vA McGill S —_————— ce ee eee a Sas z == ae ACCOUNT COAST DISEASES OF INDIA. oe ee. =e leant teeta nae oe ee AN ACCOUNT OF THE DISEASES OF INDIA, AS THEY APPEARED IN THE ENGLISH FLEET, AND IN THE NAYAL HOSPITAL, AT MADRAS, IN 1782 AND Ite: tat Re ez Meee ll; OBSERVATIONS ON ULCERS, AND THE HOSPITAL SORES OF THAT COUNTRY, &c, &e. ty Aly ae, yoesoesenr wy Me CO tA Lt LaF 7 ~ TO WHICH IS PRI EFIXED, en \ 4 VIEW OF THE DISEASES ON AN EXPEDITION, a AND PASSAGE OF A FLEET AND ARMAMENT TO INDIA, IN 178]. BY CHARLES CURTIS, FORMERLY SURGEON OF THE MEDEA FRIGATE. NN ee _—__ Edinburah : PRINTED FOR W. LAING AND LONGMAN, HURST, REES AND ORME; AND J. MURRAY, LONDON. 1807. ENTERED IN STATIONERS HALL. — Neiitzt & Co. eee Edinburgh. : Sn Seen mania RS tire iinetiates a ir, aaa . : — os, ; “ a ~ | a “te ©“ 4) ae SEE ~, ™ . TO VICE-ADMIRAI, SIR ERASMUS GOWER, Sc. §e. Se. AS a tribute of respect to his virtues, and in gratitude for many acts of kindness experienced under his command, in the Medea Frigate, this small Tract on the Diseases of India, is humbly and most re- spectfully dedicated, by His most obedient Tumble Servant, The Author. EDINBURGH, ? 19th Jan. 1807. § FO TO Dr JAMES HAMILTON Primus, EDINBURGH. STR, Tue benefit dervved from your as- sistance, in many difficult cases of Medical Practice, and the instruction I have received in regard to the treatment of others, from your late publication On the Use of Purgative Medicines ;—in particular, with respect to Chorea Sancti Viti,—a well mark- ed case of which came lately under my care, and has been perfectly cured by an adherence to the plan laid down in that excellent work ;—renders it a duty, and seems also to confer a kind of right, to inscribe to you this short Treatise on the Diseases of India. Lt pretends to little more than to give a history of facts, with a few observations relating to foreign practice ; of the accuracy or importance of which, those only who have had some medical experience in a4 India Vill DEDICATION. India can judge correctly. In taking the hberty, therefore, of presenting to you this Publication, it ¢s obvious, I cannot have so much in view to procure Sor it your patronage, as to testify those sentiments of personal esteem with which I have the honour to be, SIR, Your most obedient Servant, EE Ge EDINBURGH, ? 19th Jan. 1807. § CO N- f | i if ! ¥ a | Sg a tt ee ~ CONTENTS. Page INTRODUCTION, - XV—-xxxv DISEASES OF THE EXPEDITION. Equipment and ftate of it, “ i~=3 Typuvus Fever,—Cafes of it on the paflage to St Jago, : Fin : 4 Fleet attacked in Port Prayo Bay, by a French {quadron,—and departure from the ifland, 5-6 Fevers begin again to prevail—at firft anomalous, but end in Diarrhea and DYsSENTERY, 7 Firft acceflion of SEa-scurvy, ™ . Defcription of its fymptoms and appearances under different conditions of the fyftem, - Q~12 Progrefs of dyfentery and {curvy in the fleet, I2—15 Expedition divides off the Cape of Good Hope.— Lhe greateft part of the men of war, and all the traniports with troops make fail for the ifland of Johanna, - _ p 15 Arrives hes OE ao ET 7" 2 rc: SE — nel BE. —_. -o = CONTENTS. . Page Arrives at that ifland, and lands the greateft part of the crews and troops highly fcorbutic, 19-21 Account of the ifland, and of the accommodations it affords for a fickly fleet.—Speedy recovery of the crews from fcurvy, - 21-25 Singular cafe of land-fcurvy, (foot.note,) “ 24 The fleet reimbarks, and quits the ifland of Johan- na,—its condition at that period, - 26 Bitious Remitrent Fever caught at the ifland, and carried to fea.—Two cafes of it on board the Manilla, is “ 26-32 Bilious remittent fever continues to prevail in the tran{fports containing the 42d and 98th regi- ments, : - i 33 The fleet becalmed on its paflage to Bombay— carried out of its courfe, by currents, and an- chors in the Bay of Moribat, on the coaft of Arabia Felix—but continues healthy.—No dif- orders caught here except bowel-complaints from fifh-diet, ~ < 33-37 Fleet leaves the Bay, and arrives at Bombay har- bour.—Slight bilious fevers on the paflage.— Re-appearance of fcurvy. — Singular cafe of ophthalmia.—Part of the expedition leaves Bom: bay, and arrives at Madras, after a voyage of eleven months, from England.—General ac- count of the lofs by ficknefs, - 37—40 Reflections on the modes of fea-viCtualling.— Yranfports.—Means of preventing fea-fcurvy, and preferving the health of feamen on long voyages, &c, - . 40-44 INDIA Smeal LE ws Tere <= ; - — = ‘ ba 5 : . > ~ a $$$ a —— “- A a - . 2 ————“— _ i CONTENTS, INDIA DISEASES. Two naval actions between the French and Eng- lifh fleets, on the coaft of Coromandel.—The Englifh fleet anchors in Back Bay, Trincomalé. —State of the weather, and the nature of the climate and coaft, . “ SPASMODIC CHoLERA, or Mort DE Cuievy, fre- quent in the fleet, and at the hofpital on fhore, A number of cafes occur on board the Seahorfe. —-Full account of the difeafe.— Varieties, and fatality.—-Method of cure, &c. - More cafes of it met with in Madras Hofpital.— Cafes and difleétions, &c ‘ Its analogy with fome European complaints.---Is often to be met with under its true form in Scotland.—Statement with regard to this, Copy of a letter on the fubje&, by Dr Paistiy, Company’s phyfician at Madras, - 85 et feq. HEpPATITIS.—Full account of the difeafe.—-Fre- quently ends in fuppuration and abfcefs of the liver.—Numbers of cafes occurred at the hof- pital in the years 1782 and 1783.—Method of cure—and a particular cafe of, - 89-117 Bittous Fever aAnp Fiux.—To be diftinguifhed from dyfentery and other diforders.—Patholo- gy.—Deicription.-- Different ftages, — Cure.— Diffections.—Cafe of Enteritis, - 117~148 Cafe of feparation of the whole Rectum in a putrid bilious flux, . | JAunDICcz, Page 46 46—48 48-67 67-68 80-85 150 CONTENTS. JAunDicE, InTERMITTENTS, and Diseases oF THE THORACIC VaiscERA, as-thefe appeared in the hefpital, - RETURN FROM INDIA. Difeafes in the Medea, on her pafiage to England. Complicated cafe of India difeafe, 158-164 Generar Oxsrrvations on the Difeafes of In- dia, and on *fome accounts ‘that are given of them.—Diftinétion betweenDyfentery and theBi- lious and Hepatic Fluxes of India:—No general contagious difeafes fuppofed to prevail in that country.—A comparifon between fome India difeafes, and fimilar diforders in Europe, 161-188 Bitrous DisEasEs tn Evrore.—Imported bili- ous diathefis,—Fits of the bile.—Bilious cholic, as diftinguifhed from enteritis or ileus.—Bilious difeafes of infants and childrenm—The Jowe/- ive, a bilious inflammatory difeafe. Copy of a Lerrer from Dr Patstry, on the pe- culiar difeafes and morbid conftitution of India, ULCERS, and HOSPITAL SORES of INDIA, &c. Defcription of the Naval Hofpital at Madras, and {tate of the town and fettlement, in & 1 Suppofed peculiarities in the condition of ulcers in India.—Suppofed caufes of this.—General tendency to gangrene, and to a difeafed ftate of the periofteum,—Remarkable cafe of the fepa- ration - I55—158 Page 188 oak a Seg - _ meee | ge. eer CONTENTS. ration of the greateft part of the thigh-bone, af- ter amputation.—General treatment, and {par- ticular applications for fores and ulcers, &c. Tetanus.—Account of its fatality, S Burws from explofion of gunpowder, - FRACTURE oF THE Cranivum.—Propofed altera- tions on trepanning inftruments, ‘ 3 APPENDEX. No. I. Remarks on fome difeafes. of ‘infants in Scotland, 5 II. On the difeafe called Cholic, : III. Difeafes at the Naval Hofpital, Madras, compared with thofe at the Compa- ny’s Hofpitals, - - {V. On preferving health in India, &c. 2it 244 248 ‘CORRIGENDA, Page 5.line 2. from the bottom, for at read with I7- 2. for inverfion read invafion 3% 7. from the bottom, add Cort. Peruv. 46. 15. for fever-difeafes read liver-difeafes 83. 4. for eafe read care Appendix, No. IV. p. 172. 1. 10. add certain LT TT ee se INTRODUCTION. W HEN we confider the great extent, and flourifhing ftate of the Britifh poffeffions in India,—the fplendid eftablifhments for the improvement of {cience, and the fuccefs with which many branches of it have been pro- fecuted there; and when we obferve, that military and municipal hofpitals, with able and fkilful practitioners, have long been efta- blifhed, and are to be met with in all the principal ftations of the Company in that ex- tenfive region, it may be a matter of fome furprife to obferve, that fo little on the fub- ject of mMEpDIcINE, has been communicated from that quarter.—And ‘that no good ac- count has yet been given of the morbid con- {titution 7 +/ en as CPT RTE LAGI II TE a ae = ee — = panera ea ARTS OE TT AR. NILES AS | TE I BS a Vil INTRODUCTION. {titution belonging to the country, or of the difeafes peculiar to it; fo that ftrangers, and the younger part of the profeflion, often pre- maturely encugh called to practife there, un- der very important trufts, might be enabled to undertake it with tolerable facility to themfelves, or with fafety to thofe under their care,—imay well be matter of regret. Placed in fimilar circumftances, it required no long time to make the author fully fenfi- ble of this want; and to convince him, That European ncfology and definitions, would, in India, prove but uncertain or fallacious cuides ; that a ftranger in fhort, with a good deal to unleern, would have his way at every ftep to feel and trace out for himfelf. Nor is this perplexity, and the difficulties which we have to encounter, to be wondered at, on entering to practice in acountry, where {carce a fingle produdtion, whether of the animal or vegetable kingdom, is to be met with, bearing a true refemblance to its prototype in Europe > where, except for two or three weeks about the INTRODUCTION. XV the thifting of the monfoons, efpecially of that which happens in the month of October, (I {peak of the Eaftern Coaft only), a fhower of rain, or a breeze of wind, are almoft un- known; where fcarce ever a haze or cloud appears upon the horizon, to mitigate the dazzling ardour of an almoft vertical fun; and where the thermometer, through the whole 24 hours, feldom or never points un- der 80° of Fahrenheit, but generally far above it. At no period of life is diagno/fis. an eafy part of the medical profeflion. In the outfet it is alwaysdifficult. The authorof the follow- ing fheets had experienced this difficulty ful- ly; and this had led to an early habit of taking cafes, or notes of fuch difeafes as had fallen under his obfervation, adding fuch refleGions as were fuggefted to his mind, from {ymp- toms and events as they occurred. On being appointed, foon after his arrival in India, to do duty in the Nayal Hofpital b at “Vili INTRODUCTION<~ at Madras, during the active fervice of the fleet in the years 1782 and 1793, this prac- tice was regularly continued: Not, how- ever, to the extent of a full cate -book and perfect tables, fuch a tafk being two burden- fome for the laborious duty of this flation in fuch a climate. Regular entries were made of the principal cafes only ; and a ge- neral minute-book recorded the material cir- cumftances in fuch as were of lefs import- ance. Full opportunity was enjoyed for difle@tions, and many were accordingly per- formed, and the appearances recorded at the moment. From fuch materials, the following hiito- ries of the principal and prevailing Coaft Difeafes of India in thofe years, are, with much diffidence, prefefted to the public. Not that the author by any means pre efumes they will be found an adequate fupply for the want that has been noticed. Superior abili- ties, a longer refidence in the country, 4 more full acquaintance with the nature of the cli- mate, INTRODUCTION. XIX mate, and its influence on the European con- {titution, than he enjoyed, would have been neceflary for fuch an undertaking. If what is here attempted, fhall in any degree con- tribute to direct the inexperience of others, and preferve them from falling into errors and miftakes, which unavoidably occurred to the author in his own pradtice, by pointing out the illufive and varying formsunder which the fymptoms of known difeafes prefent themielves in this climate, fome part of the difficulty at leaft will be removed, and per- fonal induftry and experience will the fooner fupply what may ftill be wanting. Let it be obferved, however, that what is here {tated, applies properly to maritime India only, and not to all the variety of inland country comprehended within that yaft pe- ninfula. The claflification and nomenclature of difeafes, is a neceflary meafure to facilitate the ftudy of them; but we ought always to keep in view, that the beft nofology: is in hb 2 {ome xx ' | INTRODUCTION. fome meafure an artificial, often a fanciful arrangement, and behoves of neceflity to be always more or lefs a local one. | And hence, ‘n relation to difeafes of foreign countries, there arifes adanger of our being led into error, by the mifapplication of names, or by the inaccuracy of writers, in ufing thefe in a fenfe different from that adopted by nofo- logical and fyftematic authors. To reétify what appears to me, to be an error of this kind, to be met with in more than one communication on the fubject of India difeafes, is one object of the obfervations contained in the following theets. Thus the name of Dy/entery has been uni- formly made ufe of to diftinguifh an affection, which, from the accounts that are given of it, appears to be nothing different from that which takes place in the di/ious and hepatic fluxes of India; both very generally attended, like dyfentery, with fome fever in the beginning, and feldom without a confiderable degree of dyienteric affeciion in fome parts of thet: courie ; INTRODUCTION. XXI courfe; but eafily diftinguifhed from dyfente- ry, by the train of fymptoms, by the nature of the evacuations, and by what has even been taken notice of, without leading to a cor- rection of the error,—the circumftance of their never being in any degree infectious. Were there nothing but a name concerned here, the matter might be confidered as ex- ceedingly trivial. But when we find mercu- rial frictions, pufhed the whole length of a falivating courfe, recommended by one, and dofes of calomel, to the extent of ro grains every night, by another, as a fafe and ef- fectual mode of cure for what they term dy- fentery; it is evident, if this pra@tice were to be adopted in the treatment of real dyfentery, in many of its combinations, as with fcor- butic diathefis or typhus fever, much mit yp ’ chief might undoubtedly follow ;—and hence the importance of the diftindion being made, becomes evident. Of the fpafmodic difeafe known, when I was in India, under the name of Mort de Chien, b 3 no X11 INTRODUCTION. no particular account has yet been given to the public. It is fpoken of by Bontius, and has been mentioned by Mr GIRDLESTON 5 and it is more particularly referred to ina late academical thefis on the fubject of Teta- nus, of which it is confidered as a ipecies or variety™. Tetanus, under what I have always under- ftood to be its true and proper form, appear- ed on one occafion at the hofpital, and 1s taken notice of in fome of the following communications. It was in every infiance the confequence of external injury, and pre- ferved throughout its courfe, a character fo determinate, as to diftinguifh it completely from every other diforder. It did not ap- pear to me to have any agreement with the mort de chien, except in the fingle circum- ftance of external fpafm, and even in this there was a material difference. In tetanus, the fpafins are not attended with much pain in * ConsipEn De Tetano. INTRODUCTION. XX in the affected mufcl:s, fcarcely indeed with any. It is far otherwife in the mort de chien. In tetanus, there is no contraction or gather- ing up of the belly of the mufcle into a hard knot, but rather a fixed rigidity, over-tone and tenfion of the whole mulcle, or of a num- ber of the external mufcles at the fame time ; efpecially of thofe that ferve to clofe the lower jaw, than what may becalled a cramp orfpafm. Spaim was, in the cafe of tetanus, the great and principal fymptom of the difeafe, and its pro- gre{fs was regular and uniform. Whereas, in the mort de chien, it neither began nor finifhed the malady. It was moveable and variable in every degree, and the difeafe was accompa- nied all along, with fymptoms of far more ferious importance than even fpafm itfelf. In fine, fpafm appears in tetanus as the radi- cal affection: In the other it is only fymp- tomatic. Obitructed perfpiration, and the retention of acrimony fuppofed to be eliminated by the fkin, and the application of cold, efpe- b 4 cially i XK1V INTRODUCTION. cially when joined with hard exercife, and debilitating exertions, are fuppofed to fur- nifh an eafy explanation of many difeafed phenomena, and have been adduced as the caufes of tetanus, and of the difeafe under con- fideration. It may, however, be obferved, that, on. reviewing the provifions made by nature for correcting irregularities, or fup- plying the defects of this difcharge, and the great inequalities to which it is daily and hourly fubjected with impunity,—as inthe_ practice of many nations inhabiting the hot- teft countries, in haying their bodies conftant- ly befmeared with oil or greafe; we will find ourielves befet with difficulties in explaining difeafes, by referring them to this fource, in the fame manner as we find thefe difficulties in moft of our pathological inquiries. Much will depend on idiofyncrafies and peculiarities of habit, which we cannot al- ways underftand or explain. Accordingly, I recolleé& to have obferved feveral perfons of a {pare and thin habit of body, with dark hair ay Sa ge eee INTRODUCTION. XXV¥ hair and fwarthy complexions, who prefer- ved a degree of health and vigour in In- \ dia quite inconfiftent with the debilitating operation of the climate upon the genera- lity of European conftitutions; and thefe perfons fuftained the heat, without any fen- fible perfpiration at all: while others, again, . enjoyed neither health nor fpirits, nor vi- gour, but while under a continual vapour- bath of this exhalation. Whether the one or the other defcription of perfons were moft liable to the fpafmodic difeafes of the coun- try, [ made no obfervations to determine. Certain it is, that the lower clafles of the natives, whofe fkins are very black, and who peripire but little, are equally fufferers by them as the Europeans, or perhaps more fo. Hepatitis, which occupies fome room in : the following work, has been fo often treat- ed of before, that little or nothing new can be added to the fubje@t; unlefs it may he in what relates to diagnofis,—or to the im- portance XXV1 INTRODUCTION. portance of diftinguifhing between fymptoms that are primary and chara¢teriftic, and thofe that are only acceflory or accidental ; and the difficulty that frequently attends this diftinction in India, from the general promi- nency and violence of the acceflory fymp- toms there. On this fubject, we have been fomewhat particular, and have given feve- ral important and ftriking examples. On the fubjeé& of Bilious Difeafes and Ab- dominal Affections, fo uncommonly prevalent in India, a very few preliminary obfervations may be perhaps introduced here without im- propriety. Redundancy and diforder in the bilious fecretion, is a diathefis in fome meafure com- mon to all tropical countries. But in India, I am difpofed to believe, that the conftitu- tional temperament peculiar to the country extends to fomething further; namely, fan- guineous plethora, with increafed mobility and irritability over all that portion of the fyftem comprehended within the extent of the INTRODUCTION. XXVIL the cceliacal and portal circle ; and that from this fource are derived redundancy of bile and acrimony of fecretions, tendency to dif- order, difeafe, and derangement of functions over all this portion of the body, exceflive fluxes, and the whole train of topical affec- tions, to which the liver, inteftines and me- fentery are fo conftantly fubjected in India. Hence difeafes that depend on a rigid or tenfe fibre, or any other determination of the circulating fluid; fuch as rheumatifm, ca- tarrh and catarrhal affections; pleuritis or pneumonia, headachs or toothachs, are whol- ly unknown. Febrile difeafes are confined to exanthematous, fymptomatical or hedtic, and the nervous affections to the fpafmodic. Intermittents and remittents are, in Lower India, at leaft, only fymptomatics, arifing from difeafed bile in the firft paflages. Renal or urinary affections we had none; and of all our numerous cafes of obftruction of the liver or mefentery, and of cachexy from flaxes and impaired habit, not one ever end- ed ~~ eet “~ Grr Xxx INTRODUCTION. was obfervable in fhips, whether they had been a long or fhort time at fea, as well as at the hofpital. ‘True phlegmon, or any thing of the nature of eryfipelas, we never faw. This laft is indeed a frequent hofpital dif- eafe, and fome people have affigned to it a bilious origin; but it never appeared with us. Expeditions, fo tedious as that under the command of Commodore JounsTon, can but feldom happen. Paflages to India are fel- dom extended to the length of eleven months ; but they are fometimes fufliciently protract- ed, to give rife to a variety of fhip-com- plaints. An account of the kinds and fuc- ceflion of difeafes, likely to be met with in Gmilar circumftances, it is conceived, may be of fome ufe to thofe who have not been ac- cuftomed to fuch kind of fervice. Sea-fcurvy, which was formerly the bane and fcourge of many a hopeful undertaking, is now, from the reforms in fea-victualling, a much lefs frequent occurrence than for- merly. —— -e e e e — - INTRODUCTION. XXXL merly. Slighter degrees of it, not very ea- fily detected, unlefs by fome acquaintance with the difeafe under its proper form, and which never fail to give a covered and latent malignity to many other diforders, will, however, now and then occur. The fhort account of it here given will ferve in fome meafure to detect thefe, and may perhaps fuperfede the neceflity of confulting older, more minute, and tedious defcriptions. Two letters, publifhed in this Collection, may feem to require fome explanation, and perhaps an apology. The longeft and moft important of them has already been commu- nicated to the public by Dr CarmIcHaAkEL Smyta in Dr Duncan’s Annals of Medicine for the year 1801. This, it may be thought, ought to have fuperfeded the neceflity of a republication. But the fubject, and the fen- timents contained in it, do fo much elucidate and confirm the doctrines here delivered, as to render it a very important and neceflary addition. Copies of both letters were in the hands .— =a We AXEM INTRODUCTION. hands of moft of the older furgeons of the fieet under Sir Epwarp Hucues; and they were deiervedly valued, as containing by far the beft general information on the India difeafes, to be procured in the country. Al- though they were but private. letters, the hand of a mafter is vifible in both. The author has printed from the copy of them, which has been in his private pofleflion for above twenty years. The letter which re- lates to the Cholera Morbus or Mort de Chien™, as SS Fes a ee a is printed Maux de Chrens, in DrSMyTH’s co- py of the other letter. In India, | know; dogs are 1ifeafe. but never that l heard of cholera morbus or cramp. The in my copy of the fecond letter at is undoubtedly the difeafe place where Dr Smyta’s copy has Mort de chien was the name in the fleet ; n of fhip-coinage originally, im- ©] manner in which a brave and boifte- lofe his life ;—to die like et CS TE Sa - “ ‘ - : = INTRODUCTION. XXXL as appears from the ftyle and manner, has been written in much hafte; yet ftill it con- tains fo much information on the fubject, and points out fuch diftinctions, in relation to cafes and fymptoms, as to fhew of how great value a more finifhed account from the fame hand would have been. In this publication, the author has not thought it of much confequence to be very particular in ftating forms of prefcrip- tions, and dofes of medicines,—as being in a great meafure unneceflary to the clafs of readers for whom it is intended. Nor is there in faét much variety or elegance of prefcription, to be expected in a de- tail of foreign hofpital pradtice. Every thing in fuch a fituation comes neceflarily under fome general plan and fyftem of ma- nagement ; and no where is this attended with lefs inconvenience than in India, where difeafes are at bottom fo fimple, and fo little varied in their eflential characters, that a fhort experience enables a practitioner to Cc treat —oon a a : CO ree iam spose A Fe ts ght, heel —" re geen te, r - Sih Saal 7 - XXXLV INTRODUCTION. treat a number, that would be thought in any other ‘country quite incompatible with any fort of due attention or care. To exhibit ufeful facts, and to ftate only fuch as came under the author’s own obfer- vation, without indulging in theoretic dif- quifition, or laboured {peculations, has been his object throughout. By examining memoirs, reports, and ac- counts in periodical works, he could have fwelled this fmall volume to a more reipec- table fize; but this, except in fo far.as.ap- peared neceflary to the rectification of what was deemed erroneous, has been -purpofely avoided. All the difeafes here treated of, came un- der the author’s own care; not in fingle or folitary cafes, but in clafles and whole ‘wards together ; and they include all the dif- eafes of any confequence that were met with inthe country. Errors and miftakes in the treatment of them he was often fenfible of —himfelf s et Rees sce ae INTRODUCTION. XXXV himfelf; but he has made no attempts to pal- liate or conceal any of them. Thofe who have had fome experience of the difficulties which frequently occur in the profeflion, will know how to make reafonable allow- ances, He has much to fear, fhould the reader be inclined to exercife the feverity of criticifm with refpect to imperfections and defeéts in point of compofition to be found in this pub- lication. Accuftomed to commit his thoughts to writing for his own perufal only, the author is fenfible he may have contracted an abrevi- ated form of diction, lefs fuited than he could wifh to a public appearance; and a defire of adhering clofely to the ftatements in his ori- ginal notes, may doubtlefs have infufed too much of the journal ftyle into his work. But in all other refpects, he is defirous rather to folicit correction, than to deprecate- or fhun it. M E DI- =, = ee ——, ——— Ne a - oe ole.. Sa bows £ = ebs bold dane bien f | peek - ws f tein , =~ ee MEDICAL OBSERVATIONS ON AN E.-PEDITION ann PASSAGE TO INDIA, &c. 13th March 1781. On this day, a fleet, under the command of Com- modore Johnf‘one, failed from St Helen’s, confifting of the following fhips, Hero, 74; Monmouth, 643 Ifis, 50; Romney, 50; Jupiter, 50; Jafon, Ative, Mercury, and Diana frigates ; Rattlefnake and Lark cutters ; Terror bomb, and Infernal firefhip ; with five King’s tranfports, feveral ftorefhips and vic- tuallers ; having under convoy a fleet for the Weft Indies and thirteen Eaft Indiamen. On board the A tran{ports, net ie WORE ore ~~ a CES — rseeergegmees onsite DISEASES ON bo tranfports, ftorefhips, and in-the Eaft Indiamen, were embarked the 98th, rooth, and the 2d batta- lion of the 42d regiments, with four independent companies of additionals. In the King’s tranfport fhip the Manilla, were em- barked the hofpital ftaff and ftores, with two com- panies from the 98th and 1ooth, hofpital furgeon, and two mates, under whofe care the troops were. The fhip’s complement, confifting of the Lieute- nant commander, matter, warrant-oflicers, and forty feamen, being all the people whole health 1 had in charge. From the fhip being put in commiflion to our failing from St Helen’s, no difeafe had appeared among the feamen, excepting one cafe of fyno- chis fever. The pulfe, from the firft, was fre- quent and feeble, with pain of the head and back. The antimonial folution* ad vomitum, was given him in the beginning ; but by his taking it, through miftake, in too large-dofes, it brought on continued vomitings and singultus. After trying different anti-emetics and antifpafmodics, without. effect, thefe were completely removed by a large blitter inter fcapulas, which raifed his pulfe, and re- lieved ee aieisinp ee eT * Solutio Tartritis Antimonii. AN EXPEDITION, &e. | 3 lieved the anxiety and oppreflion of breaft he had complained much of for fome days before. After this, his recovery was ealy and rapid, with the affiftance of wine and cordials only. When we left St Helen’s, the fhip’s company were all in per- fect health, and there were few or no complaints among the troops; but they were new raifed, and poor looking men; many of them mere boys, and a number much over the proper age for fervice in hot climates: feveral only in a ftate of conya- lefeence from fevers, which had infefted them much in Hilfea-barracks, where they had been quartered. On the roth April, the whole fleet anchored in Port Prayo Bay, in the Ifland of St Jago, lat. 15° 30 N. The weather, from our leaving England, down Channel, and acrofs the Bay of Bifcay, was clear and moderate for the feafon; with light winds and calms in the Bay. By the 25th of March, the increafe of heat and change of climate had become perceptible. When we reached this ifland, the heat, from a nearly vertical fun, was excef- five ; yet the evenings and mornings were cool, A2 For +" wr’ EP er Dtasaeeyeviin ah Ly alain “sy a = 5 _— Lat t= ae a Mars er eS bie 5 are 2 iow a te ll RS Ne —o * i oe “53 as x ——— at. ARES > — ~~ oe ¥ ‘Eap ee he — o ae ‘ 2 See + teen Pea es St fn A ib =e PEARCE RES ores: ee a Fe age Se Wea PVs Se =e as hs : ieee a Stay eee Nama Sy mee! ae AY: SS Sos ee S 4 DISEASES ON For nearly the laft fortnight, we had found a ftea- dy wind at N. E.,; the air dry and clear, without night-dews or damps. Among the feamen, we had only a few flight rheumatic complaints down Channel ; and two or three febrile diforders in the latter part of the paflage. One of them, however, turned out continued and fatal. The patient com- plained, in the beginning, of much pain in the head, great lownefs and depreflion of {pirits, with a quick {mall pulfe. His {kin foon became dry, and his tongue parched. Belly natural, but he had much thirft, and all along an unpromifing caft of countenance. An antimonial emetic and neu- tral mixtures, with bliftering, procured no relief. A dofe of opium and camphor, on the roth day, brought out a moifture on his fkin and tongue, which promifed to be of fervice; but in the end afforded none. ‘The fweating became profufe and cold, and he died on the 12th. Our-feamen flept at this period in the fore hold, under the platform for the troops, which was exceedingly ill-aired and hot; and I had no doubt added to the malignity of this man’s difeafe. ‘lwo foldiers alfo died of fimilar fevers during the paflage. The : AN EXPEDITION; &c. 5 . The event of this cafe, and the increafe of fick- nefs among the troops, rendered it extremely ne- ceflary to provide a better fick-birth for the ac- commodation of the feamen; and every part of the deck below being taken up by the foldiers’ platforms, forefeeing a fickly paflage, I took the firft occafion to pre-occupy for this purpofe the ftern-fheets of a flat-bottomed boat, carried on the fhip’s deck under the booms. An awning being {pread over thefe, covered in the whole, and ferved our purpofe moft excellently ; while the fore part of the boat, alfo covered by the awning, but left open at the fides, afforded a fheltered fleeping- place for the reft of the failors. Of this ftation, they kept poffeffion through the whole voyage ; even during the cold weather we experienced in doubling the Cape, fo far fouth as 42°, and was without doubt a principal means of preferving - them from the influence of contagion often raging among the troops below; or at leaft rendered the effects of it much lefs fatal than otherwile it might have been. May 1.—Lat. 9° N. At fea, ftearing fouth at a fteady light breeze at N. E.; weather exceed- A 3 ingly 6 DISEASES ON ingly hot, but the atmofphere dry and clear. No complaints occurred among the feamen at St Jago; and the troops got free from the fevers which had affected them on the paffage to the ifland. ‘The fatigue of watering there was great, and expofure to the heat of the fun conftant ; the water being to roll in cafks a confiderable way to the beach, and to raft off through a heavy furf and fwell above a mile and a half to'the fhips. The people in general flept expofed to the night-air both on fhore and on beard, yet no injury to health was- fuftained. “Frefh meat, vegetables, and the tropi- cal fruits were procured in great plenty, efpecial- ly whereold clothes could be given in -barter for them; and the water was good, though fomewhat brackifh at the neareft well. While at anchor in the bay, the fleet were at- tacked by a French fquadron, commanded by Mon- four Souffrain. None were killed or wounded on board the Manilla; but fome days after the action, fourteen foldiers wounded by mufket-fhot, were put on board, under the care of the hofpital-ftaff- They were moftly flefh wounds, chiefly through the limbs; only two had the bones fractured. They all healed eafily ; nor was there in any of them AN EXPEDITION, &c. - them a neceflity for counter openings, except in one'cafe, for the extraction of a button or piece of cloth:. I did not: obferve, either in thefe, or in fome cafes I faw on board other fhips the day after the action, fo much blackening and fearing. as ball- wounds .are in general’ faid to exhibit; but I ob- ferved in all the cafes, that the ball had made a much larger opening on the fide by which it patied out than that by which it entered. Fomentation and poultices, or embrocation with faturnine folution, light rolling and dreflings, with occafional laxa- tives, and an opiate every night,. till the fuppura- tory procefs'was completely eftablifhed, and after that wine and bark, were the only means of cure employed, and in all with full fuccets. June r.—Lat. 12° 15/ South. Before the end of laft month, fevers had begun again to prevail in many of the tran{port and troop fhips. In the Manilla, out of about 180 foldiers, 56 are now in the fick-lift, under fever of confider- able variety of form; and two have died of it fince leaving St Jago. Some way before we reach- ed the Line, we were deferted by the N. E. trade- wind; and near it, were frequently becalmed for AA two Ea Tele Sake KL ore ag APL OT \ ry aT» re i Tele + SM 2 7 ok bare ut Teiv 8 LS: EA “Sie @ os Sree 2 ne ete D ofate am pk = Moe Lee ey wis Sono =F 2% Fe Pa $C (SNR ag f = ag RR AT Rae Se bo tat Sy at ye F. : e ae fe ad + a 4s i 2 ie 5° DISEASES ON two or three days together ; with now and then hurricane fqualls, tornadoes, and gufts of wind; with occafional loud thunder, and heavy falls of rain. The troops now begin to have a pale, {qualid and fickly appearance. The fever begins with pain in the head and back ; fome have alfo pains in the limbs; and in others, it is attended with diarrhcea. Generally the tongue is yellow, and the urine high coloured; but without bilious vomit- ings or yellownefs of the {kin. The army fur- geons confider this as an ardent, rather than a bi- lious fever, and fay, that bark has been generally fuccefsful in removing it. ‘Towards the end of the month, the genus of the fever became much better diftinguifhed, and, in moft of the troop-fhips, took on the dyfenteric form,—tevere diarrhoea, gripes, tenefmus, with mucous and bloody ftools. We have now, among the feamen, fluxes, with a flight even- ing fever, but with the dyfenteric affection very mild. They complain more of pains in their limbs, owing to their fleeping in a cooler fituation. One or two of them have, however, complained of fome tenefmus ; but none have had as yet mucous or bloody ftools. All of thefe have yielded eafily te AN EXPEDITION, &c, ) to imall dofes of neutral purgative falts, with gentle diaphoretics. July 1.—Lat. 29° 13 South. Weather rather cold, with frequent f{qualls and rain. Dytenteric fluxes are now, in a manner, common throughout the whole fleet ; and rage, efpecially in the troop-fhips. The fever among the foldiers in this fhip, is of a very malignant kind; and the dileafe has proved fatal to great numbers through the fleet in general. scurvy now alfo begins to make its appearance; attacking thofe firft who have been reduced by previous fevers or flux. In fuch cafes, the pa- tient goes off in a fort of general cachexy, rather than with the fymptoms of true formed fcurvy. They continue pale and fallow, with very little appetite ; a low latent ftate of fever remains, and they never recover any ftrength, but complain much of torpor and weaknefs, with difficult or op- prefled breathing. The fleth wattes away, and they go off under a flow marafmus, without the external \fymptoms of {curvy being very remark- able. When this difeafe began to thew itfelf in thofe who had been previoufly healthy, and of a found fo DISEASES ON found conftitution, the firft appearances of it were, a ftiffnefs, with fome {welling about the fides of both the ankle and knee joints, affecting the ten- dons chiefly. By degrees the {welling increafes, and pits a little, ‘but never becomes very confider- able. The parts around the joints become difco- loured,—of a duiky yellow, then livid, at laft black ; with extenfive yellow fuffufions under the fkin, along the back-part of the lee and thigh ; but affecting much more the tendinous parts about the joints, than the foft and mufcular parts, or the middle of the member, running along and fpread- ing in exanthematous patches, ftreaks and blotches, each with a yellow margin extending far a- round it. Soon after thefe begin to appear, the eums fwell, become fpongy and livid, and bleed eafily.. The whole (kin, but efpecially the face and eyes, becomes dun and yellowifh. A great de- gree of liftlefiuefs and of languor fupervenes ; though they have a tolerable appetite, are at times cheerful when not prefled to action, and have 4 flow of {pirits. Wherever this diathelis prevails to any conti- e flighteft fore or ulcer foon puts the edges become tu- mid, derable degree, th on a particular appearance > AN EXPEDITION, &c. rr mid, livid, or black and retracted... This colour diftufes itfelf fome way round the fore, declining to a dun yellow of much larger extent. A fpon- gy flefh, of a fibrous confiftence, refembling cruor or gore, {prings up in. the middle of the fore, pre- venting» all difcharge, except perhaps of a little fanies, which often iffues from it. Sometimes it dries and hardens with the air, fo as to afford no difcharge whatever ; and in this ftate the fore con- tinues without any change till the habit is correét- ed; for fuch fores never run into fpreading gan- grene. Where there are no.open fores or ulcers, there often appear a number of lumps on the {kin, owing to the effufion of blood, efpecially where any bruife or hurt has been received ; yet, when opened, thefe emit nothing, but confift of a hard coagulum, like that which takes place on the open fores. Neither fometimes do the exanthe- matous blotches about the joints, bleed upon be- ing opened with a lancet, and the whole parts be- come hard, dry and contracted, rather than {well- ed. : Where fever or flux had preceded and exhauft- ed the habit, the external fcorbutic appearances were in a much inferior degree; but the fymp- toms Lee. = ‘ gt ~~ eet: Reet - R : ¥4 \ pISEASES ON a oS toms of internal oppreffion and putrefcency of the fluids were more remarkable. The gums became early more {welled and fpongy, and bled more. The breath became feetid, and ftank ,; and every thing about them had a cadaverous {fmell. Re- fpiration became difficult and laborious ; extreme weaknefs and fainting fits came on ; and in one or other of thefe fainting fits it was that all our fcorbutics who died were carried off. Our fea- men in the Manilla have as yet exhibited no ap- pearances of feurvy, though fome feamen in the larger fhips are beginning to be tainted; but numbers of the troops are daily ‘falling down with it; and it has already proved fatal to many. Our moft fevere and fatal difeafe in the Manil- la, continues to be the fever and flux, with the fymptoms exceedingly fevere, and marking a high degree of malignity. ‘The difeafe is ftrongly in- fectious.. Where it arofe, does not well appear; but an epidemic dyfentery now rages through the whole fleet, though in very different degrees in different fhips. Almoft the whole of our tea- men have had more or lefs of it; but the degree and malignity of the difeafe, and efpecially of the febrile affedtion, has with them been greatly milder than AN EXPEDITION, &c. 13 than among the troops ; owing, I prefume, to their fleeping in a freer and purer air than any other defcription of perfons in the fhip. The greater part of thofe feized lately, have had fome fever during the firft ftage. Some of them with griping and tene{mus, mucous and bloody ftools .of confi- derable extent and continuance. Of thofe firft attacked, the recoveries were eafy ; and little be- yond fome regulation of their diet, a purge or two of fome mild neutral falt, with gentle diapho- retics occafionally ; fuch as Pulv. Jacob. gr. x. *, night and morning; or if there was any degree of griping or tenefmus, after giving one faline purgative, a pill compofed of Pulv. Ipecacuan. gr. 1., and two or three of Rhubarb twice or thrice a-day, with a bolus at bed-time, compofed of ten grains of Pulvis e Scordio cum Opio, Pd. Lond., and a few grains of James’s Powder, anfwered exceedingly well. But when the difeafe became more fevere, and came on with more fever in the beginning, I began by giving them an emetic of Ipecacuan., and for fome days following, Pulv. Ipecac, gr. 1.3 Puly. Rhei et Pulv. Jacob. a gr. v. terties > . *Pulv. Antimon. cum Phofph, Calc. P+. Edin. _ Puly, Antimon, Lond. Pulv. Stibiat. Dud, “<\. / . * Py he - a Syl > ra e ee E os —_ _- . > ‘ ‘ ln A - mPa ns AAR ease — mete << Te Aiabe be Sn ~~ + —_ ne —— Ss — ames ———— Se =. aa ro 4 —_ 2 — va — ; . ee ea a AN EXPEDITION, &c. 5 ~ veries were much lefs perfe&t ; and though the dy- ienteric fymptoms might be abated, a wafting flux and low hectic fever remained ; or they fell into a leorbutic ftate, from ‘which they never could be recovered while the fleet remained at fea. With the feamen, I thought much benefit was derived from paying ftri@ attention to their dict. Taking away their fhips’ provifion entirely, and reeding them on rice-gruel, with portable foup diffolved in it, and fago, with Port wine. After the. feverity of gripes and tenefmus had been pretty much abated, I gave them twice a-day a large bolus of Conferv. Rofarum *, with fifteen or fixteen drops of Elixir of Vitriol mixed up with it, and found it grateful, and ufeful as an aftrin- gent, and for recovering the tone of the ftomach and bowels. In the courfe of laft and this month, we have buried fifteen foldiers from dyfenteric fever and iux, or cachectics from thefe combined with fcur- ; vy. The exceflive heats, the length of time fpent near the Line, from calms, and light or baffling winds, has undoubtedly contributed much to {fo great a ficklinefs through the whole fleet. July - Rn pe eee ees * Conferv. Rofe, Dud. in Saldanha Bay. The weather b2s now become rather cold, hazy rains. Intelligence be- 2 Dutch vefiel taken m this cee co- afi by a ridge of < entered it on this day, to any among wherein re- medicines late that fome —— > in oe _si + + GLAS. ~ & confiitution puny. =come feeble and emaciated ; AN EXPEDITION, &e, 17 emaciated ; with dry fkin, thirft, and a quick and feeble pulfe. Moft probably from the inverfion of fcorbutic diathefis, though there are no ex- ternal fymptomsof that difeafe as yet. Auguft 20.—Lat. 42° South. Rounding the Cape of Good Hope at all this diftance. Wind variable, and frequent gales. The weather cold and wet, with fleet and {now fhowers. | The object of the expedition was now known to us to have been an attack upon the Cape ; but intelligence was procured at Saldanha Bay, that Monfieur Souffrain with his crippled fleet which had attacked us at Port Prayo, had arrived there long before us. Commodore Johnftone de- tached the expedition, with the Indiamen, tranf- ports and men of war, for India; returning him- felf to St Helena, with the prize fhips, the Rom- ney and moft of the frigates. The India divifion made fail through the inner pallage, between Madagafcar and the Main, for the Ifland of Jo- hanna, where it was intended we fhould refreth and water. Since our advance to colder latitudes, the frequency of fluxes has diminifhed, and many who had laboured long under them have “began to B recover. . Ke) 5 . = lng Mi yes o> - dia kt a SAP pe | ei Dots, 7 —- r > = eg Pek ar Wee ey DISEASES ON recover. But thofe who have had frequent re- lapfes, or previous fevers, do not return to a {tate of health. They continue to have a pale and fallow look, and do not acquire ftrength or flefh. The difeafe degenerates into a colliquative diar- rheea, without gripes; and they complain of op- preffion about the breait, with extreme weakneis 5 the fure fymptoms of the acceffion of fea-{curvy ‘n fuch exhaufted habits, and which foon proves fatal to fuch fubjects. : In fome of the fhips, fevers of the bilious and remittent kind have been very prevalent, and many have been cut off by them. Scurvy advances with a rapid courfe, without our having it in our power, either to check its pro- erefs, or give much relief to thofe labouring un- der it. Neither medical prefcription, nor the feanty allowance of fick provifions hitherto pro- vided to the navy furgeons, have been found of much avail againft this difeafe. Frefh meat, the ftock of vegetables and fruit laid in at St Jago, — have been long exhaufted; and moft of the fhips have long fince expended their ftock of Englith beer; nor do I underftand that effence of {pruce, or of malt, have done much, even in thofe fhips which AN EXPEDITION, Xc. 19 which had the greateft ftore of thefe articles to iffue out. But it is worthy of remark, that in fome of the India fhips, alfo carrying troops, where thefe were ferved out early, fo foon as the fhip’s beer was all expended, feurvy has been later in making its appearance, and has not made fo much pro- gre{s as in other fhips, even where thefe were fer- ved in the greateft plenty, after it had begun to fhew itfelf. So that it would appear much eafier to guard againft the accelffion of this diforder, by fuch diet and drinks as lay in a provifion againft the feptic procefs in the habit, than to counteract and refift its progrefs, after it has once begun. In nearly four months after leaving St Jago, the fleet reached the Iland of Johanna, Lat. 15° South. In this tedious voyage, no fupplies of frefh meat, vegetables, or even of frefh water, were obtained, except indeed of tea, which the wreck of one of the prize-fhips in Saldanha Bay afforded to the whole fleet in great plenty. But fugar was become a {carce article even among the officers, and the men had none. Its place was, however, fupplied with molaffes, and contributed fomewhat, no doubt, B2 to we us ~ — — 7 ee ————— oa —————— — v< ‘ee call Ss, vee : _ ~~ \ a>. eo 3 *< . 26 DISEASES ON to refift the fcorbutic diathefis. Neither feamen nor foldiers ate the four-crout in fufficient quanti- ties to do much good, though plenty of it was fer- ved out to them; and the fcorbutics, from the condition of their mouth and gums, could not,’un- lefs when boiled, which fpoils it much. A draught of water, with elixir of vitriol, or vinegar and wa- ter, three or four times a-day, after wafhing the gums with a part of it, was all we could do for them in the way of medical afliftance. The cold weather in paffing the Cape, rather hanged our dyfenteric fluxes into chronic diar- rhoea than removed the difeafe ; and this becoming combined with fcorbutic weaknefs, proved very generally fatal. Before reaching this ifland, many even of the petty-oflicers, who had been reduced to the fame provifions with the common feamen, began to exhibit the fymptoms and external ap- pearances of feurvy ; but this was only in a mild and flight degree. Bailing winds, calms and currents, kept the fleet for feveral days from reaching the anchoring- ground, with the ifland conftantly in view; and during thefe melancholy days, the fhips were eve- ry now and then committing to the deep fome un- fortunate AN EXPEDITION, Xc. Or fortunate {corbutic, whom a few cocoa-nuts and the tropical fruits, which were there in great plen- ty, might have preferved to reach the much wifh- ed for fhore. The green and picturefque appearance of this ifland affords a prof{pe& peculiarly interefting to every fhip’s company who have been any length of time at fea. To us, (at leaft to all our fcorbu- tics), it prefented fomething more. To them it was like the hope of a refurrection from the dead: and in fact, one-third of all the troops and fhips’- companies, were tranfported to its fhores in a con- dition, in which a jolt, or a rude motion, was in danger almoft to prevent their ever reaching them; and above another third more than half way to the fame condition. This, like moft of the tropical ifles, is compofed of high land, running towards the centre in irregu- lar ridges: The hills, covered to the top with the green and {preading cocoa-nut tree: Some level Jand upon the fhores, and deep and narrow valleys running backwards with more or lefs afcent among the hills. On the north fide, where the fleet an- chored, a border of low land, in fome places of half a mile or more in breadth, forms the beach ; B 2 while ¢ Pe AR ae a ee re — =~ ay a _ _—S ee 22 DISEASES ON while three frefh-water ftreams, of confiderable fize, furnifh eafy and plentiful fupplies of that ar- ticle for any fleet. Farther back the land begins to rife in irregular elevations, and the valleys, which are wide and open to the beach, narrow and con- tract as they recede from it, and foon begin to be covered with fhrubs, bufhes and underwood. The cocoa-tree feems to thrive alike at all the heights in the ifland, from the top of the higheft hil’s to within a few yards of the beach. On the banks of the middle rivulet, among the cocoa-tree groves, but where there is a firm and dry fward, and on the open beach near it, the greateft number of the fhips pitched their fick tents, while fome of the troops, the 98th and 42d regiments, went farther back into the opening of the valley, and towards the rifing grounds, farther off from the reach of the fea-breeze, where there were fewer trees, but more bufhes and underwood. Frequent rains, which fell out before we left the place, rendered their fituation ftill more unfavourable, from the ground being more imperfectly dried, while near the fhore, or among the cocoa groves, there was much more ventilation, and a much better fhade from the exceflive heats. From the lait report, on the AN EXPEDITION, &c, 23 the 20th Auguft, to our reaching this place, the deaths at fea were ten foldiers and one feaman.— The laft was the cafe mentioned in the former re- port, as not recovering from dyfentery. Symp- toms of fcurvy, or rather of fcorbutic diathetis, became more and more apparent, and the patient went off in a low opprefled wafted ftate fome days before we reached this. All the foldiers, except one, (who died from drinking fpirits to excels), were affected with fcurvy, combined with cachexy, and died in the fame way. A very few days on fhore made a remarkable change on the condition of our people. ‘Tropical fruits, pot-herbs, and frefh beef, were procured in great plenty, and the cocoa-nut was in fuch abun- dance, that both officers and men diluted their {pi- rits with no other liquor ; and at a certain period of its growth, it yields a clear {ybacid {weet juice, which, with a due proportion of fpirits, is made into excellent punch at once. On fuch diet and drinks, recoveries from the fevereft degrees of icur- vy were rapid. The fpongy gums, black vibices and exanthematous blotches, very foon began to difappear: The colour firft changing from purple or black, to a dirty yellow, and this alfo vanifhing altogether in a very fhort time longer ; fo that it B 4 was re { - : 4 } ee Ta wi Mh. i? Tei f “J 1 he i. i ‘e 4 : - yak g « ; t TEs See oy i Waal | 2 - ee ee j ae ae a | Oe > OF, og Pry ss 7 iv; & % ; $ . ee a pe . oe Da Z . Pal . er i. Salta ay . Por, gn oat oes Katy, Mas re Hie, Ke =< >, “4 5 \ ‘ —e % i U | e ae A. : Bi, aw wr a p= 3 p ay . U > ? oe * ve at . = oe - vo G re ey) ee oe a ailntilee a! Dee “gt _ RM mee ts er ah Be oes, +3 as Ti Pees S o>uy ws LS ee einen DS Ags its” 5 aS Dm aes Pai 24 DISEASES ON was very common to fee men, who had been car- ried on fhore in their hammocks, walking about with crutches, or the help of a fingle ftick, in three or four days. Some ftiffnefs and a degree of fwelling, however, remained about the joints for a longer period. Some of the feamen had a fancy of fitting with their legs buried in a hole dug in the earth, for an hour or two at atimé: I did not perceive with any effect. In fac, freth vegetable provifions in fufficient plenty were perfe@ly effectual ; nor did it feem to make any difference at all of what kind thefe were, provided they were in fufficient quan- tity *. No * The nature and caufes of Sea-feurvy are now fo well under- ftood, that it would be entirely fuperfluous to offer any expla- nation on the fubjeé&. But the following fhore cafe of it, if an Iricifm may be allowed, goes fo direétly to point out the nature and proximate caufe, that it may be worth while, for the ufe of fuch as have few opportunities of feeing the com- plaint, to put it down. ]. P. an inhabitant of Edinburgh, complained to me, fome time in the winter of 1795, of pain and ftiffnefs of his ankle joints. I did not look at the condition of the parts, but gave hun fome Liniment. Saponaceum * to rub on them. In four or five days he called again, to fay his complaint was increafing, and affected the knee-joint alfo. He had mentioned no difco- louring, * Linimeut, Saponis, Ph. Edin. AN EXPEDITION, &c. 2 tyra No new difeafes arofe among our people at the ifland, except trifling fluxes, from a too libe- ral ufe of vegetables, and drinking too freely of the cocoa-nut liquor, which is readily fermentable. But a fever, faid to be of the bilious remitting kind, nntipsadhnienretnalith renal ig sso pasa cnepbSaip SSiIGA ie louring, and I was a good deal furprifed, on infpeétion, to fee on both legs the diftinc& and well-marked appearance of fea- {curvy, fuch as it has been defcribed. On defiring him to fhew me his gums, they were fpongy, fwelled, and full of purple mulberry-like lumps, from which blood iffued. He faid alfo he was weak and breathlefs, and could not fupport his ufual exer- tions. On inquiring into his diet, and way of life, I learned that he was a remarkable dyfpeptic, and could not ufe a fingle ar- ticle of vegetable food except tea and bread,nor make ufe of any malt liquor, and drank only fpirits and water after his meals ; that his employment was ina rag warehoufe, picking and forting woollen rags for navy beds, and that he flept in a room immediately over his warehoufe. From this account the na. ture of his complaint became very evident, even though the appearances had been lefs decifive. Notwithftanding his aver- fion to vegetables, and his account that every thing of that fort gave him ftomach complaints, he was directed to eat as many oranges, either bitter or fweet, in the day, as he fhould find upon trial his fomach would bear, and alfo to try the ufual articles of vegetable diet, and porter for drink. This fort of food he now found to agree with him perfectly well ; and what is remarkable, his dyfpeptic diforder was removed by it, as well as the feurvy. He has become lufty and full, and enjoys very good health, though he continued his employ- ment in the rag warehoufe for two or three years afterwards, only changing his place of fleeping for one much better aired and healthy. | Baal i De cate a ae , : _ — EME aa ee = A o's apg Ted fa pa ; : basi c Pe Co > a rr = . £ + = Petty ie te ioe ads Fd Lhe % 1 d Vr rae ? a re bed ."y : Reet te kL SES aay £ eS : Py aes ( Rr any ane» on 25 ee 7 et i > s =? . : , =: ; < ts — en == — —— te . ~ . ~ ~ = - o* siiSae ek aS Pee) eee : KTR wale pac! Sol ~ ee gis > wrour Tr Wy, ¥. . ores ee aD eer Ay Oe ee Baa a 2 eae ? 7 f 20 CASES OF kind, had appeared among the troops of the 98th and 42d, ftationed in the mouth of the valley, and fome had died of it before our embarkation. After remaining about three weeks on {fhore, the whole expedition was again fhipped and pre- pared for fea, with a plentiful ftore of every edible vegetable the ifland afforded, pumpkins and cocoa nuts, which keep for any length of time, and as many live bullocks as every fhip could find room to ftow on their decks. With fuch provifion for the voyage to India, we flattered ourfelves with a healthy and profperous paflage. But in this we were difappointed. ‘The fever which fome of the troops had caught on the ifland, was carried with them on board, and continued to {fpread, and pro- ved fatal to many. ~ CASES OF REMITTENT FEVER. Two days before our embarkation, the com- mander of the Manilla, Lieutenant R , who had lived on fhore very intemperately, continually rambling about through the whole encampment ; often eee a REMITTENT FEVER. 27 often in a ftate of intoxicaticn, and frequently lying down to fleep in the open air, had caught the fame kind of fever which prevailed in the valley among the 98th regiment. The attack began with pain of his head, with exceffive heat of the fkin, and alfo in the internal parts; quick and fmall pulfe; naufea and ficknefs at ftomach. On his firft complaint, or as foon as it could be diftinguifhed from the effets of debauch, he was vomited with repeated {mall dofes of tar- tar emetic folution. ‘This alfc operated as a ca- thartic, and difcharged much bilious ftuff. ‘This was in the afternoon, and relieved all his com- plaints; and next morning he thought himfelf perfe@tly well. The remiflioa, however, was but fhort; and, during it, he repeated the fame fort of exceffes that had brought on the difeafe. The fever returned after dinner, but remitted again in the evening. ‘The bilious purging continued, but not fevere. On the following morning, he com- plained again as before ; but there was a coniider- able remiffion, and he walked out freely, though his tongue was white, and his pulfe too quick. This day he had fome {mall dofes of rhubarb. and ipecacuanha to promote his fiools. He had from the = Soule ‘ : ao. - ~— peo a . . y a ae = \ . ——— - “j ” . ; = 3S eaz.. LSS : co POR te aes an, Wn Ps >" ‘ 7 — Pr eh Se Ite —_ ho ~ \ - — . > . AN, fipan ys at Ses os Tak : 2 > as = = Ag ote re fa iat 2 7 7 y i. . zs a Wier ore } mm, T - ‘ ey" aula Ekin 2 i a yt st “0 = A = ¥ 4003} ‘ —_ a oe “% ' a & +r “a ) SS. - 24 CASES OP the firit refufed to take bark, which was ftrongly prefied upon him ; and in the evening he went on board the fhip. He had 2 reftleis night, moaned is fleep ; and next morning, the fourth <~- all the fymptoms were worfe. He look, and was not diftinét in very quick and catching; ) and tongue dry and parched. this day Infus. Tamarind. cum Senna, which Rice-water with tama- is boiled in it for drink, and feveral glaffes of © ira wine. fth, looks more unpromifing; pulfe and very frequent; fkin dry and t jactation and uncovering his , very indiftiné; moans much altered tone of voice; and refufes his wine and drinks.—Applic. Emplaift. Veficator. apulas, et habeat Hauft. Anodyn. h. {. The fixth; had fiweated much laft night, but General appearance no bet- wine and drinks, but takes feme at times when much preffed. Is perfedtly +. eftiefs and delirious ; attempting often to get out leeps, but moans greatly; and when awake, = : oe ne ond REMITTENT FEVER. 29 awake, feems much diftrefled. Pulfe very fre- quent, contracted, and irregular. At night can- not be got to fwallow any thing.—Applic. Cata- plafmata cum Sinap. aliquantum pedibus. On the feventh, pulfe feeble and irregular. Has had a ftool both yefterday and this morning. Ex- tremities cold; cannot be got to fwallow any thing ; refpiration quick and interrupted; cada- verous {mell; voids urine and fzeces infenfibly : by all which a {peedy diffolution was to be expect- ed; and this accordingly took place about five o’clock P. M. | The fervant of the mefs, a ftout young lad, who ns had all along attended Lieutenant R., about eight : . | days after his mafter’s death was attacked with 3 the fame difeafe. He had been obferved drooping for a day or two, before he made any complaint, but denied there was any thing the matter with him. When he’ was forced to make known his ailment, he complained only of pains in his limbs, want of appetite, and uneafinefs at the pit of his ftomach. He was vomited with tartar emetic fo- lution * in the forenoon, and found himfelf bet- | ter Ba en a te * Solutio Tartritis Antimon. a L hE a ON dal re a hs at ONS Ta a oo to ig goa), “thy ie ay | ae Big “ga eink es Ors of Ae? > aba *- Tey 4 7 oY oe “< ae. ve i ty Bits OS Tene pre 39 | CASES OF ter towards night. Next day, he theught himfelf much eafier, and continued to go about the decks, though his pulfe was fomewhat quick and fmall ; but the fever returned again in the evening. A few {mall dofes of antimonial folution had been given him through the day, and procured fome ftools. On the morning of the third, pulfe ftill fmall and frequent ; fkin hot, and breathing quickened.— Capiat Pulv. Cort. Peruv. zfs. quatuor indies. The fourth, complaints the fame. No remiffion yefterday ; tongue much furred; pulfe fmall, and very frequent. Capiat ftatim, Pulv. Sal. Nitri, gr. xv.; Tart. Antimon. gr. 1., in Aq.fontan. 31). After this, he vomited much green ftuff, and had a remiffion in the afternoon. Cont. Cortex Pe- ruy. ad 31. quatuor indies. The fifth, all his fymptoms aggravated. A num- ber of angry-looking puftules this day broke out about his lips. Pulfe regular and free; fays he throws up his drinks, which have been barley-wa- ter, or Infuf. Althzez with tamarinds: This to be changed for weak tea. Has had a ftool every day, and feveral after the laftemetic. To take his bark in Julap. Salin. The he ae 2 *. REMITTENT FEVER, 3i The fixth, general appearance the fame as ye- fterday. ‘Tongue covered with a black dry cruft; {kin dry and parched. Cont. Cortex, and to have Madeira and water for drink ad libitum. The feventh. This morning, fymptoms ftill more aggravated ; only his pulfe is fuller: fays he throws up the Madeira and water. To be changed again tor the weak tea, cold; and to have a glafs of cla- ret, unmixed, five or fix times a-day. Counte- nance retains a natural appearance, and the erup- tion about his mouth keeps out. Sleeps much ; and when awoke, {feems ftartled, and requires fome time to recollect himfelf, and give pertinent an- {wers; but is otherwife free of delirium. Pafles at times both urine and feces infenfibly. Cont. Cortex et Vin. rubr. At night, pulfe continues regular, but quick and feeble; is not fenfible of his want of drink, but takes it when offered him ; fill retains the bark on his ftomach.—Capiat omni quarta hora ad 31. in Julap. Salin. The eighth. This morning, looks worfe; is more infenfible and opprefled ; breathing very quick; itrong throbbing pulfation of the temporal arte- ries, and a few drops of blood have iffued from his noftril ; ftill he is fenfible at times, and has regular 3 aa es Ta aa te i t Rs ~-<- -~.. : ee ae 32 DISEASES ON regular paflage of his belly. Continues to take his wine and bark. Applic. Emplaftra Veficator. bra- chiis et cruribus. About eight at night, his pulfe became fo low and feeble, as hardly to be felt at the wrift; his hands and feet rather cold, with a cold fweat over his breaft. In this ftate, he lay for a confiderable time in a. kind of ftupor, with- out paying any attention to what was faid to him, and: appeared fo low as to render it doubtful whether he might furvive till morning. After fome hours he began to recover a little ; a degree of heat fpread itfelf over his limbs, and he was able to {wallow fome warm wine. By next morn- ing, a crifis was plainly diftinguifhable, by a fuller pulfe, and fofter fkin, with a rednefs and moifture on the edges of his tongue. From this period the fever abated gradually, and he recovered ftrength enough to walk the decks in lefs than a fortnight, with the affiftance of bark and wine, and light diet. Thefe two appeat to have been fevers of the Bilious Remitting kind, pretty diftin@ly marked ;, and the event of the laft cafe affords a prelump- tion, AN EXPEDITION, &c. 33 tion, that in Lieutenant R’s, where the early re- miflions were more perfect, bark might have had good effects. But as the fever fpread no farther in the fhip, we had no further means of putting it to proof. Had the difeafe once got among the troops under the deck, we had no reafon to fup! pofe it could have foon fubfided, or that many would not have been cut off by it; but the fea- mens’ fick-birth being on the open deck, fecured them from this danger. It continued to’ prevail in the tranfports with the 42d and 98th regiments for a confiderable period; and a number both of officers and men, fell a facrifice to it ; while it de- ferves to be remarked, that all the troops and thips’ companies who were encamped upon the beach, or on the dry and firm foil near it, have continued perfectly healthy. ees After a tedious and painful paflage of many weeks, arifing from calms and exceffive heats in recrofling the Line, with fhort allowance of both water and provifions, and a conftant current fet- ting us to the weftward, out of our courfe, the whole fleet came to anchor in the Bay of Moribat, on the coaft of Arabia Felix, without the Straits of Babelmandel, in Lat. 17° 30° North. C On = = “ = _— a aN 7 om x tal Ear ER — vin —— wn : “ ’ ova —_— me “~< } Aang | —— ee b » | ne y y x he. ; Fear: - Se eS wt pan wee ee - a of ns Sy re me a fee Ee es pe $ ~ = ae ~ eae aie 34 ; DISEASES ON On this paffage, the fleet in general fuffered comparatively little from ficknefs or difeafe, ex- cept thofe fhips which brought the fever from Jo- hanna. After the two cafes of it in the Manilla, we had only a few, flight and fhort fevers among the foldiers, from expofure to the exceffive heats, attended with a redundancy of bile, diftinguifhed by a loaded yellow tongue, headach, oppreffion and fickne{s at ftomach. A gentle yomit, fol- lowed. by a purgative, if given early, was ge- nerally fufficient for removing the fymptoms, or 4 repetition of them, if neceflary, was conftantly fuccefsful. It took on no regular type or dura- tion, where there exifted no infectious miafmata to combine with it. What contributed to the healthinels of this part of the voyage, was the complete wafhing and cleaning of the fhips and foldiers’ births while they were emptied at Johanna ; while the bedding, li- nen, and every part of the clothing, underwent the fame procefs on fhore; fo that not only did the people return to them in good health ; but the fhips themfelves, and every part of the clothing, were in much better condition than when we firft embarked. ' On oe — = 2 ae = —— > r pe en B Oo RT ee et i AN EXPEDITION, &e. 3: tJ On this paflage we loft the fhip’s mafter, who was found one morning dead in his cabin, moft probably from an over-dofe of brandy, as he had no known complaint, The air at Moribat appears to be very pure and dry. The heat at.this feafon was great, both with fea and land breeze. The foil is cocky and fandy, without vegetation, or the leaft veftige of tree or f{hrub within view of the fhore.. About a mile back, the land rifes in a high precipitous craggy ridge, which faces the coaft for a confide- rable length. Behind this, it is more elevated, and vegetation much greater. . No water was found here, except a little, very brackith, near the fhore. The inhabitants of a: fifhing village, from, which the bay derives its name, bring all they ufe from wells feveral miles inland, on the backs of camels. Of courfe our fupply here was very fcanty; nor could we procure any article of frefh provifions, except a lean goats; nor any vegetable, but fome preferved dates. Fifh, in great.plenty and variety, were indeed; procured in the Bay; in fo much, that a fingle draught of a fhip’s net, would {ometimes procure fufficient to ferve for a meal to the whole fleet. C 2 Before 36 DISEASES ON " Before we left this ftation, the fevers which had been brought from Johanna had entirely fubfided in all the fhips, and no new difeafes were caught by communication with this fhore. A number of our fhip’s crew and foldiers, indeed, got bowel diforders, from eating too plentifully of the fith, fometimes not in the foundeft ftate of prefervation. Similar diforders were imputed, by fome of the furgeons, to ufing the brackifh water; but it was clearly owing to the fifh diet. The complaint was attended with griping, pur- ging, and an inflated belly ; very often with rufhes and efllorefcences on the fkin: and our people had more of it after going to fea than while at anchor, from attempting to cure and preferve the fifh, by rubbing them with washed falt from the pickle tubs, and drying them in the jun,—a procefs in which they were not very fuccefsful ; but they ate them imperfectly cured, rather than the falt beef and pork, fo long as they lafted. A purge "or two, with plentiful dilution, and abftaining from the fifh, was fufficient for ‘removing all the diforder. The fleet were, in a manner, tide-bound in this bay for fome weeks, by the current fetting towards the Straits. As foon as it began fomewhat ta: abate, 37 abate, the Monmouth, Hero and Ifis attempted the AN EXPEDITION, &c. pallage to Bombay, working as much in-fhore a- long the coaft as they could, where the current was flacker. The only other fhip that at this time attempted the paflage, was the Manilla, and. fhe was enabled to keep up with the men of war, by the advantage fhe had in her lefs draught of water, whereby fhe could work her courfe much more in-fhore. In lefs than three weeks we made the harbour of Bombay, and the other divifion of the fleet, which had been left at Moribat, arrived in a fhort time after. Among the troops fcorbutic diathefis had begun again to manifeft itfelf, and fome who had fuffered much by fluxes formerly, were again attacked, but not in the -dyfenteric form. Of fuch cafes, two were loft on this part of the paflage. At this time a foldier’s wife, of a fair com- plexion, and delicate habit, was, without any known caufe, attacked with inflammation in one of her eyes, attended with dimnelis of fight, and pain over that fide of the head. A thick fpeck, of a dead white, foon appeared on the lower edge of the cornea, but, what was rather curious, was not fixed exactly to one place, but rofe higher or fell G3 lower 38 DISEASES ON lower at different times of the day. In the fore- noon, it was fometimes fo high as to obitruct the paflage of light through the pupil entirely : in the evening it was often lower than even the cornea lucida. At other times it was more fixed to a fpot, but increafed in fize; was more painful in the forenoon, and became eafier, and: diminifhed to- wards night. Dofes of coaling phyfic and fatur- nine lotions gave little or no relief. The means of topical bleeding were wanting, and her habit was too delicate to admit of any confiderable evacua- tion of blood from the arm. A blifter over the temple and forehead of the affected fide foon re- lieved the pain, and diminifhed the general in- flammation ; and the fpeck gradually difappear- ed, and left the eye perfectly found. As we ad- vanced to the northward, the coaft confifted of a dead flat, covered with a barren white fand; as far inland as the eye could reach; and we were al- ways within view of the fhore, and eenerally very near it. Whether this cafe of ophthalmia might have been occafioned by a fine drift fand from the beach, or the uncommon glare of light reflected from it, I did not then conjecture ; but from what I faw afterwards in India, 1 rather fulpect the lat- ter. AN EXPEDITION, &c. 39 ter. Thefe were cafes of nyctolopia, or perfec vi- fion only in the evening, and were moft common in fubje&s who had’ been long in the country. The eye appeared found, but they had com- monly pain in the head, faw very imperfectly in the day-time, and the pupil appeared contracted to a perfect point ; whereas, in the twilight, it was much more dilated, and vifion was much bet- ter. After refrefhing for about ten days at Bom- bay, the Manilla, with the men of war, and part of the India fhips, failed again for Madras, which we reached in five weeks, and landed all the troops and flores from the fhips. ‘Thus finifhing, in ex- actly eleven months, a tedious and fuffering paflage from England. In the latter periods of this, I was not furnifhed with the number of deaths among the troops as they happened in the fhip ; but from the account of the hofpital mates, and the officers returns, I learned, that out of the two companies embarked, with fome occafional fillings up from the other fhips as the numbers decreafed, they had loft, upon the whole, 75 men. Forty from fevers; 18 from dyfenteric flux ; and the remainder, from {curvy and cachexy. Of the fhip’s company, we loft the licutenant and one feaman from fever ; one C 4 feaman 4. ‘ i 7 poo og ed = \y * ‘WAVE SR CERIN sha ert uJ —#£ Th4 < s oil". a Se AO Ahearn We ais; , * 7 ‘ ~ sy - ¥ 9 ‘5 Ps Ta Ge-, veh esen, Lor nA eee eee . yd eee be ¢ 98 Par YY, abs rd tly as, if aa at. - % Pee - ph i SS crate ~ DISEASES ON 4 i feaman from flux combined with {curvy ; and the mafter, accidentally. From the beft accounts I could procure, the deaths in fome of the India fhips and tranfports had been in a fimilar proportion. In others of the larger tranfports, and in the men of war, the loffes were greatly inferior. By ftating a comparifon between the mortality among the feamen and the troops in this ‘fhip, no- thing more is intended than to point out the good effect of the pure and free air, in which the for- mer were kept above deck, both through the night and day, over that in which the latter were below the hatches, for preferving the health, and in re- fifting contagion and difeafe at fea. On this fubjeét, the following obfervations may not be irrelevant. Since the date of this expedition, many and great reforms have taken place in the modes of fea-vic- tualling, and in the fupplies for the fick. Much more attention has been paid to cleanlinefs, and to the means for correéting foul air in fhips; and for refitting contagion by fumigation, &c. How far thefe “a we i = = _— bei < “ c “a ~ a ‘ se vases be La F ei; =~. a . a ee = 2. : - 4 sat’ au a a 7 i eae sins or > SE Ne _ ee + Suey? . — 2a best ee sal te = aad “eG —_ = - % ~ = . = - PO ee Re ee Ol —_ eh Z Pr AN EXPEDITION, &c, 41 thefe melierations have been extended to the tranfport fervice, I am ignorant. In the man- ner in which thofe employed on our expedition were fitted up, with ftanding platforms for the foldiers’ beds, many of them were rendered im- ‘practicable. In the latter part of the voyage, we became fo fenfible of this in the Manilla, that thefe were all cleared away, and the foldiers fupplied with hammocks. ‘The fhip was alfo much over- crowded for her fize, whereby all thefe things are rendered tenfold more difficult than where there is more room. With regard to fea-fcurvy, re- ports and accounts have been publifhed, as if this had been cured at fea, by lime or citren juice, lemon rob, nitre diffolved in vinegar, nitric acid, &e. all which I would fufpeé to be rather fome- thing of the hyperbolical. But there is a plan for this purpofe recommended by a Mr Young of the Navy, which, from its practicability, and perfect conformity to known and eftablifhed principles, is. highly deferving of attention, and of being recorded in fuch a publication as this. It proceeds upon the well known fact, that nothing more is neceflary for the cure of this difeafe in any fituation where there is a tolerably pure air, than,—not dead and dried, 42 DISEASES ON dried, but freth vegetable diet, greens or roots, in fufficient quantity. To be fure, we cannot have a kitchen-garden at fea, and a fhort and fcanty crop of greens can only be raifed on board a fhip ; but beans and peafe, and barley, and other feeds, can, be carried in any quantity; and as Mr Young has very juftly ftated any kind of efculent feeds brought under the malting or vegetating procels, are con- verted into the ftate of a srowing plant, with the vital principle in full activity throughout the germ and pulp: and if eaten in this ftate without any fort of preparation, except that of feparating or rejecting the hufks, cannot fail to fupply pre- cifely what is wanted for the cure of feurvy, viz. frefh vegetable chyle. For this purpofe, befides the articles already mentioned, which may all be employed, hé gives the preference to gram, an Eaft India grain, chiefly ufed in the feeding of horfes. ‘The malting procefs is to be performed sn fhallow frames of wood, conftructed fo as to preferve the water for fucceffive operations ; and a little experience will readily lead to the proper degrees of heat and moifture for conducting it fuc- cefsfully. We * — eS LL AN EXPEDITION, &c. 43 We have only further to obferve, that in all long voyages, it ought to be our object, not only to find out and employ the moft effeCtual means to prevent or cure this difeafe, as one that proves fa- tal by itfelf, but alfo to guard as far-as poflible againft the taint ; as that which never fails to give ~ a fatal or malignant tendency to other diforders incident to this way of life; as ulcers, fevers, fluxes, &c.; and, in order to this, our preventive plan ought to commence from the firft day on which the failing ftock of frefh vegetables, and fhip’s beer, is expended: Since, from many ex- amples it appears, that much greater fuccels is likely to attend our endeavours in this way, than by referving them for the period in which the marks of {corbutic diathefis begin to manifeft them- felves. In other words, every healthy feaman car- ries with him to fea a certain quantity or propor- tion of antifcorbutic humours. ‘The ftock may be preferved, if hufbanded with care ; but cannot, in that fituation be eafily recovered, if once it is fuf- fered to run down. INDIA = 62s odes a SS . % SPASMODIC CHOLERA. INDIA DISEASES. SPASMODIC CHOLERA,—THE CRAMP,—OR, MOR?T DE CHIEN. In the beginning of the year 1782, the Hero, Monmouth, Ifis, and feveral of the King’s tranf- joined the fleet under Sir Edward port fhips, Hughes at Madras. He had juft returned from the capture of feveral Dutch fettlements on the &. The acceffion of three fhips of the line, parations for further and coa gave activity to his pre more important conguefts, when the arrival of our old acquaintance, the French Admiral Souf- frain, with twelve fail of line of battle fhips, cut out for us other employment, and put an end to our dreams of bloodlefs victories and further ac- quifitions. The firft meeting between the fleets took place to the fouthward of Madras, and ended in a drawn On this occafion, [ was on board the Iiis, whofe battle. SPASMODIC CHOLERA. 45 whofe furgeon was unable to act at the time; and on the return of the fleet, was appointed to do duty on board the Seahorfe 20 gun fhip. In this ftation, I had the firft opportunity of becoming acquainted with this fatal and untract- able India difeafe. ‘Of the names here given to it, the two laft only were employed in the coun- try. How far the firft may be ftrictly appropriate or fcientific, is fubmitted to the judgment and opinion of others. On the 12th of April 1782, the day of Rod- 4 ney’s {fplendid victory in the weft, a fecond meet- ing, and a battle of five hours continuance, took place between the fleets. But /o it did not end with us, but in hard blows and bruifes only. ‘This happened fome way to the fouthward of Trin- comalé; and was fought fo near the fhore, that both fleets came to anchor in the evening in the fame place where it had been contefted, {carcely out of reach of gun-fhot from each other, Here they both remained for more than a week, repairing damages, and looking at each other. The French fhips had fuffered leaft in action ; they were the firft to put to fea; and offered us battle for a whole day in vain,—not from any want a AD SPASMODIC CHOLERA, want of courage, either of the Admiral, or of the fleet, but blundering and mif{management had tied up our hands. The ftrength of the two fleets had been nearly equal; and whatever might be reported in gazettes at home, we certainly claim- ed no victory. When the French had left. the coaft clear, the Britith fleet made fail for Trinco- malé, and anchored in Back Bay. An hofpital was eftablifhed on fhore for the fick and wounded ; but the Seahorfe being for fome time detached on fervice within the Great Bay, I had but few op- portunities of feeing what was going on in it. Wounds, ulcers, and burns from the explofion of gunpowder, made up the bulk of furgical cafes ; Fluxes and fever difeafes, the chief part of the rémainder. The mort de chien, or cramp, I was dlfo informed by ‘the attending furgeons, had been very frequent and fatal among the feamen, both it the hofpital and in fome of the fhips, particu- larly in the Hero and Superb. The Seahorfe did not join the fleet in Back Bay till the 14th of May, when the difeafe had become much lefs frequent, nor had we any men attacked with it till the 21ft of June. Previous = SS EE———EEEEI~T Sill otto enneeteeinmmenmnat SPASMODIC CHOLERA, 47 Previous to this, our fhip’s company had been very healthy, though they had been a good deal expofed and.employed in fevere duty within the great harbour; only a few flight fluxes had ap- peared, and which we imputed to the water at Fort Ofnaburg, which is fomewhat brackifh, and apt to occafion bowel diforders. One, however, turned out differently, and ended in a way which gave me much uneafinefs.. This cafe is added af- ter the liver-difeafes, with a view to fhew the ne- ceflity of making ourfelves well acquainted with the peculiarities and fymptoms of difeafes that are varied by the influence of climate, in order to practife with fafety or fuccefs in a foreign coun- see eee The weather was at this period rough and bluf- tering. A conftant land-wind, blowing fometimes in gufts and fqualls, and without any fea-breeze, had already fet in. A ftrong and conftant land- wind prevails during the months of July and Au- guft, along the whole eaftern fide of the coaft ; but here it fets in much earlier; and by coming over a country thickly covered with bufhes, trees and underwood, feels much colder. ‘This is never heated by the fun fo much as a bare and fandy foil ; : ee ee , a SS : —— = tii : D ee . —_ = : a SS a el Oe nee 20 ag 43 SPASMODICG CHOLERA. foil; but when rain or dews fall,.a copious and quick evaporation takes place, whereby the air becomes loaded with moifture, cooled down to a confiderable degree. Early in the morning of the 21ft of June, we had two men fiezed with the mort de chien, both of whom we loft in a few hours; and in the courfe of the two following days, three more in the fame complaint, without meeting with one fortunate cafe. To the 25th, when we failed for Negapa- tam, we had three new cafes of the fame kind ; all of whom were faved, but two of them with great difficulty. Befides thefe, we had feveral others which were of a nature cenfiderably dif- ferent, being evidently combined with bilious col- luvies in the firft paffages ; a circumftance not at all difcoverable, either in the firft five cafes that ended fatally, nor in two of the others that fuc- ceeded. All thefe were found to be much more tractable, eafily removed, and attended with but little danger. In every one of the eight cafes, the fymptoms were fo much alike, both in order and degree, that a defcription of any one would anfwer almoft equally well for every other. Any difference that took NN nt em cea SPASMODIC CHOLERA. 40 took place was in the fuddennefs of the attack, or. the rapidity with which the fymptoms fucceeded each other. In all of them the difeafe began with a watery purging, attended with fome tenefmus, but with little or no griping. This always came on fome time in the night, or early towards morn- ing, and continued fome hours before any {pafms were felt ; or thefe were confined to the toes and feet ; and flight affeGtions of this kind being very common in the country, the patients feldom men- tioned them till they began to be more fevere, and extended to the legs or thighs. This purging foon brought on great weaknefs, coldnefs of the extre- mities, and a remarkable palenefs, finking and li- vidity of the whole countenance. Some at this _ period had fome naufea and retching to vomit, but brought up nothing bilious. In a fhort time the fpafms began to affe& the mufcles of the thighs, ° abdomen and thorax, and laftly they pafled to thofe of the arms, hands and fingers; but I never law, then or afterwards, thofe of the neck, face or back at all affected. The rapidity with which thefe fpafms fucceeded the firft attack, and their feverity, efpecially as affecting the mufcles of the thorax and abdomen, denoted in general the de- D gree er FESS ET — on Sas We ace” 50 SPASMODIC CHOLERA. gree of danger in the cafe. The affection is not as in tetanus confined to a fingle mufcle, or to a cet- tain clafs of mufcles only. Neither does it, as in the fpafmus clonicus, move and agitate the mem- bers. It is a fixed cramp in the belly of the mufcle, which is gathered up into a hard knot, with excruciating pain. Ina minute or two this relaxes, is again renewed, or the affection pafies to others, leaving the miferable fufferer hardly an in- terval of eafe ; and, laftly, it pafles from one fet to another ; from thofe of the inferior extremity to thofe on the upper parts, leaving the former free. The patients complain much of the pain of thefe cramps; think they obtain fome felief from friGtion of the parts, and cry to their com- panions to rub them hard. As the difeafe pro- ceeded, the countenance became more and more pale, wan and dejected ; the eyes became funk, . hollow, and furrounded with a livid circle. ‘The pulfe became more feeble, and fometimes fank fo much, as not to be felt at the wrift, in two or three hours after the fpafms came on. But fo long as st could be felt, it was but little altered in fre- quency. If the fpaims happened to intermit, it would fometimes rife a little, and the countenance aflume- SPASMODIC CHOLERA, Sf alfume a better look. The tongue was generally white, and more or lefs furred towards ‘the root ; and the patients had all great thirft, or rather a ftrong defire for cold drinks; but there was no headach or affection of the fenforium commune throughout. The coldnefs of the extremities, which was per- ceptible from the very firft, ‘continued to increafe, and {pread over the whole ‘body, but with no moifture on the fkin, till the feverity of the pain and {pafms forced out a clammy fweat, which foon became profufe. The hands now began to put on a ftriking and peculiar appearance. The nails of the fingers became livid, and bent inwards; the fkin of the palms became white, bleached, and wrinkled up into folds, as if long foaked in cold water; the effect, no doubt, of the profufe cold {weat, which is one of the moft pernicious and fatal fymptoms of the difeafe ; both from the ef- fe& it has in fuch a climate, of exhaufting the ftrength, and in abftracting heat from the.fyftem. In fome of the prefent cafes, and in many others after this, we had recoveries from the fevereft de- grees of {pafmodic affection ; even where the pulfe had been for hours completely loft at the wrift, D2 and. 52 SPASMODIC ’ CHOLERA. and the body perfectly cold; tut never of any who had thefe profufe cold clammy {weats, and where the hands had put on this appearance. All this while the purging continued frequent, and exhibited nothing but a thin watery matter or mucus. In many, the ftomach became at laft {o irritable, that nothing could be got to refit upon it; but every thing that was drunk, was {pouted up immediately, without ftraining or retching. The countenance and extremities became livid ; the pulfations of the heart more quick, frequent and feeble; the breathing began to become labo- rious and panting ; and, in fine, the whole powers of life fell under fuch a great and {peedy collapfe, as to be foon beyond the power of recovery. In this progreffion, the patient remained from three te five or fix hours from the acceffion of the fpafms feldom:longer. Thefe began at laft to abate, but with more internal oppreflion, great jactation, panting and gafping for breath; from the dim1- nifhed action of the reipiratory organs : for there were nomarksof opprefiion or effufion on the lungs; and the motion of the heart, fo long as it could be felt, became more and more quick and irregular, till — a = SPASMODIC CHOLERA, 53 till death came at laft to the relief of the mifer- able fufferer. | Some time before that event. took place, the {pafms, gradually abating, left the fufferers entire- ly; and fo much poffeffion of their faculties did they retain, that they would continue to talk fen- fibly to their meffmates, to the laft moment of their life, even when the whole body had become per- tectly cold, and all pulfation at the heart had ceafed for a long time to be diftinguifhable. A variety of opinions were entertained about the proximate and exciting caufes of this difeafe ; fome imputing it to the influence of cold and damp winds, efpecially the land-winds of the night *, D 3 in * The prevailing winds along the coaft of Coromandel, from the middle of July to the end of Auguft, are from the land ; and they blow often rong ; feel hot, fultry and parch- ing; have much effect in checking perfpiration, during even the great heat of the day; render the fkin hot and dry, with an uneafy fenfation in the Hole ha, lips and eyes ; render the re{piration unpleafant, and fometimes occafion naufea and fick- ne{fs at ftomach. At Trincomalé, the land-wind {ets in ear- lier in the feafon; and Owing to the circumftances formerly noticed, gives rather an uneafy fenfation of coldnefs. On the coalt, the foil is generally bare, dry and fandy, which affe@s the winds blowing over it very differentl y ei Bi dae a: _ ~ AE 7" — Pee ‘ _ « ites ‘ aa es — : Niet ye . ri P 4 7 — Fa r = + Ss: ¥ ae lee — AS ers — ‘ e Y . = che Whos * = es ¥ . - a = : -s ore. a =% ' ge, we, S: = t rs ~ ¥ *+ — * Ni 4 = wee 2 - 4 a =~ y - ee or = ey A 7 q —— - ws roe —_ Ps wR 2 a ae AS Gest s+ = eat vi . hen : . Zz S , on Pe en ae - at - " = J epee RT ER ee es a ~ . - — __ ’ - einem. ] ~ ~— ew Ter kab i, ° 7 - . . » . x._ = c : ae’ i weeny ms emt 54 SPASMODIC CHOLERA. in giving a fudden check to per{piration ; whereby fomething deleterious, that ought to ‘have’ been thrown off by the fkin, was retained in the'fyftem ; and without doubt the ftate of the weather, while the fleet were at Trincomalé, ‘and the -circum- fiance of almoft all the attacks being in the night- time, gave fome countenance to this opinion, That which prevailed among the older turgeons on the ftation, led, as Iknow it was, by a defer- vedly great and high authority at Madras, but taken from a hafty and imperfect letter on the fubje@, fill more loofely and imperfectly taken up and underftood ;—afcribed the proximate caufe to the action of difeafed bile in the firft paffages - confidering it in the fame light as the true Chole- xa Morbus of the fyftematic writers. Others, again, by obferving it to prevail more in certain feafons than in others, or in certain tracks and fpots, or in fhips anchored in the fame line of direction, while others, placed at no great diftance, kept entirely free from it, imputed the complaint to fome delcterious exhalations pafling through the atmofphere, in certain tracks and lines of direction, in the manner of the fmmoon or faniel blafts of the Defart. It en OE SOOO nn — As : - - ae 3 nee ae SPASMODIC CHOLERA. 5 tr It was acommon opinion among the furgeons, that it attacked moft readily the moft irregular and worft clothed men; but in the Seahorfe, fome of the beft clothed and orderly men in the fhip were affected with it. In whatever the proximate caufe might confiii, two diftiné and feemingly oppofite affections were obfervable at the fame time. Great’ debility and irritability of the whole alimentary canal, with impaired action of the heart and arteries, along with a violent increafed action of the voluntary mufcles; but how connected as caufe and effed, or depending both of them on fome particular af- fection of the nervous fyftem, may be difficult to ex- plain. ‘The moft ftriking and alarming fymptom is, the great and fudden proftration of ftrength, and de- preffion of the powers concerned in carrying on the circulation and in maintaining the vital func- tions, without being the effect of great depletion, or of exbaufted excitement, as the Brunonians {peak ; for the evacuations are, from the firft, a thin watery mucus in trifling quantity. Little or nothing is ejected by any retchings that happen ; and it is ob- fervable from the very firft, before the fyftem has juffered much from the ftimulus of pain, or the fe- D4 verity a ne; a rea hee - tm a ~« eres Ss sy : = “ m Te Pe od Ae Be pe — GND ARERR EER oe ee st _ \ andl OR RT Ty - 50 SPASMODIC CHOLERA. verity of the fpafms. In the Seahorfe, it attacked fome remarkably robuft, powerful and mufcular men, who had been in perfect health immediately before. Neither in all our clais of bad and fatal cafes, did there appear any marks of bilious collu- vies, either in the colour of the ejected matters, the ftate of the abdomen, or in the appearance of the tongue, eyes and urine. There was neither pain nor griping, nor forenefs or tendernefs on prefling the belly. We had indeed another fet of cafes, where the prefence of this was diftinguifhable by all thefe characters, but thefe were of a far flighter nature, and none of them turned out any way un- tractable or fatal. By this time I had both learned the general opinion about the difeafe, and feen the fource of it in the letter mentioned; imputing the proxi- mate caufe in a general way to the action of pu- trid and difeafed bile in the firft paflages ; and the influence of certain occafional or exciting caules, putting it into motion and adtivity. But | had met with a cafe on our paflage from Madras, which, in perfec ignorance of all thefe theories, and even of the name of fuch a diforder, I had cured by opium alone, and I determined to follow what I | thought ee a eee ee re ee SPASMODIC CHOLERA. 57 thought the guide of experience. A ftout healthy man was fuddenly feized with the fymptoms of this difeafe, which foon became fevere. The {pafms appearing the moft alarming and urgent part of the complaint, and the patient being in the vigour of life, and of uncommon mufcular ftrength, four grains of folid opium in two pills, were given him on his firft complaint, and two or three tea {poonfuls of a mixture of equal parts of laudanum and ether were rubbed into the pit of his ftomach. In half an hour the {pafms not abating, his pulfe be- coming weak, his heat diminifhing, and his coun- tenance pale and funk, after fomenting his legs with cloths rung out of warm fea-water, and rub- bing them well afterwards with dry flannel, four grains more of opium were given him in a. {mall glyfter. In about two hours after this, the fpafms began to abate; he recovered more heat, and look- ed better. An ounce and ahalf of Glauber’s falt was given him, to counteract the aftringent effeéts of fo much opium ; after which he vomited a little, was well covered'up in his hammock; foon grew hot, and {weated fome. The cramps left him, and he recovered the natural firmnefs of his pulfe, and p natural look; flept well through the night, and was 53 SPASMODIC CHOLERA. was perfectly well the next day, exeept a watery loofenefs, which continued for a few days after. ” Recolleéting the fuccefs of this cafe, our firft pa- tient at -Trincomalé, had, on his firft complaint, four grains of opium in two pills, and his ftomach was well rubbed with landanum and ether. Some- time after this, a laxative glyfter was adminiftered ; and he was put into a warm bath of fea-water, where he continued about fifteen minutes. On coming out of this, he was well rubbed and cover- ed up in bed, and had for drink warm wine, well mulled with fpices. The fpafms did not abate, and his ftools continued thin, watery and frequent. The laxative glyfter, and warm bathing were both repeated without any good effect. A cold clam- my fweat came out, and he died in about four hours after the cramps came on. The event of this cafe unfettled my opinion as to the efficacy of opium, and threw me back to the authority already mentioned. I had heard much of latent and lurking bile, as the general fource of India difeafe, and refolved to feek for, and hunt it out by the means employed by others, viz. repeat- ed {mall dofes of Sal. Glauber in Aq. Menth. Pip. sad fharpened with a very {mall proportion of Emeti¢ _—- ‘sar wrt. -—_ tt — - y 403- ’ a aot Om me” {ra ' 5-< 4 SPASMODIC CHOLERA, 59 Emetic Tartar, fuch as an eight part of a grain to each dofe, with ‘a view to quicken the operation of the falts downwards*. This plan was accord- ingly tried’ with our next patient. He threw up a very fmall quantity of greenifh-coloured bile, and the folution’ operated much downwards: but without any relief or difcharge of ‘bilious matter. i next gave him three grains of opium diflolved in a {mall mucilaginous glyfter, and’as foon as it fettled in his bowels, he'was put into the warm bath ; after which’ he was well covered up in bed, with warmed cloths conftantly applied to his tomach and limbs ; and he drank hot wine,.mulled with {pices. No relief appearing ‘to follow: thefe meafures, a warm purgative'glyfter was given him, but was followed: by no‘ bilious difcharge. No vomiting continued after the’ firft éxhibition of the.purga- tive ; but a repetition of it, to fee if any bile lurk- ed ftill in the ftomach, and could be folicited ; downwards, Pree Ee ee CL See eee Pee Lee See ee Te Tee ONE. eee * How fuch a laxative had ever come into ufe, I do not now conceive. None could have been lefs fuited to the {tate of the difeafe, in any form it which it occurred, Both of the articles are by far too irritating, and debilita- ting in their operation, to be adapted to any of the bowel Wy diforders of India, and they were accordingly foon entirely vert difcarded from ufe. C * mh «PT ae - uy OF pps et ee ae pee Ria” 5 SENS hy 7 Pee aa ee 60 SPASMODIC CHOLERA. downwards, brought on continued retching, and he threw up after this every thing he drank, till his death, which happened ia five hours after his firft complaint. In neither of thefe two patients, had the opiate the {malleft effe@, either in re- ftraining the purging, or in abating the {pa{modic affection. At this time, by cefire of the captain, we were vifited by the admiral’s furgeon. The flag-fhip had been the feveret fufferer by the dif- eafe ; and this gentleman difapproved entirely of the ufe of opiates, and recommended the employ- ment of purgatives ;—the purgative antimonial folution, caftor oil, rhubarb and calomel, with purgative glyfters ; and what was of really more worth than all of them, warm ftimulating cordials, and the application of heat in every poflible way. This plan was accordingly followed in the two fueceeding cafes, one of them ill at the time; all with the fame ill fuccefs. One of them died in feven, and the other in eight hours illnets. In the cafe of -our fifth patient, after giving the folution, till it operated both ways a little, and he had been in the warm bath, [ had recourfe again to opium, ‘Two grains were firft given him, and repeated in an hour, with the addition to each of fix oo ee are BT, nage ae wo : 2 SPASMODIC CHOLERA. 61 fix grains of camphor, and as much.aromatic pow- der *, made up into a bolus. He was covered up in bed, and had warm tea, made ftrong with ar- rack, for drink. After this, he fweated fome; his heat and pulfe were reftored in fome degree 3. his countenance aflumed a better look, and the fpafms had nearly left him. But his breathing became catching and laborious; and he had a {trong craving for cold drink, which, however, was withheld from him, and he was half-forced to drink warm wine, mulled with fpiceries. Heat was applied to his body in every poflible way ; but nothing had any further effect in recovering this, or in raifing his pulfe; and he died in five hours after the {fpafms had reached the abdomen. This patient was evidently dozed with the opium, and afforded the only inftance where this effect was perceptible from it. 7 The fymptoms in the cafe of our fixth patient differed in no refpect from any of the foregoing, except that the fpafms were never fo general or fevere. His pulfe was at one time fo weak, as not to # Puly. Aromat. PA. Lond. oF GeO POL i> ge -* ey ae a 7 Sy et AP le 4s —- >. OF LMF LS ra uA TA; aa a \ pee 2 es se, . . - os ~ Ck eee re >= — > i wet ee ‘ TT gis 5 Wy REE iene Se 62 SPASMODIG CHOLERA, to be felt at the wrift ; but after being in the bath for twenty minutes, it could be again diftinguifh- ed, and never became {fo quick.as in the advanced ftage in the other patients. A part of the notes relating to his cafe having been loft, I cannot fay what was done for him in the firft.inftance; but the fequel begins with bbferving, That he had all along coniplained of fome pain and, confufion in his head ;—that the pupils of, his eyes were. dila- ted. Some hours after being in, the: bath, his heat and pulfe returned in.a tolerable degree, and the {fpafms left him. A glyfter, with fome Ol, Ricin. was given him, and repeated again in the evening, without producing much difcharge. . Next, day, he ftill complained of ,weaknefs, confufion in, his bead, and the pupils ftill kept dilated. His pulfe was rather frequent, and his appetite was bad ; “but he mentioned no other complaint., . Wine and nourifhing diet was prefcribed for him, and he had fome dofes of calomel.and James’s. powder at night. In this way, he lingered on to the tenth day from the firft attack, when he died in a low dozing ftupid ftate *. Along i * See a fimilar inftance in the letter fubjoined. This was the only cafe I knew of, where the patient furvived the firft attack, ’ eee ees 7 SPASMODIC CHOLERA. 6 lw Along with the laft cafe, we had two firong and healthy feamen attacked in the night, in the ufual manner. { had by this time begun to conclude, that the proximate caufe of the difeafe was not to be fought for in the ftate of the bile, nor of any of the alvine fecretions, and that without any rea- foning concerning this, our remedies ought to be directed more to obviate or remove the moft ur- gent and dangerous fymptoms,—to fupport the vires nature ; the circulation and heat in the external parts, and that evacuations were not to be urged any further than merely to clear the ftomach and bowels once. Accordingly, our two patients had each, as foon .as 1 was called in the morning, a fingle dole of the purgative folution.. It only produced in one fome retching, and brought away {ome phlegm. Both were put immediately into the bathing tubs, which were now kept ready for ufe. After remaining there for a quarter of an hour, they were well dried, and rubbed all over with apartament ese attack, and did not fully recover from the effects of the dif. eafe. This cafe appearing, by its termination, fomewhat dif. ferent from all the reft, ftood fingle in the notes, and has been accordingly left out in the general enumeration. 64 SPASMODIC CHOLERA. with warm arrack, and well covered up in bed with warm blankets rolled up and laid along their fides and between their legs, with plenty of warm tea and arrack fer drink. In an hour, the fpafms not abating, the coldnefs of the extremities, fink- ing of the pulfe, and the finking and lividity of the countenance rather increafing ; they were again put into the bath, and the fame courfe of frictions and covering up in bed repeated. One recovered his heat a little while in the bath, when he ate fome food, and his pulfe, which was fcarcely: di- ftinguifhable before, could again be diftinctly felt at the wrift. He took, in two portions, after being covered up in bed, Sp. Minder. 3i.*, Sp. Lavend. comp. 3ij., Aq. Fontan. et Arrack a 3ij.. Fell foon into a warm foft fweat; recovered his ufual heat and firmnefs of pulfe, and was well next morning, except that he had a watery purging, which continued fome days, but went off under the ufe of mulled claret, and a dofe of caftor-oil. The other took, after coming out of the bath the fecond time, Ol. Menth. Pip. gtt. 1j., Spt. Corn. Cervi a at * Aq, Acetitis Ammonie, Pd. Ed. + es ees ee SPASMODIC CHOLERA. 65 Cervi gtt. Ix. * in divided portions of rice-water, and afterwards warm tea and arrack for common drink. His pulfe, which had been completely gone at the wrift, did not return, but the fpafms had abated while in the bath. A cold {weat came out on his extremities, and every part of the body became perfeétly cold; nor could the pulfe be diftinguifhed for two hours after this. His coun- tenance became exceedingly wan, funk and livid. with general oppreffion, anxiety and jactation, He drank much of the warm tea with arrack ; his pulfe began at laft to be felt, trembling at the wrift, and the fpafms gradually went off. He fell into a found fleep, and was next morning free from all complaint, except languor and weaknefs, fome pain of his head, and a watery loofenefs, which re- mained fome days; and for which only a dofe of rhubarb and calomel was prefcribed for him. - Both thefe patients had, during the complaint, glyfters of plain rice-water warmed, two or three times thrown up, merely to fupply heat internally. A feaman, who had been for fome days affected with a fevere flux, attended with griping, ftrain- E ing, * Aq. Carbon, Ammoniz, Pd, Ed. 4 - - : * . . ei tee in Ae alg gs aq yar * . v — —e ve pen gore he ge ee oe ee Oe ge ° ‘4 . SEX ; -- : =a © eS ee eee oe nS atic : < wi, . —_ bare * ES =) oe ae a , a \ 2b Pal 00 SPASMODIC CHOLERA. cm iag, mucous and bilious coloured ftools, and for which he had taken feveral evacuant medicines, was at this time attacked with the ufual fymptoms of the mort de chien.. Two grains of opium were given him on its firft invafion. This in a fhort time carried off the fpafms, and his pulfe, which had began to fink, was reftored to the natural Gate. He fweated fome, flept well through the night, a nd was well next day, but low and weak, and his flux ftill) remained unabated and of the fame appearance, but was removed for the time by the ordinary medicines; at leait he had made no further complaint, or I had neglected to take any further account of him. But it foon after appear- ed it had not been cured ; that the fource of it had been deeper in the fyitem, and that, from the be- cinning, it had been the liver-flux, though he had not at this time any pain in the fide. Symptoms of inflamed liver, however, foon took place, of which he was effectually cured under my care in Madras hofpital, by a mercurial courte. The cafes that appeared after this, were all of a different nature, much lefs fevere, and none turned out fatal. They were all ef them combined with bilious accumulations, and in patients where this diathefis , SPASMODIC CHOLERA. 67 diathefis was vifibly prefent at the time. There was a load and oppreffion about the ftomach ; the evacuations, both by ftool and vomiting, were bili- ous, and the purging was attended with griping rather than tenefmus. The countenance, in place of becoming pale and livid, was fallow, and the tongue and eyes tinged with a yellow colour; the feet and legs were very apt to become cold, but the {pafms were never fevere, and did not advance beyond the legs and thighs. The difeafe was eafily and fafe- ly cured in all thefe, by gentle laxatives, joined with aromatics, warm glyfters, warm wine, and cordial diet and drinks. | Upon the whole, the difeafe prefented itfelf un- der two diftinét and different forms, and required a treatment that behoved to embrace a confider- able variety. In what might be taken as fimple and uncom- bined cafes, where no fymptoms of. bilions collu- vies were diftinguifhable, from the appearance of the ejected matters, or from the ftate of the abdo- men, or the colour of the tongue, eyes and urine I came at laft to conclude, that all kinds of eva- cuants were not only ufelefs but hurtful; and that they only tended to increafe the proftration of 3 ttrength, 68 SPASMODIC CHOLERA. ftrength, the finking of the pulfe, and feverity of the fpafms; which, in all fuch cates, formed the moft dangerous and alarming part of the com- plaint; and although, in fuch circumftances, there was no contra-indication to the ufe of opiates; yet, unlefs they were given early, before much finking of the pulfe, and failure of the vires nature had come on, their effect was but tranfient or uncer- tain, or only trifling and temporary ; fo that no benefit was likely to be derived from them, unlefs when given on the firft acceffion, in full dofe, and joined with fome ftimulus that acts fpeedily and powerfully ; fuch as hot and. cordial fpiritous tin@tures, the aromatic oils, or the volatile alkali. That in all fuch cafes, the {fpafmodic affection was only to be contidered as fymptomatic, depending me of thefe latent and inexplicable perhaps on fo mpathies of the nervous fyftem, operations and fy about which it is of little ule to puzzle ourfelves in practice ; and that we had little to do with the difcuffion of proximate or other caufes, any further than to obviate or remove, by change of place or otherwife, fuch as might be unfavourable to the main object, viz. that of fupporting the ftrength, powers, and reftoring the activity of the moving the SPASMODIC CHOLERA. 69 the healthy action of the ftomach and inteftines, by {uch means as experience teaches us, are beft adapted to excite the vitality and action of thefe organs. In cafes where the exiftence of bilious colluvies and difeafed fecretions was to be diftinguifhed, a good deal of purging was always neceflary, with cordial diet and drinks, but opiates never. - About the middle of July 1782, I entered on duty at Madras hofpital. Here, again, I had oc- cafion to fee many more cafes of the mort de chien. It was frequent in the fleet in the month of Auguft, and beginning of September, the feafon at which the land-wind prevails on this part of the coaft. We had fome cafes in the hofpital in the end of Odtober, and in November, after the monfoon, but few» in comparifon. Here the deaths were much fewer than on board the fhips. Out of about twenty under my care, only three were loft. In general, the cafes were milder than at Trincomalé. About a third were evident- ly connected with bilious colluvies ; and in thefe, there was no great finking of the pulfe, or dimi- nution of heat; and the fpafms were confined to the legs and feet: there was fome fever, and the E 3 pulfe nal ' OW od —_ e : eal a is et al Fs Sige | w aT a ¥ - — ap Pee “a ee 3 a. a ae 7 ro —s : des et Me 7 “ Vd Tuan gms ~ Ms Le pee = ree eS ag, a . BEL gu san wwe a tee hy”. -= “ _ aay" 79 SPASMODIC CHOLERA. pulfe was frequent as well as feeble. The tongue was commonly foul, and the countenance fallow. The abdomen tumid, or tender to the touch, with more or lefs griping, and bilious difcharges by ftool. Thefe all did well under the ufe of gentle pur- eatives and glyiters frequently repeated, fuch as decoétion of Manna, with Cream of Tartar *, De- coé. Tamarind. cum Senn. and plentiful dilution with rice-water, with Caffia boiled in it. When part of the bile was thus carried off, we fometimes employed thofe that were more active, as Ol. Ri- cin: and when the ftomach was very irritable, Rhub. and Calomel+, made into {mall pills, ftaid better on it’ than any thing we tried, procuring free ftools with as little griping as any. ‘The fa- line or more active purges we entirely laid afide. When the patient appeared to be too much weak- ened by the ufe of laxatives, we intermitted them, and gave warm wine with {pices ; often punch or toddy, till the ftrength was recruited ; but we ne- ver employed opiates, or aftringents. In this way, the bile was by degrees fafely abftracted. The feverifhnels wll ee eee Se rr * Supertartris Potaile. + Submurias Hydrargyri. SPASMODIC CHOLERA. | Vi feverifhnefs abated, ‘the patient foon recovered ftrength, and the natural tone of the ftomach and inteftines ; but the ftate of thefe behoved, for fome time, to be well looked after. The cafes that ter- minated fatally were all exaétly of the fame kind as thofe we had at Trincomalé. A watery purging, but without any appearance of bile in the dif- charges, always preceded the cramps. This was foon followéd by a great finking of pulfe, pale and livid countenance, and coldnefs of the extremities. This appearance of countenance was fometimes fo remarkable, even before any cramps had come ons that in going round the hofpital, I fometimes ob- ferved it, and foretold the acceflion of {pafms an hour or two before any were felt ; and in one or two inftances, the difeafe was prevented from get- ting its full length, and the fymptoms eafily re- moved by applications made at this early period. In fuch cafes, our treatment was fomewhat differ- ent from that practifed on board the fhips. Rubbing the ftomach, legs and feet with flannel {prinkled with warm arrack, fomentations with large pieces of blanket applied as extenfively as poflible, without expofing the body to the external air, were prefer- red to the warm-bath, and warm wine was given, 4 made vs aan Cita “on 4 % - - : » : ‘ “0 F Bits! é Fs 7s 3 ; Dab cal ie Oe Ii cs Tel eer = en a ~ , a, . , para ae t a — 7) “we. ie rr Finda y; ‘ew fae a ~~ t fF , %; fay! ares EA }* DISSECTIONS. made hot with chilies. Draughts, with Sp. Corn. Cerv., Lavender and Ol. Menth. Pip., made as {trong as the patient could poflibly {wallow them, were given frequently, and glyfters of plain warm water frequently thrown up. No evacuants of any kind, or opiates, were made ufe of. In this way, almoft all of them were recovered, even in cafes where the fymptoms were exceedingly fe- vere and unpromifing. The patients who died were foon after opened: In two, there was no- thing uncommon with regard to fymptoms ; nor were any morbid appearances found on diffection. There was no bilious accumulations found any _ where, and the internal organs were all in a found ftate;; only there was more water than natural in the pericardium, and the veflels of the lungs, li- ver and mefentery, appeared to be very turgid and full of blood. In the following cafes, the cir- cumftances of difeafe, and appearances on diflec- tion. were particular. CASE. John Holland, foldier in the g$th regiment, do- ing duty as marine, xt. 30., was received into the hofpital about the latter end of July, with fymptoms DISSECTIONS. 43 iymptoms of inflamed liver, attended, as ufual, with a flux, and fhort dry cough. Towards the end, the flux had been accompanied with fevere itraining and gripes felt in the lower part of his belly, which was fore and tender to the touch: and blood commonly followed his ftools. His fide was early bliftered, and cooling laxa- tives were .given him; after which he went through a courfe of mercury, which removed all his complaints, except the griping pains felt in the lower part of the belly. But thefe were ef- fectually relieved by the application of a blifter over the part, and he never pafled blood with his ftools after this. He was confidered as convalefcent from hepatitis, and was put upon foap and {quill pills, with dofes of caftor oil occafionally, to relieve coftivenefs, (a common confequent upon liver ob- ftruction, or inflammation imperfeély removed ; ) but in other refpects he had no complaint, and he had nearly recovered his former appetite, ftrength and flefh. On the 30th of Auguit, he had liberty to walkfout of the hofpital; ate a hearty dinner in the Black Town, and drank a good deal of {pirits. He was feized in the evening with loofe- nels and gripes; and, by midnight, fevere cramps IT} 74 DISSECTIONS. in his legs and feet began to come on, and his countenance was pale and livid. Such was the account brought by the attendant of the ward, who received directions to adminifter fome elyt- ters, and a gentle laxative infufion of *fenna and tamarinds.. On vifiting him a few hours after- wards, I found his pulfe fearcely to be felt at the wrift; his eyes funk and hollow ; his whole coun- tenance livid; his hands and fingers contracted by the fpafms, with the nails livid and bent in- wards; the whole body perfely cold, with great jactation, panting and gafping for breath. From his meffmates J learned he had drank feveral times of cold water through the night; a fatal piece of imprudence in fuch complaints. All the ordinary remedies were employed for his recovery, but without effet, and he died early in the forenoon. On opening his body in the evening, we found marks of inflammation, and even that fome de- eree of fuppuration had taken place in two or three places on the furface of the liver, though all had been healed up. Large cells, of a white colour, but containing no matter or fluid, pene- trated to the depth of a quarter of an inch, in certain {pots or patches of fome extent; and over thefe DISSECTIONS. 75 thefe places the covering membrane was thicken- ed, puffy and white. In many places it adhered. to the diaphragm and fide; but its fubftance, when cut into, prefented every where a natural appearance; nor was it in any part, or the gall- bladder preternaturally large. ‘The mefenteric veffels were turgid, efpecially towards the lower part of the ilium, and the glands enlarged. . This enlargement of the glands was more remarkable upon the retum. The coats of this gut were much inflamed and thickened. The diameter of the canal was in fome places much contracted ; the internal coat {pongy and ulcerous in many portions, and, in fome fpots, had even a gangre- nous look. . Where the ilium enters the colon, there were fimilar affections, but in a much in- ferior degree. The colon appeared to be pretty found, except that the glands of the mefocolon were enlarged and hard. _ About four ounces of water were contained in the pericardium ; and two foft polypous concre- tions'adhered to the left ventricle of the heart. The right lobe of the lungs adhered. almoft eyery where to the diaphragm and fide; but there Was “6 DISSECTIONS. was neither inflammation nor ulceration in any part of its fubftance. This cafe of mort de chien feems. to have, been excited by topical irritation, and there were no marks of bilious colluvies, or that bile had been any way concerned. But it furnifhes a ferious caution againft irregularity and intemperance in fuch a country as India; it marks the ftrong dif- pofition to inflammatory difeafe of the abdominal vifcera, and the rapidity with which it proceeds to a gangrenous termination there. CASE. Yobn Giggs, feaman, a young man belonging to the Magnanime, was in the other divifion of the hofpital for an ulcer on his ler, and was of a weak and reduced habit. On the 21ft of November, he firft complained of a purging, with fome gripes and ftraining, which, he faid, had affected him only for two days. Pulfe fomewhat quick. Tongue foul. The gentleman who preferibed for him, ordered him a gentle vomit in the eve- ning, and through the night and next day {mall dofes of Glauber falts, in divided portions, diffol- 5 ved. = — DISSECTIONS. 47 ved in rice-water, made hot with Spir. Menth. Pip. On the 22d, he was attacked with {pafms in his limbs, though not at all fevere. Pulfe {mall and quick 3 countenance pale and funk; general pain and fome fpafms in the:abdominal mutcles. Belly rather tenfe and retracted, than tumid or full. He was fuppoled now to have that terrible difeafe the mort de chien, and latent and lurking bile at the bottom of it; and fo a repetition of the Glauber falts, with a grain of emetic tartar in the whole folution, was prefcribed for him in divided dofes. This produced many motions downwards, but brought away little, except dif- coloured watery ftuff. ‘Glyfters of plain rice- water were thrown up the rectum two or three times through the night, and he drank plentifully of warm rice-water with fome nitre diffolved in it. Meribe On the morning of the 23d all his fpafms had left him; he had but little pain in the abdomen, and looked better. But he became much worfe in the afternoon; for, though he continued free from cramps, his pulfe was very weak and quick; his countenance pale, funk and dejected; and the heat, ace ‘Yate i ae! BE . pap cg * ve one ie Fd oo 7 . 2 " § i \ v. » by -s | b . . _ r . \ \ = : oo ABR ~ oe” . we af by \¥ “ & , 7) ! os —7 oat: in. + , PR: ; eS P pais : f anys Ye par t- % wir? - 2% , ype ’ = 3 Z ——— Pie axe Bors > ; = ¥ . 7 ® ’ ' soe bee ai - iy e vo > Whe , > t 72% i. - “+= 7 Ds - a is 7 a ‘ — P « ‘s ts ‘ », ar ~ pet ok ’ — Moe « o'r... a ~ wee ae ae A 4 ore : ahh 1 he > a a z eas ah - 4 =~ - r —— _ ae A“ ¢ wd > ala Bats wt o> i ek 4 rae _ ye, ™ “y- yey : . ad i: all 9 ™ . me pas a ae 4 ae gtr ~—*." ‘ hee ee - . a +e Py > J a « » \ : f ’ mead: _ Peas at , 5 oo tl Se is 5 ’ ‘daa edb a tee ke Ee fey te ee “e' wae ted ~ Se ip ‘ ' + : 49 DISSECTIONS. heat, tenfion and retraction of the abdomen, were greater than ever, with much pain on prefling the umbilical region. His extremities became cold ; and he was fomewhat delirious, with conftant jactation and reftlefinefs; but had no vomiting or retching. On repeating the purging mixture, however, it was thrown up; but glyfters and fo- ‘menting the abdomen were fubftituted in place of it. Warm wine with fpices were frequently civen him; and a large blifter was applied in the evening over the middle of the abdomen. On the morning of the 24th, he was not re- lieved, he complained much of his belly and mght fide ; and the proftration of ftrength was greater. Blifter had rifen well: an opiate and fome mulled wine were given him without any relief, and he died early in the forenoon. On opening the body the following morning, the caput cceecum coli and about three inches of the colon were found in a completely mortified ftate. On cutting into it, a putrid fanies, perfect ly black, and in the higheft degree offenfive to the {mell, flowed out. Inflammation, and thickening of the procefius vermiformes of the colon, and about ten inches of the ilium, were very vifible. = args > Sais = —: a og LAE se et ’ : al - < ELLE PS en Ts DISSECTIONS. 79 The gall-bladder was much enlarged, and full of very dark-coloured bile. The liver adhered every where. to the diaphragm and fide: the left lobe was much enlarged, extending all the way to the top of the fpleen, where it alfo adhered flightly to the peritonzum of the left fide. (The ftate of its fubftance, if examined, has not been marked. ) The ftomach was very much contracted ; and the inteftines, near the mortified portion, were much inflated. There the diameter was rather contraéted. A portion of the upper part of the ilium had pufhed through a rent or opening of the omentum; but there was no ftrangulation of the gut. WNo- thing further preternatural was obferved, only there was about an Englifh pint of greenifh water in the pelvis. This appears a complicated cafe. The pathology of it is, however, exceedingly fimple. A difeafed li- ver was the foundation of the whole. Acrid bile was derived from this fource; andfromthe irritation oc- cafioned by it, and other putrefcent fordes in the ali- mentary canal, arofe inflammation and gangrene of the inteftines. Could the inflammatory affection of the gut have been moderated, and a little time ob- tained to draw off the putrid bile and fordes with which SO DISSECTIONS, &c. which the bowels were loaded, there is no ground to doubt the difeafe could have been corrected at its origin in the liver, by a mercurial courfe. For this purpofe, milder and lefs irritating evacuants, perhaps, ought to have been employed; with warm cordials, and perhaps opiates occafionally, to moderate irritation; and, above all, the early application of a blifter to the abdomen, where it was ftrongly indicated by the prefence of topical pain, tenfion, and retraction of the parietes,—ap- pearances that are never equivocal tn the abdomi- nal diforders of India. In this Cafe, alfo, the {pafmodic affection feems to have arifen from 1rri- tation; occafioned by topical affection, rather than from difeafed’bile ; and it was but flight, and ea- fily removed. Tuis variety in the appearances, on diffechon, ——topical difeafe in the abdominal vifcera evident- ly connected with it in fome inftances, bilious re- dundancy appearing in others; while in fome of the worft and fevereft cafes, neither one nor the other could be reafonably prefumed, created a com- plete SG LG ea ee ee a a SPASMODIC CHOLERA, Sr plete puzzle in all our fpeculations about the proxis mate caufe,—or to what we ought-to impute the ipafmodic affection, and great irritation on the nervous fyftem, which made fo conipicuous a part of the diforder. But about its effential character, in all the varieties, as a diféafe of extreme: debili- ty, we had little doubt. From what caufe, or how induced, might be difficult to explain, as well as to account for the other phenomena. In whatever way this may be done, or whether we are able to do it fatisfatorily or not, the thing itfelf is no way different from what I believe will be found a ge- neral rule in all cafes of irregularity and overac- tion in particular portions of the nervous fyftem : That they are all but difeafes of debility at bot- tom. ‘Thus epilepfy and hyfteria (where they cannot be traced to a difting irritation) are moft effectually cured by tonics ; and even tetanus jit- felf, if we may believe fome late accounts, has been cured by conftant libations of wine. How far the combinations between depraved or redundant fecretions of bile and the mort de chien might be accidental, or how they might ftand in the relation of caufe and elteét, antecedent or con= fequent, is not ealy to fay. We know that cer. F tain hegitf ih fis Sor ors LAO aes TL” ae . =f iy Pe ee , as —— a: § mae > . * ) F Ss Le pits eee fee n> d - ° - < ce - A P = _— Say ag eee , * —S rs of Ronin = $2 SPASMODIC CHOLERA. tain impreflions of fhort and tranfient operation © are often followed by remarkable effets upon this and fome other fecretions. ‘Thus, fudden paflions, or a fhort over-exercife in the heat of the fun, or lying down'to fleep upon damp grafs after fatiguing exertions, will, in certain feafons, bring on, in our own country, cholera morbus or a bilious fever, even where there were no marks of an increafed fecretion of bile previoutly exifting. We have many examples, again, to thew, that certain fti- muli excite their effedts neither on that part of the fyftem, to which they are directly applied, nor in proportion to their ordinary force, but according to pre-exifling tone and pre-difpofition. Thus, during the teething period, al moft every exciting caufe of difeafe produces ‘n children a complaint that foon terminates in a powel-diforder, and fo of many others. Since returning to Europe, I have had occafion to fee many cafes of the difeafe called in India - mort de chien, fimilar in all re{pects to thofe we had at Trincomalé, only that they were much milder, and attended with lefs collapfe of the a res nature. ‘The fpaims were exactly of the fame kind, but confined to the feet, legs and thighs. All of a. a 1 — aS foes ee tice o 7 oe se > hts” —cngeenttaa aa dileaiaanliaa ia ee , i ’ oe . Pie; : , r meen! ee i amid ee | tele =r tage wii 2 rr s a . od SPASMODIC CHOLERA. 83 of them happened in the fiimmer or autumnal feafon, and none of them proved fatal, except in the cafe of a poor pedlar at Dumfries, for want of proper accommodation and eafe. One inftance was in the cafe of Mr J. G., tanner in Edinburgh, whom Dr James Hamilton primus was alfo called to fee. In ali thefe cafes, warm fomentations with cor- dials were effectual ; and the Pil. Opii comp. Pd. Edin. wete retained on the ftomach, and anfwered well. No evacuants were made ufe of in any of them. which enfures the patient, and gives time to com- plete the cure. In relaxed habits, where the pulfe finks fuddenly, and brings on immediate danger, the fame method muft be purfued, but with more caution. The emetics and purges muft be gentle, and made cordial with wine and Spirit. Lavend. Laudanum muft be at hand to gain time ; and though it is a dangerous expedient to fufpend evacuations where putrid bile lurks, yet of two evils the leaft is to be chofen; for the patient muft fink to death in fuch a cafe, if a refpite from eva- cuations, pain and fpafms, 1s not procured. But if a little time can be gained, ftools can be pro- moted again. In thefe fevere cafes, wine and wa- ter acidulated, for common drink, will. be necef- fary; and fhould a fever arife, purging will re- move it.. In general, nothing that ruffles is fafe, F 4 where ——— =~. a a 88 GOPY OF A’LETTER, &e. where putrid bile lurks in the habit ; and much attention and attendance is required. This difor- der originates in the liver.’ The fecretions are difordered. The bile becomes altered in quality and confiftence, and the digeftion is impaired, un- til the foundation of fome illnefs is laid. An ac- cumulation of gelatinous ftuff in the flexures of the duodenum and colon takes place, which locks up putrid bile, until fome additional caufe fets it in motion. Bleak winds, dews, and infalutary ex- halations, from cold, unventilated, and damp fitua- tions, give a fudden check to perfpiration, which proves a ferment to attenuate and fet in motion this latent mifchief, ‘This is the fource of the | difeafe you have in camps, and of all the putrid fluxes and putrid remittents common in the coun- try where hills and woods are. As the difeafe often leaves liver-obftruG@ions behind it, which bring on fluxes, when the men have picked up s; 4 z! wy x % - | ftrength, dofes of rhubarb and calomel will be neceflary afterwards. The firft campaign made in this country, the fame difeafe was horridly fatal to the Blacks ; and fifty Europeans of the line were feized with it. I have met with many fingle cafes fince, and many of ' —_— COPY OF A LETTER, Xc: 89 of them fatal or dangerous, of -different kinds, arifing from putrid bile being difturbed by acci- dental caufes, or by emetics or purgatives, exhi- bited before it had been blunted or corrected. Thefe loofe remarks, in anfwer to yours, I have thrown together, without correétnefs, being hur- ried at the time with Europe letters. Farewel. I am, Sir, &c. J. Patsiey. N. B. T have feen a comatofe difpofition enfue, after the patient has been greatly reduced from the feverity of the fymptoms, and die. : LIVER DISEASES. HEPATITIS. Every where on the coaft of Coromandel, and, I believe, every where in Lower India, and e{pecially in camps, fleets and hofpitals, difeafes of this organ, under one form or other, prevail fo much as to entitle them to be confidered as the grand epidemics of the country. From the month of July 1782. to Match 1783, [ believe they conftituted at leaft one-third of our whole RETO = go | HEPATITIS. wholé hofpital cafes. In the fummer months of 1782, they were ftill more numerous. -’ When we confider the importance of the organ, andthe fun@tions it performs in ,the fyftem ; to- gether with the variety and delicacy of its ftruc- ture, we cannot be furprifed to find it on many occafions, the feat of extenfive and dangerous difeafes. But what the circumftances are that lead to this in India, fo much more than in all other countries under a fimilar latitude, will not be ea- fily fpecified. All the inflammatory affections of this organ are denominated here, as well as in Eu- rope, by the general name of Hepatitis. But India Hepatitis includes a variety of affections of this bowel, different in their nature, extent and ter- mination. | From what I obferved in the courfe of attend- ing a very great number of cafes, three diffe- rent fates of it were fufficiently diftinguifhable - Hepatitis, with inflammation more or lefs acute: Hepatitis, with chronic inflammation ; and. He- patitis with chronic obftruGiion. ‘The firft runs readily into fuppuration, and at an early period. The fecond only accidentally, or in conlequence of neglect, or improper treatment. Both lay the foundation eS HEPATITIS. gt foundation for long and obftinate fluxes, but are almoft always eafily cured by the proper exhibi« tron of mercury ; but now and then terminate in what may be called the third form; a ftate of chronic obftruction. This is always the confe- quence either of previous inflammation imper= feGly removed, or of the healing up of extenfive abicefles, whether by incifion or otherwife, and is always attended with a coftive belly. he cafes that terminated fatally with us, were chiefly thofe that were fent on fhore in an advant ced ftate of difeafe ; and. who had, perhaps, been negligently or improperly treated in the begin- ning. At leaft a attributed to this the great number of patients fent us from the fhips, with large fuppurated livers, during the fammer months of 1783, when we had a large fleet in the éoun- try ; many of the fhips lately from England, and, of. courfe, the furgeons but little acquainted with the India Hepatitis, which differs in many circum. {lances from that of Europe. What conftitutes the chief danger and difii- culty in managing the complaint, is, that the fymptoms which are primary, and indicate jn- flammatory affection, are often but very {lightly marked ; g2 HEPATITIS. marked: even where it is m fuch degree as to run with great xeadinefs and rapidity into fup- puration. The pain felt in the fide is not at all conftant or acute ; the patient himfelf takes little notice of it: feldom mentions it unlefs he ts afk- ed about it; and, when you do fo, he tells you only, he has felt at times flight pains about the pit of the ftomach, or about the right fide. And it is only from obferving the fecondary fymptoms, fuch as a flux, ora fhort dry cough, and pain felt at the top of the fhoulder, or that there is a degree of fulnefs or tendernefs on prefling the region of the liver a little hard, with fome yellownefs of the eyes and countenance, that the true ftate of the difordeér is to be afcertained. In about four or five cafes only, out of a great number, the commencement was attended with fymptoms of pyrexia, 7. ¢. heat, thirft, quicknefs of pulfe and rigors, with an acute pain in the fide, extending to the top of the fhoulder. ‘This Jaft, which is confidered in Europe as a conftant and pathegnomonic fymptom of the difeafe, is far from occurring in every cafe in India. It is not always, when it does occur, in proportion to the degree of fever, or pain of the fide. It is often felt : oP ey . es Pet) eee nantes Rite Ee HEPATITIS. 93 felt feverely when the laft is but inconfiderable, and fometimes. continues long after it is gone off 3 or it frequently remains during the whole time the liver is in a ftate of ulceration, or of much obftruction. Whether it be a more conftant attendant on the membranous or parenchymatous inflammation, ] was unable to determine. But in feveral cafes that ended in large and deep-feated ulcerations, it never took place: while it was common. in others that were only flight, and eafily removed. Whenever it did occur, it ferved to render the nature of the difeafe very certain.- It is moft dif- tinctly felt at the very point.of the fhoulder, ra- ther behind; and is aggravated on moving the arm. In fome cafes, where the left lobe of the li- ver was known to be affected, the fame thing was felt at the top of the left fhoulder. And-in one cafe, the patient complained of a fimilar pain in both, Though the difeafe commences often without much pain, heat, or quicknefs of pulfe; yet this is not univerfal ; for fometimes there is both quick- nefs and fulnefs in the pulfe; and in two cafes there were confiderable rigors: but moft com- monly . a i ty i ee ee ee he, ——— = 2 al a S= eee eee * — »: : . — aaa 7 te EM a Se — - — = “aD * wh Ae vi . - be! tee YG ana eS 1S AN 7 . es __ >. —e EL Set 7 O04 HEPATITIS. monly thefe leading circumftances were wanting. . We only found that the patient had had a flux, which had lafted for fome time, with more or lefs firaining and griping; and perhaps paffed fome blood with his ftools, which were flimy and bilious ; and that this flux had refifted the common reme- dies, or had been but little relieved by repeated eva- cuants. And when we came to examihe him about the ftate of his liver, he would fay he had at times felt pain in his right fide. And on examining the part, a fulnefs could perhaps be obferved under the ends of the falfe ribs, towards the pit of the ftomach ; and that he complained of fome pain upon prefiing the part a little hard, or upon taking in a full infpiration. BY thefe fymptoms, the na- ture of the complaint was rendered fully certain, thotigh he had formerly obferved no pain there, or had but little or no fever, nor ever felt any pain in the fhoulder; efpecially if to thefe were added a fallow look, and yellowifh caft of the tunica al- buginea, which never fail in fome degree to at- tend every liver affection in this country. ‘The flux very often precedes every other fymptom of the inflammation, and is the moft conftant attend- ant upon it: except in a few cafes where the at- tack HEPATITIS. 95° tack is more fudden and accute, and then a fort’ dry tickling cough is often prefent. Both ‘are fymptoms only, and are cured along with the in- flammation itfelf, and by the fame means. In fome cafes the flux remains long, and proves obftinate ; moft probably in confequence of topi- cal affection of fome part of the inteftine, occafion- ed by the irritation of difeafed and acrid ‘fecte- tions. This appears evident in the advanced ftate of liver-fluxes, by the bloody fools and ‘griping felt in the lower part of the abdomen. Fluxés; we found to be fo conftant attendants in this coun try upon a difeafed flate of the liver,’ that after a little experience, whenever they refifted even for a {hort time the ordinary methods of cure, we be- came immediately fufpicious of the flate of that‘or- gan,—that it was affected either with inflamina- tion, or ulcerated, or in a ftate of inflammatory obftruction. We knew from diffection that obftruc- ted mefentery had alio fometimes a concern ; elpe- cially in thole cafes that were of long ftanding, and attended with relaxed habit, and a debilitated ftate of the organs of digeftion: Such pattents are here called Lienterics. We had at all times a great number of cafes that were fimple, arifing from g6 | HEPATITIS. from a fuperabundant or difordered ftate of the bilious fecretion; and we had fome occafionally from irregularities, and from cold and obftructed perfpiration. But we found fo often affections of the liver at the bottom of the complaint, or ap- pearing in the courfe of it, as to make us cautious and diftruftful in almoft every cafe. True dyfen- tery never appeared in the hofpital; nor do I be- lieve it is ever to be met with in Lower India: at leaft without being imported thither, We had enough of fluxes from difeafed bile; with highly putrid and dyfenteric fymptoms as the difeafe pro- ceeded in its courfe: but thefe were of a nature totally different from true dyfentery, and began in a different quarter,—in the upper part of the in- teftinal canal. In fome cafes, after all the fymptoms of inflam- mation in the liver had been removed, and the patient had been reftored to his former ftate of health, appetite and ftrength, and a clear counte- nance, flight pains of the fide would continue to be felt at times, and a hardnefs of the bowel could be perceived ; but I never faw any very re- markable enlargement of it—Large Scirrhous Li- ver, or, what is called, Liver-grown. While HEPATITIS. 97 While this ftate ‘of hardnefs and pain continued, it was eafily aggravated by any irregularity ; par- ticularly in drinking, and it was always attended with a coftive belly ; fo that it was difficult to get | any thing to purge the patients freely, except caf- tor oil. The fame thing was obfervable jn feve- ral cafes where abfcefles of the liver had been cut for and healed up. But there were net many in- {tances of relapfe in the hofpital, where the difeafe returned again, or advanced to the ftate of uleera- tion, (though fome pain might remain at times), after the patients had gone through a proper courfe of mercury. he period of the difeafe was of no certain ex- tent or duration. If the acceffion was with py- rexia, or acute fymptoms, the progreis was more rapid than where it was flower, and where thefe were wanting. If it was neglected, or wrong treated in the beginning, it fometimes ran very fuddenly into fuppuration, even where there were no acute fymptoms. Perfons who had been long in the country, and lived irregular, were more fub- ject to it than the more temperate. Occafional caufes were not very diftinguifhable ; but I fometimes imagined, that long-ftanding bi- G lious ~ g8 HEPATITIS. lious fluxes had the effect of inducing difeafe in the liver itfelf; for certain appearances of this fome- times took place in cafes of fuch fluxes fo long af- ter they had come on, and where nothing of the kink was obfervable at firft, as could not have fub- fifted where we were fo much on our guard againtt this affection. The difeafe in the organ is, per- haps, excited by the acrimony of its own fecre- tion. When:the inflammation was not foon refolved by the exhibition of mercury, the fubftance of the liver ran {peedily into a ftate of fuppuration. An abfcefs formed, too often of very large extent. A great deal of the fubftance of the liver came to be broken down and deftroyed; the matter fome- times finding its way by the gall-dudts, which foon brings on a putrid flux, and deftroys the patient. When the abfcefs was on the convex part of the liver, the matter not unfrequently made its way through the diaphragm, eroded the lungs, and came to be fpit up. In two cafes of this fort, where the ulcer had extended deep, and eroded the gall-du@ts, much bile was brought up by cough- ing mixed with fanious matter, plainly diftinguith- able, not only by the colour, but the bitternefs of tafte. HEPATITIS. 99 tafte. One patient was opened after death, and we found the pafflage through the diaphragm not larger than would allow a very {mall quill to pafs. The liver was a mafs of ulcerations and putrid matter, and almoft the whole of the right lung was obliterated ; the fpace filled up with a {pon- gy loofe membranous fubftance, difpofed-in thin layers. What remained of the lung was fhrivel- led up to the top of the thorax, and very knotty and hard. There muft be very few inftances of fuppurations of the liver healing up in this way. We had feven or eight of thefe cafes at the hof- pital, but all of them proved fatal. When the abfcefs forms on the fore part of the liver, and is not feated very deep in its fubftance, the matter frequently points outwards, forming an indiftinct kind of tumour 5 which appears ofteneft juft under the ends of the firft falfe ribs, or be- tween them and the pit of the ftomach, fometimes right over it; and one was opened near to the ends of the falfe ribs on the left fide. In other cafes, the tumour forms more backwards within the ribs. One was opened between the fourth and fifth falfe ribs. G 2 This IOO . HEPATITIS. This tumour fometimes appears fuddenly, and, when the ulcer is not deep-feated, is tolerably cir- cumf{cribed and prominent. But unfortunately the feat of the matter, in many inftances, is not ex- actly pointed out by fuch a tumour at all. ‘There is only a fulnefs and hardnefs, or rather a general fwelling, which pits a little on prefling it with the points of the fingers: or, before any external tumour is formed, by which the feat of the matter can be’exactly known, it has {pread’ too far be- low; has formed a large abfcefs within the fub- ftance of the liver; and, when at laft an incifion is made, and the matter is let out, it has {pread and deftroyed much of the fubftance of the organ ; or it has found, or afterwards finds its way by the ' gall-duéts, and brings on a fatal putrid flux. ‘The ulcer does not fill up and heal; the matter fur- nifhed becomes acrid and ftinking, and produces new inflammation, and fpreading ulcerations. ‘This was the unfortunate courfe of a great many cafes we had in the year 1782. Out of ten pa- tients in which the abfceffes were opened, we only faved two. In one of them, the tumour was di- ftinguifhable the firft time he complained of any pain in his fide; and he never felt any in the fhoulder. — HEPATITIS, Lot fhoulder., He was in the hofpital for the cure of. an ulcer, and only had a flight flux for fix or eight days; for which fome evacuating medicines had been given him. The tumour in two days was prominent enough to be opened. The ulcer in the liver was of no great extent, and the matter was white, and without any bad fmell. The other had complained longer, but the tumour was not at all elevated nor circumfcribed.. An incifion was, however, made near an inch into the fub- ftance of the liver; but no matter being come at, and a confiderable hemorrhage enluing, it was thought unfafe to proceed farther. The matter, in two or three days, made its way to the opening. It was in no great quantity, and the patient foon got well upon a mercurial courfe *, G3 In (7275 SE cones ne * A fimilar inftance came under my care at Dumfries, in the year 1785. A boy about eleven years of age, had evi- dent fymptoms of inflamed liver, and of fuppuration having taken place within the falfe ribs, pretty far back, where they were evidently pufhed out and elevated ; forming at one place a kind of indiftin@ tumour. With fome difficulty I per. fuaded the boy himfelf, and his parents, to fubmit to have an Opening made at this place: and proceeded fo far as to cut Pp £ } : P through the kin, and divide the intercoftal mufcle, meaning to ae . jf A by ier gE F [ Bae i ' 102 HEPATITIS. In the fummer months of 1783, flill a great- er number underwent this operation, and only three or four were recovered by it. There never was any danger in making the in- cifion. ‘The nature of the complaint had always become clear enough before any thing of this kind was refolved on ; and if there was any thing of a tumour at all, we were fure that, previous to the formation of this, the inflammation had pro- duced adhefion between the membrane of the li- ver and peritoneum, fo as to exclude all the con- tiguous organs from coming in the way of the knife. I never. faw either the flomach or colon, . the only organs that could poflibly interfere, affect- ed by the inflammation, or that the matter had made its way into either of them. In feveral large fuppurations of the liver, we fometimes found ee a ees +o pufh a lancet into the tumour; put the boy himfelf got frightened, as well as the people about him, and would fub- mit to nothing farther. In the courfe of a week, however, matter in confiderable quantity began to appear; but the opening being by this time contraéted, it infinuated itfelf fe- veral ways under the fkin, and formed feveral new openings for itfelf; whereby, in the courfe of fome time, the difeafe of his liver was completely removed, and the openings all healed up. HEPATITIS. 103 found: the dreffings tinged with bile, but never any appearance that a communication had been formed with. the colon or ftomach; even where the patient furvived the opening a long time, and the difeafe proved fatal at lait. The external incifion was generally made near to and parallel with the ends of the ribs, and this was fometimes undertaken, and ‘the matter found where no diftiné fluctuation could be telt. Caution was always obferved in making it 5 to proceed flowly, to wipe away the blood, and exa- mine the parts before every ftroke of the fcalpel, until the matter was found. It was necefiary to carry the incifion of the teguments much farther than was required’ for giving verit to the dil- chargé; as the opening was very ready to clofe up, unlefs kept open by tents, which were hurtful, by confining the matter, and caufing it to {pread with- in. Of whatever kind this was, it very foon be- came exceedingly acrid ‘and ftinking, foon after it was expofed to the accefs of the-air. Generally it was fo at the very firft dilcharge ; commonly of a thick greafy confiltence, of a liver-colour, full of red lumps fwimming in it, and of a pecu- liar fmell. This we thought the wortt kind, as G4 none 104 HEPATITIS: none recovered where it was of this appearance. In others, it was more thin and pale-coloured, but equally acrid and ill-fmelled. All of it tin- ged the probe with a brown colour. Seldom, in- deed, was there any thing like good pus. In one eafe it was a clear fluid, refembling the water of an hydatid. It was common to throw in injections, with Mel Rol. or Tinéture of Myrrh, three times a-day, and to give bark. In only one cafe did the bark feem to produce any favourable change in the condition of the matter. In all the reft, it did no manner of good. In by far the greateft number, the ulcers were of very great extent. Two, three, or even more pounds of matter, were fometimes difcharged at the firft opening ; and often the finger could be turned all round within it, without reaching any part of the fubftance of the liver. Where there was fo great a deftruction of fubftance, the pro- {pect of recovery could be but very fmall. Curz.—Whenever the difeafe came on with a confiderable degree of fever, with acute and con- itant pain in the fide and fhoulder, fome bleeding was practifed: but in other cafes it was never done ; HEPATITIS. 165 done § and indeed to the extent to which it could well be carried in a warm climate, and in relaxed habits, it feldom procured much relief. A large blifter, applied over the part affe@ed, had much better effects, Oftener than once it appeared to have removed the inflammation entirely. When it was intended to follow the mercurial courfe by frictions upon the fide, this came to be in the way of that; but was never without effe@ in relieving the pain of the fide and fhoulder; and cough, when thefe were prefent. Whether bleeding or bliftering were employed, it was always. of confe- quence to clear the bowels, and carry down the difeafed fecretions, by a purgative or two ; falts and manna, in gentle dofes, or Deco@. Tamarind, cum Sen. ; or if a ftronger was wanted, ‘caftor oil, Sometimes a few cooling powders, compofed of nitre, gum-arabic and Cream of Tartar, were given fora few days at firft, along with the mercurial frictions ; efpecially where there was heat, thirft ‘and pyrexia, with a view to abate thefe, and ren: der the operation of the mercury milder. Some thought this rendered the exhibition of it more fuccefsful and fafer; and I have obferved relief obtained from the ufe of thefe before the mercu- ry . ——— er nee: a ~ pod ee f 'e t v t a a 106 i HEPATITIS. ry could have entered the fyftem in fuch quantity as to produce it. Tn all other circumftances, or as foon as the pain of the fide, heat and fever, had been a little abated by the ufe of thefe remedies, mercury was imme- diately had recourfe to, and the courfe pufhed on, as quickly as poffible, without any regard to the fate of the bowels, even where there was a con- ftant flux, with bloody ftools and tenefmus; fome- times where even a good deal of heat, thirft and general fever were prefent, provided the pulfe was not hard, andthe pain of the fide had fomewhat abated, or was not very conftant and acute. Our dependance upon it was fo great, un- lefs where it was fuppofed the diforder had al- ready advanced to fuppuration, that the more prefling the fymptoms feemed to be, we were the more anxious, with the precautions already men- tioned, to get the fyftem {peedily and fully charged with it. Its good effect in every fpécies of liver difeafe, except in tht flate of ulceration and fim- ple diforder of its fecretion, viz. fimple bilious fever and flux, were fo apparent, that we had recourie,to it with the fame confidence as in lues venerea. Scarcely was it ever obferved to. increafe the heat and HEPATITIS. | 107 and fever, or to aggravate the pain of the fide or cough; and the bowel diforder, flux and bloody ftools, were often removed by it alone, or they dif- appeared under its ufe without any other reme- dies ; fo that I began fometimes to fufpe& that.our precautions and apprehenfions about its aggravat- ing effects in certain circumftances of the difeafe, had been imaginary only. A flux is fo conftant an attendant upon inflam- mation and inflammatory obftrudtion of the liver, or obftructed mefentery, that very often, when it proved obftinate, we had recourfe to mercury for its removal, when we had no other foundation for fufpecting an unfound condition of thefe organs than merely the flux itfelf; and generally, if the conftitution was found, with perfect fuccefs, Of- ten, while we were going on with our mercurial courfes for the cure of inflamed liver, and fup- pofed it to be nearly, or fully removed, a return of the flux’ would take place on our abating the mer- cury, and we were obliged to pufh it on again, and continue it longer, for the removal of this fymptom, after all pain of the fide had been long xyemoved. The . i fay. HEPATITIS. The preparations of mercury moft generally ufed, were a pill compoled of a grain and a Half of calomel, and two of rhubarb and foap. Of thefe, two were given every night and morning, and if it was thought neceflary to have the mouth foon affected, a drachm of mercurial ointment was alfo rubbed in along the fide every night. The blue pill was fometimes ufed in place of the calomel, and anfwered equally well, efpecially where it was wifhed the mouth fhould be foon affected, and the bowel diforder was not great; but where this was the cafe, I was certain the rhubarb and calo- mel pills fooner corrected it. It may be thought, much of the mercury would run off and be loft in this way, but this did not appear; for the mouth became as foon affected with either of thefe, as by the mode of friction. This, however, is not fo eafily excited in India, and goes fooner off than ih colder climates. After the mouth became fore, the mercury was continued in fmaller dofes for» ‘two or three weeks, or until every fymptom of the difeafe had difappeared; and we had reafon fo fuppofe the inflammation quite removed, and the liver reftored to a natural healthy ftate ; mot mere- ly till the pain of the fide was removed, and the bowel HEPATITIS. 109 bowel diforder had been fully corrected, but til} the patient recovered his natural appetite and ftrength, and the fallownefs and yellow colour of the countenance was exchanged for the clear look of returning health. Few other medicines were; in general, neceflary during the ufe of*the mercu- ry ; except now and then fome eafy laxatives, fuch as {mall dofes of Rhubarb and ipecacuanha; or Khubarb and Cream of Tartar, when the other was not fufliciently active to carry off the irritating matters ; or emollient glyfters to remove tenefmus. Such is the hiftory of the acute ftate of liver inflammation as it appeared with us; and fuch was the general mode of treatment. Where the circumftances were tolerably favourable, we fuc- ceeded, in almoft every inftance, in curing it. But very often the patients were too far gone before they came under our care. ‘The difeafe had run on to a flate of fuppuration, or was too far in pro- grefs towards it, before mercury could be intro- duced to check and prevent it. Whether ulce- ratiens of any confiderable fize were healed up by it, 1 could not be very certain. But from what we faw on diflection, in fome cafes where the pa- tient died afterwards of ether complaints, and had been Fee =e —_ ; Ca Se . . - hg ‘ — ETERS go ET ede Te : eg ha 2 : . re i See » - ae MA aes ae Sh ho ; AL eee tiga os SS ee - pai s : ay a og 2a a : . 4 v¥ i} ci — Rt » fies mk ph = Re ee oes) es 114 CASE OF William Quail, feaman on board the Seahorfe, on, the 6th of June 1782, complained of flight flux, without much ftraining or gripes. Having been on fhore for the cure of a fcorbutic ulcer, his com- plaint was imputed to fome irregularity ; to drink- ing too much of the cocoa-nut juice, called toady, or too free a ule of vegetables; and a flight purge or two were only prefcribed for him. On the oth he was fuddenly feized with a cold fhivering fit, which was fevere, and followed by heat and fweat- ing. This was repeated four times in forty-eight hours, but the periods were not perfectly exact. During the fit, his pulfe was quick, and his fkin was hot; even when he was under the rigours. In the intervals, he was free from fever, and in all refpeéts pretty well. He faid he had felt at times pain in his right fide, but 1t was not conftant otf fevere. He mentioned alfo his right fhoulder, which, though I had then never feen hepatitis, fuggefted a fufpicion of his liver being affected, and I knew that it was a frequent difeafé in India, but he mentioned alfo that he had a pain acrofs his loins, and, at times, felt pain in the left fhoulder ; and fuppofing that hepatitis was always to be diftinguifhed by acute and conitant pain in the fide and. HEPATITIS. Its and fhoulder, with a conftant ftate of fever, and the fits, though fomewhat irregular, refembling thofe of intermittents, the idea of hepatitis was given up, and the complaint was fuppofed to be of the aguifo kind, arifing from fome foulnefs in the pri- me vie. He had an emetic and laxative, and, after the fecond fit was over, bark in pretty large dofes. This was continued for two days. The fits went off, but he had more fever. On the 13th he again mentioned pain of his fide, and that his flux, which had been relieved, was returned. It was now in- tended to put hin on a courfe of mercury, and, preparatory to this, his fide was fomented and a blifter applied over it; which removed the pain entirely. He had nitrous powders in his drink, a dofe of foluble tartar, and fome fmall dofes of rhubarb and ipecacuanha to the 17th, when he complained of a fulnefs and oppreffion at his fto_ mach. On infpedcion, there was no appearance of fwelling, but it was painful on being preffed. A {mall dofe of tartar emetic was given him, which evacuated him downwards. On the 20th, he com- plained of opprefion of breathing, and began to cough. ‘lhe emetic tartar was repeated ad vomi- tum. Next-day he began to fpit up bloody ftuff H 2 | with = Se J pte aa i OTT, ee a * ae sail EIT « r16 CASE OF with his cough. » This foon changed into pure pas, and in a fhort time to pure bile, which continued to the 25th, when he died.', He paffed alfo yellow purulent-like ‘matter downwards, in confiderable quantity. After the blifter, he never complained of any pain of his fide or fhoulder, but ‘at the pit of his ftomach. And the true nature of his dif- eafe was not fully underftood. till it thewed itfelf too plainly, and too late, by the {pitting of bile. The liver had been inflamed from the beginning, and the difeafed ftate of this organ: had been at the. bottom of the flux and fits of pyrexiw ; yet all this while the pain of the fide and fhoulder were but flight, never conftant, and were eafily remo- ved. But there is not the leaft doubt, if he had been narrowly queftioned, a degree of pain in the region of the liver, would have been found to exift from the very firft acceffion of the flux, though he had attended but little to it himfelf; or, atJeaft, he would-have been fenfible of fome forenefs or tendernefs to the touch, on prefling the part a little hard, or in making a full infpiration, or fome fulnefs at leaft would have been difeover- ed; and the early exhibition of mercury would, in all probability, have fucceeded in faving him. This HEPATITIS. 1i7 ‘This was an inftructive cafe, although at the poor man’s expence. More experience, acquired in a fhort time, removed all rifk of fimilar blunders, and rendered the diagnofis in fuch cafes much more eafy and certain. econ a TR eee a BILIOUS DISEASES. BILIOUS FEVER AND FLUX. By this title is not to be underftood any deter- minate {pecies of fever necéflarily connected with a bowel diforder, as in dyfentery.; or any fpecies of idiopathic difeafe of the febrile kind whatever. The fever, on the contrary, is purely and perfec- ly {ymptomatic ; and 1 am indeed doubtful, whe- ther, on the coait of India, there be any other. Ty- phus, fynochus or iynocha, fcarlatina and eryfi- pelas, were unknown to us; and both» remittents and intermittents appeared only at the hofpital as fymptomatics, depending on difordered-and fuper- abundant bile, and other vitiated accumulations in the firft paflages. H 3 Sut ri En - « rr 5S de) wD ~ ¥ ~ 7 ¥ ” ee r ‘ a . alteqel eee . - =e =I pe he SONI Ee scot germane» a deg a tate ‘ t ew ; “At Se =" ee _< Pome — - 555 ane — 7 " aw eee eee, ~ Li ea Ps wer Ne 118 BILIOUS FEVER But, although the fever makes no neceflary or effential part of the difeafe, it 1s feldom entirely wanting where the bowel-diforder has been of any ftanding ; and the fymptoms of it often run fo high, as to create no {mall additional danger, and render the management of it a matter of much delicacy: So that it becomes highly neceflary to | have a particular eye to it, both in the defcription and treatment of the complaint. This kind of fever and flux was not attended with more yellownefs of the fkin, eyes, or urine, than commonly accompanies all the India dif- eafes where the liver or its fecretion are concerned. The flux frequently precedes the acceflion of fever, or the latter only appears occafionally or tranfient- ly, according to the degree of acrimony and accu- mulation of difordered fecretions in the ftomach and. upper part of the ‘nteftinal canal ; and its ex- acerbations and alleviations follow pretty exactly the degree of thefe. The fever never remains a day after the bowel-diforder is fully corrected, but for the moft part terminates fooner, or is only occafion- ally renewed and lighted up by the renewal of frefh accumulations. That AND FLUX. 1g That both flux and fever are produced and main- tained by a fuperabundant and vitiated condition of the bilious fecretion, in the firft inftance, is a- bundantly plain from the nature of the difcharges, and the diforder induced on the alvine functions. In relation to the ftomach, it is evinced by naufea and ficknefs, bitter tafte in the mouth, load- ed yellow tongue, and want of appetite. In the upper part of the inteftinal canal, it is fhewn by anxiety, fenfe of weight, and fulnefs about the precordia, pain, tumour and fulnefs, with fome forenefs and tendernefs on prefling the part with the fingers. In the middle portion of the tract, it is evident by the tumid abdomen, with tendernefs and un- eafinefs on preffure,” gripes, flatus, borborygmi, fpafmodic and fhifting pains; and that uneafy fen- fation which may be called bowel-fickne/s ; diftin- guifhable from ftomach affection, as confifting in that fenfation that arifes in cholic, or whenever acrimonious or irritating matters are put into mo- tion in the inteftines by the action of their coats, whether from the addition of a purgative ftimulus " & or otherwife. H4 In > oe i wes peng: a a jo pAL oe . ie ae - cs Sn ee we nbeeesulicaited > - Sia Sally, OT eT ee el P< : 120 BILIOUS FEVER In ‘the! lower portion of the. inteftinal, canal, efpecially in the rectum, and. particularly ‘inthe latter ftages of the difeafe, it is teftiied by griping, ftraining,,tenefmus, mucous, and’ bloody ftoals, ofa deep bilious, or of a fanious. or, putrid appearance. More or lefs of the fame appearances are to be found in the difcharges by ftool in every ftage of the com- plaint. But unlefs where! topical. affection. has early taken place, the firft difcharges confifi more of flime and bilious matters, and,in larger quan- tity, than in the fubfequent periods,. The caufe from which the difeate had its origins always appeared to be fuperabundance and, acri- mony of bile, inducing diforder in the ftomach, and in the feeretions of the upper part of, the ca- nal. But the diforder was not long confined to. this portion, but made its way downwards by de- grees, whereby it had the appearance of being di- vided into different ftages ; which, however, had no other, diftinction, ner any certain periods. of du- ration. The occafional. or,.exciting caufes were, in ge- neral ; irregularity in living, great exertion and fa- tigue under expofure to the heat of the fun. Of this we had frequent experience among our con- | yalefcents AND FLUX. i2f valefcents who. were, allowed.to’ walk out. of the hof{pital :. and, in| the number of patients received from the fhips, parties employed in watering, and other dutiesion fhore.. In moft of thefe, the atrack was fudden and) fevere, and attended with a high degree’ of fever. ;. ‘The pulfe fometimes hard, but always very frequent; tongue and fkin dry, hot and parched ; and the patient very foon became -delirious. By>.far the greater: number were: fent us fromithe fhips with the, difeafe in a more _ad- vanced {tate ;' with, the tongue thickly covered with a yellow cruft; witha {mall and quick pulfe, pale funk, or. fallow. countenance. great heat, pain, tenfion and tumour ofthe abdomen; ftupor and anfenfibility ; now and then with wild phrenfy and delirium ; and fometimes, with. cold extremities, hiccup, and cold fweats, In this ftate, it is-hardly neceflary to fay, they generally died. Inflammation and gangrene of the inteftines foon came on. The mildeft evacuants were either rejected from the ftomach, or before it could be brought to bear fuch as could be any way effectual, the -difeafe had made too great progreis to be arrefted.by any remedies ; or the, mildeft laxations we could employ, brought on fo much irritation as greatly exafperated all the {fymptoms ; L122 BILIOUS FEVER fymptoms; ‘and ‘cordials, diluents, fomentations and glyfters, were fometimes all we had to truft to. In many inftances among thofe taken ill at the hofpital, the acceflion of the difeafe was obferved to be much more gradual; and it fometimes af- fected thofe of the moft careful and regular modes of life. A purging, with more or lefs griping and ftrain- ing, would begin to come on, attended with an uneafy fenfation of weight about the precordia ; anxiety, depreffion and lownefs of fpirits, with ftools of a bilious colour, a dark-yellow, witha ‘mixture of green ; and this would continue fome- times for weeks, the patient all the while going about, and enjoying a tolerable ftate of appetite and health ; till at laft the bilious fecretion came to be fo increafed and vitiated, as to difordex all the fun@ions of the ftomach and bowels, and to bring on fever, with an amazing redundancy of bile, which would often continue long after the fever was removed. In moft cafes, the degree of fever was pretty much in proportion to the cumv- lation in the upper part of the alimentary canal, and kept pace pretty exactly with the ftate of eya- | | cuation AND FLUX. 123 cuation made from it; fometimes difappearing in a fhort time, or being only renewed at intervals in the progrefs of the complaint, or when new accu- mulations had taken place. In this, which might be called the Fir/t Stage of the diforder, there was generally more or lefs fulnefs at the pit of the ftomach, with fome fore- nefs or tendernefs on preflure there, or rather be- tween the pit of the ftomach and right hypochon- drium ; or between it and the umbilicus, towards the right fide. And fo much fufpicion and an- xiety being neceffarily attached to the ftate of the liver in every India flux, much perplexity was apt to arife from this feeling in fimple bilious difor- ders. But in general the true index was to be found in attending to the circumftances of the cafe, ; and the concomitant fymptoms. The pain here was more dull, deep-feated, and lower down, farther from the ends of the ribs than where the liver was concerned ; and where the fever and bowel irritation was not fo great, as to prevent a brifk purgative from being given, fo as to carry down a load of difeafed congeftions from the turns of the duodenum, the pain and ; uneafinefs Ses oe —— — . —_— - —_— a —s ~~ . ‘ _ — ~ i eeecemmentens tm -—- —————— eae —_ = = 7 Nee 1 .. ¥! : | ie | y Se i > : : é : b eo Ji Sam" { {fs k "es SS Pie (4 ‘ ; , a & ' ar 4 4 bee . | Dat) Zt cet \ ; F Gre | \ "Gen bY ; eee eee a =e mere y - Lert Ee oa; ’ sy eo eee i ae <—- ius — as vr? . - li Ska ey ré cad yo ea ai t 124 BILIOUS FEVER uneafinefs in this cafe will be greatly relieved by it. But no fuch relief is obtained from them in hepatic affection. ee, Pretty acute pains are alfo fometimes felt in the courfe of the difeafe in various places of the ab- domen. Some portion of the inteftine becomes affected with pain of the fpafmodic kind ; per- haps with ftricture and accumulation of the con- tents: and this not unfrequently happens in fome part of the arch of the colon. In one cafe, where a pain of this kind kept pretty much fixed about the edge of the liver, much fufpicion was occa- fioned by it about .the fate of that organ: but from obferving, that it alternated with fimilar pains in other places of the abdomen, and from the relief obtained by purgatives, or from the motion through the inteftines being free, the true nature of the cafe was afcertained ; and fully con- firmed in, the event, by the complete recovery of the patient, without any one remedy for the cure of liver-difeafe being employed. 3 Another fymptom, often attendant upon the fe- brile ftate of this difeafe, and indeed very com- monly felt by fome perfons in India, whenever bile predominates in the firft paflages, is a torpor or numbnels AND FLUX. 32 ey numbnefs in fome of the limbs, arifing in fome cafes to a degree of paralyfis. The right arm is often affected in this. way; fometimes only the outfide of the hand, or two or three of the outer fingers are only affected. Others have {pafms and cramps in the legs or feet. The horridly-fatal difeafe, commonly known, when I was in India, by the name of the Mort de Chien, which has been already defcribed, was con- fidered by fome of the firft practitioners there, as entirely a difeafe of putrid bile. Though I did not at all embrace this opinion, but confidered the two diforders as {pecific and diftinét in their na- ture, though frequently in accidental or occafional combination ; yet both at Trincomalé, when we had the difeafe in the Seahorfe, and in the fummer months. of the year 1783, while it was frequent in | the fleet, we had patients fent to the hofpital from the fhips, under bilious fever and flux, affected with the fame fort of external {palms and cramps as take place in.that diforder. . But then, in all thefe cafes, the fpafms were much milder; the difeafe much more tractable; the fpafms appeared to be | only fecondary; and the exiftence of bilious ple- thora was perfectly confpicuous. The ye ? GR AT ce EINE, na “ Re 28 ’ Piers 5 \s " m4 mm, oi ¥ a ‘ a a) ¥ = = = 5 ON ae AP . ta ‘pipe : . aoe wd iS A " be 4 @, af oe os ‘ . - eee — s RO ee ee ore err e- ~~ — - —_- r te ~~» @&, ’ _. - A : re. ~ ange _ cae a Fen F c ae —— { I hs . be 126 BILIOUS FEVER The fame fpafmodic affection occurred alfo in fome inftances among our people at the hofpital in the courfe of bilious and liver fluxes of fome ftanding. In the firft ftage of bilious fever and flux, along with fome pain, tumour, and fulnefs of the abdo- men, with preternatural heat of the part, and fore- nefs on preflure ; the tongue was dry and yellow, and the eyes and urine had fome tinge of the fame colour. The latter fometimes tinged the linen with a duiky brown or yellow ; but this was very unfteady and variable. Very often there was little purging or griping when the patient lay ftill in bed, or while the con- tents of the bowels were not difturbed, and put in- to motion by laxatives; but as foon as their ac- tion was excited by this means, violent pain and griping were produced, with a conftant redundancy of bile and difordered fecretions, which often con- tinued for an indefinite period; and if thefe were not as conftantly carried forward by promoting the aGion of the whole inteftinal canal, a return, or aggravation of the fever, and all the fymptoms, was the infallible confequence. The AND FLUX. 127 The ftate of the abdomen was a pretty fure in- dex of the quantity and degree of thefe accumula- tions ; but this was by no means to be taken from the patient’s own defcription or feelings, but from the degree of fulnefs: and tendernefs on preffure ; from the effect the firft exhibition of purgatives or glyfters had in exciting pain, griping and fick- nefs ; or from the appearance of the difcharge pro- duced by them. This indeed was varied at differ- ent periods of the diforder. Conftantly there was a greenifh colour, varying from a dun and duifky yellow, to a dark and dirty black. The laft pre- dominates during the febrile period. I have feen them, for weeks, of the colour of mofs-water. Some- times there was more of a red colour, like choco- late or coffee grounds ; and when this was the cafe, with much pain, tumour, and tenfion of the ab- domen, the difeafe often ended in topical in- flammation and gangrene of the inteftines. When the ftomach and upper part of the intef- tinal canal had been pretty well cleared, and the difeafed fecretions carried downwards by repeated evacuations, what may be called the Second Stage ef the diforder commenced, Partial accumula- tions GE CAT a IE al 128 BILIOUS"FEVER tions of difeafed: matters: full continued td be fe- newed from time to time ; and the diforder fettled lower and lower down, accompanied with much sriping and ftraining to ftool |; often with fome blood in the ftools, and frequently,; with fome degree of dyfuria,—pain and difficulty of voiding urine ;, but with intervals, and. a confiderable abatement of fever, pain and general diforder of the abdomen: or, inftead of being tumid, the abdomen rather be- came fhrunk and retraéted, with the {kin tenfe, dry and hot, and the pain more confined to a par- ticular {pot, indicating more of topical affection ; which we found on diffeGtion to have: affected in feveral inftances the figmoid flexure of the colon, and upper part of the rectum. Irregular fpafmodic contractions. of the lower bowels, efpecially. of the rectum, frequently took place ; preventing the free and regular propul- Gon of the contents of the inteftines ; and rendered the frequent exhibition of glyfters and purgatives neceflary, even though the ftools were perfectly liquid, and in large quantity, whenever the mildeft ef thefe were given. If AND FLUX. 12g | ‘If the difeafe continued long :in this'ftate, efpe-: cially if the patient was of a reduced! habit, or much debilitated by long refidence imthe country, it ended in what was confidered as its Third and Laft Stage,—a lienteric or colliquative diarrhcea. This was often of long ftanding, and terminated fatally, long after fever and redundancy of bile had entirely difappeared. The patients continued to be haraffed with frequent watery-and liquid or mucous ftools; whatever they took by the mouth patied through them in a half-digefted ftate, till a kind of low hectic, and wafting marafmus, conclu- ded the fcene. In this ftate of the difeafe, the belly always be- came collapfed and hollow, with the fkin wrinkled up into folds, and dry ; the inteftines felt through it like a mafs of foft clay, or inelaftic fubftance ; and their contents could be pufhed backwards and forwards through them, with a rumbling noife, indicating fuch a relaxed and torpid ftate of their coats, as no means could recover, if the habit had not been remarkably {trong and good before. Several of the cafes ending in this way were open ed at the hofpital, and the general appearances were inflammation and thickening of fome part of the I inteftinal 130 BILIOUS FEVER snteftinal canal: Sometimes a degree of ulceration of the internal:coat of the rectum, and adhefions of it to fome of the neighbouring parts, and moft commonly obftruction, and enlargement of the mefenteric glands, or enlarged and obftructed liver. The rationale of this difeafe is perhaps as clear and fatisfactory as in any we meet with. It 1s a matter well eftablifhed from extenfive obferva- tion, that in all hot climates, and in India more than any, a fuperabundant and vitiated condition of the bilious fecretion, is in a manner a conftitu- tional temperament. In what manner this is pro- duced, whether from a difeafed ftate of the organ itfelf, or from an alteration produced upon the fluid after its feparation in the liver, may not be fo eafy to determine. Perhaps both may have a fhare. A quantity of this difeafed bile getting into the ftomach very readily produces diforder there, and difturbs the functions of digeftion ; and this, together with the accumulation of bile, and undigefted and difordered fluids, lodging in the turns of the duodenum, we confidered as fufli- cient to account for the-fymptoms attending the firft AND FLUX E3E firft tage of the complaint; while irregular {pafms, which generally affe& the inteftines, interrupt or prevent a free and regular paflage downwards ; and unlefs fome purgative ftimulus has been ear- ly and regularly employed, to carry off this load of bile, flime, and colluvies of difeafed fecretions, they foon run into.a ftate of putrefcent fermenta- tion, which produces an acrimony fufficient to kindle up fever, and produce all the confequences we have mentioned, While. this bilious. redun- dancy continues, the functions of digeftion, both in the ftomach and. upper trad of the inteftines, are very imperfectly performed; and_ the long- continued irritation to which the inteftines are fubjefted, comes. at laft. to debilitate their tone and action, whereby they do not fufficiently propel their contents; and. frefh accumulations. and. con-~ geftions are again and again formed, which, as they fettle lower down, bring on a difeafed ftate of the lower portion of the traé, particularly of the rec- tum, with topical affeQion of the gut. Though bilious plethora and fever, with the firft fet of af- fections have been all reduced ; yet the long-con- tinued irritation, together with debility and re- laxation ariling from the heat of the climate, has I2 in me ; | 1 =a Sethe Sn | “a g i A or = _ ~ on a ert , z 132 BILIOUS FEVER in a great meafure deftroyed the powers of digei- tion and chylifaction, fo that no found and healthy nutriment is produced; or an obftructed ftate of the mefentery, or perhaps of the liver, has come on, which lays the foundation for marafmus and a contintal flux. From this fimple view of the difeafe, our plan of treatment was deduced, and confifted chiefly, or almoft entirely, in {the choice and exhibition of evacuants, adapted as well as we could to the condition of the diforder, the ftrength and confti- ‘tution of the patient, and the irritability of the flomach and bowels, without a fpecific regard to the fever, which we confidered as fymptomatic only. ‘Notwithftanding, however, of this fimpli- city of plan, it required all our caution and judg- ment to adapt thefe properly to the varying cit cumftances and conditions of the patient, as well as in the proper choice of matters. Cure.—The ftate of the pulfe never feemed to indicate the neceffity of letting blood. This was a remedy almoft- unknown with us; nor do I re- colle& ever to have wet a lancet in India, except in fome cafes of acute hepatitis, or on account of | fome AND FLUX. 133 fome external injury. Inflammatory diathefis, or a rigid and tenfe fibre, which Europeans may be fuppofed to retain for fome time in hot climates, never appeared at all diftinguifhable in India. The long voyage, the greateft part of it within the tropics, perhaps takes off that conftitution by the time the India fhores are reached. When the fever was moderate, and the difeafe was not attended with much irritation of ‘the {ftomach, pain, tenfion, or fulnefs of the abdomen, pretty brifk purgatives might be .employed: at firft, and were neceflary to unload the upper por- tions of the alimentary canal. But thofe of the leaft irritating fort wete always chofen, fuch as Soluble Tartar *, with Manna; fometimes with the addition of Tin&. Senne Comp., ‘or, where more freedom could be ufed, Decoé. ‘Tamarind. cum Senn. ; or, in very irritable ftates of the fto- mach, a faline mixture, with a large quantity of magnefia diffufed in it, and three or: four drachms of Tinét. Rhei, given by divided dofes. This made a very pleafant and agreeable laxative, and always refted on the ftomach, efpecially if made I 3 warm * Tartris Potaflz, ce ¢ apt ; ~ SU) ES Ake ™ ‘ = be > Se * 5 —— - . 5 a ‘: n = ee has = ; ~~ — a > ey L- ge 7 a et ~ © “ Pei ws = ; oe 2 ees ee i Fn : ¥ . ‘ — " So, — = oe! re ; a ~ = ¢ ns ae 3 rahe = : 4 4 . : — > - sf by! 7 Ad . - ~y v P a See eee, ag =< q SET “ein vt < “tae - : . 3 a « , “= PEE es % ; no . + ; Te. te A RN Pe res ? as phi 2 7 a ~ “SA. 134 BILIOUS FEVER warm with Ol. Menth. Pip., or with peppermint water. When the ftomach had become fettled and fteady,;’ and ficknefs was abated, caftor oil did as well ds any. Emetics were never thought of, or the neutral falts, on account of their nau- feating effe&. Weak chamomile tea, or rice-water only, were given to wafh the ftomach when fpon- taneous vomiting took place. Perhaps, after bi- lious redundancy had been removed, and the dil- eafe had-come to fettle upon the colon and rec- tum, emetics, in mild and naufeating dofes, orm full ation, might have been ufeful, with a view to. revulfion of fecretions, and to promote the difcharge by the fkin, which, in theie circum- fiances, was always dry ; but this was not tried. Plentiful dilution with farmaceous drinks, fuch as rice-water, and frequent glyftering, were very ufeful in relieving irregular fpafms and tenefmus, efpecially on the days in which no purgative was ufed... Some. purgative medicine, however, be- hoved to be given every fecond or third day at leaft, till the fever and griping, tumour and fulnefs of the abdomen went off, and the ftools put on a healthy colour and appearance, or at leaft nearly fo; for frequently a greenifh. caft of AND FLUX. 135 of colour would remain in them, long after thefe fymptoms were in a manner removed. In this condition, caftor oil was frequently employed as a purge; and not only operated with as little ruffle and irritation as any, but brought off, perhaps, a fuller difcharge from. the upper part of the in- teftines than moft. Decodtion of Senna and ‘Ta- marinds, with a drachm or two of Sal Ro- chelle * diffolved in it, was fometimes employed. (The Soda Phofphorata + was not then known at the hofpital.) Some aromatic oil or feeds were generally added to whatever purge was made ufe of. What I thought anfwered beft, where a con- fant courfe of purging behoved to be kept up, either for the removal of bilious accumulations, or for counterating irregular fpafms interrupting free paflage, was about two drachms of cream of tartar {, with half an ounce of manna, boiled for fome time’in a confiderable quantity of water, and fome aromatic fpirit added afterwards.’ ‘This, ta- ken in divided dofes, acted with lefs irritation, 14 and oo sibepebinos tp hos veh pa els at ease. * Tartris Potafle et Sode. + Phofpas Sodz. + Supertartris Potafle. ; Ves = = —— — mS Y ow ———— eee Sb < ke ee et ad : - x36 BILIOUS. FEVER and weakened the patient lefs than moft we em- ployed. Under this treatment, the greateft number of our milder: cafes recovered in the courfe of three weeks or a fortnight, without any further afliftance than perhaps fome light infufion of aromatics and . bitters, after the bowel-diforder had fubfided. When the attack was more fudden, with more fever and general commotion in the fyftem, with greater irritability of the ftomach, bowel-fickniefs, full, tenfe or tumid abdomen, fevere griping, heat, thirft and proftration of ftrength, we thought it ne- ceflary to proceed with much greater caution. For if, under fuch cireumftances, any purge that acted brifkly was given, it was either rejected by the flomach, or it brought on fo much retching and irritability, as was very difficultly allayed, or the fever, griping and pains of the abdomen were greatly exaiperated by it. Often thofe of the mildeft kind could not be ventured on, till a quan- tity of the putrefcent fordes had been drawn off by the ufe of glyfters and plentiful dilution. But thefe, to be effeCiual, behoved to be given fre- quently in the fame day, and of confiderable quan- tity ; ufing at firft plain rice-gruel, which we had always AND FLUX. * : 137 always at hand, and afterwards adding: a little Sal Glaub. *, as we faw needful. Rice-water was what we always gave for drink, with a little caffia, fometimes with tamarinds boiled in it; and often a quantity of magnefia was diffufed in this, with directions to ftir it when ufed. If the patient was very hot and feverifh, or had a vomiting, with fome delirium, with much ten- fion, fulnefs, and pain of the abdomen, or a weak and faultering pulfe, with coldnefs of the extre- mities, (in which ftate we often found them), we thought it neceflary to defift, for fome time; from giving any laxatives by the mouth, and trufted entirely to the ufe of glyfters: but then it was doubly neceffary to be conftant in the ufe of thefe, to fupport the patient’s ftrength, and allay the irritability of the ftomach, by fuch cordials and anti-emetics as the little variety of a foreign hofpi- tal difpenfatory put within our command; a little Madeira wine, boiled with caffia, and given warm, or a little ftrong tea, with Ol. Menth. Sativ.; ot what an{wered as well as any thing, a mixture of Aq. Menth. Pip. or Sativ. with Tin@. Rhei and Magnefia, * Sulphas Soda. $35 BILIOUS FEVER Magnefia, after every fit of retching ; and in cafes of extreme irritability or weaknefs, 50 or 60 drops of laudanum, in a {mall glyfter. Given by the mouth, opiuin never appeared to be ufed either with fafety or advantage, or for any other purpote, than merely as a palliative to gain time, or unlefs when joined with antimonial or ipecacuan wine in long ftanding diarrhceas. The great danger to be apprehended in this difeafe, is from the readinefs with which inflam- mation and gangrene is brought on the inte- {tines, by irritation from acrid and putrid accumu- lations ; and the only fecurity againft it lies in the timely and conftant ufe of proper evacuants, re- peated as often as a return of fever, eriping, pain and tenfion of the abdomen, foul tongue, bad tafte in the mouth, and impaired appetite, point out a renewal of thefe; and efpecially in guarding againft all irregularity and intemperance, whereby the original fymptoms are very readily recalled, fo that the fame ’ground has to be gone over and over again, in the fame complaint. In fome inftances we had recoveries, where, from the feverity of fymptoms, continual vomit- ings, hiccup, cold {fweats, weak pulfe, and the moft AND FLUX ~- £39 moft putrefcent, offenfive and fanious difcharges by, ftool; there was every reafon to conclude, thata degrée of mortification had taken place in fome portion of the inteftines. As an inftance, I have put down the cafe of obn Quigly, not in my own department of the hofpi- tal, but whom I faw frequently'along with the gentleman who had charge of him; and who, by the conftant and afliduous application of fuch mea- fures as have been mentioned, was perfectly réco- vered, and difcharged cured. But the aggrava- ting fymptoms were two or three times renewed 5 and it behoved to keep up a conftant purging by . one means or other for the {pace of a fortnight, before there was any amendment. Another im- ftance, under my. own care, was in the cafe of Fohn Bowerman, who furvived, for a confiderable length of time, the complete feparation of the whole rectum in a putrid bilious flux; and who, I made no doubt, might have fully recovered, had due care and attention been continued to him. His cafe is added. Such was the general mode of treatment in what might be called the firft tage of bilious fever and flux ; and where there Were no rooted obftru@ions in the liver or mefentery, nor confirmed bilious diathefis 140 BILIOUS FEVER diathefis previoufly exifting, the difeafe moft:com- monly terminated here. The fever, and that pe- culiar anxiety and oppreffion of {pirits, which ac- companies redundancy of bile in the upper part — of the firft paflage, went gradually off. The ftools returned to a natural colour and appearance; and the tongue and countenance put on a clear and healthy look. But in a great proportion of cafes the difeale ran out to a’great length beyond this, and come menced what might be called the Second Stage. The patient continued to be diftreffed with a con- tinual flux, with ftraining, griping, mucous, and fometimes bloody ftools ; {pafmodic pains in dif- ferent parts of the abdomen ; with heat and dry fkin, and fome evening fever. ‘There was fome return of appetite, or rather an anxious craving for fomething to fill up, and give alittletoneandftrength to the fyftem ; and though there was but little thirft, and the tongue looked pretty clean, yet there was no healthy digeftion. There was fome yellownefs on the tongue towards the root, with a fallow and. fickly caft of countenance, and dull yellowith co- lour in the white of the eye. Under thefe cir- ~~ cumftances, AND FLUX. 14r cumftances, it was neceflary to continue the ufe of purgatives at intervals, and to employ thofe of a’ more active fort. Whether it was, that few India fluxes of any ftanding are not connected with fome difeafe, or obftruéted ftate of the liver or mefente- ry; or that fome degree of this was induced in the courfe of bilious fluxes, I could not pofitively determine: but we conftantly found, when the difeafe continued any time in this ftate, mercurial purgatives anfwered much better than any other ; or that mercury, combined with purgatives, and continued on the alterative plan; fuch as a pill, compofed of rhubarb, calomel, and foap, 15 gr. of each, given every night and morning, tillit began to affe& the mouth, effected cures when nothing elfe did any good ; giving only now and then at night, when this did not keep the belly fufficiently open, a pill with Aloes Socotorin. fubftituted in place of the rhubarb. | Whenever there was fufpicion of an inflamma- tory or obftructed ftate of the liver, the blue pills were given alone, till the mouth became affected; and thefe were continued for fome time longer in milder dofes, interpofing occafional purgatives, when pain or gtiping gave reafon to fufpect the renewal 142 BILIOUS. FEVER renewal of frefh accumulations in any part of the. canal.. Under this mode of treatment, we were frequently fuccefsful, when we were gaining no ground, nor doing any good by evacuants and pal- liatives. | Mercurial friction we feldom had recourfe to in thefe fort of cafes; nor did we carry the ufe of mercury to fuch lengths as fome pretend to have done for the cure of India fluxes, who feem to have proceeded without having had any determi- nate ideas about their nature, or the operation. of mercury. in their. cure. | ) In the advanced, and efpecially in the laft flage of this difeafe, tenefmus was apt to become a very troublefome fymptom. Giving two or three pills a-day, compofed of Pulv. Ipecac. gr. i., and Pulv, Rhei gr. iij. feldom failed to give relief; or what I fometimes fubftituted with the fame effect was, Pulv. Ipecac., gr. iij.; Pulv. Cryftal, Tart., gr. x.; Conferv. Rofarum, 3ij. made up into a bolus, and given in three equal parts through the day ; and we made it a conftant rule to add fome aromatic oil, generally the Ol. Feenicul. Dulc. to all our alterative and purgative pills. | Whenever AND FLUX. 143 ~Whenever fevere pain and grizing, with fore- nefs to the touch, or tenfion in ay par icu ar part of the abdomen, took place, and continued fixed to a {pot, and was not, fully removed by free and full evacuation, efpecially if along with thefe fymptoms, the parietes.of the abdomen were tenfe and retracted towards the back-bone; great. and immediate relief was obtained by the application ‘This we had fometimes occafion to repeat. again and again of a large blifter over the affeCed: part. in the courfe of the fame complaint, and often thought the patient. was relieved by it. from the moft imminent danger; in fo much that it became a kind of routine of practice with us in fuch like cafes, if there was a fixed pain in any particular part of the abdomen, and repeated evacuations and fomenting the belly did not fucceed in re- moving it, efpecially if this was accompanied with heat, tenfion and retraction of the teguments, or whenever, in the progrefs of the diforder, a new affection of this kind came on,—immediately to apply a large blifter over the part ; and when fe- vere griping pains came to affect the lower belly and top of the rectum, with ftraining and bloody ftools, i gttan. ihn oc at wl pe ~ ‘ - — eee 144" BILIOUS FEVER ‘ ftools, we applied them above the pubes with the fame advantage. With regard to the dietetic part of practice, an hofpital admitted of but little. choice or variety ; nor could ftri€t attention be had to this on fuch an eftablifhment, except upon a general plan. But with regard to officers, and fuch as were at fick quarters, we made it a general rule to forbid all hot broths, tea or foups, and roafted meat. What feemed to agree beft with every body where animal food could be made ufe of, was the native mode of dreffing it: The pil/aws and curries, or gril- led fowls, with native pepper, and chicken-broth with thefamefeafoning. Fat and roafted meats were ftrictly forbidden. Dried white fifh and water for breakfaft anfwered very well, and a glafs or two of Madeira, or brandy and water after din- EY, jes e Lae ie’ i ¢ ig T ) ; . Bee i. |S ‘ - } ted { ‘ ‘* t i@ - y PLAT : DEALS BE my re } 3 7. y 7 His) e sa | & . « Ff . Yap ‘ 4 7 q ia . { S| ‘ , . eee 7) : m , i - Oa o£: A Ai a ps wee {ee ‘Tp + ,) Me me) o age + ee Rie ae Bae J t + ‘ we Gu , c eR a4 q t = 4) ip Bs f t = =.= > i! > - H , . i bins - a j Sz : i 3 rr "4 p Be p> San ce | a 7 S) Sas ner. In the fecondary ftages, we never forbade the ufe of fruits, efpecially fuch as were aftrin- er = = ¥, > sae gent ; as the mango, and guavo or pomegranate ; and we always directed a part of the rind to be eaten along with them. They were grateful and oa _—~ ’ bay s, : ee Rs ee . 9 , . grene are brought on the inteftines from. caufes which are feldom, in Europe, productive of fuch effects. — seers De Soe . ure Semey e %. > At 5 {2 rahe on al Sh ai Sy he : - . TS Sai . ' DISSECTION. ure > S 7 7 . Was c ie . i. : aay . - : v= ? 4 : e SS . ~ a 4 we = ‘ = posrr => . * ye Ly aa . ne oe rote € . ’ eer ey & ——— ; 3 oe or ‘i poe ; 5 —* = “aiok: r ast ‘ ar ; = ee See i , eee : * 4 ry On the 4th of Auguft 1782, was admitted into ; the hofpital, 4. B. feaman, under thirty years of ™ — Re ORE at age, affected with fever, fmall, weak and frequent " pulfe, and pain of the abdomen ; but without ten- f Vd fion or fulnefs. He was under fome delirium, and his countenance was pale, with cold fweats over his limbs. His refpiration was laboured and ~ ee en ~~ _— i ee ae KS irregular ; with much anxiety in his countenance, and jactation of his body and limbs. He faid what he ate and drank did not pafs through him, and he complained .of much pain on prefling the um- — . ra ar, ~ : a= ane ie fan pl oa — : rien Sa 3 ‘ aD nai oo 7 F 4 nt — ~ ol oe "s > e : “at . Libcxies ra ~ —— <> ‘ - ‘= . ‘ > as ‘ » — pe aS -- A ae SY eon ate — *. ; 25> ager tee ‘ i wy at Yate? 5 r : P = . ’ r) fas 4) ~~ oN rot 2 - 4 5 % : Fae : \ So eee its) ey vey " vekis ate af > 7 * ¥ , Si ip bilical region. Warm fomentations were @P- plied to the abdomen, and fome glyfters were prefcribed for him in the evening, and through the night ; but nothing was brought away but fimy mucus, with much ftraining. , Next morning 4 . laxative 7 . , “ » — . = - — Ss ee EMIT PPS » LO Sra = Ste Ai> f / pic's . i - 7 DISSECTION: 149 laxative was given him, but was not retained on his ftomach, There was more delirium, or rather wildnefs of look and gefture, for at times he {poke very collectedly. Pulfe very weak and quick, with cold fweats, conftant jatation and reftlefsnefs. All his drink was fpouted up as foon as it reached his ftomach, but without retching or hiccup. After renewing the fomenting, and a glyfter, two pills, containing ten grains of calomel and a grain of opium were given him, and retained on his fto- mach ; but without producing any effe@, and he died in the courfe of the following night. On opening his body next afternoon, the omen- tum was found very much thickened; the lower border of it inflamed and red. The whole of it was dragged over to the left fide, where it was crammed in between the inteftines and parietes of the abdomen. The whole track of the ilium was inflamed, and its blood-veffels enlarged and full of blood. Where it enters the colon, were found coiled up two large lumbrici worms, alive when taken out. Over thefe, the coats of the inteftine were thickened and inflgmed to a high degree, and much contracted in diameter, but with no erofion or ulceration of the gut. Ke -3 In re — j i ° -| ' : .. | 2 : *, { al $ | a Ve ‘ a } | bi he e :" ras : Le Se. FA A : ¥ 7 ms . mr. ‘ : 4 . , ” he ‘ we = f : . ¥ - y re - f > 17 ay Y ‘ , - _ ee A oo Er I 0 eee ; 2 . - a, iY r 3? 8 eg : Pye tae ee : "© 5 ae ee ; -¥ .“ . cians) : f ¥ “ nes i C(O ere eas iar Lt hey oh oo one bd - ~ £24 6 a dened “ Aiea. Fae EL hb 32e : Pa Sy r ~ i a — RA . aa Wins 55 tees inet ate eel A ' Loe argh tkndeb 350 CASE OF In the ilium above, were two diftinét intus-fuf- ceptions, each of four inches in length, the fu- perior portions inverted within the inferior. The 4ncluded parts were pale and bloodlefs. ‘The colon was empty and flaccid. ‘There were no appear- ances of bilious accumulations, or other marks of difeate. CASE-OF MORTIFIED RECTUM. Fames Bowerman, invalid, fome time in the be- ginning of November 1782, complained of a loofe- nefs, with gripes and tenefmus, which he faid had come on fome days before, but which he had not mentioned fooner, in expeétation of its foon going off. He had been in good health, and the wound for which he’ had been invalided had been long healed up. On infpecting his ftools, they were of a dark colour, and very offenfive to the fmell. His pulfe was frequent, with heat of his {kin pain and tenfion of the abdomen, and fome difficulty of voiding his urine. . His tongue foul, and counte- nance fallow. His ‘urine had increafed; and for the laft twenty-four MORTIFIED RECTUM. I5f His abdomen was well fomented, and a dofe of foluble tartar and manna was immediately given him, affifted by frequent glyfters, whereby much dark-coloured fetid ftuff was brought away. This courfe was continued for four days fucceflively, without the colour or fetor of the difcharge being in the leaft altered. But the difficulty of voiding hours he had pafied only a {mall quantity, equal to a few f{poonfuls, with great ftraining and pain. There was fome fulnefs above the os pubis, but not like that occafioned by the retention of much urine in the bladder. A catheter was, however, pafied, and went eafily, but no urine was found in it. A glyfter, with forty drops of Spirit. ‘T’e- rebinth. was given him in the evening; and two tea-{poonfuls of Spirit. Nitri Dulc. were put into his drink through the night. He paffed at differ- ent times, before ten o’clock next day, about a pint of urine, but with much pain and {training. Still there was a good deal of fever, with general {welling and uneafinefs of the abdomen. Only cordial foup, and fome wine, were given him for this day. K 4 On — ~ . - __— ; = - ~ > - _ P “nahin tb TI ors ‘ a : a : — - ee “~— a >. “< =" 7. . 7 — “, - , * 4 ne, _ PRs : ene ee me ee \, Pn ye es a — 9 P . ae : = ee ae . - < q may ate : . . , ines Ass +4 “ 7 : 4 ~ = ee ~<% > - : “phd s : — : Se y ts e ee A ORE AE oe we tater . ) ~ ¢ Tr. _— = - - ar _— - F Party . 4 te , 4 Ba E) Tt. et | 152 CASE OF On the eighth and tenth day from his com- plaint, the phyfic was repeated, with a plain gly- fter at night, and the abdomen was fomented once every day. After this, he continued to pafs his urine freely. On the eleventh, there was no amendthent ; his pulfe was ftill quick and feeble; and the appear- ance of his ftools nothing better. This day he complained of a pain about the anus, which had prevented him from receiving the glyfter latt night. On infpection, the edge of the gut was found to be {welled out all round, and much in- flamed. ‘The verge of the paflage was of a deep red colour, with a thin ichorous matter draining from it. Bark and wine were now given him in large dofes, and a poultice was applied over the fwelling. By next morning, the whole was black and mortified. At night, the whole of the rec- tum was found hanging inverted from the anus nearly feven inches in length ; the greateft part in a mortified ftate, but here and there the diffe- rent coats diftinguifhable, and eafily feparated from each other. This was all removed; and after wafhing and fomenting the parts with cha- momile decoétion, the poultice was continued over the MORTIFIED RECTUM. 153 the opening. The following day, fome detached portions of the gut came away. Still there was confiderable pain and tenfion of the abdomen, with a low and weak pulfe; but he kept up his {pirits remarkably well. The inteftinal difcharge came away infenfibly, with a great deal of fanious and putrid floughs from the fides of the opening, which made a frequent renewal of the poultices necef- fary ; and every time this was done, a large fy- ringe-full of warm water, with a little Port wine, or Mel Rofarum, was thrown up. ‘To the fourth day from the feparation of the gut, there was but little change, only the difcharge was not fo much difcoloured, and his belly was confiderably eafier. The external edge of the opening was ftill black, and much {welled out*; but within there was an appearance of its cafting off. In three days more, this was effeted ; leaving a monftrous- opening, large enough to introduce a goofe’s egg with eafe. But all within, to the top of the facrum, or as far as the eye could reach, the fides of the opening were perfectly clean, with a kindly fuppuration and granulations {pringing up. The appearance of the alvine difcharge was by this time much mended, and nearly of a naturalcolour. The ftate of 154 CASE OF of the abdomen became much eafier; his pulfe fuller, and his looks better. The poultices and fyringing the fore were now laid afide, and only a little dry lint was laid lightly into the opening, with a large fpread pledget over it, to exclude the air ; and this was renewed four times in the twenty- four hours. His bark and wine were full conti- nued; but it was neceflary to interpofe a laxative every third day, otherwife his belly became tenfe and painful. In this way he went on for fourteen days from the feparation of the gut, with every appearance in his favour. The fever and flux, pain and un- eafinefs in the abdomen, had been entirely remo- ved. Urine always pafled freely, and without pain, and he had recovered his ‘appetite and a confiderable degree of ftrength, when I was dif- abled by ficknefs from attending the hofpital. Soon after this he had become worfe, and was complaining again of pain and tenfion in the ab- domen ; and I underftood that his phyfic had not been regularly continued, but in place of it opiates to allay pain and procure fleep. On the qth of December, on fending again to inquire for him, I was informed, the pain of his bowels had entirely left MORTIFIED RECTUM. 155 left him, though his belly was much fwelled, and that he had but little difcharge by ftool; that his looks were bad, and his pulfe very low and weak. From this account, it was eafy to foretell his fate, which the fame night concluded, happily, per- haps, for himfelf; though I once'confidered him as a gained cafe, and was anxioufly contriving the beft means for preferving the paflage, and how the — diftrefs of a conftant ffillicidium alvinum might be beft. prevented. SOME OBSERVATIONS ON THE OTHER BILIOUS DISEASES OF INDIA. True and formed jaundice occurred at the hof- pital, in fome inflances, where the whole fkin, eyes and urine, were tinged with a deep yellow colour. This.appeared, in all. the cafes, to arife from a redundancy of bile, without being attend- ed with obftruction of the gall-ducts, | - It was foon and eafily removed in them all by a few purges, compofed of mercury, {quills and foap, a ¥ oo + bette - 52 2 y : , * of mir. g > ) hice i as (s ‘ ( f 1g ( h é i ‘ ~ 4 2 any +) ee . 4 ‘ 7 fy : i is 4 “ ' ;? 4 at MM > ‘ : ; 4 1 . xy . Je : P yt os a :e 12% PD ee HY rT) ¢ : i i : ; ; ' ' j 4 - Ei : t br Fe ; oF i a ve ‘ as Ff ss : ‘ty } ( ( y is, | t vn & y ' 5 é y 3 a « - = La - i : ~ F ee ‘1 e oat } ve us . , ¢ - od : ~ va y —. 2 _ < = q a i 156 | JAUNDICE. foap, followed by the exhibition of bitters. But where any degree of fever or quicknefs of pulfe were prefent, two or three dofes of Soluble Tar. tar, and Manna with Tin&. Rhei, were always premifed.. Ten or twelve cafes of intermittent fever were met with; but there was not one of them that did not arife from diforder or redundancy of the bilious fecretion, or from obftructed vifcera. The type was regular in none. Quotidians chan- ged into tertians, and vice verfd. The inter- miflions were not perfect. The patient complain- ed of headach, want of appetite, oppreffion of {pirits, naufea and griping pains, or had an irre- gular flux ; fometimes a hard or tender liver. ° No perfect or lafting cures were made by bark, unlefs a long courfe of purging had gone before it. It had more or lefs effect in ftopping, or fuf- pending the fits for a time; but very often it on- ly rendered them more irregular, or, what’ was worfe, it changed the difeafe into a continued fever. It was not thought fafe or proper in any cale, to exhibit bark without a frequent alternation of purgatives, or without being combined with aro- matic - INTERMITTENT FEVER. 157 matic feeds, and vitriolated or foluble tartar. In one cafe of regular tertian, which was fuppofed to be fimple, it was thought the bark had made a per- feé& cure, and the patient was difcharged’ under that idea: but he was returned to us not many days after, under a moft violent bilious fever; with tumor, tenfion, fulnefs and heat of the abdomen, loaded yellow tongue, and fuch a degree of wild delirium, as rendered him perfectly unmanageable, fo that little or nothing could be done for him; and hé died in two days after his fecond admiflion, —a fure proof that the fource of his difeafe was deeper than had been at firft fufpected. In moft inftances, this difeafe was removed by a courfe of purging alone: or, if it proved obfti- nate, efpecially if the liver or belly felt hard, or enlarged or tender to the touch, a courfe of mer- curial alteratives, with purges occafionally inter- pofed, was certainly fuccefsful. DISEASES OF THE THORACIC VISCERA. Suc cafes were exceedingly rare, or rather ne- ver appeared at all under an idiopathic form. Pulmonary confumption was wholly unknown. There 158 PULMONARY DISEASE. There were feveral cafes, where matter colletted in the liver, eroded the diaphragm, and the lungs were wafted, and fpit up by coughing. Only two éafes of catarrh, with cough, and fymptoms threat- ening pneumonia, by being neglected, were met with ; but both of them were eafily cured by blif- tering, and the common remedies for that affec- tion. RETURN FROM INDIA IN THE MEDEA FRIGATE. For a confiderable period after leaving the In- dian feas, a tendency to the difeafes of that cli- mate, and a bilious diathefis, were obfervable among the feamen. , | We had fimple bilious fluxes; fluxes connected with old ftanding obftru@tions of the liver and me- fentery ; and a few cafes of acute hepatitis. The captain’s fteward had long laboured under one of thefe old ftanding obftrudtions of the liver, which do not readily terminate in acute inflamma- tion, but which are often attended with long-con- tinued COMPLICATED CASE, ¥59 tinued ill health ; and produce occafionally very untractable and dangerous diforders. He had been on fhore attending on his worthy and benevolent matter, Captain, (now Admiral) SirErafmus Gower, where, to his other misfortunes, he had contrived to add a confirmed pox. When he came on board, he was attacked with bilious vomitings, and an it- regular flux, and was altogether in fo reduced and impaired a ftate, that little was expected to be done for him, beyond palliating his complaints. As we approached the Cape, his difeafe put on the form of a tertian intermittent; with the fits at firft pret- ty regular; but they became lefs fo as the difeafe advanced. They were fo violent as to make it doubtful, whether he might fupport them long, unlefs they could be mitigated. A mild emetic, and feveral purges of foluble tartar with manna and magnefia, were prefcribed for him; and at laft recourfe was had to bark, with vitriolated tartar, and infufion of chamomile. This fufpended the fits for a week; but at the end of that time he did not look better, and they returned with greater violence than ever. After a few repetitions, the difeafe changed into a continued fever, With a pu- trid bilious flux, which lafted for two months. His 160 COMPLICATED CASE. His ftools were at firft thin ; almoft black, high- ly offenfive to the fmell, and attended with much pain, tumor and hardnefs of the belly. But he never complained of any pain in the region of the liver, unlefs when it was hard prefled ; though it was certain the foundation of the whole lay there. By the time the fhip reached England, which was in exa@tly four months from our leaving Madras, his complaints had been in a great meature re- moved. His ftools had become nearly natural; his countenance was putting on by degrees the look of health, which it had. long wanted, and he had recovered his appetite and fo much ftrength as to be able to walk the decks. The treatment of this cafe was throughout the fame as we followed in the India bilious fluxes; » with only this difference in the choice of laxa — tives, that a faline mixture, with about half a grain of tartar emetic, in divided dofes through the day, was frequently employed, and anfwered the purpofe of moving his bowels as well as any. Great and repeated benefit was alfo derived from bliftering the abdomen, whenever fevere pain and griping, referred to a particular fpot, gave reafon to fufpect the exiftence of topical affection there. | The GENERAL OBSERVATIONS. 16r The only radical cure for his complaints would have been a gentle and long-continued courfe of mercury; and this could now have been under- taken with fafety: but the fhip being to be paid off, he was fent to Haflar shi where he did not long furvive, GENERAL OBSERVATIONS. In many late communications from India, we find Dysznrexry (of which we have faid nothing) fo frequently fpoken of as one of the common and ordinary difeafes of the country, and without any thing ftated to diftinguith it from this difeafe, as it appears elfewhere, and has been defcribed by for- mer writers, as to render it neceffary to fubjoin fome obfervations to explain how this has happen- ed ; and alfo to fhew, why here, and no where elfe, mercury and the nitric acid have been employed, and with fo much fuccefs, in its cure, By confulting Dr Clark’s Remarks on the Dif- eafes of India, and two Memoirs on the Health of the 88th Regiment, by Dr Macgregor, publifhed L in 4 ~ - rh ' A toh phy oO Side / > + F I/F ‘2 +Y - ; r As £ 4 ae ro FT. ep tes. * gee f » + et, ots ‘ mf 7%, 7,465 TS Be - ie 7 S: oges f Pe fr bien" ; a pie - Nae? ste “arte ey iy ah A mo ok Ad be ta ht oy? eae Pee ag 7 : ra ! ¢ aN " aii _— aay Ee: 16% GENERAL OBSERVATIONS.’ ‘a Dr’ Duncan’s Annals; and in'the third Number 06 the Phyfical ‘and Surgical Journal, we find from their diffections in the complaint ‘which they uni: | formly call’ Dyfentery, the very ’fame ‘difeafed’ap: | pearances as were difeovered by us on: diffeGing - the bodies of thofe who died of bilious and liver diforders; viz. inflamed or ulcerated liver, a difeafed ftate of the mefenteric glands; inflammation and thickening of the inteftines, with effufions of blood between their coats; erofion, ulceration of the snternal membrane, and fometimes fphacelus and gangrene. But with dyfentery,.as it appears in all © other countries, liver-difeafe is rarely found con- nected ; and the inteftinal affection is in a much inferior degree, or confined more to the internal membrane. They defcribe the odie as being copious ne liquid; frequently bilious ; and never as contain- ing {cybale. Dr Macgregor fays, ‘* In 500.¢a- “ fes, he does not think that fcybalz were pafied “ in fix of them,” This difeafed condition of the inteftines, and the dyfenteric fymptoms which fometimes took place to a confiderable degree in all bilious fluxes, we confidered as the natural and -neceflary confequences of difeafed bile and. vitia- ted 7 ae GENERAL OBSERVATIONS? 163 ted fecretions, acting on parts highly irritable, and: therefore much difpofed to difeafe, as almoft the whole abdominal vifcera feem to bein India.» To« pical difeafe of the liver, we did not confider\as a caufe of fluxes, or of dyfenteric fypmptoms ‘in them, in any other way than as giving occafion to vitiated and depraved fecretions. But a fufficient diftinction is in my opinion to’ be made betweeri the di/ious and hepatic fluxes of India, and ayfentes ry, from the following confiderations. In thofe that depend on fimple diforder of the {fecretions, and where the liver is not primarily affected, there is. always much more difturbance and diforder in the functions of the ftomach, and upper part of the inteftinal canal,—bilious vomit- ings and dejections, with ftomach and bowel fick: nefs,—than takes place in dyfentery 3 and the dif eafe refembles much more cholera morbiis. The difeafe fometimes terminates, and health is reftored, by the firft evacuations, without dyfen- teric fymptoms ever appearing, or it runs on to {peedy inflammation and gangrene, with a putrid bilious flux; and although in fuch fluxes, there is generally fome fever prefent, it is only acceflary or vaccidental, and is never of any regular type or du- L 2 ration, 7 weer gr ’ . = aa SS ARIGR ST 2 Marge 6 164 GENERAL OBSERVATIONS, ration.': The ftools are generally of a deep yellow or green colour, and feldom, in the early perth the diforder; mucous; nor is tenefmus ever an early fymptom. For the moft patt, they are eafily procured by the gentleft laxatives; and when not interrupted by abdominal fpafms, copious and liquid, never fcybalous: and that kind of dyfen- tery which arifes in camps, hofpitals, and crowded fhips, is diftinguifhed from all other fluxes, in be. ing highly infectious ; whereas thofe of India, by all concurring accounts, are never fo in any degree. Fluxes properly hepatic have the fymptoms fome- what varied, but are clearly referable to a difting | affection different from the dyfenteric. Whether dyfentery, under its true and espe form, be a native difeafe of India, or of any tro pical country; or if it ever appears in them with- out being imported from colder latitudes, 1 am not prepared to fay. In crowded fhips, or in fimilar fituations, it may perhaps be generated, (efpecially among people newly from Europe) any where. But Lam not difpofed to think it a coaft difeafe of India. That which arofe in the fleet that failed from Eng- land under the command of Commodore Johoftone, gave ee tt ‘a My, ath tal ther ta thf ri eo GENERAL OBSERVATIONS. 165; gave'place to other difeafes long before we reached the Indian feas. In! Dr \Macgregor’s firft report, it is ftated, “That: the difeafes far moft prevalent” (on the Bombay coaft) “and the moft deferving of fe- “rious notice, have been dyfentery and hepatitis ; “and if not the fame difeafe, the two are moft “clearly allied in this country. Five hundred “and forty-four cafes occurred during the year “1801, and of thefe, forty died. The bodies of “twenty-two were inf{pected after death, and the ‘“‘ liver was found difeafed in fixteen.’’ It is from | this infpection that we are informed, that “ dyfen- ‘ tery is almoft always connected with a difeafe of ‘the liver as a caufe.’” Yet it is afterwards faid, that “in other cafes, the liver was found but “ flightly, or not at all affected ;”” but the morbid inteftinal affeCtions we have mentioned, were found. in allof them. With regard to the cure, fpeaking of both under one head, ‘viz. hepatitis and dyfen- tery, it is faid, “ A large proportion of the cafes ** were cured by remedies that have never been ‘* {uppofed to operate on the liver. But it muft be “ confefled,”” (he adds) “that our cures by thefe remedies were more frequent and certain, foon L 3 ‘© after as “7s — ae > Ps . i — we > ». = ng Set a é one. = ag a 7 = 4 , ot <7 = ¢ - _ < 7 ¢ 4, - .— ~, gs ALN . « Cee ~ .. - ~~ _ il } ‘ w oi * as . we s ae a = We : 7) ‘ a ty , yore 7 Poe . : . ‘s ~ ° : —— oi ta . << - - = lial ‘< ~~ «& errr a ih a — Ei —s ze = a — ge “ial » . ters : % 7 _ —— — ; Jo — = = - : P= owe : — — 7 . Ae , , ’ ? ; oe ; - BS 8 Be a" ‘a > . ~ 7 > a ay —s 4 =~ ore ers a = —_— Pay pare aan " rd — — 166: GENERAL OBSERVATIONS.) ae # after our arrival in India, than they of late have «‘been.”? The remedies employed *for the fir three Inonths are enumerated, and it is ftated, that they were ufed with confiderable fuccefs ;’ but it immediately follows, ‘‘ Yet we foon found, that ‘¢ mercury and analagous remedies,” (viz. the ni- tric pt ‘6 were to be the moft: iene relied fon/iid 3% | He 3 Much more to the fame purpofe, will be found in Dr Macgregor’s Second Memoir, and in’ Dr Clark’s Remarks; fufficient we think to warrant the conclufion, that the’ difeafe which they uni- formly called Dyfentery in India, is 1n its nature, fymptomis, proximate caufe, and alfo in-its me- thod of cure, entirely different from that which has been defcribed under this name.inall other coun: tries; that: it.differs in. nothing from bilious and liver-fluxes, fo commonly to be met with there; and. that ifthis name is to be applied, it, ought to be joined, with one which may ferve to diftinguith the difeafe from other varieties,—fuch as the He- patic or Bilious. Dyfentery of India. _. From the known effeéts of mercury in the cure of liyer-difeafes, and in the removal of mefenteric obftructions,. we will, have-an- eafy explanation, why, GENERAL, OBSERVATIONS», 167; why, inal fevere cafes of. dyfentery as it appears in India, mercury and the nitric acid) wete, to: be, the moft generally relied on for. their. removali.:. How far thefe remedies, in moderate dofes, may be. found innocent, or-ufeful, forthe cure of real. dyfentery, or in all its combinations, Ido not un- dertake to fay; but I am perfuaded, if given in: dofes that have been prefcribed for what has-gone under that name in) India, they could. not fail an many inftances to be exceedingly hurtful. . | In fluxes purely bilious, I fometimes thought! that meicury even produced good effects aga fimple* cor= reCtor,, from) an alteration for the. Better being not unfrequently (made by-it on. thé alvine difchat ges; before, it’ could have entered’ the fyftem in fuch quantity, as to affect; the Kate ant the PFGADAS con= cerned. | Both, Drs + aan Clark: and. “hry fie ikea im ftating, that. dyfentery is never contagious in India. ..I obferved no evidence of the exiftence of . this in any of the difeafes to be met with there; and I-am doubtful, whether, with the exception of the exanthemata which appear to be fo in every country, there be any others of that defcription. Lo4 -Thisy 168 GENERAL OBSERVATIONS. This, were it confirmed, might appear a ftriking. peculiarity, fince we know that in countries under a fimilar latitude, and under a fimilar degree of heat, fome of the moft active and virulent conta- gions, are in a manner endemic ; and are fuppofed — only to appear in colder climates by tranfporta- tion. Thus, Yellow Fever has become endemic _ in the Weft Indies, and the Plague in Egypt and the Levant. But plagues and contagions appear to have been in former times equally common — to all the countries of Europe ; and there are fome reafons to conclude, that the yellow fever was firft : imported to the Weft India iflands from the fouthern States of America. The Tarks are but » a late colony from the north of Afia, and the po- — pulation of the Weft Indies is conftantly recruited by fupplies from Europe or North America. Itis well afcertained, that thefe contagious difeales produce the fevereft effects upon new comers, oF perfons whofe fyitem of fibres has not been fub- dued and relaxed by a refidence in a hot climate, but from the nature of the countries in which thefe difeafes have become fixed, and from the feafon of the year, viz. the autumnal, at which the contagion fpreads and becomes moft active, there is a. a 2. &@ Ff re a XA eA GENERAL OBSERVATIONS. |’ 160 is fome reafon for fuppofing that both plague, yel- low fever, and perhaps the late Cadiz, Malaga and Gibraltar fevers, though each pofleffing a f{pecific contagion /ui generis, may yet have fo far a common character, that it is contagion combined with, or engrafted on a bilious diathefis, or vitiated ftate of this fecretion: Hence, perhaps, the reafon why fome of them are to be found at-all feafons of the year, in countries where this is a conftitutional temperament; and the difference, and even oppofi- tion in the plans of cure that have been follow. ed, has neceflarily arifen from the variety that takes place in relation to climate, feafon, and the ftate of the weather, as difpofing more or lefs to bilious redundancy, inflammatory diathefis, a rich and denfe blood, or a rigid fyftem of fibres. One reafon why contagious difeafes, prevail lefs in India than in other fimilar latitudes, may per~ haps be the greater diftance from Europe ; the long sract of navigation moftly within the tropics, which allows time for diffipating all feeds of contagion from that quarter, and for taking off the tempe- rament of body moft congenial to it, and for affi- milating the habit to what is the morbid confti- tution of the country.’ Should fuch difeafes ever became t t f ] : # ) ae f ‘ : ‘ - 4 - ‘ : - be bak > * b i 7 aia eo $ z : ve Be can e : _ % q Cs § A { iy i, we x j J ‘ - N ¥ ¥y " ; ‘ }e , ‘ i ; . ' S ; t , i » , ' 4 A < Tr wr ETRE, anyone ¥7O% LIVER, DISEASES OF: EUROPE, become endemic there, the probability 18, they will) be imported from the north.; ./.50 9) 9 “It remains to fubjoin fome obfervations on Bi- | lious and Liver Difeafes, as they appear in out own, country. | | flersas “To a ftranger, the diftinguifhing: fymptoms of liver inflammation in India appear: at firft nota little obfcure, from the prominency of. the fecon- dary and fymptomatic affeCtions, with which itis generally attended. In: Europe, the difficulty 1s rather increafed from their variety... Here we often méet with pulmonary affection: combined with it) ’ to’ fuch ‘a degree as to render it difficult for. us to fay which is the radical and which the: fympathe- tic diforder ; and: wherever there:is much delicacy of conftitution or. phthifical tendency in the habit, we are always uncertain of which the danger may be the greater ;or how far the meafures we em- ploy for the removal: of difeafe. in‘ the one orgat, may not fofter or aggravate that in the other. The ‘variety of fymptoms, referable to other heads, a thofe of dyfpepfia; hypochondriafis, and what are ealled the nervous affections, are fure to combine with e . &- tA Thi ato at ine BILIOUS DISEASES OF EUROPE? rr with it § and the radical difeafe is often fo lightly” marked, as to render it not # little difficult ‘to’ fay” what ‘or which is the — or ce among them. on at 84 Bilious redundance and depravations, which give a ftanding charaéter to many of the India difeafes, are there alfopretty diftin@tly pointed out) from the’ appearance of ‘'the'excretions, and fron — colour of the tongue, eyes and urine. Many European diforders have the ’famer ori- gin; but the marks of it are not fo well expreffed, or they are of a more temporary ftanding ;“or the fame caufe is found to operate in’ a’ different mans ner, and to produce more varieties. Of thefe, it may be: — to notice = fol lowing. fed ogee? estob iinet Perfons returning from either India, often bring home with them a conftitution, wafted: and debili- tated by the difeafes of thofe climates’; from which they recover with difficulty, or not atvalliio It is not, however, often that a fimple bilious' diathefis continues long at home, where there are no ob- {tructions in the liver or mefentery; and perfons who have been wafted and réduced to the daft de- gree by India fluxes, fometimes recover perfeétly : ~ > - biiz at 172. BILIOUS, DISEASES OF EUROPE. at home, and enjoy good health, and as firm a ftate of the ftomach and bowels as ever. es difpofition to redundancy of the bilious fe- cretion, and to cholera morbus, is obfervable du- ring. the autumnal months, in all the fouthern countries of Europe. The difeafe is, in general, very manageable, under the ufe of the fame re- medies as we employed in the milder bilious fluxes of India. Small dofes of ipecacuanha and rhubarb are very ufeful; and the beft form of thefe is when made into fmall pills. Dofes of foda phof- phorata, given in beef-tea, form one of the mildeft and moft lenient laxatives we can employ, unlefs in very irritable ftates of the ftomach. It is not very certain in its operation as a purgative ; but in re- peated fmall dofes, is the beft laxative we can ule in all cafes where blood is paffed with the ftools. Rhubarb and Pulvis antimonialis mixed together, — may be employed for the fame purpofe; or, what anfwers as certainly as any, when the ftomach is unfettled, a faline mixture with calcined mag- nefia diffufed in it. A proportion of tinéture of jalap added to this mixture and well {weetened, makes a very effectual purge, and is one as eafily” exhibited to children as any I have tried. Plen- tiful Mi Diy rab b Loy Mh pa ¢ La ios and th of f fu af the ly, w It sa! bt ye we ith ti ed ley the fie elit soft gt) i ic eo BILIOUS DISEASES OF EUROPE. 173 tiful dilution is a material part of the treatment. Opiates are but little wanted, and the premature ufe of them ‘is often hurtful. In fome habits, we find a conftitutional ten- dency to bilious difeafe, operating entirely in a different way, and which is often of long ftanding, It is moft common to females about the middle or advance of life, but never remains to old age. Far from inducing purging, the bile takes a contrary direction, and, by regurgitating into the ftomach, occafions headachs, ficknefs, depreffion of {pirits, with naufea and bilious vomitings. This comes at irregular, fometimes at lengthened intervals; lafts. for one, two or three days, and then goes off, fometimes with, but often without, a bilious pur- ging, and without much injury to the health, till the return of another fit. * I have never fucceeded in doing any thing ma- terial to corre¢t this difpofition. Keeping an open belly is always of confequence ; as the patients are difpofed to be coftive, even while under the com- plaint. For this, I have found a pill compofed of equal parts of aloes, jalap, and calomel, or of Extract. Colocynth. comp. Pd. Lond. with calo- mel, two or three for a dofe, anfwer well, And fome 174 BILIOUS. DISEASES. OF EUROPE-- fome patients have found benefit from ufing equal parts of Pulv. Rhei, Magnefia ufta, ‘Flor. Gha- mzmel. and Rad. Zinziber., as. much every day, or every.other day, as opens the belly gently. Such diforders as have been mentioned, may all be referred to fimple redundancy or regurgitation of bile, but little vitiated-or altered in its quality. But there are otheis to be met with, which feem to originate in highly depraved ftates of this fluid, together with indigefta or difordered aliments ope- rating lower down in the alimentary canal, but attended alfo with much ftomach diforder, and which are fometimes carried to a very dangerous and fatal height. This, too, occurs moft frequent- ly to females, efpecially to. thofe who are fubject to coftivenefs,: and to diforder in the digeftive or- gans; to what they call fomach cholics 3, to acid eruGations, and dyf{pepfia. They arefeized with a- fevere pain referred to the region of the ftomach, the left fide, or upper-part of the abdomen, often without any warning, and with fpafmodic ftricture, “or what.they call a fevére cramp pain.: On eXa- mination, the mufcles,of the. abdomen are fome- times found‘to be fpafmodically affected, and it is firongly retracted... Severe retching:and yomitings essel come A= BILIOUS DISEASES -OF ETUROPE, 73 éorne-on. ” The ejecta, fometimes bilious, but often- érhighly acid, orof a pungent and acrimonious tafte and fmell,, dn the worft fort.of cafes, there is great ficknefs,. with debility, and a ‘weak. faul< tering pulfe; faintings and coldnefs of the extremi: ties, witha pale hippocratic countenance from the very firft. The fpafmodic affection, perhaps, goes off, and the abdomen rather becomes tumid’ and painful, with flatulent diftention and borborygmit.. Sometimes the patient is cut off in this way before the bowels are fully moved, .to afcertain the ftate of their contents. In cafes lefs fevere, and where this is effected, the evacuations are offenfivé to the {mell, green, fetid or fanious, and the complaint is removed by a courfe of purging. Where death takes place fuddenly, the perfon is generally fup- — pofed to have been cut off by gout, or by cramp in the ftomach. Enteritis or ilrus do not attack fo very rapidly, nor do they prove fo fpeedily fa- tal; and it is not conceived, that bile or indigefta, confined in any part of the alimentary canal; can acquire an actimony that fhall produce fuch. ef- feéts at once, and without much previous warf- 176 BILIOUS DISEASES OF EUROPE. But this-is not the only cafe in which we find that the caufes of difeafe do not produce their ef- fects till they are accumulated to a certain force, Nature will do much to refift or obviate impref- fions that are hurtful, provided fhe is not furprifed and overwhelmed at once. How fhe effects this refiftance in the cafe before us, admits of an eafier explanation than we are able to give in many 0- thers. The firft paffages are all lined with a flimy mucus, to defend them from acrimony. An in- creafe of this fecretion will take place, wherever, in any of the turns of the inteftine, acrimonious indigefta begin to be accumulated. When thefe come to be carried fuddenly forward to another portion of the canal, it is then only the full effet will be produced. We had occafion to fee this often verified in the bilious difeafes of India, where we were fometimes well affured of the exiftence of highly acrimonious accumulations in the turns of the inteftines. The patient would have but little or no pain, griping, or ficknefs, while his bowels were kept quiet and undifturbed by purgatives; but the moment their contents were put in motion, every thing was fuddenly reverfed, and the patient was fometimes as quickly and effectually killed by it, BILIOUS DISEASES OF EUROPE. 177 it, as if a ftrong fedative poifon had been artificial- ly injected into his inteftines. Every perfon, fome time in his life, may have felt what will ferve to confirm what we ate endeavouring to illuftrate. Something has been eaten which has difagreed with the flomach $ that is fo fay, has not taken on the proper chylifactive digeftion, but has undergone fome other change, and generated an acrimonious mixture; and fome of the fevereft cafes of the dif- order we are defcribing, can be plainly referred to this caufe. Nothing perhaps is felt till the next day, or later. Sharp cholic pains, accompanied with bowel-ficknefs, and with a fenfe of motion through the guts, begin to be felt, This proceeds lower and lower down, till a few loofe ftools re- moves the whole. The origin of the complaint is made evident, in other cafes, from griping pain, anda feculent purging, having preceded the attack. This will be fufpended during the feverity of the ftomach affection and the fpafms, but is renewed again when thefe go off; and the complaint is re- moved by the affiftance of purgatives. We are in danger of being mifled by the {pafms, which the patient himfelf refers to the ftomach and internal parts; but in this he is miftaken. They affect M only and + ene ie omen eee tee Ge ee we ee a nr ‘ - inling - -_ _ —~ : r] wed fl. - | Be, , im ‘ a . a i F = 3 f b ; 7 sa a q ¥ a { ; & -_ e : : H ips i , : : fess o- a f ie, 7 ah } at, fi | ¥ ’ i ¥ * Baer ies , ind x 5 7 ie 72 Bae > 7 J . .* -* . hy | ? 7 ss ss . ea a va 3 £4 : i - - 4 , ) < f aa ; - ~é 1 % : " : ’ & * - 4 FE 7 ; r 1 ‘ ’ 7 i « f a »~ of . v4 7 ) z i 2 , is e's j \ 4 7 » A : q . Ph. 3 = ie % re be * - ‘ i ss 3h eo 4 ~~ - & 4 t ia > A on ~~ tT iso of 4 2 , ae & ie r > 7 i q ) : La 4 a : ‘ iz " : , { 5 2 teat : \ te : i bean , » 4 * ’ . a a ; ‘ M ) ¥ ‘6 } We aie > f Hie gabe) . by ‘=f —_ ° “a * : \ ey 7 p : y « , = - at gs Da ny Neti Sng x bs = *F . ix x . t a4 a ay ree a , 7 | 2 is F ae as : ae Sy 17% BILIOUS DISEASES OF EUROPE. only the abdominal mufcles, and are only fymp- tomatic, arifing from irritation in a diftant part; juft as happens in tetanus, or as we found them in ‘the mort de chien. The offending matters are not in this cafe lodged there, but in the turns of the duodenum or jejunum, and the ftomach atts readi- ly in ejecting the contents, and admits of being» Glled with drinks, which it could not be, were it fpafmodically contracted. Filling the ftomach with warm weak tea, is often of fervice in abating the pain and fpafms. Another way in which we are ready to deceive ourfelves, if we are not on our guard, is by diffec- tions. The patient dies. The body is permitted to be opened, and this it is fuppofed is to explain every thing. This is done 48 hours perhaps, oF longer after death. ‘The turns of the inteftines, or fome portions of them, appear fuffufed and red, or approaching to a purple colour, with the coats thickened, and the mefenteric veflels turgid; all this heightened by the contraction of parts, and coagulation of the blood, which takes place after death. Thefearefuppofed to be the effects of inflam-. J mation, and the patient is thought to have died of enteritis. But the cafe is totally different. Inflam- mation BILIOUS DISEASES OF EUROPE: 179 mation of the inteftines is quite a different thing, and never proves fo quickly fatal. Thefe appear- ances are all the effects, and not the caufe of the difeafe. They are the confequences of pain, fti- mulus and irritation, acting on delicate and fenfible membranes ; and will bé found in every cafe of fudden death, from any abdominal difeafe what- ever, or from any kind of poifon taken into the ftomach. The pulfe in this complaint, is never hard or throbbing, as in enteritis, and blood drawn in it, never exhibits any inflammatory cruft; nor is there any difficulty in moving the belly, when the ftomach will retain purgatives, asthere is in that difeafe. Much experience indeed does it require, and many diffections of fimilar cafes, to enable us to judge and diftinguifh accurately between the caufes and effects of difeafe ; and even between the effects of difeafe, and the effets of death. The diffection proceeds no further than we have men- tioned ; and if it did, it is but a very flight judg- ment we could form from appearances, of the pre- fence or abfence of noxious acrimony in the in- teftinal contents. Chemiftry itfelf has not yet imi- tated, nor can it be fuppofed ever to imitate the operation by which chyme is converted into cém- M 2 pletely a oe ~— SET Sale, Re ee ee 1eo5 = “%¢ ~ ws ‘ \ } 480 BILIOUS DISEASES OF EUROPE pletely animalized chyle; far lefs the morbid alte- nations of this procefs. What life is, or what the influence it exerts on the operations of a living fyftem, or in what way it is acted on, either by ft- mulants or fedatives, are all matters that feem to lie beyond the {phere of our inveftigation. We can do little more than obferve and inveftigate facts. Weare pretty certain, that of all the fe- creted liquors, none are more fufceptible of morbid alienations than the bile; that in a healthy flate, it is a neceflary and important agent in the chy- lous procefs, but when it is altered and difeafed, there is no faying of what kinds, or to what ex- tent, acrimapious changes may be produced on the digeftive matters. Hence, in the cure of difeafes referable to this fource, our indications are confined to the objects: of diluting and expelling what is noxious. Where the nature of this is unknown, demulcents and correétors in a proper fenfe, can have no place. In feveral cafes, however, even this is not to be undertaken without precaution, and is to be ac- complifhed only in an indirect or round-about way- The irritability of the flomach muft be taken off, before we can introduce either diluents or purga- tives BILIOUS DISEASES OF EUROPE: 182 tives with any effect; and the irritation arifing . from pain and fpafm, muft be’ allayed or mitigated in order to prevent the acceffion of inflammatory affeGtion. Nothing, in full and ftrong habits, or where the pulfe keeps tolerably firm, and where there are no fainting fits nor coldneifs of the extremi- ties, will conduce fo effeCtually to the laft purpofe, as full blood-letting. But where the circumttan- ces are reverfed, it can do no good, and the blood is often with difficulty made to flow, from the fick. nefs and faintings. In fuch circumftances, a large blifter applied over the abdomen will have much more certain effects. For the purpofe of taking off the irritability of the ftomach, and removing the vomitings, it is fel- dom that, under proper managment, we are difap- pointed in employing opium. It is almoft need- lefs to fay, that fuccefs is not to be expected, in the ordinary way of giving it by the mouth. Rub- bing two or three drachms of laudanum, mixed with warm fpirits, on the ftomach, will fometimes anfwer tolerably well. But a far more certain ef- fect is to be expected, from exhibiting it by gly- fter. From 60 to 100 drops of laudanum, (accord- ing to the feverity of the difeafe, and the patient’s M 3 previous Pes en ee ey 382 BILIOUS DISEASES OF EUROPE. previous habits with regard to the ufe of opium), im a {mall quantity of thin and liquid ftarch, forms a proper glyfter. It will be retained in the rectum, and feldom fails to procure a complete remiffion of the {pafms, pain, and retching. The ftomach will become fteady enough to retain purgatives in mo- derate but continued dofes, with mild diluent li- quors, in {mall quantity at a time, until the belly be fufficiently opened; always preferring, both with refpect to form and quality, fuch as pafs the ftomach with the leaft irritation ; and continu- ing them, till we are fure the bowels are evacuated from end toend. Glyfters, though they. may be ufeful to begin and promote evacuations, have on- ly a partial operation on the bowels, and cannot of themfelves fecure our purpofe. A-return of pain and retching may occafionally take place, and require a repetition of the opiate-glyfter for their abatement, with a repetition of the purgative me- dicines afterwards; but in this cafe, it is neceflary to watch the itate of the pulfe, left the continuance of irritation fhould light up inflammation ; which free and timous blood-letting only can prevent. -Another reafon for our prefcribing opium. 4s, that by its acting much more on the fentient, than upon BILIOUS DISEASES OF EUROPE. 183 upon the moving power, it fo far prevents irrita- tion, as to allow of acrimonious matters being drawn off through the inteftines without danger, which would ruffle and ftimulate extremely, if a temporary reduction was not thus induced on the fenforial power. In other words, the fyftem may be kept a good deal under the influence of opi- um, without our lofing much of the effect of pur- gatives. A repetition of the purgatives, or at leaft atten- tion to preferve an open belly, will be always ne- ceflary for fome time. For, to whatever caule we may impute the difeafe, not only will the aliments at the time in the bowels, be diverted from the proper chylifactive procefs, but fuch as are taken in during its continuance, will not undergo that procefs perfectly; or the action of the inteftines will be weakened, and they*will require an addi- tional ftimulus to fecure the proper propulfion of their contents. We do not intend to maintain, that every cafe of this difeafe, as we have defcribed it, is to be with certainty referred to irritation from acrimo- ny generated in the firft_paflages. The paflage of gall-ftones, through the biliary ducts, or of urinary M 4 concretions 184 BILIOUS. DISEASES OF EUROPE. concretions by the ureters, the difplacement with firangulation of any of the bowels, will be accom- panied with fymptoms very nearly fimilar: and pain, efpecially when very acute, is not always referred with much diftinétnefs to the place of the offending caufe, even by the patient himfelf. But in all thefe cafes, there will be fome hardnefs or fulnefs in the pulfe; and blood drawn during the complaint, will exhibit more or lefs of an inflam- matory cruft. ‘There may be retrocedent gout, or there may be a fpafmodic or nervous affection, {uch as we fee in fome hyfteric diforders fomewhat refembling this : But in all of them, except perhaps in the cafe of the gout, of which I fay nothing, becaufe I never faw it, or in the paflage of gall-. {tones and urinary calculi, we can never confider our patient as fecure, until his bowels are fully cleared ; and the chief part of the cure muft con- fift in purging *. Another fet of difeafes arifing in this country from depravations of bile, we meet with among in- fants. * See Appendix No. II, BILIOUS DISEASES OF EUROPE. 185 fants. In the fetus, many of the internal organs are imperfect and inative. Until birth the animal has not yet arrived at the exercife of half its func- tions. An entirely new and different way of life is then entered on, with a different diftribution of the circulating fluid; and an increafed fupply of it to moft of the internal organs, in particular to the liver. Plethora, then, or an unufual determi- nation of blood to the abdominal vifcera, is a necef- fary confequence of this change, and precedes that which, in growing animals, takes place towards the head. All the fecretions performed in this part of the body, feem to be in excefs, compared with thofe of the adult, Hence the frequency of jaundice, of the red and yellow gum, the deep yellow or green colour, fo prevalent in the ftools of infants, the frequency of loofeneffes, gripes, cholic pains and fluxes, with the ftrong tendency of all their difeafes to fall upon this part of the fyf- tem. Acidity in the firft paflages, from the na- ture of their aliment, irritation from teething, from abounding flime, or from worms, may give occa- fion to many of their complaints. But very often they have their origin from a different and more dangerous fource, viz. irregularity, excels, occa- fional ¥ —— : ~ See oe : ee ee — EE 186 BILIOUS DISEASES OF EUROPE. fional obftruétion and depravations in the bilious fecretion. Diforders arifing from this fource may be in every degree. They always become ferious, when, with fome vomiting or purging of highly-coloured bile, or at leaft with more or lefs bowel irregulari- ty, the belly becomes tumid and painful, attend- ed with fits of crying, feemingly from cholic pains ; with fome interruption or irregularity in the uri- nary difcharge; the bowels fometimes loofe,. at other times difficultly moved; with ftools of a green colour, and of a broken confiftence, inter- mixed occafionally with a white, thick and plaftic matter, and green flime. If occafional rufhes re- cede, and the healthful appearance of freckling on the fkin goes off, and if it becomes pale and white, with a livid colour about the eyes and lips; and if the child becomes unable to fuck, moans and whines ina weakened and altered tone of voice, much danger is always to be apprehended. If the difeafe proceeds, the eyes become fixed and ‘flaring, with the pupils dilated ;, and much anxiety and diftrefs is painted on the countenance. The pulfe begins to fink, and the extremities become cold and livid, with cold fweats over the body. Irregular catch- ing BILIOUS DISEASES OF EUROPE. 187 ing convulfions of the mufcles, of the fingers, arms and face, come on, indicating the approach of death ; and the abdomen {wells and becomes li- vid, fometimes before, and always foon after that event. This is the difeafe called by mothers and nurfes in Scotland, the bowel-hive. It is a dangerous in- flammatory bilious diforder; and when not foen relieved, very frequently proves fatal. It is brought on by diforders of the milk, by expofure to cold, and living in low, cold and damp fituations. Every thing here depends on free and timely eve~>*:on of the bowels, repeated as long as green, vilcid, broken, white and plaftic matter is difchar- ged. Bleeding with leeches if the child is full and {trong ; warm bathing; and bliftering the abdo- men. In weakly children, rubbing the belly with warm {pirits may be employed. It proves little ftimulant in this way ; and may be ufed with ad- vantage in many of the bowel-complaints of chil- dren. No purgative anfwers better in this cafe, or is more to be depended on, than calomel: but it ought always to be remembered, that in fome of the bowel-complaints, even of very infants, full and effectual evacuation is not to be procured, ex- cept 788 BILIOUS DISEASES OF EUROPE. cept by the exhibition of purgatives. 1n very large and repeated dofes. This may be always prefum- ed, when the ftools are plaftic and flimy ; caufing the cloths on which they are received, to cohere and ftick together. oe Ee Copy of a Letter to Mr W—— Afiftant-Surgeon Madras, ce. ‘5: Sip, ‘¢ IT have been favoured with yours by Enfign G——. As your letter fhews a candid inqufitive- nefs that merits information, I fhall be fomewhat explicit in anfwer. 3 “ Mr G——’s is one of thefe cafes, which oc- cur every day in this country, and oftener than is imagined in other hot climates; not feldom I be- lieve in camps, and in particular feafons in Eu- rope, when bilious diforders prevail. But it is generally overlooked, on the fuppofition that fluxes are fimple diarrhoeas, arifing from miafmata, pu- trid bile or crudities, or fomething acrimonious in the firtt paflages ; and of courfe are treated with emetics, COPY OF A LETTER. 189 emetics, laxatives, antifpafmodics, and bitters. In- deed, if they were only produced by fuch fimple caufes, we might generally expect fpeedy and effeGtual cures, by a perfeverance in the above remedies, properly adapted. « But on the contrary, we fee them often run on to a great length ; and often of precarious iffue : and to our mortification find, that fuch treatment proves palliative only fora day. This being evi- dently enough the cafe, we ought naturally to con- jeCture, that the fource of this obftinacy muft be looked for, beyond the inteftinal canal. Such is really the fact. A deep-rooted obftruction gene- rally fupports the difeafe, in fpite of unwearied evacuations ; and all affiftance becomes only pal- liative till this is removed. ‘* A want of attention to this circumftance, al- lows fluxes to run on to the fecond and third flages as they are called ; but which in reality are no more than difierent ftages of duration and weak- nefs; for the difeafe has been uniformly the fame from its commencement, viz. An ob- ftruéted liver and mefentery ; but chiefly the former, with fome degree of inflammation: The flux itfelf being little more than a fymptom of ° * 7 por : r : wits AEA (7) oe Bs OT ii ae “ iia as —— . * 90 COPY OF A LETTER, of the difeafe, and the effect of difeafed fecretionss “* We have feldom reafon to be doubtful of this caule ; for if we have not pain to dire¢t us, an ex- perienced touch will difcover the obftrutions, the tendernefs or enlargement of the liver. I fay an experienced touch; becaufe it requires frequent practical examination, to fatisfy one with refpec to the different degrees of hardnefs, firmnefs and fenfibility, that conititute a difeafe of this bowel. “‘ However, appearances are feldom fo equivo- cal, as to puzzle practice in general. I ven- ture to affirm, that the grand fource of health and difeafe, 1s connected with the natural or difeafed condition of the liver; and. that every chronic or lingering illnefs, arifes in a confiderable degree from fome defect there. In many acute diforders, it has alfo its fhare. But in every kind of ficknefs, whether local or general, that is peculiar to this country, it is material to examine it. For, no per- fect cures can be made, without having a ftri@t eye to it. « The flux he has laboured under for 15 months, might originally have been cured in as many days ; and even now will give but little trouble, as he has natal i ' seve aerlt > COPY OF A LETTER. ror has ftrength enough left to bear the operation of medicines. | “‘ His cafe from the beginning to this time, has been an ob{tructed liver; and could have been at no time effeétually cured, but by mercurial deob- ftruents. A ftrict diet, exercife, palliative and laxa- tive medicines, to blunt and evacuate bile difor- dered in its fecretion, when the inflammatory ten- dency had ceafed, might relieve for a time; and even produce atemporary cure. But they never could reftore him to that health, or the vivid clear- nefs of countenance peculiar to health ; nor even prevent the relapfes he has been fubject to, during fo protracted an illnefs, at fo many different periods of which, had his feelings been queftioned, they would have been fufficient to have pointed out the fource and caufe of his difeafe. For I find by his own account, his cafe has been in the beginning a great deal inflammatory. At prefent, his liver is only enlarged and hard, but no pain there. His flux is accompanied with gripes and tenefmus, and his look is bloated and fallow. His urine, too, is very high-coloured. ‘This appearance, by the by, never fails to attend liver-diforders of any ftand- ing ; though it now and then happens in nervous | habits ¥ _—— ~ -- —— -. SE tees “ —— —— - ~~ Or eee te ny ~——— = So Ay a) = Pm shi » eA t -> 1 ‘ ' ae \ SR eh ai i pe) OE qr4 -! Ore = SP VP a | f ooo ae - : - 2») « i F ;. eet ovr eS ‘ aie ra Pa - * ’ Gen TE , (Roe ; , : is “ye ne ae ara Mac PAPEL en 7 re gy piv Pag Ce atl Sarit SM = he pe - resi gy. AME * Foul =" =r 6 ae Eee —— ~*~ ™, 192 COPY OF A LETTER. habits, and in difeafes of the bile itfelf. But ia general, it is a material index to difeafes where bile prevails. « When obftructions of the liver exift, the firft digeftion goes on very imperfectly ; therefore, the firft indication in. this cafe is, to clear the bowels of phlegm, and other caufes of irritation. The fecond, to remove the obftructions of the liver ; alfo to reftore the loft tone of the inteftines, and to {trengthen the fyftem in general. “In recent cafes where tenefmus is troublefome, caftor-oil is a good purge; it operates effedually, and difcharges much gelatinous ftuff, from the flexures of the duodenum and colon; and as it enters not the blood, it creates little difturbance in the fyftem. It is therefore in recent cafes a good purge. But in his cafe, where the bowels have been much relaxed and weakened, rhubarb, quickened with calomel, or foluble tartar, is better to anfwer the firft intention ; repeated once, or of- tener, according to the nature and complexion of the excretions. ““ Proper evacuations being made; the fecond indication, of removing the obftruction of the liver, is to be anfwered by mercury, adminiftered but - flowly 3 ie adi AN | lit COPY OF A LETTER. 193 flowly ; as his complaints are of long ftanding, and his habit much relaxed. A drachm of mercurial ointment may be rubbed into his fide daily ; and ten grains of a pill compofed of equal parts of | rhubarb and! calomel may be given, one night and morning, or the following : sf RB. Species aromat. gr. iv. Vitreum Antim. cerat. Calomel. prep, utriufque gr. iij. Confect. Alkermes, q.s. ad bolum, man, et vesp. fumendum.: This is to be continued till the mercury fixes in his mouth, And by this means the obftruétions will be gradually removed,; and the load of ferous humours that flow to his guts, in their prefent re- laxed and irritable ftate, will be diverted to his mouth ; whereby his bowels will gain a truce from evacuations, ! « As the obftru@ions remove, the urine and ftools will grow more natural, and every fecretion lefs difeafed. In thefe chronic obftrudtions, the fri€tion.in the application of the mercurial oint- ment, is alfo not without its ufe. , «As you. defire my opinion of Opiates and Aftringents, I fhall give it you, from experience, in a few words. Se * Opiates ~ ‘we “ke 2 - — eee re bid i . . - —_ B wee ‘ iF 4 “ , < . Se a nai Sal al Ragas aa, a oS : aes ; a a iid lies im anal ee “ - “ay 3 “ 7 wn Sire r —" ; “ ie ul, vat ~ a age BO sid ; t ; . : Tt : x ¥ cates) met ——_— _— a4 ‘ y %) > " atti 3 — - SN 4 i ‘ : , . ; ~ J carer “r " ae ga - hy < ley Rg WE eet? > i ——— J i —~- } . + 4 cs I + syn F ath = % : = an i ’ 6 ; te - : we x ud ‘ 2 . Acne 5) - gad , rn ese > ‘- ANS ? > 7 iin ¥ ~~ ee “ha ~ =x apt i ae ~< 7 SOFTEST Qe FPO ee , a) Site et eop x QO es: TO4 COPY OF A LETTER- . Opiates aredangerous medicines in fluxes, and always to be ufed with fearful caution... Early in the diforder, where the difeafe is putrid or inflam- matory, they fhould be given in na fituation. Suf- pending evacuations for a night, may bring ona fatal inflammation. [n..chronic. cafes, freedom from gripes, the. fmell and nature of the evacua-. tions by ftool, are the only criteria to direct their ufe; for no retentions are to be made of any thing acrimonious. In fhort, in a climate where all the capital diforders arife from putrid bile, or obftruc- tions, nothing muft be fhut up. “ As to altringents, they are often dangerous medicines in fluxes, and always precarious. They can be ufed with no‘ kind of fafety, till all kinds of obftruGtions are removed, and with them every thing that is putrid and difeafed. In the acute cafes they have fatal effefis. In the more chronic they pamper and protract the diforder ; with all its concomitants, gripes, tenefmus, &c. “ When the difeafe becomes a fimple diarrhea without gripes; or thefe originating only from wind, equal parts of Prunorum Sylveft. and the Conferv. Aurantior. or Confect, Cardiacais an ele- gant and fafe aftringent. ‘The ane sepa ipes “cold wer COPY OF A LETTER. 195 cold bathing, and exercife, recover the conftitution from relaxation, “‘ Having made thefe remarks on opiates and aftringents, I come next to the fecond indication in the cafe of Mr G——; the obftruétion of his liver being removed, and the other complaints abated, it is to be anfwered by mild bitters of the leaft aftringent kind. Bark, which in mot cafes of weaknefs and irritation, is an invaluable medicine, is in liver difeafes a poifon. The Flor. Chamemel. Sem. Carvi, Sal Polychreft. of each oe will make a couple of cups of bitter tea, to be drunk before and after noon. This with proper diet and exercife will be fufficient to reftore him. “ Captain Long, whom you may know, labour- ed under a diforder of the fame kind, but worfe, being complicated with much weaknefs, and the lofs in a great meafure of the ufe of his extremi- ties. ‘The fource and caufe of his complaint had alfo been overlooked, and he alfo had trifled on with the ufual medicines for fluxes, till he was re- duced to extreme weaknefs. After reducing the ob{truction of the liver by mercury, putting the N 2 patient 196 COPY OF A LETTER. patient in a proper train for the ufe of aftringénts,” his cure was effeCtually completed, with BR. Cons. Aurantior. 31. | Pulv. Cort. Per. 3%. Pulv. Rad. Serpent. Virg» 33)- Tart. Vitriol, 3}. Syr. Aurant. q. s. ad electuar. Of this he took 38 in the day, and continued it fome time. And every night when his excretions were not free, he took 10 grains of a pill compofed of aloes, foap and calomel. “ Thefe are two inftances of liver fluxes, which you have feen. Ihave met with numberlefs un- fortunates from camps, and different parts of the country in the very fame predicament ; who have with great difficulty furvived this wreck of con. ftitution. « Butit is impoffible in a letter to enumerate the different varieties of complicated bilious dif- orders, that practice daily prefents to obfervation. Nor can I in this way convey a proper idea of the nice and particular treatment, difeafes arifing from putrid bile and obftructions require. Different cir- cumftances and conftitutions diverfify prefcription. Capital difeafes require the moft circumfpect at- tention. Omiffions or miftakes are not to be re- medied COPY OF A LETTER. 197 medied: by any. future efforts; ef{pecially. where putrid, bile lurks in the ‘habit... Difturbing it fud- denly by. evacuations, putting it in motion before it is well. diluted and.corrected, proves often like poifon, fuddenly. fatal. Of this I have feen inftan- ces In-men who were not at the time: confined to their beds. As a ftriking inftance, alfo:of the at- tention neceflary. in, the moft trifling complaints arifing from bile, I can aflure you, I have known what are, called trifling. medicines, prefcribed for ailments, which. were confidered equally trifling, productive of very ferious diforders. “‘ For example, I have feen a courfe of. bitters, ordered for what was imagined a windy relaxed fto- mach, produce obftruGions ; and in inflammatory habits, a real inflammation of that bowel. Such accidents as thefe, awaken a man’s caution. © But it is a practical fact, that no flrong aftringent bit- ter can be ufed here with impunity, unlefs the cafe is really fimple relaxation. Mixing the. gentleft kinds with neutral falts is only fafe. . Indeed, it is perhaps a problem in phyfic, how long the ufe of aftringents may be.continued with fafety, or without danger of inducing fome other diforder. N 3 ‘* Before COPY OF A LETTER. “ Before I conclude this letter, though fome- what foreign to the fubje& of yours, I cannot - avoid putting you on your guard againfta difor- ‘der of the liver, which, from its being overlooked, I have once feen in Europe, and feveral times here, attended with fatal confequences. ‘The complaint I mean, is what is called the liver-cough. The obftrudction in this cafe, is pretty generally accom- panied with fome degree of inflammation and pain ; though feldom acute, unlefs preffed with the fin- al —, fn é af - - am i ae = ¥ : =olel ae nas m . aaa ahr “ : ees . aise 3 = . — z . . a ws ih da'hc ty iy We, ’ ro i ss 2 - ? : So 5 ‘Pee... - 5 . ee : ad Pg a ‘ ba . a | ——_ y . ae a, > Ja > SS ’ . " ee : Re f x ¥ wai a8 SEs ‘ ' : oa yf TTS «43 or ~ td J . = ioe = — + : - > ~ 4 Fe . in 4 Y = was ‘ ee ees - - . 6) ae sah Fan’ +) Ve i - ay 8 Be NET TE Yl ec. a 3 a fen B - "yeue~ > - : ‘ - ns = weet | 4 he on’ ley - 5 ne, op Be cra _ ee —— me Lever 2 % se ‘ oie . ET” nw - Ralipinggs a . : ° ~ . ' . < aoe na < 2 ed i ¢ ’ aes =e : : — P — 7 Be — a : ‘ : on ¢ = ‘ { 1S n= a 3 ed noe - . ota ' : a . . i. ae ft . r - es —_— ca " P - . we ale De ae ‘ : a i ~<— =; 4 - - ae — 7 .- 7 , . I g (ee ¥ — ig ie eh etl i 2 eR =. - at, “ray ee ri = Ds ian ; S —_— TP yor ay’ a - a - err a> - +4 . : as . r rs ~~ t 7” : R ae - : : - = Ps Pe . jee 4 ‘ ' 5 5 rah. J te Ee ds. ee el eet, a ea NGS ees . % é = , -- ee he - ¥ r ° Poe Pere =, 2 ee Re oe ee a - > ae e ;,| 5 os 2 i : o - . ‘ : ’ - ° = : ca oS “a4 5 ~ ore —— ; ‘ Aaa a, oo ~ a > , ; —" : a Fer ory gers; or when the external membrane is alfo — 4 ta affected. But it often happens without pain or 4 inflammation. The cough is entirely a fymp-. 2 Weg 5 “e ~~ tomatic complaint, and isthe mifleading fymptom of the difeafe. | «The patient pronounces his own cafe’ a cold, — and is put ona courfe of ineffe€tual pectorals, takes exercife, and fhifts his fituation for health, until — his liver either fuppurates, or becomes a mafs of irrecoverable obftruGtions. In every irritable or inflammatory habit, any miftake at the commence- ment of thé difeafe, is of the moft dangerous con- fequence. The liver, diaphragm and lungs, adhere and fuppurate. A purulent fpitting fucceeds’; and — inftead of a pure uniform pus, the fubftance of the liver COPY OF A LETTER. T9Q liver is expectorated witha deep hollow cough in form? of glandular membranes, of a purplifh bloody parenchymatous look. This difeafe, like all other inflammations of the liver, is very trac- table in the beginning by ‘evacuations, relaxing antiphlogiftic medicines and mercury. “© Such cafes as the above 1 have met with, and have been happy enough toveffect fome cures even in this advanced ftage. i “ Itis to be obferved, in all diforders of the lungs of any ftanding, the liver is always affected); but in this cafe the lungs are but fecondarily fo, and never give any trouble, if the obftruction of the liver is removed: “ In them there are neither tubercles nor in- farctions. . The breathing, except in inflammatory cafes, is never affected, and the fymptomatic com- plaint of cough and pain in the fhoulder, may al- ways be mitigated by lying on:the back, with the head low, and the legs raifed. “ To the above I fhall add another diforder, which is entirely of the liver kind. j « Aoues are by no means frequent in the dry fandy foil of this coaft; but quotidian remittents often happen here, from inflammatory obftruction N 4 of 200 COPY OF A LETTER. of the liver. I fay remitients, becaufe the fever never goes entirely off; though the quotidian ague fits are very regular in their attacks,’ The patient in fuch cafes tells you only he has got the fever and ague, with a pain at the pit of his’ fto- mach. But his report is not to be trufted without farther examination; both in the ftanding and ly- ing pofture. . On prefling with your fingers to- wards his right fide, he will complain of much pain ‘and tendernefs; and his urine will be very high coloured. Sometimes he will have a pain in his Sie right fhoulder ; and generally he has a liver cough. | “This is a complicated cafe ; though there isin rea- lity no contra-indications in the cure of it. ‘The 4nflammation and obftruction of the liver, are the ‘proximate caufe of the difeafe ; and all its different -fymptoms.. Venefection is immediately neceflary 5 and if theftomach feems loaded, an emetic may Safely be ddminiftered after it; but it fhould be fuch as will operate eafily, and open the belly. Such I found the following in all bilious cafes: Vin. Ipecac. et Antimon. utriufque 3 {. Oxym. Scillit. 3 vi. M. __ “ Notwithftanding the continued fever, a drachm of mercurial ointment may be rubbed into the fide, morning © re | fer ef i¢ B mt COPY OF A LETTER, 201 ‘morning and evéning, after forhenting it.’ Saline draughts with nitre, or tartar emetic, ought,to be given every three or four’ hours.; and the, bleed- ing repeated if meceflary. ,.The ague and cough _require no attention. .They will. diminith as the mercury takes effet ;.and, entirely ceafe. when a {pitting comes‘on. . Any. bilious attacks that hap- pen during the interval, are.to be relieved by eme- tics, caftor oil,.or foluble tartar and glyfters, -as circumftances may require..; We meet: here. with quotidians of two; years ftanding, attended with a very irregular ftate of the bowels, aad on,every, ac- ceffion of the. fit, fuch an aftonifhing fecretion of bile as to produce a real cholera morbus. : .“ On the fubje&t, of agues I fhall obferve.to: you, that bark is feldom neceflary in-the cure of them ; _and often untafe ; except in cafes of 3 great weak- nefs and relaxation, or where the nervous fyftem is much affected. On) the contrary, evacuants, neutral falts, and deobftruents.are feldom ineffec- tual. However, where the indications are not fufficiently marked, and -where, difficulty . arifes about the propriety of exhibiting particular medi- cines, the following criteria, with reftrictions, may ferve as a guide, ) «¢ When 202 COPY OF A LETTER: > When bark does not fucceed in ftopping the -fitsjand preventing relapfes ; deobftruents, neutral falts, and relaxing medicines, with evacuants, ae- ns, Te La = = . - - an -. — ' : * wae~ae nt sgl = J sn ~ ‘A = . . = : =; - WE ona E 2 Pee = aes z * peed, Sr em nay | ' P 4 e - 3 ne * vi t= > ri se neh ae 4 " Ln ee “ ass “ os peste cs 48 UB 4 i, . — : te, ~— . — “" mip os ss . - = 4 « Hie ry t rd P ee Bret . — . oe " - x - : 7 v ms ‘ rn 1 = —h ° Bin book Met yn : : — ~ i 5 . — 4 a ~ Ae E Eric " ee — >. pe : : ¥ Pits € 7% : “ a. = 3 : by tng a Te < ras ee. a > * 5 LB a: ae — Sa =~ tC. ey met t —— ,? > esas ci = pal OP Feeds Np, = ha} . Sa cording to circumftances, are more likely to an- fwer. But whether in agues, or in difeafes indu- 2 a ¢ ced by obftructions of the vifcera, if the urine is DA as = high coloured in the ‘intervals of the fit, or du- ring the courfe of the difeafe, aftringents of every kind are to be avoided, as infinite mifchief may be done by them, efpecially if the diathefis be inflam- matory, or if putrid bile lurks inthe prime Vile ; from which often arifes wonderful and aftonifhing effects in the fyftem. Sudden fevers are lighted up, and all the variety of nervous affection 5 ace cording to the dégree of its acrimony, and the ~ -euliar idiofyncrafy of.the patient. “The cafe of a gentleman who was under my care not many days ago, will exemplify this. He “was young, healthy and florid, when he was fud- denly taken ill with fever, dry {kin, and his tongue “as white as a fheet ; - his urine like porter, witha : highly alkaline fmell. Great heat and fulnefs “about the pracordia. Pulfe fometimes high, fome- \times low, but always as quick as poffible. Great — reftlefinels and agitation of his whole frame. Some- 4 Md | times aan COPY OF A LETTER. 203 times the deepeft dejection of fpirits, even to cry- ing ; fometimes raving, horrors and general fpafms. Sometimes crying for wine to fupport him. Some- times crying for water to allay an unqueiich- able thirft. All thefe tranfitions were difplayed during my firft vifit, which happened in a = hours after his ‘being firft feized! | .“ This appears clear enough to be a cafe e ‘a trid bile, operating in the fyftem ; and is one of | thofe cafes, where the patient’is' either out of dan- ger, or extinguifhed in-a few hours. ~ ant On ‘The whole indication of cure in ‘fuch ‘cafes is, to dilute and evacuate the irritating caufe 5~by at- temperating medicines, to quiet the difturbance in the fyftem occafioned by it. iqmd “ Stimulants have'no place here, notwithftand- ing the variety of nervous affeGions. They un- avoidably aggravate every fymptom. Emetics ruffle too much to be ventured on, when the whole fyftem is difordered ; befides the danger of their fetting in motion at once, a deluge of putrid bile, which is never done without inftant rifk. “ For this gentleman I ordered a purging glyfter immediately ; and his legs to be fomented in falt and water ; till afolution of one ounce. of manna, and oe. sr —_ ~ j so asniaSie A 3 a 2 ‘ a ee tak oe 2H ererye Fn i 7 P ‘ et 3 “ oy » < : i z P ee ~ <4 > : ~~, ae en < “Ss i : x 5 : el STS - ° -* oe ; a + r eK . ~~ r +. " : se = Te « a >. » Sa J : ee. ees alan > aS pte erie %, eS we i Meo ° Z _ at fi fi f y ) ons wee nates oer ~- +E mens. tnd _ 22 pee Ce, es oe sip : PEL * i Vas 2 ad , _ oy — pee -- ¢ aS AMIS ae —_ —— : 2 e , - § as a > > Sb ist thas el ee |, or e on — ahaa = owe pat se ee = #e = cae 4 — si Leal —_ wo m , nie oa aa A es Po ee : TF : ‘ bid "s - rae ~ | ies 2 - ‘ = 7 Soimbf st. 2. \ ys i i ee Nie a - ‘ i y ’ = mT ul & . - : a _ Ba Wea ae) eo “ ss Pas eee olin a ©! 7 * - . ”, >) ealete “ gy, i t OCH Ret es - - hi + weeny 204 COPY. OF A LETTER and half an ounce of foluble ; tartar,)in, twelve ounces of water; could be fent him. wii “ Of this. he was. direted to take four inlde {poonfuls every hour, till it fhould operate, four times ; which brought away fome: frothy bile of an-intolerable ftench, like the workings of a beer cafk in its appearance. This was. far: from. being fufficient to produce any..confiderable.effe@t. «He was however fenfibly ‘relieved, and. it was.no {mall fatisfaction, from, the nature of. the excretions, to find the difeafe in. my.power. ; As; foon: as the-ef- fect of the laxative was. over, I, direéted,-him: to take every three hours, a table-{poonful, of the following :» B- alias gr: Xt Mucil. Gum, Arabic, 31... Amygdal. dulc. decort, re Terantur optime fimul, et adde 3 Jalap. Salin. Z x. | eee Tart. Emetic, gr. je fee Sy. Sach. 3). M. ee This to be continued i in ‘the intervals of purging and to ufe clear Rhenifh whey as common drink. ‘He pafled a more ‘tolerable night, lefs reftlefs, lefs ea okeng and his head lefs affefed. The day ee! . following cOPY' OF A LETTER: 203 following he was indeed -worle. Another ‘and more’ adtive purge was prefcribed, compofed of Fol. Senne 3]. | ~) (Manne 31j. © . Tart. Solubil. 3iij.. “rar hy Sem. Carvi 56. : = Infufed in eight ounces of boiling water; one. half.to be taken early in the morning, and the other two hours after. °This operated’five times. The ftools were of the fame nature and fmell, but plentiful, ‘and every fymptom abated confiderably. After ‘the. ope- yation of this purge, his urine and tongue remained the fame; but he was much more compofed, ‘with fewer fpafms, and fewer attacks of the depreffion of fpirits. His {kin was moifter, and ‘his -pulfe. re- cular and lefs frequent. ig ‘< Tt only remained now to prepare the remain- der of the bile for expulfion. He was there- fore directed to drink frequently, ‘and take his me- dicinés regularly for -a couple of days ; and the third day in the morning, the fame ‘purge was re- peated, with the addition of half. a drachm more of fenna. Thisoperated’very effectually, andbrought away much’ gelatinous ftuff and bile; and ‘the evening of that day ‘his urine became natural» and clear. 200 COPY OF A LETTER. clear... His complaints all. vanifhed, though his a tongue: was but little altered. Nothing further | was neceflary, but to leave a purge. with him, to continue the Rhenifh whey, and:to ufe light diet until he recovered more ftrengthy But as thefe diforders, with many others: of the *putrid bilious kind originate in the liver, relapfes cannot be pre- vented, nor perfect recoveries made, without re- moving every obftruction, and reftoring the fe- cretions to health. For though all acrimonious and putrid accumulations, arifing from difeafed fe- cretions, are removed by well-timed evacuations ; yet indigeftion and frequent colle@tions may foon occafion the fame {cene to be acted over again, if obitructions are not removed, and healthy bile re- ftored to perform Nature’s firft and greateft ope- ration in the animal economy. We, therefore fhould never think it fufficient to. fave the patient from immediate and prefent danger. . It is incum- bent on us alfo to remove the latent defe&, which is the principal fource of all; the obftructed {tate of the liver and mefenteric glands. The excre- tions and urine are minutely to be attended to; and as circumftances require, gentler or ftronger ‘mercurial deobftruents, with mild bitters and neu- tral COPY OF A LETTER. 207 tral falts, with occafional vacuants, are to be exhi- bited ; and ftrict diet is to! be recommended, till the health and conftitution be perfectly reftored ; other- wife. our fervices are flattering rather than ufe- ful,—if I may be allowed the comparifon, like the fplendid aétions of the General, which. often acquire to him reputation and honour, _but/are productive of no real advantage to the State. ‘‘ T could furnifh you) with a variety of fuch cafes, and a multitude of fuch hiftories, of other complicated bilious diforders which came. daily under my notice, but they would {well this letter to a volume, though it already exceeds the bounds I had prefcribed to it. J fhall therefore only fur- ther obferve to you in general, That bile, in differ- ent ftates and conditions, produces the appearance, and apes almoft every other diforder, and of con- fequence, much attention and experience are re- quired, to diftinguifh properly its operation and ef- feéts. In this. country there: are: but few fimple fluxes, fimple agues, or coughs, oncitdeed fimple diforders. And you may. be. afflured, that -when the liver and prime viz are‘not confidered as the grand fources . of difeafe,;,continual and. ferious blunders waill-he commutted,Mercury, in judicious hands, 208 COPY. OF A LETTER) hands, is a fafe and tractable medicine ; and as it is the only powerful and effectual deobftruent in glandular obftructions, it is of confequence the only medicine that ‘cari'be ‘depended on,’ in the latent defects of the fyftem, which entail difeafes or impede recovery. However, it often requires affiftance from other’medicines; fuch as aré an- tifpafmodic or aqueous to wath the glands, and increafe the ‘fecretions’ in general. And it alfo requires affiftance.adapted to the effects the difeafe has produced on the: conftitution. For example, in venereal and other’ habits, where the folids are much relaxed, thevblood poor and flimfy, mer- eury without bark will'{pread every ulcer, induce fibrille, and increafe every fymptom. In acute difeafes, evacuations, neutral ‘falts, and relaxing medicines, render it fafe and effectual. In irritable habits it requires management,’ as its operation 1s chiefly on the folids.. But the idea of its injuring the conftitution, by deftroying the crafis of the blood, is without foundation, On the contrary, it is but too apt to leave behind ‘it an’ inflammatory diathefis: So much fo indeed, that I would re- commend to you a general rule in all fevere at- tacks of difeafe, where mercury has preceded, to gens bleed are many difeafes here, for which it is infallible, pafs of a letter would admit of. Upon the whole, COPY OF A LETTER. 209 bleed early and freely. For, watching, fatigues, and bodily exercife of the fevereft kinds, have:not greater effects in wafting the thinner parts of the blood, and producing a denfity of it, than mercurial courfes. The mild air of this country is very fa- vourable to the operation of mercury, and there with fair play and judicious management. ‘“‘ You may obferve, I have been fomewhat ge- neral on my an{wer to yours. But I was willing to throw into it as much information as the com- it contains a few remarks which you may improve to your advantage. To have been circumftantially minute was impoffible, it being rather a fubject for a whole volume, than for a few fheets. Hofpi- tals and practice can only realize thefe hints ; and if I can at any time render you any affiftance, I fhall be ready to do it. Lam, Dear Sir, &c. J. Paistey. 210 €OPY OF A LETTER. “ P.S. [have added the ftate of our hofpital (Military) at Madras *, to fhew you the prevail- ing difeafes along the coaft for this month. o> iy ite. - a ——— Venereals, - - - 50 tus ¢ ie” ml Bae rt . my ff y ae VW oa & - a | ¢ ‘| 4 } $ 2 * P 1 an . , 7 . 7 # - oy ae) Lap oe 1" ie: Saath ; (a P : } <9 ‘ 7 ; a a fF : L 4 . -. ‘ . a J v a ‘ See J “fi \ A , - ‘ \ * ' y Ps “eo Oe of { . > 7 ' r j if , ir ~ a . ; 5 Jf. biog cr 1 ADR “ ot oe - 4 ¢ | a - + i 4 A * —., A ee ‘ i eww . } ’ ‘hd 4 - =.) a _ ‘ - \¢? , ; j 4a VG 4 4 or ¥ % > U8 ‘ ne Quotidian remittents, 2 Simple bilious fevers, é oO —c Bilious fevers, with vifceral obftructions, 15 — a | + Seas aus Simple fluxes, “thane : a Liver fluxes, and fluxes from vifceral obftruction, - - Chronic vifeeral obftru€tion from im- paired habit, - - * See Appendix, No. III. € 9 f ws | he See Be be J ee Se fat , ‘ roe es aa ‘hy Se \G ) ., Te) PF eS fee a peta) eras . ay ab) « ie \ Ale . be! Sa , et ae Aes a { ULCERS Seep e > a IE NT 1 = - ec y a = Me a TRAS png dee Fut Coat Fe hS . . ate 5 ‘ : oS ‘6 \ : : : ay BR a 4 i ‘ ray wis: PON Nica ae 3 —— ' errs Cees . . — Pie y . a Fr A - é, 2 Peiaak > 4 ULCERS AND HOSPITAL SORES. ‘Tue Naval Hofpital at Madras, confifted of a large {quare of building ; or rather of a fhade of one ftory, open every where on the inner fide; and within a few hundred yards of the fea beach, de- tached from all other houfes. A fhade open on all fides was conftructed within the fquare, and extending its whole length, for the accommodation of patients with wounds, ulcers, and fores.. And fuch was the freedom of ventilation through the whole, that no bador fickly {mell was ever perceived, except clofe to fome bad putrid ulcer, or patient with a putrid flux, The cheapnefs of labour, and the liberality of the gentlemen who had the con- O 2 . tract, 212 ULCERS AND HOSPITAL SORES. & tract, provided us with fervants for {weeping, © wafhing, and all the purpofes of cleanlinefs, to our ” utmoft with. Ventilation was our only concern; — for warmth or fhelter we needed to have no care, — Under circumftances fo favourable, we were led to - i impute the general intractability of our ulcersand — fores, rather to the influence of other caufes, than — emer ty Sean! —* = i e a : = . ‘ . AES SPE s here | Sea = Me AN , ——e — . = Sh. to = - ae re - Sh wte~ ~ ee Seas : 7 . . . , cas me peers ee AD wr * 4 ° yes Beas = Rey Be. . =e i , . J The air of a large hofpital might contribute | fomewhat to the production of this taint ; but 1 ee ae Mee . ——— > See eee : AN OT OTE ay ee e ugieces ee ll Sa is Noe ; SAPS he | om sy Wi 6.4 50. F=f yaa SF am perfuaded, the local fituation of the town, and {tate of the fettlement at that period, had a very — Sep : - 7 a ores ~o— 7, 2 ieeoa -* gas o. alta A en ~ : c rR BK ae let a ita So iS = P + a dl — : : Luis, - : ae alii satay OR Tae ee rk de ‘ Fi i Van Ps 4) NP y TS aati be pail ths SRY; AAS) al frac ahs ~ Senne t Hie : “a : s) » 7+ | Pare Sips |< ag “. iteinoed & he v confiderable fhare. The country round was more Biry py eg ee ee ee en PSone xe" io gs 2 . Seas eae SF J RRS SE Sita’: : es 4c 6 sued Je 4 N Pre) ey P Mey oe LN ett se eee ns Pe a -. than once overrun, and plundered by the horle ; troops of Hyder Ally. So that our fupply, even of freth meat, and much more of vegetables and frujts, : ON ot ta wn ULCERS AND HOSPITAL SORES. 215 fruits, was by far too fcanty. Anda few imper- fectly cultivated and unripened fruits, with the cocoa-nut juice called toady, was all wecould pro- cure for our fcorbutics. Another fouree of un- healthinefs arifes from the fituation of the town, and fort of Madras itfelf, built upon a low, flat and fandy beach, and furrounded almoft entirely with ftagnant {wamps, or ponds of ftagnant water, which are not only a receptacle for every fort of: corruption and filth, but have their edges, as well as the beach on the other fide, covered at all hours of the day with the natives, in the ad of reliev- ing nature from her burdens, to take advantage of the water for wafhing afterwards, which is their invariable cuftom. What a fource of putrid exhalations under a vertical fun! The ftreets, lanes and alleys, formed only of beaten fand, ad- mitted of no {weeping or cleaning: Nor did there feem to exift while we were there, any , fort of police for that purpofe ; or for removing nuifances of any kind. po thatif it had not been for the number of Srammany kites, carion crows, and parriar dogs, together with an innumerable mul- titude of large flies, all conftantly employed in the effice of {cavengers, in removing this offenfive O 4 mats, end we Fb x nner we ee ee ed _ a a re its @ ¢ eee Sten 4a 2S ae SE Ua . 3 . Shy SS SS PS oer in 2; oA AS © OWS vd ° ea taey oS eT a aa rr ee >. a oe omnes toni, an ee a ; r pala 4), © or. BED) - ‘ a — . ’ $055 : 3 x TES ty Swe : » Ne eee - 3 “ we 4 pies 2 ) ee = aed wel sb oS oka = "em Se wes ~ ~ alles Fttwrs weal - nist sy aul ney - PANT Te <4 ' z . 7 z4 tt “we Fete - c < - ss ae: es |) a RS , = 2 : v «i “6 & f ra. 7° =) a Br) ee veka _ 5 f ‘ a? ao ia > = Ve sg 7 ; ae > i > ye ee ub T he a oe nil o ’ na La ie = Fee rt & fags ‘2 4 "% — e af : @ 7 3 3s Bw , 21,0 ULCERS AND HOSPITAL. SORES. mals, Madras, in my opinion, could not have been habitable; How much better regulated fuch ei may be now, I know not. : _Famineswas alfo at this period {preading fick. nefs and death. The miferable natives were daily ES falling down, or laying themfelves down, an ealy and unrefifting prey to it, in every ftreet, ftall and lane about Black Town. . Nor did anybody feem to take any further concern with them, than to _carry them off, and throw them down atthe back of the bound hedge, (a kind of ditch and-bank planted with bamboos, which’ had ferved to mark out the boundaries of the firft European fettle- ments in India,) converted literally at this period into a real Golgotha, the place of many a human bone and {kull. a" At this time the country was frequently overrun by Hyder Ally’s Louties, or irregular horfe- troops; and great numbers of the inhabitants, after being plundered, or having their property deftroyed, were driven to feek refuge within the walls of Madras. A great number of the rice-thips had been loft in the monfoon. And tHe Englith fleet pee failed to memey for repairs, the Bay of : , Bengal ULCERS AND HOSPITAL SORES. 217 Bengal was left open to the operations of the’ French, with no other protection “to the rice-fhips from that quarter, (upon. which Madras depends for a great part-of its fupplies,) than the fpirited and active exertions of Captain ‘Gower, ‘in the Medea frigate, could afford them: “The confe- quence was, an extraordinary rife-in the price of rice. The company ufed fome meafures to relieve — the general diftrefs. Once or twice a week, a Peon, or De-ba/b or fome company’s fervant, under fome fuch gibberifh name, fet out from the fort, making a kind’ of hallowing’ noife, whereby he gathered all the beggars about ‘him, and from an apron or fafh, full of fenams, (a {mall filver coin ofabout 27d.), diftributed as long as he could main- tain his feet among the crowd, to every hand that was held out. When he was im danger of being trodden down or overturned, he broke from them, ran to a certain diftance, and began again the fame diftribution, without minding WG were the fol- lowers; or who they were that received, fo as he gave to every hand a piece, leaving the {tronger to rob and plunder, the weaker as they thought fit. Whether any thing more effe@tual was done Sin, ~ 9 MRS RR Se ee = et »! aera] wees ee ead ne ee eee handy dee PRAT Be RBA IE A pcr) Geel rk i Ce TIS BIE TT ee Sa i SE er, Seite ane esi ‘Seo Se om i _— ) H get q oy x 4 a nf -s f a " a is mi , = r w ita ; j ; j a at 4 ie | ae “ 5 a ‘ — ; ' Ya He. hel 3 Pp 1 > 3 4) vi a 7 3 oh ao . 4 a) ee at Oe - i x ‘ ‘ 218 ULCERS AND MOSPITAL SORES. done I was ignorant, but this I faw again and again. Another appearance in our hofpital ulcers, and which I had obferved in fhips in India, before at- tending at the hofpital ; and which I thought ow-. ing to fimple relaxation of fibre, particularly affect ing the vafcular fyftem, was a difcharge of a vaft quantity of matter upon the furface of the fores, of a confiftence altogether differing from pus, and refembling exactly gluten, or what is called i- | fiammatary buff on the furface of blood ; of a con- fiftence fo ftrongly adherent and elaftic, as not to be wiped off, but with the utmoft difficulty. This is to be met with moft frequently in ulcers of the toes and feet, often after amputation of the toes; and while this kind of difcharge lafts, the fore never fuffers any change for the worfe ; but neither does it contract or heal, nor do any fort of appli- cations produce any change, except aftringents, If thefe were applied with this matter on the fur face, they only converted it into a firm tough cruft, without affecting at all the veffels of the fore. Poul- tices made foft with oil, and applied cold, had moft effed in. difolying this, fo that the fore could be wiped clean, and tlren folutions of blue vitriol, ‘ or, tae eres on ee ee , , ULCERS AND HOSPITAL SORES. 219 er, what perhaps did ftill better, the application of plain. {pirits on a bit of charpee, foon contracted the veflels, fo as to prevent more of the glutinous | part of the blood, than could be converted into good pus, from being thrown out upon it. And the cicatrization generally proceeded readily when | this impediment was removed. some reafonable explanation could thus be made e of thefe feveral appearances and conditions of our fores. But there were others of a different and more important kind, for which it was not fo eafy : to account. Inftead of the cellular membrane and foft parts being principally affected, the difeafe much more frequently occupied the hard and folid parts; the bones, tendons and periofteum. This in many inftances might be owing to previous hurts and | bruiles, which affect more the hard parts, but very often nothing of this kind could be traced. Some- times there appeared only a {mall and fuperficial ulcer, covered over with a tough gelatinous mat- _ ter, with the bottom parts {welled and puffed up ; | and when we got the fore in fome meafure clean, we found the tendons, where any were in the > : way, either {welled up, or bare and dead in many | : places ; = ne ee ee ee, a ae eee te - 7 A ~ i ¥ ‘= io . Ss mh iivel , ber? SS te 4 a ba - it \ a Nes { oy. i " os bil fa ¢ 4 : ye we 7 mS at weh) - t _ eo t + Aid : ht 4 ** Bee 7 . | \ Tey ‘ ¥ T y 4 2 $ : : é on t ~ BY ees Bi an te ay # = % 5 iz * f r 4 Us - s : : ce” ry. . A si LA . + * + < \ “4 . ire y yy \ , -_ ‘ bs T ‘ ~ : Bt. . ¥ .2 + al Be, " o 4 “4” “4 \ a 7 om a “f' . 5 - - a. raf : ~y - y . sf f ’ i. ; : sy : be z t ~ ‘al *? . * - < - ~ ie +4, 4 " ’ r a. fo oe ; ay , t ee ;: R. - - - io Lf J ' F . j a) ' * - 7 wee - és . +e of ‘) - 7 - . °, % te we roe ‘ \) par Z ee - , 4 a J ? q ie ‘ 4. ie : hay A Lo} ~ * ces 5 bad “ > , 2 ry F . el y Lr 1* jue > ~ 7 es Weg Sua ti ¥ SS Shs SRY eis ut ery tt ¥ mf — aS ° Se wa : TIN 6 < serge 5s ee ' 6 indie oe | bes , ; - 7 2 NAR lite he a hie @ ee ae Oy : ‘ : 4 : ~ res Sea ; : Lh AY 5 Wey oie : : J We ROSEY J x ae type * SS oh Le, oe 2% +A 9 " ; 5 . ~ a 7 ive ? . eR ‘ z : T Sth ‘ es ke : : mee F*48) | 3a Ld ee, oe ee ug be ~* _—~. “a ~ — . i ¥ r Sab) > — Fewmes + & ~ ~ f aa ~s + * : : > cp cen) ees Aa - ei . \ he om = ye Noy he Saas: re wes 7 Woks sd (Ra\ j = J Y r | iis ‘ B20. ULCERS AND HOSPITAL SORES. places ; fo that they rotted away to a great length beyond the extent of the fore; or it was found neceflary to cut them through, and very often we found matter confined below them. Ifa bone was near, it was uniformly found bare, or at leaft the periofteum floughy and difeafed toa great extent, And this we fometimes found, where there appeared only a fuperficial ulcer of no great fize, feeming to extend no deeper that the cellular membrane, looking clean and granulating, and without finafes, he difeafe appeared to have begun in the periof- teum, and to have extended outwards. When- ever, therefore, we found an ulcer with the bottom parts puffed up, or higher than the neighbouring furface, we made ourfelves fure, though it looked clean, there was mifchief below. Indeed, every healing ulcer ought to be attended with contrac- tion and finking of the parts -affe@ted, and if it is otherwife, fomething rene | is always to be fu- {pected. In many cafes, where the ulcer was fituated in _ the middle of a limb, efpecially the leg; if it was of any confiderable fize, with the bone expoted and carious, we very generally found the periofteum — or feparated and cekyayed; to a much larger : ULCERS AND HOSPITAL SORES. 221 : larger extent, than either the dimenfions of the ex- ternal ulcer, or the extent of the caries of the bone. Even where the edges of the ulcer. feemed adhe- ring tothe bone all round, on trying with a probe, thefe were eafily feparated, and the periofteum was found wanting. Exfoliation of difeafed bone, again, was com- monly a difficult and imperfect procefs in this country. Inftead of cafting off in one piece, the bone came away in {mall f{pongy carious worm- eaten like bits, while flefhy granulations fpringing up from the fubftance where bone had come off, and thefe inofculating with fimilar granulations from the edges of the fore, when a new piece of bone loofened and came away, a floughy difeafed ftate of the adjoining parts was occafioned; and: this was renewed as often as there were any parts’ of the difeafed bone to come off. We feldom had oc- cafion to know in what manner fores of this kind could heal up; or whether found and healthy bone could have been formed out of thefe flefhy granu- lations: For in moft cafes, if the ulcer was of any confiderable fize, or was near the end of a bone or any of the large joints, and the deftruction of the periofteum was of large extent, (and thefe. were moft ‘ ——— S = 222 ULCERS AND HOSPITAL SORES. moft commonly the conditions), it became abfo- lutely neceffary to have recourfe to amputation at laft. The difeafe of the bone came always to reach as far, or farther, than the difeafe of its membrane, and fooner or later, the external ulcer followed the fame courfe. Hedtic fever was the certain confequence, and proved as certainly fatal, if the member was not removed. Something fimilar fometimes happened after amputation, and occa-_ fioned long ftanding and troublefome ulcerations and exfoliations, even in cafes where every thing | favourable to the healing of the ftump might have been reckoned on ; even where the bone had been very well covered at the time of the operation, and fearcely expofed to the external air at all. In fome cafes, this happened after the ftump had been perfectly healed up, and the patient had been — ufing his wooden leg. A remarkable inftance of this was in the cafe of Henry Arthur, whofe leg had been taken off above the knee, whether on board fhip, or at the hofpital, I did not know, he being already a patient in the hofpital when I came to attend. It was indeed a pyramidical ftump, but it had been healed up above 12 months ; and the man had long ufed his wooden leg. Small ulcerations Nha ol) v uve ULCERS AND HOSPITAL SORES. 223 tilcerations and collections of matter formed in feveral places about the cicatrix. On the firft ex- amination with the probe, the inftrument could be paffed its whole length all round, and within the middle of the bone, which was every where de- nuded of the periofteum. The difcharge was icho- rous and offenfive, and foon became intolerably fetid ; tinging the probe of a hepar-fulphur colour, every time it was introduced. ‘The bone began at laft to loofen, and by degrees pufhed outwards, till it came away by a kind of exfoliation, which was almoft fingular with us, viz. in one entire piece, from the trochanter minor, nearly nine inches inlength. The external furface of the bone was {mooth and little corroded, but within, the cancelli and inner tables were much deftroyed ; in fo much, ° that the whole refembled nearly the middle piece of a flute. Little more was required for this cafe, than to fupport the ftrength by wine, bark and nourifhing diet, and to wafh out the parts fre- quently, with decoction of bark, and tin€ture of myrrh. There was no occafion for any dilatations, the ulcerations having fufficiently opened up the cicatrix at an early period. About four months after the bone came away, the openings were near- ¥ ’ ‘ + i: oi “a Vie? os ve ar ae Al sa aa ‘lay ad > ¥ Be ar <—“* . this ry ai! ia SS Ne Se te ee x Se Se ees | n arin Tis f Pete Eek me . , Us * _— << Se Ghes > Ws rte yr es 7 ~ . et is ML es BES Pad Ws Aue ery : 9 SS Tye. ~1 —S > 224 ULCERS. AND HOSPITAL SORES. ly healed up, and the whole thigh felt almoft as hard and firm as the other. I could not prevail with him to allow meto retain the feparated bone; his intention being to exhibit it, with a view to an augmentation of his {mart-money at the Cheft _of Chatham, for which the neceflary centiiieae were furnifhed him. Our large ulcers at the hofpital were always much dilfpofed, when they got foul, to put on a gangrenous appearance. ‘This for the moft part ms was only a local affection, arifing from a peculiar acrimony of the difcharge, occafioned by relaxation and torpor of circulation in the extreme’ veflels, It was by far moft frequent in ulcers of the legs, toes and feet.. The edges of the fore would get inflamed, become black, and flough off by little and little, with a half fanious difcharge, till the fore became greatly enlarged in its whole circumfe- ‘rence, while the reft perhaps kept clean, and dif- ct gee good: pus, with healthy-looking granula- tions. » This was in general foon corrected by an- » tifeptic lotions ; and the application of pledgets dipped in them, fuch as Deco. Cort: Peruv. and — Flor. (Chamemel. with Tina. Myrrh., poultices, wine, and meat diet, provided the conftitution was tolerably ; ULCERS AND HOSPITAL SORES. 225 iM. cS ae > — i eps te we | aor - - cleanlinefs in drefling, very readily brought on 5 oS ae {uch a gangrenous condition in fores. ‘The matter o “Sse aA. 2 Pe eS wae" em Peso nhs 5 rae ret fees nes Se . foon became fo acrid, as to tinge the probe of a Ey oral fhining brown colour, and to produce corrofion and =} {phacelus. “ Bark did fo little good in thefe fort of clit fs that we laid it afide altogether. I was doubtful, _ Renner enperen TREY "I ee ned ‘ ; whether i in India it ever bettered the condition of any fore. In two cafes of ulcers of this fort in the foot, opium feemed to have a good effect in ftop- ping the courfe of gangrene ; but in many of the larger fores it produced no effect at all. Camphor we e = oe) rh < ; oa # j Se “ea Sx ct . om za k was tried internally, and did good in feveral in- ime s ftances. ‘ b, : , " ba OV a Lae Pres 7 . or eu . wo ee “ ae A * Ja “ ‘ a2 -* _—. , . ‘ = AF, J ee, er EN Bat ’ i eo i ee sik 2). ie $ aes m . >, ie) row. = fe ‘ oN ty peo a ; Foy . ny rN ee) cee i tom ee ee pte 7 “ . “4 2 oy < Tat S> ¥e a rs ety » : ron’ *, ; . aes 4 a* ep 2S ee, ee ae 2. B Sas cachet | | Pra >. ? x xo : Soy - é aw; / eh ‘ 4 +oe u pe iy: 5 Se! h j - Svabboaiee irae » eeeinece : > ba ‘ , — 5 ' : ir Tw eee . ‘ ‘ a : ’ ——— - r ek A ey AY “ os a ea ~~ ao eene” ee ee cee = reer BS Am asi RL «s { Oe Cel ral i << ie), ry EY ~ ‘ * 3 . 7 ; Re , pe = r —. . i branes ULCERS AND HOSPITAL SORES, GENERALE TREATMENT. We have mentioned, that the correétion of fcor- butic diathefis, which may be fuppofed to have had a very general inflvence upon the condition of our ulcers, was a matter of more difficulty at Madras, than ufually happens in other fituations. Wherever this influence was diftinguifhable from the appearance of the fore, or the known fituation of the patient previous to the complaint; the af- fiftance of internal corre@tors, as far as we could command them, was not overlooked, efpecially at the firft outfet. Wine, vegetables, and fuch _ fruits as we could procure, were given freely ; and PI obferved, that wherever, under fuch circumftan- ces, fores were difpofed to bleed eafily, a doze of elixir of vitriol in a large draught of water, twice a-day, was of much fervice in checking this. In all contufed wounds, if it be a matter of much confequence in colder climates, on the firft forma- tion of finufes, or lodgment of matter, to lay’ them open, and give the matter free vent, it is doubly fo in this, where every thing ftagnant in the fyftem, runs with fuch rapidity into a ftate of Pa putrefcent -“ nae Sait ee We ee FO al Ne det ae toy en) at eo Comeperent © ane ee poe ~~ i = = .* ee. Seat Die La ne Yaw || a Bia, 5 : ea al in ~~ bye eA m a sons + RA elu , | > - . 238 ULGERS AND HOSPITAL SORES. putrefcent and gangrenous acrimony. But this behoved to be done early or not at all; for after finufes had been formed, and lodgments of mat- ter eftablifhed, and the edges or furface of the fore had begun to become black and gangrenous; ~ the more we {carified and dilated, the more need oF there appeared for thefe operations. Scarification in fuch circumfances, only carried the acrid mat- ter deeper, and extended the mifchief. In short, nothing of this kind was ever attended with ad- vantage, but while the fore or ulcer was ina toler- able healthy ftate, and the difcharge not yet become. | fanious and brown. Whenever tendons came ee the way, and appeared foft and fpongy, of a dead ° white colour, and {welled up, we were fure that matter was confined below them, or among theit ae fheaths; and that they would never recover toa — found ftate. So that, let the importance, or con- fequence of the tendon be what it might, we found. it the beft way to cut it through, and remove a3 _ much of it as was difeafed, at once. ‘Tendinous | aponeurofes of mufcles behoved to be treated in the fame manner. Purulent matter was often con: Fe fined by them, and as they were generally long of sing” on TR oa ULCERS AND HOSPITAL SORES. ‘229 eiving way, it was thought moft advifable to di- vide them with the knife. Whenever a large ulcer came to affect the parts near any of the large joints; if the bone was ca- rious, and the periofteum feparated and difeafed, beyond the difeafed portion of the bone; we were always forced to amputate at laft, on account of hectic fever, the imperfe&t exfoliation of the bones, and the fpreading of the ulcer from this caufe, as well as from a bad difpofition in the blood, or of its own veflels. Out of fifteen cafes of amputation, of the large limbs for ulcers of this fort in the year 3782, we loft only four, and I am perfuaded more of thefe might have been faved, if recourfe had been had to it fooner; for none of the patients were loft by any confequences that arofe from the operation, but funk under the heétic fever which had come on before it was done. Some patients alfo with fpreading gangrenous fores of the legs and feet, were probably loft from an idea that was entertained, that gangrene and mortification de- pends always on a difeafe of the fyftem, and ona morbid condition’ of the folids and fluids, which muft be corrected before any operation can fuc- “ceed; and it muft be confeffed, that the directions é 3 ia ie ee ‘ Sage oe ie, Neal : “ e , bee We Tega eta See ait’ aN 236 ULCERS AND HOSPITAL SORES. in books of furgery, generally run in this way ; at leaft they commonly direct, that we fhould wait 5 till nature makes an attempt to feparate the dead q -from the living parts. But this opinion, fo far at ‘4 leaft as affects Indian practice, and the hofpital — gangrene of that country, is not well founded ; nor . perhaps with refpect to fuch mortification as is ; the immediate confequence of external injury in. 233 general *. 3) SSeS |; PR rk ST a” bs as 4, a 0h ek aoe = ory, pss ~ ee ae. ioe ee A cafe that occurred in the Medea frigate on 2 her return to England, may here be put down, — though © a) at = on * The following inftance fell under my knowledge, 13 ‘< Aus i 9 ee ae ah a ea = re OE, | Mesa 9 A young man in confequence of fraGure and tight ban- daging of the fore-arm by a country bone-fetter in the fouth of Scotland, had a mortification brought on it. The e furgeon who was called, found it advanced above the el- 2 bow, and proceeding fo rapidly, as to make it doubtful, si whether it might not reach the fhouider before hisam- putating inftruments could be brought him from Dum- i fries, a diftance of feven miles. They were but juft got — in time, and the arm was taken off within two inches of Z the head of the humerus, and very near to the discoloured 4 ays ae, ct = atl wrens He Pike Suny part of the fkin. After the amputation, every thing fuc- a Va\ar Tm ye A we ie ¢ o ceeded perfectly, and the ftump healed very quickly. ? ‘Kit roe a a eee! —" ULCERS AND HOSPITAL SORES, 231 though no certain or unequivocal inferences can be drawn from it. The fhip was difmafted in a gale of wind off the Azores. Among a number of men hurt and wounded by the fall of the mafts, we had one with a fracture of the thigh bone, which did well; and another with frature of the tibia and fibula near the ankle joint; fimple it was indeed, but the bones broken into feveral pieces. Fractured limbs are unhappy cafes to manage in a gale of wind; and this gale lafted for many days. Though in the laft cafe there was no tight ban- daging, the leg began to mortify abont the frac- tured parts, and {welled much. By the time we got our difabled fhip to anchor under the lee of St Michael, the {welling had reached the thigh ; and ecchymofis had extended on one fide fome- way above the knee. The man had alfo received a large wound upon the outfide of the fore-arm, whereby the flefh and mufcles were torn off from the bone, about half of the length; but this had begun to digeft, and was looking well. The poor fellow was very willing to have his leg taken off, and this was done a little way aboye the knee, with fome difficulty, on account of the great {wel- ling ; and fo near to the ecchymofis on the ikin, P4 that 433 ULCERS AND HOSPITAL SORES. that a fmall portion of it was at one place left. above the circular incifion. For three days he, 2 POE « ments CM ithia2 sie corn Stamey - ca oa ee ve ’ . did very well, and the fever and quicknefs of pulfe which he had before, was in a great meafure gone off. On the fourth he complained of fome pain of his belly, and that, he could not~pafs his urine. — Agra). -3 A 5 a 2a * 5 NS ares ae = Spin 4’ - a's a eid Having had no {tool from the time of the operation, Ws “2 Seemann: a dofe of caftor-oil was given him; foon after Sais sees tye lone ¥ — en TN which he fell into convulfive fits, and he died in ‘Jefs than an hour. On infpe@ing the ftump im- ° = Me I tc nasa ‘ ne f y hd . 7 -s GATE iis Saw eS— mediately after death, the fwelling of the thigh was fo much reduced, as te loofen all the bandages. A fine fuppuration was beginning to appear, and the fkin laid over it was adhering. The ecchy- mofis left above the incifion at one {fpot, as formerly mentioned, was now quite gone off, and the fkin had returned to its natural colour. It may be proper to remark, what every naval furgeon will be aware of, that this cafe could not have fair play. The patient’s habit was full, and would have required plentiful bleeding, laxatives or glyfters, &c. From the flate of the weather, none of thefe could be employed. | Ip ULCERS AND HOSPITAL SORES. 233 In the gangrenous and fphacelated ulcers at the hofpital, it was with much regret, I faw many fink under he@tic fever from the abforption, before the difcharge could be correéted ; and that in many cafes, this was not to brought about by all our remedies. It was a hard cafe to take off limbs on account of ulcers of no great extent, and which might have been cured without difficulty in other fituations. But the alternative had been fo often fatal, that we were forced at laft to have recourie ~ to it. It was firft tried in the cafe of Zohn Gib/on, a fine young lad of 20. He was {ent to the hofpi- tal with an ulcer on the back-part of ,the leg, where the gaftrocnemius mufcle begins to grow tendinous. It was of no great extent, and appear- ed to be only fuperficial, but the furface was black, and the difcharge thin and ichorous. The edges were livid and inflamed fome way round; yet. there was but little fwelling of the leg. It remain- ed in this ftate for five or fix days, unchanged by all the applications we could devife. It did not {pread, but penetrated deeper among the fibres of the internal mufcle, difcharging a great deal of thin black fanious fluid ; and a confiderable degree ef heat, thirft, and quicknels of pulfe had come - On, 234 ULCERS AND HOSPITAL SORES, on. The leg was taken off about mid-day; and I by ten at night, the heat, thirft, and quicknels of | = é _ eS yo ae en Se oe oe Me ~ . > Z ‘gongese = . . pulfe had entirely gone off. The ftump looked — well at the firft dreffing, and was foon healed up, fig Sols IOS oc Raa uoeeuteapeee : ~. without any untoward fymptom. How far this — practice was followed afterwards, the notesI had — + a A - taken do not exprefs, farther than thatit wasadopted to the faving of fome lives ; and from recolleGion, PA a oy Sa REE LL i Ee, ah 7 us ~ _ ra ore > 4 6 - rae . cs al I am prety certain it was followed in fimilar cafes, Bie — x 405 sys Ee “and that any difappointments, or ill confequences, Ses... . — ; aE ee > Oi . > 32 paren 's. a mt we SE hows: . . > ae | Sra — — — ~ . ~ de ies Se SS Ps > " . ea - xy : . ae vated a SATA bist a a aie i oe a % Per. y a — ate. Stata ‘ . = — ~ R ‘ , : wae os ’ ene Vi” ‘ Ae a) Sire, tent pds » ea” . r toy ere ¥, - re . [= — 7 " a 5 7 " I . va ” ‘J N - aa Saget ds ie ~ te “ er ad et : - " ERTS he a -; = 5 a 8 nt OE - 2m P NS te : - nol AA x eat 7 ponent oy SR eeeee > <= _~ 7 ; Lai if they had followed, would have been recorded. In other countries, inflammation, when it affeds _ ~~ tendinous or membranous parts, generally runs ear ee: ; a ; { : r ee , 4 cod — 7 ee akied ° - f ne Te a ‘ e cam AT ay Fro. - Latah, aS SAS Mara ; : : . - - Boe ye * . - 4 a ty . aes —— a =e SF we sa : : ae “ a F high; and thou gh they fuppurate unkindly and with © difficulty, this is always attended with much inflam. Paes EY mation and pain. But here it was quite a - ere i, SEW I 09 rer: 4 ark! > date be ye ae eae tT ae P eS ae erin ~ 7? ¥ ~ i ‘ hy q at 34 ~ —— i cially in cafes where the toes and feet were affed- ed. Whenever an ulcer fo fituated, got fo nat as to affect the aponeurofes, fheaths and tendons, a e , y Fe ead ae ee 4 ‘+o a LA) ite A “se yi i at : ' t 4 , A y Ty “or Fim e MP a Ss ia pops | i \ = os i= hie ase far 2) Se, 7 ee Le * ; P ><} E ee Ff : es - \ af 5 ? : > i 2 , 9, a ¥ ; 3 er Ss ; FA vm 4 a F ~ 5 ’ ae “ys a <— . ‘Te “ “ : z “4 a 3 “ ¢ é hy orn a it % ~~: ic. A ~ ows 2 en ~ QF we . beaten ae o it. was very apt to get foul and gangrenous; and ee ae ee ee ae o, = the matter was ready to fpread and infinuate itfelf — a 4 a deepamong them. The tendon, inftead of inflam- ing and floughing out, became only foft, fpongy and 4 > or ae eh af ’ AT A cE Tee ATOLL EE ae r . 2 AE , aes _— — 4 a , ULCERS AND HOSPITAL SORES. , (235 : 4 and dead; and never feparated unlefs it was cut out. We might fyringe with all the cleaning and th ftimulating liquors we could think of; and dilate 4 and make as many counter-openings in the foot ba as we pleafed, and give wine, bark and opiates in any quantity ; but where the matter had become adi black and gangrenous, and had infinuated stfelf jg. among the tendons in the fole of the foot, we , never got one of them to hea! without amputation. Badly ulcerated toes, {which in other fituations would have healed without difficulty,) were often obliged to be taken off, in order to prevent this danger. Latent and imperceptible fcorbutic ca- cochymia may be thought to have been, and pro- bably was in fome degree at the bottom of fuch a general tendency to acrimony and ill condition of our ulcers. Bark had but precarious and uncer- tain effects at beft; and independent of this, we were often prevented from a free, or full exhibi- tion of it, from bilious diathefis, or a fufpicious condition of the abdominal vifcera,—an inflamma- gory or obftructed flate of the liver or mefentery. Wine was allowed to the patients with as much i liberality, (confidering the price,) as could reafon- dP ably be expected. Vegetable diet and fruits could i be 236 ULCERS AND HOsPiTAL SORES: be procured but in {paring proportion. The ¢6: coa-tree liquor called toddy, we had, but it was of fo fermentable a nature, as to become acefcent in a fhort time, and much of it produced diforder and griping in the bowels *. ‘WU? = Our firft application to all foul, fanious ad a oe 5 an . Leas ee xo» a - >} eee ee “ . ee SS ee ome =a $ ‘ “ - aes s™ orm ees Mar err 3 = : > — pate v - re r’ . —s - - : ‘. Lor 2 : bese ao . , - ee] ; Re A cree mite wa yr floughy ulcers, or where the edges were tumid, ae oe hie gy ls ce ° vs a“ ¥ & painful, and inflamed; and to all bruifed and la- ce cerated wounds; was fomentation with Decod. , . Sn ie eae. hy 5 acl d LET pH SARS TRY = 3 dls: Recon Oar es TO: ~ : ye > =. Rtas — se —— Nas aire TTS, gee RIE te eT SE aes ie ee ae Pe NE yn Ey RS ; pay - . ~s Chamemel. Flor. Sambuc. Summat. Abfynth. ard poultices. Some people thought we were too li- beral in the ufe of thefe ; and continued them too long. It was an eafy mode of dreffing, and gave but little trouble, except to the afliftants, or the patients themfelves. And no doubt it might often happen, from the great number of cafes poured in upon us at once after actions, or on the return of the fleet from a long cruize, and the want of fufh- f ' j P| , 7 al ‘ " a 4 eR Fas came say e ¥ 4 fa taney MH oe * 2& a a \ 5 i a i 1 a e° 4 A i et ee ” cient afliftance at the hofpital, that fome irregu- SLL a - a — =. ei . . Eee > OU at . $e ee te sy he ee. t Se 8 eg we Th ah ARE kere 5 as eh larity in regard to dreflings, might now and then opty 0m Sad Naas take place. But it was oftener owing to the in- clinatio# Far ==r7 wets eee 3 te abdiert| pe = ———— SEE 3. OP, — wit Orient vs a hie dy. Pid z : 1 ' —— aa — = oe ed ~ “ae -! we « ‘ ‘7 ~ 7 a! a 7 Tr — oo ~ i isd ih : ‘ ia Ss LS 2 : sey ; he Sleye. “er : — Titer. ohn be : mm P . " z x : a ee * s) \ TST AS saat ¢ ohn ame f i— - r r bo eu’ ? s Th. Toe ~~. a A vu ¥ RE Sey % —* . c Spawning “hha J . ert» ¥. gy h : _ = ’ := =, ¢ . . a = ve " - = r = _~ ~ " E " ‘ 2 aa a EN i tad er Pee... See ee ee => ae 4 . “Ie ao + es tae . s. . re candi re - ah ve ee bs as - > . 3 ’ " - _— a a t > : ee ae -ergiat ~~ y eh ae = wee 5) ae: ’ . we - —_ Ps, i . - : ‘ ¥ — - cee : = ‘ atat - F am ee . em : ies "2 2 7 ~ ae 4 ws Sas P Ce 72 fa ese ~ a ‘ Exe ieee ten : ba > SR Sy ay , sie, b Ee ee We ¢ Xs a a ee = < is -. ‘ ere 2 aN 'y aay f 3 itn aan me ae —-e ° - a - 7 4 m : - Ce Sra ma , — is ra ee . a Pee a : ~ =— oa igs £ io sue. i. . a bal eternal A r ieee d Ee ee ee : x at : a z “ie x . , q sa Xe « + — ‘ ae ; —"p : * See Appendix No. IV. a ryt WLCERS AND HOSPITAL SORES. 237° clination of the patients themfelves; they were generally fond of continuing poultices longer than was neceflary ;—a proof that they afforded eafe at leaft. Rice boiled to a confiftence to make it foft and fmooth, or rice-flour with a little hog’s- lard, made as good an emollient poultice as we could wifh. 'To have made them of more fermen- table materials, by mixing up a quantity of cocoa juice with the boiled poultice, might have anfwered well as an antifeptic application, (if frequently enough renewed,) to our foul and putrid: fores. But this, fo far.as 1 know, was never tried. . In- deed, the common rice-poultices, from the heat of the weather, were generally in a ftate of fermenta- tion before they were removed. Soft and oily poultices applied cold were abfolutely neceflary for another condition of ulcers; where a tough adhering mucus, which could not be removed by wiping, or wafhing, was thrown out upon the fur- face of the fore. ‘This kind of difcharge was only to be removed by poultices of this fort; and then a pledget dipped in plain {pirits, foon brought the ulcer to fuch a ftate, that no more of the coagu- lable lymph, than could be converted into proper pus was thrown out upon it. b W henever _ or. Stee er . Fa hs 238 ULCERS AND HOSPITAL SORES. Whenever any portion of an ulcer got clean, and began to granulate, dry lint was there applied, - while the poultice was continued over the whole ; fo log as the edges were inflamed, and the dif. charge from any part of it foul and fanious ; or : till the whole furface became uniformly clean and- healthy. But as the ftate of our fores was fubjeét » to frequent variations, either wholly or in part; fo behoved to be our applications. > It was no un-— common thing with us, to have a large ulcer dref- 7 arr . 2 —— teak ee igi + - =e sr PO RS Bey Ae * : we A Leek ity) See > Vie EE BES hs) xe RTE RESIS > a ae z ree 2 ee i er Shr oo SF 4 ¥T) Vie sates ~ £ PA hatte ae ~~ > _ ete eet a= =~ . Sais eae Hed 2 sf Vee a nh ok as mide wl 7 ‘ ’ 7 AS fed with different applications at the fame time; pethaps a pledget of dry lint, or wetted with {pirits, or aftringent folution where it was clean, and a-poultice over the whole, to digeft and de.) 2 el Fen, — ea Seas e TT Te Pt a iat, . rm : x . " ~ s iu) : wi 5 ¥ " ; AS: ‘ 1 Re eh ate OS Fee ¢ 5 ls rn eae FA z t Tate re a ~ a? ee alin ee E < ), . térge inflamed floughy and gangrenous margins,! SMart = or to diflolve and clean away glutinous mucus. — ‘In all cafes we made it a rule to renew our < ‘ . } La pee oan poultices three times at leaft inthe day, andto “2 . . 4 s pyr " Foren Ry ee te . i Phased heath Avnet i . Sp “ Es 7 . .s 7 . , : - r wath with Decotct. Chamemel. at every applica-" - = = mae es ae ce » ys [as ; : Sa ’ Cains ay i Pepsin. \' ee. a . ’ ——5 ‘ sect + ; ores ce. (Y , j i a Se om rt aed ree \S, . Recados ng Gs “ te : — “ ~ & = -“ < - . 7 P Ne “ , > was eS . Esme = i om , = 73 7 y , 7 ra nue cote 7 ? 3 = - " . “ . ‘ x ‘wdipd — 7 o * r 7 ¥ m b Seg ey 2 —" ” _ys 7 : . ey " % . = J “ ~~ a 4 . . : dees J \ ar a - yah 7 oe 7 . ‘ ae ro Pie te ae Ss ‘ : ae ih wks ee no 7 > a "4 oe ‘ - sped bares ph Soe : he tl ™ Se WT ee ee Se . An = at BY Dp ic. se stant ane ons Tench AS nn ee eR TS Dia sl a . 83) Sewer: = ere 7 — - - >. “ ¢ a =e : arieiat Se a ral hl ae La eee sth 7a he " a ie ~ : : onal tener a ~~ ay ane < > moet " e Res. 7 ; . . F a te ; 786 ~ - k | ae . P 4 PAN i, As tert 0) i Ce . ee < i Sig Pod 3 4: et es Ea Ae lee Eb a, ie. é pry’ ULCERS AND HOSPITAL SORES- 239 had fully fubfided ; was with flips of cerate platter, and country lint. This laft was coarfe bleached. cotton thread, without any drefling, made to lie ftraight by combing it with a wide comb; and cut in lengths adapted to the fize of the fore. ‘This made the moft light and eafy dreffing I have feen, fufficiently abforbent ; and it always came off with great edfe. A long cerate ftrap over each end, fattened it'\down upon the fkin, and kept the whole fteady, till a comprefs and roller was applied. This was alfo of cotton cloth, and embraced the whole member. Upon no one thing does the healing of ulcers more depend, than upon the neat, eafy and uniform application of this. A fplit at one end, fo as to give it two heads, makes it tté eafily round the member, and prevents the ufe of pins, which are always troublefome, and often wanting in an hofpital ; or they are getting wetted and rufted, and unfit for ufe. Or perhaps they are left to the patient himfelf to put in; in the doing of which, he very often fhifts and alters the tenfion of the whole bondage. Baynton’s /iraps may do very well, and be very ufeful in private practice, or in fingle cafes; but they will never come into general ufe in large military hofpitals, until. eral eo te eee ee 7. tte. Ob abe — te Se 7 Sika. — 1 f- rs . 4 « 1 : r ” 4) + - i, es “ gd o yy i ; *. " - 7 Ta ie, +] J ; ly : ; ‘a r ia 4 ’ i : 4 } : > bo } “ 7 |= A by ’ i ' t f 4 i Ad SG, 4 oY tf j » oa Be) Pf 7 \ ¢ ae, Be ff j : 5 ’ at . is ; * - " > . J - - Mis 4 : Bae E ‘ ae ss 4 ae 3 ge " j 9 . 4 Al : : - ; 4 fr “a : +f ;a . = : oe Fi ‘ > oo 7 i.) ‘ 4 Be ‘al ae te a” ae 7 t ed oy 7, a. “EI 38 r t af a x as ee “| , By - S ee @. > nN 7 ee , a 4 y . 4 “ % r : eae , as a fs 7 h y Oy _ a ’ me a | al ears. “f é c am ; a & ~ - 4 | P s 4 f Wa \h 4. ‘ A at, , « f a) ae oe ee * = oa i: i f > 5 ae | A ~~ nail, De : > . b: ’ . at = - : - / + a ta } “aah P * + a2 i a Ay ieee ; . , a> : - . ag a > eo > a Neg 4 z "1 og a 2 “s ’ x Bd in ie co} ae $ “1 Le . ° Seti . r on te 7. * tS : y < = Fe bh ecg rr naps pe es = : , ; pres , ; it. CR een ae ‘ wr es Ss {geen : a Ene. rr” $ ” ak > —- = — ~~ *¢ ae Noir, y 7 ery Te ~ ~ fa ~~ SI —_ 4 ves 5 — se a s Ok ae ‘ . . —- = a pies af Fo a8 erie ee ; pes PST aa, = aie. sen 7" ~ _: {rity ru oe mctvah a . ial . - . - ‘ . iy Rachel ih 4 240 ULCERS AND HOSPITAL SORES, until thefe be much better provided with afliftants a than they are at prefent. We had never any trouble with hard and cal. lous edges; nor any need of cauttic for their re- du@tiion ; nor had we any occafion for precipitate to produce incipient incarnation in the bottom of fores. But we had much occafion for the latter, and the milder efcharotics and aftringents, to re- ftrain or deftroy the growth of a foft, flabby, and -fpongy flefh, which, whenever an ulcer got to- lerably clean, was but too apt to fpring up, and again become floughy and caft off. So that cica- trization was often impeded by this loofe luxurien- cy, as much as by the laxity, want of tone, and due contraction of the neighbouring fkin. Henc¢ the pe advantage derived from the ufe of aftrin- — gents ; and of all thofe which we employed, none anfwered fo well as blue vitriol, in folutions of dif. ferent ftrengths, adapted to. what we thought the s condition of the fore. A quantity of drefling cot- ton, prepared by being wetted with this, and after- , wards dried, was always kept in readinefs for this purpofe ; as well as a bottle or two of vitriol wa- ter, of different ftrengths for wathing, as the dref- fer judged preferable. Few ulcers were healed 4 | and i\} te | r 4 att ULCERS AND HOSPITAL SORES. 24t and fkinned over without this application. But when the fore was nearly clofing, we behoved to ufe this but {paringly, to avoid the danger of | forming a fcab upon it, inftead of a found cica- trix; and when this was avoided, the cicatriza- tions procured by this means, continued as firm and fteady, as where nothing of the kind was em- ployed. , As the healing of the fore goes on, it is always | of confequence to favour the contra@ion of the {kin, by the application of compreffes to the neigh- bouring parts, and to give a little more tightnefs to the bandage over thefe, with a view to dimi- nifh, as much as poffible, the extent of cicatrix, which never has the firmnefs of real {kin ; nor is furnifhed with cellular membrane, to allow free motion to the parts below it: Though it fome- times gets fo hard and contraéted, as toimpede the circulation, and occafion varicofe and cedematous fwellings. So that much of the future ufefulnefs of the member, wherever there has ‘been a large ulcer, depends on the fize and goodnefs of the ci- catrix that has been formed. It is from this Cir- cumftance, more than from the weaknefs of the new fkin, that ulcers-of any fize on the legs, are Q- attended te ‘ — > > ~ Ps ae Dae ea 2 CF Ca ge a ie y = — * = >, os 4 — ) A . o Wy “gi ie 4, ' wt e ©: we 6 > ff; Ba V4 7 . ’ = & ; ? % 3 ts, a ~~ ry ey yr & 4 b 1 Mist se Wig | Ae ; bay oe & > iit 3 q in ee ic ~ 4 N +a “ > . 7 = & s ; 2 «<¢é | 7 oe a, J a ‘a, : 3 % ae . D oh ps ; 5 . ? a be ve : ; “f ; : i i 4 = -, or . 7 i “¥ Ae SS 2 Ga + 25 -) e ys --* < en eet i = : = , « ‘ I : : sree. | RET song _ ~ er 138) ss 5 if : Ra oe 7 - : ka Ty Eide ole, iat big Mr by * ; s : oy - “=o = meer a = : >. te ee oe _ Somers tte Con eee Oe © 3 2) Wee -. a = : r xi C. Me cas Z5gisdis YVR —a Ss hy. dialiar EES Oe uy! er sw 2 Vom 4 : ieee =——’ = - , as : ye = i ; _ - P > Ng _ 7 7 » “ a om x ~~ 4 ee pike ae — . fps ’ & eae ’ | 2. a o. bs) Pex at ns = ae " y a4 = 7 x / A * an® : i ure ies Fe a ee eel “gare “s Cate a ha » t Be ee pos Tey brea SE 6 ‘ ni ae a : : Saas ep coe Oh ., i ” . Seo T= - Sey Per pe ent ae TAA (2 iy Pos MeEmer IS WN > oe Ta) : Yel P oO he ™e re _ o - dy 7 * : " . ie wz . . 7 —* r ae A : ty . ? wt > . PR —— CR ce -, y ie Rts, i Es die ee q 4 = | ae 7 EO f: A - iy is ; “ a t S : ret > - rs : ~ , we. P -T 58 a ins © » . ~— : — panel rs a | “3 . “e | : : é : , wi, : 2 > " : 7 < ; - sas, =e —_ i waa Sat aD eer ls sea x a. IA Set eee ~ ie a, — te Pak me 1 7 oe S Ke : esi . ‘> 5 r : * 2 uty \"¥ err . on te s ae st . wnt Se - ae " : = ; : y ¥ r 2 : x N a F Vee ” Sve) . A ’ ~ ae wae ihe ole 4 5 oo : : = a oa an : “9 Yt Ae res FA a ’ wee ran + I ad + rz ba e . 7 " ~ 4 we s <—". ~~ . wv : Permes ‘4 : er 46 al 9 , Pee bore at : : d Th - , = ° 7 7 o et : ‘ iy - *. +i eg» Oe I hes ‘ Y . Aa ice - oom d — A ay ai we DS Pee al oa ~*~ Md eee ~ oe s > 7 A ee . oe ‘3 oO ree . i 7 ) ) Seana aa. eu. Aig ae we 8 ‘ : a “ a a send te es fh’ . ae - aes ~y ee r : A a Goes : >: as — i=, a ai FeLi i a, gue. A a? a — . . = = pe ‘ 1S Seite ory ee « . , wii atl aoe MS “ r ‘ . x - —_ elie a ratty 1 7 4 . fins a eee — ee we mt , F y $: . wee ‘ie ‘ +t By Pan ate Lata oii ee re -_— - a eines | ». - a é om a. on oo 5 et ke 242 ULCERS AND HOSPITAL SORES. attended with fo much unfoundnefs and ditabilty of the member, and are fo liable to open up ages by any future violent exertions. If it has pene- trated fo deep as the mufcles, the rane from them unite with the new formed-fkin, withe : out the intervention of cellular membrane ; fo that , the action of the mufcle has a continual tendency to break it up afrefh. é i i Sometimes our ulcers, with every thing look Ne Bs $5 well, and filling up with healthy ca with well-conditioned pus, would without any V fible caufe become ftationary ; and then we fe A found, that by varying the dreflings, the heali a would go on again very well; very often ty withdrawing the aftringent folution, and applying poultices for a few days; or by fubftituting fpit ty tous applications, in place of the vitriolic water, And I often found, unmethodical as it may fe em, ¢ that under the alternation® of the laft with poule I+ tices, a fore would heal as well as with any | ced . - drefling whatver ; the one fo far counteratting t he other, as to preferve the proper tone in the vel -neceflary for conducting the healing procels Whenever a clean and healthy ulcer becomes # ta ‘ onary, without a fyftematic affection, I am. pe ete A se or _ é » " “ te 4 EM. 4 { tis We ay ULCERS AND HOSPITAL SORES, 243 fuaded it is from want of this neceflary condition being maintained in its veffels; and that we will often attain our purpofe, by a little variation in our applications; and where we have no particu- lar index to guide our choice, it will be found beft to adopt for a time, fuch as are of an oppofite cha- racter to the laft in ufe. Notwithftanding the general malignity, and ill- conditioned difcharges from our hofpital ulcers, whenever thofe on the legs continued long, I ob- ferved, that they became a mere local difeafe at laft; anda great deal of attention, pains, and judg- ment was requifite, to vary and adapt the dref- fings and applications to every varying ftate of fuch ulcers, in order to maintain that tone and ac- tion of the. veflels, without which no good pus nor healing procefs can be procured in any fore. Iam perfuaded, it is owing to want of attention to thefe circumftances, and owing to the dreffing of fores being left almoft entirely to the care of ftudents, mates, and hired fervants, that hofpitals, military and municipal, have incurred the oppro- brium they have long lain under, in regard to this part of practice, Q 2 Our 244 ULGERS AND HOSPITAL SORES. Our amputations were, all done on Mr Allans : 4 fon’s plan. But where the wel ight, of the patient's E body was to reft upon the end of his ftump, we | did not attempt to cover it wholly, fo as to pro. duce adhefion by the firft intention; for this Pe ways produced much wrinkling of the fkin, or in, convenient corners at each fide of the limb, We — : ; found a better ftump was formed upon the whole, a if three-fourths or fo of its circumference were healed up in this way ; and we had the remaining cicatrix generally hollow, in place of being conical : ; ‘ (i ‘ ‘ a or pufhed out. : oh i Ree “4 toad - ina eo al - B es eee se a #, pa = _- —~ . as =" - " 3 . * a2 ' 3 Pn Pa a Se en =i ee eee — 2 we ee o aut ee 7 - aks -" , 7 tie : i ee eer dda PTO ; -. e , - e . ~ _ ~ gee -- tS . ne me Pat . : 7 rs : v s es i hn) cues * e 7, } . \ - , Abe : phe |. \ ied eee © OE Seley TETANUS. In the year 1782, no ‘hes of this difeafe occur- _ e red at the hofpital, either after amputation, or from any other caufe. In the beginning of 1783, we 9 had two patients feized with it. In one cafe, it a fucceeded the amputation of the leg; and the af- fection was but flight and eafily removed by opialng a E | In the other, it arofe from a gangrenous ulcer in at the great toe. This toe was taken off as foon _ Se & 7. ia * t ‘ 4 *y < + 7 ¥ sh - ¢ - } ' ‘ - +} aa i : (3 ie £ * |i = ; ia 4 ; : wy | 6G f of ore 2 . e" Z ; a ne ) i] r ms 7 a aA 3 Bo - : ry 7 ; ‘é 4 ae ] i .. - ae { ‘ ? “a ‘ rar ene. er ee F “ ary i= . ? Be ts - Soe Z mn Se a ee. * ; : a i, ay ; i 2 ie se rr ‘4 ‘ 14 - woes :. : keds. a. ft es : “4 1 B, t A ek 4 *e Ue) sal |e a viet G wn RS a 4 «1 * a ry. t Ie af =) pa) So ea = = . ok ot > a) s Aa a. oe FC ’ 2 4] d - ' a i : a 4 } 43 es SS" ~ = 2a ee : ve hal ¥ re spams ree =< a «we ws = rt 7 ea Ta are RE TS | ee ) < mas Pe . Vg fy | ata &* . Y-- mes J Tale” a $A) Re oer ae. ow tS ” ee 6 EN TA cs — 7 * o LS me ey —_ - AF. he Re ents ee <* ee eee “— ¥ BIE h-. More a — eS. - . o we % * * .<« a oe . “ ee = a - e aie A - ~! F , 5 os oy — ~ ocr, ¥ ; i fi — nd . . = ) a - - . 5 . - \ ‘ mre v ae . x7 7 : name : ‘ = si: a My = = 6 ° oe Ss ‘ i : . 2 r le Be ee ee Sle ys | ee a ee abate ene. ee ss ial vo) ee liad ; 7 raged : te nah bd So — Sas neha ' rs ; ea ie ee Me resi ; P aa TT : 3 : =! = Ss = n = s ae < : 2 ‘ eee | Ne 7 “ 3 “9 Sate Sure 3 = . a Sy : } Ys “ ‘ ' - > - a Sz F 2 Tre =. 3 ‘ ; = — Se et | te “ a ) : | base Mi ~ ; ee oe ; a A ) ; . “ " FERRE ; " om - ‘ : - x Seat cae r ” be he th J 7 ys pray A : n 7 —- a uy = se \ ’ 7 NP mies ate | ‘ | ae te ~~ PM. | « ‘1 - Ir . r sai . | iin ‘ < . : — ee pe ra Eee ae ke A> Fo ln Soh — « ' oan (? Mey P,P ee ae eo es mae ~ " Pe we Path ~ FN oe ee = ’ Ps ,-8 — ies en da uh : - i irs ‘ : . an y " a. “ ” : ey he \ OVE ol Dene Ce Perea a‘ te 2 I See oh ee 7g ae i ee 3 oe ; | - ‘a — Sot =e on Oe - ee oe i = ~ A oe nate lat AE eh eS an * =e 3 ce i pert - — - Fenty), . = ert ~™ fants : — : é ne — ; ub % i : : SS mei . a OVE ch a we ie . oon, ny ee ae Sent ss - aa phiciad. ; ¥. : ~— : . a | : = oul — om P dhe py Sh ee Tye a> ee | , a ay pe a i} 4 TETANUS. 245 the difeafe appeared. ‘The patient had’ formerly been fubject to epileptic fits, which returned with the tetanus, and carried him off. In the latter end of July, or beginning of Au- guit 1783, on the return’of the fleet to Madras Roads, after an ation off Cuddalore, the hofpital lift was fwelled to the amount of 1800 patients, - and the apartments were much crowded, notwitk- ftanding of extenfive fick quarters added to the hofpital. Several of the fhips were but newly ar- rived from England, and the fleet had been out a long cruize.’ Many of thé people were thus in a fickly ftate, or tainted’ with fcurvy. The land winds, which blow all along this part of the coaft, had not yet fubfided ; but this is the ufual courfe in every feafon; and there was no other known circumftance, to’ which we could impute the fur- prifing prevalence and fatalaty of tetanus, which took place on this occafion. : Being employed, at this period, in the general management and regulation of the hofpital, and in drefling bad wounds and amputated limbs, (which were very numerous ,) without a particular charge, I had taken no exaé@ account of the cafes, or of the numbers, that were cut off by it. Q3 rag Se ee eee a ™ They were — - Z td ~——— —t% — incall gem; 7g | tour = ore i 7 le — 34) 5 ar ee a ee: 240 TETANUS. 4 were very numerous ; 40 or 50, or more. It feem- ed to be all one, whether the tetanus arofe from y amputations, or from fevere lacerated wounds, or from thofe that were exceedingly flight, and in a clean and healthy ftate ;. or whether fuch wounds were in the flefhy parts, or among thofe that wert » tendinous; thedifeafe almoft uniformly proved fatal. None recovered who were attacked, except one; - and in this one, the affection was flight, and cone fined. to the mufcles of the lower jaw. It cam oe on in this cafe from a bruife on the firft joint of é a finger. The finger was taken off, and the difeafe ~ was foon removed. About this time alfo a fimilar Hf flight cafe came under my care in the Medea ft ie * gate, from a hurt or bruife, with fracture of the os nafi, and was removed by opium. It was quite another kind of difeafe in all the cafes at the hole, : pital, except the one mentioned. It began ville pain and ftiffnefs in the mufcles of the lower jaw, but I never faw the jaw at any time fo ily clofed, as to prevent the introduction of liquid from the point of a fpoon. ‘The teeth could fi ; ways be opened about a quarter of an inch or more, by a little forcing. A. great degree of ftiffnels, rigidity and {pafm of the mufcles of the affect ed membet | TETANUS, 247 i member foon fucceeded with opifthotonus and af- Hk feAtion of the mufcles of the neck and back fo nt that they lay rigidly ftretched out at their full a length. There was a peculiar fhining watery look iy of the patient’s eye, oppreflion of the fpirits, and ete fighing, with a flight degree of fever, but no de- is lirium or infenfivility, In this way the fufferers ¥ generally continued for ro or 12 days, fometimes longer, and gradually funk under the difeafe, with- out any change to the laft. Some were not at- tH tacked till 14 days after the accident by which ty tetanus was brought on. Amputation was tried in im feveral cafes without effe@. The largeft. dofes of opium we could venture on both given internally, and applied to the fores, and the ftiff jaws, cam- phor, blifters to the jaws and throat, warm and cold bathing and dafhing, wine, fpirits, the vola- tile alkali, were all equally unavailing. In one cafe, full falivation was excited by mercury, with no better fuccefs. Not one patient recovered, except in the flight cafe formerly mentioned ; nor gl ee ‘ | did any of our remedies produce the {malleft mi- ee aE tigation, or feem to retard even the progrefs of the difeafe. 0? Q4 BURNS nt! os al "Gs. Rye oh Cee 44 = 5) en a eg —— — ee Tee fa 7" er a KUL | BURNS FROM GUNPOWDER. BURNS FROM EXPLOSION OF GUNPOWDER. Burwine from explofion of gunpowder was a frequent accident in feveral of our naval engage- a 3 ments; and when it went to any depth, was at. | tended with terrible confequences. Whenever the burning was upon the head, neck or face, and the cutis vera was affected, the cafe was always ee attended with much inflammation and {welling ; a and generally with fuch a degree of fever, as foon’ proved fatal. Indeed, but few recovered, where the burning was extenfive on the upper parts of © the body. The pain and torture was fo great, and — the patients fuffered fo much in dreffing, that it was with difficulty they could be got to admit — any thing more than the application of oiled cloths. - And if there was much inflammation and exfoliation of the cutis vera, ‘this was followed by fuch an exceflive difcharge,° as their conftitu- tions could not fupport. Very often the fever ran fo high, attended with delirium, hiccup and vomit- ings, as to cut them off in the firft week. We placed BURNS FROM, GUNPOWDER. 249 placed our patients with-burns in the cooleft and _ beft aired wards in the hofpital, and it was necef> fary to give them laxatives frequently, as they were difpofed to be coftive ; andto allay the febrile heat and thirft, by acids or tamarind water for common drink. But we did not purfue the-an- ~ tiphlogiftic plan any further than this. On the contrary, we thought it neceflary to fupport the ftrength by cordials, and ftrengthening diet and drinks, as foon as any abatement of fever: took place. When the fores began ''to digeft; we found the oil cloths very inconvenient, by adding to the filth and uncleanlinefs; and that it anfwered much bet- ter, to wafh the fores at each drefling with {pirits and water, of fuch ftrength as could be borne, with- out much fmarting; and to drefs with Ung. Alb. Camphorat., or, as long as the edges were {welled and inflamed, with poultices.. Of all the applications which haye been pets ed: in the recent ftate of burns, I haye never. found any equal to the Carron oil, viz. equal parts of lime water and linfeed-oil; with. an opiate in.a dofe fufficient ‘to, abate pain. twice,a day ; with wine and, novrifhing diet after the. fever has abated | Dry. 250 BURNS FROM GUNPOWDER: Te eens 3S SINE Dat pe P ~ ar _ " . * ” - " ’ “ a = = Dry powdered chalk recommended by fome in the ulcerated ftate of burns, is a coarfe and clumfy — dreffing indeed ; and’ by its adhefion to the parts, — ~] Ls vik, te = i RE 3 > a —— Ds be ” . ’ AS ~~ : bene eS ann rae - and hardning with the matter, is very ill fuited to the tender and irritable ftate of fuch fores, but may be ufed in another way with great advantage, ne ows a * ie a nae —- PO PORE mes be me — ~~ ~aeteeke ee ad Lae, a isl =e." “ Woes aie . — ™ v7. i ‘. " > = s “g ih - led i a ~ x ee cs Cine eee ae an = AS : y ? le : . es 5 at - - wes } = ‘ ™ _— = ES Sa ES eee than ett. 7 aie x ve ‘ ) See + ~ o “7S aeaN bi . a ~ ho ae | ~ ~ sen au - ¥ . =) ol ig ~ _ ENS a 4 ke ig See ee Apply all round the edges, pledgets dipped in lin- POE . an : Sit. pas 2 Wie Sto ss Po. B feed-oil, or fpread with any foft ointment. Powder a eg — - >a 4 wy . Grey — = < in “ the foreall over fully, and to fome thicknefs, with aber tes, BRIERE Bd st ‘ni Lick OPRES os 7 ee Be ancing SSE RSet Sie ST ~ —— aia ~s _ 5 oe a ne cs _ i adi r i SOs finely powdered chalk. Apply over this a piece of rag well wetted in linfeed-oil, fo as to fimeat and foften the chalk. This converts it into a fort of foft putty, which comes off perfectly eafily, and keeps the fore in a fine, clean and a dition throughout the cure. o) Deep and corroding ulcers were frequently oc- cafioned by thefe burns. In two cafes the ampu- 7 tation of the hand became neceflary, on account — of fuch ulcers affe@ting the bones and tendons. — In fome cafes of this fort, we found that a folution a ef corrofive fublimate in water, employed as 4 — wath, did more fervice than any thing we made ufe of: At leaft three or four fuch ulcers, that had xefifted every other treatment, were healed up une der its ufe, An impediment to the healing of fome ules BURNS FROM GUNPOWDER. 251 ulcers, originating from burns, and which had been obferved in other cafes, where ulcers were fituated over a joint, arofe from the action of the mufcles, on the fide oppofite to the fore ; whereby the joint being kept bent, the new granulations were kept conftantly on the ftretch, and in a {tate of irritation. ‘This was very obfervable in feveral cafes of ulcers over the joint of the great toe, and fingers, which were kept from healing, till this obftacle was removed by the application of a lined {fplint along the oppofite fide. I ee FRACTURE OF THE CRANIUM, &c, Nowhere fhould we fuppofe this to be a more frequent occurrence than on board fhips of war, and after naval actions, yet after three general en- gagements, in a fleet from g to 18 fail of the line, ‘befides feveral actions with fingle fhips, two cafes of this kind only were met with at our hofpital. The firft was a fracture over the fagittal future, of an irregular fhape; the bone cracked and fe- parated all round, of about the fize of a dollar, and A “ ‘ wl 4 8 se é he let ees eee PORE <2 5) dee Aa as Bliss as eee Fay TIENT ~ — vw oS =f ot Slee Ss serio ~ oe ee ’ rahi crab ate jhad st RAED, « 4 hid of dr ital, Gaare na Slips : PEPE hows aacaeritaiye~ 5 { We tak er al a ° a > sail 3 | i~ Se ee ae Oe Sg et ees weal : * Wie ee (nt eh deed A hel RS RSS As ~ aie fiph fo te tie! { a = ~~ . ee ee = a . % ; “fy - he ' . ‘ . > - ~ } : . > rei sion ~ . : -_ . 0 if a > o SS ae eer as p? 2 ’ . , —_— mee hl toys - P > ? * n anal “ 3 = a « ” ~ I hak BP, ih, on ¢ res * 8 ee x BO } Onn a ae a ge ae a. ¥ == Ps eet Sia . - ~ BAD Seceg : VERY Ts ey > baeee Oe yey ere oi Se | - Dos es Ns Pee x /- ‘ anaes ko OR eaters a rn - 3 _—s . 7 , “s > se T) 2 . PP iy ee = meet! - . = ‘ = = » ra L- = ~ - ts ea ’ i" + int) he, & . . peed Se = _— - eee. ; : : 2 re en : ‘ Ft ere Tes Se + a we « oa ; oS : ~, ee . > ne gemtinen. | es oe — 7. alan ate tae “ - : > . out om : st aN =a Piheses, ‘ . ‘peli, Wy o> Br sis tig ; c a ; aE ee .' ~ $ oe g re . . ™ mone oF * re den . z >. S - - 7 T =— . ~ We Pir toh 7 = 2 nis nat Brea a> gs bale eth 1 Oe aR SB woamet: Wi a Pie ~ry Rr 7 / ee ee ae TO pula °° Ae err ary oh —— pr r on A Se sl iWin, ' - it eee Xf el m ied APSR is n i . : ; 4 et) Pie estes sch oo metres eel ve (where net ee at ~ 1 a7 Mabel iret See NS was a i Fe = . ‘ 7 : e eee > oe paveg 4 ested . . ; + Q v 1 a > . “ > \- - - - ve - ba ‘ “ yu ~ ’ oF ae a me 3 , his, — / — ‘ pe tlie ye toe , = x y 5 >. ~ > : 4 ? oo | . Pet \ ’ . 1 bef per ~ . . ES - % f a2 ¥y 4 a. — PS 4 7 we b é ase Le pe a An oe a >? mY c. 4 die _ Por - a, x r - Px ny * . re ° ‘. ~ ea se - . ae a, op rs alba : 4 . iu Sees. oo ttl eon ra ; « — 4 f “Sasa " is i. = » . pei Kater . wr 9 FA AD v3 4 hie ui q . ; = . +6 * s % ‘ ned . . " - « " 4 5 \#) “ . 7 A . : J ’ 4 f a : fa ‘ a - > wal oe Si * ARs 7 7 a “ « >» ~ be ng . «/ ‘ - 7 — > * . a q . ‘ ‘ * = 4 : Pace eT] ; 7 = ue +) ap? ar . ™) {a ae ar). 252 FRACTURED (CRANIUM, © and without depreffion. The crack was fo open when he came to the hofpital, as to fhew very dif. tincily the pulfation of the brain, by the flux and receffion of the. matter refting in it. No bad fymptoms had ever occurred. The piece caft off, ; : and the opening was filled up with a flefhy fub- flance, in which new bone formed and united with the fides in no long period. The ether was a fimple fiffure, of about an inch in length, in the occipital bone. No account being received with him, nor wound or hurt. being known of, or appearing externally, he had been for fome days placed in a fever ward, and treated as under fever, until his meffmates gave information, that he had received a.blow.on the head in a@tion. On fhaving his head, a puffinefs and fome difcolour- ing of the teguments.was obferved on a particular | {pot ; and on making an opening over this: place, the fiffure of the bone was. difeovered, with the i 2 edges difcoloured, but not feparated or deprefled. a The {tate of ftupor in which the patient was, left no doubt of injury to the brain. The trephine was applied over the fiffure,; and an ounce and a half of Euless matter was difcharged, but af- mete: —.. .. forded ‘. es : be equally certain, that among favages at leaft, FRACTURED CRANIUM. 253 forded no relief, and he died in the courfe of a few days. . Little information can be derived from the re- cital. of fuch. cafes, unlefs it be to remark the dif- ference of iffue in circumftances, or from injuries nearly fimilar; and that no prognofis concerning this is to be drawn, from the extent of injury done to the bone itfelf; but from exifting fymptoms, as they may arife in every particular cafe, Thata confiderable piece of the bone of the cranium fhould be fractured, and fully detached from the neighbouring parts, without being beat in, fo as to comprefs the brain, may be difficult to conceive of. But many fuch cafes are on record. It feems to many cafes of fracture of the cranium, attended with compreffion, and with great and extenfive injury to the brain, are healed up without any affiftance from art, or at leaft only of the fimpleft kind. Thus fays Lieutenant: Watts in his ac- count of Governor Philip’s voyage: ‘* At the ‘¢ ifland of Huachuane, three of. the natives came “on board, who had the os frontis fractured in ‘‘ a terrible manner, but were perfectly recovered * from their wounds.,’’. Similar relations are given by 254 FRACTURED CRANIUM- by many other travellers and voyagers. Blows from ftones or clubs, the common inftruments of 4 of warfare among favage nations; or falls from rocks : or trees, muft be the general means, by which fuch : BR as ee re 5 ee a a wounds are inflidted, and muft in many inftances. occafion depreffion, as well as fracture of the bone. This may be either with or without detachment of the depreffed portion. How the fyftem is en-— a abled to fupport fuch a lengthened injury to the a brain, or in what way nature may operate to re- rss AO aS AN ie. et ~ — "39 + wee ~ — —— ise on oy Se ~ Se Tey : +e - k . es ™% ro. : ta ‘ - - =< Se “hes aie: SOS ‘ > “ — a : y ; : a ADO ae — XO. 2p _ = oy = ee = ee Thawres if aes Fe 4 ee ear>- ~ > ~' 5 Lickin . hal, a : 1% Pa _ — ra = 4 << _ > « > =) 4 -, > : 4 ye. r . re . a. ee . ~S ) at ; ; a es a ”~ 5 en = “Lie ‘ > . t 5 (ee - r) my 4 “8D ee “® _ iO Oe i ren, a F pea ‘ rit . 4 SRY “ ‘ “. : i . ‘ oan t 1s. a ehd- aie’ “en ’ a . A, 5 eit a ° : : — : . “i Se ; ~ a eA | . J ane , _ is + move a depreffed piece of bone, may be difficult ae to determine. A cafe I had occafion to fee, many ’ ar ciao io ae he \ . af be tae ; .? ne sanes phat “aaa years after the foregoing, fhews to what extent the Ee brain itfelf may fometimes be injured, without pro- : ducing any immediate effect upon the fyftem. a A boy about 14 years of age, running along the M: ftreets at Dumfries, came with his full force ain | if the foot of a lamplighter’s ladder, carried horizon- z tally ; whereby a ftrong’ iron pike, with which it iq was armed, was driven through the forepart of the ” os frontis into the brain ; carrying all the broken a pieces of bone along with it, and making an 4 opening, within which the finger could be eafily — turned round. Yet he was neither ftruck down, — 4 nor. much ftunned with the blow, and walked about a FRACTURED CRANIUM. 258 , about after receiving it for half an hour, the wound difcharging a good deal of blood, mixed with e broken portions of the brain. He lived for 26 days ‘ after the accident ; nor until a few days before his my death, that his left fide became in fome meafure paralytic, did there appear much fever, or any : alarming fymptoms. There was a very great difcharge of purulent-like matter, with broken portions of brain, and often in the latter pe- riod large quantities of clear lymph. After his death, the greateft part of the right anterior, and much of the lateral lobe of the brain, was found fuppurated and deftroyed. The dura mater thickened, white, and’detached from the bone, over the whole extent. of the difeafed portion of the brain. And yet the pericranium, contrary to what might have been expected, clofe to the edge of the original opening, which had been enlarged for the extraction of the broken bones, and ano- ther which had been made farther backwards, for the difcharge of matter, kept perfeclly found, and adhered to the cranium as completely as ever. } A method was adopted in this cafe, by the gentleman who had the charge of it, (Mr William Jardine, navy furgeon,) for enlarging the open- pyre | ing yb De ete SA re 8. ee 5S tat BD < x ak Pe a pak" a AAR Say t ~~ a S Sab eehiser A) ms ps a - ‘emt =— ge? —_ 7 Petmee = > a fer F#2> 2 4 F : i WOE DS agin ‘ er Tae cet tt Wye cir . - “a — ' — - wae) ae Cate - . , oe ee ag : " a ve - *~emle ed - _° ‘ d as . ty = g oT n . » Se ~ ad a Be debe 0 5) an . et e op ME, ard et ee 4 -! - se? hE. oa a 7" ' P Pe e. 4 . n “i a ‘, ° ? ‘ == ee a ee = » cae : “Ae ros (an . “, ’ ye WES ' oh [tt Pot ae eee ee +. “~* oa ro La! by, — | SER SO te ee - apy ie a s a , ry . ae) j aeee ; rs Ae we ‘ \ ieee 3 - le ; H ) g s me A, ’ ; . b wrth: te : am ats - ay ( ‘ ‘ aa 74! i. ie. ext 5 = , as a ' ” t , A ey t hse : ‘ti + . ] , , ba es “ M fe ee — $ f ¥ , : oy a af Por. ) Ww "%§ ven ae 7 Py . ee setae . ; 2 iv ‘ Gul t - g y .* F a oy * + ¥ 5 Me} - 9 A ¥ ua iy ise bg ~ 3 ‘Zi As | é a, nh 4 4 . ..) ; - ‘ i} ~ ig heel | e be - . f- oa - < 4 -< ; i ae a. os t= “1 | ‘ . « : > 3 ; _ ee ¢ fe 7 % 5 = 2 = e = os 4 = ‘ \ ae - pa > eS . ee = * _- 1) > ee. te == wf a, “~ << ie i} a 3 1S Joe 4 i: ) Be | a38 w 7G ' * 4 oe v4 : Lf 4 ) ; “4 - ’ MW 3 y “a . o “ap We: "EEL fo 4 ~ 7 5 ’ j ) $ . 4 3 1 = ‘5 Ac een ‘qa be 2 Bie: 7. ‘ r de ie Se ee ox yr? — a) in all cafes, to that by means of the Y SIT POTEET, Si e256 FRACTURED CRANIUM, ing made in it fcull, in order to facilitate shied traction of the broken pieces, which perhaps * deferving of being made known to the pub ie The-obje&t was to enter the trephine, without a ff centre pin. And it was fuecefsfully effected, by the very fimple contrivance of a circular frame of hard wood, (or the fame may be made. of ivory) of about half an inch in depth, and of fucha thick. f nefs, as to allow three well fharpened fteel points to be fixed in one of its edges, at equal diftances : from each other. The diameter of the circular rs was adapted to the trephine head, fo as to allow it to move eafily round within it, without fhaking or vacillating. This was put down upon the “4 bone round the opening, and kept fteady by means | of the fteel points, while the faw placed within it, A was entered with the utmofl eafe. ‘The. fame ine i i eects might be made of polifhed metal entirely, and adapted to the trephine head, with ni exacinefs, fo as it may move within it without the leaft fhaking, and the bottom part might be feo. lopped out between the points, fo as to fhew the entry of the faw perfe@ly. It appeared to me that i fuch an inftrument for entering the trephine, 18 f : ik perforator te ty pe FRACTURED CRANIUM: 457 perforator and centre-pin ; and for this reafon, that, whether the centre-hole be made with the perfo- rator or centre-pin, this muft require much more preflure, and that directly downward, than that occationed folely by the cutting of the faw. This may be of fome confequence, both to the patient and the operator in working on cracked or fufpec- ed portions of bone. And befides, as the centre- pin muft always proje&t fome way beyond the teeth of the faw, all danger of penetrating the bone with this, before the faw be fufficiently en- tered to take it out, is removed. This may be thought to be a very unlikely accident; but I have feen trepanned pieces of the {cull, with a hole fairly through their centre, in a furgeon’s collec- tion; and whoever will but take up half a dozen of {cull caps, and hold them up between him and the light, will be readily convinced of its pof- fibility. The objection to this mode may be, that it will require a little more room and removal of . teguments than in the ufual way. But very little harm, it is fuppofed, can ever arife from this, And R let = ‘ te different ona ol inftrument itis qui FRACTURED CRANIUM. ferved, that though the ¢ let it be ob b @. Z — iB] oH A Sad iB] = a ra 2) put) ro i | eS 1) ia a S — ~ & @) Py © cS PR ae 5) & én’an old dried cranium, frefh and living bone. 2.53 io NES RES LO om OM me ——————— oR onen wars = — 7 > hs obs ~>4 A x - — aor = er . ¥ 7 - : » > ey abe . . a — wee ~ ne A tee ati ; th beste conceal ieciaen ee an : adie a Sacre OT, . Se ee heats Loa “+ " Stes Seine, 5 ial Pa ae + IEF > PR a ew Ne Phan agrees 4 DT ogre wr” eT ee — E angrcptmcintyesion iii Ne ar Serene “ Jen: ie mr e “erro eine it Ah RT te up \ = end Taeenepi ov Em —* 0° LTRS aE rs WBE y + eran aero 3 - sXe). , re i" = ape pet Al aT = ’ ; “ : % tsar Fess dadomneoetin > ay . a 0 " Pens fem a ae - : ERNE AAT™ sk age Emme: - SAS a0. Wee 7 Oke : me Ns. ¢ = ote ; — we : Siegen iin yD he, ; Tony Siabhiaee yeh en saa { 2: ename vere Pe 5 ‘at oe I tr Pane i tees aE 58 wer APPENDIX.—NOoO. I. Remarks on fome Difeafes of Infants in Scotland, | ‘Trat there isin the habit of infants a rémark. able tendency to bowel-diforder, and to exce/five fluxes, we have the evidence of every day’s expe- rience to afflure us. Many circumftences in their conftitution com- bine to occafion this. Among others is the irri- tation arifing from dentition. ‘This is generally fpoken-of, as if it were fuppofed there exifted an eftablifhed fympathy between the membrane of the alveoli, and she coats of the ftemach and in- teflines, by which diforder and loofenefs might be produced, in confequence of the affection of the gums. But thereis no occafion for this fuppofi- tion ; and the truth is, the diforder arifes wholly R 3 from 262 APPENDIX. [No. f. from an acrimony in the fecretions from the mouth, the confequence of inflammation induced on the parts, by the rifing of the teeth. Another circumftance is weaning 3 which 1s of- ten followed by fimilar complaints, called in Scot- land the weaning-bra/b, and is generally imputed to the change of diet, or to overloading the fto- mach with improper food. I am however perfuaded, that both of thefe circumftances are much oftener the remote and indirect caufes, than the proximate and imme- diate ; and that the complaint is much more ffe- quently brought on, by what is very much over- looked ; often enough attempted to be concealed from a miftaken prejudice about the rearing of children, viz. from the application of cold. To the abfurd fancy of expofing children at all fea- fons to the open air, with a view to ftrengthen the » conititution, and make them weather-hardy, num- -berlefs lives are daily facrificed in this country. But when a fafhion has been once introduced, be it upon. whatever irrational or inconfiftent fancy it may, it has~its run till a new one,. perhaps the ‘very reverfe, comes in and fuperfedes it. . The La \ we No. t.] DISEASES OF INFANTS. 263 The idea of expofing infants, from a few weeks after birth,to all weathersthat blow, except perhaps to a very ftorm, has been probably taken up from the cool regimen, and-expofure to free and cool air, proper in fmall pox, and in the treatment ‘of fever ; and it’ proceeds upon the fuppofition, that an in- fant, born perhaps in a town in the beginning of winter, and to be brought up in all the delicacy of a city life, fhould be able to bear the applica- | tion of as much cold, as the full grown fubject, or as perhaps its parents were accuftomed to bear under a very different fort of rearing in the coun- try. All this, however, is contrary to nature, of which every mother may convince herfelf, in {pite of the fafhion, if the will condefcend to be inftruct- ed by inftinét, which never errs. Every mother who has no other inftruétor for her guide, endea- vours to fofter and cherifh her young by heat. The modern fancy is to cheri/hbthe young of the human f{pecies, by the application of cold: And for fome time, or tothe period of dentition, it goes on, without feeming to produce any bad effects. But as foon as this commences, the irritation ari- fing from it, induces a degree of febrile difpofition, R 4 whereby a oxi ; APPENDIX. [No. Te whereby every other exciting caufe is rendered active; and the fame application of cold, which before would have produccd but little or no effed, is now fufficient to light up an actual fever, The child begins at the fame time to cough, and has an unufual flow of faliva, with an inflamed or fore mouth and tongue. This continues for fome days, but ends at laft in fome ftomach-diforder and a fe- vere loofenefs. All this appears inexplicable to the mothers and nurfes; for the child has not been more expoled to cold than ufual. But they agree to call the cough a teething cough, and the bowel complaint a teething loofeness, laying their fym- pathies as broad and wide as poflible. ‘The whole matter however is perfectly fimple, and there is no need of fympathies to explain it. The appli- cation of cold naturally enough excites coughing, and the acrimony induced on the difcharge from the mouth, from teething, and from the effedts of eold, together with the difcharge from the mu- cous membrane of the lungs, all which, with them go down to the ftomach, very readily difturbs the functions of digeftion, and produces gripes and loofenefs, This No. 1.] DISEASES OF INFANTS. 265 This is the hiftory and the caufe of almoft all the febrile diforders of infants, and of what are called teething fevers, teething coughs, and teething and weaning loofeneffes. The proximate caufe of almoft all of them is untimeous and undue expo- th fure to cold ; and every mother may reft affured, ay that no infant, or child, can be brought to bear tt the fame degree of this, without danger of fuffer~ ht ing by it, as the fame child or infant will bear ~ the eafily, when advanced to the adult ftate: and that 7 ogee erscosiae | ; Vif the cold-water wafhings, and the fending infants 1 out a-airing in winter weather, and all the other a ft parts of the cafe-hardening procefs, fhould be delay- w ed till the teething and weaning be over ; or till it the child be able of itfelf to tell how fuch things n agree with it, and when it fuffers by them. ‘i The treatment of coughs and of catarrhal afe , , feciions in infants and. children, may be fafely 09 i enough trufted to a few vomits of ipecacuan wine, » repeated at fhort intervals. The fyrups and pec- ~ torals that are often fought for feldom do any 4 good, and-are ready to add to the ftomach-difor- iy der and indigeftion. Equal parts of thin mucilage of gum-arabic and Syr. Scillit. A tea-{poonful once or twice a-day maybe ufeful at-times as a petoral, ‘ * Amin or. es Hees oF ‘ / . “ end = OES eee 266 APPENDIX. NO. oe or a tea-fpoonful or two of 5Syr. Althcee, with from 10 to 20 drops of Tiné. Hyofeyami in each — dofe, will often anfwer better. But opiates in any form are to be ufed with caution in the beginniia a of the complaint, or while the ftools’ are diforder- 4 ed, and of an unnatural appearance. The pad, : 7 5 SeEP aii SS SOR Sane of eared ry ae tioner has but little to do with the cough; but he g RAP: Udita r A) Rare - Le Sg > FS eS et eS Sees STE Reapers oe * ought to be aware of what in all probability is to ; <4} follow from acrid fecretions ; and where the. eme- tics. do not open the bowels fully, they ought to “ike 4.. fe Se Poley ve.i> Pisihe thus = 2 ye, be followed with two or three purges; fuch as gi 3 or 4 grains of rhubarb, and double the quanti¢ : ty of calcined magnefia, for a child of one year ‘old y.or, what will be eafier given, 14 grain of & calomel, well rubbed up with 3 or 4 grains of lump-fugar; or Tiné. Jalap., and Syr. Sacch, of. each a drachm:and a half; and fo in pro- 4 portion for thofe above: it 5. but lefs need hard- ly be given for any age below. When, from thefe precautions being neglected, or from what- a “e a) -* - i 9 ~ ut OF 2 abe de ty owlye ever caufe it may arife, the loofenefs becomes ex* — ceffive, and the child begins to fall into the co 7 dition .mentioned fupra, page $3, any. further : . oe te anak .. ’ e hia Sow) AEA Mace) cee Cane FR : Be Bi " maz] 7 mt Me wel eee Sor C= ey “Senge FTE nee Ae Tee ee - - we — — ee ey S| ae GME SIM profecution of evacuants would be’ attended with bad effeéts: and ‘along with the other meafures ees ea eR, 8 . ~~ zs 1 me Sa - ~ ane wag 1, een eT A \ li -. “¥ wv ; ce 14e Be _, " “= 7 De be - 4 . a . = : : 4 / ‘ 7 FErE | og Le ie Ve y my ‘oS. ae ~ AS - i — : Pe Sa, i ee | we = ai! oS Th SS ‘ 2 i ? : VE ww Fs (A rs Re $ Rg , = 74 «| ge ‘ ia, . “i. > a 7 . oy 4a Se J iq ‘¢ 4 . 4 al ae 4 ry 4) re . a eB ae , ry, : t ; i :. . Vy J et. ‘ : ap) a: >! 7 ea ¢ +. : ' > | fia { H ; ’ D aN e) ‘ iN , ’ 4 4 : > S it . hy ” » ee i ‘ ' 4 4 “ y tf G 4 ’ is : J A i , i we y ‘tw Jf tj i r ¥ ‘ eo) Pa SR & oy 4 ig Bs i = fet Ce j : wat ew i 7 Ss be ie 44 7 ats ee _ 4, 3 me bos . bd - ' as San rp . Pee ; Pe ae Vv Se Ba , x 4 v ~* f 4 io , > Fi ee Saas. tI ech 0 “4 ; “Ss 7 4 ~ ‘ P > eb - ry ‘ . 2 » a. Py 4 +r as) i “ wr os ¢ hae Age . s aS =) be é a 3 a i os q ‘qd > ¢ a ‘ , : i cE > “ ' Li \ 8 4 4 oe ¢ a a 4 a : ; ~ oe j F ; ~ . gi, ; 3 ie ie q we an 4 J - - He») é tZ * ‘7 ioe ‘ : ie Gy ot “2 ‘ vi ” ‘ ¥ eed - ie) =e * . 4 { ™ rr. a af BY : 8 2 ' “¢ ayet a nie ; ‘ : 4 q BD ee i o 7 r : tin I hae e “ = i - ag A. + j if — x a , V =: ee) eh) 0 - Ms 7 | eF ih . i? _. 1 dee } y ’ ‘S r J q £ .) SS ; ‘2a a 4 = Bh 4 ‘e > ear 2, f way =o ; 4 i. a 5 : a, A ’ . i | oe 3 . 3 , et K P 7 ‘ A 7 . ) oe Zi > 2 ta ~_ ; hb - Aiea : : mm . hs : — , Bb ee. See > * wT es") 4 - ~ q . 7 s at, BS - P4 ; ls an : . j Y a 7. 4 ~ yeme = Y: < 7 = 7 b vas 7 > 7 - ee he s 4 : ae , ! "2 a a er fi gn ‘ 7 —— aS a £ Pm “ es . ie --a ES : —- of ‘ Stal a ~ oe a | a as iy " , Soe a fey ee Bas : : Z. I ew se : AT gs : : 3 ERS R Pa © = » ae Renna be y ty Se a er , iin 4 diel ’ yaa »’ weet jae Mad, Ee > SO6r te Shi onset os ies th Oa Fhe ie A Fe Oe se - apn tis eaten) his : : : ra “2 re rs. a3 aod . > A aa le bt €3 : - r > = —— a oe ed , pts pa FA Pee ye 3 crores a eS ie linigrtae » espa peti ehesss is ete DOB ae 40s dhs’) 4 oS f | . Ve To es wise re , - —) ue aia re Mint 2 “ ; 7 ; ~ = a MDs) > ey : am | ' ye eg ee ee sas ton * Me oe. 5 (ye a » 9 | " (OR ede) 2: ube . sev No. 1] DISEASES OF INFANTS. 267 there mentioned, the following mixture may be ufed with good effect : R Potio. Cretac. Tinct. Catechu, Tinct. Croci, Syr. Sacch.—utriufque, 31). Ting. Opii gutt, xx. A tea-fpoonful, or more, for ’a ‘child of one year old, two or three times a-day. Ten drops of Aq. Carbon. Ammon. to be add- ed to this. mixture, wherever the matters ejected from the ftomach, or pafled downwards, have an acid fmell. This is fo frequently the cafe in the complaints we are mentioning, that it may be in general added with advantage. Where vomitings take place at the fame time, .add to it the Aq. Ammon. with Spirit. Nucis Mofchat. 31; to, be given in the fame dofe, immediately after every fit of retching, APPEN- bags aa she al RN EON ILE LL ALGO OIE OO : SX r q M : § - > ong ‘ ? 7 » } a APPENDIX, APPENDIX.—NO. IL. On the Difeafe called Cholic. A place is given to the difeafe called Cholic in all the Nofological Syftems, and fome of them diftinguifh it into fpecies and varieties. A late eminent writer places it under the head of Spaf- a modic Affections in the natural functions ; confiders a GALS 4, i> SYS it as of the fame nature with J/eus ; and fo fat 4 from entering into thefe diftinctions, he fays: “It _ “‘ has the fame proximate caufe, and is attend- ‘‘ ed with the fame fymptoms as ileus, only inan ‘* inferior degree; that the proximate caufeisa — a in se eT ne a wes ae ~ -_, - 4 Aj y) ‘ - - - a ; : _ yf a ae q ah } 1s f 7 het ee Te ae eae P| 7 5 J a; ae ' 7 m 4 ‘ ‘ s =. , . Ge r ' : zt as Fl 2 Bs 7 ) ie) - 2 | > p ¥ pT hae Fs eo) ’ a re q » a § & : ‘ ie “ v. ~ ee 4 i kab e ae . F p/ - ¢ oe) eee ‘ “ ,? c Be 7 a * r : * es) * ae ‘ i \ y Bi i ) : . ) aa j eyiere A ; “q F i | 4 Vil bP \. " fy 4 — = pe \ - He 4 4 4 : / * ‘ ‘ j A , P ns 4 i ‘ ‘ 4 5 > oe p * - 1 m3 Tf! f * q ” yw 1 4 ; - 7 i} % 7 Yo - : f » &! Pe | 6 y ‘ d 7 ‘ [ y a. NY : i i. ae : J Lat -_ a 7 J we boat mA i . yy: 4 | i : e) } { { ay y ‘ 4 ia q F 5 : wey -¥ - & mon Ges ; 4 Py 7" ¢. , 3 oF 1-2 a ye Pe xn <) ft 1 4 : _ oy se : a A . f - 5 , = 7a xs 3 r 4% at : my 42) 2 oe Ss } StL SER at a : “eh ' P : te 7 ap. + \? < x 2 ‘ 4 r 4 a-- Gh ’ ‘ im 2 F ¥ . - ‘ ‘ 7 24 - : “ ‘ bd “ rh ir es o @ “a y yore i) rey a By — * he : q os ¥ " : s . 2 Sie te 4 ‘as a . = : at 4 faa ” é * ; ~ ‘Ss wee ee é e 7 +4 a - ‘ ’ 1 4 é - a Bo : +o y f ¢ aS ~ — Se = | ; t + ij - q aM B “4 Ay § (a ) : c * t >" | :'®\ (aa . Vs i” . J ’ y ws : oe q ; 2 h = : - ' = \ ‘ ai ; ‘ i . 7 “Be {pa{modic contraction of fome part of the in- a ‘* teftinal canal, and that he is well perfuaded that. Z ‘* this is the fame in all the fpecies that have been sw. a” (ee brame OR Lt i Bh: te A eae : 3 < ‘al 3 as 7 a} a: << S east ss > aay ii taken notice of, and that confequently the indi- a cation of cure is the fame in all of them, name- ae | 5 Le = +i Se ge o LO se a ly, to remove the fpafmodic contraGtion men- _ tioned *,”’ PR aii ahd by EM ey See ako Niaiaa “ry ZIRT tee a mn ; Pye Oh ae aeric. eu. - - “\yrery YeRE $ ‘ Fea ~ a « eta = a5 - ~ jae aan . Un ris f A ris i ie. Waly Fre be ee —* Cullen’s “ Firft Lines,” - pe ee ee Gee er wz v. mee ah Whe 5 tac s » ad 2 tb 4 7 - = me eles Pee 8 et “. Betas : Bia let se) gh” © a , S ye ee ee Sm ae aS . b) : youre Sct tan Ce ae a SS eng Be ‘ jlasie eee Pa \ Vi NO. 2.] DISEASE CALLED CHOLIc. 269 In looking over fome Notes, taken at Dumfties fo far back as the year 1786, I find that cafes had been met with, which, from the way in which the notes. have been put down, had perlaps been taken up in this view. They are to the following pur- pofe. That through the winter of that year, there had occurred an unufual number of cafes of en- teritis or ileus, feveral of them ending fatally, &c. ‘That during the fucceeding {pring months, feven er eight cafes of /pa/modic cholic were alfo met with, of which the following account is given: * That the greateft number were in female pa- tients, all of them about or above the age of forty ; but whether connected with any difor- der or irregularity in the menftrual difcharge, is not mentioned ; that the pain affected chief- ly the region of the ftomach, which was fore or tender to the touch, but without {welling or in- flation ;—that retching and vomiting took place ‘¢ in all of them foon after the fir(t attack ;—~and that the complaint was accompanied with jac- tation, flraining and twifting of the body, much ‘¢ more than is commonly obferved in perfons la. 4 ww bouring under enteritis; but that the belly was “* in general open, or eafily moved by purgatives, “ and aR 279 0 APPENDIX. be ‘To. ce “ and none died of the complaint ;—that bleed ing and opiates gave relief in every cafe ;—that laudanum, mixed with fome aromatic {pirit, and rubbed on the pit of the ftomach, was ede ly fuccefsful ; but that more certain relief was d procured from adminiftering it by glyfter, and « that it was neceflary to ufe means to preeewaling a ‘¢ open belly for fome time after recovery, im or- ‘ “« der to prevent relapfes, which were ready re « happen if this was neglected.” Nothing faid about {pafmodic’ affe@tion of the abdominal — mufcles ; and it is not now known why the a name of /pafmodic had been adopted ‘to diftin: — guifh it. ices 4 Since that period, however, I have met with fo © many cafes of fimilar difeafe, clearly relerbiiae acrimonious irritation, induced on’ the alimenta- ry matters in the ftomach or inteftines, by excels in the ufe of fpiritous liquors, or by the ufe & 2 ad ih improper and indigeftible articles of food, and ac- 4 :" eee =iey, oe l= Fin hes tt aie le tageiehasd? eames | — — —- * companied with fymptoms of imperfect or un- healthy digeftion; as gaftrodynia, anorexia, car- 4 Pe Saar ai Mein aA) . wy er Ut tt te * } ie | ~—* a7 soe ea TOE PRS Se ta mer ce > - iy dialgia, and habitual coftivenefs, as to induce 4 conviction, that though there may be cafes in wie the difeafe depends on the fame proximate ill eae ~ hed = ae x . ap oar f oY a - van — , 4 ? | Fay 2 ee vie & 7.0 mt + ./ & ch a " ue - fet * ore - 1 ' i Py 5 ro a rv] . + a s _ ‘ %y AU «BBB fe ’ W . MY j f y ae = y Al . h ‘s i } * -#8 a 4 ‘ : ; yi or t ry ne ie i? 7 ’ | rm : 4 b eer yA ' 5 at i | an na) F a2 = 4 4 i a BF q 3 , - A , a if aD “4 4 ee _ “ ; % i ‘he . - ‘ q , Ya ‘ am) é Te . \ he > os — a ‘he x — '? *- = x ‘4 4 1 oF @ : S = . : q ry "a . . = 7 Le » 2 . ber. 2, r of oe ae 4 ! 4 Sy j 2% IG. - ei vars. | ) % , 3 : . ra 7 a ee ~ we |. Ag \ aS es; ‘ 5 ag a = } ‘ -_ y t “4 - os 2 ae ©, ay > ee 8 ¥ 7 5 * + 5 \ oe ., us Ps.) ae TL es ‘ y - > = i) B 4 wee ioe ri > r.. ie fhe 24 7 4 2 , cf : a . 4 ~ £ j io oe sae My -4i wl Ae © -_ > ¢ aa aa 7 a —a¢ Fach, ; = : es & ) ts & 4 r as . ve x ¥ ’ ” : : x ~ a i ¢ ‘ 4 } ’ ‘ 4 * 4 : 7 | ne A | x ad} 3 8 Se ae 2s _ I ee | 1. | ae « , . 5 2 | tel . Ne 4 = 2. i - 2 ”“* oe » " tT , si se =~ anda 2 ed ~ id 35 4 5, ie 4 4 , at A ae ye : +, ey. oe *} é (7 & v) 4 ? 7 “ H (ar 4 ae : Pi + weet Cs ? 7 a e F bats a « > Aids ge: — PA ste ge (ht Y4 i bp), me Nov2. | DISEASE CALLED CHOLIC. 271 with ileus, viz. fpafmodic contraction in fome part of the inteftines, according to Cullen; yet there are many others, to which we mnuft. affign a dif- ferent origin, viz. the prefence of acrimony, ari- fing from difordered bile and indigefta in. the turns of the duodenum, and where the. fpaf- modic affection is merely fymptomatic. This will be confirmed by the hiftory of four different cafes, that were lately met with in the courfe of the fame week. ‘The firft was in a young woman, fubject to a variety of ftomach complaints, and habitual coftivenefs, but who was in good health at the time of the attack. This wasinitantaneous, attended with fevere pain, retch- ing, and vomiting of highly acid matters; fpaf- modic contraction of the abdominal mufcles, weak faultering pulfe, with coldnefs of the extremities. She died within twenty-four hours from the firft attack, without the bowels having been fully moved, to afcertain the ftate of their contents. The ab- domen of this patient was opened after death in the Royal Infirmary. The fecond was a matried woman, liable to frequent attacks of the fame com- plaint, and labouring at the time under a bowel. diforder, 272 | APPENDIX. | [No.3 diforder, attended with gripes and a feculent pu 3 ging, This was fufpended for the time, but was fi renewed by the purgatives given her for removing — the ftomach-complaint, and continued for fome — days. The third was in the wife of a recruiting f° fergeant, and was referred to no caufe; but I fufs pected intemperance or irregularity in her habits of life. The fourth was a male fubje&t, andthe — difeafe was plainly brought on by a dinner of beef and greens, eaten the day before, not in the beft a ftate of preparation. The three laft recovered; but two of them, not without confiderable dan- . a nS Ee a Ee ee a. ; RS Os ear ae i} r 7 ati ~ = ae ey By Vaal ) ba - : = - = z te OE a ee “hs meer bk * Rs : — PS yt SSG gt betes) ge — a ide, 5 aed AY Sv Sieg Cy ‘ >» > — : ve dele ° ~~ > Sr. a = a ous: a) s . ry ine ger. They were all treated in the way mens tioned fupra, page 184, to which this refers: Two that were full and ftrong, with blood-letting, but no inflammatory cruft was exhibited by the E blood of either. ; A proper choice of purgatives, both as to form and fubftance, comes to be a material part of the treatment of fuch a diforder as this. The Pi, Aloet. Ph}. Edin. two or three every two or three hours, until ten or twelve are taken, of till they apn’ = a nes oe TE _ . —_ if } i , “ Ty; ¥ 4 Deen. TRUE. | Oe age = ey “er TR eee ee a * : f “ ie > ie >. i. ny 4 wo : Sy eae - ‘ZS ‘4 ” + 3 U sth ay ~ -. Pan ss 7 ' J i & Wi 3 ; T a Mt 4 otis Oe oe a ee ee “ee ™ Seba at E37 <> Facet ‘> - " Be acre ah = ie : nln MOR OMS a ” Re ca a, a ig aS ¢ ner | purge freely a number of times, will often an{wer — e | eur purpofe well. In feveral fevere cafes, I have ‘| pe i Wd i NO.2.] . DISEASE CALLED CHOLIC. 293 feen. the following prove very effectual, and reft on the ftomach eafily : R Pulv: Jalap. 3ij. Magne{, uft. 3%. sacch. Alb, 3vj. Tere fimul. opt, et adde Ag. Fontan. 2iij. Ag. Menth, Pip. Ting. Senne comp. utriufque 2%, M. Two table-fpoonfuls of this to be taken, fhaking the phial, every hour or two, according to the ftate of the ftomach, and urgency of the cafe, till it operates fully. Jalap, without proper preparation and admix- ture, is but a naufeous medicine. Much depends on rubbing it into a very fine powder, with hard lump-fugar ; and by means of this, alinoft all the medical powders may be reduced to any degree of finenefs we with to give them. A variety of other purgatives, or of combina- aa .i* tions and preparations of them. may be employed Almoft every perfon has his particular form and choice in refpect of thefe ; but in fuch cafes as we have mentioned, we can hardly expect to fucceed with any of them, unlefs by pafling them through the ftomach, while the fyftem is confiderably un- der the influence of an opiate. \ 9 See, ae Le) RRB Si Aes Purgatives fully, 4 will leave any heating’ or irritating effects behind it. With refpedt, indeed, to the facility of dozing, — they are very different, I believe inde- APPEN- APPENDIX. this divifion to be quite fanciful ; and that, pendent of idiofyncrafies and peculiarities of fto- mach and habit, they are all very much alike; and that no purgative ina dofe that acts ~~ z % em 4 ~ Smt © & mS 1) © ) © oka $o ro ny cs = *m— ~ S %® nd Gael © : . ihn ee >, ‘ Vt as aa 4) : 4 Pee EY A oly “SY ie iS ae : " aaa Jb te es ir wa ' A ; a N “Aaa he = in > = do to Cw > » Of " oa ” us es aa +3 % we ela. Oi =a Bas aa ioc. eu ~aytlbe _- ~— oni le a ee a or ae ate 5 pi ’ } ; Pag . ' i , ‘+ soa “ * * \- < A Cn 4 ¥ _ ae : tae ie wy os a ; Ta” = att z : ws a > ee 4 j rr - - a » - re 2 4 5 Sian i=. © hs as ; a , ee ae : ve | : - f 7) J ? - r .* dom 4 4 Ri F i : a > ey Le ee Pt a ms p 7 & , ee - 4 a . 7 > oF 4 za y } ia} - Py } ‘ uN P t f : “a + 7 / -. Z » a4 2 ‘ : j 4 PY vy ‘ 7 \ , Pe és ee al i730 : : 4 y : r a? . 4 : a 0 F iv n A -| $ f 4 , a , + > 7 +s 4 > ; ae : i os i 2 — | Re = ' 4 b { ae } : . é 4 as bed i i «Z ’ . “ = or 54 Z far s + aa $ 3 “4 “ae ig Mee " 2. > =. 1 a. 7 +f] iv 5 ~ " j ' F : ‘ y of : ; , - . a . % mae. a , d 2) : a rn " Ww ‘ zu : * ® ‘ + J r - ft 4 '.¢ chy y x bs » > r , ie. € 2% s * ; 1 J > i i - ‘ F (4a ; + fs So ia vs - i ¢ . a ’ r ” y ; q J rive } 4 zy ft 3 - Poy h y . eras. ee \ f | (- ee E3 -: \ . 7 ¢ Lad x . d 5 ] mt on fa ©, - + 7 ~ ot i =) Shaina § . ie = 2 ee z y "os o a - aa) P = fF : _ Bt y #3: , ok 2 +4 \ Sean. a: 7 i ‘Bry ’ , ‘ 4 fm. Se 2S ¥ te ies . e.6 | ad x ak . t ° . ; ~ : La | =, * ‘ae é _ - } a . e | - - . r 1 ‘ ef . ’ he we x : we ¥ Y Y iain ” he 4 a ie > rf c - a 2 . ° & ei i , . 2 £3430 2 7 Eis A a ee ¥ re As = ve > >) f 4 “Ate : é a >. = ’ 33 Ss! i oe wy. ui - ' Ss. 5 Al “+ 4 bs r 4 ; : [2 7 - ‘ Noa + Ts be | ‘i P ~ * a » - p 5 y 4 r oe i by a x in 4 a > 5 G ~-< 4 > ea L -- ‘A ,- : i) a. ae F I 7 Pile: | ) DI 7 y v ? i ~f ‘ 7 > os Ve . iv - zs! ad , < ’ CR: 4 ig u 4 é & j «( ia Sha - t _¥ vs J a ; ‘ me : = r i be | ee ae ae i ‘ q 4 id i, x 1 | SUS 5 a mt ey % ; ’ ; 4 . ; : ‘ ij D : f UR he he ‘ . i ; | ; ; . 5 i : 4 4 % ; ae ‘ | i ie : M % 4 aA? : . 3 : E : Fs . a\4 i ‘ 4 4 , ‘ ‘ ; 2. eo) mm. 4 i 7 4 , J tS @\ 8! sd ns ; 2 ee ; -ee 2 bs ' ade. 7 1 3 é . Mi & . fat \. 4 iw aa | 4 i ’ uJ - —" - + : "4 .e Lge ee 5 . Fy. ; | = li) a 4 tha , wy ie, * & G N ay . i ’ 4 yD > . * ¥- wl J * “e 3 E. eae mae . * * 3 L Fy Bs | yeas. | O we » ¢ . j . i a 2 - ss is . 1 ee | J % oe 4, ay * i f ) ee ‘ De ee ¢ 4 +> “a % 4: ath cf A , ‘ a > & , | ¢ ee 7 + = | mm, \ - : - . t i ” a ' i 7 % h 1; ‘ : } «+ ¢ tat! My " : ‘fe : - hi be - : r ; ee} ie a ’ ce eo : 4 os > ¢ Pr’ ij Z ‘ ‘ ’ ; . alee Ap eS aa area” ~1. Be. AS See ts a i ~ ier: p > Lh apy P we =e 7 ? ° von HES 1 Sti aang. eS AT Le ARAL oo ew ni = Be co Paes ate WNT oon « wee hile” NO. 4.] PRESERVING HEALTH IN INDIA. 233 tain of the fenfuality and effeminacy of the Euro- pean refidents,—the univerfal practice of going to fleep on a couch an hour or two after dinner ; but this, the neceflity of avoiding perfe& ennul, and being left alone, foon reconciles them to; and I do not know that any evil arifes from it, pro- vided two things be attended to, viz. to guard againft a too full meal of animal food, and too much wine, and that this reftriction be not made up by a proportional indulgence at fupper. ‘To this, there is the more temptation in India, that from fupper being at a cooler hour, it is apt to become the convivial meeting, and the more focial meal. In fine, ftrangers, arriving in India, if they regard the prefervation of health, cannot too foon adopt the modes of living followed by the expe- rienced European refidents there, in the manage- ment of the whole of what have been called the Non-naturals ; and, as much as official coftume will admit, the light and loofe mode of drefling adopted by the natives, will be found far preferable to the tight and heavy clothing of Europe. } ie es, ae Dae ai rt. sal tc 4 7 33 - 7 ee F PIE FS OEE po - een er = Shnat F lah ie 2 re nie a Se rk PS hr" Peeper agi ar rome ee aS ee MEDICAL BOOKS J. CALLOW, MEDICAL BOOKSELLER, (REMOVED FROM CROWN COURT TO) princes Street, Se CORNER OF GERRARD STREET, SOHO; WHO EITHER GIVES THE FULL VALUE FOR SECOND-HAND MEDICAL BOOKS, OR EXCHANGES THEM, & . S LR ees — ADAMS’s (Dr. Joseph) GUIDE to MADEIRA: containing. asKort Account of Funchall, with Instructions to such as repair to the Island for Health, 2nd edition, price 1s. 6d. ADAMS’s (Dr, Joseph) OBSERVATIONS: on the Cancerous Breast ; consisting chiefly of original Correspondence between the Author aud Dr. Baillie, Mr. Cline, Dr. Babington, Mr. Abernethy, and Dr. Stokes ; published by Permission of the Writers ; with an. Introduetory Letter to Mr. Pitcairn: 8vo. boards, 4s. OBSERVATIONS on MORBID POISONS: in Pwo Parts:<.— Part I. containing Syphilis, Yaws, Sivvens, Elephantiasis, and the Anomala confounded with them; Part II. on Acute Contagions, particularly the Vatioltis and Vaccine: Second edition, illustrated with four coloured engravings, copious practical Remarks, and further Commentaries on‘ Mr, Hunter’s Opinions, by Joseph Adams, M.D. F.L.S. Physician to thé Stall-Pox and Ynocu- lation Hospitals. In one large 4to. vol. boards, 12. 5s. AMERICAN MEDICAL and PHILOSOPHICAL REGISTER; or Annals of Natural History and Agriculture. By David Hossack, M.D. F.L.S. and J. W. Francis, M.D. plates’ and’ portraits; 4 yol. boards, 27, 2s, ANECDOTES, Medical, Chemical, and Chirurgical ; collected, ar- ranged, and translated by an Adept. 2 vol. in ¥, 12m0, bds. 7s. 6d. AR NOLD’s (Dr. Thomas)’) OBSERVATIONS on the Nature,Kinds, Causes, and: Prevention of Insanity, 2-vol. Svo, boatis, 16s, , BADHAM's (Dr. Charles) ESSAY on Bronchitis, with a Supplement, containing Remarks.on simple Pulmonary Abseess, &c, &e. 12mo. boards, 5s, 6d. = : Pa r > 4 ee 4 Seth ae aiee cae i ee — . Site ers wliglitinimgete 2 Medical Books published by J. Callow. BARCLAY’S (Dr. John) DESCRIPTION of the Arteries of the Human Body, with copious Notes. 12mo. boards. 7s. In this description, the Ramifications, belonging to the Species, are carefully distinguished from those that characterize only Individuals ; and where there are exceptions from the general rules, those are regularly explained in the Notes. BARCLAY (Dr. John) on the MUSCULAR MOTIONS of the Hu- man Body, vo. 10s.6d. in boards. BAYNARD’s (Edward) HEALTH; a Poem, shewing bow to pro- cure, preserve, and restore it. To which is annexed, the Doetor’s Decade. 12mo. Is. 6d. BELL’s (John) DISCOURSES on the Nature and Cure of Wounds. 8vo. 3d edition, revised and corrected, with plates, 8s. in boards. VIEW of the PROGRESS and PRESENT STATE of ANIMAL CHEMISTRY. By Ions Jacob Berzelius, M.D. Professor of Medicine and Pharmacy, &c. &c. Translated from the Swedish by Gustavus Brunnmark, D. D. Chaplain to the Swedish Legation ai the Court of St.James’s, under the inspection of Dr. Young and Mr. Allen. In 8vo. price 4s. 6d. in boards. BEW’s (Charles) OPINIONS on the Causes and Effects of Diseases in the Teeth and Gums, &c. &c. 10 plates, boards. BLAINE’s (Delabere) OUTLINES of the Veterinary Art; or, the principles of Medicine, as applied to the Structure, Funetions, and Economy of the Horse, illustrated by Anatomical and other “plates. 8vo. boards, 1/. 1s. | BLAKFE’s (Dr-®-) BE O MEDICA INAUGURALIS, de Dentium Formatione et Structura in Homine et in variis Animali- bus. vo. sewed, 8s. BLAKPF’s (Dr. R.) ESSAY on the STRUCTURE and FORMATION of the TEETH in MAN and various ANIMALS, illustrated with coppet-plates; being principally a Translation of his Inaugural Dissertation, published at Edinburgh, September, 1798. 8vo. boards, 15s. Dublin. | BOYER’S LECTURES on Diseases of the Bones, arranged into a ~ Systematic Treatise, by A. Richerand, Professor of Anatomy and Philosophy, and Surgeon to the Northern Hospital at Paris; trans- lated from the French by M. Farrell, M.D. 2 vol. plates, boards, 10s. 1810. PRACTICAL INQUIRY into DISORDERED RESPIRATION, distinguishing the Species of Convulsive Asthma, their Causes, an _ Indications of Cure: by Robert Bree, M.D. F.R.S. Fellow of the Royal College of Physicians. The 5th edition, with additional Practical Observations. 8vo. boards, 10s. 6d. BRIGG’s (James) INDEX to the Anatomical, Medical, Chirurgical and Physiological Papers, contained in the Transactions of the Royal Society of London, from the commencement of that work to \ ee teak Kell be i Le hei Medical Books published by J. Callow. 3 the end of the year 1817. Chronologically and alphabetically arranged. In 1 vol. 4to. price 7s. 6d. bds. BURNET T"s (Dr. William) PRACTICAL ACCOUNT of the Fever, commonly called the Bilious Remittent, as it appeared in the Ships and Hospitals of the Mediterranean Fleet; with Cases and Dis- sections. ‘To whicharé added, Pacts aud Observations illustrative of the Causes, Symptoms, and Treatment of Fever in the Medi- terranean, comprehending the History of Beyer in the Fleet, . during the Years 1810, 1811, 1812, 1813, and of h®Gibrallar and Carthagena Fevers. 2d edition, 8vo. boards, 14s, BUTTER’s (Dr. William) ACCOUNT of PUERPERAL FEVERS, as they appeared in Derbyshire and some of the Counties adjacent; illustrated by Cases, and successful Methods both of Prevention and Cure. 2s. 6d. \ BUTTER on the INFANTILE REMITTENT FEVER, ‘commonly called the Worm Fever ; accurately describing that fatal Disease, explaining its Causes and Nature, and discovering an easy, safe, and successful Method of Cure, 2d edition, 1s. Gd. BUTTER’s (Dr. William) IMPROVED METHOD of Opening the — Temporal Artery. Also, a new Operation for extracting the Cataract. With Cases and Operations, illustrating the good Effects of Arteriotomy, Hemlock, and other Remedies, in various Diseases, 4s. BUTTER’s (Dr. William) TREATISE on the Angina Pectoris. 2s. BUTTER’s (Wm.) TREATISE on the Venereal Rose, commonly termed the Gonorrhea Virulenta, containing. a simple, safe, and certain Method of Cure, without the use of Mercury. 2s, 6d, A. CORN. CELSI de MEDICINA Libri Octo quibus accedunt, Indices Capitum Autorum et Rerum ex Recensione Leonardi Targe. In 8vo. boards, 12s, CABANIS’s (P. J. G.) SKETCH of the Revolutions of Medical Science, and Views relating to its Reform; translated from the French, with Notes, by A. Henderson, M.D. 8vo, boards, 9s, CARMICHAEL’s (R.) ESSAY on the Nature of Scrofula, with Evidence of its Origin from Disorders of the Digestive Organs : illustrated by a number of Cases, successfully treated, and inter- spersed with Observations on the General Treatment of Children, Svo. boards, 5s, CASES of the EXCISION of Carious Joints, by H. Park, Surgeon in the Liverpool Hospital; and P. F. Moreau, De Bar sur-Ornain, M.D. de l’Ecole de Paris: with Observations by James Jeffray, M.D. Professor of Anatomy and Surgery in’ the College of Glasgow. Illustrated by engravings, 12mo. boards, 4s. 6d. CLARK’s (John) OBSERVATIONS on the Diseases which prevail in long Voyages to Hot Countries, particularly to the East Indies : and on the same Diseases as they appear in Great Britain, 8vo. boards, 7s, 6d. 1809, ae , } 7 tp < ss uh ANS eA * x 4 a - - on ~ _ —— Sy i . ~¢4 Sy iad ; Bap oe ES - Parts : nom nt : eae a * s eee = = WE x: - , re o> : ery Deen ie. , = ~ ee ee Sa : 4 ae ks > = ae A x a «4 - —_— . ~ ’ ‘ : . rete : a qi ° ; ~ ed} ’ lt + . r C - . a4 4 . ~ al 4 f . b ; — : - ee ‘ i 7 t . 4 ua t 4 ys cee ‘ : - " . a. Mere a, end sar; ve : ae 4 = i 7 : ‘nels. ap pe — - ama BA OL i= . ; ~ eb Vy ts . ? \ q ~ > ur [a3 = ao + be Ser i anes EN a : ‘ Oe iad 0s > syed u nets san ’ Sen aa a ity. re Pye 5 : ‘ oS oa : iets bie ers; ee me > F en < “we . = ete ’ - 4 ; : 7 ‘ ¥ ‘ ee gay aa a - . 2 7 ™ , 5 - > - J * = me hn ot + Ms on Se ek < ee « = 7 4 °* ( < te , JTS es pw en a s es ee ie RS ae alg t ¢ ae . 4 ~ NS vee) ies “4 4 j a4) tee ee ch - { . Rk A os ‘ . i -~ c : pers 4 Medical Books published by J. Callow. PRACTICE of SURGERY.—The First Lines of the Practice of Surgery, being an Elementary Work for Students, and concise Book of Reference for Practitioners; with copper-plates. A new edition, corrected and enlarged, by Samuel Cooper, Member | of the’ Royal College of Surgeons,and Fellow of the Medical - Society in — | DICTIONARY. of PRACTICAL SURGERY: collected from the best and most original Sources of Information, and ilustrated by critical Remarks ; includiug Observations on the most important Remedies, Applications, Instruments, &c. a copious Pharmacopeeia Chirurgica, and the Etymology and Meaning of the principal Terms. The whole forming a complete Compendium of Modern Surgical Knowledge, for the use of Students, private Practitioners, and Naval and Military Surgeons ; by Samuel Cooper, Member of — the Royal College of Surgeons in London, &c. in one very neat and closely printed 8vo. vol. 3d edit. considerably enlarged, bds. 10. 4s. COOPER’s (Samuel) CRITICAL REFLECTIONS on several im- portant Practical Points relative to the Cataract. vo. bds. 5s. COOPER’s (Samuel) TREATISE on the Diseases of the Joints; being the Observations for which the Prize for 1806 was adjudged by the Royal College of Surgeons. 8vo. boards, 5s. : OBSERVATIONS on the Principal DISEASES of the RECTUM © and ANUS: particularly Stricture of the Rectum, the Hemorrhoidal - Excrescence, and Fistula in Ano. By Thomas Copeland, Fellow of » th of Surgeons, and consulting Surgeon to the Westminster General Dispensary. = : iderably enlarged, 8vo. bds. 7s. COPELAND’s (Thos.) OBSERVATIONS on the Symptoms and ‘Treatment of the Diseased Spine, more particularly relating to the Incipient Stages; with some Remarks on the consequent Palsy. 8vo. plates, boards, 6s. / av if GUIDE to HEALTH and LONG LIFE. By Lewis Cornaro, a Noble Venetian, who, by attending to. Rules herein deserib- ed, repaired a debilitated Constitution, retained Health and Activity to extreme Old Age, and declares that to be the most ~ pleasant Season of Life. Sewed, 1s. ; fine paper, 2s. COUPER’s SPECULATIONS on the Mode and Appearances of Im- pregnation in the Human Female; with an Account of the prin cipal Ancient, and an Examination of the Modern Theories of Generation. 3d edition, with considerable additions, 4s. CRICHTON (Dr. Alex.) SYNOPTICAL TABLES of Diseases, ex- hibiting their arrangement in Classes, Orders, Genera, and Species, — -desigued for the Use of Students; on 2 sheets imperial folio, 286d. | CROSS’s (John) SKETCHES. of the Schools of Paris, including Remarks on the Hospital Practice, Lectures, Anatomical Schools. and Museums; and exhibiting the actual State of Medical Instrac- tion in the French Metropolis, 8vo. boards, 8% . Ee fn Kite pts te me oie it te Medical Books published by J. Callow. 5 PRACTICAL OBSERVATIONS on the DISEASE of the JOINTS, commonly called the White Swelling; with some Re- marks on Caries, Necrosis, and Scrophulous Abscesses; in which a new and successful Method of treating these Diseases is pointed out, Second edition, ‘with.considerable additions and improve- ments, by Bryan Crowther, Member of the Royal College of Surgeons in Loudon, and Surgeon to Bridewell and Bethlem Hos- pitals. Illustrated with seven coloured plateS10s. Gd. boards. — Ditto, large paper, with proof impressions of the plates, 16s, CURTIS’s (Charles) ACCOUNT of the Diseases of India, as they appeared in the English Fleet, and in the Naval Hospital at Madras, in 1782 and 1783; with Observations on Uleers, and the Hospital Sores of that Country, &c. &e. To which is prefixed, a View of the Diseases on an Expedition and Passage of a Fleet and Armament to India, in 1781. 8vo. boards, 7s, DAUBENTON’s OBSERVATIONS on Indigestion ; in which is satisfactorily shewn the Efficacy of Ipecacuanha, in relieving this as well as its connected Train of Complaints peculiar to the De- cline of Life; translated from the French. 4th edition, with addi- tional Notes and Observations, by Dr. Buchan, 12mo. bds, 2s. 6d. DAVIS’s (Dr. J. B.) Scientific and Popular VIEW of the Fever of Walcheren, and _ its Consequences, as they appeared in the British Troops returned from the late Expedition—-with an Account of the Morbid Anatomy of the Body, and the Efficacy of Drastic Purge and Mercury in the Treatment of this Disease. 8vo, bds. 7s. DICTIONAIRE des SCIENCE MED¥CALES. 31 tomes. 161. 5s. 6d. OBSERVATIONS on the CLIMATE, MANNERS, and AMUSE. MENTS of MALTA; principally intended for the information of Invalids repairing to that Island for Recovery of Health; by William Domier, M.D. of the Royal College of Physicians, Lon- don. Boards, 4s, 6d. DUFOUR’s (W.) TREATISE on Diseases of the Urethra, particu- larly describing the various Symptoms attending Strictures, Ob- structions, Gleets, &c. and on the Prevention of Stone and Gravel : with a variety of Cases tending to show the Efficacy of Daran’s Medicated Bougies, and the new Method of treating a Goriorrhtea, &e. 7th edition, 3s. EARLE’s (Sir James) LETTER, containing some Observations on the Fractures of the Lower Limbs: to which is added, an Account pf a Contrivance to administer Cleanliness and Comfort to the yi Bed-ridden, or Persons confined to Bed by Age, Accident, Sick- ib ness, or any other Infirmity, with explanatory plates, Sewed, 3s. 6d. y EARLE’s (Sir James) OBSERVATIONS on Hemorrhoidal Ex- i crescences. 2d edition, sewed, 1s. 6d. a ae F Medical Books published by J. Callow. FARR’s (Dr. Sam.) ELEMENTS of Medical Jurisprudence, or & succinct and compendious Description of such Tokens in the Human Body as are requisite to determine the Judgment of a Coroner, or Courts of Law, in Cases of Divorce, Rape, Murder, &c. To which is added, Directions*for preserving the Public Health ;—-the 3d edition fected, and various Notes added bya Physician. To whiecft are annexed the late Dr. William Hunter's Observations onthe Uncertainty of the Sigus of Murder, in the Case of Bastard Children. 12mo. boards, 6s. OBSERVATIONS on the DISEASES of the HIP JOINT; to which is added, some Remarks on White Swellings of the Knee, the Caries of the Joint of the Wrist, and other similar Complaints. The whole illustrated by Cases and Engravings taken from the diseased part, by the late Edward Ford, Esq. F.S.A. The 2d edition, revised carefully, with some additional Observations by Thomas Copeland, Fellow of the College of Surgeons, and Assist- ant Surgeon to the Westminster General Dispensary. 8vo. boards, 12s. NEW MEDICAL DICTIONARY, containing a concise Explanation of all the Terms used in Medicine, Surgery, Pharmacy, Botany, Natural History, and Chemistry ; compiled by D. J. Fox; revised and augmented by Thomas Bradley; 12mo. boards, 7s. FRASER’s (W. W.) ESSAY on the Shoulder-Joint Operation, part- ticularly deduced from Anatomical Observation. 8vo. sewed, 2s. GALL (Dr.) Some Account of his NEW_THEORY of Physiognomy, founded upon the Anatomy and Physiology of the Brain, and the form of the Skull; with thefCritical Strictures of C. W. Hufeland. 8vo. boards, 6s. COMMENTARY on the TREATMENT of RUPTURES, par- ticularly in a state of Strangulation, By Edward Geoghegav, Member of the College of Surgeons, and Honorary Member of the — Royal Medical Society, Edinburgh. 8vo. boards, 4s. ‘¢ This work will be found highly interesting, as it proposes important improve- ments in the treatment.” GEOGHEGAN’s (Edward) COMMENTARIES on the Treatment of the Venereal Disease, particularly in its exasperated state: m- cluding a second edition of a former publication on that subject, considerably augmented and improved ; on the Use of Mercury, 80 as to ensure its successful effect ; with an Appendix, on Strictures of the Urethra, and on Morbid Retention of Urine. 8v0. boards, 6s. 6d. GILLMAN’s (James) DISSERTATION on the Bite of a Rabid Animal; being the Substance of an Essay which received a Prize from the Royal College of Surgeons in London, in the Year 1811. Bvo. boards, 7s. Medical Books published by J. Callow. 7 GIRDLESTONE (Dr. Thos.) on DIABETES, with an Historical Sketch of that Disease. Sewed, 2s. Gd. 8vo. GORDON’s (Dr. Alex.) TREATISE on the Epidemic Puerperal Fever of Aberdeen, Sewed, 2s. Gd. OBSERVATIONS on the Natural History, Climate, and Diseases of Madeira, during a Period of Eighteen Years. By William Gour- lay, M.D. Fellow of the Royal College of Physicians, Edinburgh ; and Physician to the British Factory at Madeira. “Svo, bds. Gs. GRAVES’s CONSPECTUS of the London, Edinburgh, and Dublin, Pharmacopeias ; wherein the Virtues, Uses and Doses of the several Articles contained in those Works are concisely stated ; their Pronunciation, as to Quantity, is correctly marked; and a variety of other particulars respecting them given; calculated more especially for the use of Junior Practitioners. 18mo. 4s. 6d, HARTY’s (Dr.) OBSERVATIONS on the Simple Dysentery, and its Combinations; containing a Review of the most celebrated Authors who have written on this Subject, and also an_Investiga- tion into the Source of Contagion in that and some other Diseases, Boards, 7s. 6d. 8vo. OBSERVATIONS on MADNESS and MELANCHOLY, includ- ing Practical REMARKS on those DISEASES; together with Cases, and an Account of Morbid Appearances. on Dissection. By John Haslam, M.D. 38d edit. considerably enlarged, in one vol. 8vo, boards, HASLAM’s (John) ILLUSTRATIONS on Madness; exhibiting a singular Case of Insanity, and ano less remarkable difference in Medical Opinion; developing the Nature of Assailment, and the ° Manner of Working Events; with a Description of the Tortures experienced by Bomb-bursting, Lobster-cracking, and Lengthen- ing the Brain ; illustrated witha curious plate. 8vo, bds. 5s, Gd. HAMILTON’s OBSERVATIONS on Scrofulous Affections, with Remarks on Scirrhous Cancer, and Rachitis.. 12mo. boards, 3s. HIGGINS’s (William) ESSAY on the Theory and Practice of Bleaching, wherein the Sulphuret of Lime is recommended as a substitute for Potash, Sewed, 2s, HINTS for the Recovery and Preservation of Health. 2d edition with additions, sewed, 2s. 6d. ; “ Fat paunches have lean pates, and dainty bits « Make rich the ribs, but banker out the wits.”” SHAKSPEARE, HOOPER’s Physician’s VADE MECUM : containing the Symptoms, Causes, Diagnosis, Prognosis, and Treatment of Diseases; accom- oe > See Ms wt? oe WAR . st ie ai ee Audstsies ae eb re aid =~ SR = = yt aE “Dore = a ‘ ore ae — iat otek a a >» = aos Pe x be Sie ene ’ ae —— a 22 “ai ) Se Sy gh et rly Re le - P . ; » -, z ee i =), ° | - . * 4 | é " af = ek A e £ — 7 x - aeeil ° . : “3 ie RSs eo > Pm x= : = = as owes ‘ Jag Ths An i \ Ma hod £ 2 i eee 2 eet as, 2. 2a = ps ari = — =o : - % . VS ee . 7 . i a —) y Hy _ ieee . is c 2 D ) Medical Books published by J. Callow. panied by a select Collection of Formule, and a Glossary, of Terms. By Robert Hooper, M.D. A new edition, 12mo. %s. __ HOOPER’s Anatomist's VADE MECUM: containing the Anatomy, Physiology, Morbid Appearances, &c. of the Human Body; the Art of making Anatomical Pre §, &c. To which are now added, Anatomical, Ph sical, Medical, and Surgical Exami- nations, whieh willbe found highly useful to the Student who has ege of Surgeons, or at any of the Medical Boards. ‘dition, corrected, and in other respects very materially improved, in one closely printed volume. 12mo. boards. HOOPER’ Qtcrncy’s LEXICON MEDICUM. . A new Medi- eal Dictionary; containing an explanation of the Terms in Anato- my, Phy siology, Practice of Physic, Materia Medica, Chemist- TY, Pharmacy, Surgery, Midwifery, aud the various Branches of Natural Phitosophy “connected with Medicine. Selected, ar- ranged, 2nd compiled from the best authors. S8voe.bds.18s. HOOPER’s EXAMINATIONS in Anatomy, Physiology, Prac- tice of Physic, Surzery, Materia Medica, Chemistry, and Phar- macy; for the Use of Students. 3d edition, greatly enlarged and 223 improved. t2meo. beards, 5s. 6d. pie HOOPER’s Sergeon'’s VADE MECUM; containing the Seine: Causes, Diageesis, Preenesis, and Treatment of Surgical Diseases ; accompanied by engravings to illustrate the modern and improved Metheds of i _ Also, Select Formuke of Preseriptions, and a ary ~ tly enlarged and im- = <— - o. proved, imme. beards, Ss. HOQPER’s Asatemical PLATES of the Bones and Muscles, di- minished frem Albines, fer the Use of Students in Anatomy, — aad Artest ; accumpaned by explanatory Maps. A new edition, Rime. sewed, Ts HOOPER’S Auatemical PLATES of the Thoracic and chad | Viscera, fee the Use ef Students im Anatomy, and Artists ; ac- companied by explamatery Meps. A new edit. I2mo. sewed, 5s. a. MOPRENSS (leseph) ACCOUCHEUR’ VADE MECUM, being the Sybatamte ef & series ef Lectures, delivered at the Westminster Lvingae Testtitn@®er, Queer s Square: 2 new edition, revised and Zz 4 cuerected by the Auther, «ith considerable additions and ee ieee ments Tuna beacds, Ts a WOWARDS Joba) Practical OBSERVATIONS on the Natoral istery Sad Coce Of the Veuereal Drsease. 2d edit. in 2 vol. 8vo. pintes, Reams Bis” MUNTERS Geb) TREATISE ea the Verereal Dis with an om hatradatiwat wad Commentary, by Br. Joseph Adams. 8vo, 14s. eos rhe ’ a (EG WE RR : EEE Medical Books published by J. Callow. 9 fHHUNTER’s (John) TREATISE on the Blood, Inflammation, and Gun Shot Wounds. 2 vol. 8vo. 17. ds, HUNTER (Dr. William) on the Uncertainty of the Signs of Murder in the Case of Bastard Children. S8vo. 1s. HUTCHISON's. (A=-G;)-Farther OBSERVATIONS on the Subject of the proper period for Amputating in Gun-shot Wounds, accom- panied by the Official Reports of the Surgeons ployed in his Ma- jesty's Ships and Vessels, at the late Battle before “Algiers, Svo. sewed, 2s. 6d, IDENTITIES Ascertained ; or, an Illustration of Mr. Wate’s Opinion respecting the sameness of Infection in Venereal Gonorrhea, and Opthalmia in Egypt; with an Examination of Affinity between Ancient Leprosy and Lues. 8vo. 2s. 6d. JACKSON ’s (Dr.S.H.) CAUTIONS to WOMEN RESPECTING the STATE of PREGNANCY; the Progress of Labour and Delivery; the Confinement of Childward; and some Constitutional Diseases, including Directions to Midwives and Nurses. 2d Edition, To which is added, an Explanation of Technical Terms. 12mo. bds. 5s. PRACTICAL ESSAY on CANCER, being the Substance of Observations, to which the Annual Prize for 1808 was adjudged by the Royal College of Surgeons, London. By Christopher Turner Johnson, Surgeon, of Exeter, Member of the Royal College of Sur- geons, London, and of the Royal Medical Society of Edinburgh. Svo. boards, 5s. 6d: JOHNSON’s (James) INFLUENCE of TROPICAL CLIMATES. on European Constitutions, To which is added, a Tropical Hy- giene, or the Preservation of Health in all Hot Climates, adapted to general Perusal. S8vo. boards, 16s. KEATE’s (Thomas) CASES of the HYDROCELE and HERNIA INCARCERATA, 1s. 6d. sewed. : KERR 's (Geo.) MEDICAL SKETCHES on the follow; I. On the Use of Hellebore, as a Remedy other Diseases. Il. Of Colchicum Autumnale, and its Use in Medicine, Ill. Observations on the Sudden Death of Women in Child- Bed. 12mo, boards, 4s. ng Subjects : for Insanity, and LECTURES on PHYSIOLOGY, ZOOLOGY, and the NATURAL HISTORY of MAN; delivered at the Royal College of Surgeons: illustrated with 12 copper-plate engravings. By William Lawrence F,R.S. Professor of Anatomy and Surgery te the College ; Asbista ant Surgeon to St: Bartholomew's Hospital ; Surgeon to Bethlem and Bridewell Hospitals, and to the London Infirmar for Di of the Eye, 8vo. bds, 21s, : eh J seases - nO a, ee ee _ Be * ———— - ——_—_ Medical Books published by J. Callow. panied by a select Collection of Formule, and a Glossary, of Terms. By Robert Hooper,M.D. A new edition, 12mo. 7s. HOOPER’s Anatomists VADE MECUM: containing the Anatomy, Physiology, Morbid Appearances, &c. of the Human Body; the Art of making Anatomical Preparatiofis, &c. To-which are now added, Anatomical, Phystotogical, Medical, and Surgical Exami- nations, which willbe found highly useful to the Student who has to pass at the @ollege of Surgeons, or at any of the Medical Boards. The 9th edition, corrected, and in other respects very materially improved, in one closely printed volume. 12mo. boards. — HOOPER’s Quincy’s LEXICON MEDICUM. . A new Medi- cal Dictionary; containing an explanation of the Terms in Anato- my, Physiology, Practice of Physic, Materia Medica, Chemist- ry, Pharmacy, Surgery, Midwifery, and the various Branches of Natural Philosophy connected with Medicine. Selected, ar- ranged, and compiled from the best authors. 8vo. bds. 18s. HOOPER’s EXAMINATIONS in Anatomy, Physiology, Prac- — tice of Physic, Surgery, Materia Medica, Chemistry, and Phar- macy; for the Use of Students. $d edition, greatly enlarged and improved. 12mo. boards, 5s. 6d. Pe) HOOPER’s Surgeon’s VADE MECUM;; containing the Symptoms, Causes, Diagnosis, Prognosis, and Treatment of Surgical Diseases; accompanied by engravings to illustrate the modern and improved Methods of operating. Also, Select Formule of Prescriptions, and ‘i “si ler 2d edition, greatly enlarged and im- HOQPER’s Anatomical PLATES of the Bones and Muscles, di- minished from Albinus, for the Use of Students in Anatomy, and’ Artists ; accompanied by explanatory Maps. A new edition, 42mo. sewed, 7s. me proved, 12mo. boards, 8s. HOOPER’s Anatomical PLATES of the Thoracic and Abdominal Viscera, for the Use of Students in Anatomy, and Artists ; ac- _ companied by explanatory Maps. A new edit. 12mo. sewed, 5s. HOPKINS’s (Joseph) ACCOUCHEUR’s VADE MECUM, being the Substance of a series of Lectures, delivered at the Westminster - Lying-in Institution, Queen’s Square: a new edition, revised and corrected by the Author, with considerable additions and improve- ments. 12mo, boards, 7s. 5 ‘4 HOWARD?’s (John) Practical OBSERVATIONS on tlie Natural History and Cure of the Venereal Disease. 2d edit. in 2 vol. 8vo. plates, boards, 14s. ~ ; HUNTER’s (John) TREATISE on the Venereal Disease, with an. Introduction and Commentary, by Dr. Joseph Adams, 8vo. 14s. (i hy, Medical Books published by J. Callow. 9 HUNTER’s (John) TREATISE on the Blood, Inflammation, and Gun Shot Wounds, . 2 vol. 8vo. 17. 5s, HUNTER (Dr. William) on the Uncertainty of the Signs of Murder in the Case of Bastard Children. S8vo. 1s. HUTCHISON's. (A=-G)-Farther OBSERVATIONS on the Subject of the proper period for Amputating in Gun-shot Wounds, accom- panied by the Official Reports of the Surgeons Baployed in his Ma- jesty's Ships and Vessels, at the late Battle before igiers, 8vo. sewed, 2s. 6d, IDENTITIES Ascertained; or, an Illustration of Mr. Ware’s Opinion respecting the sameness of Infection in Venereal Gonorrh@a, and Opthalmia in Egypt; with an Examination of Affinity between Ancient Leprosy and Lues. 8vo, 2s. 6d. JACKSON ’s (Dr.S.H.) CAUTIONS to WOMEN RESPECTING the STATE of PREGNANCY ; the Progress of Labour and Delivery ; the Confinement of Childward; and some Constitutional Diseases, including Directions to Midwives and Nurses. 2d Edition. To which is added, an Explanation of Technical Terms. 12mo. bds. 5s. PRACTICAL ESSAY on CANCER, being the Substance of Observations, to which the Annual Prize for 1808 was adjudged by the Royal College of Surgeons, London. By Christopher Turner Johnson, Surgeon, of Exeter, Member of the Royal College of Sur- geons, London, and of the Royal Medical Society of Edinburgh, Svo. boards, 5s. 6d. Fee re ee ae ie Fn STE MEY \ Ste Sy ts “RH JOHNSON’s (James) INFLUENCE of TROPICAL CLIMATES, on European Constitutions. To which is added, a Tropical Hy- giene, or the Preservation of Health in all Hot Climates, adapted to general Perusal. Svyo. boards, 16s. KEATE’s (Thomas) CASES of the HYDROCELE and HERNIA INCARCERATA., 1s. 6d. sewed. gs KERR ’s (Geo.) MEDICAL SKETCHES o {. On the Use of Hellebore, as a other Diseases. Hi. Of Colchicum Autumnale, and its Use in Medicine, ° lil. Observations on the Sudden Death of Women in Child- Bed. 12mo, boards, 4s. ‘ LECTURES on PHYSIOLOGY, ZOOLOGY, and thesNATURAL HISTORY of MAN; delivered at the Royal College of Surgeons: illustrated with 12 copper-plate engravings. By William Lawrence, F,R.S. Professor of Anatomy and Surgery te the College ; Assists ant Surgeot 0 St. Bartholomew's Hospital ; Surgeon to Bethlem and Bridewell Hospitals, and-to the London Infirmary for Diseases n the following Subjects : Remedy for Insanity, and of the Eye, 8vo. bds, 21s, : , + t A gg’ Tm at ? ’ 3 ae 7 ee . > i et x = as ~~ : te we a : » ™ en = * ~ ‘ eee: = . = > ied aa o ~ - 5 € = - _ mn -~<- — ~ —— - fs J ; not wee a 2 a= arate) | ae eo ee —- v ~ x _- me — ay, ~ - ‘ 3 S ‘ > =—_ pe 3 7 2 —— aay my ea | Re FET eo Fe tee = se Tt <= ~* oe Lo ‘ . =a , E s ve Pais as =. SS ee . dean >! eee = > a S257. em ee : hy : —— — be ‘i 4 . « — - 7 a? aw 7 % 7 ? = aan) ay ‘ ? naa ae , a wide 25 - 4 n ; DS q = Se - : > a fi = : be Dice date . : Se ee * oe - 4k “4 ’ - r. i ) ae - of - 3 — 3 ‘a 3 P : ee er a WAIET R : ' : } Ve ——— ot . =o — - = : - ——- +f caked ~~ . “= ? ay Ma r P "7 § ret “= c x ’ - = - + ot a . Ge, me re wy. _ = vey ba c & Pm ‘ = - ¥ in ea Ve “a7 e vr 5 | " wi pied on fers. » tal ——— SS, RYN % 10 Medical Books published by J. Callow. LAWRENCE (W.) TREATISE on RUPTURES, containing an Anatomical Description of each Species; with an Account of its Symptoms, Progress, and Treatment: illustrated with plates, &e, 3d Edit. revised, corrected, and enlarged. S8vo. boards, 14s, LAWRENCE's (William) IN TION to Comparative ANA- TOMY and PHYSIOLOGY, being the two Introductory Lectures delivered at th yal College of Surgeons in 1816. 8yo, bds, 6s. LIND on DISEASES incidental to Europeans in Hot Climates, with the Method of preventing their fatal Consequences. 6th Edition, in one vol. 8vo. 8s. boards. LIPSCOMB’s MANUAL of INOCULATION, for the Use of the Faculty and Private Families; pointing out the most approved Me- as thod of Inoculating and conducting Patients through the Small Pox. 1s, sewed. LONDON DISSECTOR;; or, System of Dissections practised in the Hospitals and Lecture Rooms of the Metropolis ; explained by the clearest Rules, for the Use of Students. Comprising a Description of the Muscles, Vessels, Nerves, and Viscera of the Human Body, - as they appear on Dissection, with Directions for their Demonstta- tion. 6th edition. 12mo. 5s. . cob by LONDON Practice of MIDWIFERY ; or, a Manual for Students; being a complete Course of Practical Midwifery, in which are in- cluded, the Treatment of Lying-in Women, and the Diseases of it. corrected. 12mo. boards,Gs. and Pathology, the Practice of Physic and Surgery, ‘Therapeutics, and Materia Medica; with whatever relates to Medicine in} tural Philosophy, Chemistry, and Natural History. By Bartholomew Parr, M.D. The whole illustrated with fifty-seven highly finished engravings. 3 vols. 4to. boards. ase LUXMORE?’s Familiar OBSERVATIONS on RUPTURES, for the “Use of Patients of both Sexes, afflicted with those Complaints. 2d edition, price 2s. A TREATISE on the ART of CUPPING; in which the History of that Operation is traced; the various Diseases in which it 1s useful indicated; and the most approved Method of performing it, describe , By Thomas Mapleson, Cupper to his Royal Highness the Prince Regent, to the Westminster Hospital, and the St. Pancras Parc Infirmary. 5 e Bight A TREATISE on the MERCURIAL DISEASE. — An Inquiry into the History and Natureof the Disease produced i Constitution by the Use of Mercury ; with Observatl on. its A n= nexion with Lues Venerea. By Andrew Mathias, Surgeon extraor ae LONDON (The) MEDICAL DICTIONARY; including, under dis- tinct heads, every Branch of Medicine, viz. Anatomy, Physiology, | nthe Human a eee hs Medical Books published by J. Callow. 11 any dinary to the Queen, and fo Her Majesty’s Household, Surgeon to to the Westminster Lying-in Hospital, and Member of the Royal Col- Nf lege of Surgeons of London. 3d Edition. 8vo. bds. 8s. 1816. Mh *‘ In concluding our remarks on this volume, we must express the great pleasure Atal and improvement which we havederived from the perusal of it; and we have no ‘ hesitation in saying, -that4t-+must produce an important change in Practice, and MO must tend to the cure of the most unfortunate states of disease to which the human On body is subject.”—-Monthly Review, for February 1811, page 197. ~ ' aay : Ci MEDICAL OBSERVATIONS and INQUIRIES. Bya Society of ya Physicians in London. Vol. VI. 2d Edit. 192s. bds. . MEDICAL FACTS and OBSERVATIONS, consisting ‘principally le Ce of Original Communications from Gentlemen of the Faculty, on lg important subjects in Medicine and Surgery, &c. By Dr. Simmons. hie Vol. VIII. 8vo. bds. 5s. MEMIS’s (John) MIDWIFE’s Pocket COMPANION: a Practical ypc Treatise on Midwifery, on anew Plan. 12mo, Is. 6d. sewed. hie ‘ agi MERRIMAN’s (Dr. Samuel) DISSERTATION on Retroversion of ee the Womb; including some Observations on extra Uterine Gesta- tis tion. S8vo. 3s. sewed, | MERRIMAN’s (Dr. Samuel) SYNOPSIS of the various kinds of tT Difficult Parturition; with Practical Remarks on the Management ge? of Labours, 2d Edition, with considerable additions. 12mo. bds. 6s. , te ; a MOORE’s (James) HISTORY and PRACTICE of VACCINATION. 6s, 8vo. bds. 9s. - = a jcass Sabena : ie’ HISTORY of the HUMAN TEETH; with a Treatise on their wy" Disease, from Infancy to Old Age, adapted for general informa- ren, tion. To which are added, Observations on the Physiognomy We: of the Teeth and Projecting Chin. Illustrated with two engravings. yi By Joseph Murphy, Surgeon Dentist. 8vo. Gs. bds. ea NISBET’s INQUIRY into the History, Nature, Causes, and different Modes of Treatment hitherto pursued in the Cure of Serofula, Pul- nth monary Consumption, and Cancer. 2d Edition: to which is added, iid at an Appendix, containing a Letter to a celebrated Professor of Edin- to burgh. S8vo. bds. 4s. af NISBET’s Practical TREATISE on DIET, and on the most salutary ite and agreeable means of supporting Life and Health by Aliment and ne Regimen, adapted to the various circumstances of Age, Constitu- ith tion, and Climate. 12mo. bds., 6s. ah one wv E a, NISBET's (Dr. W.) MEDICAL FRIEND to the Asthmatic Patient, shewing him the particular Species of his Disorder: and also what to pursue-and what to avoid, in regard to Medicine, Diet, Situation, jit and other Cireumstances connected with this Complaint. 12mo, Dit bds. 3s, 6d. | fk REN f ae a ) " 4 oe { é 4 = * iy ‘ 7 sy Sate | on L ¥ >) . a ¢ i i i 7 ‘ if, rs io « M, . o 4! “\ 4 - = a - Dia a ; : 5 2. £3 b % % Bi " ve 4 “ rs ; 4 my . one a } '¢ ¥ | ‘- z t % i ; Ly WB; i ; 4 eh - . a a mo ‘| } r \ . ‘ Ti - hire \ any hy le ; f o) . 2 Bi’ be ¥ my P14) { ; ka Te | eo rf \D bs 4 Aa 4 LB iB) 3 vf : J W 4 »\ 4 7) i Ww » iy | : PP Ie? « & I , , 4 a tgs ’ ; eB, ’e y 5 i \ Ay ing : a “a | Dy 7 ¢ . ‘ : \ a Y ~ & “f a Yt 7 ; ' Sf i i! | i f t « q a ; ro r ty : 4 ( f ? 4 ; i fi . ¥ | v 1 ) ] ; Ls ’ me Bo : : eo ie -— ao s4 te = Yee 5 : f i ae ; : “ ‘ ) Nall hl 1 are : ‘Boe a7 : a i. aaa = 4 2 is P Bhat ; # P { : ’ ~ a i % 4S rf im 5 4 > j ' ‘ * iy f Z o ’ & x , oy * 5 me q a4 ¢ - ee } - ot hw a 5 4 { Fj 5 ok i wy : A * moe +h UE 3 ' fz. yy . ty . s a | oe ee Ph ci HY ¥. : ne } 1 . 2 a eS: teh Pe f : ; vs) = m F 4 4 a 4 ™ a eH ‘* 4 ae if -_ i ho ‘ : awn ne, . oi Baa c i 4 k 4 oo te \ Z : nm 7. re 4 ¢ : 3 his. ae P j : <4 ‘a “ / : ‘ ae ke ‘ = 1 i : ’ ; ; : P a . ‘ , , = fA - q » r 7 ‘e ik ‘ _s The & * ~ A; BF i f Es ‘s . _ s L f ia ‘ on ¢ . he eee iy: yy ; « | bh 5 ee ~ | =e ri a : ~ me ae b | se " ‘s Se _ if ie , prea , * f -, . oO | a ¢ bes } . i : b e: > Fi ’ th ; b ; ‘tp a t ‘ oR, ‘ae . 4 i F ay ’ rs fad . 2a 1 oe 7, ee - 7 * : *E j ae : ‘ ; I : Og ; a. . im OA -) “ nd 1 = et fe a i" i. F, a . «4 i¥ D £3 ae | ‘ ‘if “3am ] x f ‘ te f , Me ; A A S/F bt bé : , - a34 @ 1 ‘ " r Ma : 2 rm - : om, bi-auas fi 6 | 7 % te Ps ie Ma y ; iy \ : a . » i % = oon eee PSS Re ' art eae Fs ea : “ ae — el Se, (OO ae the Mammary Abscess, and sore Nipples of Lyingn Women; Observations on the more common Disorders of the he Rat and on Gangrene. “8d Edition, revised and defended. 870. bds. 6s. “ . OF a vs VENUS SINE CONCUBKTU. By Dr. Buchan, ‘12mo,bds. 45 VINDICATION of NATURAL DIET. 12mo. sewed, 18.60. oe} et jes he f pe? ss Medical Books published by J. Callow, 15 WADD’s (W.) OBSERVATIONS on the best Mode of curing Stric- tures in the Urethra; with Remarks on the frequent Inefficacy and ill Effects of Caustic Applications. 2d Edit. enlarged, bds. 4s. WADD’s (W.) CASES of Diseased Prepuce and Scrotum: illustrated with 11 etchings, 4to. bds. 11s. WADD’s CASES of Diseased Bladdéfiaua Testicle - illustrated with 21 etchings, by the Author. 4to. bds. 188)» WADD’s Cursory REMARKS on CORPULENGE Sarees. con- sidered as a Disease: with a critical Examination of ancient and modern Opinions, relative to its Causes and Cure. 3 Edition, con- taining a reference to the most remarkable Cases that have’occurred in this country. 8vo. bds. 5s. a WEBSTER’s (Dr. Charles) FACTS; tending to shew the Connexion of the Stomach with Life, Disease, and Recovery. 1s. 6d. sewed. DESCRIPTION and Treatment of an Affection of the Tibia, in- duced by Fever ; illustrated by a coloured engraving. By Thomas Whately, Member of the Royal College of Surgeons. 2s. Gd. WHATELY’s (Thomas) Practical OBSERVATIONS on the Cure of Gonorrhea Virulenta in Men, 2d Edition, 8vo, sewed, 4s. WHATELY’s Improved Method of Treating STRICTURES in the Urethra, 3d Edition, with additions, 8vo, bds. 7s. WHATELY’s Practical OBSERVATIONS on_the Cure.of- Wounds and Ulcers on the Legs, without rest: illustrated with Cases. 2d edition, S8vo. bds, 9s. WHATELY’s REMARKS on the Treatment of some of the most pre- valent varieties of Inflammation of the Eye, with Cases. 8vo. sewed, 3s. | : WLLSON’s (Alexander) ESSAY on the NATURE of FEVER. Svo, bds. 5s. | WILSON’s (John) Familiar TREATISE on CUTANEOUS DIS. EASES; exhibiting a popular View of their respective Symptoms, detailing the limits of secure self Treatment, and illustrating the perilous abuse of Indiscriminate Remedies. 8vo. bds. 7s. 6d. WITHERING’s (Wm.) Outlines of MINERALOGY. 8yo, sewed, 2s. 6d. | WITHERING’s (Dr. W.) ACCOUNT of the SCARLET FEVER and Sore Throat, or Scarlatina Anginosa, particularly as it appeared at Birmingham in the Year 1773. 2d Edition. "To which are now prefixed, some Remarks on the Nature and Cure of the Uleerated Sore Throat, 8vo. sewed, 2s. 6d. Secon | 16 Medical Books published by J. Callow. of the W ALCHEREN REMITTENT ; commencing with ca oad State, when most dangerous and destructive to the Soldiery, and concluding with its very favourable Termination ; effected by those means first proposed by the Author only: to: the Legislature, and to the late and present.Army Medical Boned | with the Morbid Se eroil tons—also the pic 4 Anemia, Acholia, E Se eae &C. : sections. By boards. FAMILIAR ANALYSIS of the ‘Fluid capable of Phenomena of Electricity, of Galvanism, or bs some Remarks on Simpie Galvanic Girdles, and i the Vital Principle of Animals : illustrated: by F Ph ments of Aldini, Garnett, Davy, Josey. ie mp Matthew Yatman, Esq. 2s, 6d. YEATS's (Dr. G.D ) STATEMENT of the e eat arly Sys lead to the “Disease termed Water ia the Bra in on the Necessity of a watchful Attention to them, « a M D. Comeqientcted of their Neglect: ina Letter to Marti r Wa Clinical Professor ee _Byvo, be a 5s. = 7 - “t = ye oe ee — sigh Sx: +. mal —e ‘ r c ul is ° as An Annual Sabscriber to pay_ eet caus wees seen eeeee | Half a Year wececccces ssereeee aereseee enon are Ssee ' Quarter of a Year... .ee eames wen eee scenes sees Bana e an seeseeenee 3 f é fox, ail ea Bs phe gn 7 - 2 set ae: epee Fe eaten 5 : Ae Two o Olives allo equal to two Qetavos. eS ~ I ED ee eb es> Siabshecs a Prom + tare A ee j ' } t b | , rat 4 : j f 4 - > - 4 ~ fr = 7 z 4 a, / . @ ; ¢ “*. 7 - | ae - Y ’ ; : 2 ~~ =? me “a4 2 \ na a « , - ft i. Yt | = iy . . get 4 » “ ' 7, , 4 a. " = 2 . - > rs - ; 7 . a 3 : ee Phd; ‘ 4 z V7 = ot . & + ie ’ WT h \e ia 5 y i + om & ~ i? c ¥ 7 r ' Fe ~ ¢ =} f a q f 4 ee? S04 ey ea C ' Pa ae 3 ChE EY Tae: y : i] 5 u ¢ h. <5 a : » * a ; y = * i y 7 . 5 a 4 7 be ait: te r a . iar Sy A $ ble a : r _ : ire | _ « ao =a yi 4 ' : i = a i « a re ‘ 3 ; ” \ fade f ‘ is > e an : we * une a . af ‘ S = { Z i oy _. . + x = - ~*~ ; 7% | — " + Pat t | : 7 » 5 Aveta f ; ye. omen going tothe Bast or West Indiéss may be 8 u nt assortment of Books suitable io the Climates ont the shortesi notice. nf: ee ee es.) Bat ore iano ad er ost § ———— id +e q . OPN bab Sia " Salhi, a : ‘ in ; le - 4 a o ww... A> Es — —, a ~ 7 ble ——_— EE TS oe aaa ar &