Obfervations on the Dysentery of the Weft-Indies, by B. Mofeley,, Surgeon at Kington in Jamaica; with his new and fuccessful Manner of treating it.

TH

HE caufes of all difeafes, well understood and pro-' perly confidered, point to their cure.- -It is an obfervation of the great Sydenham, that he never was at a lofs to prefcribe for a difeafe, when he knew the caufe of it;" and that he always prefcribed with caution until he had found it.

The diforder in question has been, I believe, more confidered from its effects, its remote, and concurring caufes, than from its immediate caufe:hence we may account for the inefficacy of the various attempts to cure it..

The pen of writers has done little more in the bloody-flux, than record the times and places when and where it proved most fatal; the appearance it put on; its fymptoms; its devaftation; variety of modes of treatment that had no certain fuccefs; now and then a remarkable cafe, and the phænomena difcovered on dif. tecting the dead,

The great author above-mentioned, following nature as an unerring guide, never stopped at effects, but proceeded on to the caufes of difeafes; and affifted the means employed by nature to remove them, or fubftitute a fafer and better method;-to which principle the world is indebted for that ineftimable work that can only perifh with it;.a work founded in nature, on a bafis applicable to all climes; that stands as the Palladium of phyfic against the fuperftitious errors of the middle ages, and the ingenious chimeras of later times-he difcovered the dyfentery to be, fever of the feafon, or of its own kind, turned inwards upon the inteftines ;" and yet his fucceffors have made but little farther use of this excellent aphorifm, than quoting it, as their rules laid down for treating the disease sufficiently prove.

a

In the courfe of twelve years experience in this island, and from every account I have been able to procure from all parts of the Weft-Indies, I have invariably found the truth of Sydenham's opinion; and have remarked that as the flux diftinguishes, by the num

ber

ber of ftools, the quantity, fo it does the state of the fever of the feafon, when it prevails, or of the fubject difeafed; the ftools being more frequent at thofe hours when fevers are in their exacerbation, and the reverse when in their remiffion; befides, their alternate fucceffion is frequently obferved, nor can it be doubted that this fever, like most others, is caufed by obftructed perspiration; not confined to cold, hot, wet, or dry feasons, particular food, water, liquors, or fruit; but chiefly depending on fudden tranfitions, and fuch other caufes, as expofe people to have this difcharge haftily ftopped.

I know that writers lay great ftrefs on exciting, and internal pre-difpofing caufes; heat and moisture; putrid ferments; infection, &c. &c.-but, upon a ftrict examination, we shall find, that there has been too much attention employed on thefe imagi nary circumstances, whilft the immediate caufe, or primum mobile remains unnoticed. It is not to be doubted, that a conjunct caufe is neceffary, otherwife obftructed perfpiration, the parent of fo many, would always produce the fame disease.

The fkin being the great outlet for infenfible perfpiration, which is faid by Sanctorius to amount, in the temperate clime of Italy, to five-eighths of what is taken into the body, we cannot be furprifed at the violent efforts nature immediately makes, on the fudden fuppreffion of a habit of fuch extent: and if we attend to the ftools of fome patients, after the common contents of the bow

els are difcharged, before the

blood-veffels are broken, and at intervals when there is no mixture of blood or mucus, we fhall find, they are nothing but a ferous, acrid fluid.

As I have conftantly practifed in the opinion, that a flux is a certain fever of the inteftines, and, that this fever is caufed by the obstructed perspiration being thrown therefo I have ever found it relieved, by turning back that difcharge to its natural channel; nor have I often found difficulty in removing it fpeedily, when taken in the beginning.

The common and fatal practice, of attacking the diforder in the bowels, with opiates and aftrin. gents, is but aggravating the ef fect, whilft the cause is entirely neglected.

Among the multitude of formu la propofed for the flux, we find Snake-root, Dover's powder, and other diaphoretic medicines; but exhibited in fuch a manner, that` they, muft often have produced more harm than good:-however, it plainly demonftrates that the fkin has not been really looked to for relief,much less has the procefs of fweating been confidered as the only one to be relied on.

Sir John Pringle recommends ipecacuanha in fmall doses, united with philonium and opium ;-Dr. Huck, and many others, a courfe of ipecacuanha in ftages of the difeafe when the inflammatory fymptoms are over; the good effects are attributed to aftringency but, with the greatest deference poffible to fuch authority, I be lieve ipecacuanha increases the tendency of the humours to the skin, and therein confifts its ufe in

fluxes. I apprehend that no astrin

gent,

Monfieur De Senac gave emetic tartar in fmall dofes; but he exprefly fays, he gave it as a laxative, to keep up a free paffage from the ftomach to the rectum.It is a common practice to give the glass, and other preparations of antimony, in cafual dofes, and uncertain periods; but the ope ration is always intended for the firft paffages. In this practice, though the prima via are so neceffary to be cleanfed, I attribute the principal fuccefs to the effects which antimonials produce, in opening the obftructed capillaries, and preventing a reflux of humours to the bowels: for often in fluxes, when, from careleffnefs and cold, antimonials have had their whole force and action turned upon the bowels, they have increased the determination of the fluids there, and brought on fudden death; and in fevers alfo, the ftomach is fometimes deftroyed by them. When emetic tartar is injudiciously given to young, irritable, plethoric people, in the beginning of a fever, and previous to proper evacuations, inftead of exciting a diaphorefis, a fpafm is produced in the ftomach; inceffant vomiting; inflammation, the veffels of the thorax and head

are ftifled with blood, and the patient vomits away his life.

The activity of emetic tartar, makes the direction of it difficult: it is in many refpects a dangerous medicine in hot climates, the nervous fyftem being fo irritable

except merely as an emetic:it has done much mischief when employed in fevers, the reguline virulence of the antimony being combined with acid, makes its operation, as a fudorific, very precarious; and it often proves fatal to the ftomach.

Such preparations of antimony as, from the effects, I fhould fuppofe James's powder to be, that have its phlogifton mitigated, and the reguline part capable of action, from acidity, are best in fevers, being most certainly fudorific; their operation on the ftomach or bowels confiderably depends on the ftate of the humours contained there, and they principally become active when nature requires it.

Dr. Cullen objects, that the dofes of thefe preparations of antimony, cannot be fo well afcertained, as its folution by the vegetable acid; for which reason he prefers the emetic tartar for use.

It must be admitted, that emetic tartar is a certain vomit, and when given for that purpofe the dofe is eafily afcertained;-but as it acts immediately on the ftomach, it is frequently impoffible to produce any other effect by it, dofe it how you will. This learned phyfician has greatly contributed to the general ufe of emetic tartar;-the abuse of it has arifen from our refpect to his cha racter.

When we obferve with what circumfpection and prudence the moft enlightened and fcientific introduce

troduce their reflections, we fhould learn that they apprehend more from exceeding, than rejecting their doctrine.

Dr. Cullen fuppofes, that the application of cold air, as a fedative, by abating the reaction of the vafcular fyftem, may be ufeful in fome circumftances of fever; but does not venture to pronounce in what; yet we fee the extravagant practice of expofing patients indifcriminately in fevers, and other diseases almoft fub dio, not attended to, nor the mischief it produces.

A moderately cool, temperate air, is proper and neceffary in every fpecies of fever; but if any thing beyond that degree is meant, it cannot be fupported by any reafoning that applies to the fmallpox, though this gave rife to the fpeculation, and many experiments on it, in the fouthern parts of Europe.

The fmall-pox fever is fui generis, and terminates in phlegmons; it requires a treatment of its own, -For example, cooler air than is required in a state of health is neceffary; raising a fweat is prejudicial, and often changes the diftinct into the confluent fort ;on the contrary, in fevers, their folution is commonly by fweat: cold air applied, as in the fmallpox, impedes that folution, and changes an intermittent into a remittent, or both into a continued fever.

The preceding paragraph will not be deemed digreffive, as it is neceffary, to elucidate my fubject.

It is not my intention to difpute the auxiliary aid that may occafionally be drawn from aro

matics, wax, fuet, foap, limewater, calomel, various purgatives, and even various aftringents, in certain conditions of a dyfentery, diarrhoea, or tenefmus; or from rhubarb, abforbents and correctors, in unimportant complaints of the bowels, originating there from acrimony or crudities; but to recommend a practice for. removing the dyfentry, by means adequate to, and that correfpond with, its general cause.

It will occur to every practitioner, as my intention here is the ufe of fudorifics, that I mean, a careful, continued courfe of them, to keep up a sweat, in extent proportioned to the violence of the dif ease; and not the trifling way of giving small dofes, whilft the patient is expofed, and their operation difregarded.It will occur alfo, that the fudorific employed must be suitable to the nature of the flux,-the ftage of it,-the conftitution of the feafon, and the habit of the patient.

When I propose a method, for the cure of this disease by a course of fudorifics, I am aware of no objection that can poffibly attend the novelty of the doctrine-except that it wants the fanction of the fathers of phyfic, to oppofe the errors and prejudices of cuftom-but that muft yield to facts; and the important confideration, that the fuccefs of the war, and the fafety of the colonies, depend on the prefervation of the troops; among whom the flux has ever been found to make the most dreadful havoc.

As much depends on a convenient and proper hofpital, the fituation and conftruction of it require confideration.-An hofpi

tal

tal fhould not only be fituated on a healthful spot, but in the vicinity of a market; where good water, wood, and every neceffary, can be supplied without fatigue, delay, or trouble.-The evils arifing from the reverfe of this, require no animadverfion : let us confider the evils of its improper conftruction; inftead of being tofty and fpacious, we find the contrary mode is adopted; and it is generally thought fufficient to have plenty of doors and windows, in all places appropriated for the fick; thefe doors and windows are kept conftantly open to make the hofpital what is called airy.

The coft of a good hofpital is nothing in the fcale of expence; it is a folecifm in economy to have a bad one.-A bad hofpital may deprive the ftate, in a few months, of as many men as would amount, in political calculation, to a fum fufficient to build ten good ones.

It cannot have efcaped the notice of any perfon that has refided in the Welt-Indies, that fitting long in the confined direction of a breeze, brings on a feverish, difagreeable fenfation, and fometimes pains in the face, neck, joints, and a great degree of fever:-How then must it be with a patient, who, in the little huts of hofpitals, is placed at a doorway to prevent fuffocation, or raifed on a platform to the level.of an open window, if he fhould break out in a critical fweat? The fweat is fuddenly ftopped; and if death does not enfue, the disease (which, under the kind operation of nature, would be finished in a day or two) is lengthened out into months.

Hofpitals and fick-rooms ought to be well ventilated; but as the fick fhould not be ftifled with heat, fo they fhould not have currents of wind imprudently directed on their bodies:-in this cafe, no disease can poffibly be thrown off, or complete a crifis by the emunctories of the skin.-How then can foldiers recover from fevers, chiefly from obftructed perfpiration, expofed_to_a_ftill encreafing caufe ?-To this fource we may principally attribute the multitude of what are generally called convalefcents; which in truth, for the most part, are people labouring under chronic complaints from the imperfect folution of acute diseases.

Though I have continually opportunities in my private practice, to prove the extent of the doctrine I advance, it is my intention to have the application of thefe obfervations understood to belong to the military, and that degree of dyfentery which is no where to be feen but in their camps and garrifons:-for which reafon I fhall illuftrate the fubject with a fhort account of the bloody-flux, as it now rages amongst the troops in this island, and particularly in the camp at Fort Caftile, with the method I have happily found fuccefsful, in the treatment of thofe committed to my care.

This flux will appear to want almost all the fuppofed remote caufes of a dyfentery, but it will be found with the immediate one common to all.

The ftate of the human frame, during fome months paft, has undergone a multitude of diurnal transitions, from the abfence or

prefence