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NATIONAL LIBRARY OF MEDICINE
             Washington
Founded 1836
U. S. Department of Health, Education, and Welfare
             Public Health Service 
 
 
 
 
               Sow*.


A N
INAUGURAL DISSERTATION
                    ON            .  , fV

      DYSENTERY.     f':A
vfe
     SUBMITTED TO THE PUBLIC EXAMINATION

                   OF THE

   FACULTY OF  PHYSIC,

          UN&ER THE AUTHORITY OF THK

 TRUSTEES  OF COLUMBIA COLLEGE,  ,
                  IN THE

           STATE OF NEW-YORK,

WILLIAM SAMUEL  JOHNSON,  LL. D. Prefident;

             FOR THE DEGREE' OF

    DOCTOR   OF  PHYSIC,

        ON THE SIXTH DAY OF MAY, 1794.
\
By  DAVID  G.  ABEE  L, ^-—^
        Citizen of the State of New-York.   s "'- * $^  i-^-\\

The lip pale, quivering', and the beamlefs eye, \ ^ *         ,^^4.
No more with ardour brighti----        \     f^rZT^Tb^
                           Thomsso-n.LBia Kt*
               NEW-YORK:
Printed by T. and J. Swords, Printers to the Faculty of Phyfic of
        Columbia College, No. 167, Willi am-Street.
                 — 1794.—. 
m 
ISAAC ROOSEVELT, Prefident,

MOSES ROGERS, Treafurer,

JOHN H. LIVINGSTON, D. D.1
JOHN RODGERS, D. D.
ABRAHAM BEACH, D. D.
JOHN BROOME,
JOHN SLOSS HOBART,
SAMUEL OSGOOD,
JOHN WATTS,
MATTHEW CLARKSON,
JOHN COZINE,
LAWRENCE EMBREE,
.Managers of the
/ City Difpenfary.
J
JOHN CHARLTON, Prefident
           and
THOMAS JONES, VicerPrefident
THIS
PISSERTATION

          Is refpedfully inferibed,

            By their moll obedient,

              Humble fervant,
DAVID G. ABEEL. 
mm 
                         A

DISSERTATION

                        O N

      DYSENTERY.
JL/YSENTERY is a difeafe to which Phyficians have
only  of late  years annexed precife  and accurate ideas.
Every increafed difcharge from the inteftinal canal, of a
morbid nature,  and  particularly  if  accompanied  with
fome mixture of blood, was formerly confidered by  Phy-
ficians as Dyfentery.   Hippocrates himfelf feems to have
confounded the terms Dyfenteria, Diarrhoea  and Lienteria,
and to have applied them rather to exprefs particular ftages
of the fame complaint, than to have viewed them as dif-
tin& and different difeafes.*

   About  the  middle of the  prefent century, when Thy-
ficians and Philofophers became ufefully engaged in invef-
                                                tigating

               * Vide Hipp. Op. Epid. et Apb. 
                        (  6   )
tigating the caufes of difeafes,  with a view  to their more
effe&ual prevention and fuccefsful  cure,  the caufes of
dyfentery were with more accuracy  afcertained, as being
produced by a fpecific contagion.   Sir John Pringle is
among the firft whofe obfervations have tended to enlarge
our ideas on the nature of this complaint.

  Dyfentery,  as defcribed by the  moft refpe&able writers
in medicine,* is a difeafe  which  appears  to be of only
one  fpecies;  and though  if is fometimes  accompanied
with  intermittent  fever,  with miliary eruptions,  and is
often attended with difcharges of worms and other matters
from  the inteftinal  canal;  yet thefe circumfiances  can
only produce varieties of the fame difeafe.

  Doftor Cullen has  accurately  defined  dyfentery by
the following chara&eriftic fymptoms. .--■■•-•      -

  " Pyrexia contagiofa,  deje&iones firequentes, mucofae,
vel fanguinolentae", retentis plerumque foecibus alvinij,
tormina, tenefmus."f

  * See Sydenham, feci. Iv. chap. 3.  Huxam de Aere, &c. ad. ann.
1743.  Cleghornvs Difeafe«f Minorca, chap. 5. Pringle's Difeafe of the
Army.  Monro's Difeafe of the  Army,  1761.  Zimmerman on the
Dyfentery, 1765.
  f Culleni Synopfis Nofolog«e Methodicae.
HISTORY 
(  1  )
        HISTORY OF THE DISEASE.

    DYSENTERY is commonly preceded by a fenfe of
  coldnefs, more or lefs laffitude, and pains of the head,
  back and loins, which are afterwards  followed by increaf-
  ed  heat—Thefe fymptoms are fucceeded by pains in the
  bowels, about the region of the  naval, which have  been
  called  by the Latins tormina—Thefe pains are accom-
  panied with a defire of  evacuating the contents of the
  inteftines;  which is fometimes  efFeded,  attended  with
  difcharges of mucus and more  or lefs  blood.   After a
 few ftools, the difcharge  becomes liquid and of a yellow
 or brown colour,  with mucus, and fometimes pure bloodj
 The foeces are then difcharged in nodes or hard lumps,
 called by authors fcybala, the freeing the inteftines from
 which commonly  gives relief.

   When  the  fymptoms firft  come on, they are often at-
 tended  with  naufea  and vomiting, when a matter of a
 green colour, and of a bilious nature,  is  eje&ed.   The
 patient complains  of great thirft and a difagreeable bitter
 tafte.  The tongue is commonly covered with a  whitifh
 or yellow fcurf; fometimes it is brown, and in fome cafes
 black.  The  patient  has  feldom  any appetite for food,
 and  ufually complains of great proftration of ftr/ength.
 In fome inftances the patient is very coftive in the be-
ginning of the difeafe,  and  the abdomen  is fwc lied in
confequence of its being  diftended with  wind.    As the
                                              i difeafe 
                       (  8  )
difeafe increafes,  the  patient is  affeaed  with  more fre-
quent defires of  evacuating  the  contents  of  the  intef-
tines, but without producing that effea.  Subftances  of
a firm and compaa  texture, refembling  pieces of cheefe
or fat, and even parts  of the villous coat of the inteftines,
are fometimes difcharged.  There is  alfo a fluid, in ap*
pearance like pus, at times evacuated.   Unlefs purgative
medicines are adminiftered,  it is rare  that excrementitious
matters are thrown out of the inteftines.

   The efforts to evacuate the contents  of the inteftines
are accompanied with tormina, tenefmus, and much pain;
the  patient  having a  fenfation  as if the inteftines were
<ompreffed and cut.   Painful hemorrhoidal tumours  are
apt  to take  place in  thofe who have been  previoufly  af-
feaed with  them.  A prolapfus ani is alfo frequently
 produced, efpecially  in  young  perfons.   The  urine is
 cften  difcharged  with pain, difficulty, and a fenfe of
 hat.  Food taken into the ftomach is frequently ejeaed,
 wthout having  fuffered  much change  from the  organs
 of  d'tfpftion;  and in fome cafes the  aa  of deglutition
 hai been followed by griping pains  and tenefmus.  The"
 puife is frequent, but, except in thofe  who  are very ro-
 buf:, rarely hard or ftrong.

    The  dyferiteric and  febrile  fymptoms are commonly
 increifed towards evening,  but remit fomewhat towards
 morning. Before this difc-.ie proves fatal, all the fymptoms
 become more  feverc.  The tormina  and dejeaions are fo
 frequmt that  the patient  has fcarcely any intermiflion of
                                                  pain. 
                        I   9   )
pain. ; What is  difcharged  from  the  inteftines  is of  a
Very foetid nature, and frequently involuntary.  The pulfe,
during this ftage,  is fmall and frequent;  the tongue is black
and dry ; the thirft very gteat, and eVery" fyrnptom of debi-
lity manifefts itfelfj  fuch  as hlfccough,  cold fweats, pale-
nefs of the face:, coldnefs  of  the extremities, difficult  de-
glutition, and, laftly, aphtha?  in the mouth and fauces,
fvvelling of the abdomen,  involuntary difcharge of fceces
and urine, delerium, and a ceflation of pain,  are the fore-
runners of death.   With the above defcribed fymptoms, in
part or in concurrence, the difeafe continues an uncertain
length of time.   When the complaint is mild,  it fometimes
terminates in four or five  days: when  more  fevere,  not
till fourteen or fifteen days, and fometimes even later.

   When the dyfentery is  of a mild kind,  the  fymptoms
of tormina, tenefmus, and alvine excretions are  lefs fre-
quent;  the  excretions  more  natural,  lefs  mixed with
blood  or mucus,  and  not  of fo  difagreeable a fmell;
the appetite  for  food is ftronger, there is lefs thirft, and
the patient has more refrefhing  fleep.

   In this difeafe, the pains which, in  the beginning,  oc-
cupied the whole abdomen, feem, in its advanced ftate, to
be more circumfcribed, and to be confined to the infe-
rior part of  the  colon and  beginning of the  reaum.
When the pains are very fevere,  it commonly  happens
that the fmall inteftines are alfo affcaed,  as there are  a
greater number of nerves diftributed among them.

                           B                       As 
                      (   io  )
  As dyfenteries ufually  appear in  the  beginning of au-
tumn, the fever which attends them commonly puts on a
fynochus  or typhus  form;  fometimes, however,  they
are  combined with an . intermittent or  remittent fever.
Dyfenteries  have alfos fometimes  appeared  in the fpring
and fummer, and then have had fome conneaion with the
difeafes which ufually prevail at  thofe feafons of the year.


                 DISSECTIONS.

  ON examining the bodies' of thofe who have  died  of
dyfentery, the inferior parts of the colon and reaum have
been found of a black colour, and of a putrid appearance;
their coats preternaturally thickened,  and the internal parts
ulcerated. Red puftules, refembling thofe of the fmall-pox,
have been found  in the inner coats of the  inteftines.*
Schirrous tumors have alfo been difcovered fometimes in the
colon. In almoft all cafes in which gangrene had not taken
place to any great degree, confiderable portions of the large
inteftines have been found affeaed with a preternatural
conftriaion.-f
                 DIAGNOSIS.

  THE difeafes which may be miftaken for dyfentery  are
diarrhoea and cholera: but a little attention will enable  the
Phyfician to eftablifh the proper diagnofis.
                                                   In
    * Pringle's  Difeafes of the Army, p. 146.
    f Cullen's Firft Lines, vol. ii. p. 294- Par« I077- 
                        (   II  )
   In diarrhoea there is no idiopathic fever, the tormina and
 tenefmus are lefs violent, and the difcharges from the intef-
 tines are more natural.  In dyfentery the ftools  are more
 putrid, and  mixed  with more blood than  is commonly
 obferyed in diarrhoea,

   Dyfentery is  diftinguiflied from cholera by lefs copious
 bilious vomitings.   In cholera the ftools are large,  and
 mixed with confiderable quantities, of bile, but rarely any
-blood; there is no tenefmus,  and  the fpafms of the mufcles
 of the legs, which are charaaeriftic of cholera, rarely take
 place in dyfentery.   It muft alfo be obferved, that dyfentery
 is a contagious difeafe, and may be-diftinguilhed from other
 complaints by its prevailing as an  epidemic.



                     CAUSES.

   THESE may be divided into Remote and Proximate.
              REMOTE CAUSES.

   THE remote caufes may be divided into two kinds:
   i. Such as predifpofe perfons to this difeafe; or,
   3. Such as occafion or bring on the difeafe in thofe who
       are already predifpofed.
   The firft are called predifponent; the fecond, occafional
or exciting caufes—Thefe are now to be defcribed.
PREDISPONENT 
(   I*  \
        PREDISPONENT  CAUSES,

  PREDISPOSITION,  according to Doaor Brown, Is
that ftate of the body not fufficiently difordered to produce
difeafe; but, by verging towards it, renders a perfon fufcep-
tible of  the operation of the occafional or exciting eaufe.*
This ftate may be brought on by all thoiS caufes which
induce debility of the whole fyftem, and efpeciatty of the
alimentary canal.

   The caufes which debilitate the whole fyftem are ufually
too great  fatigue, and  depreffing paffions of the mind.
Thefe alfo  affeft the ftomach and  inteftines,   and  are
 known  to  have frequently interrupted digeftion, and to
 have induced ficknefs, naufea, and vomiting.

   Intoxication alfo debilitates the fyftem.  Small quanti-
 ties of  fpirituous liquors are known to exhilarate the Ipi-
 rits, and to give vigour to the fyftem: but when taken in
 too great quantities, or often repeated, they diminifh the
 nervous power, and bring on fymptoms of debility.

    The fummep heat, by debilitating the body,  alfo predif-
 pofes to  this complaint: hence  foldiers, who  have been
 much  expofed and a&ively employed in the fummer, are
 ufually taken with this difeafe towards autumn.

                                                 Cold,
f Brown's Elements of Medicine. 
(  13  )
  Cold, applied to tine body, efpecialiy at night or during
fleep, may be confidered as the moft, frequent predifponent
caatfe of, this difeafe.

  In  warm  climates, and in this  country in  autumn,  it
is very  common  for us to obferve  confiderable viciflitudes
of heat  and cold in the fpace  of  twenty-four hours.  A
fmall change in the thermometer produces a great effea on
the body, when warm  or previoufly heated: hence cold^,
applied to the body,  appears to have different eflfeas:

   l.  By debilitating the body, it predifpofes to favour the
operation of contagion.

  %.  By interrupting the determination  to  the furface,  it
caufes a greater determination to the inteftines; and,

   3.  By preventing the excretions of the various noxious
humours from the body, contributes to favour putrefcence
in the fyftem.

   When we confider thefe different effeas of cold in pre-
difpofing the fyftem to the attack of this difeafe, we may
readily  conceive  the reafons which have induced many
Phyficians to fuppofe cold to be the occafional or exciting
caufe of dyfentery.   When we reflea  that cold,  applied
to the body irt the winter,  under certain circumftances,  is
the caufe of  catarrh,  and  many  other difeafes affeaing
the thorax,  it may have a greater agency in producing
dyfentery than is  at prefent imagined.   Cold,  applied to
                                                   the 
                       (  14   )
 the  feet, is known to affea the inteftines, Infomuch that
 it is often prefcribed to obviate great degrees of conftipa-
 tion.  Cold is known to be the exciting caufe of diarrhoea,
 and  perhaps is more powerful in producing dyfentery, than
 aaing as a predifponent caufe only.

   Moifture,  combined with heat and cold,  renders the
 morbid operation  of each the more  powerful;  and hence
 it may be confidered as concurring with thefe in effeaing
 a predifpofition to dyfentery.

   In the  latter part  of fummer or beginning of autumn,
 there is much moifture in the atmofphere, in  confequence
 of the fummer heat: it is then that people are much dif-
pofed to  contraa  dyfenteries,  efpecially  in fleets and ar-
mies, where the foldiers and failors are much expofed to
the viciflitudes  of  heat and cold, from the peculiar fitua-
tion  in which they are placed.

  Previous difeafes, by weakening the fyftem and derang-
ing the different funaions, predifpofe  the body alfo to the
operation  of every kind  of contagion,  and efpecially to
that which produces dyfentery.

  Thefe,  and other  caufes  which debilitate  the fyftem,
have a manifeft effea in favouring the operation of the
occafional or exciting caufe of dyfentery, which we come
next  to confider.
OCCASIONAL 
(  i5  )
  OCCASIONAL OR EXCITING CAUSE.

   AN occafional  or  exciting caufe is  only  a poflible
 caufe, and does not produce its effeas unlefs under certain
 circumftances.  What thefe circumftances are,  I fhall not
 pretend pofitively ta determine; but they feem to be thofe
 which are marked as conftituting a predifpofition.

   The celebrated Doaor Cullen, after attending to the
 nature of dyfentery, fays,  that " the difeafe is always con-
 tagious, and by the propagating of fuch contagion, inde-
 pendent of cold or  other exciting caufes,  it becomes epi-
 demic in camps  and other places.  It is therefore to be
 doubted, if the application of cold does ever  produce the
 difeafe, unlefs when the fpecific contagion has been previ-
 oufly received into  the  body;  and, upon the  whole, it is
 probable, that a fpecific contagion is to be confidered as
 always the remote caufe of this difeafe."*

   But what the nature of the  contagion is that produces
 dyfentery, does not feem to be perfeaiy underftood; nor
 is it more evident what are the fources of its produaion.

   As dyfenteries  are commonly combined with fynochus
 and typhus, and  fometimes with intermittent and remit-
 tent fevers, it  may be doubted whether the fever accom-
 panying dyfenteries  does not arife from  the  fame  caufes
which produce thofe complaints, namely, marih or human
                                             effluvia;
       *  Culleft's Frrft Lines,  par, 1075, 
                      t   16  )
effluvia; and whether the local affection of the inteftines is
not owing to  a morbid  determination to thefe parts, in
confequence of the  operation of cold or other caufes.*
It is, however,  certain,  that  fonie fpecies  of contagion
feem to affea  certain parts of the body in a peculiar man-
ner.   Thus, the fkih is affeaed in the fmalUpox and mea-
fles,  the throat in the cynanche maligna,  the lungs in the
pertuflis, and the memibrana fneideriana in the influenza:
fo it  may be, that a contagion of a  fpecific  nature may
flffea the inteftines in preference to any other part,  though
we are unacquainted with its nature or the mode of its-pro^
duaion.

"The opinion that the febrile fymptoms which attend dy^
feriteries do not conftitute an original fevdr, or  one peculiar
to that difeafe, feems probable from this circumftance, that
fometimes the fever  is  of an intermittent form, fometimes
of a remittent, and at others of a fynochus or typhus nature.
We do not find thefe various kirids of fever in fcarlatina,
meafles, fmall-pox,  and  other difeafes which arife from a
fpecific contagion.   It has been fuppofed by  fome Phyfi-
cians, that dyfenteries are  not produced  from  contagion :f
this error has  arifeh from its being confounded with diarr-
hoea; and  perhaps thofe  cafes of dyfentery which are
mentioned by Doaor Cleghorn,{  Sir John Pri&gle,§
and others, to be combined with intermittent and remittent
fevers, have only been cafes of diarrhoea inftead of dyfentery.
                                                 Thoft
    * Dotfor Romayne's M. S. Lectures, 1791.
    •f Mofeley on Tropical Difeafes, zix.
    j Difeafe of Minorca.
    ^ Difeafes of the Army. 
                       (  i7  )
  Thofe who are but little acquainted with the writings of
many modern Phyficians, will  readily  difcover,  that the
hiftory of dyfentery is  differently ftated by moft of them;
and that this difference can only  be fettled by future obfer-
vations.
            PROXIMATE CAUSE.

  BY an attention to the feries of fymptoms which ufually
attend dyfenteries, it  is manifeft,  that a confiderable part
of their proximate caufe  is  conneaed with  a  febrile
difeafe, and that  this muft depend on  the  fame circum-
ftances as the proximate caufe of fevers in general,  which
Doaor Cullen  fuppofes to depend upon an atony and
fpafm of the-extreme veffels.  There is no doubt but that
the fymptoms of dyfentery  point out a  diminifhed energy
c»f the  nervous  fyftem and  a  tendency to putrefcence.
Thefe are  marked  in  the  languor, laflitude,  ftate of the
tongue,  ftomach,  and  the  various funaions of  the
body.   But there are another feries  of  fymptoms  which
are peculiar to dyfenteries,  and upon which  their prox-
imate caufe more immediately depends.   Thefe have been
varioufly confidered by Phyficians.

  Doaor Cullen  is of  opinion " that  the  proximate
caufe of dyfentery,  or at leaft the chief part of the  proxi-
mate caufe, confifts in a preternatural conftriaion of the
colon, occafioning at the fame  time, thofe  fpafmodic ef-
forts which are felt in fevere gripings,  and  which efforts,
                      C                    propagated 
                      ;   is   )
propagated downwards, occafron there the frequent mucous
ftools and tenefmus.*

  It is  certain,  that  many of the fymptoms Which  art
charaaeriftic of  dyfentery, are beft explained upon theft
principles; fuch  as the formation of the fcybala, and their
retention  in the inteftines, notwithftanding the efforts to
have them ejeaed. : The mucous commonly difcharged in
this difeafe is owing to an abrafion of the internal coats of
the inteftines,  which are generally covered with it in confi-
derable quantities; and it is «6t improbable but that in  this
difeafe, there is a morbid fecrfetioft  of it.   The appearance
of the blood with the mucous'may be  readily explained,
from a rupture  of fo'me  of the fmalfer blood-venels,  and
perhaps from a  dilatation  of their mouths.   The latter of
thefe Sir John  Pringle  fuppofes frequently to  happen.
He like wife obferves, "hat " ftreaks of bldod^ 'appearing
amorrg the  matter voided, " denote the- operiiftg of fome
of  the fmall venek at 'the end of the reaum, but  a more
intimate  mixture  is a fign that the "blood; comes  from a
higher f6urce."f

   Some have ftippofed tfte proximate caufe of dyfentery to
 depend upon inflammation # 'but inflammation is rather
 the natural effea of much fpafmodic effort, than the caufe.
 Hence we may  conftder  inflammation, -and its confe-
 rences, ulceration and gangrene, to be mote the effects of
 fpafm than the  caufe of it.
                                                 Other*
     '* Firft'Lines,'vol. ii. par. 1078.
     +  Pringie's Difeafes  of the Army, p. 228.
     %  Ande'ras Mitchel's Inaug. Diflfert. dc Dyfenteria, Edinb. 1789. 
                        (   *9  >
   Others have fuppofed a redundancy of bile,  and  an
increafed acrimony of it, to be the caufe of dyfentery;*
but, if much bile be generated in the courfe of dyfenteries,
it  appears  to be  an effea qf the operation of fome of the
remote caufes.   A  morbid  fecretion, and perhaps an acri-
mony  of the bile, may occafion cholera and diarrhoea; but
I cannot fuppofe that it can produce dyfentery.

   Many  have imputed the immediate  caufe of dyfentery
to the  eating a great quantity of fruit j but this, is a vulgar
error.  From obfervations now made,  it is  manifeft that
fruits  have no effea  in producing this  difeafe; and ripe
fruits are among the beft remedies to obviate the complaint,
It is a  remark made by authors in general, that dyfenteries
appear more prevalent in thofe years in which there is leaft
fruit.f  From this it  would appear,  that they have rather
a  tendency to prevent the coming on of the difeafe.

   Worms  have likewife been fuppofed to produce this
complaint,  which is  alfo a  vulgar error.  Living ani-
malculae  have been  fuppofed to produce this difeafe.  In
the Amcenitates Academic, there is a curious diflertation on
this fubjea, where the author attempts to  prove,  that
living fmall animalculae, lodged in the inteftines,  are  the
caufe  of dyfentery;|  but as we have no evidence of thefg,
we muft confider  the theory as merely an hypothefis, or
the chimera of a fanciful imagination.
   * Zimmerman on the Dyfentery,  ch. 2.  n,f .   , ,  A
   f Pi-ingle's Difeafes of the Army. Monro's Difeafes of the Army, 31S.
   % Amcenitates Academic, vol. v. differt. z.
                                         PROGNOSIS,
hkiuw-^rt !■•■-. 
(  1°  )
                  PROGNOSIS.

  THE fymptoms from which the probable event of dy-
fentery can be forefeen, may be divided into thofe which
form the febrile part of the difeafe, and into thofe which
conftitute the affeaion of the inteftines.

  A violent fever  always portends danger, from the  effea
it has  on  the fyftem at large; and it may caufe the local
affeaion of the inteftines to terminate in gangrene.  When
the  difeafe is accompanied with much debility, and want of
energy in  the fyftem, as manifefted in the ftate of the dif-
ferent funaions, it evinces great danger; and the danger will
be in proportion to the degree of debility which prevails.

  A tendency to putrefcence in the fyftem, is an index of
danger, efpecially when petechias, vibices, &c. appear on
the furface of the body, aphthze in the mouth and fauces,
and when the tongue has a black appearance.

  It can hardly  be faid, that dyfentery is in any ftage with-
out fymptoms of danger; and it is only by proper remedies,
timely adminiftered,  that the difeafe proves to have a fa-
vourable termination.

   When the heat of the body is not confiderable, the thirft
not great, the ftools copious,  and not very frequent, the
(kin moift,  the  urine natural,  and no way obftruaed, it is
probable that the difeafe will end favourably, and more efpe-
                                                  cially 
                       (  21  )
cially if the foeces become more natural, if there is a defir^
for food, and if the pulfe is moderate.

   The  fymptoms arifing  from the affeaion of the intef-
tines  denoting  danger,  are violent tormina, a great and
frequent defire of evacuating the contents of the inteftines,
without that effea, and an inability of receiving injeaions
from  a fpafmodic  affeaion of the reaum;  and laftly,  the
returning  of injeaions almoft immediately  in thofe cafes
where they could be received.
             METHOD  OF  CURE.
  DYSENTERY is a difeafe which demands the particular
attention of a Phyfician.   Nature, which, on many occa-
fions, exerts herfelf to cure difeafes, affords but little relief
in this.  In the treatment of dyfentery, fome indications of
cure are pointed out, and which ought to be purfued, pay-
ing attention to the patient's conftitution, and the feafon of
the year in which the difeafe occurs.  Thefe indications
we are now to note.
   i. To evacuate the contents of the ftomach and intef-
tines.
  2. To  relieve  the  febrile fymptoms,  and  to alter  the
determination from the inteftines.
   3. To fupport the  ftrength of the patient,-and  obviate
the tendency to putrefcence in the fyftem; and,
   4. To  diminifh  the irritability of the  inteftines,  and
reftore their tone.
                                                  Sucli 
                        C   23  )
   Such is the importance of attending to the firft  indica-
tion, that many  medicines,  which have  the power  to
fulfil it,  have been confidered by  Phyficians  as  fpecifics
in the cure of this  difeafe.   The  particular medicines we
come next to confider.

   In fome cafes,  before the  medicines are adminiftered
to fulfil the firft indication, it may be  necelTary to  take
away eight or ten ounces of blood, which will often render
the purgative and emetic medicines more fafe  and  effica-
cious.*   But  it  muft  be  remarked,  that blood-letting
fliould be praaifed with caution,  as the tendency of dyfen-
tery is .to produce  debility.   Dyfenteric cafes occuring  in
the fpring or 'beginning of fummer, generally bear blood-
letting better than thofe which occur in the fall or latter
end of fummer.

   Ipecacuanha is a medicine well adapted for all the pur-
pofes of full vomiting, and therefore may be adminiftered
with advantage in dyfenteries in their firft ftages.  Given in
fmall dofes,  it is aflb purgative, and may be faid to favour
a determination to  the furface of the body.   Such,  indeed,
have been the  good  effeas of ipecacuanha,  that it has
been confidered by Phyficians as a fpecific;  but from what
I have juft mentioned, its mode of operating muft  be ob-
vious.
                                                    The
   * The cafes in which blood-letting appears to be particularly indicated
•re tbofe in which the pulfe is full, hard and ftrong, and where an evident
inflammatory diathefis  appears in the fyftem.  Sometimes, however,
where the pain is violent, it will be neceifary to bleed, though the pulfe,
may be weak and contracted.  Doftor Monro has obferved, that in fuch
cafes the pulfe, after bleeding, becomes fuller and ftronger. 
                       <  as   )
  The chief objeaion to the ufe of ipecacuanha is, that it
is very apt to operate as an emetic when given in fmall dofes,
and  by that means  prevent our  obtaining  its  purgative
effeas,  which are rnoft req\iired to evacuate the contents of
the inteftines.

  The preparations of antimony are now preferred to every
other medicine in the cure of this difeafe; and of the various
preparations in the  difpenfatories, the tartar-emetic muft
be preferred.  In tartar-emetic, the antimony is combined
with an acid which renders its operation more certain and
aaive, when taken into the ftomach, and when it panes
into the  inteftines,  more effeaually  purgative: for this
reafon it is the preparation in moft common ufe.

  Tartar-emetic may be  given in fuch  dofes as to effea
full  vomiting when requifite, or it may be adminiftered in
dofes fo as to prove cathartic.   When the tartar-emetic is
intended to std: as an emetic,  it fliould be given in large
dofes, and at fhort intervals:  when it is  intended to aa as
a purgative, it  fhould be given at long intervals, and in
fmall dofes.  This medicine, befides the effeas  juft men-
tioned,  relaxes  the fyftem,  and determines to the furface
of the body: hence it relieves the febrile difpofition, and on
this account, it is a medicine of great efficacy in the cure
of this  complaint,  as has been juftly obferved by the cele-
brated Monfieur Senac, phyfician to the armies  of France
in the reign of Louis the fifteenth.

  The  other  antimonial  medicines which are givgn in
dyfentery,  are  thofe  in which the reguline parts are un-
                                              combined 
                       (   24  )
 combined with an acid, as in the James's powder, and glafs"
 of antimony.  The James's powder proves more certainly
 purgative, and determines  more to the ikin.than the tartar-
 emetic,  as is evident from  the nature and operation of the
 medicine.  The  glafs  of  antimony has been  commonly
 employed, combined with  wax; but this is a ufelefs  addi-
 tion, for the aaivity and value of the medicine depend on
 its meeting with an acid in the  ftomach, and there form*
 ing a kind of tartar-emetic: but as this is the  worft prepa-
 ration of antimony, it is now feldom employed.

  When emetic medicines are given,  fmall quantities of an
infufion of camomile flowers fhould be drank occafion*
 ally after the vomiting has been produced, to prevent painful
 fpafmodic affeaions of the ftomach.

  The next clafs of medicines which may be ufed to eva-
 cuate  the content's of the inteftines, and which  we now
 come  to notice,  are thofe called more  ftriaiy purgative.
 Of thefe, the neutral falts  are thofe  moft commonly em-
ployed,  fuch as Glauber's falts, Epfom's falts, and chryftals
of tartar.   The  falts fhould  be diffolved in a  fufficient
 quantity of water,  and  given in divided dofes, until free
 difcharges are  produced.   The falts may alfo be combined
 with fome other medicines.  Doaor Monro highly  re-
 commends a combination of falts, manna and oil;* but the
 moft ufeful combination to the two firft of  thefe medicines
 is that of an antimonial: thus, Glauber's falts,  manna and
 tartar-emetic,  combined in folution, make  a  convenient
                                                  and
           * Monro's Difeafes of the Army. 
                         (   H  )
and efficacious  mixture, which may be given  in divided
dofes,  until the  patient have free difcharges,  and is relieved
from the tormina or griping pains.

  Caftor oil,* tamarinds in decoaion, and medicines of this
nature, have alfo been ufed with fuccefs.f  Rheubarb, jalap
and aloes are the leaft  proper purgatives:  when given in
powder, they are apt to produce too great irritation; com-
bined  with fpirits, in the form of tinaures, they are equally
objeaionable: for thefe reafons they are not ufed by the moft
fkilful praaitioners at the prefent day.

  Under the head of  purgatives,  muft  alfo be  confidered
injeaions thrown into the inteftines.  Animal broths, mild
mucilaginous mixtures of ftarch or gum-arabic, are the moft
proper: thefe fhould be injeaed in confiderable quantities,
with the occafional addition of caftor or common oil;  and
when there is much pain, injeaions may be  ufed combined
with laudanum, or a folution of opium.J  Thefe  are  alfo
highly proper to relieve the tenefmus, which is often one of
the moft troublefome fymptoms.  Anodyne injeaions have
likewife a good  effea in preventing the prolapfus ani; but
when this occurs, it fhould be remedied by aftringent appli-
cations,  combined with fomething of an anodyne nature.
When the topical affeaion is very great, and there appears
                          D                      danger
  *  Caftor oil 5s frequently naufeous to patients, and will fometimes
occafion vomiting;  to prevent which, a fmall quantity of fpirits of laven-
der may be added.
  -}-  Under this head muft be referred mutton fuet and animal broths,
which have all a laxative effect.                      s
  J  In throwing in injections, great care mould be taken that it be done
in a gradual and eafy manner, for, if not, they may have a tendency to
increafe the irritability of the parts, and confequently the difeafe. 
                       (   i6  s
danger of gan»rene, injeaions of the infufion or decoaion
of the Peruvian bark, finely filtered, fhould be ufed every
three or four hours, or according as the cafe may require.

  The effeas of the medicines which we have juft men-
tioned, are commonly fuch as not only relieve the topical
complaints of the ftomach and inteftines, and evacuate their
contents, but alfo diminifh very much the febrile fymptoms)
for this reafon they fhould be  occafbnally  Continued
throughout the treatment of the difeafe.

   The fecond indication of cure which I have given, and
to which we fhall now attend, is that of relieving the febrile
fvmptoms and altering the determination from the inteftines.

   The febrile fymptoms are to be treated according to their"
nature, as they are attended with more or lefs excitement in
the fyftem.  In moft cafes it  will be requifite to employ the
antiphlogiftic regimen, excepting the  application  of cold,
which, by obftruaing the determination to the furface of the
body, may be injurious.   The tenfion of  the arterial fyftem
may be much diminifhed by thofe means mentioned to fulfil
the firft indication; and  as part of the proximate caufe of the
difeafe is  that of the fever, antimonial and  other  remedies
 which are difpofed to determine to the furface,  fhould be
 employed as circumftances may direa.

   In the courfe of the fever, when the inteftines have been
 fuliv difcharged,  it may, in many cafes,  be neceffary to at-
 tend more.p.ai'iiculavly to the cure of  the difeafe,, when fti-
                                                mulants
;' m 
                        (   »7  )
mulants and tonics may be ufed, fuch as good wine and the
beft Peruvian bark.  Wine may be given in any form that
may be agreeable to the patient; but it requires fome cir-
cumfpeaion in adminiftering the bark, which ought never
to be given  in fubftance where the ftomach or inteftines are
difeafed, as  the powdered  bark, however finely prepared,
may produce irritation from its mechanical aaion.   The
moft proper preparation of  the bark is the cold  infufion,
made with magnefia, and finely filtered.

   In thofe cafes of dyfentery in which the fever puts on a
remittent or intermittent form, it is  very neceffarv to  be
more free in the ufe of the infufion of the bark, to prevent
the return of the paroxvfm.*   Where  his treatment  has
been purfued, the good effeas which have refulted juftify
its propriety.

   The tendency of fevers, in dyfentery, to thofe of a typhus
nature,  andthe tendency of the fyftem to putrefcence, are
to^be obviated by due attention to  cleanlinefs, as changing
frequently the bed-clothes and body-linen of the fick.  The
air of the patient's apartment fhould be particularly attended
to; free ventilation fhould be-ufed, -and if this cannot be
properly performed, branches  of  trees or  llirubs may be
placed in the room during the day  with good effea, as they
abforb the mephitic air and emit  what is pure.. The air of the
apartment may likewife be rendered purer,  or at leaft more
agreeable, by having the floor fprinkled with vinegar, or hav-
ing different aromatic fubftances burnt in the room.  Great
                                                   care
* Cleehorn's Difeafes of Minorca, and Lind on thofe of Warm Climates. 
                      (  *8   )
care fhould be taken that all excrementitious matters be re-
moved as foon as poffible,  for they are the  chief fource of
the impurity of the air.

   Determining to the furface of the body in fevers, is well
calculated to take off the  fpafm from  the  extreme veffels,
which conftitutes a part of their proximate caufe.  But,  in
the cure of dyfentery, it is of very great confequence to re-
lieve th_ local affeaion of  the inteftines.  For this purpofe,
the furface of the body fhould be kept warm when antimo-
nial medicines are adminiftered, to caufe them to determine
to the furface, while at the fame time they may evacuate the
contents of the ftomach and inteftines.  Small dofes of lau-
danum maybe added to the antimonial medicines after proper
evacuations, to favour their operation in determining to the
furface. Upon the fame principle, bliftering and warm bathr
ing or fomentations to the abdomen, may be employed,
efpecially  when the local affeaion is any way confiderable,
and attended with violent pain.   Doaor Moseley, in his
Treatife on Tropical Difeafes and on the Climate of the
Weft-Indies,  fully  illuftrates this  praaice;*  and other
writers of eminence juftify the fame opinion, which, indeed,
 feems confonant to reafon and the nature of the difeafe.

   The third indication which I have mentioned, and to
 which we  come now to pay our attention,  is to fupport the
 ftrength of the patient,  and obviate the tendency to putter
 fcence in the fyftem.

                                            Contagious
* Page 193, &c. 
                       (  ao   )
  Contagious difeafes of all kinds have a great effea on
the nervous  fyftem,  in  inducing  a ftate of  debility; but
this  is particularly the cafe with that which  produces dy-
fentery:  therefore,  fuch medicine and diet fliould be admi-
niftered,  as may beft tend to obviate the effeas of the con-
tagion.   Wine, in proper quantities, good animal  broths,
and the Peruvian bark, are beft calculated for this purpofe.
When broth is employed, care fliould be taken that all the
tat is removed.  Salep and fago may alfo be given, accord-
ing  to circumftances: they form,  with water,  a  pleafant
mucilaginous drink, well adapted to perfons  labouring un-
der this complaint.  Ripe fruits of all kinds,  but efpecially
thofe of a fub-acid nature,  may likewife be given:  they
have been known to  be of great fervice in obftinate cafes
of the difeafe,  where other remedies had been ufed without
fuccefs.*

   It is unneceffary to repeat the direaions already propofed
to  obviate  the tendency to putrefcence in this complaint,
as the means have been mentioned in the treatment requifite
to relieve the febrile fymptoms.

   The fourth and  laft indication which I have given, and
which we come now to confider, is that of diminifhing the
irritability of the inteftines,  and reftoring their tone.

   Every part of  the human  body  becomes much more
irritable  when inflamed;  and this is efpecially the cafe in
                                                    the

   * Zimmerman on Dyfentery. Ptingle's Difeafes of the Army. Mon-
ro's Difeafes of the Army. 
                       (   3°  1
the inteftines, where  there are a confiderable number of
nervous papillae.  To obviate an irritable ftate of the intef.
tines, is of much confequence in the cure of dyfentery.

  To obtain this objea, we make ufe of mucilaginous and
anodyne medicines.

  Gum tragacanth, in  the form of mucilage, is faid to
allay the irritation of the  inteftines; but perhaps it does
it only  in an  indirea way, namely, by flieathing  the
coats  of the inteftines, and preventing their being irritated
by the acrimony which is frequently generated in them.
Gum-arabic,  ftarch,  and  flour long boiled and formed
into mucilages, have the fame good effea.  But the moft
nfeful medicines for this  purpofe,  are opiates, given  in
fome form or other;  fometimes combined with aromatics
and aftringents, and at  other times not.   The forms  in
which it is combined  with  aromatics, are the theriacs of
the  difpenfatories: thofe in  which aftringents are combined,
are the compound powder of bole, and the fpecies aromaticae,
&c.   Thefe preparations  have  at  times good effeas;  but
in the beginning of the difeafe  care ought to be taken not
to adminifter medicines which will counteraa  the full dif-
charge from the inteftines;. and therefore,  when opiates are
employed internally, they  are fafeft when  combined with
ipecacuanha or tartar-emetic.   In this way their bad effeas
onthe different fecretions are prevented.   They  may  be
alfo combined with calomel.
Opiates 
                       (   3*   )
  Opiates may alfo be employed externally, either in the
form of a plaifter to the abdomen, or in fomentations.   For
this laft purpofe,  the heads  of poppy may be ufed to make
a ftrong decoaion, and this decoaion applied in the form
of a fomentation, three or four times a day, to the abdomen,
for the fpace of one or two hours.

  A temperate atmofphere  fhould always be  obtained if
poffible;  cold fhould be avoided, as it is apt to caufe a con-
tinuance of the difeafe, from its producing a determination
to the inteftines, and often counteracting the moft powerful
remedies which can be employed.  The patient's cloathing
muft be  of a warm kind;  perhaps wearing flannel next to
the fkin would be the beft means of keeping up a conftant
determination to  the furface of the body, and of prevent-
ing, in a great meafure,  the bad effeas which might arife
from any fudden viciflitude of weather to which the patient
may be expofed.

   Aftringent and anodyne  medicines may alfo be ufed to
reftrain the difcharges from the inteftines.  The confeaio
japonica of the New Edinburgh  Difpenfatory, is  a very
proper and ufeful compofition,  as it contains fome of the
more powerful aftringents combined with aromatics, as the
gum kino and fuccus japonicus.  The cortex granatorum,
querci, lignum campechence and its extraa, rad. Columb.
alumen,  and  other aftringents,  may be alfo ufed with ad-
vantage.   The fimarouba bark has likewife been confidered
as very efficacious, and has been ufed by feveral phyficians;
but others confider it of very  little efficacy; though it is
                                                 faid 
                      C   3^  )
faid  to have fucceeded in fome very obftinate cafes,  where
more powerful aftringents had failed.

  It only remains for me now to mention  the means to be
employed by convalefcents after the difeafe, and the means
to prevent the fpreading of the contagion.  With regard to
the firft,  due attention fhould be paid to regimen, diet and
exercife; and with refpea  to the fecond,  the moft proper
means to obviate the effeas of the contagion,  is to avoid
thofe caufes which  we have marked as predifpofing the
habit to this complaint, and to avoid the occafional or ex-
citing caufe.

  The limits to which a differtation of this kind is ufually
confined, forbid my enlarging further on the fubjea.
 
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