FOOTNOTES:

FOOTNOTES:[70]I did not see the Delirium rise so high, nor the Paroxysms so severe, as in the Marsh Fever described by Dr.Pringle.[71]Dr.Hillarysays the Symptoms of this Fever inBarbadoeswere much the same as those of the συνεχης, or continued Remitting Fever in England; except only that the Urine in this hot Climate never deposits any lateritious Sediment, nor very rarely in any intermitting or any other Fever, except when a Crisis happens that Way.Observations on the Diseases of Barbadoes, p. 23.[72]Dr.Pringletakes Notice of this yellow Colour or Jaundice. He says, “some grow yellow, as in the Jaundice. This was found more frequent during the first Campaign than afterwards; it was an unfavourable, but not a mortal Symptom.”Observ.part iii. ch. 4.—Hippocratesmentions the Jaundice occurring in Fevers,Aphor.iv. § 62 & 64; and he reckons it a favourable Symptom in ardent Fevers, where it happens on the seventh Day. SeeBook on Crises’s, sect. 3.[73]Does this Fever, when accompanied with this universal Yellowness of the Skin, approach to the Nature of the yellow Fever of theWest Indies? As I had so few Cases of this Kind under my Care, I cannot determine any thing about it from my own Experience; but, from the Accounts of others, I should believe them to be very different Disorders.—In the yellow Fever of theWest Indies, the Blood appears quite loose and dissolved, without the least Appearance of Size, even on the first Day; and the general Yellowness appears on the third or fourth, with Signs of a total Dissolution, and gangrenous Diathesis of the Blood: Whereas, in the Remitting Fever ofJamaica, Mr.Nasmithtells us, (See Dr.Lind’s first Paper on Fevers), there is always an inflammatory Diathesis of the Blood. The Yellowness in both depends on a Redundancy and Absorption of Bile; but in the yellow Fever of theWest Indies, the Bile is in a much more putrescent State, and a great Part of the Cure depends on the early and speedy Evacuation of it.—In the yellow Fevers which appeared inHaslarHospital, which are taken Notice of by Dr.Lind, in hisTwo Papers on Fevers, the Blood was in quite a different State from what it is in the Yellow Fever of theWest Indies; the Blood drawn from two of these Patients became covered with a thick yellow Gluten, and the Serum was of the Consistence of a thin Syrup, and of a deep yellow Tinge, and tasted bitter; and in another who was bled two Days before his Death, it threw up the same thick yellow Gluten, tho’ the red Part below was quite loose.[74]According to Dr.Hillary’s Account of the Yellow Fever in theWest Indies, which is attended with bilious Vomiting, it bears bleeding once or twice, but not a third Time, before the third Day, but not at all after that Time; and after Bleeding a great Part of the Cure depends on carrying off as much of the putrid Bile as expeditiously and safely as possible, which he says is to be done by making the Patients drink freely of warm Water (sometimes mixed with a little simple Oxymel or Green Tea) so as to vomit seven or eight Times; and then to give a grain, or a Grain and a half of Opium, to procure Rest, and to settle the Stomach; to make the Patient take nothing for two Hours after; and then, if he has not had a Stool, to give a laxative Clyster; after six Hours Rest, to give a gentle Purge, to carry off as much as possible of the bilious corrupted Humours; and in the Course of the Disorder to repeat the Purge, as often as the Patient is attacked with an Anxiety, and a painful burning Heat about the Præcordia; which almost always depend on bilious corrupted Humours pent up within the Bowels; and to endeavour to support the Patient’s Strength, and stop the putrescent Diathesis of the Fluids by suitable Antiseptics, of which he found a watery Infusion of Snake Root, mixed withMadeiraWine and Syrup of Poppies, to answer the best of any Thing he tried, and to sit easiest on the Stomach; and to this he added the Use of Cordials, and of strong Wine Whey as the Patient became lower.Dr.Hillary’s Purge was: ℞. Mannæ sescunc. vel unc. ij. Tamarind. cond. unc. i. Tartar vitriolat. gr. x. solve in seri lactis præparat. cum Vin. Maderiens. unc. vi. Colaturæ adde Tinct. Senæ unciam dimidiam. Divide in Partes quatuor, & capt. æger unam omni hora donec laxetur alvus.His Infusion of Snake-Root was prepared in the following Manner:℞. Rad. Serpent. Virgin. drachm. ij. Croci Angl. drachmam dimidiam, infunde per horam vase clauso in aq. bull. q. s. & dein unc. vi. Colaturæ, adde aq. Menth. simp. unc. ij. Vin. Maderiensis, unc. iv. Syrup. Croci vel Syr. e Mecon. unc. i. Elix. Vitriol. acid. q. s. ad gratum saporem M. capiat æger cochlear. ij. vel iij. omni hora vel secunda quaq; hora vel sæpius pro re nata.The Stomach is so irritable in the Beginning of this Disorder, as to reject the saline Draughts, Nitre, and such other Medicines. Nor will the Bark, which might be judged a very proper Medicine in the second Stage of the Disorder, lie upon the Stomach, but is thrown up immediately, in whatever Form it is given. However, a Gentleman who had practised long in theWest Indiestold me, that although the Patient could not retain it in his Stomach, yet that he had found great Service, after the Bowels were emptied, from the Bark used freely in Clysters.Dr.Hillarydisapproves of the Use of Blisters in the advanced State of these Fevers.[75]Dr.Millar, one of the Physicians to the Army, told me inGermany, that he had given this antimonial Powder with great Success in the Remitting Fever, while the Eighth Regiment of Foot (to which he was formerly Surgeon) lay inEngland.—Dr.Pringle, in his fourth Edition of hisObservations, Part iii. ch. iv. tells us, that having given a mild Purge immediately after Bleeding, he next Morning, when there was almost always a Remission, gave a Grain of the Tartar Emetic, with twelve Grains of Crabs-Eyes, and repeated the Dose in two Hours, if the first had little or no Effect; at any Rate, in four Hours. This Medicine not only vomited, but generally opened the Body, and raised a Sweat. By these Evacuations, the Fever was sometimes quite removed, but always became easier.—This Medicine he usually repeated the second or third Day; if not, he opened the Body with some mild Laxative, or a Clyster; and continued this Medicine, till the Fever went gradually off, or intermitted.—Dr.Pringlesays, that Dr.Hucktreated this Fever in a Method similar to this, both inNorth Americaand in theWest Indies. In the Beginning he let Blood; and in the first Remission, gave four or five Grains of Ipecacuana, with Half a Grain of Tartar Emetic: This Medicine he repeated in two Hours, taking Care that the Patient should not drink before the second Dose; for by that Means the Medicine passed more readily into the Bowels, before it operated by vomiting. If, after two Hours more, the Operation either Way was small, he gave a third Dose; which commonly had a good Effect in carrying off the Bile; and then the Fever either went quite off, or intermitted so far as to admit the Bark. On the Continent he found no Difficulty after the Intermission; but in the Islands, unless he gave the Bark upon the first Intermission, though imperfect, the Fever was apt to assume a continual and dangerous Form. Dr.Hucknever varied this Method, but upon a stronger Indication to purge, than to vomit. In which Case he made an eight Ounce Decoction, with Half an Ounce ofTamarinds, two Ounces ofManna, and two Grains ofEmetic Tartar; and dividing this into four Parts, he gave one every Hour, till the Medicine operated by Stool.[76]Dr.Hillary, in mentioning the Remitting Fever of the Island ofBarbadoes, says: In those who were blooded, and took an Emetic afterwards, and then the saline Draughts, the Fever was generally carried quite off by a critical Sweat on the seventh or ninth Day; in some few it came to intermit regularly after that Time; and was soon cured by thecortex Peruviana, given with the saline Draughts, and seldom effectually without them; though these irregular ingeminated Fevers often remitted, and sometimes seemed to intermit; yet if thecortex Peruvianawas given too soon in the Disease, before it intermitted regularly (as I have more than once seen, where it had been injudiciously given), it generally caused the Fever to become continual and malignant.Observat. on the epidemic Diseases of Barbadoes, p. 22.[77]Mr.Cleghorn, after giving a very accurate Account of Tertian Fevers, as they appeared in their various Forms of true, of double, and triple Tertians, and of Semi-Tertians, in the Island ofMinorca, tells us, that he first attempted the Cure by profuse Evacuations; but afterwards learnt from Experience, that they were unnecessary; and that Bleeding and Purging once or twice in the Beginning, was all that was in general requisite; and if on the fifth Day the third Revolution was not attended with more threatening Symptoms than the second, and the Patient bore it easily, he frequently trusted the whole Business to Nature; which commonly terminated the Fever about the fourth or fifth Revolution; and for the most part with an Increase of some natural Evacuation.—But if the Paroxysm on the fifth Day was the longest and most severe that happened, attended with any doubtful or dangerous Symptom, he ordered two Scruples of the Cortex to be given every two or three Hours; so that five or six Drachms may be taken before next Day at Noon; lest, if this Interval escaped, he should not have found a favourable Opportunity of giving a sufficient Quantity of the Medicine afterwards; as the Fits about this Period are wont to become double, subintrant, or continual.—This did not always put an immediate Stop to the Fever, but it invigorated the Powers of the Body, and prevented or removed the dangerous Symptoms. Having given the Bark on the fifth Day, if a Fit came on the sixth, and declined the same Evening, he gave some more Doses of the Bark to mitigate the Fit on the seventh; yet sometimes this Fit of the sixth united with that of the seventh, and the Patient had the Heat, Restlessness, Raving, and other Complaints, greatly augmented, and the Case seemed more desperate than ever; which, however, were more dangerous in Appearance than Reality, and went off with a profuse Sweat next Morning; after which he gave the Bark freely as before; and this either stopt the Fits, or made them so moderate, as that they yielded quickly to the same Sort of Management.—By this Method, when Assistance is called timely, Mr.Cleghornsays, the most formidable Intermitting and Remitting Tertians, may be certainly and speedily brought to a happy Conclusion about the End of the first Week, or Beginning of the second. SeeObserv. on the epidemic Diseases in Minorca, chap. iii. p. 187, &c.

[70]I did not see the Delirium rise so high, nor the Paroxysms so severe, as in the Marsh Fever described by Dr.Pringle.

[71]Dr.Hillarysays the Symptoms of this Fever inBarbadoeswere much the same as those of the συνεχης, or continued Remitting Fever in England; except only that the Urine in this hot Climate never deposits any lateritious Sediment, nor very rarely in any intermitting or any other Fever, except when a Crisis happens that Way.Observations on the Diseases of Barbadoes, p. 23.

[72]Dr.Pringletakes Notice of this yellow Colour or Jaundice. He says, “some grow yellow, as in the Jaundice. This was found more frequent during the first Campaign than afterwards; it was an unfavourable, but not a mortal Symptom.”Observ.part iii. ch. 4.—Hippocratesmentions the Jaundice occurring in Fevers,Aphor.iv. § 62 & 64; and he reckons it a favourable Symptom in ardent Fevers, where it happens on the seventh Day. SeeBook on Crises’s, sect. 3.

[73]Does this Fever, when accompanied with this universal Yellowness of the Skin, approach to the Nature of the yellow Fever of theWest Indies? As I had so few Cases of this Kind under my Care, I cannot determine any thing about it from my own Experience; but, from the Accounts of others, I should believe them to be very different Disorders.—In the yellow Fever of theWest Indies, the Blood appears quite loose and dissolved, without the least Appearance of Size, even on the first Day; and the general Yellowness appears on the third or fourth, with Signs of a total Dissolution, and gangrenous Diathesis of the Blood: Whereas, in the Remitting Fever ofJamaica, Mr.Nasmithtells us, (See Dr.Lind’s first Paper on Fevers), there is always an inflammatory Diathesis of the Blood. The Yellowness in both depends on a Redundancy and Absorption of Bile; but in the yellow Fever of theWest Indies, the Bile is in a much more putrescent State, and a great Part of the Cure depends on the early and speedy Evacuation of it.—In the yellow Fevers which appeared inHaslarHospital, which are taken Notice of by Dr.Lind, in hisTwo Papers on Fevers, the Blood was in quite a different State from what it is in the Yellow Fever of theWest Indies; the Blood drawn from two of these Patients became covered with a thick yellow Gluten, and the Serum was of the Consistence of a thin Syrup, and of a deep yellow Tinge, and tasted bitter; and in another who was bled two Days before his Death, it threw up the same thick yellow Gluten, tho’ the red Part below was quite loose.

[74]According to Dr.Hillary’s Account of the Yellow Fever in theWest Indies, which is attended with bilious Vomiting, it bears bleeding once or twice, but not a third Time, before the third Day, but not at all after that Time; and after Bleeding a great Part of the Cure depends on carrying off as much of the putrid Bile as expeditiously and safely as possible, which he says is to be done by making the Patients drink freely of warm Water (sometimes mixed with a little simple Oxymel or Green Tea) so as to vomit seven or eight Times; and then to give a grain, or a Grain and a half of Opium, to procure Rest, and to settle the Stomach; to make the Patient take nothing for two Hours after; and then, if he has not had a Stool, to give a laxative Clyster; after six Hours Rest, to give a gentle Purge, to carry off as much as possible of the bilious corrupted Humours; and in the Course of the Disorder to repeat the Purge, as often as the Patient is attacked with an Anxiety, and a painful burning Heat about the Præcordia; which almost always depend on bilious corrupted Humours pent up within the Bowels; and to endeavour to support the Patient’s Strength, and stop the putrescent Diathesis of the Fluids by suitable Antiseptics, of which he found a watery Infusion of Snake Root, mixed withMadeiraWine and Syrup of Poppies, to answer the best of any Thing he tried, and to sit easiest on the Stomach; and to this he added the Use of Cordials, and of strong Wine Whey as the Patient became lower.Dr.Hillary’s Purge was: ℞. Mannæ sescunc. vel unc. ij. Tamarind. cond. unc. i. Tartar vitriolat. gr. x. solve in seri lactis præparat. cum Vin. Maderiens. unc. vi. Colaturæ adde Tinct. Senæ unciam dimidiam. Divide in Partes quatuor, & capt. æger unam omni hora donec laxetur alvus.His Infusion of Snake-Root was prepared in the following Manner:℞. Rad. Serpent. Virgin. drachm. ij. Croci Angl. drachmam dimidiam, infunde per horam vase clauso in aq. bull. q. s. & dein unc. vi. Colaturæ, adde aq. Menth. simp. unc. ij. Vin. Maderiensis, unc. iv. Syrup. Croci vel Syr. e Mecon. unc. i. Elix. Vitriol. acid. q. s. ad gratum saporem M. capiat æger cochlear. ij. vel iij. omni hora vel secunda quaq; hora vel sæpius pro re nata.The Stomach is so irritable in the Beginning of this Disorder, as to reject the saline Draughts, Nitre, and such other Medicines. Nor will the Bark, which might be judged a very proper Medicine in the second Stage of the Disorder, lie upon the Stomach, but is thrown up immediately, in whatever Form it is given. However, a Gentleman who had practised long in theWest Indiestold me, that although the Patient could not retain it in his Stomach, yet that he had found great Service, after the Bowels were emptied, from the Bark used freely in Clysters.Dr.Hillarydisapproves of the Use of Blisters in the advanced State of these Fevers.

Dr.Hillary’s Purge was: ℞. Mannæ sescunc. vel unc. ij. Tamarind. cond. unc. i. Tartar vitriolat. gr. x. solve in seri lactis præparat. cum Vin. Maderiens. unc. vi. Colaturæ adde Tinct. Senæ unciam dimidiam. Divide in Partes quatuor, & capt. æger unam omni hora donec laxetur alvus.

His Infusion of Snake-Root was prepared in the following Manner:

℞. Rad. Serpent. Virgin. drachm. ij. Croci Angl. drachmam dimidiam, infunde per horam vase clauso in aq. bull. q. s. & dein unc. vi. Colaturæ, adde aq. Menth. simp. unc. ij. Vin. Maderiensis, unc. iv. Syrup. Croci vel Syr. e Mecon. unc. i. Elix. Vitriol. acid. q. s. ad gratum saporem M. capiat æger cochlear. ij. vel iij. omni hora vel secunda quaq; hora vel sæpius pro re nata.

The Stomach is so irritable in the Beginning of this Disorder, as to reject the saline Draughts, Nitre, and such other Medicines. Nor will the Bark, which might be judged a very proper Medicine in the second Stage of the Disorder, lie upon the Stomach, but is thrown up immediately, in whatever Form it is given. However, a Gentleman who had practised long in theWest Indiestold me, that although the Patient could not retain it in his Stomach, yet that he had found great Service, after the Bowels were emptied, from the Bark used freely in Clysters.

Dr.Hillarydisapproves of the Use of Blisters in the advanced State of these Fevers.

[75]Dr.Millar, one of the Physicians to the Army, told me inGermany, that he had given this antimonial Powder with great Success in the Remitting Fever, while the Eighth Regiment of Foot (to which he was formerly Surgeon) lay inEngland.—Dr.Pringle, in his fourth Edition of hisObservations, Part iii. ch. iv. tells us, that having given a mild Purge immediately after Bleeding, he next Morning, when there was almost always a Remission, gave a Grain of the Tartar Emetic, with twelve Grains of Crabs-Eyes, and repeated the Dose in two Hours, if the first had little or no Effect; at any Rate, in four Hours. This Medicine not only vomited, but generally opened the Body, and raised a Sweat. By these Evacuations, the Fever was sometimes quite removed, but always became easier.—This Medicine he usually repeated the second or third Day; if not, he opened the Body with some mild Laxative, or a Clyster; and continued this Medicine, till the Fever went gradually off, or intermitted.—Dr.Pringlesays, that Dr.Hucktreated this Fever in a Method similar to this, both inNorth Americaand in theWest Indies. In the Beginning he let Blood; and in the first Remission, gave four or five Grains of Ipecacuana, with Half a Grain of Tartar Emetic: This Medicine he repeated in two Hours, taking Care that the Patient should not drink before the second Dose; for by that Means the Medicine passed more readily into the Bowels, before it operated by vomiting. If, after two Hours more, the Operation either Way was small, he gave a third Dose; which commonly had a good Effect in carrying off the Bile; and then the Fever either went quite off, or intermitted so far as to admit the Bark. On the Continent he found no Difficulty after the Intermission; but in the Islands, unless he gave the Bark upon the first Intermission, though imperfect, the Fever was apt to assume a continual and dangerous Form. Dr.Hucknever varied this Method, but upon a stronger Indication to purge, than to vomit. In which Case he made an eight Ounce Decoction, with Half an Ounce ofTamarinds, two Ounces ofManna, and two Grains ofEmetic Tartar; and dividing this into four Parts, he gave one every Hour, till the Medicine operated by Stool.

[76]Dr.Hillary, in mentioning the Remitting Fever of the Island ofBarbadoes, says: In those who were blooded, and took an Emetic afterwards, and then the saline Draughts, the Fever was generally carried quite off by a critical Sweat on the seventh or ninth Day; in some few it came to intermit regularly after that Time; and was soon cured by thecortex Peruviana, given with the saline Draughts, and seldom effectually without them; though these irregular ingeminated Fevers often remitted, and sometimes seemed to intermit; yet if thecortex Peruvianawas given too soon in the Disease, before it intermitted regularly (as I have more than once seen, where it had been injudiciously given), it generally caused the Fever to become continual and malignant.Observat. on the epidemic Diseases of Barbadoes, p. 22.

[77]Mr.Cleghorn, after giving a very accurate Account of Tertian Fevers, as they appeared in their various Forms of true, of double, and triple Tertians, and of Semi-Tertians, in the Island ofMinorca, tells us, that he first attempted the Cure by profuse Evacuations; but afterwards learnt from Experience, that they were unnecessary; and that Bleeding and Purging once or twice in the Beginning, was all that was in general requisite; and if on the fifth Day the third Revolution was not attended with more threatening Symptoms than the second, and the Patient bore it easily, he frequently trusted the whole Business to Nature; which commonly terminated the Fever about the fourth or fifth Revolution; and for the most part with an Increase of some natural Evacuation.—But if the Paroxysm on the fifth Day was the longest and most severe that happened, attended with any doubtful or dangerous Symptom, he ordered two Scruples of the Cortex to be given every two or three Hours; so that five or six Drachms may be taken before next Day at Noon; lest, if this Interval escaped, he should not have found a favourable Opportunity of giving a sufficient Quantity of the Medicine afterwards; as the Fits about this Period are wont to become double, subintrant, or continual.—This did not always put an immediate Stop to the Fever, but it invigorated the Powers of the Body, and prevented or removed the dangerous Symptoms. Having given the Bark on the fifth Day, if a Fit came on the sixth, and declined the same Evening, he gave some more Doses of the Bark to mitigate the Fit on the seventh; yet sometimes this Fit of the sixth united with that of the seventh, and the Patient had the Heat, Restlessness, Raving, and other Complaints, greatly augmented, and the Case seemed more desperate than ever; which, however, were more dangerous in Appearance than Reality, and went off with a profuse Sweat next Morning; after which he gave the Bark freely as before; and this either stopt the Fits, or made them so moderate, as that they yielded quickly to the same Sort of Management.—By this Method, when Assistance is called timely, Mr.Cleghornsays, the most formidable Intermitting and Remitting Tertians, may be certainly and speedily brought to a happy Conclusion about the End of the first Week, or Beginning of the second. SeeObserv. on the epidemic Diseases in Minorca, chap. iii. p. 187, &c.

ThisDisorder belongs to the same Tribe of Diseases as the Remitting Fever. We call it an Intermitting Fever, or Ague, when the Paroxysms are distinct, begin with a cold and hot Fit, and go off with a Sweat; and the Patient is cool, and free from the Fever in the Intervals between the Fits.

Many have been the Causes alledged to produce this Disorder. The great Quantity of Bile that is often thrown up in the Fit, has caused it to be ranked among the bilious Diseases; and the Seasons of the Year in which it is most frequent, and the low moist Situation of the Places where it is endemic, have made Practitioners suspect, that an obstructed Perspiration,and a Tendency in the Juices to the Putrescent, are the Cause of it.

But whatever Cause we may suppose to give Rise to the first feverish Fit, it is difficult from hence to account for the regular Returns of the Paroxysms and Intermissions: For my own Part, after considering Intermittents, which observed a regularTypein the Course of a Salivation[78]; their being so easily stopt by the Bark without any sensible Evacuation; their being sometimes put away by a Stimulus externally applied[79], or by a Fright, or sudden Plunge into cold Water[80]; their returningafter slight Errors in Diet, and sometimes by the Operation of a Purge, or of Bleeding; their attacking sometimes only particular Parts, and many such Accidents in these Fevers, I must confess, that I am unable to form any Idea, either of their Origin, Seat, or Cause[81].

The Soldiers were subject to this Disorder, particularly in Spring, if they took the Field soon, and in Autumn: The Frequency of it was in a great Measure determined by the Nature of the Ground on which they were encamped, or the Situation of the Garrison or Town in which they were quartered; for the lower and moister the Camp or Garrison, and the moremoist the Season, the more subject an Army is to Agues; and the drier the Situation of the Camp or Garrison, and the finer and drier the Weather is, the freer they are from Disorders of this Kind.

In Winter 1761, we had but very few Agues in the Hospitals; but on the Return of the Troops from the Expedition intoHesse-Cassel, and during the Spring, some (though not many) were attacked with Quotidian and Tertian Agues, and but very few with Quartans.—InJulyandAugustthey were more frequent, and accompanied with more bilious Symptoms. AtBremen, during the latter End of Autumn, and throughout the Winter and Spring 1762, we had Agues of all Sorts, and many inveterate Cases; and all this Spring, and during the Summer and Autumn, the Ague was the epidemic Disorder all overWestphalia, as well as among the Troops.

In Spring 1761, what Agues we had were mostly Tertian, some Quotidian, and but two or three of the Quartan Kind. They were, for the most part, mild, and yielded to the Bark.—Someof them began in the Form of a continued Fever; but after Bleeding, and the Use of the cooling Medicines for a few Days, they began to remit, and at last ended in regular Quotidian or Tertian Agues: Others, at first, appeared in Form of Remittent Fevers, attended with a strong throbbing Pulse; but changed to regular Intermittents by pursuing the antiphlogistic Method of Cure; and some from the Beginning assumed the Type of Quotidian or Tertian Agues, but often attended with a good deal of Fever, for the first two or three Days; and some had a slight Delirium in the Time of the Paroxysms, and the Pulse was not quite settled in the Intervals. In such Cases, where the Patient was strong, nothing answered so well as to take away some Blood; and to give the saline Draughts with Nitre till the Fever was moderated, before we gave the Bark.

In general, there is a Prejudice against bleeding in Agues, after they become regular; but I have always observed, both inEnglandand inGermany, that where Patients are strong andplethoric, and the Fever in the Paroxysms rises high, or the Pulse remains quick in the Intervals, that taking away more or less Blood, and giving the antiphlogistic Medicines in the Beginning, eased the Patient, moderated the Fever, and made it safer to give the Bark soon; and I never saw the least Inconvenience from the Practice; but, on the contrary, have seen several Intermittent Fevers change into continued ones from the Neglect of this Evacuation; and have seen Cases where the Bark, instead of stopping the Ague, rather increased the Fever, till the Patient was blooded, and had pursued the antiphlogistic Method for some Time; after which the Bark had its proper Effect, and put an End to the Disorder.

As soon as these Agues became regular, and the Patient was quite cool, and free from any Fever in the Intervals, we gave the Bark; which soon put a Stop to the Paroxysms, without the least bad Consequences; but, before giving the Bark, we always took Care to empty the first Passages by the Use of Emetics and Purgatives, where there was no Symptom toforbid their Use: In Cases where the Patient was weak, and the Fits so violent as to make it necessary to stop the Ague, before we had Time to administer Emetics or Purgatives, we added so much Rhubarb to the first Doses of the Bark as procured the Patient some loose Stools, as recommended by Dr.Mead[82]; whichdid not prevent its stopping the Ague, at the same Time that it answered the End proposed of carrying off any putrid Humours that might be lodged in the Intestines.

InEngland, Vernal, Quotidian, and Tertian Agues, frequently go off after Bleeding, and taking some Emetics and Purges, and the saline Draughts, and cooling Medicines, for some Time, without the Use of the Bark; but inGermanyvery few yielded to this Treatment, and we were obliged to give the Bark[83]before we could put a Stop to them.

In the End ofJuly, and Beginning ofAugust, the aguish Cases we had atMunstercontinued to be of the Quotidian or Tertian Kind. The greatest Part of them began in the Form of continued Fevers, tending more to the bilious Kind than the preceding Months, and many of the Sick had bilious Vomitings in the cold Fits; and the Agues we had in Spring, and during the Campaign 1762, were of the same Nature, and required the same Treatment.

Those Cases, which began in the Form of continued Fevers, were treated as such till they began to have regular Intermissions; they then yielded to the Bark.

Some were attended with the Dysentery; and the Purging and Gripes were most severe on the Days of the aguish Paroxysms. In such Cases, we were frequently obliged at first to neglect the Ague, and to treat the Disorder entirely as a Flux. Where there was much Fever, the Patient strong, and the Pains in the Bowels acute, we ordered Bleeding; and after it a gentle Emetic, and some Doses of the saline oily Purge, or of Rhubarb; and gentle Opiates in the Evening, and other Medicines proper in the Dysentery, till its Violence was abated, before we gave the Bark: though in some Cases, where the aguish Paroxysms were very severe, and helped to increase the Purging, and the Patient was in Danger of sinking, we gave the Bark, notwithstanding the Flux still continued; and the Method we followed was the same as that I formerly mentioned, where it was complicated with the Malignant Fever;which was to give the Bark, mixed with Diascord, and Opiates, or other Medicines proper for the Dysentery, in the Intervals between the Purges.

By this Treatment, very often both the Flux and Ague went off. However, it ought to be observed, that unless the aguish Paroxysms were severe, and in Danger of sinking the Patient, or that the Disorder had continued for some Time, and the Paroxysms were distinct, we seldom gave the Bark till the Violence of the Flux was abated: And where-ever much Griping and Pain in the Bowels attended the Flux and Ague, there Bleeding as well as Purgatives were necessary, before exhibiting the Bark; which seldom or ever agreed with them, till there was an evidentApurexia, or Absence of Fever in the Intervals between the Fits. Where these Cautions were neglected, the Bark generally made the Patients worse; and we were obliged to omit it, till the Violence of the Purging was over.

Some Agues were accompanied with the Jaundice, though not in such a high Degree asin the confirmed State of that Disorder; and commonly in the Beginning the Pulse continued rather quick, in the Intervals between the Paroxysms; and the Patients complained of some Degree of Sickness for the first two or three Days. With those the Bark always disagreed, till the Feverishness between the aguish Paroxysms was gone; and we found, that the best Method of treating them, was to bleed in the Beginning, if there was much Fever; and then to give a Vomit and Purge, and to repeat them, if necessary; and where there was no Purging, to give the saline Draughts, and other cooling Medicines; and to add a few Grains of Rhubarb, or to give so much of thepilulæ saponacæ cum rheo, daily, as procured one or two loose Stools.

After the Ague had regular Intermissions, and the Patient was quite cool, and without Fever in the Intervals, if the Disorder did not yield to the above Treatment, which it seldom did, we then gave the Bark freely; even though the slight icteric Symptoms still remained; and it put an End to the Ague, andremoved the Jaundice at the same Time, without the least Inconvenience to the Patient. In such Cases, we generally used to add a few Grains of Rhubarb to the first Doses of the Bark; or gave the Bark made up into Pills with Soap, and added occasionally a few Grains of Rhubarb.

Several of those who had the icteric Symptoms along with the Ague, had bilious Vomitings in the Time of the cold Fit; they found themselves sick, with a bitter Taste in their Mouth, before the Approach of the aguish Paroxysm; and many of them, though they took Emetics, which operated freely at this Time, yet did not vomit up the Bile; but the Sickness and bitter Taste continued till the cold Fit came on, when they vomited Bile in large Quantities. In such Cases, after the Use of Emetics and Purges, and the Ague was brought to have regular Paroxysms, with free Intermissions, the Bark, given as just now mentioned, removed the Ague and icteric Symptoms, without the least bad Consequences.

Many Practitioners of great Repute have been prejudiced against the Bark; and tell us, that the free Use of this Medicine often lays the Foundation of Obstructions in the abdominal Viscera, especially when it has been given where there was an icteritious Colour in the Eyes and Countenance; and that, in such Cases, we ought not to give the Bark till these Icteric Symptoms are gone. At first, I was very cautious of giving it under such Circumstances; till meeting with some Cases where the Paroxysms were severe, and became more frequent, while the Patient was so low, as to be in Danger of sinking under the Disorder, I gave the Bark freely, as the only Remedy capable of preserving Life; which not only stopt the Ague, but carried off the icteritious Symptoms[84], and restored the Patients to perfect Health.

After this I gave it freely, in the Manner above mentioned, to some Hundreds, with great Success; and I never saw any Mischief follow from using it: Indeed sometimes, where it was given rather too soon, it did not sit easy on the Stomach; and made the Patients hot and restless; but, by laying it aside, these Effects immediately ceased; and generally, after a little Time, the Paroxysms became milder and more distinct, when the Bark was again administered, agreed with the Stomach, and put an End to the Disorder; and I am now convinced, from Experience, that the Cases in which the Bark has done Mischief, or given Rise to Obstructions of the abdomenal Viscera, are but very rare; and that these Mischiefs mostly arise from the Obstinacy of the Disorder, and not from the Use of this Drug; for I have oftener observed these Obstructions where little or no Bark had been used, than where it was given freely[85]. What probably has givenRise to the Belief of the Bark’s doing so much Mischief, is, that inHolland, and other low fenny Countries, where Agues are endemic, they are oftentimes extremely obstinate, and yield hardly to any Remedies; and if they are stopt by the Bark, they often return soon after, and by their long Continuance give Rise to Obstructions of the abdomenalviscera, which have been attributed to the Use of this Specific.

In some few Cases a Purging accompanied these icteric Symptoms, which we treated much in the same Manner as when the Ague was complicated with the Flux; we gave Emetics and Purgatives; and the mindereri Draughts with Mithridate, throughout the Day, and Opiates at Night, if the Purging was violent; if it continued, accompanied with regular aguish Fits, the Bark, with Astringents, generally removed both.

In the latter Part of the Year 1761, and during Spring 1762, we had atBremenmany Patients in Agues of all Sorts; as Quotidians, Tertians, Quartans, and irregular Agues of a very obstinate Nature. The Town ofBremenis large and well built, situated in a low sandy Plain, with theWeserdividing the old from the new Town; generally a considerable Part of the Environs is covered with Water in the Winter, and frequently theWeserbreaks down some of the Dikes, and overflows all the Country round; and every Time the River overflows its Banks, the Cellars of all the new Town, and of that Part of the old Town next the River, are filled with Water. All the Year round, on digging two or three Feet deep into the Ground, you come at Water.

Agues are endemic in this Place, and great Numbers of the lower Class of People are afflicted with them at all Times of the Year, especially in Spring and Autumn.

Some of the Sick sent down from the Army were bad of Agues; but the greatest Numberwe had in Hospitals was composed of such as took it in Town; either from doing Duty on the Ramparts, or from lying in bad Quarters, or getting drunk and exposing themselves to Wet and Cold; and many Men of the invalid Companies who had come fromEmbdenbrought with them old inveterate tertian and quartan Agues.

Most of the recent Cases were easily cured by the Methods already mentioned; though they often continued longer, required a greater Quantity of the Bark to stop them, and a longer Continuance of its Use to make a Cure, than at other Places, which were more dry, and higher situated.

The most obstinate of the recent Cases were the irregular Intermittents, which had regular Paroxysms, but where the Pulse was not settled in the Intervals; which we were obliged to treat as Remitting Fevers till the Paroxysms became quite distinct, and the Patient was cool and free from any Fever in the Intervals; after which they commonly yielded to the Bark.

But many of those Agues which had continued for some Time, especially with those Invalids who came fromEmbden, or who had brought on frequent Relapses by their own Irregularities, were very obstinate. With many the Bark had no Effect; and its Use persisted in seeming rather to exasperate the Paroxysms, and to do Hurt. Nor had almost any Remedy we tried a better Effect. We gave the following Medicines to divers Patients; the saline Draughts and cooling Medicines; Infusions of Camomile Flowers and of other Bitters; Dr.Morton’s Powders of Camomile Flowers, Salt of Wormwood, and diaphoretic Antimony; Dr.Mead’s Powders of Camomile Flowers, Salt of Wormwood, Myrrh, and Alum; Alum and Nutmeg; large Doses ofsal ammoniac; large Quantities of Spirits of Hartshorn; the antimonial Drops and Powders; to some we gave Emetics, both in the Intervals and immediately before the Fits. In some we tried to promote Sweats before the Approach of the Fits, by making them drink freely of warm Liquors whilethey kept in Bed, and took diaphoretic Medicines; and to others we applied Blisters.—But all did not put a Stop to some of those Agues.

With some the Disorder continued till it broke down the Crasis of the Blood, and brought on a general Relaxation of the Fibres; and the Patients became cachectic, and fell into Dropsies, or were seized with Diarrhœas, of which they died. Some had Obstructions formed in the Liver or Spleen, or otherviscera, and fell into the Jaundice and Dropsies, which carried them off.—In the Bodies, of several whom we opened, we found Indurations of the Liver and Spleen—in two of them Suppurations of the Liver—and in one, who had had the Ague atEmbden, and had long complained of one of those Swellings towards the left Side of theabdomen, called theAgue Cake[86], the Spleen was so much enlarged as to weigh above four Pounds.

Some, whose Constitutions were worn out by these obstinate Agues, fell into Consumptions and other pulmonic Disorders in the Winter, of which they died. One Man died in the cold Fit[87].

Where-ever the Ague continued long, and the Bark had no Effect, we were obliged to lay it aside, and to try other Remedies adapted to the present Circumstances of the Patient.

The mild Methods succeeded best; giving the saline Draughts and gentle cooling Medicines to such as were strong and plethoric, and had the aguish Paroxysms violent; and the gentle Aromatics and Bitters, or Chalybeats, to those of a weakly Habit, or whose Fibres had been much relaxed, and their Constitutionsgreatly injured by this or any other preceding Disorder.

During these Courses, we gave at Times gentle Emetics; and if the Patient complained of Gripes and Purging, which they frequently did, in the Course of this Disorder, we gave a Dose of Rhubarb, or of some other mild Purge; and after it other Medicines proper for this Complaint.

By these Methods frequently the aguish Paroxysms became gradually milder, and at last vanished. At other Times, after they had continued for five or six Weeks, we again gave the Bark, and found it to have the proper Effect. With others they continued thro’ the Winter, and went off of themselves in the Spring. With others they still continued; and as no Medicines nor Time seemed to have any Effect in that Country, we recommended their being sent over toEnglandfor Change of Air, as the only Means likely to remove the Disorder.

Two Agues which had resisted the Use of the Bark were cured by Powder of Camomile-Flowers,Salt of Wormwood, and diaphoretic Antimony; and one by the Use of the aluminous Powders, with Myrrh.—One Invalid, who had long been ill of an obstinate Tertian, on catching Cold, was seized with an Inflammation of his Throat, for which he was blooded, and took a mild Purge; next Day there appeared a Swelling of one of the parotid Glands, which we endeavoured to bring to Maturation, by the Application of emollient Cataplasms; after some Days it went entirely away, without coming to Suppuration; but as there remained still a Confusion of the Head, and a Quickness of the Pulse, a large Blister was applied to the Back, which continued running for some Days; after it dried up he fell into a Fit resembling that of an Epilepsy, and next Day had another Fit of the same kind; from the Time the Swelling first appeared till the Time he had the first Fit, he had no Ague, but it returned the second Day after the second epileptic Fit; another Blister was applied, and he had no Return of the epileptic Fits, though his Ague continued obstinatetillMarch, at which Time he was sent toEngland[88].—About the same Time the aguish Fits of two others were stopt by the Application of Blisters, though they returned in both soon after.

Excepting in these few Cases, I found no Medicines effectual in stopping those Agues, which had resisted the Bark when properly given, though we tried a vast Variety in different Cases. Thecortex cascarillæ, oreleutheriæ, was given freely, both in Decoction and Substance, in four Cases, which had not yielded to the Bark, but without producing any good Effect; we had not an Opportunityof trying this Bark in more Cases of this kind, nor in Fluxes, the small Quantity of it which had come fromEnglandbeing all expended.

A Soldier of one of the Regiments of Guards, who was admitted into the Hospital for œdematous Legs, and the Remains of a very bad Flux, which he had had ever since the preceding Autumn; after being cured of the Flux, and most of the œdematous Swellings, was seized with an intermitting Complaint inFebruary. He had no regular hot and cold Fits; but every second Day, after a slight Shivering and Cold, he was seized with Gripes and a Purging. In one or two of the Fits his Pulse was very quick, and the Pain of the Bowels very acute and severe; which obliged us to blood him, and give him a Dose of the saline oily Purge; after which we treated the Disorder as a Flux complicated with the Ague, and gave the Bark mixed with Diascord, and gentle Opiates at Nights, and at Times gentle Purgatives; the Ague and Diarrhœa stopt very soon, and in a few Weeks he got free of all Complaints, though he still continued weak,till he was sent toEngland, about the Beginning ofApril.

Many, especially those whose Constitution had been shaken by this or some other Disorder, complained of flatulent Swellings of the Stomach and Bowels, which affected them either while the Ague continued, or soon after it was stopped, and were very troublesome and uneasy. For the most part, these Swellings were removed by the Use of cordial Medicines mixed with the Bark, or a Course of Bitters, and some Doses of Rhubarb given at proper Intervals. In some Cases, where they were attended with Sickness, and the Stomach seemed to be loaded, a Vomit gave Relief. Very often these Symptoms continued for Weeks after the Ague had left them, and did not go entirely off, till the Patient recovered his Strength.

InFebruary,March, andApril, 1761, severals of the Soldiers in the Hospital atPaderborncomplained of periodical Head-Achs, which returned in most, every Day; in others, only every second; and afterwards Cases ofthis Kind occurred at different Times as long as the Army continued inGermany. These Head-Achs generally began in the Forenoon, were very violent while they lasted, and confined the Patient to his Bed for some Hours. During the Pain, the Pulse was quick; but in the Intervals the Patients were quite cool, and without Fever. Sometimes, tho’ not always, the Urine deposited a little Sediment as the Head-Ach was going off. Commonly the Pain was all over the Head, but most severe in the Forehead; though sometimes it was confined to one Side only.

These Head-Achs we treated entirely as Agues of the same Type. When the Patient was strong, some Blood was taken away, and afterwards we prescribed an Emetic and Purge, and then gave the Bark liberally, which generally put an End to the Complaint, without any bad Consequences attending.

FOOTNOTES:[78]SeeVan Swieten, Vol. II. p. 537.[79]A Gentleman told me, that he was once cured of an Ague in the Country, by applying a Poultice of Garlic to his Wrists, and letting it lie on till it inflamed and blistered the Part.—I have seen Blisters cure an Ague.—In theEdinburgh Med. Essays, Vol. II. Art. v. we have an Account of Agues being cured by the Application of Poultices of recent Erigerum (Groundsel) applied to the Stomach on the Days free from the Paroxysm, which caused strong Vomiting.[80]See an Account of an Ague being cured by the Patient being pushed into a Pool of Water without any previous Notice, and being much frightened, inMason’s Account of Agues, p. 222.[81]The common Account given of the Cause of Agues, and of the regular Return of their Paroxysms, has been: That the Ague takes its Rise from some Sort of Matter, bilious, or whatever it may be, either mixed with the Blood, or lodged in the Bowels, or in some other Part of the Body; that a great Part of this Matter is thrown out of the Body, in the Time of the Paroxysm; but that so much remains as serves by Way of a Ferment to assimilate other Particles to its own Nature; which, when collected in a certain Quantity, produce a new Fit; and, according to the Time that it takes to produce this Quantity, the Disorder assumes the Form of a Quotidian, Tertian, or Quartan Ague.[82]Mr.Cleghorn, while atMinorca, after Evacuations, gave the Bark at the End of the third Period, as we observed before; but where the Fever had been neglected till about the third or fourth Period, or badly treated in the Beginning, and the Bowels were inflamed or overcharged with corrupted Gall, he was obliged to endeavour to palliate the most pressing Complaints, and to watch Evening, Night, and Morning for a Remission, and then immediately to fly to the Bark, as the only Remedy that could avert the Danger. If the Patient was strong, he gave Half an Ounce of the Bark, with six Drachms of thesal catharticum amarum, divided into four equal Parts, of which the Patient took one every two Hours; the Effect of which was, that the next Fit was mitigated, and an Intermission commonly ensued, in which the Bark was repeated without the Purgative, to finish the Cure.—But where the Patient was excessively feeble, and there was a manifest Risk of his dying in next Fit, he gave Cordials with the Bark, instead of thesal catharticum; and endeavoured to throw in six or seven Drachms in the Space of ten or twelve Hours; he having found by Experience, that if a smaller Quantity is given, the Paroxysms come on earlier than usual, and make all Attempts to preserve Life unsuccessful. See hisAccount of the epidemic Diseases of Minorca, cap. iii. 2d edit. p. 192.[83]Sometimes, when Patients are reduced low by Agues, the Stomach becomes so squeamish as to reject the Bark in every Shape it can be given; in such Cases, when the Ague cannot be stopped by other Means, it may be administered with great Advantage in Clysters, of which the following is a very remarkable Instance.—William Hadderell, a Lad seventeen Years of Age, in the End of the Year 1761, was attacked with a severe Tertian Ague, in which a Mortification came on his left Foot, and one-half of it dropt off; notwithstanding, his Ague continued to attack him every second Day, and the Sore continued running on the 12th ofOctober1763, when he was admitted intoSt. George’s Hospital. He was reduced extremely low; and the Sore of his Foot looked so bad, that it was at first imagined he must lose his Leg. He was ordered some Vomits, and a Purge, and cooling Medicines, and afterwards to take the Bark freely; but his Stomach rejected it, in whatever Form it was given. Other Means were then tried to stop his Ague, but with no Effect, till the 7th ofNovember, that I ordered two Drachms of the Powder of the Bark to be given him twice a Day in an emollient Clyster, with Half a Drachm of thetinctura thebaica, which stopt his Ague in three Days; and he had had no Return of it on the 28th ofJanuary1764, and had recruited his Health and Strength, and the Sore of his Foot was greatly lessened. Dr.Harvey(who teaches Midwifery inLondon) told me, that he has cured Children of Agues by Bark Clysters, after the Bark Waistcoats, and other Means used, had proved unsuccessful.[84]This agrees with what Mr.Cleghornremarks of Tertian Fevers in hisObservations on the epidemic Diseases of the Island of Minorca, who says, “where there is an icteritious Colour of the Eyes, we are likewise told, that the Cortex should not be administered; though, in my Opinion, it is for the most part dangerous to delay it, after the first Appearance of that Symptom.” Chap. iii. 2d edit. p. 205.[85]Dr.Pringletakes Notice, that these Obstructions happened as often without as with the Bark; and therefore seemed to depend on the long Continuance and Obstinacy of the Intermittent.Observ.part iii. chap. iv. sect. 2. p. 179. 3d Edit.[86]I have seen the dead Bodies of four People opened, who had those Swellings of the left Side, commonly called theAgue Cake, which had come after Agues; and in all the Swelling was owing to an Enlargement of the Spleen.[87]The cold Fit is the most dangerous Time of the Paroxysm, and the greatest Part of those who die of Agues die at this Time; one or two Instances of which I saw in the Military Hospital atEdinburghin the Year 1746.—Van Swietensays he has seen the trembling and shaking so great in the Time of the cold Fit of Quartans, that the Teeth have dropt out of the Head.Comment. in sect.749.Aphorism. Boerhaav.vol. II. p. 511.[88]On the 29th ofAugust1759, a Man (Murdoch Brinnen) about thirty Years of Age, was admitted intoSt. George’s Hospital for a very large Swelling of the parotid Glands and neighbouring Parts, which had come three Days before, after a Fit of the Tertian Ague, which did not return afterwards. The Swelling was discussed by the Application of emollient Cataplasms, which were intended to have brought it to Suppuration. He had no Return of the Ague, nor did any bad Consequence follow the Discussion of the Tumour, and the Cure was completed by a few Doses of Physic, and a Decoction of the Bark, which restored him to his Strength, and carried off the little Heat and Feverishness which remained.

[78]SeeVan Swieten, Vol. II. p. 537.

[79]A Gentleman told me, that he was once cured of an Ague in the Country, by applying a Poultice of Garlic to his Wrists, and letting it lie on till it inflamed and blistered the Part.—I have seen Blisters cure an Ague.—In theEdinburgh Med. Essays, Vol. II. Art. v. we have an Account of Agues being cured by the Application of Poultices of recent Erigerum (Groundsel) applied to the Stomach on the Days free from the Paroxysm, which caused strong Vomiting.

[80]See an Account of an Ague being cured by the Patient being pushed into a Pool of Water without any previous Notice, and being much frightened, inMason’s Account of Agues, p. 222.

[81]The common Account given of the Cause of Agues, and of the regular Return of their Paroxysms, has been: That the Ague takes its Rise from some Sort of Matter, bilious, or whatever it may be, either mixed with the Blood, or lodged in the Bowels, or in some other Part of the Body; that a great Part of this Matter is thrown out of the Body, in the Time of the Paroxysm; but that so much remains as serves by Way of a Ferment to assimilate other Particles to its own Nature; which, when collected in a certain Quantity, produce a new Fit; and, according to the Time that it takes to produce this Quantity, the Disorder assumes the Form of a Quotidian, Tertian, or Quartan Ague.

[82]Mr.Cleghorn, while atMinorca, after Evacuations, gave the Bark at the End of the third Period, as we observed before; but where the Fever had been neglected till about the third or fourth Period, or badly treated in the Beginning, and the Bowels were inflamed or overcharged with corrupted Gall, he was obliged to endeavour to palliate the most pressing Complaints, and to watch Evening, Night, and Morning for a Remission, and then immediately to fly to the Bark, as the only Remedy that could avert the Danger. If the Patient was strong, he gave Half an Ounce of the Bark, with six Drachms of thesal catharticum amarum, divided into four equal Parts, of which the Patient took one every two Hours; the Effect of which was, that the next Fit was mitigated, and an Intermission commonly ensued, in which the Bark was repeated without the Purgative, to finish the Cure.—But where the Patient was excessively feeble, and there was a manifest Risk of his dying in next Fit, he gave Cordials with the Bark, instead of thesal catharticum; and endeavoured to throw in six or seven Drachms in the Space of ten or twelve Hours; he having found by Experience, that if a smaller Quantity is given, the Paroxysms come on earlier than usual, and make all Attempts to preserve Life unsuccessful. See hisAccount of the epidemic Diseases of Minorca, cap. iii. 2d edit. p. 192.

[83]Sometimes, when Patients are reduced low by Agues, the Stomach becomes so squeamish as to reject the Bark in every Shape it can be given; in such Cases, when the Ague cannot be stopped by other Means, it may be administered with great Advantage in Clysters, of which the following is a very remarkable Instance.—William Hadderell, a Lad seventeen Years of Age, in the End of the Year 1761, was attacked with a severe Tertian Ague, in which a Mortification came on his left Foot, and one-half of it dropt off; notwithstanding, his Ague continued to attack him every second Day, and the Sore continued running on the 12th ofOctober1763, when he was admitted intoSt. George’s Hospital. He was reduced extremely low; and the Sore of his Foot looked so bad, that it was at first imagined he must lose his Leg. He was ordered some Vomits, and a Purge, and cooling Medicines, and afterwards to take the Bark freely; but his Stomach rejected it, in whatever Form it was given. Other Means were then tried to stop his Ague, but with no Effect, till the 7th ofNovember, that I ordered two Drachms of the Powder of the Bark to be given him twice a Day in an emollient Clyster, with Half a Drachm of thetinctura thebaica, which stopt his Ague in three Days; and he had had no Return of it on the 28th ofJanuary1764, and had recruited his Health and Strength, and the Sore of his Foot was greatly lessened. Dr.Harvey(who teaches Midwifery inLondon) told me, that he has cured Children of Agues by Bark Clysters, after the Bark Waistcoats, and other Means used, had proved unsuccessful.

[84]This agrees with what Mr.Cleghornremarks of Tertian Fevers in hisObservations on the epidemic Diseases of the Island of Minorca, who says, “where there is an icteritious Colour of the Eyes, we are likewise told, that the Cortex should not be administered; though, in my Opinion, it is for the most part dangerous to delay it, after the first Appearance of that Symptom.” Chap. iii. 2d edit. p. 205.

[85]Dr.Pringletakes Notice, that these Obstructions happened as often without as with the Bark; and therefore seemed to depend on the long Continuance and Obstinacy of the Intermittent.Observ.part iii. chap. iv. sect. 2. p. 179. 3d Edit.

[86]I have seen the dead Bodies of four People opened, who had those Swellings of the left Side, commonly called theAgue Cake, which had come after Agues; and in all the Swelling was owing to an Enlargement of the Spleen.

[87]The cold Fit is the most dangerous Time of the Paroxysm, and the greatest Part of those who die of Agues die at this Time; one or two Instances of which I saw in the Military Hospital atEdinburghin the Year 1746.—Van Swietensays he has seen the trembling and shaking so great in the Time of the cold Fit of Quartans, that the Teeth have dropt out of the Head.Comment. in sect.749.Aphorism. Boerhaav.vol. II. p. 511.

[88]On the 29th ofAugust1759, a Man (Murdoch Brinnen) about thirty Years of Age, was admitted intoSt. George’s Hospital for a very large Swelling of the parotid Glands and neighbouring Parts, which had come three Days before, after a Fit of the Tertian Ague, which did not return afterwards. The Swelling was discussed by the Application of emollient Cataplasms, which were intended to have brought it to Suppuration. He had no Return of the Ague, nor did any bad Consequence follow the Discussion of the Tumour, and the Cure was completed by a few Doses of Physic, and a Decoction of the Bark, which restored him to his Strength, and carried off the little Heat and Feverishness which remained.

TheJaundice, or a yellow Colour of the Eyes and Skin, occasioned by an Absorption of Bile into the Blood, was another Distemper which appeared towards the End of each Campaign.

This Disorder, for the most part, takes its Rise[89]from Calculi lodged in the biliary Ducts[90]; and sometimes from a viscid Mucusor Pituita obstructing those Passages[91]; and it may be brought on by a Tumour, or any other Cause[92], compressing these Ducts, so as to prevent the free Flow of the Bile into the Cavity of the Intestines.

The yellow Colour, or Jaundice, observed in the Ague, and some other bilious Disorders, seems to arise sometimes from Spasms of the Ducts; or from too great a Quantity of Bile secreted and absorbed into the Blood, which seems evidently to be the Case where largeQuantities of Bile are either vomited or discharged by Stool; a Proof that the biliary Ducts are clear, and free from Obstructions.

In the End of the Campaign of 1760, after a continued Rain for many Weeks, the Jaundice had been very frequent, and in a Manner epidemical, among the Troops, for some Time before they left the Field; and in passing thro’Munster, about the End ofDecember, I observed several ill of that Distemper in Hospitals, and met with a few Cases of this Kind in the Hospitals atPaderborninJanuary1761; but during the Spring and Summer, we had only one or two now and then sent to the Hospitals for this Complaint; though towards the End of the Campaign it became more frequent, and several were sent down toBremen; and some of the Garrison were likewise affected with it. During the Winter not above four or five were sent to the Hospitals I attended, and but a few to the flying Hospital, during the Campaign 1762. It frequently appeared in dropsical Cases, depending on obstructed Viscera.

Those in whom the Jaundice was the original Disorder, and not complicated with any other, generally got well soon; but where it appeared in dropsical Cases, depending on obstructed Viscera, it was commonly fatal.

In the Beginning of this Disease, Patients usually complained of Sickness, Heat, Thirst, and other feverish Symptoms; and some had a Vomiting, and Pain of the Stomach, for a Day or two before the Jaundice appeared; the Urine was always of a deep Colour from the first; and about the second or third Day the Skin, and the Whites of the Eyes, began to be tinged with a yellow Colour, attended with the common Symptoms of this Disorder.

Such was the Manner in which the Jaundice began in those who were taken ill in Garrison; but those sent us from the Army could seldom give any accurate Account of their own Cases.

In the Course of this Disorder, the Sick were inclined to be costive, though some few had a Diarrhœa; several, who had been reduced by Fevers, or other Complaints, before theJaundice appeared, were attacked with violent Hæmorrhages from the Nose; and two had like to have died of them before the Bleeding was stopped. The Hæmorrhages did not prove critical, but seemed to depend on a dissolved State of the Blood.

On the Patient’s being first taken ill, if he was plethoric or feverish, or complained of Pain, attended with Sickness and Vomiting, some Blood was taken away. Next Day we gave twenty-five or thirty Grains of Rhubarb in a saline Draught, and afterwards the common saline and other cooling Medicines, till the Fever was abated. If the Pain and Fever did not abate, a Vein was opened a second Time, and a few Drops of thetinctura thebaicawere added to the saline Draughts, while emollient Clysters were frequently administered, and the Stomach and Belly fomented with Flannels dipped in warm emollient Decoctions.

When the Pain and Fever were gone, we then gave a gentle Vomit in the Evening, and next Day a Dose of Rhubarb; and afterwardsso much of thepilulæ saponaceæ cum rheodaily as kept the Body open; or the saline Draughts with five or six Grains of Rhubarb in each, or such a Quantity as answered the same Purpose as the Pills; and from Time to Time repeated the Emetic[93]and Purge.

Most of the icteric Cases we had, which were not complicated with other Disorders, yielded to the above Treatment in about twelve or fourteen Days. Two or three remained obstinate for a longer Time. To one I ordered a Quart of the pectoral Decoction, made with Parsly Roots instead of the Linseed, to be drunk daily along with the Soap Pills; and the Jaundice disappeared in about eight or ten Days. One who had the Disease more obstinate than the rest, and complained for some Time of a Tension and Uneasiness about the Liver, wasordered to have the right Side fomented Morning and Evening, and to rub it for some Time after with thelinimentum saponaceumand to drink the Decoction of Sarsaparilla after the Soap Pills; and by continuing this Course forabout three Weeks, the Disorder went off[94].

The Hæmorrhage from the Nose commonly stopped soon. Where it was violent, we keptthe Patient cool, and applied Cloths dipped in Vinegar and Water to the Nose.—In two Cases, one atMunster, the other atBremen, the Patients were hot and feverish, and a Vein was opened, and eight or ten Ounces of Blood taken away; and in one Case nothing took Effect till we gave repeated Doses of thetinctura saturninain a common acid Julep.

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