Chapter VI: Part III (2)

From the days of Prosper Alpinus, the salts contained in the soil of Egypt have been supposed to be among the principal causes of the ophthalmia of the country. Though the various modifications of light and heat no doubt act as existing causes; yet to the particular soil of Egypt, and to the constitution of the air there, we must look for the regular and the principal causes of this disease.

In Egypt several causes occurred, which in any country, separately applied, would be adequate to the production of violent ophthalmia. The dry, white, dazzling, soil, and the fine sand and dust constantly thrown about in whirlwinds and entering every crevice. If an ophthalmia is epidemical or is endemic in Egypt, the above causes will render it a very violent disease.

But I conceive, that, of themselves and alone, these circumstances do not produce the violent ophthalmia seen in Egypt. In no place did these circumstances exist in greater force than at Kossier, on the march across the Great Desert, and at Ghenné. Yet, till our arrival at Ghiza, the disease did not appear. These circumstances likewise exist in great force in most places of India, where the ophthalmia occasionally occurs from them, yet it is different from the two first species of the Egyptian ophthalmia.

For the production of the third species of this disease, the same causes will account, which produce dysentery, hepatitis, and other diseases of the liver. In Egypt, I remarked, that most of the cases of this species occurred at the time that dysentery prevailed the most.

It should be mentioned, that, in Egypt, the natives are universally impressed with the idea, that sleeping in the night-air brings on the disease.

In the ophthalmia of Egypt, as in the plague, it would appear, that very much may be done in the prevention.

It could not escape observation, how rarely officers were the subjects of this disease. In accounting for this, I lay most stress on the attention which officers pay to cleanliness. In the 88th regiment, where, I believe, forty men did not escape an attack, only two officers out of thirty had ophthalmia.

In the whole of the Indian army, only one officer lost an eye by it, and this was Ensign Paton, of the 86th regiment.

The exemption of the officers from the ophthalmia gives more weight to the opinion, that in Egypt this disease is communicated by contagion.

Mr Paton, previously to embracing the military profession, had studied medicine; and, when medical assistance was much wanted, and a great many of his corps were laid up with the ophthalmia, he very humanely offered to attend them. When employed in this duty, he was himself attacked with the disease and suffered most severely by it for many months.

Mr Bellars, about this time, joined the 86th regiment at Ghiza; he took charge of the sick, and was attacked in the same manner as Mr Paton had been, and he likewise suffered most severely by it for several months.

Dr Whyte, who fell a martyr to his zeal in the investigation of the history of the plague, from a residence of some years in the Levant and some time in Egypt, had good opportunities of being acquainted with the diseases of that country, informed me, that, by making those under his charge, frequently during the day, wash the eyes with cold water in the season of the ophthalmia, he never failed in preventing the disease. He instanced particularly the sailors of the transports, of about one thousand of whom he had the medical charge. The captains of the different transports carried Dr Whyte’s preventive instructions into execution; and, though the disease raged both in the army and the navy, few of the sailors of the transports had it. By an attention to this mode of prevention, and in the season when the ophthalmia prevails most, making the soldiers wear something over the eyes, I think we should have the prospect of passing a second campaign, or season in Egypt, with less loss from ophthalmia.

GENERAL REMARKS ON THE DISEASES.

I have dwelt a considerable time on the two endemics, the plague and ophthalmia, the only diseases which we found peculiar to Egypt; and there do not many more diseases remain to detain us.

We come next to a class including several diseases, and which are usually described separately: but, I am at a loss how to disunite them, as they occur all of them in India, and as they have for the most part appeared in the Indian army in Egypt. The diseases are fever, hepatitis, and dysentery; and, as I have for the most part seen them, there exists among them a most intimate and natural connection. For a long time, the same causes appeared indifferently to produce them: there was a frequent transmutation of these diseases one into another, and in the three diseases we succeeded by a similar treatment. In offering a few remarks, however, I will preserve a distinction, and speak of these diseases separately. Before entering on them I may remark, that the effects of the solo-lunar influence, so remarkable in fever hepatitis and dysentery in India, were in Egypt likewise very observable. In the treatment of these diseases the practitioner found his account in attending to the periods of the moon; at the full and the change, paroxysms would frequently supervene, if not anticipated; and, at these periods, convalescents would frequently suffer a relapse.

OF FEVER.

The fever which we had in Egypt, at different stations and in different seasons of the year, assumed various types. That which, on the outset, prevailed among the Bombay Sepoys, was remittent. At Ghenné, the fever in the 10th regiment was continued; but it very often terminated in hepatitis. At Ghiza, we have said that we suspected contagion as the cause, at first; but, in the end, the disease was clearly kept up by marshy effluvia on Rhoda Island. It assumed a remittent, and sometimes an intermittent, form, when brought down to Rosetta; and many of the cases terminated in dysentery. At El Hammed, a majority of the fevers which occurred were intermittents; but several remittents occurred, and a few cases which had some resemblance to typhus. After October, fever was a disease of rare occurrence. In the last general return for November, fifty cases appear, of which thirty-four were natives of India. The last return in December is much the same, the native corps having a majority of the cases.

In the last return of January there appear, of continued fever, twenty-two cases; twelve of whom were Europeans. Of intermittents there were thirty-two cases, and sixteen of them were Europeans. In the general report of the 26th of February the total of fever in the army is only twenty-three, and of them, only six are natives. On the 26th of April, we had only fourteen cases, of which three were natives. In May, fever did not appear in the reports.

Though fever, as it appeared in the Indian army in Egypt, at different periods, occurred with some variation; and though particular symptoms called for occasional variation in the treatment; yet, in its general character, the disease was the same, the proximate cause appeared to be the same, and the same general indication was required to be kept in view in the cure. I am inclined to believe, that, under different names, the same fever prevails over the peninsula of India, and over the eastern islands; and, perhaps, I might venture to extend the remark to the countries between the tropics. This fever has been often well described, under the name of the remittent fever of Bengal. Dr Lind, of Windsor, several years ago, gave an excellent and concise account of it in his Thesis. In Bengal, it is known under the name of the pucca fever. In Madras and on the Coromandel coast, it is the jungle fever. At Bombay and on the Malabar coast, it is known under the same name. In the army in the Guzzerat country, to the northward of Bombay, it is this fever which has proved so destructive of late to our army in the field there, opposed to the Mahrattas. In the island of Salsette, near Bombay, it pays an annual visit, on the ceasing of the monsoon, and proves very destructive. In 1801, on one estate, in Salsette, upwards of forty people were attacked with this fever in one night. I have learned from my ingenious friend Mr Christie, surgeon-general of Ceylon, that it was from the same fever, that the 19th, 51st, and 80th regiments, have been so very much reduced; and that it was this fever which proved so destructive in the late war with the king of Candy. Mr Christie writes me, that in its destructive malignancy and ravages, particularly on the Europeans in Ceylon, it has equalled the yellow fever of the West Indies.

From many accounts of it, which I received while in India, I am convinced, that the dreadful fever which prevails in Batavia is the same disease. In Batavia, the mortality from this fever is prodigious; it is not exceeded by that from the plague in Egypt, or from the yellow fever in America. Different circumstances, it would appear, concur to the production of the disease, in a very aggravated form, in the Dutch settlement of Batavia; of which, we may mention the extreme unhealthiness of the situation, and the bad practice of the Dutch surgeons.

Dr Griffith, surgeon to the naval hospitals in India, informed me, that, when our fleet lay off Batavia, in 1801, it prevailed very much; but that, when they got the management of patients early, they were generally successful in the treatment of the disease. Bencoolen is one of the most unhealthy of our eastern settlements, solely from the prevalence of this fever. In China, it appears likewise to be a frequent and fatal disease.

Having said thus much on the identity of the fever which appeared in Egypt, with that which is seen in India, and in the eastern islands, I shall proceed to the treatment. The first step was to cleanse the primæ viæ, and some gave emetics: this, however, was not always necessary; and purging with calomel, and the neutral salts, appeared in most cases to answer the same intention. In the first stage, likewise, as particular symptoms called for them, venæsection was performed, blisters were applied, we determined to the skin, or gave opiates. However, if the fever was of any duration, the practice always was, to endeavour to affect the mouth as speedily as possible with mercury. This was the practice in continued fever, and in Egypt, as in India, we were very generally successful, if application was early made. In the destructive fever of Ceylon, Mr Christie says, that he has practised but with a moderate share of success: but that the affecting the system by mercury is by far the most successful of different modes of treatment which he had tried. He gave nitric-acid, but in a very small quantity. In the fleet, when stationed near Batavia, Dr Griffiths gave mercury more liberally than any practitioner I know. He likewise used the nitric-acid very freely, both externally and internally, and relied much on its combined use with mercury. By two very able practitioners, Dr Keir and Mr Stewart, the Salsette fever has been successfully treated by nitric-acid alone; purgatives having been previously exhibited. Some practitioners treated intermittents by bark, some by opium, or by giving this and the volatile alkali. It has sometimes occurred to myself, and I have frequently had reports from our surgeons, that agues continued obstinate till the gums could be affected by mercury.

From a very intelligent officer I had a detail, regarding the Batavia fever, so remarkable, that I shall here insert it. This gentleman is the captain of a ship in India, who, in different voyages which he had made to Batavia, had constantly lost great numbers of his ship’s crews. In his last voyage, when in a certain latitude, and as he approached Batavia, he gave daily to each of his men a few grains of the mass of the blue pill. By the time of his arrival at Batavia, he had thus very gently affected every one of their mouths; and, in that voyage, he lost not a man. Would mercury thus exhibited, as a preventive, be useful in the plague, or in the yellow fever?

Before dismissing the subject of fever I may observe that no well-marked case of typhus occurred to us in Egypt. In India we never saw a case of this species of fever. To the existence of this fever, which in Europe has committed such havoc in our fleets and armies, the climate of India is inimical. We know instances where, in transports, typhus had broke out, and, on the passage to the Cape of Good Hope or India, had proved little less destructive than the plague could have done; but the disease never reached India. If a case was landed there, it never propagated the contagion: a second case never appeared on shore. On inquiry, I found that no case had ever been known on the western side of the peninsula, nor have I ever heard of its existence in the eastern.

HEPATITIS, OR THE LIVER COMPLAINT.

In India I have often had occasion to remark, that the acute hepatitis, of Cullen, was a disease of rare occurrence. The disease which comes before us most frequently, in India, is his chronic species; and in that, most frequently, there is neither pyrexia nor the “decubitus in latus sinistrum difficilis,” which, from having included in the definition of both of his species, I suppose the illustrious and accurate professor was induced to believe was a constant symptom in this disease. In very few of his definitions is there room for alteration; and I hope, for venturing here to suggest one, that I shall not incur the charge of presumption. But hepatitis was a disease, for accounts of which the accurate nosologist must have trusted to other sources than his own observation. It should be known, that very often we meet with this disease, when few of the symptoms of his definition are found. In India I have learned from some of the oldest practitioners, and from some gentlemen of abilities, the most respectable in the profession, that very commonly hepatitis is met with when all the symptoms of Cullen’s definition are wanting. In that country, when any of the abdominal viscera are complained of, we may in general suspect some error in the hepatic system.

In India, the liver seems to be the seat of disease in nearly the same proportion that the lungs are in England.

In Upper Egypt, and at Ghiza, we had many cases of hepatitis: it was the same disease that we had seen in India. At Rosetta and Alexandria a few cases did occur, accurately answering to Cullen’s definition of the acute species. Sergeant Levi, of the 88th regiment, was one instance. On the 13th of October, he was admitted into the hospital with this disease in a most violent degree. He had been ill only twenty-four hours: he had high inflammatory fever; his side was extremely tender to the touch; he had great irritability of stomach, and pain over the belly. He was twice bled: the anti-phlogistic regimen was for thirty-six hours applied in its utmost rigour: thereafter mercury was liberally thrown in, and he recovered. We remarked that many, who, in India, were the frequent subjects of repeated attacks of hepatitis, at length never complained, or they had the disease in the mildest shape, in Egypt. After the month of October, hepatitis was a disease of still more rare occurrence. In no corps did the number of cases bear any proportion to what they were wont to be in India.

During October a considerable number of cases occurred, but almost all of them were Europeans: the proportion of the natives who had this disease was always very small.

About the beginning of November several fresh cases occurred, and all of them were acute.

By the end of December this disease was fast disappearing in the army. In the last return of the month there were only twenty-one cases, and twenty of them were Europeans.

In January it still continued to decline. In the return of the 31st of this month there appear only nine cases, and all of them are Europeans.

In the first return of February there are only five cases, and all of them are Europeans.

There was an increase in March. In the first return of the month there were twelve cases, and all were Europeans.

In the last return of April the total number was so low as six, of which number four were Europeans.

At the time of embarkation, at Suez, there was not one case reported in the army.

Hepatitis appeared more in the Company’s artillery, and in the 10th regiment, than in any other corps of the army. For its predominance in the latter corps, one reason has been assigned, and which to me appears to have had the most powerful influence.

But on the whole, this disease, once so formidable to us in India, gradually ceased to appear in the returns of the sick.

The treatment of hepatitis it is unnecessary to dwell on: for no disease are we provided with a more effectual or sure remedy. If the season for applying the remedy be not lost, we are nearly, I think, as confident of a cure by mercury, and the analogous remedies, as we are in a case of syphilis by the same remedies.

To whom the world is indebted for the successful treatment of hepatitis by mercury, I cannot correctly say. The oldest written account of this practice, that I have seen, is in a very sensible pamphlet by Dr Paisley, formerly of Madras. There is another very distinct account of it in a pamphlet by Dr Girdlestone, of Yarmouth, formerly surgeon of a regiment in India.

For the general introduction of mercury, through the western side of the peninsula of India during the last twenty years, for the application of nitric acid to the same purpose, and for the discovery of some other preparations analogous to these, we are indebted chiefly to the ingenious Mr Scott, of Bombay. About ten years ago, from some experiments which he made on the calces of mercury, he discovered the analogy between them and nitric acid, and he was the first to apply this acid to the cure of hepatitis. Subsequently, he was led to the use of nitric acid and other analogous remedies in hepatitis and other diseases, which are curable only by mercury, a practice, of which, on a large scale for the last six years, I have observed the best effects, and which is now likely to get into general use in India.

I have said, that the species of hepatitis which we met with, at last, in Egypt, was not that usually seen in India, and a corresponding change was required in the treatment. Previously to giving mercury it was found necessary to premise the anti-phlogistic regimen.

In the use of mercury great address is often required; and, in substituting nitric acid and the analogous remedies, I am convinced, that much advantage may often be gained. Sometimes one of these remedies will succeed when the other has failed; and not unfrequently have I seen their combined use succeed where separately given they had failed. In obtaining a new agent we have acquired a great deal more power in the management of a disease, the most formidable to Europeans in the eastern world.

Sometimes in Egypt, and in many instances in India, I have observed, that I could not affect the gums with mercury, or with acid, till venæsection was performed. After this operation, I have often succeeded, and induced a flow of saliva, in cases which had long resisted a liberal use of mercury and nitric acid.

If the modern practice of giving but little mercury, and to make it only touch the gums, as it is called, without exciting a flow of saliva, be proper in the venereal disease, undoubtedly it is not in hepatitis. This disease never yields till the saliva flows freely—the explanation of this I do not attempt; but the fact is as I state it, and it is well known to every man who has practised extensively in India. Whenever the gums are hard, and insensible to the effects of mercury; when, instead of a salivation, they are red, painful, spongy, or blue, the prognosis is very unfavourable: in ninety of such cases out of the hundred we lose our patients.

In the first stage of this disease, I have derived benefit from cupping and blistering the side; but I never allow these remedies to interfere, or to delay the principal indications—the affecting the gums.

Dissection shews us the liver, of appearances considerably varied when this disease has existed some time. I have preserved notes of my dissections; they are not few. I made a rule of inspecting the body of every one that died under my care for several years past. At present, I shall only mention, in general, that sometimes the liver was of the natural consistence, sometimes harder, and that it was much varied in colour; but, generally, it was considerably increased in size. After the disease had lasted long, it was sometimes much wasted, and, in a few instances, of a very small size. In a majority of the fatal terminations, there were found vomicæ, or abscesses. When matter is formed, it is well known, that it makes its escape in various ways: here surgical aid may sometimes be of use.

DYSENTERY.

This was by far the most-generally prevailing, as well as the most fatal disease in the army.

After mature deliberation, and the most satisfactory proofs, proofs nearly amounting to demonstration, I convinced myself, in India, that the dysentery of that country is a disease whose first causes lie in the biliary system. On reflection, and after looking over the accounts of my practice in the West Indies, I have little doubt but that the dysentery of that country proceeds from the same cause. In the end, I was led to think that dysentery, as it occurs in Europe, was the same disease: however, the opportunities of observation, which I had in Egypt, convinced me that I was wrong.

The dysentery which occurred in the army till we came to the shores of the Mediterranean, and for some time after, was clearly the dysentery of India; but, afterwards, we witnessed a different disease. I must confess, that, having come to so certain a conclusion, I was not ready to give up an opinion which appeared to me to rest on very sure grounds; and it was not till after much doubt, hesitation, and careful observation, that I became convinced, in Alexandria, that, with the change of country and climate, we had a different disease. This is one proof how improper, and how unsafe, it is for the practitioner of one climate to sit down and describe the diseases of another. They only who have studied the same diseases, in various and opposite climates, can fully comprehend the extreme absurdity as well as fallacy of this. From reasoning of any kind, we are incompetent to decide on the identity of disease. Reasoning from analogy here always deceives. In many of the symptoms diseases may agree; but, from thence to infer their identity is taking a very narrow view. The comparison will be found to hold good only in some points, and that we have satisfied ourselves with an imperfect outline. Between diseases, as they occur in Europe and in Asia, there are just as many shades of difference as between the plants of those opposite regions, or in the colour of the inhabitants.

The dysentery of India, or what I shall term the tropical dysentery, is not the disease which is described by Cullen under that name. The dysentery of Cullen, as it is faithfully described by Sydenham, Pringle, Monro, and Sir George Baker, is a frequent disease on the continent of Europe; and it has ever been a most destructive disease in our armies there. The dysentery of Europe I believe to be generally a disease of the intestinal canal. I have already said that the tropical dysentery proceeds from a different cause; but the diseases likewise differ much in their symptoms. The “pyrexia contagiosa” certainly forms no part of the tropical dysentery; and the torminia and tenesmus occur so rarely, that, in a definition of this disease, I presume they cannot be admitted. Spasmodic affection of the intestinal canal, I believe, rarely occurs in the tropical dysentery.

I have ever experienced difficulty in distinguishing dysentery from diarrhæa, and am inclined to think, that, in Cullen’s definition of diarrhæa, is described tropical dysentery. The diarrhæa biliosa, as well as his seventh species, the diarrhæa hepatirrhea, perhaps, ought to be included in a definition of tropical dysentery.

It has been already mentioned, that it was the tropical dysentery which principally prevailed in the army. Though I was not convinced that we had a different disease, till after we came to Alexandria, yet I am inclined to think that it was the European disease which chiefly prevailed in the army for some time before; and, if we draw the line from November, we shall not be far removed from the truth.

It will not be necessary to say much in the treatment of tropical dysentery. Mercury is now the remedy relied on every where. In Egypt, we felt the want of nitric acid in hepatitis; and we equally felt the want of this powerful remedy in dysentery. The instances which have occurred to me, during the last five years, are extremely numerous, where, after our failure with mercury, exhibited in all the variety of its preparations, we succeeded with this remedy sometimes as a substitute, and sometimes as an auxiliary.[7]

It was in the 61st regiment that cases of the dysentery of Europe were first observed. Perhaps it more readily appeared in this corps, because the greatest part of the men had not yet got rid of the European habit, and were as yet unassimilated to a warm climate. After repeated failures, and losing some men, Mr Ruxton saw the necessity of giving trial to other remedies than mercury.

The disease generally set in with a smart fever, and, unless the calomel exhibited went through the bowels, the patient felt no relief: and Mr Ruxton remarked, that the neutral salts gave this relief much more perfectly than calomel. The treatment which Mr Ruxton rested on, and with which he was at length successful, was, in most cases, putting the patient on the anti-phlogistic regimen; frequently giving laxatives; and keeping up a determination to the skin. The same practice was followed in the few fresh cases which occurred in the 88th regiment at Alexandria, and in a considerable number of cases in the hospital of the 10th regiment, and some other corps. However, it must be mentioned, that to the last period some cases did occur, in all these corps, where calomel was found necessary. When the disease was of some weeks standing, and where a chronic disease occurred, calomel given in small doses proved the best and indeed only useful remedy.

For a long time, we saw but little dysentery in the army. The number of cases which occurred, before we arrived in Lower Egypt, was inconsiderable.

In September, a great many cases occurred in the neighbourhood of Rosetta, and in the camp at El Hammed; but many of these were the sequelæ of the fever contracted at Rhoda. In October, the number of cases was greatly on the increase. The rainy weather with which the month of November began, and which continued during the following months, brought a prodigious increase of dysenteric cases. In the general return of the first week in November, there appear one hundred and sixty cases, and one hundred and twenty-three of these are Europeans. Most of the natives were from the Bengal volunteer battalion.

In the first general return in December appear two hundred and nineteen; of which one hundred and forty are Europeans.

After leaving the encampment at El Hammed, and getting into dry, comfortable barracks, at Alexandria, the disease occurred more rarely in the army.

In the last return of January, only one hundred and sixty cases are seen.

In the last return of February, the total number of dysenteric cases in the army was fifty-four, and only twenty-two of these were natives of India.

In the last return of March, there appear nineteen cases, fifteen of which were Europeans.

There are only twenty cases in the last return of April, and these cases are equally divided between the Europeans and Indians.

At the time of embarkation the number was even less than the above.

The disease was more frequently met with among the European artillery, and in the 61st regiment, than in any other corps. Among the native corps, the Bengal battalion had more of the disease than any other. I made inquiry, but could find no reason that could with probability account for this.[8]

I have continued longer on the subject of dysentery than was at first my intention. I will confess, that I think it is a subject on which I could with more propriety speak than on any other. My opportunities of seeing the disease have been no common ones. Rarely, I believe, has it fallen to the lot of an individual to see so very many cases of one disease in such a diversity of climate and situation. In the 88th regiment, during the course of upwards of ten years, I saw the same men the subject of this disease on the continent of Europe, in America, in both extremities of Africa, and in India. Of late, it has afforded me not a little amusement to review my notes as well as my journals of practice in this disease, in all these quarters.

I have now both given some account of the endemic diseases which we met with in Egypt, and offered a few remarks on those diseases which were most prevalent in the army. They are the diseases which constantly prove the most fatal to an army in India. The few which now remain, or (if I may be allowed the expression) the minor diseases, will not long detain us.

PNEUMONIA AND RHEUMATISM

I shall speak of conjointly. In the symptoms or treatment we could not observe any difference from the same diseases as they occur in Europe. If these diseases were less violent than we have seen them in Europe, they had more of the inflammatory, diathesis than in India.

It was not till after the army had been sometime in Lower Egypt, that either of these diseases appeared.

In the first general weekly return in November, there appear a total of six cases of pneumonia, and nine of rheumatism.

In the first week of December, there were twelve cases of pneumonia, and seven of rheumatism.

In the first weekly return of January, both diseases appear to have increased; there were twenty-four cases of pneumonia, and twenty of rheumatism.

In the first return of February, there are thirty-four cases of pneumonia, of which number, twenty were Europeans. Of rheumatism, there were fifteen, and only eight of them were Europeans.

In March, the first return presents only five cases of pneumonia: of these, three were Europeans; but, of rheumatism, there were twenty-seven cases, and nineteen of them were natives of India.

In April, there were sixteen cases of pneumonia, and only five were Europeans. Of twenty-five cases of rheumatism, eleven are Europeans.

The warm clothing and bedding provided by the General for the natives of India, in the cold months, no doubt protected them from the attacks of pneumonia and rheumatism. The latter disease was found to be more prevalent in the Bengal battalion of Sepoys than in any other corps.

SMALL-POX.

The cases of this disease that occurred were very few. I have said that the small-pox broke out at sea, in the division of the army commanded by colonel Murray. Mr Philips told me, that it was very fatal to the natives: he sent every case as soon as discovered into the Julia hospital ship, which was unfortunately lost, in the Red Sea, with all on board.

The Europeans, who were attacked in Egypt with this disease, all did well; but it proved a very fatal disease to the few Indians whom it attacked.

As in India, we remarked, that in Egypt the contagion did not spread so widely as in Europe. Though, at different periods, it broke out in the hospital of the 10th regiment, at Rosetta, in the department of the commissary of cattle, when encamped near the lake Mareotis, and in the garrison of Ghiza, yet in none of these instances did the disease spread. The cases that did occur were all of them very confluent. When, on the eve of our march to Suez, I received vaccine matter, sent from Constantinople by order of Lord Elgin: it arrived too late, however, for us to introduce the new inoculation either in the army, or the country; it was likewise too old and unfit to be carried into India, as we intended.[9] At one time I expected to see a curious question in physiology resolved, by observing the united agency of the variolous, and pestilential contagions. In one instance, these two poisons were in action in one corps, and at one time. A case of the small-pox, and another of the plague, broke out, in the camp of the commissary of cattle, at the same time. By the active vigilance, and the system established there, the progress of both contagions was soon stopped, and a second case of either disease did not afterwards occur.

DIARRHÆA.

I have said, that, from the quality of the water, this was a prevailing disease in crossing the desert of Thebes. It occasionally appeared, at other times, in some corps, particularly after a change of provisions, or after changing quarters, as from El Hammed to Alexandria.

SCURVY.

This disease was but little seen in the army. About twenty cases occurred in the 61st regiment while quartered in the Pharos, and one case occurred in the 80th regiment at Alexandria. At the time the disease occurred, the army was regularly supplied with fresh vegetables, and there was no scarcity of provisions in the market.

SYPHILIS.

This disease prevailed much in the garrison of Ghiza, and in the 86th regiment. At the time of embarkation there were many obstinate cases. With the small stock of nitric acid which we had, we had as strong proofs of its efficacy as in India. In the instances of some officers who were successfully treated with it, we found that the stomach seldom bore more than half the quantity which, in Bombay, we had usually exhibited in the hospital of the 88th regiment; but the acid given to these cases differed much from the acid used in India: the latter was a much pleasanter remedy.

To a few cases we successfully gave the oxymuriate of potash, and to several cases the oxymuriate of soda.

We found that syphilis was a frequent disease in every part of Egypt that we had seen, both among the Bedouins and the Fellahs; and we have seen in Upper Egypt many objects terribly mutilated from this disease. Crude mercury I have often seen in their bazars, or markets, and they appeared to be acquainted with the use of it.

THE GUINEA-WORM.

This did not frequently appear in the Indian army while they were in Egypt: on the voyage thither, however, it prevailed very much, and a great deal of it came under my own particular notice. On my return to India I found, that, in the manner of its first appearance, as well as in its progress afterwards, much of what I had observed was considered, by medical men, as new and remarkable. I shall, therefore, give some detail of it here: though this may be going a little out of my way, it may be useful. When cases of this disease crowded on me, and with the very severe symptoms with which they appeared, I was both perplexed and embarrassed; and I regretted much the not having had a previous knowledge of the disease.

This disease, as will be shewn by the table, was but little seen in Egypt. It appeared only in two European corps, the 86th and 88th regiments; and in two native Indian corps, the 1st and 7th Bombay regiments. It is a disease, of which I believe that we know but little. Industry and attention might be usefully employed in the investigation of the natural history of the dracunculus.

In September, 1799, the 86th regiment relieved the 84th in the fort of Bombay. The 86th remained in the king’s barracks there until October, 1800, at which time they were relieved by the 88th regiment from the island of Coulabah.

The 86th, on coming into the fort of Bombay, had never had a case of the Guinea-worm; and they continued free from it till the setting in of the monsoon of 1800. The king’s barracks in the fort are close to the bazar in Bombay. Here Mr Dean, the surgeon of the 86th regiment, remarked, that the Guinea-worm prevailed very much among the natives. In the course of the monsoon, nearly three hundred cases of this disease appeared in the 86th regiment. I saw, at one time, one hundred cases of it in Mr Dean’s hospital.

The 88th regiment, from the time of their arrival in India, in June, 1799, till October, 1800, was quartered in the island of Coulabah, distant one mile from Bombay. During the fifteen months of their stay at Coulabah, only one case of Guinea-worm appeared in the regiment; and this happened, as they were about exchanging quarters with the 86th regiment, in an old man, debilitated with repeated attacks of hepatitis and dysentery. No case appeared in the 88th regiment in October, nor for nearly a month after their coming into the king’s barracks in Bombay; but, in that part of November which immediately preceded their embarkation for service, three cases occurred.

The artillery, 86th and 88th regiments, as already mentioned, were embarked, at Bombay, for the Egyptian expedition. In the course of the voyage to Ceylon, a case of Guinea-worm first appeared in the detachment of the 86th regiment, on board the Minerva; and, thereafter, six cases in the 88th regiment, on board the same ship.

On our arrival at Point de Galle, in Ceylon, we found that the disease was unknown in his Majesty’s 19th foot, among the Sepoys who came from Bengal or Madras; in the Malay corps: and, as far as I could learn, among the inhabitants. During our stay in Ceylon, a few cases made their appearance in the 86th and 88th regiments on shore. On sailing from this island for the Red Sea, only three hundred and sixty men, of the 88th regiment, with the artillery, were embarked in the Minerva. Two companies of the 88th were embarked in a small vessel, the Fancy. Another vessel, the Hope, was provided for the detachment of the 86th regiment, and two officers of the 88th were embarked with them.

Soon after sailing from Ceylon, the Guinea-worm made its appearance among the 88th, both in the Minerva and Fancy: in the Minerva, particularly, it increased with alarming rapidity. By the time we reached the Straits of Babelmandel, we were in a most alarming state. Of three hundred and sixty men, whose services we had reason to expect daily might be required, one hundred and sixty-one were at this time crippled and laid up with this loathsome disease. Though contrary to every account which I had had of the disease, many circumstances at this time led me to suspect that it was infectious, and I, at length, thought it prudent to treat it as such.

The officers remarked, that it prevailed most in particular parts of the ship, and much more in some companies than in others. This, at length, so much struck the commanding officer, that the sick were separated from the sound: the men with the Guinea-worm were all placed on the orlop-deck, and the rest of the men occupied the gun-deck. At this time, too, extraordinary precautions, regarding cleanliness and ventilation, were adopted. Much lumber and luggage were stowed away, and the space between decks, which hitherto had been lumbered with it, was made open and clear, fore and aft. The decks were daily well washed with boiling water, and the nitrous fumigation was kept constantly going on throughout the ship. Besides the usual bathing three times a week, of all on board, the soldiers were made to wash their hands and feet regularly twice every day at the ship’s head.

In a little time after adopting these measures, we could perceive the disease to diminish. The number of fresh cases reported, decreased daily; and at the time of our casting anchor in Kossier Roads, though there were on the sick list many bad ulcers from the Guinea-worm, no fresh case had appeared for some days before.

During the voyage, 199 cases had appeared from 360 men of the 88th regiment; and several cases occurred among the ship’s crew; but not a single case occurred among the artillery. This struck every one on board, very early, as remarkable; yet these men had the same provisions, drank the same water, and in every other circumstance were situated as the men of the 88th regiment, except that they were kept separate. From the outset, the artillerymen were accommodated apart, on the gun-deck, in a spot divided off for themselves. Not one of the officers, either of the artillery, 88th, or belonging to the ship, had the Guinea-worm. From the strong circumstances which in its course appeared, every officer on board was impressed with the opinion of its being contagious, and was inclined to use every precaution of prevention; from which, most probably, all escaped this filthy and severe disease.

Those embarked in the Fancy, were not so fortunate; few of the men there escaped the disease. Of eight officers of the 88th, three caught it. Mr Bruce, then the assistant surgeon, was one of these: he had a worm in each leg. The Fancy was obliged to return to Bombay; most of the men were disabled by this disease; and the season was too far advanced for her getting up the Red Sea.

Among the 86th regiment in the Hope, only three cases occurred; and one of the two officers of the 88th, on board, was one of them.

I find, by my case-books, that in the part of the 88th regiment which continued in the Minerva, the disease appeared as follows:

From the 9th to the 24th December, 6 cases on the passage to Ceylon.
From the 25th Dec. to 14th Feb. 4 ditto at Ceylon, on shore.
From the 15th to the 28th Feb. 39 ditto at sea, after leaving
Ceylon.
In March 103 ditto at sea.
In April 39 ditto at sea.
In May 8 ditto at sea, till landing at
Kossier.
----
Total of cases 199
----

I have purposely excluded the cases which occurred in the 88th, on board the Fancy, or among the 86th regiment.

The disease was pretty uniform in the manner of its appearance. The patient was first sensible of an itching; and, on looking at the part, generally observed a small blister: sometimes I have seen three or four small blisters, and the part having the appearance of being stung with nettles. When the blister was snipped, a piece of mucus of the breadth of a sixpence was seen underneath, which being removed, the head of the worm was seen. It was in general firmly attached, and required force to detach it from the parts underneath. When detached with the forceps, we twisted it round a ligature or piece of lint, and thus, often on the first day, succeeded in extracting a foot, or even two, of the worm. It resembled much what is called bobbin, and was about the same size. It was transparent and moist, a white liquid being seen in it. We continued, daily, extracting as much of it as would come out with gentle pulling. It was always dangerous to pull strongly, for fear of breaking the worm: it then occasioned the most acute pain, and there followed much swelling, with inflammation of the neighbouring parts, sometimes of two or three weeks continuance, when the worm would shew itself at another part, as at first, with itching and a blister.

It seldom appeared to be deeply seated; generally, under the cutis, or among the tela cellulosa, when we could often trace it in its course, and sometimes see it: sometimes it was under the fascia, and but seldom among the muscles.

If not ushered in with fever, it was almost always attended with it in its course: when there was considerable inflammation, it ran very high. In seven cases, mortification took place, and very large sloughs were cast off. In a few cases, there was a very considerable and alarming hæmorrhage.

By presenting itself at different places, it would often leave two or three large, foul, and fistulous ulcers in different parts of a limb. When the inflammation has run very high, as I have often seen of the whole leg or thigh; and when a profuse suppuration followed; the worm frequently has come out dead, often in pieces, with the sanies, by which, probably, it had been eroded and killed.

Frequently, after extracting one worm from a patient, a second, a third, or even a fourth, would appear: after getting one out of a leg, a second would appear in the other, a third in one hand, and a fourth in the other hand.

The Guinea-worm, I believe, has been seen in every part of the body. Though the extremities appear to be its favourite seats, yet the face, breast, back, penis, &c. are not exempted from its visits. I heard of a gentleman in Bombay who had one in his scrotum and penis, and of a lady who had one in the pudenda.

The following I extract from my case-book and notes, taken on board the Minerva, by which it will be seen that the extremities are as much more frequently its principal and first seat, as in the itch.

+-----+-----+-----+-------+--------+------+------+-----+-----+-------+
| | | | | | | | | | Total |
| | Feet| Legs| Thighs| Scrotum| Groin| Hands| Arms| Body| Cases.|
| +-----+-----+-------+--------+------+------+-----+-----+-------+
|Feb. | 34 | 3 | 1 | — | — | 1 | — | — | 39 |
|Mar. | 70 | 21 | 5 | 2 | 2 | 3 | — | — | 103 |
|April| 20 | 9 | 5 | — | — | 3 | — | 2 | 39 |
+-----+-----+-----+-------+--------+------+------+-----+-----+-------+
|Total| 124 | 33 | 11 | 2 | 2 | 7 | — | 2 | 181 |
+-----+-----+-----+-------+--------+------+------+-----+-----+-------+

As to the causes of the appearance of the Guinea-worm, and the mode in which it is generated, I must confess that I have no account that I could venture to offer here.

In different parts of the world, the water drank is accused of occasioning intestinal worms, as the tænia in Switzerland, and the tænia and the teretes in the West Indies; where, likewise, I have heard the mucilaginous vegetables eaten assigned as a cause of the frequent appearance of worms. In Russia, there is a worm, the lumbricus militensis, common near swampy grounds. In Russia and in Siberia, in the same situations, the tænia infernalis prevails. But, after what has been here stated, we cannot bring the water, drank on board the Minerva, or at Bombay, to account for the Guinea-worm which prevailed: in fact, the water came from different and distant quarters, Bombay, Ceylon, and Madras. Besides, the officers of the 38th, and the artillery, drank the same water, and escaped.

No case of Guinea-worm had been known among either the Lascars or European sailors in the Minerva, when the 86th and 88th embarked in her.

I have good reason to think that the spreading of the Guinea-worm may be stopped, whenever it does appear. The means which we adopted appeared to succeed. Extreme attention to cleanliness is indispensably necessary.

In India, the native doctors are much more successful in getting out the worms, than Europeans. After long feeling with their fingers, for the body of the worm, they make an incision as nearly as they can judge over its middle, and, pulling the worm by a duplicature of it, draw out both ends of the worm at one time. I have often endeavoured to imitate this practice. My sense of touch was not so delicate, and did not guide me so correctly, as it did the Hindoo doctors; but I always found that when, on cutting down to it, I got on the middle of the worm, and, by the forceps, pulled this out, I could with ease extract a large portion, and, not unfrequently, the whole worm.

Leeches, astringent and sedative lotions, cataplasms, fomentations, &c. were applied, as required by the circumstances of the case. A good deal of attention was paid to the disease, in all its stages; and several experiments were made on the worm, which, however, it is needless to detail here.

After using a variety of articles, in the treatment of the Guinea-worm, and making them enter the system by the absorbents, I think that unctuous substances succeeded the best, particularly mercurial ointment. Passing an electrical shock through the part had no effect.

ULCERS.

In India, we remarked that ulcers, particularly of the legs, were very rarely seen; and that many men in the 88th regiment, who in Europe were always in hospitals with them, were in India quite free from them. In Egypt, they began to re-appear. In the course of six weeks after the army came to Alexandria, there appeared seventy on the general return of the army; and they continued afterwards on the increase.

TETANUS.

Though no case of this disease occurred to us while in Egypt, I met with a severe one on the voyage thither. As I was successful in this case, and by a mode of treatment which, with the theory which gave rise to it, is, I believe, now considered as obsolete, it may not be uninteresting to mention what led me to give it a trial.

In the year 1794, the first tetanic case I met with, occurred at Bergen-op-Zoom. A sergeant of the 88th regiment, after remaining drunk out all night, was in the morning found lying in a ditch. This was in August, and the weather was unusually warm. When brought to the hospital, his jaws were so firmly locked, that the blade of a pen-knife could not be introduced between the teeth. Mercury was had recourse to, but in a few hours the muscles of the neck became convulsed. By the advice of a Dutch physician, a man of great eminence, I immersed my patient four times, in the course of the day, into a bath of broth. He continued in it half an hour each time, and, after he came out, his whole body was rubbed with mercurial ointment. I do not recollect that any thing else was given to him, unless a stimulant enema. Next morning the good effects of the Dutch practice were evident: a violent salivation came on, and, in about three weeks, the man was doing his duty.

In the next case which occurred, though a cure was not completely effected, the same treatment was, for some days, attended with good effects. In the island of Grenada, a negro, attached to our pioneers, received a contusion and a slight wound of the head, which was soon followed by locked jaw. The warm bath, and the liberal use of mercury, were ordered. He, for some time, appeared to be better, and I flattered myself with the hopes of another cure; but the disease gaining ground, the cold bath and the tonic treatment were had recourse to. The patient died.

The next was a sailor, who, a few days before our embarkation, in the Minerva, at Bombay, had been slightly wounded in the foot by a copper nail. On my first seeing him, his symptoms were slight, but were gaining ground fast. On the 10th of December, the day after our embarkation, he had the most violent symptoms of the disease: the jaws were firmly locked; the muscles of the neck, before and behind, were strongly convulsed; and he had twitchings of the muscles of his face. He pointed to the region of the stomach, where, he afterwards told me, that he had intolerable pain and sickness. This man was immediately put under the same treatment as was employed in the case of Sergeant Kirkland, with this difference, that, instead of broth, a bath was made from fat, or what is, on ship-board, called the slush. The same success attended; but the symptoms yielded more slowly, and it was several months before the sailor recovered.