DYSENTERY.
This was by far the most-generally prevailing, as well as the most fatal disease in the army.
After mature deliberation, and the most satisfactory proofs, proofs nearly amounting to demonstration, I convinced myself, in India, that the dysentery of that country is a disease whose first causes lie in the biliary system. On reflection, and after looking over the accounts of my practice in the West Indies, I have little doubt but that the dysentery of that country proceeds from the same cause. In the end, I was led to think that dysentery, as it occurs in Europe, was the same disease: however, the opportunities of observation, which I had in Egypt, convinced me that I was wrong.
The dysentery which occurred in the army till we came to the shores of the Mediterranean, and for some time after, was clearly the dysentery of India; but, afterwards, we witnessed a different disease. I must confess, that, having come to so certain a conclusion, I was not ready to give up an opinion which appeared to me to rest on very sure grounds; and it was not till after much doubt, hesitation, and careful observation, that I became convinced, in Alexandria, that, with the change of country and climate, we had a different disease. This is one proof how improper, and how unsafe, it is for the practitioner of one climate to sit down and describe the diseases of another. They only who have studied the same diseases, in various and opposite climates, can fully comprehend the extreme absurdity as well as fallacy of this. From reasoning of any kind, we are incompetent to decide on the identity of disease. Reasoning from analogy here always deceives. In many of the symptoms diseases may agree; but, from thence to infer their identity is taking a very narrow view. The comparison will be found to hold good only in some points, and that we have satisfied ourselves with an imperfect outline. Between diseases, as they occur in Europe and in Asia, there are just as many shades of difference as between the plants of those opposite regions, or in the colour of the inhabitants.
The dysentery of India, or what I shall term the tropical dysentery, is not the disease which is described by Cullen under that name. The dysentery of Cullen, as it is faithfully described by Sydenham, Pringle, Monro, and Sir George Baker, is a frequent disease on the continent of Europe; and it has ever been a most destructive disease in our armies there. The dysentery of Europe I believe to be generally a disease of the intestinal canal. I have already said that the tropical dysentery proceeds from a different cause; but the diseases likewise differ much in their symptoms. The “pyrexia contagiosa” certainly forms no part of the tropical dysentery; and the torminia and tenesmus occur so rarely, that, in a definition of this disease, I presume they cannot be admitted. Spasmodic affection of the intestinal canal, I believe, rarely occurs in the tropical dysentery.
I have ever experienced difficulty in distinguishing dysentery from diarrhæa, and am inclined to think, that, in Cullen’s definition of diarrhæa, is described tropical dysentery. The diarrhæa biliosa, as well as his seventh species, the diarrhæa hepatirrhea, perhaps, ought to be included in a definition of tropical dysentery.
It has been already mentioned, that it was the tropical dysentery which principally prevailed in the army. Though I was not convinced that we had a different disease, till after we came to Alexandria, yet I am inclined to think that it was the European disease which chiefly prevailed in the army for some time before; and, if we draw the line from November, we shall not be far removed from the truth.
It will not be necessary to say much in the treatment of tropical dysentery. Mercury is now the remedy relied on every where. In Egypt, we felt the want of nitric acid in hepatitis; and we equally felt the want of this powerful remedy in dysentery. The instances which have occurred to me, during the last five years, are extremely numerous, where, after our failure with mercury, exhibited in all the variety of its preparations, we succeeded with this remedy sometimes as a substitute, and sometimes as an auxiliary.[7]
It was in the 61st regiment that cases of the dysentery of Europe were first observed. Perhaps it more readily appeared in this corps, because the greatest part of the men had not yet got rid of the European habit, and were as yet unassimilated to a warm climate. After repeated failures, and losing some men, Mr Ruxton saw the necessity of giving trial to other remedies than mercury.
The disease generally set in with a smart fever, and, unless the calomel exhibited went through the bowels, the patient felt no relief: and Mr Ruxton remarked, that the neutral salts gave this relief much more perfectly than calomel. The treatment which Mr Ruxton rested on, and with which he was at length successful, was, in most cases, putting the patient on the anti-phlogistic regimen; frequently giving laxatives; and keeping up a determination to the skin. The same practice was followed in the few fresh cases which occurred in the 88th regiment at Alexandria, and in a considerable number of cases in the hospital of the 10th regiment, and some other corps. However, it must be mentioned, that to the last period some cases did occur, in all these corps, where calomel was found necessary. When the disease was of some weeks standing, and where a chronic disease occurred, calomel given in small doses proved the best and indeed only useful remedy.
For a long time, we saw but little dysentery in the army. The number of cases which occurred, before we arrived in Lower Egypt, was inconsiderable.
In September, a great many cases occurred in the neighbourhood of Rosetta, and in the camp at El Hammed; but many of these were the sequelæ of the fever contracted at Rhoda. In October, the number of cases was greatly on the increase. The rainy weather with which the month of November began, and which continued during the following months, brought a prodigious increase of dysenteric cases. In the general return of the first week in November, there appear one hundred and sixty cases, and one hundred and twenty-three of these are Europeans. Most of the natives were from the Bengal volunteer battalion.
In the first general return in December appear two hundred and nineteen; of which one hundred and forty are Europeans.
After leaving the encampment at El Hammed, and getting into dry, comfortable barracks, at Alexandria, the disease occurred more rarely in the army.
In the last return of January, only one hundred and sixty cases are seen.
In the last return of February, the total number of dysenteric cases in the army was fifty-four, and only twenty-two of these were natives of India.
In the last return of March, there appear nineteen cases, fifteen of which were Europeans.
There are only twenty cases in the last return of April, and these cases are equally divided between the Europeans and Indians.
At the time of embarkation the number was even less than the above.
The disease was more frequently met with among the European artillery, and in the 61st regiment, than in any other corps. Among the native corps, the Bengal battalion had more of the disease than any other. I made inquiry, but could find no reason that could with probability account for this.[8]
I have continued longer on the subject of dysentery than was at first my intention. I will confess, that I think it is a subject on which I could with more propriety speak than on any other. My opportunities of seeing the disease have been no common ones. Rarely, I believe, has it fallen to the lot of an individual to see so very many cases of one disease in such a diversity of climate and situation. In the 88th regiment, during the course of upwards of ten years, I saw the same men the subject of this disease on the continent of Europe, in America, in both extremities of Africa, and in India. Of late, it has afforded me not a little amusement to review my notes as well as my journals of practice in this disease, in all these quarters.
I have now both given some account of the endemic diseases which we met with in Egypt, and offered a few remarks on those diseases which were most prevalent in the army. They are the diseases which constantly prove the most fatal to an army in India. The few which now remain, or (if I may be allowed the expression) the minor diseases, will not long detain us.