>'i*S 4.1-.*•'. .. ,lt. ■ft--' iiiiii s&fi & M &-'*0 SI m. 1 :#' .'••.; > •** SH [KM! AN INAUGURAL DISSERTATION ON DYSENTERY. SUBMITTED TO THE EXAMINATION OF THE HONORABLE ROBERT SMITH, Provost, AND OF THT. Regents of the University of Maryland; FOR THE DEGREE OF DOCTOR OF MEDICINE. Bt JOHN D. VOWELL, Of ALEXANDRIA, DISTRICT OF COLUMBIA Member of the Baltimore MHlcal Society. PRINTED BT S . S JV 0 W D E .V , ALEXANDRIA. To the Professors of Physick, IN THE UNIVERSITY OF MARYLAND, THIS Dissertation is dedicated, as a testimony of respect due to their talents, medical science, and individual polite* ness as gentlemen, By their humble Servant, THE AUTHOR. To Doctor Elisha C. Dick. DEAR SIR, •IS a formal dedication might not be agreeable to you, I hope, Sir, you will permit me to inscribe the following pages, as a partial evidence of those senlimcnts of high re- spect and esteem, entertained for yourself and truly amiable family.—That you and your family may be blest, with health, tranquility and lasting Peace, is the wish of Tour sincere Friend and Pupil, JOHN D. VOWELL. INTRODUCTION. DYSENTERY, the subject of (his Dissertation, is a dis- ease upon which much has been said, and a great deal writ- ten, by able men and very enlightened pens—Therefore it cannot be presumed that a Student can have in his profes- sion much which is new or instructive. A correct method of treatment is now generally under- stood j much innovation is therefore unnecessary. That I may not be charged^ with imprudence, it may be well to state, that I write not for fame—the laws of (lie University demand it: I write not from choice—necessity eompch me. !l- DYSENTERY. THE word Dysentery, in Latin Dysentei ?a, and Greek is derived from difficulty, and the intestines ; importing, a difficulty, or a disturbance of tho bowels. TIih Dvscn tery, is termed by the Latin writers, Difficult tas Ititcsfinoruui ; Celsus calls it Tormina, Cfcl'ms Aureli- anm, Rheumatismus cum Ulcere ; & if is thus described by Hippocrates in Lib. 3, Chap. 5, de Vietus Iiatione Sauo- rum. «• When the body is heated, and then- is an acrimonious purging, with corrosion and ulceration of the intestines, and bloody stools j the disease is called a Dysentery, and is a se- vere and dangerous disorder. Galen de Loeis Aft-ciis, Lib. 6, Chap. 2, says " It is ne- cessary to understand properly the meaning of the word Dy- sentery, as the appellation itself signifies an ulcer of t!i< in- testines. At first there is a discharge of acrid bile, then abrasions of the intestines follow, afterwards bloud is ex- creted with the abrasions; and this constitutes a true dy- sentery. G ilcn then proceeds—" When abrasions of the bowels only are disch.n•/,»d, it is to be observed, whether any fat sub- stance is voided with them ; for then the ulcer is in the large intestines When blood is voided, it is necessary to observe whether it is mixed universally with the excrements, or whe- ther it Is o»i!y superficially upon some part of them. If it be mi.ved with them, it shews that the ulcer is in the superior intestines; if it appear on the surface, the ulcer is in the in- terior intestines. The same observation applies in regard to the a'trasiaus, in some degree ; and they will also shew by t'seir proper substance, which intestine is affected. When the ulcer is in the rectum, the disease is called a Tenesmus ; it is attended with vehement straining, and a constant desire of going to stool, voiding at the same time but little, which in the beginning is pituitous and pinguiuous, hut in length of lime, a species oi anrasou is also voided: hut through th; whole of the disease, the face* from the superior ioteslio.es> have nothing of this sort mixed with tbeui. (10) In Lib. ii, chap. 5, De Loeis Aflrctis, Galen says grip- ing pains in the intestines are caused by a corroding humor, for which reason theDvsentery is always preceded by these pains ; which with an ulceration of the intestines, the mo- dern physicians, and many of the ancients, call a Dvsentery. Some of the latter not only term this, but also any bloody ex- cretion, a Dysentery. Hippocrates uses the word Dysenteria, in a general sense, as well as Galen, distinguishing this disease from the Alvi Profiuvium, or Diarrluea; and from Levitas Intestinorum, or Lientery. The Diarrhsea is described by Aretseus to be a flux of li- quid and unconeocted aliment, and by Galen to be a plenti- ful fliKofthe belly, without any inflammation or exulccration of the intestines. The Lientery is a disease, according to Ilipi»ocrates and Galen, wherein the food passes through the ' ody, unchanged, uneorrupted, liquid and without pain; and the body is wasted. Some modern writers have disputed with the ancient9. re- specting the propriety of describing the dysentery, with an ulceration of the bowels, because an ulceration is not a ptima- ry symptom, nor necessary to constitute a dysentery ; being rather the < fleet than the cause of the disease. Many diflercnt kinds of Dysentery, have been enumerated by authors; as the acute, chronic, bilious, malignant, pu- trid, benign, red, white, &e. which distinctions are only ap- plicable to the different appearances of the same disease, as influenced by climate, season, and constitution. Having premised thus much concerning the definition of the disease, as given by some of the ancient? ; we shall now endeavor to take such a v ew of the subject, as will he mora in conformity with the ideas entertained of it, by modern writers* SYMPTOMS. The Dysentery is a disease generally considered contagi* •us, in which there is an inflammation of the mucous mem- brane of the intestines; the patient has frequent stools, ac- companied with much griping, a tenesmus and fever ; the stoels, although frequent, are generally small in quantity j and the matter voided is chiefly mucous, streaked with blood. The natural iteces seldom appear* and when they do, it is usually under the form of small, compact, hard substances, known by the nawe ofscjbala. no When the inflammation begins to occupy the lower part of the intestinal canal, the stools become more frequent and less abundant, and in passing through the inflamed parts, they oc- casion great pain, so that every evacuation is pit ceded by a severe griping, and -a\>o a rumbling noise. Sometimes what is voided consists merely of a mucous matter, without any appearance of blood, exhibiting that dis- ease which is known by the name of Morbus Mueosus. It has been doubted, and I am disposed to think with pro- priety, whether this disease has any claim to the epithet, con* tagiou s. There is but one, and that a conclusive experiment by which the question can he settled, as proposed by Dr Potter ; which I believe has not been adopted, viz : Let the fsecal evacuation of a person laboring under dysentery be thrown into the bowels of a healthy person. CAUSES. This disease occurs generally in summer and autumn* and is produced by moist weather quickly succeeding intense heat or great drought ; whereby the vessels of the surface of the body beeome debilitated, and incapacitated for the discharge of their proper function ; if is in this way, that the intestinal canal is brought i.ito suffering, and not, as we suppose, by any particular and direct determination of fluids to it. Dysentery is also produced by unwholesome and putrid food, and by noxious exhalations and vapors, arising from ve- getable substances in a state of putrefaction ; hence the rea- son of its appearance in armies located in the neighborhood of low marshy grounds. Winn climates appear to be more favorable to the produc- tion of this disease, than cold ones ; in the West Indies, dur- ing the rainy season of the year, which is during the months of August, September and October, it is apt to appear, and af- fect very generally the negroes on the plantations, in the dif- ferent colonies. Acids, as Ilhenish Wines, acid unripe fruit, or large quan- tities of ripe fruit becoming acid in the stomach, may give oe* easion to this disease. (12) DIAGNOSIS. There are two diseases which bear some resemblance !• the one now under consideration : Diarrhsea and Hemoriboia; but a diagnosis sufficiently clear and dislinet, may without difficulty be drawn. Dysentery may readily be distinguished from diar-iliiea. by fever being absent in the last, the tenesmus and griping are also inconsiderable ; the appearance of the matter evacuated will assist us, which in the one disease, i-» feculent or mixed with alimentary matter ; in the other, sanguineous or pu- trid. In Hemorrhois there is no tenesmus, but when there is, we are still able to distingul h the two diseases ; for in he- morrhois the blood is li^t evacuated, in dysentery not so. In piles, mucus is seldom or never discharged. PROGNOSIS. A gentle and universal diaphoresis, moderate pyrexia, (he evacuations becoming less frequent, and more of a natural co- lor and consistence ; the strength little impaired: sediment in the urine, and a gradual diminution of the griping and tenesmus, are to be considered favorable appearances. But when the disease has become habitual from long conti- nuance ; violent and distressing tenesmus ; vomiting ,* hiccup ; apthse ; difficult deglutition ; convulsions ; cold extremities ; the tongue preternaturaily red and dry ; the pain suddenly ceasing ; great prostration of strength ; the iiccs extremely foeted; involuntary evacuations; intermitting pulse; the disease being complicated with others ; or with affections of the liver, with intermittent fever, scurvy, &e. Vie are to eonsider these as symptoms of a futal termination of the disease. TREATMENT. There is probably no disease, for the eure of which more remedies bave been advised, than for the one now under consideration ,* yet there are but few which merit our at- tention. M'r shall therefore endeavor, in as concise a man- ner as possible, to lay down such observations, as may be (13) useful in effecting the removal of this very painful and dis- tressing m .Irtdy. In the emiiineneement of the disease, partieularlv in cities, it is frequently marked with an inflammatory character; which circumstance renders it less fatal thwn in the country, where it is »pt to assume a typhus disposition. If the inflammatory symptoms are considerable it nny he ad- visable to take away a few ounces of blood ; hut if these are slight, we should be exceedingly cautious in the use of the lancet. The mo it eminent of our late practitioners, and of great- est experience in this disease, are of opinion that the most proper method of treatment is purging assiduously employed. When we depend upon purging for the cure of this disease, these should be frequently repeated, in small doses, with a view of keeping up a constant action on the bowels—glassier salt, phosjihas sodie, castor oil, or manna, may be aciMiiriistered. Calomel in some cases may beeon^-idered as possessing qual- ities preferable to every other cathartic we can employ ; should the mouth become a fleeted, from the use of calomel, we may expect an abatement, if not an entire removal of the sy»a:»;oiH». The combination of opium with calomel cannot be proper, if the inflammatory disposition existing in the system be consi- derable. The greatest benefit has been supposed to result from the use of emetics in this disease ; although we would not place too much reliance upon these, yet at the same time, there is no doubt thoj may be very generally employed in the * uuimencement of the dinase with advantage ; and those par- ticul .rly which have some action on the intestines. Should the fever continue, with hot and dry skin, it may then be necessary to make use of diaphoretic medicines. For this purpose, the Yit. cerat, antiin, is an eligible pre- paration. Ipecacuanha is also useful, as it possesses some diaphoretic property. This method of treatment may be considered as being ap- plicable to that state of the disease which is not of the Ty- phus character. When the disease is of this nature, cathar- tics, and all depletiag medicines arc generally injurious. We should rely upon the use of tonics and stimulants. . Madeira Wine in large quantities is to be ranked amongst the most powerful remedies. The system should be kept under its in- fluence, the effect of one dose not permitted to subside before another is administered. Bark is not to be passed over unno- ticed in this disease. There is another state of Dysentery which may now be mentioned :—it is that, which is known by the name of Chro- nic Dysentery. (14) Mercury may be administered with the greatest hopes of success in this stale of the disease. It has also bee t.advised, that the patient should change his jdace of residence ; which can he done with advantage ei- ther from a cold to a warm, or from a warm to a cold cli- mate. Astringents have also been advantageously exhibited; fbe Tinct. Kino in the dose of a tea spoonful, given three or four times a day is a remedy advised by Dr. Potter. Some of the essential oils have beeu highly spoken of in the treatment of this disease. If no row theory or practice be suggested, or any particu- lar ones selected from a vast assemblage as the most eligible, let this be ascribed to the firm persuasion that experience a- lone can qualify for such a task, and the piudeuce of a stu- dent will of course decline it. \ Book taken apart, leaves deaoldlflod with magnesium bicarbonate. All leaves supported vith lens tissue* Leaves mended* Reseved with new all- rag end paper signatures & unbleaohed linen hinges* Rebound in quarter un- bleached linen with Fabriane paper sides* June 1977 - W2- Carolyn Horton h Aflsooiates \/ 4 7dL ' 1+30 West 22 Street sZ/*-' N«r York. H.Y. 10011 /WeJ.^A <^-i