Читать книгу An Account of the Diseases which were most frequent in the British military hospitals in Germany - Donald Monro - Страница 5

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[1] Dr. Huxham, in his Treatise on the ulcerous sore Throat, p. 36, says, “I have very often met with this buffy or sizy Appearance of the Blood in the Beginning of Malignant Fevers; and yet, Blood drawn two or three Days afterwards, from the same Persons, hath been quite loose, dissolved, and sanious as it were.” And in his Essay on Fevers, chap. viii. p. 108. says, “The first Blood frequently appears florid; what is drawn twenty four Hours after, is commonly livid, black, and too thin; a third quantity, livid, dissolved, and sanious. I have sometimes observed the Crasis of the Blood so broke as to deposite a black Powder, like Soot, at the Bottom, the superior Part being either a livid Gore, or a dark green, and exceedingly soft Jelly.”

[2] Observations on the Diseases of the Army, part III. chap. vii. sect. 3. third Edition, 1761.

[3] Ramazini, in his Treatise De Constitutionibus annorum, 1692, 3, 4, in Mutinensi civitate, Sect. 19. mentions the Petechial Fever which had been frequent the three foregoing Years; in which the Petechiæ appeared commonly on the fourth or seventh Days, and almost all those died in whom they appeared on the first Day. These Spots came out first on the Neck, the Back and Breast; and it was observed that none escaped unless these Spots extended themselves as far as the Nails of the Toes, vanishing by Degrees on the upper Parts. He tells us likewise, that this Fever was attended with an Inflammation of the Throat, which, about the Height of this Disorder, terminated in a white ulcerous Crust. This sore Throat should seem to be the same which we now call the malignant ulcerous sore Throat, which I never once saw while I was with the Troops in Germany.

[4] Dr. Huxham, in his Essay on Fevers, ch. viii. p. 97, tells us, that sometimes, about the eleventh or twelfth Day, on the coming on of profuse Sweats, the Petechiæ disappear, and vast Quantities of small white miliary pustules break out.

[5] Dr. Hasenohrl, in his Treatise De Febre Petechiali, cap. i. p. 12. relates a very particular Case, where the Petechiæ appeared on the fourth, and the white miliary Eruptions on the seventeenth Day of the Fever.

[6] Dr. Lind, in his second Paper on Fevers, p. 105. mentions Spots which rise above the Surface of the Skin, and are of the miliary kind, as common in contagious Fevers, as he observed among the French Prisoners in Winchester Castle, in the Beginning of the Year 1761.

[7] Dr. Huxham, tho’ he says “yet Bleeding to some Degree is most commonly requisite, nay necessary, in the strong and plethoric;” yet he afterwards makes the following Remark: “Besides, the Pulse in these Cases sinks oftentimes surprisingly after a second Bleeding, nay sometimes after the first, and that even where I thought I had sufficient Indications from the Pulse to draw Blood a second time.” See his Essay on Fevers, chap. viii. And Dr. Pringle observes, that in the second Stage of the Disorder large Bleedings have generally proved fatal, by sinking the Pulse, and bringing on a Delirium. Observations on the Diseases of the Army, part III. chap. vii. sect. V.

[8] Dr. Pringle advises giving a Vomit, by way of Prevention, on the first Appearance of the Symptoms, and at Night to force a Sweat, by giving a Drachm of Theriac with ten Grains Sal volat. Corn. cervi, and some Draughts of Vinegar-whey, and to repeat the same the following Night; and says, he has often seen those Symptoms removed which he apprehended to be Forerunners of this Fever received by Contagion; but previous to Vomits, or Sweats, if the Person be plethoric, it will be necessary to take away some Blood. Observ. part III. ch. vii. sect. 5. Dr. Lind, in his second Paper on Fevers, p. 66. says, “To all who are supposed to be infected by Fevers, during this Stage of Rigours, a gentle Vomit is immediately to be exhibited before the Fever be formed, and before the Fulness or Hardness of the Pulse renders its Operation dangerous. If the Vomit be delayed too long, and especially if Bleeding must precede it, the most certain and favourable Opportunity of procuring Safety for the Patient is past.—That he has found it equally serviceable in preventing Relapses, when it is given at the Return of the Shiverings.” A loose Stool, or two, should be procured by the Emetic or Clysters, and he advises Sweating immediately after, in the manner recommended by Dr. Pringle. At other times “he gave five Grains of Camphire every four Hours, with large Draughts of Vinegar-whey. Eight Persons in ten, he says, got quite well by this Treatment.”

I have never had sufficient Opportunities of trying this Method of Prevention, to determine any thing certain about it; but it may be worth while to practise it.

[9] Petrus a Castro, in his Account of a Petechial Fever, which was frequent at Verona, tells us, that the Sick had a great Thirst, and an Aversion to Meat, but all of them had the strongest Desire for Wine, and were perpetually asking for it, even those who at other Times used to be very temperate; and that this proceeded from an Instinct of Nature, which wanted something to support the Strength. De Feb. Malig. sect. iii. chap. 26. Dr. Huxham, in his Essay on Fevers, has the following very judicious Remark on the Use of Wine: “In this View, and in those above-mentioned, I cannot but recommend a generous red Wine as a most noble, natural sub-astringent Cordial, and perhaps Art can scarce supply a better. Of this I am confident, that sometimes at the State, and more frequently in the Decline of putrid Malignant Fevers, it is of the highest Service, especially when acidulated with Juice of Seville Orange or Lemon. It may be also impregnated with some Aromatics, as Cinnamon, Seville Orange Rhind, red Roses, or the like, as may be indicated, and a few Drops of Elix. Vitrioli may be added. Rhenish and French White Wines, diluted, make a most salutary Drink in several Kinds of Fevers, and generous Cyder is little inferior to either. The Asiatics, and other Nations, where pestilential Disorders are much more rife than with us, lay more Stress on the Juice of Lemons in these Fevers than on the most celebrated Alexipharmac.” Chap, viii. second Edit. p. 123, 4.

Acid and acescent Liquors have very justly been recommended and used by most late Practitioners, in this as well as in other malignant Diseases. Vinegar-whey, Barley-water acidulated with Lemon-juice, and such other Liquors, make good Drinks for the Sick; but we were obliged, for the most part, to use the vitriolic Acid for acidulating the Patient’s Drink, as it was the easiest procured and carried about with the Flying Hospital.

[10] If the preventive Method does not succeed, Dr. Lind advises to have recourse to Blisters; and says, that sixteen out of twenty will next Morning be free of the Fever. But adds, this is said, provided the Source of their Infection be not so highly poisonous as it was in the Garland Ship, or in other such violent Contagions. Dr. Pringle mentions his having applied Blisters early, but without relieving the Head, or preventing any of the usual Symptoms. I have often ordered Blisters pretty early in the Disorder; and though I have frequently found them of use in keeping up the Pulse, and relieving the Head, and other Symptoms, yet I never saw them have such an immediate Effect as Dr. Lind mentions.

[11] It is long since the Peruvian Bark has been used by Practitioners in Malignant Disorders, though I do not know that any body gave it in this Fever to the Amount of an Ounce per Day, before Dr. Haen and Dr. Hasenohrl. Dr. Ramazini mentions its having been tried in the Petechial Fever, in the Years 1692, 3, 4. And in a Treatise on the Plague in the Ucrane, published at Petersburgh, in the Year 1750, we are told, that in the French Translation of the Philosophical Transactions for the Year 1732, there is a Note to p. 264, telling, that Mr. Amyand informed the Academy of Surgery at Paris, that Mr. Rushworth, Surgeon, had wrote to Sir Hans Sloane, on the 23d of May 1723, that when he was Surgeon to a Ship, in the Year 1694, he had cured some Men ill of the Malignant Fever, attended with pestilential Buboes, by means of the Peruvian Bark. Dr. Huxham has recommended a Tincture of the Bark; and Dr. Pringle, a strong Decoction of it, with some of the Tincture, in these Malignant Fevers.

[12] The Peruvian Bark has not only been found useful in this Malignant Fever, but has likewise been recommended in the Plague. See Morton Oper. Append. secund. Exercitat. Hist. Febr. Ann. 1658, ad. an. 1691. complexa. In the Small Pox, see Medical Essays, vol. V. art. x. and has been found serviceable in the putrid Disorders of the West Indies, as taken Notice of by Dr. Hillary; and in the malignant ulcerous sore Throat in this Country, as Dr. Wall and others have observed. And in thirty-five Cases of the malignant ulcerous sore Throat, in which I gave it, joined with Cordials, and the Use of Acids, I did not lose one Patient. Nine of them were strong People, and had plethoric Symptoms, and were blooded in the Beginning; and seven of them were costive, and took a Dose of gentle laxative Physic before taking the Bark. The rest had no Symptoms which seemed to require these Evacuations. However, it ought to be observed, that this is a Disorder of the malignant kind; and that although some well-timed gentle Evacuations may be serviceable in the Beginning, before giving the Bark; yet too free, or even gentle Evacuations, injudiciously made, will sink the Patient, and infallibly do Mischief.

The free Use of the Bark has long been found serviceable in Mortifications and foul Sores, where the Juices tend too much to the Putrescent; and has been strongly recommended by Mr. Ranby, Serjeant Surgeon to his Majesty, in the Cure of Gunshot Wounds. See his Treatise on Gunshot Wounds.

[13] Dr. Huxham, in his Treatise on the ulcerous sore Throat, p. 54, &c. condemns the Use of the volatile alcaline Salts, in Fevers of the putrid, pestilential, or petechial kind, as being apt to heat too much, and to hasten the Dissolution and consequent Putrefaction of the Blood. However, I cannot help thinking that they are the best Remedies we can use on some particular Occasions, even in this Fever; for we have no Remedy which gives such a sudden and brisk Stimulus to the Fibres as they do. And I have known many Cases of Patients who were extremely low, and whose Pulse was scarce to be felt, and others who were apt to fail into fainting Fits, who have been preserved by large and repeated Doses of these Salts, and the free Use of Wine, and acescent Liquors, to correct their alcaline Acrimony in the Blood. Though as soon as such Patients had recovered from this low State, I laid these Medicines aside; because I cannot help agreeing with the Doctor in the Belief, that their continued Use will produce the Effects he mentions. For although it be true, that these Salts, when mixed with putrescent Liquors, or with dead animal Substances, resist Putrefaction, and, like ardent Spirits and Vinegar (the other Products of Fermentation) check and put a Stop to that very Process which produced them: Yet it is also true, that, when mixed with the Blood of living Animals, they stimulate the Vessels, and increase the Heat and Momentum of the Blood, and dissolve it; and therefore I cannot but disapprove the continuing their Use longer than is immediately necessary.

[14] Some Men passed only one Worm; others, two or three; some, six or seven; and one Man, of the Guards, in January 1763, after passing three by Stools in the Course of a Fever of this Kind, discharged fourteen more upon taking a Dose of Rhubarb and Calomel after the Fever was over.

[15] Observations on the Diseases of the Army, part iii. chap. iv. Note to p. 213. third Edition.

[16] See Hoffman’s Works, vol. III. chap. x. River. Observ. commun. Obs. 13. of Observations found in a Library. Bonetus’s Sepulchret. anatom. tom. II. Gualther van Doeveren’s Inaugural Dissertation de Vermibus intestinalibus, published at Leyden, 1753; and Lancisi’s Works; for Cases where the internal Coats of the Stomach, and Intestines, have been eroded, and all the Coats perforated by Worms of the round Kind.

[17] Riverius tells us, that, according to Hippocrates’s Doctrine, Deafness is a very dangerous Symptom in the Beginning of acute Disorders, though it be a good Omen, and portends Health, when it does not appear till the Height of Fevers, especially those of a malignant Kind; and adds, that he himself has a thousand Times observed, that those labouring under this Fever have recovered, when this Symptom of Deafness came on at the Height (in statu) though the other Symptoms threatened much Danger. Prax. Medic. lib. XVII. sect. iii. cap. i. p. 451.

This Symptom of Deafness occurs in other Fevers as well as in this, and often proves a good Symptom in them likewise, as I have frequently observed. Two remarkable Examples of which I had under my Care in St. George’s Hospital, in the Year 1759. On the 17th of January 1759, James Donaldson, a young Man of nineteen Years of Age, was admitted into the Hospital for a Fever, attended with a Stupor and a Delirium, a parched dry Tongue, and other Symptoms of a Fever of the inflammatory Kind, for which he had been blooded, and used other Evacuations. On the 19th, after the Application of a Blister, he was seized with almost an entire Deafness; after which, all his other Symptoms became milder, and he mended daily, and was entirely free from the Fever by the 30th. On the 10th of April 1759, a Youth, John Young, fifteen Years of Age, was admitted into the same Hospital for a Fever, which had already continued fourteen Days. His Speech was affected, and he had entirely lost the Use of his Limbs, was delirious, and had other bad Symptoms. On the 12th, his Hearing became exceedingly dull, and he recovered daily afterwards, and was discharged, cured, the 2d of May, having recovered the Use of his Legs as well as got free of the Fever.

[18] But although these parotid Swellings were in general so favourable with us, we are not to imagine that this will always be the Case: for Riverius, though he speaks of these Swellings proving for the most part critical; yet he tells us, that, in the Year 1623, this Fever was epidemic at Montpelier, and that almost one half of the Sick died; and particularly, that most of those who had Swellings of the parotid Glands appearing about the 9th or 11th Day, were carried off within two Days of their Appearance. Having attended several who died from the Swellings not coming to Suppuration, he began to consider in his own Mind, what might be the Cause of their Death, and concluded, that it was owing to there being a greater Quantity of morbid Matter in the Blood than the Part was able to contain, and that Evacuations by blooding and purging were the only Remedies which were likely to give Relief; and therefore, in the first Case of this Kind, in which he was afterwards consulted, he ordered three Ounces of Blood to be taken away, notwithstanding the Patient was so low that the Surgeon was afraid he would have died in the Operation: The Pulse rose on bleeding, and he ordered four Ounces more to be taken in three or four Hours afterwards: The Pulse rose still more, and he ordered a Dose of Sena and Rhubarb to be taken next Day, and the Patient recovered. And he adds, that all those who were treated in this manner got well. Prax. Med. Lib. XVII. sect. iii. cap. 1.

[19] Ibid.

[20] Pringle’s Observations on the Diseases of the Army, Part III. chap. vii.

[21] This Symptom of Buboes is taken Notice of by Authors, but does not seem to be so frequent as many of them would make us believe. Neither Dr. Huxham nor Dr. Pringle mention their having seen such Buboes; and Dr. Lind says, that he never saw them till the Beginning of the Year 1763.

[22] Hippocrates takes Notice of Swellings of the Testicles in Fevers. He tells us, that a Man from Alcibiades had his left Testicle swell before the Crisis of a Fever. See his Second Book on Epidemics, sect. ii. And he mentions this Symptom as a Crisis in the ardent Fever. See his Book on Crises, sect. xi.—And Dr. Antonio Lizzari, in a Treatise which he published on the Acute Diseases which were frequent at Venice, and all over Italy, in the Years 1761, 62, tells us, that Abscesses of the Scrotum and Testicles frequently followed the Measles.

[23] These Pains and Mortifications of the Feet and Toes were not confined to those who were brought low by malignant Fevers; for, during the very hard Frost in the Beginning of the Year 1763, many of the Patients who lay in very large open Wards in the Hospital at Osnabruck, were affected in the same Way. One Man had both Feet, and Part of each Leg, compleatly mortified, and died in about nine Days after the first Appearance of the Mortification. One lost half of one Foot, and some Toes of the other; and the third lost the first Joint of some of his Toes, and the Ends of others.

[24] Hippocrat. lib ii. popul. sect. iii. text. 2.

[25] Aetius Tetrab. ii. sect. i. cap. 129. Actuar. lib. i. cap. 23.

[26] See these Causes mentioned by Riverius, and since more fully explained by Dr. Pringle, Observations on the Diseases of the Army, part iii. chap. vii.

[27] River. Prax. Med. lib. xvi. sect. iii. Præfat.

[28] The Malignant or Hospital Fever, and Petechial, seemed to me to be entirely the same Disorder, and the Petechial Spots to be only a Symptom which appeared sometimes, but not always. And Riverius says, the Petechiæ do not always appear; but when they do, it is a most certain Sign of a Pestilential Fever. See his Prax. Med. cap. xvi. sect. iii.