OF THE DISEASES OF THE INDIAN ARMY IN EGYPT.
We have now arrived at the last part of these Sketches; where it is
intended to offer some account of the diseases which we met with in Egypt.
The catalogue of military diseases is never extensive. If his peculiar
way of life exposes the soldier more to some distempers, it entirely
exempts him from many others. In an Indian army the diseases are even
fewer than in any other; at the same time, that the practice of medicine
is more simple. I am of opinion, that in India the practitioner goes on
surer ground than in Europe, partly for the above reason, and partly
from the causes of disease being less varied in that country. Though
the diseases which occurred in the Indian army, when in Egypt, were not
numerous, yet some of them were highly important, and on our arrival
in Egypt were new to every one of the medical gentlemen, excepting Mr
Bellars, of the 86th regiment, who had treated a few cases of the plague,
which occurred in a detachment of that regiment acting with the Vizier’s
army, and had himself suffered from the ophthalmia of Egypt.
I propose to include every thing that I have to offer on this part under
two heads. Under the first, I shall notice two diseases which may be
termed the endemics of Egypt, viz. the plague and the ophthalmia of that
country.
Under the second, the other diseases which prevailed will be noticed.
They are mostly tropical diseases; and with them the reader will not be
long detained.
OF THE PLAGUE.
I begin with the plague; a disease of which accounts have been handed
down to us from the earliest ages of history or of physic. The
consideration of it is important, not only on account of its frequent and
fatal occurrence, but, as being, perhaps, the most formidable disease
that the art of physic has to encounter. On this subject, however,
much will not be expected from me. Of no disease have we a more clear,
accurate, and complete, history than of this, in Dr Russel’s work on the
plague. In Egypt, we often had recourse to this work, and we readily
acknowledge our obligations to the venerable and learned author.
Though since the time that Dr Russel gave his ample history of the
plague in Syria, we have had several accounts of this disease as it
appeared in other countries; yet much has not been added to our stock
of information, and little of improvement has been made in the practice.
The proper and well-timed use of mercury, and, perhaps still more, the
application of the newly-discovered remedies analogous in their effects
to the calces of that mineral, hold out a prospect of success the most
encouraging.
In Europe, but more particularly in Britain, much of the dread, and much
of the real danger, that attended the most fatal diseases in this country
are now done away, by the late improvements in medicine, and in chemistry.
The time was, when fever, when it broke out in different parts of
England, proved little less fatal to whole villages and towns than the
plague does in the countries where it resides. From the improved practice
of the treatment of fever, but more from our knowledge of the means of
destroying contagion and preventing its spreading, the mortality from
this class of diseases is now comparatively small.
The small-pox, that plague which once carried off so great a proportion
of the population of Europe, now bids fair to be expunged from the
catalogue of diseases.
May we not indulge a hope, that, as the intercourse of civilized Europe,
with the countries of which the plague is now the scourge, becomes more
regular and intimate, we may be enabled to extend to them our discoveries
and improvements, and so direct them to the means of divesting the plague
of its terrors, and reducing the mortality from it to the scale of that
of fever and the small-pox in Europe?
Egypt has been called the cradle of the sciences. From this we
acknowledge, that the arts were derived to Greece, and subsequently to
every part of the world. It would surely be the noblest gratification,
if in return, at this period, Europe, by extending her benefits and
improvements to Egypt and to Greece, could free them from the most cruel
scourge of countries, once the most civilized and polished in the world.
It would in some measure compensate and console them for the low state of
degradation into which they have fallen.
All that I have to say of the plague will tend to diminish the dread
which has hitherto been entertained of it.
A formidable disease undoubtedly it is; but, when we hear how much of
the population of Persia, Arabia, Turkey, Syria, Egypt, and Barbary,
is now and then swept off, all must not be laid to the account of the
plague, as if its ravages admitted of no remedy. The experience of the
French and English, in Egypt, will now convince Europe, that much of the
vast mortality, in the above countries, is to be ascribed to the gross
ignorance in which they are immersed.
Were typhus, our jail or hospital fever, to be imported into a town of
Egypt, we can hardly conceive how it could ever be eradicated by the
natives. Whenever the small-pox does appear in that country, it proves a
dreadfully-destructive disease. The structure of their houses and plans
of their streets are calculated for the production of disease, and the
preservation and concentration of contagion.
It is a matter of no little consolation to us, that we know the means,
not only of excluding the plague from our own country, but that, when our
armies are stationed in the countries where the disease is endemic, we
can arrest the progress of the contagion, and with certainty eradicate it.
The plague made its first appearance, in the army from India, in the
middle of September, 1801. From its early appearance the natives were
very much alarmed, and prophesied a dreadful season of plague. They have
observed, that, when it breaks out before December, they have always a
generally-prevailing and a very destructive disease.
The number of cases which appeared in the Indian army, from the 15th of
September, 1801, to the 15th of June, 1802, is seen in an accompanying
table.
After the plague broke out, the disease was for a long time confined to
Rosetta; it was otherwise in the former season.
Soon after the British army effected their landing at Aboukir, in March,
1801, they were attacked with the plague, though the season was then on
the decline. In the beginning of the year, the disease had prevailed very
generally over the whole country, and the loss arising from thence, to
the French, was considerable. It continued to spread in the British army
till May, during which month few cases appeared; but none I believe in
June.
Though the contagion is seldom or never, I believe, out of the country,
the natives of Egypt denominate the season of plague from November or
December of one year, to June of the year following; they observe, that
the disease constantly stops at the period of the summer solstice.
I have said, that, during the season ending in June, 1801, the disease
prevailed very generally in Egypt; Rosetta, however, was an exception; if
any case did occur there it was concealed.
At Cairo, Alexandria, and Damietta; at Suez, in the villages, and in
Upper Egypt; it proved very fatal: at Siout, at Girgé, and in general
throughout the towns and villages in Upper Egypt, we saw continued marks
of its desolation, and heard many dismal accounts of its ravages.
The reason of the plague first appearing in, and afterwards being
confined only to, Rosetta, in the last season, was, that it was the only
open port to which vessels from Turkey and Greece resorted; and that from
some of these, no doubt, the disease was imported.
In the pest-houses of the army, thirteen medical gentlemen did duty,
who in the Indian army might be said to have had the post of honour.
They were, Mr Thomas, Mr Price, Mr Rice, Dr Whyte, Mr Grysadale, Mr
Adrian, Mr O’Farrel, Mr Whyte, Mr Dyson, Mr Angle, Mr Moss, Dr Buchan,[4]
and Dr Henderson. Besides these, Mr Cloran was in charge of the cases
under observation, and Mr Bell of cases under quarantine. Mr Blackwell,
surgeon on the staff of the English army, acted as inspecting surgeon
to the Board of Health. He visited every case in the first instance,
and, as he judged it necessary, sent them to the quarantine, to the
observation-ground, or to the pest-house: to Mr Blackwell’s unceasing
attention and discriminating knowledge of the pestilential symptoms, we
owed no small share of our safety in Alexandria.
Besides the above gentlemen, we had two Greeks, the barber-doctors
usually employed in Egypt, who visited the inhabitants, and before
interment narrowly examined every body. These two made a daily report to
the Board of Health of the number of deaths and of their inspection of
the bodies; they likewise did other duties under Mr Blackwell.
In order to take from our medical gentlemen, in the pest-houses, some
of the most dangerous part of the duty, it was my wish to procure some
of the Greek doctors of the country to reside in the pest-houses, to
feel the pulses there, draw blood, open and dress buboes, &c. The most
diligent search was made for those people, and very high pay was promised
to them, but we could tempt none of them to live in our pest-houses: a
plain proof of the opinion which they entertain of the contagious nature
of the disease.
The thirteen gentlemen first mentioned, were those only that were
directly in the way of contagion, for, it became their duty to come into
contact with the infected, and seven of them caught the infection, and
four died.
To the atmosphere of the disease all the medical gentlemen of the army
were exposed, as they saw and examined the cases in the first instance;
but, except from actual contact, there never appeared to be any danger.
The sketch which I mean to give of the plague, I draw principally from
the reports made to me by the surgeons of the army, and from a pretty
voluminous correspondence with the gentlemen whose names have been
already mentioned. From my own experience I hardly can venture to speak:
it was very limited. Though I saw a great many cases, in the first stage
of the disease, the number of cases which I treated throughout was very
small; they were the cases which first appeared in the army, and my
success in them leaves me little to boast of.
The reports and statements of the different gentlemen I have compared
together, and endeavoured to reconcile them by what I myself saw of many
of the cases.
I have generally given the names of the gentlemen by whom the different
facts are related: I have always done this where the reports of two
gentlemen disagreed.
From the sources of which I am possessed, I think I can bring forward
some new facts regarding the disease, particularly in the treatment. It
is much to be regretted, that no traveller, acquainted with the modern
practice with mercury and the analogous remedies, ever resided in the
countries where this disease is endemic.
In one circumstance, there is a very generally-prevailing opinion in
regard to the plague, viz. that extremes of both heat and cold stop the
progress of the contagion.
If this be true, in regard to heat, it did not appear to be so in the
army in Egypt in regard to cold.
The period at which the plague raged the most was in the coldest months.
It would appear, that, in different countries and in different seasons
in the same countries, the plague assumes very different appearances.
The plague is seen as varied in its appearance as the different fevers
described by Sydenham to prevail in different years, and under different
constitutions of the air, in England.
Our knowledge of this fact enables us to reconcile the different or
opposite accounts given of the disease, and of its treatment by different
writers.
In the Indian army, when the disease first broke out, the cases sent
from the crowded hospitals of the 61st and 88th regiments, were from the
commencement attended with the typhoid or low symptoms.
The cases sent from the Bengal volunteer battalion, and from the other
corps, when the army was encamped near the marshy ground at El Hammed,
were all of the intermittent or remittent type.
The cases which occurred, in the cold rainy months of December and
January, had much of the inflammatory diathesis. Mr A. Whyte remarked,
that every case admitted into the hospital, at Rahamania, had the
symptoms of pneumonia.
In the end of the season, at Cairo, Ghiza, Boulac, and on crossing the
isthmus of Suez, the disease wore the form of a mild continued fever.
The resemblance which some cases shewn and of others described to me bore
to the West-Indian fever struck me very forcibly.
I know not that I can better describe the disease, than by a short
statement of the cases of some of the medical gentlemen who had the
disease; most of whom wrote me accurately every thing that they felt. Dr
Whyte entered the pest-house at El Hammed on the evening of the 2d of
January, 1802. In a letter of that date he writes to me, “I just now
inoculated myself, by friction, with bubonic matter on the left thigh;”
on the 3d, he says, “I have this morning inoculated myself by incision
on the right fore-arm.” Mr Rice, then doing duty in the pest-house at El
Hammed, gives the whole of the case. In a letter on the 3d of January, he
writes to me, “Dr Whyte came here last night; soon after he came in, he
rubbed some matter from the bubo of a woman on the inside of his thighs.
The next morning, he inoculated himself in the wrist with a lancet, with
matter taken from the running bubo of a Sepoy; he appears now very well.”
In subsequent letters, Mr Rice says, “that Dr Whyte continued in good
health on the 5th, and all day on the 6th, till the evening, when he was
attacked with rigors and other febrile symptoms. He said himself that
it was the attack of an intermittent; and it bore a great resemblance
to it. After sweating profusely, he was better in the morning of the
7th, but in the afternoon the shivering returned; and, after it had
continued 30 minutes, a severe hot stage came on, then a profuse sweating
followed, but with it much affection of the head, tremor of the limbs,
particularly of the upper extremities, tongue black and dry, skin hot,
pulse full, hard, and irregular, thirst great, prostration of strength,
and anxiety. The head was the only place that he complained of, and it
seemed to be the principal seat of his disease; he still persisted that
the disease was not the plague; he would not allow his groin or arm-pits
to be examined, and he refused all medical assistance.” He asked for a
purgative, which Mr Rice gave him, and he requested to be bled, this Mr
Rice thought the state of the symptoms would not justify him in doing. On
the 8th, these symptoms continued, and there was some delirium; he begged
to be removed from the pest-house at El Hammed, to the old pest-house at
Rosetta, under the charge of Arabs. He was removed on the morning of the
9th, and died in the afternoon of that day very delirious.
2d, Mr Price did duty in the pest-house at Rosetta and at El Hammed from
the beginning of November, 1801, and had a tertian which he never could
completely remove. In the pest-house at El Hammed, he was in the evening
of the 1st of January attacked with rigors and slight febrile symptoms;
but he himself thought this was only an attack of his intermittent, he
soon however felt an affection of his head, and tremor of his limbs,
and knew his disease. On the morning of the 2d, three buboes appeared,
two femoral and one axillary; he then became delirious, and had no
recollection of any thing for several days. On the 5th, there was a
remission of the fever. He was able, on the 7th, to write me, “that he
had no fever, that one bubo was coming on, and that he was extremely
debilitated.” On the 13th Mr Rice opened his bubo; but it was two months
after this before he recovered.
I am sorry I cannot find a letter where the treatment of Mr Price is
detailed; but I am pretty clear that it was by mercury, as this was his
own practice at the time.
3d, Mr O’Farrel entered the pest-house at Aboukir on the 8th of March.
He continued well and did his duty there till the 3d of April; in the
evening of that day, when he had rigors, which he himself attributed to
cold, and says, “that sudorifics nearly cured him.” He was obstinately
costive, for which he took several drastic purgatives: the rigors
successively returned in the evenings of the 5th and 6th, and he
continued taking antimonial powder. On the night of the 6th, he was
attacked with giddiness, irritability of stomach, and low fever. Mr Dyson
wrote to me, that, on the morning of the 6th, he was delirious, that
he had applied a blister to his head; but that he could not get him
to swallow any medicine: he expired on the morning of the 7th. No bubo
appeared till the day before his death.
4th, Mr Dyson went to assist Mr O’Farrel, at Aboukir, on the 1st of
April. On the evening, of the 5th, he was attacked with lassitude, and,
on feeling his groin, he writes to me, “I discovered some inflammation
of the glands.” After this the succession of symptoms in Mr Dyson was
nearly what has been described in Dr Whyte’s case. The fever continued
for several days, and became intermittent, one bubo came to suppuration.
He obstinately refused every medicine but calomel, which he took as a
purgative, but it never salivated him. Constant nausea and vomiting were
symptoms with him from the second day of his illness, and he was a long
time before he recovered.
5th, Mr Thomas, after being three weeks in the pest-house at Rosetta,
attending the first plague-cases which came from the 88th regiment,
while walking in the garden of the establishment, laid his hand on his
groin by accident, and was alarmed to find a large swelling on one side.
He soon after felt some giddiness and fell down; as soon as he recovered,
he rubbed in mercurial ointment in great quantity, and every hour took
as much calomel with opium as his stomach could bear. His gums were very
quickly affected, his bubo came to suppuration, and, in three weeks, he
was quite well.
6th, Mr Angle, after being about a month in the lazaretto at Alexandria,
was attacked with fever and bubo. The bubo never could be brought
forward, and he died of the disease on the 14th day. I have no notes of
the treatment of this case nor that of Mr Moss; who, after having been
about the same time on duty at the lazaretto of Alexandria, caught the
infection. He likewise lived several days, and his bubo could never be
brought forward.
It is useless to detail more cases, though I am in possession of many
accurately related by several gentlemen. Nor do I mean to offer any
comment on the above.
As particularly prominent and remarkable, I cannot, however, without
some notice, pass over three cases where mercury, early and liberally
exhibited, had very remarkable effects.
I received several accounts of the good effects of mercury from the
gentlemen in the pest-houses, but none so remarkable as the following:—In
the beginning of the season, on the breaking out of the disease in the
crowded hospital of the 88th regiment; every man in the hospital was
examined at different periods of the day, and thus the disease was
detected on its very first appearance. At this time, I gave to each of
three of the men, placed in the observation-ward of the hospital, (of
whom Littlejohn and Egan have already been mentioned,) two grains of
calomel, and the sixth of a grain of opium every hour, and made them
rub into the inside of the legs, thighs, arms, and neck, half an ounce
of the strong mercurial ointment three times a day. I, at the same time,
made them take each half an ounce of nitric acid diluted in their drink
during the day, and put their feet and hands, three times during the
day, into a strong nitric bath. In about twenty-four hours, their mouths
became severely affected, a tenderness in their arm-pits and groins went
off, and the severest febrile symptoms yielded. The men were, however,
extremely debilitated, and remained a very long time convalescent. During
their convalescence, I thought it prudent to keep them in quarantine,
being fully convinced, that they had had an attack of the plague, the
progress of which had been arrested, and the disease cut short by the
above treatment.
Corporal Francis, as already mentioned, was suddenly attacked with
giddiness after coming off from duty as corporal of the guard in the
pest-house. In the very commencement of the disease, on the first feeling
of illness, he was brought to Mr Price, who instantly admitted him and
immediately exhibited mercury, and as soon as the gums became affected,
the febrile symptoms vanished. He remained some time in the hospital, on
account of a bubo, which came to suppuration; but Francis suffered very
little. He was never more than two days confined to bed, though the case
occurred at a time when the disease was very violent.
The case of Peter the interpreter strongly evinces the success of the
mercurial treatment. To this case, the mercurial pills and ointment were
given; and he was, in every respect, treated as a case of syphilis and
was speedily cured.
In the cases related, there appeared some facts as to the time the
matter of the pestilential contagion takes before it comes into action.
Other facts shew, that, in different people, and under different
circumstances, there is the greatest variety in this. The lazaretto at
Alexandria was infected by the admission of an Italian merchant, and the
guard there, consisting of 14 men, caught the disease, but were attacked
on different days. The provost’s guard and his prisoners at Alexandria
caught the infection from a deserter confined among them, and the disease
among these people appeared at very different periods.
Mr Rice relates two cases on this part of the subject, which appear
worthy of detail: he says, “we have had proofs, that the pestilential
virus remains a considerable time in the habit, without exerting its
influence or shewing its virulence. A striking case occurred lately: a
Sepoy was sent to the pest-house from the hospital of the 7th regiment
with plague; his wife could not be prevented from accompanying him, where
she attended and nursed him. The Sepoy died, and the woman was ordered
into quarantine; however, she escaped, and after some days search she
was discovered near the regimental hospital of the 7th. As this woman had
the greatest reluctance to going to quarantine, a centinel was put over
her in the hut where she was, and all communication with her was stopped:
she continued in good health till the tenth day after her escape from the
pest-house; in the afternoon of this day, she was attacked with fever,
in a few hours after, the inguinal glands became painful, and she was
carried to the pest-house at El Hammed.”
“Another case bore a great affinity to the above: a Sepoy came into the
pest-house to attend his wife: the man was sent into quarantine, and he
continued well there, till the seventeenth day, on which plague-symptoms
appeared, and he was sent to the pest-house.”
Of the symptoms of the plague, fever, though not always present, seemed
the most constant.
At the end of the season, at Cairo, at Ghiza, and at Suez, cases appeared
without any observable fever. When it did appear, as already noticed,
the type at different seasons, and in different parts of Egypt, was very
various. At the pest-house at Rosetta and El Hammed, many of the cases,
admitted from October to January, had the accompanying fever intermittent
and of the quotidian type. This I believe to be a new fact in the history
of the disease. For some time in January, February, and in some part of
March, the fever had regular remissions. After this period, it generally
appeared of the typhus form at Aboukir, except in the detachment of the
26th Light Dragoons, all of whom were young healthy men, and in them Mr
O’Farrel observed, “that there was much re-action, and that the delirium
was of the kind denominated phrenitis.”
At the pest-house, at Rahaminia, Mr Whyte observed, that all his patients
had pluritic complaints.
The second symptom in order was the tremor of the limbs. Mr Price says,
“that bubo and pyrexia are not so essential parts of the diagnosis, as
tremor of the upper extremities,” and
3dly, The affection of the head, which was sometimes phrenitis, and
sometimes typhomania. In a great majority of Mr Price’s, Mr Rice’s, and
Mr Whyte’s, cases there was much nervous affection; in one, the risus
sardonicus. Mr Adrian says, the nervous affection, in many cases, was
very remarkable; in several cases, it resembled the description, given
by authors, of that nervous affection produced by the bites of mad or
poisonous animals, an almost universal tremor.
4thly, The glandular affection was the next most generally attending
symptom. Not above one-half of Mr Whyte’s cases had buboes; and, in
a great majority of Mr Rice’s patients, this symptom did not appear.
Dr Henderson says, that, in every one of his cases, there was either
inflammation or swelling of the glands. The glands most commonly
affected were the femoral, next the axillary, then the parotid,
submaxillary, &c. In one case of Mr Adrian, an abscess, of the size of
a pigeon’s egg, formed on the inner canthus of the left eye. Mr Adrian
opened it by incision, and the patient did well. Many were surprised
at the rapidity with which the appearance of bubo followed the first
complaint of illness: in a number of cases, within four hours. Mr Rice,
on the 7th of January, admitted five cases, and in none of them were
buboes later of appearing than six hours after the first feeling of
illness. In a Sepoy of the 7th regiment, taken ill in December, the
femoral axillary, parotid, submaxillary, and sublingual, glands were all
affected. In another Sepoy of the same regiment, admitted by Mr Rice,
a case of re-infection, so very much swelled were the glands about the
neck, that the man died of suffocation the day on which he was admitted.
5thly. The next most generally-attending symptom was the affection of
the abdomen. Mr Price says, the hepatic region was in every instance
affected. Sometimes there was a swelling of the region of the liver, pain
was experienced from pressure, sometimes in the epigastric, sometimes in
the hypogastric, region; and almost always in the region of the liver, at
which time, the pain has in some cases extended to the kidneys. Swelling
of the belly was very frequent; in some cases the abdomen appeared a
mass of knots. Uneasiness at the precordia, nausea, and vomiting, were
frequent: the vomiting was always of bile, which was of different colours
in different stages of the disease. Mr Price writes, “costiveness was
a constant and obstinate symptom; and, when ten or twelve grains of
calomel brought fæces down, they were always accompanied with bile; first
brown, then yellow.” The urine was in general yellow; the skin and adnata
frequently of the same colour. Mr O’Farrel says, “I lost one of the
dragoons from the affection of his side; the fever went off some days
before his death.” Mr Adrian writes, “I do not find the constipation
an universal symptom, although, in many cases, I have met with it very
obstinate. I was once obliged to give eighteen grains of calomel and two
scruples of cathartic extract before my patient was moved.” In several
cases, the disease commenced with diarrhœa or dysentery. Some of Mr
Thomas’s patients died of dysentery; and this might have been said to be
the cause of their death, as they recovered from the bubo, fever, and
other symptoms of plague.
6thly. In the first part of the season, petechiæ, vibices, maculæ, and
carbuncles, were not seen: in the middle of the season they frequently
appeared.
7thly. Some gentlemen could distinguish the disease by a particular look
of horror and by a particular cast of the eye, which was first watery,
next blood-shot, and at last yellow.
8thly, According to the diversity of the season, the pulse varied. In
general, it was small and frequent, and often, when at the wrist it was
not perceptible, it could be felt beating 130 or 140 at the carotids.
9thly, The tongue was universally white at the edges; and, when in March
and April, some cases appeared with the fever of the typhoid form, it was
black and furred in the centre.
10thly, Several of the cases, which came under Mr Grisdale’s care in
February and March, had cough and dyspnœa. Mr Adrian makes a similar
report at the above period, and three of Mr Whyte’s patients at Rahamania
had cough and dyspnœa.
11thly, In a majority of Mr Price’s cases, he remarked an unusual dryness
of the skin, and that it was with the utmost difficulty that he could
ever excite perspiration. Mr Whyte says, that, “At Rahamania the skin
was dry, and that he had never succeeded in exciting sweating.”
These are the appearances the disease put on in the last season; and, on
inquiry, I find that they were the appearances it assumed in the former
season in the British army in Egypt.
My friend, Dr Short, who resided some time in Persia, and who has paid
much attention to the history of the plague, informed me, that, in
addition to the above, he found hemorrhage a frequent symptom in the
plague, which raged at Bagdad in 1800 and 1801.
In one case he saw a copious hemorrhage from the eyes, which continued
for nearly twelve hours. As soon as it stopped, an eruption appeared over
the body very much resembling the measles. This patient, a boy of twelve
years old, died on the 5th day of the disease.
The duration of the disease in different persons was very different. In
several instances, the effect of the pestilential contagion was the
immediate extinction of life; and we had several instances of the patient
surviving but a few hours the first sensation of illness.
The muccadum of the dooley-bearers of the 88th regiment, about nine
in the morning, exhibited the symptoms of fever. About twelve, a bubo
appeared, and he died before four o’clock. In some instances, again, the
patient lived till the thirteenth and seventeenth day of the disease;
however, these instances were rare.
Prognosis. We found that the greatest caution was requisite in giving
an opinion as to the probable event of cases: in no disease was the
practitioner oftener deceived. In several instances, patients who had
recovered from the fever, whose buboes were doing well, and people who
were convalescent, suddenly dropped down and expired. Whether this was
from re-infection, or whether it was a feature of the disease; will be
difficult to determine.
On the 24th of December, one of the Arab servants, convalescent from the
disease, and who had been convalescent for eight days, taking bark, while
smoking his pipe suddenly expired. In no disease do patients bear motion
worse than in this. The least motion[5] induced syncope or death.
Sometimes, they who had for some time been convalescent, suddenly
complained that they felt giddy, and expired. Sometimes they called for
food, and expired with it in their mouths. In one of Mr Adrian’s cases,
where the fever had for some time been gone, and the patient was so far
convalescent that he daily walked about a quarter of a mile, the man
suddenly complained of giddiness, and expired in ten minutes.
Mr Thomas had two cases where, after affecting their gums, there was a
complete apyrexia: but he lost his patients from an immense discharge
from the glands and from a secondary fever. In general, it was found,
that the patient recovered in proportion to the facility with which his
gums and skin could be affected.
The _prognosis_ likewise depended much on the degree of the affection of
the sensorium; when the patient was from the beginning comatose, the
case terminated fatally. Several of the cases in the beginning of the
season, particularly the natives of India, could never be roused. The
typhomania was a more fatal delirium than the inflammatory species.
In the _treatment_ of this disease, a variety of modes were put in
practice; but so little success attended them, that some were inclined to
despair of success from any. Though, with it, even many were lost, yet
oxygenation and particularly the use of mercury had the most success.
Though every thing was done by General Baird that the situation and
circumstances allowed, yet the gentlemen in the pest-houses laboured
under so many disadvantages, that, for the most part, there was but
little to be expected from any mode of treatment. In particular, not
a little difficulty, as well as danger, was met with in affecting the
gums. Safety required that the pest-houses should be at some distance;
perhaps, in general, the distance at which they were placed was too
great. The patient suffered much by the conveyance, and frequently the
treatment of the disease was entered on at too late a period to promise
success. In December, January, February, and March, patients suffered so
much from the extreme severity of the weather, that in some instances it
was not easy to determine whether a patient died from cold or from the
plague.
So much dejection prevailed among the natives of India, that, from the
moment of the attack, they gave themselves up, and said they were sent to
the pest-house to die. They never could be prevailed upon to swallow a
morsel of food nor any medicine, and some actually starved themselves.
With establishments of a proper structure, and under proper regulations,
we may safely venture to affirm, that our loss from the plague in Egypt
would not have been half of what it was.
In the treatment of this disease, the first indication was, to clear the
primæ viæ. Some gentlemen exhibited emetics; but in general there was
no time for this. The general practice at last was, to begin by giving
a purge of calomel, and the general remark was, that, if it operated
briskly, the head was relieved and the skin became soft.
The second indication most generally agreed upon, was the inducing
ptyalism and perspiration. As offering the fairest prospect of effecting
both at once, Mr Price proposed using the warm nitric-acid bath, but
unfortunately our stock of nitric-acid was insufficient to do this,
otherwise than on a small scale. Mr Price got a little of the acid at El
Hammed; but, from circumstances there, he could not always have the warm
bath; however, he writes, “On three of my patients, whose gums I could
not readily affect with mercury, I determined to try the nitric-acid
bath: it has shewn wonderful effects, ptyalism has been produced in all
the three; but the cold has regularly induced rigors and severe attacks
of fever, and I shall loose my patients.”
Nitric acid was given internally; and, where the patients would drink
it, it shewed good effects. Mr O’Farrel, at Aboukir, succeeded in making
three dragoons take it much diluted as their common drink; and they did
well all of them.
Mr Price thought well of citric acid. In some of the Arabs he effected
cures by this, and by a bath of strong vinegar.
Both Mr Rice and Mr Price were in the habit of washing their patients
with vinegar and sponging them with it, as strong as it could be
procured, or with lime-juice. They dipped rags in the acids, and kept
them constantly applied to the buboes. The head and stomach were relieved
by wet cloths being kept to the scrotum.
The third indication was, to obviate the debility which appeared always
to be very great. With this view, bark, wine, and opium, were very
largely given; and, at a certain stage, the cold bath.
At first, calomel was used only as a purgative, but, at last, the use
of this remedy was carried farther. The reports were, “that, upon the
mouth becoming sore, the skin became softer, the pulse more regular,
the eye more clear, the tongue more moist, and that the thirst with
the affection of the head and of the abdomen entirely disappeared. The
evacuations too were copious, and approached more nearly to their natural
colour.” Mr Price writes, “So much am I persuaded, that in the modes
of oxygenation, I am in possession of an infallible remedy, that now I
purposely expose myself.” Where he succeeded in affecting the gums, Mr
Thomas lost none of his patients, and Mr Price in a late letter says,
“Calomel affected the gums of all my patients who survived.” It was a
general remark, that the gums were remarkably obstinate and insensible
to the effects of mercury in this disease. Mr Grisdale writes, “in two
of the cases, I for five days pushed calomel and mercurial ointment to a
very great length, but never could succeed in affecting the gums.” Both
these patients, in a subsequent letter, he reports to have died. Here a
particular fact deserves to be noticed: one of the medical gentlemen, who
went on duty into the pest-house, and escaped the disease, on account
of an old venereal complaint, used mercury and nitric acid very freely
during the two months of his tour of duty, and he was one of the six who
escaped the infection. On the whole, in mercury and the nitric acid, we
appear to have excellent remedies for the plague: but they must be very
early and very liberally exhibited. If the first stage is allowed to pass
over before they are given, the season of doing it with advantage is in
danger of being lost. When the stomach becomes irritable, I suspect that
they never can be given with propriety. Perhaps, of all the cases which
occurred in the army, this treatment never got a fair chance of success,
excepting in those which occurred on the first breaking out of the
disease in the hospital of the 88th regiment, in Mr Thomas’s case, and in
that of Corporal Francis.
I regret, that, in this disease, we did not give a full and more fair
trial to cold bathing. The extraordinary circumstance of the escape of
the Lascar from the Rosetta pest-house, and the great benefit which I
have seen from it in the yellow-fever, to which the plague bears no
slight resemblance, would induce me to give it a full trial in plague.
I have, I believe, recounted the principal part of the treatment, and
that which was most generally agreed upon. Other modes received a trial;
but, from an experience of their inefficacy they were all deserted.
Dr Whyte used the lancet very freely, but every one of his patients died;
Dr Buchan was in the habit occasionally of having recourse to it; and,
in the first season, he said, that he had met with several cases where
bleeding was of the greatest service. In the beginning of the season, Mr
Price bled one patient. The blood appeared very dark, and dissolved: this
patient died, and Mr Price never repeated the operation on any other.
Some gentlemen, attached to the Brunonian system, put the stimulating
plan to the test. By Messieurs Adrian and Whyte, patients were for some
time kept under the influence of wine and opium; but, this practice was
never successful and they deserted it. It was at length the practice of
Mr Adrian to unite stimulants and mercurials.
Seldom before, I believe, have the bodies of those who died of this
disease been dissected. The first was a Sepoy, by Mr Price alone; the
second by Messieurs Price and Rice; and, in the last subject, viz.
Signior Posetti, the Italian merchant, so severely affected were both
of these gentlemen, that it put a stop to this mode of investigation.
The general appearances seen on the subjects, were, a perfectly-diseased
state of the glandular system. In the liver, no matter was found; but,
it was much enlarged and greatly diseased. Signior Posetti had only one
bubo; the femoral gland was sixteen times the natural size and weight;
and the blood, from the femoral artery, flowed black, pitchy, and
dissolved in its texture. I come now to the last, and most pleasing part
of the subject, the means of
_The prevention._ If, in the treatment of the disease, we were not
successful, we assuredly were completely so in the prevention. At length,
this became so generally known, that we no longer heard the distressing
accounts of despondence and despair among the natives. They now no longer
entertained such a dread of the pest-houses. We at length even found
volunteers from the natives for duty in the pest-houses.
There was hardly a corps, or an hospital in the army, where, at one
period or other, the disease did not make its appearance, but it was
always in our power to arrest its progress. In well regulated corps,
where a rigid discipline was enforced, and proper attention to the
interior economy was paid, it rarely happened, indeed, that much
difficulty was experienced in eradicating the contagion.
As our success in the prevention was so great, all that remains for me
is to mention the substance of General Baird’s order to the army on this
subject.
1st, To every hospital, an observation-room, or in lieu of it a tent was
attached, and to it, every case whatever with febrile symptoms was sent,
as soon as discovered, and was there most strictly watched by the surgeon.
2dly, On any symptoms of the plague appearing, the case was instantly
sent to the pest-house from the observation-room of the regimental
hospital: the patient was accompanied by the medical gentlemen of
his corps who attended him, and who gave the medical gentlemen at the
pest-house an account of the previous treatment of the case.
If any doubt remained, the patient in the first instance was placed in
the observation-room of the pest-house; and, if the disease did not turn
out to be plague, he was sent to the quarantine.
3dly, In every corps, and in every department, a minute inspection by
the surgeon was made twice a week; and every person with the smallest
appearance of ill-health was sent to the hospital.
4thly, Every corps or hospital, where a case of plague had appeared,
was put into a state of quarantine; and, in such corps or hospital,
an inspection by the surgeons was made at least two or three times
a day; and every case with suspicious symptoms was ordered to the
observation-room.
5thly, In suspected corps, it was ordered, that, under the inspection of
a commissioned officer, every person should be bathed more frequently,
and at stated periods; and, likewise, that all their clothing and bedding
should be frequently washed and baked. To all the hospitals, ovens and
smoking-rooms were attached.
6thly, Quarters of corps, hospitals, and ground of encampments, were
frequently changed.
7thly, Much is to be attributed to the nitrous fumigation. In several
instances it was attended with the best effects. The lamps, with this,
were kept constantly burning in the observation-rooms, and in the rooms
from which the cases of the plague had come. Vessels, with the materials
for the fumigation, were likewise placed under the beds, and in the
corners of the rooms. When our stock of nitric was at length exhausted,
we substituted marine salt for it; but this fumigation could not be kept
up in rooms were the patients were all confined to their beds.
OF THE OPHTHALMIA OF EGYPT.
The other endemic, and next to the plague in importance, is the
ophthalmia of Egypt; which, though a less fatal, is a more distressing,
malady.
In Egypt, at particular seasons, it is a most generally-prevailing
disease. It is not confined to the human race; the animals of the
country, particularly the dogs and camels, are subject to its attacks.
Travellers (and, if I remember, Volney is one) describe the same disease
as prevailing in Syria; and, I am informed, by my friend Dr Short, that,
in Persia, ophthalmia is a most frequent and severe disease.
In Egypt this disease proved most distressing and obstinate. The French,
it was said, sent from Egypt to France 1000 blind men.
The number sent home from the English army was very considerable
likewise. Of the Indian army, 50 were sent home invalids from blindness;
most of whom were from the 10th and 88th regiments.
Ophthalmia prevailed most in the 61st regiment; after them, in the 86th
regiment: while the 8th dragoons, the artillery, and the 80th regiment,
had very little of the disease.
It was remarked, at all times, that the disease was seen much less
frequently, and with less violence, in the native Indian, than in the
European, corps. Of the former, the 1st Bombay regiment had much more
ophthalmia than any other corps of natives. It was said, that, in the
English army, the disease prevailed most in the dragoon-regiments. The
26th dragoons was mentioned as a particular instance of this: that corps
alone, I heard, sent home about 40 invalids from ophthalmia.
Several gentlemen thought that this disease, in Egypt, was contagious.[6]
So singular an opinion I would hesitate to offer on slender grounds.
However, the remarkable prevalence of the disease in particular
regiments, and even in particular companies of regiments, while the same
general causes prevailed every where, will not be easily accounted for,
without admitting something of the kind. In some corps of the army from
England, as well as that from India, this was observed. In the 54th
regiment, my friend, Mr Ross, then the surgeon of it, informed me that
the disease was for some time not only confined to particular companies,
but to particular tents. It deserves mention, too, that, till the
arrival of the Indian army at Ghiza, ophthalmia did not appear in the
army. We found at Ghiza the 89th regiment and an ophthalmia-hospital of
the English army.
I believe that several diseases are contagious, which are not suspected
to arise from such a cause: the theory of contagion is but very
imperfectly understood.
It was said, that the sailors, on-board the fleet at Aboukir-bay, had the
disease at the same time that it prevailed in the army on-shore. Several
cases appeared among the troops after we sailed from Suez.
Ophthalmia prevailed most from May to December. At Kossier the disease
was hardly seen, nor at Ghenné. It was not till the army was encamped
at Rhoda, in August, that cases crowded in on us. In that, and the two
following months, most of the cases made their appearance.
It will be seen, in part the first of these sketches, that, in the months
of January, February, March, and April, very few cases appear in the
reports.
About the middle of May the disease began to appear in Alexandria.
Some of our medical gentlemen thought this disease very different from
the ophthalmia which they had seen in Europe or in India. In several
circumstances there certainly was a difference, and we were obliged
to have recourse to a different mode of treatment, finding we did not
succeed with that pursued in England or in India. The disease, I think,
might generally be resolved into, 1st, either of Cullen’s two species,
the ophthalmia tarsi and the ophthalmia membranarum; 2ndly, to a
combination of these two; or, 3dly, to a species of ophthalmia, frequent
in India, symptomatic of disease in the biliary secretion.
The appearance which the disease put on, particularly the two first
species of it, was nearly what we have seen in other parts of the world;
except that the symptoms advanced with alarming rapidity to the highest
inflammatory stages. In most cases the attack was sudden, and very
generally at night. Speedily, the patient complained of a burning heat
of the eye-ball, or of a sensation of needles being passed through the
eye. There was a considerable swelling of the ball of the eye, of the
eye-lids, and sometimes of the neighbouring parts. Almost always, there
was a copious flow of tears, which felt hot and scalding, and, as they
flowed down, excoriated the face. Very frequently, there was a racking
headach and general fever. Œdema of the eye-lids was frequently met with
in the early stage of the disease, and inversion of the cilia in the last
stages.
The disease very often continued two or three months: after it had
continued some time, the general health became much impaired. It often
terminated in diarrhœa or dysentery, and sometimes the patient became
hectic.
In the third species of the disease, which I have mentioned, there was
not so much active inflammation as in the other two species; and it was
generally known by a yellow tinge of the adnata, or by dyspeptic symptoms
being present; though, sometimes, we have seen those appearances absent:
and no topical application had any effect in removing the ophthalmia,
till the gums were affected by calomel or some mercurial preparation.
In the two first species of the disease, the inflammation, in a great
many instances, induced fever of many days duration, and the disease too
frequently terminated in opacity of the cornea or in suppuration of the
eye-ball.
In the treatment, it appears, from the reports, that different gentlemen
followed very different modes. We said, in general, that the European
practice did not succeed. Scarification and astringent collyria, in the
first stage, gave intolerable pain, and generally aggravated the symptoms.
The practice of the natives, was, to apply, in the first stage, emollient
decoctions of their plants, and poultices of the kali. In the last
stage, they rely much on the frequently bathing of the eye in the cold
water of the Nile: they are likewise very fond of bleeding; and I
understood that sometimes they use the actual cautery, burning behind the
ear where we usually apply blisters.
The practice, which appeared to be by far the most successful, was the
following:
For the first twenty-four or thirty-six hours after admission, the eyes
of every patient were carefully syringed with tepid water, which had been
filtered carefully. The syringing was performed from three to six times
in the day; the light was carefully excluded, the patient kept cool, and
every other part of the anti-phlogistic regimen strictly enforced. After
the above period, a weak solution of sugar of lead, or of camphor, or
vitrolated zinc, was applied. Where the pain was much complained of, a
solution of opium was added to the collyrium; opium was applied in a
cataplasm, or two or three drops of laudanum were let fall into the eye.
If there was much swelling, a saturnine poultice, or the coagulum
alluminosum, was applied to the eyes. I observed, that blistering a
large surface, and as near as possible to the seat of the pain, if kept
discharging for some time, always afforded great relief.
To remove the fever and to alleviate the distressing pain, we often gave
opium internally in a considerable quantity, and with great advantage.
Setons in the neck and the free use of bark appeared to be of the
greatest service, when the disease was of long standing.
In opacity of the cornea, and when there were specks, several gentlemen
thought highly of the aqua phagedænica of the old pharmacopeias, after
having divided the vessels which went to the speck. It gave very pungent
pain; but I have seen great relief from it, and also from a solution of
lunar caustic.
As a collyrium in Egypt, I often gave with considerable benefit what I
found in the hands of the black doctors in India, viz. a tea spoonful of
lime-juice to four table spoonfuls of water, or a tea spoonful of arrack
to two table spoonfuls of water. In the first stage, I would have applied
leeches, but never could procure them.
In Persia, Dr Short, informs me, that he was very successful in the
general use of an ointment, composed of white vitriol, tuttey, and
cinnabar, after the application of leeches and scarification.
From the days of Prosper Alpinus, the salts contained in the soil
of Egypt have been supposed to be among the principal causes of the
ophthalmia of the country. Though the various modifications of light
and heat no doubt act as existing causes; yet to the particular soil of
Egypt, and to the constitution of the air there, we must look for the
regular and the principal causes of this disease.
In Egypt several causes occurred, which in any country, separately
applied, would be adequate to the production of violent ophthalmia. The
dry, white, dazzling, soil, and the fine sand and dust constantly thrown
about in whirlwinds and entering every crevice. If an ophthalmia is
epidemical or is endemic in Egypt, the above causes will render it a very
violent disease.
But I conceive, that, of themselves and alone, these circumstances do
not produce the violent ophthalmia seen in Egypt. In no place did these
circumstances exist in greater force than at Kossier, on the march across
the Great Desert, and at Ghenné. Yet, till our arrival at Ghiza, the
disease did not appear. These circumstances likewise exist in great force
in most places of India, where the ophthalmia occasionally occurs from
them, yet it is different from the two first species of the Egyptian
ophthalmia.
For the production of the third species of this disease, the same causes
will account, which produce dysentery, hepatitis, and other diseases of
the liver. In Egypt, I remarked, that most of the cases of this species
occurred at the time that dysentery prevailed the most.
It should be mentioned, that, in Egypt, the natives are universally
impressed with the idea, that sleeping in the night-air brings on the
disease.
In the ophthalmia of Egypt, as in the plague, it would appear, that very
much may be done in the prevention.
It could not escape observation, how rarely officers were the subjects
of this disease. In accounting for this, I lay most stress on the
attention which officers pay to cleanliness. In the 88th regiment, where,
I believe, forty men did not escape an attack, only two officers out of
thirty had ophthalmia.
In the whole of the Indian army, only one officer lost an eye by it, and
this was Ensign Paton, of the 86th regiment.
The exemption of the officers from the ophthalmia gives more weight to
the opinion, that in Egypt this disease is communicated by contagion.
Mr Paton, previously to embracing the military profession, had studied
medicine; and, when medical assistance was much wanted, and a great many
of his corps were laid up with the ophthalmia, he very humanely offered
to attend them. When employed in this duty, he was himself attacked with
the disease and suffered most severely by it for many months.
Mr Bellars, about this time, joined the 86th regiment at Ghiza; he took
charge of the sick, and was attacked in the same manner as Mr Paton had
been, and he likewise suffered most severely by it for several months.
Dr Whyte, who fell a martyr to his zeal in the investigation of the
history of the plague, from a residence of some years in the Levant and
some time in Egypt, had good opportunities of being acquainted with the
diseases of that country, informed me, that, by making those under his
charge, frequently during the day, wash the eyes with cold water in the
season of the ophthalmia, he never failed in preventing the disease.
He instanced particularly the sailors of the transports, of about one
thousand of whom he had the medical charge. The captains of the different
transports carried Dr Whyte’s preventive instructions into execution;
and, though the disease raged both in the army and the navy, few of
the sailors of the transports had it. By an attention to this mode of
prevention, and in the season when the ophthalmia prevails most, making
the soldiers wear something over the eyes, I think we should have the
prospect of passing a second campaign, or season in Egypt, with less loss
from ophthalmia.
GENERAL REMARKS ON THE DISEASES.
I have dwelt a considerable time on the two endemics, the plague and
ophthalmia, the only diseases which we found peculiar to Egypt; and there
do not many more diseases remain to detain us.
We come next to a class including several diseases, and which are usually
described separately: but, I am at a loss how to disunite them, as they
occur all of them in India, and as they have for the most part appeared
in the Indian army in Egypt. The diseases are fever, hepatitis, and
dysentery; and, as I have for the most part seen them, there exists
among them a most intimate and natural connection. For a long time, the
same causes appeared indifferently to produce them: there was a frequent
transmutation of these diseases one into another, and in the three
diseases we succeeded by a similar treatment. In offering a few remarks,
however, I will preserve a distinction, and speak of these diseases
separately. Before entering on them I may remark, that the effects of the
solo-lunar influence, so remarkable in fever hepatitis and dysentery in
India, were in Egypt likewise very observable. In the treatment of these
diseases the practitioner found his account in attending to the periods
of the moon; at the full and the change, paroxysms would frequently
supervene, if not anticipated; and, at these periods, convalescents would
frequently suffer a relapse.
OF FEVER.
The fever which we had in Egypt, at different stations and in different
seasons of the year, assumed various types. That which, on the outset,
prevailed among the Bombay Sepoys, was remittent. At Ghenné, the fever
in the 10th regiment was continued; but it very often terminated in
hepatitis. At Ghiza, we have said that we suspected contagion as the
cause, at first; but, in the end, the disease was clearly kept up by
marshy effluvia on Rhoda Island. It assumed a remittent, and sometimes an
intermittent, form, when brought down to Rosetta; and many of the cases
terminated in dysentery. At El Hammed, a majority of the fevers which
occurred were intermittents; but several remittents occurred, and a few
cases which had some resemblance to typhus. After October, fever was
a disease of rare occurrence. In the last general return for November,
fifty cases appear, of which thirty-four were natives of India. The last
return in December is much the same, the native corps having a majority
of the cases.
In the last return of January there appear, of continued fever,
twenty-two cases; twelve of whom were Europeans. Of intermittents there
were thirty-two cases, and sixteen of them were Europeans. In the general
report of the 26th of February the total of fever in the army is only
twenty-three, and of them, only six are natives. On the 26th of April, we
had only fourteen cases, of which three were natives. In May, fever did
not appear in the reports.
Though fever, as it appeared in the Indian army in Egypt, at different
periods, occurred with some variation; and though particular symptoms
called for occasional variation in the treatment; yet, in its general
character, the disease was the same, the proximate cause appeared to be
the same, and the same general indication was required to be kept in view
in the cure. I am inclined to believe, that, under different names, the
same fever prevails over the peninsula of India, and over the eastern
islands; and, perhaps, I might venture to extend the remark to the
countries between the tropics. This fever has been often well described,
under the name of the remittent fever of Bengal. Dr Lind, of Windsor,
several years ago, gave an excellent and concise account of it in his
Thesis. In Bengal, it is known under the name of the pucca fever. In
Madras and on the Coromandel coast, it is the jungle fever. At Bombay and
on the Malabar coast, it is known under the same name. In the army in the
Guzzerat country, to the northward of Bombay, it is this fever which has
proved so destructive of late to our army in the field there, opposed to
the Mahrattas. In the island of Salsette, near Bombay, it pays an annual
visit, on the ceasing of the monsoon, and proves very destructive. In
1801, on one estate, in Salsette, upwards of forty people were attacked
with this fever in one night. I have learned from my ingenious friend Mr
Christie, surgeon-general of Ceylon, that it was from the same fever,
that the 19th, 51st, and 80th regiments, have been so very much reduced;
and that it was this fever which proved so destructive in the late war
with the king of Candy. Mr Christie writes me, that in its destructive
malignancy and ravages, particularly on the Europeans in Ceylon, it has
equalled the yellow fever of the West Indies.
From many accounts of it, which I received while in India, I am
convinced, that the dreadful fever which prevails in Batavia is the
same disease. In Batavia, the mortality from this fever is prodigious;
it is not exceeded by that from the plague in Egypt, or from the yellow
fever in America. Different circumstances, it would appear, concur to
the production of the disease, in a very aggravated form, in the Dutch
settlement of Batavia; of which, we may mention the extreme unhealthiness
of the situation, and the bad practice of the Dutch surgeons.
Dr Griffith, surgeon to the naval hospitals in India, informed me, that,
when our fleet lay off Batavia, in 1801, it prevailed very much; but
that, when they got the management of patients early, they were generally
successful in the treatment of the disease. Bencoolen is one of the most
unhealthy of our eastern settlements, solely from the prevalence of this
fever. In China, it appears likewise to be a frequent and fatal disease.
Having said thus much on the identity of the fever which appeared in
Egypt, with that which is seen in India, and in the eastern islands, I
shall proceed to the treatment. The first step was to cleanse the primæ
viæ, and some gave emetics: this, however, was not always necessary;
and purging with calomel, and the neutral salts, appeared in most
cases to answer the same intention. In the first stage, likewise, as
particular symptoms called for them, venæsection was performed, blisters
were applied, we determined to the skin, or gave opiates. However, if
the fever was of any duration, the practice always was, to endeavour
to affect the mouth as speedily as possible with mercury. This was the
practice in continued fever, and in Egypt, as in India, we were very
generally successful, if application was early made. In the destructive
fever of Ceylon, Mr Christie says, that he has practised but with a
moderate share of success: but that the affecting the system by mercury
is by far the most successful of different modes of treatment which he
had tried. He gave nitric-acid, but in a very small quantity. In the
fleet, when stationed near Batavia, Dr Griffiths gave mercury more
liberally than any practitioner I know. He likewise used the nitric-acid
very freely, both externally and internally, and relied much on its
combined use with mercury. By two very able practitioners, Dr Keir and Mr
Stewart, the Salsette fever has been successfully treated by nitric-acid
alone; purgatives having been previously exhibited. Some practitioners
treated intermittents by bark, some by opium, or by giving this and
the volatile alkali. It has sometimes occurred to myself, and I have
frequently had reports from our surgeons, that agues continued obstinate
till the gums could be affected by mercury.
From a very intelligent officer I had a detail, regarding the Batavia
fever, so remarkable, that I shall here insert it. This gentleman is
the captain of a ship in India, who, in different voyages which he had
made to Batavia, had constantly lost great numbers of his ship’s crews.
In his last voyage, when in a certain latitude, and as he approached
Batavia, he gave daily to each of his men a few grains of the mass of the
blue pill. By the time of his arrival at Batavia, he had thus very gently
affected every one of their mouths; and, in that voyage, he lost not a
man. Would mercury thus exhibited, as a preventive, be useful in the
plague, or in the yellow fever?
Before dismissing the subject of fever I may observe that no well-marked
case of typhus occurred to us in Egypt. In India we never saw a case of
this species of fever. To the existence of this fever, which in Europe
has committed such havoc in our fleets and armies, the climate of India
is inimical. We know instances where, in transports, typhus had broke
out, and, on the passage to the Cape of Good Hope or India, had proved
little less destructive than the plague could have done; but the disease
never reached India. If a case was landed there, it never propagated the
contagion: a second case never appeared on shore. On inquiry, I found
that no case had ever been known on the western side of the peninsula,
nor have I ever heard of its existence in the eastern.
HEPATITIS, OR THE LIVER COMPLAINT.
In India I have often had occasion to remark, that the acute hepatitis,
of Cullen, was a disease of rare occurrence. The disease which comes
before us most frequently, in India, is his chronic species; and in that,
most frequently, there is neither pyrexia nor the “decubitus in latus
sinistrum difficilis,” which, from having included in the definition of
both of his species, I suppose the illustrious and accurate professor was
induced to believe was a constant symptom in this disease. In very few of
his definitions is there room for alteration; and I hope, for venturing
here to suggest one, that I shall not incur the charge of presumption.
But hepatitis was a disease, for accounts of which the accurate
nosologist must have trusted to other sources than his own observation.
It should be known, that very often we meet with this disease, when few
of the symptoms of his definition are found. In India I have learned from
some of the oldest practitioners, and from some gentlemen of abilities,
the most respectable in the profession, that very commonly hepatitis is
met with when all the symptoms of Cullen’s definition are wanting. In
that country, when any of the abdominal viscera are complained of, we may
in general suspect some error in the hepatic system.
In India, the liver seems to be the seat of disease in nearly the same
proportion that the lungs are in England.
In Upper Egypt, and at Ghiza, we had many cases of hepatitis: it was the
same disease that we had seen in India. At Rosetta and Alexandria a few
cases did occur, accurately answering to Cullen’s definition of the acute
species. Sergeant Levi, of the 88th regiment, was one instance. On the
13th of October, he was admitted into the hospital with this disease in
a most violent degree. He had been ill only twenty-four hours: he had
high inflammatory fever; his side was extremely tender to the touch;
he had great irritability of stomach, and pain over the belly. He was
twice bled: the anti-phlogistic regimen was for thirty-six hours applied
in its utmost rigour: thereafter mercury was liberally thrown in, and
he recovered. We remarked that many, who, in India, were the frequent
subjects of repeated attacks of hepatitis, at length never complained,
or they had the disease in the mildest shape, in Egypt. After the month
of October, hepatitis was a disease of still more rare occurrence. In no
corps did the number of cases bear any proportion to what they were wont
to be in India.
During October a considerable number of cases occurred, but almost all of
them were Europeans: the proportion of the natives who had this disease
was always very small.
About the beginning of November several fresh cases occurred, and all of
them were acute.
By the end of December this disease was fast disappearing in the army. In
the last return of the month there were only twenty-one cases, and twenty
of them were Europeans.
In January it still continued to decline. In the return of the 31st of
this month there appear only nine cases, and all of them are Europeans.
In the first return of February there are only five cases, and all of
them are Europeans.
There was an increase in March. In the first return of the month there
were twelve cases, and all were Europeans.
In the last return of April the total number was so low as six, of which
number four were Europeans.
At the time of embarkation, at Suez, there was not one case reported in
the army.