Chapter XXI: Part III (3)

[107] There is a difference in the appearance of the blood when sizy, perhaps not sufficiently insisted on by practical writers; for though there should even be a very thick buff, yet, if the surface is flat, and the _crassamentum_ tender, no great inflammation is indicated, in comparison of that state of the blood wherein the surface is cupped, the _crassamentum_ contracted so as to afford the appearance of a large portion of _serum_, and where it feels firm and tenacious, though perhaps but thinly covered with buff. This is a distinction well worth attending to in practice; for it is in these last circumstances that blood-letting gives most relief, and where the patient will bear the repetition of it with most advantage.

[108] See the same observation in Mr. Hume’s Essay on this Disease, published by Dr. Donald Monro.

[109] The state of the stomach is very much affected by that of the external surface of the body; and it is sagaciously observed by Sydenham, that the stomach being commonly very irritable in the plague, the most effectual means of making it retain what was administered internally was to excite a sweat.

[110] The red bark was brought to England in a Spanish prize in the year 1781, and a very accurate account of its medical and chemical properties was published the year after by Dr. William Saunders, of Guy’s hospital. None of it had been brought to the West Indies before the peace, so that I had no opportunity of trying it in that climate.

[111] Mr. Telford related to me, that he had cured several intermittents that had baffled the bark, by means of white vitriol, whilst he was surgeon of the Yarmouth in 1779. He gave it in doses of five grains every four hours in the intermission, and was successful in every case except two, in which the patients were far advanced in the dropsy.

He met with several cases of the same kind in the Alcide, in 1782, in which he was successful with the flowers of zinc, after having given large quantities of bark to no purpose. He preferred, however, the white vitriol, as being milder in its operation, and less apt to disagree with the patient’s stomach.

He did not employ either of them in the recent state of the disease, nor does he assert that they are universal or infallible remedies; but only alledges, that he has experienced the most evident good effects from them in an advanced stage of the disease, and a reduced state of the patient, where the common remedy had failed.

[112] Dr. Huck Saunders, whose recent loss the world has reason to regret on account of his experience and sagacity as a physician, as well as his virtues as a man, communicated to me, in conversation, some observations on the cure of obstinate intermittents, which deserve to be mentioned here. When he was physician to the army at the Havannah he cured a number of agues which had resisted the bark, by giving two ounces of the vinous tincture of rhubarb and six drams of the tincture of sena seven or eight hours before the fit. This being repeated two or three times, carried off the disease. He also informed me, that he had met with agues in England which did not yield to the bark; but, upon leaving it off, and putting the patients on a course of mercury, they were cured upon returning to the use of the bark.

Arsenic has also been found to be an effectual remedy in intermittent fevers. I was informed by Dr. Huck Saunders, that when he was in North America, in the war before the last, there was an expedition undertaken against the Cherokee Indians, whose country is extremely subject to agues; and as an adequate quantity of bark would have been very cumbersome where light service was necessary, Mr. Russel, who had the medical management of the expedition, provided a great number of pills, containing each one eighth part of a grain of arsenic, by the proper use of which he was enabled to cure the intermittent fevers with which the troops were seized.

I shall here mention another unusual remedy in intermitting fevers; and though I can bring only one instance in proof of its efficacy, yet this is so strong as to make it deserve farther trial. A man, on board of the Sandwich, had an obstinate intermittent which had resisted the bark, and was stopped by applying to the stomach a plaster, composed of gum plaster, epispastic plaster, and opium, in proportions which I do not now recollect.

[113] Sir John Pringle on the Diseases of the Army.

[114] This is elegantly expressed as follows, in Sir George Baker’s learned Dissertation on this disease:--“Primo neglectus tractatu asperior occurrebat: etenim corpus extenuatum atque confectum ut morbo fervido impar erat, ita ipsi impar curationi. Itaque optimum erat occurrere ipsis principiis atque auxilia mature præripere. In hoc enim corporis affectu aliquod certe in medicina opus est, haud multum in naturæ beneficio.”

[115] In Dr. Griffith’s form of his medicine for the piles, six drachms of fresh-drawn linseed oil are joined with two drachms and a half of the vinous tincture of rhubarb, and given twice a day in a draught. I commonly used oil of almonds at the hospital. This may be considered as another instance of those useful combinations of medicines, which experience alone sometimes discovers. I have found it of use also in other internal hæmorrahages.

[116] See Diseases of the Army, p. 273. 6th Edit.

[117] Since coming to England, I have been informed by Dr. Garden, a learned and ingenious practitioner from South Carolina, that this medicine, in order to produce its proper effect, should be given in a very weak decoction; for that after having almost abandoned it in consequence of its failure when he gave it in strong decoctions, and in substance, he was again convinced of its efficacy by using it in a very weak decoction, a scruple being boiled in a pint of water to half a pint.

[118] See page 345. A fact mentioned in Capt. Cooke’s Voyage to the North Pacific Ocean, may be also alledged in favour of this opinion. He remarks, that the Kamschadales, who were habituated to hard labour, were free from scurvy, while the Russians and Cossacks, who were in garrison in their country, and led indolent lives, were subject to it.

[119] I was informed of this fact by Mr. Cairncross, an ingenious surgeon belonging to one of the battalions that served there during the siege.

[120] I imagined that this was a new practice; but I find, since the first edition of this work was printed, that it has been recommended by Pere Labat in his voyage to the Antilles.

[121] There is a symptom which takes place when men are beginning to recover from scurvy, (particularly when the cure is rapidly effected by the use of lemon and orange juice) upon which I have frequently reflected, but for which I have never been able to account. This consists in acute pains, which are felt in the breast and limbs, resembling rheumatic pains. I once knew the crew of a ship which was much affected with scurvy, and had about ninety men under cure by lemons and oranges, who were most of them affected with this symptom in one night, and made such a noise by crying out as to alarm the officers who were upon duty.

[122] See the Medical Essays of Edinburgh. Sennertus, lib. iii. part i. sect. ii.--Haller Elem. Physiolog. lib. xix. sect. ii.

[123] In the Princessa, 1781, and the Nonsuch, Prince George, and Royal Oak, in 1782.

[124] Since this was first written, the melancholy tidings have arrived of another case to be added to this fatal list. It is that of the amiable and gallant Lord Robert Manners, who commanded the Resolution on the 12th of April, and having lost his leg, besides receiving a wound in his arm and breast, died of this untractable symptom on his passage to England; and though he shared a fate to be envied by every lover of true glory, his loss can never be enough deplored by his country and friends, being formed by his great virtues and accomplishments, joined to the lustre of his rank, to hold out an example of all that was good and great as a man and an officer.

[125] See Kaau Boerhaave’s account of this epilepsy in a school at Harlaem, in a book, entitled Impetum faciens dictum Hippocrate per corpus consentiens (page 355.) A fact of the same kind is also related in a pamphlet, entitled Rapport des Commissaires chargés par le Roi de l’examen du Magnetisme Animal.

[126] London Medical Observations and Inquiries, Vol. VI.

[127] Medical Commentaries, Vol. III., and a Thesis printed at Edinburgh, 1784.

[128] See experiments on a heated room. Philosophical Transactions, 1775, Vol. LXV.

[129] That species of locked jaw, called by authors the _Trismus Infantium_, to which children are liable the first week after birth, is probably owing to the contact of the external air upon the skin, which is accustomed in the womb to a moist and warm medium.

[130] Aretæus Cappadox says, that tetanus in general is even more apt to occur in winter than in summer. De Cauf. & Sign. Morb. Acut. lib. i. cap. vi.

[131] There are several valuable practical remarks on this complaint in some of the ancient authors, especially Aretæus. Their principal means of cure consisted in the application of warm oil to the whole surface of the body, particularly of the part affected. This author also recommends clysters of warm oil, occasionally combined with a medicine called _hiera_, which consisted of certain spices and gums, with some purgative, such as aloes or colocynth. Aretæus Cappad. de Curat. Morb. Acut. cap. vi. Celsus, lib. iv. cap. iii. Goræaus in vocabulum,ἱερα.

[132] This is a fact which does not admit of doubt; but the manner in which the effect is here produced is a matter of conjecture. It is most probably owing to the compression and tremor of the air in consequence of its resistance to the motion of the ball. We can also conceive, that, with regard to an yielding part, such as the stomach or abdomen, a body flying with great velocity may even, for a moment, displace a portion of it by passing through the same space, without any other mechanical injury than contusion, in a manner similar to what happens to two balls in the act of collision in philosophical experiments made to illustrate the nature of elasticity; or the compressed air may even, in this case, act, as it were, like a cushion, preventing the sudden impulse and contact of the ball. This explanation furnishes a reason why the parts of the body above mentioned should be more liable to be affected by accidents of this kind than the head. Perhaps this difference may also, in part, arise from the principle laid down by Mr. Hunter, that the stomach is more essential to life, and more immediately the seat of it, than the head or any other member or organ of the body, and that an injury to this part is more immediately destructive of life than any other.

[133] The honourable Captain Fitzroy.

[134] Colonel Markham.

[135] Animals are affected by these accidents as well as men. A cow in one of the ships was killed in one of the actions in April, by a double-headed shot passing close to the small of her back.

[136] Hæc formula ex Pharmacopœia Nosocomii Sti. Thomæ excerpta est.

[137] Hæc formula ex Pharmacopœia Nosocomii Sti. Thomæ deprompta est.

[138] Vide pag. 408.

[139] Vide pag. 409. Hæc formulæ ex Pharmacopœia Nosocomii Sti.Thomæ excerpta est. sed vice confectionis Damocratis hodie obsoletæ, adhibentur confectio aromatica & opium purificatum, ratione habitâ ad portionem fingulorum adeo ut parem edant effectum ac in vetere formulâ.

[140] Vide pag. 456.

[141] Ex auctoritate Cl. Huck Saunders.

[142] Ex auctoritate Cl. Huck Saunders.

[143] Ex auctoritate Cl. Lind.

[144] Vide pag. 479.

[145] Vide pag. 489.

[146] Ex auctoritate Cl. Heberden apud Cl. Pringle in opere suo de morbis castrensibus.

[147] Hæc formula ex Pharmacopœiâ Nosocomii Sti. Thomæ, excerpta est.

[148] Vice olei ricini dare licet olei amygdalæ unciam unam cum tincturæ sennæ unciâ dimidiâ. Vide Pharm. Nosoc. Sti.Thomæ.

[149] Hæc formula ex auctoritate Cl. Griffiths. In periculis a me ipso factis felicissimum successum ex hoc medicamento percepi.

[150] Hoc medicamentum speciatim his hæmorrhagiis accommodatum quæ ex aliquo viscere læso vi externa exoriantur quales in nave sæpius quam alicubi accidere solent, ex præcipitiis & ex corpore colliso a molimine machinarum & tormentorum.--Prodest quoque in his casibus pulvis ipecacoanhæ compositus.

[151] Hæc formula ex Pharmacopœia Nosocomii Sti. Thomæ deprompta est.

[152] Hæc est quam proxime formula a Cl. Mead legata Nosocomio Sti. Thomæ ubi olim munere medici functus est, & ibi ex eo tempore usque hodie feliciter in hydrope adhibita est.

[153] Cl°. Huck Saunders qui dyspnœâ hydropicâ laboravit ipse, auxilio notabili erat hoc medicamentum. In talibus malis interdum summopere prodest decoctum digitalis purpureæ, ut medicus supra memoratus in suo casu compertus est.--Vid. Medical Transactions, Vol. III.

[154] Vide Cl. Pringle in opere suo de morbis castrensibus.

[155] Hujus doctrinæ auctor est Hippocrates, quæ restaurata est auctaque a Cl. Milman in opusculo suo de hydrope.

[156] Hæc methodus medendi quæ æque efficax ac simplex est, primo excogitata fuit a Cl. Georgio Fordyce medico nosocomii Sti. Thomæ, ubi & ipse felicissimo cum successu eandem expertus sum, in muneribus meis ibi fungendis.

[157] Vide opus Cl. Johannis Hunter de morbo venereo.

[158] Vires opii in isto morbo primo innotuerunt ex experientiâ Cl. Nooth, dum præfuit nosocomiis militaribus in America, & pro optimo remedio a peritissimis medicis & chirurgis jam habetur.

[159] Non hic intelligitur ptyalismum veram esse causam quâ efficitur medela morbi, sed præcipitur ut pro argumento sit hydrargyrum in vasa minima permeasse adeo ut effectum edat in subigendo morbo. Vide Opus Hunteri.

[Transcriber's Note:

Inconsistent spelling and hyphenation are as in the original.]