NATIONAL LIBRARY OF MEDICINE Bethesda, Maryland / i^^A AN INAUGURAL DISSERTATION ON DYSENTERY. AN INAUGVRAL DISSERTATION ON DYSENTERY. SUBMITTED TO THE EXAMINATION OK CHARLES ALEXANDER WARFIELD, M. D. President. And the Medical Faculty OF THE COLLEGE OF MEDICINE OF MARYLAND, ON THE FIRST OF MAY, 1812. FOR THE DEGREE OF DOCTOR OF PHYSIC. By Cor bin Amos.....of Harford County, MEMBER OF THE MEDICAL AND CHIRURGICAL FACULTY OF MARYLAND. QJkLTIMORE. PRINTED BY A, MILTENBERGEE, No. 10, NORTH HOWARP-ST, 1812. IO DOCTOR THOMAS E. BOND, v. OF HARFORD COUNTY. DEAR SIR, It affords me the highest degree of satisfaction, to have an opportunity, in this public manner, to offer you my sincere acknowledgments, for the instructions which I received, from you, whilst I had the honour of pro* secuting my Medical Studies under your direction, and for the many favours which you have conferred on me. As a public testimony of my respect and as a slender tribute of gratitude, allow me to dedicate to you my first Medical Essay. Of the politeness, with which you have always honoured me, I shall ever re- tain a grateful sense; and be assured, Sir, that no length of time or extent of distance, can ever lessen that real affection which is now cherished by Your sincere friend and former pupil, CORBIN AMOS. TO DOCTOR HENRY HOWARD, OF BALTIMORE. MUCH RESPECTED SIR, Permit me thus publicly to assure you of my grate- ful sense of the friendship and attention which you have on so many different occasions exercised towards me, I also beg you, Sir, to receive this dedication as a slight expression of my respect; and to accept of my ardent wishes for your prosperity and happmess. J am, sir, your very affectionate friend THE AUTHOR, AN INAUGURAL DISSERTATION. THE name Dysentery is derived from the Greek words hi difficile, em?«v, intestinum, et p» fluo, and signifies a disordered state of the bowels, in which their functions are performed with pain and difficul- ty. It has been said to be liable to be confounded, with several other disorders of the bowels, such are Diarrheea, Cholera Morbus, and Lientery. I conceive, however, that there are certain unequivocal symptoms of dysentery, which sufficiently distinguish it from all these affections. No disease, embraced within the whole system of nosology, has more conspicuously engaged the atten- tion of physicians, than dysentery. But although much has been written on this subject, and innumera- ble remedies for it have been recommended, we have still much to learn, both with regard to its nature, and cure. HISTORY OF THE DISEASE. The dysentery generally makes its appearance in this climate about the close of the summer or the 2 10 commencement of autumn, at which seasons the states of the atmosphere are favourable to the produc- tion of the remittent and intermittent forms of fever. In general, for some time previous to the attack of the disease, the intestines are slow, affected by flatu- lency, and pains resembling those of colick. In other cases, however, though not so frequently, the dis- ease is ushered in by an attack of diarrhasa. In some cases before the bowels are affected, the patient labours under feelings of oppressive lastitude, and considerable indisposition to motion, with cold shiverings and other symptoms which indicate the ap- proach of fever. In many instances a disorder, appar- ently a simple diarrhaea, gradually glides into the form of dysentery: but more frequently the patient is as- sailed by some uneasiness of the bowels, which prompts him to make frequent efforts to produce an. evacuation from the intestines. After a.few of the first attempts, little or nothing is voided, but an insuperable propensity to persevere in attempts to produce a stool, annoys the patient and constitutes what is called a ten- esmus. As the disease advances, the griping which incites to efforts at dejection, becomes more distres- sing, and the tenesmus which follows them becomes more intolerable. The pulse is either full and tense, not much increas- • " ed in frequency; or, is frequent and even quick, though it is sometimes natural, both as to force and frequen- 11 cy.—In some cases it is depressed.—There is always more or less fever attending this disease, though not always discoverable, at its commencement, by the pulse. The matter voided by stool, in this disease, wheth- er it may have been of longer or shorter duration, is very various : a mucous matter sometimes is voiced, without anyblood; exhibiting that disease called by some, the morbus mucosusand by others, the dy- senteria alba: but for the most part the mu- cous discharge is more or less mixed with blood, but sometimes blood unmixed is voided in considerable quantity. Unless the disease be checked at this pe- riodic griping continues to increase,and the tenesmus becomes more considerable. The fever also, which is mostly of the remittent form, increases—the stools become more frequent and painful, and exhale an ex- ceedingly foetid and offensive odour—-no excrementiti- ous matter is discharged, unless the patient be under the operation of a cathartic, and then it is voided in the form of hard lumps or scybala ; after which, the pain, griping and inclination to go to stool are alleviated. This alleviation of pain is but of short duration; for the trou- blesome symptoms often return with redoubled vio- lence, and small portions of matter of a membrane-like appearance which resemble the washings of fresh meat, are discovered among the stools, and have an ex- ' ceedingly foetid and nauseous smell; and white masses of a sebaceous appearance, which from their resem- blance to suet, have been called corpora pinguiatxWi also ccasionally discharged by stool. The stools 12 are sometimes voided intermixed with a sanious mat- ter, and Dr. Cullcn says,"it is probable that sometimes a genuine pus is voided ;" but my opportunities have not enabled me to observe it. As the dysentery advances,the symptoms above en- umerated, increase in violence, the griping continues, the stools become more frequent and painful, and the tenesmus more considerable ; and in some instances a considerable quami'y of bile is thrown up by vomiting; though this symptom sometimes occurs at an early per- iod of the disease : The pulse which before had been hard, tense, and full, now becomes small and frequent, while extreme languor and prostration of strength per- vade the system ; hiccough supervenes, the alm the same cause, and, according to his late mode of treating it, he used the same remedies, and with success. Petechiae are sometimes found in bad cases of dysentery, and some few patients have a universal yellowness of the skin; which symptoms are common in fevers. In the year 1797 an inflammatory dysentery raged at Fell's Point in June and July, while the weather continued wet; but in August when the rains had ceased, the intestinal form gradually declined, and the epidemick assumed the character of a malignant vellow fever. For two or three weeks the symptoms of the two diseases were so intermingled, that either name would have applied equally well, to the assem- blage of symptoms, in almost every case. Cleghorn% observes, that from the great similitude that exists in many respects, between the tertian fever and the dysentery, he was induced to treat them in the * Page 218. t Diseases of the army. p. 50. } P. 5. 265. 21 same manner. He further addsf " the tertian fever, cholera morbus, diarrhaea, and dysentery, are frequent- ly epidemics ; there being a near alliance between all these diseases : these frequently put on tertian periods, and they change sometimes in one, and sometimes in the other: a tertian is sometimes changed into a dysentery, and sometimes a dysentery changes into a tertian ; and when one of these diseases is suppressed the other often ensues." Wade || is of opinion, that fevers and dysentery, are ailments of a kindred nature, prevented and cur- ed in the same manner; and that they do, in every case, arise, in those climates, from the bowels and their contents. %immerman\ in his description of the dysentery in Switzerland, in 1765, observes, that there existed a great connexion between dysentery and putrid fevers. Jackson § observes, that in the first stage of the yel- low fever, symptoms occurred which would lead the physician to conclude that it was a dysenteric af- fection. Sir John Pri?igle* says, " it was observed, that those who were seized with the dysentery, usually escaped the fever; or, if any man had both, it was alternately ; so that when the flux began, his fever fP. 134. || On the diseases of the East Indies, p. 130. \ In his treatise on dysentery, chap. 2. § Fevers in Jamaica, p. 179. * On diseases of the army p. 59. 22 ceased, and when the former was stopt, the other returned ; whence it appeared, that tho' the two dis- tempers were of a very different form, yet they pro- ceeded from a like cause." Many more authorities might be adduced to shew the intimate connexion between dysentery and the bilious, intermittent and remittent fevers; and also to shew the correctness of Sydenham's idea, when he considered the disease in question, a Jebris- intro- versa, or a fever turried inwards upon the intestines ; but I presume those already adduced will be suffi- cient. REMOTE CAUSES. Many observations conspire to render it highly probable that the remote causes,of dysentery are es- sentially the same with those of intermittent and re- mittent fevers, differing only in degree or modificati- on. In support of this opinion it maybe remarked, that the dysentery seldom appears, except in situati- ons where both bilious intermittent and remittent fe- vers pervail, and that they frequently change into it: I shall therefore consider miasmata, or the elastic fluids arising from marshes, when acted on by the in- tense heat of the san, as the remote cause of this dis- ease, as well as of intermittent and remittent fevers. An atmosphere that is impregnated with miasmata, may affect the system of such persons as are exposed to its operation by entering the lungs, there mixing with the blood, and thus exerting its influence en 23 the living system ; as the blood passes in its circula- tion, it may impart to the alimentary canal a portion of the deleterious matter which it had taken up—or the miasmata may perhaps be blended with the sali- va, and thus be swallowed. This noxious fluid may al- so be absorbed from the atmosphere, by the numerous absorbing vessels spread over the whole surface of the body, in the same manner when applied to the skin, as mercury, and other substances are taken up by these vessels. But in what manner miasmata produce their effect on the body, is not known. We know only, that there do arise certain noxious vapours, from marshes and stagnant waters, which have been found from long and attentive observation, to be the princi- pal source of all the diseases, to which those coun- tries, in which they are found, are so very subject, and which have obtained the name of marsh mias- mata. But what the real nature and properties of these miasmata may be, what the various circumstances which affect their condition, and, on what their strength and noxious powers depend, are subjects, which must be left to be elucidated by the future im- provements of this intricate part of medicine. That by these miasmata, certain chemical combi- nations are formed with the fluids in the human body, destructive to the principle of life ; I think very prob- able, and presume, no one will deny it, who has seri- ously thought on the subject; in no other way can the sudden derangement of health produced by them, be* accounted for. The mechanical effects of miasmata, must from their very nature, be imperceptible, and 24 though we are utterly ignorant of the direct chemical changes or processes, yet it may be inferred, with more probability, than any other supposition, that they really exrt. The first evident effects of mias- mata on the body are, languor and debility, in many important parts, particularly the stomach and intes- tines ; as is evinced from the anorexia, nausea, vo- miting, and other symptoms of debility, that so fre- quently occur in diseases produced by them. Much might be said in support of miasmata being the remote cause of the disease under consideration, but to take further notice of it here, would extend this dis- sertation far beyond its intended limits. I shall there- fore only observe, that it appears to me that miasma- ta, or the particles of elastic vapours, arising from the earth, in the condition called marsh effluvia, and acted on by a very vigorous sun, are the remote causes of the dysentery ; and that they may enter the human system, either by the vessels of the skin, or by the lungs, or mixed with the saliva ; that they there pro- duce several morbid phaenomena or derangements, probably by forming new combinations with the sub- tle elements of the fluids and solids, and thus become noxious and destructive, by disordering the peculiar organization which produces the living condition.— But what are the chemical qualities of that principle, in a vitiated atmosphere, which constitutes miasmata, or what is the same thing, which produces this disease, I leave to those philosophers to determine, who, of late, appear to be cultivating this branch of science, with a zeal and success, which promise great future benefit to medical knowledge. 25 EXCITING CAUSES. It is not in every disease that the exciting cause is to be distinguished from the remote cause; for after the remote cause shall have produced debility, which is the predisposition, a reaction, or disease will arise in certain cases, though no exciting cause be superad- ded. This, however, is not generally the case, for an exciting cause is most commonly required. The exciting causes of this disease, therefore, are of various kinds; such as excessive fatigue, either of bo- dy or mind, great heat, intemperance in the use of ar- dent spirits, &c. But from the concurring testimony of all those physicians who have written on the dysen- tery, it appears that cold alternating with heat and moisture is the principle exciting cause of the disease. Dr. %immerman says, " in general it is not the cold that follows on heat, and remains, but that which suc- ceeds heat, and give place to it by fits,that is consider- ed as the cause of the dysentery." Hence the poorer class of people, and particularly soldiers, who are much exposed to the sudden vicissitudes of the weather, are often the unhappy subjects of this disease. From the observations of Dr. Moseley and Sir John Pringle, it appears, that there is not a more ready way for soldiers to be affected with the dysentery, than by exposing themselves to the cold of the evening when they are heated after a long march, or by drinking cold water when under a profuse sweat. Dr. Moseley says, 26 " It is the soldier's life to be much exposed, and it is "his custom to be careless of himself; when he is fa- tigued, or heated, he hastens to cool himself in the " breeze, or night air, and perhaps throws ofThis clothes, "and often lies down and sleeps in that condition. If " he is wet,he dries his clothes,linen, and skin together! '• By these means, perspiration, the great fountain of " health in hot climates, is suddenly stopped, and fe- brile strictures occupy the whole surface of the body." Dews or fogs, wet beds, wet clothes, together with cold, are exciting causes of the dysentery. This is sufficiently proven by Sir John Pringle in his book on the diseases of the army, who observes, " that no epi- demic ever ensued from the greatest heat, till the per- spiration was stopped by wet clothes, wet beds, dews or fogs." ' In the campaign 1743, though the weather continued long hot, yet we had no great sickness, till the men lay wet afer the battle of Dettingen j and then the dysentery immediately appealed.' * Again' he continues, "in the year 1747 the summer was likewise hot, but without any bad effects till towards the end of August, when the nights growing cool, the dews, and night fogs occasioning a stoppage of perspiration, brought on the same distemper."* He also says, from the 20th of July till the 10th of September, the weather was sultry ; and till the mid- dle of August, the nights were equally warm with the days, during which time there was no appearance of the dysentery; but after the middle of August, though * Page 79—80. 27 the days were still hot, yet the nights began to grow cool, and the dews to fall; and from these interchan- ges the dysentery soon took-its rise.* The same au- thor further adds, that in the beginning of October, we had a great deal of rain,and such as were exposed to it, were seized with the dystntery.f Dr. Hillary says that the dysentery returns constantly every yrear in the West Indies with the periodical rains ; hence we may conclude from the authorities above enumerated, that cold and moisture operating on the body previously de- bilitated by miasmata, are the principle exciting causes of the disease. The effluvia arising from the excretions and more especially the fasces of dysenteric patients, in confined apartments, may act as exciting causes of this disease. These effluvia however have received the name of con- tagion, on which subject authors differ very widely in their sentiments. Dr. Cullen thinks, that dysentery often evidently arises from the application of cold, "but" says he, " the disease is always contagious; and by the propagation of such contagion, independent of cold, or other exci- ting causes it becomes epidemic in camps and other places." " It is, therefore," he further adds " to be doubted, if the application of cold does ever produce the disease, unless where the specific contagion has been previously received into the bo^y : and, upon the whole, it is probable, that a specific contagion is to be considered as always the remote cause of this disease." * Page .'SS—56. f Page 57. 28 Dr. Moseleij, on the contrary, who resided for many years in the West Indies, where the dysentery was extremely prevalent, observes, that he never saw an instance in which the disease was communicated by contagion. "As to contagion," he says, cc from in- fection in the dysentery, I must confess, I never saw an instance of it; neither do I believe there is any such thing." Dr. Zimmerman, in his treatise on the epidemic dy- sentery that appeared in Switzerland in the year 1765, says, " In general, it appeared to me, that our dysen- tery became contagious purely through nastiness, and the crowding many people together in a small space, but was by no means so of itself, for though many were attacked by it at once, this seemed to proceed from a more universal and widely different cause, which operated at once on every one." Should the bile, or the use of fruits, be enumerated among the exciting causes of the dysentery ? This subject has been much contested among physicians. I am, however, induced to believe, they should not; or, at least, I have never met with an instance of the disease which appeared to me to be attributable either to bile or fruits. PROXIMATE CAUSE. The proximate cause of this disease, like that of many others, must yet remain involved in some obscuri- 29 ty. Dr. Cullers idea of a spasmodic constriction oi the colon, being the proximate cause of this disease, seems better adapted to an explanation of the phaeno- mena of colic, than those of ^dysentery. A constric- tion of the colon may take place, but it is probable that this constriction is an effect or symptom, and not the proximate cause. Dr. Rush pronounces morbid action to be the proximate cause. He considers the proximate cause and the disease to be the same. To me it does not appear just, that any one operation in nature should be considered both the cause and effect of itself. , If the proximate cause of the disease and the disease itself be the same, it is equally as rational to conclude, that the latter is the cause of the former, as the former of the latter. This disease seems to consist in an increased secre- tion of the vessels of the intestines, more especially the large guts, and if I were to adopt the sense in which Drs. Cullen and Rush use the term proximate, I should consider rhis as the proximate cause. If it were proven, which has never been done, that a spas- modic constriction,of the colon takes place, it must be the consequence of a previous irritability of the parts. But although the hypothesis, of a spasmodic constric- tion, of the colon, being the proximate cause of the disease in question, be sanctioned by the most cele- brated authority, yet to me, it appears entirely unsat- isfactory. For as well might we consider the dry tongue, thirst, pain in the head, and other symtoms, which accompany a paroxism of intermittent fever, as causes, as to consider the constriction of the colon, so a cause of the dysentery. It may be remarked, that a large majority of the cases of dysentery come on with the usual syn ptoms of fever; and the constriction of the colon(if it takes place at all) does not take place for a considerable length of time afterwards: whereas if this constriction was the prox- imate cause, it should regularly appear at the forma- tion of the disease ; the contrary however is almost uniformly the case. / I therefore object to the proximate causes adduced by Drs. Cullen and Rush as being of no practical util-. ity. But while I thus offer this objection, I must con- fess myself unable to suggest a theory perfectly sat- isfactory even to myself. CF THE CURE. The dysentery is a disease over which the physician has more controul, or which admits of more certain cure, upon a speedy application of proper remedies, than most other diseases to which man is subject. This is a truth establishedby almost every writer on the com- plaint; and confirmed by the concurring observations of physicians in many different parts of the world. The contrary, however, has likewise been ascertained, that there is no disease more difficult of cure, when not attended to, or when proper remedies are not ad- ministered in its early stage. It is evident that the cure of the dvsentery must in a great measure be Tegulated b^ the violence and du- 31 ration of the symptoms which have been enumerated above. When the disease assails the system in a mild form, and is in its incipient stage, an assiduous use of gentle purgatives, will generally be found sufficient for its removal. But v/hen its attack is accompanied with violent and urgent symptoms, it will in general require our best concerted plan and most efficacious remedies to arrest its rapid progress; The remedies are, FIRST—BLOOD-LETTING. In the mildest stage of this disease, v/hen very little, if any deviation from a healthy action i> discoverable, in the pulse, and it is unaccompanied by severe pains, blood-letting will seldom be necessary. But if on being called to a pa- tient at an early period of the disease, we find the fe- brile and inflammatory symptoms considerable, and ac- companied with much pain; blood-letting should be immediately resorted to, and repeated as often as the fngency of the symptoms may require. The many pan- ful symptoms attending this malady, as the tormina, tenesmus, and discharge of blood, which seem to derive their degree of violence, from the increased action prevailing in the sanguiferous system determin- ed to the intestines, are more instantaneously removed by this remedy, than by any other means we can em- ploy. The quantity of blood necessary to be taken at any one time, or the frequent repetition of venesection, must be entirely at the discretion of the physician, who by attending to the inflammatory symptoms present, the strength of the patient, and minutely observing the effects of this remedy, will not find it difficult to deter- mine. Perhaps his best general rule wiil be, to' use the 32 lancet, as long as the pulse continues full and hard, quick or tense, or while the tormina, tenesmus, and other painful symptoms continue to annoy the patient, provided his strength be not too much exhausted. SECONDLY—EMETICS. Vomiting has been held as a useful remedy in this disease: and may be serviceable in the beginning of it, when the stomach is highly deranged, as is manifested by a loathing of food, nausea, and bilious vomiting. It would be most advisable to administer them of such a nature, and un- der such circumstances as to evacuate completely the alimentary canal. To answer this purpose tartar emetic and ipecacuanha combined, have generally been re- commended, though I believe the emetic tartar, given alone in broken doses wi)l prove equally or more effi- cacious. This medicine may be given in small doses, and repeated every half hour; and in this manner it may produce vomiting, and also act on the intestines and skin, so as to prove cathartic, and diaphoretic. This mode of exhibiting tartar emetic, may allow the first dose to pass the Pylorus and operate on the bowels, and thus our object will generally be accomplished. Tartar emetic may also be given in combination with some of the neutral salts. It has been given in solution with sulphate of Soda, with great advantage, and by its exhibition with this salt, it acts more effectually both as as an emetic, and cathartic. Sometimes tartar- ised antimony,when the stomach is greatly disordered, may be administered with much benefit in combination with calomel, and in this manner it will vomit, and also operate gently on the intestines. 33 Emetics are also sometimes necessary in the latter stage of the disease, when the alimentary canai is in a weak and torpid state, purgatives, though they clear the bowels, often leave the stomach loaded with crudi- ties, which cannot be brought away without an eme- tic. The chief objection to emetics in this state, is the weakness they induce in the system. The lassitude felt, immediately after tlu ir operation, is truly often distressing to patients who are much reduced. But the weakness produced, by emetics properly adminis- tered, in this disease is seldom permanent. More strength is gained in the course of a day, by the relief, which the* stomach experiences, than is lost by the fa- tigue of vomiting; and the whole system is brought to a better condition. THIRDLY—PURGATIVES. It is very rarely in the dysentery that purgatives may not be used with advantage; indeed its cure seems to depend in a great measure, upon a judicious administration of them. They appear particularly well adapted to its removal, by stimulating the intestines to relieve themselves of a vast accumulation of sordes,and by reducing the morbid ex- citement in the blood-vessels; they also relieve the gri- ping and tenesmus, which are among the most trouble- some symptoms of this disease, and bring away scy- bala, which if allowed to remain constitute a constant and painful scource of irritation. Those purgatives that procure sufficient evacuation, without being very stim- ulating to the intestines are to be preferred. For this purpose the neutral salts have been employ- ed. The sulphate of soda and sulphate of magnesia are the best. 4 34 The oleum ricini, when it has not become rancid, mav be given with advantage. " It seems to be posses- " sed of an anodyne quality, frequently easing the pain- "ful gripes as soon as taken, and seldom fails, when it " agrees with the stomach, to procure copious evacua- " tions." Calomel. When the disease is attended by a high- ly considerable inflammatory action,or remains obstinate, this cathartic may be administered, with more benefit perhaps than any other contained in the Materia Medi- ca. * I affirm,5 says Dr. Rivhter, when treating of the cure of the dysentery, *that no purgative operates so 1 powerfully, and at the same time so gently as calo* ' mel. It even appeared to me to have an essential ef- ' feet on the disease itself; most purgatives increase the 'pain; calomel frequently diminishes them remarka- 1 bly.' Calomel may be administered, with much ad- vantage, either alone or combined with Jalap or Rhu- bard; but when' the stomach is much disordered, or very irritable, it may be given alone with more satisfac- tion, as it is received more kindly by the disordered stomach, than any other cathartic medicine, with which we are acquainted. This medicine may also be given combined with opium, with the most salutary effects, when the disease has resisted the ordinary remedies, and it becomes necessary to give an anodyne, in order that the patient may obtain rest. Exhibibited along with opium, it is particularly serviceable in obstinate cases of dysentery in which it is deemed proper to ex- cite a salivation. Producing a slight soreness of the gums or a gentle salivation is an almost certain cure of this diease. 35 FOURTHLY—SUDORIFICS. This class of me- dicines should not be administered until the inflammato- ry diathesis of the system has been previously reduced by bleeding and purging. For while a high degree of inflammatory action prevails in the system, it is raised above the action of diaphoretic medicines ; and in this situation it is extremely difficult to produce a diapho- resis : and were they administered under those circum- stances, they would rather aggravate than relieve the disease. In administering sudorific medicines, we should employ those of the least stimulating nature ; and care should be taken, that the patient be not exposed to cold, from having frequent occasions to rise to stool. Sma 1 doses of tartarised antimony may be given every hour or half hour, and if it should operate too much by the bowels, a small portion of opium may be combined with it. Ipecacuanha, James' powder, and sometimes Dover's, together with antimonial wine, may all be ad- ministered occasionally in smalland repeated doses, with advantage. But the most efficacious t diaphoretic medicine that I have ever given is calomel. Perhaps this medicine acts more universally on the extreme vessels of the surface, or occasions a greater discharge from the body, by insensible perspiration, than any other that has ever been administered. It should be given in doses proportioned to the urgency of the symptoms, either alone or combined with opium according as the case may require, nor need we fear its producing a saliva- tion, for under such circumstances, it is productive of the most salutary effects. And in very urgent, or ob- 36 stinate cases, together with the internal use of mercury, the oint neit should be used externally, so as to bring on a slight salivation. I say a slight salivation because it is unnecessary, cr even improper to produce any more than a soreness of the gums, or a gentle ptyalism, which generally effects a cure. Dr. Clark* speaking of the use of calomel in the epidemic dvsentery, which prevailed at New Castle in the ) ear 1783 says, " I was called to several cases in private practice, which had resisted the common treat- ment; and attended sixty patients belonging to the dis- pensary. Calomel in almost every instance in which it was exhibited,soon subdued the disease,or reduced it to the nature of a simple diarrhoea.'' He further observes, "By an inconsiderable quantity of mercury, the gums became tender; in consequence of which, the gripes and tenesmus were instantly relieved ; natural evacua- tions followed; and health was speedily, restored, with- out the assistance of any other medicine."j| FIFTHLY—OPIUM. The use of this medicine in the dysentery, is very much recon,mended, and great dependence has been placed upon it by some physi- cians, as the chief remedy for its cure. Sydenham has trusted the cure of a number of cases entirely to this med- icine. But though we cannot doubtupon the authority of so great a man, that some slight cases of this complaint have been cured in this manner ; yet I will venture to * On hot clitna,tes, p. 343. II Page 344 37. say, that opium in the dysentery, is seldom or never proper, until by the previous use of purgatives, the bowels have been evacuated. Opiates are only proper after the inflammatory action has been subdued, or when from the violence and con- tinuance oft he disease, the patient has become so debili- tated as to render further depletion improper, and when the pain, griping, and tenesmus are distressing. If the stomach under such circumstances be too weak to bear opiates, they should be thrown up the rectum. SIXTHLY—INJECTIONS. When there is much paih, griping, and tenesmus mucilaginous and oily in- jections are of particular service. They sheath the intest- ines, and defend them from the action of acrimonious matters, which they often contain, and by supplying the place of the mucous natural to these parts, afford great relief. They also assist very much by promot- ing a discharge of indurated faeces from the colon and rectum, which, by their stimulus, tend greatly to aggra- vate the complaint* When the system has been much debilitated from the continuance of the disease, injections of a nutri- tious and cordial nature should be used ; such as starch, barley water, and linseed tea combined with laudanum. SEVENTHLY—VESICATORIES. These have been supposed to prove useful by causing a translation of the diseased excitement from a more important 38 part to one less important. The advantage has been attributed to the effect of producing a mw action, al- though these suggestions are not entirely satisfactory, we must be content with them as we cannot more fully explain the fact. But before useing them, the inflam- matory action should be properly reduced. They should be applied to the abdomen, or near the part af- fected ; but if from any circumstances, they cannot be conveniently applied there, they may be put on the arms, thighs, and ankles. These are the remedies which I conceive to be pro- per during the first or inflammatory stage of the dis- ease. But it some times happens atttr the most violent and inflammatory symptoms of the complaint have been removed, that the discharge from the bowels con- tinues merely from a relaxation of the intestines. In this case such medicines as will put a stop to the eva- cuation, by their tonic and astringent powers, ought to be used; of these, the Peruvian bark, gentian, Co- lombo, and quassia may be used. But ipecacuanha, combined with opium in small portions seems prefera- ble to any other articles, for besides the astringent ef- fect of this composition, it will also act as a diaphoret- ic, for which reason it appears well adapted for the cure of this state of dysentery. When the disease continues in the form of a simple diarrhaea, astringents, such as alum, kino, opium, oak-bark, red wines, ipecacuanha, chalk, acetate of lead, &c. may be advantageously employed. Should these not succeed vesicatories applied to the extremi- ties will often have a good effect. 39 The acute dysentery sometimes runs into the chro- nic state, for the cure of which, the tonic and stimula- ting plan, together with opiates, is, in general, proper. But should these fail, a salivation should be resorted to, and here also vesicatories applied to the extremi- ties will be found to be very beneficial. The diet, it is evident, ought to be varied accord- ing as the state of the patient may require. When he is of a robust plethoric habit, or when the inflam- matory action is considerable nothing of a very stimu- lating nature should be allowed. Soups are propei, particularly mutvon soup, and generally articles of a mucilaginous nature, which may be more agreeable to the patient, ought to constitute the principal part of his diet. ' The drink should be of the demulcent and muqila- ginous kind, such as barley water, lin-seed tea, solu- tion of gum arabic, rice water, thin gruel, ^c. These taken in large quantities seem to sheath and de- fend the intestines from the action of acrid and irrita- ting humours. When the inflammatory symptoms have abated, and, the patient is much debilitated, a more generous diet should be allowed him, with good wine and water, care hcing taken that he eats or drinks very little at a time, until the stomach, and other digestive organs, have acquired their accustomed strength. 40 Pure air, together with gentle exercise, will "also contribute much to give tone to the system, and re- store the strength of the patient. Before I conclude, permit me, Gentlemen, Profess- ors in the College of Medicine of Maryland, collec- tively, and individually, to express the gratitude I feel for the advantages I have derived from your valuable lectures; and to breath a wish that your laudable ex- ertions may be crowned with success: And that the Coliege founded by you may meet with an encourage- ment beyond your fondest anticipations. ERRATA. Page 11,18th, line and elsewhere forfytid read fetid, p. 11 1 1 at bottom for ccanonally read occasionally, p. 14, 1. 3 for SymLm read symptom, p. 16,1. 1, at bottom fat face, read faxes, p. 19,1 3 for faces read faeces, p. 26, 1. 18, for afer read after, p. 29, .. 3 from bottom for symtom, read symptoms, p. 30,1. 16 for coulroultt^ control p 34 l 16 for pa n read puns, 1. 18 for Rhubard read Rhubarb, 1. 5 from boj torn for Exhibibtted read Exhibited. • Book taken apart* Leaves deaoldlfled with magnesium bicarbonate* All leaves supported with lens tissue* Reseved on linen oerds. New all-rag end paper signatures* Uhbleaohed linen hinges* Rebound in quarter unbleach- ed linen* Fabriano paper sides. fazjM*-"* Carolyn Herten & Associates ,-•'„ 7 0 1+30 West 22nd Street /-M" *,/7 New York, New Yerk 10011 / %/£. February, 1977 £^\