
+
+Though Rhubarb did not answer so well in the Beginning as the saline
+Purges; yet afterwards in the Course of the Distemper, when the
+Patient did not complain much of Gripes, half a Drachm of Rhubarb,
+either by itself or in a saline Draught, proved a good gentle Purge;
+and given with six or seven Grains of Calomel, was found to be a good
+Medicine, when the Disorder was attended with Worms.
+
+In the Evening, after the Operation of the Purge, we gave an Opiate;
+and repeated it at Nights, in the Intervals between the Purges; but
+were obliged to be very sparing of the Dose, while the Disorder
+continued in its acute State; the Opiate was only given in a Quantity
+sufficient to mitigate the Pain, and to procure Rest, but never so as
+to stupify the Patient, or prevent a due Discharge by Stool; though we
+were often obliged to encrease the Dose, as Use made it familiar to
+the Patient.
+
+In the Intervals between the Purges, we gave in the Day, the Mindereri
+Draughts with the Mithridate; or the saline Draughts with the Addition
+of four Drops of the _tinctura thebaica_; or some such mild
+diaphoretic, every four or six Hours; which helped to keep up a free
+Perspiration, without any Danger of stopping the Purging; and for the
+most part answered much better than the Diascord, or Philonium, or
+other strong Astringents and Opiates commonly prescribed for this
+Purpose; which were always liable to check the Purging too much, and
+bring on severe Gripes attended with Heat and Fever[37]; and therefore
+we seldom made Use of them in this first Stage of the Disorder.
+
+    [37] _Sydenham_, _Huxham_, and all good Practitioners, have
+    taken Notice of the bad Effects of the too free Use of
+    Astringents, and given Cautions against it.
+
+If the Patient was attacked with severe Gripes[38], and a Tenesmus,
+which the Purgatives and gentle Opiates did not relieve, we ordered
+the Abdomen to be fomented with warm Stupes; and the Patient to drink
+freely of warm Barley or Rice-water, or of weak Broth[39], or an
+Infusion of Camomile Flowers, as recommended by Dr. _Pringle_; and
+ordered first Clysters of large Quantities of the plain emollient
+Decoction to be given; and if the Gripes still continued, to be
+repeated in small Quantities, with the Addition of a Drachm or two of
+the _tinctura thebaica_; for we observed that Opiate Clysters often
+gave more Relief, than Anodynes administered in any other Way; and
+sometimes, when a Tenesmus was very troublesome, the common oily
+Clyster, with a little Diascord, and _tinctura thebaica_, or the
+Starch Clyster, gave more Ease than any other.--In some Cases, where
+the Pain was sharp, attended with a Fever, we were obliged to take
+away more or less Blood; and sometimes also to apply a Blister to that
+Part of the Abdomen where the Patient felt most Pain.
+
+    [38] If the Patient was suddenly attacked with sharp Pain of
+    the Bowels and Gripes, on a Day in which he had not Physic, a
+    Dose of the Salts and Manna was commonly given immediately,
+    to empty thoroughly the first Passages.
+
+    [39] Mr. _W. Russel_ told me, that he and Dr. _Huck_ found
+    the free Use of the following Emulsion, made of Bees Wax, to
+    be of great Use after Evacuations, where there was much Pain
+    of the Bowels, in recent Cases of Fluxes in the Hospitals in
+    _America_. Rx. Cerae alb. vel flavae drachmes tres. Sapon. alb.
+    Hispan. drachmam unam. Aquae fontanae, unciam unam, liquefiant
+    super ignem in vase ferreo, agitando spatula, & dein infunde
+    in mortarium marmoreum, & adde paulatim aq. fontanae, libras
+    duas syrupi sacchari. spiritus vini gallici tenuis, vel aquae
+    alicujus spirituosae ana unciam unam, terendo optime ut fiat
+    emulsio.
+
+    This Method of dissolving Bees Wax, in a Watery Liquor, is
+    entirely new; for before this we knew of no Way of making it
+    miscible with Water.
+
+During this Course, the Patients used the common low Diet of the
+Hospital; when they loathed the Rice-Gruel, they had Panado with a
+little Red Wine and Sugar; or Water-gruel, when it could be got, in
+its Place.--Their common Drink was Barley or Rice-water; of which it
+was recommended to them to drink plentifully; as nothing contributed
+more to the Cure than the free Use of such Liquors, to dilute and
+blunt the Acrimony of the Fluids[40]. In some Cases, when the Purging
+was violent, and not accompanied with the malignant Fever, the
+_decoctum album_ was found to be a good Drink; and we added
+occasionally a few Drops of the _tinctura thebaica_.
+
+    [40] Dr. _Huxham_ (_de Aere_, Vol. II. p. 107.) says, there
+    is no Disorder in which a diluting, sweetening Drink is more
+    necessary than in this; that he has done great Service among
+    the Poor by luke-warm Water; that, after emptying the Bowels
+    thoroughly, he has sometimes cured this Disorder by the Use
+    of pure Water, and a small Quantity of Opium. And _Baglivi_
+    (_Prax. Med._ lib. i.) tells us, that the drinking of common
+    Whey, and throwing up frequent Clysters of it, had cured
+    many, and that this was looked upon as a Specific, and kept a
+    Secret by some.
+
+Such were the chief Remedies we used in the first Stage of this
+Disorder; but after some Weeks, when the Fever had abated, and free
+Evacuations had been made, and the Complaint become in a manner
+chronic, we were obliged to try other Methods; and found that the best
+Way of treating this Disorder, was, to endeavour to brace and restore
+the Tone of the Intestines, by means of the corroborating and gentle
+astringent Medicines, mixed with Opiates; while mild Purgatives were
+given at proper Intervals.
+
+The Patients were kept to the same low Diet as before, with the
+Addition of a little Wine or Brandy. They were allowed from a Gill to
+a Pint of red Wine _per_ Day, which was commonly mulled before it was
+given them; when the Wine griped them, which it frequently did, they
+took in its Stead Half a Gill or a Gill of Brandy, mixed with a Pint
+or a Quart of Barley or Rice-water, or of the _decoctum album_.
+
+In this Stage of the Disorder we found, that the same Medicines would
+not answer with all, and therefore we were obliged to try Variety[41];
+and indeed, unless where the Violence of the Disorder had abated by
+the Use of Evacuations, the Event was always very doubtful; for when
+the Complaint had continued long and become chronic, and the Structure
+of the Intestines was much hurt, before the Sick were sent to us; or
+when it continued obstinate, and yielded but little to Evacuations,
+and the other Methods used in the first Stage, even Remedies esteemed
+the most efficacious oftentimes proved unsuccessful, and at length
+the Patient died.
+
+    [41] Dr. _Pringle_, in the _fourth Edition of his
+    Observations_, just published, in treating of the third or
+    last Stage of the Dysentery, remarks, that this is the Time
+    for Astringents, which ought not to be given sooner, or at
+    least very sparingly. And he tells us, that, in the former
+    Editions of his Work, he mentioned those Compositions which
+    he had most frequently used, but that he had now laid most of
+    them aside; and at present trusts to Vomits, and to a Milk
+    Diet, for the perfect Cure.
+
+    He says, "Whenever therefore the Patient is in this State,
+    and especially when his Pulse is quick, and he complains of
+    inward Heat, I began with giving him a Scruple of Ipecacuana;
+    and the next Day I put him upon the Milk-Diet; which I
+    continue till all the hectic Symptoms are gone, and till the
+    Bowels have recovered their Tone. During this Course I have
+    seldom had Occasion for any other Medicine, excepting the
+    Chalk Julep mentioned before, which I use for correcting that
+    strong Acid so incident to relaxed Stomachs. Sometimes also I
+    add an Opiate to procure Rest at Night; but after a few Days
+    these are likewise laid aside. All that I require (which
+    indeed is often hard to obtain) is a strict Perseverance in
+    the low Diet: and now and then a Repetition of the Vomit,
+    upon any new Disorder of the Stomach, or great Laxity of the
+    Bowels.
+
+    "Whilst the Patient continues in this Course, I forbid all
+    animal Food and fermented Liquors; and besides Milk, I allow
+    only the Preparations of Grain, Sago and Salop." See Part
+    iii. ch. vi. p. 289, 290.
+
+A Spoonful of the _mixtura fracastorii_, taken after every loose
+Stool; and an anodyne Draught at Night, had a good Effect with
+some--Repeated Doses of the _philonium Londinense_ answered better
+with others, who were low, and required a Remedy that was warm and
+cordial--And others found more Benefit from the Mindereri Draughts,
+with Mithridate, or the _confectio cardiaca_, or the Theriac anodyne
+Boluses.
+
+The _mixtura Campechensis_, both alone and with _tinctura thebaica_,
+checked the Purging, and gave Relief sometimes; and the Addition of
+some of the Extract of Bark and Tincture of Cinnamon, seemed to
+encrease its Efficacy in one or two old Cases, at _Bremen_; but it
+afterwards occasioned such Sickness, that we did not continue its Use.
+
+In other inveterate Dysenteries, where we thought that a strong
+Astringent was wanted, we added a small Proportion of Allum to the
+_Campechense_ Julep, which on first using seemed to be serviceable;
+but at other Times it occasioned a Tenesmus and Gripes; and therefore
+we were obliged to be very cautious how we used it.
+
+Equal Parts of the _electuarium diascordii_ and _electuarium
+corticis_, taken in the Quantity of a Drachm twice or thrice a Day,
+was of Use in many old Fluxes[42], though it made other Patients so
+sick, that they were obliged to lay it aside.
+
+    [42] I had lately a very remarkable Instance of the Effects
+    of this Medicine, in the Case of one _Gilchrist_, a
+    middle-aged Man, by Trade a Taylor; who was admitted into
+    _St. George_'s Hospital the 20th of _July_, 1763, for an old
+    Flux, which had continued above six Months, and reduced him
+    very low: He had taken a great many Medicines without any
+    Effect. After giving him a Vomit and two Doses of Tincture of
+    Rhubarb, I gave him four Grains of the Powder of Ipecacuana
+    with Opium three Times a Day; but that having no Effect,
+    after using it for above a Fortnight, I ordered him the
+    Electuary of Diascord and Cortex; from the Time he began to
+    use this Medicine, he mended daily; and was dismissed in good
+    Health the 26th of _September_.
+
+We tried likewise in this Stage of the Disorder, repeated small Doses
+of the Ipecacuana; but it occasioned such Sickness, that we did not
+persist in its Use.
+
+In other Cases, we gave from two to five Grains of the Ipecacuana,
+mixed with Opium, in different Proportions (from three Grains to ten
+of the Ipecacuana to one of the Opium), every four or six Hours; it
+gave sometimes a little present Ease, at other Times it occasioned
+Sickness; we often continued its Use for ten, twelve, or fourteen
+Days; but it seldom produced any remarkable Change for the better, and
+we were obliged to have Recourse to other Remedies.
+
+_Dover_'s Powder was given in large Doses, from one Scruple to two;
+and proved a good Sudorific and Anodyne in some Cases; though in
+others it made the Patients sick, without producing any good
+Effect.--It commonly answered better, when used occasionally as a
+Sudorific, than when constantly continued.
+
+During the Use of these Remedies, it was necessary to repeat the
+Purgatives from Time to Time; or to mix them occasionally with the
+other Medicines, in order to carry off any corrupted Humours, or
+Excrements that might be lodged In the Cavity of the Intestines; for
+when this was neglected, the Patients were often seized with Sickness
+and Gripes, and a more violent Purging than before:--And if at any
+Time they complained of Gripes, and passed little Pieces of hardened
+Excrements, it was mostly a certain Sign that a Purge was indicated;
+and, on such Occasions, it generally gave Relief; and when attended
+with Sickness, a Vomit was given before the Purge.--Clysters were used
+as in recent Cases, where the Sick were low, or had much Pain of the
+Bowels[43], or complained of a Tenesmus.
+
+    [43] On the 21st of _November_, 1759, _Hanah Meredith_, a
+    middle-aged Woman, was admitted into _St. George_'s Hospital
+    for a Flux, which she had six or seven Weeks; she had no
+    Fever, but complained much of Sickness and Gripes, and her
+    Disorder had reduced her very low. During the two first Weeks
+    of her being in the Hospital, she had two Vomits of
+    Ipecacuana and four Doses of Rhubarb; and in the Intervals
+    anodyne and astringent Medicines, which made no Alteration in
+    her Complaints. On the 2d of _December_, she told me, that
+    two Years before she had had a Flux for above three Months,
+    which had yielded to no Remedies till she was ordered
+    repeated Clysters, and that they had made a Cure in a short
+    Time. I then ordered an emollient Clyster with a drachm of
+    the _electuarium diascordii_, and a Scruple of the _tinctura
+    thebaica_, to be given twice a Day, which gave her almost
+    immediate Relief; and with the Assistance of some Doses of
+    Rhubarb, and one or two Vomits and occasional Opiates,
+    removed her Disorder by the Middle of _January_; though she
+    remained long weak, and troubled at Times with Gripes; but
+    these Complaints were at last got the better of by her taking
+    some Doses of Rhubarb, and drinking daily a Pint of Lime
+    Water mixed with Half a Pint of Milk.
+
+    _Sarah Spencer_, a middle-aged Woman, was admitted into _St.
+    George_'s Hospital the 9th of _November_, 1763, for a Flux,
+    which had continued for two Months, and reduced her very low.
+    She complained much of Sickness and Gripes; her Stools were
+    mostly composed of Mucus and Blood; her Pulse was low, and
+    she had no Fever, but a Whiteness of the Tongue, and
+    complained of Thirst.--The first Day she had a Vomit, and
+    next Day a Dose of the purging saline oily Draught.--She was
+    ordered to have an emollient Clyster, with a Drachm of
+    Diascord, and as much _tinctura thebaica_, given her every
+    Evening; and to have a Dose of the saline oily Purge twice a
+    Week, and Opiates occasionally; by following this Course, and
+    drinking at Times the Chalk Julep, her Disorder was removed,
+    and she was discharged the Hospital on the 30th of the same
+    Month.
+
+In some old Dysenteries, where the villous Coat of the Intestines was
+much injured, I gave the Cordial Draughts, with the Addition of Half a
+Drachm of the _balsamum copaivi_, a Scruple of the Extract of the
+Bark, and five Drops of the _tinctura thebaica_, three Times a Day.
+At first, this Medicine seemed to promise much, particularly in the
+Case of an old Invalid, _William Brookes_; who had been long ill of a
+Flux, attended with Gripes and a Tenesmus. He had used Variety of
+Remedies, without receiving any Benefit. For the first Fortnight,
+after he began the Use of this Medicine, he rested well, and found
+great Relief; and seemed to be in a fair Way of doing well. But the
+Disorder being too far advanced before he began to use it, he
+relapsed, and died. On opening his Body, the inner Coats of the Rectum
+and the lower Part of the Colon seemed to be reduced almost to a
+gelatinous Substance, and the other Coats were black, approaching to a
+Gangrene.--The same Medicine gave Relief in other Cases, but they were
+too far advanced before it was administered. In these Cases, when the
+villous Coat of the Intestines was inflamed and very irritable, the
+mucilaginous Medicines, the _pulvis e tragacantha_, and such others,
+were of Service; and frequently Starch Clysters and Anodynes gave
+Relief, when other Remedies had little Effect. Flower, boiled with
+Milk, and sweetened with Sugar, and given for Breakfast, as mentioned
+by Dr. _Pringle_, proved a good Palliative to some; and the Starch and
+Gum Arabic, dissolved in Water, a good Drink to others.--Lime Water
+and Milk, drank to the Quantity of a Pint or a Quart a Day, was of use
+to a few, though it did not agree with all.
+
+It was very common for Patients bad in the malignant Fever to be
+seized likewise with the Flux. Such Cases were always extremely
+dangerous; and when the Fever was bad, we were often obliged to
+neglect the Flux, and only attend to the Fever.--When the Purging was
+violent, and appeared very early in the Fever, it often sunk the
+Patients, and soon carried them off: but where it was moderate, and
+did not appear till towards the Height or the Decline of the Fever, it
+often proved a Crisis to the Disorder.
+
+When such Fluxes appeared early attended with sharp Pain of the
+Bowels, and Signs of Inflammation; if the Patient was strong, we
+began the Cure with opening a Vein, which the Patient bore easily, and
+it gave Relief; but when the Symptoms were mild, without any acute
+Pain, the Bleeding was omitted.--Commonly the Bowels were loaded with
+corrupted Humours, when this Symptom appeared; and, therefore, we
+found it of Advantage to give a Dose of the Salts with Manna and Oil,
+or some other gentle Purge, to carry them off; and in the Evening an
+Opiate to ease the Pain and procure the Patient Rest.
+
+After this we gave the Mindereri Draughts with Mithridate; and as soon
+as the Petechiae appeared, or we observed any Remissions in the Fever,
+the Patient took every four or six Hours, a Drachm of an Electuary,
+composed of equal Parts of the _electuarium corticis_ and the
+_electuarium diascordii_[44]; or Half a Drachm of the Powder of the
+Bark, or a Scruple of the Extract, in the Mindereri Draughts, with
+four or five Drops of the _tinctura thebaica_; and we repeated the
+Opiate in the Evening, always proportioning the Quantity of it to the
+Effects of the former Dose, and the Violence of the Purging.
+
+    [44] This Practice of giving the Cortex with Opiates in the
+    Dysentery is not new; for Dr. R. _Morton_, in his Appendix to
+    his second Exercise on the Fevers, which appeared from 1658
+    to 1691, observes, that after the Plague of 1666 had ceased,
+    a Fever from a milder Poison, attended with Gripes and
+    Dysentery, began to make its Appearance. As the common
+    Methods of Cure proved unsuccessful, and Dr. _Morton_
+    observed Exacerbations and Remissions, he resolved to give
+    the Bark mixed with Laudanum; and found it answer his
+    Expectation. The first Patient to whom he gave it, was a man
+    in _Long Lane_, who laboured under a Tertian Dysentery; upon
+    observing a Remission, he ordered a Drachm of the Bark, mixed
+    with a Grain of Opium, to be given every four Hours for six
+    Times; and this removed both the Fever and Dysentery.--He
+    says, he afterwards gave it, with equal Success, in the
+    Quotidian Dysenteries, where he observed Exacerbations or
+    Remissions; and he adds, that he does not doubt but that it
+    will answer as well in Epidemical Diarrhoea's, and Camp Fevers
+    attended with such Symptoms.
+
+    Dr. _Whytt_ of _Edinburgh_ has given with Success a strong
+    Decoction of the Bark, mixed with the _confectio japonica_ of
+    the _Edinburgh_ Dispensatory, in the bad State of the
+    Dysentery, when the Mouth and alimentary Canal were
+    threatened with Aphthae, and even sometimes after they had
+    appeared. And Dr. _Pringle_ mentions his having given the
+    Decoction of the Bark, with Snake-Root and some Drops of
+    Laudanum, in the Dysentery complicated with the malignant
+    Fever. See _Note to Page 245 of his third Edition on the
+    Diseases of the Army_.
+
+On the second or third Day, we repeated the Purge; or, if the Patient
+was weak, ordered a Clyster to be administered in its Place; in order
+to prevent the putrid Fluids and Excrements from being accumulated in
+the Bowels:--In other respects we treated it as when the Disorder was
+not complicated with the malignant Fever.
+
+This Method, though it did not succeed with all, yet it answered
+better than any other I tried;--and it ought to be remarked, that
+although it had such a good Effect in Cases attended with the
+malignant Fever, or where the Fever inclined to the intermittent Kind,
+it did not answer so well in other recent Cases, but often made the
+Patient sick.
+
+In military Hospitals, Fluxes are liable to be complicated with other
+Disorders, as well as with the malignant Fever; especially with
+Coughs, and pleuritic and peripneumonic Symptoms, when the Weather
+begins to be cold, in _October_ and _November_.--In such Cases, when
+the Patients were strong, we were often obliged to bleed freely, to
+apply Blisters, and in the Beginning treat the Disorder as
+inflammatory; having at the same Time an Eye towards the Flux, in the
+other Medicines we prescribed.
+
+Patients, who have had the Flux long, are apt to have their Legs swell
+at Nights; or to swell all over as soon as the Flux has stopped. Such
+oedematous or anasarcous Swellings, we treated nearly in the same
+Manner as those which followed the petechial Fever; only that we durst
+not at first be so free with the Use of Purgatives; for as the Bowels
+remained weak and easily irritated, such Medicines were apt to bring
+back the Flux; and therefore, in the Beginning, we were for the most
+part obliged to attempt the Cure by Diuretics and Diaphoretics; and to
+be sparing of the Use of Purgatives, especially of those of the
+hydragogue Kind; though if the Swellings continued for some Time after
+the Flux was gone off, and the Patients were strong, we then ventured
+to give Purges at proper Intervals:--And Blisters and Scarifications
+removed them in several Instances both at _Paderborn_ and
+_Osnabruck_.
+
+In _December_, 1761, we had a Case of this Kind where the _oxymel
+scilliticum_ was of remarkable Service. A Soldier, belonging to the
+Guards, after a Flux, swelled all over, and made but a very small
+Quantity of Water. He took Medicines of different Sorts for some
+Weeks, but received no Benefit till we gave him the Oxymel Mixture;
+after taking a few Doses he made Water very freely, and in large
+Quantities, and the Swellings of his Body and Scrotum began
+immediately to subside; and by continuing its Use for a Fortnight, the
+Swellings entirely disappeared, and he recovered his Health and
+Strength.--The Oxymel, at the same Time that it promoted a Flow of
+Urine, kept his Body gently open, but did not occasion any Return of
+the Flux.
+
+At the Beginning of _January_, 1762, one _Carter_, a Soldier of the
+Eleventh Regiment of Foot, laboured under an universal Anasarca; which
+about two Months before had succeeded a Flux. He made but very little
+Water, and that of a high red Colour. He took Variety of Medicines,
+as Purges, Vomits, _Dover_'s Powder, lixivial and neutral Salts with
+Opiates, Infusions of Horse-Radish, all without Effect; till he was
+ordered small Doses of Calomel, three Grains Morning and Evening.
+After the third Dose he began to make Water freely; and by the 24th of
+_January_ the Swellings were all gone, and he was shipped off for
+_England_ the 8th of _February_; having been discharged from his
+Regiment. The Ship, he went aboard of, was detained in the River
+_Weser_ for above six Weeks, and the malignant Fever broke out aboard
+the Transport: He took the Distemper, and got well of it; but towards
+the Decline was seized with a Return of the Flux, which carried him
+off.
+
+When these oedematous Swellings came after the Purging was stopt, if
+the Patient's Strength was not much exhausted, and he laboured under
+no other Disorder, he commonly got the better of it:--But when the
+Strength was gone before the Swellings appeared, the Disorder often
+ended in a confirmed Dropsy, and at last in Death; and when the
+Swellings were universal over the Body, while the Flux yet continued,
+it was a Sign of great Weakness, and they did not survive it long[45].
+
+    [45] Many other Medicines have been used for the Cure of old
+    Dysenteries,--The _Conessi Bark_, recommended as a Specific
+    in Diarrhoeas, cured a Dysentery which had yielded nothing to
+    a Variety of Medicines. _Edinburgh Medical Essays_, _Vol._
+    III. _Art._ iv.--The _cortex eleutheriae vel cascarillae_ 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_, _Aretaeus_, _Celsus_, and other
+antient Authors; and is very accurately described by many of them.--It
+is of the bilious Kind; and the Cure principally depends upon the free
+Use of warm mild Liquors in the Beginning; to dilute and blunt the
+Acrimony of the Bile, and other Fluids, and to promote their
+Discharge; and afterwards of gentle Cordials to support the Strength;
+and warm Fomentations to allay the Pain when violent; and mild Opiates
+to procure Rest; and if the Sickness or Griping remains next Day after
+the Cholera is stopt, to give a Dose of Physic and an Opiate in the
+Evening.
+
+An Officer, who had been wounded on the 15th of _July_, at the Battle
+of _Fillinghausen_, began afterwards to live very freely, and was on
+the 4th of _August_ seized in the Night with the Cholera.--About ten
+o'Clock next Day I was sent for; and found him in violent Agony, with
+sharp Pain in the Bowels, Reachings, and Strainings to Vomit, and
+Spasms and Cramps in the Bowels, Legs, and Arms.--He had large red
+Blotches on his Extremities, and no Pulse was to be felt at the Wrist,
+and rather a Fluttering than a Beating at the Heart.--He had vomited
+and purged much in the Night before I saw him, but the Purging had
+begun to abate.--I immediately ordered him an emollient Clyster, and a
+saline Draught, with the _confectio cardiaca_, and five Drops of
+liquid Laudanum; which, if he vomited up, was to be repeated soon
+after; if not, only once in four Hours: And he was directed to drink
+freely of weak Chicken Broth, warm.--Two Hours afterwards we found him
+in the same Situation; still no Pulse to be felt, which prevented us
+from bleeding him; and the violent Pain of the Stomach and Bowels, and
+the Cramps, continued. We then ordered Flannels, dipped in a warm
+emollient Decoction, to be kept constantly applied to his Belly,
+dipping them in the warm Decoction as soon as they began to grow cool;
+his Clyster to be repeated with the Addition of a Drachm of the
+_electuarium e baccis lauri_, and Half a Drachm of the _tinctura
+thebaica_; a Scruple of Castor, and Half a Drachm of Spirit of
+Lavender, to be added to each of his Draughts; and a Blister to be
+prepared, in case these Medicines gave no Relief.--Soon after,
+beginning to use the Fomentations, the Cramps and Pains began to
+abate; about four o'Clock in the Afternoon we could perceive a
+Fluttering of the Pulse at the Wrist, and all the Pains and Cramps
+were much easier; so that there was no occasion for the Blister.--Next
+Morning he was very easy, but low, and inclined to be sick; for which
+his Cordial Draughts were repeated every six Hours.--The third Day, as
+he complained of a little Griping in the Bowels, we ordered him a Dose
+of Tincture of Rhubarb, and an Opiate in the Evening, which entirely
+removed these Complaints, and he was abroad and well next Day.
+
+One Soldier, who had a good deal of Fever, and complained of acute
+Pain in the Bowels, along with the Vomiting and Purging, was blooded;
+and drank freely of warm Barley-Water while the Vomiting
+continued.--After throwing up a Quantity of green bilious Matter, the
+Vomiting ceased; and the Gripes and Purging became less violent.--In
+an Hour after, being able to retain some very weak Broth in his
+Stomach, he drank plentifully of it through the Day; and the Purging
+being abated towards Night, he took an anodyne Draught; and next Day,
+having still a little Sickness remaining, had a Dose of Physic and an
+Opiate at Night, which removed all his Complaints.
+
+The Rest, who were attacked with the Cholera at _Munster_, were
+treated much in the same Way; only as they had not such acute Pain and
+Fever as this Man, it was thought unnecessary to bleed them.
+
+The Antients[46] recommended drinking freely of warm Water in the
+Beginning, and the Use of both cold and hot Fomentations of the
+Stomach and Belly;--and in the low State, the Use of Wine, mixed with
+Water, and Polenta[47]; and to apply Rue, with Vinegar, and other
+strong smelling Things, to the Nostrils; besides Variety of other
+Remedies.--When Convulsions happen, _Celsus_[48] advises to anoint the
+Belly with warm Oil; and if that does not remove them, to apply
+Cupping-Glasses or Mustard to the Stomach; and, after sleeping, to
+abstain the second Day from Drink; and the third, to go into the Bath;
+and if any thing of a Fever remains after the Cholera is suppressed,
+to give a Purge.
+
+    [46] See _Aretaeus_, Lib. ii. Cap. 4. and _Celsus_, Lib. iv.
+    Cap. 11.
+
+    [47] The Polenta seems to have been nothing but toasted
+    Barley Meal. See _Plinii Hist. Natural._ Lib. xxii. Cap. 25.
+
+    [48] _Celsus loco citato._
+
+Dr. _Sydenham_[49] trusts principally to drinking freely of Chicken
+Broth, and throwing up Clysters of the same, and afterwards giving
+Opiates.
+
+    [49] _Processus integ. de Cholera._
+
+Dr. _Ayton Douglas_, in the sixth Volume of the _Edinburgh_ Medical
+Essays[50], recommends a Decoction of Oat Bread, baked without Leaven
+or Yest, and carefully toasted as brown as Coffee, but not burnt; as a
+Remedy very grateful to the Stomach, and useful in stopping the
+Vomiting, and sometimes the Purging too: And he relates several Cases
+where it had a good Effect. After the Vomiting was stopped, he added
+the Use of mild Opiates; and, where the Patient was low, Wine and
+other Cordials.
+
+    [50] Art. 65.
+
+
+
+
+OF THE INFLAMMATORY FEVER.
+
+
+On the Return of the Troops from the Winter Expedition into the
+Country of _Hesse_, in the Year 1761, we had several Men seized with
+Inflammatory Fevers without any topical Inflammation; and at the
+Opening of each Campaign had always Numbers sent to the Hospitals ill
+of this Disorder. Towards the End of the Campaigns, and throughout the
+Winter, many were seized with Inflammatory Fevers; but these were
+mostly complicated, with pleuritic, or peripneumonic Symptoms, or
+other topical Inflammations, or with rheumatic Complaints.
+
+In the Inflammatory Fever, the Sick were seized at first with cold and
+hot Fits, succeeded by Pain in the Head and all over the Body. The
+Pulse was strong and quick, and the Blood sizy; attended with other
+Appearances commonly observed in such Fevers.
+
+As the Summer advanced, this Fever was often accompanied with bilious
+Symptoms, with Sickness, and vomiting of bilious Matter, and very
+frequently with a Purging: Towards the End of Summer it ceased, and
+was succeeded by the bilious remittent Fever.--And it was no uncommon
+Thing to see those Fevers, which originally were entirely of an
+inflammatory Nature, after the sick had been some Days in a crowded
+Hospital, partake a good deal of the Nature of the Malignant Fever, or
+be changed entirely into it.
+
+We treated these Fevers in the common antiphlogistic Method.--We
+blooded freely in the Beginning; gave the saline Draughts with Nitre
+and other cooling Medicines; and made the Patients drink plentifully
+of small Liquors:--And when they were inclined to be costive, gave
+mild Purges, or emollient laxative Clysters. We afterwards applied
+Blisters; and if the Pulse began to sink, gave Cordials, Wine, and
+other Remedies commonly employed in such Cases;--and towards the
+Decline of the Fever endeavoured to promote such Evacuations as were
+pointed out by Nature, and likely to prove critical.
+
+When the Case was complicated with bilious Symptoms in the Beginning,
+we were obliged to have particular Regard to the first Passages. If
+the Patient complained much of Sickness, we gave a gentle Vomit in the
+Evening, after bleeding; and a Purge next Day, to carry off any
+bilious or corrupted Humours that might be lodged in the Stomach or
+Intestines; and we found that these Evacuations gave Relief, and
+generally mitigated all the Symptoms.
+
+If at any Time during the Fever a Looseness came on, especially when
+attended with Gripes, we gave a Dose of some gentle Physic, which made
+a free Evacuation; and an Opiate in the Evening after its Operation;
+and afterwards we found it answer better to attempt rather to
+moderate, than wholly stop the Purging by strong Astringents, and
+Opiates; unless where the Evacuation by Stool was so great as to be in
+Danger of sinking the Patient.
+
+The _pulvis antimonialis_, composed of ten Parts of the _pulvis e
+chelis_, and one Part of the Tartar emetic, given in small Doses, was
+serviceable in many of these Fevers, after free Evacuations had been
+made.
+
+Two Patients, one a Soldier of the Twentieth Regiment, the other a
+_German_ Waggoner, were taken ill of this Fever about the 25th of
+_December_, 1762: They were both blooded freely, and had a Dose of
+Physic in the Beginning; and the saline Draughts with Nitre and other
+cooling Remedies; and had Blisters applied without producing any
+considerable Change in their Disorder.--On the 5th of _January_, 1763,
+they both complained much of Thirst, and were inclined to be costive;
+their Tongues were parched, their Pulses quick and small, and their
+Skins dry; they were restless at Nights, and the Soldier had a slight
+Delirium.--I ordered each of them four Grains of the _pulvis
+antimonialis_ every four Hours.
+
+6th. Next Day the Soldier told me, he had had four loose Stools; his
+Senses were much clearer, the Pulse calmer and slower, and he said he
+found himself lighter and easier, and less feverish, than he had been
+since he was first taken ill. The Medicine was continued, with the
+Addition of an anodyne Draught at Night.--7th. I found him in a fine
+breathing Sweat, and he told me he had slept well in the Night:
+p.--8th. The Sweat continued till this Morning, and on going off his
+Urine let fall a copious white Sediment, and left him free from the
+Fever; after which he mended daily.
+
+The Waggoner, after taking the third Dose of the Powders, had a warm
+Moisture upon the Skin.--On the 6th was cooler and without much Fever,
+and had had one Stool.--7th. The warm Moisture ended in a profuse
+Sweat, which carried off the Fever, and he continued to recover
+daily.
+
+
+
+
+OF THE ANGINA; OR, SORE THROAT.
+
+
+Many of the Soldiers during the Campaign were seized with
+Inflammations of the Throat, especially when the Nights were cold and
+moist after warm Days; and when they did Duty in cold wet Nights in
+the Winter Season.--All of them I saw in _Germany_ were of the
+inflammatory Kind; I did not observe any that were malignant.
+
+They were treated in the antiphlogistic Method.--The Patients were
+blooded liberally in the Beginning--took the cooling nitrous and
+saline Medicines--gentle Diaphoretics and Purgatives--and used
+frequent Gargarisms.
+
+Sometimes a Flannel rubbed with camphorated Oil, or the _linimentum
+volatile_, and applied round the Neck, was of Service.--And frequently
+after bleeding sufficiently, where the Breathing or Swallowing was
+difficult, the Application of a large Blister to the Neck gave speedy
+Relief.
+
+
+
+
+OF THE PLEURISY.
+
+
+The Pleurisy, or an acute Inflammation of the Side, was most frequent
+among the Soldiers towards the latter End of the Campaigns; though
+some were attacked with it at all Times of the Year, from doing Duty
+in all Sorts of Weather.
+
+We followed the antiphlogistic Method of Cure; and ordered plentiful
+Bleeding in the Beginning, till the Violence of the Pain began to
+abate, or the Patient grew faint;--and the Side to be fomented with
+Flannels dipped in warm emollient Decoctions, and afterwards rubbed
+with volatile Liniments: At the same Time the Patient drank freely of
+warm diluting Liquors, as Barley Water, the pectoral Decoction, and
+such like; and took the saline and other cooling Medicines, mixed
+occasionally with Sperma Ceti, or some other soft Pectorals, if there
+was a tickling Cough.--When the Patient was costive, we gave a Dose of
+Salts, or some other mild Physic, or laxative Clysters.
+
+If the Pain continued very acute, we repeated the Bleeding as often as
+Necessity seemed to require, and the Pulse could bear; and immediately
+after the second Bleeding ordered a large Blister to be applied to the
+Part affected.
+
+Physicians formerly used to forbid Bleeding after the fourth Day, if
+it had been omitted so long; but when no Symptoms of Suppuration had
+already appeared, on whatever Day of the Disorder it happened, I
+ordered plentiful Bleeding, the same as in recent Cases; and never
+found any Disadvantage, but often great Service from this Practice.
+
+When the Sharpness of the Pain was gone, and the Pulse became soft,
+very often a dull Pain remained for some Time in the Part.--In some
+Cases a brisk Purge removed it;--in others, cupping above the Part,
+and afterwards rubbing it with the volatile Liniments, did
+Service;--in others, gentle Opiates at Night, especially where there
+was a tickling Cough;--and in one or two Cases, this Pain did not go
+away, till the Patient was ordered to drink every Day for some Time, a
+Quart of the Decoction of Sarsaparilla with the antimonial Wine.
+
+In the Course of this Disorder, if a kindly Moisture broke out on the
+Skin, which gave Relief, this was encouraged by the Use of mild warm
+Liquors; or if the Patient began to spit up a viscid or yellowish
+Mucus, we endeavoured to keep up the Expectoration by the Use of mild
+Pectorals; and if a Purging came on, we were careful not to check it
+too soon, unless it was so violent as to be in Danger of sinking the
+Patient.
+
+When an Inflammation of the Side came to Suppuration, which happened
+in one or two Cases at _Osnabruck_, in _May_ 1761; as soon as a
+Fluctuation of Matter was to be felt, an Incision was was made in the
+Part, and the Matter discharged; after which the Sore healed kindly,
+and the Patients recovered[51]. I am persuaded, was this Operation
+oftener performed, many would recover who die consumptive.
+
+    [51] Dr. _Mead_ advises, where the Lungs and Pleura grow
+    together, and an Abscess forms, to open it with Caustic; and
+    afterwards to keep the Ulcer open during the Patient's Life:
+    For he says, he has often seen, where such Sores were healed
+    up, that the Patient died soon after by an Efflux of Matter
+    upon the Breast. _Monita Medica_, Cap. i. Sect. 7.
+
+
+
+
+OF THE PERIPNEUMONY.
+
+
+The Soldiers were subject at all Times to the Peripneumony, or
+Inflammation of the Lungs, from doing Duty in cold wet Weather, and
+from their irregular Way of living; but more particularly towards the
+End of the Campaigns, and in Winter.
+
+This Disorder was much more dangerous and fatal than the Pleurisy,
+especially when neglected in the Beginning; for then Bleeding had
+seldom any Effect; the Difficulty of Breathing encreased, the Patient
+was seized with an Orthopnea, and such an Anxiety and Sense of
+Suffocation, that he could not sleep; and the Pulse sunk; and in these
+Cases Death only afforded Relief. This we experienced in many Men who
+had lain neglected in Quarters, for two, three, four, or five Days,
+before they were brought to the Hospital.
+
+In most of the Bodies of those who died of this Disorder, and were
+opened after Death; we found the Lungs violently inflamed, with livid
+or gangrenous Spots on their Surface; and more or less of a watery
+Serum extravasated into the Cavity of the Chest.
+
+Three had Suppurations in the Lungs. In one, who had lain sick in
+Quarters for ten Days or upwards, before he was sent to the Hospital,
+the right Cavity of the Thorax was found full of a watery Serum; and
+the Lobes of the Lungs on the same Side almost entirely wasted; and
+what remained seemed as it were composed of thickened Membranes,
+resembling those formed by the coagulable Lymph, or what is called by
+some (though improperly) the fibrous Part of the Blood. The Lobes in
+the left Side seemed to be in a sound State, or at most but slightly
+inflamed. From the right Lobes of the Lungs being so much wasted, I
+suspected that the Patient had probably laboured long under some
+Disorder of the Breast; but I could not from Enquiry obtain any
+Information in this Particular; nor did he ever mention such a Thing
+during the few Days he lived after being brought into the Hospital; he
+said, he had only been ill for eight or ten Days before; but Soldiers
+afflicted with chronic Distempers, when they are seized with violent
+Symptoms, or acute Diseases, are apt to reckon the Beginning of their
+Disorder, only from the Time they are taken ill in a violent Manner;
+and never to take any Notice of their former Complaints.
+
+Another Soldier, about the Middle of _February_, 1762, remained in
+Quarters five Days after being taken ill with a Pain of the Breast,
+and a Difficulty of Breathing; the sixth Day he was brought to the
+Hospital in the Morning, and I saw him about eleven o'Clock; he then
+had all the Symptoms of the true Peripneumony, attended with a strong
+hard Pulse. He was immediately blooded as freely as his Pulse would
+bear, had Blisters applied, and other Remedies used; notwithstanding
+which, on the eighth Day from that Time, he began to throw up a
+purulent Matter in great Quantity, attended with a constant hectic
+Heat, and Fever; which sunk him so fast, that he died the tenth Day,
+after he first began to expectorate.
+
+On the 2d of _March_, a Soldier, of the Fifty-first Regiment of Foot,
+was brought to the Hospital, with a violent Pain in the left Side, and
+a great Difficulty of Breathing. Upon examining him, he told me, that
+about two Years before he had had a violent Stitch in his left Side,
+towards the lower Part of the Thorax; that ever since he had been
+subject to a Difficulty of Breathing; and at Times to a Pain in the
+Side; but that he had only been seized with the violent Pain and
+Difficulty of Breathing he then complained of, about five Days before,
+occasioned by catching Cold, on being billeted in a low, cold, and
+damp House.--His Pulse was quick, the Pain of his Side and Difficulty
+of Breathing so great, that he could not sleep, nor lie down, but was
+obliged to sit constantly in an erect Posture; his Tongue was white
+and furred, and he had had no Stools for three Days: He was ordered to
+be blooded immediately; and to take a Dose of Salts; and his Side to
+be rubbed with the _linimentum volatile_. 3d. His Breathing and Pain
+of the Side were easier; he had slept a little in the Night, and could
+lie on his right side, but not on his left. He was ordered the Squill
+Mixture. 4th. His Breathing was worse; he was blooded a second Time;
+had a large Blister applied to his Side, and was ordered to continue
+the Use of the Squill Mixture. On the 5th, 6th, and 7th, he seemed
+easier, though the Breathing was still much affected, and his Pulse
+quick and low, attended with a hectic Heat. On the 8th, he told me
+that his left Side was swelled: On examining, I observed a Fullness in
+that Side of the Thorax; and on pressing with my Fingers between the
+Ribs, I thought I felt an obscure Fluctuation of a deep-seated Fluid.
+From these Appearances, and the History of the Case, I judged that
+there was a Collection of some Fluid within the Cavity of the Chest;
+and that the only Means left to give Relief, was to make an Opening
+into the Cavity, and so evacuate the Fluid. I therefore proposed to
+him the Operation of the Empyema, to be performed immediately; which
+he several Times obstinately refused to submit to: He allowed a Seton
+to be put in his Side, but that did not answer the End proposed: He
+languished six Days longer; and died the 14th of _March_. Next Day an
+Opening was made in the Thorax, in the Part where the Operation was
+proposed to have been performed; as soon as the Pleura was cut
+through, some Quarts of Water rushed out. We then opened the Thorax,
+and found still some Water in the left Cavity. The Pericardium was
+thickened, and slightly inflamed, and adhered to the Diaphragm; which
+was likewise a little thickened and inflamed in the adhering Part; the
+Lungs on that Side were much compressed, and contracted by the
+Pressure of the Water; but on being inflated and cut, seemed in a
+sound State, except that they were slightly inflamed. The Lungs of
+the left Side adhered every-where firmly to the Thorax, but seemed
+otherwise sound; having no Tubercles, Suppuration, or other Disorder,
+that we could observe in cutting them. The Heart and Blood Vessels
+were sound, and no other polypous Concretions were observed within
+their Cavities, but such as we find in most dead Bodies; which seem to
+be formed of the coagulable Lymph in _articulo mortis_. The Viscera of
+the Abdomen were in a sound State.
+
+We treated the Peripneumony nearly as the Pleurisy. We bled freely in
+the Beginning, till the Breathing became easier, or the Pulse began to
+sink; taking Care not to be deceived by a low oppressive Pulse, which
+generally rose upon Bleeding. We applied large Blisters; gave the mild
+Pectorals freely, and plenty of warm diluting Liquors, Barley Water,
+the pectoral Decoction, and such like; which afforded more Relief than
+any other Medicines. We gave too saline Purges, and laxative Clysters
+occasionally; and in some Cases ordered the Steams of warm emollient
+Decoctions with Vinegar to be drawn into the Lungs.
+
+By this Treatment most of them, who applied early for Relief, got the
+better of the Disorder.
+
+When the Expectoration began, the Patient continued the free Use of
+the mild Pectorals, and diluting Liquors; and no Medicines were given
+that might in the least tend to stop it; other Evacuations were
+omitted, unless where the Pain of the Breast, or the Difficulty of
+Breathing increased; in which Case, if the Pulse kept up, I ordered a
+Vein to be opened, and a suitable Quantity of Blood to be taken away;
+no other Remedy affording any Relief, till this Evacuation was made.
+Where the Patient was costive, we frequently ordered laxative
+Clysters, or a mild Purge, and found them beneficial: But where no
+such Symptoms occurred, it was best, for the most part, to omit all
+Evacuations of this Kind, after a free Expectoration had begun, and to
+trust to it for carrying off the Disorder.
+
+In some Cases, where the Expectoration stopt suddenly after bleeding,
+we gave with Advantage a gentle Vomit, as recommended by Dr.
+_Huxham_[52].
+
+    [52] Some late Authors seem to look upon the _Pleurisy_ and
+    _Peripneumony_ as the same Disorder: However, though it be
+    true, that when the _Pleura_ is inflamed, the Surface of the
+    contiguous Lungs is generally in the same State; and that,
+    when the _Lungs_ are inflamed, the Pleura is often affected;
+    yet as I have frequently seen the true Peripneumony without
+    that sharp Pain of the Side which characterizes the Pleurisy;
+    and upon opening the Bodies of People who have died of the
+    Peripneumony, have found the Lungs violently inflamed and
+    livid, and so filled with Blood as to sink in Water, without
+    the Pleura being much diseased; and upon opening the Thorax
+    of others who died of the Pleurisy, have found the
+    intercostal Muscles and Pleura violently inflamed with livid
+    Spots, and only a small Portion of the Surface of the
+    contiguous Lungs affected; I cannot help still looking upon
+    them as distinct Disorders; though they require nearly the
+    same Treatment, and are often complicated together.
+
+
+
+
+OF THE COUGH and CONSUMPTION.
+
+
+Coughs were very frequent during the Winter, and when the Weather was
+wet and cold. They were often accompanied with Pains of the Breast;
+and, when neglected, Obstructions, Tubercles, and Suppurations, were
+apt to form in the Lungs, and the Disease to end in a Consumption, or
+_Phthisis Pulmonalis_.
+
+When Coughs were slight, guarding against further Cold, and the Use of
+mild Pectorals and warm Drinks, removed them. But when the Patient
+complained of a Pain and Tightness about the Breast, it was always
+necessary to take away more or less Blood; and after Bleeding to give
+some of the mild Pectorals, such as the Sperma Ceti or oily Mixtures;
+and, if a Fever attended, to join the Use of Nitre, or of the saline
+or mindereri Draughts; and, if a tickling Cough was troublesome, to
+give frequently a Tea Spoonful of the oily Linctus, acidulated either
+with the Spirit of Vitriol, or the _oxymel scilliticum_. The mild
+Diaphoretics, such as the mindereri Draughts, given along with warm
+Drinks, to promote a free Perspiration, or Sweat, were used with
+Advantage; when the Patients kept in Bed, and lay in Wards which had
+Stoves in them.
+
+If the Cough and Pain of the Breast were not relieved by these Means,
+the Patient was bled a second Time, and a Blister applied to the Side
+immediately after; which often removed most of the Complaints. When it
+did not, we gave the pectoral Decoction for common Drink; and if there
+was a Shortness or Difficulty of Breathing, the squill Mixture, or
+_lac ammoniacum_, with Oxymel; and occasionally gentle Purges: And if
+at any Time of the Disorder the Tightness and Pain of the Breast
+returned violent, we took away some Blood, no other Remedy affording
+Relief.
+
+When there was little or no Fever, and a thin Rheum kept up a tickling
+Cough, nothing had a better Effect than to add some Drops of the
+_tinctura thebaica_, or some of the _elixir paregoricum_, to the
+oleagenous or squill Mixtures; or to give an Opiate Draught or Pill at
+Bed-Time, which eased the Cough, and procured the Patient Rest.
+
+At all Times it was necessary, when the Cough was violent, attended
+with Pains of the Breast, to keep the Patients on low Diet; and in as
+free and pure Air as the Nature of the Hospitals would admit of; for
+we often found that those Men who had laboured long under obstinate
+Coughs, which threatened Consumptions in small crowded Wards,
+recovered surprisingly on being removed to a freer Air; of which we
+had a remarkable Instance in the Hospital at _Bremen_, in _January_
+1762; upon removing some Men, afflicted with very bad Coughs, out of
+small Wards, which were damp, into one large one, which was dry and
+airy.
+
+When the Weather was good, we made the Patients walk out a little in
+the Day-Time; for we observed, that remaining always in the Hospital,
+and breathing nothing but a foul Air, helped to encrease the
+Disorder.--When we knew the Men to be sober, and not apt to commit
+Irregularities, we used to procure them good Billets, and make them
+come daily to the Hospital for their Medicines.
+
+Equal Parts of Lime-Water and Milk, drank to the Quantity of a Quart a
+Day, was of Use to some; and the _infusum amarum_, and other gentle
+Bitters, taken to the Quantity of an Ounce or two, Morning and
+Evening, to others[53].
+
+    [53] Asses Milk, and _Bristol_ and _Seltzer_ Waters, which
+    are found so serviceable in pulmonic Disorders, could not be
+    had in the military Hospitals; and riding on Horseback was
+    too expensive a Remedy for a Soldier.
+
+    In chronic Cases, where we suspect Obstructions and Tubercles
+    to be formed in the Lungs, which have not already come to
+    Suppuration, Dr. _Russel_ recommends the Use of Sea Water for
+    resolving them; but we were at too great a Distance from the
+    Sea to try this Remedy. See his _Treatise on Sea Water_, Page
+    17.
+
+A Decoction of the Cortex removed some Coughs which had continued for
+a considerable Time. In one or two of these Cases, slight hectic
+Symptoms had already appeared[54]. However, for the most part,
+where-ever Obstructions of the Lungs were confirmed, or there were
+evident hectic Symptoms without a free Discharge of purulent Matter,
+the Bark did no Service; but rather heated and increased the Fever,
+and made the Sick more restless and uneasy.--It was of most Use where
+there seemed to be no confirmed Obstructions, but the Vessels much
+relaxed; which we judged to be the Case from the Patients having no
+fixed Pain, nor the Breathing much affected. If the Sick were
+plethoric, or in the least feverish, we ordered a little Blood to be
+taken away, before we began the Use of this Medicine.
+
+    [54] _Mary Shepperd_, a Woman twenty-six Years of Age, was
+    admitted into _St. George_'s Hospital the 6th of _June_,
+    1759, for a Cough; attended with a constant hectic Fever and
+    Night Sweats, which had begun in the Month of _April_, after
+    the Measles. She complained likewise of having the _fluor
+    albus_, and she had been blooded more than once before she
+    came to the Hospital.--I at first gave her some of the mild
+    Pectorals; and a Solution of White Vitriol in Water, _utenda
+    pro inject. uterina_. After a Week, finding no Alteration in
+    her Complaints, I advised her to become an Out-patient; and
+    to go down to her Friends in the Country, to live upon a Milk
+    Diet; to take gentle Exercise, and continue the Use of her
+    Medicines; which she did, but without any Alteration in her
+    Disorder, till the 6th of _July_, when I ordered her to take
+    thrice a Day two Ounces of the Decoction of the Cortex, along
+    with a saline Draught. Immediately, on beginning to use this
+    Medicine, her Disorder began to take a favourable Turn; her
+    Fever and Night Sweats left her, her Cough became easier, and
+    she recovered Health and Strength daily. She came to the
+    Hospital the 15th of _August_, seemingly in good Health, to
+    return Thanks for her Cure.
+
+In similar Cases, I have sometimes observed good Effects from the Use
+of the Balsam _Copaivy_, or _Peru_; given either in Juleps or made up
+into an Electuary, as in the _electuarium e spermate ceti cum
+balsamo_; but in whatever Form they were given, if there were
+confirmed Obstructions of the Lungs, they rather heated and inflamed,
+than did any real Service.
+
+When Coughs continued long, attended with Pain in the Side, Difficulty
+of Breathing, and Hectic Fever and Night Sweats, we always had Reason
+to suspect, that the Disorder would terminate in a confirmed
+Consumption. When this was threatened, we found, that the principal
+Thing to be done, was to keep the Patients cool; and to endeavour to
+allay the hectic Heat and Fever; and to retard, as much as possible,
+the Progress of the Disorder. When the Case was recent, we were
+sometimes so lucky as to make a Cure; but after it was confirmed, it
+for the most part ended fatally.
+
+We kept the Patients upon a low Diet; and where-ever Milk was to be
+got easily, we allowed them a Pint a Day[55]; which was either mixed
+with Water and given for Drink, or they took it to Breakfast or
+Supper.--Their common Drink was either Barley Water or the pectoral
+Decoction; which was occasionally acidulated with a few Drops of
+Spirit of Vitriol; and we gave at the same Time the cooling
+Medicines, such as Nitre, the saline or mindereri Draughts, mixed at
+Times with Sperma Ceti, or some other of the mild Pectorals.
+
+    [55] In private Practice, at this Stage of the Disorder, the
+    Use of Asses Milk, and drinking the _Bristol_ Water at the
+    _Bristol_ Wells, and riding on Horseback daily, are justly
+    ranked amongst the most efficacious Remedies; and going into
+    the more southern Climates, as the South of _France_,
+    _Portugal_, or _Italy_, where the Air is warmer, more
+    constant, and dry, than in _England_, has often been found to
+    produce good Effects.
+
+The opening a Vein, and taking away from four to eight Ounces of
+Blood[56], whenever the Pain of the Breast was troublesome, or the
+Patient was hot and restless at Nights from the Hectic Fever, gave the
+greatest Relief of any Thing we tried; and these repeated small
+Bleedings were so far from wasting the Patient's Strength, that they
+rather seemed to prevent its being exhausted so fast as otherwise it
+would have been, by allaying the Force of the Hectic Fever.
+
+    [56] This Practice has been strongly recommended by Dr.
+    _Mead_, in his _Monita Medica_, Sect. x. and by an anonymous
+    Author in the _Edinburgh Medical Essays_, Vol. IV. Art. 28.
+    and Dr. _Mead_ says, when Things have not been quite
+    desperate, he has seen good Success from it.
+
+At this Stage of the Disorder, we put in Setons, or ordered Issues, to
+serve as a Drain to carry off the Matter, and found them of Advantage
+in some Cases. When the Patients complained of any fixed Pain, we
+always made the Issues as near the Part affected as possible[57]. On
+the 5th of _May_, 1762, a Man, belonging to the Eighty-eighth Regiment
+of Foot, was sent to the Hospital at _Bremen_ for an Haemoptoe,
+attended with a constant hectic Heat and Fever.--After being blooded,
+and using the cooling Remedies without Success, he had four Pea Issues
+made in his Back; and had a slight Decoction of the Cortex, acidulated
+with Spirit of Vitriol. As soon as the Issues began to discharge
+freely, the hectic Heat, Fever, and Spitting of Blood, diminished
+daily; and he recovered his Health and Strength in a short Time.
+However, it ought to be observed, that although these Drains are
+sometimes efficacious, yet, when the Disease is far advanced, the
+Mischief is generally too deep rooted for them to be of any Service.
+
+    [57] In _June_, 1748, a Servant Girl came to ask my Advice
+    for a Cough, attended with a constant Hectic Fever and Night
+    Sweats, which had begun some Months before, on catching Cold.
+    The Matter she spit up was yellow, and had the Appearance of
+    Pus; and she complained of a Pain in the left Side of the
+    Thorax. I ordered her the saline Mixture with Sperma Ceti to
+    be taken thrice a Day, to lose a little Blood, to drink an
+    Infusion of Linseed sweetened with Honey, and to have a Seton
+    put in her Side at the Part where she complained of Pain;
+    advising her to go home to her Father, who was a Farmer in
+    the Country, and to live upon a Milk and Vegetable Diet, and
+    ride on Horseback whenever she could conveniently. She seemed
+    so far gone in a Consumption, that I scarce expected to see
+    her again; but, in the Month of _December_, she came to
+    return me Thanks for her Cure, seeming then to be in good
+    Health. She told me, that, as soon as the Seton began to
+    discharge freely, she found Relief; and mended afterwards
+    daily, by following the Directions I had given her.
+
+The Bark, and natural Balsams, for the most part were prejudicial, and
+encreased the Hectic Heat and Fever; except in one or two Cases, where
+the Disorder seemed to depend on a Vomica of the Lungs, and the
+Patient coughed up the Matter freely.--In one Case they were of
+considerable Service; the Patient was very low, and had the Night
+Sweats, but coughed up the Matter freely: On using the Decoction of
+the Bark, and the _electuarium e spermate ceti cum balsamo_, the
+Matter expectorated became thicker, and of a more balmy Consistence,
+without any Increase of Heat or Fever; after which the Symptoms became
+gradually milder, and the Patient recovered.
+
+In the Course of this Disorder the Patients often became very hot and
+restless, and were troubled with Gripes, succeeded by a Purging: These
+Symptoms were most readily removed by a Dose of Rhubarb, or of some
+other mild Purge; for they generally proceeded from corrupted Humours
+lodged in the Intestines. In the Evening, after the Operation of the
+Purge, we gave an Opiate to procure the Patient Rest.--When the first
+Dose of Physic did not stop the Purging, we repeated the Opiates at
+Nights, and in a Day or two gave another Purge; and if there was much
+Sickness, or Load at the Stomach, gave likewise a gentle Emetic.
+
+If the Purging still continued, we were obliged to join the Use of
+Astringents along with the Opiates. In some Cases, I found good
+Effects from equal Parts of Milk and Water boiled with Rose Leaves,
+Pomegranate Bark, Balaustine Flowers, and Cinnamon, as recommended by
+Dr. _Mead_ in his _Monita Medica_[58]; it served both for Food and
+Medicine.--When Opiates and Astringents were given to stop the Purging
+at its first Appearance, before the Bowels were emptied, they always
+did Mischief; and increased the Heat and Fever: And although they
+stopt the Purging for a few Hours, it always broke out with greater
+Violence afterwards.
+
+    [58] _Sect._ x. _de Febrib. lentis sive Hecticis._
+
+When the Sick were attacked with a Shortness and Difficulty of
+Breathing, which was not relieved by Evacuations, and the Use of
+cooling Medicines, and Pectorals, and Blisters, nothing gave so much
+Ease, or had such a good Effect, as a gentle Vomit; for it often
+removed the immediate Oppression from the Breast, and helped to pump
+up the Matter from the Lungs.
+
+In the advanced State of the Consumption, the Cough was always very
+troublesome; and the Sick found no Relief but from Opiate Medicines,
+which, in such Cases, cannot be expected to do more than give a little
+present Ease.--As they were apt to obstruct the free Expectoration, we
+generally mixed them with some _oxymel scilliticum_, or _tinctura
+foetida_, which took off a good deal of their suffocating Quality.
+
+Dr. _Barry_[59] advises for the Cure of a Consumption, to make an
+Incision or Aperture into the Side; where-ever there is a fixed Pain
+attended with a Weight, a Hectic Fever, and other Symptoms of an
+evident Suppuration: He says the Pleura is thickened, and the Lungs
+adhere at the Part where they are exulcerated; and that by the
+Operation the Pus may be evacuated, and a Cure made; and he gives
+several Instances of the Success of the Operation, when performed in
+Time.
+
+    [59] _Treatise on the Digestions_, p. 410.
+
+
+
+
+OF THE Epidemical CATARRHAL FEVER Of APRIL, 1762; CALLED, THE
+INFLUENZA.
+
+
+After a very cold severe Winter at _Bremen_, the Weather, from being
+very cold, became of a sudden extremely hot, about the 10th of
+_April_. In a few Days after, many People were seized with a violent
+Catarrhal Disorder. It often began with such a Cold and Shivering,
+that many imagined at first that they were going to have Agues; but
+soon after they were attacked with a Cough, and a Difficulty of
+Breathing, and Pain of the Breast, with a Head-Ach, and Pains all over
+the Body, especially in the Limbs.--The first Nights they commonly had
+profuse Sweats.--In several, it had the Appearance of a remitting
+Fever, for the two or three first Days.--Many had a slight
+Inflammation of the Throat, and a Hoarseness. In all it was attended
+with an acute Fever in the Beginning, and the Urine was of a high
+Colour; and when the Disorder had put on the Appearance of a Remittent
+Fever in the Beginning, it dropt a Sediment towards Morning after the
+second Day; and did the same in all, when the Disorder was going
+off.--Some had a Purging, but the greater Number were rather inclined
+to be costive.--The Cough in many was very violent; and the Patients,
+after each Fit of Coughing, had Reachings, or Strainings to vomit,
+exactly resembling those which come after violent Fits of the Hooping
+Cough.--At first the Patients spit up only a little Phlegm; but in the
+Decline of the Disorder, they expectorated freely.--The violent Cough
+and Feverishness generally continued for four, five, or six Days;
+with others it continued longer; and some had a Cough for two or three
+Weeks after the Fever left them.
+
+This Catarrhal Fever seized most of the People of the Town of
+_Bremen_; and there were very few of the _British_ who escaped it; at
+the same Time, it was epidemical in most Countries in _Europe_.
+
+We treated it entirely as an inflammatory Disorder, and none died who
+applied early for Relief.--Most People recovered by one plentiful
+Bleeding, and taking the mild cooling Medicines, such as the _mixtura
+e spermate ceti cum nitro_, the saline or mindereri Draughts, or such
+like. When the Fever and Difficulty of Breathing continued after the
+first Bleeding, in a Day or two a Vein was opened a second Time; and
+immediately after a Blister was applied to the Back, which commonly
+removed the Fever, and relieved the Breathing.--When the Patients were
+inclined to be costive, a Dose of Physic was of Service.
+
+None of the _British_ died, except one or two of the Soldiers, who
+remained in Quarters after being taken ill; and, instead of bleeding
+and living low, indulged in the Use of spirituous Liquors; and were
+not brought to the Hospital, till they were in the last Stage of a
+Peripneumony.--Many of the Inhabitants of the Town died of this
+Disorder, which was probably owing to Want of Care.
+
+
+
+
+OF THE RHEUMATISM.
+
+
+The Rheumatism is one of the Disorders most generally to be met with
+in military Hospitals. There were at all Times some Men in our
+Hospitals labouring under Rheumatic Fevers, or other rheumatic
+Complaints; though we never had at any one Time a great Number; owing
+probably to the Weather being very favourable in both the Campaigns of
+1761 and 1762.--It was always most frequent when the Weather was wet
+and cold; both during the Campaign, and when we were in Winter
+Quarters.
+
+It commonly began either, 1. With an acute Fever, and Pains all over
+their Body: or, 2. With Pains in particular Parts, as the Shoulders,
+Legs, Arms, Knees, and sometimes of the Side, attended with some
+Degree of a Fever.--The first was the most common Form it assumed,
+when Men were attacked with it in the Field or in Garrison; owing to
+their doing Duty in cold wet Weather.--The other Causes generally took
+place when they had been formerly subject to rheumatic Complaints, and
+had caught Cold; or after they had been weakened and reduced low by
+Fevers, Fluxes, or other Disorders.
+
+We had but very few Rheumatisms accompanied with Swelling, Pain, and
+Inflammation of the Joints of the Knees and Wrists, &c. which are so
+common in our Hospitals about _London_. I did not meet with above a
+Dozen Cases, of this Kind, whilst in _Germany_ with the Army.
+
+When the Rheumatism began with Pains all over the Body, attended with
+a High Fever, we treated it at first entirely as an Inflammatory
+Fever[60]. We blooded freely, and repeated this Evacuation often[61],
+if the Blood continued sizy, and the Pains violent; provided the Pulse
+was strong. When the Pleura, the Lungs, or any other of the Viscera
+were affected, we blooded as freely as we should have done in acute
+Inflammations of these Parts: We gave the saline Draughts with
+Nitre[62]; and Plenty of Barley Water and other weak diluting Liquors;
+and gentle Physic once or twice a Week; and afterwards applied
+Blisters, which often relieved both the Pains and Fever.
+
+    [60] _Sydenham_, in treating of this Disease, orders
+    Bleeding, and that to be repeated next Day; and afterwards
+    every other Day, two, three, or four Times, or more, as the
+    Patients Strength can bear it; and on the intermediate Days
+    to give a purgative Clyster. But in young People, and those
+    who have lived regularly, he says, that a very low Diet will
+    cure as effectually as Bleeding and Medicines; That the
+    Patients must live four Days on Whey alone, but after this
+    may eat Bread for Dinner; and on the last Days for Supper
+    also; and when the Symptoms begin to abate, he allows them to
+    eat boiled Chicken, or other light Food; but says they must
+    live every third Day on Whey, till their Strength returns.
+    _Precess. Integr. de Rheumatismo_.
+
+    [61] A Remark of Dr. _Huxham_'s deserves to be taken Notice
+    of here: He tells us, that there are some Kinds of
+    Rheumatisms, _viz._ those which come from a sharp serous
+    Rheum, which do not bear the free Use of the Lancet; that
+    plentiful Bleeding does more Hurt than Good; and that, in
+    such Cases, the Medicines which bring out breathing Sweats,
+    and at the same Time correct the Acrimony of the Blood,
+    joined with gentle Opiates, have a much better Effect. _De
+    Aere_, Vol. II. p. 185.
+
+    [62] Dr. _Brocklesby_, in his _Observations on military
+    Diseases_, recommends the Use of large Quantities of Nitre
+    dissolved in Water Gruel, or Sage Tea, (in the Proportion of
+    two Drachms of the Nitre to a Quart of the Liquor) in acute
+    Rheumatisms. He says, "I am assured from numberless
+    Instances, that in stout young Men, by taking six hundred
+    Grains (ten Drachms) daily, for four or five Days
+    successively, and diluting plentifully, as before
+    recommended, plain Nitre proves the most powerful and best
+    Sudorific, in such Complaints, that I have ever tried; and
+    this Quantity, and even more, may be retained in the Stomach,
+    and pass through the Course of the Circulation, by only
+    diluting properly with those thin attenuating Beverages as
+    before recommended. Such Quantities, in three or four Days,
+    seldom failed wonderfully to relieve the Patient, and very
+    often to cure him entirely, by the most plentiful and profuse
+    Sweats." _See from p. 116, to p. 124._
+
+    I have never hitherto given Nitre in such large Quantities as
+    here recommended by Dr. _Brocklesby_.
+
+After some Days, if the Pains still remained, we continued the saline
+Draughts with Nitre throughout the Day; and in the Evening endeavoured
+to promote a free Perspiration by Means of the mild Diaphoretics,
+such as the mindereri Draughts with Mithridate, in Doses frequently
+repeated; at the same Time, the Patient kept in Bed, and drank freely
+of mild diluting Liquors. Sometimes we gave twenty, thirty, or forty
+Drops of Spirits of Hartshorn, in repeated Draughts of warm Barley
+Water: or a like Quantity of the Antimonial Wine, used in the same
+Manner: or from sixty to a hundred Drops of the Antimonial Wine, mixed
+with one-fourth Part of the _tinctura thebaica_, in a large Draught of
+some warm Liquor; which I have observed, in many Cases, to have a
+better Effect, than most other Medicines used for this Purpose; as it
+acts both as an Opiate in easing the Pain, and procuring Rest; at the
+same Time that it promotes a free Perspiration, or gentle Sweat, to
+carry off the Distemper.
+
+But it should be observed, that, in the Beginning of Rheumatic Fevers,
+forced Sweats generally did Hurt, and often increased both the Pain
+and Fever; and that in general we had greater Success, and made
+speedier Cures, when we did not attempt to promote Sweating, till
+after other Evacuations had been sufficiently made, and the Fever had
+begun to abate; and that in this Fever, when we did attempt to procure
+Sweats, the milder Diaphoretics, with Plenty of weak diluting Liquors,
+answered better than those of a more heating Nature; though after the
+Fever was gone, and the Pains still continued, sometimes the stronger
+Sudorifics, such as G. Guaiac, and its volatile Tincture, _Dover_'s
+Powder, and the like, best answered the Purpose, and carried off the
+Distemper, when the milder ones had little Effect.
+
+I have often observed, where Sweating made no Change in the Distemper,
+that keeping up a free Perspiration by Means of the Decoction of the
+Sarsaparilla with the Antimonial Wine, or small Doses of the _pulvis
+antimonialis_ (_gr._ v.), given twice or thrice a Day, removed
+Rheumatisms, which had resisted the Force of other Remedies.
+
+Sometimes the cold Bath[63] removed Pains which had not yielded to
+internal Medicines; but it ought to be observed, that when Patients
+went into the cold Bath while the Feverishness still remained, and the
+Blood continued sizy, or before free Evacuations had been made,
+oftentimes, instead of giving Relief, it made the Disorder worse, and
+more obstinate[64].
+
+    [63] I have frequently ordered the warm Bath with Advantage
+    in Rheumatic Cases in _St. George_'s Hospital; but we had no
+    Convenience of this Kind with the flying Hospital in
+    _Germany_.
+
+    [64] This I have seen many Instances of, particularly in the
+    Case of _Ann Walker_, a Woman of twenty three Years of Age,
+    who was under my Care in _St. George_'s Hospital, in _May_,
+    1759. Before she came to the Hospital, she had been blooded,
+    and had gone into the cold Bath four Times, which, she told
+    me, had increased her Pains to a violent Degree; in which
+    State she had continued for some Weeks before she came to the
+    Hospital; but by being blooded, and taking the cooling saline
+    Medicines, with gentle Purges, and mild Diaphoretics, she got
+    well in a Month's Time.
+
+When the Rheumatism was confined to a particular Part, attended with
+Fever, we treated it as the acute Rheumatism. Fomenting the Part with
+warm emollient Decoctions, and rubbing it afterwards with the
+volatile, or saponaceous Liniments, often gave Ease; and the
+Application of Cupping-Glasses and Blisters frequently removed the
+Disorder. In some Cases, where the first Blister did not relieve, the
+Application of a second, and afterwards keeping up a Discharge from
+the Part by Means of the Epispastic Ointment, carried off the Pain. In
+others, where the mild Diaphoretics were ineffectual, Sweating, with
+the G. Guaiac, or _Dover_'s Powder, and such other Medicines, after
+the Fever was gone, removed the Complaints[65].
+
+    [65] Warm Water, pumped upon the Part, often removes such
+    rheumatic Pains as have resisted the Force of internal and
+    other Remedies. On the 29th of _August_, 1759, _Mary Ward_
+    was admitted into _St. George_'s Hospital for rheumatic Pains
+    of the Arms, Legs, and Knees, attended with Fever, which all
+    yielded to Evacuations, and the Use of cooling Medicines,
+    mild Diaphoretics, and of the warm Bath, except the Pain of
+    the Knee; which, after it had resisted the Course
+    above-mentioned, was at last removed by pumping warm Water on
+    the Part, three Times a Week; joined to the Use of
+    Fomentations and volatile Liniments.
+
+When the Rheumatism was attended with Inflammation and Swelling of the
+Joints, we blooded freely, gave cooling Purges, and the saline
+Draughts with Nitre, along with Plenty of weak diluting Liquors, and
+prescribed a cool low Diet.
+
+After the Violence of the Fever and Inflammation was abated, fomenting
+the Parts, and rubbing them with the saponaceous or volatile
+Liniments, sometimes hastened the Discussion of the Swelling; as did
+likewise the Application of Blisters[66], after the Inflammation was
+entirely gone; but it ought to be noticed, that if volatile Liniments
+or Blisters are used too soon, they will sometimes occasion violent
+Inflammation and Pain[67].
+
+    [66] _Ann Ragen_, a Woman about thirty-three Years of Age,
+    was admitted into _St. George_'s Hospital the 17th of
+    _January_, 1759, for rheumatic Pains of her Legs and Arms,
+    and a Swelling of her right Knee. Free Evacuations, and the
+    Use of cooling Medicines, and mild Diaphoretics, removed all
+    her other Complaints, except the Swelling of the Knee, by the
+    Middle of _February_, when I ordered a Blister to be applied
+    to it; after which the Swelling gradually decreased, and she
+    was discharged, cured, the 20th of _March_.--_Rachael Hyde_,
+    a Woman twenty-four Years of Age, was admitted into _St.
+    George_'s Hospital the 9th of _May_, 1759, for similar
+    Complaints, which were removed by the same Means, all except
+    the Swelling of the Knee. A Blister was applied, and most of
+    the Swelling went away, but returned soon after: It was at
+    last removed by the Use of the warm Pump three Times a Week,
+    and drinking a Pint of the Guaiac Decoction daily.
+
+    [67] I have sometimes ordered Leetches to be applied to such
+    Swellings (as recommended by Dr. _Pringle_), and found them
+    to be of Service; and, at other Times, I have applied
+    emollient Fomentations and Poultices, which have given great
+    Ease to the Patient.--I have seen Setons or Issues, made near
+    the Part affected, afford considerable Relief.
+
+Rheumatic Cases of this Kind are often very obstinate, and require a
+considerable Length of Time before they are got the better of; and
+frequently more or less of the Swelling, especially of the Wrists and
+Joints of the Fingers, remains ever after; and Patients, who have once
+had the Rheumatism in this violent Degree, are always subject to
+Relapses; as are even those who have had the Rheumatism but slightly.
+
+Mercury[68] has been recommended in the Cure of Rheumatisms; but I
+never found it do any Service by itself, except in Cases complicated
+with venereal Symptoms; though I have often given it, and even
+sometimes gone so far as to raise a Salivation, where the Pains were
+most severe in the Night; and the Patient, at the same Time, thought
+he had some Reason to suspect a venereal Taint, though no external
+Symptom appeared. However, many good Practitioners have recommended
+small Doses of Calomel to be given at Nights, and next Morning a
+Purge; in which Way, I think, I have observed good Effects from its
+Use.
+
+    [68] Dr. _Musgrave_, in his Treatise _de Arthritide
+    Symptomat._ p. 30, cap. ii. sect. 10, says, he has known a
+    Salivation, raised by Mercury, cure the Rheumatism.
+
+The Bark was frequently of Use in restoring the Strength, and removing
+those rheumatic Pains which remained after Fevers, and other
+Disorders; but, in other Cases, it had little Effect.
+
+When the Rheumatism continues long, and has taken deep Root,
+_Sydenham_[69] advises to bleed from Time to Time, at some Weeks
+Distance; which, he says, will either entirely remove the Disease, or
+bring it to that Condition, that the Remains of it will be easily
+extirpated by an Issue; and giving some of the volatile Salts in
+_Canary_ Wine, Morning and Evening. I have always observed in
+rheumatic Cases, which continued long, that, after free Evacuations,
+the Patients received more Benefit from a mild low Diet, continued for
+some Time, and the Use of diluting Decoctions with mild Diaphoretics,
+while they took gentle Purges once or twice a Week, than from any
+other Remedies.
+
+    [69] Vide _Sydenham. Opera._ sect. vi. cap. 5.
+
+I have given Half an Ounce of Soap a Day, for a considerable Time, in
+some old rheumatic Cases, in the Manner recommended by the late Dr.
+_John Clerk_ of _Edinburgh_, as mentioned by Dr. _Pringle_; and, I
+think, with Advantage; but have not had sufficient Trials to ascertain
+the Merits of this Medicine.
+
+Dr. _Sydenham_, in treating of the Rheumatism, which he calls
+scorbutic, says; that after it had resisted Bleeding, Purging, low
+Diet, and other Remedies, he has cured it by giving thrice a Day two
+Drachms of an Electuary made of _conserv. cochlear. horten. recent.
+unc._ ij. _lujul. unc._ i. _pulv. ar. comp. drachm_ vi. _cum syrup.
+aurant._ q. s. drinking after it three Ounces of a Water drawn from
+_Brunswick_ Beer, and some of the antiscorbutic Plants.
+
+There is no Disorder which Soldiers are so apt to counterfeit as the
+Rheumatism, when ever the Duty in the Field is severe; but while there
+is no Fever or Size in the Blood, or other evident Marks of the
+Distemper, and the Men look healthy, there is always Reason to suspect
+Imposture.
+
+
+
+
+OF THE Autumnal Remitting Fever.
+
+
+The Remitting Autumnal Fever, called by the Antients [Greek: syneches],
+was also one of the most frequent Disorders during the Campaign.
+
+This Fever is observed in most Countries, after the Juices have been
+highly exalted by the Heat of Summer; and People are exposed to the
+Heats of Mid-Day, and to the cold Damps of the Night. We observe it
+every Year in the Neighbourhood of _London_, especially among the
+labouring People, who work in the Fields, towards the End of Summer,
+and in Autumn; but it is generally in a milder Degree than in Armies,
+where Men are more exposed to the Vicissitudes of the Weather.
+
+As we go further towards the South, this, as well as other bilious
+Disorders, becomes more frequent.
+
+This Fever is reckoned the endemic Distemper of the _West Indies_, of
+the Coast of _Guinea_, and other Places in the Torrid Zone; but in
+those warm Countries it appears in a more violent Degree; makes a much
+more rapid Progress; and proves far more fatal than in our cooler and
+more temperate Climate. And it is observed to be always most frequent
+and most fatal where a Country is covered with Wood, or is marshy; and
+where there are frequent Fogs, and much stagnating Water, which
+corrupts by the Heat of Summer.
+
+In _January_, _February_, and _March_ 1761, we had none of those
+Remitting Fevers at _Paderborn_. In _April_, some few of the Soldiers,
+on their Return from the Winter-Expedition into _Hesse-Cassel_, had
+Fevers attended with bilious Symptoms; but they were rather of the
+continued, inflammatory Kind, and tending to malignant, than such as
+could be called remitting.
+
+The first Time that I saw much of this Fever, was among the Sick sent
+to _Bilifield_ in the End of _June_ 1761; soon after the Army took the
+Field. The Remissions were short, and it partook much of the Nature of
+the common Inflammatory Fever; and most of them were cured by the
+antiphlogistic Method. A Day or two before we left this Place, it
+began to change into the Malignant Hospital Fever, from the Sick being
+too much crowded.
+
+In the Middle of _July_, about Twelve Hundred Sick were sent to the
+Hospital at _Munster_; and about one-third Part were ill of this
+Remitting Fever. It did not partake near so much of the inflammatory
+Nature as at _Bilifield_; the Remissions became much more evident; and
+it was attended much oftener in the Beginning with bilious Vomiting
+and Purging; and in some few the Disorder turned to a Dysentery. About
+eight or nine had it changed into the Hospital Fever, from the Wards
+in one of the Hospitals being too much crowded; and in some few the
+Disorder terminated in regular Agues. In _November_ severals were
+taken ill of it in the Garrison of _Bremen_, which mostly ended in a
+regular Intermittent, the endemic Distemper of the Place. Towards the
+End of _December_ we had none of these Remitting Fevers, the Disorders
+turning more to the inflammatory Kind.
+
+In _June_ 1762, this Fever began to appear again among the Sick, sent
+from the Army, to the Hospital at _Natzungen_; and it continued to be
+frequent through the Summer and Autumn; and the greatest Part of these
+Fevers this Year terminated in regular Agues, mostly in Tertians, and
+were cured by the Bark; whereas the Year before very few terminated
+this Way.
+
+This Disorder in the Beginning had commonly the Appearance of a
+continued Fever; and many had a Sickness and Vomiting, and threw up a
+Quantity of yellow Bile, mixed with the Contents of the Stomach. In a
+few Days, especially after Bleeding, the Remissions became clear; tho'
+on its first Appearance in _June_ 1761 they were short, and rather
+obscure; and it seemed still to partake a good deal of the Nature of
+the common Inflammatory Fever, the Blood being very sizy; but as the
+Season advanced, the Remissions became more evident, and the Paroxysms
+more like those of an Ague; and the Blood less sizy, tho' at all
+Seasons of the Year it had some Appearance of an inflammatory Buff in
+this Disorder. The Sick were restless and uneasy at Night; but
+commonly felt themselves cooler and lighter in the Day-Time: and
+although they had no cold Fit, as the Fever came on at Nights, and
+many of them no Breathing Sweat, as they became cooler and freer from
+the Fever in the Morning; yet the Fits were so remarkable, that many
+of the Patients used to say they had a regular Fit of an Ague every
+Night, or towards the Morning; and some few, that they had the Fit
+every second Night. As the Season advanced, the Remissions appeared
+more distinct. However, there was always a good Number in whom the
+Fever went on in a continued Form, through its whole Course, without
+any Signs of Remission; tho' they had all the other Symptoms of this
+Fever. In a few Instances the Fever, after it came to remit, changed
+again into a continued Form.
+
+The Heat in the Time of the Paroxysms rose high, and several were
+delirious during its Continuance[70]; but were quite sensible in the
+Intervals, though never wholly without the Fever.
+
+    [70] I did not see the Delirium rise so high, nor the
+    Paroxysms so severe, as in the Marsh Fever described by Dr.
+    _Pringle_.
+
+At the End of _July_ 1761, four or five were attacked with a Bleeding
+at the Nose, in the Time of the Paroxysms, and became cooler
+afterwards; but it did not prove a Crisis in any of them.
+
+The Urine in the Beginning was commonly of a high Colour, though
+sometimes it was pale and limpid: At first it deposited no Sediment;
+but when the Fever came to remit, there was often a small Sediment
+after each Paroxysm; and as the Fever was going off, it let fall a
+Sediment in all[71].
+
+    [71] Dr. _Hillary_ says the Symptoms of this Fever in
+    _Barbadoes_ were much the same as those of the [Greek: syneches],
+    or continued Remitting Fever in England; except only that the
+    Urine in this hot Climate never deposits any lateritious
+    Sediment, nor very rarely in any intermitting or any other
+    Fever, except when a Crisis happens that Way. _Observations
+    on the Diseases of Barbadoes_, p. 23.
+
+Some at first were inclined to be costive; others had a Sickness and
+Purging; and several of those who were costive in the Beginning, were
+in the Course of the Disorder attacked with a Purging; and others,
+after some previous Complaint of the Stomach, were seized with both
+Vomiting and Purging. In general, after the Sick continued some Days
+in the Hospital, they were inclined to be loose; which was a
+favourable Circumstance, when this Evacuation was not so great as to
+be in Danger of sinking the Patient. Some were attacked with a
+Dysentery.
+
+In this, as well as in most other Fevers, the Sick frequently passed
+by Stool Worms of the round Kind; and sometimes they vomited them up,
+or the Worms came up into their Mouth or Nostrils while they lay
+asleep in Bed; and some towards the Height were afflicted with
+Deafness, which was commonly a favourable Symptom.
+
+Most of those ill of this Disorder had a yellowish Colour of the
+Countenance, which went off with the Fever. It was more observable in
+some than in others; in general, it was slight; some few became yellow
+all over[72]; particularly one Man, in the Hospital at _Munster_, who,
+after being seized with violent Vomiting and Purging, Convulsions, and
+Twitchings of the Tendons, and Hiccup, became yellow, as in the
+deepest Jaundice. This Symptom of Yellowness arises from a Redundancy
+and Absorption of Bile; and is sometimes observed in other Fevers as
+well as this[73]; for while we were at _Paderborn_ in _February_
+1761, two Men were brought to the Hospital in Fevers, attended with
+this Symptom. They were both delirious, with parched dry Tongues,
+slight Twitchings of the Tendons, and other bad Symptoms; and one of
+them had a continual Vomiting and Purging. They both died, and the
+Body of him who had the Purging was opened. All the Bowels, especially
+the Colon, were tinged with a yellow Bile, and had a slight Degree of
+Inflammation all over their Surface; the Gall-Bladder was distended
+with a very dark-coloured Bile; but no Concretions were found in its
+Cavity, or in the bilious Ducts; nor Mucus, or any other Thing
+obstructing these Passages. The Surface of the Lungs seemed slightly
+inflamed; and there was a small Quantity of greenish Serum in the
+Cavities of the Thorax. I could not learn the Histories of these two
+Mens Disorders, before they were brought to the Hospital; but, from
+the Symptoms, was inclined to believe, that the Fevers had been of the
+malignant or petechial Kind; and that the yellow Colour was only an
+accidental Symptom of it; for on one of the Men we could perceive
+obscure Traces of dun petechial Spots on his Breast and Arms; and the
+malignant Fever was frequent at this Time among the Troops, and the
+bilious autumnal Fevers had ceased long before.
+
+    [72] Dr. _Pringle_ takes Notice of this yellow Colour or
+    Jaundice. He says, "some grow yellow, as in the Jaundice.
+    This was found more frequent during the first Campaign than
+    afterwards; it was an unfavourable, but not a mortal
+    Symptom." _Observ._ part iii. ch. 4.--_Hippocrates_ mentions
+    the Jaundice occurring in Fevers, _Aphor._ iv. Sec. 62 & 64; and
+    he reckons it a favourable Symptom in ardent Fevers, where it
+    happens on the seventh Day. See _Book on Crises_'s, sect. 3.
+
+    [73] Does this Fever, when accompanied with this universal
+    Yellowness of the Skin, approach to the Nature of the yellow
+    Fever of the _West Indies_? As I had so few Cases of this
+    Kind under my Care, I cannot determine any thing about it
+    from my own Experience; but, from the Accounts of others, I
+    should believe them to be very different Disorders.--In the
+    yellow Fever of the _West Indies_, the Blood appears quite
+    loose and dissolved, without the least Appearance of Size,
+    even on the first Day; and the general Yellowness appears on
+    the third or fourth, with Signs of a total Dissolution, and
+    gangrenous Diathesis of the Blood: Whereas, in the Remitting
+    Fever of _Jamaica_, Mr. _Nasmith_ tells us, (See Dr. _Lind_'s
+    first Paper on Fevers), there is always an inflammatory
+    Diathesis of the Blood. The Yellowness in both depends on a
+    Redundancy and Absorption of Bile; but in the yellow Fever of
+    the _West Indies_, the Bile is in a much more putrescent
+    State, and a great Part of the Cure depends on the early and
+    speedy Evacuation of it.--In the yellow Fevers which appeared
+    in _Haslar_ Hospital, which are taken Notice of by Dr.
+    _Lind_, in his _Two Papers on Fevers_, the Blood was in quite
+    a different State from what it is in the Yellow Fever of the
+    _West Indies_; the Blood drawn from two of these Patients
+    became covered with a thick yellow Gluten, and the Serum was
+    of the Consistence of a thin Syrup, and of a deep yellow
+    Tinge, and tasted bitter; and in another who was bled two
+    Days before his Death, it threw up the same thick yellow
+    Gluten, tho' the red Part below was quite loose.
+
+I could not observe any certain critical Days, or Periods, when this
+Disorder terminated.--Some, who had it slightly, got well in a few
+Days; with others, it continued longer: Some continued long feverish,
+and would seem cooler and freer from Fever for a Day or two, and then
+grow worse again; and many had repeated Relapses.
+
+Neither could I observe any regular Crisis in this Fever. Sweat was
+the Discharge which oftenest proved critical. Many seemed to be
+relieved by a Purging; but as the greater Part had a Looseness after
+some Days, which continued often through the Disorder, without
+producing any very sudden Change in the Symptoms, it seemed to be a
+favourable Circumstance; though it seldom carried off the Fever so
+suddenly as to be manifestly critical. The Urine broke, and dropt a
+Sediment, for the most part, as the Fever took a favourable Turn.
+
+When this Fever proved mortal, it commonly assumed a continued Form;
+the Tongue became parched and dry, the Patient delirious, with
+Twitchings of the Tendons, Hiccup, and other fatal Presages; while
+others were seized with a violent Diarrhoea, or Dysentery, which sunk
+them irrecoverably.
+
+In the Beginning, it was absolutely necessary to bleed the Patients
+freely; and frequently to repeat the Evacuation, where the Symptoms
+required it. The Blood was of a florid Colour, and commonly threw up
+more or less of an inflammatory Buff.
+
+In these Fevers, we were obliged to have particular Regard to the
+first Passages, especially in the Beginning of the Disorder; for they
+were generally loaded with bilious Humours[74]; which, if suffered to
+remain in the Bowels; were either absorbed, and increased the Heat
+and Fever, or brought on a violent Diarrhoea; and therefore, after
+Bleeding, we gave a Vomit in the Evening, and next Day a Dose of some
+gentle Purge, as Rhubarb or Salts; to carry off these putrid, bilious
+Humours: And afterwards, in the Course of the Disorder, if the Patient
+was costive, and grew hot, restless, and uneasy, we either repeated
+the Purge, or gave laxative Clysters, which generally removed these
+Symptoms.--Frequently after the Operation of the Emetic, the Patient
+had some loose Stools, from the Gall Bladder's being emptied in the
+Strainings to vomit. Such Stools were always bilious, as were commonly
+those procured by purgative Medicines.
+
+    [74] According to Dr. _Hillary_'s Account of the Yellow Fever
+    in the _West Indies_, which is attended with bilious
+    Vomiting, it bears bleeding once or twice, but not a third
+    Time, before the third Day, but not at all after that Time;
+    and after Bleeding a great Part of the Cure depends on
+    carrying off as much of the putrid Bile as expeditiously and
+    safely as possible, which he says is to be done by making the
+    Patients drink freely of warm Water (sometimes mixed with a
+    little simple Oxymel or Green Tea) so as to vomit seven or
+    eight Times; and then to give a grain, or a Grain and a half
+    of Opium, to procure Rest, and to settle the Stomach; to make
+    the Patient take nothing for two Hours after; and then, if he
+    has not had a Stool, to give a laxative Clyster; after six
+    Hours Rest, to give a gentle Purge, to carry off as much as
+    possible of the bilious corrupted Humours; and in the Course
+    of the Disorder to repeat the Purge, as often as the Patient
+    is attacked with an Anxiety, and a painful burning Heat about
+    the Praecordia; which almost always depend on bilious
+    corrupted Humours pent up within the Bowels; and to endeavour
+    to support the Patient's Strength, and stop the putrescent
+    Diathesis of the Fluids by suitable Antiseptics, of which he
+    found a watery Infusion of Snake Root, mixed with _Madeira_
+    Wine and Syrup of Poppies, to answer the best of any Thing he
+    tried, and to sit easiest on the Stomach; and to this he
+    added the Use of Cordials, and of strong Wine Whey as the
+    Patient became lower.
+
+    Dr. _Hillary_'s Purge was: Rx. Mannae sescunc. vel unc. ij.
+    Tamarind. cond. unc. i. Tartar vitriolat. gr. x. solve in
+    seri lactis praeparat. cum Vin. Maderiens. unc. vi. Colaturae
+    adde Tinct. Senae unciam dimidiam. Divide in Partes quatuor, &
+    capt. aeger unam omni hora donec laxetur alvus.
+
+    His Infusion of Snake-Root was prepared in the following
+    Manner:
+
+    Rx. Rad. Serpent. Virgin. drachm. ij. Croci Angl. drachmam
+    dimidiam, infunde per horam vase clauso in aq. bull. q. s. &
+    dein unc. vi. Colaturae, adde aq. Menth. simp. unc. ij. Vin.
+    Maderiensis, unc. iv. Syrup. Croci vel Syr. e Mecon. unc. i.
+    Elix. Vitriol. acid. q. s. ad gratum saporem M. capiat aeger
+    cochlear. ij. vel iij. omni hora vel secunda quaq; hora vel
+    saepius pro re nata.
+
+    The Stomach is so irritable in the Beginning of this
+    Disorder, as to reject the saline Draughts, Nitre, and such
+    other Medicines. Nor will the Bark, which might be judged a
+    very proper Medicine in the second Stage of the Disorder, lie
+    upon the Stomach, but is thrown up immediately, in whatever
+    Form it is given. However, a Gentleman who had practised long
+    in the _West Indies_ told me, that although the Patient could
+    not retain it in his Stomach, yet that he had found great
+    Service, after the Bowels were emptied, from the Bark used
+    freely in Clysters.
+
+    Dr. _Hillary_ disapproves of the Use of Blisters in the
+    advanced State of these Fevers.
+
+After emptying the Bowels, we gave the cooling, and mild Diaphoretics,
+such as the saline and mindereri Draughts, joined occasionally with
+Nitre, or the Contrayerva Powders; while we made the Patient drink
+plentifully of warm diluting Liquors; which we found to answer in
+general better than any other Remedies: They brought the Remissions to
+be more evident, and the Paroxysms to be milder, at the same Time that
+they kept up a free Perspiration, as a Means to carry off the
+Distemper.
+
+In some Cases we gave the Antimonial Powder, made of one Part of
+Tartar Emetic, and ten of the _pulvis e chelis_, in small Doses, from
+two to four Grains every four or six Hours. The first Doses of this
+Powder sometimes made the Patient sick, and acted as a Purgative, and
+kept up a free Perspiration; at other Times, it produced no visible
+Effect. In some Cases, where it was given early, it operated both by
+Stool, and as a Diaphoretic, and removed the Fever[75]; and it was of
+Use in others, towards the Decline of the Fever; but we were often
+obliged to lay it aside; for it either acted too roughly, or produced
+no visible Effect or Alteration in the Disorder.
+
+    [75] Dr. _Millar_, one of the Physicians to the Army, told me
+    in _Germany_, that he had given this antimonial Powder with
+    great Success in the Remitting Fever, while the Eighth
+    Regiment of Foot (to which he was formerly Surgeon) lay in
+    _England_.--Dr. _Pringle_, in his fourth Edition of his
+    _Observations_, Part iii. ch. iv. tells us, that having given
+    a mild Purge immediately after Bleeding, he next Morning,
+    when there was almost always a Remission, gave a Grain of the
+    Tartar Emetic, with twelve Grains of Crabs-Eyes, and repeated
+    the Dose in two Hours, if the first had little or no Effect;
+    at any Rate, in four Hours. This Medicine not only vomited,
+    but generally opened the Body, and raised a Sweat. By these
+    Evacuations, the Fever was sometimes quite removed, but
+    always became easier.--This Medicine he usually repeated the
+    second or third Day; if not, he opened the Body with some
+    mild Laxative, or a Clyster; and continued this Medicine,
+    till the Fever went gradually off, or intermitted.--Dr.
+    _Pringle_ says, that Dr. _Huck_ treated this Fever in a
+    Method similar to this, both in _North America_ and in the
+    _West Indies_. In the Beginning he let Blood; and in the
+    first Remission, gave four or five Grains of Ipecacuana, with
+    Half a Grain of Tartar Emetic: This Medicine he repeated in
+    two Hours, taking Care that the Patient should not drink
+    before the second Dose; for by that Means the Medicine passed
+    more readily into the Bowels, before it operated by vomiting.
+    If, after two Hours more, the Operation either Way was small,
+    he gave a third Dose; which commonly had a good Effect in
+    carrying off the Bile; and then the Fever either went quite
+    off, or intermitted so far as to admit the Bark. On the
+    Continent he found no Difficulty after the Intermission; but
+    in the Islands, unless he gave the Bark upon the first
+    Intermission, though imperfect, the Fever was apt to assume a
+    continual and dangerous Form. Dr. _Huck_ never varied this
+    Method, but upon a stronger Indication to purge, than to
+    vomit. In which Case he made an eight Ounce Decoction, with
+    Half an Ounce of _Tamarinds_, two Ounces of _Manna_, and two
+    Grains of _Emetic Tartar_; and dividing this into four Parts,
+    he gave one every Hour, till the Medicine operated by Stool.
+
+When the Fever came to remit, we were obliged, for the most part, to
+continue the Use of the mild Diaphoretics, as before; for, although
+the Disorder put on a remitting Form, the Bark had very little Effect
+in stopping it[76], unless where the Fever changed into a regular
+Quotidian or Tertian Ague.--In the Year 1761, very few of these Fevers
+turned to regular Intermittents; but, in the Year 1762, the greater
+Part of them terminated in regular Agues, and were cured by the
+Bark[77].
+
+    [76] Dr. _Hillary_, in mentioning the Remitting Fever of the
+    Island of _Barbadoes_, says: In those who were blooded, and
+    took an Emetic afterwards, and then the saline Draughts, the
+    Fever was generally carried quite off by a critical Sweat on
+    the seventh or ninth Day; in some few it came to intermit
+    regularly after that Time; and was soon cured by the _cortex
+    Peruviana_, given with the saline Draughts, and seldom
+    effectually without them; though these irregular ingeminated
+    Fevers often remitted, and sometimes seemed to intermit; yet
+    if the _cortex Peruviana_ was given too soon in the Disease,
+    before it intermitted regularly (as I have more than once
+    seen, where it had been injudiciously given), it generally
+    caused the Fever to become continual and malignant.
+    _Observat. on the epidemic Diseases of Barbadoes_, p. 22.
+
+    [77] Mr. _Cleghorn_, after giving a very accurate Account of
+    Tertian Fevers, as they appeared in their various Forms of
+    true, of double, and triple Tertians, and of Semi-Tertians,
+    in the Island of _Minorca_, tells us, that he first attempted
+    the Cure by profuse Evacuations; but afterwards learnt from
+    Experience, that they were unnecessary; and that Bleeding and
+    Purging once or twice in the Beginning, was all that was in
+    general requisite; and if on the fifth Day the third
+    Revolution was not attended with more threatening Symptoms
+    than the second, and the Patient bore it easily, he
+    frequently trusted the whole Business to Nature; which
+    commonly terminated the Fever about the fourth or fifth
+    Revolution; and for the most part with an Increase of some
+    natural Evacuation.--But if the Paroxysm on the fifth Day was
+    the longest and most severe that happened, attended with any
+    doubtful or dangerous Symptom, he ordered two Scruples of the
+    Cortex to be given every two or three Hours; so that five or
+    six Drachms may be taken before next Day at Noon; lest, if
+    this Interval escaped, he should not have found a favourable
+    Opportunity of giving a sufficient Quantity of the Medicine
+    afterwards; as the Fits about this Period are wont to become
+    double, subintrant, or continual.--This did not always put an
+    immediate Stop to the Fever, but it invigorated the Powers of
+    the Body, and prevented or removed the dangerous Symptoms.
+    Having given the Bark on the fifth Day, if a Fit came on the
+    sixth, and declined the same Evening, he gave some more Doses
+    of the Bark to mitigate the Fit on the seventh; yet sometimes
+    this Fit of the sixth united with that of the seventh, and
+    the Patient had the Heat, Restlessness, Raving, and other
+    Complaints, greatly augmented, and the Case seemed more
+    desperate than ever; which, however, were more dangerous in
+    Appearance than Reality, and went off with a profuse Sweat
+    next Morning; after which he gave the Bark freely as before;
+    and this either stopt the Fits, or made them so moderate, as
+    that they yielded quickly to the same Sort of Management.--By
+    this Method, when Assistance is called timely, Mr. _Cleghorn_
+    says, the most formidable Intermitting and Remitting
+    Tertians, may be certainly and speedily brought to a happy
+    Conclusion about the End of the first Week, or Beginning of
+    the second. See _Observ. on the epidemic Diseases in
+    Minorca_, chap. iii. p. 187, &c.
+
+In the Year 1761, we tried the Bark in various Forms in many Cases,
+where the Patient had been blooded and purged in the Beginning, and
+used the cooling Medicines; and where the Remissions were very clear:
+Yet it had no Effect in removing the Disorder, except in two or three
+Cases at _Munster_, where the Paroxysms assumed a tertian Form; for
+the most part, it made the Patients more hot and feverish, and we were
+obliged to leave off using it, as it was in Danger of changing the
+remittent into a continued Fever. However, it was of Service after the
+Fever came to a Crisis, and was going off; and Dr. _Pringle_ has very
+justly observed, that it hastened the Recovery, and that those who
+used it were less subject to Relapses than such as did not; and
+therefore we commonly gave it in a convalescent State.--Before giving
+the Bark, I always found it of Advantage to give a Dose of Rhubarb, or
+of some other Purgative, or to mix some Rhubarb with the first Doses,
+so as to procure the Patient some loose Stools.
+
+When either the Fever went on without Intermission, or changed into a
+continued Form, or the Patient continued hot and feverish through the
+Day, with a Head-Ach, and other feverish Symptoms, nothing answered
+better, after free Evacuations had been made, than to apply a large
+Blister to the Back; and to make the Patient drink freely of cooling
+diluting Liquors; which generally relieved the Head, and abated the
+Violence of the other Symptoms.
+
+When a Purging came on in the Course of this Disorder, if there was
+much Fever, with a strong throbbing Pulse, Gripes and Pain of the
+Bowels, some Blood was taken away; and immediately after the Patient
+took a Dose of Salts and Manna, or of Rhubarb; and an Opiate in the
+Evening after its Operation: But if there was little or no Fever, or
+sharp Pain, Bleeding was omitted; and if the Patient complained of
+Sickness, a few Grains of Ipecacuana were given previous to the Purge.
+
+After this, if the Purging was moderate, and did not sink the Patient,
+we did nothing to stop it; but if it was violent, we gave the
+mindereri Draughts with Mithridate, and the Chalk Julep in the Day,
+and an Opiate at going to Rest; and occasionally used the emollient
+and anodyne Clyster; and, if necessary, repeated the Emetic and Purge.
+
+The Hiccup seldom appeared in this Fever till the Patient was reduced
+very low, and was commonly the Forerunner of Death. Some few, who had
+a Purging and Vomiting, were taken with a Hiccup, attended with
+Sickness, and Load at the Stomach, which seemed to depend on bilious
+Humours lodged in the Stomach and Bowels. This induced me to give a
+few Grains of the Ipecacuana; and to make the Patients drink an
+Infusion of Camomile Flowers till they vomited freely, and afterwards
+to take some mild Purge, or use laxative Clysters; after which they
+found themselves easier, and an anodyne Draught, with twenty or
+twenty-five Drops of the _tinctura thebaica_, put an End to the
+Hiccup. Others required the Use of Cordial Draughts, mixed with
+Opiates; and repeated Clysters and Fomentations, before they found
+Relief.--The Application of a Blister removed the Hiccup in one,
+after the above Remedies had proved ineffectual; as did the Musk Julep
+with Opium, and the Application of an aromatic Plaister to the
+Stomach, in another Patient.
+
+Several of them complained of a burning Heat and Pain in making Water;
+which commonly went off by drinking freely of the Gum Arabic
+Decoction, with the dulcified Spirit of Nitre, and the Use of oily
+Draughts; though in some it required the Assistance of Opiates, and of
+Fomentations and Clysters, before it was got the better of.
+
+The Symptom of Worms we were often obliged to neglect till the Fever
+was over, and then we treated it as formerly mentioned.
+
+The Deafness, though not near so frequent in this as the Malignant
+Fever, was rather a favourable Symptom, and mostly went away of
+itself; though in a few Cases, where it continued long, we applied
+Blisters behind the Ears, or to the Neck, with Advantage.
+
+Many, especially those who were brought low, complained, after the
+Crisis of the Fever, of Restlessness, and Want of Sleep; which,
+however, went off as their Strength returned: Where it fatigued them
+much, and kept them low, we gave a Cordial anodyne Draught at Night;
+and if that did not answer, commonly the Addition of a few Glasses of
+Wine in the Afternoon had the desired Effect.
+
+Others, in their convalescent State, complained of such a Giddiness,
+and Lightness of the Head, that they could neither walk nor stand;
+others, of a Dimness of the Eyes. These Symptoms, for the most part,
+went off as the Patients gathered Strength: The Use of the Bark, with
+now and then a Glass of Wine, hastened the Cure; and in two or three
+Cases we were obliged to give a Dose or two of some gentle Physic, and
+to apply a Blister, before the Patient got the better of them.
+
+As the Sick were recovering, it was common for them to complain of
+Pains of the Shoulders, Arms, and Legs, which also left them as they
+recovered their Strength; where they did not, the saline Draughts, and
+a low Diet, generally had a good Effect; and where it had not, we
+treated them as rheumatic Complaints.
+
+When the yellowish Colour of the Countenance remained after the Fever,
+we kept the Patient on a low Diet; and his Body open by Means of the
+saline Draughts, with a few Grains of Rhubarb, or by giving Half a
+Drachm, or two Scruples of the Soap Pills with Rhubarb daily; which,
+for the most part, removed the Yellowness soon. Two only had a
+Jaundice remain after the Fever, and both were cured in a short Time.
+
+In other Respects, the Treatment of this Fever, when it degenerated
+into a continued Form, had nothing particular in it; nor differed from
+the common Practice of giving cooling Medicines when the Fever was
+high, and supporting Nature by the Use of Cordials and Wine, and the
+Application of Blisters, &c. when low; and promoting such Evacuations
+as Nature pointed out for a Crisis.
+
+
+
+
+OF THE Intermitting Fever, or Ague.
+
+
+This Disorder belongs to the same Tribe of Diseases as the Remitting
+Fever. We call it an Intermitting Fever, or Ague, when the Paroxysms
+are distinct, begin with a cold and hot Fit, and go off with a Sweat;
+and the Patient is cool, and free from the Fever in the Intervals
+between the Fits.
+
+Many have been the Causes alledged to produce this Disorder. The great
+Quantity of Bile that is often thrown up in the Fit, has caused it to
+be ranked among the bilious Diseases; and the Seasons of the Year in
+which it is most frequent, and the low moist Situation of the Places
+where it is endemic, have made Practitioners suspect, that an
+obstructed Perspiration, and a Tendency in the Juices to the
+Putrescent, are the Cause of it.
+
+But whatever Cause we may suppose to give Rise to the first feverish
+Fit, it is difficult from hence to account for the regular Returns of
+the Paroxysms and Intermissions: For my own Part, after considering
+Intermittents, which observed a regular _Type_ in the Course of a
+Salivation[78]; their being so easily stopt by the Bark without any
+sensible Evacuation; their being sometimes put away by a Stimulus
+externally applied[79], or by a Fright, or sudden Plunge into cold
+Water[80]; their returning after slight Errors in Diet, and sometimes
+by the Operation of a Purge, or of Bleeding; their attacking sometimes
+only particular Parts, and many such Accidents in these Fevers, I must
+confess, that I am unable to form any Idea, either of their Origin,
+Seat, or Cause[81].
+
+    [78] See _Van Swieten_, Vol. II. p. 537.
+
+    [79] A Gentleman told me, that he was once cured of an Ague
+    in the Country, by applying a Poultice of Garlic to his
+    Wrists, and letting it lie on till it inflamed and blistered
+    the Part.--I have seen Blisters cure an Ague.--In the
+    _Edinburgh Med. Essays_, Vol. II. Art. v. we have an Account
+    of Agues being cured by the Application of Poultices of
+    recent Erigerum (Groundsel) applied to the Stomach on the
+    Days free from the Paroxysm, which caused strong Vomiting.
+
+    [80] See an Account of an Ague being cured by the Patient
+    being pushed into a Pool of Water without any previous
+    Notice, and being much frightened, in _Mason's Account of
+    Agues_, p. 222.
+
+    [81] The common Account given of the Cause of Agues, and of
+    the regular Return of their Paroxysms, has been: That the
+    Ague takes its Rise from some Sort of Matter, bilious, or
+    whatever it may be, either mixed with the Blood, or lodged in
+    the Bowels, or in some other Part of the Body; that a great
+    Part of this Matter is thrown out of the Body, in the Time of
+    the Paroxysm; but that so much remains as serves by Way of a
+    Ferment to assimilate other Particles to its own Nature;
+    which, when collected in a certain Quantity, produce a new
+    Fit; and, according to the Time that it takes to produce this
+    Quantity, the Disorder assumes the Form of a Quotidian,
+    Tertian, or Quartan Ague.
+
+The Soldiers were subject to this Disorder, particularly in Spring, if
+they took the Field soon, and in Autumn: The Frequency of it was in a
+great Measure determined by the Nature of the Ground on which they
+were encamped, or the Situation of the Garrison or Town in which they
+were quartered; for the lower and moister the Camp or Garrison, and
+the more moist the Season, the more subject an Army is to Agues; and
+the drier the Situation of the Camp or Garrison, and the finer and
+drier the Weather is, the freer they are from Disorders of this Kind.
+
+In Winter 1761, we had but very few Agues in the Hospitals; but on the
+Return of the Troops from the Expedition into _Hesse-Cassel_, and
+during the Spring, some (though not many) were attacked with Quotidian
+and Tertian Agues, and but very few with Quartans.--In _July_ and
+_August_ they were more frequent, and accompanied with more bilious
+Symptoms. At _Bremen_, during the latter End of Autumn, and throughout
+the Winter and Spring 1762, we had Agues of all Sorts, and many
+inveterate Cases; and all this Spring, and during the Summer and
+Autumn, the Ague was the epidemic Disorder all over _Westphalia_, as
+well as among the Troops.
+
+In Spring 1761, what Agues we had were mostly Tertian, some Quotidian,
+and but two or three of the Quartan Kind. They were, for the most
+part, mild, and yielded to the Bark.--Some of them began in the Form
+of a continued Fever; but after Bleeding, and the Use of the cooling
+Medicines for a few Days, they began to remit, and at last ended in
+regular Quotidian or Tertian Agues: Others, at first, appeared in Form
+of Remittent Fevers, attended with a strong throbbing Pulse; but
+changed to regular Intermittents by pursuing the antiphlogistic Method
+of Cure; and some from the Beginning assumed the Type of Quotidian or
+Tertian Agues, but often attended with a good deal of Fever, for the
+first two or three Days; and some had a slight Delirium in the Time of
+the Paroxysms, and the Pulse was not quite settled in the Intervals.
+In such Cases, where the Patient was strong, nothing answered so well
+as to take away some Blood; and to give the saline Draughts with Nitre
+till the Fever was moderated, before we gave the Bark.
+
+In general, there is a Prejudice against bleeding in Agues, after they
+become regular; but I have always observed, both in _England_ and in
+_Germany_, that where Patients are strong and plethoric, and the
+Fever in the Paroxysms rises high, or the Pulse remains quick in the
+Intervals, that taking away more or less Blood, and giving the
+antiphlogistic Medicines in the Beginning, eased the Patient,
+moderated the Fever, and made it safer to give the Bark soon; and I
+never saw the least Inconvenience from the Practice; but, on the
+contrary, have seen several Intermittent Fevers change into continued
+ones from the Neglect of this Evacuation; and have seen Cases where
+the Bark, instead of stopping the Ague, rather increased the Fever,
+till the Patient was blooded, and had pursued the antiphlogistic
+Method for some Time; after which the Bark had its proper Effect, and
+put an End to the Disorder.
+
+As soon as these Agues became regular, and the Patient was quite cool,
+and free from any Fever in the Intervals, we gave the Bark; which soon
+put a Stop to the Paroxysms, without the least bad Consequences; but,
+before giving the Bark, we always took Care to empty the first
+Passages by the Use of Emetics and Purgatives, where there was no
+Symptom to forbid their Use: In Cases where the Patient was weak, and
+the Fits so violent as to make it necessary to stop the Ague, before
+we had Time to administer Emetics or Purgatives, we added so much
+Rhubarb to the first Doses of the Bark as procured the Patient some
+loose Stools, as recommended by Dr. _Mead_[82]; which did not prevent
+its stopping the Ague, at the same Time that it answered the End
+proposed of carrying off any putrid Humours that might be lodged in
+the Intestines.
+
+    [82] Mr. _Cleghorn_, while at _Minorca_, after Evacuations,
+    gave the Bark at the End of the third Period, as we observed
+    before; but where the Fever had been neglected till about the
+    third or fourth Period, or badly treated in the Beginning,
+    and the Bowels were inflamed or overcharged with corrupted
+    Gall, he was obliged to endeavour to palliate the most
+    pressing Complaints, and to watch Evening, Night, and Morning
+    for a Remission, and then immediately to fly to the Bark, as
+    the only Remedy that could avert the Danger. If the Patient
+    was strong, he gave Half an Ounce of the Bark, with six
+    Drachms of the _sal catharticum amarum_, divided into four
+    equal Parts, of which the Patient took one every two Hours;
+    the Effect of which was, that the next Fit was mitigated, and
+    an Intermission commonly ensued, in which the Bark was
+    repeated without the Purgative, to finish the Cure.--But
+    where the Patient was excessively feeble, and there was a
+    manifest Risk of his dying in next Fit, he gave Cordials with
+    the Bark, instead of the _sal catharticum_; and endeavoured
+    to throw in six or seven Drachms in the Space of ten or
+    twelve Hours; he having found by Experience, that if a
+    smaller Quantity is given, the Paroxysms come on earlier than
+    usual, and make all Attempts to preserve Life unsuccessful.
+    See his _Account of the epidemic Diseases of Minorca_, cap.
+    iii. 2d edit. p. 192.
+
+In _England_, Vernal, Quotidian, and Tertian Agues, frequently go off
+after Bleeding, and taking some Emetics and Purges, and the saline
+Draughts, and cooling Medicines, for some Time, without the Use of the
+Bark; but in _Germany_ very few yielded to this Treatment, and we were
+obliged to give the Bark[83] before we could put a Stop to them.
+
+    [83] Sometimes, when Patients are reduced low by Agues, the
+    Stomach becomes so squeamish as to reject the Bark in every
+    Shape it can be given; in such Cases, when the Ague cannot be
+    stopped by other Means, it may be administered with great
+    Advantage in Clysters, of which the following is a very
+    remarkable Instance.--_William Hadderell_, a Lad seventeen
+    Years of Age, in the End of the Year 1761, was attacked with
+    a severe Tertian Ague, in which a Mortification came on his
+    left Foot, and one-half of it dropt off; notwithstanding, his
+    Ague continued to attack him every second Day, and the Sore
+    continued running on the 12th of _October_ 1763, when he was
+    admitted into _St. George_'s Hospital. He was reduced
+    extremely low; and the Sore of his Foot looked so bad, that
+    it was at first imagined he must lose his Leg. He was ordered
+    some Vomits, and a Purge, and cooling Medicines, and
+    afterwards to take the Bark freely; but his Stomach rejected
+    it, in whatever Form it was given. Other Means were then
+    tried to stop his Ague, but with no Effect, till the 7th of
+    _November_, that I ordered two Drachms of the Powder of the
+    Bark to be given him twice a Day in an emollient Clyster,
+    with Half a Drachm of the _tinctura thebaica_, which stopt
+    his Ague in three Days; and he had had no Return of it on the
+    28th of _January_ 1764, and had recruited his Health and
+    Strength, and the Sore of his Foot was greatly lessened. Dr.
+    _Harvey_ (who teaches Midwifery in _London_) told me, that he
+    has cured Children of Agues by Bark Clysters, after the Bark
+    Waistcoats, and other Means used, had proved unsuccessful.
+
+In the End of _July_, and Beginning of _August_, the aguish Cases we
+had at _Munster_ continued to be of the Quotidian or Tertian Kind. The
+greatest Part of them began in the Form of continued Fevers, tending
+more to the bilious Kind than the preceding Months, and many of the
+Sick had bilious Vomitings in the cold Fits; and the Agues we had in
+Spring, and during the Campaign 1762, were of the same Nature, and
+required the same Treatment.
+
+Those Cases, which began in the Form of continued Fevers, were
+treated as such till they began to have regular Intermissions; they
+then yielded to the Bark.
+
+Some were attended with the Dysentery; and the Purging and Gripes were
+most severe on the Days of the aguish Paroxysms. In such Cases, we
+were frequently obliged at first to neglect the Ague, and to treat the
+Disorder entirely as a Flux. Where there was much Fever, the Patient
+strong, and the Pains in the Bowels acute, we ordered Bleeding; and
+after it a gentle Emetic, and some Doses of the saline oily Purge, or
+of Rhubarb; and gentle Opiates in the Evening, and other Medicines
+proper in the Dysentery, till its Violence was abated, before we gave
+the Bark: though in some Cases, where the aguish Paroxysms were very
+severe, and helped to increase the Purging, and the Patient was in
+Danger of sinking, we gave the Bark, notwithstanding the Flux still
+continued; and the Method we followed was the same as that I formerly
+mentioned, where it was complicated with the Malignant Fever; which
+was to give the Bark, mixed with Diascord, and Opiates, or other
+Medicines proper for the Dysentery, in the Intervals between the
+Purges.
+
+By this Treatment, very often both the Flux and Ague went off.
+However, it ought to be observed, that unless the aguish Paroxysms
+were severe, and in Danger of sinking the Patient, or that the
+Disorder had continued for some Time, and the Paroxysms were distinct,
+we seldom gave the Bark till the Violence of the Flux was abated: And
+where-ever much Griping and Pain in the Bowels attended the Flux and
+Ague, there Bleeding as well as Purgatives were necessary, before
+exhibiting the Bark; which seldom or ever agreed with them, till there
+was an evident _Apurexia_, or Absence of Fever in the Intervals
+between the Fits. Where these Cautions were neglected, the Bark
+generally made the Patients worse; and we were obliged to omit it,
+till the Violence of the Purging was over.
+
+Some Agues were accompanied with the Jaundice, though not in such a
+high Degree as in the confirmed State of that Disorder; and commonly
+in the Beginning the Pulse continued rather quick, in the Intervals
+between the Paroxysms; and the Patients complained of some Degree of
+Sickness for the first two or three Days. With those the Bark always
+disagreed, till the Feverishness between the aguish Paroxysms was
+gone; and we found, that the best Method of treating them, was to
+bleed in the Beginning, if there was much Fever; and then to give a
+Vomit and Purge, and to repeat them, if necessary; and where there was
+no Purging, to give the saline Draughts, and other cooling Medicines;
+and to add a few Grains of Rhubarb, or to give so much of the _pilulae
+saponacae cum rheo_, daily, as procured one or two loose Stools.
+
+After the Ague had regular Intermissions, and the Patient was quite
+cool, and without Fever in the Intervals, if the Disorder did not
+yield to the above Treatment, which it seldom did, we then gave the
+Bark freely; even though the slight icteric Symptoms still remained;
+and it put an End to the Ague, and removed the Jaundice at the same
+Time, without the least Inconvenience to the Patient. In such Cases,
+we generally used to add a few Grains of Rhubarb to the first Doses of
+the Bark; or gave the Bark made up into Pills with Soap, and added
+occasionally a few Grains of Rhubarb.
+
+Several of those who had the icteric Symptoms along with the Ague, had
+bilious Vomitings in the Time of the cold Fit; they found themselves
+sick, with a bitter Taste in their Mouth, before the Approach of the
+aguish Paroxysm; and many of them, though they took Emetics, which
+operated freely at this Time, yet did not vomit up the Bile; but the
+Sickness and bitter Taste continued till the cold Fit came on, when
+they vomited Bile in large Quantities. In such Cases, after the Use of
+Emetics and Purges, and the Ague was brought to have regular
+Paroxysms, with free Intermissions, the Bark, given as just now
+mentioned, removed the Ague and icteric Symptoms, without the least
+bad Consequences.
+
+Many Practitioners of great Repute have been prejudiced against the
+Bark; and tell us, that the free Use of this Medicine often lays the
+Foundation of Obstructions in the abdominal Viscera, especially when
+it has been given where there was an icteritious Colour in the Eyes
+and Countenance; and that, in such Cases, we ought not to give the
+Bark till these Icteric Symptoms are gone. At first, I was very
+cautious of giving it under such Circumstances; till meeting with some
+Cases where the Paroxysms were severe, and became more frequent, while
+the Patient was so low, as to be in Danger of sinking under the
+Disorder, I gave the Bark freely, as the only Remedy capable of
+preserving Life; which not only stopt the Ague, but carried off the
+icteritious Symptoms[84], and restored the Patients to perfect Health.
+
+    [84] This agrees with what Mr. _Cleghorn_ remarks of Tertian
+    Fevers in his _Observations on the epidemic Diseases of the
+    Island of Minorca_, who says, "where there is an icteritious
+    Colour of the Eyes, we are likewise told, that the Cortex
+    should not be administered; though, in my Opinion, it is for
+    the most part dangerous to delay it, after the first
+    Appearance of that Symptom." Chap. iii. 2d edit. p. 205.
+
+After this I gave it freely, in the Manner above mentioned, to some
+Hundreds, with great Success; and I never saw any Mischief follow from
+using it: Indeed sometimes, where it was given rather too soon, it did
+not sit easy on the Stomach; and made the Patients hot and restless;
+but, by laying it aside, these Effects immediately ceased; and
+generally, after a little Time, the Paroxysms became milder and more
+distinct, when the Bark was again administered, agreed with the
+Stomach, and put an End to the Disorder; and I am now convinced, from
+Experience, that the Cases in which the Bark has done Mischief, or
+given Rise to Obstructions of the abdomenal Viscera, are but very
+rare; and that these Mischiefs mostly arise from the Obstinacy of the
+Disorder, and not from the Use of this Drug; for I have oftener
+observed these Obstructions where little or no Bark had been used,
+than where it was given freely[85]. What probably has given Rise to
+the Belief of the Bark's doing so much Mischief, is, that in
+_Holland_, and other low fenny Countries, where Agues are endemic,
+they are oftentimes extremely obstinate, and yield hardly to any
+Remedies; and if they are stopt by the Bark, they often return soon
+after, and by their long Continuance give Rise to Obstructions of the
+abdomenal _viscera_, which have been attributed to the Use of this
+Specific.
+
+    [85] Dr. _Pringle_ takes Notice, that these Obstructions
+    happened as often without as with the Bark; and therefore
+    seemed to depend on the long Continuance and Obstinacy of the
+    Intermittent. _Observ._ part iii. chap. iv. sect. 2. p. 179.
+    3d Edit.
+
+In some few Cases a Purging accompanied these icteric Symptoms, which
+we treated much in the same Manner as when the Ague was complicated
+with the Flux; we gave Emetics and Purgatives; and the mindereri
+Draughts with Mithridate, throughout the Day, and Opiates at Night, if
+the Purging was violent; if it continued, accompanied with regular
+aguish Fits, the Bark, with Astringents, generally removed both.
+
+In the latter Part of the Year 1761, and during Spring 1762, we had
+at _Bremen_ many Patients in Agues of all Sorts; as Quotidians,
+Tertians, Quartans, and irregular Agues of a very obstinate Nature.
+The Town of _Bremen_ is large and well built, situated in a low sandy
+Plain, with the _Weser_ dividing the old from the new Town; generally
+a considerable Part of the Environs is covered with Water in the
+Winter, and frequently the _Weser_ breaks down some of the Dikes, and
+overflows all the Country round; and every Time the River overflows
+its Banks, the Cellars of all the new Town, and of that Part of the
+old Town next the River, are filled with Water. All the Year round, on
+digging two or three Feet deep into the Ground, you come at Water.
+
+Agues are endemic in this Place, and great Numbers of the lower Class
+of People are afflicted with them at all Times of the Year, especially
+in Spring and Autumn.
+
+Some of the Sick sent down from the Army were bad of Agues; but the
+greatest Number we had in Hospitals was composed of such as took it
+in Town; either from doing Duty on the Ramparts, or from lying in bad
+Quarters, or getting drunk and exposing themselves to Wet and Cold;
+and many Men of the invalid Companies who had come from _Embden_
+brought with them old inveterate tertian and quartan Agues.
+
+Most of the recent Cases were easily cured by the Methods already
+mentioned; though they often continued longer, required a greater
+Quantity of the Bark to stop them, and a longer Continuance of its Use
+to make a Cure, than at other Places, which were more dry, and higher
+situated.
+
+The most obstinate of the recent Cases were the irregular
+Intermittents, which had regular Paroxysms, but where the Pulse was
+not settled in the Intervals; which we were obliged to treat as
+Remitting Fevers till the Paroxysms became quite distinct, and the
+Patient was cool and free from any Fever in the Intervals; after which
+they commonly yielded to the Bark.
+
+But many of those Agues which had continued for some Time, especially
+with those Invalids who came from _Embden_, or who had brought on
+frequent Relapses by their own Irregularities, were very obstinate.
+With many the Bark had no Effect; and its Use persisted in seeming
+rather to exasperate the Paroxysms, and to do Hurt. Nor had almost any
+Remedy we tried a better Effect. We gave the following Medicines to
+divers Patients; the saline Draughts and cooling Medicines; Infusions
+of Camomile Flowers and of other Bitters; Dr. _Morton_'s Powders of
+Camomile Flowers, Salt of Wormwood, and diaphoretic Antimony; Dr.
+_Mead_'s Powders of Camomile Flowers, Salt of Wormwood, Myrrh, and
+Alum; Alum and Nutmeg; large Doses of _sal ammoniac_; large Quantities
+of Spirits of Hartshorn; the antimonial Drops and Powders; to some we
+gave Emetics, both in the Intervals and immediately before the Fits.
+In some we tried to promote Sweats before the Approach of the Fits, by
+making them drink freely of warm Liquors while they kept in Bed, and
+took diaphoretic Medicines; and to others we applied Blisters.--But
+all did not put a Stop to some of those Agues.
+
+With some the Disorder continued till it broke down the Crasis of the
+Blood, and brought on a general Relaxation of the Fibres; and the
+Patients became cachectic, and fell into Dropsies, or were seized with
+Diarrhoeas, of which they died. Some had Obstructions formed in the
+Liver or Spleen, or other _viscera_, and fell into the Jaundice and
+Dropsies, which carried them off.--In the Bodies, of several whom we
+opened, we found Indurations of the Liver and Spleen--in two of them
+Suppurations of the Liver--and in one, who had had the Ague at
+_Embden_, and had long complained of one of those Swellings towards
+the left Side of the _abdomen_, called the _Ague Cake_[86], the Spleen
+was so much enlarged as to weigh above four Pounds.
+
+    [86] I have seen the dead Bodies of four People opened, who
+    had those Swellings of the left Side, commonly called the
+    _Ague Cake_, which had come after Agues; and in all the
+    Swelling was owing to an Enlargement of the Spleen.
+
+Some, whose Constitutions were worn out by these obstinate Agues, fell
+into Consumptions and other pulmonic Disorders in the Winter, of which
+they died. One Man died in the cold Fit[87].
+
+    [87] The cold Fit is the most dangerous Time of the Paroxysm,
+    and the greatest Part of those who die of Agues die at this
+    Time; one or two Instances of which I saw in the Military
+    Hospital at _Edinburgh_ in the Year 1746.--_Van Swieten_ says
+    he has seen the trembling and shaking so great in the Time of
+    the cold Fit of Quartans, that the Teeth have dropt out of
+    the Head. _Comment. in sect._ 749. _Aphorism. Boerhaav._ vol.
+    II. p. 511.
+
+Where-ever the Ague continued long, and the Bark had no Effect, we
+were obliged to lay it aside, and to try other Remedies adapted to the
+present Circumstances of the Patient.
+
+The mild Methods succeeded best; giving the saline Draughts and gentle
+cooling Medicines to such as were strong and plethoric, and had the
+aguish Paroxysms violent; and the gentle Aromatics and Bitters, or
+Chalybeats, to those of a weakly Habit, or whose Fibres had been much
+relaxed, and their Constitutions greatly injured by this or any other
+preceding Disorder.
+
+During these Courses, we gave at Times gentle Emetics; and if the
+Patient complained of Gripes and Purging, which they frequently did,
+in the Course of this Disorder, we gave a Dose of Rhubarb, or of some
+other mild Purge; and after it other Medicines proper for this
+Complaint.
+
+By these Methods frequently the aguish Paroxysms became gradually
+milder, and at last vanished. At other Times, after they had continued
+for five or six Weeks, we again gave the Bark, and found it to have
+the proper Effect. With others they continued thro' the Winter, and
+went off of themselves in the Spring. With others they still
+continued; and as no Medicines nor Time seemed to have any Effect in
+that Country, we recommended their being sent over to _England_ for
+Change of Air, as the only Means likely to remove the Disorder.
+
+Two Agues which had resisted the Use of the Bark were cured by Powder
+of Camomile-Flowers, Salt of Wormwood, and diaphoretic Antimony; and
+one by the Use of the aluminous Powders, with Myrrh.--One Invalid, who
+had long been ill of an obstinate Tertian, on catching Cold, was
+seized with an Inflammation of his Throat, for which he was blooded,
+and took a mild Purge; next Day there appeared a Swelling of one of
+the parotid Glands, which we endeavoured to bring to Maturation, by
+the Application of emollient Cataplasms; after some Days it went
+entirely away, without coming to Suppuration; but as there remained
+still a Confusion of the Head, and a Quickness of the Pulse, a large
+Blister was applied to the Back, which continued running for some
+Days; after it dried up he fell into a Fit resembling that of an
+Epilepsy, and next Day had another Fit of the same kind; from the Time
+the Swelling first appeared till the Time he had the first Fit, he had
+no Ague, but it returned the second Day after the second epileptic
+Fit; another Blister was applied, and he had no Return of the
+epileptic Fits, though his Ague continued obstinate till _March_, at
+which Time he was sent to _England_[88].--About the same Time the
+aguish Fits of two others were stopt by the Application of Blisters,
+though they returned in both soon after.
+
+    [88] On the 29th of _August_ 1759, a Man (_Murdoch Brinnen_)
+    about thirty Years of Age, was admitted into _St. George_'s
+    Hospital for a very large Swelling of the parotid Glands and
+    neighbouring Parts, which had come three Days before, after a
+    Fit of the Tertian Ague, which did not return afterwards. The
+    Swelling was discussed by the Application of emollient
+    Cataplasms, which were intended to have brought it to
+    Suppuration. He had no Return of the Ague, nor did any bad
+    Consequence follow the Discussion of the Tumour, and the Cure
+    was completed by a few Doses of Physic, and a Decoction of
+    the Bark, which restored him to his Strength, and carried off
+    the little Heat and Feverishness which remained.
+
+Excepting in these few Cases, I found no Medicines effectual in
+stopping those Agues, which had resisted the Bark when properly given,
+though we tried a vast Variety in different Cases. The _cortex
+cascarillae_, or _eleutheriae_, was given freely, both in Decoction and
+Substance, in four Cases, which had not yielded to the Bark, but
+without producing any good Effect; we had not an Opportunity of
+trying this Bark in more Cases of this kind, nor in Fluxes, the small
+Quantity of it which had come from _England_ being all expended.
+
+A Soldier of one of the Regiments of Guards, who was admitted into the
+Hospital for oedematous Legs, and the Remains of a very bad Flux, which
+he had had ever since the preceding Autumn; after being cured of the
+Flux, and most of the oedematous Swellings, was seized with an
+intermitting Complaint in _February_. He had no regular hot and cold
+Fits; but every second Day, after a slight Shivering and Cold, he was
+seized with Gripes and a Purging. In one or two of the Fits his Pulse
+was very quick, and the Pain of the Bowels very acute and severe;
+which obliged us to blood him, and give him a Dose of the saline oily
+Purge; after which we treated the Disorder as a Flux complicated with
+the Ague, and gave the Bark mixed with Diascord, and gentle Opiates at
+Nights, and at Times gentle Purgatives; the Ague and Diarrhoea stopt
+very soon, and in a few Weeks he got free of all Complaints, though he
+still continued weak, till he was sent to _England_, about the
+Beginning of _April_.
+
+Many, especially those whose Constitution had been shaken by this or
+some other Disorder, complained of flatulent Swellings of the Stomach
+and Bowels, which affected them either while the Ague continued, or
+soon after it was stopped, and were very troublesome and uneasy. For
+the most part, these Swellings were removed by the Use of cordial
+Medicines mixed with the Bark, or a Course of Bitters, and some Doses
+of Rhubarb given at proper Intervals. In some Cases, where they were
+attended with Sickness, and the Stomach seemed to be loaded, a Vomit
+gave Relief. Very often these Symptoms continued for Weeks after the
+Ague had left them, and did not go entirely off, till the Patient
+recovered his Strength.
+
+In _February_, _March_, and _April_, 1761, severals of the Soldiers in
+the Hospital at _Paderborn_ complained of periodical Head-Achs, which
+returned in most, every Day; in others, only every second; and
+afterwards Cases of this Kind occurred at different Times as long as
+the Army continued in _Germany_. These Head-Achs generally began in
+the Forenoon, were very violent while they lasted, and confined the
+Patient to his Bed for some Hours. During the Pain, the Pulse was
+quick; but in the Intervals the Patients were quite cool, and without
+Fever. Sometimes, tho' not always, the Urine deposited a little
+Sediment as the Head-Ach was going off. Commonly the Pain was all over
+the Head, but most severe in the Forehead; though sometimes it was
+confined to one Side only.
+
+These Head-Achs we treated entirely as Agues of the same Type. When
+the Patient was strong, some Blood was taken away, and afterwards we
+prescribed an Emetic and Purge, and then gave the Bark liberally,
+which generally put an End to the Complaint, without any bad
+Consequences attending.
+
+
+
+
+OF THE JAUNDICE.
+
+
+The Jaundice, or a yellow Colour of the Eyes and Skin, occasioned by
+an Absorption of Bile into the Blood, was another Distemper which
+appeared towards the End of each Campaign.
+
+This Disorder, for the most part, takes its Rise[89] from Calculi
+lodged in the biliary Ducts[90]; and sometimes from a viscid Mucus or
+Pituita obstructing those Passages[91]; and it may be brought on by a
+Tumour, or any other Cause[92], compressing these Ducts, so as to
+prevent the free Flow of the Bile into the Cavity of the Intestines.
+
+    [89] Obstructions and Scirrhi of the Liver have been assigned
+    as the Cause of the Jaundice; but as we have so many Cases of
+    this Kind related where no Jaundice appeared, it is now much
+    doubted, whether such Obstructions, which do not affect the
+    Ducts, are capable of producing this Disorder.
+
+    [90] We have numerous Cases in _Bonetus_, and other physical
+    Observations, where Calculi have been found in the Gall
+    Bladder, and Ducts of People who have died of the Jaundice;
+    and I have frequently found two, three, and sometimes twelve,
+    fifteen, or twenty, such bilious Calculi in these Cavities.
+
+    [91] Viscid Mucus or Pituita, or viscid Bile, has been
+    observed frequently to obstruct the Ducts. Dr. _Coe_ says,
+    sometimes icteric Patients discharge very thick Bile, almost
+    as viscid as Bird-Lime. See his _Treatise on biliary
+    Concretions_, chap. ii. where he has collected a great Number
+    of icteric Cases, in which the Bile has been found quite
+    viscid after Death.
+
+    [92] See the Case of a Jaundice in _Bonetus's Sepulchretum
+    Anatomicum_, tom. II. p. 326, where the Sides of the common
+    biliary Duct were compressed by an Enlargement of the Glands
+    about the _vena portarum_; and we sometimes meet with a
+    Jaundice in pregnant Women which goes off after Delivery, and
+    seems to have been caused by the Pressure of the Uterus and
+    indurated Foeces in the Colon. _Van Swieten_ says, he has seen
+    this very frequently, vol. III. sect. 918, p. 95.
+
+The yellow Colour, or Jaundice, observed in the Ague, and some other
+bilious Disorders, seems to arise sometimes from Spasms of the Ducts;
+or from too great a Quantity of Bile secreted and absorbed into the
+Blood, which seems evidently to be the Case where large Quantities of
+Bile are either vomited or discharged by Stool; a Proof that the
+biliary Ducts are clear, and free from Obstructions.
+
+In the End of the Campaign of 1760, after a continued Rain for many
+Weeks, the Jaundice had been very frequent, and in a Manner
+epidemical, among the Troops, for some Time before they left the
+Field; and in passing thro' _Munster_, about the End of _December_, I
+observed several ill of that Distemper in Hospitals, and met with a
+few Cases of this Kind in the Hospitals at _Paderborn_ in _January_
+1761; but during the Spring and Summer, we had only one or two now and
+then sent to the Hospitals for this Complaint; though towards the End
+of the Campaign it became more frequent, and several were sent down to
+_Bremen_; and some of the Garrison were likewise affected with it.
+During the Winter not above four or five were sent to the Hospitals I
+attended, and but a few to the flying Hospital, during the Campaign
+1762. It frequently appeared in dropsical Cases, depending on
+obstructed Viscera.
+
+Those in whom the Jaundice was the original Disorder, and not
+complicated with any other, generally got well soon; but where it
+appeared in dropsical Cases, depending on obstructed Viscera, it was
+commonly fatal.
+
+In the Beginning of this Disease, Patients usually complained of
+Sickness, Heat, Thirst, and other feverish Symptoms; and some had a
+Vomiting, and Pain of the Stomach, for a Day or two before the
+Jaundice appeared; the Urine was always of a deep Colour from the
+first; and about the second or third Day the Skin, and the Whites of
+the Eyes, began to be tinged with a yellow Colour, attended with the
+common Symptoms of this Disorder.
+
+Such was the Manner in which the Jaundice began in those who were
+taken ill in Garrison; but those sent us from the Army could seldom
+give any accurate Account of their own Cases.
+
+In the Course of this Disorder, the Sick were inclined to be costive,
+though some few had a Diarrhoea; several, who had been reduced by
+Fevers, or other Complaints, before the Jaundice appeared, were
+attacked with violent Haemorrhages from the Nose; and two had like to
+have died of them before the Bleeding was stopped. The Haemorrhages did
+not prove critical, but seemed to depend on a dissolved State of the
+Blood.
+
+On the Patient's being first taken ill, if he was plethoric or
+feverish, or complained of Pain, attended with Sickness and Vomiting,
+some Blood was taken away. Next Day we gave twenty-five or thirty
+Grains of Rhubarb in a saline Draught, and afterwards the common
+saline and other cooling Medicines, till the Fever was abated. If the
+Pain and Fever did not abate, a Vein was opened a second Time, and a
+few Drops of the _tinctura thebaica_ were added to the saline
+Draughts, while emollient Clysters were frequently administered, and
+the Stomach and Belly fomented with Flannels dipped in warm emollient
+Decoctions.
+
+When the Pain and Fever were gone, we then gave a gentle Vomit in the
+Evening, and next Day a Dose of Rhubarb; and afterwards so much of
+the _pilulae saponaceae cum rheo_ daily as kept the Body open; or the
+saline Draughts with five or six Grains of Rhubarb in each, or such a
+Quantity as answered the same Purpose as the Pills; and from Time to
+Time repeated the Emetic[93] and Purge.
+
+    [93] Vomits are reckoned amongst the most efficacious
+    Remedies in this Disorder, and I have often seen good Effects
+    follow their Use.--_Janet Crags_, a Woman thirty Years of
+    Age, was, on the 21st of _December_ 1758 admitted into _St.
+    George_'s Hospital for a Jaundice of some Months Continuance.
+    Her Eyes and Skin were not of the common icteric Colour, but
+    of a dark livid yellow, for which Reason both she and the
+    Nurses termed her Disorder the Black Jaundice. She at first
+    complained of a Difficulty of Breathing, and a Weight and
+    Oppression about the Region of the Liver, for which she was
+    blooded, took some Doses of Physick, and the Soap Pills with
+    Rhubarb; but these produced no Change in her Complaints. On
+    the 29th she had a Cough, and complained much of Sickness and
+    Difficulty of Breathing, for which she was ordered a Vomit,
+    and afterwards to take the Squill Draught Morning and
+    Evening, which occasioned a Purging and Gripes. On the 5th of
+    _January_ 1759, the Looseness still continuing, I ordered her
+    to leave off the Use of the Squill Draughts, and to take only
+    some Rhubarb in an oily Draught every Night at Bed-Time. On
+    the 8th, tho' the Purging had increased, I did not chuse to
+    check it, as I suspected it would prove a Crisis to the
+    Disorder, and therefore only ordered her the Cordial Draughts
+    and Wine to support her Strength. The Looseness continued
+    till the 15th, when most of the icteric Symptoms were gone,
+    and by the 30th they entirely disappeared. However, she
+    continued low, and subject to Flatulencies for some Months
+    afterwards, which were at last removed by the continued Use
+    of Cordials, gentle Bitters, a nourishing Diet, and repeated
+    Doses of Rhubarb; and on the 2d of _May_ she was discharged
+    in a firm State of Health.
+
+    Dr. _Coe_ says, "I have more Reason to be satisfied of the
+    Effect of Vomits in dislodging these Calculi, than of any
+    other, or indeed of all other Medicines." _Treatise on
+    biliary Concretions_, chap. ii. p. 253. Besides viscid
+    Humours, which Vomits bring away from the biliary Passages,
+    how often are Gall Stones likewise found in the Stools after
+    the Operation of a Vomit? _Ibid._ p. 256.
+
+Most of the icteric Cases we had, which were not complicated with
+other Disorders, yielded to the above Treatment in about twelve or
+fourteen Days. Two or three remained obstinate for a longer Time. To
+one I ordered a Quart of the pectoral Decoction, made with Parsly
+Roots instead of the Linseed, to be drunk daily along with the Soap
+Pills; and the Jaundice disappeared in about eight or ten Days. One
+who had the Disease more obstinate than the rest, and complained for
+some Time of a Tension and Uneasiness about the Liver, was ordered to
+have the right Side fomented Morning and Evening, and to rub it for
+some Time after with the _linimentum saponaceum_ and to drink the
+Decoction of Sarsaparilla after the Soap Pills; and by continuing this
+Course for about three Weeks, the Disorder went off[94].
+
+    [94] Sometimes the warm Bath has a good Effect after other
+    Remedies have afforded no Relief. In the Year 1743, a young
+    Gentleman, a Student of Physic at _Edinburgh_, had a Jaundice
+    for which he had taken Variety of Medicines, and rode daily
+    on Horseback for some Weeks, without receiving any Benefit:
+    At last, by my Father's Advice, he took a brisk Dose of
+    Physic, and before it began to operate had a large Quantity
+    of warm Whey thrown up by way of a Clyster, and went
+    immediately into the warm Bath. In the Bath he was taken with
+    a violent Inclination to go to Stool; and after coming out,
+    had a great Number of bilious Stools that Day, and next
+    Morning was still inclined to be loose; and in a few Days all
+    the icteric Symptoms vanished. On the 20th of _July_ 1763, a
+    middle aged Woman, _Elizabeth Hosier_, was admitted into _St.
+    George_'s Hospital for a Jaundice, which came about a
+    Fortnight before. She had been blooded, and had taken some
+    Medicines, before I saw her. I ordered her a Vomit and Purge,
+    and to take too Scruples of the Soap Pills and Rhubarb daily;
+    and four Days afterwards the Vomit and Purge were repeated,
+    but without making any Change in her Disorder. On the 29th
+    she went into the warm Bath, and took a Vomit immediately on
+    coming out. After the Vomit she had some loose Stools, and
+    the icteric Symptoms went all off in a few Days. She
+    continued well for some Months; but I have been told, that
+    she has since relapsed.
+
+    When the Jaundice continues obstinate, there is hardly any
+    Thing has often a better Effect than the continued Use of
+    Decoctions of the Juices of succulent Plants, of Whey in the
+    Spring, Soap, and such like Medicines. The Baron _Van
+    Swieten_ tells us, that he has cured many obstinate Jaundices
+    by making the Patients drink daily a Pint or two Pints of a
+    Decoction of Grass, Dandelion, Fumaria, Succory, and such
+    like, prepared in Whey; to each Pint of which he added Half
+    an Ounce of _sal polychrest_, and an Ounce or two of Syrup of
+    the five aperient Roots; and by ordering them to drink the
+    Spa Water in Summer, and take freely of Soap, along with a
+    Decoction of the aperient Roots, in Winter. In those who were
+    cured by these Remedies, he says, Stones, or a kind of a
+    grumous calculous Matter, were always found in the Stools, as
+    the Jaundice was going off. He relates one very particular
+    Case of a Lady of sixty Years of Age, who had had a black
+    Jaundice for twelve Years, and was cured by continuing the
+    Use of these Medicines for eighteen Months; during the last
+    six Months of which she had a Looseness, and constantly
+    discharged by Stool a fetid granulated Matter of the Colour
+    of Clay;--and another singular Case of a Man who was cured by
+    living mostly upon Grass, and a Decoction of it, for two
+    Years together. The Man came at last to devour such
+    Quantities of it, and could distinguish the good Sort from
+    the bad so well, that the Farmers often used to drive him out
+    of their Fields. Vol. III. Sec.. 950.
+
+    _Glisson_ tells us, that Cattle are subject to bilious
+    Concretions in Winter, which are dissolved and evacuated in
+    the Spring, when they begin to move much about, and to eat
+    the new Grass, which purges them. _Oper._ vol. II. _Anat.
+    Hepat._ chap. vii. p. 104.
+
+    Dr. _Russel_ greatly recommends the Use of Sea Water along
+    with the saponaceous Medicines. See his _Treatise on the Use
+    of Sea Water_.
+
+The Haemorrhage from the Nose commonly stopped soon. Where it was
+violent, we kept the Patient cool, and applied Cloths dipped in
+Vinegar and Water to the Nose.--In two Cases, one at _Munster_, the
+other at _Bremen_, the Patients were hot and feverish, and a Vein was
+opened, and eight or ten Ounces of Blood taken away; and in one Case
+nothing took Effect till we gave repeated Doses of the _tinctura
+saturnina_ in a common acid Julep.
+
+
+
+
+OF TUMOURS of the BREAST.
+
+
+In _May_ 1761, a great many of the Patients, who had been in Hospitals
+the preceding Winter, had Tumours formed on the external Part of the
+Breast, which they shewed me at _Osnabruck_. They began in the Form of
+indolent Tumours, and came slowly to Suppuration. For the most part,
+the Suppuration was only partial, and the Tumour, on being opened,
+discharged a very small Quantity of Matter. Some of them, though they
+felt soft, and seemed to contain Matter, yet, upon being opened,
+discharged only a small Quantity of black Blood. None of them melted
+down entirely into Pus, or came fully to Suppuration, and healed
+kindly as Abscesses which succeed acute Inflammations. But after a
+small Quantity of Matter was discharged, for the most part, there
+still remained a hard Tumour, which felt as if it was a Swelling of
+the Bone, or Cartilage below; and in some the Surface of the Bone was
+found rough at the Bottom of the Abscess.
+
+These Tumours seldom rose high, and were most of them situated at the
+lower Part of the Sternum, or a little to one Side of it, commonly on
+the left Side, above the _cartilago ensiformis_. Some Patients had
+only one, others two, and some three such Tumours. The first of them I
+saw was on the left Side, which, on being felt, gave exactly the same
+Sensation as when the Cartilages of the Sternum are begun to be raised
+by an Aneurism of the Aorta; only no Pulsation was to be perceived;
+and most of them had the same Appearance.
+
+The Patients, who had such Tumours, commonly complained of Pains of
+their Breast. One or two, after these Tumours came to Suppuration,
+seemed to recover their Health, and to feel no Uneasiness, tho' some
+of the Swelling remained: But many of them were inclined to be
+hectic, and seemed likely to grow consumptive.
+
+Being ordered up to the flying Hospital in _June_, and the Sick going
+down to _Bremen_, I had no Opportunity of seeing the Event of these
+Tumours, or of examining the Bodies of those who died with them. One I
+accidentally met with the following Winter at _Bremen_, who died of a
+Consumption and Diarrhoea. He had a large Abscess, which penetrated
+into the Cavity of the Chest, and discharged a great Quantity of very
+fetid Matter, at the Part where one of these Tumours had been seated,
+and the Sternum and Ribs were carious all round the Abscess.
+
+
+
+
+OF PARALYTIC COMPLAINTS.
+
+
+Some of the Soldiers, from lying out in the Nights on the wet Ground,
+and from doing Duty in cold rainy Weather, were seized with a Pain and
+Numbness all over, and lost the Use of their Limbs, which in some was
+succeeded with a Palsy of these Parts: But the greatest Number of
+those afflicted with Paralytic Symptoms were seized with them either
+in Fevers, or after feverish and other Disorders. The Number, who were
+attacked with Complaints of this Kind, were but few.
+
+When Men were suddenly taken with Pain and Numbness all over, we found
+that the best Method of treating them was to put them to Bed, and give
+them Plenty of mild warm diluting Liquors for Drink; and if there was
+much of a Fever, to open a Vein, to give the cooling antiphlogistic
+Medicines, and apply Blisters; and if these Complaints still remained,
+to endeavour to promote a breathing Sweat, by means of Diaphoretics
+and warm Drinks. Several who were brought to the Hospital, soon after
+being seized in this Manner, got well; but in some few, one or other
+of the Limbs would begin to waste, and remain paralytic afterwards.
+
+Those who had the true confirmed Palsy seldom remained long enough
+with us to be cured. Two or three received Benefit from Blisters
+applied to the Parts, and from Issues; drinking at the same time the
+Decoction of the Woods, or of Sarsaparilla, and taking the volatile
+Tincture of Guaiac or Valerian[95], and being sweated by the Use of
+_Dover_'s Powder, or other Diaphoretics.
+
+    [95] On _Wednesday_ the 1st of _February_ 1764, _Margaret
+    Julion_, a Woman between fifty and sixty Years of Age, was
+    admitted into _St. George_'s Hospital for an entire Loss of
+    Speech, which seemed to depend on a paralytic Disorder of the
+    Parts about the Larynx. The Account her Friends who came with
+    her to the Hospital gave of her Case was, that she had been
+    for five Months troubled at Times with Pains of her Bowels,
+    and a Purging; that on _Sunday_ se'night before coming to the
+    Hospital, she had suddenly lost the Use of her Speech, and
+    had not spoke since that Time, though she seemed to hear and
+    understand whatever was said to her. I asked her some
+    Questions, which she answered distinctly by Signs. She had no
+    paralytic Complaint of her Face, Arms, Legs, or any other
+    Part of her Body, and swallowed both Fluids and Solids with
+    Ease. She had no Fever, and seemed to complain of nothing but
+    the Loss of Speech.--A Blister was applied to her Neck, and
+    she was ordered the saline Draughts, with a Scruple of Powder
+    of Valerian in each, to be taken three Times a-day, and a
+    Dose of sacred Tincture, to be taken twice a-Week. She
+    followed this Course for a Fortnight, when another Blister
+    was applied to the Fore-part of the Neck, and the Powder of
+    Valerian in the Draughts was changed for two Drachms of the
+    _tinctura valeriana volatilis_. At the End of three Weeks she
+    could pronounce the two Words _Why_, _What_. She continued
+    the same Course till this Day, the 16th of _March_, and can
+    now pronounce many Words and short Sentences.
+
+One Man of the 51st Regiment of Foot, after doing Duty in very cold
+wet Weather, in the Beginning of the Year 1762, was seized with a
+Palsy of one Side of his Face, which prevented him from speaking
+distinctly, and was an Impediment to his eating. He mended much after
+being blooded, and having a large Blister to his Neck, kept open for
+some time by means of the epispastic Ointment.
+
+
+
+
+OF AN INCONTINENCY of URINE.
+
+
+An Incontinency of Urine was another Complaint frequent among the
+Soldiers; but it seemed to me to be counterfeited by many. All, who
+had it, said that they had received some Hurt[96] or Sprain of the
+Back, or a Kick from a Horse, or that a Carriage had run over them.
+
+    [96] A Soldier in the Hospital at _Paderborn_ used to
+    discharge his Water involuntarily, and mixed with Pus, which
+    came from some violent Blows he had received on the Back.
+
+    _John Pearce_, a young Man about eighteen Years of Age, was
+    admitted into _St. George_'s Hospital, the 10th of _April_
+    1759, for a Pain of his Side, and a Complaint of the Bladder.
+    The Account which he gave of his own Case was, that, some
+    Months before, he had received a violent Blow with a
+    Cricket-Bat on the left Side, on the Region of the Kidney;
+    and that ever since he had had a sharp Pain in that Part, and
+    sometimes had a Stoppage of Urine, and at other Times it came
+    away insensibly. His Pulse was rather quick, but low, and he
+    had a feverish Heat. He at first took some cooling Medicines;
+    but on the 20th, being low and faint, he had some of the
+    foetid Julep. On the 23d he was attacked with a sharp Pain in
+    the Belly and Side, had a Stoppage in making Water, a quick
+    and full Pulse, and most of the Symptoms of the Stone. He was
+    ordered to be blooded immediately, to take the saline
+    Draughts every four Hours; and as he was inclined to be
+    costive, to take as much lenitive Electuary as to procure him
+    a loose Stool; and it was recommended that he should be
+    sounded as soon as the Violence of the Fever was over. On the
+    25th he continued much in the same Way, and had made some
+    Water, which was intolerably foetid. Half a Drachm of the
+    dulcified Spirit of Nitre, and five Drops of the _tinctura
+    thebaica_, were added to each of his Draughts, as the Pain
+    and Difficulty of making Water had increased. On the 26th his
+    Pulse rose, and became very hard and quick; the Pain in his
+    Side, and the Dysuria, became more violent; and about Twelve
+    o'Clock he had a convulsive Fit, resembling that of an
+    Epilepsy; after coming out of the Fit, as the Fever and Pain
+    had increased, he was blooded; the Belly was fomented and
+    embrocated, and he took the oily Draughts four Times a-Day;
+    his Blood immediately threw up a very thick Buff. He remained
+    pretty easy the rest of the Day; but about the same Time next
+    Day, he had another convulsive Fit, and died.
+
+    On opening his Body, we found about two or three Pints of a
+    dark-coloured foetid Water in the Abdomen; on cutting through,
+    and squeezing the right Kidney, there came out a thin
+    purulent Matter every where from its Substance, though it
+    appeared sound; on raising and cutting through the
+    Peritoneum, covering the left Kidney, there was a Discharge
+    of about a Pint of black and very foetid Water, which had
+    every where surrounded this Kidney; and there were six
+    mortified Spots on its Surface, as large as the End of one's
+    Finger, with a Depression in each about a Quarter or Half an
+    Inch deep; most of the Substance of this Kidney seemed
+    diseased, and it was full of Suppurations. The Bladder was
+    contracted and thickened, and contained a rough Stone, which
+    weighed three Ounces. The rest of the _viscera_ were sound.
+    This Stone had certainly been in the Bladder long before the
+    young Fellow received the Blow with the Cricket-Bat; but the
+    Injury done the Kidney had probably aggravated the Symptoms.
+
+    I do not remember ever to have seen convulsive Fits, such as
+    this young Man had, in acute Diseases, except in one Case of
+    a slow Fever, which came by taking Cold after a Salivation,
+    and which I attended, along with Dr. _Pringle_. The Gentleman
+    had three Fits exactly of the same kind as this young Man, at
+    twenty-four Hours Distance from one another, and he died of
+    the third.
+
+Those who really had the Disorder seemed to have received such an
+Injury of the Bladder, or Kidneys as required a considerable Space of
+Time to get the better of; and by reason of the short Time we had them
+under our Care at the flying Hospital, they seldom received much
+Benefit. One or two thought they grew better on taking the Bark and
+Balsam of _Peru_; at the same Time they bathed Morning and Evening the
+lower Part of the Abdomen and Perinaeum, with Flannels dipped in gentle
+astringent Liquors, applied cold. Blisters applied to the _os sacrum_
+had no Effect.
+
+
+
+
+OF A STOPPAGE of URINE.
+
+
+We formerly mentioned, that in acute Diseases many complained of a
+Stoppage or Difficulty of making Water; and others had this Complaint
+from Strictures of the Urethra, or Disorders of the Bladder or
+Kidneys[97].
+
+    [97] It is often very difficult to judge of the Cause, or to
+    be able to determine exactly the Seat of these Disorders
+    before Death; as the following Cases will shew.
+
+    _John Waden_, a middle-aged Man, was admitted into _St.
+    George_'s Hospital the 10th of _April_ 1759, for a Swelling
+    of the Abdomen, and a Difficulty of making Water, which he
+    said begun about two Months before, with a violent Pain in
+    his Back and Belly, occasioned by his being employed in
+    making of Cyder in a very cold Cellar. He had not had a Stool
+    for some Days: at first he took a Dose of Physic, and some of
+    the saline Draughts; but in a Day or two complained that his
+    Belly had grown to a monstrous Size, and that he had not made
+    Water for above twenty-four Hours; on examining, we found the
+    Bladder so much distended as to reach up to the Navel; and
+    upon a Catheter's being introduced, above two Quarts of Water
+    were drawn off, and the Swelling immediately subsided; but in
+    the Afternoon was as large as before, the Bladder seeming to
+    be in a paralytic State. During the Months of _May_ and
+    _June_, his Water was drawn off twice a-Day; he had his Belly
+    fomented with emollient, astringent, and other Decoctions,
+    and embrocated with Liniments; was blooded once when
+    feverish, took Cordials, the Bark, Myrrh, and a Variety of
+    Medicines, without any Effect. On the 3d of _July_, a
+    flexible Catheter was introduced into the Bladder, and left
+    there, in order that the Urine might drain away as fast as it
+    was secreted, and the Bladder be allowed to contract, and
+    recover its Tone. The Catheter gave him no Pain, and he
+    thought himself much easier by the Bladder's never being too
+    much stretched; but on taking out the Catheter some Days
+    after, he had the same Stoppage of Water as before. On
+    consulting with Dr. _Batt_ and the other Physicians, it was
+    agreed to give two Grains of the Powder of Cantharides, with
+    three Grains of Camphor and ten of Sugar, rubbed well
+    together in a Mortar, twice a-Day; and to continue the Use of
+    the flexible Catheter. He found no Uneasiness or Strangury
+    from the Use of the Cantharides, and thought he passed his
+    Water more freely, when the Catheter was taken out; but after
+    fourteen Days, finding no Change for the better, and being
+    free from any Fever, he was ordered into the cold Bath; the
+    two first Days he found himself more lively and brisk; but
+    the third Day was chilly and cold after coming out of it, and
+    therefore was desired to leave it off; some Days after he
+    became hectic, and I observed Pus in his Water, which he said
+    he had passed with his Urine for above three Months; after
+    this he languished for near a Month, and died upon the 25th
+    of _August_.--Upon examining his Body next Day, we found the
+    thoracic Viscera in a sound State, except that the Lungs
+    adhered a little on the right Side. Both Kidneys were
+    diseased; they were inflamed, and seemed enlarged; and on
+    cutting them, had Tubercles dispersed every where through
+    their Substance, which had come to Suppuration, and contained
+    a good deal of Matter; the lower Part of the left Kidney was
+    mortified, and contained two or three Ounces of a black foetid
+    Liquor. The Bladder of Urine was contracted, and its Coats
+    greatly thickened, and the internal Coat much inflamed; and
+    there was a Cyst full of Matter, about Half the Size of a
+    Walnut, between the muscular and villous Coats, towards the
+    lower Part of the right Side of the Bladder; and there were
+    two large Cysts, containing a small Quantity of Matter,
+    though capable of containing near two Ounces each; one
+    situated between the _vesiculae seminales_ and Rectum, the
+    other between the _vesiculae_ and Bladder, which opened into
+    the Urethra by one common Orifice, capable of admitting a
+    large Quill, at the Side of the _caput galinaginis_. The rest
+    of the Viscera were in a sound State.
+
+    _Mary Hibbard_, a Woman twenty-four Years of Age, was
+    admitted into _St. George_'s Hospital, the 6th _June_ 1759,
+    for a Complaint of her Bladder. The Account she gave of
+    herself was, that, about _Christmas_ 1758, she had parted
+    with some Gravel; and about fourteen Days before coming to
+    the Hospital, she was seized with a violent Pain in her Back
+    and Loins, attended with a Sickness and Nausea; and very soon
+    after complained of a violent Pain in the lower Part of her
+    Belly, and with a perpetual Inclination to make Water, though
+    she felt a sharp Pain and Difficulty in doing it; and that
+    these Complaints still remained. Her Pulse was quick and
+    strong, and she was inclined to be costive. She was
+    immediately blooded, took the oily Draughts three Times
+    a-Day, the _decoctum furfuris_ for common Drink, and so much
+    lenitive Electuary as procured her a Stool next Day. As there
+    was a strong Suspicion of her having a Stone, she was
+    sounded; but nothing at all was to be felt in the Bladder.
+    Her Medicines eased her Pain in making Water, but not the
+    Pain in her Back. On the 16th her Water was thick and turbid,
+    and deposited a brown Sediment; and the Difficulty in making
+    Water still remained; instead of the lenitive Electuary she
+    was ordered the Rhubarb oily Draught to be taken every Night.
+    On the 18th, there being no Change in her Disorder, she had
+    Draughts made of an Ounce and a Half of simple Mint Water,
+    Half a Drachm of the dulcified Spirit of Nitre, and five
+    Drops of the _tinctura thebaica_, and Syrup three Times
+    a-Day; but on the 22d she complained, that since she left off
+    the oily Medicines, her Pain and Difficulty in making Water
+    had grown worse; she was therefore ordered the saline and
+    oily Draughts alternately, and to take the Rhubarb oily
+    Draught occasionally when costive, which removed these
+    Complaints; and they did not return while she remained in the
+    House; but on the 4th of _July_, the Day before she was to
+    have been discharged as cured, she was attacked with a sharp
+    Pain in her Hip and Loins, and about the _os coccygis_; which
+    increased till the 9th, and extended itself all along the
+    Outside of the right Thigh; it was most acute about the _os
+    coccygis_; but on examining, nothing was to be observed
+    externally: This Pain continued more or less all that Month,
+    and till the End of the next, and so obstinate as not to be
+    altered by bleeding, and the Use of Liniments, Blisters,
+    cooling Medicines, Opiates, warm Baths, and other Remedies.
+    On the 20th of _August_, a strengthening Plaister was applied
+    to her Back, which gave immediate Relief, and she was
+    discharged cured the 29th. She continued well till _October_,
+    when she was attacked with a violent Fever at _Hounslow_, and
+    was brought to the Hospital on the 24th of that Month, and
+    the tenth Day of the Fever. She died the 3d of _November_.
+    During the Course of the Fever, she only complained once of a
+    Difficulty of making Water.--After Death I had her Body
+    opened, when the only Thing particular which we could
+    observe, was the urinary Bladder about four times the natural
+    Size; it seemed to be flaccid, and in a State of Relaxation;
+    the Kidneys were sound, and no Signs of any Distemper could
+    be observed about the Uterus or Rectum, or near the _os
+    coccygis_.--When she was first in the Hospital, I desired her
+    always to examine her Urine; but she never observed that she
+    passed any Sand, Gravel, or any thing of that kind.
+
+    _Thomas Jacey_, an elderly Man, was admitted into _St.
+    George_'s Hospital the 14th of _March_ 1759, for a Pain in
+    his Back, and a Difficulty and Pain in making Water, which
+    was often mixed with grumous Blood; but he had never observed
+    any Sand or Gravel in it. His Pulse was quick and full,
+    attended with Heat and Thirst; and he was inclined to be
+    costive; he was at first blooded, and took a Dose of laxative
+    Mixture, and two Ounces of the Tincture of Roses, four Times
+    a Day, and the _decoctum malvae_ for common Drink. At first he
+    seemed relieved, and passed no grumous Blood for some Days;
+    but on the 26th, as he complained much of a Pain in making
+    Water, the Tincture of Roses was changed for the oily
+    Draughts, and he was ordered the Rhubarb oily Draught
+    occasionally. On the 9th of _April_ he fell suddenly into a
+    comatose Way, and remained so till the 12th, when he died,
+    notwithstanding the Use of divers Remedies.--Upon examining
+    his Body, both Kidneys were found in a sound State; the
+    Intestines covered with slight inflammatory Spots, the
+    Bladder of Urine quite contracted, schirrhous, and greatly
+    thickened; and its internal Surface rough and eroded, with
+    one or two black Spots on it, and some grumous Blood lying on
+    its Surface. The other viscera were sound.
+
+    In Ulcers of these Organs, the natural Balsams, mixed with
+    soft Things, are often of great Service; of which the
+    following Case is an Example.--_William Lumley_, a Boy nine
+    Years of Age, was admitted into _St. George_'s Hospital, the
+    6th of _September_ 1759, for a Pain in the Bladder, and a
+    Difficulty in making Water, which was always more or less
+    mixed with Matter. At first there was a Suspicion of his
+    having the Stone; but on sounding, none was to be found. From
+    the Symptoms, it appeared as if there was an Ulcer in the
+    Bladder near to its Neck; the Boy had a Cough, was very low,
+    and inclined to be costive; at first he took three Spoonfuls
+    of the Sperma Ceti Mixture four Times a-Day, and a Dose of
+    Physic; but the Symptoms still remaining, on the 2d of
+    _October_ he was ordered to take a Scruple of the
+    _electuarium e spermate ceti_ three or four Times a Day, and
+    to have the Gum-Arabic Decoction for his common Drink. By
+    continuing the Use of these Things, and taking some opiate
+    and laxative Medicines occasionally, he mended by slow
+    Degrees, and all his Symptoms went off; and he recovered his
+    Health and Strength, and returned Thanks for his Cure the
+    18th of _January_ 1760.
+
+    The following Account of a remarkable Suppression of Urine I
+    had in a Letter, dated the 25th of _November_ 1757, from Mr.
+    _Pearson_, one of the Surgeons to his Majesty's Military
+    Hospitals, who then served as a Mate.
+
+    _James Ruffendal_, aged Twenty, of a delicate Habit, was, in
+    the Middle of _July_ last, seized with a violent Pain in both
+    Kidneys, which extended along the Ureters to the Bladder, and
+    remained in the same Situation for about three Weeks; during
+    which Period his Urine began to decrease in Quantity, and the
+    voiding of it was attended with acute Pain about the Neck of
+    the Bladder. The Secretion then totally stopt; he remained
+    for upwards of five Weeks in the Hospital at _Dorchester_,
+    and made no Water; at the End of which Time I first visited
+    him along with Mr. _Adair_. He complained then of a slight
+    Pain in his Kidneys, and told us he had a tolerable Appetite,
+    sweated little, and voided every Day four or five Liquid
+    Stools. He was ordered Boluses of Camphor, and _sal. vol. c.
+    cervi_, and every Night a Dose of _tinctura cantharidum_;
+    which he continued to take for a Fortnight without receiving
+    the least Benefit. I then blooded him to the Quantity of ten
+    Ounces, and gave him an Emetic of six Drachms of the _vinum
+    ipecacoanhae_, and two Ounces of the Oxymel of Squills, which
+    operated very well; and afterwards ordered him to take one of
+    the following Boluses every four Hours. Rx Sapon. dur. Hispan.
+    drachm. i. Sal. Absynth. gr. vi. Calc. Viv. gr. x. Balsam.
+    Peruv. q. s. ut fiat Bolus. These he continued to take for
+    twelve Days. On the Morning of the 14th of _October_, he was
+    suddenly seized with an acute Pain in both Kidneys, and about
+    Noon voided upwards of Half a Pint of straw-coloured Urine,
+    which let fall a clay-coloured Sediment. As he was feverish,
+    I took away twelve Ounces of Blood, and ordered him
+    Barley-Water with Nitre for Drink. He was easy in the Night,
+    and made upwards of two Pints of Urine, which deposited a
+    Sediment of a gelatinous Consistence. Next Morning the Pain
+    increased, especially in his Right Side, and ten Ounces more
+    of Blood was taken away. This lowered the Pulse, and
+    considerably abated the Pain. Both this and the Blood taken
+    away the Day before threw up an inflammatory Buff. He was
+    ordered to continue the Use of the Barley Water with Nitre,
+    and to take three Spoonfuls of a Mixture with _spiritus
+    mindereri_ every two Hours. He had an easy Night, and was
+    next Day free from Fever; but complained of an Uneasiness in
+    his Stomach and Nausea. He was ordered a Scruple of the
+    Powder of Ipecacoanha, which vomited him, and procured him a
+    Stool. He was easy in the Night; but in the Morning was hot,
+    and complained of a Pain in his Right Kidney, and all over
+    his Bones, as he expressed it. I then gave him a Mixture,
+    with _spiritus mindereri_, and the _pulvis contrayerva comp._
+    of which I desired him to take some Spoonfuls frequently.
+    This procured him a plentiful Sweat, which removed the Fever
+    and Pain: these Symptoms returned next Day, but were removed
+    by the same Means. I remained at _Dorchester_ for a Week
+    after, and he recovered his Strength and Appetite as much as
+    could be expected in so short a Time; but he still complained
+    of Pain in his Right Kidney, tho' he made Water freely. By a
+    Letter I received from the Gentleman whose Care I left him
+    under, I understood he had a Relapse, which he has since got
+    the better of.
+
+    I forgot to inform you, that his Father died of the same
+    Complaints, after being six Months without secreting a Drop
+    of Urine; and his Brother died of the same in about ten
+    Weeks.
+
+Where it depended on Strictures of the Urethra, Bougies introduced
+into that Passage, and worn for some Time, were of great Service. The
+Patients were at the same time ordered to live on a cool Diet, and to
+drink the _decoctum Arabicum_, or an Infusion of Linseed, or such
+other mild mucilaginous Liquors; and to take oily Medicines and
+Opiates occasionally, and gentle Laxatives, to keep the Body open;
+which Method of Treatment generally gave Relief. Where the Patients
+were plethoric, or complained of Pain, or the Disorder was attended
+with a Fever, Bleeding was often necessary.
+
+When the Stoppage of Urine seemed to arise from an Inflammation of
+the Kidneys or Bladder, or other Diseases of these Parts, we treated
+it accordingly; and where the Fever was considerable, we made
+Evacuations, and gave plenty of diluting Liquors, and the cooling
+saline Medicines, and afterwards those of the soft, mucilaginous, and
+oily Nature, and mild Diuretics and Opiates.
+
+When the Disorder, in its Progress, became chronical, the Sick were
+commonly sent down to the fixed Hospital, so that we had no
+Opportunity of examining the Bodies of such as might die of this
+Complaint.
+
+
+
+
+OF THE EPILEPSY.
+
+
+The Epilepsy, or Falling Sickness, attacked a Number of Men, from the
+severe Duty of long Marches in hot Weather, and afterwards lying out
+on the cold Ground, exposed to the Damps of the Night[98].
+
+    [98] I saw above twenty Men, while I was in _Germany_, who
+    attributed the Epileptic Fits they were attacked with to
+    these Causes, and said they had never had the Epilepsy
+    before; besides others, who had been formerly subject to
+    these Fits, who declared, that the Disorder was brought back
+    by the same Means.
+
+It was very seldom that Men were cured of this Disorder in the
+military Hospitals. We had some few Instances, indeed, where Relief
+seemed to be obtained by Rest, a regular Diet, gentle Evacuations,
+and Issues[99]; but even those Men generally relapsed as soon as they
+were sent to their Regiments, and began to do Duty. All who had these
+Fits after being some Time with their Regiments, were at last
+discharged, and sent home. However, before Men are discharged for
+Fits, they should be watched very narrowly for some Time; for there is
+no Disorder which Soldiers are more apt to counterfeit than this.
+
+    [99] _William Wilson_, a Boy fourteen Years of Age, was
+    admitted into _St. George_'s Hospital, _Sept._ 20, 1758, for
+    Epileptic Fits, which he had been subject to for some Time,
+    and which generally seized him three or four Times a Week. He
+    took Variety of Medicines without any Effect till the 6th of
+    _November_, when I ordered him to take eight Grains of the
+    _pilulae foetidae_ Morning and Evening, and Physic twice a Week,
+    and a Seton to be made in his Neck. After the Seton began to
+    run, he had but three or four slight Fits in _November_, and
+    none the following Month; and he was discharged the Hospital
+    the 3d of _January_ 1759, seemingly in good Health, with
+    Directions to keep the Seton running at least for some Months
+    after he went home, and to come again to the Hospital if he
+    should have any Return of his Fits; but we never heard more
+    of him.
+
+    _Mary Hacket_, a Girl of nineteen Years of Age, was admitted
+    into _St. George_'s Hospital the 14th of _February_ 1759, for
+    Fits. The Account she gave of her Case, was, that about five
+    Years before she was seized with the first Fit, after a
+    Fright; three Years afterwards she had a second Fit, and for
+    some Time after had a Fit commonly once a Month, about the
+    Time of the full Moon; and since had them more frequently;
+    that the Fits began with a Trembling and Shaking of the right
+    Foot, and she had frequent pricking Pains in the right Thigh,
+    and what she called convulsive Tremors in the right Leg and
+    Foot. She was regular in her menstrual Discharge. At the Time
+    she came into the Hospital, she was feverish, and complained
+    much of a sharp Pain in the right Thigh: She was blooded, and
+    took some cooling Medicine, and had no Fit till the 9th of
+    _March_: She then took the fetid Pills and camphorated Julep
+    twice a Day; but still the Fits returned frequently. She then
+    had the Bark, Valerian and Purging Doses successively, and
+    used the warm Bath; but without any Effect. On the 7th of
+    _May_ a Blister was applied to her right Foot, which was
+    intended to be kept open; but an Inflammation coming on that
+    Leg and Foot, it was suffered to dry up, and an Issue made in
+    the same Leg. From the Time the Blister was applied, she had
+    no Fit while she remained in the Hospital. She was discharged
+    the 15th of _July_, seemingly in good Health; though during
+    that Period she had some little Tremors in her Foot, and was
+    subject to be low and faintish, which was always relieved by
+    cordial anodyne Medicines. After going out of the Hospital,
+    she remained in good Health for seven or eight Months, when I
+    was told her Disease had returned as violent as ever.
+
+It is no Wonder that Soldiers, during the Time of Service, should
+seldom be cured of these Fits; for in Adults it is not often cured
+even in private Practice, with all the Conveniencies and Advantages
+to be wished for; and generally the few that do get well, require a
+considerable Length of Time to accomplish the Cure; and we find from
+daily Experience, as well as from examining the Records of Medicine,
+that the Cures that have been made, have mostly been performed either
+by a Change of Air, such as going from a cold to a hot Climate[100],
+by some remarkable Change of Life[101], or some accidental
+Disorder;[102] or by Issues or Drains[103]; or by the Removal of some
+acrid or irritating Substance, or such like[104]; or by preventing
+the Cause[105]; and that those Medicines called Specifics have in
+general had but little Share in the Cure.
+
+    [100] _Hippocrates_ lays the chief Stress of the Cure upon
+    Change of Air, Aphor. 4, 5, sect. ii. The Baron _Van Swieten_
+    says, he has known a great Number cured by going to the _East
+    Indies_; many of whom have remained well ever after, while
+    others had a Return of the Disorder when they came back to
+    _Holland_. _Comment._ vol. III. p. 436. sect. 1080.
+
+    [101] _Celsus_ has long ago observed, that the Appearance of
+    the Menses in Girls, and of Puberty in Boys, often removes
+    this Disorder, lib. iii. cap. xxiii.--On the 22d of
+    _November_ 1758, _Mary Evans_, a Girl of eighteen Years of
+    Age, was admitted into _St. George_'s Hospital for Fits. She
+    had never had the Menstrua; but, for above two Years, found
+    regularly, once a Month, a Fulness in her Breasts, and had a
+    slight Head Ach, and other Symptoms which generally precede
+    this Discharge; and were succeeded with violent Epileptic
+    Fits, which continued returning frequently for two or three
+    Days, and then went off; and she had no more Symptoms of
+    them, till about the same Time next Month. She was ordered to
+    take ten Grains of the _pilulae foetidae_ Morning and Evening,
+    and a Dose of Physic twice a Week; and as I found that she
+    became plethoric near the Time her Fits used to return, I
+    began to imagine, that both the Fits and Stoppage of the
+    Menstrua were owing to too great a Fullness of the Vessels,
+    which prevented the Heart and vascular System from having
+    such free Play, as to drive the Blood through the extreme
+    uterine Vessels: I therefore ordered seven Ounces of Blood to
+    be taken away from her immediately. In three Days Time the
+    menstrual Discharge began to make its Appearance; and on the
+    10th of _January_ she was discharged the Hospital, seemingly
+    in good Health, after the menstrual Discharge had returned
+    for two regular Periods, without any Appearance of Epileptic
+    Fits. She was desired to come back to the Hospital, if the
+    Fits returned; but I never heard more of her.
+
+    [102] _William Glen_, a Patient in the _Royal Infirmary_ at
+    _Edinburgh_ in _September_ 1747, was freed from Epileptic
+    Fits, which used to return ten or twelve Times a Day, for a
+    Quarter of a Year, by a Diarrhoea coming on; but they
+    afterwards returned.
+
+    _A Man_ subject to the Epilepsy was cured of it by a Quartan
+    Ague, and had afterwards no Return of the Disorder. _Miscell.
+    Curios. Dec. 3. Ann. 3._ p. 34.
+
+    [103] There are numerous Instances of the good Effects of
+    Issues and Drains in diverse Authors. _Tulpius_, _Van
+    Swieten_, &c.
+
+    [104] _La Motte_ gives one Instance of a Person being cured
+    of the Epilepsy by voiding five Stones, _Chirurg._ vol. II.
+    p. 20; and of another who died of the Fits from a triangular
+    Stone remaining in the Kidneys, _ibid._ p. 416. Dr. _Short_
+    cured a Woman of an Epilepsy of twelve Years standing, by
+    extirpating a cartilagenous Substance, about the Bigness of a
+    large Pea, seated on the gastronemei Muscles, above a Nerve
+    which he cut asunder. _Edin. Medic. Essays_, vol. IV. Art.
+    27.
+
+    [105] _Galen_, tells us, of his having prevented the
+    Epileptic Fits in a Boy, who used to have one whenever he was
+    hungry, by making him carry Bread in his Pocket, and eat a
+    little as soon as he found the least Symptoms of Hunger. _De
+    Loc. Affect._ lib. v. cap. vi.--And _Van Swieten_ mentions
+    how he cured a Boy, who had a Fit every full Moon; whose
+    under Lip used to fall a Trembling before it began (a Symptom
+    which, he says, often precedes Vomiting); by giving a Vomit
+    every Month, for six Months successively, three Days before
+    the full Moon, and an Opiate in the Evening after its
+    Operation; and by putting him under a Course of strengthening
+    Medicines. It was observeable, that if he vomited in the Time
+    of the Paroxysm, it was soon at an End. See his _Comment._
+    vol. III. p. 439. sect. 1050.
+
+
+
+
+OF THE SMALL-POX.
+
+
+The Small-Pox appeared at _Paderborn_ in the Spring 1761, and five had
+the distinct Kind, who recovered. Six or seven had them at _Osnabruck_
+in _May_ and _June_, and one Man and a Child died of the confluent
+Kind. Four had the distinct Kind at _Munster_ in _July_ and _August_
+who all did well. During the Winter, we had sixteen in the Hospital I
+attended at _Bremen_; ten had the distinct Kind, and all recovered;
+five had the confluent Kind, of whom two died; as did also one who was
+brought to the Hospital with all the Symptoms of the most malignant
+Kind. Two were sent to _Natzungen_ in _July_, both ill of the
+confluent Kind; the one died two Hours after his Arrival; the other
+recovered: And we had only two in the Hospital at _Osnabruck_ in
+Winter 1762-63, and both did well.
+
+There was nothing particular either in the Course or Treatment of this
+Disorder, different from what we meet with in daily Practice; only as
+the Soldiers, who were attacked with it, were strong, and in full
+Health, they required Bleeding and gentle Evacuations, and a cooling
+Regimen, on the first Appearance of the Symptoms.
+
+The malignant Kind required the Use of Acids, and the Bark; which
+last, could often only be administered by Way of Clyster, as the Sick
+could not swallow it: In short, we treated the Patients much in the
+same Way as in the malignant Fever, Allowance only being made for the
+present Circumstances.
+
+Luckily this Disorder never spread much in the Army, while I was in
+_Germany_.
+
+
+
+
+OF ERISYPILATOUS SWELLINGS.
+
+
+In _January_ 1762, several Patients in the Hospitals I had the Care of
+at _Bremen_, had shining watery Swellings of the Face, or Extremities;
+which came suddenly, and were attended with a slight Degree of
+Inflammation, and watery Blisters rising above the Skin, and some
+Degree of Fever. The Blisters were not small, round, and angry, as in
+_St. Antony_'s Fire; but larger, and of an irregular Figure,
+resembling those raised when People are scalded by boiling Water. The
+Swellings did not pit on being pressed, as the oedematous Swellings
+commonly do: They gave Pain when pressed, but the Inflammation was not
+in that high Degree as it is in the common Phlegmon: The Blood was
+sizy, and the Water of a high Colour. The Disorder seemed to be a
+Species of the Erisypelas.
+
+Between the 9th and 12th of _January_, three Patients were seized with
+such Swellings.
+
+The first was a Dragoon, who had just recovered from a Flux, and a bad
+Cough. On the 9th, he was suddenly seized in the Night with a large
+Swelling of his Face, Hands, and Arms, which had a shining oedematous
+Appearance, with a small Degree of Redness, and was painful when
+pressed; and he had two or three watery Blisters rose on the Back of
+each Hand above the Division of the Fingers, attended with a quick
+full Pulse, a feverish Heat and Thirst, a Cough, and somewhat of a
+Difficulty of Breathing, and high-coloured Water; and he was inclined
+to be costive. He was immediately blooded, had a saline Mixture with
+Contrayerva and Nitre, and was ordered to take a Purge in the Morning.
+Next Day the Blood had thrown up an inflammatory Buff, the Fever was
+abated, and the Breathing easier; but the Cough and Swelling still
+remained. He then took a Julep made of equal Parts of the Saline and
+Sperma Ceti Mixtures, which eased the Cough. The fourth Day the Pulse
+was soft, and the Swellings still in the same Situation, and the
+Breathing a little affected. A large Blister was applied to his Back,
+which discharged plentifully, relieved the Breathing, and lessened the
+Swellings considerably. The Cough and some Degree of Swelling still
+remained; but were removed by the Use of the Sperma Ceti Mixture with
+Oxymel, gentle Opiates, and some Doses of Physic.
+
+The second was a Man of the Twentieth Regiment of Foot, who had been
+some Months in the Hospital for a hectic Complaint; he was taken ill,
+the same Night as the Dragoon, with a Swelling of his whole Face,
+particularly the Lips, which had a shining watery Appearance, and a
+slight Degree of Redness, attended with a strong Fever; and was cured
+by Bleeding, Purging, the Use of the saline Medicines, and the
+Application of a Blister.
+
+The third was an Invalid, who had been admitted for a pleuritic
+Complaint, which he had got the better of. He was attacked, the second
+Night after the other two, with a shineing, watery, reddish Swelling,
+of his right Hand and Arm, up as far as the Joint of the Shoulder;
+four large watery Bladders likewise appeared on the fore Part of his
+Arm, above the Joint of the Elbow. Bleeding, with the cooling
+Medicines, and two Doses of Salts, carried off the Fever, and lessened
+the Swelling, in about seven Days Time; but a little of it, with a
+Stiffness, still remained; which at last was removed by the Use of
+aromatic Fomentations, rubbing with the _linimentum saponaceum_, and
+taking two Doses of Physic.
+
+Within less than a Fortnight, five or six more were seized with
+Swellings of the same Kind on some of the Extremities, and all got
+well by nearly the same Treatment; excepting one Man, who was in a
+very low State, and had a large deep Ulcer on his Hip, where there had
+been a Mortification from his lying on that Part in a Fever. The
+Swelling at first seemed to give Way; but on the third or fourth Day,
+having got a severe Cough, the Swelling increased, and the
+Inflammation began to look livid, and the Discharge from the Sore to
+look bad; and, notwithstanding various Means were used, a
+Mortification of the Part came on, and he died the seventh Day.
+
+
+
+
+OF THE SCURVY.
+
+
+The true Scurvy, attended with spungy fetid Gums of a livid Colour,
+with livid Blotches, and Ulcers of the Legs, and other Symptoms, began
+to shew itself at _Bremen_ in _January_ 1762; tho' we had not the
+least Appearance of this Disorder in the Hospitals at any other Place,
+while I was with the Troops in _Germany_.
+
+A great Variety of Disorders have been called by the Name of Scurvy:
+and the Disease has been divided into hot and cold; into the Acid, the
+Alcaline; and the Muriatic, according to the different Fancies of
+Authors, and the Causes they imagined it took its Rise from; but, from
+later and more accurate Observations, Dr. _Lind_ has justly remarked,
+that the true Scurvy has been found to be the same in all the
+different Parts of the Globe, and to take its Rise from similar
+Causes; from Cold and Moisture, and living much upon salted
+Provisions, joined to a Want of fresh Vegetables, and of good generous
+fermented Liquors; and hence it is most frequent in low marshy Places
+in northern Climates, where there is a Scarcity of fresh Vegetables;
+and where the Inhabitants live much upon salted Provisions in Winter;
+and aboard of Ships in long Voyages or Cruizes, especially in the
+northern Seas; and hence this Disorder was so frequent at _Quebec_ the
+first Winter it was in our Possession; and in some of the other Forts
+in _North America_, which were taken so late in the Year, that the
+Troops had not sufficient Time to lay in a Stock of Vegetables, and of
+fresh Meat to be preserved by the Frost[106]; but were obliged to live
+mostly on Ship Provisions.
+
+    [106] In _Quebec_, and other northern Parts of _North
+    America_, as soon as the Frost sets in, they kill their Meat
+    intended for their Winter Store, and hang it up: It soon
+    freezes, and will keep in this Manner all through the Winter.
+    They preserve Vegetables in the same Way; and when they
+    intend to make Use of either, they put so much as they want
+    into cold Water for some Time, which draws the Frost out of
+    it; and then they boil or roast it, as they think proper.
+
+It is observed, both at Sea and Land, that where the Scurvy rages,
+those People are least subject to it who are well cloathed; who live
+in dry Habitations, or lie in dry Births; who take proper Exercise,
+without being too much exposed to the Inclemency of the Weather; and
+who live well, and drink good Beer, Cyder, or Wine; as has been
+remarked by Dr. _Pringle_, Dr. _Lind_, and others.
+
+At _Bremen_ the Disorder was only observed among the Soldiers; not one
+of the Gentlemen belonging to the Hospital, or to the Commissariate,
+nor one of the military Officers, not even of the Serjeants, having
+the least Symptom of it. The Reason of its being frequent among the
+Soldiers was, that the Place is situated on a Plain naturally very
+damp; and the Soldiers were quartered in very low damp Houses; at the
+same Time, no Vegetables or Greens were to be bought in the Market;
+and fresh Meat, and other fresh Provisions, were at so high a Price,
+that the Soldiers could not afford to buy them; but were obliged to
+live on salted Meat, and salted Herrings, during the Winter; and what
+little Money they had remaining, they laid out on spirituous Liquors,
+which were sold cheap.
+
+The Cure of this Disorder requires--living in a dry comfortable
+Place--good Cloathing--light Food of easy Digestion, such as good
+Bread, Panado, Milk, Whey, Broths made of fresh Meats--white Meats,
+with Greens, or other Vegetable, &c.--the Use of Liquors of the acid
+or acescent Kind, or the moderate Use of Beer, Cyder, good Wine, or
+weak Punch[107]--And, by Way of Medicine, gentle Purges, mild
+Diaphoretics; the free Use of acid or acescent Fruits, Lemons,
+Oranges, Apples, Pears, Currans, Grapes, &c. and of the antiscorbutic
+Plants and their Juices, as Succory, Endive, Water-Cresses,
+Scurvy-Grass[108], &c. on which a great Part of the Cure principally
+depends; and the Use of some of the strengthening Bitters[109], of
+which the Bark is not the least efficacious.
+
+    [107] The free Use of raw Spirits is found to be very
+    prejudicial; but a moderate Quantity of these Spirits,
+    diluted with Water, and acidulated with Lemons or Oranges (or
+    with Cream of Tartar, or Tamarinds, when the former cannot be
+    got), and made into Punch, is found to be a good
+    Antiscorbutic.
+
+    [108] Most ripe Fruits, particularly Lemons and Oranges, and
+    esculent Herbs, and many Kinds of Roots, such as
+    Horse-Radish, Onions, Leeks, and many others, have been found
+    the most useful Remedies in the Cure of the Scurvy.
+    Decoctions and Infusions of Fir-Tops, of Spruce, and of other
+    Species of the Pine-Tree; and Beer made of these Infusions,
+    by fermenting them with Molasses, are approved
+    Antiscorbutics: and when such Remedies cannot be got,
+    Infusions of the common Bitters, and weak Punch, made with
+    Tamarinds or Cream of Tartar, have proved serviceable; and
+    where these Acids cannot be had, the Mineral Acids may be
+    used for acidulating the Drink. However, it ought always to
+    be remembered, that fresh Vegetables and Fruits, and
+    vegetable Acids, produce much better Effects in the Scurvy,
+    than any other Sorts of Remedies; and ought always to be
+    used, when they can be got.
+
+    [109] Most of the common Bitters have been strongly
+    recommended in this Disorder, Gentian, Trifoil, Wormwood,
+    &c.--as likewise aromatic Bitters and Aromatics; such as
+    _calamus aromaticus_, Carvi Seeds, Winters Bark, Cinnamon,
+    and many others.
+
+Bleeding is seldom requisite, except where there is much Heat or
+Fever; or a sharp Pain of the Side, or Difficulty of Breathing, or
+some Symptom of the like Kind; it is then sometimes necessary to take
+away some Blood: And in obstinate Cases, it is often found of Use to
+promote Sweats, by making the Patient, while in Bed, drink freely of
+warm Whey, or Sack Whey, mixed with the scorbutic Juices; or warm
+Barley Water, or the like, mixed with a small Quantity of the
+Antimonial Wine, or some other mild Diaphoretic.
+
+And where the Patient is strong, and there is no Danger of
+Haemorrhages, warm aromatic Baths have sometimes been found
+serviceable; but they are not to be used where the Patient is weak.
+
+The first Time I saw this Disorder at _Bremen_, was in an old Invalid,
+_James Long_, who had come from _Bristol_ to _Embden_, and from thence
+to _Bremen_. He was some Weeks in the Hospital before I discovered his
+Disorder to be the Scurvy. He at first complained only of great
+Weakness, and such a Giddiness, when he got out of Bed, that he could
+not walk, and of what he called flying rheumatic Pains of his Legs.
+He had no other visible Complaint; all which, I imagined, proceeded
+from Old-Age, and being worn out in the Service. At last, on the 25th
+of _January_, he complained of his Gums being sore; and, on examining
+him, I found his Breath fetid, his Gums swelled, soft, and spungy, his
+Legs covered with scorbutic Blotches, and other Symptoms, which
+evidently proved his Disorder to be the true Scurvy.
+
+Upon which, I ordered him a low Diet, with the Addition of Greens for
+Dinner, and a Quart of Lemonade, with a Gill of Brandy in it, _per_
+Day, for his common Drink; and, by Way of Medicine, a Decoction of the
+Bark, with the Elixir of Vitriol; and, at the same Time, ordered his
+Gums to be scarified, where they were most swelled and spungy; and to
+be washed frequently with an astringent Gargle; and to be rubbed now
+and then with burnt Alum[110]. By these Means, in a Fortnight's Time,
+his Gums became firmer, and his scorbutic Symptoms decreased. During
+that Course he took cold, and had a Stitch in his Side, for which he
+was blooded. The Blood threw up a very thin Buff, which was not of a
+firm Consistence[111]; the Crassamentum below was of a blackish
+Colour and of a loose Texture, and the Serum in a large Proportion. By
+the 2d of _March_ his Gums had recovered their natural Firmness and
+Texture, and the scorbutic Spots and Pains of the Legs were gone, and
+he had recovered his Strength; the only remaining Complaint was a
+little Swelling about the Ankles, for which he continued the same
+Course, and took a Dose or two of Physic. By the 16th of _March_ all
+these Symptoms were gone, and he was dismissed the Hospital free from
+all Complaints. I saw him well the last Week in _May_; and he told me,
+he had had no scorbutic Symptom since he left the Hospital.
+
+    [110] Dr. _Lind_, who has wrote one of the best Treatises on
+    this Disorder, and who had a great Deal of Practice himself,
+    says, "When first the Patient complains of an Itching and a
+    Spunginess of the Gums, with loose Teeth, either a Tincture
+    of the Bark in Brandy, or aluminous Medicines, will be found
+    serviceable in putting a Stop to the Beginning Laxity of
+    these Parts." When the Putrefaction increases, he recommends
+    the Use of some of the mineral Acids. See his _Treatise on
+    the Scurvy_, part ii. chap. v. p. 201.--_Van Swieten_ says,
+    he never found any Thing answer better than a Gargle made of
+    four Ounces of Elder or Rose Water, acidulated with a Drachm
+    of the Spirit of Sea Salt; and where the Gums were very
+    putrid and gangrened, he has been obliged to touch them
+    slightly with the pure Acid Spirit, and some Hours after to
+    have them washed with the Gargle just mentioned. Vide
+    _Comment._ vol. III. p. 629, sect. 1163.
+
+    If the Spunginess of the Gums sprout out into a luxuriant
+    Fungus, it is sometimes requisite to cut such Funguses away,
+    and to wash the Sores frequently with gentle astringent or
+    acid Liquors.
+
+    [111] Dr. _Huxham_ observes, that, after the Disease has
+    continued some Time, the Blood appears a mere Gore as it
+    were, not separating into Serum and Crassamentum as usual,
+    but remaining an uniform half-coagulated Mass, generally of a
+    more livid or darker Colour than common; though sometimes it
+    continues long very florid; but it always putrifies soon. See
+    his _Essay on Fevers_, chap. v.
+
+    There is something very particular in the Nature of this
+    Disorder, according to an Observation of Dr. _Lind_'s; who
+    says, "That the Scurvy is a Disease in its Nature very
+    opposite to that of a Fever; insomuch, that even an Infection
+    is long resisted by a scorbutic Habit; and those of a
+    scorbutic Habit being seized with the Fever, was a Proof of
+    its proceeding entirely from Infection." See his _First Paper
+    on Fevers_, p. 4.
+
+In the Beginning of _February_, another of the Invalids, who had been
+in the Hospital for a Fever and rheumatic Complaints, had Blotches
+appear on his Legs, complained of great Weakness, and fainted away in
+attempting to walk; which made me suspect his Disorder to be the
+Scurvy; and, on examining him, I found his Gums soft and spongy,
+attended with the other Symptoms of the true Scurvy. I put him nearly
+on the same Course as in the last-mentioned Case: He used a low Diet,
+with the Addition of Greens for Dinner, which he eat with a little
+Butter and Vinegar; and he had a Quart of Lemonade, with two Ounces of
+Brandy, for his common Drink during the Day; and, by Way of Medicine,
+a Decoction of the Bark, with two Drachms of the _confectio cordiaca_
+to each Half Pint, which he took by Spoonfuls. Next Day he complained
+of a Pain in his Leg; and, on examining it more particularly, I found
+a large livid Blotch, yellow all round the Edges, on the fore Part,
+and a Tension all over that Leg. As he was so extremely low, as to be
+in Danger of fainting whenever he sat up, I was afraid lest a
+Mortification should ensue; and therefore ordered his Leg to be bathed
+Morning and Evening with a warm aromatic Fomentation, and a Poultice
+of Theriaca to be applied after it; and desired him to take as much of
+the Decoction of the Bark with the Cordial as possible; and allowed
+him a Glass of Mountain Wine every two or three Hours. By the
+Continuance of this Course for some Weeks, the livid Blotches, Pain,
+and Stiffness of his Leg, and most of the other scorbutic Symptoms,
+went away; his Gums were restored to their natural Firmness; and he
+recovered his Strength so much as to be able to sit up all Day long;
+though he still remained very weak when he was sent to _England_, in
+_March_.
+
+In _February_ and _March_, seven or eight more scorbutic Patients were
+sent to the Hospital I attended, who were all treated in the same
+Manner; and all did well. About the Middle of _February_ this
+Distemper began to shew itself in the other Hospital attended by Dr.
+_Miller_, who treated the Patients nearly in the same Way, and they
+all recovered.
+
+On the 5th of _April_, a young Man, belonging to the Eighth Regiment
+of Foot, came to the Hospital with all the Symptoms of the true
+Scurvy; his Gums were spungy and foetid; he had livid Blotches on his
+Legs, and Contractions of the Hams, and a Stiffness and Hardness in
+the Calves of both Legs[112]. By following the same Course as the
+others, and the Use of frequent Fomentations, and rubbing the
+contracted Parts with soft Liniments, he mended daily; and, after
+taking a Dose or two of Physic, was dismissed perfectly recovered on
+the 10th of _May_. At his first Admission into the Hospital, he was
+taken with a severe Cough, attended with Pain of the Breast, and a
+Spitting of Blood for a Day or two, for which he was blooded. His
+Blood threw up a little Buff; the Crassamentum was of a blackish
+Colour and of a loose Texture, with a good Proportion of a yellowish
+Serum. This Bleeding relieved the Complaints of his Breast, and he had
+no Return of them while he remained in the Hospital.
+
+    [112] If the Swellings become large, stiff, and painful, Dr.
+    _Lind_ recommends that the Legs should be frequently bathed
+    and fomented; or, what he has found preferable, to be exposed
+    to their Steams, after being well covered with Blankets.
+    After this Operation, he advises the Limb to be rubbed with
+    some mild Oil, such as _oleum palmae_, or Salad Oil; and if
+    the Swellings resist both the general Cure and these
+    Applications, the Limbs to be sweated with Spirits. See his
+    _Treatise on the Scurvy_, part ii, chap. v.
+
+The first Week in _May_ four Invalids were admitted into the Hospital
+for this Disorder. The first had spungy Gums, a foetid Breath, his Legs
+swelled and hard, and of a deep purple Colour. The second was a Case
+at first of a more doubtful Kind; there were no spungy Gums, though an
+offensive Breath; his Ancles and Feet were swelled, attended with Pain
+and Uneasiness, and a great Weakness and Lassitude; but no Fever, nor
+any livid Blotches. The Swelling of the Feet and Ancles seemed at
+first Sight rather gouty or rheumatic, than of the scorbutic Kind; but
+from the Man's Way of Life, and the Disorder being so frequent, we
+discovered it to be the Scurvy. The third had a very foetid Breath and
+spungy Gums, livid Spots and fungous Ulcers[113] on his Legs, with
+Pains and Weakness all over. The fourth had also spungy Gums and a
+foetid Breath, Pains of the Legs and Arms, livid Blotches on his Legs,
+great Hardness and Contraction of the right Ham, and a livid hard
+Swelling on the Outside of the left Thigh, immediately above the Knee.
+
+    [113] "Ulcers on the Legs, or any other Part of the Body,
+    require pretty much the same Treatment, _viz._ very gentle
+    Compression, in order to keep under the Fungus, and such
+    antiseptic Applications as have been recommended for putrid
+    Gums, _viz. mel rosat._ acidulated with _spiritus vitrioli_,
+    _ung. AEgiptiacum_, &c. but nothing will avail where the
+    Patient cannot have Vegetables and Fruits." _Dr. Lind's
+    Treatise on Scurvy_, part ii. chap. v. p. 204. And he
+    recommends, if the Swellings and Ulcers of the Legs neither
+    yield to the general Cure nor to the Methods here proposed,
+    that a slow and gentle Course of Mercury should be tried,
+    after the scorbutic Taint is a good deal removed, and the
+    Gums are sufficiently firm; and to give along with it a
+    Decoction of the Woods, or of Sarsaparilla; but this Method
+    ought not to be attempted till the Gums have acquired a
+    proper Firmness. See _ibid._ part ii. chap. v.
+
+We treated them all four in the Method above-mentioned, adding a Mess
+of Greens to Dinner, giving Lemonade for Drink, and the Bark, with
+Elixir of Vitriol, by Way of Medicine. The Parts that were hard and
+swelled, were fomented, and rubbed with soft Liniments, and Poultices
+were applied to the hard Swelling on the Outside of the left Thigh;
+and the Ulcers of the Legs dressed with Digestives, and occasionally
+washed with spirituous Tinctures, and touched with Escharotics. Before
+I left _Bremen_, the first Week in _June_, the first and second
+Patients were perfectly recovered, and the third and fourth almost
+well. All of them had had the Disorder some Months before they came to
+the Hospital.
+
+
+
+
+OF THE ITCH.
+
+
+There was no Disorder so common in the military Hospitals as the Itch.
+It is of an infectious Nature, and now most commonly believed to be
+entirely owing to little Insects lodged in the Skin, which many
+Authors affirm they have seen in the Pustules by the Help of a
+Microscope; and that the Disorder is entirely communicated by
+Infection, and does not arise from any Fault in the Fluids or Solids.
+
+It has been found by Experience, that internal Medicines have little
+or no Effect in removing this Disorder; and that only external
+Remedies, which come immediately in contact with the Parts affected,
+are capable of making a Cure; which has been brought as a farther
+Proof, that the Itch is owing to Animalcules or Insects; as it is
+alledged, that no Remedies will cure the Distemper, but such as are
+capable of killing them.
+
+The Medicines, which are most commonly used for the Cure, are
+_Mercury_, _White Helebore_, and _Sulphur_.
+
+Mercurial Frictions on the Part are often made use of, and sometimes
+with Success, though they are by no Means to be depended upon for a
+Cure; besides that, they are liable to throw the Patients into a
+Salivation, as I have seen happen more than once; for which Reasons I
+would never recommend this Method where the Patient labours under no
+other Disorder which requires the Use of Mercury, and would confine it
+entirely to Cases where Patients, having the Itch, labour, at the same
+Time, under the _Lues venerea_, and require the free Use of mercurial
+Frictions; under such Circumstances the mercurial Ointment may be as
+well rubbed on the Parts affected with the Itch as upon any other.
+
+The Powder of the Root of _White Helebore_, made up into an Ointment
+with Hogs Lard, or a strong Decoction of it in Water, rubbed on the
+Parts, will often cure the Itch; but it is a sharp Medicine, and
+generally smarts, and sometimes inflames the Parts on which it is
+rubbed; and therefore it is not so commonly used, as we know a much
+surer and milder Remedy. Though I have cured some People with the
+Helebore Lotion without any Inconvenience, who would not use the
+Sulphur on Account of its Smell.
+
+_Sulphur_ is the most certain and easy Cure for the Itch of any we
+know, and perhaps is more certain in the Cure of this Disorder than
+almost any other Medicine in any other Disorder whatever. We used it
+in Form of the Sulphur Ointment of the _London Dispensatory_, of which
+one, two, or more Drachms were rubbed in every Night, in Proportion to
+the Extent of the Parts affected. These Unctions were continued from
+four or five to ten or twelve Nights, according to the Violence and
+Continuance of the Disorder. Most were cured in a few Days; others
+required a longer Time. As the sulphureous Unctions tend to obstruct
+the Perspiration, we generally ordered a Purge to be given before
+rubbing the Sulphur Ointment, and in full Habits sometimes ordered a
+little Blood to be taken away; and put them all under a low Diet.
+After the Disorder seemed to be removed, they took another Dose or two
+of Physic to carry off any Impurities that might have been thrown upon
+the Bowels, during the Use of the Sulphur Ointment. In inveterate
+Cases, the Sulphur was given internally at the same Time that the
+Patient rubbed with the Ointment.
+
+It is generally believed (though denied by some) that Sulphur, taken
+internally, enters the Blood; and its Steams are thrown off by the
+perspiratory Vessels, and assists more effectually to destroy the
+Insects and their Ovula, which give Rise to the Itch; but whether this
+Effect be true or not, I found it to answer another very good Purpose;
+which was to keep the Belly rather loose, while the Patient used the
+Unction; and by this Way it carried off those Humours, which ought to
+have passed off by the Skin; and for that Reason, when it had not that
+Effect, we joined some Lenitive Electuary to it.
+
+There is one Thing to be observed with regard to sulphureous Unctions,
+which is, that we ought not to use them too soon with People
+recovering out of Fevers, or other Disorders which bring them low;
+otherwise there will be Danger of bringing on a Relapse, which I have
+often observed to happen in military Hospitals, where the Itch has
+appeared as the Patients were recovering from Fevers and other
+Disorders, and the Unctions were used too soon: But whether these
+Relapses were owing to the sulphureous Unction's stopping up the Pores
+of the Skin, and obstructing a free Perspiration, or to the Patient's
+being more apt to take Cold while they used the Sulphur Ointment, than
+at any other Time, is what I cannot determine; but to me it seems most
+probable, that these Unctions rather obstruct the Perspiration; and
+that when they are used too soon with People recovering from Fevers,
+especially those of the putrid Kind, they prevent those Particles
+from passing off by the Skin, which it was necessary should be
+evacuated, in order to free the Body from the Seeds of the Fever, or
+other Disorders the Patients laboured under. But however this be,
+Experience has shewn, that we ought not to attempt the Cure of the
+Itch, in Patients so circumstanced, till their Strength be in a great
+Measure re-established, otherwise there will be Danger of a Relapse;
+and likewise, that Patients using Sulphur externally, ought to be
+particularly on their Guard against Cold.
+
+This Observation of Peoples being so apt to relapse after Fevers by
+the too early Use of sulphureous Unction, is a strong Proof of the
+Usefulness of keeping the Body open during the Time of Rubbing and of
+Purging the Patient afterwards; as by these Means we may carry off by
+the Bowels those Particles which could not pass by the Skin; and I
+think, so far as I have been able to observe, those People have been
+less subject to relapse into Fevers where this Caution has been used,
+than where it has been neglected.
+
+That Species of the Itch where it forms small Ulcers or Pustules in
+the Skin, is the worst Kind, and most contagious, and seems to take
+its Rise from the common Itch continuing long, and making its Way
+deeper into the Skin. The Cure is the same, only this requires more
+frequent Unctions, and those to be continued longer, than before the
+Disorder has taken such deep Root.
+
+It is no uncommon Thing to see the Itch appear again, some Weeks after
+it has seemingly been cured by the Use of sulphureous Unctions; which
+most commonly happened to those who were in too great a Hurry to get
+well, and left off the Use of the Unctions too soon. Such Returns of
+the Itch were generally cured by the Repetition of the same Treatment
+as before.
+
+
+
+
+TABLE of DIET.
+
+
+The following is a Copy of the Table of Diet which was used in the
+Hospital all the Time I was with the Troops in _Germany_:
+
+                     _Breakfast._     |   _Dinner._      |   _Supper._
+                                      |                  |
+               One Pint of Rice       |                  |
+               Gruel; made with two   |                  |
+               Ounces of Rice, one    |                  |
+  Full Diet,   Spoonful of fine       | One Pound of     | As Breakfast.
+               Flower, a little       | Meat.            |
+               common Salt, and fine  |                  |
+               Sugar.                 |                  |
+  ______________________________________________________________________
+                                      | One Pint of      |
+  Middle Diet, As above.              | Broth, Half a    | As above.
+                                      | Pound of Meat.   |
+  ______________________________________________________________________
+                                      | One Pint of      |
+                                      | Broth; or Half   |
+               As above, or           | a Pint of        |
+               according to           | Panado, with two |
+  Low Diet,    the Patient's          | Spoonfuls of     | As Breakfast.
+               Stomach or             | Wine, and a      |
+               Indisposition.         | Quarter of an    |
+                                      | Ounce of fine    |
+                                      | Sugar.           |
+
+The daily Allowance of Bread was a Pound to those on full and middle
+Diet, and Half a Pound to those on low Diet, or a Pound, if so ordered
+by the Physician.
+
+Those on full and middle Diet were allowed daily three Pints of Barley
+or Rice Water; to each Pint of which were added two Spoonfuls of
+Brandy, and a Quarter of an Ounce of Lump Sugar. Small Beer was
+mentioned in the Diet Table; but this we could never have good; and
+therefore was not used.
+
+Those on low Diet were allowed Barley or Rice Water; to which some
+Wine or Brandy was occasionally added, if ordered so by the Physician.
+
+Besides this, the Physician might order an additional Quantity of
+Wine, Brandy, or Milk, or Water Gruel, or any other Articles which he
+thought proper for the Sick under his Care, and which could be got
+easily.
+
+
+
+
+PHARMACOPOEIA IN USUM
+
+Nosocomii Regii Militaris Britanici.
+
+MDCCLXI.
+
+
+
+
+PHARMACOPOEIA IN USUM
+
+Nosocomii Regii Militaris.
+
+Ann. MDCCLXI.
+
+
+AQUAE SIMPLICES ET SPIRITUOSAE.
+
+    AQUA Alexeteria.
+    ---- Bacc. Juniperi.
+    ---- Cinnamomi.
+    ---- Menthae vulgaris.
+    ---- Menthae piperitidis.
+    ---- Nucis moschatae.
+    ---- Pulegii.
+    ---- Rutae.
+
+    Vel aliae aquae hujus generis praeparari possint, terendo in
+    mortario vitreo elaeosacchara praeparata, cum oleis
+    essentialibus, et sacchari albi 12la quantitate; et dein
+    addendo aquae fontanae vel spiritus vini tenuis quantitatem
+    sufficientem[114].
+
+    [114] Such _Elaeosacchara_ (as they are called), made by
+    rubbing the essential Oils with twelve Times the Quantity of
+    Sugar, may at all Times be prepared at the fixed Hospital,
+    and carried about with the flying Hospital, much more
+    conveniently than the simple or compound Waters themselves.
+
+Aqua calcis simp. Ph. Lond.
+
+    Dosis a lib. i. ad lib. ij. in die.
+
+Aqua Hordeata. Ph. Lond.
+
+    Utenda pro potu.
+
+
+BOLUS.
+
+Bolus anodynus astringens.
+
+    Rx Theriacae andromachi, drachm. dimid. opii, gr. i. M. pro
+    dosi semel vel bis die.
+
+Bolus e rheo cum mercurio.
+
+    Rx Pulv. rhei, gr. xxv. calomel, gr. v. syrup sacchari, q. s.
+
+Bolus e calomel.
+
+    Rx Calomel gr. v. conserv. rosar. scrup. i. M.
+
+Bolus mercurialis.
+
+    Rx Argenti vivi, gr. x. extingue in balsam copaivi, q. s. et
+    adde conserv. rosar. q. s.
+
+Bolus e scordio cum rheo.
+
+    Rx Elect. e scordio, scrup. i. pulv. Rhei, gr. x. syrup, q. s.
+    ut fiat bolus sumendus semel, bis, terve die.
+
+
+COLLYRIA.
+
+Collyrium saturninum.
+
+    Rx Sacchari saturni, salis ammoniaci crudi ana gr. vi. solve
+    in aq. fontanae, unc. xij. adde pro re nata tinct. thebaicae,
+    drachm. i.
+
+Collyrium vitriolicum.
+
+    Rx Vitrioli albi, drachm. ss. solve in aq. fontanae, lib. i.
+
+Confectio cardiaca. Ph. Lond.
+
+Conserva cynosbat. Ph. Lond.
+
+Conserva rosar. Ph. Lond.
+
+
+DECOCTA.
+
+Decoctum album. Ph. Lond. utendum pro potu.
+
+Decoctum arabicum.
+
+    Rx Gum. arabici, unc. dimid. coque in aq. hordeatae bullientis,
+    lib. ij. ad solutionem Gummi. utend. pro potu.--addi possit
+    pro re nata spirit. nitri dulcis, drachm. ij.
+
+Dococtum corticis Peruviani.
+
+    Rx Cort. Peruv. crass. pulv. unc. i. coque in aq. fontan. lib.
+    iij. ad lib. ij. Colaturae adde tinct. cort. Peruv. unc. i.
+    spirit vini Gallici sescunc. Dosis ab uncia i. ad unc. iv.
+    bis ter. quaterve die.
+
+Decoctum cort. cum serpentaria.
+
+    Fit addendo decocto cort. Peruv. sub sinem coctionis, rad.
+    serpentariae virgin. contus. unc. dimid. Dosis ab unc. i. ad
+    unc. iij. ter quaterve die.
+
+Decoct. commun. pro clyster.
+
+    Rx Flor. vel herb. chamaemel. unc. i. coque in aq. fontan. lib.
+    i.ss. ad lib. i. & cola.
+
+Decoctum ligni guaiaci.
+
+    Rx Ligni guaiaci ras. lib. ss. aq. fontanae bullientis, cong.
+    ij. macera per noctem; mane coque ad congium. i. & cola;
+    Capiat a lib. ss. ad lib. ij. die.
+
+Decoctum nitrosum.
+
+    Rx Coccinel. scrupul. i. coque in aq. fontan. lib. ijss. ad
+    lib. ij. & dein adde salis nitri, unc. i. sacchar. albi
+    sescunc. Colaturae addi possit pro re nata aq. alicujus
+    spirit. unc. ij. Dosis ab unc. i. ad unc. iv. 4tis vel 6tis
+    horis.
+
+Decoctum pectorale.
+
+    Rx Fol. herb. malvae, unc. ij. feminum lini, unc. dimid. coque
+    in aq. fontan. lib. ivss. ad lib. iv. addendo sub finem
+    coctionis rad glycyrrhiz sescunc. vel mellis optimi, unc. i.
+    Cola pro potu.--Adde pro re nata aceti, sescunc.
+
+Decoctum rad. sarsaparillae.
+
+    Rx Rad. sarsaparillae, unc. iij. coque in aq. fontan. lib. iij.
+    ad lib. ij. adde sub finem coctionis ligni sasafras, drachm.
+    i. rad. glycyrrhizae, drachm. ij. Colaturae capiat a lib. i.
+    ad lib. ij. in die.--Adde pro re nata vini antimonialis,
+    drachm. ij.
+
+
+ELECTARIA.
+
+Elect. astringens balsamicum.
+
+    Rx Specier. e scordio, pulv. e tragacanth. comp. ana unc. i.
+    tincturae thebaicae, drachm. ij. syrup sacchari, q. s. ut fiat
+    elect. Dosis ad molem N. M. bis, ter. quaterve in die.
+
+Elect. corticis Peruviani.
+
+    Rx Pulv. cort. Peruv. unc. iv. syrup sacchari, q. s. Dosis a
+    scrup. i. ad drachm. unam, bis, ter, 4r. 6ties. vel decies
+    die.
+
+Elect. corticis anodynum.
+
+    Rx Elect. cort. Peruv. unc. 1nam. elect. e scordio unciam
+    dimidiam, vel tinct. thebaicae scrup. ij.
+
+Elect. corticis astringens.
+
+    Rx Elect. cort. Peruv. semunc. pulv. rad. tormentil, lapidis
+    cancror. ppt. singulorum, drachm. i. syrup, q. s.
+
+Elect. cort. cum serpentaria.
+
+    Rx Elect. cort. Peruv. unc. i. pulv. rad. serpentar. virgin.
+    cort. canel. alb. ana, drachm ij. syrup. q. s.
+
+Elect. cort. cum sale ammoniac.
+
+    Rx Elect. cort. Peruv. sescunciam. sal. ammon. crud. drachm. i.
+
+Elect. e baccis lauri. Ph. Lond.
+
+Elect. lenitiv. Ph. Lond.
+
+Elect. lenitivum cum sulphure.
+
+    Rx Elect. lenitiv. lib. ss. flor. sulphuris, unc. ij. Dosis,
+    moles, N. M. vel ad semunc. pro re nata.
+
+Elect. lenitivum compositum.
+
+    Rx Elect. lenitiv. lib. i. pulv. jalap. unc. i. sal. nitri,
+    drachm. ij. syrup. q. s. Dosis a drach. i. ad drach. iv. pro
+    r. n.
+
+Elect. lenitivum balsamicum.
+
+    Rx Elect. lenitiv. comp. unc. ij. bals. copaiv. unc. i. gum
+    guaiac. unc. ss. M. Dosis, cochleare theae, h. s. vel mane &
+    vesperi.
+
+Electuar. e scordio vel diascordium. Ph. Lond.
+
+Elect. e spermat. ceti.
+
+    Rx Balsam Peruv. unc. im. misce optime cum mucilag. gum arab.
+    sescunciam & adde spermat. ceti, conserv. rosar. ana unc.
+    xij. syrup sacchar. q. s. dosis, a dimidia drachma bis die ad
+    drachm. im. quater vel sexties die.
+
+Elect. stomachicum.
+
+    Rx Conserv. cynosbat. unc. iv. pulv. rad. zinziber. drachm.
+    ij. canell. alb. unc. i. rubigin. martis, drachm. ij. syrup.
+    q. s. dosis a scrup. i. bis terve die ad semidrach. 4tis
+    horis.
+
+Elect. e scammon. Ph. Lond.
+
+
+ELIXIR.
+
+Elix. aloes. Ph. Lond.
+
+Elix. paregoricum. Ph. Lond.
+
+Elix. vitrioli acid. Ph. Lond.
+
+
+ENEMATA.
+
+Enema commune laxativ.
+
+    Rx Aq. fontan. calid. unc. xij. elect. lenitiv. semunc. sal.
+    cathartici amari, unc. i. M.
+
+Enema commun. oleos.
+
+    Rx Aq. fontan. bullient. unc. x. mucilag. gum arabic. unc. im.
+    olei olivar. unc. ij. adde pro re nata elect. e scord.
+    drachm. ij. vel. tinct. thebaic. drachm. i.
+
+Enema ex amylo.
+
+    Rx Aq. fontan. calid. unc. iv. gelatin. amyli, unc. v. elect.
+    e scord. drachm. i. M.
+
+Enema terebinth.
+
+    Rx Terebinth commun. drachm. vi. solve in vitello ovi & adde
+    enemat. oleos. unc. x.
+
+Emplastrum vesicatorium. Ph. Lond.
+
+
+FOTUS.
+
+Fotus communis.
+
+    Rx Fol. malv. flor. chamaemel. singulorum, m. i. coque in aq.
+    fontan. q. s.
+
+Fotus commun. spirit.
+
+    Rx Fotus commun. lib. ij. aceti, lib. i. spirit. vini tenuis,
+    lib. ss. M. pro fotu.
+
+Fotus cum sale ammoniac.
+
+    Rx Fotus commun. lib. ij. sal ammoniac crud. unc. i.
+
+Fotus volatilis.
+
+    Rx Fotus commun. q. s. asperge panno statim ante applicationem
+    spiritus sal. ammoniac, q. s.
+
+
+GARGARISMATA.
+
+Gargarisma commune.
+
+    Rx Aq. hordeat. unc. xij. sal. nitri, drachm. i. mellis
+    semunc. M. adde pro re nata spirit. vin. unciam i.
+
+Gargarisma acidum.
+
+    Rx Aq. hordeat. unc. xij. spirit. vini gallici, unc. i. aceti
+    sescunc. tinct. myrrhae, drachm. ij. M.
+
+Gargarisma volatile.
+
+    Rx Aq. hordeat. unc. xij. spirit. vin gallic. unc. ij. sal.
+    vol. ammoniaci, drachm. i. M.
+
+
+GUTTAE ANTIMONIALES ANODYNAE.
+
+    Rx Vini antimonialis, unc. im tinct. thebaic. drachm. ij.
+    dosis a gutt. 30 ad 40 bis terve die, vel a gutt. 60 ad 140,
+    h. s. in potu tepido.
+
+
+HAUSTUS.
+
+Haustus simplex.
+
+    Rx Aq. fontan. sescunc. spirit. vini gallici drachm. i. ss.
+    sacchar alb. drachm. dimidiam M.--Haustus praeparari possit
+    aqua aliqua simp. et spirit. loco aq fontan. & spirit. vini
+    gallici pro re nata.
+
+Haustus anodynus.
+
+    Rx Haust. simp. sescunc. tinct. thebaic. gutt. xx. M.
+
+Haustus camphoratus.
+
+    Rx Camphorae, gr. iij. tere in mortario cum sacchar. alb.
+    drach. dimid. & dein adde mucilag. gum arabici, drachm. ij.
+    haust. simp. sescunciam. M. s. a. Dosis repetenda, 4ta vel
+    6ta. quaque hora.
+
+Haust. emetic. antimonialis.
+
+    Rx Vini antimonialis semunciam. Dari possit ad drachm. x. pro r. n.
+
+Haust. emeticus scilliticus.
+
+    Rx Oxymel. scillit. drachm. x. aq. fontan. semunc. pulv. rad.
+    ipecacoan. gr. vi.
+
+Haustus cardiacus.
+
+    Rx Haust. simp. sescunciam confect. cardiac. scrup. im. M. f.
+    haustus repetendus 4tis. vel 6tis. horis--adde pro re nata
+    sp. lavend. comp. dr. i.
+
+Haustus cardiacus oleosus.
+
+    Rx Ol. essential. menth. gutt. ij. tere in mortario vitreo cum
+    sacchar. alb. drachm. dimid. & adde haust. simplicis sescunc.
+    tinct. stomachic. drachm. i. M.--adde pro re nata tinctur.
+    thebaic. gutt. x.
+
+Haustus lixiviosus anodynus.
+
+    Rx Haust. simp. sescunciam, lixivii tartari, drachmam dimidiam
+    tincturae thebaicae, gutt. xx. cap. h. s. vel mane & vesperi.
+
+Haustus e mithridatio.
+
+    Rx Haust. simp. sescunc. mithridat. scrup. i. aceti vin.
+    drachm. iij. dosis repetenda 4tis. vel 6tis. horis.
+
+Haustus oleosus communis.
+
+    Rx Mucilagin. gum arabici, drachm, iv. ol. olivar, drachm. v.
+    misce s. a. & adde haust. simp. sescunciam. Repet. 4tis. vel
+    6tis. horis.
+
+Haustus oleosus cum rheo.
+
+    Rx Haust. oleos. communis, unc. ij. tinct. rhei sescunc. vel
+    pulv. rhei, gr. xxv. tinct. thebaic. gutt. xv. M. fiat
+    haustus sumendus vel h. s. vel primo mane.
+
+Haustus purgans.
+
+    Rx Infus. senae. unc. iij. sal. glauber. drachm. iij. spirit.
+    vin. gallici, drachm. ij. sacchar. alb. drachm. dimid. capiat mane.
+
+Haustus salinus communis.
+
+    Rx Aceti vinosi vel succ. limonum semunciam, sal. absynth.
+    scrup. i. vel ad saturationem, haust. simp. sescunciam adde
+    pro re nata pulv. contrayerv. comp. scrup. i. vel pulv.
+    contrayerv. cum nitro, scrup. ij.--Haustus praeparari possit
+    cum salis diuretici drachma dimid. loco acidi & salis
+    absynthii. Dosis repetend. 3tiis. 4tis. vel 6tis.
+    horis--Eodem modo sit haustus cum spirit. mindereri uncia
+    dimidia.
+
+Haust. salin. cum confect. cardiaca.
+
+    Rx Haust. salin. commun. unc. ij. confect. cardiac. scrup. i.
+    M. repet. 4tis. vel 6tis. horis.
+
+Haust. salin. cum mithridatio.
+
+    Rx Haust. salin. commun. unc. ij. mithridatii, scrup. i. M.
+    sumend. 4tis. vel 6tis. horis.
+
+Haustus salin. cum rheo.
+
+    Rx Haust. salin. com. uncias ij. pulv. rhei, gr. xxv. M.
+    capiat mane.
+
+Haustus salin. cum phu.
+
+    Rx Haust. salin. commun. unc. ij. pulv. rad. valerian.
+    sylvestris, scrup. ij. Dosis repetend. 2dis. 4tis. vel 6tis.
+    horis.
+
+Haust. salinus succinatus.
+
+    Rx Haust. salin. commun. unc. ij. sal succini, pulv. castorei
+    singulorum, gr. x. H. repetend. 4tis. vel 6tis. horis.
+
+Haust. salinus purg. oleosus.
+
+    Rx Mannae opt. semunc. olei olivar. drachm. vi. vitelli ovi q.
+    s. tere in mortario, addendo paulatim sal cathartici amari,
+    unc. i. solutam in aq. fontan. calid. unc. iij. spirit. vini
+    gallici vel aq. alicujus spirituosae, drachm. iij. M. s. a pro
+    dosi matutino.
+
+Haustus volatilis.
+
+    Rx Haust. simp. sescunciam sal. vol. c. cervi, gr. x. M. H.
+    repet. 4tis. vel 6tis. horis.
+
+
+INFUSA.
+
+    Infusum amarum. Ph. Lond. Addi possit pro re nata in
+    praeparando spirit. vini tenuis, lib. ss. ad lib. ij. infusi.
+    Dosis ab unc. ina. bis die ad unc. ij. ter. die.
+
+Infusum raphani rusticani.
+
+    Rx Rad. raphani rusticani, unc. ij. baccar. juniper, unc.
+    inam. cort. canell. alb. drachm. ij. aq. fontan. bullient,
+    lib. iv. infunde per noctem leni calore. Colaturae adde
+    spirit. vini gallici unc. iv. Dosis ab. unc. i. bis terve die
+    ad unc. iv. 6tis. horis.
+
+Infusum senae commun. Ph. Lond.
+
+
+JULEPUM E MOSCHO.
+
+    Rx Mosch. drachmam im. tere optime in mortario cum sacchar.
+    alb. drachm. iij. & adde mucilagin. gum arab. dr. iv. Haust.
+    simp. unc. vi. Dosis unc. ij. 4tis. vel 6tis. horis.
+
+
+LINCTUS.
+
+    Rx Conserv. cynosbat. unc. iv. ol. olivar. syrup. sacchari vel
+    mellis ana unc. ij. adde pro re nata spirit. vitrioli tenuis,
+    drachm. iv. Dosis cochleare theae urgente tussi.
+
+
+LINIMENTA.
+
+Liniment. saponaceum. Ph. Lond.
+
+Linimentum camphoratum.
+
+    Rx Olei olivar. unc. ij. camphorae, drachm. ij. M.
+
+Linimentum volatile. Ph. Lond.
+
+Linimentum volatile commune.
+
+    Rx Olei olivar. unc. iij. spiritus salis ammoniaci, dr. vi. M.
+
+
+MELLA.
+
+Mel cum borace.
+
+    Rx Mellis optimi, unc. i. pulv. subtilissim. boracis, dr. i. M.
+
+Mel AEgyptiacum. Ph. Lond.
+
+Mel rosaceum. Ph. Lond.
+
+MITHRIDATIUM. Ph. Lond.
+
+
+MIXTURAE.
+
+Mixtura acida communis.
+
+    Rx Haust. simp. unc: viij. spirit. vitrioli tenuis, scrup. ij.
+    vel ad gratam aciditatem. Dosis ab. unc. ij. ad unc iv. 4tis.
+    vel 6tis. horis.
+
+Mixtura ammoniaca.
+
+    Rx Gum ammoniaci, drachm. i. solve in haust. simp. unc. vi.
+    Dosis ab. unc. i. ad unc. ij. bis terve in die.
+
+Mixtura ammon. cum oxymel.
+
+    Rx Mixt. ammoniac. unc. vi. oxymel scillit. drachm. vi. Dosis
+    a cochlear. i. ad unc. ii. ter. 4rve. die.
+
+Mixtura ammoniac. anodyna.
+
+    Rx Mixt. ammoniac. cum oxymel. unc. vi. tinct. thebaic.
+    drachm. dimid. Dosis a cochlear. i. ad iv. 4tis. vel 6tis.
+    horis.
+
+Mixtura Campechensis.
+
+    Rx Extract. ligni Campechensis, drachm. iij. solve in haust.
+    simplic. unc. vi. adde pro re nata tinct. thebaic. gutt. xxx.
+    vel Philon. Londinen. drachm. i. Dosis ab. unc. i. ad unc.
+    iij. bis, ter, 4rve. die.
+
+Mixtura faetida.
+
+    Rx G. asafaetid. drachm. i. solve in haust. simp. unc. vi.
+    Dosis ab. unc. i. ad unc. iij. 4r. die.
+
+Mixtura faetida volatilis.
+
+    Rx Mixt. faetid. unc. vi. spirit. volat. sal. ammon. drachm. i.
+    Dosis ab. unc. i. ad unc. ij. bis, ter, 4rve. die.
+
+Mixtura fracastorii.
+
+    Rx Haust. simp. unc. viij. Elect. e scordio, drachm. iv. Dosis
+    ab. unc. i. ad unc. ij. 4tis. vel 6tis. horis.
+
+Mixtura japonica.
+
+    Rx Haust. simp. unc. vi. Tinct. japonic. unc. i. adde pro re
+    nata tinct. thebaic. dr. i.
+
+Mixtura laxativa.
+
+    Rx Elect. lenitiv. unc. i. Mannae semunc. coque in aq fontan.
+    unc. xvi. ad unc. xij. Colaturae adde sal. cathartici amari.
+    sescunciam. spirit. vini gallici, unc. i. Dosis ab. unc. ij.
+    ad unc. xij.
+
+Mixtura purg. antimonial.
+
+    Rx Elect. lenitiv. sescunc. mannae semunc. coque in aq. fontan.
+    unc. xx. ad unc. xvi. & dein solve tartar. emetici, gr. x.
+    Colaturae dosis ab. unc. i. ad unc. iv. omni hora vel omni
+    2da. vel 3tia. vel 4ta. hora, donec laxetur alvus.
+
+Mixtura oleosa volatilis.
+
+    Rx Haust. simp. unc. vi. ol. olivar. unc. iij. spirit.
+    volatil. salis ammoniaci drachmam inam. M. Dosis ab. unc. i.
+    ad unc. iij. 3tiis. vel 4tis. horis.
+
+Mixtura scillitica.
+
+    Rx Haust. simp. unc. vi. oxymel scillitic. drachm. vi. Dosis a
+    drachm. iv. ad unc. ij. bis, ter, 4rve. die.
+
+Mixtura e spermat. ceti.
+
+    Rx Spermat. ceti, drachm. ij. solve in vitello ovi & adde
+    haust. simp. unc. vi. adde, pro re nata, tinct. thebaic.
+    scrup. ij. Dosis ab. unc. i. ad unc. ij. 4tis. vel 6tis.
+    horis.
+
+Mixtura e spermat. ceti cum balsamo.
+
+    Rx Balsam. copaiv. drachm. ij. tere in mortario cum mucilag.
+    gum arabici, drachm. iij. & dein adde mixtur. e spermat.
+    ceti, unc. vi. Dosis ab. unc. i. ad unc. iij. 4tis. vel 6tis.
+    horis.
+
+
+MUCILAGO. G. ARABICI.
+
+    Rx G. arabici pulv. unc. iv. solve in aq. purae bullient. unc. x.
+
+Oxymel scillit. Ph. Lond.
+
+Philonium Londinen. Ph. Lond.
+
+
+PILULAE.
+
+Pilulae faetidae.
+
+    Rx Gum asafaetid. myrrh. ana drachm. i. sapon. alb. hispan.
+    drachm. ij. Tinct. fuliginis q. s. Dosis a gr. x. ad drachm.
+    dimid. bis terve die.
+
+Pilulae guaiac.
+
+    Rx Sapon. albi hispanici semunc. gum guaiac, scrup. iv. syrup.
+    q. s. Dosis a scrup. i. ad drachmam dimidiam bis terve die.
+
+Pilulae gummosae. Ph. Lond.
+
+Pilulae mercuriales.
+
+    Rx Argenti vivi semunc. extingue in balsam. copaiv. q. s. &
+    adde pulv. glycyrrhiz. gum guaiac. singulorum, drachm. vi.
+    syrup. q. s. ut fiat massa. Dosis a scrup. ss. ad drachmam
+    dimidiam semel vel bis die.
+
+Pilulae rufi. Ph. Lond.
+
+Pilulae saponaceae. Ph. Lond.
+
+Pilulae saponaceae cum rheo.
+
+    Rx Sapon. alb. hispanici, drachm. vi. pulv. rhei, drachm. ij.
+    syrup. sacchari q. s. Dosis a scrup. i. ad scrup. ij. bis
+    terve die.
+
+Pilulae scilliticae.
+
+    Rx Pulv. glycyrhiz. rad. scill. exsiccat ana drachm. dimid.
+    rad. zinziber. drachm. i. sapon. alb. hispan. drachm. ij.
+    syrup. q. s. Dosis a gr. iv. ad. gr. xvi. bis terve die.
+
+Pilulae stomachicae.
+
+    Rx Pulv. canell. alb. drachm. ij. extract. rad. gentian. dr.
+    i. mucilag. gum arabici q. s. Dosis a scrup. i. ad drachmam
+    dimid. bis die--adde pro re nata rubigin. martis drachmam
+    dimid.
+
+
+PULVERES.
+
+Pulvis astringens.
+
+    Rx Pulv. canell. alb. rad. tormentill. singulorum, drachm. i.
+    M. Dosis a scrup. i. ad drachm. i.
+
+Pulvis aluminosus.
+
+    Rx Alumin. crud. terrae japonicae ana partes aequales dosis a gr.
+    viij. ad drachmam dimidiam.
+
+Pulv. anodynus Doveri.
+
+    Rx Sal. nitri, tartari vitriolati singulorum, unc. iv. in
+    crucibulum candens injice, agitetur donec deflagratio &
+    scintillatio desinat, & adde opii concisi, unc. i. & in
+    pulverem redige addendo rad. glycyrrhiz. ipecacoanhae
+    subtilissime pulver. ana, unc. i. & dein probe misceantur
+    omnia. Dosis a gr. x. ad scrup. ij. vel ad drachmam 1nam.
+
+Pulvis antimonialis.
+
+    Rx Pulv. e chel. cancror. drachm. x. tartari emetici, dr. i.
+    M. fiat pulv. subtilissimus. Dosis a gr. iij. ad gr. x. 4ta.
+    vel 6ta. quaque hora.
+
+Pulvis cardiacus.
+
+    Rx Pulv. canell. alb. drachm. i. rad. zedoariae, drachm. ij.
+    rad. serpentar. drachm. i. M. dosis a scrup. i. ad drachm. i.
+    4tis. vel 6tis. horis.
+
+Pulvis chamaemelinus.
+
+    Rx Pulv. flor. chamaemel. drachm. iij. aluminis, g. myrrh. ana
+    drachm. i. Dosis a scrup. i. ad scrup. ij.
+
+Pulv. contrayerv. comp. Ph. Lond.
+
+Pulv. contrayerv. cum nitro.
+
+    Rx Pulv. contrayerv. comp. unc. iv. salis nitri, drachm. i. M.
+    Dosis a scrup. i. ad drachm. i. 4tis. vel 6tis. horis.
+
+Pulvis emeticus.
+
+    Rx Pulv. ipecacoanhae, scrup. i. tartar emetici, gr. ij. Dosis
+    a gr. xi. ad gr. xxii.
+
+Hiera picra. Ph. Lond.
+
+Pulv. Ipecacuanhae cum opio.
+
+    Rx Pulv. rad. ipecacoan. gr. x. opii, gr. ij. dosis a gr. iij.
+    ad gr. xij.
+
+Pulv. e jalapio.
+
+    Rx Pulv. rad. jalapii, drachm. vi. rad. zinzib. drachm. ij.
+    Dosis a scrup. i. ad scrup. ij.
+
+Pulv. jalapii cum nitro.
+
+    Rx Pulv. rad. jalap. drachm. iv. salis nitri drachm. im. Dosis
+    a scrup. i. ad scrup. ij.
+
+Magnesia alba.
+
+Pulv. nitrosus.
+
+    Rx Pulv. e chel. cancror. drachm. iij. nitri, drachm. i. M.
+    Dosis a scrup. i. ad scrup. ij. vel ad drachmam. i.
+
+Pulv. nitrosus camphoratus.
+
+    Rx Pulv. nitros, scrup. ij. camphorae, gr. v. M. Dosis a scrup.
+    i. ad scrup. ij.
+
+Pulv. nitrosus cum gum guaiac.
+
+    Rx Sal. nitri, drachm. ij. gum guaiac. drachm. dimid. Dosis a
+    gr. v. ad drachm. dimid.
+
+Pulv. plummeri.
+
+    Rx Calomel, sulph. aurat antimonii ana dr. ij. tere in
+    mortario ut fiat pulv. subtilissimus. Dosis a gr. ij. ad gr.
+    x. vel ad scrup. im.
+
+Pulvis stanni. Ph. Lond.
+
+Pulv. e spermat. ceti cum nitro.
+
+    Rx Spermat. ceti, drachm. ij. sacchar. albi sal. nitri ana
+    unc. im. Dosis a scrup. dimid. ad drachmam i.
+
+Pulv. e tragacanth. Ph. Lond.
+
+
+SALES ACIDI.
+
+                                                     PRAEPARATIONES.
+                  Spir. vitrioli fortis |                       |
+  Acida           ---- tenuis           |Spir. vitrioli dulcis  |
+  mineralis       Spiritus nitri        |Spir. nitri dulcis     | AEther.
+                  Spir. salis marini    |Spir. salis dulcis.    |
+
+  Varietat. acid. Acetum.
+  vegit.          Spiritus aceti vel acetum distillatum.
+                  Succus limonum.
+                  Chrystalli tartari.
+
+  Acid. anomal.   Sal. succini.
+                  Sal. sedativus Hombergeri.
+
+
+SALES ALCALINI.
+
+  Alcal. vegit.  Sal. absynthii.
+                 Sal. tartari.
+
+  Alcal. min.    Sal. alcali mineral. seu soda, seu natrum.
+
+  Alcal. vol.    Sal. volatilis c. cervi.
+                 Sal. volatilis sal. ammoniaci.
+
+
+SALES NEUTRI.
+
+SALES NEUTRI, qui fiunt        ex ALCALI            et ACIDO.
+
+            Tartarus vitriol.  | vegetab.      |
+            Sal. glauberi      | minerali      | vitrioli.
+            Sal. am. vitrioli  | volatili      |
+
+            Sal. nit. com.     | vegetab.      |
+            Nit. cubicum       | mineral.      | nitri.
+            Sal. am. nitrosum  | volatili.     |
+
+            Sal. digest. sylvii| vegetabil.    |
+            ---- marin. com.   | minerali      | Sal. marini.
+            ---- ammon. com.   | volatili      |
+
+Varietates  Sal. diureticus    | vegetab.      | aceti.
+salis       Tartar. tartar.    | veget.        | chryst. tartar.
+neutri                         |   tartari     |
+comp. ex    Sal. citratus com. | veget.        | succ. limonum.  Vegetabil.
+alcal. &                       |   absynth.    |
+acid.       Sal. de seignette  | minerali      | chryst. tartar.
+vegitab.    Spir. mindereri.   | volatili      | acet. distillat.
+
+Hi omnes sales neutri praeparari possint pro usu medico admiscendo
+Alcali & acidum ad saturationem; alii vero in crystallos redacti, s.
+a. commodius circumferuntur pro usu militari; alii ut _sal. citratus
+comm._ et _spiritus mindereri_ facilius praeparantur ad miscendo alcali
+& acidum ad saturationem pro re nata[115].
+
+    [115] This Table of neutral Salts is nearly the same as one I
+    have seen, which was said to be a Copy of that given yearly
+    by Dr. _Cullen_, Professor of Chymistry in the University of
+    _Edinburgh_, to his Pupils; and as that published by Dr.
+    _Vogel_, in his _Institutiones Chymiae_, sect. 629. These
+    neutral Salts are likewise taken Notice of by _Macquer_, in
+    his _Elemens de Chymie_, and other late chymical Authors.
+
+Solutio mercurii corrosivi sublimati.
+
+    Rx Mercur. corrosiv. sublimat. gr. vi. spir. vini gallici,
+    unc. xii. M. fiat solutio. Dosis a semunc ad unc. i. die.
+
+    Species aromaticae. Ph. Lond.
+    ---- e scordio. Ph. Lond.
+
+Tartar. emetic. Ph. Lond.
+
+Theriaca andromachi. Ph. Lond.
+
+
+TINCTURAE.
+
+    Tinctura amara.
+    ---- corticis Puruv.
+    ---- martis in sp. sal.
+    ---- japonica.
+    ---- melampodii.          Pharm. Lond.
+    ---- myrrhae.
+    ---- sacra.
+    ---- saturnina.
+    ---- serpentariae.
+    ---- thebaica.
+
+Tinctura rhei.
+
+    Rx Pulv. rad. rhei, unc. ij. semin. cardamom minor. decortic.
+    semunc. vini alb. hisp. lib. ij. sp. vini gallici, unc. viij.
+    digere sine calore & cola. Dosis ab. unc. i. ad unc. iij.
+
+Tinctura stomachica.
+
+    Rx Cort. canell. alb. semunc. cort. aurantior. unc. i. semin.
+    cardam. minor. decort. drachm. ij. spirit. vini gallici lib.
+    ij. digere sine calore & cola. Dosis a semunc ad unc. i. bis
+    terve die.--Adde pro re nata vin alb. hisp. lib. i.
+
+
+UNGUENTA.
+
+Unguenta caerulea vel mercurial. Ph. Lond.
+
+Unguentum sulphuratum. Ph. Lond.
+
+
+VINA.
+
+    Vinum amarum.
+    ---- antimoniale.   Pharm. Lond.
+    ---- chalybeatum.
+
+
+VITRUM CERATUM ANTIMONII.
+
+
+
+
+AN ESSAY ON THE MEANS of Preserving the Health of SOLDIERS on SERVICE.
+AND Conducting MILITARY HOSPITALS.
+
+
+
+
+OF THE Means of Preserving the Health of Soldiers on Service.
+
+
+The Life of _British_ Soldiers on Service, in Time of War, is so very
+different from what they lead in Time of Peace, as to subject them to
+many Inconveniences and Diseases.
+
+In Time of Peace, Soldiers are quartered either in Towns or Garrisons,
+where they are under the Eye of their Officers, who take Care that
+they keep themselves clean, and provided with Necessaries; they lie
+either in private Houses or in Barracks, where they have a good Bed,
+regular Meals of wholesome Provisions, and enjoy most of the other
+Necessaries of Life in common with the lower Class of People, their
+Duty is easy, they mount Guard but seldom, and in other Nights enjoy
+an undisturbed Rest.
+
+Whereas, during the Time of an active Campaign, they are seldom in
+Houses; they lie in Tents upon the Ground, which is often bare, and at
+best covered only with Straw and a Blanket; and sometimes they are
+obliged, after fatiguing Marches in wet Weather, to lie on the bare
+Ground, without even a Tent to cover them; they must stand Centinel,
+and be upon Pikets and other Out-Posts in the Night, during all Kinds
+of Weather; besides performing long fatiguing Marches, and other
+military Duties; and when near an Enemy, they are perhaps on Duty
+every second or third Night, besides working Parties, and other Duties
+of Fatigue; and what Rest they have is interrupted by frequent Alarms.
+They have often but little Time or Convenience to make themselves
+clean. Provisions are sometimes scarce, and frequently on long Marches
+they have no Opportunity of dressing what they can get: Water is
+sometimes difficult to be come at, and what is to be got, is bad. And
+it frequently happens, that neither Beer, Wine, nor Spirits, can be
+purchased for Money. In fixed Camps, they are often exposed to the
+putrid Effluvia of dead Bodies, of dead Horses, and other Animals, and
+of the Privies and Dung of the Horses[116]; and, in some Encampments,
+likewise to the unwholesome Vapours of marshy Ground, and of corrupt
+stagnating Water: All which, joined to the other Hardships and
+Inconveniences unavoidably attending a military Life in Time of
+Service, often give Rise to numerous Diseases, which weaken an Army in
+a most surprising Manner; and therefore Commanders ought to use every
+Means in their Power, consistent with the necessary military
+Operations, to preserve the Health of the Soldiers.
+
+    [116] In the Year 1760, the Men, who remained in the fixed
+    Camp about _Warbourg_, were very unhealthy; while the
+    Regiments who were detached to the _Lower Rhine_, under the
+    Command of the Hereditary Prince of _Brunswick_, enjoyed a
+    much better State of Health; and notwithstanding their great
+    Fatigues, and the Loss they sustained at the Affair of
+    _Kampen_, were much stronger when they rejoined the Army to
+    go upon the Winter Expedition into the Country of _Hesse_,
+    than those Regiments which had remained in the fixed Camp.
+
+Diseases are more or less frequent in Armies according as the Season
+is hot or cold, wet or dry; according to the Nature of the Climate,
+and the Time of the Year in which military Operations are carried on;
+the Nature of the Ground on which the Army is encamped, or the
+Situation of the Towns or Villages in which they are cantonned; the
+Cleanness, Neatness, and Dryness of the Camp, and of the Tents or
+Houses in which the Soldiers are lodged; according as the Men are
+supplied with Provisions, and good Water, good Beer, Wine, or other
+fermented Liquors; or are well cloathed, and well furnished with Straw
+and Blankets; in proportion as the Duty is more or less severe; and to
+the Care taken of such as are attacked with Sickness.
+
+Soldiers generally enjoy good Health in cold dry Weather, even during
+the Time of severe Frost; if they be kept in Exercise, be well
+cloathed, and well supplied with Provisions and good Liquors, and
+with Wood; as the Troops, both in _Germany_ and _North America_,
+experienced during the late War; but Cold joined to Moisture was
+observed always to be productive of Diseases.
+
+Nor is mere Heat of itself such an Enemy to Health[117] as is
+generally apprehended; but when joined to Moisture, is observed to
+give Rise to the most fatal Disorders in the warm Climates.
+
+    [117] This Dr. _Pringle_ takes Notice of; and Mr. _Naesmith_
+    says, he observed it in Voyages to the _East Indies_, which
+    afford the fairest Trials of this Kind. See Dr. _Lind's Essay
+    on the Means of Preserving the Health of Seamen_, 2d edit.
+    note to page 5.
+
+In our northern Climates the Winters are cold, and the Weather
+variable; sometimes it is cold and rainy, at other Times thick and
+foggy; sometimes we have fair Weather and Sunshine, at other Times
+Frost and Snow; and sometimes it happens that we have all these
+different Sorts of Weather in the same Day. During this Season,
+Soldiers are subject to Coughs, Pleurisies, Peripneumonies,
+Rheumatisms, and other Disorders of the inflammatory Kind. And in
+very intense Frost, they are liable to have their Limbs benumbed with
+Cold, and their Extremities Frost bit (as it is called).
+
+And where there is a Want of fresh Provisions, and they are obliged to
+live on salted Meat, and cannot have Greens, Pot Herbs, Roots, or
+other fresh Vegetables, nor be properly supplied with Beer, Cyder,
+Wine, or other generous fermented Liquors, they, as well as Sailors,
+are subject to the Scurvy[118]; especially if they be encamped or
+quartered in low damp Places.
+
+    [118] Dr. _Joh. Valint. Willius_, Army Physician to the King
+    of _Denmark_, in his Treatise on Camp Diseases, says, you
+    scarce find a Camp in these northern Countries in which the
+    true Scurvy, attended with stinking Breath and eroded Gums,
+    is not to be observed. _Cap._ iii. _sect._ iii.
+
+The best Means of guarding against inflammatory Disorders, and other
+Mischiefs arising from Cold, whether in Camp or in Quarters, is, to
+take Care that the Soldiers be well cloathed; that they lie dry, and
+be well provided with Straw and Blankets, and with Wood; and to
+prevent, as much as possible, their exposing themselves to sudden
+changes from Heat to Cold.
+
+In these northern Climates, it would be right to allow every Soldier
+on Service a Flannel Waistcoat, a Pair of worsted Gloves, and a warm
+woollen Stock, or a Neckcloth, to wear when on Duty in cold and wet
+Weather, as soon as the Winter begins to set in[119]. Dr. _Pringle_
+mentions the Advantage the Troops received from the Flannel
+Waistcoats supplied by the Quakers, in the Winter Campaign of 1745-6,
+in _Britain_; and those Regiments who had them for their Men towards
+the End of the Campaigns in _Germany_, found that they contributed
+greatly to keep the Men in Health. Officers ought to take particular
+Care that the Men be well provided with good strong Shoes and
+Stockings; and where the Troops remain late in the Field, if the
+Government allowed a Pair or two extraordinary of each to every Foot
+Soldier, it would be of great Use to the Service.
+
+    [119] A Flannel Waistcoat, worsted Gloves, and woollen Stock,
+    or a Neckcloth, may be purchased for about Half a Crown _per_
+    Man, and would contribute to preserve the Lives of many; the
+    recruiting of others, to supply whose Places, if they die,
+    will cost the Government a great deal more than the Price of
+    the Articles mentioned; which for a Regiment of nine hundred
+    Men, at the Rate of two Shillings and Six-Pence _per_ Man,
+    comes only to 112_l._ 10_s._ _per Ann._ Every Recruit sent
+    from _England_ to the Army in _Germany_, cost the Government
+    at least twenty Guineas before he joined his Regiment; and
+    every sick Man sent to the general Hospital, cost the
+    Government at least sixteen Pence _per_ Day, which is ten
+    Pence above his Pay; so that, if we suppose the extraordinary
+    Cloathing here mentioned would preserve only the Lives of
+    nine Men to each Regiment yearly, and keep forty in Health
+    who would otherwise be sick, we see what great Gainers the
+    Government will be in Point of Money at the Year's End;
+    besides preserving the Lives and Health of so many Men.
+
+Blankets ought to be provided for each Tent, and those carried along
+with the Regiment, so as to be always ready for the Men when they come
+to their Ground. During the late War in _Germany_, a Couple of
+Blankets were allowed for each Tent of the _British_ Troops, and each
+Company carried their Blankets covered with an Oil Cloth on a Horse;
+so that they were always up with the Regiments when they came to their
+Ground.
+
+Each Regiment ought to be provided with a Number of Watch Coats
+sufficient to serve the Centinels who are to be on Camp Duty, or
+general Guards, in very cold and wet Weather. Some of the Regiments in
+_Germany_ had such Coats, and found great Service from them.
+
+In Winter Quarters, Soldiers are apt to make the Rooms in which they
+sit, and their Guard Rooms, as hot as possible; especially in
+_Germany_, where the Inhabitants use close Stoves, instead of open
+Fires; and continue in these warm Rooms till they are called out on
+Duty, when, by being exposed to sudden Cold, they are apt to be seized
+with Inflammations of the Breast; and therefore Officers ought to
+examine carefully the Quarters and Guard Rooms allotted for their Men,
+and chuse them dry and comfortable, if possible[120]; but never to
+allow the Men to keep them as hot as Ovens, by Means of close Stoves,
+or other such Contrivances; but to depend more on good warm Cloathing,
+and dry Quarters, for guarding against Diseases, than upon artificial
+Heat. Many of the Regiments in _Germany_ made the People in whose
+Houses their Men were quartered, take down their Stoves, and use only
+open Fires; when there was no Danger of the Soldiers making their
+Quarters too warm, as Wood was difficult to be got.
+
+    [120] Dr. _Pringle_ has very justly observed, that upper
+    Stories are preferable to Ground Floors; and that all
+    uninhabited large damp Houses ought to be rejected.
+    _Observat. on Diseases of the Army_, part ii. chap. iii.
+    sect. 2.
+
+    If Necessity obliges Officers to put up with such Places for
+    their Men, Care ought to be taken to clean them well, and to
+    air and dry them by Means of Fires, before the Soldiers go
+    into them; and to supply well the Men who are to lodge in
+    them with Straw and Blankets, and with Wood or Turf.
+
+But although close Stoves are prejudicial in small Rooms, yet when a
+Town is much crowded, and Men are obliged to be lodged, in Winter, in
+large Barns or Churches, or other large open Places, the _German_
+Stoves may be used with great Advantage in airing and drying such
+Places, and keeping them of a moderate Heat; especially if there be a
+Place in them for an open Fire, or if they be of that Kind which the
+_Germans_ call _wynd Stoves_, which have a Door opening into the
+Chamber where the People are lodged; or if there be broken Windows, or
+any other Opening by which a free Circulation of Air can be kept up
+in the Men's Apartments.
+
+In Winter, when the Weather is very cold or wet, a Glass of Brandy, or
+of the spirituous Tincture of the Bark, given to the Men as they went
+upon Duty, especially in the Night, has been found to be of great
+Use[121]. Dr. _Pringle_ has very justly observed, that the Times of
+standing Centinel, and being upon Out-posts, ought, if possible, to be
+shortened at such Seasons; and that Fires in the Rear of the Camp, for
+Men coming off Duty to warm and dry themselves at, were found to be of
+great Service.
+
+    [121] Dr. _Pringle_ has taken Notice, that it would be a
+    right Measure to make an Allowance of Spirits to the Infantry
+    on Service; which certainly would be of great Use, and save
+    many Mens Lives; and might be done at a small Expence to the
+    Government, if properly managed; as it would only be
+    requisite to make such an Allowance when the Troops are in
+    the Field, and to such Men as mount Guard in cold wet
+    Weather, or at Nights in Garrison Towns, during the Winter.
+    If ever such an Allowance be made, what Spirits are given to
+    the Men ought to be mixed with five or six Times the Quantity
+    of Water; except when Men are to stand Centinels, or to be
+    upon Out-Posts, in a frosty Season, or in cold wet Weather;
+    at which Time a small Glass of pure Spirits may be given them
+    in Presence of the Officer or Serjeant of the Guard.
+
+In Spring, and the latter End of Autumn, the Days are sometimes
+extremely hot, and the Nights cold and damp, and the Men exposed to
+these sudden Changes; at such Times, the Men who go upon Duty in the
+Night, ought to put on their Flannel Waistcoats, and be warmer
+cloathed than in the Day; and use many of the Precautions practised in
+Winter for the Preservation of their Health.
+
+In _North America_, when the Men were in the Field in very hard frosty
+Weather, Fires were lighted at the Ends of the Tents, and Centinels
+set over them to prevent their doing Mischief; and both in _Germany_
+and _North America_, when the Troops were in the Field without Tents,
+they cut down Wood and made large Fires, and the Soldiers lay down and
+slept round these Fires, with their Feet next to them; and Fires were
+lighted at all Out-posts, where it could be done with Safety.
+
+In _Germany_, when the Weather set in rainy or cold towards the End of
+the Campaigns, and the Army was in a fixed Position, his Serene
+Highness Prince _Ferdinand_ constantly ordered the Army to Hutt;
+which was done either by thatching their Tents, or building Hurdles,
+or digging Pitts, and covering and thatching them over. The Officers
+either built Hutts with Fire Places, or had Chimnies built to their
+Tents.
+
+If, notwithstanding all Precautions, Men upon Out-posts should be
+benumbed with Cold, or Frost bit, as soon as they are brought into
+Camp or Quarters, their Extremities ought to be rubbed with Snow, or
+put into cold Water[122]; and afterwards well dried, and wrapt up in
+Blankets; and warm mild Liquors given them to drink, and afterwards
+Cordials; and, after some Time, they may be brought near the Fire, or
+put to Bed. Dr. _Lind_[123] mentions one Caution to be used when Men
+are found in this Condition; which is, not to give them immediately
+strong spirituous Liquors, for that those often prove instantaneously
+fatal; but to put them to Bed, and give warm Water Gruel, or some
+other mild diluting Liquor, to drink; after which, he says, a Glass of
+Spirits will prove less dangerous and more beneficial.
+
+    [122] _Hildanus_ relates a very remarkable Instance of the
+    good Effects of this Treatment. A Man was found quite stiff
+    and frozen all over. He was put into cold Water, and
+    immediately the icy Spicula were discharged from all Parts of
+    his Body, so that he seemed covered with an icy Crust. He was
+    then put into a warm Bed, and took a Cordial Draught, and a
+    plentiful Sweat followed; after which he recovered with the
+    Loss of the last Joints of his Fingers and Toes. _De
+    Gangraena_, cap. xiii. People who are benumbed with Cold in
+    frosty Weather ought never to be brought immediately near a
+    Fire; for that has been found either to cause immediate Death
+    or Gangrenes of the Extremities; and even Apples and other
+    Fruits which have been frozen, if brought immediately near a
+    Fire, turn soft and rot; but if put into cold Water, throw
+    out the icy Spicula, and recover, so as to be almost as good
+    as before they were frozen.
+
+    [123] _Means of Preserving the Health of Seamen_, 2d edition,
+    page 19.
+
+When Men are quartered or cantonned in Towns or Villages, whose
+Situation is low and damp, and where fresh Meat and Vegetables are
+scarce in Winter, and the Scurvy frequent among the lower Class of
+People; Commanding Officers, at the Approach of Winter, ought to use
+their Endeavours to provide a Store of Potatoes, Onions, Cabbages,
+sour Crout; of pickled Cabbages, and other pickled Vegetables; of
+Apples and other Fruits, preserved in different Forms, to be laid up,
+and sold out to the Men at a cheap Rate during the Winter. They
+should contract, if possible, with Butchers to furnish the Men with
+fresh Meat[124], and endeavour to procure good small Beer, or Cyder or
+Wine in the Wine or Cyder Countries; or Spirits to be mixed with
+Water, and a small Proportion of Cream of Tartar or Vinegar; or some
+other wholesome fermented Liquor for their Drink[125]; and to put
+their Men into as dry comfortable Quarters as possible.
+
+    [124] The Regiments in _Germany_ who kept their Butchers in
+    Winter, and made Stoppages of the Mens Pay, and obliged them
+    to take a certain Quantity of Meat daily, were much more
+    healthy than those who used no Precaution of this Kind.
+
+    [125] In Places where the Articles here mentioned are at too
+    high a Price for a Soldier's Pay, a small Allowance, from the
+    Government, of such Things would contribute much to the
+    Preservation of the Mens Health in unwholesome Garrisons.
+
+In Times of War, when Men are sent upon Expeditions into warm
+Climates, great Care ought to be taken to embark such only as are in
+good Health; particular Regard ought to be paid to those who are
+picked up in the Streets, or have been taken out of the _Savoy_, or
+other Jails. All dirty Rags from off such People ought to be thrown
+away or burnt; and the Men, after being well washed, and new cloathed,
+ought to be kept for a Fortnight or three Weeks in some Garrison Town,
+or with their Regiments, in open airy Places, that it may be
+ascertained that they have no infectious Disorder before they be put
+aboard the Transports.
+
+All Ships allotted for Transports ought to be well aired and purified,
+and every Thing fitted up properly, before the Men are embarked. They
+ought to be provided with Ventilators, or Wind Sails, to make a free
+Circulation of Air through the Vessel[126]; and they ought never to be
+crowded; but full Room allowed for each Man, in Proportion to the
+Length of the Voyage[127].
+
+    [126] See Dr. _Lind's Treatise on the Means of Preserving the
+    Health of Seamen in the Royal Navy_, where he takes Notice of
+    most of the Articles here mentioned with regard to Transport
+    Ships in treating of Ships of War.
+
+    [127] When Ships are too much crowded with Men, if they meet
+    with a tedious Passage, and hot moist close Weather, they are
+    often attacked with Diseases which prove very fatal. Dr.
+    _Lind_, talking of Ships of War, says it is a Mistake
+    destructive to the Men to crowd too many of them together in
+    a southern Voyage, or in a hot Climate; as the Ship will be
+    found, before the End of the Voyage, in more Distress for
+    Want of Men, than she would have been, had she at first
+    carried out only her proper Compliment. An additional Number
+    is made, in order to supply an expected Mortality; but they
+    generally increase that Mortality to double or triple their
+    own Number. _Ibid. note to p. 48._
+
+In military Expeditions, Soldiers are put upon Ships Allowance;
+which, Dr. _Lind_ very justly observes, ought not, in Voyages to the
+warm Climates, be made up so much of salted Beef and salted Pork
+(which always tend to the Putrescent), as is the common Practice of
+the Navy; but that a greater Share of Biscuit, Flour, Oatmeal, Goarts,
+Rice, and other Stores of that Kind, ought to be laid in; and a
+greater Proportion of them, and a Less of the salted Meat, distributed
+among the Men: And he is certainly in the Right, when he says, that a
+full Animal Diet, and tenacious Malt Liquors, are well adapted to the
+Constitution of our own, and of other northern Climates; and that
+Sailors who visit the _Greenland_ Seas, and are remarkable for a
+voracious Appetite, and a strong Digestion of hard salted Meat, and
+the coarsest Fare, when sent to the _West Indies_, soon become
+sensible of a Decay of Appetite, and find a full gross salted Diet
+pernicious to Health. "Instinct (he says) has taught the Natives
+between the Tropics to live chiefly on a Vegetable Diet, of Grains,
+Roots, and subacid Fruits, with Plenty of diluting Liquors[128]."
+
+    [128] The following is the Diet established for the Seamen of
+    his Majesty's Navy.
+
+    Every Man is allowed a Pound of Biscuit, _Averdupoiz Weight_,
+    and a Gallon of Beer, _Wine Measure_, _per_ Day.
+
+    On _Sunday_ and _Thursday_, one Pound of Pork, and Half a
+    Pint of Peas, _Winchester Measure_.
+
+    On _Monday_, _Wednesday_, and _Friday_, one Pint of Oatmeal,
+    two Ounces of Butter, and four Ounces of Cheese.
+
+    On _Tuesday_ and _Saturday_ two Pounds of Beef.
+
+    It is left to the Commanders of Squadrons to shorten the
+    aforesaid Allowance of Provisions according to the Exigence
+    of the Service, taking Care that the Men be punctually paid
+    for the same. As it is thought for the Benefit of the Service
+    to alter some of the foregoing Particulars of Provisions in
+    Ships employed on foreign Voyages, it is to be observed, that
+
+    A Pint of Wine, or Half a Pint of Rum, Arrack, or Brandy,
+    hold Proportion to a Gallon of Beer.
+
+    Four Pounds of Flour, or three Pounds of the same with a
+    Pound of Raisins, Half a Pound of Currans, or Half a Pound of
+    Beef Suet pickled, are equal to a four Pound Piece of Beef,
+    or two Pound Piece of Pork with Peas.
+
+    Half a Pound of Rice is equal to a Pint of Oatmeal.
+
+    A Pint of Olive Oil is equal to a Pound of Butter, or two
+    Pounds of _Cheshire_ Cheese.
+
+    And Two-thirds of a Pound of _Cheshire_ Cheese is equal to a
+    Pound of _Suffolk_.
+
+    If Soldiers are sent as Passengers on board of King's Ships,
+    or on board of Transports, their Allowance is generally but
+    Two-thirds of the above.
+
+A Store of Vegetables, such as Mustard Seed, Garlick, Onions,
+Potatoes, pickled Cabbages and other pickled Vegetables, sour Crout
+and other Things of that Kind, which can be purchased at a cheap Rate,
+and preserved for some Months, ought to be laid in; which may be mixed
+with the Soops prepared for the Men, or given them to eat along with
+their salted Provisions.
+
+A Quantity of Beer, Cyder, or Wine, ought to be put aboard, and a
+certain Allowance distributed to each Man daily. When, for Want of
+these, Men are reduced to an Allowance of Spirits, they ought to be
+mixed with seven or eight Times the Quantity of Water, or made into
+Punch, by the Mixture of Water and Molosses, and the Juice of Lemons,
+before they are given to the Men; and, if Lemons cannot be got, Cream
+of Tartar, or Vinegar, ought to supply their Place; and it ought to be
+a Duty of one of the military Officers on board to see the Punch made,
+and distributed among the Men daily.
+
+It would be right, on all Expeditions into warm Climates, to send some
+Sloops of War, or other armed Vessels, before the grand Fleet, to take
+up a Quantity of Wine that will keep, either at the _Madeira_, or
+other Wine Countries; and afterwards to go to any of our Settlements
+that are nearest the Place of Destination, and to take in a Quantity
+of Limes, Lemons, Oranges, and other Fruits, and Vegetables which will
+keep for some little Time; and of Spirits, live Stock, and other
+Provisions proper for the Army; and then to meet the Fleet at the
+general Rendezvous. When once a Landing is made good, these Vessels,
+after having unloaded their Cargoes, may either be employed on other
+Services, or kept constantly going and coming for whatever Stores or
+Provisions are wanted for the Army or Fleet.
+
+A sufficient Quantity of Vinegar ought to be put on board of each
+Transport, both for the Men to eat with their Victuals, and likewise
+for fumigating and washing between Decks occasionally. And a Quantity
+of Molosses, or coarse brown Sugar, and of Lemons, or their
+inspissated Juice, or Cream of Tartar, ought to be allowed for making
+the Punch, as well as for other Purposes.
+
+If the Water become foetid, the Quantity to be used in the Day ought to
+be sweetened by Means of the Ventilator contrived by the ingenious Dr.
+_Hales_[129] for that Purpose.
+
+    [129] This Ventilator is no more than a long Tube, with a Tin
+    Box, about six Inches wide and four high, with a Number of
+    Holes at the Top, fixed at one End; and this Box is put down
+    to the Bottom of the Water, and the Nose of a Pair of Bellows
+    fixed to the other End of the Tube, which is above the Water;
+    by working the Bellows, fresh Air is driven through the whole
+    Body of Water, the putrid Effluvia are evaporated and
+    dispersed, and the Water becomes sweet in a very short Time.
+
+The Men ought to be brought upon Deck, and Roll called two or three
+Times a Day; they should be made to comb their Hair, and wash their
+Hands and Face every Day, and to shift themselves sometimes, if
+possible; and in every respect keep themselves as clean as the Nature
+of the Service will admit; and proper Exercises should be contrived,
+to keep them in Health.
+
+All the Parts of the Ship ought to be kept very neat and clean; and
+the Hold, and all between Decks, ought to be scraped and swept daily;
+and every Morning, in fair Weather, ought likewise to be washed, and
+afterwards sprinkled or washed with warm Vinegar, while the Men are
+upon Deck[130].
+
+    [130] This ought always to be done in the Morning, that all
+    the Parts of the Ship may have Time to dry before the Men go
+    to rest in their Births at Night; but it ought never to be
+    done after Sun-set.
+
+When the Weather will permit, Fires of dried Wood may be lighted in
+Iron Kettles between Decks, and Centinels set over them, and the Fires
+sprinkled with Rosin or Bits of Rope dipt in Tar, or with some cheap
+Aromatic; and these Fires may be carried into all the Parts of the
+Ship that Safety will permit, in order to dry and purify the Air[131].
+After this Operation all the Ports and Hatchways should be opened,
+and the Air in all the Parts of the Ship often renewed by working the
+Ventilators.
+
+    [131] It has been proposed, that the Air in Ships of War
+    should be purified in this Way both by Dr. _Lind_ and by
+    Mons. _de Hamel de Monceau_.
+
+The Mens Hammocks and Beds ought to be brought up upon Deck in fair
+Weather, and well aired, and afterwards put in their Places, and Fires
+lighted below Decks.
+
+When Troops, sent on an Expedition into warm Climates, arrive at the
+Place of their Destination, particular Care should be taken to guard
+them against the Diseases peculiar to such Climates, which are
+different from those common to our more northern Latitudes.
+
+Dr. _Lind_ says, that People coming first from a cold into a hot
+Climate are apt to have plethoric Symptoms; a Pain of the Head,
+Giddiness, a Sense of Weight, and Fulness of the Breast, and a slight
+Inflammation of the _tunica conjunctiva_; and that some are apt to be
+seized with ardent Fevers and Diarrhoeas. And all Practitioners have
+observed, that New-Comers into warm Climates are at first liable to
+Fevers tending to the Ardent, and are very subject to Fevers of the
+remitting and intermitting Kind, which are the Endemics of all warm
+Countries at certain Seasons of the Year; and after some Time they are
+apt to fall into Fluxes, the Yellow Fever, and other Diseases
+depending on a putrescent State of the Juices. In military Expeditions
+these Disorders are liable to be complicated with Fevers of the
+Malignant or Hospital Kind, if Care is not taken to prevent it. And
+nothing has been found to be more productive of Diseases in those warm
+Climates, than indulging freely in the Use of Spirits and other strong
+fermented Liquors; exposing one's self to the Damps, especially lying
+on the Ground after the Dews fall; and working hard, or using violent
+Exercise in the Heat of the Day.
+
+The best Preservatives against Diseases in warm Climates have been
+found to be,--1. Temperance; a Diet of light and easy Digestion,
+composed more of vegetable than of animal Food; such as a small
+Portion of fresh Meat, joined with a sufficient Quantity of
+Vegetables; Rice, _Indian_ Corn, and other Grains, and Roots of
+various Kinds, prepared in different Forms; well baked Bread; the
+moderate Use of ripe Fruits; and the free Use of mild cooling subacid
+Liquors, joined with a small Proportion of vinous or spirituous
+Liquors; carefully avoiding the too liberal Use of Wine, Spirits, or
+other strong fermented Liquors.--2. Great Care not to expose one's
+self to the Damps of the Night, nor lie down to sleep on the Grass, or
+in woody moist Places, in the Day; and to avoid all violent Exercise
+in the Heat of the Sun.--3. Such Means as tend to support the Spirits;
+for Chearfulness has been observed to contribute as much to the
+Preservation of Health, as Fear and Dejection of Spirits to the
+Production of Diseases.--4. Keeping the Body clean, and bathing
+frequently in the Sea, or in a River, in the Morning.
+
+And therefore, in warm Climates, Officers ought to be particularly
+careful to keep their Men sober and temperate; to procure them good
+Bread, and Plenty of Vegetables and fresh Meat, if possible; and
+where no other but salted Meat can be got, to make them boil a small
+Proportion of it in their Camp Kettles, along with Onions, Goarts,
+Rice, Carrots, Turnips, Greens, or any other wholesome Roots or Herbs
+which the Country affords, or they can get, and of these to prepare a
+good wholesome Soop for themselves; and where there is Plenty of the
+ripe acescent Fruits, which are reckoned wholesome, to distribute a
+moderate Quantity among the Soldiers daily, which will both help to
+preserve their Health, and prevent them from privately stealing and
+eating large Quantities to the Prejudice of their Health.--To
+encourage their Men, and keep up their Spirits.
+
+They should also prevent, as much as possible, the too free Use of
+Wine, Spirits, or other strong fermented Liquors; and in Wine
+Countries give every Man a daily Allowance of Wine, to be mixed with
+Water for his common Drink; and in Countries where nothing but Spirits
+can be got, make the Spirit be mixed with Water, or made into a very
+weak Punch, before it is given to the Men, as Lemons, Oranges, Limes,
+and other Fruits proper for this Purpose, are generally to be had in
+most warm Countries.
+
+They should be careful not to march their Men in the Heat of the Day,
+nor order them upon Duty where they must stand exposed to the Dews and
+Damps of the Night, unless where the military Operations absolutely
+require it.
+
+They should endeavour to make the Bottom of the Tents be covered with
+Straw, or dried Leaves of Trees, or dried Reeds, and with
+Blankets[132], for the Men to lie upon.
+
+    [132] A sufficient Store of Blankets has often been neglected
+    to be carried out in Expeditions into warm Climates; but
+    Blankets are no-where more necessary, as it is very
+    prejudicial to the Health of Soldiers to be obliged to lie
+    down on the bare Ground; and Straw, dried Reeds, and other
+    such Things, are often difficult to be got in the warm
+    Climates.
+
+The Time of standing Centinel, and being upon Out-posts, if possible,
+should be short, where Men are exposed to the scorching Heat of the
+Sun; and when Men are upon Out-posts in the Night, it should be
+recommended to them to lie down on the Ground as little as possible;
+and if they do it, to chuse a dry Place; and, where it can be done,
+to have it covered with Straw or a Blanket, and to have some light
+Covering to defend them from the Dews.
+
+The Tents should be covered with Boughs of Trees, and the Men should
+be ordered sometimes to strike them in the Middle of the Day, and air
+well every Thing within them.
+
+The Men should be obliged to keep themselves neat and clean; to comb
+their Hair, and change their Linen often; and if the Camp be near the
+Sea, or a large River, they ought to bathe early in the Morning as
+often as the Nature of the Service will permit. However the following
+Caution, mentioned by Dr. _Lind_, ought to be observed, which is, not
+to go into the cold Bath when overheated with Work or Liquor, or when
+the Stomach is full, or when a critical Eruption, called the prickly
+Heat, appears on the Skin[133].
+
+    [133] Dr. _Lind_ says, the Use of the cold Bath, either in
+    Tubs under the Forecastle, or to dip in the Sea early in the
+    Morning, has been found extremely beneficial in warm Weather
+    and hot Countries; and that he can affirm, from his own
+    Experience in hot Climates, that many Diarrhoeas and other
+    Complaints, the pure and sole Effect of an unusual and great
+    Heat (relaxing the System of the Solids, and occasioning a
+    Colliquation of the Animal Juices), have not only been cured
+    by cold Bathing; but their Return, and even the Attack of
+    such Diseases, effectually prevented by it. _Ibid._ p. 44,
+    &c.
+
+When Men are seized with inflammatory Symptoms on entering into warm
+Climates, they may be blooded freely: Afterwards they do not easily
+bear such copious Evacuations, but rather require to have them made in
+smaller Quantities, and very early and frequent, as Inflammations make
+a rapid Progress in warm Countries. Dr. _Lind_ says, many
+Practitioners disapprove of Blood-letting in the Countries lying under
+the Torrid Zone, on a Supposition that the Blood is too much
+dissolved; but he thinks that this Rule will admit of many Exceptions;
+and that Sailors (_and consequently Soldiers_), being strong and
+robust, and exposed to greater Vicissitudes of Heat and Cold, and more
+Excesses, and other Accidents in general, bear freer Bleeding than any
+other Set of People.
+
+After some Time, the Diseases in these warm Climates tend to the
+putrid Kind, and must be treated as such.
+
+In all Countries, and in all Climates, great Care ought to be taken in
+chusing the Ground on which Men are to encamp. Dry high Grounds,
+exposed to the Winds, where there is a free Current of Air, and which
+lie at a Distance from Marshes, stagnating Water, and large Woods, are
+generally healthful in very different Climates[134]. But Places
+situated low, where, on digging two or three Feet below the Surface of
+the Earth, you come to Water[135], and marshy Grounds, and Places
+surrounded with corrupt stagnating Water, are almost always the
+contrary, and very unhealthful; as are often those Grounds which are
+subject to be overflowed by large Rivers, and low Places covered with
+Wood, where there is no free Circulation of Air. However, it ought to
+be observed, that it is not the Neighbourhood of Water alone which is
+prejudicial, but the watery Vapours which keep the Air perpetually
+moist, and the Exhalations of corrupt Effluvia, which render such
+Places unwholesome; for the Neighbourhood of Rivers, and of the Sea,
+where the Tide ebbs and flows freely, has no such Effect, where the
+Situation is dry and airy; and those very unhealthy marshy Grounds
+often continue healthy in cold Weather, when their Waters are
+refreshed with Rains[136], and little or no moist putrid Exhalations
+rise from them; though, as Dr. _Pringle_ observes, in Summer and
+Autumn, when their Waters begin to corrupt, and the Exhalation is
+strong, they are always exposed to Diseases; and it is for this
+Reason that such Places are always very unhealthy in warm Climates.
+
+    [134] Mr. _du Hamel_ says, that the Air of the Island of _St.
+    Domingo_ is very fatal to _Europeans_; but it is observed
+    that those People who inhabit the rising Grounds are much
+    less exposed to Diseases than those who live in the Vallies.
+    _Sur la sante des Equipages_, art. i. p. 16.
+
+    [135] Ground may seem very dry and healthful, and yet be
+    quite the contrary, as Dr. _Pringle_ remarks is the Case in
+    the Neighbourhood of _Bois le Duc_, in _Flanders_, where
+    Water is found every where at the Depth of two or three Feet
+    from the Surface.
+
+    [136] Mr. _du Hamel_ remarks, that Places which were formerly
+    very subject to Diseases have become healthful when the Water
+    which surrounded them was refreshed by opening a
+    Communication with the Sea. _Ibid._ art. i. p. 18.
+
+Hence, where the military Operations will permit, Commanders, if
+possible, ought to chuse a dry Ground, whose Situation is high, and
+which admits a free Current of Air, such as on the Banks of Rivers,
+where there is generally a Stream of fresh Air, and Plenty of fresh
+Water to supply the Camp[137]; taking Care to avoid the Neighbourhood
+of low marshy Grounds, and corrupt stagnating Waters, especially in
+Summer, and in hot Climates.
+
+    [137] Dr. _Pringle_ observes, that where Grounds are equally
+    dry, that the Camps are always most healthful on the Banks of
+    large Rivers; because in the hot Season Situations of this
+    Kind have a Stream of fresh Air from the Water, tending to
+    carry off both the moist and putrid Exhalations.--And in
+    Cantonments we are not only to seek Villages removed from
+    marshy Grounds, but such as are least choaked with
+    Plantations, and stand highest above subterraneous Water. See
+    his _Observat. on Diseases of the Army_, 3d edit. p. 99.
+
+When Necessity obliges Commanders to take Post, or encamp in a wet or
+marshy Ground, they should endeavour to make it as dry as possible, by
+ordering Trenches to be cut for Drains across the Field and round the
+Mens Tents; to see that the Ground within the Tents be well covered
+with Straw; to order the Tents to be struck at Mid-Day, in dry warm
+Weather, and the Men to dry and air the Straw, and change it
+frequently; to have a proper Supply of Blankets for the Men, and to
+take Care that they be well cloathed, especially those who go upon
+Duty in the Nights; and, in the northern Climates, to have Fires in
+proper Places for warming the Men and drying their Cloaths, and for
+correcting the Dampness of the Air[138].
+
+    [138] The Negroes on the Coast of _Guinea_, and some of the
+    _Indians_, both of whom sleep on the Ground, have constantly
+    a Fire producing a little Smoak burning in the Hutts where
+    they sleep, which corrects the Moisture of the Night, and
+    renders the Damp of the Earth less noxious; and during the
+    Time of the very unwholesome Fogs on the Coast of _Guinea_,
+    called Harmattans, which lay waste whole Negroe Towns, the
+    Smoak of Wood, of pitched Staves, and such Things, are found
+    to be the best Correctors of this thick Air. See Dr. _Lind's
+    Means of preserving the Health of Seamen_.
+
+In Countries lying under the Torrid Zone, the Parts near the Sea Shore
+are often marshy, or close and covered with Wood, or have swampy
+Beaches, and are very unwholesome; and therefore where Soldiers aboard
+of Transports keep their Health, Commanders ought to be very careful
+not to allow them to land, till they come to the Place of their
+Destination. Dr. _Lind_ observes, that Men commonly live more healthy
+in warm Climates at Sea, where the Air is dry and serene, and the Heat
+moderated by refreshing Breezes, than when they arrive in Harbours, or
+get within Reach of the noxious Vapours which arise from many Parts of
+the Land[139].
+
+    [139] Dr. _Lind_ says, that it is constantly observed in
+    unhealthy Harbours, that the Boats Crews employed in wooding
+    and watering the Ships, who are obliged to lie on Shore,
+    suffer most. _Ibid._ p. 72.
+
+When Necessity requires Parties to be landed for Wood or Water, or on
+other Duties, they should always be obliged to return and lie aboard
+at Night; and if that cannot be done, they should be cautioned to
+avoid lying down to sleep on the Grass, where the Air is fresh, or
+they are exposed to the Dews; and to pitch their Tents on a rising
+Ground, covered with Straw or dried Reeds, and a Blanket; and to use
+the other Precautions necessary for encamping in these warm Climates;
+for where this Care has been neglected, the Consequences have
+frequently proved fatal[140].
+
+    [140] A very remarkable Instance of this we have related by
+    Dr. _Lind_. In the Year 1739, in _Mahon_ Harbour, a Party of
+    Men were sent with the Coopers from Admiral _Haddock_'s Fleet
+    to refit and fill the Water Casks, who, finding an artificial
+    Cave dug out of a soft sandy Stone, put their bedding into
+    it; every one who slept in this damp Place was infected with
+    the Tertian Fever, then epidemic in _Minorca_, and not one in
+    eight recovered. At the same Time the Men aboard the Ships
+    continued healthy; and others, who were afterwards sent on
+    the same Duty, enjoyed perfect Health by being obliged to
+    sleep in their respective Ships. He says, he has known a
+    whole Boat's Crew seized next Morning with bad Fevers by
+    sleeping near the Mangroves, with which the Sides of the
+    Rivers are frequently planted in the Torrid Zone. _Ibid._ p.
+    74, 75.
+
+On unhealthful Coasts, the noxious Land Vapours often affect the Crews
+of Ships that run up into Rivers or Harbours, and cause great
+Sickness; and therefore in such Places Ships should anchor at as great
+a Distance from the Shore as can well be done, that they may be
+exposed to the Sea Breezes, and as much to the Windward of the Woods
+and Marshes as possible; and if the Anchorage is safe, one should
+prefer the open Sea to running up into Rivers or Creeks[141].
+
+    [141] The higher that Ships sail up the Rivers upon the Coast
+    of _Guinea_, the more sickly they become: Such, however, as
+    keep at Sea beyond the Reach of the Land Breezes (that is,
+    two or three Leagues at Sea), are for the most part healthy.
+    _Lind_, _ibid._ p. 65. The Malignity of these Land Vapours
+    often does not extend itself to any considerable Distance, as
+    we know by manifold Experience. The Troops in _Zealand_ were
+    very unhealthy when Admiral _Mitchel_'s Squadron, which lay
+    but a little Way from the Shore, enjoyed perfect Health.--Dr.
+    _Pringle's Observat. on the Diseases of the Army_, p. 1.
+    chap. vii.--In _July_ and _August_ 1744, two Ships, belonging
+    to Admiral _Long_'s Squadron in the _Mediterranean_, lying
+    near the Mouth of the River _Tyber_, began to be affected,
+    while others, though at a very small Distance, but further
+    out at Sea, had not a Man sick. _Lind_, _ibid._ p. 66.
+
+Cleanness and Neatness in the Camp is another Article that ought to be
+particularly regarded. _Portius_, _Ramazini_, and most other Authors
+who treat of Camp Diseases, attribute those of the putrid Kind in a
+great Measure to the Stench and putrid Effluvia arising from the
+Excrements of Men and Beasts, and from the dead Bodies of Men, Horses,
+and other Animals, lying unburied in the Neighbourhood of Camps, and
+have in a particular Manner mentioned the Necessity of burying such
+putrid Substances. Dr. _Pringle_ has very justly recommended the
+Digging of Deep Pits for Privies in Camp, and covering the Excrements
+with Earth daily[142] till the Pits are near full, and then to fill
+them up with Earth, and dig new ones; and to punish every Person who
+shall ease himself any where in Camp but in the Privies: And he
+remarks, that when the Camp begins to turn unhealthy, that often the
+only Means that will preserve the Health of the Men, is to change the
+Ground, and to leave behind all the Filth and Nastiness which gave
+Rise to those putrid Disorders.
+
+    [142] The divine Lawgiver _Moses_ has enjoined Cleanliness in
+    the Camp to the _Jews_ in a particular Manner, when he says,
+
+    "Thou shalt have a Place also without the Camp, whither thou
+    shalt go forth abroad; and thou shalt have a Paddle upon thy
+    Weapon, and it shall be when thou wilt ease thyself abroad
+    thou shalt dig therewith, and shalt turn back and cover that
+    which cometh from thee. For the Lord thy God walketh in the
+    Midst of thy Camp; therefore shall thy Camp be holy, that he
+    see no unclean Thing in thee, and turn away from thee."
+    _Deuteronomy_, chap. xxiii. verses 12, 13, 14.
+
+In fixed Camps, the striking the Tents at Mid-Day in fair Weather,
+and turning and airing the Straw, and changing it often, as
+recommended by Dr. _Pringle_, will contribute much to preserve the
+Health of the Men; and making the Men wash themselves daily, and
+change their Linen often, and keep themselves otherwise clean, ought
+never to be omitted by the Officers.
+
+All military Authors have recommended to Commanders always to have
+Straw for their Men when they come to their Ground, if possible; and
+to have the Army well supplied with Provisions; giving proper
+Encouragement to the Country People, and to Suttlers and Merchants of
+all Sorts, to bring in every Kind of Provisions and other Necessaries
+to Camp; and preventing, as much as possible, the Soldiers from
+moroding. And the Commanders of every Corps ought to take Care that
+their Men form themselves into Messes, and that Stoppages be made for
+buying them Provisions.
+
+In _Germany_ every Regiment of the _British_ Troops contracted with a
+Butcher, who was obliged to carry along with them, at all Times, a
+certain Number of live Sheep and Oxen to kill when wanted, and to sell
+the Meat at a fixed Price. Every Soldier was obliged to take a certain
+Quantity, which was paid for by Stoppages made in his Pay; and this
+Meat was boiled in the Camp Kettles, with such Roots and Greens as
+could be got; by which Means the Men, whenever they could use their
+Kettles, had always a good warm Soop, as well as Meat, to refresh them
+after their Fatigues, which, along with their Ammunition Bread, made a
+good wholesome Food.
+
+In Countries where Fruit is plentiful, a certain Quantity of what is
+fully ripe, distributed to the Men in warm Weather, and in hot
+Climates, will contribute to preserve their Health, though the Abuse
+of it will prove prejudicial; but unripe and acrid Fruits are always
+hurtful[143].
+
+    [143] The _British_ Soldiers in _Germany_ used sometimes to
+    hurt their Health by eating great Quantities of raw unripe
+    Apples, Plumbs, and other unripe Fruits; but the foreign
+    Troops had a much better Method of using such Fruits: They
+    commonly boiled or stewed them, and eat them with Bread, or
+    with their Meat, which in a great Measure corrected their bad
+    Qualities.
+
+    The Orders in the _French_ Camp, prohibiting the Men from
+    eating unripe Fruit, were strictly complied with every-where
+    in _Germany_ during the late War.
+
+Water is another Article which Commanders endeavour to have their Camp
+well supplied with, and therefore they generally encamp near Rivers or
+Rivulets. Where the Stream is small, Care ought to be taken that its
+Course be not interrupted, and that no Filth or Nastiness, or any
+Thing that will spoil or corrupt the Water, be thrown into it.
+
+When there are no Rivers or Rivulets near a Camp, and the Men are
+supplied from Wells, if the Water is not pure, very often the digging
+of deep Pits, and covering the Bottom and Sides with large Stones, and
+over these a Lay of Sand, Gravel, or Chalk, will make the Water pure
+in a few Hours.
+
+In fixed Camps, where the Water is bad, _Portius_[144] proposes
+straining it thro' Sand, and has given Figures of Machines to be used
+for that Purpose; but the Method proposed by Dr. _Lind_ is still more
+simple, which is, to get a broad Cask with one End struck out; then
+put a longer Cask, with both Ends struck out, in the Middle of it;
+fill the short Cask one-third with Sand, and the inner longer Cask
+above one-half; fill the Rest of the inner Cask with the Water, which
+will filter through the Sand, and rise above the Sand in the outer
+Cask, where it may be allowed to run off into Vessels placed to
+receive it, by Means of a Cock, put into the Side of the outer Cask,
+fifteen or twenty Inches above the Level of the Sand.
+
+    [144] See the Treatise published by Dr. _Luc. Anton. Portius_
+    in 1686, _de Militis in castris sanitate tuenda_, _part._ ii.
+    _cap._ vi. In this Book we have many useful Things mentioned
+    relative to the Health of Soldiers.
+
+Where there are no such Conveniences for purifying the Water, what is
+used for Drink ought to be mixed with a small Proportion of Spirits,
+or Wine, or with Vinegar, or Cream of Tartar, when neither of the
+other two can be got; and if the Water be previously boiled, it will
+be so much the better.
+
+In Expeditions into warm Countries, where fresh Water is difficult to
+be had, a few Stills, with a proper Apparatus, ought to be carried
+out; and after a Landing is made, the Stills ought to be set to work
+for distilling fresh Water from Sea Water in the Manner mentioned by
+Dr. _Lind_[145]; and although a sufficient Quantity cannot be
+distilled for serving the whole Army, yet enough may be got in this
+Way for the Use of the Sick.
+
+    [145] Dr. _Lind_ relates a Number of Experiments of his
+    having distilled Sea Water in different Manners, as
+    recommended by others; and concludes, that the best Way of
+    getting fresh Water from Salt, is to distil the Sea Water by
+    itself, without any Mixture; and he proposes having a Still
+    Head to the Coppers or Iron Pots in which the Meat is dressed
+    aboard a Ship. _Ibid. note to p. 84_, &c.
+
+When Men are very warm, after long Marches, and other hard Duties, in
+Summer; Officers should endeavour to prevent their swallowing
+immediately great Quantities of cold Water, and persuade them to wait
+a little till they cool; and at such Times, if Spirits can be got
+easily, to order a small Quantity to be mixed with the Water in each
+Man's Canteen.
+
+Though the Abuse of vinous and spirituous Liquors is very destructive
+to the Constitution, yet these same Liquors, given in Moderation to
+Soldiers on Service, during the Times of great Fatigues, are some of
+the best Preservatives of Health. Spirits, for common Use, ought to
+be mixed with Water; and in the hot Climates made into Punch; though
+in very cold and wet Weather, and in damp Nights, a Glass of pure
+Spirits, given to the Men going on Duty, is of great Service; for it
+is always observed, that Men are much less apt to catch Diseases from
+being wet when they are upon a March, or at hard Work, than when they
+stand Centinels, or are upon Out-Posts where they move but little, or
+when they lie down in their wet Cloaths; and that they are less liable
+to be affected by the Weather after a hearty Meal, or drinking a Glass
+of Spirits, or some generous Liquor, than when their Stomachs are
+empty.
+
+An Infusion of Bark or other Bitters, and of Garlick, in Spirits, has
+been found to encrease their Efficacy as Preservatives both against
+the Effects of Cold and malignant Distempers. Dr. _Lind_ has
+recommended an Infusion of Garlick in Spirits as one of the best
+Stomachics and Diaphoretics he knows in cold wet Weather. And many
+have recommended a Tincture of the Bark[146]: Towards the End of the
+Year 1743, Mr. _Tough_, one of the Apothecaries to the _British_
+military Hospital in the late War, then a Mate to a marching Regiment,
+was ordered to go down the _Rhine_ with a Party of Sick, who had the
+Seeds of the Hospital Fever among them, and were to go in Bilanders,
+from _Germany_ to _Flanders_. Having had a Cask or two of Brandy put
+aboard as Part of the Stores for the Sick, he was afraid lest the Men
+should make too free with the Spirits; to prevent which he threw in a
+Quantity of Bark into each Cask, and gave the Men regularly, Morning
+and Evening, a Glass of this bitter Tincture. At the same Time, the
+Men were kept extremely clean. By these Means most of the Sick mended
+upon the Passage, without the Malignant Fever appearing again amongst
+them; whereas, Dr. _Pringle_, who takes Notice of the other Parties
+who came from the same Hospitals in _Germany_, tells us, that the
+Malignant Fever broke out in a violent Degree, and Half the Number
+died by the Way, and federal others soon after their Arrival[147].
+
+    [146] During the Campaign in _Hungary_, in the Year 1717,
+    Count _Boneval_ preserved both himself and Family from
+    Disorders, by taking himself, and making all his Domesticks
+    take, two or three Times a Day, a small Quantity of Brandy,
+    in which Bark had been infused, at a Time when all the Rest
+    of the Army were infected with malignant Disorders. A
+    Regiment in _Italy_ continued healthy by the Use of the Bark,
+    when the Rest of the _Austrian_ Army, who did not pursue the
+    same Method, were greatly annoyed with Sickness. See
+    _Kramer._ quoted by Dr. _Lind_.
+
+    [147] _Observat._ part. i. chap. iii.
+
+Commanding Officers ought always to endeavour to proportion the Time
+the Men are to be upon Duty to the Weather and the Nature of the
+Climate. The Time of standing Centinel in very hard Frost, and in cold
+wet Weather, or in the Heat of the Day in Summer, when the Weather is
+very warm, and in hot Climates, ought to be shorter than when the
+Weather is dry and more temperate.
+
+The Marches of Troops ought, if possible, during the Time of very hot
+Weather, to be made either very early in the Morning, in the Evening,
+or at Night; and Officers, during the Course of an active Campaign,
+ought to spare their Men as much as possible.
+
+And when they are in Quarters, and have nothing to do, they should
+narrowly inspect into their Manner of living; and have them out daily,
+when the Weather will permit, and exercise them, or march them two or
+three _English_ Miles a-Day, in order to prevent their falling sick
+for want of Exercise; for Soldiers left to themselves are very subject
+to Diseases when they come into Quarters after an active Campaign, by
+leading too indolent a Life, if Officers do not take Care to prevent
+it. However, at such Times, the Exercise ought to be moderate, and the
+Men should not be brought out in wet Weather.
+
+
+
+
+OF MILITARY HOSPITALS.
+
+
+Whenever Men are seized with Distempers, they ought immediately to be
+separated from those in Health, and either sent to the Regimental[148]
+or General Hospital.
+
+    [148] Some of the regimental Surgeons in _Germany_, when they
+    took the Field, had always some spare Tents carried along
+    with their Medicine Chests; and when any of their Men fell
+    sick in Camp, and they could get no House for a regimental
+    Hospital in Villages, they ordered these Tents to be pitched,
+    and had the Ground within well covered with Straw and
+    Blankets, and then put the Sick into them, and there took
+    Care of them till they found an Opportunity of sending them
+    to the Flying Hospital.
+
+There is no Part of the Service that requires more to be regarded than
+the Choice of proper Places for Hospitals, and the right Management
+of them, on which the Health and Strength of an Army often depends;
+for in wet unwholesome Seasons, if infectious Disorders get into the
+Hospitals, which possibly might have been prevented by proper Care,
+they often weaken an Army in a very short Time far more than the Sword
+of the Enemy.
+
+We have no Account of the particular Manner in which the Antients took
+Care of their Sick and Wounded in Times of War; for although we read
+in _Homer_[149] of Surgeons or Physicians attending the _Grecian_
+Camp, and in _Xenophon_[150] of _Cyrus_'s having appointed Physicians
+to his Army; and we learn from _Tacitus_[151] and _Livy_[152], that
+the wounded _Romans_ were received into the Houses of the Nobility,
+and had Physicians to attend them, and were furnished with
+Fomentations and other proper Remedies; and from _Justin_[153], that
+the _Lacedemonians_ followed the same Method: yet these Authors make
+no Mention of the particular Oeconomy or Manner in which these
+Hospitals were conducted.
+
+    [149] _Homer_ mentions _Podalirius_ and _Machaon_, sons of
+    _AEsculapius_, as two excellent Physicians or Surgeons in the
+    _Grecian_ Army. Vid. _Iliad_, lib. ii. Physic and Surgery
+    were antiently exercised by the same Persons.
+
+    [150] Vid. _Xenophon. de Institut. Cyri._ lib. i. et viii.
+
+    [151] _Tacitus_, after giving an Account of 50,000 People
+    being killed by the Fall of an Amphitheatre at _Fidena_,
+    during the Time of a Shew of Gladiators, has these Words:
+    "Ceterum post recentem cladem, patuere procerum domus,
+    fomenta & medici passim praebiti; suit urbs per illos dies,
+    quanquam maesta facie veterum institutis similis, qui magna
+    post praelia saucios largitione & cura sustentabant." _Vid.
+    lib._ iv. _Annal._ Sec. 63.
+
+    [152] In _Livy_ we find the following Passage: "Neque immemor
+    ejus quod initio consulatus imbiberat, conciliandi animos
+    plebis, saucios milites curandos dividit patribus. Fabiis
+    plurimi dati, nec alibi majore cura habiti." _Vid. lib._ ii.
+    cap. xlvii.
+
+    [153] _Justin_ mentions the same Thing of the _Spartans_
+    after their Defeat at _Sellasia_--"Patentibus omnes domibus
+    saucios excipiebant, vulnera curabant, lapsos reficiebant."
+    _Vid. lib._ xxviii. cap. iv.
+
+The Hospitals commonly wanted for an Army acting on the Continent,
+are,
+
+1. One in the Rear, to follow their Motions, so as to be always ready
+to receive the Sick from Camp, which is called the Moveable or Flying
+Hospital. 2. One or more, at some Distance, in Towns, to receive such
+of the Sick as can be moved from the Flying Hospital, when they are
+obliged to go from one Place to another; or when a greater Number of
+Sick is sent to them than they can easily take Care of[154].
+
+    [154] When Parties of Sick or Wounded are to be sent from
+    Camp, or from one Hospital to another, Care ought to be taken
+    that they are placed properly in the Waggons; that they have
+    proper physical People, Nurses, &c. to attend them; as well
+    as Provisions, and other Necessaries, so as to be in no
+    Danger of wanting any Thing while they are on their Journey.
+
+Each of the Hospitals ought to be provided with Physicians, Surgeons
+Mates, Purveyors, or Commissaries, and others, to attend and take Care
+of the Sick.
+
+Besides the physical People who attend the Hospital, one or two
+Physicians ought to go along with the Army to attend the Commander in
+Chief, and the General and Staff Officers, in Case of Sickness; and an
+Apothecary, provided with a small Chest of Medicines, ought to attend
+at Head Quarters to make up the Prescriptions of the Physicians.
+
+A Number of Hospital Surgeons also, with Mates, ought to attend the
+Army, to be ready in Case of an Action. These ought to be attached to
+the Suite of the Commanders of the different Corps or Brigades, and to
+be quartered or encamped with them. And each Surgeon should be
+provided with a Waggon or some Horses loaded with a proper chirurgical
+Apparatus, as Instruments, Bandages, Lint, and other Things necessary
+for taking Care of the Wounded.
+
+A small Quantity of Medicines, some Wine, Rice, portable Soop, &c. and
+Utensils for a small Hospital, and two, three, or four hundred Sets of
+Bedding, should be carried about with the Army, in Case of an Action,
+for the Use of the Wounded, till they have Time to receive Assistance
+from the Flying Hospital. Some of the Bedding ought to be carried on
+Horseback, so as to be at Hand when any of the Surgeons are sent with
+Detachments that are going upon an Attack.
+
+To prevent crowding the General Hospitals in Winter Quarters, every
+Regiment ought to take Care of their own Sick, and to have proper
+Hospitals fitted up for them.
+
+Dr. _Pringle_ has laid down some very good Directions with regard to
+the Choice of Places fit for Hospitals, and the Method of preventing
+infectious Disorders in them; and we find many excellent Hints of this
+Kind in Dr. _Lind_ and Mons. _du Hamel_'s Treatises on the Means of
+Preserving the Health of Seamen, and some likewise in Dr.
+_Brocklesby_'s late Treatise on military Disorders.
+
+In the Time of Service the Commander in Chief generally orders the
+Hospitals to be established in Towns or Villages that least interfere
+with the military Operations, to which the Sick and Wounded can most
+easily be conveyed; and which he can best protect from the Insults of
+the Enemy[155].
+
+    [155] The _Roman_ Generals seem to have sent their Sick and
+    Wounded into Towns, in the same Manner as is done by those of
+    the present Time. For we read in _Caesar's Commentaries_ of
+    this Method having been practised on more Occasions than one.
+    In the sixty-second Chapter of the third Book, _de Bello
+    Civili_, we have the following Passage: "Itaque nulla
+    interposita mora, sauciorum modo & aegrorum habita ratione,
+    impedimenta omnia silentio prima nocte ex castris _Apolloniae_
+    praemisit, ac conquiescere ante iter confectum vetuit. His una
+    legio missa praesidio est."--And immediately after, in chap.
+    lxv. "Itaque praemissis nunciis ad Cn. Domitium Caesar
+    scripsit, & quid fieri vellet ostendit: praesidioque
+    _Apolloniae_ cohortibus iv. _Lissi_ i. tres _Orici_ relictis;
+    quique erant ex vulneribus aegri depositis; per Epirum atque
+    Arcarniam iter facere caepit."
+
+    And in the twentieth chapter, _de Bello Africano_, we read:
+    "_Labienus_ saucios suos, quorum numerus maximus fuit, jubet
+    in plaustris deligatos _Adrumentum_ deportari."
+
+    It would be a right Measure, in the Beginning of every War,
+    to settle by a Cartel that military Hospitals on both Sides
+    should be considered as Sanctuaries for the Sick, and
+    mutually protected; as was agreed upon between the late Earl
+    of _Stairs_, who commanded the _British_ Troops, and the Duke
+    _de Noailles_, who commanded the _French_ in the Campaign in
+    _Germany_ in the year 1743. See _Dr. Pringle's Preface_.
+
+In Towns, the Places fittest for Hospitals are public Buildings, which
+have large dry airy Apartments, situated on a high Ground, where there
+is a free Draught of Air, and a Command of Water.
+
+In Winter, those Houses, which have open Fire Places in the Rooms, are
+always preferable to such as have close Stoves, or no Fire Place at
+all; for an open Fire Place serves to keep up a free Circulation of
+Air in a Room, as well as to keep it warm. And for the same Reason,
+where nothing but Stoves can be got to warm the Wards, the Wynd
+Stoves, which open into the Room or Ward, are vastly preferable to the
+close ones.
+
+Where there are no public Buildings, private Houses answering nearest
+to the above Description are most proper for Hospitals. In general,
+Houses with small Rooms make but bad Hospitals; and very Damp and
+close Places ought by all Means to be avoided.
+
+In Summer, when the Moveable or Flying Hospital is ordered into
+Villages, large Barns, and the largest airy Houses, are the best.
+
+Churches, situated on a dry high Ground, make good Summer Hospitals;
+and in Winter, when Necessity obliged us sometimes to use them in
+_Germany_ for this Purpose, they were found to answer very well, when
+we had Bedsteads or Cradles for the Men to lie upon, and the Wynd
+Stoves to keep them of a moderate Heat.
+
+In making Choice of Houses for Hospitals, particular Regard ought to
+be had to the Privies or Necessaries; because, where their Smell is
+offensive, there is always Danger of infectious Disorders. If,
+therefore, there be no proper Conveniencies of this Kind about an
+Hospital, such ought to be contrived so as to prevent any Danger from
+their putrid Effluvia. If there be a River near the Hospital, the
+Necessaries may be made above it at a Place where there is a rapid
+Stream below. In Villages deep Pits may be dug in the Ground behind
+the Hospital, and Seats made over them, as in Camp; and a thick Lay of
+Earth be thrown above the Foeces every Morning, till the Pits are near
+full, and then they must be filled up, and others dug to supply their
+Place.
+
+When once the Places are fixed upon for Hospitals, every Ward ought to
+be made perfectly sweet and clean; first, by scraping and washing with
+Soap and Water, and afterwards with warm Vinegar; and then they ought
+to be fumigated with the Smoke of wetted Gunpowder and of Aromatics,
+and afterwards well dried and aired by lighting Fires, and opening
+the Windows, before any Sick are admitted.
+
+After this the Beds ought to be laid; in doing of which great Care
+should be taken not to crowd the Wards too much, as nothing corrupts
+the Air so much, or so soon brings on infectious Disorders. Dr.
+_Pringle_ says, the Beds ought to be laid so thin, that a Person
+unacquainted with the Danger of bad Air, might imagine there was Room
+for double or triple the Number. In high lofty Apartments, and in
+Churches, and other large Places, the Beds may be laid much closer
+together than in Rooms with low Cielings. In Churches, or such Places,
+thirty-six square Feet, or a Square of six Feet by six, may be allowed
+for each Man; but in common Wards we must allow from forty-two square
+Feet, _i. e._ six by seven Feet, to sixty-four square Feet, or eight
+by eight, according to the Height of the Cieling, the Airyness of the
+Place, and the Nature of the Diseases of the Patients.
+
+The Bedding most fit for Hospitals, is Palliasses and Bolsters filled
+with Straw, Sheets, and Blankets, as they can easily be washed.
+Feather Beds and Matrasses are apt to retain Infection, and cannot be
+easily cleansed. In the fixed Hospitals, Bedsteads or Cradles may be
+set up for laying the Bedding on: But in the Moveable or Flying
+Hospital the Bedding must be, for the most part, laid on the Floor.
+
+When once the Beds are laid, and the Sick arrive, some of the
+Gentlemen belonging to the physical Department ought to attend, to
+distribute the Sick properly through the Hospitals.
+
+All the Surgery Patients, such as have Wounds, Ulcers, Sores, the
+Venereal Disease, &c. should be separated from the Rest, and put
+either into particular Wards by themselves, or into an Hospital fitted
+up for that Purpose under the Direction of the Surgeons.
+
+Those labouring under infectious Fevers and Fluxes, should each of
+them be placed in good airy Wards by themselves, where the Beds are
+laid much thinner than in the other Wards of the Hospital. If the Flux
+Wards have a Privy near them, where the Men can ease themselves,
+without being offensive either to their own Ward, or any other Part of
+the Hospital, they are so much the fitter for such Patients. In the
+Hospital I attended at _Bremen_, the Flux Ward had a Necessary that
+opened into the River _Weser_, and at _Natzungen_ a deep Pit was dug
+in the Field about twenty Yards from the Barn where the Flux Men lay,
+which kept these Wards always sweet.
+
+Patients that have got the Itch, or any other infectious Distemper,
+ought likewise to be put into separate Wards by themselves; and at all
+Times a Place should be set apart for those who may be taken ill of
+the Measles or Small-Pox. A House separated from the other Hospitals,
+with a distinct Set of Nurses and other Attendants, bids fairest to
+prevent the Infection from spreading.
+
+When once the Sick are properly ranged, the next Care must be to
+prevent infectious and malignant Disorders from being generated, and
+from spreading amongst the Sick; which is principally to be effected
+by keeping the Sick and the Hospital extremely clean and well-aired,
+and the Wards as sweet, and free from putrid and offensive Smells, as
+possible.
+
+Every sick Man, as soon as he arrives at an Hospital, should be washed
+with warm Water, or if there is a warm Bath, or bathing Tub, to be put
+into it; and afterwards be supplied with a clean Shirt[156] well-aired
+before he be put to Bed; and his own dirty Linen should be immediately
+carried to the Wash-House: And every Morning each Nurse ought to carry
+a Bucket full of warm Water, and a Piece of Soap and a Towel, round to
+each of her Patients, and make them wash their Hands and Face, and
+their Feet, when dirty.
+
+    [156] Every military Hospital ought to have a Number of
+    Shirts belonging to it, for the Use of the Sick who arrive
+    without having clean Linen with them. As soon as their own
+    Shirts are washed and dried, or that new ones are provided by
+    their Regiments, the Hospital Shirts ought to be taken from
+    them.
+
+Every Morning all the Wards ought to be scraped and swept, and
+afterwards sprinkled with warm Vinegar; and when dirty, they ought to
+be washed after the Fires are lighted.
+
+Every Thing in the Wards, and about the Sick, should be kept as clean
+as possible; the Chamber-Pots and Close-Stools ought to be carried
+away as soon as used, and immediately emptied and washed before they
+be brought back.
+
+The Windows of the Wards ought to be kept open to admit fresh Air
+Morning and Evening, for a longer or shorter Time, according as the
+Weather will permit.
+
+If the Wards are close, and the Cieling too low, Dr. _Pringle_ advises
+to remove some Part of them, and to open the Garret Story to the
+Tiles[157]; and if the Opening of the Windows is not sufficient to
+air the Wards, Ventilators of different Kinds, such as those mentioned
+by Dr. _Hales_ and Dr. _Pringle_, may be used, especially when the
+Weather is hot.
+
+    [157] In Wards which are too close, it has been found that
+    one or two square Holes (of about six or eight, or ten Inches
+    diameter), cut in the Cieling, and a Tube made of Wood fitted
+    to it, and carried up into the Chimney of the Ward above, so
+    as to enter above the Grate, is one of the best Contrivances
+    for procuring a free Circulation of Air; as the foul Air,
+    which is lightest, and occupies the highest Part of the Ward,
+    finds a free Exit by these Tubes: We have such Tubes now
+    fixed in several of the Wards in _St. George_'s Hospital. A
+    Hole cut above the Door of the Ward, or in the upper Part of
+    the Windows, and one of what are called the _Chamber
+    Ventilators_ fixed in it, will answer, where Holes cannot be
+    conveniently cut in the Cieling.
+
+In Winter, Fires should be lighted in all the Wards where it can be
+done.
+
+In foreign Countries, when we meet with Hospitals where there are no
+Places for open Fires, but only close Stoves, different Contrivances
+may be used to renew the Air. Ventilators of different Kinds may be
+used, or Openings made in the Doors and Windows. In Winter 1761-62,
+some of the Wards in the Hospital at _Bremen_ which I attended had
+such Stoves. In order to keep up a free Circulation of Air in those
+Wards, I directed large Holes to be cut in the lower Part of the Door
+in each Ward, and two Grooves to be made on the Outside of the Door,
+above and below the Hole, parallel to each other, in which a Board
+slided; by means of which, the Hole could be either quite covered or
+only in Part, or left entirely open; and I directed a Casement, about
+eight or nine Inches square, to be made in the upper Corner of each
+Window. After the Fires were lighted, upon removing the Board which
+covered the Hole in the Door, and opening the little square Windows, a
+Current of fresh cool Air rushed into the Ward by the Door, while the
+heated foul Air found an Exit by the Windows. In very cold Weather,
+the Opening of the small Windows was sufficient; but in mild Weather,
+and in Summer, it was necessary to keep both open.
+
+The Wards should be daily fumigated by Means of Aromatics, or wetted
+Gunpowder thrown on burning Coals, put in an Iron Pot or Chaffern, or
+with the Steams of warm Vinegar placed in the Middle of the Ward. Dr.
+_Lind_ says, that although Cleanliness and a pure Air contribute much
+to prevent infectious Disorders, or to check them, yet that they of
+themselves are not always sufficient; but that he seldom or never knew
+a proper Application of Fire and Smoke to be unsuccessful in producing
+the happy Consequence of effectually purifying all tainted Places,
+Materials, and Substances[158].
+
+    [158] Dr. _Lind_ tells us, that the Ships of War in his
+    Majesty's Service are purified by Fire and Smoke, and gives
+    the Process by which it is done; and he says, that he never
+    heard of any Ship, which, after being carefully and properly
+    smoked, did not immediately become healthy for the Men.--See
+    _First Paper on Fevers and Infection_.--And he observes, that
+    these Steams and Smoke, which are inoffensive to the Lungs,
+    besides correcting the bad Quality of the Air, produce
+    another good Effect; which is, to make both the Patients and
+    Nurses desirous of opening the Doors and Windows for the
+    Admission of fresh Air. _Ibid._ p. 51.
+
+In all Military Hospitals, at least in the fixed ones, one Ward ought
+to be always kept empty; and whenever a malignant Fever, or any other
+infectious Disorder, breaks out in any Ward, the Men ought to be
+removed into this empty one; and the foul Ward purified, by washing
+and cleaning it well with Soap and Water, and then with warm Vinegar;
+and afterwards purifying it with Smoke, in the same Manner as is
+practised in his Majesty's Ships of War; and Fires should be lighted
+daily, and the Windows kept open for some Time, before any Sick be
+again admitted into it.
+
+As soon as any Patient dies, the Body ought to be removed to the Dead
+House; and the Bedding he lay upon should be carried away immediately,
+and not used again till it has been smoked, well-aired, and washed.
+
+All the Linen of Patients in Fevers, Fluxes, and other infectious
+Disorders, ought to be changed often; and all the foul Linen and foul
+Bedding of the Hospital should be smoked with the Fumes of Brimstone,
+or of wetted Gunpowder, in a Place set apart for that Purpose; and Dr.
+_Lind_ advises to steep them first in cold Water, or cold Soap Lees,
+before putting them in warm Water; as it is dangerous for any Person
+to receive the Steam that may at first arise, where this Precaution is
+not used.
+
+All the Cloaths, of Soldiers who die in Hospitals, ought to be sent to
+the Smoke House, and be well fumigated, and afterwards aired, before
+they are put up in the Store-House.
+
+The next Thing to be considered about a Military Hospital is the Diet
+of the Patients, which should consist of good wholesome Provisions,
+that can be purchased easily, and at a cheap Rate[159].
+
+    [159] The _French_, and many other Nations, give their
+    Patients Meat Soops in acute Diseases, and after capital
+    Operations; and they allow them but little Bread or other
+    Preparations of Vegetable Substances: But these Meat Soops
+    without Bread do not nourish the Patient sufficiently, and
+    tend too much to the Putrescent; and this is one Reason why
+    more Sick die in the _French_ than in the _British_
+    Hospitals.
+
+Good Bread[160] is a standing Article of Provisions for an Hospital in
+all Countries and in all Climates; and a certain Quantity of it ought
+to be distributed to each Man daily.
+
+    [160] On Expeditions where a Siege is expected, a Quantity of
+    Flour ought to be carried out, and a Number of portable Ovens
+    for baking bread for the Sick, which may be put up after the
+    Troops have made good their Landing.
+
+The Breakfast and Supper in most Military Hospitals must be made of
+Water Gruel or Rice Gruel; as either Rice or Oatmeal can be got in
+most Places, and are very portable.--Water Gruel is in general
+preferable to the Rice Gruel, because most Patients nauseate the Rice
+Gruel, after eating it for some Days, but not the Water Gruel, as
+every Person, who has attended the Military Hospitals, must have
+experienced. Where both Rice and Oatmeal can be had, Rice Gruel may
+be used two or three Times a Week by Way of Variety.
+
+But although Rice Gruel is not so proper for constant Use, yet Rice
+should always make an Article among the Stores for an Hospital, as it
+is useful for making Rice Water for Drink; and it can be boiled or
+ground, and made into a light Pudding, and in short may be used in a
+Variety of Forms to make a good and wholesome Food for the Sick.
+
+Oatmeal is cheaper than Rice, and can be procured almost every-where
+in _Europe_, where Armies make Campaigns; as Oats make such a great
+Article in the Forage for Horses. And a sufficient Quantity can at any
+Time be ground into Meal for the Use of the Sick, at the Mills which
+are employed for making Flour for the Bakery, if there be none nearer
+the Hospital.
+
+In Countries where neither Oatmeal nor Rice can be had, _Indian_ or
+some other Corn, which is known to be wholesome, and which the Country
+affords, may be employed in their Place.
+
+When fresh Meat can be got, the Men who are on full Diet, and the
+Nurses and other Servants about the Hospital, should have Meat for
+Dinner; and the Meat that is boiled for them ought to make Broth for
+the Sick who are kept on a low or middle Diet. Some Barley or Rice
+should be added to the Broth; and a small Quantity of Carrots,
+Turnips, or other Vegetables, boiled along with them, will make it
+more agreeable to the Taste.
+
+On Expeditions where nothing but salted Meat can be had, a Quantity of
+portable Soop should always be carried out for the Use of the Sick;
+which with Water and some Barley, and fresh Vegetables, when they can
+be got, will make a good Soop or Broth. On such Occasions, the Dinner
+ought to consist of Soop and Bread, or of light Puddings made of Flour
+or of Rice, of boiled Rice or Barley, or of Panado, &c.
+
+Nurses and recovered Men may be allowed salted Meat twice or thrice a
+Week.
+
+The common Drink of Military Hospitals ought to be Rice and Barley
+Water, with a small Proportion of Spirits and Sugar. Small Beer is a
+good Drink where it can be easily procured; as is Wine and Water, or a
+very small Negus, or very weak Punch in warm Climates.
+
+Besides this Diet, extraordinary Indulgences may be occasionally
+allowed to particular Patients, as Wine, Brandy, Sugar, Milk. And the
+Physicians and Surgeons ought to have a discretionary Power to order a
+Vegetable or any other proper Diet for Patients in the Scurvy, or any
+other particular Complaints.
+
+
+The Established Diet of a Military Hospital may be,
+
+                _Breakfast._         _Dinner._       _Supper._
+             One Pint of Water  |                |
+             or Rice Gruel.     |                |
+                                |                |
+             Water Gruel made   |                |
+             with 3 or 4 Ounces |                |
+             of Oatmeal, a      |                |
+             little common Salt,|One Pound       |
+             and with or without|of boiled fresh |
+  Full Diet, a little           |Meat.           |  As Breakfast.
+             Sweet Oil, and     |                |
+             two Spoonfuls of   |                |
+             Wine.              |                |
+                                |                |
+             Rice Gruel made    |                |
+             with two Ounces of |                |
+             Rice, one Spoonful |                |
+             of fine Flour, a   |                |
+             little             |                |
+             common Salt and    |                |
+             Sugar.             |                |
+  -----------------------------------------------------------------
+                                |One Pint of     |
+                                |Broth, half     |
+  Middle Diet, Ditto.           |Pound of boiled |  Ditto.
+                                |Meat.           |
+  -----------------------------------------------------------------
+                                |One Pint of     |
+                                |Broth, or       |
+  Low Diet,  Ditto, or according|half a Pint of  |
+             to the Patient's   |Panado, with    |
+             Appetite.          |two Spoonfulls  |  Ditto.
+                                |of Wine,        |
+                                |and a Quarter   |
+                                |of an Ounce     |
+                                |of Sugar.       |
+
+
+The daily Allowance of Bread to be one Pound to each Man.
+
+The common Drink for those on full and middle Diet to be Rice or
+Barley Water, with two Spoonfuls of Brandy to each Pint, and a Quarter
+of an Ounce of Lump Sugar; small Beer, or very weak Punch; or Wine and
+Water, two Ounces of Wine to a Pint of Water, and a Quarter of an
+Ounce of Sugar. The Quantity not to exceed three Pints _per_ Day.
+
+Those on low Diet to have Rice or Barley Water as above, with or
+without Wine or Brandy.
+
+
+The Diet Boards hung up in the Hospitals may be made with the
+following Columns, nearly as they were with us in _Germany_.
+
+  Regiments.|Mens  |  Diet  |Wine.     |Brandy.|Milk.     |Sugar. |
+            |Names.|F.|M.|L.|1/2 Pints.  |Ounces.|1/2 Pints.  |Ounces.|
+  ----------+------+--+--+--+----------+-------+----------+-------+
+            |      |  |  |  |          |       |          |       |
+            |      |  |  |  |          |       |          |       |
+            |      |  |  |  |          |       |          |       |
+            |      |  |  |  |          |       |          |       |
+            |      |  |  |  |          |       |          |       |
+            |      |  |  |  |          |       |          |       |
+            |      |  |  |  |          |       |          |       |
+            |      |  |  |  |          |       |          |       |
+            |      |  |  |  |          |       |          |       |
+            |      |  |  |  |          |       |          |       |
+            |      |  |  |  |          |       |          |       |
+  ----------+------+--+--+--+----------+-------+----------+-------+
+
+When such Diet Boards are kept in an Hospital, and the Mens Names and
+Regiments are once wrote down, the Patients may with very little
+Trouble be put upon the full, middle, or low Diet, with so much of the
+above-mentioned Extraordinaries as may be judged proper.
+
+If any Thing else be wanted for the Sick, the Physician ought to give
+a particular Order in Writing for it, the Columns here marked being
+only for such Things as are most frequently wanted.
+
+It should be a general Rule in all Military Hospitals, that, when a
+Party of Sick arrives, every Man may have immediately a Mess of Water
+Gruel given him, and afterwards be put on low Diet till it is ordered
+otherwise by the Physician or Surgeon who attends him.
+
+It is not to be supposed that the Diet here mentioned can be strictly
+kept to in all Parts of the World; for it must often be varied
+according to the Difference of the Climates, and to the Provision of
+the Countries where the Scene of War may be.
+
+Whenever a Moveable or Flying Hospital is to attend an Army, a
+Quantity of Bedding, and of all Utensils for forming an Hospital,
+ought to be put up in the Waggons, together with Provisions of
+different Kinds, such as Oatmeal, Rice, Sago, Brandy, Wine, Sugar, &c.
+A Butcher with a Stock of live Cattle, and a Baker with a proper
+Quantity of Flour for making Bread ought constantly to attend; and a
+Number of empty Waggons should likewise be always in Readiness, to
+transport the Sick when the Hospital moves, or when a Party is to be
+sent to the fixed Hospitals.
+
+When Troops go upon an Expedition, besides the common Hospital Ships,
+another Ship ought to be properly fitted up for the Reception of sick
+Officers[161]; and every Hospital Ship ought to be supplied with all
+Sorts of Provisions, and other Necessaries fit for forming an
+Hospital, before they leave _England_.--And one or more armed Vessels
+loaded with Provisions, Wine, and all Sorts of Necessaries for the
+Sick, ought to attend them; or if the Expedition be intended for the
+warm Climates, these Vessels ought to go before the Fleet to take up
+Wine and Fruits, such as Lemons, Oranges, &c. Vegetables of different
+Kinds, and a live Stock for the Use of the Sick.
+
+    [161] If there be no Ship fitted up for the Reception of sick
+    Officers, those who are taken ill on Expeditions must be in a
+    most miserable Situation; as there is no Place to receive
+    them in the common Hospital Ships, they must remain almost
+    without Assistance in a crowded Cabin amongst People in
+    Health; as was the Case in some of our Expeditions during the
+    late War.
+
+All Hospitals attending Expeditions should carry out among their
+Stores a Number of large Tents for lodging the Sick and Wounded
+immediately on making good their Landing. Where a Siege is expected
+which will take up Time, and where no Accommodations for the Sick can
+be had till the Siege is over, a Ship or two, with Boards, and other
+Necessaries for building large Sheds, or temporary Hutts, for the
+Sick, as proposed by Dr. _Brocklesby_, ought to go along with the
+Fleet, or meet them at the Place of their Destination. Such thatched
+Sheds, or Hutts, are very necessary in the warm Climates, as the
+perpendicular Rays of the Sun, beating upon Canvass, make Tents
+intolerably hot. When any of our own Settlements happen to be near the
+Place attacked, a fixed Hospital may be established there; either in
+Houses, if proper ones can be found; or in temporary Sheds or Hutts
+erected for that Purpose; and some Vessels, properly fitted up, may be
+kept going with the Sick and Wounded, and bringing back the recovered
+Men.
+
+At every Military Hospital a Serjeant's Guard ought to mount; and
+Centinels be placed at the Doors of the Hospital, 1. To prevent all
+Visitors, who have not proper Leave, from coming into the Hospitals;
+as such People oftentimes crowd the Wards, disturb the Sick, and are
+apt to catch infectious Distempers, and to spread them among the
+Troops. 2. To take Care the Patients do not go out of the Hospital
+without having a Ticket[162] of Leave for that Purpose, signed by the
+Physician, Surgeon, or Apothecary, belonging to the Hospital. 3. To
+prevent spirituous Liquors, or other Things of that Kind, being
+clandestinely carried into the Hospital.
+
+    [162] At every Hospital there ought to be a Number of printed
+    Tickets lying ready to be filled up and signed by the
+    Physicians and Surgeons, and no Man ought to be allowed to go
+    out without a Ticket so signed.
+
+The Serjeant of the Guard, attended by the Ward Master, ought, every
+Morning, to go round the Wards to call a Roll, and see that every Man
+is in his Ward; and to do the same at Night before the Hospital Doors
+are shut, and at this Time to order every Person out of the Hospital
+who does not belong to it. And the Serjeant, every Morning, ought to
+report to the Physician, Surgeon, or Apothecary, every Man's Name who
+was found to be absent at Roll-calling; and whether he found every
+Thing regular and in good Order in going his Rounds.
+
+Every large Military Hospital ought to have one Head Nurse, and a
+sufficient Number of other Nurses, to attend and take Care of the
+Sick.
+
+Orders to the following Purport, hung up in every Military Hospital,
+would serve to shew the Nurses and Patients what their Duty is, and
+to maintain Regularity and good Order through the whole Hospital.
+
+
+_Matron, or Head Nurse._
+
+Every Matron, or Head Nurse, is to go round all the Wards of the
+Hospital at least twice a Day, Morning and Evening; to see that the
+Nurses keep their Wards clean; that they behave themselves soberly and
+regularly, and give due Attendance to their Patients; and to examine
+the Diet of the Patients, and see that it is good and well dressed;
+and if she finds any Thing amiss, to report the same to the Physician,
+Surgeon, or Apothecary, of the Hospital.
+
+
+_Common Nurses._
+
+1. The Nurses are to give due Attendance to their Patients; and to
+keep them always as neat and clean, as the Nature of their Distempers
+will admit of; to give them their Diet regularly; to be particularly
+careful to see them take the Medicines ordered by the Physicians,
+according to the Directions given; to report to the Physician,
+Surgeon, or Apothecary, any Faults or Irregularities which any of
+their Patients may have committed; and to acquaint the Ward Matter and
+Head Nurse of the Death of any of their Patients as soon as it
+happens, that proper Care may be taken of their Cloaths and Effects.
+
+2. They are to keep their Wards extremely clean, to sprinkle them
+every Morning with Vinegar, and to fumigate them with the Smoke of
+wetted Gunpowder, or of Frankincense, or any other Aromatics that may
+be thought proper; in fair Weather to keep open the Windows of their
+Wards, twice or thrice a Day; for a longer or shorter Time, as the
+Weather will permit; to attend at the Steward's Room for the
+Provisions of the Patients at the Hours appointed for that Purpose;
+and to pay implicit Obedience to the Matron, or Head Nurse, in what
+relates to their Duty; and punctually to obey all Orders they receive
+from the Physician, Surgeon, or Apothecary, of the Hospital.
+
+3. They are to keep themselves clean and decently dressed, and to
+observe the strictest Rules of Sobriety; remembering, that if any one
+is found intoxicated with Liquor, that she is immediately to be sent
+to the Guard, and afterwards discharged.
+
+4. They are not to absent themselves from their Wards, unless when
+employed in the Discharge of their Duty; nor to go out of the Hospital
+to which they belong, without having a Ticket of Leave signed by the
+Physician, Surgeon, Apothecary, or Head Nurse, belonging to the
+Hospital.
+
+5. They are not to throw Nastiness of any Kind out at the Windows, but
+to carry it to the common Necessaries, and to empty the Chamber Pots
+and Close-stools as soon as used, and be careful to wash them before
+they bring them back.
+
+6. They are not, upon any Pretence whatever, to alter the Diet ordered
+by the Physicians or Surgeons to the Patients on the Diet Boards; nor
+to suffer their Patients to use any other Diet than what is allowed by
+the Hospital; nor are they to bring, or allow others to bring, Meat,
+spirituous Liquors, or other Things of that Kind, into their Wards,
+except what is allowed by the Physicians or Surgeons. Whenever any
+Thing of this Kind is found in any of the Wards, it ought immediately
+to be thrown into the common Necessary; and if it be found in the
+Custody of a Nurse, she ought to be confined in the Guard, or
+discharged.
+
+7. Nurses guilty of great Neglect of Duty, or of getting drunk and
+using their Patients ill, or of stealing, or concealing or taking away
+the Effects of Men who die in the Hospital, are to be immediately sent
+to the Guard, and reported to the Commanding Officer of the Place,
+that they may be tried by a Court-Martial, and be confined, whipped,
+or otherwise punished, as the military Law directs; all Followers of
+Armies on foreign Service being equally subject to the military Law as
+the Soldiers themselves.
+
+
+_Patients._
+
+1. All sick Soldiers, on their Arrival at a Military Hospital, are to
+be washed all over with warm Water, or to go into a warm Bath; and
+afterwards to wash their Face and Hands every Morning, and their Feet
+occasionally, with warm Water and Soap, brought round every Morning by
+the Nurses for that Purpose; and they ought to comb their Head every
+Day. If they be too weak to wash and comb themselves, it is to be done
+by their Nurses.
+
+2. Every Patient is to be shaved and have clean Linen twice a Week, or
+oftener if requisite.
+
+3. They are punctually to obey the Directions given them, and to take
+the Medicines ordered by the Physician; and none to be allowed to go
+out of the Hospital without a Ticket of Leave signed by the Physician,
+Surgeon, or Apothecary, of the Hospital.
+
+4. They must commit no Disorder or Riot, but in all Respects behave
+themselves well.
+
+5. If any Man disobeys the Orders he receives from the Physicians or
+Surgeons, or is irregular in Conduct, gets drunk, and commits Riots in
+the Hospital, or is found guilty of Theft or other Crimes, the same
+is to be reported to the Commanding Officer of the Place, and he to be
+tried by a Court-Martial, and punished as soon as his Strength will
+permit.
+
+In conducting the Military Hospitals, we found that it was always
+right to discharge the Patients from the sick Hospitals as soon as
+they were recovered, and to send them either to Billet, or to a
+convalescent Hospital; because recovered Men are always the most
+riotous; besides they crowded the Hospitals, and were in Danger of
+catching fresh Disorders from those who were sick; and therefore the
+recovering Men in every Hospital ought to be reviewed once or twice a
+Week by the Physician or Surgeon, and the Names of such Men as are
+well enough, to be marked; in order that they may be sent the next Day
+to the convalescent Hospital, or to Billet. A Return of those marked
+for Billet ought immediately to be sent to the Officers on
+convalescent Duty.
+
+When a convalescent Hospital is established, it ought to be put under
+proper Regulations; the following are those which I drew up for that
+established at _Osnabruck_ in _April_ 1761, and which were found to
+answer the Purpose intended.
+
+
+_Regulations for a Convalescent Hospital._
+
+1. That this Hospital be entirely occupied by such Men as are
+recovered from Diseases; that no Men be sent there but those whose
+Names are returned to the Purveyor's Office by the Physician or
+Surgeon of the Hospital.
+
+2. That all the Patients shall be upon full Diet, unless in particular
+Cases it be ordered otherwise by the Physician or Surgeon.
+
+3. That all the Patients shall breakfast, dine, and sup, at regular
+stated Hours, in the Hall appointed for that Purpose: Breakfast to be
+ready at nine, Dinner at one, and Supper at seven o'Clock in the
+Evening.
+
+4. That no Patient shall carry up any Victuals into the Wards
+appointed for sleeping in; and if any Patient does not attend at the
+regular Hours of Meals, no Allowance of Victuals shall be made him in
+the Place of such Meals, unless he has been absent on Hospital
+Business, or been confined to Bed by Sickness.
+
+5. That as soon as the Men are come down Stairs to Breakfast, the
+Wards in which they sleep shall be cleaned out and sprinkled with
+Vinegar, and the Windows opened to air them.
+
+6. That the Doors of this Hospital shall be locked every Night at
+eight o'Clock, and no Man be allowed to come in or go out after that
+Time. The Doors to be opened again at seven o'Clock in the Morning.
+
+7. That the said Hospital is to be visited two or three Times a Week
+by the Physician, Surgeon, and Apothecary, who are to see that the
+above Orders are complied with; to examine the Diet, and take Care
+that every Thing is carried on properly; and to prescribe for any
+little Disorders the Men may be affected with.
+
+8. That one of the Hospital Mates be appointed to visit this Hospital
+daily, to administer any Medicines which may have been prescribed by
+the Physician; to apply any Dressings ordered by the Surgeon; and to
+acquaint the Physician or Surgeon if any of the Men be so bad as to
+require their Attendance, or to be sent back again to the Sick
+Hospital.
+
+9. That for the better executing these Regulations, orderly Serjeants
+or Corporals be appointed for the Care of the Men; who shall mount a
+Guard of six or more of such of the Patients of the said Hospital as
+are fit for this Duty--That the Serjeants are to call a Roll of all
+the Patients regularly three Times a Day, before Breakfast, Dinner,
+and Supper; to see that the Men behave themselves soberly and
+decently; and that they keep themselves clean, and commit no Riots;
+and to confine in the Guard such as commit Riots and other
+Irregularities, or whom they find drunk, or who stay out all Night;
+and to report the same to the Officer on Duty.
+
+10. That an Officer on convalescent Duty do visit the said Hospital
+daily at the Times of Roll-calling, to see that every Thing be carried
+on properly; and to receive the Reports from the Serjeants, and give
+what Orders he may think proper for the better regulating the said
+Hospital.
+
+11. That if at any Time it should happen that there are more
+Convalescents than the Hospital can hold conveniently, a Review be
+made of all the Patients, and the strongest and most healthy be sent
+to Billet.
+
+12. That a Review be always made, when any Party is going to join the
+Army, to pick out the Men who are fit to join their Regiments.
+
+The Physical Officers employed in the Military Hospitals, are
+Physicians, Surgeons, and Apothecaries.
+
+No Person ought to be appointed a Physician to the Army, or Military
+Hospitals, without previously undergoing the same Examination at the
+College of Physicians, as those do who enter Fellows and Licentiates
+of the College, that none but proper Persons may be employed. On such
+Examinations the Physician General to the Army ought to be allowed to
+sit as one of the Censors of the College.
+
+The Surgeons are all obliged to pass an Examination at Surgeons Hall
+before they are appointed, and the Apothecaries ought in like Manner
+to pass an Examination at Apothecaries Hall.
+
+The Mates employed in the Service ought, previous to their
+Appointment, to be examined both in Surgery and Pharmacy, as the
+Service commonly requires their acting in both Branches.
+
+The Direction of all Military Hospitals ought always to be committed
+to the Physicians, who have the immediate Care of Hospitals.
+
+When an Army is acting on a Continent, and there is a Number of
+Hospitals in different Places, the Physician who attends the Commander
+in Chief ought to be made Physician General and Director of the
+Hospitals, with proper Appointments; and all Orders from Head Quarters
+ought to go immediately thro' this Channel.
+
+Every other Physician at the different Hospitals ought to direct every
+Thing about the Hospital which he attends, and his Orders ought to be
+punctually obeyed; and he ought to keep up a constant Correspondence
+with the Physician General; acquainting him from Time to Time with the
+State of the Hospital, and what is wanted for it; and he ought
+punctually to obey whatever Orders he receives from the Physician
+General.
+
+If there be separate Hospitals for the Surgery Patients, the eldest
+Surgeon ought to direct every Thing in the Hospital he attends; and
+when any Thing is wanted for his Hospital, to report the same to the
+Physician General.
+
+The directing and purveying Branches ought never to be entrusted to
+the same Person, as the Temptation of accumulating Wealth has at all
+Times, and in all Services, given Rise to the grossest Abuses, which
+have been a great Detriment to the Service, as well as to the poor
+wounded and sick Soldiers, and has occasioned the Loss of many Lives.
+And therefore neither the Physician General, nor any of the Physicians
+or Surgeons of the Army, or any other Person concerned in the
+Direction of the Military Hospitals, ought ever to act as Purveyor or
+Commissary; nor ought they ever to have any Thing to do with the
+Accounts, Contracts, or any other Money Affairs relating to the
+Hospital; and if ever they be found to intermeddle in these Affairs,
+they ought to be immediately dismissed the Service.
+
+The purveying or commissariate Branch ought to be entirely distinct
+from the physical. The Purveyors or Commissaries ought punctually to
+obey whatever Orders they receive from the Physicians or Surgeons; to
+provide every Thing for the Hospital; to keep regular Accounts of all
+the Men who come into, or go out of the Hospitals; and from Time to
+Time to make Returns to Head Quarters of all the Men in Hospitals; and
+their Accounts ought to be controuled by such Persons as the
+Government may think proper.
+
+Every Physician and Surgeon of a Military Hospital ought to visit the
+Sick at regular stated Hours, and the Mates to attend and go round
+with them, and receive and execute their Orders.
+
+Every Mate ought to have a certain Number of Patients allotted him,
+for whom he is to make up all Medicines, dress all Sores, and execute
+whatever Orders he receives from the Physician, Surgeon, or
+Apothecary. That the Mates may know and execute their Duty, proper
+Orders in Writing should be hung up in the Apothecaries Shop for that
+Purpose. The following are those which I gave out at all the Hospitals
+I attended in _Germany_.
+
+
+_Orders for the Mates._
+
+1. That all the Gentlemen do attend at the Apothecaries Shop every
+Morning at eight o'Clock, to assist in making up the common Medicines
+of the Day, and afterwards to go round the Hospitals with the
+Physicians and Surgeons.
+
+2. That every Mate have a Book for writing the Prescriptions of the
+Physicians in, which is to be kept in the following Order.--First, to
+mark the Patient's Name and Regiment; then the Day of his Entry into
+the Hospital and his Disorder; then the Prescriptions of the
+Physician; and after all the Day of his Discharge, or of his Death.
+_Ex. gr._
+
+     _John Clarke_, 20th Regiment. _Jan._ 1. Fever.
+
+     _Jan._ 1. V. S. unc. x.--H. salin. cum pulv. contrayerv.
+     4r. die.--2. Emplast. vesicat. dorso, &c.
+
+       Discharged or dead _Jan._ 28.
+
+3. That every Mate make up himself the Physician's Prescriptions for
+his own Patients, and afterwards go round and administer them, or give
+them to his Patients with proper Directions; that he bleed his own
+Patients, and dress any slight Sores they may have, which do not
+require their being sent to the Surgery Hospital.
+
+4. That every Mate go round amongst his Patients in the Evening, to
+see that every Thing is well conducted, and to report to the Physician
+or Apothecary if any Thing extraordinary happens.
+
+5. That two of the Mates attend all Day at the Apothecary's Shop to
+receive any Sick that may arrive, and to place them properly; to make
+up what Medicines they may immediately want; to order each of them a
+Mess of Water Gruel; and if any Thing extraordinary occurs, to send an
+orderly Man to acquaint the Physician or Apothecary with the same. The
+orderly Mates to make up likewise for Officers, or others, all
+Prescriptions sent to the Apothecary's Shop through the Day.
+
+A Joint of Meat, roasted or boiled, for Dinner, and a Bottle of Wine,
+was allowed to the orderly Mates, by Lord _Granby_'s Order, that they
+might not absent themselves from their Duty.--Where there was
+Conveniency for it, a Mate lodged in the Hospital.
+
+The Apothecary ought to take Care of the Medicines; to go round the
+Hospitals in the Morning before the Time of the Physician's visiting;
+to see that the Wards are in proper Order; that the Nurses and other
+Servants have done their Duty; to examine into the State of the Sick,
+and to see that the Provisions are good; and make a faithful Report
+of all these Things to the Physician when he arrives.--To take Care
+that the Mates prepare in the Morning the Medicines that are commonly
+wanted for the Day; and that they afterwards make up faithfully the
+Prescriptions of the Physician; to go round the Hospital again in the
+Evening, to see that the Sick have got their Medicines regularly; and
+to make the same Enquiries as in the Morning.
+
+The Apothecary should always be lodged near the Hospital, to assist in
+Case of any Accidents happening, or of Sick arriving at the Hospital.
+
+When there are any strong infectious Disorders in Military Hospitals,
+the physical Gentlemen may use the following Precautions to guard
+themselves against Infection.
+
+1. Never to visit the Sick with an empty Stomach; but to eat Breakfast
+before they go into the Hospital.
+
+2. To have a Suit of Cloaths reserved for visiting the Hospital, and a
+waxed Linen Coat to wear above them in going round the Wards; and as
+soon as they have come out of the Hospital, to wash and change their
+Linen and Cloaths.
+
+3. Before they go into the Wards, to order that they be well cleaned
+out, and sprinkled with Vinegar, and afterwards fumigated, and aired
+by opening the Windows, or by Working the Ventilators.
+
+4. If the Infection be very strong, to take a Glass of the spirituous
+Tincture of the Bark just before they go into the Hospital.
+
+5. To put small Rolls of Lint, dipped in camphorated Spirits, up the
+Nostrils, and to direct a Vessel, with warm camphorated Vinegar, to be
+carried round, and held near the Patients they are examining.
+
+6. In examining Patients affected with the Petechial Fever, or any
+other malignant Distempers, to stand at some little Distance, and ask
+what Questions they may think proper; and when they come near, to feel
+the Pulse, and examine the Skin, not to inspire while their Head is
+near the Patient's Body; but after being fully satisfied in these
+Points, to retire a little, and ask what other Questions may be
+necessary.
+
+It would be right to establish some military Rank for every
+commissioned Officer of the Hospital on Service, and to settle the
+same Subordination in the physical as in the military Department. By
+these Means, the Service would be carried on with greater Order, and
+more Advantage to the Sick.
+
+And it would be right, in Times of War, to add a Clause in the Mutiny
+Bill to allow any military Officer on convalescent Duty to call in the
+commissioned physical Officers to assist in making up a Court-Martial,
+when there are not a sufficient Number of military Officers in a
+Place, to try convalescent Soldiers guilty of Crimes. For in Times of
+Service, very often a sufficient Number of military Officers cannot be
+spared to be on Duty at the different Military Hospitals; and at all
+such Places the Convalescents are generally very disorderly, when they
+know that there is not a sufficient Number of Officers to form a
+Court-Martial for punishing them. Where-ever there are a sufficient
+Number of military Officers, no physical Officer ought ever to be
+called upon as a Member of a Court-Martial.
+
+Men, in Time of Service, are often apt to saunter in and about
+Hospitals, and there learn all Manner of Debaucheries, and lose all
+Sense of Discipline; and therefore, to keep up Order and Decorum,
+there ought to be, at every Fixed and every large Military Hospital, a
+military Inspector or Commander, an Officer of known Activity and
+Probity; and a Number of Officers on convalescent Duty sufficient to
+form a Court-Martial whenever required.
+
+The Duty of the Military Inspector, or Commander, should be, to take
+Care of all Convalescents on Billet; to see that the Officers under
+him do their Duty, and maintain the same Regularity and Discipline
+among the Men belonging to their respective Corps, as if they were
+with their Regiments; and that the Men attend the Parade and
+Roll-calling; and that they always appear neat and clean.
+
+He ought, from Time to Time, to visit the Hospitals; to see if they
+are kept clean; to enquire if the Men behave well, if the Diet is
+good, and the Officers, Nurses, and Servants, do their Duty; and if he
+finds any Thing amiss, to report the same to the Physicians and
+Surgeons of the Hospital, or to the Purveyor or Commissary, or others,
+under whose Department it may be, that the same may be immediately
+rectified; and if he finds that the superior Officers of the Hospital
+overlook such Abuses, notwithstanding his Representations, to report
+the same immediately to the Head Quarters.
+
+He ought to order one of the Officers on convalescent Duty to visit
+the Hospitals daily, to make the Enquiries above-mentioned, and to
+give him a Report of the same in Writing.
+
+The Purveyor or Commissary ought to make a Return to him twice or
+thrice a Week of every Man admitted into, or discharged from, the
+Hospitals, or who dies in them; marking in the Return the Name of
+every Man, and the Company and Regiment he belongs to; that he may
+report the same to the Officers of the different Brigades or
+Regiments.
+
+The Military Inspector ought to have the Power of providing Billets
+for all Officers and Soldiers about Hospitals; and the Names of all
+Men to be discharged from Hospitals should be sent to him the Day
+before they are discharged, that he may provide Billets for them; and
+next Day the Men ought to march from the Hospitals to the Parade, to
+receive their Billets, and the Orders of the Military Inspector, and
+of the Officers of the Corps they belong to.
+
+The Military Inspector ought to see that the Arms of the sick Men, and
+the Arms and Cloaths of those who die and are lodged in the Magazines,
+be properly taken Care of; and that the Stores of the different
+Regiments be properly looked after.
+
+As the Service often makes it necessary at Military Hospitals, where
+the Number of Sick is great, to employ the convalescent Soldiers[163]
+as orderly Men and Servants about Hospitals, all Men thus employed
+ought to have a special Leave from the Military Inspector for so
+doing; and no Man should be employed in any Capacity as a Servant
+about an Hospital, who at that Time is on the Books as a Patient. And
+all Men employed about the Hospital ought to be reviewed once a Week
+by the Military Inspector, and likewise whenever a Party of
+Convalescents is going to join the Army, or their Regiments; that no
+Man may be allowed to remain with the Hospital, after he is fit to do
+Duty in his Regiment.
+
+    [163] In the _French_ Hospitals there are always a Number of
+    Men who attend their Sick who belong to the Hospital, so that
+    they have no Occasion to employ their Convalescents, as we
+    are often obliged to do, where the Sick are attended by
+    Nurses, who are commonly Soldiers Wives, and not so capable
+    of doing such laborious Work as the Men.
+
+When the Military Inspector is absent, the eldest Officer on
+convalescent Duty ought to act in his Place.
+
+Every Officer sent on convalescent Duty ought, as soon as he arrives
+at the Place where the Hospital is, to wait on the Commandant, or
+Military Inspector; to acquaint him of his Arrival, and to receive his
+Commands. He ought then to go to the Purveyor or Commissary's Office,
+to get a List of all the Soldiers who are in or about the Hospital,
+and belong to the Regiment or Brigade he is employed for, wherein
+those on Billet are distinguished from those in Hospitals. The next
+Day he ought to parade all those marked on Billet, to see if the
+Number of Men agrees with the List given him, and to examine in what
+State each Man is, and how he is employed; and then he ought to go
+round the Hospitals, attended by an orderly Serjeant, to see all the
+Men in the Hospitals, and to know if the List given him at the
+Purveyor's Office was right; and afterwards he ought to send every Day
+a Serjeant or Corporal to see the Men in Hospitals, and to report to
+him when any Men are discharged or die.--And he ought to procure from
+the Military Inspector a Return of all the Men of his Corps, who are
+either admitted into, or discharged from Hospitals, on the Days when
+such Returns are made. He ought to make all his Men on Billet appear
+regularly on the Parade at Roll-calling, and to oblige them to keep
+themselves clean and their Arms in good Order, and to endeavour to
+preserve the same Regularity and Discipline as when they are with
+their Regiments. And whenever a Party is to be sent to join their
+Regiments, he ought to have all his Men particularly examined; and
+those Men who are found to be perfectly recovered, should be sent to
+their Regiments.
+
+If every Officer on convalescent Duty conform to these Directions, no
+Man can ever be detained without his Knowledge in or about Hospitals,
+as he must always know where every Man is, in what State of Health,
+and how he is employed; and may at any Time be able to make a Return
+to the Brigade or Regiment for which he is employed, of every Man who
+is admitted, discharged, or dies in the Hospital.
+
+
+FINIS.
+
+
+
+
+
+End of the Project Gutenberg EBook of An Account of the Diseases which were
+most frequent in the British military hospitals in Germany, by Donald Monro
+
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