FOOTNOTES:

FOOTNOTES:[29]The Dysentery has been long alledged to arise from a putrescent Cause in Camps; from the Smell of corrupted dead Animals, and of Excrements, during the Heat of Summer.Ramazini, in his Chapter on Camp-Diseases, informs us, that Dr. G.Erric Barnstorff, Physician to the Duke ofBrunswick, who served five Campaigns with theBrunswickandLunenburgTroops inHungary, told him, that the Camp Diseases, particularly the Malignant Fever and Dysentery, took their Rise from the Troops remaining long encamped on the same Ground, and being exposed to the corrupted Steams of the Bodies of dead Men, Horses, and other Animals, which lay unburied; and of Excrements, which were not covered with Earth. And these Causes have since been particularly taken notice of by Dr.Pringle, in hisObservation on the Diseases of the Army.Many have imputed the Cause of this Disorder to the eating of Fruit in excess, because it generally appears about the Middle of Summer, the Time the Fruit begins to be in Season, and continues through the Autumn. But from later Observations this should seem to be a vulgar Error. Dr.Pringle(part i. ch. iii. p. 20.) tells us, that, in the Year 1743, this Sickness began and raged before any Fruit was in Season, except Strawberries, (which from their high Price the Men never tasted) and ended about the Time the Grapes were ripe; which growing in open Vineyards were freely eat by every body. And Dr.Tissot, in a Treatise which he published, calledAvis au Peuple sur la Santé, in his Chapter on theDysentery, § 320, says, that ripe Fruit, especially the Summer-Fruits, are so far from being the Cause of the Disorder, that they are the great Preservatives against it: he says, that, in the Years which the Fruit is most plentiful, the Dysentery is least frequent; and he relates several Instances where the Use of ripe Grapes proved a Cure for the Disorder. Eleven People were attacked by the Dysentery, nine eat Fruit, and all recovered; the other two, a Grandmother and Child, from Prejudice, eat none, and both died. A Regiment ofSwissSoldiers, in Garrison in the South ofFrance, had the Dysentery very frequent among them. The Captains purchased some Acres of a Vineyard, and carried the sick Soldiers to the Field, and gave them the Grapes to eat; and ordered the Men in Health to live upon them chiefly. After this not one Person died, nor was any one seized with the Distemper.—In an Account of a Treatise on the Dysentery, published atHamburgin 1753, which was epidemical the Year before, inAugustandSeptember, we are told, that it did not proceed, as is commonly believed, from the eating of Fruit; for it was observed, that those who eat Fruit freely escaped better than those who abstained from it altogether.Vide Comment. de Rebus in Hist. Nat. & Medecin. Gestis, vol. II. par. iv. sect. v.Generally inAugustandSeptemberwe have People admitted intoSt. George’s Hospital for the Dysentery; who have certainly not catched the Disorder from eating of Fruit, but from working in the Fields, and being exposed to Causes similar to those which produce the Dysentery in Camps.[30]Most Authors, who treat of the Dysentery, mention this Symptom of Worms; and Dr.Huxhamtells us, that, in some Seasons, he has seen round Worms in the Stools of most of the Dysenteric Patients.De Aere, vol. II. p. 98.[31]From the Accounts we have in Authors, of the Dissection of the Bodies of Persons who died of the Dysentery, it would appear; that there is no Part of the alimentary Canal which has not some time or other been found inflamed, or in a state of Suppuration or Gangrene; and the Liver, Spleen, and other Viscera, have likewise been found diseased, but the Rectum and Colon have almost in all been more or less affected. The following Account I had, in the Year 1748, from the late Dr.L. Fraser, who afterwards practised in the Island ofNevis, two Days after the Patient died.Mary Reid, a Woman thirty Years of Age, was taken ill of a Dysentery, which in Three Weeks Time killed her. In her Life-time she complained, more than ordinary, of Gripes in her Belly, especially in her Left Side. Her Body was opened in Presence of Dr.Dundas, who had attended her, during her Illness. All the Intestines and Mesentery were inflamed, especially the Colon and Rectum; the internal Side of which was quite in a mortified State, and contained little Vesicles full of a putrid fetid Liquor, Numbers of which she had evacuated by Stool some Days before her Death.[32]While this Sheet was in the Press, I received Dr.Pringle’s 4th Edition of hisObservations on the Diseases of the Army, and Dr.Baker’s Treatise on theDysentery which was epidemic in London in the Year 1762. Both these Gentlemen give an Account of the Dissection of the Bodies of some People who died of the Dysentery; where, besides the common Appearances of the inner Surface of the Rectum and Colon being covered with a bloody Slime, and their internal Coats being inflamed, gangrened, or in a putrid State, there were observed on the Inside of the lower Part of the Colon, and upper Part of the Rectum, a Number of little Tubercles, or Excrescences, which resembled the Small Pox, of a flat Sort at the Height of the Disorder; but differed from them in this, that they were of a firm Consistence, without any Cavity: they were believed to take their Rise from the cellular Membrane, which lies immediately above the villous Coat. Perhaps such Tubercles might have been found in the Colon and Rectum of those Bodies we opened; but not looking for them, they may have passed unobserved.Morgagni, in his Book lately published,de Sede & Causis Morborum, epist. xxxi. is of Opinion, that the Filaments, and Pieces of Membranes, which are frequently observed in the Stools, are often formed of inspissated Mucus and Lymph, and other Liquors; and not the Fibres, or Pieces of the villous Coat of the Intestines, as alledged by many Authors.[33]Mr.Cleghorn, in hisAccount of the Diseases of the Island of Minorca, says, “That almost all the Dysenteries which fell under my Observation, unless they were speedily cured in the Beginning, at best proved obstinate, and too frequently fatal, in spite of the many boasted Specificks for this Distemper.” chap. v. p. 228.—The physical Gentlemen employed on theAmericanService have told me, that the old Flux Cases were as fatal inAmerica, as we found them inGermany. I would not from thence have it believed, that every old Flux was to be looked on as a lost Case; and for that Reason given up, and no Attempts be made to cure it; for many, by great Care, and Strength of Constitution, have gradually surmounted the Disorder, and recovered their Health; especially when they got over the Winter, and lived till the warm Weather began.[34]Although Bleeding, in the Beginning, has been recommended bySydenham,Huxham,Pringle, and other Practitioners; yet it has been reckoned unnecessary in this Disorder by some late Authors. But in most of the recent Cases I saw, it was extremely necessary, and contributed greatly to the Relief as well as the Cure of the Patient; indeed where the Disorder had already continued some time, and the Fever was gone off before the Patient was sent to us; and the Disorder had become in a manner chronic, and the Patient low, then bleeding was unnecessary, and would have probably done Hurt. Mr.Francis Russeltold me, that when the Dysentery was epidemical atGibraltar, in Summer 1756, he found that by bleeding such Patients as he met with at the first coming on of the Symptoms, and by giving them immediately a Vomit, and afterwards a sudorific Draught, the Disorder was rendered mild, and few of those died.[35]Mr.W. Russel, who was with the Hospital atMartinico, told me, that, when he was there, he found the Vomit with the Tartar Emetic to be far preferable to any other, in all Cases where there was much putrid Bile lodged in the alimentary Canal; as it speedily carried off those corrupt Humours, which were often productive of the greatest Mischiefs, if they remained, but for a short Time, pent up within the Bowels.[36]Variety of Medicines have been recommended to answer this Purpose.Thevitrum ceratum antimoniiproved often too rough a Medicine, and therefore we laid it almost entirely aside.Repeated small Doses of the Ipecacuana, from four to six Grains, operated both as an Emetic, and kept up a Purging; but they made the Men so sick, that we could not prevail upon them to continue their Use. Mr.Francis Russeltold me, that, in the Year 1756, he found a few Grains of Rhubarb added to each Dose, made it operate more as a Purgative, and did not make the Men so sick.—Dr.Akensideproposes giving the Ipecacuana in so small Doses as one or two Grains every six Hours, in a Draught made of Mint-water, and Half a Drachm ofconfectio cardiaca; and, after bleeding and vomiting once, seems to depend almost entirely on the Use of this Medicine for the Cure of the Dysentery. See hisComment. de Dysenteria, cap. 2.The watery Tincture of Rhubarb, recommended byDegnerus, we tried in some Cases at Bremen; and found it to be a good mild Purge, but not to answer so well as the Salts and Manna in recent Cases. Mr.William Russeltold me that they found this watery Tincture of Rhubarb to answer better inAmericathan any other of the Preparations of Rhubarb.Calomel has been recommended by many as a Purge in Dysenteries; and Dr.Huxham(de Aere, Vol. II. P. 100) assures us, that he has often experienced the good Effects of it, especially when the Patient at the same time had Worms; in such Cases we joined it to Rhubarb as mentioned in the Text, or gave a Calomel Bolus over Night, and a Purge next Morning. Dr.Duncan, Physician to his Majesty, told me, that he found the following Method of Cure always successful in the Dysentery, which was epidemic inLondonin the Year 1762.If the Patient was Plethoric, or had much Fever, he ordered more or less Blood to be taken away; and then gave four Ounces of the following Julep, every Half Hour, till it both vomited and purged. ℞Tartar. emetic. gr.iijMannæ elect. Unc.ijsolve in Aq. hordeat. Lib.1.—The next Day, and for five or six Days more, the Patient took so much of a Decoction, of Manna, Tamarinds, and soluble Tartar, as kept up a free Discharge by Stool.—If the Irritation and Griping were severe, he found that a Solution of Manna, in the common Almond Emulsion, was sufficient.When the Pain, or Tenesmus, was violent, a Clyster, of Chicken Broth, or of an Infusion of Linseed, with an Ounce or two of Oil of sweet Almonds dissolved in the Yolk of an Egg, injected once or twice a Day, was of great Use.Upon the whole, he was always pleased when he saw large excrementitious Stools come away; and when that could be procured by a gentle Method, he was the more pleased.This Disorder was very often cured in a few Days, and in that Case he dropt the further Use of Medicines; but when it exceeded the Period of six or seven Days, he then added thirty or forty Drops of thetinctura thebaicato the Clysters; and ordered a Scruple of the Extract of the Logwood to be taken thrice a Day in some proper Vehicle.The Patient’s Diet was Rice-Gruel, Sago, Panado, and such like; no Animal Food, not so much as Chicken-Broth, was allowed in the Beginning of the Distemper, nor even Oil, Butter, or Fat of any Kind. The common Drink was Almond Emulsion, Rice-Water, or Barley-Water with Gum Arabic.Dr.Duncanlost but one Patient out of Eighty, whom he had under his Care that Season; and he was delirious, had a high Fever, and asubsultus tendinumbefore the Doctor was called to him, and he died the next Day.The late Dr.Young, ofEdinburgh, seems to have had a very just Notion of this Disorder, and of the proper Method of treating it; for, in his Treatise on Opium, sect. vii. he says, “I am convinced from Experience, that most of the Dysenteries I have hitherto met with, might have been cured by purging mildly, but constantly; and at the same time abating the Acrimony in the great Guts by emollient Clysters, and in the small ones by Plenty of Absorbents, and a Diet of Chicken Broth: But it must be observed with regard to Purgatives, that Manna agrees best with some, Rhubarb with others, Jalap, Mercury, and toasted Rhubarb with others; while others are sooner cured by emollient Clysters. I use Opium only when the Disease is mild, or after its Violence is abated by Evacuants and Emollients.”Scammony, Aloes, and the other strong resinous and hydragogue Purges, are hurtful, and occasion Pain. I always observed, that those Purges answered best which made the freest Evacuation, and acted with the greatest Ease to the Patient; of which the Salts and Manna answered best of any I have hitherto used.[37]Sydenham,Huxham, and all good Practitioners, have taken Notice of the bad Effects of the too free Use of Astringents, and given Cautions against it.[38]If the Patient was suddenly attacked with sharp Pain of the Bowels and Gripes, on a Day in which he had not Physic, a Dose of the Salts and Manna was commonly given immediately, to empty thoroughly the first Passages.[39]Mr.W. Russeltold me, that he and Dr.Huckfound the free Use of the following Emulsion, made of Bees Wax, to be of great Use after Evacuations, where there was much Pain of the Bowels, in recent Cases of Fluxes in the Hospitals inAmerica. ℞. Ceræ alb. vel flavæ drachmes tres. Sapon. alb. Hispan. drachmam unam. Aquæ fontanæ, unciam unam, liquefiant super ignem in vase ferreo, agitando spatula, & dein infunde in mortarium marmoreum, & adde paulatim aq. fontanæ, libras duas syrupi sacchari. spiritus vini gallici tenuis, vel aquæ alicujus spirituosæ ana unciam unam, terendo optime ut fiat emulsio.This Method of dissolving Bees Wax, in a Watery Liquor, is entirely new; for before this we knew of no Way of making it miscible with Water.[40]Dr.Huxham(de Aere, Vol. II. p. 107.) says, there is no Disorder in which a diluting, sweetening Drink is more necessary than in this; that he has done great Service among the Poor by luke-warm Water; that, after emptying the Bowels thoroughly, he has sometimes cured this Disorder by the Use of pure Water, and a small Quantity of Opium. AndBaglivi(Prax. Med.lib. i.) tells us, that the drinking of common Whey, and throwing up frequent Clysters of it, had cured many, and that this was looked upon as a Specific, and kept a Secret by some.[41]Dr.Pringle, in thefourth Edition of his Observations, just published, in treating of the third or last Stage of the Dysentery, remarks, that this is the Time for Astringents, which ought not to be given sooner, or at least very sparingly. And he tells us, that, in the former Editions of his Work, he mentioned those Compositions which he had most frequently used, but that he had now laid most of them aside; and at present trusts to Vomits, and to a Milk Diet, for the perfect Cure.He says, “Whenever therefore the Patient is in this State, and especially when his Pulse is quick, and he complains of inward Heat, I began with giving him a Scruple of Ipecacuana; and the next Day I put him upon the Milk-Diet; which I continue till all the hectic Symptoms are gone, and till the Bowels have recovered their Tone. During this Course I have seldom had Occasion for any other Medicine, excepting the Chalk Julep mentioned before, which I use for correcting that strong Acid so incident to relaxed Stomachs. Sometimes also I add an Opiate to procure Rest at Night; but after a few Days these are likewise laid aside. All that I require (which indeed is often hard to obtain) is a strict Perseverance in the low Diet: and now and then a Repetition of the Vomit, upon any new Disorder of the Stomach, or great Laxity of the Bowels.“Whilst the Patient continues in this Course, I forbid all animal Food and fermented Liquors; and besides Milk, I allow only the Preparations of Grain, Sago and Salop.” See Part iii. ch. vi. p. 289, 290.[42]I had lately a very remarkable Instance of the Effects of this Medicine, in the Case of oneGilchrist, a middle-aged Man, by Trade a Taylor; who was admitted intoSt. George’s Hospital the 20th ofJuly, 1763, for an old Flux, which had continued above six Months, and reduced him very low: He had taken a great many Medicines without any Effect. After giving him a Vomit and two Doses of Tincture of Rhubarb, I gave him four Grains of the Powder of Ipecacuana with Opium three Times a Day; but that having no Effect, after using it for above a Fortnight, I ordered him the Electuary of Diascord and Cortex; from the Time he began to use this Medicine, he mended daily; and was dismissed in good Health the 26th ofSeptember.[43]On the 21st ofNovember, 1759,Hanah Meredith, a middle-aged Woman, was admitted intoSt. George’s Hospital for a Flux, which she had six or seven Weeks; she had no Fever, but complained much of Sickness and Gripes, and her Disorder had reduced her very low. During the two first Weeks of her being in the Hospital, she had two Vomits of Ipecacuana and four Doses of Rhubarb; and in the Intervals anodyne and astringent Medicines, which made no Alteration in her Complaints. On the 2d ofDecember, she told me, that two Years before she had had a Flux for above three Months, which had yielded to no Remedies till she was ordered repeated Clysters, and that they had made a Cure in a short Time. I then ordered an emollient Clyster with a drachm of theelectuarium diascordii, and a Scruple of thetinctura thebaica, to be given twice a Day, which gave her almost immediate Relief; and with the Assistance of some Doses of Rhubarb, and one or two Vomits and occasional Opiates, removed her Disorder by the Middle ofJanuary; though she remained long weak, and troubled at Times with Gripes; but these Complaints were at last got the better of by her taking some Doses of Rhubarb, and drinking daily a Pint of Lime Water mixed with Half a Pint of Milk.Sarah Spencer, a middle-aged Woman, was admitted intoSt. George’s Hospital the 9th ofNovember, 1763, for a Flux, which had continued for two Months, and reduced her very low. She complained much of Sickness and Gripes; her Stools were mostly composed of Mucus and Blood; her Pulse was low, and she had no Fever, but a Whiteness of the Tongue, and complained of Thirst.—The first Day she had a Vomit, and next Day a Dose of the purging saline oily Draught.—She was ordered to have an emollient Clyster, with a Drachm of Diascord, and as muchtinctura thebaica, given her every Evening; and to have a Dose of the saline oily Purge twice a Week, and Opiates occasionally; by following this Course, and drinking at Times the Chalk Julep, her Disorder was removed, and she was discharged the Hospital on the 30th of the same Month.[44]This Practice of giving the Cortex with Opiates in the Dysentery is not new; for Dr. R.Morton, in his Appendix to his second Exercise on the Fevers, which appeared from 1658 to 1691, observes, that after the Plague of 1666 had ceased, a Fever from a milder Poison, attended with Gripes and Dysentery, began to make its Appearance. As the common Methods of Cure proved unsuccessful, and Dr.Mortonobserved Exacerbations and Remissions, he resolved to give the Bark mixed with Laudanum; and found it answer his Expectation. The first Patient to whom he gave it, was a man inLong Lane, who laboured under a Tertian Dysentery; upon observing a Remission, he ordered a Drachm of the Bark, mixed with a Grain of Opium, to be given every four Hours for six Times; and this removed both the Fever and Dysentery.—He says, he afterwards gave it, with equal Success, in the Quotidian Dysenteries, where he observed Exacerbations or Remissions; and he adds, that he does not doubt but that it will answer as well in Epidemical Diarrhœa’s, and Camp Fevers attended with such Symptoms.Dr.WhyttofEdinburghhas given with Success a strong Decoction of the Bark, mixed with theconfectio japonicaof theEdinburghDispensatory, in the bad State of the Dysentery, when the Mouth and alimentary Canal were threatened with Aphthæ, and even sometimes after they had appeared. And Dr.Pringlementions his having given the Decoction of the Bark, with Snake-Root and some Drops of Laudanum, in the Dysentery complicated with the malignant Fever. SeeNote to Page 245 of his third Edition on the Diseases of the Army.[45]Many other Medicines have been used for the Cure of old Dysenteries,—TheConessi Bark, recommended as a Specific in Diarrhœas, cured a Dysentery which had yielded nothing to a Variety of Medicines.Edinburgh Medical Essays,Vol.III.Art.iv.—Thecortex eleutheriæ vel cascarillæis much recommended for the Cure of Dysenteries in theMemoir. de L’Academie des Sciences a Paris1719, and is still in great Repute among theGermans.—The Decoction of thesemirubaBark was found to have a good Effect in the Dysentery, where the Patient continued to void Blood with his Stools; and when the Stools were only liquid, without a Mixture of Blood, some of the Cascarilla added to the Decoction encreased its Efficacy. SeeDegnerus’s Treatisede Dysenteria,cap.iii.sect.55. These and many other Remedies have been tried in obstinate Dysenteries.From what I have observed myself, and from the Accounts of others, I am now convinced, that such Cases as are not already too far gone, are most likely to be cured,1. By keeping the Patients on a low Diet, composed principally of Milk, Sago, Rice, Salop, and such other Things as are recommended by Dr.Pringle; allowing weak Broths, and a small Quantity of white Meat, as they recover their Strength. The common Drink to be Barley or Rice-Water, Toast and Water,BristolWater, Almond Emulsion, and such like.—By making them wear some additional Cloathing, and guarding carefully against catching cold.—Errors of Diet and Exposure to Cold being the most frequent Causes of Relapses into this Disorder.2. By giving from Time to Time a Dose of some mild Purge; such as a little Manna and Salts; a Solution of Manna in Almond Emulsion; twenty or thirty Grains of Rhubarb, in a saline Draught, or such like; and occasionally gentle Emetics.3. By the Use of some of the mild Astringents and Corroborants.—The Bark, with Astringents and Opiates, agreeing best with some—Decoctions of the Semiruba with others—Chalk in Electuaries, or Juleps, with others—anodyne and astringent Clysters with others—while others receive more Benefit from other Remedies—and severals find themselves better when they use no Medicines of this Kind.4. And by the occasional Use of Opiates, and a free Air: And by moderate Exercise on Horseback, or in a Machine in the convalescent State.I ought not to omit mentioning, that I have seen some Cases where Evacuations had been used in the Beginning, which, after they had continued for some Time, were cured by a regular Diet of Broths, and white Meats; riding daily on Horseback; and drinking a generous good Claret Wine. However, it ought to be remarked, that this Method only succeeded where the Disorder was mild, and its Violence had abated by previous Evacuations.

[29]The Dysentery has been long alledged to arise from a putrescent Cause in Camps; from the Smell of corrupted dead Animals, and of Excrements, during the Heat of Summer.Ramazini, in his Chapter on Camp-Diseases, informs us, that Dr. G.Erric Barnstorff, Physician to the Duke ofBrunswick, who served five Campaigns with theBrunswickandLunenburgTroops inHungary, told him, that the Camp Diseases, particularly the Malignant Fever and Dysentery, took their Rise from the Troops remaining long encamped on the same Ground, and being exposed to the corrupted Steams of the Bodies of dead Men, Horses, and other Animals, which lay unburied; and of Excrements, which were not covered with Earth. And these Causes have since been particularly taken notice of by Dr.Pringle, in hisObservation on the Diseases of the Army.Many have imputed the Cause of this Disorder to the eating of Fruit in excess, because it generally appears about the Middle of Summer, the Time the Fruit begins to be in Season, and continues through the Autumn. But from later Observations this should seem to be a vulgar Error. Dr.Pringle(part i. ch. iii. p. 20.) tells us, that, in the Year 1743, this Sickness began and raged before any Fruit was in Season, except Strawberries, (which from their high Price the Men never tasted) and ended about the Time the Grapes were ripe; which growing in open Vineyards were freely eat by every body. And Dr.Tissot, in a Treatise which he published, calledAvis au Peuple sur la Santé, in his Chapter on theDysentery, § 320, says, that ripe Fruit, especially the Summer-Fruits, are so far from being the Cause of the Disorder, that they are the great Preservatives against it: he says, that, in the Years which the Fruit is most plentiful, the Dysentery is least frequent; and he relates several Instances where the Use of ripe Grapes proved a Cure for the Disorder. Eleven People were attacked by the Dysentery, nine eat Fruit, and all recovered; the other two, a Grandmother and Child, from Prejudice, eat none, and both died. A Regiment ofSwissSoldiers, in Garrison in the South ofFrance, had the Dysentery very frequent among them. The Captains purchased some Acres of a Vineyard, and carried the sick Soldiers to the Field, and gave them the Grapes to eat; and ordered the Men in Health to live upon them chiefly. After this not one Person died, nor was any one seized with the Distemper.—In an Account of a Treatise on the Dysentery, published atHamburgin 1753, which was epidemical the Year before, inAugustandSeptember, we are told, that it did not proceed, as is commonly believed, from the eating of Fruit; for it was observed, that those who eat Fruit freely escaped better than those who abstained from it altogether.Vide Comment. de Rebus in Hist. Nat. & Medecin. Gestis, vol. II. par. iv. sect. v.Generally inAugustandSeptemberwe have People admitted intoSt. George’s Hospital for the Dysentery; who have certainly not catched the Disorder from eating of Fruit, but from working in the Fields, and being exposed to Causes similar to those which produce the Dysentery in Camps.

Many have imputed the Cause of this Disorder to the eating of Fruit in excess, because it generally appears about the Middle of Summer, the Time the Fruit begins to be in Season, and continues through the Autumn. But from later Observations this should seem to be a vulgar Error. Dr.Pringle(part i. ch. iii. p. 20.) tells us, that, in the Year 1743, this Sickness began and raged before any Fruit was in Season, except Strawberries, (which from their high Price the Men never tasted) and ended about the Time the Grapes were ripe; which growing in open Vineyards were freely eat by every body. And Dr.Tissot, in a Treatise which he published, calledAvis au Peuple sur la Santé, in his Chapter on theDysentery, § 320, says, that ripe Fruit, especially the Summer-Fruits, are so far from being the Cause of the Disorder, that they are the great Preservatives against it: he says, that, in the Years which the Fruit is most plentiful, the Dysentery is least frequent; and he relates several Instances where the Use of ripe Grapes proved a Cure for the Disorder. Eleven People were attacked by the Dysentery, nine eat Fruit, and all recovered; the other two, a Grandmother and Child, from Prejudice, eat none, and both died. A Regiment ofSwissSoldiers, in Garrison in the South ofFrance, had the Dysentery very frequent among them. The Captains purchased some Acres of a Vineyard, and carried the sick Soldiers to the Field, and gave them the Grapes to eat; and ordered the Men in Health to live upon them chiefly. After this not one Person died, nor was any one seized with the Distemper.—In an Account of a Treatise on the Dysentery, published atHamburgin 1753, which was epidemical the Year before, inAugustandSeptember, we are told, that it did not proceed, as is commonly believed, from the eating of Fruit; for it was observed, that those who eat Fruit freely escaped better than those who abstained from it altogether.Vide Comment. de Rebus in Hist. Nat. & Medecin. Gestis, vol. II. par. iv. sect. v.

Generally inAugustandSeptemberwe have People admitted intoSt. George’s Hospital for the Dysentery; who have certainly not catched the Disorder from eating of Fruit, but from working in the Fields, and being exposed to Causes similar to those which produce the Dysentery in Camps.

[30]Most Authors, who treat of the Dysentery, mention this Symptom of Worms; and Dr.Huxhamtells us, that, in some Seasons, he has seen round Worms in the Stools of most of the Dysenteric Patients.De Aere, vol. II. p. 98.

[31]From the Accounts we have in Authors, of the Dissection of the Bodies of Persons who died of the Dysentery, it would appear; that there is no Part of the alimentary Canal which has not some time or other been found inflamed, or in a state of Suppuration or Gangrene; and the Liver, Spleen, and other Viscera, have likewise been found diseased, but the Rectum and Colon have almost in all been more or less affected. The following Account I had, in the Year 1748, from the late Dr.L. Fraser, who afterwards practised in the Island ofNevis, two Days after the Patient died.Mary Reid, a Woman thirty Years of Age, was taken ill of a Dysentery, which in Three Weeks Time killed her. In her Life-time she complained, more than ordinary, of Gripes in her Belly, especially in her Left Side. Her Body was opened in Presence of Dr.Dundas, who had attended her, during her Illness. All the Intestines and Mesentery were inflamed, especially the Colon and Rectum; the internal Side of which was quite in a mortified State, and contained little Vesicles full of a putrid fetid Liquor, Numbers of which she had evacuated by Stool some Days before her Death.

[32]While this Sheet was in the Press, I received Dr.Pringle’s 4th Edition of hisObservations on the Diseases of the Army, and Dr.Baker’s Treatise on theDysentery which was epidemic in London in the Year 1762. Both these Gentlemen give an Account of the Dissection of the Bodies of some People who died of the Dysentery; where, besides the common Appearances of the inner Surface of the Rectum and Colon being covered with a bloody Slime, and their internal Coats being inflamed, gangrened, or in a putrid State, there were observed on the Inside of the lower Part of the Colon, and upper Part of the Rectum, a Number of little Tubercles, or Excrescences, which resembled the Small Pox, of a flat Sort at the Height of the Disorder; but differed from them in this, that they were of a firm Consistence, without any Cavity: they were believed to take their Rise from the cellular Membrane, which lies immediately above the villous Coat. Perhaps such Tubercles might have been found in the Colon and Rectum of those Bodies we opened; but not looking for them, they may have passed unobserved.Morgagni, in his Book lately published,de Sede & Causis Morborum, epist. xxxi. is of Opinion, that the Filaments, and Pieces of Membranes, which are frequently observed in the Stools, are often formed of inspissated Mucus and Lymph, and other Liquors; and not the Fibres, or Pieces of the villous Coat of the Intestines, as alledged by many Authors.

Morgagni, in his Book lately published,de Sede & Causis Morborum, epist. xxxi. is of Opinion, that the Filaments, and Pieces of Membranes, which are frequently observed in the Stools, are often formed of inspissated Mucus and Lymph, and other Liquors; and not the Fibres, or Pieces of the villous Coat of the Intestines, as alledged by many Authors.

[33]Mr.Cleghorn, in hisAccount of the Diseases of the Island of Minorca, says, “That almost all the Dysenteries which fell under my Observation, unless they were speedily cured in the Beginning, at best proved obstinate, and too frequently fatal, in spite of the many boasted Specificks for this Distemper.” chap. v. p. 228.—The physical Gentlemen employed on theAmericanService have told me, that the old Flux Cases were as fatal inAmerica, as we found them inGermany. I would not from thence have it believed, that every old Flux was to be looked on as a lost Case; and for that Reason given up, and no Attempts be made to cure it; for many, by great Care, and Strength of Constitution, have gradually surmounted the Disorder, and recovered their Health; especially when they got over the Winter, and lived till the warm Weather began.

[34]Although Bleeding, in the Beginning, has been recommended bySydenham,Huxham,Pringle, and other Practitioners; yet it has been reckoned unnecessary in this Disorder by some late Authors. But in most of the recent Cases I saw, it was extremely necessary, and contributed greatly to the Relief as well as the Cure of the Patient; indeed where the Disorder had already continued some time, and the Fever was gone off before the Patient was sent to us; and the Disorder had become in a manner chronic, and the Patient low, then bleeding was unnecessary, and would have probably done Hurt. Mr.Francis Russeltold me, that when the Dysentery was epidemical atGibraltar, in Summer 1756, he found that by bleeding such Patients as he met with at the first coming on of the Symptoms, and by giving them immediately a Vomit, and afterwards a sudorific Draught, the Disorder was rendered mild, and few of those died.

[35]Mr.W. Russel, who was with the Hospital atMartinico, told me, that, when he was there, he found the Vomit with the Tartar Emetic to be far preferable to any other, in all Cases where there was much putrid Bile lodged in the alimentary Canal; as it speedily carried off those corrupt Humours, which were often productive of the greatest Mischiefs, if they remained, but for a short Time, pent up within the Bowels.

[36]Variety of Medicines have been recommended to answer this Purpose.Thevitrum ceratum antimoniiproved often too rough a Medicine, and therefore we laid it almost entirely aside.Repeated small Doses of the Ipecacuana, from four to six Grains, operated both as an Emetic, and kept up a Purging; but they made the Men so sick, that we could not prevail upon them to continue their Use. Mr.Francis Russeltold me, that, in the Year 1756, he found a few Grains of Rhubarb added to each Dose, made it operate more as a Purgative, and did not make the Men so sick.—Dr.Akensideproposes giving the Ipecacuana in so small Doses as one or two Grains every six Hours, in a Draught made of Mint-water, and Half a Drachm ofconfectio cardiaca; and, after bleeding and vomiting once, seems to depend almost entirely on the Use of this Medicine for the Cure of the Dysentery. See hisComment. de Dysenteria, cap. 2.The watery Tincture of Rhubarb, recommended byDegnerus, we tried in some Cases at Bremen; and found it to be a good mild Purge, but not to answer so well as the Salts and Manna in recent Cases. Mr.William Russeltold me that they found this watery Tincture of Rhubarb to answer better inAmericathan any other of the Preparations of Rhubarb.Calomel has been recommended by many as a Purge in Dysenteries; and Dr.Huxham(de Aere, Vol. II. P. 100) assures us, that he has often experienced the good Effects of it, especially when the Patient at the same time had Worms; in such Cases we joined it to Rhubarb as mentioned in the Text, or gave a Calomel Bolus over Night, and a Purge next Morning. Dr.Duncan, Physician to his Majesty, told me, that he found the following Method of Cure always successful in the Dysentery, which was epidemic inLondonin the Year 1762.If the Patient was Plethoric, or had much Fever, he ordered more or less Blood to be taken away; and then gave four Ounces of the following Julep, every Half Hour, till it both vomited and purged. ℞Tartar. emetic. gr.iijMannæ elect. Unc.ijsolve in Aq. hordeat. Lib.1.—The next Day, and for five or six Days more, the Patient took so much of a Decoction, of Manna, Tamarinds, and soluble Tartar, as kept up a free Discharge by Stool.—If the Irritation and Griping were severe, he found that a Solution of Manna, in the common Almond Emulsion, was sufficient.When the Pain, or Tenesmus, was violent, a Clyster, of Chicken Broth, or of an Infusion of Linseed, with an Ounce or two of Oil of sweet Almonds dissolved in the Yolk of an Egg, injected once or twice a Day, was of great Use.Upon the whole, he was always pleased when he saw large excrementitious Stools come away; and when that could be procured by a gentle Method, he was the more pleased.This Disorder was very often cured in a few Days, and in that Case he dropt the further Use of Medicines; but when it exceeded the Period of six or seven Days, he then added thirty or forty Drops of thetinctura thebaicato the Clysters; and ordered a Scruple of the Extract of the Logwood to be taken thrice a Day in some proper Vehicle.The Patient’s Diet was Rice-Gruel, Sago, Panado, and such like; no Animal Food, not so much as Chicken-Broth, was allowed in the Beginning of the Distemper, nor even Oil, Butter, or Fat of any Kind. The common Drink was Almond Emulsion, Rice-Water, or Barley-Water with Gum Arabic.Dr.Duncanlost but one Patient out of Eighty, whom he had under his Care that Season; and he was delirious, had a high Fever, and asubsultus tendinumbefore the Doctor was called to him, and he died the next Day.The late Dr.Young, ofEdinburgh, seems to have had a very just Notion of this Disorder, and of the proper Method of treating it; for, in his Treatise on Opium, sect. vii. he says, “I am convinced from Experience, that most of the Dysenteries I have hitherto met with, might have been cured by purging mildly, but constantly; and at the same time abating the Acrimony in the great Guts by emollient Clysters, and in the small ones by Plenty of Absorbents, and a Diet of Chicken Broth: But it must be observed with regard to Purgatives, that Manna agrees best with some, Rhubarb with others, Jalap, Mercury, and toasted Rhubarb with others; while others are sooner cured by emollient Clysters. I use Opium only when the Disease is mild, or after its Violence is abated by Evacuants and Emollients.”Scammony, Aloes, and the other strong resinous and hydragogue Purges, are hurtful, and occasion Pain. I always observed, that those Purges answered best which made the freest Evacuation, and acted with the greatest Ease to the Patient; of which the Salts and Manna answered best of any I have hitherto used.

[36]Variety of Medicines have been recommended to answer this Purpose.

Thevitrum ceratum antimoniiproved often too rough a Medicine, and therefore we laid it almost entirely aside.

Repeated small Doses of the Ipecacuana, from four to six Grains, operated both as an Emetic, and kept up a Purging; but they made the Men so sick, that we could not prevail upon them to continue their Use. Mr.Francis Russeltold me, that, in the Year 1756, he found a few Grains of Rhubarb added to each Dose, made it operate more as a Purgative, and did not make the Men so sick.—Dr.Akensideproposes giving the Ipecacuana in so small Doses as one or two Grains every six Hours, in a Draught made of Mint-water, and Half a Drachm ofconfectio cardiaca; and, after bleeding and vomiting once, seems to depend almost entirely on the Use of this Medicine for the Cure of the Dysentery. See hisComment. de Dysenteria, cap. 2.

The watery Tincture of Rhubarb, recommended byDegnerus, we tried in some Cases at Bremen; and found it to be a good mild Purge, but not to answer so well as the Salts and Manna in recent Cases. Mr.William Russeltold me that they found this watery Tincture of Rhubarb to answer better inAmericathan any other of the Preparations of Rhubarb.

Calomel has been recommended by many as a Purge in Dysenteries; and Dr.Huxham(de Aere, Vol. II. P. 100) assures us, that he has often experienced the good Effects of it, especially when the Patient at the same time had Worms; in such Cases we joined it to Rhubarb as mentioned in the Text, or gave a Calomel Bolus over Night, and a Purge next Morning. Dr.Duncan, Physician to his Majesty, told me, that he found the following Method of Cure always successful in the Dysentery, which was epidemic inLondonin the Year 1762.

If the Patient was Plethoric, or had much Fever, he ordered more or less Blood to be taken away; and then gave four Ounces of the following Julep, every Half Hour, till it both vomited and purged. ℞Tartar. emetic. gr.iijMannæ elect. Unc.ijsolve in Aq. hordeat. Lib.1.—The next Day, and for five or six Days more, the Patient took so much of a Decoction, of Manna, Tamarinds, and soluble Tartar, as kept up a free Discharge by Stool.—If the Irritation and Griping were severe, he found that a Solution of Manna, in the common Almond Emulsion, was sufficient.

When the Pain, or Tenesmus, was violent, a Clyster, of Chicken Broth, or of an Infusion of Linseed, with an Ounce or two of Oil of sweet Almonds dissolved in the Yolk of an Egg, injected once or twice a Day, was of great Use.

Upon the whole, he was always pleased when he saw large excrementitious Stools come away; and when that could be procured by a gentle Method, he was the more pleased.

This Disorder was very often cured in a few Days, and in that Case he dropt the further Use of Medicines; but when it exceeded the Period of six or seven Days, he then added thirty or forty Drops of thetinctura thebaicato the Clysters; and ordered a Scruple of the Extract of the Logwood to be taken thrice a Day in some proper Vehicle.

The Patient’s Diet was Rice-Gruel, Sago, Panado, and such like; no Animal Food, not so much as Chicken-Broth, was allowed in the Beginning of the Distemper, nor even Oil, Butter, or Fat of any Kind. The common Drink was Almond Emulsion, Rice-Water, or Barley-Water with Gum Arabic.

Dr.Duncanlost but one Patient out of Eighty, whom he had under his Care that Season; and he was delirious, had a high Fever, and asubsultus tendinumbefore the Doctor was called to him, and he died the next Day.

The late Dr.Young, ofEdinburgh, seems to have had a very just Notion of this Disorder, and of the proper Method of treating it; for, in his Treatise on Opium, sect. vii. he says, “I am convinced from Experience, that most of the Dysenteries I have hitherto met with, might have been cured by purging mildly, but constantly; and at the same time abating the Acrimony in the great Guts by emollient Clysters, and in the small ones by Plenty of Absorbents, and a Diet of Chicken Broth: But it must be observed with regard to Purgatives, that Manna agrees best with some, Rhubarb with others, Jalap, Mercury, and toasted Rhubarb with others; while others are sooner cured by emollient Clysters. I use Opium only when the Disease is mild, or after its Violence is abated by Evacuants and Emollients.”

Scammony, Aloes, and the other strong resinous and hydragogue Purges, are hurtful, and occasion Pain. I always observed, that those Purges answered best which made the freest Evacuation, and acted with the greatest Ease to the Patient; of which the Salts and Manna answered best of any I have hitherto used.

[37]Sydenham,Huxham, and all good Practitioners, have taken Notice of the bad Effects of the too free Use of Astringents, and given Cautions against it.

[38]If the Patient was suddenly attacked with sharp Pain of the Bowels and Gripes, on a Day in which he had not Physic, a Dose of the Salts and Manna was commonly given immediately, to empty thoroughly the first Passages.

[39]Mr.W. Russeltold me, that he and Dr.Huckfound the free Use of the following Emulsion, made of Bees Wax, to be of great Use after Evacuations, where there was much Pain of the Bowels, in recent Cases of Fluxes in the Hospitals inAmerica. ℞. Ceræ alb. vel flavæ drachmes tres. Sapon. alb. Hispan. drachmam unam. Aquæ fontanæ, unciam unam, liquefiant super ignem in vase ferreo, agitando spatula, & dein infunde in mortarium marmoreum, & adde paulatim aq. fontanæ, libras duas syrupi sacchari. spiritus vini gallici tenuis, vel aquæ alicujus spirituosæ ana unciam unam, terendo optime ut fiat emulsio.This Method of dissolving Bees Wax, in a Watery Liquor, is entirely new; for before this we knew of no Way of making it miscible with Water.

This Method of dissolving Bees Wax, in a Watery Liquor, is entirely new; for before this we knew of no Way of making it miscible with Water.

[40]Dr.Huxham(de Aere, Vol. II. p. 107.) says, there is no Disorder in which a diluting, sweetening Drink is more necessary than in this; that he has done great Service among the Poor by luke-warm Water; that, after emptying the Bowels thoroughly, he has sometimes cured this Disorder by the Use of pure Water, and a small Quantity of Opium. AndBaglivi(Prax. Med.lib. i.) tells us, that the drinking of common Whey, and throwing up frequent Clysters of it, had cured many, and that this was looked upon as a Specific, and kept a Secret by some.

[41]Dr.Pringle, in thefourth Edition of his Observations, just published, in treating of the third or last Stage of the Dysentery, remarks, that this is the Time for Astringents, which ought not to be given sooner, or at least very sparingly. And he tells us, that, in the former Editions of his Work, he mentioned those Compositions which he had most frequently used, but that he had now laid most of them aside; and at present trusts to Vomits, and to a Milk Diet, for the perfect Cure.He says, “Whenever therefore the Patient is in this State, and especially when his Pulse is quick, and he complains of inward Heat, I began with giving him a Scruple of Ipecacuana; and the next Day I put him upon the Milk-Diet; which I continue till all the hectic Symptoms are gone, and till the Bowels have recovered their Tone. During this Course I have seldom had Occasion for any other Medicine, excepting the Chalk Julep mentioned before, which I use for correcting that strong Acid so incident to relaxed Stomachs. Sometimes also I add an Opiate to procure Rest at Night; but after a few Days these are likewise laid aside. All that I require (which indeed is often hard to obtain) is a strict Perseverance in the low Diet: and now and then a Repetition of the Vomit, upon any new Disorder of the Stomach, or great Laxity of the Bowels.“Whilst the Patient continues in this Course, I forbid all animal Food and fermented Liquors; and besides Milk, I allow only the Preparations of Grain, Sago and Salop.” See Part iii. ch. vi. p. 289, 290.

He says, “Whenever therefore the Patient is in this State, and especially when his Pulse is quick, and he complains of inward Heat, I began with giving him a Scruple of Ipecacuana; and the next Day I put him upon the Milk-Diet; which I continue till all the hectic Symptoms are gone, and till the Bowels have recovered their Tone. During this Course I have seldom had Occasion for any other Medicine, excepting the Chalk Julep mentioned before, which I use for correcting that strong Acid so incident to relaxed Stomachs. Sometimes also I add an Opiate to procure Rest at Night; but after a few Days these are likewise laid aside. All that I require (which indeed is often hard to obtain) is a strict Perseverance in the low Diet: and now and then a Repetition of the Vomit, upon any new Disorder of the Stomach, or great Laxity of the Bowels.

“Whilst the Patient continues in this Course, I forbid all animal Food and fermented Liquors; and besides Milk, I allow only the Preparations of Grain, Sago and Salop.” See Part iii. ch. vi. p. 289, 290.

[42]I had lately a very remarkable Instance of the Effects of this Medicine, in the Case of oneGilchrist, a middle-aged Man, by Trade a Taylor; who was admitted intoSt. George’s Hospital the 20th ofJuly, 1763, for an old Flux, which had continued above six Months, and reduced him very low: He had taken a great many Medicines without any Effect. After giving him a Vomit and two Doses of Tincture of Rhubarb, I gave him four Grains of the Powder of Ipecacuana with Opium three Times a Day; but that having no Effect, after using it for above a Fortnight, I ordered him the Electuary of Diascord and Cortex; from the Time he began to use this Medicine, he mended daily; and was dismissed in good Health the 26th ofSeptember.

[43]On the 21st ofNovember, 1759,Hanah Meredith, a middle-aged Woman, was admitted intoSt. George’s Hospital for a Flux, which she had six or seven Weeks; she had no Fever, but complained much of Sickness and Gripes, and her Disorder had reduced her very low. During the two first Weeks of her being in the Hospital, she had two Vomits of Ipecacuana and four Doses of Rhubarb; and in the Intervals anodyne and astringent Medicines, which made no Alteration in her Complaints. On the 2d ofDecember, she told me, that two Years before she had had a Flux for above three Months, which had yielded to no Remedies till she was ordered repeated Clysters, and that they had made a Cure in a short Time. I then ordered an emollient Clyster with a drachm of theelectuarium diascordii, and a Scruple of thetinctura thebaica, to be given twice a Day, which gave her almost immediate Relief; and with the Assistance of some Doses of Rhubarb, and one or two Vomits and occasional Opiates, removed her Disorder by the Middle ofJanuary; though she remained long weak, and troubled at Times with Gripes; but these Complaints were at last got the better of by her taking some Doses of Rhubarb, and drinking daily a Pint of Lime Water mixed with Half a Pint of Milk.Sarah Spencer, a middle-aged Woman, was admitted intoSt. George’s Hospital the 9th ofNovember, 1763, for a Flux, which had continued for two Months, and reduced her very low. She complained much of Sickness and Gripes; her Stools were mostly composed of Mucus and Blood; her Pulse was low, and she had no Fever, but a Whiteness of the Tongue, and complained of Thirst.—The first Day she had a Vomit, and next Day a Dose of the purging saline oily Draught.—She was ordered to have an emollient Clyster, with a Drachm of Diascord, and as muchtinctura thebaica, given her every Evening; and to have a Dose of the saline oily Purge twice a Week, and Opiates occasionally; by following this Course, and drinking at Times the Chalk Julep, her Disorder was removed, and she was discharged the Hospital on the 30th of the same Month.

Sarah Spencer, a middle-aged Woman, was admitted intoSt. George’s Hospital the 9th ofNovember, 1763, for a Flux, which had continued for two Months, and reduced her very low. She complained much of Sickness and Gripes; her Stools were mostly composed of Mucus and Blood; her Pulse was low, and she had no Fever, but a Whiteness of the Tongue, and complained of Thirst.—The first Day she had a Vomit, and next Day a Dose of the purging saline oily Draught.—She was ordered to have an emollient Clyster, with a Drachm of Diascord, and as muchtinctura thebaica, given her every Evening; and to have a Dose of the saline oily Purge twice a Week, and Opiates occasionally; by following this Course, and drinking at Times the Chalk Julep, her Disorder was removed, and she was discharged the Hospital on the 30th of the same Month.

[44]This Practice of giving the Cortex with Opiates in the Dysentery is not new; for Dr. R.Morton, in his Appendix to his second Exercise on the Fevers, which appeared from 1658 to 1691, observes, that after the Plague of 1666 had ceased, a Fever from a milder Poison, attended with Gripes and Dysentery, began to make its Appearance. As the common Methods of Cure proved unsuccessful, and Dr.Mortonobserved Exacerbations and Remissions, he resolved to give the Bark mixed with Laudanum; and found it answer his Expectation. The first Patient to whom he gave it, was a man inLong Lane, who laboured under a Tertian Dysentery; upon observing a Remission, he ordered a Drachm of the Bark, mixed with a Grain of Opium, to be given every four Hours for six Times; and this removed both the Fever and Dysentery.—He says, he afterwards gave it, with equal Success, in the Quotidian Dysenteries, where he observed Exacerbations or Remissions; and he adds, that he does not doubt but that it will answer as well in Epidemical Diarrhœa’s, and Camp Fevers attended with such Symptoms.Dr.WhyttofEdinburghhas given with Success a strong Decoction of the Bark, mixed with theconfectio japonicaof theEdinburghDispensatory, in the bad State of the Dysentery, when the Mouth and alimentary Canal were threatened with Aphthæ, and even sometimes after they had appeared. And Dr.Pringlementions his having given the Decoction of the Bark, with Snake-Root and some Drops of Laudanum, in the Dysentery complicated with the malignant Fever. SeeNote to Page 245 of his third Edition on the Diseases of the Army.

Dr.WhyttofEdinburghhas given with Success a strong Decoction of the Bark, mixed with theconfectio japonicaof theEdinburghDispensatory, in the bad State of the Dysentery, when the Mouth and alimentary Canal were threatened with Aphthæ, and even sometimes after they had appeared. And Dr.Pringlementions his having given the Decoction of the Bark, with Snake-Root and some Drops of Laudanum, in the Dysentery complicated with the malignant Fever. SeeNote to Page 245 of his third Edition on the Diseases of the Army.

[45]Many other Medicines have been used for the Cure of old Dysenteries,—TheConessi Bark, recommended as a Specific in Diarrhœas, cured a Dysentery which had yielded nothing to a Variety of Medicines.Edinburgh Medical Essays,Vol.III.Art.iv.—Thecortex eleutheriæ vel cascarillæis much recommended for the Cure of Dysenteries in theMemoir. de L’Academie des Sciences a Paris1719, and is still in great Repute among theGermans.—The Decoction of thesemirubaBark was found to have a good Effect in the Dysentery, where the Patient continued to void Blood with his Stools; and when the Stools were only liquid, without a Mixture of Blood, some of the Cascarilla added to the Decoction encreased its Efficacy. SeeDegnerus’s Treatisede Dysenteria,cap.iii.sect.55. These and many other Remedies have been tried in obstinate Dysenteries.From what I have observed myself, and from the Accounts of others, I am now convinced, that such Cases as are not already too far gone, are most likely to be cured,1. By keeping the Patients on a low Diet, composed principally of Milk, Sago, Rice, Salop, and such other Things as are recommended by Dr.Pringle; allowing weak Broths, and a small Quantity of white Meat, as they recover their Strength. The common Drink to be Barley or Rice-Water, Toast and Water,BristolWater, Almond Emulsion, and such like.—By making them wear some additional Cloathing, and guarding carefully against catching cold.—Errors of Diet and Exposure to Cold being the most frequent Causes of Relapses into this Disorder.2. By giving from Time to Time a Dose of some mild Purge; such as a little Manna and Salts; a Solution of Manna in Almond Emulsion; twenty or thirty Grains of Rhubarb, in a saline Draught, or such like; and occasionally gentle Emetics.3. By the Use of some of the mild Astringents and Corroborants.—The Bark, with Astringents and Opiates, agreeing best with some—Decoctions of the Semiruba with others—Chalk in Electuaries, or Juleps, with others—anodyne and astringent Clysters with others—while others receive more Benefit from other Remedies—and severals find themselves better when they use no Medicines of this Kind.4. And by the occasional Use of Opiates, and a free Air: And by moderate Exercise on Horseback, or in a Machine in the convalescent State.I ought not to omit mentioning, that I have seen some Cases where Evacuations had been used in the Beginning, which, after they had continued for some Time, were cured by a regular Diet of Broths, and white Meats; riding daily on Horseback; and drinking a generous good Claret Wine. However, it ought to be remarked, that this Method only succeeded where the Disorder was mild, and its Violence had abated by previous Evacuations.

From what I have observed myself, and from the Accounts of others, I am now convinced, that such Cases as are not already too far gone, are most likely to be cured,

1. By keeping the Patients on a low Diet, composed principally of Milk, Sago, Rice, Salop, and such other Things as are recommended by Dr.Pringle; allowing weak Broths, and a small Quantity of white Meat, as they recover their Strength. The common Drink to be Barley or Rice-Water, Toast and Water,BristolWater, Almond Emulsion, and such like.—By making them wear some additional Cloathing, and guarding carefully against catching cold.—Errors of Diet and Exposure to Cold being the most frequent Causes of Relapses into this Disorder.

2. By giving from Time to Time a Dose of some mild Purge; such as a little Manna and Salts; a Solution of Manna in Almond Emulsion; twenty or thirty Grains of Rhubarb, in a saline Draught, or such like; and occasionally gentle Emetics.

3. By the Use of some of the mild Astringents and Corroborants.—The Bark, with Astringents and Opiates, agreeing best with some—Decoctions of the Semiruba with others—Chalk in Electuaries, or Juleps, with others—anodyne and astringent Clysters with others—while others receive more Benefit from other Remedies—and severals find themselves better when they use no Medicines of this Kind.

4. And by the occasional Use of Opiates, and a free Air: And by moderate Exercise on Horseback, or in a Machine in the convalescent State.

I ought not to omit mentioning, that I have seen some Cases where Evacuations had been used in the Beginning, which, after they had continued for some Time, were cured by a regular Diet of Broths, and white Meats; riding daily on Horseback; and drinking a generous good Claret Wine. However, it ought to be remarked, that this Method only succeeded where the Disorder was mild, and its Violence had abated by previous Evacuations.

TheCholera Morbus, or a sudden and violent Vomiting and Purging, was very frequent inJulyandAugust1701; and several were attacked with it atMunster.—It was attended with great Sickness, with Pain, and Inflation of the Abdomen, Thirst, and a small quick Pulse: Some had it in a pretty violent Degree, but in general it was mild; and although the Sickness, Vomiting, and Purging, continued, in one or two Cases, for above a Day; yet none of those died whom I saw.

This Disorder weakens the Patient much, in a short Space of Time; and sometimes, when violent, kills in less than twenty-four Hours. It is always most frequent in Summer and theBeginning of Autumn; and is taken Notice of byHippocrates,Aretæus,Celsus, and other antient Authors; and is very accurately described by many of them.—It is of the bilious Kind; and the Cure principally depends upon the free Use of warm mild Liquors in the Beginning; to dilute and blunt the Acrimony of the Bile, and other Fluids, and to promote their Discharge; and afterwards of gentle Cordials to support the Strength; and warm Fomentations to allay the Pain when violent; and mild Opiates to procure Rest; and if the Sickness or Griping remains next Day after the Cholera is stopt, to give a Dose of Physic and an Opiate in the Evening.

An Officer, who had been wounded on the 15th ofJuly, at the Battle ofFillinghausen, began afterwards to live very freely, and was on the 4th ofAugustseized in the Night with the Cholera.—About ten o’Clock next Day I was sent for; and found him in violent Agony, with sharp Pain in the Bowels, Reachings, and Strainings to Vomit, and Spasms and Cramps in the Bowels, Legs, and Arms.—He had largered Blotches on his Extremities, and no Pulse was to be felt at the Wrist, and rather a Fluttering than a Beating at the Heart.—He had vomited and purged much in the Night before I saw him, but the Purging had begun to abate.—I immediately ordered him an emollient Clyster, and a saline Draught, with theconfectio cardiaca, and five Drops of liquid Laudanum; which, if he vomited up, was to be repeated soon after; if not, only once in four Hours: And he was directed to drink freely of weak Chicken Broth, warm.—Two Hours afterwards we found him in the same Situation; still no Pulse to be felt, which prevented us from bleeding him; and the violent Pain of the Stomach and Bowels, and the Cramps, continued. We then ordered Flannels, dipped in a warm emollient Decoction, to be kept constantly applied to his Belly, dipping them in the warm Decoction as soon as they began to grow cool; his Clyster to be repeated with the Addition of a Drachm of theelectuarium e baccis lauri, and Half a Drachm of thetinctura thebaica; a Scruple of Castor, and Half aDrachm of Spirit of Lavender, to be added to each of his Draughts; and a Blister to be prepared, in case these Medicines gave no Relief.—Soon after, beginning to use the Fomentations, the Cramps and Pains began to abate; about four o’Clock in the Afternoon we could perceive a Fluttering of the Pulse at the Wrist, and all the Pains and Cramps were much easier; so that there was no occasion for the Blister.—Next Morning he was very easy, but low, and inclined to be sick; for which his Cordial Draughts were repeated every six Hours.—The third Day, as he complained of a little Griping in the Bowels, we ordered him a Dose of Tincture of Rhubarb, and an Opiate in the Evening, which entirely removed these Complaints, and he was abroad and well next Day.

One Soldier, who had a good deal of Fever, and complained of acute Pain in the Bowels, along with the Vomiting and Purging, was blooded; and drank freely of warm Barley-Water while the Vomiting continued.—After throwing up a Quantity of green bilious Matter,the Vomiting ceased; and the Gripes and Purging became less violent.—In an Hour after, being able to retain some very weak Broth in his Stomach, he drank plentifully of it through the Day; and the Purging being abated towards Night, he took an anodyne Draught; and next Day, having still a little Sickness remaining, had a Dose of Physic and an Opiate at Night, which removed all his Complaints.

The Rest, who were attacked with the Cholera atMunster, were treated much in the same Way; only as they had not such acute Pain and Fever as this Man, it was thought unnecessary to bleed them.

The Antients[46]recommended drinking freely of warm Water in the Beginning, and the Use of both cold and hot Fomentations of the Stomach and Belly;—and in the low State, the Use of Wine, mixed with Water, and Polenta[47]; and to apply Rue, with Vinegar, andother strong smelling Things, to the Nostrils; besides Variety of other Remedies.—When Convulsions happen,Celsus[48]advises to anoint the Belly with warm Oil; and if that does not remove them, to apply Cupping-Glasses or Mustard to the Stomach; and, after sleeping, to abstain the second Day from Drink; and the third, to go into the Bath; and if any thing of a Fever remains after the Cholera is suppressed, to give a Purge.

Dr.Sydenham[49]trusts principally to drinking freely of Chicken Broth, and throwing up Clysters of the same, and afterwards giving Opiates.

Dr.Ayton Douglas, in the sixth Volume of theEdinburghMedical Essays[50], recommends a Decoction of Oat Bread, baked without Leaven or Yest, and carefully toasted as brown as Coffee, but not burnt; as a Remedy very grateful to the Stomach, and useful in stopping the Vomiting, and sometimes the Purging too: And he relates several Caseswhere it had a good Effect. After the Vomiting was stopped, he added the Use of mild Opiates; and, where the Patient was low, Wine and other Cordials.

FOOTNOTES:[46]SeeAretæus, Lib. ii. Cap. 4. andCelsus, Lib. iv. Cap. 11.[47]The Polenta seems to have been nothing but toasted Barley Meal. SeePlinii Hist. Natural.Lib. xxii. Cap. 25.[48]Celsus loco citato.[49]Processus integ. de Cholera.[50]Art. 65.

[46]SeeAretæus, Lib. ii. Cap. 4. andCelsus, Lib. iv. Cap. 11.

[47]The Polenta seems to have been nothing but toasted Barley Meal. SeePlinii Hist. Natural.Lib. xxii. Cap. 25.

[48]Celsus loco citato.

[49]Processus integ. de Cholera.

[50]Art. 65.

Onthe Return of the Troops from the Winter Expedition into the Country ofHesse, in the Year 1761, we had several Men seized with Inflammatory Fevers without any topical Inflammation; and at the Opening of each Campaign had always Numbers sent to the Hospitals ill of this Disorder. Towards the End of the Campaigns, and throughout the Winter, many were seized with Inflammatory Fevers; but these were mostly complicated, with pleuritic, or peripneumonic Symptoms, or other topical Inflammations, or with rheumatic Complaints.

In the Inflammatory Fever, the Sick were seized at first with cold and hot Fits, succeededby Pain in the Head and all over the Body. The Pulse was strong and quick, and the Blood sizy; attended with other Appearances commonly observed in such Fevers.

As the Summer advanced, this Fever was often accompanied with bilious Symptoms, with Sickness, and vomiting of bilious Matter, and very frequently with a Purging: Towards the End of Summer it ceased, and was succeeded by the bilious remittent Fever.—And it was no uncommon Thing to see those Fevers, which originally were entirely of an inflammatory Nature, after the sick had been some Days in a crowded Hospital, partake a good deal of the Nature of the Malignant Fever, or be changed entirely into it.

We treated these Fevers in the common antiphlogistic Method.—We blooded freely in the Beginning; gave the saline Draughts with Nitre and other cooling Medicines; and made the Patients drink plentifully of small Liquors:—And when they were inclined to be costive, gave mild Purges, or emollient laxative Clysters. We afterwards applied Blisters;and if the Pulse began to sink, gave Cordials, Wine, and other Remedies commonly employed in such Cases;—and towards the Decline of the Fever endeavoured to promote such Evacuations as were pointed out by Nature, and likely to prove critical.

When the Case was complicated with bilious Symptoms in the Beginning, we were obliged to have particular Regard to the first Passages. If the Patient complained much of Sickness, we gave a gentle Vomit in the Evening, after bleeding; and a Purge next Day, to carry off any bilious or corrupted Humours that might be lodged in the Stomach or Intestines; and we found that these Evacuations gave Relief, and generally mitigated all the Symptoms.

If at any Time during the Fever a Looseness came on, especially when attended with Gripes, we gave a Dose of some gentle Physic, which made a free Evacuation; and an Opiate in the Evening after its Operation; and afterwards we found it answer better to attempt rather to moderate, than wholly stop the Purgingby strong Astringents, and Opiates; unless where the Evacuation by Stool was so great as to be in Danger of sinking the Patient.

Thepulvis antimonialis, composed of ten Parts of thepulvis e chelis, and one Part of the Tartar emetic, given in small Doses, was serviceable in many of these Fevers, after free Evacuations had been made.

Two Patients, one a Soldier of the Twentieth Regiment, the other aGermanWaggoner, were taken ill of this Fever about the 25th ofDecember, 1762: They were both blooded freely, and had a Dose of Physic in the Beginning; and the saline Draughts with Nitre and other cooling Remedies; and had Blisters applied without producing any considerable Change in their Disorder.—On the 5th ofJanuary, 1763, they both complained much of Thirst, and were inclined to be costive; their Tongues were parched, their Pulses quick and small, and their Skins dry; they were restless at Nights, and the Soldier had a slight Delirium.—I ordered each of them four Grains of thepulvis antimonialisevery four Hours.

6th. Next Day the Soldier told me, he had had four loose Stools; his Senses were much clearer, the Pulse calmer and slower, and he said he found himself lighter and easier, and less feverish, than he had been since he was first taken ill. The Medicine was continued, with the Addition of an anodyne Draught at Night.—7th. I found him in a fine breathing Sweat, and he told me he had slept well in the Night: p.—8th. The Sweat continued till this Morning, and on going off his Urine let fall a copious white Sediment, and left him free from the Fever; after which he mended daily.

The Waggoner, after taking the third Dose of the Powders, had a warm Moisture upon the Skin.—On the 6th was cooler and without much Fever, and had had one Stool.—7th. The warm Moisture ended in a profuse Sweat, which carried off the Fever, and he continued to recover daily.

Manyof the Soldiers during the Campaign were seized with Inflammations of the Throat, especially when the Nights were cold and moist after warm Days; and when they did Duty in cold wet Nights in the Winter Season.—All of them I saw inGermanywere of the inflammatory Kind; I did not observe any that were malignant.

They were treated in the antiphlogistic Method.—The Patients were blooded liberallyin the Beginning—took the cooling nitrous and saline Medicines—gentle Diaphoretics and Purgatives—and used frequent Gargarisms.

Sometimes a Flannel rubbed with camphorated Oil, or thelinimentum volatile, and applied round the Neck, was of Service.—And frequently after bleeding sufficiently, where the Breathing or Swallowing was difficult, the Application of a large Blister to the Neck gave speedy Relief.

ThePleurisy, or an acute Inflammation of the Side, was most frequent among the Soldiers towards the latter End of the Campaigns; though some were attacked with it at all Times of the Year, from doing Duty in all Sorts of Weather.

We followed the antiphlogistic Method of Cure; and ordered plentiful Bleeding in the Beginning, till the Violence of the Pain began to abate, or the Patient grew faint;—and the Side to be fomented with Flannels dipped in warm emollient Decoctions, and afterwards rubbed with volatile Liniments: At the same Time the Patient drank freely of warm dilutingLiquors, as Barley Water, the pectoral Decoction, and such like; and took the saline and other cooling Medicines, mixed occasionally with Sperma Ceti, or some other soft Pectorals, if there was a tickling Cough.—When the Patient was costive, we gave a Dose of Salts, or some other mild Physic, or laxative Clysters.

If the Pain continued very acute, we repeated the Bleeding as often as Necessity seemed to require, and the Pulse could bear; and immediately after the second Bleeding ordered a large Blister to be applied to the Part affected.

Physicians formerly used to forbid Bleeding after the fourth Day, if it had been omitted so long; but when no Symptoms of Suppuration had already appeared, on whatever Day of the Disorder it happened, I ordered plentiful Bleeding, the same as in recent Cases; and never found any Disadvantage, but often great Service from this Practice.

When the Sharpness of the Pain was gone, and the Pulse became soft, very often a dullPain remained for some Time in the Part.—In some Cases a brisk Purge removed it;—in others, cupping above the Part, and afterwards rubbing it with the volatile Liniments, did Service;—in others, gentle Opiates at Night, especially where there was a tickling Cough;—and in one or two Cases, this Pain did not go away, till the Patient was ordered to drink every Day for some Time, a Quart of the Decoction of Sarsaparilla with the antimonial Wine.

In the Course of this Disorder, if a kindly Moisture broke out on the Skin, which gave Relief, this was encouraged by the Use of mild warm Liquors; or if the Patient began to spit up a viscid or yellowish Mucus, we endeavoured to keep up the Expectoration by the Use of mild Pectorals; and if a Purging came on, we were careful not to check it too soon, unless it was so violent as to be in Danger of sinking the Patient.

When an Inflammation of the Side came to Suppuration, which happened in one or two Cases atOsnabruck, inMay1761; as soon as a Fluctuation of Matter was to be felt, an Incision waswas made in the Part, and the Matter discharged; after which the Sore healed kindly, and the Patients recovered[51]. I am persuaded, was this Operation oftener performed, many would recover who die consumptive.

FOOTNOTES:[51]Dr.Meadadvises, where the Lungs and Pleura grow together, and an Abscess forms, to open it with Caustic; and afterwards to keep the Ulcer open during the Patient’s Life: For he says, he has often seen, where such Sores were healed up, that the Patient died soon after by an Efflux of Matter upon the Breast.Monita Medica, Cap. i. Sect. 7.

[51]Dr.Meadadvises, where the Lungs and Pleura grow together, and an Abscess forms, to open it with Caustic; and afterwards to keep the Ulcer open during the Patient’s Life: For he says, he has often seen, where such Sores were healed up, that the Patient died soon after by an Efflux of Matter upon the Breast.Monita Medica, Cap. i. Sect. 7.

TheSoldiers were subject at all Times to the Peripneumony, or Inflammation of the Lungs, from doing Duty in cold wet Weather, and from their irregular Way of living; but more particularly towards the End of the Campaigns, and in Winter.

This Disorder was much more dangerous and fatal than the Pleurisy, especially when neglected in the Beginning; for then Bleeding had seldom any Effect; the Difficulty of Breathing encreased, the Patient was seized with an Orthopnea, and such an Anxiety and Sense of Suffocation, that he could not sleep; and the Pulse sunk; and in these Cases Death only afforded Relief. This we experienced in manyMen who had lain neglected in Quarters, for two, three, four, or five Days, before they were brought to the Hospital.

In most of the Bodies of those who died of this Disorder, and were opened after Death; we found the Lungs violently inflamed, with livid or gangrenous Spots on their Surface; and more or less of a watery Serum extravasated into the Cavity of the Chest.

Three had Suppurations in the Lungs. In one, who had lain sick in Quarters for ten Days or upwards, before he was sent to the Hospital, the right Cavity of the Thorax was found full of a watery Serum; and the Lobes of the Lungs on the same Side almost entirely wasted; and what remained seemed as it were composed of thickened Membranes, resembling those formed by the coagulable Lymph, or what is called by some (though improperly) the fibrous Part of the Blood. The Lobes in the left Side seemed to be in a sound State, or at most but slightly inflamed. From the right Lobes of the Lungs being so much wasted, I suspected that the Patient had probably laboured longunder some Disorder of the Breast; but I could not from Enquiry obtain any Information in this Particular; nor did he ever mention such a Thing during the few Days he lived after being brought into the Hospital; he said, he had only been ill for eight or ten Days before; but Soldiers afflicted with chronic Distempers, when they are seized with violent Symptoms, or acute Diseases, are apt to reckon the Beginning of their Disorder, only from the Time they are taken ill in a violent Manner; and never to take any Notice of their former Complaints.

Another Soldier, about the Middle ofFebruary, 1762, remained in Quarters five Days after being taken ill with a Pain of the Breast, and a Difficulty of Breathing; the sixth Day he was brought to the Hospital in the Morning, and I saw him about eleven o’Clock; he then had all the Symptoms of the true Peripneumony, attended with a strong hard Pulse. He was immediately blooded as freely as his Pulse would bear, had Blisters applied, and other Remedies used; notwithstanding which,on the eighth Day from that Time, he began to throw up a purulent Matter in great Quantity, attended with a constant hectic Heat, and Fever; which sunk him so fast, that he died the tenth Day, after he first began to expectorate.

On the 2d ofMarch, a Soldier, of the Fifty-first Regiment of Foot, was brought to the Hospital, with a violent Pain in the left Side, and a great Difficulty of Breathing. Upon examining him, he told me, that about two Years before he had had a violent Stitch in his left Side, towards the lower Part of the Thorax; that ever since he had been subject to a Difficulty of Breathing; and at Times to a Pain in the Side; but that he had only been seized with the violent Pain and Difficulty of Breathing he then complained of, about five Days before, occasioned by catching Cold, on being billeted in a low, cold, and damp House.—His Pulse was quick, the Pain of his Side and Difficulty of Breathing so great, that he could not sleep, nor lie down, but was obliged to sit constantly in an erect Posture; his Tongue waswhite and furred, and he had had no Stools for three Days: He was ordered to be blooded immediately; and to take a Dose of Salts; and his Side to be rubbed with thelinimentum volatile. 3d. His Breathing and Pain of the Side were easier; he had slept a little in the Night, and could lie on his right side, but not on his left. He was ordered the Squill Mixture. 4th. His Breathing was worse; he was blooded a second Time; had a large Blister applied to his Side, and was ordered to continue the Use of the Squill Mixture. On the 5th, 6th, and 7th, he seemed easier, though the Breathing was still much affected, and his Pulse quick and low, attended with a hectic Heat. On the 8th, he told me that his left Side was swelled: On examining, I observed a Fullness in that Side of the Thorax; and on pressing with my Fingers between the Ribs, I thought I felt an obscure Fluctuation of a deep-seated Fluid. From these Appearances, and the History of the Case, I judged that there was a Collection of some Fluid within the Cavity of the Chest;and that the only Means left to give Relief, was to make an Opening into the Cavity, and so evacuate the Fluid. I therefore proposed to him the Operation of the Empyema, to be performed immediately; which he several Times obstinately refused to submit to: He allowed a Seton to be put in his Side, but that did not answer the End proposed: He languished six Days longer; and died the 14th ofMarch. Next Day an Opening was made in the Thorax, in the Part where the Operation was proposed to have been performed; as soon as the Pleura was cut through, some Quarts of Water rushed out. We then opened the Thorax, and found still some Water in the left Cavity. The Pericardium was thickened, and slightly inflamed, and adhered to the Diaphragm; which was likewise a little thickened and inflamed in the adhering Part; the Lungs on that Side were much compressed, and contracted by the Pressure of the Water; but on being inflated and cut, seemed in a sound State, except that they were slightly inflamed. TheLungs of the left Side adhered every-where firmly to the Thorax, but seemed otherwise sound; having no Tubercles, Suppuration, or other Disorder, that we could observe in cutting them. The Heart and Blood Vessels were sound, and no other polypous Concretions were observed within their Cavities, but such as we find in most dead Bodies; which seem to be formed of the coagulable Lymph inarticulo mortis. The Viscera of the Abdomen were in a sound State.

We treated the Peripneumony nearly as the Pleurisy. We bled freely in the Beginning, till the Breathing became easier, or the Pulse began to sink; taking Care not to be deceived by a low oppressive Pulse, which generally rose upon Bleeding. We applied large Blisters; gave the mild Pectorals freely, and plenty of warm diluting Liquors, Barley Water, the pectoral Decoction, and such like; which afforded more Relief than any other Medicines. We gave too saline Purges, and laxative Clysters occasionally; and in some Cases ordered theSteams of warm emollient Decoctions with Vinegar to be drawn into the Lungs.

By this Treatment most of them, who applied early for Relief, got the better of the Disorder.

When the Expectoration began, the Patient continued the free Use of the mild Pectorals, and diluting Liquors; and no Medicines were given that might in the least tend to stop it; other Evacuations were omitted, unless where the Pain of the Breast, or the Difficulty of Breathing increased; in which Case, if the Pulse kept up, I ordered a Vein to be opened, and a suitable Quantity of Blood to be taken away; no other Remedy affording any Relief, till this Evacuation was made. Where the Patient was costive, we frequently ordered laxative Clysters, or a mild Purge, and found them beneficial: But where no such Symptoms occurred, it was best, for the most part, to omit all Evacuations of this Kind, after a free Expectoration had begun, and to trust to it for carrying off the Disorder.

In some Cases, where the Expectoration stopt suddenly after bleeding, we gave with Advantage a gentle Vomit, as recommended by Dr.Huxham[52].

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