PART III.

OF THE DISEASES OF THE INDIAN ARMY IN EGYPT.

We have now arrived at the last part of these Sketches; where it is intended to offer some account of the diseases which we met with in Egypt.

The catalogue of military diseases is never extensive. If his peculiar way of life exposes the soldier more to some distempers, it entirely exempts him from many others. In an Indian army the diseases are even fewer than in any other; at the same time, that the practice of medicine is more simple. I am of opinion, that in India the practitioner goes on surer ground than in Europe, partly for the above reason, and partly from the causes of disease being less varied in that country. Though the diseases which occurred in the Indian army, when in Egypt, were not numerous, yet some of them were highly important, and on our arrival in Egypt were new to every one of the medical gentlemen, excepting Mr Bellars, of the 86th regiment, who had treated a few cases of the plague, which occurred in a detachment of that regiment acting with the Vizier’s army, and had himself suffered from the ophthalmia of Egypt.

I propose to include every thing that I have to offer on this part under two heads. Under the first, I shall notice two diseases which may be termed the endemics of Egypt, viz. the plague and the ophthalmia of that country.

Under the second, the other diseases which prevailed will be noticed. They are mostly tropical diseases; and with them the reader will not be long detained.

OF THE PLAGUE.

I begin with the plague; a disease of which accounts have been handed down to us from the earliest ages of history or of physic. The consideration of it is important, not only on account of its frequent and fatal occurrence, but, as being, perhaps, the most formidable disease that the art of physic has to encounter. On this subject, however, much will not be expected from me. Of no disease have we a more clear, accurate, and complete, history than of this, in Dr Russel’s work on the plague. In Egypt, we often had recourse to this work, and we readily acknowledge our obligations to the venerable and learned author.

Though since the time that Dr Russel gave his ample history of the plague in Syria, we have had several accounts of this disease as it appeared in other countries; yet much has not been added to our stock of information, and little of improvement has been made in the practice. The proper and well-timed use of mercury, and, perhaps still more, the application of the newly-discovered remedies analogous in their effects to the calces of that mineral, hold out a prospect of success the most encouraging.

In Europe, but more particularly in Britain, much of the dread, and much of the real danger, that attended the most fatal diseases in this country are now done away, by the late improvements in medicine, and in chemistry.

The time was, when fever, when it broke out in different parts of England, proved little less fatal to whole villages and towns than the plague does in the countries where it resides. From the improved practice of the treatment of fever, but more from our knowledge of the means of destroying contagion and preventing its spreading, the mortality from this class of diseases is now comparatively small.

The small-pox, that plague which once carried off so great a proportion of the population of Europe, now bids fair to be expunged from the catalogue of diseases.

May we not indulge a hope, that, as the intercourse of civilized Europe, with the countries of which the plague is now the scourge, becomes more regular and intimate, we may be enabled to extend to them our discoveries and improvements, and so direct them to the means of divesting the plague of its terrors, and reducing the mortality from it to the scale of that of fever and the small-pox in Europe?

Egypt has been called the cradle of the sciences. From this we acknowledge, that the arts were derived to Greece, and subsequently to every part of the world. It would surely be the noblest gratification, if in return, at this period, Europe, by extending her benefits and improvements to Egypt and to Greece, could free them from the most cruel scourge of countries, once the most civilized and polished in the world. It would in some measure compensate and console them for the low state of degradation into which they have fallen.

All that I have to say of the plague will tend to diminish the dread which has hitherto been entertained of it.

A formidable disease undoubtedly it is; but, when we hear how much of the population of Persia, Arabia, Turkey, Syria, Egypt, and Barbary, is now and then swept off, all must not be laid to the account of the plague, as if its ravages admitted of no remedy. The experience of the French and English, in Egypt, will now convince Europe, that much of the vast mortality, in the above countries, is to be ascribed to the gross ignorance in which they are immersed.

Were typhus, our jail or hospital fever, to be imported into a town of Egypt, we can hardly conceive how it could ever be eradicated by the natives. Whenever the small-pox does appear in that country, it proves a dreadfully-destructive disease. The structure of their houses and plans of their streets are calculated for the production of disease, and the preservation and concentration of contagion.

It is a matter of no little consolation to us, that we know the means, not only of excluding the plague from our own country, but that, when our armies are stationed in the countries where the disease is endemic, we can arrest the progress of the contagion, and with certainty eradicate it.

The plague made its first appearance, in the army from India, in the middle of September, 1801. From its early appearance the natives were very much alarmed, and prophesied a dreadful season of plague. They have observed, that, when it breaks out before December, they have always a generally-prevailing and a very destructive disease.

The number of cases which appeared in the Indian army, from the 15th of September, 1801, to the 15th of June, 1802, is seen in an accompanying table.

After the plague broke out, the disease was for a long time confined to Rosetta; it was otherwise in the former season.

Soon after the British army effected their landing at Aboukir, in March, 1801, they were attacked with the plague, though the season was then on the decline. In the beginning of the year, the disease had prevailed very generally over the whole country, and the loss arising from thence, to the French, was considerable. It continued to spread in the British army till May, during which month few cases appeared; but none I believe in June.

Though the contagion is seldom or never, I believe, out of the country, the natives of Egypt denominate the season of plague from November or December of one year, to June of the year following; they observe, that the disease constantly stops at the period of the summer solstice.

I have said, that, during the season ending in June, 1801, the disease prevailed very generally in Egypt; Rosetta, however, was an exception; if any case did occur there it was concealed.

At Cairo, Alexandria, and Damietta; at Suez, in the villages, and in Upper Egypt; it proved very fatal: at Siout, at Girgé, and in general throughout the towns and villages in Upper Egypt, we saw continued marks of its desolation, and heard many dismal accounts of its ravages.

The reason of the plague first appearing in, and afterwards being confined only to, Rosetta, in the last season, was, that it was the only open port to which vessels from Turkey and Greece resorted; and that from some of these, no doubt, the disease was imported.

In the pest-houses of the army, thirteen medical gentlemen did duty, who in the Indian army might be said to have had the post of honour. They were, Mr Thomas, Mr Price, Mr Rice, Dr Whyte, Mr Grysadale, Mr Adrian, Mr O’Farrel, Mr Whyte, Mr Dyson, Mr Angle, Mr Moss, Dr Buchan,[4] and Dr Henderson. Besides these, Mr Cloran was in charge of the cases under observation, and Mr Bell of cases under quarantine. Mr Blackwell, surgeon on the staff of the English army, acted as inspecting surgeon to the Board of Health. He visited every case in the first instance, and, as he judged it necessary, sent them to the quarantine, to the observation-ground, or to the pest-house: to Mr Blackwell’s unceasing attention and discriminating knowledge of the pestilential symptoms, we owed no small share of our safety in Alexandria.

Besides the above gentlemen, we had two Greeks, the barber-doctors usually employed in Egypt, who visited the inhabitants, and before interment narrowly examined every body. These two made a daily report to the Board of Health of the number of deaths and of their inspection of the bodies; they likewise did other duties under Mr Blackwell.

In order to take from our medical gentlemen, in the pest-houses, some of the most dangerous part of the duty, it was my wish to procure some of the Greek doctors of the country to reside in the pest-houses, to feel the pulses there, draw blood, open and dress buboes, &c. The most diligent search was made for those people, and very high pay was promised to them, but we could tempt none of them to live in our pest-houses: a plain proof of the opinion which they entertain of the contagious nature of the disease.

The thirteen gentlemen first mentioned, were those only that were directly in the way of contagion, for, it became their duty to come into contact with the infected, and seven of them caught the infection, and four died.

To the atmosphere of the disease all the medical gentlemen of the army were exposed, as they saw and examined the cases in the first instance; but, except from actual contact, there never appeared to be any danger.

The sketch which I mean to give of the plague, I draw principally from the reports made to me by the surgeons of the army, and from a pretty voluminous correspondence with the gentlemen whose names have been already mentioned. From my own experience I hardly can venture to speak: it was very limited. Though I saw a great many cases, in the first stage of the disease, the number of cases which I treated throughout was very small; they were the cases which first appeared in the army, and my success in them leaves me little to boast of.

The reports and statements of the different gentlemen I have compared together, and endeavoured to reconcile them by what I myself saw of many of the cases.

I have generally given the names of the gentlemen by whom the different facts are related: I have always done this where the reports of two gentlemen disagreed.

From the sources of which I am possessed, I think I can bring forward some new facts regarding the disease, particularly in the treatment. It is much to be regretted, that no traveller, acquainted with the modern practice with mercury and the analogous remedies, ever resided in the countries where this disease is endemic.

In one circumstance, there is a very generally-prevailing opinion in regard to the plague, viz. that extremes of both heat and cold stop the progress of the contagion.

If this be true, in regard to heat, it did not appear to be so in the army in Egypt in regard to cold.

The period at which the plague raged the most was in the coldest months.

It would appear, that, in different countries and in different seasons in the same countries, the plague assumes very different appearances. The plague is seen as varied in its appearance as the different fevers described by Sydenham to prevail in different years, and under different constitutions of the air, in England.

Our knowledge of this fact enables us to reconcile the different or opposite accounts given of the disease, and of its treatment by different writers.

In the Indian army, when the disease first broke out, the cases sent from the crowded hospitals of the 61st and 88th regiments, were from the commencement attended with the typhoid or low symptoms.

The cases sent from the Bengal volunteer battalion, and from the other corps, when the army was encamped near the marshy ground at El Hammed, were all of the intermittent or remittent type.

The cases which occurred, in the cold rainy months of December and January, had much of the inflammatory diathesis. Mr A. Whyte remarked, that every case admitted into the hospital, at Rahamania, had the symptoms of pneumonia.

In the end of the season, at Cairo, Ghiza, Boulac, and on crossing the isthmus of Suez, the disease wore the form of a mild continued fever.

The resemblance which some cases shewn and of others described to me bore to the West-Indian fever struck me very forcibly.

I know not that I can better describe the disease, than by a short statement of the cases of some of the medical gentlemen who had the disease; most of whom wrote me accurately every thing that they felt. Dr Whyte entered the pest-house at El Hammed on the evening of the 2d of January, 1802. In a letter of that date he writes to me, “I just now inoculated myself, by friction, with bubonic matter on the left thigh;” on the 3d, he says, “I have this morning inoculated myself by incision on the right fore-arm.” Mr Rice, then doing duty in the pest-house at El Hammed, gives the whole of the case. In a letter on the 3d of January, he writes to me, “Dr Whyte came here last night; soon after he came in, he rubbed some matter from the bubo of a woman on the inside of his thighs. The next morning, he inoculated himself in the wrist with a lancet, with matter taken from the running bubo of a Sepoy; he appears now very well.”

In subsequent letters, Mr Rice says, “that Dr Whyte continued in good health on the 5th, and all day on the 6th, till the evening, when he was attacked with rigors and other febrile symptoms. He said himself that it was the attack of an intermittent; and it bore a great resemblance to it. After sweating profusely, he was better in the morning of the 7th, but in the afternoon the shivering returned; and, after it had continued 30 minutes, a severe hot stage came on, then a profuse sweating followed, but with it much affection of the head, tremor of the limbs, particularly of the upper extremities, tongue black and dry, skin hot, pulse full, hard, and irregular, thirst great, prostration of strength, and anxiety. The head was the only place that he complained of, and it seemed to be the principal seat of his disease; he still persisted that the disease was not the plague; he would not allow his groin or arm-pits to be examined, and he refused all medical assistance.” He asked for a purgative, which Mr Rice gave him, and he requested to be bled, this Mr Rice thought the state of the symptoms would not justify him in doing. On the 8th, these symptoms continued, and there was some delirium; he begged to be removed from the pest-house at El Hammed, to the old pest-house at Rosetta, under the charge of Arabs. He was removed on the morning of the 9th, and died in the afternoon of that day very delirious.

2d, Mr Price did duty in the pest-house at Rosetta and at El Hammed from the beginning of November, 1801, and had a tertian which he never could completely remove. In the pest-house at El Hammed, he was in the evening of the 1st of January attacked with rigors and slight febrile symptoms; but he himself thought this was only an attack of his intermittent, he soon however felt an affection of his head, and tremor of his limbs, and knew his disease. On the morning of the 2d, three buboes appeared, two femoral and one axillary; he then became delirious, and had no recollection of any thing for several days. On the 5th, there was a remission of the fever. He was able, on the 7th, to write me, “that he had no fever, that one bubo was coming on, and that he was extremely debilitated.” On the 13th Mr Rice opened his bubo; but it was two months after this before he recovered.

I am sorry I cannot find a letter where the treatment of Mr Price is detailed; but I am pretty clear that it was by mercury, as this was his own practice at the time.

3d, Mr O’Farrel entered the pest-house at Aboukir on the 8th of March. He continued well and did his duty there till the 3d of April; in the evening of that day, when he had rigors, which he himself attributed to cold, and says, “that sudorifics nearly cured him.” He was obstinately costive, for which he took several drastic purgatives: the rigors successively returned in the evenings of the 5th and 6th, and he continued taking antimonial powder. On the night of the 6th, he was attacked with giddiness, irritability of stomach, and low fever. Mr Dyson wrote to me, that, on the morning of the 6th, he was delirious, that he had applied a blister to his head; but that he could not get him to swallow any medicine: he expired on the morning of the 7th. No bubo appeared till the day before his death.

4th, Mr Dyson went to assist Mr O’Farrel, at Aboukir, on the 1st of April. On the evening, of the 5th, he was attacked with lassitude, and, on feeling his groin, he writes to me, “I discovered some inflammation of the glands.” After this the succession of symptoms in Mr Dyson was nearly what has been described in Dr Whyte’s case. The fever continued for several days, and became intermittent, one bubo came to suppuration. He obstinately refused every medicine but calomel, which he took as a purgative, but it never salivated him. Constant nausea and vomiting were symptoms with him from the second day of his illness, and he was a long time before he recovered.

5th, Mr Thomas, after being three weeks in the pest-house at Rosetta, attending the first plague-cases which came from the 88th regiment, while walking in the garden of the establishment, laid his hand on his groin by accident, and was alarmed to find a large swelling on one side. He soon after felt some giddiness and fell down; as soon as he recovered, he rubbed in mercurial ointment in great quantity, and every hour took as much calomel with opium as his stomach could bear. His gums were very quickly affected, his bubo came to suppuration, and, in three weeks, he was quite well.

6th, Mr Angle, after being about a month in the lazaretto at Alexandria, was attacked with fever and bubo. The bubo never could be brought forward, and he died of the disease on the 14th day. I have no notes of the treatment of this case nor that of Mr Moss; who, after having been about the same time on duty at the lazaretto of Alexandria, caught the infection. He likewise lived several days, and his bubo could never be brought forward.

It is useless to detail more cases, though I am in possession of many accurately related by several gentlemen. Nor do I mean to offer any comment on the above.

As particularly prominent and remarkable, I cannot, however, without some notice, pass over three cases where mercury, early and liberally exhibited, had very remarkable effects.

I received several accounts of the good effects of mercury from the gentlemen in the pest-houses, but none so remarkable as the following:—In the beginning of the season, on the breaking out of the disease in the crowded hospital of the 88th regiment; every man in the hospital was examined at different periods of the day, and thus the disease was detected on its very first appearance. At this time, I gave to each of three of the men, placed in the observation-ward of the hospital, (of whom Littlejohn and Egan have already been mentioned,) two grains of calomel, and the sixth of a grain of opium every hour, and made them rub into the inside of the legs, thighs, arms, and neck, half an ounce of the strong mercurial ointment three times a day. I, at the same time, made them take each half an ounce of nitric acid diluted in their drink during the day, and put their feet and hands, three times during the day, into a strong nitric bath. In about twenty-four hours, their mouths became severely affected, a tenderness in their arm-pits and groins went off, and the severest febrile symptoms yielded. The men were, however, extremely debilitated, and remained a very long time convalescent. During their convalescence, I thought it prudent to keep them in quarantine, being fully convinced, that they had had an attack of the plague, the progress of which had been arrested, and the disease cut short by the above treatment.

Corporal Francis, as already mentioned, was suddenly attacked with giddiness after coming off from duty as corporal of the guard in the pest-house. In the very commencement of the disease, on the first feeling of illness, he was brought to Mr Price, who instantly admitted him and immediately exhibited mercury, and as soon as the gums became affected, the febrile symptoms vanished. He remained some time in the hospital, on account of a bubo, which came to suppuration; but Francis suffered very little. He was never more than two days confined to bed, though the case occurred at a time when the disease was very violent.

The case of Peter the interpreter strongly evinces the success of the mercurial treatment. To this case, the mercurial pills and ointment were given; and he was, in every respect, treated as a case of syphilis and was speedily cured.

In the cases related, there appeared some facts as to the time the matter of the pestilential contagion takes before it comes into action. Other facts shew, that, in different people, and under different circumstances, there is the greatest variety in this. The lazaretto at Alexandria was infected by the admission of an Italian merchant, and the guard there, consisting of 14 men, caught the disease, but were attacked on different days. The provost’s guard and his prisoners at Alexandria caught the infection from a deserter confined among them, and the disease among these people appeared at very different periods.

Mr Rice relates two cases on this part of the subject, which appear worthy of detail: he says, “we have had proofs, that the pestilential virus remains a considerable time in the habit, without exerting its influence or shewing its virulence. A striking case occurred lately: a Sepoy was sent to the pest-house from the hospital of the 7th regiment with plague; his wife could not be prevented from accompanying him, where she attended and nursed him. The Sepoy died, and the woman was ordered into quarantine; however, she escaped, and after some days search she was discovered near the regimental hospital of the 7th. As this woman had the greatest reluctance to going to quarantine, a centinel was put over her in the hut where she was, and all communication with her was stopped: she continued in good health till the tenth day after her escape from the pest-house; in the afternoon of this day, she was attacked with fever, in a few hours after, the inguinal glands became painful, and she was carried to the pest-house at El Hammed.”

“Another case bore a great affinity to the above: a Sepoy came into the pest-house to attend his wife: the man was sent into quarantine, and he continued well there, till the seventeenth day, on which plague-symptoms appeared, and he was sent to the pest-house.”

Of the symptoms of the plague, fever, though not always present, seemed the most constant.

At the end of the season, at Cairo, at Ghiza, and at Suez, cases appeared without any observable fever. When it did appear, as already noticed, the type at different seasons, and in different parts of Egypt, was very various. At the pest-house at Rosetta and El Hammed, many of the cases, admitted from October to January, had the accompanying fever intermittent and of the quotidian type. This I believe to be a new fact in the history of the disease. For some time in January, February, and in some part of March, the fever had regular remissions. After this period, it generally appeared of the typhus form at Aboukir, except in the detachment of the 26th Light Dragoons, all of whom were young healthy men, and in them Mr O’Farrel observed, “that there was much re-action, and that the delirium was of the kind denominated phrenitis.”

At the pest-house, at Rahaminia, Mr Whyte observed, that all his patients had pluritic complaints.

The second symptom in order was the tremor of the limbs. Mr Price says, “that bubo and pyrexia are not so essential parts of the diagnosis, as tremor of the upper extremities,” and

3dly, The affection of the head, which was sometimes phrenitis, and sometimes typhomania. In a great majority of Mr Price’s, Mr Rice’s, and Mr Whyte’s, cases there was much nervous affection; in one, the risus sardonicus. Mr Adrian says, the nervous affection, in many cases, was very remarkable; in several cases, it resembled the description, given by authors, of that nervous affection produced by the bites of mad or poisonous animals, an almost universal tremor.

4thly, The glandular affection was the next most generally attending symptom. Not above one-half of Mr Whyte’s cases had buboes; and, in a great majority of Mr Rice’s patients, this symptom did not appear. Dr Henderson says, that, in every one of his cases, there was either inflammation or swelling of the glands. The glands most commonly affected were the femoral, next the axillary, then the parotid, submaxillary, &c. In one case of Mr Adrian, an abscess, of the size of a pigeon’s egg, formed on the inner canthus of the left eye. Mr Adrian opened it by incision, and the patient did well. Many were surprised at the rapidity with which the appearance of bubo followed the first complaint of illness: in a number of cases, within four hours. Mr Rice, on the 7th of January, admitted five cases, and in none of them were buboes later of appearing than six hours after the first feeling of illness. In a Sepoy of the 7th regiment, taken ill in December, the femoral axillary, parotid, submaxillary, and sublingual, glands were all affected. In another Sepoy of the same regiment, admitted by Mr Rice, a case of re-infection, so very much swelled were the glands about the neck, that the man died of suffocation the day on which he was admitted.

5thly. The next most generally-attending symptom was the affection of the abdomen. Mr Price says, the hepatic region was in every instance affected. Sometimes there was a swelling of the region of the liver, pain was experienced from pressure, sometimes in the epigastric, sometimes in the hypogastric, region; and almost always in the region of the liver, at which time, the pain has in some cases extended to the kidneys. Swelling of the belly was very frequent; in some cases the abdomen appeared a mass of knots. Uneasiness at the precordia, nausea, and vomiting, were frequent: the vomiting was always of bile, which was of different colours in different stages of the disease. Mr Price writes, “costiveness was a constant and obstinate symptom; and, when ten or twelve grains of calomel brought fæces down, they were always accompanied with bile; first brown, then yellow.” The urine was in general yellow; the skin and adnata frequently of the same colour. Mr O’Farrel says, “I lost one of the dragoons from the affection of his side; the fever went off some days before his death.” Mr Adrian writes, “I do not find the constipation an universal symptom, although, in many cases, I have met with it very obstinate. I was once obliged to give eighteen grains of calomel and two scruples of cathartic extract before my patient was moved.” In several cases, the disease commenced with diarrhœa or dysentery. Some of Mr Thomas’s patients died of dysentery; and this might have been said to be the cause of their death, as they recovered from the bubo, fever, and other symptoms of plague.

6thly. In the first part of the season, petechiæ, vibices, maculæ, and carbuncles, were not seen: in the middle of the season they frequently appeared.

7thly. Some gentlemen could distinguish the disease by a particular look of horror and by a particular cast of the eye, which was first watery, next blood-shot, and at last yellow.

8thly, According to the diversity of the season, the pulse varied. In general, it was small and frequent, and often, when at the wrist it was not perceptible, it could be felt beating 130 or 140 at the carotids.

9thly, The tongue was universally white at the edges; and, when in March and April, some cases appeared with the fever of the typhoid form, it was black and furred in the centre.

10thly, Several of the cases, which came under Mr Grisdale’s care in February and March, had cough and dyspnœa. Mr Adrian makes a similar report at the above period, and three of Mr Whyte’s patients at Rahamania had cough and dyspnœa.

11thly, In a majority of Mr Price’s cases, he remarked an unusual dryness of the skin, and that it was with the utmost difficulty that he could ever excite perspiration. Mr Whyte says, that, “At Rahamania the skin was dry, and that he had never succeeded in exciting sweating.”

These are the appearances the disease put on in the last season; and, on inquiry, I find that they were the appearances it assumed in the former season in the British army in Egypt.

My friend, Dr Short, who resided some time in Persia, and who has paid much attention to the history of the plague, informed me, that, in addition to the above, he found hemorrhage a frequent symptom in the plague, which raged at Bagdad in 1800 and 1801.

In one case he saw a copious hemorrhage from the eyes, which continued for nearly twelve hours. As soon as it stopped, an eruption appeared over the body very much resembling the measles. This patient, a boy of twelve years old, died on the 5th day of the disease.

The duration of the disease in different persons was very different. In several instances, the effect of the pestilential contagion was the immediate extinction of life; and we had several instances of the patient surviving but a few hours the first sensation of illness.

The muccadum of the dooley-bearers of the 88th regiment, about nine in the morning, exhibited the symptoms of fever. About twelve, a bubo appeared, and he died before four o’clock. In some instances, again, the patient lived till the thirteenth and seventeenth day of the disease; however, these instances were rare.

Prognosis. We found that the greatest caution was requisite in giving an opinion as to the probable event of cases: in no disease was the practitioner oftener deceived. In several instances, patients who had recovered from the fever, whose buboes were doing well, and people who were convalescent, suddenly dropped down and expired. Whether this was from re-infection, or whether it was a feature of the disease; will be difficult to determine.

On the 24th of December, one of the Arab servants, convalescent from the disease, and who had been convalescent for eight days, taking bark, while smoking his pipe suddenly expired. In no disease do patients bear motion worse than in this. The least motion[5] induced syncope or death.

Sometimes, they who had for some time been convalescent, suddenly complained that they felt giddy, and expired. Sometimes they called for food, and expired with it in their mouths. In one of Mr Adrian’s cases, where the fever had for some time been gone, and the patient was so far convalescent that he daily walked about a quarter of a mile, the man suddenly complained of giddiness, and expired in ten minutes.

Mr Thomas had two cases where, after affecting their gums, there was a complete apyrexia: but he lost his patients from an immense discharge from the glands and from a secondary fever. In general, it was found, that the patient recovered in proportion to the facility with which his gums and skin could be affected.

The _prognosis_ likewise depended much on the degree of the affection of the sensorium; when the patient was from the beginning comatose, the case terminated fatally. Several of the cases in the beginning of the season, particularly the natives of India, could never be roused. The typhomania was a more fatal delirium than the inflammatory species.

In the _treatment_ of this disease, a variety of modes were put in practice; but so little success attended them, that some were inclined to despair of success from any. Though, with it, even many were lost, yet oxygenation and particularly the use of mercury had the most success.

Though every thing was done by General Baird that the situation and circumstances allowed, yet the gentlemen in the pest-houses laboured under so many disadvantages, that, for the most part, there was but little to be expected from any mode of treatment. In particular, not a little difficulty, as well as danger, was met with in affecting the gums. Safety required that the pest-houses should be at some distance; perhaps, in general, the distance at which they were placed was too great. The patient suffered much by the conveyance, and frequently the treatment of the disease was entered on at too late a period to promise success. In December, January, February, and March, patients suffered so much from the extreme severity of the weather, that in some instances it was not easy to determine whether a patient died from cold or from the plague.

So much dejection prevailed among the natives of India, that, from the moment of the attack, they gave themselves up, and said they were sent to the pest-house to die. They never could be prevailed upon to swallow a morsel of food nor any medicine, and some actually starved themselves.

With establishments of a proper structure, and under proper regulations, we may safely venture to affirm, that our loss from the plague in Egypt would not have been half of what it was.

In the treatment of this disease, the first indication was, to clear the primæ viæ. Some gentlemen exhibited emetics; but in general there was no time for this. The general practice at last was, to begin by giving a purge of calomel, and the general remark was, that, if it operated briskly, the head was relieved and the skin became soft.

The second indication most generally agreed upon, was the inducing ptyalism and perspiration. As offering the fairest prospect of effecting both at once, Mr Price proposed using the warm nitric-acid bath, but unfortunately our stock of nitric-acid was insufficient to do this, otherwise than on a small scale. Mr Price got a little of the acid at El Hammed; but, from circumstances there, he could not always have the warm bath; however, he writes, “On three of my patients, whose gums I could not readily affect with mercury, I determined to try the nitric-acid bath: it has shewn wonderful effects, ptyalism has been produced in all the three; but the cold has regularly induced rigors and severe attacks of fever, and I shall loose my patients.”

Nitric acid was given internally; and, where the patients would drink it, it shewed good effects. Mr O’Farrel, at Aboukir, succeeded in making three dragoons take it much diluted as their common drink; and they did well all of them.

Mr Price thought well of citric acid. In some of the Arabs he effected cures by this, and by a bath of strong vinegar.

Both Mr Rice and Mr Price were in the habit of washing their patients with vinegar and sponging them with it, as strong as it could be procured, or with lime-juice. They dipped rags in the acids, and kept them constantly applied to the buboes. The head and stomach were relieved by wet cloths being kept to the scrotum.

The third indication was, to obviate the debility which appeared always to be very great. With this view, bark, wine, and opium, were very largely given; and, at a certain stage, the cold bath.

At first, calomel was used only as a purgative, but, at last, the use of this remedy was carried farther. The reports were, “that, upon the mouth becoming sore, the skin became softer, the pulse more regular, the eye more clear, the tongue more moist, and that the thirst with the affection of the head and of the abdomen entirely disappeared. The evacuations too were copious, and approached more nearly to their natural colour.” Mr Price writes, “So much am I persuaded, that in the modes of oxygenation, I am in possession of an infallible remedy, that now I purposely expose myself.” Where he succeeded in affecting the gums, Mr Thomas lost none of his patients, and Mr Price in a late letter says, “Calomel affected the gums of all my patients who survived.” It was a general remark, that the gums were remarkably obstinate and insensible to the effects of mercury in this disease. Mr Grisdale writes, “in two of the cases, I for five days pushed calomel and mercurial ointment to a very great length, but never could succeed in affecting the gums.” Both these patients, in a subsequent letter, he reports to have died. Here a particular fact deserves to be noticed: one of the medical gentlemen, who went on duty into the pest-house, and escaped the disease, on account of an old venereal complaint, used mercury and nitric acid very freely during the two months of his tour of duty, and he was one of the six who escaped the infection. On the whole, in mercury and the nitric acid, we appear to have excellent remedies for the plague: but they must be very early and very liberally exhibited. If the first stage is allowed to pass over before they are given, the season of doing it with advantage is in danger of being lost. When the stomach becomes irritable, I suspect that they never can be given with propriety. Perhaps, of all the cases which occurred in the army, this treatment never got a fair chance of success, excepting in those which occurred on the first breaking out of the disease in the hospital of the 88th regiment, in Mr Thomas’s case, and in that of Corporal Francis.

I regret, that, in this disease, we did not give a full and more fair trial to cold bathing. The extraordinary circumstance of the escape of the Lascar from the Rosetta pest-house, and the great benefit which I have seen from it in the yellow-fever, to which the plague bears no slight resemblance, would induce me to give it a full trial in plague.

I have, I believe, recounted the principal part of the treatment, and that which was most generally agreed upon. Other modes received a trial; but, from an experience of their inefficacy they were all deserted.

Dr Whyte used the lancet very freely, but every one of his patients died; Dr Buchan was in the habit occasionally of having recourse to it; and, in the first season, he said, that he had met with several cases where bleeding was of the greatest service. In the beginning of the season, Mr Price bled one patient. The blood appeared very dark, and dissolved: this patient died, and Mr Price never repeated the operation on any other.

Some gentlemen, attached to the Brunonian system, put the stimulating plan to the test. By Messieurs Adrian and Whyte, patients were for some time kept under the influence of wine and opium; but, this practice was never successful and they deserted it. It was at length the practice of Mr Adrian to unite stimulants and mercurials.

Seldom before, I believe, have the bodies of those who died of this disease been dissected. The first was a Sepoy, by Mr Price alone; the second by Messieurs Price and Rice; and, in the last subject, viz. Signior Posetti, the Italian merchant, so severely affected were both of these gentlemen, that it put a stop to this mode of investigation. The general appearances seen on the subjects, were, a perfectly-diseased state of the glandular system. In the liver, no matter was found; but, it was much enlarged and greatly diseased. Signior Posetti had only one bubo; the femoral gland was sixteen times the natural size and weight; and the blood, from the femoral artery, flowed black, pitchy, and dissolved in its texture. I come now to the last, and most pleasing part of the subject, the means of

_The prevention._ If, in the treatment of the disease, we were not successful, we assuredly were completely so in the prevention. At length, this became so generally known, that we no longer heard the distressing accounts of despondence and despair among the natives. They now no longer entertained such a dread of the pest-houses. We at length even found volunteers from the natives for duty in the pest-houses.

There was hardly a corps, or an hospital in the army, where, at one period or other, the disease did not make its appearance, but it was always in our power to arrest its progress. In well regulated corps, where a rigid discipline was enforced, and proper attention to the interior economy was paid, it rarely happened, indeed, that much difficulty was experienced in eradicating the contagion.

As our success in the prevention was so great, all that remains for me is to mention the substance of General Baird’s order to the army on this subject.

1st, To every hospital, an observation-room, or in lieu of it a tent was attached, and to it, every case whatever with febrile symptoms was sent, as soon as discovered, and was there most strictly watched by the surgeon.

2dly, On any symptoms of the plague appearing, the case was instantly sent to the pest-house from the observation-room of the regimental hospital: the patient was accompanied by the medical gentlemen of his corps who attended him, and who gave the medical gentlemen at the pest-house an account of the previous treatment of the case.

If any doubt remained, the patient in the first instance was placed in the observation-room of the pest-house; and, if the disease did not turn out to be plague, he was sent to the quarantine.

3dly, In every corps, and in every department, a minute inspection by the surgeon was made twice a week; and every person with the smallest appearance of ill-health was sent to the hospital.

4thly, Every corps or hospital, where a case of plague had appeared, was put into a state of quarantine; and, in such corps or hospital, an inspection by the surgeons was made at least two or three times a day; and every case with suspicious symptoms was ordered to the observation-room.

5thly, In suspected corps, it was ordered, that, under the inspection of a commissioned officer, every person should be bathed more frequently, and at stated periods; and, likewise, that all their clothing and bedding should be frequently washed and baked. To all the hospitals, ovens and smoking-rooms were attached.

6thly, Quarters of corps, hospitals, and ground of encampments, were frequently changed.

7thly, Much is to be attributed to the nitrous fumigation. In several instances it was attended with the best effects. The lamps, with this, were kept constantly burning in the observation-rooms, and in the rooms from which the cases of the plague had come. Vessels, with the materials for the fumigation, were likewise placed under the beds, and in the corners of the rooms. When our stock of nitric was at length exhausted, we substituted marine salt for it; but this fumigation could not be kept up in rooms were the patients were all confined to their beds.

OF THE OPHTHALMIA OF EGYPT.

The other endemic, and next to the plague in importance, is the ophthalmia of Egypt; which, though a less fatal, is a more distressing, malady.

In Egypt, at particular seasons, it is a most generally-prevailing disease. It is not confined to the human race; the animals of the country, particularly the dogs and camels, are subject to its attacks. Travellers (and, if I remember, Volney is one) describe the same disease as prevailing in Syria; and, I am informed, by my friend Dr Short, that, in Persia, ophthalmia is a most frequent and severe disease.

In Egypt this disease proved most distressing and obstinate. The French, it was said, sent from Egypt to France 1000 blind men.

The number sent home from the English army was very considerable likewise. Of the Indian army, 50 were sent home invalids from blindness; most of whom were from the 10th and 88th regiments.

Ophthalmia prevailed most in the 61st regiment; after them, in the 86th regiment: while the 8th dragoons, the artillery, and the 80th regiment, had very little of the disease.

It was remarked, at all times, that the disease was seen much less frequently, and with less violence, in the native Indian, than in the European, corps. Of the former, the 1st Bombay regiment had much more ophthalmia than any other corps of natives. It was said, that, in the English army, the disease prevailed most in the dragoon-regiments. The 26th dragoons was mentioned as a particular instance of this: that corps alone, I heard, sent home about 40 invalids from ophthalmia.

Several gentlemen thought that this disease, in Egypt, was contagious.[6] So singular an opinion I would hesitate to offer on slender grounds. However, the remarkable prevalence of the disease in particular regiments, and even in particular companies of regiments, while the same general causes prevailed every where, will not be easily accounted for, without admitting something of the kind. In some corps of the army from England, as well as that from India, this was observed. In the 54th regiment, my friend, Mr Ross, then the surgeon of it, informed me that the disease was for some time not only confined to particular companies, but to particular tents. It deserves mention, too, that, till the arrival of the Indian army at Ghiza, ophthalmia did not appear in the army. We found at Ghiza the 89th regiment and an ophthalmia-hospital of the English army.

I believe that several diseases are contagious, which are not suspected to arise from such a cause: the theory of contagion is but very imperfectly understood.

It was said, that the sailors, on-board the fleet at Aboukir-bay, had the disease at the same time that it prevailed in the army on-shore. Several cases appeared among the troops after we sailed from Suez.

Ophthalmia prevailed most from May to December. At Kossier the disease was hardly seen, nor at Ghenné. It was not till the army was encamped at Rhoda, in August, that cases crowded in on us. In that, and the two following months, most of the cases made their appearance.

It will be seen, in part the first of these sketches, that, in the months of January, February, March, and April, very few cases appear in the reports.

About the middle of May the disease began to appear in Alexandria.

Some of our medical gentlemen thought this disease very different from the ophthalmia which they had seen in Europe or in India. In several circumstances there certainly was a difference, and we were obliged to have recourse to a different mode of treatment, finding we did not succeed with that pursued in England or in India. The disease, I think, might generally be resolved into, 1st, either of Cullen’s two species, the ophthalmia tarsi and the ophthalmia membranarum; 2ndly, to a combination of these two; or, 3dly, to a species of ophthalmia, frequent in India, symptomatic of disease in the biliary secretion.

The appearance which the disease put on, particularly the two first species of it, was nearly what we have seen in other parts of the world; except that the symptoms advanced with alarming rapidity to the highest inflammatory stages. In most cases the attack was sudden, and very generally at night. Speedily, the patient complained of a burning heat of the eye-ball, or of a sensation of needles being passed through the eye. There was a considerable swelling of the ball of the eye, of the eye-lids, and sometimes of the neighbouring parts. Almost always, there was a copious flow of tears, which felt hot and scalding, and, as they flowed down, excoriated the face. Very frequently, there was a racking headach and general fever. Œdema of the eye-lids was frequently met with in the early stage of the disease, and inversion of the cilia in the last stages.

The disease very often continued two or three months: after it had continued some time, the general health became much impaired. It often terminated in diarrhœa or dysentery, and sometimes the patient became hectic.

In the third species of the disease, which I have mentioned, there was not so much active inflammation as in the other two species; and it was generally known by a yellow tinge of the adnata, or by dyspeptic symptoms being present; though, sometimes, we have seen those appearances absent: and no topical application had any effect in removing the ophthalmia, till the gums were affected by calomel or some mercurial preparation.

In the two first species of the disease, the inflammation, in a great many instances, induced fever of many days duration, and the disease too frequently terminated in opacity of the cornea or in suppuration of the eye-ball.

In the treatment, it appears, from the reports, that different gentlemen followed very different modes. We said, in general, that the European practice did not succeed. Scarification and astringent collyria, in the first stage, gave intolerable pain, and generally aggravated the symptoms.

The practice of the natives, was, to apply, in the first stage, emollient decoctions of their plants, and poultices of the kali. In the last stage, they rely much on the frequently bathing of the eye in the cold water of the Nile: they are likewise very fond of bleeding; and I understood that sometimes they use the actual cautery, burning behind the ear where we usually apply blisters.

The practice, which appeared to be by far the most successful, was the following:

For the first twenty-four or thirty-six hours after admission, the eyes of every patient were carefully syringed with tepid water, which had been filtered carefully. The syringing was performed from three to six times in the day; the light was carefully excluded, the patient kept cool, and every other part of the anti-phlogistic regimen strictly enforced. After the above period, a weak solution of sugar of lead, or of camphor, or vitrolated zinc, was applied. Where the pain was much complained of, a solution of opium was added to the collyrium; opium was applied in a cataplasm, or two or three drops of laudanum were let fall into the eye.

If there was much swelling, a saturnine poultice, or the coagulum alluminosum, was applied to the eyes. I observed, that blistering a large surface, and as near as possible to the seat of the pain, if kept discharging for some time, always afforded great relief.

To remove the fever and to alleviate the distressing pain, we often gave opium internally in a considerable quantity, and with great advantage.

Setons in the neck and the free use of bark appeared to be of the greatest service, when the disease was of long standing.

In opacity of the cornea, and when there were specks, several gentlemen thought highly of the aqua phagedænica of the old pharmacopeias, after having divided the vessels which went to the speck. It gave very pungent pain; but I have seen great relief from it, and also from a solution of lunar caustic.

As a collyrium in Egypt, I often gave with considerable benefit what I found in the hands of the black doctors in India, viz. a tea spoonful of lime-juice to four table spoonfuls of water, or a tea spoonful of arrack to two table spoonfuls of water. In the first stage, I would have applied leeches, but never could procure them.

In Persia, Dr Short, informs me, that he was very successful in the general use of an ointment, composed of white vitriol, tuttey, and cinnabar, after the application of leeches and scarification.

From the days of Prosper Alpinus, the salts contained in the soil of Egypt have been supposed to be among the principal causes of the ophthalmia of the country. Though the various modifications of light and heat no doubt act as existing causes; yet to the particular soil of Egypt, and to the constitution of the air there, we must look for the regular and the principal causes of this disease.

In Egypt several causes occurred, which in any country, separately applied, would be adequate to the production of violent ophthalmia. The dry, white, dazzling, soil, and the fine sand and dust constantly thrown about in whirlwinds and entering every crevice. If an ophthalmia is epidemical or is endemic in Egypt, the above causes will render it a very violent disease.

But I conceive, that, of themselves and alone, these circumstances do not produce the violent ophthalmia seen in Egypt. In no place did these circumstances exist in greater force than at Kossier, on the march across the Great Desert, and at Ghenné. Yet, till our arrival at Ghiza, the disease did not appear. These circumstances likewise exist in great force in most places of India, where the ophthalmia occasionally occurs from them, yet it is different from the two first species of the Egyptian ophthalmia.

For the production of the third species of this disease, the same causes will account, which produce dysentery, hepatitis, and other diseases of the liver. In Egypt, I remarked, that most of the cases of this species occurred at the time that dysentery prevailed the most.

It should be mentioned, that, in Egypt, the natives are universally impressed with the idea, that sleeping in the night-air brings on the disease.

In the ophthalmia of Egypt, as in the plague, it would appear, that very much may be done in the prevention.

It could not escape observation, how rarely officers were the subjects of this disease. In accounting for this, I lay most stress on the attention which officers pay to cleanliness. In the 88th regiment, where, I believe, forty men did not escape an attack, only two officers out of thirty had ophthalmia.

In the whole of the Indian army, only one officer lost an eye by it, and this was Ensign Paton, of the 86th regiment.

The exemption of the officers from the ophthalmia gives more weight to the opinion, that in Egypt this disease is communicated by contagion.

Mr Paton, previously to embracing the military profession, had studied medicine; and, when medical assistance was much wanted, and a great many of his corps were laid up with the ophthalmia, he very humanely offered to attend them. When employed in this duty, he was himself attacked with the disease and suffered most severely by it for many months.

Mr Bellars, about this time, joined the 86th regiment at Ghiza; he took charge of the sick, and was attacked in the same manner as Mr Paton had been, and he likewise suffered most severely by it for several months.

Dr Whyte, who fell a martyr to his zeal in the investigation of the history of the plague, from a residence of some years in the Levant and some time in Egypt, had good opportunities of being acquainted with the diseases of that country, informed me, that, by making those under his charge, frequently during the day, wash the eyes with cold water in the season of the ophthalmia, he never failed in preventing the disease. He instanced particularly the sailors of the transports, of about one thousand of whom he had the medical charge. The captains of the different transports carried Dr Whyte’s preventive instructions into execution; and, though the disease raged both in the army and the navy, few of the sailors of the transports had it. By an attention to this mode of prevention, and in the season when the ophthalmia prevails most, making the soldiers wear something over the eyes, I think we should have the prospect of passing a second campaign, or season in Egypt, with less loss from ophthalmia.

GENERAL REMARKS ON THE DISEASES.

I have dwelt a considerable time on the two endemics, the plague and ophthalmia, the only diseases which we found peculiar to Egypt; and there do not many more diseases remain to detain us.

We come next to a class including several diseases, and which are usually described separately: but, I am at a loss how to disunite them, as they occur all of them in India, and as they have for the most part appeared in the Indian army in Egypt. The diseases are fever, hepatitis, and dysentery; and, as I have for the most part seen them, there exists among them a most intimate and natural connection. For a long time, the same causes appeared indifferently to produce them: there was a frequent transmutation of these diseases one into another, and in the three diseases we succeeded by a similar treatment. In offering a few remarks, however, I will preserve a distinction, and speak of these diseases separately. Before entering on them I may remark, that the effects of the solo-lunar influence, so remarkable in fever hepatitis and dysentery in India, were in Egypt likewise very observable. In the treatment of these diseases the practitioner found his account in attending to the periods of the moon; at the full and the change, paroxysms would frequently supervene, if not anticipated; and, at these periods, convalescents would frequently suffer a relapse.

OF FEVER.

The fever which we had in Egypt, at different stations and in different seasons of the year, assumed various types. That which, on the outset, prevailed among the Bombay Sepoys, was remittent. At Ghenné, the fever in the 10th regiment was continued; but it very often terminated in hepatitis. At Ghiza, we have said that we suspected contagion as the cause, at first; but, in the end, the disease was clearly kept up by marshy effluvia on Rhoda Island. It assumed a remittent, and sometimes an intermittent, form, when brought down to Rosetta; and many of the cases terminated in dysentery. At El Hammed, a majority of the fevers which occurred were intermittents; but several remittents occurred, and a few cases which had some resemblance to typhus. After October, fever was a disease of rare occurrence. In the last general return for November, fifty cases appear, of which thirty-four were natives of India. The last return in December is much the same, the native corps having a majority of the cases.

In the last return of January there appear, of continued fever, twenty-two cases; twelve of whom were Europeans. Of intermittents there were thirty-two cases, and sixteen of them were Europeans. In the general report of the 26th of February the total of fever in the army is only twenty-three, and of them, only six are natives. On the 26th of April, we had only fourteen cases, of which three were natives. In May, fever did not appear in the reports.

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

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

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

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

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

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

HEPATITIS, OR THE LIVER COMPLAINT.

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

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

In Upper Egypt, and at Ghiza, we had many cases of hepatitis: it was the same disease that we had seen in India. At Rosetta and Alexandria a few cases did occur, accurately answering to Cullen’s definition of the acute species. Sergeant Levi, of the 88th regiment, was one instance. On the 13th of October, he was admitted into the hospital with this disease in a most violent degree. He had been ill only twenty-four hours: he had high inflammatory fever; his side was extremely tender to the touch; he had great irritability of stomach, and pain over the belly. He was twice bled: the anti-phlogistic regimen was for thirty-six hours applied in its utmost rigour: thereafter mercury was liberally thrown in, and he recovered. We remarked that many, who, in India, were the frequent subjects of repeated attacks of hepatitis, at length never complained, or they had the disease in the mildest shape, in Egypt. After the month of October, hepatitis was a disease of still more rare occurrence. In no corps did the number of cases bear any proportion to what they were wont to be in India.

During October a considerable number of cases occurred, but almost all of them were Europeans: the proportion of the natives who had this disease was always very small.

About the beginning of November several fresh cases occurred, and all of them were acute.

By the end of December this disease was fast disappearing in the army. In the last return of the month there were only twenty-one cases, and twenty of them were Europeans.

In January it still continued to decline. In the return of the 31st of this month there appear only nine cases, and all of them are Europeans.

In the first return of February there are only five cases, and all of them are Europeans.

There was an increase in March. In the first return of the month there were twelve cases, and all were Europeans.

In the last return of April the total number was so low as six, of which number four were Europeans.

At the time of embarkation, at Suez, there was not one case reported in the army.

Hepatitis appeared more in the Company’s artillery, and in the 10th regiment, than in any other corps of the army. For its predominance in the latter corps, one reason has been assigned, and which to me appears to have had the most powerful influence.

But on the whole, this disease, once so formidable to us in India, gradually ceased to appear in the returns of the sick.

The treatment of hepatitis it is unnecessary to dwell on: for no disease are we provided with a more effectual or sure remedy. If the season for applying the remedy be not lost, we are nearly, I think, as confident of a cure by mercury, and the analogous remedies, as we are in a case of syphilis by the same remedies.

To whom the world is indebted for the successful treatment of hepatitis by mercury, I cannot correctly say. The oldest written account of this practice, that I have seen, is in a very sensible pamphlet by Dr Paisley, formerly of Madras. There is another very distinct account of it in a pamphlet by Dr Girdlestone, of Yarmouth, formerly surgeon of a regiment in India.

For the general introduction of mercury, through the western side of the peninsula of India during the last twenty years, for the application of nitric acid to the same purpose, and for the discovery of some other preparations analogous to these, we are indebted chiefly to the ingenious Mr Scott, of Bombay. About ten years ago, from some experiments which he made on the calces of mercury, he discovered the analogy between them and nitric acid, and he was the first to apply this acid to the cure of hepatitis. Subsequently, he was led to the use of nitric acid and other analogous remedies in hepatitis and other diseases, which are curable only by mercury, a practice, of which, on a large scale for the last six years, I have observed the best effects, and which is now likely to get into general use in India.

I have said, that the species of hepatitis which we met with, at last, in Egypt, was not that usually seen in India, and a corresponding change was required in the treatment. Previously to giving mercury it was found necessary to premise the anti-phlogistic regimen.

In the use of mercury great address is often required; and, in substituting nitric acid and the analogous remedies, I am convinced, that much advantage may often be gained. Sometimes one of these remedies will succeed when the other has failed; and not unfrequently have I seen their combined use succeed where separately given they had failed. In obtaining a new agent we have acquired a great deal more power in the management of a disease, the most formidable to Europeans in the eastern world.

Sometimes in Egypt, and in many instances in India, I have observed, that I could not affect the gums with mercury, or with acid, till venæsection was performed. After this operation, I have often succeeded, and induced a flow of saliva, in cases which had long resisted a liberal use of mercury and nitric acid.

If the modern practice of giving but little mercury, and to make it only touch the gums, as it is called, without exciting a flow of saliva, be proper in the venereal disease, undoubtedly it is not in hepatitis. This disease never yields till the saliva flows freely—the explanation of this I do not attempt; but the fact is as I state it, and it is well known to every man who has practised extensively in India. Whenever the gums are hard, and insensible to the effects of mercury; when, instead of a salivation, they are red, painful, spongy, or blue, the prognosis is very unfavourable: in ninety of such cases out of the hundred we lose our patients.

In the first stage of this disease, I have derived benefit from cupping and blistering the side; but I never allow these remedies to interfere, or to delay the principal indications—the affecting the gums.

Dissection shews us the liver, of appearances considerably varied when this disease has existed some time. I have preserved notes of my dissections; they are not few. I made a rule of inspecting the body of every one that died under my care for several years past. At present, I shall only mention, in general, that sometimes the liver was of the natural consistence, sometimes harder, and that it was much varied in colour; but, generally, it was considerably increased in size. After the disease had lasted long, it was sometimes much wasted, and, in a few instances, of a very small size. In a majority of the fatal terminations, there were found vomicæ, or abscesses. When matter is formed, it is well known, that it makes its escape in various ways: here surgical aid may sometimes be of use.

DYSENTERY.

This was by far the most-generally prevailing, as well as the most fatal disease in the army.

After mature deliberation, and the most satisfactory proofs, proofs nearly amounting to demonstration, I convinced myself, in India, that the dysentery of that country is a disease whose first causes lie in the biliary system. On reflection, and after looking over the accounts of my practice in the West Indies, I have little doubt but that the dysentery of that country proceeds from the same cause. In the end, I was led to think that dysentery, as it occurs in Europe, was the same disease: however, the opportunities of observation, which I had in Egypt, convinced me that I was wrong.

The dysentery which occurred in the army till we came to the shores of the Mediterranean, and for some time after, was clearly the dysentery of India; but, afterwards, we witnessed a different disease. I must confess, that, having come to so certain a conclusion, I was not ready to give up an opinion which appeared to me to rest on very sure grounds; and it was not till after much doubt, hesitation, and careful observation, that I became convinced, in Alexandria, that, with the change of country and climate, we had a different disease. This is one proof how improper, and how unsafe, it is for the practitioner of one climate to sit down and describe the diseases of another. They only who have studied the same diseases, in various and opposite climates, can fully comprehend the extreme absurdity as well as fallacy of this. From reasoning of any kind, we are incompetent to decide on the identity of disease. Reasoning from analogy here always deceives. In many of the symptoms diseases may agree; but, from thence to infer their identity is taking a very narrow view. The comparison will be found to hold good only in some points, and that we have satisfied ourselves with an imperfect outline. Between diseases, as they occur in Europe and in Asia, there are just as many shades of difference as between the plants of those opposite regions, or in the colour of the inhabitants.

The dysentery of India, or what I shall term the tropical dysentery, is not the disease which is described by Cullen under that name. The dysentery of Cullen, as it is faithfully described by Sydenham, Pringle, Monro, and Sir George Baker, is a frequent disease on the continent of Europe; and it has ever been a most destructive disease in our armies there. The dysentery of Europe I believe to be generally a disease of the intestinal canal. I have already said that the tropical dysentery proceeds from a different cause; but the diseases likewise differ much in their symptoms. The “pyrexia contagiosa” certainly forms no part of the tropical dysentery; and the torminia and tenesmus occur so rarely, that, in a definition of this disease, I presume they cannot be admitted. Spasmodic affection of the intestinal canal, I believe, rarely occurs in the tropical dysentery.

I have ever experienced difficulty in distinguishing dysentery from diarrhæa, and am inclined to think, that, in Cullen’s definition of diarrhæa, is described tropical dysentery. The diarrhæa biliosa, as well as his seventh species, the diarrhæa hepatirrhea, perhaps, ought to be included in a definition of tropical dysentery.

It has been already mentioned, that it was the tropical dysentery which principally prevailed in the army. Though I was not convinced that we had a different disease, till after we came to Alexandria, yet I am inclined to think that it was the European disease which chiefly prevailed in the army for some time before; and, if we draw the line from November, we shall not be far removed from the truth.

It will not be necessary to say much in the treatment of tropical dysentery. Mercury is now the remedy relied on every where. In Egypt, we felt the want of nitric acid in hepatitis; and we equally felt the want of this powerful remedy in dysentery. The instances which have occurred to me, during the last five years, are extremely numerous, where, after our failure with mercury, exhibited in all the variety of its preparations, we succeeded with this remedy sometimes as a substitute, and sometimes as an auxiliary.[7]

It was in the 61st regiment that cases of the dysentery of Europe were first observed. Perhaps it more readily appeared in this corps, because the greatest part of the men had not yet got rid of the European habit, and were as yet unassimilated to a warm climate. After repeated failures, and losing some men, Mr Ruxton saw the necessity of giving trial to other remedies than mercury.

The disease generally set in with a smart fever, and, unless the calomel exhibited went through the bowels, the patient felt no relief: and Mr Ruxton remarked, that the neutral salts gave this relief much more perfectly than calomel. The treatment which Mr Ruxton rested on, and with which he was at length successful, was, in most cases, putting the patient on the anti-phlogistic regimen; frequently giving laxatives; and keeping up a determination to the skin. The same practice was followed in the few fresh cases which occurred in the 88th regiment at Alexandria, and in a considerable number of cases in the hospital of the 10th regiment, and some other corps. However, it must be mentioned, that to the last period some cases did occur, in all these corps, where calomel was found necessary. When the disease was of some weeks standing, and where a chronic disease occurred, calomel given in small doses proved the best and indeed only useful remedy.

For a long time, we saw but little dysentery in the army. The number of cases which occurred, before we arrived in Lower Egypt, was inconsiderable.

In September, a great many cases occurred in the neighbourhood of Rosetta, and in the camp at El Hammed; but many of these were the sequelæ of the fever contracted at Rhoda. In October, the number of cases was greatly on the increase. The rainy weather with which the month of November began, and which continued during the following months, brought a prodigious increase of dysenteric cases. In the general return of the first week in November, there appear one hundred and sixty cases, and one hundred and twenty-three of these are Europeans. Most of the natives were from the Bengal volunteer battalion.

In the first general return in December appear two hundred and nineteen; of which one hundred and forty are Europeans.

After leaving the encampment at El Hammed, and getting into dry, comfortable barracks, at Alexandria, the disease occurred more rarely in the army.

In the last return of January, only one hundred and sixty cases are seen.

In the last return of February, the total number of dysenteric cases in the army was fifty-four, and only twenty-two of these were natives of India.

In the last return of March, there appear nineteen cases, fifteen of which were Europeans.

There are only twenty cases in the last return of April, and these cases are equally divided between the Europeans and Indians.

At the time of embarkation the number was even less than the above.

The disease was more frequently met with among the European artillery, and in the 61st regiment, than in any other corps. Among the native corps, the Bengal battalion had more of the disease than any other. I made inquiry, but could find no reason that could with probability account for this.[8]

I have continued longer on the subject of dysentery than was at first my intention. I will confess, that I think it is a subject on which I could with more propriety speak than on any other. My opportunities of seeing the disease have been no common ones. Rarely, I believe, has it fallen to the lot of an individual to see so very many cases of one disease in such a diversity of climate and situation. In the 88th regiment, during the course of upwards of ten years, I saw the same men the subject of this disease on the continent of Europe, in America, in both extremities of Africa, and in India. Of late, it has afforded me not a little amusement to review my notes as well as my journals of practice in this disease, in all these quarters.

I have now both given some account of the endemic diseases which we met with in Egypt, and offered a few remarks on those diseases which were most prevalent in the army. They are the diseases which constantly prove the most fatal to an army in India. The few which now remain, or (if I may be allowed the expression) the minor diseases, will not long detain us.

PNEUMONIA AND RHEUMATISM

I shall speak of conjointly. In the symptoms or treatment we could not observe any difference from the same diseases as they occur in Europe. If these diseases were less violent than we have seen them in Europe, they had more of the inflammatory, diathesis than in India.

It was not till after the army had been sometime in Lower Egypt, that either of these diseases appeared.

In the first general weekly return in November, there appear a total of six cases of pneumonia, and nine of rheumatism.

In the first week of December, there were twelve cases of pneumonia, and seven of rheumatism.

In the first weekly return of January, both diseases appear to have increased; there were twenty-four cases of pneumonia, and twenty of rheumatism.

In the first return of February, there are thirty-four cases of pneumonia, of which number, twenty were Europeans. Of rheumatism, there were fifteen, and only eight of them were Europeans.

In March, the first return presents only five cases of pneumonia: of these, three were Europeans; but, of rheumatism, there were twenty-seven cases, and nineteen of them were natives of India.

In April, there were sixteen cases of pneumonia, and only five were Europeans. Of twenty-five cases of rheumatism, eleven are Europeans.

The warm clothing and bedding provided by the General for the natives of India, in the cold months, no doubt protected them from the attacks of pneumonia and rheumatism. The latter disease was found to be more prevalent in the Bengal battalion of Sepoys than in any other corps.

SMALL-POX.

The cases of this disease that occurred were very few. I have said that the small-pox broke out at sea, in the division of the army commanded by colonel Murray. Mr Philips told me, that it was very fatal to the natives: he sent every case as soon as discovered into the Julia hospital ship, which was unfortunately lost, in the Red Sea, with all on board.

The Europeans, who were attacked in Egypt with this disease, all did well; but it proved a very fatal disease to the few Indians whom it attacked.

As in India, we remarked, that in Egypt the contagion did not spread so widely as in Europe. Though, at different periods, it broke out in the hospital of the 10th regiment, at Rosetta, in the department of the commissary of cattle, when encamped near the lake Mareotis, and in the garrison of Ghiza, yet in none of these instances did the disease spread. The cases that did occur were all of them very confluent. When, on the eve of our march to Suez, I received vaccine matter, sent from Constantinople by order of Lord Elgin: it arrived too late, however, for us to introduce the new inoculation either in the army, or the country; it was likewise too old and unfit to be carried into India, as we intended.[9] At one time I expected to see a curious question in physiology resolved, by observing the united agency of the variolous, and pestilential contagions. In one instance, these two poisons were in action in one corps, and at one time. A case of the small-pox, and another of the plague, broke out, in the camp of the commissary of cattle, at the same time. By the active vigilance, and the system established there, the progress of both contagions was soon stopped, and a second case of either disease did not afterwards occur.

DIARRHÆA.

I have said, that, from the quality of the water, this was a prevailing disease in crossing the desert of Thebes. It occasionally appeared, at other times, in some corps, particularly after a change of provisions, or after changing quarters, as from El Hammed to Alexandria.

SCURVY.

This disease was but little seen in the army. About twenty cases occurred in the 61st regiment while quartered in the Pharos, and one case occurred in the 80th regiment at Alexandria. At the time the disease occurred, the army was regularly supplied with fresh vegetables, and there was no scarcity of provisions in the market.

SYPHILIS.

This disease prevailed much in the garrison of Ghiza, and in the 86th regiment. At the time of embarkation there were many obstinate cases. With the small stock of nitric acid which we had, we had as strong proofs of its efficacy as in India. In the instances of some officers who were successfully treated with it, we found that the stomach seldom bore more than half the quantity which, in Bombay, we had usually exhibited in the hospital of the 88th regiment; but the acid given to these cases differed much from the acid used in India: the latter was a much pleasanter remedy.

To a few cases we successfully gave the oxymuriate of potash, and to several cases the oxymuriate of soda.

We found that syphilis was a frequent disease in every part of Egypt that we had seen, both among the Bedouins and the Fellahs; and we have seen in Upper Egypt many objects terribly mutilated from this disease. Crude mercury I have often seen in their bazars, or markets, and they appeared to be acquainted with the use of it.

THE GUINEA-WORM.

This did not frequently appear in the Indian army while they were in Egypt: on the voyage thither, however, it prevailed very much, and a great deal of it came under my own particular notice. On my return to India I found, that, in the manner of its first appearance, as well as in its progress afterwards, much of what I had observed was considered, by medical men, as new and remarkable. I shall, therefore, give some detail of it here: though this may be going a little out of my way, it may be useful. When cases of this disease crowded on me, and with the very severe symptoms with which they appeared, I was both perplexed and embarrassed; and I regretted much the not having had a previous knowledge of the disease.

This disease, as will be shewn by the table, was but little seen in Egypt. It appeared only in two European corps, the 86th and 88th regiments; and in two native Indian corps, the 1st and 7th Bombay regiments. It is a disease, of which I believe that we know but little. Industry and attention might be usefully employed in the investigation of the natural history of the dracunculus.

In September, 1799, the 86th regiment relieved the 84th in the fort of Bombay. The 86th remained in the king’s barracks there until October, 1800, at which time they were relieved by the 88th regiment from the island of Coulabah.

The 86th, on coming into the fort of Bombay, had never had a case of the Guinea-worm; and they continued free from it till the setting in of the monsoon of 1800. The king’s barracks in the fort are close to the bazar in Bombay. Here Mr Dean, the surgeon of the 86th regiment, remarked, that the Guinea-worm prevailed very much among the natives. In the course of the monsoon, nearly three hundred cases of this disease appeared in the 86th regiment. I saw, at one time, one hundred cases of it in Mr Dean’s hospital.

The 88th regiment, from the time of their arrival in India, in June, 1799, till October, 1800, was quartered in the island of Coulabah, distant one mile from Bombay. During the fifteen months of their stay at Coulabah, only one case of Guinea-worm appeared in the regiment; and this happened, as they were about exchanging quarters with the 86th regiment, in an old man, debilitated with repeated attacks of hepatitis and dysentery. No case appeared in the 88th regiment in October, nor for nearly a month after their coming into the king’s barracks in Bombay; but, in that part of November which immediately preceded their embarkation for service, three cases occurred.

The artillery, 86th and 88th regiments, as already mentioned, were embarked, at Bombay, for the Egyptian expedition. In the course of the voyage to Ceylon, a case of Guinea-worm first appeared in the detachment of the 86th regiment, on board the Minerva; and, thereafter, six cases in the 88th regiment, on board the same ship.

On our arrival at Point de Galle, in Ceylon, we found that the disease was unknown in his Majesty’s 19th foot, among the Sepoys who came from Bengal or Madras; in the Malay corps: and, as far as I could learn, among the inhabitants. During our stay in Ceylon, a few cases made their appearance in the 86th and 88th regiments on shore. On sailing from this island for the Red Sea, only three hundred and sixty men, of the 88th regiment, with the artillery, were embarked in the Minerva. Two companies of the 88th were embarked in a small vessel, the Fancy. Another vessel, the Hope, was provided for the detachment of the 86th regiment, and two officers of the 88th were embarked with them.

Soon after sailing from Ceylon, the Guinea-worm made its appearance among the 88th, both in the Minerva and Fancy: in the Minerva, particularly, it increased with alarming rapidity. By the time we reached the Straits of Babelmandel, we were in a most alarming state. Of three hundred and sixty men, whose services we had reason to expect daily might be required, one hundred and sixty-one were at this time crippled and laid up with this loathsome disease. Though contrary to every account which I had had of the disease, many circumstances at this time led me to suspect that it was infectious, and I, at length, thought it prudent to treat it as such.

The officers remarked, that it prevailed most in particular parts of the ship, and much more in some companies than in others. This, at length, so much struck the commanding officer, that the sick were separated from the sound: the men with the Guinea-worm were all placed on the orlop-deck, and the rest of the men occupied the gun-deck. At this time, too, extraordinary precautions, regarding cleanliness and ventilation, were adopted. Much lumber and luggage were stowed away, and the space between decks, which hitherto had been lumbered with it, was made open and clear, fore and aft. The decks were daily well washed with boiling water, and the nitrous fumigation was kept constantly going on throughout the ship. Besides the usual bathing three times a week, of all on board, the soldiers were made to wash their hands and feet regularly twice every day at the ship’s head.

In a little time after adopting these measures, we could perceive the disease to diminish. The number of fresh cases reported, decreased daily; and at the time of our casting anchor in Kossier Roads, though there were on the sick list many bad ulcers from the Guinea-worm, no fresh case had appeared for some days before.

During the voyage, 199 cases had appeared from 360 men of the 88th regiment; and several cases occurred among the ship’s crew; but not a single case occurred among the artillery. This struck every one on board, very early, as remarkable; yet these men had the same provisions, drank the same water, and in every other circumstance were situated as the men of the 88th regiment, except that they were kept separate. From the outset, the artillerymen were accommodated apart, on the gun-deck, in a spot divided off for themselves. Not one of the officers, either of the artillery, 88th, or belonging to the ship, had the Guinea-worm. From the strong circumstances which in its course appeared, every officer on board was impressed with the opinion of its being contagious, and was inclined to use every precaution of prevention; from which, most probably, all escaped this filthy and severe disease.

Those embarked in the Fancy, were not so fortunate; few of the men there escaped the disease. Of eight officers of the 88th, three caught it. Mr Bruce, then the assistant surgeon, was one of these: he had a worm in each leg. The Fancy was obliged to return to Bombay; most of the men were disabled by this disease; and the season was too far advanced for her getting up the Red Sea.

Among the 86th regiment in the Hope, only three cases occurred; and one of the two officers of the 88th, on board, was one of them.

I find, by my case-books, that in the part of the 88th regiment which continued in the Minerva, the disease appeared as follows:

From the 9th to the 24th December, 6 cases on the passage to Ceylon. From the 25th Dec. to 14th Feb. 4 ditto at Ceylon, on shore. From the 15th to the 28th Feb. 39 ditto at sea, after leaving Ceylon. In March 103 ditto at sea. In April 39 ditto at sea. In May 8 ditto at sea, till landing at Kossier. ---- Total of cases 199 ----

I have purposely excluded the cases which occurred in the 88th, on board the Fancy, or among the 86th regiment.

The disease was pretty uniform in the manner of its appearance. The patient was first sensible of an itching; and, on looking at the part, generally observed a small blister: sometimes I have seen three or four small blisters, and the part having the appearance of being stung with nettles. When the blister was snipped, a piece of mucus of the breadth of a sixpence was seen underneath, which being removed, the head of the worm was seen. It was in general firmly attached, and required force to detach it from the parts underneath. When detached with the forceps, we twisted it round a ligature or piece of lint, and thus, often on the first day, succeeded in extracting a foot, or even two, of the worm. It resembled much what is called bobbin, and was about the same size. It was transparent and moist, a white liquid being seen in it. We continued, daily, extracting as much of it as would come out with gentle pulling. It was always dangerous to pull strongly, for fear of breaking the worm: it then occasioned the most acute pain, and there followed much swelling, with inflammation of the neighbouring parts, sometimes of two or three weeks continuance, when the worm would shew itself at another part, as at first, with itching and a blister.

It seldom appeared to be deeply seated; generally, under the cutis, or among the tela cellulosa, when we could often trace it in its course, and sometimes see it: sometimes it was under the fascia, and but seldom among the muscles.

If not ushered in with fever, it was almost always attended with it in its course: when there was considerable inflammation, it ran very high. In seven cases, mortification took place, and very large sloughs were cast off. In a few cases, there was a very considerable and alarming hæmorrhage.

By presenting itself at different places, it would often leave two or three large, foul, and fistulous ulcers in different parts of a limb. When the inflammation has run very high, as I have often seen of the whole leg or thigh; and when a profuse suppuration followed; the worm frequently has come out dead, often in pieces, with the sanies, by which, probably, it had been eroded and killed.

Frequently, after extracting one worm from a patient, a second, a third, or even a fourth, would appear: after getting one out of a leg, a second would appear in the other, a third in one hand, and a fourth in the other hand.

The Guinea-worm, I believe, has been seen in every part of the body. Though the extremities appear to be its favourite seats, yet the face, breast, back, penis, &c. are not exempted from its visits. I heard of a gentleman in Bombay who had one in his scrotum and penis, and of a lady who had one in the pudenda.

The following I extract from my case-book and notes, taken on board the Minerva, by which it will be seen that the extremities are as much more frequently its principal and first seat, as in the itch.

+-----+-----+-----+-------+--------+------+------+-----+-----+-------+ | | | | | | | | | | Total | | | Feet| Legs| Thighs| Scrotum| Groin| Hands| Arms| Body| Cases.| | +-----+-----+-------+--------+------+------+-----+-----+-------+ |Feb. | 34 | 3 | 1 | — | — | 1 | — | — | 39 | |Mar. | 70 | 21 | 5 | 2 | 2 | 3 | — | — | 103 | |April| 20 | 9 | 5 | — | — | 3 | — | 2 | 39 | +-----+-----+-----+-------+--------+------+------+-----+-----+-------+ |Total| 124 | 33 | 11 | 2 | 2 | 7 | — | 2 | 181 | +-----+-----+-----+-------+--------+------+------+-----+-----+-------+

As to the causes of the appearance of the Guinea-worm, and the mode in which it is generated, I must confess that I have no account that I could venture to offer here.

In different parts of the world, the water drank is accused of occasioning intestinal worms, as the tænia in Switzerland, and the tænia and the teretes in the West Indies; where, likewise, I have heard the mucilaginous vegetables eaten assigned as a cause of the frequent appearance of worms. In Russia, there is a worm, the lumbricus militensis, common near swampy grounds. In Russia and in Siberia, in the same situations, the tænia infernalis prevails. But, after what has been here stated, we cannot bring the water, drank on board the Minerva, or at Bombay, to account for the Guinea-worm which prevailed: in fact, the water came from different and distant quarters, Bombay, Ceylon, and Madras. Besides, the officers of the 38th, and the artillery, drank the same water, and escaped.

No case of Guinea-worm had been known among either the Lascars or European sailors in the Minerva, when the 86th and 88th embarked in her.

I have good reason to think that the spreading of the Guinea-worm may be stopped, whenever it does appear. The means which we adopted appeared to succeed. Extreme attention to cleanliness is indispensably necessary.

In India, the native doctors are much more successful in getting out the worms, than Europeans. After long feeling with their fingers, for the body of the worm, they make an incision as nearly as they can judge over its middle, and, pulling the worm by a duplicature of it, draw out both ends of the worm at one time. I have often endeavoured to imitate this practice. My sense of touch was not so delicate, and did not guide me so correctly, as it did the Hindoo doctors; but I always found that when, on cutting down to it, I got on the middle of the worm, and, by the forceps, pulled this out, I could with ease extract a large portion, and, not unfrequently, the whole worm.

Leeches, astringent and sedative lotions, cataplasms, fomentations, &c. were applied, as required by the circumstances of the case. A good deal of attention was paid to the disease, in all its stages; and several experiments were made on the worm, which, however, it is needless to detail here.

After using a variety of articles, in the treatment of the Guinea-worm, and making them enter the system by the absorbents, I think that unctuous substances succeeded the best, particularly mercurial ointment. Passing an electrical shock through the part had no effect.

ULCERS.

In India, we remarked that ulcers, particularly of the legs, were very rarely seen; and that many men in the 88th regiment, who in Europe were always in hospitals with them, were in India quite free from them. In Egypt, they began to re-appear. In the course of six weeks after the army came to Alexandria, there appeared seventy on the general return of the army; and they continued afterwards on the increase.

TETANUS.

Though no case of this disease occurred to us while in Egypt, I met with a severe one on the voyage thither. As I was successful in this case, and by a mode of treatment which, with the theory which gave rise to it, is, I believe, now considered as obsolete, it may not be uninteresting to mention what led me to give it a trial.

In the year 1794, the first tetanic case I met with, occurred at Bergen-op-Zoom. A sergeant of the 88th regiment, after remaining drunk out all night, was in the morning found lying in a ditch. This was in August, and the weather was unusually warm. When brought to the hospital, his jaws were so firmly locked, that the blade of a pen-knife could not be introduced between the teeth. Mercury was had recourse to, but in a few hours the muscles of the neck became convulsed. By the advice of a Dutch physician, a man of great eminence, I immersed my patient four times, in the course of the day, into a bath of broth. He continued in it half an hour each time, and, after he came out, his whole body was rubbed with mercurial ointment. I do not recollect that any thing else was given to him, unless a stimulant enema. Next morning the good effects of the Dutch practice were evident: a violent salivation came on, and, in about three weeks, the man was doing his duty.

In the next case which occurred, though a cure was not completely effected, the same treatment was, for some days, attended with good effects. In the island of Grenada, a negro, attached to our pioneers, received a contusion and a slight wound of the head, which was soon followed by locked jaw. The warm bath, and the liberal use of mercury, were ordered. He, for some time, appeared to be better, and I flattered myself with the hopes of another cure; but the disease gaining ground, the cold bath and the tonic treatment were had recourse to. The patient died.

The next was a sailor, who, a few days before our embarkation, in the Minerva, at Bombay, had been slightly wounded in the foot by a copper nail. On my first seeing him, his symptoms were slight, but were gaining ground fast. On the 10th of December, the day after our embarkation, he had the most violent symptoms of the disease: the jaws were firmly locked; the muscles of the neck, before and behind, were strongly convulsed; and he had twitchings of the muscles of his face. He pointed to the region of the stomach, where, he afterwards told me, that he had intolerable pain and sickness. This man was immediately put under the same treatment as was employed in the case of Sergeant Kirkland, with this difference, that, instead of broth, a bath was made from fat, or what is, on ship-board, called the slush. The same success attended; but the symptoms yielded more slowly, and it was several months before the sailor recovered.

From hearing me relate these successful cases, by the warm bath and mercury, some cases in the Bombay general hospital were treated in the same manner. My friend, Dr Keir, informed me that he tried it in three cases of tetanus, in the garrison hospital. It succeeded in one, but failed in the other two.

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

When I had nearly brought these sketches to a conclusion, I met with two books which I regret that I did not see earlier, viz. Dr Chisholm’s work on the Pestilential Fever of the West Indies, and Dr Wittman’s Travels. In perusing these works, I have had great satisfaction to find a coincidence with me in some opinions which I had formed, and which I have introduced into this treatise.

It is matter of regret to me, that I did not meet Dr Wittman in Egypt. Most of my observations, I find, coincide with his; and I am glad to have mine confirmed by authority so respectable.

The frictions with oil we did use to a small extent, in an infected corps of the Indian army; but the report made to me, by the surgeon, was unfavourable, and I never recommended its use in any other corps. Since reading what Dr Wittman says on the subject of friction with oil, I think it not improbable, that, in addition to the great care which captain Burr took of the commissariat department, another circumstance may have conduced to their exemption from the plague. The camels of the army, to the number of some hundreds, were, as well as the horses and buffaloes, under the charge of the commissary of cattle, captain Burr; and his people were entrusted with the care of them. In the cold and wet season, which commenced in November, the camels became very sickly, and many of them had an eruption over the body. In the course of three months, I believe, more than three-fourths of these useful animals died. Captain Burr employed some Arabs, who were reputed to be skilful in the treatment of the camel. The plan which they followed I remember well. It was, after shaving or cutting the hair very close, to rub them all over with oil, daily. The men of the commissariat department were, during the day, constantly employed in these frictions, or in tending the cattle: and the great mortality among the camels happened in November, December, and January, the months in which the plague raged the most in the army. The circumstance I think not unworthy of notice; I leave others to ascribe to it what degree of importance they think it deserving of.

I have mentioned, that I thought I could see a characteristic similitude in many of the symptoms between the plague and the destructive fever which has for some years devastated the continent of America and the West India islands; and to the end of the account which I gave of the plague, I add a table of the principal points where it appeared to me that the two diseases agreed.[10] I am now glad to find, that in this opinion I do not stand alone; I have been particularly gratified to find that this is the opinion of so very respectable authority as Dr Chisholm.

I have had the greatest satisfaction in the perusal of the very complete history of the West India fever which Dr Chisholm gives. In most points, the result of my observations on this, coincides with the doctor’s. My experience, in a particular situation, supplied me with some very strong facts, touching the question of the contagious nature of this fever.

From my case-books and notes, while in the West Indies, I have thrown, under a few heads, a brief extract of the result of my observations, which I shall here insert. From the similitude which I think I can trace, this is not foreign to the principal subject of these Sketches; and, as the result of close observation, unattached to any theory, they may, perhaps, be not without interest or use.

1st. In Barbadoes, both in the end of 1795, and in the beginning of 1796, the only disease which prevailed was typhus. The 88th regiment was healthy at St Lucia, and continued pretty healthy at Grenada for three months after their arrival there, or as long as they remained to the windward side of the island. This was likewise the case with the 10th, 25th, and other regiments. It was only after our return to St George’s and to Richmond Hill, after we had communication with the 68th regiment, and the general hospitals, where the yellow fever had for many months prevailed, that it appeared in the 38th, and in the other corps.

2d. Before the appearance of this fever in the 88th, as well as in other corps, dysentery and intermittents prevailed most.

3d. On the 12th of July, 1796, a detachment of the 88th regiment was embarked at Grenada, in the Betsy transport, for England. We embarked one hundred and forty, and I was most particularly careful not to take any man on board with the slightest appearance of illness. Every precaution which regarded cleanliness, ventilation, or fumigation, was adopted. The remains of the 8th, 10th, 25th, and other regiments, were at the same time embarked, at Grenada, for England.

4th. From the time we sailed from Grenada, on the 19th of July to the 5th of August, seven days after we sailed from Tortola, (where we had touched for water) no case of this fever appeared in the Betsy. The other corps, which left Grenada along with us, had not been so fortunate. The 8th, 10th, and 25th regiments, all of them suffered severely on the passage from Grenada to Tortola; the 8th particularly. This corps, besides the loss of many non-commissioned officers, in this short passage, lost every officer on board, except the surgeon in second, and major and captain Armstrong; and these two gentlemen were ill of the yellow fever on coming into Tortola. I was requested to go on board to visit them, but the request was opposed by all the officers on board the Betsy, as well those of the ship as by the officers of the 88th regiment on board. So very much were all impressed with an opinion of the fatally infectious nature of this fever, that they remonstrated with me, and told me, that the ship and the regiment were now perfectly free from this fever; but that, by my going to see the 8th, I should certainly bring the fever into the Betsy. However, a second message having come for me to visit captain and major Armstrong, I instantly accompanied the messenger on board. From seeing the state of their transport, I immediately ordered major and captain Armstrong on shore, and accompanied them to the hotel. Here we found that the prejudices in the Betsy transport prevailed in the island of Tortola. The doors of the hotel were shut against the yellow fever, and it required a very _forcible_ remonstrance to persuade them to admit these two officers, who, however, both of them, died the next day in the hotel.

5th. The state of the other corps, after sailing from Tortola, I am unacquainted with. When lying at Tortola, on the 29th and 30th of July, the Betsy communicated with the transports which had the 8th and 10th regiments on board. On the 6th of August, the first case of the yellow fever appeared on board the Betsy; from which period to the 12th of September, 1796, every person almost was once, and a great many on board twice, attacked with this fever. Of one hundred and forty people on board the Betsy, the captain of the ship, eighteen soldiers, and one woman, died in this period. It should, however, be mentioned, that, of the soldiers, several were old and worn-out invalids. During the passage from Tortola to England, our convoy, the Hebe frigate, suffered even more than the Betsy. When sent for on board, by Captain Scott, I found that he had not only lost many seamen and marines, but several officers, and two medical gentlemen.

6th. On the fleet, from Grenada, anchoring at Tortola, the yellow fever was unknown there; thereafter, I have heard, that it prevailed generally, and committed great havoc.

7th. Those labouring under dysentery, ague, &c. were those first seized with this fever.

8th. [_Symptoms._]—The attack was first with extreme debility, affection of the head, and frequently the appearance of drunkenness. Next, the abdomen was complained of, and the biliary system appeared to be a principal seat of the disease. The yellowness, though not a constant, was a generally attending symptom. The eyes first appeared of a watery suffusion; they next were observed to be blood-shot; and, in a short time after, yellow; from the eye, the yellowness quickly spread over all the body, and the patient in a little time had the appearance of one highly jaundiced. Sometimes the yellow colour of the body continued for some time after the patient got well, and purgatives brought off yellow stools, while the urine was at the same time yellowish. The irritability of the stomach, and what is called the black vomiting, were pretty constant attending symptoms. The state of the pulse varied in the course of the disease; there was at first, almost always, a firm and strong pulse, with so much re-action, as would lead a stranger to the disease to blood-letting and the anti-phlogistic regimen. The bowels were, in general, very unequal; there was either a looseness or costiveness, though most frequently the latter.

9th. The duration of the disease was, in different cases, and in different situations, very different. In Grenada, when it first broke out, it generally ran its course from twenty-four, thirty-six, to forty-eight hours, in the hospitals. Soon after we sailed from Grenada, cases terminated in three days: thereafter, and as we approached the higher latitudes, and before we reached Ireland, cases were drawn out to ten, twelve, and fifteen days.

10th. The prognosis. The danger was generally in proportion to the degree of affection of the head, irritability of the stomach, and yellowness of the skin, and as these appeared early or not.

11th. In the treatment various modes were tried. Emetics appeared to be unnecessary; and, in general, seemed to do mischief, as did all antimonials. I have witnessed the practice of a large hospital, where blood-letting was premised in every case; but this was by no means a successful practice. In three cases in the Betsy, and where the state of the pulse and other symptoms seemed particularly to call for it, I performed venæsection; but I lost my three patients. Clearing the bowels appeared to be a principal indication: when this was repeatedly done by drastic purgatives, and when a free perspiration was kept up, there was always less complaint of the head, and, in some cases, a remission was thus obtained, and the bark could then be given with manifest advantage. In the few cases where it was used to produce salivation, calomel did more good than any other remedy whatever. I lost no case, where I succeeded in inducing a flow of saliva.

In some cases, and these all proved fatal, the gums became insensible to the effects of mercury; and though one drachm of calomel in one case, and two scruples in another, were given in a very short period, yet the patient died without a flow of saliva having been excited.

Nothing gave more relief than the cold bath; it generally suppressed the irritability of stomach for some time; it always induced sleep, and brought out a gentle sweat, which most commonly relieved the patient. The Brunonian practice I saw tried with no advantage.

These are the principal of the leading circumstances, regarding the yellow fever, which came immediately under my notice.

Dr Chisholm, when he formed the opinion of the similarity of the plague and the yellow fever, was not singular.

Since my arrival in England, I have received several letters addressed to me in Egypt, and which followed me from that country to India, and from thence to Europe; mostly answers to letters which I wrote from Egypt. By two of my West-India correspondents, in particular, this opinion is repeatedly expressed. I have several letters on the subject from two most respectable physicians, Dr Paterson, of Grenada, and Dr Robertson, of Barbadoes. From the opinion which he had formed, Dr Paterson repeatedly urges me to the use of mercury, and of the cold bath, in the plague.

Dr Robertson, in one letter says, “I decidedly agree with you, that there is a strong similitude between the symptoms of the yellow fever and the plague: although the latter disease never came under my observation, yet I was so struck with the appearance of yellow fever, and the histories of the other disease, which I had read, that, at one time, I was almost disposed to consider them both as different modifications of the same diseased state of body, and actually wrote a paper on the subject in February, 1797.”

In the practice in Egypt, Mr Price’s observation militates against the use of cold bathing in the plague. It should be recollected, however, that, when Mr Price made his observation, it was in the severest part of the season, when the plague raged the most, and when Mr Price laboured under many disadvantages in his practice. I anxiously wish to see cold bathing, or sponging, extensively tried in the plague. I have great expectations from it in that disease, from having so often seen how much it has done in the yellow fever and in typhus fever, where I consider it to be the most valuable part of the treatment.

In concluding, I am impelled to do an act of justice, and acquit myself of a debt of gratitude. The use of this invaluable remedy, and what else I know of tropical practice, I learned many years ago from my venerable and much-respected friend Dr Wright. By the use of the cold bathing, my life was saved in Jersey, in 1794, when I was ill of typhus fever, by Dr Jackson, then surgeon of the Buffs, who, at the same time, attended my hospital for me, and with the greatest benefit, and introduced this practice into the 88th regiment, where typhus then raged.

The use of cold water and cold bathing has since been diffused by the ingenious and elegant pen of Dr Currie. This I conceive to be one of the greatest improvements which the practice of physic has received in modern times.

FOOTNOTES

[1] A plan established in the army proved so useful, that I will here mention it. The letters and reports of the medical gentlemen in the pest-houses, I constantly sewed together, made them up in monthly volumes, and kept them at my quarters, where every medical gentleman in the army was invited to come and daily peruse them. The disease became thus the subject of daily discussion; and, from these discussions, I was enabled daily to propose queries in my letters to the gentlemen in the pest-houses. Thus, the history of the disease, in most of its points, came to be investigated; and, previously to entering a pest-house, before his tour of duty came round, every gentleman had acquired some knowledge of the plague, and of the success of other practitioners.

[2] These circumstances I learned from a member of the French Institute, and from the Pharmacien en Chéf to the French army, who often related to me the order which Bonaparte gave him to poison the wounded with opium.

[3] In Dr Duncan’s Annals of Medicine, for 1801, I have adduced a striking instance of this.

[4] Dr Buchan was on the staff of the British army, but twice nobly volunteered his services, and twice did duty in the lazaretto of Alexandria, at this period common both to the English and Indian armies.

[5] This remark we found to be particularly applicable to the last stages of the disease. In the beginning of the season, one case occurred that gave rise to much conversation in the army. From having come into contact with a case of plague, a Lascar, in the department of the commissary of cattle, was sent into the observation-room of the pest-house of Rosetta; he was brought there much against his will, and contrived to make his escape from it, on the evening of the day on which he was admitted, though fired at by the dragoon-centries placed round the establishment. Ineffectual search was made for him every where in the neighbourhood of Rosetta, and we could hear nothing of him for about five weeks, when he was discovered at Boulac. On being brought down to Rosetta, I examined him with Mr Guild, the surgeon of his corps. We found him then well; but certainly he had had the disease, for we saw an axillary bubo not quite healed. He told us, that he remained concealed for a great part of the time among the rushes by the side of the river. On mentioning this case to Dr Currie, of Liverpool, I think he said, he had heard of some similar cases.

[6] Since my arrival in England I see that the contagious nature of the Egyptian ophthalmia has been noticed by two gentlemen of the English army, Mr Edmonstone and Mr Powers.

[7] Though this practice is now followed by many gentlemen in India, yet I believe that it has been carried to a greater extent by Messrs Dean and Bellars, of the 86th regiment, than by any other practitioners. These gentlemen have recorded several hundreds of cases of dysentery treated solely by nitric mixture and bath.

[8] In Egypt we gave trial to a mode of treatment which was strongly recommended to me by Dr Whyte. It was the application of flannel bandages over the whole abdomen. In chronic cases, and in convalescents, it appeared to be of the greatest service; and, in recent cases, when the appropriate remedies were used at the same time, it appeared to shorten the cure. I have seen it tried alone but in a few cases of this disease. From the result of these, however, in cases of either the European or tropical dysentery, I would not venture to rely on it alone for a cure.

Before leaving the subject of dysentery I may mention, that, in India, I have met with some cases of a very violent dysentery which ran its course in three, four, or five days. In this disease the usual practice did not succeed. The best treatment appeared to be, after a dose of castor oil, to give opium liberally by the mouth, and by clyster; and to make the patient drink very freely of gum arabic at the same time. In some of these cases I have likewise given diluted nitric-acid. A constriction of the vessels discharging mucus was in this way effected; the incessant discharge was stopped, and time given for a secretion of mucus to cover the abraded gut. I have thus sometimes succeeded in checking a most violent disease. Thereafter, the mouth could be gradually and gently affected by mercury, or by nitric-acid.

On opening the bodies of those who died of the tropical dysentery, in Egypt as in India, we almost constantly found the liver diseased. In old cases, we likewise most commonly found ulceration of the great intestines, and very frequently within the reach of enemata. In the composition of these, a variety of articles were used: most frequently, I think, solutions of sugar of lead, or vitriolated zinc, gave greatest relief; and we sometimes found that gum arabic, milk, and broths, gave relief, when many other things had failed.

[9] It was soon afterwards introduced to India, by the exertions of the Medical Board at Bombay; and the world has had a full account of its introduction and success from my friend Dr Keir, who had the charge of the institution for disseminating the vaccine disease, from Bombay through India.

[10] Vide Appendix.

THE END

Marchant, Printer, 3, Greville-Street, Holborn.

TABLE I.

I have said, that the similarity between a number of the symptoms of the plague, and those of the destructive fever which I saw in the West-Indian islands, in 1795 and 1796, struck me in Egypt. On my return to India, having recourse to my papers and case-books, written while I was in the West Indies, I found a very great resemblance between the two diseases, as I had seen them, in countries so remote. At Bombay, in conversation with General Nicolls, who commanded at Grenada while I was in that island, I mentioned the resemblance of the two diseases, in very many of their features, as being remarkable. At the general’s suggestion, I soon after drew out, in a tabular form, the principal points of resemblance between the plague and the yellow fever. This table appeared curious to the general, and to my ingenious and esteemed friend, Mr Scott, as well as to other friends at Bombay; and, at their desire, I appended it to my Memoir. I here subjoin it in the abstract: it may suggest hints that might be useful to future observers in the West-Indian fever as well as in the plague.

_Points of Resemblance between the PLAGUE and the YELLOW FEVER._

THE PLAGUE. THE YELLOW FEVER.

1st. The attack is sudden, and 1st. Men were suddenly attacked with the greatest prostration on duty, and with the greatest of strength. debility, from the first.

2d. The head is the part 2d. The attack was almost principally complained of at constantly with a pain of the first; thereafter the abdomen head, the eye being first of a and limbs. watery suffusion, then blood-shot, and, at last, yellow.

3d. In a majority of the 3d. The black vomiting is an fatal cases, there is an almost constant attendant of unconquerable irritability of the fatal cases, and which stomach, and a vomiting of rarely any thing was found to frothy bile. relieve.

4th. The biliary system 4th. From the yellowness of the appeared in most cases to be body so generally seen, as well the seat of the principal as from the very unequal state complaints: there was often of the bowels, we were led to pain, sometimes swelling of think, that, in this fever, the liver, and the bowels the system of the liver was were generally unequal. principally affected.

5th. In many cases there were 5th. In a great many cases remissions; and, in some there were remissions, and cases, particularly of the some cases terminated in Sepoys, there were perfect intermittents. intermissions.

6th. The disease frequently 6th. In several instances it alternated with the tropical alternated with dysentery, and diseases, arising from morbid in some cases with affections action of the liver, viz. of the liver. colera, icterus, hepatitis, and dysentery.

7th. In a majority of cases, 7th. In some cases there were we saw glandular swellings, swellings of the parotid gland, petechiæ, maculæ, or vibices. petechiæ, maculæ, and vibices.

8th. Some cases died without 8th. We lost several cases, who bubo or irritability of the never had the yellowness, nor stomach. the black vomit.

9th. In those cases which 9th. Whenever we could excite a proved fatal, it was found flow of saliva, the patient was impossible to produce considered to be safe, and did salivation. well.

TABLE II.

STATE of the DEATHS and DISEASES in the INDIAN ARMY in EGYPT, from the Time of Embarkation to the Return to INDIA.

Transcriber’s Note: Key to table columns is as follows.

A: Effective Strength of different Corps. B: Invalided or sent to India or England on recovery. C: Dead. D: Plague. E: Fever. F: Liver complaint. G: Dysentery. H: Diseases of the Lungs. I: Stroke of the Sun. J: Casualties and Diseases unknown.

========================================================================== EUROPEANS. --------------+----+---------------------+---+---+---+---+--+---+--+--+--- | |Place of Embarkation,| | | | | | | | | | | and Dates included. | | | | | | | | | CORPS. | A +-----------+---------+ B | C | D | E | F| G | H| I| J | | | Date | | | | | | | | | | | Place. |included.| | | | | | | | | --------------+----+-----------+---------+---+---+---+---+--+---+--+--+--- His Majesty’s | 80|Cape of |1st | —| 2| —| —| 2| —| —| —| — 8th Light | |Good Hope |March, | | | | | | | | | Dragoons | | |1801, to | | | | | | | | | | | |4th June,| | | | | | | | | | | |1802 | | | | | | | | | | | | | | | | | | | | | Royal | 44|Ditto |Ditto to | —| 2| —| —| 1| 1| —| —| — Artillery | | |to 1st | | | | | | | | | | | |April, | | | | | | | | | | | |1802 | | | | | | | | | | | | | | | | | | | | | The Honourable| 27|Calcutta |18th Nov.| 1| —| —| —| —| —| —| —| — Company’s | | |1801, to | | | | | | | | | Horse- | | |4th June,| | | | | | | | | Artillery | | |1802 | | | | | | | | | | | | | | | | | | | | | Bengal ditto | 37|Ditto |Ditto | —| 3| —| 1| 1| 1| —| —| — | | |Ditto | | | | | | | | | | | | | | | | | | | | | Madras ditto | 96|Madras |28th Dec.| 2| 5| —| 1| 3| 2| —| —| — | | |1800, to | | | | | | | | | | | |4th June,| | | | | | | | | | | |1802 | | | | | | | | | | | | | | | | | | | | | Bombay ditto | 144|Bombay |.. March,| 2| 9| 5| —| 1| 1| 1| —| — | | |1801, to | | | | | | | | | | | |Ditto | | | | | | | | | | | | | | | | | | | | | His Majesty’s | 984|Calcutta |28th Nov.| 49| 98| 4| 12|18| 63| —| 1| — 10th Regiment| | |1800, to | | | | | | | | | of Foot | | |1st May, | | | | | | | | | | | |1802 | | | | | | | | | | | | | | | | | | | | | 61st ditto | 980|Cape of |1st | 15| 88| 11| —| 6| 40| 2| —| 25 | |Good Hope |March, | | | | | | | | | | | |1801, to | | | | | | | | | | | |Ditto | | | | | | | | | | | | | | | | | | | | | 80th ditto | 496|Trincomalée|14th Feb.| —| 34| 2| 2| 8| 20| —| —| 2 | | |1801, to | | | | | | | | | | | |4th June,| | | | | | | | | | | |1802 | | | | | | | | | | | | | | | | | | | | | 86th ditto | 405|Bombay |3d April,| 23| 34| 4| 2|12| 14| 1| —| — | | |1802, | | | | | | | | | | | |to Ditto | | | | | | | | | | | | | | | | | | | | | 88th ditto | 466|Ditto |Ditto | 25| 40| 12| —|12| 6| —| 1| 8 | | |to 1st | | | | | | | | | | | |May, 1802| | | | | | | | | | | | | | | | | | | | | --------------+----+-----------+---------+---+---+---+---+--+---+--+--+--- |3759| | |117|309| 38| 18|64|148| 4| 2| 41 ==============+====+===========+=========+===+===+===+===+==+===+==+==+=== NATIVES OF INDIA. --------------+----+-----------+---------+---+---+---+---+--+---+--+--+--- The Honourable| 160|Calcutta |18th Nov.| —| 1| —| —| —| 1| —| —| — Company’s | | |1800, to | | | | | | | | | Horse- | | |4th June,| | | | | | | | | Artillery | | |1802 | | | | | | | | | | | | | | | | | | | | | Bengal ditto | 157|Ditto |28th Dec.| —| 4| —| —| 2| 2| —| —| — | | |1801, to | | | | | | | | | | | |ditto | | | | | | | | | | | | | | | | | | | | | Madras ditto | 197|Madras |Ditto to | 6| 22| —| 6| 1| 1| —| —| 14 | | |ditto | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Bombay ditto | 200|Bombay |4th | —| 40| 8| 2| 5| 14| —| —| 8 | | |March, | | | | | | | | | | | |1801, to | | | | | | | | | | | |ditto | | | | | | | | | | | | | | | | | | | | | Engineers | 38|Madras |28th Dec.| 2| 1| —| —| —| 1| —| —| — | | |1800, to | | | | | | | | | | | |ditto | | | | | | | | | | | | | | | | | | | | | Bengal | 658|Calcutta |.. Nov. | 6| 25| 6| 5| —| 9| 1| —| 3 Volunteer | | |1800, to | | | | | | | | | Battalion | | |ditto | | | | | | | | | | | | | | | | | | | | | 1st Bombay | 828|Bombay |4th | 15| 70| 28| 29| 1| 8| 1| —| 7 Regiment | | |March, | | | | | | | | | | | |1801, to | | | | | | | | | | | |ditto | | | | | | | | | | | | | | | | | | | | | 7th ditto | 708|Ditto |Ditto | 10|160| 69| 42| 1| 6| 1| —| 41 | | | | | | | | | | | | Pioneer | 96|Madras |28th Dec.| 2| 3| 1| 1| —| —| 1| —| — Corps | | |1800, to | | | | | | | | | | | |ditto | | | | | | | | | | | | | | | | | | | | | Departments | 419|Ditto |Ditto to | —| 25| 10| 2| 2| —| —| —| 7 | | |ditto | | | | | | | | | | | | | | | | | | | | | Public and | 666|Different |At | —| 40| 15| 5| —| 5| 2| —| 13 private | |Places |different| | | | | | | | | Followers | | |Periods | | | | | | | | | | | | | | | | | | | | | --------------+----+-----------+---------+---+---+---+---+--+---+--+--+--- Total of | | | | | | | | | | | | Natives |4127| | | 41|391|127| 92|12| 47| 6|— | 93 --------------+----+-----------+---------+---+---+---+---+--+---+--+--+--- Grand Total|7886| | |158|700|165|110|76|195|10| 2|134 ==============+====+===========+=========+===+===+===+===+==+===+==+==+===

NOTE.—The column “Diseases unknown” includes all the Casualties in the Army, and the Small Pox and other cases lost in the Julia hospital-ship. It includes likewise some deaths which happened in the Corps previously to the Surgeons taking charge of them.

Transcriber’s Note: The numbers in this table don’t always add up to the given totals, but they are as printed.