The following symptoms have been extracted from these cases, and may be worth our attention as undoubtedly having been results of the action of the drug.
Cold face and hands, with small and feeble pulse. Lips dark red and swollen. All the pains, but especially those of the rectum, are < by motion. Pulse small, hard and frequent. Coma. Cramps in anus, hands and fingers, legs, feet and toes. Faintings. Weakness and shuddering in the limbs. The limbs as if bruised and trembling. Great anxiety and palpitation of the heart. Wandering shiverings. Sensation of coldness, pale face, and slight nausea. Coldness of the lower part of the abdomen.
Abdomen tense, hard, and sensitive to pressure, especially about the navel. Obstinate sleeplessness. Dysphagia. Astringent, metallic taste in the mouth. Great prostration after the vomiting of food. Hiccough. Frequent eructations. Painful pinchings in the stomach. Spasmodic, watery vomiting, without previous nausea. Severe shooting pains in the stomach and liver, with vomiting of bile. Drinks are immediately vomited, with great effort, mixed with tenacious, stringy mucus. Severe pains in the rectum which continue after the discharges. The fruitless urgency to stool increases the pains. Pain extends from for the naval to the back. Distension of the abdomen, with borborygmus. Evacuations very offensive. Suppression of the secretion of the urine. Retention of urine.
In addition to the above symptoms, and in harmony especially with the two last, it may be remembered that Prof. Carroll Dunham, some years since, after disappointments in the use of sublimate similar to my own, found it promptly efficacious in cases complicated with urinary tenesmus. My own experience has since confirmed his judgment that the particular province of sublimate in dysentery is in the treatment of cases with this peculiar complications. It may have other Dunham yet to discover. I have found it curative in cases with suppressed urinary secretion.
Nux vom. has small, frequent evacuations, with violent tenesmus; pressing pains in the loins and upper part of the sacral region, with sensation as if broken. Great heat and thirst, with redness of the face. The importance of this drug in the treatment of dysentery is hardly second to that of any other. That is to say the proportion of cases in practice, which call for this remedy, i as a great, to say the least, as that which shows relationship to any one other drug.
The resemblance of the specific symptoms by which this and one or two other important remedies are related to the treatment of this disease is so great that, to the beginner, there is often no little difficulty in deciding as to which the preference case. Take, for example, Caps., Merc. sol. and Nux vom., and we have a group of remedies equal to the cure of a majority of cases as they occur in this latitude. But it is by no means a matter of in difference which of the group we shall give to our case or whether indeed we shall give either of them.
The difficulty of selection between these three is chiefly in the great resemblance of their symptoms. This is so great that many have been left to the only resort they knew, that of giving them in succession, if the right have been missed. This ought not to be, and need not. Care on the part of the practitioner and memory of the distinctions we are about to give will make a mistake impossible. This is here the more to be insisted on, as the use of the wrong remedy not only protracts the torture of the wrong remedy not only protracts the torture of the patient, but renders his cure more difficult, if not uncertain, by the use of that which is right, subsequently-a danger we cannot too carefully avoid.
These drugs are like in the character of their evacuations, the quantity of each being small with each discharge. The discharges of each are preceded by similar severe pains, which are continued through the period of the evacuation. In all they are attended by severe tenesmus. In all they recur at short intervals, with pains extending to the back. The above are the similarities.
The following are the differences. With Nux vom. the pains, especially those in the back, cease with the evacuation. Those of Caps. and Merc. are continued after. The pains of Nux v. in the back are pressing, as if broken, and like a bruise. Those of Capsicum are drawing. Those of Merc. like a bruise. With a recollection of these facts, and a careful attention to the symptoms given of each of these remedies there need be no confusion in prescribing them, because of their resemblances.
Plumbum has great violence of tenesmus. Frequent and almost fruitless efforts to stool. Cutting pains, with violent outcries, retraction of the abdomen, constriction and retraction of the anus. Prolapsus ani.
Pulsatilla belongs rather to dysenteric diarrhoea than to true dysentery, but may be appropriate in cases with slimy evacuations, slight tenesmus, and nocturnal aggravations.
Rhus tox. This remedy is rarely called for in the early stage of the disease, but is often valuable later in the attack, especially when there are nocturnal exacerbations, and also in the diarrhoea which sometimes follow dysentery. The case is marked for Rhus if there be constant tenesmus and urging to stool, with nausea, and the passing of but little bloody water. It is appropriate also in the late stage of the attack, with nocturnal aggravations.
Sulphur has spasmodic constricting pains, extending to the chest, groins and genitals. Cutting pains while urging at stool, from pressure on the abdomen, or bending the body backwards. Prolapsus ani at stool. Cutting pains in the abdomen, lower part of the loins, and upper part of the sacrum, after midnight. Pains relieved by the application of dry heat to the abdomen. The blood in the stool is in streaks. Sulph. is especially appropriate in cases attended with difficult breathing at the outset, and also in those of haemorrhoidal subjects. It is seldom in place at the commencement of an attack, but in the later stages is often of great value and even at times indispensable, especially in cases threatening ulceration of the mucous surface of the intestine.
When this great evil has actually occurred, Sulph. is still one of our chief reliances for a cure, and in this state is related to Arn., Ars. Lach. and Merc. In selecting either of these remedies in a given case, careful attention is to be given of the specific symptoms of th case and the drug, before the decision is made and of these the general or constitutional symptoms are to be regarded as of he first importance. There are, to be sure, differences in character of the discharge of these drugs, which are to be noted, but they are not more important than those general, and too often overlooked symptoms, which in many cases are the only sure guides to the true remedy.
Although the provings have not demonstrated the relationship of Ipecacuanha to amoebic dysentery its use in that connection has been verified in some cases, and there is enough material in the provings to indicate its use when the symptoms are like those of the case. External chilliness and internal heat; his body and particularly the extremities are cold to touch, but not to the patient’s sensation. The key-note of the remedy, constant unavailing desire to vomit, or desire to vomit rather renewed than relieved from vomiting, are present in these conditions. Nausea with clean tongue. Nausea with the stool; with the haemorrhage.
The stomach feels as if hanging down relaxed. Mouth corners drawn down, blue rings about the eyes. Dysenteric evacuations with white flocks, followed by tenesmus. Black pitch-like evacuations. In the early stages, the evacuations may be yeasty.
Like Ipecac., Terebinth has a clean tongue, (smooth, red, glossy) and like Ipecac. Terebinth has nausea with the bowel symptoms, but it differs in that the nausea of Ter. is immediately > from stool. Hering given the remedy as a useful prophylactic in tropical fever. Burnett gives as a key-note: Pains in the bowels which cause frequent micturition. There is burning throughout the alimentary tract, < warm drinks; with the intestinal symptoms there is usually the concomitance of the urinary symptoms.
There is coldness about the navel, as if covered with a cold round plate, and a sensation as if the intestines were drawn toward the spine. there is tenesmus, with bloody stools; much abdominal distension; sensation as of much incarcerated flatus. Pains > by passing flatus. After stool burning in anus and rectum, exhaustion and fainting. This remedy is particularly useful in old people and in approaching collapse, with rapid pulse with distension, and cold sweat of the lower limbs.
Argentum nit. may be useful in advanced cases with suspected ulceration. In the early stages this remedy has the chopped spinach stools; then membranous, bloody, slimy and with epithelium. “as soon as the least drink is taken it goes right through,” is none of the peculiar symptoms of the remedy. Kent reports a case of severe diarrhoea in a nursing infant where the mother ate a pound of candy daily; this would be equally suitable in some cases of infant dysentery. Argentum nit. is always an exceedingly nervous patient; it is never indicated where placidity is present.
