Chronic Dysentery.

Chronic inflammation of the large intestine is usually the result of the acute form, though in rare cases it is subacute from the beginning. When not the result of an acute attack, a catarrhal condition of the rectum and colon usually precedes the disease, while wrongs of the liver and spleen are frequent. Dr. Scudder thus describes the disease:

Symptoms.—"The prominent symptom of the affection is more or less frequent discharges from the bowels, attended with more or less pain and tenesmus. The discharges vary greatly in color and character, sometimes a whitish-gray or yellowish mucus, occasionally mixed with blood, but more frequently with feculent matter. In some cases all the discharges are feculent, but of small size, and at the last part the mucus is discharged with tenesmus. In severe cases, the discharges are reddish, pultaceous, with more or less pus, and very offensive."

The small intestine may be either irritable or torpid. In the first case the feces are discharged in a fluid form; in the second, usually in hard masses, sometimes scybalous.

"In some rare cases we find more or less fluid feculent material with every discharge, and suppose from this that the small intestines are working; but the administration of a cathartic will bring away large masses of scybala.

"The condition of the general health varies greatly. Usually we find a dry, harsh skin, imperfect action of the kidneys, irregular appetite, more or less pain in the head and in various parts of the body, with great loss of flesh and strength. In some cases these symptoms are very marked, the patient being confined to his bed a considerable part of the time.

"Where the disease was contracted in a hot climate, the skin is frequently sallow and yellow, dry like parchment, or relaxed and flabby. In severe cases the disease is complicated with an intermittent fever, recurring every day, every other day, or at intervals of a week; all the dysenteric symptoms being aggravated at that time. The disease continuing, terminates fatally by exhaustion, or by ulceration and perforation, or more frequently by inducing an asthenic condition, terminating in disease of the lungs, liver, or brain."

Diagnosis.—"Chronic dysentery is one of the most easily recognized of diseases, though the condition of the bowels and complications are hard to determine. Where any doubt exists the rectum should be examined with a speculum."

Prognosis.—"Where of not very long- standing, the general health being pretty good, there is not much difficulty in its removal; but if of long duration, the general health being severely affected, and evidence of considerable structural change, the prognosis is uncertain."

Treatment.—"In the treatment of chronic dysentery we are not to forget the general character of the disease as well as the local trouble. There is usually derangement of the entire digestive apparatus, stomach, bowels, and liver. The secretions are also deranged. The skin is either dry and harsh, or relaxed and doughy. The kidneys are sluggish, and a successful treatment will necessitate the care "of the entire organism.

"A good stomachic is desirable very early in the treatment, and ihere is none better than nux vomica and hydrastin. For the kidneys, saline diuretics are of much benefit. For the sluggish liver, Podophyllin and leptandrin in small doses give good results.

"For the dysentery, white liquid physic is as efficacious in this form as it is in the acute. Where there is great relaxation, and the stools are a glairy or jelly-like mucus, bismuth subgallate and opium are among the best. Where there is general soreness, dioscorea is a most useful agent. The furred tongue, with full tissues and doughy skin, calls for the second trituration of podophyllin.

"For rectal irritation, where there is a feeding as though there was a foreign body in the rectum, colocynth is the remedy. Where the tongue is coated in patches, is moist and pallid, and the hemorrhage is passive, carbo veg., in three-grain doses of the first trituration, will prove curative.

"Where there is relaxation of the entire bowel, tincture of geranium or epilobium has been successfully used by our school.

"As to local measures, they are often indispensable. A flexible rectal tube, carefully introduced a few inches into the bowel, and a stream from a fountain syringe allowed to flow till the bowel is slightly distended, when the tube is pushed in a little further, always following the distention caused by the flow till the tube is introduced a foot or more—in this way there is little danger of injuring the bowel, and a thorough flushing is secured. Boracic acid, a tonic, or astringent wash, may be selected according to the needs of the bowel.

"'Where the disease persists despite the treatment, an early examination of the rectum and sigmoid should be made with a speculum, and any wrong, such as fissure, ulcer, or hemorrhoid, should be corrected. If there be catarrh of the sigmoid, a pledget of absorbent cotton, smeared with balsam of Peru, and introduced through a sigmoid speculum by means of a long-dressing forceps, will give the most satisfactory results. This may be used every other day."

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.