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PRINTED FOR RICHARD PHILLIPS, No. 7, BRIDGE-STREET,

BLACKFRIARS.

BY E, HEMSTED, GREAT NEW STREBT, FETTER LANG.

[Entered at Stationers Hall.]

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GENTLEMEN, THE first of the sick arrived at Ipswich on the 10th of September, 1809, several of whom were found, when removed from the waggons, in a comatose stupid state, in which they continued till death. The greater number, however, were afflicted with intermittents and remittents of irre, gular and anomalous types, often united with pulmonic and bowel complaints. Almost every week, and sometimes daily, men were brought to the Hospitals and Barrack rooms, the latter of which were now converted into Wards, for the conyenience of the sick. The number increased to between five and six hundred. Those who recovered were always discharged, as soon as possible, to provide for the worst cases among the fresh arrivals.

of the intermittents, which were the chief and original complaints, very few died affected with this disease alone. When they terminated fatally the disorder, some days pre. vious to death, first changed into a continued fever, and afterwards assumed the typhoid type, with great pain of the head, anorexia, tongue covered with a brown crust, low mutterings and delirium. When reduced to this state, few escaped. Those who recovered relapsed so frequently, that . many were discharged and re-admitted in the course of the same week. This return appeared after the slightest change of weather or exposure to cold, many falling down while on parade, and others during the time they stood on guard. To avoid this as much as possible, all those who were discharged from the hospital were placed in convalescent barracks, and excused every kind of duty for several weeks, and (No. 143.)

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when thus seasoned were discharged. The relapses, how: ever, were found to be as numerous among these convalescents, as among those who were at duty; and it was rea marked, that the men who had recovered in Walcheren were less liable to relapses than the others who recovered at home. Perhaps this may be accounted for, by the duration of the disease inducing greater debility. In fact, the men continued in such a weak, languid state till the beginning of June 1810, that few were able to bear the least excitement of whatever kind, without causing relapses. These returns of the disease were also frequently united with pulmonic complaints, which increasing soon terminated fatally. In these critical cases all the efforts of the medical practitioner were too often of no avail, for while he endeavoured to evade Scylla, he was sure to fall on Charybdis.

The time this disease lay latent in some habits, who were not affected with it while in Holland, appears a curious fact; several being attacked with different species of intermittents after they had been home seven or eight months. Many officers as well as privates were thus attacked at different subsequent periods. · As an example of the extent to which this malignant endemic proceeded, I need only mention, that out of one battalion consisting of about seven hundred men, only 21 escaped its attack, and about an hundred of the others fell its victims. .

About the middle of October a great many were attacked with hydropic complaints, so that one third almost of the patients who laboured under the different forms of intermittents became dropsical. At first hydrothorax and universal anasarca often suddenly appeared, which increased by the violence of the paroxysms of ague, frequently terninated fatally during the exacerbation. I was present at three of these afflicting scenes, even conversing with my patient a few minutes before his erit, which was so unexpected, that I saw one rise out of bed and place himself on the close stool, where he expired in a few seconds. Another robust, athletic man was seized with a violent paroxysm of ague, when his respiration became so difficult and hurried, that he was obliged to sit lip in bed to assist his breathing. His thirst was insatiable. He spoke frequently, and said he should die ; and with these words he leaned himself backwards and immedi.. ately expired: Being present I took hold of his hand, when I felt the pulse beat, which continued its pulsations for near two minutes after respiration and other vital appearances ceased. This man had no other external appearance of dropsy than that of a slight tumefaction about his ancles. , On cx

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amining the body a large quantity of water was found in the thorax, and near six ounces in the pericardium. The abdomen also contained some serous fluid.

The third case was a man who had just arrived, and who appeared so well that he was sent to the convalescent Wards where I saw him, at which time no hydropic complaint appeared. An universal anasarca attacked him so quickly that he died a few hours after. On viewing the body the skin seemed so distended on every part, that it was ready to burst, and a general exudation had commenced, especially on the scrotum and thighs.

These dropsical affections had now become so prevalent, that it was a general rule particularly to examine the patient concerning then..

Some time afterwards Dysenteria appeared, and the sick increasing, it very soon became a frequent and fatal malady. The disease was, in general, preceded by a diarrhæa. The sick labouring under the greatest debility from the length of time they had been afflicted, and froin the immense quantities of bark and other medicines administered, among which purgatives held a principal station, it will not be difficult to conceive what must be the consequence. The bowels thus repeatedly harassed and irritated with these inedicines, gradually lost their tone, when diarrhæa was produced ; and as the intermittents often did not even then subside, it was kept * up by the continued exhibition of the remedies for the origi. nal complaint.

When therefore the purging was not checked by proper remedies, it soon degenerated into a dysentery, which was peculiarly distinguished by that most harassing symptom tenesmus, accompanied with bloody mucous stools, and continued pain of the hypogastric region; for the support of which flannel rollers were constantly used, and found highly beneficial. This diseasc being often combined with others was seldom without fever. Many died soon after its appearance, so that some medical men concluded that no man who was attacked with it would recover. This conclusion, however, proved to be falsc. Several languished for many weeks, till they became so emaciated as to appear nothing more than skin and bones (to use the vulgar phrase) and at length recovered. When it appeared in this chronic state, the patient's appetite remained good till death, which generally snatched him off during his slumbers.

* Boerhaave mentions tbis disease as frequently occurring in Holland, para ticularly among robust people, to whom, after much muscular action, culd and inactivity suoi succeed.

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