We have now arrived at the last part of
these Sketches; where it is intended to
offer some account of the diseases which
we met with in Egypt.
The catalogue of military diseases is
never extensive. If his peculiar way of
life exposes the soldier more to some
distempers, it entirely exempts him from
many others. In an Indian army the diseases
are even fewer than in any other; at
the same time, that the practice of medicine
is more simple. I am of opinion,
that in India the practitioner goes on surer
ground than in Europe, partly for the
above reason, and partly from the causes
of disease being less varied in that country.
Though the diseases which occurred
in the Indian army, when in Egypt, were
not numerous, yet some of them were
highly important, and on our arrival in
Egypt were new to every one of the medical
gentlemen, excepting Mr Bellars,
of the 86th regiment, who had treated a
few cases of the plague, which occurred
in a detachment of that regiment acting
with the Vizier’s army, and had himself
suffered from the ophthalmia of Egypt.
I propose to include every thing that I
have to offer on this part under two heads.
Under the first, I shall notice two diseases
which may be termed the endemics of
Egypt, viz. the plague and the ophthalmia
of that country.
Under the second, the other diseases
which prevailed will be noticed. They are
mostly tropical diseases; and with them the
reader will not be long detained.
I begin with the plague; a disease of
which accounts have been handed down
to us from the earliest ages of history or
of physic. The consideration of it is important,
not only on account of its frequent
and fatal occurrence, but, as being, perhaps,
the most formidable disease that the
art of physic has to encounter. On this
subject, however, much will not be expected
from me. Of no disease have we a
more clear, accurate, and complete, history
than of this, in Dr Russel’s work on the
plague. In Egypt, we often had recourse
to this work, and we readily acknowledge
our obligations to the venerable and learned
author.
Though since the time that Dr Russel
gave his ample history of the plague in
Syria, we have had several accounts of
this disease as it appeared in other countries;
yet much has not been added to
our stock of information, and little of improvement
has been made in the practice.
The proper and well-timed use of mercury,
and, perhaps still more, the application
of the newly-discovered remedies analogous
in their effects to the calces of that
mineral, hold out a prospect of success
the most encouraging.
In Europe, but more particularly in
Britain, much of the dread, and much of
the real danger, that attended the most
fatal diseases in this country are now done
away, by the late improvements in medicine,
and in chemistry.
The time was, when fever, when it broke
out in different parts of England, proved
little less fatal to whole villages and towns
than the plague does in the countries where
it resides. From the improved practice of
the treatment of fever, but more from
our knowledge of the means of destroying
contagion and preventing its spreading, the
mortality from this class of diseases is now
comparatively small.
The small-pox, that plague which once
carried off so great a proportion of the
population of Europe, now bids fair to be
expunged from the catalogue of diseases.
May we not indulge a hope, that, as
the intercourse of civilized Europe, with
the countries of which the plague is now
the scourge, becomes more regular and
intimate, we may be enabled to extend to
them our discoveries and improvements,
and so direct them to the means of divesting
the plague of its terrors, and reducing
the mortality from it to the scale
of that of fever and the small-pox in Europe?
Egypt has been called the cradle of the
sciences. From this we acknowledge, that
the arts were derived to Greece, and subsequently
to every part of the world. It
would surely be the noblest gratification,
if in return, at this period, Europe, by extending
her benefits and improvements to
Egypt and to Greece, could free them from
the most cruel scourge of countries, once
the most civilized and polished in the
world. It would in some measure compensate
and console them for the low
state of degradation into which they have
fallen.
All that I have to say of the plague
will tend to diminish the dread which has
hitherto been entertained of it.
A formidable disease undoubtedly it is;
but, when we hear how much of the population
of Persia, Arabia, Turkey, Syria,
Egypt, and Barbary, is now and then swept
off, all must not be laid to the account
of the plague, as if its ravages admitted
of no remedy. The experience of the
French and English, in Egypt, will now
convince Europe, that much of the vast
mortality, in the above countries, is to be
ascribed to the gross ignorance in which
they are immersed.
Were typhus, our jail or hospital fever,
to be imported into a town of Egypt, we
can hardly conceive how it could ever be
eradicated by the natives. Whenever the
small-pox does appear in that country, it
proves a dreadfully-destructive disease.
The structure of their houses and plans of
their streets are calculated for the production
of disease, and the preservation and
concentration of contagion.
It is a matter of no little consolation to
us, that we know the means, not only of
excluding the plague from our own country,
but that, when our armies are stationed
in the countries where the disease is
endemic, we can arrest the progress of
the contagion, and with certainty eradicate
it.
The plague made its first appearance, in
the army from India, in the middle of
September, 1801. From its early appearance
the natives were very much alarmed,
and prophesied a dreadful season of plague.
They have observed, that, when it breaks
out before December, they have always a
generally-prevailing and a very destructive
disease.
The number of cases which appeared
in the Indian army, from the 15th of
September, 1801, to the 15th of June,
1802, is seen in an accompanying table.
After the plague broke out, the disease
was for a long time confined to Rosetta;
it was otherwise in the former season.
Soon after the British army effected their
landing at Aboukir, in March, 1801, they
were attacked with the plague, though the
season was then on the decline. In the
beginning of the year, the disease had
prevailed very generally over the whole
country, and the loss arising from thence, to
the French, was considerable. It continued
to spread in the British army till May, during
which month few cases appeared; but
none I believe in June.
Though the contagion is seldom or never,
I believe, out of the country, the natives
of Egypt denominate the season of plague
from November or December of one year,
to June of the year following; they observe,
that the disease constantly stops at
the period of the summer solstice.
I have said, that, during the season ending
in June, 1801, the disease prevailed
very generally in Egypt; Rosetta, however,
was an exception; if any case did occur
there it was concealed.
At Cairo, Alexandria, and Damietta; at
Suez, in the villages, and in Upper Egypt;
it proved very fatal: at Siout, at Girgé,
and in general throughout the towns and
villages in Upper Egypt, we saw continued
marks of its desolation, and heard many
dismal accounts of its ravages.
The reason of the plague first appearing
in, and afterwards being confined only
to, Rosetta, in the last season, was, that it
was the only open port to which vessels from
Turkey and Greece resorted; and that
from some of these, no doubt, the disease
was imported.
In the pest-houses of the army, thirteen
medical gentlemen did duty, who in the
Indian army might be said to have had the
post of honour. They were, Mr Thomas,
Mr Price, Mr Rice, Dr Whyte, Mr Grysadale,
Mr Adrian, Mr O’Farrel, Mr Whyte,
Mr Dyson, Mr Angle, Mr Moss, Dr Buchan,[4]
and Dr Henderson. Besides these,
Mr Cloran was in charge of the cases
under observation, and Mr Bell of cases
under quarantine. Mr Blackwell, surgeon
on the staff of the English army, acted
as inspecting surgeon to the Board of
Health. He visited every case in the first
instance, and, as he judged it necessary,
sent them to the quarantine, to the observation-ground,
or to the pest-house: to
Mr Blackwell’s unceasing attention and discriminating
knowledge of the pestilential
symptoms, we owed no small share of our
safety in Alexandria.
Besides the above gentlemen, we had
two Greeks, the barber-doctors usually employed
in Egypt, who visited the inhabitants,
and before interment narrowly examined
every body. These two made a
daily report to the Board of Health of
the number of deaths and of their inspection
of the bodies; they likewise did
other duties under Mr Blackwell.
In order to take from our medical
gentlemen, in the pest-houses, some of the
most dangerous part of the duty, it was
my wish to procure some of the Greek
doctors of the country to reside in the
pest-houses, to feel the pulses there, draw
blood, open and dress buboes, &c. The
most diligent search was made for those
people, and very high pay was promised
to them, but we could tempt none of them
to live in our pest-houses: a plain proof
of the opinion which they entertain of
the contagious nature of the disease.
The thirteen gentlemen first mentioned,
were those only that were directly in the
way of contagion, for, it became their
duty to come into contact with the infected,
and seven of them caught the infection,
and four died.
To the atmosphere of the disease all the
medical gentlemen of the army were exposed,
as they saw and examined the cases
in the first instance; but, except from
actual contact, there never appeared to be
any danger.
The sketch which I mean to give of
the plague, I draw principally from the
reports made to me by the surgeons of
the army, and from a pretty voluminous
correspondence with the gentlemen whose
names have been already mentioned. From
my own experience I hardly can venture
to speak: it was very limited. Though I
saw a great many cases, in the first stage
of the disease, the number of cases which
I treated throughout was very small; they
were the cases which first appeared in
the army, and my success in them leaves
me little to boast of.
The reports and statements of the different
gentlemen I have compared together,
and endeavoured to reconcile them by
what I myself saw of many of the cases.
I have generally given the names of
the gentlemen by whom the different
facts are related: I have always done this
where the reports of two gentlemen disagreed.
From the sources of which I am possessed,
I think I can bring forward some
new facts regarding the disease, particularly
in the treatment. It is much to be
regretted, that no traveller, acquainted with
the modern practice with mercury and
the analogous remedies, ever resided in
the countries where this disease is endemic.
In one circumstance, there is a very
generally-prevailing opinion in regard to
the plague, viz. that extremes of both heat
and cold stop the progress of the contagion.
If this be true, in regard to heat, it did
not appear to be so in the army in Egypt
in regard to cold.
The period at which the plague raged
the most was in the coldest months.
It would appear, that, in different countries
and in different seasons in the same
countries, the plague assumes very different
appearances. The plague is seen as
varied in its appearance as the different
fevers described by Sydenham to prevail
in different years, and under different
constitutions of the air, in England.
Our knowledge of this fact enables us
to reconcile the different or opposite accounts
given of the disease, and of its
treatment by different writers.
In the Indian army, when the disease
first broke out, the cases sent from the
crowded hospitals of the 61st and 88th
regiments, were from the commencement
attended with the typhoid or low symptoms.
The cases sent from the Bengal volunteer
battalion, and from the other corps,
when the army was encamped near the
marshy ground at El Hammed, were all
of the intermittent or remittent type.
The cases which occurred, in the cold
rainy months of December and January,
had much of the inflammatory diathesis.
Mr A. Whyte remarked, that every case
admitted into the hospital, at Rahamania,
had the symptoms of pneumonia.
In the end of the season, at Cairo,
Ghiza, Boulac, and on crossing the isthmus
of Suez, the disease wore the form of a
mild continued fever.
The resemblance which some cases
shewn and of others described to me bore
to the West-Indian fever struck me very
forcibly.
I know not that I can better describe
the disease, than by a short statement of
the cases of some of the medical gentlemen
who had the disease; most of whom
wrote me accurately every thing that they
felt. Dr Whyte entered the pest-house at
El Hammed on the evening of the 2d of
January, 1802. In a letter of that date
he writes to me, “I just now inoculated
myself, by friction, with bubonic matter
on the left thigh;” on the 3d, he says, “I
have this morning inoculated myself by
incision on the right fore-arm.” Mr Rice,
then doing duty in the pest-house at El
Hammed, gives the whole of the case. In
a letter on the 3d of January, he writes
to me, “Dr Whyte came here last night;
soon after he came in, he rubbed some
matter from the bubo of a woman on the
inside of his thighs. The next morning,
he inoculated himself in the wrist with a
lancet, with matter taken from the running
bubo of a Sepoy; he appears now
very well.”
In subsequent letters, Mr Rice says,
“that Dr Whyte continued in good health
on the 5th, and all day on the 6th, till
the evening, when he was attacked with
rigors and other febrile symptoms. He said
himself that it was the attack of an intermittent;
and it bore a great resemblance
to it. After sweating profusely, he was
better in the morning of the 7th, but in
the afternoon the shivering returned; and,
after it had continued 30 minutes, a severe
hot stage came on, then a profuse sweating
followed, but with it much affection
of the head, tremor of the limbs, particularly
of the upper extremities, tongue
black and dry, skin hot, pulse full, hard,
and irregular, thirst great, prostration of
strength, and anxiety. The head was the
only place that he complained of, and it
seemed to be the principal seat of his disease;
he still persisted that the disease was
not the plague; he would not allow his
groin or arm-pits to be examined, and he
refused all medical assistance.” He asked
for a purgative, which Mr Rice gave him,
and he requested to be bled, this Mr
Rice thought the state of the symptoms
would not justify him in doing. On the
8th, these symptoms continued, and there
was some delirium; he begged to be removed
from the pest-house at El Hammed,
to the old pest-house at Rosetta,
under the charge of Arabs. He was removed
on the morning of the 9th, and
died in the afternoon of that day very
delirious.
2d, Mr Price did duty in the pest-house
at Rosetta and at El Hammed from
the beginning of November, 1801, and
had a tertian which he never could completely
remove. In the pest-house at El
Hammed, he was in the evening of the
1st of January attacked with rigors and
slight febrile symptoms; but he himself
thought this was only an attack of his
intermittent, he soon however felt an affection
of his head, and tremor of his
limbs, and knew his disease. On the
morning of the 2d, three buboes appeared,
two femoral and one axillary; he
then became delirious, and had no recollection
of any thing for several days. On
the 5th, there was a remission of the fever.
He was able, on the 7th, to write
me, “that he had no fever, that one
bubo was coming on, and that he was
extremely debilitated.” On the 13th Mr
Rice opened his bubo; but it was two
months after this before he recovered.
I am sorry I cannot find a letter where
the treatment of Mr Price is detailed; but
I am pretty clear that it was by mercury,
as this was his own practice at the
time.
3d, Mr O’Farrel entered the pest-house
at Aboukir on the 8th of March. He
continued well and did his duty there
till the 3d of April; in the evening of that
day, when he had rigors, which he himself
attributed to cold, and says, “that sudorifics
nearly cured him.” He was obstinately
costive, for which he took several drastic
purgatives: the rigors successively returned
in the evenings of the 5th and 6th, and
he continued taking antimonial powder.
On the night of the 6th, he was attacked
with giddiness, irritability of stomach, and
low fever. Mr Dyson wrote to me, that, on
the morning of the 6th, he was delirious,
that he had applied a blister to his head;
but that he could not get him to swallow
any medicine: he expired on the morning
of the 7th. No bubo appeared till
the day before his death.
4th, Mr Dyson went to assist Mr O’Farrel,
at Aboukir, on the 1st of April. On the
evening, of the 5th, he was attacked with
lassitude, and, on feeling his groin, he
writes to me, “I discovered some inflammation
of the glands.” After this the
succession of symptoms in Mr Dyson was
nearly what has been described in Dr
Whyte’s case. The fever continued for
several days, and became intermittent, one
bubo came to suppuration. He obstinately
refused every medicine but calomel, which
he took as a purgative, but it never salivated
him. Constant nausea and vomiting
were symptoms with him from the
second day of his illness, and he was a
long time before he recovered.
5th, Mr Thomas, after being three weeks
in the pest-house at Rosetta, attending the
first plague-cases which came from the
88th regiment, while walking in the garden
of the establishment, laid his hand on his
groin by accident, and was alarmed to find
a large swelling on one side. He soon
after felt some giddiness and fell down;
as soon as he recovered, he rubbed in
mercurial ointment in great quantity, and
every hour took as much calomel with
opium as his stomach could bear. His
gums were very quickly affected, his bubo
came to suppuration, and, in three weeks,
he was quite well.
6th, Mr Angle, after being about a month
in the lazaretto at Alexandria, was attacked
with fever and bubo. The bubo never
could be brought forward, and he died of
the disease on the 14th day. I have no
notes of the treatment of this case nor
that of Mr Moss; who, after having been
about the same time on duty at the lazaretto
of Alexandria, caught the infection.
He likewise lived several days, and his
bubo could never be brought forward.
It is useless to detail more cases, though
I am in possession of many accurately
related by several gentlemen. Nor do I
mean to offer any comment on the
above.
As particularly prominent and remarkable,
I cannot, however, without some notice,
pass over three cases where mercury,
early and liberally exhibited, had very remarkable
effects.
I received several accounts of the good
effects of mercury from the gentlemen in
the pest-houses, but none so remarkable
as the following:—In the beginning of
the season, on the breaking out of the
disease in the crowded hospital of the
88th regiment; every man in the hospital
was examined at different periods of the
day, and thus the disease was detected on
its very first appearance. At this time, I
gave to each of three of the men, placed
in the observation-ward of the hospital,
(of whom Littlejohn and Egan have already
been mentioned,) two grains of calomel,
and the sixth of a grain of opium
every hour, and made them rub into the
inside of the legs, thighs, arms, and neck,
half an ounce of the strong mercurial
ointment three times a day. I, at the
same time, made them take each half
an ounce of nitric acid diluted in their
drink during the day, and put their feet
and hands, three times during the day,
into a strong nitric bath. In about twenty-four
hours, their mouths became severely
affected, a tenderness in their arm-pits and
groins went off, and the severest febrile
symptoms yielded. The men were, however,
extremely debilitated, and remained a
very long time convalescent. During their
convalescence, I thought it prudent to
keep them in quarantine, being fully convinced,
that they had had an attack of
the plague, the progress of which had been
arrested, and the disease cut short by the
above treatment.
Corporal Francis, as already mentioned,
was suddenly attacked with giddiness after
coming off from duty as corporal of the
guard in the pest-house. In the very
commencement of the disease, on the first
feeling of illness, he was brought to Mr
Price, who instantly admitted him and immediately
exhibited mercury, and as soon
as the gums became affected, the febrile
symptoms vanished. He remained some
time in the hospital, on account of a bubo,
which came to suppuration; but
Francis suffered very little. He was never
more than two days confined to bed,
though the case occurred at a time when
the disease was very violent.
The case of Peter the interpreter strongly
evinces the success of the mercurial
treatment. To this case, the mercurial
pills and ointment were given; and he was,
in every respect, treated as a case of syphilis
and was speedily cured.
In the cases related, there appeared some
facts as to the time the matter of the pestilential
contagion takes before it comes into
action. Other facts shew, that, in different
people, and under different circumstances,
there is the greatest variety in this. The
lazaretto at Alexandria was infected by the
admission of an Italian merchant, and the
guard there, consisting of 14 men, caught
the disease, but were attacked on different
days. The provost’s guard and his prisoners
at Alexandria caught the infection from a
deserter confined among them, and the
disease among these people appeared at
very different periods.
Mr Rice relates two cases on this part
of the subject, which appear worthy of
detail: he says, “we have had proofs, that
the pestilential virus remains a considerable
time in the habit, without exerting
its influence or shewing its virulence. A
striking case occurred lately: a Sepoy
was sent to the pest-house from the hospital
of the 7th regiment with plague;
his wife could not be prevented from accompanying
him, where she attended and
nursed him. The Sepoy died, and the
woman was ordered into quarantine; however,
she escaped, and after some days
search she was discovered near the regimental
hospital of the 7th. As this woman
had the greatest reluctance to going
to quarantine, a centinel was put over her
in the hut where she was, and all communication
with her was stopped: she continued
in good health till the tenth day
after her escape from the pest-house; in
the afternoon of this day, she was attacked
with fever, in a few hours after, the
inguinal glands became painful, and she
was carried to the pest-house at El Hammed.”
“Another case bore a great affinity to
the above: a Sepoy came into the pest-house
to attend his wife: the man was
sent into quarantine, and he continued
well there, till the seventeenth day, on
which plague-symptoms appeared, and he
was sent to the pest-house.”
Of the symptoms of the plague, fever,
though not always present, seemed the
most constant.
At the end of the season, at Cairo, at
Ghiza, and at Suez, cases appeared without
any observable fever. When it did
appear, as already noticed, the type at
different seasons, and in different parts of
Egypt, was very various. At the pest-house
at Rosetta and El Hammed, many of the
cases, admitted from October to January,
had the accompanying fever intermittent
and of the quotidian type. This I believe
to be a new fact in the history of the
disease. For some time in January, February,
and in some part of March, the fever
had regular remissions. After this
period, it generally appeared of the typhus
form at Aboukir, except in the detachment
of the 26th Light Dragoons, all of
whom were young healthy men, and in
them Mr O’Farrel observed, “that there
was much re-action, and that the delirium
was of the kind denominated phrenitis.”
At the pest-house, at Rahaminia, Mr
Whyte observed, that all his patients had
pluritic complaints.
The second symptom in order was the
tremor of the limbs. Mr Price says, “that
bubo and pyrexia are not so essential
parts of the diagnosis, as tremor of the
upper extremities,” and
3dly, The affection of the head, which
was sometimes phrenitis, and sometimes
typhomania. In a great majority of Mr
Price’s, Mr Rice’s, and Mr Whyte’s, cases
there was much nervous affection; in one,
the risus sardonicus. Mr Adrian says, the
nervous affection, in many cases, was very
remarkable; in several cases, it resembled
the description, given by authors, of that
nervous affection produced by the bites of
mad or poisonous animals, an almost universal
tremor.
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.
My friend, Dr Short, who resided some
time in Persia, and who has paid much
attention to the history of the plague, informed
me, that, in addition to the above,
he found hemorrhage a frequent symptom
in the plague, which raged at Bagdad in
1800 and 1801.
In one case he saw a copious hemorrhage
from the eyes, which continued for
nearly twelve hours. As soon as it stopped,
an eruption appeared over the body
very much resembling the measles. This
patient, a boy of twelve years old, died on
the 5th day of the disease.
The duration of the disease in different
persons was very different. In several instances,
the effect of the pestilential contagion
was the immediate extinction of
life; and we had several instances of the
patient surviving but a few hours the first
sensation of illness.
The muccadum of the dooley-bearers
of the 88th regiment, about nine in the
morning, exhibited the symptoms of fever.
About twelve, a bubo appeared, and
he died before four o’clock. In some
instances, again, the patient lived till the
thirteenth and seventeenth day of the
disease; however, these instances were
rare.
Prognosis. We found that the greatest
caution was requisite in giving an opinion
as to the probable event of cases: in no
disease was the practitioner oftener deceived.
In several instances, patients who
had recovered from the fever, whose buboes
were doing well, and people who
were convalescent, suddenly dropped down
and expired. Whether this was from re-infection,
or whether it was a feature of the
disease; will be difficult to determine.
On the 24th of December, one of the
Arab servants, convalescent from the disease,
and who had been convalescent for eight
days, taking bark, while smoking his pipe
suddenly expired. In no disease do patients
bear motion worse than in this.
The least motion[5] induced syncope or
death.
Sometimes, they who had for some time
been convalescent, suddenly complained that
they felt giddy, and expired. Sometimes
they called for food, and expired with it
in their mouths. In one of Mr Adrian’s
cases, where the fever had for some time
been gone, and the patient was so far
convalescent that he daily walked about
a quarter of a mile, the man suddenly
complained of giddiness, and expired in
ten minutes.
Mr Thomas had two cases where, after
affecting their gums, there was a complete
apyrexia: but he lost his patients from an
immense discharge from the glands and
from a secondary fever. In general, it
was found, that the patient recovered in
proportion to the facility with which his
gums and skin could be affected.
The prognosis likewise depended much
on the degree of the affection of the sensorium;
when the patient was from the
beginning comatose, the case terminated
fatally. Several of the cases in the beginning
of the season, particularly the natives
of India, could never be roused. The typhomania
was a more fatal delirium than
the inflammatory species.
In the treatment of this disease, a variety
of modes were put in practice; but
so little success attended them, that some
were inclined to despair of success from
any. Though, with it, even many were
lost, yet oxygenation and particularly the
use of mercury had the most success.
Though every thing was done by General
Baird that the situation and circumstances
allowed, yet the gentlemen in the
pest-houses laboured under so many disadvantages,
that, for the most part, there was
but little to be expected from any mode
of treatment. In particular, not a little
difficulty, as well as danger, was met with
in affecting the gums. Safety required that
the pest-houses should be at some distance;
perhaps, in general, the distance at which
they were placed was too great. The patient
suffered much by the conveyance,
and frequently the treatment of the disease
was entered on at too late a period
to promise success. In December, January,
February, and March, patients suffered so
much from the extreme severity of the
weather, that in some instances it was not
easy to determine whether a patient died
from cold or from the plague.
So much dejection prevailed among the
natives of India, that, from the moment of
the attack, they gave themselves up, and
said they were sent to the pest-house to
die. They never could be prevailed upon
to swallow a morsel of food nor any
medicine, and some actually starved themselves.
With establishments of a proper structure,
and under proper regulations, we may
safely venture to affirm, that our loss from
the plague in Egypt would not have been
half of what it was.
In the treatment of this disease, the
first indication was, to clear the primæ
viæ. Some gentlemen exhibited emetics;
but in general there was no time for this.
The general practice at last was, to begin
by giving a purge of calomel, and the
general remark was, that, if it operated
briskly, the head was relieved and the
skin became soft.
The second indication most generally
agreed upon, was the inducing ptyalism and
perspiration. As offering the fairest prospect
of effecting both at once, Mr Price
proposed using the warm nitric-acid bath,
but unfortunately our stock of nitric-acid
was insufficient to do this, otherwise than
on a small scale. Mr Price got a little
of the acid at El Hammed; but, from
circumstances there, he could not always
have the warm bath; however, he writes,
“On three of my patients, whose gums
I could not readily affect with mercury,
I determined to try the nitric-acid bath:
it has shewn wonderful effects, ptyalism
has been produced in all the three; but
the cold has regularly induced rigors and
severe attacks of fever, and I shall loose
my patients.”
Nitric acid was given internally; and,
where the patients would drink it, it shewed
good effects. Mr O’Farrel, at Aboukir,
succeeded in making three dragoons take
it much diluted as their common drink;
and they did well all of them.
Mr Price thought well of citric acid. In
some of the Arabs he effected cures by
this, and by a bath of strong vinegar.
Both Mr Rice and Mr Price were in the
habit of washing their patients with vinegar
and sponging them with it, as strong
as it could be procured, or with lime-juice.
They dipped rags in the acids, and
kept them constantly applied to the buboes.
The head and stomach were relieved by
wet cloths being kept to the scrotum.
The third indication was, to obviate the
debility which appeared always to be very
great. With this view, bark, wine, and
opium, were very largely given; and, at a
certain stage, the cold bath.
At first, calomel was used only as a
purgative, but, at last, the use of this remedy
was carried farther. The reports
were, “that, upon the mouth becoming
sore, the skin became softer, the pulse
more regular, the eye more clear, the
tongue more moist, and that the thirst with
the affection of the head and of the abdomen
entirely disappeared. The evacuations
too were copious, and approached
more nearly to their natural colour.”
Mr Price writes, “So much am I persuaded,
that in the modes of oxygenation,
I am in possession of an infallible remedy,
that now I purposely expose myself.”
Where he succeeded in affecting the gums,
Mr Thomas lost none of his patients, and
Mr Price in a late letter says, “Calomel
affected the gums of all my patients who
survived.” It was a general remark, that
the gums were remarkably obstinate and
insensible to the effects of mercury in
this disease. Mr Grisdale writes, “in two
of the cases, I for five days pushed calomel
and mercurial ointment to a very
great length, but never could succeed in
affecting the gums.” Both these patients,
in a subsequent letter, he reports to have
died. Here a particular fact deserves to
be noticed: one of the medical gentlemen,
who went on duty into the pest-house,
and escaped the disease, on account of
an old venereal complaint, used mercury
and nitric acid very freely during the two
months of his tour of duty, and he was
one of the six who escaped the infection.
On the whole, in mercury and the nitric
acid, we appear to have excellent remedies
for the plague: but they must be
very early and very liberally exhibited. If
the first stage is allowed to pass over before
they are given, the season of doing
it with advantage is in danger of being
lost. When the stomach becomes irritable,
I suspect that they never can be given
with propriety. Perhaps, of all the cases
which occurred in the army, this treatment
never got a fair chance of success,
excepting in those which occurred on the
first breaking out of the disease in the hospital
of the 88th regiment, in Mr Thomas’s
case, and in that of Corporal Francis.
I regret, that, in this disease, we did
not give a full and more fair trial to cold
bathing. The extraordinary circumstance
of the escape of the Lascar from the Rosetta
pest-house, and the great benefit which
I have seen from it in the yellow-fever,
to which the plague bears no slight resemblance,
would induce me to give it a
full trial in plague.
I have, I believe, recounted the principal
part of the treatment, and that which
was most generally agreed upon. Other
modes received a trial; but, from an experience
of their inefficacy they were all
deserted.
Dr Whyte used the lancet very freely, but
every one of his patients died; Dr Buchan
was in the habit occasionally of having
recourse to it; and, in the first season, he
said, that he had met with several cases
where bleeding was of the greatest service.
In the beginning of the season, Mr Price
bled one patient. The blood appeared very
dark, and dissolved: this patient died, and
Mr Price never repeated the operation on
any other.
Some gentlemen, attached to the Brunonian
system, put the stimulating plan to
the test. By Messieurs Adrian and Whyte,
patients were for some time kept under
the influence of wine and opium; but,
this practice was never successful and they
deserted it. It was at length the practice
of Mr Adrian to unite stimulants and mercurials.
Seldom before, I believe, have the bodies
of those who died of this disease been
dissected. The first was a Sepoy, by Mr
Price alone; the second by Messieurs
Price and Rice; and, in the last subject,
viz. Signior Posetti, the Italian merchant,
so severely affected were both of these
gentlemen, that it put a stop to this mode
of investigation. The general appearances
seen on the subjects, were, a perfectly-diseased
state of the glandular system.
In the liver, no matter was found; but,
it was much enlarged and greatly diseased.
Signior Posetti had only one bubo; the femoral
gland was sixteen times the natural
size and weight; and the blood, from the
femoral artery, flowed black, pitchy, and
dissolved in its texture. I come now to
the last, and most pleasing part of the
subject, the means of
The prevention. If, in the treatment of
the disease, we were not successful, we
assuredly were completely so in the prevention.
At length, this became so generally
known, that we no longer heard the
distressing accounts of despondence and
despair among the natives. They now no
longer entertained such a dread of the
pest-houses. We at length even found volunteers
from the natives for duty in the
pest-houses.
There was hardly a corps, or an hospital
in the army, where, at one period
or other, the disease did not make its appearance,
but it was always in our power
to arrest its progress. In well regulated
corps, where a rigid discipline was enforced,
and proper attention to the interior
economy was paid, it rarely happened, indeed,
that much difficulty was experienced
in eradicating the contagion.
As our success in the prevention was
so great, all that remains for me is to
mention the substance of General Baird’s
order to the army on this subject.
1st, To every hospital, an observation-room,
or in lieu of it a tent was attached,
and to it, every case whatever with febrile
symptoms was sent, as soon as discovered,
and was there most strictly watched
by the surgeon.
2dly, On any symptoms of the plague
appearing, the case was instantly sent to
the pest-house from the observation-room
of the regimental hospital: the patient was
accompanied by the medical gentlemen
of his corps who attended him, and who
gave the medical gentlemen at the pest-house
an account of the previous treatment
of the case.
If any doubt remained, the patient in
the first instance was placed in the observation-room
of the pest-house; and, if the
disease did not turn out to be plague, he
was sent to the quarantine.
3dly, In every corps, and in every department,
a minute inspection by the surgeon
was made twice a week; and every
person with the smallest appearance of ill-health
was sent to the hospital.
4thly, Every corps or hospital, where
a case of plague had appeared, was put
into a state of quarantine; and, in such
corps or hospital, an inspection by the
surgeons was made at least two or three
times a day; and every case with suspicious
symptoms was ordered to the observation-room.
5thly, In suspected corps, it was ordered,
that, under the inspection of a commissioned
officer, every person should be bathed more
frequently, and at stated periods; and, likewise,
that all their clothing and bedding
should be frequently washed and baked.
To all the hospitals, ovens and smoking-rooms
were attached.
6thly, Quarters of corps, hospitals, and
ground of encampments, were frequently
changed.
7thly, Much is to be attributed to the
nitrous fumigation. In several instances
it was attended with the best effects. The
lamps, with this, were kept constantly burning
in the observation-rooms, and in the
rooms from which the cases of the plague
had come. Vessels, with the materials for
the fumigation, were likewise placed under
the beds, and in the corners of the rooms.
When our stock of nitric was at length
exhausted, we substituted marine salt for it;
but this fumigation could not be kept up
in rooms were the patients were all confined
to their beds.
The other endemic, and next to the
plague in importance, is the ophthalmia
of Egypt; which, though a less fatal, is
a more distressing, malady.
In Egypt, at particular seasons, it is a
most generally-prevailing disease. It is not
confined to the human race; the animals
of the country, particularly the dogs and
camels, are subject to its attacks. Travellers
(and, if I remember, Volney is one)
describe the same disease as prevailing in
Syria; and, I am informed, by my friend
Dr Short, that, in Persia, ophthalmia is a
most frequent and severe disease.
In Egypt this disease proved most distressing
and obstinate. The French, it was
said, sent from Egypt to France 1000 blind
men.
The number sent home from the English
army was very considerable likewise. Of
the Indian army, 50 were sent home invalids
from blindness; most of whom were
from the 10th and 88th regiments.
Ophthalmia prevailed most in the 61st
regiment; after them, in the 86th regiment:
while the 8th dragoons, the artillery, and
the 80th regiment, had very little of the
disease.
It was remarked, at all times, that the
disease was seen much less frequently, and
with less violence, in the native Indian,
than in the European, corps. Of the former,
the 1st Bombay regiment had much
more ophthalmia than any other corps of
natives. It was said, that, in the English
army, the disease prevailed most in the
dragoon-regiments. The 26th dragoons
was mentioned as a particular instance of
this: that corps alone, I heard, sent home
about 40 invalids from ophthalmia.
Several gentlemen thought that this disease,
in Egypt, was contagious.[6] So singular
an opinion I would hesitate to offer
on slender grounds. However, the remarkable
prevalence of the disease in particular
regiments, and even in particular companies
of regiments, while the same general causes
prevailed every where, will not be easily
accounted for, without admitting something
of the kind. In some corps of the
army from England, as well as that from
India, this was observed. In the 54th regiment,
my friend, Mr Ross, then the surgeon
of it, informed me that the disease
was for some time not only confined to particular
companies, but to particular tents.
It deserves mention, too, that, till the arrival
of the Indian army at Ghiza, ophthalmia
did not appear in the army. We found at
Ghiza the 89th regiment and an ophthalmia-hospital
of the English army.
I believe that several diseases are contagious,
which are not suspected to arise from
such a cause: the theory of contagion is
but very imperfectly understood.
It was said, that the sailors, on-board the
fleet at Aboukir-bay, had the disease at the
same time that it prevailed in the army
on-shore. Several cases appeared among
the troops after we sailed from Suez.
Ophthalmia prevailed most from May to
December. At Kossier the disease was hardly
seen, nor at Ghenné. It was not till the
army was encamped at Rhoda, in August,
that cases crowded in on us. In that, and
the two following months, most of the cases
made their appearance.
It will be seen, in part the first of these
sketches, that, in the months of January,
February, March, and April, very few
cases appear in the reports.
About the middle of May the disease
began to appear in Alexandria.
Some of our medical gentlemen thought
this disease very different from the ophthalmia
which they had seen in Europe or in India.
In several circumstances there certainly was
a difference, and we were obliged to have
recourse to a different mode of treatment,
finding we did not succeed with that pursued
in England or in India. The disease,
I think, might generally be resolved into,
1st, either of Cullen’s two species, the
ophthalmia tarsi and the ophthalmia membranarum;
2ndly, to a combination of these
two; or, 3dly, to a species of ophthalmia,
frequent in India, symptomatic of disease
in the biliary secretion.
The appearance which the disease put on,
particularly the two first species of it, was
nearly what we have seen in other parts of
the world; except that the symptoms advanced
with alarming rapidity to the highest
inflammatory stages. In most cases the
attack was sudden, and very generally at
night. Speedily, the patient complained
of a burning heat of the eye-ball, or of
a sensation of needles being passed through
the eye. There was a considerable swelling
of the ball of the eye, of the eye-lids, and
sometimes of the neighbouring parts. Almost
always, there was a copious flow of
tears, which felt hot and scalding, and, as
they flowed down, excoriated the face.
Very frequently, there was a racking headach
and general fever. Œdema of the
eye-lids was frequently met with in the
early stage of the disease, and inversion
of the cilia in the last stages.
The disease very often continued two or
three months: after it had continued some
time, the general health became much
impaired. It often terminated in diarrhœa
or dysentery, and sometimes the patient
became hectic.
In the third species of the disease, which I
have mentioned, there was not so much active
inflammation as in the other two species;
and it was generally known by a yellow
tinge of the adnata, or by dyspeptic symptoms
being present; though, sometimes,
we have seen those appearances absent: and
no topical application had any effect in
removing the ophthalmia, till the gums
were affected by calomel or some mercurial
preparation.
In the two first species of the disease,
the inflammation, in a great many instances,
induced fever of many days duration, and
the disease too frequently terminated in opacity
of the cornea or in suppuration of the
eye-ball.
In the treatment, it appears, from the
reports, that different gentlemen followed
very different modes. We said, in general,
that the European practice did not succeed.
Scarification and astringent collyria, in the
first stage, gave intolerable pain, and generally
aggravated the symptoms.
The practice of the natives, was, to apply,
in the first stage, emollient decoctions of
their plants, and poultices of the kali. In
the last stage, they rely much on the frequently
bathing of the eye in the cold water
of the Nile: they are likewise very fond
of bleeding; and I understood that sometimes
they use the actual cautery, burning
behind the ear where we usually apply
blisters.
The practice, which appeared to be by
far the most successful, was the following:
For the first twenty-four or thirty-six
hours after admission, the eyes of every
patient were carefully syringed with tepid
water, which had been filtered carefully.
The syringing was performed from three
to six times in the day; the light was
carefully excluded, the patient kept cool,
and every other part of the anti-phlogistic
regimen strictly enforced. After the above
period, a weak solution of sugar of lead,
or of camphor, or vitrolated zinc, was applied.
Where the pain was much complained
of, a solution of opium was added
to the collyrium; opium was applied in
a cataplasm, or two or three drops of
laudanum were let fall into the eye.
If there was much swelling, a saturnine
poultice, or the coagulum alluminosum,
was applied to the eyes. I observed, that
blistering a large surface, and as near as
possible to the seat of the pain, if kept
discharging for some time, always afforded
great relief.
To remove the fever and to alleviate the
distressing pain, we often gave opium internally
in a considerable quantity, and
with great advantage.
Setons in the neck and the free use
of bark appeared to be of the greatest
service, when the disease was of long
standing.
In opacity of the cornea, and when
there were specks, several gentlemen
thought highly of the aqua phagedænica
of the old pharmacopeias, after having
divided the vessels which went to the
speck. It gave very pungent pain; but
I have seen great relief from it, and also
from a solution of lunar caustic.
As a collyrium in Egypt, I often gave
with considerable benefit what I found
in the hands of the black doctors in India,
viz. a tea spoonful of lime-juice to
four table spoonfuls of water, or a tea
spoonful of arrack to two table spoonfuls
of water. In the first stage, I would
have applied leeches, but never could procure
them.
In Persia, Dr Short, informs me, that
he was very successful in the general use
of an ointment, composed of white vitriol,
tuttey, and cinnabar, after the application
of leeches and scarification.
From the days of Prosper Alpinus, the
salts contained in the soil of Egypt have
been supposed to be among the principal
causes of the ophthalmia of the country.
Though the various modifications of light
and heat no doubt act as existing causes;
yet to the particular soil of Egypt, and
to the constitution of the air there, we
must look for the regular and the principal
causes of this disease.
In Egypt several causes occurred, which
in any country, separately applied, would be
adequate to the production of violent ophthalmia.
The dry, white, dazzling, soil, and
the fine sand and dust constantly thrown
about in whirlwinds and entering every
crevice. If an ophthalmia is epidemical
or is endemic in Egypt, the above causes
will render it a very violent disease.
But I conceive, that, of themselves and
alone, these circumstances do not produce
the violent ophthalmia seen in Egypt. In
no place did these circumstances exist in
greater force than at Kossier, on the march
across the Great Desert, and at Ghenné.
Yet, till our arrival at Ghiza, the disease
did not appear. These circumstances likewise
exist in great force in most places
of India, where the ophthalmia occasionally
occurs from them, yet it is different
from the two first species of the Egyptian
ophthalmia.
For the production of the third species
of this disease, the same causes will account,
which produce dysentery, hepatitis,
and other diseases of the liver. In Egypt,
I remarked, that most of the cases of
this species occurred at the time that dysentery
prevailed the most.
It should be mentioned, that, in Egypt,
the natives are universally impressed with
the idea, that sleeping in the night-air
brings on the disease.
In the ophthalmia of Egypt, as in the
plague, it would appear, that very much
may be done in the prevention.
It could not escape observation, how
rarely officers were the subjects of this
disease. In accounting for this, I lay most
stress on the attention which officers pay
to cleanliness. In the 88th regiment,
where, I believe, forty men did not escape
an attack, only two officers out of thirty
had ophthalmia.
In the whole of the Indian army, only
one officer lost an eye by it, and this
was Ensign Paton, of the 86th regiment.
The exemption of the officers from the
ophthalmia gives more weight to the
opinion, that in Egypt this disease is communicated
by contagion.
Mr Paton, previously to embracing the
military profession, had studied medicine;
and, when medical assistance was much
wanted, and a great many of his corps
were laid up with the ophthalmia, he
very humanely offered to attend them.
When employed in this duty, he was himself
attacked with the disease and suffered
most severely by it for many months.
Mr Bellars, about this time, joined the
86th regiment at Ghiza; he took charge
of the sick, and was attacked in the same
manner as Mr Paton had been, and he
likewise suffered most severely by it for
several months.
Dr Whyte, who fell a martyr to his
zeal in the investigation of the history of
the plague, from a residence of some years
in the Levant and some time in Egypt,
had good opportunities of being acquainted
with the diseases of that country, informed
me, that, by making those under his charge,
frequently during the day, wash the eyes
with cold water in the season of the ophthalmia,
he never failed in preventing the
disease. He instanced particularly the sailors
of the transports, of about one thousand
of whom he had the medical charge.
The captains of the different transports
carried Dr Whyte’s preventive instructions
into execution; and, though the disease
raged both in the army and the navy,
few of the sailors of the transports had it.
By an attention to this mode of prevention,
and in the season when the ophthalmia
prevails most, making the soldiers
wear something over the eyes, I think we
should have the prospect of passing a second
campaign, or season in Egypt, with
less loss from ophthalmia.
I have dwelt a considerable time on
the two endemics, the plague and ophthalmia,
the only diseases which we found
peculiar to Egypt; and there do not many
more diseases remain to detain us.
We come next to a class including several
diseases, and which are usually described
separately: but, I am at a loss how
to disunite them, as they occur all of them
in India, and as they have for the most part
appeared in the Indian army in Egypt.
The diseases are fever, hepatitis, and dysentery;
and, as I have for the most part
seen them, there exists among them a
most intimate and natural connection. For
a long time, the same causes appeared
indifferently to produce them: there was
a frequent transmutation of these diseases
one into another, and in the three diseases
we succeeded by a similar treatment. In
offering a few remarks, however, I will
preserve a distinction, and speak of these
diseases separately. Before entering on
them I may remark, that the effects of
the solo-lunar influence, so remarkable
in fever hepatitis and dysentery in India,
were in Egypt likewise very observable.
In the treatment of these diseases the
practitioner found his account in attending
to the periods of the moon; at the
full and the change, paroxysms would frequently
supervene, if not anticipated;
and, at these periods, convalescents would
frequently suffer a relapse.
The fever which we had in Egypt, at
different stations and in different seasons
of the year, assumed various types.
That which, on the outset, prevailed
among the Bombay Sepoys, was remittent.
At Ghenné, the fever in the
10th regiment was continued; but it very
often terminated in hepatitis. At Ghiza,
we have said that we suspected contagion
as the cause, at first; but, in the end, the
disease was clearly kept up by marshy
effluvia on Rhoda Island. It assumed a
remittent, and sometimes an intermittent,
form, when brought down to Rosetta;
and many of the cases terminated in dysentery.
At El Hammed, a majority of
the fevers which occurred were intermittents;
but several remittents occurred,
and a few cases which had some resemblance
to typhus. After October, fever
was a disease of rare occurrence. In the
last general return for November, fifty
cases appear, of which thirty-four were
natives of India. The last return in December
is much the same, the native corps
having a majority of the cases.
In the last return of January there appear,
of continued fever, twenty-two cases;
twelve of whom were Europeans. Of
intermittents there were thirty-two cases,
and sixteen of them were Europeans. In
the general report of the 26th of February
the total of fever in the army is only
twenty-three, and of them, only six are
natives. On the 26th of April, we had
only fourteen cases, of which three were
natives. In May, fever did not appear
in the reports.
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.
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.
In Upper Egypt, and at Ghiza, we
had many cases of hepatitis: it was the
same disease that we had seen in India.
At Rosetta and Alexandria a few cases
did occur, accurately answering to Cullen’s
definition of the acute species. Sergeant
Levi, of the 88th regiment, was one
instance. On the 13th of October, he
was admitted into the hospital with this
disease in a most violent degree. He
had been ill only twenty-four hours: he
had high inflammatory fever; his side
was extremely tender to the touch; he
had great irritability of stomach, and pain
over the belly. He was twice bled: the
anti-phlogistic regimen was for thirty-six
hours applied in its utmost rigour: thereafter
mercury was liberally thrown in, and
he recovered. We remarked that many,
who, in India, were the frequent subjects
of repeated attacks of hepatitis, at length
never complained, or they had the disease
in the mildest shape, in Egypt.
After the month of October, hepatitis
was a disease of still more rare occurrence.
In no corps did the number of cases bear
any proportion to what they were wont
to be in India.
During October a considerable number
of cases occurred, but almost all of them
were Europeans: the proportion of the
natives who had this disease was always
very small.
About the beginning of November several
fresh cases occurred, and all of them
were acute.
By the end of December this disease
was fast disappearing in the army. In
the last return of the month there were
only twenty-one cases, and twenty of
them were Europeans.
In January it still continued to decline.
In the return of the 31st of this month
there appear only nine cases, and all of
them are Europeans.
In the first return of February there
are only five cases, and all of them are
Europeans.
There was an increase in March. In
the first return of the month there were
twelve cases, and all were Europeans.
In the last return of April the total
number was so low as six, of which number
four were Europeans.
At the time of embarkation, at Suez,
there was not one case reported in the
army.
Hepatitis appeared more in the Company’s
artillery, and in the 10th regiment,
than in any other corps of the army. For
its predominance in the latter corps, one
reason has been assigned, and which to
me appears to have had the most powerful
influence.
But on the whole, this disease, once
so formidable to us in India, gradually
ceased to appear in the returns of the
sick.
The treatment of hepatitis it is unnecessary
to dwell on: for no disease are we
provided with a more effectual or sure
remedy. If the season for applying the
remedy be not lost, we are nearly, I think,
as confident of a cure by mercury, and
the analogous remedies, as we are in a
case of syphilis by the same remedies.
To whom the world is indebted for the
successful treatment of hepatitis by mercury,
I cannot correctly say. The oldest
written account of this practice, that I
have seen, is in a very sensible pamphlet
by Dr Paisley, formerly of Madras.
There is another very distinct account of
it in a pamphlet by Dr Girdlestone, of
Yarmouth, formerly surgeon of a regiment
in India.
For the general introduction of mercury,
through the western side of the
peninsula of India during the last twenty
years, for the application of nitric acid
to the same purpose, and for the discovery
of some other preparations analogous
to these, we are indebted chiefly to
the ingenious Mr Scott, of Bombay.
About ten years ago, from some experiments
which he made on the calces of
mercury, he discovered the analogy between
them and nitric acid, and he was
the first to apply this acid to the cure of
hepatitis. Subsequently, he was led to
the use of nitric acid and other analogous
remedies in hepatitis and other
diseases, which are curable only by mercury,
a practice, of which, on a large scale
for the last six years, I have observed the
best effects, and which is now likely to
get into general use in India.
I have said, that the species of hepatitis
which we met with, at last, in Egypt,
was not that usually seen in India, and a
corresponding change was required in the
treatment. Previously to giving mercury
it was found necessary to premise the
anti-phlogistic regimen.
In the use of mercury great address is
often required; and, in substituting nitric
acid and the analogous remedies, I
am convinced, that much advantage
may often be gained. Sometimes one of
these remedies will succeed when the
other has failed; and not unfrequently
have I seen their combined use succeed
where separately given they had failed.
In obtaining a new agent we have acquired
a great deal more power in the
management of a disease, the most formidable
to Europeans in the eastern
world.
Sometimes in Egypt, and in many instances
in India, I have observed, that
I could not affect the gums with mercury,
or with acid, till venæsection was performed.
After this operation, I have often
succeeded, and induced a flow of saliva,
in cases which had long resisted a liberal
use of mercury and nitric acid.
If the modern practice of giving but
little mercury, and to make it only touch
the gums, as it is called, without exciting
a flow of saliva, be proper in the venereal
disease, undoubtedly it is not in hepatitis.
This disease never yields till the
saliva flows freely—the explanation of this
I do not attempt; but the fact is as I
state it, and it is well known to every
man who has practised extensively in India.
Whenever the gums are hard, and
insensible to the effects of mercury;
when, instead of a salivation, they are
red, painful, spongy, or blue, the prognosis
is very unfavourable: in ninety of
such cases out of the hundred we lose
our patients.
In the first stage of this disease, I have
derived benefit from cupping and blistering
the side; but I never allow these remedies
to interfere, or to delay the principal
indications—the affecting the gums.
Dissection shews us the liver, of appearances
considerably varied when this
disease has existed some time. I have
preserved notes of my dissections; they
are not few. I made a rule of inspecting
the body of every one that died under
my care for several years past. At present,
I shall only mention, in general,
that sometimes the liver was of the
natural consistence, sometimes harder, and
that it was much varied in colour; but,
generally, it was considerably increased
in size. After the disease had lasted long,
it was sometimes much wasted, and, in
a few instances, of a very small size.
In a majority of the fatal terminations,
there were found vomicæ, or abscesses.
When matter is formed, it is well known,
that it makes its escape in various ways:
here surgical aid may sometimes be of
use.
This was by far the most-generally
prevailing, as well as the most fatal disease
in the army.
After mature deliberation, and the
most satisfactory proofs, proofs nearly
amounting to demonstration, I convinced
myself, in India, that the dysentery of that
country is a disease whose first causes
lie in the biliary system. On reflection,
and after looking over the accounts of
my practice in the West Indies, I have
little doubt but that the dysentery of that
country proceeds from the same cause.
In the end, I was led to think that dysentery,
as it occurs in Europe, was the same
disease: however, the opportunities of
observation, which I had in Egypt, convinced
me that I was wrong.
The dysentery which occurred in the
army till we came to the shores of the
Mediterranean, and for some time after,
was clearly the dysentery of India; but,
afterwards, we witnessed a different disease.
I must confess, that, having come
to so certain a conclusion, I was not
ready to give up an opinion which appeared
to me to rest on very sure grounds;
and it was not till after much doubt,
hesitation, and careful observation, that I
became convinced, in Alexandria, that,
with the change of country and climate,
we had a different disease. This is one
proof how improper, and how unsafe, it
is for the practitioner of one climate to
sit down and describe the diseases of another.
They only who have studied the
same diseases, in various and opposite
climates, can fully comprehend the extreme
absurdity as well as fallacy of this.
From reasoning of any kind, we are incompetent
to decide on the identity of
disease. Reasoning from analogy here
always deceives. In many of the symptoms
diseases may agree; but, from
thence to infer their identity is taking a
very narrow view. The comparison will be
found to hold good only in some points,
and that we have satisfied ourselves with
an imperfect outline. Between diseases,
as they occur in Europe and in Asia,
there are just as many shades of difference
as between the plants of those opposite
regions, or in the colour of the inhabitants.
The dysentery of India, or what I
shall term the tropical dysentery, is not
the disease which is described by Cullen
under that name. The dysentery of
Cullen, as it is faithfully described by
Sydenham, Pringle, Monro, and Sir
George Baker, is a frequent disease on
the continent of Europe; and it has ever
been a most destructive disease in our armies
there. The dysentery of Europe
I believe to be generally a disease of the
intestinal canal. I have already said that
the tropical dysentery proceeds from a
different cause; but the diseases likewise
differ much in their symptoms. The
“pyrexia contagiosa” certainly forms no
part of the tropical dysentery; and the
torminia and tenesmus occur so rarely,
that, in a definition of this disease, I presume
they cannot be admitted. Spasmodic
affection of the intestinal canal, I believe,
rarely occurs in the tropical dysentery.
I have ever experienced difficulty in
distinguishing dysentery from diarrhæa,
and am inclined to think, that, in Cullen’s
definition of diarrhæa, is described tropical
dysentery. The diarrhæa biliosa,
as well as his seventh species, the diarrhæa
hepatirrhea, perhaps, ought to be
included in a definition of tropical dysentery.
It has been already mentioned, that it
was the tropical dysentery which principally
prevailed in the army. Though I
was not convinced that we had a different
disease, till after we came to Alexandria,
yet I am inclined to think that it
was the European disease which chiefly
prevailed in the army for some time before;
and, if we draw the line from November,
we shall not be far removed from
the truth.
It will not be necessary to say much in
the treatment of tropical dysentery. Mercury
is now the remedy relied on every
where. In Egypt, we felt the want of
nitric acid in hepatitis; and we equally
felt the want of this powerful remedy in
dysentery. The instances which have occurred
to me, during the last five years,
are extremely numerous, where, after
our failure with mercury, exhibited in all
the variety of its preparations, we succeeded
with this remedy sometimes as a
substitute, and sometimes as an auxiliary.[7]
It was in the 61st regiment that cases
of the dysentery of Europe were first observed.
Perhaps it more readily appeared
in this corps, because the greatest part of
the men had not yet got rid of the European
habit, and were as yet unassimilated
to a warm climate. After repeated
failures, and losing some men, Mr Ruxton
saw the necessity of giving trial to
other remedies than mercury.
The disease generally set in with a
smart fever, and, unless the calomel exhibited
went through the bowels, the patient
felt no relief: and Mr Ruxton
remarked, that the neutral salts gave this
relief much more perfectly than calomel.
The treatment which Mr Ruxton rested
on, and with which he was at length successful,
was, in most cases, putting the
patient on the anti-phlogistic regimen;
frequently giving laxatives; and keeping
up a determination to the skin. The
same practice was followed in the few
fresh cases which occurred in the 88th
regiment at Alexandria, and in a considerable
number of cases in the hospital
of the 10th regiment, and some other
corps. However, it must be mentioned,
that to the last period some cases did
occur, in all these corps, where calomel
was found necessary. When the disease
was of some weeks standing, and where
a chronic disease occurred, calomel given
in small doses proved the best and indeed
only useful remedy.
For a long time, we saw but little
dysentery in the army. The number of
cases which occurred, before we arrived
in Lower Egypt, was inconsiderable.
In September, a great many cases occurred
in the neighbourhood of Rosetta,
and in the camp at El Hammed; but
many of these were the sequelæ of the
fever contracted at Rhoda. In October,
the number of cases was greatly
on the increase. The rainy weather with
which the month of November began,
and which continued during the following
months, brought a prodigious increase
of dysenteric cases. In the general
return of the first week in November,
there appear one hundred and sixty cases,
and one hundred and twenty-three of
these are Europeans. Most of the natives
were from the Bengal volunteer
battalion.
In the first general return in December
appear two hundred and nineteen; of
which one hundred and forty are Europeans.
After leaving the encampment at El
Hammed, and getting into dry, comfortable
barracks, at Alexandria, the disease
occurred more rarely in the army.
In the last return of January, only one
hundred and sixty cases are seen.
In the last return of February, the total
number of dysenteric cases in the army
was fifty-four, and only twenty-two of
these were natives of India.
In the last return of March, there appear
nineteen cases, fifteen of which were
Europeans.
There are only twenty cases in the last
return of April, and these cases are equally
divided between the Europeans and
Indians.
At the time of embarkation the number
was even less than the above.
The disease was more frequently met
with among the European artillery, and
in the 61st regiment, than in any other
corps. Among the native corps, the Bengal
battalion had more of the disease
than any other. I made inquiry, but
could find no reason that could with probability
account for this.[8]
I have continued longer on the subject
of dysentery than was at first my intention.
I will confess, that I think it is a subject
on which I could with more propriety
speak than on any other. My opportunities
of seeing the disease have been no
common ones. Rarely, I believe, has it
fallen to the lot of an individual to see so
very many cases of one disease in such a
diversity of climate and situation. In the
88th regiment, during the course of upwards
of ten years, I saw the same men
the subject of this disease on the continent
of Europe, in America, in both extremities
of Africa, and in India. Of late,
it has afforded me not a little amusement
to review my notes as well as my journals
of practice in this disease, in all these
quarters.
I have now both given some account of
the endemic diseases which we met with
in Egypt, and offered a few remarks on
those diseases which were most prevalent
in the army. They are the diseases
which constantly prove the most fatal to
an army in India. The few which now
remain, or (if I may be allowed the expression)
the minor diseases, will not long
detain us.
I shall speak of conjointly. In the
symptoms or treatment we could not observe
any difference from the same diseases
as they occur in Europe. If these
diseases were less violent than we have seen
them in Europe, they had more of the inflammatory,
diathesis than in India.
It was not till after the army had been
sometime in Lower Egypt, that either of
these diseases appeared.
In the first general weekly return in November,
there appear a total of six cases
of pneumonia, and nine of rheumatism.
In the first week of December, there
were twelve cases of pneumonia, and seven
of rheumatism.
In the first weekly return of January,
both diseases appear to have increased;
there were twenty-four cases of pneumonia,
and twenty of rheumatism.
In the first return of February, there
are thirty-four cases of pneumonia, of
which number, twenty were Europeans.
Of rheumatism, there were fifteen, and
only eight of them were Europeans.
In March, the first return presents only
five cases of pneumonia: of these, three
were Europeans; but, of rheumatism,
there were twenty-seven cases, and nineteen
of them were natives of India.
In April, there were sixteen cases of
pneumonia, and only five were Europeans.
Of twenty-five cases of rheumatism,
eleven are Europeans.
The warm clothing and bedding provided
by the General for the natives of
India, in the cold months, no doubt protected
them from the attacks of pneumonia
and rheumatism. The latter disease
was found to be more prevalent in the
Bengal battalion of Sepoys than in any
other corps.
The cases of this disease that occurred
were very few. I have said that the
small-pox broke out at sea, in the division
of the army commanded by colonel Murray.
Mr Philips told me, that it was very
fatal to the natives: he sent every case as
soon as discovered into the Julia hospital
ship, which was unfortunately lost, in the
Red Sea, with all on board.
The Europeans, who were attacked in
Egypt with this disease, all did well; but
it proved a very fatal disease to the few
Indians whom it attacked.
As in India, we remarked, that in
Egypt the contagion did not spread so
widely as in Europe. Though, at different
periods, it broke out in the hospital of the
10th regiment, at Rosetta, in the department
of the commissary of cattle, when
encamped near the lake Mareotis, and in
the garrison of Ghiza, yet in none of these
instances did the disease spread. The
cases that did occur were all of them
very confluent. When, on the eve of our
march to Suez, I received vaccine matter,
sent from Constantinople by order of
Lord Elgin: it arrived too late, however,
for us to introduce the new inoculation
either in the army, or the country; it was
likewise too old and unfit to be carried
into India, as we intended.[9] At one time
I expected to see a curious question in
physiology resolved, by observing the
united agency of the variolous, and pestilential
contagions. In one instance,
these two poisons were in action in one
corps, and at one time. A case of the
small-pox, and another of the plague,
broke out, in the camp of the commissary
of cattle, at the same time. By the active
vigilance, and the system established
there, the progress of both contagions was
soon stopped, and a second case of either
disease did not afterwards occur.
I have said, that, from the quality of
the water, this was a prevailing disease
in crossing the desert of Thebes. It occasionally
appeared, at other times, in
some corps, particularly after a change
of provisions, or after changing quarters,
as from El Hammed to Alexandria.
This disease was but little seen in the
army. About twenty cases occurred in
the 61st regiment while quartered in the
Pharos, and one case occurred in the
80th regiment at Alexandria. At the
time the disease occurred, the army was
regularly supplied with fresh vegetables,
and there was no scarcity of provisions in
the market.
This disease prevailed much in the
garrison of Ghiza, and in the 86th regiment.
At the time of embarkation there
were many obstinate cases. With the
small stock of nitric acid which we had,
we had as strong proofs of its efficacy as
in India. In the instances of some officers
who were successfully treated with
it, we found that the stomach seldom
bore more than half the quantity which,
in Bombay, we had usually exhibited in
the hospital of the 88th regiment; but
the acid given to these cases differed much
from the acid used in India: the latter
was a much pleasanter remedy.
To a few cases we successfully gave the
oxymuriate of potash, and to several
cases the oxymuriate of soda.
We found that syphilis was a frequent
disease in every part of Egypt that we
had seen, both among the Bedouins and
the Fellahs; and we have seen in Upper
Egypt many objects terribly mutilated
from this disease. Crude mercury I have
often seen in their bazars, or markets,
and they appeared to be acquainted with
the use of it.
This did not frequently appear in the
Indian army while they were in Egypt:
on the voyage thither, however, it prevailed
very much, and a great deal of it
came under my own particular notice.
On my return to India I found, that, in
the manner of its first appearance, as well
as in its progress afterwards, much of
what I had observed was considered, by
medical men, as new and remarkable. I
shall, therefore, give some detail of it
here: though this may be going a little
out of my way, it may be useful. When
cases of this disease crowded on me,
and with the very severe symptoms with
which they appeared, I was both perplexed
and embarrassed; and I regretted
much the not having had a previous
knowledge of the disease.
This disease, as will be shewn by the
table, was but little seen in Egypt. It
appeared only in two European corps,
the 86th and 88th regiments; and in two
native Indian corps, the 1st and 7th
Bombay regiments. It is a disease, of
which I believe that we know but little.
Industry and attention might be usefully
employed in the investigation of the natural
history of the dracunculus.
In September, 1799, the 86th regiment
relieved the 84th in the fort of Bombay.
The 86th remained in the king’s barracks
there until October, 1800, at which time
they were relieved by the 88th regiment
from the island of Coulabah.
The 86th, on coming into the fort of
Bombay, had never had a case of the
Guinea-worm; and they continued free
from it till the setting in of the monsoon
of 1800. The king’s barracks in the fort
are close to the bazar in Bombay. Here
Mr Dean, the surgeon of the 86th regiment,
remarked, that the Guinea-worm prevailed
very much among the natives. In the
course of the monsoon, nearly three hundred
cases of this disease appeared in the
86th regiment. I saw, at one time, one
hundred cases of it in Mr Dean’s hospital.
The 88th regiment, from the time of
their arrival in India, in June, 1799, till
October, 1800, was quartered in the
island of Coulabah, distant one mile from
Bombay. During the fifteen months of
their stay at Coulabah, only one case of
Guinea-worm appeared in the regiment;
and this happened, as they were about
exchanging quarters with the 86th regiment,
in an old man, debilitated with repeated
attacks of hepatitis and dysentery.
No case appeared in the 88th regiment
in October, nor for nearly a
month after their coming into the king’s
barracks in Bombay; but, in that part of
November which immediately preceded
their embarkation for service, three cases
occurred.
The artillery, 86th and 88th regiments,
as already mentioned, were embarked, at
Bombay, for the Egyptian expedition.
In the course of the voyage to Ceylon,
a case of Guinea-worm first appeared in
the detachment of the 86th regiment, on
board the Minerva; and, thereafter, six
cases in the 88th regiment, on board the
same ship.
On our arrival at Point de Galle, in
Ceylon, we found that the disease was
unknown in his Majesty’s 19th foot,
among the Sepoys who came from Bengal
or Madras; in the Malay corps: and, as
far as I could learn, among the inhabitants.
During our stay in Ceylon, a few
cases made their appearance in the 86th
and 88th regiments on shore. On sailing
from this island for the Red Sea, only
three hundred and sixty men, of the 88th
regiment, with the artillery, were embarked
in the Minerva. Two companies of
the 88th were embarked in a small vessel,
the Fancy. Another vessel, the Hope,
was provided for the detachment of the
86th regiment, and two officers of the
88th were embarked with them.
Soon after sailing from Ceylon, the
Guinea-worm made its appearance among
the 88th, both in the Minerva and Fancy:
in the Minerva, particularly, it increased
with alarming rapidity. By the time we
reached the Straits of Babelmandel, we
were in a most alarming state. Of three
hundred and sixty men, whose services
we had reason to expect daily might be
required, one hundred and sixty-one were
at this time crippled and laid up with
this loathsome disease. Though contrary
to every account which I had had of the
disease, many circumstances at this time
led me to suspect that it was infectious,
and I, at length, thought it prudent to
treat it as such.
The officers remarked, that it prevailed
most in particular parts of the ship, and
much more in some companies than in
others. This, at length, so much struck
the commanding officer, that the sick
were separated from the sound: the men
with the Guinea-worm were all placed on
the orlop-deck, and the rest of the men
occupied the gun-deck. At this time,
too, extraordinary precautions, regarding
cleanliness and ventilation, were adopted.
Much lumber and luggage were stowed
away, and the space between decks,
which hitherto had been lumbered with
it, was made open and clear, fore and aft.
The decks were daily well washed with
boiling water, and the nitrous fumigation
was kept constantly going on throughout
the ship. Besides the usual bathing three
times a week, of all on board, the soldiers
were made to wash their hands and feet
regularly twice every day at the ship’s
head.
In a little time after adopting these
measures, we could perceive the disease
to diminish. The number of fresh cases
reported, decreased daily; and at the
time of our casting anchor in Kossier
Roads, though there were on the sick
list many bad ulcers from the Guinea-worm,
no fresh case had appeared for
some days before.
During the voyage, 199 cases had appeared
from 360 men of the 88th regiment;
and several cases occurred among
the ship’s crew; but not a single case
occurred among the artillery. This struck
every one on board, very early, as remarkable;
yet these men had the same provisions,
drank the same water, and in every
other circumstance were situated as the
men of the 88th regiment, except that they
were kept separate. From the outset, the
artillerymen were accommodated apart,
on the gun-deck, in a spot divided off
for themselves. Not one of the officers,
either of the artillery, 88th, or belonging
to the ship, had the Guinea-worm.
From the strong circumstances which in
its course appeared, every officer on
board was impressed with the opinion
of its being contagious, and was inclined
to use every precaution of prevention;
from which, most probably, all escaped
this filthy and severe disease.
Those embarked in the Fancy, were
not so fortunate; few of the men there
escaped the disease. Of eight officers of
the 88th, three caught it. Mr Bruce,
then the assistant surgeon, was one of
these: he had a worm in each leg. The
Fancy was obliged to return to Bombay;
most of the men were disabled by this
disease; and the season was too far advanced
for her getting up the Red Sea.
Among the 86th regiment in the Hope,
only three cases occurred; and one of
the two officers of the 88th, on board,
was one of them.
I find, by my case-books, that in the
part of the 88th regiment which continued
in the Minerva, the disease appeared
as follows:
| From the 9th to the 24th December, |
6 |
cases on the passage to Ceylon. |
| From the 25th Dec. to 14th Feb. |
4 |
ditto at Ceylon, on shore. |
| From the 15th to the 28th Feb. |
39 |
ditto at sea, after leaving Ceylon. |
| In March |
103 |
ditto at sea. |
| In April |
39 |
ditto at sea. |
| In May |
8 |
ditto at sea, till landing at Kossier. |
| Total of cases |
199 |
|
I have purposely excluded the cases
which occurred in the 88th, on board the
Fancy, or among the 86th regiment.
The disease was pretty uniform in the
manner of its appearance. The patient
was first sensible of an itching; and, on
looking at the part, generally observed
a small blister: sometimes I have seen
three or four small blisters, and the part
having the appearance of being stung
with nettles. When the blister was snipped,
a piece of mucus of the breadth of
a sixpence was seen underneath, which
being removed, the head of the worm
was seen. It was in general firmly attached,
and required force to detach it
from the parts underneath. When detached
with the forceps, we twisted it
round a ligature or piece of lint, and
thus, often on the first day, succeeded in
extracting a foot, or even two, of the
worm. It resembled much what is called
bobbin, and was about the same size. It
was transparent and moist, a white liquid
being seen in it. We continued, daily, extracting
as much of it as would come
out with gentle pulling. It was always
dangerous to pull strongly, for fear of
breaking the worm: it then occasioned the
most acute pain, and there followed much
swelling, with inflammation of the neighbouring
parts, sometimes of two or
three weeks continuance, when the worm
would shew itself at another part, as at
first, with itching and a blister.
It seldom appeared to be deeply
seated; generally, under the cutis, or
among the tela cellulosa, when we could
often trace it in its course, and sometimes
see it: sometimes it was under the
fascia, and but seldom among the muscles.
If not ushered in with fever, it was
almost always attended with it in its
course: when there was considerable inflammation,
it ran very high. In seven
cases, mortification took place, and very
large sloughs were cast off. In a few
cases, there was a very considerable and
alarming hæmorrhage.
By presenting itself at different places, it
would often leave two or three large, foul,
and fistulous ulcers in different parts of a
limb. When the inflammation has run
very high, as I have often seen of the
whole leg or thigh; and when a profuse
suppuration followed; the worm frequently
has come out dead, often in
pieces, with the sanies, by which, probably,
it had been eroded and killed.
Frequently, after extracting one worm
from a patient, a second, a third, or even
a fourth, would appear: after getting one
out of a leg, a second would appear in
the other, a third in one hand, and a
fourth in the other hand.
The Guinea-worm, I believe, has been
seen in every part of the body. Though
the extremities appear to be its favourite
seats, yet the face, breast, back, penis,
&c. are not exempted from its visits. I
heard of a gentleman in Bombay who
had one in his scrotum and penis, and of
a lady who had one in the pudenda.
The following I extract from my case-book
and notes, taken on board the Minerva,
by which it will be seen that the
extremities are as much more frequently
its principal and first seat, as in the itch.
|
Feet |
Legs |
Thighs |
Scrotum |
Groin |
Hands |
Arms |
Body |
Total Cases. |
| Feb. |
34 |
3 |
1 |
— |
— |
1 |
— |
— |
39 |
| Mar. |
70 |
21 |
5 |
2 |
2 |
3 |
— |
— |
103 |
| April |
20 |
9 |
5 |
— |
— |
3 |
— |
2 |
39 |
| Total |
124 |
33 |
11 |
2 |
2 |
7 |
— |
2 |
181 |
As to the causes of the appearance of
the Guinea-worm, and the mode in
which it is generated, I must confess that
I have no account that I could venture
to offer here.
In different parts of the world, the
water drank is accused of occasioning
intestinal worms, as the tænia in Switzerland,
and the tænia and the teretes
in the West Indies; where, likewise, I
have heard the mucilaginous vegetables
eaten assigned as a cause of the frequent
appearance of worms. In Russia, there
is a worm, the lumbricus militensis, common
near swampy grounds. In Russia
and in Siberia, in the same situations,
the tænia infernalis prevails. But, after
what has been here stated, we cannot
bring the water, drank on board the
Minerva, or at Bombay, to account for
the Guinea-worm which prevailed: in
fact, the water came from different and
distant quarters, Bombay, Ceylon, and
Madras. Besides, the officers of the
38th, and the artillery, drank the same
water, and escaped.
No case of Guinea-worm had been
known among either the Lascars or European
sailors in the Minerva, when the
86th and 88th embarked in her.
I have good reason to think that the
spreading of the Guinea-worm may be
stopped, whenever it does appear. The
means which we adopted appeared to
succeed. Extreme attention to cleanliness
is indispensably necessary.
In India, the native doctors are much
more successful in getting out the worms,
than Europeans. After long feeling with
their fingers, for the body of the worm,
they make an incision as nearly as they
can judge over its middle, and, pulling
the worm by a duplicature of it, draw out
both ends of the worm at one time. I
have often endeavoured to imitate this
practice. My sense of touch was not so
delicate, and did not guide me so correctly,
as it did the Hindoo doctors; but
I always found that when, on cutting
down to it, I got on the middle of the
worm, and, by the forceps, pulled this
out, I could with ease extract a large
portion, and, not unfrequently, the whole
worm.
Leeches, astringent and sedative lotions,
cataplasms, fomentations, &c. were
applied, as required by the circumstances
of the case. A good deal of attention
was paid to the disease, in all its stages;
and several experiments were made on
the worm, which, however, it is needless
to detail here.
After using a variety of articles, in the
treatment of the Guinea-worm, and making
them enter the system by the absorbents,
I think that unctuous substances
succeeded the best, particularly mercurial
ointment. Passing an electrical shock
through the part had no effect.
In India, we remarked that ulcers,
particularly of the legs, were very rarely
seen; and that many men in the 88th
regiment, who in Europe were always in
hospitals with them, were in India quite
free from them. In Egypt, they began
to re-appear. In the course of six weeks
after the army came to Alexandria, there
appeared seventy on the general return
of the army; and they continued afterwards
on the increase.
Though no case of this disease occurred
to us while in Egypt, I met with
a severe one on the voyage thither. As
I was successful in this case, and by a
mode of treatment which, with the theory
which gave rise to it, is, I believe, now
considered as obsolete, it may not be uninteresting
to mention what led me to
give it a trial.
In the year 1794, the first tetanic case
I met with, occurred at Bergen-op-Zoom.
A sergeant of the 88th regiment, after
remaining drunk out all night, was in the
morning found lying in a ditch. This
was in August, and the weather was unusually
warm. When brought to the hospital,
his jaws were so firmly locked, that
the blade of a pen-knife could not be
introduced between the teeth. Mercury
was had recourse to, but in a few hours
the muscles of the neck became convulsed.
By the advice of a Dutch physician,
a man of great eminence, I
immersed my patient four times, in the
course of the day, into a bath of broth.
He continued in it half an hour each
time, and, after he came out, his whole
body was rubbed with mercurial ointment.
I do not recollect that any thing else
was given to him, unless a stimulant
enema. Next morning the good effects
of the Dutch practice were evident: a
violent salivation came on, and, in about
three weeks, the man was doing his
duty.
In the next case which occurred,
though a cure was not completely effected,
the same treatment was, for some
days, attended with good effects. In the
island of Grenada, a negro, attached to
our pioneers, received a contusion and a
slight wound of the head, which was
soon followed by locked jaw. The warm
bath, and the liberal use of mercury,
were ordered. He, for some time, appeared
to be better, and I flattered
myself with the hopes of another cure;
but the disease gaining ground, the cold
bath and the tonic treatment were had
recourse to. The patient died.
The next was a sailor, who, a few days
before our embarkation, in the Minerva,
at Bombay, had been slightly wounded
in the foot by a copper nail. On my first
seeing him, his symptoms were slight,
but were gaining ground fast. On the
10th of December, the day after our
embarkation, he had the most violent
symptoms of the disease: the jaws were
firmly locked; the muscles of the neck,
before and behind, were strongly convulsed;
and he had twitchings of the
muscles of his face. He pointed to the
region of the stomach, where, he afterwards
told me, that he had intolerable
pain and sickness. This man was immediately
put under the same treatment as
was employed in the case of Sergeant
Kirkland, with this difference, that, instead
of broth, a bath was made from
fat, or what is, on ship-board, called the
slush. The same success attended; but
the symptoms yielded more slowly, and
it was several months before the sailor
recovered.
From hearing me relate these successful
cases, by the warm bath and mercury,
some cases in the Bombay general hospital
were treated in the same manner.
My friend, Dr Keir, informed me that he
tried it in three cases of tetanus, in the
garrison hospital. It succeeded in one,
but failed in the other two.
When I had nearly brought these
sketches to a conclusion, I met with two
books which I regret that I did not see
earlier, viz. Dr Chisholm’s work on the
Pestilential Fever of the West Indies, and
Dr Wittman’s Travels. In perusing these
works, I have had great satisfaction to
find a coincidence with me in some
opinions which I had formed, and which
I have introduced into this treatise.
It is matter of regret to me, that I
did not meet Dr Wittman in Egypt.
Most of my observations, I find, coincide
with his; and I am glad to have mine
confirmed by authority so respectable.
The frictions with oil we did use to a
small extent, in an infected corps of the
Indian army; but the report made to me,
by the surgeon, was unfavourable, and
I never recommended its use in any other
corps. Since reading what Dr Wittman
says on the subject of friction with oil,
I think it not improbable, that, in addition
to the great care which captain Burr
took of the commissariat department,
another circumstance may have conduced
to their exemption from the plague. The
camels of the army, to the number of
some hundreds, were, as well as the horses
and buffaloes, under the charge of the
commissary of cattle, captain Burr; and
his people were entrusted with the care
of them. In the cold and wet season,
which commenced in November, the
camels became very sickly, and many of
them had an eruption over the body. In
the course of three months, I believe, more
than three-fourths of these useful animals
died. Captain Burr employed some
Arabs, who were reputed to be skilful in
the treatment of the camel. The plan
which they followed I remember well.
It was, after shaving or cutting the hair
very close, to rub them all over with oil,
daily. The men of the commissariat department
were, during the day, constantly
employed in these frictions, or in tending
the cattle: and the great mortality among
the camels happened in November, December,
and January, the months in which
the plague raged the most in the army.
The circumstance I think not unworthy
of notice; I leave others to ascribe to it
what degree of importance they think it
deserving of.
I have mentioned, that I thought I
could see a characteristic similitude in
many of the symptoms between the plague
and the destructive fever which has for
some years devastated the continent of
America and the West India islands; and
to the end of the account which I gave of
the plague, I add a table of the principal
points where it appeared to me that the
two diseases agreed.[10] I am now glad to
find, that in this opinion I do not stand
alone; I have been particularly gratified
to find that this is the opinion of so very
respectable authority as Dr Chisholm.
I have had the greatest satisfaction in
the perusal of the very complete history
of the West India fever which Dr Chisholm
gives. In most points, the result
of my observations on this, coincides with
the doctor’s. My experience, in a particular
situation, supplied me with some
very strong facts, touching the question
of the contagious nature of this fever.
From my case-books and notes, while
in the West Indies, I have thrown, under
a few heads, a brief extract of the result
of my observations, which I shall here insert.
From the similitude which I think I can
trace, this is not foreign to the principal
subject of these Sketches; and, as the result
of close observation, unattached to
any theory, they may, perhaps, be not
without interest or use.
1st. In Barbadoes, both in the end of 1795,
and in the beginning of 1796, the only
disease which prevailed was typhus. The
88th regiment was healthy at St Lucia,
and continued pretty healthy at Grenada
for three months after their arrival there,
or as long as they remained to the windward
side of the island. This was likewise
the case with the 10th, 25th, and other
regiments. It was only after our return
to St George’s and to Richmond Hill,
after we had communication with the 68th
regiment, and the general hospitals, where
the yellow fever had for many months
prevailed, that it appeared in the 38th,
and in the other corps.
2d. Before the appearance of this fever
in the 88th, as well as in other corps, dysentery
and intermittents prevailed most.
3d. On the 12th of July, 1796, a detachment
of the 88th regiment was embarked
at Grenada, in the Betsy transport,
for England. We embarked one hundred
and forty, and I was most particularly
careful not to take any man on board with
the slightest appearance of illness. Every
precaution which regarded cleanliness,
ventilation, or fumigation, was adopted.
The remains of the 8th, 10th, 25th, and
other regiments, were at the same time
embarked, at Grenada, for England.
4th. From the time we sailed from
Grenada, on the 19th of July to the 5th
of August, seven days after we sailed from
Tortola, (where we had touched for water)
no case of this fever appeared in the
Betsy. The other corps, which left Grenada
along with us, had not been so fortunate.
The 8th, 10th, and 25th regiments,
all of them suffered severely on the passage
from Grenada to Tortola; the 8th
particularly. This corps, besides the loss
of many non-commissioned officers, in
this short passage, lost every officer on
board, except the surgeon in second, and
major and captain Armstrong; and these
two gentlemen were ill of the yellow fever
on coming into Tortola. I was requested
to go on board to visit them, but the request
was opposed by all the officers on
board the Betsy, as well those of the ship
as by the officers of the 88th regiment on
board. So very much were all impressed
with an opinion of the fatally infectious
nature of this fever, that they remonstrated
with me, and told me, that the ship
and the regiment were now perfectly free
from this fever; but that, by my going
to see the 8th, I should certainly bring
the fever into the Betsy. However, a
second message having come for me to
visit captain and major Armstrong, I
instantly accompanied the messenger on
board. From seeing the state of their
transport, I immediately ordered major
and captain Armstrong on shore, and
accompanied them to the hotel. Here
we found that the prejudices in the Betsy
transport prevailed in the island of Tortola.
The doors of the hotel were shut
against the yellow fever, and it required
a very forcible remonstrance to persuade
them to admit these two officers, who,
however, both of them, died the next day
in the hotel.
5th. The state of the other corps, after
sailing from Tortola, I am unacquainted
with. When lying at Tortola, on the 29th
and 30th of July, the Betsy communicated
with the transports which had the
8th and 10th regiments on board. On
the 6th of August, the first case of the
yellow fever appeared on board the
Betsy; from which period to the 12th of
September, 1796, every person almost
was once, and a great many on board
twice, attacked with this fever. Of one
hundred and forty people on board the
Betsy, the captain of the ship, eighteen
soldiers, and one woman, died in this
period. It should, however, be mentioned,
that, of the soldiers, several were
old and worn-out invalids. During the
passage from Tortola to England, our
convoy, the Hebe frigate, suffered even
more than the Betsy. When sent for on
board, by Captain Scott, I found that
he had not only lost many seamen and
marines, but several officers, and two
medical gentlemen.
6th. On the fleet, from Grenada, anchoring
at Tortola, the yellow fever was
unknown there; thereafter, I have heard,
that it prevailed generally, and committed
great havoc.
7th. Those labouring under dysentery,
ague, &c. were those first seized with this
fever.
8th. [Symptoms.]—The attack was first
with extreme debility, affection of the
head, and frequently the appearance of
drunkenness. Next, the abdomen was
complained of, and the biliary system appeared
to be a principal seat of the disease.
The yellowness, though not a constant,
was a generally attending symptom.
The eyes first appeared of a watery
suffusion; they next were observed to be
blood-shot; and, in a short time after, yellow;
from the eye, the yellowness quickly
spread over all the body, and the patient
in a little time had the appearance
of one highly jaundiced. Sometimes the
yellow colour of the body continued for
some time after the patient got well, and
purgatives brought off yellow stools, while
the urine was at the same time yellowish.
The irritability of the stomach, and what
is called the black vomiting, were pretty
constant attending symptoms. The state
of the pulse varied in the course of the
disease; there was at first, almost always,
a firm and strong pulse, with so
much re-action, as would lead a stranger
to the disease to blood-letting and the
anti-phlogistic regimen. The bowels were,
in general, very unequal; there was either
a looseness or costiveness, though most
frequently the latter.
9th. The duration of the disease was,
in different cases, and in different situations,
very different. In Grenada, when
it first broke out, it generally ran its
course from twenty-four, thirty-six, to
forty-eight hours, in the hospitals. Soon
after we sailed from Grenada, cases terminated
in three days: thereafter, and as
we approached the higher latitudes, and
before we reached Ireland, cases were
drawn out to ten, twelve, and fifteen
days.
10th. The prognosis. The danger was
generally in proportion to the degree of
affection of the head, irritability of the
stomach, and yellowness of the skin, and
as these appeared early or not.
11th. In the treatment various modes
were tried. Emetics appeared to be unnecessary;
and, in general, seemed to do
mischief, as did all antimonials. I have
witnessed the practice of a large hospital,
where blood-letting was premised in every
case; but this was by no means a successful
practice. In three cases in the
Betsy, and where the state of the pulse
and other symptoms seemed particularly
to call for it, I performed venæsection;
but I lost my three patients. Clearing
the bowels appeared to be a principal
indication: when this was repeatedly
done by drastic purgatives, and when a
free perspiration was kept up, there was
always less complaint of the head, and,
in some cases, a remission was thus obtained,
and the bark could then be given
with manifest advantage. In the few
cases where it was used to produce salivation,
calomel did more good than any
other remedy whatever. I lost no case,
where I succeeded in inducing a flow of
saliva.
In some cases, and these all proved fatal,
the gums became insensible to the
effects of mercury; and though one
drachm of calomel in one case, and two
scruples in another, were given in a very
short period, yet the patient died without
a flow of saliva having been excited.
Nothing gave more relief than the cold
bath; it generally suppressed the irritability
of stomach for some time; it always
induced sleep, and brought out a
gentle sweat, which most commonly relieved
the patient. The Brunonian practice
I saw tried with no advantage.
These are the principal of the leading
circumstances, regarding the yellow fever,
which came immediately under my notice.
Dr Chisholm, when he formed the opinion
of the similarity of the plague and
the yellow fever, was not singular.
Since my arrival in England, I have
received several letters addressed to me
in Egypt, and which followed me from
that country to India, and from thence
to Europe; mostly answers to letters
which I wrote from Egypt. By two of
my West-India correspondents, in particular,
this opinion is repeatedly expressed.
I have several letters on the subject
from two most respectable physicians,
Dr Paterson, of Grenada, and Dr Robertson,
of Barbadoes. From the opinion
which he had formed, Dr Paterson
repeatedly urges me to the use of mercury,
and of the cold bath, in the plague.
Dr Robertson, in one letter says, “I
decidedly agree with you, that there is a
strong similitude between the symptoms
of the yellow fever and the plague: although
the latter disease never came under
my observation, yet I was so struck
with the appearance of yellow fever, and
the histories of the other disease, which I
had read, that, at one time, I was almost
disposed to consider them both as different
modifications of the same diseased
state of body, and actually wrote a paper
on the subject in February, 1797.”
In the practice in Egypt, Mr Price’s
observation militates against the use of
cold bathing in the plague. It should be
recollected, however, that, when Mr
Price made his observation, it was in the
severest part of the season, when the
plague raged the most, and when Mr
Price laboured under many disadvantages
in his practice. I anxiously wish to see
cold bathing, or sponging, extensively
tried in the plague. I have great expectations
from it in that disease, from having so
often seen how much it has done
in the yellow fever and in typhus fever,
where I consider it to be the most valuable
part of the treatment.
In concluding, I am impelled to do an
act of justice, and acquit myself of a
debt of gratitude. The use of this invaluable
remedy, and what else I know of
tropical practice, I learned many years
ago from my venerable and much-respected
friend Dr Wright. By the use
of the cold bathing, my life was saved
in Jersey, in 1794, when I was ill of typhus
fever, by Dr Jackson, then surgeon
of the Buffs, who, at the same time, attended
my hospital for me, and with the
greatest benefit, and introduced this practice
into the 88th regiment, where typhus
then raged.
The use of cold water and cold bathing
has since been diffused by the ingenious
and elegant pen of Dr Currie. This I
conceive to be one of the greatest improvements
which the practice of physic has
received in modern times.