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15th. The bolus gave him several stools; the bubo, and the other symptoms, the same as yesterday. The ointment was again rubbed in, and the bolus repeated this day.
16th.-Eyes less dull; tongue clean and moist, with less of the chalky appearance; has had plentiful evacuations by stool; tu mour stationary. To continue the ointment.
B. Calom. gr. iij.
Pulv. Jacob. gr. v.
Cons. q. s. ft. bol. сар. h. S.
17th. Tumour seems less; tongue has lost the brown streak; he seems more cheerful; had a gentle moisture on the skin dur ing the night, and slept well. The bolus and the ungt. hydr. to be repeated.
18th. Tumour less, mouth sore, tongue nearly the natural appearance. The ointment was omitted, but the bolus continued several days longer. The mouth was kept tender with calom. gr. i. night and morning, until the 28th. He was discharged to his duty on the 2d July. He has continued in perfect health ever since.
10th July 1813.-ROBERT CLARK, aged about 24, spare habit, lively disposition. Had never been in the hospital in my re collection. Had mounted guard this morning, after a minute naked inspection, when not a suspicious spot was to be seen on his body or extremities. His feet and hands had been carefully washed. About noon, I was sent for to visit him, he having been taken suddenly lame while on sentry. On examining him, I found a small pimple in appearance between the large and the next toe of the right foot. The pain he declared to be excessive, and likened it to a burning coal. While inspecting it, I could discover rising from it a red streak, which speedily ascended up the inside of the leg, and very soon after a swelling took place in the inferior inguinal gland. He was immediately sent to the hospital. The foot was well washed in warm water, a cataplasm applied to it, and the whole of the inside of the leg was rubbed with ungt. hydr. without any regard to quantity, as long as he had strength to rub it in, and calom. and jalap. each gr. x. given him at the same time. On seeing him in the evening, the pain from the pimple was less, but still severe, with considerable pain in the groin. He had several stools. He seemed to have some fever, and apparent giddiness in the head, but did not complain of pain in it.
On visiting him in the morning, I found the pimple had now the appearance of a small ill-conditioned ulcer. It was again
cleansed, and the cataplasm applied. On washing away the ointment to look at the absorbent, I found it considerably enlarged; and, arming my finger with a little of the ungt. hydr. I traced it from the sore to the bubo. It no longer appeared charged with a red fluid, but had a yellowish look. The tumour was, at this time, the size of a pigeon's egg. The ointment was again used in the same way, and the bolus repeated. This method was continued until the mouth became very sore. The ulcer soon healed, and the bubo gradually disappeared. He went to his duty on the 25th of August, and has continued well. His description of the first attack was, that he was standing sentry on the top of the arch, through which was the only passage into the country; that a pest-cart had that instant passed through, heavily laden with dead bodies, from which proceeded a horrid smell; that the attack was instantaneous, as though he had been shot. I was instantly sent for, and was with him in three minutes, my quarters being near his post. My opinion was, that, from some defect in his shoe, some pest-dust had got in, and was the true cause of his complaint. He mounted guard at seven o'clock in the morning, and had to march half a mile from the barracks to his post.
I have often read, and been otherwise informed, that when the pest-tumour could be brought to suppurate, the result was frequently favourable. I had determined, if I found a tumour of this description that would not submit to the mercurial inunction, with the calomel purges, &c. to throw in the bark and wine largely.
Oct. 17th.-ALBERT ROSTOSKI, a Pole, aged 35, spare habit of body, dark complexion, was this day placed in observation, complaining of slight pain in the head and back; tongue clean and moist, but much of the chalky appearance; eyes heavy, but clear; bowels regular; spirits much depressed; a small tumour in the lower gland of the left thigh. He was immediately ordered the Cal. c. jalap. and
B. Cal. gr. iii.
Pulv. ant. gr. v. to be taken at bed-time; and to rub 31. ungt. hydr. along the course of the absorbents. 18th. Seems to have more fever; headach worse; more vivacity in the eyes; has had several stools; had no moisture on the skin; has more thirst; tongue much whiter. A blister was applied between the shoulders; the saline mixture given him frequently; the bolus and ungt. repeated in the evening; and an emollient cataplasm to the bubo.
19th. The bubo a little larger; slept a little in the night; VOL. XII. No. 45.
had some moisture on the surface; the blister rose well; seems to have less pain; tongue the same as yesterday. Ordered all the medicines to be continued.
20th.-Symptoms all nearly the same as yesterday; bubo stationary, with a little more pain; has had no stools the last 24 hours; mouth not in the least sore. The bolus Cal. c. jalap. was given instantly; and the bolus Cal. c. pulv. ant. and the ointment, to be repeated in the evening.
21st.-Nearly the same in every particular; bubo stationary, with considerable pain; has not had suflicient stools from the bolus. Ordered him Nat. vitr. 3i. On visiting him in the afternoon, found him considerably worse; great giddiness in the head, and apparent paralysis of every linib, but perfectly sensible, and answered correctly to all my questions. In attempting to go to the close-stool, which was within two yards of him, he had fallen several times, had cut his head, and bruised his arms and shoulders very severely. Dr Calvert (to whose recollection of this case I beg leave to refer) saw him in this state. I asked his opinion as to giving him bark and wine, as I had long made up my mind to try it in such a case. He said, he looked on the man as lost;' but desired me to try any thing I pleased to save him. I instantly ordered 3i. pulv. cinchon. to be taken every hour, and a pint best white wine to be taken during the evening, and Calom. gr. iii. Pulv. Jacob. gr. v. Opii pur. gr. iss. to be taken at bed-time. Dr Calvert ordered that he should be moved to the pest-hospital in the morning, if alive.
22d.-Infinitely better; slept well during the night, with a gentle and general moisture on the skin; the bubo less painful, and larger; has completely lost his vertigo, and apparent paralysis. When the sick-cart came for him in the morning, he insisted that the men that came with it should not touch him ; nor would he go into the cart, but declared he was able to walk, which he did up a very steep and rough hill, and down again, upwards of half a mile, to the boat, which conveyed him to the pest-hospital. I feel that, for the man and myself, it was very fortunate that Mr Cloak, a young man of great ability, and then first assistant-surgeon to this battalion, was on duty at the hospital at that time. "He knew my ideas of the disease, and my moce of treating this case. He was so kind as to continue the same plan. In a few days the bubo suppurated; he opened it, the man perfectly recovered, and has been in good health ever since.
It will probably be alleged against me, that I did not use the remedy in the last case with my usual boldness. My ans swer is, I was under critical inspection.
It is the duty of every practitioner, in writing on such a disease, to record his failures as well as his successes; and, if he has been guilty of inattention, to record that likewise, as a beacon to himself and others.
July 22d.-JOHN EVANS, aged about 30, spare habit of body, much addicted to liquor, always dirty and slovenly, for which reasons he was made a pioneer, to clean the barracks, carry burdens, go messages, &c. He was employed on this day to carry something to Boschetta, a distance of seven miles; he returned in the evening very drunk, with two black eyes, and several bruises about the arms and shoulders. I found him in this state the next morning, sleeping among his comrades of the same description. I immediately placed him in observation, gave him 3i. nat. vitriol., and inspected him morning and evening naked. Found no suspicious marks on the trunk or lower extremities. I gave him no other medicine.
25th. On this day, the steward of the hospital came to inform me, that this man had a total suppression of urine; that on his trying to pass it, on his hands and knees, he (the steward) saw, on the lumbar region, a tumour, small at first, but rapidly increasing in size as he was looking at it. I lost no time (the distance was half a mile) in going to him, and found him dead. The tumour appeared to me to be a carbuncle of the most malignant kind. I ought to have supposed that extreme debility would come on from the fatigue of his long journey under a summer sun. I ought to have known the debility that comes on after excessive drinking, perhaps spirituous liquors. I ought to have supposed he had been in contact with some pest person, it having, at this time, spread to every part of the island. In fact, I should not have waited to treat the disease, after it appeared in such a habit as his, there being not strength sufficient in the system to resist it one hour.
Oct. 20th.-EDWARD TRAYNOR, aged about 27, stout, well made; had never been sick in my remembrance; was placed in observation this day. I was informed that he had slept on the battery, exposed to the night dews, two nights, with a common woman. He complains of severe headach, thirst, nausea, pain in the back; tongue whitish, and dry. This was not supposed to be a case of plague, as the imprudence of his conduct was sufficient to account for all the symptoms. I ordered him immediately into a warm bath, and to take an emetic while in it; a
blister between his shoulders, and Pulv. antim. gr. vi. Opii gr. i. to be taken at bed-time; mist. salin. very frequently; the bolus Cal. c. jalap. in the morning.
21st, Sunrise. Considerably worse; considerable wildness in the eyes, and slight inflammation, vertigo, and slight delirium ; tongue much whiter. Saw him again twelve o'clock. The bolus had not operated to my satisfaction. Gave him 3i. natron. vitr, ; saw him again in the evening, and found a tumour in the usual, place in the groin. The bolus was repeated in the evening, and 3ii. ungt. hydr. rubbed as usual. The next morning he was much worse. Sent him to the pest-hospital; he died in the evening. 22d. The woman was sent into quarantine, but never betrayed the smallest symptom of the complaint.
I was informed that a man-servant of Captain Chilcott, R. N. passed a night in a house of ill fame. In a very short time after, a bubo appeared in the inferior gland of the groin, which, on inspection, was found to be plague. He was sent to the hospital, and died very soon after. I understand that this man did the usual duty of the house, and actually nursed one of the children a short time before he was sent to the hospital. The inspector of hospitals informed me, that a young lady in his neighbourhood married during the plague, and died soon after, and no other of the family. Some time early in October, a serjeant of the 14th regiment, who acted as blacksmith to the officers of the garrison, had his forge in Floriana, and had one of our men to assist him. The serjeant being a very useful man, and excused all other du ty, was allowed to live as he pleased, and to go when and where he pleased. He was very fond of liquor and women. It is known he frequently went into Valletta, on pretences of business, and probably went into improper houses. He applied to a surgeon for relief for a tumour in the groin. It was examined, and supposed to be venereal, and intended to be treated as such, the man having no other apparent complaint at the time. On his being visited next morning, his case was found to be plague. He died the same evening. When inspected in the morning, the man belonging to our battalion was sleeping in the same bed with him. On examining the dead body, it was found to be a case of the most malignant kind, with large broad livid spots, and numberless petechiae all over the trunk and thighs. As there was no doubt that our man had been in close contact with him, as they had constantly slept together, handled the same working tools, eating and drinking together, on placing him in observation, I was determined not to wait for the appearance of the symptoms, but try if I could prevent it. He was several times purged with calomel, and took small