Fever, we treated it as the acute Rheumatism. Fomenting the Part with
warm emollient Decoctions, and rubbing it afterwards with the
volatile, or saponaceous Liniments, often gave Ease; and the
Application of Cupping-Glasses and Blisters frequently removed the
Disorder. In some Cases, where the first Blister did not relieve, the
Application of a second, and afterwards keeping up a Discharge from
the Part by Means of the Epispastic Ointment, carried off the Pain. In
others, where the mild Diaphoretics were ineffectual, Sweating, with
the G. Guaiac, or _Dover_'s Powder, and such other Medicines, after
the Fever was gone, removed the Complaints[65].
[65] Warm Water, pumped upon the Part, often removes such
rheumatic Pains as have resisted the Force of internal and
other Remedies. On the 29th of _August_, 1759, _Mary Ward_
was admitted into _St. George_'s Hospital for rheumatic Pains
of the Arms, Legs, and Knees, attended with Fever, which all
yielded to Evacuations, and the Use of cooling Medicines,
mild Diaphoretics, and of the warm Bath, except the Pain of
the Knee; which, after it had resisted the Course
above-mentioned, was at last removed by pumping warm Water on
the Part, three Times a Week; joined to the Use of
Fomentations and volatile Liniments.
When the Rheumatism was attended with Inflammation and Swelling of the
Joints, we blooded freely, gave cooling Purges, and the saline
Draughts with Nitre, along with Plenty of weak diluting Liquors, and
prescribed a cool low Diet.
After the Violence of the Fever and Inflammation was abated, fomenting
the Parts, and rubbing them with the saponaceous or volatile
Liniments, sometimes hastened the Discussion of the Swelling; as did
likewise the Application of Blisters[66], after the Inflammation was
entirely gone; but it ought to be noticed, that if volatile Liniments
or Blisters are used too soon, they will sometimes occasion violent
Inflammation and Pain[67].
[66] _Ann Ragen_, a Woman about thirty-three Years of Age,
was admitted into _St. George_'s Hospital the 17th of
_January_, 1759, for rheumatic Pains of her Legs and Arms,
and a Swelling of her right Knee. Free Evacuations, and the
Use of cooling Medicines, and mild Diaphoretics, removed all
her other Complaints, except the Swelling of the Knee, by the
Middle of _February_, when I ordered a Blister to be applied
to it; after which the Swelling gradually decreased, and she
was discharged, cured, the 20th of _March_.--_Rachael Hyde_,
a Woman twenty-four Years of Age, was admitted into _St.
George_'s Hospital the 9th of _May_, 1759, for similar
Complaints, which were removed by the same Means, all except
the Swelling of the Knee. A Blister was applied, and most of
the Swelling went away, but returned soon after: It was at
last removed by the Use of the warm Pump three Times a Week,
and drinking a Pint of the Guaiac Decoction daily.
[67] I have sometimes ordered Leetches to be applied to such
Swellings (as recommended by Dr. _Pringle_), and found them
to be of Service; and, at other Times, I have applied
emollient Fomentations and Poultices, which have given great
Ease to the Patient.--I have seen Setons or Issues, made near
the Part affected, afford considerable Relief.
Rheumatic Cases of this Kind are often very obstinate, and require a
considerable Length of Time before they are got the better of; and
frequently more or less of the Swelling, especially of the Wrists and
Joints of the Fingers, remains ever after; and Patients, who have once
had the Rheumatism in this violent Degree, are always subject to
Relapses; as are even those who have had the Rheumatism but slightly.
Mercury[68] has been recommended in the Cure of Rheumatisms; but I
never found it do any Service by itself, except in Cases complicated
with venereal Symptoms; though I have often given it, and even
sometimes gone so far as to raise a Salivation, where the Pains were
most severe in the Night; and the Patient, at the same Time, thought
he had some Reason to suspect a venereal Taint, though no external
Symptom appeared. However, many good Practitioners have recommended
small Doses of Calomel to be given at Nights, and next Morning a
Purge; in which Way, I think, I have observed good Effects from its
Use.
[68] Dr. _Musgrave_, in his Treatise _de Arthritide
Symptomat._ p. 30, cap. ii. sect. 10, says, he has known a
Salivation, raised by Mercury, cure the Rheumatism.
The Bark was frequently of Use in restoring the Strength, and removing
those rheumatic Pains which remained after Fevers, and other
Disorders; but, in other Cases, it had little Effect.
When the Rheumatism continues long, and has taken deep Root,
_Sydenham_[69] advises to bleed from Time to Time, at some Weeks
Distance; which, he says, will either entirely remove the Disease, or
bring it to that Condition, that the Remains of it will be easily
extirpated by an Issue; and giving some of the volatile Salts in
_Canary_ Wine, Morning and Evening. I have always observed in
rheumatic Cases, which continued long, that, after free Evacuations,
the Patients received more Benefit from a mild low Diet, continued for
some Time, and the Use of diluting Decoctions with mild Diaphoretics,
while they took gentle Purges once or twice a Week, than from any
other Remedies.
[69] Vide _Sydenham. Opera._ sect. vi. cap. 5.
I have given Half an Ounce of Soap a Day, for a considerable Time, in
some old rheumatic Cases, in the Manner recommended by the late Dr.
_John Clerk_ of _Edinburgh_, as mentioned by Dr. _Pringle_; and, I
think, with Advantage; but have not had sufficient Trials to ascertain
the Merits of this Medicine.
Dr. _Sydenham_, in treating of the Rheumatism, which he calls
scorbutic, says; that after it had resisted Bleeding, Purging, low
Diet, and other Remedies, he has cured it by giving thrice a Day two
Drachms of an Electuary made of _conserv. cochlear. horten. recent.
unc._ ij. _lujul. unc._ i. _pulv. ar. comp. drachm_ vi. _cum syrup.
aurant._ q. s. drinking after it three Ounces of a Water drawn from
_Brunswick_ Beer, and some of the antiscorbutic Plants.
There is no Disorder which Soldiers are so apt to counterfeit as the
Rheumatism, when ever the Duty in the Field is severe; but while there
is no Fever or Size in the Blood, or other evident Marks of the
Distemper, and the Men look healthy, there is always Reason to suspect
Imposture.
OF THE Autumnal Remitting Fever.
The Remitting Autumnal Fever, called by the Antients [Greek: synechês],
was also one of the most frequent Disorders during the Campaign.
This Fever is observed in most Countries, after the Juices have been
highly exalted by the Heat of Summer; and People are exposed to the
Heats of Mid-Day, and to the cold Damps of the Night. We observe it
every Year in the Neighbourhood of _London_, especially among the
labouring People, who work in the Fields, towards the End of Summer,
and in Autumn; but it is generally in a milder Degree than in Armies,
where Men are more exposed to the Vicissitudes of the Weather.
As we go further towards the South, this, as well as other bilious
Disorders, becomes more frequent.
This Fever is reckoned the endemic Distemper of the _West Indies_, of
the Coast of _Guinea_, and other Places in the Torrid Zone; but in
those warm Countries it appears in a more violent Degree; makes a much
more rapid Progress; and proves far more fatal than in our cooler and
more temperate Climate. And it is observed to be always most frequent
and most fatal where a Country is covered with Wood, or is marshy; and
where there are frequent Fogs, and much stagnating Water, which
corrupts by the Heat of Summer.
In _January_, _February_, and _March_ 1761, we had none of those
Remitting Fevers at _Paderborn_. In _April_, some few of the Soldiers,
on their Return from the Winter-Expedition into _Hesse-Cassel_, had
Fevers attended with bilious Symptoms; but they were rather of the
continued, inflammatory Kind, and tending to malignant, than such as
could be called remitting.
The first Time that I saw much of this Fever, was among the Sick sent
to _Bilifield_ in the End of _June_ 1761; soon after the Army took the
Field. The Remissions were short, and it partook much of the Nature of
the common Inflammatory Fever; and most of them were cured by the
antiphlogistic Method. A Day or two before we left this Place, it
began to change into the Malignant Hospital Fever, from the Sick being
too much crowded.
In the Middle of _July_, about Twelve Hundred Sick were sent to the
Hospital at _Munster_; and about one-third Part were ill of this
Remitting Fever. It did not partake near so much of the inflammatory
Nature as at _Bilifield_; the Remissions became much more evident; and
it was attended much oftener in the Beginning with bilious Vomiting
and Purging; and in some few the Disorder turned to a Dysentery. About
eight or nine had it changed into the Hospital Fever, from the Wards
in one of the Hospitals being too much crowded; and in some few the
Disorder terminated in regular Agues. In _November_ severals were
taken ill of it in the Garrison of _Bremen_, which mostly ended in a
regular Intermittent, the endemic Distemper of the Place. Towards the
End of _December_ we had none of these Remitting Fevers, the Disorders
turning more to the inflammatory Kind.
In _June_ 1762, this Fever began to appear again among the Sick, sent
from the Army, to the Hospital at _Natzungen_; and it continued to be
frequent through the Summer and Autumn; and the greatest Part of these
Fevers this Year terminated in regular Agues, mostly in Tertians, and
were cured by the Bark; whereas the Year before very few terminated
this Way.
This Disorder in the Beginning had commonly the Appearance of a
continued Fever; and many had a Sickness and Vomiting, and threw up a
Quantity of yellow Bile, mixed with the Contents of the Stomach. In a
few Days, especially after Bleeding, the Remissions became clear; tho'
on its first Appearance in _June_ 1761 they were short, and rather
obscure; and it seemed still to partake a good deal of the Nature of
the common Inflammatory Fever, the Blood being very sizy; but as the
Season advanced, the Remissions became more evident, and the Paroxysms
more like those of an Ague; and the Blood less sizy, tho' at all
Seasons of the Year it had some Appearance of an inflammatory Buff in
this Disorder. The Sick were restless and uneasy at Night; but
commonly felt themselves cooler and lighter in the Day-Time: and
although they had no cold Fit, as the Fever came on at Nights, and
many of them no Breathing Sweat, as they became cooler and freer from
the Fever in the Morning; yet the Fits were so remarkable, that many
of the Patients used to say they had a regular Fit of an Ague every
Night, or towards the Morning; and some few, that they had the Fit
every second Night. As the Season advanced, the Remissions appeared
more distinct. However, there was always a good Number in whom the
Fever went on in a continued Form, through its whole Course, without
any Signs of Remission; tho' they had all the other Symptoms of this
Fever. In a few Instances the Fever, after it came to remit, changed
again into a continued Form.
The Heat in the Time of the Paroxysms rose high, and several were
delirious during its Continuance[70]; but were quite sensible in the
Intervals, though never wholly without the Fever.
[70] I did not see the Delirium rise so high, nor the
Paroxysms so severe, as in the Marsh Fever described by Dr.
_Pringle_.
At the End of _July_ 1761, four or five were attacked with a Bleeding
at the Nose, in the Time of the Paroxysms, and became cooler
afterwards; but it did not prove a Crisis in any of them.
The Urine in the Beginning was commonly of a high Colour, though
sometimes it was pale and limpid: At first it deposited no Sediment;
but when the Fever came to remit, there was often a small Sediment
after each Paroxysm; and as the Fever was going off, it let fall a
Sediment in all[71].
[71] Dr. _Hillary_ says the Symptoms of this Fever in
_Barbadoes_ were much the same as those of the [Greek: synechês],
or continued Remitting Fever in England; except only that the
Urine in this hot Climate never deposits any lateritious
Sediment, nor very rarely in any intermitting or any other
Fever, except when a Crisis happens that Way. _Observations
on the Diseases of Barbadoes_, p. 23.
Some at first were inclined to be costive; others had a Sickness and
Purging; and several of those who were costive in the Beginning, were
in the Course of the Disorder attacked with a Purging; and others,
after some previous Complaint of the Stomach, were seized with both
Vomiting and Purging. In general, after the Sick continued some Days
in the Hospital, they were inclined to be loose; which was a
favourable Circumstance, when this Evacuation was not so great as to
be in Danger of sinking the Patient. Some were attacked with a
Dysentery.
In this, as well as in most other Fevers, the Sick frequently passed
by Stool Worms of the round Kind; and sometimes they vomited them up,
or the Worms came up into their Mouth or Nostrils while they lay
asleep in Bed; and some towards the Height were afflicted with
Deafness, which was commonly a favourable Symptom.
Most of those ill of this Disorder had a yellowish Colour of the
Countenance, which went off with the Fever. It was more observable in
some than in others; in general, it was slight; some few became yellow
all over[72]; particularly one Man, in the Hospital at _Munster_, who,
after being seized with violent Vomiting and Purging, Convulsions, and
Twitchings of the Tendons, and Hiccup, became yellow, as in the
deepest Jaundice. This Symptom of Yellowness arises from a Redundancy
and Absorption of Bile; and is sometimes observed in other Fevers as
well as this[73]; for while we were at _Paderborn_ in _February_
1761, two Men were brought to the Hospital in Fevers, attended with
this Symptom. They were both delirious, with parched dry Tongues,
slight Twitchings of the Tendons, and other bad Symptoms; and one of
them had a continual Vomiting and Purging. They both died, and the
Body of him who had the Purging was opened. All the Bowels, especially
the Colon, were tinged with a yellow Bile, and had a slight Degree of
Inflammation all over their Surface; the Gall-Bladder was distended
with a very dark-coloured Bile; but no Concretions were found in its
Cavity, or in the bilious Ducts; nor Mucus, or any other Thing
obstructing these Passages. The Surface of the Lungs seemed slightly
inflamed; and there was a small Quantity of greenish Serum in the
Cavities of the Thorax. I could not learn the Histories of these two
Mens Disorders, before they were brought to the Hospital; but, from
the Symptoms, was inclined to believe, that the Fevers had been of the
malignant or petechial Kind; and that the yellow Colour was only an
accidental Symptom of it; for on one of the Men we could perceive
obscure Traces of dun petechial Spots on his Breast and Arms; and the
malignant Fever was frequent at this Time among the Troops, and the
bilious autumnal Fevers had ceased long before.
[72] Dr. _Pringle_ takes Notice of this yellow Colour or
Jaundice. He says, "some grow yellow, as in the Jaundice.
This was found more frequent during the first Campaign than
afterwards; it was an unfavourable, but not a mortal
Symptom." _Observ._ part iii. ch. 4.--_Hippocrates_ mentions
the Jaundice occurring in Fevers, _Aphor._ iv. § 62 & 64; and
he reckons it a favourable Symptom in ardent Fevers, where it
happens on the seventh Day. See _Book on Crises_'s, sect. 3.
[73] Does this Fever, when accompanied with this universal
Yellowness of the Skin, approach to the Nature of the yellow
Fever of the _West Indies_? As I had so few Cases of this
Kind under my Care, I cannot determine any thing about it
from my own Experience; but, from the Accounts of others, I
should believe them to be very different Disorders.--In the
yellow Fever of the _West Indies_, the Blood appears quite
loose and dissolved, without the least Appearance of Size,
even on the first Day; and the general Yellowness appears on
the third or fourth, with Signs of a total Dissolution, and
gangrenous Diathesis of the Blood: Whereas, in the Remitting
Fever of _Jamaica_, Mr. _Nasmith_ tells us, (See Dr. _Lind_'s
first Paper on Fevers), there is always an inflammatory
Diathesis of the Blood. The Yellowness in both depends on a
Redundancy and Absorption of Bile; but in the yellow Fever of
the _West Indies_, the Bile is in a much more putrescent
State, and a great Part of the Cure depends on the early and
speedy Evacuation of it.--In the yellow Fevers which appeared
in _Haslar_ Hospital, which are taken Notice of by Dr.
_Lind_, in his _Two Papers on Fevers_, the Blood was in quite
a different State from what it is in the Yellow Fever of the
_West Indies_; the Blood drawn from two of these Patients
became covered with a thick yellow Gluten, and the Serum was
of the Consistence of a thin Syrup, and of a deep yellow
Tinge, and tasted bitter; and in another who was bled two
Days before his Death, it threw up the same thick yellow
Gluten, tho' the red Part below was quite loose.
I could not observe any certain critical Days, or Periods, when this
Disorder terminated.--Some, who had it slightly, got well in a few
Days; with others, it continued longer: Some continued long feverish,
and would seem cooler and freer from Fever for a Day or two, and then
grow worse again; and many had repeated Relapses.
Neither could I observe any regular Crisis in this Fever. Sweat was
the Discharge which oftenest proved critical. Many seemed to be
relieved by a Purging; but as the greater Part had a Looseness after
some Days, which continued often through the Disorder, without
producing any very sudden Change in the Symptoms, it seemed to be a
favourable Circumstance; though it seldom carried off the Fever so
suddenly as to be manifestly critical. The Urine broke, and dropt a
Sediment, for the most part, as the Fever took a favourable Turn.
When this Fever proved mortal, it commonly assumed a continued Form;
the Tongue became parched and dry, the Patient delirious, with
Twitchings of the Tendons, Hiccup, and other fatal Presages; while
others were seized with a violent Diarrhoea, or Dysentery, which sunk
them irrecoverably.
In the Beginning, it was absolutely necessary to bleed the Patients
freely; and frequently to repeat the Evacuation, where the Symptoms
required it. The Blood was of a florid Colour, and commonly threw up
more or less of an inflammatory Buff.
In these Fevers, we were obliged to have particular Regard to the
first Passages, especially in the Beginning of the Disorder; for they
were generally loaded with bilious Humours[74]; which, if suffered to
remain in the Bowels; were either absorbed, and increased the Heat
and Fever, or brought on a violent Diarrhoea; and therefore, after
Bleeding, we gave a Vomit in the Evening, and next Day a Dose of some
gentle Purge, as Rhubarb or Salts; to carry off these putrid, bilious
Humours: And afterwards, in the Course of the Disorder, if the Patient
was costive, and grew hot, restless, and uneasy, we either repeated
the Purge, or gave laxative Clysters, which generally removed these
Symptoms.--Frequently after the Operation of the Emetic, the Patient
had some loose Stools, from the Gall Bladder's being emptied in the
Strainings to vomit. Such Stools were always bilious, as were commonly
those procured by purgative Medicines.
[74] According to Dr. _Hillary_'s Account of the Yellow Fever
in the _West Indies_, which is attended with bilious
Vomiting, it bears bleeding once or twice, but not a third
Time, before the third Day, but not at all after that Time;
and after Bleeding a great Part of the Cure depends on
carrying off as much of the putrid Bile as expeditiously and
safely as possible, which he says is to be done by making the
Patients drink freely of warm Water (sometimes mixed with a
little simple Oxymel or Green Tea) so as to vomit seven or
eight Times; and then to give a grain, or a Grain and a half
of Opium, to procure Rest, and to settle the Stomach; to make
the Patient take nothing for two Hours after; and then, if he
has not had a Stool, to give a laxative Clyster; after six
Hours Rest, to give a gentle Purge, to carry off as much as
possible of the bilious corrupted Humours; and in the Course
of the Disorder to repeat the Purge, as often as the Patient
is attacked with an Anxiety, and a painful burning Heat about
the Præcordia; which almost always depend on bilious
corrupted Humours pent up within the Bowels; and to endeavour
to support the Patient's Strength, and stop the putrescent
Diathesis of the Fluids by suitable Antiseptics, of which he
found a watery Infusion of Snake Root, mixed with _Madeira_
Wine and Syrup of Poppies, to answer the best of any Thing he
tried, and to sit easiest on the Stomach; and to this he
added the Use of Cordials, and of strong Wine Whey as the
Patient became lower.
Dr. _Hillary_'s Purge was: Rx. Mannæ sescunc. vel unc. ij.
Tamarind. cond. unc. i. Tartar vitriolat. gr. x. solve in
seri lactis præparat. cum Vin. Maderiens. unc. vi. Colaturæ
adde Tinct. Senæ unciam dimidiam. Divide in Partes quatuor, &
capt. æger unam omni hora donec laxetur alvus.
His Infusion of Snake-Root was prepared in the following
Manner:
Rx. Rad. Serpent. Virgin. drachm. ij. Croci Angl. drachmam
dimidiam, infunde per horam vase clauso in aq. bull. q. s. &
dein unc. vi. Colaturæ, adde aq. Menth. simp. unc. ij. Vin.
Maderiensis, unc. iv. Syrup. Croci vel Syr. e Mecon. unc. i.
Elix. Vitriol. acid. q. s. ad gratum saporem M. capiat æger
cochlear. ij. vel iij. omni hora vel secunda quaq; hora vel
sæpius pro re nata.
The Stomach is so irritable in the Beginning of this
Disorder, as to reject the saline Draughts, Nitre, and such
other Medicines. Nor will the Bark, which might be judged a
very proper Medicine in the second Stage of the Disorder, lie
upon the Stomach, but is thrown up immediately, in whatever
Form it is given. However, a Gentleman who had practised long
in the _West Indies_ told me, that although the Patient could
not retain it in his Stomach, yet that he had found great
Service, after the Bowels were emptied, from the Bark used
freely in Clysters.
Dr. _Hillary_ disapproves of the Use of Blisters in the
advanced State of these Fevers.
After emptying the Bowels, we gave the cooling, and mild Diaphoretics,
such as the saline and mindereri Draughts, joined occasionally with
Nitre, or the Contrayerva Powders; while we made the Patient drink
plentifully of warm diluting Liquors; which we found to answer in
general better than any other Remedies: They brought the Remissions to
be more evident, and the Paroxysms to be milder, at the same Time that
they kept up a free Perspiration, as a Means to carry off the
Distemper.
In some Cases we gave the Antimonial Powder, made of one Part of
Tartar Emetic, and ten of the _pulvis e chelis_, in small Doses, from
two to four Grains every four or six Hours. The first Doses of this
Powder sometimes made the Patient sick, and acted as a Purgative, and
kept up a free Perspiration; at other Times, it produced no visible
Effect. In some Cases, where it was given early, it operated both by
Stool, and as a Diaphoretic, and removed the Fever[75]; and it was of
Use in others, towards the Decline of the Fever; but we were often
obliged to lay it aside; for it either acted too roughly, or produced
no visible Effect or Alteration in the Disorder.