PART III. (continued 2)

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.

ULCERS.

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.

TETANUS.

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.

GENERAL REMARKS ON THE YELLOW FEVER, AND THE RESEMBLANCE WHICH THIS DISEASE BEARS TO THE PLAGUE.

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.