Chapter II: Part III: chap. vii (1)

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 _guttæ antimoniales anodynæ_.

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 Hæmorrhages 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 Petechiæ, 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. Præfat.

[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 Petechiæ 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 Santé_, in his Chapter on the
_Dysentery_, § 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 _Mannæ 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. Ceræ alb. vel flavæ drachmes tres. Sapon. alb.
Hispan. drachmam unam. Aquæ fontanæ, unciam unam, liquefiant
super ignem in vase ferreo, agitando spatula, & dein infunde
in mortarium marmoreum, & adde paulatim aq. fontanæ, libras
duas syrupi sacchari. spiritus vini gallici tenuis, vel aquæ
alicujus spirituosæ 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.