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diff --git a/31338-8.txt b/31338-8.txt new file mode 100644 index 0000000..90fa415 --- /dev/null +++ b/31338-8.txt @@ -0,0 +1,9145 @@ +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 _Chamæmel_. + + 290, 4, for _3tis 4tiis_, read _3tiis 4tis_. + + 293, 13, for _Mithridatum_, read _Mithridatium_. + + 336, 12 & 13, for _bathe themselves as often_, read _bathe early + in the Morning as often_. + + 352, 7, for _in Bilanders_, read _and were to go in Bilanders_. + + 353, 2, for _the least Appearance of the Malignant Fever_, read + _the Malignant Fever appearing_. + + + + +OF THE MALIGNANT and PETECHIAL FEVER. + + +A Malignant Fever, and Fluxes, began to appear among the Soldiers in +Autumn, 1760, while the Allied Army remained encamped about +_Warbourg_, from the Beginning of _August_ till the 13th of +_December_, when they went into Cantonments. During that Time, there +had been a continued Rain for some Months, and the Camp and +neighbouring Fields, and Villages, were not only filled with the +Excrements of such a numerous Army, but likewise with infinite Numbers +of dead Horses, and other dead Animals, which had died in doing the +necessary military Duties, and in bringing Forage, Provisions, and +other Necessaries, to the Camp: besides this, the Field where there +had been an Action on the 31st of _July_, and where many of the Dead +were scarce covered with Earth, was in the Neighbourhood of the Camp. + +Not only the Soldiers, but the Inhabitants of the Country, who were +reduced to the greatest Misery and Want, were infected with the +Malignant Fever, and whole Villages almost laid waste by it. + +Such a Number of Soldiers was sent to _Paderborn_ as crowded the +Hospitals there, and increased the Malignancy of the Distempers so +that a great many died. + +When I arrived at _Paderborn_, in the Beginning of _January_ 1761, the +Fever was upon the Decline in the General Hospitals, though it was +still rife; but by sending off a Party of Convalescents to +_Hervorden_, which thinned the Hospitals, it became less frequent, and +but few died. The Guards marched upon the Expedition into _Hesse_, on +the eleventh of _February_, which gave us full Room for billetting all +our Convalescents, and thinning the Wards; by which Means the Fever +almost entirely ceased in all the Hospitals we had before they went +away; though there still remained about four hundred sick. + +When the Guards marched out of _Paderborn_, they left the Care of +their Sick to us, who belonged to the General Hospital: the first +Regiment of Guards left sixty sick; the second, twenty-nine; the +third, twenty-eight; and the Granadiers, fifteen, in their regimental +Infirmaries; who were mostly ill of the Malignant Fever: amongst whom +the Infection was so very strong, that, although I procured the Sick +new airy Houses for Hospitals, which were kept as clean and well-aired +as possible, and procured clean Bedding, and clean Linen for every +Man, and had the Sick laid thin, yet several died, and it was some +Time before we got entirely free of the Infection. The first and third +Regiments suffered most, owing to all the Sick of each Regiment being +put into a particular Hospital by themselves, which kept up the +Infection, so that they lost one-third of those left ill of this +Fever; and many of the Nurses, and People who attended them, were +seized with it. But not being able to procure particular Houses for +the Sick of the _Coldstream_ or Second Regiment, and for the +Granadiers, I distributed them through the different Hospitals we had +then in Town, where the Contagion had ceased; and by their being thus +scattered, while they were kept very clean, and at as great a Distance +as possible, from the other Patients in the Wards where they were put, +they lost few in Proportion to the first and third Regiments, and the +Disorder did not spread. + +About the End of _May_, the Weather was very warm at _Osnabruck_; when +this Fever began to make its Appearance in the Corner of a large Ward, +which was next to one kept for salivating venereal Patients; and only +divided from it by means of a few thin Deals. Perceiving a strong +Smell in this Place, I suspected that the Fever arose from the foul +Steams coming from the next Ward, and therefore ordered the salivating +Ward to be thinned, and removed all the Sick from the Places near that +Ward; and ordered those that had catched the Fever to be put into +large airy Places; by which means the Infection spread no further, +and only one, out of six or seven who had got the Fever, died. + +At the End of _June_, the Weather was very hot at _Bilifield_, and the +Fever began to shew itself by the Hospital being overcrowded, by a +greater Number of Sick being sent from the Army than we had proper +Places to put them in; but it was put a Stop to in a few Days, by the +Removal of the Hospital. Seventy Sick were left behind to the Care of +a Mate, most of them ill of the Fever, of whom twelve died. + +In the Beginning of _August_, a few Men were taken ill of the same +Fever at _Munster_, in one of the Hospitals which was too much +crowded; but its further Progress was stopped by sending a Number of +recovered Men to Billet. + +In _November_ and _December_ 1761, and _January_, _February_, and +_March_ 1762, we had several Men sent from Quarters in the Town of +_Bremen_ to the Hospital, sick of the Petechial Fever: they were +quartered on the Ground-floors of low damp Houses, and fresh Meat and +Vegetables so dear that they could not afford to buy them; but were +obliged to live mostly on salt Provisions. I was told likewise that +the spotted Fever was frequent among the lower Class of the +Inhabitants. Some few were seized with this Fever in the Hospital +itself; yet as the House was not crowded, and we had a Number of small +airy Wards, the Infection did not spread; and we had but one or two +who died of this Fever during the Winter, in the Hospital I attended. + +In Summer 1762, we had only ten or eleven ill of this Fever in the +Hospital at _Natzungen_, and only one died. + +When the Troops marched from their Cantonments, in _December_ 1762, +towards the Borders of _Holland_, the twentieth and twenty-fifth +Regiments of Foot left behind them, at _Osnabruck_, thirty sick; five +of whom had Symptoms of the Hospital Fever, though no Petechiæ +appeared; three recovered, and two died suddenly, being lodged in +large open Wards (the only Places we had to put them in) with the +Windows all broke, in very cold frosty Weather. + +In _January_ 1763, we had only three Patients in this Fever, with the +Petechiæ upon them, who all recovered. After this we had none taken +ill of it at _Osnabruck_, while I remained there, which was till the +twenty-fifth of _March_. + +This Malignant Fever begun variously in different Subjects; for the +most part with Cold and Shivering, Pain in the Head, and other +Symptoms, commonly described as peculiar to this Fever. In some, it +begun with a sharp Pain of the Side, or other Parts, attended with +acute inflammatory Symptoms; in others, it put on the Appearance of +the common, low, or nervous Fever, for a Day or two. Blood drawn in +the Beginning from some Patients did not seem much altered; from +others it threw up a strong inflammatory Buff[1]; but where the Fever +had continued some time, it was commonly of a loose Texture, and of a +livid Colour; unless when the Sick were accidentally seized with +pleuritic Stitches, or other Disorders of this kind. + + [1] Dr. _Huxham_, in his _Treatise on the ulcerous sore + Throat_, p. 36, says, "I have very often met with this buffy + or sizy Appearance of the Blood in the Beginning of Malignant + Fevers; and yet, Blood drawn two or three Days afterwards, + from the same Persons, hath been quite loose, dissolved, and + sanious as it were." And in his _Essay on Fevers_, chap. + viii. p. 108. says, "The first Blood frequently appears + florid; what is drawn twenty four Hours after, is commonly + livid, black, and too thin; a third quantity, livid, + dissolved, and sanious. I have sometimes observed the Crasis + of the Blood so broke as to deposite a black Powder, like + Soot, at the Bottom, the superior Part being either a livid + Gore, or a dark green, and exceedingly soft Jelly." + +The Reason of this Difference of Symptoms in the Beginning, and of +these different Appearances of the Blood, seemed to be, that such +Patients as laboured under Pleurisies, low or other Fevers, being +brought into Hospitals where the Malignant Fever was frequent, had +their original Disorders changed into this Fever by breathing a foul +infected Air, and by their Communication with those ill of the Fever, +and of Fluxes; at other Times, a mere Acrimony of the Blood, set in +Motion by a supervening Fever, determined the Disorder to be of this +kind: and I always observed, that those Men were most apt to catch +this Fever, whose Constitutions had been broke down by previous +Disorders. + +The Fever appeared in different Forms. Some had only a Quickness of +the Pulse, attended with a slight Head-ach and Sickness, Whiteness of +the Tongue and Thirst, and a Lowness and Languor; which continued for +a Week or more, and then went off, either insensibly, or with a +profuse Sweat, succeeded by a plentiful Sediment in the Urine. Most of +those who fell into profuse kindly-warm Sweats recovered, the Sweat +carrying off the Fever. These profuse Sweats continued for twelve or +twenty-four Hours, and sometimes for two, three, or four Days. In +those who had the Fever in this slight Degree, the Petechiæ seldom +appeared; and it was only known to be this sort of Fever by the other +Symptoms, and the Malignant Fever being frequent at that time in the +Hospitals. Dr. _Pringle_[2] very justly observes, "That these low +Degrees of this Fever are hardly to be characterised, and are only to +be discovered, in full Hospitals, by observing Men languish; though +the Nature of the Illness, for which they come in, should seem to +admit of a speedier Cure." + + [2] _Observations on the Diseases of the Army_, part III. + chap. vii. sect. 3. third Edition, 1761. + +For the most Part the Fever appeared with more violent Symptoms, the +Tongue became more parched and dry, more or less of a Delirium came +on, attended with the other Symptoms commonly described as peculiar to +this Fever. + +When the Petechiæ appeared, they came out on the fourth, fifth, sixth, +or seventh Day; seldom after the eleventh or twelfth[3]. They appeared +mostly on the Breast, Back, Arms, and Legs, and sometimes, tho' +rarely, on the Face. They had exactly the Appearance described by Dr. +_Pringle_, either like small distinct Spots of a reddish Colour, or +the Skin looked sometimes as if it had been marbled, or variegated as +in the Measles, but of a Colour more dull and lured. As they began to +disappear, they inclined to a dun or brown Colour, and looked like so +many dirty Spots. I never saw them rise above the Skin; nor did I once +see any miliary Eruptions in this Fever; which agreed exactly with +what Dr. _Pringle_ had observed in the former War, and in the +Beginning of this; however, we ought not to conclude from thence that +miliary Eruptions are never observed in Fevers of this kind; for Dr. +_Huxham_[4], Dr. _Hasenohrl_[5] and Dr. _Lind_[6], besides many other +good Practitioners, mention their having seen them. + + [3] _Ramazini_, in his Treatise _De Constitutionibus + annorum_, 1692, 3, 4, _in Mutinensi civitate_, Sect. 19. + mentions the Petechial Fever which had been frequent the + three foregoing Years; in which the Petechiæ appeared + commonly on the fourth or seventh Days, and almost all those + died in whom they appeared on the first Day. These Spots came + out first on the Neck, the Back and Breast; and it was + observed that none escaped unless these Spots extended + themselves as far as the Nails of the Toes, vanishing by + Degrees on the upper Parts. He tells us likewise, that this + Fever was attended with an Inflammation of the Throat, which, + about the Height of this Disorder, terminated in a white + ulcerous Crust. This sore Throat should seem to be the same + which we now call _the malignant ulcerous sore Throat_, which + I never once saw while I was with the Troops in _Germany_. + + [4] Dr. _Huxham_, in his _Essay on Fevers_, ch. viii. p. 97, + tells us, that sometimes, about the eleventh or twelfth Day, + on the coming on of profuse Sweats, the Petechiæ disappear, + and vast Quantities of small white miliary pustules break + out. + + [5] Dr. _Hasenohrl_, in his Treatise _De Febre Petechiali_, + cap. i. p. 12. relates a very particular Case, where the + Petechiæ appeared on the fourth, and the white miliary + Eruptions on the seventeenth Day of the Fever. + + [6] Dr. _Lind_, in his _second Paper on Fevers_, p. 105. + mentions Spots which rise above the Surface of the Skin, and + are of the miliary kind, as common in contagious Fevers, as + he observed among the _French_ Prisoners in _Winchester_ + Castle, in the Beginning of the Year 1761. + +Many had no Petechiæ through the whole Course of the Disorder; but in +all who were very bad, the Countenance looked bloated, and the Eyes +reddish and somewhat inflamed; and though the Skin was commonly dry, +yet the _Perspiration from the Lungs_ was strong. By these +Circumstances one might frequently discover that the Patient laboured +under the malignant Fever, without asking any Questions. + + * * * * * + +When Men were taken ill of a Fever, which we suspected to be of the +malignant kind, our first Care was to lay them in airy Places, +separate as much as possible from the other Men, and to keep them +extremely clean; and they were put on low Diet, and allowed as much +Barley or Rice-water as they chose to drink, which was commonly +ordered to be acidulated with the _Spiritus Vitrioli_. + +For the first two or three Days we could seldom distinguish, with +Certainty, that the Fever was of the malignant kind, though we had +often Reason to suspect it. The Pain of the Head, the Fulness and +Quickness of the Pulse, and other Symptoms, led us commonly to take +away more or less Blood, which the Patient bore easily, and for the +most part it gave Relief[7]. We seldom repeated this Evacuation where +we suspected the Fever to be of the malignant kind, unless a pleuritic +Stitch, an acute Pain of the Bowels, or some other accidental Symptom, +required it; or the Patient was strong, and there were evident +Symptoms of Fullness immediately before we intended giving the Bark, +as shall be mentioned afterwards; for under other Circumstances, if +the Blooding was repeated, and other Evacuations used freely, I always +observed that it did Harm, and was apt to sink the Patient too much; +as Dr. _Huxham_, Dr. _Pringle_, and other good Practitioners, have +remarked. + + [7] Dr. _Huxham_, tho' he says "yet Bleeding to some Degree + is most commonly requisite, nay necessary, in the strong and + plethoric;" yet he afterwards makes the following Remark: + "Besides, the Pulse in these Cases sinks oftentimes + surprisingly after a second Bleeding, nay sometimes after the + first, and that even where I thought I had sufficient + Indications from the Pulse to draw Blood a second time." See + his _Essay on Fevers_, chap. viii. And Dr. _Pringle_ + observes, that in the second Stage of the Disorder large + Bleedings have generally proved fatal, by sinking the Pulse, + and bringing on a Delirium. _Observations on the Diseases of + the Army_, part III. chap. vii. sect. V. + +After Bleeding, if the Patient was costive, or complained of Gripes, +he had a Dose of Rhubarb, or Salts, or a laxative Clyster; but where +there was much Sickness of the Stomach, we gave a gentle Emetic[8] in +the Evening, and the Purge next Morning. And if in the Course of the +Disorder the Sickness and Nausea returned, attended with Griping and +Costiveness, or very fetid loose Stools, these Medicines were +repeated, and a gentle Opiate given in the Evening after their +Operation. + + [8] Dr. _Pringle_ advises giving a Vomit, by way of + Prevention, on the first Appearance of the Symptoms, and at + Night to force a Sweat, by giving a Drachm of Theriac with + ten Grains _Sal volat. Corn. cervi_, and some Draughts of + Vinegar-whey, and to repeat the same the following Night; and + says, he has often seen those Symptoms removed which he + apprehended to be Forerunners of this Fever received by + Contagion; but previous to Vomits, or Sweats, if the Person + be plethoric, it will be necessary to take away some Blood. + _Observ._ part III. ch. vii. sect. 5. Dr. _Lind_, in his + _second Paper on Fevers_, p. 66. says, "To all who are + supposed to be infected by Fevers, during this Stage of + Rigours, a gentle Vomit is immediately to be exhibited before + the Fever be formed, and before the Fulness or Hardness of + the Pulse renders its Operation dangerous. If the Vomit be + delayed too long, and especially if Bleeding must precede it, + the most certain and favourable Opportunity of procuring + Safety for the Patient is past.--That he has found it equally + serviceable in preventing Relapses, when it is given at the + Return of the Shiverings." A loose Stool, or two, should be + procured by the Emetic or Clysters, and he advises Sweating + immediately after, in the manner recommended by Dr. + _Pringle_. At other times "he gave five Grains of Camphire + every four Hours, with large Draughts of Vinegar-whey. Eight + Persons in ten, he says, got quite well by this Treatment." + + I have never had sufficient Opportunities of trying this + Method of Prevention, to determine any thing certain about + it; but it may be worth while to practise it. + +After Evacuations, if the Pulse kept up, we commonly gave nothing but +the saline Draughts, with the _Pulvis contrayervæ_, or some temperate +Medicine, for the first Day or two. As soon as we could distinguish +the Fever to be of the malignant kind, and that the Pulse rather sunk, +we joined some of the Cordials to the saline Medicines, and allowed +the Patient more or less Wine, according to the Degree of the Fever. +Dr. _De Haen_ has found Fault with Dr. _Pringle_ and Dr. _Huxham_, for +administering cordial Medicines and Wine in the low State of this +Fever; but nothing answered so well with us as these Remedies under +such Circumstances; and I have frequently seen every Symptom changed +for the better by their Use; and even when I gave the Bark, in the +Manner recommended by _De Haen_, I often found it necessary to join +the free Use of Wine[9], Cordials and Blisters[10], in order to +support the Patient's Strength. + + [9] _Petrus a Castro_, in his Account of a Petechial Fever, + which was frequent at _Verona_, tells us, that the Sick had a + great Thirst, and an Aversion to Meat, but all of them had + the strongest Desire for Wine, and were perpetually asking + for it, even those who at other Times used to be very + temperate; and that this proceeded from an Instinct of + Nature, which wanted something to support the Strength. _De + Feb. Malig._ sect. iii. chap. 26. Dr. _Huxham_, in his _Essay + on Fevers_, has the following very judicious Remark on the + Use of Wine: "In this View, and in those above-mentioned, I + cannot but recommend a generous red Wine as a most noble, + natural sub-astringent Cordial, and perhaps Art can scarce + supply a better. Of this I am confident, that sometimes at + the State, and more frequently in the Decline of putrid + Malignant Fevers, it is of the highest Service, especially + when acidulated with Juice of _Seville_ Orange or Lemon. It + may be also impregnated with some Aromatics, as Cinnamon, + _Seville_ Orange Rhind, red Roses, or the like, as may be + indicated, and a few Drops of _Elix. Vitrioli_ may be added. + Rhenish and French White Wines, diluted, make a most salutary + Drink in several Kinds of Fevers, and generous Cyder is + little inferior to either. The _Asiatics_, and other Nations, + where pestilential Disorders are much more rife than with us, + lay more Stress on the Juice of Lemons in these Fevers than + on the most celebrated _Alexipharmac._" Chap, viii. second + Edit. p. 123, 4. + + Acid and acescent Liquors have very justly been recommended + and used by most late Practitioners, in this as well as in + other malignant Diseases. Vinegar-whey, Barley-water + acidulated with Lemon-juice, and such other Liquors, make + good Drinks for the Sick; but we were obliged, for the most + part, to use the vitriolic Acid for acidulating the Patient's + Drink, as it was the easiest procured and carried about with + the Flying Hospital. + + [10] If the preventive Method does not succeed, Dr. _Lind_ + advises to have recourse to Blisters; and says, that sixteen + out of twenty will next Morning be free of the Fever. But + adds, this is said, provided the Source of their Infection be + not so highly poisonous as it was in the Garland Ship, or in + other such violent Contagions. Dr. _Pringle_ mentions his + having applied Blisters early, but without relieving the + Head, or preventing any of the usual Symptoms. I have often + ordered Blisters pretty early in the Disorder; and though I + have frequently found them of use in keeping up the Pulse, + and relieving the Head, and other Symptoms, yet I never saw + them have such an immediate Effect as Dr. _Lind_ mentions. + +After reading the Treatises of Dr. _De Haen_ and Dr. _Hasenohrl_, on +this Fever, I resolved on giving the Bark[11] in large Quantities, and +found it to answer the Recommendations given by these Gentlemen; and +shall relate here two or three Cases, out of above a hundred and +fifty, in which I gave it. + + [11] It is long since the _Peruvian_ Bark has been used by + Practitioners in Malignant Disorders, though I do not know + that any body gave it in this Fever to the Amount of an Ounce + per Day, before Dr. _Haen_ and Dr. _Hasenohrl_. Dr. + _Ramazini_ mentions its having been tried in the Petechial + Fever, in the Years 1692, 3, 4. And in a Treatise on the + Plague in the _Ucrane_, published at _Petersburgh_, in the + Year 1750, we are told, that in the _French_ Translation of + the Philosophical Transactions for the Year 1732, there is a + Note to p. 264, telling, that Mr. _Amyand_ informed the + Academy of Surgery at _Paris_, that Mr. _Rushworth_, Surgeon, + had wrote to Sir _Hans Sloane_, on the 23d of _May_ 1723, + that when he was Surgeon to a Ship, in the Year 1694, he had + cured some Men ill of the Malignant Fever, attended with + pestilential Buboes, by means of the _Peruvian_ Bark. Dr. + _Huxham_ has recommended a Tincture of the Bark; and Dr. + _Pringle_, a strong Decoction of it, with some of the + Tincture, in these Malignant Fevers. + +I. _Robert Wilson_, of the Second Regiment of Foot Guards, on the 19th +of _February_ 1761, was seized with a Shivering and Coldness, +succeeded with Heat, Thirst, a short dry Cough, Difficulty of +Breathing, Head-ach, and slight Stitches in his Breast; some Blood was +taken away, which was sizy, and he was ordered two Ounces of the +_Sperma Ceti_ Mixture, with the _spiritus mindereri_, every two or +three Hours. He continued without any manifest Alteration in the +Symptoms, till the 21st, when a Number of dun Petechiæ appeared all +over his Body, particularly on his Breast. The Stitches and Cough were +then much easier, and he had his Medicines as before. On the 22d, he +was seized with a Delirium, and was somewhat comatose; when he was +ordered a Drachm of the Bark every six Hours. The 23d, the comatose +Symptoms had increased, and he had slight Twitchings of the Tendons, a +dry brown-coloured Tongue, and a Faultering in his Speech. The Bark +was continued, with the Addition of two Spoonfuls of Mountain Wine +every two Hours. On the 24th, he had several loose Stools. The 25th, +he was still loose, and went on as before, with the Addition of six +Grains of the _Pilulæ saponaceæ_ in the Evening. The 26th, the +Petechiæ were not so apparent as before, but he had still the nervous +Symptoms, and his Breathing grew more difficult; and therefore a +Blister was applied between his Shoulders, and his Medicines +continued; as they were likewise on the 27th, without any Alteration +in the Symptoms. On the 28th, his Tongue became moister, and the +Pulse, which had been low and quick the four preceding Days, became +fuller and slower. On the 29th, he was much more sensible, his Tongue +more moist, and the Twitchings of the Tendons much less; and in the +Evening he fell into a profuse Sweat, which lasted all the 30th. On +the 1st of _March_, his feverish Symptoms were much abated, his Pulse +was calmer, his Skin moist, his Drought less, and his Urine dropt a +plentiful Sediment. On the 2d, his Fever was almost entirely gone, but +he had still a Cough, and spit up a viscid Matter. He was ordered to +go on as before, with the Addition of two Spoonfuls of the _Sperma +Ceti_ Mixture, and the _Spiritus Mindereri_, when his Cough was +troublesome. He followed this Course till the 7th, when, his Cough and +Fever being gone, he was ordered a Dose of Tincture of Rhubarb; after +which he recruited his Strength daily, without the Assistance of any +more Medicines. + +II. On the 5th of _March_ 1761, _Thomas Stagg_, of the Second Regiment +of Foot Guards, was seized with the same Symptoms as _Robert Wilson_ +had been in the Beginning of his Fever, but in a more violent Degree. +He was blooded to about twelve Ounces, and was ordered a saline +Draught every six Hours. On the 6th, the Blood, which had been drawn +the Day before, had thrown up a slight Buff; it appeared to contain +but a small Proportion of Serum, and the Crassamentum was of a loose +Texture. The feverish Symptoms had increased, with the Addition of a +Delirium: pergat. On the 7th, the Delirium was grown more violent, so +that he could scarce be kept in Bed; his Breathing was difficult, his +Eyes red and florid: A Blister was applied to his Back, and the saline +Mixture continued. On the 8th, there was no Alteration in the Course +of that Day; but being lower towards Night, Blisters were applied to +his Legs, and he was ordered to have a Pint of Wine allowed him in +twenty-four Hours. On the 9th, the Petechiæ appeared over his whole +Body, of a broad dunnish kind; his Breathing became easier, and his +Pulse stronger, though the Delirium was still as bad as before: He was +ordered a Drachm of the Bark every fourth Hour in a saline Draught. On +the 10th, the Bark gave him several loose Stools, but the Petechiæ +were of a more florid Colour; the Delirium was less, and his Tongue +moist, and therefore he was ordered to continue the same Medicines as +the Day before, with the Addition of ten Grains of the _Pilulæ +saponaceæ_ in the Evening. The 11th Day, he fell into a fine breathing +Sweat, his Pulse became fuller and slower, and the Delirium abated: p. +The 12th, his Pulse was regular, and the Delirium gone, and he was +much inclined to sleep. The 13th, after a calm Sleep, which had lasted +twelve or fourteen Hours, he became quite free of Fever. After this he +continued the Use of his Medicines for some Days, and recovered his +Health and Strength daily. + +III. On the 23d of _May_ 1761, _Lionel Thompson_, of the First +Regiment of Foot Guards, was seized with all the Symptoms of a +Peripneumony, attended with a high Fever, for which he was ordered to +be blooded. After losing eight Ounces of Blood, he fell into a +fainting Fit; on recovering out of which, his Breathing being still +much affected, he had a Mixture made of four Ounces of the _Lac +Ammoniacum_, and one of the _spiritus mindereri_, of which he was +desired to take two Spoonfuls every four Hours. The 24th, the Symptoms +the same: He complained of having had no Stool for some Days, and took +half an Ounce of the _sal catharticum amarum_, which gave him two +loose Stools. On the 25th, his Pulse was small and quick, his +Breathing difficult; he was low, and had a slight Delirium: A large +Blister was applied between his Shoulders, and the Medicines +continued. On the 26th, in the Morning, the Petechiæ appeared, and his +Breathing was freer: He was ordered a Drachm of the Bark, in a saline +Draught, every four Hours. The 27th, the Pulse better: p. The 28th, +was more sensible, and had a kindly warm Moisture all over the Skin. +The 29th, the Fever was much abated, and his Tongue, which was before +parched and dry, became moist and white: He continued the Use of the +Cortex for three Days more, which removed the Fever; and being +costive, he took a Dose of the Tincture of Rhubarb. After this he used +the Bark for a few Days longer, and got perfectly well. + +After giving the Bark[12] with Success, in the two first of the Cases +mentioned, and to two young Gentlemen, Mates of the Hospital, who had +caught the Fever from their Attendance on the Sick, I gave it to above +a hundred and fifty at _Paderborn_, and elsewhere, during my +Attendance in the Military Hospitals in _Germany_; and although it did +not answer in every Case, yet it was found to have a better Effect +than any other Remedy that was tried. We joined different Medicines +with it, according to the State of the Patient. We gave the _Confectio +cardiaca_, _Rad. serpent. Virg._ and other cordial Medicines, and +Wine, when the Pulse was low; _Oxymel scilliticum_, and other +Pectorals, when the Breathing was difficult; Opiates, where the +Patient was inclined to be too loose; the _spiritus mindereri_, and +other Diaphoretics, when we wanted to promote a free Perspiration; and +we applied Blisters as Occasion required. + + [12] The _Peruvian_ Bark has not only been found useful in + this Malignant Fever, but has likewise been recommended in + the Plague. See _Morton Oper. Append. secund. Exercitat. + Hist. Febr. Ann. 1658, ad. an. 1691. complexa_. In the Small + Pox, see _Medical Essays_, vol. V. art. x. and has been found + serviceable in the putrid Disorders of the _West Indies_, as + taken Notice of by Dr. _Hillary_; and in the malignant + ulcerous sore Throat in this Country, as Dr. _Wall_ and + others have observed. And in thirty-five Cases of the + malignant ulcerous sore Throat, in which I gave it, joined + with Cordials, and the Use of Acids, I did not lose one + Patient. Nine of them were strong People, and had plethoric + Symptoms, and were blooded in the Beginning; and seven of + them were costive, and took a Dose of gentle laxative Physic + before taking the Bark. The rest had no Symptoms which seemed + to require these Evacuations. However, it ought to be + observed, that this is a Disorder of the malignant kind; and + that although some well-timed gentle Evacuations may be + serviceable in the Beginning, before giving the Bark; yet too + free, or even gentle Evacuations, injudiciously made, will + sink the Patient, and infallibly do Mischief. + + The free Use of the Bark has long been found serviceable in + Mortifications and foul Sores, where the Juices tend too much + to the Putrescent; and has been strongly recommended by Mr. + _Ranby_, Serjeant Surgeon to his Majesty, in the Cure of + Gunshot Wounds. See his _Treatise on Gunshot Wounds_. + +When the Patient was strong, the Pulse quick and full, the Eyes looked +red, and the Breathing was difficult, after the Petechiæ appeared; I +took away more or less Blood before giving the Bark. Most +Practitioners of late Years have been against Bleeding in this Stage +of the Disorder; but trusting to the Assurances given by Dr. +_Hasenohrl_ of its being safe, nay of Advantage to bleed at this Time, +if the Symptoms required it, I ventured upon it, and found it to be of +the greatest Service, in many Cases, in the Hospitals at _Paderborn_ +and elsewhere; and particularly in two Cases at _Bremen_, and one at +_Osnabruck_, where it gave immediate Relief, and seemed to shorten the +Disease much. One of the Patients at _Bremen_, _Robert Ellis_, +belonged to an Independant Company; the other, _Francis Hamstan_, of +the 24th Regiment, had formerly had his Skull fractured, and took the +Fever, while he was in the Hospital, for violent Head-achs, which he +had been subject to, at times, ever after his Skull had been +fractured. The Case at _Osnabruck_ was a Nurse of the Hospital, whose +Name was ---- _Andrews_, a Woman about twenty-five Years of Age, who, +after attending a Dragoon in the Small Pox, and suckling at the same +time her own Child, then in the same Disorder, was, on the 18th of +_January_ 1763, attacked with a Fever. I saw her for the first time on +the 20th, and found her Pulse quick, full, and strong. She complained +of a violent Head-ach; for which she was blooded, and took the saline +Mixture, with Nitre and Contrayerva. Next Day, the 21st, her Blood +appeared very sizy, and she complained of having been costive for some +Days. We gave her immediately an Ounce of the _sal catharticum +amarum_, which operated well. She continued much in the same Way the +22d, and had some loose Stools that Day. Being still inclined to be +loose the 23d, instead of her former Medicines, she was ordered the +_spiritus mindereri_ Mixture, with Mithridate. This checked the +Purging, but did not stop it entirely. The Fever went on, without any +remarkable Change, till the 27th; at which time the Petechiæ appeared +all over her Body, attended with a Redness of the Eyes, and a violent +Oppression and Pain of her Head, and a quick Pulse. I ordered six +Ounces of Blood to be taken away immediately, and a large Blister to +be applied to her Back, and, at the same time, ordered her a cordial +Mixture, with half an Ounce of the Extract of the Bark in it, to be +taken every twenty-four Hours. The 28th, her Pulse was not so hard, +her Head was much easier, the Redness of her Eyes was much less, and +the Petechiæ had begun to die away. The Blood which was taken away the +Day before, had a thin Buff at the Top, but the _Crassamentum_ +underneath was of a dark Colour, and of a loose Texture: p. On the +29th, she told me that she had had two or three loose Stools, and she +was lower than the Day before; and therefore a Drachm of Mithridate, +and two Drachms of the Tincture of Cinnamon, were added to her cordial +Mixture, with the Cortex; and she was allowed half a Pint of Red Wine, +mulled with Cinnamon, _per_ Day. 30th, Her Tongue rather moister than +the Day before; and she not so low, but she was still inclined to be +loose; and therefore was ordered the anodyne Draught at Nights, and to +continue the other Medicines. 31st, She was still inclined to be +loose; but her Pulse kept up, her Tongue was moister, and she found +herself pretty easy: p. _Feb._ 1st, Her Pulse pretty strong, and she +found herself much cooler, and freer from the Fever, and complained of +a Dullness of Hearing. On the 2d, in the Morning, she felt a warm +Moisture all over her Skin, which, about Noon, broke out into a +profuse Sweat, and continued till the 4th; when it went off, and her +Urine let fall a copious whitish Sediment. She had then little or no +Fever. The Dullness of Hearing still continued, though it was much +less than before. After this the Deafness went gradually away. She +continued the Use of the cordial Mixture, with the Cortex, till the +12th, and recovered Strength daily. After this, she had no other +Medicine, except two Doses of the Tincture of Rhubarb, and was soon +in good Health, and able to discharge her Duty as a Nurse. + +However, it ought to be observed, that we must not bleed so freely, in +this or any other Stage of the Malignant Fever, as in acute +inflammatory Disorders, otherwise we shall sink the Patient, and hurry +him to his Grave; and that Bleeding can only take place with Safety +and Advantage, under the Circumstances above-mentioned, immediately +before giving the Bark freely; or where some accidental sharp Pain in +the Breast, or Bowels, or some other violent Symptom, may require it. +They err equally, who recommend Bleeding freely in this Fever, with +those who entirely forbid its Use. + +Although we found the Bark to be in general the best Remedy in this +malignant Petechial Fever, yet it did not answer in every Case; for in +some we found other Remedies had a better Effect: And therefore, when +we observed that, notwithstanding the Use of the Bark, the Patient +sunk, and the Symptoms grew worse, we did not persist obstinately in +its Use, but tried the Effect of other Medicines. + +Towards the End of _May_ 1761, two Soldiers in the Hospital, at +_Osnabruck_, were taken ill of this Fever; who, after using the Bark +freely, and being allowed a Pint of Red Wine _per_ Day, for some Days +together, began to sink, and had a Delirium and other bad Symptoms +hastening on: upon which I laid aside the Use of the Bark, and ordered +each of them a Blister to the Back, and to take a cordial Draught, +with fifteen Grains of Musk in it, every four Hours; and to have their +Wine mulled with Cinnamon; and although at that Time they were both so +low that I scarce imagined they would live twenty-four Hours, yet next +Day I found them greatly mended; and they had a kindly warm Moisture +all over their Skin, and the Pulse had rose considerably in both. By +the Continuance of the same Medicine the feverish Symptoms gradually +abated, and they both got well. + +About the same time, having given the Bark freely for some Days, and +applied a Blister, to another Patient, after the Petechiæ had +appeared, I found him one Morning so low that his Pulse could scarce +be felt. He could not speak; he had a Delirium, and rather a Tremor +than a _subsultus tendinum_, and he had all the Appearance of a dying +Man. However, as he still swallowed whatever was put in his Mouth, I +changed the Bark Mixture for Draughts, which contained a Scruple of +the _confectio cardiaca_, and seven Grains of the _sal vol. corn. +cerv._[13] each, and ordered one to be given immediately, and +afterwards to be repeated every four Hours; and, in the Intervals, to +give him frequently a Tea-cup full of Red Wine, mulled with Cinnamon; +and to apply two large Blisters to his Legs. Next Day, his Pulse had +rose; and by the Continuance of the same Remedies it became gradually +fuller and stronger, and the third Day after he recovered his Voice; +and a warm kindly Moisture which ended in a profuse Sweat coming on, +the feverish Symptoms went off soon after, and he recovered his +Health. + + [13] Dr. _Huxham_, in his _Treatise on the ulcerous sore + Throat_, p. 54, &c. condemns the Use of the volatile alcaline + Salts, in Fevers of the putrid, pestilential, or petechial + kind, as being apt to heat too much, and to hasten the + Dissolution and consequent Putrefaction of the Blood. + However, I cannot help thinking that they are the best + Remedies we can use on some particular Occasions, even in + this Fever; for we have no Remedy which gives such a sudden + and brisk _Stimulus_ to the Fibres as they do. And I have + known many Cases of Patients who were extremely low, and + whose Pulse was scarce to be felt, and others who were apt to + fail into fainting Fits, who have been preserved by large and + repeated Doses of these Salts, and the free Use of Wine, and + acescent Liquors, to correct their alcaline Acrimony in the + Blood. Though as soon as such Patients had recovered from + this low State, I laid these Medicines aside; because I + cannot help agreeing with the Doctor in the Belief, that + their continued Use will produce the Effects he mentions. For + although it be true, that these Salts, when mixed with + putrescent Liquors, or with dead animal Substances, resist + Putrefaction, and, like ardent Spirits and Vinegar (the other + Products of Fermentation) check and put a Stop to that very + Process which produced them: Yet it is also true, that, when + mixed with the Blood of living Animals, they stimulate the + Vessels, and increase the Heat and _Momentum_ of the Blood, + and dissolve it; and therefore I cannot but disapprove the + continuing their Use longer than is immediately necessary. + +At _Bremen_ there were two Men, one in _January_, and the other in +_February_ 1762, on whom the Cortex had but little Effect, who +recovered by the free Use of Mixtures, with the _confectio cardiaca_ +and _rad. serpentariæ_, and of Wine, with the Application of large +Blisters. Several Cases of this kind occurred in the Hospitals, where +the Bark did not answer. + +There is one thing to be observed with respect to Malignant Fevers, +which is, that if ever they appear in large crowded Hospitals, unless +we can thin the Wards, and procure a free Circulation of Air, and keep +the Hospital and Sick extremely clean, the Fevers will continue to +spread, and great Numbers will die; and even the most efficacious +Remedies will have little or no Effect. And that when once the +Infection is grown strong, it requires the greatest Care, and some +Time, before it can be entirely got the better of. And that if a great +number of Men, ill of this Fever, be kept in the same Ward, they will +help to keep up the Infection; and therefore it is always proper, when +it can possibly be done, to lay but a few of them in one Ward; not +above one-third of the Number generally admitted. + +Many of the Patients, towards the Height of this Fever, sooner or +later, had a Purging, which seldom proved critical; and some were +seized with the Flux. A gentle _diarrhoea_, such as did not sink the +Patient, was commonly of Service; but when violent, or a Dysentery +came on, the Case was always dangerous; for whatever stopped the Flux +increased the Fever; and, if the Purging or Flux continued, it sunk +the Patient. Such Fluxes we treated in the Manner to be mentioned +afterwards, when we come to the History of the Dysentery. + +In this Fever, it was common for Patients to vomit Worms[14], or to +pass them by Stool, or, what was more frequent, to have them come up +into their Throat and Mouth, or sometimes into their Nostrils, while +they were asleep in Bed, and to pull them out with their Fingers. The +same Thing happened to most of the _British_ Soldiers, brought to the +Hospitals for other feverish Disorders as well as this. Dr. +_Pringle_[15] when he mentions Worms being observed in this Fever, +seems to embrace _Lancisius_'s Opinion; and believes that these Worms +are not the Cause of the Fever; but being lodged in the Intestines, +before the Fever comes on, they are annoyed by the Increase of the +Heat, and the Corruption of the Humours, in the Cavity of the +Intestines of Persons labouring under Fevers, especially of the putrid +Kind; and so they begin to move and struggle to get out. This seemed +evidently to be the Case with many of the Patients we had; though in +some the Worms seemed to have given Rise to the Fever, which the bad +State of the Patient's Humours, or the infected Air of Hospitals, +determined to be of this Kind. In many, the Fever lessened, or went +off entirely, soon after; and they were no more affected with Symptoms +of Worms. But some notwithstanding were subject to frequent Sickness, +Pain of the Stomach, and Uneasiness in the Bowels, and discharged some +Worms from Time to Time. Others had frequent Relapses into Fevers, +which seemed to be owing to the Irritation of these Insects. + + [14] Some Men passed only one Worm; others, two or three; + some, six or seven; and one Man, of the Guards, in _January_ + 1763, after passing three by Stools in the Course of a Fever + of this Kind, discharged fourteen more upon taking a Dose of + Rhubarb and Calomel after the Fever was over. + + [15] _Observations on the Diseases of the Army_, part iii. + chap. iv. Note to p. 213. third Edition. + +It is no Wonder that Worms of the round Kind should be productive of +troublesome Symptoms, and occasion these Relapses; since we know that +they have sometimes perforated the Intestines, and been found in the +Cavity of the Abdomen[16]. + + [16] See _Hoffman_'s Works, vol. III. chap. x. _River. + Observ. commun._ Obs. 13. _of Observations found in a + Library._ _Bonetus's Sepulchret. anatom._ tom. II. _Gualther + van Doeveren's Inaugural Dissertation de Vermibus + intestinalibus_, published at _Leyden_, 1753; and _Lancisi_'s + Works; for Cases where the internal Coats of the Stomach, and + Intestines, have been eroded, and all the Coats perforated by + Worms of the round Kind. + +As soon as we observed a Patient to be troubled with Worms, if his +present Situation did not prevent it, we gave twenty-five or thirty +Grains of Rhubarb, with five or six Grains of Calomel; and if there +was much Sickness, we likewise gave an Emetic; which, in more than one +Case, brought up two or three Worms of the round Kind, and gave great +Relief. But where the Fever was violent, we were obliged to neglect +this Symptom of Worms for the present; and when the Fever was over, if +there still remained any Symptoms of Worms, we gave the purgative +Medicine once or oftener, and in the Intervals gave the _pulvis +stanni_, or an Infusion of Camomile Flowers; and in some Cases, oily +Medicines. By these Means most of the Patients got well and recovered +their Health, and seemed to be freed, at least for the present, from +these troublesome Insects; though a few continued to complain of +Sickness, and other Symptoms of Worms, for some Time afterwards. + +What was the Cause of the Army's being so much troubled with Worms of +the round Kind, is not easy to ascertain; unless it was owing to the +great Quantity of crude Vegetables, and Fruits, which the Soldiers eat +in the Course of the Summer and Autumn, and to the bad Water they were +often obliged to drink. + +In the Malignant Fever at _Paderborn_, many complained of a Dysuria, +and some of a Suppression of Urine, especially towards the Decline of +the Fever; and others, of a Scalding and Pain in making Water, though +they had no venereal Complaint. These Symptoms appeared in other +Places, but not near so frequently as at _Paderborn_. Decoctions of +Gum Arabic, with some of the _spiritus nitri dulcis_, and oily +Mixtures, and Opiates, commonly gave immediate Relief, and soon +removed this Complaint. + +One of the first salutary Symptoms which most generally appeared in +those who recovered, was a Dullness of Hearing, or Deafness[17]; which +came on about the Height of the Fever, and continued a longer or +shorter Time, generally till the Fever was entirely gone; and +sometimes for a considerable Time afterwards. For the most Part we +did nothing for this Complaint, and it went off as the Patient +recovered his Strength. When it continued long, Blisters applied +behind the Ears, or on the Neck, and washing the _meatus auditorius_ +with the emollient Decoction, in which a small Quantity of Soap was +dissolved, proved of Service. + + [17] _Riverius_ tells us, that, according to _Hippocrates_'s + Doctrine, Deafness is a very dangerous Symptom in the + Beginning of acute Disorders, though it be a good Omen, and + portends Health, when it does not appear till the Height of + Fevers, especially those of a malignant Kind; and adds, that + he himself has a thousand Times observed, that those + labouring under this Fever have recovered, when this Symptom + of Deafness came on at the Height (_in statu_) though the + other Symptoms threatened much Danger. _Prax. Medic._ lib. + XVII. sect. iii. cap. i. p. 451. + + This Symptom of Deafness occurs in other Fevers as well as in + this, and often proves a good Symptom in them likewise, as I + have frequently observed. Two remarkable Examples of which I + had under my Care in St. _George_'s Hospital, in the Year + 1759. On the 17th of _January_ 1759, _James Donaldson_, a + young Man of nineteen Years of Age, was admitted into the + Hospital for a Fever, attended with a Stupor and a Delirium, + a parched dry Tongue, and other Symptoms of a Fever of the + inflammatory Kind, for which he had been blooded, and used + other Evacuations. On the 19th, after the Application of a + Blister, he was seized with almost an entire Deafness; after + which, all his other Symptoms became milder, and he mended + daily, and was entirely free from the Fever by the 30th. On + the 10th of _April_ 1759, a Youth, _John Young_, fifteen + Years of Age, was admitted into the same Hospital for a + Fever, which had already continued fourteen Days. His Speech + was affected, and he had entirely lost the Use of his Limbs, + was delirious, and had other bad Symptoms. On the 12th, his + Hearing became exceedingly dull, and he recovered daily + afterwards, and was discharged, cured, the 2d of _May_, + having recovered the Use of his Legs as well as got free of + the Fever. + +Swellings of the parotid Glands appeared in many Subjects, towards the +Decline of the Fever, which came to Suppuration, and proved critical. +In two only, out of those I attended while in _Germany_, they came on +early in the Fever, but did not suppurate. Both Patients died; all +the rest recovered, except one old Man, an Invalid at _Bremen_; who, +after having one Swelling appear on the right Side, which came to +Suppuration, and seemed critical, relapsed into the Fever; and another +formed on the other Side, which came likewise to Suppuration, and the +Fever ceased, after having reduced him very low; but the great +Discharge from the Sores wasted him gradually, and he died hectic in +about a Month after the Fever had left him[18]. + + [18] But although these parotid Swellings were in general so + favourable with us, we are not to imagine that this will + always be the Case: for _Riverius_, though he speaks of these + Swellings proving for the most part critical; yet he tells + us, that, in the Year 1623, this Fever was epidemic at + _Montpelier_, and that almost one half of the Sick died; and + particularly, that most of those who had Swellings of the + parotid Glands appearing about the 9th or 11th Day, were + carried off within two Days of their Appearance. Having + attended several who died from the Swellings not coming to + Suppuration, he began to consider in his own Mind, what might + be the Cause of their Death, and concluded, that it was owing + to there being a greater Quantity of morbid Matter in the + Blood than the Part was able to contain, and that Evacuations + by blooding and purging were the only Remedies which were + likely to give Relief; and therefore, in the first Case of + this Kind, in which he was afterwards consulted, he ordered + three Ounces of Blood to be taken away, notwithstanding the + Patient was so low that the Surgeon was afraid he would have + died in the Operation: The Pulse rose on bleeding, and he + ordered four Ounces more to be taken in three or four Hours + afterwards: The Pulse rose still more, and he ordered a Dose + of Sena and Rhubarb to be taken next Day, and the Patient + recovered. And he adds, that all those who were treated in + this manner got well. _Prax. Med. Lib._ XVII. _sect._ iii. + _cap._ 1. + +As soon as these Swellings of the parotid Glands appeared, we +endeavoured to bring them forward to Suppuration, by the Application +of emollient Cataplasms, or of gummous Plaisters; and had them opened +as soon as a Fluctuation of Matter was to be felt, and afterwards +treated them as common Abscesses. _Riverius_[19] very justly observes, +that when such Tumours encrease in such a Manner as to endanger +Suffocation, they ought to be opened before they come to Maturation; +and Dr. _Pringle_[20] desires us not to wait for a Fluctuation of +Matter, but to open the Abscess as soon as it can be supposed to have +formed. + + [19] Ibid. + + [20] _Pringle's Observations on the Diseases of the Army_, + Part III. chap. vii. + +In _February_ 1761, three Patients in the Decline of this Fever had +Buboes formed in the Groin, which proved critical. At first, on +observing them, I suspected them to be venereal; but on examining the +Patients, they obstinately denied their having any Reason to suspect +any such Cause; and the favourable Manner in which they healed without +the Appearance of any other venereal Symptom, made me believe what +they asserted to be true; especially as such People are not shy in +owning Complaints of that Kind. The first Patient I saw who had a Bubo +in the Decline of one of these Malignant Fevers, was a Woman, Wife to +a Soldier of the thirty-seventh Regiment of Foot; she had a Child at +her Breast, and her Husband was living with her at the Time she was +taken ill of the Fever, and neither of them had the least venereal +Complaint. In a few Days afterwards, two Soldiers in other Hospitals, +towards the Decline of very bad Petechial Fevers, had likewise Buboes +formed in the Groin, without any Suspicion of a venereal Taint. Except +in these three, I did not see any critical Buboes appear in this Fever +while I was with the Troops in _Germany_; tho' Mr. _Lovet_, who +served as a Mate to the Hospitals, and who was at _Hoxter_, where we +had another Hospital established, while I was at _Paderborn_, told me, +that, in the Beginning of the Year 1761, they had several Men in the +Hospital ill of this Fever, who had critical Buboes formed in the +Groins and Armpits[21]. + + [21] This Symptom of Buboes is taken Notice of by Authors, + but does not seem to be so frequent as many of them would + make us believe. Neither Dr. _Huxham_ nor Dr. _Pringle_ + mention their having seen such Buboes; and Dr. _Lind_ says, + that he never saw them till the Beginning of the Year 1763. + +About the same Time that these Buboes appeared, severals towards the +Decline of this Fever complained of a Pain all along the Spermatic +Chord; and soon after a Swelling of the Testicle appeared[22]. +However, this Complaint was not peculiar to those who had the Fever; +for others recovering from Fluxes, and other Disorders, were likewise +affected with such Swellings. I did not observe any Symptom of this +Kind in Fevers while I was with the Troops in _Germany_, except in +_January_, _February_, _March_, and _April_ 1761. By Bleeding, and +applying emollient Fomentations and Cataplasms, and bathing the Parts +with _spiritus mindereri_ on the first Attack of the Pain, the +Swelling of the Testicle was prevented; but where no Mention was made +of this Pain till the Swelling had already begun, it commonly ended in +a Suppuration of the Scrotum or Testicle, which healed very kindly. We +had no Reason to suspect any venereal Taint in any of them. + + [22] _Hippocrates_ takes Notice of Swellings of the Testicles + in Fevers. He tells us, that a Man from Alcibiades had his + left Testicle swell before the Crisis of a Fever. _See his + Second Book on Epidemics_, sect. ii. And he mentions this + Symptom as a Crisis in the ardent Fever. _See his Book on + Crises_, sect. xi.--And Dr. _Antonio Lizzari_, in a Treatise + which he published on the _Acute Diseases which were frequent + at Venice, and all over Italy, in the Years 1761, 62_, tells + us, that Abscesses of the Scrotum and Testicles frequently + followed the Measles. + +Many, while recovering from this Fever, were seized with an +Ophthalmia, or Inflammation of the Eye; for the most part of one Eye +only, sometimes of both. When the Patients were strong, they were +blooded, and had Blisters applied behind the Ears; and sometimes, +where the Pain was great, had Poultices of Bread and Milk applied to +the inflamed Eye; which, with the Assistance of some cooling Physick, +commonly removed this Complaint; tho' in some obstinate Cases we were +obliged to repeat the Evacuations, to apply Leeches to the Temples; +and after the acute State of the Disorder was passed, to order the Eye +to be washed frequently with the Collyrium vitriolicum, or Collyrium +Saturninum, before we got the better of this Complaint. However, it +ought to be observed, that if these astringent Collyria were used too +soon, they did hurt. When these Ophthalmias were neglected in the +Beginning, the Inflammation frequently rose to a great Height, and +left an Obscurity or Philm over the Cornea, which remained an +Impediment to the Sight not to be removed. + +Towards the Decline of these Fevers, and very often during the Course +of them, many complained of Pains in their Feet and Toes, which +sometimes ended in Mortifications, especially where the Patients lay +in very cold Wards. For the most Part, the Mortification extended no +further than the Ends of the Toes, tho' in some it spread over the +Feet, and in two or three advanced up the Leg. Several lost one or +more Toes; and in _February_ 1761, one Man lost Half of each Foot; +another lost both Feet, and Part of each Leg. Both got the better of +the Fever, tho' the Man who lost both Feet languished a long time +afterwards. These Pains of the Feet and Toes, and the Mortifications +which followed, were for the most part owing to the Patients being +exposed to too much Cold while they were very weak, the Circulation +languid, and the Juices vitiated by a putrid Distemper; by which means +the Vessels were rendered incapable of carrying on the Circulation in +their extreme Branches[23]. + + [23] These Pains and Mortifications of the Feet and Toes were + not confined to those who were brought low by malignant + Fevers; for, during the very hard Frost in the Beginning of + the Year 1763, many of the Patients who lay in very large + open Wards in the Hospital at _Osnabruck_, were affected in + the same Way. One Man had both Feet, and Part of each Leg, + compleatly mortified, and died in about nine Days after the + first Appearance of the Mortification. One lost half of one + Foot, and some Toes of the other; and the third lost the + first Joint of some of his Toes, and the Ends of others. + +As soon as the Sick began to complain of these Pains of the Toes and +Feet, I found the best Remedy to be, the Bathing of the Feet in warm +Water, or in warm aromatic Fomentations; and, after keeping the Feet +for some time in these warm Liquors, to dry them well, and then rub +them with the _linimentum saponaceum_, or _linimentum volatile_, and +wrap them up in Flannel. And if ever any Lividness or Redness appeared +on the Parts, we gave plentifully of the Cortex and Cordials, if not +contra-indicated by the other Symptoms. When Vesicles arose on the +Part, and a Gangrene formed, we directed the Parts to be scarified, +and proper Dressings to be applied, while warm aromatic Fomentations +and Cataplasms were used. + +In _January_ 1762, one Patient, ill of the Petechial Fever at +_Bremen_, had a Lividness and Blackness, threatning a Mortification, +which appeared at the End of his Nose. I expected for some Days, that, +if he recovered, he would lose Part of his Nose; but, by giving him +large and repeated Doses of the _cortex_ and _confectio cardiaca_, in +a Mindereri Mixture, and allowing him the free Use of Wine, its +further Progress was prevented; and as the Patient got clear of the +Fever, the Nose recovered its natural Colour, and only the scarf Skin +peeled off from the End of it. + +When the Fever continued long, and reduced the Patients low, it was +very common for the Back, and Parts on which the Weight of the Body +rested, to mortify. As soon as any thing of this Kind was observed, we +ordered such Parts to be covered with proper Dressings, and gave the +Bark and Cordials freely; and took care to make the Patient change his +Posture; and by Pillows prevented as much as possible the Weight of +the Body from resting on that Part. By this Treatment, many recovered, +where the Fever was on the Decline, and the Strength not too much +exhausted; even tho' a very large Surface of the Skin had mortified; +but where the Patients were very low, and the Fever still continued, +or where it was complicated with a Flux, which kept them perpetually +nasty, and exhausted the Strength, it generally proved fatal. + +Patients, who were reduced very low by this Fever, or by repeated +Relapses, were subject to oedematous Swellings; especially of the +Feet, towards the Evening, after sitting up all the Day. These +Swellings generally went away as the Sick recovered their Strength; +but in some Cases they continued obstinate, and ascended towards the +Thighs; and in some spread all over the Body, and terminated in an +universal Anasarca. + +When these Swellings were recent, and confined to the Feet and Legs, +commonly the Bark joined to the lixivial Salts, or the Oxymel of +Squills, or other Diuretics, and a Purgative once or twice a Week, +removed them. In some, an Infusion of Horse-radish had a good Effect; +in others, Sweats brought out by means of _Dover_'s Powder, or of the +_guttæ antimoniales anodynæ_. + +Sometimes these Swellings were very obstinate, and resisted the Force +of all internal Remedies. In such Cases, Punctures made in the Feet, +or lower Part of the Legs, which furnished a Drain for the Water, had +a good Effect. Blisters applied to the Legs were of Service to some. +When the Punctures were made, or the Blisters applied, before the +Patient's Strength was exhausted, provided that he laboured under no +other Disorder but these oedematous Swellings, which proceeded from +Weakness, I never observed any bad Effects from them; tho' I used them +both repeatedly in a Variety of Cases. But if the Patient was very +weak; or had a Hectic Fever or Purging; or other Disorders, and the +oedematous Swellings large; then oftentimes the great Discharge +exhausted his Strength, and a Gangrene and Death were the Consequence. + +One of the most remarkable Instances of the good Effects of Blisters, +was in the Case of a Soldier at _Paderborn_; _Thomas Hope_, of the +Second Regiment of Foot Guards, after a Fever of this Kind, was +swelled all over, especially about the Face and Neck, and had a +Difficulty of Breathing: after having tried Variety of Medicines for +this Complaint, without any Effect, he had a large Blister applied to +his Back, and took the Cortex in a Mixture, with the Oxymel of +Squills. As soon as the Blister began to discharge, the Swellings +decreased; and were afterwards entirely removed by the Help of one or +two Doses of Physic, and the continued Use of the Medicines before +prescribed. Three other Men in the Hospital at _Osnabruck_, in _May_ +1761, having oedematous Swellings of the Feet and Legs, which yielded +to no internal Remedies, had Blisters applied to their Legs, used the +Cortex, with the lixivial Salts, two or three Times a Day, and a Purge +every fourth Day; which removed the Swellings in a short Time. + +Some of the Soldiers, who had repeated Hospital Fevers, had their +Blood so much broke down, as to be subject to profuse Hæmorrhages from +the Nose; and some of them passed Blood likewise by Stool; which +reduced them to a very low State, sometimes attended with imminent +Danger. In such Cases we found nothing to answer so well as to give +freely of the Bark; to acidulate their Drinks with the _spiritus +vitrioli_; to allow them as much Red Wine as the Strength and present +Circumstances could bear; and at the same Time to support the +Patient's Strength by a mild Diet, of light Digestion; as Water or +Rice Gruel, Panado, weak Broth, and the like. When there was a +Tendency to a Diarrhoea, we were obliged to add some of the +_electuarium diascordii_ to the Cortex, and frequently to give an +Opiate in the Evening. One Case, where this Method of Cure had a very +remarkable good Effect, I had under my Care at _Paderborn_. A Soldier +who lay in one of the lower Wards of the Jesuits Hospital, after a +Malignant Fever, attended with a Flux, used to bleed at the Nose, to +four, five, or six Ounces at a Time; and once or twice lost near a +Pint of Blood, of a dark Colour, very thin and watery, and of so loose +a Texture, that the grumous Part scarcely coagulated. This Evacuation +brought him so low, that he could scarce turn himself in Bed; and his +Pulse might be said rather to flutter than beat: By the continued Use +of the Bark, and of Cordials, and Drinks acidulated with _spiritus +vitrioli_, and some Spoonfulls of mulled Red Wine every two or three +Hours, he was restored to Health and Strength. The only Accident which +happened during the Cure, was a Threatening of a Looseness, and the +Return of his Flux; which however was stopt by a Dose of the +_tinctura rhei_; by joining some of the _electuarium diascordii_ with +the Bark, and giving an Opiate in the Evening. + + * * * * * + +Putrid Malignant Fevers, attended with Eruptions, are taken Notice of +by _Hippocrates_[24], and other antient Authors[25]; but whether they +meant that particular Sort of Eruption which we now call Petechiæ, is +uncertain; as their Descriptions are not clear enough to distinguish +it from the Miliary and other Kinds. But since the Year 1500, we have +had many accurate Accounts of Fevers of this Kind, which have appeared +in different Parts of the World: from all which it appears that such +Fevers generally take their Rise either from some antecedent Acrimony +of the Blood; or, what is more frequent, from some Source of +Corruption or Contagion; from the Use of putrescent animal Food, and a +Want of fresh Vegetables and acescent Liquors; from the putrid Steams +of corrupted animal Substances; from the moist putrid Vapour of low +marshy Places in Summer, where there is stagnating Water, which +corrupts by the Heat; from the foul Air of crowded Hospitals, Jails, +and Ships; and from such like Causes[26]. + + [24] _Hippocrat._ lib ii. popul. sect. iii. text. 2. + + [25] _Aetius Tetrab._ ii. sect. i. cap. 129. _Actuar._ lib. + i. cap. 23. + + [26] See these Causes mentioned by _Riverius_, and since more + fully explained by Dr. _Pringle_, _Observations on the + Diseases of the Army_, part iii. chap. vii. + +When once this Fever begins, it is observed to be of a contagious +Nature, and (if proper Care is not taken) to affect those who attend +the Sick, or who live in the same Room, and breathe the same Air with +them. + +Many Authors have reckoned the Malignant, Petechial, and Pestilential, +to be distinct Species of Fevers; and have treated each of them under +a particular Head. But _Riverius_[27] has very justly observed, that +they all belong to the same pestilential Tribe, and only differ from +one another in the Degree of Infection, and the Violence of the +Symptoms[28]; and that they are to be cured by the same general +Treatment, and the same Medicines. + + [27] _River. Prax. Med._ lib. xvi. sect. iii. Præfat. + + [28] The Malignant or Hospital Fever, and Petechial, seemed + to me to be entirely the same Disorder, and the Petechial + Spots to be only a Symptom which appeared sometimes, but not + always. And _Riverius_ says, the Petechiæ do not always + appear; but when they do, it is a most certain Sign of a + Pestilential Fever. See his _Prax. Med._ cap. xvi. sect. iii. + + + + +OF THE DYSENTERY. + + +The Dysentery generally began to appear soon after the Army took the +Field; and became frequent about the End of _July_, and continued so +till the Army went into Winter-Quarters; and through the Winter, many +of those, who had this Disorder in Autumn, relapsed, upon returning to +their Duty; or by drinking too freely of spirituous Liquors, and being +irregular in their Living. + +It is now generally agreed upon, that this Disorder is entirely +produced by such Causes as make the Juices become too putrescent, and +turn the Flow of Humours to the Bowels; and in the Camp it seemed to +arise principally from an obstructed Perspiration caused by the Men's +lying in the Field, and doing the necessary Military Duties in all +Sorts of Weather; at the same Time being often exposed to the putrid +Steams of dead Horses, of the Privies, and of other corrupted Animal +or Vegetable Substances[29], after their Juices had been highly +exalted by the Heat of Summer. + + [29] The Dysentery has been long alledged to arise from a + putrescent Cause in Camps; from the Smell of corrupted dead + Animals, and of Excrements, during the Heat of Summer. + _Ramazini_, in his Chapter on Camp-Diseases, informs us, that + Dr. G. _Erric Barnstorff_, Physician to the Duke of + _Brunswick_, who served five Campaigns with the _Brunswick_ + and _Lunenburg_ Troops in _Hungary_, told him, that the Camp + Diseases, particularly the Malignant Fever and Dysentery, + took their Rise from the Troops remaining long encamped on + the same Ground, and being exposed to the corrupted Steams of + the Bodies of dead Men, Horses, and other Animals, which lay + unburied; and of Excrements, which were not covered with + Earth. And these Causes have since been particularly taken + notice of by Dr. _Pringle_, in his _Observation on the + Diseases of the Army_. + + Many have imputed the Cause of this Disorder to the eating of + Fruit in excess, because it generally appears about the + Middle of Summer, the Time the Fruit begins to be in Season, + and continues through the Autumn. But from later Observations + this should seem to be a vulgar Error. Dr. _Pringle_ (part i. + ch. iii. p. 20.) tells us, that, in the Year 1743, this + Sickness began and raged before any Fruit was in Season, + except Strawberries, (which from their high Price the Men + never tasted) and ended about the Time the Grapes were ripe; + which growing in open Vineyards were freely eat by every + body. And Dr. _Tissot_, in a Treatise which he published, + called _Avis au Peuple sur la Santé_, in his Chapter on the + _Dysentery_, § 320, says, that ripe Fruit, especially the + Summer-Fruits, are so far from being the Cause of the + Disorder, that they are the great Preservatives against it: + he says, that, in the Years which the Fruit is most + plentiful, the Dysentery is least frequent; and he relates + several Instances where the Use of ripe Grapes proved a Cure + for the Disorder. Eleven People were attacked by the + Dysentery, nine eat Fruit, and all recovered; the other two, + a Grandmother and Child, from Prejudice, eat none, and both + died. A Regiment of _Swiss_ Soldiers, in Garrison in the + South of _France_, had the Dysentery very frequent among + them. The Captains purchased some Acres of a Vineyard, and + carried the sick Soldiers to the Field, and gave them the + Grapes to eat; and ordered the Men in Health to live upon + them chiefly. After this not one Person died, nor was any one + seized with the Distemper.--In an Account of a Treatise on + the Dysentery, published at _Hamburg_ in 1753, which was + epidemical the Year before, in _August_ and _September_, we + are told, that it did not proceed, as is commonly believed, + from the eating of Fruit; for it was observed, that those who + eat Fruit freely escaped better than those who abstained from + it altogether. _Vide Comment. de Rebus in Hist. Nat. & + Medecin. Gestis_, vol. II. par. iv. sect. v. + + Generally in _August_ and _September_ we have People admitted + into _St. George_'s Hospital for the Dysentery; who have + certainly not catched the Disorder from eating of Fruit, but + from working in the Fields, and being exposed to Causes + similar to those which produce the Dysentery in Camps. + +At the Time the Petechial Fever was frequent at _Paderborn_ in +_January_, _February_, and _March_ 1761, the Flux frequently +accompanied it; and we had in the Hospitals likewise a Number of old +Cases of this Kind, the Remains of the preceding Campaign about +_Warbourg_; besides some Men who had relapsed during the Winter, and +were sent to us when the Troops marched, upon the Winter-Expedition, +into the Country of _Hesse_. In _May_ and _June_, what Fluxes we had +at _Osnabruck_, were the remaining old Cases of the Hospitals of +_Munster_, _Paderborn_, _Hoxter_, and _Niehms_. Some few recent ones +were sent to _Bilifield_ about the End of _June_, and above 300 to +_Munster_, in _July_ and _August_. Those sent to _Bremen_, in +_November_ and _December_, had continued for some time before they +reached us; but a good many of the Soldiers in the Garrison were taken +ill of this Disorder, and sent immediately to the Hospital. In the +Beginning of _May_ we had but four ill of this Complaint in the +Hospital I attended; and there were not above six or seven, among the +Sick sent down from the Army, in the Middle of this Month. In _June_ +there were but two sent to the Hospital at _Minden_; and not above ten +among the Sick sent to _Natzungen_ in the Beginning of _July_; tho' +towards the Middle of this Month they began to be more frequent; and +continued to be more so in _August_ and _September_; and in the +Hospital at _Osnabruck_ we had not above five or six ill of this +Disorder, in _December_ 1762, and in _January_, _February_ and _March_ +1763. + +The Dysentery commonly begun with Sickness and Gripes, succeeded by a +Purging, and attended with more or less Fever. Very soon the Gripes +became more severe, attended with a Flatulency in the Bowels, and +often with a Tenesmus. The Stools were chiefly composed of Mucus, +mixed with Bile, and more or less Blood: tho' sometimes no Blood could +be observed in them; and then the Soldiers used to say they had the +White Flux. + +After eight, ten, or twelve, Days, if the Disorder was not complicated +with any other, there remained little or no Fever, unless where some +Accident supervened; tho' in Cases which terminated fatally, towards +the latter End came on a Fever of a low malignant Kind, attended with +black fetid Stools, Lientery, Hiccup, Stupor, and other bad Symptoms. + +It often happened, that, after the Dysentery had continued for some +Time, the Sick complained for a Day or two of severe Gripes; and then +discharged along with the Stools little Pieces of hardened Excrements; +at other Times, tho' more rarely, little Pieces of white Stuff like +Tallow or Suet: Frequently small Filaments, and little Pieces of +Membranes, were found floating in the Stools; and it was very common +for the Sick to vomit up Worms of the round Kind, or discharge them by +Stool[30]. + + [30] Most Authors, who treat of the Dysentery, mention this + Symptom of Worms; and Dr. _Huxham_ tells us, that, in some + Seasons, he has seen round Worms in the Stools of most of the + Dysenteric Patients. _De Aere_, vol. II. p. 98. + +In the Course of the Disorder, the Men often complained of a violent +Pain of the Rectum, near the Fundament, which was most excruciating +when they went to Stool; it continued for some Days, sometimes for a +Week or more; and then they passed more or less of a Yellow Pus with +their Excrements, and the violent Pain ceased. Mr. _A. Tough_, one of +the Apothecaries to the Military Hospital in _Germany_, was the first +who told me that I should find Pus mixed with the Stools: on my +mentioning a Case of this Kind, which had been relieved by Bleeding, +and Clysters often repeated; he told me he had observed it frequently +at _Gibraltar_; and was at a Loss to understand the Nature of the +Symptom, till he observed the Matter in the Stools; which at once +shewed him that it had been originally an acute Inflammation of the +Part, and pointed out to him the proper Method of Cure. + +Oftentimes the Bilious and Malignant Fevers terminated in the +Dysentery; or were accompanied with it, when it might be looked upon +as a Symptom of these Fevers. + +The Appearances we found after Death in the Bodies of some Patients, +who died of old Fluxes at _Bremen_, were: In all of them the Rectum +was inflamed, and partly gangrened, especially the internal Coat. In +two the lower Part of the Colon was inflamed, and there were several +livid Spots on its great Arcade. In one whose Body was much emaciated, +and who had been seized with a violent Pain of the Bowels two Days +before his Death, all the small Guts were red and inflamed; and in +another there were livid gangrened Spots on the Stomach[31]. + + [31] From the Accounts we have in Authors, of the Dissection + of the Bodies of Persons who died of the Dysentery, it would + appear; that there is no Part of the alimentary Canal which + has not some time or other been found inflamed, or in a state + of Suppuration or Gangrene; and the Liver, Spleen, and other + Viscera, have likewise been found diseased, but the Rectum + and Colon have almost in all been more or less affected. The + following Account I had, in the Year 1748, from the late Dr. + _L. Fraser_, who afterwards practised in the Island of + _Nevis_, two Days after the Patient died. _Mary Reid_, a + Woman thirty Years of Age, was taken ill of a Dysentery, + which in Three Weeks Time killed her. In her Life-time she + complained, more than ordinary, of Gripes in her Belly, + especially in her Left Side. Her Body was opened in Presence + of Dr. _Dundas_, who had attended her, during her Illness. + All the Intestines and Mesentery were inflamed, especially + the Colon and Rectum; the internal Side of which was quite in + a mortified State, and contained little Vesicles full of a + putrid fetid Liquor, Numbers of which she had evacuated by + Stool some Days before her Death. + +There was no Disorder we were more successful in the Cure of, than +recent Fluxes; but after they had continued for Weeks, and were become +in a manner chronic, they often foiled all our Endeavours, and a great +Number died[32]. + + [32] While this Sheet was in the Press, I received Dr. + _Pringle_'s 4th Edition of his _Observations on the Diseases + of the Army_, and Dr. _Baker_'s Treatise on the _Dysentery + which was epidemic in London in the Year 1762_. Both these + Gentlemen give an Account of the Dissection of the Bodies of + some People who died of the Dysentery; where, besides the + common Appearances of the inner Surface of the Rectum and + Colon being covered with a bloody Slime, and their internal + Coats being inflamed, gangrened, or in a putrid State, there + were observed on the Inside of the lower Part of the Colon, + and upper Part of the Rectum, a Number of little Tubercles, + or Excrescences, which resembled the Small Pox, of a flat + Sort at the Height of the Disorder; but differed from them in + this, that they were of a firm Consistence, without any + Cavity: they were believed to take their Rise from the + cellular Membrane, which lies immediately above the villous + Coat. Perhaps such Tubercles might have been found in the + Colon and Rectum of those Bodies we opened; but not looking + for them, they may have passed unobserved. + + _Morgagni_, in his Book lately published, _de Sede & Causis + Morborum_, epist. xxxi. is of Opinion, that the Filaments, + and Pieces of Membranes, which are frequently observed in the + Stools, are often formed of inspissated Mucus and Lymph, and + other Liquors; and not the Fibres, or Pieces of the villous + Coat of the Intestines, as alledged by many Authors. + +Upon my first being employed in the Military Hospitals in _Germany_, +I was surprised to see so many of the old Dysenteric Cases end +fatally; and imagined I had not fallen upon the Right Method of +treating them: but upon consulting the other Physical People[33] +employed in the same Service, I found them as unsuccessful, as myself, +after having tried a Variety of Remedies: And at last, I was +convinced, that when once the Flux had continued long, and injured the +Structure of the Intestines to a certain Length, a Gangrene will +often form by slow Degrees; and the Disorder end fatally, +notwithstanding the Use of what are esteemed the most efficacious +Remedies; and that, when this Disorder is violent, the Cure +principally depends upon an early and speedy Application of proper +Remedies, before the Strength be exhausted, or the Structure of the +Bowels too much hurt. The bad Success we had in treating these old +Cases, may perhaps surprise those who have never practised except in +healthful Cities, where the Disease is commonly mild, and People apply +soon for Advice. But all those Gentlemen who have had the Care of +Military Hospitals, where the Dysentery has been frequent, and where +the Sick have been often sent a great Way, before they reached the +Hospitals, must be convinced of the Truth of what is here asserted. + + [33] Mr. _Cleghorn_, in his _Account of the Diseases of the + Island of Minorca_, says, "That almost all the Dysenteries + which fell under my Observation, unless they were speedily + cured in the Beginning, at best proved obstinate, and too + frequently fatal, in spite of the many boasted Specificks for + this Distemper." chap. v. p. 228.--The physical Gentlemen + employed on the _American_ Service have told me, that the old + Flux Cases were as fatal in _America_, as we found them in + _Germany_. I would not from thence have it believed, that + every old Flux was to be looked on as a lost Case; and for + that Reason given up, and no Attempts be made to cure it; for + many, by great Care, and Strength of Constitution, have + gradually surmounted the Disorder, and recovered their + Health; especially when they got over the Winter, and lived + till the warm Weather began. + +In the Treatment of this Disorder, as well as of the Malignant Fever, +nothing contributed more to the Cure, than keeping the Sick as clean +as possible, and in large airy Wards. + +Most of the recent Fluxes, which I saw, were at first attended with a +good deal of Fever, and Pain in the Bowels; and required more or less +Blood to be taken away, according to the Strength of the Patient, and +the Violence of the Symptoms. + +When the Patients were strong, and complained of sharp Pain of the +Bowels, attended with a Fever, we used the Lancet freely, nor were we +discouraged from bleeding in the Beginning by the low quick Pulse +which often attended the Disorder; and we frequently found the Pulse +rise as the Blood flowed from the Vein. But when the Sick were low and +weak, without much Pain or Fever, and the Pulse was soft, we were more +sparing of the vital Fluid[34]. + + [34] Although Bleeding, in the Beginning, has been + recommended by _Sydenham_, _Huxham_, _Pringle_, and other + Practitioners; yet it has been reckoned unnecessary in this + Disorder by some late Authors. But in most of the recent + Cases I saw, it was extremely necessary, and contributed + greatly to the Relief as well as the Cure of the Patient; + indeed where the Disorder had already continued some time, + and the Fever was gone off before the Patient was sent to us; + and the Disorder had become in a manner chronic, and the + Patient low, then bleeding was unnecessary, and would have + probably done Hurt. Mr. _Francis Russel_ told me, that when + the Dysentery was epidemical at _Gibraltar_, in Summer 1756, + he found that by bleeding such Patients as he met with at the + first coming on of the Symptoms, and by giving them + immediately a Vomit, and afterwards a sudorific Draught, the + Disorder was rendered mild, and few of those died. + +As the Disorder was for the most part attended with Sickness in the +Beginning, we gave a Vomit after bleeding; which not only discharged +the Contents of the Stomach, and a Quantity of Bile, but relieved the +Sickness, and frequently threw the Patient into a breathing Sweat; and +made the Purgatives which were given next Day operate more freely, and +with more evident good Effects than where no Vomit had been +administered.--If in the Course of the Disease the Sickness returned, +the Emetic was repeated; and we often observed, when the Flux was +obstinate, that well-timed Vomits greatly promoted the Cure.--The +Vomit we commonly employed was the Powder of Ipecacuana, which we gave +from ten to twenty Grains; and where the Patient was strong, and we +wanted to make a free Evacuation, we added one, two, or three Grains +of the Tartar Emetic; which encreased the Strength of the Vomit, and +commonly operated likewise by Stool[35], as Dr. _Pringle_ has +observed. + + [35] Mr. _W. Russel_, who was with the Hospital at + _Martinico_, told me, that, when he was there, he found the + Vomit with the Tartar Emetic to be far preferable to any + other, in all Cases where there was much putrid Bile lodged + in the alimentary Canal; as it speedily carried off those + corrupt Humours, which were often productive of the greatest + Mischiefs, if they remained, but for a short Time, pent up + within the Bowels. + +Next Day we ordered a Purge to empty the other Parts of the alimentary +Canal. The Purgative, that at first was most employed for this +Purpose, was Rhubarb; but upon repeated Trials we did not find, that, +in general, it answered so well, in this first Stage of the Disorder, +as the _sal catharticum amarum_, with Manna and Oil; which operated +without griping or disturbing the Patient, procured a freer +Evacuation, and gave greater Relief than any other purgative Medicine +we tried. Mr. _Francis Russel_, Surgeon to the _British_ Military +Hospital in _America_, who was formerly Surgeon to the Island of +_Minorca_, was the first Person who informed me (in the Year 1757) of +the Use of the _sal catharticum amarum_ in the Dysentery; he told me, +that the Year before (1756) the Dysentery had been very frequent and +very fatal at _Gibraltar_; and, after trying Variety of Medicines, he +had found nothing give more Relief, or contribute more to the Cure, +than repeated Doses of these Salts. + +As a great Part of the Cure depended on the frequent Use of gentle +Purges[36] in the Beginning, to carry off the corrupted Humours; the +Purgative was repeated every second, third, or fourth Day, as the Case +required; the Operation of the former Purge, and the Symptoms, +determining the Frequency of the Repetition. It was surprising with +how little Loss of Strength the Sick bore the Operation of these +Purges; I have sometimes given them to strong People every Day, for +two, three, or four Days successively; and observed that the Patient, +instead of being weakened, seemed stronger, and more brisk and lively, +after the Operation of each, from the Relief it gave; by evacuating +those putrid, corrupted Humours, which kept him perpetually sick and +uneasy, while they remained within the Bowels. + + [36] Variety of Medicines have been recommended to answer + this Purpose. + + The _vitrum ceratum antimonii_ proved often too rough a + Medicine, and therefore we laid it almost entirely aside. + + Repeated small Doses of the Ipecacuana, from four to six + Grains, operated both as an Emetic, and kept up a Purging; + but they made the Men so sick, that we could not prevail upon + them to continue their Use. Mr. _Francis Russel_ told me, + that, in the Year 1756, he found a few Grains of Rhubarb + added to each Dose, made it operate more as a Purgative, and + did not make the Men so sick.--Dr. _Akenside_ proposes giving + the Ipecacuana in so small Doses as one or two Grains every + six Hours, in a Draught made of Mint-water, and Half a Drachm + of _confectio cardiaca_; and, after bleeding and vomiting + once, seems to depend almost entirely on the Use of this + Medicine for the Cure of the Dysentery. See his _Comment. de + Dysenteria_, cap. 2. + + The watery Tincture of Rhubarb, recommended by _Degnerus_, we + tried in some Cases at Bremen; and found it to be a good mild + Purge, but not to answer so well as the Salts and Manna in + recent Cases. Mr. _William Russel_ told me that they found + this watery Tincture of Rhubarb to answer better in _America_ + than any other of the Preparations of Rhubarb. + + Calomel has been recommended by many as a Purge in + Dysenteries; and Dr. _Huxham_ (_de Aere_, Vol. II. P. 100) + assures us, that he has often experienced the good Effects of + it, especially when the Patient at the same time had Worms; + in such Cases we joined it to Rhubarb as mentioned in the + Text, or gave a Calomel Bolus over Night, and a Purge next + Morning. Dr. _Duncan_, Physician to his Majesty, told me, + that he found the following Method of Cure always successful + in the Dysentery, which was epidemic in _London_ in the Year + 1762. + + If the Patient was Plethoric, or had much Fever, he ordered + more or less Blood to be taken away; and then gave four + Ounces of the following Julep, every Half Hour, till it both + vomited and purged. Rx _Tartar. emetic. gr._ iij _Mannæ elect. + Unc._ ij _solve in Aq. hordeat. Lib._ 1.--The next Day, and + for five or six Days more, the Patient took so much of a + Decoction, of Manna, Tamarinds, and soluble Tartar, as kept + up a free Discharge by Stool.--If the Irritation and Griping + were severe, he found that a Solution of Manna, in the common + Almond Emulsion, was sufficient. + + When the Pain, or Tenesmus, was violent, a Clyster, of + Chicken Broth, or of an Infusion of Linseed, with an Ounce or + two of Oil of sweet Almonds dissolved in the Yolk of an Egg, + injected once or twice a Day, was of great Use. + + Upon the whole, he was always pleased when he saw large + excrementitious Stools come away; and when that could be + procured by a gentle Method, he was the more pleased. + + This Disorder was very often cured in a few Days, and in that + Case he dropt the further Use of Medicines; but when it + exceeded the Period of six or seven Days, he then added + thirty or forty Drops of the _tinctura thebaica_ to the + Clysters; and ordered a Scruple of the Extract of the Logwood + to be taken thrice a Day in some proper Vehicle. + + The Patient's Diet was Rice-Gruel, Sago, Panado, and such + like; no Animal Food, not so much as Chicken-Broth, was + allowed in the Beginning of the Distemper, nor even Oil, + Butter, or Fat of any Kind. The common Drink was Almond + Emulsion, Rice-Water, or Barley-Water with Gum Arabic. + + Dr. _Duncan_ lost but one Patient out of Eighty, whom he had + under his Care that Season; and he was delirious, had a high + Fever, and a _subsultus tendinum_ before the Doctor was + called to him, and he died the next Day. + + The late Dr. _Young_, of _Edinburgh_, seems to have had a + very just Notion of this Disorder, and of the proper Method + of treating it; for, in his Treatise on Opium, sect. vii. he + says, "I am convinced from Experience, that most of the + Dysenteries I have hitherto met with, might have been cured + by purging mildly, but constantly; and at the same time + abating the Acrimony in the great Guts by emollient Clysters, + and in the small ones by Plenty of Absorbents, and a Diet of + Chicken Broth: But it must be observed with regard to + Purgatives, that Manna agrees best with some, Rhubarb with + others, Jalap, Mercury, and toasted Rhubarb with others; + while others are sooner cured by emollient Clysters. I use + Opium only when the Disease is mild, or after its Violence is + abated by Evacuants and Emollients." + + Scammony, Aloes, and the other strong resinous and hydragogue + Purges, are hurtful, and occasion Pain. I always observed, + that those Purges answered best which made the freest + Evacuation, and acted with the greatest Ease to the Patient; + of which the Salts and Manna answered best of any I have + hitherto used. + +Though Rhubarb did not answer so well in the Beginning as the saline +Purges; yet afterwards in the Course of the Distemper, when the +Patient did not complain much of Gripes, half a Drachm of Rhubarb, +either by itself or in a saline Draught, proved a good gentle Purge; +and given with six or seven Grains of Calomel, was found to be a good +Medicine, when the Disorder was attended with Worms. + +In the Evening, after the Operation of the Purge, we gave an Opiate; +and repeated it at Nights, in the Intervals between the Purges; but +were obliged to be very sparing of the Dose, while the Disorder +continued in its acute State; the Opiate was only given in a Quantity +sufficient to mitigate the Pain, and to procure Rest, but never so as +to stupify the Patient, or prevent a due Discharge by Stool; though we +were often obliged to encrease the Dose, as Use made it familiar to +the Patient. + +In the Intervals between the Purges, we gave in the Day, the Mindereri +Draughts with the Mithridate; or the saline Draughts with the Addition +of four Drops of the _tinctura thebaica_; or some such mild +diaphoretic, every four or six Hours; which helped to keep up a free +Perspiration, without any Danger of stopping the Purging; and for the +most part answered much better than the Diascord, or Philonium, or +other strong Astringents and Opiates commonly prescribed for this +Purpose; which were always liable to check the Purging too much, and +bring on severe Gripes attended with Heat and Fever[37]; and therefore +we seldom made Use of them in this first Stage of the Disorder. + + [37] _Sydenham_, _Huxham_, and all good Practitioners, have + taken Notice of the bad Effects of the too free Use of + Astringents, and given Cautions against it. + +If the Patient was attacked with severe Gripes[38], and a Tenesmus, +which the Purgatives and gentle Opiates did not relieve, we ordered +the Abdomen to be fomented with warm Stupes; and the Patient to drink +freely of warm Barley or Rice-water, or of weak Broth[39], or an +Infusion of Camomile Flowers, as recommended by Dr. _Pringle_; and +ordered first Clysters of large Quantities of the plain emollient +Decoction to be given; and if the Gripes still continued, to be +repeated in small Quantities, with the Addition of a Drachm or two of +the _tinctura thebaica_; for we observed that Opiate Clysters often +gave more Relief, than Anodynes administered in any other Way; and +sometimes, when a Tenesmus was very troublesome, the common oily +Clyster, with a little Diascord, and _tinctura thebaica_, or the +Starch Clyster, gave more Ease than any other.--In some Cases, where +the Pain was sharp, attended with a Fever, we were obliged to take +away more or less Blood; and sometimes also to apply a Blister to that +Part of the Abdomen where the Patient felt most Pain. + + [38] If the Patient was suddenly attacked with sharp Pain of + the Bowels and Gripes, on a Day in which he had not Physic, a + Dose of the Salts and Manna was commonly given immediately, + to empty thoroughly the first Passages. + + [39] Mr. _W. Russel_ told me, that he and Dr. _Huck_ found + the free Use of the following Emulsion, made of Bees Wax, to + be of great Use after Evacuations, where there was much Pain + of the Bowels, in recent Cases of Fluxes in the Hospitals in + _America_. Rx. Ceræ alb. vel flavæ drachmes tres. Sapon. alb. + Hispan. drachmam unam. Aquæ fontanæ, unciam unam, liquefiant + super ignem in vase ferreo, agitando spatula, & dein infunde + in mortarium marmoreum, & adde paulatim aq. fontanæ, libras + duas syrupi sacchari. spiritus vini gallici tenuis, vel aquæ + alicujus spirituosæ ana unciam unam, terendo optime ut fiat + emulsio. + + This Method of dissolving Bees Wax, in a Watery Liquor, is + entirely new; for before this we knew of no Way of making it + miscible with Water. + +During this Course, the Patients used the common low Diet of the +Hospital; when they loathed the Rice-Gruel, they had Panado with a +little Red Wine and Sugar; or Water-gruel, when it could be got, in +its Place.--Their common Drink was Barley or Rice-water; of which it +was recommended to them to drink plentifully; as nothing contributed +more to the Cure than the free Use of such Liquors, to dilute and +blunt the Acrimony of the Fluids[40]. In some Cases, when the Purging +was violent, and not accompanied with the malignant Fever, the +_decoctum album_ was found to be a good Drink; and we added +occasionally a few Drops of the _tinctura thebaica_. + + [40] Dr. _Huxham_ (_de Aere_, Vol. II. p. 107.) says, there + is no Disorder in which a diluting, sweetening Drink is more + necessary than in this; that he has done great Service among + the Poor by luke-warm Water; that, after emptying the Bowels + thoroughly, he has sometimes cured this Disorder by the Use + of pure Water, and a small Quantity of Opium. And _Baglivi_ + (_Prax. Med._ lib. i.) tells us, that the drinking of common + Whey, and throwing up frequent Clysters of it, had cured + many, and that this was looked upon as a Specific, and kept a + Secret by some. + +Such were the chief Remedies we used in the first Stage of this +Disorder; but after some Weeks, when the Fever had abated, and free +Evacuations had been made, and the Complaint become in a manner +chronic, we were obliged to try other Methods; and found that the best +Way of treating this Disorder, was, to endeavour to brace and restore +the Tone of the Intestines, by means of the corroborating and gentle +astringent Medicines, mixed with Opiates; while mild Purgatives were +given at proper Intervals. + +The Patients were kept to the same low Diet as before, with the +Addition of a little Wine or Brandy. They were allowed from a Gill to +a Pint of red Wine _per_ Day, which was commonly mulled before it was +given them; when the Wine griped them, which it frequently did, they +took in its Stead Half a Gill or a Gill of Brandy, mixed with a Pint +or a Quart of Barley or Rice-water, or of the _decoctum album_. + +In this Stage of the Disorder we found, that the same Medicines would +not answer with all, and therefore we were obliged to try Variety[41]; +and indeed, unless where the Violence of the Disorder had abated by +the Use of Evacuations, the Event was always very doubtful; for when +the Complaint had continued long and become chronic, and the Structure +of the Intestines was much hurt, before the Sick were sent to us; or +when it continued obstinate, and yielded but little to Evacuations, +and the other Methods used in the first Stage, even Remedies esteemed +the most efficacious oftentimes proved unsuccessful, and at length +the Patient died. + + [41] Dr. _Pringle_, in the _fourth Edition of his + Observations_, just published, in treating of the third or + last Stage of the Dysentery, remarks, that this is the Time + for Astringents, which ought not to be given sooner, or at + least very sparingly. And he tells us, that, in the former + Editions of his Work, he mentioned those Compositions which + he had most frequently used, but that he had now laid most of + them aside; and at present trusts to Vomits, and to a Milk + Diet, for the perfect Cure. + + He says, "Whenever therefore the Patient is in this State, + and especially when his Pulse is quick, and he complains of + inward Heat, I began with giving him a Scruple of Ipecacuana; + and the next Day I put him upon the Milk-Diet; which I + continue till all the hectic Symptoms are gone, and till the + Bowels have recovered their Tone. During this Course I have + seldom had Occasion for any other Medicine, excepting the + Chalk Julep mentioned before, which I use for correcting that + strong Acid so incident to relaxed Stomachs. Sometimes also I + add an Opiate to procure Rest at Night; but after a few Days + these are likewise laid aside. All that I require (which + indeed is often hard to obtain) is a strict Perseverance in + the low Diet: and now and then a Repetition of the Vomit, + upon any new Disorder of the Stomach, or great Laxity of the + Bowels. + + "Whilst the Patient continues in this Course, I forbid all + animal Food and fermented Liquors; and besides Milk, I allow + only the Preparations of Grain, Sago and Salop." See Part + iii. ch. vi. p. 289, 290. + +A Spoonful of the _mixtura fracastorii_, taken after every loose +Stool; and an anodyne Draught at Night, had a good Effect with +some--Repeated Doses of the _philonium Londinense_ answered better +with others, who were low, and required a Remedy that was warm and +cordial--And others found more Benefit from the Mindereri Draughts, +with Mithridate, or the _confectio cardiaca_, or the Theriac anodyne +Boluses. + +The _mixtura Campechensis_, both alone and with _tinctura thebaica_, +checked the Purging, and gave Relief sometimes; and the Addition of +some of the Extract of Bark and Tincture of Cinnamon, seemed to +encrease its Efficacy in one or two old Cases, at _Bremen_; but it +afterwards occasioned such Sickness, that we did not continue its Use. + +In other inveterate Dysenteries, where we thought that a strong +Astringent was wanted, we added a small Proportion of Allum to the +_Campechense_ Julep, which on first using seemed to be serviceable; +but at other Times it occasioned a Tenesmus and Gripes; and therefore +we were obliged to be very cautious how we used it. + +Equal Parts of the _electuarium diascordii_ and _electuarium +corticis_, taken in the Quantity of a Drachm twice or thrice a Day, +was of Use in many old Fluxes[42], though it made other Patients so +sick, that they were obliged to lay it aside. + + [42] I had lately a very remarkable Instance of the Effects + of this Medicine, in the Case of one _Gilchrist_, a + middle-aged Man, by Trade a Taylor; who was admitted into + _St. George_'s Hospital the 20th of _July_, 1763, for an old + Flux, which had continued above six Months, and reduced him + very low: He had taken a great many Medicines without any + Effect. After giving him a Vomit and two Doses of Tincture of + Rhubarb, I gave him four Grains of the Powder of Ipecacuana + with Opium three Times a Day; but that having no Effect, + after using it for above a Fortnight, I ordered him the + Electuary of Diascord and Cortex; from the Time he began to + use this Medicine, he mended daily; and was dismissed in good + Health the 26th of _September_. + +We tried likewise in this Stage of the Disorder, repeated small Doses +of the Ipecacuana; but it occasioned such Sickness, that we did not +persist in its Use. + +In other Cases, we gave from two to five Grains of the Ipecacuana, +mixed with Opium, in different Proportions (from three Grains to ten +of the Ipecacuana to one of the Opium), every four or six Hours; it +gave sometimes a little present Ease, at other Times it occasioned +Sickness; we often continued its Use for ten, twelve, or fourteen +Days; but it seldom produced any remarkable Change for the better, and +we were obliged to have Recourse to other Remedies. + +_Dover_'s Powder was given in large Doses, from one Scruple to two; +and proved a good Sudorific and Anodyne in some Cases; though in +others it made the Patients sick, without producing any good +Effect.--It commonly answered better, when used occasionally as a +Sudorific, than when constantly continued. + +During the Use of these Remedies, it was necessary to repeat the +Purgatives from Time to Time; or to mix them occasionally with the +other Medicines, in order to carry off any corrupted Humours, or +Excrements that might be lodged In the Cavity of the Intestines; for +when this was neglected, the Patients were often seized with Sickness +and Gripes, and a more violent Purging than before:--And if at any +Time they complained of Gripes, and passed little Pieces of hardened +Excrements, it was mostly a certain Sign that a Purge was indicated; +and, on such Occasions, it generally gave Relief; and when attended +with Sickness, a Vomit was given before the Purge.--Clysters were used +as in recent Cases, where the Sick were low, or had much Pain of the +Bowels[43], or complained of a Tenesmus. + + [43] On the 21st of _November_, 1759, _Hanah Meredith_, a + middle-aged Woman, was admitted into _St. George_'s Hospital + for a Flux, which she had six or seven Weeks; she had no + Fever, but complained much of Sickness and Gripes, and her + Disorder had reduced her very low. During the two first Weeks + of her being in the Hospital, she had two Vomits of + Ipecacuana and four Doses of Rhubarb; and in the Intervals + anodyne and astringent Medicines, which made no Alteration in + her Complaints. On the 2d of _December_, she told me, that + two Years before she had had a Flux for above three Months, + which had yielded to no Remedies till she was ordered + repeated Clysters, and that they had made a Cure in a short + Time. I then ordered an emollient Clyster with a drachm of + the _electuarium diascordii_, and a Scruple of the _tinctura + thebaica_, to be given twice a Day, which gave her almost + immediate Relief; and with the Assistance of some Doses of + Rhubarb, and one or two Vomits and occasional Opiates, + removed her Disorder by the Middle of _January_; though she + remained long weak, and troubled at Times with Gripes; but + these Complaints were at last got the better of by her taking + some Doses of Rhubarb, and drinking daily a Pint of Lime + Water mixed with Half a Pint of Milk. + + _Sarah Spencer_, a middle-aged Woman, was admitted into _St. + George_'s Hospital the 9th of _November_, 1763, for a Flux, + which had continued for two Months, and reduced her very low. + She complained much of Sickness and Gripes; her Stools were + mostly composed of Mucus and Blood; her Pulse was low, and + she had no Fever, but a Whiteness of the Tongue, and + complained of Thirst.--The first Day she had a Vomit, and + next Day a Dose of the purging saline oily Draught.--She was + ordered to have an emollient Clyster, with a Drachm of + Diascord, and as much _tinctura thebaica_, given her every + Evening; and to have a Dose of the saline oily Purge twice a + Week, and Opiates occasionally; by following this Course, and + drinking at Times the Chalk Julep, her Disorder was removed, + and she was discharged the Hospital on the 30th of the same + Month. + +In some old Dysenteries, where the villous Coat of the Intestines was +much injured, I gave the Cordial Draughts, with the Addition of Half a +Drachm of the _balsamum copaivi_, a Scruple of the Extract of the +Bark, and five Drops of the _tinctura thebaica_, three Times a Day. +At first, this Medicine seemed to promise much, particularly in the +Case of an old Invalid, _William Brookes_; who had been long ill of a +Flux, attended with Gripes and a Tenesmus. He had used Variety of +Remedies, without receiving any Benefit. For the first Fortnight, +after he began the Use of this Medicine, he rested well, and found +great Relief; and seemed to be in a fair Way of doing well. But the +Disorder being too far advanced before he began to use it, he +relapsed, and died. On opening his Body, the inner Coats of the Rectum +and the lower Part of the Colon seemed to be reduced almost to a +gelatinous Substance, and the other Coats were black, approaching to a +Gangrene.--The same Medicine gave Relief in other Cases, but they were +too far advanced before it was administered. In these Cases, when the +villous Coat of the Intestines was inflamed and very irritable, the +mucilaginous Medicines, the _pulvis e tragacantha_, and such others, +were of Service; and frequently Starch Clysters and Anodynes gave +Relief, when other Remedies had little Effect. Flower, boiled with +Milk, and sweetened with Sugar, and given for Breakfast, as mentioned +by Dr. _Pringle_, proved a good Palliative to some; and the Starch and +Gum Arabic, dissolved in Water, a good Drink to others.--Lime Water +and Milk, drank to the Quantity of a Pint or a Quart a Day, was of use +to a few, though it did not agree with all. + +It was very common for Patients bad in the malignant Fever to be +seized likewise with the Flux. Such Cases were always extremely +dangerous; and when the Fever was bad, we were often obliged to +neglect the Flux, and only attend to the Fever.--When the Purging was +violent, and appeared very early in the Fever, it often sunk the +Patients, and soon carried them off: but where it was moderate, and +did not appear till towards the Height or the Decline of the Fever, it +often proved a Crisis to the Disorder. + +When such Fluxes appeared early attended with sharp Pain of the +Bowels, and Signs of Inflammation; if the Patient was strong, we +began the Cure with opening a Vein, which the Patient bore easily, and +it gave Relief; but when the Symptoms were mild, without any acute +Pain, the Bleeding was omitted.--Commonly the Bowels were loaded with +corrupted Humours, when this Symptom appeared; and, therefore, we +found it of Advantage to give a Dose of the Salts with Manna and Oil, +or some other gentle Purge, to carry them off; and in the Evening an +Opiate to ease the Pain and procure the Patient Rest. + +After this we gave the Mindereri Draughts with Mithridate; and as soon +as the Petechiæ appeared, or we observed any Remissions in the Fever, +the Patient took every four or six Hours, a Drachm of an Electuary, +composed of equal Parts of the _electuarium corticis_ and the +_electuarium diascordii_[44]; or Half a Drachm of the Powder of the +Bark, or a Scruple of the Extract, in the Mindereri Draughts, with +four or five Drops of the _tinctura thebaica_; and we repeated the +Opiate in the Evening, always proportioning the Quantity of it to the +Effects of the former Dose, and the Violence of the Purging. + + [44] This Practice of giving the Cortex with Opiates in the + Dysentery is not new; for Dr. R. _Morton_, in his Appendix to + his second Exercise on the Fevers, which appeared from 1658 + to 1691, observes, that after the Plague of 1666 had ceased, + a Fever from a milder Poison, attended with Gripes and + Dysentery, began to make its Appearance. As the common + Methods of Cure proved unsuccessful, and Dr. _Morton_ + observed Exacerbations and Remissions, he resolved to give + the Bark mixed with Laudanum; and found it answer his + Expectation. The first Patient to whom he gave it, was a man + in _Long Lane_, who laboured under a Tertian Dysentery; upon + observing a Remission, he ordered a Drachm of the Bark, mixed + with a Grain of Opium, to be given every four Hours for six + Times; and this removed both the Fever and Dysentery.--He + says, he afterwards gave it, with equal Success, in the + Quotidian Dysenteries, where he observed Exacerbations or + Remissions; and he adds, that he does not doubt but that it + will answer as well in Epidemical Diarrhoea's, and Camp Fevers + attended with such Symptoms. + + Dr. _Whytt_ of _Edinburgh_ has given with Success a strong + Decoction of the Bark, mixed with the _confectio japonica_ of + the _Edinburgh_ Dispensatory, in the bad State of the + Dysentery, when the Mouth and alimentary Canal were + threatened with Aphthæ, and even sometimes after they had + appeared. And Dr. _Pringle_ mentions his having given the + Decoction of the Bark, with Snake-Root and some Drops of + Laudanum, in the Dysentery complicated with the malignant + Fever. See _Note to Page 245 of his third Edition on the + Diseases of the Army_. + +On the second or third Day, we repeated the Purge; or, if the Patient +was weak, ordered a Clyster to be administered in its Place; in order +to prevent the putrid Fluids and Excrements from being accumulated in +the Bowels:--In other respects we treated it as when the Disorder was +not complicated with the malignant Fever. + +This Method, though it did not succeed with all, yet it answered +better than any other I tried;--and it ought to be remarked, that +although it had such a good Effect in Cases attended with the +malignant Fever, or where the Fever inclined to the intermittent Kind, +it did not answer so well in other recent Cases, but often made the +Patient sick. + +In military Hospitals, Fluxes are liable to be complicated with other +Disorders, as well as with the malignant Fever; especially with +Coughs, and pleuritic and peripneumonic Symptoms, when the Weather +begins to be cold, in _October_ and _November_.--In such Cases, when +the Patients were strong, we were often obliged to bleed freely, to +apply Blisters, and in the Beginning treat the Disorder as +inflammatory; having at the same Time an Eye towards the Flux, in the +other Medicines we prescribed. + +Patients, who have had the Flux long, are apt to have their Legs swell +at Nights; or to swell all over as soon as the Flux has stopped. Such +oedematous or anasarcous Swellings, we treated nearly in the same +Manner as those which followed the petechial Fever; only that we durst +not at first be so free with the Use of Purgatives; for as the Bowels +remained weak and easily irritated, such Medicines were apt to bring +back the Flux; and therefore, in the Beginning, we were for the most +part obliged to attempt the Cure by Diuretics and Diaphoretics; and to +be sparing of the Use of Purgatives, especially of those of the +hydragogue Kind; though if the Swellings continued for some Time after +the Flux was gone off, and the Patients were strong, we then ventured +to give Purges at proper Intervals:--And Blisters and Scarifications +removed them in several Instances both at _Paderborn_ and +_Osnabruck_. + +In _December_, 1761, we had a Case of this Kind where the _oxymel +scilliticum_ was of remarkable Service. A Soldier, belonging to the +Guards, after a Flux, swelled all over, and made but a very small +Quantity of Water. He took Medicines of different Sorts for some +Weeks, but received no Benefit till we gave him the Oxymel Mixture; +after taking a few Doses he made Water very freely, and in large +Quantities, and the Swellings of his Body and Scrotum began +immediately to subside; and by continuing its Use for a Fortnight, the +Swellings entirely disappeared, and he recovered his Health and +Strength.--The Oxymel, at the same Time that it promoted a Flow of +Urine, kept his Body gently open, but did not occasion any Return of +the Flux. + +At the Beginning of _January_, 1762, one _Carter_, a Soldier of the +Eleventh Regiment of Foot, laboured under an universal Anasarca; which +about two Months before had succeeded a Flux. He made but very little +Water, and that of a high red Colour. He took Variety of Medicines, +as Purges, Vomits, _Dover_'s Powder, lixivial and neutral Salts with +Opiates, Infusions of Horse-Radish, all without Effect; till he was +ordered small Doses of Calomel, three Grains Morning and Evening. +After the third Dose he began to make Water freely; and by the 24th of +_January_ the Swellings were all gone, and he was shipped off for +_England_ the 8th of _February_; having been discharged from his +Regiment. The Ship, he went aboard of, was detained in the River +_Weser_ for above six Weeks, and the malignant Fever broke out aboard +the Transport: He took the Distemper, and got well of it; but towards +the Decline was seized with a Return of the Flux, which carried him +off. + +When these oedematous Swellings came after the Purging was stopt, if +the Patient's Strength was not much exhausted, and he laboured under +no other Disorder, he commonly got the better of it:--But when the +Strength was gone before the Swellings appeared, the Disorder often +ended in a confirmed Dropsy, and at last in Death; and when the +Swellings were universal over the Body, while the Flux yet continued, +it was a Sign of great Weakness, and they did not survive it long[45]. + + [45] Many other Medicines have been used for the Cure of old + Dysenteries,--The _Conessi Bark_, recommended as a Specific + in Diarrhoeas, cured a Dysentery which had yielded nothing to + a Variety of Medicines. _Edinburgh Medical Essays_, _Vol._ + III. _Art._ iv.--The _cortex eleutheriæ vel cascarillæ_ is + much recommended for the Cure of Dysenteries in the _Memoir. + de L'Academie des Sciences a Paris_ 1719, and is still in + great Repute among the _Germans_.--The Decoction of the + _semiruba_ Bark was found to have a good Effect in the + Dysentery, where the Patient continued to void Blood with his + Stools; and when the Stools were only liquid, without a + Mixture of Blood, some of the Cascarilla added to the + Decoction encreased its Efficacy. See _Degnerus_'s Treatise + _de Dysenteria_, _cap._ iii. _sect._ 55. These and many other + Remedies have been tried in obstinate Dysenteries. + + From what I have observed myself, and from the Accounts of + others, I am now convinced, that such Cases as are not + already too far gone, are most likely to be cured, + + 1. By keeping the Patients on a low Diet, composed + principally of Milk, Sago, Rice, Salop, and such other Things + as are recommended by Dr. _Pringle_; allowing weak Broths, + and a small Quantity of white Meat, as they recover their + Strength. The common Drink to be Barley or Rice-Water, Toast + and Water, _Bristol_ Water, Almond Emulsion, and such + like.--By making them wear some additional Cloathing, and + guarding carefully against catching cold.--Errors of Diet and + Exposure to Cold being the most frequent Causes of Relapses + into this Disorder. + + 2. By giving from Time to Time a Dose of some mild Purge; + such as a little Manna and Salts; a Solution of Manna in + Almond Emulsion; twenty or thirty Grains of Rhubarb, in a + saline Draught, or such like; and occasionally gentle + Emetics. + + 3. By the Use of some of the mild Astringents and + Corroborants.--The Bark, with Astringents and Opiates, + agreeing best with some--Decoctions of the Semiruba with + others--Chalk in Electuaries, or Juleps, with others--anodyne + and astringent Clysters with others--while others receive + more Benefit from other Remedies--and severals find + themselves better when they use no Medicines of this Kind. + + 4. And by the occasional Use of Opiates, and a free Air: And + by moderate Exercise on Horseback, or in a Machine in the + convalescent State. + + I ought not to omit mentioning, that I have seen some Cases + where Evacuations had been used in the Beginning, which, + after they had continued for some Time, were cured by a + regular Diet of Broths, and white Meats; riding daily on + Horseback; and drinking a generous good Claret Wine. However, + it ought to be remarked, that this Method only succeeded + where the Disorder was mild, and its Violence had abated by + previous Evacuations. + + + + +OF THE CHOLERA MORBUS. + + +The Cholera Morbus, or a sudden and violent Vomiting and Purging, was +very frequent in _July_ and _August_ 1701; and several were attacked +with it at _Munster_.--It was attended with great Sickness, with Pain, +and Inflation of the Abdomen, Thirst, and a small quick Pulse: Some +had it in a pretty violent Degree, but in general it was mild; and +although the Sickness, Vomiting, and Purging, continued, in one or two +Cases, for above a Day; yet none of those died whom I saw. + +This Disorder weakens the Patient much, in a short Space of Time; and +sometimes, when violent, kills in less than twenty-four Hours. It is +always most frequent in Summer and the Beginning of Autumn; and is +taken Notice of by _Hippocrates_, _Aretæus_, _Celsus_, and other +antient Authors; and is very accurately described by many of them.--It +is of the bilious Kind; and the Cure principally depends upon the free +Use of warm mild Liquors in the Beginning; to dilute and blunt the +Acrimony of the Bile, and other Fluids, and to promote their +Discharge; and afterwards of gentle Cordials to support the Strength; +and warm Fomentations to allay the Pain when violent; and mild Opiates +to procure Rest; and if the Sickness or Griping remains next Day after +the Cholera is stopt, to give a Dose of Physic and an Opiate in the +Evening. + +An Officer, who had been wounded on the 15th of _July_, at the Battle +of _Fillinghausen_, began afterwards to live very freely, and was on +the 4th of _August_ seized in the Night with the Cholera.--About ten +o'Clock next Day I was sent for; and found him in violent Agony, with +sharp Pain in the Bowels, Reachings, and Strainings to Vomit, and +Spasms and Cramps in the Bowels, Legs, and Arms.--He had large red +Blotches on his Extremities, and no Pulse was to be felt at the Wrist, +and rather a Fluttering than a Beating at the Heart.--He had vomited +and purged much in the Night before I saw him, but the Purging had +begun to abate.--I immediately ordered him an emollient Clyster, and a +saline Draught, with the _confectio cardiaca_, and five Drops of +liquid Laudanum; which, if he vomited up, was to be repeated soon +after; if not, only once in four Hours: And he was directed to drink +freely of weak Chicken Broth, warm.--Two Hours afterwards we found him +in the same Situation; still no Pulse to be felt, which prevented us +from bleeding him; and the violent Pain of the Stomach and Bowels, and +the Cramps, continued. We then ordered Flannels, dipped in a warm +emollient Decoction, to be kept constantly applied to his Belly, +dipping them in the warm Decoction as soon as they began to grow cool; +his Clyster to be repeated with the Addition of a Drachm of the +_electuarium e baccis lauri_, and Half a Drachm of the _tinctura +thebaica_; a Scruple of Castor, and Half a Drachm of Spirit of +Lavender, to be added to each of his Draughts; and a Blister to be +prepared, in case these Medicines gave no Relief.--Soon after, +beginning to use the Fomentations, the Cramps and Pains began to +abate; about four o'Clock in the Afternoon we could perceive a +Fluttering of the Pulse at the Wrist, and all the Pains and Cramps +were much easier; so that there was no occasion for the Blister.--Next +Morning he was very easy, but low, and inclined to be sick; for which +his Cordial Draughts were repeated every six Hours.--The third Day, as +he complained of a little Griping in the Bowels, we ordered him a Dose +of Tincture of Rhubarb, and an Opiate in the Evening, which entirely +removed these Complaints, and he was abroad and well next Day. + +One Soldier, who had a good deal of Fever, and complained of acute +Pain in the Bowels, along with the Vomiting and Purging, was blooded; +and drank freely of warm Barley-Water while the Vomiting +continued.--After throwing up a Quantity of green bilious Matter, the +Vomiting ceased; and the Gripes and Purging became less violent.--In +an Hour after, being able to retain some very weak Broth in his +Stomach, he drank plentifully of it through the Day; and the Purging +being abated towards Night, he took an anodyne Draught; and next Day, +having still a little Sickness remaining, had a Dose of Physic and an +Opiate at Night, which removed all his Complaints. + +The Rest, who were attacked with the Cholera at _Munster_, were +treated much in the same Way; only as they had not such acute Pain and +Fever as this Man, it was thought unnecessary to bleed them. + +The Antients[46] recommended drinking freely of warm Water in the +Beginning, and the Use of both cold and hot Fomentations of the +Stomach and Belly;--and in the low State, the Use of Wine, mixed with +Water, and Polenta[47]; and to apply Rue, with Vinegar, and other +strong smelling Things, to the Nostrils; besides Variety of other +Remedies.--When Convulsions happen, _Celsus_[48] advises to anoint the +Belly with warm Oil; and if that does not remove them, to apply +Cupping-Glasses or Mustard to the Stomach; and, after sleeping, to +abstain the second Day from Drink; and the third, to go into the Bath; +and if any thing of a Fever remains after the Cholera is suppressed, +to give a Purge. + + [46] See _Aretæus_, Lib. ii. Cap. 4. and _Celsus_, Lib. iv. + Cap. 11. + + [47] The Polenta seems to have been nothing but toasted + Barley Meal. See _Plinii Hist. Natural._ Lib. xxii. Cap. 25. + + [48] _Celsus loco citato._ + +Dr. _Sydenham_[49] trusts principally to drinking freely of Chicken +Broth, and throwing up Clysters of the same, and afterwards giving +Opiates. + + [49] _Processus integ. de Cholera._ + +Dr. _Ayton Douglas_, in the sixth Volume of the _Edinburgh_ Medical +Essays[50], recommends a Decoction of Oat Bread, baked without Leaven +or Yest, and carefully toasted as brown as Coffee, but not burnt; as a +Remedy very grateful to the Stomach, and useful in stopping the +Vomiting, and sometimes the Purging too: And he relates several Cases +where it had a good Effect. After the Vomiting was stopped, he added +the Use of mild Opiates; and, where the Patient was low, Wine and +other Cordials. + + [50] Art. 65. + + + + +OF THE INFLAMMATORY FEVER. + + +On the Return of the Troops from the Winter Expedition into the +Country of _Hesse_, in the Year 1761, we had several Men seized with +Inflammatory Fevers without any topical Inflammation; and at the +Opening of each Campaign had always Numbers sent to the Hospitals ill +of this Disorder. Towards the End of the Campaigns, and throughout the +Winter, many were seized with Inflammatory Fevers; but these were +mostly complicated, with pleuritic, or peripneumonic Symptoms, or +other topical Inflammations, or with rheumatic Complaints. + +In the Inflammatory Fever, the Sick were seized at first with cold and +hot Fits, succeeded by Pain in the Head and all over the Body. The +Pulse was strong and quick, and the Blood sizy; attended with other +Appearances commonly observed in such Fevers. + +As the Summer advanced, this Fever was often accompanied with bilious +Symptoms, with Sickness, and vomiting of bilious Matter, and very +frequently with a Purging: Towards the End of Summer it ceased, and +was succeeded by the bilious remittent Fever.--And it was no uncommon +Thing to see those Fevers, which originally were entirely of an +inflammatory Nature, after the sick had been some Days in a crowded +Hospital, partake a good deal of the Nature of the Malignant Fever, or +be changed entirely into it. + +We treated these Fevers in the common antiphlogistic Method.--We +blooded freely in the Beginning; gave the saline Draughts with Nitre +and other cooling Medicines; and made the Patients drink plentifully +of small Liquors:--And when they were inclined to be costive, gave +mild Purges, or emollient laxative Clysters. We afterwards applied +Blisters; and if the Pulse began to sink, gave Cordials, Wine, and +other Remedies commonly employed in such Cases;--and towards the +Decline of the Fever endeavoured to promote such Evacuations as were +pointed out by Nature, and likely to prove critical. + +When the Case was complicated with bilious Symptoms in the Beginning, +we were obliged to have particular Regard to the first Passages. If +the Patient complained much of Sickness, we gave a gentle Vomit in the +Evening, after bleeding; and a Purge next Day, to carry off any +bilious or corrupted Humours that might be lodged in the Stomach or +Intestines; and we found that these Evacuations gave Relief, and +generally mitigated all the Symptoms. + +If at any Time during the Fever a Looseness came on, especially when +attended with Gripes, we gave a Dose of some gentle Physic, which made +a free Evacuation; and an Opiate in the Evening after its Operation; +and afterwards we found it answer better to attempt rather to +moderate, than wholly stop the Purging by strong Astringents, and +Opiates; unless where the Evacuation by Stool was so great as to be in +Danger of sinking the Patient. + +The _pulvis antimonialis_, composed of ten Parts of the _pulvis e +chelis_, and one Part of the Tartar emetic, given in small Doses, was +serviceable in many of these Fevers, after free Evacuations had been +made. + +Two Patients, one a Soldier of the Twentieth Regiment, the other a +_German_ Waggoner, were taken ill of this Fever about the 25th of +_December_, 1762: They were both blooded freely, and had a Dose of +Physic in the Beginning; and the saline Draughts with Nitre and other +cooling Remedies; and had Blisters applied without producing any +considerable Change in their Disorder.--On the 5th of _January_, 1763, +they both complained much of Thirst, and were inclined to be costive; +their Tongues were parched, their Pulses quick and small, and their +Skins dry; they were restless at Nights, and the Soldier had a slight +Delirium.--I ordered each of them four Grains of the _pulvis +antimonialis_ every four Hours. + +6th. Next Day the Soldier told me, he had had four loose Stools; his +Senses were much clearer, the Pulse calmer and slower, and he said he +found himself lighter and easier, and less feverish, than he had been +since he was first taken ill. The Medicine was continued, with the +Addition of an anodyne Draught at Night.--7th. I found him in a fine +breathing Sweat, and he told me he had slept well in the Night: +p.--8th. The Sweat continued till this Morning, and on going off his +Urine let fall a copious white Sediment, and left him free from the +Fever; after which he mended daily. + +The Waggoner, after taking the third Dose of the Powders, had a warm +Moisture upon the Skin.--On the 6th was cooler and without much Fever, +and had had one Stool.--7th. The warm Moisture ended in a profuse +Sweat, which carried off the Fever, and he continued to recover +daily. + + + + +OF THE ANGINA; OR, SORE THROAT. + + +Many of the Soldiers during the Campaign were seized with +Inflammations of the Throat, especially when the Nights were cold and +moist after warm Days; and when they did Duty in cold wet Nights in +the Winter Season.--All of them I saw in _Germany_ were of the +inflammatory Kind; I did not observe any that were malignant. + +They were treated in the antiphlogistic Method.--The Patients were +blooded liberally in the Beginning--took the cooling nitrous and +saline Medicines--gentle Diaphoretics and Purgatives--and used +frequent Gargarisms. + +Sometimes a Flannel rubbed with camphorated Oil, or the _linimentum +volatile_, and applied round the Neck, was of Service.--And frequently +after bleeding sufficiently, where the Breathing or Swallowing was +difficult, the Application of a large Blister to the Neck gave speedy +Relief. + + + + +OF THE PLEURISY. + + +The Pleurisy, or an acute Inflammation of the Side, was most frequent +among the Soldiers towards the latter End of the Campaigns; though +some were attacked with it at all Times of the Year, from doing Duty +in all Sorts of Weather. + +We followed the antiphlogistic Method of Cure; and ordered plentiful +Bleeding in the Beginning, till the Violence of the Pain began to +abate, or the Patient grew faint;--and the Side to be fomented with +Flannels dipped in warm emollient Decoctions, and afterwards rubbed +with volatile Liniments: At the same Time the Patient drank freely of +warm diluting Liquors, as Barley Water, the pectoral Decoction, and +such like; and took the saline and other cooling Medicines, mixed +occasionally with Sperma Ceti, or some other soft Pectorals, if there +was a tickling Cough.--When the Patient was costive, we gave a Dose of +Salts, or some other mild Physic, or laxative Clysters. + +If the Pain continued very acute, we repeated the Bleeding as often as +Necessity seemed to require, and the Pulse could bear; and immediately +after the second Bleeding ordered a large Blister to be applied to the +Part affected. + +Physicians formerly used to forbid Bleeding after the fourth Day, if +it had been omitted so long; but when no Symptoms of Suppuration had +already appeared, on whatever Day of the Disorder it happened, I +ordered plentiful Bleeding, the same as in recent Cases; and never +found any Disadvantage, but often great Service from this Practice. + +When the Sharpness of the Pain was gone, and the Pulse became soft, +very often a dull Pain remained for some Time in the Part.--In some +Cases a brisk Purge removed it;--in others, cupping above the Part, +and afterwards rubbing it with the volatile Liniments, did +Service;--in others, gentle Opiates at Night, especially where there +was a tickling Cough;--and in one or two Cases, this Pain did not go +away, till the Patient was ordered to drink every Day for some Time, a +Quart of the Decoction of Sarsaparilla with the antimonial Wine. + +In the Course of this Disorder, if a kindly Moisture broke out on the +Skin, which gave Relief, this was encouraged by the Use of mild warm +Liquors; or if the Patient began to spit up a viscid or yellowish +Mucus, we endeavoured to keep up the Expectoration by the Use of mild +Pectorals; and if a Purging came on, we were careful not to check it +too soon, unless it was so violent as to be in Danger of sinking the +Patient. + +When an Inflammation of the Side came to Suppuration, which happened +in one or two Cases at _Osnabruck_, in _May_ 1761; as soon as a +Fluctuation of Matter was to be felt, an Incision was was made in the +Part, and the Matter discharged; after which the Sore healed kindly, +and the Patients recovered[51]. I am persuaded, was this Operation +oftener performed, many would recover who die consumptive. + + [51] Dr. _Mead_ advises, where the Lungs and Pleura grow + together, and an Abscess forms, to open it with Caustic; and + afterwards to keep the Ulcer open during the Patient's Life: + For he says, he has often seen, where such Sores were healed + up, that the Patient died soon after by an Efflux of Matter + upon the Breast. _Monita Medica_, Cap. i. Sect. 7. + + + + +OF THE PERIPNEUMONY. + + +The Soldiers were subject at all Times to the Peripneumony, or +Inflammation of the Lungs, from doing Duty in cold wet Weather, and +from their irregular Way of living; but more particularly towards the +End of the Campaigns, and in Winter. + +This Disorder was much more dangerous and fatal than the Pleurisy, +especially when neglected in the Beginning; for then Bleeding had +seldom any Effect; the Difficulty of Breathing encreased, the Patient +was seized with an Orthopnea, and such an Anxiety and Sense of +Suffocation, that he could not sleep; and the Pulse sunk; and in these +Cases Death only afforded Relief. This we experienced in many Men who +had lain neglected in Quarters, for two, three, four, or five Days, +before they were brought to the Hospital. + +In most of the Bodies of those who died of this Disorder, and were +opened after Death; we found the Lungs violently inflamed, with livid +or gangrenous Spots on their Surface; and more or less of a watery +Serum extravasated into the Cavity of the Chest. + +Three had Suppurations in the Lungs. In one, who had lain sick in +Quarters for ten Days or upwards, before he was sent to the Hospital, +the right Cavity of the Thorax was found full of a watery Serum; and +the Lobes of the Lungs on the same Side almost entirely wasted; and +what remained seemed as it were composed of thickened Membranes, +resembling those formed by the coagulable Lymph, or what is called by +some (though improperly) the fibrous Part of the Blood. The Lobes in +the left Side seemed to be in a sound State, or at most but slightly +inflamed. From the right Lobes of the Lungs being so much wasted, I +suspected that the Patient had probably laboured long under some +Disorder of the Breast; but I could not from Enquiry obtain any +Information in this Particular; nor did he ever mention such a Thing +during the few Days he lived after being brought into the Hospital; he +said, he had only been ill for eight or ten Days before; but Soldiers +afflicted with chronic Distempers, when they are seized with violent +Symptoms, or acute Diseases, are apt to reckon the Beginning of their +Disorder, only from the Time they are taken ill in a violent Manner; +and never to take any Notice of their former Complaints. + +Another Soldier, about the Middle of _February_, 1762, remained in +Quarters five Days after being taken ill with a Pain of the Breast, +and a Difficulty of Breathing; the sixth Day he was brought to the +Hospital in the Morning, and I saw him about eleven o'Clock; he then +had all the Symptoms of the true Peripneumony, attended with a strong +hard Pulse. He was immediately blooded as freely as his Pulse would +bear, had Blisters applied, and other Remedies used; notwithstanding +which, on the eighth Day from that Time, he began to throw up a +purulent Matter in great Quantity, attended with a constant hectic +Heat, and Fever; which sunk him so fast, that he died the tenth Day, +after he first began to expectorate. + +On the 2d of _March_, a Soldier, of the Fifty-first Regiment of Foot, +was brought to the Hospital, with a violent Pain in the left Side, and +a great Difficulty of Breathing. Upon examining him, he told me, that +about two Years before he had had a violent Stitch in his left Side, +towards the lower Part of the Thorax; that ever since he had been +subject to a Difficulty of Breathing; and at Times to a Pain in the +Side; but that he had only been seized with the violent Pain and +Difficulty of Breathing he then complained of, about five Days before, +occasioned by catching Cold, on being billeted in a low, cold, and +damp House.--His Pulse was quick, the Pain of his Side and Difficulty +of Breathing so great, that he could not sleep, nor lie down, but was +obliged to sit constantly in an erect Posture; his Tongue was white +and furred, and he had had no Stools for three Days: He was ordered to +be blooded immediately; and to take a Dose of Salts; and his Side to +be rubbed with the _linimentum volatile_. 3d. His Breathing and Pain +of the Side were easier; he had slept a little in the Night, and could +lie on his right side, but not on his left. He was ordered the Squill +Mixture. 4th. His Breathing was worse; he was blooded a second Time; +had a large Blister applied to his Side, and was ordered to continue +the Use of the Squill Mixture. On the 5th, 6th, and 7th, he seemed +easier, though the Breathing was still much affected, and his Pulse +quick and low, attended with a hectic Heat. On the 8th, he told me +that his left Side was swelled: On examining, I observed a Fullness in +that Side of the Thorax; and on pressing with my Fingers between the +Ribs, I thought I felt an obscure Fluctuation of a deep-seated Fluid. +From these Appearances, and the History of the Case, I judged that +there was a Collection of some Fluid within the Cavity of the Chest; +and that the only Means left to give Relief, was to make an Opening +into the Cavity, and so evacuate the Fluid. I therefore proposed to +him the Operation of the Empyema, to be performed immediately; which +he several Times obstinately refused to submit to: He allowed a Seton +to be put in his Side, but that did not answer the End proposed: He +languished six Days longer; and died the 14th of _March_. Next Day an +Opening was made in the Thorax, in the Part where the Operation was +proposed to have been performed; as soon as the Pleura was cut +through, some Quarts of Water rushed out. We then opened the Thorax, +and found still some Water in the left Cavity. The Pericardium was +thickened, and slightly inflamed, and adhered to the Diaphragm; which +was likewise a little thickened and inflamed in the adhering Part; the +Lungs on that Side were much compressed, and contracted by the +Pressure of the Water; but on being inflated and cut, seemed in a +sound State, except that they were slightly inflamed. The Lungs of +the left Side adhered every-where firmly to the Thorax, but seemed +otherwise sound; having no Tubercles, Suppuration, or other Disorder, +that we could observe in cutting them. The Heart and Blood Vessels +were sound, and no other polypous Concretions were observed within +their Cavities, but such as we find in most dead Bodies; which seem to +be formed of the coagulable Lymph in _articulo mortis_. The Viscera of +the Abdomen were in a sound State. + +We treated the Peripneumony nearly as the Pleurisy. We bled freely in +the Beginning, till the Breathing became easier, or the Pulse began to +sink; taking Care not to be deceived by a low oppressive Pulse, which +generally rose upon Bleeding. We applied large Blisters; gave the mild +Pectorals freely, and plenty of warm diluting Liquors, Barley Water, +the pectoral Decoction, and such like; which afforded more Relief than +any other Medicines. We gave too saline Purges, and laxative Clysters +occasionally; and in some Cases ordered the Steams of warm emollient +Decoctions with Vinegar to be drawn into the Lungs. + +By this Treatment most of them, who applied early for Relief, got the +better of the Disorder. + +When the Expectoration began, the Patient continued the free Use of +the mild Pectorals, and diluting Liquors; and no Medicines were given +that might in the least tend to stop it; other Evacuations were +omitted, unless where the Pain of the Breast, or the Difficulty of +Breathing increased; in which Case, if the Pulse kept up, I ordered a +Vein to be opened, and a suitable Quantity of Blood to be taken away; +no other Remedy affording any Relief, till this Evacuation was made. +Where the Patient was costive, we frequently ordered laxative +Clysters, or a mild Purge, and found them beneficial: But where no +such Symptoms occurred, it was best, for the most part, to omit all +Evacuations of this Kind, after a free Expectoration had begun, and to +trust to it for carrying off the Disorder. + +In some Cases, where the Expectoration stopt suddenly after bleeding, +we gave with Advantage a gentle Vomit, as recommended by Dr. +_Huxham_[52]. + + [52] Some late Authors seem to look upon the _Pleurisy_ and + _Peripneumony_ as the same Disorder: However, though it be + true, that when the _Pleura_ is inflamed, the Surface of the + contiguous Lungs is generally in the same State; and that, + when the _Lungs_ are inflamed, the Pleura is often affected; + yet as I have frequently seen the true Peripneumony without + that sharp Pain of the Side which characterizes the Pleurisy; + and upon opening the Bodies of People who have died of the + Peripneumony, have found the Lungs violently inflamed and + livid, and so filled with Blood as to sink in Water, without + the Pleura being much diseased; and upon opening the Thorax + of others who died of the Pleurisy, have found the + intercostal Muscles and Pleura violently inflamed with livid + Spots, and only a small Portion of the Surface of the + contiguous Lungs affected; I cannot help still looking upon + them as distinct Disorders; though they require nearly the + same Treatment, and are often complicated together. + + + + +OF THE COUGH and CONSUMPTION. + + +Coughs were very frequent during the Winter, and when the Weather was +wet and cold. They were often accompanied with Pains of the Breast; +and, when neglected, Obstructions, Tubercles, and Suppurations, were +apt to form in the Lungs, and the Disease to end in a Consumption, or +_Phthisis Pulmonalis_. + +When Coughs were slight, guarding against further Cold, and the Use of +mild Pectorals and warm Drinks, removed them. But when the Patient +complained of a Pain and Tightness about the Breast, it was always +necessary to take away more or less Blood; and after Bleeding to give +some of the mild Pectorals, such as the Sperma Ceti or oily Mixtures; +and, if a Fever attended, to join the Use of Nitre, or of the saline +or mindereri Draughts; and, if a tickling Cough was troublesome, to +give frequently a Tea Spoonful of the oily Linctus, acidulated either +with the Spirit of Vitriol, or the _oxymel scilliticum_. The mild +Diaphoretics, such as the mindereri Draughts, given along with warm +Drinks, to promote a free Perspiration, or Sweat, were used with +Advantage; when the Patients kept in Bed, and lay in Wards which had +Stoves in them. + +If the Cough and Pain of the Breast were not relieved by these Means, +the Patient was bled a second Time, and a Blister applied to the Side +immediately after; which often removed most of the Complaints. When it +did not, we gave the pectoral Decoction for common Drink; and if there +was a Shortness or Difficulty of Breathing, the squill Mixture, or +_lac ammoniacum_, with Oxymel; and occasionally gentle Purges: And if +at any Time of the Disorder the Tightness and Pain of the Breast +returned violent, we took away some Blood, no other Remedy affording +Relief. + +When there was little or no Fever, and a thin Rheum kept up a tickling +Cough, nothing had a better Effect than to add some Drops of the +_tinctura thebaica_, or some of the _elixir paregoricum_, to the +oleagenous or squill Mixtures; or to give an Opiate Draught or Pill at +Bed-Time, which eased the Cough, and procured the Patient Rest. + +At all Times it was necessary, when the Cough was violent, attended +with Pains of the Breast, to keep the Patients on low Diet; and in as +free and pure Air as the Nature of the Hospitals would admit of; for +we often found that those Men who had laboured long under obstinate +Coughs, which threatened Consumptions in small crowded Wards, +recovered surprisingly on being removed to a freer Air; of which we +had a remarkable Instance in the Hospital at _Bremen_, in _January_ +1762; upon removing some Men, afflicted with very bad Coughs, out of +small Wards, which were damp, into one large one, which was dry and +airy. + +When the Weather was good, we made the Patients walk out a little in +the Day-Time; for we observed, that remaining always in the Hospital, +and breathing nothing but a foul Air, helped to encrease the +Disorder.--When we knew the Men to be sober, and not apt to commit +Irregularities, we used to procure them good Billets, and make them +come daily to the Hospital for their Medicines. + +Equal Parts of Lime-Water and Milk, drank to the Quantity of a Quart a +Day, was of Use to some; and the _infusum amarum_, and other gentle +Bitters, taken to the Quantity of an Ounce or two, Morning and +Evening, to others[53]. + + [53] Asses Milk, and _Bristol_ and _Seltzer_ Waters, which + are found so serviceable in pulmonic Disorders, could not be + had in the military Hospitals; and riding on Horseback was + too expensive a Remedy for a Soldier. + + In chronic Cases, where we suspect Obstructions and Tubercles + to be formed in the Lungs, which have not already come to + Suppuration, Dr. _Russel_ recommends the Use of Sea Water for + resolving them; but we were at too great a Distance from the + Sea to try this Remedy. See his _Treatise on Sea Water_, Page + 17. + +A Decoction of the Cortex removed some Coughs which had continued for +a considerable Time. In one or two of these Cases, slight hectic +Symptoms had already appeared[54]. However, for the most part, +where-ever Obstructions of the Lungs were confirmed, or there were +evident hectic Symptoms without a free Discharge of purulent Matter, +the Bark did no Service; but rather heated and increased the Fever, +and made the Sick more restless and uneasy.--It was of most Use where +there seemed to be no confirmed Obstructions, but the Vessels much +relaxed; which we judged to be the Case from the Patients having no +fixed Pain, nor the Breathing much affected. If the Sick were +plethoric, or in the least feverish, we ordered a little Blood to be +taken away, before we began the Use of this Medicine. + + [54] _Mary Shepperd_, a Woman twenty-six Years of Age, was + admitted into _St. George_'s Hospital the 6th of _June_, + 1759, for a Cough; attended with a constant hectic Fever and + Night Sweats, which had begun in the Month of _April_, after + the Measles. She complained likewise of having the _fluor + albus_, and she had been blooded more than once before she + came to the Hospital.--I at first gave her some of the mild + Pectorals; and a Solution of White Vitriol in Water, _utenda + pro inject. uterina_. After a Week, finding no Alteration in + her Complaints, I advised her to become an Out-patient; and + to go down to her Friends in the Country, to live upon a Milk + Diet; to take gentle Exercise, and continue the Use of her + Medicines; which she did, but without any Alteration in her + Disorder, till the 6th of _July_, when I ordered her to take + thrice a Day two Ounces of the Decoction of the Cortex, along + with a saline Draught. Immediately, on beginning to use this + Medicine, her Disorder began to take a favourable Turn; her + Fever and Night Sweats left her, her Cough became easier, and + she recovered Health and Strength daily. She came to the + Hospital the 15th of _August_, seemingly in good Health, to + return Thanks for her Cure. + +In similar Cases, I have sometimes observed good Effects from the Use +of the Balsam _Copaivy_, or _Peru_; given either in Juleps or made up +into an Electuary, as in the _electuarium e spermate ceti cum +balsamo_; but in whatever Form they were given, if there were +confirmed Obstructions of the Lungs, they rather heated and inflamed, +than did any real Service. + +When Coughs continued long, attended with Pain in the Side, Difficulty +of Breathing, and Hectic Fever and Night Sweats, we always had Reason +to suspect, that the Disorder would terminate in a confirmed +Consumption. When this was threatened, we found, that the principal +Thing to be done, was to keep the Patients cool; and to endeavour to +allay the hectic Heat and Fever; and to retard, as much as possible, +the Progress of the Disorder. When the Case was recent, we were +sometimes so lucky as to make a Cure; but after it was confirmed, it +for the most part ended fatally. + +We kept the Patients upon a low Diet; and where-ever Milk was to be +got easily, we allowed them a Pint a Day[55]; which was either mixed +with Water and given for Drink, or they took it to Breakfast or +Supper.--Their common Drink was either Barley Water or the pectoral +Decoction; which was occasionally acidulated with a few Drops of +Spirit of Vitriol; and we gave at the same Time the cooling +Medicines, such as Nitre, the saline or mindereri Draughts, mixed at +Times with Sperma Ceti, or some other of the mild Pectorals. + + [55] In private Practice, at this Stage of the Disorder, the + Use of Asses Milk, and drinking the _Bristol_ Water at the + _Bristol_ Wells, and riding on Horseback daily, are justly + ranked amongst the most efficacious Remedies; and going into + the more southern Climates, as the South of _France_, + _Portugal_, or _Italy_, where the Air is warmer, more + constant, and dry, than in _England_, has often been found to + produce good Effects. + +The opening a Vein, and taking away from four to eight Ounces of +Blood[56], whenever the Pain of the Breast was troublesome, or the +Patient was hot and restless at Nights from the Hectic Fever, gave the +greatest Relief of any Thing we tried; and these repeated small +Bleedings were so far from wasting the Patient's Strength, that they +rather seemed to prevent its being exhausted so fast as otherwise it +would have been, by allaying the Force of the Hectic Fever. + + [56] This Practice has been strongly recommended by Dr. + _Mead_, in his _Monita Medica_, Sect. x. and by an anonymous + Author in the _Edinburgh Medical Essays_, Vol. IV. Art. 28. + and Dr. _Mead_ says, when Things have not been quite + desperate, he has seen good Success from it. + +At this Stage of the Disorder, we put in Setons, or ordered Issues, to +serve as a Drain to carry off the Matter, and found them of Advantage +in some Cases. When the Patients complained of any fixed Pain, we +always made the Issues as near the Part affected as possible[57]. On +the 5th of _May_, 1762, a Man, belonging to the Eighty-eighth Regiment +of Foot, was sent to the Hospital at _Bremen_ for an Hæmoptoe, +attended with a constant hectic Heat and Fever.--After being blooded, +and using the cooling Remedies without Success, he had four Pea Issues +made in his Back; and had a slight Decoction of the Cortex, acidulated +with Spirit of Vitriol. As soon as the Issues began to discharge +freely, the hectic Heat, Fever, and Spitting of Blood, diminished +daily; and he recovered his Health and Strength in a short Time. +However, it ought to be observed, that although these Drains are +sometimes efficacious, yet, when the Disease is far advanced, the +Mischief is generally too deep rooted for them to be of any Service. + + [57] In _June_, 1748, a Servant Girl came to ask my Advice + for a Cough, attended with a constant Hectic Fever and Night + Sweats, which had begun some Months before, on catching Cold. + The Matter she spit up was yellow, and had the Appearance of + Pus; and she complained of a Pain in the left Side of the + Thorax. I ordered her the saline Mixture with Sperma Ceti to + be taken thrice a Day, to lose a little Blood, to drink an + Infusion of Linseed sweetened with Honey, and to have a Seton + put in her Side at the Part where she complained of Pain; + advising her to go home to her Father, who was a Farmer in + the Country, and to live upon a Milk and Vegetable Diet, and + ride on Horseback whenever she could conveniently. She seemed + so far gone in a Consumption, that I scarce expected to see + her again; but, in the Month of _December_, she came to + return me Thanks for her Cure, seeming then to be in good + Health. She told me, that, as soon as the Seton began to + discharge freely, she found Relief; and mended afterwards + daily, by following the Directions I had given her. + +The Bark, and natural Balsams, for the most part were prejudicial, and +encreased the Hectic Heat and Fever; except in one or two Cases, where +the Disorder seemed to depend on a Vomica of the Lungs, and the +Patient coughed up the Matter freely.--In one Case they were of +considerable Service; the Patient was very low, and had the Night +Sweats, but coughed up the Matter freely: On using the Decoction of +the Bark, and the _electuarium e spermate ceti cum balsamo_, the +Matter expectorated became thicker, and of a more balmy Consistence, +without any Increase of Heat or Fever; after which the Symptoms became +gradually milder, and the Patient recovered. + +In the Course of this Disorder the Patients often became very hot and +restless, and were troubled with Gripes, succeeded by a Purging: These +Symptoms were most readily removed by a Dose of Rhubarb, or of some +other mild Purge; for they generally proceeded from corrupted Humours +lodged in the Intestines. In the Evening, after the Operation of the +Purge, we gave an Opiate to procure the Patient Rest.--When the first +Dose of Physic did not stop the Purging, we repeated the Opiates at +Nights, and in a Day or two gave another Purge; and if there was much +Sickness, or Load at the Stomach, gave likewise a gentle Emetic. + +If the Purging still continued, we were obliged to join the Use of +Astringents along with the Opiates. In some Cases, I found good +Effects from equal Parts of Milk and Water boiled with Rose Leaves, +Pomegranate Bark, Balaustine Flowers, and Cinnamon, as recommended by +Dr. _Mead_ in his _Monita Medica_[58]; it served both for Food and +Medicine.--When Opiates and Astringents were given to stop the Purging +at its first Appearance, before the Bowels were emptied, they always +did Mischief; and increased the Heat and Fever: And although they +stopt the Purging for a few Hours, it always broke out with greater +Violence afterwards. + + [58] _Sect._ x. _de Febrib. lentis sive Hecticis._ + +When the Sick were attacked with a Shortness and Difficulty of +Breathing, which was not relieved by Evacuations, and the Use of +cooling Medicines, and Pectorals, and Blisters, nothing gave so much +Ease, or had such a good Effect, as a gentle Vomit; for it often +removed the immediate Oppression from the Breast, and helped to pump +up the Matter from the Lungs. + +In the advanced State of the Consumption, the Cough was always very +troublesome; and the Sick found no Relief but from Opiate Medicines, +which, in such Cases, cannot be expected to do more than give a little +present Ease.--As they were apt to obstruct the free Expectoration, we +generally mixed them with some _oxymel scilliticum_, or _tinctura +foetida_, which took off a good deal of their suffocating Quality. + +Dr. _Barry_[59] advises for the Cure of a Consumption, to make an +Incision or Aperture into the Side; where-ever there is a fixed Pain +attended with a Weight, a Hectic Fever, and other Symptoms of an +evident Suppuration: He says the Pleura is thickened, and the Lungs +adhere at the Part where they are exulcerated; and that by the +Operation the Pus may be evacuated, and a Cure made; and he gives +several Instances of the Success of the Operation, when performed in +Time. + + [59] _Treatise on the Digestions_, p. 410. + + + + +OF THE Epidemical CATARRHAL FEVER Of APRIL, 1762; CALLED, THE +INFLUENZA. + + +After a very cold severe Winter at _Bremen_, the Weather, from being +very cold, became of a sudden extremely hot, about the 10th of +_April_. In a few Days after, many People were seized with a violent +Catarrhal Disorder. It often began with such a Cold and Shivering, +that many imagined at first that they were going to have Agues; but +soon after they were attacked with a Cough, and a Difficulty of +Breathing, and Pain of the Breast, with a Head-Ach, and Pains all over +the Body, especially in the Limbs.--The first Nights they commonly had +profuse Sweats.--In several, it had the Appearance of a remitting +Fever, for the two or three first Days.--Many had a slight +Inflammation of the Throat, and a Hoarseness. In all it was attended +with an acute Fever in the Beginning, and the Urine was of a high +Colour; and when the Disorder had put on the Appearance of a Remittent +Fever in the Beginning, it dropt a Sediment towards Morning after the +second Day; and did the same in all, when the Disorder was going +off.--Some had a Purging, but the greater Number were rather inclined +to be costive.--The Cough in many was very violent; and the Patients, +after each Fit of Coughing, had Reachings, or Strainings to vomit, +exactly resembling those which come after violent Fits of the Hooping +Cough.--At first the Patients spit up only a little Phlegm; but in the +Decline of the Disorder, they expectorated freely.--The violent Cough +and Feverishness generally continued for four, five, or six Days; +with others it continued longer; and some had a Cough for two or three +Weeks after the Fever left them. + +This Catarrhal Fever seized most of the People of the Town of +_Bremen_; and there were very few of the _British_ who escaped it; at +the same Time, it was epidemical in most Countries in _Europe_. + +We treated it entirely as an inflammatory Disorder, and none died who +applied early for Relief.--Most People recovered by one plentiful +Bleeding, and taking the mild cooling Medicines, such as the _mixtura +e spermate ceti cum nitro_, the saline or mindereri Draughts, or such +like. When the Fever and Difficulty of Breathing continued after the +first Bleeding, in a Day or two a Vein was opened a second Time; and +immediately after a Blister was applied to the Back, which commonly +removed the Fever, and relieved the Breathing.--When the Patients were +inclined to be costive, a Dose of Physic was of Service. + +None of the _British_ died, except one or two of the Soldiers, who +remained in Quarters after being taken ill; and, instead of bleeding +and living low, indulged in the Use of spirituous Liquors; and were +not brought to the Hospital, till they were in the last Stage of a +Peripneumony.--Many of the Inhabitants of the Town died of this +Disorder, which was probably owing to Want of Care. + + + + +OF THE RHEUMATISM. + + +The Rheumatism is one of the Disorders most generally to be met with +in military Hospitals. There were at all Times some Men in our +Hospitals labouring under Rheumatic Fevers, or other rheumatic +Complaints; though we never had at any one Time a great Number; owing +probably to the Weather being very favourable in both the Campaigns of +1761 and 1762.--It was always most frequent when the Weather was wet +and cold; both during the Campaign, and when we were in Winter +Quarters. + +It commonly began either, 1. With an acute Fever, and Pains all over +their Body: or, 2. With Pains in particular Parts, as the Shoulders, +Legs, Arms, Knees, and sometimes of the Side, attended with some +Degree of a Fever.--The first was the most common Form it assumed, +when Men were attacked with it in the Field or in Garrison; owing to +their doing Duty in cold wet Weather.--The other Causes generally took +place when they had been formerly subject to rheumatic Complaints, and +had caught Cold; or after they had been weakened and reduced low by +Fevers, Fluxes, or other Disorders. + +We had but very few Rheumatisms accompanied with Swelling, Pain, and +Inflammation of the Joints of the Knees and Wrists, &c. which are so +common in our Hospitals about _London_. I did not meet with above a +Dozen Cases, of this Kind, whilst in _Germany_ with the Army. + +When the Rheumatism began with Pains all over the Body, attended with +a High Fever, we treated it at first entirely as an Inflammatory +Fever[60]. We blooded freely, and repeated this Evacuation often[61], +if the Blood continued sizy, and the Pains violent; provided the Pulse +was strong. When the Pleura, the Lungs, or any other of the Viscera +were affected, we blooded as freely as we should have done in acute +Inflammations of these Parts: We gave the saline Draughts with +Nitre[62]; and Plenty of Barley Water and other weak diluting Liquors; +and gentle Physic once or twice a Week; and afterwards applied +Blisters, which often relieved both the Pains and Fever. + + [60] _Sydenham_, in treating of this Disease, orders + Bleeding, and that to be repeated next Day; and afterwards + every other Day, two, three, or four Times, or more, as the + Patients Strength can bear it; and on the intermediate Days + to give a purgative Clyster. But in young People, and those + who have lived regularly, he says, that a very low Diet will + cure as effectually as Bleeding and Medicines; That the + Patients must live four Days on Whey alone, but after this + may eat Bread for Dinner; and on the last Days for Supper + also; and when the Symptoms begin to abate, he allows them to + eat boiled Chicken, or other light Food; but says they must + live every third Day on Whey, till their Strength returns. + _Precess. Integr. de Rheumatismo_. + + [61] A Remark of Dr. _Huxham_'s deserves to be taken Notice + of here: He tells us, that there are some Kinds of + Rheumatisms, _viz._ those which come from a sharp serous + Rheum, which do not bear the free Use of the Lancet; that + plentiful Bleeding does more Hurt than Good; and that, in + such Cases, the Medicines which bring out breathing Sweats, + and at the same Time correct the Acrimony of the Blood, + joined with gentle Opiates, have a much better Effect. _De + Aere_, Vol. II. p. 185. + + [62] Dr. _Brocklesby_, in his _Observations on military + Diseases_, recommends the Use of large Quantities of Nitre + dissolved in Water Gruel, or Sage Tea, (in the Proportion of + two Drachms of the Nitre to a Quart of the Liquor) in acute + Rheumatisms. He says, "I am assured from numberless + Instances, that in stout young Men, by taking six hundred + Grains (ten Drachms) daily, for four or five Days + successively, and diluting plentifully, as before + recommended, plain Nitre proves the most powerful and best + Sudorific, in such Complaints, that I have ever tried; and + this Quantity, and even more, may be retained in the Stomach, + and pass through the Course of the Circulation, by only + diluting properly with those thin attenuating Beverages as + before recommended. Such Quantities, in three or four Days, + seldom failed wonderfully to relieve the Patient, and very + often to cure him entirely, by the most plentiful and profuse + Sweats." _See from p. 116, to p. 124._ + + I have never hitherto given Nitre in such large Quantities as + here recommended by Dr. _Brocklesby_. + +After some Days, if the Pains still remained, we continued the saline +Draughts with Nitre throughout the Day; and in the Evening endeavoured +to promote a free Perspiration by Means of the mild Diaphoretics, +such as the mindereri Draughts with Mithridate, in Doses frequently +repeated; at the same Time, the Patient kept in Bed, and drank freely +of mild diluting Liquors. Sometimes we gave twenty, thirty, or forty +Drops of Spirits of Hartshorn, in repeated Draughts of warm Barley +Water: or a like Quantity of the Antimonial Wine, used in the same +Manner: or from sixty to a hundred Drops of the Antimonial Wine, mixed +with one-fourth Part of the _tinctura thebaica_, in a large Draught of +some warm Liquor; which I have observed, in many Cases, to have a +better Effect, than most other Medicines used for this Purpose; as it +acts both as an Opiate in easing the Pain, and procuring Rest; at the +same Time that it promotes a free Perspiration, or gentle Sweat, to +carry off the Distemper. + +But it should be observed, that, in the Beginning of Rheumatic Fevers, +forced Sweats generally did Hurt, and often increased both the Pain +and Fever; and that in general we had greater Success, and made +speedier Cures, when we did not attempt to promote Sweating, till +after other Evacuations had been sufficiently made, and the Fever had +begun to abate; and that in this Fever, when we did attempt to procure +Sweats, the milder Diaphoretics, with Plenty of weak diluting Liquors, +answered better than those of a more heating Nature; though after the +Fever was gone, and the Pains still continued, sometimes the stronger +Sudorifics, such as G. Guaiac, and its volatile Tincture, _Dover_'s +Powder, and the like, best answered the Purpose, and carried off the +Distemper, when the milder ones had little Effect. + +I have often observed, where Sweating made no Change in the Distemper, +that keeping up a free Perspiration by Means of the Decoction of the +Sarsaparilla with the Antimonial Wine, or small Doses of the _pulvis +antimonialis_ (_gr._ v.), given twice or thrice a Day, removed +Rheumatisms, which had resisted the Force of other Remedies. + +Sometimes the cold Bath[63] removed Pains which had not yielded to +internal Medicines; but it ought to be observed, that when Patients +went into the cold Bath while the Feverishness still remained, and the +Blood continued sizy, or before free Evacuations had been made, +oftentimes, instead of giving Relief, it made the Disorder worse, and +more obstinate[64]. + + [63] I have frequently ordered the warm Bath with Advantage + in Rheumatic Cases in _St. George_'s Hospital; but we had no + Convenience of this Kind with the flying Hospital in + _Germany_. + + [64] This I have seen many Instances of, particularly in the + Case of _Ann Walker_, a Woman of twenty three Years of Age, + who was under my Care in _St. George_'s Hospital, in _May_, + 1759. Before she came to the Hospital, she had been blooded, + and had gone into the cold Bath four Times, which, she told + me, had increased her Pains to a violent Degree; in which + State she had continued for some Weeks before she came to the + Hospital; but by being blooded, and taking the cooling saline + Medicines, with gentle Purges, and mild Diaphoretics, she got + well in a Month's Time. + +When the Rheumatism was confined to a particular Part, attended with +Fever, we treated it as the acute Rheumatism. Fomenting the Part with +warm emollient Decoctions, and rubbing it afterwards with the +volatile, or saponaceous Liniments, often gave Ease; and the +Application of Cupping-Glasses and Blisters frequently removed the +Disorder. In some Cases, where the first Blister did not relieve, the +Application of a second, and afterwards keeping up a Discharge from +the Part by Means of the Epispastic Ointment, carried off the Pain. In +others, where the mild Diaphoretics were ineffectual, Sweating, with +the G. Guaiac, or _Dover_'s Powder, and such other Medicines, after +the Fever was gone, removed the Complaints[65]. + + [65] Warm Water, pumped upon the Part, often removes such + rheumatic Pains as have resisted the Force of internal and + other Remedies. On the 29th of _August_, 1759, _Mary Ward_ + was admitted into _St. George_'s Hospital for rheumatic Pains + of the Arms, Legs, and Knees, attended with Fever, which all + yielded to Evacuations, and the Use of cooling Medicines, + mild Diaphoretics, and of the warm Bath, except the Pain of + the Knee; which, after it had resisted the Course + above-mentioned, was at last removed by pumping warm Water on + the Part, three Times a Week; joined to the Use of + Fomentations and volatile Liniments. + +When the Rheumatism was attended with Inflammation and Swelling of the +Joints, we blooded freely, gave cooling Purges, and the saline +Draughts with Nitre, along with Plenty of weak diluting Liquors, and +prescribed a cool low Diet. + +After the Violence of the Fever and Inflammation was abated, fomenting +the Parts, and rubbing them with the saponaceous or volatile +Liniments, sometimes hastened the Discussion of the Swelling; as did +likewise the Application of Blisters[66], after the Inflammation was +entirely gone; but it ought to be noticed, that if volatile Liniments +or Blisters are used too soon, they will sometimes occasion violent +Inflammation and Pain[67]. + + [66] _Ann Ragen_, a Woman about thirty-three Years of Age, + was admitted into _St. George_'s Hospital the 17th of + _January_, 1759, for rheumatic Pains of her Legs and Arms, + and a Swelling of her right Knee. Free Evacuations, and the + Use of cooling Medicines, and mild Diaphoretics, removed all + her other Complaints, except the Swelling of the Knee, by the + Middle of _February_, when I ordered a Blister to be applied + to it; after which the Swelling gradually decreased, and she + was discharged, cured, the 20th of _March_.--_Rachael Hyde_, + a Woman twenty-four Years of Age, was admitted into _St. + George_'s Hospital the 9th of _May_, 1759, for similar + Complaints, which were removed by the same Means, all except + the Swelling of the Knee. A Blister was applied, and most of + the Swelling went away, but returned soon after: It was at + last removed by the Use of the warm Pump three Times a Week, + and drinking a Pint of the Guaiac Decoction daily. + + [67] I have sometimes ordered Leetches to be applied to such + Swellings (as recommended by Dr. _Pringle_), and found them + to be of Service; and, at other Times, I have applied + emollient Fomentations and Poultices, which have given great + Ease to the Patient.--I have seen Setons or Issues, made near + the Part affected, afford considerable Relief. + +Rheumatic Cases of this Kind are often very obstinate, and require a +considerable Length of Time before they are got the better of; and +frequently more or less of the Swelling, especially of the Wrists and +Joints of the Fingers, remains ever after; and Patients, who have once +had the Rheumatism in this violent Degree, are always subject to +Relapses; as are even those who have had the Rheumatism but slightly. + +Mercury[68] has been recommended in the Cure of Rheumatisms; but I +never found it do any Service by itself, except in Cases complicated +with venereal Symptoms; though I have often given it, and even +sometimes gone so far as to raise a Salivation, where the Pains were +most severe in the Night; and the Patient, at the same Time, thought +he had some Reason to suspect a venereal Taint, though no external +Symptom appeared. However, many good Practitioners have recommended +small Doses of Calomel to be given at Nights, and next Morning a +Purge; in which Way, I think, I have observed good Effects from its +Use. + + [68] Dr. _Musgrave_, in his Treatise _de Arthritide + Symptomat._ p. 30, cap. ii. sect. 10, says, he has known a + Salivation, raised by Mercury, cure the Rheumatism. + +The Bark was frequently of Use in restoring the Strength, and removing +those rheumatic Pains which remained after Fevers, and other +Disorders; but, in other Cases, it had little Effect. + +When the Rheumatism continues long, and has taken deep Root, +_Sydenham_[69] advises to bleed from Time to Time, at some Weeks +Distance; which, he says, will either entirely remove the Disease, or +bring it to that Condition, that the Remains of it will be easily +extirpated by an Issue; and giving some of the volatile Salts in +_Canary_ Wine, Morning and Evening. I have always observed in +rheumatic Cases, which continued long, that, after free Evacuations, +the Patients received more Benefit from a mild low Diet, continued for +some Time, and the Use of diluting Decoctions with mild Diaphoretics, +while they took gentle Purges once or twice a Week, than from any +other Remedies. + + [69] Vide _Sydenham. Opera._ sect. vi. cap. 5. + +I have given Half an Ounce of Soap a Day, for a considerable Time, in +some old rheumatic Cases, in the Manner recommended by the late Dr. +_John Clerk_ of _Edinburgh_, as mentioned by Dr. _Pringle_; and, I +think, with Advantage; but have not had sufficient Trials to ascertain +the Merits of this Medicine. + +Dr. _Sydenham_, in treating of the Rheumatism, which he calls +scorbutic, says; that after it had resisted Bleeding, Purging, low +Diet, and other Remedies, he has cured it by giving thrice a Day two +Drachms of an Electuary made of _conserv. cochlear. horten. recent. +unc._ ij. _lujul. unc._ i. _pulv. ar. comp. drachm_ vi. _cum syrup. +aurant._ q. s. drinking after it three Ounces of a Water drawn from +_Brunswick_ Beer, and some of the antiscorbutic Plants. + +There is no Disorder which Soldiers are so apt to counterfeit as the +Rheumatism, when ever the Duty in the Field is severe; but while there +is no Fever or Size in the Blood, or other evident Marks of the +Distemper, and the Men look healthy, there is always Reason to suspect +Imposture. + + + + +OF THE Autumnal Remitting Fever. + + +The Remitting Autumnal Fever, called by the Antients [Greek: synechês], +was also one of the most frequent Disorders during the Campaign. + +This Fever is observed in most Countries, after the Juices have been +highly exalted by the Heat of Summer; and People are exposed to the +Heats of Mid-Day, and to the cold Damps of the Night. We observe it +every Year in the Neighbourhood of _London_, especially among the +labouring People, who work in the Fields, towards the End of Summer, +and in Autumn; but it is generally in a milder Degree than in Armies, +where Men are more exposed to the Vicissitudes of the Weather. + +As we go further towards the South, this, as well as other bilious +Disorders, becomes more frequent. + +This Fever is reckoned the endemic Distemper of the _West Indies_, of +the Coast of _Guinea_, and other Places in the Torrid Zone; but in +those warm Countries it appears in a more violent Degree; makes a much +more rapid Progress; and proves far more fatal than in our cooler and +more temperate Climate. And it is observed to be always most frequent +and most fatal where a Country is covered with Wood, or is marshy; and +where there are frequent Fogs, and much stagnating Water, which +corrupts by the Heat of Summer. + +In _January_, _February_, and _March_ 1761, we had none of those +Remitting Fevers at _Paderborn_. In _April_, some few of the Soldiers, +on their Return from the Winter-Expedition into _Hesse-Cassel_, had +Fevers attended with bilious Symptoms; but they were rather of the +continued, inflammatory Kind, and tending to malignant, than such as +could be called remitting. + +The first Time that I saw much of this Fever, was among the Sick sent +to _Bilifield_ in the End of _June_ 1761; soon after the Army took the +Field. The Remissions were short, and it partook much of the Nature of +the common Inflammatory Fever; and most of them were cured by the +antiphlogistic Method. A Day or two before we left this Place, it +began to change into the Malignant Hospital Fever, from the Sick being +too much crowded. + +In the Middle of _July_, about Twelve Hundred Sick were sent to the +Hospital at _Munster_; and about one-third Part were ill of this +Remitting Fever. It did not partake near so much of the inflammatory +Nature as at _Bilifield_; the Remissions became much more evident; and +it was attended much oftener in the Beginning with bilious Vomiting +and Purging; and in some few the Disorder turned to a Dysentery. About +eight or nine had it changed into the Hospital Fever, from the Wards +in one of the Hospitals being too much crowded; and in some few the +Disorder terminated in regular Agues. In _November_ severals were +taken ill of it in the Garrison of _Bremen_, which mostly ended in a +regular Intermittent, the endemic Distemper of the Place. Towards the +End of _December_ we had none of these Remitting Fevers, the Disorders +turning more to the inflammatory Kind. + +In _June_ 1762, this Fever began to appear again among the Sick, sent +from the Army, to the Hospital at _Natzungen_; and it continued to be +frequent through the Summer and Autumn; and the greatest Part of these +Fevers this Year terminated in regular Agues, mostly in Tertians, and +were cured by the Bark; whereas the Year before very few terminated +this Way. + +This Disorder in the Beginning had commonly the Appearance of a +continued Fever; and many had a Sickness and Vomiting, and threw up a +Quantity of yellow Bile, mixed with the Contents of the Stomach. In a +few Days, especially after Bleeding, the Remissions became clear; tho' +on its first Appearance in _June_ 1761 they were short, and rather +obscure; and it seemed still to partake a good deal of the Nature of +the common Inflammatory Fever, the Blood being very sizy; but as the +Season advanced, the Remissions became more evident, and the Paroxysms +more like those of an Ague; and the Blood less sizy, tho' at all +Seasons of the Year it had some Appearance of an inflammatory Buff in +this Disorder. The Sick were restless and uneasy at Night; but +commonly felt themselves cooler and lighter in the Day-Time: and +although they had no cold Fit, as the Fever came on at Nights, and +many of them no Breathing Sweat, as they became cooler and freer from +the Fever in the Morning; yet the Fits were so remarkable, that many +of the Patients used to say they had a regular Fit of an Ague every +Night, or towards the Morning; and some few, that they had the Fit +every second Night. As the Season advanced, the Remissions appeared +more distinct. However, there was always a good Number in whom the +Fever went on in a continued Form, through its whole Course, without +any Signs of Remission; tho' they had all the other Symptoms of this +Fever. In a few Instances the Fever, after it came to remit, changed +again into a continued Form. + +The Heat in the Time of the Paroxysms rose high, and several were +delirious during its Continuance[70]; but were quite sensible in the +Intervals, though never wholly without the Fever. + + [70] I did not see the Delirium rise so high, nor the + Paroxysms so severe, as in the Marsh Fever described by Dr. + _Pringle_. + +At the End of _July_ 1761, four or five were attacked with a Bleeding +at the Nose, in the Time of the Paroxysms, and became cooler +afterwards; but it did not prove a Crisis in any of them. + +The Urine in the Beginning was commonly of a high Colour, though +sometimes it was pale and limpid: At first it deposited no Sediment; +but when the Fever came to remit, there was often a small Sediment +after each Paroxysm; and as the Fever was going off, it let fall a +Sediment in all[71]. + + [71] Dr. _Hillary_ says the Symptoms of this Fever in + _Barbadoes_ were much the same as those of the [Greek: synechês], + or continued Remitting Fever in England; except only that the + Urine in this hot Climate never deposits any lateritious + Sediment, nor very rarely in any intermitting or any other + Fever, except when a Crisis happens that Way. _Observations + on the Diseases of Barbadoes_, p. 23. + +Some at first were inclined to be costive; others had a Sickness and +Purging; and several of those who were costive in the Beginning, were +in the Course of the Disorder attacked with a Purging; and others, +after some previous Complaint of the Stomach, were seized with both +Vomiting and Purging. In general, after the Sick continued some Days +in the Hospital, they were inclined to be loose; which was a +favourable Circumstance, when this Evacuation was not so great as to +be in Danger of sinking the Patient. Some were attacked with a +Dysentery. + +In this, as well as in most other Fevers, the Sick frequently passed +by Stool Worms of the round Kind; and sometimes they vomited them up, +or the Worms came up into their Mouth or Nostrils while they lay +asleep in Bed; and some towards the Height were afflicted with +Deafness, which was commonly a favourable Symptom. + +Most of those ill of this Disorder had a yellowish Colour of the +Countenance, which went off with the Fever. It was more observable in +some than in others; in general, it was slight; some few became yellow +all over[72]; particularly one Man, in the Hospital at _Munster_, who, +after being seized with violent Vomiting and Purging, Convulsions, and +Twitchings of the Tendons, and Hiccup, became yellow, as in the +deepest Jaundice. This Symptom of Yellowness arises from a Redundancy +and Absorption of Bile; and is sometimes observed in other Fevers as +well as this[73]; for while we were at _Paderborn_ in _February_ +1761, two Men were brought to the Hospital in Fevers, attended with +this Symptom. They were both delirious, with parched dry Tongues, +slight Twitchings of the Tendons, and other bad Symptoms; and one of +them had a continual Vomiting and Purging. They both died, and the +Body of him who had the Purging was opened. All the Bowels, especially +the Colon, were tinged with a yellow Bile, and had a slight Degree of +Inflammation all over their Surface; the Gall-Bladder was distended +with a very dark-coloured Bile; but no Concretions were found in its +Cavity, or in the bilious Ducts; nor Mucus, or any other Thing +obstructing these Passages. The Surface of the Lungs seemed slightly +inflamed; and there was a small Quantity of greenish Serum in the +Cavities of the Thorax. I could not learn the Histories of these two +Mens Disorders, before they were brought to the Hospital; but, from +the Symptoms, was inclined to believe, that the Fevers had been of the +malignant or petechial Kind; and that the yellow Colour was only an +accidental Symptom of it; for on one of the Men we could perceive +obscure Traces of dun petechial Spots on his Breast and Arms; and the +malignant Fever was frequent at this Time among the Troops, and the +bilious autumnal Fevers had ceased long before. + + [72] Dr. _Pringle_ takes Notice of this yellow Colour or + Jaundice. He says, "some grow yellow, as in the Jaundice. + This was found more frequent during the first Campaign than + afterwards; it was an unfavourable, but not a mortal + Symptom." _Observ._ part iii. ch. 4.--_Hippocrates_ mentions + the Jaundice occurring in Fevers, _Aphor._ iv. § 62 & 64; and + he reckons it a favourable Symptom in ardent Fevers, where it + happens on the seventh Day. See _Book on Crises_'s, sect. 3. + + [73] Does this Fever, when accompanied with this universal + Yellowness of the Skin, approach to the Nature of the yellow + Fever of the _West Indies_? As I had so few Cases of this + Kind under my Care, I cannot determine any thing about it + from my own Experience; but, from the Accounts of others, I + should believe them to be very different Disorders.--In the + yellow Fever of the _West Indies_, the Blood appears quite + loose and dissolved, without the least Appearance of Size, + even on the first Day; and the general Yellowness appears on + the third or fourth, with Signs of a total Dissolution, and + gangrenous Diathesis of the Blood: Whereas, in the Remitting + Fever of _Jamaica_, Mr. _Nasmith_ tells us, (See Dr. _Lind_'s + first Paper on Fevers), there is always an inflammatory + Diathesis of the Blood. The Yellowness in both depends on a + Redundancy and Absorption of Bile; but in the yellow Fever of + the _West Indies_, the Bile is in a much more putrescent + State, and a great Part of the Cure depends on the early and + speedy Evacuation of it.--In the yellow Fevers which appeared + in _Haslar_ Hospital, which are taken Notice of by Dr. + _Lind_, in his _Two Papers on Fevers_, the Blood was in quite + a different State from what it is in the Yellow Fever of the + _West Indies_; the Blood drawn from two of these Patients + became covered with a thick yellow Gluten, and the Serum was + of the Consistence of a thin Syrup, and of a deep yellow + Tinge, and tasted bitter; and in another who was bled two + Days before his Death, it threw up the same thick yellow + Gluten, tho' the red Part below was quite loose. + +I could not observe any certain critical Days, or Periods, when this +Disorder terminated.--Some, who had it slightly, got well in a few +Days; with others, it continued longer: Some continued long feverish, +and would seem cooler and freer from Fever for a Day or two, and then +grow worse again; and many had repeated Relapses. + +Neither could I observe any regular Crisis in this Fever. Sweat was +the Discharge which oftenest proved critical. Many seemed to be +relieved by a Purging; but as the greater Part had a Looseness after +some Days, which continued often through the Disorder, without +producing any very sudden Change in the Symptoms, it seemed to be a +favourable Circumstance; though it seldom carried off the Fever so +suddenly as to be manifestly critical. The Urine broke, and dropt a +Sediment, for the most part, as the Fever took a favourable Turn. + +When this Fever proved mortal, it commonly assumed a continued Form; +the Tongue became parched and dry, the Patient delirious, with +Twitchings of the Tendons, Hiccup, and other fatal Presages; while +others were seized with a violent Diarrhoea, or Dysentery, which sunk +them irrecoverably. + +In the Beginning, it was absolutely necessary to bleed the Patients +freely; and frequently to repeat the Evacuation, where the Symptoms +required it. The Blood was of a florid Colour, and commonly threw up +more or less of an inflammatory Buff. + +In these Fevers, we were obliged to have particular Regard to the +first Passages, especially in the Beginning of the Disorder; for they +were generally loaded with bilious Humours[74]; which, if suffered to +remain in the Bowels; were either absorbed, and increased the Heat +and Fever, or brought on a violent Diarrhoea; and therefore, after +Bleeding, we gave a Vomit in the Evening, and next Day a Dose of some +gentle Purge, as Rhubarb or Salts; to carry off these putrid, bilious +Humours: And afterwards, in the Course of the Disorder, if the Patient +was costive, and grew hot, restless, and uneasy, we either repeated +the Purge, or gave laxative Clysters, which generally removed these +Symptoms.--Frequently after the Operation of the Emetic, the Patient +had some loose Stools, from the Gall Bladder's being emptied in the +Strainings to vomit. Such Stools were always bilious, as were commonly +those procured by purgative Medicines. + + [74] According to Dr. _Hillary_'s Account of the Yellow Fever + in the _West Indies_, which is attended with bilious + Vomiting, it bears bleeding once or twice, but not a third + Time, before the third Day, but not at all after that Time; + and after Bleeding a great Part of the Cure depends on + carrying off as much of the putrid Bile as expeditiously and + safely as possible, which he says is to be done by making the + Patients drink freely of warm Water (sometimes mixed with a + little simple Oxymel or Green Tea) so as to vomit seven or + eight Times; and then to give a grain, or a Grain and a half + of Opium, to procure Rest, and to settle the Stomach; to make + the Patient take nothing for two Hours after; and then, if he + has not had a Stool, to give a laxative Clyster; after six + Hours Rest, to give a gentle Purge, to carry off as much as + possible of the bilious corrupted Humours; and in the Course + of the Disorder to repeat the Purge, as often as the Patient + is attacked with an Anxiety, and a painful burning Heat about + the Præcordia; which almost always depend on bilious + corrupted Humours pent up within the Bowels; and to endeavour + to support the Patient's Strength, and stop the putrescent + Diathesis of the Fluids by suitable Antiseptics, of which he + found a watery Infusion of Snake Root, mixed with _Madeira_ + Wine and Syrup of Poppies, to answer the best of any Thing he + tried, and to sit easiest on the Stomach; and to this he + added the Use of Cordials, and of strong Wine Whey as the + Patient became lower. + + Dr. _Hillary_'s Purge was: Rx. Mannæ sescunc. vel unc. ij. + Tamarind. cond. unc. i. Tartar vitriolat. gr. x. solve in + seri lactis præparat. cum Vin. Maderiens. unc. vi. Colaturæ + adde Tinct. Senæ unciam dimidiam. Divide in Partes quatuor, & + capt. æger unam omni hora donec laxetur alvus. + + His Infusion of Snake-Root was prepared in the following + Manner: + + Rx. Rad. Serpent. Virgin. drachm. ij. Croci Angl. drachmam + dimidiam, infunde per horam vase clauso in aq. bull. q. s. & + dein unc. vi. Colaturæ, adde aq. Menth. simp. unc. ij. Vin. + Maderiensis, unc. iv. Syrup. Croci vel Syr. e Mecon. unc. i. + Elix. Vitriol. acid. q. s. ad gratum saporem M. capiat æger + cochlear. ij. vel iij. omni hora vel secunda quaq; hora vel + sæpius pro re nata. + + The Stomach is so irritable in the Beginning of this + Disorder, as to reject the saline Draughts, Nitre, and such + other Medicines. Nor will 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 +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 +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 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 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 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 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 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 _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. 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 + _pilulæ foetidæ_ 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 foetidæ_ 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 +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 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 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 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. 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. + + + + +PHARMACOPOEIA IN USUM + +Nosocomii Regii Militaris Britanici. + +MDCCLXI. + + + + +PHARMACOPOEIA 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. + + Rx Theriacæ 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. fontanæ, unc. xij. adde pro re nata tinct. thebaicæ, + drachm. i. + +Collyrium vitriolicum. + + Rx 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. + + Rx 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. + + Rx 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. + + Rx Flor. vel herb. chamæmel. unc. i. coque in aq. fontan. lib. + i.ss. ad lib. i. & cola. + +Decoctum ligni guaiaci. + + Rx 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. + + Rx 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. + + Rx 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. + + Rx 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. + + Rx 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. + + 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. thebaicæ 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 theæ, 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 dimidiâ 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. chamæmel. 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. myrrhæ, drachm. ij. M. + +Gargarisma volatile. + + Rx Aq. hordeat. unc. xij. spirit. vin gallic. unc. ij. sal. + vol. ammoniaci, drachm. i. M. + + +GUTTÆ ANTIMONIALES ANODYNÆ. + + 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 præparari 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 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. + + 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 + tincturæ thebaicæ, 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. senæ. 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 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. + + 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 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. + + 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 + præparando 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. 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. + + 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 theæ urgente tussi. + + +LINIMENTA. + +Liniment. saponaceum. Ph. Lond. + +Linimentum camphoratum. + + Rx Olei olivar. unc. ij. camphoræ, 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 Ægyptiacum. Ph. Lond. + +Mel rosaceum. Ph. Lond. + +MITHRIDATIUM. Ph. Lond. + + +MIXTURÆ. + +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 fætida. + + Rx G. asafætid. drachm. i. solve in haust. simp. unc. vi. + Dosis ab. unc. i. ad unc. iij. 4r. die. + +Mixtura fætida volatilis. + + Rx Mixt. fætid. 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. 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. + + Rx 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. + + 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. puræ bullient. unc. x. + +Oxymel scillit. Ph. Lond. + +Philonium Londinen. Ph. Lond. + + +PILULÆ. + +Pilulæ fætidæ. + + Rx 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. + + Rx 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. + + 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. + +Pilulæ rufi. Ph. Lond. + +Pilulæ saponaceæ. Ph. Lond. + +Pilulæ saponaceæ 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. + +Pilulæ scilliticæ. + + 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. + +Pilulæ stomachicæ. + + 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. terræ japonicæ ana partes æquales 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. ipecacoanhæ + 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. zedoariæ, drachm. ij. + rad. serpentar. drachm. i. M. dosis a scrup. i. ad drachm. i. + 4tis. vel 6tis. horis. + +Pulvis chamæmelinus. + + Rx 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. + + 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. ipecacoanhæ, scrup. i. tartar emetici, gr. ij. Dosis + a gr. xi. ad gr. xxii. + +Hiera picra. Ph. Lond. + +Pulv. Ipecacuanhæ 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. camphoræ, 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. + + 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. + + Rx 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. + + 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 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 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 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 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.|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 hospitals in Germany, by Donald Monro + +*** END OF THIS PROJECT GUTENBERG EBOOK BRITISH MILITARY HOSPITALS *** + +***** This file should be named 31338-8.txt or 31338-8.zip ***** +This and all associated files of various formats will be found in: + http://www.gutenberg.org/3/1/3/3/31338/ + +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) + + +Updated editions will replace the previous one--the old editions +will be renamed. + +Creating the works from public domain print editions means that no +one owns a United States copyright in these works, so the Foundation +(and you!) can copy and distribute it in the United States without +permission and without paying copyright royalties. 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