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

by Donald Monro

When the Disorder, in its Progress, became chronical, the Sick were commonly sent down to the fixed Hospital, so that we had no Opportunity of examining the Bodies of such as might die of this Complaint.

FOOTNOTES:

[97] It is often very difficult to judge of the Cause, or to be able to determine exactly the Seat of these Disorders before Death; as the following Cases will shew.

John Waden, a middle-aged Man, was admitted into St. George’s Hospital the 10th of April 1759, for a Swelling of the Abdomen, and a Difficulty of making Water, which he said begun about two Months before, with a violent Pain in his Back and Belly, occasioned by his being employed in making of Cyder in a very cold Cellar. He had not had a Stool for some Days: at first he took a Dose of Physic, and some of the saline Draughts; but in a Day or two complained that his Belly had grown to a monstrous Size, and that he had not made Water for above twenty-four Hours; on examining, we found the Bladder so much distended as to reach up to the Navel; and upon a Catheter’s being introduced, above two Quarts of Water were drawn off, and the Swelling immediately subsided; but in the Afternoon was as large as before, the Bladder seeming to be in a paralytic State. During the Months of May and June, his Water was drawn off twice a-Day; he had his Belly fomented with emollient, astringent, and other Decoctions, and embrocated with Liniments; was blooded once when feverish, took Cordials, the Bark, Myrrh, and a Variety of Medicines, without any Effect. On the 3d of July, a flexible Catheter was introduced into the Bladder, and left there, in order that the Urine might drain away as fast as it was secreted, and the Bladder be allowed to contract, and recover its Tone. The Catheter gave him no Pain, and he thought himself much easier by the Bladder’s never being too much stretched; but on taking out the Catheter some Days after, he had the same Stoppage of Water as before. On consulting with Dr. Batt and the other Physicians, it was agreed to give two Grains of the Powder of Cantharides, with three Grains of Camphor and ten of Sugar, rubbed well together in a Mortar, twice a-Day; and to continue the Use of the flexible Catheter. He found no Uneasiness or Strangury from the Use of the Cantharides, and thought he passed his Water more freely, when the Catheter was taken out; but after fourteen Days, finding no Change for the better, and being free from any Fever, he was ordered into the cold Bath; the two first Days he found himself more lively and brisk; but the third Day was chilly and cold after coming out of it, and therefore was desired to leave it off; some Days after he became hectic, and I observed Pus in his Water, which he said he had passed with his Urine for above three Months; after this he languished for near a Month, and died upon the 25th of August.—Upon examining his Body next Day, we found the thoracic Viscera in a sound State, except that the Lungs adhered a little on the right Side. Both Kidneys were diseased; they were inflamed, and seemed enlarged; and on cutting them, had Tubercles dispersed every where through their Substance, which had come to Suppuration, and contained a good deal of Matter; the lower Part of the left Kidney was mortified, and contained two or three Ounces of a black fœtid Liquor. The Bladder of Urine was contracted, and its Coats greatly thickened, and the internal Coat much inflamed; and there was a Cyst full of Matter, about Half the Size of a Walnut, between the muscular and villous Coats, towards the lower Part of the right Side of the Bladder; and there were two large Cysts, containing a small Quantity of Matter, though capable of containing near two Ounces each; one situated between the vesiculæ seminales and Rectum, the other between the vesiculæ and Bladder, which opened into the Urethra by one common Orifice, capable of admitting a large Quill, at the Side of the caput galinaginis. The rest of the Viscera were in a sound State.

Mary Hibbard, a Woman twenty-four Years of Age, was admitted into St. George’s Hospital, the 6th June 1759, for a Complaint of her Bladder. The Account she gave of herself was, that, about Christmas 1758, she had parted with some Gravel; and about fourteen Days before coming to the Hospital, she was seized with a violent Pain in her Back and Loins, attended with a Sickness and Nausea; and very soon after complained of a violent Pain in the lower Part of her Belly, and with a perpetual Inclination to make Water, though she felt a sharp Pain and Difficulty in doing it; and that these Complaints still remained. Her Pulse was quick and strong, and she was inclined to be costive. She was immediately blooded, took the oily Draughts three Times a-Day, the decoctum furfuris for common Drink, and so much lenitive Electuary as procured her a Stool next Day. As there was a strong Suspicion of her having a Stone, she was sounded; but nothing at all was to be felt in the Bladder. Her Medicines eased her Pain in making Water, but not the Pain in her Back. On the 16th her Water was thick and turbid, and deposited a brown Sediment; and the Difficulty in making Water still remained; instead of the lenitive Electuary she was ordered the Rhubarb oily Draught to be taken every Night. On the 18th, there being no Change in her Disorder, she had Draughts made of an Ounce and a Half of simple Mint Water, Half a Drachm of the dulcified Spirit of Nitre, and five Drops of the tinctura thebaica, and Syrup three Times a-Day; but on the 22d she complained, that since she left off the oily Medicines, her Pain and Difficulty in making Water had grown worse; she was therefore ordered the saline and oily Draughts alternately, and to take the Rhubarb oily Draught occasionally when costive, which removed these Complaints; and they did not return while she remained in the House; but on the 4th of July, the Day before she was to have been discharged as cured, she was attacked with a sharp Pain in her Hip and Loins, and about the os coccygis; which increased till the 9th, and extended itself all along the Outside of the right Thigh; it was most acute about the os coccygis; but on examining, nothing was to be observed externally: This Pain continued more or less all that Month, and till the End of the next, and so obstinate as not to be altered by bleeding, and the Use of Liniments, Blisters, cooling Medicines, Opiates, warm Baths, and other Remedies. On the 20th of August, a strengthening Plaister was applied to her Back, which gave immediate Relief, and she was discharged cured the 29th. She continued well till October, when she was attacked with a violent Fever at Hounslow, and was brought to the Hospital on the 24th of that Month, and the tenth Day of the Fever. She died the 3d of November. During the Course of the Fever, she only complained once of a Difficulty of making Water.—After Death I had her Body opened, when the only Thing particular which we could observe, was the urinary Bladder about four times the natural Size; it seemed to be flaccid, and in a State of Relaxation; the Kidneys were sound, and no Signs of any Distemper could be observed about the Uterus or Rectum, or near the os coccygis.—When she was first in the Hospital, I desired her always to examine her Urine; but she never observed that she passed any Sand, Gravel, or any thing of that kind.

Thomas Jacey, an elderly Man, was admitted into St. George’s Hospital the 14th of March 1759, for a Pain in his Back, and a Difficulty and Pain in making Water, which was often mixed with grumous Blood; but he had never observed any Sand or Gravel in it. His Pulse was quick and full, attended with Heat and Thirst; and he was inclined to be costive; he was at first blooded, and took a Dose of laxative Mixture, and two Ounces of the Tincture of Roses, four Times a Day, and the decoctum malvæ for common Drink. At first he seemed relieved, and passed no grumous Blood for some Days; but on the 26th, as he complained much of a Pain in making Water, the Tincture of Roses was changed for the oily Draughts, and he was ordered the Rhubarb oily Draught occasionally. On the 9th of April he fell suddenly into a comatose Way, and remained so till the 12th, when he died, notwithstanding the Use of divers Remedies.—Upon examining his Body, both Kidneys were found in a sound State; the Intestines covered with slight inflammatory Spots, the Bladder of Urine quite contracted, schirrhous, and greatly thickened; and its internal Surface rough and eroded, with one or two black Spots on it, and some grumous Blood lying on its Surface. The other viscera were sound.

In Ulcers of these Organs, the natural Balsams, mixed with soft Things, are often of great Service; of which the following Case is an Example.—William Lumley, a Boy nine Years of Age, was admitted into St. George’s Hospital, the 6th of September 1759, for a Pain in the Bladder, and a Difficulty in making Water, which was always more or less mixed with Matter. At first there was a Suspicion of his having the Stone; but on sounding, none was to be found. From the Symptoms, it appeared as if there was an Ulcer in the Bladder near to its Neck; the Boy had a Cough, was very low, and inclined to be costive; at first he took three Spoonfuls of the Sperma Ceti Mixture four Times a-Day, and a Dose of Physic; but the Symptoms still remaining, on the 2d of October he was ordered to take a Scruple of the electuarium e spermate ceti three or four Times a Day, and to have the Gum-Arabic Decoction for his common Drink. By continuing the Use of these Things, and taking some opiate and laxative Medicines occasionally, he mended by slow Degrees, and all his Symptoms went off; and he recovered his Health and Strength, and returned Thanks for his Cure the 18th of January 1760.

The following Account of a remarkable Suppression of Urine I had in a Letter, dated the 25th of November 1757, from Mr. Pearson, one of the Surgeons to his Majesty’s Military Hospitals, who then served as a Mate.

James Ruffendal, aged Twenty, of a delicate Habit, was, in the Middle of July last, seized with a violent Pain in both Kidneys, which extended along the Ureters to the Bladder, and remained in the same Situation for about three Weeks; during which Period his Urine began to decrease in Quantity, and the voiding of it was attended with acute Pain about the Neck of the Bladder. The Secretion then totally stopt; he remained for upwards of five Weeks in the Hospital at Dorchester, and made no Water; at the End of which Time I first visited him along with Mr. Adair. He complained then of a slight Pain in his Kidneys, and told us he had a tolerable Appetite, sweated little, and voided every Day four or five Liquid Stools. He was ordered Boluses of Camphor, and sal. vol. c. cervi, and every Night a Dose of tinctura cantharidum; which he continued to take for a Fortnight without receiving the least Benefit. I then blooded him to the Quantity of ten Ounces, and gave him an Emetic of six Drachms of the vinum ipecacoanhæ, and two Ounces of the Oxymel of Squills, which operated very well; and afterwards ordered him to take one of the following Boluses every four Hours. ℞ Sapon. dur. Hispan. drachm. i. Sal. Absynth. gr. vi. Calc. Viv. gr. x. Balsam. Peruv. q. s. ut fiat Bolus. These he continued to take for twelve Days. On the Morning of the 14th of October, he was suddenly seized with an acute Pain in both Kidneys, and about Noon voided upwards of Half a Pint of straw-coloured Urine, which let fall a clay-coloured Sediment. As he was feverish, I took away twelve Ounces of Blood, and ordered him Barley-Water with Nitre for Drink. He was easy in the Night, and made upwards of two Pints of Urine, which deposited a Sediment of a gelatinous Consistence. Next Morning the Pain increased, especially in his Right Side, and ten Ounces more of Blood was taken away. This lowered the Pulse, and considerably abated the Pain. Both this and the Blood taken away the Day before threw up an inflammatory Buff. He was ordered to continue the Use of the Barley Water with Nitre, and to take three Spoonfuls of a Mixture with spiritus mindereri every two Hours. He had an easy Night, and was next Day free from Fever; but complained of an Uneasiness in his Stomach and Nausea. He was ordered a Scruple of the Powder of Ipecacoanha, which vomited him, and procured him a Stool. He was easy in the Night; but in the Morning was hot, and complained of a Pain in his Right Kidney, and all over his Bones, as he expressed it. I then gave him a Mixture, with spiritus mindereri, and the pulvis contrayerva comp. of which I desired him to take some Spoonfuls frequently. This procured him a plentiful Sweat, which removed the Fever and Pain: these Symptoms returned next Day, but were removed by the same Means. I remained at Dorchester for a Week after, and he recovered his Strength and Appetite as much as could be expected in so short a Time; but he still complained of Pain in his Right Kidney, tho’ he made Water freely. By a Letter I received from the Gentleman whose Care I left him under, I understood he had a Relapse, which he has since got the better of.

I forgot to inform you, that his Father died of the same Complaints, after being six Months without secreting a Drop of Urine; and his Brother died of the same in about ten Weeks.