19. Many causes concurred to produce, and increase this fever; such as the want of cleanliness, excessive fatigue, the ignorance or negligence of officers in providing suitable diet and accommodations for their men, the general use of linen instead of woollen clothes in the summer months, and the crowding too many patients together in one hospital, with such other inconveniences and abuses, as usually follow the union of the _purveying_ and _directing_ departments of hospitals in the _same_ persons. But there is one more cause of this fever which remains to be mentioned, and that is, the sudden assembling of a great number of persons together of different habits and manners, such as the soldiers of the American army were in the years 1776 and 1777. Doctor Blane informs us, in his observations upon the diseases of seamen, "that it sometimes happens that a ship with a long established crew shall be very _healthy_, yet if strangers are introduced among them, who are also _healthy_, sickness will be mutually produced." The history of diseases furnishes many proofs of the truth of this assertion[51]. It is very remarkable, that while the American army at Cambridge, in the year 1775, consisted only of New-Englandmen (whose habits and manners were the same) there was scarcely any sickness among them. It was not till the troops of the eastern, middle, and southern states met at New-York and Ticonderoga, in the year 1776, that the typhus became universal, and spread with such peculiar mortality in the armies of the United States. [51] "Cleanliness is founded on a natural aversion to what is unseemly and offensive in the persons of others; and there seems also to be an instinctive horror at strangers implanted in human nature for the same purpose, as is visible in young children, and uncultivated people. In the early ages of Rome, the same word signified both a stranger and an enemy." Dr. Blane, p. 225. 20. The dysentery prevailed, in the summer of 1777, in the military hospitals of New-Jersey, but with very few instances of mortality. This dysentery was frequently followed by an obstinate diarrh[oe]a, in which the warm bath was found in many cases to be an effectual remedy. 21. I saw several instances of fevers occasioned by the use of the common ointment made of the flour of sulphur and hog's lard, for the cure of the itch. The fevers were probably brought on by the exposure of the body to the cold air, in the usual method in which that ointment is applied. I have since learned, that the itch may be cured as speedily by rubbing the parts affected, two or three times, with the dry flour of sulphur, and that no inconvenience, and scarcely any smell, follow this mode of using it. 22. In gun-shot wounds of the joints, Mr. Ranby's advice of amputating the limb was followed with success. I saw two cases of death where this advice was neglected.