Draughts with the Mithridate; or the saline Draughts with the Addition
of four Drops of the _tinctura thebaica_; or some such mild
diaphoretic, every four or six Hours; which helped to keep up a free
Perspiration, without any Danger of stopping the Purging; and for the
most part answered much better than the Diascord, or Philonium, or
other strong Astringents and Opiates commonly prescribed for this
Purpose; which were always liable to check the Purging too much, and
bring on severe Gripes attended with Heat and Fever[37]; and therefore
we seldom made Use of them in this first Stage of the Disorder.
[37] _Sydenham_, _Huxham_, and all good Practitioners, have
taken Notice of the bad Effects of the too free Use of
Astringents, and given Cautions against it.
If the Patient was attacked with severe Gripes[38], and a Tenesmus,
which the Purgatives and gentle Opiates did not relieve, we ordered
the Abdomen to be fomented with warm Stupes; and the Patient to drink
freely of warm Barley or Rice-water, or of weak Broth[39], or an
Infusion of Camomile Flowers, as recommended by Dr. _Pringle_; and
ordered first Clysters of large Quantities of the plain emollient
Decoction to be given; and if the Gripes still continued, to be
repeated in small Quantities, with the Addition of a Drachm or two of
the _tinctura thebaica_; for we observed that Opiate Clysters often
gave more Relief, than Anodynes administered in any other Way; and
sometimes, when a Tenesmus was very troublesome, the common oily
Clyster, with a little Diascord, and _tinctura thebaica_, or the
Starch Clyster, gave more Ease than any other.--In some Cases, where
the Pain was sharp, attended with a Fever, we were obliged to take
away more or less Blood; and sometimes also to apply a Blister to that
Part of the Abdomen where the Patient felt most Pain.
[38] If the Patient was suddenly attacked with sharp Pain of
the Bowels and Gripes, on a Day in which he had not Physic, a
Dose of the Salts and Manna was commonly given immediately,
to empty thoroughly the first Passages.
[39] Mr. _W. Russel_ told me, that he and Dr. _Huck_ found
the free Use of the following Emulsion, made of Bees Wax, to
be of great Use after Evacuations, where there was much Pain
of the Bowels, in recent Cases of Fluxes in the Hospitals in
_America_. Rx. Ceræ alb. vel flavæ drachmes tres. Sapon. alb.
Hispan. drachmam unam. Aquæ fontanæ, unciam unam, liquefiant
super ignem in vase ferreo, agitando spatula, & dein infunde
in mortarium marmoreum, & adde paulatim aq. fontanæ, libras
duas syrupi sacchari. spiritus vini gallici tenuis, vel aquæ
alicujus spirituosæ ana unciam unam, terendo optime ut fiat
emulsio.
This Method of dissolving Bees Wax, in a Watery Liquor, is
entirely new; for before this we knew of no Way of making it
miscible with Water.
During this Course, the Patients used the common low Diet of the
Hospital; when they loathed the Rice-Gruel, they had Panado with a
little Red Wine and Sugar; or Water-gruel, when it could be got, in
its Place.--Their common Drink was Barley or Rice-water; of which it
was recommended to them to drink plentifully; as nothing contributed
more to the Cure than the free Use of such Liquors, to dilute and
blunt the Acrimony of the Fluids[40]. In some Cases, when the Purging
was violent, and not accompanied with the malignant Fever, the
_decoctum album_ was found to be a good Drink; and we added
occasionally a few Drops of the _tinctura thebaica_.
[40] Dr. _Huxham_ (_de Aere_, Vol. II. p. 107.) says, there
is no Disorder in which a diluting, sweetening Drink is more
necessary than in this; that he has done great Service among
the Poor by luke-warm Water; that, after emptying the Bowels
thoroughly, he has sometimes cured this Disorder by the Use
of pure Water, and a small Quantity of Opium. And _Baglivi_
(_Prax. Med._ lib. i.) tells us, that the drinking of common
Whey, and throwing up frequent Clysters of it, had cured
many, and that this was looked upon as a Specific, and kept a
Secret by some.
Such were the chief Remedies we used in the first Stage of this
Disorder; but after some Weeks, when the Fever had abated, and free
Evacuations had been made, and the Complaint become in a manner
chronic, we were obliged to try other Methods; and found that the best
Way of treating this Disorder, was, to endeavour to brace and restore
the Tone of the Intestines, by means of the corroborating and gentle
astringent Medicines, mixed with Opiates; while mild Purgatives were
given at proper Intervals.
The Patients were kept to the same low Diet as before, with the
Addition of a little Wine or Brandy. They were allowed from a Gill to
a Pint of red Wine _per_ Day, which was commonly mulled before it was
given them; when the Wine griped them, which it frequently did, they
took in its Stead Half a Gill or a Gill of Brandy, mixed with a Pint
or a Quart of Barley or Rice-water, or of the _decoctum album_.
In this Stage of the Disorder we found, that the same Medicines would
not answer with all, and therefore we were obliged to try Variety[41];
and indeed, unless where the Violence of the Disorder had abated by
the Use of Evacuations, the Event was always very doubtful; for when
the Complaint had continued long and become chronic, and the Structure
of the Intestines was much hurt, before the Sick were sent to us; or
when it continued obstinate, and yielded but little to Evacuations,
and the other Methods used in the first Stage, even Remedies esteemed
the most efficacious oftentimes proved unsuccessful, and at length
the Patient died.
[41] Dr. _Pringle_, in the _fourth Edition of his
Observations_, just published, in treating of the third or
last Stage of the Dysentery, remarks, that this is the Time
for Astringents, which ought not to be given sooner, or at
least very sparingly. And he tells us, that, in the former
Editions of his Work, he mentioned those Compositions which
he had most frequently used, but that he had now laid most of
them aside; and at present trusts to Vomits, and to a Milk
Diet, for the perfect Cure.
He says, "Whenever therefore the Patient is in this State,
and especially when his Pulse is quick, and he complains of
inward Heat, I began with giving him a Scruple of Ipecacuana;
and the next Day I put him upon the Milk-Diet; which I
continue till all the hectic Symptoms are gone, and till the
Bowels have recovered their Tone. During this Course I have
seldom had Occasion for any other Medicine, excepting the
Chalk Julep mentioned before, which I use for correcting that
strong Acid so incident to relaxed Stomachs. Sometimes also I
add an Opiate to procure Rest at Night; but after a few Days
these are likewise laid aside. All that I require (which
indeed is often hard to obtain) is a strict Perseverance in
the low Diet: and now and then a Repetition of the Vomit,
upon any new Disorder of the Stomach, or great Laxity of the
Bowels.
"Whilst the Patient continues in this Course, I forbid all
animal Food and fermented Liquors; and besides Milk, I allow
only the Preparations of Grain, Sago and Salop." See Part
iii. ch. vi. p. 289, 290.
A Spoonful of the _mixtura fracastorii_, taken after every loose
Stool; and an anodyne Draught at Night, had a good Effect with
some--Repeated Doses of the _philonium Londinense_ answered better
with others, who were low, and required a Remedy that was warm and
cordial--And others found more Benefit from the Mindereri Draughts,
with Mithridate, or the _confectio cardiaca_, or the Theriac anodyne
Boluses.
The _mixtura Campechensis_, both alone and with _tinctura thebaica_,
checked the Purging, and gave Relief sometimes; and the Addition of
some of the Extract of Bark and Tincture of Cinnamon, seemed to
encrease its Efficacy in one or two old Cases, at _Bremen_; but it
afterwards occasioned such Sickness, that we did not continue its Use.
In other inveterate Dysenteries, where we thought that a strong
Astringent was wanted, we added a small Proportion of Allum to the
_Campechense_ Julep, which on first using seemed to be serviceable;
but at other Times it occasioned a Tenesmus and Gripes; and therefore
we were obliged to be very cautious how we used it.
Equal Parts of the _electuarium diascordii_ and _electuarium
corticis_, taken in the Quantity of a Drachm twice or thrice a Day,
was of Use in many old Fluxes[42], though it made other Patients so
sick, that they were obliged to lay it aside.
[42] I had lately a very remarkable Instance of the Effects
of this Medicine, in the Case of one _Gilchrist_, a
middle-aged Man, by Trade a Taylor; who was admitted into
_St. George_'s Hospital the 20th of _July_, 1763, for an old
Flux, which had continued above six Months, and reduced him
very low: He had taken a great many Medicines without any
Effect. After giving him a Vomit and two Doses of Tincture of
Rhubarb, I gave him four Grains of the Powder of Ipecacuana
with Opium three Times a Day; but that having no Effect,
after using it for above a Fortnight, I ordered him the
Electuary of Diascord and Cortex; from the Time he began to
use this Medicine, he mended daily; and was dismissed in good
Health the 26th of _September_.
We tried likewise in this Stage of the Disorder, repeated small Doses
of the Ipecacuana; but it occasioned such Sickness, that we did not
persist in its Use.
In other Cases, we gave from two to five Grains of the Ipecacuana,
mixed with Opium, in different Proportions (from three Grains to ten
of the Ipecacuana to one of the Opium), every four or six Hours; it
gave sometimes a little present Ease, at other Times it occasioned
Sickness; we often continued its Use for ten, twelve, or fourteen
Days; but it seldom produced any remarkable Change for the better, and
we were obliged to have Recourse to other Remedies.
_Dover_'s Powder was given in large Doses, from one Scruple to two;
and proved a good Sudorific and Anodyne in some Cases; though in
others it made the Patients sick, without producing any good
Effect.--It commonly answered better, when used occasionally as a
Sudorific, than when constantly continued.
During the Use of these Remedies, it was necessary to repeat the
Purgatives from Time to Time; or to mix them occasionally with the
other Medicines, in order to carry off any corrupted Humours, or
Excrements that might be lodged In the Cavity of the Intestines; for
when this was neglected, the Patients were often seized with Sickness
and Gripes, and a more violent Purging than before:--And if at any
Time they complained of Gripes, and passed little Pieces of hardened
Excrements, it was mostly a certain Sign that a Purge was indicated;
and, on such Occasions, it generally gave Relief; and when attended
with Sickness, a Vomit was given before the Purge.--Clysters were used
as in recent Cases, where the Sick were low, or had much Pain of the
Bowels[43], or complained of a Tenesmus.
[43] On the 21st of _November_, 1759, _Hanah Meredith_, a
middle-aged Woman, was admitted into _St. George_'s Hospital
for a Flux, which she had six or seven Weeks; she had no
Fever, but complained much of Sickness and Gripes, and her
Disorder had reduced her very low. During the two first Weeks
of her being in the Hospital, she had two Vomits of
Ipecacuana and four Doses of Rhubarb; and in the Intervals
anodyne and astringent Medicines, which made no Alteration in
her Complaints. On the 2d of _December_, she told me, that
two Years before she had had a Flux for above three Months,
which had yielded to no Remedies till she was ordered
repeated Clysters, and that they had made a Cure in a short
Time. I then ordered an emollient Clyster with a drachm of
the _electuarium diascordii_, and a Scruple of the _tinctura
thebaica_, to be given twice a Day, which gave her almost
immediate Relief; and with the Assistance of some Doses of
Rhubarb, and one or two Vomits and occasional Opiates,
removed her Disorder by the Middle of _January_; though she
remained long weak, and troubled at Times with Gripes; but
these Complaints were at last got the better of by her taking
some Doses of Rhubarb, and drinking daily a Pint of Lime
Water mixed with Half a Pint of Milk.
_Sarah Spencer_, a middle-aged Woman, was admitted into _St.
George_'s Hospital the 9th of _November_, 1763, for a Flux,
which had continued for two Months, and reduced her very low.
She complained much of Sickness and Gripes; her Stools were
mostly composed of Mucus and Blood; her Pulse was low, and
she had no Fever, but a Whiteness of the Tongue, and
complained of Thirst.--The first Day she had a Vomit, and
next Day a Dose of the purging saline oily Draught.--She was
ordered to have an emollient Clyster, with a Drachm of
Diascord, and as much _tinctura thebaica_, given her every
Evening; and to have a Dose of the saline oily Purge twice a
Week, and Opiates occasionally; by following this Course, and
drinking at Times the Chalk Julep, her Disorder was removed,
and she was discharged the Hospital on the 30th of the same
Month.
In some old Dysenteries, where the villous Coat of the Intestines was
much injured, I gave the Cordial Draughts, with the Addition of Half a
Drachm of the _balsamum copaivi_, a Scruple of the Extract of the
Bark, and five Drops of the _tinctura thebaica_, three Times a Day.
At first, this Medicine seemed to promise much, particularly in the
Case of an old Invalid, _William Brookes_; who had been long ill of a
Flux, attended with Gripes and a Tenesmus. He had used Variety of
Remedies, without receiving any Benefit. For the first Fortnight,
after he began the Use of this Medicine, he rested well, and found
great Relief; and seemed to be in a fair Way of doing well. But the
Disorder being too far advanced before he began to use it, he
relapsed, and died. On opening his Body, the inner Coats of the Rectum
and the lower Part of the Colon seemed to be reduced almost to a
gelatinous Substance, and the other Coats were black, approaching to a
Gangrene.--The same Medicine gave Relief in other Cases, but they were
too far advanced before it was administered. In these Cases, when the
villous Coat of the Intestines was inflamed and very irritable, the
mucilaginous Medicines, the _pulvis e tragacantha_, and such others,
were of Service; and frequently Starch Clysters and Anodynes gave
Relief, when other Remedies had little Effect. Flower, boiled with
Milk, and sweetened with Sugar, and given for Breakfast, as mentioned
by Dr. _Pringle_, proved a good Palliative to some; and the Starch and
Gum Arabic, dissolved in Water, a good Drink to others.--Lime Water
and Milk, drank to the Quantity of a Pint or a Quart a Day, was of use
to a few, though it did not agree with all.
It was very common for Patients bad in the malignant Fever to be
seized likewise with the Flux. Such Cases were always extremely
dangerous; and when the Fever was bad, we were often obliged to
neglect the Flux, and only attend to the Fever.--When the Purging was
violent, and appeared very early in the Fever, it often sunk the
Patients, and soon carried them off: but where it was moderate, and
did not appear till towards the Height or the Decline of the Fever, it
often proved a Crisis to the Disorder.
When such Fluxes appeared early attended with sharp Pain of the
Bowels, and Signs of Inflammation; if the Patient was strong, we
began the Cure with opening a Vein, which the Patient bore easily, and
it gave Relief; but when the Symptoms were mild, without any acute
Pain, the Bleeding was omitted.--Commonly the Bowels were loaded with
corrupted Humours, when this Symptom appeared; and, therefore, we
found it of Advantage to give a Dose of the Salts with Manna and Oil,
or some other gentle Purge, to carry them off; and in the Evening an
Opiate to ease the Pain and procure the Patient Rest.
After this we gave the Mindereri Draughts with Mithridate; and as soon
as the Petechiæ appeared, or we observed any Remissions in the Fever,
the Patient took every four or six Hours, a Drachm of an Electuary,
composed of equal Parts of the _electuarium corticis_ and the
_electuarium diascordii_[44]; or Half a Drachm of the Powder of the
Bark, or a Scruple of the Extract, in the Mindereri Draughts, with
four or five Drops of the _tinctura thebaica_; and we repeated the
Opiate in the Evening, always proportioning the Quantity of it to the
Effects of the former Dose, and the Violence of the Purging.
[44] This Practice of giving the Cortex with Opiates in the
Dysentery is not new; for Dr. R. _Morton_, in his Appendix to
his second Exercise on the Fevers, which appeared from 1658
to 1691, observes, that after the Plague of 1666 had ceased,
a Fever from a milder Poison, attended with Gripes and
Dysentery, began to make its Appearance. As the common
Methods of Cure proved unsuccessful, and Dr. _Morton_
observed Exacerbations and Remissions, he resolved to give
the Bark mixed with Laudanum; and found it answer his
Expectation. The first Patient to whom he gave it, was a man
in _Long Lane_, who laboured under a Tertian Dysentery; upon
observing a Remission, he ordered a Drachm of the Bark, mixed
with a Grain of Opium, to be given every four Hours for six
Times; and this removed both the Fever and Dysentery.--He
says, he afterwards gave it, with equal Success, in the
Quotidian Dysenteries, where he observed Exacerbations or
Remissions; and he adds, that he does not doubt but that it
will answer as well in Epidemical Diarrhoea's, and Camp Fevers
attended with such Symptoms.
Dr. _Whytt_ of _Edinburgh_ has given with Success a strong
Decoction of the Bark, mixed with the _confectio japonica_ of
the _Edinburgh_ Dispensatory, in the bad State of the
Dysentery, when the Mouth and alimentary Canal were
threatened with Aphthæ, and even sometimes after they had
appeared. And Dr. _Pringle_ mentions his having given the
Decoction of the Bark, with Snake-Root and some Drops of
Laudanum, in the Dysentery complicated with the malignant
Fever. See _Note to Page 245 of his third Edition on the
Diseases of the Army_.
On the second or third Day, we repeated the Purge; or, if the Patient
was weak, ordered a Clyster to be administered in its Place; in order
to prevent the putrid Fluids and Excrements from being accumulated in
the Bowels:--In other respects we treated it as when the Disorder was
not complicated with the malignant Fever.
This Method, though it did not succeed with all, yet it answered
better than any other I tried;--and it ought to be remarked, that
although it had such a good Effect in Cases attended with the
malignant Fever, or where the Fever inclined to the intermittent Kind,
it did not answer so well in other recent Cases, but often made the
Patient sick.
In military Hospitals, Fluxes are liable to be complicated with other
Disorders, as well as with the malignant Fever; especially with
Coughs, and pleuritic and peripneumonic Symptoms, when the Weather
begins to be cold, in _October_ and _November_.--In such Cases, when
the Patients were strong, we were often obliged to bleed freely, to
apply Blisters, and in the Beginning treat the Disorder as
inflammatory; having at the same Time an Eye towards the Flux, in the
other Medicines we prescribed.
Patients, who have had the Flux long, are apt to have their Legs swell
at Nights; or to swell all over as soon as the Flux has stopped. Such
oedematous or anasarcous Swellings, we treated nearly in the same
Manner as those which followed the petechial Fever; only that we durst
not at first be so free with the Use of Purgatives; for as the Bowels
remained weak and easily irritated, such Medicines were apt to bring
back the Flux; and therefore, in the Beginning, we were for the most
part obliged to attempt the Cure by Diuretics and Diaphoretics; and to
be sparing of the Use of Purgatives, especially of those of the
hydragogue Kind; though if the Swellings continued for some Time after
the Flux was gone off, and the Patients were strong, we then ventured
to give Purges at proper Intervals:--And Blisters and Scarifications
removed them in several Instances both at _Paderborn_ and
_Osnabruck_.
In _December_, 1761, we had a Case of this Kind where the _oxymel
scilliticum_ was of remarkable Service. A Soldier, belonging to the
Guards, after a Flux, swelled all over, and made but a very small
Quantity of Water. He took Medicines of different Sorts for some
Weeks, but received no Benefit till we gave him the Oxymel Mixture;
after taking a few Doses he made Water very freely, and in large
Quantities, and the Swellings of his Body and Scrotum began
immediately to subside; and by continuing its Use for a Fortnight, the
Swellings entirely disappeared, and he recovered his Health and
Strength.--The Oxymel, at the same Time that it promoted a Flow of
Urine, kept his Body gently open, but did not occasion any Return of
the Flux.
At the Beginning of _January_, 1762, one _Carter_, a Soldier of the
Eleventh Regiment of Foot, laboured under an universal Anasarca; which
about two Months before had succeeded a Flux. He made but very little
Water, and that of a high red Colour. He took Variety of Medicines,
as Purges, Vomits, _Dover_'s Powder, lixivial and neutral Salts with
Opiates, Infusions of Horse-Radish, all without Effect; till he was
ordered small Doses of Calomel, three Grains Morning and Evening.
After the third Dose he began to make Water freely; and by the 24th of
_January_ the Swellings were all gone, and he was shipped off for
_England_ the 8th of _February_; having been discharged from his
Regiment. The Ship, he went aboard of, was detained in the River
_Weser_ for above six Weeks, and the malignant Fever broke out aboard
the Transport: He took the Distemper, and got well of it; but towards
the Decline was seized with a Return of the Flux, which carried him
off.
When these oedematous Swellings came after the Purging was stopt, if
the Patient's Strength was not much exhausted, and he laboured under
no other Disorder, he commonly got the better of it:--But when the
Strength was gone before the Swellings appeared, the Disorder often
ended in a confirmed Dropsy, and at last in Death; and when the
Swellings were universal over the Body, while the Flux yet continued,
it was a Sign of great Weakness, and they did not survive it long[45].
[45] Many other Medicines have been used for the Cure of old
Dysenteries,--The _Conessi Bark_, recommended as a Specific
in Diarrhoeas, cured a Dysentery which had yielded nothing to
a Variety of Medicines. _Edinburgh Medical Essays_, _Vol._
III. _Art._ iv.--The _cortex eleutheriæ vel cascarillæ_ is
much recommended for the Cure of Dysenteries in the _Memoir.
de L'Academie des Sciences a Paris_ 1719, and is still in
great Repute among the _Germans_.--The Decoction of the
_semiruba_ Bark was found to have a good Effect in the
Dysentery, where the Patient continued to void Blood with his
Stools; and when the Stools were only liquid, without a
Mixture of Blood, some of the Cascarilla added to the
Decoction encreased its Efficacy. See _Degnerus_'s Treatise
_de Dysenteria_, _cap._ iii. _sect._ 55. These and many other
Remedies have been tried in obstinate Dysenteries.
From what I have observed myself, and from the Accounts of
others, I am now convinced, that such Cases as are not
already too far gone, are most likely to be cured,
1. By keeping the Patients on a low Diet, composed
principally of Milk, Sago, Rice, Salop, and such other Things
as are recommended by Dr. _Pringle_; allowing weak Broths,
and a small Quantity of white Meat, as they recover their
Strength. The common Drink to be Barley or Rice-Water, Toast
and Water, _Bristol_ Water, Almond Emulsion, and such
like.--By making them wear some additional Cloathing, and
guarding carefully against catching cold.--Errors of Diet and
Exposure to Cold being the most frequent Causes of Relapses
into this Disorder.
2. By giving from Time to Time a Dose of some mild Purge;
such as a little Manna and Salts; a Solution of Manna in
Almond Emulsion; twenty or thirty Grains of Rhubarb, in a
saline Draught, or such like; and occasionally gentle
Emetics.