[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 retard, 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.