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GEN. X.

SPEC. I. Dysenteria

acuta.

Acute dysentery. Medical

treatment.

Flannel swathe.

Singular sudorific plan mentioned by Darwin.

Astringents and tonics.

Dewar's recommendation
cumberband bound round the abdomen, is, however,
better entitled to practice, as it affords support as well
as warmth: on both which accounts Sir James M'Gri-
gor tells us he has found it very useful +.

of a broad flannel swathe or

Dr. Darwin amuses us with a singular mode of producing the same result, and one which, if continued long enough, might probably prove as powerful a revellent as any of those already noticed, but which we should not always recommend, nor find our patients disposed to carry into effect. "Two dysenteric patients", says he, "in the same ward of the Infirmary at Edinburgh, quarrelled and whipped each other with horse-whips a long time, and were both much better after it."‡

If the flux of blood, or any other morbid material, continue and be considerable, and especially if there be still an intermixture of sanious grume and shreds of membranes, evidently proving vascular disintegration and the approach of gangrene, astringents and tonics must enter into the plan of treatment. And in this case great benefit has been obtained by the mineral acids in union with sulphate of zinc, or with opium.

The former combination was a favourite medicine with Dr. Moseley, who, of the mineral acids, preferred alum, and varied the proportions according to the strength or age, the degree of costiveness or of hemorrhage, of the patient: sometimes giving two or three grains of each at a dose, to be repeated three or four times a-day; where the hemorrhage is considerable, increasing the alum; and where feculent evacuations were required, diminishing it or even omitting it altogether. The preparation is valuable as it unites a powerful metallic tonic, which is a true character of the sulphate Their virtue of zinc, with an acid which has the singular virtue of

in combina

tion.

* Observations on Diarrhoea and Dysentery, as those Diseases appeared in the British Army in Egypt in 1807.

† Medico-Chir. Trans. vi. 433.

Zoonom, Cl. п. i. 3. 19.

GEN. X.

SPEC. I.

Acute dys

proving astringent to the sanguineous and secernent system, while it produces little effect upon the peristaltic Dysenteria motion, and by some physiologists is thought rather to acuta. quicken it. Dr. Adair employed alum alone; but it is entery. greatly improved by the addition of the white vitriol. Medical Dr. Jackson recommends either, or both conjointly and both himself and Dr. Moseley employed injections at the same time, composed of a solution of acetate of lead, and apparently with great benefit.

treatment.

acids with

A like beneficial effect, however, has been derived Mineral from uniting the mineral acids with laudanum. The laudanum. sulphuric, though the pleasantest to the taste, is more apt to irritate the bowels than the nitric. But the best mode of giving the latter, is, by combining it with muriatic acid in the proportion of two thirds of the former to one of the latter, imitating hereby the chrysulea of Van Helmont, or the aqua regia of later chemists, the nitro-muriatic acid of the resent day, in doses of two drops of the nitric, one of the muriatic, and ten minims of laudanum, intermixed with infusion of roses or that of the more powerful astringents logwood, catechu, and gum kino. I have employed this medicine with peculiar advantage, not only in dysenteric, but in many other loosenesses, and hemorrhages of the bowels, increasing the proportion of the acid or the laudanum as the urgency of the symptoms require.

When, however, the thirst is considerable, and aci- Acidulous

dulous drinks are called for, we may for this purpose drinks.
use the sulphuric acid as the most grateful; though in
this case the citric acid will usually be preferred, and
the patient may be allowed to exercise his choice. Yet
the one or the other of the above compounds should be
continued without any alteration in consequence of such
a beverage.

debility;

As the disease declines, there will often be found a Diarrhoea very considerable degree of debility, and a chronic dia- from chronic rrhoea, with occasional discharges of blood from the excoriated state of many of the minute blood-vessels of the mucous membrane of the intestines, or perhaps from

GEN. X.
SPEC. I.

acuta.

Acute dys

entery.

Medical treatment.

to be opposed by

bitters and acids. Have been employed from the

a simple relaxation of the mouths of the capillaries. And Dysenteria in this situation, and especially where the disease has assumed a highly malignant character, many of the bitters of the Materia Medica, as the cinchona, columbo, simarouba, or extract of chamomile; and, perhaps, the nerium antidysenterium of Linnéus, may be resorted to, in connexion with acids, with great advantage. They have indeed occasionally been given from the first; and in a few very slight cases and very infirm constitutions the practice may have succeeded; but as a general rule of conduct it is highly rash, and has rarely been tried without repentance. Some of them may have a power of stimulating the intestinal canal; or, in large quantities, this, as conjectured by Dr. Cullen, may be a power common to all of them; but their chief virtue is that of increasing the tone, and they cannot therefore be employed at the commencement of the disease, when the fever is severe and the constriction rigid, without certain and essential mischief. In the decline of the disease, however, we may take our choice.

first;

but injudiciously.

In conjunction with this process, the very great tenderness of the interior of the larger intestines, from erosion or abrasion, will often, for a long time, demand peculiar local attention; and demulcent or bland oleaBland injec- ginous injections, as the infusion or oil of linseed, or

tions often

requisite.

olive oil with a little wax and soap dissolved in it, together with a grain or two of opium if there should be much pain (the whole not to exceed three or four ounces in quantity), will often be found of great assistance, as well in affording present ease, as in forwarding the expansion of a new cuticle.

Opium alone in the form of a small pill or suppository, as recommended by many practitioners, will be generally Opiate pas found too harsh; and, where there is much tenesmus, it

tiles.

will be impossible to retain it. The only mode in which I have found it useful in this way is to rub it into an impalpable pulp with a little of the oil or butter of the cocoa-nut, and to mould it into small pastiles of a sufficient consistency to bear the touch.

GEN. X.

SPEC. I.

Acute dys

Medical

treatment.

In long protracted and chronic cases, lime-water drunk freely, has occasionally also proved useful. The Dysenteria coat of the intestinal canal is here, however, sometimes acuta. very considerably thickened and indurated. And in entery. such cases the best remedy we can have recourse to is mercury. Houlston recommends such a course to be Lime-water persisted in to salivation*. Libavius commenced his in chronic mercurial plan with mercurial ointment +. Stoll, on dissection, found in several instances, the affected intestines thickened, indurated, rigid, yet without ulceration; and sometimes evidently marked with chronic inflammationt.

The liberal and experimental practice pursued at the Dublin and various other hospitals in Ireland during the the late severe attacks of epidemic dysentery, and its general though often discrepant effects may be appealed to in confirmation of the mode of treatment thus far laid down.

Such was the fatal ravage of the disease that no one plan hitherto devised offered more than a very unsatisfactory success ;--and hence almost every plan was tried in its turn.

66

From the treatment by mercury much was at first expected; and in many cases it seems to have been of use: but it "did not succeed", says Dr. Cheyne, "so well as I expected. Calomel tried in every proportion and distance of time often failed with me and my colleagues."§ And he adds shortly afterwards, Mercury could not be depended upon, and did not relieve in numerous instances where the mouth was affected; and sometimes seemed to increase the disease." || And even where the symptoms distinctly pointed out a morbid organization of the liver, the result of this treatment was unsatisfactory. "Mercurial frictions", says Dr. Cheyne, "were tried in all the forms over the region of the liver; but the advantages were not so extensively beneficial as I had

Observations on Poisons, &c.
Rat. Med. Part. 1. p. 277.

|| Id. p. 45.

+ Hornung, Cista, p. 2.
§ Report, &c. ut suprà, p. 41.

cases.

Recent

treatment in

the Dublin and other hospitals of Ireland.

Mercury generally of advantage:

found not

Sometimes

mischievous.

even where

the liver was

affected.

GEN. X.

SPEC. I. Dysenteria

acuta.

Acute dys

entery.

Medical

treatment.

Advantages

of general and local bleeding. Blisters, aperients

and anodynes.

Opium of chief benefit.

The old proceeding still further fol

lowed in slighter

cases.

reason to suppose from finding that in every dissection the liver was in its structure more or less destroyed.”* Venesection and opium seem to have been more beneficial. "The lancet", he further adds, "has repeatedly afforded great temporary relief where ulceration seemed to have taken place; and the relief proved permanent from blisters, mild aperients, and anodynes. Where the lancet was not allowable leeches were also highly useful."+ Free venesection we are told, in another place, often procured a large feculent stool, where even purgatives failed. In conjunction with a blister it often removed even the alarming symptom of dyspnea when timely applied ‡.

Dr. Cheyne's sheet-anchor seems to have been opium and to this he shews as strong an attachment as Sydenham, who only preferred the liquid to the solid form of this medicine, as he expressly tells us, on account of its more easy sub-action. Dr. Cheyne, however, carried his practice here, as well as in bleeding, to a considerably larger range, at least in severe and alarming cases. "The mercurials", says he, "with opium sometimes seemed to answer: but in future I should chiefly depend upon opiates in doses of four or five grains, as this seemed chiefly to arrest the progress of inflammation, diminished agony, and sometimes proved of permanent benefit."§

In less violent assaults, he at length fell back still more fully into the practice of former times. "In the middle stages", he tells us, "I preferred to the treatment by mercurials, the old proceeding; venesection, purgatives (chiefly the saline): bath in the evening; diaphoretic at night. This was frequently successful in an early stage." The blood drawn on the first use of the lancet was from thirty to forty ounces or more; which was repeated as often as necessary. With the saline purgative was often intermixed emetic tartar, to act on the stomach as well as on the bowels; and to these were

Report, &c. p. 89.

+ Id. p. 47.

Id. p. 26.

§ Id. p. 44.

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