Coughs were very frequent during the Winter, and when the Weather was
wet and cold. They were often accompanied with Pains of the Breast;
and, when neglected, Obstructions, Tubercles, and Suppurations, were
apt to form in the Lungs, and the Disease to end in a Consumption, or
_Phthisis Pulmonalis_.
When Coughs were slight, guarding against further Cold, and the Use of
mild Pectorals and warm Drinks, removed them. But when the Patient
complained of a Pain and Tightness about the Breast, it was always
necessary to take away more or less Blood; and after Bleeding to give
some of the mild Pectorals, such as the Sperma Ceti or oily Mixtures;
and, if a Fever attended, to join the Use of Nitre, or of the saline
or mindereri Draughts; and, if a tickling Cough was troublesome, to
give frequently a Tea Spoonful of the oily Linctus, acidulated either
with the Spirit of Vitriol, or the _oxymel scilliticum_. The mild
Diaphoretics, such as the mindereri Draughts, given along with warm
Drinks, to promote a free Perspiration, or Sweat, were used with
Advantage; when the Patients kept in Bed, and lay in Wards which had
Stoves in them.
If the Cough and Pain of the Breast were not relieved by these Means,
the Patient was bled a second Time, and a Blister applied to the Side
immediately after; which often removed most of the Complaints. When it
did not, we gave the pectoral Decoction for common Drink; and if there
was a Shortness or Difficulty of Breathing, the squill Mixture, or
_lac ammoniacum_, with Oxymel; and occasionally gentle Purges: And if
at any Time of the Disorder the Tightness and Pain of the Breast
returned violent, we took away some Blood, no other Remedy affording
Relief.
When there was little or no Fever, and a thin Rheum kept up a tickling
Cough, nothing had a better Effect than to add some Drops of the
_tinctura thebaica_, or some of the _elixir paregoricum_, to the
oleagenous or squill Mixtures; or to give an Opiate Draught or Pill at
Bed-Time, which eased the Cough, and procured the Patient Rest.
At all Times it was necessary, when the Cough was violent, attended
with Pains of the Breast, to keep the Patients on low Diet; and in as
free and pure Air as the Nature of the Hospitals would admit of; for
we often found that those Men who had laboured long under obstinate
Coughs, which threatened Consumptions in small crowded Wards,
recovered surprisingly on being removed to a freer Air; of which we
had a remarkable Instance in the Hospital at _Bremen_, in _January_
1762; upon removing some Men, afflicted with very bad Coughs, out of
small Wards, which were damp, into one large one, which was dry and
airy.
When the Weather was good, we made the Patients walk out a little in
the Day-Time; for we observed, that remaining always in the Hospital,
and breathing nothing but a foul Air, helped to encrease the
Disorder.--When we knew the Men to be sober, and not apt to commit
Irregularities, we used to procure them good Billets, and make them
come daily to the Hospital for their Medicines.
Equal Parts of Lime-Water and Milk, drank to the Quantity of a Quart a
Day, was of Use to some; and the _infusum amarum_, and other gentle
Bitters, taken to the Quantity of an Ounce or two, Morning and
Evening, to others[53].
[53] Asses Milk, and _Bristol_ and _Seltzer_ Waters, which
are found so serviceable in pulmonic Disorders, could not be
had in the military Hospitals; and riding on Horseback was
too expensive a Remedy for a Soldier.
In chronic Cases, where we suspect Obstructions and Tubercles
to be formed in the Lungs, which have not already come to
Suppuration, Dr. _Russel_ recommends the Use of Sea Water for
resolving them; but we were at too great a Distance from the
Sea to try this Remedy. See his _Treatise on Sea Water_, Page
17.
A Decoction of the Cortex removed some Coughs which had continued for
a considerable Time. In one or two of these Cases, slight hectic
Symptoms had already appeared[54]. However, for the most part,
where-ever Obstructions of the Lungs were confirmed, or there were
evident hectic Symptoms without a free Discharge of purulent Matter,
the Bark did no Service; but rather heated and increased the Fever,
and made the Sick more restless and uneasy.--It was of most Use where
there seemed to be no confirmed Obstructions, but the Vessels much
relaxed; which we judged to be the Case from the Patients having no
fixed Pain, nor the Breathing much affected. If the Sick were
plethoric, or in the least feverish, we ordered a little Blood to be
taken away, before we began the Use of this Medicine.
[54] _Mary Shepperd_, a Woman twenty-six Years of Age, was
admitted into _St. George_'s Hospital the 6th of _June_,
1759, for a Cough; attended with a constant hectic Fever and
Night Sweats, which had begun in the Month of _April_, after
the Measles. She complained likewise of having the _fluor
albus_, and she had been blooded more than once before she
came to the Hospital.--I at first gave her some of the mild
Pectorals; and a Solution of White Vitriol in Water, _utenda
pro inject. uterina_. After a Week, finding no Alteration in
her Complaints, I advised her to become an Out-patient; and
to go down to her Friends in the Country, to live upon a Milk
Diet; to take gentle Exercise, and continue the Use of her
Medicines; which she did, but without any Alteration in her
Disorder, till the 6th of _July_, when I ordered her to take
thrice a Day two Ounces of the Decoction of the Cortex, along
with a saline Draught. Immediately, on beginning to use this
Medicine, her Disorder began to take a favourable Turn; her
Fever and Night Sweats left her, her Cough became easier, and
she recovered Health and Strength daily. She came to the
Hospital the 15th of _August_, seemingly in good Health, to
return Thanks for her Cure.
In similar Cases, I have sometimes observed good Effects from the Use
of the Balsam _Copaivy_, or _Peru_; given either in Juleps or made up
into an Electuary, as in the _electuarium e spermate ceti cum
balsamo_; but in whatever Form they were given, if there were
confirmed Obstructions of the Lungs, they rather heated and inflamed,
than did any real Service.
When Coughs continued long, attended with Pain in the Side, Difficulty
of Breathing, and Hectic Fever and Night Sweats, we always had Reason
to suspect, that the Disorder would terminate in a confirmed
Consumption. When this was threatened, we found, that the principal
Thing to be done, was to keep the Patients cool; and to endeavour to
allay the hectic Heat and Fever; and to retard, as much as possible,
the Progress of the Disorder. When the Case was recent, we were
sometimes so lucky as to make a Cure; but after it was confirmed, it
for the most part ended fatally.
We kept the Patients upon a low Diet; and where-ever Milk was to be
got easily, we allowed them a Pint a Day[55]; which was either mixed
with Water and given for Drink, or they took it to Breakfast or
Supper.--Their common Drink was either Barley Water or the pectoral
Decoction; which was occasionally acidulated with a few Drops of
Spirit of Vitriol; and we gave at the same Time the cooling
Medicines, such as Nitre, the saline or mindereri Draughts, mixed at
Times with Sperma Ceti, or some other of the mild Pectorals.
[55] In private Practice, at this Stage of the Disorder, the
Use of Asses Milk, and drinking the _Bristol_ Water at the
_Bristol_ Wells, and riding on Horseback daily, are justly
ranked amongst the most efficacious Remedies; and going into
the more southern Climates, as the South of _France_,
_Portugal_, or _Italy_, where the Air is warmer, more
constant, and dry, than in _England_, has often been found to
produce good Effects.
The opening a Vein, and taking away from four to eight Ounces of
Blood[56], whenever the Pain of the Breast was troublesome, or the
Patient was hot and restless at Nights from the Hectic Fever, gave the
greatest Relief of any Thing we tried; and these repeated small
Bleedings were so far from wasting the Patient's Strength, that they
rather seemed to prevent its being exhausted so fast as otherwise it
would have been, by allaying the Force of the Hectic Fever.
[56] This Practice has been strongly recommended by Dr.
_Mead_, in his _Monita Medica_, Sect. x. and by an anonymous
Author in the _Edinburgh Medical Essays_, Vol. IV. Art. 28.
and Dr. _Mead_ says, when Things have not been quite
desperate, he has seen good Success from it.
At this Stage of the Disorder, we put in Setons, or ordered Issues, to
serve as a Drain to carry off the Matter, and found them of Advantage
in some Cases. When the Patients complained of any fixed Pain, we
always made the Issues as near the Part affected as possible[57]. On
the 5th of _May_, 1762, a Man, belonging to the Eighty-eighth Regiment
of Foot, was sent to the Hospital at _Bremen_ for an Hæmoptoe,
attended with a constant hectic Heat and Fever.--After being blooded,
and using the cooling Remedies without Success, he had four Pea Issues
made in his Back; and had a slight Decoction of the Cortex, acidulated
with Spirit of Vitriol. As soon as the Issues began to discharge
freely, the hectic Heat, Fever, and Spitting of Blood, diminished
daily; and he recovered his Health and Strength in a short Time.
However, it ought to be observed, that although these Drains are
sometimes efficacious, yet, when the Disease is far advanced, the
Mischief is generally too deep rooted for them to be of any Service.
[57] In _June_, 1748, a Servant Girl came to ask my Advice
for a Cough, attended with a constant Hectic Fever and Night
Sweats, which had begun some Months before, on catching Cold.
The Matter she spit up was yellow, and had the Appearance of
Pus; and she complained of a Pain in the left Side of the
Thorax. I ordered her the saline Mixture with Sperma Ceti to
be taken thrice a Day, to lose a little Blood, to drink an
Infusion of Linseed sweetened with Honey, and to have a Seton
put in her Side at the Part where she complained of Pain;
advising her to go home to her Father, who was a Farmer in
the Country, and to live upon a Milk and Vegetable Diet, and
ride on Horseback whenever she could conveniently. She seemed
so far gone in a Consumption, that I scarce expected to see
her again; but, in the Month of _December_, she came to
return me Thanks for her Cure, seeming then to be in good
Health. She told me, that, as soon as the Seton began to
discharge freely, she found Relief; and mended afterwards
daily, by following the Directions I had given her.
The Bark, and natural Balsams, for the most part were prejudicial, and
encreased the Hectic Heat and Fever; except in one or two Cases, where
the Disorder seemed to depend on a Vomica of the Lungs, and the
Patient coughed up the Matter freely.--In one Case they were of
considerable Service; the Patient was very low, and had the Night
Sweats, but coughed up the Matter freely: On using the Decoction of
the Bark, and the _electuarium e spermate ceti cum balsamo_, the
Matter expectorated became thicker, and of a more balmy Consistence,
without any Increase of Heat or Fever; after which the Symptoms became
gradually milder, and the Patient recovered.
In the Course of this Disorder the Patients often became very hot and
restless, and were troubled with Gripes, succeeded by a Purging: These
Symptoms were most readily removed by a Dose of Rhubarb, or of some
other mild Purge; for they generally proceeded from corrupted Humours
lodged in the Intestines. In the Evening, after the Operation of the
Purge, we gave an Opiate to procure the Patient Rest.--When the first
Dose of Physic did not stop the Purging, we repeated the Opiates at
Nights, and in a Day or two gave another Purge; and if there was much
Sickness, or Load at the Stomach, gave likewise a gentle Emetic.
If the Purging still continued, we were obliged to join the Use of
Astringents along with the Opiates. In some Cases, I found good
Effects from equal Parts of Milk and Water boiled with Rose Leaves,
Pomegranate Bark, Balaustine Flowers, and Cinnamon, as recommended by
Dr. _Mead_ in his _Monita Medica_[58]; it served both for Food and
Medicine.--When Opiates and Astringents were given to stop the Purging
at its first Appearance, before the Bowels were emptied, they always
did Mischief; and increased the Heat and Fever: And although they
stopt the Purging for a few Hours, it always broke out with greater
Violence afterwards.
[58] _Sect._ x. _de Febrib. lentis sive Hecticis._
When the Sick were attacked with a Shortness and Difficulty of
Breathing, which was not relieved by Evacuations, and the Use of
cooling Medicines, and Pectorals, and Blisters, nothing gave so much
Ease, or had such a good Effect, as a gentle Vomit; for it often
removed the immediate Oppression from the Breast, and helped to pump
up the Matter from the Lungs.
In the advanced State of the Consumption, the Cough was always very
troublesome; and the Sick found no Relief but from Opiate Medicines,
which, in such Cases, cannot be expected to do more than give a little
present Ease.--As they were apt to obstruct the free Expectoration, we
generally mixed them with some _oxymel scilliticum_, or _tinctura
foetida_, which took off a good deal of their suffocating Quality.
Dr. _Barry_[59] advises for the Cure of a Consumption, to make an
Incision or Aperture into the Side; where-ever there is a fixed Pain
attended with a Weight, a Hectic Fever, and other Symptoms of an
evident Suppuration: He says the Pleura is thickened, and the Lungs
adhere at the Part where they are exulcerated; and that by the
Operation the Pus may be evacuated, and a Cure made; and he gives
several Instances of the Success of the Operation, when performed in
Time.
[59] _Treatise on the Digestions_, p. 410.
OF THE Epidemical CATARRHAL FEVER Of APRIL, 1762; CALLED, THE
INFLUENZA.
After a very cold severe Winter at _Bremen_, the Weather, from being
very cold, became of a sudden extremely hot, about the 10th of
_April_. In a few Days after, many People were seized with a violent
Catarrhal Disorder. It often began with such a Cold and Shivering,
that many imagined at first that they were going to have Agues; but
soon after they were attacked with a Cough, and a Difficulty of
Breathing, and Pain of the Breast, with a Head-Ach, and Pains all over
the Body, especially in the Limbs.--The first Nights they commonly had
profuse Sweats.--In several, it had the Appearance of a remitting
Fever, for the two or three first Days.--Many had a slight
Inflammation of the Throat, and a Hoarseness. In all it was attended
with an acute Fever in the Beginning, and the Urine was of a high
Colour; and when the Disorder had put on the Appearance of a Remittent
Fever in the Beginning, it dropt a Sediment towards Morning after the
second Day; and did the same in all, when the Disorder was going
off.--Some had a Purging, but the greater Number were rather inclined
to be costive.--The Cough in many was very violent; and the Patients,
after each Fit of Coughing, had Reachings, or Strainings to vomit,
exactly resembling those which come after violent Fits of the Hooping
Cough.--At first the Patients spit up only a little Phlegm; but in the
Decline of the Disorder, they expectorated freely.--The violent Cough
and Feverishness generally continued for four, five, or six Days;
with others it continued longer; and some had a Cough for two or three
Weeks after the Fever left them.
This Catarrhal Fever seized most of the People of the Town of
_Bremen_; and there were very few of the _British_ who escaped it; at
the same Time, it was epidemical in most Countries in _Europe_.
We treated it entirely as an inflammatory Disorder, and none died who
applied early for Relief.--Most People recovered by one plentiful
Bleeding, and taking the mild cooling Medicines, such as the _mixtura
e spermate ceti cum nitro_, the saline or mindereri Draughts, or such
like. When the Fever and Difficulty of Breathing continued after the
first Bleeding, in a Day or two a Vein was opened a second Time; and
immediately after a Blister was applied to the Back, which commonly
removed the Fever, and relieved the Breathing.--When the Patients were
inclined to be costive, a Dose of Physic was of Service.
None of the _British_ died, except one or two of the Soldiers, who
remained in Quarters after being taken ill; and, instead of bleeding
and living low, indulged in the Use of spirituous Liquors; and were
not brought to the Hospital, till they were in the last Stage of a
Peripneumony.--Many of the Inhabitants of the Town died of this
Disorder, which was probably owing to Want of Care.
OF THE RHEUMATISM.
The Rheumatism is one of the Disorders most generally to be met with
in military Hospitals. There were at all Times some Men in our
Hospitals labouring under Rheumatic Fevers, or other rheumatic
Complaints; though we never had at any one Time a great Number; owing
probably to the Weather being very favourable in both the Campaigns of
1761 and 1762.--It was always most frequent when the Weather was wet
and cold; both during the Campaign, and when we were in Winter
Quarters.
It commonly began either, 1. With an acute Fever, and Pains all over
their Body: or, 2. With Pains in particular Parts, as the Shoulders,
Legs, Arms, Knees, and sometimes of the Side, attended with some
Degree of a Fever.--The first was the most common Form it assumed,
when Men were attacked with it in the Field or in Garrison; owing to
their doing Duty in cold wet Weather.--The other Causes generally took
place when they had been formerly subject to rheumatic Complaints, and
had caught Cold; or after they had been weakened and reduced low by
Fevers, Fluxes, or other Disorders.
We had but very few Rheumatisms accompanied with Swelling, Pain, and
Inflammation of the Joints of the Knees and Wrists, &c. which are so
common in our Hospitals about _London_. I did not meet with above a
Dozen Cases, of this Kind, whilst in _Germany_ with the Army.
When the Rheumatism began with Pains all over the Body, attended with
a High Fever, we treated it at first entirely as an Inflammatory
Fever[60]. We blooded freely, and repeated this Evacuation often[61],
if the Blood continued sizy, and the Pains violent; provided the Pulse
was strong. When the Pleura, the Lungs, or any other of the Viscera
were affected, we blooded as freely as we should have done in acute
Inflammations of these Parts: We gave the saline Draughts with
Nitre[62]; and Plenty of Barley Water and other weak diluting Liquors;
and gentle Physic once or twice a Week; and afterwards applied
Blisters, which often relieved both the Pains and Fever.
[60] _Sydenham_, in treating of this Disease, orders
Bleeding, and that to be repeated next Day; and afterwards
every other Day, two, three, or four Times, or more, as the
Patients Strength can bear it; and on the intermediate Days
to give a purgative Clyster. But in young People, and those
who have lived regularly, he says, that a very low Diet will
cure as effectually as Bleeding and Medicines; That the
Patients must live four Days on Whey alone, but after this
may eat Bread for Dinner; and on the last Days for Supper
also; and when the Symptoms begin to abate, he allows them to
eat boiled Chicken, or other light Food; but says they must
live every third Day on Whey, till their Strength returns.
_Precess. Integr. de Rheumatismo_.
[61] A Remark of Dr. _Huxham_'s deserves to be taken Notice
of here: He tells us, that there are some Kinds of
Rheumatisms, _viz._ those which come from a sharp serous
Rheum, which do not bear the free Use of the Lancet; that
plentiful Bleeding does more Hurt than Good; and that, in
such Cases, the Medicines which bring out breathing Sweats,
and at the same Time correct the Acrimony of the Blood,
joined with gentle Opiates, have a much better Effect. _De
Aere_, Vol. II. p. 185.
[62] Dr. _Brocklesby_, in his _Observations on military
Diseases_, recommends the Use of large Quantities of Nitre
dissolved in Water Gruel, or Sage Tea, (in the Proportion of
two Drachms of the Nitre to a Quart of the Liquor) in acute
Rheumatisms. He says, "I am assured from numberless
Instances, that in stout young Men, by taking six hundred
Grains (ten Drachms) daily, for four or five Days
successively, and diluting plentifully, as before
recommended, plain Nitre proves the most powerful and best
Sudorific, in such Complaints, that I have ever tried; and
this Quantity, and even more, may be retained in the Stomach,
and pass through the Course of the Circulation, by only
diluting properly with those thin attenuating Beverages as
before recommended. Such Quantities, in three or four Days,
seldom failed wonderfully to relieve the Patient, and very
often to cure him entirely, by the most plentiful and profuse
Sweats." _See from p. 116, to p. 124._
I have never hitherto given Nitre in such large Quantities as
here recommended by Dr. _Brocklesby_.
After some Days, if the Pains still remained, we continued the saline
Draughts with Nitre throughout the Day; and in the Evening endeavoured
to promote a free Perspiration by Means of the mild Diaphoretics,
such as the mindereri Draughts with Mithridate, in Doses frequently
repeated; at the same Time, the Patient kept in Bed, and drank freely
of mild diluting Liquors. Sometimes we gave twenty, thirty, or forty
Drops of Spirits of Hartshorn, in repeated Draughts of warm Barley
Water: or a like Quantity of the Antimonial Wine, used in the same
Manner: or from sixty to a hundred Drops of the Antimonial Wine, mixed
with one-fourth Part of the _tinctura thebaica_, in a large Draught of
some warm Liquor; which I have observed, in many Cases, to have a
better Effect, than most other Medicines used for this Purpose; as it
acts both as an Opiate in easing the Pain, and procuring Rest; at the
same Time that it promotes a free Perspiration, or gentle Sweat, to
carry off the Distemper.
But it should be observed, that, in the Beginning of Rheumatic Fevers,
forced Sweats generally did Hurt, and often increased both the Pain
and Fever; and that in general we had greater Success, and made
speedier Cures, when we did not attempt to promote Sweating, till
after other Evacuations had been sufficiently made, and the Fever had
begun to abate; and that in this Fever, when we did attempt to procure
Sweats, the milder Diaphoretics, with Plenty of weak diluting Liquors,
answered better than those of a more heating Nature; though after the
Fever was gone, and the Pains still continued, sometimes the stronger
Sudorifics, such as G. Guaiac, and its volatile Tincture, _Dover_'s
Powder, and the like, best answered the Purpose, and carried off the
Distemper, when the milder ones had little Effect.
I have often observed, where Sweating made no Change in the Distemper,
that keeping up a free Perspiration by Means of the Decoction of the
Sarsaparilla with the Antimonial Wine, or small Doses of the _pulvis
antimonialis_ (_gr._ v.), given twice or thrice a Day, removed
Rheumatisms, which had resisted the Force of other Remedies.
Sometimes the cold Bath[63] removed Pains which had not yielded to
internal Medicines; but it ought to be observed, that when Patients
went into the cold Bath while the Feverishness still remained, and the
Blood continued sizy, or before free Evacuations had been made,
oftentimes, instead of giving Relief, it made the Disorder worse, and
more obstinate[64].
[63] I have frequently ordered the warm Bath with Advantage
in Rheumatic Cases in _St. George_'s Hospital; but we had no
Convenience of this Kind with the flying Hospital in
_Germany_.
[64] This I have seen many Instances of, particularly in the
Case of _Ann Walker_, a Woman of twenty three Years of Age,
who was under my Care in _St. George_'s Hospital, in _May_,
1759. Before she came to the Hospital, she had been blooded,
and had gone into the cold Bath four Times, which, she told
me, had increased her Pains to a violent Degree; in which
State she had continued for some Weeks before she came to the
Hospital; but by being blooded, and taking the cooling saline
Medicines, with gentle Purges, and mild Diaphoretics, she got
well in a Month's Time.