Medical Sketches of the Expedition to Egypt, from India

by Sir James McGrigor

OF THE PLAGUE.

I begin with the plague; a disease of which accounts have been handed down to us from the earliest ages of history or of physic. The consideration of it is important, not only on account of its frequent and fatal occurrence, but, as being, perhaps, the most formidable disease that the art of physic has to encounter. On this subject, however, much will not be expected from me. Of no disease have we a more clear, accurate, and complete, history than of this, in Dr Russel’s work on the plague. In Egypt, we often had recourse to this work, and we readily acknowledge our obligations to the venerable and learned author.

Though since the time that Dr Russel gave his ample history of the plague in Syria, we have had several accounts of this disease as it appeared in other countries; yet much has not been added to our stock of information, and little of improvement has been made in the practice. The proper and well-timed use of mercury, and, perhaps still more, the application of the newly-discovered remedies analogous in their effects to the calces of that mineral, hold out a prospect of success the most encouraging.

In Europe, but more particularly in Britain, much of the dread, and much of the real danger, that attended the most fatal diseases in this country are now done away, by the late improvements in medicine, and in chemistry.

The time was, when fever, when it broke out in different parts of England, proved little less fatal to whole villages and towns than the plague does in the countries where it resides. From the improved practice of the treatment of fever, but more from our knowledge of the means of destroying contagion and preventing its spreading, the mortality from this class of diseases is now comparatively small.

The small-pox, that plague which once carried off so great a proportion of the population of Europe, now bids fair to be expunged from the catalogue of diseases.

May we not indulge a hope, that, as the intercourse of civilized Europe, with the countries of which the plague is now the scourge, becomes more regular and intimate, we may be enabled to extend to them our discoveries and improvements, and so direct them to the means of divesting the plague of its terrors, and reducing the mortality from it to the scale of that of fever and the small-pox in Europe?

Egypt has been called the cradle of the sciences. From this we acknowledge, that the arts were derived to Greece, and subsequently to every part of the world. It would surely be the noblest gratification, if in return, at this period, Europe, by extending her benefits and improvements to Egypt and to Greece, could free them from the most cruel scourge of countries, once the most civilized and polished in the world. It would in some measure compensate and console them for the low state of degradation into which they have fallen.

All that I have to say of the plague will tend to diminish the dread which has hitherto been entertained of it.

A formidable disease undoubtedly it is; but, when we hear how much of the population of Persia, Arabia, Turkey, Syria, Egypt, and Barbary, is now and then swept off, all must not be laid to the account of the plague, as if its ravages admitted of no remedy. The experience of the French and English, in Egypt, will now convince Europe, that much of the vast mortality, in the above countries, is to be ascribed to the gross ignorance in which they are immersed.

Were typhus, our jail or hospital fever, to be imported into a town of Egypt, we can hardly conceive how it could ever be eradicated by the natives. Whenever the small-pox does appear in that country, it proves a dreadfully-destructive disease. The structure of their houses and plans of their streets are calculated for the production of disease, and the preservation and concentration of contagion.

It is a matter of no little consolation to us, that we know the means, not only of excluding the plague from our own country, but that, when our armies are stationed in the countries where the disease is endemic, we can arrest the progress of the contagion, and with certainty eradicate it.

The plague made its first appearance, in the army from India, in the middle of September, 1801. From its early appearance the natives were very much alarmed, and prophesied a dreadful season of plague. They have observed, that, when it breaks out before December, they have always a generally-prevailing and a very destructive disease.

The number of cases which appeared in the Indian army, from the 15th of September, 1801, to the 15th of June, 1802, is seen in an accompanying table.

After the plague broke out, the disease was for a long time confined to Rosetta; it was otherwise in the former season.

Soon after the British army effected their landing at Aboukir, in March, 1801, they were attacked with the plague, though the season was then on the decline. In the beginning of the year, the disease had prevailed very generally over the whole country, and the loss arising from thence, to the French, was considerable. It continued to spread in the British army till May, during which month few cases appeared; but none I believe in June.

Though the contagion is seldom or never, I believe, out of the country, the natives of Egypt denominate the season of plague from November or December of one year, to June of the year following; they observe, that the disease constantly stops at the period of the summer solstice.

I have said, that, during the season ending in June, 1801, the disease prevailed very generally in Egypt; Rosetta, however, was an exception; if any case did occur there it was concealed.

At Cairo, Alexandria, and Damietta; at Suez, in the villages, and in Upper Egypt; it proved very fatal: at Siout, at Girgé, and in general throughout the towns and villages in Upper Egypt, we saw continued marks of its desolation, and heard many dismal accounts of its ravages.

The reason of the plague first appearing in, and afterwards being confined only to, Rosetta, in the last season, was, that it was the only open port to which vessels from Turkey and Greece resorted; and that from some of these, no doubt, the disease was imported.

In the pest-houses of the army, thirteen medical gentlemen did duty, who in the Indian army might be said to have had the post of honour. They were, Mr Thomas, Mr Price, Mr Rice, Dr Whyte, Mr Grysadale, Mr Adrian, Mr O’Farrel, Mr Whyte, Mr Dyson, Mr Angle, Mr Moss, Dr Buchan,[4] and Dr Henderson. Besides these, Mr Cloran was in charge of the cases under observation, and Mr Bell of cases under quarantine. Mr Blackwell, surgeon on the staff of the English army, acted as inspecting surgeon to the Board of Health. He visited every case in the first instance, and, as he judged it necessary, sent them to the quarantine, to the observation-ground, or to the pest-house: to Mr Blackwell’s unceasing attention and discriminating knowledge of the pestilential symptoms, we owed no small share of our safety in Alexandria.

Besides the above gentlemen, we had two Greeks, the barber-doctors usually employed in Egypt, who visited the inhabitants, and before interment narrowly examined every body. These two made a daily report to the Board of Health of the number of deaths and of their inspection of the bodies; they likewise did other duties under Mr Blackwell.

In order to take from our medical gentlemen, in the pest-houses, some of the most dangerous part of the duty, it was my wish to procure some of the Greek doctors of the country to reside in the pest-houses, to feel the pulses there, draw blood, open and dress buboes, &c. The most diligent search was made for those people, and very high pay was promised to them, but we could tempt none of them to live in our pest-houses: a plain proof of the opinion which they entertain of the contagious nature of the disease.

The thirteen gentlemen first mentioned, were those only that were directly in the way of contagion, for, it became their duty to come into contact with the infected, and seven of them caught the infection, and four died.

To the atmosphere of the disease all the medical gentlemen of the army were exposed, as they saw and examined the cases in the first instance; but, except from actual contact, there never appeared to be any danger.

The sketch which I mean to give of the plague, I draw principally from the reports made to me by the surgeons of the army, and from a pretty voluminous correspondence with the gentlemen whose names have been already mentioned. From my own experience I hardly can venture to speak: it was very limited. Though I saw a great many cases, in the first stage of the disease, the number of cases which I treated throughout was very small; they were the cases which first appeared in the army, and my success in them leaves me little to boast of.

The reports and statements of the different gentlemen I have compared together, and endeavoured to reconcile them by what I myself saw of many of the cases.

I have generally given the names of the gentlemen by whom the different facts are related: I have always done this where the reports of two gentlemen disagreed.

From the sources of which I am possessed, I think I can bring forward some new facts regarding the disease, particularly in the treatment. It is much to be regretted, that no traveller, acquainted with the modern practice with mercury and the analogous remedies, ever resided in the countries where this disease is endemic.

In one circumstance, there is a very generally-prevailing opinion in regard to the plague, viz. that extremes of both heat and cold stop the progress of the contagion.

If this be true, in regard to heat, it did not appear to be so in the army in Egypt in regard to cold.

The period at which the plague raged the most was in the coldest months.

It would appear, that, in different countries and in different seasons in the same countries, the plague assumes very different appearances. The plague is seen as varied in its appearance as the different fevers described by Sydenham to prevail in different years, and under different constitutions of the air, in England.

Our knowledge of this fact enables us to reconcile the different or opposite accounts given of the disease, and of its treatment by different writers.

In the Indian army, when the disease first broke out, the cases sent from the crowded hospitals of the 61st and 88th regiments, were from the commencement attended with the typhoid or low symptoms.

The cases sent from the Bengal volunteer battalion, and from the other corps, when the army was encamped near the marshy ground at El Hammed, were all of the intermittent or remittent type.

The cases which occurred, in the cold rainy months of December and January, had much of the inflammatory diathesis. Mr A. Whyte remarked, that every case admitted into the hospital, at Rahamania, had the symptoms of pneumonia.

In the end of the season, at Cairo, Ghiza, Boulac, and on crossing the isthmus of Suez, the disease wore the form of a mild continued fever.

The resemblance which some cases shewn and of others described to me bore to the West-Indian fever struck me very forcibly.

I know not that I can better describe the disease, than by a short statement of the cases of some of the medical gentlemen who had the disease; most of whom wrote me accurately every thing that they felt. Dr Whyte entered the pest-house at El Hammed on the evening of the 2d of January, 1802. In a letter of that date he writes to me, “I just now inoculated myself, by friction, with bubonic matter on the left thigh;” on the 3d, he says, “I have this morning inoculated myself by incision on the right fore-arm.” Mr Rice, then doing duty in the pest-house at El Hammed, gives the whole of the case. In a letter on the 3d of January, he writes to me, “Dr Whyte came here last night; soon after he came in, he rubbed some matter from the bubo of a woman on the inside of his thighs. The next morning, he inoculated himself in the wrist with a lancet, with matter taken from the running bubo of a Sepoy; he appears now very well.”

In subsequent letters, Mr Rice says, “that Dr Whyte continued in good health on the 5th, and all day on the 6th, till the evening, when he was attacked with rigors and other febrile symptoms. He said himself that it was the attack of an intermittent; and it bore a great resemblance to it. After sweating profusely, he was better in the morning of the 7th, but in the afternoon the shivering returned; and, after it had continued 30 minutes, a severe hot stage came on, then a profuse sweating followed, but with it much affection of the head, tremor of the limbs, particularly of the upper extremities, tongue black and dry, skin hot, pulse full, hard, and irregular, thirst great, prostration of strength, and anxiety. The head was the only place that he complained of, and it seemed to be the principal seat of his disease; he still persisted that the disease was not the plague; he would not allow his groin or arm-pits to be examined, and he refused all medical assistance.” He asked for a purgative, which Mr Rice gave him, and he requested to be bled, this Mr Rice thought the state of the symptoms would not justify him in doing. On the 8th, these symptoms continued, and there was some delirium; he begged to be removed from the pest-house at El Hammed, to the old pest-house at Rosetta, under the charge of Arabs. He was removed on the morning of the 9th, and died in the afternoon of that day very delirious.

2d, Mr Price did duty in the pest-house at Rosetta and at El Hammed from the beginning of November, 1801, and had a tertian which he never could completely remove. In the pest-house at El Hammed, he was in the evening of the 1st of January attacked with rigors and slight febrile symptoms; but he himself thought this was only an attack of his intermittent, he soon however felt an affection of his head, and tremor of his limbs, and knew his disease. On the morning of the 2d, three buboes appeared, two femoral and one axillary; he then became delirious, and had no recollection of any thing for several days. On the 5th, there was a remission of the fever. He was able, on the 7th, to write me, “that he had no fever, that one bubo was coming on, and that he was extremely debilitated.” On the 13th Mr Rice opened his bubo; but it was two months after this before he recovered.

I am sorry I cannot find a letter where the treatment of Mr Price is detailed; but I am pretty clear that it was by mercury, as this was his own practice at the time.

3d, Mr O’Farrel entered the pest-house at Aboukir on the 8th of March. He continued well and did his duty there till the 3d of April; in the evening of that day, when he had rigors, which he himself attributed to cold, and says, “that sudorifics nearly cured him.” He was obstinately costive, for which he took several drastic purgatives: the rigors successively returned in the evenings of the 5th and 6th, and he continued taking antimonial powder. On the night of the 6th, he was attacked with giddiness, irritability of stomach, and low fever. Mr Dyson wrote to me, that, on the morning of the 6th, he was delirious, that he had applied a blister to his head; but that he could not get him to swallow any medicine: he expired on the morning of the 7th. No bubo appeared till the day before his death.

4th, Mr Dyson went to assist Mr O’Farrel, at Aboukir, on the 1st of April. On the evening, of the 5th, he was attacked with lassitude, and, on feeling his groin, he writes to me, “I discovered some inflammation of the glands.” After this the succession of symptoms in Mr Dyson was nearly what has been described in Dr Whyte’s case. The fever continued for several days, and became intermittent, one bubo came to suppuration. He obstinately refused every medicine but calomel, which he took as a purgative, but it never salivated him. Constant nausea and vomiting were symptoms with him from the second day of his illness, and he was a long time before he recovered.

5th, Mr Thomas, after being three weeks in the pest-house at Rosetta, attending the first plague-cases which came from the 88th regiment, while walking in the garden of the establishment, laid his hand on his groin by accident, and was alarmed to find a large swelling on one side. He soon after felt some giddiness and fell down; as soon as he recovered, he rubbed in mercurial ointment in great quantity, and every hour took as much calomel with opium as his stomach could bear. His gums were very quickly affected, his bubo came to suppuration, and, in three weeks, he was quite well.

6th, Mr Angle, after being about a month in the lazaretto at Alexandria, was attacked with fever and bubo. The bubo never could be brought forward, and he died of the disease on the 14th day. I have no notes of the treatment of this case nor that of Mr Moss; who, after having been about the same time on duty at the lazaretto of Alexandria, caught the infection. He likewise lived several days, and his bubo could never be brought forward.

It is useless to detail more cases, though I am in possession of many accurately related by several gentlemen. Nor do I mean to offer any comment on the above.

As particularly prominent and remarkable, I cannot, however, without some notice, pass over three cases where mercury, early and liberally exhibited, had very remarkable effects.

I received several accounts of the good effects of mercury from the gentlemen in the pest-houses, but none so remarkable as the following:—In the beginning of the season, on the breaking out of the disease in the crowded hospital of the 88th regiment; every man in the hospital was examined at different periods of the day, and thus the disease was detected on its very first appearance. At this time, I gave to each of three of the men, placed in the observation-ward of the hospital, (of whom Littlejohn and Egan have already been mentioned,) two grains of calomel, and the sixth of a grain of opium every hour, and made them rub into the inside of the legs, thighs, arms, and neck, half an ounce of the strong mercurial ointment three times a day. I, at the same time, made them take each half an ounce of nitric acid diluted in their drink during the day, and put their feet and hands, three times during the day, into a strong nitric bath. In about twenty-four hours, their mouths became severely affected, a tenderness in their arm-pits and groins went off, and the severest febrile symptoms yielded. The men were, however, extremely debilitated, and remained a very long time convalescent. During their convalescence, I thought it prudent to keep them in quarantine, being fully convinced, that they had had an attack of the plague, the progress of which had been arrested, and the disease cut short by the above treatment.

Corporal Francis, as already mentioned, was suddenly attacked with giddiness after coming off from duty as corporal of the guard in the pest-house. In the very commencement of the disease, on the first feeling of illness, he was brought to Mr Price, who instantly admitted him and immediately exhibited mercury, and as soon as the gums became affected, the febrile symptoms vanished. He remained some time in the hospital, on account of a bubo, which came to suppuration; but Francis suffered very little. He was never more than two days confined to bed, though the case occurred at a time when the disease was very violent.

The case of Peter the interpreter strongly evinces the success of the mercurial treatment. To this case, the mercurial pills and ointment were given; and he was, in every respect, treated as a case of syphilis and was speedily cured.

In the cases related, there appeared some facts as to the time the matter of the pestilential contagion takes before it comes into action. Other facts shew, that, in different people, and under different circumstances, there is the greatest variety in this. The lazaretto at Alexandria was infected by the admission of an Italian merchant, and the guard there, consisting of 14 men, caught the disease, but were attacked on different days. The provost’s guard and his prisoners at Alexandria caught the infection from a deserter confined among them, and the disease among these people appeared at very different periods.

Mr Rice relates two cases on this part of the subject, which appear worthy of detail: he says, “we have had proofs, that the pestilential virus remains a considerable time in the habit, without exerting its influence or shewing its virulence. A striking case occurred lately: a Sepoy was sent to the pest-house from the hospital of the 7th regiment with plague; his wife could not be prevented from accompanying him, where she attended and nursed him. The Sepoy died, and the woman was ordered into quarantine; however, she escaped, and after some days search she was discovered near the regimental hospital of the 7th. As this woman had the greatest reluctance to going to quarantine, a centinel was put over her in the hut where she was, and all communication with her was stopped: she continued in good health till the tenth day after her escape from the pest-house; in the afternoon of this day, she was attacked with fever, in a few hours after, the inguinal glands became painful, and she was carried to the pest-house at El Hammed.”

“Another case bore a great affinity to the above: a Sepoy came into the pest-house to attend his wife: the man was sent into quarantine, and he continued well there, till the seventeenth day, on which plague-symptoms appeared, and he was sent to the pest-house.”

Of the symptoms of the plague, fever, though not always present, seemed the most constant.

At the end of the season, at Cairo, at Ghiza, and at Suez, cases appeared without any observable fever. When it did appear, as already noticed, the type at different seasons, and in different parts of Egypt, was very various. At the pest-house at Rosetta and El Hammed, many of the cases, admitted from October to January, had the accompanying fever intermittent and of the quotidian type. This I believe to be a new fact in the history of the disease. For some time in January, February, and in some part of March, the fever had regular remissions. After this period, it generally appeared of the typhus form at Aboukir, except in the detachment of the 26th Light Dragoons, all of whom were young healthy men, and in them Mr O’Farrel observed, “that there was much re-action, and that the delirium was of the kind denominated phrenitis.”

At the pest-house, at Rahaminia, Mr Whyte observed, that all his patients had pluritic complaints.

The second symptom in order was the tremor of the limbs. Mr Price says, “that bubo and pyrexia are not so essential parts of the diagnosis, as tremor of the upper extremities,” and

3dly, The affection of the head, which was sometimes phrenitis, and sometimes typhomania. In a great majority of Mr Price’s, Mr Rice’s, and Mr Whyte’s, cases there was much nervous affection; in one, the risus sardonicus. Mr Adrian says, the nervous affection, in many cases, was very remarkable; in several cases, it resembled the description, given by authors, of that nervous affection produced by the bites of mad or poisonous animals, an almost universal tremor.

4thly, The glandular affection was the next most generally attending symptom. Not above one-half of Mr Whyte’s cases had buboes; and, in a great majority of Mr Rice’s patients, this symptom did not appear. Dr Henderson says, that, in every one of his cases, there was either inflammation or swelling of the glands. The glands most commonly affected were the femoral, next the axillary, then the parotid, submaxillary, &c. In one case of Mr Adrian, an abscess, of the size of a pigeon’s egg, formed on the inner canthus of the left eye. Mr Adrian opened it by incision, and the patient did well. Many were surprised at the rapidity with which the appearance of bubo followed the first complaint of illness: in a number of cases, within four hours. Mr Rice, on the 7th of January, admitted five cases, and in none of them were buboes later of appearing than six hours after the first feeling of illness. In a Sepoy of the 7th regiment, taken ill in December, the femoral axillary, parotid, submaxillary, and sublingual, glands were all affected. In another Sepoy of the same regiment, admitted by Mr Rice, a case of re-infection, so very much swelled were the glands about the neck, that the man died of suffocation the day on which he was admitted.

5thly. The next most generally-attending symptom was the affection of the abdomen. Mr Price says, the hepatic region was in every instance affected. Sometimes there was a swelling of the region of the liver, pain was experienced from pressure, sometimes in the epigastric, sometimes in the hypogastric, region; and almost always in the region of the liver, at which time, the pain has in some cases extended to the kidneys. Swelling of the belly was very frequent; in some cases the abdomen appeared a mass of knots. Uneasiness at the precordia, nausea, and vomiting, were frequent: the vomiting was always of bile, which was of different colours in different stages of the disease. Mr Price writes, “costiveness was a constant and obstinate symptom; and, when ten or twelve grains of calomel brought fæces down, they were always accompanied with bile; first brown, then yellow.” The urine was in general yellow; the skin and adnata frequently of the same colour. Mr O’Farrel says, “I lost one of the dragoons from the affection of his side; the fever went off some days before his death.” Mr Adrian writes, “I do not find the constipation an universal symptom, although, in many cases, I have met with it very obstinate. I was once obliged to give eighteen grains of calomel and two scruples of cathartic extract before my patient was moved.” In several cases, the disease commenced with diarrhœa or dysentery. Some of Mr Thomas’s patients died of dysentery; and this might have been said to be the cause of their death, as they recovered from the bubo, fever, and other symptoms of plague.

6thly. In the first part of the season, petechiæ, vibices, maculæ, and carbuncles, were not seen: in the middle of the season they frequently appeared.

7thly. Some gentlemen could distinguish the disease by a particular look of horror and by a particular cast of the eye, which was first watery, next blood-shot, and at last yellow.

8thly, According to the diversity of the season, the pulse varied. In general, it was small and frequent, and often, when at the wrist it was not perceptible, it could be felt beating 130 or 140 at the carotids.

9thly, The tongue was universally white at the edges; and, when in March and April, some cases appeared with the fever of the typhoid form, it was black and furred in the centre.

10thly, Several of the cases, which came under Mr Grisdale’s care in February and March, had cough and dyspnœa. Mr Adrian makes a similar report at the above period, and three of Mr Whyte’s patients at Rahamania had cough and dyspnœa.

11thly, In a majority of Mr Price’s cases, he remarked an unusual dryness of the skin, and that it was with the utmost difficulty that he could ever excite perspiration. Mr Whyte says, that, “At Rahamania the skin was dry, and that he had never succeeded in exciting sweating.”

These are the appearances the disease put on in the last season; and, on inquiry, I find that they were the appearances it assumed in the former season in the British army in Egypt.

My friend, Dr Short, who resided some time in Persia, and who has paid much attention to the history of the plague, informed me, that, in addition to the above, he found hemorrhage a frequent symptom in the plague, which raged at Bagdad in 1800 and 1801.

In one case he saw a copious hemorrhage from the eyes, which continued for nearly twelve hours. As soon as it stopped, an eruption appeared over the body very much resembling the measles. This patient, a boy of twelve years old, died on the 5th day of the disease.

The duration of the disease in different persons was very different. In several instances, the effect of the pestilential contagion was the immediate extinction of life; and we had several instances of the patient surviving but a few hours the first sensation of illness.

The muccadum of the dooley-bearers of the 88th regiment, about nine in the morning, exhibited the symptoms of fever. About twelve, a bubo appeared, and he died before four o’clock. In some instances, again, the patient lived till the thirteenth and seventeenth day of the disease; however, these instances were rare.

Prognosis. We found that the greatest caution was requisite in giving an opinion as to the probable event of cases: in no disease was the practitioner oftener deceived. In several instances, patients who had recovered from the fever, whose buboes were doing well, and people who were convalescent, suddenly dropped down and expired. Whether this was from re-infection, or whether it was a feature of the disease; will be difficult to determine.

On the 24th of December, one of the Arab servants, convalescent from the disease, and who had been convalescent for eight days, taking bark, while smoking his pipe suddenly expired. In no disease do patients bear motion worse than in this. The least motion[5] induced syncope or death.

Sometimes, they who had for some time been convalescent, suddenly complained that they felt giddy, and expired. Sometimes they called for food, and expired with it in their mouths. In one of Mr Adrian’s cases, where the fever had for some time been gone, and the patient was so far convalescent that he daily walked about a quarter of a mile, the man suddenly complained of giddiness, and expired in ten minutes.

Mr Thomas had two cases where, after affecting their gums, there was a complete apyrexia: but he lost his patients from an immense discharge from the glands and from a secondary fever. In general, it was found, that the patient recovered in proportion to the facility with which his gums and skin could be affected.

The prognosis likewise depended much on the degree of the affection of the sensorium; when the patient was from the beginning comatose, the case terminated fatally. Several of the cases in the beginning of the season, particularly the natives of India, could never be roused. The typhomania was a more fatal delirium than the inflammatory species.

In the treatment of this disease, a variety of modes were put in practice; but so little success attended them, that some were inclined to despair of success from any. Though, with it, even many were lost, yet oxygenation and particularly the use of mercury had the most success.

Though every thing was done by General Baird that the situation and circumstances allowed, yet the gentlemen in the pest-houses laboured under so many disadvantages, that, for the most part, there was but little to be expected from any mode of treatment. In particular, not a little difficulty, as well as danger, was met with in affecting the gums. Safety required that the pest-houses should be at some distance; perhaps, in general, the distance at which they were placed was too great. The patient suffered much by the conveyance, and frequently the treatment of the disease was entered on at too late a period to promise success. In December, January, February, and March, patients suffered so much from the extreme severity of the weather, that in some instances it was not easy to determine whether a patient died from cold or from the plague.

So much dejection prevailed among the natives of India, that, from the moment of the attack, they gave themselves up, and said they were sent to the pest-house to die. They never could be prevailed upon to swallow a morsel of food nor any medicine, and some actually starved themselves.

With establishments of a proper structure, and under proper regulations, we may safely venture to affirm, that our loss from the plague in Egypt would not have been half of what it was.

In the treatment of this disease, the first indication was, to clear the primæ viæ. Some gentlemen exhibited emetics; but in general there was no time for this. The general practice at last was, to begin by giving a purge of calomel, and the general remark was, that, if it operated briskly, the head was relieved and the skin became soft.

The second indication most generally agreed upon, was the inducing ptyalism and perspiration. As offering the fairest prospect of effecting both at once, Mr Price proposed using the warm nitric-acid bath, but unfortunately our stock of nitric-acid was insufficient to do this, otherwise than on a small scale. Mr Price got a little of the acid at El Hammed; but, from circumstances there, he could not always have the warm bath; however, he writes, “On three of my patients, whose gums I could not readily affect with mercury, I determined to try the nitric-acid bath: it has shewn wonderful effects, ptyalism has been produced in all the three; but the cold has regularly induced rigors and severe attacks of fever, and I shall loose my patients.”

Nitric acid was given internally; and, where the patients would drink it, it shewed good effects. Mr O’Farrel, at Aboukir, succeeded in making three dragoons take it much diluted as their common drink; and they did well all of them.

Mr Price thought well of citric acid. In some of the Arabs he effected cures by this, and by a bath of strong vinegar.

Both Mr Rice and Mr Price were in the habit of washing their patients with vinegar and sponging them with it, as strong as it could be procured, or with lime-juice. They dipped rags in the acids, and kept them constantly applied to the buboes. The head and stomach were relieved by wet cloths being kept to the scrotum.

The third indication was, to obviate the debility which appeared always to be very great. With this view, bark, wine, and opium, were very largely given; and, at a certain stage, the cold bath.

At first, calomel was used only as a purgative, but, at last, the use of this remedy was carried farther. The reports were, “that, upon the mouth becoming sore, the skin became softer, the pulse more regular, the eye more clear, the tongue more moist, and that the thirst with the affection of the head and of the abdomen entirely disappeared. The evacuations too were copious, and approached more nearly to their natural colour.” Mr Price writes, “So much am I persuaded, that in the modes of oxygenation, I am in possession of an infallible remedy, that now I purposely expose myself.” Where he succeeded in affecting the gums, Mr Thomas lost none of his patients, and Mr Price in a late letter says, “Calomel affected the gums of all my patients who survived.” It was a general remark, that the gums were remarkably obstinate and insensible to the effects of mercury in this disease. Mr Grisdale writes, “in two of the cases, I for five days pushed calomel and mercurial ointment to a very great length, but never could succeed in affecting the gums.” Both these patients, in a subsequent letter, he reports to have died. Here a particular fact deserves to be noticed: one of the medical gentlemen, who went on duty into the pest-house, and escaped the disease, on account of an old venereal complaint, used mercury and nitric acid very freely during the two months of his tour of duty, and he was one of the six who escaped the infection. On the whole, in mercury and the nitric acid, we appear to have excellent remedies for the plague: but they must be very early and very liberally exhibited. If the first stage is allowed to pass over before they are given, the season of doing it with advantage is in danger of being lost. When the stomach becomes irritable, I suspect that they never can be given with propriety. Perhaps, of all the cases which occurred in the army, this treatment never got a fair chance of success, excepting in those which occurred on the first breaking out of the disease in the hospital of the 88th regiment, in Mr Thomas’s case, and in that of Corporal Francis.

I regret, that, in this disease, we did not give a full and more fair trial to cold bathing. The extraordinary circumstance of the escape of the Lascar from the Rosetta pest-house, and the great benefit which I have seen from it in the yellow-fever, to which the plague bears no slight resemblance, would induce me to give it a full trial in plague.

I have, I believe, recounted the principal part of the treatment, and that which was most generally agreed upon. Other modes received a trial; but, from an experience of their inefficacy they were all deserted.

Dr Whyte used the lancet very freely, but every one of his patients died; Dr Buchan was in the habit occasionally of having recourse to it; and, in the first season, he said, that he had met with several cases where bleeding was of the greatest service. In the beginning of the season, Mr Price bled one patient. The blood appeared very dark, and dissolved: this patient died, and Mr Price never repeated the operation on any other.

Some gentlemen, attached to the Brunonian system, put the stimulating plan to the test. By Messieurs Adrian and Whyte, patients were for some time kept under the influence of wine and opium; but, this practice was never successful and they deserted it. It was at length the practice of Mr Adrian to unite stimulants and mercurials.

Seldom before, I believe, have the bodies of those who died of this disease been dissected. The first was a Sepoy, by Mr Price alone; the second by Messieurs Price and Rice; and, in the last subject, viz. Signior Posetti, the Italian merchant, so severely affected were both of these gentlemen, that it put a stop to this mode of investigation. The general appearances seen on the subjects, were, a perfectly-diseased state of the glandular system. In the liver, no matter was found; but, it was much enlarged and greatly diseased. Signior Posetti had only one bubo; the femoral gland was sixteen times the natural size and weight; and the blood, from the femoral artery, flowed black, pitchy, and dissolved in its texture. I come now to the last, and most pleasing part of the subject, the means of

The prevention. If, in the treatment of the disease, we were not successful, we assuredly were completely so in the prevention. At length, this became so generally known, that we no longer heard the distressing accounts of despondence and despair among the natives. They now no longer entertained such a dread of the pest-houses. We at length even found volunteers from the natives for duty in the pest-houses.

There was hardly a corps, or an hospital in the army, where, at one period or other, the disease did not make its appearance, but it was always in our power to arrest its progress. In well regulated corps, where a rigid discipline was enforced, and proper attention to the interior economy was paid, it rarely happened, indeed, that much difficulty was experienced in eradicating the contagion.

As our success in the prevention was so great, all that remains for me is to mention the substance of General Baird’s order to the army on this subject.

1st, To every hospital, an observation-room, or in lieu of it a tent was attached, and to it, every case whatever with febrile symptoms was sent, as soon as discovered, and was there most strictly watched by the surgeon.

2dly, On any symptoms of the plague appearing, the case was instantly sent to the pest-house from the observation-room of the regimental hospital: the patient was accompanied by the medical gentlemen of his corps who attended him, and who gave the medical gentlemen at the pest-house an account of the previous treatment of the case.

If any doubt remained, the patient in the first instance was placed in the observation-room of the pest-house; and, if the disease did not turn out to be plague, he was sent to the quarantine.

3dly, In every corps, and in every department, a minute inspection by the surgeon was made twice a week; and every person with the smallest appearance of ill-health was sent to the hospital.

4thly, Every corps or hospital, where a case of plague had appeared, was put into a state of quarantine; and, in such corps or hospital, an inspection by the surgeons was made at least two or three times a day; and every case with suspicious symptoms was ordered to the observation-room.

5thly, In suspected corps, it was ordered, that, under the inspection of a commissioned officer, every person should be bathed more frequently, and at stated periods; and, likewise, that all their clothing and bedding should be frequently washed and baked. To all the hospitals, ovens and smoking-rooms were attached.

6thly, Quarters of corps, hospitals, and ground of encampments, were frequently changed.

7thly, Much is to be attributed to the nitrous fumigation. In several instances it was attended with the best effects. The lamps, with this, were kept constantly burning in the observation-rooms, and in the rooms from which the cases of the plague had come. Vessels, with the materials for the fumigation, were likewise placed under the beds, and in the corners of the rooms. When our stock of nitric was at length exhausted, we substituted marine salt for it; but this fumigation could not be kept up in rooms were the patients were all confined to their beds.