An Account of the Diseases which were most frequent in the British military hospitals in Germany

by Donald Monro

Generally in August and September we have People admitted into St. George’s Hospital for the Dysentery; who have certainly not catched the Disorder from eating of Fruit, but from working in the Fields, and being exposed to Causes similar to those which produce the Dysentery in Camps.

[30] Most Authors, who treat of the Dysentery, mention this Symptom of Worms; and Dr. Huxham tells us, that, in some Seasons, he has seen round Worms in the Stools of most of the Dysenteric Patients. De Aere, vol. II. p. 98.

[31] From the Accounts we have in Authors, of the Dissection of the Bodies of Persons who died of the Dysentery, it would appear; that there is no Part of the alimentary Canal which has not some time or other been found inflamed, or in a state of Suppuration or Gangrene; and the Liver, Spleen, and other Viscera, have likewise been found diseased, but the Rectum and Colon have almost in all been more or less affected. The following Account I had, in the Year 1748, from the late Dr. L. Fraser, who afterwards practised in the Island of Nevis, two Days after the Patient died. Mary Reid, a Woman thirty Years of Age, was taken ill of a Dysentery, which in Three Weeks Time killed her. In her Life-time she complained, more than ordinary, of Gripes in her Belly, especially in her Left Side. Her Body was opened in Presence of Dr. Dundas, who had attended her, during her Illness. All the Intestines and Mesentery were inflamed, especially the Colon and Rectum; the internal Side of which was quite in a mortified State, and contained little Vesicles full of a putrid fetid Liquor, Numbers of which she had evacuated by Stool some Days before her Death.

[32] While this Sheet was in the Press, I received Dr. Pringle’s 4th Edition of his Observations on the Diseases of the Army, and Dr. Baker’s Treatise on the Dysentery which was epidemic in London in the Year 1762. Both these Gentlemen give an Account of the Dissection of the Bodies of some People who died of the Dysentery; where, besides the common Appearances of the inner Surface of the Rectum and Colon being covered with a bloody Slime, and their internal Coats being inflamed, gangrened, or in a putrid State, there were observed on the Inside of the lower Part of the Colon, and upper Part of the Rectum, a Number of little Tubercles, or Excrescences, which resembled the Small Pox, of a flat Sort at the Height of the Disorder; but differed from them in this, that they were of a firm Consistence, without any Cavity: they were believed to take their Rise from the cellular Membrane, which lies immediately above the villous Coat. Perhaps such Tubercles might have been found in the Colon and Rectum of those Bodies we opened; but not looking for them, they may have passed unobserved.

Morgagni, in his Book lately published, de Sede & Causis Morborum, epist. xxxi. is of Opinion, that the Filaments, and Pieces of Membranes, which are frequently observed in the Stools, are often formed of inspissated Mucus and Lymph, and other Liquors; and not the Fibres, or Pieces of the villous Coat of the Intestines, as alledged by many Authors.

[33] Mr. Cleghorn, in his Account of the Diseases of the Island of Minorca, says, “That almost all the Dysenteries which fell under my Observation, unless they were speedily cured in the Beginning, at best proved obstinate, and too frequently fatal, in spite of the many boasted Specificks for this Distemper.” chap. v. p. 228.—The physical Gentlemen employed on the American Service have told me, that the old Flux Cases were as fatal in America, as we found them in Germany. I would not from thence have it believed, that every old Flux was to be looked on as a lost Case; and for that Reason given up, and no Attempts be made to cure it; for many, by great Care, and Strength of Constitution, have gradually surmounted the Disorder, and recovered their Health; especially when they got over the Winter, and lived till the warm Weather began.

[34] Although Bleeding, in the Beginning, has been recommended by Sydenham, Huxham, Pringle, and other Practitioners; yet it has been reckoned unnecessary in this Disorder by some late Authors. But in most of the recent Cases I saw, it was extremely necessary, and contributed greatly to the Relief as well as the Cure of the Patient; indeed where the Disorder had already continued some time, and the Fever was gone off before the Patient was sent to us; and the Disorder had become in a manner chronic, and the Patient low, then bleeding was unnecessary, and would have probably done Hurt. Mr. Francis Russel told me, that when the Dysentery was epidemical at Gibraltar, in Summer 1756, he found that by bleeding such Patients as he met with at the first coming on of the Symptoms, and by giving them immediately a Vomit, and afterwards a sudorific Draught, the Disorder was rendered mild, and few of those died.

[35] Mr. W. Russel, who was with the Hospital at Martinico, told me, that, when he was there, he found the Vomit with the Tartar Emetic to be far preferable to any other, in all Cases where there was much putrid Bile lodged in the alimentary Canal; as it speedily carried off those corrupt Humours, which were often productive of the greatest Mischiefs, if they remained, but for a short Time, pent up within the Bowels.

[36] Variety of Medicines have been recommended to answer this Purpose.

The vitrum ceratum antimonii proved often too rough a Medicine, and therefore we laid it almost entirely aside.