vomited very violently the first day, and were relieved by it; many had this propenfity to vomit, even in the progrefs of the disease, and continued to caft up with great benefit till the fourth day. Such as from the first had fought for refuge in wine, and other hot things, brought up every thing they took into their ftomachs, almost every day, complained of the heart-burn, and were in the greatest danger.

The hot fit followed immediately after the cold; and in very bad cafes, fome had the firft day an intolerable head-ach. The fever at first appeared to be fmall in moft, but in the courfe of the diforder, was still more and more confiderable; yet in the most violent fpecies, and where there was the most danger, it was at times not obfervable, and the pulfe infinitely weak; in lefs violent kinds, the fever was often very high: I faw too, in fome, even at the first day, a perfect delirium; in others, a continual lethargy, which accompanied many in defperate cafes, and was particularly conftant in children. The difeafe was very favourable in fome, after a flight attack: thefe had little fever in the beginning, and their ftools, even the third day, continued to be yellow, and very little offenfive; but after that time, they began to complain of a bitter taste in their mouths, and the violence of the fever increased with the increafing discolouration of their stools.

I always found the excrements thin; but very often viscous, and that even at the beginning of the diforder. With fome, they were quite bloody the first day, with others, later: in thofe that were feverely attacked, as well as young children, they were mixed from the beginning, with grumous blood. I have feen children, from whom, in the first days of malady, the blood has flowed in ftreams down their legs; just after appeared a quite green matter, and this gave place to a red; with moft, the excrements were at the fame time white, red, yellow, brown, green, and fometimes even black, for the most part yielding a very bad fmell, which was at times perfectly cadaverous. The excretions in fome, who had taken no medicine, remained for a whole week quite white, and came away without pain; a week after that, red, with great pain; and throughout feveral fucceeding weeks, red, white, and very little painful.

In flight indifpofitions, the patients went to ftool about fifteen or twenty times a day, and many forty or fifty. I faw, and even cured fome, that in the fpace of twelve hours, had from an hundred and fifty to two hundred ftools, and whofe evacuations came fo quick one upon another, that one would have thought their whole infide was coming out.

The tormina were always more violent before going to ftool, and I thought my patients very well off, when the pains remitted after evacuation; in many they were very fharp, and in severe illneffes drove the patient almoft to defpair. They were accompanied in the course of the diforder, by a smart pain in the back, fometimes a heat of urine, and in most perfons by a tenefmus.

In the worst fpecies, the cheft was oppreffed. In all kinds I found the appetite and natural fleep entirely gone: moft had an inextinguishable thirft, and the greateft part were obliged to keep their beds, by reafon of their extreme feebleness; many were in

conceivably

conceivably weak, and at times fainted away. There were, howfome who were able to fit up out of bed; and many, in light indifpofitions, walked about. Many fweated, but without benefit.

eyer,

The bad forts of this dyfentery lafted fometimes from fourteen to fixteen days, especially when proper evacuations could not be made during the firft days of the diforder; though most of my patients recovered in five or fix days. There appeared in fome, that were very hard befet with the diforder, a rash on the mouth and tongue, in others, all over the abdomen, and in others, all over the body; though the difeafe, in reality, was as good as cured. In one fingle fubject, I faw, after a happy and perfect cure, a prolapof any my fus of the rectum. I have not experienced a relapfe in patients, excepting two in one perfon; the firft proceeding from a violent fit of anger, and the other, becaufe he got out of bed in the night, and was forced to run about the streets feveral times in a hard fhower of rain.

They who were the most dangerously ill, had a regular miliary eruption; and, at the fame time, ulcers about the body at a time when the diforder was at its greatest height, if they had not taken The greatest misfortune the purging medicine that was ordered. that attended very young children, who were very feverely feized by this malady, confifted in the fpafmodic contractions of the nerves, which came on at its first commencement, and by which they were immediately deprived of all fenfation.

When the difeafe terminated fatally, the tormina did not remit after going to ftool, but were every day more and more intolerable, and the tools remained equal in number; a hiccough, at times a vomiting, and fwelling of the abdomen next followed, and lastly, the cholic pains ceafed. Death brought up the rear, (efpecially with them who had drink freely of wine) as early as the fifth, eighth, ninth, and fourteenth day, and fometimes later.

They that in fevere cafes, only took medicines in the beginning of the distemper, and afterwards laid them afide, were in very great danger; and though they took to them again in fix or eight days, yet till they continued a long time ill, if at length they did not happen to die. Many that took no medicines at all, had a gentle, but tedious dyfentery; gripes, tenefmus, and alfo blood mixed with their excretions. which otherwife had only been flimy; great wearinefs in the members, frequent returns of the coid fit, violent fweats, indigeftion, and pains in the ftomach from every thing they ate. Others were haraffed with a flying gout; others, among whom were likewife children, with a dropfy; others, again, with obftinate fwellings in the feet; and with others, from whom the evil feemed to go away of itfelf, ftill remained a great pain in the loins, and a heumatism in the joints.

The more favourable fpecies of the dyfentery, fhewed themfelves by an univerfal languor, a fhivering, feme propenfity to vomit, a cholic of no very long continuance, and much lefs frequent, as well as lefs griping tools. The excrements were for the most part white, and their food came away undigelled; the blood did not ap◄ pear till after fome days, or elfe the figns of it were hardly to be perceived.

Rev. Jan. 1772.

C

Some,

Some, in the beginning or end of the epidemy, especially those who lived towards the boundaries of its ravages, were only troubled with a violent griping, which continued five or fix days, and fometimes a fortnight, without purging, but rather a conftipation of the belly: though when I had given them fomething opening, I found their excretions mixed with blood and white-like pus. Such as had taken no medicine in these circumstances, fell into a moft dreadful dyfentery.

Many had a mere griping diarrhoea, which ftaid with most perfons but a few days, in which, however, I found the excrements frothy, and mixed with gall. A purging of this kind remained fix weeks with a lad, to whom I purpofely gave no medicines, as I hoped, that by means of this, he would be rid of a different kind of distemper, which returned upon him every year; which accordingly happened.

Some that were not attacked by the dyfentery where it had raged, but had attended on those that were fick of this disorder, or lived in the house with them, at the end of the epidemy were plagued with large boils on the breaft, under the arms, on the knees, and legs; fome had them on the head, and over their whole body; many, instead of boils, had great white bladders: yet none of these people kept their beds.'

The curative indications laid down by our Author are, as quickly as poffible to expel the putrid matters, and to correct the tendency to putrefaction.-Thefe ends are to be anfwered by emetics and cathartics, and by mild acids used as antifeptics. The pains are to be relieved by foft, mucilaginous liquors, rather than opiates.

After having given, fays Dr. Zimmerman, the vomit in the morning, I ordered them to fet out in the afternoon with the following drink: Take two ounces of barley, and boil them up with an ounce of cream of tartar, in two pints and a half of water, till the barley burfts; then ftrain it through a linen cloth, and fet the liquor by, which will amount to about a quart, to be drank warm at proper intervals, during the firft afternoon, and the whole fucceeding night throughout. Lleffened the dofe of the cream of tartar according to the age of the patient, though I moftly ftuck to the proportion before-mentioned.

On the second day in the morning, I gave to adults three ounces of tamarinds, boiled up for the space of two minutes, with half a pint of warm water, and ftrained off; to children two ounces, and to very small infants one. This gently-opening medicine directly brought on the ftools more copioufly than before, but after this their number was generally diminished; fometimes the tormina went quite away, but for the most part, were at leaft greatly alleviated.. A large copious excretion produced by this medicine, had always an excellent effect. Inftead of tamarinds, I fometimes gave Sedliz falts, to the quantity of one ounce, or an ounce and an half, with the like fuccefs. During the night, I repeated the barley-water with the cream of tartar. On the third day, I gave ftill the tamarind decoction, if the malady was not fufficiently diminished; otherwife I put

it off till the fourth day, and ordered nothing further in the mean time, than barley-water with cream of tartar.

I gave the peasants pretty often after the emetic, on the afternoon of the first day, a drachm of cream of tartar, with the like quantity of rhubarb the fame dofe in the morning and evening of the fecond day, and the morning of the third. Sometimes I divided this into fix dofes, and ordered the whole fix to be taken by the fourth day, while, at the fame time, I prefcribed the barley-water in the fame manner; I diminished the dofes likewife in proportion to the patient's age. The fuccefs was not bad; for, by means of a vomit given at the beginning, two drachms of powdered rhubarb, with the like quantity of cream of tartar, and the common barleywater, with an ounce of the fame falt, I have done many people great fervice in three days time, and have in this manner even perfectly cured a woman fourscore years old, of the dyfentery. By this method, however, the pains did not fo foon remit; but, on the contrary, grew much more violent; which did not happen when I omitted the rhubarb.

The cream of tartar and tamarinds did not only occafion nơ pain, but very much diminished it when they proved fufficiently purgative. They had alfo this advantage over rhubarb, that by means of their acidity, they acted very powerfully against the putrid fever; while, on the contrary, rhubarb, except a deterfive and (as it appears to me) not very antifeptic power, can boast of nothing more, than of being capable of contracting the fibres.

In obftinate and tedious cafes, by means of an opening medicine, confifting of three ounces of tamarinds, the ftools became less frequent in the very height of the diforder, and the patients were always relieved. So far from being weakened by this purge, I perceived that they grew ftronger and more alert than they had been before, when their bowels were diftended with putrid matter.

In general, the tamarinds had a much quicker and better effect than rhubarb alone. So far from caufing pain, they alleviated it very much, and, accompanied with the cream of tartar during the intervals, finished the disease in three or four days, even when the attack was very violent. Notwithstanding the emetic, the tools grew very copious and of a bad appearance fome hours afterwards, the pains great, and the wearinefs of the members very confiderable. But very often all these symptoms fuddenly vanished on purging the patient with tamarinds.

As faft as each fymptom of the dyfentery decreased, and at Fength vanished, I perceived that the fever in like manner decreased and vanished. It took a faft hold, and even grew very confiderable, when the putrid matter was not evacuated in fufficient quantities directly at the beginning. I made ufe of no other remedy for it, than those which I have already indicated. They were fufficiently capable of correcting and evacuating the bilious matter, and thus likewife of putting an end to the fever.

After the emetic I fometimes too gave cream of tartar, rhubarb, and tamarinds by turns, with good fuccefs. But I was guilty of an error in not being content with tamarinds, and the other medicines alone, when I had omitted the rhubarb.

C 2

In general, at the beginning of the diftemper, ipecacuanha, cream of tartar given in great quantities with barley-water, and tamarinds, were my principal remedies. Against the tormina, I made ufe of chamomile and linfeed-tea, almond-emullions, gum-arabicclyfters, and, but feldom, and that with the greatest caution, of laudanum. Towards the end of the difeafe, rhubarb was of fingu Far fervice.'

The great evils arifing from aftringents, conftipating medicines, fpices, brandy and wine, are earnestly reprefented.

The remainder of this treatife is employed in obfervations and more determinate conclufions, refpecting the diagnosis and cure of moft fpecies of the dyfentery.-The fpecics which our Author chiefly enlarges upon, are here pointed out.

However, we must diftinguith from all thefe fymptomatical fpecies, fuch as do not depend upon another diforder, and of thefe only we here treat at prefent, and fhall take four fpecies into confideration, though there are, perhaps, more; if there be, however, they are but feldom feen. The most ufual are, the fpecies which accompanies an inflammatory fever; that which attends a bilious or putrid fever, the most common of any; that which is concomitant on a malignant fever; and, lally, (if it may be admitted,) the chronic dyfentery.'

The characters of these four species are thus marked out:

An inflammatory dyfentery makes its appearance, at the beginning, with a very violent fever, a very hard pulfe, which, in other dyfenteries, is mostly fmall, and but feldom (and that only in the progrefs of the ficknefs) becomes full; an almoft continual and intolerable pain in the belly, which increafes on the part's being rouched, and fill more after vomiting; ftools very inconfiderable with refpect to quantity, a head-ach, red face, and fometimes a diftended abdomen. A putrid dyfentery difcovers itfelf by a bitterness in the mouth that appears directly on the first attack; a vomiting of a bilious matter, which is fometimes alfo mingled with worms, a fhivering that returns in the courfe of the diforder, the fometimes apparent flightnefs of the fever, the commonly pale colour of the countenance, the cafe that is found after vomiting, the variegated colour of the excrements, and fometimes by the worms contained in them. We may always fuppofe à priori the prefence of a malignant dyfentery; where many people, fick of the dyfentery, are crouded together in a fmall space; but this diforder may likewife proceed from many other external, as well as internal, caufes: its fureft pathognomonic figns are, the quick approach of a more than natural weaknels, great anxiety about the pit of the flomach, a heavinefs in the head, a wild, and yet at the fame time, a dead-like look, fpirits extremely depreffed, or a perfect indifference to every thing in the world, frequent flight convullions, a very weak voice, a great many fainting fis, fometimes a miliary cruption, patechiz, aphtha, a very weak pulfe, a vait fickness at the ftomach, and the other ufual fymptoms in malignant fevers, which have been above related. The low, or chronic dyfentery, is manifeft enough of itfell, and requires no defcription.'