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GEN. X. SPEC. I. Dysenteria

acuta.

Acute dysentery :

and hence disputes

its imme

diate seat.

Ordinary exciting

cause, sup

pressed perspiration from cold.

and hence the origin of most of the disputes concerning the precise spot of the disease, which have long occupied so much of the attention of the medical community..

The ordinary exciting cause, however, of acute dysentery, under all its varieties of fixation, there can be little question, is suppressed perspiration or a sudden concerning chill applied to the surface, acting in conjunction with the predisposing cause of an atmosphere varying rapidly from heat to cold and from moist to dry; but by what means this exciting cause operates upon the larger intestines rather than upon any other cavity, or produces the symptoms of dysentery rather than those of diarrhoea, cholera, or colic, we seem to be incapable of determining. We perceive, however, in the events of every day, that sudden chills on the surface are possessIts action il- ed of a revellent power, and throw the action which is lost on the skin on various internal organs, and especially on cavities of mucous membranes, which, in consequence of this excitement, become inflamed, and pour forth an additional secretion. Such is especially the case in rheumatism and catarrh, both which terms are derived from the same Greek root, and import defluxion. And from this common character the three diseases and catarrh. have by some pathologists been conceived to be so much alike, that dysentery has been regarded as an intestinal rheumatism by Cœlius Aurelianus, Akenside, Stoll, and Richter; and is actually set down, by Dr. Parr, as a species of catarrh, in his nosological classification.

lustrated

by that of rheumatism

We also see why dysentery, like catarrh, may be either sporadic or epidemic; as also why, in each case, it may be either slight, and pass off without any serious evil, in a few days, or accompanied with great inflammatory action and continued fever: thus giving rise to the two following varieties: a Simplex.

Simple acute dysentery.

Feces often discharged without considerable pain; of a natural quality and affording ease: abdominal tenderness unheeded.

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Sydenham.

These are the two varieties under which acute dysen- Thus artery is described by Sydenham, who indeed limits himself ranged by almost entirely to these forms of the disease, since though he notices the second species or chronic dysentery, he merely glances at it in a kind of postscript to his chapter. Yet his description concerning both these is so accurate, and the author is not afraid to add, his general mode of treatment so judicious, that we shall find in the prosecution of this subject, both have been supported by the concurrent practice of the most approved pathologists from his own day to the present.

As the local inflammatory action is more usually Colonitis of traced in the colon than elsewhere, Stoll, and various Ballingall. other writers have fixed upon this intestine as its proper seat; and hence Dr. Ballingall has distinguished it by the name of colonitis. A nearer approach however to the present general arrangement will be found in Mr. Bampfield's valuable treatise†, though the complicated subdivisions of Sauvages seem to be here unnecessarily revived and imitated.

It has been already observed that in dysentery although the primary seat of inflammatory action is the intestines, yet the functions of the skin and of the liver are from the first, as well as throughout the whole course of the disease, considerably disturbed by sympathetic excitement. The liver, however, suffers in many instances not only on this account, but from a continuous spread of the inflammatory action through the medium of the biliary ducts, and becomes injured in its organi

Rat. Med. Part 1. p. 294, 326.

† A Practical Treatise on Tropical Dysentery, more particularly as it oc

eurs in the East Indies.

Functions of liver affected at the same

the skin and

time.

GEN. X. SPEC. I. Dysenteria

acuta.

entery.

zation as well as in its function. Some pathologists, as Dr. Chisholm, conceive that they can trace this extension of the inflammatory process to the liver by parAcute dys- ticular symptoms, as a fixt pain at the stomach, a constant head-ache, and frequent dejections at the commencement of the disease; and they have consequently Hepatic dysentery of given us a distinct division of it under the name of heChisholm. patic dysentery. It is sufficiently ascertained, however, that the structure of the liver has been often considerably affected and even destroyed, when neither these nor any other peculiar symptoms have presented themselves; and hence it is a distinction which can be made no use of. A frequency of dejections at the commencement is rather an anomalous fact than a pathognomic sign: while as to the other two indications it is admitted by Dr. Chisholm himself that they are "apparently NOT characteristic symptoms"; in other respects, says he, "the disease does not seem to differ from the idiopathic or common dysentery".

Doctrine

Some writers, however, as Piso* formerly, and Dr. James Johnson in our own day †, have carried this view of the subject considerably farther than my late learned and venerated friend Dr. Chisholm ever intended; for they have boldly reversed the general opinion that has prevailed, and especially since the days of Sydenham, and contended that the liver itself forms in every instance the primary seat of the disease, the intestines being only affected secondarily. Whence the latest of these two distinguished authors has ventured a scoff at the pathology of Sydenham, "who", says he, "it is our firm Sydenham. belief never examined a dead body after he left his academical studies;—at least he has given us no indication of pathological knowledge in any of his works."

that the liver

forms the

primary seat of disease,

as opposed to that of

I value Dr. Johnson's friendship, and have an equal value for his talents, but I cannot concur with him in

1623.

Discours sur la Nature, &c. des Maladies accompagnées de Dysenterie,

+ Influence of Tropical Climates, &c. Edit. 1. p. 197.
Medico-Chirurg, Rev. Mar. 1823. p.830.

GEN. X.

SPEC. I. Dysenteria

acuta.

entery.

Sydenham

thus tearing from the temples of an illustrious countryman the wreathes of honour he has so deservedly earned, and which have been bestowed on him by our best foreign as well as domestic judges, from Boerhaave and Acute dysSauvages, in the middle of the last century, to the younger Frank in the present day. His language indeed is tinctured with the prevailing errors of the humoral hypothesis, which at that period it was impossible illustrated. altogether to avoid, and which is again rising into notice in some quarters; but sifted of this, his pathological doctrines are those of the present day, to which in the main they have given rise; and better stand the test of dissection than those of Dr. Johnson himself. "His observations", says Dr. Bostock, "will be commonly found to be correct, although his hypotheses are too often fallacious."* These "observations" teach us in few words, that dysentery is an inflammatory affection of some part of the larger intestines, which, in its idiopathic and milder state, subsides without serious evil in a few days; but which, occurring in the autumn, is apt to associate itself with whatever febrile epidemy is then prevalent, to become a far more important and complicated malady, and to ravage over a much larger field of organization; the fever aggravating the dysentery and the dysentery the fever; while, not unfrequently, a metastasis ensues and the fever is thrown upon the intestinal canal, and expends its violence topically: during which vehemence of action a peccant material (the contagious principle of Dr. Cullen), is elaborated in the constitution and thrown out on the surface. To oppose all which he lays down a therapeutic plan which evinces an equal degree of judgement; and consists in bleeding, purging, diaphoresis, and opium; in other words in taking off congestion, and inflammatory action, in allaying irritation, and restoring to the circulatory system its proper balance. It may perhaps be said by some modern writers that he did not always carry these prin

* Elementary System of Physiology. Vol. 1. p. 448, 8vo. 1824.

GEN. X. SPEC. I. Dysenteria

acuta.

entery.

ciples far enough Possibly not in every instance: but this must altogether depend upon the severity of the disease. And we have a proof, in his own success, that Acute dys- he carried them far enough in general; while his great merit consists in the establishment of such principles; and in squaring a correct line of practice to a correct pathology. It may also be objected that calomel does not appear to have entered into his list of deobstruents. That he did not use it among other cathartics, shews, evidently, that his cathartic catalogue might have been improved; but to have employed it as a sialagogue, and to have depended upon curing the disease, almost exclusively, as his loudest opposers have endeavoured to do, by ptyalism-however valuable such a process may be in a few instances would not I fear have added to his reputation or increased the number of his followers.

Shown to be in coincid

ence with the best

opinions and practice of

day.

Had the animadversion, indeed, which I have thus felt it my duty to notice been delayed but a few months, it is most probable that it would not have been advanced at all. For whilst the learned writer who has made it, the present had already to struggle with perhaps a majority of the most judicious tropical writers, in denying the existence of contagion at all times, and regarding the very opinion as absurd; he would have found in the admirable treatises on dysentery which have since been furnished us from Ireland, not only that this opinion, as already observed, seems to have a firm foundation under particular circumstances; but that his favourite doctrine that the liver is the primary seat of the disease, is completely unhinged; as also that his favourite plan of treatment has as little succeeded here, as it did in India under Dr. Ballingall, or as Dr. Frank informs us it did in his hands in Egypt during the occupation of that country by the French army.

a D. acuta simplex.

The diagnostics of the first variety, or SIMPLE ACUTE Simple acute DYSENTERY, unaccompanied with the prevailing fever of dysentery. the season, are thus accurately laid down by Sydenham:

* Influence of Tropical Climates. Edit. ш. p. 223.

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