AN ESSAY ON COLONIAL FEVER; WITH OBSERVATIONS ON DIARRHŒA AND DYSENTERY (As at present prevailing in Otago).

Otago Witness, Issue 654, 11 June 1864, Page 17

AN ESSAY ON COLONIAL FEVER; WITH OBSERVATIONS ON DIARRHŒA AND DYSENTERY (As at present prevailing in Otago).

Bt Jambs Bennett Clcttebbucjc, M.D.

(No. IX.) DYSENTERY, continued.

Opium — Its Use. — It will be proper to advert to the use of a remedy which has been more generally resorted to than any other in this affection— viz., opium. The effects of this drug are very uncertain, but are sometimes exemplified according to the quantity administered. Thus, in doses of two or three grains, the secretions become partially, often completely, suspended. In smaller proportions, as a quarter of a grain, or less, given at intervals of every three or four hours, it is found to induce diaphoresis. The manner in which the first of these effects is brought about is involved in uncertainty, notwithstanding the discussion and endless controversy on the subject ; its action, however, is supposed to be primarily ■ exerted on the nervous system, and, subsequently, on other parts ; suspension, partial or complete, of the functions of secretion of the mucous membrane of the intestinal canal is hence one of the results of the use of this drug. We can seldom, perhaps never, determine ar priori whether a sedative and permanently good effect will follow the administration of large doses. In the January number of the "Lancet" for 1864, Mr Skey, one of the surgeons of St. Bartholomew's Hospital, passes the highest encomium on the value of opium in the treatment of chronic ulcers, ten or fifteen drops being given night and morning for a week. He moreover says : " Judiciously employed, 00 drug in our Pharmacopoeia is more innocuous." The endeavor to palliate particular symptoms by the use of astringents, whilst the disease producing those symptoms is neglected, has elsewhere been alluded to. It might, therefore, be said that, even after blood-letting has been premised, powerful doses of this drug will rarely accomplish the object aimed at in Dysentery, besides the uncertainty attending its operation. The production of a constricted state of the muscular portion of the bowels, even were this attainable, would be but transitory, the looseness recurring so soon as the influence of an unusually large dose had been expended (this I have often witnessed on trying the experiment), and should the measure be persisted in, and to the same extent, restlessness, thirst, headache, and even vertigo ensue, without a compensative operation. Indeed, the disease then becomes masked or disguised, and, under so complicated a state of things, the most fatal mischief may be going on in the general structure or body of the intestine. Sudorifics. — Most practitioners are convinced of the propriety of using these in the majority of diseases, and by some eminent men dysentery has, been treated exclusively by such measures, and, apparently, ■ successfully.* ' Opium, in very sm ill and repeated doses, hi combination with ipecacuanha, as in the common form of Doyer's Powder, frequently induces increased action of the capillary vessels, sweating takes place, to favour which the patient should be strictly confined to his bed, otherwise exposure to the open air will completely neutralize our efforts to restore the balance of circulation between the extremities and central parts of the hody. The frequent use of the hot bath is eminently serviceable, especially at an advanced period and in the chronic form of the disease. Counter-irritation also, by the usual methods, over the abdomen, may be instituted, together with the occasional use of mild aperients at the commencement, or during the progress of dysenteric purging^ as circumstances may seem to indicate.

liqecUons, their Use. — However plausible $ie doctrine, " weakness of the vessels " of the mucous membrane might at first sight appear, if physiology be taken as a guide, and a rigid inquiry be instituted into the real merits of the - question, there seems amole reason, I think, to disprove its legitimacy; and if so, the custom of treating inflammation of the mucous membrane of the lower bowels by injections is liable to objection, notwithstanding the antiquity of such practice. None of those astringents, sometimes recommended in the present day, an^ which, if I recollect rightly, ' were apparently used with advantage by many srmy surgeons during the Peninsular war (as the 1 8olutio plumbi acetatis, &c), have, m my hands, appeared to possess the power, which has been attributed to them — that of permanent suppression of- the evacuations ; on the contrary, their introduction, through the usnal medium, has seemed to distress a patient, and increased that painful and harrassing feeling, tenemus. With respect to emollientinjections, these probably inherit no .qualities, strictly speaking, of a medicinal nature; indeed it is difficult to understand on what principle the application of a ma-

• "Mosley oa Tropical Diseases."

cilaginous fluid to the internal surface of a portion of the lower intestines, can remove or mitigate that morbid condition which I have assumed to exist in dysenteric purging. The theory of Dr. Cullen, " spasm of the vessels," being now ' generally exploded, such a measure cannot be used with a view of faking of the spasm. It has been assumed, however, that such means are calculated to protect the inflamed membrane against saline or other irritating matter contained in the secretions ; but, in order effectually to " sooth the parts" as we are accustomed to express it, the application of the agent employed should be constant, or the effect anticipated will not ensue, and it is almost superfluous to remark on the impracticability of accomplishing this object. It is to be presumed the coagulable lymph, which is so abundantly effused in this disease, is amply sufficient to protect the interior of the membrane from any fancied "acrimony of the Juices." When we consider the very trifling degree of disturbance which sometimes wises from the absorbtion of bile into the system in ca^ea of jaundice, it might reasonably be concluded that in dysentery none of the fluids secreted are capable, per se, of irritating the canal, and hence that injections of an " emollient " kind are valueless. The introduction of 20 grains of the ext. hyos., if it can be retained for an hour, has on some occasions been succeeded by a remission of tenesmus, the patient obtaining an interval of three or four hours comparative ease.

Diarrhoea is a disease so readily known, and its treatment so simple, that, on reconsideration, it would' be little better than waste of time to trespass more largely on the columns of this journal by detailing its career. The nature of this and the preceding affection is identically the same— the one consisting in inflammation of the mucous membrane of the small intestines ; dysentery in that of the large. The principles of cure are the same in both instances, modified by the particular seat of mischief and other causes. General blood-letting is rarely called for. At the .commencement, pulv. rhoei, magn. carbon —subsequently, diaphoretics and astringents, opium being exhibited with great caution, especially to infants. In a recent number of the "Lancet" the Liquor Calcis is highly commended, several children to whom it was administered by Mr. May, and whose cases are described as apparently hopeless, having rapidly recovered by its use. At the same time, however, " one grain of the compound ipecacuanha powder, with two grains of mercury with chalk, were administered, the vomiting and purging ceasing, and the children recovering from what seemed to be a fatal attack." As a combination of mean?, therefore, were used, the value of the alkaline remedy can hardly be > estimated. Should diarrhoea prove obstinate, immediate removal to the seaside is of paramount importance, the good effects of which it is impossible to over-estimate. -A milk diet appears to be the most suitable, conjoined with ground rice or other farinaceoe. On numerous occasions diarrhoea declines spontaneously, unaided by art.

I omitted in a preceding paragraph to illustrate the good effects of the joint operation of blood-letting with subsequent mercurial treatment in " Colonial Fever. 1 " As the case appeared to me hopeless, it may be usefully related :— On the morning of the 6th April, Mra GK, confined three weeks previously, requested my attendance. Her illness had commenced five days previously, and she had now been in bed two days. Every symptom clearly denoted the nature of her disease, Colonial Fever of a very severe type 5 incessant pain in the head (no uneasiness elsewhere) ; throbbing of the temporal arteries, thirst, anxious countenance, tongue thickly coated with a brown fur, pulse 120, and feeble, great prostration of strength, burning skin; had not slept for four days and nights. I had met this patient a few days previously, who was then in excellent health. Although the case was one which portended great danger, being in its second, indeed bordering on the third stage; yet, taking into consideration the fact of her previously good state jof health, I thought it possible the loss of a few ounces of blood, taken j rapidly trom - the arm, might par- j I tially relieve the inordinate action of the cerebral vessels. Accordingly, six ounces ' were removed ; one-eighth of a grain of ant. tart., with two drachms of mag. sulph. every four houra. In the evening, no perceptible amendment 5 the blood drawn was sizy -and cupped — eightleeches to the temples — evaporating lotion to the. head. 7th.— Great restlessness— ! symptoms rather aggravated ; tinct. digital. ; one drachm, liq. am. acet., an ounce, I and a half, water, four ounces ; one ounce ! every second hour. Bth. — Much/worse ; tongue dry, and dark brown, intense thirst, great prostration, with wandering pulse .125; hyd. chlorid. twelve grains, half a grain of pulv. opii, pulv. Jacob, ver. sixteen grains, divided into 6 — one every second hour; no amendment in the evening. 9th.— Gums slightly affected, pulse 110,

tongue cleaner and moist, pyrexia less severe ; discontinue all medicine. 10th. — Pain in head considerably abated — profuse sweating. 11th and 12th.— -Gradually mending. 13th. — Had a severe rigor, pain in head considerable, tongue more extensively coated, pulse 115, and strongeight leeches to the temples—repeat the powders. 14th. — Mercury again taking effect, slight salivation ; better than yesterday. 15th. — Improving. 16. — Another smart rigor, head-ache, pulse 125, tongue encrusted with a moist brown fur, has had no sleep during the preceding 48 hours ; ammon. carbon. 2 drachma, infus. cascarill 8 ounces — one ounce every second hour. 17th. — Better, but much watchfulness; 12. grain 3of extract, hyosc. at night. 18th. — Has had four hours refreshing sleep ; is generally improved. 19th. — Has had three or four slight rigors during this day ; 3 grains quinine-disulp. thrice daily; beef tea. 20th.— From this date gradual improvement took place ; and, by the 30th, she had regained her strength, having been allowed the use of any food she fancied. I have not gone minutely into this case, but enough has been stated to show the decisive benefit which accrued from the introduction of mercury at a time when the disease was hastening, as I believed, towards a fatal termination. The removal of a few ounces of blood materially assisted the action of the mineral ; in other words, its absorption was more rapidly and speedily effected by the previous loss of blood.

It would be irrelevant to the present inquiry to enter on a discussion of other forms of disease ; en passant, however, it might he stated, inflammation of the' mucous membrane of the air-passages prevails at the present time as extensively amongst children as, recently, diarrhoea or dysentery. Inflammation of the lungs in adults is also equally prevalent. In this latter case, lam persuaded the safely of a patient depends upon the judicious use of general blood-letting, and which may be resorted to many hours after the commencement of the attack ; the quantity of blood to be drawn being, of course, regulated by the duration of the disease. The " tartar emetic treatment," blistering, and the like, however useful as auxiliaries, are no adequate substitutes for the lancet, the sheet anchor in so formidable an affection, and which, as is well known, not unfrequently ends fatally within five or six days, unless arrested by this the most powerful agent at command.

la the treatment of the so-called "Colonial Fever," timely and moderate sanguineous depletion has been advocated, in order to bring the disease to a more speedy termination than usually ensues und^r ordinary treatment. The beneficial effect of the remedy (properly used) in this affection, at once, I think, disproves the spmewhat popular notion that its essence: consents in " a contaminated or poisoned condition of the blood," for it is inconceivable that the removal, by the lancet, of so small a portion of the vital fluid could influence the entire mass as to deprive it altogether of its supposed virus, ! or to render it, if present, innocuous. In dysentery, the same measure, bloodletting, has been relied upon, in order,, chiefly to preserve the structure- of the intestines—i.^., to lessen its tendency to, or susceptibility of, ulceratidn. Scepticism has been indulged in, regarding the . value of astringents (" binding medicines," as the ancients termed them), it being very problematical whether they inherit the pro r perty, strictly speaking, of causing con' tractility of any portion of the intestinal tube, or of producing an effect analogous to it. A few only of the astringent class of substances (and these, conjointly with other means) serve any really useful purpese, either in diarrhoea or dysentery ;. and how this is attained we are wholly ignorant.

'I cannot omit the present opportunity of remarking, on a custom so generally, sanctioned by parents, but which is replete with the most baneful consequences ; I allude to the practice of administering opium and wine to children, from a notion that, to relieve pain, or to recruit the strength of their offspring— one or other

of the above is imperiously demanded— hence the use of that poisonous compound " paregojic," in cases of painful dentition, or where unusual restlessness of infants prevails. In either case, a .tea-spoonful of the above is frequently 'given; in other words, nearly a quarter of a grain of pure opium ! It is truly deplorable to find the guardians of; youth adopting practices of such delusive tendency. As regards the prevailing practice of giving wine, in health as well as in disease, the expediency of the measure has been urged on the gratuitous plea—" peculiarities of climate in different regions of the globe demand t^eir exhibition." Unquestionably the speciousriess of such doctrine has procured many proselytes ; but assertion is not proof—stimulation is not strength— the vigor of childhood can be maintained by the smallest possible stimulus ; and whatever attempts may be made to distort the truth of the statement, wine (styled a tonic remedy*) employed to the extent so customary, excites and stimulates unduly the arteries of the brain 5 derangement of function fol1 lows ; and, if at this period of life there be a tendency to disease of this organ, or of its membranes, in the form of fever, water on the brain, or convulsions,^ their development is farther favored by! such agency. The children of the. peasantry of many provinces (few of vhom, it is to be credited, know ' the taste of alcohol in any form) are proofs confirmatory of the untenable nature of the proposition, that fresh vigour and" lasting strength are attainable by the method insisted on; and whatever notions' our friends in India, may have imbibed on the subject— many of whom literally /W.'their children on port wine — the juvenile ; portion in this country demands no such artificial stimulus in order to support their stamina. The attempt to provote an appetite, by the means alluded to, in a child who may evince a disinclination for food, is a3 chimerical as it ia pernicious fa its consequences. There can be little doubt that water, when it can be obtained pure, is the best, because the most natural, beverage for delicate and sickly children. To substitute alcoholic drinks, on the grounds alluded to, betrays, in my humble judgment, mistaken and delusive views, alike inconsistent with the laws of nature and of health. {Concluded.)

The "Yeoman" has some remarks upon rowing, which we would recommend to' the young men of Dunedin, who are fond of aquatic amusements- :r- rt The main object of scientific rowing, is to reduce human power to the regularity of a machine. Now every rower, however well he row, has a tendency to pall a stroke of his own, and in a scratch crew of the very be3t men obtainable, however good the time may appear, to a looker on, it is really impossible for the blades to I take the water with the same perfection as with one that has long pulled together. As » matter of course, therefore, a champion 1 crew should be selected for months before the race, and once chosen, never changed. I Whenever Melbourne-, and Sydney contest again, the crews should be chosen at least six months before, and chosen for good. But even if the men are got together long enough beforehand, and practise continually, thia will be of no avail it the stroke be imperfect. Its essence is regularity. It must be such as it is possible for human endurance ■ to pall out without the slightest variation. The moment the rower jerks on his oar it is all up with the race. Lastly, comes the great question of the training, applicable for all athletic exercises whatever. To arrive at a state of good condition strict attention to certain principles is indispensable. The general, state of the health should be improved * by the ordinary precautions of regular and early hours, cold bathing, plenty of outdoor exercise, and eschewing excesses of every description. The next point is the reduction .of &t, but not a too rapid reduction. A sharp run of a mile or two every day will do much, but the work done in the boat will do more.- The crew should begin with long, steady rows, and quicken only as they improve. A long training in so strict a course is not overpleasant, but there is no doing without it." A young lady who is better acquainted with" French than farming, was recently married t<t a farmer. In examining her new domains, she .one day visited the cowhouse, when . she thus interrogated the milkmaid. " By-the 1 by, Mary, .which of these cows is it that gives the buttermilk?", The famous. John WUkes must have teen a very uncomfortable antagonist in a duel. In iuV affair with Lord Talbot,-. the latter asked how many times they were to fire. " Just as often* as your lordship pleases," said Wilkes. "I- have brought a bag of bullets and a- flask of gunpowder." ' • ; „ , "How dreadful ihat, cigar smells!" exclaimed a banker's clerk to his, companion > " why; it's an awful smelling thing. V— " Oh, noj.it'a not the cigar, that knells," was the reply. " What is it then?" he inquired. •< Why, it's your nose that smells, of course— that's what noses are made for." • . . . , . A sailor about to be married, could not find money enough for the parson's fees, • The reverend gentleman, unwilling to tie the couple without the accustomed fee, demurred, whoa Jack, placing his hand in his pocket, drew, .out * few shillings, saying,' "Mover mind, matt, marry us as far as it will go.? : * " Mankind are apt to be 'the dupes of mif. applied terms."— Wilberforce. "' ERBATUM.—In last number, for " view," md y'rwimr." , _, I m ~i