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                                  AN
                                ACCOUNT
                                OF THE
                               DISEASES

                    Which were most frequent in the

                      BRITISH MILITARY HOSPITALS

                              in Germany,

             From January 1761 to the Return of the Troops
                       to England in March 1763.

                          To which is added,

            An ESSAY on the Means of Preserving the Health
            of Soldiers, and conducting Military Hospitals.


                         By DONALD MONRO, M.D.

                PHYSICIAN to his MAJESTY'S ARMY, and to
                        ST. GEORGE's Hospital.


                                LONDON:

           Printed for A. MILLAR, D. WILSON, and T. DURHAM,
            in the Strand; and T. PAYNE, at the Mews-Gate.

                               MDCCLXIV.




TO THE KING.


May it please Your MAJESTY,

To permit me to lay at your Feet the following Sheets, published with
a View to be useful to those, who hereafter may have the Care of the
Health of your MAJESTY's Troops.

YOUR MAJESTY's particular Inquiries into the State of Your Military
Hospitals, in every Quarter of the World, in the Time of the late
glorious and successful War; Your Concern for every Officer and
Soldier who suffered either by Sickness or by Wounds in the Cause of
their King and Country; and Your Solicitude to procure them every
possible Assistance and Relief, cannot fail to excite the highest
Admiration of Your MAJESTY's Goodness in the Breast of every Subject,
and the warmest Gratitude in the Heart of every Soldier.

The Knowledge of these Circumstances induced me to flatter myself,
that a Work of this Kind would be agreeable to Your MAJESTY; and
should this Attempt towards pointing out the Means of alleviating
those Miseries, which necessarily attend a Military Life in the Time
of Service, be acceptable, I shall obtain the utmost of my Wishes; it
being the greatest Ambition of my Heart ever so to act as to merit
Your MAJESTY's Approbation, and to subscribe myself,

      May it please Your MAJESTY,

    Your MAJESTY's most dutiful Subject,

        And most faithful

          and humble Servant,

      DONALD MONRO.




THE PREFACE.

Among the numerous Authors of Observations in the Art of Physick,
there are but few who have expressly written on the Treatment of those
Distempers, most generally incident to an Army in the Field: The
following Work, therefore, seems to have a fair Claim to be acceptable
to the Publick, having been compiled during the Author's Attendance on
the _British_ Military Hospitals in _Germany_ in the late War; and in
order to render it of still further Use, he has occasionally added, by
Way of Note, the Practice of some of the most eminent Physicians in
similar Diseases, as well as a few Histories of Cases which passed
under his own Care at _St. George_'s Hospital, _London_.

To avoid the Repetition of the Composition of particular Medicines,
and the Interruption that would be given by their being inserted in
the Body of the Work, a small Pharmacopoeia is added, to which his
Practice in the Army Hospitals was chiefly confined.

In a commercial Country like our own, where Numbers of Hands are
constantly wanted for the carrying on our Manufactories, we have a
strong political Argument to add to that drawn from the Dictates of
Humanity, why the Life of every individual should be most carefully
attended to.

The Preservation of the Lives of Soldiers is then with us a Matter of
the highest Importance, in order to make as low as possible the Number
of Recruits who must be perpetually drawn off for the Service of War.
The Author has, therefore, in this Treatise, endeavoured to point out
the Means most likely to keep Men healthy when employed in different
Services; and also the Manner in which Military Hospitals ought to be
fitted up, and conducted.--As he was never in any of the warm
Climates, nor ever at Sea along with Troops aboard of Transports,
whatever is mentioned relative to such Situations, is to be understood
as taken from printed Accounts of these Subjects, or collected from
the Conversation of physical Gentlemen, who were employed on such
Services during the two last Wars.

It is but Justice here to observe, that the Marquis of _Granby_,
Commander in Chief of the _British_ Troops in _Germany_, as well as
the Rest of the General Officers employed on the _German_ Service,
always paid the greatest Attention to the Soldiers when sick in
Hospitals; and were particularly ready in giving Orders for all such
Things as were necessary or proper for them.

  JERMYN-STREET,
    April 15, 1764.




CONTENTS.

                                                                      PAGE.

Of the Malignant and Petechial Fever,                                    1

Of the Dysentery,                                                       57

Of the Cholera Morbus,                                                  97

Of the Inflammatory Fever,                                             104

Of the Angina,                                                         109

Of the Pleurisy,                                                       111

Of the Peripneumony,                                                   115

Of the Cough and Consumption,                                          124

Of the Epidemical Catarrhal Fever of _April_ 1762,                     137

Of the Rheumatism,                                                     141

Of the Autumnal Remitting Fever,                                       154

Of the Intermitting Fever, or Ague,                                    179

Of the Jaundice,                                                       206

Of Tumours of the Breast,                                              216

Of Paralytic Complaints,                                               219

Of an Incontinency of Urine,                                           223

Of a Stoppage of Urine,                                                227

Of the Epilepsy,                                                       237

Of the Small-Pox,                                                      243

Of Erisypilatous Swellings,                                            245

Of the Scurvy,                                                         250

Of the Itch,                                                           265

Table of Diet used in the _British_ Military Hospitals in _Germany_,   273


PHARMACOPOEIA in usum Nosocomii militaris regii Britannici 1761,       275


OF THE MEANS of Preserving the Health of Soldiers on Service,          309

---- in Winter, and in cold Climates,                                  313

---- aboard of Transport Ships,                                        323

---- in warm Climates,                                                 331

Of healthful and unhealthful Grounds for the Encampment of Troops,     338

Of keeping Camps clean,                                                344

Of supplying an Army with Straw and with Provisions, and obliging
  the Soldiers to buy a certain Quantity of Meat daily,                346

Of Water, and the Means of correcting its bad Qualities in Camps,      348

Of vinous and spirituous Liquors,                                      350

Of keeping Men healthful in Quarters after an active Campaign,         354


Of MILITARY HOSPITALS,                                                 355

Of the Manner in which the Antients disposed of their Sick
  and Wounded,                                                         356

Of the Hospitals wanted for an Army acting on a Continent,             357

Of the Houses most fit for Hospitals,                                  361

Of fitting them up, and distributing the Sick in them,                 363

Of preventing infectious Disorders from being generated or
  spreading among the Sick,                                            366

Of the Diet of Military Hospitals,                                     372

Of providing the Flying Hospital,                                      380

Of Hospitals on Expedition Service,                                    380

Of a Guard for Hospitals,                                              382

Of the Nurses and Patients, and Orders for them,                       383

Of a convalescent Hospital,                                            389

Of the Physicians, Surgeons, Apothecaries, and Mates,                  393

Of the Direction of Military Hospitals,                                394

Of the Purveyor or Commissary of the Hospital,                         396

Orders for the Mates,                                                  397

Of Precautions for guarding against infectious Disorders,              400

Of a Military Inspector and Officers on convalescent Duty,             403


ERRATA CORRIGENDA.

Page 13, line 11, for _Pleuretic_, read _Pleuritic_.

     18,      10, of Notes, for _Acadamy_, read _Academy_.

     28,      22, for _Cinamon_, read _Cinnamon_.

     35,       5, of Notes, for _Calomile_, read _Calomel_.

     51,      12, dele _used in this Way_.

    166,      12, of Notes, for _which almost depend_, read _which almost
                  always depend_.

    207,      13, of Notes, for _Vena postarum_, read _Vena portarum_.

    259,       4, for _appeared_, read _appear_.

    261,       1, of Notes, for _became_, read _become_.

    280,      20, for _Chamamel_, read _Chamaemel_.

    290,       4, for _3tis 4tiis_, read _3tiis 4tis_.

    293,      13, for _Mithridatum_, read _Mithridatium_.

    336,      12 & 13, for _bathe themselves as often_, read _bathe early
                       in the Morning as often_.

    352,       7, for _in Bilanders_, read _and were to go in Bilanders_.

    353,       2, for _the least Appearance of the Malignant Fever_, read
                  _the Malignant Fever appearing_.




OF THE MALIGNANT and PETECHIAL FEVER.


A Malignant Fever, and Fluxes, began to appear among the Soldiers in
Autumn, 1760, while the Allied Army remained encamped about
_Warbourg_, from the Beginning of _August_ till the 13th of
_December_, when they went into Cantonments. During that Time, there
had been a continued Rain for some Months, and the Camp and
neighbouring Fields, and Villages, were not only filled with the
Excrements of such a numerous Army, but likewise with infinite Numbers
of dead Horses, and other dead Animals, which had died in doing the
necessary military Duties, and in bringing Forage, Provisions, and
other Necessaries, to the Camp: besides this, the Field where there
had been an Action on the 31st of _July_, and where many of the Dead
were scarce covered with Earth, was in the Neighbourhood of the Camp.

Not only the Soldiers, but the Inhabitants of the Country, who were
reduced to the greatest Misery and Want, were infected with the
Malignant Fever, and whole Villages almost laid waste by it.

Such a Number of Soldiers was sent to _Paderborn_ as crowded the
Hospitals there, and increased the Malignancy of the Distempers so
that a great many died.

When I arrived at _Paderborn_, in the Beginning of _January_ 1761, the
Fever was upon the Decline in the General Hospitals, though it was
still rife; but by sending off a Party of Convalescents to
_Hervorden_, which thinned the Hospitals, it became less frequent, and
but few died. The Guards marched upon the Expedition into _Hesse_, on
the eleventh of _February_, which gave us full Room for billetting all
our Convalescents, and thinning the Wards; by which Means the Fever
almost entirely ceased in all the Hospitals we had before they went
away; though there still remained about four hundred sick.

When the Guards marched out of _Paderborn_, they left the Care of
their Sick to us, who belonged to the General Hospital: the first
Regiment of Guards left sixty sick; the second, twenty-nine; the
third, twenty-eight; and the Granadiers, fifteen, in their regimental
Infirmaries; who were mostly ill of the Malignant Fever: amongst whom
the Infection was so very strong, that, although I procured the Sick
new airy Houses for Hospitals, which were kept as clean and well-aired
as possible, and procured clean Bedding, and clean Linen for every
Man, and had the Sick laid thin, yet several died, and it was some
Time before we got entirely free of the Infection. The first and third
Regiments suffered most, owing to all the Sick of each Regiment being
put into a particular Hospital by themselves, which kept up the
Infection, so that they lost one-third of those left ill of this
Fever; and many of the Nurses, and People who attended them, were
seized with it. But not being able to procure particular Houses for
the Sick of the _Coldstream_ or Second Regiment, and for the
Granadiers, I distributed them through the different Hospitals we had
then in Town, where the Contagion had ceased; and by their being thus
scattered, while they were kept very clean, and at as great a Distance
as possible, from the other Patients in the Wards where they were put,
they lost few in Proportion to the first and third Regiments, and the
Disorder did not spread.

About the End of _May_, the Weather was very warm at _Osnabruck_; when
this Fever began to make its Appearance in the Corner of a large Ward,
which was next to one kept for salivating venereal Patients; and only
divided from it by means of a few thin Deals. Perceiving a strong
Smell in this Place, I suspected that the Fever arose from the foul
Steams coming from the next Ward, and therefore ordered the salivating
Ward to be thinned, and removed all the Sick from the Places near that
Ward; and ordered those that had catched the Fever to be put into
large airy Places; by which means the Infection spread no further,
and only one, out of six or seven who had got the Fever, died.

At the End of _June_, the Weather was very hot at _Bilifield_, and the
Fever began to shew itself by the Hospital being overcrowded, by a
greater Number of Sick being sent from the Army than we had proper
Places to put them in; but it was put a Stop to in a few Days, by the
Removal of the Hospital. Seventy Sick were left behind to the Care of
a Mate, most of them ill of the Fever, of whom twelve died.

In the Beginning of _August_, a few Men were taken ill of the same
Fever at _Munster_, in one of the Hospitals which was too much
crowded; but its further Progress was stopped by sending a Number of
recovered Men to Billet.

In _November_ and _December_ 1761, and _January_, _February_, and
_March_ 1762, we had several Men sent from Quarters in the Town of
_Bremen_ to the Hospital, sick of the Petechial Fever: they were
quartered on the Ground-floors of low damp Houses, and fresh Meat and
Vegetables so dear that they could not afford to buy them; but were
obliged to live mostly on salt Provisions. I was told likewise that
the spotted Fever was frequent among the lower Class of the
Inhabitants. Some few were seized with this Fever in the Hospital
itself; yet as the House was not crowded, and we had a Number of small
airy Wards, the Infection did not spread; and we had but one or two
who died of this Fever during the Winter, in the Hospital I attended.

In Summer 1762, we had only ten or eleven ill of this Fever in the
Hospital at _Natzungen_, and only one died.

When the Troops marched from their Cantonments, in _December_ 1762,
towards the Borders of _Holland_, the twentieth and twenty-fifth
Regiments of Foot left behind them, at _Osnabruck_, thirty sick; five
of whom had Symptoms of the Hospital Fever, though no Petechiae
appeared; three recovered, and two died suddenly, being lodged in
large open Wards (the only Places we had to put them in) with the
Windows all broke, in very cold frosty Weather.

In _January_ 1763, we had only three Patients in this Fever, with the
Petechiae upon them, who all recovered. After this we had none taken
ill of it at _Osnabruck_, while I remained there, which was till the
twenty-fifth of _March_.

This Malignant Fever begun variously in different Subjects; for the
most part with Cold and Shivering, Pain in the Head, and other
Symptoms, commonly described as peculiar to this Fever. In some, it
begun with a sharp Pain of the Side, or other Parts, attended with
acute inflammatory Symptoms; in others, it put on the Appearance of
the common, low, or nervous Fever, for a Day or two. Blood drawn in
the Beginning from some Patients did not seem much altered; from
others it threw up a strong inflammatory Buff[1]; but where the Fever
had continued some time, it was commonly of a loose Texture, and of a
livid Colour; unless when the Sick were accidentally seized with
pleuritic Stitches, or other Disorders of this kind.

    [1] Dr. _Huxham_, in his _Treatise on the ulcerous sore
    Throat_, p. 36, says, "I have very often met with this buffy
    or sizy Appearance of the Blood in the Beginning of Malignant
    Fevers; and yet, Blood drawn two or three Days afterwards,
    from the same Persons, hath been quite loose, dissolved, and
    sanious as it were." And in his _Essay on Fevers_, chap.
    viii. p. 108. says, "The first Blood frequently appears
    florid; what is drawn twenty four Hours after, is commonly
    livid, black, and too thin; a third quantity, livid,
    dissolved, and sanious. I have sometimes observed the Crasis
    of the Blood so broke as to deposite a black Powder, like
    Soot, at the Bottom, the superior Part being either a livid
    Gore, or a dark green, and exceedingly soft Jelly."

The Reason of this Difference of Symptoms in the Beginning, and of
these different Appearances of the Blood, seemed to be, that such
Patients as laboured under Pleurisies, low or other Fevers, being
brought into Hospitals where the Malignant Fever was frequent, had
their original Disorders changed into this Fever by breathing a foul
infected Air, and by their Communication with those ill of the Fever,
and of Fluxes; at other Times, a mere Acrimony of the Blood, set in
Motion by a supervening Fever, determined the Disorder to be of this
kind: and I always observed, that those Men were most apt to catch
this Fever, whose Constitutions had been broke down by previous
Disorders.

The Fever appeared in different Forms. Some had only a Quickness of
the Pulse, attended with a slight Head-ach and Sickness, Whiteness of
the Tongue and Thirst, and a Lowness and Languor; which continued for
a Week or more, and then went off, either insensibly, or with a
profuse Sweat, succeeded by a plentiful Sediment in the Urine. Most of
those who fell into profuse kindly-warm Sweats recovered, the Sweat
carrying off the Fever. These profuse Sweats continued for twelve or
twenty-four Hours, and sometimes for two, three, or four Days. In
those who had the Fever in this slight Degree, the Petechiae seldom
appeared; and it was only known to be this sort of Fever by the other
Symptoms, and the Malignant Fever being frequent at that time in the
Hospitals. Dr. _Pringle_[2] very justly observes, "That these low
Degrees of this Fever are hardly to be characterised, and are only to
be discovered, in full Hospitals, by observing Men languish; though
the Nature of the Illness, for which they come in, should seem to
admit of a speedier Cure."

    [2] _Observations on the Diseases of the Army_, part III.
    chap. vii. sect. 3. third Edition, 1761.

For the most Part the Fever appeared with more violent Symptoms, the
Tongue became more parched and dry, more or less of a Delirium came
on, attended with the other Symptoms commonly described as peculiar to
this Fever.

When the Petechiae appeared, they came out on the fourth, fifth, sixth,
or seventh Day; seldom after the eleventh or twelfth[3]. They appeared
mostly on the Breast, Back, Arms, and Legs, and sometimes, tho'
rarely, on the Face. They had exactly the Appearance described by Dr.
_Pringle_, either like small distinct Spots of a reddish Colour, or
the Skin looked sometimes as if it had been marbled, or variegated as
in the Measles, but of a Colour more dull and lured. As they began to
disappear, they inclined to a dun or brown Colour, and looked like so
many dirty Spots. I never saw them rise above the Skin; nor did I once
see any miliary Eruptions in this Fever; which agreed exactly with
what Dr. _Pringle_ had observed in the former War, and in the
Beginning of this; however, we ought not to conclude from thence that
miliary Eruptions are never observed in Fevers of this kind; for Dr.
_Huxham_[4], Dr. _Hasenohrl_[5] and Dr. _Lind_[6], besides many other
good Practitioners, mention their having seen them.

    [3] _Ramazini_, in his Treatise _De Constitutionibus
    annorum_, 1692, 3, 4, _in Mutinensi civitate_, Sect. 19.
    mentions the Petechial Fever which had been frequent the
    three foregoing Years; in which the Petechiae appeared
    commonly on the fourth or seventh Days, and almost all those
    died in whom they appeared on the first Day. These Spots came
    out first on the Neck, the Back and Breast; and it was
    observed that none escaped unless these Spots extended
    themselves as far as the Nails of the Toes, vanishing by
    Degrees on the upper Parts. He tells us likewise, that this
    Fever was attended with an Inflammation of the Throat, which,
    about the Height of this Disorder, terminated in a white
    ulcerous Crust. This sore Throat should seem to be the same
    which we now call _the malignant ulcerous sore Throat_, which
    I never once saw while I was with the Troops in _Germany_.

    [4] Dr. _Huxham_, in his _Essay on Fevers_, ch. viii. p. 97,
    tells us, that sometimes, about the eleventh or twelfth Day,
    on the coming on of profuse Sweats, the Petechiae disappear,
    and vast Quantities of small white miliary pustules break
    out.

    [5] Dr. _Hasenohrl_, in his Treatise _De Febre Petechiali_,
    cap. i. p. 12. relates a very particular Case, where the
    Petechiae appeared on the fourth, and the white miliary
    Eruptions on the seventeenth Day of the Fever.

    [6] Dr. _Lind_, in his _second Paper on Fevers_, p. 105.
    mentions Spots which rise above the Surface of the Skin, and
    are of the miliary kind, as common in contagious Fevers, as
    he observed among the _French_ Prisoners in _Winchester_
    Castle, in the Beginning of the Year 1761.

Many had no Petechiae through the whole Course of the Disorder; but in
all who were very bad, the Countenance looked bloated, and the Eyes
reddish and somewhat inflamed; and though the Skin was commonly dry,
yet the _Perspiration from the Lungs_ was strong. By these
Circumstances one might frequently discover that the Patient laboured
under the malignant Fever, without asking any Questions.

       *       *       *       *       *

When Men were taken ill of a Fever, which we suspected to be of the
malignant kind, our first Care was to lay them in airy Places,
separate as much as possible from the other Men, and to keep them
extremely clean; and they were put on low Diet, and allowed as much
Barley or Rice-water as they chose to drink, which was commonly
ordered to be acidulated with the _Spiritus Vitrioli_.

For the first two or three Days we could seldom distinguish, with
Certainty, that the Fever was of the malignant kind, though we had
often Reason to suspect it. The Pain of the Head, the Fulness and
Quickness of the Pulse, and other Symptoms, led us commonly to take
away more or less Blood, which the Patient bore easily, and for the
most part it gave Relief[7]. We seldom repeated this Evacuation where
we suspected the Fever to be of the malignant kind, unless a pleuritic
Stitch, an acute Pain of the Bowels, or some other accidental Symptom,
required it; or the Patient was strong, and there were evident
Symptoms of Fullness immediately before we intended giving the Bark,
as shall be mentioned afterwards; for under other Circumstances, if
the Blooding was repeated, and other Evacuations used freely, I always
observed that it did Harm, and was apt to sink the Patient too much;
as Dr. _Huxham_, Dr. _Pringle_, and other good Practitioners, have
remarked.

    [7] Dr. _Huxham_, tho' he says "yet Bleeding to some Degree
    is most commonly requisite, nay necessary, in the strong and
    plethoric;" yet he afterwards makes the following Remark:
    "Besides, the Pulse in these Cases sinks oftentimes
    surprisingly after a second Bleeding, nay sometimes after the
    first, and that even where I thought I had sufficient
    Indications from the Pulse to draw Blood a second time." See
    his _Essay on Fevers_, chap. viii. And Dr. _Pringle_
    observes, that in the second Stage of the Disorder large
    Bleedings have generally proved fatal, by sinking the Pulse,
    and bringing on a Delirium. _Observations on the Diseases of
    the Army_, part III. chap. vii. sect. V.

After Bleeding, if the Patient was costive, or complained of Gripes,
he had a Dose of Rhubarb, or Salts, or a laxative Clyster; but where
there was much Sickness of the Stomach, we gave a gentle Emetic[8] in
the Evening, and the Purge next Morning. And if in the Course of the
Disorder the Sickness and Nausea returned, attended with Griping and
Costiveness, or very fetid loose Stools, these Medicines were
repeated, and a gentle Opiate given in the Evening after their
Operation.

    [8] Dr. _Pringle_ advises giving a Vomit, by way of
    Prevention, on the first Appearance of the Symptoms, and at
    Night to force a Sweat, by giving a Drachm of Theriac with
    ten Grains _Sal volat. Corn. cervi_, and some Draughts of
    Vinegar-whey, and to repeat the same the following Night; and
    says, he has often seen those Symptoms removed which he
    apprehended to be Forerunners of this Fever received by
    Contagion; but previous to Vomits, or Sweats, if the Person
    be plethoric, it will be necessary to take away some Blood.
    _Observ._ part III. ch. vii. sect. 5. Dr. _Lind_, in his
    _second Paper on Fevers_, p. 66. says, "To all who are
    supposed to be infected by Fevers, during this Stage of
    Rigours, a gentle Vomit is immediately to be exhibited before
    the Fever be formed, and before the Fulness or Hardness of
    the Pulse renders its Operation dangerous. If the Vomit be
    delayed too long, and especially if Bleeding must precede it,
    the most certain and favourable Opportunity of procuring
    Safety for the Patient is past.--That he has found it equally
    serviceable in preventing Relapses, when it is given at the
    Return of the Shiverings." A loose Stool, or two, should be
    procured by the Emetic or Clysters, and he advises Sweating
    immediately after, in the manner recommended by Dr.
    _Pringle_. At other times "he gave five Grains of Camphire
    every four Hours, with large Draughts of Vinegar-whey. Eight
    Persons in ten, he says, got quite well by this Treatment."

    I have never had sufficient Opportunities of trying this
    Method of Prevention, to determine any thing certain about
    it; but it may be worth while to practise it.

After Evacuations, if the Pulse kept up, we commonly gave nothing but
the saline Draughts, with the _Pulvis contrayervae_, or some temperate
Medicine, for the first Day or two. As soon as we could distinguish
the Fever to be of the malignant kind, and that the Pulse rather sunk,
we joined some of the Cordials to the saline Medicines, and allowed
the Patient more or less Wine, according to the Degree of the Fever.
Dr. _De Haen_ has found Fault with Dr. _Pringle_ and Dr. _Huxham_, for
administering cordial Medicines and Wine in the low State of this
Fever; but nothing answered so well with us as these Remedies under
such Circumstances; and I have frequently seen every Symptom changed
for the better by their Use; and even when I gave the Bark, in the
Manner recommended by _De Haen_, I often found it necessary to join
the free Use of Wine[9], Cordials and Blisters[10], in order to
support the Patient's Strength.

    [9] _Petrus a Castro_, in his Account of a Petechial Fever,
    which was frequent at _Verona_, tells us, that the Sick had a
    great Thirst, and an Aversion to Meat, but all of them had
    the strongest Desire for Wine, and were perpetually asking
    for it, even those who at other Times used to be very
    temperate; and that this proceeded from an Instinct of
    Nature, which wanted something to support the Strength. _De
    Feb. Malig._ sect. iii. chap. 26. Dr. _Huxham_, in his _Essay
    on Fevers_, has the following very judicious Remark on the
    Use of Wine: "In this View, and in those above-mentioned, I
    cannot but recommend a generous red Wine as a most noble,
    natural sub-astringent Cordial, and perhaps Art can scarce
    supply a better. Of this I am confident, that sometimes at
    the State, and more frequently in the Decline of putrid
    Malignant Fevers, it is of the highest Service, especially
    when acidulated with Juice of _Seville_ Orange or Lemon. It
    may be also impregnated with some Aromatics, as Cinnamon,
    _Seville_ Orange Rhind, red Roses, or the like, as may be
    indicated, and a few Drops of _Elix. Vitrioli_ may be added.
    Rhenish and French White Wines, diluted, make a most salutary
    Drink in several Kinds of Fevers, and generous Cyder is
    little inferior to either. The _Asiatics_, and other Nations,
    where pestilential Disorders are much more rife than with us,
    lay more Stress on the Juice of Lemons in these Fevers than
    on the most celebrated _Alexipharmac._" Chap, viii. second
    Edit. p. 123, 4.

    Acid and acescent Liquors have very justly been recommended
    and used by most late Practitioners, in this as well as in
    other malignant Diseases. Vinegar-whey, Barley-water
    acidulated with Lemon-juice, and such other Liquors, make
    good Drinks for the Sick; but we were obliged, for the most
    part, to use the vitriolic Acid for acidulating the Patient's
    Drink, as it was the easiest procured and carried about with
    the Flying Hospital.

    [10] If the preventive Method does not succeed, Dr. _Lind_
    advises to have recourse to Blisters; and says, that sixteen
    out of twenty will next Morning be free of the Fever. But
    adds, this is said, provided the Source of their Infection be
    not so highly poisonous as it was in the Garland Ship, or in
    other such violent Contagions. Dr. _Pringle_ mentions his
    having applied Blisters early, but without relieving the
    Head, or preventing any of the usual Symptoms. I have often
    ordered Blisters pretty early in the Disorder; and though I
    have frequently found them of use in keeping up the Pulse,
    and relieving the Head, and other Symptoms, yet I never saw
    them have such an immediate Effect as Dr. _Lind_ mentions.

After reading the Treatises of Dr. _De Haen_ and Dr. _Hasenohrl_, on
this Fever, I resolved on giving the Bark[11] in large Quantities, and
found it to answer the Recommendations given by these Gentlemen; and
shall relate here two or three Cases, out of above a hundred and
fifty, in which I gave it.

    [11] It is long since the _Peruvian_ Bark has been used by
    Practitioners in Malignant Disorders, though I do not know
    that any body gave it in this Fever to the Amount of an Ounce
    per Day, before Dr. _Haen_ and Dr. _Hasenohrl_. Dr.
    _Ramazini_ mentions its having been tried in the Petechial
    Fever, in the Years 1692, 3, 4. And in a Treatise on the
    Plague in the _Ucrane_, published at _Petersburgh_, in the
    Year 1750, we are told, that in the _French_ Translation of
    the Philosophical Transactions for the Year 1732, there is a
    Note to p. 264, telling, that Mr. _Amyand_ informed the
    Academy of Surgery at _Paris_, that Mr. _Rushworth_, Surgeon,
    had wrote to Sir _Hans Sloane_, on the 23d of _May_ 1723,
    that when he was Surgeon to a Ship, in the Year 1694, he had
    cured some Men ill of the Malignant Fever, attended with
    pestilential Buboes, by means of the _Peruvian_ Bark. Dr.
    _Huxham_ has recommended a Tincture of the Bark; and Dr.
    _Pringle_, a strong Decoction of it, with some of the
    Tincture, in these Malignant Fevers.

I. _Robert Wilson_, of the Second Regiment of Foot Guards, on the 19th
of _February_ 1761, was seized with a Shivering and Coldness,
succeeded with Heat, Thirst, a short dry Cough, Difficulty of
Breathing, Head-ach, and slight Stitches in his Breast; some Blood was
taken away, which was sizy, and he was ordered two Ounces of the
_Sperma Ceti_ Mixture, with the _spiritus mindereri_, every two or
three Hours. He continued without any manifest Alteration in the
Symptoms, till the 21st, when a Number of dun Petechiae appeared all
over his Body, particularly on his Breast. The Stitches and Cough were
then much easier, and he had his Medicines as before. On the 22d, he
was seized with a Delirium, and was somewhat comatose; when he was
ordered a Drachm of the Bark every six Hours. The 23d, the comatose
Symptoms had increased, and he had slight Twitchings of the Tendons, a
dry brown- Tongue, and a Faultering in his Speech. The Bark
was continued, with the Addition of two Spoonfuls of Mountain Wine
every two Hours. On the 24th, he had several loose Stools. The 25th,
he was still loose, and went on as before, with the Addition of six
Grains of the _Pilulae saponaceae_ in the Evening. The 26th, the
Petechiae were not so apparent as before, but he had still the nervous
Symptoms, and his Breathing grew more difficult; and therefore a
Blister was applied between his Shoulders, and his Medicines
continued; as they were likewise on the 27th, without any Alteration
in the Symptoms. On the 28th, his Tongue became moister, and the
Pulse, which had been low and quick the four preceding Days, became
fuller and slower. On the 29th, he was much more sensible, his Tongue
more moist, and the Twitchings of the Tendons much less; and in the
Evening he fell into a profuse Sweat, which lasted all the 30th. On
the 1st of _March_, his feverish Symptoms were much abated, his Pulse
was calmer, his Skin moist, his Drought less, and his Urine dropt a
plentiful Sediment. On the 2d, his Fever was almost entirely gone, but
he had still a Cough, and spit up a viscid Matter. He was ordered to
go on as before, with the Addition of two Spoonfuls of the _Sperma
Ceti_ Mixture, and the _Spiritus Mindereri_, when his Cough was
troublesome. He followed this Course till the 7th, when, his Cough and
Fever being gone, he was ordered a Dose of Tincture of Rhubarb; after
which he recruited his Strength daily, without the Assistance of any
more Medicines.

II. On the 5th of _March_ 1761, _Thomas Stagg_, of the Second Regiment
of Foot Guards, was seized with the same Symptoms as _Robert Wilson_
had been in the Beginning of his Fever, but in a more violent Degree.
He was blooded to about twelve Ounces, and was ordered a saline
Draught every six Hours. On the 6th, the Blood, which had been drawn
the Day before, had thrown up a slight Buff; it appeared to contain
but a small Proportion of Serum, and the Crassamentum was of a loose
Texture. The feverish Symptoms had increased, with the Addition of a
Delirium: pergat. On the 7th, the Delirium was grown more violent, so
that he could scarce be kept in Bed; his Breathing was difficult, his
Eyes red and florid: A Blister was applied to his Back, and the saline
Mixture continued. On the 8th, there was no Alteration in the Course
of that Day; but being lower towards Night, Blisters were applied to
his Legs, and he was ordered to have a Pint of Wine allowed him in
twenty-four Hours. On the 9th, the Petechiae appeared over his whole
Body, of a broad dunnish kind; his Breathing became easier, and his
Pulse stronger, though the Delirium was still as bad as before: He was
ordered a Drachm of the Bark every fourth Hour in a saline Draught. On
the 10th, the Bark gave him several loose Stools, but the Petechiae
were of a more florid Colour; the Delirium was less, and his Tongue
moist, and therefore he was ordered to continue the same Medicines as
the Day before, with the Addition of ten Grains of the _Pilulae
saponaceae_ in the Evening. The 11th Day, he fell into a fine breathing
Sweat, his Pulse became fuller and slower, and the Delirium abated: p.
The 12th, his Pulse was regular, and the Delirium gone, and he was
much inclined to sleep. The 13th, after a calm Sleep, which had lasted
twelve or fourteen Hours, he became quite free of Fever. After this he
continued the Use of his Medicines for some Days, and recovered his
Health and Strength daily.

III. On the 23d of _May_ 1761, _Lionel Thompson_, of the First
Regiment of Foot Guards, was seized with all the Symptoms of a
Peripneumony, attended with a high Fever, for which he was ordered to
be blooded. After losing eight Ounces of Blood, he fell into a
fainting Fit; on recovering out of which, his Breathing being still
much affected, he had a Mixture made of four Ounces of the _Lac
Ammoniacum_, and one of the _spiritus mindereri_, of which he was
desired to take two Spoonfuls every four Hours. The 24th, the Symptoms
the same: He complained of having had no Stool for some Days, and took
half an Ounce of the _sal catharticum amarum_, which gave him two
loose Stools. On the 25th, his Pulse was small and quick, his
Breathing difficult; he was low, and had a slight Delirium: A large
Blister was applied between his Shoulders, and the Medicines
continued. On the 26th, in the Morning, the Petechiae appeared, and his
Breathing was freer: He was ordered a Drachm of the Bark, in a saline
Draught, every four Hours. The 27th, the Pulse better: p. The 28th,
was more sensible, and had a kindly warm Moisture all over the Skin.
The 29th, the Fever was much abated, and his Tongue, which was before
parched and dry, became moist and white: He continued the Use of the
Cortex for three Days more, which removed the Fever; and being
costive, he took a Dose of the Tincture of Rhubarb. After this he used
the Bark for a few Days longer, and got perfectly well.

After giving the Bark[12] with Success, in the two first of the Cases
mentioned, and to two young Gentlemen, Mates of the Hospital, who had
caught the Fever from their Attendance on the Sick, I gave it to above
a hundred and fifty at _Paderborn_, and elsewhere, during my
Attendance in the Military Hospitals in _Germany_; and although it did
not answer in every Case, yet it was found to have a better Effect
than any other Remedy that was tried. We joined different Medicines
with it, according to the State of the Patient. We gave the _Confectio
cardiaca_, _Rad. serpent. Virg._ and other cordial Medicines, and
Wine, when the Pulse was low; _Oxymel scilliticum_, and other
Pectorals, when the Breathing was difficult; Opiates, where the
Patient was inclined to be too loose; the _spiritus mindereri_, and
other Diaphoretics, when we wanted to promote a free Perspiration; and
we applied Blisters as Occasion required.

    [12] The _Peruvian_ Bark has not only been found useful in
    this Malignant Fever, but has likewise been recommended in
    the Plague. See _Morton Oper. Append. secund. Exercitat.
    Hist. Febr. Ann. 1658, ad. an. 1691. complexa_. In the Small
    Pox, see _Medical Essays_, vol. V. art. x. and has been found
    serviceable in the putrid Disorders of the _West Indies_, as
    taken Notice of by Dr. _Hillary_; and in the malignant
    ulcerous sore Throat in this Country, as Dr. _Wall_ and
    others have observed. And in thirty-five Cases of the
    malignant ulcerous sore Throat, in which I gave it, joined
    with Cordials, and the Use of Acids, I did not lose one
    Patient. Nine of them were strong People, and had plethoric
    Symptoms, and were blooded in the Beginning; and seven of
    them were costive, and took a Dose of gentle laxative Physic
    before taking the Bark. The rest had no Symptoms which seemed
    to require these Evacuations. However, it ought to be
    observed, that this is a Disorder of the malignant kind; and
    that although some well-timed gentle Evacuations may be
    serviceable in the Beginning, before giving the Bark; yet too
    free, or even gentle Evacuations, injudiciously made, will
    sink the Patient, and infallibly do Mischief.

    The free Use of the Bark has long been found serviceable in
    Mortifications and foul Sores, where the Juices tend too much
    to the Putrescent; and has been strongly recommended by Mr.
    _Ranby_, Serjeant Surgeon to his Majesty, in the Cure of
    Gunshot Wounds. See his _Treatise on Gunshot Wounds_.

When the Patient was strong, the Pulse quick and full, the Eyes looked
red, and the Breathing was difficult, after the Petechiae appeared; I
took away more or less Blood before giving the Bark. Most
Practitioners of late Years have been against Bleeding in this Stage
of the Disorder; but trusting to the Assurances given by Dr.
_Hasenohrl_ of its being safe, nay of Advantage to bleed at this Time,
if the Symptoms required it, I ventured upon it, and found it to be of
the greatest Service, in many Cases, in the Hospitals at _Paderborn_
and elsewhere; and particularly in two Cases at _Bremen_, and one at
_Osnabruck_, where it gave immediate Relief, and seemed to shorten the
Disease much. One of the Patients at _Bremen_, _Robert Ellis_,
belonged to an Independant Company; the other, _Francis Hamstan_, of
the 24th Regiment, had formerly had his Skull fractured, and took the
Fever, while he was in the Hospital, for violent Head-achs, which he
had been subject to, at times, ever after his Skull had been
fractured. The Case at _Osnabruck_ was a Nurse of the Hospital, whose
Name was ---- _Andrews_, a Woman about twenty-five Years of Age, who,
after attending a Dragoon in the Small Pox, and suckling at the same
time her own Child, then in the same Disorder, was, on the 18th of
_January_ 1763, attacked with a Fever. I saw her for the first time on
the 20th, and found her Pulse quick, full, and strong. She complained
of a violent Head-ach; for which she was blooded, and took the saline
Mixture, with Nitre and Contrayerva. Next Day, the 21st, her Blood
appeared very sizy, and she complained of having been costive for some
Days. We gave her immediately an Ounce of the _sal catharticum
amarum_, which operated well. She continued much in the same Way the
22d, and had some loose Stools that Day. Being still inclined to be
loose the 23d, instead of her former Medicines, she was ordered the
_spiritus mindereri_ Mixture, with Mithridate. This checked the
Purging, but did not stop it entirely. The Fever went on, without any
remarkable Change, till the 27th; at which time the Petechiae appeared
all over her Body, attended with a Redness of the Eyes, and a violent
Oppression and Pain of her Head, and a quick Pulse. I ordered six
Ounces of Blood to be taken away immediately, and a large Blister to
be applied to her Back, and, at the same time, ordered her a cordial
Mixture, with half an Ounce of the Extract of the Bark in it, to be
taken every twenty-four Hours. The 28th, her Pulse was not so hard,
her Head was much easier, the Redness of her Eyes was much less, and
the Petechiae had begun to die away. The Blood which was taken away the
Day before, had a thin Buff at the Top, but the _Crassamentum_
underneath was of a dark Colour, and of a loose Texture: p. On the
29th, she told me that she had had two or three loose Stools, and she
was lower than the Day before; and therefore a Drachm of Mithridate,
and two Drachms of the Tincture of Cinnamon, were added to her cordial
Mixture, with the Cortex; and she was allowed half a Pint of Red Wine,
mulled with Cinnamon, _per_ Day. 30th, Her Tongue rather moister than
the Day before; and she not so low, but she was still inclined to be
loose; and therefore was ordered the anodyne Draught at Nights, and to
continue the other Medicines. 31st, She was still inclined to be
loose; but her Pulse kept up, her Tongue was moister, and she found
herself pretty easy: p. _Feb._ 1st, Her Pulse pretty strong, and she
found herself much cooler, and freer from the Fever, and complained of
a Dullness of Hearing. On the 2d, in the Morning, she felt a warm
Moisture all over her Skin, which, about Noon, broke out into a
profuse Sweat, and continued till the 4th; when it went off, and her
Urine let fall a copious whitish Sediment. She had then little or no
Fever. The Dullness of Hearing still continued, though it was much
less than before. After this the Deafness went gradually away. She
continued the Use of the cordial Mixture, with the Cortex, till the
12th, and recovered Strength daily. After this, she had no other
Medicine, except two Doses of the Tincture of Rhubarb, and was soon
in good Health, and able to discharge her Duty as a Nurse.

However, it ought to be observed, that we must not bleed so freely, in
this or any other Stage of the Malignant Fever, as in acute
inflammatory Disorders, otherwise we shall sink the Patient, and hurry
him to his Grave; and that Bleeding can only take place with Safety
and Advantage, under the Circumstances above-mentioned, immediately
before giving the Bark freely; or where some accidental sharp Pain in
the Breast, or Bowels, or some other violent Symptom, may require it.
They err equally, who recommend Bleeding freely in this Fever, with
those who entirely forbid its Use.

Although we found the Bark to be in general the best Remedy in this
malignant Petechial Fever, yet it did not answer in every Case; for in
some we found other Remedies had a better Effect: And therefore, when
we observed that, notwithstanding the Use of the Bark, the Patient
sunk, and the Symptoms grew worse, we did not persist obstinately in
its Use, but tried the Effect of other Medicines.

Towards the End of _May_ 1761, two Soldiers in the Hospital, at
_Osnabruck_, were taken ill of this Fever; who, after using the Bark
freely, and being allowed a Pint of Red Wine _per_ Day, for some Days
together, began to sink, and had a Delirium and other bad Symptoms
hastening on: upon which I laid aside the Use of the Bark, and ordered
each of them a Blister to the Back, and to take a cordial Draught,
with fifteen Grains of Musk in it, every four Hours; and to have their
Wine mulled with Cinnamon; and although at that Time they were both so
low that I scarce imagined they would live twenty-four Hours, yet next
Day I found them greatly mended; and they had a kindly warm Moisture
all over their Skin, and the Pulse had rose considerably in both. By
the Continuance of the same Medicine the feverish Symptoms gradually
abated, and they both got well.

About the same time, having given the Bark freely for some Days, and
applied a Blister, to another Patient, after the Petechiae had
appeared, I found him one Morning so low that his Pulse could scarce
be felt. He could not speak; he had a Delirium, and rather a Tremor
than a _subsultus tendinum_, and he had all the Appearance of a dying
Man. However, as he still swallowed whatever was put in his Mouth, I
changed the Bark Mixture for Draughts, which contained a Scruple of
the _confectio cardiaca_, and seven Grains of the _sal vol. corn.
cerv._[13] each, and ordered one to be given immediately, and
afterwards to be repeated every four Hours; and, in the Intervals, to
give him frequently a Tea-cup full of Red Wine, mulled with Cinnamon;
and to apply two large Blisters to his Legs. Next Day, his Pulse had
rose; and by the Continuance of the same Remedies it became gradually
fuller and stronger, and the third Day after he recovered his Voice;
and a warm kindly Moisture which ended in a profuse Sweat coming on,
the feverish Symptoms went off soon after, and he recovered his
Health.

    [13] Dr. _Huxham_, in his _Treatise on the ulcerous sore
    Throat_, p. 54, &c. condemns the Use of the volatile alcaline
    Salts, in Fevers of the putrid, pestilential, or petechial
    kind, as being apt to heat too much, and to hasten the
    Dissolution and consequent Putrefaction of the Blood.
    However, I cannot help thinking that they are the best
    Remedies we can use on some particular Occasions, even in
    this Fever; for we have no Remedy which gives such a sudden
    and brisk _Stimulus_ to the Fibres as they do. And I have
    known many Cases of Patients who were extremely low, and
    whose Pulse was scarce to be felt, and others who were apt to
    fail into fainting Fits, who have been preserved by large and
    repeated Doses of these Salts, and the free Use of Wine, and
    acescent Liquors, to correct their alcaline Acrimony in the
    Blood. Though as soon as such Patients had recovered from
    this low State, I laid these Medicines aside; because I
    cannot help agreeing with the Doctor in the Belief, that
    their continued Use will produce the Effects he mentions. For
    although it be true, that these Salts, when mixed with
    putrescent Liquors, or with dead animal Substances, resist
    Putrefaction, and, like ardent Spirits and Vinegar (the other
    Products of Fermentation) check and put a Stop to that very
    Process which produced them: Yet it is also true, that, when
    mixed with the Blood of living Animals, they stimulate the
    Vessels, and increase the Heat and _Momentum_ of the Blood,
    and dissolve it; and therefore I cannot but disapprove the
    continuing their Use longer than is immediately necessary.

At _Bremen_ there were two Men, one in _January_, and the other in
_February_ 1762, on whom the Cortex had but little Effect, who
recovered by the free Use of Mixtures, with the _confectio cardiaca_
and _rad. serpentariae_, and of Wine, with the Application of large
Blisters. Several Cases of this kind occurred in the Hospitals, where
the Bark did not answer.

There is one thing to be observed with respect to Malignant Fevers,
which is, that if ever they appear in large crowded Hospitals, unless
we can thin the Wards, and procure a free Circulation of Air, and keep
the Hospital and Sick extremely clean, the Fevers will continue to
spread, and great Numbers will die; and even the most efficacious
Remedies will have little or no Effect. And that when once the
Infection is grown strong, it requires the greatest Care, and some
Time, before it can be entirely got the better of. And that if a great
number of Men, ill of this Fever, be kept in the same Ward, they will
help to keep up the Infection; and therefore it is always proper, when
it can possibly be done, to lay but a few of them in one Ward; not
above one-third of the Number generally admitted.

Many of the Patients, towards the Height of this Fever, sooner or
later, had a Purging, which seldom proved critical; and some were
seized with the Flux. A gentle _diarrhoea_, such as did not sink the
Patient, was commonly of Service; but when violent, or a Dysentery
came on, the Case was always dangerous; for whatever stopped the Flux
increased the Fever; and, if the Purging or Flux continued, it sunk
the Patient. Such Fluxes we treated in the Manner to be mentioned
afterwards, when we come to the History of the Dysentery.

In this Fever, it was common for Patients to vomit Worms[14], or to
pass them by Stool, or, what was more frequent, to have them come up
into their Throat and Mouth, or sometimes into their Nostrils, while
they were asleep in Bed, and to pull them out with their Fingers. The
same Thing happened to most of the _British_ Soldiers, brought to the
Hospitals for other feverish Disorders as well as this. Dr.
_Pringle_[15] when he mentions Worms being observed in this Fever,
seems to embrace _Lancisius_'s Opinion; and believes that these Worms
are not the Cause of the Fever; but being lodged in the Intestines,
before the Fever comes on, they are annoyed by the Increase of the
Heat, and the Corruption of the Humours, in the Cavity of the
Intestines of Persons labouring under Fevers, especially of the putrid
Kind; and so they begin to move and struggle to get out. This seemed
evidently to be the Case with many of the Patients we had; though in
some the Worms seemed to have given Rise to the Fever, which the bad
State of the Patient's Humours, or the infected Air of Hospitals,
determined to be of this Kind. In many, the Fever lessened, or went
off entirely, soon after; and they were no more affected with Symptoms
of Worms. But some notwithstanding were subject to frequent Sickness,
Pain of the Stomach, and Uneasiness in the Bowels, and discharged some
Worms from Time to Time. Others had frequent Relapses into Fevers,
which seemed to be owing to the Irritation of these Insects.

    [14] Some Men passed only one Worm; others, two or three;
    some, six or seven; and one Man, of the Guards, in _January_
    1763, after passing three by Stools in the Course of a Fever
    of this Kind, discharged fourteen more upon taking a Dose of
    Rhubarb and Calomel after the Fever was over.

    [15] _Observations on the Diseases of the Army_, part iii.
    chap. iv. Note to p. 213. third Edition.

It is no Wonder that Worms of the round Kind should be productive of
troublesome Symptoms, and occasion these Relapses; since we know that
they have sometimes perforated the Intestines, and been found in the
Cavity of the Abdomen[16].

    [16] See _Hoffman_'s Works, vol. III. chap. x. _River.
    Observ. commun._ Obs. 13. _of Observations found in a
    Library._ _Bonetus's Sepulchret. anatom._ tom. II. _Gualther
    van Doeveren's Inaugural Dissertation de Vermibus
    intestinalibus_, published at _Leyden_, 1753; and _Lancisi_'s
    Works; for Cases where the internal Coats of the Stomach, and
    Intestines, have been eroded, and all the Coats perforated by
    Worms of the round Kind.

As soon as we observed a Patient to be troubled with Worms, if his
present Situation did not prevent it, we gave twenty-five or thirty
Grains of Rhubarb, with five or six Grains of Calomel; and if there
was much Sickness, we likewise gave an Emetic; which, in more than one
Case, brought up two or three Worms of the round Kind, and gave great
Relief. But where the Fever was violent, we were obliged to neglect
this Symptom of Worms for the present; and when the Fever was over, if
there still remained any Symptoms of Worms, we gave the purgative
Medicine once or oftener, and in the Intervals gave the _pulvis
stanni_, or an Infusion of Camomile Flowers; and in some Cases, oily
Medicines. By these Means most of the Patients got well and recovered
their Health, and seemed to be freed, at least for the present, from
these troublesome Insects; though a few continued to complain of
Sickness, and other Symptoms of Worms, for some Time afterwards.

What was the Cause of the Army's being so much troubled with Worms of
the round Kind, is not easy to ascertain; unless it was owing to the
great Quantity of crude Vegetables, and Fruits, which the Soldiers eat
in the Course of the Summer and Autumn, and to the bad Water they were
often obliged to drink.

In the Malignant Fever at _Paderborn_, many complained of a Dysuria,
and some of a Suppression of Urine, especially towards the Decline of
the Fever; and others, of a Scalding and Pain in making Water, though
they had no venereal Complaint. These Symptoms appeared in other
Places, but not near so frequently as at _Paderborn_. Decoctions of
Gum Arabic, with some of the _spiritus nitri dulcis_, and oily
Mixtures, and Opiates, commonly gave immediate Relief, and soon
removed this Complaint.

One of the first salutary Symptoms which most generally appeared in
those who recovered, was a Dullness of Hearing, or Deafness[17]; which
came on about the Height of the Fever, and continued a longer or
shorter Time, generally till the Fever was entirely gone; and
sometimes for a considerable Time afterwards. For the most Part we
did nothing for this Complaint, and it went off as the Patient
recovered his Strength. When it continued long, Blisters applied
behind the Ears, or on the Neck, and washing the _meatus auditorius_
with the emollient Decoction, in which a small Quantity of Soap was
dissolved, proved of Service.

    [17] _Riverius_ tells us, that, according to _Hippocrates_'s
    Doctrine, Deafness is a very dangerous Symptom in the
    Beginning of acute Disorders, though it be a good Omen, and
    portends Health, when it does not appear till the Height of
    Fevers, especially those of a malignant Kind; and adds, that
    he himself has a thousand Times observed, that those
    labouring under this Fever have recovered, when this Symptom
    of Deafness came on at the Height (_in statu_) though the
    other Symptoms threatened much Danger. _Prax. Medic._ lib.
    XVII. sect. iii. cap. i. p. 451.

    This Symptom of Deafness occurs in other Fevers as well as in
    this, and often proves a good Symptom in them likewise, as I
    have frequently observed. Two remarkable Examples of which I
    had under my Care in St. _George_'s Hospital, in the Year
    1759. On the 17th of _January_ 1759, _James Donaldson_, a
    young Man of nineteen Years of Age, was admitted into the
    Hospital for a Fever, attended with a Stupor and a Delirium,
    a parched dry Tongue, and other Symptoms of a Fever of the
    inflammatory Kind, for which he had been blooded, and used
    other Evacuations. On the 19th, after the Application of a
    Blister, he was seized with almost an entire Deafness; after
    which, all his other Symptoms became milder, and he mended
    daily, and was entirely free from the Fever by the 30th. On
    the 10th of _April_ 1759, a Youth, _John Young_, fifteen
    Years of Age, was admitted into the same Hospital for a
    Fever, which had already continued fourteen Days. His Speech
    was affected, and he had entirely lost the Use of his Limbs,
    was delirious, and had other bad Symptoms. On the 12th, his
    Hearing became exceedingly dull, and he recovered daily
    afterwards, and was discharged, cured, the 2d of _May_,
    having recovered the Use of his Legs as well as got free of
    the Fever.

Swellings of the parotid Glands appeared in many Subjects, towards the
Decline of the Fever, which came to Suppuration, and proved critical.
In two only, out of those I attended while in _Germany_, they came on
early in the Fever, but did not suppurate. Both Patients died; all
the rest recovered, except one old Man, an Invalid at _Bremen_; who,
after having one Swelling appear on the right Side, which came to
Suppuration, and seemed critical, relapsed into the Fever; and another
formed on the other Side, which came likewise to Suppuration, and the
Fever ceased, after having reduced him very low; but the great
Discharge from the Sores wasted him gradually, and he died hectic in
about a Month after the Fever had left him[18].

    [18] But although these parotid Swellings were in general so
    favourable with us, we are not to imagine that this will
    always be the Case: for _Riverius_, though he speaks of these
    Swellings proving for the most part critical; yet he tells
    us, that, in the Year 1623, this Fever was epidemic at
    _Montpelier_, and that almost one half of the Sick died; and
    particularly, that most of those who had Swellings of the
    parotid Glands appearing about the 9th or 11th Day, were
    carried off within two Days of their Appearance. Having
    attended several who died from the Swellings not coming to
    Suppuration, he began to consider in his own Mind, what might
    be the Cause of their Death, and concluded, that it was owing
    to there being a greater Quantity of morbid Matter in the
    Blood than the Part was able to contain, and that Evacuations
    by blooding and purging were the only Remedies which were
    likely to give Relief; and therefore, in the first Case of
    this Kind, in which he was afterwards consulted, he ordered
    three Ounces of Blood to be taken away, notwithstanding the
    Patient was so low that the Surgeon was afraid he would have
    died in the Operation: The Pulse rose on bleeding, and he
    ordered four Ounces more to be taken in three or four Hours
    afterwards: The Pulse rose still more, and he ordered a Dose
    of Sena and Rhubarb to be taken next Day, and the Patient
    recovered. And he adds, that all those who were treated in
    this manner got well. _Prax. Med. Lib._ XVII. _sect._ iii.
    _cap._ 1.

As soon as these Swellings of the parotid Glands appeared, we
endeavoured to bring them forward to Suppuration, by the Application
of emollient Cataplasms, or of gummous Plaisters; and had them opened
as soon as a Fluctuation of Matter was to be felt, and afterwards
treated them as common Abscesses. _Riverius_[19] very justly observes,
that when such Tumours encrease in such a Manner as to endanger
Suffocation, they ought to be opened before they come to Maturation;
and Dr. _Pringle_[20] desires us not to wait for a Fluctuation of
Matter, but to open the Abscess as soon as it can be supposed to have
formed.

    [19] Ibid.

    [20] _Pringle's Observations on the Diseases of the Army_,
    Part III. chap. vii.

In _February_ 1761, three Patients in the Decline of this Fever had
Buboes formed in the Groin, which proved critical. At first, on
observing them, I suspected them to be venereal; but on examining the
Patients, they obstinately denied their having any Reason to suspect
any such Cause; and the favourable Manner in which they healed without
the Appearance of any other venereal Symptom, made me believe what
they asserted to be true; especially as such People are not shy in
owning Complaints of that Kind. The first Patient I saw who had a Bubo
in the Decline of one of these Malignant Fevers, was a Woman, Wife to
a Soldier of the thirty-seventh Regiment of Foot; she had a Child at
her Breast, and her Husband was living with her at the Time she was
taken ill of the Fever, and neither of them had the least venereal
Complaint. In a few Days afterwards, two Soldiers in other Hospitals,
towards the Decline of very bad Petechial Fevers, had likewise Buboes
formed in the Groin, without any Suspicion of a venereal Taint. Except
in these three, I did not see any critical Buboes appear in this Fever
while I was with the Troops in _Germany_; tho' Mr. _Lovet_, who
served as a Mate to the Hospitals, and who was at _Hoxter_, where we
had another Hospital established, while I was at _Paderborn_, told me,
that, in the Beginning of the Year 1761, they had several Men in the
Hospital ill of this Fever, who had critical Buboes formed in the
Groins and Armpits[21].

    [21] This Symptom of Buboes is taken Notice of by Authors,
    but does not seem to be so frequent as many of them would
    make us believe. Neither Dr. _Huxham_ nor Dr. _Pringle_
    mention their having seen such Buboes; and Dr. _Lind_ says,
    that he never saw them till the Beginning of the Year 1763.

About the same Time that these Buboes appeared, severals towards the
Decline of this Fever complained of a Pain all along the Spermatic
Chord; and soon after a Swelling of the Testicle appeared[22].
However, this Complaint was not peculiar to those who had the Fever;
for others recovering from Fluxes, and other Disorders, were likewise
affected with such Swellings. I did not observe any Symptom of this
Kind in Fevers while I was with the Troops in _Germany_, except in
_January_, _February_, _March_, and _April_ 1761. By Bleeding, and
applying emollient Fomentations and Cataplasms, and bathing the Parts
with _spiritus mindereri_ on the first Attack of the Pain, the
Swelling of the Testicle was prevented; but where no Mention was made
of this Pain till the Swelling had already begun, it commonly ended in
a Suppuration of the Scrotum or Testicle, which healed very kindly. We
had no Reason to suspect any venereal Taint in any of them.

    [22] _Hippocrates_ takes Notice of Swellings of the Testicles
    in Fevers. He tells us, that a Man from Alcibiades had his
    left Testicle swell before the Crisis of a Fever. _See his
    Second Book on Epidemics_, sect. ii. And he mentions this
    Symptom as a Crisis in the ardent Fever. _See his Book on
    Crises_, sect. xi.--And Dr. _Antonio Lizzari_, in a Treatise
    which he published on the _Acute Diseases which were frequent
    at Venice, and all over Italy, in the Years 1761, 62_, tells
    us, that Abscesses of the Scrotum and Testicles frequently
    followed the Measles.

Many, while recovering from this Fever, were seized with an
Ophthalmia, or Inflammation of the Eye; for the most part of one Eye
only, sometimes of both. When the Patients were strong, they were
blooded, and had Blisters applied behind the Ears; and sometimes,
where the Pain was great, had Poultices of Bread and Milk applied to
the inflamed Eye; which, with the Assistance of some cooling Physick,
commonly removed this Complaint; tho' in some obstinate Cases we were
obliged to repeat the Evacuations, to apply Leeches to the Temples;
and after the acute State of the Disorder was passed, to order the Eye
to be washed frequently with the Collyrium vitriolicum, or Collyrium
Saturninum, before we got the better of this Complaint. However, it
ought to be observed, that if these astringent Collyria were used too
soon, they did hurt. When these Ophthalmias were neglected in the
Beginning, the Inflammation frequently rose to a great Height, and
left an Obscurity or Philm over the Cornea, which remained an
Impediment to the Sight not to be removed.

Towards the Decline of these Fevers, and very often during the Course
of them, many complained of Pains in their Feet and Toes, which
sometimes ended in Mortifications, especially where the Patients lay
in very cold Wards. For the most Part, the Mortification extended no
further than the Ends of the Toes, tho' in some it spread over the
Feet, and in two or three advanced up the Leg. Several lost one or
more Toes; and in _February_ 1761, one Man lost Half of each Foot;
another lost both Feet, and Part of each Leg. Both got the better of
the Fever, tho' the Man who lost both Feet languished a long time
afterwards. These Pains of the Feet and Toes, and the Mortifications
which followed, were for the most part owing to the Patients being
exposed to too much Cold while they were very weak, the Circulation
languid, and the Juices vitiated by a putrid Distemper; by which means
the Vessels were rendered incapable of carrying on the Circulation in
their extreme Branches[23].

    [23] These Pains and Mortifications of the Feet and Toes were
    not confined to those who were brought low by malignant
    Fevers; for, during the very hard Frost in the Beginning of
    the Year 1763, many of the Patients who lay in very large
    open Wards in the Hospital at _Osnabruck_, were affected in
    the same Way. One Man had both Feet, and Part of each Leg,
    compleatly mortified, and died in about nine Days after the
    first Appearance of the Mortification. One lost half of one
    Foot, and some Toes of the other; and the third lost the
    first Joint of some of his Toes, and the Ends of others.

As soon as the Sick began to complain of these Pains of the Toes and
Feet, I found the best Remedy to be, the Bathing of the Feet in warm
Water, or in warm aromatic Fomentations; and, after keeping the Feet
for some time in these warm Liquors, to dry them well, and then rub
them with the _linimentum saponaceum_, or _linimentum volatile_, and
wrap them up in Flannel. And if ever any Lividness or Redness appeared
on the Parts, we gave plentifully of the Cortex and Cordials, if not
contra-indicated by the other Symptoms. When Vesicles arose on the
Part, and a Gangrene formed, we directed the Parts to be scarified,
and proper Dressings to be applied, while warm aromatic Fomentations
and Cataplasms were used.

In _January_ 1762, one Patient, ill of the Petechial Fever at
_Bremen_, had a Lividness and Blackness, threatning a Mortification,
which appeared at the End of his Nose. I expected for some Days, that,
if he recovered, he would lose Part of his Nose; but, by giving him
large and repeated Doses of the _cortex_ and _confectio cardiaca_, in
a Mindereri Mixture, and allowing him the free Use of Wine, its
further Progress was prevented; and as the Patient got clear of the
Fever, the Nose recovered its natural Colour, and only the scarf Skin
peeled off from the End of it.

When the Fever continued long, and reduced the Patients low, it was
very common for the Back, and Parts on which the Weight of the Body
rested, to mortify. As soon as any thing of this Kind was observed, we
ordered such Parts to be covered with proper Dressings, and gave the
Bark and Cordials freely; and took care to make the Patient change his
Posture; and by Pillows prevented as much as possible the Weight of
the Body from resting on that Part. By this Treatment, many recovered,
where the Fever was on the Decline, and the Strength not too much
exhausted; even tho' a very large Surface of the Skin had mortified;
but where the Patients were very low, and the Fever still continued,
or where it was complicated with a Flux, which kept them perpetually
nasty, and exhausted the Strength, it generally proved fatal.

Patients, who were reduced very low by this Fever, or by repeated
Relapses, were subject to oedematous Swellings; especially of the
Feet, towards the Evening, after sitting up all the Day. These
Swellings generally went away as the Sick recovered their Strength;
but in some Cases they continued obstinate, and ascended towards the
Thighs; and in some spread all over the Body, and terminated in an
universal Anasarca.

When these Swellings were recent, and confined to the Feet and Legs,
commonly the Bark joined to the lixivial Salts, or the Oxymel of
Squills, or other Diuretics, and a Purgative once or twice a Week,
removed them. In some, an Infusion of Horse-radish had a good Effect;
in others, Sweats brought out by means of _Dover_'s Powder, or of the
_guttae antimoniales anodynae_.

Sometimes these Swellings were very obstinate, and resisted the Force
of all internal Remedies. In such Cases, Punctures made in the Feet,
or lower Part of the Legs, which furnished a Drain for the Water, had
a good Effect. Blisters applied to the Legs were of Service to some.
When the Punctures were made, or the Blisters applied, before the
Patient's Strength was exhausted, provided that he laboured under no
other Disorder but these oedematous Swellings, which proceeded from
Weakness, I never observed any bad Effects from them; tho' I used them
both repeatedly in a Variety of Cases. But if the Patient was very
weak; or had a Hectic Fever or Purging; or other Disorders, and the
oedematous Swellings large; then oftentimes the great Discharge
exhausted his Strength, and a Gangrene and Death were the Consequence.

One of the most remarkable Instances of the good Effects of Blisters,
was in the Case of a Soldier at _Paderborn_; _Thomas Hope_, of the
Second Regiment of Foot Guards, after a Fever of this Kind, was
swelled all over, especially about the Face and Neck, and had a
Difficulty of Breathing: after having tried Variety of Medicines for
this Complaint, without any Effect, he had a large Blister applied to
his Back, and took the Cortex in a Mixture, with the Oxymel of
Squills. As soon as the Blister began to discharge, the Swellings
decreased; and were afterwards entirely removed by the Help of one or
two Doses of Physic, and the continued Use of the Medicines before
prescribed. Three other Men in the Hospital at _Osnabruck_, in _May_
1761, having oedematous Swellings of the Feet and Legs, which yielded
to no internal Remedies, had Blisters applied to their Legs, used the
Cortex, with the lixivial Salts, two or three Times a Day, and a Purge
every fourth Day; which removed the Swellings in a short Time.

Some of the Soldiers, who had repeated Hospital Fevers, had their
Blood so much broke down, as to be subject to profuse Haemorrhages from
the Nose; and some of them passed Blood likewise by Stool; which
reduced them to a very low State, sometimes attended with imminent
Danger. In such Cases we found nothing to answer so well as to give
freely of the Bark; to acidulate their Drinks with the _spiritus
vitrioli_; to allow them as much Red Wine as the Strength and present
Circumstances could bear; and at the same Time to support the
Patient's Strength by a mild Diet, of light Digestion; as Water or
Rice Gruel, Panado, weak Broth, and the like. When there was a
Tendency to a Diarrhoea, we were obliged to add some of the
_electuarium diascordii_ to the Cortex, and frequently to give an
Opiate in the Evening. One Case, where this Method of Cure had a very
remarkable good Effect, I had under my Care at _Paderborn_. A Soldier
who lay in one of the lower Wards of the Jesuits Hospital, after a
Malignant Fever, attended with a Flux, used to bleed at the Nose, to
four, five, or six Ounces at a Time; and once or twice lost near a
Pint of Blood, of a dark Colour, very thin and watery, and of so loose
a Texture, that the grumous Part scarcely coagulated. This Evacuation
brought him so low, that he could scarce turn himself in Bed; and his
Pulse might be said rather to flutter than beat: By the continued Use
of the Bark, and of Cordials, and Drinks acidulated with _spiritus
vitrioli_, and some Spoonfulls of mulled Red Wine every two or three
Hours, he was restored to Health and Strength. The only Accident which
happened during the Cure, was a Threatening of a Looseness, and the
Return of his Flux; which however was stopt by a Dose of the
_tinctura rhei_; by joining some of the _electuarium diascordii_ with
the Bark, and giving an Opiate in the Evening.

       *       *       *       *       *

Putrid Malignant Fevers, attended with Eruptions, are taken Notice of
by _Hippocrates_[24], and other antient Authors[25]; but whether they
meant that particular Sort of Eruption which we now call Petechiae, is
uncertain; as their Descriptions are not clear enough to distinguish
it from the Miliary and other Kinds. But since the Year 1500, we have
had many accurate Accounts of Fevers of this Kind, which have appeared
in different Parts of the World: from all which it appears that such
Fevers generally take their Rise either from some antecedent Acrimony
of the Blood; or, what is more frequent, from some Source of
Corruption or Contagion; from the Use of putrescent animal Food, and a
Want of fresh Vegetables and acescent Liquors; from the putrid Steams
of corrupted animal Substances; from the moist putrid Vapour of low
marshy Places in Summer, where there is stagnating Water, which
corrupts by the Heat; from the foul Air of crowded Hospitals, Jails,
and Ships; and from such like Causes[26].

    [24] _Hippocrat._ lib ii. popul. sect. iii. text. 2.

    [25] _Aetius Tetrab._ ii. sect. i. cap. 129. _Actuar._ lib.
    i. cap. 23.

    [26] See these Causes mentioned by _Riverius_, and since more
    fully explained by Dr. _Pringle_, _Observations on the
    Diseases of the Army_, part iii. chap. vii.

When once this Fever begins, it is observed to be of a contagious
Nature, and (if proper Care is not taken) to affect those who attend
the Sick, or who live in the same Room, and breathe the same Air with
them.

Many Authors have reckoned the Malignant, Petechial, and Pestilential,
to be distinct Species of Fevers; and have treated each of them under
a particular Head. But _Riverius_[27] has very justly observed, that
they all belong to the same pestilential Tribe, and only differ from
one another in the Degree of Infection, and the Violence of the
Symptoms[28]; and that they are to be cured by the same general
Treatment, and the same Medicines.

    [27] _River. Prax. Med._ lib. xvi. sect. iii. Praefat.

    [28] The Malignant or Hospital Fever, and Petechial, seemed
    to me to be entirely the same Disorder, and the Petechial
    Spots to be only a Symptom which appeared sometimes, but not
    always. And _Riverius_ says, the Petechiae do not always
    appear; but when they do, it is a most certain Sign of a
    Pestilential Fever. See his _Prax. Med._ cap. xvi. sect. iii.




OF THE DYSENTERY.


The Dysentery generally began to appear soon after the Army took the
Field; and became frequent about the End of _July_, and continued so
till the Army went into Winter-Quarters; and through the Winter, many
of those, who had this Disorder in Autumn, relapsed, upon returning to
their Duty; or by drinking too freely of spirituous Liquors, and being
irregular in their Living.

It is now generally agreed upon, that this Disorder is entirely
produced by such Causes as make the Juices become too putrescent, and
turn the Flow of Humours to the Bowels; and in the Camp it seemed to
arise principally from an obstructed Perspiration caused by the Men's
lying in the Field, and doing the necessary Military Duties in all
Sorts of Weather; at the same Time being often exposed to the putrid
Steams of dead Horses, of the Privies, and of other corrupted Animal
or Vegetable Substances[29], after their Juices had been highly
exalted by the Heat of Summer.

    [29] The Dysentery has been long alledged to arise from a
    putrescent Cause in Camps; from the Smell of corrupted dead
    Animals, and of Excrements, during the Heat of Summer.
    _Ramazini_, in his Chapter on Camp-Diseases, informs us, that
    Dr. G. _Erric Barnstorff_, Physician to the Duke of
    _Brunswick_, who served five Campaigns with the _Brunswick_
    and _Lunenburg_ Troops in _Hungary_, told him, that the Camp
    Diseases, particularly the Malignant Fever and Dysentery,
    took their Rise from the Troops remaining long encamped on
    the same Ground, and being exposed to the corrupted Steams of
    the Bodies of dead Men, Horses, and other Animals, which lay
    unburied; and of Excrements, which were not covered with
    Earth. And these Causes have since been particularly taken
    notice of by Dr. _Pringle_, in his _Observation on the
    Diseases of the Army_.

    Many have imputed the Cause of this Disorder to the eating of
    Fruit in excess, because it generally appears about the
    Middle of Summer, the Time the Fruit begins to be in Season,
    and continues through the Autumn. But from later Observations
    this should seem to be a vulgar Error. Dr. _Pringle_ (part i.
    ch. iii. p. 20.) tells us, that, in the Year 1743, this
    Sickness began and raged before any Fruit was in Season,
    except Strawberries, (which from their high Price the Men
    never tasted) and ended about the Time the Grapes were ripe;
    which growing in open Vineyards were freely eat by every
    body. And Dr. _Tissot_, in a Treatise which he published,
    called _Avis au Peuple sur la Sante_, in his Chapter on the
    _Dysentery_, Sec. 320, says, that ripe Fruit, especially the
    Summer-Fruits, are so far from being the Cause of the
    Disorder, that they are the great Preservatives against it:
    he says, that, in the Years which the Fruit is most
    plentiful, the Dysentery is least frequent; and he relates
    several Instances where the Use of ripe Grapes proved a Cure
    for the Disorder. Eleven People were attacked by the
    Dysentery, nine eat Fruit, and all recovered; the other two,
    a Grandmother and Child, from Prejudice, eat none, and both
    died. A Regiment of _Swiss_ Soldiers, in Garrison in the
    South of _France_, had the Dysentery very frequent among
    them. The Captains purchased some Acres of a Vineyard, and
    carried the sick Soldiers to the Field, and gave them the
    Grapes to eat; and ordered the Men in Health to live upon
    them chiefly. After this not one Person died, nor was any one
    seized with the Distemper.--In an Account of a Treatise on
    the Dysentery, published at _Hamburg_ in 1753, which was
    epidemical the Year before, in _August_ and _September_, we
    are told, that it did not proceed, as is commonly believed,
    from the eating of Fruit; for it was observed, that those who
    eat Fruit freely escaped better than those who abstained from
    it altogether. _Vide Comment. de Rebus in Hist. Nat. &
    Medecin. Gestis_, vol. II. par. iv. sect. v.

    Generally in _August_ and _September_ we have People admitted
    into _St. George_'s Hospital for the Dysentery; who have
    certainly not catched the Disorder from eating of Fruit, but
    from working in the Fields, and being exposed to Causes
    similar to those which produce the Dysentery in Camps.

At the Time the Petechial Fever was frequent at _Paderborn_ in
_January_, _February_, and _March_ 1761, the Flux frequently
accompanied it; and we had in the Hospitals likewise a Number of old
Cases of this Kind, the Remains of the preceding Campaign about
_Warbourg_; besides some Men who had relapsed during the Winter, and
were sent to us when the Troops marched, upon the Winter-Expedition,
into the Country of _Hesse_. In _May_ and _June_, what Fluxes we had
at _Osnabruck_, were the remaining old Cases of the Hospitals of
_Munster_, _Paderborn_, _Hoxter_, and _Niehms_. Some few recent ones
were sent to _Bilifield_ about the End of _June_, and above 300 to
_Munster_, in _July_ and _August_. Those sent to _Bremen_, in
_November_ and _December_, had continued for some time before they
reached us; but a good many of the Soldiers in the Garrison were taken
ill of this Disorder, and sent immediately to the Hospital. In the
Beginning of _May_ we had but four ill of this Complaint in the
Hospital I attended; and there were not above six or seven, among the
Sick sent down from the Army, in the Middle of this Month. In _June_
there were but two sent to the Hospital at _Minden_; and not above ten
among the Sick sent to _Natzungen_ in the Beginning of _July_; tho'
towards the Middle of this Month they began to be more frequent; and
continued to be more so in _August_ and _September_; and in the
Hospital at _Osnabruck_ we had not above five or six ill of this
Disorder, in _December_ 1762, and in _January_, _February_ and _March_
1763.

The Dysentery commonly begun with Sickness and Gripes, succeeded by a
Purging, and attended with more or less Fever. Very soon the Gripes
became more severe, attended with a Flatulency in the Bowels, and
often with a Tenesmus. The Stools were chiefly composed of Mucus,
mixed with Bile, and more or less Blood: tho' sometimes no Blood could
be observed in them; and then the Soldiers used to say they had the
White Flux.

After eight, ten, or twelve, Days, if the Disorder was not complicated
with any other, there remained little or no Fever, unless where some
Accident supervened; tho' in Cases which terminated fatally, towards
the latter End came on a Fever of a low malignant Kind, attended with
black fetid Stools, Lientery, Hiccup, Stupor, and other bad Symptoms.

It often happened, that, after the Dysentery had continued for some
Time, the Sick complained for a Day or two of severe Gripes; and then
discharged along with the Stools little Pieces of hardened Excrements;
at other Times, tho' more rarely, little Pieces of white Stuff like
Tallow or Suet: Frequently small Filaments, and little Pieces of
Membranes, were found floating in the Stools; and it was very common
for the Sick to vomit up Worms of the round Kind, or discharge them by
Stool[30].

    [30] Most Authors, who treat of the Dysentery, mention this
    Symptom of Worms; and Dr. _Huxham_ tells us, that, in some
    Seasons, he has seen round Worms in the Stools of most of the
    Dysenteric Patients. _De Aere_, vol. II. p. 98.

In the Course of the Disorder, the Men often complained of a violent
Pain of the Rectum, near the Fundament, which was most excruciating
when they went to Stool; it continued for some Days, sometimes for a
Week or more; and then they passed more or less of a Yellow Pus with
their Excrements, and the violent Pain ceased. Mr. _A. Tough_, one of
the Apothecaries to the Military Hospital in _Germany_, was the first
who told me that I should find Pus mixed with the Stools: on my
mentioning a Case of this Kind, which had been relieved by Bleeding,
and Clysters often repeated; he told me he had observed it frequently
at _Gibraltar_; and was at a Loss to understand the Nature of the
Symptom, till he observed the Matter in the Stools; which at once
shewed him that it had been originally an acute Inflammation of the
Part, and pointed out to him the proper Method of Cure.

Oftentimes the Bilious and Malignant Fevers terminated in the
Dysentery; or were accompanied with it, when it might be looked upon
as a Symptom of these Fevers.

The Appearances we found after Death in the Bodies of some Patients,
who died of old Fluxes at _Bremen_, were: In all of them the Rectum
was inflamed, and partly gangrened, especially the internal Coat. In
two the lower Part of the Colon was inflamed, and there were several
livid Spots on its great Arcade. In one whose Body was much emaciated,
and who had been seized with a violent Pain of the Bowels two Days
before his Death, all the small Guts were red and inflamed; and in
another there were livid gangrened Spots on the Stomach[31].

    [31] From the Accounts we have in Authors, of the Dissection
    of the Bodies of Persons who died of the Dysentery, it would
    appear; that there is no Part of the alimentary Canal which
    has not some time or other been found inflamed, or in a state
    of Suppuration or Gangrene; and the Liver, Spleen, and other
    Viscera, have likewise been found diseased, but the Rectum
    and Colon have almost in all been more or less affected. The
    following Account I had, in the Year 1748, from the late Dr.
    _L. Fraser_, who afterwards practised in the Island of
    _Nevis_, two Days after the Patient died. _Mary Reid_, a
    Woman thirty Years of Age, was taken ill of a Dysentery,
    which in Three Weeks Time killed her. In her Life-time she
    complained, more than ordinary, of Gripes in her Belly,
    especially in her Left Side. Her Body was opened in Presence
    of Dr. _Dundas_, who had attended her, during her Illness.
    All the Intestines and Mesentery were inflamed, especially
    the Colon and Rectum; the internal Side of which was quite in
    a mortified State, and contained little Vesicles full of a
    putrid fetid Liquor, Numbers of which she had evacuated by
    Stool some Days before her Death.

There was no Disorder we were more successful in the Cure of, than
recent Fluxes; but after they had continued for Weeks, and were become
in a manner chronic, they often foiled all our Endeavours, and a great
Number died[32].

    [32] While this Sheet was in the Press, I received Dr.
    _Pringle_'s 4th Edition of his _Observations on the Diseases
    of the Army_, and Dr. _Baker_'s Treatise on the _Dysentery
    which was epidemic in London in the Year 1762_. Both these
    Gentlemen give an Account of the Dissection of the Bodies of
    some People who died of the Dysentery; where, besides the
    common Appearances of the inner Surface of the Rectum and
    Colon being covered with a bloody Slime, and their internal
    Coats being inflamed, gangrened, or in a putrid State, there
    were observed on the Inside of the lower Part of the Colon,
    and upper Part of the Rectum, a Number of little Tubercles,
    or Excrescences, which resembled the Small Pox, of a flat
    Sort at the Height of the Disorder; but differed from them in
    this, that they were of a firm Consistence, without any
    Cavity: they were believed to take their Rise from the
    cellular Membrane, which lies immediately above the villous
    Coat. Perhaps such Tubercles might have been found in the
    Colon and Rectum of those Bodies we opened; but not looking
    for them, they may have passed unobserved.

    _Morgagni_, in his Book lately published, _de Sede & Causis
    Morborum_, epist. xxxi. is of Opinion, that the Filaments,
    and Pieces of Membranes, which are frequently observed in the
    Stools, are often formed of inspissated Mucus and Lymph, and
    other Liquors; and not the Fibres, or Pieces of the villous
    Coat of the Intestines, as alledged by many Authors.

Upon my first being employed in the Military Hospitals in _Germany_,
I was surprised to see so many of the old Dysenteric Cases end
fatally; and imagined I had not fallen upon the Right Method of
treating them: but upon consulting the other Physical People[33]
employed in the same Service, I found them as unsuccessful, as myself,
after having tried a Variety of Remedies: And at last, I was
convinced, that when once the Flux had continued long, and injured the
Structure of the Intestines to a certain Length, a Gangrene will
often form by slow Degrees; and the Disorder end fatally,
notwithstanding the Use of what are esteemed the most efficacious
Remedies; and that, when this Disorder is violent, the Cure
principally depends upon an early and speedy Application of proper
Remedies, before the Strength be exhausted, or the Structure of the
Bowels too much hurt. The bad Success we had in treating these old
Cases, may perhaps surprise those who have never practised except in
healthful Cities, where the Disease is commonly mild, and People apply
soon for Advice. But all those Gentlemen who have had the Care of
Military Hospitals, where the Dysentery has been frequent, and where
the Sick have been often sent a great Way, before they reached the
Hospitals, must be convinced of the Truth of what is here asserted.

    [33] Mr. _Cleghorn_, in his _Account of the Diseases of the
    Island of Minorca_, says, "That almost all the Dysenteries
    which fell under my Observation, unless they were speedily
    cured in the Beginning, at best proved obstinate, and too
    frequently fatal, in spite of the many boasted Specificks for
    this Distemper." chap. v. p. 228.--The physical Gentlemen
    employed on the _American_ Service have told me, that the old
    Flux Cases were as fatal in _America_, as we found them in
    _Germany_. I would not from thence have it believed, that
    every old Flux was to be looked on as a lost Case; and for
    that Reason given up, and no Attempts be made to cure it; for
    many, by great Care, and Strength of Constitution, have
    gradually surmounted the Disorder, and recovered their
    Health; especially when they got over the Winter, and lived
    till the warm Weather began.

In the Treatment of this Disorder, as well as of the Malignant Fever,
nothing contributed more to the Cure, than keeping the Sick as clean
as possible, and in large airy Wards.

Most of the recent Fluxes, which I saw, were at first attended with a
good deal of Fever, and Pain in the Bowels; and required more or less
Blood to be taken away, according to the Strength of the Patient, and
the Violence of the Symptoms.

When the Patients were strong, and complained of sharp Pain of the
Bowels, attended with a Fever, we used the Lancet freely, nor were we
discouraged from bleeding in the Beginning by the low quick Pulse
which often attended the Disorder; and we frequently found the Pulse
rise as the Blood flowed from the Vein. But when the Sick were low and
weak, without much Pain or Fever, and the Pulse was soft, we were more
sparing of the vital Fluid[34].

    [34] Although Bleeding, in the Beginning, has been
    recommended by _Sydenham_, _Huxham_, _Pringle_, and other
    Practitioners; yet it has been reckoned unnecessary in this
    Disorder by some late Authors. But in most of the recent
    Cases I saw, it was extremely necessary, and contributed
    greatly to the Relief as well as the Cure of the Patient;
    indeed where the Disorder had already continued some time,
    and the Fever was gone off before the Patient was sent to us;
    and the Disorder had become in a manner chronic, and the
    Patient low, then bleeding was unnecessary, and would have
    probably done Hurt. Mr. _Francis Russel_ told me, that when
    the Dysentery was epidemical at _Gibraltar_, in Summer 1756,
    he found that by bleeding such Patients as he met with at the
    first coming on of the Symptoms, and by giving them
    immediately a Vomit, and afterwards a sudorific Draught, the
    Disorder was rendered mild, and few of those died.

As the Disorder was for the most part attended with Sickness in the
Beginning, we gave a Vomit after bleeding; which not only discharged
the Contents of the Stomach, and a Quantity of Bile, but relieved the
Sickness, and frequently threw the Patient into a breathing Sweat; and
made the Purgatives which were given next Day operate more freely, and
with more evident good Effects than where no Vomit had been
administered.--If in the Course of the Disease the Sickness returned,
the Emetic was repeated; and we often observed, when the Flux was
obstinate, that well-timed Vomits greatly promoted the Cure.--The
Vomit we commonly employed was the Powder of Ipecacuana, which we gave
from ten to twenty Grains; and where the Patient was strong, and we
wanted to make a free Evacuation, we added one, two, or three Grains
of the Tartar Emetic; which encreased the Strength of the Vomit, and
commonly operated likewise by Stool[35], as Dr. _Pringle_ has
observed.

    [35] Mr. _W. Russel_, who was with the Hospital at
    _Martinico_, told me, that, when he was there, he found the
    Vomit with the Tartar Emetic to be far preferable to any
    other, in all Cases where there was much putrid Bile lodged
    in the alimentary Canal; as it speedily carried off those
    corrupt Humours, which were often productive of the greatest
    Mischiefs, if they remained, but for a short Time, pent up
    within the Bowels.

Next Day we ordered a Purge to empty the other Parts of the alimentary
Canal. The Purgative, that at first was most employed for this
Purpose, was Rhubarb; but upon repeated Trials we did not find, that,
in general, it answered so well, in this first Stage of the Disorder,
as the _sal catharticum amarum_, with Manna and Oil; which operated
without griping or disturbing the Patient, procured a freer
Evacuation, and gave greater Relief than any other purgative Medicine
we tried. Mr. _Francis Russel_, Surgeon to the _British_ Military
Hospital in _America_, who was formerly Surgeon to the Island of
_Minorca_, was the first Person who informed me (in the Year 1757) of
the Use of the _sal catharticum amarum_ in the Dysentery; he told me,
that the Year before (1756) the Dysentery had been very frequent and
very fatal at _Gibraltar_; and, after trying Variety of Medicines, he
had found nothing give more Relief, or contribute more to the Cure,
than repeated Doses of these Salts.

As a great Part of the Cure depended on the frequent Use of gentle
Purges[36] in the Beginning, to carry off the corrupted Humours; the
Purgative was repeated every second, third, or fourth Day, as the Case
required; the Operation of the former Purge, and the Symptoms,
determining the Frequency of the Repetition. It was surprising with
how little Loss of Strength the Sick bore the Operation of these
Purges; I have sometimes given them to strong People every Day, for
two, three, or four Days successively; and observed that the Patient,
instead of being weakened, seemed stronger, and more brisk and lively,
after the Operation of each, from the Relief it gave; by evacuating
those putrid, corrupted Humours, which kept him perpetually sick and
uneasy, while they remained within the Bowels.

    [36] Variety of Medicines have been recommended to answer
    this Purpose.

    The _vitrum ceratum antimonii_ proved often too rough a
    Medicine, and therefore we laid it almost entirely aside.

    Repeated small Doses of the Ipecacuana, from four to six
    Grains, operated both as an Emetic, and kept up a Purging;
    but they made the Men so sick, that we could not prevail upon
    them to continue their Use. Mr. _Francis Russel_ told me,
    that, in the Year 1756, he found a few Grains of Rhubarb
    added to each Dose, made it operate more as a Purgative, and
    did not make the Men so sick.--Dr. _Akenside_ proposes giving
    the Ipecacuana in so small Doses as one or two Grains every
    six Hours, in a Draught made of Mint-water, and Half a Drachm
    of _confectio cardiaca_; and, after bleeding and vomiting
    once, seems to depend almost entirely on the Use of this
    Medicine for the Cure of the Dysentery. See his _Comment. de
    Dysenteria_, cap. 2.

    The watery Tincture of Rhubarb, recommended by _Degnerus_, we
    tried in some Cases at Bremen; and found it to be a good mild
    Purge, but not to answer so well as the Salts and Manna in
    recent Cases. Mr. _William Russel_ told me that they found
    this watery Tincture of Rhubarb to answer better in _America_
    than any other of the Preparations of Rhubarb.

    Calomel has been recommended by many as a Purge in
    Dysenteries; and Dr. _Huxham_ (_de Aere_, Vol. II. P. 100)
    assures us, that he has often experienced the good Effects of
    it, especially when the Patient at the same time had Worms;
    in such Cases we joined it to Rhubarb as mentioned in the
    Text, or gave a Calomel Bolus over Night, and a Purge next
    Morning. Dr. _Duncan_, Physician to his Majesty, told me,
    that he found the following Method of Cure always successful
    in the Dysentery, which was epidemic in _London_ in the Year
    1762.

    If the Patient was Plethoric, or had much Fever, he ordered
    more or less Blood to be taken away; and then gave four
    Ounces of the following Julep, every Half Hour, till it both
    vomited and purged. Rx _Tartar. emetic. gr._ iij _Mannae elect.
    Unc._ ij _solve in Aq. hordeat. Lib._ 1.--The next Day, and
    for five or six Days more, the Patient took so much of a
    Decoction, of Manna, Tamarinds, and soluble Tartar, as kept
    up a free Discharge by Stool.--If the Irritation and Griping
    were severe, he found that a Solution of Manna, in the common
    Almond Emulsion, was sufficient.

    When the Pain, or Tenesmus, was violent, a Clyster, of
    Chicken Broth, or of an Infusion of Linseed, with an Ounce or
    two of Oil of sweet Almonds dissolved in the Yolk of an Egg,
    injected once or twice a Day, was of great Use.

    Upon the whole, he was always pleased when he saw large
    excrementitious Stools come away; and when that could be
    procured by a gentle Method, he was the more pleased.

    This Disorder was very often cured in a few Days, and in that
    Case he dropt the further Use of Medicines; but when it
    exceeded the Period of six or seven Days, he then added
    thirty or forty Drops of the _tinctura thebaica_ to the
    Clysters; and ordered a Scruple of the Extract of the Logwood
    to be taken thrice a Day in some proper Vehicle.

    The Patient's Diet was Rice-Gruel, Sago, Panado, and such
    like; no Animal Food, not so much as Chicken-Broth, was
    allowed in the Beginning of the Distemper, nor even Oil,
    Butter, or Fat of any Kind. The common Drink was Almond
    Emulsion, Rice-Water, or Barley-Water with Gum Arabic.

    Dr. _Duncan_ lost but one Patient out of Eighty, whom he had
    under his Care that Season; and he was delirious, had a high
    Fever, and a _subsultus tendinum_ before the Doctor was
    called to him, and he died the next Day.

    The late Dr. _Young_, of _Edinburgh_, seems to have had a
    very just Notion of this Disorder, and of the proper Method
    of treating it; for, in his Treatise on Opium, sect. vii. he
    says, "I am convinced from Experience, that most of the
    Dysenteries I have hitherto met with, might have been cured
    by purging mildly, but constantly; and at the same time
    abating the Acrimony in the great Guts by emollient Clysters,
    and in the small ones by Plenty of Absorbents, and a Diet of
    Chicken Broth: But it must be observed with regard to
    Purgatives, that Manna agrees best with some, Rhubarb with
    others, Jalap, Mercury, and toasted Rhubarb with others;
    while others are sooner cured by emollient Clysters. I use
    Opium only when the Disease is mild, or after its Violence is
    abated by Evacuants and Emollients."

    Scammony, Aloes, and the other strong resinous and hydragogue
    Purges, are hurtful, and occasion Pain. I always observed,
    that those Purges answered best which made the freest
    Evacuation, and acted with the greatest Ease to the Patient;
    of which the Salts and Manna answered best of any I have
    hitherto used.

Though Rhubarb did not answer so well in the Beginning as the saline
Purges; yet afterwards in the Course of the Distemper, when the
Patient did not complain much of Gripes, half a Drachm of Rhubarb,
either by itself or in a saline Draught, proved a good gentle Purge;
and given with six or seven Grains of Calomel, was found to be a good
Medicine, when the Disorder was attended with Worms.

In the Evening, after the Operation of the Purge, we gave an Opiate;
and repeated it at Nights, in the Intervals between the Purges; but
were obliged to be very sparing of the Dose, while the Disorder
continued in its acute State; the Opiate was only given in a Quantity
sufficient to mitigate the Pain, and to procure Rest, but never so as
to stupify the Patient, or prevent a due Discharge by Stool; though we
were often obliged to encrease the Dose, as Use made it familiar to
the Patient.

In the Intervals between the Purges, we gave in the Day, the Mindereri
Draughts with the Mithridate; or the saline Draughts with the Addition
of four Drops of the _tinctura thebaica_; or some such mild
diaphoretic, every four or six Hours; which helped to keep up a free
Perspiration, without any Danger of stopping the Purging; and for the
most part answered much better than the Diascord, or Philonium, or
other strong Astringents and Opiates commonly prescribed for this
Purpose; which were always liable to check the Purging too much, and
bring on severe Gripes attended with Heat and Fever[37]; and therefore
we seldom made Use of them in this first Stage of the Disorder.

    [37] _Sydenham_, _Huxham_, and all good Practitioners, have
    taken Notice of the bad Effects of the too free Use of
    Astringents, and given Cautions against it.

If the Patient was attacked with severe Gripes[38], and a Tenesmus,
which the Purgatives and gentle Opiates did not relieve, we ordered
the Abdomen to be fomented with warm Stupes; and the Patient to drink
freely of warm Barley or Rice-water, or of weak Broth[39], or an
Infusion of Camomile Flowers, as recommended by Dr. _Pringle_; and
ordered first Clysters of large Quantities of the plain emollient
Decoction to be given; and if the Gripes still continued, to be
repeated in small Quantities, with the Addition of a Drachm or two of
the _tinctura thebaica_; for we observed that Opiate Clysters often
gave more Relief, than Anodynes administered in any other Way; and
sometimes, when a Tenesmus was very troublesome, the common oily
Clyster, with a little Diascord, and _tinctura thebaica_, or the
Starch Clyster, gave more Ease than any other.--In some Cases, where
the Pain was sharp, attended with a Fever, we were obliged to take
away more or less Blood; and sometimes also to apply a Blister to that
Part of the Abdomen where the Patient felt most Pain.

    [38] If the Patient was suddenly attacked with sharp Pain of
    the Bowels and Gripes, on a Day in which he had not Physic, a
    Dose of the Salts and Manna was commonly given immediately,
    to empty thoroughly the first Passages.

    [39] Mr. _W. Russel_ told me, that he and Dr. _Huck_ found
    the free Use of the following Emulsion, made of Bees Wax, to
    be of great Use after Evacuations, where there was much Pain
    of the Bowels, in recent Cases of Fluxes in the Hospitals in
    _America_. Rx. Cerae alb. vel flavae drachmes tres. Sapon. alb.
    Hispan. drachmam unam. Aquae fontanae, unciam unam, liquefiant
    super ignem in vase ferreo, agitando spatula, & dein infunde
    in mortarium marmoreum, & adde paulatim aq. fontanae, libras
    duas syrupi sacchari. spiritus vini gallici tenuis, vel aquae
    alicujus spirituosae ana unciam unam, terendo optime ut fiat
    emulsio.

    This Method of dissolving Bees Wax, in a Watery Liquor, is
    entirely new; for before this we knew of no Way of making it
    miscible with Water.

During this Course, the Patients used the common low Diet of the
Hospital; when they loathed the Rice-Gruel, they had Panado with a
little Red Wine and Sugar; or Water-gruel, when it could be got, in
its Place.--Their common Drink was Barley or Rice-water; of which it
was recommended to them to drink plentifully; as nothing contributed
more to the Cure than the free Use of such Liquors, to dilute and
blunt the Acrimony of the Fluids[40]. In some Cases, when the Purging
was violent, and not accompanied with the malignant Fever, the
_decoctum album_ was found to be a good Drink; and we added
occasionally a few Drops of the _tinctura thebaica_.

    [40] Dr. _Huxham_ (_de Aere_, Vol. II. p. 107.) says, there
    is no Disorder in which a diluting, sweetening Drink is more
    necessary than in this; that he has done great Service among
    the Poor by luke-warm Water; that, after emptying the Bowels
    thoroughly, he has sometimes cured this Disorder by the Use
    of pure Water, and a small Quantity of Opium. And _Baglivi_
    (_Prax. Med._ lib. i.) tells us, that the drinking of common
    Whey, and throwing up frequent Clysters of it, had cured
    many, and that this was looked upon as a Specific, and kept a
    Secret by some.

Such were the chief Remedies we used in the first Stage of this
Disorder; but after some Weeks, when the Fever had abated, and free
Evacuations had been made, and the Complaint become in a manner
chronic, we were obliged to try other Methods; and found that the best
Way of treating this Disorder, was, to endeavour to brace and restore
the Tone of the Intestines, by means of the corroborating and gentle
astringent Medicines, mixed with Opiates; while mild Purgatives were
given at proper Intervals.

The Patients were kept to the same low Diet as before, with the
Addition of a little Wine or Brandy. They were allowed from a Gill to
a Pint of red Wine _per_ Day, which was commonly mulled before it was
given them; when the Wine griped them, which it frequently did, they
took in its Stead Half a Gill or a Gill of Brandy, mixed with a Pint
or a Quart of Barley or Rice-water, or of the _decoctum album_.

In this Stage of the Disorder we found, that the same Medicines would
not answer with all, and therefore we were obliged to try Variety[41];
and indeed, unless where the Violence of the Disorder had abated by
the Use of Evacuations, the Event was always very doubtful; for when
the Complaint had continued long and become chronic, and the Structure
of the Intestines was much hurt, before the Sick were sent to us; or
when it continued obstinate, and yielded but little to Evacuations,
and the other Methods used in the first Stage, even Remedies esteemed
the most efficacious oftentimes proved unsuccessful, and at length
the Patient died.

    [41] Dr. _Pringle_, in the _fourth Edition of his
    Observations_, just published, in treating of the third or
    last Stage of the Dysentery, remarks, that this is the Time
    for Astringents, which ought not to be given sooner, or at
    least very sparingly. And he tells us, that, in the former
    Editions of his Work, he mentioned those Compositions which
    he had most frequently used, but that he had now laid most of
    them aside; and at present trusts to Vomits, and to a Milk
    Diet, for the perfect Cure.

    He says, "Whenever therefore the Patient is in this State,
    and especially when his Pulse is quick, and he complains of
    inward Heat, I began with giving him a Scruple of Ipecacuana;
    and the next Day I put him upon the Milk-Diet; which I
    continue till all the hectic Symptoms are gone, and till the
    Bowels have recovered their Tone. During this Course I have
    seldom had Occasion for any other Medicine, excepting the
    Chalk Julep mentioned before, which I use for correcting that
    strong Acid so incident to relaxed Stomachs. Sometimes also I
    add an Opiate to procure Rest at Night; but after a few Days
    these are likewise laid aside. All that I require (which
    indeed is often hard to obtain) is a strict Perseverance in
    the low Diet: and now and then a Repetition of the Vomit,
    upon any new Disorder of the Stomach, or great Laxity of the
    Bowels.

    "Whilst the Patient continues in this Course, I forbid all
    animal Food and fermented Liquors; and besides Milk, I allow
    only the Preparations of Grain, Sago and Salop." See Part
    iii. ch. vi. p. 289, 290.

A Spoonful of the _mixtura fracastorii_, taken after every loose
Stool; and an anodyne Draught at Night, had a good Effect with
some--Repeated Doses of the _philonium Londinense_ answered better
with others, who were low, and required a Remedy that was warm and
cordial--And others found more Benefit from the Mindereri Draughts,
with Mithridate, or the _confectio cardiaca_, or the Theriac anodyne
Boluses.

The _mixtura Campechensis_, both alone and with _tinctura thebaica_,
checked the Purging, and gave Relief sometimes; and the Addition of
some of the Extract of Bark and Tincture of Cinnamon, seemed to
encrease its Efficacy in one or two old Cases, at _Bremen_; but it
afterwards occasioned such Sickness, that we did not continue its Use.

In other inveterate Dysenteries, where we thought that a strong
Astringent was wanted, we added a small Proportion of Allum to the
_Campechense_ Julep, which on first using seemed to be serviceable;
but at other Times it occasioned a Tenesmus and Gripes; and therefore
we were obliged to be very cautious how we used it.

Equal Parts of the _electuarium diascordii_ and _electuarium
corticis_, taken in the Quantity of a Drachm twice or thrice a Day,
was of Use in many old Fluxes[42], though it made other Patients so
sick, that they were obliged to lay it aside.

    [42] I had lately a very remarkable Instance of the Effects
    of this Medicine, in the Case of one _Gilchrist_, a
    middle-aged Man, by Trade a Taylor; who was admitted into
    _St. George_'s Hospital the 20th of _July_, 1763, for an old
    Flux, which had continued above six Months, and reduced him
    very low: He had taken a great many Medicines without any
    Effect. After giving him a Vomit and two Doses of Tincture of
    Rhubarb, I gave him four Grains of the Powder of Ipecacuana
    with Opium three Times a Day; but that having no Effect,
    after using it for above a Fortnight, I ordered him the
    Electuary of Diascord and Cortex; from the Time he began to
    use this Medicine, he mended daily; and was dismissed in good
    Health the 26th of _September_.

We tried likewise in this Stage of the Disorder, repeated small Doses
of the Ipecacuana; but it occasioned such Sickness, that we did not
persist in its Use.

In other Cases, we gave from two to five Grains of the Ipecacuana,
mixed with Opium, in different Proportions (from three Grains to ten
of the Ipecacuana to one of the Opium), every four or six Hours; it
gave sometimes a little present Ease, at other Times it occasioned
Sickness; we often continued its Use for ten, twelve, or fourteen
Days; but it seldom produced any remarkable Change for the better, and
we were obliged to have Recourse to other Remedies.

_Dover_'s Powder was given in large Doses, from one Scruple to two;
and proved a good Sudorific and Anodyne in some Cases; though in
others it made the Patients sick, without producing any good
Effect.--It commonly answered better, when used occasionally as a
Sudorific, than when constantly continued.

During the Use of these Remedies, it was necessary to repeat the
Purgatives from Time to Time; or to mix them occasionally with the
other Medicines, in order to carry off any corrupted Humours, or
Excrements that might be lodged In the Cavity of the Intestines; for
when this was neglected, the Patients were often seized with Sickness
and Gripes, and a more violent Purging than before:--And if at any
Time they complained of Gripes, and passed little Pieces of hardened
Excrements, it was mostly a certain Sign that a Purge was indicated;
and, on such Occasions, it generally gave Relief; and when attended
with Sickness, a Vomit was given before the Purge.--Clysters were used
as in recent Cases, where the Sick were low, or had much Pain of the
Bowels[43], or complained of a Tenesmus.

    [43] On the 21st of _November_, 1759, _Hanah Meredith_, a
    middle-aged Woman, was admitted into _St. George_'s Hospital
    for a Flux, which she had six or seven Weeks; she had no
    Fever, but complained much of Sickness and Gripes, and her
    Disorder had reduced her very low. During the two first Weeks
    of her being in the Hospital, she had two Vomits of
    Ipecacuana and four Doses of Rhubarb; and in the Intervals
    anodyne and astringent Medicines, which made no Alteration in
    her Complaints. On the 2d of _December_, she told me, that
    two Years before she had had a Flux for above three Months,
    which had yielded to no Remedies till she was ordered
    repeated Clysters, and that they had made a Cure in a short
    Time. I then ordered an emollient Clyster with a drachm of
    the _electuarium diascordii_, and a Scruple of the _tinctura
    thebaica_, to be given twice a Day, which gave her almost
    immediate Relief; and with the Assistance of some Doses of
    Rhubarb, and one or two Vomits and occasional Opiates,
    removed her Disorder by the Middle of _January_; though she
    remained long weak, and troubled at Times with Gripes; but
    these Complaints were at last got the better of by her taking
    some Doses of Rhubarb, and drinking daily a Pint of Lime
    Water mixed with Half a Pint of Milk.

    _Sarah Spencer_, a middle-aged Woman, was admitted into _St.
    George_'s Hospital the 9th of _November_, 1763, for a Flux,
    which had continued for two Months, and reduced her very low.
    She complained much of Sickness and Gripes; her Stools were
    mostly composed of Mucus and Blood; her Pulse was low, and
    she had no Fever, but a Whiteness of the Tongue, and
    complained of Thirst.--The first Day she had a Vomit, and
    next Day a Dose of the purging saline oily Draught.--She was
    ordered to have an emollient Clyster, with a Drachm of
    Diascord, and as much _tinctura thebaica_, given her every
    Evening; and to have a Dose of the saline oily Purge twice a
    Week, and Opiates occasionally; by following this Course, and
    drinking at Times the Chalk Julep, her Disorder was removed,
    and she was discharged the Hospital on the 30th of the same
    Month.

In some old Dysenteries, where the villous Coat of the Intestines was
much injured, I gave the Cordial Draughts, with the Addition of Half a
Drachm of the _balsamum copaivi_, a Scruple of the Extract of the
Bark, and five Drops of the _tinctura thebaica_, three Times a Day.
At first, this Medicine seemed to promise much, particularly in the
Case of an old Invalid, _William Brookes_; who had been long ill of a
Flux, attended with Gripes and a Tenesmus. He had used Variety of
Remedies, without receiving any Benefit. For the first Fortnight,
after he began the Use of this Medicine, he rested well, and found
great Relief; and seemed to be in a fair Way of doing well. But the
Disorder being too far advanced before he began to use it, he
relapsed, and died. On opening his Body, the inner Coats of the Rectum
and the lower Part of the Colon seemed to be reduced almost to a
gelatinous Substance, and the other Coats were black, approaching to a
Gangrene.--The same Medicine gave Relief in other Cases, but they were
too far advanced before it was administered. In these Cases, when the
villous Coat of the Intestines was inflamed and very irritable, the
mucilaginous Medicines, the _pulvis e tragacantha_, and such others,
were of Service; and frequently Starch Clysters and Anodynes gave
Relief, when other Remedies had little Effect. Flower, boiled with
Milk, and sweetened with Sugar, and given for Breakfast, as mentioned
by Dr. _Pringle_, proved a good Palliative to some; and the Starch and
Gum Arabic, dissolved in Water, a good Drink to others.--Lime Water
and Milk, drank to the Quantity of a Pint or a Quart a Day, was of use
to a few, though it did not agree with all.

It was very common for Patients bad in the malignant Fever to be
seized likewise with the Flux. Such Cases were always extremely
dangerous; and when the Fever was bad, we were often obliged to
neglect the Flux, and only attend to the Fever.--When the Purging was
violent, and appeared very early in the Fever, it often sunk the
Patients, and soon carried them off: but where it was moderate, and
did not appear till towards the Height or the Decline of the Fever, it
often proved a Crisis to the Disorder.

When such Fluxes appeared early attended with sharp Pain of the
Bowels, and Signs of Inflammation; if the Patient was strong, we
began the Cure with opening a Vein, which the Patient bore easily, and
it gave Relief; but when the Symptoms were mild, without any acute
Pain, the Bleeding was omitted.--Commonly the Bowels were loaded with
corrupted Humours, when this Symptom appeared; and, therefore, we
found it of Advantage to give a Dose of the Salts with Manna and Oil,
or some other gentle Purge, to carry them off; and in the Evening an
Opiate to ease the Pain and procure the Patient Rest.

After this we gave the Mindereri Draughts with Mithridate; and as soon
as the Petechiae appeared, or we observed any Remissions in the Fever,
the Patient took every four or six Hours, a Drachm of an Electuary,
composed of equal Parts of the _electuarium corticis_ and the
_electuarium diascordii_[44]; or Half a Drachm of the Powder of the
Bark, or a Scruple of the Extract, in the Mindereri Draughts, with
four or five Drops of the _tinctura thebaica_; and we repeated the
Opiate in the Evening, always proportioning the Quantity of it to the
Effects of the former Dose, and the Violence of the Purging.

    [44] This Practice of giving the Cortex with Opiates in the
    Dysentery is not new; for Dr. R. _Morton_, in his Appendix to
    his second Exercise on the Fevers, which appeared from 1658
    to 1691, observes, that after the Plague of 1666 had ceased,
    a Fever from a milder Poison, attended with Gripes and
    Dysentery, began to make its Appearance. As the common
    Methods of Cure proved unsuccessful, and Dr. _Morton_
    observed Exacerbations and Remissions, he resolved to give
    the Bark mixed with Laudanum; and found it answer his
    Expectation. The first Patient to whom he gave it, was a man
    in _Long Lane_, who laboured under a Tertian Dysentery; upon
    observing a Remission, he ordered a Drachm of the Bark, mixed
    with a Grain of Opium, to be given every four Hours for six
    Times; and this removed both the Fever and Dysentery.--He
    says, he afterwards gave it, with equal Success, in the
    Quotidian Dysenteries, where he observed Exacerbations or
    Remissions; and he adds, that he does not doubt but that it
    will answer as well in Epidemical Diarrhoea's, and Camp Fevers
    attended with such Symptoms.

    Dr. _Whytt_ of _Edinburgh_ has given with Success a strong
    Decoction of the Bark, mixed with the _confectio japonica_ of
    the _Edinburgh_ Dispensatory, in the bad State of the
    Dysentery, when the Mouth and alimentary Canal were
    threatened with Aphthae, and even sometimes after they had
    appeared. And Dr. _Pringle_ mentions his having given the
    Decoction of the Bark, with Snake-Root and some Drops of
    Laudanum, in the Dysentery complicated with the malignant
    Fever. See _Note to Page 245 of his third Edition on the
    Diseases of the Army_.

On the second or third Day, we repeated the Purge; or, if the Patient
was weak, ordered a Clyster to be administered in its Place; in order
to prevent the putrid Fluids and Excrements from being accumulated in
the Bowels:--In other respects we treated it as when the Disorder was
not complicated with the malignant Fever.

This Method, though it did not succeed with all, yet it answered
better than any other I tried;--and it ought to be remarked, that
although it had such a good Effect in Cases attended with the
malignant Fever, or where the Fever inclined to the intermittent Kind,
it did not answer so well in other recent Cases, but often made the
Patient sick.

In military Hospitals, Fluxes are liable to be complicated with other
Disorders, as well as with the malignant Fever; especially with
Coughs, and pleuritic and peripneumonic Symptoms, when the Weather
begins to be cold, in _October_ and _November_.--In such Cases, when
the Patients were strong, we were often obliged to bleed freely, to
apply Blisters, and in the Beginning treat the Disorder as
inflammatory; having at the same Time an Eye towards the Flux, in the
other Medicines we prescribed.

Patients, who have had the Flux long, are apt to have their Legs swell
at Nights; or to swell all over as soon as the Flux has stopped. Such
oedematous or anasarcous Swellings, we treated nearly in the same
Manner as those which followed the petechial Fever; only that we durst
not at first be so free with the Use of Purgatives; for as the Bowels
remained weak and easily irritated, such Medicines were apt to bring
back the Flux; and therefore, in the Beginning, we were for the most
part obliged to attempt the Cure by Diuretics and Diaphoretics; and to
be sparing of the Use of Purgatives, especially of those of the
hydragogue Kind; though if the Swellings continued for some Time after
the Flux was gone off, and the Patients were strong, we then ventured
to give Purges at proper Intervals:--And Blisters and Scarifications
removed them in several Instances both at _Paderborn_ and
_Osnabruck_.

In _December_, 1761, we had a Case of this Kind where the _oxymel
scilliticum_ was of remarkable Service. A Soldier, belonging to the
Guards, after a Flux, swelled all over, and made but a very small
Quantity of Water. He took Medicines of different Sorts for some
Weeks, but received no Benefit till we gave him the Oxymel Mixture;
after taking a few Doses he made Water very freely, and in large
Quantities, and the Swellings of his Body and Scrotum began
immediately to subside; and by continuing its Use for a Fortnight, the
Swellings entirely disappeared, and he recovered his Health and
Strength.--The Oxymel, at the same Time that it promoted a Flow of
Urine, kept his Body gently open, but did not occasion any Return of
the Flux.

At the Beginning of _January_, 1762, one _Carter_, a Soldier of the
Eleventh Regiment of Foot, laboured under an universal Anasarca; which
about two Months before had succeeded a Flux. He made but very little
Water, and that of a high red Colour. He took Variety of Medicines,
as Purges, Vomits, _Dover_'s Powder, lixivial and neutral Salts with
Opiates, Infusions of Horse-Radish, all without Effect; till he was
ordered small Doses of Calomel, three Grains Morning and Evening.
After the third Dose he began to make Water freely; and by the 24th of
_January_ the Swellings were all gone, and he was shipped off for
_England_ the 8th of _February_; having been discharged from his
Regiment. The Ship, he went aboard of, was detained in the River
_Weser_ for above six Weeks, and the malignant Fever broke out aboard
the Transport: He took the Distemper, and got well of it; but towards
the Decline was seized with a Return of the Flux, which carried him
off.

When these oedematous Swellings came after the Purging was stopt, if
the Patient's Strength was not much exhausted, and he laboured under
no other Disorder, he commonly got the better of it:--But when the
Strength was gone before the Swellings appeared, the Disorder often
ended in a confirmed Dropsy, and at last in Death; and when the
Swellings were universal over the Body, while the Flux yet continued,
it was a Sign of great Weakness, and they did not survive it long[45].

    [45] Many other Medicines have been used for the Cure of old
    Dysenteries,--The _Conessi Bark_, recommended as a Specific
    in Diarrhoeas, cured a Dysentery which had yielded nothing to
    a Variety of Medicines. _Edinburgh Medical Essays_, _Vol._
    III. _Art._ iv.--The _cortex eleutheriae vel cascarillae_ is
    much recommended for the Cure of Dysenteries in the _Memoir.
    de L'Academie des Sciences a Paris_ 1719, and is still in
    great Repute among the _Germans_.--The Decoction of the
    _semiruba_ Bark was found to have a good Effect in the
    Dysentery, where the Patient continued to void Blood with his
    Stools; and when the Stools were only liquid, without a
    Mixture of Blood, some of the Cascarilla added to the
    Decoction encreased its Efficacy. See _Degnerus_'s Treatise
    _de Dysenteria_, _cap._ iii. _sect._ 55. These and many other
    Remedies have been tried in obstinate Dysenteries.

    From what I have observed myself, and from the Accounts of
    others, I am now convinced, that such Cases as are not
    already too far gone, are most likely to be cured,

    1. By keeping the Patients on a low Diet, composed
    principally of Milk, Sago, Rice, Salop, and such other Things
    as are recommended by Dr. _Pringle_; allowing weak Broths,
    and a small Quantity of white Meat, as they recover their
    Strength. The common Drink to be Barley or Rice-Water, Toast
    and Water, _Bristol_ Water, Almond Emulsion, and such
    like.--By making them wear some additional Cloathing, and
    guarding carefully against catching cold.--Errors of Diet and
    Exposure to Cold being the most frequent Causes of Relapses
    into this Disorder.

    2. By giving from Time to Time a Dose of some mild Purge;
    such as a little Manna and Salts; a Solution of Manna in
    Almond Emulsion; twenty or thirty Grains of Rhubarb, in a
    saline Draught, or such like; and occasionally gentle
    Emetics.

    3. By the Use of some of the mild Astringents and
    Corroborants.--The Bark, with Astringents and Opiates,
    agreeing best with some--Decoctions of the Semiruba with
    others--Chalk in Electuaries, or Juleps, with others--anodyne
    and astringent Clysters with others--while others receive
    more Benefit from other Remedies--and severals find
    themselves better when they use no Medicines of this Kind.

    4. And by the occasional Use of Opiates, and a free Air: And
    by moderate Exercise on Horseback, or in a Machine in the
    convalescent State.

    I ought not to omit mentioning, that I have seen some Cases
    where Evacuations had been used in the Beginning, which,
    after they had continued for some Time, were cured by a
    regular Diet of Broths, and white Meats; riding daily on
    Horseback; and drinking a generous good Claret Wine. However,
    it ought to be remarked, that this Method only succeeded
    where the Disorder was mild, and its Violence had abated by
    previous Evacuations.




OF THE CHOLERA MORBUS.


The Cholera Morbus, or a sudden and violent Vomiting and Purging, was
very frequent in _July_ and _August_ 1701; and several were attacked
with it at _Munster_.--It was attended with great Sickness, with Pain,
and Inflation of the Abdomen, Thirst, and a small quick Pulse: Some
had it in a pretty violent Degree, but in general it was mild; and
although the Sickness, Vomiting, and Purging, continued, in one or two
Cases, for above a Day; yet none of those died whom I saw.

This Disorder weakens the Patient much, in a short Space of Time; and
sometimes, when violent, kills in less than twenty-four Hours. It is
always most frequent in Summer and the Beginning of Autumn; and is
taken Notice of by _Hippocrates_, _Aretaeus_, _Celsus_, and other
antient Authors; and is very accurately described by many of them.--It
is of the bilious Kind; and the Cure principally depends upon the free
Use of warm mild Liquors in the Beginning; to dilute and blunt the
Acrimony of the Bile, and other Fluids, and to promote their
Discharge; and afterwards of gentle Cordials to support the Strength;
and warm Fomentations to allay the Pain when violent; and mild Opiates
to procure Rest; and if the Sickness or Griping remains next Day after
the Cholera is stopt, to give a Dose of Physic and an Opiate in the
Evening.

An Officer, who had been wounded on the 15th of _July_, at the Battle
of _Fillinghausen_, began afterwards to live very freely, and was on
the 4th of _August_ seized in the Night with the Cholera.--About ten
o'Clock next Day I was sent for; and found him in violent Agony, with
sharp Pain in the Bowels, Reachings, and Strainings to Vomit, and
Spasms and Cramps in the Bowels, Legs, and Arms.--He had large red
Blotches on his Extremities, and no Pulse was to be felt at the Wrist,
and rather a Fluttering than a Beating at the Heart.--He had vomited
and purged much in the Night before I saw him, but the Purging had
begun to abate.--I immediately ordered him an emollient Clyster, and a
saline Draught, with the _confectio cardiaca_, and five Drops of
liquid Laudanum; which, if he vomited up, was to be repeated soon
after; if not, only once in four Hours: And he was directed to drink
freely of weak Chicken Broth, warm.--Two Hours afterwards we found him
in the same Situation; still no Pulse to be felt, which prevented us
from bleeding him; and the violent Pain of the Stomach and Bowels, and
the Cramps, continued. We then ordered Flannels, dipped in a warm
emollient Decoction, to be kept constantly applied to his Belly,
dipping them in the warm Decoction as soon as they began to grow cool;
his Clyster to be repeated with the Addition of a Drachm of the
_electuarium e baccis lauri_, and Half a Drachm of the _tinctura
thebaica_; a Scruple of Castor, and Half a Drachm of Spirit of
Lavender, to be added to each of his Draughts; and a Blister to be
prepared, in case these Medicines gave no Relief.--Soon after,
beginning to use the Fomentations, the Cramps and Pains began to
abate; about four o'Clock in the Afternoon we could perceive a
Fluttering of the Pulse at the Wrist, and all the Pains and Cramps
were much easier; so that there was no occasion for the Blister.--Next
Morning he was very easy, but low, and inclined to be sick; for which
his Cordial Draughts were repeated every six Hours.--The third Day, as
he complained of a little Griping in the Bowels, we ordered him a Dose
of Tincture of Rhubarb, and an Opiate in the Evening, which entirely
removed these Complaints, and he was abroad and well next Day.

One Soldier, who had a good deal of Fever, and complained of acute
Pain in the Bowels, along with the Vomiting and Purging, was blooded;
and drank freely of warm Barley-Water while the Vomiting
continued.--After throwing up a Quantity of green bilious Matter, the
Vomiting ceased; and the Gripes and Purging became less violent.--In
an Hour after, being able to retain some very weak Broth in his
Stomach, he drank plentifully of it through the Day; and the Purging
being abated towards Night, he took an anodyne Draught; and next Day,
having still a little Sickness remaining, had a Dose of Physic and an
Opiate at Night, which removed all his Complaints.

The Rest, who were attacked with the Cholera at _Munster_, were
treated much in the same Way; only as they had not such acute Pain and
Fever as this Man, it was thought unnecessary to bleed them.

The Antients[46] recommended drinking freely of warm Water in the
Beginning, and the Use of both cold and hot Fomentations of the
Stomach and Belly;--and in the low State, the Use of Wine, mixed with
Water, and Polenta[47]; and to apply Rue, with Vinegar, and other
strong smelling Things, to the Nostrils; besides Variety of other
Remedies.--When Convulsions happen, _Celsus_[48] advises to anoint the
Belly with warm Oil; and if that does not remove them, to apply
Cupping-Glasses or Mustard to the Stomach; and, after sleeping, to
abstain the second Day from Drink; and the third, to go into the Bath;
and if any thing of a Fever remains after the Cholera is suppressed,
to give a Purge.

    [46] See _Aretaeus_, Lib. ii. Cap. 4. and _Celsus_, Lib. iv.
    Cap. 11.

    [47] The Polenta seems to have been nothing but toasted
    Barley Meal. See _Plinii Hist. Natural._ Lib. xxii. Cap. 25.

    [48] _Celsus loco citato._

Dr. _Sydenham_[49] trusts principally to drinking freely of Chicken
Broth, and throwing up Clysters of the same, and afterwards giving
Opiates.

    [49] _Processus integ. de Cholera._

Dr. _Ayton Douglas_, in the sixth Volume of the _Edinburgh_ Medical
Essays[50], recommends a Decoction of Oat Bread, baked without Leaven
or Yest, and carefully toasted as brown as Coffee, but not burnt; as a
Remedy very grateful to the Stomach, and useful in stopping the
Vomiting, and sometimes the Purging too: And he relates several Cases
where it had a good Effect. After the Vomiting was stopped, he added
the Use of mild Opiates; and, where the Patient was low, Wine and
other Cordials.

    [50] Art. 65.




OF THE INFLAMMATORY FEVER.


On the Return of the Troops from the Winter Expedition into the
Country of _Hesse_, in the Year 1761, we had several Men seized with
Inflammatory Fevers without any topical Inflammation; and at the
Opening of each Campaign had always Numbers sent to the Hospitals ill
of this Disorder. Towards the End of the Campaigns, and throughout the
Winter, many were seized with Inflammatory Fevers; but these were
mostly complicated, with pleuritic, or peripneumonic Symptoms, or
other topical Inflammations, or with rheumatic Complaints.

In the Inflammatory Fever, the Sick were seized at first with cold and
hot Fits, succeeded by Pain in the Head and all over the Body. The
Pulse was strong and quick, and the Blood sizy; attended with other
Appearances commonly observed in such Fevers.

As the Summer advanced, this Fever was often accompanied with bilious
Symptoms, with Sickness, and vomiting of bilious Matter, and very
frequently with a Purging: Towards the End of Summer it ceased, and
was succeeded by the bilious remittent Fever.--And it was no uncommon
Thing to see those Fevers, which originally were entirely of an
inflammatory Nature, after the sick had been some Days in a crowded
Hospital, partake a good deal of the Nature of the Malignant Fever, or
be changed entirely into it.

We treated these Fevers in the common antiphlogistic Method.--We
blooded freely in the Beginning; gave the saline Draughts with Nitre
and other cooling Medicines; and made the Patients drink plentifully
of small Liquors:--And when they were inclined to be costive, gave
mild Purges, or emollient laxative Clysters. We afterwards applied
Blisters; and if the Pulse began to sink, gave Cordials, Wine, and
other Remedies commonly employed in such Cases;--and towards the
Decline of the Fever endeavoured to promote such Evacuations as were
pointed out by Nature, and likely to prove critical.

When the Case was complicated with bilious Symptoms in the Beginning,
we were obliged to have particular Regard to the first Passages. If
the Patient complained much of Sickness, we gave a gentle Vomit in the
Evening, after bleeding; and a Purge next Day, to carry off any
bilious or corrupted Humours that might be lodged in the Stomach or
Intestines; and we found that these Evacuations gave Relief, and
generally mitigated all the Symptoms.

If at any Time during the Fever a Looseness came on, especially when
attended with Gripes, we gave a Dose of some gentle Physic, which made
a free Evacuation; and an Opiate in the Evening after its Operation;
and afterwards we found it answer better to attempt rather to
moderate, than wholly stop the Purging by strong Astringents, and
Opiates; unless where the Evacuation by Stool was so great as to be in
Danger of sinking the Patient.

The _pulvis antimonialis_, composed of ten Parts of the _pulvis e
chelis_, and one Part of the Tartar emetic, given in small Doses, was
serviceable in many of these Fevers, after free Evacuations had been
made.

Two Patients, one a Soldier of the Twentieth Regiment, the other a
_German_ Waggoner, were taken ill of this Fever about the 25th of
_December_, 1762: They were both blooded freely, and had a Dose of
Physic in the Beginning; and the saline Draughts with Nitre and other
cooling Remedies; and had Blisters applied without producing any
considerable Change in their Disorder.--On the 5th of _January_, 1763,
they both complained much of Thirst, and were inclined to be costive;
their Tongues were parched, their Pulses quick and small, and their
Skins dry; they were restless at Nights, and the Soldier had a slight
Delirium.--I ordered each of them four Grains of the _pulvis
antimonialis_ every four Hours.

6th. Next Day the Soldier told me, he had had four loose Stools; his
Senses were much clearer, the Pulse calmer and slower, and he said he
found himself lighter and easier, and less feverish, than he had been
since he was first taken ill. The Medicine was continued, with the
Addition of an anodyne Draught at Night.--7th. I found him in a fine
breathing Sweat, and he told me he had slept well in the Night:
p.--8th. The Sweat continued till this Morning, and on going off his
Urine let fall a copious white Sediment, and left him free from the
Fever; after which he mended daily.

The Waggoner, after taking the third Dose of the Powders, had a warm
Moisture upon the Skin.--On the 6th was cooler and without much Fever,
and had had one Stool.--7th. The warm Moisture ended in a profuse
Sweat, which carried off the Fever, and he continued to recover
daily.




OF THE ANGINA; OR, SORE THROAT.


Many of the Soldiers during the Campaign were seized with
Inflammations of the Throat, especially when the Nights were cold and
moist after warm Days; and when they did Duty in cold wet Nights in
the Winter Season.--All of them I saw in _Germany_ were of the
inflammatory Kind; I did not observe any that were malignant.

They were treated in the antiphlogistic Method.--The Patients were
blooded liberally in the Beginning--took the cooling nitrous and
saline Medicines--gentle Diaphoretics and Purgatives--and used
frequent Gargarisms.

Sometimes a Flannel rubbed with camphorated Oil, or the _linimentum
volatile_, and applied round the Neck, was of Service.--And frequently
after bleeding sufficiently, where the Breathing or Swallowing was
difficult, the Application of a large Blister to the Neck gave speedy
Relief.




OF THE PLEURISY.


The Pleurisy, or an acute Inflammation of the Side, was most frequent
among the Soldiers towards the latter End of the Campaigns; though
some were attacked with it at all Times of the Year, from doing Duty
in all Sorts of Weather.

We followed the antiphlogistic Method of Cure; and ordered plentiful
Bleeding in the Beginning, till the Violence of the Pain began to
abate, or the Patient grew faint;--and the Side to be fomented with
Flannels dipped in warm emollient Decoctions, and afterwards rubbed
with volatile Liniments: At the same Time the Patient drank freely of
warm diluting Liquors, as Barley Water, the pectoral Decoction, and
such like; and took the saline and other cooling Medicines, mixed
occasionally with Sperma Ceti, or some other soft Pectorals, if there
was a tickling Cough.--When the Patient was costive, we gave a Dose of
Salts, or some other mild Physic, or laxative Clysters.

If the Pain continued very acute, we repeated the Bleeding as often as
Necessity seemed to require, and the Pulse could bear; and immediately
after the second Bleeding ordered a large Blister to be applied to the
Part affected.

Physicians formerly used to forbid Bleeding after the fourth Day, if
it had been omitted so long; but when no Symptoms of Suppuration had
already appeared, on whatever Day of the Disorder it happened, I
ordered plentiful Bleeding, the same as in recent Cases; and never
found any Disadvantage, but often great Service from this Practice.

When the Sharpness of the Pain was gone, and the Pulse became soft,
very often a dull Pain remained for some Time in the Part.--In some
Cases a brisk Purge removed it;--in others, cupping above the Part,
and afterwards rubbing it with the volatile Liniments, did
Service;--in others, gentle Opiates at Night, especially where there
was a tickling Cough;--and in one or two Cases, this Pain did not go
away, till the Patient was ordered to drink every Day for some Time, a
Quart of the Decoction of Sarsaparilla with the antimonial Wine.

In the Course of this Disorder, if a kindly Moisture broke out on the
Skin, which gave Relief, this was encouraged by the Use of mild warm
Liquors; or if the Patient began to spit up a viscid or yellowish
Mucus, we endeavoured to keep up the Expectoration by the Use of mild
Pectorals; and if a Purging came on, we were careful not to check it
too soon, unless it was so violent as to be in Danger of sinking the
Patient.

When an Inflammation of the Side came to Suppuration, which happened
in one or two Cases at _Osnabruck_, in _May_ 1761; as soon as a
Fluctuation of Matter was to be felt, an Incision was was made in the
Part, and the Matter discharged; after which the Sore healed kindly,
and the Patients recovered[51]. I am persuaded, was this Operation
oftener performed, many would recover who die consumptive.

    [51] Dr. _Mead_ advises, where the Lungs and Pleura grow
    together, and an Abscess forms, to open it with Caustic; and
    afterwards to keep the Ulcer open during the Patient's Life:
    For he says, he has often seen, where such Sores were healed
    up, that the Patient died soon after by an Efflux of Matter
    upon the Breast. _Monita Medica_, Cap. i. Sect. 7.




OF THE PERIPNEUMONY.


The Soldiers were subject at all Times to the Peripneumony, or
Inflammation of the Lungs, from doing Duty in cold wet Weather, and
from their irregular Way of living; but more particularly towards the
End of the Campaigns, and in Winter.

This Disorder was much more dangerous and fatal than the Pleurisy,
especially when neglected in the Beginning; for then Bleeding had
seldom any Effect; the Difficulty of Breathing encreased, the Patient
was seized with an Orthopnea, and such an Anxiety and Sense of
Suffocation, that he could not sleep; and the Pulse sunk; and in these
Cases Death only afforded Relief. This we experienced in many Men who
had lain neglected in Quarters, for two, three, four, or five Days,
before they were brought to the Hospital.

In most of the Bodies of those who died of this Disorder, and were
opened after Death; we found the Lungs violently inflamed, with livid
or gangrenous Spots on their Surface; and more or less of a watery
Serum extravasated into the Cavity of the Chest.

Three had Suppurations in the Lungs. In one, who had lain sick in
Quarters for ten Days or upwards, before he was sent to the Hospital,
the right Cavity of the Thorax was found full of a watery Serum; and
the Lobes of the Lungs on the same Side almost entirely wasted; and
what remained seemed as it were composed of thickened Membranes,
resembling those formed by the coagulable Lymph, or what is called by
some (though improperly) the fibrous Part of the Blood. The Lobes in
the left Side seemed to be in a sound State, or at most but slightly
inflamed. From the right Lobes of the Lungs being so much wasted, I
suspected that the Patient had probably laboured long under some
Disorder of the Breast; but I could not from Enquiry obtain any
Information in this Particular; nor did he ever mention such a Thing
during the few Days he lived after being brought into the Hospital; he
said, he had only been ill for eight or ten Days before; but Soldiers
afflicted with chronic Distempers, when they are seized with violent
Symptoms, or acute Diseases, are apt to reckon the Beginning of their
Disorder, only from the Time they are taken ill in a violent Manner;
and never to take any Notice of their former Complaints.

Another Soldier, about the Middle of _February_, 1762, remained in
Quarters five Days after being taken ill with a Pain of the Breast,
and a Difficulty of Breathing; the sixth Day he was brought to the
Hospital in the Morning, and I saw him about eleven o'Clock; he then
had all the Symptoms of the true Peripneumony, attended with a strong
hard Pulse. He was immediately blooded as freely as his Pulse would
bear, had Blisters applied, and other Remedies used; notwithstanding
which, on the eighth Day from that Time, he began to throw up a
purulent Matter in great Quantity, attended with a constant hectic
Heat, and Fever; which sunk him so fast, that he died the tenth Day,
after he first began to expectorate.

On the 2d of _March_, a Soldier, of the Fifty-first Regiment of Foot,
was brought to the Hospital, with a violent Pain in the left Side, and
a great Difficulty of Breathing. Upon examining him, he told me, that
about two Years before he had had a violent Stitch in his left Side,
towards the lower Part of the Thorax; that ever since he had been
subject to a Difficulty of Breathing; and at Times to a Pain in the
Side; but that he had only been seized with the violent Pain and
Difficulty of Breathing he then complained of, about five Days before,
occasioned by catching Cold, on being billeted in a low, cold, and
damp House.--His Pulse was quick, the Pain of his Side and Difficulty
of Breathing so great, that he could not sleep, nor lie down, but was
obliged to sit constantly in an erect Posture; his Tongue was white
and furred, and he had had no Stools for three Days: He was ordered to
be blooded immediately; and to take a Dose of Salts; and his Side to
be rubbed with the _linimentum volatile_. 3d. His Breathing and Pain
of the Side were easier; he had slept a little in the Night, and could
lie on his right side, but not on his left. He was ordered the Squill
Mixture. 4th. His Breathing was worse; he was blooded a second Time;
had a large Blister applied to his Side, and was ordered to continue
the Use of the Squill Mixture. On the 5th, 6th, and 7th, he seemed
easier, though the Breathing was still much affected, and his Pulse
quick and low, attended with a hectic Heat. On the 8th, he told me
that his left Side was swelled: On examining, I observed a Fullness in
that Side of the Thorax; and on pressing with my Fingers between the
Ribs, I thought I felt an obscure Fluctuation of a deep-seated Fluid.
From these Appearances, and the History of the Case, I judged that
there was a Collection of some Fluid within the Cavity of the Chest;
and that the only Means left to give Relief, was to make an Opening
into the Cavity, and so evacuate the Fluid. I therefore proposed to
him the Operation of the Empyema, to be performed immediately; which
he several Times obstinately refused to submit to: He allowed a Seton
to be put in his Side, but that did not answer the End proposed: He
languished six Days longer; and died the 14th of _March_. Next Day an
Opening was made in the Thorax, in the Part where the Operation was
proposed to have been performed; as soon as the Pleura was cut
through, some Quarts of Water rushed out. We then opened the Thorax,
and found still some Water in the left Cavity. The Pericardium was
thickened, and slightly inflamed, and adhered to the Diaphragm; which
was likewise a little thickened and inflamed in the adhering Part; the
Lungs on that Side were much compressed, and contracted by the
Pressure of the Water; but on being inflated and cut, seemed in a
sound State, except that they were slightly inflamed. The Lungs of
the left Side adhered every-where firmly to the Thorax, but seemed
otherwise sound; having no Tubercles, Suppuration, or other Disorder,
that we could observe in cutting them. The Heart and Blood Vessels
were sound, and no other polypous Concretions were observed within
their Cavities, but such as we find in most dead Bodies; which seem to
be formed of the coagulable Lymph in _articulo mortis_. The Viscera of
the Abdomen were in a sound State.

We treated the Peripneumony nearly as the Pleurisy. We bled freely in
the Beginning, till the Breathing became easier, or the Pulse began to
sink; taking Care not to be deceived by a low oppressive Pulse, which
generally rose upon Bleeding. We applied large Blisters; gave the mild
Pectorals freely, and plenty of warm diluting Liquors, Barley Water,
the pectoral Decoction, and such like; which afforded more Relief than
any other Medicines. We gave too saline Purges, and laxative Clysters
occasionally; and in some Cases ordered the Steams of warm emollient
Decoctions with Vinegar to be drawn into the Lungs.

By this Treatment most of them, who applied early for Relief, got the
better of the Disorder.

When the Expectoration began, the Patient continued the free Use of
the mild Pectorals, and diluting Liquors; and no Medicines were given
that might in the least tend to stop it; other Evacuations were
omitted, unless where the Pain of the Breast, or the Difficulty of
Breathing increased; in which Case, if the Pulse kept up, I ordered a
Vein to be opened, and a suitable Quantity of Blood to be taken away;
no other Remedy affording any Relief, till this Evacuation was made.
Where the Patient was costive, we frequently ordered laxative
Clysters, or a mild Purge, and found them beneficial: But where no
such Symptoms occurred, it was best, for the most part, to omit all
Evacuations of this Kind, after a free Expectoration had begun, and to
trust to it for carrying off the Disorder.

In some Cases, where the Expectoration stopt suddenly after bleeding,
we gave with Advantage a gentle Vomit, as recommended by Dr.
_Huxham_[52].

    [52] Some late Authors seem to look upon the _Pleurisy_ and
    _Peripneumony_ as the same Disorder: However, though it be
    true, that when the _Pleura_ is inflamed, the Surface of the
    contiguous Lungs is generally in the same State; and that,
    when the _Lungs_ are inflamed, the Pleura is often affected;
    yet as I have frequently seen the true Peripneumony without
    that sharp Pain of the Side which characterizes the Pleurisy;
    and upon opening the Bodies of People who have died of the
    Peripneumony, have found the Lungs violently inflamed and
    livid, and so filled with Blood as to sink in Water, without
    the Pleura being much diseased; and upon opening the Thorax
    of others who died of the Pleurisy, have found the
    intercostal Muscles and Pleura violently inflamed with livid
    Spots, and only a small Portion of the Surface of the
    contiguous Lungs affected; I cannot help still looking upon
    them as distinct Disorders; though they require nearly the
    same Treatment, and are often complicated together.




OF THE COUGH and CONSUMPTION.


Coughs were very frequent during the Winter, and when the Weather was
wet and cold. They were often accompanied with Pains of the Breast;
and, when neglected, Obstructions, Tubercles, and Suppurations, were
apt to form in the Lungs, and the Disease to end in a Consumption, or
_Phthisis Pulmonalis_.

When Coughs were slight, guarding against further Cold, and the Use of
mild Pectorals and warm Drinks, removed them. But when the Patient
complained of a Pain and Tightness about the Breast, it was always
necessary to take away more or less Blood; and after Bleeding to give
some of the mild Pectorals, such as the Sperma Ceti or oily Mixtures;
and, if a Fever attended, to join the Use of Nitre, or of the saline
or mindereri Draughts; and, if a tickling Cough was troublesome, to
give frequently a Tea Spoonful of the oily Linctus, acidulated either
with the Spirit of Vitriol, or the _oxymel scilliticum_. The mild
Diaphoretics, such as the mindereri Draughts, given along with warm
Drinks, to promote a free Perspiration, or Sweat, were used with
Advantage; when the Patients kept in Bed, and lay in Wards which had
Stoves in them.

If the Cough and Pain of the Breast were not relieved by these Means,
the Patient was bled a second Time, and a Blister applied to the Side
immediately after; which often removed most of the Complaints. When it
did not, we gave the pectoral Decoction for common Drink; and if there
was a Shortness or Difficulty of Breathing, the squill Mixture, or
_lac ammoniacum_, with Oxymel; and occasionally gentle Purges: And if
at any Time of the Disorder the Tightness and Pain of the Breast
returned violent, we took away some Blood, no other Remedy affording
Relief.

When there was little or no Fever, and a thin Rheum kept up a tickling
Cough, nothing had a better Effect than to add some Drops of the
_tinctura thebaica_, or some of the _elixir paregoricum_, to the
oleagenous or squill Mixtures; or to give an Opiate Draught or Pill at
Bed-Time, which eased the Cough, and procured the Patient Rest.

At all Times it was necessary, when the Cough was violent, attended
with Pains of the Breast, to keep the Patients on low Diet; and in as
free and pure Air as the Nature of the Hospitals would admit of; for
we often found that those Men who had laboured long under obstinate
Coughs, which threatened Consumptions in small crowded Wards,
recovered surprisingly on being removed to a freer Air; of which we
had a remarkable Instance in the Hospital at _Bremen_, in _January_
1762; upon removing some Men, afflicted with very bad Coughs, out of
small Wards, which were damp, into one large one, which was dry and
airy.

When the Weather was good, we made the Patients walk out a little in
the Day-Time; for we observed, that remaining always in the Hospital,
and breathing nothing but a foul Air, helped to encrease the
Disorder.--When we knew the Men to be sober, and not apt to commit
Irregularities, we used to procure them good Billets, and make them
come daily to the Hospital for their Medicines.

Equal Parts of Lime-Water and Milk, drank to the Quantity of a Quart a
Day, was of Use to some; and the _infusum amarum_, and other gentle
Bitters, taken to the Quantity of an Ounce or two, Morning and
Evening, to others[53].

    [53] Asses Milk, and _Bristol_ and _Seltzer_ Waters, which
    are found so serviceable in pulmonic Disorders, could not be
    had in the military Hospitals; and riding on Horseback was
    too expensive a Remedy for a Soldier.

    In chronic Cases, where we suspect Obstructions and Tubercles
    to be formed in the Lungs, which have not already come to
    Suppuration, Dr. _Russel_ recommends the Use of Sea Water for
    resolving them; but we were at too great a Distance from the
    Sea to try this Remedy. See his _Treatise on Sea Water_, Page
    17.

A Decoction of the Cortex removed some Coughs which had continued for
a considerable Time. In one or two of these Cases, slight hectic
Symptoms had already appeared[54]. However, for the most part,
where-ever Obstructions of the Lungs were confirmed, or there were
evident hectic Symptoms without a free Discharge of purulent Matter,
the Bark did no Service; but rather heated and increased the Fever,
and made the Sick more restless and uneasy.--It was of most Use where
there seemed to be no confirmed Obstructions, but the Vessels much
relaxed; which we judged to be the Case from the Patients having no
fixed Pain, nor the Breathing much affected. If the Sick were
plethoric, or in the least feverish, we ordered a little Blood to be
taken away, before we began the Use of this Medicine.

    [54] _Mary Shepperd_, a Woman twenty-six Years of Age, was
    admitted into _St. George_'s Hospital the 6th of _June_,
    1759, for a Cough; attended with a constant hectic Fever and
    Night Sweats, which had begun in the Month of _April_, after
    the Measles. She complained likewise of having the _fluor
    albus_, and she had been blooded more than once before she
    came to the Hospital.--I at first gave her some of the mild
    Pectorals; and a Solution of White Vitriol in Water, _utenda
    pro inject. uterina_. After a Week, finding no Alteration in
    her Complaints, I advised her to become an Out-patient; and
    to go down to her Friends in the Country, to live upon a Milk
    Diet; to take gentle Exercise, and continue the Use of her
    Medicines; which she did, but without any Alteration in her
    Disorder, till the 6th of _July_, when I ordered her to take
    thrice a Day two Ounces of the Decoction of the Cortex, along
    with a saline Draught. Immediately, on beginning to use this
    Medicine, her Disorder began to take a favourable Turn; her
    Fever and Night Sweats left her, her Cough became easier, and
    she recovered Health and Strength daily. She came to the
    Hospital the 15th of _August_, seemingly in good Health, to
    return Thanks for her Cure.

In similar Cases, I have sometimes observed good Effects from the Use
of the Balsam _Copaivy_, or _Peru_; given either in Juleps or made up
into an Electuary, as in the _electuarium e spermate ceti cum
balsamo_; but in whatever Form they were given, if there were
confirmed Obstructions of the Lungs, they rather heated and inflamed,
than did any real Service.

When Coughs continued long, attended with Pain in the Side, Difficulty
of Breathing, and Hectic Fever and Night Sweats, we always had Reason
to suspect, that the Disorder would terminate in a confirmed
Consumption. When this was threatened, we found, that the principal
Thing to be done, was to keep the Patients cool; and to endeavour to
allay the hectic Heat and Fever; and to <DW44>, as much as possible,
the Progress of the Disorder. When the Case was recent, we were
sometimes so lucky as to make a Cure; but after it was confirmed, it
for the most part ended fatally.

We kept the Patients upon a low Diet; and where-ever Milk was to be
got easily, we allowed them a Pint a Day[55]; which was either mixed
with Water and given for Drink, or they took it to Breakfast or
Supper.--Their common Drink was either Barley Water or the pectoral
Decoction; which was occasionally acidulated with a few Drops of
Spirit of Vitriol; and we gave at the same Time the cooling
Medicines, such as Nitre, the saline or mindereri Draughts, mixed at
Times with Sperma Ceti, or some other of the mild Pectorals.

    [55] In private Practice, at this Stage of the Disorder, the
    Use of Asses Milk, and drinking the _Bristol_ Water at the
    _Bristol_ Wells, and riding on Horseback daily, are justly
    ranked amongst the most efficacious Remedies; and going into
    the more southern Climates, as the South of _France_,
    _Portugal_, or _Italy_, where the Air is warmer, more
    constant, and dry, than in _England_, has often been found to
    produce good Effects.

The opening a Vein, and taking away from four to eight Ounces of
Blood[56], whenever the Pain of the Breast was troublesome, or the
Patient was hot and restless at Nights from the Hectic Fever, gave the
greatest Relief of any Thing we tried; and these repeated small
Bleedings were so far from wasting the Patient's Strength, that they
rather seemed to prevent its being exhausted so fast as otherwise it
would have been, by allaying the Force of the Hectic Fever.

    [56] This Practice has been strongly recommended by Dr.
    _Mead_, in his _Monita Medica_, Sect. x. and by an anonymous
    Author in the _Edinburgh Medical Essays_, Vol. IV. Art. 28.
    and Dr. _Mead_ says, when Things have not been quite
    desperate, he has seen good Success from it.

At this Stage of the Disorder, we put in Setons, or ordered Issues, to
serve as a Drain to carry off the Matter, and found them of Advantage
in some Cases. When the Patients complained of any fixed Pain, we
always made the Issues as near the Part affected as possible[57]. On
the 5th of _May_, 1762, a Man, belonging to the Eighty-eighth Regiment
of Foot, was sent to the Hospital at _Bremen_ for an Haemoptoe,
attended with a constant hectic Heat and Fever.--After being blooded,
and using the cooling Remedies without Success, he had four Pea Issues
made in his Back; and had a slight Decoction of the Cortex, acidulated
with Spirit of Vitriol. As soon as the Issues began to discharge
freely, the hectic Heat, Fever, and Spitting of Blood, diminished
daily; and he recovered his Health and Strength in a short Time.
However, it ought to be observed, that although these Drains are
sometimes efficacious, yet, when the Disease is far advanced, the
Mischief is generally too deep rooted for them to be of any Service.

    [57] In _June_, 1748, a Servant Girl came to ask my Advice
    for a Cough, attended with a constant Hectic Fever and Night
    Sweats, which had begun some Months before, on catching Cold.
    The Matter she spit up was yellow, and had the Appearance of
    Pus; and she complained of a Pain in the left Side of the
    Thorax. I ordered her the saline Mixture with Sperma Ceti to
    be taken thrice a Day, to lose a little Blood, to drink an
    Infusion of Linseed sweetened with Honey, and to have a Seton
    put in her Side at the Part where she complained of Pain;
    advising her to go home to her Father, who was a Farmer in
    the Country, and to live upon a Milk and Vegetable Diet, and
    ride on Horseback whenever she could conveniently. She seemed
    so far gone in a Consumption, that I scarce expected to see
    her again; but, in the Month of _December_, she came to
    return me Thanks for her Cure, seeming then to be in good
    Health. She told me, that, as soon as the Seton began to
    discharge freely, she found Relief; and mended afterwards
    daily, by following the Directions I had given her.

The Bark, and natural Balsams, for the most part were prejudicial, and
encreased the Hectic Heat and Fever; except in one or two Cases, where
the Disorder seemed to depend on a Vomica of the Lungs, and the
Patient coughed up the Matter freely.--In one Case they were of
considerable Service; the Patient was very low, and had the Night
Sweats, but coughed up the Matter freely: On using the Decoction of
the Bark, and the _electuarium e spermate ceti cum balsamo_, the
Matter expectorated became thicker, and of a more balmy Consistence,
without any Increase of Heat or Fever; after which the Symptoms became
gradually milder, and the Patient recovered.

In the Course of this Disorder the Patients often became very hot and
restless, and were troubled with Gripes, succeeded by a Purging: These
Symptoms were most readily removed by a Dose of Rhubarb, or of some
other mild Purge; for they generally proceeded from corrupted Humours
lodged in the Intestines. In the Evening, after the Operation of the
Purge, we gave an Opiate to procure the Patient Rest.--When the first
Dose of Physic did not stop the Purging, we repeated the Opiates at
Nights, and in a Day or two gave another Purge; and if there was much
Sickness, or Load at the Stomach, gave likewise a gentle Emetic.

If the Purging still continued, we were obliged to join the Use of
Astringents along with the Opiates. In some Cases, I found good
Effects from equal Parts of Milk and Water boiled with Rose Leaves,
Pomegranate Bark, Balaustine Flowers, and Cinnamon, as recommended by
Dr. _Mead_ in his _Monita Medica_[58]; it served both for Food and
Medicine.--When Opiates and Astringents were given to stop the Purging
at its first Appearance, before the Bowels were emptied, they always
did Mischief; and increased the Heat and Fever: And although they
stopt the Purging for a few Hours, it always broke out with greater
Violence afterwards.

    [58] _Sect._ x. _de Febrib. lentis sive Hecticis._

When the Sick were attacked with a Shortness and Difficulty of
Breathing, which was not relieved by Evacuations, and the Use of
cooling Medicines, and Pectorals, and Blisters, nothing gave so much
Ease, or had such a good Effect, as a gentle Vomit; for it often
removed the immediate Oppression from the Breast, and helped to pump
up the Matter from the Lungs.

In the advanced State of the Consumption, the Cough was always very
troublesome; and the Sick found no Relief but from Opiate Medicines,
which, in such Cases, cannot be expected to do more than give a little
present Ease.--As they were apt to obstruct the free Expectoration, we
generally mixed them with some _oxymel scilliticum_, or _tinctura
foetida_, which took off a good deal of their suffocating Quality.

Dr. _Barry_[59] advises for the Cure of a Consumption, to make an
Incision or Aperture into the Side; where-ever there is a fixed Pain
attended with a Weight, a Hectic Fever, and other Symptoms of an
evident Suppuration: He says the Pleura is thickened, and the Lungs
adhere at the Part where they are exulcerated; and that by the
Operation the Pus may be evacuated, and a Cure made; and he gives
several Instances of the Success of the Operation, when performed in
Time.

    [59] _Treatise on the Digestions_, p. 410.




OF THE Epidemical CATARRHAL FEVER Of APRIL, 1762; CALLED, THE
INFLUENZA.


After a very cold severe Winter at _Bremen_, the Weather, from being
very cold, became of a sudden extremely hot, about the 10th of
_April_. In a few Days after, many People were seized with a violent
Catarrhal Disorder. It often began with such a Cold and Shivering,
that many imagined at first that they were going to have Agues; but
soon after they were attacked with a Cough, and a Difficulty of
Breathing, and Pain of the Breast, with a Head-Ach, and Pains all over
the Body, especially in the Limbs.--The first Nights they commonly had
profuse Sweats.--In several, it had the Appearance of a remitting
Fever, for the two or three first Days.--Many had a slight
Inflammation of the Throat, and a Hoarseness. In all it was attended
with an acute Fever in the Beginning, and the Urine was of a high
Colour; and when the Disorder had put on the Appearance of a Remittent
Fever in the Beginning, it dropt a Sediment towards Morning after the
second Day; and did the same in all, when the Disorder was going
off.--Some had a Purging, but the greater Number were rather inclined
to be costive.--The Cough in many was very violent; and the Patients,
after each Fit of Coughing, had Reachings, or Strainings to vomit,
exactly resembling those which come after violent Fits of the Hooping
Cough.--At first the Patients spit up only a little Phlegm; but in the
Decline of the Disorder, they expectorated freely.--The violent Cough
and Feverishness generally continued for four, five, or six Days;
with others it continued longer; and some had a Cough for two or three
Weeks after the Fever left them.

This Catarrhal Fever seized most of the People of the Town of
_Bremen_; and there were very few of the _British_ who escaped it; at
the same Time, it was epidemical in most Countries in _Europe_.

We treated it entirely as an inflammatory Disorder, and none died who
applied early for Relief.--Most People recovered by one plentiful
Bleeding, and taking the mild cooling Medicines, such as the _mixtura
e spermate ceti cum nitro_, the saline or mindereri Draughts, or such
like. When the Fever and Difficulty of Breathing continued after the
first Bleeding, in a Day or two a Vein was opened a second Time; and
immediately after a Blister was applied to the Back, which commonly
removed the Fever, and relieved the Breathing.--When the Patients were
inclined to be costive, a Dose of Physic was of Service.

None of the _British_ died, except one or two of the Soldiers, who
remained in Quarters after being taken ill; and, instead of bleeding
and living low, indulged in the Use of spirituous Liquors; and were
not brought to the Hospital, till they were in the last Stage of a
Peripneumony.--Many of the Inhabitants of the Town died of this
Disorder, which was probably owing to Want of Care.




OF THE RHEUMATISM.


The Rheumatism is one of the Disorders most generally to be met with
in military Hospitals. There were at all Times some Men in our
Hospitals labouring under Rheumatic Fevers, or other rheumatic
Complaints; though we never had at any one Time a great Number; owing
probably to the Weather being very favourable in both the Campaigns of
1761 and 1762.--It was always most frequent when the Weather was wet
and cold; both during the Campaign, and when we were in Winter
Quarters.

It commonly began either, 1. With an acute Fever, and Pains all over
their Body: or, 2. With Pains in particular Parts, as the Shoulders,
Legs, Arms, Knees, and sometimes of the Side, attended with some
Degree of a Fever.--The first was the most common Form it assumed,
when Men were attacked with it in the Field or in Garrison; owing to
their doing Duty in cold wet Weather.--The other Causes generally took
place when they had been formerly subject to rheumatic Complaints, and
had caught Cold; or after they had been weakened and reduced low by
Fevers, Fluxes, or other Disorders.

We had but very few Rheumatisms accompanied with Swelling, Pain, and
Inflammation of the Joints of the Knees and Wrists, &c. which are so
common in our Hospitals about _London_. I did not meet with above a
Dozen Cases, of this Kind, whilst in _Germany_ with the Army.

When the Rheumatism began with Pains all over the Body, attended with
a High Fever, we treated it at first entirely as an Inflammatory
Fever[60]. We blooded freely, and repeated this Evacuation often[61],
if the Blood continued sizy, and the Pains violent; provided the Pulse
was strong. When the Pleura, the Lungs, or any other of the Viscera
were affected, we blooded as freely as we should have done in acute
Inflammations of these Parts: We gave the saline Draughts with
Nitre[62]; and Plenty of Barley Water and other weak diluting Liquors;
and gentle Physic once or twice a Week; and afterwards applied
Blisters, which often relieved both the Pains and Fever.

    [60] _Sydenham_, in treating of this Disease, orders
    Bleeding, and that to be repeated next Day; and afterwards
    every other Day, two, three, or four Times, or more, as the
    Patients Strength can bear it; and on the intermediate Days
    to give a purgative Clyster. But in young People, and those
    who have lived regularly, he says, that a very low Diet will
    cure as effectually as Bleeding and Medicines; That the
    Patients must live four Days on Whey alone, but after this
    may eat Bread for Dinner; and on the last Days for Supper
    also; and when the Symptoms begin to abate, he allows them to
    eat boiled Chicken, or other light Food; but says they must
    live every third Day on Whey, till their Strength returns.
    _Precess. Integr. de Rheumatismo_.

    [61] A Remark of Dr. _Huxham_'s deserves to be taken Notice
    of here: He tells us, that there are some Kinds of
    Rheumatisms, _viz._ those which come from a sharp serous
    Rheum, which do not bear the free Use of the Lancet; that
    plentiful Bleeding does more Hurt than Good; and that, in
    such Cases, the Medicines which bring out breathing Sweats,
    and at the same Time correct the Acrimony of the Blood,
    joined with gentle Opiates, have a much better Effect. _De
    Aere_, Vol. II. p. 185.

    [62] Dr. _Brocklesby_, in his _Observations on military
    Diseases_, recommends the Use of large Quantities of Nitre
    dissolved in Water Gruel, or Sage Tea, (in the Proportion of
    two Drachms of the Nitre to a Quart of the Liquor) in acute
    Rheumatisms. He says, "I am assured from numberless
    Instances, that in stout young Men, by taking six hundred
    Grains (ten Drachms) daily, for four or five Days
    successively, and diluting plentifully, as before
    recommended, plain Nitre proves the most powerful and best
    Sudorific, in such Complaints, that I have ever tried; and
    this Quantity, and even more, may be retained in the Stomach,
    and pass through the Course of the Circulation, by only
    diluting properly with those thin attenuating Beverages as
    before recommended. Such Quantities, in three or four Days,
    seldom failed wonderfully to relieve the Patient, and very
    often to cure him entirely, by the most plentiful and profuse
    Sweats." _See from p. 116, to p. 124._

    I have never hitherto given Nitre in such large Quantities as
    here recommended by Dr. _Brocklesby_.

After some Days, if the Pains still remained, we continued the saline
Draughts with Nitre throughout the Day; and in the Evening endeavoured
to promote a free Perspiration by Means of the mild Diaphoretics,
such as the mindereri Draughts with Mithridate, in Doses frequently
repeated; at the same Time, the Patient kept in Bed, and drank freely
of mild diluting Liquors. Sometimes we gave twenty, thirty, or forty
Drops of Spirits of Hartshorn, in repeated Draughts of warm Barley
Water: or a like Quantity of the Antimonial Wine, used in the same
Manner: or from sixty to a hundred Drops of the Antimonial Wine, mixed
with one-fourth Part of the _tinctura thebaica_, in a large Draught of
some warm Liquor; which I have observed, in many Cases, to have a
better Effect, than most other Medicines used for this Purpose; as it
acts both as an Opiate in easing the Pain, and procuring Rest; at the
same Time that it promotes a free Perspiration, or gentle Sweat, to
carry off the Distemper.

But it should be observed, that, in the Beginning of Rheumatic Fevers,
forced Sweats generally did Hurt, and often increased both the Pain
and Fever; and that in general we had greater Success, and made
speedier Cures, when we did not attempt to promote Sweating, till
after other Evacuations had been sufficiently made, and the Fever had
begun to abate; and that in this Fever, when we did attempt to procure
Sweats, the milder Diaphoretics, with Plenty of weak diluting Liquors,
answered better than those of a more heating Nature; though after the
Fever was gone, and the Pains still continued, sometimes the stronger
Sudorifics, such as G. Guaiac, and its volatile Tincture, _Dover_'s
Powder, and the like, best answered the Purpose, and carried off the
Distemper, when the milder ones had little Effect.

I have often observed, where Sweating made no Change in the Distemper,
that keeping up a free Perspiration by Means of the Decoction of the
Sarsaparilla with the Antimonial Wine, or small Doses of the _pulvis
antimonialis_ (_gr._ v.), given twice or thrice a Day, removed
Rheumatisms, which had resisted the Force of other Remedies.

Sometimes the cold Bath[63] removed Pains which had not yielded to
internal Medicines; but it ought to be observed, that when Patients
went into the cold Bath while the Feverishness still remained, and the
Blood continued sizy, or before free Evacuations had been made,
oftentimes, instead of giving Relief, it made the Disorder worse, and
more obstinate[64].

    [63] I have frequently ordered the warm Bath with Advantage
    in Rheumatic Cases in _St. George_'s Hospital; but we had no
    Convenience of this Kind with the flying Hospital in
    _Germany_.

    [64] This I have seen many Instances of, particularly in the
    Case of _Ann Walker_, a Woman of twenty three Years of Age,
    who was under my Care in _St. George_'s Hospital, in _May_,
    1759. Before she came to the Hospital, she had been blooded,
    and had gone into the cold Bath four Times, which, she told
    me, had increased her Pains to a violent Degree; in which
    State she had continued for some Weeks before she came to the
    Hospital; but by being blooded, and taking the cooling saline
    Medicines, with gentle Purges, and mild Diaphoretics, she got
    well in a Month's Time.

When the Rheumatism was confined to a particular Part, attended with
Fever, we treated it as the acute Rheumatism. Fomenting the Part with
warm emollient Decoctions, and rubbing it afterwards with the
volatile, or saponaceous Liniments, often gave Ease; and the
Application of Cupping-Glasses and Blisters frequently removed the
Disorder. In some Cases, where the first Blister did not relieve, the
Application of a second, and afterwards keeping up a Discharge from
the Part by Means of the Epispastic Ointment, carried off the Pain. In
others, where the mild Diaphoretics were ineffectual, Sweating, with
the G. Guaiac, or _Dover_'s Powder, and such other Medicines, after
the Fever was gone, removed the Complaints[65].

    [65] Warm Water, pumped upon the Part, often removes such
    rheumatic Pains as have resisted the Force of internal and
    other Remedies. On the 29th of _August_, 1759, _Mary Ward_
    was admitted into _St. George_'s Hospital for rheumatic Pains
    of the Arms, Legs, and Knees, attended with Fever, which all
    yielded to Evacuations, and the Use of cooling Medicines,
    mild Diaphoretics, and of the warm Bath, except the Pain of
    the Knee; which, after it had resisted the Course
    above-mentioned, was at last removed by pumping warm Water on
    the Part, three Times a Week; joined to the Use of
    Fomentations and volatile Liniments.

When the Rheumatism was attended with Inflammation and Swelling of the
Joints, we blooded freely, gave cooling Purges, and the saline
Draughts with Nitre, along with Plenty of weak diluting Liquors, and
prescribed a cool low Diet.

After the Violence of the Fever and Inflammation was abated, fomenting
the Parts, and rubbing them with the saponaceous or volatile
Liniments, sometimes hastened the Discussion of the Swelling; as did
likewise the Application of Blisters[66], after the Inflammation was
entirely gone; but it ought to be noticed, that if volatile Liniments
or Blisters are used too soon, they will sometimes occasion violent
Inflammation and Pain[67].

    [66] _Ann Ragen_, a Woman about thirty-three Years of Age,
    was admitted into _St. George_'s Hospital the 17th of
    _January_, 1759, for rheumatic Pains of her Legs and Arms,
    and a Swelling of her right Knee. Free Evacuations, and the
    Use of cooling Medicines, and mild Diaphoretics, removed all
    her other Complaints, except the Swelling of the Knee, by the
    Middle of _February_, when I ordered a Blister to be applied
    to it; after which the Swelling gradually decreased, and she
    was discharged, cured, the 20th of _March_.--_Rachael Hyde_,
    a Woman twenty-four Years of Age, was admitted into _St.
    George_'s Hospital the 9th of _May_, 1759, for similar
    Complaints, which were removed by the same Means, all except
    the Swelling of the Knee. A Blister was applied, and most of
    the Swelling went away, but returned soon after: It was at
    last removed by the Use of the warm Pump three Times a Week,
    and drinking a Pint of the Guaiac Decoction daily.

    [67] I have sometimes ordered Leetches to be applied to such
    Swellings (as recommended by Dr. _Pringle_), and found them
    to be of Service; and, at other Times, I have applied
    emollient Fomentations and Poultices, which have given great
    Ease to the Patient.--I have seen Setons or Issues, made near
    the Part affected, afford considerable Relief.

Rheumatic Cases of this Kind are often very obstinate, and require a
considerable Length of Time before they are got the better of; and
frequently more or less of the Swelling, especially of the Wrists and
Joints of the Fingers, remains ever after; and Patients, who have once
had the Rheumatism in this violent Degree, are always subject to
Relapses; as are even those who have had the Rheumatism but slightly.

Mercury[68] has been recommended in the Cure of Rheumatisms; but I
never found it do any Service by itself, except in Cases complicated
with venereal Symptoms; though I have often given it, and even
sometimes gone so far as to raise a Salivation, where the Pains were
most severe in the Night; and the Patient, at the same Time, thought
he had some Reason to suspect a venereal Taint, though no external
Symptom appeared. However, many good Practitioners have recommended
small Doses of Calomel to be given at Nights, and next Morning a
Purge; in which Way, I think, I have observed good Effects from its
Use.

    [68] Dr. _Musgrave_, in his Treatise _de Arthritide
    Symptomat._ p. 30, cap. ii. sect. 10, says, he has known a
    Salivation, raised by Mercury, cure the Rheumatism.

The Bark was frequently of Use in restoring the Strength, and removing
those rheumatic Pains which remained after Fevers, and other
Disorders; but, in other Cases, it had little Effect.

When the Rheumatism continues long, and has taken deep Root,
_Sydenham_[69] advises to bleed from Time to Time, at some Weeks
Distance; which, he says, will either entirely remove the Disease, or
bring it to that Condition, that the Remains of it will be easily
extirpated by an Issue; and giving some of the volatile Salts in
_Canary_ Wine, Morning and Evening. I have always observed in
rheumatic Cases, which continued long, that, after free Evacuations,
the Patients received more Benefit from a mild low Diet, continued for
some Time, and the Use of diluting Decoctions with mild Diaphoretics,
while they took gentle Purges once or twice a Week, than from any
other Remedies.

    [69] Vide _Sydenham. Opera._ sect. vi. cap. 5.

I have given Half an Ounce of Soap a Day, for a considerable Time, in
some old rheumatic Cases, in the Manner recommended by the late Dr.
_John Clerk_ of _Edinburgh_, as mentioned by Dr. _Pringle_; and, I
think, with Advantage; but have not had sufficient Trials to ascertain
the Merits of this Medicine.

Dr. _Sydenham_, in treating of the Rheumatism, which he calls
scorbutic, says; that after it had resisted Bleeding, Purging, low
Diet, and other Remedies, he has cured it by giving thrice a Day two
Drachms of an Electuary made of _conserv. cochlear. horten. recent.
unc._ ij. _lujul. unc._ i. _pulv. ar. comp. drachm_ vi. _cum syrup.
aurant._ q. s. drinking after it three Ounces of a Water drawn from
_Brunswick_ Beer, and some of the antiscorbutic Plants.

There is no Disorder which Soldiers are so apt to counterfeit as the
Rheumatism, when ever the Duty in the Field is severe; but while there
is no Fever or Size in the Blood, or other evident Marks of the
Distemper, and the Men look healthy, there is always Reason to suspect
Imposture.




OF THE Autumnal Remitting Fever.


The Remitting Autumnal Fever, called by the Antients [Greek: syneches],
was also one of the most frequent Disorders during the Campaign.

This Fever is observed in most Countries, after the Juices have been
highly exalted by the Heat of Summer; and People are exposed to the
Heats of Mid-Day, and to the cold Damps of the Night. We observe it
every Year in the Neighbourhood of _London_, especially among the
labouring People, who work in the Fields, towards the End of Summer,
and in Autumn; but it is generally in a milder Degree than in Armies,
where Men are more exposed to the Vicissitudes of the Weather.

As we go further towards the South, this, as well as other bilious
Disorders, becomes more frequent.

This Fever is reckoned the endemic Distemper of the _West Indies_, of
the Coast of _Guinea_, and other Places in the Torrid Zone; but in
those warm Countries it appears in a more violent Degree; makes a much
more rapid Progress; and proves far more fatal than in our cooler and
more temperate Climate. And it is observed to be always most frequent
and most fatal where a Country is covered with Wood, or is marshy; and
where there are frequent Fogs, and much stagnating Water, which
corrupts by the Heat of Summer.

In _January_, _February_, and _March_ 1761, we had none of those
Remitting Fevers at _Paderborn_. In _April_, some few of the Soldiers,
on their Return from the Winter-Expedition into _Hesse-Cassel_, had
Fevers attended with bilious Symptoms; but they were rather of the
continued, inflammatory Kind, and tending to malignant, than such as
could be called remitting.

The first Time that I saw much of this Fever, was among the Sick sent
to _Bilifield_ in the End of _June_ 1761; soon after the Army took the
Field. The Remissions were short, and it partook much of the Nature of
the common Inflammatory Fever; and most of them were cured by the
antiphlogistic Method. A Day or two before we left this Place, it
began to change into the Malignant Hospital Fever, from the Sick being
too much crowded.

In the Middle of _July_, about Twelve Hundred Sick were sent to the
Hospital at _Munster_; and about one-third Part were ill of this
Remitting Fever. It did not partake near so much of the inflammatory
Nature as at _Bilifield_; the Remissions became much more evident; and
it was attended much oftener in the Beginning with bilious Vomiting
and Purging; and in some few the Disorder turned to a Dysentery. About
eight or nine had it changed into the Hospital Fever, from the Wards
in one of the Hospitals being too much crowded; and in some few the
Disorder terminated in regular Agues. In _November_ severals were
taken ill of it in the Garrison of _Bremen_, which mostly ended in a
regular Intermittent, the endemic Distemper of the Place. Towards the
End of _December_ we had none of these Remitting Fevers, the Disorders
turning more to the inflammatory Kind.

In _June_ 1762, this Fever began to appear again among the Sick, sent
from the Army, to the Hospital at _Natzungen_; and it continued to be
frequent through the Summer and Autumn; and the greatest Part of these
Fevers this Year terminated in regular Agues, mostly in Tertians, and
were cured by the Bark; whereas the Year before very few terminated
this Way.

This Disorder in the Beginning had commonly the Appearance of a
continued Fever; and many had a Sickness and Vomiting, and threw up a
Quantity of yellow Bile, mixed with the Contents of the Stomach. In a
few Days, especially after Bleeding, the Remissions became clear; tho'
on its first Appearance in _June_ 1761 they were short, and rather
obscure; and it seemed still to partake a good deal of the Nature of
the common Inflammatory Fever, the Blood being very sizy; but as the
Season advanced, the Remissions became more evident, and the Paroxysms
more like those of an Ague; and the Blood less sizy, tho' at all
Seasons of the Year it had some Appearance of an inflammatory Buff in
this Disorder. The Sick were restless and uneasy at Night; but
commonly felt themselves cooler and lighter in the Day-Time: and
although they had no cold Fit, as the Fever came on at Nights, and
many of them no Breathing Sweat, as they became cooler and freer from
the Fever in the Morning; yet the Fits were so remarkable, that many
of the Patients used to say they had a regular Fit of an Ague every
Night, or towards the Morning; and some few, that they had the Fit
every second Night. As the Season advanced, the Remissions appeared
more distinct. However, there was always a good Number in whom the
Fever went on in a continued Form, through its whole Course, without
any Signs of Remission; tho' they had all the other Symptoms of this
Fever. In a few Instances the Fever, after it came to remit, changed
again into a continued Form.

The Heat in the Time of the Paroxysms rose high, and several were
delirious during its Continuance[70]; but were quite sensible in the
Intervals, though never wholly without the Fever.

    [70] I did not see the Delirium rise so high, nor the
    Paroxysms so severe, as in the Marsh Fever described by Dr.
    _Pringle_.

At the End of _July_ 1761, four or five were attacked with a Bleeding
at the Nose, in the Time of the Paroxysms, and became cooler
afterwards; but it did not prove a Crisis in any of them.

The Urine in the Beginning was commonly of a high Colour, though
sometimes it was pale and limpid: At first it deposited no Sediment;
but when the Fever came to remit, there was often a small Sediment
after each Paroxysm; and as the Fever was going off, it let fall a
Sediment in all[71].

    [71] Dr. _Hillary_ says the Symptoms of this Fever in
    _Barbadoes_ were much the same as those of the [Greek: syneches],
    or continued Remitting Fever in England; except only that the
    Urine in this hot Climate never deposits any lateritious
    Sediment, nor very rarely in any intermitting or any other
    Fever, except when a Crisis happens that Way. _Observations
    on the Diseases of Barbadoes_, p. 23.

Some at first were inclined to be costive; others had a Sickness and
Purging; and several of those who were costive in the Beginning, were
in the Course of the Disorder attacked with a Purging; and others,
after some previous Complaint of the Stomach, were seized with both
Vomiting and Purging. In general, after the Sick continued some Days
in the Hospital, they were inclined to be loose; which was a
favourable Circumstance, when this Evacuation was not so great as to
be in Danger of sinking the Patient. Some were attacked with a
Dysentery.

In this, as well as in most other Fevers, the Sick frequently passed
by Stool Worms of the round Kind; and sometimes they vomited them up,
or the Worms came up into their Mouth or Nostrils while they lay
asleep in Bed; and some towards the Height were afflicted with
Deafness, which was commonly a favourable Symptom.

Most of those ill of this Disorder had a yellowish Colour of the
Countenance, which went off with the Fever. It was more observable in
some than in others; in general, it was slight; some few became yellow
all over[72]; particularly one Man, in the Hospital at _Munster_, who,
after being seized with violent Vomiting and Purging, Convulsions, and
Twitchings of the Tendons, and Hiccup, became yellow, as in the
deepest Jaundice. This Symptom of Yellowness arises from a Redundancy
and Absorption of Bile; and is sometimes observed in other Fevers as
well as this[73]; for while we were at _Paderborn_ in _February_
1761, two Men were brought to the Hospital in Fevers, attended with
this Symptom. They were both delirious, with parched dry Tongues,
slight Twitchings of the Tendons, and other bad Symptoms; and one of
them had a continual Vomiting and Purging. They both died, and the
Body of him who had the Purging was opened. All the Bowels, especially
the Colon, were tinged with a yellow Bile, and had a slight Degree of
Inflammation all over their Surface; the Gall-Bladder was distended
with a very dark- Bile; but no Concretions were found in its
Cavity, or in the bilious Ducts; nor Mucus, or any other Thing
obstructing these Passages. The Surface of the Lungs seemed slightly
inflamed; and there was a small Quantity of greenish Serum in the
Cavities of the Thorax. I could not learn the Histories of these two
Mens Disorders, before they were brought to the Hospital; but, from
the Symptoms, was inclined to believe, that the Fevers had been of the
malignant or petechial Kind; and that the yellow Colour was only an
accidental Symptom of it; for on one of the Men we could perceive
obscure Traces of dun petechial Spots on his Breast and Arms; and the
malignant Fever was frequent at this Time among the Troops, and the
bilious autumnal Fevers had ceased long before.

    [72] Dr. _Pringle_ takes Notice of this yellow Colour or
    Jaundice. He says, "some grow yellow, as in the Jaundice.
    This was found more frequent during the first Campaign than
    afterwards; it was an unfavourable, but not a mortal
    Symptom." _Observ._ part iii. ch. 4.--_Hippocrates_ mentions
    the Jaundice occurring in Fevers, _Aphor._ iv. Sec. 62 & 64; and
    he reckons it a favourable Symptom in ardent Fevers, where it
    happens on the seventh Day. See _Book on Crises_'s, sect. 3.

    [73] Does this Fever, when accompanied with this universal
    Yellowness of the Skin, approach to the Nature of the yellow
    Fever of the _West Indies_? As I had so few Cases of this
    Kind under my Care, I cannot determine any thing about it
    from my own Experience; but, from the Accounts of others, I
    should believe them to be very different Disorders.--In the
    yellow Fever of the _West Indies_, the Blood appears quite
    loose and dissolved, without the least Appearance of Size,
    even on the first Day; and the general Yellowness appears on
    the third or fourth, with Signs of a total Dissolution, and
    gangrenous Diathesis of the Blood: Whereas, in the Remitting
    Fever of _Jamaica_, Mr. _Nasmith_ tells us, (See Dr. _Lind_'s
    first Paper on Fevers), there is always an inflammatory
    Diathesis of the Blood. The Yellowness in both depends on a
    Redundancy and Absorption of Bile; but in the yellow Fever of
    the _West Indies_, the Bile is in a much more putrescent
    State, and a great Part of the Cure depends on the early and
    speedy Evacuation of it.--In the yellow Fevers which appeared
    in _Haslar_ Hospital, which are taken Notice of by Dr.
    _Lind_, in his _Two Papers on Fevers_, the Blood was in quite
    a different State from what it is in the Yellow Fever of the
    _West Indies_; the Blood drawn from two of these Patients
    became covered with a thick yellow Gluten, and the Serum was
    of the Consistence of a thin Syrup, and of a deep yellow
    Tinge, and tasted bitter; and in another who was bled two
    Days before his Death, it threw up the same thick yellow
    Gluten, tho' the red Part below was quite loose.

I could not observe any certain critical Days, or Periods, when this
Disorder terminated.--Some, who had it slightly, got well in a few
Days; with others, it continued longer: Some continued long feverish,
and would seem cooler and freer from Fever for a Day or two, and then
grow worse again; and many had repeated Relapses.

Neither could I observe any regular Crisis in this Fever. Sweat was
the Discharge which oftenest proved critical. Many seemed to be
relieved by a Purging; but as the greater Part had a Looseness after
some Days, which continued often through the Disorder, without
producing any very sudden Change in the Symptoms, it seemed to be a
favourable Circumstance; though it seldom carried off the Fever so
suddenly as to be manifestly critical. The Urine broke, and dropt a
Sediment, for the most part, as the Fever took a favourable Turn.

When this Fever proved mortal, it commonly assumed a continued Form;
the Tongue became parched and dry, the Patient delirious, with
Twitchings of the Tendons, Hiccup, and other fatal Presages; while
others were seized with a violent Diarrhoea, or Dysentery, which sunk
them irrecoverably.

In the Beginning, it was absolutely necessary to bleed the Patients
freely; and frequently to repeat the Evacuation, where the Symptoms
required it. The Blood was of a florid Colour, and commonly threw up
more or less of an inflammatory Buff.

In these Fevers, we were obliged to have particular Regard to the
first Passages, especially in the Beginning of the Disorder; for they
were generally loaded with bilious Humours[74]; which, if suffered to
remain in the Bowels; were either absorbed, and increased the Heat
and Fever, or brought on a violent Diarrhoea; and therefore, after
Bleeding, we gave a Vomit in the Evening, and next Day a Dose of some
gentle Purge, as Rhubarb or Salts; to carry off these putrid, bilious
Humours: And afterwards, in the Course of the Disorder, if the Patient
was costive, and grew hot, restless, and uneasy, we either repeated
the Purge, or gave laxative Clysters, which generally removed these
Symptoms.--Frequently after the Operation of the Emetic, the Patient
had some loose Stools, from the Gall Bladder's being emptied in the
Strainings to vomit. Such Stools were always bilious, as were commonly
those procured by purgative Medicines.

    [74] According to Dr. _Hillary_'s Account of the Yellow Fever
    in the _West Indies_, which is attended with bilious
    Vomiting, it bears bleeding once or twice, but not a third
    Time, before the third Day, but not at all after that Time;
    and after Bleeding a great Part of the Cure depends on
    carrying off as much of the putrid Bile as expeditiously and
    safely as possible, which he says is to be done by making the
    Patients drink freely of warm Water (sometimes mixed with a
    little simple Oxymel or Green Tea) so as to vomit seven or
    eight Times; and then to give a grain, or a Grain and a half
    of Opium, to procure Rest, and to settle the Stomach; to make
    the Patient take nothing for two Hours after; and then, if he
    has not had a Stool, to give a laxative Clyster; after six
    Hours Rest, to give a gentle Purge, to carry off as much as
    possible of the bilious corrupted Humours; and in the Course
    of the Disorder to repeat the Purge, as often as the Patient
    is attacked with an Anxiety, and a painful burning Heat about
    the Praecordia; which almost always depend on bilious
    corrupted Humours pent up within the Bowels; and to endeavour
    to support the Patient's Strength, and stop the putrescent
    Diathesis of the Fluids by suitable Antiseptics, of which he
    found a watery Infusion of Snake Root, mixed with _Madeira_
    Wine and Syrup of Poppies, to answer the best of any Thing he
    tried, and to sit easiest on the Stomach; and to this he
    added the Use of Cordials, and of strong Wine Whey as the
    Patient became lower.

    Dr. _Hillary_'s Purge was: Rx. Mannae sescunc. vel unc. ij.
    Tamarind. cond. unc. i. Tartar vitriolat. gr. x. solve in
    seri lactis praeparat. cum Vin. Maderiens. unc. vi. Colaturae
    adde Tinct. Senae unciam dimidiam. Divide in Partes quatuor, &
    capt. aeger unam omni hora donec laxetur alvus.

    His Infusion of Snake-Root was prepared in the following
    Manner:

    Rx. Rad. Serpent. Virgin. drachm. ij. Croci Angl. drachmam
    dimidiam, infunde per horam vase clauso in aq. bull. q. s. &
    dein unc. vi. Colaturae, adde aq. Menth. simp. unc. ij. Vin.
    Maderiensis, unc. iv. Syrup. Croci vel Syr. e Mecon. unc. i.
    Elix. Vitriol. acid. q. s. ad gratum saporem M. capiat aeger
    cochlear. ij. vel iij. omni hora vel secunda quaq; hora vel
    saepius pro re nata.

    The Stomach is so irritable in the Beginning of this
    Disorder, as to reject the saline Draughts, Nitre, and such
    other Medicines. Nor will the Bark, which might be judged a
    very proper Medicine in the second Stage of the Disorder, lie
    upon the Stomach, but is thrown up immediately, in whatever
    Form it is given. However, a Gentleman who had practised long
    in the _West Indies_ told me, that although the Patient could
    not retain it in his Stomach, yet that he had found great
    Service, after the Bowels were emptied, from the Bark used
    freely in Clysters.

    Dr. _Hillary_ disapproves of the Use of Blisters in the
    advanced State of these Fevers.

After emptying the Bowels, we gave the cooling, and mild Diaphoretics,
such as the saline and mindereri Draughts, joined occasionally with
Nitre, or the Contrayerva Powders; while we made the Patient drink
plentifully of warm diluting Liquors; which we found to answer in
general better than any other Remedies: They brought the Remissions to
be more evident, and the Paroxysms to be milder, at the same Time that
they kept up a free Perspiration, as a Means to carry off the
Distemper.

In some Cases we gave the Antimonial Powder, made of one Part of
Tartar Emetic, and ten of the _pulvis e chelis_, in small Doses, from
two to four Grains every four or six Hours. The first Doses of this
Powder sometimes made the Patient sick, and acted as a Purgative, and
kept up a free Perspiration; at other Times, it produced no visible
Effect. In some Cases, where it was given early, it operated both by
Stool, and as a Diaphoretic, and removed the Fever[75]; and it was of
Use in others, towards the Decline of the Fever; but we were often
obliged to lay it aside; for it either acted too roughly, or produced
no visible Effect or Alteration in the Disorder.

    [75] Dr. _Millar_, one of the Physicians to the Army, told me
    in _Germany_, that he had given this antimonial Powder with
    great Success in the Remitting Fever, while the Eighth
    Regiment of Foot (to which he was formerly Surgeon) lay in
    _England_.--Dr. _Pringle_, in his fourth Edition of his
    _Observations_, Part iii. ch. iv. tells us, that having given
    a mild Purge immediately after Bleeding, he next Morning,
    when there was almost always a Remission, gave a Grain of the
    Tartar Emetic, with twelve Grains of Crabs-Eyes, and repeated
    the Dose in two Hours, if the first had little or no Effect;
    at any Rate, in four Hours. This Medicine not only vomited,
    but generally opened the Body, and raised a Sweat. By these
    Evacuations, the Fever was sometimes quite removed, but
    always became easier.--This Medicine he usually repeated the
    second or third Day; if not, he opened the Body with some
    mild Laxative, or a Clyster; and continued this Medicine,
    till the Fever went gradually off, or intermitted.--Dr.
    _Pringle_ says, that Dr. _Huck_ treated this Fever in a
    Method similar to this, both in _North America_ and in the
    _West Indies_. In the Beginning he let Blood; and in the
    first Remission, gave four or five Grains of Ipecacuana, with
    Half a Grain of Tartar Emetic: This Medicine he repeated in
    two Hours, taking Care that the Patient should not drink
    before the second Dose; for by that Means the Medicine passed
    more readily into the Bowels, before it operated by vomiting.
    If, after two Hours more, the Operation either Way was small,
    he gave a third Dose; which commonly had a good Effect in
    carrying off the Bile; and then the Fever either went quite
    off, or intermitted so far as to admit the Bark. On the
    Continent he found no Difficulty after the Intermission; but
    in the Islands, unless he gave the Bark upon the first
    Intermission, though imperfect, the Fever was apt to assume a
    continual and dangerous Form. Dr. _Huck_ never varied this
    Method, but upon a stronger Indication to purge, than to
    vomit. In which Case he made an eight Ounce Decoction, with
    Half an Ounce of _Tamarinds_, two Ounces of _Manna_, and two
    Grains of _Emetic Tartar_; and dividing this into four Parts,
    he gave one every Hour, till the Medicine operated by Stool.

When the Fever came to remit, we were obliged, for the most part, to
continue the Use of the mild Diaphoretics, as before; for, although
the Disorder put on a remitting Form, the Bark had very little Effect
in stopping it[76], unless where the Fever changed into a regular
Quotidian or Tertian Ague.--In the Year 1761, very few of these Fevers
turned to regular Intermittents; but, in the Year 1762, the greater
Part of them terminated in regular Agues, and were cured by the
Bark[77].

    [76] Dr. _Hillary_, in mentioning the Remitting Fever of the
    Island of _Barbadoes_, says: In those who were blooded, and
    took an Emetic afterwards, and then the saline Draughts, the
    Fever was generally carried quite off by a critical Sweat on
    the seventh or ninth Day; in some few it came to intermit
    regularly after that Time; and was soon cured by the _cortex
    Peruviana_, given with the saline Draughts, and seldom
    effectually without them; though these irregular ingeminated
    Fevers often remitted, and sometimes seemed to intermit; yet
    if the _cortex Peruviana_ was given too soon in the Disease,
    before it intermitted regularly (as I have more than once
    seen, where it had been injudiciously given), it generally
    caused the Fever to become continual and malignant.
    _Observat. on the epidemic Diseases of Barbadoes_, p. 22.

    [77] Mr. _Cleghorn_, after giving a very accurate Account of
    Tertian Fevers, as they appeared in their various Forms of
    true, of double, and triple Tertians, and of Semi-Tertians,
    in the Island of _Minorca_, tells us, that he first attempted
    the Cure by profuse Evacuations; but afterwards learnt from
    Experience, that they were unnecessary; and that Bleeding and
    Purging once or twice in the Beginning, was all that was in
    general requisite; and if on the fifth Day the third
    Revolution was not attended with more threatening Symptoms
    than the second, and the Patient bore it easily, he
    frequently trusted the whole Business to Nature; which
    commonly terminated the Fever about the fourth or fifth
    Revolution; and for the most part with an Increase of some
    natural Evacuation.--But if the Paroxysm on the fifth Day was
    the longest and most severe that happened, attended with any
    doubtful or dangerous Symptom, he ordered two Scruples of the
    Cortex to be given every two or three Hours; so that five or
    six Drachms may be taken before next Day at Noon; lest, if
    this Interval escaped, he should not have found a favourable
    Opportunity of giving a sufficient Quantity of the Medicine
    afterwards; as the Fits about this Period are wont to become
    double, subintrant, or continual.--This did not always put an
    immediate Stop to the Fever, but it invigorated the Powers of
    the Body, and prevented or removed the dangerous Symptoms.
    Having given the Bark on the fifth Day, if a Fit came on the
    sixth, and declined the same Evening, he gave some more Doses
    of the Bark to mitigate the Fit on the seventh; yet sometimes
    this Fit of the sixth united with that of the seventh, and
    the Patient had the Heat, Restlessness, Raving, and other
    Complaints, greatly augmented, and the Case seemed more
    desperate than ever; which, however, were more dangerous in
    Appearance than Reality, and went off with a profuse Sweat
    next Morning; after which he gave the Bark freely as before;
    and this either stopt the Fits, or made them so moderate, as
    that they yielded quickly to the same Sort of Management.--By
    this Method, when Assistance is called timely, Mr. _Cleghorn_
    says, the most formidable Intermitting and Remitting
    Tertians, may be certainly and speedily brought to a happy
    Conclusion about the End of the first Week, or Beginning of
    the second. See _Observ. on the epidemic Diseases in
    Minorca_, chap. iii. p. 187, &c.

In the Year 1761, we tried the Bark in various Forms in many Cases,
where the Patient had been blooded and purged in the Beginning, and
used the cooling Medicines; and where the Remissions were very clear:
Yet it had no Effect in removing the Disorder, except in two or three
Cases at _Munster_, where the Paroxysms assumed a tertian Form; for
the most part, it made the Patients more hot and feverish, and we were
obliged to leave off using it, as it was in Danger of changing the
remittent into a continued Fever. However, it was of Service after the
Fever came to a Crisis, and was going off; and Dr. _Pringle_ has very
justly observed, that it hastened the Recovery, and that those who
used it were less subject to Relapses than such as did not; and
therefore we commonly gave it in a convalescent State.--Before giving
the Bark, I always found it of Advantage to give a Dose of Rhubarb, or
of some other Purgative, or to mix some Rhubarb with the first Doses,
so as to procure the Patient some loose Stools.

When either the Fever went on without Intermission, or changed into a
continued Form, or the Patient continued hot and feverish through the
Day, with a Head-Ach, and other feverish Symptoms, nothing answered
better, after free Evacuations had been made, than to apply a large
Blister to the Back; and to make the Patient drink freely of cooling
diluting Liquors; which generally relieved the Head, and abated the
Violence of the other Symptoms.

When a Purging came on in the Course of this Disorder, if there was
much Fever, with a strong throbbing Pulse, Gripes and Pain of the
Bowels, some Blood was taken away; and immediately after the Patient
took a Dose of Salts and Manna, or of Rhubarb; and an Opiate in the
Evening after its Operation: But if there was little or no Fever, or
sharp Pain, Bleeding was omitted; and if the Patient complained of
Sickness, a few Grains of Ipecacuana were given previous to the Purge.

After this, if the Purging was moderate, and did not sink the Patient,
we did nothing to stop it; but if it was violent, we gave the
mindereri Draughts with Mithridate, and the Chalk Julep in the Day,
and an Opiate at going to Rest; and occasionally used the emollient
and anodyne Clyster; and, if necessary, repeated the Emetic and Purge.

The Hiccup seldom appeared in this Fever till the Patient was reduced
very low, and was commonly the Forerunner of Death. Some few, who had
a Purging and Vomiting, were taken with a Hiccup, attended with
Sickness, and Load at the Stomach, which seemed to depend on bilious
Humours lodged in the Stomach and Bowels. This induced me to give a
few Grains of the Ipecacuana; and to make the Patients drink an
Infusion of Camomile Flowers till they vomited freely, and afterwards
to take some mild Purge, or use laxative Clysters; after which they
found themselves easier, and an anodyne Draught, with twenty or
twenty-five Drops of the _tinctura thebaica_, put an End to the
Hiccup. Others required the Use of Cordial Draughts, mixed with
Opiates; and repeated Clysters and Fomentations, before they found
Relief.--The Application of a Blister removed the Hiccup in one,
after the above Remedies had proved ineffectual; as did the Musk Julep
with Opium, and the Application of an aromatic Plaister to the
Stomach, in another Patient.

Several of them complained of a burning Heat and Pain in making Water;
which commonly went off by drinking freely of the Gum Arabic
Decoction, with the dulcified Spirit of Nitre, and the Use of oily
Draughts; though in some it required the Assistance of Opiates, and of
Fomentations and Clysters, before it was got the better of.

The Symptom of Worms we were often obliged to neglect till the Fever
was over, and then we treated it as formerly mentioned.

The Deafness, though not near so frequent in this as the Malignant
Fever, was rather a favourable Symptom, and mostly went away of
itself; though in a few Cases, where it continued long, we applied
Blisters behind the Ears, or to the Neck, with Advantage.

Many, especially those who were brought low, complained, after the
Crisis of the Fever, of Restlessness, and Want of Sleep; which,
however, went off as their Strength returned: Where it fatigued them
much, and kept them low, we gave a Cordial anodyne Draught at Night;
and if that did not answer, commonly the Addition of a few Glasses of
Wine in the Afternoon had the desired Effect.

Others, in their convalescent State, complained of such a Giddiness,
and Lightness of the Head, that they could neither walk nor stand;
others, of a Dimness of the Eyes. These Symptoms, for the most part,
went off as the Patients gathered Strength: The Use of the Bark, with
now and then a Glass of Wine, hastened the Cure; and in two or three
Cases we were obliged to give a Dose or two of some gentle Physic, and
to apply a Blister, before the Patient got the better of them.

As the Sick were recovering, it was common for them to complain of
Pains of the Shoulders, Arms, and Legs, which also left them as they
recovered their Strength; where they did not, the saline Draughts, and
a low Diet, generally had a good Effect; and where it had not, we
treated them as rheumatic Complaints.

When the yellowish Colour of the Countenance remained after the Fever,
we kept the Patient on a low Diet; and his Body open by Means of the
saline Draughts, with a few Grains of Rhubarb, or by giving Half a
Drachm, or two Scruples of the Soap Pills with Rhubarb daily; which,
for the most part, removed the Yellowness soon. Two only had a
Jaundice remain after the Fever, and both were cured in a short Time.

In other Respects, the Treatment of this Fever, when it degenerated
into a continued Form, had nothing particular in it; nor differed from
the common Practice of giving cooling Medicines when the Fever was
high, and supporting Nature by the Use of Cordials and Wine, and the
Application of Blisters, &c. when low; and promoting such Evacuations
as Nature pointed out for a Crisis.




OF THE Intermitting Fever, or Ague.


This Disorder belongs to the same Tribe of Diseases as the Remitting
Fever. We call it an Intermitting Fever, or Ague, when the Paroxysms
are distinct, begin with a cold and hot Fit, and go off with a Sweat;
and the Patient is cool, and free from the Fever in the Intervals
between the Fits.

Many have been the Causes alledged to produce this Disorder. The great
Quantity of Bile that is often thrown up in the Fit, has caused it to
be ranked among the bilious Diseases; and the Seasons of the Year in
which it is most frequent, and the low moist Situation of the Places
where it is endemic, have made Practitioners suspect, that an
obstructed Perspiration, and a Tendency in the Juices to the
Putrescent, are the Cause of it.

But whatever Cause we may suppose to give Rise to the first feverish
Fit, it is difficult from hence to account for the regular Returns of
the Paroxysms and Intermissions: For my own Part, after considering
Intermittents, which observed a regular _Type_ in the Course of a
Salivation[78]; their being so easily stopt by the Bark without any
sensible Evacuation; their being sometimes put away by a Stimulus
externally applied[79], or by a Fright, or sudden Plunge into cold
Water[80]; their returning after slight Errors in Diet, and sometimes
by the Operation of a Purge, or of Bleeding; their attacking sometimes
only particular Parts, and many such Accidents in these Fevers, I must
confess, that I am unable to form any Idea, either of their Origin,
Seat, or Cause[81].

    [78] See _Van Swieten_, Vol. II. p. 537.

    [79] A Gentleman told me, that he was once cured of an Ague
    in the Country, by applying a Poultice of Garlic to his
    Wrists, and letting it lie on till it inflamed and blistered
    the Part.--I have seen Blisters cure an Ague.--In the
    _Edinburgh Med. Essays_, Vol. II. Art. v. we have an Account
    of Agues being cured by the Application of Poultices of
    recent Erigerum (Groundsel) applied to the Stomach on the
    Days free from the Paroxysm, which caused strong Vomiting.

    [80] See an Account of an Ague being cured by the Patient
    being pushed into a Pool of Water without any previous
    Notice, and being much frightened, in _Mason's Account of
    Agues_, p. 222.

    [81] The common Account given of the Cause of Agues, and of
    the regular Return of their Paroxysms, has been: That the
    Ague takes its Rise from some Sort of Matter, bilious, or
    whatever it may be, either mixed with the Blood, or lodged in
    the Bowels, or in some other Part of the Body; that a great
    Part of this Matter is thrown out of the Body, in the Time of
    the Paroxysm; but that so much remains as serves by Way of a
    Ferment to assimilate other Particles to its own Nature;
    which, when collected in a certain Quantity, produce a new
    Fit; and, according to the Time that it takes to produce this
    Quantity, the Disorder assumes the Form of a Quotidian,
    Tertian, or Quartan Ague.

The Soldiers were subject to this Disorder, particularly in Spring, if
they took the Field soon, and in Autumn: The Frequency of it was in a
great Measure determined by the Nature of the Ground on which they
were encamped, or the Situation of the Garrison or Town in which they
were quartered; for the lower and moister the Camp or Garrison, and
the more moist the Season, the more subject an Army is to Agues; and
the drier the Situation of the Camp or Garrison, and the finer and
drier the Weather is, the freer they are from Disorders of this Kind.

In Winter 1761, we had but very few Agues in the Hospitals; but on the
Return of the Troops from the Expedition into _Hesse-Cassel_, and
during the Spring, some (though not many) were attacked with Quotidian
and Tertian Agues, and but very few with Quartans.--In _July_ and
_August_ they were more frequent, and accompanied with more bilious
Symptoms. At _Bremen_, during the latter End of Autumn, and throughout
the Winter and Spring 1762, we had Agues of all Sorts, and many
inveterate Cases; and all this Spring, and during the Summer and
Autumn, the Ague was the epidemic Disorder all over _Westphalia_, as
well as among the Troops.

In Spring 1761, what Agues we had were mostly Tertian, some Quotidian,
and but two or three of the Quartan Kind. They were, for the most
part, mild, and yielded to the Bark.--Some of them began in the Form
of a continued Fever; but after Bleeding, and the Use of the cooling
Medicines for a few Days, they began to remit, and at last ended in
regular Quotidian or Tertian Agues: Others, at first, appeared in Form
of Remittent Fevers, attended with a strong throbbing Pulse; but
changed to regular Intermittents by pursuing the antiphlogistic Method
of Cure; and some from the Beginning assumed the Type of Quotidian or
Tertian Agues, but often attended with a good deal of Fever, for the
first two or three Days; and some had a slight Delirium in the Time of
the Paroxysms, and the Pulse was not quite settled in the Intervals.
In such Cases, where the Patient was strong, nothing answered so well
as to take away some Blood; and to give the saline Draughts with Nitre
till the Fever was moderated, before we gave the Bark.

In general, there is a Prejudice against bleeding in Agues, after they
become regular; but I have always observed, both in _England_ and in
_Germany_, that where Patients are strong and plethoric, and the
Fever in the Paroxysms rises high, or the Pulse remains quick in the
Intervals, that taking away more or less Blood, and giving the
antiphlogistic Medicines in the Beginning, eased the Patient,
moderated the Fever, and made it safer to give the Bark soon; and I
never saw the least Inconvenience from the Practice; but, on the
contrary, have seen several Intermittent Fevers change into continued
ones from the Neglect of this Evacuation; and have seen Cases where
the Bark, instead of stopping the Ague, rather increased the Fever,
till the Patient was blooded, and had pursued the antiphlogistic
Method for some Time; after which the Bark had its proper Effect, and
put an End to the Disorder.

As soon as these Agues became regular, and the Patient was quite cool,
and free from any Fever in the Intervals, we gave the Bark; which soon
put a Stop to the Paroxysms, without the least bad Consequences; but,
before giving the Bark, we always took Care to empty the first
Passages by the Use of Emetics and Purgatives, where there was no
Symptom to forbid their Use: In Cases where the Patient was weak, and
the Fits so violent as to make it necessary to stop the Ague, before
we had Time to administer Emetics or Purgatives, we added so much
Rhubarb to the first Doses of the Bark as procured the Patient some
loose Stools, as recommended by Dr. _Mead_[82]; which did not prevent
its stopping the Ague, at the same Time that it answered the End
proposed of carrying off any putrid Humours that might be lodged in
the Intestines.

    [82] Mr. _Cleghorn_, while at _Minorca_, after Evacuations,
    gave the Bark at the End of the third Period, as we observed
    before; but where the Fever had been neglected till about the
    third or fourth Period, or badly treated in the Beginning,
    and the Bowels were inflamed or overcharged with corrupted
    Gall, he was obliged to endeavour to palliate the most
    pressing Complaints, and to watch Evening, Night, and Morning
    for a Remission, and then immediately to fly to the Bark, as
    the only Remedy that could avert the Danger. If the Patient
    was strong, he gave Half an Ounce of the Bark, with six
    Drachms of the _sal catharticum amarum_, divided into four
    equal Parts, of which the Patient took one every two Hours;
    the Effect of which was, that the next Fit was mitigated, and
    an Intermission commonly ensued, in which the Bark was
    repeated without the Purgative, to finish the Cure.--But
    where the Patient was excessively feeble, and there was a
    manifest Risk of his dying in next Fit, he gave Cordials with
    the Bark, instead of the _sal catharticum_; and endeavoured
    to throw in six or seven Drachms in the Space of ten or
    twelve Hours; he having found by Experience, that if a
    smaller Quantity is given, the Paroxysms come on earlier than
    usual, and make all Attempts to preserve Life unsuccessful.
    See his _Account of the epidemic Diseases of Minorca_, cap.
    iii. 2d edit. p. 192.

In _England_, Vernal, Quotidian, and Tertian Agues, frequently go off
after Bleeding, and taking some Emetics and Purges, and the saline
Draughts, and cooling Medicines, for some Time, without the Use of the
Bark; but in _Germany_ very few yielded to this Treatment, and we were
obliged to give the Bark[83] before we could put a Stop to them.

    [83] Sometimes, when Patients are reduced low by Agues, the
    Stomach becomes so squeamish as to reject the Bark in every
    Shape it can be given; in such Cases, when the Ague cannot be
    stopped by other Means, it may be administered with great
    Advantage in Clysters, of which the following is a very
    remarkable Instance.--_William Hadderell_, a Lad seventeen
    Years of Age, in the End of the Year 1761, was attacked with
    a severe Tertian Ague, in which a Mortification came on his
    left Foot, and one-half of it dropt off; notwithstanding, his
    Ague continued to attack him every second Day, and the Sore
    continued running on the 12th of _October_ 1763, when he was
    admitted into _St. George_'s Hospital. He was reduced
    extremely low; and the Sore of his Foot looked so bad, that
    it was at first imagined he must lose his Leg. He was ordered
    some Vomits, and a Purge, and cooling Medicines, and
    afterwards to take the Bark freely; but his Stomach rejected
    it, in whatever Form it was given. Other Means were then
    tried to stop his Ague, but with no Effect, till the 7th of
    _November_, that I ordered two Drachms of the Powder of the
    Bark to be given him twice a Day in an emollient Clyster,
    with Half a Drachm of the _tinctura thebaica_, which stopt
    his Ague in three Days; and he had had no Return of it on the
    28th of _January_ 1764, and had recruited his Health and
    Strength, and the Sore of his Foot was greatly lessened. Dr.
    _Harvey_ (who teaches Midwifery in _London_) told me, that he
    has cured Children of Agues by Bark Clysters, after the Bark
    Waistcoats, and other Means used, had proved unsuccessful.

In the End of _July_, and Beginning of _August_, the aguish Cases we
had at _Munster_ continued to be of the Quotidian or Tertian Kind. The
greatest Part of them began in the Form of continued Fevers, tending
more to the bilious Kind than the preceding Months, and many of the
Sick had bilious Vomitings in the cold Fits; and the Agues we had in
Spring, and during the Campaign 1762, were of the same Nature, and
required the same Treatment.

Those Cases, which began in the Form of continued Fevers, were
treated as such till they began to have regular Intermissions; they
then yielded to the Bark.

Some were attended with the Dysentery; and the Purging and Gripes were
most severe on the Days of the aguish Paroxysms. In such Cases, we
were frequently obliged at first to neglect the Ague, and to treat the
Disorder entirely as a Flux. Where there was much Fever, the Patient
strong, and the Pains in the Bowels acute, we ordered Bleeding; and
after it a gentle Emetic, and some Doses of the saline oily Purge, or
of Rhubarb; and gentle Opiates in the Evening, and other Medicines
proper in the Dysentery, till its Violence was abated, before we gave
the Bark: though in some Cases, where the aguish Paroxysms were very
severe, and helped to increase the Purging, and the Patient was in
Danger of sinking, we gave the Bark, notwithstanding the Flux still
continued; and the Method we followed was the same as that I formerly
mentioned, where it was complicated with the Malignant Fever; which
was to give the Bark, mixed with Diascord, and Opiates, or other
Medicines proper for the Dysentery, in the Intervals between the
Purges.

By this Treatment, very often both the Flux and Ague went off.
However, it ought to be observed, that unless the aguish Paroxysms
were severe, and in Danger of sinking the Patient, or that the
Disorder had continued for some Time, and the Paroxysms were distinct,
we seldom gave the Bark till the Violence of the Flux was abated: And
where-ever much Griping and Pain in the Bowels attended the Flux and
Ague, there Bleeding as well as Purgatives were necessary, before
exhibiting the Bark; which seldom or ever agreed with them, till there
was an evident _Apurexia_, or Absence of Fever in the Intervals
between the Fits. Where these Cautions were neglected, the Bark
generally made the Patients worse; and we were obliged to omit it,
till the Violence of the Purging was over.

Some Agues were accompanied with the Jaundice, though not in such a
high Degree as in the confirmed State of that Disorder; and commonly
in the Beginning the Pulse continued rather quick, in the Intervals
between the Paroxysms; and the Patients complained of some Degree of
Sickness for the first two or three Days. With those the Bark always
disagreed, till the Feverishness between the aguish Paroxysms was
gone; and we found, that the best Method of treating them, was to
bleed in the Beginning, if there was much Fever; and then to give a
Vomit and Purge, and to repeat them, if necessary; and where there was
no Purging, to give the saline Draughts, and other cooling Medicines;
and to add a few Grains of Rhubarb, or to give so much of the _pilulae
saponacae cum rheo_, daily, as procured one or two loose Stools.

After the Ague had regular Intermissions, and the Patient was quite
cool, and without Fever in the Intervals, if the Disorder did not
yield to the above Treatment, which it seldom did, we then gave the
Bark freely; even though the slight icteric Symptoms still remained;
and it put an End to the Ague, and removed the Jaundice at the same
Time, without the least Inconvenience to the Patient. In such Cases,
we generally used to add a few Grains of Rhubarb to the first Doses of
the Bark; or gave the Bark made up into Pills with Soap, and added
occasionally a few Grains of Rhubarb.

Several of those who had the icteric Symptoms along with the Ague, had
bilious Vomitings in the Time of the cold Fit; they found themselves
sick, with a bitter Taste in their Mouth, before the Approach of the
aguish Paroxysm; and many of them, though they took Emetics, which
operated freely at this Time, yet did not vomit up the Bile; but the
Sickness and bitter Taste continued till the cold Fit came on, when
they vomited Bile in large Quantities. In such Cases, after the Use of
Emetics and Purges, and the Ague was brought to have regular
Paroxysms, with free Intermissions, the Bark, given as just now
mentioned, removed the Ague and icteric Symptoms, without the least
bad Consequences.

Many Practitioners of great Repute have been prejudiced against the
Bark; and tell us, that the free Use of this Medicine often lays the
Foundation of Obstructions in the abdominal Viscera, especially when
it has been given where there was an icteritious Colour in the Eyes
and Countenance; and that, in such Cases, we ought not to give the
Bark till these Icteric Symptoms are gone. At first, I was very
cautious of giving it under such Circumstances; till meeting with some
Cases where the Paroxysms were severe, and became more frequent, while
the Patient was so low, as to be in Danger of sinking under the
Disorder, I gave the Bark freely, as the only Remedy capable of
preserving Life; which not only stopt the Ague, but carried off the
icteritious Symptoms[84], and restored the Patients to perfect Health.

    [84] This agrees with what Mr. _Cleghorn_ remarks of Tertian
    Fevers in his _Observations on the epidemic Diseases of the
    Island of Minorca_, who says, "where there is an icteritious
    Colour of the Eyes, we are likewise told, that the Cortex
    should not be administered; though, in my Opinion, it is for
    the most part dangerous to delay it, after the first
    Appearance of that Symptom." Chap. iii. 2d edit. p. 205.

After this I gave it freely, in the Manner above mentioned, to some
Hundreds, with great Success; and I never saw any Mischief follow from
using it: Indeed sometimes, where it was given rather too soon, it did
not sit easy on the Stomach; and made the Patients hot and restless;
but, by laying it aside, these Effects immediately ceased; and
generally, after a little Time, the Paroxysms became milder and more
distinct, when the Bark was again administered, agreed with the
Stomach, and put an End to the Disorder; and I am now convinced, from
Experience, that the Cases in which the Bark has done Mischief, or
given Rise to Obstructions of the abdomenal Viscera, are but very
rare; and that these Mischiefs mostly arise from the Obstinacy of the
Disorder, and not from the Use of this Drug; for I have oftener
observed these Obstructions where little or no Bark had been used,
than where it was given freely[85]. What probably has given Rise to
the Belief of the Bark's doing so much Mischief, is, that in
_Holland_, and other low fenny Countries, where Agues are endemic,
they are oftentimes extremely obstinate, and yield hardly to any
Remedies; and if they are stopt by the Bark, they often return soon
after, and by their long Continuance give Rise to Obstructions of the
abdomenal _viscera_, which have been attributed to the Use of this
Specific.

    [85] Dr. _Pringle_ takes Notice, that these Obstructions
    happened as often without as with the Bark; and therefore
    seemed to depend on the long Continuance and Obstinacy of the
    Intermittent. _Observ._ part iii. chap. iv. sect. 2. p. 179.
    3d Edit.

In some few Cases a Purging accompanied these icteric Symptoms, which
we treated much in the same Manner as when the Ague was complicated
with the Flux; we gave Emetics and Purgatives; and the mindereri
Draughts with Mithridate, throughout the Day, and Opiates at Night, if
the Purging was violent; if it continued, accompanied with regular
aguish Fits, the Bark, with Astringents, generally removed both.

In the latter Part of the Year 1761, and during Spring 1762, we had
at _Bremen_ many Patients in Agues of all Sorts; as Quotidians,
Tertians, Quartans, and irregular Agues of a very obstinate Nature.
The Town of _Bremen_ is large and well built, situated in a low sandy
Plain, with the _Weser_ dividing the old from the new Town; generally
a considerable Part of the Environs is covered with Water in the
Winter, and frequently the _Weser_ breaks down some of the Dikes, and
overflows all the Country round; and every Time the River overflows
its Banks, the Cellars of all the new Town, and of that Part of the
old Town next the River, are filled with Water. All the Year round, on
digging two or three Feet deep into the Ground, you come at Water.

Agues are endemic in this Place, and great Numbers of the lower Class
of People are afflicted with them at all Times of the Year, especially
in Spring and Autumn.

Some of the Sick sent down from the Army were bad of Agues; but the
greatest Number we had in Hospitals was composed of such as took it
in Town; either from doing Duty on the Ramparts, or from lying in bad
Quarters, or getting drunk and exposing themselves to Wet and Cold;
and many Men of the invalid Companies who had come from _Embden_
brought with them old inveterate tertian and quartan Agues.

Most of the recent Cases were easily cured by the Methods already
mentioned; though they often continued longer, required a greater
Quantity of the Bark to stop them, and a longer Continuance of its Use
to make a Cure, than at other Places, which were more dry, and higher
situated.

The most obstinate of the recent Cases were the irregular
Intermittents, which had regular Paroxysms, but where the Pulse was
not settled in the Intervals; which we were obliged to treat as
Remitting Fevers till the Paroxysms became quite distinct, and the
Patient was cool and free from any Fever in the Intervals; after which
they commonly yielded to the Bark.

But many of those Agues which had continued for some Time, especially
with those Invalids who came from _Embden_, or who had brought on
frequent Relapses by their own Irregularities, were very obstinate.
With many the Bark had no Effect; and its Use persisted in seeming
rather to exasperate the Paroxysms, and to do Hurt. Nor had almost any
Remedy we tried a better Effect. We gave the following Medicines to
divers Patients; the saline Draughts and cooling Medicines; Infusions
of Camomile Flowers and of other Bitters; Dr. _Morton_'s Powders of
Camomile Flowers, Salt of Wormwood, and diaphoretic Antimony; Dr.
_Mead_'s Powders of Camomile Flowers, Salt of Wormwood, Myrrh, and
Alum; Alum and Nutmeg; large Doses of _sal ammoniac_; large Quantities
of Spirits of Hartshorn; the antimonial Drops and Powders; to some we
gave Emetics, both in the Intervals and immediately before the Fits.
In some we tried to promote Sweats before the Approach of the Fits, by
making them drink freely of warm Liquors while they kept in Bed, and
took diaphoretic Medicines; and to others we applied Blisters.--But
all did not put a Stop to some of those Agues.

With some the Disorder continued till it broke down the Crasis of the
Blood, and brought on a general Relaxation of the Fibres; and the
Patients became cachectic, and fell into Dropsies, or were seized with
Diarrhoeas, of which they died. Some had Obstructions formed in the
Liver or Spleen, or other _viscera_, and fell into the Jaundice and
Dropsies, which carried them off.--In the Bodies, of several whom we
opened, we found Indurations of the Liver and Spleen--in two of them
Suppurations of the Liver--and in one, who had had the Ague at
_Embden_, and had long complained of one of those Swellings towards
the left Side of the _abdomen_, called the _Ague Cake_[86], the Spleen
was so much enlarged as to weigh above four Pounds.

    [86] I have seen the dead Bodies of four People opened, who
    had those Swellings of the left Side, commonly called the
    _Ague Cake_, which had come after Agues; and in all the
    Swelling was owing to an Enlargement of the Spleen.

Some, whose Constitutions were worn out by these obstinate Agues, fell
into Consumptions and other pulmonic Disorders in the Winter, of which
they died. One Man died in the cold Fit[87].

    [87] The cold Fit is the most dangerous Time of the Paroxysm,
    and the greatest Part of those who die of Agues die at this
    Time; one or two Instances of which I saw in the Military
    Hospital at _Edinburgh_ in the Year 1746.--_Van Swieten_ says
    he has seen the trembling and shaking so great in the Time of
    the cold Fit of Quartans, that the Teeth have dropt out of
    the Head. _Comment. in sect._ 749. _Aphorism. Boerhaav._ vol.
    II. p. 511.

Where-ever the Ague continued long, and the Bark had no Effect, we
were obliged to lay it aside, and to try other Remedies adapted to the
present Circumstances of the Patient.

The mild Methods succeeded best; giving the saline Draughts and gentle
cooling Medicines to such as were strong and plethoric, and had the
aguish Paroxysms violent; and the gentle Aromatics and Bitters, or
Chalybeats, to those of a weakly Habit, or whose Fibres had been much
relaxed, and their Constitutions greatly injured by this or any other
preceding Disorder.

During these Courses, we gave at Times gentle Emetics; and if the
Patient complained of Gripes and Purging, which they frequently did,
in the Course of this Disorder, we gave a Dose of Rhubarb, or of some
other mild Purge; and after it other Medicines proper for this
Complaint.

By these Methods frequently the aguish Paroxysms became gradually
milder, and at last vanished. At other Times, after they had continued
for five or six Weeks, we again gave the Bark, and found it to have
the proper Effect. With others they continued thro' the Winter, and
went off of themselves in the Spring. With others they still
continued; and as no Medicines nor Time seemed to have any Effect in
that Country, we recommended their being sent over to _England_ for
Change of Air, as the only Means likely to remove the Disorder.

Two Agues which had resisted the Use of the Bark were cured by Powder
of Camomile-Flowers, Salt of Wormwood, and diaphoretic Antimony; and
one by the Use of the aluminous Powders, with Myrrh.--One Invalid, who
had long been ill of an obstinate Tertian, on catching Cold, was
seized with an Inflammation of his Throat, for which he was blooded,
and took a mild Purge; next Day there appeared a Swelling of one of
the parotid Glands, which we endeavoured to bring to Maturation, by
the Application of emollient Cataplasms; after some Days it went
entirely away, without coming to Suppuration; but as there remained
still a Confusion of the Head, and a Quickness of the Pulse, a large
Blister was applied to the Back, which continued running for some
Days; after it dried up he fell into a Fit resembling that of an
Epilepsy, and next Day had another Fit of the same kind; from the Time
the Swelling first appeared till the Time he had the first Fit, he had
no Ague, but it returned the second Day after the second epileptic
Fit; another Blister was applied, and he had no Return of the
epileptic Fits, though his Ague continued obstinate till _March_, at
which Time he was sent to _England_[88].--About the same Time the
aguish Fits of two others were stopt by the Application of Blisters,
though they returned in both soon after.

    [88] On the 29th of _August_ 1759, a Man (_Murdoch Brinnen_)
    about thirty Years of Age, was admitted into _St. George_'s
    Hospital for a very large Swelling of the parotid Glands and
    neighbouring Parts, which had come three Days before, after a
    Fit of the Tertian Ague, which did not return afterwards. The
    Swelling was discussed by the Application of emollient
    Cataplasms, which were intended to have brought it to
    Suppuration. He had no Return of the Ague, nor did any bad
    Consequence follow the Discussion of the Tumour, and the Cure
    was completed by a few Doses of Physic, and a Decoction of
    the Bark, which restored him to his Strength, and carried off
    the little Heat and Feverishness which remained.

Excepting in these few Cases, I found no Medicines effectual in
stopping those Agues, which had resisted the Bark when properly given,
though we tried a vast Variety in different Cases. The _cortex
cascarillae_, or _eleutheriae_, was given freely, both in Decoction and
Substance, in four Cases, which had not yielded to the Bark, but
without producing any good Effect; we had not an Opportunity of
trying this Bark in more Cases of this kind, nor in Fluxes, the small
Quantity of it which had come from _England_ being all expended.

A Soldier of one of the Regiments of Guards, who was admitted into the
Hospital for oedematous Legs, and the Remains of a very bad Flux, which
he had had ever since the preceding Autumn; after being cured of the
Flux, and most of the oedematous Swellings, was seized with an
intermitting Complaint in _February_. He had no regular hot and cold
Fits; but every second Day, after a slight Shivering and Cold, he was
seized with Gripes and a Purging. In one or two of the Fits his Pulse
was very quick, and the Pain of the Bowels very acute and severe;
which obliged us to blood him, and give him a Dose of the saline oily
Purge; after which we treated the Disorder as a Flux complicated with
the Ague, and gave the Bark mixed with Diascord, and gentle Opiates at
Nights, and at Times gentle Purgatives; the Ague and Diarrhoea stopt
very soon, and in a few Weeks he got free of all Complaints, though he
still continued weak, till he was sent to _England_, about the
Beginning of _April_.

Many, especially those whose Constitution had been shaken by this or
some other Disorder, complained of flatulent Swellings of the Stomach
and Bowels, which affected them either while the Ague continued, or
soon after it was stopped, and were very troublesome and uneasy. For
the most part, these Swellings were removed by the Use of cordial
Medicines mixed with the Bark, or a Course of Bitters, and some Doses
of Rhubarb given at proper Intervals. In some Cases, where they were
attended with Sickness, and the Stomach seemed to be loaded, a Vomit
gave Relief. Very often these Symptoms continued for Weeks after the
Ague had left them, and did not go entirely off, till the Patient
recovered his Strength.

In _February_, _March_, and _April_, 1761, severals of the Soldiers in
the Hospital at _Paderborn_ complained of periodical Head-Achs, which
returned in most, every Day; in others, only every second; and
afterwards Cases of this Kind occurred at different Times as long as
the Army continued in _Germany_. These Head-Achs generally began in
the Forenoon, were very violent while they lasted, and confined the
Patient to his Bed for some Hours. During the Pain, the Pulse was
quick; but in the Intervals the Patients were quite cool, and without
Fever. Sometimes, tho' not always, the Urine deposited a little
Sediment as the Head-Ach was going off. Commonly the Pain was all over
the Head, but most severe in the Forehead; though sometimes it was
confined to one Side only.

These Head-Achs we treated entirely as Agues of the same Type. When
the Patient was strong, some Blood was taken away, and afterwards we
prescribed an Emetic and Purge, and then gave the Bark liberally,
which generally put an End to the Complaint, without any bad
Consequences attending.




OF THE JAUNDICE.


The Jaundice, or a yellow Colour of the Eyes and Skin, occasioned by
an Absorption of Bile into the Blood, was another Distemper which
appeared towards the End of each Campaign.

This Disorder, for the most part, takes its Rise[89] from Calculi
lodged in the biliary Ducts[90]; and sometimes from a viscid Mucus or
Pituita obstructing those Passages[91]; and it may be brought on by a
Tumour, or any other Cause[92], compressing these Ducts, so as to
prevent the free Flow of the Bile into the Cavity of the Intestines.

    [89] Obstructions and Scirrhi of the Liver have been assigned
    as the Cause of the Jaundice; but as we have so many Cases of
    this Kind related where no Jaundice appeared, it is now much
    doubted, whether such Obstructions, which do not affect the
    Ducts, are capable of producing this Disorder.

    [90] We have numerous Cases in _Bonetus_, and other physical
    Observations, where Calculi have been found in the Gall
    Bladder, and Ducts of People who have died of the Jaundice;
    and I have frequently found two, three, and sometimes twelve,
    fifteen, or twenty, such bilious Calculi in these Cavities.

    [91] Viscid Mucus or Pituita, or viscid Bile, has been
    observed frequently to obstruct the Ducts. Dr. _Coe_ says,
    sometimes icteric Patients discharge very thick Bile, almost
    as viscid as Bird-Lime. See his _Treatise on biliary
    Concretions_, chap. ii. where he has collected a great Number
    of icteric Cases, in which the Bile has been found quite
    viscid after Death.

    [92] See the Case of a Jaundice in _Bonetus's Sepulchretum
    Anatomicum_, tom. II. p. 326, where the Sides of the common
    biliary Duct were compressed by an Enlargement of the Glands
    about the _vena portarum_; and we sometimes meet with a
    Jaundice in pregnant Women which goes off after Delivery, and
    seems to have been caused by the Pressure of the Uterus and
    indurated Foeces in the Colon. _Van Swieten_ says, he has seen
    this very frequently, vol. III. sect. 918, p. 95.

The yellow Colour, or Jaundice, observed in the Ague, and some other
bilious Disorders, seems to arise sometimes from Spasms of the Ducts;
or from too great a Quantity of Bile secreted and absorbed into the
Blood, which seems evidently to be the Case where large Quantities of
Bile are either vomited or discharged by Stool; a Proof that the
biliary Ducts are clear, and free from Obstructions.

In the End of the Campaign of 1760, after a continued Rain for many
Weeks, the Jaundice had been very frequent, and in a Manner
epidemical, among the Troops, for some Time before they left the
Field; and in passing thro' _Munster_, about the End of _December_, I
observed several ill of that Distemper in Hospitals, and met with a
few Cases of this Kind in the Hospitals at _Paderborn_ in _January_
1761; but during the Spring and Summer, we had only one or two now and
then sent to the Hospitals for this Complaint; though towards the End
of the Campaign it became more frequent, and several were sent down to
_Bremen_; and some of the Garrison were likewise affected with it.
During the Winter not above four or five were sent to the Hospitals I
attended, and but a few to the flying Hospital, during the Campaign
1762. It frequently appeared in dropsical Cases, depending on
obstructed Viscera.

Those in whom the Jaundice was the original Disorder, and not
complicated with any other, generally got well soon; but where it
appeared in dropsical Cases, depending on obstructed Viscera, it was
commonly fatal.

In the Beginning of this Disease, Patients usually complained of
Sickness, Heat, Thirst, and other feverish Symptoms; and some had a
Vomiting, and Pain of the Stomach, for a Day or two before the
Jaundice appeared; the Urine was always of a deep Colour from the
first; and about the second or third Day the Skin, and the Whites of
the Eyes, began to be tinged with a yellow Colour, attended with the
common Symptoms of this Disorder.

Such was the Manner in which the Jaundice began in those who were
taken ill in Garrison; but those sent us from the Army could seldom
give any accurate Account of their own Cases.

In the Course of this Disorder, the Sick were inclined to be costive,
though some few had a Diarrhoea; several, who had been reduced by
Fevers, or other Complaints, before the Jaundice appeared, were
attacked with violent Haemorrhages from the Nose; and two had like to
have died of them before the Bleeding was stopped. The Haemorrhages did
not prove critical, but seemed to depend on a dissolved State of the
Blood.

On the Patient's being first taken ill, if he was plethoric or
feverish, or complained of Pain, attended with Sickness and Vomiting,
some Blood was taken away. Next Day we gave twenty-five or thirty
Grains of Rhubarb in a saline Draught, and afterwards the common
saline and other cooling Medicines, till the Fever was abated. If the
Pain and Fever did not abate, a Vein was opened a second Time, and a
few Drops of the _tinctura thebaica_ were added to the saline
Draughts, while emollient Clysters were frequently administered, and
the Stomach and Belly fomented with Flannels dipped in warm emollient
Decoctions.

When the Pain and Fever were gone, we then gave a gentle Vomit in the
Evening, and next Day a Dose of Rhubarb; and afterwards so much of
the _pilulae saponaceae cum rheo_ daily as kept the Body open; or the
saline Draughts with five or six Grains of Rhubarb in each, or such a
Quantity as answered the same Purpose as the Pills; and from Time to
Time repeated the Emetic[93] and Purge.

    [93] Vomits are reckoned amongst the most efficacious
    Remedies in this Disorder, and I have often seen good Effects
    follow their Use.--_Janet Crags_, a Woman thirty Years of
    Age, was, on the 21st of _December_ 1758 admitted into _St.
    George_'s Hospital for a Jaundice of some Months Continuance.
    Her Eyes and Skin were not of the common icteric Colour, but
    of a dark livid yellow, for which Reason both she and the
    Nurses termed her Disorder the Black Jaundice. She at first
    complained of a Difficulty of Breathing, and a Weight and
    Oppression about the Region of the Liver, for which she was
    blooded, took some Doses of Physick, and the Soap Pills with
    Rhubarb; but these produced no Change in her Complaints. On
    the 29th she had a Cough, and complained much of Sickness and
    Difficulty of Breathing, for which she was ordered a Vomit,
    and afterwards to take the Squill Draught Morning and
    Evening, which occasioned a Purging and Gripes. On the 5th of
    _January_ 1759, the Looseness still continuing, I ordered her
    to leave off the Use of the Squill Draughts, and to take only
    some Rhubarb in an oily Draught every Night at Bed-Time. On
    the 8th, tho' the Purging had increased, I did not chuse to
    check it, as I suspected it would prove a Crisis to the
    Disorder, and therefore only ordered her the Cordial Draughts
    and Wine to support her Strength. The Looseness continued
    till the 15th, when most of the icteric Symptoms were gone,
    and by the 30th they entirely disappeared. However, she
    continued low, and subject to Flatulencies for some Months
    afterwards, which were at last removed by the continued Use
    of Cordials, gentle Bitters, a nourishing Diet, and repeated
    Doses of Rhubarb; and on the 2d of _May_ she was discharged
    in a firm State of Health.

    Dr. _Coe_ says, "I have more Reason to be satisfied of the
    Effect of Vomits in dislodging these Calculi, than of any
    other, or indeed of all other Medicines." _Treatise on
    biliary Concretions_, chap. ii. p. 253. Besides viscid
    Humours, which Vomits bring away from the biliary Passages,
    how often are Gall Stones likewise found in the Stools after
    the Operation of a Vomit? _Ibid._ p. 256.

Most of the icteric Cases we had, which were not complicated with
other Disorders, yielded to the above Treatment in about twelve or
fourteen Days. Two or three remained obstinate for a longer Time. To
one I ordered a Quart of the pectoral Decoction, made with Parsly
Roots instead of the Linseed, to be drunk daily along with the Soap
Pills; and the Jaundice disappeared in about eight or ten Days. One
who had the Disease more obstinate than the rest, and complained for
some Time of a Tension and Uneasiness about the Liver, was ordered to
have the right Side fomented Morning and Evening, and to rub it for
some Time after with the _linimentum saponaceum_ and to drink the
Decoction of Sarsaparilla after the Soap Pills; and by continuing this
Course for about three Weeks, the Disorder went off[94].

    [94] Sometimes the warm Bath has a good Effect after other
    Remedies have afforded no Relief. In the Year 1743, a young
    Gentleman, a Student of Physic at _Edinburgh_, had a Jaundice
    for which he had taken Variety of Medicines, and rode daily
    on Horseback for some Weeks, without receiving any Benefit:
    At last, by my Father's Advice, he took a brisk Dose of
    Physic, and before it began to operate had a large Quantity
    of warm Whey thrown up by way of a Clyster, and went
    immediately into the warm Bath. In the Bath he was taken with
    a violent Inclination to go to Stool; and after coming out,
    had a great Number of bilious Stools that Day, and next
    Morning was still inclined to be loose; and in a few Days all
    the icteric Symptoms vanished. On the 20th of _July_ 1763, a
    middle aged Woman, _Elizabeth Hosier_, was admitted into _St.
    George_'s Hospital for a Jaundice, which came about a
    Fortnight before. She had been blooded, and had taken some
    Medicines, before I saw her. I ordered her a Vomit and Purge,
    and to take too Scruples of the Soap Pills and Rhubarb daily;
    and four Days afterwards the Vomit and Purge were repeated,
    but without making any Change in her Disorder. On the 29th
    she went into the warm Bath, and took a Vomit immediately on
    coming out. After the Vomit she had some loose Stools, and
    the icteric Symptoms went all off in a few Days. She
    continued well for some Months; but I have been told, that
    she has since relapsed.

    When the Jaundice continues obstinate, there is hardly any
    Thing has often a better Effect than the continued Use of
    Decoctions of the Juices of succulent Plants, of Whey in the
    Spring, Soap, and such like Medicines. The Baron _Van
    Swieten_ tells us, that he has cured many obstinate Jaundices
    by making the Patients drink daily a Pint or two Pints of a
    Decoction of Grass, Dandelion, Fumaria, Succory, and such
    like, prepared in Whey; to each Pint of which he added Half
    an Ounce of _sal polychrest_, and an Ounce or two of Syrup of
    the five aperient Roots; and by ordering them to drink the
    Spa Water in Summer, and take freely of Soap, along with a
    Decoction of the aperient Roots, in Winter. In those who were
    cured by these Remedies, he says, Stones, or a kind of a
    grumous calculous Matter, were always found in the Stools, as
    the Jaundice was going off. He relates one very particular
    Case of a Lady of sixty Years of Age, who had had a black
    Jaundice for twelve Years, and was cured by continuing the
    Use of these Medicines for eighteen Months; during the last
    six Months of which she had a Looseness, and constantly
    discharged by Stool a fetid granulated Matter of the Colour
    of Clay;--and another singular Case of a Man who was cured by
    living mostly upon Grass, and a Decoction of it, for two
    Years together. The Man came at last to devour such
    Quantities of it, and could distinguish the good Sort from
    the bad so well, that the Farmers often used to drive him out
    of their Fields. Vol. III. Sec.. 950.

    _Glisson_ tells us, that Cattle are subject to bilious
    Concretions in Winter, which are dissolved and evacuated in
    the Spring, when they begin to move much about, and to eat
    the new Grass, which purges them. _Oper._ vol. II. _Anat.
    Hepat._ chap. vii. p. 104.

    Dr. _Russel_ greatly recommends the Use of Sea Water along
    with the saponaceous Medicines. See his _Treatise on the Use
    of Sea Water_.

The Haemorrhage from the Nose commonly stopped soon. Where it was
violent, we kept the Patient cool, and applied Cloths dipped in
Vinegar and Water to the Nose.--In two Cases, one at _Munster_, the
other at _Bremen_, the Patients were hot and feverish, and a Vein was
opened, and eight or ten Ounces of Blood taken away; and in one Case
nothing took Effect till we gave repeated Doses of the _tinctura
saturnina_ in a common acid Julep.




OF TUMOURS of the BREAST.


In _May_ 1761, a great many of the Patients, who had been in Hospitals
the preceding Winter, had Tumours formed on the external Part of the
Breast, which they shewed me at _Osnabruck_. They began in the Form of
indolent Tumours, and came slowly to Suppuration. For the most part,
the Suppuration was only partial, and the Tumour, on being opened,
discharged a very small Quantity of Matter. Some of them, though they
felt soft, and seemed to contain Matter, yet, upon being opened,
discharged only a small Quantity of black Blood. None of them melted
down entirely into Pus, or came fully to Suppuration, and healed
kindly as Abscesses which succeed acute Inflammations. But after a
small Quantity of Matter was discharged, for the most part, there
still remained a hard Tumour, which felt as if it was a Swelling of
the Bone, or Cartilage below; and in some the Surface of the Bone was
found rough at the Bottom of the Abscess.

These Tumours seldom rose high, and were most of them situated at the
lower Part of the Sternum, or a little to one Side of it, commonly on
the left Side, above the _cartilago ensiformis_. Some Patients had
only one, others two, and some three such Tumours. The first of them I
saw was on the left Side, which, on being felt, gave exactly the same
Sensation as when the Cartilages of the Sternum are begun to be raised
by an Aneurism of the Aorta; only no Pulsation was to be perceived;
and most of them had the same Appearance.

The Patients, who had such Tumours, commonly complained of Pains of
their Breast. One or two, after these Tumours came to Suppuration,
seemed to recover their Health, and to feel no Uneasiness, tho' some
of the Swelling remained: But many of them were inclined to be
hectic, and seemed likely to grow consumptive.

Being ordered up to the flying Hospital in _June_, and the Sick going
down to _Bremen_, I had no Opportunity of seeing the Event of these
Tumours, or of examining the Bodies of those who died with them. One I
accidentally met with the following Winter at _Bremen_, who died of a
Consumption and Diarrhoea. He had a large Abscess, which penetrated
into the Cavity of the Chest, and discharged a great Quantity of very
fetid Matter, at the Part where one of these Tumours had been seated,
and the Sternum and Ribs were carious all round the Abscess.




OF PARALYTIC COMPLAINTS.


Some of the Soldiers, from lying out in the Nights on the wet Ground,
and from doing Duty in cold rainy Weather, were seized with a Pain and
Numbness all over, and lost the Use of their Limbs, which in some was
succeeded with a Palsy of these Parts: But the greatest Number of
those afflicted with Paralytic Symptoms were seized with them either
in Fevers, or after feverish and other Disorders. The Number, who were
attacked with Complaints of this Kind, were but few.

When Men were suddenly taken with Pain and Numbness all over, we found
that the best Method of treating them was to put them to Bed, and give
them Plenty of mild warm diluting Liquors for Drink; and if there was
much of a Fever, to open a Vein, to give the cooling antiphlogistic
Medicines, and apply Blisters; and if these Complaints still remained,
to endeavour to promote a breathing Sweat, by means of Diaphoretics
and warm Drinks. Several who were brought to the Hospital, soon after
being seized in this Manner, got well; but in some few, one or other
of the Limbs would begin to waste, and remain paralytic afterwards.

Those who had the true confirmed Palsy seldom remained long enough
with us to be cured. Two or three received Benefit from Blisters
applied to the Parts, and from Issues; drinking at the same time the
Decoction of the Woods, or of Sarsaparilla, and taking the volatile
Tincture of Guaiac or Valerian[95], and being sweated by the Use of
_Dover_'s Powder, or other Diaphoretics.

    [95] On _Wednesday_ the 1st of _February_ 1764, _Margaret
    Julion_, a Woman between fifty and sixty Years of Age, was
    admitted into _St. George_'s Hospital for an entire Loss of
    Speech, which seemed to depend on a paralytic Disorder of the
    Parts about the Larynx. The Account her Friends who came with
    her to the Hospital gave of her Case was, that she had been
    for five Months troubled at Times with Pains of her Bowels,
    and a Purging; that on _Sunday_ se'night before coming to the
    Hospital, she had suddenly lost the Use of her Speech, and
    had not spoke since that Time, though she seemed to hear and
    understand whatever was said to her. I asked her some
    Questions, which she answered distinctly by Signs. She had no
    paralytic Complaint of her Face, Arms, Legs, or any other
    Part of her Body, and swallowed both Fluids and Solids with
    Ease. She had no Fever, and seemed to complain of nothing but
    the Loss of Speech.--A Blister was applied to her Neck, and
    she was ordered the saline Draughts, with a Scruple of Powder
    of Valerian in each, to be taken three Times a-day, and a
    Dose of sacred Tincture, to be taken twice a-Week. She
    followed this Course for a Fortnight, when another Blister
    was applied to the Fore-part of the Neck, and the Powder of
    Valerian in the Draughts was changed for two Drachms of the
    _tinctura valeriana volatilis_. At the End of three Weeks she
    could pronounce the two Words _Why_, _What_. She continued
    the same Course till this Day, the 16th of _March_, and can
    now pronounce many Words and short Sentences.

One Man of the 51st Regiment of Foot, after doing Duty in very cold
wet Weather, in the Beginning of the Year 1762, was seized with a
Palsy of one Side of his Face, which prevented him from speaking
distinctly, and was an Impediment to his eating. He mended much after
being blooded, and having a large Blister to his Neck, kept open for
some time by means of the epispastic Ointment.




OF AN INCONTINENCY of URINE.


An Incontinency of Urine was another Complaint frequent among the
Soldiers; but it seemed to me to be counterfeited by many. All, who
had it, said that they had received some Hurt[96] or Sprain of the
Back, or a Kick from a Horse, or that a Carriage had run over them.

    [96] A Soldier in the Hospital at _Paderborn_ used to
    discharge his Water involuntarily, and mixed with Pus, which
    came from some violent Blows he had received on the Back.

    _John Pearce_, a young Man about eighteen Years of Age, was
    admitted into _St. George_'s Hospital, the 10th of _April_
    1759, for a Pain of his Side, and a Complaint of the Bladder.
    The Account which he gave of his own Case was, that, some
    Months before, he had received a violent Blow with a
    Cricket-Bat on the left Side, on the Region of the Kidney;
    and that ever since he had had a sharp Pain in that Part, and
    sometimes had a Stoppage of Urine, and at other Times it came
    away insensibly. His Pulse was rather quick, but low, and he
    had a feverish Heat. He at first took some cooling Medicines;
    but on the 20th, being low and faint, he had some of the
    foetid Julep. On the 23d he was attacked with a sharp Pain in
    the Belly and Side, had a Stoppage in making Water, a quick
    and full Pulse, and most of the Symptoms of the Stone. He was
    ordered to be blooded immediately, to take the saline
    Draughts every four Hours; and as he was inclined to be
    costive, to take as much lenitive Electuary as to procure him
    a loose Stool; and it was recommended that he should be
    sounded as soon as the Violence of the Fever was over. On the
    25th he continued much in the same Way, and had made some
    Water, which was intolerably foetid. Half a Drachm of the
    dulcified Spirit of Nitre, and five Drops of the _tinctura
    thebaica_, were added to each of his Draughts, as the Pain
    and Difficulty of making Water had increased. On the 26th his
    Pulse rose, and became very hard and quick; the Pain in his
    Side, and the Dysuria, became more violent; and about Twelve
    o'Clock he had a convulsive Fit, resembling that of an
    Epilepsy; after coming out of the Fit, as the Fever and Pain
    had increased, he was blooded; the Belly was fomented and
    embrocated, and he took the oily Draughts four Times a-Day;
    his Blood immediately threw up a very thick Buff. He remained
    pretty easy the rest of the Day; but about the same Time next
    Day, he had another convulsive Fit, and died.

    On opening his Body, we found about two or three Pints of a
    dark- foetid Water in the Abdomen; on cutting through,
    and squeezing the right Kidney, there came out a thin
    purulent Matter every where from its Substance, though it
    appeared sound; on raising and cutting through the
    Peritoneum, covering the left Kidney, there was a Discharge
    of about a Pint of black and very foetid Water, which had
    every where surrounded this Kidney; and there were six
    mortified Spots on its Surface, as large as the End of one's
    Finger, with a Depression in each about a Quarter or Half an
    Inch deep; most of the Substance of this Kidney seemed
    diseased, and it was full of Suppurations. The Bladder was
    contracted and thickened, and contained a rough Stone, which
    weighed three Ounces. The rest of the _viscera_ were sound.
    This Stone had certainly been in the Bladder long before the
    young Fellow received the Blow with the Cricket-Bat; but the
    Injury done the Kidney had probably aggravated the Symptoms.

    I do not remember ever to have seen convulsive Fits, such as
    this young Man had, in acute Diseases, except in one Case of
    a slow Fever, which came by taking Cold after a Salivation,
    and which I attended, along with Dr. _Pringle_. The Gentleman
    had three Fits exactly of the same kind as this young Man, at
    twenty-four Hours Distance from one another, and he died of
    the third.

Those who really had the Disorder seemed to have received such an
Injury of the Bladder, or Kidneys as required a considerable Space of
Time to get the better of; and by reason of the short Time we had them
under our Care at the flying Hospital, they seldom received much
Benefit. One or two thought they grew better on taking the Bark and
Balsam of _Peru_; at the same Time they bathed Morning and Evening the
lower Part of the Abdomen and Perinaeum, with Flannels dipped in gentle
astringent Liquors, applied cold. Blisters applied to the _os sacrum_
had no Effect.




OF A STOPPAGE of URINE.


We formerly mentioned, that in acute Diseases many complained of a
Stoppage or Difficulty of making Water; and others had this Complaint
from Strictures of the Urethra, or Disorders of the Bladder or
Kidneys[97].

    [97] It is often very difficult to judge of the Cause, or to
    be able to determine exactly the Seat of these Disorders
    before Death; as the following Cases will shew.

    _John Waden_, a middle-aged Man, was admitted into _St.
    George_'s Hospital the 10th of _April_ 1759, for a Swelling
    of the Abdomen, and a Difficulty of making Water, which he
    said begun about two Months before, with a violent Pain in
    his Back and Belly, occasioned by his being employed in
    making of Cyder in a very cold Cellar. He had not had a Stool
    for some Days: at first he took a Dose of Physic, and some of
    the saline Draughts; but in a Day or two complained that his
    Belly had grown to a monstrous Size, and that he had not made
    Water for above twenty-four Hours; on examining, we found the
    Bladder so much distended as to reach up to the Navel; and
    upon a Catheter's being introduced, above two Quarts of Water
    were drawn off, and the Swelling immediately subsided; but in
    the Afternoon was as large as before, the Bladder seeming to
    be in a paralytic State. During the Months of _May_ and
    _June_, his Water was drawn off twice a-Day; he had his Belly
    fomented with emollient, astringent, and other Decoctions,
    and embrocated with Liniments; was blooded once when
    feverish, took Cordials, the Bark, Myrrh, and a Variety of
    Medicines, without any Effect. On the 3d of _July_, a
    flexible Catheter was introduced into the Bladder, and left
    there, in order that the Urine might drain away as fast as it
    was secreted, and the Bladder be allowed to contract, and
    recover its Tone. The Catheter gave him no Pain, and he
    thought himself much easier by the Bladder's never being too
    much stretched; but on taking out the Catheter some Days
    after, he had the same Stoppage of Water as before. On
    consulting with Dr. _Batt_ and the other Physicians, it was
    agreed to give two Grains of the Powder of Cantharides, with
    three Grains of Camphor and ten of Sugar, rubbed well
    together in a Mortar, twice a-Day; and to continue the Use of
    the flexible Catheter. He found no Uneasiness or Strangury
    from the Use of the Cantharides, and thought he passed his
    Water more freely, when the Catheter was taken out; but after
    fourteen Days, finding no Change for the better, and being
    free from any Fever, he was ordered into the cold Bath; the
    two first Days he found himself more lively and brisk; but
    the third Day was chilly and cold after coming out of it, and
    therefore was desired to leave it off; some Days after he
    became hectic, and I observed Pus in his Water, which he said
    he had passed with his Urine for above three Months; after
    this he languished for near a Month, and died upon the 25th
    of _August_.--Upon examining his Body next Day, we found the
    thoracic Viscera in a sound State, except that the Lungs
    adhered a little on the right Side. Both Kidneys were
    diseased; they were inflamed, and seemed enlarged; and on
    cutting them, had Tubercles dispersed every where through
    their Substance, which had come to Suppuration, and contained
    a good deal of Matter; the lower Part of the left Kidney was
    mortified, and contained two or three Ounces of a black foetid
    Liquor. The Bladder of Urine was contracted, and its Coats
    greatly thickened, and the internal Coat much inflamed; and
    there was a Cyst full of Matter, about Half the Size of a
    Walnut, between the muscular and villous Coats, towards the
    lower Part of the right Side of the Bladder; and there were
    two large Cysts, containing a small Quantity of Matter,
    though capable of containing near two Ounces each; one
    situated between the _vesiculae seminales_ and Rectum, the
    other between the _vesiculae_ and Bladder, which opened into
    the Urethra by one common Orifice, capable of admitting a
    large Quill, at the Side of the _caput galinaginis_. The rest
    of the Viscera were in a sound State.

    _Mary Hibbard_, a Woman twenty-four Years of Age, was
    admitted into _St. George_'s Hospital, the 6th _June_ 1759,
    for a Complaint of her Bladder. The Account she gave of
    herself was, that, about _Christmas_ 1758, she had parted
    with some Gravel; and about fourteen Days before coming to
    the Hospital, she was seized with a violent Pain in her Back
    and Loins, attended with a Sickness and Nausea; and very soon
    after complained of a violent Pain in the lower Part of her
    Belly, and with a perpetual Inclination to make Water, though
    she felt a sharp Pain and Difficulty in doing it; and that
    these Complaints still remained. Her Pulse was quick and
    strong, and she was inclined to be costive. She was
    immediately blooded, took the oily Draughts three Times
    a-Day, the _decoctum furfuris_ for common Drink, and so much
    lenitive Electuary as procured her a Stool next Day. As there
    was a strong Suspicion of her having a Stone, she was
    sounded; but nothing at all was to be felt in the Bladder.
    Her Medicines eased her Pain in making Water, but not the
    Pain in her Back. On the 16th her Water was thick and turbid,
    and deposited a brown Sediment; and the Difficulty in making
    Water still remained; instead of the lenitive Electuary she
    was ordered the Rhubarb oily Draught to be taken every Night.
    On the 18th, there being no Change in her Disorder, she had
    Draughts made of an Ounce and a Half of simple Mint Water,
    Half a Drachm of the dulcified Spirit of Nitre, and five
    Drops of the _tinctura thebaica_, and Syrup three Times
    a-Day; but on the 22d she complained, that since she left off
    the oily Medicines, her Pain and Difficulty in making Water
    had grown worse; she was therefore ordered the saline and
    oily Draughts alternately, and to take the Rhubarb oily
    Draught occasionally when costive, which removed these
    Complaints; and they did not return while she remained in the
    House; but on the 4th of _July_, the Day before she was to
    have been discharged as cured, she was attacked with a sharp
    Pain in her Hip and Loins, and about the _os coccygis_; which
    increased till the 9th, and extended itself all along the
    Outside of the right Thigh; it was most acute about the _os
    coccygis_; but on examining, nothing was to be observed
    externally: This Pain continued more or less all that Month,
    and till the End of the next, and so obstinate as not to be
    altered by bleeding, and the Use of Liniments, Blisters,
    cooling Medicines, Opiates, warm Baths, and other Remedies.
    On the 20th of _August_, a strengthening Plaister was applied
    to her Back, which gave immediate Relief, and she was
    discharged cured the 29th. She continued well till _October_,
    when she was attacked with a violent Fever at _Hounslow_, and
    was brought to the Hospital on the 24th of that Month, and
    the tenth Day of the Fever. She died the 3d of _November_.
    During the Course of the Fever, she only complained once of a
    Difficulty of making Water.--After Death I had her Body
    opened, when the only Thing particular which we could
    observe, was the urinary Bladder about four times the natural
    Size; it seemed to be flaccid, and in a State of Relaxation;
    the Kidneys were sound, and no Signs of any Distemper could
    be observed about the Uterus or Rectum, or near the _os
    coccygis_.--When she was first in the Hospital, I desired her
    always to examine her Urine; but she never observed that she
    passed any Sand, Gravel, or any thing of that kind.

    _Thomas Jacey_, an elderly Man, was admitted into _St.
    George_'s Hospital the 14th of _March_ 1759, for a Pain in
    his Back, and a Difficulty and Pain in making Water, which
    was often mixed with grumous Blood; but he had never observed
    any Sand or Gravel in it. His Pulse was quick and full,
    attended with Heat and Thirst; and he was inclined to be
    costive; he was at first blooded, and took a Dose of laxative
    Mixture, and two Ounces of the Tincture of Roses, four Times
    a Day, and the _decoctum malvae_ for common Drink. At first he
    seemed relieved, and passed no grumous Blood for some Days;
    but on the 26th, as he complained much of a Pain in making
    Water, the Tincture of Roses was changed for the oily
    Draughts, and he was ordered the Rhubarb oily Draught
    occasionally. On the 9th of _April_ he fell suddenly into a
    comatose Way, and remained so till the 12th, when he died,
    notwithstanding the Use of divers Remedies.--Upon examining
    his Body, both Kidneys were found in a sound State; the
    Intestines covered with slight inflammatory Spots, the
    Bladder of Urine quite contracted, schirrhous, and greatly
    thickened; and its internal Surface rough and eroded, with
    one or two black Spots on it, and some grumous Blood lying on
    its Surface. The other viscera were sound.

    In Ulcers of these Organs, the natural Balsams, mixed with
    soft Things, are often of great Service; of which the
    following Case is an Example.--_William Lumley_, a Boy nine
    Years of Age, was admitted into _St. George_'s Hospital, the
    6th of _September_ 1759, for a Pain in the Bladder, and a
    Difficulty in making Water, which was always more or less
    mixed with Matter. At first there was a Suspicion of his
    having the Stone; but on sounding, none was to be found. From
    the Symptoms, it appeared as if there was an Ulcer in the
    Bladder near to its Neck; the Boy had a Cough, was very low,
    and inclined to be costive; at first he took three Spoonfuls
    of the Sperma Ceti Mixture four Times a-Day, and a Dose of
    Physic; but the Symptoms still remaining, on the 2d of
    _October_ he was ordered to take a Scruple of the
    _electuarium e spermate ceti_ three or four Times a Day, and
    to have the Gum-Arabic Decoction for his common Drink. By
    continuing the Use of these Things, and taking some opiate
    and laxative Medicines occasionally, he mended by slow
    Degrees, and all his Symptoms went off; and he recovered his
    Health and Strength, and returned Thanks for his Cure the
    18th of _January_ 1760.

    The following Account of a remarkable Suppression of Urine I
    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
    ipecacoanhae_, 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- Urine,
    which let fall a clay- 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
    _pilulae foetidae_ 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 _pilulae foetidae_ 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- 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.

Bleeding is seldom requisite, except where there is much Heat or
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
Haemorrhages, 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 palmae_, 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. AEgiptiacum_, &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.


AQUAE SIMPLICES ET SPIRITUOSAE.

    AQUA Alexeteria.
    ---- Bacc. Juniperi.
    ---- Cinnamomi.
    ---- Menthae vulgaris.
    ---- Menthae piperitidis.
    ---- Nucis moschatae.
    ---- Pulegii.
    ---- Rutae.

    Vel aliae aquae hujus generis praeparari possint, terendo in
    mortario vitreo elaeosacchara praeparata, cum oleis
    essentialibus, et sacchari albi 12la quantitate; et dein
    addendo aquae fontanae 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 Theriacae 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. fontanae, unc. xij. adde pro re nata tinct. thebaicae,
    drachm. i.

Collyrium vitriolicum.

    Rx Vitrioli albi, drachm. ss. solve in aq. fontanae, 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. hordeatae 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. Colaturae 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.
    serpentariae virgin. contus. unc. dimid. Dosis ab unc. i. ad
    unc. iij. ter quaterve die.

Decoct. commun. pro clyster.

    Rx Flor. vel herb. chamaemel. unc. i. coque in aq. fontan. lib.
    i.ss. ad lib. i. & cola.

Decoctum ligni guaiaci.

    Rx Ligni guaiaci ras. lib. ss. aq. fontanae 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. Colaturae 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. malvae, 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. sarsaparillae.

    Rx Rad. sarsaparillae, unc. iij. coque in aq. fontan. lib. iij.
    ad lib. ij. adde sub finem coctionis ligni sasafras, drachm.
    i. rad. glycyrrhizae, drachm. ij. Colaturae 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.
    tincturae thebaicae, 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. thebaicae 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 theae, 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 dimidia drachma bis die ad
    drachm. im. quater vel sexties die.

Elect. stomachicum.

    Rx Conserv. cynosbat. unc. iv. pulv. rad. zinziber. drachm.
    ij. canell. alb. unc. i. rubigin. martis, drachm. ij. syrup.
    q. s. dosis a scrup. i. bis terve die ad semidrach. 4tis
    horis.

Elect. e scammon. Ph. Lond.


ELIXIR.

Elix. aloes. Ph. Lond.

Elix. paregoricum. Ph. Lond.

Elix. vitrioli acid. Ph. Lond.


ENEMATA.

Enema commune laxativ.

    Rx Aq. fontan. calid. unc. xij. elect. lenitiv. semunc. sal.
    cathartici amari, unc. i. M.

Enema commun. oleos.

    Rx Aq. fontan. bullient. unc. x. mucilag. gum arabic. unc. im.
    olei olivar. unc. ij. adde pro re nata elect. e scord.
    drachm. ij. vel. tinct. thebaic. drachm. i.

Enema ex amylo.

    Rx Aq. fontan. calid. unc. iv. gelatin. amyli, unc. v. elect.
    e scord. drachm. i. M.

Enema terebinth.

    Rx Terebinth commun. drachm. vi. solve in vitello ovi & adde
    enemat. oleos. unc. x.

Emplastrum vesicatorium. Ph. Lond.


FOTUS.

Fotus communis.

    Rx Fol. malv. flor. chamaemel. singulorum, m. i. coque in aq.
    fontan. q. s.

Fotus commun. spirit.

    Rx Fotus commun. lib. ij. aceti, lib. i. spirit. vini tenuis,
    lib. ss. M. pro fotu.

Fotus cum sale ammoniac.

    Rx Fotus commun. lib. ij. sal ammoniac crud. unc. i.

Fotus volatilis.

    Rx Fotus commun. q. s. asperge panno statim ante applicationem
    spiritus sal. ammoniac, q. s.


GARGARISMATA.

Gargarisma commune.

    Rx Aq. hordeat. unc. xij. sal. nitri, drachm. i. mellis
    semunc. M. adde pro re nata spirit. vin. unciam i.

Gargarisma acidum.

    Rx Aq. hordeat. unc. xij. spirit. vini gallici, unc. i. aceti
    sescunc. tinct. myrrhae, drachm. ij. M.

Gargarisma volatile.

    Rx Aq. hordeat. unc. xij. spirit. vin gallic. unc. ij. sal.
    vol. ammoniaci, drachm. i. M.


GUTTAE ANTIMONIALES ANODYNAE.

    Rx Vini antimonialis, unc. im tinct. thebaic. drachm. ij.
    dosis a gutt. 30 ad 40 bis terve die, vel a gutt. 60 ad 140,
    h. s. in potu tepido.


HAUSTUS.

Haustus simplex.

    Rx Aq. fontan. sescunc. spirit. vini gallici drachm. i. ss.
    sacchar alb. drachm. dimidiam M.--Haustus praeparari possit
    aqua aliqua simp. et spirit. loco aq fontan. & spirit. vini
    gallici pro re nata.

Haustus anodynus.

    Rx Haust. simp. sescunc. tinct. thebaic. gutt. xx. M.

Haustus camphoratus.

    Rx Camphorae, gr. iij. tere in mortario cum sacchar. alb.
    drach. dimid. & dein adde mucilag. gum arabici, drachm. ij.
    haust. simp. sescunciam. M. s. a. Dosis repetenda, 4ta vel
    6ta. quaque hora.

Haust. emetic. antimonialis.

    Rx Vini antimonialis semunciam. Dari possit ad drachm. x. pro r. n.

Haust. emeticus scilliticus.

    Rx Oxymel. scillit. drachm. x. aq. fontan. semunc. pulv. rad.
    ipecacoan. gr. vi.

Haustus cardiacus.

    Rx Haust. simp. sescunciam confect. cardiac. scrup. im. M. f.
    haustus repetendus 4tis. vel 6tis. horis--adde pro re nata
    sp. lavend. comp. dr. i.

Haustus cardiacus oleosus.

    Rx Ol. essential. menth. gutt. ij. tere in mortario vitreo cum
    sacchar. alb. drachm. dimid. & adde haust. simplicis sescunc.
    tinct. stomachic. drachm. i. M.--adde pro re nata tinctur.
    thebaic. gutt. x.

Haustus lixiviosus anodynus.

    Rx Haust. simp. sescunciam, lixivii tartari, drachmam dimidiam
    tincturae thebaicae, gutt. xx. cap. h. s. vel mane & vesperi.

Haustus e mithridatio.

    Rx Haust. simp. sescunc. mithridat. scrup. i. aceti vin.
    drachm. iij. dosis repetenda 4tis. vel 6tis. horis.

Haustus oleosus communis.

    Rx Mucilagin. gum arabici, drachm, iv. ol. olivar, drachm. v.
    misce s. a. & adde haust. simp. sescunciam. Repet. 4tis. vel
    6tis. horis.

Haustus oleosus cum rheo.

    Rx Haust. oleos. communis, unc. ij. tinct. rhei sescunc. vel
    pulv. rhei, gr. xxv. tinct. thebaic. gutt. xv. M. fiat
    haustus sumendus vel h. s. vel primo mane.

Haustus purgans.

    Rx Infus. senae. unc. iij. sal. glauber. drachm. iij. spirit.
    vin. gallici, drachm. ij. sacchar. alb. drachm. dimid. capiat mane.

Haustus salinus communis.

    Rx Aceti vinosi vel succ. limonum semunciam, sal. absynth.
    scrup. i. vel ad saturationem, haust. simp. sescunciam adde
    pro re nata pulv. contrayerv. comp. scrup. i. vel pulv.
    contrayerv. cum nitro, scrup. ij.--Haustus praeparari possit
    cum salis diuretici drachma dimid. loco acidi & salis
    absynthii. Dosis repetend. 3tiis. 4tis. vel 6tis.
    horis--Eodem modo sit haustus cum spirit. mindereri uncia
    dimidia.

Haust. salin. cum confect. cardiaca.

    Rx Haust. salin. commun. unc. ij. confect. cardiac. scrup. i.
    M. repet. 4tis. vel 6tis. horis.

Haust. salin. cum mithridatio.

    Rx Haust. salin. commun. unc. ij. mithridatii, scrup. i. M.
    sumend. 4tis. vel 6tis. horis.

Haustus salin. cum rheo.

    Rx Haust. salin. com. uncias ij. pulv. rhei, gr. xxv. M.
    capiat mane.

Haustus salin. cum phu.

    Rx Haust. salin. commun. unc. ij. pulv. rad. valerian.
    sylvestris, scrup. ij. Dosis repetend. 2dis. 4tis. vel 6tis.
    horis.

Haust. salinus succinatus.

    Rx Haust. salin. commun. unc. ij. sal succini, pulv. castorei
    singulorum, gr. x. H. repetend. 4tis. vel 6tis. horis.

Haust. salinus purg. oleosus.

    Rx Mannae opt. semunc. olei olivar. drachm. vi. vitelli ovi q.
    s. tere in mortario, addendo paulatim sal cathartici amari,
    unc. i. solutam in aq. fontan. calid. unc. iij. spirit. vini
    gallici vel aq. alicujus spirituosae, drachm. iij. M. s. a pro
    dosi matutino.

Haustus volatilis.

    Rx Haust. simp. sescunciam sal. vol. c. cervi, gr. x. M. H.
    repet. 4tis. vel 6tis. horis.


INFUSA.

    Infusum amarum. Ph. Lond. Addi possit pro re nata in
    praeparando spirit. vini tenuis, lib. ss. ad lib. ij. infusi.
    Dosis ab unc. ina. bis die ad unc. ij. ter. die.

Infusum raphani rusticani.

    Rx Rad. raphani rusticani, unc. ij. baccar. juniper, unc.
    inam. cort. canell. alb. drachm. ij. aq. fontan. bullient,
    lib. iv. infunde per noctem leni calore. Colaturae adde
    spirit. vini gallici unc. iv. Dosis ab. unc. i. bis terve die
    ad unc. iv. 6tis. horis.

Infusum senae commun. Ph. Lond.


JULEPUM E MOSCHO.

    Rx Mosch. drachmam im. tere optime in mortario cum sacchar.
    alb. drachm. iij. & adde mucilagin. gum arab. dr. iv. Haust.
    simp. unc. vi. Dosis unc. ij. 4tis. vel 6tis. horis.


LINCTUS.

    Rx Conserv. cynosbat. unc. iv. ol. olivar. syrup. sacchari vel
    mellis ana unc. ij. adde pro re nata spirit. vitrioli tenuis,
    drachm. iv. Dosis cochleare theae urgente tussi.


LINIMENTA.

Liniment. saponaceum. Ph. Lond.

Linimentum camphoratum.

    Rx Olei olivar. unc. ij. camphorae, drachm. ij. M.

Linimentum volatile. Ph. Lond.

Linimentum volatile commune.

    Rx Olei olivar. unc. iij. spiritus salis ammoniaci, dr. vi. M.


MELLA.

Mel cum borace.

    Rx Mellis optimi, unc. i. pulv. subtilissim. boracis, dr. i. M.

Mel AEgyptiacum. Ph. Lond.

Mel rosaceum. Ph. Lond.

MITHRIDATIUM. Ph. Lond.


MIXTURAE.

Mixtura acida communis.

    Rx Haust. simp. unc: viij. spirit. vitrioli tenuis, scrup. ij.
    vel ad gratam aciditatem. Dosis ab. unc. ij. ad unc iv. 4tis.
    vel 6tis. horis.

Mixtura ammoniaca.

    Rx Gum ammoniaci, drachm. i. solve in haust. simp. unc. vi.
    Dosis ab. unc. i. ad unc. ij. bis terve in die.

Mixtura ammon. cum oxymel.

    Rx Mixt. ammoniac. unc. vi. oxymel scillit. drachm. vi. Dosis
    a cochlear. i. ad unc. ii. ter. 4rve. die.

Mixtura ammoniac. anodyna.

    Rx Mixt. ammoniac. cum oxymel. unc. vi. tinct. thebaic.
    drachm. dimid. Dosis a cochlear. i. ad iv. 4tis. vel 6tis.
    horis.

Mixtura Campechensis.

    Rx Extract. ligni Campechensis, drachm. iij. solve in haust.
    simplic. unc. vi. adde pro re nata tinct. thebaic. gutt. xxx.
    vel Philon. Londinen. drachm. i. Dosis ab. unc. i. ad unc.
    iij. bis, ter, 4rve. die.

Mixtura faetida.

    Rx G. asafaetid. drachm. i. solve in haust. simp. unc. vi.
    Dosis ab. unc. i. ad unc. iij. 4r. die.

Mixtura faetida volatilis.

    Rx Mixt. faetid. unc. vi. spirit. volat. sal. ammon. drachm. i.
    Dosis ab. unc. i. ad unc. ij. bis, ter, 4rve. die.

Mixtura fracastorii.

    Rx Haust. simp. unc. viij. Elect. e scordio, drachm. iv. Dosis
    ab. unc. i. ad unc. ij. 4tis. vel 6tis. horis.

Mixtura japonica.

    Rx Haust. simp. unc. vi. Tinct. japonic. unc. i. adde pro re
    nata tinct. thebaic. dr. i.

Mixtura laxativa.

    Rx Elect. lenitiv. unc. i. Mannae semunc. coque in aq fontan.
    unc. xvi. ad unc. xij. Colaturae adde sal. cathartici amari.
    sescunciam. spirit. vini gallici, unc. i. Dosis ab. unc. ij.
    ad unc. xij.

Mixtura purg. antimonial.

    Rx Elect. lenitiv. sescunc. mannae semunc. coque in aq. fontan.
    unc. xx. ad unc. xvi. & dein solve tartar. emetici, gr. x.
    Colaturae dosis ab. unc. i. ad unc. iv. omni hora vel omni
    2da. vel 3tia. vel 4ta. hora, donec laxetur alvus.

Mixtura oleosa volatilis.

    Rx Haust. simp. unc. vi. ol. olivar. unc. iij. spirit.
    volatil. salis ammoniaci drachmam inam. M. Dosis ab. unc. i.
    ad unc. iij. 3tiis. vel 4tis. horis.

Mixtura scillitica.

    Rx Haust. simp. unc. vi. oxymel scillitic. drachm. vi. Dosis a
    drachm. iv. ad unc. ij. bis, ter, 4rve. die.

Mixtura e spermat. ceti.

    Rx Spermat. ceti, drachm. ij. solve in vitello ovi & adde
    haust. simp. unc. vi. adde, pro re nata, tinct. thebaic.
    scrup. ij. Dosis ab. unc. i. ad unc. ij. 4tis. vel 6tis.
    horis.

Mixtura e spermat. ceti cum balsamo.

    Rx Balsam. copaiv. drachm. ij. tere in mortario cum mucilag.
    gum arabici, drachm. iij. & dein adde mixtur. e spermat.
    ceti, unc. vi. Dosis ab. unc. i. ad unc. iij. 4tis. vel 6tis.
    horis.


MUCILAGO. G. ARABICI.

    Rx G. arabici pulv. unc. iv. solve in aq. purae bullient. unc. x.

Oxymel scillit. Ph. Lond.

Philonium Londinen. Ph. Lond.


PILULAE.

Pilulae faetidae.

    Rx Gum asafaetid. myrrh. ana drachm. i. sapon. alb. hispan.
    drachm. ij. Tinct. fuliginis q. s. Dosis a gr. x. ad drachm.
    dimid. bis terve die.

Pilulae guaiac.

    Rx Sapon. albi hispanici semunc. gum guaiac, scrup. iv. syrup.
    q. s. Dosis a scrup. i. ad drachmam dimidiam bis terve die.

Pilulae gummosae. Ph. Lond.

Pilulae mercuriales.

    Rx Argenti vivi semunc. extingue in balsam. copaiv. q. s. &
    adde pulv. glycyrrhiz. gum guaiac. singulorum, drachm. vi.
    syrup. q. s. ut fiat massa. Dosis a scrup. ss. ad drachmam
    dimidiam semel vel bis die.

Pilulae rufi. Ph. Lond.

Pilulae saponaceae. Ph. Lond.

Pilulae saponaceae cum rheo.

    Rx Sapon. alb. hispanici, drachm. vi. pulv. rhei, drachm. ij.
    syrup. sacchari q. s. Dosis a scrup. i. ad scrup. ij. bis
    terve die.

Pilulae scilliticae.

    Rx Pulv. glycyrhiz. rad. scill. exsiccat ana drachm. dimid.
    rad. zinziber. drachm. i. sapon. alb. hispan. drachm. ij.
    syrup. q. s. Dosis a gr. iv. ad. gr. xvi. bis terve die.

Pilulae stomachicae.

    Rx Pulv. canell. alb. drachm. ij. extract. rad. gentian. dr.
    i. mucilag. gum arabici q. s. Dosis a scrup. i. ad drachmam
    dimid. bis die--adde pro re nata rubigin. martis drachmam
    dimid.


PULVERES.

Pulvis astringens.

    Rx Pulv. canell. alb. rad. tormentill. singulorum, drachm. i.
    M. Dosis a scrup. i. ad drachm. i.

Pulvis aluminosus.

    Rx Alumin. crud. terrae japonicae ana partes aequales dosis a gr.
    viij. ad drachmam dimidiam.

Pulv. anodynus Doveri.

    Rx Sal. nitri, tartari vitriolati singulorum, unc. iv. in
    crucibulum candens injice, agitetur donec deflagratio &
    scintillatio desinat, & adde opii concisi, unc. i. & in
    pulverem redige addendo rad. glycyrrhiz. ipecacoanhae
    subtilissime pulver. ana, unc. i. & dein probe misceantur
    omnia. Dosis a gr. x. ad scrup. ij. vel ad drachmam 1nam.

Pulvis antimonialis.

    Rx Pulv. e chel. cancror. drachm. x. tartari emetici, dr. i.
    M. fiat pulv. subtilissimus. Dosis a gr. iij. ad gr. x. 4ta.
    vel 6ta. quaque hora.

Pulvis cardiacus.

    Rx Pulv. canell. alb. drachm. i. rad. zedoariae, drachm. ij.
    rad. serpentar. drachm. i. M. dosis a scrup. i. ad drachm. i.
    4tis. vel 6tis. horis.

Pulvis chamaemelinus.

    Rx Pulv. flor. chamaemel. drachm. iij. aluminis, g. myrrh. ana
    drachm. i. Dosis a scrup. i. ad scrup. ij.

Pulv. contrayerv. comp. Ph. Lond.

Pulv. contrayerv. cum nitro.

    Rx Pulv. contrayerv. comp. unc. iv. salis nitri, drachm. i. M.
    Dosis a scrup. i. ad drachm. i. 4tis. vel 6tis. horis.

Pulvis emeticus.

    Rx Pulv. ipecacoanhae, scrup. i. tartar emetici, gr. ij. Dosis
    a gr. xi. ad gr. xxii.

Hiera picra. Ph. Lond.

Pulv. Ipecacuanhae cum opio.

    Rx Pulv. rad. ipecacoan. gr. x. opii, gr. ij. dosis a gr. iij.
    ad gr. xij.

Pulv. e jalapio.

    Rx Pulv. rad. jalapii, drachm. vi. rad. zinzib. drachm. ij.
    Dosis a scrup. i. ad scrup. ij.

Pulv. jalapii cum nitro.

    Rx Pulv. rad. jalap. drachm. iv. salis nitri drachm. im. Dosis
    a scrup. i. ad scrup. ij.

Magnesia alba.

Pulv. nitrosus.

    Rx Pulv. e chel. cancror. drachm. iij. nitri, drachm. i. M.
    Dosis a scrup. i. ad scrup. ij. vel ad drachmam. i.

Pulv. nitrosus camphoratus.

    Rx Pulv. nitros, scrup. ij. camphorae, gr. v. M. Dosis a scrup.
    i. ad scrup. ij.

Pulv. nitrosus cum gum guaiac.

    Rx Sal. nitri, drachm. ij. gum guaiac. drachm. dimid. Dosis a
    gr. v. ad drachm. dimid.

Pulv. plummeri.

    Rx Calomel, sulph. aurat antimonii ana dr. ij. tere in
    mortario ut fiat pulv. subtilissimus. Dosis a gr. ij. ad gr.
    x. vel ad scrup. im.

Pulvis stanni. Ph. Lond.

Pulv. e spermat. ceti cum nitro.

    Rx Spermat. ceti, drachm. ij. sacchar. albi sal. nitri ana
    unc. im. Dosis a scrup. dimid. ad drachmam i.

Pulv. e tragacanth. Ph. Lond.


SALES ACIDI.

                                                     PRAEPARATIONES.
                  Spir. vitrioli fortis |                       |
  Acida           ---- tenuis           |Spir. vitrioli dulcis  |
  mineralis       Spiritus nitri        |Spir. nitri dulcis     | AEther.
                  Spir. salis marini    |Spir. salis dulcis.    |

  Varietat. acid. Acetum.
  vegit.          Spiritus aceti vel acetum distillatum.
                  Succus limonum.
                  Chrystalli tartari.

  Acid. anomal.   Sal. succini.
                  Sal. sedativus Hombergeri.


SALES ALCALINI.

  Alcal. vegit.  Sal. absynthii.
                 Sal. tartari.

  Alcal. min.    Sal. alcali mineral. seu soda, seu natrum.

  Alcal. vol.    Sal. volatilis c. cervi.
                 Sal. volatilis sal. ammoniaci.


SALES NEUTRI.

SALES NEUTRI, qui fiunt        ex ALCALI            et ACIDO.

            Tartarus vitriol.  | vegetab.      |
            Sal. glauberi      | minerali      | vitrioli.
            Sal. am. vitrioli  | volatili      |

            Sal. nit. com.     | vegetab.      |
            Nit. cubicum       | mineral.      | nitri.
            Sal. am. nitrosum  | volatili.     |

            Sal. digest. sylvii| vegetabil.    |
            ---- marin. com.   | minerali      | Sal. marini.
            ---- ammon. com.   | volatili      |

Varietates  Sal. diureticus    | vegetab.      | aceti.
salis       Tartar. tartar.    | veget.        | chryst. tartar.
neutri                         |   tartari     |
comp. ex    Sal. citratus com. | veget.        | succ. limonum.  Vegetabil.
alcal. &                       |   absynth.    |
acid.       Sal. de seignette  | minerali      | chryst. tartar.
vegitab.    Spir. mindereri.   | volatili      | acet. distillat.

Hi omnes sales neutri praeparari possint pro usu medico admiscendo
Alcali & acidum ad saturationem; alii vero in crystallos redacti, s.
a. commodius circumferuntur pro usu militari; alii ut _sal. citratus
comm._ et _spiritus mindereri_ facilius praeparantur ad miscendo alcali
& acidum ad saturationem pro re nata[115].

    [115] This Table of neutral Salts is nearly the same as one I
    have seen, which was said to be a Copy of that given yearly
    by Dr. _Cullen_, Professor of Chymistry in the University of
    _Edinburgh_, to his Pupils; and as that published by Dr.
    _Vogel_, in his _Institutiones Chymiae_, sect. 629. These
    neutral Salts are likewise taken Notice of by _Macquer_, in
    his _Elemens de Chymie_, and other late chymical Authors.

Solutio mercurii corrosivi sublimati.

    Rx Mercur. corrosiv. sublimat. gr. vi. spir. vini gallici,
    unc. xii. M. fiat solutio. Dosis a semunc ad unc. i. die.

    Species aromaticae. Ph. Lond.
    ---- e scordio. Ph. Lond.

Tartar. emetic. Ph. Lond.

Theriaca andromachi. Ph. Lond.


TINCTURAE.

    Tinctura amara.
    ---- corticis Puruv.
    ---- martis in sp. sal.
    ---- japonica.
    ---- melampodii.          Pharm. Lond.
    ---- myrrhae.
    ---- sacra.
    ---- saturnina.
    ---- serpentariae.
    ---- thebaica.

Tinctura rhei.

    Rx Pulv. rad. rhei, unc. ij. semin. cardamom minor. decortic.
    semunc. vini alb. hisp. lib. ij. sp. vini gallici, unc. viij.
    digere sine calore & cola. Dosis ab. unc. i. ad unc. iij.

Tinctura stomachica.

    Rx Cort. canell. alb. semunc. cort. aurantior. unc. i. semin.
    cardam. minor. decort. drachm. ij. spirit. vini gallici lib.
    ij. digere sine calore & cola. Dosis a semunc ad unc. i. bis
    terve die.--Adde pro re nata vin alb. hisp. lib. i.


UNGUENTA.

Unguenta caerulea vel mercurial. Ph. Lond.

Unguentum sulphuratum. Ph. Lond.


VINA.

    Vinum amarum.
    ---- antimoniale.   Pharm. Lond.
    ---- chalybeatum.


VITRUM CERATUM ANTIMONII.




AN ESSAY ON THE MEANS of Preserving the Health of SOLDIERS on SERVICE.
AND Conducting MILITARY HOSPITALS.




OF THE Means of Preserving the Health of Soldiers on Service.


The Life of _British_ Soldiers on Service, in Time of War, is so very
different from what they lead in Time of Peace, as to subject them to
many Inconveniences and Diseases.

In Time of Peace, Soldiers are quartered either in Towns or Garrisons,
where they are under the Eye of their Officers, who take Care that
they keep themselves clean, and provided with Necessaries; they lie
either in private Houses or in Barracks, where they have a good Bed,
regular Meals of wholesome Provisions, and enjoy most of the other
Necessaries of Life in common with the lower Class of People, their
Duty is easy, they mount Guard but seldom, and in other Nights enjoy
an undisturbed Rest.

Whereas, during the Time of an active Campaign, they are seldom in
Houses; they lie in Tents upon the Ground, which is often bare, and at
best covered only with Straw and a Blanket; and sometimes they are
obliged, after fatiguing Marches in wet Weather, to lie on the bare
Ground, without even a Tent to cover them; they must stand Centinel,
and be upon Pikets and other Out-Posts in the Night, during all Kinds
of Weather; besides performing long fatiguing Marches, and other
military Duties; and when near an Enemy, they are perhaps on Duty
every second or third Night, besides working Parties, and other Duties
of Fatigue; and what Rest they have is interrupted by frequent Alarms.
They have often but little Time or Convenience to make themselves
clean. Provisions are sometimes scarce, and frequently on long Marches
they have no Opportunity of dressing what they can get: Water is
sometimes difficult to be come at, and what is to be got, is bad. And
it frequently happens, that neither Beer, Wine, nor Spirits, can be
purchased for Money. In fixed Camps, they are often exposed to the
putrid Effluvia of dead Bodies, of dead Horses, and other Animals, and
of the Privies and Dung of the Horses[116]; and, in some Encampments,
likewise to the unwholesome Vapours of marshy Ground, and of corrupt
stagnating Water: All which, joined to the other Hardships and
Inconveniences unavoidably attending a military Life in Time of
Service, often give Rise to numerous Diseases, which weaken an Army in
a most surprising Manner; and therefore Commanders ought to use every
Means in their Power, consistent with the necessary military
Operations, to preserve the Health of the Soldiers.

    [116] In the Year 1760, the Men, who remained in the fixed
    Camp about _Warbourg_, were very unhealthy; while the
    Regiments who were detached to the _Lower Rhine_, under the
    Command of the Hereditary Prince of _Brunswick_, enjoyed a
    much better State of Health; and notwithstanding their great
    Fatigues, and the Loss they sustained at the Affair of
    _Kampen_, were much stronger when they rejoined the Army to
    go upon the Winter Expedition into the Country of _Hesse_,
    than those Regiments which had remained in the fixed Camp.

Diseases are more or less frequent in Armies according as the Season
is hot or cold, wet or dry; according to the Nature of the Climate,
and the Time of the Year in which military Operations are carried on;
the Nature of the Ground on which the Army is encamped, or the
Situation of the Towns or Villages in which they are cantonned; the
Cleanness, Neatness, and Dryness of the Camp, and of the Tents or
Houses in which the Soldiers are lodged; according as the Men are
supplied with Provisions, and good Water, good Beer, Wine, or other
fermented Liquors; or are well cloathed, and well furnished with Straw
and Blankets; in proportion as the Duty is more or less severe; and to
the Care taken of such as are attacked with Sickness.

Soldiers generally enjoy good Health in cold dry Weather, even during
the Time of severe Frost; if they be kept in Exercise, be well
cloathed, and well supplied with Provisions and good Liquors, and
with Wood; as the Troops, both in _Germany_ and _North America_,
experienced during the late War; but Cold joined to Moisture was
observed always to be productive of Diseases.

Nor is mere Heat of itself such an Enemy to Health[117] as is
generally apprehended; but when joined to Moisture, is observed to
give Rise to the most fatal Disorders in the warm Climates.

    [117] This Dr. _Pringle_ takes Notice of; and Mr. _Naesmith_
    says, he observed it in Voyages to the _East Indies_, which
    afford the fairest Trials of this Kind. See Dr. _Lind's Essay
    on the Means of Preserving the Health of Seamen_, 2d edit.
    note to page 5.

In our northern Climates the Winters are cold, and the Weather
variable; sometimes it is cold and rainy, at other Times thick and
foggy; sometimes we have fair Weather and Sunshine, at other Times
Frost and Snow; and sometimes it happens that we have all these
different Sorts of Weather in the same Day. During this Season,
Soldiers are subject to Coughs, Pleurisies, Peripneumonies,
Rheumatisms, and other Disorders of the inflammatory Kind. And in
very intense Frost, they are liable to have their Limbs benumbed with
Cold, and their Extremities Frost bit (as it is called).

And where there is a Want of fresh Provisions, and they are obliged to
live on salted Meat, and cannot have Greens, Pot Herbs, Roots, or
other fresh Vegetables, nor be properly supplied with Beer, Cyder,
Wine, or other generous fermented Liquors, they, as well as Sailors,
are subject to the Scurvy[118]; especially if they be encamped or
quartered in low damp Places.

    [118] Dr. _Joh. Valint. Willius_, Army Physician to the King
    of _Denmark_, in his Treatise on Camp Diseases, says, you
    scarce find a Camp in these northern Countries in which the
    true Scurvy, attended with stinking Breath and eroded Gums,
    is not to be observed. _Cap._ iii. _sect._ iii.

The best Means of guarding against inflammatory Disorders, and other
Mischiefs arising from Cold, whether in Camp or in Quarters, is, to
take Care that the Soldiers be well cloathed; that they lie dry, and
be well provided with Straw and Blankets, and with Wood; and to
prevent, as much as possible, their exposing themselves to sudden
changes from Heat to Cold.

In these northern Climates, it would be right to allow every Soldier
on Service a Flannel Waistcoat, a Pair of worsted Gloves, and a warm
woollen Stock, or a Neckcloth, to wear when on Duty in cold and wet
Weather, as soon as the Winter begins to set in[119]. Dr. _Pringle_
mentions the Advantage the Troops received from the Flannel
Waistcoats supplied by the Quakers, in the Winter Campaign of 1745-6,
in _Britain_; and those Regiments who had them for their Men towards
the End of the Campaigns in _Germany_, found that they contributed
greatly to keep the Men in Health. Officers ought to take particular
Care that the Men be well provided with good strong Shoes and
Stockings; and where the Troops remain late in the Field, if the
Government allowed a Pair or two extraordinary of each to every Foot
Soldier, it would be of great Use to the Service.

    [119] A Flannel Waistcoat, worsted Gloves, and woollen Stock,
    or a Neckcloth, may be purchased for about Half a Crown _per_
    Man, and would contribute to preserve the Lives of many; the
    recruiting of others, to supply whose Places, if they die,
    will cost the Government a great deal more than the Price of
    the Articles mentioned; which for a Regiment of nine hundred
    Men, at the Rate of two Shillings and Six-Pence _per_ Man,
    comes only to 112_l._ 10_s._ _per Ann._ Every Recruit sent
    from _England_ to the Army in _Germany_, cost the Government
    at least twenty Guineas before he joined his Regiment; and
    every sick Man sent to the general Hospital, cost the
    Government at least sixteen Pence _per_ Day, which is ten
    Pence above his Pay; so that, if we suppose the extraordinary
    Cloathing here mentioned would preserve only the Lives of
    nine Men to each Regiment yearly, and keep forty in Health
    who would otherwise be sick, we see what great Gainers the
    Government will be in Point of Money at the Year's End;
    besides preserving the Lives and Health of so many Men.

Blankets ought to be provided for each Tent, and those carried along
with the Regiment, so as to be always ready for the Men when they come
to their Ground. During the late War in _Germany_, a Couple of
Blankets were allowed for each Tent of the _British_ Troops, and each
Company carried their Blankets covered with an Oil Cloth on a Horse;
so that they were always up with the Regiments when they came to their
Ground.

Each Regiment ought to be provided with a Number of Watch Coats
sufficient to serve the Centinels who are to be on Camp Duty, or
general Guards, in very cold and wet Weather. Some of the Regiments in
_Germany_ had such Coats, and found great Service from them.

In Winter Quarters, Soldiers are apt to make the Rooms in which they
sit, and their Guard Rooms, as hot as possible; especially in
_Germany_, where the Inhabitants use close Stoves, instead of open
Fires; and continue in these warm Rooms till they are called out on
Duty, when, by being exposed to sudden Cold, they are apt to be seized
with Inflammations of the Breast; and therefore Officers ought to
examine carefully the Quarters and Guard Rooms allotted for their Men,
and chuse them dry and comfortable, if possible[120]; but never to
allow the Men to keep them as hot as Ovens, by Means of close Stoves,
or other such Contrivances; but to depend more on good warm Cloathing,
and dry Quarters, for guarding against Diseases, than upon artificial
Heat. Many of the Regiments in _Germany_ made the People in whose
Houses their Men were quartered, take down their Stoves, and use only
open Fires; when there was no Danger of the Soldiers making their
Quarters too warm, as Wood was difficult to be got.

    [120] Dr. _Pringle_ has very justly observed, that upper
    Stories are preferable to Ground Floors; and that all
    uninhabited large damp Houses ought to be rejected.
    _Observat. on Diseases of the Army_, part ii. chap. iii.
    sect. 2.

    If Necessity obliges Officers to put up with such Places for
    their Men, Care ought to be taken to clean them well, and to
    air and dry them by Means of Fires, before the Soldiers go
    into them; and to supply well the Men who are to lodge in
    them with Straw and Blankets, and with Wood or Turf.

But although close Stoves are prejudicial in small Rooms, yet when a
Town is much crowded, and Men are obliged to be lodged, in Winter, in
large Barns or Churches, or other large open Places, the _German_
Stoves may be used with great Advantage in airing and drying such
Places, and keeping them of a moderate Heat; especially if there be a
Place in them for an open Fire, or if they be of that Kind which the
_Germans_ call _wynd Stoves_, which have a Door opening into the
Chamber where the People are lodged; or if there be broken Windows, or
any other Opening by which a free Circulation of Air can be kept up
in the Men's Apartments.

In Winter, when the Weather is very cold or wet, a Glass of Brandy, or
of the spirituous Tincture of the Bark, given to the Men as they went
upon Duty, especially in the Night, has been found to be of great
Use[121]. Dr. _Pringle_ has very justly observed, that the Times of
standing Centinel, and being upon Out-posts, ought, if possible, to be
shortened at such Seasons; and that Fires in the Rear of the Camp, for
Men coming off Duty to warm and dry themselves at, were found to be of
great Service.

    [121] Dr. _Pringle_ has taken Notice, that it would be a
    right Measure to make an Allowance of Spirits to the Infantry
    on Service; which certainly would be of great Use, and save
    many Mens Lives; and might be done at a small Expence to the
    Government, if properly managed; as it would only be
    requisite to make such an Allowance when the Troops are in
    the Field, and to such Men as mount Guard in cold wet
    Weather, or at Nights in Garrison Towns, during the Winter.
    If ever such an Allowance be made, what Spirits are given to
    the Men ought to be mixed with five or six Times the Quantity
    of Water; except when Men are to stand Centinels, or to be
    upon Out-Posts, in a frosty Season, or in cold wet Weather;
    at which Time a small Glass of pure Spirits may be given them
    in Presence of the Officer or Serjeant of the Guard.

In Spring, and the latter End of Autumn, the Days are sometimes
extremely hot, and the Nights cold and damp, and the Men exposed to
these sudden Changes; at such Times, the Men who go upon Duty in the
Night, ought to put on their Flannel Waistcoats, and be warmer
cloathed than in the Day; and use many of the Precautions practised in
Winter for the Preservation of their Health.

In _North America_, when the Men were in the Field in very hard frosty
Weather, Fires were lighted at the Ends of the Tents, and Centinels
set over them to prevent their doing Mischief; and both in _Germany_
and _North America_, when the Troops were in the Field without Tents,
they cut down Wood and made large Fires, and the Soldiers lay down and
slept round these Fires, with their Feet next to them; and Fires were
lighted at all Out-posts, where it could be done with Safety.

In _Germany_, when the Weather set in rainy or cold towards the End of
the Campaigns, and the Army was in a fixed Position, his Serene
Highness Prince _Ferdinand_ constantly ordered the Army to Hutt;
which was done either by thatching their Tents, or building Hurdles,
or digging Pitts, and covering and thatching them over. The Officers
either built Hutts with Fire Places, or had Chimnies built to their
Tents.

If, notwithstanding all Precautions, Men upon Out-posts should be
benumbed with Cold, or Frost bit, as soon as they are brought into
Camp or Quarters, their Extremities ought to be rubbed with Snow, or
put into cold Water[122]; and afterwards well dried, and wrapt up in
Blankets; and warm mild Liquors given them to drink, and afterwards
Cordials; and, after some Time, they may be brought near the Fire, or
put to Bed. Dr. _Lind_[123] mentions one Caution to be used when Men
are found in this Condition; which is, not to give them immediately
strong spirituous Liquors, for that those often prove instantaneously
fatal; but to put them to Bed, and give warm Water Gruel, or some
other mild diluting Liquor, to drink; after which, he says, a Glass of
Spirits will prove less dangerous and more beneficial.

    [122] _Hildanus_ relates a very remarkable Instance of the
    good Effects of this Treatment. A Man was found quite stiff
    and frozen all over. He was put into cold Water, and
    immediately the icy Spicula were discharged from all Parts of
    his Body, so that he seemed covered with an icy Crust. He was
    then put into a warm Bed, and took a Cordial Draught, and a
    plentiful Sweat followed; after which he recovered with the
    Loss of the last Joints of his Fingers and Toes. _De
    Gangraena_, cap. xiii. People who are benumbed with Cold in
    frosty Weather ought never to be brought immediately near a
    Fire; for that has been found either to cause immediate Death
    or Gangrenes of the Extremities; and even Apples and other
    Fruits which have been frozen, if brought immediately near a
    Fire, turn soft and rot; but if put into cold Water, throw
    out the icy Spicula, and recover, so as to be almost as good
    as before they were frozen.

    [123] _Means of Preserving the Health of Seamen_, 2d edition,
    page 19.

When Men are quartered or cantonned in Towns or Villages, whose
Situation is low and damp, and where fresh Meat and Vegetables are
scarce in Winter, and the Scurvy frequent among the lower Class of
People; Commanding Officers, at the Approach of Winter, ought to use
their Endeavours to provide a Store of Potatoes, Onions, Cabbages,
sour Crout; of pickled Cabbages, and other pickled Vegetables; of
Apples and other Fruits, preserved in different Forms, to be laid up,
and sold out to the Men at a cheap Rate during the Winter. They
should contract, if possible, with Butchers to furnish the Men with
fresh Meat[124], and endeavour to procure good small Beer, or Cyder or
Wine in the Wine or Cyder Countries; or Spirits to be mixed with
Water, and a small Proportion of Cream of Tartar or Vinegar; or some
other wholesome fermented Liquor for their Drink[125]; and to put
their Men into as dry comfortable Quarters as possible.

    [124] The Regiments in _Germany_ who kept their Butchers in
    Winter, and made Stoppages of the Mens Pay, and obliged them
    to take a certain Quantity of Meat daily, were much more
    healthy than those who used no Precaution of this Kind.

    [125] In Places where the Articles here mentioned are at too
    high a Price for a Soldier's Pay, a small Allowance, from the
    Government, of such Things would contribute much to the
    Preservation of the Mens Health in unwholesome Garrisons.

In Times of War, when Men are sent upon Expeditions into warm
Climates, great Care ought to be taken to embark such only as are in
good Health; particular Regard ought to be paid to those who are
picked up in the Streets, or have been taken out of the _Savoy_, or
other Jails. All dirty Rags from off such People ought to be thrown
away or burnt; and the Men, after being well washed, and new cloathed,
ought to be kept for a Fortnight or three Weeks in some Garrison Town,
or with their Regiments, in open airy Places, that it may be
ascertained that they have no infectious Disorder before they be put
aboard the Transports.

All Ships allotted for Transports ought to be well aired and purified,
and every Thing fitted up properly, before the Men are embarked. They
ought to be provided with Ventilators, or Wind Sails, to make a free
Circulation of Air through the Vessel[126]; and they ought never to be
crowded; but full Room allowed for each Man, in Proportion to the
Length of the Voyage[127].

    [126] See Dr. _Lind's Treatise on the Means of Preserving the
    Health of Seamen in the Royal Navy_, where he takes Notice of
    most of the Articles here mentioned with regard to Transport
    Ships in treating of Ships of War.

    [127] When Ships are too much crowded with Men, if they meet
    with a tedious Passage, and hot moist close Weather, they are
    often attacked with Diseases which prove very fatal. Dr.
    _Lind_, talking of Ships of War, says it is a Mistake
    destructive to the Men to crowd too many of them together in
    a southern Voyage, or in a hot Climate; as the Ship will be
    found, before the End of the Voyage, in more Distress for
    Want of Men, than she would have been, had she at first
    carried out only her proper Compliment. An additional Number
    is made, in order to supply an expected Mortality; but they
    generally increase that Mortality to double or triple their
    own Number. _Ibid. note to p. 48._

In military Expeditions, Soldiers are put upon Ships Allowance;
which, Dr. _Lind_ very justly observes, ought not, in Voyages to the
warm Climates, be made up so much of salted Beef and salted Pork
(which always tend to the Putrescent), as is the common Practice of
the Navy; but that a greater Share of Biscuit, Flour, Oatmeal, Goarts,
Rice, and other Stores of that Kind, ought to be laid in; and a
greater Proportion of them, and a Less of the salted Meat, distributed
among the Men: And he is certainly in the Right, when he says, that a
full Animal Diet, and tenacious Malt Liquors, are well adapted to the
Constitution of our own, and of other northern Climates; and that
Sailors who visit the _Greenland_ Seas, and are remarkable for a
voracious Appetite, and a strong Digestion of hard salted Meat, and
the coarsest Fare, when sent to the _West Indies_, soon become
sensible of a Decay of Appetite, and find a full gross salted Diet
pernicious to Health. "Instinct (he says) has taught the Natives
between the Tropics to live chiefly on a Vegetable Diet, of Grains,
Roots, and subacid Fruits, with Plenty of diluting Liquors[128]."

    [128] The following is the Diet established for the Seamen of
    his Majesty's Navy.

    Every Man is allowed a Pound of Biscuit, _Averdupoiz Weight_,
    and a Gallon of Beer, _Wine Measure_, _per_ Day.

    On _Sunday_ and _Thursday_, one Pound of Pork, and Half a
    Pint of Peas, _Winchester Measure_.

    On _Monday_, _Wednesday_, and _Friday_, one Pint of Oatmeal,
    two Ounces of Butter, and four Ounces of Cheese.

    On _Tuesday_ and _Saturday_ two Pounds of Beef.

    It is left to the Commanders of Squadrons to shorten the
    aforesaid Allowance of Provisions according to the Exigence
    of the Service, taking Care that the Men be punctually paid
    for the same. As it is thought for the Benefit of the Service
    to alter some of the foregoing Particulars of Provisions in
    Ships employed on foreign Voyages, it is to be observed, that

    A Pint of Wine, or Half a Pint of Rum, Arrack, or Brandy,
    hold Proportion to a Gallon of Beer.

    Four Pounds of Flour, or three Pounds of the same with a
    Pound of Raisins, Half a Pound of Currans, or Half a Pound of
    Beef Suet pickled, are equal to a four Pound Piece of Beef,
    or two Pound Piece of Pork with Peas.

    Half a Pound of Rice is equal to a Pint of Oatmeal.

    A Pint of Olive Oil is equal to a Pound of Butter, or two
    Pounds of _Cheshire_ Cheese.

    And Two-thirds of a Pound of _Cheshire_ Cheese is equal to a
    Pound of _Suffolk_.

    If Soldiers are sent as Passengers on board of King's Ships,
    or on board of Transports, their Allowance is generally but
    Two-thirds of the above.

A Store of Vegetables, such as Mustard Seed, Garlick, Onions,
Potatoes, pickled Cabbages and other pickled Vegetables, sour Crout
and other Things of that Kind, which can be purchased at a cheap Rate,
and preserved for some Months, ought to be laid in; which may be mixed
with the Soops prepared for the Men, or given them to eat along with
their salted Provisions.

A Quantity of Beer, Cyder, or Wine, ought to be put aboard, and a
certain Allowance distributed to each Man daily. When, for Want of
these, Men are reduced to an Allowance of Spirits, they ought to be
mixed with seven or eight Times the Quantity of Water, or made into
Punch, by the Mixture of Water and Molosses, and the Juice of Lemons,
before they are given to the Men; and, if Lemons cannot be got, Cream
of Tartar, or Vinegar, ought to supply their Place; and it ought to be
a Duty of one of the military Officers on board to see the Punch made,
and distributed among the Men daily.

It would be right, on all Expeditions into warm Climates, to send some
Sloops of War, or other armed Vessels, before the grand Fleet, to take
up a Quantity of Wine that will keep, either at the _Madeira_, or
other Wine Countries; and afterwards to go to any of our Settlements
that are nearest the Place of Destination, and to take in a Quantity
of Limes, Lemons, Oranges, and other Fruits, and Vegetables which will
keep for some little Time; and of Spirits, live Stock, and other
Provisions proper for the Army; and then to meet the Fleet at the
general Rendezvous. When once a Landing is made good, these Vessels,
after having unloaded their Cargoes, may either be employed on other
Services, or kept constantly going and coming for whatever Stores or
Provisions are wanted for the Army or Fleet.

A sufficient Quantity of Vinegar ought to be put on board of each
Transport, both for the Men to eat with their Victuals, and likewise
for fumigating and washing between Decks occasionally. And a Quantity
of Molosses, or coarse brown Sugar, and of Lemons, or their
inspissated Juice, or Cream of Tartar, ought to be allowed for making
the Punch, as well as for other Purposes.

If the Water become foetid, the Quantity to be used in the Day ought to
be sweetened by Means of the Ventilator contrived by the ingenious Dr.
_Hales_[129] for that Purpose.

    [129] This Ventilator is no more than a long Tube, with a Tin
    Box, about six Inches wide and four high, with a Number of
    Holes at the Top, fixed at one End; and this Box is put down
    to the Bottom of the Water, and the Nose of a Pair of Bellows
    fixed to the other End of the Tube, which is above the Water;
    by working the Bellows, fresh Air is driven through the whole
    Body of Water, the putrid Effluvia are evaporated and
    dispersed, and the Water becomes sweet in a very short Time.

The Men ought to be brought upon Deck, and Roll called two or three
Times a Day; they should be made to comb their Hair, and wash their
Hands and Face every Day, and to shift themselves sometimes, if
possible; and in every respect keep themselves as clean as the Nature
of the Service will admit; and proper Exercises should be contrived,
to keep them in Health.

All the Parts of the Ship ought to be kept very neat and clean; and
the Hold, and all between Decks, ought to be scraped and swept daily;
and every Morning, in fair Weather, ought likewise to be washed, and
afterwards sprinkled or washed with warm Vinegar, while the Men are
upon Deck[130].

    [130] This ought always to be done in the Morning, that all
    the Parts of the Ship may have Time to dry before the Men go
    to rest in their Births at Night; but it ought never to be
    done after Sun-set.

When the Weather will permit, Fires of dried Wood may be lighted in
Iron Kettles between Decks, and Centinels set over them, and the Fires
sprinkled with Rosin or Bits of Rope dipt in Tar, or with some cheap
Aromatic; and these Fires may be carried into all the Parts of the
Ship that Safety will permit, in order to dry and purify the Air[131].
After this Operation all the Ports and Hatchways should be opened,
and the Air in all the Parts of the Ship often renewed by working the
Ventilators.

    [131] It has been proposed, that the Air in Ships of War
    should be purified in this Way both by Dr. _Lind_ and by
    Mons. _de Hamel de Monceau_.

The Mens Hammocks and Beds ought to be brought up upon Deck in fair
Weather, and well aired, and afterwards put in their Places, and Fires
lighted below Decks.

When Troops, sent on an Expedition into warm Climates, arrive at the
Place of their Destination, particular Care should be taken to guard
them against the Diseases peculiar to such Climates, which are
different from those common to our more northern Latitudes.

Dr. _Lind_ says, that People coming first from a cold into a hot
Climate are apt to have plethoric Symptoms; a Pain of the Head,
Giddiness, a Sense of Weight, and Fulness of the Breast, and a slight
Inflammation of the _tunica conjunctiva_; and that some are apt to be
seized with ardent Fevers and Diarrhoeas. And all Practitioners have
observed, that New-Comers into warm Climates are at first liable to
Fevers tending to the Ardent, and are very subject to Fevers of the
remitting and intermitting Kind, which are the Endemics of all warm
Countries at certain Seasons of the Year; and after some Time they are
apt to fall into Fluxes, the Yellow Fever, and other Diseases
depending on a putrescent State of the Juices. In military Expeditions
these Disorders are liable to be complicated with Fevers of the
Malignant or Hospital Kind, if Care is not taken to prevent it. And
nothing has been found to be more productive of Diseases in those warm
Climates, than indulging freely in the Use of Spirits and other strong
fermented Liquors; exposing one's self to the Damps, especially lying
on the Ground after the Dews fall; and working hard, or using violent
Exercise in the Heat of the Day.

The best Preservatives against Diseases in warm Climates have been
found to be,--1. Temperance; a Diet of light and easy Digestion,
composed more of vegetable than of animal Food; such as a small
Portion of fresh Meat, joined with a sufficient Quantity of
Vegetables; Rice, _Indian_ Corn, and other Grains, and Roots of
various Kinds, prepared in different Forms; well baked Bread; the
moderate Use of ripe Fruits; and the free Use of mild cooling subacid
Liquors, joined with a small Proportion of vinous or spirituous
Liquors; carefully avoiding the too liberal Use of Wine, Spirits, or
other strong fermented Liquors.--2. Great Care not to expose one's
self to the Damps of the Night, nor lie down to sleep on the Grass, or
in woody moist Places, in the Day; and to avoid all violent Exercise
in the Heat of the Sun.--3. Such Means as tend to support the Spirits;
for Chearfulness has been observed to contribute as much to the
Preservation of Health, as Fear and Dejection of Spirits to the
Production of Diseases.--4. Keeping the Body clean, and bathing
frequently in the Sea, or in a River, in the Morning.

And therefore, in warm Climates, Officers ought to be particularly
careful to keep their Men sober and temperate; to procure them good
Bread, and Plenty of Vegetables and fresh Meat, if possible; and
where no other but salted Meat can be got, to make them boil a small
Proportion of it in their Camp Kettles, along with Onions, Goarts,
Rice, Carrots, Turnips, Greens, or any other wholesome Roots or Herbs
which the Country affords, or they can get, and of these to prepare a
good wholesome Soop for themselves; and where there is Plenty of the
ripe acescent Fruits, which are reckoned wholesome, to distribute a
moderate Quantity among the Soldiers daily, which will both help to
preserve their Health, and prevent them from privately stealing and
eating large Quantities to the Prejudice of their Health.--To
encourage their Men, and keep up their Spirits.

They should also prevent, as much as possible, the too free Use of
Wine, Spirits, or other strong fermented Liquors; and in Wine
Countries give every Man a daily Allowance of Wine, to be mixed with
Water for his common Drink; and in Countries where nothing but Spirits
can be got, make the Spirit be mixed with Water, or made into a very
weak Punch, before it is given to the Men, as Lemons, Oranges, Limes,
and other Fruits proper for this Purpose, are generally to be had in
most warm Countries.

They should be careful not to march their Men in the Heat of the Day,
nor order them upon Duty where they must stand exposed to the Dews and
Damps of the Night, unless where the military Operations absolutely
require it.

They should endeavour to make the Bottom of the Tents be covered with
Straw, or dried Leaves of Trees, or dried Reeds, and with
Blankets[132], for the Men to lie upon.

    [132] A sufficient Store of Blankets has often been neglected
    to be carried out in Expeditions into warm Climates; but
    Blankets are no-where more necessary, as it is very
    prejudicial to the Health of Soldiers to be obliged to lie
    down on the bare Ground; and Straw, dried Reeds, and other
    such Things, are often difficult to be got in the warm
    Climates.

The Time of standing Centinel, and being upon Out-posts, if possible,
should be short, where Men are exposed to the scorching Heat of the
Sun; and when Men are upon Out-posts in the Night, it should be
recommended to them to lie down on the Ground as little as possible;
and if they do it, to chuse a dry Place; and, where it can be done,
to have it covered with Straw or a Blanket, and to have some light
Covering to defend them from the Dews.

The Tents should be covered with Boughs of Trees, and the Men should
be ordered sometimes to strike them in the Middle of the Day, and air
well every Thing within them.

The Men should be obliged to keep themselves neat and clean; to comb
their Hair, and change their Linen often; and if the Camp be near the
Sea, or a large River, they ought to bathe early in the Morning as
often as the Nature of the Service will permit. However the following
Caution, mentioned by Dr. _Lind_, ought to be observed, which is, not
to go into the cold Bath when overheated with Work or Liquor, or when
the Stomach is full, or when a critical Eruption, called the prickly
Heat, appears on the Skin[133].

    [133] Dr. _Lind_ says, the Use of the cold Bath, either in
    Tubs under the Forecastle, or to dip in the Sea early in the
    Morning, has been found extremely beneficial in warm Weather
    and hot Countries; and that he can affirm, from his own
    Experience in hot Climates, that many Diarrhoeas and other
    Complaints, the pure and sole Effect of an unusual and great
    Heat (relaxing the System of the Solids, and occasioning a
    Colliquation of the Animal Juices), have not only been cured
    by cold Bathing; but their Return, and even the Attack of
    such Diseases, effectually prevented by it. _Ibid._ p. 44,
    &c.

When Men are seized with inflammatory Symptoms on entering into warm
Climates, they may be blooded freely: Afterwards they do not easily
bear such copious Evacuations, but rather require to have them made in
smaller Quantities, and very early and frequent, as Inflammations make
a rapid Progress in warm Countries. Dr. _Lind_ says, many
Practitioners disapprove of Blood-letting in the Countries lying under
the Torrid Zone, on a Supposition that the Blood is too much
dissolved; but he thinks that this Rule will admit of many Exceptions;
and that Sailors (_and consequently Soldiers_), being strong and
robust, and exposed to greater Vicissitudes of Heat and Cold, and more
Excesses, and other Accidents in general, bear freer Bleeding than any
other Set of People.

After some Time, the Diseases in these warm Climates tend to the
putrid Kind, and must be treated as such.

In all Countries, and in all Climates, great Care ought to be taken in
chusing the Ground on which Men are to encamp. Dry high Grounds,
exposed to the Winds, where there is a free Current of Air, and which
lie at a Distance from Marshes, stagnating Water, and large Woods, are
generally healthful in very different Climates[134]. But Places
situated low, where, on digging two or three Feet below the Surface of
the Earth, you come to Water[135], and marshy Grounds, and Places
surrounded with corrupt stagnating Water, are almost always the
contrary, and very unhealthful; as are often those Grounds which are
subject to be overflowed by large Rivers, and low Places covered with
Wood, where there is no free Circulation of Air. However, it ought to
be observed, that it is not the Neighbourhood of Water alone which is
prejudicial, but the watery Vapours which keep the Air perpetually
moist, and the Exhalations of corrupt Effluvia, which render such
Places unwholesome; for the Neighbourhood of Rivers, and of the Sea,
where the Tide ebbs and flows freely, has no such Effect, where the
Situation is dry and airy; and those very unhealthy marshy Grounds
often continue healthy in cold Weather, when their Waters are
refreshed with Rains[136], and little or no moist putrid Exhalations
rise from them; though, as Dr. _Pringle_ observes, in Summer and
Autumn, when their Waters begin to corrupt, and the Exhalation is
strong, they are always exposed to Diseases; and it is for this
Reason that such Places are always very unhealthy in warm Climates.

    [134] Mr. _du Hamel_ says, that the Air of the Island of _St.
    Domingo_ is very fatal to _Europeans_; but it is observed
    that those People who inhabit the rising Grounds are much
    less exposed to Diseases than those who live in the Vallies.
    _Sur la sante des Equipages_, art. i. p. 16.

    [135] Ground may seem very dry and healthful, and yet be
    quite the contrary, as Dr. _Pringle_ remarks is the Case in
    the Neighbourhood of _Bois le Duc_, in _Flanders_, where
    Water is found every where at the Depth of two or three Feet
    from the Surface.

    [136] Mr. _du Hamel_ remarks, that Places which were formerly
    very subject to Diseases have become healthful when the Water
    which surrounded them was refreshed by opening a
    Communication with the Sea. _Ibid._ art. i. p. 18.

Hence, where the military Operations will permit, Commanders, if
possible, ought to chuse a dry Ground, whose Situation is high, and
which admits a free Current of Air, such as on the Banks of Rivers,
where there is generally a Stream of fresh Air, and Plenty of fresh
Water to supply the Camp[137]; taking Care to avoid the Neighbourhood
of low marshy Grounds, and corrupt stagnating Waters, especially in
Summer, and in hot Climates.

    [137] Dr. _Pringle_ observes, that where Grounds are equally
    dry, that the Camps are always most healthful on the Banks of
    large Rivers; because in the hot Season Situations of this
    Kind have a Stream of fresh Air from the Water, tending to
    carry off both the moist and putrid Exhalations.--And in
    Cantonments we are not only to seek Villages removed from
    marshy Grounds, but such as are least choaked with
    Plantations, and stand highest above subterraneous Water. See
    his _Observat. on Diseases of the Army_, 3d edit. p. 99.

When Necessity obliges Commanders to take Post, or encamp in a wet or
marshy Ground, they should endeavour to make it as dry as possible, by
ordering Trenches to be cut for Drains across the Field and round the
Mens Tents; to see that the Ground within the Tents be well covered
with Straw; to order the Tents to be struck at Mid-Day, in dry warm
Weather, and the Men to dry and air the Straw, and change it
frequently; to have a proper Supply of Blankets for the Men, and to
take Care that they be well cloathed, especially those who go upon
Duty in the Nights; and, in the northern Climates, to have Fires in
proper Places for warming the Men and drying their Cloaths, and for
correcting the Dampness of the Air[138].

    [138] The <DW64>s on the Coast of _Guinea_, and some of the
    _Indians_, both of whom sleep on the Ground, have constantly
    a Fire producing a little Smoak burning in the Hutts where
    they sleep, which corrects the Moisture of the Night, and
    renders the Damp of the Earth less noxious; and during the
    Time of the very unwholesome Fogs on the Coast of _Guinea_,
    called Harmattans, which lay waste whole Negroe Towns, the
    Smoak of Wood, of pitched Staves, and such Things, are found
    to be the best Correctors of this thick Air. See Dr. _Lind's
    Means of preserving the Health of Seamen_.

In Countries lying under the Torrid Zone, the Parts near the Sea Shore
are often marshy, or close and covered with Wood, or have swampy
Beaches, and are very unwholesome; and therefore where Soldiers aboard
of Transports keep their Health, Commanders ought to be very careful
not to allow them to land, till they come to the Place of their
Destination. Dr. _Lind_ observes, that Men commonly live more healthy
in warm Climates at Sea, where the Air is dry and serene, and the Heat
moderated by refreshing Breezes, than when they arrive in Harbours, or
get within Reach of the noxious Vapours which arise from many Parts of
the Land[139].

    [139] Dr. _Lind_ says, that it is constantly observed in
    unhealthy Harbours, that the Boats Crews employed in wooding
    and watering the Ships, who are obliged to lie on Shore,
    suffer most. _Ibid._ p. 72.

When Necessity requires Parties to be landed for Wood or Water, or on
other Duties, they should always be obliged to return and lie aboard
at Night; and if that cannot be done, they should be cautioned to
avoid lying down to sleep on the Grass, where the Air is fresh, or
they are exposed to the Dews; and to pitch their Tents on a rising
Ground, covered with Straw or dried Reeds, and a Blanket; and to use
the other Precautions necessary for encamping in these warm Climates;
for where this Care has been neglected, the Consequences have
frequently proved fatal[140].

    [140] A very remarkable Instance of this we have related by
    Dr. _Lind_. In the Year 1739, in _Mahon_ Harbour, a Party of
    Men were sent with the Coopers from Admiral _Haddock_'s Fleet
    to refit and fill the Water Casks, who, finding an artificial
    Cave dug out of a soft sandy Stone, put their bedding into
    it; every one who slept in this damp Place was infected with
    the Tertian Fever, then epidemic in _Minorca_, and not one in
    eight recovered. At the same Time the Men aboard the Ships
    continued healthy; and others, who were afterwards sent on
    the same Duty, enjoyed perfect Health by being obliged to
    sleep in their respective Ships. He says, he has known a
    whole Boat's Crew seized next Morning with bad Fevers by
    sleeping near the Mangroves, with which the Sides of the
    Rivers are frequently planted in the Torrid Zone. _Ibid._ p.
    74, 75.

On unhealthful Coasts, the noxious Land Vapours often affect the Crews
of Ships that run up into Rivers or Harbours, and cause great
Sickness; and therefore in such Places Ships should anchor at as great
a Distance from the Shore as can well be done, that they may be
exposed to the Sea Breezes, and as much to the Windward of the Woods
and Marshes as possible; and if the Anchorage is safe, one should
prefer the open Sea to running up into Rivers or Creeks[141].

    [141] The higher that Ships sail up the Rivers upon the Coast
    of _Guinea_, the more sickly they become: Such, however, as
    keep at Sea beyond the Reach of the Land Breezes (that is,
    two or three Leagues at Sea), are for the most part healthy.
    _Lind_, _ibid._ p. 65. The Malignity of these Land Vapours
    often does not extend itself to any considerable Distance, as
    we know by manifold Experience. The Troops in _Zealand_ were
    very unhealthy when Admiral _Mitchel_'s Squadron, which lay
    but a little Way from the Shore, enjoyed perfect Health.--Dr.
    _Pringle's Observat. on the Diseases of the Army_, p. 1.
    chap. vii.--In _July_ and _August_ 1744, two Ships, belonging
    to Admiral _Long_'s Squadron in the _Mediterranean_, lying
    near the Mouth of the River _Tyber_, began to be affected,
    while others, though at a very small Distance, but further
    out at Sea, had not a Man sick. _Lind_, _ibid._ p. 66.

Cleanness and Neatness in the Camp is another Article that ought to be
particularly regarded. _Portius_, _Ramazini_, and most other Authors
who treat of Camp Diseases, attribute those of the putrid Kind in a
great Measure to the Stench and putrid Effluvia arising from the
Excrements of Men and Beasts, and from the dead Bodies of Men, Horses,
and other Animals, lying unburied in the Neighbourhood of Camps, and
have in a particular Manner mentioned the Necessity of burying such
putrid Substances. Dr. _Pringle_ has very justly recommended the
Digging of Deep Pits for Privies in Camp, and covering the Excrements
with Earth daily[142] till the Pits are near full, and then to fill
them up with Earth, and dig new ones; and to punish every Person who
shall ease himself any where in Camp but in the Privies: And he
remarks, that when the Camp begins to turn unhealthy, that often the
only Means that will preserve the Health of the Men, is to change the
Ground, and to leave behind all the Filth and Nastiness which gave
Rise to those putrid Disorders.

    [142] The divine Lawgiver _Moses_ has enjoined Cleanliness in
    the Camp to the _Jews_ in a particular Manner, when he says,

    "Thou shalt have a Place also without the Camp, whither thou
    shalt go forth abroad; and thou shalt have a Paddle upon thy
    Weapon, and it shall be when thou wilt ease thyself abroad
    thou shalt dig therewith, and shalt turn back and cover that
    which cometh from thee. For the Lord thy God walketh in the
    Midst of thy Camp; therefore shall thy Camp be holy, that he
    see no unclean Thing in thee, and turn away from thee."
    _Deuteronomy_, chap. xxiii. verses 12, 13, 14.

In fixed Camps, the striking the Tents at Mid-Day in fair Weather,
and turning and airing the Straw, and changing it often, as
recommended by Dr. _Pringle_, will contribute much to preserve the
Health of the Men; and making the Men wash themselves daily, and
change their Linen often, and keep themselves otherwise clean, ought
never to be omitted by the Officers.

All military Authors have recommended to Commanders always to have
Straw for their Men when they come to their Ground, if possible; and
to have the Army well supplied with Provisions; giving proper
Encouragement to the Country People, and to Suttlers and Merchants of
all Sorts, to bring in every Kind of Provisions and other Necessaries
to Camp; and preventing, as much as possible, the Soldiers from
moroding. And the Commanders of every Corps ought to take Care that
their Men form themselves into Messes, and that Stoppages be made for
buying them Provisions.

In _Germany_ every Regiment of the _British_ Troops contracted with a
Butcher, who was obliged to carry along with them, at all Times, a
certain Number of live Sheep and Oxen to kill when wanted, and to sell
the Meat at a fixed Price. Every Soldier was obliged to take a certain
Quantity, which was paid for by Stoppages made in his Pay; and this
Meat was boiled in the Camp Kettles, with such Roots and Greens as
could be got; by which Means the Men, whenever they could use their
Kettles, had always a good warm Soop, as well as Meat, to refresh them
after their Fatigues, which, along with their Ammunition Bread, made a
good wholesome Food.

In Countries where Fruit is plentiful, a certain Quantity of what is
fully ripe, distributed to the Men in warm Weather, and in hot
Climates, will contribute to preserve their Health, though the Abuse
of it will prove prejudicial; but unripe and acrid Fruits are always
hurtful[143].

    [143] The _British_ Soldiers in _Germany_ used sometimes to
    hurt their Health by eating great Quantities of raw unripe
    Apples, Plumbs, and other unripe Fruits; but the foreign
    Troops had a much better Method of using such Fruits: They
    commonly boiled or stewed them, and eat them with Bread, or
    with their Meat, which in a great Measure corrected their bad
    Qualities.

    The Orders in the _French_ Camp, prohibiting the Men from
    eating unripe Fruit, were strictly complied with every-where
    in _Germany_ during the late War.

Water is another Article which Commanders endeavour to have their Camp
well supplied with, and therefore they generally encamp near Rivers or
Rivulets. Where the Stream is small, Care ought to be taken that its
Course be not interrupted, and that no Filth or Nastiness, or any
Thing that will spoil or corrupt the Water, be thrown into it.

When there are no Rivers or Rivulets near a Camp, and the Men are
supplied from Wells, if the Water is not pure, very often the digging
of deep Pits, and covering the Bottom and Sides with large Stones, and
over these a Lay of Sand, Gravel, or Chalk, will make the Water pure
in a few Hours.

In fixed Camps, where the Water is bad, _Portius_[144] proposes
straining it thro' Sand, and has given Figures of Machines to be used
for that Purpose; but the Method proposed by Dr. _Lind_ is still more
simple, which is, to get a broad Cask with one End struck out; then
put a longer Cask, with both Ends struck out, in the Middle of it;
fill the short Cask one-third with Sand, and the inner longer Cask
above one-half; fill the Rest of the inner Cask with the Water, which
will filter through the Sand, and rise above the Sand in the outer
Cask, where it may be allowed to run off into Vessels placed to
receive it, by Means of a Cock, put into the Side of the outer Cask,
fifteen or twenty Inches above the Level of the Sand.

    [144] See the Treatise published by Dr. _Luc. Anton. Portius_
    in 1686, _de Militis in castris sanitate tuenda_, _part._ ii.
    _cap._ vi. In this Book we have many useful Things mentioned
    relative to the Health of Soldiers.

Where there are no such Conveniences for purifying the Water, what is
used for Drink ought to be mixed with a small Proportion of Spirits,
or Wine, or with Vinegar, or Cream of Tartar, when neither of the
other two can be got; and if the Water be previously boiled, it will
be so much the better.

In Expeditions into warm Countries, where fresh Water is difficult to
be had, a few Stills, with a proper Apparatus, ought to be carried
out; and after a Landing is made, the Stills ought to be set to work
for distilling fresh Water from Sea Water in the Manner mentioned by
Dr. _Lind_[145]; and although a sufficient Quantity cannot be
distilled for serving the whole Army, yet enough may be got in this
Way for the Use of the Sick.

    [145] Dr. _Lind_ relates a Number of Experiments of his
    having distilled Sea Water in different Manners, as
    recommended by others; and concludes, that the best Way of
    getting fresh Water from Salt, is to distil the Sea Water by
    itself, without any Mixture; and he proposes having a Still
    Head to the Coppers or Iron Pots in which the Meat is dressed
    aboard a Ship. _Ibid. note to p. 84_, &c.

When Men are very warm, after long Marches, and other hard Duties, in
Summer; Officers should endeavour to prevent their swallowing
immediately great Quantities of cold Water, and persuade them to wait
a little till they cool; and at such Times, if Spirits can be got
easily, to order a small Quantity to be mixed with the Water in each
Man's Canteen.

Though the Abuse of vinous and spirituous Liquors is very destructive
to the Constitution, yet these same Liquors, given in Moderation to
Soldiers on Service, during the Times of great Fatigues, are some of
the best Preservatives of Health. Spirits, for common Use, ought to
be mixed with Water; and in the hot Climates made into Punch; though
in very cold and wet Weather, and in damp Nights, a Glass of pure
Spirits, given to the Men going on Duty, is of great Service; for it
is always observed, that Men are much less apt to catch Diseases from
being wet when they are upon a March, or at hard Work, than when they
stand Centinels, or are upon Out-Posts where they move but little, or
when they lie down in their wet Cloaths; and that they are less liable
to be affected by the Weather after a hearty Meal, or drinking a Glass
of Spirits, or some generous Liquor, than when their Stomachs are
empty.

An Infusion of Bark or other Bitters, and of Garlick, in Spirits, has
been found to encrease their Efficacy as Preservatives both against
the Effects of Cold and malignant Distempers. Dr. _Lind_ has
recommended an Infusion of Garlick in Spirits as one of the best
Stomachics and Diaphoretics he knows in cold wet Weather. And many
have recommended a Tincture of the Bark[146]: Towards the End of the
Year 1743, Mr. _Tough_, one of the Apothecaries to the _British_
military Hospital in the late War, then a Mate to a marching Regiment,
was ordered to go down the _Rhine_ with a Party of Sick, who had the
Seeds of the Hospital Fever among them, and were to go in Bilanders,
from _Germany_ to _Flanders_. Having had a Cask or two of Brandy put
aboard as Part of the Stores for the Sick, he was afraid lest the Men
should make too free with the Spirits; to prevent which he threw in a
Quantity of Bark into each Cask, and gave the Men regularly, Morning
and Evening, a Glass of this bitter Tincture. At the same Time, the
Men were kept extremely clean. By these Means most of the Sick mended
upon the Passage, without the Malignant Fever appearing again amongst
them; whereas, Dr. _Pringle_, who takes Notice of the other Parties
who came from the same Hospitals in _Germany_, tells us, that the
Malignant Fever broke out in a violent Degree, and Half the Number
died by the Way, and federal others soon after their Arrival[147].

    [146] During the Campaign in _Hungary_, in the Year 1717,
    Count _Boneval_ preserved both himself and Family from
    Disorders, by taking himself, and making all his Domesticks
    take, two or three Times a Day, a small Quantity of Brandy,
    in which Bark had been infused, at a Time when all the Rest
    of the Army were infected with malignant Disorders. A
    Regiment in _Italy_ continued healthy by the Use of the Bark,
    when the Rest of the _Austrian_ Army, who did not pursue the
    same Method, were greatly annoyed with Sickness. See
    _Kramer._ quoted by Dr. _Lind_.

    [147] _Observat._ part. i. chap. iii.

Commanding Officers ought always to endeavour to proportion the Time
the Men are to be upon Duty to the Weather and the Nature of the
Climate. The Time of standing Centinel in very hard Frost, and in cold
wet Weather, or in the Heat of the Day in Summer, when the Weather is
very warm, and in hot Climates, ought to be shorter than when the
Weather is dry and more temperate.

The Marches of Troops ought, if possible, during the Time of very hot
Weather, to be made either very early in the Morning, in the Evening,
or at Night; and Officers, during the Course of an active Campaign,
ought to spare their Men as much as possible.

And when they are in Quarters, and have nothing to do, they should
narrowly inspect into their Manner of living; and have them out daily,
when the Weather will permit, and exercise them, or march them two or
three _English_ Miles a-Day, in order to prevent their falling sick
for want of Exercise; for Soldiers left to themselves are very subject
to Diseases when they come into Quarters after an active Campaign, by
leading too indolent a Life, if Officers do not take Care to prevent
it. However, at such Times, the Exercise ought to be moderate, and the
Men should not be brought out in wet Weather.




OF MILITARY HOSPITALS.


Whenever Men are seized with Distempers, they ought immediately to be
separated from those in Health, and either sent to the Regimental[148]
or General Hospital.

    [148] Some of the regimental Surgeons in _Germany_, when they
    took the Field, had always some spare Tents carried along
    with their Medicine Chests; and when any of their Men fell
    sick in Camp, and they could get no House for a regimental
    Hospital in Villages, they ordered these Tents to be pitched,
    and had the Ground within well covered with Straw and
    Blankets, and then put the Sick into them, and there took
    Care of them till they found an Opportunity of sending them
    to the Flying Hospital.

There is no Part of the Service that requires more to be regarded than
the Choice of proper Places for Hospitals, and the right Management
of them, on which the Health and Strength of an Army often depends;
for in wet unwholesome Seasons, if infectious Disorders get into the
Hospitals, which possibly might have been prevented by proper Care,
they often weaken an Army in a very short Time far more than the Sword
of the Enemy.

We have no Account of the particular Manner in which the Antients took
Care of their Sick and Wounded in Times of War; for although we read
in _Homer_[149] of Surgeons or Physicians attending the _Grecian_
Camp, and in _Xenophon_[150] of _Cyrus_'s having appointed Physicians
to his Army; and we learn from _Tacitus_[151] and _Livy_[152], that
the wounded _Romans_ were received into the Houses of the Nobility,
and had Physicians to attend them, and were furnished with
Fomentations and other proper Remedies; and from _Justin_[153], that
the _Lacedemonians_ followed the same Method: yet these Authors make
no Mention of the particular Oeconomy or Manner in which these
Hospitals were conducted.

    [149] _Homer_ mentions _Podalirius_ and _Machaon_, sons of
    _AEsculapius_, as two excellent Physicians or Surgeons in the
    _Grecian_ Army. Vid. _Iliad_, lib. ii. Physic and Surgery
    were antiently exercised by the same Persons.

    [150] Vid. _Xenophon. de Institut. Cyri._ lib. i. et viii.

    [151] _Tacitus_, after giving an Account of 50,000 People
    being killed by the Fall of an Amphitheatre at _Fidena_,
    during the Time of a Shew of Gladiators, has these Words:
    "Ceterum post recentem cladem, patuere procerum domus,
    fomenta & medici passim praebiti; suit urbs per illos dies,
    quanquam maesta facie veterum institutis similis, qui magna
    post praelia saucios largitione & cura sustentabant." _Vid.
    lib._ iv. _Annal._ Sec. 63.

    [152] In _Livy_ we find the following Passage: "Neque immemor
    ejus quod initio consulatus imbiberat, conciliandi animos
    plebis, saucios milites curandos dividit patribus. Fabiis
    plurimi dati, nec alibi majore cura habiti." _Vid. lib._ ii.
    cap. xlvii.

    [153] _Justin_ mentions the same Thing of the _Spartans_
    after their Defeat at _Sellasia_--"Patentibus omnes domibus
    saucios excipiebant, vulnera curabant, lapsos reficiebant."
    _Vid. lib._ xxviii. cap. iv.

The Hospitals commonly wanted for an Army acting on the Continent,
are,

1. One in the Rear, to follow their Motions, so as to be always ready
to receive the Sick from Camp, which is called the Moveable or Flying
Hospital. 2. One or more, at some Distance, in Towns, to receive such
of the Sick as can be moved from the Flying Hospital, when they are
obliged to go from one Place to another; or when a greater Number of
Sick is sent to them than they can easily take Care of[154].

    [154] When Parties of Sick or Wounded are to be sent from
    Camp, or from one Hospital to another, Care ought to be taken
    that they are placed properly in the Waggons; that they have
    proper physical People, Nurses, &c. to attend them; as well
    as Provisions, and other Necessaries, so as to be in no
    Danger of wanting any Thing while they are on their Journey.

Each of the Hospitals ought to be provided with Physicians, Surgeons
Mates, Purveyors, or Commissaries, and others, to attend and take Care
of the Sick.

Besides the physical People who attend the Hospital, one or two
Physicians ought to go along with the Army to attend the Commander in
Chief, and the General and Staff Officers, in Case of Sickness; and an
Apothecary, provided with a small Chest of Medicines, ought to attend
at Head Quarters to make up the Prescriptions of the Physicians.

A Number of Hospital Surgeons also, with Mates, ought to attend the
Army, to be ready in Case of an Action. These ought to be attached to
the Suite of the Commanders of the different Corps or Brigades, and to
be quartered or encamped with them. And each Surgeon should be
provided with a Waggon or some Horses loaded with a proper chirurgical
Apparatus, as Instruments, Bandages, Lint, and other Things necessary
for taking Care of the Wounded.

A small Quantity of Medicines, some Wine, Rice, portable Soop, &c. and
Utensils for a small Hospital, and two, three, or four hundred Sets of
Bedding, should be carried about with the Army, in Case of an Action,
for the Use of the Wounded, till they have Time to receive Assistance
from the Flying Hospital. Some of the Bedding ought to be carried on
Horseback, so as to be at Hand when any of the Surgeons are sent with
Detachments that are going upon an Attack.

To prevent crowding the General Hospitals in Winter Quarters, every
Regiment ought to take Care of their own Sick, and to have proper
Hospitals fitted up for them.

Dr. _Pringle_ has laid down some very good Directions with regard to
the Choice of Places fit for Hospitals, and the Method of preventing
infectious Disorders in them; and we find many excellent Hints of this
Kind in Dr. _Lind_ and Mons. _du Hamel_'s Treatises on the Means of
Preserving the Health of Seamen, and some likewise in Dr.
_Brocklesby_'s late Treatise on military Disorders.

In the Time of Service the Commander in Chief generally orders the
Hospitals to be established in Towns or Villages that least interfere
with the military Operations, to which the Sick and Wounded can most
easily be conveyed; and which he can best protect from the Insults of
the Enemy[155].

    [155] The _Roman_ Generals seem to have sent their Sick and
    Wounded into Towns, in the same Manner as is done by those of
    the present Time. For we read in _Caesar's Commentaries_ of
    this Method having been practised on more Occasions than one.
    In the sixty-second Chapter of the third Book, _de Bello
    Civili_, we have the following Passage: "Itaque nulla
    interposita mora, sauciorum modo & aegrorum habita ratione,
    impedimenta omnia silentio prima nocte ex castris _Apolloniae_
    praemisit, ac conquiescere ante iter confectum vetuit. His una
    legio missa praesidio est."--And immediately after, in chap.
    lxv. "Itaque praemissis nunciis ad Cn. Domitium Caesar
    scripsit, & quid fieri vellet ostendit: praesidioque
    _Apolloniae_ cohortibus iv. _Lissi_ i. tres _Orici_ relictis;
    quique erant ex vulneribus aegri depositis; per Epirum atque
    Arcarniam iter facere caepit."

    And in the twentieth chapter, _de Bello Africano_, we read:
    "_Labienus_ saucios suos, quorum numerus maximus fuit, jubet
    in plaustris deligatos _Adrumentum_ deportari."

    It would be a right Measure, in the Beginning of every War,
    to settle by a Cartel that military Hospitals on both Sides
    should be considered as Sanctuaries for the Sick, and
    mutually protected; as was agreed upon between the late Earl
    of _Stairs_, who commanded the _British_ Troops, and the Duke
    _de Noailles_, who commanded the _French_ in the Campaign in
    _Germany_ in the year 1743. See _Dr. Pringle's Preface_.

In Towns, the Places fittest for Hospitals are public Buildings, which
have large dry airy Apartments, situated on a high Ground, where there
is a free Draught of Air, and a Command of Water.

In Winter, those Houses, which have open Fire Places in the Rooms, are
always preferable to such as have close Stoves, or no Fire Place at
all; for an open Fire Place serves to keep up a free Circulation of
Air in a Room, as well as to keep it warm. And for the same Reason,
where nothing but Stoves can be got to warm the Wards, the Wynd
Stoves, which open into the Room or Ward, are vastly preferable to the
close ones.

Where there are no public Buildings, private Houses answering nearest
to the above Description are most proper for Hospitals. In general,
Houses with small Rooms make but bad Hospitals; and very Damp and
close Places ought by all Means to be avoided.

In Summer, when the Moveable or Flying Hospital is ordered into
Villages, large Barns, and the largest airy Houses, are the best.

Churches, situated on a dry high Ground, make good Summer Hospitals;
and in Winter, when Necessity obliged us sometimes to use them in
_Germany_ for this Purpose, they were found to answer very well, when
we had Bedsteads or Cradles for the Men to lie upon, and the Wynd
Stoves to keep them of a moderate Heat.

In making Choice of Houses for Hospitals, particular Regard ought to
be had to the Privies or Necessaries; because, where their Smell is
offensive, there is always Danger of infectious Disorders. If,
therefore, there be no proper Conveniencies of this Kind about an
Hospital, such ought to be contrived so as to prevent any Danger from
their putrid Effluvia. If there be a River near the Hospital, the
Necessaries may be made above it at a Place where there is a rapid
Stream below. In Villages deep Pits may be dug in the Ground behind
the Hospital, and Seats made over them, as in Camp; and a thick Lay of
Earth be thrown above the Foeces every Morning, till the Pits are near
full, and then they must be filled up, and others dug to supply their
Place.

When once the Places are fixed upon for Hospitals, every Ward ought to
be made perfectly sweet and clean; first, by scraping and washing with
Soap and Water, and afterwards with warm Vinegar; and then they ought
to be fumigated with the Smoke of wetted Gunpowder and of Aromatics,
and afterwards well dried and aired by lighting Fires, and opening
the Windows, before any Sick are admitted.

After this the Beds ought to be laid; in doing of which great Care
should be taken not to crowd the Wards too much, as nothing corrupts
the Air so much, or so soon brings on infectious Disorders. Dr.
_Pringle_ says, the Beds ought to be laid so thin, that a Person
unacquainted with the Danger of bad Air, might imagine there was Room
for double or triple the Number. In high lofty Apartments, and in
Churches, and other large Places, the Beds may be laid much closer
together than in Rooms with low Cielings. In Churches, or such Places,
thirty-six square Feet, or a Square of six Feet by six, may be allowed
for each Man; but in common Wards we must allow from forty-two square
Feet, _i. e._ six by seven Feet, to sixty-four square Feet, or eight
by eight, according to the Height of the Cieling, the Airyness of the
Place, and the Nature of the Diseases of the Patients.

The Bedding most fit for Hospitals, is Palliasses and Bolsters filled
with Straw, Sheets, and Blankets, as they can easily be washed.
Feather Beds and Matrasses are apt to retain Infection, and cannot be
easily cleansed. In the fixed Hospitals, Bedsteads or Cradles may be
set up for laying the Bedding on: But in the Moveable or Flying
Hospital the Bedding must be, for the most part, laid on the Floor.

When once the Beds are laid, and the Sick arrive, some of the
Gentlemen belonging to the physical Department ought to attend, to
distribute the Sick properly through the Hospitals.

All the Surgery Patients, such as have Wounds, Ulcers, Sores, the
Venereal Disease, &c. should be separated from the Rest, and put
either into particular Wards by themselves, or into an Hospital fitted
up for that Purpose under the Direction of the Surgeons.

Those labouring under infectious Fevers and Fluxes, should each of
them be placed in good airy Wards by themselves, where the Beds are
laid much thinner than in the other Wards of the Hospital. If the Flux
Wards have a Privy near them, where the Men can ease themselves,
without being offensive either to their own Ward, or any other Part of
the Hospital, they are so much the fitter for such Patients. In the
Hospital I attended at _Bremen_, the Flux Ward had a Necessary that
opened into the River _Weser_, and at _Natzungen_ a deep Pit was dug
in the Field about twenty Yards from the Barn where the Flux Men lay,
which kept these Wards always sweet.

Patients that have got the Itch, or any other infectious Distemper,
ought likewise to be put into separate Wards by themselves; and at all
Times a Place should be set apart for those who may be taken ill of
the Measles or Small-Pox. A House separated from the other Hospitals,
with a distinct Set of Nurses and other Attendants, bids fairest to
prevent the Infection from spreading.

When once the Sick are properly ranged, the next Care must be to
prevent infectious and malignant Disorders from being generated, and
from spreading amongst the Sick; which is principally to be effected
by keeping the Sick and the Hospital extremely clean and well-aired,
and the Wards as sweet, and free from putrid and offensive Smells, as
possible.

Every sick Man, as soon as he arrives at an Hospital, should be washed
with warm Water, or if there is a warm Bath, or bathing Tub, to be put
into it; and afterwards be supplied with a clean Shirt[156] well-aired
before he be put to Bed; and his own dirty Linen should be immediately
carried to the Wash-House: And every Morning each Nurse ought to carry
a Bucket full of warm Water, and a Piece of Soap and a Towel, round to
each of her Patients, and make them wash their Hands and Face, and
their Feet, when dirty.

    [156] Every military Hospital ought to have a Number of
    Shirts belonging to it, for the Use of the Sick who arrive
    without having clean Linen with them. As soon as their own
    Shirts are washed and dried, or that new ones are provided by
    their Regiments, the Hospital Shirts ought to be taken from
    them.

Every Morning all the Wards ought to be scraped and swept, and
afterwards sprinkled with warm Vinegar; and when dirty, they ought to
be washed after the Fires are lighted.

Every Thing in the Wards, and about the Sick, should be kept as clean
as possible; the Chamber-Pots and Close-Stools ought to be carried
away as soon as used, and immediately emptied and washed before they
be brought back.

The Windows of the Wards ought to be kept open to admit fresh Air
Morning and Evening, for a longer or shorter Time, according as the
Weather will permit.

If the Wards are close, and the Cieling too low, Dr. _Pringle_ advises
to remove some Part of them, and to open the Garret Story to the
Tiles[157]; and if the Opening of the Windows is not sufficient to
air the Wards, Ventilators of different Kinds, such as those mentioned
by Dr. _Hales_ and Dr. _Pringle_, may be used, especially when the
Weather is hot.

    [157] In Wards which are too close, it has been found that
    one or two square Holes (of about six or eight, or ten Inches
    diameter), cut in the Cieling, and a Tube made of Wood fitted
    to it, and carried up into the Chimney of the Ward above, so
    as to enter above the Grate, is one of the best Contrivances
    for procuring a free Circulation of Air; as the foul Air,
    which is lightest, and occupies the highest Part of the Ward,
    finds a free Exit by these Tubes: We have such Tubes now
    fixed in several of the Wards in _St. George_'s Hospital. A
    Hole cut above the Door of the Ward, or in the upper Part of
    the Windows, and one of what are called the _Chamber
    Ventilators_ fixed in it, will answer, where Holes cannot be
    conveniently cut in the Cieling.

In Winter, Fires should be lighted in all the Wards where it can be
done.

In foreign Countries, when we meet with Hospitals where there are no
Places for open Fires, but only close Stoves, different Contrivances
may be used to renew the Air. Ventilators of different Kinds may be
used, or Openings made in the Doors and Windows. In Winter 1761-62,
some of the Wards in the Hospital at _Bremen_ which I attended had
such Stoves. In order to keep up a free Circulation of Air in those
Wards, I directed large Holes to be cut in the lower Part of the Door
in each Ward, and two Grooves to be made on the Outside of the Door,
above and below the Hole, parallel to each other, in which a Board
slided; by means of which, the Hole could be either quite covered or
only in Part, or left entirely open; and I directed a Casement, about
eight or nine Inches square, to be made in the upper Corner of each
Window. After the Fires were lighted, upon removing the Board which
covered the Hole in the Door, and opening the little square Windows, a
Current of fresh cool Air rushed into the Ward by the Door, while the
heated foul Air found an Exit by the Windows. In very cold Weather,
the Opening of the small Windows was sufficient; but in mild Weather,
and in Summer, it was necessary to keep both open.

The Wards should be daily fumigated by Means of Aromatics, or wetted
Gunpowder thrown on burning Coals, put in an Iron Pot or Chaffern, or
with the Steams of warm Vinegar placed in the Middle of the Ward. Dr.
_Lind_ says, that although Cleanliness and a pure Air contribute much
to prevent infectious Disorders, or to check them, yet that they of
themselves are not always sufficient; but that he seldom or never knew
a proper Application of Fire and Smoke to be unsuccessful in producing
the happy Consequence of effectually purifying all tainted Places,
Materials, and Substances[158].

    [158] Dr. _Lind_ tells us, that the Ships of War in his
    Majesty's Service are purified by Fire and Smoke, and gives
    the Process by which it is done; and he says, that he never
    heard of any Ship, which, after being carefully and properly
    smoked, did not immediately become healthy for the Men.--See
    _First Paper on Fevers and Infection_.--And he observes, that
    these Steams and Smoke, which are inoffensive to the Lungs,
    besides correcting the bad Quality of the Air, produce
    another good Effect; which is, to make both the Patients and
    Nurses desirous of opening the Doors and Windows for the
    Admission of fresh Air. _Ibid._ p. 51.

In all Military Hospitals, at least in the fixed ones, one Ward ought
to be always kept empty; and whenever a malignant Fever, or any other
infectious Disorder, breaks out in any Ward, the Men ought to be
removed into this empty one; and the foul Ward purified, by washing
and cleaning it well with Soap and Water, and then with warm Vinegar;
and afterwards purifying it with Smoke, in the same Manner as is
practised in his Majesty's Ships of War; and Fires should be lighted
daily, and the Windows kept open for some Time, before any Sick be
again admitted into it.

As soon as any Patient dies, the Body ought to be removed to the Dead
House; and the Bedding he lay upon should be carried away immediately,
and not used again till it has been smoked, well-aired, and washed.

All the Linen of Patients in Fevers, Fluxes, and other infectious
Disorders, ought to be changed often; and all the foul Linen and foul
Bedding of the Hospital should be smoked with the Fumes of Brimstone,
or of wetted Gunpowder, in a Place set apart for that Purpose; and Dr.
_Lind_ advises to steep them first in cold Water, or cold Soap Lees,
before putting them in warm Water; as it is dangerous for any Person
to receive the Steam that may at first arise, where this Precaution is
not used.

All the Cloaths, of Soldiers who die in Hospitals, ought to be sent to
the Smoke House, and be well fumigated, and afterwards aired, before
they are put up in the Store-House.

The next Thing to be considered about a Military Hospital is the Diet
of the Patients, which should consist of good wholesome Provisions,
that can be purchased easily, and at a cheap Rate[159].

    [159] The _French_, and many other Nations, give their
    Patients Meat Soops in acute Diseases, and after capital
    Operations; and they allow them but little Bread or other
    Preparations of Vegetable Substances: But these Meat Soops
    without Bread do not nourish the Patient sufficiently, and
    tend too much to the Putrescent; and this is one Reason why
    more Sick die in the _French_ than in the _British_
    Hospitals.

Good Bread[160] is a standing Article of Provisions for an Hospital in
all Countries and in all Climates; and a certain Quantity of it ought
to be distributed to each Man daily.

    [160] On Expeditions where a Siege is expected, a Quantity of
    Flour ought to be carried out, and a Number of portable Ovens
    for baking bread for the Sick, which may be put up after the
    Troops have made good their Landing.

The Breakfast and Supper in most Military Hospitals must be made of
Water Gruel or Rice Gruel; as either Rice or Oatmeal can be got in
most Places, and are very portable.--Water Gruel is in general
preferable to the Rice Gruel, because most Patients nauseate the Rice
Gruel, after eating it for some Days, but not the Water Gruel, as
every Person, who has attended the Military Hospitals, must have
experienced. Where both Rice and Oatmeal can be had, Rice Gruel may
be used two or three Times a Week by Way of Variety.

But although Rice Gruel is not so proper for constant Use, yet Rice
should always make an Article among the Stores for an Hospital, as it
is useful for making Rice Water for Drink; and it can be boiled or
ground, and made into a light Pudding, and in short may be used in a
Variety of Forms to make a good and wholesome Food for the Sick.

Oatmeal is cheaper than Rice, and can be procured almost every-where
in _Europe_, where Armies make Campaigns; as Oats make such a great
Article in the Forage for Horses. And a sufficient Quantity can at any
Time be ground into Meal for the Use of the Sick, at the Mills which
are employed for making Flour for the Bakery, if there be none nearer
the Hospital.

In Countries where neither Oatmeal nor Rice can be had, _Indian_ or
some other Corn, which is known to be wholesome, and which the Country
affords, may be employed in their Place.

When fresh Meat can be got, the Men who are on full Diet, and the
Nurses and other Servants about the Hospital, should have Meat for
Dinner; and the Meat that is boiled for them ought to make Broth for
the Sick who are kept on a low or middle Diet. Some Barley or Rice
should be added to the Broth; and a small Quantity of Carrots,
Turnips, or other Vegetables, boiled along with them, will make it
more agreeable to the Taste.

On Expeditions where nothing but salted Meat can be had, a Quantity of
portable Soop should always be carried out for the Use of the Sick;
which with Water and some Barley, and fresh Vegetables, when they can
be got, will make a good Soop or Broth. On such Occasions, the Dinner
ought to consist of Soop and Bread, or of light Puddings made of Flour
or of Rice, of boiled Rice or Barley, or of Panado, &c.

Nurses and recovered Men may be allowed salted Meat twice or thrice a
Week.

The common Drink of Military Hospitals ought to be Rice and Barley
Water, with a small Proportion of Spirits and Sugar. Small Beer is a
good Drink where it can be easily procured; as is Wine and Water, or a
very small Negus, or very weak Punch in warm Climates.

Besides this Diet, extraordinary Indulgences may be occasionally
allowed to particular Patients, as Wine, Brandy, Sugar, Milk. And the
Physicians and Surgeons ought to have a discretionary Power to order a
Vegetable or any other proper Diet for Patients in the Scurvy, or any
other particular Complaints.


The Established Diet of a Military Hospital may be,

                _Breakfast._         _Dinner._       _Supper._
             One Pint of Water  |                |
             or Rice Gruel.     |                |
                                |                |
             Water Gruel made   |                |
             with 3 or 4 Ounces |                |
             of Oatmeal, a      |                |
             little common Salt,|One Pound       |
             and with or without|of boiled fresh |
  Full Diet, a little           |Meat.           |  As Breakfast.
             Sweet Oil, and     |                |
             two Spoonfuls of   |                |
             Wine.              |                |
                                |                |
             Rice Gruel made    |                |
             with two Ounces of |                |
             Rice, one Spoonful |                |
             of fine Flour, a   |                |
             little             |                |
             common Salt and    |                |
             Sugar.             |                |
  -----------------------------------------------------------------
                                |One Pint of     |
                                |Broth, half     |
  Middle Diet, Ditto.           |Pound of boiled |  Ditto.
                                |Meat.           |
  -----------------------------------------------------------------
                                |One Pint of     |
                                |Broth, or       |
  Low Diet,  Ditto, or according|half a Pint of  |
             to the Patient's   |Panado, with    |
             Appetite.          |two Spoonfulls  |  Ditto.
                                |of Wine,        |
                                |and a Quarter   |
                                |of an Ounce     |
                                |of Sugar.       |


The daily Allowance of Bread to be one Pound to each Man.

The common Drink for those on full and middle Diet to be Rice or
Barley Water, with two Spoonfuls of Brandy to each Pint, and a Quarter
of an Ounce of Lump Sugar; small Beer, or very weak Punch; or Wine and
Water, two Ounces of Wine to a Pint of Water, and a Quarter of an
Ounce of Sugar. The Quantity not to exceed three Pints _per_ Day.

Those on low Diet to have Rice or Barley Water as above, with or
without Wine or Brandy.


The Diet Boards hung up in the Hospitals may be made with the
following Columns, nearly as they were with us in _Germany_.

  Regiments.|Mens  |  Diet  |Wine.     |Brandy.|Milk.     |Sugar. |
            |Names.|F.|M.|L.|1/2 Pints.  |Ounces.|1/2 Pints.  |Ounces.|
  ----------+------+--+--+--+----------+-------+----------+-------+
            |      |  |  |  |          |       |          |       |
            |      |  |  |  |          |       |          |       |
            |      |  |  |  |          |       |          |       |
            |      |  |  |  |          |       |          |       |
            |      |  |  |  |          |       |          |       |
            |      |  |  |  |          |       |          |       |
            |      |  |  |  |          |       |          |       |
            |      |  |  |  |          |       |          |       |
            |      |  |  |  |          |       |          |       |
            |      |  |  |  |          |       |          |       |
            |      |  |  |  |          |       |          |       |
  ----------+------+--+--+--+----------+-------+----------+-------+

When such Diet Boards are kept in an Hospital, and the Mens Names and
Regiments are once wrote down, the Patients may with very little
Trouble be put upon the full, middle, or low Diet, with so much of the
above-mentioned Extraordinaries as may be judged proper.

If any Thing else be wanted for the Sick, the Physician ought to give
a particular Order in Writing for it, the Columns here marked being
only for such Things as are most frequently wanted.

It should be a general Rule in all Military Hospitals, that, when a
Party of Sick arrives, every Man may have immediately a Mess of Water
Gruel given him, and afterwards be put on low Diet till it is ordered
otherwise by the Physician or Surgeon who attends him.

It is not to be supposed that the Diet here mentioned can be strictly
kept to in all Parts of the World; for it must often be varied
according to the Difference of the Climates, and to the Provision of
the Countries where the Scene of War may be.

Whenever a Moveable or Flying Hospital is to attend an Army, a
Quantity of Bedding, and of all Utensils for forming an Hospital,
ought to be put up in the Waggons, together with Provisions of
different Kinds, such as Oatmeal, Rice, Sago, Brandy, Wine, Sugar, &c.
A Butcher with a Stock of live Cattle, and a Baker with a proper
Quantity of Flour for making Bread ought constantly to attend; and a
Number of empty Waggons should likewise be always in Readiness, to
transport the Sick when the Hospital moves, or when a Party is to be
sent to the fixed Hospitals.

When Troops go upon an Expedition, besides the common Hospital Ships,
another Ship ought to be properly fitted up for the Reception of sick
Officers[161]; and every Hospital Ship ought to be supplied with all
Sorts of Provisions, and other Necessaries fit for forming an
Hospital, before they leave _England_.--And one or more armed Vessels
loaded with Provisions, Wine, and all Sorts of Necessaries for the
Sick, ought to attend them; or if the Expedition be intended for the
warm Climates, these Vessels ought to go before the Fleet to take up
Wine and Fruits, such as Lemons, Oranges, &c. Vegetables of different
Kinds, and a live Stock for the Use of the Sick.

    [161] If there be no Ship fitted up for the Reception of sick
    Officers, those who are taken ill on Expeditions must be in a
    most miserable Situation; as there is no Place to receive
    them in the common Hospital Ships, they must remain almost
    without Assistance in a crowded Cabin amongst People in
    Health; as was the Case in some of our Expeditions during the
    late War.

All Hospitals attending Expeditions should carry out among their
Stores a Number of large Tents for lodging the Sick and Wounded
immediately on making good their Landing. Where a Siege is expected
which will take up Time, and where no Accommodations for the Sick can
be had till the Siege is over, a Ship or two, with Boards, and other
Necessaries for building large Sheds, or temporary Hutts, for the
Sick, as proposed by Dr. _Brocklesby_, ought to go along with the
Fleet, or meet them at the Place of their Destination. Such thatched
Sheds, or Hutts, are very necessary in the warm Climates, as the
perpendicular Rays of the Sun, beating upon Canvass, make Tents
intolerably hot. When any of our own Settlements happen to be near the
Place attacked, a fixed Hospital may be established there; either in
Houses, if proper ones can be found; or in temporary Sheds or Hutts
erected for that Purpose; and some Vessels, properly fitted up, may be
kept going with the Sick and Wounded, and bringing back the recovered
Men.

At every Military Hospital a Serjeant's Guard ought to mount; and
Centinels be placed at the Doors of the Hospital, 1. To prevent all
Visitors, who have not proper Leave, from coming into the Hospitals;
as such People oftentimes crowd the Wards, disturb the Sick, and are
apt to catch infectious Distempers, and to spread them among the
Troops. 2. To take Care the Patients do not go out of the Hospital
without having a Ticket[162] of Leave for that Purpose, signed by the
Physician, Surgeon, or Apothecary, belonging to the Hospital. 3. To
prevent spirituous Liquors, or other Things of that Kind, being
clandestinely carried into the Hospital.

    [162] At every Hospital there ought to be a Number of printed
    Tickets lying ready to be filled up and signed by the
    Physicians and Surgeons, and no Man ought to be allowed to go
    out without a Ticket so signed.

The Serjeant of the Guard, attended by the Ward Master, ought, every
Morning, to go round the Wards to call a Roll, and see that every Man
is in his Ward; and to do the same at Night before the Hospital Doors
are shut, and at this Time to order every Person out of the Hospital
who does not belong to it. And the Serjeant, every Morning, ought to
report to the Physician, Surgeon, or Apothecary, every Man's Name who
was found to be absent at Roll-calling; and whether he found every
Thing regular and in good Order in going his Rounds.

Every large Military Hospital ought to have one Head Nurse, and a
sufficient Number of other Nurses, to attend and take Care of the
Sick.

Orders to the following Purport, hung up in every Military Hospital,
would serve to shew the Nurses and Patients what their Duty is, and
to maintain Regularity and good Order through the whole Hospital.


_Matron, or Head Nurse._

Every Matron, or Head Nurse, is to go round all the Wards of the
Hospital at least twice a Day, Morning and Evening; to see that the
Nurses keep their Wards clean; that they behave themselves soberly and
regularly, and give due Attendance to their Patients; and to examine
the Diet of the Patients, and see that it is good and well dressed;
and if she finds any Thing amiss, to report the same to the Physician,
Surgeon, or Apothecary, of the Hospital.


_Common Nurses._

1. The Nurses are to give due Attendance to their Patients; and to
keep them always as neat and clean, as the Nature of their Distempers
will admit of; to give them their Diet regularly; to be particularly
careful to see them take the Medicines ordered by the Physicians,
according to the Directions given; to report to the Physician,
Surgeon, or Apothecary, any Faults or Irregularities which any of
their Patients may have committed; and to acquaint the Ward Matter and
Head Nurse of the Death of any of their Patients as soon as it
happens, that proper Care may be taken of their Cloaths and Effects.

2. They are to keep their Wards extremely clean, to sprinkle them
every Morning with Vinegar, and to fumigate them with the Smoke of
wetted Gunpowder, or of Frankincense, or any other Aromatics that may
be thought proper; in fair Weather to keep open the Windows of their
Wards, twice or thrice a Day; for a longer or shorter Time, as the
Weather will permit; to attend at the Steward's Room for the
Provisions of the Patients at the Hours appointed for that Purpose;
and to pay implicit Obedience to the Matron, or Head Nurse, in what
relates to their Duty; and punctually to obey all Orders they receive
from the Physician, Surgeon, or Apothecary, of the Hospital.

3. They are to keep themselves clean and decently dressed, and to
observe the strictest Rules of Sobriety; remembering, that if any one
is found intoxicated with Liquor, that she is immediately to be sent
to the Guard, and afterwards discharged.

4. They are not to absent themselves from their Wards, unless when
employed in the Discharge of their Duty; nor to go out of the Hospital
to which they belong, without having a Ticket of Leave signed by the
Physician, Surgeon, Apothecary, or Head Nurse, belonging to the
Hospital.

5. They are not to throw Nastiness of any Kind out at the Windows, but
to carry it to the common Necessaries, and to empty the Chamber Pots
and Close-stools as soon as used, and be careful to wash them before
they bring them back.

6. They are not, upon any Pretence whatever, to alter the Diet ordered
by the Physicians or Surgeons to the Patients on the Diet Boards; nor
to suffer their Patients to use any other Diet than what is allowed by
the Hospital; nor are they to bring, or allow others to bring, Meat,
spirituous Liquors, or other Things of that Kind, into their Wards,
except what is allowed by the Physicians or Surgeons. Whenever any
Thing of this Kind is found in any of the Wards, it ought immediately
to be thrown into the common Necessary; and if it be found in the
Custody of a Nurse, she ought to be confined in the Guard, or
discharged.

7. Nurses guilty of great Neglect of Duty, or of getting drunk and
using their Patients ill, or of stealing, or concealing or taking away
the Effects of Men who die in the Hospital, are to be immediately sent
to the Guard, and reported to the Commanding Officer of the Place,
that they may be tried by a Court-Martial, and be confined, whipped,
or otherwise punished, as the military Law directs; all Followers of
Armies on foreign Service being equally subject to the military Law as
the Soldiers themselves.


_Patients._

1. All sick Soldiers, on their Arrival at a Military Hospital, are to
be washed all over with warm Water, or to go into a warm Bath; and
afterwards to wash their Face and Hands every Morning, and their Feet
occasionally, with warm Water and Soap, brought round every Morning by
the Nurses for that Purpose; and they ought to comb their Head every
Day. If they be too weak to wash and comb themselves, it is to be done
by their Nurses.

2. Every Patient is to be shaved and have clean Linen twice a Week, or
oftener if requisite.

3. They are punctually to obey the Directions given them, and to take
the Medicines ordered by the Physician; and none to be allowed to go
out of the Hospital without a Ticket of Leave signed by the Physician,
Surgeon, or Apothecary, of the Hospital.

4. They must commit no Disorder or Riot, but in all Respects behave
themselves well.

5. If any Man disobeys the Orders he receives from the Physicians or
Surgeons, or is irregular in Conduct, gets drunk, and commits Riots in
the Hospital, or is found guilty of Theft or other Crimes, the same
is to be reported to the Commanding Officer of the Place, and he to be
tried by a Court-Martial, and punished as soon as his Strength will
permit.

In conducting the Military Hospitals, we found that it was always
right to discharge the Patients from the sick Hospitals as soon as
they were recovered, and to send them either to Billet, or to a
convalescent Hospital; because recovered Men are always the most
riotous; besides they crowded the Hospitals, and were in Danger of
catching fresh Disorders from those who were sick; and therefore the
recovering Men in every Hospital ought to be reviewed once or twice a
Week by the Physician or Surgeon, and the Names of such Men as are
well enough, to be marked; in order that they may be sent the next Day
to the convalescent Hospital, or to Billet. A Return of those marked
for Billet ought immediately to be sent to the Officers on
convalescent Duty.

When a convalescent Hospital is established, it ought to be put under
proper Regulations; the following are those which I drew up for that
established at _Osnabruck_ in _April_ 1761, and which were found to
answer the Purpose intended.


_Regulations for a Convalescent Hospital._

1. That this Hospital be entirely occupied by such Men as are
recovered from Diseases; that no Men be sent there but those whose
Names are returned to the Purveyor's Office by the Physician or
Surgeon of the Hospital.

2. That all the Patients shall be upon full Diet, unless in particular
Cases it be ordered otherwise by the Physician or Surgeon.

3. That all the Patients shall breakfast, dine, and sup, at regular
stated Hours, in the Hall appointed for that Purpose: Breakfast to be
ready at nine, Dinner at one, and Supper at seven o'Clock in the
Evening.

4. That no Patient shall carry up any Victuals into the Wards
appointed for sleeping in; and if any Patient does not attend at the
regular Hours of Meals, no Allowance of Victuals shall be made him in
the Place of such Meals, unless he has been absent on Hospital
Business, or been confined to Bed by Sickness.

5. That as soon as the Men are come down Stairs to Breakfast, the
Wards in which they sleep shall be cleaned out and sprinkled with
Vinegar, and the Windows opened to air them.

6. That the Doors of this Hospital shall be locked every Night at
eight o'Clock, and no Man be allowed to come in or go out after that
Time. The Doors to be opened again at seven o'Clock in the Morning.

7. That the said Hospital is to be visited two or three Times a Week
by the Physician, Surgeon, and Apothecary, who are to see that the
above Orders are complied with; to examine the Diet, and take Care
that every Thing is carried on properly; and to prescribe for any
little Disorders the Men may be affected with.

8. That one of the Hospital Mates be appointed to visit this Hospital
daily, to administer any Medicines which may have been prescribed by
the Physician; to apply any Dressings ordered by the Surgeon; and to
acquaint the Physician or Surgeon if any of the Men be so bad as to
require their Attendance, or to be sent back again to the Sick
Hospital.

9. That for the better executing these Regulations, orderly Serjeants
or Corporals be appointed for the Care of the Men; who shall mount a
Guard of six or more of such of the Patients of the said Hospital as
are fit for this Duty--That the Serjeants are to call a Roll of all
the Patients regularly three Times a Day, before Breakfast, Dinner,
and Supper; to see that the Men behave themselves soberly and
decently; and that they keep themselves clean, and commit no Riots;
and to confine in the Guard such as commit Riots and other
Irregularities, or whom they find drunk, or who stay out all Night;
and to report the same to the Officer on Duty.

10. That an Officer on convalescent Duty do visit the said Hospital
daily at the Times of Roll-calling, to see that every Thing be carried
on properly; and to receive the Reports from the Serjeants, and give
what Orders he may think proper for the better regulating the said
Hospital.

11. That if at any Time it should happen that there are more
Convalescents than the Hospital can hold conveniently, a Review be
made of all the Patients, and the strongest and most healthy be sent
to Billet.

12. That a Review be always made, when any Party is going to join the
Army, to pick out the Men who are fit to join their Regiments.

The Physical Officers employed in the Military Hospitals, are
Physicians, Surgeons, and Apothecaries.

No Person ought to be appointed a Physician to the Army, or Military
Hospitals, without previously undergoing the same Examination at the
College of Physicians, as those do who enter Fellows and Licentiates
of the College, that none but proper Persons may be employed. On such
Examinations the Physician General to the Army ought to be allowed to
sit as one of the Censors of the College.

The Surgeons are all obliged to pass an Examination at Surgeons Hall
before they are appointed, and the Apothecaries ought in like Manner
to pass an Examination at Apothecaries Hall.

The Mates employed in the Service ought, previous to their
Appointment, to be examined both in Surgery and Pharmacy, as the
Service commonly requires their acting in both Branches.

The Direction of all Military Hospitals ought always to be committed
to the Physicians, who have the immediate Care of Hospitals.

When an Army is acting on a Continent, and there is a Number of
Hospitals in different Places, the Physician who attends the Commander
in Chief ought to be made Physician General and Director of the
Hospitals, with proper Appointments; and all Orders from Head Quarters
ought to go immediately thro' this Channel.

Every other Physician at the different Hospitals ought to direct every
Thing about the Hospital which he attends, and his Orders ought to be
punctually obeyed; and he ought to keep up a constant Correspondence
with the Physician General; acquainting him from Time to Time with the
State of the Hospital, and what is wanted for it; and he ought
punctually to obey whatever Orders he receives from the Physician
General.

If there be separate Hospitals for the Surgery Patients, the eldest
Surgeon ought to direct every Thing in the Hospital he attends; and
when any Thing is wanted for his Hospital, to report the same to the
Physician General.

The directing and purveying Branches ought never to be entrusted to
the same Person, as the Temptation of accumulating Wealth has at all
Times, and in all Services, given Rise to the grossest Abuses, which
have been a great Detriment to the Service, as well as to the poor
wounded and sick Soldiers, and has occasioned the Loss of many Lives.
And therefore neither the Physician General, nor any of the Physicians
or Surgeons of the Army, or any other Person concerned in the
Direction of the Military Hospitals, ought ever to act as Purveyor or
Commissary; nor ought they ever to have any Thing to do with the
Accounts, Contracts, or any other Money Affairs relating to the
Hospital; and if ever they be found to intermeddle in these Affairs,
they ought to be immediately dismissed the Service.

The purveying or commissariate Branch ought to be entirely distinct
from the physical. The Purveyors or Commissaries ought punctually to
obey whatever Orders they receive from the Physicians or Surgeons; to
provide every Thing for the Hospital; to keep regular Accounts of all
the Men who come into, or go out of the Hospitals; and from Time to
Time to make Returns to Head Quarters of all the Men in Hospitals; and
their Accounts ought to be controuled by such Persons as the
Government may think proper.

Every Physician and Surgeon of a Military Hospital ought to visit the
Sick at regular stated Hours, and the Mates to attend and go round
with them, and receive and execute their Orders.

Every Mate ought to have a certain Number of Patients allotted him,
for whom he is to make up all Medicines, dress all Sores, and execute
whatever Orders he receives from the Physician, Surgeon, or
Apothecary. That the Mates may know and execute their Duty, proper
Orders in Writing should be hung up in the Apothecaries Shop for that
Purpose. The following are those which I gave out at all the Hospitals
I attended in _Germany_.


_Orders for the Mates._

1. That all the Gentlemen do attend at the Apothecaries Shop every
Morning at eight o'Clock, to assist in making up the common Medicines
of the Day, and afterwards to go round the Hospitals with the
Physicians and Surgeons.

2. That every Mate have a Book for writing the Prescriptions of the
Physicians in, which is to be kept in the following Order.--First, to
mark the Patient's Name and Regiment; then the Day of his Entry into
the Hospital and his Disorder; then the Prescriptions of the
Physician; and after all the Day of his Discharge, or of his Death.
_Ex. gr._

     _John Clarke_, 20th Regiment. _Jan._ 1. Fever.

     _Jan._ 1. V. S. unc. x.--H. salin. cum pulv. contrayerv.
     4r. die.--2. Emplast. vesicat. dorso, &c.

       Discharged or dead _Jan._ 28.

3. That every Mate make up himself the Physician's Prescriptions for
his own Patients, and afterwards go round and administer them, or give
them to his Patients with proper Directions; that he bleed his own
Patients, and dress any slight Sores they may have, which do not
require their being sent to the Surgery Hospital.

4. That every Mate go round amongst his Patients in the Evening, to
see that every Thing is well conducted, and to report to the Physician
or Apothecary if any Thing extraordinary happens.

5. That two of the Mates attend all Day at the Apothecary's Shop to
receive any Sick that may arrive, and to place them properly; to make
up what Medicines they may immediately want; to order each of them a
Mess of Water Gruel; and if any Thing extraordinary occurs, to send an
orderly Man to acquaint the Physician or Apothecary with the same. The
orderly Mates to make up likewise for Officers, or others, all
Prescriptions sent to the Apothecary's Shop through the Day.

A Joint of Meat, roasted or boiled, for Dinner, and a Bottle of Wine,
was allowed to the orderly Mates, by Lord _Granby_'s Order, that they
might not absent themselves from their Duty.--Where there was
Conveniency for it, a Mate lodged in the Hospital.

The Apothecary ought to take Care of the Medicines; to go round the
Hospitals in the Morning before the Time of the Physician's visiting;
to see that the Wards are in proper Order; that the Nurses and other
Servants have done their Duty; to examine into the State of the Sick,
and to see that the Provisions are good; and make a faithful Report
of all these Things to the Physician when he arrives.--To take Care
that the Mates prepare in the Morning the Medicines that are commonly
wanted for the Day; and that they afterwards make up faithfully the
Prescriptions of the Physician; to go round the Hospital again in the
Evening, to see that the Sick have got their Medicines regularly; and
to make the same Enquiries as in the Morning.

The Apothecary should always be lodged near the Hospital, to assist in
Case of any Accidents happening, or of Sick arriving at the Hospital.

When there are any strong infectious Disorders in Military Hospitals,
the physical Gentlemen may use the following Precautions to guard
themselves against Infection.

1. Never to visit the Sick with an empty Stomach; but to eat Breakfast
before they go into the Hospital.

2. To have a Suit of Cloaths reserved for visiting the Hospital, and a
waxed Linen Coat to wear above them in going round the Wards; and as
soon as they have come out of the Hospital, to wash and change their
Linen and Cloaths.

3. Before they go into the Wards, to order that they be well cleaned
out, and sprinkled with Vinegar, and afterwards fumigated, and aired
by opening the Windows, or by Working the Ventilators.

4. If the Infection be very strong, to take a Glass of the spirituous
Tincture of the Bark just before they go into the Hospital.

5. To put small Rolls of Lint, dipped in camphorated Spirits, up the
Nostrils, and to direct a Vessel, with warm camphorated Vinegar, to be
carried round, and held near the Patients they are examining.

6. In examining Patients affected with the Petechial Fever, or any
other malignant Distempers, to stand at some little Distance, and ask
what Questions they may think proper; and when they come near, to feel
the Pulse, and examine the Skin, not to inspire while their Head is
near the Patient's Body; but after being fully satisfied in these
Points, to retire a little, and ask what other Questions may be
necessary.

It would be right to establish some military Rank for every
commissioned Officer of the Hospital on Service, and to settle the
same Subordination in the physical as in the military Department. By
these Means, the Service would be carried on with greater Order, and
more Advantage to the Sick.

And it would be right, in Times of War, to add a Clause in the Mutiny
Bill to allow any military Officer on convalescent Duty to call in the
commissioned physical Officers to assist in making up a Court-Martial,
when there are not a sufficient Number of military Officers in a
Place, to try convalescent Soldiers guilty of Crimes. For in Times of
Service, very often a sufficient Number of military Officers cannot be
spared to be on Duty at the different Military Hospitals; and at all
such Places the Convalescents are generally very disorderly, when they
know that there is not a sufficient Number of Officers to form a
Court-Martial for punishing them. Where-ever there are a sufficient
Number of military Officers, no physical Officer ought ever to be
called upon as a Member of a Court-Martial.

Men, in Time of Service, are often apt to saunter in and about
Hospitals, and there learn all Manner of Debaucheries, and lose all
Sense of Discipline; and therefore, to keep up Order and Decorum,
there ought to be, at every Fixed and every large Military Hospital, a
military Inspector or Commander, an Officer of known Activity and
Probity; and a Number of Officers on convalescent Duty sufficient to
form a Court-Martial whenever required.

The Duty of the Military Inspector, or Commander, should be, to take
Care of all Convalescents on Billet; to see that the Officers under
him do their Duty, and maintain the same Regularity and Discipline
among the Men belonging to their respective Corps, as if they were
with their Regiments; and that the Men attend the Parade and
Roll-calling; and that they always appear neat and clean.

He ought, from Time to Time, to visit the Hospitals; to see if they
are kept clean; to enquire if the Men behave well, if the Diet is
good, and the Officers, Nurses, and Servants, do their Duty; and if he
finds any Thing amiss, to report the same to the Physicians and
Surgeons of the Hospital, or to the Purveyor or Commissary, or others,
under whose Department it may be, that the same may be immediately
rectified; and if he finds that the superior Officers of the Hospital
overlook such Abuses, notwithstanding his Representations, to report
the same immediately to the Head Quarters.

He ought to order one of the Officers on convalescent Duty to visit
the Hospitals daily, to make the Enquiries above-mentioned, and to
give him a Report of the same in Writing.

The Purveyor or Commissary ought to make a Return to him twice or
thrice a Week of every Man admitted into, or discharged from, the
Hospitals, or who dies in them; marking in the Return the Name of
every Man, and the Company and Regiment he belongs to; that he may
report the same to the Officers of the different Brigades or
Regiments.

The Military Inspector ought to have the Power of providing Billets
for all Officers and Soldiers about Hospitals; and the Names of all
Men to be discharged from Hospitals should be sent to him the Day
before they are discharged, that he may provide Billets for them; and
next Day the Men ought to march from the Hospitals to the Parade, to
receive their Billets, and the Orders of the Military Inspector, and
of the Officers of the Corps they belong to.

The Military Inspector ought to see that the Arms of the sick Men, and
the Arms and Cloaths of those who die and are lodged in the Magazines,
be properly taken Care of; and that the Stores of the different
Regiments be properly looked after.

As the Service often makes it necessary at Military Hospitals, where
the Number of Sick is great, to employ the convalescent Soldiers[163]
as orderly Men and Servants about Hospitals, all Men thus employed
ought to have a special Leave from the Military Inspector for so
doing; and no Man should be employed in any Capacity as a Servant
about an Hospital, who at that Time is on the Books as a Patient. And
all Men employed about the Hospital ought to be reviewed once a Week
by the Military Inspector, and likewise whenever a Party of
Convalescents is going to join the Army, or their Regiments; that no
Man may be allowed to remain with the Hospital, after he is fit to do
Duty in his Regiment.

    [163] In the _French_ Hospitals there are always a Number of
    Men who attend their Sick who belong to the Hospital, so that
    they have no Occasion to employ their Convalescents, as we
    are often obliged to do, where the Sick are attended by
    Nurses, who are commonly Soldiers Wives, and not so capable
    of doing such laborious Work as the Men.

When the Military Inspector is absent, the eldest Officer on
convalescent Duty ought to act in his Place.

Every Officer sent on convalescent Duty ought, as soon as he arrives
at the Place where the Hospital is, to wait on the Commandant, or
Military Inspector; to acquaint him of his Arrival, and to receive his
Commands. He ought then to go to the Purveyor or Commissary's Office,
to get a List of all the Soldiers who are in or about the Hospital,
and belong to the Regiment or Brigade he is employed for, wherein
those on Billet are distinguished from those in Hospitals. The next
Day he ought to parade all those marked on Billet, to see if the
Number of Men agrees with the List given him, and to examine in what
State each Man is, and how he is employed; and then he ought to go
round the Hospitals, attended by an orderly Serjeant, to see all the
Men in the Hospitals, and to know if the List given him at the
Purveyor's Office was right; and afterwards he ought to send every Day
a Serjeant or Corporal to see the Men in Hospitals, and to report to
him when any Men are discharged or die.--And he ought to procure from
the Military Inspector a Return of all the Men of his Corps, who are
either admitted into, or discharged from Hospitals, on the Days when
such Returns are made. He ought to make all his Men on Billet appear
regularly on the Parade at Roll-calling, and to oblige them to keep
themselves clean and their Arms in good Order, and to endeavour to
preserve the same Regularity and Discipline as when they are with
their Regiments. And whenever a Party is to be sent to join their
Regiments, he ought to have all his Men particularly examined; and
those Men who are found to be perfectly recovered, should be sent to
their Regiments.

If every Officer on convalescent Duty conform to these Directions, no
Man can ever be detained without his Knowledge in or about Hospitals,
as he must always know where every Man is, in what State of Health,
and how he is employed; and may at any Time be able to make a Return
to the Brigade or Regiment for which he is employed, of every Man who
is admitted, discharged, or dies in the Hospital.


FINIS.





End of the Project Gutenberg EBook of An Account of the Diseases which were
most frequent in the British military hospitals in Germany, by Donald Monro

*** 