A sketch (analytical) of the history and cure of contagious fever
Jackson, Robert, 1750-1827
^ , V ■^ ik'^t .A ,„V ' A .''*' "f ■■ r ■^-f*|: ^>^i/'M'^ :■■' .-^\ -* ^- <V^ 'If- -f 75/ ^ / 1% (JiJtr Boston Medical Library Association, 19 BOYLSTON PLACE, LIBRARY OF THE MASS. MED. COLLEGE. Rules and Regulations. ' 1. Students attending any of the Lectures in the Massachusetts Medical College may take books from the Library during the course, by depositing Five Dollars with the Dean ; and the students of any of the Medical Professors may have the same privilege on the same terms throughout the year. 2. The Library shall be open on the afternoon of every Saturday, -from 3 to 5 o'clock, for the de- livery and. return of books. 3. Three volumes may be taken at a time, and kept four weeks, or returned sooner if desired. — Twenty-five cents a week will be charged for each volume that is kept beyond that !ime ; and when a fine is incurred, it must be paid before any more books can be taken out. 4. All the books must be returned .on or before the last Wednesday in February, and on or before the first Wednesday in August, preparatory to the semi-annual examinations of the Library. 5. If a volume be lost, or injured, tlie price of the 'book, or the amount necessary to repair the injury, as the case may be, will be deducted from the sum deposited ; otherwise the whole amount will be returned to the depositor, when he ceases to use the Library. Digitized by tine Internet Arciiive in 2011 with funding from Open Knowledge Commons and Harvard Medical School http://www.archive.org/details/sketchanalyticalOOjack SKETCH, (Analytical) HISTORY AND CURE CONTAGIOUS FEVER. BY ROBERT JACKSON, M.D. LONDON: PRINTED FOR BURGESS AND HILL, GREAT WINDMILL STREET, HAYMARKET. -^ 1819. o '& Reed. Printer, 6, Red Lion Court, Fleet Street, , PREFACE. Jr EVER, in one form or other, as the most common, is the most important of the diseases to which the human frame is liable ; it is the one which more than any other has attracted the attention of the Author. The Author's views upon the subject have been before the public for a long time past ; not, he is ready to confess, in a systematic and well digested form, but still he believes in a form that is intel- ligible, and that may be applied to use by the junior members of the profession. With the intention of putting the public in possession of any knowledge he might have acquired by observation, in a long course of experience, he published, in the year I8I7, a Sketch of the History and ir. PREFACE. Cure of Endemic Fever ; and, that the subject of febrile diseases may be farther elucidated, he now adds to it a similar sketch of the fever which is contagious ; a disease of frequent occurrence in civil- ized life, olten generated by artificial causes, and often er aggravated than mo- derated by the means that are instituted for its cure ; that is, by the institution of hospitals for masses of military sick. The Author has little opportunity, in his present situation, of applying to books for information on the subject of which he treats ; and, if he had the opportunity, the labour of reading with a view to learn, would not suit with his failing eye-sight ; he must therefore content himself with giving a bare statement of what he has seen, done, or thought of doing: the record is meagre, but authentic. The doctrines and practices of physici- ans are, like most other things in this sublunary system, liable to fluctuate and PREFACE. V, change. The change which has lately taken place ill Great Britain in the manner of treating febrile diseases, particularly in treatins: the contagious fever known in this country by the name of Typhus, may be termed a revokition. The theoretical doctrine, respecting the nature of the dis- ease, appears to be abandoned ; the prac- tical proceeding is not modified, but lite- rally reversed. Blood-letting, which, twenty years ago, was reprobated as mur- der— direct or indirect, is now not only admitted among the remedies, but extolled above all remedies. Experience supports the opinion that is given of it. The practice is unquestionably salutary. The Author can bear witness to the good eifect; andj though he does not present himself as the person who first directed the public atten- tion to it, he takes leave to say that he has known, since the beginning of the year 1796, that blood may be abstracted, in the contagious fever, with the same safety as in the endemic. In saying this. VI. PREFACE. he does not pretend to say that blood- letting is indispensably necessary for the cure of the simpler forms of contagious fever. He knows that the disease may often be safely cured -without it ; but lie knows at the same time that blood may be abstracted with safety, and that the abstraction may be so managed as to faci- litate and expedite the cure of the most simple : — it is indispensable, to the cure of those that are complicated and aggra- vated. Blood, it is maintained, may be abstracted from subjects who are ill of con- tagious fever without apprehension of dan- ger on the score of its being contagious. — This cannot be denieci ; for it has been fully proved. But, though this be admit- ted, it is proper to bear in mind that the safety of the practice is assured, the power of the remedy augmented by management. Abstraction may be dangerous, or of no effect, as simple abstraction ; it may be rendered safe, and powerful as preceded by, or executed with other compani- PREFACE. VII. ment; viz. fomentations with hot water, hot steam, immersion in warm water, frictions, and other means which act pow- erfully and directly upon the surface of the body. It may be observed in this place that, though the action of the cause of contagious fever pervades the system as generally as the action of a febrile disease can well be supposed to do, yet that the force of the action is principally manifested upon one system, or series of parts, in the cutaneous expansions, inter- nal or external. It is a fact which no one will dispute that diseases are cured by sub- version of the diseased action at its proper base ; it may therefore be presumed that it is most speedily and most eifectually cured by applications which act direc^^iy and immediately upon the series of parts affected ; that is, the exhalants of the skin. The Author has kept this point in view in his practical proceeding; and he takes leave to say that, if there be any thing use- VIII. PREFACE. ful or peculiar in the present work, it is chiefly on that head that it is to be found. A SKETC-H OF THE HISTORY Mp CURE 1° ' « ^ cS^ OF , .o Contagious jTeijen CHAPTER I. Summary of Histories. In analyzing the history, and in adjusting the place of the remedies that have been applied to the cure of contagious fever, I only state what has occurred within my own observation. As individual observation constitutes the basis of my work, I conceive it to be proper to give preliminarily, a history of the field, from which the materials on which I build my system were drawn, so that the reader may have it in his power to ascertain their authenticity, and to estimate their value on just grounds, as appli- cable to common practice; the experiments were principally made upon the military, which is in some manner, an insulated class. B A SKJiltil OF THE U lb TORY AND SECTION I. Summary of the J\Iedical History of the Sd! Regiment of Foot, or Buff s, from the Month of November, 1793, to the Month of Aprils 1795, ivith Cursory Remarks on the Medical History of the British Army, in its Retreat through Holland, ^'c. in the Years 1794 and 1795. It is here proper that I apprize the reader, that I joined the 3d regiment of foot, in the month of October, 1793, in quality of surgeon. That regiment, like most of the infantry regi- ments in England, has been recently aug- mented by recruits, from a levy raised by com- panies, under the name of Independent, and like most of the others, it had suffered, more or less, from fever, during summer and the early part of the autumn. It was embarked at Ports- mouth early in October, as part of an arma- ment about to be dispatched to the West Indies, under the command of Lieutenant-General Sir Charles Grey. It was detained at Spithead after embarkation ; and a project having been formed in the mean time of invading, or of making a demonstration of invading the coast of France, the Buff, in exigence, was transferred to this service, the execution of which was intrusted to the Earl of Moira. The expedi- CURE OF CONTAGIOUS FEVER. 3 tion, under Earl Moira, left Spithead, recon- noitred the coast of France at a distance, and perceiving no signals of friendly reception, it cast anchor in the road at Guernsey, where, after remaining for some days^ it retmned to England — to Cowes, in the Isle of Wight, before the end of December. The seeds of disease, which were comparatively dormant while the Buff remained at Spithead, became active before the end of December ; the activity appa- rently augmented by the preposterous measure of diminishing the tonnage, because the troops were to navigate in seas of high latitude. The Buff was sickly, and scarcely one of the regi- ments which composed Lord Moira's army, could be said to be healthy at the time that it cast anchor at Cowes. In some of the corps the number of sick was high, the character of the disease contagious, the symptoms sometimes violent. The Buff, 19th and 42d regiments, formed into a brigade, under the immediate command of Major- General Lord Cathcart, w ere ordered, about the 20th of January, 1794, to Lymington, to be dispersed in cantonments. The weather, during this season, was cold ; the winter 1794, was in fact a hard one. Cowes, the place of rendezvous, afforded no means of accommodation for the sick ; and as the sick of the expedition were numerous, the hardships were considerable. A mast-shed was all that could be obtained for the hospital of the Buff; B 2 4 A SKETCH OF THK HISTORY AND it was open and cold, but decidedly the most wholesome, and even the most comfortable of the places that were obtainable for the recep- tion of sick ; wicker hurdles, which had been prepared for agricultural purposes, were pur- chased, and laid upon the masts which were at the time in the shed, so that formed into a plat- form, covered with clean straw, and the clean bedding which had been lecently allowed for the corps, as destined for foreign service, the condition of the sick, as to accommodation, was not uncomfortable. Open fire- stoves were placed at different distances within the shed ; but it was not possible, even by the means of stoves, to raise the temperature to pleasant warmth; the air was, notwithstanding, pure, and the effect upon the health was fortunate. The corps, as already stated, was ordered to Lymington ; and no place being provided for the reception of the sick at that cantonment, fifteen were left at Cowes, which were sent subse- quently to the general hospital at Southampton. Fever occurred only occasionally, in the Buff, until the middle of December ; eruptions on the skin, blotches, or moist itch sores, and spreading ulcers on the legs ; diarrhea, or flux were frequent from the time of embarkation. The febrile form prevailed about the latter end of December, aggravated in s^^mptoms, and so common as to constitute one half of the sick list, during the months of January, February, CURE OF CONTAGIOUS FEVER. 5 and part of March. The corps disembarked from the transport ships at the beginning of February, was quartered at farm-houses, near Lymington — in barns, or oth^r vacant build- ings. 1 he cause of the disease, diluted, by dis- persion, though still continued to act, acted with diminished force, and probably would have soon ceased to act, had not an exigence of service, which occnrred about the end of March, occasioned the Buff to be again embarked, in order to proceed to Jersey, which was threatened with an attack from the enemy. The Buff, the 19th and 42d regiments, formed, as already observed, the brigade of Lord Cath- cart. The sick list was high in the Buff, still higher in the l9th ; it was comparatively low in the 42d. Besides the brigade of Lord Cathcart, three other brigades, consisting of the 27th, 28th, 54th, 57th, 59th, and 2d battalion of the 78th, composed the force under the command of the Earl Moira. The greater number of these corps were sickly — contagioqs fever the predominant disease. They were disembarked, and dispersed in quarters in the vicinity of Southampton, wher« a granary or malt-house was converted into an hospital for the reception of their sick. The Buff was thrust into the barrack, St. Laurence, on its arrival at Jersey. That bar- rack is not well contrived, by form of construc- tion, for the preservation of health ; and it was 6 A SKETCH OF THE HISTORY AND not in fact wholesome at the time the BufF went into it, having been occupied during the winter by the 63d regiment, which, like most others, was in a sickly state. The fever, which had been frequent in the BufF from the time of i(s arrival at Cowes, appeared to abate in frequency under the dispersion of cantonment near Ly- mington: it was not extinguished. It re-ap- peared, even acq uired force, as soon as the corps was brought together in mass in the barrack St. Laurence, at St. Helier ; and it continued to increase in frequency and force, until the cause was diffused and dissipated by the dispersion that belongs to encampment ; that is, until the corps was put under canvas about the begimiing of May. Besides dispersion implied in the constitution of encampment, the weather was warm, the site of the camp dry^ the sea conti- guous ; sea-bathing was recommended as means conducive to the recovery of health ; the prac- tice was enforced, and together with this, a routine of exercises and amusements, (which kept the soldier almost always in the open air during the day,) was instituted, followed up, and with such good effect, that at' the end of six weeks, and before the corps was ordered to the Continent, there was not, with the excep- tion of three or four invalids, sent to England to be discharged, an individual in the ranks who was not capable of effective duty. The disease which prevailed among the CURE OF CONTAGIOUS FEVER. 7 troops of the Earl of Moira's command, was fever of a clecidedly contagious character.— There is reason to believe that it was introduced into most of the corps by recruits from the independent companies, many of whom were drawn from jails and manufacturing towns, where the seeds of contagious fever generally exist. In the Buff, which was more immedi- ately under my own observation than any other^ cutaneous eruptions, ulcers on the legs, diarrhea or flux, and fever, constituted the principal forms of indisposition. The Buff was sickly, but not the most sickly corps on the expedition : the 2d battalion of the 78th regiment, a corps of highlanders, newly raised, was healthy, at least, without fever. The symptoms of the fever differed in force and in mode. They were sometimes violent, manifesting irritated and highly excited action in the circulating system, or violent cerebral irritations, tremors, startings, and partial con- vulsions. These modes of irritation were some- times general throughout the system, sometimes prominent in the functions of one organ more than another, more fixed or more fluctuating* according to contingence. In this manner, the morbid suffering, conspicuous at one time in the organs of the thoracic cavity, was suddenly transferred to the cerebral ; and from the cere- bral returned again to the thoracic, either through treatment or by accident. A grim, cloudy, and 8 A SKETCH OF THE HISTORY AND bloated aspect of countenance was usually con- nected with predominant pneumonic symptoms, a validly rolling eye, delirium, startings and threatenino's of convulsion with the cerebral. The course of the disease was usually rapid, seldom extending beyond the seventh day with- out crisis, or change in the nature of the symptoms. In others, instead of a mixed and complicated expression of morbid suffering, the force of the disease was chiefly manifested in the functions of the circulating system. The pulse, for in- stance, was sometimes frequent, quick, and irritated ; sometimes little disturbed in order and regularity, but deep seated, and without expansive energy. The heat of the surface was ardent and strong in one ; caustic, pungent, and disagreeable to sensation in another — not high, as measured by the scale of the thermo- meter ; the skin in both was thick and inelastic. The duration of the ardent and irritated stage was short, sometimes terminated on the third day, rarely extended beyond the seventh. — Symptoms of irritation and ardency subsided, and the powers of life emerged from a given point of depression, assuming a form of activity which assured crisis ; or if this did not take place, they subsided rapidly, and were only prevented from total quiescence, or death, by Herculean means of remedy. The forms now alluded to occurred some- CURE OF CONTAGIOUS FEVER. 9 times, but they were comparatively rare. The symptoms were ordinarily moderate, the action of the vascular system preternatu rally excited, but not inordinately. The skin was frequently tender, or sore to the touch, as if it had been bruised; it was almost always dry — not hot, but hotter than natural. Thirst was consider- able— not intense ; the tongue was foul, often white and slimy ; sleep was disturbed by dreaming and wanderings of the fancy, like delirium ; the action of the vascular system expanded gradually, and marks of crisis were perceivable about the seventh day ; sometimes the energies subsided about that period, the pulse graduall}^ losing force and expansion, the heat of the surface (particularly of the extremi- ties) diminishing, the blood appearing to stag- nate in the veinous extremities, presumptively in organs of spongy structure — lungs, liver, and sipleen, obviously on the skin, produced petchiae or lividness on the extremities : the skin was sometimes dry, sometimes dingy^ damp, and greasy. Sometimes, instead of crisis at a given period, or marks of commencing retrograde, and tendency to stagnation, the character of the disease assumed another form, proceeding under its new form, through a course of regular febrile development, to termination or change, accompanied, not unfrequently, with delirium, sometimes high and violent, oftener moderate, lively and cheerful. Crisis, or toi'mi nation, oc- 10 A SKETCH OF THE HISTORY AND curred in tins case, on the fourteenth, from the coniniencernent of indisposition ; on the seventh, from the change noted to take place in the character of the symptoms. Sometimes, instead of crisis, there was only a change in the nature of the symptoms, more or less obscure, the tinal termination not happening until after another septenary period, sometimes until after several. Distinct and final crisis did not often occur at an early period. Helapse was frequent ; and relapse was always to be expected, when the ostensible febrile act subsided without open marks of crisis, viz. sweat, or other visible and copious evacuations. Where the cessation of fever was unaccompanied by visible and copious evacuations, the course which appeared to have ceased, was often found, when the case was closely examined, to be suspended, rather than finally completed. The disease recurred; ceased, and recurred again, sometimes for four or five different times, the symptoms in relapse frequently, but not always, differing in appear- ance from those of the original. Diarrhea, or dysentery, was predominant among the forms of relapse : where the issue was fatal, it was the more common mode of termination. Instead of diarrhea, or relapse in distinct febrile form, irregular flying pains in difierent parts of the body, sudden and unaccountable qualms of sickness, copious puriform expectorations, CURE OF CONTAGIOUS FEVER. 11 tlireatening pulmonary consumption, not un- frequentlj harrassed the patient tor a iengtli of time. The mortality of the disease under view, was not great inherently; it became great by crowd- ing the subjects of it into ill-ventilated liospitals. It appeared to be greater among men of a full habit and large size, than among those of slender figure and middle stature. It was thus greater in the grenadier and liglit infantry com- panies of the troops collected near Southamp- ton, than in the companies of the battalion. It was also proportionally greater among those beyond forty years of age than under it ; and it was greater, in a marked degree, in the gene- ral hospital at Southampton tiian in the different regimental hospitals in the vicinity, notwith- standing their inferior equipment, and pro- bably the inferior skill of the medical officers who conducted them. The ButF lost one man only, out of more than one hundred who were treated in the regimental hospital, between the month of November, 1793, and the month of July following. Fifteen, as already observed, were left at Cowes, to be sent to Southampton ; fourteen or fifteen were left at Lymington, to be sent to the same receptacle, whe>i the corps was ordered to Jersey. One-third of these appeared, by the Paymaster's roll, to have died before the 24th of June. The precise relative proportion of deaths to 12 A SKETCH OF THE HISTORY AND discharges, among the sick of Lord Moira^s army, is not within the knowledge of the writer. The fact stated, viz. that it was greater in the general hospital at Soulhampton than in the different regimental hospitals in the vicinitj'^, is correct. The general hospital at Southamp- ton was amply provided with every comfort, exce]>t pure air, that sick men could require, and that England could supply. Its chief medical officers were physicians of the universities ; its economy was arranged, and its order superin- tended by a man of experience in the army, and of some reputation in his profession. It is ne- cessary to say this; but it is not said as ob- liquely implying censure to the physicians or the superintendant-general of Southampton hospital. It is the statement of a fact which, with other similar statements, may, perhaps, in future times, induce those who preside over the affairs of nations, to inspect localities, and to estimate their properties, as relative to health, before they give orders to found establishments for the reception of the sick of armies. I do not consider it as rash to maintain that mortality would have been less than it actually was, if the sick of Lord Moira's army had found no other shelter than the lee-side qf a hedge, and no other covering and comfort than a blanket and a jug of water. The assertion is bold ; but it is true, and easily understood. A granary, Qr malt-house of several stories, the apartments CURE OF CONTAGIOUS FEVER. 13 low roofed, imperfectly ventilated, every niche occupied by a sick man's cradle, could not well fail, under tlie best care and management of the ablest physicians, to become a hot-bed of infection. Such it in fact became. The infec- tion, which was virulent, extended to nurses and attendants. The mortality exceeded the ordinary mortality of the disease, as left to its own course in open air and scattered quarters; and it exceeded it obviously by mistaken care and ill-considered kindness; that is, crowded wards and full living. CASES Jllustratwe of History. Lymington. Serjeant M — ns, was attacked on the 20th of March, 1794, with symptoms of fever. The symptoms were violent from the commencement ; but the serjeant, being at an out-quarter, was not submitted to treatment until the 21st. The head-ache was then uncommonly severe ; the skin was tender of the touch; the mind was irritable; the ideas confused; tremors; threatened convulsion. Ca- lomel and James's powders; blisters to the forehead and nape of the neck, — 22. Appearances suspicious ; febrile heat subsided; the pulse small and frequent; the skin damp and greasy; intellect not clear. The apartment in which the ser- geant lies, is close, almost without ventilation. — 23. Delirious, nearly insensible ; the urine and stools pass involuntarily, or unconsciously; the pulse is scarcely perceptible; the skin greasy, clammy, and of a dusky colour; the lips pale; the countenance collapsed and inanimate ; the eye languid and sunk. He was brought from his apartment to the hall ; the hands, face, and breast were washed with cold water; 14 A SKETCH Ol THE HISTORY AND laid upon straw, in a wlieel-banow, be was moved throU)^h the open air to some distance. He recovered recollection, and spoke feebly ; he was convalescent in a few days. He relapsed on the passage to Jersey — the symptoms severe, but less threatening than tho^e of the original attack. Washed with cold salt water — refreshed. A severe griping pain came on in the course of a few hours, followed by copious stools, mixed with blood, as if from the rupture of blood-vessels. The fever ceased : the recovery was rapid and perfect. Lymington, March 2, 1794. Sergeant Brown, aged thirty, of an athletic form, and florid complexion, attacked in the morning of the 2d, with head-acbe of uncommon severity; severe pains of the limbs and joints ; general feelings of distress, with considerable tumult and irregularity in the action ol" the vascular system. — 3. The violence of the symptoms increased ; the countenance grim and cloudy ; the tongue white and slimy; the pulse quick, frequent, and Irregular; the skin hot and dry; the respiration heavy and oppressed ; anxiety, restlessness, apprehension of danger. Blisters to the forehead and temples: Calomel and James's powders. The head-ache somewhat relieved in the evening; the body opened; the skin still dry. — 4. The symptoms abated; the head-ache severe; the eye stares wildly; de- lirious during the night; startings, tremors, convulsive twitchings ; breathing oppressed ; countenance overcast. Blisters to the head, chest, and neck; bark, snake-root, camphire, James's powders, and calomel, in large doses: extremities fonaented with flannels wrung out of hot water; the face and upper parts of the body washed lavishly with water from the pump. Evening, somewhat relieved ; the skin softer, and less hot; delirium moderated; pain of the head and oppression at the chest relieved, not removed : the two last symptoms alternate, in some degree, with eac|j other. — 6. More promise of safety ; the pulse opens and expands. — 7. Better — no decided crisis.— 9. Crisis distinct. — There was no relapse in regular febrile form ; but there were frequently, for at least six weeks, recurrences of un- CURE OF CONTAGIOUS FEVER. 15 pleasant feelings, and at one time, appearances which gave suspicion of impending consumption in the lungs. Lymington, February 10, 1794. John Jackson, private soldier, attacked on the 10th with severe head-ache, excru- ciating pains in the limbs, pains in the side, &c, ; the pulse quick and frequent; the heat considerably above natural; the skin dry; the tongue foul ; thirst urgent. An emetic was given as soon as he was brought to the hospital, fol- lowed by a dose of calomel and James's powder; blisters were applied to the forehead, temples, and neck. — 1 1, Con- siderably relieved : towards evening, difficulty in breathing; pains ro various parts of the body • agitation, tendency to convulsion. — 12, Bad night : breathing difficult; the pulse intermits. — 13. The pulse small, intermitting ; the eye and countenance express something to the observer, of which words can convey no adequate idea; urinary discharge suppressed, with sensations of severe pain in the urinary organs. — 14. Bloody urine in great quantity ; the pulse natural ; the skin soft ; the crisis evident. This man had two relapses of fever ; the symptoms in the relapse of the same kind as those of the original, but less violent in degree. The critical period was marked by suppression of urine ; the crisis accompanied by a copious discharge of blood from the urinary passage. Jersey, May 10, 1794. Cummins, a grenadier of large size and gross habit, on the eve of being dismissed from the hospital, where he had been for some time, on account of an ulcer on the leg, was attacked suddenly with symptoms of fever, which (having no duty to perform) he concealed from the medical officer nntil the third day. When brought to the fever ward, the pulse was quick and frequent ; the head-ache severe in an extraordinary degree ; thirst great ; heat of the skin ardent, deep, or concentrated ; the skin itself dry, and, as it were, compacted — somewhat livid or marble at the extremities. The countenance was dark and cloudy ; restlessness, jactitation, total want of sleep, with partial twitchings of spasm, were conspicuous. Laxatives, 16 A SKETCH or THE HISTORY AND sudorifics, antimonials, camphire, opium, &c. were given freely, but without benefit. The pulse, on the morning of the sixth day of the disease, was frequent in time, weak in strength, and sunk, as it were, in the arm. The heat of the skin was less than natural ; the surface of the body tender of the touch, as if it had been bruised ; the eye and counte- nance heavy and inanimate; the intellect confused with subsultus, &c, Wiae was given in great quantity ; the cold- ness of the skin, notwithstanding, increased ; the pulse retired from the surface, or appeared to contract itself. Ten grains of ammonia, one drachm of bark, twenty grains of powder of snakeroot, were made into a bolus, with one grain of opium, and given at intervals of two hours, washed down with a wine-olass full of Geneva, The body was washed frequently with cold salt water; and blisters were applied to the neck and extremities. The pulse became strong, full, and open; the skin warm, even hotter than natural; the countenance animated; the eye expressive; starlings and twitchings still continued. During the seventh, eighth, and ninth, the ideas were clear, the eye and countenance animated, the pulse strong and full, the skin warm, the sur- face dry and thick — preternaturally constructed. During the tenth and eleventh, the countenance lost somewhat of its animation, the eye of its vivacity, the stattings and twitchmgs were less frequent, and less expressive of power : the course was, upon the whole, retrograde. The 3d regiment of foot was ordered from Jersey in the summer, 1794, to join the army on the Continent. It embarked at St. Helier in the latter end of July, and arrived at Bergen- op-Zoom, in Brabant, after a passage of eight days. When the Buff arrived at the Scheldt, it was in perfect health, there not being a per- CURE OF CONTAGIOUS FEVER. 17 son belonging- to the ranks incapable of duty, at the time of disembarkation. Liquor was easily procured at Bergen-op-Zoom, and intoxication was general on the day of landing, as if it had proceeded from a regimental order. The in- toxication produced,, as might be expected, a disorderly scene at the time ; and the effects of it were visible next day, on the march to Rosen- dael, where the main army was encamped. The British army had now commenced a retreat. It was in daily expectation of being pressed by the enemy ; and it was judged proper, under that expectation, to send every person, who was unfit to keep his place in the line of march, or to act in the field, to a sick depot in the rear. It was scarcely to be expected that a regiment like the Buff, awkward and inexpe- rienced, as entering upon its first campaign, could remain many days without furnishing recruits for the sick depot. It happened as might have been expected ; the Buff, previously to breaking up from Rosendael, was under the necessity of sending thirteen men to the general hospital at Rhenen, not one of them seriously ill, but all of them unable to continue in the line of march, and perform the duties that might fall to the lot of a soldier, under retreat in the face of an enemy. This practice, which began at Rosendael, was repeated in every change of position ; from the effect of it a hundred and sixty of the corps were found in the list of c / 18 A SKETCH OF THE HISTORY AND the general hospital before the iiiiilcUe of November. The British aruij^ passed the Maes, about the middle of September, prior to which, those of the Buff, who had been sent to the sick depot, had been sent chiefly on account of accidents, or slight indispositions, which incapacitated them from continuing in the line of march of a retreating army. The army, having passed the Maes, took a position on the heath of Maek, on the 22d of September. On the next day, between sixty and seventy persons, fifteen of them belong- ing to the company of light infantry, appeared in the sick report, the disease distinctly fever. The symptoms of this disease were violent from the commencement. The head-ache came on suddenly, and it was generally of great severity. The eye was hot, painful, and shunned the light ; the countenance was flushed, cloudy, and grim ; the sensation of pain in the loins and limbs was grievous, similar to the achings commonly noticed in the cold stage of inter- mittent fevers, frequently accompanied with sensations of gnawing or tearing of the flesh, particularly at the shoulders and arms. The skin was generally dry, and tender of the touch ; the heat sometimes ardent and par- ticularly pungent. The pulse was insidious, sometimes tumultuous and irregular, some- times little changed in point of frequency or order, but deficient in energy, elasticity, and CURE OF CONTAGIOUS FEVER. 19 expansion. The tongue was usually white and slimy; nausea and squeamish ness were common ; vomitting occurred sometimes; thirst was irre- gular; sleep altogetlier wanting, or disturbed bj frightful dreams. Costiveness or obstinacy in the bowels occurred on some occasions; purging, similating dysentery, prevailed in others ; convulsive or spasmodic twitchings in the limbs; tremor, starting, difficult respira- tion— continual, or alternating with pain in the head, &c. were not unfrequent. — This form of disease, though it did not terminate by inter- mission at regular periods, like fever of en- demic origin, was, notwithstanding, disposed to subside in three or five days ; it rarely ex- tended to seven. Relapse occurred after a short, period of convalescence ; and after a continu- ance of a {ew days, it again subsided or ceased. In this manner, recurrences of fever, and sus- pensions, alternated at short intervals for several w^eeks ; when health was re-established, or a local form of disease, generally the dysentery, got permanent possession of the field. The Bufi'was detached from the encampment at Maek in the latter end of September. The subjects of the fever now alluded to, two-thirds of whom were not yet sufficiently recovered to undertake a service which required exertion, were sent to Nymegen, and from thence to the great hospital at Rhenen. The Buff remained on detachment at Nysterich, Bathenburgh, and c 2 20 A SKETCH OF THE HISTORY AND Graaf, for upwards of three weeks. It returned to the army on the 20th of October, and en- camped on the glacis of Nymegen, with a sick list of no more than nine persons, none of them seriously ill. From the 20th of October until the 7th of November, when the army crossed the Maal, after sustaining a short siege in Nyniegen, every person who was indisposed, so as to be unable to do the duty of the garrison, was sent to an hospital in the rear, as to a place of safety. The British troops were withdrawn from Nymegen on the 7th of November. The Buff, the 40th, 55th, 59th, and 79th, were encamped near Lent, on the right bank of the Waal. The position was supposed to be safe, as a military position ; and, as such, it was supposed to be a position for the winter. The ground upon which the Buff was ordered to encamp, was ploughed field, or meadow — the surface flat. Rains were frequent during a great part of November, consequently the ground of encamp- ment was partially under water ; it was always mire. The tents and huts did not afford suffi- cient protection from the falling rain ; the supply of straw for the bed was scanty ; and when procured it was soon spoiled, in a miry soil. Frost set in early in December ; it was intensely severe. The sick of the Buff, instead of being sent to the general hospitals at Arn- lieim, or Khenen, were received into a barn CURE OF CONTAGIOUS FEVER. 21 contiguous to the encampment. The barn was capacious, and clean straw was supplied in abundance. The sickness, which had increased in the armj^ with the progress of the season, spread rapidly in the Buff and other regiments that lay contiguous to Lent. In the short period of six weeks, one hundred and fifty persons, from a corps of about three hundred rank and file, entered the regimental hospital under one form or other of the fever then prevailing among the troops. The Buff was ordered to break up from Lent on the 3lst of December; and, as it was ordered upon service of alert, the sick, amounts ing to forty-five, were sent to the general hos- pital—to a house on the north side of the Rhine, within two miles of Arnheim. The disease, as it appeared among the soldiers of the Buff, while they remained encamped at Lent, exhibited considerable variety, in form and intensity ; but, however varied, it manir fested the contagious property in all its forms. In some, the attack was sudden, the pain of tbe head distressing — rending, almost intolerable — ■ the more common seat of it the forehead, imme- diately over the eyes. The eye itself was cloudy and confused ; the countenance dark and grim ; the skin generally dry, sometimes purplish or marbled ; the heat great, more pro- perly ardent and caustic ; local pains severe, seldom fixed. Shooting pains often proceeded 22 A SKETCH OF THE HISTORY AND along the shoulders and arms in succession, rapid in their course as an electric explosion ; aching pains were sometimes irksome in the lower limbs and joints, similar to the aching pains that are common in the cold stage of the more malignant forms of intermittent. The skin was frequently tender — impatient of the touch, or of pressure. The pulses of the heart and arteries were irregular, sometimes irritated, sometimes torpid, or unergetic ; the tongue was white and slimy, sometimes of a leaden colour, and swollen, but not foul ; thirst was variable ; nausea and squeamishness common ; actual vomiting rare. Tremors, starlings, or spasmodic twitchings occurred frequently ; sleep was wanting, or disturbed by dreamings and wanderings, approaching to delirium. Pneu- monic symptoms were not unusual; they fluc- tuated, and frequently alternated with spasms, delirium, or coma,. The symptoms now no- ticed, discovered themselves in the more intense degree at the commencement, and continued for the most part, in a high degree of intensity until the third, fifth, and sometimes the seventh day ; when they subsided, rather than termi- nated. After a few days of suspension, under an aspect more or less promising, fever recurred, sometimes similar, sometimes diflferent in the nature of its symptoms from the original ; sometimes of the same, sometimes of different duration. CURE OF CONTAGIOUS FEVER. 23 111 other forms of the disease, and upon the whole, ill the more numerous, the pulse, differ- ing little from natural in point of time, was deficient in energy and expansion ; the heat, moderate in degree at the extreme surface, and on the extremities, was often sharp and pun- gent at the prcecordia, on the trunk of the bodj^ and even on the extremities, as closely pressed by the hand. The skin was often dry and arid ; sometimes flaccid and withered ; sometimes clammy, greasy, and dusky in colour; it was generally tender of the touch, or impa- tient of pressure.. The aching pains in the limbs were often distressing ; the pain in the head was ordinarily moderate, viz. confusion and muzziness, rather than actual pain. The tongue, as clean and moist, in many cases, dif- fered little from natural during the first days of the disease. It was sometimes smooth and pale, sometimes rough and moist, the roughness adhering firmly to its substance. A black crust or sooty pellicle, sometimes moist, oftener dry, covered its surface, not unfrequently at late periods ; sometimes the surface was smooth, glossy, or shining as if it had been covered with a coat of varnish ; in such case, it was usually dry, even parched. The disease, under the form now described, rarely ceased, or changed materially the tenor of its proceeding, before the seventh day. It then sometimes terminated critically; sometimes changed character and 24 A SKETCH OF THE HISTORY AND run over a course of similar duration as the original, distinguished, for the most part, by marks of vascular excitement, general expan- sion in the extreme vessels of the surface, and more or less of mental derangement. The forms now cursorily marked, present an outline of what was most common in the Buff, during the time of its encampment at Lent. Besides these, pneumonic and dysenteric forms were frequent ; the first, as original ; the second, sometimes as original, oftener as secondary ; that is, as the mode assumed by the action of the morbid cause in relapse. The Buff moved from its encampment at Lent on the 1st of January, 1795, the sick, as already stated, having been previously sent to an hospital in the vicinity of Arnheim. The great rivers were frozen ; and the threatening movements of the enemy kept every part of the army in a state of alert. The Buff, among others, marched and countermarched between the Waal and the Rhine day after day during the first ten days of the month ; and, notwith- standing daily change of position, and an ex- treme intensity of cold, no material abatement was observed in the rate of the sickness. From the 1st to the 20th, about forty persons were sent to hospital from a corps under three hundred rank and file. From the 20th, when the division in which the ButF moved arrived at Deventer, waggons were provided, whether CURE OF CONTAGIOUS FEVER. 25 hired or pressed, to cany sick and other incum- brances in the train of the respective corps; and, in consequence of that measure, the BufF ceased to send its sick to the general hospital when ordered to march. The weather was now excessively cold, the frost intense, or under thaw. The travelling was slow, on account of the bad- ness of the roads : and, as the journies were sometimes long, the waggons, with the sick, did not always arrive at the quarter before dark. A barn was the common place of accommoda- tion, necessarily without fire, but ordinarily well stored with clean straw. During the march from Deventer to Bremen, that is, from the 20th of January to the beginning of April, the list of sick, partly owing to the accession of stragglers from the general hospital, which was also on the route, was seldom, during the first six weeks, under thirty, often above it. At the beginning of April, when the corps arrived at Bremen, two persons only M^ere sent to hos- pital, as unable to walk to Bremenlehe without assistance. The above sketch comprehends a summary of the medical history of the 3d regiment of foot, during its service on the Continent, from the month of August, 1794, lo the month of April, 1795. The medical history of the British army, in the retreat from Antwerp to Bremen, is a history of some importance. It furnishes points of information deserving the attention of states- 26 A SKETCH OF THE HISTORY AND men and generals, as well as physicians who superintend the medical concerns of armies. Contagious fever, whether introduced into the armj^ at the beginning- of the war 1793 by im- pro])er modes of recruiting, and bj^ carelessness ■in the manner of incorporating recruits into healthy regiments, or otherwise generated, was rendered virulent by accumulating the subjects of it into receptacles called general hospitals. Frotn these the seeds of disease were sent forth, and diffused widely through the army by ig- norance or inattention ; that is, want of know- ledge of the principles of military economy, or disregard of the manner of applying them. 