PNEUMONIA AND RHEUMATISM

I have now both given some account of the endemic diseases which we met with in Egypt, and offered a few remarks on those diseases which were most prevalent in the army. They are the diseases which constantly prove the most fatal toan army in India. The few which now remain, or (if I may be allowed the expression) the minor diseases, will not long detain us.

I shall speak of conjointly. In the symptoms or treatment we could not observe any difference from the same diseases as they occur in Europe. If these diseases were less violent than we have seen them in Europe, they had more of the inflammatory, diathesis than in India.

It was not till after the army had been sometime in Lower Egypt, that either of these diseases appeared.

In the first general weekly return in November, there appear a total of six cases of pneumonia, and nine of rheumatism.

In the first week of December, there were twelve cases of pneumonia, and seven of rheumatism.

In the first weekly return of January, both diseases appear to have increased; there were twenty-four cases of pneumonia, and twenty of rheumatism.

In the first return of February, there are thirty-four cases of pneumonia, of which number, twenty were Europeans. Of rheumatism, there were fifteen, and only eight of them were Europeans.

In March, the first return presents only five cases of pneumonia: of these, three were Europeans; but, of rheumatism, there were twenty-seven cases, and nineteen of them were natives of India.

In April, there were sixteen cases of pneumonia, and only five were Europeans. Of twenty-five cases of rheumatism, eleven are Europeans.

The warm clothing and bedding provided by the General for the natives of India, in the cold months, no doubt protected them from the attacks of pneumonia and rheumatism. The latter disease was found to be more prevalent in the Bengal battalion of Sepoys than in any other corps.

The cases of this disease that occurred were very few. I have said that the small-pox broke out at sea, in the division of the army commanded by colonel Murray. Mr Philips told me, that it was very fatal to the natives: he sent every case as soon as discovered into the Julia hospital ship, which was unfortunately lost, in the Red Sea, with all on board.

The Europeans, who were attacked in Egypt with this disease, all did well; but it proved a very fatal disease to the few Indians whom it attacked.

As in India, we remarked, that in Egypt the contagion did not spread so widely as in Europe. Though, at different periods, it broke out in the hospital of the 10th regiment, at Rosetta, in the department of the commissary of cattle, whenencamped near the lake Mareotis, and in the garrison of Ghiza, yet in none of these instances did the disease spread. The cases that did occur were all of them very confluent. When, on the eve of our march to Suez, I received vaccine matter, sent from Constantinople by order of Lord Elgin: it arrived too late, however, for us to introduce the new inoculation either in the army, or the country; it was likewise too old and unfit to be carried into India, as we intended.[9]At one time I expected to see a curious question in physiology resolved, by observing the united agency of the variolous, and pestilential contagions. In one instance, these two poisons were in action in one corps, and at one time. A case of thesmall-pox, and another of the plague, broke out, in the camp of the commissary of cattle, at the same time. By the active vigilance, and the system established there, the progress of both contagions was soon stopped, and a second case of either disease did not afterwards occur.

I have said, that, from the quality of the water, this was a prevailing disease in crossing the desert of Thebes. It occasionally appeared, at other times, in some corps, particularly after a change of provisions, or after changing quarters, as from El Hammed to Alexandria.

This disease was but little seen in the army. About twenty cases occurred in the 61st regiment while quartered in the Pharos, and one case occurred in the 80th regiment at Alexandria. At the time the disease occurred, the army was regularly supplied with fresh vegetables, and there was no scarcity of provisions in the market.

This disease prevailed much in the garrison of Ghiza, and in the 86th regiment. At the time of embarkation there were many obstinate cases. With the small stock of nitric acid which we had, we had as strong proofs of its efficacy as in India. In the instances of some officers who were successfully treated with it, we found that the stomach seldom bore more than half the quantity which, in Bombay, we had usually exhibited in the hospital of the 88th regiment; but the acid given to these cases differed much from the acid used in India: the latter was a much pleasanter remedy.

To a few cases we successfully gave the oxymuriate of potash, and to several cases the oxymuriate of soda.

We found that syphilis was a frequentdisease in every part of Egypt that we had seen, both among the Bedouins and the Fellahs; and we have seen in Upper Egypt many objects terribly mutilated from this disease. Crude mercury I have often seen in their bazars, or markets, and they appeared to be acquainted with the use of it.

This did not frequently appear in the Indian army while they were in Egypt: on the voyage thither, however, it prevailed very much, and a great deal of it came under my own particular notice. On my return to India I found, that, in the manner of its first appearance, as well as in its progress afterwards, much of what I had observed was considered, by medical men, as new and remarkable. I shall, therefore, give some detail of it here: though this may be going a little out of my way, it may be useful. When cases of this disease crowded on me, and with the very severe symptoms with which they appeared, I was both perplexed and embarrassed; and I regretted much the not having had a previous knowledge of the disease.

This disease, as will be shewn by the table, was but little seen in Egypt. It appeared only in two European corps, the 86th and 88th regiments; and in two native Indian corps, the 1st and 7th Bombay regiments. It is a disease, of which I believe that we know but little. Industry and attention might be usefully employed in the investigation of the natural history of the dracunculus.

In September, 1799, the 86th regiment relieved the 84th in the fort of Bombay. The 86th remained in the king’s barracks there until October, 1800, at which time they were relieved by the 88th regiment from the island of Coulabah.

The 86th, on coming into the fort of Bombay, had never had a case of the Guinea-worm; and they continued free from it till the setting in of the monsoon of 1800. The king’s barracks in the fort are close to the bazar in Bombay. Here Mr Dean, the surgeon of the 86th regiment,remarked, that the Guinea-worm prevailed very much among the natives. In the course of the monsoon, nearly three hundred cases of this disease appeared in the 86th regiment. I saw, at one time, one hundred cases of it in Mr Dean’s hospital.

The 88th regiment, from the time of their arrival in India, in June, 1799, till October, 1800, was quartered in the island of Coulabah, distant one mile from Bombay. During the fifteen months of their stay at Coulabah, only one case of Guinea-worm appeared in the regiment; and this happened, as they were about exchanging quarters with the 86th regiment, in an old man, debilitated with repeated attacks of hepatitis and dysentery. No case appeared in the 88th regiment in October, nor for nearly a month after their coming into the king’s barracks in Bombay; but, in that part of November which immediately precededtheir embarkation for service, three cases occurred.

The artillery, 86th and 88th regiments, as already mentioned, were embarked, at Bombay, for the Egyptian expedition. In the course of the voyage to Ceylon, a case of Guinea-worm first appeared in the detachment of the 86th regiment, on board the Minerva; and, thereafter, six cases in the 88th regiment, on board the same ship.

On our arrival at Point de Galle, in Ceylon, we found that the disease was unknown in his Majesty’s 19th foot, among the Sepoys who came from Bengal or Madras; in the Malay corps: and, as far as I could learn, among the inhabitants. During our stay in Ceylon, a few cases made their appearance in the 86th and 88th regiments on shore. On sailing from this island for the Red Sea, only three hundred and sixty men, of the 88th regiment, with the artillery, were embarkedin the Minerva. Two companies of the 88th were embarked in a small vessel, the Fancy. Another vessel, the Hope, was provided for the detachment of the 86th regiment, and two officers of the 88th were embarked with them.

Soon after sailing from Ceylon, the Guinea-worm made its appearance among the 88th, both in the Minerva and Fancy: in the Minerva, particularly, it increased with alarming rapidity. By the time we reached the Straits of Babelmandel, we were in a most alarming state. Of three hundred and sixty men, whose services we had reason to expect daily might be required, one hundred and sixty-one were at this time crippled and laid up with this loathsome disease. Though contrary to every account which I had had of the disease, many circumstances at this time led me to suspect that it was infectious, and I, at length, thought it prudent to treat it as such.

The officers remarked, that it prevailed most in particular parts of the ship, and much more in some companies than in others. This, at length, so much struck the commanding officer, that the sick were separated from the sound: the men with the Guinea-worm were all placed on the orlop-deck, and the rest of the men occupied the gun-deck. At this time, too, extraordinary precautions, regarding cleanliness and ventilation, were adopted. Much lumber and luggage were stowed away, and the space between decks, which hitherto had been lumbered with it, was made open and clear, fore and aft. The decks were daily well washed with boiling water, and the nitrous fumigation was kept constantly going on throughout the ship. Besides the usual bathing three times a week, of all on board, the soldiers were made to wash their hands and feet regularly twice every day at the ship’s head.

In a little time after adopting these measures, we could perceive the disease to diminish. The number of fresh cases reported, decreased daily; and at the time of our casting anchor in Kossier Roads, though there were on the sick list many bad ulcers from the Guinea-worm, no fresh case had appeared for some days before.

During the voyage, 199 cases had appeared from 360 men of the 88th regiment; and several cases occurred among the ship’s crew; but not a single case occurred among the artillery. This struck every one on board, very early, as remarkable; yet these men had the same provisions, drank the same water, and in every other circumstance were situated as the men of the 88th regiment, except that they were kept separate. From the outset, the artillerymen were accommodated apart, on the gun-deck, in a spot divided off for themselves. Not one of the officers,either of the artillery, 88th, or belonging to the ship, had the Guinea-worm. From the strong circumstances which in its course appeared, every officer on board was impressed with the opinion of its being contagious, and was inclined to use every precaution of prevention; from which, most probably, all escaped this filthy and severe disease.

Those embarked in the Fancy, were not so fortunate; few of the men there escaped the disease. Of eight officers of the 88th, three caught it. Mr Bruce, then the assistant surgeon, was one of these: he had a worm in each leg. The Fancy was obliged to return to Bombay; most of the men were disabled by this disease; and the season was too far advanced for her getting up the Red Sea.

Among the 86th regiment in the Hope, only three cases occurred; and one of the two officers of the 88th, on board, was one of them.

I find, by my case-books, that in the part of the 88th regiment which continued in the Minerva, the disease appeared as follows:

I have purposely excluded the cases which occurred in the 88th, on board the Fancy, or among the 86th regiment.

The disease was pretty uniform in the manner of its appearance. The patient was first sensible of an itching; and, on looking at the part, generally observed a small blister: sometimes I have seen three or four small blisters, and the part having the appearance of being stung with nettles. When the blister was snipped, a piece of mucus of the breadth ofa sixpence was seen underneath, which being removed, the head of the worm was seen. It was in general firmly attached, and required force to detach it from the parts underneath. When detached with the forceps, we twisted it round a ligature or piece of lint, and thus, often on the first day, succeeded in extracting a foot, or even two, of the worm. It resembled much what is called bobbin, and was about the same size. It was transparent and moist, a white liquid being seen in it. We continued, daily, extracting as much of it as would come out with gentle pulling. It was always dangerous to pull strongly, for fear of breaking the worm: it then occasioned the most acute pain, and there followed much swelling, with inflammation of the neighbouring parts, sometimes of two or three weeks continuance, when the worm would shew itself at another part, as at first, with itching and a blister.

It seldom appeared to be deeply seated; generally, under the cutis, or among the tela cellulosa, when we could often trace it in its course, and sometimes see it: sometimes it was under the fascia, and but seldom among the muscles.

If not ushered in with fever, it was almost always attended with it in its course: when there was considerable inflammation, it ran very high. In seven cases, mortification took place, and very large sloughs were cast off. In a few cases, there was a very considerable and alarming hæmorrhage.

By presenting itself at different places, it would often leave two or three large, foul, and fistulous ulcers in different parts of a limb. When the inflammation has run very high, as I have often seen of the whole leg or thigh; and when a profuse suppuration followed; the worm frequently has come out dead, often inpieces, with the sanies, by which, probably, it had been eroded and killed.

Frequently, after extracting one worm from a patient, a second, a third, or even a fourth, would appear: after getting one out of a leg, a second would appear in the other, a third in one hand, and a fourth in the other hand.

The Guinea-worm, I believe, has been seen in every part of the body. Though the extremities appear to be its favourite seats, yet the face, breast, back, penis, &c. are not exempted from its visits. I heard of a gentleman in Bombay who had one in his scrotum and penis, and of a lady who had one in the pudenda.

The following I extract from my case-book and notes, taken on board the Minerva, by which it will be seen that the extremities are as much more frequently its principal and first seat, as in the itch.

As to the causes of the appearance of the Guinea-worm, and the mode in which it is generated, I must confess that I have no account that I could venture to offer here.

In different parts of the world, the water drank is accused of occasioning intestinal worms, as the tænia in Switzerland, and the tænia and the teretes in the West Indies; where, likewise, I have heard the mucilaginous vegetables eaten assigned as a cause of the frequent appearance of worms. In Russia, there is a worm, the lumbricus militensis, common near swampy grounds. In Russia and in Siberia, in the same situations, the tænia infernalis prevails. But, afterwhat has been here stated, we cannot bring the water, drank on board the Minerva, or at Bombay, to account for the Guinea-worm which prevailed: in fact, the water came from different and distant quarters, Bombay, Ceylon, and Madras. Besides, the officers of the 38th, and the artillery, drank the same water, and escaped.

No case of Guinea-worm had been known among either the Lascars or European sailors in the Minerva, when the 86th and 88th embarked in her.

I have good reason to think that the spreading of the Guinea-worm may be stopped, whenever it does appear. The means which we adopted appeared to succeed. Extreme attention to cleanliness is indispensably necessary.

In India, the native doctors are much more successful in getting out the worms, than Europeans. After long feeling with their fingers, for the body of the worm,they make an incision as nearly as they can judge over its middle, and, pulling the worm by a duplicature of it, draw out both ends of the worm at one time. I have often endeavoured to imitate this practice. My sense of touch was not so delicate, and did not guide me so correctly, as it did the Hindoo doctors; but I always found that when, on cutting down to it, I got on the middle of the worm, and, by the forceps, pulled this out, I could with ease extract a large portion, and, not unfrequently, the whole worm.

Leeches, astringent and sedative lotions, cataplasms, fomentations, &c. were applied, as required by the circumstances of the case. A good deal of attention was paid to the disease, in all its stages; and several experiments were made on the worm, which, however, it is needless to detail here.

After using a variety of articles, in thetreatment of the Guinea-worm, and making them enter the system by the absorbents, I think that unctuous substances succeeded the best, particularly mercurial ointment. Passing an electrical shock through the part had no effect.

In India, we remarked that ulcers, particularly of the legs, were very rarely seen; and that many men in the 88th regiment, who in Europe were always in hospitals with them, were in India quite free from them. In Egypt, they began to re-appear. In the course of six weeks after the army came to Alexandria, there appeared seventy on the general return of the army; and they continued afterwards on the increase.

Though no case of this disease occurred to us while in Egypt, I met with a severe one on the voyage thither. As I was successful in this case, and by a mode of treatment which, with the theory which gave rise to it, is, I believe, now considered as obsolete, it may not be uninteresting to mention what led me to give it a trial.

In the year 1794, the first tetanic case I met with, occurred at Bergen-op-Zoom. A sergeant of the 88th regiment, after remaining drunk out all night, was in the morning found lying in a ditch. This was in August, and the weather was unusually warm. When brought to the hospital, his jaws were so firmly locked, that the blade of a pen-knife could not be introduced between the teeth. Mercurywas had recourse to, but in a few hours the muscles of the neck became convulsed. By the advice of a Dutch physician, a man of great eminence, I immersed my patient four times, in the course of the day, into a bath of broth. He continued in it half an hour each time, and, after he came out, his whole body was rubbed with mercurial ointment. I do not recollect that any thing else was given to him, unless a stimulant enema. Next morning the good effects of the Dutch practice were evident: a violent salivation came on, and, in about three weeks, the man was doing his duty.

In the next case which occurred, though a cure was not completely effected, the same treatment was, for some days, attended with good effects. In the island of Grenada, a negro, attached to our pioneers, received a contusion and a slight wound of the head, which wassoon followed by locked jaw. The warm bath, and the liberal use of mercury, were ordered. He, for some time, appeared to be better, and I flattered myself with the hopes of another cure; but the disease gaining ground, the cold bath and the tonic treatment were had recourse to. The patient died.

The next was a sailor, who, a few days before our embarkation, in the Minerva, at Bombay, had been slightly wounded in the foot by a copper nail. On my first seeing him, his symptoms were slight, but were gaining ground fast. On the 10th of December, the day after our embarkation, he had the most violent symptoms of the disease: the jaws were firmly locked; the muscles of the neck, before and behind, were strongly convulsed; and he had twitchings of the muscles of his face. He pointed to the region of the stomach, where, he afterwards told me, that he had intolerablepain and sickness. This man was immediately put under the same treatment as was employed in the case of Sergeant Kirkland, with this difference, that, instead of broth, a bath was made from fat, or what is, on ship-board, called the slush. The same success attended; but the symptoms yielded more slowly, and it was several months before the sailor recovered.

From hearing me relate these successful cases, by the warm bath and mercury, some cases in the Bombay general hospital were treated in the same manner. My friend, Dr Keir, informed me that he tried it in three cases of tetanus, in the garrison hospital. It succeeded in one, but failed in the other two.

When I had nearly brought these sketches to a conclusion, I met with two books which I regret that I did not see earlier, viz. Dr Chisholm’s work on the Pestilential Fever of the West Indies, and Dr Wittman’s Travels. In perusing these works, I have had great satisfaction to find a coincidence with me in some opinions which I had formed, and which I have introduced into this treatise.

It is matter of regret to me, that I did not meet Dr Wittman in Egypt. Most of my observations, I find, coincide with his; and I am glad to have mine confirmed by authority so respectable.

The frictions with oil we did use to a small extent, in an infected corps of the Indian army; but the report made to me, by the surgeon, was unfavourable, and I never recommended its use in any othercorps. Since reading what Dr Wittman says on the subject of friction with oil, I think it not improbable, that, in addition to the great care which captain Burr took of the commissariat department, another circumstance may have conduced to their exemption from the plague. The camels of the army, to the number of some hundreds, were, as well as the horses and buffaloes, under the charge of the commissary of cattle, captain Burr; and his people were entrusted with the care of them. In the cold and wet season, which commenced in November, the camels became very sickly, and many of them had an eruption over the body. In the course of three months, I believe, more than three-fourths of these useful animals died. Captain Burr employed some Arabs, who were reputed to be skilful in the treatment of the camel. The plan which they followed I remember well. It was, after shaving or cutting the hair very close, to rub them all over with oil,daily. The men of the commissariat department were, during the day, constantly employed in these frictions, or in tending the cattle: and the great mortality among the camels happened in November, December, and January, the months in which the plague raged the most in the army. The circumstance I think not unworthy of notice; I leave others to ascribe to it what degree of importance they think it deserving of.

I have mentioned, that I thought I could see a characteristic similitude in many of the symptoms between the plague and the destructive fever which has for some years devastated the continent of America and the West India islands; and to the end of the account which I gave of the plague, I add a table of the principal points where it appeared to me that the two diseases agreed.[10]I am now glad to find, that in this opinion I do not standalone; I have been particularly gratified to find that this is the opinion of so very respectable authority as Dr Chisholm.

I have had the greatest satisfaction in the perusal of the very complete history of the West India fever which Dr Chisholm gives. In most points, the result of my observations on this, coincides with the doctor’s. My experience, in a particular situation, supplied me with some very strong facts, touching the question of the contagious nature of this fever.

From my case-books and notes, while in the West Indies, I have thrown, under a few heads, a brief extract of the result of my observations, which I shall here insert. From the similitude which I think I can trace, this is not foreign to the principal subject of these Sketches; and, as the result of close observation, unattached to any theory, they may, perhaps, be not without interest or use.

1st. In Barbadoes, both in the end of 1795, and in the beginning of 1796, the onlydisease which prevailed was typhus. The 88th regiment was healthy at St Lucia, and continued pretty healthy at Grenada for three months after their arrival there, or as long as they remained to the windward side of the island. This was likewise the case with the 10th, 25th, and other regiments. It was only after our return to St George’s and to Richmond Hill, after we had communication with the 68th regiment, and the general hospitals, where the yellow fever had for many months prevailed, that it appeared in the 38th, and in the other corps.

2d. Before the appearance of this fever in the 88th, as well as in other corps, dysentery and intermittents prevailed most.

3d. On the 12th of July, 1796, a detachment of the 88th regiment was embarked at Grenada, in the Betsy transport, for England. We embarked one hundred and forty, and I was most particularly careful not to take any man on board with the slightest appearance of illness. Everyprecaution which regarded cleanliness, ventilation, or fumigation, was adopted. The remains of the 8th, 10th, 25th, and other regiments, were at the same time embarked, at Grenada, for England.

4th. From the time we sailed from Grenada, on the 19th of July to the 5th of August, seven days after we sailed from Tortola, (where we had touched for water) no case of this fever appeared in the Betsy. The other corps, which left Grenada along with us, had not been so fortunate. The 8th, 10th, and 25th regiments, all of them suffered severely on the passage from Grenada to Tortola; the 8th particularly. This corps, besides the loss of many non-commissioned officers, in this short passage, lost every officer on board, except the surgeon in second, and major and captain Armstrong; and these two gentlemen were ill of the yellow fever on coming into Tortola. I was requested to go on board to visit them, but the request was opposed by all the officers onboard the Betsy, as well those of the ship as by the officers of the 88th regiment on board. So very much were all impressed with an opinion of the fatally infectious nature of this fever, that they remonstrated with me, and told me, that the ship and the regiment were now perfectly free from this fever; but that, by my going to see the 8th, I should certainly bring the fever into the Betsy. However, a second message having come for me to visit captain and major Armstrong, I instantly accompanied the messenger on board. From seeing the state of their transport, I immediately ordered major and captain Armstrong on shore, and accompanied them to the hotel. Here we found that the prejudices in the Betsy transport prevailed in the island of Tortola. The doors of the hotel were shut against the yellow fever, and it required a veryforcibleremonstrance to persuade them to admit these two officers, who,however, both of them, died the next day in the hotel.

5th. The state of the other corps, after sailing from Tortola, I am unacquainted with. When lying at Tortola, on the 29th and 30th of July, the Betsy communicated with the transports which had the 8th and 10th regiments on board. On the 6th of August, the first case of the yellow fever appeared on board the Betsy; from which period to the 12th of September, 1796, every person almost was once, and a great many on board twice, attacked with this fever. Of one hundred and forty people on board the Betsy, the captain of the ship, eighteen soldiers, and one woman, died in this period. It should, however, be mentioned, that, of the soldiers, several were old and worn-out invalids. During the passage from Tortola to England, our convoy, the Hebe frigate, suffered even more than the Betsy. When sent for onboard, by Captain Scott, I found that he had not only lost many seamen and marines, but several officers, and two medical gentlemen.

6th. On the fleet, from Grenada, anchoring at Tortola, the yellow fever was unknown there; thereafter, I have heard, that it prevailed generally, and committed great havoc.

7th. Those labouring under dysentery, ague, &c. were those first seized with this fever.

8th. [Symptoms.]—The attack was first with extreme debility, affection of the head, and frequently the appearance of drunkenness. Next, the abdomen was complained of, and the biliary system appeared to be a principal seat of the disease. The yellowness, though not a constant, was a generally attending symptom. The eyes first appeared of a watery suffusion; they next were observed to be blood-shot; and, in a short time after, yellow; from the eye, the yellowness quicklyspread over all the body, and the patient in a little time had the appearance of one highly jaundiced. Sometimes the yellow colour of the body continued for some time after the patient got well, and purgatives brought off yellow stools, while the urine was at the same time yellowish. The irritability of the stomach, and what is called the black vomiting, were pretty constant attending symptoms. The state of the pulse varied in the course of the disease; there was at first, almost always, a firm and strong pulse, with so much re-action, as would lead a stranger to the disease to blood-letting and the anti-phlogistic regimen. The bowels were, in general, very unequal; there was either a looseness or costiveness, though most frequently the latter.

9th. The duration of the disease was, in different cases, and in different situations, very different. In Grenada, when it first broke out, it generally ran its course from twenty-four, thirty-six, toforty-eight hours, in the hospitals. Soon after we sailed from Grenada, cases terminated in three days: thereafter, and as we approached the higher latitudes, and before we reached Ireland, cases were drawn out to ten, twelve, and fifteen days.

10th. The prognosis. The danger was generally in proportion to the degree of affection of the head, irritability of the stomach, and yellowness of the skin, and as these appeared early or not.

11th. In the treatment various modes were tried. Emetics appeared to be unnecessary; and, in general, seemed to do mischief, as did all antimonials. I have witnessed the practice of a large hospital, where blood-letting was premised in every case; but this was by no means a successful practice. In three cases in the Betsy, and where the state of the pulse and other symptoms seemed particularly to call for it, I performed venæsection; but I lost my three patients. Clearingthe bowels appeared to be a principal indication: when this was repeatedly done by drastic purgatives, and when a free perspiration was kept up, there was always less complaint of the head, and, in some cases, a remission was thus obtained, and the bark could then be given with manifest advantage. In the few cases where it was used to produce salivation, calomel did more good than any other remedy whatever. I lost no case, where I succeeded in inducing a flow of saliva.

In some cases, and these all proved fatal, the gums became insensible to the effects of mercury; and though one drachm of calomel in one case, and two scruples in another, were given in a very short period, yet the patient died without a flow of saliva having been excited.

Nothing gave more relief than the cold bath; it generally suppressed the irritability of stomach for some time; it alwaysinduced sleep, and brought out a gentle sweat, which most commonly relieved the patient. The Brunonian practice I saw tried with no advantage.

These are the principal of the leading circumstances, regarding the yellow fever, which came immediately under my notice.

Dr Chisholm, when he formed the opinion of the similarity of the plague and the yellow fever, was not singular.

Since my arrival in England, I have received several letters addressed to me in Egypt, and which followed me from that country to India, and from thence to Europe; mostly answers to letters which I wrote from Egypt. By two of my West-India correspondents, in particular, this opinion is repeatedly expressed. I have several letters on the subject from two most respectable physicians, Dr Paterson, of Grenada, and Dr Robertson, of Barbadoes. From the opinion which he had formed, Dr Patersonrepeatedly urges me to the use of mercury, and of the cold bath, in the plague.

Dr Robertson, in one letter says, “I decidedly agree with you, that there is a strong similitude between the symptoms of the yellow fever and the plague: although the latter disease never came under my observation, yet I was so struck with the appearance of yellow fever, and the histories of the other disease, which I had read, that, at one time, I was almost disposed to consider them both as different modifications of the same diseased state of body, and actually wrote a paper on the subject in February, 1797.”

In the practice in Egypt, Mr Price’s observation militates against the use of cold bathing in the plague. It should be recollected, however, that, when Mr Price made his observation, it was in the severest part of the season, when the plague raged the most, and when Mr Price laboured under many disadvantagesin his practice. I anxiously wish to see cold bathing, or sponging, extensively tried in the plague. I have great expectations from it in that disease, from having so often seen how much it has done in the yellow fever and in typhus fever, where I consider it to be the most valuable part of the treatment.

In concluding, I am impelled to do an act of justice, and acquit myself of a debt of gratitude. The use of this invaluable remedy, and what else I know of tropical practice, I learned many years ago from my venerable and much-respected friend Dr Wright. By the use of the cold bathing, my life was saved in Jersey, in 1794, when I was ill of typhus fever, by Dr Jackson, then surgeon of the Buffs, who, at the same time, attended my hospital for me, and with the greatest benefit, and introduced this practice into the 88th regiment, where typhus then raged.

The use of cold water and cold bathing has since been diffused by the ingenious and elegant pen of Dr Currie. This I conceive to be one of the greatest improvements which the practice of physic has received in modern times.

FOOTNOTES[1]A plan established in the army proved so useful, that I will here mention it. The letters and reports of the medical gentlemen in the pest-houses, I constantly sewed together, made them up in monthly volumes, and kept them at my quarters, where every medical gentleman in the army was invited to come and daily peruse them. The disease became thus the subject of daily discussion; and, from these discussions, I was enabled daily to propose queries in my letters to the gentlemen in the pest-houses. Thus, the history of the disease, in most of its points, came to be investigated; and, previously to entering a pest-house, before his tour of duty came round, every gentleman had acquired some knowledge of the plague, and of the success of other practitioners.[2]These circumstances I learned from a member of the French Institute, and from the Pharmacien en Chéf to the French army, who often related to me the order which Bonaparte gave him to poison the wounded with opium.[3]In Dr Duncan’s Annals of Medicine, for 1801, I have adduced a striking instance of this.[4]Dr Buchan was on the staff of the British army, but twice nobly volunteered his services, and twice did duty in the lazaretto of Alexandria, at this period common both to the English and Indian armies.[5]This remark we found to be particularly applicable to the last stages of the disease. In the beginning of the season, one case occurred that gave rise to much conversation in the army. From having come into contact with a case of plague, a Lascar, in the department of the commissary of cattle, was sent into the observation-room of the pest-house of Rosetta; he was brought there much against his will, and contrived to make his escape from it, on the evening of the day on which he was admitted, though fired at by the dragoon-centries placed round the establishment. Ineffectual search was made for him every where in the neighbourhood of Rosetta, and we could hear nothing of him for about five weeks, when he was discovered at Boulac. On being brought down to Rosetta, I examined him with Mr Guild, the surgeon of his corps. We found him then well; but certainly he had had the disease, for we saw an axillary bubo not quite healed. He told us, that he remained concealed for a great part of the time among the rushes by the side of the river. On mentioning this case to Dr Currie, of Liverpool, I think he said, he had heard of some similar cases.[6]Since my arrival in England I see that the contagious nature of the Egyptian ophthalmia has been noticed by two gentlemen of the English army, Mr Edmonstone and Mr Powers.[7]Though this practice is now followed by many gentlemen in India, yet I believe that it has been carried to a greater extent by Messrs Dean and Bellars, of the 86th regiment, than by any other practitioners. These gentlemen have recorded several hundreds of cases of dysentery treated solely by nitric mixture and bath.[8]In Egypt we gave trial to a mode of treatment which was strongly recommended to me by Dr Whyte. It was the application of flannel bandages over the whole abdomen. In chronic cases, and in convalescents, it appeared to be of the greatest service; and, in recent cases, when the appropriate remedies were used at the same time, it appeared to shorten the cure. I have seen it tried alone but in a few cases of this disease. From the result of these, however, in cases of either the European or tropical dysentery, I would not venture to rely on it alone for a cure.Before leaving the subject of dysentery I may mention, that, in India, I have met with some cases of a very violent dysentery which ran its course in three, four, or five days. In this disease the usual practice did not succeed. The best treatment appeared to be, after a dose of castor oil, to give opium liberally by the mouth, and by clyster; and to make the patient drink very freely of gum arabic at the same time. In some of these cases I have likewise given diluted nitric-acid. A constriction of the vessels discharging mucus was in this way effected; the incessant discharge was stopped, and time given for a secretion of mucus to cover the abraded gut. I have thus sometimes succeeded in checking a most violent disease. Thereafter, the mouth could be gradually and gently affected by mercury, or by nitric-acid.On opening the bodies of those who died of the tropical dysentery, in Egypt as in India, we almost constantly found the liver diseased. In old cases, we likewise most commonly found ulceration of the great intestines, and very frequently within the reach of enemata. In the composition of these, a variety of articles were used: most frequently, I think, solutions of sugar of lead, or vitriolated zinc, gave greatest relief; and we sometimes found that gum arabic, milk, and broths, gave relief, when many other things had failed.[9]It was soon afterwards introduced to India, by the exertions of the Medical Board at Bombay; and the world has had a full account of its introduction and success from my friend Dr Keir, who had the charge of the institution for disseminating the vaccine disease, from Bombay through India.[10]Vide Appendix.

[1]A plan established in the army proved so useful, that I will here mention it. The letters and reports of the medical gentlemen in the pest-houses, I constantly sewed together, made them up in monthly volumes, and kept them at my quarters, where every medical gentleman in the army was invited to come and daily peruse them. The disease became thus the subject of daily discussion; and, from these discussions, I was enabled daily to propose queries in my letters to the gentlemen in the pest-houses. Thus, the history of the disease, in most of its points, came to be investigated; and, previously to entering a pest-house, before his tour of duty came round, every gentleman had acquired some knowledge of the plague, and of the success of other practitioners.

[2]These circumstances I learned from a member of the French Institute, and from the Pharmacien en Chéf to the French army, who often related to me the order which Bonaparte gave him to poison the wounded with opium.

[3]In Dr Duncan’s Annals of Medicine, for 1801, I have adduced a striking instance of this.

[4]Dr Buchan was on the staff of the British army, but twice nobly volunteered his services, and twice did duty in the lazaretto of Alexandria, at this period common both to the English and Indian armies.

[5]This remark we found to be particularly applicable to the last stages of the disease. In the beginning of the season, one case occurred that gave rise to much conversation in the army. From having come into contact with a case of plague, a Lascar, in the department of the commissary of cattle, was sent into the observation-room of the pest-house of Rosetta; he was brought there much against his will, and contrived to make his escape from it, on the evening of the day on which he was admitted, though fired at by the dragoon-centries placed round the establishment. Ineffectual search was made for him every where in the neighbourhood of Rosetta, and we could hear nothing of him for about five weeks, when he was discovered at Boulac. On being brought down to Rosetta, I examined him with Mr Guild, the surgeon of his corps. We found him then well; but certainly he had had the disease, for we saw an axillary bubo not quite healed. He told us, that he remained concealed for a great part of the time among the rushes by the side of the river. On mentioning this case to Dr Currie, of Liverpool, I think he said, he had heard of some similar cases.

[6]Since my arrival in England I see that the contagious nature of the Egyptian ophthalmia has been noticed by two gentlemen of the English army, Mr Edmonstone and Mr Powers.

[7]Though this practice is now followed by many gentlemen in India, yet I believe that it has been carried to a greater extent by Messrs Dean and Bellars, of the 86th regiment, than by any other practitioners. These gentlemen have recorded several hundreds of cases of dysentery treated solely by nitric mixture and bath.

[8]In Egypt we gave trial to a mode of treatment which was strongly recommended to me by Dr Whyte. It was the application of flannel bandages over the whole abdomen. In chronic cases, and in convalescents, it appeared to be of the greatest service; and, in recent cases, when the appropriate remedies were used at the same time, it appeared to shorten the cure. I have seen it tried alone but in a few cases of this disease. From the result of these, however, in cases of either the European or tropical dysentery, I would not venture to rely on it alone for a cure.Before leaving the subject of dysentery I may mention, that, in India, I have met with some cases of a very violent dysentery which ran its course in three, four, or five days. In this disease the usual practice did not succeed. The best treatment appeared to be, after a dose of castor oil, to give opium liberally by the mouth, and by clyster; and to make the patient drink very freely of gum arabic at the same time. In some of these cases I have likewise given diluted nitric-acid. A constriction of the vessels discharging mucus was in this way effected; the incessant discharge was stopped, and time given for a secretion of mucus to cover the abraded gut. I have thus sometimes succeeded in checking a most violent disease. Thereafter, the mouth could be gradually and gently affected by mercury, or by nitric-acid.On opening the bodies of those who died of the tropical dysentery, in Egypt as in India, we almost constantly found the liver diseased. In old cases, we likewise most commonly found ulceration of the great intestines, and very frequently within the reach of enemata. In the composition of these, a variety of articles were used: most frequently, I think, solutions of sugar of lead, or vitriolated zinc, gave greatest relief; and we sometimes found that gum arabic, milk, and broths, gave relief, when many other things had failed.

Before leaving the subject of dysentery I may mention, that, in India, I have met with some cases of a very violent dysentery which ran its course in three, four, or five days. In this disease the usual practice did not succeed. The best treatment appeared to be, after a dose of castor oil, to give opium liberally by the mouth, and by clyster; and to make the patient drink very freely of gum arabic at the same time. In some of these cases I have likewise given diluted nitric-acid. A constriction of the vessels discharging mucus was in this way effected; the incessant discharge was stopped, and time given for a secretion of mucus to cover the abraded gut. I have thus sometimes succeeded in checking a most violent disease. Thereafter, the mouth could be gradually and gently affected by mercury, or by nitric-acid.

On opening the bodies of those who died of the tropical dysentery, in Egypt as in India, we almost constantly found the liver diseased. In old cases, we likewise most commonly found ulceration of the great intestines, and very frequently within the reach of enemata. In the composition of these, a variety of articles were used: most frequently, I think, solutions of sugar of lead, or vitriolated zinc, gave greatest relief; and we sometimes found that gum arabic, milk, and broths, gave relief, when many other things had failed.

[9]It was soon afterwards introduced to India, by the exertions of the Medical Board at Bombay; and the world has had a full account of its introduction and success from my friend Dr Keir, who had the charge of the institution for disseminating the vaccine disease, from Bombay through India.

[10]Vide Appendix.

THE END

Marchant, Printer, 3, Greville-Street, Holborn.

I have said, that the similarity between a number of the symptoms of the plague, and those of the destructive fever which I saw in the West-Indian islands, in 1795 and 1796, struck me in Egypt. On my return to India, having recourse to my papers and case-books, written while I was in the West Indies, I found a very great resemblance between the two diseases, as I had seen them, in countries so remote. At Bombay, in conversation with General Nicolls, who commanded at Grenada while I was in that island, I mentioned the resemblance of the two diseases, in very many of their features, as being remarkable. At the general’s suggestion, I soon after drew out, in a tabular form, the principal points of resemblance between the plague and the yellow fever. This table appeared curious to the general, and to my ingenious and esteemed friend, Mr Scott, as well as to other friends at Bombay; and, at their desire, I appended it to my Memoir. I here subjoin it in the abstract: it may suggest hints that might be useful to future observers in the West-Indian fever as well as in the plague.

Points of Resemblance between thePlagueand theYellow Fever.

Note.—The column “Diseases unknown” includes all the Casualties in the Army, and the Small Pox and other cases lost in the Julia hospital-ship. It includes likewise some deaths which happened in the Corps previously to the Surgeons taking charge of them.

Transcriber’s Note: The numbers in this table don’t always add up to the given totals, but they are as printed.

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