Donald Monro

“ When once this Fever begins, it is observed to be of a contagious Nature, and (if proper Care is not taken) to affect those who attend the Sick, or who live in the same Room, and breathe the same Air with them.
Many Authors have reckoned the Malignant, Petechial, and Pestilential, to be distinct Species of Fevers; and have treated each of them under a particular Head. But Riverius [27] has very justly observed, that they all belong to the same pestilential Tribe, and only differ from one another in the Degree of Infection, [56] and the Violence of the Symptoms [28] ”

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

“ As the Disorder was for the most part attended with Sickness in the Beginning, we gave a Vomit after bleeding; which not only discharged the Contents of the Stomach, and a Quantity of Bile, but relieved the Sickness, and frequently threw the Patient into a breathing Sweat; and made the Purgatives which were given next Day operate more freely, and with more evident good Effects than where no Vomit had been administered.—If in the Course of the Disease the Sickness returned, the Emetic was repeated ”

“ SCURVY. The true Scurvy, attended with spungy fetid Gums of a livid Colour, with livid Blotches, and Ulcers of the Legs, and other Symptoms, began to shew itself at Bremen in January 1762; tho’ we had not the least Appearance of this Disorder in the Hospitals at any other Place, while I was with the Troops in Germany.
A great Variety of Disorders have been called by the Name of Scurvy: and the Disease has been divided into hot and cold ”

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

“ Most Practitioners of late Years have been against Bleeding in this Stage of the Disorder; but trusting to the Assurances given by Dr. Hasenohrl of its being safe, nay of Advantage to bleed at this Time, if the Symptoms required it, I ventured upon it, and found it to be of the greatest Service, in many Cases, in the Hospitals at Paderborn and elsewhere; and particularly in two Cases at Bremen, and one at Osnabruck, where it gave immediate Relief, and seemed to shorten the Disease much. One of the Patients at Bremen, Robert Ellis, belonged to an Independant Company ”

“ A Quantity of Beer, Cyder, or Wine, ought to be put aboard, and a certain Allowance distributed to each Man daily. When, for Want of these, Men are reduced to an Allowance of Spirits, they ought to be mixed with seven or eight Times the Quantity of Water, or [328] made into Punch, by the Mixture of Water and Molosses, and the Juice of Lemons, before they are given to the Men; and, if Lemons cannot be got, Cream of Tartar, or Vinegar, ought to supply their Place; and it ought to be a Duty of one of the military Officers on board to see the Punch made, and distributed among the Men daily. ”

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

“ When the Weather was good, we made the Patients walk out a little in the Day-Time; for we observed, that remaining always in the Hospital, and breathing nothing but a foul Air, helped to encrease the Disorder.—When we knew the Men to be sober, and not apt to commit Irregularities, we used to procure them good Billets, and make them come daily to the Hospital for their Medicines. ”

“ In this View, and in those above-mentioned, I cannot but recommend a generous red Wine as a most noble, natural sub-astringent Cordial, and perhaps Art can scarce supply a better. Of this I am confident, that sometimes at the State, and more frequently in the Decline of putrid Malignant Fevers, it is of the highest Service, especially when acidulated with Juice of Seville Orange or Lemon. It may be also impregnated with some Aromatics, as Cinnamon, Seville Orange Rhind, red Roses, or the like, as may be indicated, and a few Drops of Elix. ”

“ Every Recruit sent from England to the Army in Germany, cost the Government at least twenty Guineas before he joined his Regiment; and every sick Man sent to the general Hospital, cost the Government at least sixteen Pence per Day, which is ten Pence above his Pay; so that, if we suppose the extraordinary Cloathing here mentioned would preserve only the Lives of nine Men to each Regiment yearly, and keep forty in Health who would otherwise be sick, we see what great Gainers the Government will be in Point of Money at the Year’s End; besides preserving the Lives and Health of so many Men. ”

“ When Men were taken ill of a Fever, which we suspected to be of the malignant kind, our first Care was to lay them in airy Places, separate as much as possible from the other Men, and to keep them extremely clean; and they were put on low Diet, and allowed as much Barley or Rice-water as they chose to drink, which was commonly ordered to be acidulated with the Spiritus Vitrioli. ”

“ Most of the recent Fluxes, which I saw, were at first attended with a good deal of Fever, and Pain in the Bowels; and required more or less Blood to be taken away, according to the Strength of the Patient, and the Violence of the Symptoms.
When the Patients were strong, and complained of sharp Pain of the Bowels, attended with a Fever, we used the Lancet freely, nor were we discouraged from bleeding in the Beginning by the low quick Pulse which often attended the Disorder; and we frequently found the Pulse rise as the Blood flowed from the Vein. ”

“ As the Service often makes it necessary at Military Hospitals, where the Number of Sick is great, to employ the convalescent Soldiers [163] [406] as orderly Men and Servants about Hospitals, all Men thus employed ought to have a special Leave from the Military Inspector for so doing; and no Man should be employed in any Capacity as a Servant about an Hospital, who at that Time is on the Books as a Patient. ”

“ For in Times of Service, very often a sufficient Number of military Officers cannot be spared to be on Duty at the different Military Hospitals; and at all such Places the Convalescents are generally very disorderly, when they know that there is not a sufficient Number of Officers to form a Court-Martial for punishing them. Where-ever [403] there are a sufficient Number of military Officers, no physical Officer ought ever to be called upon as a Member of a Court-Martial. ”

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

“ At first, on observing them, I suspected them to be venereal; but on examining the Patients, they obstinately denied their having any Reason to suspect any such Cause; and the favourable Manner in which they healed without the Appearance of any other venereal Symptom, made me believe what they asserted to be true; especially as such People are not shy in owning Complaints of that Kind. The first Patient I saw who had a Bubo in the Decline of one of these Malignant Fevers, was a Woman, Wife to a Soldier of the thirty-seventh Regiment of Foot ”

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

“ This Fever is reckoned the endemic Distemper of the West Indies, of the Coast of Guinea, and other Places in the Torrid Zone; but in those warm Countries it appears in a more violent Degree; makes a much more rapid Progress; and proves far more fatal than in our cooler and more temperate Climate. And it is observed to be always most frequent and most fatal where a Country is covered with Wood, or is marshy; and where there are frequent Fogs, and much stagnating Water, which corrupts by the Heat of Summer.
In January, February, and March 1761, we had none of those Remitting Fevers at Paderborn. ”

“ Riverius tells us, that, according to Hippocrates’s Doctrine, Deafness is a very dangerous Symptom in the Beginning of acute Disorders, though it be a good Omen, and portends Health, when it does not appear till the Height of Fevers, especially those of a malignant Kind; and adds, that he himself has a thousand Times observed, that those labouring under this Fever have recovered, when this Symptom of Deafness came on at the Height (in statu) though the other Symptoms threatened much Danger. ”

“ At all Times it was necessary, when the Cough was violent, attended with Pains of the Breast, to keep the Patients on low Diet; and in as free and pure Air as the Nature of the Hospitals would admit of; for we often found that those Men who had laboured long under obstinate Coughs, which threatened Consumptions in small crowded Wards, recovered surprisingly on being removed to a freer Air; of which we had a remarkable Instance in the Hospital at Bremen, in January 1762 ”

“ Nature of the common Inflammatory Fever, the Blood being very sizy; but as the Season advanced, the Remissions became more evident, and the Paroxysms more like those of an Ague; and the Blood less sizy, tho’ at all Seasons of the Year it had some Appearance of an inflammatory Buff in this Disorder. The Sick were restless and uneasy at Night; but commonly felt themselves cooler and lighter in the Day-Time: and although they had no cold Fit, as the Fever came on at Nights, and many of them no Breathing Sweat, as they became cooler and freer from the Fever in the Morning ”

“ Tough, one of the Apothecaries to the British military Hospital in the late War, then a Mate to a marching Regiment, was ordered to go down the Rhine with a Party of Sick, who had the Seeds of the Hospital Fever among them, and were to go in Bilanders, from Germany to Flanders. Having had a Cask or two of Brandy put aboard as Part of the Stores for the Sick, he was afraid lest the Men should make too free with the Spirits; to prevent which he threw in a Quantity of Bark into each Cask, and gave the Men regularly, Morning and Evening, a Glass of this bitter Tincture. ”

“ Some of the Soldiers, who had repeated Hospital Fevers, had their Blood so much broke down, as to be subject to profuse Hæmorrhages from the Nose; and some of them passed Blood likewise by Stool; which reduced them to a very low State, sometimes attended with imminent Danger. In such Cases we found nothing to answer so well as to give freely of the Bark; to acidulate their Drinks with the spiritus vitrioli; to allow them as much Red Wine as the Strength and present Circumstances could bear; and at the same Time to support the Patient’s Strength by a mild Diet, of light Digestion ”

“ Many of the Regiments in Germany made the People in whose Houses their Men were quartered, take down their Stoves, and use only open Fires; when there was no Danger of the Soldiers making their Quarters too warm, as Wood was difficult to be got.
But although close Stoves are prejudicial in small Rooms, yet when a Town is much crowded, and Men are obliged to be lodged, in Winter, in large Barns or Churches, or other large open Places, the German Stoves may be used with great Advantage in airing and drying such Places, and keeping them of a moderate Heat ”

“ Small Beer is a good Drink where it can be easily procured; as is Wine and Water, or a very small Negus, or very weak Punch in warm Climates.
Besides this Diet, extraordinary Indulgences may be occasionally allowed to particular Patients, as Wine, Brandy, Sugar, Milk. And the Physicians and Surgeons ought to have a discretionary Power to order a Vegetable or any other proper Diet for Patients in the Scurvy, or any other particular Complaints.
The Established Diet of a Military Hospital [377] may be,
The daily Allowance of Bread to be one Pound to each Man. ”