FOOTNOTES:

Putrid Malignant Fevers, attended with Eruptions, are taken Notice of byHippocrates[24], and other antient Authors[25]; but whether they meant that particular Sort of Eruption which we now call Petechiæ, is uncertain; as their Descriptions are not clear enough to distinguish it from the Miliary and other Kinds. But since the Year 1500, we have had many accurate Accounts of Fevers of this Kind, which have appeared in different Parts of the World: from all which it appears that such Fevers generally take their Rise either from some antecedent Acrimony of the Blood; or, what is more frequent, from some Source of Corruption or Contagion; from the Use of putrescent animal Food, and a Want of fresh Vegetables and acescent Liquors; fromthe putrid Steams of corrupted animal Substances; from the moist putrid Vapour of low marshy Places in Summer, where there is stagnating Water, which corrupts by the Heat; from the foul Air of crowded Hospitals, Jails, and Ships; and from such like Causes[26].

When once this Fever begins, it is observed to be of a contagious Nature, and (if proper Care is not taken) to affect those who attend the Sick, or who live in the same Room, and breathe the same Air with them.

Many Authors have reckoned the Malignant, Petechial, and Pestilential, to be distinct Species of Fevers; and have treated each of them under a particular Head. ButRiverius[27]has very justly observed, that they all belong to the same pestilential Tribe, and only differ from one another in the Degree of Infection,and the Violence of the Symptoms[28]; and that they are to be cured by the same general Treatment, and the same Medicines.

FOOTNOTES:[1]Dr.Huxham, in hisTreatise on the ulcerous sore Throat, p. 36, says, “I have very often met with this buffy or sizy Appearance of the Blood in the Beginning of Malignant Fevers; and yet, Blood drawn two or three Days afterwards, from the same Persons, hath been quite loose, dissolved, and sanious as it were.” And in hisEssay on Fevers, chap. viii. p. 108. says, “The first Blood frequently appears florid; what is drawn twenty four Hours after, is commonly livid, black, and too thin; a third quantity, livid, dissolved, and sanious. I have sometimes observed the Crasis of the Blood so broke as to deposite a black Powder, like Soot, at the Bottom, the superior Part being either a livid Gore, or a dark green, and exceedingly soft Jelly.”[2]Observations on the Diseases of the Army, part III. chap. vii. sect. 3. third Edition, 1761.[3]Ramazini, in his TreatiseDe Constitutionibus annorum, 1692, 3, 4,in Mutinensi civitate, Sect. 19. mentions the Petechial Fever which had been frequent the three foregoing Years; in which the Petechiæ appeared commonly on the fourth or seventh Days, and almost all those died in whom they appeared on the first Day. These Spots came out first on the Neck, the Back and Breast; and it was observed that none escaped unless these Spots extended themselves as far as the Nails of the Toes, vanishing by Degrees on the upper Parts. He tells us likewise, that this Fever was attended with an Inflammation of the Throat, which, about the Height of this Disorder, terminated in a white ulcerous Crust. This sore Throat should seem to be the same which we now callthe malignant ulcerous sore Throat, which I never once saw while I was with the Troops inGermany.[4]Dr.Huxham, in hisEssay on Fevers, ch. viii. p. 97, tells us, that sometimes, about the eleventh or twelfth Day, on the coming on of profuse Sweats, the Petechiæ disappear, and vast Quantities of small white miliary pustules break out.[5]Dr.Hasenohrl, in his TreatiseDe Febre Petechiali, cap. i. p. 12. relates a very particular Case, where the Petechiæ appeared on the fourth, and the white miliary Eruptions on the seventeenth Day of the Fever.[6]Dr.Lind, in hissecond Paper on Fevers, p. 105. mentions Spots which rise above the Surface of the Skin, and are of the miliary kind, as common in contagious Fevers, as he observed among theFrenchPrisoners inWinchesterCastle, in the Beginning of the Year 1761.[7]Dr.Huxham, tho’ he says “yet Bleeding to some Degree is most commonly requisite, nay necessary, in the strong and plethoric;” yet he afterwards makes the following Remark: “Besides, the Pulse in these Cases sinks oftentimes surprisingly after a second Bleeding, nay sometimes after the first, and that even where I thought I had sufficient Indications from the Pulse to draw Blood a second time.” See hisEssay on Fevers, chap. viii. And Dr.Pringleobserves, that in the second Stage of the Disorder large Bleedings have generally proved fatal, by sinking the Pulse, and bringing on a Delirium.Observations on the Diseases of the Army, part III. chap. vii. sect. V.[8]Dr.Pringleadvises giving a Vomit, by way of Prevention, on the first Appearance of the Symptoms, and at Night to force a Sweat, by giving a Drachm of Theriac with ten GrainsSal volat. Corn. cervi, and some Draughts of Vinegar-whey, and to repeat the same the following Night; and says, he has often seen those Symptoms removed which he apprehended to be Forerunners of this Fever received by Contagion; but previous to Vomits, or Sweats, if the Person be plethoric, it will be necessary to take away some Blood.Observ.part III. ch. vii. sect. 5. Dr.Lind, in hissecond Paper on Fevers, p. 66. says, “To all who are supposed to be infected by Fevers, during this Stage of Rigours, a gentle Vomit is immediately to be exhibited before the Fever be formed, and before the Fulness or Hardness of the Pulse renders its Operation dangerous. If the Vomit be delayed too long, and especially if Bleeding must precede it, the most certain and favourable Opportunity of procuring Safety for the Patient is past.—That he has found it equally serviceable in preventing Relapses, when it is given at the Return of the Shiverings.” A loose Stool, or two, should be procured by the Emetic or Clysters, and he advises Sweating immediately after, in the manner recommended by Dr.Pringle. At other times “he gave five Grains of Camphire every four Hours, with large Draughts of Vinegar-whey. Eight Persons in ten, he says, got quite well by this Treatment.”I have never had sufficient Opportunities of trying this Method of Prevention, to determine any thing certain about it; but it may be worth while to practise it.[9]Petrus a Castro, in his Account of a Petechial Fever, which was frequent atVerona, tells us, that the Sick had a great Thirst, and an Aversion to Meat, but all of them had the strongest Desire for Wine, and were perpetually asking for it, even those who at other Times used to be very temperate; and that this proceeded from an Instinct of Nature, which wanted something to support the Strength.De Feb. Malig.sect. iii. chap. 26. Dr.Huxham, in hisEssay on Fevers, has the following very judicious Remark on the Use of Wine: “In this View, and in those above-mentioned, I cannot but recommend a generous red Wine as a most noble, natural sub-astringent Cordial, and perhaps Art can scarce supply a better. Of this I am confident, that sometimes at the State, and more frequently in the Decline of putrid Malignant Fevers, it is of the highest Service, especially when acidulated with Juice ofSevilleOrange or Lemon. It may be also impregnated with some Aromatics, as Cinnamon,SevilleOrange Rhind, red Roses, or the like, as may be indicated, and a few Drops ofElix. Vitriolimay be added. Rhenish and French White Wines, diluted, make a most salutary Drink in several Kinds of Fevers, and generous Cyder is little inferior to either. TheAsiatics, and other Nations, where pestilential Disorders are much more rife than with us, lay more Stress on the Juice of Lemons in these Fevers than on the most celebratedAlexipharmac.” Chap, viii. second Edit. p. 123, 4.Acid and acescent Liquors have very justly been recommended and used by most late Practitioners, in this as well as in other malignant Diseases. Vinegar-whey, Barley-water acidulated with Lemon-juice, and such other Liquors, make good Drinks for the Sick; but we were obliged, for the most part, to use the vitriolic Acid for acidulating the Patient’s Drink, as it was the easiest procured and carried about with the Flying Hospital.[10]If the preventive Method does not succeed, Dr.Lindadvises to have recourse to Blisters; and says, that sixteen out of twenty will next Morning be free of the Fever. But adds, this is said, provided the Source of their Infection be not so highly poisonous as it was in the Garland Ship, or in other such violent Contagions. Dr.Pringlementions his having applied Blisters early, but without relieving the Head, or preventing any of the usual Symptoms. I have often ordered Blisters pretty early in the Disorder; and though I have frequently found them of use in keeping up the Pulse, and relieving the Head, and other Symptoms, yet I never saw them have such an immediate Effect as Dr.Lindmentions.[11]It is long since thePeruvianBark has been used by Practitioners in Malignant Disorders, though I do not know that any body gave it in this Fever to the Amount of an Ounce per Day, before Dr.Haenand Dr.Hasenohrl. Dr.Ramazinimentions its having been tried in the Petechial Fever, in the Years 1692, 3, 4. And in a Treatise on the Plague in theUcrane, published atPetersburgh, in the Year 1750, we are told, that in theFrenchTranslation of the Philosophical Transactions for the Year 1732, there is a Note to p. 264, telling, that Mr.Amyandinformed the Academy of Surgery atParis, that Mr.Rushworth, Surgeon, had wrote to SirHans Sloane, on the 23d ofMay1723, that when he was Surgeon to a Ship, in the Year 1694, he had cured some Men ill of the Malignant Fever, attended with pestilential Buboes, by means of thePeruvianBark. Dr.Huxhamhas recommended a Tincture of the Bark; and Dr.Pringle, a strong Decoction of it, with some of the Tincture, in these Malignant Fevers.[12]ThePeruvianBark has not only been found useful in this Malignant Fever, but has likewise been recommended in the Plague. SeeMorton Oper. Append. secund. Exercitat. Hist. Febr. Ann. 1658, ad. an. 1691. complexa. In the Small Pox, seeMedical Essays, vol. V. art. x. and has been found serviceable in the putrid Disorders of theWest Indies, as taken Notice of by Dr.Hillary; and in the malignant ulcerous sore Throat in this Country, as Dr.Walland others have observed. And in thirty-five Cases of the malignant ulcerous sore Throat, in which I gave it, joined with Cordials, and the Use of Acids, I did not lose one Patient. Nine of them were strong People, and had plethoric Symptoms, and were blooded in the Beginning; and seven of them were costive, and took a Dose of gentle laxative Physic before taking the Bark. The rest had no Symptoms which seemed to require these Evacuations. However, it ought to be observed, that this is a Disorder of the malignant kind; and that although some well-timed gentle Evacuations may be serviceable in the Beginning, before giving the Bark; yet too free, or even gentle Evacuations, injudiciously made, will sink the Patient, and infallibly do Mischief.The free Use of the Bark has long been found serviceable in Mortifications and foul Sores, where the Juices tend too much to the Putrescent; and has been strongly recommended by Mr.Ranby, Serjeant Surgeon to his Majesty, in the Cure of Gunshot Wounds. See hisTreatise on Gunshot Wounds.[13]Dr.Huxham, in hisTreatise on the ulcerous sore Throat, p. 54, &c. condemns the Use of the volatile alcaline Salts, in Fevers of the putrid, pestilential, or petechial kind, as being apt to heat too much, and to hasten the Dissolution and consequent Putrefaction of the Blood. However, I cannot help thinking that they are the best Remedies we can use on some particular Occasions, even in this Fever; for we have no Remedy which gives such a sudden and briskStimulusto the Fibres as they do. And I have known many Cases of Patients who were extremely low, and whose Pulse was scarce to be felt, and others who were apt to fail into fainting Fits, who have been preserved by large and repeated Doses of these Salts, and the free Use of Wine, and acescent Liquors, to correct their alcaline Acrimony in the Blood. Though as soon as such Patients had recovered from this low State, I laid these Medicines aside; because I cannot help agreeing with the Doctor in the Belief, that their continued Use will produce the Effects he mentions. For although it be true, that these Salts, when mixed with putrescent Liquors, or with dead animal Substances, resist Putrefaction, and, like ardent Spirits and Vinegar (the other Products of Fermentation) check and put a Stop to that very Process which produced them: Yet it is also true, that, when mixed with the Blood of living Animals, they stimulate the Vessels, and increase the Heat andMomentumof the Blood, and dissolve it; and therefore I cannot but disapprove the continuing their Use longer than is immediately necessary.[14]Some Men passed only one Worm; others, two or three; some, six or seven; and one Man, of the Guards, inJanuary1763, after passing three by Stools in the Course of a Fever of this Kind, discharged fourteen more upon taking a Dose of Rhubarb and Calomel after the Fever was over.[15]Observations on the Diseases of the Army, part iii. chap. iv. Note to p. 213. third Edition.[16]SeeHoffman’s Works, vol. III. chap. x.River. Observ. commun.Obs. 13.of Observations found in a Library.Bonetus’s Sepulchret. anatom.tom. II.Gualther van Doeveren’s Inaugural Dissertation de Vermibus intestinalibus, published atLeyden, 1753; andLancisi’s Works; for Cases where the internal Coats of the Stomach, and Intestines, have been eroded, and all the Coats perforated by Worms of the round Kind.[17]Riveriustells us, that, according toHippocrates’s Doctrine, Deafness is a very dangerous Symptom in the Beginning of acute Disorders, though it be a good Omen, and portends Health, when it does not appear till the Height of Fevers, especially those of a malignant Kind; and adds, that he himself has a thousand Times observed, that those labouring under this Fever have recovered, when this Symptom of Deafness came on at the Height (in statu) though the other Symptoms threatened much Danger.Prax. Medic.lib. XVII. sect. iii. cap. i. p. 451.This Symptom of Deafness occurs in other Fevers as well as in this, and often proves a good Symptom in them likewise, as I have frequently observed. Two remarkable Examples of which I had under my Care in St.George’s Hospital, in the Year 1759. On the 17th ofJanuary1759,James Donaldson, a young Man of nineteen Years of Age, was admitted into the Hospital for a Fever, attended with a Stupor and a Delirium, a parched dry Tongue, and other Symptoms of a Fever of the inflammatory Kind, for which he had been blooded, and used other Evacuations. On the 19th, after the Application of a Blister, he was seized with almost an entire Deafness; after which, all his other Symptoms became milder, and he mended daily, and was entirely free from the Fever by the 30th. On the 10th ofApril1759, a Youth,John Young, fifteen Years of Age, was admitted into the same Hospital for a Fever, which had already continued fourteen Days. His Speech was affected, and he had entirely lost the Use of his Limbs, was delirious, and had other bad Symptoms. On the 12th, his Hearing became exceedingly dull, and he recovered daily afterwards, and was discharged, cured, the 2d ofMay, having recovered the Use of his Legs as well as got free of the Fever.[18]But although these parotid Swellings were in general so favourable with us, we are not to imagine that this will always be the Case: forRiverius, though he speaks of these Swellings proving for the most part critical; yet he tells us, that, in the Year 1623, this Fever was epidemic atMontpelier, and that almost one half of the Sick died; and particularly, that most of those who had Swellings of the parotid Glands appearing about the 9th or 11th Day, were carried off within two Days of their Appearance. Having attended several who died from the Swellings not coming to Suppuration, he began to consider in his own Mind, what might be the Cause of their Death, and concluded, that it was owing to there being a greater Quantity of morbid Matter in the Blood than the Part was able to contain, and that Evacuations by blooding and purging were the only Remedies which were likely to give Relief; and therefore, in the first Case of this Kind, in which he was afterwards consulted, he ordered three Ounces of Blood to be taken away, notwithstanding the Patient was so low that the Surgeon was afraid he would have died in the Operation: The Pulse rose on bleeding, and he ordered four Ounces more to be taken in three or four Hours afterwards: The Pulse rose still more, and he ordered a Dose of Sena and Rhubarb to be taken next Day, and the Patient recovered. And he adds, that all those who were treated in this manner got well.Prax. Med. Lib.XVII.sect.iii.cap.1.[19]Ibid.[20]Pringle’s Observations on the Diseases of the Army, Part III. chap. vii.[21]This Symptom of Buboes is taken Notice of by Authors, but does not seem to be so frequent as many of them would make us believe. Neither Dr.Huxhamnor Dr.Pringlemention their having seen such Buboes; and Dr.Lindsays, that he never saw them till the Beginning of the Year 1763.[22]Hippocratestakes Notice of Swellings of the Testicles in Fevers. He tells us, that a Man from Alcibiades had his left Testicle swell before the Crisis of a Fever.See his Second Book on Epidemics, sect. ii. And he mentions this Symptom as a Crisis in the ardent Fever.See his Book on Crises, sect. xi.—And Dr.Antonio Lizzari, in a Treatise which he published on theAcute Diseases which were frequent at Venice, and all over Italy, in the Years 1761, 62, tells us, that Abscesses of the Scrotum and Testicles frequently followed the Measles.[23]These Pains and Mortifications of the Feet and Toes were not confined to those who were brought low by malignant Fevers; for, during the very hard Frost in the Beginning of the Year 1763, many of the Patients who lay in very large open Wards in the Hospital atOsnabruck, were affected in the same Way. One Man had both Feet, and Part of each Leg, compleatly mortified, and died in about nine Days after the first Appearance of the Mortification. One lost half of one Foot, and some Toes of the other; and the third lost the first Joint of some of his Toes, and the Ends of others.[24]Hippocrat.lib ii. popul. sect. iii. text. 2.[25]Aetius Tetrab.ii. sect. i. cap. 129.Actuar.lib. i. cap. 23.[26]See these Causes mentioned byRiverius, and since more fully explained by Dr.Pringle,Observations on the Diseases of the Army, part iii. chap. vii.[27]River. Prax. Med.lib. xvi. sect. iii. Præfat.[28]The Malignant or Hospital Fever, and Petechial, seemed to me to be entirely the same Disorder, and the Petechial Spots to be only a Symptom which appeared sometimes, but not always. AndRiveriussays, the Petechiæ do not always appear; but when they do, it is a most certain Sign of a Pestilential Fever. See hisPrax. Med.cap. xvi. sect. iii.

[1]Dr.Huxham, in hisTreatise on the ulcerous sore Throat, p. 36, says, “I have very often met with this buffy or sizy Appearance of the Blood in the Beginning of Malignant Fevers; and yet, Blood drawn two or three Days afterwards, from the same Persons, hath been quite loose, dissolved, and sanious as it were.” And in hisEssay on Fevers, chap. viii. p. 108. says, “The first Blood frequently appears florid; what is drawn twenty four Hours after, is commonly livid, black, and too thin; a third quantity, livid, dissolved, and sanious. I have sometimes observed the Crasis of the Blood so broke as to deposite a black Powder, like Soot, at the Bottom, the superior Part being either a livid Gore, or a dark green, and exceedingly soft Jelly.”

[2]Observations on the Diseases of the Army, part III. chap. vii. sect. 3. third Edition, 1761.

[3]Ramazini, in his TreatiseDe Constitutionibus annorum, 1692, 3, 4,in Mutinensi civitate, Sect. 19. mentions the Petechial Fever which had been frequent the three foregoing Years; in which the Petechiæ appeared commonly on the fourth or seventh Days, and almost all those died in whom they appeared on the first Day. These Spots came out first on the Neck, the Back and Breast; and it was observed that none escaped unless these Spots extended themselves as far as the Nails of the Toes, vanishing by Degrees on the upper Parts. He tells us likewise, that this Fever was attended with an Inflammation of the Throat, which, about the Height of this Disorder, terminated in a white ulcerous Crust. This sore Throat should seem to be the same which we now callthe malignant ulcerous sore Throat, which I never once saw while I was with the Troops inGermany.

[4]Dr.Huxham, in hisEssay on Fevers, ch. viii. p. 97, tells us, that sometimes, about the eleventh or twelfth Day, on the coming on of profuse Sweats, the Petechiæ disappear, and vast Quantities of small white miliary pustules break out.

[5]Dr.Hasenohrl, in his TreatiseDe Febre Petechiali, cap. i. p. 12. relates a very particular Case, where the Petechiæ appeared on the fourth, and the white miliary Eruptions on the seventeenth Day of the Fever.

[6]Dr.Lind, in hissecond Paper on Fevers, p. 105. mentions Spots which rise above the Surface of the Skin, and are of the miliary kind, as common in contagious Fevers, as he observed among theFrenchPrisoners inWinchesterCastle, in the Beginning of the Year 1761.

[7]Dr.Huxham, tho’ he says “yet Bleeding to some Degree is most commonly requisite, nay necessary, in the strong and plethoric;” yet he afterwards makes the following Remark: “Besides, the Pulse in these Cases sinks oftentimes surprisingly after a second Bleeding, nay sometimes after the first, and that even where I thought I had sufficient Indications from the Pulse to draw Blood a second time.” See hisEssay on Fevers, chap. viii. And Dr.Pringleobserves, that in the second Stage of the Disorder large Bleedings have generally proved fatal, by sinking the Pulse, and bringing on a Delirium.Observations on the Diseases of the Army, part III. chap. vii. sect. V.

[8]Dr.Pringleadvises giving a Vomit, by way of Prevention, on the first Appearance of the Symptoms, and at Night to force a Sweat, by giving a Drachm of Theriac with ten GrainsSal volat. Corn. cervi, and some Draughts of Vinegar-whey, and to repeat the same the following Night; and says, he has often seen those Symptoms removed which he apprehended to be Forerunners of this Fever received by Contagion; but previous to Vomits, or Sweats, if the Person be plethoric, it will be necessary to take away some Blood.Observ.part III. ch. vii. sect. 5. Dr.Lind, in hissecond Paper on Fevers, p. 66. says, “To all who are supposed to be infected by Fevers, during this Stage of Rigours, a gentle Vomit is immediately to be exhibited before the Fever be formed, and before the Fulness or Hardness of the Pulse renders its Operation dangerous. If the Vomit be delayed too long, and especially if Bleeding must precede it, the most certain and favourable Opportunity of procuring Safety for the Patient is past.—That he has found it equally serviceable in preventing Relapses, when it is given at the Return of the Shiverings.” A loose Stool, or two, should be procured by the Emetic or Clysters, and he advises Sweating immediately after, in the manner recommended by Dr.Pringle. At other times “he gave five Grains of Camphire every four Hours, with large Draughts of Vinegar-whey. Eight Persons in ten, he says, got quite well by this Treatment.”I have never had sufficient Opportunities of trying this Method of Prevention, to determine any thing certain about it; but it may be worth while to practise it.

I have never had sufficient Opportunities of trying this Method of Prevention, to determine any thing certain about it; but it may be worth while to practise it.

[9]Petrus a Castro, in his Account of a Petechial Fever, which was frequent atVerona, tells us, that the Sick had a great Thirst, and an Aversion to Meat, but all of them had the strongest Desire for Wine, and were perpetually asking for it, even those who at other Times used to be very temperate; and that this proceeded from an Instinct of Nature, which wanted something to support the Strength.De Feb. Malig.sect. iii. chap. 26. Dr.Huxham, in hisEssay on Fevers, has the following very judicious Remark on the Use of Wine: “In this View, and in those above-mentioned, I cannot but recommend a generous red Wine as a most noble, natural sub-astringent Cordial, and perhaps Art can scarce supply a better. Of this I am confident, that sometimes at the State, and more frequently in the Decline of putrid Malignant Fevers, it is of the highest Service, especially when acidulated with Juice ofSevilleOrange or Lemon. It may be also impregnated with some Aromatics, as Cinnamon,SevilleOrange Rhind, red Roses, or the like, as may be indicated, and a few Drops ofElix. Vitriolimay be added. Rhenish and French White Wines, diluted, make a most salutary Drink in several Kinds of Fevers, and generous Cyder is little inferior to either. TheAsiatics, and other Nations, where pestilential Disorders are much more rife than with us, lay more Stress on the Juice of Lemons in these Fevers than on the most celebratedAlexipharmac.” Chap, viii. second Edit. p. 123, 4.Acid and acescent Liquors have very justly been recommended and used by most late Practitioners, in this as well as in other malignant Diseases. Vinegar-whey, Barley-water acidulated with Lemon-juice, and such other Liquors, make good Drinks for the Sick; but we were obliged, for the most part, to use the vitriolic Acid for acidulating the Patient’s Drink, as it was the easiest procured and carried about with the Flying Hospital.

Acid and acescent Liquors have very justly been recommended and used by most late Practitioners, in this as well as in other malignant Diseases. Vinegar-whey, Barley-water acidulated with Lemon-juice, and such other Liquors, make good Drinks for the Sick; but we were obliged, for the most part, to use the vitriolic Acid for acidulating the Patient’s Drink, as it was the easiest procured and carried about with the Flying Hospital.

[10]If the preventive Method does not succeed, Dr.Lindadvises to have recourse to Blisters; and says, that sixteen out of twenty will next Morning be free of the Fever. But adds, this is said, provided the Source of their Infection be not so highly poisonous as it was in the Garland Ship, or in other such violent Contagions. Dr.Pringlementions his having applied Blisters early, but without relieving the Head, or preventing any of the usual Symptoms. I have often ordered Blisters pretty early in the Disorder; and though I have frequently found them of use in keeping up the Pulse, and relieving the Head, and other Symptoms, yet I never saw them have such an immediate Effect as Dr.Lindmentions.

[11]It is long since thePeruvianBark has been used by Practitioners in Malignant Disorders, though I do not know that any body gave it in this Fever to the Amount of an Ounce per Day, before Dr.Haenand Dr.Hasenohrl. Dr.Ramazinimentions its having been tried in the Petechial Fever, in the Years 1692, 3, 4. And in a Treatise on the Plague in theUcrane, published atPetersburgh, in the Year 1750, we are told, that in theFrenchTranslation of the Philosophical Transactions for the Year 1732, there is a Note to p. 264, telling, that Mr.Amyandinformed the Academy of Surgery atParis, that Mr.Rushworth, Surgeon, had wrote to SirHans Sloane, on the 23d ofMay1723, that when he was Surgeon to a Ship, in the Year 1694, he had cured some Men ill of the Malignant Fever, attended with pestilential Buboes, by means of thePeruvianBark. Dr.Huxhamhas recommended a Tincture of the Bark; and Dr.Pringle, a strong Decoction of it, with some of the Tincture, in these Malignant Fevers.

[12]ThePeruvianBark has not only been found useful in this Malignant Fever, but has likewise been recommended in the Plague. SeeMorton Oper. Append. secund. Exercitat. Hist. Febr. Ann. 1658, ad. an. 1691. complexa. In the Small Pox, seeMedical Essays, vol. V. art. x. and has been found serviceable in the putrid Disorders of theWest Indies, as taken Notice of by Dr.Hillary; and in the malignant ulcerous sore Throat in this Country, as Dr.Walland others have observed. And in thirty-five Cases of the malignant ulcerous sore Throat, in which I gave it, joined with Cordials, and the Use of Acids, I did not lose one Patient. Nine of them were strong People, and had plethoric Symptoms, and were blooded in the Beginning; and seven of them were costive, and took a Dose of gentle laxative Physic before taking the Bark. The rest had no Symptoms which seemed to require these Evacuations. However, it ought to be observed, that this is a Disorder of the malignant kind; and that although some well-timed gentle Evacuations may be serviceable in the Beginning, before giving the Bark; yet too free, or even gentle Evacuations, injudiciously made, will sink the Patient, and infallibly do Mischief.The free Use of the Bark has long been found serviceable in Mortifications and foul Sores, where the Juices tend too much to the Putrescent; and has been strongly recommended by Mr.Ranby, Serjeant Surgeon to his Majesty, in the Cure of Gunshot Wounds. See hisTreatise on Gunshot Wounds.

The free Use of the Bark has long been found serviceable in Mortifications and foul Sores, where the Juices tend too much to the Putrescent; and has been strongly recommended by Mr.Ranby, Serjeant Surgeon to his Majesty, in the Cure of Gunshot Wounds. See hisTreatise on Gunshot Wounds.

[13]Dr.Huxham, in hisTreatise on the ulcerous sore Throat, p. 54, &c. condemns the Use of the volatile alcaline Salts, in Fevers of the putrid, pestilential, or petechial kind, as being apt to heat too much, and to hasten the Dissolution and consequent Putrefaction of the Blood. However, I cannot help thinking that they are the best Remedies we can use on some particular Occasions, even in this Fever; for we have no Remedy which gives such a sudden and briskStimulusto the Fibres as they do. And I have known many Cases of Patients who were extremely low, and whose Pulse was scarce to be felt, and others who were apt to fail into fainting Fits, who have been preserved by large and repeated Doses of these Salts, and the free Use of Wine, and acescent Liquors, to correct their alcaline Acrimony in the Blood. Though as soon as such Patients had recovered from this low State, I laid these Medicines aside; because I cannot help agreeing with the Doctor in the Belief, that their continued Use will produce the Effects he mentions. For although it be true, that these Salts, when mixed with putrescent Liquors, or with dead animal Substances, resist Putrefaction, and, like ardent Spirits and Vinegar (the other Products of Fermentation) check and put a Stop to that very Process which produced them: Yet it is also true, that, when mixed with the Blood of living Animals, they stimulate the Vessels, and increase the Heat andMomentumof the Blood, and dissolve it; and therefore I cannot but disapprove the continuing their Use longer than is immediately necessary.

[14]Some Men passed only one Worm; others, two or three; some, six or seven; and one Man, of the Guards, inJanuary1763, after passing three by Stools in the Course of a Fever of this Kind, discharged fourteen more upon taking a Dose of Rhubarb and Calomel after the Fever was over.

[15]Observations on the Diseases of the Army, part iii. chap. iv. Note to p. 213. third Edition.

[16]SeeHoffman’s Works, vol. III. chap. x.River. Observ. commun.Obs. 13.of Observations found in a Library.Bonetus’s Sepulchret. anatom.tom. II.Gualther van Doeveren’s Inaugural Dissertation de Vermibus intestinalibus, published atLeyden, 1753; andLancisi’s Works; for Cases where the internal Coats of the Stomach, and Intestines, have been eroded, and all the Coats perforated by Worms of the round Kind.

[17]Riveriustells us, that, according toHippocrates’s Doctrine, Deafness is a very dangerous Symptom in the Beginning of acute Disorders, though it be a good Omen, and portends Health, when it does not appear till the Height of Fevers, especially those of a malignant Kind; and adds, that he himself has a thousand Times observed, that those labouring under this Fever have recovered, when this Symptom of Deafness came on at the Height (in statu) though the other Symptoms threatened much Danger.Prax. Medic.lib. XVII. sect. iii. cap. i. p. 451.This Symptom of Deafness occurs in other Fevers as well as in this, and often proves a good Symptom in them likewise, as I have frequently observed. Two remarkable Examples of which I had under my Care in St.George’s Hospital, in the Year 1759. On the 17th ofJanuary1759,James Donaldson, a young Man of nineteen Years of Age, was admitted into the Hospital for a Fever, attended with a Stupor and a Delirium, a parched dry Tongue, and other Symptoms of a Fever of the inflammatory Kind, for which he had been blooded, and used other Evacuations. On the 19th, after the Application of a Blister, he was seized with almost an entire Deafness; after which, all his other Symptoms became milder, and he mended daily, and was entirely free from the Fever by the 30th. On the 10th ofApril1759, a Youth,John Young, fifteen Years of Age, was admitted into the same Hospital for a Fever, which had already continued fourteen Days. His Speech was affected, and he had entirely lost the Use of his Limbs, was delirious, and had other bad Symptoms. On the 12th, his Hearing became exceedingly dull, and he recovered daily afterwards, and was discharged, cured, the 2d ofMay, having recovered the Use of his Legs as well as got free of the Fever.

This Symptom of Deafness occurs in other Fevers as well as in this, and often proves a good Symptom in them likewise, as I have frequently observed. Two remarkable Examples of which I had under my Care in St.George’s Hospital, in the Year 1759. On the 17th ofJanuary1759,James Donaldson, a young Man of nineteen Years of Age, was admitted into the Hospital for a Fever, attended with a Stupor and a Delirium, a parched dry Tongue, and other Symptoms of a Fever of the inflammatory Kind, for which he had been blooded, and used other Evacuations. On the 19th, after the Application of a Blister, he was seized with almost an entire Deafness; after which, all his other Symptoms became milder, and he mended daily, and was entirely free from the Fever by the 30th. On the 10th ofApril1759, a Youth,John Young, fifteen Years of Age, was admitted into the same Hospital for a Fever, which had already continued fourteen Days. His Speech was affected, and he had entirely lost the Use of his Limbs, was delirious, and had other bad Symptoms. On the 12th, his Hearing became exceedingly dull, and he recovered daily afterwards, and was discharged, cured, the 2d ofMay, having recovered the Use of his Legs as well as got free of the Fever.

[18]But although these parotid Swellings were in general so favourable with us, we are not to imagine that this will always be the Case: forRiverius, though he speaks of these Swellings proving for the most part critical; yet he tells us, that, in the Year 1623, this Fever was epidemic atMontpelier, and that almost one half of the Sick died; and particularly, that most of those who had Swellings of the parotid Glands appearing about the 9th or 11th Day, were carried off within two Days of their Appearance. Having attended several who died from the Swellings not coming to Suppuration, he began to consider in his own Mind, what might be the Cause of their Death, and concluded, that it was owing to there being a greater Quantity of morbid Matter in the Blood than the Part was able to contain, and that Evacuations by blooding and purging were the only Remedies which were likely to give Relief; and therefore, in the first Case of this Kind, in which he was afterwards consulted, he ordered three Ounces of Blood to be taken away, notwithstanding the Patient was so low that the Surgeon was afraid he would have died in the Operation: The Pulse rose on bleeding, and he ordered four Ounces more to be taken in three or four Hours afterwards: The Pulse rose still more, and he ordered a Dose of Sena and Rhubarb to be taken next Day, and the Patient recovered. And he adds, that all those who were treated in this manner got well.Prax. Med. Lib.XVII.sect.iii.cap.1.

[19]Ibid.

[20]Pringle’s Observations on the Diseases of the Army, Part III. chap. vii.

[21]This Symptom of Buboes is taken Notice of by Authors, but does not seem to be so frequent as many of them would make us believe. Neither Dr.Huxhamnor Dr.Pringlemention their having seen such Buboes; and Dr.Lindsays, that he never saw them till the Beginning of the Year 1763.

[22]Hippocratestakes Notice of Swellings of the Testicles in Fevers. He tells us, that a Man from Alcibiades had his left Testicle swell before the Crisis of a Fever.See his Second Book on Epidemics, sect. ii. And he mentions this Symptom as a Crisis in the ardent Fever.See his Book on Crises, sect. xi.—And Dr.Antonio Lizzari, in a Treatise which he published on theAcute Diseases which were frequent at Venice, and all over Italy, in the Years 1761, 62, tells us, that Abscesses of the Scrotum and Testicles frequently followed the Measles.

[23]These Pains and Mortifications of the Feet and Toes were not confined to those who were brought low by malignant Fevers; for, during the very hard Frost in the Beginning of the Year 1763, many of the Patients who lay in very large open Wards in the Hospital atOsnabruck, were affected in the same Way. One Man had both Feet, and Part of each Leg, compleatly mortified, and died in about nine Days after the first Appearance of the Mortification. One lost half of one Foot, and some Toes of the other; and the third lost the first Joint of some of his Toes, and the Ends of others.

[24]Hippocrat.lib ii. popul. sect. iii. text. 2.

[25]Aetius Tetrab.ii. sect. i. cap. 129.Actuar.lib. i. cap. 23.

[26]See these Causes mentioned byRiverius, and since more fully explained by Dr.Pringle,Observations on the Diseases of the Army, part iii. chap. vii.

[27]River. Prax. Med.lib. xvi. sect. iii. Præfat.

[28]The Malignant or Hospital Fever, and Petechial, seemed to me to be entirely the same Disorder, and the Petechial Spots to be only a Symptom which appeared sometimes, but not always. AndRiveriussays, the Petechiæ do not always appear; but when they do, it is a most certain Sign of a Pestilential Fever. See hisPrax. Med.cap. xvi. sect. iii.

TheDysentery generally began to appear soon after the Army took the Field; and became frequent about the End ofJuly, and continued so till the Army went into Winter-Quarters; and through the Winter, many of those, who had this Disorder in Autumn, relapsed, upon returning to their Duty; or by drinking too freely of spirituous Liquors, and being irregular in their Living.

It is now generally agreed upon, that this Disorder is entirely produced by such Causes as make the Juices become too putrescent, and turn the Flow of Humours to the Bowels; and in the Camp it seemed to arise principally from an obstructed Perspiration caused by the Men’slying in the Field, and doing the necessary Military Duties in all Sorts of Weather; at the same Time being often exposed to the putrid Steams of dead Horses, of the Privies, and of other corrupted Animal or Vegetable Substances[29], after their Juices had been highly exalted by the Heat of Summer.

At the Time the Petechial Fever was frequent atPaderborninJanuary,February, andMarch1761, the Flux frequently accompaniedit; and we had in the Hospitals likewise a Number of old Cases of this Kind, the Remains of the preceding Campaign aboutWarbourg; besides some Men who had relapsed during the Winter, and were sent to us when the Troops marched, upon the Winter-Expedition, into the Country ofHesse. InMayandJune, what Fluxes we had atOsnabruck, were the remaining old Cases of the Hospitals ofMunster,Paderborn,Hoxter, andNiehms. Some few recent ones were sent toBilifieldabout the End ofJune, and above 300 toMunster, inJulyandAugust. Those sent toBremen, inNovemberandDecember, had continued for some time before they reached us; but a good many of the Soldiers in the Garrison were taken ill of this Disorder, and sent immediately to the Hospital. In theBeginning ofMaywe had but four ill of this Complaint in the Hospital I attended; and there were not above six or seven, among the Sick sent down from the Army, in the Middle of this Month. InJunethere were but two sent to the Hospital atMinden; and not above ten among the Sick sent toNatzungenin the Beginning ofJuly; tho’ towards the Middle of this Month they began to be more frequent; and continued to be more so inAugustandSeptember; and in the Hospital atOsnabruckwe had not above five or six ill of this Disorder, inDecember1762, and inJanuary,FebruaryandMarch1763.

The Dysentery commonly begun with Sickness and Gripes, succeeded by a Purging, and attended with more or less Fever. Very soon the Gripes became more severe, attended with a Flatulency in the Bowels, and often with a Tenesmus. The Stools were chiefly composed of Mucus, mixed with Bile, and more or less Blood: tho’ sometimes no Blood could be observed in them; and then the Soldiers used to say they had the White Flux.

After eight, ten, or twelve, Days, if the Disorder was not complicated with any other, there remained little or no Fever, unless where some Accident supervened; tho’ in Cases which terminated fatally, towards the latter End came on a Fever of a low malignant Kind, attended with black fetid Stools, Lientery, Hiccup, Stupor, and other bad Symptoms.

It often happened, that, after the Dysentery had continued for some Time, the Sick complained for a Day or two of severe Gripes; and then discharged along with the Stools little Pieces of hardened Excrements; at other Times, tho’ more rarely, little Pieces of white Stuff like Tallow or Suet: Frequently small Filaments, and little Pieces of Membranes, were found floating in the Stools; and it was very common for the Sick to vomit up Worms of the round Kind, or discharge them by Stool[30].

In the Course of the Disorder, the Men often complained of a violent Pain of the Rectum,near the Fundament, which was most excruciating when they went to Stool; it continued for some Days, sometimes for a Week or more; and then they passed more or less of a Yellow Pus with their Excrements, and the violent Pain ceased. Mr.A. Tough, one of the Apothecaries to the Military Hospital inGermany, was the first who told me that I should find Pus mixed with the Stools: on my mentioning a Case of this Kind, which had been relieved by Bleeding, and Clysters often repeated; he told me he had observed it frequently atGibraltar; and was at a Loss to understand the Nature of the Symptom, till he observed the Matter in the Stools; which at once shewed him that it had been originally an acute Inflammation of the Part, and pointed out to him the proper Method of Cure.

Oftentimes the Bilious and Malignant Fevers terminated in the Dysentery; or were accompanied with it, when it might be looked upon as a Symptom of these Fevers.

The Appearances we found after Death in the Bodies of some Patients, who died of old FluxesatBremen, were: In all of them the Rectum was inflamed, and partly gangrened, especially the internal Coat. In two the lower Part of the Colon was inflamed, and there were several livid Spots on its great Arcade. In one whose Body was much emaciated, and who had been seized with a violent Pain of the Bowels two Days before his Death, all the small Guts were red and inflamed; and in another there were livid gangrened Spots on the Stomach[31].

There was no Disorder we were more successful in the Cure of, than recent Fluxes; but after they had continued for Weeks, and were become in a manner chronic, they often foiled allour Endeavours, and a great Number died[32].

Upon my first being employed in the MilitaryHospitals inGermany, I was surprised to see so many of the old Dysenteric Cases end fatally; and imagined I had not fallen upon the Right Method of treating them: but upon consulting the other Physical People[33]employed in the same Service, I found them as unsuccessful, as myself, after having tried a Variety of Remedies: And at last, I was convinced, that when once the Flux had continued long, and injured the Structure of the Intestines to a certain Length, a Gangrenewill often form by slow Degrees; and the Disorder end fatally, notwithstanding the Use of what are esteemed the most efficacious Remedies; and that, when this Disorder is violent, the Cure principally depends upon an early and speedy Application of proper Remedies, before the Strength be exhausted, or the Structure of the Bowels too much hurt. The bad Success we had in treating these old Cases, may perhaps surprise those who have never practised except in healthful Cities, where the Disease is commonly mild, and People apply soon for Advice. But all those Gentlemen who have had the Care of Military Hospitals, where the Dysentery has been frequent, and where the Sick have been often sent a great Way, before they reached the Hospitals, must be convinced of the Truth of what is here asserted.

In the Treatment of this Disorder, as well as of the Malignant Fever, nothing contributed more to the Cure, than keeping the Sick as clean as possible, and in large airy Wards.

Most of the recent Fluxes, which I saw, were at first attended with a good deal of Fever, and Pain in the Bowels; and required more or less Blood to be taken away, according to the Strength of the Patient, and the Violence of the Symptoms.

When the Patients were strong, and complained of sharp Pain of the Bowels, attended with a Fever, we used the Lancet freely, nor were we discouraged from bleeding in the Beginning by the low quick Pulse which often attended the Disorder; and we frequently found the Pulse rise as the Blood flowed from the Vein. But when the Sick were low and weak, without much Pain or Fever, and the Pulse was soft, we were more sparing of the vital Fluid[34].

As the Disorder was for the most part attended with Sickness in the Beginning, we gave a Vomit after bleeding; which not only discharged the Contents of the Stomach, and a Quantity of Bile, but relieved the Sickness, and frequently threw the Patient into a breathing Sweat; and made the Purgatives which were given next Day operate more freely, and with more evident good Effects than where no Vomit had been administered.—If in the Course of the Disease the Sickness returned, the Emetic was repeated; and we often observed, when the Flux was obstinate, that well-timed Vomitsgreatly promoted the Cure.—The Vomit we commonly employed was the Powder of Ipecacuana, which we gave from ten to twenty Grains; and where the Patient was strong, and we wanted to make a free Evacuation, we added one, two, or three Grains of the Tartar Emetic; which encreased the Strength of the Vomit, and commonly operated likewise by Stool[35], as Dr.Pringlehas observed.

Next Day we ordered a Purge to empty the other Parts of the alimentary Canal. The Purgative, that at first was most employed for this Purpose, was Rhubarb; but upon repeated Trials we did not find, that, in general, it answered so well, in this first Stage of the Disorder, as thesal catharticum amarum, with Mannaand Oil; which operated without griping or disturbing the Patient, procured a freer Evacuation, and gave greater Relief than any other purgative Medicine we tried. Mr.Francis Russel, Surgeon to theBritishMilitary Hospital inAmerica, who was formerly Surgeon to the Island ofMinorca, was the first Person who informed me (in the Year 1757) of the Use of thesal catharticum amarumin the Dysentery; he told me, that the Year before (1756) the Dysentery had been very frequent and very fatal atGibraltar; and, after trying Variety of Medicines, he had found nothing give more Relief, or contribute more to the Cure, than repeated Doses of these Salts.

As a great Part of the Cure depended on the frequent Use of gentle Purges[36]in the Beginning,to carry off the corrupted Humours; the Purgative was repeated every second, third, or fourth Day, as the Case required; the Operationof the former Purge, and the Symptoms, determining the Frequency of the Repetition.It was surprising with how little Loss of Strength the Sick bore the Operation of these Purges; I have sometimes given them to strong Peopleevery Day, for two, three, or four Days successively; and observed that the Patient, instead of being weakened, seemed stronger, and more brisk and lively, after the Operation of each, from the Relief it gave; by evacuating those putrid, corrupted Humours, which kept him perpetually sick and uneasy, while they remained within the Bowels.

Though Rhubarb did not answer so well in the Beginning as the saline Purges; yet afterwards in the Course of the Distemper, when the Patient did not complain much of Gripes, half a Drachm of Rhubarb, either by itself or in a saline Draught, proved a good gentle Purge; and given with six or seven Grains of Calomel, was found to be a good Medicine, when the Disorder was attended with Worms.

In the Evening, after the Operation of the Purge, we gave an Opiate; and repeated it at Nights, in the Intervals between the Purges; but were obliged to be very sparing of the Dose, while the Disorder continued in its acute State; the Opiate was only given in a Quantity sufficient to mitigate the Pain, and to procure Rest,but never so as to stupify the Patient, or prevent a due Discharge by Stool; though we were often obliged to encrease the Dose, as Use made it familiar to the Patient.

In the Intervals between the Purges, we gave in the Day, the Mindereri Draughts with the Mithridate; or the saline Draughts with the Addition of four Drops of thetinctura thebaica; or some such mild diaphoretic, every four or six Hours; which helped to keep up a free Perspiration, without any Danger of stopping the Purging; and for the most part answered much better than the Diascord, or Philonium, or other strong Astringents and Opiates commonly prescribed for this Purpose; which were always liable to check the Purging too much, and bring on severe Gripes attended with Heat and Fever[37]; and therefore we seldom made Use of them in this first Stage of the Disorder.

If the Patient was attacked with severe Gripes[38], and a Tenesmus, which the Purgatives and gentle Opiates did not relieve, we ordered the Abdomen to be fomented with warm Stupes; and the Patient to drink freely of warm Barley or Rice-water, or of weak Broth[39], or an Infusion of Camomile Flowers, as recommended by Dr.Pringle; and ordered first Clysters of large Quantities of the plain emollient Decoction to be given; and if the Gripes stillcontinued, to be repeated in small Quantities, with the Addition of a Drachm or two of thetinctura thebaica; for we observed that Opiate Clysters often gave more Relief, than Anodynes administered in any other Way; and sometimes, when a Tenesmus was very troublesome, the common oily Clyster, with a little Diascord, andtinctura thebaica, or the Starch Clyster, gave more Ease than any other.—In some Cases, where the Pain was sharp, attended with a Fever, we were obliged to take away more or less Blood; and sometimes also to apply a Blister to that Part of the Abdomen where the Patient felt most Pain.

During this Course, the Patients used the common low Diet of the Hospital; when they loathed the Rice-Gruel, they had Panado with a little Red Wine and Sugar; or Water-gruel, when it could be got, in its Place.—Their common Drink was Barley or Rice-water; of which it was recommended to them to drink plentifully; as nothing contributed more to the Cure than the free Use of such Liquors, to diluteand blunt the Acrimony of the Fluids[40]. In some Cases, when the Purging was violent, and not accompanied with the malignant Fever, thedecoctum albumwas found to be a good Drink; and we added occasionally a few Drops of thetinctura thebaica.

Such were the chief Remedies we used in the first Stage of this Disorder; but after some Weeks, when the Fever had abated, and free Evacuations had been made, and the Complaint become in a manner chronic, we were obliged to try other Methods; and found that the best Way of treating this Disorder, was, to endeavour to brace and restore the Tone of the Intestines, by means of the corroborating and gentle astringent Medicines, mixed with Opiates;while mild Purgatives were given at proper Intervals.

The Patients were kept to the same low Diet as before, with the Addition of a little Wine or Brandy. They were allowed from a Gill to a Pint of red WineperDay, which was commonly mulled before it was given them; when the Wine griped them, which it frequently did, they took in its Stead Half a Gill or a Gill of Brandy, mixed with a Pint or a Quart of Barley or Rice-water, or of thedecoctum album.

In this Stage of the Disorder we found, that the same Medicines would not answer with all, and therefore we were obliged to try Variety[41];and indeed, unless where the Violence of the Disorder had abated by the Use of Evacuations, the Event was always very doubtful; for when the Complaint had continued long and become chronic, and the Structure of the Intestines was much hurt, before the Sick were sent to us; or when it continued obstinate, and yielded but little to Evacuations, and the other Methods used in the first Stage, even Remedies esteemedthe most efficacious oftentimes proved unsuccessful, and at length the Patient died.

A Spoonful of themixtura fracastorii, taken after every loose Stool; and an anodyne Draught at Night, had a good Effect with some—Repeated Doses of thephilonium Londinenseanswered better with others, who were low, and required a Remedy that was warm and cordial—And others found more Benefit from the Mindereri Draughts, with Mithridate, or theconfectio cardiaca, or the Theriac anodyne Boluses.

Themixtura Campechensis, both alone and withtinctura thebaica, checked the Purging, and gave Relief sometimes; and the Addition of some of the Extract of Bark and Tincture of Cinnamon, seemed to encrease its Efficacy in one or two old Cases, atBremen; but it afterwards occasioned such Sickness, that we did not continue its Use.

In other inveterate Dysenteries, where we thought that a strong Astringent was wanted, we added a small Proportion of Allum to theCampechenseJulep, which on first using seemedto be serviceable; but at other Times it occasioned a Tenesmus and Gripes; and therefore we were obliged to be very cautious how we used it.

Equal Parts of theelectuarium diascordiiandelectuarium corticis, taken in the Quantity of a Drachm twice or thrice a Day, was of Use in many old Fluxes[42], though it made other Patients so sick, that they were obliged to lay it aside.

We tried likewise in this Stage of the Disorder, repeated small Doses of the Ipecacuana; but it occasioned such Sickness, that we did not persist in its Use.

In other Cases, we gave from two to five Grains of the Ipecacuana, mixed with Opium, in different Proportions (from three Grains to ten of the Ipecacuana to one of the Opium), every four or six Hours; it gave sometimes a little present Ease, at other Times it occasioned Sickness; we often continued its Use for ten, twelve, or fourteen Days; but it seldom produced any remarkable Change for the better, and we were obliged to have Recourse to other Remedies.

Dover’s Powder was given in large Doses, from one Scruple to two; and proved a good Sudorific and Anodyne in some Cases; though in others it made the Patients sick, without producing any good Effect.—It commonly answered better, when used occasionally as a Sudorific, than when constantly continued.

During the Use of these Remedies, it was necessary to repeat the Purgatives from Time to Time; or to mix them occasionally with the other Medicines, in order to carry off any corrupted Humours, or Excrements that might be lodged In the Cavity of the Intestines; forwhen this was neglected, the Patients were often seized with Sickness and Gripes, and a more violent Purging than before:—And if at any Time they complained of Gripes, and passed little Pieces of hardened Excrements, it was mostly a certain Sign that a Purge was indicated; and, on such Occasions, it generally gave Relief; and when attended with Sickness, a Vomit was given before the Purge.—Clysters were used as in recent Cases, where the Sick were low, or had much Pain of the Bowels[43], or complained of a Tenesmus.

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 thebalsamum copaivi, a Scruple of the Extract of the Bark, and five Drops ofthetinctura 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, thepulvis e tragacantha, and such others, were of Service; and frequently Starch Clysters and Anodynesgave 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 Patientwas 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 theelectuarium corticisand theelectuarium diascordii[44]; or Halfa Drachm of the Powder of the Bark, or a Scruple of the Extract, in the Mindereri Draughts, with four or five Drops of thetinctura 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.

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, inOctoberandNovember.—In such Cases, when the Patients were strong, we were often obliged to bleed freely, to apply Blisters, and in theBeginning 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 atPaderbornandOsnabruck.

InDecember, 1761, we had a Case of this Kind where theoxymel scilliticumwas 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 ofJanuary, 1762, oneCarter, 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 Varietyof 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 ofJanuarythe Swellings were all gone, and he was shipped off forEnglandthe 8th ofFebruary; having been discharged from his Regiment. The Ship, he went aboard of, was detained in the RiverWeserfor 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 lastin 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].

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