Fever; or a sharp Pain of the Side, or Difficulty of Breathing, or
some Symptom of the like Kind; it is then sometimes necessary to take
away some Blood: And in obstinate Cases, it is often found of Use to
promote Sweats, by making the Patient, while in Bed, drink freely of
warm Whey, or Sack Whey, mixed with the scorbutic Juices; or warm
Barley Water, or the like, mixed with a small Quantity of the
Antimonial Wine, or some other mild Diaphoretic.
And where the Patient is strong, and there is no Danger of
Hæmorrhages, warm aromatic Baths have sometimes been found
serviceable; but they are not to be used where the Patient is weak.
The first Time I saw this Disorder at _Bremen_, was in an old Invalid,
_James Long_, who had come from _Bristol_ to _Embden_, and from thence
to _Bremen_. He was some Weeks in the Hospital before I discovered his
Disorder to be the Scurvy. He at first complained only of great
Weakness, and such a Giddiness, when he got out of Bed, that he could
not walk, and of what he called flying rheumatic Pains of his Legs.
He had no other visible Complaint; all which, I imagined, proceeded
from Old-Age, and being worn out in the Service. At last, on the 25th
of _January_, he complained of his Gums being sore; and, on examining
him, I found his Breath fetid, his Gums swelled, soft, and spungy, his
Legs covered with scorbutic Blotches, and other Symptoms, which
evidently proved his Disorder to be the true Scurvy.
Upon which, I ordered him a low Diet, with the Addition of Greens for
Dinner, and a Quart of Lemonade, with a Gill of Brandy in it, _per_
Day, for his common Drink; and, by Way of Medicine, a Decoction of the
Bark, with the Elixir of Vitriol; and, at the same Time, ordered his
Gums to be scarified, where they were most swelled and spungy; and to
be washed frequently with an astringent Gargle; and to be rubbed now
and then with burnt Alum[110]. By these Means, in a Fortnight's Time,
his Gums became firmer, and his scorbutic Symptoms decreased. During
that Course he took cold, and had a Stitch in his Side, for which he
was blooded. The Blood threw up a very thin Buff, which was not of a
firm Consistence[111]; the Crassamentum below was of a blackish
Colour and of a loose Texture, and the Serum in a large Proportion. By
the 2d of _March_ his Gums had recovered their natural Firmness and
Texture, and the scorbutic Spots and Pains of the Legs were gone, and
he had recovered his Strength; the only remaining Complaint was a
little Swelling about the Ankles, for which he continued the same
Course, and took a Dose or two of Physic. By the 16th of _March_ all
these Symptoms were gone, and he was dismissed the Hospital free from
all Complaints. I saw him well the last Week in _May_; and he told me,
he had had no scorbutic Symptom since he left the Hospital.
[110] Dr. _Lind_, who has wrote one of the best Treatises on
this Disorder, and who had a great Deal of Practice himself,
says, "When first the Patient complains of an Itching and a
Spunginess of the Gums, with loose Teeth, either a Tincture
of the Bark in Brandy, or aluminous Medicines, will be found
serviceable in putting a Stop to the Beginning Laxity of
these Parts." When the Putrefaction increases, he recommends
the Use of some of the mineral Acids. See his _Treatise on
the Scurvy_, part ii. chap. v. p. 201.--_Van Swieten_ says,
he never found any Thing answer better than a Gargle made of
four Ounces of Elder or Rose Water, acidulated with a Drachm
of the Spirit of Sea Salt; and where the Gums were very
putrid and gangrened, he has been obliged to touch them
slightly with the pure Acid Spirit, and some Hours after to
have them washed with the Gargle just mentioned. Vide
_Comment._ vol. III. p. 629, sect. 1163.
If the Spunginess of the Gums sprout out into a luxuriant
Fungus, it is sometimes requisite to cut such Funguses away,
and to wash the Sores frequently with gentle astringent or
acid Liquors.
[111] Dr. _Huxham_ observes, that, after the Disease has
continued some Time, the Blood appears a mere Gore as it
were, not separating into Serum and Crassamentum as usual,
but remaining an uniform half-coagulated Mass, generally of a
more livid or darker Colour than common; though sometimes it
continues long very florid; but it always putrifies soon. See
his _Essay on Fevers_, chap. v.
There is something very particular in the Nature of this
Disorder, according to an Observation of Dr. _Lind_'s; who
says, "That the Scurvy is a Disease in its Nature very
opposite to that of a Fever; insomuch, that even an Infection
is long resisted by a scorbutic Habit; and those of a
scorbutic Habit being seized with the Fever, was a Proof of
its proceeding entirely from Infection." See his _First Paper
on Fevers_, p. 4.
In the Beginning of _February_, another of the Invalids, who had been
in the Hospital for a Fever and rheumatic Complaints, had Blotches
appear on his Legs, complained of great Weakness, and fainted away in
attempting to walk; which made me suspect his Disorder to be the
Scurvy; and, on examining him, I found his Gums soft and spongy,
attended with the other Symptoms of the true Scurvy. I put him nearly
on the same Course as in the last-mentioned Case: He used a low Diet,
with the Addition of Greens for Dinner, which he eat with a little
Butter and Vinegar; and he had a Quart of Lemonade, with two Ounces of
Brandy, for his common Drink during the Day; and, by Way of Medicine,
a Decoction of the Bark, with two Drachms of the _confectio cordiaca_
to each Half Pint, which he took by Spoonfuls. Next Day he complained
of a Pain in his Leg; and, on examining it more particularly, I found
a large livid Blotch, yellow all round the Edges, on the fore Part,
and a Tension all over that Leg. As he was so extremely low, as to be
in Danger of fainting whenever he sat up, I was afraid lest a
Mortification should ensue; and therefore ordered his Leg to be bathed
Morning and Evening with a warm aromatic Fomentation, and a Poultice
of Theriaca to be applied after it; and desired him to take as much of
the Decoction of the Bark with the Cordial as possible; and allowed
him a Glass of Mountain Wine every two or three Hours. By the
Continuance of this Course for some Weeks, the livid Blotches, Pain,
and Stiffness of his Leg, and most of the other scorbutic Symptoms,
went away; his Gums were restored to their natural Firmness; and he
recovered his Strength so much as to be able to sit up all Day long;
though he still remained very weak when he was sent to _England_, in
_March_.
In _February_ and _March_, seven or eight more scorbutic Patients were
sent to the Hospital I attended, who were all treated in the same
Manner; and all did well. About the Middle of _February_ this
Distemper began to shew itself in the other Hospital attended by Dr.
_Miller_, who treated the Patients nearly in the same Way, and they
all recovered.
On the 5th of _April_, a young Man, belonging to the Eighth Regiment
of Foot, came to the Hospital with all the Symptoms of the true
Scurvy; his Gums were spungy and foetid; he had livid Blotches on his
Legs, and Contractions of the Hams, and a Stiffness and Hardness in
the Calves of both Legs[112]. By following the same Course as the
others, and the Use of frequent Fomentations, and rubbing the
contracted Parts with soft Liniments, he mended daily; and, after
taking a Dose or two of Physic, was dismissed perfectly recovered on
the 10th of _May_. At his first Admission into the Hospital, he was
taken with a severe Cough, attended with Pain of the Breast, and a
Spitting of Blood for a Day or two, for which he was blooded. His
Blood threw up a little Buff; the Crassamentum was of a blackish
Colour and of a loose Texture, with a good Proportion of a yellowish
Serum. This Bleeding relieved the Complaints of his Breast, and he had
no Return of them while he remained in the Hospital.
[112] If the Swellings become large, stiff, and painful, Dr.
_Lind_ recommends that the Legs should be frequently bathed
and fomented; or, what he has found preferable, to be exposed
to their Steams, after being well covered with Blankets.
After this Operation, he advises the Limb to be rubbed with
some mild Oil, such as _oleum palmæ_, or Salad Oil; and if
the Swellings resist both the general Cure and these
Applications, the Limbs to be sweated with Spirits. See his
_Treatise on the Scurvy_, part ii, chap. v.
The first Week in _May_ four Invalids were admitted into the Hospital
for this Disorder. The first had spungy Gums, a foetid Breath, his Legs
swelled and hard, and of a deep purple Colour. The second was a Case
at first of a more doubtful Kind; there were no spungy Gums, though an
offensive Breath; his Ancles and Feet were swelled, attended with Pain
and Uneasiness, and a great Weakness and Lassitude; but no Fever, nor
any livid Blotches. The Swelling of the Feet and Ancles seemed at
first Sight rather gouty or rheumatic, than of the scorbutic Kind; but
from the Man's Way of Life, and the Disorder being so frequent, we
discovered it to be the Scurvy. The third had a very foetid Breath and
spungy Gums, livid Spots and fungous Ulcers[113] on his Legs, with
Pains and Weakness all over. The fourth had also spungy Gums and a
foetid Breath, Pains of the Legs and Arms, livid Blotches on his Legs,
great Hardness and Contraction of the right Ham, and a livid hard
Swelling on the Outside of the left Thigh, immediately above the Knee.
[113] "Ulcers on the Legs, or any other Part of the Body,
require pretty much the same Treatment, _viz._ very gentle
Compression, in order to keep under the Fungus, and such
antiseptic Applications as have been recommended for putrid
Gums, _viz. mel rosat._ acidulated with _spiritus vitrioli_,
_ung. Ægiptiacum_, &c. but nothing will avail where the
Patient cannot have Vegetables and Fruits." _Dr. Lind's
Treatise on Scurvy_, part ii. chap. v. p. 204. And he
recommends, if the Swellings and Ulcers of the Legs neither
yield to the general Cure nor to the Methods here proposed,
that a slow and gentle Course of Mercury should be tried,
after the scorbutic Taint is a good deal removed, and the
Gums are sufficiently firm; and to give along with it a
Decoction of the Woods, or of Sarsaparilla; but this Method
ought not to be attempted till the Gums have acquired a
proper Firmness. See _ibid._ part ii. chap. v.
We treated them all four in the Method above-mentioned, adding a Mess
of Greens to Dinner, giving Lemonade for Drink, and the Bark, with
Elixir of Vitriol, by Way of Medicine. The Parts that were hard and
swelled, were fomented, and rubbed with soft Liniments, and Poultices
were applied to the hard Swelling on the Outside of the left Thigh;
and the Ulcers of the Legs dressed with Digestives, and occasionally
washed with spirituous Tinctures, and touched with Escharotics. Before
I left _Bremen_, the first Week in _June_, the first and second
Patients were perfectly recovered, and the third and fourth almost
well. All of them had had the Disorder some Months before they came to
the Hospital.
OF THE ITCH.
There was no Disorder so common in the military Hospitals as the Itch.
It is of an infectious Nature, and now most commonly believed to be
entirely owing to little Insects lodged in the Skin, which many
Authors affirm they have seen in the Pustules by the Help of a
Microscope; and that the Disorder is entirely communicated by
Infection, and does not arise from any Fault in the Fluids or Solids.
It has been found by Experience, that internal Medicines have little
or no Effect in removing this Disorder; and that only external
Remedies, which come immediately in contact with the Parts affected,
are capable of making a Cure; which has been brought as a farther
Proof, that the Itch is owing to Animalcules or Insects; as it is
alledged, that no Remedies will cure the Distemper, but such as are
capable of killing them.
The Medicines, which are most commonly used for the Cure, are
_Mercury_, _White Helebore_, and _Sulphur_.
Mercurial Frictions on the Part are often made use of, and sometimes
with Success, though they are by no Means to be depended upon for a
Cure; besides that, they are liable to throw the Patients into a
Salivation, as I have seen happen more than once; for which Reasons I
would never recommend this Method where the Patient labours under no
other Disorder which requires the Use of Mercury, and would confine it
entirely to Cases where Patients, having the Itch, labour, at the same
Time, under the _Lues venerea_, and require the free Use of mercurial
Frictions; under such Circumstances the mercurial Ointment may be as
well rubbed on the Parts affected with the Itch as upon any other.
The Powder of the Root of _White Helebore_, made up into an Ointment
with Hogs Lard, or a strong Decoction of it in Water, rubbed on the
Parts, will often cure the Itch; but it is a sharp Medicine, and
generally smarts, and sometimes inflames the Parts on which it is
rubbed; and therefore it is not so commonly used, as we know a much
surer and milder Remedy. Though I have cured some People with the
Helebore Lotion without any Inconvenience, who would not use the
Sulphur on Account of its Smell.
_Sulphur_ is the most certain and easy Cure for the Itch of any we
know, and perhaps is more certain in the Cure of this Disorder than
almost any other Medicine in any other Disorder whatever. We used it
in Form of the Sulphur Ointment of the _London Dispensatory_, of which
one, two, or more Drachms were rubbed in every Night, in Proportion to
the Extent of the Parts affected. These Unctions were continued from
four or five to ten or twelve Nights, according to the Violence and
Continuance of the Disorder. Most were cured in a few Days; others
required a longer Time. As the sulphureous Unctions tend to obstruct
the Perspiration, we generally ordered a Purge to be given before
rubbing the Sulphur Ointment, and in full Habits sometimes ordered a
little Blood to be taken away; and put them all under a low Diet.
After the Disorder seemed to be removed, they took another Dose or two
of Physic to carry off any Impurities that might have been thrown upon
the Bowels, during the Use of the Sulphur Ointment. In inveterate
Cases, the Sulphur was given internally at the same Time that the
Patient rubbed with the Ointment.
It is generally believed (though denied by some) that Sulphur, taken
internally, enters the Blood; and its Steams are thrown off by the
perspiratory Vessels, and assists more effectually to destroy the
Insects and their Ovula, which give Rise to the Itch; but whether this
Effect be true or not, I found it to answer another very good Purpose;
which was to keep the Belly rather loose, while the Patient used the
Unction; and by this Way it carried off those Humours, which ought to
have passed off by the Skin; and for that Reason, when it had not that
Effect, we joined some Lenitive Electuary to it.
There is one Thing to be observed with regard to sulphureous Unctions,
which is, that we ought not to use them too soon with People
recovering out of Fevers, or other Disorders which bring them low;
otherwise there will be Danger of bringing on a Relapse, which I have
often observed to happen in military Hospitals, where the Itch has
appeared as the Patients were recovering from Fevers and other
Disorders, and the Unctions were used too soon: But whether these
Relapses were owing to the sulphureous Unction's stopping up the Pores
of the Skin, and obstructing a free Perspiration, or to the Patient's
being more apt to take Cold while they used the Sulphur Ointment, than
at any other Time, is what I cannot determine; but to me it seems most
probable, that these Unctions rather obstruct the Perspiration; and
that when they are used too soon with People recovering from Fevers,
especially those of the putrid Kind, they prevent those Particles
from passing off by the Skin, which it was necessary should be
evacuated, in order to free the Body from the Seeds of the Fever, or
other Disorders the Patients laboured under. But however this be,
Experience has shewn, that we ought not to attempt the Cure of the
Itch, in Patients so circumstanced, till their Strength be in a great
Measure re-established, otherwise there will be Danger of a Relapse;
and likewise, that Patients using Sulphur externally, ought to be
particularly on their Guard against Cold.
This Observation of Peoples being so apt to relapse after Fevers by
the too early Use of sulphureous Unction, is a strong Proof of the
Usefulness of keeping the Body open during the Time of Rubbing and of
Purging the Patient afterwards; as by these Means we may carry off by
the Bowels those Particles which could not pass by the Skin; and I
think, so far as I have been able to observe, those People have been
less subject to relapse into Fevers where this Caution has been used,
than where it has been neglected.
That Species of the Itch where it forms small Ulcers or Pustules in
the Skin, is the worst Kind, and most contagious, and seems to take
its Rise from the common Itch continuing long, and making its Way
deeper into the Skin. The Cure is the same, only this requires more
frequent Unctions, and those to be continued longer, than before the
Disorder has taken such deep Root.
It is no uncommon Thing to see the Itch appear again, some Weeks after
it has seemingly been cured by the Use of sulphureous Unctions; which
most commonly happened to those who were in too great a Hurry to get
well, and left off the Use of the Unctions too soon. Such Returns of
the Itch were generally cured by the Repetition of the same Treatment
as before.
TABLE of DIET.
The following is a Copy of the Table of Diet which was used in the
Hospital all the Time I was with the Troops in _Germany_:
_Breakfast._ | _Dinner._ | _Supper._
| |
One Pint of Rice | |
Gruel; made with two | |
Ounces of Rice, one | |
Full Diet, Spoonful of fine | One Pound of | As Breakfast.
Flower, a little | Meat. |
common Salt, and fine | |
Sugar. | |
______________________________________________________________________
| One Pint of |
Middle Diet, As above. | Broth, Half a | As above.
| Pound of Meat. |
______________________________________________________________________
| One Pint of |
| Broth; or Half |
As above, or | a Pint of |
according to | Panado, with two |
Low Diet, the Patient's | Spoonfuls of | As Breakfast.
Stomach or | Wine, and a |
Indisposition. | Quarter of an |
| Ounce of fine |
| Sugar. |
The daily Allowance of Bread was a Pound to those on full and middle
Diet, and Half a Pound to those on low Diet, or a Pound, if so ordered
by the Physician.
Those on full and middle Diet were allowed daily three Pints of Barley
or Rice Water; to each Pint of which were added two Spoonfuls of
Brandy, and a Quarter of an Ounce of Lump Sugar. Small Beer was
mentioned in the Diet Table; but this we could never have good; and
therefore was not used.
Those on low Diet were allowed Barley or Rice Water; to which some
Wine or Brandy was occasionally added, if ordered so by the Physician.
Besides this, the Physician might order an additional Quantity of
Wine, Brandy, or Milk, or Water Gruel, or any other Articles which he
thought proper for the Sick under his Care, and which could be got
easily.
PHARMACOPOEIA IN USUM
Nosocomii Regii Militaris Britanici.
MDCCLXI.
PHARMACOPOEIA IN USUM
Nosocomii Regii Militaris.
Ann. MDCCLXI.
AQUÆ SIMPLICES ET SPIRITUOSÆ.
AQUA Alexeteria.
---- Bacc. Juniperi.
---- Cinnamomi.
---- Menthæ vulgaris.
---- Menthæ piperitidis.
---- Nucis moschatæ.
---- Pulegii.
---- Rutæ.
Vel aliæ aquæ hujus generis præparari possint, terendo in
mortario vitreo elaeosacchara præparata, cum oleis
essentialibus, et sacchari albi 12la quantitate; et dein
addendo aquæ fontanæ vel spiritus vini tenuis quantitatem
sufficientem[114].
[114] Such _Elaeosacchara_ (as they are called), made by
rubbing the essential Oils with twelve Times the Quantity of
Sugar, may at all Times be prepared at the fixed Hospital,
and carried about with the flying Hospital, much more
conveniently than the simple or compound Waters themselves.
Aqua calcis simp. Ph. Lond.
Dosis a lib. i. ad lib. ij. in die.
Aqua Hordeata. Ph. Lond.
Utenda pro potu.
BOLUS.
Bolus anodynus astringens.
Rx Theriacæ andromachi, drachm. dimid. opii, gr. i. M. pro
dosi semel vel bis die.
Bolus e rheo cum mercurio.
Rx Pulv. rhei, gr. xxv. calomel, gr. v. syrup sacchari, q. s.
Bolus e calomel.
Rx Calomel gr. v. conserv. rosar. scrup. i. M.
Bolus mercurialis.
Rx Argenti vivi, gr. x. extingue in balsam copaivi, q. s. et
adde conserv. rosar. q. s.
Bolus e scordio cum rheo.
Rx Elect. e scordio, scrup. i. pulv. Rhei, gr. x. syrup, q. s.
ut fiat bolus sumendus semel, bis, terve die.
COLLYRIA.
Collyrium saturninum.
Rx Sacchari saturni, salis ammoniaci crudi ana gr. vi. solve
in aq. fontanæ, unc. xij. adde pro re nata tinct. thebaicæ,
drachm. i.
Collyrium vitriolicum.
Rx Vitrioli albi, drachm. ss. solve in aq. fontanæ, lib. i.
Confectio cardiaca. Ph. Lond.
Conserva cynosbat. Ph. Lond.
Conserva rosar. Ph. Lond.
DECOCTA.
Decoctum album. Ph. Lond. utendum pro potu.
Decoctum arabicum.
Rx Gum. arabici, unc. dimid. coque in aq. hordeatæ bullientis,
lib. ij. ad solutionem Gummi. utend. pro potu.--addi possit
pro re nata spirit. nitri dulcis, drachm. ij.
Dococtum corticis Peruviani.
Rx Cort. Peruv. crass. pulv. unc. i. coque in aq. fontan. lib.
iij. ad lib. ij. Colaturæ adde tinct. cort. Peruv. unc. i.
spirit vini Gallici sescunc. Dosis ab uncia i. ad unc. iv.
bis ter. quaterve die.
Decoctum cort. cum serpentaria.
Fit addendo decocto cort. Peruv. sub sinem coctionis, rad.
serpentariæ virgin. contus. unc. dimid. Dosis ab unc. i. ad
unc. iij. ter quaterve die.
Decoct. commun. pro clyster.
Rx Flor. vel herb. chamæmel. unc. i. coque in aq. fontan. lib.
i.ss. ad lib. i. & cola.
Decoctum ligni guaiaci.
Rx Ligni guaiaci ras. lib. ss. aq. fontanæ bullientis, cong.
ij. macera per noctem; mane coque ad congium. i. & cola;
Capiat a lib. ss. ad lib. ij. die.
Decoctum nitrosum.
Rx Coccinel. scrupul. i. coque in aq. fontan. lib. ijss. ad
lib. ij. & dein adde salis nitri, unc. i. sacchar. albi
sescunc. Colaturæ addi possit pro re nata aq. alicujus
spirit. unc. ij. Dosis ab unc. i. ad unc. iv. 4tis vel 6tis
horis.
Decoctum pectorale.
Rx Fol. herb. malvæ, unc. ij. feminum lini, unc. dimid. coque
in aq. fontan. lib. ivss. ad lib. iv. addendo sub finem
coctionis rad glycyrrhiz sescunc. vel mellis optimi, unc. i.
Cola pro potu.--Adde pro re nata aceti, sescunc.
Decoctum rad. sarsaparillæ.
Rx Rad. sarsaparillæ, unc. iij. coque in aq. fontan. lib. iij.
ad lib. ij. adde sub finem coctionis ligni sasafras, drachm.
i. rad. glycyrrhizæ, drachm. ij. Colaturæ capiat a lib. i.
ad lib. ij. in die.--Adde pro re nata vini antimonialis,
drachm. ij.
ELECTARIA.
Elect. astringens balsamicum.
Rx Specier. e scordio, pulv. e tragacanth. comp. ana unc. i.
tincturæ thebaicæ, drachm. ij. syrup sacchari, q. s. ut fiat
elect. Dosis ad molem N. M. bis, ter. quaterve in die.
Elect. corticis Peruviani.
Rx Pulv. cort. Peruv. unc. iv. syrup sacchari, q. s. Dosis a
scrup. i. ad drachm. unam, bis, ter, 4r. 6ties. vel decies
die.
Elect. corticis anodynum.
Rx Elect. cort. Peruv. unc. 1nam. elect. e scordio unciam
dimidiam, vel tinct. thebaicæ scrup. ij.
Elect. corticis astringens.
Rx Elect. cort. Peruv. semunc. pulv. rad. tormentil, lapidis
cancror. ppt. singulorum, drachm. i. syrup, q. s.
Elect. cort. cum serpentaria.
Rx Elect. cort. Peruv. unc. i. pulv. rad. serpentar. virgin.
cort. canel. alb. ana, drachm ij. syrup. q. s.
Elect. cort. cum sale ammoniac.
Rx Elect. cort. Peruv. sescunciam. sal. ammon. crud. drachm. i.
Elect. e baccis lauri. Ph. Lond.
Elect. lenitiv. Ph. Lond.
Elect. lenitivum cum sulphure.
Rx Elect. lenitiv. lib. ss. flor. sulphuris, unc. ij. Dosis,
moles, N. M. vel ad semunc. pro re nata.
Elect. lenitivum compositum.
Rx Elect. lenitiv. lib. i. pulv. jalap. unc. i. sal. nitri,
drachm. ij. syrup. q. s. Dosis a drach. i. ad drach. iv. pro
r. n.
Elect. lenitivum balsamicum.
Rx Elect. lenitiv. comp. unc. ij. bals. copaiv. unc. i. gum
guaiac. unc. ss. M. Dosis, cochleare theæ, h. s. vel mane &
vesperi.
Electuar. e scordio vel diascordium. Ph. Lond.
Elect. e spermat. ceti.
Rx Balsam Peruv. unc. im. misce optime cum mucilag. gum arab.
sescunciam & adde spermat. ceti, conserv. rosar. ana unc.
xij. syrup sacchar. q. s. dosis, a dimidiâ drachma bis die ad
drachm. im. quater vel sexties die.
Elect. stomachicum.