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AN
ACCOUNT
OF THE
DISEASES
Which were most frequent in the
BRITISH MILITARY HOSPITALS
in Germany,
From January 1761 to the Return of the Troops
to England in March 1763.
To which is added,
An ESSAY on the Means of Preserving the Health
of Soldiers, and conducting Military Hospitals.
By DONALD MONRO, M.D.
PHYSICIAN to his MAJESTY'S ARMY, and to
ST. GEORGE's Hospital.
LONDON:
Printed for A. MILLAR, D. WILSON, and T. DURHAM,
in the Strand; and T. PAYNE, at the Mews-Gate.
MDCCLXIV.
TO THE KING.
May it please Your MAJESTY,
To permit me to lay at your Feet the following Sheets, published with
a View to be useful to those, who hereafter may have the Care of the
Health of your MAJESTY's Troops.
YOUR MAJESTY's particular Inquiries into the State of Your Military
Hospitals, in every Quarter of the World, in the Time of the late
glorious and successful War; Your Concern for every Officer and
Soldier who suffered either by Sickness or by Wounds in the Cause of
their King and Country; and Your Solicitude to procure them every
possible Assistance and Relief, cannot fail to excite the highest
Admiration of Your MAJESTY's Goodness in the Breast of every Subject,
and the warmest Gratitude in the Heart of every Soldier.
The Knowledge of these Circumstances induced me to flatter myself,
that a Work of this Kind would be agreeable to Your MAJESTY; and
should this Attempt towards pointing out the Means of alleviating
those Miseries, which necessarily attend a Military Life in the Time
of Service, be acceptable, I shall obtain the utmost of my Wishes; it
being the greatest Ambition of my Heart ever so to act as to merit
Your MAJESTY's Approbation, and to subscribe myself,
May it please Your MAJESTY,
Your MAJESTY's most dutiful Subject,
And most faithful
and humble Servant,
DONALD MONRO.
THE PREFACE.
Among the numerous Authors of Observations in the Art of Physick,
there are but few who have expressly written on the Treatment of those
Distempers, most generally incident to an Army in the Field: The
following Work, therefore, seems to have a fair Claim to be acceptable
to the Publick, having been compiled during the Author's Attendance on
the _British_ Military Hospitals in _Germany_ in the late War; and in
order to render it of still further Use, he has occasionally added, by
Way of Note, the Practice of some of the most eminent Physicians in
similar Diseases, as well as a few Histories of Cases which passed
under his own Care at _St. George_'s Hospital, _London_.
To avoid the Repetition of the Composition of particular Medicines,
and the Interruption that would be given by their being inserted in
the Body of the Work, a small Pharmacopoeia is added, to which his
Practice in the Army Hospitals was chiefly confined.
In a commercial Country like our own, where Numbers of Hands are
constantly wanted for the carrying on our Manufactories, we have a
strong political Argument to add to that drawn from the Dictates of
Humanity, why the Life of every individual should be most carefully
attended to.
The Preservation of the Lives of Soldiers is then with us a Matter of
the highest Importance, in order to make as low as possible the Number
of Recruits who must be perpetually drawn off for the Service of War.
The Author has, therefore, in this Treatise, endeavoured to point out
the Means most likely to keep Men healthy when employed in different
Services; and also the Manner in which Military Hospitals ought to be
fitted up, and conducted.--As he was never in any of the warm
Climates, nor ever at Sea along with Troops aboard of Transports,
whatever is mentioned relative to such Situations, is to be understood
as taken from printed Accounts of these Subjects, or collected from
the Conversation of physical Gentlemen, who were employed on such
Services during the two last Wars.
It is but Justice here to observe, that the Marquis of _Granby_,
Commander in Chief of the _British_ Troops in _Germany_, as well as
the Rest of the General Officers employed on the _German_ Service,
always paid the greatest Attention to the Soldiers when sick in
Hospitals; and were particularly ready in giving Orders for all such
Things as were necessary or proper for them.
JERMYN-STREET,
April 15, 1764.
CONTENTS.
PAGE.
Of the Malignant and Petechial Fever, 1
Of the Dysentery, 57
Of the Cholera Morbus, 97
Of the Inflammatory Fever, 104
Of the Angina, 109
Of the Pleurisy, 111
Of the Peripneumony, 115
Of the Cough and Consumption, 124
Of the Epidemical Catarrhal Fever of _April_ 1762, 137
Of the Rheumatism, 141
Of the Autumnal Remitting Fever, 154
Of the Intermitting Fever, or Ague, 179
Of the Jaundice, 206
Of Tumours of the Breast, 216
Of Paralytic Complaints, 219
Of an Incontinency of Urine, 223
Of a Stoppage of Urine, 227
Of the Epilepsy, 237
Of the Small-Pox, 243
Of Erisypilatous Swellings, 245
Of the Scurvy, 250
Of the Itch, 265
Table of Diet used in the _British_ Military Hospitals in _Germany_, 273
PHARMACOPOEIA in usum Nosocomii militaris regii Britannici 1761, 275
OF THE MEANS of Preserving the Health of Soldiers on Service, 309
---- in Winter, and in cold Climates, 313
---- aboard of Transport Ships, 323
---- in warm Climates, 331
Of healthful and unhealthful Grounds for the Encampment of Troops, 338
Of keeping Camps clean, 344
Of supplying an Army with Straw and with Provisions, and obliging
the Soldiers to buy a certain Quantity of Meat daily, 346
Of Water, and the Means of correcting its bad Qualities in Camps, 348
Of vinous and spirituous Liquors, 350
Of keeping Men healthful in Quarters after an active Campaign, 354
Of MILITARY HOSPITALS, 355
Of the Manner in which the Antients disposed of their Sick
and Wounded, 356
Of the Hospitals wanted for an Army acting on a Continent, 357
Of the Houses most fit for Hospitals, 361
Of fitting them up, and distributing the Sick in them, 363
Of preventing infectious Disorders from being generated or
spreading among the Sick, 366
Of the Diet of Military Hospitals, 372
Of providing the Flying Hospital, 380
Of Hospitals on Expedition Service, 380
Of a Guard for Hospitals, 382
Of the Nurses and Patients, and Orders for them, 383
Of a convalescent Hospital, 389
Of the Physicians, Surgeons, Apothecaries, and Mates, 393
Of the Direction of Military Hospitals, 394
Of the Purveyor or Commissary of the Hospital, 396
Orders for the Mates, 397
Of Precautions for guarding against infectious Disorders, 400
Of a Military Inspector and Officers on convalescent Duty, 403
ERRATA CORRIGENDA.
Page 13, line 11, for _Pleuretic_, read _Pleuritic_.
18, 10, of Notes, for _Acadamy_, read _Academy_.
28, 22, for _Cinamon_, read _Cinnamon_.
35, 5, of Notes, for _Calomile_, read _Calomel_.
51, 12, dele _used in this Way_.
166, 12, of Notes, for _which almost depend_, read _which almost
always depend_.
207, 13, of Notes, for _Vena postarum_, read _Vena portarum_.
259, 4, for _appeared_, read _appear_.
261, 1, of Notes, for _became_, read _become_.
280, 20, for _Chamamel_, read _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.