Klicka här för att ange Titel British, medical practitioners’ perspectives on dysentery 1740-1800
------Filip Hellström
------Filip Hellström
Master Thesis in History 45 Hp Author: Filip Hellström Advisor: Professor Margaret Hunt Seminar leader: Associate professor Björn Furuhagen Ventilation date: 2020 10 16
HISTORISKA INSTITUTIONEN
Preface
This master thesis, examines the disease of dysentery and the threat to human health that the disease posed historically through the descriptions of mainly British medical practitioners such as physicians and surgeons. It focuses on the second half of the eighteenth century. This kind of study gives perspective on how people actively participated and reacted to diseases. This was a time, when disease played a very intrusive role in people’s lives. Studying descriptions of medical practitioners such as physicians and surgeons provides knowledge about changes in the views and practices related to an important killer disease. The process of my studies have been amazing and taught me not only about the social- historical and social developmental topic, but also about scientific methods and theories as well. In the realization of this dissertation I have had appreciated support from my scientific advisor professor Margaret Hunt. I thank you for that support. I would also like to warmly thank my family for the support they have given me in different ways. It has been an important period of my life!
Filip Hellström Autumn term 2020 Uppsala University, Sweden Department of History
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Abstract
This master thesis aims to show how a qualitative approach to early modern medical practitioners’ perspectives can provide a basis for a better understanding of the disease of dysentery. The focus is on: 1) How the disease of dysentery was described and how the challenge of dysentery was perceived. 2) What individual measure and commitments were taken for the patients and why. 3) How the cause of the disease was understood and explained. 4) How perspectives differed between physicians and surgeons. Of particular interest when it comes to the disease of dysentery is how the disease and its cause were perceived. Eleven texts written by mainly British medical practitioners from primary sources such as reports, logbooks and letters on dysentery written during the years 1740 - 1800 have been used for close readings and a qualitative analysis was performed on the collected data. The analysis showed (i) that medical practitioners expressed considerable interest in dysentery and in trying to understand it as a great suffering for individuals, for society and for humanity as a whole. (ii) Medical practitioners took treatment measures based on how they understood the cause of the disease outbreak. Either the dysentery was referred to internal causes, as sickness in organs, especially the organs that produced bodily fluids, or it was referred to external causes, as a sickness caused by heat, cold, weather, winds, air, climate, seasons, lunar position, etc. (iii) The cause of the disease was understood and explained both as an infection and as a pre-disposition for imbalances in body fluids. (iv) Both physicians and surgeons understood that the disease of dysentery was a global phenomenon and that the disease often was connected to the climate and weather. This standpoint was based on the fact that dysentery distinguished itself as an autumnal disease. Its eruption usually began with a few scattered cases in July, then increased in August and culminated in September. Theories about the disease, its causes and treatment did not differ significantly between physicians and surgeons. However, the views of different physicians did differ. The thematic map of understanding related to disease of dysentery, shows that medical practitioners’ knowledge, theories and ideas behind the medical practice of dysentery, have an ambiguity in the view of both the dysentery and the treatment of it. This was probably due to interpretation based both on observable causes of diseases, and on a more theoretical abstract meaning, where diseases to a greater extent was understood on the basis of symptoms and signs. It is suggested that regardless of the knowledge base of the individual medical practitioner, no one represented an independent knowledge base for their treatment of dysentery; rather they participated actively with each other in a mutually constitutive way in order to shape their understanding of the dysentery. This theses’ qualitative approach, allows dysentery patients and their medical practitioners via the texts of the medical practitioners, to offer very personal accounts of a highly contagious disease.
Key words: British, Medical practitioners, Dysentery, Physicians, Surgeons, Early modern period, Medical knowledge. 2
Contents
Preface ...... 1 Abstract ...... 2
List of tables and figures ...... 5 Abbreviations ...... 5
Chapter one ...... 6 Introduction ...... 6 The disease dysentery as a threat to health and life ...... 7 Medical practitioners ...... 8 Physicians and surgeons ...... 9 Problem ...... 10 Research Questions ...... 10
Method and Theoretical framework ...... 11 Procedure for selection of the sources ...... 12 The outcome of the text search ...... 13 Presentation of the primary sources ...... 14 Ethical, credibility and validity aspects ...... 16
Chapter two……………………………………………………………………… 15 The topic of Dysentery……………………………………………………….. 15
Previous Research ...... 17 Previous research about understanding of Dysentery as a Contagious Disease in Demographical Terms from 1640-1770 in Sweden ...... 19 Previous research about dysentery and actions against it related to cause and impact ...... 19 Previous research about challenges from dysentery and actions against it related to impact and suffering ...... 21 Previous research about dysentery in relation to other life threatening diseases ...... 22 Summary of previous research ...... 25
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Chapter three…………………………………………………………………… 26
Results ...... 26
Medical practitioners’ contextual setting – the background to perspective on understanding and measures in praxis…………………………………….. 26
Summary of the background as a basis for the interpretation of what is being said by the medical practitioners ...... 37
Medical practitioners understanding, experiences and praxis – the figure ...... 39 Dysentery and suffering ...... 39 A contagious disease ...... 41 Charting the causes and spread of civilian outbreaks ...... 42 Climate and weather as an explanation for the occurrence of dysentery ...... 44 Definitions of the disease ...... 47 In pursuit of new knowledge about dysentery ...... 48 Cure and treatment ...... 52 Summary ...... 54
Conclusion……………………………………………………………………..55
Sources and list of literature…………………………………………………..59
Printed primary sources ...... 59 Literature ...... 60 Appendix 1. Table 2. Medical practitioners’ understanding of dysentery and actions against it.63
Appendix 2. Table 3. Characteristics of the data material (n = 11)…………………………...64
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List of tables and figures
Table 1 Presentation of the data material (n = 11). Table 2 The findings presented as categories and subcategories. Table 3 Characteristics of the data material (n = 11).
Figure1 The flow of texts from search to inclusion Data and analysis
Abbreviations
URL Uniform Resource Locator EEBO Early English books online ECCO Eighteenth Century Collection Online Dr. Doctor RCP Royal College of Physicians M.D. Doctor of medicine (a person who holds a doctorate in medicine)
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Chapter one
Introduction
Medical theory can tell us much about ideas, beliefs and prejudices of the society in which it was born.1 Dysentery as an infectious disease has proven a virtual rich source for historians who have successfully proven its relationship to larger themes such as poverty, mortality and lack of food, poor hygiene and bad sanitary conditions, etc. There also exists a rich historiography on early modern theories of disease and treatment. However, it often overlooks important relations to the individual understanding and experience -a phenomenon of increasing significance.2 Scholars have furthermore shown that illness often was attributed to the imbalance of the body’s ‘humours’, and medicine was designed to correct these humors.3 Such insights are valuable, but they do not constitute a comprehensive picture of early modern understanding of how the treating medical practitioners themselves thought about underlying reasons to the disease or what their ideas were about the cause, symptoms and treatment of dysentery. Was dysentery seen as a serous pathological condition? Who treated dysentery and how did they think about the illness? Presumably, even at this time, it was the physicians' duty to apply best practice in treatment in relation to their understanding of dysentery as a disease and how it would be mastered, - at best, even cured. The answers to these questions reveal surprising discontinuities between perceptions about the disease of dysentery and its lived reality. By exposing these perceptions and investigating the understanding, knowledge, theoretical standpoints and ideas behind the medical practice of dysentery, this thesis further develops our view of the medical and social historical life, - in this thesis from the perspective of the medical practitioners themselves. This thesis is based on material from British medical practitioners, but some aspects of their understanding of dysentery and the context are compared in some matters with examples from Sweden as well as being compared with others conditions. The concept of knowledge and understanding therefore has a central position in this thesis. Although eighteenth century medical practitioners often lacked knowledge of the causes of the dysentery, I argue that they still developed medical theories and ideas for their work by drawing upon all avenues of knowledge, - mainly from their own practice-based knowledge. In this way they improved in some fields of knowledge and remain more or less stationary in others.
1 Heather 1979. 2 Jacobsen 2011. 3 Newton 2018. 6
Why study the individual medical practitioners’ experience and understanding of dysentery in early modern times? One important reason is that the early modern period looked so different from today’s world, and one of the main differences lies in understandings of the mechanisms through which dysentery was cured4. In the early modern time in general, diseases were believed to be removed by combined efforts of three agents: God, Nature, and the practitioner.5 One question this thesis addresses is whether this was really what the practitioners thought?
The disease dysentery as a threat to health and life
Let us now turn to some early modern challenges to health and life. As mentioned, a disease that was a great challenge to human health and welfare during the period was dysentery. That is for example apparent from the following quote by one Scottish naval surgeon James Lind (1716 – 1794), when describing the connection between hot climate and fluxes. He estimated that: It is now a well-known and most certain truth, that of such Europeans as have fallen victims to the intemperature of foreign climates, nineteen in twenty have been cut off by fevers and fluxes; these being the prevailing and fatal diseases in unhealthy counties through all parts of the world6.
Being a sailor or a soldier aboard a warship at that time also came with a high risk of becoming ill and even die7. The former English surgeon-general in Jamaica, Benjamin Mosely (1742-1819) wrote in his Treatise of tropical diseases, during the American War of Independence that: …Dysentery was a subject, in which the welfare of mankind is deeply interested, and often the glory and honour of a nation. If the cause of humanity were not alone a sufficient motive to induce to this research, we need but turn our eyes on political field; there we may behold the best concerted measures defeated by its influents8.
Britain and the British colonies were not alone in suffering major outbreaks of dysentery. In Sweden infectious diseases were the major causes of death during the eighteenth and nineteenth century. In that era, 10,000 people could die of dysentery in a single year.9 Consequently, the disease of dysentery was understood as a threat to one’s own health, both from an individual and contextual perspective. Threats here mean how people experience, feel and describe the challenge of the disease.
4 Eklöf 2014. 5 Newton 2018. 6 Lind 1777 p.9-10. 7 Haycock 2002. 8 Haycock 2002. 9 Castenbrandt 2014, pp. 612 – 639. 7
Behind this lay the reality of people´s poor living conditions, including various diseases and plagues and the limited knowledge about how diseases spread and could be prevented10. From the literature it is well documented that living conditions were bad especially among the poor and that countermeasures also were lacking.11 Countermeasures that would have been especially relevant in the case of dysentery and which could reduce the risk of dysentery were better sanitation and less crowding. Furthermore, epidemics were common such as for example: The Great plague of London from 1665 to 1666, the Plague of 1738 and the 1817–24 cholera pandemic.12 For example, during the great plague of London the poorest areas were the most unsanitary and thus the poorest areas were hit the hardest.13 When it comes to the disease of dysentery, it was also especially common in armies and as mentioned, on ships. This was because of the conditions aboard the ships/vessels. For example, the food was eaten jointly from the same large vessel, and this helped to spread diseases rapidly. In addition, rats and other vermin were plentiful below deck. The vessels were therefore often haunted by diseases and epidemics, among other things, scurvy due to the lack of vitamin C, or dysentery due to the spread of bacteria. The result of this was that many of the crew died, and one could coldly count sometimes to lose half the crew without a fight.14
Medical practitioners
From the literature we can also find plenty of examples of people who tried to help others to recover from illness during the early modern period. The phenomenon of health measures itself is of course not limited to the altruistic motives of ordinary individuals. In the medical arena for example, people have made efforts for the development of knowledge in order to cure people from diseases. Physicians’ and surgeons’ health-supporting actions are examples of such efforts. Their efforts for curing diseases were literally a matter of people’s lives and death, and they often failed. Haycock quotes a physician from Edinburgh Andrew Wilson who described the case of a young servant girl in his own household taken sick during an epidemic of dysentery in September 1759: …I found her as violently ill as any I have ever seen, who was not in the last stage of the disease. Constant violent gripes and tenesmus, great heat and drought, a quick but not a full pulse, bloody, slimy stools, but no natural ones, from the very first
10 Tulchinsky & Varavikova 2014, pp 1-42 11 Tulchinsky & Varavikova 2014, pp 1-42. 12 Bradman 2017. 13 Bradman 2017. 14 Lambert 2000. 8
invasion of the disease; and, as she had almost no remission of pain, she got no sleep./…/The girl died on the fourteenth day, with little or no delirium until within a few hours of death 15.
This kind of descriptions gives an insight into conditions that are not always so far back in time, and to how this disease was so rapid and devastating. Consequently, an analysis of physicians’ and surgeons’ work gives an account of medical practitioners who, through their actions sought to mitigate the effects of the rapid life-threatening effects of dysentery. Thereby the commitment of these physicians and surgeons to their patients is of importance, despite the negligence of the larger institutions (the navy and the trade companies) in which they often found themselves.
Physicians and surgeons
In this introductory part it is also important to distinguish between formally trained and licensed physicians and other medical practitioners. The sheer numbers of people who practiced medicine in some form or other during the early modern periods are overwhelming. According to Jonathan Barry,16 medical practitioners were, quite literally, everywhere. He writes that; “From ‘formal’ trained and licensed physicians across to the village blacksmith who might perform a secondary role as tooth-drawer, the types of practitioner are also legion”. Therefore, with reference to Barry, it is not unusual to find a man described as a surgeon in one source, and then as a ‘gentleman’ in another. Neither are the terms mutually exclusive17. However, there were certainly general categories into which medical practitioners could, at least nominally, be fitted. These categories were physicians, surgeons and apothecaries.18 So for example, in The British Isles there were three separate corporate structures of medicine: the Society of Apothecaries, the Barber- Surgeon’s company and the College of Physicians (later changed to the Royal College of Physicians).19 The Royal College of Physicians was Founded in 1518 by a Royal Charter from King Henry VIII20. The Royal College of Physicians of London is the oldest medical college in England, often playing a pivotal role in raising standards and shaping public health. Physicians were to be the educated elite of the medical world. A degree would usually be required to gain a license21. Candidates took an oral examination to demonstrate that they were ‘groundedly learned’
15 Wilson 1777 / 2002, p.49-52. 16 Barry 2018. 17 Barry 2018. 18 Barry 2018. 19 Barry 2018. 20 Royal college of Physicians 2020. 21 Royal college of Physicians 2020. 9
(classically educated) in a range of subjects. In addition, fellowship (full voting membership) required a degree from Oxford, Cambridge or other higher institutes of learning.22 Thus, the interest in this master thesis consists of physicians’ and surgeons’ perspective on dysentery through their descriptions. The interest also consists of eventual differences in their perspectives. Physicians and surgeons were an authority who could in different ways give voice, comment and point out the challenge of diseases. As a collective, especially the physicians were persons with knowledge (although limited) who came in contact with people who suffered from diseases. Finally, they were also literate during this time and could actually document their efforts to heal the sick and their perspectives on dysentery.23 I shall therefore contrast the different practitioner’s understanding of the dysentery and treatment of their patients.
Problem
As shown above, the disease of dysentery was a great challenge against ordinary people’s lives as well against soldiers aboard warships. The disease of dysentery and the many deaths were a social, medical, military and political problem. However little is known about the actual understanding and experience of treating this socially significant malady of dysentery. Little is also known about what the treating medical practitioners thought about underlying reasons to the disease and their theoretical standpoints and ideas about the cause, symptoms and treatment of dysentery. By exposing these perceptions and investigating understanding, the knowledge, theoretical standpoints and ideas behind the medical practice of dysentery, this thesis further develops our view of medical and social life during the early modern period.
Research Questions
As mentioned before, of particular interest when it comes to the disease of dysentery is how the disease and its cause were perceived. For example, how did the physicians of that time explain the spread of dysentery and how could they manage the spread? What individual measures and commitments were taken for the patients? How cause of the disease was understood and explained? How did perspectives differ between physicians and surgeons? This master thesis aims to show how a qualitative approach to early modern medical practitioners’ perspectives can provide a basis for a better understanding of the disease of dysentery.
22 Royal college of Physicians 2020. 23 Sjöstrand 2007. 10
Method and Theoretical framework
A qualitative perspective has been adopted in the thesis. The method chosen is close reading of eleven treatises24 on dysentery (also named the bloody flux) by ten British medical practitioners and one Hanoverian (in the eighteenth century Hanover was rules by the British King) from the second half of the eighteenth century. Close reading is a careful, sustained interpretation of a text emphasizing the single and the particular over the general. 25 The reading allowed me to find in small parts of the text clues to help me understand the whole and unpack the meaning. The method chosen enables also detailed analysis to be undertaken of how the medical practitioners understood dysentery. A text is an artefact that stimulates meaning,26 i.e. an object made by a human being, typically an item of cultural or historical interest. I therefore suggest that the medical practitioners’ understanding and experiences are the foreground or the figure and the cultural context of the early modern time is the background in this analysis. The background provides a basis for the interpretation of what was being said by the medical practitioners. Therefore, dysentery from the lived experience27 is worth a more detailed historical attention. The research questions presented above, led me to focus on: 1) the context based on authors’ biography, 2) described symptoms of dysentery, described causes of dysentery and described cure of dysentery and 3) commitment to the patients. The main themes I uncovered were (i) Dysentery and suffering, (ii) A contagious disease, (iii) Charting the causes and spread of civilian outbreaks, (iv) Climate and weather as an explanation for the occurrence of dysentery, (v) Definitions of the disease, (vi) In pursuit of new knowledge about dysentery, (vii) Cure and treatment. However, the meaning of theme iii, iv and vii requires an explanation regarding causes and explanations about cures as these explanations are often based on the “theory of humoral medicine or humoral pathology.” - What was the humoral pathology then, within the framework of these themes and which the medical practitioners based on their understanding when it came to the disease of dysentery? – Well, with reference to Bujalkova, Straka and Jureckova28 it can be said to be a perception of the onset of diseases as a result of imbalance of body fluids. The humoral pathology was based on the idea that human bodies have four important fluids or
24 Close reading of eleven treatises, meaning here; written works dealing formally and systematically with the subject of dysentery. 25 Klarer 2004. 26 Ruiz De Castilla 2018. 27 By "lived experience" with reference to Bengtsson 2008, p. 30 is meant here the concrete reality that the medical practitioners encountered, related to, experienced and that they shared with others. 28 Bujalkova, Straka & Jureckova 2001. 11 humors--blood, phlegm, black bile, and yellow bile. Because of this belief, humoral pathology is also called the "Hippocratic doctrine of four humors.29" o’Neil writes about it that:
Each humor is thought to have its own "complexion." Blood is hot and wet. Phlegm is cold and wet. Black bile is cold and dry. Yellow bile is hot and dry. These complexions have nothing to do with actual temperature and humidity. For instance, coldness is thought to come from water, but boiling water is cold and ice is hot. In addition to bodily fluids, four internal organs are considered highly important in humoral pathology. The liver, brain, lungs, spleen, and gall bladder each have the same complexion as their presumably associated humor […]. Different kinds of illnesses, medicines, foods, and most natural objects also have specific complexions. Curing an illness involves discovering the complexion imbalance and rectifying it30.
This understanding of medicine, integrated three components: experience (empirical observations), religion/magic and speculation of natural philosophers.31 On the other hand, there were also physicians that based their understanding of dysentery on medicine, - what today is called scientific knowledge based medicine. Scientific knowledge based medicine is in this thesis identified as knowledge with a process of investigation32. This kind of understanding of dysentery is based on theoretical abstract understanding, where diseases to a greater extent are understood on the basis of symptoms and signs.
Procedure for selection of the sources
The selection of the original sources that I have chosen for this master thesis comes from Early English books online (EEBO) and Eighteenth Century Collection Online (ECCO). The procedure for selection of the sources was as follows: Firstly, I went to Uppsala University’s electronic website and up to the Uppsala university library homepage (Uppsala universitetsbibliotek). Secondly, I used the database function to search for data material described above. The database EEBO33 is a collection of electronic versions of books listed in Pollard & Redgrave’s Short‐Title Catalogue (1475‐1640), Wing’s Short‐Title Catalogue (1641‐1700), and the Thomason Tracts (1640‐1661). On EEBO, I typed in the word “Dysentery” in the search engine. I also tried searching for variations regarding that subject, such as the disease of dysentery and the illness of dysentery. I further set other parameters for my search results, such as typing in the dates for the time period relevant to this master thesis, for example 1600 -1880, in order to specifically acquire texts from a particular era. In this way, I found 15 hits from which I used seven different texts for my thesis. Thirdly, through these texts I searched for the database for where they were full-text published, namely the database ECCO. This database includes over
29 Perveen, Hasan & Alam 2015. 30 O’Neil 2007, p .1. 31 Bujalkova, Straka & Jureckova 2001. 32 Marshall 1997. 33 Early English books online 2019. 12
180.000 titles including books, essays, and more – works, that are published in the UK and elsewhere. This database also offered full-text sources. Fourthly, searching in this database I used the keywords dysentery, physician, bloody flux, the bloody flux, to find relevant texts as well as I made a selection of the texts by choosing the subject areas Medicine, Science and Technology; History and Geography and Social Sciences. The continued selection process was performed by using the keywords dysentery and physician and threat in these subject areas to get relevant texts.
The outcome of the text search
The search in the subject area of Medicine, Science and Technology for the word dysentery in the search database ECCO, resulted in 1737 hits. When searching for the phrase bloody flux the page showed 420 hits, although most of these search results did not have anything to do with dysentery; the subject area of History and Geography searches resulted in 398 hits, and the subject area of Social Sciences resulted in 115 hits. The process continued with reading the title of the sources. If the title was relevant to the purpose of the study, the full-text version was opened and electronically reviewed if it contained words like dysentery. The keywords and inclusion / exclusion criteria were chosen according to the purpose of the study. The inclusion criteria were: (i) that the purpose or the context for which the texts were written appeared; (ii) that the texts were written by physicians and/or surgeons; (iii) that the texts contained physicians’ and surgeons’ work related to dysentery; (iv) that the texts were written in English; (v) that the texts were written during the eighteenth centuries. The texts which fell within the scope of the inclusion criteria resulted in eleven texts. This process is illustrated in figure 1, below.
•Searching in databases 1. •EEBO and ECCO
•Keyword identification 2.
•2670 hits 3. •Review the titles of the texts 4.
•Inclusion criteria applied 5.
•The entire texts was read through 6.
7. •11 text were selected as data material
8. •1524 pages totaly, forms the basis for the analysis
Figure1. The flow from search to include data. 13
Presentation of the primary sources
The data material consists of 1524 pages of primary sources from texts such as books, essays and longer comments, or descriptions of the disease of dysentery and efforts to be taken to the patients. These texts were written by physicians and surgeons regarding the dysentery. The authors of the texts were mostly British physicians and surgeons (one of them was from Pennsylvania). One of the physicians stationed in Hanover (then ruled by the King of England) but writing about an outbreak of dysentery in Switzerland. Table 1 below presents the data material. However, more on the biographies of the eleven medical practitioners will be presented in chapter two in the results section.
Table 1: Presentation of the data material (n = 11), which two of the writers are surgeons, one both surgeon and man-midwife and the rest of them are physicians; however some of them worked as surgeons as well. Texts from primary Num Author Title sources ber of pages 1. 54 James Fisher, M.D. (1774-1822). An inaugural dissertation on that Philadelphia: Printed by James, Fisher, of Delaware, Member of grade of the intestinal state of fever Omrod & Conrad, 41, the Philadelphia Medical Society. known by the name of dysentery. Chestnut-Street. (M.D. diss.). 1797 2. 34 Benjamin Moseley. M.D. (1742-1819), Observations on the dysentery of London: The London and Surgeon at Kingston in Jamaica the West-Indies, with a new and medical journal. successful manner of treating it. 1781 3. 99 Mark Akenside, (1721-1770). Doctor of A commentary on the dysentery or, London: Printed for F. physic. bloody flux. Noble, near Middle- Row, Holborn and J. Fellow of the College of Physicians, Noble, in St. Martin´s Member of the Royal Society, and Court, near Leicester physician to her present Majesty Square. (Translated from Latin by) John Ryan 1767 M.D. 4. 210 Robert Robertson, (1742–1829). M.D. Metrological and Physical London: Printed for E. and Surgeon of his Majesty’s Navy and Observations made in 1769, 1772, and C. Dilly, in the a Fellow of the Royal Society. 1773 and 1774, on the Coast of Poultry; J. Rorson and Africa and in the West-indies. Co. New Bond Street & A Physical Journal kept on board T. Cadwell, in the His Majesty´s ship Rainbow. During Strand; and T. Evans, three voyages to the Coast of Africa, Pater-nofter-row. and West indies, in the years 1772, 1769. 1773, and 1774:
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5. 84 William Cockburn, M.D. (1669-1739), Some Observations on the Power Printed for the Author, et al. and Efficacy Of a Medicine against Loosenesses, Bloody Fluxes. and Sold by M. Lewis, By the late Dr. William Cockburn, Of in Paternoster-Row the College of Physicians, and Fellow 1757. of the Royal Society; late of St. James’s- Street.
6. 64 Dale Ingram, (1710-1793). Surgeon and An Essay on the Nature, Cause and Printed for William Man-Midwife Seat of Dysentery in: Letter to Dr. Beeby, at the Spring Henry Warren of Barbados. Clock, at the Corner of House in Cheapside near the Custom-house. 1744 7. 103 Andrew Wilson, M.D. (1718-1792). An Essay on the Autumnal London: Printed for Fellow of the Royal College of Dysentery. Hooper and Davis, No. Physicians at Edinburgh, and Physician 25, Ludgate-Hill, and G. of the Medical Asylum, London Robinson, Paternoster- Row. 1777. 8. 78 Thomas Houlston, M.D. (1745-1787). Observations on Poisons and the London: Printed for R. use of Mercury in the cure of Physician to the Liverpool Infirmary, Obstinate Dysenteries. Baldwi, Pater- Noster_Row, By H. and honorary member of The Literary Reynell, (No. 21,) and Philosophical Society of Picadilly. 1784 Manchester 9. 200 John Ball, (1704-1779), M.D. The modern practice of Physic: or, a London: Printed for A. Apothecary. Method of judiciously Treating the Millar, in the Strand, Several Disorders Incident to The Human Body: Together with a 1762 Recital of their Causes, Symptoms, Diagnostics, Prognostics, and the Regimen necessary to be observed in regard of them. With A Variety of Efficacious and Elegant Extemporaneous Prescriptions, adapted to each particular Case and Circumstance. (1769). 10. 348 John Peter Wade, (1762-1802). M.D. Select Evidences of a successful London: Printed for J. Of the Honourable East-India method of treating Fever and Murray, N⸰ 32, Fleet Company’s Bengal Establishment Dysentery in Bengal Street. 1791 11. 250 John George Zimmerman, (1728- A Treaties on the Dysentery: With a London: Printed for 1795). M.D. Description of the Epidemic John and Francis Translated from the Original German Dysentery That prevailed in Rivington, at the Bible of John George Zimmerman, M.D. Switzerland in the Year 1771 and Crown (N⸰ 62.) in Physician in Ordinary to His Britannic St. Paul’s Church-yard. Majesty at Hannover, by C.R. Hopson, 1774 M.D. Total number of data material consisted of 1524 pages from original sources.
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Ethical, credibility and validity aspects
With references to the Council of Science34 (Vetenskapsrådet) and their text Good research practice regarding ethical aspects in historical research, and to the requirements of conduct set on the researchers’ role, I have considered the following aspects.35
- An honest and clear account of the background to the study, which means that you cite and refer to relevant earlier publications. - Description of material and method, which means that it must be so clear and detailed that the reader can assess the scientific quality or the weight of the results. In empirical but non-experimental research, for example in historical disciplines, reporting of source material and evidence of the claims made is required. - That the study's fulfillment and analyzes are made as transparent as possible. - The presentation of the research results and conclusions must be well-balanced and fair.
Outline
This thesis is split into three chapters. Chapter one will introduce the thesis and broadly cover the problem, research questions and purpose of the study and the context of this kind of social- historical type of inquiry, namely physicians’ and surgeons’ texts from the perspective of early modern period. Chapter two will focus on previous research. Chapter three presents the results from the analysis and the findings.
Chapter two
The topic of Dysentery
The term dysentery is defined by Britannica Academic as follows: Dysentery is described as an infectious disease that is characterized by inflammation of the intestine.36 The Oxford English Dictionary defines it as: A disease characterized by inflammation of the mucous membrane and glands of the large intestine, accompanied with griping pains, and mucous and bloody evacuations37. The origin of the word is derived from old French word dissenterie (13th cent. dissintere), from Latin dysenteria and from Greek
34 Vetenskapsrådet [The science council] 2017. 35 Lindberg 2018. 36 Britannica Academic 2018. 37 Oxford English Dictionary 2020. 16
δυσεντερία, δυσέντερος afflicted in the bowels The early name for dysentery was Flux, meaning a flowing, flow specifically in physiological sense as flux of blood. The word is defined as: An abnormally copious flowing of blood, excrement, etc. from the bowels or other organs; a morbid or excessive discharge.38 Dysentery patients present with abdominal pain, diarrhoea and stool that often contains blood and mucus. Further symptoms include fever, vomiting and dehydration. The disease can prove fatal to individuals because of dehydration from the loss of bodily fluids.39 With reference to Britannica Academic40, today dysentery is a significant cause of illness and death in young children who live in under-developed countries. According to the same source, there are two major types of dysentery: 1) bacillary dysentery and 2) amoebic dysentery, these are respectively caused by bacteria and by amoebas. The most severe bacillary infections are caused by Shigella dysenteriae type 1; these are found chiefly in tropical and subtropical regions of the world. As far as we know, the amoebic version of dysentery seems to be the more dangerous of the two, since the disease is more difficult to treat because the organism occurs in two forms, a motile one and a cyst, and these require different treatments.41 Dysentery is transmitted through the ingestion of food or water that has been contaminated by feces. The transmission is often spread by individuals who have handled food but without washing their hands. Finally the modern treatment at least of bacillary dysentery is based on the use of antibiotics, the administration of fluids and, where necessary blood transfusions.42
Previous Research
In this section I am going to investigate what other authors in previous studies have written about the history of dysentery and other diseases / epidemics. This research review aims to build a logical framework for my thesis that sets it within a context of related studies and to identify the area of knowledge gap that the thesis is intended to fill. Into the twentieth century, dysentery was a serious medical problem. In Sweden for example, industrialization and urbanization brought new problems due to poor conditions of water supply and hygiene which in turn created ill health. According to Sjöstrand,43 this is illustrated with the Swedish Public Health Act [Häslovårdstadgan] which was introduced in 1875
38 Oxford English Dictionary 2020. 39 Sjukvårdsupplysningen [Medical information] 2019. 40 Britannica Academic 2018 41 Britannica Academic 2018. 42 Sjukvårdsupplysningen [Medical information] 2019. 43 Sjöstrand 2007, p.105. 17 and with it came a new organizational structure mostly when it came to preventative measures in urban environments. The Swedish Public Health Act regulated questions about for example water and drainage, latrine- and waste disposal, housing hygiene and food hygiene.44 However, this requires a question namely, what was the situation like during the early modern period? Oskar Sjöström, argues that the medical understanding of most diseases was quite flawed45. He writes that the knowledge of medicine was extremely limited. Within the academies the representatives of the healing arts still relied on the ancient humoral theories 46 and lay people had no other authorities to turn to, other than local healers or traveling charlatans.47 The field surgeons (during wartime) practiced a kind of mix of academic theory and folk medicine as a knowledge base for their actions. In both cases the patient became the victim of the healing arts because of misunderstanding, superstition and magic.48 With reference to the same source, in the year 1686 Sweden’s foremost agency / authority on questions of medicine was the Collegium medicum. This agency printed a so-called pharmacopoeia – a collections of recipes for pharmaceuticals. Among the approximately 800 drugs, that pharmacists and physicians was supposed to create using mortars and bottle into powders, ointments, oils and liquids, both for internal and external use, there were several suspect ingredients to be found. According to Sjöström, these included rattlesnake meat, horn of a rhinoceros, earthworms, frogspawn, fox intestines, elk hooves, pike jaws and boar tusks. Seeds, herbs, bark, stones, roots, mud, including a number of substances dangerous to one’s health such as, gun powder and lead were common ingredients in ordinary medicines. In some recipes the ingredients consisted of excrement from people as well as animals, parts of mummies, brainpans [hjärnskålar] from hanged or decapitated criminals as well as moss from old human bones, and other repulsive ingredients. Against anxiety, depression or homesickness surgeons could prescribe magic amulets or spells.49 However, little is said in the pharmacopeia about how the practicing physicians and surgeons themselves explained their choice of treatments or countermeasures and how they understood dysentery.
44 Sjöstrand 2007, p.105. 45 Sjöström 2008. 46 Larsson 2015. Acoording to humoral pathology a disease arose because of an unbalance between the four bodily fluids namely blood, (sanguis), black bile (melancholia), mucus (phlegma) and yellow bild (cholera). The prominent figure within Cellular patology. 47 Sjöström 2008. 48 Sjöström 2008. 49 Sjöström 2008. 18
Previous research about understanding of Dysentery as a Contagious Disease in Demographical Terms from 1640-1770 in Sweden
To use Sweden as an example, there are many studies about demographic information from the early modern period. An example of them is Daniel Larsson’s dissertation50 “The Hidden Transition: about a demographic long-term change in early 18th century Sweden”. This dissertation relates to information about demographics. The author conducts a study of four causes of death that were prominent during this era. These are small pox, dysentery, the plague and typhus. The big long term changes were that the outbreak of smallpox became much more common from around the year 1700 and that the plague disappeared after 1713. There also seems to have been a connection between crop failures and increased mortality during this period. With reference to the faculty's opponent Sören Edvinsson who carefully examined and analyzed the dissertation, this thesis provides a good contextual description of the occurrence of dysentery and its causes in addition to the disease description itself. It also shows clear links between diseases, mortality and lack of food51. Larsson himself writes in the dissertation's abstract that “if looking on the growth rate’s components, these were characterized before 1720 by powerful waves in the increase of births. These waves can clearly be seen in the number of deaths which fluctuated a lot before 1720”52. Through different analyses of parish registers and other sources, Larsson’s thesis shows that changes in important areas of demography took place in beginning of the eighteen century. Mortality crises as consequences of harvest failure and epidemics between the mid seventeen century and the 1710’s were more frequent and more severe than between 1720-70. According to Larsson, They caused a relatively greater number of deaths among adults than crises during later periods.
Previous research about dysentery and actions against it related to cause and impact
Discussion about causes behind outbreak of diseases follows from a doctoral thesis by Helene Castenbrandt, entitled: “Rödsot i Sverige 1750 – 1900: En sjukdoms demografiska och medicinska historia” [Dysentery in Sweden 1750 - 1900: A demographic and medical history]. She also asks what is behind the appearance and disappearance of diseases. Her thesis also describes the demographic consequences of dysentery in Sweden and at the same time she analyzes the causes behind the presence and disappearance of the disease. The disease is mapped over Sweden with focus on changes over time as well as regional and local differences. Jönköping County is used as a case study.53
50 Larsson 2006. 51 Edvinsson 2007. 52 Larsson 2006, p. 1. 53 Castenbrandt 2012. 19
Castenbrandt’s study highlights dysentery’s devastating effects and the disease’s epidemic nature is clarified. The analysis emphasizes the complex interaction between different variables which all contributed to dysentery outbreaks (causes). It brings to the fore valuable knowledge of dysentery’s historical consequences and also clarifies the importance of studying the history of these complex issues, all of which enhance our understanding of this historical period. Its overarching purpose is to show the historical significance of dysentery, as well as to find explanations for its appearance and disappearance.54 The results of this thesis about dysentery and actions against it related to cause and impact, show that, at times dysentery had a huge impact on the mortality rate and during certain years, dysentery caused 90% of all deaths in one parish [socken]. Further results show that there were differences in the mortality rate in different counties. For example sparsely populated areas such as Norrland County [Norrlandslän] and more populated areas such as in Stockholm county and Malmöhus county, generally fared better when it came to the mortality rate from dysentery. This was, in contrast to the counties of Kopparberg, Värmland, Skaraborg, Älvsborg and Jönköping, which were hit with epidemics of dysentery much more frequently than the other previously mentioned counties. As shown, the historical significance of dysentery is well documented in this study; however the documentation is on demographic level and does not describe the lived reality.55 Dysentery was especially feared by military planners, and epidemics of it were often associated with war. This is outlined in a study entitled: “More Fatal than Powder and Shot, dysentery in the U.S. Army during the Mexican War, 1846–48” by Vincent J. Cirillo. This article examines U.S. Army disease fatalities during the Mexican War, a large part of which was due to dysentery. For example, Cirillo shows that over an 11 month period 51% of all fatalities at the U.S. Army General Hospital at Veracruz were because of Dysentery. The larger implications are spelled out by Cirillo as follows:
…In terms of deaths due to disease, the Mexican War (1846–48) was the deadliest of all American wars. Nearly 13% of the entire U.S. force perished from disease. Of the total 12,535 war deaths, 10,986 (88%) were due to infectious diseases (overwhelmingly dysentery, both bacterial and amoebic); seven men died from disease for every man killed by Mexican musket balls. Camp pollution was the greatest error committed by U.S. troops in the Mexican War. The indifference of line officers and recruits to the need for proper sanitation and military hygiene fueled the dysentery outbreaks, and the poor conditions in military hospitals contributed further to the spread of disease. This defect in military culture undermined the health of the
54 Castenbrandt 2012. 55 Castenbrandt 2012. 20
army and led to medical disaster. Disease caused an enormous drain on the U.S. Army’s resources, eroded troop morale, and influenced strategy and tactics56.
Interestingly, it appears that nobody learned anything about preventive measures despite the enormous number of fatalities. Similar conditions were also frequent during the American civil war. For example, the author mentions U.S. Army Surgeon Joseph Janvier Woodward (1879), who reported in his treatise on the al vine (intestinal) fluxes that diarrhea and dysentery claimed the lives of 44,558 union army soldiers during the Civil War. Cirillo finally points out that even today thousands die from this disease annually and recommends implementation of well- established public health measures, such as proper disposal of human and animal wastes for the prevention and containment of dysentery outbreaks.57 The relevance for this text to my thesis is to show the great impact dysentery outbreaks can have on people and an army during a war. This shows what a huge threat the disease is against human life, health and existence. That 88% of all deaths in a war were due to dysentery and other diseases is astonishing. More interestingly it shows that even though the disease had the biggest impact on casualties, authorities did not take steps to contain it. This becomes especially clear when one looks at the 44.000 + union soldiers that were killed by disease in a later war.
Previous research about challenges from dysentery and actions against it related to impact and suffering
A study entitled: “Hygeia and Empire: the Impact of Disease on the Coming of Colonial Rule in British West Africa”, by Tom Gale58 discusses how disease dictated policy decisions of the British Empire. The article points out that because of the suppression of slave trade during the beginning of the 1800s the forts and settlements there were no longer self-supporting and a financial burden. The acquisition of Lagos in 1861 was called 'that deadly gift from the Foreign office” by the Colonial Office and the forts and settlements were called expensive and troublesome. Further it was difficult to attract men to serve in Africa;
…Four different individuals actually refused offers to serve as governor of the Gold Coast. Those who did accept often died; for example in near-by Sierra Leone between 1808 and 1888, nine of 26 governors died; of disease in addition to eight acting governor. Periodically the death tolls reached such heights that everyone was reminded once again that West Africa was indeed the white man's grave. Between 1823 and 1825, 1476 soldiers arrived in Sierra Leone for military duty. An incredible 924 died of disease59.
56 Cirillo 2009. 57 Cirillo 2009. 58 Gale 1982. 59 Gale 1982. 21
The conclusion of this article is that, even though health problems and problems with sanitation deteriorated over time and became simply horrible, both for the Europeans and the natives; it was events in Europe that spurred on colonization. These problems no longer mattered when it came to prestige and a desire to grab land by the European powers. Once one country started to colonize Africa the effect snowballed and everybody wanted a piece. So for reasons of state, colonial rule was going to be extended regardless of the health problems involved. However, the story in Africa is more complex than this example suggests. High rates of disease in some parts of Africa did inhibit European colonization. Sierra Leone was especially complicated, and Europeans tried to get ethnic Africans (former slaves) to settle it on their behalf, claiming they were less susceptible to disease (they went and many of them died). The relevance of this text to my thesis is that, like the previous text showed that there was a serious problem but when a pretext was found (in this case for colonization) this problem and the deaths were unresolved issues, caused by reasons that people often did not know how to solve the problem. As we see, the early modern problem of countless people dying from disease was taken seriously, however only taken seriously in terms of finance and profit. The individual perspective of the life-threating situation caused by dysentery is missing. Instead, a nation’s so called prestige took precedence over casualties and this was used as an argument to expand colonization instead of decreasing it.
Previous research about dysentery in relation to other life threatening diseases
Haycock60 argues that dysentery as a life threatening disease, has not received the same attention as, for example, Asiatic cholera despite its physical similarities. He thinks this was because dysentery did not have the same exotic shock factor or did not have the immediate medical significance of an affliction such as smallpox.61 I will therefore look briefly at the cholera and smallpox literature to see how medical practitioners reacted to fairly dramatic contagious diseases, professionally and in cultural terms in the eighteenth century. Smallpox and cholera were quite dramatic diseases: they appeared suddenly, they killed large numbers of people very fast, and they also presented in a dramatic way in terms of the symptoms. So, they presented a huge challenge for the medical practitioners. Smallpox was a viral disease that previously affected people all over the world. Smallpox was caused by variola virus, a so-called pox virus. Smallpox was a very contagious disease. It was
60 Haycock 2002. 61 Haycock 2002. 22 spread mainly as a drop infection but could also be spread by airborne means. Smallpox differs from many other infectious diseases in that there can be no infection carriers without symptoms. The disease is known for its characteristic rashes, often all over the body, but the smallpox virus could engage virtually all organ systems, not least the respiratory tract. The sick were usually severely affected, and mortality rates may have been around 20 per cent, but could be significantly higher in certain epidemics. Neurological consequences were very common. Until about 1000 years ago, the disease was mainly found in East Asia. After that, it also gained a foothold in Europe, and the smallpox became a feared ingredient in human life in the coming centuries. It especially affected the children, and one saying was: "A child cannot be counted as a family member until it has passed through the disease”. As far as Europe is concerned, the eighteenth century appears to have been the century of the smallpox, and it has been estimated that about 60 million people died from the disease, of which 90 percent were children.62 In her study “Smallpox in Washington's Army: Strategic Implications of the Disease During the American Revolutionary War”, Becker investigated the impact of smallpox (how or why the disease affected military strategy) during the American revolutionary war, and how it affected General George Washington's army. An interesting point that the article brings up is that the disease of smallpox in North America, appeared periodically in epidemics, whereas in Europe it was primarily an endemic disease generally suffered in childhood, particularly in urban areas. The periodically appearance in epidemics made the smallpox actually more like dysentery. Further, colonists in the US during outbreaks tried among other things isolation and inoculation. Inoculation was first introduced in Boston by Zabediel Boylston and Cotton Mather during the epidemic of 1721.63 The interesting parts of this article and more relevant to this master thesis is how it describes preventative measures and countermeasures taken by the army in handling outbreaks of the smallpox. Preventive measure that was taken was to appoint a person who would make daily inspections of the soldiers for any signs of smallpox, those who did show signs were isolated immediately.64 Further the article mentions that in order to prevent the spread Washington restricted camp access, checked refugees, and isolated his troops from the contagion. Countermeasures for those who already had smallpox consisted for example of the army established a hospital at Dorchester, Massachusetts, in January 1776 in order to isolate American officers and soldiers who contracted the disease.65 As can be seen, practical measures to be taken
62 Folkhälsomyndigheten [The Public Health Agency of Sweden ] 2020. 63 Becker 2004. 64 Becker 2004. 65 Becker 2004. 23 were thus isolation as a tool in the fight against the disease, which was not as obvious action regarding dysentery. Also Mark’s and Rigau-Pérez’ article called: “The World's First Immunization Campaign: The Spanish Smallpox Vaccine Expedition, 1803–1813,” claims that smallpox was instrumental to the American defeat in Canada, and that the disease adversely affected recruitment, increased desertions, and forced commanding officers to proceed with inadequate forces. This article describes The Royal Philanthropic Vaccine Expedition 1803–1813 and its efforts to try to inoculate people from the smallpox virus mostly in South America. Further it describes the threat of smallpox and how people tried to combat it along with mortality rates for the disease compared to when one has been inoculated. The relevance of this account to my thesis lies in the fact that the cause of the spread of infection and vaccination against disease was already known in the eighteen century. This can be connected to the context of dysentery and the understanding how the medical practitioners were responding to it. Firstly, Mark and Rigau-Pérez describes inoculation (variolation) and claims that this method of treatment has been practiced in both Asia and Africa since ancient times. However this method was introduced to the Western world first by its use in London and Boston during epidemics there in 172166. Thus, this article confirms the previous articles statements about inoculation in Boston during the year 1721. Secondly this articled describes inoculation as follows: “Inoculation was performed by introducing a small amount of liquid from a smallpox vesicle into the subcutaneous tissue of a healthy subject, who then acquired a mild case of smallpox, which usually healed without scarring”.67 Another example of a previous historical research perspective is societal and institutional responses to epidemics during early modern period and other eras. When it comes to responses to cholera which has physical similarities to dysentery, Tognotti argues in her article “Lessons from the History of Quarantine, from Plague to Influenza A”, that the use of quarantine has been the cornerstone of organized responses to infectious disease outbreaks. I will here focus on the preventative measures taken against epidemics that are brought up in this article. The first institutional response to an epidemic was during the plague in the years of 1347-1352. Tognotti says that some of the city-states in Italy prevented strangers from entering their cities, as a preventative measure in order to stop the spread of infectious diseases. Notable, however, is that this was mostly done against merchants and different minority groups such as Jews. The Italian states introduced a sanitary cordon that if broken would result in the death penalty. Armed
66 Mark & Rigau-Pérez 2009, p. 65. 67 Mark & Rigau-Pérez 2009, p. 65. 24 guards were also posted on different transit routes and access points to the cities68. The relevance of this article to my thesis about dysentery is to be found in the societal and institutional use, or lack of use of quarantine, border controls, contact tracing, and surveillance as a method of preventing the spread of dysentery. –Methods, that for centuries have been practiced as a cornerstone of organized responses to infectious disease outbreaks.69 With no effective medical response the strategies adopted by health officials were essentially those that had been used against plague. She continues: Scientists and health administrators began to allege the importance of sanitary cordons and maritime quarantine against cholera. These old measures depended on the idea that contagion was spread through the interpersonal transmission of germs or by contaminated clothing and objects. This theory justified the severity of measures used against cholera; after all, it had worked well against the plague.70
Here we see that since no medicine worked against cholera at the time, the only response was to introduce the same strategy that had been used over 500 years previously, namely to quarantine people, simply because that strategy was effective against the plague. However this quarantine strategy did not work as a method for preventing either yellow fever or cholera. People against quarantine and isolation as a measure of combating cholera argued that it was a relic of the past and was damaging to commerce and that it inspired a false sense of security for people. In regards to dysentery and my study, it can be seen regarding dysentery that the medical practitioners also tried to quarantine or at least separate people with dysentery. So, in other words partly the same strategy. Here we just see it on a larger scale with different diseases and governments and health officials enacting these same strategies.
Summary of previous research
As shown by previous research about dysentery, the challenges of disease to people’s health and measures against the disease, dysentery was during the early modern period and later a deadly disease. It caused, during war for example, sometimes more deaths than the actual casualties from the battlefield. The review of earlier studies also shows that the possibility of being afflicted by this disease was not only confined to Britain, but was widespread across Europe and other continents. Like dysentery Smallpox and cholera were very common diseases with frequent outbreaks. As can be seen, there was knowledge during the early modern period and in earlier
68 Tognotti 2013, p. 254. 69 Tognotti 2013, p. 254. 70 Tognotti 2013, p. 257. 25 times about the spread of infection and even about inoculation, as was the case with smallpox. The knowledge of inoculation reached the West in many different ways and in different countries. However, this review also shows that knowledge was limited when it comes to medical practitioners’ understanding and experience of the dysentery. I hope that the contribution from this master thesis now can be put into a larger body of literature in dialogue with the narrower issue of the medical practitioners’ understanding and reactions to dysentery. It is in this area of research that this master thesis, in a medical and social-historical context, hopes to contribute and to fill a knowledge gap that the previous research is missing.
Chapter three
Results
Medical practitioners’ contextual setting – the background to perspective on understanding and measures in praxis
I suggest that the medical practitioners’ understanding and experiences are the foreground and the cultural context of the early modern time is the background in this analysis. The background provides a basis for the interpretation of what is being said by the medical practitioners and can be used to enhance our understanding of the relationship between the contexts and the medical understanding or thoughts about dysentery in early modern period in continental Europe. My first analysis of the primary sources in this thesis begins therefore by examining the settings based on biographies of the medical practitioners. These biographical details are important for the texts analyzed in this master thesis. As mentioned, they help us understand some of the practitioners’ views on dysentery, the types of outbreaks they witnessed (many of them in military settings) and their treatment regimens. The kind of education and other training they received also bring us closer to their larger understanding of the causes of dysentery. The presented biographies also help us to understand the position of medical practitioners as a professional group related to the society of eighteen century.
26
COCKBURN, WILLIAM, (1669–1739), M.D. Physician.
Born: Unknown Background: Unknown Education: University of Edinburgh/University of Leiden 1691 Title: Physician, M.D., M.S. Held the post: Physician to the Blue squadron of the Admiralty board / a fellow of the Royal Society Biography of Cockburn, W. with reference to Oxford Dictionary of National Biographies, Charles Creighton, 2008, revised by Anita Guerrini71.
William Cockburn became a student of medicine in 1691 at Leiden, and in 1694 he became a licentiate of the Royal College of Physicians in London.72 The same year, he was appointed as a physician to the Blue squadron, of the Admiralty board. From the same source of Oxford Dictionary of National Biographies, it appears that the year after in 1695, he published his first book entitled “Oeconomia Corporis Animalis”, which he dedicated to Admiral Sir William Bidgeman.73 In 1696 Cockburn published a text that dealt with nature, causes, symptoms and cure of the distempers that are incident of seafaring people. This text was based on his experiences as a physician aboard ships during two years74. With reference to the Royal College of physicians of Edinburgh, Cockburn noted that fresh vegetables were effective in curing scurvy but argued that the disease was caused by idleness and recommended daily exercise as a preventative measure.75 There is a story described about how his treatment methods against diarrhea and bloody fluxes became widely known and talked about, namely when around a hundred men on a ship were got sick. Cockburn used his method of treatment on these men, who had already recovered the next day. His success was reported to the Admiralty board by Sir Cloudesley Shovell who then came to use the treatment for the Mediterranean squadron.76 Cockburn supplied the fleet with it for 40 years and the army which had important ramifications for the nation. In this way Cockburn became famous and wealthy by having introduced a medical treatment against the fluxes. Cockburn was elected as a fellow of the Royal Society in 1696 and in 1697 he achieved the rank of M.D. at Kings’ College, Aberdeen. In the year 1700 he moved to London where he had a
71 Creighton 2008. 72 Creighton 2008. 73 Creighton 2008. 74 Cockburn 1697. 75 Royal college of physicians 2020. 76 Creighton 2008. 27 successful career as a physician and in 1731 he became a physician to Greenwich Hospital. William Cockburn died in 1739 aged 70 as a wealthy man. He was buried in Westminster Abbey.77
DALE INGRAM (1710-1793). Surgeon and man-midwife.
Born: Spalding, Lincolnshire in Britain the 10th of September 1710 Background: Father: William Ingram – Mother: Cathrine Education: Position of an apprentice and studies in the country (Britain) Title: Surgeon and man-midwife Held the post: Surgeon at Christ Hospital Biography of Ingram, D. with reference to Oxford Dictionary of National Biographies, Norman Moore, 2004, revised by Michael Bevan78.
Dale Ingram was born at Spalding in 1710. After apprenticeship and study in the country, Ingram began practice at Reading, Berkshire, in the year 173379. In 1743, he published a text entitled: “An Essay on the Gout.” In the pre word of this text Ingram thanks a William Strode for employing him as “Your Family physician,” and speaks of what a great honor this is.80 Later in that year he emigrated to Barbados, where he worked until 1750 (seven years). After he returned to England he opened up a practice as a surgeon and man-midwife at Tower Hill London. Dale Ingman held a position as a surgeon and man-midwife.81 With reference to Royal college of Physicians,82 around 1783 midwifery was becoming established as an acceptable profession for men to engage in. They write that, its rising status is demonstrated by the Royal Colleges of Physician’s interest in linking to this area of medical practice. The statutes were changed to allow the College to offer a license in obstetrics for male midwives. However, the license is discontinued in 1819 due to the low numbers of applicants.83 In 1751 Ingman published ‘Practical Cases and Observations in Surgery,’ which became his most important work. The procedure in this work described one of the earliest English examples of a method of surgery which has only been universally adopted within the last few years84. It contained notes regarding cases and observations both from England and from the West Indies. Another publication which can be mentioned is “An historical Account of the Several Plagues
77 Creighton 2008. 78 Moore 2004. 79 Moore 2004. 80 Moore 2004. 81 Moore 2004. 82 Royal college of Physicians 2020. 83 Royal college of Physicians 2020. 84 Moore 2004. 28 that have appeared in the World since the year 1346”. In the text Ingram described that the plague is a Contagious Distemper.85 In the year 1754 he moved to Fenchurch Street, in London. During this time he not only practiced medicine, but also lectured in anatomy. In 1759 Ingram was elected from among five candidates to the office of surgeon to Christ's Hospital, and thenceforward resided there. In 1790 it was stated that he was too old for his work at Christ's Hospital, and as he would not resign he was fired in 1791. He died at Epsom on 5 April 1793.86
MOSELEY BENJAMIN, (1742-1819). M.D. Physician and surgeon-apothecary.
Born: Essex in Britain Background: Unknown – Family might have been from Lancashire Education: Medical education in London and Paris – completed his training in 1768 Title: Surgeon-apothecary in Kingston Jamaica Held the post: Surgeon-general Biography of Moseley, Benjamin. with reference to Oxford Dictionary of National Biographies, Brunton, Deborah, 200487.
Benjamin Moseley took an academic degree of M.D at St Andrews University in 1784. He became a licentiate of the Royal College of Physicians in London in 1787.88 In general it can be said that Moseley belonged to an intellectual elite with high professional status. After his education he worked as surgeon-apothecary in Kingston, Jamaica. Moseley, according to the Oxford Dictionary of National Biographies, worked 18 years in the West Indies which gave him a lot of experience in the medical profession. That experience helped him in his professional career. In Jamaica he published several texts about treatment of dysentery, as well as writing treatise on sugar and coffee.89 In 1784 he returned to Britain. After traveling around Europe and living in several places for example Venice, he set up a practice which catered to the upper classes of London. With support (patronage) from Lord Musgrave he got a post as doctor at the Royal Hospital in Chelsea. His vast experience when it came to treating tropical diseases gave him status and income from his publications.90
85 Moore 2004. 86 Oxford Dictionary of National Biographies 2004. 87 Brunton, 2004. 88 Brunton, 2004. 89 Brunton 2004. 90 Brunton 2004. 29
Moseley has made an impression in medical history by being a fierce opponent of vaccination. He made claims that children became idiots and adults became insane form vaccination. He died the 25 of September 1819 at Southend, he was buried in London.91
ROBERTSON ROBERT, (1742–1829), M.D. Physician.
Born: Coupar Angus, Perthshire, Scotland. Background: Father John Robertson, mother Mary Livingston. Royal Navy Education: Apprenticeship as surgeon for 4 years in Scotland / University of Aberdeen Title: Surgeon’s mate ranked petty officer Held the post: Physician in charge of the Royal Hospital Greenwich / Royal Society / one of the 24 directors of the hospital board (served in a total of eighteen men-of-war) Biography of Robertson, R. with reference to Oxford Dictionary of National Biographies, Short, Bruce H., 200492.
Robert Robertson was a MD93 and physician. He was born 1742 in a little town Coupar Angus in Scotland. Robert Robertson performed his apprenticeship as a surgeon for four years in Scotland. 1760, he sailed as a surgeon aboard the ship “The Grand Tully”, with it he sailed to Greenland, - a journey that took four months. Also in 1760, he underwent examinations at Surgeon’s Hall by physicians at the Royal Hospital, Greenwich. After that Robertson went into service in the Royal Navy as a surgeon. He sailed to the West Indies, Africa, America and Gulf of Guinea.94 In 1779 he became a doctor of medicine at the University of Aberdeen. He practiced medicine as a physician in Hynthe, Hampshire between the years of 1773-1789. In 1790 he advanced to physician in charge of the Royal Hospital in Greenwich, where he worked until his retirement at the age of 77 in the year of 1819. He became a member of the Royal Society in 1803.95 His work as a physician aboard ships was well documented in two volumes where he describes his “Observations on fevers” which were published in four volumes in 1807. Between the 1777 and 1812 he published a total of 12 volumes that dealt with fevers.96 Robertson developed a plan for the Admiralty in order to improve the medical treatment at sea and for the work conditions of the surgeons during their service. He also advocated that bark as a medicine should be provided for free. Together with his lifelong friend and mentor James Lind (a naval surgeon and doctor), Robertson shared his interest in fever. Robertson formulated
91 Brunton 2004. 92 Short, 2004. 93 Oxford Dictionary of National Biographies 2004. 94 Short 2004. 95 Short 2004. 96 Short 2004. 30 a doctrine of "febrile infection" and provided clinical documentation on typhus fever. He died at Crooms Hill, Greenwich 1829.97
AKENSIDE MARK (1721–1770). M.D. Poet and physician.
Born: Butcher Bank, St. Nicolas, Newcastle upon Tyne Background: Parents: Mark (butcher) & Mary Akenside Education: Newcastle Royal Grammar School / University of Edinburgh / Leiden University / Cambridge Title: Fellowship at the Royal College of physicians / Fellowship of the Royal Society Held the post: Principal Physician - St. Thomas Hospital in London Biography of Akenside, M. with reference to Oxford Dictionary of National Biographies, Dix, Robert, 200698.
Mark Akenside went to school at Newcastle Royal Grammar School but was also taught by William Wilsson who had ties to the non-conformist meeting-house established in 1727 at Hanover Square. Akenside was seen as a very diligent and with reference to the Oxford Dictionary of National Biographies, it was said that during church services a lamp was placed at the Akenside family’s spot so that Mark could take notes during the service.99 Akenside had a gift for literature and already as a teen he had started to write poetry. He published his first article anonymously, in gentleman’s Magazine in 1737. This publication was followed by several more, and his publications impressed many in the establishment. Akenside got economical support towards advancing his career from the Dissident’s Society in London in order to be able to study at Edinburgh University in preparation to become a clergyman. His studies started in 1738. However, just a year after, he switched subjects to medicine and was chosen to the Medical Society in 1740. In 1742 he returned to Newcastle and paid back the scholarship that he had gotten form the Dissenters Society.100 His friend Jeremiah Dyson – a lawyer and student from Edinburgh, later came to be Akenside’s patron. Like many others of Edinburgh students, Akenside continued his studies at Leiden university 1744, in order to complete his medical studies. He returned to England almost immediately and started his medical practice in Northampton with support from the eminent physician Richard Mead.101 Akenside moved eventually to Bloomsbury Square where he lived until 1759 on income which he received from his publications. He was also supported economically by his old friend
97 Short 2004. 98 Dix 2006. 99 Dix 2006. 100 Dix 2006. 101 Dix 2006. 31
Jeremiah Dyson who was now a lawyer. Akenside became a licentiate of the Royal College of Physicians in 1751 which entitled him to practice medicine in London. He continued his career and he became an M.D at Cambridge, an academic level in order to be accepted for fellowship at the Royal College of physicians in 1754. He was later elected to the fellowship of the Royal Society in 1753. Akenside was active as an assistant physician at St. Thomas Hospital in London and was after three months promoted to principal physician. His professional opportunities progressed with an appointment as Queen Charlotte’s personal physician until he died in 1770.102
WILSON ANDREW, M.D. (1718–1792), M.D. Philosopher and medical writer.
Born: Unknown Background: Only son of Rachel Corsan and Gabriel Wilson (minister at Maxton Roxburghshire) Education: University of Edinburgh Title: Licentiate of the Royal College of Physicians of Edinburgh / M.D. University of Edinburgh Held the post: Consulting physician to the Medical Asylum in Welbeck Street Biography of Wilson, A. with reference to Oxford Dictionary of National Biographies, Weight, John, P., 2004.
Andrew Wilson (1718-1792) studied at the University of Edinburgh and became an M.D, with his dissertation called “De luce” on the 29th of June in 1749.103 After his dissertation he opened a practice in Newcastle upon Tyne where he stayed until 1776. However, already in 1764 he became a licentiate of The Royal College of physicians of Edinburgh. He moved to London and became consulting physician to the Medical Asylum in Welbeck Street.104 Henceforth, he produced many texts about theories having to do with natural phenomena, linked to natural philosophy. Some texts dealt with the “natural inferiority of women”, others about hygiene in the military, children’s diseases and the efficacy of Bath Waters.105 Wilson had been supported in his medical career by a professor Rutherford in Edinburgh, to whom Wilson dedicates his text “An Essay on autumnal Dysentery, 1777.” Wilson begins the text by writing: “Sir, I Had the Honour of Addressing this Essay to You, as my respected Master, my Patron, and my Friend; almost Twenty Years ago.”106 Wilson died 1792.107
102 Dix 2006. 103 Weight 2004. 104 Weight 2004. 105 Weight 2004. 106 Wilson 1777. 107 Weight 2004. 32
ZIMMERMAN JOHN GEORGE, (1728-1795), M.D. Physician, philosophical writer and naturalist.
Born: Brugg, in the Canton of Berne, Switzerland on the 8th of December 1728 Background: Father John Zimmerman was a member of the provincial council Education: University of Bern / University of Gottingen Title: Ordinary physician to His Britannic Majesty at Hannover Held the post: Principal physician to the king of Great Britain, at Hanover Biography of Zimmerman, J. G. with reference to Mason Frederich, 1837, p. v. The life of Zimmerman in “Zimmerman on Solitude with a sketch of the author’s life”. (new ed.) London: Leighton and Murphy, Printers, johnson’s – court, Fleet-Street. Downloaded from British Library
John George Zimmermann was born at Brugg, in the Canton of Berne, Switzerland on the 8th of December 1728. 108 He was early destined to the medical line. Already at the age of 14 years of age Zimmermans father sent him to the University of Bern where he studied for three years under the guidance of professor Kishcberger (history and rhetoric) and professor Altman (Greek). He continued to study there for a total of almost five years. After that, he began to follow the practice of physic at the University of Gottingen, where he was a student and friend of the celebrated Haller109. Haller had recently been promoted to a professorship by the King George the Second. According to Encyclopedia Britannica, Zimmerman established his reputation by the dissertation “De irritabillitate” (1751).110 In 1768 Zimmerman appointed principal physician to the king of Great Britain, at Hanover.111 Zimmerman, was a physician in “Ordinary to His Britannic Majesty at Hannover”112. He first resided and practiced physic at the place of his birth place and afterwards at Berne. During his residences at Berne he published excellent essays.113 His renown had long been established as a correct and energetic writer, a sound philosopher, and an able physician114. Zimmerman died 1795.115
HOULSTON, THOMAS, (1745-1787) M.D. Physician.
Born: Unknown Background: Unknown Education: Unknown Title: Honorary member of the literary and philosophical society of Manchester
108 Mason 1837, p. v. 109 Mason 1837, p. v. 110 Encyclopedia Britannica 2020. 111 Mason 1837, p. vi. 112 Mason 1837, p. vi. 113 Mason 1837, p. v. 114 Mason 1837, p. v. 115 Encyclopedia Britannica 2020. 33
Held the M.D. and physician to the Liverpool Infirmary post: Biography of Wilson, A. with reference to Birkenhead,1965. J. of British Medicine.
Thomas Houlston was an honorary member of the literary and philosophical society of Manchester.116 Houlston was appointed to the Liverpool Infirmary in 1774 when he was 29 years old117. Houlston was interested in resuscitation by artificial respiration after drowning. According to Birkenhead,118 Houlston successfully performed resuscitation on many people. In 1773 Houlston published an essay praising the fine qualities of Liverpool’s spa waters and claimed that they had all sorts of healing properties. Houlston also claimed that these waters were beneficial to almost all diseases. However, this attempt to attract patients to the spa failed119. In his “Essay on the Liverpool spa' water” he dedicates the text to a “Sir Gregory Turner Baronet, son of the late Sir Edward Turner member for Oxfordshire.” Houlston writes that the dedication is: “as a mark of sincere friendship and esteem; This essay is, respectfully and gratefully inscribed by, his obliged and obedient servant, the author”.120 Houlston died in the year 1787.
WADE, JOHN PETER (1762-1802). M.D. Physician.
Born: Unknown Background: Unknown Education: Unknown Title: Assistant Medical Surgeon, M.D. Held the post: Of the Honorable East-India Company’s Bengal Establishment Biography of Wade. J. with reference to Saikia, A. 2019. In Bhattacharya, Neeladri & Pachuau, Joy L. K. (Eds.) Landscape, Culture, and Belonging Writing the History of Northeast India. Cambridge University Press.121
Not much information is known about, John Peter Wade (1762-1802). We do know that he worked for The East India Company and that he joined a military expedition to the Kingdom of Assam in 1792 as an Assistant Medical Surgeon.122 From Wade’s own text “Select evidences of a successful method of treating fever and dysentery in Bengal” he describes medical cases written at the beds of patients at the General
116 Houlston 1784. 117 Birkenhead 1965, p. 311 118 Birkenhead 1965, p. 311. 119 Birkenhead 1965, p. 311. 120 Houlston 1773. 121 Saikia 2019. 122 Saikia 2019, p.110-128. 34
Hospital at Chunar in the province of Benares123. We can therefor assume Wade also worked at said hospital in Chunar. From the same text we can read that Wade refers to himself as an M.D. In another text written by Wade “Nature and effects of emetics, purgatives, mercurials, and low diet, in disorders of Bengal and similar latitudes” he talks about forty men being ill of fevers on board the ship Houghton in the river Gagnes.124 Wade has also written several pages about “ship fevers” or (fevers and diseases aboard ships). Accordingly, from this we can assume that he also worked onboard ships as a ship physician. So to summarize, we know he was an M.D. and worked as an Assistant Medical Surgeon. We know he was part of a military expedition conducted by the East India Company for which he worked. Wade also worked at the General Hospital in Chunar according to himself. He also worked onboard ships for the East India Company, and finally we known that he wrote several texts where he describes medical cases and cures for various fevers and diseases that people were afflicted by in Bengal and onboard ships. He died in 1802.
BALL, JOHN, (1704-1779). M.D. Physician, Apothecary and medical writer.
Born: Unknown Background: Unknown Education: Unkown Title: Apothecary / medical writer / M.D. Held the post: Unkown Biography of Ball, J. 1762. The Modern practice of Physic. With reference to Eighteen Century Collections Online125. Ball belongs to the category of medically trained practitioners. He was an apothecary, M.D. and medical writer of text such as; “A treatise of fevers; wherein are set forth the causes, symptoms, diagnostics, and prognostics (1758)…together with the method of cure”,126and “The modern practice of physic: or, a method of judiciously treating the several disorders incident to the human body” 1762127; “The female physician or Every Woman her own Doctor, 1771. Ball explains that he has published this greatly extended English version of his popular
123 Wade 1791. p.vii. 124 Wade 1792, p.65. 125 Ball. 1762. 126 Ball 1758. 127 Ball 1762. 35
“Pharmacopoeia Domestica Nova”, which had completed three editions in the 1750s, “not as a 'book of practice' but instead 'a register of what the apothecary is to be furnished with”.128 Ball’s work “The female physician: or, every woman her own doctor, wherein is summarily comprised, “All that is necessary to be known in the cure of the several disorders to which the Fair Sex are liable; together with Prescriptions in English of the respective Medicines proper to be given in each Case,” London: printed for L. Davis, 1770, was the first British works of advice to women about disorders particular to their gender. Ball describes this work as of great utility to young physicians, surgeons and apothecaries129. According to Ball “The text was delivered in a manner so concise, familiar and intelligible, that every woman of common capacity may be able, upon most occasions to relieve herself”130. However, Ball wrote on fevers as well as on various other diseases and their treatments and prepared compilations of medicines. He was obviously a physician of varied interests and specialties.131
FISHER, JAMES, of Delaware (1774-1822). M.D. Physician.
Born: Unknown Background: Wifes: M.Sarah Truitt Fisher & Anne McClymenth Fisher Education: Doctor of Medicine at the Faculty of Medicine of Pennsylvania Title: Doctor of Medicine Held the post: Member of the Philadelphia Medical Society. Biography of Fisher, J. with reference to Ecco. Eighteen Century Collections Online, 2020132.
James Fisher wrote the thesis “An inaugural dissertation on that grade of the intestinal state of fever known by the name of dysentery” for the degree of Doctor of Medicine at the Faculty of Medicine of Pennsylvania on May 12, 1797. This work was dedicated to James Woodhouse professor of chemistry at the university of Pennsylvania and Elijah Barrat physician, in Kent County in Delaware. Fisher calls himself a pupil when talking about Barret. So what we can conclude was that Barret was Fishers mentor / teacher. It’s worth mentioning that Fisher is the only American among the medical practitioners that I’m using for this thesis since Fisher was born the same year that the United States was founded and his text is written in 1797. Fisher also refers to himself as James Fisher of Delaware133. Further his dissertation is also submitted to the examination of the Rev. John Ewing, S.T.P., provost, the trustees and medical faculty of the
128 Ball 1770, p. 2 129 Ball 1770, p. 2 130 Ball 1770, p. 2. 131 Hardesty & Berger 2014. 132 Fisher 1797. 133 Fisher 1797. 36
University of Pennsylvania134. Fisher mentions Zimmerman and Sydenham (great authorities of that time) in his dissertation text, so Fisher is aware of these physicians during that time. Sadly not much is known about the life of James Fisher, his one dissertation is the only example I can find that he has written. He died in the year 1822 and was buried at the Old Presbyterian Cemetery, Dover, Kent County, Delaware USA.135
Summary and conclusions of contextual display
To summarize the contextual background to the individual practitioners' understanding of dysentery, I will begin by asking the following questions: What does the contextual setting tell us about the medical practitioners who write texts on the subject of dysentery, and how do their life stories help us to better understand their context? As we can see, the medical practitioners performed their medical work, either as a general practitioner at a hospital, at their own clinics, in the service of the East-Indian company, or in the service in the Royal Navy, as surgeons. Some of them specialized in the treatment of dysentery, while others specialized in making observations of how the disease manifested itself and analyzing possible causes of it. Within the framework of both specializations, accurate notes were made to form the basis for the dissemination of knowledge. Those medical practitioners, who worked as surgeons on ships, could be away for up to sixteen years. This, of course, contributed to extensive experience and knowledge of how the disease of dysentery affected seafarers and how it spread. A common experience that is described is the desire to share their knowledge about dysentery, as well as knowledge about its causes, symptoms and treatment. All medical practitioners wrote down their experiences in different texts such as essay’s and rapports, which was published in different publications. The purpose of these publications according to the authors was to spread knowledge and to benefit humanity as a whole, but also it seems to become famous, further their careers and to earn money. Significant about the educational background of medical practitioners is that the dissertation for the academic doctorate M.D. usually opened doors for further careers but only once they had been elected as members of ex. Medical Societies, Royal College of Physicians. For the surgeons who did not have the same level of education as the physicians, it was particularly important to publish their knowledge and experience, and to get support from a wealthy patron. For both categories of practitioners, support from a mentor and older colleague or just a wealthy patron, was thus a prerequisite for career advancement. This support was an important factor in career development, but also in other ways. For example, it could benefit the practitioners’ own
134 Fisher 1797. 135 Find A Grave Memorial 2020. 37 reputation, or own knowledge in regards to his subject. In most cases, the patron would provide financial assistance. How important of an issue was the military or naval experiences then? As can be seen from the biographies, the Colonial context was an important factor in the careers of several medical practitioners. Through it, the medical practitioners increased their own knowledge about the disease and they got experience and it increased their reputation. As shown, the similarities found in the biographies are that many of these medical practitioners studied medicine at The University of Edinburgh, but several also studied at the University of Leiden in Holland. As mentioned, several of them went abroad, often working in different parts of the world. Some of them went to the Caribbean to study cases of dysentery, some went to India, and others went on ships sailing to many exotic foreign locations. Another similarity in regards to being abroad was the colonial context. Either they worked for the Royal Navy onboard their ships. In other words, many of the British medical practitioners went to the English colonies to work. The exception is, however, Fisher who seemed to both live and die in Delaware in the United States. However, he is the only American in the data material of this thesis. So what does this tell us about the society that the medical practitioners lived in? Regarding the practitioner’s economic status in society it’s somewhat difficult to determine since several of their backgrounds are unknown, and their biographical information starts of at the university level. However, we can assume that these people belonged to a particular category of people (wealthy) since they had the means to even go to a university. Furthermore, we do learn that Akenside’s father was a butcher, which means that they were not all wealthy before their medical careers, but certainly not sons of poor peasants. When it comes to the practitioner’s professional status in society of that time, we can state that they belonged to a category of people who had education, expertise and the relationship to master the threat of dysentery, as a common aspect. Thus, they certainly had a certain position of power. However, they still had to be supported by a patron or a scholarship in order to succeed in their carrier. What does this contextual biographies tell us about these people who wrote about dysentery, and how do their life stories help us better understand their context? - Well, The context for the medical practitioners work on disease epidemics such as dysentery is that there was no collected effort when it came to countering the disease, meaning no unilateral guide to treatment that society or the state ordered or recommended (no instructions from above). Instead here it was up to the individual practitioners to try to cure the disease that afflicted people through trial and error, in other words coming up with new ways and countermeasures to combat the disease. The practitioners were trying to cure individual cases by using new methods and understandings. With this we can understand that they individually but in discussion with each other by different publications, tried to develop their knowledge about dysentery from 38 different angles. This is shown for example, by the physician Akenside who is calling for a philosophical approach and method in order to analyze causes for dysentery. He writes:
...for in every kind of philosophy, there ought to be a freedom to choose, but particularly in physical questions, where the mind must extend itself, to the right understanding, both the occasion of what is to know, and the matter to be learned thereby. But if it should happen, that such as differed from great men in their sentiments, would be thought to violate the esteem and reverence for them, it must infallibly happen, that students thus circumstanced, would make little progress, nay scarce would have a beginning or increase, but rather continue in a state of infancy; a complaint which may be with great justice taken up, concerning medicine, above any other art of employment whatsoever136.
/…/but then the same gentlemen approving more the synthetic method, form a conclusion some way or other drawn from the analytic way, as a principle already granted; and according to this, they judge of the various symptoms of the disease, they direct the intent of the cure, they fix upon medicines; and in fine, explain the force and efficacy thereof. Such as follow this method judges themselves to be the only physicians worthy the dignified title of philosophers; they give out that their medicine is the only true, substantial, and rational one to be met with137.
The contextual situation above, thus points also to a context of a professional status in society as a developer of medical knowledge. The biographies show as well the importance of the Royal College of Physicians playing a pivotal role in raising standards and shaping public health, additionally they constituted a place of influence and respect for scientific knowledge. The individual biographies thus show a context for the development of practice-based knowledge of the work of medical practitioners.
Medical practitioners understanding, experiences and praxis – the figure
The further analysis of the individual authors is about how dysentery was understood, experienced and what measures were taken in praxis.
Dysentery and suffering
Many of the medical practitioners whose works I consulted for this thesis seems to have been deeply affected by the human toll of dysentery and they often described it in quite dramatic terms. Dysentery was a major source of human misery as the American physician James Fisher (1774-1802) noted in his text “An inaugural dissertation on that grade of the intestinal state of fever known by dysentery”:
136 Akenside 1767, p. 4 -5. 137 Akenside 1767, p.5. 39
…there is perhaps no disease, to which mankind are subject, that more deserve the attention of physicians, or upon which more has been said, and more contradictory opinions advanced, then the Dysentery. And notwithstanding the many improvements that has been made in medical science; it is too true, that it still continues to be one of the greatest forces of human misery among us; particularly in fleets and armies, of which it has been, and still remains the scourge of every part of the globe138.
The surgeon and man-midwife Dale Ingram (1710-1793), also notes this misery and calls for action to find a remedy for the disease. In his letter to Dr. Henry Warren of Barbados Ingram writes: …Compassion to our short Period of Life, and Humanity to the Afflicted, are sufficient Motives to Spirit up the Learned to find out the most certain Remedy’s for such Distempers139.
Ingram’s understanding and experiences of human suffering caused by dysentery does not differentiate from James Fischer’s understanding of human suffering and demands for continued action to reduce suffering. Ingram vows that his concentration and action will henceforth be directed to finding that remedy. He states that:
…The Multitude that have sunk under the fatal Dysentery, which hath for some time reigned in this Town and Island in General, have so far take up my Attention, as to prompt Me to make some Anatomical Inquiry into that Distemper, and as I know your Humanity and good Nature must Commiserate [sympathize] this general Calamity [disaster]. /…/I shall think myself sufficiently recompensed for this my small Labor towards the public Service140.
In an dramatic way Robertson (1742 – 1829) describes dysentery as a threat to human life and writes that:
…Of all the diseases which infest a ship’s company, the dysentery, in my opinion, if not the most fatal, is at least equally so with any other, and by far the most loathsome141.
As shown, these medical practitioners express demands for continued actions to reduce human suffering. Dysentery is thus understood as a reason for the practitioners' further attention and action against it.
138 Fisher 1797, p. 5. 139 Ingram 1744, p.3. 140 Ingram 1744, p.2. 141 Robertson 1769, p. xi. 40
A contagious disease
The disease of dysentery as such, is understood as an epidemic disease that is spread especially on board navy warships, and in armies. This is for example evident from Robertson’s text in which he expresses the contagious and epidemic character of the disease.
I will not pretend to say that the diseases which fell under my observation upon that coast, the short time which we stayed each voyage, are all the diseases that are to be met with there; for a disease may happen and be epidemic there one year, as well as in any other part of the world, which may not occur for a number of years following – At least I imagine so142.
This kind of descriptions is an example of understanding dysentery as a contagious epidemic or a widespread occurrence of dysentery during that particular time and place. Robertson says about his observations concerning the cause of the fevers prevailing on board that:
…The time when, and manner in which the preceding case occurred, puts it beyond a doubt, that remitting fevers are contagious.143/…/One would imagine from the similarity of the two cases, that the Sergeant was infected from him; but he must at that rate have caught it in the first paroxysm of Clency’s fever; for Clency had only had one before he was seized with his144.
Another way of understanding the epidemic disease of dysentery is to describe the nature of the epidemic. Mark Akenside (1721–1770), poet, doctor of physic, and practicing physician understood dysentery as an epidemic disorder and from that basis discusses the contagious indirectly by comparing symptoms as being similar to those of smallpox. His comparison of different variants of dysentery with smallpox he mentions them both in the context of a widespread occurrence of a disease145. He writes about symptoms of epidemic disorders that:
…In doing which things, however my opinion may differ from others, I do not mean thereby to waken their credit, nor reflect upon their diligence; for the complexion of the same disease, may at various times, appear differently, so that no physician, however skilled in these things, can twice expect the same symptoms; for according to Sydenham, “It may happen that there may be as different sorts of a dysentery, as of the small-pox, and other epidemic disorders, and which, on that account, require a different kind of cure in some, from what is to be used in others”; for if this was not the case, we could not take the liberty of making any excuse in any species of it146.
142 Robertson 1769, p. xi. 143 Robertson 1769, p. 21 144 Robertson 1769, p. 21. 145 Akenside 1767, p. 3. 146 Akenside 1767, p. 3. 41
Such understanding was questioned, however, by the former surgeon-general in Jamaica, Benjamin Mosely (1742-1819) who claimed that there were no epidemical, nor contagious diseases. He writes that …I know that writers lay great stress on exiting, and internal pre-disposing causes; heat and moisture; putrid ferments; infection, etc. etc.---but, upon a strict examination, we shall find, that there has been too much attention employed on these imaginary circumstance, whilst the immediate cause, or primum mobile remains unnoticed147.
However, he did notice the suffering caused by dysentery and describes what his view of a soldier’s life is and the conditions that the soldier endures, but describes the cause of the disease to be a question of preventing sweating. Sweating is a natural way of the body to regulate body fluids. If these regulations are prevented or put out of play, for example by careless handling of one's own health or body, illness occurs. He writes that
…It is the soldiers life to be much exposed, and it is this custom to be careless of himself:--- when he is fatigued or heated he hastens to cool himself in the breeze of night air; and perhaps throws off his cloaths, and often lies down and sleeps in that condition:---if he is wet, he dries his cloaths, linen and skin together;--By these means, perspiration, the great fountain of health in hot climates, is suddenly stopped, and febrile strictures occupy the whole surface of the body148.
As shown from the description above, the cause of dysentery is attributed to the soldier's vulnerable lifestyle, rather than external factors such as the spread of infection.
Charting the causes and spread of civilian outbreaks
Nevertheless, dysentery can also occur in society among ordinary people and in addition, they were affected very quickly by the disease. One such event is described by the physician and M.D. Andrew Wilson (1718–1792), as follows:
…The putrid fever in May 1765, seized on the children and adults in my neighborhood, so very suddenly, that they were perfectly in health, and extremely ill, within the space of a quarter of an hour149.
This experience indicates that the disease epidemic was abrupt and unexpected. Perhaps the sudden outbreak of the disease and its effects were precisely the greatest threat both to society and the individual's health. After all, here dysentery was understood as an epidemic infection as is evident from the following individual description by the physician Wilson.
147 Moseley 1781, p. 5. 148 Moseley 1781, p. 14. 149 Wilson 1777, p. 11. 42
Within lest then two months after I went to reside at Newcastle, an epidemic of Dysentery (a disease they had no memory of the place being ever visited before) broke out there with great violence, and to the great terror both of the town and populous country about it, in the beginning of the month of August, after an uncommon heat and drought for several months preceding150.
The physician Wilson describes how this epidemic disease affects the body and writes that
…The Bloody Flux was an epidemic febrile, putrescent, painful inflammation, primarily affecting the inner coat, but gradually extended itself through the whole substance, or all the coats of the great guts, especially of the lowest or rectum151.
However, the medical practitioners did not really know how the actual spread of the infection occurred. Consequently, depending on how the medical practitioner understood the root cause of the disease, the treatment of the disease was thereby differently adapted, which means that different treatments were proposed. So both the root cause of the disease and its treatment, varied. Furthermore, if we continue to refer to Wilson, who understood dysentery as an infectious epidemic disorder, he could however, not decide whether it was treatments for the infection or how the disease was expressed in the form of bloody diarrhea, to where the efforts of treatment should be directed. He wrote that:
…It has been already observed that this disease ought to be regarded as a fever as well as a tropical inflammation: as such it requires the use of every medicine proper in autumnal fever which is not contrary to the disease as a flux; such as bleeding, diluters, cordials, perspiratives, may even sometimes blisters (I do not mean the unmerciful abuse of them) may be necessary. As dysentery, it demands vomits, purgatives, emollient balsamic incrassants, persouratves, anodynes, antiseptics152 153.
As can be seen, Wilson suggests prescribing treatment both to balance the body fluids and to an antiseptic compound or preparation154. The last one, aimed to reduce the possibility of infection. When it comes to medical professionals’ understanding of causes, outbreaks and spread of the disease among civilians the physician James Fisher (1744 – 1802) points out how dysentery is spread:
150 Wilson 1777, p. viii. 151 Wilson 1777, p. 2. 152 Antiseptics (from Greek ἀντί anti, "against and σηπτικός sēptikos, "putrefactive" are antimicrobial substances that are applied to living tissue/skin to reduce the possibility of infection, sepsis, or putrefaction. Antiseptics are generally distinguished from antibiotics by the latter's ability to safely destroy bacteria within the body, and from disinfectants, which destroy microorganisms found on non-living objects. 153 Wilson 1777, p. 31-32. 154 Antiseptics (from Greek ἀντί anti, "against and σηπτικός sēptikos, "putrefactive" are antimicrobial substances that are applied to living tissue/skin to reduce the possibility of infection, sepsis, or putrefaction. 43
…From the above fact it not only appears, that the dysentery which attacked Yokeum (a person), owed its origin to marsh miasmata155, but that it spread amongst the others by contagion, for almost every persons who either from necessity or choice, came into the room which Yokeum lay, was in short time attracted, either with dysentery, a coming remitting or yellow fever, according as they were predisposed to the one other disease 156
As shown, the cause and spread of civilian outbreaks is attributed to the victim's predisposition to infection, rather than to the infection itself.
Climate and weather as an explanation for the occurrence of dysentery
Although the medical practitioners did not have much common ground as to any specific explanation for the cause of dysentery, it was nevertheless noted that the disease was a global phenomenon and occurred on every part of the globe and was often connected to the climate or weather. Mainly, the medical practitioners understood dysentery as a classic seasonal disease. Places from which physicians and surgeons made their observations included a plethora of countries and places, for example, the West Indies the Coast of Africa and Bengal, but also places in Europe such as Newcastle, Liverpool, Bern and Swabia157 in Switzerland, and in districts of Upper Austria. They noted as mentioned before, that dysentery was an epidemic inflammation affecting, for example, the liver and its secretions, elaborated from the returning venous blood of the intestines and the cause of dysentery, which was linked to the climate or weather. How this link that caused the disease itself was unknown. Instead, it was speculated about it in different ways. What seemed to be the medical practitioners’ main interpretation, was the connection to only warm weather or air, and the physician Andrew Wilson from Newcastle, tried to explain the influence of climate.
…I have attempted to explain how, or why such climates should have such a seeming direct and primary influence upon the liver, it’s connexions and secretions.[-
155 Oxford English dictionary 2020. Miasmata. “Noxious vapour rising from putrescent organic matter, marshland, etc. which pollutes the atmosphere; a cloud of such vapour”. 156 Fisher 1797, p. 23-24. 157 Swabia/Schwaben, originally called Alemannia or Alemannia, is a historic region and a language area, at the far south-west of present-day Germany with neighboring countries. In addition to the Bavarian government of the same name, the historic Duchy of Schwaben corresponded in large part to Württemberg (the eastern part of the state of Baden-Württemberg). During the Middle Ages, most of Switzerland and Alsace were also considered to belong to Swabia. This corresponds in total to areas populated by the two Germanic peoples (compare Swabers) and Alemans (compare French Allemagne and Spanish Alemánia). For many Germans, Swabia is still synonymous with Württemberg, where the population speaks the Swabian dialect.
44
--]…a leading cause (a leading symptom it undoubtedly is) of all autumnal, putrid redmittent, intermittent, &c. diseases of a malignant type. Numberless modern observations and treatises’ on the diseases of hot climates, all settle on this. But few have attempted to explain how or why such climates should have such a seeming direct and primary influence upon the liver, its connexions and secretions158.
Wilson continues and explains,
…It is certain that by continued great degrees of heat the constitution is unaccustomed to, besides relaxing the solids and rendering the circulation languid in general by increasing the perspiration excessively, both the action and the secretions of the intestines are remarkably retarded, which circumstances cannot fail of affecting the liver and its secretions, elaborated from the returning venous blood of the intestines159.
The medical practitioners’ understandings and experiences were governed by the contextual or cultural understanding of that time, namely that dysentery was a seasonal disease. In 1765 Zimmerman (1728-1795), the physician from Hanover describes the relationship of the dysentery with weather and states in an outbreak in his native land of Switzerland:
…the weather this year seemed perfectly favorable to this dysentery. The air was in June very inconstant, but for the most part humid; and when the sun broke forth, there ensued a suffocating heat: July was full as changeable; but the heat never rose to so high a pitch: August was, during the better half, cloudy and rainy: afterwards the days were fine and very warm, and at the same time the nights extremely cold: till the middle of September, and longer, the sky was continually clear, at noon, it was extraordinary hot, in the morning, evening, and chiefly throughout the whole knight, intolerably cold, afterward the air grew foggy, damp, and cold; and we had fine weather and rain by turns: October was very variable, though for the most part cool; and the close of the month was stormy, rainy, and pretty cold160.
Also, the physician Andrew Wilson (1718–1792) in his essay titled: “An Essay on the Autumnal Dysentery”, states that: …This Dysentery is an epidemic distemper, is evident from its recurring periodically at a certain season, namely, during the harvest quarter. In the end of august, and in the month of September, while in fine clear weather [which is the most infectious] the days are almost as hot as at Midsummer, the evenings and mornings grow then remarkably colder than they are a moth later in the season161.
158 Wilson 1777, p. 15. 159 Wilson 1777, p. 15. 160 Zimmerman 1765, p.20. 161 Wilson 1777, p. 4. 45
As shown, both physicians and surgeons noted that the disease of dysentery was a global phenomenon and that the disease often was connected to the climate and weather. Dysentery distinguished itself as an autumnal disease. Its eruption began with a few scattered cases in July, then increased in August and culminated in September. Accordingly, the connection of occurrence of dysentery to the air, weather or climate and is often described and explained. The medical practitioners made the connection based on their observations from voyages in countries with hot climates. This was done in parallel with the knowledge that dysentery was the same disease that existed in Europe. On the other hand, it could be very hot in Europe during the summer month. However, the connection between climate and dysentery is explained not only by the degree of heat and moisture but by the nature of the soil and the winds. In his letter to Dr. Henry Warren of Barbados, “An Essay on the Nature, Cause and Sea of Dysentery”, the surgeon and man-midwife Dale Ingram explains that:
…Another cause of the dysentery is chiefly from the southerly air, that in one time of the year blows here, and as soon as the winds begins to chop about to the southward, dysentery’s make their appearance, for then as it were the natural climate is altered, the air being at such times more moist, phlegmy and light, then when it was northerly, therefore it is not to be wondered at, that the humane structure becomes too much unbraced, and when so the consequence will be a relaxation of the liver and other secretory organs, they being by their natural structure more subject to be unbraced162.
As can be seen, it is apparent that seasonality was one feature considered key to explanations to the occurrence of dysentery. However, the understanding of dysentery and its connection to heat was in some way a relevant notion. It is easy from the perspective of today's knowledge to agree on the “heat connections”, in that the bacteria's rate of distribution increases with heat. Microorganisms grow vigorously at temperatures between 20-50 degrees of Celsius (C) and they are therefore a risk for food poisoning if the food is not cooked above 70 degrees C. Thus, how the food was handled posed a considerable risk to be affected of dysentery and the spread of the disease. Accordingly practitioners paid a lot of attention to weather shifts and seasonal changes. Careful notes were made monthly about the air, the sun's light, the clouds and even the moon's position of “full moon” or “new moon” in relation to how the disease and its spread were affected. With a similar understanding, the Hanoverian physician George Zimmerman noted that when the weather was very hot and men became sweaty, the men drank much more cold water than normal, and this caused them to become sick from dysentery, this in comparison with people who did not drink as much. However, the physician did not associate the cause of the
162 Ingram 1744, p. 23. 46 disease with the water the men drank, but instead with the heat and how hot they became. He describes his observation as follows:
…I have, indeed, remarked, that those chiefly were taken with the dysentery, who after having much heated themselves, cooled themselves directly after; especially such as drank great quantities of cold water, when they were in a profuse sweat. This seemed to be the reason, that most of our peasants fell sick of the dysentery. In general, it is not the cold that follows on heat, and remains, but that which succeeds heat, and gives place to it by fits, that is considered as the cause of the dysentery163.
As shown from the analysis above, the climate and weather were considered to be the key theoretical standpoint and explanation for the occurrence of dysentery, rather than contagion.
Definitions of the disease
Then, how did the early modern medical practitioners understand the disease itself? –Well, in his text, “The modern practice of Physic: or, a Method of judiciously Treating the Several Disorders Incident to The Human Body”… the physician and apothecary John Ball (1704-1779), defines dysentery as follows:
A Dysentery, is a frequent discharge form the bowels of blood mixed with slime, ichorous matter, liquid excrements, skinny slough, and sometimes a fleshy substance resembling the inner coat of the intestines; constantly accompanied with a sever griping pain the in the guts164.
This eighteenth century definition of dysentery can then be compared with the definition from 2018 which reads as follows:
Dysentery is described as an infectious disease that is characterized by inflammation of the intestine. Dysentery presents with abdominal pain, diarrhea and the stool can often contain blood and mucus. Further symptoms include fever, vomiting and dehydration. The disease can prove fatal to individuals because of dehydration from the loss of bodily fluids165.
As can be seen, the symptoms of the disease are relatively similarly described. However, the causes of the disease are not described in the eighteenth century definition at all. The early modern medical practitioners understanding of the disease was based either on contagion theory
163 Zimmerman 1771, p. 21. 164 Ball 1762, p. 174. 165 Britannica Academic 2018. 47 or on the theory of predisposition or susceptibility to imbalance in body fluids, i.e. inhibition of natural flow of body fluids caused by secondary grounds.
In pursuit of new knowledge about dysentery
The medical practitioners saw their medical responsibilities in finding a cure as a challenge and their work seemed to be stimulation for their own personal knowledge development as well as for the ambitions for the development of knowledge in the subject of medicine. The physician and surgeon Robert Robertson who traveled both to the West Indies and Africa's coasts between 1769 and 1774 wrote that there was no certain knowledge at all about how the diseases of dysentery should be cured and he expressed distress that no “certain method” of curing it had yet been discovered.166 According to Robertson,
…Of all the diseases which infest a ship’s company, the dysentery, in my opinion, if not the most fatal, is at least equally so with any other, and by far the most loathsome167.
Robertson expressed the wish that his many observations about dysentery during his many voyages should benefit the young inexperienced surgeons who were sent out into the world and to various climate areas. In this way, they would be given a guide to prevent the worst mistakes and advised that …Hence, I Apprehend public advantages would accrue. The unexperienced and young Surgeon, sent to different climates would be furnished with a guide to avoid errors and mistakes of dangerous consequences168.
Without precisely identifying the origin and cause of dysentery and with the ongoing debate about whether it was contagious, prevention proved difficult and a real cure seemed impossible. However, the physician and the surgeon Robert Robertson believed that …cleanliness is the key to relive the disease./…/ If cleanliness in the sick births is always necessary in other diseases there seems to be yet a more indispensable necessity for their being kept remarkably clean in the dysentery, for the reasons already mentioned169.
This is a perfectly correct standpoint, seen from the perspective of today's knowledge of how infection can be avoided, namely, cleanliness, and washing cooking utensils and one’s hands as the infection spreads through people's contact with food and water.170 An opposite view to
166 Robertson 1769, p. 170. 167 Robertson 1769, p. 169. 168 Robertson 1769, p. 169. 169 Robertson 1769, p. 170. 170 Sjukvårdsupplysningen [The medical information] 2019. 48 prevention perspective is supported by Benjamin Mosely (1742-1819) who referred to the authoritative English physician on domestic epidemic diseases and fevers Thomas Sydenham (1625-1689)171 who claimed that …a succession of very hot summers had meant that the blood and humors arrived to a great adustion and sharpness, so that colera morbus, gripeing in the bowels without stools and dysenteries became very epidemical/…/ the dysentery we speak of is the very fever itself, with this particularly, that is turned inwards upon the intestines, and discharges itself that way172.
Turning back to the physician Robertson, he criticizes other physicians who prescribe, for example, bloodletting, or treatment with Opium, Ipecacuanha173 in order to cause vomiting, or physicians who have prescribed roasted rhubarb as treatment. However, with reference to the knowledge of today, at least, prescription of opium was quit right as it has a stopping effect on diarrhea.174 Here, Robertson’s criticism has a perspective on curing the dysentery. When it comes to today's modern medical treatment of the bacterially-caused dysentery, it is primarily focused on antibiotics and oral rehydration therapy with water and restoration of salts, but prevention rather than cure remains paramount175. However, as shown the early modern practitioners did not pay much attention to replacing lost fluid or that the severely sick patient with bloody and watery diarrhea could suffer from dehydration. The understanding was the opposite, namely that the diseased body fluids or their abundance would instead be released through bloodletting, vomiting and sweating. The American physician James Fisher also tried to contribute to the general fund of knowledge about dysentery. He notes that previously dysentery was thought of as local and thus
171 Haycock 2002. 172 Haycock 2002. 173 Carapichea ipecacuanha is a flowering plant, which has a well-developed rootstock, from which numerous, small- knotted, ringing rootstocks originate. Especially the middle part is swollen and the stronger the bark is, the better the drug can be extracted for the production of the powerful emetic herbal syrup. The active substances contained in the bark are primarily the alkaloids emetin, cafaelin and psychotrin. The Ipecacuanha is originally from Brazil. It was introduced to Europe for the first time in 1672. 174 Opium. The drug has been used throughout thousands of years within traditional medicine, in order to relive pain, counteract diarrhea, reduce anxiety and to induce sleep. The drug produces an euphoric effect. Opium contains around twenty different alkaloids including morphine, noscapine, condeine and papaverine. Opium is currently used as a drug under the product name Dropizol, and is a drug containing morphine. Dropizol belongs to a group of medicines called propulsion suppressants (drugs that suppress the bowel motor) and is intended for the treatment of severe diarrhea such as diarrhea caused by cancer drugs, radiation therapy and certain tumors in adults. Dropizol should only be used when other diarrhea treatment has not had the desired effect. It works by inhibiting bowel movements. Taken from Opium is currently used as a drug under the product name Dropizol, and is a drug containing morphine. Dropizol belongs to a group of medicines called propulsion suppressants (drugs that suppress the bowel motor) and is intended for the treatment of severe diarrhea such as diarrhea caused by cancer drugs, radiation therapy and certain tumors in adults. Dropizol should only be used when other diarrhea treatment has not had the desired effect. It works by inhibiting bowel movements. 175 Haycock 2002. 49 local remedies were tried out. Fisher refers to Sydenham (and agrees with him) likewise physician Mosely, who noted that the disease is nothing more than a “fever of the bowels”.176 Here, we can see the knowledge gap, namely that this physician was unaware of either bacteria or amoebas which could not be observed with the naked eye, and assumes that the symptom i.e. fever is the root cause of the disease. However, we know today that with dysentery the intestine is inflamed, but thinking that the intestine might have a fever, was perhaps a logical conclusion. In order to contribute to the development of knowledge about the disease of dysentery and about the risks and threats posed by this disease, the physician and surgeon Robert Robertson also discussed other reasons as a reason to pursue more knowledge about the disease. He writes to the First Lord Commissioner for Executing the Office of Lord High Admiral of Great Britain and Ireland, John Earl of Sandwich, who had made great improvements in His Majesty’s navy over the years:
…Hence, My Lord, as the following sheets are designed to benefit His Majesty’s navy, in a Physical way, I have presumed to lay them at your lordship’s feet—humbly to implore your countenance of them. Should they, My Lord, fortunately meet with such an auspicious protection; gentlemen of greater abilities in the profession, and from a longer experience in the service, will thereby encouraged to extend the knowledge of Physick throughout the royal navy; and to render the practice of it safe, efficacious, and systematical: which, with the other daily improvements in His Majesty’s service, under your Lordship’s patronage, will no doubt, afford your Lordships inexpressible satisfaction177.
Many practitioners sought to contribute to knowledge of the disease by revealing their treatment regimen, and the medications used in detail. Physician William Cockburn, (1669–1739), believed that dysentery could be treated and cured. In his text titled: “Some Observations on the Power and Efficacy of a Medicine against Looseness, Bloody Fluxes,” 178 Cockburn expresses, his view about the possibility of curing dysentery, as follows:
…Dysenteries are possible to cure with medicine. Had I any other design, the World would equally be surprised with the treaties of the Cures, and the Boldnes of an invidious Inquiry that was once made in the Success of my Medicine179.
He prescribes “Dose of rhubarb, twenty grains one with another and ten grains of the Powder of Cinnamon. Cordial and White drink. Opium every six hours”. 180
176 Fisher 1797, p. 6. 177 Robertson 1769, p. b. 178 Cockburn 1757. 179 Cockburn 1757, p. 44 180 Cockburn 1757, p. 16. 50
The physician Thomas Houlston, claims with reference to his own practical experience, that toxins like Mercury can be used to cure dysentery. He writes as follows:
It would seem, at first sight, that no medicine was less adapted to the cure of Dysentery than Mercury [a drug containing mercury ‘kvicksilver’, my comment] and yet the following cases, which, having occurred in the public Infirmary at Liverpool, were seen and known by numbers, will, I flatter myself, evince that the application of it in certain circumstances is founded in reason, and justified by success181.
Physician Houlston recommends the treatment, in this way: …The practice now recommended, I apprehend, has been sufficiently experienced to justify, a trial of it. Success in a number of cases can alone establish its propriety”. The dry vomit, as I Observed above, is a composition of equal parts of tart. /…/ A quantity of it is mixed at once, and the dose of this mixture, commonly given, is five grains, on an empty stomach, in about half a meat-spoonful of water. The patient is directed to drink nothing after it. In a short time after swallowing it, sickness is produced, and quantity of bile is generally thrown up. To take off the sickness, a spoonful of brandy, or of any spirit, may then be given, and if that should come up, a second182.
Overall, the key issue is that the medical practitioners were engaged in a constant search for knowledge and understanding of the disease. They tested and processed their own knowledge related to the illness as well as that of other physicians. The debate over the knowledge generally, accepted practice, theories of the dysentery, prevention, and cure as well as the number of deaths was ongoing and stimulated further investigative activities. Dysentery's threat to human health and life stimulated to further research. The surgeon and man-midwife Dale Ingram comments on this as follows:
…The Multitude that have sunk under the fatal Dysentery, which hath for some time reigned in this Town and Island in General, have so far taken up my Attention, as to prompt Me to make some Anatomical Inquiry into that Distemper183.
As shown, the medical practitioners believed there was a need for more knowledge about dysentery as such and its treatment which is specifically expressed by Benjamin Moseley:
…We have greatly to lament, that the labours of medical writers have met with so little success; and that their best endeavours have only shown, how little we know, and how much we have to learn, in treating this disease184.
181 Houlston 1784, p. 55. 182 Houlston 1784, p. 95. 183 Ingram 1744, p. 2. 184 Moseley 1781, p. 2. 51
Practitioners had very little theoretical knowledge to build on so their knowledge was largely based upon their long experience of treating the disease. Physicians and surgeons then compared their own observations with others.
Cure and treatment
Without doubt, the search for a cure was as important as the search for the cause. In his dissertation written for the degree of Doctor of Medicine, “An inaugural dissertation on that grade of the intestinal state of fever known by the name of dysentery”(1797),185 James Fisher, wrote that the cure depends on the symptoms. What were the symptoms then? –Well, According to Fisher, there are several symptoms. Those of more general ones could be loss of appetite, delirium, even gangrene. Although, not all of these symptoms might appear, he notes. Fisher refers to Dr. Sydenham who says that the disease is nothing more than a “febris introverta or fever of thrown upon bowels”.186 The cause to this fever might be communicated by contact or breathing in infected air in confined places, Fisher points out.187 This idea of an airborne contagion is called miasma, or as Fisher writes miasmata. Fisher is of two minds about the causes of the dysentery. Here it is important to mention, that Fisher realizes and points out that dysentery itself can be very contagious, just that it does not originate as a contagion.188 However, he falls back on the cause theory that some people are predisposed to imbalances in body fluids. Fever is then explained as excess heat. Since the blood was perceived as a heat-emitting source in the body, it then became natural to release excess heat by bloodletting and in that way restore the balance. But, it’s only under certain conditions that the fever emerges, according to him. This predisposing theory is explained by Fisher as follows:
…A lack of exercise, great fatigue, long walking or great heat. These conditions will act as a predisposing cause; the poison to which now has lain dormant, acts with sufficient force to an irregular action and a fever is produced189.
Consequently, Fisher bases his treatment on bloodletting. He says that if the afflicted has a high pulse or has extreme pain in his stomach or bowls, then bloodletting is as an effective cure. Also, an effective treatment can be as Fisher puts it: The use of emetic fluid as a purgative, e.g. Castor oil./…/Injections of cold water/…/ Doses of opium and Mercury190.
185 Fisher 1797. 186 Fisher 1797, p. 6. 187 Fisher 1797, p. 29. 188 Fisher 1797, p. 24. 189 Fisher 1797, p. 31. 190 Fisher 1797, p. 10. 52
Based on the same cause theory, the physician Benjamin Mosely suggests Sudorfics, an agent that promotes sweating as a way to release excess heat and thereby balance the body fluids. Curative indications according to Mosely, are to cause convulsions to the surface of body and to cleanse the intestines, this being done as speedily as possible, if done too late this treatment will be ineffective. Further parts of the cure, he also recommends bloodletting and Ipecacuanha, a plant to induce vomiting and after that an opiate. Very specific symptoms followed by treatment measures to be implemented are described by physician and assistant medical surgeon of the company East India Company (EIC) 1792, Peter Wade (1762-1802), when he is describing cases from a hospital, in an essay of “Select evidences of a successful method of treating fevers in Bengal”191. All the patients were afflicted with fevers of dysentery, he writes. The aim of the essay was to present over 400 cases that might furnish the medical world with some very important facts.192 He begins with a case; a patient of age 30 admitted 1st March 1787 and says:
…His pulse is very quick, and his skin very hot; his tongue extremely foul. He complains of a very violent pain in his bowels and in his breast. He discharges very offensive faeces involuntarily, but in very small quantity. – The solution of salts, rendered palatable with syrup and peppermint-water, and three ounces every half hour, until it shall have operated by stool. Let his bowels be fomented frequently until the pain abate; and clyster be injected every half hour, till stools be produced193.
The idea behind the further treatment was to follow a purgative plan which is based on the same humoral theory, namely that some people are predisposed to imbalances in body fluids. Wade says: …The medicines employed latterly were bark and anodyne draughts. Three glasses of red wine and middle diet had been allowed daily. A pill of four grains of camimel, and one of opium, to be taken at bed-time and a solution of salts in the morning until larger and easier stools have been produced194.
Successful treatments are described by the physician John Ball (1704 – 1779). He focuses on how successful the medical practitioner is in finding the exact place in the body that is affected by the disease. This is done by identifying the distemper. He says:
…We may make use of some certain signs, in order to distinguish the particular place where this distemper is seated: for if the small intestines are affected, the pain is seated higher near the navel; and there is a greater interval between this and the stool:
191 Wade 1791 192 Wade 1791, p. 10. 193 Wade 1791, p. 1. 194 Wade 1791, p. 242. 53
the blood and whatever part of this intestine is discharged are more exactly mixed with the exrements; the delirium recurs more frequently and with greater vehemence: there is a fever and a drought195 /…/ black blood mixed with the exrements, as also with yellow bile196 /…/ greater thirst and nausea, as likewise a greater loathing of food and sometimes a vomiting ensues197.
The medicine recommended for dysentery is described by the physician John Ball, as follows:
…The butyrum carae Bateanum, made by melting bees-wax in spirit of wine upon the fire, and filtering off the spirit, that it may remain in the paper like butter, may be an excellent medicine in painful Dysenteries198.
As can be seen from the analysis, it can be said that the medical practitioners showed considerable interest in dysentery and in trying to understand it as (i) a great suffering for individual, for society and for humanity as a whole. (ii) The medical practitioners took treatment measures based on how they understood the cause of the disease outbreak. Either the dysentery was referred to internal causes, as sickness in organs, especially the organs that produced bodily fluids, or it was referred to external causes, as a sickness caused by heat, cold, weather, winds, air, climate, seasons, lunar position, etc. (iii) The cause of the disease was understood and explained both as an infection (however, it is not the case that they believed in microbes) and as a pre- disposition for imbalances in body fluids. Their ideas were that there was a need for knowledge development about dysentery as such and its treatment. (iv) Both physicians and surgeons noted that the disease of dysentery was a global phenomenon and that the disease often was connected to the climate and weather. This standpoint was based on that dysentery distinguished itself as an autumnal disease. Its eruption began with a few scattered cases in July, then increased in August and culminated in September. Understanding about the disease, its causes and treatment does not differ significantly between physicians and surgeons. However, different physicians had different views about the causes of the disease and now it should be treated.
Summary
As shown, the main findings here are that dysentery was understood as a big challenge threatening the society and peoples´ lives. Furthermore, that some of the early-modern medical practitioners seems to be familiar with the explanatory model on contagion or infections
195 Ball 1762, p. 176. 196 Ball 1762, p. 176. 197 Ball 1762, p. 177. 198 Ball 1762, p. 179. 54 regarding dysentery. At the same time, they did not know how the infection itself was spread. Equally, there were others who knew about contagion theory, but did not believe in it. They also knew that dysentery caused bloody and mucous diarrhea and high fever. However, they did not understood that it was an infection caused by bacteria (found in polluted water and food), that produced the tract infection.199 Instead, the medical practitioners thought that it was the fever itself that attacked the intestines or the veins, or caused some disorder of the liver and gall-bladder and even that the weather could have caused this. The analysis of the medical practitioners’ perceptions about the suffering from dysentery and how the disease of dysentery were understood, based from their lived reality, shows double standpoints. For example, physicians Fischer200 and Moseley 201go against the idea of contagion. Today, we know that dysentery is spread with contaminated water or with food that is not cooked properly. Even food that is not properly cooked or fried can cause dysentery.202
Conclusion
The general purpose of this master thesis was to gain knowledge about physicians’ and surgeons’ perspective of dysentery focusing on eighteenth century perceptions of the disease. As shown, eighteenth-century physicians and surgeons actively worked to better their understanding of the disease of dysentery. At the same time, the thesis has shown how the understanding of the disease of dysentery differs greatly from that of today. These differences are due to the fact that medical practices of the eighteenth century appear to be operating with two parallel knowledge paradigms; (i) the theoretical abstract understanding, where diseases to a greater extent is understood on the basis of symptoms and signs, and what today is called scientific knowledge based medicine203 and (ii) the humoral medicine. As we saw, Newton argues that in general, diseases were believed to be cured by the combined efforts of three agents: God, nature, and the practitioner204. However, not one of the physicians or surgeons in this thesis named God as an agent. Physicians and surgeons never referred to religion or magic (as one component in the ancient medicine) in their understanding or conclusions of dysentery. What is clear from this thesis, however, was that the medical practitioners often refer to factors such as weather, winds, air, climate, seasons, lunar position, etc. as causes of dysentery, and an imbalance in body fluids. Furthermore, as the analysis shows, the physicians and surgeons in this thesis did not only try to make sense of the dysentery through treating the sick. They also tried to make sense of it in
199 van Leeuwenhoek 2010. 200 Fisher 1797, pp. 38, 41. 201 Moseley 1781, p.7 202 Sjukvårdsupplysningen [ Medical information] 2019. 203 Scientific knowledge based medicine is identified as mentioned before in this thesis, as knowledge with a process of investigation. 204 Newton 2018. 55 a more clinical way by writing down their observations and treatment regimens so that their understanding of dysentery would benefit society at large. The medical practitioners wrote and made accurate notes of their observations when serving at home or on board vessels in distant countries about their experiences, practical observations and close studies. These notes aimed to contribute new knowledge. Not least, this is shown by Ingram's texts for method development for surgeons, and Cockburn's texts on how he developed medical treatment in order to treat the dysentery. This result is also supported by Haycock,205 who found that analysis and descriptions of the medical practitioners’ own practice were the main way to further one's own and the profession’s understanding of the disease dysentery. These findings were enthusiastically discussed among medical practitioners, which in itself contributed to the development of their own knowledge and understanding of dysentery. As we have shown, the disease of dysentery was seen as something that had to do with organs in the body and especially the organs that produced bodily fluids, such as mucus, blood, bile feces, urine, saliva and sweat. These causes are thus referred to as internal causes. The medical practitioners’ actions based on such understanding led to acts such as trying to get out the "bad" fluids and were probably the reason why they prescribed herbal remedies, laxatives and bloodletting, to name a few such treatment methods. This kind of understanding is based on the pre-disposing cause which meant that the medical practitioner's task then was to balance the natural body flows. Here, the agent is the physician or the surgeon. Furthermore, if the cause of dysentery was understood as caused by external factors such as heat, cold, weather, winds, air, climate, seasons, full- or crescent moon, etc. This also affected the medication prescribed. In these cases it could be usual to use herbal remedies such as cinnamon, rhubarb, bee wax or wine, spirits and sweat inducing drugs like Diaphoretic. Here again, the agent is the physician or the surgeon. The question of whether or not the external factor was contagious was however, the source of great controversy. This is not least apparent from Physicians Mosley's, Fisher's and Akenside's arguments for or against it. Thus, in practice the view that dysentery’s causes were internal was mixed with the view that the causes were external. These two beliefs existed in parallel but they also existed during a time when new knowledge and understanding was being introduced. However, the knowledge about bacteria as cause of the dysentery was still lacking. Eighteenth-century practitioners saw dysentery from the perspective of Humoral medicine and from the perspective of what today is called scientific knowledge-based medicine. This kind of analysis is also supported by other studies. Shulman, in his article entitled “The History of Pediatric Infectious Diseases” argues that very careful and detailed description of diseases was
205 Haycock 2002. 56 associated with a rebirth of medicine, “ and for the first time since Hippocrates clinical observations became important”[---] not least because it allowed for some initial rejection of some of the ancient theories of disease.206 The conclusion that emerges from such thinking about the disease of dysentery is that health on the other hand, is perceived as the opposite, ie. as normal harmony in the balance between different body fluids. This kind of approach is also supported by Bujakova, Straka and Jureckova in their study of humoral pathology. Health is therefore a natural balance between body humors. Physicians’ role is then to be a regulator for this complicated balance. 207 Thus, it is logical that as a physician and surgeon operating in an eighteenth-century context might advocate bloodletting, vomiting, sweating or even provoke more diarrhea than what the dysentery itself caused. However, early modern practitioners did not pay much attention to replacing lost fluid or to dehydration. The understanding was the opposite, namely that the diseased body fluids or their abundance should instead be released. However, it is important to also emphasize the contrast with medical practitioners who stated that there was no cure for dysentery. Theoretically, the physicians’ understanding of dysentery, not only were based on individual experiences of being a helper or a regulator of the imbalance of body fluid, but also on the understanding that is embedded in their own social and cultural context. Thus, when it comes to new theoretical understanding it can be stated that regardless of the knowledge base of the individual medical practitioner no one represented an independent knowledge base; rather they participated actively with each other in a mutually constitutive way in order to shape their understanding of disease of dysentery. Moreover, in practice they drew upon several bodies of knowledge in order to do that. This thesis sought to explore the relationship between medicine and context, or in other words, to show how the context features of the medical practitioners’ understanding, standpoints and thoughts of dysentery and their commitments to patients were interwoven in the individual standpoints. This background makes the medical practitioners’ perspective comprehensible. I suggest that the medical practitioners’ understanding and experiences are the foreground in this thesis and the context of the early modern time is the background in this presentation. Both perspectives are needed to get a full view of the individual experience and understanding from the eighteenth-century practitioners’ perspective. This master thesis gives perspective, as well as a portrayal of early modern societies and societal development where physicians and surgeons actively participated to shape their
206 Shulman, 2004. 207 Bujalkova, Straka & Jureckova, 2001, p. 491. 57 understanding of the time in situations. The physicians and surgeons tried to do so through their observations, which they wrote down in a precise and detailed manner in order to disseminate to others that their knowledge of the disease could be useful. From their accounts we learn that the traditional thinking on diseases such as dysentery was based on the humoral medical theory and that this had major implications for the treatment of the disease. At the same time during the eighteenth-century the thinking of diseases was developed on the scientific knowledge based theory of medicine. This thesis also has shown that an analysis of the disease of dysentery from the eighteenth- century perspective has been worth the detailed attention in order to be a useful resource to others, as to students on different levels. The main conclusions can be summarized in the following aspects: (i) Eighteenth-century perspective on the dysentery derived from two parallel knowledge processes based on Humoral medicine as well as on the theoretical abstract understanding, where diseases to a greater extent is understood on the basis of symptoms and signs, and what today is called knowledge based medicine. (ii) The eighteenth-century physicians participated actively to shape their understanding of the time. They tried to do so through their observations, which they wrote down in a precise and detailed manner in order to disseminate them to others so that their knowledge of the disease could thus be useful. However, no one represented an independent knowledge base; rather they participated actively with each other in a mutually constitutive way in order to shape their understanding of the time. (ii) We can recognize the perspective of the eighteenth-century on the understanding of diseases such as dysentery, even today.
Suggestions for further studies are to increase the perspective of physicians’ and surgeons’ descriptions of dysentery to include social, military and political aspects as well.
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Sources and list of literature
Printed primary sources
Akenside, Mark. 1767, A commentary on the dysentery or, bloody flux. Printed for F. Noble, near Middle- Row, Holborn and J. Noble, in St. martin´s Court, near Leicester Square, London. Ball, 1762. The modern practice of physic: or, a method of judiciously treating the several disorders incident to the human body: In two volumes. (The third edition), London: printed for A. Millar, and solid by T. Cadell. Great Britain England London. Cockburn, William. et al. 1757, Some Observations on the Power and Efficacy Of a Medicine against Loofeneffes, Bloody Fluxes. Printed for the Author, and Sold by M. Lewis, in Paternoster-Row. Fisher, James. 1797. An inaugural dissertation on that grade of the intestinal state of fever known by the name of dysentery. Medicine, Science and Technology, Philadelphia. Houlston, Thomas. 1784 Observations on Poisons and the use of Mercury in the cure of Obstinate Dysenteries. Printed for R. Baldwi, Pater-Noster_Row, By H. Reynell, (No. 21,) Picadilly. Ingram, Dale. 1744, An Essay on the Nature, Cause and Seat of Dysentery in Letter to Dr. Henry Warren of Barbados. Printed for William Beeby, at the Spring Clock, at the Corner of House in Cheapside near the Custom-house. Moseley, Benjamin. 1781, Observations on the dysentery of the West-Indies, with a new and successful manner of treating it. The London medical journal. 1781 august; (2). Robertson, Robert. 1769, Metrological and Physical Observations made in 1769, 1772, 1773 and 1774, on the Coast of Africa and in the West-indies. Printed for E. and C. Dilly, in the Poultry; J. Rorson and Co. New Bond Street & T. Cadwell, in the Strand; and T. Evans, Pater-nofter-row, London. Wade, John Peter. 1791, Select Evidence of a Successful method of Treating Fever and Dysentery in Bengal. Printed for J. Murray, N⸰ 32, Fleet Street. Wilson, Andrew. 1777, An Essay On The Autumnal Dysentery. London: Printed for Hooper and Davis, No. 25, Ludgate-Hill, and G. Robinson, Paternoster-Row. Zimmerman, Jhon George, 1771. A treatise on the dysentery: With a description of the epidemic dysentery that prevailed in Switzerland in the year. John and Fracis Rivington, at the Bible and Crown, No 62. In St. Pauls´s Chureh-yard.
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Jacobsen, Dag Ingvar, 2011. Förståelse, beskrivning och förklaring: introduktion till samhällsvetenskaplig metod för hälsovård och socialt arbete. [Understanding, description and explanation: introduction to social science method for health care and social work]. Lund: Studentlitteratur. Klarer, Mario, 2004. An introduction to Literary Studies. (3ed Ed.) London and New York: Routledge Taylor & Francis Group. Lambert, Andrew, 2000. War at Sea in the Age of Sail, London: United Kingdom. Larsson, Daniel, 2006. Den dolda Transitionen: om ett demografiskt brytningsskede i det tidiga 1700- talets Sverige, [The Hidden Transition: about a demographic long-term change in early 18th century Sweden]. (dr. diss.). Göteborg: Historiska institutionen, Göteborgs universitet. Larsson Lars Edvard, 2015. Sjukdomsteorier och kunskapsförnyelse. Downloaded 2019-08-16 from: http://landberga.se/medicinhistoria/sjukdomsteorier.html Lind, James 1777. An essay on the diseases incidental to Europeans in hot climates. With the method of preventing their fatal consequences. London. Lindberg, Erik, 2018 -09-20. Föreläsningsmaerial om Etiska aspekter i historisk forskning. Uppsala: Uppsala universitet, Historiska institutionen. Mark, Catherine and Rigau-Pérez, José G., 2009. The World's First Immunization Campaign: The Spanish Smallpox Vaccine Expedition, 1803–1813. Bulletin of the History of Medicine. Volume 83, Number 1, Johns Hopkins University Press. Article. Downloaded from: https://muse-jhu-edu.ezproxy.its.uu.se/article/261666 Marshall, Tom, 1997. Scientifick knowledge in medicine: A new clinical epistemology? Literature Review. Journal of evaluation in clinical practice. 3(2):133-8 Mason, 1837. The life of Zimmerman in “Zimmerman on Solitude with a sketch of the author’s life”. (new ed.) by Frederich J. Mason. London: Leighton and Murphy, Printers, johnson’s – court, Fleet-Street. Downloaded from British Library http://access.bl.uk/item/viewer/ark:/81055/vdc_100025709271.0x000001#?c=0&m=0& s=0&cv=11&xywh=-368%2C200%2C2559%2C1563 Moore, Norman, 2004. Ingram, Dale. Oxford Dictionary of National Biographies. Newton, Hanna. 2018, Misery to Mirth. Recovery from Illness in Early Modern England. Oxford University Press, Oxford, UK. O’Neil, Dennis, 2007. Humorral Pathology. Page updated Wednesday December 26. Downloaded 2019-08-16 from https://www2.palomar.edu/anthro/medical/humoral_pathology.htm Oxford Dictionary of National Biographies, 2004. Ingram Dale. Downloaded from: https://doi- org.ezproxy.its.uu.se/10.1093/ref:odnb/14415
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Oxford English Dictionary, The definitive record of the English Language, 2020. Dysentery. Downloaded from: https://www-oed- com.ezproxy.its.uu.se/view/Entry/58878?redirectedFrom=dysentery#eid Oxford English Dictionary, The definitive record of the English Language, 2020. Flux. Downloaded from: https://www-oed- com.ezproxy.its.uu.se/view/Entry/72249?rskey=nUlRHk&result=1#eid Oxford English Dictionary, The definitive record of the English Language, 2020. Miasmata. Downloaded from: https://www-oed- com.ezproxy.its.uu.se/view/Entry/117825?redirectedFrom=Miasmata#eid Perveen, Aisha, Hasan, Izharul & Alam, Tanwir MD. 2015. Humoral Pathology: Adjustment and Regulation. Createrspace Independent Publishing Platform. Royal college, 2020. Scurvy in the College Collections. Downloaded from: https://www.rcpe.ac.uk/heritage/scurvy-college-collections Royal college of Physicians, 2020. History of RCP, timeline. Downloaded from: https://history.rcplondon.ac.uk/timeline Ruiz De Castilla, Clariza, 2018. Close Reading. In the Sage Encyclopedia of Communication Research Methods (Ed. Mike Allen). The Sage Encyclopedia of Communication Research Methods. Sage Publications. Saikia, Arupjyoti, 2019. Geographical Exploration and Historical Investigation: John Peter Wade in Assam. In Bhattacharya, Neeladri & Pachuau, Joy L. K. (Eds.) Landscape, Culture, and Belonging Writing the History of Northeast India. Cambridge University Press Short, Bruce, 2004. Robertson, Robert. Oxford Dictionary of National Biographies. Shulman, Stanford T. 2004. The History of Pediatric Infectious Diseases. Pediatric Research, - special article, A history of pediatric specialties. Vol. 55, No. 1, 163-176. Sjukvårdsupplysningen, 2019. [The medical information] Dysenteri. Downloaded: 2018-08-16 from: 177.se/sjukdomar--besvar/infektioner/infektioner-i-mage-och-tarmar/dysenteri— shigella/ Sjöstrand, Ylva, 2007, Kontroll, humanitet eller bara en fråga om pengar. Läkares diskussion kring införandet av Hälsovårdsstadgan 1875. Svensk Medicinhistorisk Tidskrift volym 11. Taken from: http://www.medicinhistorisktidskrift.se/data/uploads/medhisttid-2007.pdf Sjöström, Oskar, 2008, Fraustadt 1706 – ett fält färgat rött [Fraustadt 1706 - a field colored red.] Taken 2019-08-16 from: https://popularhistoria.se/artiklar/sjukdomar-soldaternas-varsta- fiender
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Sydenham, Thomas, in Dewhurst Kenneth, 1966. Dr. Thomas Sydenham 1624-1689: his life and original writings, London, Wellcome Historical Medical Library,. 123 British Library MS Locke c. 29, ff. 19-20 (1670). Tognotti, Eugenia, 2013. Lessons from the History of Quarantine, from Plague to Influenza A. Emerg. Infect. Dis. 19 (2): 254-259. Tulchinsky, Theodore & Varavikova, Elena (Eds.) 2014. A History of Public Health in The New Public Health (Third Edition). ISBN: 9780124157675, Elsevier Academic Press. van Leeuwenhoek, Antony, 2010. Discovery Of Bacteria. Explorable.com (Jan 13, 2010). Downloaded Aug 11, 2020 from Explorable.com: https://explorable.com/discovery-of- bacteria Vetenskapsrådet, 2017. [The science council]. God forskningssed. [Good ethical standard] Vetenskapsrådet, Stockholm. Wade, John Peter, 1792. Nature and effects of emetics, purgatives, mercurials, and low diet, in disorders of Bengal and similar latitudes. London: Printed for J. Murray, 32, Fleet Street. Weight, John P. 2004. Wilson, Andrew. Oxford Dictionary of National Biographies. Wikipedia, 2020. Antiseptics. Downloaded from: https://en.wikipedia.org/wiki/Antiseptic. Wikipedia, 2019. Opium. Downloaded 2019-08-16 from https://sv.wikipedia.org/wiki/Opium. Wikipedia, 2019. Schwaben. Downloaded 2019-08-07 from https://sv.wikipedia.org/wiki/Schwaben Wikipedia, 2019. Carapichea ipecacuanha. Downloaded from: https://en.wikipedia.org/wiki/Carapichea_ipecacuanha Wilson, Andrew, 1777 / 2002. An Essay on the autumnal dysentery. In Haycock, David Boyd, 2002. Exterminated by the bloody flux. Journal for Maritime Research. 4:1, 15-39.
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Appendix 1. Tabel 2. Medical practitioners’ understanding of dysentery and actions against it.
Medical practitioners’ understanding of dysentery and actions against it Cate- A great suffering Need of more Occurrence Cure and treatment gories knowledge Sub-cate- For For For Personal Medical (Where) (When) (Internal) (External) Cure gories Indivi- Society Humanity A global Season- Cure the Cure the with dual pheno- related imbalance external medica- menon in fluids course tion Exam- A very Which Greatest Constant Deserve Every A fever A careful Dysenterie ples malignant yearly forces of practice, more part of of the continued Cleanliness s are disease proves human to attention the season course of is key in possible to exposing fatal to misery observe from globe them to order to cure with the many physicians keep up a relive the medicine patient to English sweat, disease great seamen Compassion Found by Epidemi Conditio proportion In every danger to our short experienc Are c n of the ed to the A great degree of If not the period of e described disorder air and violence of cleanliness, age, sex, As a most fatal, life, and differently diet the disease. filling the and
rheumatis at least humanity patients constitutio m in the equally so Prompt Dysenter The To cause chamber n; and in intestines with any me to Evidently ies was weather convulsion with fresh all seasons, other Far the make turn to the common alone or s to the air the most some good of the in the the surface of medicine Inflamma Great loathsome anatomic community regiment heavy body and equally tion in terror al inquiry rains to cleanse produces that both of into that Public the its salutary disease the town distemper advantages Bloody Another intestines virtue. and would accrue Flux is cause of Different populous an the The use of Dose of sorts of country Sufficient epidemic dysenter emetic rhubarb, dysentery motives to febrile, y is fluid as a twenty , spirit up the putresce chiefly purgatives grains one learned to nt, from the with Require a find out the painful southerl Bloodlettin another different most certain inflamm y air g is and ten kind of remedy’s ation, suggested grains of cure primarily A the That some affecting residenc The Powder of utility to the inner e in the Ipecacuan Cinnamon society might coat hot ha possibly climates Cordial thence result and White drink And less expensive, Opium form to the every six public hours.
A spoonful of brandy, or of any spirit, may then be given
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Appendix 2. Table 3. Characteristics of the data material (n = 11).
Text Author Title Description of the Symptoms of Causes of Measurements in order Dysentery and the Dysentery Dysentery to cure, relieve or purpose of the text prevent Dysentery (exerpts) (The language in the descriptions below is altered from sf to s in order to make it easier for a modern audience). 1. Fisher, An There is perhaps no Loss of Febris introverta. A Depending on the symptoms Philadelp James. inaugura disease, to which appetite fever of the bowels. bloodletting is suggested. hia, 1797 Fisher l mankind are subject, that The disease might (1774- dissertati more deserve the be `communicated` 1822). on on attention of physicians, Delirium by contact or The use of emetic fluid as a purgatives, James, that or upon which more has …with breathing in Fisher, grade of been said, and more possible infected air in ex. Castor oil the contradictory opinions confined places. of gangrene Delawar intestina advanced, then the Miasmata Injections of cold water. e, l state of Dysentery. And …although A lack of exercise, Member fever notwithstanding the not all of these great fatigue, long of the known many improvements that symptoms walking or great Doses of opium, mercury Philadel by the has been made in medical might appear. heat. These phia name of science; it is too true, that dysenter it still continues to be one conditions will act Medical as a predisposing Society. y. of the greatest forces of human misery among us; cause; particularly in fleets and the poison to which armies, of which it has now has lain been, and still remains dormant, acts with the scourge of every part sufficient force to of the globe. an irregular action and a fever is produced 2. Moseley, Observa A fever of the season, or A fever of the This fever is caused Sudorific (an agent that The Benjami tions on of its own kind, turned intestines. by obstructed promotes sweating. London n. (1742- the inwards upon the perspiration and A careful continued course of medical 1819). dysenter intestines”. that it’s not them to keep up a sweat, journal. Surgeon y of the The Dysentery or constricted to hot, proportioned to the violence 1781 at West- Bloody-Flux, being a wet, cold or dry of the disease. Indies, seasons. august; Kingsto disease so destructive to To cause convulsions to the (2). n in with a soldiers in camps and Dysentery as a new and surface of body and to cleanse Jamaica garrisons, and a constant sickness is a fever of the intestines. successf attendant on all military the intestine that is ul operations in hot caused by manner climates. --- it is of the obstructed of utmost importance to perspiration. treating investigate the disease, on it. every occasion, with the greatest attention, in hopes of finding some method to put a stop to its devastation (p.1). Nor can it be doubted that this fever, like most others, is caused by 66
obstructed perspiration (p.4).
3. Mark A I looked upon the Acute gripping Epidemical To cause convulsions to the London, Akensid commen dysentery, as a in the belly. inflammation. surface of body and to cleanse Printed e tary on rheumatism in the Frequent p.13 – men who are the intestines, (p.41-51). for F. the intestines; not indeed un inclination to naturally of a Noble, (Translat dysenter the same tense./…/ stool. warmer y or, For in every degree of age, near ed from The other signs arising to Evacuations constitution, or who sex, and constitution; and in Middle- latin by) bloody the patient, are not contract a fever flux. with bloody or all seasons, the medicine Row, John precisely examined by mucous from other causes , equally produces its salutary Holborn Ryan this rule, but are matter. a dysentery is virtue. and J. M.D. described differently by attended with a Noble, in different authors; but as I fever; but in an Fellow Fever St. of the had frequent years encampment or martin´s College constant practice, to from some peculiar Court, of observe several things, condition of the air near Physicia which either did not and diet, the face of Leicester ns, occur to others, or have the disease will Square. Member appeared to them in a become different. 1767 of the different light from what they did to me, the right Royal Society, understanding of which, and would in my opinion, physicia evidently turn to the n to her good of the community, I determined with myself, present to lay before the public, Majesty what I found by experience to be almost of an infallible efficacy: (Translat /…/ it may happen that ed from there may be as different latin by) sorts of a dysentery, as of John the small-pox, and other Ryan epidemic disorders, and M.D. which, on that account, require a different kind of cure in some, (p. 4). 4. Robert Metrolo The following Journals Frequent loose The weather alone The more distressing is, there London: Roberts gical and and Observations are the stools, or the heavy rains, not being any certain method Printed on Physical result of an unwearied -sometimes in my opinion , of curing it yet discovered, for E. and Surgeon Observa and close attention to with blood or were sufficient to (p.170). C. Dilly, of his tions nature and diseases in a violent gripes. occasion the fever Majesty’ made in distant part of the world, in the (on three different Robertson points out that Poultry; J. s Navy 1769, and in a climate which vessels at three 1772, yearly proves fatal to A soreness of cleanliness is key in order to Rorson different locations), relive the disease, however he and Co. 1773 many English the belly. (p.21). and seamen./…/Hence, I criticizes several other cures New and treatments suggested by Bond 1774, on Apprehend public A pain and other doctors, such as: Street & the advantages would accrue. weakness of Bloodletting, Opium, T. Coast of The unexperienced and the loins, Ipecacoanha, Cadwell, Africa young Surgeon, sent to together with Toasted or untoasted in the and in different climates/…/be a nausea and Rhubarb Strand; the furnished with a guide to thirst and T. West- avoid errors and mistakes Evans, indies. of dangerous consequences. Pater- A Quicker pulse. nofter- Physical Of all the diseases which 67 row. 1769 Journal infest a ship’s company, kept on the dysentery, in my board opinion, if not the most Hotter skin His fatal, is at least equally so and dryer than Majesty´ with any other, and by far natural. s ship the most loathsome. Fever Rainbow (p.169). , During three voyages to the Coast of Africa, and West indies, in the years 1772, 1773, and 1774: 5. Dr. Some Dysenteries were Pain, Dose of rhubarb, twenty Printed William Observa common in the regiment. Griping all grains one with another and for the Cockbur tions on Dysenteries are possible over the belly, ten grains of the Powder of Author, n the to cure with medicin. Cinnamon (p.16). Power Liquid and Sold et al. ” Had I any other design, extrements Cordial and White drink. by M. and By the Efficacy the World would equally mixed with Opium every six hours. Lewis, in late Dr. be surprised with the blood Paternost Of a William Medicin reatnes of the Cures, and er-Row Cockbur the Boldnes of an 1757. e against n, Of Loofene invidious Inquiry that was the ffes, once made inte Succes of College Bloody my Medicine”, (p. 44). of Fluxes. Physicia ns, and Fellow of the Royal Society; late of St. James’s- Street. 6. Dale An “Compassion to our Neausea, “The dysentery is The Ipecacuanha Cinamon (in Printed Ingram Essay short Period of Life, and Reachings, caused by to treat a various forms) for Surgeon on the Humanity to the Strainings, quantity of bilious Diaphoretic medicaments. William and Nature, Afflicted, are sufficient juices, flowing Man- Cause Motives to Spirit up the Abdominial continually, and to It is sufficient to understand Beeby, at muscles in that they are only to be the Spring Midwife and Sea Learned to find out the abundantly into the (view ?) most certain Remedy’s violent action. duodenum, caused administered by able Clock, at physicians but even with the the of for such Distempers More pungent by some disorder of Dysente (p.3). bile is thrown the liver and gall- utmost tenderness and Corner of circumspection, first weighing House in ry in /…/ The Multitude that into the guts bladder, from which Letter to in greater arises the griping the occasion, season, age and Cheapside have sunk under the fatal constitution with the near the Dr. Dysentery, which hath quantities now and grumbling pains Henry than at other in the bowles which symptoms and stage of the Custom- for some time reigned in distemper, (p.48). house. Warren this Town and Island in times. are well known to of be the first 68
1744 Barbado General, have so far take symptom of this s. up my Attention, as to The first disease” (p.23). prompt Me to make symptoms that some Anatomical Inquiry attack the into that Distemper, and tender boy, are /…/ Another cause as I know your Humanity griping pains of the dysentery is and good Nature must for two or chiefly from the Commiserate this general three daysm southerly air, that in Calamity. accompanied one time of the year with frequent blows here, and as /…/ I shall thin myself soon as the winds sufficiently recompensed large bloody and slimy begins to chop for this my small Labor about to the towards the publick stooles (p. 36). southward, Service” (p.2). dysentery’s make The last stools their appearance, that are voided for then as it were before the natural climate Deathm are is altered, the air most being at such times commonly of more moist, a blackish phlegmy and light, yhellow and then when it was very frothry, northerly, therefore (p.39). it is not to be wondered at, that the humane structure becomes to much unbraced, and when so the consequence will be a relaxation of the liver and other secretory organs, they being by their natural structure more subject to be unbraced, (p.30). 7. Andrew An Within lest then two Fever, There is one Purging, Printed Wilson, Essay months after I went to putridity of observation which Bolus’s or soft pills of for M.D. on the reside at Newcastle, an the blood, seems to argue, that rhubarb or ipecacuan Autumn epidemic of Dysentery (a inflammation the corrupted state Hooper Fellow and of the al disease they had no of the rectum. of the bile should Davis, Royal Dysente memory of the place (p. ix). rather be ranked It has already been observed No. 25, College ry. being ever visited before) among the causes that this deasease ought to be broke out there with then among the regarded as a fever as well as a Ludgate- of I have already Hill, and Physicia great violence, and to the effects of this tropiclal inflammation: as great terror both of the classed this disease. It is, that such it requires the use of G. ns at disease among Robinson, Edinbur town and populous when the dysentery every medicine proper in country about it, in the the bebrile is epidemic, it is not autumnal fever which is not Paternost gh, and ones. er-Row. Physicia beginning of the month uncommon for contrary to the disease as a 1777. n of the of August, after an people who escape flux; such as bleeding, uncommon heat and the dysentery itself, Medical The perminant diluters, cordials, drought for several to have their stools Asylum, concominant perspiratives, nay even months /…/ There is no altered from their London complaints sometimes blisters ( I do not disease that demands natural color to attending it men a the unmerciful abuse more the use of warming sometimes a after it is of them) may be necessary. As cordials than the greenish hue, as if formed are, a dysentery, it demands dysentery does; as is they had eaten constant fever, vomits, purgatives, emollient evident from the faintest, much hearbs; dought, balsamic incrassants, clammy sweats and low sometimes of a clay parchedness persouratves, anodynes, 69 pulse that are so frequent of the mouth colour, and antiseptics. in it; nor can they have and throat, sometimes, quite any bad influence on the dejection of blackish, as if they The simple and proper primary seat of the the spirits, had eaten a quantity method of treating this inflammation in that profilation of of blood. But as disease will appear more disease, (p.viii). the strength, diseases airing from plainly by surveying the three The Bloody Flux is an sickness at the the irritation of the general indications of cure; epidemic febrile, stomch, bile in the Primae which are, 1st, Yo allay the putrescent, painful frequent Viae, generally fever and resolve the inflammation, primarily viscid, acid, or manifest themselves inflammation. affecting the inner coat, bilious by acute pains in the vomiting, stomach and small 2dly, To resist the tendency to but gradually extending putrefaction in the fluids. itself through the whole flatulency in guts (p.15-16) substance, or all the coats the belly, 3dly, To support and promote wringing pain the peristaltic motion of the of the great guts, There seems to be especially of the lowest or in the lower intestines (p.31-32). part of it, and an universal consent rectum. (p.2) /…/ often in the among aneients The disease is called the same region of (ancients?) and bloody Flux, because the back; these moderns in fixing more or less blood is pains upon the vitiated generally, though not sometimes bile, or a vitiated always, mixed with the constant but secretion of it, as a slimy, fetid stools which always leading cause (a are discharged during the preceding leading symptom it course of it. (p.2). stools (p. 29- undoubtedly is) of 30). all autumnal, putrid redmittent, intermittent, &c. /…/ but the diseases of a signs of malignant type. immediate Numberless danger are, modern decrease of observations and pain, great treatises’ sinking of the (behandlingar) on spirits, the diseases of hot lowness of the climates, all seattle pulse, on this. But few beginning have attempted to coldness of explain how, or why the such climates extremities, should have such a parchedness seeming direct and and blackness primary influence of the tongue, upon the liver, it’s apthae, white connexions and (fcurf) or secretions. ulceration of the throat and If the distinction I (fauces), and have made of the constant three surfaces below hiccup. in page and of their subservience to each other does not throw some light into that subject, I won I do not know how, otherwise to account for it. – It is certain that by continued
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greatdegrees of heat the constitution is unaccustomed to, besides relaxing the solids and rendering the circulation languid in general by increasing the perspiration excessivly, both the action and the secretions of the intestines are remarably retarded, which circumstances cannot fail of affecting the liver and its secretions, elaborated from the returning venous blood of the intestines (p.15). 8. Thomas Observa In compliance with the Intermittent I have found in The practice now Printed Houlsto tions on sentiments of those who fever, many instances recommended, I apprehend, for R. n, M.D. Poisons have judged favourably loss of where after a has been sufficiently Baldwi, Physicia and the of them, and hoping, appetite, residence in the hot experienced to justify, a trial Pater- n to the use of with them, that some vomiting, climates, the liver of it. Succes in a number of Noster_R Liverpo Mercury utility to society might has been obstructed cases can alone establish its in the possibly thence result, violent pain of and enlarged, that propriety. /…/ ow, By H. ol the belly, Reynell, Infirmar cure of they are now offered in a very great benefit The dry vomit, as I Observed (No. 21,) y, and Obstinat more commodious, and shivering and has been obtained above, is a composition of Picadilly. honorar e less expensive, form to fever, by the gradual, and equal parts of tart. emet. and Dysente the public. prudent use of Picadilly. y bloody stools. vitr. roman. A quantity of it is member ries mercurial… (p.64) mixed at once, and the dose M,DCC, LXXXIV. of The It would seem, at first of this mixture, commonly Literary given, is five grains, on an sight, that no medicine and was less adapted to the empty stomach, in about half 1784 Philosop cure of Dysentery than a meat-spoonful of water. The hical Mercury (a drug patient is directed to drink Society containing mercury nothing after it. In a short of [kvicksilverföreninar]); time after swallowing it, Manches and yet the following sickness is produced, and ter cases, which, having quantity of bile (galla) is occurred in the public generally thrown up. To take Infirmary at Liverpool, off the sickness, a spoonful of were seen and known by brandy, or of any spirit, may numbers, will, I flatter then be given, and if that myself, evince that the should come up, a second. application of it in certain circumstances is founded in reason, and justified by success (p. 55). 9. John The The simple and the fullest But we may This disease may First to bleed, then to give an London: Ball modern definition I can give of a make use of proceed from an emetic or two if Printed M.D. practice Dysentery, is what some certain increase of the same ipecacoanham and after that a for A. of follows. A Dysentery, is a signs, in order causes which brings lenient purge or more of Millar, in Physic: frequent discharge form to distinguish on a diarrhea; for a rhubarb; and after the bowles the or, a the bowels of blood the particular Dysentery is a havem been these means, 71
Strand, Method mixed with slime, place where bloody diarrhea, been duly prepared by 1762 of ichorous matter, liquid this distemper attended with evacuating the acrid humous judicious excrements, skinny is seated: for if griping or great pain therein contained, we may ly slough, and sometimes a the small in the intestines then safely have recourse to Treating fleshy substance intestines are (p174-175). balsamics, agglutinants, the resembling the inner coat affected, the astringents, and opiates, Several of the intestines; pain is seated which must be contrived in Disorder constantly accompanied higher near proportion to the necessity of s with a sever griping pain the navel; and the patient, the violence of Incident the in the guts, (p.174). there is a the flux, and the length of it’s to The greater interval duration (p.178). Human between this Body: and the stool: Togeath the blood and Three or four drachms of er with a whatever part rhubarb, and as much syrup Recital of this of marchmallows, as is of their intestine is necessary may be occasionally Causes, discharged are added to this electary (p.178) Sympto more exactly ms, mixed with the The butyrum carae Bateanum, Diagnos exrements; the made by melting bees-wax in tics, delirium recurs spirit of wine upon the fire, Prognos more and filtering off the spirit, that tics, and frequently and it may remain in the paper like the with greater butter, may be an excellent Regimen vehemence: medicine in painful necessar there is a fever Dysenteries (p.179). y to be and a drought
observe (p.176).
d in regard /…/ black of them. blood mixed With A with the Variety exrements, as of also with Efficaci yellow bile ous and (p.176). Elegant Extemp /…/ greater oraneuo thirst and us nausea, as Prescript likewise a ions, greater adapted loathing of to each food and particula sometimes a r Case vomiting and ensues (p.177). Circums tance.
10. John Fever On first Although I cannot The medicines employed Printed Peter and seizure, blood find any specific latterly were bark and for J. Wade Dysente frequently explanation for the anodyne draughts. Murray, M.D. ry in accompanied cause of dysentery N⸰ 32, Of the Bengal with stools the author seems to with severe place great Three glasses of red winem Fleet Honour and middle diet, had been Street. able gripping and importance on the straining, weather. In the allowed daily. East- 72
1791 India (p.242). preface he describes A pill of four grains of Compan at great length the camimel, and one of opium, y’s weather and climate to be taken at bed-time and a Bengal even terrain of solution of salts in the Establis Bengal. Further he morning until larger and hment even seems to easier stools have been connect his cases to produced. (s.242). the moons lunar faces and in each case he points out if it was a “full moon” or “new moon.
It is to be presumed that these cases may prove a body of evidence, by which the system of lunar influence in Fevers may be judged”, (p.x). 11. Translat A The dysentery has raged All those who The weather this IN the beginning, I effected Printed ed from Treaties this year in the canton of were violently year seemed this by a vomit, that consisted for John the on the Bern, in the marquifate of disordered, perfectly favourable at most of Forty grains of and Original Dysente Torgau, in divers other were seized at to this dysentery. ipecacuanha, and the weight Francis German ry: With parts of Switzerland, and first with an The air was in June was diminished in proportion Rivington of John a in Swabia. It has ben also universal chill very inconstant, but to the age of and other , at the George Descript very formidable in those (p.2). for the most part circumstances of the patient Bible and Zimmer ion of districts of Upper- humid; and when (p.50). Crown man, the Austria, which lie nearest the sun broke forth, M.D. Epidemi to us (p.1). /…/ The there ensued a (N⸰ 62.) cholic came As I gave it, it excites the in St. Physicia c /…/. Many were taken suffocating heat: n in Dysente on July was full as vomiting three or four, or Paul’s with this malady, without immediately at even eight times. This Church- Ordinar ry That the least preceding changeable; but the y to His prevaile the beginning, heat never rose to vomiting took away the yard. 1771 symptom, and that with great thickness, and the more gall Britanni d in chiefly in desperate cases; so high a pitch: c Switzerl violence; but August was, during there came away, the more in others, it gave tokens the service it did; I have even on Majesty and in of its approach before the better half, at the Year evacuation, cloudy and rainy: the third day of a confirmed, hand, and came on by with some though not very violent Hannov 1765 degrees (p.2). afterwards the days er, by people, did were fine and very dysentery, with forty grains of C.R. not follow so warm, and at the ipecacuanha, brought away Hopson, The putrid fever in May quick (p.2). same time the from a farmer’s daughter such M.D. 1765, seized on the nights extremely an astonishing quantity of cold: till the middle bilious matter, that the children and adults in my neighborhood, so very of September, and dysentery was entirely suddenly, that they were longer, the sky was subdued at once (p.51). perfectly in health, and continually clear, at noon, it was extremely ill, within the Cream of tartar space of a quarter of an extraordinary hot, in hour (p.11). the morning, evening, and chiefly Tamarinds throughout the
whole knight, intolerably cold, Rhubarb afterward the air grew foggy, damp, and cold; and we Barley-water had fine weather and rain by turns: 73
October was very variable, though for the most part cool; and the close of the month was stormy, rainy, and pretty cold. By means of these great changes from heat to cold, the perspiration was by turns first promoted, and afterwards on that very account the more violently checked; thus the putrid scum of our bodies remained for the most part behind, and was forced to empty itself into the inner cavities.
I have, indeed, remarked, that those chiefly were taken with the dysentery, who after having much heated themselves, cooled themselves directly after; especially such as drank great quantities of cold water, when they were in a profuse sweat. This seemed to be the reason, that most of our peasants fell sick of the dysentery. In general, it is not the cold that follows on heat, and remains, but that which succeeds heat, and gives place to it by (fits, / sits?) that is considered as the cause of the dysentery (p.20-21).
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