Dysentery

“ Collapse Types.—In the most severe types of dysentery we may have an abrupt onset with rigors and vomiting and a high fever. This fever gives way to a subnormal temperature and the patient shows signs of collapse and such a case may die without having passed dysenteric stools. The abdomen is rigid and very tender on palpation.
Entero-dysentery.—In those cases where the process extends to the lower portion of the small intestine the general symptoms are much more severe although the tenesmus is less and the stools less frequent and more voluminous. ”

“ The characteristics of this type of dysentery, at all events of that type of bacillary dysentery which has received of late so much attention, are acuteness of onset, often a well-marked initial fever, little tendency to relapse after the initial attack, the presence of Bacillus dysenteriœ in the stools, an initial diphtheroid necrosis of the mucosa of the large intestine, non-liability to abscess of the liver, occurrence in epidemic form and in all latitudes, and in the lunatic asylums of this and other countries. ”

“ The case 471 in which there was none was not so much a case of dysentery as of inflamed bowels, brought on by the man having drank to excess of spirits while he was recovering from a dysentery. The acute tormina which always occur in the first days of the disease seem owing to an inflammation, which terminates in ulcers; and these being constantly irritated by the sharp humours, produce the tenesmus, which is the symptom most essential to dysentery in the after part of the disease. Any diarrhœa may in this manner become dysenteric. ”

“ DYSENTERY (from the Gr. prefix δυσ-, in the sense of “bad,” and ἔντερον, the intestine) , also called “bloody flux,” an infectious disease with a local lesion in the form of inflammation and ulceration of the lower portion of the bowels. Although at one time a common disease in Great Britain, dysentery is now very rarely met with there, and is for the most part confined to warm countries, where it is the cause of a large amount of mortality. (For the pathology see Digestive Organs.) ”

“ This stage of the disease is generally attended with a small obscure pulse and cold extremities, but I have seen it in some particular cases otherwise.
... When dysentery is epidemic, it is not uncommon for people who escape the dysentery itself to have their stools altered from their natural colour to sometimes a greenish hue, as if they had eaten much herbs, sometimes of a clay colour, and sometimes quite blackish, as if they had eaten a quantity of blood.... ”

“ It is impossible to trace the subsequent history of dysentery in England by the usual statistical means of the Registrar-General’s tables of the causes of death, for the reason that dysentery, a rare and curious disease of all ages in this country, is merged with diarrhoea, one of the commonest causes of infantile mortality. ”

“ Lastly, dysentery is a disease which may recur repeatedly in the same individual, one attack rather predisposing to than preventing another.
ETIOLOGY.—Dysentery is an omnipresent disease. "Wherever man is," Ayres observed of it nearly a quarter of a century ago, "there will some of its forms appear." But the character of the form, and more especially the extent and severity of the disease, vary in extreme degree with the conditions surrounding the abode of man. No one of these conditions affects the disease so markedly as the climate. ”

“ Cælius Aurelianus gives a very comprehensive description of dysentery, the principal symptoms of which are fever, anxiety, rumbling of the belly, sometimes retention of urine; tongue rough, furred, and black; tenesmus and pungent pains of the intestines and anus. The disease, he says, consists of a defluxion from the belly with ulceration, and is preceded by diarrhœa, cholera, or inflammation. He animadverts upon the treatment of others with his usual freedom. Thus he blames Erasistratus for using nothing but astringents, whereas many cases of dysentery require laxatives. ”

“ Anything approaching a scientific description of dysentery is as yet impossible. I am obliged, therefore, in describing the clinical features of dysentery to adopt an arbitrary and unscientific classification; and to deal with effects before discussing possible causes, symptoms before etiology.
Symptoms.— In ordinary cases the leading symptoms of dysentery are those of inflammation of the great intestine namely, griping, tenesmus, and the passage of frequent, loose, scanty, muco-sanguineous stools. The illness commences in various ways insidiously or suddenly ”

“ Many attempts have been made to induce dysentery by the injection of animals, or by feeding them with material— stools, liver pus, cultures— containing amœbæ. In a proportion of instances, especially where injections were used, amœbic dysentery has resulted. But as it is impossible to secure the amœba in pure culture, unless it may be in liver pus, these experiments are open to the objection that the successes depended possibly not on the amœbæ present, but on other micro-organisms of a pathogenic nature unavoidably introduced at the same time. ”

“ An acute case of catarrhal dysentery generally subsides without lesions, and the natural duration of the attack may be much abbreviated by proper treatment. Specific or epidemic dysentery lasts from two to four weeks, or, becoming chronic, continues for years or for life, with exacerbations and remissions.
Various complications are liable to occur in the course of the disease. Three deserve especial mention—viz. affection of the joints (rheumatism) , paralysis, and abscess of the liver. ”

“ Although dysentery is a disease of the large intestine, its lesions are not exclusively limited to this structure. It is always a purely local disease at first, and, strictly speaking, continues so throughout its course, yet it produces in severe or chronic cases widespread and general effects. Rapid emaciation sets in, and anæmia is soon pronounced in all the internal organs. The mesenteric glands show signs of irritation or of absorption of specific products in hyperæmic pigmentation and hyperplasia. ”

“ In obstinate chronic dysentery it is often a good thing to change the diet from slops to solids, from a meagre to a more liberal one. The quantity of food is as important as the quality. Chronic dysenteries should eat no more than suffices to maintain their weight. Large meals must be avoided, and food should not be taken unless there is appetite. ”

“ The fluxes that arose in the fleet were either what may be called the acute idiopathic dysenteries, or a dysenteric state of the bowels from neglected diarrhœas, which was most apt to occur in the convalescent state of fevers, or in men labouring under the scurvy. The body is more susceptible of infection in a state of weakness from these or any other causes; and in hot climates the dysentery seems to be more infectious than fevers; for at hospitals it was so frequently 470 communicated to men who were ill of other complaints, that it was in these the principal cause of mortality. ”

“ The only point which seems admissible is that this disease, which Moussu considered to have analogies with chronic sporadic dysentery in man, is due to one or several organisms, which develop in the intestine and produce toxins, causing diarrhœa, without, however, marked inflammation of the intestinal mucous membrane. ”

“ One c.c. of the filtrate of freshly isolated dysentery cultures injected intraperitoneally is fatal to a rabbit. In two experiments on man, one intentional, the other accidental, ingestion of the pure cultures was followed, within a short time, by well-marked symptoms of dysentery. The bacillus agglutinates with the blood serum of " epidemic dysentery in dilutions of 1 in 10 to 200.* [1] Furthermore, Shiga claims by immunizing animals to have produced a serum which has reduced the mortality in " epidemic " dysentery in Japan from about 35 per cent, to 9 per cent. ”

“ The germs of dysentery often water-borne.— Notwithstanding the vast amount of speculation, time, and work expended in endeavouring to ascertain what the germ or germs of dysentery may be, it cannot be said that as yet we are even near the complete solution of the problem. ”

“ Paratyphoid infections may give the clinical picture of a colitis and such cases at times show a large amount of blood in the dysenteric stools. Usually the symptoms are rather those of an entero-colitis or a gastro-enteritis.
3. In Japan, dysentery-like epidemics of a very fatal disease, termed ekiri, occur among young children. The organism is very motile, producing gas and acid in glucose, but not in lactose media. It is reported at times to show indol production. ”

“ The dysentery prevailed, in the summer of 1777, in the military hospitals of New-Jersey, but [274] with very few instances of mortality. This dysentery was frequently followed by an obstinate diarrhœa, in which the warm bath was found in many cases to be an effectual remedy.
21. I saw several instances of fevers occasioned by the use of the common ointment made of the flour of sulphur and hog's lard, for the cure of the itch. The fevers were probably brought on by the exposure of the body to the cold air, in the usual method in which that ointment is applied. ”

“ There is heat, tenderness, and bearing down about the outlet of the bowel, with considerable prostration and probably some fever; there is frequently a constant desire to pass water. All these symptoms may be due to severe ordinary diarrhœa; but in the tropics it is best to treat them as if they were dysenteric. Some guide may be obtained as to the form of dysentery from which the patient is suffering by taking his temperature. ”

“ It appears, that though the proportion of fevers had increased somewhat this month over that of fluxes, yet the former were less fatal; and, I think, the true dysentery is more frequent in this climate, and more apt to prove fatal in its acute state, than in the West Indies. I have indeed preferred the term flux to that of dysentery, for this reason, that the symptoms in many cases did not rise so high as properly to constitute dysentery; and the disease proves fatal in the West Indies more frequently in the chronic than in the acute state. ”

“ This siege of typhoid had been preceded by one of dysentery earlier in the season, but this first appearance of dysentery was directly traceable to the water, for at that time the sterilizing plant had not been installed, and men had been working for some time in the shaft from which Hibbing got its water supply. I was told by a local physician that they could predict, in that town, an epidemic of typhoid after one of dysentery—dysentery appearing to make the system especially susceptible to the former disease. ”

“ Dr. Balfour tells us, in his account of the intestinal remitting fever of Bengal [42] , that it often appeared with symptoms of dysentery, rheumatism, and pleurisy. Dr. Cleghorn and Dr. Lind mention many cases of the bilious fever appearing in the form of a dysentery. Dr. Clark ascribes the dysentery, the diarrhœa, the colic, and even the palsy, to the same cause which produced the bilious fever in the East-Indies [43] ; and Dr. Hunter, in his treatise upon the diseases of Jamaica, mentions the locked jaw as one of its occasional symptoms. ”

“ Assuming that there are several specific causes for dysentery, it is to be expected that the corresponding primary lesions should differ; that whilst one causes a suppurating or a gangrenous lesion, another may produce a croupous or a diphtheritic; that whilst one species of dysenteric germ attacks the mucosa, another species may select the submucosa; one may attack the glandular structures, another the connective tissue, another the epithelial layer. ”

“ The infection is epidemic, endemic, or sporadic in its occurrence." In quite recent times a bacterium of dysentery has actually been isolated, and we have evidence enough both in Fiji and in Futuna (New Hebrides) , where in February, 1893, the Empreza, a labour ship from Queensland, landed a child suffering from dysentery, and caused the death of nearly a third of the population by dysentery during the following six months, [92] to show that dysentery is highly contagious. ”

“ Generally in August and September we have People admitted into St. George’s Hospital for the Dysentery; who have certainly not catched the Disorder from eating of Fruit, but from working in the Fields, and being exposed to Causes similar to those which produce the Dysentery in Camps.
[30] Most Authors, who treat of the Dysentery, mention this Symptom of Worms; and Dr. Huxham tells us, that, in some Seasons, he has seen round Worms in the Stools of most of the Dysenteric Patients. ”

“ Dysentery has been bad for a long time, and when the sick get helpless and their condition offensive, it is almost impossible to get anyone to care for them unless they have near relatives. Dysentery and measles have both been epidemic for a long time, and nearly all deaths are directly due to one or both of these diseases. ”

“ It is heart-rending to have to attend a bad case of dysentery in a child,—the writhing, the screaming, the frequent vomiting, the pitiful look, the rapid wasting and exhaustion, make it more distressing to witness than almost any other disease a doctor attends. ”

“ The night air is to be carefully avoided, and all communication with the sick. Bad smells are likewise to be shunned, especially those which arise from putrid animal substances. The necessaries where the sick go are carefully to be avoided.
When the first symptoms of the dysentery appear, the patient ought immediately to take a vomit, to go to bed, and drink plentifully of weak warm liquor, to promote a sweat. This, with a dose or two of rhubarb at the beginning, would often carry off the disease. ”