Statistical report on the sickness and mortality in the Army of the United States : embracing a period of sixteen years, from January 1839 to January 1855 / compiled from the records of the Surgeon General's Office ; prepared under the direction of Thomas Lawson by Richard H. Coolidge.

  • Coolidge, Richard H. (Richard Henry), 1816-1866.
Date:
1856
Catalogue details

Licence: Public Domain Mark

Credit: Statistical report on the sickness and mortality in the Army of the United States : embracing a period of sixteen years, from January 1839 to January 1855 / compiled from the records of the Surgeon General's Office ; prepared under the direction of Thomas Lawson by Richard H. Coolidge. Source: Wellcome Collection.

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    while I will not deny that quinine was often abused in Florida, during 1841, and that bowel affections might (but of this I will not be positive, though I will not deny it) at times be traced to this abuse, yet I cannot shut my eyes to the facts, that malarious fevers and bowel affections often owe their origin to one cause; that the increase of fever and bowel affections in 1840, &c, went pari passu; and, finally, that diarrhoea and dysentery commenced being more frequent and obstinate before quinine was used, either largely or in large doses, in Florida. Nor must it be forgotten, that length of exposure alone to the heat of the south, to the fatigues undergone, &c, must have rendered the mucous membrane of the bowels more irritable and obnoxious to disease. Hence, the longer troops remain in the south, within a period of four or five years, the more frequent, ceteris paribus, may we expect dysentery to be. On the whole, then, I am disposed to think that much of the outcry against quinine is the result of preconceived notions. Among the older physicians, bark and enlargement of the liver and spleen were inseparable companions; so were dysentery, and organically or functionally diseased liver; hence the transition was easy to the conclusion that the use of quinine would produce dysentery. This is a part of those doctrines which taught, among other things, that bark is more efficacious in the treatment of fever than quinine. Now, all these doctrines may be true, but I have yet to see the demonstration of their truth. 8th. The effects of the climate of Florida are, an increase of the nervous excitability, impair- ment of the powers of the digestive organs, and a general feeling of feebleness, not inaptly ex- pressed by the terms enervated or relaxed. Such are the results in the healthy portion of the country. When malaria is added (and it very generally is) to the high degree of temperature, malarious fevers in all their varieties of intermittent, remittent, continued, and congestive, together with diarrhoea and dysentery, are induced. Nine-tenths, if not a greater proportion of the diseases of Florida, may be ranged under one or other of these heads. Liver affections are, I think, of rare occurrence in Florida, if we except the trifling functional derangements which are met with in fever. The temperature is not sufficiently high, and uni- formly so, to produce them with any degree of frequency. This fact receives confirmation from the remarks made by Johnson, in his work on tropical climates, under the head of hepatic affec- tions.* My dissections, too, confirm this conclusion; for I rarely met with any other (to me) appreciable deviation from the natural condition of the liver than the fatty degeneration conse- quent upon a life of intemperance. From the fact that quinine was largely used in Florida, and that I rarely met with diseased livers, enlarged spleens, or dropsies consequent upon fevers, I must acquit this drug of the charge often brought against it, of inducing these affections. When they do exist, 1 am more inclined to attribute them to the depleting means often too liberally employed (dropsies), to the continued action of malaria, and to repetition of paroxysms of fever, which should have been checked at once by some anti-periodic. If epidemics show a strong tendency to fasten upon some particular organ, physicians evince an equally strong one to follow their example. Until lately, the liver has nearly filled up the pathological anatomy of some physicians of our country, and calomel their therapeutics. So often have I seen patients drugged for bile and liver affections, where none existed; so very rarely have I seen unequivocally diseased livers in dead bodies, that I look with suspicion on those cases so often spoken of under the vague terms of hepatic derangements and congested livers. Nor do I extend to them a greater share of confidence when they are reported in con- nexion with the use of quinine, and said to exist as a pretty constant cause or part of dysen- tery, f These notions are so much opposed to my own observation, and savor so strongly of ° See his comparison between tbe coast of Coromandel and the plains of Bengal. f I might remark that the curative influence of mercury over dysentery (confessedly great), can be explained on more satisfactory principles than by its action on the liver. Mercury cures sclerotitis and iritis, but hardly, I suppose, by acting on the liver. I have opened many bodies dead of dysentery, but have seen few diseased livers. S. 96 87