Dysentery is an ulceration of the intestines, sometimes arising from the
translation of tenesmus, or some of the disorders of the bowels formerly
mentioned, and sometimes being itself the primary affection; and it is
attended with evacuations, at first bilious, and of various colours,
then, accordingly, bloody, and at last ichorous, like that which runs
from dead bodies. Dysentery, arising from black bile, is necessarily
fatal, as indicating an ulcerated cancer. If, therefore, the appearances
of ulceration be discharged, mixed with the fæces, and attended with
pains and tormina, you may be sure that the ulceration is seated in
the small intestines, and is to be remedied by medicines swallowed by
the mouth; but if the fæces be passed unmixed with the blood, it is an
affection of the large intestines, and will yield rather to clysters.
When there is a great discharge of blood by itself, the disease is called
the bloody dysentery. Sometimes the blood which is discharged is blacker
than natural and shining, owing to the liver’s not digesting properly
the food which is sent to it; and owing to an atony of the retentive or
of the alterative faculty of the stomach, it is discharged from it like
the washings of newly-killed flesh. This is called hepatic dysentery, and
will be treated of along with the affections of the liver.
In general, therefore, we must use those things which were recommended
for cæliac and other preternatural evacuations; but, in particular, the
Lemnian earth cures a spreading dysentery when drunk or injected, the
intestine being previously washed out with honied water, and afterwards
with salt water; and the juice of purslain is proper for dysenteric
affections when drunk, or the purslain itself when boiled in oxycrate and
eaten. Plantain also is proper, and the fruit and leaves of the bramble,
the decoction of the root of marshmallows, the herb horsetail drunk in
water or wine, and the juice of it, the unripe fruit of the mulberry
dried, and, still more, bramble-berries when similarly dried. Eggs
boiled with vinegar and eaten, dry up fluxes of the belly; but it will
answer better if, mixing with them some of the articles which are good
for dysentery, you fry them, and give to eat. The wine of unripe grapes
is most useful in these cases, and the red sumach, and the juice of it,
the rind of pomegranate, galls, grape-stones, medlars, myrtles, cornels,
the ashes of snails roasted whole. The following is a compound medicine:
Of the ashes of snails, p. iv; of galls, p. ij; of pepper, p. j; reduce
to a fine powder, and sprinkle upon the condiments, or give to drink in
water, or a white watery wine. It greatly helps dysenteric patients, when
the ulcers are not putrid. But the dried dung of dogs who have eaten
bones, when drank in milk which has been curdled by having heated pebbles
put into it, is of great service. The following are compound remedies:
The trochisk from Egyptian thorn, that of Philip, that from hartshorn,
that from seeds, and the Trigonus. The pills from macer are excellent
remedies. The following is an admirable one: Of opium, of saffron, of
Indian Lycium (_catechu?_), of acacia, of sumach, of frankincense, of
galls, of hypocistis, of pomegranate-rind, of myrrh, of aloes, equal
parts; give in water to the amount of three oboli.—_Another_: Of sumach,
dr. viij; of galls, of pomegranate rind, of each, dr. iv; give in a
spoonful of wine.—_Another_: Of sumach, dr. viij; of galls, of acacia,
of gum, of each, dr. ij; of opium, dr. j; give one drachm in diluted
wine. This linctus will suit with them: Of black myrtles, one sextarius;
of Syriac sumach, one sextarius; of Theban dates, lb. ij; of the flesh
of quinces, lb. j; ten sour pomegranates with their rind; of astringent
wine, one sextarius: boil to a third, and, having strained, add of honey,
lb. vj; and, having boiled to a proper consistence, give for a linctus.
It is clear, that the cataplasms should be made from astringents the
materials of which you are acquainted with. On account of the tenesmus,
which proves a troublesome symptom in dysentery, injections made from
the juice of rice, chondrus, or the like, with the tallow of goats,
and likewise those recommended in the section on Tenesmus will prove
serviceable. But, if there is a discharge of blood, we must inject the
juice of knotgrass, or of plantain, with acacia, hypocistis, or the like.
But, if this symptom be urgent, we may inject some styptic, such as
the ashes of unwashed wool, or of new sponge, which has been soaked in
liquid pitch, or the blood of an ox, or liquid alum; or it may be soaked
in the juice of asses’ dung in like manner, and burnt. And the trochisk
of Andron is an excellent remedy, and that of Musa, and the like. But
suppositories of collyria are among the most effectual remedies, more
particularly when the discharges are attended with pain. When there is a
spreading ulcer in the intestines, which you may ascertain from the fetid
smell and putridity of the discharges, and from its not having occurred
at the commencement, but after some interval, we must use escharotic
injections, such as the trochisks called Faustiani, that from paper, the
Bithynian, the Thronian, and that from cork, injected in the decoction
of dried lentils, or of some of the other astringents. And the following
enema is of approved efficacy: Of burnt omphacis (it is the cavity from
which grows the acorn which the tanners use), of arsenic, of comfrey, of
Syriac sumach, equal parts. Mix about two spoonfuls of these when pounded
together with the juice of rice, and the juice of alkanet that has the
thorny, broad, and black leaf (which they call _chærospelethron_), and
with the white of eggs, to the amount of two or three ounces; and give
for an injection. Those epithemes apply which were mentioned for cæliac
affection. And, in like manner, those liniments to the belly which are
composed of astringent and desiccative materials, with some of the
glutinous substances, gum, frankincense, taurocolla, fine flour, may
have place with the corresponding cataplasms. The food at first should
be eggs mixed with milk, and the spoon-meats made from frumentaceous
substances, either alone or boiled with milk. And milk itself moderately
boiled is an excellent thing. The use of pot-herbs is not necessary;
however, we may allow the patients to taste of boiled endive, of succory,
of plantain, of cabbage twice boiled, and of the autumnal fruits, such
as are astringent, spitting out the fleshy parts, and whatever else will
irritate the intestines. When the intemperament is very hot, we must
give raw succory, and make the patients drink of cold water. The other
drink should be rain-water; and, when the stomach is languid, wine may be
taken. Afterwards they may take the drier and more digestible parts of
fowls, and use baths of sweet water. But if the flux is brought on by the
use of them, soak a large sponge or pieces of bread made from fine flour
in wine of Ascalon, or some of the hot astringents, apply to the whole
abdomen, bind it on, and order them to bathe in this state.
* * * * *
COMMENTARY. Consult Hippocrates (Aphoris., de Affect. Epidem.); Galen
(Comment. de Med. sec. loc. ix); Aretæus (Morb. Chron. ii, 9); Celsus
(iv, 15); Cælius Aurelianus (Pass. Tard. iv, 6); Alexander (vii, 21 and
x, 1); Aëtius (ix, 43); Oribasius (Synops. ix, 14, and Loc. Affect. iv,
88); Actuarius (Meth. Med. i, 41); Nonnus (167); Leo (v, 9); Octavius
Horatianus (ii, 31); Marcellus (27); Scribonius Largus (xi); Averrhoes
(Collig. iv, 59); Avicenna (iii, 16, 2, 7); Serapion (iii, 26); Avenzoar
(ii, 1, 5); Haly Abbas (Theor. ix, 26; Pract. vii, 22); Alsaharavius
(Pract. xvii, 1); Rhases (ad Mansor. ix, 72; Divis. 67; Cont. xiii.)
Hippocrates briefly describes dysentery as being a complaint attended
with pain throughout the whole belly, tormina, and discharges of bile,
phlegm, and blood. The disease, he says, is occasioned by an overflow
of phlegm and bile to the veins of the belly, producing erosion and
ulceration of the intestines. His treatment consists of purging the
head, emetics, opening the belly, emollient clysters, and a regulated
diet. In one of his aphorisms he states that a spontaneous vomiting
cures dysentery. Another of his aphorisms is that a dysentery commencing
from black bile is mortal. Another is, that when substances resembling
flesh are discharged by a person affected with dysentery it is a mortal
symptom. (iv.) His commentator Theophilus says, in explanation, that it
is because the intestines are ulcerated and do not readily heal. (Ed.
Dietz, 401.)
Galen treats separately of hepatic dysentery and of dysentery connected
with ulceration of the mucous membrane of the intestines. Of his remedies
some are astringents, such as galls, alum, dried roses, and hypocistis;
some anodyne, such as opium and henbane; some are detergents, such as
myrrh, pepper, spikenard, &c.; and some escharotics, such as arsenic,
sandarach, the scales of copper, and the like. These last are to be
given only in clysters. Modern physicians will be disposed to condemn
them without a trial; and yet, as arsenic may be given by the mouth in
properly-regulated doses, there appears no good reason why it may not be
safely administered in injections. Rogerius, one of the earlier modern
writers, speaks favorably of trochisks of arsenic. (i, 37.) Sprengel,
however, decidedly condemns the practice. He says of Athenæus: “Il
recommandait dans la dyssenterie un lavement dont un _mélange affreux_
d’orpiment et de realgar formait la base.” (Hist. de la Méd.) See Sect.
xxix of this Book.
Aretæus gives a very circumstantial description of the symptoms of
dysentery, but unfortunately his chapter on the treatment is entirely
wanting. He describes all the varieties of ulcers, the superficial, the
deep-seated, the irritable, the callous, and the like; and the discharges
from them, whether thin, bilious, fetid, devoid of smell, high-seated, or
otherwise. Of the other authorities, Alexander may be mentioned as the
one who has most correctly pointed out the importance of attending to
the part of the intestines in which the ulceration is seated. The large
intestines, he says, are most commonly affected. He approves of bleeding
in certain cases. His treatment is judiciously regulated according to
the exciting causes; and, in many cases, he prescribes gentle laxatives.
One of the varieties of dysentery described by him is said to proceed
from disorder of the liver, which is impaired in its attractive faculty.
This variety he calls hepatic dysentery, which, instead of attempting
to cure, as he says many do empirically, by a combination of aloes with
astringents, he recommends to be treated according to the nature of the
affection and the humour which produces it. His views of the treatment
are given at great length.
Celsus gives a very distinct account of the treatment. He enjoins rest,
as all motion proves injurious to the ulcers; recommends astringent
cataplasms, frequent washing with warm water in which vervain has been
boiled, astringent food, injections of ptisan, milk, oil, the decoction
of linseed, the yelks of eggs with rose-water, &c. For drink he directs
tepid water to be given, either alone or with an austere wine; or, if
these things fail, a draught of cold water to stop the discharges from
the bowels. When the disease is seated high up, the belly is to be opened.
Aëtius allows the abstraction of a small quantity of blood from the arm
when inflammation is present. He says it allays heat, produces revulsion,
and induces sleep. His internal remedies are much the same as those of
Galen.
Much of our author’s treatment is borrowed from Oribasius.
Octavius Horatianus, like the others, recommends, when the ulcers are
attended with putridity, a powder containing arsenic, quicklime, and
burnt paper, administered in an astringent wine, or in a decoction of
astringent herbs. Marcellus makes mention of a similar application, which
he directs to be used only when symptoms of malignity appear.
Cælius Aurelianus gives a very comprehensive description of dysentery,
the principal symptoms of which are fever, anxiety, rumbling of the
belly, sometimes retention of urine; tongue rough, furred, and black;
tenesmus and pungent pains of the intestines and anus. The disease, he
says, consists of a defluxion from the belly with ulceration, and is
preceded by diarrhœa, cholera, or inflammation. He animadverts upon the
treatment of others with his usual freedom. Thus he blames Erasistratus
for using nothing but astringents, whereas many cases of dysentery
require laxatives. His treatment is minutely detailed, but is not very
different from our author’s.
Leo, for bloody dysentery, like our author, recommends pills of macer,
the troche of corals, and the decoction of rhubarb.
According to Sprengel, Nonnus is the first author who distinguishes
the white dysentery from the red. It is obvious, however, that the
distinction between the two varieties had been made by earlier
authorities. We may add that Actuarius treats of the bloody dysentery
very fully.
The Arabians follow closely the treatment of the Greeks. Injections
containing arsenic are recommended by Serapion, Avicenna, and Haly Abbas.
Rhases, like Aëtius, admits of venesection in certain cases. He refers
the disease, in general, to debility of the retentive faculty of the
liver and derangement of the bile. Haly treats separately and minutely
first of intestinal dysentery and next of hepatic. The intestinal, he
says, is occasioned by ulceration of the intestines. He also describes
the bloody dysentery, like our author. His treatment is directed upon
general principles. He recommends various clysters; and, when the ulcers
are in the rectum, he directs us, among other remedies, to introduce a
tent, soaked in a solution of arsenic, quicklime, hypocistis, &c. Some of
his stimulant applications, however, are merely detergents, and do not
contain septics. The ingredients of his ordinary injections are either
emollients or astringents, according to circumstances. The account given
by Alsaharavius is valuable, but too long for our limits. Rhases, in
cases of protracted dysentery, directs snow to be applied to the belly.
In fact most of the ancient authorities recommend cold applications in
cases of chronic dysentery.