Diagnosis

The diagnosis of acute dysentery is usually very easy. The symptoms above described, being ordinarily present, cannot fail to indicate the disease. The most reliable evidence is afforded by the character of the dejecta, the presence of mucus, an admixture of blood and pus corpuscles. Appendicitis is occasionally simulated by dysentery if the pains involve principally the appendicular region. Usually, however, it will be found that, besides the tenderness over the appendix, there are also similar areas of pain over other portions of the large bowel, especially in the left iliac fossa. Besides, the character of the stool will help to reveal the true condition.

The diagnosis of chronic dysentery- is usually somewhat more difficult. Repeated examinations of the faeces will, as a rule, reveal the presence of amoebae at one time or another and thus aid in discovering the disease. Many diseases of the rectum, as for instance proctitis, rectal polypus, and cancer, often present symptoms similar to those of chronic dysentery. A careful local examination, however, will clear up the diagnosis without difficulty.

Prognosis

Dysentery must always be considered a quite serious disease. Even the mild form is at times liable to assume a dangerous character. On the whole dysentery must be regarded as a treacherous and insidious malady. In general it must be said that cases of sporadic dysentery or of the epidemic form appearing in the cold and temperate zones take a much milder course and thus present a more favorable prognosis than does the endemic dysentery of hot climates. These remarks apply to both acute and chronic dysentery.

Treatment Of Acute Dysentery

The patient must be kept abed and put on a diet consisting of liquid food (milk and strained barley water, bouillon, bouillon with egg, egg water, tea). Ipecacuanha has been found of great benefit in this disease. It may be given, according to Sodre, in the following combination:

Powdered ipecacuanha..........

0.1

(gr. ij.)

Powdered opium...........

0.02

(gr 1/3)

Calomel.............

0.05

(gr.3/4)

In capsules, one to be taken every two hours.

In case the evacuations contain very small quantities of fecal matter, it is best to give a cathartic, as a large dose of castor oil (one to two tablespoonfuls) or sodium or magnesium sulphate one teaspoonful twice during the day. The purgative, however, should be administered only on the first or second day of the disease, and not be kept up for a long time. In order to allay the pains, hot poultices are applied over the abdomen and opium is administered. Thus, Dover's powder may be given in three-grain doses every two or three hours. This medicament may also be combined with salol, subnitrate of bismuth, tannigen, tannalbin, etc. The tenesmus, if severe, must be subdued by suppositories containing opium and belladonna, and by washing out the bowel with a quart of water containing a teaspoonful of essence of peppermint, which can be done once or twice in twenty-four hours. Astringent solutions have been recommended as injections for the large bowel. They are not, however, of great benefit in acute dysentery. Besides the points just mentioned, the condition of the patient must be carefully watched and every complication treated by itself. The high fever may necessitate the use of an antipyretic; the weak action of the heart analeptic drugs, etc.

As soon as the severe symptoms are allayed and the patient is on the way to recovery the diet can be cautiously increased.

Treatment Of Chronic Dysentery

If the patient is living in an endemic centre of dysentery, it is best to send him to another climate. The hygienic surroundings of the patient should be carefully selected. The food should be well prepared. The patient should eat often, not too much at a time, and should avoid all coarse and highly seasoned substances. Tannigen gr. viii. three times daily or benzo-naphthol in the same dose, or subnitrate of bismuth gr. xxx. t.i.d., can be advantageously given. Sometimes these drugs are combined with codeine or opium. Here local remedies play a prominent part. Loesch was the first to recommend injections into the bowel of solution of quinine (1:5,000); tannic acid, nitrate of silver, permanganate of potassium have also been employed in clysters with good results. Harris very recently recommended the use of hydrogen dioxide. The ordinary commercial hydrogen dioxide is diluted from four to eight times with water and the solution injected. About a quart is injected twice daily for about a week and then gradually decreased. Harris has seen very good results from this mode of treatment.

In cases in which there is an exacerbation of the disorder, the same mode of treatment may be required as in acute dysentery.