Medical Sketches of the Expedition to Egypt, from India

by Sir James McGrigor

Though fever, as it appeared in the Indian army in Egypt, at different periods, occurred with some variation; and though particular symptoms called for occasional variation in the treatment; yet, in its general character, the disease was the same, the proximate cause appeared to be the same, and the same general indication was required to be kept in view in the cure. I am inclined to believe, that, under different names, the same fever prevails over the peninsula of India, and over the eastern islands; and, perhaps, I might venture to extend the remark to the countries between the tropics. This fever has been often well described, under the name of the remittent fever of Bengal. Dr Lind, of Windsor, several years ago, gave an excellent and concise account of it in his Thesis. In Bengal, it is known under the name of the pucca fever. In Madras and on the Coromandel coast, it is the jungle fever. At Bombay and on the Malabar coast, it is known under the same name. In the army in the Guzzerat country, to the northward of Bombay, it is this fever which has proved so destructive of late to our army in the field there, opposed to the Mahrattas. In the island of Salsette, near Bombay, it pays an annual visit, on the ceasing of the monsoon, and proves very destructive. In 1801, on one estate, in Salsette, upwards of forty people were attacked with this fever in one night. I have learned from my ingenious friend Mr Christie, surgeon-general of Ceylon, that it was from the same fever, that the 19th, 51st, and 80th regiments, have been so very much reduced; and that it was this fever which proved so destructive in the late war with the king of Candy. Mr Christie writes me, that in its destructive malignancy and ravages, particularly on the Europeans in Ceylon, it has equalled the yellow fever of the West Indies.

From many accounts of it, which I received while in India, I am convinced, that the dreadful fever which prevails in Batavia is the same disease. In Batavia, the mortality from this fever is prodigious; it is not exceeded by that from the plague in Egypt, or from the yellow fever in America. Different circumstances, it would appear, concur to the production of the disease, in a very aggravated form, in the Dutch settlement of Batavia; of which, we may mention the extreme unhealthiness of the situation, and the bad practice of the Dutch surgeons.

Dr Griffith, surgeon to the naval hospitals in India, informed me, that, when our fleet lay off Batavia, in 1801, it prevailed very much; but that, when they got the management of patients early, they were generally successful in the treatment of the disease. Bencoolen is one of the most unhealthy of our eastern settlements, solely from the prevalence of this fever. In China, it appears likewise to be a frequent and fatal disease.

Having said thus much on the identity of the fever which appeared in Egypt, with that which is seen in India, and in the eastern islands, I shall proceed to the treatment. The first step was to cleanse the primæ viæ, and some gave emetics: this, however, was not always necessary; and purging with calomel, and the neutral salts, appeared in most cases to answer the same intention. In the first stage, likewise, as particular symptoms called for them, venæsection was performed, blisters were applied, we determined to the skin, or gave opiates. However, if the fever was of any duration, the practice always was, to endeavour to affect the mouth as speedily as possible with mercury. This was the practice in continued fever, and in Egypt, as in India, we were very generally successful, if application was early made. In the destructive fever of Ceylon, Mr Christie says, that he has practised but with a moderate share of success: but that the affecting the system by mercury is by far the most successful of different modes of treatment which he had tried. He gave nitric-acid, but in a very small quantity. In the fleet, when stationed near Batavia, Dr Griffiths gave mercury more liberally than any practitioner I know. He likewise used the nitric-acid very freely, both externally and internally, and relied much on its combined use with mercury. By two very able practitioners, Dr Keir and Mr Stewart, the Salsette fever has been successfully treated by nitric-acid alone; purgatives having been previously exhibited. Some practitioners treated intermittents by bark, some by opium, or by giving this and the volatile alkali. It has sometimes occurred to myself, and I have frequently had reports from our surgeons, that agues continued obstinate till the gums could be affected by mercury.

From a very intelligent officer I had a detail, regarding the Batavia fever, so remarkable, that I shall here insert it. This gentleman is the captain of a ship in India, who, in different voyages which he had made to Batavia, had constantly lost great numbers of his ship’s crews. In his last voyage, when in a certain latitude, and as he approached Batavia, he gave daily to each of his men a few grains of the mass of the blue pill. By the time of his arrival at Batavia, he had thus very gently affected every one of their mouths; and, in that voyage, he lost not a man. Would mercury thus exhibited, as a preventive, be useful in the plague, or in the yellow fever?

Before dismissing the subject of fever I may observe that no well-marked case of typhus occurred to us in Egypt. In India we never saw a case of this species of fever. To the existence of this fever, which in Europe has committed such havoc in our fleets and armies, the climate of India is inimical. We know instances where, in transports, typhus had broke out, and, on the passage to the Cape of Good Hope or India, had proved little less destructive than the plague could have done; but the disease never reached India. If a case was landed there, it never propagated the contagion: a second case never appeared on shore. On inquiry, I found that no case had ever been known on the western side of the peninsula, nor have I ever heard of its existence in the eastern.

HEPATITIS, OR THE LIVER COMPLAINT.

In India I have often had occasion to remark, that the acute hepatitis, of Cullen, was a disease of rare occurrence. The disease which comes before us most frequently, in India, is his chronic species; and in that, most frequently, there is neither pyrexia nor the “decubitus in latus sinistrum difficilis,” which, from having included in the definition of both of his species, I suppose the illustrious and accurate professor was induced to believe was a constant symptom in this disease. In very few of his definitions is there room for alteration; and I hope, for venturing here to suggest one, that I shall not incur the charge of presumption. But hepatitis was a disease, for accounts of which the accurate nosologist must have trusted to other sources than his own observation. It should be known, that very often we meet with this disease, when few of the symptoms of his definition are found. In India I have learned from some of the oldest practitioners, and from some gentlemen of abilities, the most respectable in the profession, that very commonly hepatitis is met with when all the symptoms of Cullen’s definition are wanting. In that country, when any of the abdominal viscera are complained of, we may in general suspect some error in the hepatic system.

In India, the liver seems to be the seat of disease in nearly the same proportion that the lungs are in England.