.JKEN3QS 
 
 INAUGURAL DISSERTATION ... DYSENTERY 
 
M-fclAS 
 
 Q2 
 
 Columbia IBntoergitp 
 
 intljeCttpoflrtngork 
 
 College of iPfjpgtctang ano gmrgeona 
 
 Hifcrarp 
 
Digitized by the Internet Archive 
 
 in 2011 with funding from 
 
 Open Knowledge Commons 
 
 http://www.archive.org/details/inauguraldissertOOquac 
 
AN 
 
 INAUGURAL DISSERTATION, 
 
 IN WHICH, BY AN INDUCTION OF FACTS FROM 
 
 DYSENTERY, 
 
 THE 
 
 MITCHILLIAN DOCTRINE OF PESTILENTIAL FLUIDS 
 IS ILLUSTRATED. 
 
 SUBMITTED TO THE PUBLIC EXAMINATION OF THE 
 
 FACULTY OF PHYSIC 
 
 fcNDER THE AUTHORITY OF THE TRUSTEES OF COLUMBIA COLLEGE, 
 IN THE STATE OF NEW-YORK, 
 
 The Right Rev. BENJAMIN MOORE, D.D. President; 
 
 FOR THE DEGREE OF 
 
 DOCTOR OF PHYSIC, 
 
 On the 9lh Day of November, 1802. 
 
 BY NICHOLAS I. QUACKENBOS, A.B. 
 
 Citizen of the State of New- York. 
 
 - 
 
 NEW-YORK.- 
 
 Primed by T. & J. StlroRD , Printer! to the Faculty of Physic 
 ot C'olumlii.i L'ollcgc. 
 
 1802. 
 
y&£r(JSH 
 
 ? ~dM 
 
 
TO 
 
 JOHN R. B. RODGERS, M.D. 
 
 Professor of Obstetrics and Clinical Medicine in Columbia College $ 
 
 / 
 
 AND 
 
 SAMUEL L. MITCHILL, M.D. F.R.S.E. 
 
 Gentlemen, 
 
 IN the dedications of books, so much adulation has been 
 frequently poured forth to the patrons of authors, as to 
 have thrown the practice, in a great measure, into disrepute. 
 When a young writer, however, in his first attempt to at- 
 tract public notice, acknowledges the immense obligations 
 he lies under to that gentleman who has, with unremitted 
 assiduity, conducted him in the pursuit of professional know- 
 ledge; and when he expresses his gratitude to another, 
 whose name is deservedly famous in the republic of letters, 
 for his polite condescension and friendly assistance, while 
 engaged in the prosecution of his studies ; a dedication, in 
 such a case, will be universally allowed to be proper, as 
 silence would be culpable; and the highest expressions of 
 esteem and respect can be only considered as the effusions 
 of a grateful mind. 
 
 Impressed, therefore, with such sentiments, the author 
 conceives it a tribute no less due to superior merit, than to 
 principles of the purest gratitude and warmest affection, to 
 itc this treatise to you, to whom he sincerely wishes 
 B long and successful continuation of your truly valuable 
 labours, 
 
AN 
 
 INAUGURAL DISSERTATION 
 
 ON 
 
 DYSENTERY. 
 
 CHAP. I. 
 
 LITERARY AND PHILOLOGICAL REMARKS. 
 
 XIl GREAT controversy exists among Phy- 
 sicians concerning the true meaning of the 
 words Contagion and Infection. Some have 
 considered them as synonymous, and others 
 have contended that they signify things of 
 a very different nature. It does not, per- 
 haps, become one just entering into the pro- 
 le --ion to decide on this point, upon which 
 men of bigh character and eminence have 
 differed so widely: yet 1 cannot suppress a 
 belief that the two words did originally 
 denote ideas very unlike each other, and 
 
( ? ) 
 
 that at this time they ought not to be con- 
 founded. 
 
 There is scarcely an instance of two words 
 in the English, Latin, or any other language, 
 possessing the same critical meaning. Though 
 in common speech, they may be employed 
 as convertible terms; yet they are always 
 found, on nice examination, to have a plain 
 and sensible difference. The books of rhetoric 
 and belles lettres inform us wherein " pride" 
 differs from "vanity;" how " fatigue" is dis* 
 tinguished from "uneasiness;" and by what 
 means " delight" varies from " pleasure;" 
 with hundreds of other examples of the kind. 
 These, though in common acceptation, re- 
 puted to be synonymous words, are in reality 
 very far from each other in true significa^ 
 tion. 
 
 What happens in the language of common 
 life occurs also in the dialect of medicine. 
 Words reputed by many to be quite alike, are 
 known by the correct and learned to intend 
 things widely remote in their meaning. Thus 
 " Lues," " Pestis," " Contagium," and " In* 
 fectio," have been supposed by many as 
 words of signification so nearly alike, that 
 
( 7 ) 
 
 in glossaries and lexicons they have been 
 employed familiarly one instead of the other. 
 But I shall endeavour to show that this is a 
 mistake. 
 
 1. " Lues" seems to be derived from luo, 
 to pay the cost, make atonement, or suffer punish- 
 vient for a crime or fault. Hence lucre peenas 
 signifies to suffer the penalty for an omission 
 or breach of duty. And, for the same reason, 
 " lues" is employed to mean any distemper 
 brought on through or by a violation of moral 
 obligation: particularly it applies to the dis- 
 ease consequent upon scortatory love, which 
 has been termed emphatically " Lues Vene- 
 rea," the malady incident to prostituted em- 
 braces. Such is the literal and original mean- 
 ing of the word ; but like other words, it ac- 
 quired afterwards a greater latitude of signifi- 
 cation. 
 
 Thus Claud ian the poet writes, 
 
 " Hinc hominum, pecudumque lues, hinc pestifer acr ;" 
 
 alluding to the sufferings of men and cattle; 
 and Virgil goes a step further, and extends 
 the idea to trees and corn: 
 
 " Ai boi iUr/jue MLttsque iucs, et kthifcr annus.'* 
 
tl 
 
 ( 8 ) 
 
 2. Whether " Pestis" is derived front! 
 pereo," to perish or to die; or comes from* 
 the Hebrew " paschat," importing to spoil or 
 pillage, seems not necessary now to be dis- 
 puted.* It is sufficient for the present pur- 
 
 * Since the above was written I have been favoured with 
 a letter from the Rev. J. C. Kunze, S. T. D. on the etymo- 
 logy of this important word. The remarks of this gentle* 
 man, so well known for his biblical ar^d oriental erudition, 
 are so valuable that I insert them entire. 
 
 " New-Tork, October 13, 1802. 
 « Dear Sir, 
 
 " Accept iny hearty thanks for the permission of perusing 
 your Inaugural Dissertation on Dysentery in manuscript^ 
 which I herewith return. 
 
 " The derivation of the word pestis, from the Hebrew uiz/3, 
 may be a just one, as the word is used for undressing, Lev* 
 vi. 4. Cant. v. 3. with which the Hebrews always connect 
 the idea of weakening. From Judges xi. 33. it appears, like- 
 wise, that that verb has the signification of rushing upon 
 somebody in order to destroy him. In the most places it 
 occurs for plundering ; as 2 Sam. xxiii. 10. Nahurr iii. 16* 
 it is applied to the mischiefs of the canker-worm. 
 
 " It seems, however, more probable to me, that the word 
 arose from another verb, rr<P3, passah, which signifies ex- 
 tending itself and making progress. So much I can assure 
 you, that there is hardly a noun in Latin, Greek, English, 
 or German, that signifies an object of the external senses, 
 and certainly very few that denote abstract notions, which 
 could not, in the most simple and obvious manner, be de- 
 rived from Hebrew roots. It would be a pleasing task for 
 one who had time to compose a Dictionary with such a view. 
 A small one of that kind I have, of Jouchim Lange, under 
 the title ' Subsidium Harmonicum.' 
 
 " If the Hebrew roots do not lead us to a noun of a simi- 
 lar sound in the more modern languages, they give us an 
 idea of the nature of the thing, and in this striking disco- 
 
( a ) 
 
 pose to show that whether the former or latter 
 etymology be adopted, pestis means some- 
 
 Veries are sometimes made. The lion, for instance, has 
 seven names in Hebrew ; one only resembles the modern 
 sound — x^ 1 ?, lab'u The German word is loewe, with which 
 the Latin leo has a similarity. This is derived from joS 
 carrying the notion of devouring: but all the others point at 
 particular properties of that animal, as -IK, at tearing to 
 pieces j vsa, a t its strength ; a'* 1 ?, at its superiority ; from 
 which comes the Greek *k, a lion. 
 
 " The chief idea the scriptures connect with the plague, 
 I find, is that of diffusing itself, making slow, and, to the 
 senses, imperceptible progress. Hence pestilence is said to 
 walk in darkness, Ps. xci. 6. rrtpn is the proper verb de- 
 noting this, and is, in many places, used for the plague, as 
 Lev. xiii. 5, 6, 5 1, 5 5. xiv. 39. The Hebrew A, I must here 
 add, is, for grammatical reasons, often changed to t. 
 
 " Perhaps you, Sir, and your medical brethren, will par- 
 don me, if I draw from this the following conclusion : — Epi- 
 demical diseases, which, as you justly have observed, may 
 arise from various causes — as from a vitiated atmosphere— 
 from provisions used by people living in a district together, 
 &c. have not the name of pestilence in the ancient lan- 
 guages, and should, perhaps, not be called so in the mo- 
 dern. Pestilence, in my opinion, arises from a matter con- 
 cealed somewhere, and in a progressive manner diffusing 
 itself like the smoke of a fire-brand, with this difference 
 only, that as no carbone is mixed with it, as with the smoke, 
 this matter remains invisible. 
 
 " That you step forth in support of the Mitchillian doc- 
 trine is a matter peculiarly pleasing to me. In Germany 
 this doctrine gains ground every where. The King of 
 Prussia has, on account of this, called a renowned physi- 
 cian, Dr. Kciche, with a handsome salary, to Berlin ; and 
 1 am happy to hear that opposition to it in this country is on 
 the decline. 
 
 " I am, with particular esteem, 
 
 " Your most Obedient] humble- si rvant, 
 
 « JOHN C. KUN2E." 
 
( io ) 
 
 thing ruinous and destructive; generally ap- 
 plying to such calamities as cannot be pre- 
 vented by human foresight. Pestilence is 
 therefore coupled by Virgil with the anger 
 of the Gods: 
 
 " Pestis et ira Deorum stygiis sese extulit undis." 
 
 And again there is classical authority for the 
 following : 
 
 " Me eruciat sv&vo pestis violenta vefteno j" 
 
 showing that the word originally signified 
 almost any unavoidable distress; and, in a 
 limited sense, applied particularly to disas- 
 trous sickness, and endemic distempers. 
 
 3. No person doubts that contages, conta* 
 gium, and contagio, are fair derivatives from 
 contingo, to touch or be in contact. Their 
 primitive sense doubtless was, " Diseases 
 communicable by approximation of skin 
 to skin." Hence these forms of expres- 
 sion apply peculiarly to gregarious animals, 
 as sheep, cattle, and the human species. 
 Creatures of these kinds, herding and ming- 
 ling together, associating while they feed, 
 and when they lie down to rest, are remark- 
 ably prone to catch diseases by contact. 
 
( 11 ) 
 
 In this strain Melibceus assures Tetyrus that 
 (Virgil, Eel. i. v. 51.) the noxious contagion 
 of the neighbour's flock shall do no injury 
 to his: 
 
 " Nee mala vicini pecoris contagia Indent." 
 
 The forms of expression, when either of these 
 words is used, are adapted to give an idea 
 of something creeping, or passing off from 
 one person to another — thus: 
 
 " Dira per in incautura serpunt contagia vulgus." 
 
 And again: 
 
 " Dira per omnes 
 Manabant populos foedi contagia morbi." 
 
 And also: 
 
 " Invadunt totum contagia morbida regnum." 
 
 From these authorities it would seem plain, 
 that the popular and obvious meaning of 
 contagion could scarcely be misunderstood, 
 since it respected merely that class of dis- 
 orders among men and brutes, which were 
 imparted from one to another by contact \ as 
 they fed, slept, played, and associated to- 
 gether. 
 
 Contagion therefore is that peculiar, morbid 
 
( 1* ) 
 
 poison, which is prepared in the bodies of 
 living animals, especially of those which flock 
 and huddle in crowds, and is wiped off, or 
 is communicated by touch from those that 
 are contaminated, to those which too nearly 
 approach them. Such was the common 
 sense of mankind, while it remained un- 
 w r arped by prejudice and forced meanings. 
 It is a pity that such unlettered, though 
 strong common sense was ever departed from. 
 
 4. " Infection" was certainly derived from 
 inficio. This word was of very various and 
 questionable meaning among the Romans. 
 It is compounded of in, negative, and facio, 
 to do, signifying to undo, or rather to violate, 
 to corrupt, to taint, or to tincture any thing. 
 To be a little more particular — the verb inficio 
 expressed that property of an agent, by which 
 it embued the substance upon which it acted, 
 manifestly and glaringly changed its qualities, 
 and altered it materially from what it ori- 
 ginally was. The substance or thing so al- 
 tered was said to be infected. 
 
 One of :he most frequent and distinguish-, 
 able cases of infection was the change which 
 white cloths underwent by dying. The 
 
( 13 ) 
 
 colouring material, or the dye-stuff, was the 
 agent, and the changing or vitiating the white 
 colour by its tinging property, was said to in- 
 fect or stain the fabric ; its whiteness was al- 
 leged to be overcast, polluted, spoiled, or un- 
 done. 
 
 So when the clear and fine atmosphere was 
 vitiated by mixtures of noxious vapours, and 
 poisonous gases extricated from corrupting bo- 
 dies, it was declared to be infected. The pure 
 air, like the white cloth, had acquired a fo- 
 reign tincture ; and this effect, wrought upon 
 the respirable and healdiy atmosphere by the 
 adventitious material with which it was 
 charged, was, in a figurative sense, denomi- 
 nated infection. The air so vitiated or cor- 
 rupted, so different in its constitution, and so 
 altered from what it was, literally speaking, 
 had become infected, or " vifectus, ,f that is, 
 undone, or spoiled for the purposes of its pri- 
 mitive and ordinary destination. Air thus 
 vitiated was infected air. 
 
 In like; manner, a healthy animal might be 
 infected by coming into an atmosphere of 
 -in li a tint lure, or so corrupted. An exter- 
 nal igeol of this kind could infect or undo 
 
( I* ) 
 
 the healthy frame. When this act of undoing, 
 or, in other words, of unfitting it for the per- 
 formance of its accustomed and useful functions, 
 was accomplished, the constitution was af- 
 firmed to be infected: as was observed in a 
 preceding paragraph* infection was, in one 
 of its senses, but another term for dying or 
 imparting colours. In many forms of dis- 
 tempers excited by pestilential air, there was 
 observed, in addition to the other symptoms 
 of debility, &c. a remarkable change of com- 
 plexion. In many cases the patients looked 
 almost as if they had been dyed, or coloured 
 with some tinging material. This confirmed 
 the notion of infection having penetrated the 
 body, and wrought a change, as evident to 
 the eyes of others as uncomfortable to the 
 feelings of the individual himself. And by 
 this process of the human mind, it seems to 
 have been accepted and understood, that a 
 white garment put into dye-stuff, pure air 
 exposed to septic exhalations, and a healthy 
 animal acted upon by a pestilential atmos- 
 phere, Avere all examples of " infection" 
 The term was applied to another case. 
 When any thing noxious was added to whole- 
 
( 15 ) 
 
 some drink, it was declared to be infected, 
 that is, to be undone or spoiled for the natu- 
 ral and intended purpose of slaking thirst 
 healthily. The beverage was infected ; i. e* 
 the pure liquor has had something infused 
 into it, by which it has been vitiated or poi- 
 soned. Hence the verse can be interpreted: 
 
 " Pocula si quando ssevx infecere noverc<e." 
 
 Having thus discussed the history of these 
 words, I shall observe that they all refer to 
 popular and not to scientific distinctions in 
 things. They may perhaps answer well 
 enough for the purposes of ordinary conver- 
 sation, but possess not sufficient distinctness 
 for those of medical and philosophical lan- 
 guage. 
 
 Considering the matter with the best in- 
 formation I have had, there appear to be 
 but two great operations in nature, for pre- 
 paring or engendering noxious fluids. The 
 former of these is accomplished by the instru- 
 mentality of the living vascular action of ani- 
 mal-, and ii may be, of vegetables. The 
 latter t& produced by a putrefactive process 
 taking place in certain organized bodies alter 
 
( Id ) 
 
 death. To signify these two grand natural 
 processes, there ought to be invented two 
 suitable and appropriate terms. But as such 
 an innovation in the technology of the pro- 
 fession might not be right, I shall employ 
 the two words, Contagion and Infection, to de- 
 note them. 
 
 When noxious fluids are produced by liv- 
 ing vascular action, I call them Contagion: 
 When they are the offspring of putrefaction, 
 I term them Infection. 
 
 But as this subject has been stated with 
 great perspicuity in that valuable periodical 
 work, the Medical Repository; a work 
 which is an ornament and an honour to our 
 nation, as well as our city; I shall quote the 
 passage (vol. v. p. 186.) 
 
 " That vitiated product of living vascular 
 action, which can excite in a well person a 
 disease like that by which itself was pro- 
 duced, and continue indefinitely to do so 
 after being transferred from one body to 
 another, will be denominated Contagion ; and 
 lues, vaccinia, measles, and small-pox, will 
 be considered examples of it. On the other 
 hand, that venomous offspring of putrefaction 
 
( 17 ) 
 
 going on in some of the kinds of organic 
 matter after death, or separation from the liv- 
 ing frame, which disorders the healthy func- 
 tions without being specifically communica- 
 ble, and without the power of communi- 
 cating itself, will be called Infection; and 
 typhus, dysentery, plague, and yellow-fever 
 will be given as instances/' 
 
 CHAP. II. 
 
 MEDICAL AND PHYSIOLOGICAL 
 CONSIDERATIONS. 
 
 Wi 
 
 E now proceed to the medical history of 
 our subject. In describing this, we shall de* 
 part from the common mode of mentioning 
 the symptoms, diagnosis, &c. and offer such 
 reflections as have occurred. 
 
 It appears evident that the combination of 
 elementary substances, which, when applied 
 externally, would occasion the disorders com- 
 monly called " lovers," would do the same, 
 if they came in contact with the internal parts. 
 Thia is woll shown in a piece published first 
 in the New-York Magazine, in \1 ( J", and 
 
 c 
 
( 18 ) 
 
 afterwards in the Medical Repository for that 
 year. The principal points which appeared 
 at that time, were, that septic acid frequently 
 existed in the alimentary canal as an exciting 
 cause of fevers, and that neutral salts were 
 more useful than other cathartics in such 
 cases, because a great proportion of them 
 could neutralize that acid by means of the 
 superior attraction existing between it and 
 their alkaline bases. 
 
 Doctor William Bay, who graduated in 
 physic, in May, 1797, in this college, chose 
 Dysentery as the subject of his Inaugural Dis- 
 sertation ; and having adopted the above prin- 
 ciple, endeavoured to show that if septic acid 
 was the exciting cause, neutral salts, in which 
 potash and soda are united to the weaker acids, 
 were very efficacious remedies. This dissert 
 tation fell into the hands of the monthly re- 
 viewers in London, and the writer of the cri- 
 ticism upon it rejected the doctrines con-* 
 tained in it, both practical and theoretical. 
 And more recently, in one of the numbers 
 of the Monthly Review, for 1801, the writer 
 of the criticism upon Dr. Chisholm's Essay 
 on Malignant and Pestilential Fever, speaks 
 
( IS ) 
 
 disrespectfully of that excellent work, be- 
 cause the author has advanced doctrines de- 
 rived from the same source.* 
 
 Anatomists have agreed that the cuticle 
 reflected or continued over the lips at the 
 mouth, passes down the pharynx and oeso- 
 phagus, and after lining the stomacH and 
 intestines, both small and great, is connected 
 again with the true skin at the verge of the 
 anu«. The inside of the body then, or what 
 is called the alimentary canal, in all its turn- 
 ings and windings, is a surface coated with 
 
 * Vide the note, page 14 of Chisholm's 2d volume. 
 
 " See the case of the manufacturers of soap and candles 
 in the city of New-York, stated and examined, &c. published 
 by the association of tallow-chandlers and soap-makers." 
 The advocate employed on this occasion was Dr. Mitchill, 
 the ingenious and learned Professor of Chemistry in Colum- 
 bia College ; and the scientific knowledge, the general erur 
 dition, the good sense, and the elegant language displayed 
 in the course of his argument, in support of his clients, must 
 secure the admiration and applause of those who read his 
 " Remarks on the Proceedings of (lie Legislature of the 
 State of New- York ;" and his " application of the Mitchillian 
 Doctrine of septic fluids, to the processes carried on in seve 
 ral branches of handicraft business, particularly the making 
 pf soap and candles," I.e.. Without a hyperbole, he may 
 ■ be considered," to use his own language, u as haviug 
 ■ nature in her work-shop, examined her collection ol 
 discovered which of them she i mployec| 
 in this fearful manufacture (the acid of putr ction or infqe- 
 
 \lii<h, like the poisoned shirt of llenule;, enwrap 
 
( 20 ) 
 
 an epedermis in connection with the muscu- 
 lar, vascular, and nervous parts beneath, with- 
 out the intervention of a true skin. It resem- 
 bles, in this respect, cicatrization on the limbs, 
 or other external parts of the body, where 
 spots that had been ulcerated, are skinned 
 over after a destruction of a portion of the 
 cutis vera. Such places are tender, and more 
 liable than others to accidents. 
 
 We call the stomach and intestines a part 
 of the internal structure of an animal. There 
 is one sense, in which this is hardly correct, 
 or is apt to mislead. Their internal structure 
 is as much an inside as the barrel or bore of 
 zpump is the inside of that machine. They 
 are open at both extremities, the substances 
 they transmit are forced in at one end, and 
 expelled at the other, or at some intervening 
 outlet. Air and water move easily through, 
 and are applied freely to their insides as well 
 as to their outsides: and besides those two 
 fluids, a variety of substances mingled w r ith 
 them, even to the thickest consistence that 
 can pass the valves, are pushed along their 
 cavities. The bore of a pump is thus, strictly 
 speaking, an outside surface, or at least as 
 
< 21 ) 
 
 commonly and indeed more exposed than 
 that which is ordinarily termed the outside. 
 The perforation through the body of an ani- 
 mal, extending from the mouth to the anus, 
 ought to be deemed an external surface, or, 
 at least, a surface as much or more exposed 
 to harm and accident, than any part of the 
 external or cuticular surface. It is the tho- 
 roughfare of every thing put into it for the 
 purposes of hunger, thirst, gluttony, intem- 
 perance, and medicine. The alimentary 
 canal being thus, like the pump, in almost 
 constant action, and besides the perpetual con- 
 duct of foul and noxious matters, will often 
 get out of order, and of course stand in need 
 of frequent repairs. 
 
 One of the accidents to which this inter- 
 nal apparatus is frequently subjected, is called 
 " Dysentery,'" and has been known by a sy- 
 nonymous word from a remote antiquity. 
 
 Such persons as subsist chiefly on oily, gela- 
 tinous farinaceous, and saccharine food, arc 
 V( ry little incommoded by this disease. On 
 the other hand, the victims of its violence 
 ;ire commonly such as cat animal food hear- 
 tily, particularly that which is lean. In the 
 
( 22 ) 
 
 American and British service, both by sea and 
 land, dysentery is nearly connected with the 
 beef -ration, which is dealt out to the seamen 
 and soldiers. Our experience in New- York 
 has convinced us of the readiness of beef to 
 corrupt, and of the offensiveness and viru^ 
 lence of the gases which exhale from it during 
 that process. We know these vapours have 
 very often produced dysentery in the repackers 
 and salters of beef, who were exposed to it. 
 And from a variety of testimony it may be 
 concluded, that this deleterious effluvium 
 from beef is septic acid (the acid of azote) in 
 a volatile form. Of a number of persons ex-» 
 posed to this septic effluvium, some were 
 seized with dysentery and others with fever. 
 Such a disposition and quality we know to 
 reside in beef, which I have given as an ex^ 
 ample, and doubtless inhere in all other lean 
 animal substances. 
 
 Beef, in a corrupting condition, called 
 tainted or semi-putrid, is not an uncommon 
 article of diet in armies and navies. Whe- 
 ther this vitiation arises from the small quan^ 
 tity of muriate of soda (sea salt) or from an 
 adulteration of the muriate of soda applied, 
 
( S3 ) 
 
 or from an inherent predisposition in the beef 
 to spoil, the ultimate effect is nearly the same- 
 It becomes charged with that acid, which is 
 capable of producing those mischievous ef- 
 fects in the alimentary canal, the aggregate of 
 which is denominated Dysentery. Or, as the 
 septic poison in the meat acts upon a secret- 
 ing surface, it may cause zjlux in some con- 
 stitutions, as well as a dysentery in others, and 
 act as a cause of some species of diarrhoea. 
 If absorbed, it stimulates the sanguiferous sys- 
 tem to morbid action, and induces that condi- 
 tion thereof called " Fever." Being of an 
 acid quality, it irritates the orifice of the com- 
 mon bile-duct, and provokes a more free se- 
 cretion and supply of the gall. This alkaline 
 fluid from the liver, in moderate forms of 
 disease, is generally excreted copiously, and 
 thus neutralizes the exciting cause. As the 
 bile is plentifully prepared and discharged, 
 diseases in which it abounds are com- 
 monly culled " Bilious;" and the ordinary 
 opinion is, that the bile itself is the peccant 
 matter or cause of the malady. But this no- 
 tion is very erroneous* The bile is but the 
 effect, and not the came. And the reason 
 
( 24 ) 
 
 wherefore it runs so readily and plentifully* 
 is to correct the mischievous quality of the 
 offending cause in the stomach and intes- 
 tines, whether engendered there or taken 
 in from without: accordingly, some of the 
 worst forms of dysentery, and other malig- 
 nant distempers, are those in which the bile 
 is excreted from its viscus in scanty propor- 
 tion, or not at all. 
 
 Though the alimentary canal may receive 
 the septic acid or exciting cause of dysentery 
 from the atmosphere, or in tainted beef or 
 other lean animal substance, these are not the 
 only ways by which it may come in contact 
 with the stomach and intestines. Lean ani- 
 mal matter, as beef, mutton or fish, may be 
 eaten in its entire and uncorrupted state; but 
 it may be so long retained in the body, especi- 
 ally in the large intestines, that it may corrupt, 
 and septic acid be formed from it there; and 
 this accident is very liable to befall those per- 
 sons who are subject to indigestion and costive- 
 ness, or, in other words, who are not regular 
 in respect to alvine evacuations. In such 
 cases scybala may be formed in consequence 
 of too great absorption of the fluids of the 
 
( 25 ) 
 
 intestines, and from the residuary lumps of 
 hardened faeces, containing some septic acid, 
 and engendering more, is the spasmodic con-^ 
 dition of the colon induced, 
 
 A cause of dysentery may thus be received 
 into the body from without, or it may be pro- 
 duced within it from the decomposition of 
 such articles of food as contain septon or azote. 
 The former is the distemper deemed infectious 
 or endemic; the latter, the sporadic. But it 
 may so happen on board a ship or in a camp, 
 that many persons of a crew, or a detachment 
 fed on similar rations, may fall sick together 
 from the unwholesome quality of their food, 
 without any vitiation in the air at all : and the 
 disease, though strictly sporadic, may thus as- 
 sume the guise of an endemic. The like 
 may happen in neighbourhoods and districts 
 in the country, where the inhabitants live 
 very much alike, or subsist on nearly similar 
 articles of diet, and feed on meat cured with 
 muriate of soda, (generally adulterated, and 
 rarely or never purified in America), bought 
 at the same -tore, and part of the same parcel. 
 
 Il' there should happen a condition of the 
 digestive organs, wherein tl»<- gall should 
 
 p 
 
( 26 ) 
 
 cease to flow at a time when oxygenated sep~ 
 ton, from any of the sources already men- 
 tioned, abounded in the alimentary canal, 
 disease might be expected to ensue. But 
 such a disorder would not be ?c mere jaundice, 
 from a retention of bilious matter tinging the 
 skin with an icteritious or yellow hue, but 
 would be a disease from poison, causing the sto- 
 mach and upper intestines to invert their mo- 
 tions and expel their contents; creating pain, 
 flatulency, heat, and inward distress ; and stir- 
 ring up more or less of "fever" by an imbibi- 
 tion of some of the septic venom: to all which 
 there might be superadded the peculiar and 
 characteristic symptoms of dysentery. For 
 violent fits of the American yellow fever have 
 occurred in cases where the stomach and in- 
 testines had been much disordered, termi* 
 nating favourably after tormina, tenesmus, 
 and slimy stools mixed with blood. Whence 
 the connection between yellow fever and dy- 
 sentery can be discerned; both arising from 
 the same general cause, and chiefly differing 
 in the part of the body particularly invaded 
 by that cause. Dysentery may exist without 
 being accompanied with yellow fever, and 
 
( 27 ) 
 
 yellow fever may arise unattended by bloody- 
 flux. Yet though it may be easy to distin- 
 guish the extremes, there is nothing more 
 difficult than the establishment of the limits 
 between the two, in cases where they are 
 blended and incorporated with each other. 
 In short, though Nosology may distinguish, 
 and sever and place them far asunder, sci* 
 c?ice, with better information, traces their 
 genealogy from one original, and finds them 
 intimate kindred, descended from the same 
 parent. 
 
 This is by no means a new opinion. If 
 we look back into history, we will find that 
 the ancients were also well acquainted with 
 this fact. Diodorus Siculus, who has always 
 been considered a correct and faithful histo- 
 rian (lib. xii. cap. 2.) gives an account of 
 the expedition of the Athenians under Eury- 
 medon and Demosthenes against Syracuse. 
 This was about the 410th year before the 
 Christian sera. A plague broke out in their 
 camp adjoining the city, owing loan offensive 
 marsk in the neighbourhood, and raged and 
 increased to such a degree, that a great part 
 of the army perished. 
 
( 28 )' 
 
 t)iodorus (lib. xiv. cap. 7.) describes, with 
 some detail, the distemper which invaded the 
 Carthaginians in the year before Christ 394?, 
 When encamped on the same ground, near 
 Syracuse, that had been formerly occupied 
 by the Athenians. He calls it a " plague;'* 
 says it was first ascribed to the vengeance of 
 the gods, for the rifling and plundering of 
 the temples of Ceres and Proserpine. But 
 he considers the place itself as the great occa- 
 sion of the disorder. The ground was marshy 
 and spungy — great multitudes of men were 
 thronged together — it was summer — the 
 nights were chilly and the days intolerably 
 hot — the pestilential air was blown upon 
 them by a southerly wind — there was no 
 idea of importation from foreign places— the 
 symptoms Were " catarrhs and swellings of the 
 throat, which were caused by the stench of 
 the bodies that lay unburied, and the putre* 
 faction of the soil. Then followed fevers, 
 pains in the back, heaviness of the loins, dysen- 
 teries, blotches and boils over the whole body. 
 Some ran mad, beating every one they met." 
 
 The exciting cause of dysentery being 
 known, there is no difficulty in administer- 
 
( 29 ) 
 
 Ing remedies which, in most cases, will de* 
 6troy or expel it. From the known efficacy 
 of alkaline salts to correct putrid taints and 
 tendencies in beef, and in all animal sub- 
 stances, pot-ash and soda present themselves 
 first on the list of antidysenteric remedies. 
 "We know they can correct offensive and vi- 
 rulent qualities of the fasces out of the body, 
 or in beef after it has been eaten, and natu- 
 rally enough can believe they will act in a 
 similar way in the intestines, provided they 
 can by any means be conveyed there. 
 
 Notwithstanding the prejudices of some 
 against the employment of alkalies, and the 
 belief of others in their being unwholesome 
 and improper in the extreme; that acids are 
 the great and useful antiseptics, and of course, 
 by the rule of opposites, that alkalies are 
 endowed with qualities directly the reverse: 
 Notwithstanding all this, I am one of those 
 who have an entire confidence in the superior 
 Honey of alkaline medicines. 
 
 It is known that in some parts of our coun- 
 try the persons who practice the veterinary 
 art, give to horses, and other creatures weak 
 Mlkaiine ley, made by boiling wood aslic* in wa- 
 
( 30 ) 
 
 ter, for the colic and scowers. And occa* 
 sionally the country people will, in similar 
 diseases, take some of the like medicine in- 
 ternally for their own relief. Besides, it is 
 said that during a severe dysentery which 
 prevailed among the Indians near Detroit, 
 some years ago, the prescribers of medicine 
 among the savages administered weak ley of 
 pot-ash to the sick, and with admirable suc- 
 cess. 
 
 A strong solution of muriate of soda, di- 
 luted with a third of sharp acetic acid, has 
 been often administered to dysenteric patients, 
 as is credibly reported, with excellent ef- 
 feet. After recommending this remedy, and 
 witnessing the operation of the brine, swal- 
 lowed as hot as the patient could bear, in doses 
 of two or three table spoons full, repeated fre- 
 quently, I have had reason to think favourably 
 of it, as an antidysenteric prescription. And 
 what seems more capable of being deduced 
 in favour of alkalies in the intestinal canal, is 
 the known constitution of the gall ; a secreted 
 fluid abounding with the very alkali which is 
 the basis of common salt, and in times of 
 health perpetually mingling with the alimen- 
 
( 31 ) 
 
 tary mass, for the purpose apparently of pre- 
 venting its degeneracy to something noxious. 
 It seems therefore clear, that a solution of 
 carbonate of soda in water might be employed 
 at any time in aid of the bile, or in some 
 measure as a substitute for it if deficient, and 
 thus allay the uneasiness and pain frequently 
 caused by it. 
 
 We know that gall has been long employed 
 by dyers and scourers to cleanse silks and 
 delicate stuffs, and to free them from spots 
 and stains; it is therefore not improbable that 
 this saponaceous liquid acts in a like man- 
 ner in the alimentary canal, deterging and 
 cleansing the whole passage, as far as its 
 strength and virtues extend. 
 
 Alkalies promise to be useful on another 
 account. The discharge per anum in some 
 of our pestilential and dysenteric diseases, 
 are so sharp and corrosive as to excoriate the 
 skin around the anus, and to excite inflam- 
 mation almost wherever they touch an exter- 
 nal part.* When shirts, sheets, or drawers 
 
 • In Lowthorp'fl Abridgment (Pliil. Trans, vol. iii. p. 
 232.) may be seen an account of Mr. Bayle'o Experiment 
 (tinted to the Royal Society in 1664, of the antiseptic 
 power of fiii<j urinous spirit, or spirit of sal ammoniac, in 
 
( 52 ) 
 
 are besmeared with these or any other kind* 
 of fsecal matter, alkaline leys are always 
 competent to destroy their activity, to carry 
 them off, and to leave the garment clean 
 and uninfected in the hands of the washer. 
 
 If alkalies can accomplish these desirable 
 objects in alimentary egesta immediately after 
 their evacuation, there remains no doubt of 
 their capability to accomplish as good a pur- 
 pose, if injected into the intestinum rectum, 
 and made to penetrate the colon itself. 
 
 In addition to all this, it seems to be estab- 
 lished as a truth, that in those parts of the 
 United States where carbonate of lime con- 
 stitutes the great strata of the earth, and 
 where of course the water contains a consider- 
 able quantity of lime in solution, dysenteric 
 complaints are comparatively rare and mild, 
 
 preserving blood yet warm from the veins, from coagulation 
 and from putrefaction a long time. This experiment, he says, 
 he devised to show the " amicableness of volatile spirits with 
 the blood." 
 
 In the same volume (p. 115.) in a paper on dysentery, 
 may be seen the writer's opinion that the sharp corrosive 
 humours in that disease, " are of the nature of aqua-fortis 
 and spirit of nitre, and which eat away the tunicles of the 
 intestines and mouths of the vessels." For correcting this 
 he adds " the absorbent earth crabs-eyes to his prescript 
 lion." 
 
C 33 ) 
 
 The lime-water which the inhabitants of 
 these situations constantly drink, acting al- 
 ways as a preventive of the disease, or as a 
 corrector of its exciting cause within the body. 
 
 We shall next consider which of the alka- 
 lies will be preferable, and also what form or 
 combination of either will answer best the 
 purpose of prescription. 
 
 To give the alkalies in their simple or 
 Caustic condition would be injurious: the dis-* 
 ease would be aggravated, not cured by such 
 harsh medicines* 
 
 I begin with pot-ash (salt of tartar) and 
 would give the carbonate in dysentery, mak- 
 ing a solution of it of such a strength as, on 
 being tasted, should not affect unpleasantly 
 the mouth. To this sugar may sometimes 
 be added to help the taste. A table spoon- 
 ful may be given every quarter or half hour, 
 according to circumstances, until the patient 
 experience relief. And in order to render 
 Its effects more speedy and certain, cnemata 
 of the same weak alkaline solution should be 
 given from time to time, either alone or with 
 broth or starch; occasionally with the addi- 
 tion of a binall quantity of thebaic tincture 
 
 £ 
 
( 34 ) 
 
 to the mixture taken by the mouth, as well 
 as to that administered per anum. Much be-> 
 nefit will/ I presume^ be derived from this 
 mode of treatment. 
 
 On trials with carbonate of magnesia, it 
 appears to be not sufficiently strong and effi- 
 cacious. Its powers are greatly inferior to 
 carbonate of pot-ash. Though its qualities 
 are good as far as they go, yet they are, how- 
 ever, too feeble to be relied on in eases where 
 decisive and energetic practice is required. 
 
 The disagreeable taste of pot-ash is some- 
 times objected to by patients. When this 
 happens, carbonate of soda may be employed. 
 This is much less unpleasant, and may be 
 tasted and swallowed with ease : indeed, on 
 reflecting that soda is the basis of the bile, and 
 of the culinary salt, which we constantly and 
 by instinct as it were, swallow with our food, 
 it appears to be more natural and friendly to 
 the constitution than either pot-ash or mag- 
 nesia ; and for this reason it is that neutral 
 salts, with a basis of soda, are preferable to 
 all others, for their efficacious, safe and kind 
 operation. The bringing them more gene j 
 rally into use would be a great improvement 
 in the practice of physic. 
 
( 35 } 
 
 The formula of giving carbonate of soda 
 in dysenteric cases is, a solution in water strong 
 enough to be taken into the mouth and su> 
 mach without smarting, or any other incon- 
 venience. The dose is from a tea spoonful 
 to two or three table spoonsful; and the 
 times of administration are every quarter or 
 half hour, or every second and third hour, 
 as the symptoms seem to require. Portions 
 of the same solution are applied in the form 
 of glister, to be retained ; and they are very 
 useful and efficacious in allaying tenesmus, 
 and diminishing the frequency of evacuar 
 '{ions. I have seen several cases of dysentery 
 cured with this plain prescription in the tttm 
 modes just mentioned. 
 
 Sometimes, however, the carbonate of soda 
 may be dissolved in mint-water, instead of 
 common water: and occasionally the addi- 
 tion of some laudanum, where the patient 
 suffers much pain, lias bad a happy effect. 
 I think whore alkalies are prescribed there 
 need be Less hesitation to administer opiates 
 than in conjunction with any oilier remedy. 
 f ol. ricirri, or of ol. olivarum, may 
 a tonally interposed with advantage, as. 
 
( 36 ) 
 
 mild oils have a tendency to obtund the acid 
 exciting cause of the malady. The same 
 quality probably belongs to all fat and greasy 
 substances that are not rancid. On the con- 
 trary, lean meats are found universally bad 
 for dysenteric patients, who ought always to 
 be interdicted their use, I have known a 
 convalescent relapse into dysentery after eat- 
 ing a dinner of beef. For food we would re- 
 commend rice, tapioca, sago, panada, and ge- 
 nerally farinaceous and saccharine substances; 
 and likewise soups and jellies, if the sick have 
 an inclination for them. 
 
 In all these kinds of food an advantage 
 would be derived from sprinkling in as much 
 muriate of soda as can be conveniently and 
 agreeably done. 
 
 By these means the alimentary canal can 
 in general be sufficiently alkalized. We al- 
 kalize our clothes and the outer surface of our 
 bodies with solutions of soap and weak leys, 
 to keep ourselves clean and healthy. The 
 intestines are alkalized by the bile, and their 
 internal surface is protected by the mediation 
 of that admirable liquid, which is prepared 
 and applied without our knowledge or con^ 
 
( 37 ) 
 
 currence, by the most excellent provision in 
 the animal economy. When the gall is in- 
 sufficient, it becomes the physician to alka- 
 lize the intestines and their contents, by some- 
 thing as nearly allied to the bile as he can 
 find. Soda is such a substance. Perhaps 
 camomile, gentian, or some other bitter, would 
 improve it, by making it resemble the natu- 
 ral secretion more nearly. 
 
 The carbonates of pot-ash and soda seem 
 to be better in dysentery than the combina- 
 tion of those simple salts with stronger acids. 
 They arc more easily decompounded, and 
 while the septic acid of the intestines joins 
 the alkalies, to form septitcs of pot-ash and 
 soda, the carbonic acfd is extricated to pro- 
 duce the agreeable effect of which it is sup- 
 posed capable, and for which it has been long 
 celebrated. But it ought to be remembered 
 that tbe tart rites of pot-ash (soluble tartar), and 
 of soda (Rochelle salt), and phosphate of soda 
 are very valuable remedies. And to these 
 \m may add muriate of soda, by which is 
 meant the compound formed by mere tnuri* 
 acid unci goda, and not the adulterated 
 and heterogeneous composition forming the 
 
( 38 ) 
 
 sea-salt commonly in use. No objection 
 ought to arise against the use of these alkaline 
 remedies, in ordinary cases, as being too fiery 
 and pungent; nor even in cases of inflamma- 
 tion and ulceration of the intestines: for it 
 is shown, in a memoir in the Medical Repo- 
 sitory, by Dr. Mitchill, that carbonates of pot- 
 ash and soda are very substantial helps to the 
 surgeon, when applied to the surface of foul 
 and eroding ulcers. And from their internal 
 use, another good effect will ensue: the fasces 
 will possess very little fastor, and no infection, 
 Nurses and attendants may perform their ser- 
 vices commodiously, and without hazard of 
 catching the distemper. Under the use of 
 these remedies it can never spread. 
 
 Alkaline remedies, excellent as they are, 
 may be abused ; and for want of proper care 
 'in their administration and continuance the 
 customary good effects may not be produced 
 by them *. but they can do a great deal; for 
 they can overcome the acid exciting cause of the 
 dysentery, and prevent its further mischievous 
 operation upon the intestines, and its absorption 
 into the system. They may do all this, and 
 yet not be capable of curing every case that 
 presents. 
 
( ™ ) 
 
 Inveterate dysenteries and fluxes will often 
 baffle medical skill, and end fatally, in oppo- 
 sition to alkaline and all other remedies. 
 After the stomach has lost, in a considerable 
 degree, its power to digest, the liver to fur- 
 nish bile, the lacteals to imbibe their appro- 
 priate fluid, and the intestines to perform 
 their peristaltic movements, there is no great 
 prospect of recovery, even though the excit- 
 ing cause of the malady should have been 
 entirely expelled from the body. Still it ap- 
 pears, from repeated trials and careful obser- 
 vation, that the alkaline plan of treatment 
 which we have described, is preferable to 
 every other. Rhubarb, ipecacuanha, cerated 
 glass of antimony, calomel, and Peruvian 
 bark, seem to be very inferior remedies. 
 None of them promise to do much good, fur- 
 ther than as they operate as cathartics. And 
 for a purgative purpose, the neutral salts 
 which we have enumerated possess a decided 
 superiority. 
 
 THE END, 
 

 Date Due 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 9 
 
 
 
 
QuaeW 
 
 Inaugu] 
 terv 
 
 3.7 sen-