Letter I received from the Gentleman whose Care I left him

under, I understood he had a Relapse, which he has since got the better of.

I forgot to inform you, that his Father died of the same Complaints, after being six Months without secreting a Drop of Urine; and his Brother died of the same in about ten Weeks.

Where it depended on Strictures of the Urethra, Bougies introduced into that Passage, and worn for some Time, were of great Service. The Patients were at the same time ordered to live on a cool Diet, and to drink the _decoctum Arabicum_, or an Infusion of Linseed, or such other mild mucilaginous Liquors; and to take oily Medicines and Opiates occasionally, and gentle Laxatives, to keep the Body open; which Method of Treatment generally gave Relief. Where the Patients were plethoric, or complained of Pain, or the Disorder was attended with a Fever, Bleeding was often necessary.

When the Stoppage of Urine seemed to arise from an Inflammation of the Kidneys or Bladder, or other Diseases of these Parts, we treated it accordingly; and where the Fever was considerable, we made Evacuations, and gave plenty of diluting Liquors, and the cooling saline Medicines, and afterwards those of the soft, mucilaginous, and oily Nature, and mild Diuretics and Opiates.

When the Disorder, in its Progress, became chronical, the Sick were commonly sent down to the fixed Hospital, so that we had no Opportunity of examining the Bodies of such as might die of this Complaint.

OF THE EPILEPSY.

The Epilepsy, or Falling Sickness, attacked a Number of Men, from the severe Duty of long Marches in hot Weather, and afterwards lying out on the cold Ground, exposed to the Damps of the Night[98].

[98] I saw above twenty Men, while I was in _Germany_, who attributed the Epileptic Fits they were attacked with to these Causes, and said they had never had the Epilepsy before; besides others, who had been formerly subject to these Fits, who declared, that the Disorder was brought back by the same Means.

It was very seldom that Men were cured of this Disorder in the military Hospitals. We had some few Instances, indeed, where Relief seemed to be obtained by Rest, a regular Diet, gentle Evacuations, and Issues[99]; but even those Men generally relapsed as soon as they were sent to their Regiments, and began to do Duty. All who had these Fits after being some Time with their Regiments, were at last discharged, and sent home. However, before Men are discharged for Fits, they should be watched very narrowly for some Time; for there is no Disorder which Soldiers are more apt to counterfeit than this.

[99] _William Wilson_, a Boy fourteen Years of Age, was admitted into _St. George_'s Hospital, _Sept._ 20, 1758, for Epileptic Fits, which he had been subject to for some Time, and which generally seized him three or four Times a Week. He took Variety of Medicines without any Effect till the 6th of _November_, when I ordered him to take eight Grains of the _pilulæ foetidæ_ Morning and Evening, and Physic twice a Week, and a Seton to be made in his Neck. After the Seton began to run, he had but three or four slight Fits in _November_, and none the following Month; and he was discharged the Hospital the 3d of _January_ 1759, seemingly in good Health, with Directions to keep the Seton running at least for some Months after he went home, and to come again to the Hospital if he should have any Return of his Fits; but we never heard more of him.

_Mary Hacket_, a Girl of nineteen Years of Age, was admitted into _St. George_'s Hospital the 14th of _February_ 1759, for Fits. The Account she gave of her Case, was, that about five Years before she was seized with the first Fit, after a Fright; three Years afterwards she had a second Fit, and for some Time after had a Fit commonly once a Month, about the Time of the full Moon; and since had them more frequently; that the Fits began with a Trembling and Shaking of the right Foot, and she had frequent pricking Pains in the right Thigh, and what she called convulsive Tremors in the right Leg and Foot. She was regular in her menstrual Discharge. At the Time she came into the Hospital, she was feverish, and complained much of a sharp Pain in the right Thigh: She was blooded, and took some cooling Medicine, and had no Fit till the 9th of _March_: She then took the fetid Pills and camphorated Julep twice a Day; but still the Fits returned frequently. She then had the Bark, Valerian and Purging Doses successively, and used the warm Bath; but without any Effect. On the 7th of _May_ a Blister was applied to her right Foot, which was intended to be kept open; but an Inflammation coming on that Leg and Foot, it was suffered to dry up, and an Issue made in the same Leg. From the Time the Blister was applied, she had no Fit while she remained in the Hospital. She was discharged the 15th of _July_, seemingly in good Health; though during that Period she had some little Tremors in her Foot, and was subject to be low and faintish, which was always relieved by cordial anodyne Medicines. After going out of the Hospital, she remained in good Health for seven or eight Months, when I was told her Disease had returned as violent as ever.

It is no Wonder that Soldiers, during the Time of Service, should seldom be cured of these Fits; for in Adults it is not often cured even in private Practice, with all the Conveniencies and Advantages to be wished for; and generally the few that do get well, require a considerable Length of Time to accomplish the Cure; and we find from daily Experience, as well as from examining the Records of Medicine, that the Cures that have been made, have mostly been performed either by a Change of Air, such as going from a cold to a hot Climate[100], by some remarkable Change of Life[101], or some accidental Disorder;[102] or by Issues or Drains[103]; or by the Removal of some acrid or irritating Substance, or such like[104]; or by preventing the Cause[105]; and that those Medicines called Specifics have in general had but little Share in the Cure.

[100] _Hippocrates_ lays the chief Stress of the Cure upon Change of Air, Aphor. 4, 5, sect. ii. The Baron _Van Swieten_ says, he has known a great Number cured by going to the _East Indies_; many of whom have remained well ever after, while others had a Return of the Disorder when they came back to _Holland_. _Comment._ vol. III. p. 436. sect. 1080.

[101] _Celsus_ has long ago observed, that the Appearance of the Menses in Girls, and of Puberty in Boys, often removes this Disorder, lib. iii. cap. xxiii.--On the 22d of _November_ 1758, _Mary Evans_, a Girl of eighteen Years of Age, was admitted into _St. George_'s Hospital for Fits. She had never had the Menstrua; but, for above two Years, found regularly, once a Month, a Fulness in her Breasts, and had a slight Head Ach, and other Symptoms which generally precede this Discharge; and were succeeded with violent Epileptic Fits, which continued returning frequently for two or three Days, and then went off; and she had no more Symptoms of them, till about the same Time next Month. She was ordered to take ten Grains of the _pilulæ foetidæ_ Morning and Evening, and a Dose of Physic twice a Week; and as I found that she became plethoric near the Time her Fits used to return, I began to imagine, that both the Fits and Stoppage of the Menstrua were owing to too great a Fullness of the Vessels, which prevented the Heart and vascular System from having such free Play, as to drive the Blood through the extreme uterine Vessels: I therefore ordered seven Ounces of Blood to be taken away from her immediately. In three Days Time the menstrual Discharge began to make its Appearance; and on the 10th of _January_ she was discharged the Hospital, seemingly in good Health, after the menstrual Discharge had returned for two regular Periods, without any Appearance of Epileptic Fits. She was desired to come back to the Hospital, if the Fits returned; but I never heard more of her.

[102] _William Glen_, a Patient in the _Royal Infirmary_ at _Edinburgh_ in _September_ 1747, was freed from Epileptic Fits, which used to return ten or twelve Times a Day, for a Quarter of a Year, by a Diarrhoea coming on; but they afterwards returned.

_A Man_ subject to the Epilepsy was cured of it by a Quartan Ague, and had afterwards no Return of the Disorder. _Miscell. Curios. Dec. 3. Ann. 3._ p. 34.

[103] There are numerous Instances of the good Effects of Issues and Drains in diverse Authors. _Tulpius_, _Van Swieten_, &c.

[104] _La Motte_ gives one Instance of a Person being cured of the Epilepsy by voiding five Stones, _Chirurg._ vol. II. p. 20; and of another who died of the Fits from a triangular Stone remaining in the Kidneys, _ibid._ p. 416. Dr. _Short_ cured a Woman of an Epilepsy of twelve Years standing, by extirpating a cartilagenous Substance, about the Bigness of a large Pea, seated on the gastronemei Muscles, above a Nerve which he cut asunder. _Edin. Medic. Essays_, vol. IV. Art. 27.

[105] _Galen_, tells us, of his having prevented the Epileptic Fits in a Boy, who used to have one whenever he was hungry, by making him carry Bread in his Pocket, and eat a little as soon as he found the least Symptoms of Hunger. _De Loc. Affect._ lib. v. cap. vi.--And _Van Swieten_ mentions how he cured a Boy, who had a Fit every full Moon; whose under Lip used to fall a Trembling before it began (a Symptom which, he says, often precedes Vomiting); by giving a Vomit every Month, for six Months successively, three Days before the full Moon, and an Opiate in the Evening after its Operation; and by putting him under a Course of strengthening Medicines. It was observeable, that if he vomited in the Time of the Paroxysm, it was soon at an End. See his _Comment._ vol. III. p. 439. sect. 1050.

OF THE SMALL-POX.

The Small-Pox appeared at _Paderborn_ in the Spring 1761, and five had the distinct Kind, who recovered. Six or seven had them at _Osnabruck_ in _May_ and _June_, and one Man and a Child died of the confluent Kind. Four had the distinct Kind at _Munster_ in _July_ and _August_ who all did well. During the Winter, we had sixteen in the Hospital I attended at _Bremen_; ten had the distinct Kind, and all recovered; five had the confluent Kind, of whom two died; as did also one who was brought to the Hospital with all the Symptoms of the most malignant Kind. Two were sent to _Natzungen_ in _July_, both ill of the confluent Kind; the one died two Hours after his Arrival; the other recovered: And we had only two in the Hospital at _Osnabruck_ in Winter 1762-63, and both did well.

There was nothing particular either in the Course or Treatment of this Disorder, different from what we meet with in daily Practice; only as the Soldiers, who were attacked with it, were strong, and in full Health, they required Bleeding and gentle Evacuations, and a cooling Regimen, on the first Appearance of the Symptoms.

The malignant Kind required the Use of Acids, and the Bark; which last, could often only be administered by Way of Clyster, as the Sick could not swallow it: In short, we treated the Patients much in the same Way as in the malignant Fever, Allowance only being made for the present Circumstances.

Luckily this Disorder never spread much in the Army, while I was in _Germany_.

OF ERISYPILATOUS SWELLINGS.

In _January_ 1762, several Patients in the Hospitals I had the Care of at _Bremen_, had shining watery Swellings of the Face, or Extremities; which came suddenly, and were attended with a slight Degree of Inflammation, and watery Blisters rising above the Skin, and some Degree of Fever. The Blisters were not small, round, and angry, as in _St. Antony_'s Fire; but larger, and of an irregular Figure, resembling those raised when People are scalded by boiling Water. The Swellings did not pit on being pressed, as the oedematous Swellings commonly do: They gave Pain when pressed, but the Inflammation was not in that high Degree as it is in the common Phlegmon: The Blood was sizy, and the Water of a high Colour. The Disorder seemed to be a Species of the Erisypelas.

Between the 9th and 12th of _January_, three Patients were seized with such Swellings.

The first was a Dragoon, who had just recovered from a Flux, and a bad Cough. On the 9th, he was suddenly seized in the Night with a large Swelling of his Face, Hands, and Arms, which had a shining oedematous Appearance, with a small Degree of Redness, and was painful when pressed; and he had two or three watery Blisters rose on the Back of each Hand above the Division of the Fingers, attended with a quick full Pulse, a feverish Heat and Thirst, a Cough, and somewhat of a Difficulty of Breathing, and high-coloured Water; and he was inclined to be costive. He was immediately blooded, had a saline Mixture with Contrayerva and Nitre, and was ordered to take a Purge in the Morning. Next Day the Blood had thrown up an inflammatory Buff, the Fever was abated, and the Breathing easier; but the Cough and Swelling still remained. He then took a Julep made of equal Parts of the Saline and Sperma Ceti Mixtures, which eased the Cough. The fourth Day the Pulse was soft, and the Swellings still in the same Situation, and the Breathing a little affected. A large Blister was applied to his Back, which discharged plentifully, relieved the Breathing, and lessened the Swellings considerably. The Cough and some Degree of Swelling still remained; but were removed by the Use of the Sperma Ceti Mixture with Oxymel, gentle Opiates, and some Doses of Physic.

The second was a Man of the Twentieth Regiment of Foot, who had been some Months in the Hospital for a hectic Complaint; he was taken ill, the same Night as the Dragoon, with a Swelling of his whole Face, particularly the Lips, which had a shining watery Appearance, and a slight Degree of Redness, attended with a strong Fever; and was cured by Bleeding, Purging, the Use of the saline Medicines, and the Application of a Blister.

The third was an Invalid, who had been admitted for a pleuritic Complaint, which he had got the better of. He was attacked, the second Night after the other two, with a shineing, watery, reddish Swelling, of his right Hand and Arm, up as far as the Joint of the Shoulder; four large watery Bladders likewise appeared on the fore Part of his Arm, above the Joint of the Elbow. Bleeding, with the cooling Medicines, and two Doses of Salts, carried off the Fever, and lessened the Swelling, in about seven Days Time; but a little of it, with a Stiffness, still remained; which at last was removed by the Use of aromatic Fomentations, rubbing with the _linimentum saponaceum_, and taking two Doses of Physic.

Within less than a Fortnight, five or six more were seized with Swellings of the same Kind on some of the Extremities, and all got well by nearly the same Treatment; excepting one Man, who was in a very low State, and had a large deep Ulcer on his Hip, where there had been a Mortification from his lying on that Part in a Fever. The Swelling at first seemed to give Way; but on the third or fourth Day, having got a severe Cough, the Swelling increased, and the Inflammation began to look livid, and the Discharge from the Sore to look bad; and, notwithstanding various Means were used, a Mortification of the Part came on, and he died the seventh Day.

OF THE SCURVY.

The true Scurvy, attended with spungy fetid Gums of a livid Colour, with livid Blotches, and Ulcers of the Legs, and other Symptoms, began to shew itself at _Bremen_ in _January_ 1762; tho' we had not the least Appearance of this Disorder in the Hospitals at any other Place, while I was with the Troops in _Germany_.

A great Variety of Disorders have been called by the Name of Scurvy: and the Disease has been divided into hot and cold; into the Acid, the Alcaline; and the Muriatic, according to the different Fancies of Authors, and the Causes they imagined it took its Rise from; but, from later and more accurate Observations, Dr. _Lind_ has justly remarked, that the true Scurvy has been found to be the same in all the different Parts of the Globe, and to take its Rise from similar Causes; from Cold and Moisture, and living much upon salted Provisions, joined to a Want of fresh Vegetables, and of good generous fermented Liquors; and hence it is most frequent in low marshy Places in northern Climates, where there is a Scarcity of fresh Vegetables; and where the Inhabitants live much upon salted Provisions in Winter; and aboard of Ships in long Voyages or Cruizes, especially in the northern Seas; and hence this Disorder was so frequent at _Quebec_ the first Winter it was in our Possession; and in some of the other Forts in _North America_, which were taken so late in the Year, that the Troops had not sufficient Time to lay in a Stock of Vegetables, and of fresh Meat to be preserved by the Frost[106]; but were obliged to live mostly on Ship Provisions.

[106] In _Quebec_, and other northern Parts of _North America_, as soon as the Frost sets in, they kill their Meat intended for their Winter Store, and hang it up: It soon freezes, and will keep in this Manner all through the Winter. They preserve Vegetables in the same Way; and when they intend to make Use of either, they put so much as they want into cold Water for some Time, which draws the Frost out of it; and then they boil or roast it, as they think proper.

It is observed, both at Sea and Land, that where the Scurvy rages, those People are least subject to it who are well cloathed; who live in dry Habitations, or lie in dry Births; who take proper Exercise, without being too much exposed to the Inclemency of the Weather; and who live well, and drink good Beer, Cyder, or Wine; as has been remarked by Dr. _Pringle_, Dr. _Lind_, and others.

At _Bremen_ the Disorder was only observed among the Soldiers; not one of the Gentlemen belonging to the Hospital, or to the Commissariate, nor one of the military Officers, not even of the Serjeants, having the least Symptom of it. The Reason of its being frequent among the Soldiers was, that the Place is situated on a Plain naturally very damp; and the Soldiers were quartered in very low damp Houses; at the same Time, no Vegetables or Greens were to be bought in the Market; and fresh Meat, and other fresh Provisions, were at so high a Price, that the Soldiers could not afford to buy them; but were obliged to live on salted Meat, and salted Herrings, during the Winter; and what little Money they had remaining, they laid out on spirituous Liquors, which were sold cheap.

The Cure of this Disorder requires--living in a dry comfortable Place--good Cloathing--light Food of easy Digestion, such as good Bread, Panado, Milk, Whey, Broths made of fresh Meats--white Meats, with Greens, or other Vegetable, &c.--the Use of Liquors of the acid or acescent Kind, or the moderate Use of Beer, Cyder, good Wine, or weak Punch[107]--And, by Way of Medicine, gentle Purges, mild Diaphoretics; the free Use of acid or acescent Fruits, Lemons, Oranges, Apples, Pears, Currans, Grapes, &c. and of the antiscorbutic Plants and their Juices, as Succory, Endive, Water-Cresses, Scurvy-Grass[108], &c. on which a great Part of the Cure principally depends; and the Use of some of the strengthening Bitters[109], of which the Bark is not the least efficacious.

[107] The free Use of raw Spirits is found to be very prejudicial; but a moderate Quantity of these Spirits, diluted with Water, and acidulated with Lemons or Oranges (or with Cream of Tartar, or Tamarinds, when the former cannot be got), and made into Punch, is found to be a good Antiscorbutic.

[108] Most ripe Fruits, particularly Lemons and Oranges, and esculent Herbs, and many Kinds of Roots, such as Horse-Radish, Onions, Leeks, and many others, have been found the most useful Remedies in the Cure of the Scurvy. Decoctions and Infusions of Fir-Tops, of Spruce, and of other Species of the Pine-Tree; and Beer made of these Infusions, by fermenting them with Molasses, are approved Antiscorbutics: and when such Remedies cannot be got, Infusions of the common Bitters, and weak Punch, made with Tamarinds or Cream of Tartar, have proved serviceable; and where these Acids cannot be had, the Mineral Acids may be used for acidulating the Drink. However, it ought always to be remembered, that fresh Vegetables and Fruits, and vegetable Acids, produce much better Effects in the Scurvy, than any other Sorts of Remedies; and ought always to be used, when they can be got.

[109] Most of the common Bitters have been strongly recommended in this Disorder, Gentian, Trifoil, Wormwood, &c.--as likewise aromatic Bitters and Aromatics; such as _calamus aromaticus_, Carvi Seeds, Winters Bark, Cinnamon, and many others.

Bleeding is seldom requisite, except where there is much Heat or Fever; or a sharp Pain of the Side, or Difficulty of Breathing, or some Symptom of the like Kind; it is then sometimes necessary to take away some Blood: And in obstinate Cases, it is often found of Use to promote Sweats, by making the Patient, while in Bed, drink freely of warm Whey, or Sack Whey, mixed with the scorbutic Juices; or warm Barley Water, or the like, mixed with a small Quantity of the Antimonial Wine, or some other mild Diaphoretic.

And where the Patient is strong, and there is no Danger of Hæmorrhages, warm aromatic Baths have sometimes been found serviceable; but they are not to be used where the Patient is weak.

The first Time I saw this Disorder at _Bremen_, was in an old Invalid, _James Long_, who had come from _Bristol_ to _Embden_, and from thence to _Bremen_. He was some Weeks in the Hospital before I discovered his Disorder to be the Scurvy. He at first complained only of great Weakness, and such a Giddiness, when he got out of Bed, that he could not walk, and of what he called flying rheumatic Pains of his Legs. He had no other visible Complaint; all which, I imagined, proceeded from Old-Age, and being worn out in the Service. At last, on the 25th of _January_, he complained of his Gums being sore; and, on examining him, I found his Breath fetid, his Gums swelled, soft, and spungy, his Legs covered with scorbutic Blotches, and other Symptoms, which evidently proved his Disorder to be the true Scurvy.

Upon which, I ordered him a low Diet, with the Addition of Greens for Dinner, and a Quart of Lemonade, with a Gill of Brandy in it, _per_ Day, for his common Drink; and, by Way of Medicine, a Decoction of the Bark, with the Elixir of Vitriol; and, at the same Time, ordered his Gums to be scarified, where they were most swelled and spungy; and to be washed frequently with an astringent Gargle; and to be rubbed now and then with burnt Alum[110]. By these Means, in a Fortnight's Time, his Gums became firmer, and his scorbutic Symptoms decreased. During that Course he took cold, and had a Stitch in his Side, for which he was blooded. The Blood threw up a very thin Buff, which was not of a firm Consistence[111]; the Crassamentum below was of a blackish Colour and of a loose Texture, and the Serum in a large Proportion. By the 2d of _March_ his Gums had recovered their natural Firmness and Texture, and the scorbutic Spots and Pains of the Legs were gone, and he had recovered his Strength; the only remaining Complaint was a little Swelling about the Ankles, for which he continued the same Course, and took a Dose or two of Physic. By the 16th of _March_ all these Symptoms were gone, and he was dismissed the Hospital free from all Complaints. I saw him well the last Week in _May_; and he told me, he had had no scorbutic Symptom since he left the Hospital.

[110] Dr. _Lind_, who has wrote one of the best Treatises on this Disorder, and who had a great Deal of Practice himself, says, "When first the Patient complains of an Itching and a Spunginess of the Gums, with loose Teeth, either a Tincture of the Bark in Brandy, or aluminous Medicines, will be found serviceable in putting a Stop to the Beginning Laxity of these Parts." When the Putrefaction increases, he recommends the Use of some of the mineral Acids. See his _Treatise on the Scurvy_, part ii. chap. v. p. 201.--_Van Swieten_ says, he never found any Thing answer better than a Gargle made of four Ounces of Elder or Rose Water, acidulated with a Drachm of the Spirit of Sea Salt; and where the Gums were very putrid and gangrened, he has been obliged to touch them slightly with the pure Acid Spirit, and some Hours after to have them washed with the Gargle just mentioned. Vide _Comment._ vol. III. p. 629, sect. 1163.

If the Spunginess of the Gums sprout out into a luxuriant Fungus, it is sometimes requisite to cut such Funguses away, and to wash the Sores frequently with gentle astringent or acid Liquors.

[111] Dr. _Huxham_ observes, that, after the Disease has continued some Time, the Blood appears a mere Gore as it were, not separating into Serum and Crassamentum as usual, but remaining an uniform half-coagulated Mass, generally of a more livid or darker Colour than common; though sometimes it continues long very florid; but it always putrifies soon. See his _Essay on Fevers_, chap. v.

There is something very particular in the Nature of this Disorder, according to an Observation of Dr. _Lind_'s; who says, "That the Scurvy is a Disease in its Nature very opposite to that of a Fever; insomuch, that even an Infection is long resisted by a scorbutic Habit; and those of a scorbutic Habit being seized with the Fever, was a Proof of its proceeding entirely from Infection." See his _First Paper on Fevers_, p. 4.

In the Beginning of _February_, another of the Invalids, who had been in the Hospital for a Fever and rheumatic Complaints, had Blotches appear on his Legs, complained of great Weakness, and fainted away in attempting to walk; which made me suspect his Disorder to be the Scurvy; and, on examining him, I found his Gums soft and spongy, attended with the other Symptoms of the true Scurvy. I put him nearly on the same Course as in the last-mentioned Case: He used a low Diet, with the Addition of Greens for Dinner, which he eat with a little Butter and Vinegar; and he had a Quart of Lemonade, with two Ounces of Brandy, for his common Drink during the Day; and, by Way of Medicine, a Decoction of the Bark, with two Drachms of the _confectio cordiaca_ to each Half Pint, which he took by Spoonfuls. Next Day he complained of a Pain in his Leg; and, on examining it more particularly, I found a large livid Blotch, yellow all round the Edges, on the fore Part, and a Tension all over that Leg. As he was so extremely low, as to be in Danger of fainting whenever he sat up, I was afraid lest a Mortification should ensue; and therefore ordered his Leg to be bathed Morning and Evening with a warm aromatic Fomentation, and a Poultice of Theriaca to be applied after it; and desired him to take as much of the Decoction of the Bark with the Cordial as possible; and allowed him a Glass of Mountain Wine every two or three Hours. By the Continuance of this Course for some Weeks, the livid Blotches, Pain, and Stiffness of his Leg, and most of the other scorbutic Symptoms, went away; his Gums were restored to their natural Firmness; and he recovered his Strength so much as to be able to sit up all Day long; though he still remained very weak when he was sent to _England_, in _March_.

In _February_ and _March_, seven or eight more scorbutic Patients were sent to the Hospital I attended, who were all treated in the same Manner; and all did well. About the Middle of _February_ this Distemper began to shew itself in the other Hospital attended by Dr. _Miller_, who treated the Patients nearly in the same Way, and they all recovered.

On the 5th of _April_, a young Man, belonging to the Eighth Regiment of Foot, came to the Hospital with all the Symptoms of the true Scurvy; his Gums were spungy and foetid; he had livid Blotches on his Legs, and Contractions of the Hams, and a Stiffness and Hardness in the Calves of both Legs[112]. By following the same Course as the others, and the Use of frequent Fomentations, and rubbing the contracted Parts with soft Liniments, he mended daily; and, after taking a Dose or two of Physic, was dismissed perfectly recovered on the 10th of _May_. At his first Admission into the Hospital, he was taken with a severe Cough, attended with Pain of the Breast, and a Spitting of Blood for a Day or two, for which he was blooded. His Blood threw up a little Buff; the Crassamentum was of a blackish Colour and of a loose Texture, with a good Proportion of a yellowish Serum. This Bleeding relieved the Complaints of his Breast, and he had no Return of them while he remained in the Hospital.

[112] If the Swellings become large, stiff, and painful, Dr. _Lind_ recommends that the Legs should be frequently bathed and fomented; or, what he has found preferable, to be exposed to their Steams, after being well covered with Blankets. After this Operation, he advises the Limb to be rubbed with some mild Oil, such as _oleum palmæ_, or Salad Oil; and if the Swellings resist both the general Cure and these Applications, the Limbs to be sweated with Spirits. See his _Treatise on the Scurvy_, part ii, chap. v.

The first Week in _May_ four Invalids were admitted into the Hospital for this Disorder. The first had spungy Gums, a foetid Breath, his Legs swelled and hard, and of a deep purple Colour. The second was a Case at first of a more doubtful Kind; there were no spungy Gums, though an offensive Breath; his Ancles and Feet were swelled, attended with Pain and Uneasiness, and a great Weakness and Lassitude; but no Fever, nor any livid Blotches. The Swelling of the Feet and Ancles seemed at first Sight rather gouty or rheumatic, than of the scorbutic Kind; but from the Man's Way of Life, and the Disorder being so frequent, we discovered it to be the Scurvy. The third had a very foetid Breath and spungy Gums, livid Spots and fungous Ulcers[113] on his Legs, with Pains and Weakness all over. The fourth had also spungy Gums and a foetid Breath, Pains of the Legs and Arms, livid Blotches on his Legs, great Hardness and Contraction of the right Ham, and a livid hard Swelling on the Outside of the left Thigh, immediately above the Knee.

[113] "Ulcers on the Legs, or any other Part of the Body, require pretty much the same Treatment, _viz._ very gentle Compression, in order to keep under the Fungus, and such antiseptic Applications as have been recommended for putrid Gums, _viz. mel rosat._ acidulated with _spiritus vitrioli_, _ung. Ægiptiacum_, &c. but nothing will avail where the Patient cannot have Vegetables and Fruits." _Dr. Lind's Treatise on Scurvy_, part ii. chap. v. p. 204. And he recommends, if the Swellings and Ulcers of the Legs neither yield to the general Cure nor to the Methods here proposed, that a slow and gentle Course of Mercury should be tried, after the scorbutic Taint is a good deal removed, and the Gums are sufficiently firm; and to give along with it a Decoction of the Woods, or of Sarsaparilla; but this Method ought not to be attempted till the Gums have acquired a proper Firmness. See _ibid._ part ii. chap. v.

We treated them all four in the Method above-mentioned, adding a Mess of Greens to Dinner, giving Lemonade for Drink, and the Bark, with Elixir of Vitriol, by Way of Medicine. The Parts that were hard and swelled, were fomented, and rubbed with soft Liniments, and Poultices were applied to the hard Swelling on the Outside of the left Thigh; and the Ulcers of the Legs dressed with Digestives, and occasionally washed with spirituous Tinctures, and touched with Escharotics. Before I left _Bremen_, the first Week in _June_, the first and second Patients were perfectly recovered, and the third and fourth almost well. All of them had had the Disorder some Months before they came to the Hospital.

OF THE ITCH.

There was no Disorder so common in the military Hospitals as the Itch. It is of an infectious Nature, and now most commonly believed to be entirely owing to little Insects lodged in the Skin, which many Authors affirm they have seen in the Pustules by the Help of a Microscope; and that the Disorder is entirely communicated by Infection, and does not arise from any Fault in the Fluids or Solids.

It has been found by Experience, that internal Medicines have little or no Effect in removing this Disorder; and that only external Remedies, which come immediately in contact with the Parts affected, are capable of making a Cure; which has been brought as a farther Proof, that the Itch is owing to Animalcules or Insects; as it is alledged, that no Remedies will cure the Distemper, but such as are capable of killing them.

The Medicines, which are most commonly used for the Cure, are _Mercury_, _White Helebore_, and _Sulphur_.

Mercurial Frictions on the Part are often made use of, and sometimes with Success, though they are by no Means to be depended upon for a Cure; besides that, they are liable to throw the Patients into a Salivation, as I have seen happen more than once; for which Reasons I would never recommend this Method where the Patient labours under no other Disorder which requires the Use of Mercury, and would confine it entirely to Cases where Patients, having the Itch, labour, at the same Time, under the _Lues venerea_, and require the free Use of mercurial Frictions; under such Circumstances the mercurial Ointment may be as well rubbed on the Parts affected with the Itch as upon any other.

The Powder of the Root of _White Helebore_, made up into an Ointment with Hogs Lard, or a strong Decoction of it in Water, rubbed on the Parts, will often cure the Itch; but it is a sharp Medicine, and generally smarts, and sometimes inflames the Parts on which it is rubbed; and therefore it is not so commonly used, as we know a much surer and milder Remedy. Though I have cured some People with the Helebore Lotion without any Inconvenience, who would not use the Sulphur on Account of its Smell.

_Sulphur_ is the most certain and easy Cure for the Itch of any we know, and perhaps is more certain in the Cure of this Disorder than almost any other Medicine in any other Disorder whatever. We used it in Form of the Sulphur Ointment of the _London Dispensatory_, of which one, two, or more Drachms were rubbed in every Night, in Proportion to the Extent of the Parts affected. These Unctions were continued from four or five to ten or twelve Nights, according to the Violence and Continuance of the Disorder. Most were cured in a few Days; others required a longer Time. As the sulphureous Unctions tend to obstruct the Perspiration, we generally ordered a Purge to be given before rubbing the Sulphur Ointment, and in full Habits sometimes ordered a little Blood to be taken away; and put them all under a low Diet. After the Disorder seemed to be removed, they took another Dose or two of Physic to carry off any Impurities that might have been thrown upon the Bowels, during the Use of the Sulphur Ointment. In inveterate Cases, the Sulphur was given internally at the same Time that the Patient rubbed with the Ointment.

It is generally believed (though denied by some) that Sulphur, taken internally, enters the Blood; and its Steams are thrown off by the perspiratory Vessels, and assists more effectually to destroy the Insects and their Ovula, which give Rise to the Itch; but whether this Effect be true or not, I found it to answer another very good Purpose; which was to keep the Belly rather loose, while the Patient used the Unction; and by this Way it carried off those Humours, which ought to have passed off by the Skin; and for that Reason, when it had not that Effect, we joined some Lenitive Electuary to it.

There is one Thing to be observed with regard to sulphureous Unctions, which is, that we ought not to use them too soon with People recovering out of Fevers, or other Disorders which bring them low; otherwise there will be Danger of bringing on a Relapse, which I have often observed to happen in military Hospitals, where the Itch has appeared as the Patients were recovering from Fevers and other Disorders, and the Unctions were used too soon: But whether these Relapses were owing to the sulphureous Unction's stopping up the Pores of the Skin, and obstructing a free Perspiration, or to the Patient's being more apt to take Cold while they used the Sulphur Ointment, than at any other Time, is what I cannot determine; but to me it seems most probable, that these Unctions rather obstruct the Perspiration; and that when they are used too soon with People recovering from Fevers, especially those of the putrid Kind, they prevent those Particles from passing off by the Skin, which it was necessary should be evacuated, in order to free the Body from the Seeds of the Fever, or other Disorders the Patients laboured under. But however this be, Experience has shewn, that we ought not to attempt the Cure of the Itch, in Patients so circumstanced, till their Strength be in a great Measure re-established, otherwise there will be Danger of a Relapse; and likewise, that Patients using Sulphur externally, ought to be particularly on their Guard against Cold.

This Observation of Peoples being so apt to relapse after Fevers by the too early Use of sulphureous Unction, is a strong Proof of the Usefulness of keeping the Body open during the Time of Rubbing and of Purging the Patient afterwards; as by these Means we may carry off by the Bowels those Particles which could not pass by the Skin; and I think, so far as I have been able to observe, those People have been less subject to relapse into Fevers where this Caution has been used, than where it has been neglected.

That Species of the Itch where it forms small Ulcers or Pustules in the Skin, is the worst Kind, and most contagious, and seems to take its Rise from the common Itch continuing long, and making its Way deeper into the Skin. The Cure is the same, only this requires more frequent Unctions, and those to be continued longer, than before the Disorder has taken such deep Root.

It is no uncommon Thing to see the Itch appear again, some Weeks after it has seemingly been cured by the Use of sulphureous Unctions; which most commonly happened to those who were in too great a Hurry to get well, and left off the Use of the Unctions too soon. Such Returns of the Itch were generally cured by the Repetition of the same Treatment as before.

TABLE of DIET.

The following is a Copy of the Table of Diet which was used in the Hospital all the Time I was with the Troops in _Germany_:

_Breakfast._ | _Dinner._ | _Supper._ | | One Pint of Rice | | Gruel; made with two | | Ounces of Rice, one | | Full Diet, Spoonful of fine | One Pound of | As Breakfast. Flower, a little | Meat. | common Salt, and fine | | Sugar. | | ______________________________________________________________________ | One Pint of | Middle Diet, As above. | Broth, Half a | As above. | Pound of Meat. | ______________________________________________________________________ | One Pint of | | Broth; or Half | As above, or | a Pint of | according to | Panado, with two | Low Diet, the Patient's | Spoonfuls of | As Breakfast. Stomach or | Wine, and a | Indisposition. | Quarter of an | | Ounce of fine | | Sugar. |

The daily Allowance of Bread was a Pound to those on full and middle Diet, and Half a Pound to those on low Diet, or a Pound, if so ordered by the Physician.

Those on full and middle Diet were allowed daily three Pints of Barley or Rice Water; to each Pint of which were added two Spoonfuls of Brandy, and a Quarter of an Ounce of Lump Sugar. Small Beer was mentioned in the Diet Table; but this we could never have good; and therefore was not used.

Those on low Diet were allowed Barley or Rice Water; to which some Wine or Brandy was occasionally added, if ordered so by the Physician.

Besides this, the Physician might order an additional Quantity of Wine, Brandy, or Milk, or Water Gruel, or any other Articles which he thought proper for the Sick under his Care, and which could be got easily.

PHARMACOPOEIA IN USUM

Nosocomii Regii Militaris Britanici.

MDCCLXI.

PHARMACOPOEIA IN USUM

Nosocomii Regii Militaris.

Ann. MDCCLXI.

AQUÆ SIMPLICES ET SPIRITUOSÆ.

AQUA Alexeteria. ---- Bacc. Juniperi. ---- Cinnamomi. ---- Menthæ vulgaris. ---- Menthæ piperitidis. ---- Nucis moschatæ. ---- Pulegii. ---- Rutæ.

Vel aliæ aquæ hujus generis præparari possint, terendo in mortario vitreo elaeosacchara præparata, cum oleis essentialibus, et sacchari albi 12la quantitate; et dein addendo aquæ fontanæ vel spiritus vini tenuis quantitatem sufficientem[114].

[114] Such _Elaeosacchara_ (as they are called), made by rubbing the essential Oils with twelve Times the Quantity of Sugar, may at all Times be prepared at the fixed Hospital, and carried about with the flying Hospital, much more conveniently than the simple or compound Waters themselves.

Aqua calcis simp. Ph. Lond.

Dosis a lib. i. ad lib. ij. in die.

Aqua Hordeata. Ph. Lond.

Utenda pro potu.

BOLUS.

Bolus anodynus astringens.

Rx Theriacæ andromachi, drachm. dimid. opii, gr. i. M. pro dosi semel vel bis die.

Bolus e rheo cum mercurio.

Rx Pulv. rhei, gr. xxv. calomel, gr. v. syrup sacchari, q. s.

Bolus e calomel.

Rx Calomel gr. v. conserv. rosar. scrup. i. M.

Bolus mercurialis.

Rx Argenti vivi, gr. x. extingue in balsam copaivi, q. s. et adde conserv. rosar. q. s.

Bolus e scordio cum rheo.

Rx Elect. e scordio, scrup. i. pulv. Rhei, gr. x. syrup, q. s. ut fiat bolus sumendus semel, bis, terve die.

COLLYRIA.

Collyrium saturninum.

Rx Sacchari saturni, salis ammoniaci crudi ana gr. vi. solve in aq. fontanæ, unc. xij. adde pro re nata tinct. thebaicæ, drachm. i.

Collyrium vitriolicum.

Rx Vitrioli albi, drachm. ss. solve in aq. fontanæ, lib. i.

Confectio cardiaca. Ph. Lond.

Conserva cynosbat. Ph. Lond.

Conserva rosar. Ph. Lond.

DECOCTA.

Decoctum album. Ph. Lond. utendum pro potu.

Decoctum arabicum.

Rx Gum. arabici, unc. dimid. coque in aq. hordeatæ bullientis, lib. ij. ad solutionem Gummi. utend. pro potu.--addi possit pro re nata spirit. nitri dulcis, drachm. ij.

Dococtum corticis Peruviani.

Rx Cort. Peruv. crass. pulv. unc. i. coque in aq. fontan. lib. iij. ad lib. ij. Colaturæ adde tinct. cort. Peruv. unc. i. spirit vini Gallici sescunc. Dosis ab uncia i. ad unc. iv. bis ter. quaterve die.

Decoctum cort. cum serpentaria.

Fit addendo decocto cort. Peruv. sub sinem coctionis, rad. serpentariæ virgin. contus. unc. dimid. Dosis ab unc. i. ad unc. iij. ter quaterve die.

Decoct. commun. pro clyster.

Rx Flor. vel herb. chamæmel. unc. i. coque in aq. fontan. lib. i.ss. ad lib. i. & cola.

Decoctum ligni guaiaci.

Rx Ligni guaiaci ras. lib. ss. aq. fontanæ bullientis, cong. ij. macera per noctem; mane coque ad congium. i. & cola; Capiat a lib. ss. ad lib. ij. die.

Decoctum nitrosum.

Rx Coccinel. scrupul. i. coque in aq. fontan. lib. ijss. ad lib. ij. & dein adde salis nitri, unc. i. sacchar. albi sescunc. Colaturæ addi possit pro re nata aq. alicujus spirit. unc. ij. Dosis ab unc. i. ad unc. iv. 4tis vel 6tis horis.

Decoctum pectorale.

Rx Fol. herb. malvæ, unc. ij. feminum lini, unc. dimid. coque in aq. fontan. lib. ivss. ad lib. iv. addendo sub finem coctionis rad glycyrrhiz sescunc. vel mellis optimi, unc. i. Cola pro potu.--Adde pro re nata aceti, sescunc.

Decoctum rad. sarsaparillæ.

Rx Rad. sarsaparillæ, unc. iij. coque in aq. fontan. lib. iij. ad lib. ij. adde sub finem coctionis ligni sasafras, drachm. i. rad. glycyrrhizæ, drachm. ij. Colaturæ capiat a lib. i. ad lib. ij. in die.--Adde pro re nata vini antimonialis, drachm. ij.

ELECTARIA.

Elect. astringens balsamicum.

Rx Specier. e scordio, pulv. e tragacanth. comp. ana unc. i. tincturæ thebaicæ, drachm. ij. syrup sacchari, q. s. ut fiat elect. Dosis ad molem N. M. bis, ter. quaterve in die.

Elect. corticis Peruviani.

Rx Pulv. cort. Peruv. unc. iv. syrup sacchari, q. s. Dosis a scrup. i. ad drachm. unam, bis, ter, 4r. 6ties. vel decies die.

Elect. corticis anodynum.

Rx Elect. cort. Peruv. unc. 1nam. elect. e scordio unciam dimidiam, vel tinct. thebaicæ scrup. ij.

Elect. corticis astringens.

Rx Elect. cort. Peruv. semunc. pulv. rad. tormentil, lapidis cancror. ppt. singulorum, drachm. i. syrup, q. s.

Elect. cort. cum serpentaria.

Rx Elect. cort. Peruv. unc. i. pulv. rad. serpentar. virgin. cort. canel. alb. ana, drachm ij. syrup. q. s.

Elect. cort. cum sale ammoniac.

Rx Elect. cort. Peruv. sescunciam. sal. ammon. crud. drachm. i.

Elect. e baccis lauri. Ph. Lond.

Elect. lenitiv. Ph. Lond.

Elect. lenitivum cum sulphure.

Rx Elect. lenitiv. lib. ss. flor. sulphuris, unc. ij. Dosis, moles, N. M. vel ad semunc. pro re nata.

Elect. lenitivum compositum.

Rx Elect. lenitiv. lib. i. pulv. jalap. unc. i. sal. nitri, drachm. ij. syrup. q. s. Dosis a drach. i. ad drach. iv. pro r. n.

Elect. lenitivum balsamicum.

Rx Elect. lenitiv. comp. unc. ij. bals. copaiv. unc. i. gum guaiac. unc. ss. M. Dosis, cochleare theæ, h. s. vel mane & vesperi.

Electuar. e scordio vel diascordium. Ph. Lond.

Elect. e spermat. ceti.

Rx Balsam Peruv. unc. im. misce optime cum mucilag. gum arab. sescunciam & adde spermat. ceti, conserv. rosar. ana unc. xij. syrup sacchar. q. s. dosis, a dimidiâ drachma bis die ad drachm. im. quater vel sexties die.

Elect. stomachicum.

Rx Conserv. cynosbat. unc. iv. pulv. rad. zinziber. drachm. ij. canell. alb. unc. i. rubigin. martis, drachm. ij. syrup. q. s. dosis a scrup. i. bis terve die ad semidrach. 4tis horis.

Elect. e scammon. Ph. Lond.

ELIXIR.

Elix. aloes. Ph. Lond.

Elix. paregoricum. Ph. Lond.

Elix. vitrioli acid. Ph. Lond.

ENEMATA.

Enema commune laxativ.

Rx Aq. fontan. calid. unc. xij. elect. lenitiv. semunc. sal. cathartici amari, unc. i. M.

Enema commun. oleos.

Rx Aq. fontan. bullient. unc. x. mucilag. gum arabic. unc. im. olei olivar. unc. ij. adde pro re nata elect. e scord. drachm. ij. vel. tinct. thebaic. drachm. i.

Enema ex amylo.

Rx Aq. fontan. calid. unc. iv. gelatin. amyli, unc. v. elect. e scord. drachm. i. M.

Enema terebinth.

Rx Terebinth commun. drachm. vi. solve in vitello ovi & adde enemat. oleos. unc. x.

Emplastrum vesicatorium. Ph. Lond.

FOTUS.

Fotus communis.

Rx Fol. malv. flor. chamæmel. singulorum, m. i. coque in aq. fontan. q. s.

Fotus commun. spirit.

Rx Fotus commun. lib. ij. aceti, lib. i. spirit. vini tenuis, lib. ss. M. pro fotu.

Fotus cum sale ammoniac.

Rx Fotus commun. lib. ij. sal ammoniac crud. unc. i.

Fotus volatilis.

Rx Fotus commun. q. s. asperge panno statim ante applicationem spiritus sal. ammoniac, q. s.

GARGARISMATA.

Gargarisma commune.

Rx Aq. hordeat. unc. xij. sal. nitri, drachm. i. mellis semunc. M. adde pro re nata spirit. vin. unciam i.

Gargarisma acidum.

Rx Aq. hordeat. unc. xij. spirit. vini gallici, unc. i. aceti sescunc. tinct. myrrhæ, drachm. ij. M.

Gargarisma volatile.

Rx Aq. hordeat. unc. xij. spirit. vin gallic. unc. ij. sal. vol. ammoniaci, drachm. i. M.

GUTTÆ ANTIMONIALES ANODYNÆ.

Rx Vini antimonialis, unc. im tinct. thebaic. drachm. ij. dosis a gutt. 30 ad 40 bis terve die, vel a gutt. 60 ad 140, h. s. in potu tepido.

HAUSTUS.

Haustus simplex.

Rx Aq. fontan. sescunc. spirit. vini gallici drachm. i. ss. sacchar alb. drachm. dimidiam M.--Haustus præparari possit aqua aliqua simp. et spirit. loco aq fontan. & spirit. vini gallici pro re nata.

Haustus anodynus.

Rx Haust. simp. sescunc. tinct. thebaic. gutt. xx. M.

Haustus camphoratus.

Rx Camphoræ, gr. iij. tere in mortario cum sacchar. alb. drach. dimid. & dein adde mucilag. gum arabici, drachm. ij. haust. simp. sescunciam. M. s. a. Dosis repetenda, 4ta vel 6ta. quaque hora.

Haust. emetic. antimonialis.

Rx Vini antimonialis semunciam. Dari possit ad drachm. x. pro r. n.

Haust. emeticus scilliticus.

Rx Oxymel. scillit. drachm. x. aq. fontan. semunc. pulv. rad. ipecacoan. gr. vi.

Haustus cardiacus.

Rx Haust. simp. sescunciam confect. cardiac. scrup. im. M. f. haustus repetendus 4tis. vel 6tis. horis--adde pro re nata sp. lavend. comp. dr. i.

Haustus cardiacus oleosus.

Rx Ol. essential. menth. gutt. ij. tere in mortario vitreo cum sacchar. alb. drachm. dimid. & adde haust. simplicis sescunc. tinct. stomachic. drachm. i. M.--adde pro re nata tinctur. thebaic. gutt. x.

Haustus lixiviosus anodynus.

Rx Haust. simp. sescunciam, lixivii tartari, drachmam dimidiam tincturæ thebaicæ, gutt. xx. cap. h. s. vel mane & vesperi.

Haustus e mithridatio.

Rx Haust. simp. sescunc. mithridat. scrup. i. aceti vin. drachm. iij. dosis repetenda 4tis. vel 6tis. horis.

Haustus oleosus communis.

Rx Mucilagin. gum arabici, drachm, iv. ol. olivar, drachm. v. misce s. a. & adde haust. simp. sescunciam. Repet. 4tis. vel 6tis. horis.

Haustus oleosus cum rheo.

Rx Haust. oleos. communis, unc. ij. tinct. rhei sescunc. vel pulv. rhei, gr. xxv. tinct. thebaic. gutt. xv. M. fiat haustus sumendus vel h. s. vel primo mane.

Haustus purgans.

Rx Infus. senæ. unc. iij. sal. glauber. drachm. iij. spirit. vin. gallici, drachm. ij. sacchar. alb. drachm. dimid. capiat mane.

Haustus salinus communis.

Rx Aceti vinosi vel succ. limonum semunciam, sal. absynth. scrup. i. vel ad saturationem, haust. simp. sescunciam adde pro re nata pulv. contrayerv. comp. scrup. i. vel pulv. contrayerv. cum nitro, scrup. ij.--Haustus præparari possit cum salis diuretici drachma dimid. loco acidi & salis absynthii. Dosis repetend. 3tiis. 4tis. vel 6tis. horis--Eodem modo sit haustus cum spirit. mindereri uncia dimidiâ.

Haust. salin. cum confect. cardiaca.

Rx Haust. salin. commun. unc. ij. confect. cardiac. scrup. i. M. repet. 4tis. vel 6tis. horis.

Haust. salin. cum mithridatio.

Rx Haust. salin. commun. unc. ij. mithridatii, scrup. i. M. sumend. 4tis. vel 6tis. horis.

Haustus salin. cum rheo.

Rx Haust. salin. com. uncias ij. pulv. rhei, gr. xxv. M. capiat mane.

Haustus salin. cum phu.

Rx Haust. salin. commun. unc. ij. pulv. rad. valerian. sylvestris, scrup. ij. Dosis repetend. 2dis. 4tis. vel 6tis. horis.

Haust. salinus succinatus.

Rx Haust. salin. commun. unc. ij. sal succini, pulv. castorei singulorum, gr. x. H. repetend. 4tis. vel 6tis. horis.

Haust. salinus purg. oleosus.

Rx Mannæ opt. semunc. olei olivar. drachm. vi. vitelli ovi q. s. tere in mortario, addendo paulatim sal cathartici amari, unc. i. solutam in aq. fontan. calid. unc. iij. spirit. vini gallici vel aq. alicujus spirituosæ, drachm. iij. M. s. a pro dosi matutino.

Haustus volatilis.

Rx Haust. simp. sescunciam sal. vol. c. cervi, gr. x. M. H. repet. 4tis. vel 6tis. horis.

INFUSA.

Infusum amarum. Ph. Lond. Addi possit pro re nata in præparando spirit. vini tenuis, lib. ss. ad lib. ij. infusi. Dosis ab unc. ina. bis die ad unc. ij. ter. die.

Infusum raphani rusticani.

Rx Rad. raphani rusticani, unc. ij. baccar. juniper, unc. inam. cort. canell. alb. drachm. ij. aq. fontan. bullient, lib. iv. infunde per noctem leni calore. Colaturæ adde spirit. vini gallici unc. iv. Dosis ab. unc. i. bis terve die ad unc. iv. 6tis. horis.

Infusum senæ commun. Ph. Lond.

JULEPUM E MOSCHO.

Rx Mosch. drachmam im. tere optime in mortario cum sacchar. alb. drachm. iij. & adde mucilagin. gum arab. dr. iv. Haust. simp. unc. vi. Dosis unc. ij. 4tis. vel 6tis. horis.

LINCTUS.

Rx Conserv. cynosbat. unc. iv. ol. olivar. syrup. sacchari vel mellis ana unc. ij. adde pro re nata spirit. vitrioli tenuis, drachm. iv. Dosis cochleare theæ urgente tussi.

LINIMENTA.

Liniment. saponaceum. Ph. Lond.

Linimentum camphoratum.

Rx Olei olivar. unc. ij. camphoræ, drachm. ij. M.

Linimentum volatile. Ph. Lond.

Linimentum volatile commune.

Rx Olei olivar. unc. iij. spiritus salis ammoniaci, dr. vi. M.

MELLA.

Mel cum borace.

Rx Mellis optimi, unc. i. pulv. subtilissim. boracis, dr. i. M.

Mel Ægyptiacum. Ph. Lond.

Mel rosaceum. Ph. Lond.

MITHRIDATIUM. Ph. Lond.

MIXTURÆ.

Mixtura acida communis.

Rx Haust. simp. unc: viij. spirit. vitrioli tenuis, scrup. ij. vel ad gratam aciditatem. Dosis ab. unc. ij. ad unc iv. 4tis. vel 6tis. horis.

Mixtura ammoniaca.

Rx Gum ammoniaci, drachm. i. solve in haust. simp. unc. vi. Dosis ab. unc. i. ad unc. ij. bis terve in die.

Mixtura ammon. cum oxymel.

Rx Mixt. ammoniac. unc. vi. oxymel scillit. drachm. vi. Dosis a cochlear. i. ad unc. ii. ter. 4rve. die.

Mixtura ammoniac. anodyna.

Rx Mixt. ammoniac. cum oxymel. unc. vi. tinct. thebaic. drachm. dimid. Dosis a cochlear. i. ad iv. 4tis. vel 6tis. horis.

Mixtura Campechensis.

Rx Extract. ligni Campechensis, drachm. iij. solve in haust. simplic. unc. vi. adde pro re nata tinct. thebaic. gutt. xxx. vel Philon. Londinen. drachm. i. Dosis ab. unc. i. ad unc. iij. bis, ter, 4rve. die.

Mixtura fætida.

Rx G. asafætid. drachm. i. solve in haust. simp. unc. vi. Dosis ab. unc. i. ad unc. iij. 4r. die.

Mixtura fætida volatilis.

Rx Mixt. fætid. unc. vi. spirit. volat. sal. ammon. drachm. i. Dosis ab. unc. i. ad unc. ij. bis, ter, 4rve. die.

Mixtura fracastorii.

Rx Haust. simp. unc. viij. Elect. e scordio, drachm. iv. Dosis ab. unc. i. ad unc. ij. 4tis. vel 6tis. horis.

Mixtura japonica.

Rx Haust. simp. unc. vi. Tinct. japonic. unc. i. adde pro re nata tinct. thebaic. dr. i.

Mixtura laxativa.

Rx Elect. lenitiv. unc. i. Mannæ semunc. coque in aq fontan. unc. xvi. ad unc. xij. Colaturæ adde sal. cathartici amari. sescunciam. spirit. vini gallici, unc. i. Dosis ab. unc. ij. ad unc. xij.

Mixtura purg. antimonial.

Rx Elect. lenitiv. sescunc. mannæ semunc. coque in aq. fontan. unc. xx. ad unc. xvi. & dein solve tartar. emetici, gr. x. Colaturæ dosis ab. unc. i. ad unc. iv. omni hora vel omni 2da. vel 3tia. vel 4ta. hora, donec laxetur alvus.

Mixtura oleosa volatilis.

Rx Haust. simp. unc. vi. ol. olivar. unc. iij. spirit. volatil. salis ammoniaci drachmam inam. M. Dosis ab. unc. i. ad unc. iij. 3tiis. vel 4tis. horis.

Mixtura scillitica.

Rx Haust. simp. unc. vi. oxymel scillitic. drachm. vi. Dosis a drachm. iv. ad unc. ij. bis, ter, 4rve. die.

Mixtura e spermat. ceti.

Rx Spermat. ceti, drachm. ij. solve in vitello ovi & adde haust. simp. unc. vi. adde, pro re nata, tinct. thebaic. scrup. ij. Dosis ab. unc. i. ad unc. ij. 4tis. vel 6tis. horis.

Mixtura e spermat. ceti cum balsamo.

Rx Balsam. copaiv. drachm. ij. tere in mortario cum mucilag. gum arabici, drachm. iij. & dein adde mixtur. e spermat. ceti, unc. vi. Dosis ab. unc. i. ad unc. iij. 4tis. vel 6tis. horis.

MUCILAGO. G. ARABICI.

Rx G. arabici pulv. unc. iv. solve in aq. puræ bullient. unc. x.

Oxymel scillit. Ph. Lond.

Philonium Londinen. Ph. Lond.

PILULÆ.

Pilulæ fætidæ.

Rx Gum asafætid. myrrh. ana drachm. i. sapon. alb. hispan. drachm. ij. Tinct. fuliginis q. s. Dosis a gr. x. ad drachm. dimid. bis terve die.

Pilulæ guaiac.

Rx Sapon. albi hispanici semunc. gum guaiac, scrup. iv. syrup. q. s. Dosis a scrup. i. ad drachmam dimidiam bis terve die.

Pilulæ gummosæ. Ph. Lond.

Pilulæ mercuriales.

Rx Argenti vivi semunc. extingue in balsam. copaiv. q. s. & adde pulv. glycyrrhiz. gum guaiac. singulorum, drachm. vi. syrup. q. s. ut fiat massa. Dosis a scrup. ss. ad drachmam dimidiam semel vel bis die.

Pilulæ rufi. Ph. Lond.

Pilulæ saponaceæ. Ph. Lond.

Pilulæ saponaceæ cum rheo.

Rx Sapon. alb. hispanici, drachm. vi. pulv. rhei, drachm. ij. syrup. sacchari q. s. Dosis a scrup. i. ad scrup. ij. bis terve die.

Pilulæ scilliticæ.

Rx Pulv. glycyrhiz. rad. scill. exsiccat ana drachm. dimid. rad. zinziber. drachm. i. sapon. alb. hispan. drachm. ij. syrup. q. s. Dosis a gr. iv. ad. gr. xvi. bis terve die.

Pilulæ stomachicæ.

Rx Pulv. canell. alb. drachm. ij. extract. rad. gentian. dr. i. mucilag. gum arabici q. s. Dosis a scrup. i. ad drachmam dimid. bis die--adde pro re nata rubigin. martis drachmam dimid.

PULVERES.

Pulvis astringens.

Rx Pulv. canell. alb. rad. tormentill. singulorum, drachm. i. M. Dosis a scrup. i. ad drachm. i.

Pulvis aluminosus.

Rx Alumin. crud. terræ japonicæ ana partes æquales dosis a gr. viij. ad drachmam dimidiam.

Pulv. anodynus Doveri.

Rx Sal. nitri, tartari vitriolati singulorum, unc. iv. in crucibulum candens injice, agitetur donec deflagratio & scintillatio desinat, & adde opii concisi, unc. i. & in pulverem redige addendo rad. glycyrrhiz. ipecacoanhæ subtilissime pulver. ana, unc. i. & dein probe misceantur omnia. Dosis a gr. x. ad scrup. ij. vel ad drachmam 1nam.

Pulvis antimonialis.

Rx Pulv. e chel. cancror. drachm. x. tartari emetici, dr. i. M. fiat pulv. subtilissimus. Dosis a gr. iij. ad gr. x. 4ta. vel 6ta. quaque hora.

Pulvis cardiacus.

Rx Pulv. canell. alb. drachm. i. rad. zedoariæ, drachm. ij. rad. serpentar. drachm. i. M. dosis a scrup. i. ad drachm. i. 4tis. vel 6tis. horis.

Pulvis chamæmelinus.

Rx Pulv. flor. chamæmel. drachm. iij. aluminis, g. myrrh. ana drachm. i. Dosis a scrup. i. ad scrup. ij.

Pulv. contrayerv. comp. Ph. Lond.

Pulv. contrayerv. cum nitro.

Rx Pulv. contrayerv. comp. unc. iv. salis nitri, drachm. i. M. Dosis a scrup. i. ad drachm. i. 4tis. vel 6tis. horis.

Pulvis emeticus.

Rx Pulv. ipecacoanhæ, scrup. i. tartar emetici, gr. ij. Dosis a gr. xi. ad gr. xxii.

Hiera picra. Ph. Lond.

Pulv. Ipecacuanhæ cum opio.

Rx Pulv. rad. ipecacoan. gr. x. opii, gr. ij. dosis a gr. iij. ad gr. xij.

Pulv. e jalapio.

Rx Pulv. rad. jalapii, drachm. vi. rad. zinzib. drachm. ij. Dosis a scrup. i. ad scrup. ij.

Pulv. jalapii cum nitro.

Rx Pulv. rad. jalap. drachm. iv. salis nitri drachm. im. Dosis a scrup. i. ad scrup. ij.

Magnesia alba.

Pulv. nitrosus.

Rx Pulv. e chel. cancror. drachm. iij. nitri, drachm. i. M. Dosis a scrup. i. ad scrup. ij. vel ad drachmam. i.

Pulv. nitrosus camphoratus.

Rx Pulv. nitros, scrup. ij. camphoræ, gr. v. M. Dosis a scrup. i. ad scrup. ij.

Pulv. nitrosus cum gum guaiac.

Rx Sal. nitri, drachm. ij. gum guaiac. drachm. dimid. Dosis a gr. v. ad drachm. dimid.

Pulv. plummeri.

Rx Calomel, sulph. aurat antimonii ana dr. ij. tere in mortario ut fiat pulv. subtilissimus. Dosis a gr. ij. ad gr. x. vel ad scrup. im.

Pulvis stanni. Ph. Lond.

Pulv. e spermat. ceti cum nitro.

Rx Spermat. ceti, drachm. ij. sacchar. albi sal. nitri ana unc. im. Dosis a scrup. dimid. ad drachmam i.

Pulv. e tragacanth. Ph. Lond.

SALES ACIDI.

PRÆPARATIONES. Spir. vitrioli fortis | | Acida ---- tenuis |Spir. vitrioli dulcis | mineralis Spiritus nitri |Spir. nitri dulcis | Æther. Spir. salis marini |Spir. salis dulcis. |

Varietat. acid. Acetum. vegit. Spiritus aceti vel acetum distillatum. Succus limonum. Chrystalli tartari.

Acid. anomal. Sal. succini. Sal. sedativus Hombergeri.

SALES ALCALINI.

Alcal. vegit. Sal. absynthii. Sal. tartari.

Alcal. min. Sal. alcali mineral. seu soda, seu natrum.

Alcal. vol. Sal. volatilis c. cervi. Sal. volatilis sal. ammoniaci.

SALES NEUTRI.

SALES NEUTRI, qui fiunt ex ALCALI et ACIDO.

Tartarus vitriol. | vegetab. | Sal. glauberi | minerali | vitrioli. Sal. am. vitrioli | volatili |

Sal. nit. com. | vegetab. | Nit. cubicum | mineral. | nitri. Sal. am. nitrosum | volatili. |

Sal. digest. sylvii| vegetabil. | ---- marin. com. | minerali | Sal. marini. ---- ammon. com. | volatili |

Varietates Sal. diureticus | vegetab. | aceti. salis Tartar. tartar. | veget. | chryst. tartar. neutri | tartari | comp. ex Sal. citratus com. | veget. | succ. limonum. Vegetabil. alcal. & | absynth. | acid. Sal. de seignette | minerali | chryst. tartar. vegitab. Spir. mindereri. | volatili | acet. distillat.

Hi omnes sales neutri præparari possint pro usu medico admiscendo Alcali & acidum ad saturationem; alii vero in crystallos redacti, s. a. commodius circumferuntur pro usu militari; alii ut _sal. citratus comm._ et _spiritus mindereri_ facilius præparantur ad miscendo alcali & acidum ad saturationem pro re nata[115].

[115] This Table of neutral Salts is nearly the same as one I have seen, which was said to be a Copy of that given yearly by Dr. _Cullen_, Professor of Chymistry in the University of _Edinburgh_, to his Pupils; and as that published by Dr. _Vogel_, in his _Institutiones Chymiæ_, sect. 629. These neutral Salts are likewise taken Notice of by _Macquer_, in his _Elemens de Chymie_, and other late chymical Authors.

Solutio mercurii corrosivi sublimati.

Rx Mercur. corrosiv. sublimat. gr. vi. spir. vini gallici, unc. xii. M. fiat solutio. Dosis a semunc ad unc. i. die.

Species aromaticæ. Ph. Lond. ---- e scordio. Ph. Lond.

Tartar. emetic. Ph. Lond.

Theriaca andromachi. Ph. Lond.

TINCTURÆ.

Tinctura amara. ---- corticis Puruv. ---- martis in sp. sal. ---- japonica. ---- melampodii. Pharm. Lond. ---- myrrhæ. ---- sacra. ---- saturnina. ---- serpentariæ. ---- thebaica.

Tinctura rhei.

Rx Pulv. rad. rhei, unc. ij. semin. cardamom minor. decortic. semunc. vini alb. hisp. lib. ij. sp. vini gallici, unc. viij. digere sine calore & cola. Dosis ab. unc. i. ad unc. iij.

Tinctura stomachica.

Rx Cort. canell. alb. semunc. cort. aurantior. unc. i. semin. cardam. minor. decort. drachm. ij. spirit. vini gallici lib. ij. digere sine calore & cola. Dosis a semunc ad unc. i. bis terve die.--Adde pro re nata vin alb. hisp. lib. i.

UNGUENTA.

Unguenta cærulea vel mercurial. Ph. Lond.

Unguentum sulphuratum. Ph. Lond.

VINA.

Vinum amarum. ---- antimoniale. Pharm. Lond. ---- chalybeatum.

VITRUM CERATUM ANTIMONII.

AN ESSAY ON THE MEANS of Preserving the Health of SOLDIERS on SERVICE. AND Conducting MILITARY HOSPITALS.

OF THE Means of Preserving the Health of Soldiers on Service.

The Life of _British_ Soldiers on Service, in Time of War, is so very different from what they lead in Time of Peace, as to subject them to many Inconveniences and Diseases.

In Time of Peace, Soldiers are quartered either in Towns or Garrisons, where they are under the Eye of their Officers, who take Care that they keep themselves clean, and provided with Necessaries; they lie either in private Houses or in Barracks, where they have a good Bed, regular Meals of wholesome Provisions, and enjoy most of the other Necessaries of Life in common with the lower Class of People, their Duty is easy, they mount Guard but seldom, and in other Nights enjoy an undisturbed Rest.

Whereas, during the Time of an active Campaign, they are seldom in Houses; they lie in Tents upon the Ground, which is often bare, and at best covered only with Straw and a Blanket; and sometimes they are obliged, after fatiguing Marches in wet Weather, to lie on the bare Ground, without even a Tent to cover them; they must stand Centinel, and be upon Pikets and other Out-Posts in the Night, during all Kinds of Weather; besides performing long fatiguing Marches, and other military Duties; and when near an Enemy, they are perhaps on Duty every second or third Night, besides working Parties, and other Duties of Fatigue; and what Rest they have is interrupted by frequent Alarms. They have often but little Time or Convenience to make themselves clean. Provisions are sometimes scarce, and frequently on long Marches they have no Opportunity of dressing what they can get: Water is sometimes difficult to be come at, and what is to be got, is bad. And it frequently happens, that neither Beer, Wine, nor Spirits, can be purchased for Money. In fixed Camps, they are often exposed to the putrid Effluvia of dead Bodies, of dead Horses, and other Animals, and of the Privies and Dung of the Horses[116]; and, in some Encampments, likewise to the unwholesome Vapours of marshy Ground, and of corrupt stagnating Water: All which, joined to the other Hardships and Inconveniences unavoidably attending a military Life in Time of Service, often give Rise to numerous Diseases, which weaken an Army in a most surprising Manner; and therefore Commanders ought to use every Means in their Power, consistent with the necessary military Operations, to preserve the Health of the Soldiers.

[116] In the Year 1760, the Men, who remained in the fixed Camp about _Warbourg_, were very unhealthy; while the Regiments who were detached to the _Lower Rhine_, under the Command of the Hereditary Prince of _Brunswick_, enjoyed a much better State of Health; and notwithstanding their great Fatigues, and the Loss they sustained at the Affair of _Kampen_, were much stronger when they rejoined the Army to go upon the Winter Expedition into the Country of _Hesse_, than those Regiments which had remained in the fixed Camp.

Diseases are more or less frequent in Armies according as the Season is hot or cold, wet or dry; according to the Nature of the Climate, and the Time of the Year in which military Operations are carried on; the Nature of the Ground on which the Army is encamped, or the Situation of the Towns or Villages in which they are cantonned; the Cleanness, Neatness, and Dryness of the Camp, and of the Tents or Houses in which the Soldiers are lodged; according as the Men are supplied with Provisions, and good Water, good Beer, Wine, or other fermented Liquors; or are well cloathed, and well furnished with Straw and Blankets; in proportion as the Duty is more or less severe; and to the Care taken of such as are attacked with Sickness.

Soldiers generally enjoy good Health in cold dry Weather, even during the Time of severe Frost; if they be kept in Exercise, be well cloathed, and well supplied with Provisions and good Liquors, and with Wood; as the Troops, both in _Germany_ and _North America_, experienced during the late War; but Cold joined to Moisture was observed always to be productive of Diseases.

Nor is mere Heat of itself such an Enemy to Health[117] as is generally apprehended; but when joined to Moisture, is observed to give Rise to the most fatal Disorders in the warm Climates.

[117] This Dr. _Pringle_ takes Notice of; and Mr. _Naesmith_ says, he observed it in Voyages to the _East Indies_, which afford the fairest Trials of this Kind. See Dr. _Lind's Essay on the Means of Preserving the Health of Seamen_, 2d edit. note to page 5.

In our northern Climates the Winters are cold, and the Weather variable; sometimes it is cold and rainy, at other Times thick and foggy; sometimes we have fair Weather and Sunshine, at other Times Frost and Snow; and sometimes it happens that we have all these different Sorts of Weather in the same Day. During this Season, Soldiers are subject to Coughs, Pleurisies, Peripneumonies, Rheumatisms, and other Disorders of the inflammatory Kind. And in very intense Frost, they are liable to have their Limbs benumbed with Cold, and their Extremities Frost bit (as it is called).

And where there is a Want of fresh Provisions, and they are obliged to live on salted Meat, and cannot have Greens, Pot Herbs, Roots, or other fresh Vegetables, nor be properly supplied with Beer, Cyder, Wine, or other generous fermented Liquors, they, as well as Sailors, are subject to the Scurvy[118]; especially if they be encamped or quartered in low damp Places.

[118] Dr. _Joh. Valint. Willius_, Army Physician to the King of _Denmark_, in his Treatise on Camp Diseases, says, you scarce find a Camp in these northern Countries in which the true Scurvy, attended with stinking Breath and eroded Gums, is not to be observed. _Cap._ iii. _sect._ iii.

The best Means of guarding against inflammatory Disorders, and other Mischiefs arising from Cold, whether in Camp or in Quarters, is, to take Care that the Soldiers be well cloathed; that they lie dry, and be well provided with Straw and Blankets, and with Wood; and to prevent, as much as possible, their exposing themselves to sudden changes from Heat to Cold.

In these northern Climates, it would be right to allow every Soldier on Service a Flannel Waistcoat, a Pair of worsted Gloves, and a warm woollen Stock, or a Neckcloth, to wear when on Duty in cold and wet Weather, as soon as the Winter begins to set in[119]. Dr. _Pringle_ mentions the Advantage the Troops received from the Flannel Waistcoats supplied by the Quakers, in the Winter Campaign of 1745-6, in _Britain_; and those Regiments who had them for their Men towards the End of the Campaigns in _Germany_, found that they contributed greatly to keep the Men in Health. Officers ought to take particular Care that the Men be well provided with good strong Shoes and Stockings; and where the Troops remain late in the Field, if the Government allowed a Pair or two extraordinary of each to every Foot Soldier, it would be of great Use to the Service.

[119] A Flannel Waistcoat, worsted Gloves, and woollen Stock, or a Neckcloth, may be purchased for about Half a Crown _per_ Man, and would contribute to preserve the Lives of many; the recruiting of others, to supply whose Places, if they die, will cost the Government a great deal more than the Price of the Articles mentioned; which for a Regiment of nine hundred Men, at the Rate of two Shillings and Six-Pence _per_ Man, comes only to 112_l._ 10_s._ _per Ann._ Every Recruit sent from _England_ to the Army in _Germany_, cost the Government at least twenty Guineas before he joined his Regiment; and every sick Man sent to the general Hospital, cost the Government at least sixteen Pence _per_ Day, which is ten Pence above his Pay; so that, if we suppose the extraordinary Cloathing here mentioned would preserve only the Lives of nine Men to each Regiment yearly, and keep forty in Health who would otherwise be sick, we see what great Gainers the Government will be in Point of Money at the Year's End; besides preserving the Lives and Health of so many Men.

Blankets ought to be provided for each Tent, and those carried along with the Regiment, so as to be always ready for the Men when they come to their Ground. During the late War in _Germany_, a Couple of Blankets were allowed for each Tent of the _British_ Troops, and each Company carried their Blankets covered with an Oil Cloth on a Horse; so that they were always up with the Regiments when they came to their Ground.

Each Regiment ought to be provided with a Number of Watch Coats sufficient to serve the Centinels who are to be on Camp Duty, or general Guards, in very cold and wet Weather. Some of the Regiments in _Germany_ had such Coats, and found great Service from them.

In Winter Quarters, Soldiers are apt to make the Rooms in which they sit, and their Guard Rooms, as hot as possible; especially in _Germany_, where the Inhabitants use close Stoves, instead of open Fires; and continue in these warm Rooms till they are called out on Duty, when, by being exposed to sudden Cold, they are apt to be seized with Inflammations of the Breast; and therefore Officers ought to examine carefully the Quarters and Guard Rooms allotted for their Men, and chuse them dry and comfortable, if possible[120]; but never to allow the Men to keep them as hot as Ovens, by Means of close Stoves, or other such Contrivances; but to depend more on good warm Cloathing, and dry Quarters, for guarding against Diseases, than upon artificial Heat. Many of the Regiments in _Germany_ made the People in whose Houses their Men were quartered, take down their Stoves, and use only open Fires; when there was no Danger of the Soldiers making their Quarters too warm, as Wood was difficult to be got.

[120] Dr. _Pringle_ has very justly observed, that upper Stories are preferable to Ground Floors; and that all uninhabited large damp Houses ought to be rejected. _Observat. on Diseases of the Army_, part ii. chap. iii. sect. 2.

If Necessity obliges Officers to put up with such Places for their Men, Care ought to be taken to clean them well, and to air and dry them by Means of Fires, before the Soldiers go into them; and to supply well the Men who are to lodge in them with Straw and Blankets, and with Wood or Turf.

But although close Stoves are prejudicial in small Rooms, yet when a Town is much crowded, and Men are obliged to be lodged, in Winter, in large Barns or Churches, or other large open Places, the _German_ Stoves may be used with great Advantage in airing and drying such Places, and keeping them of a moderate Heat; especially if there be a Place in them for an open Fire, or if they be of that Kind which the _Germans_ call _wynd Stoves_, which have a Door opening into the Chamber where the People are lodged; or if there be broken Windows, or any other Opening by which a free Circulation of Air can be kept up in the Men's Apartments.

In Winter, when the Weather is very cold or wet, a Glass of Brandy, or of the spirituous Tincture of the Bark, given to the Men as they went upon Duty, especially in the Night, has been found to be of great Use[121]. Dr. _Pringle_ has very justly observed, that the Times of standing Centinel, and being upon Out-posts, ought, if possible, to be shortened at such Seasons; and that Fires in the Rear of the Camp, for Men coming off Duty to warm and dry themselves at, were found to be of great Service.

[121] Dr. _Pringle_ has taken Notice, that it would be a right Measure to make an Allowance of Spirits to the Infantry on Service; which certainly would be of great Use, and save many Mens Lives; and might be done at a small Expence to the Government, if properly managed; as it would only be requisite to make such an Allowance when the Troops are in the Field, and to such Men as mount Guard in cold wet Weather, or at Nights in Garrison Towns, during the Winter. If ever such an Allowance be made, what Spirits are given to the Men ought to be mixed with five or six Times the Quantity of Water; except when Men are to stand Centinels, or to be upon Out-Posts, in a frosty Season, or in cold wet Weather; at which Time a small Glass of pure Spirits may be given them in Presence of the Officer or Serjeant of the Guard.

In Spring, and the latter End of Autumn, the Days are sometimes extremely hot, and the Nights cold and damp, and the Men exposed to these sudden Changes; at such Times, the Men who go upon Duty in the Night, ought to put on their Flannel Waistcoats, and be warmer cloathed than in the Day; and use many of the Precautions practised in Winter for the Preservation of their Health.

In _North America_, when the Men were in the Field in very hard frosty Weather, Fires were lighted at the Ends of the Tents, and Centinels set over them to prevent their doing Mischief; and both in _Germany_ and _North America_, when the Troops were in the Field without Tents, they cut down Wood and made large Fires, and the Soldiers lay down and slept round these Fires, with their Feet next to them; and Fires were lighted at all Out-posts, where it could be done with Safety.

In _Germany_, when the Weather set in rainy or cold towards the End of the Campaigns, and the Army was in a fixed Position, his Serene Highness Prince _Ferdinand_ constantly ordered the Army to Hutt; which was done either by thatching their Tents, or building Hurdles, or digging Pitts, and covering and thatching them over. The Officers either built Hutts with Fire Places, or had Chimnies built to their Tents.

If, notwithstanding all Precautions, Men upon Out-posts should be benumbed with Cold, or Frost bit, as soon as they are brought into Camp or Quarters, their Extremities ought to be rubbed with Snow, or put into cold Water[122]; and afterwards well dried, and wrapt up in Blankets; and warm mild Liquors given them to drink, and afterwards Cordials; and, after some Time, they may be brought near the Fire, or put to Bed. Dr. _Lind_[123] mentions one Caution to be used when Men are found in this Condition; which is, not to give them immediately strong spirituous Liquors, for that those often prove instantaneously fatal; but to put them to Bed, and give warm Water Gruel, or some other mild diluting Liquor, to drink; after which, he says, a Glass of Spirits will prove less dangerous and more beneficial.

[122] _Hildanus_ relates a very remarkable Instance of the good Effects of this Treatment. A Man was found quite stiff and frozen all over. He was put into cold Water, and immediately the icy Spicula were discharged from all Parts of his Body, so that he seemed covered with an icy Crust. He was then put into a warm Bed, and took a Cordial Draught, and a plentiful Sweat followed; after which he recovered with the Loss of the last Joints of his Fingers and Toes. _De Gangræna_, cap. xiii. People who are benumbed with Cold in frosty Weather ought never to be brought immediately near a Fire; for that has been found either to cause immediate Death or Gangrenes of the Extremities; and even Apples and other Fruits which have been frozen, if brought immediately near a Fire, turn soft and rot; but if put into cold Water, throw out the icy Spicula, and recover, so as to be almost as good as before they were frozen.

[123] _Means of Preserving the Health of Seamen_, 2d edition, page 19.

When Men are quartered or cantonned in Towns or Villages, whose Situation is low and damp, and where fresh Meat and Vegetables are scarce in Winter, and the Scurvy frequent among the lower Class of People; Commanding Officers, at the Approach of Winter, ought to use their Endeavours to provide a Store of Potatoes, Onions, Cabbages, sour Crout; of pickled Cabbages, and other pickled Vegetables; of Apples and other Fruits, preserved in different Forms, to be laid up, and sold out to the Men at a cheap Rate during the Winter. They should contract, if possible, with Butchers to furnish the Men with fresh Meat[124], and endeavour to procure good small Beer, or Cyder or Wine in the Wine or Cyder Countries; or Spirits to be mixed with Water, and a small Proportion of Cream of Tartar or Vinegar; or some other wholesome fermented Liquor for their Drink[125]; and to put their Men into as dry comfortable Quarters as possible.

[124] The Regiments in _Germany_ who kept their Butchers in Winter, and made Stoppages of the Mens Pay, and obliged them to take a certain Quantity of Meat daily, were much more healthy than those who used no Precaution of this Kind.

[125] In Places where the Articles here mentioned are at too high a Price for a Soldier's Pay, a small Allowance, from the Government, of such Things would contribute much to the Preservation of the Mens Health in unwholesome Garrisons.

In Times of War, when Men are sent upon Expeditions into warm Climates, great Care ought to be taken to embark such only as are in good Health; particular Regard ought to be paid to those who are picked up in the Streets, or have been taken out of the _Savoy_, or other Jails. All dirty Rags from off such People ought to be thrown away or burnt; and the Men, after being well washed, and new cloathed, ought to be kept for a Fortnight or three Weeks in some Garrison Town, or with their Regiments, in open airy Places, that it may be ascertained that they have no infectious Disorder before they be put aboard the Transports.

All Ships allotted for Transports ought to be well aired and purified, and every Thing fitted up properly, before the Men are embarked. They ought to be provided with Ventilators, or Wind Sails, to make a free Circulation of Air through the Vessel[126]; and they ought never to be crowded; but full Room allowed for each Man, in Proportion to the Length of the Voyage[127].

[126] See Dr. _Lind's Treatise on the Means of Preserving the Health of Seamen in the Royal Navy_, where he takes Notice of most of the Articles here mentioned with regard to Transport Ships in treating of Ships of War.

[127] When Ships are too much crowded with Men, if they meet with a tedious Passage, and hot moist close Weather, they are often attacked with Diseases which prove very fatal. Dr. _Lind_, talking of Ships of War, says it is a Mistake destructive to the Men to crowd too many of them together in a southern Voyage, or in a hot Climate; as the Ship will be found, before the End of the Voyage, in more Distress for Want of Men, than she would have been, had she at first carried out only her proper Compliment. An additional Number is made, in order to supply an expected Mortality; but they generally increase that Mortality to double or triple their own Number. _Ibid. note to p. 48._

In military Expeditions, Soldiers are put upon Ships Allowance; which, Dr. _Lind_ very justly observes, ought not, in Voyages to the warm Climates, be made up so much of salted Beef and salted Pork (which always tend to the Putrescent), as is the common Practice of the Navy; but that a greater Share of Biscuit, Flour, Oatmeal, Goarts, Rice, and other Stores of that Kind, ought to be laid in; and a greater Proportion of them, and a Less of the salted Meat, distributed among the Men: And he is certainly in the Right, when he says, that a full Animal Diet, and tenacious Malt Liquors, are well adapted to the Constitution of our own, and of other northern Climates; and that Sailors who visit the _Greenland_ Seas, and are remarkable for a voracious Appetite, and a strong Digestion of hard salted Meat, and the coarsest Fare, when sent to the _West Indies_, soon become sensible of a Decay of Appetite, and find a full gross salted Diet pernicious to Health. "Instinct (he says) has taught the Natives between the Tropics to live chiefly on a Vegetable Diet, of Grains, Roots, and subacid Fruits, with Plenty of diluting Liquors[128]."

[128] The following is the Diet established for the Seamen of his Majesty's Navy.

Every Man is allowed a Pound of Biscuit, _Averdupoiz Weight_, and a Gallon of Beer, _Wine Measure_, _per_ Day.

On _Sunday_ and _Thursday_, one Pound of Pork, and Half a Pint of Peas, _Winchester Measure_.

On _Monday_, _Wednesday_, and _Friday_, one Pint of Oatmeal, two Ounces of Butter, and four Ounces of Cheese.

On _Tuesday_ and _Saturday_ two Pounds of Beef.

It is left to the Commanders of Squadrons to shorten the aforesaid Allowance of Provisions according to the Exigence of the Service, taking Care that the Men be punctually paid for the same. As it is thought for the Benefit of the Service to alter some of the foregoing Particulars of Provisions in Ships employed on foreign Voyages, it is to be observed, that

A Pint of Wine, or Half a Pint of Rum, Arrack, or Brandy, hold Proportion to a Gallon of Beer.

Four Pounds of Flour, or three Pounds of the same with a Pound of Raisins, Half a Pound of Currans, or Half a Pound of Beef Suet pickled, are equal to a four Pound Piece of Beef, or two Pound Piece of Pork with Peas.

Half a Pound of Rice is equal to a Pint of Oatmeal.

A Pint of Olive Oil is equal to a Pound of Butter, or two Pounds of _Cheshire_ Cheese.

And Two-thirds of a Pound of _Cheshire_ Cheese is equal to a Pound of _Suffolk_.

If Soldiers are sent as Passengers on board of King's Ships, or on board of Transports, their Allowance is generally but Two-thirds of the above.

A Store of Vegetables, such as Mustard Seed, Garlick, Onions, Potatoes, pickled Cabbages and other pickled Vegetables, sour Crout and other Things of that Kind, which can be purchased at a cheap Rate, and preserved for some Months, ought to be laid in; which may be mixed with the Soops prepared for the Men, or given them to eat along with their salted Provisions.

A Quantity of Beer, Cyder, or Wine, ought to be put aboard, and a certain Allowance distributed to each Man daily. When, for Want of these, Men are reduced to an Allowance of Spirits, they ought to be mixed with seven or eight Times the Quantity of Water, or made into Punch, by the Mixture of Water and Molosses, and the Juice of Lemons, before they are given to the Men; and, if Lemons cannot be got, Cream of Tartar, or Vinegar, ought to supply their Place; and it ought to be a Duty of one of the military Officers on board to see the Punch made, and distributed among the Men daily.

It would be right, on all Expeditions into warm Climates, to send some Sloops of War, or other armed Vessels, before the grand Fleet, to take up a Quantity of Wine that will keep, either at the _Madeira_, or other Wine Countries; and afterwards to go to any of our Settlements that are nearest the Place of Destination, and to take in a Quantity of Limes, Lemons, Oranges, and other Fruits, and Vegetables which will keep for some little Time; and of Spirits, live Stock, and other Provisions proper for the Army; and then to meet the Fleet at the general Rendezvous. When once a Landing is made good, these Vessels, after having unloaded their Cargoes, may either be employed on other Services, or kept constantly going and coming for whatever Stores or Provisions are wanted for the Army or Fleet.

A sufficient Quantity of Vinegar ought to be put on board of each Transport, both for the Men to eat with their Victuals, and likewise for fumigating and washing between Decks occasionally. And a Quantity of Molosses, or coarse brown Sugar, and of Lemons, or their inspissated Juice, or Cream of Tartar, ought to be allowed for making the Punch, as well as for other Purposes.

If the Water become foetid, the Quantity to be used in the Day ought to be sweetened by Means of the Ventilator contrived by the ingenious Dr. _Hales_[129] for that Purpose.

[129] This Ventilator is no more than a long Tube, with a Tin Box, about six Inches wide and four high, with a Number of Holes at the Top, fixed at one End; and this Box is put down to the Bottom of the Water, and the Nose of a Pair of Bellows fixed to the other End of the Tube, which is above the Water; by working the Bellows, fresh Air is driven through the whole Body of Water, the putrid Effluvia are evaporated and dispersed, and the Water becomes sweet in a very short Time.

The Men ought to be brought upon Deck, and Roll called two or three Times a Day; they should be made to comb their Hair, and wash their Hands and Face every Day, and to shift themselves sometimes, if possible; and in every respect keep themselves as clean as the Nature of the Service will admit; and proper Exercises should be contrived, to keep them in Health.

All the Parts of the Ship ought to be kept very neat and clean; and the Hold, and all between Decks, ought to be scraped and swept daily; and every Morning, in fair Weather, ought likewise to be washed, and afterwards sprinkled or washed with warm Vinegar, while the Men are upon Deck[130].

[130] This ought always to be done in the Morning, that all the Parts of the Ship may have Time to dry before the Men go to rest in their Births at Night; but it ought never to be done after Sun-set.

When the Weather will permit, Fires of dried Wood may be lighted in Iron Kettles between Decks, and Centinels set over them, and the Fires sprinkled with Rosin or Bits of Rope dipt in Tar, or with some cheap Aromatic; and these Fires may be carried into all the Parts of the Ship that Safety will permit, in order to dry and purify the Air[131]. After this Operation all the Ports and Hatchways should be opened, and the Air in all the Parts of the Ship often renewed by working the Ventilators.

[131] It has been proposed, that the Air in Ships of War should be purified in this Way both by Dr. _Lind_ and by Mons. _de Hamel de Monceau_.

The Mens Hammocks and Beds ought to be brought up upon Deck in fair Weather, and well aired, and afterwards put in their Places, and Fires lighted below Decks.

When Troops, sent on an Expedition into warm Climates, arrive at the Place of their Destination, particular Care should be taken to guard them against the Diseases peculiar to such Climates, which are different from those common to our more northern Latitudes.

Dr. _Lind_ says, that People coming first from a cold into a hot Climate are apt to have plethoric Symptoms; a Pain of the Head, Giddiness, a Sense of Weight, and Fulness of the Breast, and a slight Inflammation of the _tunica conjunctiva_; and that some are apt to be seized with ardent Fevers and Diarrhoeas. And all Practitioners have observed, that New-Comers into warm Climates are at first liable to Fevers tending to the Ardent, and are very subject to Fevers of the remitting and intermitting Kind, which are the Endemics of all warm Countries at certain Seasons of the Year; and after some Time they are apt to fall into Fluxes, the Yellow Fever, and other Diseases depending on a putrescent State of the Juices. In military Expeditions these Disorders are liable to be complicated with Fevers of the Malignant or Hospital Kind, if Care is not taken to prevent it. And nothing has been found to be more productive of Diseases in those warm Climates, than indulging freely in the Use of Spirits and other strong fermented Liquors; exposing one's self to the Damps, especially lying on the Ground after the Dews fall; and working hard, or using violent Exercise in the Heat of the Day.

The best Preservatives against Diseases in warm Climates have been found to be,--1. Temperance; a Diet of light and easy Digestion, composed more of vegetable than of animal Food; such as a small Portion of fresh Meat, joined with a sufficient Quantity of Vegetables; Rice, _Indian_ Corn, and other Grains, and Roots of various Kinds, prepared in different Forms; well baked Bread; the moderate Use of ripe Fruits; and the free Use of mild cooling subacid Liquors, joined with a small Proportion of vinous or spirituous Liquors; carefully avoiding the too liberal Use of Wine, Spirits, or other strong fermented Liquors.--2. Great Care not to expose one's self to the Damps of the Night, nor lie down to sleep on the Grass, or in woody moist Places, in the Day; and to avoid all violent Exercise in the Heat of the Sun.--3. Such Means as tend to support the Spirits; for Chearfulness has been observed to contribute as much to the Preservation of Health, as Fear and Dejection of Spirits to the Production of Diseases.--4. Keeping the Body clean, and bathing frequently in the Sea, or in a River, in the Morning.

And therefore, in warm Climates, Officers ought to be particularly careful to keep their Men sober and temperate; to procure them good Bread, and Plenty of Vegetables and fresh Meat, if possible; and where no other but salted Meat can be got, to make them boil a small Proportion of it in their Camp Kettles, along with Onions, Goarts, Rice, Carrots, Turnips, Greens, or any other wholesome Roots or Herbs which the Country affords, or they can get, and of these to prepare a good wholesome Soop for themselves; and where there is Plenty of the ripe acescent Fruits, which are reckoned wholesome, to distribute a moderate Quantity among the Soldiers daily, which will both help to preserve their Health, and prevent them from privately stealing and eating large Quantities to the Prejudice of their Health.--To encourage their Men, and keep up their Spirits.

They should also prevent, as much as possible, the too free Use of Wine, Spirits, or other strong fermented Liquors; and in Wine Countries give every Man a daily Allowance of Wine, to be mixed with Water for his common Drink; and in Countries where nothing but Spirits can be got, make the Spirit be mixed with Water, or made into a very weak Punch, before it is given to the Men, as Lemons, Oranges, Limes, and other Fruits proper for this Purpose, are generally to be had in most warm Countries.

They should be careful not to march their Men in the Heat of the Day, nor order them upon Duty where they must stand exposed to the Dews and Damps of the Night, unless where the military Operations absolutely require it.

They should endeavour to make the Bottom of the Tents be covered with Straw, or dried Leaves of Trees, or dried Reeds, and with Blankets[132], for the Men to lie upon.

[132] A sufficient Store of Blankets has often been neglected to be carried out in Expeditions into warm Climates; but Blankets are no-where more necessary, as it is very prejudicial to the Health of Soldiers to be obliged to lie down on the bare Ground; and Straw, dried Reeds, and other such Things, are often difficult to be got in the warm Climates.

The Time of standing Centinel, and being upon Out-posts, if possible, should be short, where Men are exposed to the scorching Heat of the Sun; and when Men are upon Out-posts in the Night, it should be recommended to them to lie down on the Ground as little as possible; and if they do it, to chuse a dry Place; and, where it can be done, to have it covered with Straw or a Blanket, and to have some light Covering to defend them from the Dews.

The Tents should be covered with Boughs of Trees, and the Men should be ordered sometimes to strike them in the Middle of the Day, and air well every Thing within them.

The Men should be obliged to keep themselves neat and clean; to comb their Hair, and change their Linen often; and if the Camp be near the Sea, or a large River, they ought to bathe early in the Morning as often as the Nature of the Service will permit. However the following Caution, mentioned by Dr. _Lind_, ought to be observed, which is, not to go into the cold Bath when overheated with Work or Liquor, or when the Stomach is full, or when a critical Eruption, called the prickly Heat, appears on the Skin[133].

[133] Dr. _Lind_ says, the Use of the cold Bath, either in Tubs under the Forecastle, or to dip in the Sea early in the Morning, has been found extremely beneficial in warm Weather and hot Countries; and that he can affirm, from his own Experience in hot Climates, that many Diarrhoeas and other Complaints, the pure and sole Effect of an unusual and great Heat (relaxing the System of the Solids, and occasioning a Colliquation of the Animal Juices), have not only been cured by cold Bathing; but their Return, and even the Attack of such Diseases, effectually prevented by it. _Ibid._ p. 44, &c.

When Men are seized with inflammatory Symptoms on entering into warm Climates, they may be blooded freely: Afterwards they do not easily bear such copious Evacuations, but rather require to have them made in smaller Quantities, and very early and frequent, as Inflammations make a rapid Progress in warm Countries. Dr. _Lind_ says, many Practitioners disapprove of Blood-letting in the Countries lying under the Torrid Zone, on a Supposition that the Blood is too much dissolved; but he thinks that this Rule will admit of many Exceptions; and that Sailors (_and consequently Soldiers_), being strong and robust, and exposed to greater Vicissitudes of Heat and Cold, and more Excesses, and other Accidents in general, bear freer Bleeding than any other Set of People.

After some Time, the Diseases in these warm Climates tend to the putrid Kind, and must be treated as such.

In all Countries, and in all Climates, great Care ought to be taken in chusing the Ground on which Men are to encamp. Dry high Grounds, exposed to the Winds, where there is a free Current of Air, and which lie at a Distance from Marshes, stagnating Water, and large Woods, are generally healthful in very different Climates[134]. But Places situated low, where, on digging two or three Feet below the Surface of the Earth, you come to Water[135], and marshy Grounds, and Places surrounded with corrupt stagnating Water, are almost always the contrary, and very unhealthful; as are often those Grounds which are subject to be overflowed by large Rivers, and low Places covered with Wood, where there is no free Circulation of Air. However, it ought to be observed, that it is not the Neighbourhood of Water alone which is prejudicial, but the watery Vapours which keep the Air perpetually moist, and the Exhalations of corrupt Effluvia, which render such Places unwholesome; for the Neighbourhood of Rivers, and of the Sea, where the Tide ebbs and flows freely, has no such Effect, where the Situation is dry and airy; and those very unhealthy marshy Grounds often continue healthy in cold Weather, when their Waters are refreshed with Rains[136], and little or no moist putrid Exhalations rise from them; though, as Dr. _Pringle_ observes, in Summer and Autumn, when their Waters begin to corrupt, and the Exhalation is strong, they are always exposed to Diseases; and it is for this Reason that such Places are always very unhealthy in warm Climates.

[134] Mr. _du Hamel_ says, that the Air of the Island of _St. Domingo_ is very fatal to _Europeans_; but it is observed that those People who inhabit the rising Grounds are much less exposed to Diseases than those who live in the Vallies. _Sur la santé des Equipages_, art. i. p. 16.

[135] Ground may seem very dry and healthful, and yet be quite the contrary, as Dr. _Pringle_ remarks is the Case in the Neighbourhood of _Bois le Duc_, in _Flanders_, where Water is found every where at the Depth of two or three Feet from the Surface.

[136] Mr. _du Hamel_ remarks, that Places which were formerly very subject to Diseases have become healthful when the Water which surrounded them was refreshed by opening a Communication with the Sea. _Ibid._ art. i. p. 18.

Hence, where the military Operations will permit, Commanders, if possible, ought to chuse a dry Ground, whose Situation is high, and which admits a free Current of Air, such as on the Banks of Rivers, where there is generally a Stream of fresh Air, and Plenty of fresh Water to supply the Camp[137]; taking Care to avoid the Neighbourhood of low marshy Grounds, and corrupt stagnating Waters, especially in Summer, and in hot Climates.

[137] Dr. _Pringle_ observes, that where Grounds are equally dry, that the Camps are always most healthful on the Banks of large Rivers; because in the hot Season Situations of this Kind have a Stream of fresh Air from the Water, tending to carry off both the moist and putrid Exhalations.--And in Cantonments we are not only to seek Villages removed from marshy Grounds, but such as are least choaked with Plantations, and stand highest above subterraneous Water. See his _Observat. on Diseases of the Army_, 3d edit. p. 99.

When Necessity obliges Commanders to take Post, or encamp in a wet or marshy Ground, they should endeavour to make it as dry as possible, by ordering Trenches to be cut for Drains across the Field and round the Mens Tents; to see that the Ground within the Tents be well covered with Straw; to order the Tents to be struck at Mid-Day, in dry warm Weather, and the Men to dry and air the Straw, and change it frequently; to have a proper Supply of Blankets for the Men, and to take Care that they be well cloathed, especially those who go upon Duty in the Nights; and, in the northern Climates, to have Fires in proper Places for warming the Men and drying their Cloaths, and for correcting the Dampness of the Air[138].

[138] The Negroes on the Coast of _Guinea_, and some of the _Indians_, both of whom sleep on the Ground, have constantly a Fire producing a little Smoak burning in the Hutts where they sleep, which corrects the Moisture of the Night, and renders the Damp of the Earth less noxious; and during the Time of the very unwholesome Fogs on the Coast of _Guinea_, called Harmattans, which lay waste whole Negroe Towns, the Smoak of Wood, of pitched Staves, and such Things, are found to be the best Correctors of this thick Air. See Dr. _Lind's Means of preserving the Health of Seamen_.

In Countries lying under the Torrid Zone, the Parts near the Sea Shore are often marshy, or close and covered with Wood, or have swampy Beaches, and are very unwholesome; and therefore where Soldiers aboard of Transports keep their Health, Commanders ought to be very careful not to allow them to land, till they come to the Place of their Destination. Dr. _Lind_ observes, that Men commonly live more healthy in warm Climates at Sea, where the Air is dry and serene, and the Heat moderated by refreshing Breezes, than when they arrive in Harbours, or get within Reach of the noxious Vapours which arise from many Parts of the Land[139].

[139] Dr. _Lind_ says, that it is constantly observed in unhealthy Harbours, that the Boats Crews employed in wooding and watering the Ships, who are obliged to lie on Shore, suffer most. _Ibid._ p. 72.

When Necessity requires Parties to be landed for Wood or Water, or on other Duties, they should always be obliged to return and lie aboard at Night; and if that cannot be done, they should be cautioned to avoid lying down to sleep on the Grass, where the Air is fresh, or they are exposed to the Dews; and to pitch their Tents on a rising Ground, covered with Straw or dried Reeds, and a Blanket; and to use the other Precautions necessary for encamping in these warm Climates; for where this Care has been neglected, the Consequences have frequently proved fatal[140].

[140] A very remarkable Instance of this we have related by Dr. _Lind_. In the Year 1739, in _Mahon_ Harbour, a Party of Men were sent with the Coopers from Admiral _Haddock_'s Fleet to refit and fill the Water Casks, who, finding an artificial Cave dug out of a soft sandy Stone, put their bedding into it; every one who slept in this damp Place was infected with the Tertian Fever, then epidemic in _Minorca_, and not one in eight recovered. At the same Time the Men aboard the Ships continued healthy; and others, who were afterwards sent on the same Duty, enjoyed perfect Health by being obliged to sleep in their respective Ships. He says, he has known a whole Boat's Crew seized next Morning with bad Fevers by sleeping near the Mangroves, with which the Sides of the Rivers are frequently planted in the Torrid Zone. _Ibid._ p. 74, 75.

On unhealthful Coasts, the noxious Land Vapours often affect the Crews of Ships that run up into Rivers or Harbours, and cause great Sickness; and therefore in such Places Ships should anchor at as great a Distance from the Shore as can well be done, that they may be exposed to the Sea Breezes, and as much to the Windward of the Woods and Marshes as possible; and if the Anchorage is safe, one should prefer the open Sea to running up into Rivers or Creeks[141].

[141] The higher that Ships sail up the Rivers upon the Coast of _Guinea_, the more sickly they become: Such, however, as keep at Sea beyond the Reach of the Land Breezes (that is, two or three Leagues at Sea), are for the most part healthy. _Lind_, _ibid._ p. 65. The Malignity of these Land Vapours often does not extend itself to any considerable Distance, as we know by manifold Experience. The Troops in _Zealand_ were very unhealthy when Admiral _Mitchel_'s Squadron, which lay but a little Way from the Shore, enjoyed perfect Health.--Dr. _Pringle's Observat. on the Diseases of the Army_, p. 1. chap. vii.--In _July_ and _August_ 1744, two Ships, belonging to Admiral _Long_'s Squadron in the _Mediterranean_, lying near the Mouth of the River _Tyber_, began to be affected, while others, though at a very small Distance, but further out at Sea, had not a Man sick. _Lind_, _ibid._ p. 66.

Cleanness and Neatness in the Camp is another Article that ought to be particularly regarded. _Portius_, _Ramazini_, and most other Authors who treat of Camp Diseases, attribute those of the putrid Kind in a great Measure to the Stench and putrid Effluvia arising from the Excrements of Men and Beasts, and from the dead Bodies of Men, Horses, and other Animals, lying unburied in the Neighbourhood of Camps, and have in a particular Manner mentioned the Necessity of burying such putrid Substances. Dr. _Pringle_ has very justly recommended the Digging of Deep Pits for Privies in Camp, and covering the Excrements with Earth daily[142] till the Pits are near full, and then to fill them up with Earth, and dig new ones; and to punish every Person who shall ease himself any where in Camp but in the Privies: And he remarks, that when the Camp begins to turn unhealthy, that often the only Means that will preserve the Health of the Men, is to change the Ground, and to leave behind all the Filth and Nastiness which gave Rise to those putrid Disorders.

[142] The divine Lawgiver _Moses_ has enjoined Cleanliness in the Camp to the _Jews_ in a particular Manner, when he says,

"Thou shalt have a Place also without the Camp, whither thou shalt go forth abroad; and thou shalt have a Paddle upon thy Weapon, and it shall be when thou wilt ease thyself abroad thou shalt dig therewith, and shalt turn back and cover that which cometh from thee. For the Lord thy God walketh in the Midst of thy Camp; therefore shall thy Camp be holy, that he see no unclean Thing in thee, and turn away from thee." _Deuteronomy_, chap. xxiii. verses 12, 13, 14.

In fixed Camps, the striking the Tents at Mid-Day in fair Weather, and turning and airing the Straw, and changing it often, as recommended by Dr. _Pringle_, will contribute much to preserve the Health of the Men; and making the Men wash themselves daily, and change their Linen often, and keep themselves otherwise clean, ought never to be omitted by the Officers.

All military Authors have recommended to Commanders always to have Straw for their Men when they come to their Ground, if possible; and to have the Army well supplied with Provisions; giving proper Encouragement to the Country People, and to Suttlers and Merchants of all Sorts, to bring in every Kind of Provisions and other Necessaries to Camp; and preventing, as much as possible, the Soldiers from moroding. And the Commanders of every Corps ought to take Care that their Men form themselves into Messes, and that Stoppages be made for buying them Provisions.

In _Germany_ every Regiment of the _British_ Troops contracted with a Butcher, who was obliged to carry along with them, at all Times, a certain Number of live Sheep and Oxen to kill when wanted, and to sell the Meat at a fixed Price. Every Soldier was obliged to take a certain Quantity, which was paid for by Stoppages made in his Pay; and this Meat was boiled in the Camp Kettles, with such Roots and Greens as could be got; by which Means the Men, whenever they could use their Kettles, had always a good warm Soop, as well as Meat, to refresh them after their Fatigues, which, along with their Ammunition Bread, made a good wholesome Food.

In Countries where Fruit is plentiful, a certain Quantity of what is fully ripe, distributed to the Men in warm Weather, and in hot Climates, will contribute to preserve their Health, though the Abuse of it will prove prejudicial; but unripe and acrid Fruits are always hurtful[143].

[143] The _British_ Soldiers in _Germany_ used sometimes to hurt their Health by eating great Quantities of raw unripe Apples, Plumbs, and other unripe Fruits; but the foreign Troops had a much better Method of using such Fruits: They commonly boiled or stewed them, and eat them with Bread, or with their Meat, which in a great Measure corrected their bad Qualities.

The Orders in the _French_ Camp, prohibiting the Men from eating unripe Fruit, were strictly complied with every-where in _Germany_ during the late War.

Water is another Article which Commanders endeavour to have their Camp well supplied with, and therefore they generally encamp near Rivers or Rivulets. Where the Stream is small, Care ought to be taken that its Course be not interrupted, and that no Filth or Nastiness, or any Thing that will spoil or corrupt the Water, be thrown into it.

When there are no Rivers or Rivulets near a Camp, and the Men are supplied from Wells, if the Water is not pure, very often the digging of deep Pits, and covering the Bottom and Sides with large Stones, and over these a Lay of Sand, Gravel, or Chalk, will make the Water pure in a few Hours.

In fixed Camps, where the Water is bad, _Portius_[144] proposes straining it thro' Sand, and has given Figures of Machines to be used for that Purpose; but the Method proposed by Dr. _Lind_ is still more simple, which is, to get a broad Cask with one End struck out; then put a longer Cask, with both Ends struck out, in the Middle of it; fill the short Cask one-third with Sand, and the inner longer Cask above one-half; fill the Rest of the inner Cask with the Water, which will filter through the Sand, and rise above the Sand in the outer Cask, where it may be allowed to run off into Vessels placed to receive it, by Means of a Cock, put into the Side of the outer Cask, fifteen or twenty Inches above the Level of the Sand.

[144] See the Treatise published by Dr. _Luc. Anton. Portius_ in 1686, _de Militis in castris sanitate tuenda_, _part._ ii. _cap._ vi. In this Book we have many useful Things mentioned relative to the Health of Soldiers.

Where there are no such Conveniences for purifying the Water, what is used for Drink ought to be mixed with a small Proportion of Spirits, or Wine, or with Vinegar, or Cream of Tartar, when neither of the other two can be got; and if the Water be previously boiled, it will be so much the better.

In Expeditions into warm Countries, where fresh Water is difficult to be had, a few Stills, with a proper Apparatus, ought to be carried out; and after a Landing is made, the Stills ought to be set to work for distilling fresh Water from Sea Water in the Manner mentioned by Dr. _Lind_[145]; and although a sufficient Quantity cannot be distilled for serving the whole Army, yet enough may be got in this Way for the Use of the Sick.

[145] Dr. _Lind_ relates a Number of Experiments of his having distilled Sea Water in different Manners, as recommended by others; and concludes, that the best Way of getting fresh Water from Salt, is to distil the Sea Water by itself, without any Mixture; and he proposes having a Still Head to the Coppers or Iron Pots in which the Meat is dressed aboard a Ship. _Ibid. note to p. 84_, &c.

When Men are very warm, after long Marches, and other hard Duties, in Summer; Officers should endeavour to prevent their swallowing immediately great Quantities of cold Water, and persuade them to wait a little till they cool; and at such Times, if Spirits can be got easily, to order a small Quantity to be mixed with the Water in each Man's Canteen.

Though the Abuse of vinous and spirituous Liquors is very destructive to the Constitution, yet these same Liquors, given in Moderation to Soldiers on Service, during the Times of great Fatigues, are some of the best Preservatives of Health. Spirits, for common Use, ought to be mixed with Water; and in the hot Climates made into Punch; though in very cold and wet Weather, and in damp Nights, a Glass of pure Spirits, given to the Men going on Duty, is of great Service; for it is always observed, that Men are much less apt to catch Diseases from being wet when they are upon a March, or at hard Work, than when they stand Centinels, or are upon Out-Posts where they move but little, or when they lie down in their wet Cloaths; and that they are less liable to be affected by the Weather after a hearty Meal, or drinking a Glass of Spirits, or some generous Liquor, than when their Stomachs are empty.

An Infusion of Bark or other Bitters, and of Garlick, in Spirits, has been found to encrease their Efficacy as Preservatives both against the Effects of Cold and malignant Distempers. Dr. _Lind_ has recommended an Infusion of Garlick in Spirits as one of the best Stomachics and Diaphoretics he knows in cold wet Weather. And many have recommended a Tincture of the Bark[146]: Towards the End of the Year 1743, Mr. _Tough_, one of the Apothecaries to the _British_ military Hospital in the late War, then a Mate to a marching Regiment, was ordered to go down the _Rhine_ with a Party of Sick, who had the Seeds of the Hospital Fever among them, and were to go in Bilanders, from _Germany_ to _Flanders_. Having had a Cask or two of Brandy put aboard as Part of the Stores for the Sick, he was afraid lest the Men should make too free with the Spirits; to prevent which he threw in a Quantity of Bark into each Cask, and gave the Men regularly, Morning and Evening, a Glass of this bitter Tincture. At the same Time, the Men were kept extremely clean. By these Means most of the Sick mended upon the Passage, without the Malignant Fever appearing again amongst them; whereas, Dr. _Pringle_, who takes Notice of the other Parties who came from the same Hospitals in _Germany_, tells us, that the Malignant Fever broke out in a violent Degree, and Half the Number died by the Way, and federal others soon after their Arrival[147].

[146] During the Campaign in _Hungary_, in the Year 1717, Count _Boneval_ preserved both himself and Family from Disorders, by taking himself, and making all his Domesticks take, two or three Times a Day, a small Quantity of Brandy, in which Bark had been infused, at a Time when all the Rest of the Army were infected with malignant Disorders. A Regiment in _Italy_ continued healthy by the Use of the Bark, when the Rest of the _Austrian_ Army, who did not pursue the same Method, were greatly annoyed with Sickness. See _Kramer._ quoted by Dr. _Lind_.

[147] _Observat._ part. i. chap. iii.

Commanding Officers ought always to endeavour to proportion the Time the Men are to be upon Duty to the Weather and the Nature of the Climate. The Time of standing Centinel in very hard Frost, and in cold wet Weather, or in the Heat of the Day in Summer, when the Weather is very warm, and in hot Climates, ought to be shorter than when the Weather is dry and more temperate.

The Marches of Troops ought, if possible, during the Time of very hot Weather, to be made either very early in the Morning, in the Evening, or at Night; and Officers, during the Course of an active Campaign, ought to spare their Men as much as possible.

And when they are in Quarters, and have nothing to do, they should narrowly inspect into their Manner of living; and have them out daily, when the Weather will permit, and exercise them, or march them two or three _English_ Miles a-Day, in order to prevent their falling sick for want of Exercise; for Soldiers left to themselves are very subject to Diseases when they come into Quarters after an active Campaign, by leading too indolent a Life, if Officers do not take Care to prevent it. However, at such Times, the Exercise ought to be moderate, and the Men should not be brought out in wet Weather.

OF MILITARY HOSPITALS.

Whenever Men are seized with Distempers, they ought immediately to be separated from those in Health, and either sent to the Regimental[148] or General Hospital.

[148] Some of the regimental Surgeons in _Germany_, when they took the Field, had always some spare Tents carried along with their Medicine Chests; and when any of their Men fell sick in Camp, and they could get no House for a regimental Hospital in Villages, they ordered these Tents to be pitched, and had the Ground within well covered with Straw and Blankets, and then put the Sick into them, and there took Care of them till they found an Opportunity of sending them to the Flying Hospital.

There is no Part of the Service that requires more to be regarded than the Choice of proper Places for Hospitals, and the right Management of them, on which the Health and Strength of an Army often depends; for in wet unwholesome Seasons, if infectious Disorders get into the Hospitals, which possibly might have been prevented by proper Care, they often weaken an Army in a very short Time far more than the Sword of the Enemy.

We have no Account of the particular Manner in which the Antients took Care of their Sick and Wounded in Times of War; for although we read in _Homer_[149] of Surgeons or Physicians attending the _Grecian_ Camp, and in _Xenophon_[150] of _Cyrus_'s having appointed Physicians to his Army; and we learn from _Tacitus_[151] and _Livy_[152], that the wounded _Romans_ were received into the Houses of the Nobility, and had Physicians to attend them, and were furnished with Fomentations and other proper Remedies; and from _Justin_[153], that the _Lacedemonians_ followed the same Method: yet these Authors make no Mention of the particular Oeconomy or Manner in which these Hospitals were conducted.

[149] _Homer_ mentions _Podalirius_ and _Machaon_, sons of _Æsculapius_, as two excellent Physicians or Surgeons in the _Grecian_ Army. Vid. _Iliad_, lib. ii. Physic and Surgery were antiently exercised by the same Persons.

[150] Vid. _Xenophon. de Institut. Cyri._ lib. i. et viii.

[151] _Tacitus_, after giving an Account of 50,000 People being killed by the Fall of an Amphitheatre at _Fidena_, during the Time of a Shew of Gladiators, has these Words: "Ceterum post recentem cladem, patuere procerum domus, fomenta & medici passim præbiti; suit urbs per illos dies, quanquam mæsta facie veterum institutis similis, qui magna post prælia saucios largitione & cura sustentabant." _Vid. lib._ iv. _Annal._ § 63.

[152] In _Livy_ we find the following Passage: "Neque immemor ejus quod initio consulatus imbiberat, conciliandi animos plebis, saucios milites curandos dividit patribus. Fabiis plurimi dati, nec alibi majore cura habiti." _Vid. lib._ ii. cap. xlvii.

[153] _Justin_ mentions the same Thing of the _Spartans_ after their Defeat at _Sellasia_--"Patentibus omnes domibus saucios excipiebant, vulnera curabant, lapsos reficiebant." _Vid. lib._ xxviii. cap. iv.

The Hospitals commonly wanted for an Army acting on the Continent, are,

1. One in the Rear, to follow their Motions, so as to be always ready to receive the Sick from Camp, which is called the Moveable or Flying Hospital. 2. One or more, at some Distance, in Towns, to receive such of the Sick as can be moved from the Flying Hospital, when they are obliged to go from one Place to another; or when a greater Number of Sick is sent to them than they can easily take Care of[154].

[154] When Parties of Sick or Wounded are to be sent from Camp, or from one Hospital to another, Care ought to be taken that they are placed properly in the Waggons; that they have proper physical People, Nurses, &c. to attend them; as well as Provisions, and other Necessaries, so as to be in no Danger of wanting any Thing while they are on their Journey.

Each of the Hospitals ought to be provided with Physicians, Surgeons Mates, Purveyors, or Commissaries, and others, to attend and take Care of the Sick.

Besides the physical People who attend the Hospital, one or two Physicians ought to go along with the Army to attend the Commander in Chief, and the General and Staff Officers, in Case of Sickness; and an Apothecary, provided with a small Chest of Medicines, ought to attend at Head Quarters to make up the Prescriptions of the Physicians.

A Number of Hospital Surgeons also, with Mates, ought to attend the Army, to be ready in Case of an Action. These ought to be attached to the Suite of the Commanders of the different Corps or Brigades, and to be quartered or encamped with them. And each Surgeon should be provided with a Waggon or some Horses loaded with a proper chirurgical Apparatus, as Instruments, Bandages, Lint, and other Things necessary for taking Care of the Wounded.

A small Quantity of Medicines, some Wine, Rice, portable Soop, &c. and Utensils for a small Hospital, and two, three, or four hundred Sets of Bedding, should be carried about with the Army, in Case of an Action, for the Use of the Wounded, till they have Time to receive Assistance from the Flying Hospital. Some of the Bedding ought to be carried on Horseback, so as to be at Hand when any of the Surgeons are sent with Detachments that are going upon an Attack.

To prevent crowding the General Hospitals in Winter Quarters, every Regiment ought to take Care of their own Sick, and to have proper Hospitals fitted up for them.

Dr. _Pringle_ has laid down some very good Directions with regard to the Choice of Places fit for Hospitals, and the Method of preventing infectious Disorders in them; and we find many excellent Hints of this Kind in Dr. _Lind_ and Mons. _du Hamel_'s Treatises on the Means of Preserving the Health of Seamen, and some likewise in Dr. _Brocklesby_'s late Treatise on military Disorders.

In the Time of Service the Commander in Chief generally orders the Hospitals to be established in Towns or Villages that least interfere with the military Operations, to which the Sick and Wounded can most easily be conveyed; and which he can best protect from the Insults of the Enemy[155].

[155] The _Roman_ Generals seem to have sent their Sick and Wounded into Towns, in the same Manner as is done by those of the present Time. For we read in _Cæsar's Commentaries_ of this Method having been practised on more Occasions than one. In the sixty-second Chapter of the third Book, _de Bello Civili_, we have the following Passage: "Itaque nulla interposita mora, sauciorum modo & ægrorum habita ratione, impedimenta omnia silentio prima nocte ex castris _Apolloniæ_ præmisit, ac conquiescere ante iter confectum vetuit. His una legio missa præsidio est."--And immediately after, in chap. lxv. "Itaque præmissis nunciis ad Cn. Domitium Cæsar scripsit, & quid fieri vellet ostendit: præsidioque _Apolloniæ_ cohortibus iv. _Lissi_ i. tres _Orici_ relictis; quique erant ex vulneribus ægri depositis; per Epirum atque Arcarniam iter facere cæpit."

And in the twentieth chapter, _de Bello Africano_, we read: "_Labienus_ saucios suos, quorum numerus maximus fuit, jubet in plaustris deligatos _Adrumentum_ deportari."

It would be a right Measure, in the Beginning of every War, to settle by a Cartel that military Hospitals on both Sides should be considered as Sanctuaries for the Sick, and mutually protected; as was agreed upon between the late Earl of _Stairs_, who commanded the _British_ Troops, and the Duke _de Noailles_, who commanded the _French_ in the Campaign in _Germany_ in the year 1743. See _Dr. Pringle's Preface_.

In Towns, the Places fittest for Hospitals are public Buildings, which have large dry airy Apartments, situated on a high Ground, where there is a free Draught of Air, and a Command of Water.

In Winter, those Houses, which have open Fire Places in the Rooms, are always preferable to such as have close Stoves, or no Fire Place at all; for an open Fire Place serves to keep up a free Circulation of Air in a Room, as well as to keep it warm. And for the same Reason, where nothing but Stoves can be got to warm the Wards, the Wynd Stoves, which open into the Room or Ward, are vastly preferable to the close ones.

Where there are no public Buildings, private Houses answering nearest to the above Description are most proper for Hospitals. In general, Houses with small Rooms make but bad Hospitals; and very Damp and close Places ought by all Means to be avoided.

In Summer, when the Moveable or Flying Hospital is ordered into Villages, large Barns, and the largest airy Houses, are the best.

Churches, situated on a dry high Ground, make good Summer Hospitals; and in Winter, when Necessity obliged us sometimes to use them in _Germany_ for this Purpose, they were found to answer very well, when we had Bedsteads or Cradles for the Men to lie upon, and the Wynd Stoves to keep them of a moderate Heat.

In making Choice of Houses for Hospitals, particular Regard ought to be had to the Privies or Necessaries; because, where their Smell is offensive, there is always Danger of infectious Disorders. If, therefore, there be no proper Conveniencies of this Kind about an Hospital, such ought to be contrived so as to prevent any Danger from their putrid Effluvia. If there be a River near the Hospital, the Necessaries may be made above it at a Place where there is a rapid Stream below. In Villages deep Pits may be dug in the Ground behind the Hospital, and Seats made over them, as in Camp; and a thick Lay of Earth be thrown above the Foeces every Morning, till the Pits are near full, and then they must be filled up, and others dug to supply their Place.

When once the Places are fixed upon for Hospitals, every Ward ought to be made perfectly sweet and clean; first, by scraping and washing with Soap and Water, and afterwards with warm Vinegar; and then they ought to be fumigated with the Smoke of wetted Gunpowder and of Aromatics, and afterwards well dried and aired by lighting Fires, and opening the Windows, before any Sick are admitted.

After this the Beds ought to be laid; in doing of which great Care should be taken not to crowd the Wards too much, as nothing corrupts the Air so much, or so soon brings on infectious Disorders. Dr. _Pringle_ says, the Beds ought to be laid so thin, that a Person unacquainted with the Danger of bad Air, might imagine there was Room for double or triple the Number. In high lofty Apartments, and in Churches, and other large Places, the Beds may be laid much closer together than in Rooms with low Cielings. In Churches, or such Places, thirty-six square Feet, or a Square of six Feet by six, may be allowed for each Man; but in common Wards we must allow from forty-two square Feet, _i. e._ six by seven Feet, to sixty-four square Feet, or eight by eight, according to the Height of the Cieling, the Airyness of the Place, and the Nature of the Diseases of the Patients.

The Bedding most fit for Hospitals, is Palliasses and Bolsters filled with Straw, Sheets, and Blankets, as they can easily be washed. Feather Beds and Matrasses are apt to retain Infection, and cannot be easily cleansed. In the fixed Hospitals, Bedsteads or Cradles may be set up for laying the Bedding on: But in the Moveable or Flying Hospital the Bedding must be, for the most part, laid on the Floor.

When once the Beds are laid, and the Sick arrive, some of the Gentlemen belonging to the physical Department ought to attend, to distribute the Sick properly through the Hospitals.

All the Surgery Patients, such as have Wounds, Ulcers, Sores, the Venereal Disease, &c. should be separated from the Rest, and put either into particular Wards by themselves, or into an Hospital fitted up for that Purpose under the Direction of the Surgeons.

Those labouring under infectious Fevers and Fluxes, should each of them be placed in good airy Wards by themselves, where the Beds are laid much thinner than in the other Wards of the Hospital. If the Flux Wards have a Privy near them, where the Men can ease themselves, without being offensive either to their own Ward, or any other Part of the Hospital, they are so much the fitter for such Patients. In the Hospital I attended at _Bremen_, the Flux Ward had a Necessary that opened into the River _Weser_, and at _Natzungen_ a deep Pit was dug in the Field about twenty Yards from the Barn where the Flux Men lay, which kept these Wards always sweet.

Patients that have got the Itch, or any other infectious Distemper, ought likewise to be put into separate Wards by themselves; and at all Times a Place should be set apart for those who may be taken ill of the Measles or Small-Pox. A House separated from the other Hospitals, with a distinct Set of Nurses and other Attendants, bids fairest to prevent the Infection from spreading.

When once the Sick are properly ranged, the next Care must be to prevent infectious and malignant Disorders from being generated, and from spreading amongst the Sick; which is principally to be effected by keeping the Sick and the Hospital extremely clean and well-aired, and the Wards as sweet, and free from putrid and offensive Smells, as possible.

Every sick Man, as soon as he arrives at an Hospital, should be washed with warm Water, or if there is a warm Bath, or bathing Tub, to be put into it; and afterwards be supplied with a clean Shirt[156] well-aired before he be put to Bed; and his own dirty Linen should be immediately carried to the Wash-House: And every Morning each Nurse ought to carry a Bucket full of warm Water, and a Piece of Soap and a Towel, round to each of her Patients, and make them wash their Hands and Face, and their Feet, when dirty.

[156] Every military Hospital ought to have a Number of Shirts belonging to it, for the Use of the Sick who arrive without having clean Linen with them. As soon as their own Shirts are washed and dried, or that new ones are provided by their Regiments, the Hospital Shirts ought to be taken from them.

Every Morning all the Wards ought to be scraped and swept, and afterwards sprinkled with warm Vinegar; and when dirty, they ought to be washed after the Fires are lighted.

Every Thing in the Wards, and about the Sick, should be kept as clean as possible; the Chamber-Pots and Close-Stools ought to be carried away as soon as used, and immediately emptied and washed before they be brought back.

The Windows of the Wards ought to be kept open to admit fresh Air Morning and Evening, for a longer or shorter Time, according as the Weather will permit.

If the Wards are close, and the Cieling too low, Dr. _Pringle_ advises to remove some Part of them, and to open the Garret Story to the Tiles[157]; and if the Opening of the Windows is not sufficient to air the Wards, Ventilators of different Kinds, such as those mentioned by Dr. _Hales_ and Dr. _Pringle_, may be used, especially when the Weather is hot.

[157] In Wards which are too close, it has been found that one or two square Holes (of about six or eight, or ten Inches diameter), cut in the Cieling, and a Tube made of Wood fitted to it, and carried up into the Chimney of the Ward above, so as to enter above the Grate, is one of the best Contrivances for procuring a free Circulation of Air; as the foul Air, which is lightest, and occupies the highest Part of the Ward, finds a free Exit by these Tubes: We have such Tubes now fixed in several of the Wards in _St. George_'s Hospital. A Hole cut above the Door of the Ward, or in the upper Part of the Windows, and one of what are called the _Chamber Ventilators_ fixed in it, will answer, where Holes cannot be conveniently cut in the Cieling.

In Winter, Fires should be lighted in all the Wards where it can be done.

In foreign Countries, when we meet with Hospitals where there are no Places for open Fires, but only close Stoves, different Contrivances may be used to renew the Air. Ventilators of different Kinds may be used, or Openings made in the Doors and Windows. In Winter 1761-62, some of the Wards in the Hospital at _Bremen_ which I attended had such Stoves. In order to keep up a free Circulation of Air in those Wards, I directed large Holes to be cut in the lower Part of the Door in each Ward, and two Grooves to be made on the Outside of the Door, above and below the Hole, parallel to each other, in which a Board slided; by means of which, the Hole could be either quite covered or only in Part, or left entirely open; and I directed a Casement, about eight or nine Inches square, to be made in the upper Corner of each Window. After the Fires were lighted, upon removing the Board which covered the Hole in the Door, and opening the little square Windows, a Current of fresh cool Air rushed into the Ward by the Door, while the heated foul Air found an Exit by the Windows. In very cold Weather, the Opening of the small Windows was sufficient; but in mild Weather, and in Summer, it was necessary to keep both open.

The Wards should be daily fumigated by Means of Aromatics, or wetted Gunpowder thrown on burning Coals, put in an Iron Pot or Chaffern, or with the Steams of warm Vinegar placed in the Middle of the Ward. Dr. _Lind_ says, that although Cleanliness and a pure Air contribute much to prevent infectious Disorders, or to check them, yet that they of themselves are not always sufficient; but that he seldom or never knew a proper Application of Fire and Smoke to be unsuccessful in producing the happy Consequence of effectually purifying all tainted Places, Materials, and Substances[158].

[158] Dr. _Lind_ tells us, that the Ships of War in his Majesty's Service are purified by Fire and Smoke, and gives the Process by which it is done; and he says, that he never heard of any Ship, which, after being carefully and properly smoked, did not immediately become healthy for the Men.--See _First Paper on Fevers and Infection_.--And he observes, that these Steams and Smoke, which are inoffensive to the Lungs, besides correcting the bad Quality of the Air, produce another good Effect; which is, to make both the Patients and Nurses desirous of opening the Doors and Windows for the Admission of fresh Air. _Ibid._ p. 51.

In all Military Hospitals, at least in the fixed ones, one Ward ought to be always kept empty; and whenever a malignant Fever, or any other infectious Disorder, breaks out in any Ward, the Men ought to be removed into this empty one; and the foul Ward purified, by washing and cleaning it well with Soap and Water, and then with warm Vinegar; and afterwards purifying it with Smoke, in the same Manner as is practised in his Majesty's Ships of War; and Fires should be lighted daily, and the Windows kept open for some Time, before any Sick be again admitted into it.

As soon as any Patient dies, the Body ought to be removed to the Dead House; and the Bedding he lay upon should be carried away immediately, and not used again till it has been smoked, well-aired, and washed.

All the Linen of Patients in Fevers, Fluxes, and other infectious Disorders, ought to be changed often; and all the foul Linen and foul Bedding of the Hospital should be smoked with the Fumes of Brimstone, or of wetted Gunpowder, in a Place set apart for that Purpose; and Dr. _Lind_ advises to steep them first in cold Water, or cold Soap Lees, before putting them in warm Water; as it is dangerous for any Person to receive the Steam that may at first arise, where this Precaution is not used.

All the Cloaths, of Soldiers who die in Hospitals, ought to be sent to the Smoke House, and be well fumigated, and afterwards aired, before they are put up in the Store-House.

The next Thing to be considered about a Military Hospital is the Diet of the Patients, which should consist of good wholesome Provisions, that can be purchased easily, and at a cheap Rate[159].

[159] The _French_, and many other Nations, give their Patients Meat Soops in acute Diseases, and after capital Operations; and they allow them but little Bread or other Preparations of Vegetable Substances: But these Meat Soops without Bread do not nourish the Patient sufficiently, and tend too much to the Putrescent; and this is one Reason why more Sick die in the _French_ than in the _British_ Hospitals.

Good Bread[160] is a standing Article of Provisions for an Hospital in all Countries and in all Climates; and a certain Quantity of it ought to be distributed to each Man daily.

[160] On Expeditions where a Siege is expected, a Quantity of Flour ought to be carried out, and a Number of portable Ovens for baking bread for the Sick, which may be put up after the Troops have made good their Landing.

The Breakfast and Supper in most Military Hospitals must be made of Water Gruel or Rice Gruel; as either Rice or Oatmeal can be got in most Places, and are very portable.--Water Gruel is in general preferable to the Rice Gruel, because most Patients nauseate the Rice Gruel, after eating it for some Days, but not the Water Gruel, as every Person, who has attended the Military Hospitals, must have experienced. Where both Rice and Oatmeal can be had, Rice Gruel may be used two or three Times a Week by Way of Variety.

But although Rice Gruel is not so proper for constant Use, yet Rice should always make an Article among the Stores for an Hospital, as it is useful for making Rice Water for Drink; and it can be boiled or ground, and made into a light Pudding, and in short may be used in a Variety of Forms to make a good and wholesome Food for the Sick.

Oatmeal is cheaper than Rice, and can be procured almost every-where in _Europe_, where Armies make Campaigns; as Oats make such a great Article in the Forage for Horses. And a sufficient Quantity can at any Time be ground into Meal for the Use of the Sick, at the Mills which are employed for making Flour for the Bakery, if there be none nearer the Hospital.

In Countries where neither Oatmeal nor Rice can be had, _Indian_ or some other Corn, which is known to be wholesome, and which the Country affords, may be employed in their Place.

When fresh Meat can be got, the Men who are on full Diet, and the Nurses and other Servants about the Hospital, should have Meat for Dinner; and the Meat that is boiled for them ought to make Broth for the Sick who are kept on a low or middle Diet. Some Barley or Rice should be added to the Broth; and a small Quantity of Carrots, Turnips, or other Vegetables, boiled along with them, will make it more agreeable to the Taste.

On Expeditions where nothing but salted Meat can be had, a Quantity of portable Soop should always be carried out for the Use of the Sick; which with Water and some Barley, and fresh Vegetables, when they can be got, will make a good Soop or Broth. On such Occasions, the Dinner ought to consist of Soop and Bread, or of light Puddings made of Flour or of Rice, of boiled Rice or Barley, or of Panado, &c.

Nurses and recovered Men may be allowed salted Meat twice or thrice a Week.

The common Drink of Military Hospitals ought to be Rice and Barley Water, with a small Proportion of Spirits and Sugar. Small Beer is a good Drink where it can be easily procured; as is Wine and Water, or a very small Negus, or very weak Punch in warm Climates.

Besides this Diet, extraordinary Indulgences may be occasionally allowed to particular Patients, as Wine, Brandy, Sugar, Milk. And the Physicians and Surgeons ought to have a discretionary Power to order a Vegetable or any other proper Diet for Patients in the Scurvy, or any other particular Complaints.

The Established Diet of a Military Hospital may be,

_Breakfast._ _Dinner._ _Supper._ One Pint of Water | | or Rice Gruel. | | | | Water Gruel made | | with 3 or 4 Ounces | | of Oatmeal, a | | little common Salt,|One Pound | and with or without|of boiled fresh | Full Diet, a little |Meat. | As Breakfast. Sweet Oil, and | | two Spoonfuls of | | Wine. | | | | Rice Gruel made | | with two Ounces of | | Rice, one Spoonful | | of fine Flour, a | | little | | common Salt and | | Sugar. | | ----------------------------------------------------------------- |One Pint of | |Broth, half | Middle Diet, Ditto. |Pound of boiled | Ditto. |Meat. | ----------------------------------------------------------------- |One Pint of | |Broth, or | Low Diet, Ditto, or according|half a Pint of | to the Patient's |Panado, with | Appetite. |two Spoonfulls | Ditto. |of Wine, | |and a Quarter | |of an Ounce | |of Sugar. |

The daily Allowance of Bread to be one Pound to each Man.

The common Drink for those on full and middle Diet to be Rice or Barley Water, with two Spoonfuls of Brandy to each Pint, and a Quarter of an Ounce of Lump Sugar; small Beer, or very weak Punch; or Wine and Water, two Ounces of Wine to a Pint of Water, and a Quarter of an Ounce of Sugar. The Quantity not to exceed three Pints _per_ Day.

Those on low Diet to have Rice or Barley Water as above, with or without Wine or Brandy.

The Diet Boards hung up in the Hospitals may be made with the following Columns, nearly as they were with us in _Germany_.

Regiments.|Mens | Diet |Wine. |Brandy.|Milk. |Sugar. | |Names.|F.|M.|L.|½ Pints. |Ounces.|½ Pints. |Ounces.| ----------+------+--+--+--+----------+-------+----------+-------+ | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | ----------+------+--+--+--+----------+-------+----------+-------+

When such Diet Boards are kept in an Hospital, and the Mens Names and Regiments are once wrote down, the Patients may with very little Trouble be put upon the full, middle, or low Diet, with so much of the above-mentioned Extraordinaries as may be judged proper.

If any Thing else be wanted for the Sick, the Physician ought to give a particular Order in Writing for it, the Columns here marked being only for such Things as are most frequently wanted.

It should be a general Rule in all Military Hospitals, that, when a Party of Sick arrives, every Man may have immediately a Mess of Water Gruel given him, and afterwards be put on low Diet till it is ordered otherwise by the Physician or Surgeon who attends him.

It is not to be supposed that the Diet here mentioned can be strictly kept to in all Parts of the World; for it must often be varied according to the Difference of the Climates, and to the Provision of the Countries where the Scene of War may be.

Whenever a Moveable or Flying Hospital is to attend an Army, a Quantity of Bedding, and of all Utensils for forming an Hospital, ought to be put up in the Waggons, together with Provisions of different Kinds, such as Oatmeal, Rice, Sago, Brandy, Wine, Sugar, &c. A Butcher with a Stock of live Cattle, and a Baker with a proper Quantity of Flour for making Bread ought constantly to attend; and a Number of empty Waggons should likewise be always in Readiness, to transport the Sick when the Hospital moves, or when a Party is to be sent to the fixed Hospitals.

When Troops go upon an Expedition, besides the common Hospital Ships, another Ship ought to be properly fitted up for the Reception of sick Officers[161]; and every Hospital Ship ought to be supplied with all Sorts of Provisions, and other Necessaries fit for forming an Hospital, before they leave _England_.--And one or more armed Vessels loaded with Provisions, Wine, and all Sorts of Necessaries for the Sick, ought to attend them; or if the Expedition be intended for the warm Climates, these Vessels ought to go before the Fleet to take up Wine and Fruits, such as Lemons, Oranges, &c. Vegetables of different Kinds, and a live Stock for the Use of the Sick.

[161] If there be no Ship fitted up for the Reception of sick Officers, those who are taken ill on Expeditions must be in a most miserable Situation; as there is no Place to receive them in the common Hospital Ships, they must remain almost without Assistance in a crowded Cabin amongst People in Health; as was the Case in some of our Expeditions during the late War.

All Hospitals attending Expeditions should carry out among their Stores a Number of large Tents for lodging the Sick and Wounded immediately on making good their Landing. Where a Siege is expected which will take up Time, and where no Accommodations for the Sick can be had till the Siege is over, a Ship or two, with Boards, and other Necessaries for building large Sheds, or temporary Hutts, for the Sick, as proposed by Dr. _Brocklesby_, ought to go along with the Fleet, or meet them at the Place of their Destination. Such thatched Sheds, or Hutts, are very necessary in the warm Climates, as the perpendicular Rays of the Sun, beating upon Canvass, make Tents intolerably hot. When any of our own Settlements happen to be near the Place attacked, a fixed Hospital may be established there; either in Houses, if proper ones can be found; or in temporary Sheds or Hutts erected for that Purpose; and some Vessels, properly fitted up, may be kept going with the Sick and Wounded, and bringing back the recovered Men.

At every Military Hospital a Serjeant's Guard ought to mount; and Centinels be placed at the Doors of the Hospital, 1. To prevent all Visitors, who have not proper Leave, from coming into the Hospitals; as such People oftentimes crowd the Wards, disturb the Sick, and are apt to catch infectious Distempers, and to spread them among the Troops. 2. To take Care the Patients do not go out of the Hospital without having a Ticket[162] of Leave for that Purpose, signed by the Physician, Surgeon, or Apothecary, belonging to the Hospital. 3. To prevent spirituous Liquors, or other Things of that Kind, being clandestinely carried into the Hospital.

[162] At every Hospital there ought to be a Number of printed Tickets lying ready to be filled up and signed by the Physicians and Surgeons, and no Man ought to be allowed to go out without a Ticket so signed.

The Serjeant of the Guard, attended by the Ward Master, ought, every Morning, to go round the Wards to call a Roll, and see that every Man is in his Ward; and to do the same at Night before the Hospital Doors are shut, and at this Time to order every Person out of the Hospital who does not belong to it. And the Serjeant, every Morning, ought to report to the Physician, Surgeon, or Apothecary, every Man's Name who was found to be absent at Roll-calling; and whether he found every Thing regular and in good Order in going his Rounds.

Every large Military Hospital ought to have one Head Nurse, and a sufficient Number of other Nurses, to attend and take Care of the Sick.

Orders to the following Purport, hung up in every Military Hospital, would serve to shew the Nurses and Patients what their Duty is, and to maintain Regularity and good Order through the whole Hospital.

_Matron, or Head Nurse._

Every Matron, or Head Nurse, is to go round all the Wards of the Hospital at least twice a Day, Morning and Evening; to see that the Nurses keep their Wards clean; that they behave themselves soberly and regularly, and give due Attendance to their Patients; and to examine the Diet of the Patients, and see that it is good and well dressed; and if she finds any Thing amiss, to report the same to the Physician, Surgeon, or Apothecary, of the Hospital.

_Common Nurses._

1. The Nurses are to give due Attendance to their Patients; and to keep them always as neat and clean, as the Nature of their Distempers will admit of; to give them their Diet regularly; to be particularly careful to see them take the Medicines ordered by the Physicians, according to the Directions given; to report to the Physician, Surgeon, or Apothecary, any Faults or Irregularities which any of their Patients may have committed; and to acquaint the Ward Matter and Head Nurse of the Death of any of their Patients as soon as it happens, that proper Care may be taken of their Cloaths and Effects.

2. They are to keep their Wards extremely clean, to sprinkle them every Morning with Vinegar, and to fumigate them with the Smoke of wetted Gunpowder, or of Frankincense, or any other Aromatics that may be thought proper; in fair Weather to keep open the Windows of their Wards, twice or thrice a Day; for a longer or shorter Time, as the Weather will permit; to attend at the Steward's Room for the Provisions of the Patients at the Hours appointed for that Purpose; and to pay implicit Obedience to the Matron, or Head Nurse, in what relates to their Duty; and punctually to obey all Orders they receive from the Physician, Surgeon, or Apothecary, of the Hospital.

3. They are to keep themselves clean and decently dressed, and to observe the strictest Rules of Sobriety; remembering, that if any one is found intoxicated with Liquor, that she is immediately to be sent to the Guard, and afterwards discharged.

4. They are not to absent themselves from their Wards, unless when employed in the Discharge of their Duty; nor to go out of the Hospital to which they belong, without having a Ticket of Leave signed by the Physician, Surgeon, Apothecary, or Head Nurse, belonging to the Hospital.

5. They are not to throw Nastiness of any Kind out at the Windows, but to carry it to the common Necessaries, and to empty the Chamber Pots and Close-stools as soon as used, and be careful to wash them before they bring them back.

6. They are not, upon any Pretence whatever, to alter the Diet ordered by the Physicians or Surgeons to the Patients on the Diet Boards; nor to suffer their Patients to use any other Diet than what is allowed by the Hospital; nor are they to bring, or allow others to bring, Meat, spirituous Liquors, or other Things of that Kind, into their Wards, except what is allowed by the Physicians or Surgeons. Whenever any Thing of this Kind is found in any of the Wards, it ought immediately to be thrown into the common Necessary; and if it be found in the Custody of a Nurse, she ought to be confined in the Guard, or discharged.

7. Nurses guilty of great Neglect of Duty, or of getting drunk and using their Patients ill, or of stealing, or concealing or taking away the Effects of Men who die in the Hospital, are to be immediately sent to the Guard, and reported to the Commanding Officer of the Place, that they may be tried by a Court-Martial, and be confined, whipped, or otherwise punished, as the military Law directs; all Followers of Armies on foreign Service being equally subject to the military Law as the Soldiers themselves.

_Patients._

1. All sick Soldiers, on their Arrival at a Military Hospital, are to be washed all over with warm Water, or to go into a warm Bath; and afterwards to wash their Face and Hands every Morning, and their Feet occasionally, with warm Water and Soap, brought round every Morning by the Nurses for that Purpose; and they ought to comb their Head every Day. If they be too weak to wash and comb themselves, it is to be done by their Nurses.

2. Every Patient is to be shaved and have clean Linen twice a Week, or oftener if requisite.

3. They are punctually to obey the Directions given them, and to take the Medicines ordered by the Physician; and none to be allowed to go out of the Hospital without a Ticket of Leave signed by the Physician, Surgeon, or Apothecary, of the Hospital.

4. They must commit no Disorder or Riot, but in all Respects behave themselves well.

5. If any Man disobeys the Orders he receives from the Physicians or Surgeons, or is irregular in Conduct, gets drunk, and commits Riots in the Hospital, or is found guilty of Theft or other Crimes, the same is to be reported to the Commanding Officer of the Place, and he to be tried by a Court-Martial, and punished as soon as his Strength will permit.

In conducting the Military Hospitals, we found that it was always right to discharge the Patients from the sick Hospitals as soon as they were recovered, and to send them either to Billet, or to a convalescent Hospital; because recovered Men are always the most riotous; besides they crowded the Hospitals, and were in Danger of catching fresh Disorders from those who were sick; and therefore the recovering Men in every Hospital ought to be reviewed once or twice a Week by the Physician or Surgeon, and the Names of such Men as are well enough, to be marked; in order that they may be sent the next Day to the convalescent Hospital, or to Billet. A Return of those marked for Billet ought immediately to be sent to the Officers on convalescent Duty.

When a convalescent Hospital is established, it ought to be put under proper Regulations; the following are those which I drew up for that established at _Osnabruck_ in _April_ 1761, and which were found to answer the Purpose intended.

_Regulations for a Convalescent Hospital._

1. That this Hospital be entirely occupied by such Men as are recovered from Diseases; that no Men be sent there but those whose Names are returned to the Purveyor's Office by the Physician or Surgeon of the Hospital.

2. That all the Patients shall be upon full Diet, unless in particular Cases it be ordered otherwise by the Physician or Surgeon.

3. That all the Patients shall breakfast, dine, and sup, at regular stated Hours, in the Hall appointed for that Purpose: Breakfast to be ready at nine, Dinner at one, and Supper at seven o'Clock in the Evening.

4. That no Patient shall carry up any Victuals into the Wards appointed for sleeping in; and if any Patient does not attend at the regular Hours of Meals, no Allowance of Victuals shall be made him in the Place of such Meals, unless he has been absent on Hospital Business, or been confined to Bed by Sickness.

5. That as soon as the Men are come down Stairs to Breakfast, the Wards in which they sleep shall be cleaned out and sprinkled with Vinegar, and the Windows opened to air them.

6. That the Doors of this Hospital shall be locked every Night at eight o'Clock, and no Man be allowed to come in or go out after that Time. The Doors to be opened again at seven o'Clock in the Morning.

7. That the said Hospital is to be visited two or three Times a Week by the Physician, Surgeon, and Apothecary, who are to see that the above Orders are complied with; to examine the Diet, and take Care that every Thing is carried on properly; and to prescribe for any little Disorders the Men may be affected with.

8. That one of the Hospital Mates be appointed to visit this Hospital daily, to administer any Medicines which may have been prescribed by the Physician; to apply any Dressings ordered by the Surgeon; and to acquaint the Physician or Surgeon if any of the Men be so bad as to require their Attendance, or to be sent back again to the Sick Hospital.

9. That for the better executing these Regulations, orderly Serjeants or Corporals be appointed for the Care of the Men; who shall mount a Guard of six or more of such of the Patients of the said Hospital as are fit for this Duty--That the Serjeants are to call a Roll of all the Patients regularly three Times a Day, before Breakfast, Dinner, and Supper; to see that the Men behave themselves soberly and decently; and that they keep themselves clean, and commit no Riots; and to confine in the Guard such as commit Riots and other Irregularities, or whom they find drunk, or who stay out all Night; and to report the same to the Officer on Duty.

10. That an Officer on convalescent Duty do visit the said Hospital daily at the Times of Roll-calling, to see that every Thing be carried on properly; and to receive the Reports from the Serjeants, and give what Orders he may think proper for the better regulating the said Hospital.

11. That if at any Time it should happen that there are more Convalescents than the Hospital can hold conveniently, a Review be made of all the Patients, and the strongest and most healthy be sent to Billet.

12. That a Review be always made, when any Party is going to join the Army, to pick out the Men who are fit to join their Regiments.

The Physical Officers employed in the Military Hospitals, are Physicians, Surgeons, and Apothecaries.

No Person ought to be appointed a Physician to the Army, or Military Hospitals, without previously undergoing the same Examination at the College of Physicians, as those do who enter Fellows and Licentiates of the College, that none but proper Persons may be employed. On such Examinations the Physician General to the Army ought to be allowed to sit as one of the Censors of the College.

The Surgeons are all obliged to pass an Examination at Surgeons Hall before they are appointed, and the Apothecaries ought in like Manner to pass an Examination at Apothecaries Hall.

The Mates employed in the Service ought, previous to their Appointment, to be examined both in Surgery and Pharmacy, as the Service commonly requires their acting in both Branches.

The Direction of all Military Hospitals ought always to be committed to the Physicians, who have the immediate Care of Hospitals.

When an Army is acting on a Continent, and there is a Number of Hospitals in different Places, the Physician who attends the Commander in Chief ought to be made Physician General and Director of the Hospitals, with proper Appointments; and all Orders from Head Quarters ought to go immediately thro' this Channel.

Every other Physician at the different Hospitals ought to direct every Thing about the Hospital which he attends, and his Orders ought to be punctually obeyed; and he ought to keep up a constant Correspondence with the Physician General; acquainting him from Time to Time with the State of the Hospital, and what is wanted for it; and he ought punctually to obey whatever Orders he receives from the Physician General.

If there be separate Hospitals for the Surgery Patients, the eldest Surgeon ought to direct every Thing in the Hospital he attends; and when any Thing is wanted for his Hospital, to report the same to the Physician General.

The directing and purveying Branches ought never to be entrusted to the same Person, as the Temptation of accumulating Wealth has at all Times, and in all Services, given Rise to the grossest Abuses, which have been a great Detriment to the Service, as well as to the poor wounded and sick Soldiers, and has occasioned the Loss of many Lives. And therefore neither the Physician General, nor any of the Physicians or Surgeons of the Army, or any other Person concerned in the Direction of the Military Hospitals, ought ever to act as Purveyor or Commissary; nor ought they ever to have any Thing to do with the Accounts, Contracts, or any other Money Affairs relating to the Hospital; and if ever they be found to intermeddle in these Affairs, they ought to be immediately dismissed the Service.

The purveying or commissariate Branch ought to be entirely distinct from the physical. The Purveyors or Commissaries ought punctually to obey whatever Orders they receive from the Physicians or Surgeons; to provide every Thing for the Hospital; to keep regular Accounts of all the Men who come into, or go out of the Hospitals; and from Time to Time to make Returns to Head Quarters of all the Men in Hospitals; and their Accounts ought to be controuled by such Persons as the Government may think proper.

Every Physician and Surgeon of a Military Hospital ought to visit the Sick at regular stated Hours, and the Mates to attend and go round with them, and receive and execute their Orders.

Every Mate ought to have a certain Number of Patients allotted him, for whom he is to make up all Medicines, dress all Sores, and execute whatever Orders he receives from the Physician, Surgeon, or Apothecary. That the Mates may know and execute their Duty, proper Orders in Writing should be hung up in the Apothecaries Shop for that Purpose. The following are those which I gave out at all the Hospitals I attended in _Germany_.

_Orders for the Mates._

1. That all the Gentlemen do attend at the Apothecaries Shop every Morning at eight o'Clock, to assist in making up the common Medicines of the Day, and afterwards to go round the Hospitals with the Physicians and Surgeons.

2. That every Mate have a Book for writing the Prescriptions of the Physicians in, which is to be kept in the following Order.--First, to mark the Patient's Name and Regiment; then the Day of his Entry into the Hospital and his Disorder; then the Prescriptions of the Physician; and after all the Day of his Discharge, or of his Death. _Ex. gr._

_John Clarke_, 20th Regiment. _Jan._ 1. Fever.

_Jan._ 1. V. S. unc. x.--H. salin. cum pulv. contrayerv. 4r. die.--2. Emplast. vesicat. dorso, &c.

Discharged or dead _Jan._ 28.

3. That every Mate make up himself the Physician's Prescriptions for his own Patients, and afterwards go round and administer them, or give them to his Patients with proper Directions; that he bleed his own Patients, and dress any slight Sores they may have, which do not require their being sent to the Surgery Hospital.

4. That every Mate go round amongst his Patients in the Evening, to see that every Thing is well conducted, and to report to the Physician or Apothecary if any Thing extraordinary happens.

5. That two of the Mates attend all Day at the Apothecary's Shop to receive any Sick that may arrive, and to place them properly; to make up what Medicines they may immediately want; to order each of them a Mess of Water Gruel; and if any Thing extraordinary occurs, to send an orderly Man to acquaint the Physician or Apothecary with the same. The orderly Mates to make up likewise for Officers, or others, all Prescriptions sent to the Apothecary's Shop through the Day.

A Joint of Meat, roasted or boiled, for Dinner, and a Bottle of Wine, was allowed to the orderly Mates, by Lord _Granby_'s Order, that they might not absent themselves from their Duty.--Where there was Conveniency for it, a Mate lodged in the Hospital.

The Apothecary ought to take Care of the Medicines; to go round the Hospitals in the Morning before the Time of the Physician's visiting; to see that the Wards are in proper Order; that the Nurses and other Servants have done their Duty; to examine into the State of the Sick, and to see that the Provisions are good; and make a faithful Report of all these Things to the Physician when he arrives.--To take Care that the Mates prepare in the Morning the Medicines that are commonly wanted for the Day; and that they afterwards make up faithfully the Prescriptions of the Physician; to go round the Hospital again in the Evening, to see that the Sick have got their Medicines regularly; and to make the same Enquiries as in the Morning.

The Apothecary should always be lodged near the Hospital, to assist in Case of any Accidents happening, or of Sick arriving at the Hospital.

When there are any strong infectious Disorders in Military Hospitals, the physical Gentlemen may use the following Precautions to guard themselves against Infection.

1. Never to visit the Sick with an empty Stomach; but to eat Breakfast before they go into the Hospital.

2. To have a Suit of Cloaths reserved for visiting the Hospital, and a waxed Linen Coat to wear above them in going round the Wards; and as soon as they have come out of the Hospital, to wash and change their Linen and Cloaths.

3. Before they go into the Wards, to order that they be well cleaned out, and sprinkled with Vinegar, and afterwards fumigated, and aired by opening the Windows, or by Working the Ventilators.

4. If the Infection be very strong, to take a Glass of the spirituous Tincture of the Bark just before they go into the Hospital.

5. To put small Rolls of Lint, dipped in camphorated Spirits, up the Nostrils, and to direct a Vessel, with warm camphorated Vinegar, to be carried round, and held near the Patients they are examining.

6. In examining Patients affected with the Petechial Fever, or any other malignant Distempers, to stand at some little Distance, and ask what Questions they may think proper; and when they come near, to feel the Pulse, and examine the Skin, not to inspire while their Head is near the Patient's Body; but after being fully satisfied in these Points, to retire a little, and ask what other Questions may be necessary.

It would be right to establish some military Rank for every commissioned Officer of the Hospital on Service, and to settle the same Subordination in the physical as in the military Department. By these Means, the Service would be carried on with greater Order, and more Advantage to the Sick.

And it would be right, in Times of War, to add a Clause in the Mutiny Bill to allow any military Officer on convalescent Duty to call in the commissioned physical Officers to assist in making up a Court-Martial, when there are not a sufficient Number of military Officers in a Place, to try convalescent Soldiers guilty of Crimes. For in Times of Service, very often a sufficient Number of military Officers cannot be spared to be on Duty at the different Military Hospitals; and at all such Places the Convalescents are generally very disorderly, when they know that there is not a sufficient Number of Officers to form a Court-Martial for punishing them. Where-ever there are a sufficient Number of military Officers, no physical Officer ought ever to be called upon as a Member of a Court-Martial.

Men, in Time of Service, are often apt to saunter in and about Hospitals, and there learn all Manner of Debaucheries, and lose all Sense of Discipline; and therefore, to keep up Order and Decorum, there ought to be, at every Fixed and every large Military Hospital, a military Inspector or Commander, an Officer of known Activity and Probity; and a Number of Officers on convalescent Duty sufficient to form a Court-Martial whenever required.

The Duty of the Military Inspector, or Commander, should be, to take Care of all Convalescents on Billet; to see that the Officers under him do their Duty, and maintain the same Regularity and Discipline among the Men belonging to their respective Corps, as if they were with their Regiments; and that the Men attend the Parade and Roll-calling; and that they always appear neat and clean.

He ought, from Time to Time, to visit the Hospitals; to see if they are kept clean; to enquire if the Men behave well, if the Diet is good, and the Officers, Nurses, and Servants, do their Duty; and if he finds any Thing amiss, to report the same to the Physicians and Surgeons of the Hospital, or to the Purveyor or Commissary, or others, under whose Department it may be, that the same may be immediately rectified; and if he finds that the superior Officers of the Hospital overlook such Abuses, notwithstanding his Representations, to report the same immediately to the Head Quarters.

He ought to order one of the Officers on convalescent Duty to visit the Hospitals daily, to make the Enquiries above-mentioned, and to give him a Report of the same in Writing.

The Purveyor or Commissary ought to make a Return to him twice or thrice a Week of every Man admitted into, or discharged from, the Hospitals, or who dies in them; marking in the Return the Name of every Man, and the Company and Regiment he belongs to; that he may report the same to the Officers of the different Brigades or Regiments.

The Military Inspector ought to have the Power of providing Billets for all Officers and Soldiers about Hospitals; and the Names of all Men to be discharged from Hospitals should be sent to him the Day before they are discharged, that he may provide Billets for them; and next Day the Men ought to march from the Hospitals to the Parade, to receive their Billets, and the Orders of the Military Inspector, and of the Officers of the Corps they belong to.

The Military Inspector ought to see that the Arms of the sick Men, and the Arms and Cloaths of those who die and are lodged in the Magazines, be properly taken Care of; and that the Stores of the different Regiments be properly looked after.

As the Service often makes it necessary at Military Hospitals, where the Number of Sick is great, to employ the convalescent Soldiers[163] as orderly Men and Servants about Hospitals, all Men thus employed ought to have a special Leave from the Military Inspector for so doing; and no Man should be employed in any Capacity as a Servant about an Hospital, who at that Time is on the Books as a Patient. And all Men employed about the Hospital ought to be reviewed once a Week by the Military Inspector, and likewise whenever a Party of Convalescents is going to join the Army, or their Regiments; that no Man may be allowed to remain with the Hospital, after he is fit to do Duty in his Regiment.

[163] In the _French_ Hospitals there are always a Number of Men who attend their Sick who belong to the Hospital, so that they have no Occasion to employ their Convalescents, as we are often obliged to do, where the Sick are attended by Nurses, who are commonly Soldiers Wives, and not so capable of doing such laborious Work as the Men.

When the Military Inspector is absent, the eldest Officer on convalescent Duty ought to act in his Place.

Every Officer sent on convalescent Duty ought, as soon as he arrives at the Place where the Hospital is, to wait on the Commandant, or Military Inspector; to acquaint him of his Arrival, and to receive his Commands. He ought then to go to the Purveyor or Commissary's Office, to get a List of all the Soldiers who are in or about the Hospital, and belong to the Regiment or Brigade he is employed for, wherein those on Billet are distinguished from those in Hospitals. The next Day he ought to parade all those marked on Billet, to see if the Number of Men agrees with the List given him, and to examine in what State each Man is, and how he is employed; and then he ought to go round the Hospitals, attended by an orderly Serjeant, to see all the Men in the Hospitals, and to know if the List given him at the Purveyor's Office was right; and afterwards he ought to send every Day a Serjeant or Corporal to see the Men in Hospitals, and to report to him when any Men are discharged or die.--And he ought to procure from the Military Inspector a Return of all the Men of his Corps, who are either admitted into, or discharged from Hospitals, on the Days when such Returns are made. He ought to make all his Men on Billet appear regularly on the Parade at Roll-calling, and to oblige them to keep themselves clean and their Arms in good Order, and to endeavour to preserve the same Regularity and Discipline as when they are with their Regiments. And whenever a Party is to be sent to join their Regiments, he ought to have all his Men particularly examined; and those Men who are found to be perfectly recovered, should be sent to their Regiments.

If every Officer on convalescent Duty conform to these Directions, no Man can ever be detained without his Knowledge in or about Hospitals, as he must always know where every Man is, in what State of Health, and how he is employed; and may at any Time be able to make a Return to the Brigade or Regiment for which he is employed, of every Man who is admitted, discharged, or dies in the Hospital.

FINIS.