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

by Donald Monro

For the first two or three Days we could seldom distinguish, with Certainty, that the Fever was of the malignant kind, though we had often Reason to suspect it. The Pain of the Head, the Fulness and Quickness of the Pulse, and other Symptoms, led us commonly to take away more or less Blood, which the Patient bore easily, and for the most part it gave Relief[7]. We seldom repeated this Evacuation where we suspected the Fever to be of the malignant kind, unless a pleuritic Stitch, an acute Pain of the Bowels, or some other accidental Symptom, required it; or the Patient was strong, and there were evident Symptoms of Fullness immediately before we intended giving the Bark, as shall be mentioned afterwards; for under other Circumstances, if the Blooding was repeated, and other Evacuations used freely, I always observed that it did Harm, and was apt to sink the Patient too much; as Dr. Huxham, Dr. Pringle, and other good Practitioners, have remarked.

After Bleeding, if the Patient was costive, or complained of Gripes, he had a Dose of Rhubarb, or Salts, or a laxative Clyster; but where there was much Sickness of the Stomach, we gave a gentle Emetic[8] in the Evening, and the Purge next Morning. And if in the Course of the Disorder the Sickness and Nausea returned, attended with Griping and Costiveness, or very fetid loose Stools, these Medicines were repeated, and a gentle Opiate given in the Evening after their Operation.

After Evacuations, if the Pulse kept up, we commonly gave nothing but the saline Draughts, with the Pulvis contrayervæ, or some temperate Medicine, for the first Day or two. As soon as we could distinguish the Fever to be of the malignant kind, and that the Pulse rather sunk, we joined some of the Cordials to the saline Medicines, and allowed the Patient more or less Wine, according to the Degree of the Fever. Dr. De Haen has found Fault with Dr. Pringle and Dr. Huxham, for administering cordial Medicines and Wine in the low State of this Fever; but nothing answered so well with us as these Remedies under such Circumstances; and I have frequently seen every Symptom changed for the better by their Use; and even when I gave the Bark, in the Manner recommended by De Haen, I often found it necessary to join the free Use of Wine[9], Cordials and Blisters[10], in order to support the Patient’s Strength.

After reading the Treatises of Dr. De Haen and Dr. Hasenohrl, on this Fever, I resolved on giving the Bark[11] in large Quantities, and found it to answer the Recommendations given by these Gentlemen; and shall relate here two or three Cases, out of above a hundred and fifty, in which I gave it.

I. Robert Wilson, of the Second Regiment of Foot Guards, on the 19th of February 1761, was seized with a Shivering and Coldness, succeeded with Heat, Thirst, a short dry Cough, Difficulty of Breathing, Head-ach, and slight Stitches in his Breast; some Blood was taken away, which was sizy, and he was ordered two Ounces of the Sperma Ceti Mixture, with the spiritus mindereri, every two or three Hours. He continued without any manifest Alteration in the Symptoms, till the 21st, when a Number of dun Petechiæ appeared all over his Body, particularly on his Breast. The Stitches and Cough were then much easier, and he had his Medicines as before. On the 22d, he was seized with a Delirium, and was somewhat comatose; when he was ordered a Drachm of the Bark every six Hours. The 23d, the comatose Symptoms had increased, and he had slight Twitchings of the Tendons, a dry brown-coloured Tongue, and a Faultering in his Speech. The Bark was continued, with the Addition of two Spoonfuls of Mountain Wine every two Hours. On the 24th, he had several loose Stools. The 25th, he was still loose, and went on as before, with the Addition of six Grains of the Pilulæ saponaceæ in the Evening. The 26th, the Petechiæ were not so apparent as before, but he had still the nervous Symptoms, and his Breathing grew more difficult; and therefore a Blister was applied between his Shoulders, and his Medicines continued; as they were likewise on the 27th, without any Alteration in the Symptoms. On the 28th, his Tongue became moister, and the Pulse, which had been low and quick the four preceding Days, became fuller and slower. On the 29th, he was much more sensible, his Tongue more moist, and the Twitchings of the Tendons much less; and in the Evening he fell into a profuse Sweat, which lasted all the 30th. On the 1st of March, his feverish Symptoms were much abated, his Pulse was calmer, his Skin moist, his Drought less, and his Urine dropt a plentiful Sediment. On the 2d, his Fever was almost entirely gone, but he had still a Cough, and spit up a viscid Matter. He was ordered to go on as before, with the Addition of two Spoonfuls of the Sperma Ceti Mixture, and the Spiritus Mindereri, when his Cough was troublesome. He followed this Course till the 7th, when, his Cough and Fever being gone, he was ordered a Dose of Tincture of Rhubarb; after which he recruited his Strength daily, without the Assistance of any more Medicines.

II. On the 5th of March 1761, Thomas Stagg, of the Second Regiment of Foot Guards, was seized with the same Symptoms as Robert Wilson had been in the Beginning of his Fever, but in a more violent Degree. He was blooded to about twelve Ounces, and was ordered a saline Draught every six Hours. On the 6th, the Blood, which had been drawn the Day before, had thrown up a slight Buff; it appeared to contain but a small Proportion of Serum, and the Crassamentum was of a loose Texture. The feverish Symptoms had increased, with the Addition of a Delirium: pergat. On the 7th, the Delirium was grown more violent, so that he could scarce be kept in Bed; his Breathing was difficult, his Eyes red and florid: A Blister was applied to his Back, and the saline Mixture continued. On the 8th, there was no Alteration in the Course of that Day; but being lower towards Night, Blisters were applied to his Legs, and he was ordered to have a Pint of Wine allowed him in twenty-four Hours. On the 9th, the Petechiæ appeared over his whole Body, of a broad dunnish kind; his Breathing became easier, and his Pulse stronger, though the Delirium was still as bad as before: He was ordered a Drachm of the Bark every fourth Hour in a saline Draught. On the 10th, the Bark gave him several loose Stools, but the Petechiæ were of a more florid Colour; the Delirium was less, and his Tongue moist, and therefore he was ordered to continue the same Medicines as the Day before, with the Addition of ten Grains of the Pilulæ saponaceæ in the Evening. The 11th Day, he fell into a fine breathing Sweat, his Pulse became fuller and slower, and the Delirium abated: p. The 12th, his Pulse was regular, and the Delirium gone, and he was much inclined to sleep. The 13th, after a calm Sleep, which had lasted twelve or fourteen Hours, he became quite free of Fever. After this he continued the Use of his Medicines for some Days, and recovered his Health and Strength daily.

III. On the 23d of May 1761, Lionel Thompson, of the First Regiment of Foot Guards, was seized with all the Symptoms of a Peripneumony, attended with a high Fever, for which he was ordered to be blooded. After losing eight Ounces of Blood, he fell into a fainting Fit; on recovering out of which, his Breathing being still much affected, he had a Mixture made of four Ounces of the Lac Ammoniacum, and one of the spiritus mindereri, of which he was desired to take two Spoonfuls every four Hours. The 24th, the Symptoms the same: He complained of having had no Stool for some Days, and took half an Ounce of the sal catharticum amarum, which gave him two loose Stools. On the 25th, his Pulse was small and quick, his Breathing difficult; he was low, and had a slight Delirium: A large Blister was applied between his Shoulders, and the Medicines continued. On the 26th, in the Morning, the Petechiæ appeared, and his Breathing was freer: He was ordered a Drachm of the Bark, in a saline Draught, every four Hours. The 27th, the Pulse better: p. The 28th, was more sensible, and had a kindly warm Moisture all over the Skin. The 29th, the Fever was much abated, and his Tongue, which was before parched and dry, became moist and white: He continued the Use of the Cortex for three Days more, which removed the Fever; and being costive, he took a Dose of the Tincture of Rhubarb. After this he used the Bark for a few Days longer, and got perfectly well.

After giving the Bark[12] with Success, in the two first of the Cases mentioned, and to two young Gentlemen, Mates of the Hospital, who had caught the Fever from their Attendance on the Sick, I gave it to above a hundred and fifty at Paderborn, and elsewhere, during my Attendance in the Military Hospitals in Germany; and although it did not answer in every Case, yet it was found to have a better Effect than any other Remedy that was tried. We joined different Medicines with it, according to the State of the Patient. We gave the Confectio cardiaca, Rad. serpent. Virg. and other cordial Medicines, and Wine, when the Pulse was low; Oxymel scilliticum, and other Pectorals, when the Breathing was difficult; Opiates, where the Patient was inclined to be too loose; the spiritus mindereri, and other Diaphoretics, when we wanted to promote a free Perspiration; and we applied Blisters as Occasion required.