PATHOLOGY. 
or, in other words, excitement of thofe veflels. Whe¬ 
ther this excitement bedeferving of the name of inflam¬ 
mation has been difputed. It is, however, a queftion of 
no great moment. We (hall have occafion to (how, when 
the filbjeft comes before us, that the two above-mentioned 
Kates are, as far as regards the mucous membranes, very 
clofely allied ; and in the prefent cafe, even if inflamma¬ 
tion be not the mode of action primarily eftablifhed, dif- 
feCtion (hows that it is almoft always unequivocally and 
extenflvely prefent in fatal cafes. 
It has been objected againfl confidering this difeafe as 
inflammation of the bowels, or enteritis, that the latter 
difeafe is uniformly accompanied with eoflivenejs and fup- 
prefled fecretion. It mull; be noted, however, that a 
diftinCtion (hould be made between inflammation as it 
affeCls the exhalent orifices of veflels, and the fame aCtion 
affeCting the blood-veflels more extenflvely. As far as 
regards the bowels only, it feems very clear that diarrhoea 
and dyfentery are the fame difeafe, fince increafed and 
morbid fecretion are in each apparent. Dyfentery, how¬ 
ever, appears to affeCt a larger extent of the fyftem than 
the former complaint; and indeed we cannot help coin¬ 
ciding with Dr. J. Johnfon in confidering that we mud 
look to aferiesof caufes rather than to a proximate one 
for illuftrating the nature of this difeafe. From the la¬ 
bours of this author and of feveral of his contempora¬ 
ries it is made evident, that the (kin and liver are the 
parts primarily affeCted in dyfentery. jThe difeafe hap¬ 
pens for the mod: part in warm climates, where of courfe 
thefe organs are fubjeCted, as is well known, to the influ¬ 
ence of debilitating agents. It happens too, mofl com¬ 
monly, when wet or damp weather fupervenes to that 
which was airy and warm. That fuch change of tempe¬ 
rature (hould produce this difeafe in fome cafes, while 
enteritis or other maladies are caufed by the fame agent 
' at other times, can only be accounted for on the afiump- 
tion of predifpofition to difeafe. Thus we (hould be in¬ 
clined to think, a priori, that hepatitis, cholera, and dy¬ 
fentery, might be brought on by the fame caufes, according 
to the debility which the habits or conditutionof the indi¬ 
vidual affeCted might produce in a particular part of the fyf- 
iem : and this accords with the experience of the bed prac¬ 
titioners. In faCt a little confideration (hows us, that this 
opinion may be pu(hed much further. In cold climates 
the lungs are the organs which undergo the greated de¬ 
gree of flimulation from the atmofphere; and hence, if 
the cutaneous perfpiration be checked, we find a vica¬ 
rious difcharge take place on the bronchial membrane, 
and pneumonia and phthifis become common. So, the 
liver being the part mod called on for exertion in warmer 
climates, and the whole of the digedive powers being 
weakened in the fame ratio, we find, in thefe fituations, 
that the hindrance of the cutaneous difcharge caufes 
larger afflux of fluids to the abdominal vifcera, and a con- 
fequent diflurbance of function. 
Stimulating and indigefiible diet, which is often ufed by 
the European in tropical climates, has been mentioned as 
another caufe of the prevalence of dyfentery ; and Mr. 
Bampfield (Practical Treatife on Dyfentery) is of opi¬ 
nion, that the peculiarities of clothing may be looked to 
as another caufe. He fays, “ The copious perfpiration 
of the newly-arrived European becomes accumulated, 
when he is fitting or walking, on the lower part of the 
(flirt, more especially about that part of the abdomen 
where the wailtband of the fmall-clothes or pantaloons 
prefles againd it, the tight or clofe application of which 
occafions an increafe of heat and of perfpiration at this 
particular part during the day, and intercepts the exha¬ 
lation as it flows down the body ; hence, if he (hould lie 
down in this date, cold will be induced on a particular 
part of the abdomen, by the evaporation of the exhaled 
fluid from the wet linen in contaCt with it; perfpiration, 
before profufe, will be now effectually fuppreffed, and its 
injurious confequences be felt by the chylopo'ietic vif- 
_ c'era.” - 
It. is a propofition almofl proved, then, that the (kin 
Voe. XIX. No. 1294. 
155 
is firfl affeCted in dyfentery, and that a vicarious difcharge 
of mucus takes place from the bowels. The doppage of 
the perfpiration induces moreover a general plethora of 
the abdominal vifcera; and, as the liver commonly par¬ 
ticipates in the inaCtion of the veflels of the furface, this 
important gland, and probably other glands, fail to un¬ 
load this plethora by fecretion ; fo that not only is a great 
difcharge thrown on the bowels, but, the latter organs 
being infufficient for its removal, a generally plethoric 
and febrile date is eflablifhed. The irritation made on 
the nerves of the bowels by the morbid fecretions induces 
irregular and violent contractions of the mufcular fibres; 
and hence we explain the occurrence of pain, tenefmus, 
and retention of faeces, as well as of thofe permanent 
ftriCtures which are fometimes found in thefe parts on dil- 
feCtion. 
The firfi notice of this difeafe is generally a fenfation 
of chillinefs and flight rigour ; to this fucceed anorexia 
and uneafinefs in the bowels ; in a few hours this is fol¬ 
lowed by griping and purging, attended with tenefmus, 
during which mucus only is evacuated ; at the fame time 
febrile fymptoms make their appearance ; the (kin be¬ 
comes hot and dry ; and reftlefl’nefs, and fometimes deli¬ 
rium, occur; an indefcribable languor foon after this 
pervades the mufcular fyflem, blood is poured forth 
(when from the reCtum in flreaks, when from the higher 
parts of the bowels perfectly mixed) with mucus. Severe 
pain and inceflant purging attend the motions, emitting 
little odour, and often containing membraniform lymph. 
If the complaint continues uninfluenced by medicine, or 
receives no relief from the exhauflion of the veflels by 
their fpontaneous action, death occurs with the ufual 
fymptoms of high inflammation and mortification. Or, 
if the difeafe does not arrive at this termination, a chro¬ 
nic date of the difeafe is induced, which, lading for a 
longer or (horter time, ends in Ample diarrhoea, in ulce¬ 
ration of the villous coats, in permanent contractions, 
or more favourably and lefs frequently in recovery. 
The degree of violence with which the fanguineous 
and nervous fyflems are affeCted is various. Sometimes 
the pulfeis little altered ; and in this cafe we feldom find 
much blood in the flools, but merely mucus and ferum, 
and thofe in fmall quantities. A pain in the abdomen is 
felt juft before each evacuation, and at that period only. 
From this (late we find every grade of fever, and increafe 
of the other fymptoms in proportion, until we arrive at 
a variety in which the pulfe is accelerated to an amazing 
height, and delirium manifeft ; in which there is a con- 
ltant fixed acute pain of fome part of the abdomen or 
inteftinal canal, including the parts contained in the pel¬ 
vis ; obftinate retention of faeces, but very frequent and 
copious dejeftions of mucus, ferum, or blood, or a mix¬ 
ture of thefe, together with fevere tormina and tenefmus. 
The blood drawn and concreted exhibits the inflamma¬ 
tory buff. Sometimes the fever is of the intermittent or 
remittent kind. 
The cure of dyfentery is founded on the following indi¬ 
cations : viz. to remove the violence of morbid aCtion, 
left inflammation, and its fatal confequences, (hould come 
on ; to reftore the balance of the circulation ; and, laftly, 
to correCt the altered (late of the fecreting veflels of the 
inteftines, and allay the contraction of the mufcular coats 
of the fame (truCtures. The firft is, of courfe, done by 
bleeding. Sydenham ufed this meafure, though not to 
any important extent; and it was not till after the late 
war on the peninfula that its ufe became general. 
As to the extent which bleeding (hould be carried to 
in dyfentery, no general rules can be given, fince this mult 
be regulated rather by its effects on the pulfe than by 
quantity; and in faCt it fometimes happens that fo little 
fever attends, that bleeding is unneceffary. In violent 
cafes bleeding ad deliquum (hould be had recourfe to, 
fince, as in all other complaints characterized by in¬ 
creafed vafcular aCtion, the fuddennefs with which we 
abftraCt blood is of great importance. 
As the (teces are retained notwithftanding the urgency 
S s for 
