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                            MEDICAL SKETCHES
                                 OF THE
                         _EXPEDITION TO EGYPT_,
                               FROM INDIA.

                         BY JAMES M‘GREGOR, A.M.
           Member of the Royal College of Surgeons, of London;
             Surgeon to the Royal Regiment of Horse Guards;
                and lately Superintending Surgeon to the
                          Indian Army in Egypt.

                                 LONDON:
               PRINTED FOR JOHN MURRAY, 32, FLEET-STREET;
                    BELL AND BRADFUTE, EDINBURGH; AND
                       GILBERT AND HODGES, DUBLIN.
                                  1804.

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




                                   TO

                         SIR LUCAS PEPYS, BART.
                       Physician General, &c. &c.

                       THOMAS KEATE, ESQ. F. R. S.
                        Surgeon General, &c. &c.

                                 AND TO

                          FRANCIS KNIGHT, ESQ.
                 Inspector General of Hospitals, &c. &c.

                 THE MEMBERS OF THE ARMY MEDICAL BOARD,

                             THESE SKETCHES
                 are dedicated, with the utmost respect,
                         by their most obedient
                        and very humble servant,
                             JAMES M‘GREGOR.




CONTENTS.


  INTRODUCTION                                        v-xv

                         PART I.

  _Journal of the Indian Expedition to Egypt_         1-55

                         PART II.

  _Of the Causes of the Diseases which prevailed in
    the Indian Army_                                 56-97

                        PART III.

  _Of the Diseases of the Indian Army in Egypt_         99

             FIRST, THE ENDEMIC DISEASES OF EGYPT.

  _Of the Plague_                                  100-146

  _Of the Ophthalmia of Egypt_                     146-159

  _General Remarks on the Diseases_                160-161

            SECONDLY, OF THE OTHER DISEASES OF
                     THE INDIAN ARMY.

  _Fever_                                          162-170

  _Hepatitis_                                      171-180

  _Dysentery_                                      181-192

  _Pneumonia and Rheumatism_                       193-194

  _Small-Pox_                                      195-197

  _Diarrhœa_                                           198

  _Scurvy_                                             199

  _Syphilis_                                       200-201

  _The Guinea-Worm_                                202-217

  _Ulcers_                                             218

  _Tetanus_                                        219-222

  _General Remarks on the Yellow Fever, and the
    Resemblance which this Disease bears to the
    Plague_                                        223-238


   TABLE I. _The Points of Resemblance between
             the Plague and the Yellow Fever._

  TABLE II. _State of the Diseases and Deaths
             in the Indian Army._




ERRATA.


  Page  6, line 17, for _time_ read _service_.
   —    9,  —    6, for _Ghenna_ read _Ghenné_.
   —   15,  —    3, from bottom, for _Ghiza_ read _Damietta_.
   —   23,  —    1, _et passim_, for _Thiza_ read _Ghiza_.
   —   26, last line, for _typhaid_ read _typhoid_.
   —   47,  —   11, for _prevent_ read _prevents_.
   —   48,  —    7, for _Hepiopolis_ read _Heliopolis_.
   —   48,  —    7, for _B El Hadje_ read _Birket El Hadje_.
   —   50,  —   12, dele _the_.
   —   73,  —   14, for _the matter_ read _it_.
   —   73,  —   15, for _quantity_ read _piece_.
   —   83,  —   12, dele _where_.
   —   86,  —   12, for _gums_ read _germs_.
   —   94,  —    4, for _inspired_ read _imposed_.
   —  101,  —    3, from bottom, for _prevent_ read _preventing_.
   —  103,  —    4, from bottom, for _goal_ read _jail_.
   —  122,  —   12, from bottom, for _appears_ read _appear_.
   —  128,  —    6, from bottom, for _viluces_ read _vibices_.
   —  129,  —    5, after _often_ a _comma_.
   —  129,  —    6, after _perceptible_ a _comma_.
   —  133,  —   13, for _patient_ read _patients_.
   —  137,  —    9, dele the first _as_.
   —  151,  —   11, after _flowed_ insert _down_.
   —  166,  —    5, for _healthiness_ read _unhealthiness_.
   —  171,  —    7, for _decubities_ read _decubitus_.
   —  190,  —    8, from bottom, note, for _instantly_ read _constantly_.
   —  191,  —   10, for _man_ read _men_.

Transcriber’s Note: the above errata have been corrected, and in
addition, those listed below. Where there were two spelling variants in
use in equal measure (e.g. diarrhœa/diarrhæa; Signior Positti/Posetti),
both are left as printed.

  Page

   22 “conside-derable” changed to “considerable” (mortality of
       the month was very considerable).

   23 “fumegation” changed to “fumigation” (regarding cleanliness
       and fumigation).

   44 “O’Farrol” changed to “O’Farrel” (Mr O’Farrel, who had
       charge of the pest-house).

   45 “O’Farrol” changed to “O’Farrel” (went to Aboukir to relieve
       Mr O’Farrel).

   98 “medidicine” changed to “medicine” (the practice of
       medidicine is more simple).

   99 “occured” changed to “occurred” (cases of the plague, which
       occurred).

  103 “diminsh” changed to “diminish” (will tend to diminish).

  113 “fom” changed to “from” (some matter from the bubo).

  117 “medecine” changed to “medicine” (he could not get him to
       swallow any medicine).

  117 “inflamation” changed to “inflammation” (I discovered some
       inflammation of the glands).

  122 “prevost’s” changed to “provost’s” (The provost’s guard and
       his prisoners).

  126 “abcess” changed to “abscess” (an abscess, of the size of a
       pigeon’s egg).

  130 “succeded” changed to “succeeded” (that he had never
       succeeded in exciting sweating).

  136 “medecine” changed to “medicine” (a morsel of food nor any
       medicine).

  137 “spunging” changed to “sponging” (washing their patients
       with vinegar and sponging them with it).

  138 “possesion” changed to “possession” and “infalliable” changed
       to “infallible” (I am in possession of an infallible remedy).

  139 “veneral” changed to “venereal” (an old venereal complaint).

  145 “nitrie” changed to “nitric” (When our stock of nitric was
       at length exhausted).

  153 “camphir” changed to “camphor” (a weak solution of sugar of
       lead, or of camphor).

  158 “medecine” changed to “medicine” (Mr Paton, previously to
       embracing the military profession, had studied medicine).

  160 “GENERAL REMARKS ON THE DISEASES.” Heading added.

  161 “convalecents” changed to “convalescents” (convalescents
       would frequently suffer a relapse).

  223 “GENERAL REMARKS ON THE YELLOW FEVER, AND THE RESEMBLANCE
       WHICH THIS DISEASE BEARS TO THE PLAGUE.” Heading added.

  Footnote 5 duplicated word “down” removed (On being brought
       down to Rosetta).




INTRODUCTION.


In consequence of orders, from the Court of Directors to the Government
in India, it became my duty to give some account of the health of the
troops employed on the late expedition from India to Egypt, and to
describe the prevailing diseases.

The sources of information, to which I had recourse, were the reports
made to me, and an extensive correspondence with the medical gentlemen of
the army; particularly those employed in the pest-establishments. Besides
these, to which my situation, at the head of the medical department
of the army from India, gave me access, other sources of information,
regarding the plague, were open to me, as a Member of the Board of Health
in Egypt.

Some may think the present a very short, and many may think it an
incomplete account; but, I trust, it will not be found incorrect. I have
purposely avoided doubtful speculations and hypotheses. Anxious, above
all things, to adhere closely to facts, and keep these unmixed with any
notions of my own, I have, in most cases, published the extracts from
letters to me, without altering a word of the correspondence.

Of the numerous imperfection of these Sketches, I am abundantly sensible.
The life of a medical man in the army is at no time very favourable to
literary pursuits; mine has been peculiarly unfavourable; and I have had
little time or opportunity, since I first entered the army, to attend
to the ornaments of diction. For the last fifteen years of my life;
mostly spent in the East Indies, West Indies, or at the Cape of Good
Hope; sometimes at sea, sometimes on land; my time has been occupied in a
laborious attention to my duty in the army.

Some necessary avocations oblige me to dismiss this tract in a more
imperfect form than it might have appeared in, perhaps with more leisure.
As it is, it conveyed to government, in India, all the information which
they required; and I must mention, that it comes before the public very
nearly in the state in which I presented it as a report in India. From
materials in my possession, I could have enlarged most parts of it, and
rendered the whole more complete; but, when I drew up the following
account in India, it never occurred to me, that my imperfect Memoir
would be the only medical account of the Egyptian expedition. I expected,
on my arrival in England, to have found complete histories of the climate
and diseases of Egypt, during the time that it was occupied by the
English, from some of the medical staff of the British army; several of
whom were known to be fully equal to the task. If any of these gentlemen
should hereafter give to the world the medical history of this renowned
campaign, my Memoir may stand in some stead: it gives some facts and it
will supply some information to which no one but myself had access.

At the present moment, I have not leisure to enlarge or alter it; and
some friends, who have seen the manuscript, press its publication at the
present time.

In the execution of my duty, during a long and perilous voyage, and alter
the most fatiguing marches, I sometimes laboured under difficulties; but
my duty was in every instance much facilitated, and it would be unjust
in me not to mention it. I acknowledge my obligations to all the medical
gentlemen of the Indian army, by whom I was most cordially and well
seconded in all that I undertook.

From the nature of the prevailing diseases, the campaign in Egypt was,
in a particular degree, a service of danger. To their regret, the Indian
army arrived too late in Egypt to share in any other dangers than
those arising from the diseases of the country; and here, the medical
gentlemen had the post of honour. The zeal, attention, and perseverance,
displayed, particularly by those employed in the plague-establishments,
deserve every praise. Nothing can so powerfully incite the exertions
of medical men, in such circumstances of danger, as the consciousness
of co-operating with the best and most enlightened of mankind, for the
alleviation of human misery. Intrepidity is more a military than a
medical virtue; but seldom I believe has there been a greater display of
it than among the medical officers, in Egypt, whose duty it became to
reside in the pest-houses.[1]

There are two names which I cannot pass over with general praise. At
a period of universal alarm, and of real danger, when the plague was
committing the greatest ravages, two gentlemen stepped forward, and
generously volunteered their services in the pest-houses. It so happened,
too, that, from their acquirements, these two were the best calculated,
of any in the army, to succeed in this dangerous duty. Dr Buchan had
acquired a perfect knowledge of the disease in the former year; and while
on duty at the pest-house, at Aboukir, had got the infection there,
soon after the memorable landing of Sir Ralph Abercrombie. Mr Price
had made the history of the plague his particular study, and, from his
acquaintance with the oriental languages, was peculiarly calculated to be
master of every thing relating to it. As will be seen hereafter, in the
execution of his duty at El-Hammed, he, likewise, caught the infection.
To the exertions of these two gentlemen, the service owes much; their
country very much. I would fain hope, that from them, who are so able to
do it, we may look for something like a history of the plague in Egypt.

Dr Shapter, who was for some time in charge of the medical department of
the Indian army, and who succeeded Mr Young, as head of the medical staff
of the English Army, deserves our thanks for his very ready accommodation
on every occasion, and compliance with every request for assistance, and
for many things, of which an army which had traversed an immense desert
was necessarily destitute.

Thus far I have discharged debts which I felt that I owed. I must add a
few words more, in explanation.

To some, it may appear that, in the following Sketches, I have given too
large a space to the journal; and that I have been too copious in my
extracts from letters. Both of these are, no doubt, to many, dry and
uninteresting; but, as statements of facts, from which every one can
form deductions for himself, as they stand, they appeared to me much
more useful than any conjectures which I might hazard to advance. It
is to be feared that, too often, facts and details are made to bend to
preconceived opinions and theories.

On the causes of diseases, I have dwelt a shorter time than to some may
have appeared necessary. But I thought that, while the general causes
of the diseases of soldiers and sailors have been so ably handled by a
Pringle and a Lind, a Cleghorn and a Huxam, a Blane and a Hunter—from me,
little could be expected. All that appeared necessary for me to do, was,
to assign the extraordinary causes—those incidental to the expedition, or
peculiar to Egypt; those, in fine, which rendered the service treated of
different from former services, either on the continent of Europe, or in
tropical climates.

It will be observed, that the diseases which occurred in the Indian army
were but few; and, except on the plague, I detain the reader but a short
time on this part of my subject. A long description of the symptoms,
or of the history, of dysentery, diarrhæa, hepatitis, or ophthalmia,
appeared to me superfluous; when, besides the very clear and perfect
nosological account of the illustrious Cullen, we have many complete
histories of these diseases, in books which are in the hands of every
person.

Finally: in justice to myself, and in extenuation of errors in these
Sketches, I must mention, that, when they were preparing for the press,
I laboured under many and very considerable disadvantages. I was on duty
in a remote corner of the kingdom, and have been, necessarily from the
same reason, at a distance from the press, since, and while the printing
went on: circumstances which, I hope, will conciliate the indulgence of
readers in general, and shield me from the severity of criticism.




_MEDICAL SKETCHES, &c. &c._




PART I.


In complying with the orders of government in India, I have sincere
pleasure in being able, from original documents, to present them with
a correct account of the diseases and mortality which occurred in
their army during the late expedition to Egypt. From the period of the
first sailing of the expedition, and my appointment to the medical
superintendance of it, I retained both the reports of the different
medical gentlemen employed in it, and my own memorandums written on
the spot. During the period in which Dr Shapter acted, and until I was
re-appointed, I likewise kept states of the sick and mortality of the
army, and thereafter, till the return and landing of every corps of the
army at Calcutta, Madras, and Bombay, or at Ceylon.

The India government has ever been peculiarly anxious about every thing
that related to the health of their troops, zealous in collecting any
fact and circumstance touching the causes of diseases or the means of
obviating them, and most liberal in every thing that regarded the health
of the sick soldier.

During an uncommonly long voyage, in a march over extensive deserts, and
in a country and climate described as the most inimical to the human
race, the Indian army enjoyed a considerable degree of health, and
suffered but a small mortality. The causes of this I shall attempt to
develope: the investigation may be useful.

The prevention of disease is usually the province, and is mostly in the
power, of the military officer; the cure lies with the medical: in the
expedition to Egypt very much was done by both.

The medical officers deserve my grateful thanks, and I readily
acknowledge my obligations to them. For every assistance in their power,
I am under not fewer obligations to the military officers. In no army,
perhaps, was the health of every soldier in it more the care of every
officer, from the general downwards, than in the Indian army.

It would be doing violence to my feelings not to mention how much my duty
was abridged by having such a commander-in-chief as General Baird. His
military abilities are well known. His extreme attention to every thing
which regarded the health and comfort of the soldier, I must mention, was
a principal cause of the great degree of health enjoyed by the army.

To Brigadier-General Beresford the army owes very much likewise. It
is not my business to say how much all were indebted to the man, who,
under circumstances the most discouraging, led the advance over the
desert. In my official capacity I cannot but notice how much the British
army, as well as that from India, were indebted to him, as President
of the Board of Health, and as Commandant of Alexandria. The excellent
police established by him gave security to the army as well as to the
inhabitants; and, more than any other circumstance, tended to the
exclusion of the plague from Alexandria.

The route which we took from India to Egypt is remarkable for having been
that by which, in the earliest ages, the commerce of Asia, its spices,
its gums, its perfumes, and all the luxuries of the East, were conveyed
to Tyre, Sidon, Carthage, Rome, Marseilles, and in a word to all the
coasts of the Mediterranean, from Egypt, a country rendered extremely
interesting by various recollections.—The situation of the army from
India has accordingly excited no common share of interest.

It penetrated Egypt by a route over the desert of Thebes, a route
unattempted by any army for perhaps two or three thousand years.
Independently of late circumstances, Egypt and Arabia peculiarly interest
every man of science, and more particularly medical men, from the
occurrence of the plague, and the ophthalmia, or the disorder of the
eyes, in Egypt.

On one account the situation of the Indian army in Egypt is not a little
curious. It consisted of about eight thousand men; of which number about
one-half were natives of India, and the other half Europeans. We have
often seen the changes effected on a European habit by a removal to a
tropical or to a warm climate, but not, till now, the changes in the
constitution of an Asiatic army brought to a cold climate: for such were
the bleak shores of the Mediterranean to the feeble Indian.

The following Sketches I have divided into three parts. The first gives
the medical history, or rather the journal, of the expedition: in the
second, after attempting to assign the causes of the diseases which
prevailed, some modes of prevention are offered: and in the third there
is some account of the diseases.

The first division of the army intended for the expedition to Egypt,
under Colonel Murray, sailed from Bombay in January, 1801. Their voyage
was rather a tedious one, and the small-pox and a remittent fever broke
out among them. They touched for refreshments at Mocha and at Jedda, and
on the 16th May, 1801, came to anchor in Kossier-bay; the prevailing
winds in the Red Sea, at this time, rendering it impossible to get so far
up as Suez.

The second division of troops, (originally intended for another service,)
under Colonel Beresford, sailed from Point de Galle, in Ceylon, on the
19th February; and on the 19th May disembarked at Kossier.

The last division, under Colonel Ramsay, sailed from Trincomalée, in
Ceylon. They were later of arriving at Kossier, and were not able to
cross the desert before July.

At Kossier there is a fort and a town, if they deserve the name. They are
built of mud, and the Arabs inhabit them only at the season when caravans
arrive with the pilgrims for Mecca, and with corn for that and the other
ports on the opposite Arabian coast.

Like every other place described by Mr Bruce, that we have seen, we found
Kossier most accurately laid down by that traveller in lat. 26° 7″, and
long. 34. 04.

Kossier is situated on the western coast of the Red Sea. Here, vessels
for the expedition were daily arriving, and the troops in general landed
in a very healthy condition. In one column of an annexed table, intended
to show the diseases and mortality of the army, will be seen the strength
of the different corps employed in that service.


JUNE, 1801.

At the beginning of this month we were in camp near the village of
Kossier. Soon after the arrival of the troops at Kossier, all were
attacked with a diarrhœa, occasioned by the water, which contained much
sulphate of magnesia. At first it greatly debilitated the men; but, as
they became used to it, the water ceased to affect the bowels. On the
whole it appeared to have produced salutary effects, and the army was,
for some time, uncommonly healthy.

On the 19th, the 88th, with two companies of the 80th regiment, under the
command of Colonel Beresford, as the advance of the army, commenced the
march across the desert. Having the digging of wells and other duties to
perform, the advance did not reach the banks of the Nile until the next
month. The rest of the army marched on the following days, the marches
being always performed by night; and the army, with a very inconsiderable
loss, reached the banks of the Nile in a very healthy state. The course
which we took was nearly that travelled by Mr Bruce. For a considerable
way after we left Kossier, the road had the strongest resemblance to the
bed of a river. As we advanced from Kossier, the water became daily less
salt, and less bitter. At Le Gita, and at Bir Amber, the two stations
nearest to Ghenné, it was not much complained of.

The winds in Kossier camp, from nine to twelve o’clock, generally blew
from the N. W. accompanied with torrents of sand.

On the march, a very hot suffocating wind from the W. set in about ten
and continued till three o’clock. The thermometer at Kossier could not be
attended to.

On the 29th, at Le Gita, in my tent, at three P. M. the mercury stood at
114°. In the soldiers tents it could not have been less than 118°. At
six o’clock in the morning, in a well three feet deep, it was at 69°;
and, after taking it out, it fell to 63°: but evaporation must have had
a share in the reduction. In other places, on the march, the degree of
heat must have been higher. Le Gita is not a situation favourable to the
centration of heat: it is situated in a large open plain of many miles
extent.

There was but little sickness in this month, and yet almost every
exciting cause existed. The heat was intense. In the currents of dust,
