Repeated small Doses of the Ipecacuana, from four to six Grains, operated both as an Emetic, and kept up a Purging; but they made the Men so sick, that we could not prevail upon them to continue their Use. Mr. Francis Russel told me, that, in the Year 1756, he found a few Grains of Rhubarb added to each Dose, made it operate more as a Purgative, and did not make the Men so sick.—Dr. Akenside proposes giving the Ipecacuana in so small Doses as one or two Grains every six Hours, in a Draught made of Mint-water, and Half a Drachm of confectio cardiaca; and, after bleeding and vomiting once, seems to depend almost entirely on the Use of this Medicine for the Cure of the Dysentery. See his Comment. de Dysenteria, cap. 2.
The watery Tincture of Rhubarb, recommended by Degnerus, we tried in some Cases at Bremen; and found it to be a good mild Purge, but not to answer so well as the Salts and Manna in recent Cases. Mr. William Russel told me that they found this watery Tincture of Rhubarb to answer better in America than any other of the Preparations of Rhubarb.
Calomel has been recommended by many as a Purge in Dysenteries; and Dr. Huxham (de Aere, Vol. II. P. 100) assures us, that he has often experienced the good Effects of it, especially when the Patient at the same time had Worms; in such Cases we joined it to Rhubarb as mentioned in the Text, or gave a Calomel Bolus over Night, and a Purge next Morning. Dr. Duncan, Physician to his Majesty, told me, that he found the following Method of Cure always successful in the Dysentery, which was epidemic in London in the Year 1762.
If the Patient was Plethoric, or had much Fever, he ordered more or less Blood to be taken away; and then gave four Ounces of the following Julep, every Half Hour, till it both vomited and purged. ℞ Tartar. emetic. gr. iij Mannæ elect. Unc. ij solve in Aq. hordeat. Lib. 1.—The next Day, and for five or six Days more, the Patient took so much of a Decoction, of Manna, Tamarinds, and soluble Tartar, as kept up a free Discharge by Stool.—If the Irritation and Griping were severe, he found that a Solution of Manna, in the common Almond Emulsion, was sufficient.
When the Pain, or Tenesmus, was violent, a Clyster, of Chicken Broth, or of an Infusion of Linseed, with an Ounce or two of Oil of sweet Almonds dissolved in the Yolk of an Egg, injected once or twice a Day, was of great Use.
Upon the whole, he was always pleased when he saw large excrementitious Stools come away; and when that could be procured by a gentle Method, he was the more pleased.
This Disorder was very often cured in a few Days, and in that Case he dropt the further Use of Medicines; but when it exceeded the Period of six or seven Days, he then added thirty or forty Drops of the tinctura thebaica to the Clysters; and ordered a Scruple of the Extract of the Logwood to be taken thrice a Day in some proper Vehicle.
The Patient’s Diet was Rice-Gruel, Sago, Panado, and such like; no Animal Food, not so much as Chicken-Broth, was allowed in the Beginning of the Distemper, nor even Oil, Butter, or Fat of any Kind. The common Drink was Almond Emulsion, Rice-Water, or Barley-Water with Gum Arabic.
Dr. Duncan lost but one Patient out of Eighty, whom he had under his Care that Season; and he was delirious, had a high Fever, and a subsultus tendinum before the Doctor was called to him, and he died the next Day.
The late Dr. Young, of Edinburgh, seems to have had a very just Notion of this Disorder, and of the proper Method of treating it; for, in his Treatise on Opium, sect. vii. he says, “I am convinced from Experience, that most of the Dysenteries I have hitherto met with, might have been cured by purging mildly, but constantly; and at the same time abating the Acrimony in the great Guts by emollient Clysters, and in the small ones by Plenty of Absorbents, and a Diet of Chicken Broth: But it must be observed with regard to Purgatives, that Manna agrees best with some, Rhubarb with others, Jalap, Mercury, and toasted Rhubarb with others; while others are sooner cured by emollient Clysters. I use Opium only when the Disease is mild, or after its Violence is abated by Evacuants and Emollients.”