Imatges de pàgina
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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 disease 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 showed themselves; at other times, pyrexia, high or slight, * 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 showed structural de. rangement, 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

* I may observe, that I never had the slightest reason to believe the dis. ease itself, or its attendant pyrexia, to be at all contagious. I may also re. mark here, though I anticipate the course of the narrative, that in April and May, when the weather became hot, the character of the prevailing dysen. tery was rather exasperated by it; unlike the dysentery of cold climates, which is generally rendered milder, if not extinguished, by atmospheric heat.

pus,

similar in colour and consistence to what is usually found in psoas ab- .

scesses.

On the villous coats of the colon and rectum, there were numerous excoriated points, with small superficial ulcers here and there, like the sequelæ 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.

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 nurture. This 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 Fanus-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 disease, and tracing its seat to the colon and rectum, medical men will regard it merely as secondary to, and symptomatic of hepatic affection, and will seek its cause in a morbid condition of that impor. tant 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. How. ever 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.

* It seems to be one of the errors of modern medicine, to overlook in practice 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.

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 generally 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 diarrhea 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 fux, and of excoriating and ulcerating the villous coat of the colon and rectum?

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 obstruc. tion of the liver. In short, the functions and sympathies of this gland, which were deservedly of so high account with the ancients, seem to be insuffi. ciently studied by modern physicians.

Horace, in the following lines, instead of a popular or poetical tenet, has probably expressed a curious and unexpected pathological fact.

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Væ, meum
Fervens difficili bile tumet jecur.
Tunc nec mens mihi, nec color
Certâ sede manet.- -Horat. Carn.

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.”

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 crucis, 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 VOL. VI.

3 K

No. 24.

Though mercury had, in this manner, such commanding influence over the disease, still experience here was not always uniform, for there were several vexatious instances where it failed. I do not speak of the fatal cases (for in them neither laxatives, astringents, fomentations, blisters, opiates, mercurial frictions on the abdomen, por calomel pushed to salivation, ever were able to keep off the unhappy event), but expressly of those few instances where the patients, after being apparently cured, relapsed without any evident cause (I may observe, by the way, that relapses are more frequent, and more generally fatal, in this disease than in any other), or where ptyalism mitigated the symptoms somewhat, perhaps even suspended the disease entirely, until the mouth was well, and then it returned with much of its pristine violence. The disease thus ran into the chronic form, and harassed the patient for weeks, or even months, with the various symptoms arising from a weak irritable condition of the primæ viæ, irregular hepatic secretion, and imperfect formation of the chyme. The chief of these symptoms were, vomiting after meals, night-sweats, febricula, watching, pains in the lower

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rest of our force had retired. From the large expenditure of calomel, 1 at last had none left, and there was not a grain to be procured. At this time I had several 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. Next morning the patient was better; had passed a tolerable night; had less tormina and tenesmus, and a cleaner tongue. I increased the dose to one scruple night and morning, and thenceforth his improvement was perceptible from day to day. The pyrexia soon abated, and, in ten days, his dejections, from being green and fetid, had recovered the natural yellow colour, or nearly so. No complaint remained but a sore mouth. The patient is now living, and likely to live, a witness to the superior efficacy of this mode of treatment. The above is merely one of many instances where I have seen calomel work rapidly, and like a charm.

As a proof with how little apprehension calomel may be given to persons of all ages, I may state, that, to a boy of 14, one hundred and fifty-two grains were given, during the acute stage of a most dangerous attack of dysentery, before his mouth became fairly sore!! He fully recovered.

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