prefence of a violent fea breeze: the weather has been remarkably dry and hot, and at times fultry it was impoffible to ufe the leaft exercife, without being heated; and it was almost impoffible to get heated, without being immediately, chilled by the breeze.

It is the foldier's life to be much expofed, and it is his cuftom to be careless of him felf:when he is fatigued or heated he haftens to cool himfelf in the breeze or night air; and perhaps throws off his cloaths, and often lies down and fleeps in that condition if he is wet, he dries his cloaths, linen, and skin together: -by thefe means, perfpiration, the great fountain of health in hot climates, is fuddenly stopped, and febrile ftrictures occupy the whole furface of the body.

A flux, following thefe data, will distinguish felf by an inflammatory diathefis; and its progrefs will confequently be rapid.

The general fymptoms are, a chillness in the beginning, fucceeded by feverish heats; gripings and frequent fmall motions; fickness of the ftomach, and fometimes retchings; copious purging foca follows, with green, brown, or yellow watery ftools; thefe are now mixed with, or fucceeded by, great difcharges of blood; the ftools vary in fætor and appearance, according to the periods of the difcafe, or as they are more or lefs retained: a confiderable degree of fever brings on the difeafe, and accompanies it, with fome; with others but little; fmall, bloody, flimy ftcols, continually harrafs the patient in he laft ftages, particularly at nights;

the tongue is greatly furred, and fometimes of a brown or black colour; apthe appear but feldom.

This is the general account of thofe who experience the violence of the difeafe, and furvive the firft week; but many who were feized at the fetting in of the flux this fpring, perished within that time.

The curative indications areto caufe a révulfion to the furface of the body, and to cleanfe the intestines

The difeafe being rapid, the cure depends on performing these things as fpeedily as poffible.

Experience having fhewn, that the common methods and medicines hitherto ufed, fall far fhort of obtaining the important point of revulfion in proper time, and fupporting it, the practice will ftill be deficient, if we cannot find means adequate to that purpose.

The inductive confiderations are, to bleed whenever it can be done with fafety; to cleanfe the prime via; to check the impetus with which the circulation is determined on the intestines, diftending and bursting the coats of the veffels; to remove the fpafm from the veffels of the furface of the body, and to caufe a diver. fion there: all thefe must be done immediately, that the revulfion may be effectual.

Bleeding being an operation of great confequence in the flux, the cure is generally begun with it, repeating it as the fymptoms authorife-there are but few inftances where it may not fafely be donc in the beginning of the dif eafe; the neceffity is obvious where the patient is young, plethoric, with fever and full pulfe.

After bleeding, a vomit of ipe-. cacuanha

cacuanba is to be given, which commonly relieves the ftomach from a load of acid, poraceous, bilious impurities:-but our great expectation from vomiting is, that its action on the mufcular fibres of the ftomach, forces open the extreme arterial capillaries, forwards the circulation to the furface of the body, and induces to fweat.-An opiate after its operation is necefiary.

After the vomit and opiate, it is proper to empty the bowels; but with caution in cafe the patient is weak; and in fuch a manncr as not to increase the determination of the blood there, and divert it from the furface; for then we fhould lofe the ground gained by the vomit, and counteract our principal defign.-An antimonial that acts much upon the skin, and purges at the fame time, is what I always ufe.

The prime via being cleanfed, and the revulfion begun, it muft be completed by fudorifics, that the difeafe may be thrown off by fweat. This will be effected by uniting an opiate with a diaphoretic, and adminiftering it as occafion requires. Laudanum and antimonial wine combined, is a medicine that caufes little or no irritation, and is a pleafant and certain diaphoretic: it is always neceffary in the flux, when a fweat is intended by antimonial or other emetic medicines in fmall dofes, to add laudanum, to take off their irritation; by which means, their dofes and effects may be greatly extended.

James's powder is admirably well calculated to answer the first intentions in this disease; it poffeffes this great advantage, that

though it shall effectually cleanfe the prima via properly given, it never fails to excite a plentiful fweat, and terminates on the skin.

This double operation (if I may fo call it) perhaps has made it fo decifive in obftinate fevers.

When the diaphorefis is begun, I cover my patient with his blanket, (which no foldier should be without) and take care that the wind is not admitted directly upon him. I do not fuffer him to uncover himself, but order whatever he wants to be brought to him, and fupply him copiously with warm mint, fage, balm, oatmeal tea; and now and then give him a bason of gruel, or thin flour pap, with a spoonful or' two of good found white wine, as free as poffible from acidity.

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When the fudorific process has been fuccefsfully continued, all the fymptoms grow milder; and if the patient breaks out in a rafh, or efflorefcent eruptions, or boils, the difeafe will foon vanish.

In cafe the flux continues obftinate, and the fweats do not go on kindly, it will not only be requifite to carry off the morbific humours, by a dofe of the antimonial purgative, but repeated vomits of ipecacuanha are to be given. In this cafe, the circulation has not been enough diverted from the inteftines, to produce a full and fufficient diaphorefis; it is therefore neceffary to give a fresh impulfe to the fibres, by the action of vomiting, for in vomiting, the action of the ftomach, and the contraction of the abdominal vifcera, forces the blood to the surface, and upper parts of the body.

Another caufe of obftinacy in

the

the flux, is indurated fæces lodged in the intestines ;-and though the patient hall have, been repeatedly purged, and taken nothing but fluids during his illness, it is amazing what lumps of excrement will fometimes be brought away by a repetition of the antimonial purgative, after an interval of feveral days;-for which reason, when the fweats have been plentiful, the pulfe moderate, and the flux ftill continues obftinate, we may fufpect this to be the cafe. The extraordinary appearance thefe balls of excrement fometimes acquire, from a long retention amongst diseased fecretions, have induced fome to whimfical fuppofitions concerning their caufe, and component principles.

I pursue this method, regulating it as occafion may require, or particular occurrences fuggeft, until the patient is in a condition for bark, and other tonics and corroborants.

The flux will continue troublesome in fome fubjects, from mere weakness and relaxation of the veffels, without any material gripings or feverish fymptoms:here I never hesitate to give bark with fnake-root and wine.

In all complaints of the bowels, particularly in the dyfentery, the bark fhould never be given in fubftance; it caufes irritation, and gripings; and either brings back the difeafe, or fills the patient with obftructions-a ftrong decoction therefore is ever to be ferred.

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As the flux is always increased at the approach of night; fo, for fome time after it has abated, the pulfe quickens, and the patient grows feverish in the evening.

This is an admonition, that we fhould defift from the bark, and give a gentle diaphoretic at night.

The remaining acrimony, which fometimes keeps up a fmall irritation after every other fymptom is removed, may be corrected with abforbents, and carried off before the ufe of the bark; or at any fubfequent period, if it fhould recur, with rhubarb and magnesia, or any mild cathartic.

During the convalefcent ftate of those who have been much reduced, and to pervent a relapfe, a flannel shirt or jacket, worn next the fkin, is of fingular benefit.-When the bowels have fuffered confiderably by the flux, and cannot recover their tone, but from weakness are fubject to returns of that complaint, or to diarrhoea or tenefmus, on the leaft expofition to cold; a flannel jacket worn next the fkin will be found almost a certain remedy, and preventative. Such occafional cloathing is very useful to officers and foldiers on fervice in hot climates, expofed to rains, dews, or night air; or to put on after having been wet, fatigued, or heated, that perfpiration may not be fuddenly checked, and that the body may cool gradually.

It is to be obferved, when the attack is fudden and violent, it will be neceffary to overtake the difeafe with opiates and cordials, before any recourfe to its principles can be adopted; otherwife the patient may be exhaufted and funk beyond the recovery of medicine.

Here I cannot help expreffing my concern, that the aggravated fymptoms which return in the morning, have not put an end to

the

the custom of giving pills of opium at night. When opium is given alone, and continued for any time, after its cordial effects are over, it weakens the veffels, injures the nerves, caufes a ftrangury, and lowers the powers of life: the humours, instead of being diffipated, accumulate in the diseased parts, that when the conftipation is off, the blood rufhes forth with increased violence, and accelerates the patient's end.

In the far advanced state of the difeafe, we find the mefenteric veffels and glands enlarged, and obftructed; the glandulæ peyerianæ of the inteftines thickened, their coats tumified, relaxed, abraded, and haftening into a state of fphacelation opium in this fituation muft increase and multiply every evil.

The real ufe of opium is, to arreft the hurry of the disease; to procure time to put fome rational means of cure into execution; to give other medicines their intended effect, and to ease those tormi na which fometimes are intolerable. Here the matchless power of opium raises our admiration.

In the preceding history it will appear, that the flux is not confined to particular feafons and fituations ;-that, what have been commonly confidered as univerfal remote caufes, only give the type to the disease ;-and that its general caufe, producible various ways, is obftructed perfpiration.

The flux that prevailed last autumn, was attended with many of thofe caufes that are called remote:-Auguft, September, October, and the beginning of November, were remarkably clofe,

and fultry, with frequent rains

the great discharge of perfpiration, from the rarefaction of the blood, in fuch a-feafon, relaxes the extremities of the perfpirable veffels, and fubjects them to fudden fpafin, and collapfion.

The camp dyfentery, in low, damp, marthy countries, in the autumnal feafon, has all the concomitants and type of a flux in hot climates after heavy rains ;-there will be lefs difpofition to inflam、 mation, and the fluids will tend more to a state of diffolution-yet it is a fever turned upon the inteftines, for want of a free and regular perfpiration, from the thicknefs and moisture of the atmofphere.

The irritation thus produced on the bowels, foon caufes a violent determination of blood there and as the circulation is diminished in the veffels of the furface of the body, it is increased in thofe of the intestines.

By this increased action of the arteries, the progress of the blood is impeded, in the minute ramifications of the veffels ;-hence hæmorrhage, and extravafation:an immediate revulfion is there, fore neceffary:--it must be extenfive, but fuitable, that there may be no mifchief done by increafing the debility incident to the difeafe,

Bleeding cannot be performed in every fubject, nor in every stage or condition of a flux;-cathartics only cleanse the affected parts; emetics are limited to anfwer certain purpofes; diaphoretics have never been used, in a manner nor extent fufficient to produce an effect; and the custom of expofing patients

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patients to partial currents of cold air, prevents nature from doing any thing towards the cure.

The type of the difeafe, being duly attended to, will indicate the quantity, and nature of the evacuations neceffary to facilitate revulfion; and it is fafely and effectually completed, by a careful continued courfe of fudorifics, kept up in extent proportioned to

the disease.

Thus have I communicated what I conceive to be the general canfe of the dyfentery of the Weft-Indies, which has been fo deftructive to the troops and entered into a fhort difquifition of its nature, and explained the method I have followed in its cure.I have avoided the detail of minute defcriptions, circumstances, and particular cafes, as not coming with in my defign; which is, to explain my method of cure, applicable to the caufe I have affigned of this disease, and comprised in the following confiderations ; that the dyfentery is a fever of the inteftines; that the caufe is obftructed perfpiration; and that the cure is in calling back the circulation to the furface of the body, and increafing the fenfible perfpiration by the most active fudorifics.

curing hands to take up my lent or fummer corn in the method ufually practifed in this county, that is, by forking the fwarths into cocks, and raking the ground with hand-rakes by women. Men are generally employed in forking it. It therefore occurred to me that an inftrument might be made to answer the purpofe of raking it by hand. I knew the Norfolk method of doing it by drag-rakes, (as they are cailed) drawn by men; but the men were wanting elsewhere. I had often seen a horfe-rake, made for gathering the gramen canine or couch-grafs together upon fallow lands, and knew a farmer who had used it for his mown wheat stubbles; but this rake being drawn from the end of the beam by the horse, dragging the ends of the teeth upon the ground, collected fuch quantities of weeds, grafs, earth, and ftones with it, as nearly to render the corn of no value; befides, it could not be used for clofe-mown ftubbles at all. Having for many years ufed the Norfolk ploughs here, I thought a rake might be fo conftructed as to go on the breaft-work of one of thefe ploughs in the fame manner as the plough itself is used.

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I therefore had one made nine feet and a half long, and the teeth fix inches afunder. Upon apply ing it in the place of the plough on the breaft-work, I found it anfwered extremely well, except that when it met with confi derable obftruction at one end, it drew the other end aflant. To remedy this inconvenience, I took away the pillar (the part of the breaft-work that the beam refts upon, and which is raised higher, H

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