Dysentery is a destructive inflammatory disease resulting in ulceration of the lining membrane of the bowel. It is attended with more or less haemorrhage and a copious discharge of mucus with the faeces. It differs from diarrhoea not merely in the frequency of the discharges and in their character, but also the constitutional disturbance associated with it. It has not been satisfactorily traced to the introduction of specific disease germs, nor are there any decided proofs of its greater frequency in insanitary surroundings; - more often is it attributed to causes of an exhausting character, as bad and insufficient food, and exposure to weather without preparation, and it may also arise as a sequel to diarrhoea and as the result of some poisonous matter in the blood. The presence of parasites in unusual numbers, and drinking-water in which decaying animal matter is present, are said also to be exciting causes.
In some cases profuse evacuations of a fluid consistence mark the onset of the disease, others may exhibit preliminary fever and excessive prostration. Elevation of temperature and rigors may be observed in the commencement, or be continuous in the course of the disease, accompanied by a small and irritable pulse. Abdominal pain prior to, or immediately following on the evacuation of faeces, is a common symptom, with hidebound, general marasmus, or wasting and loss of appetite. In the faeces, though fluid, may be found hardened masses as indicating quite a different condition in some parts of the canal from others, while casts of mucus, sometimes mistaken for worms, are commingled with jelly-like material and bloody shreds of membrane. A particularly offensive odour characterizes the evacuations. In fatal cases there is an increase of abdominal pain, thirst, exhaustion, and prolonged fever. Only in the stage of collapse is the temperature lowered, and it may then fall below normal. Dysentery, unlike other bowel affections, does not usually carry off its victims in a few hours, or days, but may continue for weeks. In the later stages only do we see the worn and anxious countenance associated with acute intestinal affections.
Fig. 104. - Dysentery.
More reliance is to be placed upon good nursing and hygienic conditions than actual medicines, a suitable dietary being the chief consideration. Given a warm, dry, well-ventilated stable, we have next to consider the most suitable food, which must be free from irritating-properties, easy of digestion, nutritious, and soft. In eggs and milk, gruel and meal, we have these desiderata, and they may be supplemented with port-wine, while some would add beef-tea.
When there is much evidence of pain, opium may be given in small and repeated doses. When the evacuations produce a foul atmosphere and the season compels closed doors, it may be corrected to an extent by the internal administration of carbolic acid, as well as the use of disinfectants and deodorizers in the building. If carbolic acid is chosen as an internal agent, it should be dissolved in glycerine, or rubbed up with soft soap and freely diluted in water, or given in gruel. Chlorodyne is extremely valuable in some instances, and bismuth, in powder as trisnitrate, or subcarbonate, is recommended as a means of forming a coating over the broken surface of the membrane. Maintenance of surface warmth should not be neglected; the legs should be bandaged with woollen, and the body clothed with warm wraps. Increased circulation in the skin and extremities is a favourable symptom. Despite the most assiduous care many cases terminate fatally, but the proportion of recoveries should be an inducement to strenuous efforts and unremitting care.