Chapter III: Part III: chap. vii (2)

[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 Petechiæ 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 Aphthæ, 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 eleutheriæ vel cascarillæ_ 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_, _Aretæus_, _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 _Aretæus_, 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 Hæmoptoe, 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.