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INAUGURAL DISSERTATION 
 
 O N 
 
 DYSENTERY. 
 
 SUBMITTED TO THB PUBLIC EXAMINATION 
 OP THE 
 
 FACULTY OF PHYSIC, 
 
 UNDER THE AUTHORITY OF THE 
 
 TRUSTEES OF COLUMBIA COLLEGE, 
 
 IN THE 
 
 STATE OF NEW-YORK, 
 
 WILLIAM SAMUEL JOHNSON, LL. D, Prefident; 
 
 FOR The degree of 
 
 DOCTOR OF PHYSIC, 
 
 ON THE SIXTH DAY OF MAY, 1794. 
 
 By DAVID G. A B E E L, 
 
 Citizen of the State of New-York, 
 
 The Hp pale, quivering) and the beamlefs eye, 
 No more with ardour bright.— — 
 
 Thomson. 
 
 NEir-YORK: 
 
 Printed by T. and J. Swords, Printers to the Faculty of Phyfic of 
 
 Columbia College, No. 167, "William-Street. 
 
 — 1794.—^ 
 
,^^y9^ 
 
 
 4i- -. ^<^^*^'--^ 
 
r o 
 
 ISAAC ROOSEVELT, Prefident, 
 
 MOSES ROGERS, Treafurer, 
 
 JOHN H. LIVINGSTON, D. D.^ 
 JOHN RODGERS, D. D. 
 ABRAHAM BEACH, D. D. 
 JOHN BROOME, 
 JOHN SLOSS HOBART, 
 SAMUEL OSGOOD, ., 
 
 JOHN WATTS, 
 MATTHEW CLARKSON, 
 JOHN COZINE, 
 LAWRENCE EMBREE, 
 
 Managers of the 
 / City Difpenfaiy. 
 
 JOHN CHARLTON, Prefident, 
 
 and 
 THOMAS JONES, Vice-Prefident, 
 
 I 
 
 Of the Medical Society 
 of the State of Newr 
 York, and ex-officio 
 Managers of the City 
 Difpenfary. 
 
 THIS 
 
 DISSERTATION 
 
 Is refpedfully infcribed, 
 By their mofl obedient, 
 Humble fervant, 
 
 DAVID G. ABEEL. 
 
^ 
 
■■ . .0 ■" . „ „ I .1 ''■ =£= 
 
 BISSERTATION 
 
 ON 
 
 DYSENTERY. 
 
 D 
 
 YSENTERY is a difeafe to which Phyficians have 
 only of late years annexed precife and accurate ideas. 
 Every increafed difcharge from the inteftinal canal, of a 
 paorbid nature, and particularly if accompanied with 
 fome mixture of blood, was formerly confidered by Phy- 
 ficians as Dyfentery. Hippocrates himfelf feems to have 
 confounded the terms Dyfenteria, Diarrhoea and Lienteria, 
 and to have applied them rather to exprefs particular ftages 
 of the fame complaint, than to have viewed them as dif- 
 tinft and different difeafes.* 
 
 About the middle of the prefent century, when Phy- 
 licians and Philofophers became ufefully engaged in invef- 
 
 tig^ating 
 
 * Vide Hipp. Op, Epld. et Apb. 
 
( 6 ) 
 
 tigating the caufes of difeafes, with a view to their more 
 effedual prevention and fuccefsful cure, the caufes of 
 dyfentery were with more accuracy afcertained, as being 
 produced by a fpecific contagion. Sir John Pringle is 
 among the firfl whofe obferyations have tended to enlarge 
 our ideas on the nature of this complaint. 
 
 Dyfentery, as defcribed by the moft refpe6lable writers 
 in medicine,* is a difeafe which appears to be of only 
 one fpecies; and though it is fometimes accompanied 
 with intermittent fever, with miliary eruptions, and is 
 often attended with difcharges of worms and other matters 
 from the inteftinal canal; yet thefe circumftances can, 
 only produce varieties of the fame difeafe. 
 
 ■ I)o<^or GuLLEN has accurately defined dyfentery by 
 the following charai^eriftic fymptoms. 
 
 " Pyrexia contagiofa, deje<5Vione8 fre^uentes, mmoi^Sf 
 vel fanguinolentae, retentis plerumque fcecibus akipis; 
 tormina, tenefmus."f - a~:;ijxi 
 
 * See Sydenham, fe£l. iv. chap, 3. Huxam de Acre, &c. ad. ann. 
 1743. Cleghorn''s Difeafe of Minorca, chap. 5. Pringle's Difeafe of the 
 Army. Monro's Difeafe of the Army, 1761, Zimmerman en the 
 Dyfentery, 1765. 
 
 f Culleni Synopfis Nofologras Metbodlcae. 
 
 HISTORY 
 
( 7 ) 
 
 HISTORY OF THE DISEASE. 
 
 DYSENTERY is commonly preceded by a fenfe of 
 coldnefs, more or lefs laflitude, and pains of the head, 
 back and loins, which are afterwards followed by increaf- 
 ed heat — Thefe fymptoms are fucceeded by pains in the 
 bowels, about the region of the naval, which have been 
 called by the Latins tormina — Thefe pains are accom- 
 panied with a defire of evacuating the contents of the 
 intellines; which is fometimes effected, attended with 
 difcharges of mucus and more or lefs blood. After ^ 
 few llools, the difcharge becomes liquid and of a yellow- 
 er brown colour, with mucus, and fometimes pure blood. 
 The foeces are then difcharged in nodes or hard lumps^ 
 called by authors fcybala, the freeing the intellines from 
 which commonly gives relief. 
 
 When the fymptoms firfl come on, they are often at- 
 tended with naufea and vomiting, when a matter of a 
 green colour, and of a bilious nature, is ejected. The 
 patient complains of great thirft and a difagreeable bitter 
 tafte. The tongue is commonly covered with a whitifh 
 or yellow fcurfj fometimes it is brown, and in fome cafes 
 black. The patiant has feldom any appetite for food, 
 and ufually complains of great proflration of ftrength. 
 In fome inftances the patient is very coftive in the be* 
 ginning of the difeafe,- and the abdomen is fwelled in 
 confequence of its being diilended with wind. As the 
 
 difeafe 
 
( s ) 
 
 difeafe increafeSj the patient is affe6led with more fre- 
 quent defires of evacuating the contents of the intef- 
 tines, but withotit producing that effeS:. Subflances of 
 a firm and compa6t texture, refembling pieces of cheefe 
 or fat, and even parts of the villous coat of the inteftines, 
 are fometimes difcharged. There is alfo a fluid, in ap- 
 pearance like pus, at times evacuated. Unlefs purgative 
 medicines are adrriiniftered, it is rare that excrementitioud 
 matters are thrown out of the inteftines. 
 
 The efforts to evacuate the contents bf the inteftineg. 
 are accompanied with tormina, tenefmus, and much pain; 
 the patient having a fenfation as if the inteftines were 
 tomprefted and cut. Painful haemorrhoidal tumours are 
 apt to take place in thofe who have been previoufty af- 
 fected with them. A prolapfus ani is alfo frequently- 
 produced, efpecially in young perfons. The urine i^ 
 often difcharged with pain^ difficulty, and a fenfe of 
 heat. Food taken into the ftomach is frequently ejected, 
 without having fufFered much change from the organs 
 of digeftioh; and in fome cafes the a6l of deglutition 
 has been followed by griping pains and tenefmus. The 
 pulfe is frequent, but, except in thofe who are very ro- 
 buft, rarely hard or ftrong. 
 
 The dyfenteric and febrile fymptoms are commonly 
 increafed towards evening, but remit fomewhat towards 
 morning. Before this difeafe proves fatal, all the fymptoms 
 become more fevere. The tormina and deje(5lions are fo 
 frequent that the patient has fcarcely any intermiffion of 
 
 pain. 
 
( 9 ) 
 
 pain. What, is difcharged from the intefllnes is of a 
 very foetid nature, and frequently involuntary. The pulfe, 
 during this ftage, is fmall and frequent; the tongue is black 
 and dry ; the thirft very great, and every fymptom of debi- 
 lity manifefls itfelf; fuch as hiccough, cold fweats, pale- 
 nefs of the fac,e, coldnefs of the extremities, difficult de- 
 glutition, and, laftly, aphthae in the mouth and fauces, 
 fwelling of the abdomen, involuntary difcharge of foeces 
 and urine, delerium, and a cefTation of pain, are the fore- 
 runners of death. With the above defcribed fymptoms, in 
 part or in concurrence, the difeafe continues an uncertain 
 length of time. When the complaint is mild, itfometimes 
 terminates in four or five days: when more fevere, not 
 til-i fourteen or fifteen days, and fometimes even later. 
 
 When the dyfentery is of a mild kind, the fymptoms 
 of tormina, tenefmus, and alvine excretions are lefs fre- 
 quent j the excretions more natural, lefs mixed with 
 blood or mucus, and not of fo difagreeable a fmell; 
 the appetite, for food is llronger, there is lefs thirft, and 
 the patient has more refrefliing fleep. 
 
 In this difeafe, the pains which, in the beginning, oc- 
 cupied the whole abdomen, feem, in its advanced ftate, to 
 be more circumfcribed, and to be confined to the infe- 
 rior part of the colon and beginning of the redum. 
 When the pains are very fevere, it commonly happens 
 that the fmall inteftines are alfo affe6led, as there are a 
 greater number of nerves diftributed among them. 
 
 B As 
 
( lo > 
 
 As dyfenteries ufually appear in the beginning of au* 
 tumn, the fever which attends them commonly puts on a 
 fynochus or typhus form: fometimes, however, they 
 are combined with an intermittent or remittent fever. 
 Dyfenteries have aifo fometimes appeared in the fpring. 
 and fummer, and then have had fome connection with the 
 difeafes which ufually prevail at thofe feafons of the year. 
 
 DISSECTIONS. 
 
 O N examining the bodies of thofe who have died of 
 dyfentery, the inferior parts of the colon and re6lum have 
 been found of a black colour, and of a putrid appearance; 
 their coats preternatu rally thickened, and the internal parts 
 ulcerated. Red puftule^, refembling thofe of the fmall-pox, 
 have been found in the inner coats of the inteftines.* 
 Schirrous tumors have alfo been difcovered fometimes in the 
 colon. In almofl all cafes in which gangrene had not taken 
 place to any great degree, ccnliderable portions of the large 
 inteftines have been found affefted with a preternatural 
 confLri(?tion.'f- 
 
 DIAGNOSIS. 
 
 THE difeafes which may be miftaken for dyfentery are 
 dianficea and cholera: but a little attention will enable the 
 Phyfician to eftablifa the proper diagnofis. 
 
 In 
 
 * P-ilngle's Difeafes of the Army, p. 246. 
 
 f CiiUen's Firll Liriss, vol. ii. p. 294. par. 1077* 
 
In diarrhoea there Is no idiopathic fever, the tormina and 
 tenefmus are lefs violent, and the difcharges from the intef- 
 tines are more natural. In dyfentery the flools are more 
 putrid, and mixed with more b)ood than is commonly 
 obferved in diarrhcsa. 
 
 Dyfentery is diilinguiflied from cholera by lefs copiou^ 
 bilious vomitings. In cholera the ftools are large, and 
 mixed with confiderable quantities of bile, but rarely any 
 blood; ther^ is no tenefmus, and the fpafms of the mufcles 
 of the legs, which are chara6leriftic of cholera, rarely take 
 place in dyfentery. It mull alfo be obferved, that dyfentery 
 is a contagious difeafe, and may be diftingulfhed from other 
 com.plaints by its prevailing as an epidemic. 
 
 CAUSES. 
 
 THESE may be divided into Remote and Proximate. 
 
 REMOTE CAUSES. 
 
 THE remote caufes may be divided into two kinds: 
 
 I. Such as predifpofe perfons to this difeafe; or, 
 
 a. Such as occafion or bring on the difeafe in thofe who 
 
 are already predifpofed. 
 The firft are called predifponent; the fecond, occalional 
 or exciting caufes — Thefe are now to be defcribed. 
 
 PREDISPONENT 
 
( 12 ) 
 
 PREDISPONENT CAUSES. 
 
 PREDISPOSITION, according to Doaor Brown, is 
 that ilate of the body not fufficiently difordered to produce 
 difeafe; but, by verging towards it, renders a perfon fufcep- 
 tible of the operation of the occafional or exciting caufe.^ 
 This ftate may be brought on by all thofe caufes which 
 induce debility of the whole fyftem, and efpecialiy of the 
 alimentary canal. 
 
 The caufes which debilitate the whole fyflem are ufually 
 too great fatigue, and deprefling paffions of the mind. 
 Thefe alfo affe6l the ftomach and inteftines, and are 
 known to have frequently interrupted digeftion, and to 
 have induced iicknefs, naufea, and vomiting. 
 
 Intoxication alfo debilitates the fyftem. Small quanti- 
 ties of fpirituous liquors are known to exhilarate the fpi- 
 rits, and to give vigour to the fyftem : but when taken in 
 too great quantities, or often repeated, they diminifh the 
 nervous power, and bring on fymptoms of debility. 
 
 The fummer heat, by debilitating the body, alfo predif- 
 pofes to this complaint : hence foldiers, who have been 
 much expofed and aftively employed in the fum.mer, are 
 ufuajly taken with this difeafe towards autumn. 
 
 Cold, 
 
 ^ Brown's Elements of Medicine. 
 
( '3 ) 
 
 Cold, applied to the body, efpecially at night or during 
 fleep, may be confidered as the mofl frequent predifpdnent 
 caufe of this difeafe. 
 
 In warm climates, and in this country in autumn, it 
 is very common for us to obferve coniiderable viciflitudes 
 of heat and cold in the fpace of twenty-four hours. A 
 fmall change in the thermometer produces a great eifed on 
 the body, when warm or previoufly heated: hence cold, 
 applied to the body, appears to have different efFeds: 
 
 1. By debilitating the body, it predifpofes to favour the 
 operation of contagion. 
 
 2. By interrupting the determination to the furface, it 
 eaufes a greater determination to the inteflines; and, 
 
 3- By preventing the excretions of the various noxious 
 humours from the body, contributes to favour putrefcence 
 in the fyftem. 
 
 When we confider thefe different effects of cold in pre^ 
 difpofing the fyflem to the attack of this difeafe, we may 
 readily conceive the reafons which have induced many 
 Phyficians to fuppofe cold to be the occafional or exciting 
 caufe of dyfentery. When we refleft that cold, applied 
 to the body in the winter, under certain circumftances, is 
 the caufe of catarrh, and many other difeafes affeding 
 the thorax, it may have a greater agency in producing 
 dyfentery than is at prefent imagined. Cold, applied to 
 
 the 
 
( H ) 
 
 ihe feet, is known to affed the inteftines, infomuch that 
 it is often prefcribed to obviate great degrees of conflipa- 
 tion. Cold is known to be the exciting caufe of diarrhoea, 
 and perhaps is more powerful in producing dyfentery, than 
 acting as a predifponent caufe only. 
 
 Moiflure, combined with heat and cold, renders the 
 morbid operation of each the more powerful; and hence 
 it may be conlidered as concurring with thefe in eireding 
 a predifpofition to dyfentery. 
 
 In the latter part of fummer or beginning of autumn, 
 there is much moiflure in the atmofphere, in confequence 
 of the fummer heat : it is then that people are much dif- 
 pofed to contraft dyfenteries, efpecially in fleets and ar- 
 mies, where the foldiers and failors are much expofed to 
 the viciffitudes of heat and cold, from the peculiar fitua- 
 tion in which they are placed. 
 
 Previous difeafes, by weakening the fyftem and derang- 
 ing the different funftions, predifpofe the body alfo to the 
 operation of every kind of contagion, and efpecially to 
 that which produces dyfentery. 
 
 Thefe, and other caufes which debilitate the fyflem, 
 have a manifefl etfed in favouring the operation of the 
 occafional or exciting caufe of dyfentery, which we come 
 next to confider. 
 
 OCCASIONAL 
 
( H ) 
 
 OCCASIONAL OR EXCITING CAUSE. 
 
 AN occafional or exciting caufe is only a poUible 
 caufe, and does not produce its effeds unlefs under certain 
 circumftances. What thefe circumllances are, I fhall not 
 pretend pofitively to deterrnine ; but they feem to be thofe 
 which are marked as conftituting a predifpofition. 
 
 The celebrated Do£tor Cullen, after attending to the 
 nature of dyfentery, fays, that " the difeafe is always con- 
 tagious, and by the propagating of fuch contagion, inde- 
 pendent of cold or other exciting caufes, it becomes epi- 
 demic in camps and other places. It is therefore to be 
 doubted, if the application of cold does ever produce the 
 difeafe, unlefs when the fpecific contagion has been previ- 
 oufly received into the body; and, upon the whole, it is 
 probable, that a fpecific contagion is to be confidered as 
 always the remote caufe of this difeafe."* 
 
 But what the nature of the contagion is that produces 
 dyfentery, does not feem to be perfectly underftood; nor 
 is it more evident what are the fources of its produftion. 
 
 As dyfenteries are commonly combined with fynochus 
 and typhus, and fometimes with intermittent and remit- 
 tent fevers, it may be doubted whether the fever accom- 
 panying dyfenteries does not arife from the fame caufes 
 which produce thofe complaints, namely, marfh or human 
 
 effluvia ; 
 * CuUen's Firft Lines, par. 1075. 
 
( i6 ) 
 
 eflPiuvIa; and whether the local afFe(5lion of the inteftines is 
 not owing to a morbid determination to thefe parts, in 
 confequence of the operation of cold or other caufes.* 
 It is, however, certain, that fome fpecies of contagion 
 feem to affe6l certain parts of the body in a peculiar man- 
 ner. Thus, the ikin is afFe6ted in the fmall-pox and mea- 
 fles, the throat in the cynanche maligna, the lungs in the 
 pertuffis, and the membrana fneideriana in the influenza: 
 fo it may be, that a contagion of a fpecific nature may 
 afFed the inteftines in preference to any other part, though 
 we are unacquainted with its nature or the mode of its pro- 
 duftion. 
 
 The opinion that the febrile fymptoms which attend dy* 
 fenteries do not conftitute an original fever, or one peculiar 
 to that difeafe, feems probable from this circumftance, that 
 fometimes the fever is of an intermittent form, fometimes 
 of a remittent, and at others of afynochus or typhus nature. 
 We do not find thefe various kinds of fever in fcarlatina^ 
 meafles, fmall-pox, and other difeafes which arife from a 
 fpecific contagion. It has been fuppofed by fome Phyli- 
 cians, that dyfenteries are not produced from contagion :f 
 this error has arifen from its being confounded with diarr- 
 hoea; and perhaps thofe cafes of dyfentery which are 
 mentioned by Do<5lor Cleghorn,| Sir John Pringle,§ 
 and others, to be combined with intermittent and remittent 
 fevers, have only been cafes of diarrhoea inftead of dyfentery. 
 
 Thofe. 
 
 * Doftor Romayne's M, S, Leftures, 1791, 
 ■f Mofeley on Tropical Difeafes, 21 1» 
 X Difeafe of Minorca. 
 § Difeafes of the Army, 
 
( 17 ) 
 
 Thofe who are but little acquainted with the writings of 
 inany modem Phyficians, will readily difcover, that the 
 hiflory of dyfentery is differently flated by moft of them; 
 and that this difference can only be fettled by future obfer- 
 vationso 
 
 PROXIMATE CAUSE. 
 
 BY an attention to the feries of fymptoms which ufually 
 attend dyfenteries, it is manifefl, that a confiderable part 
 of their proximate eaufe is conne6led with a febrile 
 difeafe, and that this mufl depend on the fame circum- 
 flances as the proximate caufe of fevers in general, which 
 Do6lor CuLLEN fuppofes to depend upon an atony and 
 fpafm of the extreme vefTels. There is no doubt but that 
 the fymptoms of dyfentery point out a diminifhed energy 
 of the nervous fyflem and a tendency to putrefcence, 
 Thefe are marked in the languor, laflitude, Hate of the 
 tongue, flomach, and the various functions of the 
 body. But there are another feries of fymptoms M^hich 
 are peculiar to dyfenteries, and upon which their prox- 
 imate caufe more immediately depends. Thefe have been 
 variouOy coniidered by Phyficians. 
 
 Doftor CuLLEN is of opinion ^' that the proximate 
 caufe of dyfentery, or at leaft the chief part of the proxi- 
 mate caufe, confifts in a preternatural conflri6tion of the 
 coloD) occafioning at the fame time, thofe fpafmodic ef- 
 forts which are felt in fevere gripings, and which efforts, 
 C propagated 
 
( iS ) 
 
 propagated downwards, occafiorx there the frequent mucous 
 ilools and tenefmus."^ 
 
 It is certain, that many of the fymptoms which are 
 chara6teriftic of dyfentery, are beft explained upon thefe 
 principles; fuch as the formation of the fcybala, and their 
 retention in the inteflines, notwithftanding the efforts to 
 have them ejefted. The mucous commonly difcharged in 
 this difeafe is owing to an abrafion of the internal coats of 
 the inteftines, which are generally covered with it in confi- 
 derable quantities; and it is not improbable but that in this 
 difeafe, there is a morbid fecretion of it. The appearance 
 of the blood with the mucous maybe readily explained, 
 from a i-upture of fome of the fmaller blood- veffels, and 
 perhaps from a dilatation of their mouths. The latter of 
 thefe Sir John Pringle fuppofes frequently to happen. 
 He likewife obferves, that " flreaks of blood'' appearing 
 among the matter voided, " denote the opening of fome 
 of the fmall veffels at the end of the reftum, but a more 
 intimate mixture is a lign that the blood comes from *i 
 higher fource."f 
 
 - Some have fuppofed the proximate caufe of dyfentery to 
 depend upon inflammation ;t but inflammation is racher 
 the natural efied of much fpafmodic effort, than the caufe. 
 Hence we may confider inflammation, and its confe- 
 quences, ulceration and gangrene, to be more the effe<5ls of 
 fpafm than the caufe of it. 
 
 Others 
 
 * Flrfl Lines, vol. ii- par. 1078. 
 
 '[ Pringie''s Difeafes of the Army, p. 2z8. 
 
 % Anderas Mitchel's Inaug. Diilsrt. dc Dyfenterla, Edinb. 17S93 
 
( ^9 ) 
 
 Others have fuppofed a redundancy of bile, and an 
 increafed acrimony of it, to be the caufe of dyfentery;* 
 but, if much bile be generated in the courfe of dyfenteries, 
 it appears to be an efFe6l of the operation of fome of the 
 remote caufes. A morbid fecretion, and perhaps an acri- 
 mony of the bile, may occafion cholera and diarrhoea; but 
 I cannot fuppofe that it can produce dyfentery. 
 
 Many have imputed the immediate caufe of dyfentery 
 to the eating a great quantity of fruit; but this is a vulgar 
 error. From obfervations now made, it is manifeft that 
 fruits have no effe£t in producing this difeafe; and ripe 
 fruits are among the belt remedies to obviate the complaint. 
 It is a remark made by authors in general, that dyfenteries 
 appear more prevalent in thofe years in which there is leaft 
 fruit.f From this it would appear, that they have rather 
 9. tendency to prevent the coming on of the difeafe. 
 
 Worms have likewife been fuppofed to produce this 
 complaint, which is alfo a vulgar error. Living ahi- 
 malculae have been fuppofed to produce this difeafe. In 
 the Amcenitates Academiae, there is a curious diflertation on 
 this fubjed, where the author attempts to prove, that 
 living fmall animalculae, lodged in the inteftines, are the 
 caufe of dyfentery; J but as we have no evidence of thefe, 
 we muft confider the theory as merely an hypothefis, or 
 the chimera of a fanciful imagination. 
 
 * Zimmerman on the Dyfentery, ch, 2. 
 
 f Pringle'sDifeafes of the Army. Monro's Difeafes of the Army, 3 iS. 
 
 j Amcenitates Academiae, vol. v. difTertt^a. 
 
 PROGNOSIS. 
 
( 20 ) 
 
 PROGNOSIS. 
 
 THE fymptoms from which the probable event of dy. 
 fentery can be forefeen, may be divided into thofe which 
 form the febrile part of the difeafe, and into thofe which 
 conflitiite the ^eftion of the inteftines. 
 
 A violent fever always portends danger, from the effect 
 it has on the fyflem at large; and it may caufe the local 
 afFe6lion of the inteftines to terminate in gangrene. When 
 the difeafe is accompanied with much debility, and want of 
 energy in the fyftem, as manifefted in the ftate of the dif- 
 ferent funftions, it evinces great danger; and the danger will 
 be in proportion to the degree of debility which prevails. 
 
 A tendency to putrefcence in the fyftem, is an index of 
 danger, efpecially when petechias, vibices, &c, appear on 
 the ftirface of the body, aphthse in the mouth and fauces, 
 and v/hen the tongue has a black appearance. 
 
 It can hardly be faid, that dyfentery is in any ftage with- 
 out fymptoms of danger; and it is only by proper remedies, 
 timely adminiftered, that the difeafe proves to have a fa- 
 vourable termination. 
 
 When the heat of the body is not conliderable, the thirft 
 not great, the ftools copious, and not very frequent, the 
 fkin moift, the urine natural, and no way obftrufted, it is 
 probable that the difeafe v/iii end favourably, and more efpe- 
 cially 
 
( ^^ ) 
 
 cially if the foeces become more natural, if there is a deiire 
 for food, and if the pulfe is moderate. 
 
 The fymptoms arifing from the afFeftion of the intef- 
 tines denoting danger, are violent tormina, a great and 
 frequent defire of evacuating the contents of the inteftines, 
 without that effed, and an inability of receiving injedionf 
 from a fpafmodic afFe6lion of the re6lum; and laftly, the 
 returning of injections almoft immediately in thofe cafes 
 where they could be received. 
 
 METHOD OF CURE. 
 
 DYSENTERY is a difeafe which demands the particular 
 attention of a Phyfician. Nature, which, on many occa- 
 fions, exerts herfelf to cure difeafes, affords but little relief 
 in this. In the treatment of dyfentery, fome indications of 
 cure are pointed out, and which ought to be purfued, pay- 
 ing attention to the patient's conftitution, and the feafon of 
 the year in which the difeafe occurs. Thefe indications 
 we are now to note. 
 
 I. To evacuate the contents of the flomach and intef- 
 tines. 
 
 3. To relieve the febrile fymptoms, and to alter the 
 determination from the inteflines. 
 
 3. To fupport the flrength of the patient, and obviate 
 the tendency to putrefcence in the fyllem ; and, 
 
 4. To diminiih the irritability of the inteflines, and 
 reflore their tone. 
 
 Such 
 
( 22 ) 
 
 Such is the importance of attending to the firft indica- 
 tion, that many medicines, which have the power to 
 fulfil it, have been confidered by Phyficians as fpecifics 
 in the cure of this difeafe. The particular njedicines we 
 come next to confider. 
 
 In fome cafes, before the medicines are adminiftered 
 to fulfil the firfl indication, it may be neceflary to take 
 away eight or ten ounces of blood, which will often render 
 the purgative and emetic medicines more fafe and efficar 
 cious.* But it muft be remarked, that blood-letting 
 ihould be pra6tifed with caution, as the tendency of dyfen- 
 tery is to produce debility. Dyfenteric cafes occuring in 
 the fpring or beginning of fummer, generally bear blood- 
 letting better than thofe which occur in the fall or latter 
 end of fummer. 
 
 Ipecacuanha is a medicine well adapted for all the pur- 
 
 pofes of ftiU vomiting, and therefore may be adminiftered 
 with advantage in dyfenteries in their firft ftages. Given in 
 fmall dofes, it is alfo purgative, and may be faid to favour 
 a determination to the furface of the body. Such, indeed, 
 liave been the good effefts of ipecacuanha, that it has 
 been confidered by Phyficians as a fpecific; but from what 
 1 have jufl mentioned, its mode of operating mufi: be ob- 
 vious. , 
 
 The 
 
 * The cafes in which blood-letting appears to be particularly indicated 
 are thofe in which the pulfe is full, hard and ftrong, and where an evident 
 inflammatory diathefis appears in the fyilem. Sometimes, however, 
 where the pain is violent, it will be neceflary to bleed, though the pulfe 
 may be weak and contracted. Do£lor Monro has obf2rved, that in fuch 
 cafes the pulfe, after bleeding, becomes fuller and ftronger. 
 
( 23 ) 
 
 'I'hc chief obje6lioA to the ufe of ipecacuanha is, that it 
 is very apt to operate as an emetic when given in fmall dofes, 
 and by that means prevent our obtaining its purgative 
 efFefts, which are mofl required to evacuate the contents of 
 the inteftines. 
 
 The preparations of antimony are now preferred to every 
 other medicine in the cure of this difeafe; and of the various 
 preparations in the difpenfatories, the tartar-emetic muft 
 be preferred. In tartar-emetic, the antimony is combined 
 with an acid which renders its operation more certain and 
 a<Elive, when taken into the flomach^ and when it pafies 
 into the inteftines, more efFe6lually purgative: for this 
 reafon it is the preparation in moft common ufe. 
 
 Tartar-emetic may be given in fuch dofes as to effeft 
 full vomiting when requifite, or it may be adminiftered in 
 dofes fo as to prove cathartic. When the tartar-emetic is 
 intended to a6l as an emetic, it fhould be given in large 
 dofes, and at fhort intervals: when it is intended to a6l as 
 a purgative, it fhould be given at long intervals, and in 
 fmall dofes. This medicine, belides the efFefts juft men- 
 tioned, relaxes the fyftem, and determines to the furface 
 of the body : hence it relieves the febrile difpofition, and on 
 this account, it is a medicine of great efficacy in the cure 
 of this complaint, as has been juftly obferved by the cele- 
 brated Monfieur Senac, phylician to the armies of France 
 in the reign of Louis the fifteenth. 
 
 The other antimonial medicines which are given in 
 dyfentery, are thofe in which the reguline parts are un- 
 
 combined 
 
( 24 ) 
 
 combined with an acid, as in the James's powder, and glafs 
 of antimony. The James's powder proves more certainly 
 purgative, and determines more to the /kin than the tartar- 
 emetic, as is evident from the nature and operation of the 
 medicine. The glafs of antimony has been commonly 
 employed, combined with wax ; but this is a ufelefs addi- 
 tion, for the activity and value of the medicine depend on 
 its meeting with an acid in the ftomach, and there form- 
 ing a kind of tartar-emetic : but as this is the worft prepa- 
 ration of antimony, it is how feldom employed. 
 
 When emetic medicines are given, fmall quantities of an 
 infuiion of camomile flowers fhould be drank occafion- 
 ally after the vomiting has been produced, to prevent painful 
 
 fpafmodic afFeftions of the ftomach. 
 
 The next clafs of medicines which may be ufed to eva!- 
 cuate the contents of the inteftines, and which we now 
 come to notice, are thofe called more ftriftly purgative. 
 Of thefe, the neutral falts are thofe moft commonly em- 
 ployed, fuch as Glauber's falts, Epfom's falts, and chryftals 
 of tartar. The falts ftiould be diflblved in a fuflicient 
 quantity of water, and given in divided dofes, until free 
 difcharges are produced. The falts may alfo be combined 
 with fome other medicines. Doctor Monro highly re- 
 com.mends a combination of falts, manna and oil;* but the 
 moft ufeful combination to the two firft of thefe medicines 
 is that of an antimonial: thus, Glauber's falts, manna and 
 tartar-emetic, combined in folution, make a convenient 
 
 and 
 
 * Monro's Difsafes of the Army, 
 
aftd efficacious mixture, which may be given in divided 
 dbfes^ until the patient have free difeharges, and is relieved 
 fi-otri thfe tormina or griping pains. 
 
 "Gaftof oil,* tamarinds in decoction, and medicines of this 
 nature, have alfo been ufed with fiiccefs.f Rheubarb, jalap 
 and aloes arfe" the leaft proper purgatives : when given ia 
 powder, they are apt to produce too great irritation; com- 
 bined with fpiritSj in the form of tinftures, they are equally 
 obje6lionable : for th'efe reafons they are not ufed by the mofi: 
 Ikilful practitioners at the prefent day. 
 
 Under the head of purgatives, muft alfo be confidered 
 iiijeCtions thrown into the inteltines. Animal broths, mild 
 mucilaginous mixtures of flarch or gum-arabic, are the moft 
 j5roper: thefe lllould be inje6ted in confiderable quantities, 
 With the occafional addition of caftor or common oil; and 
 When there is much pain, inje6tions may be ufed combined 
 with laudanum, or a folution of opium. + Thefe are alfo 
 highly proper to relieve the tenefmus, which is often one of 
 the moft troublefome fymptoms. Anodyne injections have 
 likewife a gOod eifeCt in preventing the prolapfus ani ; but 
 when this oc-curs, if ihould be remedied by aftringent appli- 
 cations, combined with fomething of an anodyne nature. 
 When the topical aiFeCtion is very great, and there appear^ 
 D danger 
 
 * Caftor oil is frequently naufeous to patients, and will fometlmea 
 occafion vomiting} to prevent which, a fmall quantity of fpirits of laven- 
 der may be added. 
 
 -}- Under this head muft be referred mutton fuet and animal broths, 
 which have all a laxative effedl:. 
 
 J In throwing in injedions, great care fhould be taken that it be done 
 in a gradual and eafy manner, for, if not, they may have a tendency to 
 increafe the irritability of the parts, and confequently the difeafe. 
 
( 26 ) 
 
 danger of gangrene, injedions of the infulion or decoclroa 
 
 of the Perjvlan bark, finely filtered, fhould be ufed every 
 three or four hours, or according as the cafe may require. 
 
 The efFefts of the medicines which we have juft men- 
 tioned, are commonly fuch as not only relieve the topical 
 complaints of the ftomach and inteflines, and evacuate their 
 contents, but alfo diminifii very much the febrile fymptomsj 
 for this reafon they fhould be occafionally continued 
 throughout the treatment of the difeafe. 
 
 The fecond indication of cure which I have given, and 
 to which we fhall now attend, is that of relieving the febrile 
 fymptoms and altering the determination from the inteflines. 
 
 The febrile fymptoms are to be treated according to their 
 nature, as they are attended with more or lefs excitement in 
 the fyftem. In mofl cafes it will be requifite to employ the 
 antiphlogiftic regimen, excepting the application of cold, 
 which, by obflru fling the determination to the furface of the 
 body, may be injurious. The tenfion of the arterial fyflem 
 may be much diminifhed by thofe means mentioned to fulfil 
 the firft indication ; ancf as part of the proximate caufe of the 
 difeafe is that of the fever, antimonial and other remedies 
 which are difpofed to determine to the furface, fhould be 
 employed as circumfiances may direfl. 
 
 In the courfe of the fever, when the inteflines have been 
 fully difcharged, it may, in many cafes, be necefTary to at- 
 tend more particularly to the cure of the difeafe, when fli- 
 
 mulants 
 
( ^7 ) 
 
 mulants and tonics may be ufed, fuch as good wine and the 
 befl Peruvian bark. Wine may be given in any form that 
 may be agreeable to the patient; but it requires feme cir- 
 .cumfpe£lion in adminiftering the bark, which ought never 
 to be given in fubllance where the flomach or inteftines are 
 difeafed, as the powdered bark, however finely prepared, 
 may produce irritation from its mechanical action. The 
 mofl proper preparation of the bark is the cold infufion, 
 made with magnefia, and finely filtered. 
 
 In thofe cafes of dyfentery in which the fever puts on a 
 remittent or intermittent form, it is very necelTary to be 
 more free in the ufe of the infufion of the bark, to prevent 
 the return of the paroxyfm.* Where l-his treatment has 
 been purfued, the good effects which have refulted juflify 
 its propriety. 
 
 The tendency of fevers, in dyfentery, to thofe of a typhus 
 nature, and the tendency of the fyflem to putrefcence, are 
 to be obviated by due attention to cleanlinefs, as changing 
 frequently the bed-clothes and body-linen of the fick. The 
 air of the patient's apartment Ihould be particularly attended 
 to; free ventilation fhould be ufed, and if this cannot be 
 properly performed, branches of trees or fhruLs may be 
 placed in the room during the day with good efFeft, as they 
 abforb the mephitic air and emit what is pure. The air of the 
 apartment may likewife be rendered purer, or at leail more 
 agreeable, by having the floor fprinkled with vinegar, or hav- 
 ing different aromatic fubflances burnt in the room. Great 
 
 care 
 
 * Cleghorn'sDifeafes of Minorca, and Llnd on thofe of Warm Climates. 
 
care fhould be taken that all excrementitious matters be re* 
 moved as foon as poffible, for they are the chief fource of 
 
 the impurity of the air. 
 
 Determining to the fiirface of the body in fevers, is Ayell 
 calculated to take off the fpafpri from the extreme vefTels, 
 which conftitutes a part of their proximate caufe. But, in 
 the cure of dyfentery, it i^ of very great confequence to re- 
 lieve the local affeftion of the inteftines. For this purpofe, 
 the furface of the body fhould be kept warm when antimo- 
 nial medicines are adminillered, to caufe them to de1;ern:;ine 
 to the furface, while at the fame time they may evacuate the 
 contents of the ftomachand intellines. Small dofes of lau- 
 danum m.ay be added to the antimonial medicines afterproper 
 evacuations, to favour their operation in determining to the 
 furface. Upon the fame principle, bliftering and warm bath? 
 ing or fomentations to the abdomen, may be employed, 
 efpecially when the local affe.clion is any way confiderable, 
 and attended with violent pain. Dodor Moseley, in his 
 Trealife on Tropical pifeafes and on the Climate of the 
 Weft-Indies, fully illuftrates this practice ;*. a;id othe^. 
 writers of eminence juftify the fame opinion, w.hich, indeed, 
 feems confonant to reafon and the nature of the difeafq. 
 
 The third indication which I have mentioned,, and to 
 hich we come now to pay our attention, is to fupport the 
 frrength of the patient, and obviate the tendency to putre- 
 fcence in the fyflem. 
 
 w 
 
 Contagion? 
 
( 29 ) 
 
 Contagious difeafes of all kinds have a great eflfed Qt\ 
 the nervpus fyftem, in inducing a ftate of debility j bu| 
 this, is particularly the cafe with that which produces dyt 
 fentery: therefore, fuch medicine and diet fliould be admi- 
 niilered, as may bed tend to obviate 'the'eifefts of the con- 
 tagion. Wine, in proper quantities, good animal broths^ 
 and the Peruvian bark, are befl calculated for this purpofe. 
 When broth is employed, care . fliould be taken that all the 
 tat is removed. Salep and fago may alfo be given, accord-^ 
 ing to circumftances : they form, with water, a pleafant: 
 mucilaginous drink, well adapted to perfons labouring un- 
 der this complaint. R.ipe fruits of ail kinds,, but efpec.ialljf 
 thofe of a fub-acid nature, may likewife be given: tiiejr 
 have been known to be of great fervice in obflinate cafes 
 9^ the difeafe, where other remedies had been ufed without 
 
 • It is unnecefTary to repeat the directions already propofed 
 t© obviate the tendency to putrefcence in this complaint, 
 a^ the m.eans have been mentioned in the treatment requifite 
 ^ jfelieve the? febjrile fy mptoms. 
 
 The fourth and lafl indication which I have given, and 
 l^hich vt/e come now to coniider, is that of diminifhing the 
 yfritability of the inteilines, and reiloring their tone. 
 
 Every part of the human body becomes much more 
 irritable when inflamed ; and this is efpecially the cafe in 
 
 the 
 
 * Zimmerman on Dyfentery, Prlngle's Difeafes of the Army. Mon- 
 ro's Difeafes of tiie Army. 
 
( 30 ) 
 
 the inteftines, where there are a confiderable number of 
 nervous papillse. To obviate an h'ritable flate of the intef- 
 tines, is of much confequence in the cure of dyfentery. 
 
 To obtain this object, we make ufe of mucilaginous and 
 anodyne medicines, 
 
 Gum tragacanthj in the form of mucilage, is laid to 
 allay the irritation of the inteftines; but perhaps it does 
 it only in an indirect way, namely, by flieathing the 
 coats of the inteftines, and preventing their being irritated 
 by the acrimony which is frequently generated in them. 
 Gum-arabic, ftarch, and flour long boiled and formed 
 into mucilages, have the fame good effeil. But the moft 
 ufeful medicines for this purpofe, are opiates, given in 
 fome form or other; fometimes combined with aromatics 
 and aftringents, and at other times not. The forms in 
 which it is combined with aromatics, are the theriacs of 
 the difpenfatories : thofe in which aftringents are combined, 
 are the compound powder of bole, and the fpecies aromaticae, 
 &c. Thefe preparations have at times good effects ; but 
 in the beginning of the difeafe care ought to be taken not 
 to adminifter medicines which will counteract the full dif- 
 charge from the inteftines; and therefore, M^hen opiates arc 
 employed internally, they are fafeft when combined with 
 ipecacuanha or tartar-emetic. In this v\'ay their bad effefb 
 on the different fecretions are prevented. They may be 
 alfo combmed with calomel 
 
 Opiates 
 
( 31 ) 
 
 Opiates may alfo be employed externally, either in th« 
 form of a plaifter to the abdomen, or in fomentations. For 
 this lafl purpofe, the heads of poppy may be ufcd to make 
 a ftrong decoftion, and this deco6lion applied in the form 
 of a fomentation, three or four times a day, to the abdomen, 
 for the fpace of one or two hours. 
 
 A temperate atmofphere fhould always be obtained if 
 poffible; cold fliould be avoided, as it is apt to caufe a con- 
 tinuance of the difeafe, from its producing a determination 
 to the inteftines, and often counteracting the moft powerful 
 remedies which can be employed. The patient's cloathing 
 mufl be of a warm kind; perhaps wearing flannel next to 
 the fkin would be the beft means of keeping up a conflant 
 determination to the furface of the body, and of prevent- 
 ing, in a great meafure, the bad effefts which might arife 
 from any fudden viciffitude of weather to which the patient 
 may be expofed. 
 
 Aftringent and anodyne medicines may alfo be ufed to 
 reftrain the difcharges from the inteftines. The confedio 
 japonica of the New Edinburgh Difpenfatory, is a very 
 proper and ufeful compofition, as it contains fome of the 
 more powerful aflringents combined with aromatics, as the 
 gum kino and fuccus japonicus. The cortex granatorum, 
 querci, lignum campechence and its extraft, rad. Colombo 
 alumen, and other aftringents, may be alfo ufed with ad- 
 vantage. The fimarouba bark has likewife been confidered 
 as very efficacious, and has been ufed by feveral phyficians; 
 but others confider it of very little efficacy; though it is 
 
 faid 
 
( 3^ ) 
 
 laid to have fucceeded in fome very obftinate cafes, wh'efe 
 more powerful aftringents had failed. 
 
 ' It only remains for me now to mention the meafis to be 
 employed by convalefcents after the difeafe, and the means 
 to prevent the fpreading of the contagion. With regard to 
 the firll, due attention fhould be paid to regimen, diet and 
 exercife; and with refpeft to the fecond, the moft proper 
 means to obviate the effects of the contagion, is to avoid 
 thofe caufes which we have marked as predifpoling th^ 
 llabit to this complaint, and to avoid the occalional or ex- 
 citing caufe. 
 
 The limits to which a difTertation of this kind is ufually 
 confined, Torbid my enlarging furthef On the fubjef^. 
 
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