Page:Encyclopædia Britannica, Ninth Edition, v. 7.djvu/607

585 certain characters of climate and soil are known to favour the increase and propagation of dysentery. Long continued high temperature of the air and ground, such as exists in the tropics, together with a soil of swampy character, are the conditions generally present where dysentery prevails endemically, aud where it is propagated as an epidemic these factors are seldom absent. Among other causes well recognized as favouring the spread of epidemic dysentery are impure air and water, improper and insufficient food, unripe fruit, excessive indulgence in alcoholic liquors, and exposure to chills in warm weather, all or many of which have been often found connected with the propagation of dysentery among large bodies of people, as in the case of armies, where also the disease has been frequently associated with outbreaks of scurvy. The contagiousness of epidemic dysentery is generally admitted, and it is probable that in this disease as in cholera the vehicle of its transmission is contained in the matter discharged from the bowels of those affected. Dysentery manifests itself with varying degrees of inten sity, but in well-marked cases the following are the chief symptoms. The attack is commonly preceded by certain premonitory indications in the form of general illness, loss of appetite, and some amount of diarrhoea, which gradually increases in severity, and is accompanied with griping pains in the abdomen (tormina). The discharges from the bowels succeed each other with great frequency, aud the painful feeling of pressure downwards (tenesmus) becomes so intense that the patient is constantly desiring to defecate. The matters passed from the towels, which at first resemble those of ordinary diarrhoea, soon change their character, becoming scanty, mucous or slimy, and subsequently mixed with, or consisting wholly of, blood, along with sbreds of exudation thrown off from the mucous membrane of the intestine. The evacuations possess a peculiarly offensive odour characteristic of the disease. Although the constitutional disturbance is at first comparatively slight, it increases with the advance of the disease, and febrile symptoms come on attended with urgent thirst aud scanty and painful flow of urine. Along with this the nervous depression is very marked, and the state of prostration to which the patient is reduced can scarcely be exceeded. Should no improvement occur death may take place in from one to three weeks, either from repeated losses of blood, or from gradual exhaustion consequent on the con tinuance of the symptoms, in which case the discharges from the bowels become more offensive and are passed in voluntarily. When, on the other hand, the disease is checked, the signs of improvement are shown in the cessation of the pain, in the evacuations being less frequent and more natural, and in relief from the state of extreme depression. Con valescence is, however, generally slow, and recovery may be imperfect the disease continuing in a chronic form, which may exist for a variable length of time, giving rise to much suffering, and not unfrequently leading to an ultimately fatal result. Several varieties of dysentery are described in which the symptoms are modified by the association of the disease with other morbid conditions. Thus the form known as Malarial Dysentery is complicated with febrile attacks of an intermittent character, and is frequently attended with hepatic, splenic, and renal affections ; while it is most suc cessfully treated by remedies which are of value in malarial diseases, such as quinine. Again, in Scorbutic Dysentery the attack is accompanied with the great prostration char acteristic of scorbutus, and also with dangerous hemorrhage. Malignant Dysentery is the term applied to those cases where all the symptoms are present in great intensity, and progress rapidly to a fatal termination. Such cases are 585 often attended with gangrene and sloughing of the mucous membrane of the affected portion of the bowel. The dysentery poison appears to exert its effects upon the glandular structures of the large intestine, particularly in its lower part. In the milder forms of the disease there is simply a congested or inflamed condition of the mucous membrane, with perhaps some inflammatory exudation on its surface, which is passed off by the discharges from the bowels. But in the more severe forms ulceration of the mucous membrane takes place. Commencing in and around the solitary glands of the large intestine in the form of exudations, these ulcers, small at first, enlarge and run into each other, till a large portion of the bowel may be implicated in the ulcerative process. Should the disease be arrested these ulcers may heal entirely, but occasionally they remain, causing more or less disorganization of the coats of the intestines, as is often found in chronic dysentery. Sometimes, though rarely, the ulcers perforate the intestines, causing rapidly fatal inflammation of the peritoneum, or they may erode a blood vessel and produce violent hemor rhage. Even where they undergo healing they may cause such a stricture of the calibre of the intestinal canal as to give rise to the symptoms of obstruction which ultimately prove fatal. The occurrence of abscess of the liver in connection with attacks of dysentery is frequently observed. It has been ascribed to the passage of morbid material from the diseased intestine into the liver, but by many high authori ties is regarded more as a coincidence, depending upon the same climatic causes as those which predispose to the dysentery. Treatment. &quot;Where the disease is endemic or is prevailing epidemically, it is of great importance to use all preventive measures, and for this purpose the avoidance of all causes likely to precipitate an attack is to be enjoined. Exposure to cold after heat, the use of unripe fruit, and intemperance in eating and drinking should be forbidden ; and the utmost care taken as to the quality of the food and drink ing water. In houses or hospitals where cases of the disease are under treatment, disinfectants should be freely employed, and the evacuations of the patients removed as speedily as possible. In the milder varieties of this complaint, such as those occurring sporadically, and where the symptoms are probably due to matters in the bowels setting up the dysenteric irritation, the employment of diaphoretic medicines is to be recommended, and the administration of such a laxative as castor-oil, to which a small quantity of laudanum has been added, will often, by removing the source of the mischief, arrest the attack. In the severer forms of the disease, those, namely, occurring in warm climates, the remedy most to be relied on is ipecacuanha. This drug, which has long been known as possessing special efficacy in dysentery (and was originally introduced into this country from Peru as the radix auti-dysenterica has proved of signal value in the treatment of the disease in India, and, as shown by Dr Maclean, has diminished the mortality to a remarkable extent. It is administered in full doses of 25-30 grains of the powder, which are repeated in from six to ten hours, gradually lessening the quantity- the effect observable is a diminution in the pain, and in the frequency and offensive character of the stools, along with the accession of profuse perspiration and quiet sleep. Hot opiate fomentations applied to the abdomen are of use in relieving the tenesmus. Ice may be freely taken to allay thirst. The diet should be light, consisting of soups and farinaceous food. In malarial dysentery quinine is the most successful remedy, ipecacuanha being generally found, to be Unsuitable ; while in scorbutic dysentery the treat ment must bear reference to the depraved condition of the general health characteristic of scorbutus. In this form VII. - 74