Corroborants.--The Bark, with Astringents and Opiates,
agreeing best with some--Decoctions of the Semiruba with
others--Chalk in Electuaries, or Juleps, with others--anodyne
and astringent Clysters with others--while others receive
more Benefit from other Remedies--and severals find
themselves better when they use no Medicines of this Kind.
4. And by the occasional Use of Opiates, and a free Air: And
by moderate Exercise on Horseback, or in a Machine in the
convalescent State.
I ought not to omit mentioning, that I have seen some Cases
where Evacuations had been used in the Beginning, which,
after they had continued for some Time, were cured by a
regular Diet of Broths, and white Meats; riding daily on
Horseback; and drinking a generous good Claret Wine. However,
it ought to be remarked, that this Method only succeeded
where the Disorder was mild, and its Violence had abated by
previous Evacuations.
OF THE CHOLERA MORBUS.
The Cholera Morbus, or a sudden and violent Vomiting and Purging, was
very frequent in _July_ and _August_ 1701; and several were attacked
with it at _Munster_.--It was attended with great Sickness, with Pain,
and Inflation of the Abdomen, Thirst, and a small quick Pulse: Some
had it in a pretty violent Degree, but in general it was mild; and
although the Sickness, Vomiting, and Purging, continued, in one or two
Cases, for above a Day; yet none of those died whom I saw.
This Disorder weakens the Patient much, in a short Space of Time; and
sometimes, when violent, kills in less than twenty-four Hours. It is
always most frequent in Summer and the Beginning of Autumn; and is
taken Notice of by _Hippocrates_, _Aretæus_, _Celsus_, and other
antient Authors; and is very accurately described by many of them.--It
is of the bilious Kind; and the Cure principally depends upon the free
Use of warm mild Liquors in the Beginning; to dilute and blunt the
Acrimony of the Bile, and other Fluids, and to promote their
Discharge; and afterwards of gentle Cordials to support the Strength;
and warm Fomentations to allay the Pain when violent; and mild Opiates
to procure Rest; and if the Sickness or Griping remains next Day after
the Cholera is stopt, to give a Dose of Physic and an Opiate in the
Evening.
An Officer, who had been wounded on the 15th of _July_, at the Battle
of _Fillinghausen_, began afterwards to live very freely, and was on
the 4th of _August_ seized in the Night with the Cholera.--About ten
o'Clock next Day I was sent for; and found him in violent Agony, with
sharp Pain in the Bowels, Reachings, and Strainings to Vomit, and
Spasms and Cramps in the Bowels, Legs, and Arms.--He had large red
Blotches on his Extremities, and no Pulse was to be felt at the Wrist,
and rather a Fluttering than a Beating at the Heart.--He had vomited
and purged much in the Night before I saw him, but the Purging had
begun to abate.--I immediately ordered him an emollient Clyster, and a
saline Draught, with the _confectio cardiaca_, and five Drops of
liquid Laudanum; which, if he vomited up, was to be repeated soon
after; if not, only once in four Hours: And he was directed to drink
freely of weak Chicken Broth, warm.--Two Hours afterwards we found him
in the same Situation; still no Pulse to be felt, which prevented us
from bleeding him; and the violent Pain of the Stomach and Bowels, and
the Cramps, continued. We then ordered Flannels, dipped in a warm
emollient Decoction, to be kept constantly applied to his Belly,
dipping them in the warm Decoction as soon as they began to grow cool;
his Clyster to be repeated with the Addition of a Drachm of the
_electuarium e baccis lauri_, and Half a Drachm of the _tinctura
thebaica_; a Scruple of Castor, and Half a Drachm of Spirit of
Lavender, to be added to each of his Draughts; and a Blister to be
prepared, in case these Medicines gave no Relief.--Soon after,
beginning to use the Fomentations, the Cramps and Pains began to
abate; about four o'Clock in the Afternoon we could perceive a
Fluttering of the Pulse at the Wrist, and all the Pains and Cramps
were much easier; so that there was no occasion for the Blister.--Next
Morning he was very easy, but low, and inclined to be sick; for which
his Cordial Draughts were repeated every six Hours.--The third Day, as
he complained of a little Griping in the Bowels, we ordered him a Dose
of Tincture of Rhubarb, and an Opiate in the Evening, which entirely
removed these Complaints, and he was abroad and well next Day.
One Soldier, who had a good deal of Fever, and complained of acute
Pain in the Bowels, along with the Vomiting and Purging, was blooded;
and drank freely of warm Barley-Water while the Vomiting
continued.--After throwing up a Quantity of green bilious Matter, the
Vomiting ceased; and the Gripes and Purging became less violent.--In
an Hour after, being able to retain some very weak Broth in his
Stomach, he drank plentifully of it through the Day; and the Purging
being abated towards Night, he took an anodyne Draught; and next Day,
having still a little Sickness remaining, had a Dose of Physic and an
Opiate at Night, which removed all his Complaints.
The Rest, who were attacked with the Cholera at _Munster_, were
treated much in the same Way; only as they had not such acute Pain and
Fever as this Man, it was thought unnecessary to bleed them.
The Antients[46] recommended drinking freely of warm Water in the
Beginning, and the Use of both cold and hot Fomentations of the
Stomach and Belly;--and in the low State, the Use of Wine, mixed with
Water, and Polenta[47]; and to apply Rue, with Vinegar, and other
strong smelling Things, to the Nostrils; besides Variety of other
Remedies.--When Convulsions happen, _Celsus_[48] advises to anoint the
Belly with warm Oil; and if that does not remove them, to apply
Cupping-Glasses or Mustard to the Stomach; and, after sleeping, to
abstain the second Day from Drink; and the third, to go into the Bath;
and if any thing of a Fever remains after the Cholera is suppressed,
to give a Purge.
[46] See _Aretæus_, Lib. ii. Cap. 4. and _Celsus_, Lib. iv.
Cap. 11.
[47] The Polenta seems to have been nothing but toasted
Barley Meal. See _Plinii Hist. Natural._ Lib. xxii. Cap. 25.
[48] _Celsus loco citato._
Dr. _Sydenham_[49] trusts principally to drinking freely of Chicken
Broth, and throwing up Clysters of the same, and afterwards giving
Opiates.
[49] _Processus integ. de Cholera._
Dr. _Ayton Douglas_, in the sixth Volume of the _Edinburgh_ Medical
Essays[50], recommends a Decoction of Oat Bread, baked without Leaven
or Yest, and carefully toasted as brown as Coffee, but not burnt; as a
Remedy very grateful to the Stomach, and useful in stopping the
Vomiting, and sometimes the Purging too: And he relates several Cases
where it had a good Effect. After the Vomiting was stopped, he added
the Use of mild Opiates; and, where the Patient was low, Wine and
other Cordials.
[50] Art. 65.
OF THE INFLAMMATORY FEVER.
On the Return of the Troops from the Winter Expedition into the
Country of _Hesse_, in the Year 1761, we had several Men seized with
Inflammatory Fevers without any topical Inflammation; and at the
Opening of each Campaign had always Numbers sent to the Hospitals ill
of this Disorder. Towards the End of the Campaigns, and throughout the
Winter, many were seized with Inflammatory Fevers; but these were
mostly complicated, with pleuritic, or peripneumonic Symptoms, or
other topical Inflammations, or with rheumatic Complaints.
In the Inflammatory Fever, the Sick were seized at first with cold and
hot Fits, succeeded by Pain in the Head and all over the Body. The
Pulse was strong and quick, and the Blood sizy; attended with other
Appearances commonly observed in such Fevers.
As the Summer advanced, this Fever was often accompanied with bilious
Symptoms, with Sickness, and vomiting of bilious Matter, and very
frequently with a Purging: Towards the End of Summer it ceased, and
was succeeded by the bilious remittent Fever.--And it was no uncommon
Thing to see those Fevers, which originally were entirely of an
inflammatory Nature, after the sick had been some Days in a crowded
Hospital, partake a good deal of the Nature of the Malignant Fever, or
be changed entirely into it.
We treated these Fevers in the common antiphlogistic Method.--We
blooded freely in the Beginning; gave the saline Draughts with Nitre
and other cooling Medicines; and made the Patients drink plentifully
of small Liquors:--And when they were inclined to be costive, gave
mild Purges, or emollient laxative Clysters. We afterwards applied
Blisters; and if the Pulse began to sink, gave Cordials, Wine, and
other Remedies commonly employed in such Cases;--and towards the
Decline of the Fever endeavoured to promote such Evacuations as were
pointed out by Nature, and likely to prove critical.
When the Case was complicated with bilious Symptoms in the Beginning,
we were obliged to have particular Regard to the first Passages. If
the Patient complained much of Sickness, we gave a gentle Vomit in the
Evening, after bleeding; and a Purge next Day, to carry off any
bilious or corrupted Humours that might be lodged in the Stomach or
Intestines; and we found that these Evacuations gave Relief, and
generally mitigated all the Symptoms.
If at any Time during the Fever a Looseness came on, especially when
attended with Gripes, we gave a Dose of some gentle Physic, which made
a free Evacuation; and an Opiate in the Evening after its Operation;
and afterwards we found it answer better to attempt rather to
moderate, than wholly stop the Purging by strong Astringents, and
Opiates; unless where the Evacuation by Stool was so great as to be in
Danger of sinking the Patient.
The _pulvis antimonialis_, composed of ten Parts of the _pulvis e
chelis_, and one Part of the Tartar emetic, given in small Doses, was
serviceable in many of these Fevers, after free Evacuations had been
made.
Two Patients, one a Soldier of the Twentieth Regiment, the other a
_German_ Waggoner, were taken ill of this Fever about the 25th of
_December_, 1762: They were both blooded freely, and had a Dose of
Physic in the Beginning; and the saline Draughts with Nitre and other
cooling Remedies; and had Blisters applied without producing any
considerable Change in their Disorder.--On the 5th of _January_, 1763,
they both complained much of Thirst, and were inclined to be costive;
their Tongues were parched, their Pulses quick and small, and their
Skins dry; they were restless at Nights, and the Soldier had a slight
Delirium.--I ordered each of them four Grains of the _pulvis
antimonialis_ every four Hours.
6th. Next Day the Soldier told me, he had had four loose Stools; his
Senses were much clearer, the Pulse calmer and slower, and he said he
found himself lighter and easier, and less feverish, than he had been
since he was first taken ill. The Medicine was continued, with the
Addition of an anodyne Draught at Night.--7th. I found him in a fine
breathing Sweat, and he told me he had slept well in the Night:
p.--8th. The Sweat continued till this Morning, and on going off his
Urine let fall a copious white Sediment, and left him free from the
Fever; after which he mended daily.
The Waggoner, after taking the third Dose of the Powders, had a warm
Moisture upon the Skin.--On the 6th was cooler and without much Fever,
and had had one Stool.--7th. The warm Moisture ended in a profuse
Sweat, which carried off the Fever, and he continued to recover
daily.
OF THE ANGINA; OR, SORE THROAT.
Many of the Soldiers during the Campaign were seized with
Inflammations of the Throat, especially when the Nights were cold and
moist after warm Days; and when they did Duty in cold wet Nights in
the Winter Season.--All of them I saw in _Germany_ were of the
inflammatory Kind; I did not observe any that were malignant.
They were treated in the antiphlogistic Method.--The Patients were
blooded liberally in the Beginning--took the cooling nitrous and
saline Medicines--gentle Diaphoretics and Purgatives--and used
frequent Gargarisms.
Sometimes a Flannel rubbed with camphorated Oil, or the _linimentum
volatile_, and applied round the Neck, was of Service.--And frequently
after bleeding sufficiently, where the Breathing or Swallowing was
difficult, the Application of a large Blister to the Neck gave speedy
Relief.
OF THE PLEURISY.
The Pleurisy, or an acute Inflammation of the Side, was most frequent
among the Soldiers towards the latter End of the Campaigns; though
some were attacked with it at all Times of the Year, from doing Duty
in all Sorts of Weather.
We followed the antiphlogistic Method of Cure; and ordered plentiful
Bleeding in the Beginning, till the Violence of the Pain began to
abate, or the Patient grew faint;--and the Side to be fomented with
Flannels dipped in warm emollient Decoctions, and afterwards rubbed
with volatile Liniments: At the same Time the Patient drank freely of
warm diluting Liquors, as Barley Water, the pectoral Decoction, and
such like; and took the saline and other cooling Medicines, mixed
occasionally with Sperma Ceti, or some other soft Pectorals, if there
was a tickling Cough.--When the Patient was costive, we gave a Dose of
Salts, or some other mild Physic, or laxative Clysters.
If the Pain continued very acute, we repeated the Bleeding as often as
Necessity seemed to require, and the Pulse could bear; and immediately
after the second Bleeding ordered a large Blister to be applied to the
Part affected.
Physicians formerly used to forbid Bleeding after the fourth Day, if
it had been omitted so long; but when no Symptoms of Suppuration had
already appeared, on whatever Day of the Disorder it happened, I
ordered plentiful Bleeding, the same as in recent Cases; and never
found any Disadvantage, but often great Service from this Practice.
When the Sharpness of the Pain was gone, and the Pulse became soft,
very often a dull Pain remained for some Time in the Part.--In some
Cases a brisk Purge removed it;--in others, cupping above the Part,
and afterwards rubbing it with the volatile Liniments, did
Service;--in others, gentle Opiates at Night, especially where there
was a tickling Cough;--and in one or two Cases, this Pain did not go
away, till the Patient was ordered to drink every Day for some Time, a
Quart of the Decoction of Sarsaparilla with the antimonial Wine.
In the Course of this Disorder, if a kindly Moisture broke out on the
Skin, which gave Relief, this was encouraged by the Use of mild warm
Liquors; or if the Patient began to spit up a viscid or yellowish
Mucus, we endeavoured to keep up the Expectoration by the Use of mild
Pectorals; and if a Purging came on, we were careful not to check it
too soon, unless it was so violent as to be in Danger of sinking the
Patient.
When an Inflammation of the Side came to Suppuration, which happened
in one or two Cases at _Osnabruck_, in _May_ 1761; as soon as a
Fluctuation of Matter was to be felt, an Incision was was made in the
Part, and the Matter discharged; after which the Sore healed kindly,
and the Patients recovered[51]. I am persuaded, was this Operation
oftener performed, many would recover who die consumptive.
[51] Dr. _Mead_ advises, where the Lungs and Pleura grow
together, and an Abscess forms, to open it with Caustic; and
afterwards to keep the Ulcer open during the Patient's Life:
For he says, he has often seen, where such Sores were healed
up, that the Patient died soon after by an Efflux of Matter
upon the Breast. _Monita Medica_, Cap. i. Sect. 7.
OF THE PERIPNEUMONY.
The Soldiers were subject at all Times to the Peripneumony, or
Inflammation of the Lungs, from doing Duty in cold wet Weather, and
from their irregular Way of living; but more particularly towards the
End of the Campaigns, and in Winter.
This Disorder was much more dangerous and fatal than the Pleurisy,
especially when neglected in the Beginning; for then Bleeding had
seldom any Effect; the Difficulty of Breathing encreased, the Patient
was seized with an Orthopnea, and such an Anxiety and Sense of
Suffocation, that he could not sleep; and the Pulse sunk; and in these
Cases Death only afforded Relief. This we experienced in many Men who
had lain neglected in Quarters, for two, three, four, or five Days,
before they were brought to the Hospital.
In most of the Bodies of those who died of this Disorder, and were
opened after Death; we found the Lungs violently inflamed, with livid
or gangrenous Spots on their Surface; and more or less of a watery
Serum extravasated into the Cavity of the Chest.
Three had Suppurations in the Lungs. In one, who had lain sick in
Quarters for ten Days or upwards, before he was sent to the Hospital,
the right Cavity of the Thorax was found full of a watery Serum; and
the Lobes of the Lungs on the same Side almost entirely wasted; and
what remained seemed as it were composed of thickened Membranes,
resembling those formed by the coagulable Lymph, or what is called by
some (though improperly) the fibrous Part of the Blood. The Lobes in
the left Side seemed to be in a sound State, or at most but slightly
inflamed. From the right Lobes of the Lungs being so much wasted, I
suspected that the Patient had probably laboured long under some
Disorder of the Breast; but I could not from Enquiry obtain any
Information in this Particular; nor did he ever mention such a Thing
during the few Days he lived after being brought into the Hospital; he
said, he had only been ill for eight or ten Days before; but Soldiers
afflicted with chronic Distempers, when they are seized with violent
Symptoms, or acute Diseases, are apt to reckon the Beginning of their
Disorder, only from the Time they are taken ill in a violent Manner;
and never to take any Notice of their former Complaints.
Another Soldier, about the Middle of _February_, 1762, remained in
Quarters five Days after being taken ill with a Pain of the Breast,
and a Difficulty of Breathing; the sixth Day he was brought to the
Hospital in the Morning, and I saw him about eleven o'Clock; he then
had all the Symptoms of the true Peripneumony, attended with a strong
hard Pulse. He was immediately blooded as freely as his Pulse would
bear, had Blisters applied, and other Remedies used; notwithstanding
which, on the eighth Day from that Time, he began to throw up a
purulent Matter in great Quantity, attended with a constant hectic
Heat, and Fever; which sunk him so fast, that he died the tenth Day,
after he first began to expectorate.
On the 2d of _March_, a Soldier, of the Fifty-first Regiment of Foot,
was brought to the Hospital, with a violent Pain in the left Side, and
a great Difficulty of Breathing. Upon examining him, he told me, that
about two Years before he had had a violent Stitch in his left Side,
towards the lower Part of the Thorax; that ever since he had been
subject to a Difficulty of Breathing; and at Times to a Pain in the
Side; but that he had only been seized with the violent Pain and
Difficulty of Breathing he then complained of, about five Days before,
occasioned by catching Cold, on being billeted in a low, cold, and
damp House.--His Pulse was quick, the Pain of his Side and Difficulty
of Breathing so great, that he could not sleep, nor lie down, but was
obliged to sit constantly in an erect Posture; his Tongue was white
and furred, and he had had no Stools for three Days: He was ordered to
be blooded immediately; and to take a Dose of Salts; and his Side to
be rubbed with the _linimentum volatile_. 3d. His Breathing and Pain
of the Side were easier; he had slept a little in the Night, and could
lie on his right side, but not on his left. He was ordered the Squill
Mixture. 4th. His Breathing was worse; he was blooded a second Time;
had a large Blister applied to his Side, and was ordered to continue
the Use of the Squill Mixture. On the 5th, 6th, and 7th, he seemed
easier, though the Breathing was still much affected, and his Pulse
quick and low, attended with a hectic Heat. On the 8th, he told me
that his left Side was swelled: On examining, I observed a Fullness in
that Side of the Thorax; and on pressing with my Fingers between the
Ribs, I thought I felt an obscure Fluctuation of a deep-seated Fluid.
From these Appearances, and the History of the Case, I judged that
there was a Collection of some Fluid within the Cavity of the Chest;
and that the only Means left to give Relief, was to make an Opening
into the Cavity, and so evacuate the Fluid. I therefore proposed to
him the Operation of the Empyema, to be performed immediately; which
he several Times obstinately refused to submit to: He allowed a Seton
to be put in his Side, but that did not answer the End proposed: He
languished six Days longer; and died the 14th of _March_. Next Day an
Opening was made in the Thorax, in the Part where the Operation was
proposed to have been performed; as soon as the Pleura was cut
through, some Quarts of Water rushed out. We then opened the Thorax,
and found still some Water in the left Cavity. The Pericardium was
thickened, and slightly inflamed, and adhered to the Diaphragm; which
was likewise a little thickened and inflamed in the adhering Part; the
Lungs on that Side were much compressed, and contracted by the
Pressure of the Water; but on being inflated and cut, seemed in a
sound State, except that they were slightly inflamed. The Lungs of
the left Side adhered every-where firmly to the Thorax, but seemed
otherwise sound; having no Tubercles, Suppuration, or other Disorder,
that we could observe in cutting them. The Heart and Blood Vessels
were sound, and no other polypous Concretions were observed within
their Cavities, but such as we find in most dead Bodies; which seem to
be formed of the coagulable Lymph in _articulo mortis_. The Viscera of
the Abdomen were in a sound State.
We treated the Peripneumony nearly as the Pleurisy. We bled freely in
the Beginning, till the Breathing became easier, or the Pulse began to
sink; taking Care not to be deceived by a low oppressive Pulse, which
generally rose upon Bleeding. We applied large Blisters; gave the mild
Pectorals freely, and plenty of warm diluting Liquors, Barley Water,
the pectoral Decoction, and such like; which afforded more Relief than
any other Medicines. We gave too saline Purges, and laxative Clysters
occasionally; and in some Cases ordered the Steams of warm emollient
Decoctions with Vinegar to be drawn into the Lungs.
By this Treatment most of them, who applied early for Relief, got the
better of the Disorder.
When the Expectoration began, the Patient continued the free Use of
the mild Pectorals, and diluting Liquors; and no Medicines were given
that might in the least tend to stop it; other Evacuations were
omitted, unless where the Pain of the Breast, or the Difficulty of
Breathing increased; in which Case, if the Pulse kept up, I ordered a
Vein to be opened, and a suitable Quantity of Blood to be taken away;
no other Remedy affording any Relief, till this Evacuation was made.
Where the Patient was costive, we frequently ordered laxative
Clysters, or a mild Purge, and found them beneficial: But where no
such Symptoms occurred, it was best, for the most part, to omit all
Evacuations of this Kind, after a free Expectoration had begun, and to
trust to it for carrying off the Disorder.
In some Cases, where the Expectoration stopt suddenly after bleeding,
we gave with Advantage a gentle Vomit, as recommended by Dr.
_Huxham_[52].
[52] Some late Authors seem to look upon the _Pleurisy_ and
_Peripneumony_ as the same Disorder: However, though it be
true, that when the _Pleura_ is inflamed, the Surface of the
contiguous Lungs is generally in the same State; and that,
when the _Lungs_ are inflamed, the Pleura is often affected;
yet as I have frequently seen the true Peripneumony without
that sharp Pain of the Side which characterizes the Pleurisy;
and upon opening the Bodies of People who have died of the
Peripneumony, have found the Lungs violently inflamed and
livid, and so filled with Blood as to sink in Water, without
the Pleura being much diseased; and upon opening the Thorax
of others who died of the Pleurisy, have found the
intercostal Muscles and Pleura violently inflamed with livid
Spots, and only a small Portion of the Surface of the
contiguous Lungs affected; I cannot help still looking upon
them as distinct Disorders; though they require nearly the
same Treatment, and are often complicated together.