* approaches of British vengeance. They durst not follow up their blow; all our wounded outside their works were conveyed away by their comrades; and finally, they never ventured to obstruct the re-embarkation of the troops, or to harass the rear of the retiring, but still dreaded army. The main object of the expedition having thus failed of success, the troops were once more collected on board the fleet, and proceeded off Mobille river, to attack the town of that name. Fort Bowyer, which defends the harbour's mouth, being quickly and regularly invested, was captured on the 11th of February, but the ulterior operations were suspended by the arrival from England of the news of the peace of Ghent. The troops were disembarked on a sandy uninhabited spot, called Dauphin island, there to await the ratification of the treaty, and the arrival of such supplies of provisions as would enable them to prosecute the voyage homeward. It is worthy of remark, that, notwithstanding the almost unexampled fatigues and privations of all sorts to which the army and navy had been exposed while before New-Orleans, sickness of any kind, up to the 8th of January, had made comparatively little progress amongst them. The bowel-complaints, though numerous, were for the most part easily removed; and no other disease of any consequence prevailed. It is a remarkable fact, in the medical history of fleets and armies, that, during the fatigues and sufferings of a hot campaign, or the active progress of warlike operations, the men are very little subject to illness of any sort; as if the elation of hope, and the other great passions with which they are agitated, had the virtue to steel the constitution against the most powerful causes of disease. This circumstance, no less curious than true, proudly proves the ætherial origin of our nature, and goes far to assert the omnipotence of mind over matter. No sooner, however, does a great failure, and the dejection it draws after it,-a cessation of operations, and a return to the "vita mollis," allow the spirit of enterprise to flag, than the previous fatigues and exposures being "Invide, dicebant, paries, quid fortibus obstas ? Quantum erat, ut sineres nos toto corpore jungi !!"—OVID. Metam. This sentiment burst indignantly and unanimously from our troops. In order to estimate how far the Americans deserved credit for coming to close quarters, I may mention that more than three-fourths of the British wounded came under my eyes, and not a single bayonet or sabre wound was found amongst them. Many of them were slight from buck-shot. "There are certain objects that are best kept at a distance." This rule in perspective the Americans seem to have made their particular study. to tell upon the constitution by their usual results disease. Like a machine wound up beyond its pitch,-the excitement of accumulated motives once withdrawn,-the human frame rapidly runs down, and yields with a facility, almost as unexpected as its former resistance. Hence, after a campaign, diseases of all sorts are prone to a type of debility and aggravation, and the proportion of deaths is unusually numerous. Accordingly, in the instance before us, the pressure of ill success began to be severely felt after the failure of the 8th, and the consequent reimbarkation of the army. By this time unremitted fatigues, poor living, and that at short allowance, with the total want of fresh beef and succulent vegetables, not only altered for the worse the character of the bowel-complaints, and produced a fatal relapse in some recently cured, but also introduced scurvy, with its multifarious train of perplexing symptoms. Exposure to marsh miasmata, also, produced many cases of intermittent fever. By this time, too, the weather was getting warmer (the thermometer generally ranging from 60° to 70°), accompanied with more sudden vicissitudes, and a greater proportion of rain. Dysentery now put on that exasperated form in which it has so often scourged our camps and fleets; and never shall I forget the terrible force of this invisible enemy. In all cases it was a very baffling untractable disease, but in those who had previously served long in warm climates, and whose livers were thereby affected, it was almost uniformly mortal. When the discase attacked such persons, it was a subject of melancholy but curious speculation to witness the headlong course of the disease, and how unavailing any species of treatment invariably proved. It knew neither pause nor hindrance, but, like the fabled vulture of Prometheus, pursued its cruel task from day to day. Dissection always brought to light extensive visceral obstructions, particularly chronic inflammation, or abscess of the liver, with or without enlargement. Nothing but experience can convey adequate ideas of the ungovernable nature of this disease, or of the insidious masked approaches of its attack. Days of an indisposition, apparently trivial, sometimes occurred ere the peculiar symptoms of dysentery shewed themselves; at other times, pyrexia, high or slight, * I may observe, that I never had the slightest reason to believe the disease itself, or its attendant pyrexia, to be at all contagious. I may also remark here, though I anticipate the course of the narrative, that in April and May, when the weather became hot, the character of the prevailing dysentery was rather and occasionally pain in the right side, obtuse or acute, followed by frequent copious dark green stools (like boiled spinage chopt), slightly tinged with blood, were the form of the disease. Griping was little complained of. There was merely a sense of weight in the hypogastric region, and a copious flux of green or dark-coloured sordes, voided without straining. The tongue was covered with a yellow fur, which, in the advanced stage of the disease, became thick, dark, and immoveable, as a slab of black marble. The pulse was sharp, but weak; frequent retching and hiccup attended; and a sensation, as if all the drink swallowed, hot or cold, ran speedily through the intestines. Oftener the complaint would make its attack with the common introductory symptoms, and no pain in the right hypochondrium was felt throughout the disease, either on inspiration, or strong pressure beneath the ribs. Under whatever garb of disguise it made its appearance, disease of the liver (as I have before stated), and consequently a vitiated state of its secretions, were undoubtedly the primary cause of the mischief. Dissection of the fatal cases shewed structural derangement, and generally suppuration of that viscus. I have often found two separate abscesses in the central part of its large lobe, containing in some instances a pint of pus, similar in colour and consistence to what is usually found in psoas abscesses. On the villous coats of the colon and rectum, there were numerous excoriated points, with small superficial ulcers here and there, like the sequelae of erythematous inflammation; but there were no morbid alterations sufficient to account for death; no ravages of gangrene, &c. like those related by Sir John Pringle and others, in their accounts of this malady. ture. In short, to give a condensed view of the whole matter, the phenomena of the cases that recovered, as well as the morbid appearances of those that died, impressed upon my mind a conviction, that the diseased condition of the liver was the soil from which dysentery drew its malignant growth, strength, and nurThis was the "fons et origo mali ;" by it the dysentery was excited, and only by its removal could it be removed. This double detriment-this Janus-like aspect of the disease, I rather think, is new to many of the profession, but I trust it will soon be widely known and acknowledged. I hope the time is not far distant, when, instead of viewing dysentery as an idiopathic dissease, and tracing its seat to the colon and rectum, medical men exasperated by it; unlike the dysentery of cold climates, which is generally rendered milder, if not extinguished, by atmospheric heat. will regard it merely as secondary to, and symptomatic of hepatic affection, and will seek its cause in a morbid condition of that important gland. Whatever may be the mode of connection between hepatitis and dysentery, I have no doubt that, at least in tropical climates, they are connected like cause and effect. I am unwilling to offer any hypothesis on this subject, purely because I am unable; this I confess, for I shall never chime in with that tone of affected contempt for all theories, in which presumptuous dulness so often shelters its imbecility. Those who indulge this disgusting oft-repeated cant, ("crambe bis millies cocta,") ought to be reminded, that not merely in medicine, but in all other sciences, few brilliant discoveries have been made, except by those acute and industrious men that were shapening and toiling at some untractable theory. However much all their diligence might fall short of the results they themselves fondly expected, still so much digging and delving often turned up very valuable ore, and always left the soil in a fitter state for the future labourers in the great field of improvement. To return to the subject under consideration, I can readily conceive, that, from disease of any gland, the fluid it secretes may acquire acrimonious properties, sufficient to injure the fabric of the passages through which it is destined to pass. We gene It seems to be one of the errors of modern medicine, to overlook in prac tice the liver and spleen, merely because the necessity of their functions is not so obvious and immediate as that of some other organs. That a gland so large and of such unexampled vascular structure as the liver, should have much occult influence in all diseases, might, from the mere reason of the thing, be supposed. Its secretions influence the state of the stomach, and are influenced in their turn by the passions of the mind; and many facts would lead us to believe that there is a hitherto undescribed sympathy betwixt this viscus and the brain. I am informed, from a gentleman who has practised long in India, that patients have been suddenly seized with amentia, rigors, delirium, and syncope, speedily followed by death, and that, on dissection, abscess of the liver was the only perceptible cause of such symptoms. The depressing passions I have seen to have a striking effect on the biliary secretion, and even to induce cholera; whereas anger, like intoxication, when habitually indulged, gives rise to chronic enlargement and obstruction of the liver. In short, the functions and sympathies of this gland, which were deserv edly of so high account with the ancients, seem to be insufficiently studied by modern physicians. Horace, in the following lines, instead of a popular or poetical tenet, has pro bably expressed a curious and unexpected pathological fact. rally observe in dyspeptic complaints, or after a period of constipation, when the bile, from remora in the bowels, becomes morbid in quantity or quality, either that a spontaneous diarrhoea comes on, or, after a brisk cathartic has been exhibited, that the dislodged bile excites a sensation in the rectum, as if boiling lead were voided. When the state of the liver is still more morbid, may not the bile acquire the property of exciting flux, and of excoriating and ulcerating the villous coat of the colon and rectum ? These speculations I present with the greatest diffidence; and certainly do not wish to amalgamate them with the facts above recorded, which I pledge myself to have observed diligently, and reported faithfully. The latter are Nature's work, and, as such, will be confirmed by future experience: the former are matter of conjecture and personal opinion, which may stand or fall at the reader's pleasure; for, as Cicero well observes, " Opinionum commenta delet dies, naturæ judicia confirmat." 66 Whether, therefore, the ratio symptomatum just given approach to nature's actual steps, I know not; but it is certain, that the practice which most readily removes the disease seems to countenance the above mode of reasoning. The mercurial method I have pushed to a great extent, and its results have been such as to give it a very decided preference, in my estimation. Calomel, that great specific in obstructions of the liver, given in large doses (generally one scruple twice a-day), combined with opium, to cause it to be retained in the system, corrects the condition of the liver, prompts healthy secretion, and resolves pyrexia; as soon as ptyalism takes place, the dysenteric symptoms disappear, and the appetite gradually returns. Upon the whole, my own experience, as well as that of some others that served in this fleet and army, warrants a far more certain expectation from this mode of treatment than from the alternation of purgatives with astringents, or any other heretofore in use. * I shall here mention a fact which may be regarded as the experimentum arucis, decisive of the rival merits of the two methods of treatment. The ship in which I am employed remained in the Gulf of Mexico after all the rest of our force had retired. From the large expenditure of calomel, I at last had none left, and there was not a grain to be procured. At this time I had seve ral cases of dysentery, which, from necessity, I was obliged to treat, for several days, on the old plan, by neutral salts, or oleum ricini, alternated with anodyne sudorifics, mistur. cretac. rhubarb, diluents, &c. &c. One case was, indeed, of so bad a type, that I had made up my mind for its ending fatally. Luckily, however, our arrival at the Havannah enabled me to procure a supply of good calomel; and I immediately commenced with ten-grain doses thrice a-day. |