Medical Sketches of the Expedition to Egypt, from India

by Sir James McGrigor

4thly, The glandular affection was the next most generally attending symptom. Not above one-half of Mr Whyte’s cases had buboes; and, in a great majority of Mr Rice’s patients, this symptom did not appear. Dr Henderson says, that, in every one of his cases, there was either inflammation or swelling of the glands. The glands most commonly affected were the femoral, next the axillary, then the parotid, submaxillary, &c. In one case of Mr Adrian, an abscess, of the size of a pigeon’s egg, formed on the inner canthus of the left eye. Mr Adrian opened it by incision, and the patient did well. Many were surprised at the rapidity with which the appearance of bubo followed the first complaint of illness: in a number of cases, within four hours. Mr Rice, on the 7th of January, admitted five cases, and in none of them were buboes later of appearing than six hours after the first feeling of illness. In a Sepoy of the 7th regiment, taken ill in December, the femoral axillary, parotid, submaxillary, and sublingual, glands were all affected. In another Sepoy of the same regiment, admitted by Mr Rice, a case of re-infection, so very much swelled were the glands about the neck, that the man died of suffocation the day on which he was admitted.

5thly. The next most generally-attending symptom was the affection of the abdomen. Mr Price says, the hepatic region was in every instance affected. Sometimes there was a swelling of the region of the liver, pain was experienced from pressure, sometimes in the epigastric, sometimes in the hypogastric, region; and almost always in the region of the liver, at which time, the pain has in some cases extended to the kidneys. Swelling of the belly was very frequent; in some cases the abdomen appeared a mass of knots. Uneasiness at the precordia, nausea, and vomiting, were frequent: the vomiting was always of bile, which was of different colours in different stages of the disease. Mr Price writes, “costiveness was a constant and obstinate symptom; and, when ten or twelve grains of calomel brought fæces down, they were always accompanied with bile; first brown, then yellow.” The urine was in general yellow; the skin and adnata frequently of the same colour. Mr O’Farrel says, “I lost one of the dragoons from the affection of his side; the fever went off some days before his death.” Mr Adrian writes, “I do not find the constipation an universal symptom, although, in many cases, I have met with it very obstinate. I was once obliged to give eighteen grains of calomel and two scruples of cathartic extract before my patient was moved.” In several cases, the disease commenced with diarrhœa or dysentery. Some of Mr Thomas’s patients died of dysentery; and this might have been said to be the cause of their death, as they recovered from the bubo, fever, and other symptoms of plague.

6thly. In the first part of the season, petechiæ, vibices, maculæ, and carbuncles, were not seen: in the middle of the season they frequently appeared.

7thly. Some gentlemen could distinguish the disease by a particular look of horror and by a particular cast of the eye, which was first watery, next blood-shot, and at last yellow.

8thly, According to the diversity of the season, the pulse varied. In general, it was small and frequent, and often, when at the wrist it was not perceptible, it could be felt beating 130 or 140 at the carotids.

9thly, The tongue was universally white at the edges; and, when in March and April, some cases appeared with the fever of the typhoid form, it was black and furred in the centre.

10thly, Several of the cases, which came under Mr Grisdale’s care in February and March, had cough and dyspnœa. Mr Adrian makes a similar report at the above period, and three of Mr Whyte’s patients at Rahamania had cough and dyspnœa.

11thly, In a majority of Mr Price’s cases, he remarked an unusual dryness of the skin, and that it was with the utmost difficulty that he could ever excite perspiration. Mr Whyte says, that, “At Rahamania the skin was dry, and that he had never succeeded in exciting sweating.”

These are the appearances the disease put on in the last season; and, on inquiry, I find that they were the appearances it assumed in the former season in the British army in Egypt.