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

by Donald Monro

When the Patient was strong, the Pulse quick and full, the Eyes looked red, and the Breathing was difficult, after the Petechiæ appeared; I took away more or less Blood before giving the Bark. Most Practitioners of late Years have been against Bleeding in this Stage of the Disorder; but trusting to the Assurances given by Dr. Hasenohrl of its being safe, nay of Advantage to bleed at this Time, if the Symptoms required it, I ventured upon it, and found it to be of the greatest Service, in many Cases, in the Hospitals at Paderborn and elsewhere; and particularly in two Cases at Bremen, and one at Osnabruck, where it gave immediate Relief, and seemed to shorten the Disease much. One of the Patients at Bremen, Robert Ellis, belonged to an Independant Company; the other, Francis Hamstan, of the 24th Regiment, had formerly had his Skull fractured, and took the Fever, while he was in the Hospital, for violent Head-achs, which he had been subject to, at times, ever after his Skull had been fractured. The Case at Osnabruck was a Nurse of the Hospital, whose Name was —— Andrews, a Woman about twenty-five Years of Age, who, after attending a Dragoon in the Small Pox, and suckling at the same time her own Child, then in the same Disorder, was, on the 18th of January 1763, attacked with a Fever. I saw her for the first time on the 20th, and found her Pulse quick, full, and strong. She complained of a violent Head-ach; for which she was blooded, and took the saline Mixture, with Nitre and Contrayerva. Next Day, the 21st, her Blood appeared very sizy, and she complained of having been costive for some Days. We gave her immediately an Ounce of the sal catharticum amarum, which operated well. She continued much in the same Way the 22d, and had some loose Stools that Day. Being still inclined to be loose the 23d, instead of her former Medicines, she was ordered the spiritus mindereri Mixture, with Mithridate. This checked the Purging, but did not stop it entirely. The Fever went on, without any remarkable Change, till the 27th; at which time the Petechiæ appeared all over her Body, attended with a Redness of the Eyes, and a violent Oppression and Pain of her Head, and a quick Pulse. I ordered six Ounces of Blood to be taken away immediately, and a large Blister to be applied to her Back, and, at the same time, ordered her a cordial Mixture, with half an Ounce of the Extract of the Bark in it, to be taken every twenty-four Hours. The 28th, her Pulse was not so hard, her Head was much easier, the Redness of her Eyes was much less, and the Petechiæ had begun to die away. The Blood which was taken away the Day before, had a thin Buff at the Top, but the Crassamentum underneath was of a dark Colour, and of a loose Texture: p. On the 29th, she told me that she had had two or three loose Stools, and she was lower than the Day before; and therefore a Drachm of Mithridate, and two Drachms of the Tincture of Cinnamon, were added to her cordial Mixture, with the Cortex; and she was allowed half a Pint of Red Wine, mulled with Cinnamon, per Day. 30th, Her Tongue rather moister than the Day before; and she not so low, but she was still inclined to be loose; and therefore was ordered the anodyne Draught at Nights, and to continue the other Medicines. 31st, She was still inclined to be loose; but her Pulse kept up, her Tongue was moister, and she found herself pretty easy: p. Feb. 1st, Her Pulse pretty strong, and she found herself much cooler, and freer from the Fever, and complained of a Dullness of Hearing. On the 2d, in the Morning, she felt a warm Moisture all over her Skin, which, about Noon, broke out into a profuse Sweat, and continued till the 4th; when it went off, and her Urine let fall a copious whitish Sediment. She had then little or no Fever. The Dullness of Hearing still continued, though it was much less than before. After this the Deafness went gradually away. She continued the Use of the cordial Mixture, with the Cortex, till the 12th, and recovered Strength daily. After this, she had no other Medicine, except two Doses of the Tincture of Rhubarb, and was soon in good Health, and able to discharge her Duty as a Nurse.

However, it ought to be observed, that we must not bleed so freely, in this or any other Stage of the Malignant Fever, as in acute inflammatory Disorders, otherwise we shall sink the Patient, and hurry him to his Grave; and that Bleeding can only take place with Safety and Advantage, under the Circumstances above-mentioned, immediately before giving the Bark freely; or where some accidental sharp Pain in the Breast, or Bowels, or some other violent Symptom, may require it. They err equally, who recommend Bleeding freely in this Fever, with those who entirely forbid its Use.

Although we found the Bark to be in general the best Remedy in this malignant Petechial Fever, yet it did not answer in every Case; for in some we found other Remedies had a better Effect: And therefore, when we observed that, notwithstanding the Use of the Bark, the Patient sunk, and the Symptoms grew worse, we did not persist obstinately in its Use, but tried the Effect of other Medicines.

Towards the End of May 1761, two Soldiers in the Hospital, at Osnabruck, were taken ill of this Fever; who, after using the Bark freely, and being allowed a Pint of Red Wine per Day, for some Days together, began to sink, and had a Delirium and other bad Symptoms hastening on: upon which I laid aside the Use of the Bark, and ordered each of them a Blister to the Back, and to take a cordial Draught, with fifteen Grains of Musk in it, every four Hours; and to have their Wine mulled with Cinnamon; and although at that Time they were both so low that I scarce imagined they would live twenty-four Hours, yet next Day I found them greatly mended; and they had a kindly warm Moisture all over their Skin, and the Pulse had rose considerably in both. By the Continuance of the same Medicine the feverish Symptoms gradually abated, and they both got well.

About the same time, having given the Bark freely for some Days, and applied a Blister, to another Patient, after the Petechiæ had appeared, I found him one Morning so low that his Pulse could scarce be felt. He could not speak; he had a Delirium, and rather a Tremor than a subsultus tendinum, and he had all the Appearance of a dying Man. However, as he still swallowed whatever was put in his Mouth, I changed the Bark Mixture for Draughts, which contained a Scruple of the confectio cardiaca, and seven Grains of the sal vol. corn. cerv.[13] each, and ordered one to be given immediately, and afterwards to be repeated every four Hours; and, in the Intervals, to give him frequently a Tea-cup full of Red Wine, mulled with Cinnamon; and to apply two large Blisters to his Legs. Next Day, his Pulse had rose; and by the Continuance of the same Remedies it became gradually fuller and stronger, and the third Day after he recovered his Voice; and a warm kindly Moisture which ended in a profuse Sweat coming on, the feverish Symptoms went off soon after, and he recovered his Health.

At Bremen there were two Men, one in January, and the other in February 1762, on whom the Cortex had but little Effect, who recovered by the free Use of Mixtures, with the confectio cardiaca and rad. serpentariæ, and of Wine, with the Application of large Blisters. Several Cases of this kind occurred in the Hospitals, where the Bark did not answer.

There is one thing to be observed with respect to Malignant Fevers, which is, that if ever they appear in large crowded Hospitals, unless we can thin the Wards, and procure a free Circulation of Air, and keep the Hospital and Sick extremely clean, the Fevers will continue to spread, and great Numbers will die; and even the most efficacious Remedies will have little or no Effect. And that when once the Infection is grown strong, it requires the greatest Care, and some Time, before it can be entirely got the better of. And that if a great number of Men, ill of this Fever, be kept in the same Ward, they will help to keep up the Infection; and therefore it is always proper, when it can possibly be done, to lay but a few of them in one Ward; not above one-third of the Number generally admitted.

Many of the Patients, towards the Height of this Fever, sooner or later, had a Purging, which seldom proved critical; and some were seized with the Flux. A gentle diarrhœa, such as did not sink the Patient, was commonly of Service; but when violent, or a Dysentery came on, the Case was always dangerous; for whatever stopped the Flux increased the Fever; and, if the Purging or Flux continued, it sunk the Patient. Such Fluxes we treated in the Manner to be mentioned afterwards, when we come to the History of the Dysentery.

In this Fever, it was common for Patients to vomit Worms[14], or to pass them by Stool, or, what was more frequent, to have them come up into their Throat and Mouth, or sometimes into their Nostrils, while they were asleep in Bed, and to pull them out with their Fingers. The same Thing happened to most of the British Soldiers, brought to the Hospitals for other feverish Disorders as well as this. Dr. Pringle[15] when he mentions Worms being observed in this Fever, seems to embrace Lancisius’s Opinion; and believes that these Worms are not the Cause of the Fever; but being lodged in the Intestines, before the Fever comes on, they are annoyed by the Increase of the Heat, and the Corruption of the Humours, in the Cavity of the Intestines of Persons labouring under Fevers, especially of the putrid Kind; and so they begin to move and struggle to get out. This seemed evidently to be the Case with many of the Patients we had; though in some the Worms seemed to have given Rise to the Fever, which the bad State of the Patient’s Humours, or the infected Air of Hospitals, determined to be of this Kind. In many, the Fever lessened, or went off entirely, soon after; and they were no more affected with Symptoms of Worms. But some notwithstanding were subject to frequent Sickness, Pain of the Stomach, and Uneasiness in the Bowels, and discharged some Worms from Time to Time. Others had frequent Relapses into Fevers, which seemed to be owing to the Irritation of these Insects.

It is no Wonder that Worms of the round Kind should be productive of troublesome Symptoms, and occasion these Relapses; since we know that they have sometimes perforated the Intestines, and been found in the Cavity of the Abdomen[16].