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.

    134/976 (page 114)
    are common in various parts of the body, and the patient looks older than he is. This is the general condition, but it is liable to be modi- fied by any complication that may be present, the malarious, or syphi- litic, or scorbutic cachexia, or by hepatic disease. The condition of the patient will also depend on the extent of injury done in the acute stage to the mucous and glandular structures of the intestine, the presence or not of unhealed ulcers, the condition of the intestine as regards thickening of its coats, or the opposite state of atrophy; whether or not the lesions are bounded by the ileo-colic valve, or pass into the small intestine; and, in no small degree, on the extent to which the solid viscera, liver, spleen and kidneys are implicated. Thus it will be seen that chronic dysentery is not, as many sup- pose, merely due to abortive cicatrization of the ulcers left by the acute stage, but is often a much more complex state. I believe, and shall presently demonstrate, that Acute Dysenteiy is in a high degree amenable to early and judicious treatment. On the other hand, speaking from a large experience, I affirm that com- plete restoration to health by the unaided efforts of nature, is an ex- tremely rare occurrence; one of two things happens, either the disease destroys the patient, or it passes into the chronic form just described. Malarious Dysentery.—By this term I mean to indicate those cases in which malaria acts with a high degree of intensity on the system, developing, in addition to the symptoms already described, those which are characteristic of malarious fevers. It is in this form that we find hepatic complications most frequently present—complications which add greatly to the gravity of the disease, and unfavourably influence the prognosis: such cases will be recog- nised by the periodicity of the febrile paroxysms, the presence of gastric irritability, such as we see in remittent fevers, and by the peculiar nature of the evacuations, which from the first are serous, and contain little blood, but have the characteristic dysenteric odour. There is also a therapeutic aid to diagnosis ; ipecacuanha is not well borne, and quinine acts powerfully in checking the febrile paroxysms. Malignant Dysentery.—I have already described the conditions under which the disease is generated; it has been described as “Dy- sentery plus the typhoid condition.” From the first, the patient has a cachectic aspect, the countenance soon becomes sunken, listless, and sodden, a burning heat in the belly is complained of,, with great oppression and sinking; the voice is weak, the stomach irritable, the pulse frequent, small and compressible. The evacuations are serous and bloody, attended with tormina and tenesmus, and the dysenteric odour is intense from the beginning. For a short time alter the first burst, the stools may be muciform and bloody, but this condition does not last long; they again become abundant, serous and bloody, con- sisting of dissolved blood, serum, epithelium and gangrenous portions of semi-dissolved mucous membrane, exhaling an insupportable gan- grenous odour. The urine is scanty, scalding and foetid, and in extreme cases the secretion is suppressed entirely, as in cholera. Ihe skin is