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facked with very severe pneumonic symptoms ; no fatal cascs, however, occurred, although frequent phlebotomy was in several found necessary.
On the 22d of September the ship anchored in Table Bay, in a very healthy state, there being no remains of the former alarming disorder.
After being refreshed at the Cape, the ship departed on the 15th of October, but about the 5th of November (south lat. 36 deg. 16 min. east long. 53 deg. 40 min.) the surgeon was extremely anxious, on observing that several men, to the number of eigbt or ten, made complaint of disordered bowels, accompanied with griping tenesmus, and frequent scanty mucous alvine evacuations. These complaints continued to be made for several succeeding days, but very easily giving way to medicine, and being for the most part unaccompanied with 'pyrexia, he was inclined to believe they proceeded from some other cause than contagion. The men, on leaving the Cape, had had a change in their diet; having formerly had rum, but now wine, which is made at the Cape, and which is generally drank too new ; and it is a common observation there, that it is often productive of these disorders; he therefore advised that half allowance of grog should be scrved out, and this seemed to have the intended good effect; but few further instances of sickness appearing during the time the ship conti. nued on her voyage, which terminated on the 28th of December.
Thus after a voyage of vast extent, approaching to near 20,000 miles, in most of the climates of the globe, in a crowded ship, during which time upwards of 600 persons applied to the surgeon for assistance, many of them with a disease manifestly contagious, often dangerous, and whose presence has often in camps and ships been synonymous with death and desolation ; so little was the mortality that only two persons could be said absolutely to die of the disease it. self, and two others of its consequences, mesenteric obstruction and marasmus,
Having now therefore described the events as they oco curred, and stated that only four persons died, whose deaths proceeded from the disease in question, I come to mention by what means this success was produced ; what were the at: tempts of the surgeon to stop its progress; and what his treatment of the disease when it actually appeared.
When a disease of an infectious nature prevails in any situation and spreads much, there is great reason to suppose that there either is some neglect or mismanagement, or that the necessary preventatives are out of the reach of the medi,
cal attendant, which latter circumstance is much more frequent on board ships than on shore, sceing that a separation of the sick from the bealthy is there but slightly practicable. It, however, an actual non-intercourse cannot be effected, it ought, as much as possible, to be approached to; hence, when the surgeon of the ship was ordered to attend the military, and found nearly thirty men confined to their beds with the disease, in different parts of the sbip, he ordered them to be conveyed forward, and permitted no person but the medical attendants and servants to have intercourse with them ; and aided by the commanding officers, a line of demarkation was strictly kept on both sides the deck by sentries. When the weather would permit the ports were kept open, and in the night windsails were well attended by sentries at the different batchways, who were kept to their duty by the frequent visitations of the military officer having the watch ; the deck under the hammocks was frequently sprinkled with vinegar, and a fumigatinig lamp suspended over the fore pcak scuttle, and kept almost constantly burning..
And here it may be necessary to mention, that the naval surgeon discovered a source of evil, that evidently prevailed much in favouring the spreading of the disease among the persons in the lower deck. Many of the sick being too ill to reach the necessary on the upper deck, and baving the frequent calls for evacuation so common in this complaint, had been furnished with small tubs for this purpose ; and these most unwisely were unprovided with covers, from whence arose a continual source of danger; these conveniences, therefore, were immediately provided with such covers as could not be left open, and men were ordered very frequently to wash out these utensils with sca-water. Alterations also were made in the head of the ship, to which the healthy men resorted, to prevent any lodgement of stercoraceous matter ; and one side of it was kept for the healthy, and the other for such of the sick as were able to come upon deck. Small conveniences for the same purpose were made in the fore-chains, so contrived, as easily to be removed as soon as no longer required ; and to these salutary alterations more than to any thing else, the surgeon of the ship attributed the fortunate change, that took place soon after the ship left the Brazil coast.
With respect to the medical treatment little need be said, there being nothing unusual in it, nor did the surgeon follow any particular practice, or prescribe any thing more than is furnished to every ship of war; calomel, opium, neutral salts, magnesia, ipecacuanha, castor oil, jalap, senna, and. quassia amara, form nearly all the materia medica employed
for the cure of this disease, and he has reason to believe, that a judicious exbibition of these alone will in most cases effect a cure, though he has seen, from a misapplication of them, the worst and most dangerous effects. All these medicines were employed according to circumstances, but it would be impossible to give such an account of their effects, as to form rules for future practice, this disease being so variable in its progress, and so often requiring sudden changes of treatment. Nor would he enter into a disquisition on the pathology of the complaint, or mention the different opinions held by me. dical men on the nature of the disease, or the different modes of treatment that have been proposed. No one can doubt from the symptoms, the causes, and the appearances on dis. section, that it consisted in a specific inflammation of some part or other of the intestines, by which their functions are injured or destroyed, and the progressive impulse of their contents impeded ; and being affected with a morbidly increased sensibility from their inner coats being abraded, the patients often, particularly if the included matter be hard or scyba. lous, are thrown into extreme torture. This complaint, he believes, like most, if not all of the exanthemata that depend upon specific inflammation, has its commencement, increase and decline at certain periods, at the end of which the specific action ceases : and though the painful symptoms often continue for a great length of time, nearly as acute as during the prevalence of the complaint itself, yet they are occasioned by the abrasion of the intestines, which are sometimes left inflamed, ulcerated, or scirrhous, and these protracted symptoms are often very difficultly removed and sometimes prove fatal, being attended with almost continual pain, emaciation, dehility and hectic, which at length terminate the sufferings of the patient, unless he be previously cut off by an active and more general inflammation induced by the obstructions of the mesentery. I
To mention the medicines above spoken of, individually, it may be stated, that calomel was often used as a purge, with jalap, senna, salts, or ipecacuanba, sometimes as an alterative with opium, or mercurial pill. In the more ordinary cases, a few doses of laxative medicines would effect a cure ; in others the disease was more complicated. In a very few cases, the surgeon was obliged to resort to ptyalism, which had the desired effect; but he repaired to this as seldom as possible, and only in the most severe instances, as the patients were by it much reduced, and the recuperative means in his power very scanty. In some cases it was found adviseable to induce a copious sweat, and this was generally done by
Dover's powder and calomel ; when the perspiration was sufficiently profuse, it was very beneficial.
Opium was often found necessary, and however it may have been reprobated by some physicians, seemed not a lit- : tle to have been required, to relieve the inordinate action and long continued distress, under which some of the patients suffered ; he had occasion, however, in a few instances, to observe its deleterious effects when improperly prescribed. Neutral salts were a common purgative employed at the beginning of the disease, sometimes with calomel and senna ; and a few drops of sulphuric acid, or two ounces of lime juice, were found' an excellent addition.
Ipecacuanha has been a common remedy in this disease ; by some reprobated, by others extolled, but ought not to be withheld. It was found beneficial when combined with opium as a sudorific, and with rhubarb as a purge, and the most remarkable and unequivocal good effect, arose from a bihorial repetition of balf a grain of ipecacuanha with two of rhubarb, the belly having been previously fully evacuated by more active cathartics.
From magnesia was often obser:ed the greatest relief ; it sometimes occurred, that patients in the protracted stages of the disorder suffered with severe gastrodynia, and spasmodic affections of the abdominal viscera, which were often relieved by this medicine and oleum menthæ piperitæ alone, sometimes with opium. In two cases the most excruciating agony, accompanied with violent convulsions terrible to be looked upon, the patients mean while bowling with intolerable suffering, were relieved and soon removed by these inedi, cines.
Jalap was sometimes employed with calomel in the more trivial cases, or on the first onset, and had the best effects, but it was evidently too rough when the complaint was fully formed.
Of all the purgatives, castor oil was found in the advanced stage of the disorder to be the safest, most effectual, and the easiest of operation; there was scarcely a doubt, but that the life of one man was actually preserved by repeated doses of it, every other purgative throwing him into the most dread. ful convulsions.
These were the medicines principally employed during the disease itself; when its symptoms went off, and the patient was left weak, emaciated, and often at death's door, the in. tention was to strengthen the stomach, and by sympathy with it the other functions of the body; and this was very effectually done by a weak infusion of quassia amara, to which was added a small quantity of zingiber. By these
means nearly all the patients who suffered with dysentery recovered, and its further progress was prevented.”
Thus, Gentlemen, I have related, as they are reported to have occurred, a faithful history of the events that happened lately on board one of his Majesty's ships, and as they were of very unusual and fortunate event, seeing that during a very long voyage, performed in eight months, only seven persons died, one by an accident, and another of asthma, who was an old invalid; I would from a revision of the circumstances inculcate, that however adverse may be the circumstances, whatever opposition may be made to his attempts, or whatever obstructions should oppose the efforts of the medical man, when called upon to give his assistance in such cases, still he ought to embrace every, even the slightest means of ecsuring success, and thus in many cases of almost hopeless good event, prosperity will ultimately crown his efforts.
I have the honour to be,
With the greatest respect, Suffolk, Noo. 10, Your obedient servant, 1810.
JOSEPH ARNOLÓ, M. D. &c.
To the Editors of the Medical and Physical Journal:
If the following accidental core of a tape-worm, and the singular occurrence of a fair lady turning as black as a negro, appear worthy of your Journal, they are at your service.
A poor woman of Leeds, in Yorkshire, of the name of Weird, undertook to walk to the vicinity of Stowmarket in Suffolk, to see her daughter, who had inarried a militia man. The great length of the journey crippled and swelled ber ancles so much, as to occasion her sending to a neighbouring surgeon for some spirits to bathe then with, and she received some spt. vin. camph. for that purpose. The old lady admired its look and smell, and having for two years past been afflicted with pain in her stomach, observed to her daughter, 66 what was gude for the cote side might be gude for the in, and that she would e'en take a gulp of it.” Accordingly