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cessfully, contrary to the opinions of the medical officers, and others who knew him, I take the liberty of giving an outline of it. He was seized suddenly with the common symptoms, as cold shiverings, violent pain of the head, loins, and calves of the legs; great pain and redness of the eyes, dimness of sight, vomiting, hot dry skin, coated tongue, and quick strong pulse. I took away immediately forty ounces of blood. After the loss of twenty ounces, he expressed great relief, and begged of me to continue it, wbich I did till the above quantity was abstracted. His head became instantly relieved; he could see distinctly, and his pulse, from 125, was reduced to 90. I ordered him a strong purgative of cal mel and jalap, and cold water, with vinegar, to be applied to his forehead. Four hours afterwards I visited him again. Found that his head was entirely relieved, but some pains of the loins and calves of the legs remaining. He had had some sleep, his skin was moist, bis bowels were moved, and his pulse nearly natural. He was directed to take three grains of calomel every three or four hours, and on the fifth day he was perfectly recovered. Mrs Pringle, who was constantly with him, escaped, as did the children.
Seeing, from the above case, that bleeding and the depleting system was attended with beneficial effects, instead of bringing on extreme debility and certain dissolution, as I was told it would, I was induced to try the same system with the next patient I might be called to, which was an officer of the Royal Engineers. I found him labouring under the symptoms of the prevailing fever, complaining of an extreme pain of the head, Toins, and the calves of his legs; pain and redness of the eyes, dimness of sight, hot skin, quick pulse, and bilious vomiting, I opened a vein in the arm, and drew away thirty-six ounces of blood. His head was immediately relieved, as were his eyes, loins, and legs; and his pulse, which was 120 before bleeding, was reduced to 92. The same treatment was adopted as with Mr Pringle, and in a few days he was recovered. Four others of the officers of Engineers were ill with the fever in 1813; threc of them I bled largely, and all in a few days recovered; but the other, Captain C, I did not bleed; his attack was slight, and gradually ran into that insidious form which has too often deceived me. He was extremely ill for several days, and suffered the most severe gastric symptoms I ever witnessed. The vomiting was so distressing and frequent, that nothing for three days would remain on the stomach. He had occasionally hiccough, which lasted some hours, extreme anxiety and restlessness, a dry coated tongue, great thirst, a small quick pulse, delirium, and a yellow suffusion all over the body. Had I taken blood from him at the attack, although the symptoms were not violent, I have no doubt, by similar cases which I witnessed in 1814, that I should have spared him all the agonies he suffered. Three servants to officers of Engineers, and several men in the ordnance department, were bled by me, and all of them in three or four days recovered. The master cooper of that department I ventured to bleed sonie hours after the attack. He was taken suddenly ill with every symptom of the disease, and would not be convinced for some hours that he had the fever, till his head became so violently painful, that he could not bear it moved, and his eyes looked red. I was then desired to see him. I found him complaining of severe pain of his head, pain of loins, and calves of the legs ; eyes suffused, flushed countenance, hot skin, quick pulse, dry coated tonguc, and bilious vomitings. I bled him to forty ounces, and he expressed, directly afterwards, that his head was entirely relieved ; that he could see objects distinctly, and that he felt considerably better. Purgatives were given ; cold applications of vinegar and water were directed to be applied to his head; and on the fifth day he was well enough to resume his duty. His wife and attendants remained free from the disease.
Many other cases I could adduce of persons who were bled and recovered; not one died whom I had the sole charge of, that lost blood; but I imagine that these alone will be sufficiently illustrative, that bleeding has not the effect of causing that extreme debility which it is said to have in this disease. Instead of producing debility, or deleterious effects, it is the very measure that prevents these happening. The debility that we find arises from the increased vascular action not being reduced. The heart labours exceedingly, and, if the volume of blood is not lessened, it continues to beat till absolute exhaustion ensues, or the destruction of some important viscus essential to life. The disease must then take its course; incessant vomiting comes on, terminating in the black vomit, delirium, suppression of urine, hiccough, small indistinct pulse, and the whole train of mortal symptoms. Wine, bark, opium, brandy, æther, and all the stimulants, we know to have but little effect when the disease is allowed to arrive at this advanced stage, from active measures not having been employed at its commencement.
Many have been saved without losing blood, but, generally speaking, the attacks were slight, and quietude, with a little medicine, and the great aid of nature, which alone will frequently accomplish cures, would be sufficient to restore them again to health, but the medical attendant is too often deceived in
these called slight cases. At first, the patient does not suffer much; he complains but of little pain of the head, loins, or calves of the legs; the eyes are but slightly suffused, and, in moving them, not much pain is excited; the skin has not that burning feel, and is sometimes moist ; the pulse not full, or much accelerated; tongue triflingly coated, and vomiting not
If these symptoms do not increase, the case is indeed slight, and purgative medicines, cold affusion, confinement to bed, and the starving system, will frequently effect the cure. But in a few hours these symptoms commonly increase, and on the third day the stomach becomes irritable; the pain of the head and loins much increased ; the patient complains of difficulty of making water, and when passed it is high-coloured and scanty; the countenance assumes a most expressive and anxious cast, and the patient becomes extremely uneasy and restless; the head, breast, and upper extremities, slightly tinged with yellow; pulse about 120; tongue dry and conted ; ard great thirst. On the fourth day the patient is delirious ; he has frequent vomitings, and the contents thrown up are slimy, and similar to the grounds of coffee ; a suppression of urine; the whole body suffused ; a small vibrating sort of pulse; the mouth parched, with sordes adhering to the teeth, gums, and lips ; a severe and constant pain at the pit of the stomach; and, in a few hours, the scene of life is closed. This is the insidious form of this destructive disease. We ought not, therefore, to consider it as a slight attack exactly, and place our dependence in purgatives, the cold affusion, diuretics, &c. for a cure, which is now and then effected by them where the symptoms do not exceed what I have above mentioned ; but if, in five or six hours after the attack, there is an increase of pain, the eyes more suffused, and the pulse more frequent ; if, instead of 90, it is 100, or exceeding that, blood-letting should immediately be bad recourse to. By this measure we are acting on the safe side, as we find the head relieved, the dimness of sight removed, and the heart, which was beating forcibly, lowered to nearly its natural action; the patient after this falls asleep, and generally perspires freely.
In witnessing this disease again in 1814, I was fully convinced of the utility of observing closely the insidious form of attack, and of bleeding instantly upon the increase of symptoms ; it, in every case, arrested the progress of the disease, and saved the patient. On the contrary, where the lancet has not been used, medicine and its auxiliaries have rarely had the same effect, and death has been too frequently the consequence.
What has been said will probably not be sufficiently convincing to those who were, and still are, averse to blood-letting in this disease; but I should hope, that, when I am able to assert that every patient but one labouring under this fever in 1814, who was bled by me, and under my own immediate charge, recovered, it will be acknowledged to have some weight in favour of bleeding; the one who died, it is necessary to remark, had been suffering some time from visceral obstructions.
It is now pretty well established as a fact, that the fever is local, not imported, or propagated by contagion ; that all the regulations of quarantine, and other precautionary measures, have had but little effect in either preventing or lessening the ravages of the disease ; that the fever is alone influenced by the season of the year, and gradually lessens in severity as the cold weather, with wind and heavy rain, succeed to the autumnal heat; and that the only measure found decidedly efficacious, has been the removal of the people from the western side of the rock, that is to say, from the range of action of the local causes.
As I have endeavoured to inculcate the necessity of evacuating blood in the early stage of this disease, and of the depleting instead of the stimulating system, it may be deemed necessary to describe the appearances which I usually observed on dissection after death. They were as follows:
The body externally of a pale yellow colour, and very offensive.
On removing the skull-cap, the dura mater extremely vascular, and turgid, as was the surface of the brain. Cutting into the substance of the cerebrum, the vessels much injected, and the cut surfaces soon became covered with blood, and, in some instances, three or four ounces of serum have been found in the basis of the cranium. On opening the abdomen, most of the viscera in the cavity inflamed, the vessels of the omentum, mesentery, large and small intestines, very turgid. The stomach contained a quantity of a dark or black slimy fluid, adhering closely to the internal coat, which was red, and also inflamed, The kidneys generally of a livid cast, and, when cut into, there was in some an unusual quantity of a purplish-coloured fluid, The urinary bladder sometimes found to contain two, three, and four ounces, and, in other instances, scarcely any water.
Gibraltar, 31st July 1813.
Proofs of the Bulam Fever attacking the Human Frame only
once. By W. Pym, M. D. Inspector of Hospitals. In my observations upon Bulam Fever, page 122, I have
mentioned that all the officers and men quartered in Gibraltar during the prevalence of the fever in 1809, who had had it at a former period in the West Indies, escaped it.
And, at page 27, that, out of the whole civil population of the garrison (amounting to nearly 14,000), only 28 persons cscaped an attack of it; and of this small number 12 had had it at a former period, either in America, in Spain, or in the West Indies.
At Gibraltar, during the prevalence of the disease, in the years 1810, 1813, and 1814, there was no well-authenticated instance of a second attack; every person escaped it who had had it at any former period. And this fact is now so well established there, that, among the quarantine regulations against the introduction of the disease this year (1815), all the troops who have not passed the disease are encamped, while those who have passed it are doing the duty of the town.
At Cadiz, Carthagena, and Malaga, the fact of persons not þeing liable to a second attack of this disease is considered to be as firmly established as it is in small.pox.
The following circumstantial evidence respecting the malady at Gibraltar in 1804, establishes the fact beyond a doubt. In the corps of Royal Artillery, there were only two officers who escaped an attack of it, viz. General Smith and Captain Campbell, both of whom had had it some time before in the West Indies.
In the corps of Royal Engineers, there was only one officer, viz. Captain Thackery, who had had it in the West Indies; and he was the only one who escaped it, excepting Colonel Fyers, who kept himself and family in quarantine.
In the 2d, or Queen's Regiment, there were five officers, viz. Colonel Jones, Major Kingsbury, Captain Walsh, Paymaster Wainwright, and Assistant-Surgeon Borlase, who had had it in the West Indies, and all escaped it, when every other officer in the regiment was attacked by it.
In the 10th Regiment, every officer was attacked by it, excepting Captain Carpenter, who had had it in the West Indies.
In the 13th Regiment, there were seven officers, viz. Lieu