FOOTNOTES:

FOOTNOTES:[52]Some late Authors seem to look upon thePleurisyandPeripneumonyas the same Disorder: However, though it be true, that when thePleurais inflamed, the Surface of the contiguous Lungs is generally in the same State; and that, when theLungsare inflamed, the Pleura is often affected; yet as I have frequently seen the true Peripneumony without that sharp Pain of the Side which characterizes the Pleurisy; and upon opening the Bodies of People who have died of the Peripneumony, have found the Lungs violently inflamed and livid, and so filled with Blood as to sink in Water, without the Pleura being much diseased; and upon opening the Thorax of others who died of the Pleurisy, have found the intercostal Muscles and Pleura violently inflamed with livid Spots, and only a small Portion of the Surface of the contiguous Lungs affected; I cannot help still looking upon them as distinct Disorders; though they require nearly the same Treatment, and are often complicated together.

[52]Some late Authors seem to look upon thePleurisyandPeripneumonyas the same Disorder: However, though it be true, that when thePleurais inflamed, the Surface of the contiguous Lungs is generally in the same State; and that, when theLungsare inflamed, the Pleura is often affected; yet as I have frequently seen the true Peripneumony without that sharp Pain of the Side which characterizes the Pleurisy; and upon opening the Bodies of People who have died of the Peripneumony, have found the Lungs violently inflamed and livid, and so filled with Blood as to sink in Water, without the Pleura being much diseased; and upon opening the Thorax of others who died of the Pleurisy, have found the intercostal Muscles and Pleura violently inflamed with livid Spots, and only a small Portion of the Surface of the contiguous Lungs affected; I cannot help still looking upon them as distinct Disorders; though they require nearly the same Treatment, and are often complicated together.

Coughswere very frequent during the Winter, and when the Weather was wet and cold. They were often accompanied with Pains of the Breast; and, when neglected, Obstructions, Tubercles, and Suppurations, were apt to form in the Lungs, and the Disease to end in a Consumption, orPhthisis Pulmonalis.

When Coughs were slight, guarding against further Cold, and the Use of mild Pectorals and warm Drinks, removed them. But when the Patient complained of a Pain and Tightness about the Breast, it was always necessary to take away more or less Blood; and after Bleeding to give some of the mild Pectorals, such asthe Sperma Ceti or oily Mixtures; and, if a Fever attended, to join the Use of Nitre, or of the saline or mindereri Draughts; and, if a tickling Cough was troublesome, to give frequently a Tea Spoonful of the oily Linctus, acidulated either with the Spirit of Vitriol, or theoxymel scilliticum. The mild Diaphoretics, such as the mindereri Draughts, given along with warm Drinks, to promote a free Perspiration, or Sweat, were used with Advantage; when the Patients kept in Bed, and lay in Wards which had Stoves in them.

If the Cough and Pain of the Breast were not relieved by these Means, the Patient was bled a second Time, and a Blister applied to the Side immediately after; which often removed most of the Complaints. When it did not, we gave the pectoral Decoction for common Drink; and if there was a Shortness or Difficulty of Breathing, the squill Mixture, orlac ammoniacum, with Oxymel; and occasionally gentle Purges: And if at any Time of the Disorder the Tightness and Pain of the Breastreturned violent, we took away some Blood, no other Remedy affording Relief.

When there was little or no Fever, and a thin Rheum kept up a tickling Cough, nothing had a better Effect than to add some Drops of thetinctura thebaica, or some of theelixir paregoricum, to the oleagenous or squill Mixtures; or to give an Opiate Draught or Pill at Bed-Time, which eased the Cough, and procured the Patient Rest.

At all Times it was necessary, when the Cough was violent, attended with Pains of the Breast, to keep the Patients on low Diet; and in as free and pure Air as the Nature of the Hospitals would admit of; for we often found that those Men who had laboured long under obstinate Coughs, which threatened Consumptions in small crowded Wards, recovered surprisingly on being removed to a freer Air; of which we had a remarkable Instance in the Hospital atBremen, inJanuary1762; upon removing some Men, afflicted with very bad Coughs, out of small Wards, which were damp, into one large one, which was dry and airy.

When the Weather was good, we made the Patients walk out a little in the Day-Time; for we observed, that remaining always in the Hospital, and breathing nothing but a foul Air, helped to encrease the Disorder.—When we knew the Men to be sober, and not apt to commit Irregularities, we used to procure them good Billets, and make them come daily to the Hospital for their Medicines.

Equal Parts of Lime-Water and Milk, drank to the Quantity of a Quart a Day, was of Use to some; and theinfusum amarum, and other gentle Bitters, taken to the Quantity of an Ounce or two, Morning and Evening, to others[53].

A Decoction of the Cortex removed some Coughs which had continued for a considerable Time. In one or two of these Cases, slight hectic Symptoms had already appeared[54]. However, for the most part, where-ever Obstructions of the Lungs were confirmed, or there were evident hectic Symptoms withouta free Discharge of purulent Matter, the Bark did no Service; but rather heated and increased the Fever, and made the Sick more restless and uneasy.—It was of most Use where there seemed to be no confirmed Obstructions, but the Vessels much relaxed; which we judged to be the Case from the Patients having no fixed Pain, nor the Breathing much affected. If the Sick were plethoric, or in the least feverish, we ordered a little Blood to be taken away, before we began the Use of this Medicine.

In similar Cases, I have sometimes observed good Effects from the Use of the BalsamCopaivy, orPeru; given either in Juleps or made up into an Electuary, as in theelectuarium e spermate ceti cum balsamo; but in whatever Form they were given, if there were confirmed Obstructions of the Lungs, they rather heated and inflamed, than did any real Service.

When Coughs continued long, attended with Pain in the Side, Difficulty of Breathing, and Hectic Fever and Night Sweats, we alwayshad Reason to suspect, that the Disorder would terminate in a confirmed Consumption. When this was threatened, we found, that the principal Thing to be done, was to keep the Patients cool; and to endeavour to allay the hectic Heat and Fever; and to retard, as much as possible, the Progress of the Disorder. When the Case was recent, we were sometimes so lucky as to make a Cure; but after it was confirmed, it for the most part ended fatally.

We kept the Patients upon a low Diet; and where-ever Milk was to be got easily, we allowed them a Pint a Day[55]; which was either mixed with Water and given for Drink, or they took it to Breakfast or Supper.—Their common Drink was either Barley Water or the pectoral Decoction; which was occasionally acidulated with a few Drops of Spirit ofVitriol; and we gave at the same Time the cooling Medicines, such as Nitre, the saline or mindereri Draughts, mixed at Times with Sperma Ceti, or some other of the mild Pectorals.

The opening a Vein, and taking away from four to eight Ounces of Blood[56], whenever the Pain of the Breast was troublesome, or the Patient was hot and restless at Nights from the Hectic Fever, gave the greatest Relief of any Thing we tried; and these repeated small Bleedings were so far from wasting the Patient’s Strength, that they rather seemed to prevent its being exhausted so fast as otherwise it would have been, by allaying the Force of the Hectic Fever.

At this Stage of the Disorder, we put in Setons, or ordered Issues, to serve as a Drain to carry off the Matter, and found them of Advantage in some Cases. When the Patientscomplained of any fixed Pain, we always made the Issues as near the Part affected as possible[57]. On the 5th ofMay, 1762, a Man, belonging to the Eighty-eighth Regiment of Foot, was sent to the Hospital atBremenfor an Hæmoptoe, attended with a constant hectic Heat and Fever.—After being blooded, and using the cooling Remedies without Success, he had four Pea Issues made in his Back; and had a slight Decoction of the Cortex, acidulatedwith Spirit of Vitriol. As soon as the Issues began to discharge freely, the hectic Heat, Fever, and Spitting of Blood, diminished daily; and he recovered his Health and Strength in a short Time. However, it ought to be observed, that although these Drains are sometimes efficacious, yet, when the Disease is far advanced, the Mischief is generally too deep rooted for them to be of any Service.

The Bark, and natural Balsams, for the most part were prejudicial, and encreased the Hectic Heat and Fever; except in one or two Cases, where the Disorder seemed to depend on a Vomica of the Lungs, and the Patient coughed up the Matter freely.—In one Case they were of considerable Service; the Patient was very low, and had the Night Sweats, but coughed up the Matter freely: On using the Decoction of the Bark, and theelectuarium e spermate ceti cum balsamo, the Matter expectorated became thicker, and of a more balmy Consistence, without any Increase of Heat or Fever; after which the Symptoms became gradually milder, and the Patient recovered.

In the Course of this Disorder the Patients often became very hot and restless, and were troubled with Gripes, succeeded by a Purging: These Symptoms were most readily removed by a Dose of Rhubarb, or of some other mild Purge; for they generally proceeded from corrupted Humours lodged in the Intestines. In the Evening, after the Operation of the Purge, we gave an Opiate to procure the Patient Rest.—When the first Dose of Physic did not stop the Purging, we repeated the Opiates at Nights, and in a Day or two gave another Purge; and if there was much Sickness, or Load at the Stomach, gave likewise a gentle Emetic.

If the Purging still continued, we were obliged to join the Use of Astringents along with the Opiates. In some Cases, I found good Effects from equal Parts of Milk and Water boiled with Rose Leaves, Pomegranate Bark, Balaustine Flowers, and Cinnamon, as recommended by Dr.Meadin hisMonita Medica[58]; it servedboth for Food and Medicine.—When Opiates and Astringents were given to stop the Purging at its first Appearance, before the Bowels were emptied, they always did Mischief; and increased the Heat and Fever: And although they stopt the Purging for a few Hours, it always broke out with greater Violence afterwards.

When the Sick were attacked with a Shortness and Difficulty of Breathing, which was not relieved by Evacuations, and the Use of cooling Medicines, and Pectorals, and Blisters, nothing gave so much Ease, or had such a good Effect, as a gentle Vomit; for it often removed the immediate Oppression from the Breast, and helped to pump up the Matter from the Lungs.

In the advanced State of the Consumption, the Cough was always very troublesome; and the Sick found no Relief but from Opiate Medicines, which, in such Cases, cannot be expected to do more than give a little present Ease.—As they were apt to obstruct the free Expectoration, we generally mixed them withsomeoxymel scilliticum, ortinctura fœtida, which took off a good deal of their suffocating Quality.

Dr.Barry[59]advises for the Cure of a Consumption, to make an Incision or Aperture into the Side; where-ever there is a fixed Pain attended with a Weight, a Hectic Fever, and other Symptoms of an evident Suppuration: He says the Pleura is thickened, and the Lungs adhere at the Part where they are exulcerated; and that by the Operation the Pus may be evacuated, and a Cure made; and he gives several Instances of the Success of the Operation, when performed in Time.

FOOTNOTES:[53]Asses Milk, andBristolandSeltzerWaters, which are found so serviceable in pulmonic Disorders, could not be had in the military Hospitals; and riding on Horseback was too expensive a Remedy for a Soldier.In chronic Cases, where we suspect Obstructions and Tubercles to be formed in the Lungs, which have not already come to Suppuration, Dr.Russelrecommends the Use of Sea Water for resolving them; but we were at too great a Distance from the Sea to try this Remedy. See hisTreatise on Sea Water, Page 17.[54]Mary Shepperd, a Woman twenty-six Years of Age, was admitted intoSt. George’s Hospital the 6th ofJune, 1759, for a Cough; attended with a constant hectic Fever and Night Sweats, which had begun in the Month ofApril, after the Measles. She complained likewise of having thefluor albus, and she had been blooded more than once before she came to the Hospital.—I at first gave her some of the mild Pectorals; and a Solution of White Vitriol in Water,utenda pro inject. uterina. After a Week, finding no Alteration in her Complaints, I advised her to become an Out-patient; and to go down to her Friends in the Country, to live upon a Milk Diet; to take gentle Exercise, and continue the Use of her Medicines; which she did, but without any Alteration in her Disorder, till the 6th ofJuly, when I ordered her to take thrice a Day two Ounces of the Decoction of the Cortex, along with a saline Draught. Immediately, on beginning to use this Medicine, her Disorder began to take a favourable Turn; her Fever and Night Sweats left her, her Cough became easier, and she recovered Health and Strength daily. She came to the Hospital the 15th ofAugust, seemingly in good Health, to return Thanks for her Cure.[55]In private Practice, at this Stage of the Disorder, the Use of Asses Milk, and drinking theBristolWater at theBristolWells, and riding on Horseback daily, are justly ranked amongst the most efficacious Remedies; and going into the more southern Climates, as the South ofFrance,Portugal, orItaly, where the Air is warmer, more constant, and dry, than inEngland, has often been found to produce good Effects.[56]This Practice has been strongly recommended by Dr.Mead, in hisMonita Medica, Sect. x. and by an anonymous Author in theEdinburgh Medical Essays, Vol. IV. Art. 28. and Dr.Meadsays, when Things have not been quite desperate, he has seen good Success from it.[57]InJune, 1748, a Servant Girl came to ask my Advice for a Cough, attended with a constant Hectic Fever and Night Sweats, which had begun some Months before, on catching Cold. The Matter she spit up was yellow, and had the Appearance of Pus; and she complained of a Pain in the left Side of the Thorax. I ordered her the saline Mixture with Sperma Ceti to be taken thrice a Day, to lose a little Blood, to drink an Infusion of Linseed sweetened with Honey, and to have a Seton put in her Side at the Part where she complained of Pain; advising her to go home to her Father, who was a Farmer in the Country, and to live upon a Milk and Vegetable Diet, and ride on Horseback whenever she could conveniently. She seemed so far gone in a Consumption, that I scarce expected to see her again; but, in the Month ofDecember, she came to return me Thanks for her Cure, seeming then to be in good Health. She told me, that, as soon as the Seton began to discharge freely, she found Relief; and mended afterwards daily, by following the Directions I had given her.[58]Sect.x.de Febrib. lentis sive Hecticis.[59]Treatise on the Digestions, p. 410.

[53]Asses Milk, andBristolandSeltzerWaters, which are found so serviceable in pulmonic Disorders, could not be had in the military Hospitals; and riding on Horseback was too expensive a Remedy for a Soldier.In chronic Cases, where we suspect Obstructions and Tubercles to be formed in the Lungs, which have not already come to Suppuration, Dr.Russelrecommends the Use of Sea Water for resolving them; but we were at too great a Distance from the Sea to try this Remedy. See hisTreatise on Sea Water, Page 17.

In chronic Cases, where we suspect Obstructions and Tubercles to be formed in the Lungs, which have not already come to Suppuration, Dr.Russelrecommends the Use of Sea Water for resolving them; but we were at too great a Distance from the Sea to try this Remedy. See hisTreatise on Sea Water, Page 17.

[54]Mary Shepperd, a Woman twenty-six Years of Age, was admitted intoSt. George’s Hospital the 6th ofJune, 1759, for a Cough; attended with a constant hectic Fever and Night Sweats, which had begun in the Month ofApril, after the Measles. She complained likewise of having thefluor albus, and she had been blooded more than once before she came to the Hospital.—I at first gave her some of the mild Pectorals; and a Solution of White Vitriol in Water,utenda pro inject. uterina. After a Week, finding no Alteration in her Complaints, I advised her to become an Out-patient; and to go down to her Friends in the Country, to live upon a Milk Diet; to take gentle Exercise, and continue the Use of her Medicines; which she did, but without any Alteration in her Disorder, till the 6th ofJuly, when I ordered her to take thrice a Day two Ounces of the Decoction of the Cortex, along with a saline Draught. Immediately, on beginning to use this Medicine, her Disorder began to take a favourable Turn; her Fever and Night Sweats left her, her Cough became easier, and she recovered Health and Strength daily. She came to the Hospital the 15th ofAugust, seemingly in good Health, to return Thanks for her Cure.

[55]In private Practice, at this Stage of the Disorder, the Use of Asses Milk, and drinking theBristolWater at theBristolWells, and riding on Horseback daily, are justly ranked amongst the most efficacious Remedies; and going into the more southern Climates, as the South ofFrance,Portugal, orItaly, where the Air is warmer, more constant, and dry, than inEngland, has often been found to produce good Effects.

[56]This Practice has been strongly recommended by Dr.Mead, in hisMonita Medica, Sect. x. and by an anonymous Author in theEdinburgh Medical Essays, Vol. IV. Art. 28. and Dr.Meadsays, when Things have not been quite desperate, he has seen good Success from it.

[57]InJune, 1748, a Servant Girl came to ask my Advice for a Cough, attended with a constant Hectic Fever and Night Sweats, which had begun some Months before, on catching Cold. The Matter she spit up was yellow, and had the Appearance of Pus; and she complained of a Pain in the left Side of the Thorax. I ordered her the saline Mixture with Sperma Ceti to be taken thrice a Day, to lose a little Blood, to drink an Infusion of Linseed sweetened with Honey, and to have a Seton put in her Side at the Part where she complained of Pain; advising her to go home to her Father, who was a Farmer in the Country, and to live upon a Milk and Vegetable Diet, and ride on Horseback whenever she could conveniently. She seemed so far gone in a Consumption, that I scarce expected to see her again; but, in the Month ofDecember, she came to return me Thanks for her Cure, seeming then to be in good Health. She told me, that, as soon as the Seton began to discharge freely, she found Relief; and mended afterwards daily, by following the Directions I had given her.

[58]Sect.x.de Febrib. lentis sive Hecticis.

[59]Treatise on the Digestions, p. 410.

Aftera very cold severe Winter atBremen, the Weather, from being very cold, became of a sudden extremely hot, about the 10th ofApril. In a few Days after, many People were seized with a violent Catarrhal Disorder. It often began with such a Cold and Shivering, that many imagined at first that they were going to have Agues; but soon after they were attacked with a Cough, and a Difficultyof Breathing, and Pain of the Breast, with a Head-Ach, and Pains all over the Body, especially in the Limbs.—The first Nights they commonly had profuse Sweats.—In several, it had the Appearance of a remitting Fever, for the two or three first Days.—Many had a slight Inflammation of the Throat, and a Hoarseness. In all it was attended with an acute Fever in the Beginning, and the Urine was of a high Colour; and when the Disorder had put on the Appearance of a Remittent Fever in the Beginning, it dropt a Sediment towards Morning after the second Day; and did the same in all, when the Disorder was going off.—Some had a Purging, but the greater Number were rather inclined to be costive.—The Cough in many was very violent; and the Patients, after each Fit of Coughing, had Reachings, or Strainings to vomit, exactly resembling those which come after violent Fits of the Hooping Cough.—At first the Patients spit up only a little Phlegm; but in the Decline of the Disorder, they expectorated freely.—The violent Cough and Feverishness generally continued for four, five,or six Days; with others it continued longer; and some had a Cough for two or three Weeks after the Fever left them.

This Catarrhal Fever seized most of the People of the Town ofBremen; and there were very few of theBritishwho escaped it; at the same Time, it was epidemical in most Countries inEurope.

We treated it entirely as an inflammatory Disorder, and none died who applied early for Relief.—Most People recovered by one plentiful Bleeding, and taking the mild cooling Medicines, such as themixtura e spermate ceti cum nitro, the saline or mindereri Draughts, or such like. When the Fever and Difficulty of Breathing continued after the first Bleeding, in a Day or two a Vein was opened a second Time; and immediately after a Blister was applied to the Back, which commonly removed the Fever, and relieved the Breathing.—When the Patients were inclined to be costive, a Dose of Physic was of Service.

None of theBritishdied, except one or two of the Soldiers, who remained in Quarters afterbeing taken ill; and, instead of bleeding and living low, indulged in the Use of spirituous Liquors; and were not brought to the Hospital, till they were in the last Stage of a Peripneumony.—Many of the Inhabitants of the Town died of this Disorder, which was probably owing to Want of Care.

TheRheumatism is one of the Disorders most generally to be met with in military Hospitals. There were at all Times some Men in our Hospitals labouring under Rheumatic Fevers, or other rheumatic Complaints; though we never had at any one Time a great Number; owing probably to the Weather being very favourable in both the Campaigns of 1761 and 1762.—It was always most frequent when the Weather was wet and cold; both during the Campaign, and when we were in Winter Quarters.

It commonly began either, 1. With an acute Fever, and Pains all over their Body: or, 2. With Pains in particular Parts, as the Shoulders, Legs, Arms, Knees, and sometimes of the Side, attended with some Degree of a Fever.—The first was the most common Form it assumed, when Men were attacked with it in the Field or in Garrison; owing to their doing Duty in cold wet Weather.—The other Causes generally took place when they had been formerly subject to rheumatic Complaints, and had caught Cold; or after they had been weakened and reduced low by Fevers, Fluxes, or other Disorders.

We had but very few Rheumatisms accompanied with Swelling, Pain, and Inflammation of the Joints of the Knees and Wrists, &c. which are so common in our Hospitals aboutLondon. I did not meet with above a Dozen Cases, of this Kind, whilst inGermanywith the Army.

When the Rheumatism began with Pains all over the Body, attended with a High Fever, we treated it at first entirely as an InflammatoryFever[60]. We blooded freely, and repeated this Evacuation often[61], if the Blood continued sizy, and the Pains violent; provided the Pulse was strong. When the Pleura, the Lungs, or any other of the Viscera were affected, we blooded as freely as we should have done in acute Inflammations of these Parts:We gave the saline Draughts with Nitre[62]; and Plenty of Barley Water and other weak diluting Liquors; and gentle Physic once or twice a Week; and afterwards applied Blisters, which often relieved both the Pains and Fever.

After some Days, if the Pains still remained, we continued the saline Draughts with Nitre throughout the Day; and in the Evening endeavouredto promote a free Perspiration by Means of the mild Diaphoretics, such as the mindereri Draughts with Mithridate, in Doses frequently repeated; at the same Time, the Patient kept in Bed, and drank freely of mild diluting Liquors. Sometimes we gave twenty, thirty, or forty Drops of Spirits of Hartshorn, in repeated Draughts of warm Barley Water: or a like Quantity of the Antimonial Wine, used in the same Manner: or from sixty to a hundred Drops of the Antimonial Wine, mixed with one-fourth Part of thetinctura thebaica, in a large Draught of some warm Liquor; which I have observed, in many Cases, to have a better Effect, than most other Medicines used for this Purpose; as it acts both as an Opiate in easing the Pain, and procuring Rest; at the same Time that it promotes a free Perspiration, or gentle Sweat, to carry off the Distemper.

But it should be observed, that, in the Beginning of Rheumatic Fevers, forced Sweats generally did Hurt, and often increased both the Pain and Fever; and that in general wehad greater Success, and made speedier Cures, when we did not attempt to promote Sweating, till after other Evacuations had been sufficiently made, and the Fever had begun to abate; and that in this Fever, when we did attempt to procure Sweats, the milder Diaphoretics, with Plenty of weak diluting Liquors, answered better than those of a more heating Nature; though after the Fever was gone, and the Pains still continued, sometimes the stronger Sudorifics, such as G. Guaiac, and its volatile Tincture,Dover’s Powder, and the like, best answered the Purpose, and carried off the Distemper, when the milder ones had little Effect.

I have often observed, where Sweating made no Change in the Distemper, that keeping up a free Perspiration by Means of the Decoction of the Sarsaparilla with the Antimonial Wine, or small Doses of thepulvis antimonialis(gr.v.), given twice or thrice a Day, removed Rheumatisms, which had resisted the Force of other Remedies.

Sometimes the cold Bath[63]removed Pains which had not yielded to internal Medicines; but it ought to be observed, that when Patients went into the cold Bath while the Feverishness still remained, and the Blood continued sizy, or before free Evacuations had been made, oftentimes, instead of giving Relief, it made the Disorder worse, and more obstinate[64].

When the Rheumatism was confined to a particular Part, attended with Fever, we treated it as the acute Rheumatism. Fomenting the Part with warm emollient Decoctions, andrubbing it afterwards with the volatile, or saponaceous Liniments, often gave Ease; and the Application of Cupping-Glasses and Blisters frequently removed the Disorder. In some Cases, where the first Blister did not relieve, the Application of a second, and afterwards keeping up a Discharge from the Part by Means of the Epispastic Ointment, carried off the Pain. In others, where the mild Diaphoretics were ineffectual, Sweating, with the G. Guaiac, orDover’s Powder, and such other Medicines, after the Fever was gone, removed the Complaints[65].

When the Rheumatism was attended with Inflammation and Swelling of the Joints, we blooded freely, gave cooling Purges, and the saline Draughts with Nitre, along with Plenty of weak diluting Liquors, and prescribed a cool low Diet.

After the Violence of the Fever and Inflammation was abated, fomenting the Parts, and rubbing them with the saponaceous or volatile Liniments, sometimes hastened the Discussion of the Swelling; as did likewise the Application of Blisters[66], after the Inflammation wasentirely gone; but it ought to be noticed, that if volatile Liniments or Blisters are used too soon, they will sometimes occasion violent Inflammation and Pain[67].

Rheumatic Cases of this Kind are often very obstinate, and require a considerable Length of Time before they are got the better of; and frequently more or less of the Swelling, especially of the Wrists and Joints of the Fingers, remains ever after; and Patients, who have once had the Rheumatism in this violent Degree, are always subject to Relapses; as are even those who have had the Rheumatism but slightly.

Mercury[68]has been recommended in theCure of Rheumatisms; but I never found it do any Service by itself, except in Cases complicated with venereal Symptoms; though I have often given it, and even sometimes gone so far as to raise a Salivation, where the Pains were most severe in the Night; and the Patient, at the same Time, thought he had some Reason to suspect a venereal Taint, though no external Symptom appeared. However, many good Practitioners have recommended small Doses of Calomel to be given at Nights, and next Morning a Purge; in which Way, I think, I have observed good Effects from its Use.

The Bark was frequently of Use in restoring the Strength, and removing those rheumatic Pains which remained after Fevers, and other Disorders; but, in other Cases, it had little Effect.

When the Rheumatism continues long, and has taken deep Root,Sydenham[69]advises to bleed from Time to Time, at some Weeks Distance; which, he says, will either entirelyremove the Disease, or bring it to that Condition, that the Remains of it will be easily extirpated by an Issue; and giving some of the volatile Salts inCanaryWine, Morning and Evening. I have always observed in rheumatic Cases, which continued long, that, after free Evacuations, the Patients received more Benefit from a mild low Diet, continued for some Time, and the Use of diluting Decoctions with mild Diaphoretics, while they took gentle Purges once or twice a Week, than from any other Remedies.

I have given Half an Ounce of Soap a Day, for a considerable Time, in some old rheumatic Cases, in the Manner recommended by the late Dr.John ClerkofEdinburgh, as mentioned by Dr.Pringle; and, I think, with Advantage; but have not had sufficient Trials to ascertain the Merits of this Medicine.

Dr.Sydenham, in treating of the Rheumatism, which he calls scorbutic, says; that after it had resisted Bleeding, Purging, low Diet, and other Remedies, he has cured it by giving thrice a Day two Drachms of an Electuarymade ofconserv. cochlear. horten. recent. unc.ij.lujul. unc.i.pulv. ar. comp. drachmvi.cum syrup. aurant.q. s. drinking after it three Ounces of a Water drawn fromBrunswickBeer, and some of the antiscorbutic Plants.

There is no Disorder which Soldiers are so apt to counterfeit as the Rheumatism, when ever the Duty in the Field is severe; but while there is no Fever or Size in the Blood, or other evident Marks of the Distemper, and the Men look healthy, there is always Reason to suspect Imposture.

FOOTNOTES:[60]Sydenham, in treating of this Disease, orders Bleeding, and that to be repeated next Day; and afterwards every other Day, two, three, or four Times, or more, as the Patients Strength can bear it; and on the intermediate Days to give a purgative Clyster. But in young People, and those who have lived regularly, he says, that a very low Diet will cure as effectually as Bleeding and Medicines; That the Patients must live four Days on Whey alone, but after this may eat Bread for Dinner; and on the last Days for Supper also; and when the Symptoms begin to abate, he allows them to eat boiled Chicken, or other light Food; but says they must live every third Day on Whey, till their Strength returns.Precess. Integr. de Rheumatismo.[61]A Remark of Dr.Huxham’s deserves to be taken Notice of here: He tells us, that there are some Kinds of Rheumatisms,viz.those which come from a sharp serous Rheum, which do not bear the free Use of the Lancet; that plentiful Bleeding does more Hurt than Good; and that, in such Cases, the Medicines which bring out breathing Sweats, and at the same Time correct the Acrimony of the Blood, joined with gentle Opiates, have a much better Effect.De Aere, Vol. II. p. 185.[62]Dr.Brocklesby, in hisObservations on military Diseases, recommends the Use of large Quantities of Nitre dissolved in Water Gruel, or Sage Tea, (in the Proportion of two Drachms of the Nitre to a Quart of the Liquor) in acute Rheumatisms. He says, “I am assured from numberless Instances, that in stout young Men, by taking six hundred Grains (ten Drachms) daily, for four or five Days successively, and diluting plentifully, as before recommended, plain Nitre proves the most powerful and best Sudorific, in such Complaints, that I have ever tried; and this Quantity, and even more, may be retained in the Stomach, and pass through the Course of the Circulation, by only diluting properly with those thin attenuating Beverages as before recommended. Such Quantities, in three or four Days, seldom failed wonderfully to relieve the Patient, and very often to cure him entirely, by the most plentiful and profuse Sweats.”See from p. 116, to p. 124.I have never hitherto given Nitre in such large Quantities as here recommended by Dr.Brocklesby.[63]I have frequently ordered the warm Bath with Advantage in Rheumatic Cases inSt. George’s Hospital; but we had no Convenience of this Kind with the flying Hospital inGermany.[64]This I have seen many Instances of, particularly in the Case ofAnn Walker, a Woman of twenty three Years of Age, who was under my Care inSt. George’s Hospital, inMay, 1759. Before she came to the Hospital, she had been blooded, and had gone into the cold Bath four Times, which, she told me, had increased her Pains to a violent Degree; in which State she had continued for some Weeks before she came to the Hospital; but by being blooded, and taking the cooling saline Medicines, with gentle Purges, and mild Diaphoretics, she got well in a Month’s Time.[65]Warm Water, pumped upon the Part, often removes such rheumatic Pains as have resisted the Force of internal and other Remedies. On the 29th ofAugust, 1759,Mary Wardwas admitted intoSt. George’s Hospital for rheumatic Pains of the Arms, Legs, and Knees, attended with Fever, which all yielded to Evacuations, and the Use of cooling Medicines, mild Diaphoretics, and of the warm Bath, except the Pain of the Knee; which, after it had resisted the Course above-mentioned, was at last removed by pumping warm Water on the Part, three Times a Week; joined to the Use of Fomentations and volatile Liniments.[66]Ann Ragen, a Woman about thirty-three Years of Age, was admitted intoSt. George’s Hospital the 17th ofJanuary, 1759, for rheumatic Pains of her Legs and Arms, and a Swelling of her right Knee. Free Evacuations, and the Use of cooling Medicines, and mild Diaphoretics, removed all her other Complaints, except the Swelling of the Knee, by the Middle ofFebruary, when I ordered a Blister to be applied to it; after which the Swelling gradually decreased, and she was discharged, cured, the 20th ofMarch.—Rachael Hyde, a Woman twenty-four Years of Age, was admitted intoSt. George’s Hospital the 9th ofMay, 1759, for similar Complaints, which were removed by the same Means, all except the Swelling of the Knee. A Blister was applied, and most of the Swelling went away, but returned soon after: It was at last removed by the Use of the warm Pump three Times a Week, and drinking a Pint of the Guaiac Decoction daily.[67]I have sometimes ordered Leetches to be applied to such Swellings (as recommended by Dr.Pringle), and found them to be of Service; and, at other Times, I have applied emollient Fomentations and Poultices, which have given great Ease to the Patient.—I have seen Setons or Issues, made near the Part affected, afford considerable Relief.[68]Dr.Musgrave, in his Treatisede Arthritide Symptomat.p. 30, cap. ii. sect. 10, says, he has known a Salivation, raised by Mercury, cure the Rheumatism.[69]VideSydenham. Opera.sect. vi. cap. 5.

[60]Sydenham, in treating of this Disease, orders Bleeding, and that to be repeated next Day; and afterwards every other Day, two, three, or four Times, or more, as the Patients Strength can bear it; and on the intermediate Days to give a purgative Clyster. But in young People, and those who have lived regularly, he says, that a very low Diet will cure as effectually as Bleeding and Medicines; That the Patients must live four Days on Whey alone, but after this may eat Bread for Dinner; and on the last Days for Supper also; and when the Symptoms begin to abate, he allows them to eat boiled Chicken, or other light Food; but says they must live every third Day on Whey, till their Strength returns.Precess. Integr. de Rheumatismo.

[61]A Remark of Dr.Huxham’s deserves to be taken Notice of here: He tells us, that there are some Kinds of Rheumatisms,viz.those which come from a sharp serous Rheum, which do not bear the free Use of the Lancet; that plentiful Bleeding does more Hurt than Good; and that, in such Cases, the Medicines which bring out breathing Sweats, and at the same Time correct the Acrimony of the Blood, joined with gentle Opiates, have a much better Effect.De Aere, Vol. II. p. 185.

[62]Dr.Brocklesby, in hisObservations on military Diseases, recommends the Use of large Quantities of Nitre dissolved in Water Gruel, or Sage Tea, (in the Proportion of two Drachms of the Nitre to a Quart of the Liquor) in acute Rheumatisms. He says, “I am assured from numberless Instances, that in stout young Men, by taking six hundred Grains (ten Drachms) daily, for four or five Days successively, and diluting plentifully, as before recommended, plain Nitre proves the most powerful and best Sudorific, in such Complaints, that I have ever tried; and this Quantity, and even more, may be retained in the Stomach, and pass through the Course of the Circulation, by only diluting properly with those thin attenuating Beverages as before recommended. Such Quantities, in three or four Days, seldom failed wonderfully to relieve the Patient, and very often to cure him entirely, by the most plentiful and profuse Sweats.”See from p. 116, to p. 124.I have never hitherto given Nitre in such large Quantities as here recommended by Dr.Brocklesby.

I have never hitherto given Nitre in such large Quantities as here recommended by Dr.Brocklesby.

[63]I have frequently ordered the warm Bath with Advantage in Rheumatic Cases inSt. George’s Hospital; but we had no Convenience of this Kind with the flying Hospital inGermany.

[64]This I have seen many Instances of, particularly in the Case ofAnn Walker, a Woman of twenty three Years of Age, who was under my Care inSt. George’s Hospital, inMay, 1759. Before she came to the Hospital, she had been blooded, and had gone into the cold Bath four Times, which, she told me, had increased her Pains to a violent Degree; in which State she had continued for some Weeks before she came to the Hospital; but by being blooded, and taking the cooling saline Medicines, with gentle Purges, and mild Diaphoretics, she got well in a Month’s Time.

[65]Warm Water, pumped upon the Part, often removes such rheumatic Pains as have resisted the Force of internal and other Remedies. On the 29th ofAugust, 1759,Mary Wardwas admitted intoSt. George’s Hospital for rheumatic Pains of the Arms, Legs, and Knees, attended with Fever, which all yielded to Evacuations, and the Use of cooling Medicines, mild Diaphoretics, and of the warm Bath, except the Pain of the Knee; which, after it had resisted the Course above-mentioned, was at last removed by pumping warm Water on the Part, three Times a Week; joined to the Use of Fomentations and volatile Liniments.

[66]Ann Ragen, a Woman about thirty-three Years of Age, was admitted intoSt. George’s Hospital the 17th ofJanuary, 1759, for rheumatic Pains of her Legs and Arms, and a Swelling of her right Knee. Free Evacuations, and the Use of cooling Medicines, and mild Diaphoretics, removed all her other Complaints, except the Swelling of the Knee, by the Middle ofFebruary, when I ordered a Blister to be applied to it; after which the Swelling gradually decreased, and she was discharged, cured, the 20th ofMarch.—Rachael Hyde, a Woman twenty-four Years of Age, was admitted intoSt. George’s Hospital the 9th ofMay, 1759, for similar Complaints, which were removed by the same Means, all except the Swelling of the Knee. A Blister was applied, and most of the Swelling went away, but returned soon after: It was at last removed by the Use of the warm Pump three Times a Week, and drinking a Pint of the Guaiac Decoction daily.

[67]I have sometimes ordered Leetches to be applied to such Swellings (as recommended by Dr.Pringle), and found them to be of Service; and, at other Times, I have applied emollient Fomentations and Poultices, which have given great Ease to the Patient.—I have seen Setons or Issues, made near the Part affected, afford considerable Relief.

[68]Dr.Musgrave, in his Treatisede Arthritide Symptomat.p. 30, cap. ii. sect. 10, says, he has known a Salivation, raised by Mercury, cure the Rheumatism.

[69]VideSydenham. Opera.sect. vi. cap. 5.

TheRemitting Autumnal Fever, called by the Antients συνεχης, was also one of the most frequent Disorders during the Campaign.

This Fever is observed in most Countries, after the Juices have been highly exalted by the Heat of Summer; and People are exposed to the Heats of Mid-Day, and to the cold Damps of the Night. We observe it every Year in the Neighbourhood ofLondon, especially among the labouring People, who work in the Fields, towards the End of Summer, and in Autumn; but it is generally in a milder Degree than in Armies, where Men are more exposed to the Vicissitudes of the Weather.

As we go further towards the South, this, as well as other bilious Disorders, becomes more frequent.

This Fever is reckoned the endemic Distemper of theWest Indies, of the Coast ofGuinea, and other Places in the Torrid Zone; but in those warm Countries it appears in a more violent Degree; makes a much more rapid Progress; and proves far more fatal than in our cooler and more temperate Climate. And it is observed to be always most frequent and most fatal where a Country is covered with Wood, or is marshy; and where there are frequent Fogs, and much stagnating Water, which corrupts by the Heat of Summer.

InJanuary,February, andMarch1761, we had none of those Remitting Fevers atPaderborn. InApril, some few of the Soldiers, on their Return from the Winter-Expedition intoHesse-Cassel, had Fevers attended with bilious Symptoms; but they were rather of the continued, inflammatory Kind, and tending to malignant, than such as could be called remitting.

The first Time that I saw much of this Fever, was among the Sick sent toBilifieldin the End ofJune1761; soon after the Army took the Field. The Remissions were short, and it partook much of the Nature of the common Inflammatory Fever; and most of them were cured by the antiphlogistic Method. A Day or two before we left this Place, it began to change into the Malignant Hospital Fever, from the Sick being too much crowded.

In the Middle ofJuly, about Twelve Hundred Sick were sent to the Hospital atMunster; and about one-third Part were ill of this Remitting Fever. It did not partake near so much of the inflammatory Nature as atBilifield; the Remissions became much more evident; and it was attended much oftener in the Beginning with bilious Vomiting and Purging; and in some few the Disorder turned to a Dysentery. About eight or nine had it changed into the Hospital Fever, from the Wards in one of the Hospitals being too much crowded; and in some few the Disorder terminated in regular Agues. InNovemberseverals were takenill of it in the Garrison ofBremen, which mostly ended in a regular Intermittent, the endemic Distemper of the Place. Towards the End ofDecemberwe had none of these Remitting Fevers, the Disorders turning more to the inflammatory Kind.

InJune1762, this Fever began to appear again among the Sick, sent from the Army, to the Hospital atNatzungen; and it continued to be frequent through the Summer and Autumn; and the greatest Part of these Fevers this Year terminated in regular Agues, mostly in Tertians, and were cured by the Bark; whereas the Year before very few terminated this Way.

This Disorder in the Beginning had commonly the Appearance of a continued Fever; and many had a Sickness and Vomiting, and threw up a Quantity of yellow Bile, mixed with the Contents of the Stomach. In a few Days, especially after Bleeding, the Remissions became clear; tho’ on its first Appearance inJune1761 they were short, and rather obscure; and it seemed still to partake a good deal of theNature of the common Inflammatory Fever, the Blood being very sizy; but as the Season advanced, the Remissions became more evident, and the Paroxysms more like those of an Ague; and the Blood less sizy, tho’ at all Seasons of the Year it had some Appearance of an inflammatory Buff in this Disorder. The Sick were restless and uneasy at Night; but commonly felt themselves cooler and lighter in the Day-Time: and although they had no cold Fit, as the Fever came on at Nights, and many of them no Breathing Sweat, as they became cooler and freer from the Fever in the Morning; yet the Fits were so remarkable, that many of the Patients used to say they had a regular Fit of an Ague every Night, or towards the Morning; and some few, that they had the Fit every second Night. As the Season advanced, the Remissions appeared more distinct. However, there was always a good Number in whom the Fever went on in a continued Form, through its whole Course, without any Signs of Remission; tho’ they had all the other Symptoms of this Fever. In a fewInstances the Fever, after it came to remit, changed again into a continued Form.

The Heat in the Time of the Paroxysms rose high, and several were delirious during its Continuance[70]; but were quite sensible in the Intervals, though never wholly without the Fever.

At the End ofJuly1761, four or five were attacked with a Bleeding at the Nose, in the Time of the Paroxysms, and became cooler afterwards; but it did not prove a Crisis in any of them.

The Urine in the Beginning was commonly of a high Colour, though sometimes it was pale and limpid: At first it deposited no Sediment; but when the Fever came to remit, there was often a small Sediment after each Paroxysm; and as the Fever was going off, it let fall a Sediment in all[71].

Some at first were inclined to be costive; others had a Sickness and Purging; and several of those who were costive in the Beginning, were in the Course of the Disorder attacked with a Purging; and others, after some previous Complaint of the Stomach, were seized with both Vomiting and Purging. In general, after the Sick continued some Days in the Hospital, they were inclined to be loose; which was a favourable Circumstance, when this Evacuation was not so great as to be in Danger of sinking the Patient. Some were attacked with a Dysentery.

In this, as well as in most other Fevers, the Sick frequently passed by Stool Worms of the round Kind; and sometimes they vomited them up, or the Worms came up into their Mouth or Nostrils while they lay asleep in Bed; and some towards the Height were afflictedwith Deafness, which was commonly a favourable Symptom.

Most of those ill of this Disorder had a yellowish Colour of the Countenance, which went off with the Fever. It was more observable in some than in others; in general, it was slight; some few became yellow all over[72]; particularly one Man, in the Hospital atMunster, who, after being seized with violent Vomiting and Purging, Convulsions, and Twitchings of the Tendons, and Hiccup, became yellow, as in the deepest Jaundice. This Symptom of Yellowness arises from a Redundancy and Absorption of Bile; and is sometimes observed in other Fevers as well as this[73]; forwhile we were atPaderborninFebruary1761, two Men were brought to the Hospital in Fevers, attended with this Symptom. They were both delirious, with parched dry Tongues, slightTwitchings of the Tendons, and other bad Symptoms; and one of them had a continual Vomiting and Purging. They both died, and the Body of him who had the Purging was opened. All the Bowels, especially the Colon, were tinged with a yellow Bile, and had a slight Degree of Inflammation all over their Surface; the Gall-Bladder was distended with a very dark-coloured Bile; but no Concretions were found in its Cavity, or in the bilious Ducts; nor Mucus, or any other Thing obstructing these Passages. The Surface of the Lungs seemed slightly inflamed; and there was a small Quantity of greenish Serum in the Cavities of the Thorax. I could not learn the Histories of these two Mens Disorders, before they were brought to the Hospital; but, from the Symptoms, was inclined to believe, that the Fevers had been of the malignant or petechial Kind; and that the yellow Colour was only an accidental Symptom of it; for on one of the Men we could perceive obscure Traces of dun petechial Spots on his Breast and Arms; and the malignant Fever was frequent at thisTime among the Troops, and the bilious autumnal Fevers had ceased long before.

I could not observe any certain critical Days, or Periods, when this Disorder terminated.—Some, who had it slightly, got well in a few Days; with others, it continued longer: Some continued long feverish, and would seem cooler and freer from Fever for a Day or two, and then grow worse again; and many had repeated Relapses.

Neither could I observe any regular Crisis in this Fever. Sweat was the Discharge which oftenest proved critical. Many seemed to be relieved by a Purging; but as the greater Part had a Looseness after some Days, which continued often through the Disorder, without producing any very sudden Change in the Symptoms, it seemed to be a favourable Circumstance; though it seldom carried off the Fever so suddenly as to be manifestly critical. The Urine broke, and dropt a Sediment, for the most part, as the Fever took a favourable Turn.

When this Fever proved mortal, it commonly assumed a continued Form; the Tongue became parched and dry, the Patient delirious, with Twitchings of the Tendons, Hiccup, and other fatal Presages; while others were seized with a violent Diarrhœa, or Dysentery, which sunk them irrecoverably.

In the Beginning, it was absolutely necessary to bleed the Patients freely; and frequently to repeat the Evacuation, where the Symptoms required it. The Blood was of a florid Colour, and commonly threw up more or less of an inflammatory Buff.

In these Fevers, we were obliged to have particular Regard to the first Passages, especially in the Beginning of the Disorder; for they were generally loaded with bilious Humours[74]; which, if suffered to remain in theBowels; were either absorbed, and increased the Heat and Fever, or brought on a violent Diarrhœa; and therefore, after Bleeding, we gavea Vomit in the Evening, and next Day a Dose of some gentle Purge, as Rhubarb or Salts; to carry off these putrid, bilious Humours: And afterwards, in the Course of the Disorder, if the Patient was costive, and grew hot, restless, and uneasy, we either repeated the Purge, or gave laxative Clysters, which generally removedthese Symptoms.—Frequently after the Operation of the Emetic, the Patient had some loose Stools, from the Gall Bladder’s being emptied in the Strainings to vomit. Such Stools were always bilious, as were commonly those procured by purgative Medicines.

After emptying the Bowels, we gave the cooling, and mild Diaphoretics, such as the saline and mindereri Draughts, joined occasionally with Nitre, or the Contrayerva Powders; while we made the Patient drink plentifully of warm diluting Liquors; which we found to answer in general better than any other Remedies: They brought the Remissions to be more evident, and the Paroxysms to be milder, at the same Time that they kept up a free Perspiration, as a Means to carry off the Distemper.

In some Cases we gave the Antimonial Powder, made of one Part of Tartar Emetic, and ten of thepulvis e chelis, in small Doses, from two to four Grains every four or six Hours. The first Doses of this Powder sometimes made the Patient sick, and acted as a Purgative, andkept up a free Perspiration; at other Times, it produced no visible Effect. In some Cases, where it was given early, it operated both by Stool, and as a Diaphoretic, and removed the Fever[75]; and it was of Use in others, towardsthe Decline of the Fever; but we were often obliged to lay it aside; for it either acted too roughly, or produced no visible Effect or Alteration in the Disorder.

When the Fever came to remit, we were obliged, for the most part, to continue the Use of the mild Diaphoretics, as before; for, although the Disorder put on a remitting Form, the Bark had very little Effect in stopping it[76],unless where the Fever changed into a regular Quotidian or Tertian Ague.—In the Year 1761, very few of these Fevers turned to regular Intermittents; but, in the Year 1762, the greater Part of them terminated in regular Agues, and were cured by the Bark[77].

In the Year 1761, we tried the Bark in various Forms in many Cases, where the Patient had been blooded and purged in the Beginning, and used the cooling Medicines; and wherethe Remissions were very clear: Yet it had no Effect in removing the Disorder, except in two or three Cases atMunster, where the Paroxysms assumed a tertian Form; for the most part, it made the Patients more hot and feverish, and we were obliged to leave off using it, as it was in Danger of changing the remittent into a continued Fever. However, it was of Service after the Fever came to a Crisis, and was going off; and Dr.Pringlehas very justly observed, that it hastened the Recovery, and that those who used it were less subject to Relapses than such as did not; and therefore we commonly gave it in a convalescent State.—Before giving the Bark, I always found it of Advantage to give a Dose of Rhubarb, or of some other Purgative, or to mix some Rhubarb with the first Doses, so as to procure the Patient some loose Stools.

When either the Fever went on without Intermission, or changed into a continuedForm, or the Patient continued hot and feverish through the Day, with a Head-Ach, and other feverish Symptoms, nothing answered better, after free Evacuations had been made, than to apply a large Blister to the Back; and to make the Patient drink freely of cooling diluting Liquors; which generally relieved the Head, and abated the Violence of the other Symptoms.

When a Purging came on in the Course of this Disorder, if there was much Fever, with a strong throbbing Pulse, Gripes and Pain of the Bowels, some Blood was taken away; and immediately after the Patient took a Dose of Salts and Manna, or of Rhubarb; and an Opiate in the Evening after its Operation: But if there was little or no Fever, or sharp Pain, Bleeding was omitted; and if the Patient complained of Sickness, a few Grains of Ipecacuana were given previous to the Purge.

After this, if the Purging was moderate, and did not sink the Patient, we did nothing to stop it; but if it was violent, we gave the mindereri Draughts with Mithridate, and the ChalkJulep in the Day, and an Opiate at going to Rest; and occasionally used the emollient and anodyne Clyster; and, if necessary, repeated the Emetic and Purge.

The Hiccup seldom appeared in this Fever till the Patient was reduced very low, and was commonly the Forerunner of Death. Some few, who had a Purging and Vomiting, were taken with a Hiccup, attended with Sickness, and Load at the Stomach, which seemed to depend on bilious Humours lodged in the Stomach and Bowels. This induced me to give a few Grains of the Ipecacuana; and to make the Patients drink an Infusion of Camomile Flowers till they vomited freely, and afterwards to take some mild Purge, or use laxative Clysters; after which they found themselves easier, and an anodyne Draught, with twenty or twenty-five Drops of thetinctura thebaica, put an End to the Hiccup. Others required the Use of Cordial Draughts, mixed with Opiates; and repeated Clysters and Fomentations, before they found Relief.—The Application of a Blister removed the Hiccupin one, after the above Remedies had proved ineffectual; as did the Musk Julep with Opium, and the Application of an aromatic Plaister to the Stomach, in another Patient.

Several of them complained of a burning Heat and Pain in making Water; which commonly went off by drinking freely of the Gum Arabic Decoction, with the dulcified Spirit of Nitre, and the Use of oily Draughts; though in some it required the Assistance of Opiates, and of Fomentations and Clysters, before it was got the better of.

The Symptom of Worms we were often obliged to neglect till the Fever was over, and then we treated it as formerly mentioned.

The Deafness, though not near so frequent in this as the Malignant Fever, was rather a favourable Symptom, and mostly went away of itself; though in a few Cases, where it continued long, we applied Blisters behind the Ears, or to the Neck, with Advantage.

Many, especially those who were brought low, complained, after the Crisis of the Fever, of Restlessness, and Want of Sleep; which,however, went off as their Strength returned: Where it fatigued them much, and kept them low, we gave a Cordial anodyne Draught at Night; and if that did not answer, commonly the Addition of a few Glasses of Wine in the Afternoon had the desired Effect.

Others, in their convalescent State, complained of such a Giddiness, and Lightness of the Head, that they could neither walk nor stand; others, of a Dimness of the Eyes. These Symptoms, for the most part, went off as the Patients gathered Strength: The Use of the Bark, with now and then a Glass of Wine, hastened the Cure; and in two or three Cases we were obliged to give a Dose or two of some gentle Physic, and to apply a Blister, before the Patient got the better of them.

As the Sick were recovering, it was common for them to complain of Pains of the Shoulders, Arms, and Legs, which also left them as they recovered their Strength; where they did not, the saline Draughts, and a low Diet, generally had a good Effect; and where it had not, we treated them as rheumatic Complaints.

When the yellowish Colour of the Countenance remained after the Fever, we kept the Patient on a low Diet; and his Body open by Means of the saline Draughts, with a few Grains of Rhubarb, or by giving Half a Drachm, or two Scruples of the Soap Pills with Rhubarb daily; which, for the most part, removed the Yellowness soon. Two only had a Jaundice remain after the Fever, and both were cured in a short Time.

In other Respects, the Treatment of this Fever, when it degenerated into a continued Form, had nothing particular in it; nor differed from the common Practice of giving cooling Medicines when the Fever was high, and supporting Nature by the Use of Cordials and Wine, and the Application of Blisters, &c. when low; and promoting such Evacuations as Nature pointed out for a Crisis.

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