had in a Letter, dated the 25th of _November_ 1757, from Mr.
_Pearson_, one of the Surgeons to his Majesty's Military
Hospitals, who then served as a Mate.
_James Ruffendal_, aged Twenty, of a delicate Habit, was, in
the Middle of _July_ last, seized with a violent Pain in both
Kidneys, which extended along the Ureters to the Bladder, and
remained in the same Situation for about three Weeks; during
which Period his Urine began to decrease in Quantity, and the
voiding of it was attended with acute Pain about the Neck of
the Bladder. The Secretion then totally stopt; he remained
for upwards of five Weeks in the Hospital at _Dorchester_,
and made no Water; at the End of which Time I first visited
him along with Mr. _Adair_. He complained then of a slight
Pain in his Kidneys, and told us he had a tolerable Appetite,
sweated little, and voided every Day four or five Liquid
Stools. He was ordered Boluses of Camphor, and _sal. vol. c.
cervi_, and every Night a Dose of _tinctura cantharidum_;
which he continued to take for a Fortnight without receiving
the least Benefit. I then blooded him to the Quantity of ten
Ounces, and gave him an Emetic of six Drachms of the _vinum
ipecacoanhæ_, and two Ounces of the Oxymel of Squills, which
operated very well; and afterwards ordered him to take one of
the following Boluses every four Hours. Rx Sapon. dur. Hispan.
drachm. i. Sal. Absynth. gr. vi. Calc. Viv. gr. x. Balsam.
Peruv. q. s. ut fiat Bolus. These he continued to take for
twelve Days. On the Morning of the 14th of _October_, he was
suddenly seized with an acute Pain in both Kidneys, and about
Noon voided upwards of Half a Pint of straw-coloured Urine,
which let fall a clay-coloured Sediment. As he was feverish,
I took away twelve Ounces of Blood, and ordered him
Barley-Water with Nitre for Drink. He was easy in the Night,
and made upwards of two Pints of Urine, which deposited a
Sediment of a gelatinous Consistence. Next Morning the Pain
increased, especially in his Right Side, and ten Ounces more
of Blood was taken away. This lowered the Pulse, and
considerably abated the Pain. Both this and the Blood taken
away the Day before threw up an inflammatory Buff. He was
ordered to continue the Use of the Barley Water with Nitre,
and to take three Spoonfuls of a Mixture with _spiritus
mindereri_ every two Hours. He had an easy Night, and was
next Day free from Fever; but complained of an Uneasiness in
his Stomach and Nausea. He was ordered a Scruple of the
Powder of Ipecacoanha, which vomited him, and procured him a
Stool. He was easy in the Night; but in the Morning was hot,
and complained of a Pain in his Right Kidney, and all over
his Bones, as he expressed it. I then gave him a Mixture,
with _spiritus mindereri_, and the _pulvis contrayerva comp._
of which I desired him to take some Spoonfuls frequently.
This procured him a plentiful Sweat, which removed the Fever
and Pain: these Symptoms returned next Day, but were removed
by the same Means. I remained at _Dorchester_ for a Week
after, and he recovered his Strength and Appetite as much as
could be expected in so short a Time; but he still complained
of Pain in his Right Kidney, tho' he made Water freely. By a
Letter I received from the Gentleman whose Care I left him
under, I understood he had a Relapse, which he has since got
the better of.
I forgot to inform you, that his Father died of the same
Complaints, after being six Months without secreting a Drop
of Urine; and his Brother died of the same in about ten
Weeks.
Where it depended on Strictures of the Urethra, Bougies introduced
into that Passage, and worn for some Time, were of great Service. The
Patients were at the same time ordered to live on a cool Diet, and to
drink the _decoctum Arabicum_, or an Infusion of Linseed, or such
other mild mucilaginous Liquors; and to take oily Medicines and
Opiates occasionally, and gentle Laxatives, to keep the Body open;
which Method of Treatment generally gave Relief. Where the Patients
were plethoric, or complained of Pain, or the Disorder was attended
with a Fever, Bleeding was often necessary.
When the Stoppage of Urine seemed to arise from an Inflammation of
the Kidneys or Bladder, or other Diseases of these Parts, we treated
it accordingly; and where the Fever was considerable, we made
Evacuations, and gave plenty of diluting Liquors, and the cooling
saline Medicines, and afterwards those of the soft, mucilaginous, and
oily Nature, and mild Diuretics and Opiates.
When the Disorder, in its Progress, became chronical, the Sick were
commonly sent down to the fixed Hospital, so that we had no
Opportunity of examining the Bodies of such as might die of this
Complaint.
OF THE EPILEPSY.
The Epilepsy, or Falling Sickness, attacked a Number of Men, from the
severe Duty of long Marches in hot Weather, and afterwards lying out
on the cold Ground, exposed to the Damps of the Night[98].
[98] I saw above twenty Men, while I was in _Germany_, who
attributed the Epileptic Fits they were attacked with to
these Causes, and said they had never had the Epilepsy
before; besides others, who had been formerly subject to
these Fits, who declared, that the Disorder was brought back
by the same Means.
It was very seldom that Men were cured of this Disorder in the
military Hospitals. We had some few Instances, indeed, where Relief
seemed to be obtained by Rest, a regular Diet, gentle Evacuations,
and Issues[99]; but even those Men generally relapsed as soon as they
were sent to their Regiments, and began to do Duty. All who had these
Fits after being some Time with their Regiments, were at last
discharged, and sent home. However, before Men are discharged for
Fits, they should be watched very narrowly for some Time; for there is
no Disorder which Soldiers are more apt to counterfeit than this.
[99] _William Wilson_, a Boy fourteen Years of Age, was
admitted into _St. George_'s Hospital, _Sept._ 20, 1758, for
Epileptic Fits, which he had been subject to for some Time,
and which generally seized him three or four Times a Week. He
took Variety of Medicines without any Effect till the 6th of
_November_, when I ordered him to take eight Grains of the
_pilulæ foetidæ_ Morning and Evening, and Physic twice a Week,
and a Seton to be made in his Neck. After the Seton began to
run, he had but three or four slight Fits in _November_, and
none the following Month; and he was discharged the Hospital
the 3d of _January_ 1759, seemingly in good Health, with
Directions to keep the Seton running at least for some Months
after he went home, and to come again to the Hospital if he
should have any Return of his Fits; but we never heard more
of him.
_Mary Hacket_, a Girl of nineteen Years of Age, was admitted
into _St. George_'s Hospital the 14th of _February_ 1759, for
Fits. The Account she gave of her Case, was, that about five
Years before she was seized with the first Fit, after a
Fright; three Years afterwards she had a second Fit, and for
some Time after had a Fit commonly once a Month, about the
Time of the full Moon; and since had them more frequently;
that the Fits began with a Trembling and Shaking of the right
Foot, and she had frequent pricking Pains in the right Thigh,
and what she called convulsive Tremors in the right Leg and
Foot. She was regular in her menstrual Discharge. At the Time
she came into the Hospital, she was feverish, and complained
much of a sharp Pain in the right Thigh: She was blooded, and
took some cooling Medicine, and had no Fit till the 9th of
_March_: She then took the fetid Pills and camphorated Julep
twice a Day; but still the Fits returned frequently. She then
had the Bark, Valerian and Purging Doses successively, and
used the warm Bath; but without any Effect. On the 7th of
_May_ a Blister was applied to her right Foot, which was
intended to be kept open; but an Inflammation coming on that
Leg and Foot, it was suffered to dry up, and an Issue made in
the same Leg. From the Time the Blister was applied, she had
no Fit while she remained in the Hospital. She was discharged
the 15th of _July_, seemingly in good Health; though during
that Period she had some little Tremors in her Foot, and was
subject to be low and faintish, which was always relieved by
cordial anodyne Medicines. After going out of the Hospital,
she remained in good Health for seven or eight Months, when I
was told her Disease had returned as violent as ever.
It is no Wonder that Soldiers, during the Time of Service, should
seldom be cured of these Fits; for in Adults it is not often cured
even in private Practice, with all the Conveniencies and Advantages
to be wished for; and generally the few that do get well, require a
considerable Length of Time to accomplish the Cure; and we find from
daily Experience, as well as from examining the Records of Medicine,
that the Cures that have been made, have mostly been performed either
by a Change of Air, such as going from a cold to a hot Climate[100],
by some remarkable Change of Life[101], or some accidental
Disorder;[102] or by Issues or Drains[103]; or by the Removal of some
acrid or irritating Substance, or such like[104]; or by preventing
the Cause[105]; and that those Medicines called Specifics have in
general had but little Share in the Cure.
[100] _Hippocrates_ lays the chief Stress of the Cure upon
Change of Air, Aphor. 4, 5, sect. ii. The Baron _Van Swieten_
says, he has known a great Number cured by going to the _East
Indies_; many of whom have remained well ever after, while
others had a Return of the Disorder when they came back to
_Holland_. _Comment._ vol. III. p. 436. sect. 1080.
[101] _Celsus_ has long ago observed, that the Appearance of
the Menses in Girls, and of Puberty in Boys, often removes
this Disorder, lib. iii. cap. xxiii.--On the 22d of
_November_ 1758, _Mary Evans_, a Girl of eighteen Years of
Age, was admitted into _St. George_'s Hospital for Fits. She
had never had the Menstrua; but, for above two Years, found
regularly, once a Month, a Fulness in her Breasts, and had a
slight Head Ach, and other Symptoms which generally precede
this Discharge; and were succeeded with violent Epileptic
Fits, which continued returning frequently for two or three
Days, and then went off; and she had no more Symptoms of
them, till about the same Time next Month. She was ordered to
take ten Grains of the _pilulæ foetidæ_ Morning and Evening,
and a Dose of Physic twice a Week; and as I found that she
became plethoric near the Time her Fits used to return, I
began to imagine, that both the Fits and Stoppage of the
Menstrua were owing to too great a Fullness of the Vessels,
which prevented the Heart and vascular System from having
such free Play, as to drive the Blood through the extreme
uterine Vessels: I therefore ordered seven Ounces of Blood to
be taken away from her immediately. In three Days Time the
menstrual Discharge began to make its Appearance; and on the
10th of _January_ she was discharged the Hospital, seemingly
in good Health, after the menstrual Discharge had returned
for two regular Periods, without any Appearance of Epileptic
Fits. She was desired to come back to the Hospital, if the
Fits returned; but I never heard more of her.
[102] _William Glen_, a Patient in the _Royal Infirmary_ at
_Edinburgh_ in _September_ 1747, was freed from Epileptic
Fits, which used to return ten or twelve Times a Day, for a
Quarter of a Year, by a Diarrhoea coming on; but they
afterwards returned.
_A Man_ subject to the Epilepsy was cured of it by a Quartan
Ague, and had afterwards no Return of the Disorder. _Miscell.
Curios. Dec. 3. Ann. 3._ p. 34.
[103] There are numerous Instances of the good Effects of
Issues and Drains in diverse Authors. _Tulpius_, _Van
Swieten_, &c.
[104] _La Motte_ gives one Instance of a Person being cured
of the Epilepsy by voiding five Stones, _Chirurg._ vol. II.
p. 20; and of another who died of the Fits from a triangular
Stone remaining in the Kidneys, _ibid._ p. 416. Dr. _Short_
cured a Woman of an Epilepsy of twelve Years standing, by
extirpating a cartilagenous Substance, about the Bigness of a
large Pea, seated on the gastronemei Muscles, above a Nerve
which he cut asunder. _Edin. Medic. Essays_, vol. IV. Art.
27.
[105] _Galen_, tells us, of his having prevented the
Epileptic Fits in a Boy, who used to have one whenever he was
hungry, by making him carry Bread in his Pocket, and eat a
little as soon as he found the least Symptoms of Hunger. _De
Loc. Affect._ lib. v. cap. vi.--And _Van Swieten_ mentions
how he cured a Boy, who had a Fit every full Moon; whose
under Lip used to fall a Trembling before it began (a Symptom
which, he says, often precedes Vomiting); by giving a Vomit
every Month, for six Months successively, three Days before
the full Moon, and an Opiate in the Evening after its
Operation; and by putting him under a Course of strengthening
Medicines. It was observeable, that if he vomited in the Time
of the Paroxysm, it was soon at an End. See his _Comment._
vol. III. p. 439. sect. 1050.
OF THE SMALL-POX.
The Small-Pox appeared at _Paderborn_ in the Spring 1761, and five had
the distinct Kind, who recovered. Six or seven had them at _Osnabruck_
in _May_ and _June_, and one Man and a Child died of the confluent
Kind. Four had the distinct Kind at _Munster_ in _July_ and _August_
who all did well. During the Winter, we had sixteen in the Hospital I
attended at _Bremen_; ten had the distinct Kind, and all recovered;
five had the confluent Kind, of whom two died; as did also one who was
brought to the Hospital with all the Symptoms of the most malignant
Kind. Two were sent to _Natzungen_ in _July_, both ill of the
confluent Kind; the one died two Hours after his Arrival; the other
recovered: And we had only two in the Hospital at _Osnabruck_ in
Winter 1762-63, and both did well.
There was nothing particular either in the Course or Treatment of this
Disorder, different from what we meet with in daily Practice; only as
the Soldiers, who were attacked with it, were strong, and in full
Health, they required Bleeding and gentle Evacuations, and a cooling
Regimen, on the first Appearance of the Symptoms.
The malignant Kind required the Use of Acids, and the Bark; which
last, could often only be administered by Way of Clyster, as the Sick
could not swallow it: In short, we treated the Patients much in the
same Way as in the malignant Fever, Allowance only being made for the
present Circumstances.
Luckily this Disorder never spread much in the Army, while I was in
_Germany_.
OF ERISYPILATOUS SWELLINGS.
In _January_ 1762, several Patients in the Hospitals I had the Care of
at _Bremen_, had shining watery Swellings of the Face, or Extremities;
which came suddenly, and were attended with a slight Degree of
Inflammation, and watery Blisters rising above the Skin, and some
Degree of Fever. The Blisters were not small, round, and angry, as in
_St. Antony_'s Fire; but larger, and of an irregular Figure,
resembling those raised when People are scalded by boiling Water. The
Swellings did not pit on being pressed, as the oedematous Swellings
commonly do: They gave Pain when pressed, but the Inflammation was not
in that high Degree as it is in the common Phlegmon: The Blood was
sizy, and the Water of a high Colour. The Disorder seemed to be a
Species of the Erisypelas.
Between the 9th and 12th of _January_, three Patients were seized with
such Swellings.
The first was a Dragoon, who had just recovered from a Flux, and a bad
Cough. On the 9th, he was suddenly seized in the Night with a large
Swelling of his Face, Hands, and Arms, which had a shining oedematous
Appearance, with a small Degree of Redness, and was painful when
pressed; and he had two or three watery Blisters rose on the Back of
each Hand above the Division of the Fingers, attended with a quick
full Pulse, a feverish Heat and Thirst, a Cough, and somewhat of a
Difficulty of Breathing, and high-coloured Water; and he was inclined
to be costive. He was immediately blooded, had a saline Mixture with
Contrayerva and Nitre, and was ordered to take a Purge in the Morning.
Next Day the Blood had thrown up an inflammatory Buff, the Fever was
abated, and the Breathing easier; but the Cough and Swelling still
remained. He then took a Julep made of equal Parts of the Saline and
Sperma Ceti Mixtures, which eased the Cough. The fourth Day the Pulse
was soft, and the Swellings still in the same Situation, and the
Breathing a little affected. A large Blister was applied to his Back,
which discharged plentifully, relieved the Breathing, and lessened the
Swellings considerably. The Cough and some Degree of Swelling still
remained; but were removed by the Use of the Sperma Ceti Mixture with
Oxymel, gentle Opiates, and some Doses of Physic.
The second was a Man of the Twentieth Regiment of Foot, who had been
some Months in the Hospital for a hectic Complaint; he was taken ill,
the same Night as the Dragoon, with a Swelling of his whole Face,
particularly the Lips, which had a shining watery Appearance, and a
slight Degree of Redness, attended with a strong Fever; and was cured
by Bleeding, Purging, the Use of the saline Medicines, and the
Application of a Blister.
The third was an Invalid, who had been admitted for a pleuritic
Complaint, which he had got the better of. He was attacked, the second
Night after the other two, with a shineing, watery, reddish Swelling,
of his right Hand and Arm, up as far as the Joint of the Shoulder;
four large watery Bladders likewise appeared on the fore Part of his
Arm, above the Joint of the Elbow. Bleeding, with the cooling
Medicines, and two Doses of Salts, carried off the Fever, and lessened
the Swelling, in about seven Days Time; but a little of it, with a
Stiffness, still remained; which at last was removed by the Use of
aromatic Fomentations, rubbing with the _linimentum saponaceum_, and
taking two Doses of Physic.
Within less than a Fortnight, five or six more were seized with
Swellings of the same Kind on some of the Extremities, and all got
well by nearly the same Treatment; excepting one Man, who was in a
very low State, and had a large deep Ulcer on his Hip, where there had
been a Mortification from his lying on that Part in a Fever. The
Swelling at first seemed to give Way; but on the third or fourth Day,
having got a severe Cough, the Swelling increased, and the
Inflammation began to look livid, and the Discharge from the Sore to
look bad; and, notwithstanding various Means were used, a
Mortification of the Part came on, and he died the seventh Day.
OF THE SCURVY.
The true Scurvy, attended with spungy fetid Gums of a livid Colour,
with livid Blotches, and Ulcers of the Legs, and other Symptoms, began
to shew itself at _Bremen_ in _January_ 1762; tho' we had not the
least Appearance of this Disorder in the Hospitals at any other Place,
while I was with the Troops in _Germany_.
A great Variety of Disorders have been called by the Name of Scurvy:
and the Disease has been divided into hot and cold; into the Acid, the
Alcaline; and the Muriatic, according to the different Fancies of
Authors, and the Causes they imagined it took its Rise from; but, from
later and more accurate Observations, Dr. _Lind_ has justly remarked,
that the true Scurvy has been found to be the same in all the
different Parts of the Globe, and to take its Rise from similar
Causes; from Cold and Moisture, and living much upon salted
Provisions, joined to a Want of fresh Vegetables, and of good generous
fermented Liquors; and hence it is most frequent in low marshy Places
in northern Climates, where there is a Scarcity of fresh Vegetables;
and where the Inhabitants live much upon salted Provisions in Winter;
and aboard of Ships in long Voyages or Cruizes, especially in the
northern Seas; and hence this Disorder was so frequent at _Quebec_ the
first Winter it was in our Possession; and in some of the other Forts
in _North America_, which were taken so late in the Year, that the
Troops had not sufficient Time to lay in a Stock of Vegetables, and of
fresh Meat to be preserved by the Frost[106]; but were obliged to live
mostly on Ship Provisions.
[106] In _Quebec_, and other northern Parts of _North
America_, as soon as the Frost sets in, they kill their Meat
intended for their Winter Store, and hang it up: It soon
freezes, and will keep in this Manner all through the Winter.
They preserve Vegetables in the same Way; and when they
intend to make Use of either, they put so much as they want
into cold Water for some Time, which draws the Frost out of
it; and then they boil or roast it, as they think proper.
It is observed, both at Sea and Land, that where the Scurvy rages,
those People are least subject to it who are well cloathed; who live
in dry Habitations, or lie in dry Births; who take proper Exercise,
without being too much exposed to the Inclemency of the Weather; and
who live well, and drink good Beer, Cyder, or Wine; as has been
remarked by Dr. _Pringle_, Dr. _Lind_, and others.
At _Bremen_ the Disorder was only observed among the Soldiers; not one
of the Gentlemen belonging to the Hospital, or to the Commissariate,
nor one of the military Officers, not even of the Serjeants, having
the least Symptom of it. The Reason of its being frequent among the
Soldiers was, that the Place is situated on a Plain naturally very
damp; and the Soldiers were quartered in very low damp Houses; at the
same Time, no Vegetables or Greens were to be bought in the Market;
and fresh Meat, and other fresh Provisions, were at so high a Price,
that the Soldiers could not afford to buy them; but were obliged to
live on salted Meat, and salted Herrings, during the Winter; and what
little Money they had remaining, they laid out on spirituous Liquors,
which were sold cheap.
The Cure of this Disorder requires--living in a dry comfortable
Place--good Cloathing--light Food of easy Digestion, such as good
Bread, Panado, Milk, Whey, Broths made of fresh Meats--white Meats,
with Greens, or other Vegetable, &c.--the Use of Liquors of the acid
or acescent Kind, or the moderate Use of Beer, Cyder, good Wine, or
weak Punch[107]--And, by Way of Medicine, gentle Purges, mild
Diaphoretics; the free Use of acid or acescent Fruits, Lemons,
Oranges, Apples, Pears, Currans, Grapes, &c. and of the antiscorbutic
Plants and their Juices, as Succory, Endive, Water-Cresses,
Scurvy-Grass[108], &c. on which a great Part of the Cure principally
depends; and the Use of some of the strengthening Bitters[109], of
which the Bark is not the least efficacious.
[107] The free Use of raw Spirits is found to be very
prejudicial; but a moderate Quantity of these Spirits,
diluted with Water, and acidulated with Lemons or Oranges (or
with Cream of Tartar, or Tamarinds, when the former cannot be
got), and made into Punch, is found to be a good
Antiscorbutic.
[108] Most ripe Fruits, particularly Lemons and Oranges, and
esculent Herbs, and many Kinds of Roots, such as
Horse-Radish, Onions, Leeks, and many others, have been found
the most useful Remedies in the Cure of the Scurvy.
Decoctions and Infusions of Fir-Tops, of Spruce, and of other
Species of the Pine-Tree; and Beer made of these Infusions,
by fermenting them with Molasses, are approved
Antiscorbutics: and when such Remedies cannot be got,
Infusions of the common Bitters, and weak Punch, made with
Tamarinds or Cream of Tartar, have proved serviceable; and
where these Acids cannot be had, the Mineral Acids may be
used for acidulating the Drink. However, it ought always to
be remembered, that fresh Vegetables and Fruits, and
vegetable Acids, produce much better Effects in the Scurvy,
than any other Sorts of Remedies; and ought always to be
used, when they can be got.
[109] Most of the common Bitters have been strongly
recommended in this Disorder, Gentian, Trifoil, Wormwood,
&c.--as likewise aromatic Bitters and Aromatics; such as
_calamus aromaticus_, Carvi Seeds, Winters Bark, Cinnamon,
and many others.