J#£r': jMll^nyH, ^ J iv *&* •JKs ■ Q j .! 1 ^'^r V M P M" ■$■ 4 ^ ■ >' \ ^ J ?.*fc k i W-* 1"#k >v^«*2 AN Inaugural Diflertation ON THE DYSENTERY. Submitted to the Examination of THE REV. JOHN EWING, S.S.T.P. Pxorost, THE TRUSTEES AND MEDICAL FACULTY OF TBS UNIVERSITY OF PENNSYLVANIA. On the 12th Day of May, 1797. For the DEGREE of DOCTOR of MEDICINE. Moooooeoaotocooooooeoodtooootbovoeoooooooooeeoo By COLIN MACKENZIE, of Baltimore, Member of the Philadelphia Medical and Chemical Societies. D99MOOOOOOOOOQOQOeO3*OOOOOOOOO0OOO9O 993*0000003 Qua prefenti opufculo defunt, fuppkat etas. FruSutn Jludiorum viridem, et adhuc dulcem, promt decet; dum et venia et fpes ejly et par at us favor, et audere non dedecet. qvintillian. PHILADELPHIA: f&iNTXD Br ORMROD fcf CONRAD, 41, creskutstreet. /■ 6- ■ ' * ^ e- V''' ////•// " ^sjtS 2-- T O GEORGE BROWN, M. D. OF BALTIMORE. DEAR SIR, It affords me the highejl degree offatif- faclion, to be able, thus publicly, to return you my unfeigned thanks, for the many acls of kindnefs which you have conferred on me, and for the re- peated tejlimonies offriendfhip which I have ever experienced from you. In dedicating, therefore, the following pages to you, permit me to call it, a dedication of gra- titude—thefincere wi/h of a pupil to teflify his regard and efleemfor a beloved preceptor, from whom he has received fo much ufeful inflruclion, and to whom he is under fenfible and lafling ob~ ligations. B f If J Whatever fhare, Sir, of medical informa- tion Imay poffefs, the chief fource from whence it has been derived, can never efcape my recollection : Nor fhall I fail to accompany your progrefs through life, with my mofl fervent wifhes for your health, profperity, and future happinefs. COLIN MACKENZIE, INTRODUCTION. AMONG all the comforts allotted to man- kind, nothing is certainly more defirable, than the enjoyment of health.—But the human frame, in confequence of its delicate ftructure, is fo fufceptible of difeafe, that no fooner has the new-born babe infpired the breath of life, than it becomes liable to fome of thofe com- plaints, peculiar to the infantile ftate. Holy writ informs us, that in the begin- ning, when the omnipotent Creator formed man out of the duft, he enjoyed the moft fub- lime happinefs, and was altogether free from thofe pains and infirmities, to which his pofte- rity have fince been fubjected.—But as by his fall, he forfeited the favour of his Maker, and was doomed to fuffer both ficknefs and death ; Priovidence therefore wifely implanted in him a natural inftinct, to feek for remedies to pre- ferve health, and moderate the violence of dif- eafe : Nor has he fought in vain.—Many of thofe difeafes which were formerly fuppofed to be incurable, have at length yielded to modern ( vi ) improvements in the healing art; and many medicines have been difcovered of late, which ad almoft with certainty, in removing thofe complaints, which were anciently denominat- ed the opprobria medicorum.—As this is the cafe, we have reafon, I think, to entertain a fond hope, that e're long, few avenues will remain to the grave, fave that of old age. "In the firft fteps of our enquiry y^e meet " indeed with much variety and obfcurity; " but the further we penetrate into nature, we " find fo much analogy among all her works, " as to be forced to acknowledge and to revere " her fimplicity." This juft obfervation of the illuftrious Pringle, mould ever be deeply imprefled on the minds of thofe, whofe wifh it is, to make flrid refearches into the arcana of nature.— In order to inveftigate more minutely, thofe fubjeds, which have hitherto appeared to us inexplicable, we fhould always view nature as being clothed in afimplegarb, and eonduding all her operations in an uniform and perfpicu- ous manner. tc Nature in fimple dignity appears, " And all her works, a hand divine declares. " We trace in Nature's moft minute defign, " The fignature and ftamp of power divine." I have chofen the Dyfentery for the theme of my inaugural difTertation, not with the moft diftant view of doing it more juftice than it has hitherto met with, or of faying any thing new on the fubjed ; but merely becaufe I have had fome opportunities of becoming acquaint- ed with it.—And although it has heretofore been treated of at large, by many of the moft refpedable medical writers which the world has afforded, yet, even at the prefent day, phyficians appear to be undecided in their opi- nions refpeding it.—Its ftill frequent occur- rence and melancholy effeds, will, therefore, I hope, be admitted as a fufficient apology, for every pofliblc attempt to inveftigate its caufe, to elucidate its nature, or to obviate with fuc- cefs, its fatal termination. I submit this difTertation to the examina- tion of the medical faculty, and to its fate. AN Inaugural DifTertation. X HE Dyfentery, (the difeafe which is in- tended for the fubje£t of the prefent difTertation) is derived from, the Greek word $«? which fig- nifies, with difficulty, and nrepa, the interlines; importing a difficulty, or a difturbance of the functions of the interlines. This difeafe is peculiar to no country, for inftancesof it are recorded by writers, in almofb every part of the globe. It may occur in all places, and at all feafons, but it is generally moft prevalent during the autumn, in cities, and other Confined places, where numbers are expofed to the fame remote and exciting caufes.—It is like- wife often epidemic in fleets and armies ; and the great havoc it has occafioned among foldiers in thefe fituations, is well known. " The page " of military hiftory weeps lefs for the flain in " battle, than for thofe who have fallen victims " to this calamity." From the definition which Dr. Cullen has given of the dyfentery, it appears, that he view- ed it as being always a contagious difeafe, de- pending folely upon the action of a fpecific con- tagion. As I hope however, to prove hereafter, that the difeafe is not always contagious, and that it is very frequently owing to the fame caus- es which produce intermitting and remitting fe- vers, I fhall "therefore take the liberty to deviate a little from him, by leaving out the word conta- gious in the definition which I am about to give. I would therefore define the dyfentery to confift in a fever, accompanied with frequent mucous, and fometimes bloody fiools, attended with tormina, tenefmus, and a retention of the natural faeces. HISTORY OF THE DISEASE. The Dyfentery (as was before faid) may occur at any feafon of the year, in general how- ever, it makes its appearance towards the latter end of July, or the beginning of Auguft, and ceafes gradually on the approach of winter. The difeafe is for the mofl part ufhered in, by the following premonitory fymptoms. The ( " ) patient is feized with an univerfal languor and laffitude, accompanied with anorexia, frequent chilly fits, a bitter tafle in the mouth, andfome- times with naufea and vomiting. Thefe fymp- toms are in a (hort time fucceeded by morbid ac- tion in the arterial fyilem, attended with a fevere pain in the head, exceffive thirft, bilious flools, and, when the attack is very violent, with deli- rium and coma.—The pulfe, which in the be- ginning, was fcarcely perceptible, becomes now full and flrong, and excruciating tormina harrafs the bowels. In other inflances, the pain in the bowels comes on, unaccompanied by any apparent fe- brile affection, and is fucceeded by a tenefmus, and frequent, but fmall difcharges, from the bowels, confuting for the mofl part, of an inter- mixture of blood and mucus. Together with thefe fymptoms, the appetite for food becomes languid, but naufea and vomiting rarely occur.— After an uncertain length of time, the patient is attacked with a fever, in a more or Iefs violent degree, and with it the tormina and tenefmus become more coniiderable, and the flools more frequent. The fever fometimes puts on the form of an intermittent, more frequently that of a remittent, and is often likewife of a continued kind, accompanied with highly inflammatory C ( I* ) fymptoms.—The matter evacuated from the bowels, differs confiderably in its appearance ; fometimes it confifls entirely of mucus ; at other times, of pure blood ; but in the generality of cafes, the mucus and blood are intermixed with each other. The flools are often unufually foetid. It is remarked by fome authors, that a ge- nuine purulent matter has fometimes been voided by ilool, and frequently, a putrid fanies, pro- ceeding from gangrenous parts*. The former of thofe appearances, I believe, is rarely to be met with, and the latter does not occur, excepting in the advanced flage of the difeafe. Writers on the Dyfentery make mention of fmall membrane-like appearances, which have on fome occafions been difcovered among the foe* ces, and were formerly fuppofed to be portions of the villous coat of the interlines, abraded, as it were, by the acrid humours generated there.— White manes of a febaceous nature, are fome- times too, difcharged by flool; which from their refemblance to fuet, have received the appella- tion of corpora pinguia. I have in a few inflan- ces only, met with either of the above fubilan- ces; much has been faid concerning them, but * Culien's firft lines. ( »5 ) phyficians Mill appear to differ in fentiment, res- pecting their nature. Although the evacuations by flool are ve- ry frequent, yet, natural foeces are rarely excret- ed ; and when they do at any time appear, they are discharged in the form of fmall indurated manes, termed by writers, Scybala.—" When " thefe are voided, whether by the efforts of na- " ture, or as foiicited by art, they procure a re- " million of all the fymptoms, and more efpecial- " ly of the frequent flools, griping and tenefmus." In the courfe of the diforder, worms are fometimes difcharged both from the flomach and bowels; but this occurrence is altogether accident- al. A procidentia ani and a fuppreffion of urine, fometimes too, take place, and tend confiderably to increafe the fufferingsof the miferable patient. In attacks of a more violent nature than thofe which have yet been mentioned, fymptoms of mortification in a fhort time enfiie, and clofe the fcene. When the bowels become affected with gangrene, the patient, heretofore refllefs, and in great agony, now complains but little, ei- ther of pain or tenefmus; the pulfe finks ; deli- rium and coma fupervene*; and the miferable * In fome inftances however, the fenfes remain perfe& and unimpaired, till the laft moments of life. ( M ) fufferer at length quietly finks, into the arms of death. When the difeafe arrives at its highefl de- gree of danger, a miliary eruption is frequently obfet ved on the fkin, and ulcers appear on differ- ent parts of the bodyf. Children, at this flage of the complaint, are fometimes attacked with convulfionsj. When the difeafe'is mild, it fometimes goes offfpontanecufly ; the difcharges from the bowels become lefs frequent; the tormina and tenefmus gradually abate ; and the foeces put on a natural appearance. f Pringle, Monro, and others. + A fymptom which fometimes takes place in the courfe of this difeafe, is an immediate call to go to ftool, upon fwallowing any thing either folid or liquid, accompanied with a feeling, as if what was juft fwallowed, were running through the bowels. This fenfation is often fo ftrong, that the tick imagine, that the food they have taken has really paffed through them, and are not con- vinced of the contrary, till they find that the difcharge has been dime or mucus, without any refemblance to what they had fwal- lowed. I have met with this fymptom, but once. It occurred in the cafe of a patient, who laboured under an attack of the dy- fentery, in the Baltimore alms-houfe. It undoubtedly (hews great irritability in the bowels, by which, a motion excited in the Horn- ach, is almoft inftantaneoufly propagated to the anus. ( »* ) From the hiftory of the dyfentery which has now been given, it is evident, that it prevails chieflv at that feafon of the year, in which, intermitting and remitting fevers are rife: Hence I think, we may with propriety conclude, that it arifes from the fame general caufes, by which, thefe fevers are produced. The opinion, long fince advanced by Dr. Sy- denham, that the dyfentery was " a fever turn- ed inwards upon the interlines," is, in my mind, a very juft one; and indeed, the truth of it has been fo clearly eftablifhed by later experience, that it is almoft unneceflary for me to fay any thing in this place, on the fubject. I (hall how- ever, quote a few paffages from fome of the moft refpectable writers on this difeafe, merely wich a view to fhevv, that Sydenham's opinion concern- ing it appears to have been accurate and well founded. We are furnifhed with many inflances which inconteflibly prove, that intermitting awd remit- ting fevers frequently terminate in dyfentery, and vice verfa. Dr. Cleg horn tells us, he has oh- ferved, that when one of thefe difeafes is fuppreff- ( *6 ) ed, the other often enfues ; nor is it uncommon for dyfenteric fevers to put on the form of ter- tians ; and for the fits of tertians, to be regularly accompanied by gripesand flools*. Dr. Moseley informs us too, that he had frequently obferved the fame circumftance to take place in the Weft Indies; and fays he has remarked, " that as the " flux conforms by the number of flools, and by " its rapidity, to the degree, fo it does to the " flate of the fever, of the feafon, when it pre- " vails; the flools being more frequent, and all " the fymptoms more aggravated, at thofe hours " when the current fevers are in their exacerba- " tion, and the reverfe, when thofe fevers are " in their remiffiont." The jail or fhip fever frequently too, af- fumes the form of dyfentery. Dr. Blane in his account of the difeafes incident to feamen, tells us, that when this fever prevailed on board of any (hip coming from a northern climate to the Weft-indies, it was foon after its arrival there, * Difeafes of Minorca. f On tropical difeafes. " A fymptomatic dyfentery fre- quently accompanies the autumnal fevers in Pennfylvania. In the hilly parts of the ftate, it has been remarked, that it prevails chief- ly on the high grounds; while remitting and intermitting fevers prevail in the neighbourhood below them." ( *7 ) converted into a dyfentery ; and that thofe fhips which arrived cither from England or North America, with the greateft flock of fevcrifh in- fection, were the mofl fubjett to fluxes, after be- ing a fhort time in the Weft-indies. This in all probability was owing, to the patients being in- duced, in confequence of the exceffive heat of the climate, to expofc themfelves to the influence of the cool breezes, by which means, perfora- tion was checked, and the difeafe thrown with its whole force upon the bowels. These obfervations will, I prefume be fuf- ficient, to fhew, that the difeafe under confider- ation, is a fever of the inteflines* Many more arguments might be adduced in fupport of this opinion, but to infert them here, would extend this difTertation far beyond its intended limits. DIAGNOSIS. This part of the fludy of medicine, has of late, been defervedly confidered of much lefs con- fequence than formerly, fince the fallacy of pre- ferring for the name of a difeafe has been fo fully, and in my opinion, juflly condemned, by the gen- erality of Phyficians. As in this complaint how- ever, the hopes of a cure, depend in a great mea- ( «8 ) fure upon the mode of treatment employed du- ring the firft few days of its attack, it therefore becomes a matter of fome importance, to be ac- quainted with it, in its early ffcage. Few inflances perhaps, ever occur, in which the Dyfentery may not be diilinguifhed with eafe from every other complaint. There are two difeafes however, with which, it may poffibly fometimes be confounded, to wit, Diarrhoea and Cholera Morbus. The neceffary discrimination between the diarrhoea and dyfentery may be ascertained with- out much difficulty, by attending particularly to the following circumflances. In the former com- plaint, the alvine discharges are generally copi- ous, confiding chiefly of natural fceces; and the difeafe is for the mofl part accompanied with lit- tle or no fever. In the latter, the natural foeces are, at leafl for fome time, retained, and when evacuated, they appear in fmall hardened maffes, attended at the fame time with confiderable fe- ver, fevere griping, and tenefmus. Thefe lafl mentioned fymptoms, do now and then occur in cafes of diarrhoea, but they are by no means fo vi- olent as in the dyfentery. The diagnoflic fymptoms of the dyfentery, differ fo materially from thofe, which character- ( «9 ) ize the Cholera, that it is almoft impoffible to confound them. In this lad mentioned difeafe, a bilious matter is difcharged in confiderable quantities, both from the flomach and bowels, and the febrile fymptoms are generally not fo for- midable, as in an attack of the former. REMOTE CAUSES. These have generally been divided by au- thors into the predifpofing, and exciting orocca- fional caufes. Under the firft head, we confider debility, either direct, or indirect, or as it affects the whole, or certain parts of the body, only.— In what manner therefore, or by what means, this debility is produced, remains now to be men- tioned. And First. Among thofe caufes which induce direct debility, the depreffing paffions of the mind, fuch as fear, grief, and defpair, are de- fervedly to be enumerated. Thefe affections un- doubtedly act on the whole fyflem, but they ap- pear to produce their effects chiefly on the flo- mach, as is evidently demonflrated, by the de- fect of appetite, cardialgia, acid eructations, and other fymptoms, the confequence of a lofs of tone in the mufcular fibres of that organ. D ( *» > But the ratio in which the difeafe under con- fideration is fucceeded, by thofe affections of the mind, remains as yet in obfcurity. Secondly. Cold. This is univerfally ac- knowledged to be a powerful caufe in inducing debility. When applied to the body, it produc- es languor and inactivity, and leffens both the force and frequency of the pulfe. Thirdly. Preceding diforders debilitate the body, and predifpofe it to difeafe; hence the dyfentery frequently Succeeds intermitting and remitting fevers. Fourthly. Famine. Fifthly. Filthinefs. This has always been confidered as a fruitful fource of the difeafe of which I am now treating, and its frequent occur- rence in camps and hofpitals has been adduced in fupport of this opinion. A neglect of cleanli- nefs, has no doubt, a confiderable Share in ren- dering the difeafe more violent when it has taken place, and may probably fometimes concur with other circumflances to produce it ; for we find, that the poorer clafs of people, many of whom are deflitute of the common neceflaries of exist- ence, become much fooner affected, both with < " ) this, and many other difeafes, than thofe who enjoy a higher flation in life. Those caufes which predifpofe to this dif- eafe by inducing indirect debility, are, First. Heat. Hence the greater frequency of the difeafe in warm climates, and in warm weather. Secondly. Intemperance in the ufe of ar- dent fpirits. Spirituous liquors if taken diluted, and in fmall quantity, appear to fortify, as it were, and give tone to the whole fyftem. Me- lancholy experience however, teaches us, that an immoderate ufe of them, not only weakens the whole frame, but likewife renders it more excitable, and of courfe, more liable to the whole train of difeafes, with which the human race are afflicted. The debility induced by the too free ufe of thefe liquors, is feated principally, in the flomach and interlines ; which is one reafon, and I think, a powerful one, why hard drinkers, are ceteris paribus, more Subject to attacks of the dyfentery, than thofe who lead a fober and regular life. ( « ) Thirdly. Exceffive fatigue, either of the body or mind, weakens the fyflem, and renders it more fufceptible of difeafe. Fourthly, and laflly. Human and marfh effluvia. EXCITING CAUSES. From the concurring teltimony of all thofe phyficians who have written on the dyfentery, it appears, that the difeafe is more prevalent during the autumn, than at any other feafbn of the year. At this time, the heat is exceffive through- out the day, while the evenings are uffiered in by cool breezes, attended with heavy falls of dew. Hence the poorer clafs of people, and particularly foldiers, who are much expofed to thofe fudden changes of the weather are often the Subjects of this difeafe. " It is the Soldier's life," fays Dr. Moseley, " to be much expofed, and it is his cuftom to be " carelefs of himfelf: WThen he is fatigued, or " heated, he haflens to cool himfelf in the breeze, " or night air, and perhaps throws off his clothes, " and often lies down and Sleeps in that condi- " tion. If he is wet, he dries his clothes, linen, " and fkin, together. By thefe means, perfpira- C »3 ) *' tion, the great fountain of health in hot cli- " mates, is Suddenly flopped, and febrile flrictures " occupy the whole furface of the body." We are informed likewife, by Sir John Pringle*, that during the month of Auguft, when the days are commonly very warm, and the nights, cool and damp ; that the foldiers who were expofed to thofe fudden viciffitudes of the weather, were generally attacked with the dy- fentery ; and Dr. Hillary, in his account of the difeafes of Barbadoes, tells us, he has always ob- ferved, " that if the months of May, June, July " and Auguft were very hot and dry, and the " following months of September, October, and " November, were accompanied with much rain, " fo that the air was rendered cool and damp, and " if the intermediate days between the rainy ones " were very hot, that Dyfenteries were very fre- " quent and epidemical, and were generally plethoric, with much fever, full pulfe, " and fevere pains." Nor fhould a low pulfe, (when it occurs in the beginning of the difeafe) deter us from bleeding, for it often becomes full, and even tcnfe, after the operation. Dr.DoNALD Monro, in his obfervations on the cure of the dyfentery, tells us, that when the patients were ftrong, and complained of much pain in the bowels amended with a fever, he ufed the lancet freely ; nor was he difcouraged from bleeding by the low quick pulfe which often attended the beginning of the diforder, for it frequently rofe as the blood flowed from the vein.* The low, or more properly Difeafes of the army. ( 38 ) Speaking, thedeprefled pulfe, which often occurs in the beginning of this, and many other febrile difeafes, is entirely the conScquence of an high degree of inflammatory aaion, and is therefore to be remedied by the ufe of the lancet. Secondly. Emetics. Thefe are often highly Serviceable in removing crudities from the Sto- mach', and cleanfing the prima via. But our great expeaation from vomiting is, that its aaion on the mufcular fibres of the Stomach, forces open the extreme arterial capillaries, forwards the circulation to the fuiface of the body, and induces to Svveat. In this intention therefore, either tartar- emetic or ipecacuanha, may, according to cir- cumstances, be ufed. When administered in Suitable doSes, and at proper intervals, they not only prove emetic and diaphoretic, but often likewife, produce free and copious difcharges from the bowels. They are often advantage- oufly given in combination with each other. Thirdly. Purgatives. Medicines of this cfafs have bsen highly recommended and freely ufed by all phyficians. They are undoubtedly of con- siderable utility in evacuating the indurated fceees and acrid humours from the bowels; which, by being retained there, would tend to ( 39 ) increa-fe the inflammation, and aggravate all the fymptoms. At the Same time however, that they are given with an intention to evacuate freely, they fhould not prove too flimulating, Thofe of the milder clafs therefore, are always to be preferred. Under thefe impreffions, the neutral purging falts, are, at the preSent day in general ufe. The ehieS of thefe are glaubets fait'*, the bitter purging faltf, and Soluble tartar^. Caftor oil too, when it is properly prepared, and has not become rancid by keeping, is one of the beft purges in the dySentery. It frequently eafes the painful gripes as fbon as it is taken, and feldom fails, when it agrees with the Stomach, to procure copious evacuations, Calomel is likewife an ufeful purgative. Fourthly. Sudorifics. Thefe aa by deter- mining the fluids from the bowels to the organ of perfpiration. They may be ufed thereSore with the greateft advantage in this ftage of the difeaSe. * Natron vitriolatum Fh. Lond. 1788. f Magnefia vitriolata Ph. Lond. 1788. + Kali tartaris atum Ph. Loud. 1788. ( 40 ) The uSe of fudorifics has of late been high- ly extolled in the prefent complaint by Dr. Moseley, who declares, that the bark is not a more certain remedy in intermittents, than fu- dorifics are in the dyfentery. The good effeas which I have oSten experienced from them, convinces me, that MoSeley has not Said toa much in their favour. i With a view to excite perfpiration, a vari- ety of medicines have been at different times recommended by authors. Moseley Speaks highly in favour of James's powder ; and I have often feen the beft effeas from the ufe of Dover's powder*, antimonial wine, Sec. But the mofl powerful diaphoretic with which I am acquainted is calomel. This invaluable reme- dy aas forcibly on the extreme veffels of the fu- perficies, producing at the fame time little or no irritation in the Sanguiferous Syftem. It was uSed with the happieft effeas by my worthy pre- ceptor Dr. Brown, in the late epidemic dySen- tery which prevailed in Baltimore. It is like- wiSe highly Spoken of by many late writers, par- ticularly by Doaors' Clarkj and Wade;J * Pulvis Ipecacuanhce comp. Ph. Lond. + On hot climates. % Obfervations on the difeafes of Bengal, C 4* ) both of which gentlemen have given us a varie- ty of cafes in proof of its fuperior efficacy in this difeafe. It fhould be given in dofes propor- tioned to the urgency of the complaint, either alone, or combined with a fufficient quantity of opium to procure an alleviation of the griping pains, which are fometimes infupportable. But I do not wiffi it to be understood here, that I fuppofe calomel is always produaive of good effeas, by aaing folefy as a diaphoretic. On the contrary, many cafes of the difeafe have come within my own obfervation, in which, no apparent advantage refulted from the uSe of this medicine, until it had affeaed the Salivary, glands. In theSe inftances it appears to operate, by exciting a new atlion or an artificial. diSeaSe in the glands above mentioned, and thereby con- centrating or inviting as it were, the diSorder from the bowels to thefe parts*. * Dr. Clark, fpeaking of the ufe of Calomel in the epidemic dyfentery which prevailed at New Caftle in the year 1783, ob- ferves, " although in the ahove inftances of epidemic dyferite- " ry, the fuperior efficacy of calomel leemed to be eftablifhed, " yet I was ftill in doubt whether to impute its virtues to its " purgative or to its mercurial quality. But in the autumn of " the year 1785, the dyfentery again made its appearance, and " was attended, in many patients with fo great irritability of " the ftomach, that the common purgatives were immediately ( 4* ) Fifthly. Blifters. Should the pain in the bowels continue obftinate, notwithftanding the ufeof the feveral remedies abovementioned, im- mediate recourSe fhould be had to the aid of blifters, which indeed often aa like a charm in removing this harraffing Symptom. They may be applied with advantage to almoft any part of the body : but they are generally more certain in their effeas, and produaive of more imme- diate relief, when laid on the abdomen. Fo- mentations to the abdomen and extremities are likewife frequently of fervice in alleviating the griping pains. " rejected. To two patients in this fituation, I gave three " grains of calomel conjoined with opium, every four hours, " which in both, allayed the vomiting. By an inconfiderable " quantity of mercury, the gums became tender ; in confe- " quence of which, the gripes and tenefmus were inftantly re- " lieved ; natural evacuations followed ; and health was fpeedily " reftored, without the affiftance of any other medicine. " Being now thoroughly convinced of the advantages refult- " ing from calomel as a mercurial, I gave it more freely du- " ring the courfe of the epidemic, and. alfo recommended the "- practice to all my medical friends in this neighbourhood. All " of them have concurred in obferving, that they were much " more fuccefsful than formerly, and that generally as foon as the " medicine occafioned the flighteft tendernefs of the gums, the " diftemper was either fpeedily removed, or became extremely " tradable." ( 43 ) The fecond indication was, to remove irri- tation. In endeavouring to accomplifh this, opi- um claims our moft pointed attention. In this Stage of the difeafe, opium is undoubt- edly a fovereign remedy. It affifts powerfully in removing the gripes and tenefmus, procures re- frefhing fleep to the exhausted patient, and paves the way for the ufe of tonics. When by the de- pleting plan above laid down, the Sever and the determination to the bowels, have been in a great meaSure Subdued, and the tormina and te- nefmus appear to be owing to irritation alone ; in Such caSes, the uSe of opium will be attended with the happieft effeas. It fhould be given in Small doSes throughout the day, and increaSed at night. Demulcents may be uSed with advantage in every Stage of the difeafe. They fhould be taken by the patient as common drink, and in- jeaed likewife, if neccffary, in the form of cly- ster. Starch, gum-arabic, or lint-Seed, proper- ly prepared, may be beneficially employed in either of the above intentions. They anfwer a good purpofe by fheathing and defending the in- terlines from the aaion of thofe acrid and irri- G ( 44 ) tating humours, which are conftantly generated during the whole courfe of the complaint.* The third and laft indication of cure was, to reftore the Strength oS the patient. Authors differ but little, withrefpea to the mode oS treatment proper to be purSued in this Stage of the difeafe, and here indeed their differ- ence is but of little confequence. For unleSs, (as Dr. Moseley juftly obServes,) the diSeaSe has been managed with judgment in the beginning; the patient is generally indebted for his recovery, to the Strength of his constitution, or to Some fortunate change, that time, and not medicine effeas in his habit. It fometimes happens however, after the moft violent fymptoms of the difeafe have been removed, that the difcharge from the bowels, and teneSmus, will continue to be troubleSome and diftreffing Srom mere debility and relaxation of the inteftines, unaccompanied by any mate- rial gripings or Sebrile Symptoms. When this is * I have obferved the moft beneficial effects in this difeafe, from the ufe of a mixture compofed of equal paits of the oil of olives and rofe-water, with the addition of a fufficient quantity of fugar to render it agreeable. The dofe is a table-fpoonful every hour or two. Mutton fuet boiled in milk, has likewife been ufed with great advantage. ( 45 ) the cafe, it will be proper to have immediate recourfe to the aid of tonics. Of thefe, the Pe- ruvian and anguftura barks, fimarouba, quaffia, colombo-root, and the various preparations of Steel, are the moft powerful. If acidity prevails in the prima via, mag- nefia, prepared chalk, or any other abforbent, may be prefcribed with advantage, either alone, or in conjunaion with fome of the remedies jufl mentioned. When the diSeaSe is reduced to the State of a Simple diarrhoea, aftringents, Such as gum ki- no, alumen, the red wines, Sec. may be benefi- cially employed. Should theSe fail, the vitrio- lic solution may be tried in the manner re- commended by Dr. Moseley. It has frequent- ly been of fervice, and fhould always therefore be kept in view.* Another powerful remedy which I muft by no means rieglea to mention in this place, is that of blistering. After the whole routine of remedies enumerated under the prefent head of * I have never myfelf made trial of this folution. Dr. Good- win however, a phyfician of eminence in Baltimore, informed me, that he had ufed it in two or three cafes with obvious advan- tage. ( 45 ) cure, have been adminiftcred without the leaft benefit to the patient; blifters, applied to the ex- tremities, (as recommended by Dr. Rush) will often be produaive of the moft falutary effeas : They fet up a new atfion on the fkin, and thus re- lieve the difordered bowels. Pure air, together with moderate exercife, a nourifhing and fomcwhat Stimulating diet, and a proper attention to cleanlinefs, will all, pow- erSully tend to give tone to the fyftem, and reftore the ftrength of the patient. " During the convalefcent ftate of thofe " who have been much reduced, and to prevent " a relapfe, a flannel fliirt, or jacket, worn next " the fkin, is very beneficial. When the bowels " have fuffered considerably by the flux, and " cannot recover their tone, but from weaknefs " are fubjea to returns of the difeafe, or to di- " arrhcea or tenefmus, on the leaft expofure to cold; " a flannel jacket next the fkin, will be found al- u moft a certain remedy and preventative." ( 47 ) Having now concluded my Thefis, I have only to bid a cordial and an affeaionate adieu to this Univerfity, and its worthy Profcffors, under whofe aufpices, I have had the honour of finifh- ing my medical education. To you gentlemen, I beg leave to return my warmeft acknowledge- ments, for the ufeful information which I have received from your valuable leaures. *. -*-A' V7\'"' < v-*M ■**►£ <*" *^^>1> ^ Jrf