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.