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

by Donald Monro

Many, while recovering from this Fever, were seized with an Ophthalmia, or Inflammation of the Eye; for the most part of one Eye only, sometimes of both. When the Patients were strong, they were blooded, and had Blisters applied behind the Ears; and sometimes, where the Pain was great, had Poultices of Bread and Milk applied to the inflamed Eye; which, with the Assistance of some cooling Physick, commonly removed this Complaint; tho’ in some obstinate Cases we were obliged to repeat the Evacuations, to apply Leeches to the Temples; and after the acute State of the Disorder was passed, to order the Eye to be washed frequently with the Collyrium vitriolicum, or Collyrium Saturninum, before we got the better of this Complaint. However, it ought to be observed, that if these astringent Collyria were used too soon, they did hurt. When these Ophthalmias were neglected in the Beginning, the Inflammation frequently rose to a great Height, and left an Obscurity or Philm over the Cornea, which remained an Impediment to the Sight not to be removed.

Towards the Decline of these Fevers, and very often during the Course of them, many complained of Pains in their Feet and Toes, which sometimes ended in Mortifications, especially where the Patients lay in very cold Wards. For the most Part, the Mortification extended no further than the Ends of the Toes, tho’ in some it spread over the Feet, and in two or three advanced up the Leg. Several lost one or more Toes; and in February 1761, one Man lost Half of each Foot; another lost both Feet, and Part of each Leg. Both got the better of the Fever, tho’ the Man who lost both Feet languished a long time afterwards. These Pains of the Feet and Toes, and the Mortifications which followed, were for the most part owing to the Patients being exposed to too much Cold while they were very weak, the Circulation languid, and the Juices vitiated by a putrid Distemper; by which means the Vessels were rendered incapable of carrying on the Circulation in their extreme Branches[23].

As soon as the Sick began to complain of these Pains of the Toes and Feet, I found the best Remedy to be, the Bathing of the Feet in warm Water, or in warm aromatic Fomentations; and, after keeping the Feet for some time in these warm Liquors, to dry them well, and then rub them with the linimentum saponaceum, or linimentum volatile, and wrap them up in Flannel. And if ever any Lividness or Redness appeared on the Parts, we gave plentifully of the Cortex and Cordials, if not contra-indicated by the other Symptoms. When Vesicles arose on the Part, and a Gangrene formed, we directed the Parts to be scarified, and proper Dressings to be applied, while warm aromatic Fomentations and Cataplasms were used.

In January 1762, one Patient, ill of the Petechial Fever at Bremen, had a Lividness and Blackness, threatning a Mortification, which appeared at the End of his Nose. I expected for some Days, that, if he recovered, he would lose Part of his Nose; but, by giving him large and repeated Doses of the cortex and confectio cardiaca, in a Mindereri Mixture, and allowing him the free Use of Wine, its further Progress was prevented; and as the Patient got clear of the Fever, the Nose recovered its natural Colour, and only the scarf Skin peeled off from the End of it.

When the Fever continued long, and reduced the Patients low, it was very common for the Back, and Parts on which the Weight of the Body rested, to mortify. As soon as any thing of this Kind was observed, we ordered such Parts to be covered with proper Dressings, and gave the Bark and Cordials freely; and took care to make the Patient change his Posture; and by Pillows prevented as much as possible the Weight of the Body from resting on that Part. By this Treatment, many recovered, where the Fever was on the Decline, and the Strength not too much exhausted; even tho’ a very large Surface of the Skin had mortified; but where the Patients were very low, and the Fever still continued, or where it was complicated with a Flux, which kept them perpetually nasty, and exhausted the Strength, it generally proved fatal.

Patients, who were reduced very low by this Fever, or by repeated Relapses, were subject to oedematous Swellings; especially of the Feet, towards the Evening, after sitting up all the Day. These Swellings generally went away as the Sick recovered their Strength; but in some Cases they continued obstinate, and ascended towards the Thighs; and in some spread all over the Body, and terminated in an universal Anasarca.

When these Swellings were recent, and confined to the Feet and Legs, commonly the Bark joined to the lixivial Salts, or the Oxymel of Squills, or other Diuretics, and a Purgative once or twice a Week, removed them. In some, an Infusion of Horse-radish had a good Effect; in others, Sweats brought out by means of Dover’s Powder, or of the guttæ antimoniales anodynæ.

Sometimes these Swellings were very obstinate, and resisted the Force of all internal Remedies. In such Cases, Punctures made in the Feet, or lower Part of the Legs, which furnished a Drain for the Water, had a good Effect. Blisters applied to the Legs were of Service to some. When the Punctures were made, or the Blisters applied, before the Patient’s Strength was exhausted, provided that he laboured under no other Disorder but these oedematous Swellings, which proceeded from Weakness, I never observed any bad Effects from them; tho’ I used them both repeatedly in a Variety of Cases. But if the Patient was very weak; or had a Hectic Fever or Purging; or other Disorders, and the oedematous Swellings large; then oftentimes the great Discharge exhausted his Strength, and a Gangrene and Death were the Consequence.

One of the most remarkable Instances of the good Effects of Blisters, was in the Case of a Soldier at Paderborn; Thomas Hope, of the Second Regiment of Foot Guards, after a Fever of this Kind, was swelled all over, especially about the Face and Neck, and had a Difficulty of Breathing: after having tried Variety of Medicines for this Complaint, without any Effect, he had a large Blister applied to his Back, and took the Cortex in a Mixture, with the Oxymel of Squills. As soon as the Blister began to discharge, the Swellings decreased; and were afterwards entirely removed by the Help of one or two Doses of Physic, and the continued Use of the Medicines before prescribed. Three other Men in the Hospital at Osnabruck, in May 1761, having oedematous Swellings of the Feet and Legs, which yielded to no internal Remedies, had Blisters applied to their Legs, used the Cortex, with the lixivial Salts, two or three Times a Day, and a Purge every fourth Day; which removed the Swellings in a short Time.

Some of the Soldiers, who had repeated Hospital Fevers, had their Blood so much broke down, as to be subject to profuse Hæmorrhages from the Nose; and some of them passed Blood likewise by Stool; which reduced them to a very low State, sometimes attended with imminent Danger. In such Cases we found nothing to answer so well as to give freely of the Bark; to acidulate their Drinks with the spiritus vitrioli; to allow them as much Red Wine as the Strength and present Circumstances could bear; and at the same Time to support the Patient’s Strength by a mild Diet, of light Digestion; as Water or Rice Gruel, Panado, weak Broth, and the like. When there was a Tendency to a Diarrhœa, we were obliged to add some of the electuarium diascordii to the Cortex, and frequently to give an Opiate in the Evening. One Case, where this Method of Cure had a very remarkable good Effect, I had under my Care at Paderborn. A Soldier who lay in one of the lower Wards of the Jesuits Hospital, after a Malignant Fever, attended with a Flux, used to bleed at the Nose, to four, five, or six Ounces at a Time; and once or twice lost near a Pint of Blood, of a dark Colour, very thin and watery, and of so loose a Texture, that the grumous Part scarcely coagulated. This Evacuation brought him so low, that he could scarce turn himself in Bed; and his Pulse might be said rather to flutter than beat: By the continued Use of the Bark, and of Cordials, and Drinks acidulated with spiritus vitrioli, and some Spoonfulls of mulled Red Wine every two or three Hours, he was restored to Health and Strength. The only Accident which happened during the Cure, was a Threatening of a Looseness, and the Return of his Flux; which however was stopt by a Dose of the tinctura rhei; by joining some of the electuarium diascordii with the Bark, and giving an Opiate in the Evening.