(BACILLARY DYSENTERY)
This is the variety most frequently found in temperate climates. It
occurs either sporadically or endemically. The Flexner bacillus is
frequently found, as well as pus micro-organisms. There are various
strains of the bacillus. There is a catarrhal inflammation of part or
the whole of the large bowel. Other forms may occur, as ulcerative and
membranous.
=Osteopathic Etiology= and =Pathology=.—Sudden atmospheric changes and
simple irritants, such as unripe and indigestible food, are usually the
immediate causes. The predisposing cause of acute catarrhal dysentery
is always found by the osteopath to be due to spinal derangements in
the lumbar region. The lesion is generally a slight lateral deviation
of a vertebra. It is generally found at the second or third lumbar;
still, the trouble may be found at any point in the lumbar section. The
lesion involves vasomotor nerves to the intestinal mucous membrane,
thus causing the inflammation. The drinking of impure water in itself
may not be the cause of the disease, but is a favorable medium for the
development of the organisms which may excite it. Dyspeptic conditions
and constipation seem to predispose to the disease.
The mucous membrane is injected and swollen and often covered with
bloody mucus. The follicles of Lieberkuhn are enlarged from retention
of their contents, the result of the swelling; the follicles are often
ruptured and the mucous membrane sloughs off in patches, forming
ulcers. These may extend along the whole colon and frequently into the
ileum.
=Symptoms.=—Diarrhea is the most common initial symptom; the stools
being copious and painless. The stools soon become small and frequent,
covered with mucus and streaked with blood. These are passed with
straining and tenesmus, accompanied by colicky abdominal pains of a
griping character. Chills are rare. The tongue is furred and moist:
later it becomes dry. Nausea and vomiting may be present, but not as
a rule. There is fever and often excessive thirst. Later the stools
become green in color, due to the bile which causes a burning sensation
in the rectum.
On examination there are found red blood-corpuscles and leucocytes,
and large, round and oval epithelioid cells containing fat drops
and vacuoles. In mild cases, the course is about eight days; severe
cases subside within four weeks, but if the =osteopathic treatment=
is careful and specific, the usual duration can generally be reduced
one-half.
=Prognosis.=—The prognosis is generally favorable in the catarrhal form
when the disease is treated properly. The previous general health,
hygienic conditions, and sanitary surroundings are of great importance.
When there is ulceration or membranes the prognosis should be guarded.
The condition may become =chronic=.
=Treatment.=—The bowel should be thoroughly washed out by warm water
enema, several times, if necessary, to remove irritating material.
Invariably a lesion of the spinal column is found at the third and
fourth lumbars or near by. It is generally a subluxation, of a lateral
nature, between these vertebræ: rarely is the lesion above or below
this point. The treatment should be applied immediately and directly
to this region. Time is valuable in these cases and one should go to
work at once to correct the irritation. An attempt should be made at
each treatment to correct the disorder. This should not be delayed
by wasting time in relaxing muscles and inhibiting, for unusually
this gives only temporary relief. When a slight movement has been
accomplished between disordered vertebræ, treatment should be stopped
and results watched, because the adjustment may have released all
obstructions or irritations causing the disease. In many cases, to
get an anatomically correct spine is an impossibility, from the fact
that the displacements may be of long standing and naturally the
subluxated vertebræ have conformed themselves to some extent to their
unnatural position. In other words, what has been lost in the position
and relation of a vertebra may have been compensated by reducing the
effect of the lesion to a minimum. A lesion of this nature at the
third lumbar impairs the innervation to the colon and consequently
produces a stasis of blood in the mesenteric circulation, followed by
inflammation, bloody discharges, cramps, etc. A single treatment is
usually quite sufficient in milder cases. Other cases require treatment
every few hours or thereabouts, until recovery.
Treatment directly over the abdomen through the mesenteric circulation
and glands is an effective treatment in most cases and especially when
the attack is severe. It relaxes the tissues about the mesentery,
thereby relieving the stasis and freeing the circulation. The greatest
care, however should be exercised in giving this treatment.
The constant desire to defecate, that is common to many cases, is a
very annoying symptom. Strong, thorough treatment over the sacral
region, by inhibition over the sacral foramina and by relaxing the
tense muscles of the sacrum, will relieve this condition. In relaxing
these muscles, place the whole hand against the muscles and push upward
toward the occiput. This treatment inhibits the nerves to the rectum
and lessens the =tenesmus=.
Attention should be paid to the liver to keep it active. Washing out
the large bowel with tepid water produces a soothing effect, besides
having a tendency to allay inflammation. The blandest of liquid foods,
as peptonized or boiled milk, broths, beef juice, barley and rice,
should be given. The patient should remain in bed until completely
cured.