ap

tion of Diarrhoea; and from that enumeration it will pear, that many, and indeed the greater part of the cases of diarrhoea, are to be considered as sympathetic affections, and to be cured only by curing the primary disease upon which they depend; of which, however, I cannot properly treat here. From our enumeration it will also appear, that many of the cases of diarrhoea which may be considered as idiopathic, will not require my saying much of them here. In many instances, the disease is ascertained, and also the cause assigned, by the condition of the matter evacuated so that what is necessary to correct or remove it will be sufficiently obvious to practitioners of any knowledge. In short, I do not find that I can offer any general plan for the cure of diarrhoea; and all that I can pretend to do on this subject, is to give some general remarks on the practice that has been commonly followed in the cure of this disease.

;

1496.] The practice in this disease has chiefly proceeded upon the supposition of an acrimony in the fluids, or of a laxity in the simple and moving fibres of the intestines; and the remedies employed have accordingly been, Correctors of particular acrimony, general demulcents, evacuants by vomiting or purging, astringents, or opiates. Upon each of these kinds of remedies I shall now offer some remarks.

1497.] An acid acrimony is, upon several occasions, the cause of diarrhoea, particularly in children; and in such cases the absorbent earths have been very properly employed. The common, however, and promiscuous use of these, hath been very injudicious; and where there is any putrescency, they must be hurtful.

1498.] The cases in which there is a putrid or putrescent acrimony prevailing, have been, I think too seldom taken notice of; and, therefore, the use of acids too seldom admitted. The acrimony to be suspected in bilious cases, is probably of the putrescent kind.

1499.] The general correctors of acrimony are the mild diluents and demulcents. The former have not been so much employed in diarrhoea as they ought; for, joined with demulcents, they very much increase the effects of the latter and although the demulcents, both mucilaginous and oily, may by themselves be useful, yet without the assistance of diluents they can hardly be introduced in such quantity as to answer the purpose.

*

*Lintseed tea is both diluent and demulcent; but as the patient sometimes loaths it, we may in its place use a decoction of marsh-mallow root, or of quince seed. These infusions and decoctions ought to be extremely thin. An ounce of bruised quince seed will make three pints

1500.] As indigestion and crudities present in the stomach are so often the cause of diarrhoea, vomiting must therefore be frequently very useful in this disease.

In like manner, when the disease proceeds, as it often does, from obstructed perspiration, and increased afflux of fluids to the intestines, vomiting is perhaps the most effec tual means of restoring the determination of the fluids to the surface of the body.

It is possible also, that vomiting may give some inversion of the peristaltic motion, which is determined too much downwards in diarrhea; so that upon the whole it is a remedy which may be very generally useful in this disease.*

1501.] Purging has been supposed to be more universally necessary, and has been more generally practised. This, however, in my opinion, proceeds upon very mistaken notions with respect to the disease; and such a prac tice seems to me for the most part superfluous, and in many cases very hurtful. It goes upon the supposition of an acrimony present in the intestines, that ought to be carried out by purging: but, if that acrimony has either been introduced by the mouth, or brought into the intestines from other parts of the body, purging can neither be a means of correcting nor of exhausting it; and must rather have the effect of increasing its afflux, and of aggravating its effects. From whatever source the acrimony which can excite a diarrhoea proceeds, it may be supposed sufficient to evacuate itself, so far as that can be done by purging; and as in cholera, so in the same kind of diarrhoea, it will be more proper to assist the evacuation by diluents and demulcents, than to increase the irritation by purgatives.

1502.] If, then, the use of purgatives in diarrhoea may be considered, even when an acrimony is present, as superfluous, there are many other cases in which it may be extremely hurtful. If the irritability of the intestines shall,

of water as thick and ropy as the white of an egg: hence a drachm is sufficient for a pint of the decoction.

We have another instance of a diluent and demulcent in the almond emulsion, which is an exceedingly elegant medicine. The formulæ in both the London and Edinburgh Pharmacopoeias are not well adapted to cases of diarrhea: for the former contains sugar, and the latter bitter almonds; both of which ingredients increase the irritation. In these cases, therefore, an emul sion made with sweet almonds and gum arabic, is preferable to either of the others: as,

R. Amygdal. dulc. decorticat. 3i.

Gum Arabic. 3i.

Tere in mortario marmoreo, et adde gradatim,

Aq. font. lb. i.

M. f. Emuls.

The methods of giving the tartar emetic, for producing either vomiting or sweating, may be seen in the notes on article 185.

from affections in other parts of the system, or other causes, have been already very much increased, purgatives must necessarily aggravate the disease. In the case of lientery, nobody thinks of giving a purgative; and in many cases of diarrhoea approaching to that, they must be equally improper. I have already observed, that when diarrhoea proceeds from an afflux of fluids to the intestines, whether in too great quantity, or of an acrid quality, purgatives may be hurtful; and, whoever, therefore, considers the numerous and various sources from which acrid matter may be poured into the cavity of the intestines, will readily perceive, that in many cases of diarrhoea, purgatives may be extremely pernicious.

There is one case in particular to be taken notice of. When, from a general and acrid dissolution of the blood, the serous fluids run off too copiously in the cavity of the intestines, and excite that diarrhoea which attends the advanced state of hectic fever, and is properly called a Colliquative Diarrhoea; I have, in such cases, often seen purga. tives given with the most baneful effects.

There is still another case of diarrhoea in which purgatives are pernicious; and that is, when the disease depends, as we have alledged it sometimes may, upon an erythematic inflammation of the intestines.

I need hardly add, that if there be a case of diarrhoea depending upon a laxity of the solids, purgatives cannot there be of any service, and may do much harm. Upon the whole, it will, I think, appear, that the use of purgatives in diarrhoea is very much limited; and that the promiscu ous use of them, which has been so common, is injudicious, and often pernicious. I believe the practice has been chiefly owing to the use of purgatives in dysenteric cases, in which they are truly useful; because, contrary to the case of diarrhoea, there is in dysentery a considerable constriction of the intestines.*

1503.] Another set of remedies employed in diarrhoea are astringents. There has been some hesitation about the

*Nothwithstanding all the author advances concerning the danger of purgatives in a diarrhea, there are some cases in which they are of singular utility. His arguments in this article are doubtless just; and, in the species of diarrhea which he here enumerates, purgatives are certainly hurtful: but many instances of diarrhoea occur, which proceed from an acrimony that is. extremely tenacious, and that adheres closely to the internal surface of the intestines, or is retained in their folds. In such cases, purgatives are the only remedies for removing the disease, and ought therefore to be used. In all other cases, as the author justly observes, they are cer tainly pernicious. Having ascertained when purgatives are proper, the next consideration is, what purgatives ought to be used? The answer is obvious:-Neutral salts, particularly Soda phosphorata, Rochel salt, Glauber's salts, and Epsom salt, which are enumerated in the order of their being agreeable, but in a contrary order to their degree of efficacy; the Epsom salt being the least agreeable, but the most efficacious.

employment of these in recent cases, upon the supposition that they might occasion the retention of an acrid matter that should be thrown out. I cannot, however, well understand or assign the cases in which such caution is necessary and I think that the power of astringents is seldom so great as to render their use very dangerous.

The only difficulty which has occurred to me, with respect to their use, has been to judge of the circumstances to which they are especially adapted. It appears to me to be only in those where the irritability of the intestines depends upon a loss of tone; and this, I think, may occur from the debility of the whole system, or from causes acting on the intestines alone. All violent or long continued spasmodic and convulsive affections of the intestinal canal necessarily induce a debility there; and such causes often take place, from violent irritation, in colic, dysentery, cholera, and diarrhoea.*

1504.] The last of the remedies of diarrhoea that remain to be mentioned are opiates. The same objections have been made to the use of these, in recent cases of diarrhoea, as to that of astringents; but on no good grounds: for the effect of opiates, as astringent, is never very permanent; and an evacuation depending upon irritation, though it may be for some time suspended by opiates, yet always returns very soon. It is only by taking off irritability that opiates are useful in diarrhoea; and therefore, when the disease depends upon an increase of irritability alone, or when, though proceeding from irritation, that irritation is corrected or exhausted, opiates are the most useful and certain remedy. And though opiates are not suited to correct or remove an irritation applied, they are often of great benefit in suspending the effects of that irritation whenever these are violent :

The astringents to be used, when they are proper, are various: as Alum, Logwood, Catechu, Rhubarb, &c. The author justly remarks, that astringents are only useful in cases of debiPity, and therefore the tonic astringents are undoubtedly preferable to any other. Rhubarb and Peruvian bark, each possessing both these qualities, may therefore be advantageously used conjointly, as in the following formula:

R. Pulv. Cort. Peruv. 3i.

Rad. Rhei, 3

M. f. Pulv.

The dose of this powder may be varied according to circumstances, from a scruple to a drachm, twice a day, with a glass of Port wine after it. It may not be improper to observe, that in diarrhoeas in general, peculiar attention must be paid to diet. The oleraceous and acescent vege-. tables must be carefully avoided; as must also all fermented liquors except Port wine: of the farinaceous vegetables, rice is the best; and rice-water, with a little cinnamon and Port wine, is the most proper drink for patients in these cases. Roasted meats are preferable to boiled; and veal, lamb, or chickens, preferable to beef or mutton. Pork is very improper; as are also all kinds of fish. Puddings of all kinds without fruit are very proper food for such patients, especially rice-puddings made without eggs, but with milk and cinnamon; and also rice-milk, sago with Port wine, blanc mange, &c.

and, upon the whole, it will appear, that opiates may be very frequently, and with great propriety, employed in the cure of diarrhoea.

1-505.] TH

CHAPTER XII.

OF THE DIABETES.

HIS disease consists in the voiding of an unusually large quantity of urine.

As hardly any secretion can be increased without an in(creased action of the vessels concerned in it, and as some instances of this disease are attended with affections manifestly spasmodic, I have had no doubt of arranging the diabetes under the order of Spasmi.

1506.] This disease is always accompanied with a great degree of thirst, and therefore with the taking in of a great quantity of drink. This in some measure accounts for the very extraordinary quantities of urine voided: but still, independent of this, a peculiar disease certainly takes place ; as the quantity of urine voided does almost always exceed the whole of the liquids, and sometimes the whole of both solids and liquids, taken in.

1507.] The urine voided in this disease is always very clear, and at first sight appears entirely without any color; but viewed in a certain light, it generally appears to be slightly tinged with a yellowish green, and in this respect has been very properly compared to a solution of honey in a large proportion of water.

Examined by the taste, it is very generally found to be more or less sweet; and many experiments that have now been made in different instances of the disease show clearly that such urine contains, in considerable quantity, a saccharine matter which appears to be very exactly of the nature of common sugar.

1508.] Doctor Willis seems to me to have been the first who took notice of the sweetness of the urine in diabetes, and almost every physician of England has since taken notice of the same. It is to be doubted, indeed, if there is any case of idiopathic diabetes in which the urine is of a different kind. Though neither the ancients, nor, in the other countries of Europe, the moderns, till the latter were directed to it by the English, have taken notice of the