Dysentery : with special reference to the disease as studied in Persia

Abstract

TREATMENT OF COMPLICATIONS AND SPECIAL FORMS OF DYSENTERY: I. Liver abscess. It would be quite outside the scope of this thesis to discuss fully the treatment of hepatic abscess; here, I can only indicate very briefly the present mode of treatment.Immediately when symptoms of congestion of the liver make their appearance in any case of dysentery, intestinal antiseptics should at once be employed, and when the diagnosis of liver abscess is quite clear, ipecacuanha should be dropped (40). Personally, I would suggest leaving off earlier, or not giving the drug at all in cases where congestion of the liver was suspected.The medicinal treatment of liver abscess is merely to put on poultices and apply counter-irritation over the region of the liver, and to go on treating the dysentery and fever.The old expectant treatment has now passed away for good, (at least it is to be hoped that it has.). It used to consist in watching and hoping that the pus would become absorbed, or that it would burrow and find a way out for itself by bursting into the right lung and thus being coughed up, or into the intestine to be discharged by the bowel. They feared to operate because the old open method of opening the abscess gave such a high mortality.The present treatment first proposed and carried out by Manson, is purely surgical. Briefly put, it consists in exploring the liver with a needle for pus, and the diagnosis being confirmed by having found it; the surgeon then proceeds to plunge into the liver a specially constructed trocar and cannula, the trocar is removed and the abscess is drained. Out of five cases operated upon in Ispahan, Persia, three died and two made a good recovery. We noticed in the three who died, that they commenced going down hill as soon as bile made its appearance. They went on draining away almost pure bile and rapidly became exhausted. The two who recovered lost no bile.There has been much controversy over this operation — many have not hesitated to call it unsurgical, working in the dark, etc., but the results gained have proved that it is a great advance upon the old method, which although a much more serious operation, yet did not give nearly such good results as this new method.II. Continuous fever. If the fever is very high give twenty to thirty grains of Antipyrin, otherwise proceed with the treatment of the dysentery.III. Malaria. In every case of dysentery it is as well to examine the patient's blood and search for the malarial parasite. When malaria complicates dysentery, Quinine must be given in full doses either by the mouth or by intramuscular injection, alternating with full dosss of Ipecacuanha (23) or salines. If the dysenteric symptoms intermit, the chances are that the dysentery is merely symptomatic of the malaria and it is best to treat with full doses of Quinine only.The Quinine will also probably be-sufficient to check the haemorrhages which are often characteristic of Malarial dysentery, if not, Ergotin must be injected. Davidson speaks of a special form of Caecal dysentery accompanied by malaria and great prostration in which Ipecacuanha is contra-indicated. In its stead he recommends Quinine, small purgative doses of Castor oil combined with 20 to 30 minims of oil of Turpentine, also frequent small doses of wine. (1). The malarial dysentery which attacked the troops in Mauritius in 1867, resisted all forms of treatment except large doses of Perchloride of Iron.In all cases of malarial dysentery change of air is urgently needed.All the iron preparations are useful in dysentery where there is any malarial taint.IV. Haemorrhage. When this complication occurs in dysentery from the erosion of an intestinal blood-vessel, if the source of the bleeding be situated in the Rectum or Sigmoid flexure, astringent injections may prove sufficient to stop it; if not, or if the bleeding occurs from a site higher up in the bowel, a full dose of Ergotin (mx) must be injected hypodermically.V. General Peritonitis following perforation of an ulcer. Case is then hopeless, the only treatment being to keep the patient under the influence of Morphia.VI. Toxaemia, giving rise to typhoid symptoms. The treatment is the same as that already indicated for gangrenous dysentery, but give large enemas of warm water containing either Carbolic Acid, Permanganate of Potash, or Oil of Turpentine. If there is much fever present five grains of Quinine may be given three times daily. If abscesses appear they must be opened and drained antiseptically. (23).VII. Scurvy. Scurvy in combination with dysentery renders the prognosis much graver. Milk diet is absolutely essential in the treatment, and if possible, the milk should be fresh and unboiled. Plenty of fruit, e.g., grapes, oranges, pomegranates or guavas should be given, the patient being warned to reject the skin and stones, or better still if able to be procured, fresh lemon and limejuice. Bael fruit has been recommended in the form of sherbet. If the motions contain dark liquid blood, give Pernitrate of Iron; if it fail Oil of Turpentine m 15 to 30. If Ipecacuanha is being given, it is wise to combine it with Opium.Davidson remarks "there is a dysenteric Scorbutus as well as a scorbutic dysentery, the drain on the system causing scorbutic spots to appear." (2). Then the more urgent indication is to stop the dysentery.VIII. Rheumatism. When this complication appears in cases of dysentery, local applications (e.g., Opium and Belladonna) generally prove sufficient, the affected joints being wrapped up in wool and swathed in flannel.Day (50) during the South African war observed a case of synovitis complicating dysentery which shewed an apparent exacerbation of the dysentery at the time of the onset of the synovitis. It started at the metatarsophalangeal joint of the great toe, and shewed all the symptoms of acute gout but would not yield to treatment. The patient suffered a good deal of pain; the temperature varied from 99° to 102*6° F. Salicylates pushed to salicysm had no effect, but local anodynes gave relief. The ankles and knees also became affected. The attack gradually aborted, and the patient became convalescent.IX. Paralysis. This complication of, or sequel to dysentery is associated with anaemia and debility and indicates the need for tonics, e.g., iron, quinine, nourishing diet, and if necessary, constant or interrupted currents of electricity. (23).X. Typhus or Typhoid. If one or other of these diseases complicate a case of dysentery, the treatment will vary according to which disease predominates, and also according to the general condition of the patient.