secretory and excretory apparatus to work, while it equalizes the circulation in every part of the system.

Observations on the Dysentery of New Orleans. By ARCHIBALD RoBERTSON, M. D. Resident Physician at Northampton.*

SEC. VIII. About the middle of November, 1814, the expeditionary force destined to act against New Orleans arrived at Jamaica, under the command of Vice-Admiral the Hon. Sir Alexander Cochrane ; and the whole fleet of ships, of war and transports, having rendezvoused there, took their departure from Negril Bay, at the west end of that island, about the end of November, full of health and hope.

Before the middle of December, the fleet arrived on the coast of Louisiana, and took steps for disembarking the troops without delay —a measure against which nature seemed to have opposed ample and almost insurmountable obstacles. Moreover, the passage of those lakes which formed the only practicable approach, was obstructed by five large American smacks or gun vessels, mounting several heavy guns each, and admirably adapted, from their build, for operating in those shallow waters.

The latter vexatious impediment, however, was soon conquered by our sailors, who showed, on this occasion, all that æs triplex,' that hardy, careless, characteristic valour for which they are so illustrious. The boats of the fleet, manned and armed, were sent away, and, after a tiresome row of thirty-six hours, succeeded in penning the enemy up in a creek, where they attacked them against the superior odds of their position and their force, and after a furious engagement, captured every one of them. This achievement was decidedly gallant, and would have stood amidst the most brilliant feats of naval warfare, had not the subsequent failure of the main object of the expedition thrown a bleak shade over its lustre.

About the beginning of January, (1815,) bowel complaints, which had previously appeared amongst the boats' crews and the fatigue parties of the army, began to be very rife.-They varied in degree of severity, from the milder symptoms of dysentery to its most aggravated forms. I may enumerate in a few words the symptoms of the disease. The patients, for the most part, complained of severe tormina, tenesmus, scanty blood dejections, want of appetite and strength, general pains and soreness, and strong disposition to vomit on taking either food or drink. The tongue was white or yellow; the eye languid; the pulse above 100, small and easily compressed; the skin often dry, or covered with clammy sweat, but always considerably increased in temperature.

The causes were, generally speaking, obvious enough. - The men had been rowing all day, and sleeping all night in the open boats. They had incautiously drank the brackish water of the lakes, and

* I have been obliged, for want of space, to greatly curtail Dr. Robertson's valuable paper, by omitting the part of it which treats on fever-a subject which has occupied a great portion of this work.-J. JOHNSON.

had sometimes been obliged to eat their beef or pork raw, when, on an emergency, they were deprived of an opportunity of cooking it. They were often drenched with rain, or dripping with spray, without being able to put on dry clothes. Added to all this the weather was extremely cold, particularly in the night, the thermometer before sun-rise being often as low as 25 or 26 degrees, rising no higher during the day than 30 or 38 degrees, and seldom above 50.*

The locality of the general rendezvous for the boats was very bad, (though the best that could be found,) being a miry place, covered with reeds, and abounding in miasmal exhalations.

The encampment of the army, too, was on a swampy spot on the left bank of the Mississippi, about six miles from New Orleans. Indeed, the whole vicinity is a swamp, which, after the rains so frequent at that season of the year, became a perfect puddle. Having the Mississippi on their left, they drank its discol ured and polluted water, and were exposed to the effluvium of its slimy mud, as well as to the paludal exhalations of an impracticable wooded morass on their right. The huts, also, in which the troops were sheltered, were far from being impervious either to rain or cold so that, upon the whole, the army and navy, in point of privations, were much upon a par.

On the first appearance of Dysentery, its treatment was commenced by a flannel roller bound fight round the abdomen, and ordering flannel clothing next the skin, if the patients had it not already. Saline cathartics, and particularly oleum ricini, with now and then a few grains of calomel were repeatedly given, until the stools were increased in quantity and more freely rendered. At the same time, plentiful dilution with tepid gruel, warm tea, rice, or barley-water, (with a tinge of port-wine and a little sugar, so as to remove its nauseous insipidity, and allure the patient to drink it in such quantities as would prove useful.) as also decoctions of linseed or of gum arabic, I always considered of primary importance as well in promoting the cure, as in alleviating symptoms. Demulcent drinks I hold to be of much moment in this complaint, as they, no doubt, in some measure, defend the irritable or semi-inflamed coats of the bowels from the stimulus of the ingesta, besides sheathing the acrimonious secretions which, during this disease, are unquestionably poured out from the intestinal glands, and supplying the want of excretion from the mu

The Physiologist might have contemplated with interest, on this occasion, the marked difference in the effect of cold on the European and the African constitutions. While the former were, comparatively, only incommoded, the latter were severely injured by it. Many soldiers of the Negro regiments had their feet frost-bitten, and lost their toes by the consequent gangrene and sphacelus. Some of them even died in the camp or in the boats, from excessive cold. Of our own people, many of the boat's crews, and even of the officers, on their return from boat service, were incapacitated for six or ten days, by pain, numbness, shooting, and tingling of the lower extremities. They expressed their distress to be as great as if their feet and legs, from the knees downwards, had been one immense chilblain! Various remedies were tried for this teasing affection; but nothing I could devise gave any relief. Temporary ease was derived from frequently bathing the feet in cold salt water. This peculiar affection I no where find mentioned by writers on the effects of cold.

cous follicles.-I have had occasion to see even olive oil given with this view, in doses of an ounce or two, and the relief that always followed it, even though it had no laxative effect, was very conspicuous.

When the primæ viæ had been fully evacuated, an attempt was made to restore the natural secretions, and the balance of the circulation, by opening the pores of the skin. Antimonial powder, with opium was employed for this purpose; but more generally the pulvis ipecacuanha compositus, which certainly seemed to succeed best.

Whenever tormina and straining returned in a worse degree than ordinary, a cathartic was given in the morning, followed by a large dose of opium, or an anodyne diaphoretic at night.

Believing, as I firmly do, that wherever there is morbid activity of the vascular, and increased mobility or excitability of the nervous system, (the former evinced by undue velocity and force of motion of the heart and great vessels, and the latter by morbid evolvement of animal heat, general pains, lassitude, &c.) there blood-letting is very seldom inadmissible, whatever be the name or nature of the disease, -it is almost unnecessary to say that, in the complaint I am now describing, the lancet formed a leading agent in the methodus medendi. Whenever the stools resembled the "lotura carnium," I practised depletion with as much freedom as if there had been active hæmorrhage from the intestines from any other cause ;-the amended appearance of the alvine discharges, and the diminution of the pyrexial symptoms not only justified but sanctioned the apparent boldness of a measure, which, I have reason to know, has succeeded equally well in other hands besides my own. Many of our primary cases, however, were not so severe as to require venesection.

By these means, aided by perfect quietude, repose, and low diet, the febrile state soon disappeared, and nothing remained but debility and irregularity of the bowels, which were to be removed by the mistura cretæ cum opio, the infusum quassiæ excelsæ, or the mistura cinchonæ, given thrice or four times a-day, and a gentle laxative once in three or four days.

Many of our earlier and milder cases yielded to this treatment; but those of a severer sort required measures less inert. In these malignant forms of the disease, I began by giving a strong saline or lubricating cathartic. Here, too, blood-letting was very freely practised, when the patients were young and robust, or indeed, whenever the force of the pulse and pyrexia seemed on general principles, to justify it. I never once saw cause to repent of this evacuation, though I have more than once carried it to a great extent. It often moderated local pain of the abdomen, diminished the severity of the griping, and, when practised with prudence, did not perceptibly increase the subsequent debility.-These preliminary steps being taken, immediately commenced the use of calomel, and pushed on undeviatingly to salivation, from the belief, which seems to be wellfounded, of an occult connection betwixt dysentery and a morbid condition of the liver.

The doses I gave were regulated by the constitution of the patients, and the actual state of the symptoms; but one scruple night and

morning, was the most usual prescription,-seldom less than ten grains thrice a-day! I gave a scruple night and morning so often, and in such great variety of habits, that I soon ceased to be at all fearful of hypercatharsis, or, indeed, of any other unpleasant effect. It certainly seldom, in any case increased tormina and tenesmus, but generally lessened both very materially, and produced five or six large motions, voided with less straining, and less tinged with blood. I have in this way given 16, 24, or 32 scruples of calomel in the course of half as many days, before the mouth became affected. When the gums were fairly sore, with some ptyalism, the calomel was omitted, the tormina, tenesmus, and general fever disappeared as a matter of course, and the bowels gradually returned to their natural state, the stools often changing, in one night's time, from a dark brown or spinage colour, to a bright healthy yellow, with the odour of natural fæees. Some tonic or stomachic was prescribed during the days of convalescence; and generally, as soon as the mouth was well, the patients were fit for duty.

Calomel was often thus given alone and uncombined; but often I thought it preferable, on account of occasional symptoms, to conjoin with it two grains of opium, or to give at noon, (in the interval between the doses of calomel,) twelve or fifteen grains of the pulvis ipecacuanha compositus.-This was done in order to lessen the irritability of the bowels, and to support the cuticular discharge. Under such management, every case recovered where no visceral obstructions existed, or where the co-existent disease of the liver was not irretrievable from having passed into disorganization.

As to the fact of visceral obstructions, I believe they are a more frequent occurrence, even in our own climate, than is generally supposed; but I am persuaded that, of those who have lived for any length of time within the tropics, scarcely fewer than four-fifths have one viscus or other in the abdomen, more or less altered by morbid action. This opinion is deduced from a very considerable number of dissections of such subjects.

Opium is one of those remedies of doubtful utility in dysentery, which has been by some violently decried, and by most rather sparingly used, from its alleged tendency to suspend the natural secretions, lock up the excretory ducts, and check the transpiration by the skin. Candour obliges me to say that I have used it largely, particularly in the chronic forms of the disease, and that I have never noticed any of the unfavourable effects urged against it; but on the contrary, can bear witness with the illustrious Sydenham, Dr. John Hunter, and several living authors, to its beneficial power. Given after purgatives, it can seldom be unsafe, and, if it does no more, it procures a temporary truce from the disease. How important a cessation from suffering is, in every illness, but more especially in so endless and harassing a complaint as dysentery, I need not sayprejudices, probably illusory and theoretical, ought to give way to an advantage so substantial.

Nevertheless it must be admitted, that in the early or acute stage of dysentery, this remedy must be administered with a very cautious and discriminating hand, -inasmuch as, at that period of the disease,