Volume 1

A system of medicine / edited by J. Russell Reynolds.

Date:
1866-1879
Catalogue details

Licence: Public Domain Mark

Credit: A system of medicine / edited by J. Russell Reynolds. Source: Wellcome Collection.

    128/976 (page 108)
    or, after much destruction of the glandular and mucous tissues of the great intestine and much suffering, to an imperfect recovery. Still, this form of the disease, when early seen and well treated, gives a hhdi ratio of speedy and complete recoveries. The duration of the disease is from nine days to three weeks. It may prove fatal on the eighth or ninth day, or death may not take place until the end of the third week; this termination is ushered in by sudden cessation of abdo- minal pain, increased fluidity, and gangrenous effluvia of the stools, and delirium. In the malarial form, the course of the disease partakes of the periodic nature of the complication. There are remissions and exacerbations of the febrile symptoms, the solid viscera of the ab- domen are apt to be deeply implicated, and hepatic, splenic, or renal symptoms may seriously complicate the case, and determine an unfavourable issue. The typhoid or malignant form, often with a scorbutic taint grafted on it, is the most hopeless and fatal type of the disease. This is the form seen in unsanitary camps and besieged garrisons, in beaten armies after great privations, and sometimes in armies that have not sustained any military disaster, but have the misfortune to be commanded by generals who set at nought the laws of health, as was the case notably in the first wars in Burmah and China, and more conspicuously, in the Crimea, In this form the lesions are not confined to the colon, but, passing the ileo-colic valve, extend into the small intestine. The disease runs its course in about fifteen days or less ; nervous depression is extreme, and the tendency to death is by exhaustion. Causes.—When we consider the variety of causes to which this disease has been attributed, it is impossible to admit that agents so many and various can give rise to an affection which in all climates has presented so much uniformity in its symptoms and anatomical lesions. It appears to me that many of the so-called “ causes ” of dysentery must be regarded more as active agents of propagation than of causa- tion. For my own part, I believe dysentery to be caused by the action on the blood of a poison having a peculiar affinity for the glandular structures of the large intestine. This poison I believe to be a malaria generated in the soil by the decomposition of organic matter. Once a common and fatal disease in this country, it is now so rare that a London hospital physician rarely, if ever, sees a case of genuine specific dysentery, save such as have been imported from malarious countries. ITow comes it that a disease with which our predecessors were -so familiar has become so rare? Many of the commonly received “ causes ” are as much in operation now as • then; c.g. the combined action of cold and moisture, the action of irritants on the mucous membrane, unripe fruit, unwholesome and indigestible food of all kinds, feculent and other accumulations