FOOTNOTES:

FOOTNOTES:[89]Obstructions and Scirrhi of the Liver have been assigned as the Cause of the Jaundice; but as we have so many Cases of this Kind related where no Jaundice appeared, it is now much doubted, whether such Obstructions, which do not affect the Ducts, are capable of producing this Disorder.[90]We have numerous Cases inBonetus, and other physical Observations, where Calculi have been found in the Gall Bladder, and Ducts of People who have died of the Jaundice; and I have frequently found two, three, and sometimes twelve, fifteen, or twenty, such bilious Calculi in these Cavities.[91]Viscid Mucus or Pituita, or viscid Bile, has been observed frequently to obstruct the Ducts. Dr.Coesays, sometimes icteric Patients discharge very thick Bile, almost as viscid as Bird-Lime. See hisTreatise on biliary Concretions, chap. ii. where he has collected a great Number of icteric Cases, in which the Bile has been found quite viscid after Death.[92]See the Case of a Jaundice inBonetus’s Sepulchretum Anatomicum, tom. II. p. 326, where the Sides of the common biliary Duct were compressed by an Enlargement of the Glands about thevena portarum; and we sometimes meet with a Jaundice in pregnant Women which goes off after Delivery, and seems to have been caused by the Pressure of the Uterus and indurated Fœces in the Colon.Van Swietensays, he has seen this very frequently, vol. III. sect. 918, p. 95.[93]Vomits are reckoned amongst the most efficacious Remedies in this Disorder, and I have often seen good Effects follow their Use.—Janet Crags, a Woman thirty Years of Age, was, on the 21st ofDecember1758 admitted intoSt. George’s Hospital for a Jaundice of some Months Continuance. Her Eyes and Skin were not of the common icteric Colour, but of a dark livid yellow, for which Reason both she and the Nurses termed her Disorder the Black Jaundice. She at first complained of a Difficulty of Breathing, and a Weight and Oppression about the Region of the Liver, for which she was blooded, took some Doses of Physick, and the Soap Pills with Rhubarb; but these produced no Change in her Complaints. On the 29th she had a Cough, and complained much of Sickness and Difficulty of Breathing, for which she was ordered a Vomit, and afterwards to take the Squill Draught Morning and Evening, which occasioned a Purging and Gripes. On the 5th ofJanuary1759, the Looseness still continuing, I ordered her to leave off the Use of the Squill Draughts, and to take only some Rhubarb in an oily Draught every Night at Bed-Time. On the 8th, tho’ the Purging had increased, I did not chuse to check it, as I suspected it would prove a Crisis to the Disorder, and therefore only ordered her the Cordial Draughts and Wine to support her Strength. The Looseness continued till the 15th, when most of the icteric Symptoms were gone, and by the 30th they entirely disappeared. However, she continued low, and subject to Flatulencies for some Months afterwards, which were at last removed by the continued Use of Cordials, gentle Bitters, a nourishing Diet, and repeated Doses of Rhubarb; and on the 2d ofMayshe was discharged in a firm State of Health.Dr.Coesays, “I have more Reason to be satisfied of the Effect of Vomits in dislodging these Calculi, than of any other, or indeed of all other Medicines.”Treatise on biliary Concretions, chap. ii. p. 253. Besides viscid Humours, which Vomits bring away from the biliary Passages, how often are Gall Stones likewise found in the Stools after the Operation of a Vomit?Ibid.p. 256.[94]Sometimes the warm Bath has a good Effect after other Remedies have afforded no Relief. In the Year 1743, a young Gentleman, a Student of Physic atEdinburgh, had a Jaundice for which he had taken Variety of Medicines, and rode daily on Horseback for some Weeks, without receiving any Benefit: At last, by my Father’s Advice, he took a brisk Dose of Physic, and before it began to operate had a large Quantity of warm Whey thrown up by way of a Clyster, and went immediately into the warm Bath. In the Bath he was taken with a violent Inclination to go to Stool; and after coming out, had a great Number of bilious Stools that Day, and next Morning was still inclined to be loose; and in a few Days all the icteric Symptoms vanished. On the 20th ofJuly1763, a middle aged Woman,Elizabeth Hosier, was admitted intoSt. George’s Hospital for a Jaundice, which came about a Fortnight before. She had been blooded, and had taken some Medicines, before I saw her. I ordered her a Vomit and Purge, and to take too Scruples of the Soap Pills and Rhubarb daily; and four Days afterwards the Vomit and Purge were repeated, but without making any Change in her Disorder. On the 29th she went into the warm Bath, and took a Vomit immediately on coming out. After the Vomit she had some loose Stools, and the icteric Symptoms went all off in a few Days. She continued well for some Months; but I have been told, that she has since relapsed.When the Jaundice continues obstinate, there is hardly any Thing has often a better Effect than the continued Use of Decoctions of the Juices of succulent Plants, of Whey in the Spring, Soap, and such like Medicines. The BaronVan Swietentells us, that he has cured many obstinate Jaundices by making the Patients drink daily a Pint or two Pints of a Decoction of Grass, Dandelion, Fumaria, Succory, and such like, prepared in Whey; to each Pint of which he added Half an Ounce ofsal polychrest, and an Ounce or two of Syrup of the five aperient Roots; and by ordering them to drink the Spa Water in Summer, and take freely of Soap, along with a Decoction of the aperient Roots, in Winter. In those who were cured by these Remedies, he says, Stones, or a kind of a grumous calculous Matter, were always found in the Stools, as the Jaundice was going off. He relates one very particular Case of a Lady of sixty Years of Age, who had had a black Jaundice for twelve Years, and was cured by continuing the Use of these Medicines for eighteen Months; during the last six Months of which she had a Looseness, and constantly discharged by Stool a fetid granulated Matter of the Colour of Clay;—and another singular Case of a Man who was cured by living mostly upon Grass, and a Decoction of it, for two Years together. The Man came at last to devour such Quantities of it, and could distinguish the good Sort from the bad so well, that the Farmers often used to drive him out of their Fields. Vol. III. §. 950.Glissontells us, that Cattle are subject to bilious Concretions in Winter, which are dissolved and evacuated in the Spring, when they begin to move much about, and to eat the new Grass, which purges them.Oper.vol. II.Anat. Hepat.chap. vii. p. 104.Dr.Russelgreatly recommends the Use of Sea Water along with the saponaceous Medicines. See hisTreatise on the Use of Sea Water.

[89]Obstructions and Scirrhi of the Liver have been assigned as the Cause of the Jaundice; but as we have so many Cases of this Kind related where no Jaundice appeared, it is now much doubted, whether such Obstructions, which do not affect the Ducts, are capable of producing this Disorder.

[90]We have numerous Cases inBonetus, and other physical Observations, where Calculi have been found in the Gall Bladder, and Ducts of People who have died of the Jaundice; and I have frequently found two, three, and sometimes twelve, fifteen, or twenty, such bilious Calculi in these Cavities.

[91]Viscid Mucus or Pituita, or viscid Bile, has been observed frequently to obstruct the Ducts. Dr.Coesays, sometimes icteric Patients discharge very thick Bile, almost as viscid as Bird-Lime. See hisTreatise on biliary Concretions, chap. ii. where he has collected a great Number of icteric Cases, in which the Bile has been found quite viscid after Death.

[92]See the Case of a Jaundice inBonetus’s Sepulchretum Anatomicum, tom. II. p. 326, where the Sides of the common biliary Duct were compressed by an Enlargement of the Glands about thevena portarum; and we sometimes meet with a Jaundice in pregnant Women which goes off after Delivery, and seems to have been caused by the Pressure of the Uterus and indurated Fœces in the Colon.Van Swietensays, he has seen this very frequently, vol. III. sect. 918, p. 95.

[93]Vomits are reckoned amongst the most efficacious Remedies in this Disorder, and I have often seen good Effects follow their Use.—Janet Crags, a Woman thirty Years of Age, was, on the 21st ofDecember1758 admitted intoSt. George’s Hospital for a Jaundice of some Months Continuance. Her Eyes and Skin were not of the common icteric Colour, but of a dark livid yellow, for which Reason both she and the Nurses termed her Disorder the Black Jaundice. She at first complained of a Difficulty of Breathing, and a Weight and Oppression about the Region of the Liver, for which she was blooded, took some Doses of Physick, and the Soap Pills with Rhubarb; but these produced no Change in her Complaints. On the 29th she had a Cough, and complained much of Sickness and Difficulty of Breathing, for which she was ordered a Vomit, and afterwards to take the Squill Draught Morning and Evening, which occasioned a Purging and Gripes. On the 5th ofJanuary1759, the Looseness still continuing, I ordered her to leave off the Use of the Squill Draughts, and to take only some Rhubarb in an oily Draught every Night at Bed-Time. On the 8th, tho’ the Purging had increased, I did not chuse to check it, as I suspected it would prove a Crisis to the Disorder, and therefore only ordered her the Cordial Draughts and Wine to support her Strength. The Looseness continued till the 15th, when most of the icteric Symptoms were gone, and by the 30th they entirely disappeared. However, she continued low, and subject to Flatulencies for some Months afterwards, which were at last removed by the continued Use of Cordials, gentle Bitters, a nourishing Diet, and repeated Doses of Rhubarb; and on the 2d ofMayshe was discharged in a firm State of Health.Dr.Coesays, “I have more Reason to be satisfied of the Effect of Vomits in dislodging these Calculi, than of any other, or indeed of all other Medicines.”Treatise on biliary Concretions, chap. ii. p. 253. Besides viscid Humours, which Vomits bring away from the biliary Passages, how often are Gall Stones likewise found in the Stools after the Operation of a Vomit?Ibid.p. 256.

Dr.Coesays, “I have more Reason to be satisfied of the Effect of Vomits in dislodging these Calculi, than of any other, or indeed of all other Medicines.”Treatise on biliary Concretions, chap. ii. p. 253. Besides viscid Humours, which Vomits bring away from the biliary Passages, how often are Gall Stones likewise found in the Stools after the Operation of a Vomit?Ibid.p. 256.

[94]Sometimes the warm Bath has a good Effect after other Remedies have afforded no Relief. In the Year 1743, a young Gentleman, a Student of Physic atEdinburgh, had a Jaundice for which he had taken Variety of Medicines, and rode daily on Horseback for some Weeks, without receiving any Benefit: At last, by my Father’s Advice, he took a brisk Dose of Physic, and before it began to operate had a large Quantity of warm Whey thrown up by way of a Clyster, and went immediately into the warm Bath. In the Bath he was taken with a violent Inclination to go to Stool; and after coming out, had a great Number of bilious Stools that Day, and next Morning was still inclined to be loose; and in a few Days all the icteric Symptoms vanished. On the 20th ofJuly1763, a middle aged Woman,Elizabeth Hosier, was admitted intoSt. George’s Hospital for a Jaundice, which came about a Fortnight before. She had been blooded, and had taken some Medicines, before I saw her. I ordered her a Vomit and Purge, and to take too Scruples of the Soap Pills and Rhubarb daily; and four Days afterwards the Vomit and Purge were repeated, but without making any Change in her Disorder. On the 29th she went into the warm Bath, and took a Vomit immediately on coming out. After the Vomit she had some loose Stools, and the icteric Symptoms went all off in a few Days. She continued well for some Months; but I have been told, that she has since relapsed.When the Jaundice continues obstinate, there is hardly any Thing has often a better Effect than the continued Use of Decoctions of the Juices of succulent Plants, of Whey in the Spring, Soap, and such like Medicines. The BaronVan Swietentells us, that he has cured many obstinate Jaundices by making the Patients drink daily a Pint or two Pints of a Decoction of Grass, Dandelion, Fumaria, Succory, and such like, prepared in Whey; to each Pint of which he added Half an Ounce ofsal polychrest, and an Ounce or two of Syrup of the five aperient Roots; and by ordering them to drink the Spa Water in Summer, and take freely of Soap, along with a Decoction of the aperient Roots, in Winter. In those who were cured by these Remedies, he says, Stones, or a kind of a grumous calculous Matter, were always found in the Stools, as the Jaundice was going off. He relates one very particular Case of a Lady of sixty Years of Age, who had had a black Jaundice for twelve Years, and was cured by continuing the Use of these Medicines for eighteen Months; during the last six Months of which she had a Looseness, and constantly discharged by Stool a fetid granulated Matter of the Colour of Clay;—and another singular Case of a Man who was cured by living mostly upon Grass, and a Decoction of it, for two Years together. The Man came at last to devour such Quantities of it, and could distinguish the good Sort from the bad so well, that the Farmers often used to drive him out of their Fields. Vol. III. §. 950.Glissontells us, that Cattle are subject to bilious Concretions in Winter, which are dissolved and evacuated in the Spring, when they begin to move much about, and to eat the new Grass, which purges them.Oper.vol. II.Anat. Hepat.chap. vii. p. 104.Dr.Russelgreatly recommends the Use of Sea Water along with the saponaceous Medicines. See hisTreatise on the Use of Sea Water.

When the Jaundice continues obstinate, there is hardly any Thing has often a better Effect than the continued Use of Decoctions of the Juices of succulent Plants, of Whey in the Spring, Soap, and such like Medicines. The BaronVan Swietentells us, that he has cured many obstinate Jaundices by making the Patients drink daily a Pint or two Pints of a Decoction of Grass, Dandelion, Fumaria, Succory, and such like, prepared in Whey; to each Pint of which he added Half an Ounce ofsal polychrest, and an Ounce or two of Syrup of the five aperient Roots; and by ordering them to drink the Spa Water in Summer, and take freely of Soap, along with a Decoction of the aperient Roots, in Winter. In those who were cured by these Remedies, he says, Stones, or a kind of a grumous calculous Matter, were always found in the Stools, as the Jaundice was going off. He relates one very particular Case of a Lady of sixty Years of Age, who had had a black Jaundice for twelve Years, and was cured by continuing the Use of these Medicines for eighteen Months; during the last six Months of which she had a Looseness, and constantly discharged by Stool a fetid granulated Matter of the Colour of Clay;—and another singular Case of a Man who was cured by living mostly upon Grass, and a Decoction of it, for two Years together. The Man came at last to devour such Quantities of it, and could distinguish the good Sort from the bad so well, that the Farmers often used to drive him out of their Fields. Vol. III. §. 950.

Glissontells us, that Cattle are subject to bilious Concretions in Winter, which are dissolved and evacuated in the Spring, when they begin to move much about, and to eat the new Grass, which purges them.Oper.vol. II.Anat. Hepat.chap. vii. p. 104.

Dr.Russelgreatly recommends the Use of Sea Water along with the saponaceous Medicines. See hisTreatise on the Use of Sea Water.

InMay1761, a great many of the Patients, who had been in Hospitals the preceding Winter, had Tumours formed on the external Part of the Breast, which they shewed me atOsnabruck. They began in the Form of indolent Tumours, and came slowly to Suppuration. For the most part, the Suppuration was only partial, and the Tumour, on being opened, discharged a very small Quantity of Matter. Some of them, though they felt soft, and seemed to contain Matter, yet, upon being opened, discharged only a small Quantity of black Blood. None of them melted down entirely into Pus, or came fully to Suppuration, and healed kindly as Abscesses which succeedacute Inflammations. But after a small Quantity of Matter was discharged, for the most part, there still remained a hard Tumour, which felt as if it was a Swelling of the Bone, or Cartilage below; and in some the Surface of the Bone was found rough at the Bottom of the Abscess.

These Tumours seldom rose high, and were most of them situated at the lower Part of the Sternum, or a little to one Side of it, commonly on the left Side, above thecartilago ensiformis. Some Patients had only one, others two, and some three such Tumours. The first of them I saw was on the left Side, which, on being felt, gave exactly the same Sensation as when the Cartilages of the Sternum are begun to be raised by an Aneurism of the Aorta; only no Pulsation was to be perceived; and most of them had the same Appearance.

The Patients, who had such Tumours, commonly complained of Pains of their Breast. One or two, after these Tumours came to Suppuration, seemed to recover their Health, and to feel no Uneasiness, tho’ some of the Swellingremained: But many of them were inclined to be hectic, and seemed likely to grow consumptive.

Being ordered up to the flying Hospital inJune, and the Sick going down toBremen, I had no Opportunity of seeing the Event of these Tumours, or of examining the Bodies of those who died with them. One I accidentally met with the following Winter atBremen, who died of a Consumption and Diarrhœa. He had a large Abscess, which penetrated into the Cavity of the Chest, and discharged a great Quantity of very fetid Matter, at the Part where one of these Tumours had been seated, and the Sternum and Ribs were carious all round the Abscess.

Someof the Soldiers, from lying out in the Nights on the wet Ground, and from doing Duty in cold rainy Weather, were seized with a Pain and Numbness all over, and lost the Use of their Limbs, which in some was succeeded with a Palsy of these Parts: But the greatest Number of those afflicted with Paralytic Symptoms were seized with them either in Fevers, or after feverish and other Disorders. The Number, who were attacked with Complaints of this Kind, were but few.

When Men were suddenly taken with Pain and Numbness all over, we found that the best Method of treating them was to put them to Bed, and give them Plenty of mild warm dilutingLiquors for Drink; and if there was much of a Fever, to open a Vein, to give the cooling antiphlogistic Medicines, and apply Blisters; and if these Complaints still remained, to endeavour to promote a breathing Sweat, by means of Diaphoretics and warm Drinks. Several who were brought to the Hospital, soon after being seized in this Manner, got well; but in some few, one or other of the Limbs would begin to waste, and remain paralytic afterwards.

Those who had the true confirmed Palsy seldom remained long enough with us to be cured. Two or three received Benefit from Blisters applied to the Parts, and from Issues; drinking at the same time the Decoction of the Woods, or of Sarsaparilla, and taking the volatile Tincture of Guaiac or Valerian[95],and being sweated by the Use ofDover’s Powder, or other Diaphoretics.

One Man of the 51st Regiment of Foot, after doing Duty in very cold wet Weather, in the Beginning of the Year 1762, was seized with a Palsy of one Side of his Face, whichprevented him from speaking distinctly, and was an Impediment to his eating. He mended much after being blooded, and having a large Blister to his Neck, kept open for some time by means of the epispastic Ointment.

FOOTNOTES:[95]OnWednesdaythe 1st ofFebruary1764,Margaret Julion, a Woman between fifty and sixty Years of Age, was admitted intoSt. George’s Hospital for an entire Loss of Speech, which seemed to depend on a paralytic Disorder of the Parts about the Larynx. The Account her Friends who came with her to the Hospital gave of her Case was, that she had been for five Months troubled at Times with Pains of her Bowels, and a Purging; that onSundayse’night before coming to the Hospital, she had suddenly lost the Use of her Speech, and had not spoke since that Time, though she seemed to hear and understand whatever was said to her. I asked her some Questions, which she answered distinctly by Signs. She had no paralytic Complaint of her Face, Arms, Legs, or any other Part of her Body, and swallowed both Fluids and Solids with Ease. She had no Fever, and seemed to complain of nothing but the Loss of Speech.—A Blister was applied to her Neck, and she was ordered the saline Draughts, with a Scruple of Powder of Valerian in each, to be taken three Times a-day, and a Dose of sacred Tincture, to be taken twice a-Week. She followed this Course for a Fortnight, when another Blister was applied to the Fore-part of the Neck, and the Powder of Valerian in the Draughts was changed for two Drachms of thetinctura valeriana volatilis. At the End of three Weeks she could pronounce the two WordsWhy,What. She continued the same Course till this Day, the 16th ofMarch, and can now pronounce many Words and short Sentences.

[95]OnWednesdaythe 1st ofFebruary1764,Margaret Julion, a Woman between fifty and sixty Years of Age, was admitted intoSt. George’s Hospital for an entire Loss of Speech, which seemed to depend on a paralytic Disorder of the Parts about the Larynx. The Account her Friends who came with her to the Hospital gave of her Case was, that she had been for five Months troubled at Times with Pains of her Bowels, and a Purging; that onSundayse’night before coming to the Hospital, she had suddenly lost the Use of her Speech, and had not spoke since that Time, though she seemed to hear and understand whatever was said to her. I asked her some Questions, which she answered distinctly by Signs. She had no paralytic Complaint of her Face, Arms, Legs, or any other Part of her Body, and swallowed both Fluids and Solids with Ease. She had no Fever, and seemed to complain of nothing but the Loss of Speech.—A Blister was applied to her Neck, and she was ordered the saline Draughts, with a Scruple of Powder of Valerian in each, to be taken three Times a-day, and a Dose of sacred Tincture, to be taken twice a-Week. She followed this Course for a Fortnight, when another Blister was applied to the Fore-part of the Neck, and the Powder of Valerian in the Draughts was changed for two Drachms of thetinctura valeriana volatilis. At the End of three Weeks she could pronounce the two WordsWhy,What. She continued the same Course till this Day, the 16th ofMarch, and can now pronounce many Words and short Sentences.

AnIncontinency of Urine was another Complaint frequent among the Soldiers; but it seemed to me to be counterfeited by many. All, who had it, said that they had received some Hurt[96]or Sprain of the Back,or a Kick from a Horse, or that a Carriage had run over them.

Those who really had the Disorder seemed to have received such an Injury of the Bladder, or Kidneys as required a considerable Space of Time to get the better of; and by reason of the short Time we had them under our Care at the flying Hospital, they seldom receivedmuch Benefit. One or two thought they grew better on taking the Bark and Balsam ofPeru; at the same Time they bathed Morning and Evening the lower Part of the Abdomen and Perinæum, with Flannels dipped in gentle astringent Liquors, applied cold. Blisters applied to theos sacrumhad no Effect.

FOOTNOTES:[96]A Soldier in the Hospital atPaderbornused to discharge his Water involuntarily, and mixed with Pus, which came from some violent Blows he had received on the Back.John Pearce, a young Man about eighteen Years of Age, was admitted intoSt. George’s Hospital, the 10th ofApril1759, for a Pain of his Side, and a Complaint of the Bladder. The Account which he gave of his own Case was, that, some Months before, he had received a violent Blow with a Cricket-Bat on the left Side, on the Region of the Kidney; and that ever since he had had a sharp Pain in that Part, and sometimes had a Stoppage of Urine, and at other Times it came away insensibly. His Pulse was rather quick, but low, and he had a feverish Heat. He at first took some cooling Medicines; but on the 20th, being low and faint, he had some of the fœtid Julep. On the 23d he was attacked with a sharp Pain in the Belly and Side, had a Stoppage in making Water, a quick and full Pulse, and most of the Symptoms of the Stone. He was ordered to be blooded immediately, to take the saline Draughts every four Hours; and as he was inclined to be costive, to take as much lenitive Electuary as to procure him a loose Stool; and it was recommended that he should be sounded as soon as the Violence of the Fever was over. On the 25th he continued much in the same Way, and had made some Water, which was intolerably fœtid. Half a Drachm of the dulcified Spirit of Nitre, and five Drops of thetinctura thebaica, were added to each of his Draughts, as the Pain and Difficulty of making Water had increased. On the 26th his Pulse rose, and became very hard and quick; the Pain in his Side, and the Dysuria, became more violent; and about Twelve o’Clock he had a convulsive Fit, resembling that of an Epilepsy; after coming out of the Fit, as the Fever and Pain had increased, he was blooded; the Belly was fomented and embrocated, and he took the oily Draughts four Times a-Day; his Blood immediately threw up a very thick Buff. He remained pretty easy the rest of the Day; but about the same Time next Day, he had another convulsive Fit, and died.On opening his Body, we found about two or three Pints of a dark-coloured fœtid Water in the Abdomen; on cutting through, and squeezing the right Kidney, there came out a thin purulent Matter every where from its Substance, though it appeared sound; on raising and cutting through the Peritoneum, covering the left Kidney, there was a Discharge of about a Pint of black and very fœtid Water, which had every where surrounded this Kidney; and there were six mortified Spots on its Surface, as large as the End of one’s Finger, with a Depression in each about a Quarter or Half an Inch deep; most of the Substance of this Kidney seemed diseased, and it was full of Suppurations. The Bladder was contracted and thickened, and contained a rough Stone, which weighed three Ounces. The rest of theviscerawere sound. This Stone had certainly been in the Bladder long before the young Fellow received the Blow with the Cricket-Bat; but the Injury done the Kidney had probably aggravated the Symptoms.I do not remember ever to have seen convulsive Fits, such as this young Man had, in acute Diseases, except in one Case of a slow Fever, which came by taking Cold after a Salivation, and which I attended, along with Dr.Pringle. The Gentleman had three Fits exactly of the same kind as this young Man, at twenty-four Hours Distance from one another, and he died of the third.

[96]A Soldier in the Hospital atPaderbornused to discharge his Water involuntarily, and mixed with Pus, which came from some violent Blows he had received on the Back.John Pearce, a young Man about eighteen Years of Age, was admitted intoSt. George’s Hospital, the 10th ofApril1759, for a Pain of his Side, and a Complaint of the Bladder. The Account which he gave of his own Case was, that, some Months before, he had received a violent Blow with a Cricket-Bat on the left Side, on the Region of the Kidney; and that ever since he had had a sharp Pain in that Part, and sometimes had a Stoppage of Urine, and at other Times it came away insensibly. His Pulse was rather quick, but low, and he had a feverish Heat. He at first took some cooling Medicines; but on the 20th, being low and faint, he had some of the fœtid Julep. On the 23d he was attacked with a sharp Pain in the Belly and Side, had a Stoppage in making Water, a quick and full Pulse, and most of the Symptoms of the Stone. He was ordered to be blooded immediately, to take the saline Draughts every four Hours; and as he was inclined to be costive, to take as much lenitive Electuary as to procure him a loose Stool; and it was recommended that he should be sounded as soon as the Violence of the Fever was over. On the 25th he continued much in the same Way, and had made some Water, which was intolerably fœtid. Half a Drachm of the dulcified Spirit of Nitre, and five Drops of thetinctura thebaica, were added to each of his Draughts, as the Pain and Difficulty of making Water had increased. On the 26th his Pulse rose, and became very hard and quick; the Pain in his Side, and the Dysuria, became more violent; and about Twelve o’Clock he had a convulsive Fit, resembling that of an Epilepsy; after coming out of the Fit, as the Fever and Pain had increased, he was blooded; the Belly was fomented and embrocated, and he took the oily Draughts four Times a-Day; his Blood immediately threw up a very thick Buff. He remained pretty easy the rest of the Day; but about the same Time next Day, he had another convulsive Fit, and died.On opening his Body, we found about two or three Pints of a dark-coloured fœtid Water in the Abdomen; on cutting through, and squeezing the right Kidney, there came out a thin purulent Matter every where from its Substance, though it appeared sound; on raising and cutting through the Peritoneum, covering the left Kidney, there was a Discharge of about a Pint of black and very fœtid Water, which had every where surrounded this Kidney; and there were six mortified Spots on its Surface, as large as the End of one’s Finger, with a Depression in each about a Quarter or Half an Inch deep; most of the Substance of this Kidney seemed diseased, and it was full of Suppurations. The Bladder was contracted and thickened, and contained a rough Stone, which weighed three Ounces. The rest of theviscerawere sound. This Stone had certainly been in the Bladder long before the young Fellow received the Blow with the Cricket-Bat; but the Injury done the Kidney had probably aggravated the Symptoms.I do not remember ever to have seen convulsive Fits, such as this young Man had, in acute Diseases, except in one Case of a slow Fever, which came by taking Cold after a Salivation, and which I attended, along with Dr.Pringle. The Gentleman had three Fits exactly of the same kind as this young Man, at twenty-four Hours Distance from one another, and he died of the third.

[96]A Soldier in the Hospital atPaderbornused to discharge his Water involuntarily, and mixed with Pus, which came from some violent Blows he had received on the Back.

John Pearce, a young Man about eighteen Years of Age, was admitted intoSt. George’s Hospital, the 10th ofApril1759, for a Pain of his Side, and a Complaint of the Bladder. The Account which he gave of his own Case was, that, some Months before, he had received a violent Blow with a Cricket-Bat on the left Side, on the Region of the Kidney; and that ever since he had had a sharp Pain in that Part, and sometimes had a Stoppage of Urine, and at other Times it came away insensibly. His Pulse was rather quick, but low, and he had a feverish Heat. He at first took some cooling Medicines; but on the 20th, being low and faint, he had some of the fœtid Julep. On the 23d he was attacked with a sharp Pain in the Belly and Side, had a Stoppage in making Water, a quick and full Pulse, and most of the Symptoms of the Stone. He was ordered to be blooded immediately, to take the saline Draughts every four Hours; and as he was inclined to be costive, to take as much lenitive Electuary as to procure him a loose Stool; and it was recommended that he should be sounded as soon as the Violence of the Fever was over. On the 25th he continued much in the same Way, and had made some Water, which was intolerably fœtid. Half a Drachm of the dulcified Spirit of Nitre, and five Drops of thetinctura thebaica, were added to each of his Draughts, as the Pain and Difficulty of making Water had increased. On the 26th his Pulse rose, and became very hard and quick; the Pain in his Side, and the Dysuria, became more violent; and about Twelve o’Clock he had a convulsive Fit, resembling that of an Epilepsy; after coming out of the Fit, as the Fever and Pain had increased, he was blooded; the Belly was fomented and embrocated, and he took the oily Draughts four Times a-Day; his Blood immediately threw up a very thick Buff. He remained pretty easy the rest of the Day; but about the same Time next Day, he had another convulsive Fit, and died.

On opening his Body, we found about two or three Pints of a dark-coloured fœtid Water in the Abdomen; on cutting through, and squeezing the right Kidney, there came out a thin purulent Matter every where from its Substance, though it appeared sound; on raising and cutting through the Peritoneum, covering the left Kidney, there was a Discharge of about a Pint of black and very fœtid Water, which had every where surrounded this Kidney; and there were six mortified Spots on its Surface, as large as the End of one’s Finger, with a Depression in each about a Quarter or Half an Inch deep; most of the Substance of this Kidney seemed diseased, and it was full of Suppurations. The Bladder was contracted and thickened, and contained a rough Stone, which weighed three Ounces. The rest of theviscerawere sound. This Stone had certainly been in the Bladder long before the young Fellow received the Blow with the Cricket-Bat; but the Injury done the Kidney had probably aggravated the Symptoms.

I do not remember ever to have seen convulsive Fits, such as this young Man had, in acute Diseases, except in one Case of a slow Fever, which came by taking Cold after a Salivation, and which I attended, along with Dr.Pringle. The Gentleman had three Fits exactly of the same kind as this young Man, at twenty-four Hours Distance from one another, and he died of the third.

Weformerly mentioned, that in acute Diseases many complained of a Stoppage or Difficulty of making Water; andothers had this Complaint from Strictures of the Urethra, or Disorders of the Bladder or Kidneys[97].

Where it depended on Strictures of the Urethra, Bougies introduced into that Passage,and worn for some Time, were of great Service. The Patients were at the same time orderedto live on a cool Diet, and to drink thedecoctum Arabicum, or an Infusion of Linseed, or such other mild mucilaginous Liquors;and to take oily Medicines and Opiates occasionally, and gentle Laxatives, to keep the Body open; which Method of Treatment generallygave Relief. Where the Patients were plethoric, or complained of Pain, or the Disorderwas attended with a Fever, Bleeding was often necessary.

When the Stoppage of Urine seemed toarise from an Inflammation of the Kidneys or Bladder, or other Diseases of these Parts, we treated it accordingly; and where the Fever was considerable, we made Evacuations, andgave plenty of diluting Liquors, and the cooling saline Medicines, and afterwards those of the soft, mucilaginous, and oily Nature, andmild Diuretics and Opiates.

When the Disorder, in its Progress, became chronical, the Sick were commonly sent down to the fixed Hospital, so that we had no Opportunity of examining the Bodies of such as might die of this Complaint.

FOOTNOTES:[97]It is often very difficult to judge of the Cause, or to be able to determine exactly the Seat of these Disorders before Death; as the following Cases will shew.John Waden, a middle-aged Man, was admitted intoSt. George’s Hospital the 10th ofApril1759, for a Swelling of the Abdomen, and a Difficulty of making Water, which he said begun about two Months before, with a violent Pain in his Back and Belly, occasioned by his being employed in making of Cyder in a very cold Cellar. He had not had a Stool for some Days: at first he took a Dose of Physic, and some of the saline Draughts; but in a Day or two complained that his Belly had grown to a monstrous Size, and that he had not made Water for above twenty-four Hours; on examining, we found the Bladder so much distended as to reach up to the Navel; and upon a Catheter’s being introduced, above two Quarts of Water were drawn off, and the Swelling immediately subsided; but in the Afternoon was as large as before, the Bladder seeming to be in a paralytic State. During the Months ofMayandJune, his Water was drawn off twice a-Day; he had his Belly fomented with emollient, astringent, and other Decoctions, and embrocated with Liniments; was blooded once when feverish, took Cordials, the Bark, Myrrh, and a Variety of Medicines, without any Effect. On the 3d ofJuly, a flexible Catheter was introduced into the Bladder, and left there, in order that the Urine might drain away as fast as it was secreted, and the Bladder be allowed to contract, and recover its Tone. The Catheter gave him no Pain, and he thought himself much easier by the Bladder’s never being too much stretched; but on taking out the Catheter some Days after, he had the same Stoppage of Water as before. On consulting with Dr.Battand the other Physicians, it was agreed to give two Grains of the Powder of Cantharides, with three Grains of Camphor and ten of Sugar, rubbed well together in a Mortar, twice a-Day; and to continue the Use of the flexible Catheter. He found no Uneasiness or Strangury from the Use of the Cantharides, and thought he passed his Water more freely, when the Catheter was taken out; but after fourteen Days, finding no Change for the better, and being free from any Fever, he was ordered into the cold Bath; the two first Days he found himself more lively and brisk; but the third Day was chilly and cold after coming out of it, and therefore was desired to leave it off; some Days after he became hectic, and I observed Pus in his Water, which he said he had passed with his Urine for above three Months; after this he languished for near a Month, and died upon the 25th ofAugust.—Upon examining his Body next Day, we found the thoracic Viscera in a sound State, except that the Lungs adhered a little on the right Side. Both Kidneys were diseased; they were inflamed, and seemed enlarged; and on cutting them, had Tubercles dispersed every where through their Substance, which had come to Suppuration, and contained a good deal of Matter; the lower Part of the left Kidney was mortified, and contained two or three Ounces of a black fœtid Liquor. The Bladder of Urine was contracted, and its Coats greatly thickened, and the internal Coat much inflamed; and there was a Cyst full of Matter, about Half the Size of a Walnut, between the muscular and villous Coats, towards the lower Part of the right Side of the Bladder; and there were two large Cysts, containing a small Quantity of Matter, though capable of containing near two Ounces each; one situated between thevesiculæ seminalesand Rectum, the other between thevesiculæand Bladder, which opened into the Urethra by one common Orifice, capable of admitting a large Quill, at the Side of thecaput galinaginis. The rest of the Viscera were in a sound State.Mary Hibbard, a Woman twenty-four Years of Age, was admitted intoSt. George’s Hospital, the 6thJune1759, for a Complaint of her Bladder. The Account she gave of herself was, that, aboutChristmas1758, she had parted with some Gravel; and about fourteen Days before coming to the Hospital, she was seized with a violent Pain in her Back and Loins, attended with a Sickness and Nausea; and very soon after complained of a violent Pain in the lower Part of her Belly, and with a perpetual Inclination to make Water, though she felt a sharp Pain and Difficulty in doing it; and that these Complaints still remained. Her Pulse was quick and strong, and she was inclined to be costive. She was immediately blooded, took the oily Draughts three Times a-Day, thedecoctum furfurisfor common Drink, and so much lenitive Electuary as procured her a Stool next Day. As there was a strong Suspicion of her having a Stone, she was sounded; but nothing at all was to be felt in the Bladder. Her Medicines eased her Pain in making Water, but not the Pain in her Back. On the 16th her Water was thick and turbid, and deposited a brown Sediment; and the Difficulty in making Water still remained; instead of the lenitive Electuary she was ordered the Rhubarb oily Draught to be taken every Night. On the 18th, there being no Change in her Disorder, she had Draughts made of an Ounce and a Half of simple Mint Water, Half a Drachm of the dulcified Spirit of Nitre, and five Drops of thetinctura thebaica, and Syrup three Times a-Day; but on the 22d she complained, that since she left off the oily Medicines, her Pain and Difficulty in making Water had grown worse; she was therefore ordered the saline and oily Draughts alternately, and to take the Rhubarb oily Draught occasionally when costive, which removed these Complaints; and they did not return while she remained in the House; but on the 4th ofJuly, the Day before she was to have been discharged as cured, she was attacked with a sharp Pain in her Hip and Loins, and about theos coccygis; which increased till the 9th, and extended itself all along the Outside of the right Thigh; it was most acute about theos coccygis; but on examining, nothing was to be observed externally: This Pain continued more or less all that Month, and till the End of the next, and so obstinate as not to be altered by bleeding, and the Use of Liniments, Blisters, cooling Medicines, Opiates, warm Baths, and other Remedies. On the 20th ofAugust, a strengthening Plaister was applied to her Back, which gave immediate Relief, and she was discharged cured the 29th. She continued well tillOctober, when she was attacked with a violent Fever atHounslow, and was brought to the Hospital on the 24th of that Month, and the tenth Day of the Fever. She died the 3d ofNovember. During the Course of the Fever, she only complained once of a Difficulty of making Water.—After Death I had her Body opened, when the only Thing particular which we could observe, was the urinary Bladder about four times the natural Size; it seemed to be flaccid, and in a State of Relaxation; the Kidneys were sound, and no Signs of any Distemper could be observed about the Uterus or Rectum, or near theos coccygis.—When she was first in the Hospital, I desired her always to examine her Urine; but she never observed that she passed any Sand, Gravel, or any thing of that kind.Thomas Jacey, an elderly Man, was admitted intoSt. George’s Hospital the 14th ofMarch1759, for a Pain in his Back, and a Difficulty and Pain in making Water, which was often mixed with grumous Blood; but he had never observed any Sand or Gravel in it. His Pulse was quick and full, attended with Heat and Thirst; and he was inclined to be costive; he was at first blooded, and took a Dose of laxative Mixture, and two Ounces of the Tincture of Roses, four Times a Day, and thedecoctum malvæfor common Drink. At first he seemed relieved, and passed no grumous Blood for some Days; but on the 26th, as he complained much of a Pain in making Water, the Tincture of Roses was changed for the oily Draughts, and he was ordered the Rhubarb oily Draught occasionally. On the 9th ofAprilhe fell suddenly into a comatose Way, and remained so till the 12th, when he died, notwithstanding the Use of divers Remedies.—Upon examining his Body, both Kidneys were found in a sound State; the Intestines covered with slight inflammatory Spots, the Bladder of Urine quite contracted, schirrhous, and greatly thickened; and its internal Surface rough and eroded, with one or two black Spots on it, and some grumous Blood lying on its Surface. The other viscera were sound.In Ulcers of these Organs, the natural Balsams, mixed with soft Things, are often of great Service; of which the following Case is an Example.—William Lumley, a Boy nine Years of Age, was admitted intoSt. George’s Hospital, the 6th ofSeptember1759, for a Pain in the Bladder, and a Difficulty in making Water, which was always more or less mixed with Matter. At first there was a Suspicion of his having the Stone; but on sounding, none was to be found. From the Symptoms, it appeared as if there was an Ulcer in the Bladder near to its Neck; the Boy had a Cough, was very low, and inclined to be costive; at first he took three Spoonfuls of the Sperma Ceti Mixture four Times a-Day, and a Dose of Physic; but the Symptoms still remaining, on the 2d ofOctoberhe was ordered to take a Scruple of theelectuarium e spermate cetithree or four Times a Day, and to have the Gum-Arabic Decoction for his common Drink. By continuing the Use of these Things, and taking some opiate and laxative Medicines occasionally, he mended by slow Degrees, and all his Symptoms went off; and he recovered his Health and Strength, and returned Thanks for his Cure the 18th ofJanuary1760.The following Account of a remarkable Suppression of Urine I had in a Letter, dated the 25th ofNovember1757, from Mr.Pearson, one of the Surgeons to his Majesty’s Military Hospitals, who then served as a Mate.James Ruffendal, aged Twenty, of a delicate Habit, was, in the Middle ofJulylast, seized with a violent Pain in both Kidneys, which extended along the Ureters to the Bladder, and remained in the same Situation for about three Weeks; during which Period his Urine began to decrease in Quantity, and the voiding of it was attended with acute Pain about the Neck of the Bladder. The Secretion then totally stopt; he remained for upwards of five Weeks in the Hospital atDorchester, and made no Water; at the End of which Time I first visited him along with Mr.Adair. He complained then of a slight Pain in his Kidneys, and told us he had a tolerable Appetite, sweated little, and voided every Day four or five Liquid Stools. He was ordered Boluses of Camphor, andsal. vol. c. cervi, and every Night a Dose oftinctura cantharidum; which he continued to take for a Fortnight without receiving the least Benefit. I then blooded him to the Quantity of ten Ounces, and gave him an Emetic of six Drachms of thevinum ipecacoanhæ, and two Ounces of the Oxymel of Squills, which operated very well; and afterwards ordered him to take one of the following Boluses every four Hours. ℞ Sapon. dur. Hispan. drachm. i. Sal. Absynth. gr. vi. Calc. Viv. gr. x. Balsam. Peruv. q. s. ut fiat Bolus. These he continued to take for twelve Days. On the Morning of the 14th ofOctober, he was suddenly seized with an acute Pain in both Kidneys, and about Noon voided upwards of Half a Pint of straw-coloured Urine, which let fall a clay-coloured Sediment. As he was feverish, I took away twelve Ounces of Blood, and ordered him Barley-Water with Nitre for Drink. He was easy in the Night, and made upwards of two Pints of Urine, which deposited a Sediment of a gelatinous Consistence. Next Morning the Pain increased, especially in his Right Side, and ten Ounces more of Blood was taken away. This lowered the Pulse, and considerably abated the Pain. Both this and the Blood taken away the Day before threw up an inflammatory Buff. He was ordered to continue the Use of the Barley Water with Nitre, and to take three Spoonfuls of a Mixture withspiritus mindererievery two Hours. He had an easy Night, and was next Day free from Fever; but complained of an Uneasiness in his Stomach and Nausea. He was ordered a Scruple of the Powder of Ipecacoanha, which vomited him, and procured him a Stool. He was easy in the Night; but in the Morning was hot, and complained of a Pain in his Right Kidney, and all over his Bones, as he expressed it. I then gave him a Mixture, withspiritus mindereri, and thepulvis contrayerva comp.of which I desired him to take some Spoonfuls frequently. This procured him a plentiful Sweat, which removed the Fever and Pain: these Symptoms returned next Day, but were removed by the same Means. I remained atDorchesterfor a Week after, and he recovered his Strength and Appetite as much as could be expected in so short a Time; but he still complained of Pain in his Right Kidney, tho’ he made Water freely. By a Letter I received from the Gentleman whose Care I left him under, I understood he had a Relapse, which he has since got the better of.I forgot to inform you, that his Father died of the same Complaints, after being six Months without secreting a Drop of Urine; and his Brother died of the same in about ten Weeks.

[97]It is often very difficult to judge of the Cause, or to be able to determine exactly the Seat of these Disorders before Death; as the following Cases will shew.John Waden, a middle-aged Man, was admitted intoSt. George’s Hospital the 10th ofApril1759, for a Swelling of the Abdomen, and a Difficulty of making Water, which he said begun about two Months before, with a violent Pain in his Back and Belly, occasioned by his being employed in making of Cyder in a very cold Cellar. He had not had a Stool for some Days: at first he took a Dose of Physic, and some of the saline Draughts; but in a Day or two complained that his Belly had grown to a monstrous Size, and that he had not made Water for above twenty-four Hours; on examining, we found the Bladder so much distended as to reach up to the Navel; and upon a Catheter’s being introduced, above two Quarts of Water were drawn off, and the Swelling immediately subsided; but in the Afternoon was as large as before, the Bladder seeming to be in a paralytic State. During the Months ofMayandJune, his Water was drawn off twice a-Day; he had his Belly fomented with emollient, astringent, and other Decoctions, and embrocated with Liniments; was blooded once when feverish, took Cordials, the Bark, Myrrh, and a Variety of Medicines, without any Effect. On the 3d ofJuly, a flexible Catheter was introduced into the Bladder, and left there, in order that the Urine might drain away as fast as it was secreted, and the Bladder be allowed to contract, and recover its Tone. The Catheter gave him no Pain, and he thought himself much easier by the Bladder’s never being too much stretched; but on taking out the Catheter some Days after, he had the same Stoppage of Water as before. On consulting with Dr.Battand the other Physicians, it was agreed to give two Grains of the Powder of Cantharides, with three Grains of Camphor and ten of Sugar, rubbed well together in a Mortar, twice a-Day; and to continue the Use of the flexible Catheter. He found no Uneasiness or Strangury from the Use of the Cantharides, and thought he passed his Water more freely, when the Catheter was taken out; but after fourteen Days, finding no Change for the better, and being free from any Fever, he was ordered into the cold Bath; the two first Days he found himself more lively and brisk; but the third Day was chilly and cold after coming out of it, and therefore was desired to leave it off; some Days after he became hectic, and I observed Pus in his Water, which he said he had passed with his Urine for above three Months; after this he languished for near a Month, and died upon the 25th ofAugust.—Upon examining his Body next Day, we found the thoracic Viscera in a sound State, except that the Lungs adhered a little on the right Side. Both Kidneys were diseased; they were inflamed, and seemed enlarged; and on cutting them, had Tubercles dispersed every where through their Substance, which had come to Suppuration, and contained a good deal of Matter; the lower Part of the left Kidney was mortified, and contained two or three Ounces of a black fœtid Liquor. The Bladder of Urine was contracted, and its Coats greatly thickened, and the internal Coat much inflamed; and there was a Cyst full of Matter, about Half the Size of a Walnut, between the muscular and villous Coats, towards the lower Part of the right Side of the Bladder; and there were two large Cysts, containing a small Quantity of Matter, though capable of containing near two Ounces each; one situated between thevesiculæ seminalesand Rectum, the other between thevesiculæand Bladder, which opened into the Urethra by one common Orifice, capable of admitting a large Quill, at the Side of thecaput galinaginis. The rest of the Viscera were in a sound State.Mary Hibbard, a Woman twenty-four Years of Age, was admitted intoSt. George’s Hospital, the 6thJune1759, for a Complaint of her Bladder. The Account she gave of herself was, that, aboutChristmas1758, she had parted with some Gravel; and about fourteen Days before coming to the Hospital, she was seized with a violent Pain in her Back and Loins, attended with a Sickness and Nausea; and very soon after complained of a violent Pain in the lower Part of her Belly, and with a perpetual Inclination to make Water, though she felt a sharp Pain and Difficulty in doing it; and that these Complaints still remained. Her Pulse was quick and strong, and she was inclined to be costive. She was immediately blooded, took the oily Draughts three Times a-Day, thedecoctum furfurisfor common Drink, and so much lenitive Electuary as procured her a Stool next Day. As there was a strong Suspicion of her having a Stone, she was sounded; but nothing at all was to be felt in the Bladder. Her Medicines eased her Pain in making Water, but not the Pain in her Back. On the 16th her Water was thick and turbid, and deposited a brown Sediment; and the Difficulty in making Water still remained; instead of the lenitive Electuary she was ordered the Rhubarb oily Draught to be taken every Night. On the 18th, there being no Change in her Disorder, she had Draughts made of an Ounce and a Half of simple Mint Water, Half a Drachm of the dulcified Spirit of Nitre, and five Drops of thetinctura thebaica, and Syrup three Times a-Day; but on the 22d she complained, that since she left off the oily Medicines, her Pain and Difficulty in making Water had grown worse; she was therefore ordered the saline and oily Draughts alternately, and to take the Rhubarb oily Draught occasionally when costive, which removed these Complaints; and they did not return while she remained in the House; but on the 4th ofJuly, the Day before she was to have been discharged as cured, she was attacked with a sharp Pain in her Hip and Loins, and about theos coccygis; which increased till the 9th, and extended itself all along the Outside of the right Thigh; it was most acute about theos coccygis; but on examining, nothing was to be observed externally: This Pain continued more or less all that Month, and till the End of the next, and so obstinate as not to be altered by bleeding, and the Use of Liniments, Blisters, cooling Medicines, Opiates, warm Baths, and other Remedies. On the 20th ofAugust, a strengthening Plaister was applied to her Back, which gave immediate Relief, and she was discharged cured the 29th. She continued well tillOctober, when she was attacked with a violent Fever atHounslow, and was brought to the Hospital on the 24th of that Month, and the tenth Day of the Fever. She died the 3d ofNovember. During the Course of the Fever, she only complained once of a Difficulty of making Water.—After Death I had her Body opened, when the only Thing particular which we could observe, was the urinary Bladder about four times the natural Size; it seemed to be flaccid, and in a State of Relaxation; the Kidneys were sound, and no Signs of any Distemper could be observed about the Uterus or Rectum, or near theos coccygis.—When she was first in the Hospital, I desired her always to examine her Urine; but she never observed that she passed any Sand, Gravel, or any thing of that kind.Thomas Jacey, an elderly Man, was admitted intoSt. George’s Hospital the 14th ofMarch1759, for a Pain in his Back, and a Difficulty and Pain in making Water, which was often mixed with grumous Blood; but he had never observed any Sand or Gravel in it. His Pulse was quick and full, attended with Heat and Thirst; and he was inclined to be costive; he was at first blooded, and took a Dose of laxative Mixture, and two Ounces of the Tincture of Roses, four Times a Day, and thedecoctum malvæfor common Drink. At first he seemed relieved, and passed no grumous Blood for some Days; but on the 26th, as he complained much of a Pain in making Water, the Tincture of Roses was changed for the oily Draughts, and he was ordered the Rhubarb oily Draught occasionally. On the 9th ofAprilhe fell suddenly into a comatose Way, and remained so till the 12th, when he died, notwithstanding the Use of divers Remedies.—Upon examining his Body, both Kidneys were found in a sound State; the Intestines covered with slight inflammatory Spots, the Bladder of Urine quite contracted, schirrhous, and greatly thickened; and its internal Surface rough and eroded, with one or two black Spots on it, and some grumous Blood lying on its Surface. The other viscera were sound.In Ulcers of these Organs, the natural Balsams, mixed with soft Things, are often of great Service; of which the following Case is an Example.—William Lumley, a Boy nine Years of Age, was admitted intoSt. George’s Hospital, the 6th ofSeptember1759, for a Pain in the Bladder, and a Difficulty in making Water, which was always more or less mixed with Matter. At first there was a Suspicion of his having the Stone; but on sounding, none was to be found. From the Symptoms, it appeared as if there was an Ulcer in the Bladder near to its Neck; the Boy had a Cough, was very low, and inclined to be costive; at first he took three Spoonfuls of the Sperma Ceti Mixture four Times a-Day, and a Dose of Physic; but the Symptoms still remaining, on the 2d ofOctoberhe was ordered to take a Scruple of theelectuarium e spermate cetithree or four Times a Day, and to have the Gum-Arabic Decoction for his common Drink. By continuing the Use of these Things, and taking some opiate and laxative Medicines occasionally, he mended by slow Degrees, and all his Symptoms went off; and he recovered his Health and Strength, and returned Thanks for his Cure the 18th ofJanuary1760.The following Account of a remarkable Suppression of Urine I had in a Letter, dated the 25th ofNovember1757, from Mr.Pearson, one of the Surgeons to his Majesty’s Military Hospitals, who then served as a Mate.James Ruffendal, aged Twenty, of a delicate Habit, was, in the Middle ofJulylast, seized with a violent Pain in both Kidneys, which extended along the Ureters to the Bladder, and remained in the same Situation for about three Weeks; during which Period his Urine began to decrease in Quantity, and the voiding of it was attended with acute Pain about the Neck of the Bladder. The Secretion then totally stopt; he remained for upwards of five Weeks in the Hospital atDorchester, and made no Water; at the End of which Time I first visited him along with Mr.Adair. He complained then of a slight Pain in his Kidneys, and told us he had a tolerable Appetite, sweated little, and voided every Day four or five Liquid Stools. He was ordered Boluses of Camphor, andsal. vol. c. cervi, and every Night a Dose oftinctura cantharidum; which he continued to take for a Fortnight without receiving the least Benefit. I then blooded him to the Quantity of ten Ounces, and gave him an Emetic of six Drachms of thevinum ipecacoanhæ, and two Ounces of the Oxymel of Squills, which operated very well; and afterwards ordered him to take one of the following Boluses every four Hours. ℞ Sapon. dur. Hispan. drachm. i. Sal. Absynth. gr. vi. Calc. Viv. gr. x. Balsam. Peruv. q. s. ut fiat Bolus. These he continued to take for twelve Days. On the Morning of the 14th ofOctober, he was suddenly seized with an acute Pain in both Kidneys, and about Noon voided upwards of Half a Pint of straw-coloured Urine, which let fall a clay-coloured Sediment. As he was feverish, I took away twelve Ounces of Blood, and ordered him Barley-Water with Nitre for Drink. He was easy in the Night, and made upwards of two Pints of Urine, which deposited a Sediment of a gelatinous Consistence. Next Morning the Pain increased, especially in his Right Side, and ten Ounces more of Blood was taken away. This lowered the Pulse, and considerably abated the Pain. Both this and the Blood taken away the Day before threw up an inflammatory Buff. He was ordered to continue the Use of the Barley Water with Nitre, and to take three Spoonfuls of a Mixture withspiritus mindererievery two Hours. He had an easy Night, and was next Day free from Fever; but complained of an Uneasiness in his Stomach and Nausea. He was ordered a Scruple of the Powder of Ipecacoanha, which vomited him, and procured him a Stool. He was easy in the Night; but in the Morning was hot, and complained of a Pain in his Right Kidney, and all over his Bones, as he expressed it. I then gave him a Mixture, withspiritus mindereri, and thepulvis contrayerva comp.of which I desired him to take some Spoonfuls frequently. This procured him a plentiful Sweat, which removed the Fever and Pain: these Symptoms returned next Day, but were removed by the same Means. I remained atDorchesterfor a Week after, and he recovered his Strength and Appetite as much as could be expected in so short a Time; but he still complained of Pain in his Right Kidney, tho’ he made Water freely. By a Letter I received from the Gentleman whose Care I left him under, I understood he had a Relapse, which he has since got the better of.I forgot to inform you, that his Father died of the same Complaints, after being six Months without secreting a Drop of Urine; and his Brother died of the same in about ten Weeks.

[97]It is often very difficult to judge of the Cause, or to be able to determine exactly the Seat of these Disorders before Death; as the following Cases will shew.

John Waden, a middle-aged Man, was admitted intoSt. George’s Hospital the 10th ofApril1759, for a Swelling of the Abdomen, and a Difficulty of making Water, which he said begun about two Months before, with a violent Pain in his Back and Belly, occasioned by his being employed in making of Cyder in a very cold Cellar. He had not had a Stool for some Days: at first he took a Dose of Physic, and some of the saline Draughts; but in a Day or two complained that his Belly had grown to a monstrous Size, and that he had not made Water for above twenty-four Hours; on examining, we found the Bladder so much distended as to reach up to the Navel; and upon a Catheter’s being introduced, above two Quarts of Water were drawn off, and the Swelling immediately subsided; but in the Afternoon was as large as before, the Bladder seeming to be in a paralytic State. During the Months ofMayandJune, his Water was drawn off twice a-Day; he had his Belly fomented with emollient, astringent, and other Decoctions, and embrocated with Liniments; was blooded once when feverish, took Cordials, the Bark, Myrrh, and a Variety of Medicines, without any Effect. On the 3d ofJuly, a flexible Catheter was introduced into the Bladder, and left there, in order that the Urine might drain away as fast as it was secreted, and the Bladder be allowed to contract, and recover its Tone. The Catheter gave him no Pain, and he thought himself much easier by the Bladder’s never being too much stretched; but on taking out the Catheter some Days after, he had the same Stoppage of Water as before. On consulting with Dr.Battand the other Physicians, it was agreed to give two Grains of the Powder of Cantharides, with three Grains of Camphor and ten of Sugar, rubbed well together in a Mortar, twice a-Day; and to continue the Use of the flexible Catheter. He found no Uneasiness or Strangury from the Use of the Cantharides, and thought he passed his Water more freely, when the Catheter was taken out; but after fourteen Days, finding no Change for the better, and being free from any Fever, he was ordered into the cold Bath; the two first Days he found himself more lively and brisk; but the third Day was chilly and cold after coming out of it, and therefore was desired to leave it off; some Days after he became hectic, and I observed Pus in his Water, which he said he had passed with his Urine for above three Months; after this he languished for near a Month, and died upon the 25th ofAugust.—Upon examining his Body next Day, we found the thoracic Viscera in a sound State, except that the Lungs adhered a little on the right Side. Both Kidneys were diseased; they were inflamed, and seemed enlarged; and on cutting them, had Tubercles dispersed every where through their Substance, which had come to Suppuration, and contained a good deal of Matter; the lower Part of the left Kidney was mortified, and contained two or three Ounces of a black fœtid Liquor. The Bladder of Urine was contracted, and its Coats greatly thickened, and the internal Coat much inflamed; and there was a Cyst full of Matter, about Half the Size of a Walnut, between the muscular and villous Coats, towards the lower Part of the right Side of the Bladder; and there were two large Cysts, containing a small Quantity of Matter, though capable of containing near two Ounces each; one situated between thevesiculæ seminalesand Rectum, the other between thevesiculæand Bladder, which opened into the Urethra by one common Orifice, capable of admitting a large Quill, at the Side of thecaput galinaginis. The rest of the Viscera were in a sound State.

Mary Hibbard, a Woman twenty-four Years of Age, was admitted intoSt. George’s Hospital, the 6thJune1759, for a Complaint of her Bladder. The Account she gave of herself was, that, aboutChristmas1758, she had parted with some Gravel; and about fourteen Days before coming to the Hospital, she was seized with a violent Pain in her Back and Loins, attended with a Sickness and Nausea; and very soon after complained of a violent Pain in the lower Part of her Belly, and with a perpetual Inclination to make Water, though she felt a sharp Pain and Difficulty in doing it; and that these Complaints still remained. Her Pulse was quick and strong, and she was inclined to be costive. She was immediately blooded, took the oily Draughts three Times a-Day, thedecoctum furfurisfor common Drink, and so much lenitive Electuary as procured her a Stool next Day. As there was a strong Suspicion of her having a Stone, she was sounded; but nothing at all was to be felt in the Bladder. Her Medicines eased her Pain in making Water, but not the Pain in her Back. On the 16th her Water was thick and turbid, and deposited a brown Sediment; and the Difficulty in making Water still remained; instead of the lenitive Electuary she was ordered the Rhubarb oily Draught to be taken every Night. On the 18th, there being no Change in her Disorder, she had Draughts made of an Ounce and a Half of simple Mint Water, Half a Drachm of the dulcified Spirit of Nitre, and five Drops of thetinctura thebaica, and Syrup three Times a-Day; but on the 22d she complained, that since she left off the oily Medicines, her Pain and Difficulty in making Water had grown worse; she was therefore ordered the saline and oily Draughts alternately, and to take the Rhubarb oily Draught occasionally when costive, which removed these Complaints; and they did not return while she remained in the House; but on the 4th ofJuly, the Day before she was to have been discharged as cured, she was attacked with a sharp Pain in her Hip and Loins, and about theos coccygis; which increased till the 9th, and extended itself all along the Outside of the right Thigh; it was most acute about theos coccygis; but on examining, nothing was to be observed externally: This Pain continued more or less all that Month, and till the End of the next, and so obstinate as not to be altered by bleeding, and the Use of Liniments, Blisters, cooling Medicines, Opiates, warm Baths, and other Remedies. On the 20th ofAugust, a strengthening Plaister was applied to her Back, which gave immediate Relief, and she was discharged cured the 29th. She continued well tillOctober, when she was attacked with a violent Fever atHounslow, and was brought to the Hospital on the 24th of that Month, and the tenth Day of the Fever. She died the 3d ofNovember. During the Course of the Fever, she only complained once of a Difficulty of making Water.—After Death I had her Body opened, when the only Thing particular which we could observe, was the urinary Bladder about four times the natural Size; it seemed to be flaccid, and in a State of Relaxation; the Kidneys were sound, and no Signs of any Distemper could be observed about the Uterus or Rectum, or near theos coccygis.—When she was first in the Hospital, I desired her always to examine her Urine; but she never observed that she passed any Sand, Gravel, or any thing of that kind.

Thomas Jacey, an elderly Man, was admitted intoSt. George’s Hospital the 14th ofMarch1759, for a Pain in his Back, and a Difficulty and Pain in making Water, which was often mixed with grumous Blood; but he had never observed any Sand or Gravel in it. His Pulse was quick and full, attended with Heat and Thirst; and he was inclined to be costive; he was at first blooded, and took a Dose of laxative Mixture, and two Ounces of the Tincture of Roses, four Times a Day, and thedecoctum malvæfor common Drink. At first he seemed relieved, and passed no grumous Blood for some Days; but on the 26th, as he complained much of a Pain in making Water, the Tincture of Roses was changed for the oily Draughts, and he was ordered the Rhubarb oily Draught occasionally. On the 9th ofAprilhe fell suddenly into a comatose Way, and remained so till the 12th, when he died, notwithstanding the Use of divers Remedies.—Upon examining his Body, both Kidneys were found in a sound State; the Intestines covered with slight inflammatory Spots, the Bladder of Urine quite contracted, schirrhous, and greatly thickened; and its internal Surface rough and eroded, with one or two black Spots on it, and some grumous Blood lying on its Surface. The other viscera were sound.

In Ulcers of these Organs, the natural Balsams, mixed with soft Things, are often of great Service; of which the following Case is an Example.—William Lumley, a Boy nine Years of Age, was admitted intoSt. George’s Hospital, the 6th ofSeptember1759, for a Pain in the Bladder, and a Difficulty in making Water, which was always more or less mixed with Matter. At first there was a Suspicion of his having the Stone; but on sounding, none was to be found. From the Symptoms, it appeared as if there was an Ulcer in the Bladder near to its Neck; the Boy had a Cough, was very low, and inclined to be costive; at first he took three Spoonfuls of the Sperma Ceti Mixture four Times a-Day, and a Dose of Physic; but the Symptoms still remaining, on the 2d ofOctoberhe was ordered to take a Scruple of theelectuarium e spermate cetithree or four Times a Day, and to have the Gum-Arabic Decoction for his common Drink. By continuing the Use of these Things, and taking some opiate and laxative Medicines occasionally, he mended by slow Degrees, and all his Symptoms went off; and he recovered his Health and Strength, and returned Thanks for his Cure the 18th ofJanuary1760.

The following Account of a remarkable Suppression of Urine I had in a Letter, dated the 25th ofNovember1757, from Mr.Pearson, one of the Surgeons to his Majesty’s Military Hospitals, who then served as a Mate.

James Ruffendal, aged Twenty, of a delicate Habit, was, in the Middle ofJulylast, seized with a violent Pain in both Kidneys, which extended along the Ureters to the Bladder, and remained in the same Situation for about three Weeks; during which Period his Urine began to decrease in Quantity, and the voiding of it was attended with acute Pain about the Neck of the Bladder. The Secretion then totally stopt; he remained for upwards of five Weeks in the Hospital atDorchester, and made no Water; at the End of which Time I first visited him along with Mr.Adair. He complained then of a slight Pain in his Kidneys, and told us he had a tolerable Appetite, sweated little, and voided every Day four or five Liquid Stools. He was ordered Boluses of Camphor, andsal. vol. c. cervi, and every Night a Dose oftinctura cantharidum; which he continued to take for a Fortnight without receiving the least Benefit. I then blooded him to the Quantity of ten Ounces, and gave him an Emetic of six Drachms of thevinum ipecacoanhæ, and two Ounces of the Oxymel of Squills, which operated very well; and afterwards ordered him to take one of the following Boluses every four Hours. ℞ Sapon. dur. Hispan. drachm. i. Sal. Absynth. gr. vi. Calc. Viv. gr. x. Balsam. Peruv. q. s. ut fiat Bolus. These he continued to take for twelve Days. On the Morning of the 14th ofOctober, he was suddenly seized with an acute Pain in both Kidneys, and about Noon voided upwards of Half a Pint of straw-coloured Urine, which let fall a clay-coloured Sediment. As he was feverish, I took away twelve Ounces of Blood, and ordered him Barley-Water with Nitre for Drink. He was easy in the Night, and made upwards of two Pints of Urine, which deposited a Sediment of a gelatinous Consistence. Next Morning the Pain increased, especially in his Right Side, and ten Ounces more of Blood was taken away. This lowered the Pulse, and considerably abated the Pain. Both this and the Blood taken away the Day before threw up an inflammatory Buff. He was ordered to continue the Use of the Barley Water with Nitre, and to take three Spoonfuls of a Mixture withspiritus mindererievery two Hours. He had an easy Night, and was next Day free from Fever; but complained of an Uneasiness in his Stomach and Nausea. He was ordered a Scruple of the Powder of Ipecacoanha, which vomited him, and procured him a Stool. He was easy in the Night; but in the Morning was hot, and complained of a Pain in his Right Kidney, and all over his Bones, as he expressed it. I then gave him a Mixture, withspiritus mindereri, and thepulvis contrayerva comp.of which I desired him to take some Spoonfuls frequently. This procured him a plentiful Sweat, which removed the Fever and Pain: these Symptoms returned next Day, but were removed by the same Means. I remained atDorchesterfor a Week after, and he recovered his Strength and Appetite as much as could be expected in so short a Time; but he still complained of Pain in his Right Kidney, tho’ he made Water freely. By a Letter I received from the Gentleman whose Care I left him under, I understood he had a Relapse, which he has since got the better of.

I forgot to inform you, that his Father died of the same Complaints, after being six Months without secreting a Drop of Urine; and his Brother died of the same in about ten Weeks.

TheEpilepsy, or Falling Sickness, attacked a Number of Men, from the severe Duty of long Marches in hot Weather, and afterwards lying out on the cold Ground, exposed to the Damps of the Night[98].

It was very seldom that Men were cured of this Disorder in the military Hospitals. We had some few Instances, indeed, where Relief seemed to be obtained by Rest, a regularDiet, gentle Evacuations, and Issues[99]; but even those Men generally relapsed as soon asthey were sent to their Regiments, and began to do Duty. All who had these Fits after being some Time with their Regiments, were at last discharged, and sent home. However, before Men are discharged for Fits, they should be watched very narrowly for some Time; for there is no Disorder which Soldiers are more apt to counterfeit than this.

It is no Wonder that Soldiers, during the Time of Service, should seldom be cured of these Fits; for in Adults it is not often curedeven in private Practice, with all the Conveniencies and Advantages to be wished for; and generally the few that do get well, require a considerable Length of Time to accomplish the Cure; and we find from daily Experience, as well as from examining the Records of Medicine, that the Cures that have been made, have mostly been performed eitherby a Change of Air, such as going from a cold to a hot Climate[100], by some remarkable Change of Life[101], or some accidental Disorder;[102]or by Issues or Drains[103]; or by the Removal of some acrid or irritating Substance, or such like[104]; or by preventing the Cause[105]; and that those Medicines called Specifics have in general had but little Share inthe Cure.

FOOTNOTES:[98]I saw above twenty Men, while I was inGermany, who attributed the Epileptic Fits they were attacked with to these Causes, and said they had never had the Epilepsy before; besides others, who had been formerly subject to these Fits, who declared, that the Disorder was brought back by the same Means.[99]William Wilson, a Boy fourteen Years of Age, was admitted intoSt. George’s Hospital,Sept.20, 1758, for Epileptic Fits, which he had been subject to for some Time, and which generally seized him three or four Times a Week. He took Variety of Medicines without any Effect till the 6th ofNovember, when I ordered him to take eight Grains of thepilulæ fœtidæMorning and Evening, and Physic twice a Week, and a Seton to be made in his Neck. After the Seton began to run, he had but three or four slight Fits inNovember, and none the following Month; and he was discharged the Hospital the 3d ofJanuary1759, seemingly in good Health, with Directions to keep the Seton running at least for some Months after he went home, and to come again to the Hospital if he should have any Return of his Fits; but we never heard more of him.Mary Hacket, a Girl of nineteen Years of Age, was admitted intoSt. George’s Hospital the 14th ofFebruary1759, for Fits. The Account she gave of her Case, was, that about five Years before she was seized with the first Fit, after a Fright; three Years afterwards she had a second Fit, and for some Time after had a Fit commonly once a Month, about the Time of the full Moon; and since had them more frequently; that the Fits began with a Trembling and Shaking of the right Foot, and she had frequent pricking Pains in the right Thigh, and what she called convulsive Tremors in the right Leg and Foot. She was regular in her menstrual Discharge. At the Time she came into the Hospital, she was feverish, and complained much of a sharp Pain in the right Thigh: She was blooded, and took some cooling Medicine, and had no Fit till the 9th ofMarch: She then took the fetid Pills and camphorated Julep twice a Day; but still the Fits returned frequently. She then had the Bark, Valerian and Purging Doses successively, and used the warm Bath; but without any Effect. On the 7th ofMaya Blister was applied to her right Foot, which was intended to be kept open; but an Inflammation coming on that Leg and Foot, it was suffered to dry up, and an Issue made in the same Leg. From the Time the Blister was applied, she had no Fit while she remained in the Hospital. She was discharged the 15th ofJuly, seemingly in good Health; though during that Period she had some little Tremors in her Foot, and was subject to be low and faintish, which was always relieved by cordial anodyne Medicines. After going out of the Hospital, she remained in good Health for seven or eight Months, when I was told her Disease had returned as violent as ever.[100]Hippocrateslays the chief Stress of the Cure upon Change of Air, Aphor. 4, 5, sect. ii. The BaronVan Swietensays, he has known a great Number cured by going to theEast Indies; many of whom have remained well ever after, while others had a Return of the Disorder when they came back toHolland.Comment.vol. III. p. 436. sect. 1080.[101]Celsushas long ago observed, that the Appearance of the Menses in Girls, and of Puberty in Boys, often removes this Disorder, lib. iii. cap. xxiii.—On the 22d ofNovember1758,Mary Evans, a Girl of eighteen Years of Age, was admitted intoSt. George’s Hospital for Fits. She had never had the Menstrua; but, for above two Years, found regularly, once a Month, a Fulness in her Breasts, and had a slight Head Ach, and other Symptoms which generally precede this Discharge; and were succeeded with violent Epileptic Fits, which continued returning frequently for two or three Days, and then went off; and she had no more Symptoms of them, till about the same Time next Month. She was ordered to take ten Grains of thepilulæ fœtidæMorning and Evening, and a Dose of Physic twice a Week; and as I found that she became plethoric near the Time her Fits used to return, I began to imagine, that both the Fits and Stoppage of the Menstrua were owing to too great a Fullness of the Vessels, which prevented the Heart and vascular System from having such free Play, as to drive the Blood through the extreme uterine Vessels: I therefore ordered seven Ounces of Blood to be taken away from her immediately. In three Days Time the menstrual Discharge began to make its Appearance; and on the 10th ofJanuaryshe was discharged the Hospital, seemingly in good Health, after the menstrual Discharge had returned for two regular Periods, without any Appearance of Epileptic Fits. She was desired to come back to the Hospital, if the Fits returned; but I never heard more of her.[102]William Glen, a Patient in theRoyal InfirmaryatEdinburghinSeptember1747, was freed from Epileptic Fits, which used to return ten or twelve Times a Day, for a Quarter of a Year, by a Diarrhœa coming on; but they afterwards returned.A Mansubject to the Epilepsy was cured of it by a Quartan Ague, and had afterwards no Return of the Disorder.Miscell. Curios. Dec. 3. Ann. 3.p. 34.[103]There are numerous Instances of the good Effects of Issues and Drains in diverse Authors.Tulpius,Van Swieten, &c.[104]La Mottegives one Instance of a Person being cured of the Epilepsy by voiding five Stones,Chirurg.vol. II. p. 20; and of another who died of the Fits from a triangular Stone remaining in the Kidneys,ibid.p. 416. Dr.Shortcured a Woman of an Epilepsy of twelve Years standing, by extirpating a cartilagenous Substance, about the Bigness of a large Pea, seated on the gastronemei Muscles, above a Nerve which he cut asunder.Edin. Medic. Essays, vol. IV. Art. 27.[105]Galen, tells us, of his having prevented the Epileptic Fits in a Boy, who used to have one whenever he was hungry, by making him carry Bread in his Pocket, and eat a little as soon as he found the least Symptoms of Hunger.De Loc. Affect.lib. v. cap. vi.—AndVan Swietenmentions how he cured a Boy, who had a Fit every full Moon; whose under Lip used to fall a Trembling before it began (a Symptom which, he says, often precedes Vomiting); by giving a Vomit every Month, for six Months successively, three Days before the full Moon, and an Opiate in the Evening after its Operation; and by putting him under a Course of strengthening Medicines. It was observeable, that if he vomited in the Time of the Paroxysm, it was soon at an End. See hisComment.vol. III. p. 439. sect. 1050.

[98]I saw above twenty Men, while I was inGermany, who attributed the Epileptic Fits they were attacked with to these Causes, and said they had never had the Epilepsy before; besides others, who had been formerly subject to these Fits, who declared, that the Disorder was brought back by the same Means.

[99]William Wilson, a Boy fourteen Years of Age, was admitted intoSt. George’s Hospital,Sept.20, 1758, for Epileptic Fits, which he had been subject to for some Time, and which generally seized him three or four Times a Week. He took Variety of Medicines without any Effect till the 6th ofNovember, when I ordered him to take eight Grains of thepilulæ fœtidæMorning and Evening, and Physic twice a Week, and a Seton to be made in his Neck. After the Seton began to run, he had but three or four slight Fits inNovember, and none the following Month; and he was discharged the Hospital the 3d ofJanuary1759, seemingly in good Health, with Directions to keep the Seton running at least for some Months after he went home, and to come again to the Hospital if he should have any Return of his Fits; but we never heard more of him.Mary Hacket, a Girl of nineteen Years of Age, was admitted intoSt. George’s Hospital the 14th ofFebruary1759, for Fits. The Account she gave of her Case, was, that about five Years before she was seized with the first Fit, after a Fright; three Years afterwards she had a second Fit, and for some Time after had a Fit commonly once a Month, about the Time of the full Moon; and since had them more frequently; that the Fits began with a Trembling and Shaking of the right Foot, and she had frequent pricking Pains in the right Thigh, and what she called convulsive Tremors in the right Leg and Foot. She was regular in her menstrual Discharge. At the Time she came into the Hospital, she was feverish, and complained much of a sharp Pain in the right Thigh: She was blooded, and took some cooling Medicine, and had no Fit till the 9th ofMarch: She then took the fetid Pills and camphorated Julep twice a Day; but still the Fits returned frequently. She then had the Bark, Valerian and Purging Doses successively, and used the warm Bath; but without any Effect. On the 7th ofMaya Blister was applied to her right Foot, which was intended to be kept open; but an Inflammation coming on that Leg and Foot, it was suffered to dry up, and an Issue made in the same Leg. From the Time the Blister was applied, she had no Fit while she remained in the Hospital. She was discharged the 15th ofJuly, seemingly in good Health; though during that Period she had some little Tremors in her Foot, and was subject to be low and faintish, which was always relieved by cordial anodyne Medicines. After going out of the Hospital, she remained in good Health for seven or eight Months, when I was told her Disease had returned as violent as ever.

Mary Hacket, a Girl of nineteen Years of Age, was admitted intoSt. George’s Hospital the 14th ofFebruary1759, for Fits. The Account she gave of her Case, was, that about five Years before she was seized with the first Fit, after a Fright; three Years afterwards she had a second Fit, and for some Time after had a Fit commonly once a Month, about the Time of the full Moon; and since had them more frequently; that the Fits began with a Trembling and Shaking of the right Foot, and she had frequent pricking Pains in the right Thigh, and what she called convulsive Tremors in the right Leg and Foot. She was regular in her menstrual Discharge. At the Time she came into the Hospital, she was feverish, and complained much of a sharp Pain in the right Thigh: She was blooded, and took some cooling Medicine, and had no Fit till the 9th ofMarch: She then took the fetid Pills and camphorated Julep twice a Day; but still the Fits returned frequently. She then had the Bark, Valerian and Purging Doses successively, and used the warm Bath; but without any Effect. On the 7th ofMaya Blister was applied to her right Foot, which was intended to be kept open; but an Inflammation coming on that Leg and Foot, it was suffered to dry up, and an Issue made in the same Leg. From the Time the Blister was applied, she had no Fit while she remained in the Hospital. She was discharged the 15th ofJuly, seemingly in good Health; though during that Period she had some little Tremors in her Foot, and was subject to be low and faintish, which was always relieved by cordial anodyne Medicines. After going out of the Hospital, she remained in good Health for seven or eight Months, when I was told her Disease had returned as violent as ever.

[100]Hippocrateslays the chief Stress of the Cure upon Change of Air, Aphor. 4, 5, sect. ii. The BaronVan Swietensays, he has known a great Number cured by going to theEast Indies; many of whom have remained well ever after, while others had a Return of the Disorder when they came back toHolland.Comment.vol. III. p. 436. sect. 1080.

[101]Celsushas long ago observed, that the Appearance of the Menses in Girls, and of Puberty in Boys, often removes this Disorder, lib. iii. cap. xxiii.—On the 22d ofNovember1758,Mary Evans, a Girl of eighteen Years of Age, was admitted intoSt. George’s Hospital for Fits. She had never had the Menstrua; but, for above two Years, found regularly, once a Month, a Fulness in her Breasts, and had a slight Head Ach, and other Symptoms which generally precede this Discharge; and were succeeded with violent Epileptic Fits, which continued returning frequently for two or three Days, and then went off; and she had no more Symptoms of them, till about the same Time next Month. She was ordered to take ten Grains of thepilulæ fœtidæMorning and Evening, and a Dose of Physic twice a Week; and as I found that she became plethoric near the Time her Fits used to return, I began to imagine, that both the Fits and Stoppage of the Menstrua were owing to too great a Fullness of the Vessels, which prevented the Heart and vascular System from having such free Play, as to drive the Blood through the extreme uterine Vessels: I therefore ordered seven Ounces of Blood to be taken away from her immediately. In three Days Time the menstrual Discharge began to make its Appearance; and on the 10th ofJanuaryshe was discharged the Hospital, seemingly in good Health, after the menstrual Discharge had returned for two regular Periods, without any Appearance of Epileptic Fits. She was desired to come back to the Hospital, if the Fits returned; but I never heard more of her.

[102]William Glen, a Patient in theRoyal InfirmaryatEdinburghinSeptember1747, was freed from Epileptic Fits, which used to return ten or twelve Times a Day, for a Quarter of a Year, by a Diarrhœa coming on; but they afterwards returned.A Mansubject to the Epilepsy was cured of it by a Quartan Ague, and had afterwards no Return of the Disorder.Miscell. Curios. Dec. 3. Ann. 3.p. 34.

A Mansubject to the Epilepsy was cured of it by a Quartan Ague, and had afterwards no Return of the Disorder.Miscell. Curios. Dec. 3. Ann. 3.p. 34.

[103]There are numerous Instances of the good Effects of Issues and Drains in diverse Authors.Tulpius,Van Swieten, &c.

[104]La Mottegives one Instance of a Person being cured of the Epilepsy by voiding five Stones,Chirurg.vol. II. p. 20; and of another who died of the Fits from a triangular Stone remaining in the Kidneys,ibid.p. 416. Dr.Shortcured a Woman of an Epilepsy of twelve Years standing, by extirpating a cartilagenous Substance, about the Bigness of a large Pea, seated on the gastronemei Muscles, above a Nerve which he cut asunder.Edin. Medic. Essays, vol. IV. Art. 27.

[105]Galen, tells us, of his having prevented the Epileptic Fits in a Boy, who used to have one whenever he was hungry, by making him carry Bread in his Pocket, and eat a little as soon as he found the least Symptoms of Hunger.De Loc. Affect.lib. v. cap. vi.—AndVan Swietenmentions how he cured a Boy, who had a Fit every full Moon; whose under Lip used to fall a Trembling before it began (a Symptom which, he says, often precedes Vomiting); by giving a Vomit every Month, for six Months successively, three Days before the full Moon, and an Opiate in the Evening after its Operation; and by putting him under a Course of strengthening Medicines. It was observeable, that if he vomited in the Time of the Paroxysm, it was soon at an End. See hisComment.vol. III. p. 439. sect. 1050.

TheSmall-Pox appeared atPaderbornin the Spring 1761, and five had the distinct Kind, who recovered. Six or seven had them atOsnabruckinMayandJune, and one Man and a Child died of the confluent Kind. Four had the distinct Kind atMunsterinJulyandAugustwho all did well. During the Winter, we had sixteen in the Hospital I attended atBremen; ten had the distinct Kind, and all recovered; five had the confluent Kind, of whom two died; as did also one who was brought to the Hospital with all the Symptoms of the most malignant Kind. Two were sent toNatzungeninJuly, both ill of the confluent Kind; the one died two Hours after his Arrival;the other recovered: And we had only two in the Hospital atOsnabruckin Winter 1762-63, and both did well.

There was nothing particular either in the Course or Treatment of this Disorder, different from what we meet with in daily Practice; only as the Soldiers, who were attacked with it, were strong, and in full Health, they required Bleeding and gentle Evacuations, and a cooling Regimen, on the first Appearance of the Symptoms.

The malignant Kind required the Use of Acids, and the Bark; which last, could often only be administered by Way of Clyster, as the Sick could not swallow it: In short, we treated the Patients much in the same Way as in the malignant Fever, Allowance only being made for the present Circumstances.

Luckily this Disorder never spread much in the Army, while I was inGermany.

InJanuary1762, several Patients in the Hospitals I had the Care of atBremen, had shining watery Swellings of the Face, or Extremities; which came suddenly, and were attended with a slight Degree of Inflammation, and watery Blisters rising above the Skin, and some Degree of Fever. The Blisters were not small, round, and angry, as inSt. Antony’s Fire; but larger, and of an irregular Figure, resembling those raised when People are scalded by boiling Water. The Swellings did not pit on being pressed, as the oedematous Swellings commonly do: They gave Pain when pressed, but the Inflammation was not in that high Degree as it is in the common Phlegmon:The Blood was sizy, and the Water of a high Colour. The Disorder seemed to be a Species of the Erisypelas.

Between the 9th and 12th ofJanuary, three Patients were seized with such Swellings.

The first was a Dragoon, who had just recovered from a Flux, and a bad Cough. On the 9th, he was suddenly seized in the Night with a large Swelling of his Face, Hands, and Arms, which had a shining oedematous Appearance, with a small Degree of Redness, and was painful when pressed; and he had two or three watery Blisters rose on the Back of each Hand above the Division of the Fingers, attended with a quick full Pulse, a feverish Heat and Thirst, a Cough, and somewhat of a Difficulty of Breathing, and high-coloured Water; and he was inclined to be costive. He was immediately blooded, had a saline Mixture with Contrayerva and Nitre, and was ordered to take a Purge in the Morning. Next Day the Blood had thrown up an inflammatory Buff, the Fever was abated, and the Breathing easier; but the Cough and Swelling still remained.He then took a Julep made of equal Parts of the Saline and Sperma Ceti Mixtures, which eased the Cough. The fourth Day the Pulse was soft, and the Swellings still in the same Situation, and the Breathing a little affected. A large Blister was applied to his Back, which discharged plentifully, relieved the Breathing, and lessened the Swellings considerably. The Cough and some Degree of Swelling still remained; but were removed by the Use of the Sperma Ceti Mixture with Oxymel, gentle Opiates, and some Doses of Physic.

The second was a Man of the Twentieth Regiment of Foot, who had been some Months in the Hospital for a hectic Complaint; he was taken ill, the same Night as the Dragoon, with a Swelling of his whole Face, particularly the Lips, which had a shining watery Appearance, and a slight Degree of Redness, attended with a strong Fever; and was cured by Bleeding, Purging, the Use of the saline Medicines, and the Application of a Blister.

The third was an Invalid, who had been admitted for a pleuritic Complaint, which he had got the better of. He was attacked, the second Night after the other two, with a shineing, watery, reddish Swelling, of his right Hand and Arm, up as far as the Joint of the Shoulder; four large watery Bladders likewise appeared on the fore Part of his Arm, above the Joint of the Elbow. Bleeding, with the cooling Medicines, and two Doses of Salts, carried off the Fever, and lessened the Swelling, in about seven Days Time; but a little of it, with a Stiffness, still remained; which at last was removed by the Use of aromatic Fomentations, rubbing with thelinimentum saponaceum, and taking two Doses of Physic.

Within less than a Fortnight, five or six more were seized with Swellings of the same Kind on some of the Extremities, and all got well by nearly the same Treatment; excepting one Man, who was in a very low State, and had a large deep Ulcer on his Hip, where there had been a Mortification from his lying on that Part in a Fever. The Swelling at firstseemed to give Way; but on the third or fourth Day, having got a severe Cough, the Swelling increased, and the Inflammation began to look livid, and the Discharge from the Sore to look bad; and, notwithstanding various Means were used, a Mortification of the Part came on, and he died the seventh Day.

Thetrue Scurvy, attended with spungy fetid Gums of a livid Colour, with livid Blotches, and Ulcers of the Legs, and other Symptoms, began to shew itself atBremeninJanuary1762; tho’ we had not the least Appearance of this Disorder in the Hospitals at any other Place, while I was with the Troops inGermany.

A great Variety of Disorders have been called by the Name of Scurvy: and the Disease has been divided into hot and cold; into the Acid, the Alcaline; and the Muriatic, according to the different Fancies of Authors, and the Causes they imagined it took its Rise from; but, from later and more accurate Observations, Dr.Lindhas justly remarked, that the true Scurvy has been found to be the same in all the different Parts of the Globe, and to take its Rise from similar Causes; from Cold and Moisture, and living much upon salted Provisions, joined to a Want of fresh Vegetables, and of good generous fermented Liquors; and hence it is most frequent in low marshy Places in northern Climates, where there is a Scarcity of fresh Vegetables; and where the Inhabitants live much upon salted Provisions in Winter; and aboard of Ships in long Voyages or Cruizes, especially in the northern Seas; and hence this Disorder was so frequent atQuebecthe first Winter it was in our Possession; and in some of the other Forts inNorth America, which were taken so late in the Year, that the Troops had not sufficient Time to lay in a Stock of Vegetables, and of fresh Meat to be preserved by the Frost[106]; but were obliged to live mostly on Ship Provisions.

It is observed, both at Sea and Land, that where the Scurvy rages, those People are least subject to it who are well cloathed; who live in dry Habitations, or lie in dry Births; who take proper Exercise, without being too much exposed to the Inclemency of the Weather; and who live well, and drink good Beer, Cyder, or Wine; as has been remarked by Dr.Pringle, Dr.Lind, and others.

AtBrementhe Disorder was only observed among the Soldiers; not one of the Gentlemen belonging to the Hospital, or to the Commissariate, nor one of the military Officers, not even of the Serjeants, having the least Symptom of it. The Reason of its being frequent among the Soldiers was, that the Place is situated on a Plain naturally very damp; and the Soldiers were quartered in very low damp Houses; at the same Time, no Vegetables orGreens were to be bought in the Market; and fresh Meat, and other fresh Provisions, were at so high a Price, that the Soldiers could not afford to buy them; but were obliged to live on salted Meat, and salted Herrings, during the Winter; and what little Money they had remaining, they laid out on spirituous Liquors, which were sold cheap.

The Cure of this Disorder requires—living in a dry comfortable Place—good Cloathing—light Food of easy Digestion, such as good Bread, Panado, Milk, Whey, Broths made of fresh Meats—white Meats, with Greens, or other Vegetable, &c.—the Use of Liquors of the acid or acescent Kind, or the moderate Use of Beer, Cyder, good Wine, or weak Punch[107]—And, by Way of Medicine, gentle Purges, mild Diaphoretics; the free Use of acid or acescent Fruits, Lemons, Oranges, Apples, Pears,Currans, Grapes, &c. and of the antiscorbutic Plants and their Juices, as Succory, Endive, Water-Cresses, Scurvy-Grass[108], &c. on which a great Part of the Cure principally depends; and the Use of some of the strengthening Bitters[109], of which the Bark is not the least efficacious.

Bleeding is seldom requisite, except where there is much Heat or Fever; or a sharp Painof the Side, or Difficulty of Breathing, or some Symptom of the like Kind; it is then sometimes necessary to take away some Blood: And in obstinate Cases, it is often found of Use to promote Sweats, by making the Patient, while in Bed, drink freely of warm Whey, or Sack Whey, mixed with the scorbutic Juices; or warm Barley Water, or the like, mixed with a small Quantity of the Antimonial Wine, or some other mild Diaphoretic.

And where the Patient is strong, and there is no Danger of Hæmorrhages, warm aromatic Baths have sometimes been found serviceable; but they are not to be used where the Patient is weak.

The first Time I saw this Disorder atBremen, was in an old Invalid,James Long, who had come fromBristoltoEmbden, and from thence toBremen. He was some Weeks in the Hospital before I discovered his Disorder to be the Scurvy. He at first complained only of great Weakness, and such a Giddiness, when he got out of Bed, that he could not walk, and of what he called flying rheumatic Pains of hisLegs. He had no other visible Complaint; all which, I imagined, proceeded from Old-Age, and being worn out in the Service. At last, on the 25th ofJanuary, he complained of his Gums being sore; and, on examining him, I found his Breath fetid, his Gums swelled, soft, and spungy, his Legs covered with scorbutic Blotches, and other Symptoms, which evidently proved his Disorder to be the true Scurvy.

Upon which, I ordered him a low Diet, with the Addition of Greens for Dinner, and a Quart of Lemonade, with a Gill of Brandy in it,perDay, for his common Drink; and, by Way of Medicine, a Decoction of the Bark, with the Elixir of Vitriol; and, at the same Time, ordered his Gums to be scarified, where they were most swelled and spungy; and to be washed frequently with an astringent Gargle; and to be rubbed now and then with burnt Alum[110]. By these Means, in a Fortnight’sTime, his Gums became firmer, and his scorbutic Symptoms decreased. During that Course he took cold, and had a Stitch in his Side, for which he was blooded. The Blood threw up a very thin Buff, which was not of a firm Consistence[111]; the Crassamentum below was ofa blackish Colour and of a loose Texture, and the Serum in a large Proportion. By the 2d ofMarchhis Gums had recovered their natural Firmness and Texture, and the scorbutic Spots and Pains of the Legs were gone, and he had recovered his Strength; the only remaining Complaint was a little Swelling about the Ankles, for which he continued the same Course, and took a Dose or two of Physic. By the 16th ofMarchall these Symptoms were gone, and he was dismissed the Hospital free from all Complaints. I saw him well the last Week inMay; and he told me, he had had no scorbutic Symptom since he left the Hospital.

In the Beginning ofFebruary, another of the Invalids, who had been in the Hospital for a Fever and rheumatic Complaints, had Blotches appear on his Legs, complained of great Weakness, and fainted away in attempting to walk; which made me suspect his Disorder to be the Scurvy; and, on examining him, I found his Gums soft and spongy, attended with the other Symptoms of the true Scurvy. I put him nearly on the same Course as in the last-mentioned Case: He used a low Diet, with the Addition of Greens for Dinner, which he eat with a little Butter and Vinegar; and he had a Quart of Lemonade, with two Ounces of Brandy, for his common Drink during the Day; and, by Way of Medicine, a Decoction of the Bark, with two Drachms of theconfectio cordiacato each Half Pint, which he took by Spoonfuls. Next Day he complained of a Pain in his Leg; and, on examining it more particularly, I found a large livid Blotch, yellow all round the Edges, on the fore Part, and a Tension all over that Leg. As he was so extremely low, as to be in Danger offainting whenever he sat up, I was afraid lest a Mortification should ensue; and therefore ordered his Leg to be bathed Morning and Evening with a warm aromatic Fomentation, and a Poultice of Theriaca to be applied after it; and desired him to take as much of the Decoction of the Bark with the Cordial as possible; and allowed him a Glass of Mountain Wine every two or three Hours. By the Continuance of this Course for some Weeks, the livid Blotches, Pain, and Stiffness of his Leg, and most of the other scorbutic Symptoms, went away; his Gums were restored to their natural Firmness; and he recovered his Strength so much as to be able to sit up all Day long; though he still remained very weak when he was sent toEngland, inMarch.

InFebruaryandMarch, seven or eight more scorbutic Patients were sent to the Hospital I attended, who were all treated in the same Manner; and all did well. About the Middle ofFebruarythis Distemper began to shew itself in the other Hospital attended by Dr.Miller,who treated the Patients nearly in the same Way, and they all recovered.

On the 5th ofApril, a young Man, belonging to the Eighth Regiment of Foot, came to the Hospital with all the Symptoms of the true Scurvy; his Gums were spungy and fœtid; he had livid Blotches on his Legs, and Contractions of the Hams, and a Stiffness and Hardness in the Calves of both Legs[112]. By following the same Course as the others, and the Use of frequent Fomentations, and rubbing the contracted Parts with soft Liniments, he mended daily; and, after taking a Dose or two of Physic, was dismissed perfectly recovered on the 10th ofMay. At his first Admission into the Hospital, he was taken with a severe Cough,attended with Pain of the Breast, and a Spitting of Blood for a Day or two, for which he was blooded. His Blood threw up a little Buff; the Crassamentum was of a blackish Colour and of a loose Texture, with a good Proportion of a yellowish Serum. This Bleeding relieved the Complaints of his Breast, and he had no Return of them while he remained in the Hospital.

The first Week inMayfour Invalids were admitted into the Hospital for this Disorder. The first had spungy Gums, a fœtid Breath, his Legs swelled and hard, and of a deep purple Colour. The second was a Case at first of a more doubtful Kind; there were no spungy Gums, though an offensive Breath; his Ancles and Feet were swelled, attended with Pain and Uneasiness, and a great Weakness and Lassitude; but no Fever, nor any livid Blotches. The Swelling of the Feet and Ancles seemed at first Sight rather gouty or rheumatic, than of the scorbutic Kind; but from the Man’s Way of Life, and the Disorder being so frequent, we discovered it to be the Scurvy. The third hada very fœtid Breath and spungy Gums, livid Spots and fungous Ulcers[113]on his Legs, with Pains and Weakness all over. The fourth had also spungy Gums and a fœtid Breath, Pains of the Legs and Arms, livid Blotches on his Legs, great Hardness and Contraction of the right Ham, and a livid hard Swelling on the Outside of the left Thigh, immediately above the Knee.

We treated them all four in the Method above-mentioned, adding a Mess of Greens toDinner, giving Lemonade for Drink, and the Bark, with Elixir of Vitriol, by Way of Medicine. The Parts that were hard and swelled, were fomented, and rubbed with soft Liniments, and Poultices were applied to the hard Swelling on the Outside of the left Thigh; and the Ulcers of the Legs dressed with Digestives, and occasionally washed with spirituous Tinctures, and touched with Escharotics. Before I leftBremen, the first Week inJune, the first and second Patients were perfectly recovered, and the third and fourth almost well. All of them had had the Disorder some Months before they came to the Hospital.

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