2d, Mr Price did duty in the pest-house at Rosetta and at El Hammed from the beginning of November, 1801, and had a tertian which he never could completely remove. In the pest-house at El Hammed, he was in the evening of the 1st of January attacked with rigors and slight febrile symptoms; but he himself thought this was only an attack of his intermittent, he soon however felt an affection of his head, and tremor of his limbs, and knew his disease. On the morning of the 2d, three buboes appeared, two femoral and one axillary; he then became delirious, and had no recollection of any thing for several days. On the 5th, there was a remission of the fever. He was able, on the 7th, to write me, “that he had no fever, that one bubo was coming on, and that he wasextremely debilitated.” On the 13th Mr Rice opened his bubo; but it was two months after this before he recovered.
I am sorry I cannot find a letter where the treatment of Mr Price is detailed; but I am pretty clear that it was by mercury, as this was his own practice at the time.
3d, Mr O’Farrel entered the pest-house at Aboukir on the 8th of March. He continued well and did his duty there till the 3d of April; in the evening of that day, when he had rigors, which he himself attributed to cold, and says, “that sudorifics nearly cured him.” He was obstinately costive, for which he took several drastic purgatives: the rigors successively returned in the evenings of the 5th and 6th, and he continued taking antimonial powder. On the night of the 6th, he was attacked with giddiness, irritability of stomach, and low fever. Mr Dyson wrote to me, that, on the morning of the 6th, he was delirious, that he had applied a blister to his head;but that he could not get him to swallow any medicine: he expired on the morning of the 7th. No bubo appeared till the day before his death.
4th, Mr Dyson went to assist Mr O’Farrel, at Aboukir, on the 1st of April. On the evening, of the 5th, he was attacked with lassitude, and, on feeling his groin, he writes to me, “I discovered some inflammation of the glands.” After this the succession of symptoms in Mr Dyson was nearly what has been described in Dr Whyte’s case. The fever continued for several days, and became intermittent, one bubo came to suppuration. He obstinately refused every medicine but calomel, which he took as a purgative, but it never salivated him. Constant nausea and vomiting were symptoms with him from the second day of his illness, and he was a long time before he recovered.
5th, Mr Thomas, after being three weeks in the pest-house at Rosetta, attending the first plague-cases which came from the88th regiment, while walking in the garden of the establishment, laid his hand on his groin by accident, and was alarmed to find a large swelling on one side. He soon after felt some giddiness and fell down; as soon as he recovered, he rubbed in mercurial ointment in great quantity, and every hour took as much calomel with opium as his stomach could bear. His gums were very quickly affected, his bubo came to suppuration, and, in three weeks, he was quite well.
6th, Mr Angle, after being about a month in the lazaretto at Alexandria, was attacked with fever and bubo. The bubo never could be brought forward, and he died of the disease on the 14th day. I have no notes of the treatment of this case nor that of Mr Moss; who, after having been about the same time on duty at the lazaretto of Alexandria, caught the infection. He likewise lived several days, and his bubo could never be brought forward.
It is useless to detail more cases, though I am in possession of many accurately related by several gentlemen. Nor do I mean to offer any comment on the above.
As particularly prominent and remarkable, I cannot, however, without some notice, pass over three cases where mercury, early and liberally exhibited, had very remarkable effects.
I received several accounts of the good effects of mercury from the gentlemen in the pest-houses, but none so remarkable as the following:—In the beginning of the season, on the breaking out of the disease in the crowded hospital of the 88th regiment; every man in the hospital was examined at different periods of the day, and thus the disease was detected on its very first appearance. At this time, I gave to each of three of the men, placed in the observation-ward of the hospital, (of whom Littlejohn and Egan have already been mentioned,) two grains of calomel,and the sixth of a grain of opium every hour, and made them rub into the inside of the legs, thighs, arms, and neck, half an ounce of the strong mercurial ointment three times a day. I, at the same time, made them take each half an ounce of nitric acid diluted in their drink during the day, and put their feet and hands, three times during the day, into a strong nitric bath. In about twenty-four hours, their mouths became severely affected, a tenderness in their arm-pits and groins went off, and the severest febrile symptoms yielded. The men were, however, extremely debilitated, and remained a very long time convalescent. During their convalescence, I thought it prudent to keep them in quarantine, being fully convinced, that they had had an attack of the plague, the progress of which had been arrested, and the disease cut short by the above treatment.
Corporal Francis, as already mentioned, was suddenly attacked with giddiness aftercoming off from duty as corporal of the guard in the pest-house. In the very commencement of the disease, on the first feeling of illness, he was brought to Mr Price, who instantly admitted him and immediately exhibited mercury, and as soon as the gums became affected, the febrile symptoms vanished. He remained some time in the hospital, on account of a bubo, which came to suppuration; but Francis suffered very little. He was never more than two days confined to bed, though the case occurred at a time when the disease was very violent.
The case of Peter the interpreter strongly evinces the success of the mercurial treatment. To this case, the mercurial pills and ointment were given; and he was, in every respect, treated as a case of syphilis and was speedily cured.
In the cases related, there appeared some facts as to the time the matter of the pestilential contagion takes before it comes into action. Other facts shew, that, in differentpeople, and under different circumstances, there is the greatest variety in this. The lazaretto at Alexandria was infected by the admission of an Italian merchant, and the guard there, consisting of 14 men, caught the disease, but were attacked on different days. The provost’s guard and his prisoners at Alexandria caught the infection from a deserter confined among them, and the disease among these people appeared at very different periods.
Mr Rice relates two cases on this part of the subject, which appear worthy of detail: he says, “we have had proofs, that the pestilential virus remains a considerable time in the habit, without exerting its influence or shewing its virulence. A striking case occurred lately: a Sepoy was sent to the pest-house from the hospital of the 7th regiment with plague; his wife could not be prevented from accompanying him, where she attended and nursed him. The Sepoy died, and the woman was ordered into quarantine; however,she escaped, and after some days search she was discovered near the regimental hospital of the 7th. As this woman had the greatest reluctance to going to quarantine, a centinel was put over her in the hut where she was, and all communication with her was stopped: she continued in good health till the tenth day after her escape from the pest-house; in the afternoon of this day, she was attacked with fever, in a few hours after, the inguinal glands became painful, and she was carried to the pest-house at El Hammed.”
“Another case bore a great affinity to the above: a Sepoy came into the pest-house to attend his wife: the man was sent into quarantine, and he continued well there, till the seventeenth day, on which plague-symptoms appeared, and he was sent to the pest-house.”
Of the symptoms of the plague, fever, though not always present, seemed the most constant.
At the end of the season, at Cairo, at Ghiza, and at Suez, cases appeared without any observable fever. When it did appear, as already noticed, the type at different seasons, and in different parts of Egypt, was very various. At the pest-house at Rosetta and El Hammed, many of the cases, admitted from October to January, had the accompanying fever intermittent and of the quotidian type. This I believe to be a new fact in the history of the disease. For some time in January, February, and in some part of March, the fever had regular remissions. After this period, it generally appeared of the typhus form at Aboukir, except in the detachment of the 26th Light Dragoons, all of whom were young healthy men, and in them Mr O’Farrel observed, “that there was much re-action, and that the delirium was of the kind denominated phrenitis.”
At the pest-house, at Rahaminia, Mr Whyte observed, that all his patients had pluritic complaints.
The second symptom in order was the tremor of the limbs. Mr Price says, “that bubo and pyrexia are not so essential parts of the diagnosis, as tremor of the upper extremities,” and
3dly, The affection of the head, which was sometimes phrenitis, and sometimes typhomania. In a great majority of Mr Price’s, Mr Rice’s, and Mr Whyte’s, cases there was much nervous affection; in one, the risus sardonicus. Mr Adrian says, the nervous affection, in many cases, was very remarkable; in several cases, it resembled the description, given by authors, of that nervous affection produced by the bites of mad or poisonous animals, an almost universal tremor.
4thly, The glandular affection was the next most generally attending symptom. Not above one-half of Mr Whyte’s cases had buboes; and, in a great majority of Mr Rice’s patients, this symptom did not appear. Dr Henderson says, that, in every one of his cases, there was either inflammationor swelling of the glands. The glands most commonly affected were the femoral, next the axillary, then the parotid, submaxillary, &c. In one case of Mr Adrian, an abscess, of the size of a pigeon’s egg, formed on the inner canthus of the left eye. Mr Adrian opened it by incision, and the patient did well. Many were surprised at the rapidity with which the appearance of bubo followed the first complaint of illness: in a number of cases, within four hours. Mr Rice, on the 7th of January, admitted five cases, and in none of them were buboes later of appearing than six hours after the first feeling of illness. In a Sepoy of the 7th regiment, taken ill in December, the femoral axillary, parotid, submaxillary, and sublingual, glands were all affected. In another Sepoy of the same regiment, admitted by Mr Rice, a case of re-infection, so very much swelled were the glands about the neck, that the man died of suffocation the day on which he was admitted.
5thly. The next most generally-attending symptom was the affection of the abdomen. Mr Price says, the hepatic region was in every instance affected. Sometimes there was a swelling of the region of the liver, pain was experienced from pressure, sometimes in the epigastric, sometimes in the hypogastric, region; and almost always in the region of the liver, at which time, the pain has in some cases extended to the kidneys. Swelling of the belly was very frequent; in some cases the abdomen appeared a mass of knots. Uneasiness at the precordia, nausea, and vomiting, were frequent: the vomiting was always of bile, which was of different colours in different stages of the disease. Mr Price writes, “costiveness was a constant and obstinate symptom; and, when ten or twelve grains of calomel brought fæces down, they were always accompanied with bile; first brown, then yellow.” The urine was in general yellow; the skin and adnata frequently of the samecolour. Mr O’Farrel says, “I lost one of the dragoons from the affection of his side; the fever went off some days before his death.” Mr Adrian writes, “I do not find the constipation an universal symptom, although, in many cases, I have met with it very obstinate. I was once obliged to give eighteen grains of calomel and two scruples of cathartic extract before my patient was moved.” In several cases, the disease commenced with diarrhœa or dysentery. Some of Mr Thomas’s patients died of dysentery; and this might have been said to be the cause of their death, as they recovered from the bubo, fever, and other symptoms of plague.
6thly. In the first part of the season, petechiæ, vibices, maculæ, and carbuncles, were not seen: in the middle of the season they frequently appeared.
7thly. Some gentlemen could distinguish the disease by a particular look of horror and by a particular cast of the eye, whichwas first watery, next blood-shot, and at last yellow.
8thly, According to the diversity of the season, the pulse varied. In general, it was small and frequent, and often, when at the wrist it was not perceptible, it could be felt beating 130 or 140 at the carotids.
9thly, The tongue was universally white at the edges; and, when in March and April, some cases appeared with the fever of the typhoid form, it was black and furred in the centre.
10thly, Several of the cases, which came under Mr Grisdale’s care in February and March, had cough and dyspnœa. Mr Adrian makes a similar report at the above period, and three of Mr Whyte’s patients at Rahamania had cough and dyspnœa.
11thly, In a majority of Mr Price’s cases, he remarked an unusual dryness of the skin, and that it was with the utmost difficulty that he could ever excite perspiration. Mr Whyte says, that, “At Rahamania the skinwas dry, and that he had never succeeded in exciting sweating.”
These are the appearances the disease put on in the last season; and, on inquiry, I find that they were the appearances it assumed in the former season in the British army in Egypt.
My friend, Dr Short, who resided some time in Persia, and who has paid much attention to the history of the plague, informed me, that, in addition to the above, he found hemorrhage a frequent symptom in the plague, which raged at Bagdad in 1800 and 1801.
In one case he saw a copious hemorrhage from the eyes, which continued for nearly twelve hours. As soon as it stopped, an eruption appeared over the body very much resembling the measles. This patient, a boy of twelve years old, died on the 5th day of the disease.
The duration of the disease in different persons was very different. In several instances, the effect of the pestilential contagionwas the immediate extinction of life; and we had several instances of the patient surviving but a few hours the first sensation of illness.
The muccadum of the dooley-bearers of the 88th regiment, about nine in the morning, exhibited the symptoms of fever. About twelve, a bubo appeared, and he died before four o’clock. In some instances, again, the patient lived till the thirteenth and seventeenth day of the disease; however, these instances were rare.
Prognosis. We found that the greatest caution was requisite in giving an opinion as to the probable event of cases: in no disease was the practitioner oftener deceived. In several instances, patients who had recovered from the fever, whose buboes were doing well, and people who were convalescent, suddenly dropped down and expired. Whether this was from re-infection, or whether it was a feature of the disease; will be difficult to determine.
On the 24th of December, one of the Arab servants, convalescent from the disease, and who had been convalescent for eight days, taking bark, while smoking his pipe suddenly expired. In no disease do patients bear motion worse than in this. The least motion[5]induced syncope or death.
Sometimes, they who had for some time been convalescent, suddenly complained that they felt giddy, and expired. Sometimes they called for food, and expired with it in their mouths. In one of Mr Adrian’s cases, where the fever had for some time been gone, and the patient was so far convalescent that he daily walked about a quarter of a mile, the man suddenly complained of giddiness, and expired in ten minutes.
Mr Thomas had two cases where, after affecting their gums, there was a complete apyrexia: but he lost his patients from an immense discharge from the glands and from a secondary fever. In general, it was found, that the patient recovered in proportion to the facility with which his gums and skin could be affected.
Theprognosislikewise depended much on the degree of the affection of the sensorium;when the patient was from the beginning comatose, the case terminated fatally. Several of the cases in the beginning of the season, particularly the natives of India, could never be roused. The typhomania was a more fatal delirium than the inflammatory species.
In thetreatmentof this disease, a variety of modes were put in practice; but so little success attended them, that some were inclined to despair of success from any. Though, with it, even many were lost, yet oxygenation and particularly the use of mercury had the most success.
Though every thing was done by General Baird that the situation and circumstances allowed, yet the gentlemen in the pest-houses laboured under so many disadvantages, that, for the most part, there was but little to be expected from any mode of treatment. In particular, not a little difficulty, as well as danger, was met with in affecting the gums. Safety required that the pest-houses should be at some distance;perhaps, in general, the distance at which they were placed was too great. The patient suffered much by the conveyance, and frequently the treatment of the disease was entered on at too late a period to promise success. In December, January, February, and March, patients suffered so much from the extreme severity of the weather, that in some instances it was not easy to determine whether a patient died from cold or from the plague.
So much dejection prevailed among the natives of India, that, from the moment of the attack, they gave themselves up, and said they were sent to the pest-house to die. They never could be prevailed upon to swallow a morsel of food nor any medicine, and some actually starved themselves.
With establishments of a proper structure, and under proper regulations, we may safely venture to affirm, that our loss from the plague in Egypt would not have been half of what it was.
In the treatment of this disease, the first indication was, to clear the primæ viæ. Some gentlemen exhibited emetics; but in general there was no time for this. The general practice at last was, to begin by giving a purge of calomel, and the general remark was, that, if it operated briskly, the head was relieved and the skin became soft.
The second indication most generally agreed upon, was the inducing ptyalism and perspiration. As offering the fairest prospect of effecting both at once, Mr Price proposed using the warm nitric-acid bath, but unfortunately our stock of nitric-acid was insufficient to do this, otherwise than on a small scale. Mr Price got a little of the acid at El Hammed; but, from circumstances there, he could not always have the warm bath; however, he writes, “On three of my patients, whose gums I could not readily affect with mercury, I determined to try the nitric-acid bath: it has shewn wonderful effects, ptyalismhas been produced in all the three; but the cold has regularly induced rigors and severe attacks of fever, and I shall loose my patients.”
Nitric acid was given internally; and, where the patients would drink it, it shewed good effects. Mr O’Farrel, at Aboukir, succeeded in making three dragoons take it much diluted as their common drink; and they did well all of them.
Mr Price thought well of citric acid. In some of the Arabs he effected cures by this, and by a bath of strong vinegar.
Both Mr Rice and Mr Price were in the habit of washing their patients with vinegar and sponging them with it, as strong as it could be procured, or with lime-juice. They dipped rags in the acids, and kept them constantly applied to the buboes. The head and stomach were relieved by wet cloths being kept to the scrotum.
The third indication was, to obviate the debility which appeared always to be very great. With this view, bark, wine, andopium, were very largely given; and, at a certain stage, the cold bath.
At first, calomel was used only as a purgative, but, at last, the use of this remedy was carried farther. The reports were, “that, upon the mouth becoming sore, the skin became softer, the pulse more regular, the eye more clear, the tongue more moist, and that the thirst with the affection of the head and of the abdomen entirely disappeared. The evacuations too were copious, and approached more nearly to their natural colour.” Mr Price writes, “So much am I persuaded, that in the modes of oxygenation, I am in possession of an infallible remedy, that now I purposely expose myself.” Where he succeeded in affecting the gums, Mr Thomas lost none of his patients, and Mr Price in a late letter says, “Calomel affected the gums of all my patients who survived.” It was a general remark, that the gums were remarkably obstinate and insensible to the effects of mercury inthis disease. Mr Grisdale writes, “in two of the cases, I for five days pushed calomel and mercurial ointment to a very great length, but never could succeed in affecting the gums.” Both these patients, in a subsequent letter, he reports to have died. Here a particular fact deserves to be noticed: one of the medical gentlemen, who went on duty into the pest-house, and escaped the disease, on account of an old venereal complaint, used mercury and nitric acid very freely during the two months of his tour of duty, and he was one of the six who escaped the infection. On the whole, in mercury and the nitric acid, we appear to have excellent remedies for the plague: but they must be very early and very liberally exhibited. If the first stage is allowed to pass over before they are given, the season of doing it with advantage is in danger of being lost. When the stomach becomes irritable, I suspect that they never can be given with propriety. Perhaps, of all the caseswhich occurred in the army, this treatment never got a fair chance of success, excepting in those which occurred on the first breaking out of the disease in the hospital of the 88th regiment, in Mr Thomas’s case, and in that of Corporal Francis.
I regret, that, in this disease, we did not give a full and more fair trial to cold bathing. The extraordinary circumstance of the escape of the Lascar from the Rosetta pest-house, and the great benefit which I have seen from it in the yellow-fever, to which the plague bears no slight resemblance, would induce me to give it a full trial in plague.
I have, I believe, recounted the principal part of the treatment, and that which was most generally agreed upon. Other modes received a trial; but, from an experience of their inefficacy they were all deserted.
Dr Whyte used the lancet very freely, but every one of his patients died; Dr Buchan was in the habit occasionally of havingrecourse to it; and, in the first season, he said, that he had met with several cases where bleeding was of the greatest service. In the beginning of the season, Mr Price bled one patient. The blood appeared very dark, and dissolved: this patient died, and Mr Price never repeated the operation on any other.
Some gentlemen, attached to the Brunonian system, put the stimulating plan to the test. By Messieurs Adrian and Whyte, patients were for some time kept under the influence of wine and opium; but, this practice was never successful and they deserted it. It was at length the practice of Mr Adrian to unite stimulants and mercurials.
Seldom before, I believe, have the bodies of those who died of this disease been dissected. The first was a Sepoy, by Mr Price alone; the second by Messieurs Price and Rice; and, in the last subject, viz. Signior Posetti, the Italian merchant, so severely affected were both of thesegentlemen, that it put a stop to this mode of investigation. The general appearances seen on the subjects, were, a perfectly-diseased state of the glandular system. In the liver, no matter was found; but, it was much enlarged and greatly diseased. Signior Posetti had only one bubo; the femoral gland was sixteen times the natural size and weight; and the blood, from the femoral artery, flowed black, pitchy, and dissolved in its texture. I come now to the last, and most pleasing part of the subject, the means of
The prevention.If, in the treatment of the disease, we were not successful, we assuredly were completely so in the prevention. At length, this became so generally known, that we no longer heard the distressing accounts of despondence and despair among the natives. They now no longer entertained such a dread of the pest-houses. We at length even found volunteers from the natives for duty in the pest-houses.
There was hardly a corps, or an hospital in the army, where, at one period or other, the disease did not make its appearance, but it was always in our power to arrest its progress. In well regulated corps, where a rigid discipline was enforced, and proper attention to the interior economy was paid, it rarely happened, indeed, that much difficulty was experienced in eradicating the contagion.
As our success in the prevention was so great, all that remains for me is to mention the substance of General Baird’s order to the army on this subject.
1st, To every hospital, an observation-room, or in lieu of it a tent was attached, and to it, every case whatever with febrile symptoms was sent, as soon as discovered, and was there most strictly watched by the surgeon.
2dly, On any symptoms of the plague appearing, the case was instantly sent to the pest-house from the observation-room of the regimental hospital: the patient wasaccompanied by the medical gentlemen of his corps who attended him, and who gave the medical gentlemen at the pest-house an account of the previous treatment of the case.
If any doubt remained, the patient in the first instance was placed in the observation-room of the pest-house; and, if the disease did not turn out to be plague, he was sent to the quarantine.
3dly, In every corps, and in every department, a minute inspection by the surgeon was made twice a week; and every person with the smallest appearance of ill-health was sent to the hospital.
4thly, Every corps or hospital, where a case of plague had appeared, was put into a state of quarantine; and, in such corps or hospital, an inspection by the surgeons was made at least two or three times a day; and every case with suspicious symptoms was ordered to the observation-room.
5thly, In suspected corps, it was ordered, that, under the inspection of a commissioned officer, every person should be bathed more frequently, and at stated periods; and, likewise, that all their clothing and bedding should be frequently washed and baked. To all the hospitals, ovens and smoking-rooms were attached.
6thly, Quarters of corps, hospitals, and ground of encampments, were frequently changed.
7thly, Much is to be attributed to the nitrous fumigation. In several instances it was attended with the best effects. The lamps, with this, were kept constantly burning in the observation-rooms, and in the rooms from which the cases of the plague had come. Vessels, with the materials for the fumigation, were likewise placed under the beds, and in the corners of the rooms. When our stock of nitric was at length exhausted, we substituted marine salt for it; but this fumigation could not be kept upin rooms were the patients were all confined to their beds.
The other endemic, and next to the plague in importance, is the ophthalmia of Egypt; which, though a less fatal, is a more distressing, malady.
In Egypt, at particular seasons, it is a most generally-prevailing disease. It is not confined to the human race; the animals of the country, particularly the dogs and camels, are subject to its attacks. Travellers (and, if I remember, Volney is one) describe the same disease as prevailing in Syria; and, I am informed, by my friendDr Short, that, in Persia, ophthalmia is a most frequent and severe disease.
In Egypt this disease proved most distressing and obstinate. The French, it was said, sent from Egypt to France 1000 blind men.
The number sent home from the English army was very considerable likewise. Of the Indian army, 50 were sent home invalids from blindness; most of whom were from the 10th and 88th regiments.
Ophthalmia prevailed most in the 61st regiment; after them, in the 86th regiment: while the 8th dragoons, the artillery, and the 80th regiment, had very little of the disease.
It was remarked, at all times, that the disease was seen much less frequently, and with less violence, in the native Indian, than in the European, corps. Of the former, the 1st Bombay regiment had much more ophthalmia than any other corps of natives. It was said, that, in the English army, the disease prevailed most in thedragoon-regiments. The 26th dragoons was mentioned as a particular instance of this: that corps alone, I heard, sent home about 40 invalids from ophthalmia.
Several gentlemen thought that this disease, in Egypt, was contagious.[6]So singular an opinion I would hesitate to offer on slender grounds. However, the remarkable prevalence of the disease in particular regiments, and even in particular companies of regiments, while the same general causes prevailed every where, will not be easily accounted for, without admitting something of the kind. In some corps of the army from England, as well as that from India, this was observed. In the 54th regiment, my friend, Mr Ross, then the surgeon of it, informed me that the disease was for some time not only confined to particular companies, but to particular tents.It deserves mention, too, that, till the arrival of the Indian army at Ghiza, ophthalmia did not appear in the army. We found at Ghiza the 89th regiment and an ophthalmia-hospital of the English army.
I believe that several diseases are contagious, which are not suspected to arise from such a cause: the theory of contagion is but very imperfectly understood.
It was said, that the sailors, on-board the fleet at Aboukir-bay, had the disease at the same time that it prevailed in the army on-shore. Several cases appeared among the troops after we sailed from Suez.
Ophthalmia prevailed most from May to December. At Kossier the disease was hardly seen, nor at Ghenné. It was not till the army was encamped at Rhoda, in August, that cases crowded in on us. In that, and the two following months, most of the cases made their appearance.
It will be seen, in part the first of these sketches, that, in the months of January,February, March, and April, very few cases appear in the reports.
About the middle of May the disease began to appear in Alexandria.
Some of our medical gentlemen thought this disease very different from the ophthalmia which they had seen in Europe or in India. In several circumstances there certainly was a difference, and we were obliged to have recourse to a different mode of treatment, finding we did not succeed with that pursued in England or in India. The disease, I think, might generally be resolved into, 1st, either of Cullen’s two species, the ophthalmia tarsi and the ophthalmia membranarum; 2ndly, to a combination of these two; or, 3dly, to a species of ophthalmia, frequent in India, symptomatic of disease in the biliary secretion.
The appearance which the disease put on, particularly the two first species of it, was nearly what we have seen in other parts of the world; except that the symptoms advanced with alarming rapidity to the highestinflammatory stages. In most cases the attack was sudden, and very generally at night. Speedily, the patient complained of a burning heat of the eye-ball, or of a sensation of needles being passed through the eye. There was a considerable swelling of the ball of the eye, of the eye-lids, and sometimes of the neighbouring parts. Almost always, there was a copious flow of tears, which felt hot and scalding, and, as they flowed down, excoriated the face. Very frequently, there was a racking headach and general fever. Œdema of the eye-lids was frequently met with in the early stage of the disease, and inversion of the cilia in the last stages.
The disease very often continued two or three months: after it had continued some time, the general health became much impaired. It often terminated in diarrhœa or dysentery, and sometimes the patient became hectic.
In the third species of the disease, which I have mentioned, there was not so much activeinflammation as in the other two species; and it was generally known by a yellow tinge of the adnata, or by dyspeptic symptoms being present; though, sometimes, we have seen those appearances absent: and no topical application had any effect in removing the ophthalmia, till the gums were affected by calomel or some mercurial preparation.
In the two first species of the disease, the inflammation, in a great many instances, induced fever of many days duration, and the disease too frequently terminated in opacity of the cornea or in suppuration of the eye-ball.
In the treatment, it appears, from the reports, that different gentlemen followed very different modes. We said, in general, that the European practice did not succeed. Scarification and astringent collyria, in the first stage, gave intolerable pain, and generally aggravated the symptoms.
The practice of the natives, was, to apply, in the first stage, emollient decoctions oftheir plants, and poultices of the kali. In the last stage, they rely much on the frequently bathing of the eye in the cold water of the Nile: they are likewise very fond of bleeding; and I understood that sometimes they use the actual cautery, burning behind the ear where we usually apply blisters.
The practice, which appeared to be by far the most successful, was the following:
For the first twenty-four or thirty-six hours after admission, the eyes of every patient were carefully syringed with tepid water, which had been filtered carefully. The syringing was performed from three to six times in the day; the light was carefully excluded, the patient kept cool, and every other part of the anti-phlogistic regimen strictly enforced. After the above period, a weak solution of sugar of lead, or of camphor, or vitrolated zinc, was applied. Where the pain was much complained of, a solution of opium was addedto the collyrium; opium was applied in a cataplasm, or two or three drops of laudanum were let fall into the eye.
If there was much swelling, a saturnine poultice, or the coagulum alluminosum, was applied to the eyes. I observed, that blistering a large surface, and as near as possible to the seat of the pain, if kept discharging for some time, always afforded great relief.
To remove the fever and to alleviate the distressing pain, we often gave opium internally in a considerable quantity, and with great advantage.
Setons in the neck and the free use of bark appeared to be of the greatest service, when the disease was of long standing.
In opacity of the cornea, and when there were specks, several gentlemen thought highly of the aqua phagedænica of the old pharmacopeias, after having divided the vessels which went to the speck. It gave very pungent pain; butI have seen great relief from it, and also from a solution of lunar caustic.
As a collyrium in Egypt, I often gave with considerable benefit what I found in the hands of the black doctors in India, viz. a tea spoonful of lime-juice to four table spoonfuls of water, or a tea spoonful of arrack to two table spoonfuls of water. In the first stage, I would have applied leeches, but never could procure them.
In Persia, Dr Short, informs me, that he was very successful in the general use of an ointment, composed of white vitriol, tuttey, and cinnabar, after the application of leeches and scarification.
From the days of Prosper Alpinus, the salts contained in the soil of Egypt have been supposed to be among the principal causes of the ophthalmia of the country. Though the various modifications of light and heat no doubt act as existing causes; yet to the particular soil of Egypt, and to the constitution of the air there, wemust look for the regular and the principal causes of this disease.
In Egypt several causes occurred, which in any country, separately applied, would be adequate to the production of violent ophthalmia. The dry, white, dazzling, soil, and the fine sand and dust constantly thrown about in whirlwinds and entering every crevice. If an ophthalmia is epidemical or is endemic in Egypt, the above causes will render it a very violent disease.
But I conceive, that, of themselves and alone, these circumstances do not produce the violent ophthalmia seen in Egypt. In no place did these circumstances exist in greater force than at Kossier, on the march across the Great Desert, and at Ghenné. Yet, till our arrival at Ghiza, the disease did not appear. These circumstances likewise exist in great force in most places of India, where the ophthalmia occasionally occurs from them, yet it is different from the two first species of the Egyptian ophthalmia.
For the production of the third species of this disease, the same causes will account, which produce dysentery, hepatitis, and other diseases of the liver. In Egypt, I remarked, that most of the cases of this species occurred at the time that dysentery prevailed the most.
It should be mentioned, that, in Egypt, the natives are universally impressed with the idea, that sleeping in the night-air brings on the disease.
In the ophthalmia of Egypt, as in the plague, it would appear, that very much may be done in the prevention.
It could not escape observation, how rarely officers were the subjects of this disease. In accounting for this, I lay most stress on the attention which officers pay to cleanliness. In the 88th regiment, where, I believe, forty men did not escape an attack, only two officers out of thirty had ophthalmia.
In the whole of the Indian army, only one officer lost an eye by it, and thiswas Ensign Paton, of the 86th regiment.
The exemption of the officers from the ophthalmia gives more weight to the opinion, that in Egypt this disease is communicated by contagion.
Mr Paton, previously to embracing the military profession, had studied medicine; and, when medical assistance was much wanted, and a great many of his corps were laid up with the ophthalmia, he very humanely offered to attend them. When employed in this duty, he was himself attacked with the disease and suffered most severely by it for many months.
Mr Bellars, about this time, joined the 86th regiment at Ghiza; he took charge of the sick, and was attacked in the same manner as Mr Paton had been, and he likewise suffered most severely by it for several months.
Dr Whyte, who fell a martyr to his zeal in the investigation of the history of the plague, from a residence of some yearsin the Levant and some time in Egypt, had good opportunities of being acquainted with the diseases of that country, informed me, that, by making those under his charge, frequently during the day, wash the eyes with cold water in the season of the ophthalmia, he never failed in preventing the disease. He instanced particularly the sailors of the transports, of about one thousand of whom he had the medical charge. The captains of the different transports carried Dr Whyte’s preventive instructions into execution; and, though the disease raged both in the army and the navy, few of the sailors of the transports had it. By an attention to this mode of prevention, and in the season when the ophthalmia prevails most, making the soldiers wear something over the eyes, I think we should have the prospect of passing a second campaign, or season in Egypt, with less loss from ophthalmia.
I have dwelt a considerable time on the two endemics, the plague and ophthalmia, the only diseases which we found peculiar to Egypt; and there do not many more diseases remain to detain us.
We come next to a class including several diseases, and which are usually described separately: but, I am at a loss how to disunite them, as they occur all of them in India, and as they have for the most part appeared in the Indian army in Egypt. The diseases are fever, hepatitis, and dysentery; and, as I have for the most part seen them, there exists among them a most intimate and natural connection. For a long time, the same causes appeared indifferently to produce them: there was a frequent transmutation of these diseases one into another, and in the three diseases we succeeded by a similar treatment. In offering a few remarks, however, I willpreserve a distinction, and speak of these diseases separately. Before entering on them I may remark, that the effects of the solo-lunar influence, so remarkable in fever hepatitis and dysentery in India, were in Egypt likewise very observable. In the treatment of these diseases the practitioner found his account in attending to the periods of the moon; at the full and the change, paroxysms would frequently supervene, if not anticipated; and, at these periods, convalescents would frequently suffer a relapse.
The fever which we had in Egypt, at different stations and in different seasons of the year, assumed various types. That which, on the outset, prevailed among the Bombay Sepoys, was remittent. At Ghenné, the fever in the 10th regiment was continued; but it very often terminated in hepatitis. At Ghiza, we have said that we suspected contagion as the cause, at first; but, in the end, the disease was clearly kept up by marshy effluvia on Rhoda Island. It assumed a remittent, and sometimes an intermittent, form, when brought down to Rosetta; and many of the cases terminated in dysentery. At El Hammed, a majority of the fevers which occurred were intermittents; but several remittents occurred, and a few cases which had some resemblance to typhus. After October, feverwas a disease of rare occurrence. In the last general return for November, fifty cases appear, of which thirty-four were natives of India. The last return in December is much the same, the native corps having a majority of the cases.
In the last return of January there appear, of continued fever, twenty-two cases; twelve of whom were Europeans. Of intermittents there were thirty-two cases, and sixteen of them were Europeans. In the general report of the 26th of February the total of fever in the army is only twenty-three, and of them, only six are natives. On the 26th of April, we had only fourteen cases, of which three were natives. In May, fever did not appear in the reports.
Though fever, as it appeared in the Indian army in Egypt, at different periods, occurred with some variation; and though particular symptoms called for occasional variation in the treatment; yet, in its general character, the diseasewas the same, the proximate cause appeared to be the same, and the same general indication was required to be kept in view in the cure. I am inclined to believe, that, under different names, the same fever prevails over the peninsula of India, and over the eastern islands; and, perhaps, I might venture to extend the remark to the countries between the tropics. This fever has been often well described, under the name of the remittent fever of Bengal. Dr Lind, of Windsor, several years ago, gave an excellent and concise account of it in his Thesis. In Bengal, it is known under the name of the pucca fever. In Madras and on the Coromandel coast, it is the jungle fever. At Bombay and on the Malabar coast, it is known under the same name. In the army in the Guzzerat country, to the northward of Bombay, it is this fever which has proved so destructive of late to our army in the field there, opposed to the Mahrattas. In the island of Salsette, near Bombay,it pays an annual visit, on the ceasing of the monsoon, and proves very destructive. In 1801, on one estate, in Salsette, upwards of forty people were attacked with this fever in one night. I have learned from my ingenious friend Mr Christie, surgeon-general of Ceylon, that it was from the same fever, that the 19th, 51st, and 80th regiments, have been so very much reduced; and that it was this fever which proved so destructive in the late war with the king of Candy. Mr Christie writes me, that in its destructive malignancy and ravages, particularly on the Europeans in Ceylon, it has equalled the yellow fever of the West Indies.
From many accounts of it, which I received while in India, I am convinced, that the dreadful fever which prevails in Batavia is the same disease. In Batavia, the mortality from this fever is prodigious; it is not exceeded by that from the plague in Egypt, or from the yellow fever in America. Different circumstances, itwould appear, concur to the production of the disease, in a very aggravated form, in the Dutch settlement of Batavia; of which, we may mention the extreme unhealthiness of the situation, and the bad practice of the Dutch surgeons.
Dr Griffith, surgeon to the naval hospitals in India, informed me, that, when our fleet lay off Batavia, in 1801, it prevailed very much; but that, when they got the management of patients early, they were generally successful in the treatment of the disease. Bencoolen is one of the most unhealthy of our eastern settlements, solely from the prevalence of this fever. In China, it appears likewise to be a frequent and fatal disease.
Having said thus much on the identity of the fever which appeared in Egypt, with that which is seen in India, and in the eastern islands, I shall proceed to the treatment. The first step was to cleanse the primæ viæ, and some gave emetics:this, however, was not always necessary; and purging with calomel, and the neutral salts, appeared in most cases to answer the same intention. In the first stage, likewise, as particular symptoms called for them, venæsection was performed, blisters were applied, we determined to the skin, or gave opiates. However, if the fever was of any duration, the practice always was, to endeavour to affect the mouth as speedily as possible with mercury. This was the practice in continued fever, and in Egypt, as in India, we were very generally successful, if application was early made. In the destructive fever of Ceylon, Mr Christie says, that he has practised but with a moderate share of success: but that the affecting the system by mercury is by far the most successful of different modes of treatment which he had tried. He gave nitric-acid, but in a very small quantity. In the fleet, when stationed near Batavia, DrGriffiths gave mercury more liberally than any practitioner I know. He likewise used the nitric-acid very freely, both externally and internally, and relied much on its combined use with mercury. By two very able practitioners, Dr Keir and Mr Stewart, the Salsette fever has been successfully treated by nitric-acid alone; purgatives having been previously exhibited. Some practitioners treated intermittents by bark, some by opium, or by giving this and the volatile alkali. It has sometimes occurred to myself, and I have frequently had reports from our surgeons, that agues continued obstinate till the gums could be affected by mercury.
From a very intelligent officer I had a detail, regarding the Batavia fever, so remarkable, that I shall here insert it. This gentleman is the captain of a ship in India, who, in different voyages which he had made to Batavia, had constantly lost great numbers of his ship’s crews.In his last voyage, when in a certain latitude, and as he approached Batavia, he gave daily to each of his men a few grains of the mass of the blue pill. By the time of his arrival at Batavia, he had thus very gently affected every one of their mouths; and, in that voyage, he lost not a man. Would mercury thus exhibited, as a preventive, be useful in the plague, or in the yellow fever?
Before dismissing the subject of fever I may observe that no well-marked case of typhus occurred to us in Egypt. In India we never saw a case of this species of fever. To the existence of this fever, which in Europe has committed such havoc in our fleets and armies, the climate of India is inimical. We know instances where, in transports, typhus had broke out, and, on the passage to the Cape of Good Hope or India, had proved little less destructive than the plague could have done; but the disease never reachedIndia. If a case was landed there, it never propagated the contagion: a second case never appeared on shore. On inquiry, I found that no case had ever been known on the western side of the peninsula, nor have I ever heard of its existence in the eastern.
In India I have often had occasion to remark, that the acute hepatitis, of Cullen, was a disease of rare occurrence. The disease which comes before us most frequently, in India, is his chronic species; and in that, most frequently, there is neither pyrexia nor the “decubitus in latus sinistrum difficilis,” which, from having included in the definition of both of his species, I suppose the illustrious and accurate professor was induced to believe was a constant symptom in this disease. In very few of his definitions is there room for alteration; and I hope, for venturing here to suggest one, that I shall not incur the charge of presumption. But hepatitis was a disease, for accounts of which the accurate nosologist must have trusted to other sources thanhis own observation. It should be known, that very often we meet with this disease, when few of the symptoms of his definition are found. In India I have learned from some of the oldest practitioners, and from some gentlemen of abilities, the most respectable in the profession, that very commonly hepatitis is met with when all the symptoms of Cullen’s definition are wanting. In that country, when any of the abdominal viscera are complained of, we may in general suspect some error in the hepatic system.
In India, the liver seems to be the seat of disease in nearly the same proportion that the lungs are in England.
In Upper Egypt, and at Ghiza, we had many cases of hepatitis: it was the same disease that we had seen in India. At Rosetta and Alexandria a few cases did occur, accurately answering to Cullen’s definition of the acute species. Sergeant Levi, of the 88th regiment, was one instance. On the 13th of October, hewas admitted into the hospital with this disease in a most violent degree. He had been ill only twenty-four hours: he had high inflammatory fever; his side was extremely tender to the touch; he had great irritability of stomach, and pain over the belly. He was twice bled: the anti-phlogistic regimen was for thirty-six hours applied in its utmost rigour: thereafter mercury was liberally thrown in, and he recovered. We remarked that many, who, in India, were the frequent subjects of repeated attacks of hepatitis, at length never complained, or they had the disease in the mildest shape, in Egypt. After the month of October, hepatitis was a disease of still more rare occurrence. In no corps did the number of cases bear any proportion to what they were wont to be in India.
During October a considerable number of cases occurred, but almost all of them were Europeans: the proportion of thenatives who had this disease was always very small.
About the beginning of November several fresh cases occurred, and all of them were acute.
By the end of December this disease was fast disappearing in the army. In the last return of the month there were only twenty-one cases, and twenty of them were Europeans.
In January it still continued to decline. In the return of the 31st of this month there appear only nine cases, and all of them are Europeans.
In the first return of February there are only five cases, and all of them are Europeans.
There was an increase in March. In the first return of the month there were twelve cases, and all were Europeans.
In the last return of April the total number was so low as six, of which number four were Europeans.
At the time of embarkation, at Suez, there was not one case reported in the army.
Hepatitis appeared more in the Company’s artillery, and in the 10th regiment, than in any other corps of the army. For its predominance in the latter corps, one reason has been assigned, and which to me appears to have had the most powerful influence.
But on the whole, this disease, once so formidable to us in India, gradually ceased to appear in the returns of the sick.
The treatment of hepatitis it is unnecessary to dwell on: for no disease are we provided with a more effectual or sure remedy. If the season for applying the remedy be not lost, we are nearly, I think, as confident of a cure by mercury, and the analogous remedies, as we are in a case of syphilis by the same remedies.
To whom the world is indebted for the successful treatment of hepatitis by mercury,I cannot correctly say. The oldest written account of this practice, that I have seen, is in a very sensible pamphlet by Dr Paisley, formerly of Madras. There is another very distinct account of it in a pamphlet by Dr Girdlestone, of Yarmouth, formerly surgeon of a regiment in India.
For the general introduction of mercury, through the western side of the peninsula of India during the last twenty years, for the application of nitric acid to the same purpose, and for the discovery of some other preparations analogous to these, we are indebted chiefly to the ingenious Mr Scott, of Bombay. About ten years ago, from some experiments which he made on the calces of mercury, he discovered the analogy between them and nitric acid, and he was the first to apply this acid to the cure of hepatitis. Subsequently, he was led to the use of nitric acid and other analogous remedies in hepatitis and otherdiseases, which are curable only by mercury, a practice, of which, on a large scale for the last six years, I have observed the best effects, and which is now likely to get into general use in India.
I have said, that the species of hepatitis which we met with, at last, in Egypt, was not that usually seen in India, and a corresponding change was required in the treatment. Previously to giving mercury it was found necessary to premise the anti-phlogistic regimen.
In the use of mercury great address is often required; and, in substituting nitric acid and the analogous remedies, I am convinced, that much advantage may often be gained. Sometimes one of these remedies will succeed when the other has failed; and not unfrequently have I seen their combined use succeed where separately given they had failed. In obtaining a new agent we have acquired a great deal more power in the management of a disease, the most formidableto Europeans in the eastern world.
Sometimes in Egypt, and in many instances in India, I have observed, that I could not affect the gums with mercury, or with acid, till venæsection was performed. After this operation, I have often succeeded, and induced a flow of saliva, in cases which had long resisted a liberal use of mercury and nitric acid.
If the modern practice of giving but little mercury, and to make it only touch the gums, as it is called, without exciting a flow of saliva, be proper in the venereal disease, undoubtedly it is not in hepatitis. This disease never yields till the saliva flows freely—the explanation of this I do not attempt; but the fact is as I state it, and it is well known to every man who has practised extensively in India. Whenever the gums are hard, and insensible to the effects of mercury; when, instead of a salivation, they are red, painful, spongy, or blue, the prognosisis very unfavourable: in ninety of such cases out of the hundred we lose our patients.
In the first stage of this disease, I have derived benefit from cupping and blistering the side; but I never allow these remedies to interfere, or to delay the principal indications—the affecting the gums.
Dissection shews us the liver, of appearances considerably varied when this disease has existed some time. I have preserved notes of my dissections; they are not few. I made a rule of inspecting the body of every one that died under my care for several years past. At present, I shall only mention, in general, that sometimes the liver was of the natural consistence, sometimes harder, and that it was much varied in colour; but, generally, it was considerably increased in size. After the disease had lasted long, it was sometimes much wasted, and, in a few instances, of a very small size. In a majority of the fatal terminations,there were found vomicæ, or abscesses. When matter is formed, it is well known, that it makes its escape in various ways: here surgical aid may sometimes be of use.
This was by far the most-generally prevailing, as well as the most fatal disease in the army.
After mature deliberation, and the most satisfactory proofs, proofs nearly amounting to demonstration, I convinced myself, in India, that the dysentery of that country is a disease whose first causes lie in the biliary system. On reflection, and after looking over the accounts of my practice in the West Indies, I have little doubt but that the dysentery of that country proceeds from the same cause. In the end, I was led to think that dysentery, as it occurs in Europe, was the same disease: however, the opportunities of observation, which I had in Egypt, convinced me that I was wrong.
The dysentery which occurred in the army till we came to the shores of theMediterranean, and for some time after, was clearly the dysentery of India; but, afterwards, we witnessed a different disease. I must confess, that, having come to so certain a conclusion, I was not ready to give up an opinion which appeared to me to rest on very sure grounds; and it was not till after much doubt, hesitation, and careful observation, that I became convinced, in Alexandria, that, with the change of country and climate, we had a different disease. This is one proof how improper, and how unsafe, it is for the practitioner of one climate to sit down and describe the diseases of another. They only who have studied the same diseases, in various and opposite climates, can fully comprehend the extreme absurdity as well as fallacy of this. From reasoning of any kind, we are incompetent to decide on the identity of disease. Reasoning from analogy here always deceives. In many of the symptoms diseases may agree; but, fromthence to infer their identity is taking a very narrow view. The comparison will be found to hold good only in some points, and that we have satisfied ourselves with an imperfect outline. Between diseases, as they occur in Europe and in Asia, there are just as many shades of difference as between the plants of those opposite regions, or in the colour of the inhabitants.
The dysentery of India, or what I shall term the tropical dysentery, is not the disease which is described by Cullen under that name. The dysentery of Cullen, as it is faithfully described by Sydenham, Pringle, Monro, and Sir George Baker, is a frequent disease on the continent of Europe; and it has ever been a most destructive disease in our armies there. The dysentery of Europe I believe to be generally a disease of the intestinal canal. I have already said that the tropical dysentery proceeds from a different cause; but the diseases likewisediffer much in their symptoms. The “pyrexia contagiosa” certainly forms no part of the tropical dysentery; and the torminia and tenesmus occur so rarely, that, in a definition of this disease, I presume they cannot be admitted. Spasmodic affection of the intestinal canal, I believe, rarely occurs in the tropical dysentery.
I have ever experienced difficulty in distinguishing dysentery from diarrhæa, and am inclined to think, that, in Cullen’s definition of diarrhæa, is described tropical dysentery. The diarrhæa biliosa, as well as his seventh species, the diarrhæa hepatirrhea, perhaps, ought to be included in a definition of tropical dysentery.
It has been already mentioned, that it was the tropical dysentery which principally prevailed in the army. Though I was not convinced that we had a different disease, till after we came to Alexandria, yet I am inclined to think that itwas the European disease which chiefly prevailed in the army for some time before; and, if we draw the line from November, we shall not be far removed from the truth.
It will not be necessary to say much in the treatment of tropical dysentery. Mercury is now the remedy relied on every where. In Egypt, we felt the want of nitric acid in hepatitis; and we equally felt the want of this powerful remedy in dysentery. The instances which have occurred to me, during the last five years, are extremely numerous, where, after our failure with mercury, exhibited in all the variety of its preparations, we succeeded with this remedy sometimes as a substitute, and sometimes as an auxiliary.[7]
It was in the 61st regiment that cases of the dysentery of Europe were first observed. Perhaps it more readily appeared in this corps, because the greatest part of the men had not yet got rid of the European habit, and were as yet unassimilated to a warm climate. After repeated failures, and losing some men, Mr Ruxton saw the necessity of giving trial to other remedies than mercury.
The disease generally set in with a smart fever, and, unless the calomel exhibited went through the bowels, the patient felt no relief: and Mr Ruxton remarked, that the neutral salts gave this relief much more perfectly than calomel. The treatment which Mr Ruxton rested on, and with which he was at length successful, was, in most cases, putting the patient on the anti-phlogistic regimen; frequently giving laxatives; and keeping up a determination to the skin. The same practice was followed in the few fresh cases which occurred in the 88thregiment at Alexandria, and in a considerable number of cases in the hospital of the 10th regiment, and some other corps. However, it must be mentioned, that to the last period some cases did occur, in all these corps, where calomel was found necessary. When the disease was of some weeks standing, and where a chronic disease occurred, calomel given in small doses proved the best and indeed only useful remedy.
For a long time, we saw but little dysentery in the army. The number of cases which occurred, before we arrived in Lower Egypt, was inconsiderable.
In September, a great many cases occurred in the neighbourhood of Rosetta, and in the camp at El Hammed; but many of these were the sequelæ of the fever contracted at Rhoda. In October, the number of cases was greatly on the increase. The rainy weather with which the month of November began, and which continued during the followingmonths, brought a prodigious increase of dysenteric cases. In the general return of the first week in November, there appear one hundred and sixty cases, and one hundred and twenty-three of these are Europeans. Most of the natives were from the Bengal volunteer battalion.
In the first general return in December appear two hundred and nineteen; of which one hundred and forty are Europeans.
After leaving the encampment at El Hammed, and getting into dry, comfortable barracks, at Alexandria, the disease occurred more rarely in the army.
In the last return of January, only one hundred and sixty cases are seen.
In the last return of February, the total number of dysenteric cases in the army was fifty-four, and only twenty-two of these were natives of India.
In the last return of March, there appearnineteen cases, fifteen of which were Europeans.
There are only twenty cases in the last return of April, and these cases are equally divided between the Europeans and Indians.
At the time of embarkation the number was even less than the above.
The disease was more frequently met with among the European artillery, and in the 61st regiment, than in any other corps. Among the native corps, the Bengal battalion had more of the disease than any other. I made inquiry, but could find no reason that could with probability account for this.[8]
I have continued longer on the subject of dysentery than was at first my intention.I will confess, that I think it is a subject on which I could with more propriety speak than on any other. My opportunities of seeing the disease have been no common ones. Rarely, I believe, has it fallen to the lot of an individual to see so very many cases of one disease in such a diversity of climate and situation. In the 88th regiment, during the course of upwards of ten years, I saw the same men the subject of this disease on the continent of Europe, in America, in both extremities of Africa, and in India. Of late, it has afforded me not a little amusement to review my notes as well as my journals of practice in this disease, in all these quarters.