Part 34

Of the Dysentery, or Bloody-flux.

_Sect._ 329.

The Dysentery is a Flux or Looseness of the Belly, attended with great Restlessness and Anguish, with severe Gripings, and frequent Propensities to go to Stool. There is generally a little Blood in the Stools, though this is not a constant Symptom, and is not essential to the Existence of a Dysentery; notwithstanding it may not be much less dangerous, for the Absence of this Symptom.

Sec. 330. The Dysentery is often epidemical; beginning sometimes at the End of July, though oftner in August, and going off when the Frosts set in. The great preceding Heats render the Blood and the Bile acrid or sharp; and though, during the Continuance of the Heat, Perspiration is kept up (See Introduct. P. 28) yet as soon as the Heat abates, especially in the Mornings and Evenings, that Discharge is diminished; and by how much the more Viscidity or Thickness the Humours have acquired, in Consequence of the violent Heats, the Discharge of the sharp Humour by Perspiration being now checked, it is thrown upon the Bowels which it irritates, producing Pains in, and Evacuations from them.

This Kind of Dysentery may happen at all Times, and in all Countries; but if other Causes, capable of producing a Putridity of the Humours, be complicated with it; such as the crouding up a great Number of People into very little Room, and very close Quarters, as in Hospitals, Camps, or Prisons, this introduces a malignant Principle into the Humours, which, co-operating with the simpler Cause of the Dysentery, renders it the more difficult and dangerous.

Sec. 331. This Disease begins with a general Coldness rather than a Shivering, which lasts some Hours; the Patient's Strength soon abates, and he feels sharp Pains in his Belly, which sometimes continue for several Hours, before the Flux begins. He is affected with Vertigos, or Swimmings in the Head, with Reachings to vomit, and grows pale; his Pulse at the same Time being very little, if at all, feverish, but commonly small, and at length the Purging begins. The first Stools are often thin, and yellowish; but in a little Time they are mixt with a viscid ropy Matter, which is often tinged with Blood. Their Colour and Consistence are various too, being either brown, greenish or black, thinner or thicker, and foetid: The Pains increase before each of the Discharges, which grow very frequent, to the Number of eight, ten, twelve or fifteen in an Hour: then the Fundament becomes considerably irritated, and the Tenesmus (which is a great Urgency to go to Stool, though without any Effect) is joined to the Dysentery or Flux, and often brings on a Protrusion or falling down of the Fundament, the Patient being now most severely afflicted. Worms are sometimes voided, and glairy hairy Humours, resembling Pieces or Peelings of Guts, and sometimes Clots of Blood.

If the Distemper rises to a violent Height, the Guts become inflamed, which terminates either in Suppuration or in Mortification; the miserable Patient discharges Pus, or black and foetid watery Stools: the Hiccup supervenes; he grows delirious; his Pulse sinks; and he falls into cold Sweats and Faintings which terminate in Death.

A kind of Phrenzy, or raging Delirium, sometimes comes on before the Minute of Expiration. I have seen a very unusual Symptom accompany this Disease in two Persons, which was an Impossibility of swallowing, for three Days before Death.

But in general this Distemper is not so extremely violent; the Discharges are less frequent, being from twenty-five to forty within a Day and Night. Their Contents are less various and uncommon, and mixed with very little Blood; the Patient retains more Strength; the Number of Stools gradually decrease; the Blood disappears; the Consistence of the Discharges improves; Sleep and Appetite return, and the Sick recovers.

Many of the Sick have not the least Degree of Fever, nor of Thirst, which perhaps is less common in this Disease, than in a simple Purging or Looseness.

Their Urine sometimes is but in a small Quantity; and many Patients have ineffectual Endeavours to pass it, to their no small Affliction and Restlessness.

Sec. 332. The most efficacious Remedy for this Disease is a Vomit. That of No. 34, (when there is no present Circumstance that forbids the giving a Vomit) if taken immediately on the first Invasion of it, often removes it at once; and always shortens its Duration. That of No. 35 is not less effectual; it has been considered for a long Time, even as a certain Specific, which it is not, though a very useful Medicine. If the Stools prove less frequent after the Operation of either of them, it is a good Sign; if they are no Ways diminished, we may apprehend the Disease is like to be tedious and obstinate.

The Patient is to be ordered to a Regimen, abstaining from all Flesh-meat with the strictest Attention, until the perfect Cure of the Disease. The Ptisan No. 3 is the best Drink for him.

The Day after the Vomit, he must take the Powder No. 51 divided into two Doses: the next Day he should take no other Medicine but his Ptisan; on the fourth the Rhubarb must be repeated; after which the Violence of the Disease commonly abates: His Diet during the Disease is nevertheless to be continued exactly for some Days; after which he may be allowed to enter upon that of Persons in a State of Recovery.

Sec. 333. The Dysentery sometimes commences with an inflammatory Fever; a feverish, hard, full Pulse, with a violent Pain in the Head and Loins, and a stiff distended Belly. In such a Case the Patient must be bled once; and daily receive three or even four of the Glysters No. 6, drinking plentifully of the Drink No. 3.

When all Dread of an Inflammation is entirely over, the Patient is to be treated in the Manner just related; though often there is no Necessity for the Vomit: and if the inflammatory Symptoms have run high, his first Purge should be that of No. 11, and the Use of the Rhubarb may be postponed, till about the manifest Conclusion of the Disease.

I have cured many Dysenteries, by ordering the Sick no other Remedy, but a Cup of warm Water every Quarter of an Hour; and it were better to rely only on this simple Remedy, which must be of some Utility, than to employ those, of whose Effects Country People are ignorant, and which are often productive of very dangerous ones.

Sec. 334. It sometimes happens that the Dysentery is combined with a putrid Fever, which makes it necessary, after the Vomit, to give the Purges No. 23 or 47, and several Doses of No. 24, before the Rhubarb is given. No. 32 is excellent in this combined Case.

There was in Swisserland in the Autumn of 1755, after a very numerous Prevalence of epidemical putrid Fevers had ceased, a Multitude of Dysenteries, which had no small Affinity with, or Relation to, such Fevers. I treated them first, with the Prescription No. 34, giving afterwards No. 32; and I directed the Rhubarb only to very few, and that towards the Conclusion of the Disease. By much the greater Number of them were cured at the End of four or five Days. A small Proportion of them, to whom I could not give the Vomit, or whose Cases were more complicated, remained languid a considerable Time, though without Fatality or Danger.

Sec. 335. When the Dysentery is blended with Symptoms of Malignity (See Sec. 245) after premising the Prescription No. 35, those of No. 38 and 39 may be called in successfully.

Sec. 336. When the Disease has already been of many Days standing, without the Patient's having taken any Medicines, or only such as were injurious to him, he must be treated as if the Distemper had but just commenced; unless some Symptoms, foreign to the Nature of the Dysentery, had supervened upon it.

Sec. 337. Relapses sometimes occur in Dysenteries, some few Days after the Patients appeared well; much the greater Number of which are occasioned either by some Error in Diet, by cold Air, or by being considerably over-heated. They are to be prevented by avoiding these Causes of them; and may be removed by putting the Patient on his Regimen, and giving him one Dose of the Prescription No. 51. Should it return even without any such discoverable Causes, and if it manifests itself to be the same Distemper renewed, it must be treated as such.

Sec. 338. This Disease is sometimes combined too with an intermitting Fever; in which Case the Dysentery must be removed first, and the intermittent afterwards. Nevertheless if the Access, the Fits of the Fever have been very strong, the Bark must be given as directed Sec. 259.

Sec. 339. One pernicious Prejudice, which still generally prevails is, that Fruits are noxious in a Dysentery, that they even give it, and aggravate it; and this perhaps is an extremely ill-grounded one. In truth bad Fruits, and such as have not ripened well, in unseasonable Years, may really occasion Cholics, a Looseness (though oftner a Costiveness) and Disorders of the Nerves, and of the Skin; but never can occasion an epidemical Dysentery or Flux. Ripe Fruits, of whatever Species, and especially Summer Fruits, are the real Preservatives from this Disease. The greatest Mischief they can effect, must result from their thinning and washing down the Humours, especially the thick glutinous Bile, if they are in such a State; good ripe Fruits being the true Dissolvents of such; by which indeed they may bring on a Purging, but such a one, as is rather a Guard against a Dysentery.

We had a great, an extraordinary Abundance of Fruit in 1759 and 1760, but scarcely any Dysenteries. It has been even observed to be more rare, and less dangerous than formerly; and if the Fact is certain, it cannot be attributed to any thing more probably, than to the very numerous Plantations of Trees, which have rendered Fruit very plenty, cheap and common. Whenever I have observed Dysenteries to prevail, I made it a Rule to eat less Flesh, and Plenty of Fruit; I have never had the slightest Attack of one; and several Physicians use the same Caution with the same Success.

I have seen eleven Patients in a Dysentery in one House, of whom nine were very tractable; they eat Fruit and recovered. The Grandmother and one Child, whom she loved more than the rest, were carried off. She managed the Child after her own Fashion, with burnt Wine, Oil, and some Spices, but no Fruit. She conducted herself in the very same Manner, and both died.

In a Country Seat near Berne, in the Year 1751, when these Fluxes made great Havock, and People were severely warned against the Use of Fruits, out of eleven Persons in the Family, ten eat plentifully of Prunes, and not one of them was seized with it: The poor Coachman alone rigidly observed that Abstinence from Fruit injoined by this Prejudice, and took a terrible Dysentery.

This same Distemper had nearly destroyed a Swiss Regiment in Garrison in the South of France; the Captains purchased the whole Crop of several Acres of Vineyard; there they carried the sick Soldiers, and gathered the Grapes for such as could not bear being carried into the Vineyard; those who were well eating nothing else: after this not one more died, nor were any more even attacked with the Dysentery.