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.