If the Patient was attacked with severe Gripes[38], and a Tenesmus, which the Purgatives and gentle Opiates did not relieve, we ordered the Abdomen to be fomented with warm Stupes; and the Patient to drink freely of warm Barley or Rice-water, or of weak Broth[39], or an Infusion of Camomile Flowers, as recommended by Dr. Pringle; and ordered first Clysters of large Quantities of the plain emollient Decoction to be given; and if the Gripes still continued, to be repeated in small Quantities, with the Addition of a Drachm or two of the tinctura thebaica; for we observed that Opiate Clysters often gave more Relief, than Anodynes administered in any other Way; and sometimes, when a Tenesmus was very troublesome, the common oily Clyster, with a little Diascord, and tinctura thebaica, or the Starch Clyster, gave more Ease than any other.—In some Cases, where the Pain was sharp, attended with a Fever, we were obliged to take away more or less Blood; and sometimes also to apply a Blister to that Part of the Abdomen where the Patient felt most Pain.
During this Course, the Patients used the common low Diet of the Hospital; when they loathed the Rice-Gruel, they had Panado with a little Red Wine and Sugar; or Water-gruel, when it could be got, in its Place.—Their common Drink was Barley or Rice-water; of which it was recommended to them to drink plentifully; as nothing contributed more to the Cure than the free Use of such Liquors, to dilute and blunt the Acrimony of the Fluids[40]. In some Cases, when the Purging was violent, and not accompanied with the malignant Fever, the decoctum album was found to be a good Drink; and we added occasionally a few Drops of the tinctura thebaica.
Such were the chief Remedies we used in the first Stage of this Disorder; but after some Weeks, when the Fever had abated, and free Evacuations had been made, and the Complaint become in a manner chronic, we were obliged to try other Methods; and found that the best Way of treating this Disorder, was, to endeavour to brace and restore the Tone of the Intestines, by means of the corroborating and gentle astringent Medicines, mixed with Opiates; while mild Purgatives were given at proper Intervals.
The Patients were kept to the same low Diet as before, with the Addition of a little Wine or Brandy. They were allowed from a Gill to a Pint of red Wine per Day, which was commonly mulled before it was given them; when the Wine griped them, which it frequently did, they took in its Stead Half a Gill or a Gill of Brandy, mixed with a Pint or a Quart of Barley or Rice-water, or of the decoctum album.
In this Stage of the Disorder we found, that the same Medicines would not answer with all, and therefore we were obliged to try Variety[41]; and indeed, unless where the Violence of the Disorder had abated by the Use of Evacuations, the Event was always very doubtful; for when the Complaint had continued long and become chronic, and the Structure of the Intestines was much hurt, before the Sick were sent to us; or when it continued obstinate, and yielded but little to Evacuations, and the other Methods used in the first Stage, even Remedies esteemed the most efficacious oftentimes proved unsuccessful, and at length the Patient died.
A Spoonful of the mixtura fracastorii, taken after every loose Stool; and an anodyne Draught at Night, had a good Effect with some—Repeated Doses of the philonium Londinense answered better with others, who were low, and required a Remedy that was warm and cordial—And others found more Benefit from the Mindereri Draughts, with Mithridate, or the confectio cardiaca, or the Theriac anodyne Boluses.
The mixtura Campechensis, both alone and with tinctura thebaica, checked the Purging, and gave Relief sometimes; and the Addition of some of the Extract of Bark and Tincture of Cinnamon, seemed to encrease its Efficacy in one or two old Cases, at Bremen; but it afterwards occasioned such Sickness, that we did not continue its Use.
In other inveterate Dysenteries, where we thought that a strong Astringent was wanted, we added a small Proportion of Allum to the Campechense Julep, which on first using seemed to be serviceable; but at other Times it occasioned a Tenesmus and Gripes; and therefore we were obliged to be very cautious how we used it.
Equal Parts of the electuarium diascordii and electuarium corticis, taken in the Quantity of a Drachm twice or thrice a Day, was of Use in many old Fluxes[42], though it made other Patients so sick, that they were obliged to lay it aside.
We tried likewise in this Stage of the Disorder, repeated small Doses of the Ipecacuana; but it occasioned such Sickness, that we did not persist in its Use.