this gentleman, as quoted by Messrs. Churchill | of the root of the chiococca racemosa auguifuga, or snow-berry tree, belonging to the natural family of the Rubiaceæ. This bark furnishes a bitter principle, crystallizable in delicate needles, without smell, of a bitter and rather an astringent taste, soluble in water, very soluble in alcohol, especially when warm, and reddening the tincture of turnsole; in this principle all the peculiar medical properties reside. This remedy is said by M. Le A decoction of the bark is made by macerating two drachms of the bark in eight ounces of water, then boiling for ten minutes, and straining the liquor off, which is divided into two doses, and the second dose is taken two hours after the first. The cases related by M. Lemasson are all connected with great general debility of the system. One was a case of chronic bronchitis with slight dilatation of the heart, and in this patient the fee and Stephenson, "when first given, it made a distinct and evident impression on the disease, communicating an increased activity to the absorbents, followed by a great augmentation of the excretion from the kidneys. The benefit, however, with me, has been in most instances temporary, and it was found better to omit the medicine for a time, and to resume it afresh, than to continue it until the system had become insensible to its sti-masson to be chiefly applicable to atonic dropsies. mulus. After suspending it for a week or two, the same distinct operation took place on returning to its use, as had been manifested in the first instance. It proved in almost every instance an acceptable medicine to the patient, and was preferred, both for its sensible qualities and its effects on the stomach, to other diuretics and alteratives which had been prescribed." The paper of Dr. Somerville, which is contained in the fifth volume of the Medico-Chirurgical Transactions, is valuableness was very considerable. Two were the ble from the post-mortem examination of Sir James Craig, to whom the plant had afforded very important benefit. In this instance the liver was studded with innumerable tubercles, the peritoneum throughout was thickened, and the intestines were glued together with coagulable lymph.* The lungs on the left side were sound, but compressed on the right side by three pints of water. The pericardium contained six ounces of water, and the heart was somewhat larger than usual. The history of this case abundantly proves that the original malady was in the liver. According to Dr. Somerville, the virtues of this plant do not reside in any volatile principle, and he found consequently that a decoction acted much more energetically than an infusion. In order to make this decoction, an ounce of the dried plant, including the root, stalks, and leaves, is cut into small pieces, and macerated twelve hours in two pints of cold water, and then boiled till it yields one pint of strained liquor. Mr. Carter found that thirty-four pounds avoirdupois of the recent herb produced four pounds of extract, which had the same properties with the decoction. Five scruples of this extract in pills or in solution may be given in twenty-four hours. The spartium scoparium or common broom, the leontodon taraxacum or dandelion, the apium petroselinum or common parsley, the juniperus communis, and the colchicum autumnale, all possess considerable diuretic powers, and may frequently be united with some of those above mentioned, with much advantage. The meadow-saffron is perhaps the most powerful of all these, and we have succeeded with it in conjunction with mercurials, in acting upon the kidneys in hepatic disease when no other remedy had any effect. The spiritus colchici ammoniatus of the London Pharmacopoeia is the preparation which we have chiefly relied upon, given in half-drachm doses three times a day, with a blue pill night and morning, and sometimes mercurial frictions over the abdomen being added. In the 57th number of the Journal Hebdomadaire, for October, 1831, M. Lemasson has given a detailed account of the employment of the bark As, however, he had been frequently tapped, this last appearance was probably a consequence of the operation and not a part of the original disease. consequence of syphilis and mercurial courses, to which universal anasarca succeeded, but without any particular visceral disease. In one patient affected with dilatation of the right cavities of the heart, the exhibition of the bark was preceded by bleeding. The effect in all was an improvement of the appetite, and a great increase in the flow of urine. The medicine is administered as abovementioned in two four-ounce doses, with an interval of two hours between the first and second dose; when this affects the kidneys, they continue their action for several days, and the medicine is not again exhibited till the urine diminishes. In the first case which was related, it was given on the 18th of June, on the 20th of the same month, and not again till the 5th of July, after which it was not repeated. In the second case it was only given twice. On the 22d of May, and on the 29th, both terminated successfully, and the medicine had a similar effect of increasing the appetite and the flow of urine together. Emetics. These have been recommended by some authors, and cases have been given, in which they have succeeded when other remedies had failed. We have ourselves no experience of their effect in this disease, and they appear to be banished from modern practice. We shall content ourselves therefore with this intimation. Sudorifics.-These are unquestionably in some cases highly useful, more particularly however when disease of the lungs is present. The vapourbath has occasionally been successful in such cases. The celebrated Dampier cured himself by covering himself all over with sand, heated by the sun, in California, for an hour, after which “ he was carried to his bed and well covered with clothes, where he fell into a profuse sweat, after which he recovered daily." The compound ipecacuanha powder has in this way been successful, and we have seen ascites attended with liver disease removed by it, though the patient died soon after, from the original malady. Tonics. Every species of dropsy may in some part of its course require the exhibition of tonics, for a state of debility easily follows depletion, however necessary it may have been; and it has not unfrequently happened that a patient has been cured of dropsy, and died of the weakness induced by the remedies. To obviate this, appears to 66 It is probable that many other of the common mineral and vegetable tonics may be employed in asthenic dropsy, and it will always be advisable that the practitioner should, as far as possible, be provided with substitutes, as, from particular idiosyncrasies, individuals are sometimes incapable of taking what may in other respects be the most appropriate remedy. have been the object of the celebrated electuary | tioners against the danger which may ensue from of Dover, which is a combination of scammony, the poisonous properties of the black hellebore, sulphuret of iron, and crude mercury. Of this and here therefore we shall only inculcate exformula Dr. Blackall says, that it has certainly treme watchfulness whenever this remedy is experformed many cures, and there is so much de- hibited. bility in the disease, that the addition of tonics to purgatives, never indifferent, is particularly desirable here, where it can be made with safety." Steel and bark are the principal tonic remedies that have been used in dropsy, and we consider the ferrum tartarizatum to be the best preparation of the former, as it unites a diuretic with its tonic properties. We have usually given it in combination with infusum calumbæ, and particularly in those asthenic dropsies in which the heart or lungs are diseased. In the asthenic dropsy consequent to chronic bronchitis, united with counter-irritation of the chest, it will sometimes alone remove the effusion. The sulphate of quinine is given with the same intention, and in weak and scrofulous habits it seems preferable to the preparations of steel. Dr. Blackall prefers bark also in the debility consequent to dropsy after an acute disease. In the exhibition of these tonics the utmost care is necessary that they are not given in an inflammatory state of the system, nor while the tendency to inflammation remains; but when by bleeding, digitalis, and other evacuants, the effusion has nearly disappeared, and the urine recovered its natural state and quantity, tonics will complete the cure, and secure the patient from a relapse. The action of the remedies just mentioned is more distinctly known than that of the tonic pills of Bacher, and which we have noticed under the article ASCITES. More like cream of tartar than common tonics, these pills seem sometimes to be merely anti-hydropic, removing the effusion without inducing any increase in the urine or alvine evacuations. The dropsies in which we have found them most useful are those which occur in girls about the age of puberty, without manifest derangement of any particular organ, and we have observed them to be more useful in ascites than anasarca. The younger Bacher, in speaking of black hellebore, says that it is not applicable to cases in which the solids are firm, nor when the fibre is greatly relaxed and weakened, but when, with some degree of debility, the circulation is irregular, and determined to some particular organ. We may observe, however, that in many of the cases he has related, no such determination is indicated by the symptoms enumerated, and in our own practice they have seldom been of use, when there has been evidence of organic disease. The action of these pills, as we have already mentioned, is often imperceptible, but at other times they procure copious evacuations from the kidneys and bowels, and sometimes, according to Bacher, they cause profuse perspiration. The following is the formula of Bacher, as published by his son :R Extracti hellebori nigri, Myrrhæ solutæ, aa, Zi. Cardui benedict. pulv. ziiii. M. s. a. Fiat massa aere sicco exsiccanda, donec formandis pilulis apta sit. Singulæ ad grana sex. Ten of these pills were given three times a day. We have repeatedly cautioned medical practi [Methodical compression, where it can be employed, is often of decided service in promoting absorption; at other times, it is employed only as a support when the integuments are largely distended with the fluid of dropsy. Frequently, the benefits from compression are more apparent than real-the fluid being simply forced from the cellular membrane pressed upon by the bandage, and returning to its former position when the pressure is withdrawn.] Friction. Under the head of ASCITES, we have referred to a case in the 49th volume of the Philosophical Transactions, in which friction with oil effected a cure in an old case of ascites. We are unacquainted with the particular symptoms which more particularly indicate this remedy, but there certainly can be no objection to it in any case in which the abdomen is free from tender ness. Blisters. These sometimes afford great relief and we have often had recourse to them in our own practice. They are not, however, alway unattended with danger, and whenever they are applied, the surgeon ought to be requested to attend to their progress. We have more than once seen death hastened by the blistered surface becoming inflamed, and mortification ensuing. Scarifications. These are indeed the opprobria medicinæ. They afford relief from the pressure and weight of the effused fluid, but too often at the same time give rise to inflammation, gangrene, and death. Yet there may be cases in which the distension is so great and the distress so intense, that the operation may not only be justified, but may be demanded. Upon this head we would briefly remark, that in old and very debilitated persons they should seldom, perhaps we might more properly say, they should never be practised, and that in young persons in whom the reparative process is more readily set up, great attention should be paid to their appearance and progress. The mere presence of dropsy will make no difference as to the proper manner of treating the wounds; but if inflammation be present, or gangrene, the same local and general remedies must be recurred to, as if no effusion had existed; nor indeed is this only useful to the wounds; frequently when the fluid has escaped, the tonic and stimulating remedies which the surgical treat ment has required, have prevented the return of the effusion. Acupuncture.-This is only a milder manner than scarification, of effecting the mechanical escape of the fluid; and the remarks made upon the former are equally applicable to the present remedy. Evil consequences are perhaps less fro quent, but still they do not unfrequently occur. (See ACUPUNCTURE.) Paracentesis. Of this operation we have spoken under the head of ASCITES, nor does it appear to us necessary to add to the remarks which we have there made. Diet. The only point that remains to be noticed is that of diet, but upon this head, we do not feel called upon to make many remarks, nor should we indeed have mentioned it at all, had it not been for the vulgar opinion which formerly prevailed, that fluids ought not to be allowed to dropsical patients. Even this notice is perhaps quite unnecessary, as the error is, so far as we know, completely exploded. Sir Francis Milman first examined the question, and gave the most satisfactory evidence that the restriction from fluids was not only not beneficial, but was in many cases even injurious; and since his time, so much additional evidence has been obtained to the same purpose, that to allow dropsical patients as much fluid as they wish to drink, is becoming an axiom in the treatment of disease. It has been well ascertained that many diuretics only stimulate the kidneys in proportion to the quantity of liquid in which they are given. With respect to the nicer question of food, it seems unnecessary to make any remark: this must be varied with the nature of the dropsy, and the symptoms by which it is attended; and whoever understands the meaning of a phlogistic and antiphlogistic regimen will know how to apply either of these, or to vary from one to the other, in the disease of which we have been treating, as circumstances may require. JOHN DARWALL. Various writers have proposed divisions of the acute stage into species, and complex arrangements of this kind are to be found in systematic works. From what has been stated respecting the nature of the disease, it will be manifest that any distinction between cases of uncomplicated dysentery must be principally founded either on the degree of inflammation, or the extent of intestine affected by it. The former circumstance unquestionably gives rise to various shades of discrepancy between different cases, but admits of no precise line of demarcation by which any assemblage of cases can be contradistinguished from others. The extent of bowel implicated in the disease constitutes a somewhat more important ground of distinction, for it is supposed that in the warmer regions a larger portion of intestine is affected with inflammation than in temperate climates; and that this circumstance, coupled with certain effects produced on the constitution by a high temperature, invests the disorder named by recent writers tropical dysentery, and by Savages, dysenteria æquinoctialis, with a peculiarity of character meriting special notice. It will hence appear that uncomplicated dysentery may be considered under two heads, the first comprising that form of the disease most frequently observed in temperate climates, whilst tropical dysentery is discussed under the second. It should be remarked, however, that though the distinction between the extremes of these varieties may be very manifest, intermediate degrees will be found, and such it has not unfrequently occurred to the writer of this article to observe in the south of Europe, which might be referred with almost equal propriety to either the one form or the other. Besides these varieties in the character of simple dysentery, its complications with other diseases require attention. The following definition of dysentery will perbe found sufficiently precise:-Frequent mucous or muco-sanguinolent stools, pain in the abdomen, griping, and tenesmus, generally accompanied with pyrexia. DYSENTERY.-This word is derived from the Greek word dvaevrepía, which is compounded of dùs (difficile, ægre, male,) and Evrepov (intesti-haps num), and signifies that the intestines are morbidly affected. By Celsus the disease is named tormina, from one of its leading symptoms; and by Cælius Aurelianus rheumatismus intestinorum cum ulcere. Dr. Ballingall applies to it the not inappropriate appellation of colonitis. By certain French writers it is called colitis (colite), and in common language it is named flux or bloody flux, according as the intestinal discharges are free from blood or sanguinolent. It is placed as a genus in the class pyrexia, and order profluvia of Dr. Cullen; in the class fluxus, and order alvi fluxus, of Sauvages; and, very correctly, in the class hamatica, and order phlogotica, of Dr. Mason Good. Division of the Disease. - Dysentery consists, in its early and acute stage, of inflammation of the mucous membrane of the intestines, especially of the colon and rectum. This inflammation, by implicating the other coats of the bowel, and by generating ulcers, nay produce extensive and very intractable disorganization, giving rise to symptoms less acute than those of the early stage, but bearing a considerable resemblance to them. Hence it appears that there is a natural division of the disease into an acute and chronic form; the first consisting of inflammation, the second of its occasional effects, supervening on attacks of the acute disease, which have been imperfectly treated, or which our art has proved too feeble to subdue. The uncomplicated dysentery of temperate climates.-Premising that many degrees of intensity are found in this affection, from the slight sporadic case in which the general health is but little de ranged and no danger threatens life, to the widewasting epidemic which has proved the scourge of fleets and armies, we shall present a sketch of as mild a form as the disease is almost ever observed to wear. A case of this description may commence with feculent and liquid stools, and they may become subsequently mucous, with occasionally a slight admixture of blood; or, they may be of the latter character from the beginning. There is little if any fixed pain in the abdomen; but considerable griping previously to the patient's rising to the night-chair, with a peculiar sense of working or commotion in the bowels, often referred to the situation of the sigmoid flexure of the colon; there is generally some heat at the anus, but the sensation extending thence up the rectum is one rather of irksomeness than of heat, and it induces very distressing straining, constituting the affection called tenesmus; the dejections do not exceed seven or eight in the day, and after they have acquired the mucous or sanguinolent character, traces of feculent matter are occasionally percepti ble in them. Dysury is rarely observed, dyspnoea never, though both of these morbid states are very general attendants of more severe cases of the disease; the appetite is generally impaired; the thirst is considerable; the tongue is sometimes furred, occasionally natural, and the pulse is little, if at all, quickened or affected with. respect to its force. The mean duration of this slight form of the disease is from seven to eight days; it may be said to be never fatal, but it not unfrequently lays the foundation of chronic dysentery, and often leaves such a tenderness of the bowels as renders them more prone than before to morbid action from cold or other causes. We should presume that the inflammation in such a case as this was slight in degree, and limited to the rectum and inferior portion of the colon. A more intense form of the disease than that which has just been described, will be found of frequent occurrence when dysentery is prevailing epidemically. This more severe disease may be preceded by diarrhoea, which we have observed to be a very general precursor of dysentery in whatever climate we have witnessed it; or it may occur without this premonitory symptom. Occasionally a well-marked rigor, followed speedily by febrile heat, introduces the disease; whilst, in other cases, the first symptom is pain in the bowels, to which the mucous stools characteristic of dysentery in a short time succeed. In many instances some slight derangement of the stomach and bowels, indicated by flatulency, costiveness, inappetency, nausea, and occasionally vomiting, is experienced for some days before the attack. When the disease is fully formed, the characteristic mucous or muco-sanguinolent stools are passed very frequently, with great pain, an extreme degree of straining, and a feeling as if the viscera themselves were about to be discharged. Feculent stools occasionally intervene between the dysenteric discharges, and pure blood is sometimes voided in considerable quantity, especially in an advanced stage of the disease. After the disorder has subsisted some days, it is not unusual for the patient to void portions of a substance resembling suet, tallow, or flesh. A sense of heat, or, as the patients express it, burning at the anus, extending thence up the rectum, and which becomes excessive when there is a call to empty the bowels, is much complained of. When fever has occurred from the commencement of the disease, it of course subsists throughout its progress; and in cases in which it has not existed from the first, it usually arises when the intestinal disorder has become so fully formed as we are now describing it to be. There is a warm skin; a hard, generally frequent and small pulse; the tongue is either covered with a white mucous coat, or it is dark and dry; there is great prostration of strength, and the urine is scanty, high-coloured, and is passed with pain and difficulty. The griping which precedes each evacuation is very distressing throughout the disease; but only in an advanced stage, and in a case which has held its course uninfluenced, at least beneficially, by treatment, is there much if any permanent pain in the abdomen. When it occurs, it is generally situated in the hypogastric region, and is increased by pressure. Its presence, especially if it is accompanied by fulness and tenVOL. I.-91 3 L sion of the abdomen, may be generally considered as a bad omen, as indicating that the inflammation has extended to the exterior tunic of the bowel. Dyspnoea is frequently observed to co-exist with the symptoms, denoting that the peritoneal surface of the intestines is affected. Throughout the disease there is loathing of all solid food, and the thirst is great, sometimes intense; and it is attended with this distressing circumstance to the patient, that in many cases everything which is taken to allay it produces tormina, and an instantaneous and irresistible impulse to go to stool. Should no relief be afforded by the remedies employed, the prostration of strength becomes great; the pulse feeble, with coldness of the extremities; the tongue either furred and brown, or glazed, red, and aphthous; the discharges from the intestines are dark and offensive; the mind is low and desponding; hiccough is an occasional symptom, and death sometimes takes place in a period varying from a fortnight to three weeks from the commencement of the attack. But much more frequently, even in bad cases, some mitigation at least of symptoms is obtained, and the disease degenerates into a chronic form. Restoration to health may be expected when there is diminution of pain in the abdomen, of tenesmus, and of the frequency of the discharges, and especially if, instead of the mucous or mucosanguinolent dejections, the stools become natural. An abatement of the febrile symptoms and thirst, and a return of appetite, are favourable signs; but all favourable symptoms are to a certain extent fallacious, for after a truce of a few days we may discover that we have that insidious and slowly. wasting disease, chronic dysentery, to combat. This description, which comprises the two extremes of the disease as it has fallen to our lot to observe it in Europe, is drawn from personal observation. For an account of dysentery as it occurs between the tropics, we must be indebted to the able men who have witnessed its ravages in those regions. Tropical Dysentery. The following is Sir G. Ballingall's description of tropical dysentery, or, as he very properly terms it, colonitis. "The form of flux now under consideration commences in general with much of the appearance of a common diarrhoea; frequent and unseasonable calls to stool, with an irresistible inclination to strain over it. The evacuations are generally copious, of a fluid consistence, without any peculiar fœtor; sometimes streaked with blood, and at other times a small quantity of blood is voided in a separate form, unmixed with the fæcal matter. The pulse, in this stage of the disease, is seldom altered; the heat of the skin is not perceptibly increased, and the tongue is frequently but little changed in its appearance. There is always a great prostration of strength and depression of spirits; the former symptom being always strongly dwelt upon by the patient; the appetite is indifferent, and the thirst urgent. To these symptoms succeed a fixed pain in the hypogastrium, more or less acute; the pain extending to, and peculiarly urgent in, one or both ileac regions, and sometimes to be traced along the whole course of the colon, with a sense of fulness, tension, and ten derness upon pressure; and on applying the hand to the surface of the abdomen, a preternatural de- | but in cholera it is generally absent. In cholera gree of heat is frequently perceptible in the integuments. The evacuations now become more frequent and less copious; they consist chiefly of blood and mucus, or are composed of a peculiar bloody serum, which has been very aptly compared to water in which beef has been washed or macerated. A suppression of urine and distressing tenesmus now become urgent symptoms; the indifference to solid food increases, while there is an uncontrollable desire for liquids, particularly cold water, which the patient prefers to any drink that may be offered to him, and from which he expresses his inability to refrain, though prepossessed with the idea of its being injurious. The tongue is now generally white and furred; sometimes, however, exhibiting a florid, smooth, and glassy appearance, with a tremulous motion when thrust out; the skin is either parching hot, so as to render it even painful to retain the hand in contact with it, or covered with profuse perspiration, insomuch that it may often be observed standing in large drops on the surface; the pulse is still frequently but little affected; sometimes, however, it assumes a febrile quickness, without any other remarkable feature; at other times it will be found without any increase of velocity, but full and bounding, with a peculiar thrilling sensation under the fingers. This state of the pulse, whenever it takes place, always denotes extreme danger, and shows that the disease is rapidly hurrying on to the final stage, in which the lassitude and dejection so conspicuous throughout its course are now converted into the utmost degree of anxiety, depression, and fear of death. The patient generally shows an inclination to dwell upon symptoms which to a spectator would appear of minor importance. He evinces the greatest reluctance to part with his medical attendant, though fully sensible how unavailing the efforts of medicine are likely to prove. The discharges by stool, which are frequently involuntary, are now accompanied with the most intolerable fœtor; they are frequently mixed with shreds of membrane, and quantities of purulent matter; a protrusion of the gut, forming a complete procidentia ani, takes place; and cases are not wanting where a portion of the inner coat of the intestines amounting to some inches has been thrown off in a state of mortification." (Observations on Dysentery, p. 49.) It is needless to say what must be the result of such a case as this, unless it is efficiently succoured in an early stage. Diagnosis. The only diseases with which dysentery can possibly be confounded are cholera, hemorrhoidal flux, and diarrhoea. the alvine discharges are copious, and are passed with violence; the very reverse is the case in dysentery, and the former disease is attended with spasms of the extremities, which are not perceived in the latter. The tumours at the margin of the anus; the blood flowing from the commencement of the disease unmixed with mucus; the comparative absence of tenesmus; the freedom from abdominal pain; and the solid nature of the feculent discharges, which are observed in hemorrhoids, will secure us from confounding this disease with dysentery. The distinction between dysentery and diarrhoea is easily drawn, in the more advanced stage of the former disease, from the mucous and sanguinolent condition of the alvine discharges; but the testimony of the writer must be added to that of Sir James M'Grigor and many others in proof of its extreme difficulty, in many cases, in an early stage. If it is then to be found at all, it must be sought in the character of the prevailing epidemic rather than in that of any individual case submitted to our observation. We believe that the pathological condition in dysentery, and in cases of severe diarrhoea, is in its nature the same; but that the inflammation of the lining of the digestive canal is more intense and enduring in the former than in the latter disease. In both cases, the first effect of this inflammation is the rapid expulsion of the ordinary contents of the intestinal canal; but the inflammation existing in dysentery remains after the canal is entirely emptied, and gives rise to those secretions from the lining membrane which constitute the discharges characteristic of the disease. In certain cases, those unpreceded by diarrhoea, the site of the inflammation in the lower part of the bowels seems to have the effect of retaining the natural contents of the canal, and of causing, from the first, evacuations consisting merely of matters secreted from the bowels. From the description given of epidemic choleric fever, (see CHOLERA,) it will be manifest that from the moment the choleric stage is fully formed, no confusion can arise between this disease and dysentery. The spasms, serous discharges, and early collapse of the former disease, are extremely distinctive. But in the incipient stage of the two disorders, some difficulty might be experienced, which would, however, be dispelled by a reference to the character of the prevailing epidemic. In this view of the diagnosis of intestinal affections attended with increased discharge, it is impossible not to be struck with the strong relation which in their rudimental stage they generally bear to each other—a relation which cannot but lead to the suspicion, that, however widely differ fully formed, the primary pathological condition is, in all, if not identical, certainly closely analogous. The rapidity of the march of cholera, compared with the long duration of dysentery, is alone an important ground of distinction between them.ent in character and danger they may be when Cholera occasionally ceases in twenty-four hours, and perhaps never lasts beyond a week; whilst the mean duration of dysentery is probably about a fortnight; and many cases endure for months. Chronic Dysentery.-This may be considered Vomiting is a uniform attendant of cholera, and as almost a more distressing termination of the is seldom observed in dysentery; the purging, acute form than death itself, for recoveries from it during a considerable part of the course of dysen- are rare, and it is fatal after an amount of protery, is mucous or muco-sanguinolent, whilst its tracted suffering which is extreme. The fever prevailing character in cholera is bilious. Tenes- which attended the acute form subsides, and a nus is a most distressing symptom of dysentery, temporary recruiting of strength and appetite is |