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

by Donald Monro

In Summer 1762, we had only ten or eleven ill of this Fever in the Hospital at Natzungen, and only one died.

When the Troops marched from their Cantonments, in December 1762, towards the Borders of Holland, the twentieth and twenty-fifth Regiments of Foot left behind them, at Osnabruck, thirty sick; five of whom had Symptoms of the Hospital Fever, though no Petechiæ appeared; three recovered, and two died suddenly, being lodged in large open Wards (the only Places we had to put them in) with the Windows all broke, in very cold frosty Weather.

In January 1763, we had only three Patients in this Fever, with the Petechiæ upon them, who all recovered. After this we had none taken ill of it at Osnabruck, while I remained there, which was till the twenty-fifth of March.

This Malignant Fever begun variously in different Subjects; for the most part with Cold and Shivering, Pain in the Head, and other Symptoms, commonly described as peculiar to this Fever. In some, it begun with a sharp Pain of the Side, or other Parts, attended with acute inflammatory Symptoms; in others, it put on the Appearance of the common, low, or nervous Fever, for a Day or two. Blood drawn in the Beginning from some Patients did not seem much altered; from others it threw up a strong inflammatory Buff[1]; but where the Fever had continued some time, it was commonly of a loose Texture, and of a livid Colour; unless when the Sick were accidentally seized with pleuritic Stitches, or other Disorders of this kind.

The Reason of this Difference of Symptoms in the Beginning, and of these different Appearances of the Blood, seemed to be, that such Patients as laboured under Pleurisies, low or other Fevers, being brought into Hospitals where the Malignant Fever was frequent, had their original Disorders changed into this Fever by breathing a foul infected Air, and by their Communication with those ill of the Fever, and of Fluxes; at other Times, a mere Acrimony of the Blood, set in Motion by a supervening Fever, determined the Disorder to be of this kind: and I always observed, that those Men were most apt to catch this Fever, whose Constitutions had been broke down by previous Disorders.

The Fever appeared in different Forms. Some had only a Quickness of the Pulse, attended with a slight Head-ach and Sickness, Whiteness of the Tongue and Thirst, and a Lowness and Languor; which continued for a Week or more, and then went off, either insensibly, or with a profuse Sweat, succeeded by a plentiful Sediment in the Urine. Most of those who fell into profuse kindly-warm Sweats recovered, the Sweat carrying off the Fever. These profuse Sweats continued for twelve or twenty-four Hours, and sometimes for two, three, or four Days. In those who had the Fever in this slight Degree, the Petechiæ seldom appeared; and it was only known to be this sort of Fever by the other Symptoms, and the Malignant Fever being frequent at that time in the Hospitals. Dr. Pringle[2] very justly observes, “That these low Degrees of this Fever are hardly to be characterised, and are only to be discovered, in full Hospitals, by observing Men languish; though the Nature of the Illness, for which they come in, should seem to admit of a speedier Cure.”

For the most Part the Fever appeared with more violent Symptoms, the Tongue became more parched and dry, more or less of a Delirium came on, attended with the other Symptoms commonly described as peculiar to this Fever.

When the Petechiæ appeared, they came out on the fourth, fifth, sixth, or seventh Day; seldom after the eleventh or twelfth[3]. They appeared mostly on the Breast, Back, Arms, and Legs, and sometimes, tho’ rarely, on the Face. They had exactly the Appearance described by Dr. Pringle, either like small distinct Spots of a reddish Colour, or the Skin looked sometimes as if it had been marbled, or variegated as in the Measles, but of a Colour more dull and lured. As they began to disappear, they inclined to a dun or brown Colour, and looked like so many dirty Spots. I never saw them rise above the Skin; nor did I once see any miliary Eruptions in this Fever; which agreed exactly with what Dr. Pringle had observed in the former War, and in the Beginning of this; however, we ought not to conclude from thence that miliary Eruptions are never observed in Fevers of this kind; for Dr. Huxham[4], Dr. Hasenohrl[5] and Dr. Lind[6], besides many other good Practitioners, mention their having seen them.

Many had no Petechiæ through the whole Course of the Disorder; but in all who were very bad, the Countenance looked bloated, and the Eyes reddish and somewhat inflamed; and though the Skin was commonly dry, yet the Perspiration from the Lungs was strong. By these Circumstances one might frequently discover that the Patient laboured under the malignant Fever, without asking any Questions.

When Men were taken ill of a Fever, which we suspected to be of the malignant kind, our first Care was to lay them in airy Places, separate as much as possible from the other Men, and to keep them extremely clean; and they were put on low Diet, and allowed as much Barley or Rice-water as they chose to drink, which was commonly ordered to be acidulated with the Spiritus Vitrioli.