other Disorders, yielded to the above Treatment in about twelve or
fourteen Days. Two or three remained obstinate for a longer Time. To
one I ordered a Quart of the pectoral Decoction, made with Parsly
Roots instead of the Linseed, to be drunk daily along with the Soap
Pills; and the Jaundice disappeared in about eight or ten Days. One
who had the Disease more obstinate than the rest, and complained for
some Time of a Tension and Uneasiness about the Liver, was ordered to
have the right Side fomented Morning and Evening, and to rub it for
some Time after with the _linimentum saponaceum_ and to drink the
Decoction of Sarsaparilla after the Soap Pills; and by continuing this
Course for about three Weeks, the Disorder went off[94].
[94] Sometimes the warm Bath has a good Effect after other
Remedies have afforded no Relief. In the Year 1743, a young
Gentleman, a Student of Physic at _Edinburgh_, had a Jaundice
for which he had taken Variety of Medicines, and rode daily
on Horseback for some Weeks, without receiving any Benefit:
At last, by my Father's Advice, he took a brisk Dose of
Physic, and before it began to operate had a large Quantity
of warm Whey thrown up by way of a Clyster, and went
immediately into the warm Bath. In the Bath he was taken with
a violent Inclination to go to Stool; and after coming out,
had a great Number of bilious Stools that Day, and next
Morning was still inclined to be loose; and in a few Days all
the icteric Symptoms vanished. On the 20th of _July_ 1763, a
middle aged Woman, _Elizabeth Hosier_, was admitted into _St.
George_'s Hospital for a Jaundice, which came about a
Fortnight before. She had been blooded, and had taken some
Medicines, before I saw her. I ordered her a Vomit and Purge,
and to take too Scruples of the Soap Pills and Rhubarb daily;
and four Days afterwards the Vomit and Purge were repeated,
but without making any Change in her Disorder. On the 29th
she went into the warm Bath, and took a Vomit immediately on
coming out. After the Vomit she had some loose Stools, and
the icteric Symptoms went all off in a few Days. She
continued well for some Months; but I have been told, that
she has since relapsed.
When the Jaundice continues obstinate, there is hardly any
Thing has often a better Effect than the continued Use of
Decoctions of the Juices of succulent Plants, of Whey in the
Spring, Soap, and such like Medicines. The Baron _Van
Swieten_ tells us, that he has cured many obstinate Jaundices
by making the Patients drink daily a Pint or two Pints of a
Decoction of Grass, Dandelion, Fumaria, Succory, and such
like, prepared in Whey; to each Pint of which he added Half
an Ounce of _sal polychrest_, and an Ounce or two of Syrup of
the five aperient Roots; and by ordering them to drink the
Spa Water in Summer, and take freely of Soap, along with a
Decoction of the aperient Roots, in Winter. In those who were
cured by these Remedies, he says, Stones, or a kind of a
grumous calculous Matter, were always found in the Stools, as
the Jaundice was going off. He relates one very particular
Case of a Lady of sixty Years of Age, who had had a black
Jaundice for twelve Years, and was cured by continuing the
Use of these Medicines for eighteen Months; during the last
six Months of which she had a Looseness, and constantly
discharged by Stool a fetid granulated Matter of the Colour
of Clay;--and another singular Case of a Man who was cured by
living mostly upon Grass, and a Decoction of it, for two
Years together. The Man came at last to devour such
Quantities of it, and could distinguish the good Sort from
the bad so well, that the Farmers often used to drive him out
of their Fields. Vol. III. §. 950.
_Glisson_ tells us, that Cattle are subject to bilious
Concretions in Winter, which are dissolved and evacuated in
the Spring, when they begin to move much about, and to eat
the new Grass, which purges them. _Oper._ vol. II. _Anat.
Hepat._ chap. vii. p. 104.
Dr. _Russel_ greatly recommends the Use of Sea Water along
with the saponaceous Medicines. See his _Treatise on the Use
of Sea Water_.
The Hæmorrhage from the Nose commonly stopped soon. Where it was
violent, we kept the Patient cool, and applied Cloths dipped in
Vinegar and Water to the Nose.--In two Cases, one at _Munster_, the
other at _Bremen_, the Patients were hot and feverish, and a Vein was
opened, and eight or ten Ounces of Blood taken away; and in one Case
nothing took Effect till we gave repeated Doses of the _tinctura
saturnina_ in a common acid Julep.
OF TUMOURS of the BREAST.
In _May_ 1761, a great many of the Patients, who had been in Hospitals
the preceding Winter, had Tumours formed on the external Part of the
Breast, which they shewed me at _Osnabruck_. They began in the Form of
indolent Tumours, and came slowly to Suppuration. For the most part,
the Suppuration was only partial, and the Tumour, on being opened,
discharged a very small Quantity of Matter. Some of them, though they
felt soft, and seemed to contain Matter, yet, upon being opened,
discharged only a small Quantity of black Blood. None of them melted
down entirely into Pus, or came fully to Suppuration, and healed
kindly as Abscesses which succeed acute Inflammations. But after a
small Quantity of Matter was discharged, for the most part, there
still remained a hard Tumour, which felt as if it was a Swelling of
the Bone, or Cartilage below; and in some the Surface of the Bone was
found rough at the Bottom of the Abscess.
These Tumours seldom rose high, and were most of them situated at the
lower Part of the Sternum, or a little to one Side of it, commonly on
the left Side, above the _cartilago ensiformis_. Some Patients had
only one, others two, and some three such Tumours. The first of them I
saw was on the left Side, which, on being felt, gave exactly the same
Sensation as when the Cartilages of the Sternum are begun to be raised
by an Aneurism of the Aorta; only no Pulsation was to be perceived;
and most of them had the same Appearance.
The Patients, who had such Tumours, commonly complained of Pains of
their Breast. One or two, after these Tumours came to Suppuration,
seemed to recover their Health, and to feel no Uneasiness, tho' some
of the Swelling remained: But many of them were inclined to be
hectic, and seemed likely to grow consumptive.
Being ordered up to the flying Hospital in _June_, and the Sick going
down to _Bremen_, I had no Opportunity of seeing the Event of these
Tumours, or of examining the Bodies of those who died with them. One I
accidentally met with the following Winter at _Bremen_, who died of a
Consumption and Diarrhoea. He had a large Abscess, which penetrated
into the Cavity of the Chest, and discharged a great Quantity of very
fetid Matter, at the Part where one of these Tumours had been seated,
and the Sternum and Ribs were carious all round the Abscess.
OF PARALYTIC COMPLAINTS.
Some of the Soldiers, from lying out in the Nights on the wet Ground,
and from doing Duty in cold rainy Weather, were seized with a Pain and
Numbness all over, and lost the Use of their Limbs, which in some was
succeeded with a Palsy of these Parts: But the greatest Number of
those afflicted with Paralytic Symptoms were seized with them either
in Fevers, or after feverish and other Disorders. The Number, who were
attacked with Complaints of this Kind, were but few.
When Men were suddenly taken with Pain and Numbness all over, we found
that the best Method of treating them was to put them to Bed, and give
them Plenty of mild warm diluting Liquors for Drink; and if there was
much of a Fever, to open a Vein, to give the cooling antiphlogistic
Medicines, and apply Blisters; and if these Complaints still remained,
to endeavour to promote a breathing Sweat, by means of Diaphoretics
and warm Drinks. Several who were brought to the Hospital, soon after
being seized in this Manner, got well; but in some few, one or other
of the Limbs would begin to waste, and remain paralytic afterwards.
Those who had the true confirmed Palsy seldom remained long enough
with us to be cured. Two or three received Benefit from Blisters
applied to the Parts, and from Issues; drinking at the same time the
Decoction of the Woods, or of Sarsaparilla, and taking the volatile
Tincture of Guaiac or Valerian[95], and being sweated by the Use of
_Dover_'s Powder, or other Diaphoretics.
[95] On _Wednesday_ the 1st of _February_ 1764, _Margaret
Julion_, a Woman between fifty and sixty Years of Age, was
admitted into _St. George_'s Hospital for an entire Loss of
Speech, which seemed to depend on a paralytic Disorder of the
Parts about the Larynx. The Account her Friends who came with
her to the Hospital gave of her Case was, that she had been
for five Months troubled at Times with Pains of her Bowels,
and a Purging; that on _Sunday_ se'night before coming to the
Hospital, she had suddenly lost the Use of her Speech, and
had not spoke since that Time, though she seemed to hear and
understand whatever was said to her. I asked her some
Questions, which she answered distinctly by Signs. She had no
paralytic Complaint of her Face, Arms, Legs, or any other
Part of her Body, and swallowed both Fluids and Solids with
Ease. She had no Fever, and seemed to complain of nothing but
the Loss of Speech.--A Blister was applied to her Neck, and
she was ordered the saline Draughts, with a Scruple of Powder
of Valerian in each, to be taken three Times a-day, and a
Dose of sacred Tincture, to be taken twice a-Week. She
followed this Course for a Fortnight, when another Blister
was applied to the Fore-part of the Neck, and the Powder of
Valerian in the Draughts was changed for two Drachms of the
_tinctura valeriana volatilis_. At the End of three Weeks she
could pronounce the two Words _Why_, _What_. She continued
the same Course till this Day, the 16th of _March_, and can
now pronounce many Words and short Sentences.
One Man of the 51st Regiment of Foot, after doing Duty in very cold
wet Weather, in the Beginning of the Year 1762, was seized with a
Palsy of one Side of his Face, which prevented him from speaking
distinctly, and was an Impediment to his eating. He mended much after
being blooded, and having a large Blister to his Neck, kept open for
some time by means of the epispastic Ointment.
OF AN INCONTINENCY of URINE.
An Incontinency of Urine was another Complaint frequent among the
Soldiers; but it seemed to me to be counterfeited by many. All, who
had it, said that they had received some Hurt[96] or Sprain of the
Back, or a Kick from a Horse, or that a Carriage had run over them.
[96] A Soldier in the Hospital at _Paderborn_ used to
discharge his Water involuntarily, and mixed with Pus, which
came from some violent Blows he had received on the Back.
_John Pearce_, a young Man about eighteen Years of Age, was
admitted into _St. George_'s Hospital, the 10th of _April_
1759, for a Pain of his Side, and a Complaint of the Bladder.
The Account which he gave of his own Case was, that, some
Months before, he had received a violent Blow with a
Cricket-Bat on the left Side, on the Region of the Kidney;
and that ever since he had had a sharp Pain in that Part, and
sometimes had a Stoppage of Urine, and at other Times it came
away insensibly. His Pulse was rather quick, but low, and he
had a feverish Heat. He at first took some cooling Medicines;
but on the 20th, being low and faint, he had some of the
foetid Julep. On the 23d he was attacked with a sharp Pain in
the Belly and Side, had a Stoppage in making Water, a quick
and full Pulse, and most of the Symptoms of the Stone. He was
ordered to be blooded immediately, to take the saline
Draughts every four Hours; and as he was inclined to be
costive, to take as much lenitive Electuary as to procure him
a loose Stool; and it was recommended that he should be
sounded as soon as the Violence of the Fever was over. On the
25th he continued much in the same Way, and had made some
Water, which was intolerably foetid. Half a Drachm of the
dulcified Spirit of Nitre, and five Drops of the _tinctura
thebaica_, were added to each of his Draughts, as the Pain
and Difficulty of making Water had increased. On the 26th his
Pulse rose, and became very hard and quick; the Pain in his
Side, and the Dysuria, became more violent; and about Twelve
o'Clock he had a convulsive Fit, resembling that of an
Epilepsy; after coming out of the Fit, as the Fever and Pain
had increased, he was blooded; the Belly was fomented and
embrocated, and he took the oily Draughts four Times a-Day;
his Blood immediately threw up a very thick Buff. He remained
pretty easy the rest of the Day; but about the same Time next
Day, he had another convulsive Fit, and died.
On opening his Body, we found about two or three Pints of a
dark-coloured foetid Water in the Abdomen; on cutting through,
and squeezing the right Kidney, there came out a thin
purulent Matter every where from its Substance, though it
appeared sound; on raising and cutting through the
Peritoneum, covering the left Kidney, there was a Discharge
of about a Pint of black and very foetid Water, which had
every where surrounded this Kidney; and there were six
mortified Spots on its Surface, as large as the End of one's
Finger, with a Depression in each about a Quarter or Half an
Inch deep; most of the Substance of this Kidney seemed
diseased, and it was full of Suppurations. The Bladder was
contracted and thickened, and contained a rough Stone, which
weighed three Ounces. The rest of the _viscera_ were sound.
This Stone had certainly been in the Bladder long before the
young Fellow received the Blow with the Cricket-Bat; but the
Injury done the Kidney had probably aggravated the Symptoms.
I do not remember ever to have seen convulsive Fits, such as
this young Man had, in acute Diseases, except in one Case of
a slow Fever, which came by taking Cold after a Salivation,
and which I attended, along with Dr. _Pringle_. The Gentleman
had three Fits exactly of the same kind as this young Man, at
twenty-four Hours Distance from one another, and he died of
the third.
Those who really had the Disorder seemed to have received such an
Injury of the Bladder, or Kidneys as required a considerable Space of
Time to get the better of; and by reason of the short Time we had them
under our Care at the flying Hospital, they seldom received much
Benefit. One or two thought they grew better on taking the Bark and
Balsam of _Peru_; at the same Time they bathed Morning and Evening the
lower Part of the Abdomen and Perinæum, with Flannels dipped in gentle
astringent Liquors, applied cold. Blisters applied to the _os sacrum_
had no Effect.
OF A STOPPAGE of URINE.
We formerly mentioned, that in acute Diseases many complained of a
Stoppage or Difficulty of making Water; and others had this Complaint
from Strictures of the Urethra, or Disorders of the Bladder or
Kidneys[97].
[97] It is often very difficult to judge of the Cause, or to
be able to determine exactly the Seat of these Disorders
before Death; as the following Cases will shew.
_John Waden_, a middle-aged Man, was admitted into _St.
George_'s Hospital the 10th of _April_ 1759, for a Swelling
of the Abdomen, and a Difficulty of making Water, which he
said begun about two Months before, with a violent Pain in
his Back and Belly, occasioned by his being employed in
making of Cyder in a very cold Cellar. He had not had a Stool
for some Days: at first he took a Dose of Physic, and some of
the saline Draughts; but in a Day or two complained that his
Belly had grown to a monstrous Size, and that he had not made
Water for above twenty-four Hours; on examining, we found the
Bladder so much distended as to reach up to the Navel; and
upon a Catheter's being introduced, above two Quarts of Water
were drawn off, and the Swelling immediately subsided; but in
the Afternoon was as large as before, the Bladder seeming to
be in a paralytic State. During the Months of _May_ and
_June_, his Water was drawn off twice a-Day; he had his Belly
fomented with emollient, astringent, and other Decoctions,
and embrocated with Liniments; was blooded once when
feverish, took Cordials, the Bark, Myrrh, and a Variety of
Medicines, without any Effect. On the 3d of _July_, a
flexible Catheter was introduced into the Bladder, and left
there, in order that the Urine might drain away as fast as it
was secreted, and the Bladder be allowed to contract, and
recover its Tone. The Catheter gave him no Pain, and he
thought himself much easier by the Bladder's never being too
much stretched; but on taking out the Catheter some Days
after, he had the same Stoppage of Water as before. On
consulting with Dr. _Batt_ and the other Physicians, it was
agreed to give two Grains of the Powder of Cantharides, with
three Grains of Camphor and ten of Sugar, rubbed well
together in a Mortar, twice a-Day; and to continue the Use of
the flexible Catheter. He found no Uneasiness or Strangury
from the Use of the Cantharides, and thought he passed his
Water more freely, when the Catheter was taken out; but after
fourteen Days, finding no Change for the better, and being
free from any Fever, he was ordered into the cold Bath; the
two first Days he found himself more lively and brisk; but
the third Day was chilly and cold after coming out of it, and
therefore was desired to leave it off; some Days after he
became hectic, and I observed Pus in his Water, which he said
he had passed with his Urine for above three Months; after
this he languished for near a Month, and died upon the 25th
of _August_.--Upon examining his Body next Day, we found the
thoracic Viscera in a sound State, except that the Lungs
adhered a little on the right Side. Both Kidneys were
diseased; they were inflamed, and seemed enlarged; and on
cutting them, had Tubercles dispersed every where through
their Substance, which had come to Suppuration, and contained
a good deal of Matter; the lower Part of the left Kidney was
mortified, and contained two or three Ounces of a black foetid
Liquor. The Bladder of Urine was contracted, and its Coats
greatly thickened, and the internal Coat much inflamed; and
there was a Cyst full of Matter, about Half the Size of a
Walnut, between the muscular and villous Coats, towards the
lower Part of the right Side of the Bladder; and there were
two large Cysts, containing a small Quantity of Matter,
though capable of containing near two Ounces each; one
situated between the _vesiculæ seminales_ and Rectum, the
other between the _vesiculæ_ and Bladder, which opened into
the Urethra by one common Orifice, capable of admitting a
large Quill, at the Side of the _caput galinaginis_. The rest
of the Viscera were in a sound State.
_Mary Hibbard_, a Woman twenty-four Years of Age, was
admitted into _St. George_'s Hospital, the 6th _June_ 1759,
for a Complaint of her Bladder. The Account she gave of
herself was, that, about _Christmas_ 1758, she had parted
with some Gravel; and about fourteen Days before coming to
the Hospital, she was seized with a violent Pain in her Back
and Loins, attended with a Sickness and Nausea; and very soon
after complained of a violent Pain in the lower Part of her
Belly, and with a perpetual Inclination to make Water, though
she felt a sharp Pain and Difficulty in doing it; and that
these Complaints still remained. Her Pulse was quick and
strong, and she was inclined to be costive. She was
immediately blooded, took the oily Draughts three Times
a-Day, the _decoctum furfuris_ for common Drink, and so much
lenitive Electuary as procured her a Stool next Day. As there
was a strong Suspicion of her having a Stone, she was
sounded; but nothing at all was to be felt in the Bladder.
Her Medicines eased her Pain in making Water, but not the
Pain in her Back. On the 16th her Water was thick and turbid,
and deposited a brown Sediment; and the Difficulty in making
Water still remained; instead of the lenitive Electuary she
was ordered the Rhubarb oily Draught to be taken every Night.
On the 18th, there being no Change in her Disorder, she had
Draughts made of an Ounce and a Half of simple Mint Water,
Half a Drachm of the dulcified Spirit of Nitre, and five
Drops of the _tinctura thebaica_, and Syrup three Times
a-Day; but on the 22d she complained, that since she left off
the oily Medicines, her Pain and Difficulty in making Water
had grown worse; she was therefore ordered the saline and
oily Draughts alternately, and to take the Rhubarb oily
Draught occasionally when costive, which removed these
Complaints; and they did not return while she remained in the
House; but on the 4th of _July_, the Day before she was to
have been discharged as cured, she was attacked with a sharp
Pain in her Hip and Loins, and about the _os coccygis_; which
increased till the 9th, and extended itself all along the
Outside of the right Thigh; it was most acute about the _os
coccygis_; but on examining, nothing was to be observed
externally: This Pain continued more or less all that Month,
and till the End of the next, and so obstinate as not to be
altered by bleeding, and the Use of Liniments, Blisters,
cooling Medicines, Opiates, warm Baths, and other Remedies.
On the 20th of _August_, a strengthening Plaister was applied
to her Back, which gave immediate Relief, and she was
discharged cured the 29th. She continued well till _October_,
when she was attacked with a violent Fever at _Hounslow_, and
was brought to the Hospital on the 24th of that Month, and
the tenth Day of the Fever. She died the 3d of _November_.
During the Course of the Fever, she only complained once of a
Difficulty of making Water.--After Death I had her Body
opened, when the only Thing particular which we could
observe, was the urinary Bladder about four times the natural
Size; it seemed to be flaccid, and in a State of Relaxation;
the Kidneys were sound, and no Signs of any Distemper could
be observed about the Uterus or Rectum, or near the _os
coccygis_.--When she was first in the Hospital, I desired her
always to examine her Urine; but she never observed that she
passed any Sand, Gravel, or any thing of that kind.
_Thomas Jacey_, an elderly Man, was admitted into _St.
George_'s Hospital the 14th of _March_ 1759, for a Pain in
his Back, and a Difficulty and Pain in making Water, which
was often mixed with grumous Blood; but he had never observed
any Sand or Gravel in it. His Pulse was quick and full,
attended with Heat and Thirst; and he was inclined to be
costive; he was at first blooded, and took a Dose of laxative
Mixture, and two Ounces of the Tincture of Roses, four Times
a Day, and the _decoctum malvæ_ for common Drink. At first he
seemed relieved, and passed no grumous Blood for some Days;
but on the 26th, as he complained much of a Pain in making
Water, the Tincture of Roses was changed for the oily
Draughts, and he was ordered the Rhubarb oily Draught
occasionally. On the 9th of _April_ he fell suddenly into a
comatose Way, and remained so till the 12th, when he died,
notwithstanding the Use of divers Remedies.--Upon examining
his Body, both Kidneys were found in a sound State; the
Intestines covered with slight inflammatory Spots, the
Bladder of Urine quite contracted, schirrhous, and greatly
thickened; and its internal Surface rough and eroded, with
one or two black Spots on it, and some grumous Blood lying on
its Surface. The other viscera were sound.
In Ulcers of these Organs, the natural Balsams, mixed with
soft Things, are often of great Service; of which the
following Case is an Example.--_William Lumley_, a Boy nine
Years of Age, was admitted into _St. George_'s Hospital, the
6th of _September_ 1759, for a Pain in the Bladder, and a
Difficulty in making Water, which was always more or less
mixed with Matter. At first there was a Suspicion of his
having the Stone; but on sounding, none was to be found. From
the Symptoms, it appeared as if there was an Ulcer in the
Bladder near to its Neck; the Boy had a Cough, was very low,
and inclined to be costive; at first he took three Spoonfuls
of the Sperma Ceti Mixture four Times a-Day, and a Dose of
Physic; but the Symptoms still remaining, on the 2d of
_October_ he was ordered to take a Scruple of the
_electuarium e spermate ceti_ three or four Times a Day, and
to have the Gum-Arabic Decoction for his common Drink. By
continuing the Use of these Things, and taking some opiate
and laxative Medicines occasionally, he mended by slow
Degrees, and all his Symptoms went off; and he recovered his
Health and Strength, and returned Thanks for his Cure the
18th of _January_ 1760.