DYSENTERY


Medical writers from the time of Hippocrates have prated of dysentery, and the variety of opinions they have entertained is but little less than the number of writers by whom the subject has been discussed. Three thousand years have not sufficed to settle the question for all, whether it be really a disease of independent existence, or whether it be only an adjunct of some other more general form of evil.


Medical writers from the time of Hippocrates have prated of dysentery, and the variety of opinions they have entertained is but little less than the number of writers by whom the subject has been discussed. Three thousand years have not sufficed to settle the question for all, whether it be really a disease of independent existence, or whether it be only an adjunct of some other more general form of evil.

Those who have regarded it as an independent disease have had no agreement of views as to its true nature, while those who have contended for its derived status have failed equally to agree as to the origin to be assigned to it, and the nosological relations in which it ought to be placed. From Hippocrates and Celsus, Aretaeus and Galen, through the long list of those of the ancients and middle ages, as well as through that of the moderns down to the latest and best of the writers of our own day, nothing is established but a great diversity of opinion, though nearly all have tried their best to remove difficulties and differences….

Though the modern medical laboratory has given us the answer to a part of the question relative to dysentery, we find that modern medicine is faced today with the old, old problem of cure

of the condition, regardless of the possible bacteriological background. Because of this ever recurrent problem, and because the problem is bound to appear ever more frequently under world wide war conditions, it is worthwhile considering the manuscript left by one of our major homoeopathic philosophers and prescribers. The allopathic school has been able to pin down much in the way of causes since Wells’ day, as related to the transmission of bacteria, but the other and more subtle elements of the problem of personality and cure are as far from being solved by the allopathic school today as they were in the past.

Homoeopathy is ageless; the individual suffers, and to him is the promise of homoeopathy today, as it has always been.–H.A.R. historical interest to commend them to our attention. They are confidently presented as the strongest witnesses to the erroneous ideas if the nature of the disease in general, which have prevailed with a uniform continuance, in the antique school of the profession from its origin to this day. However diverse these opinions, there is no one of them which has not something of fact on which the great variety of opinions which have prevailed on this subject with the best minds of the profession have more than an it has been based.

The second difficulty has been that observers have each confined their attention chiefly to such facts as favored their individual opinions, having no eyes for others, or giving them no place in the view from which their judgment was made up. With this partial view of the facts, any philosophy of the disease was possible, and all were about equally plausible, and worthless.

It is only when disease is recognized as a state, affecting the vital condition of the whole man, and not as a thing, localized in some isolated spot or organ, that a philosophy of individual forms of it, which will bear scrutiny in the light of the facts, and be found equally applicable to all its examples, can be possible. In this matter of the nature of disease in general, the whole has been ordered and fixed by a Power above all appeal, and nothing has been left to the disposal of those who make its cure their business, but to see things as they are, and deal with them accordingly. Dogmatism here is of no importance, no matter how high the authority from which it comes. It is ever a cheap method in science. Here it is worthless and contemptible.

To this failure to recognize the actual and fixed nature of disease in general, and to this partial observation of facts, by those who have been the successive teachers of successive generations, is to be ascribed the ever shifting and multitudinous theories which constitute so large a proportion of the history of practical medicine, for three thousand years. Teachers and writers before the time of Hahnemann failed to recognize the truth that Almighty Power had established all the facts and relations of the case before their day, and they have neither the power nor the calling to change them in the least particular.

That their whole duty was first to see what God had done; and second, to accept this and deal with it according to the requirements of the law He had enacted for the government and necessities of the case. That in this is comprised the whole scene of the physician’s practical duties. In this view, let us see what are the facts and the duties, so established, in the matter of dysentery.

And the first fact which was recognized is, that this, like all other diseases, is a general fact, pervading the whole

individual man, reaching to and affecting all the functions of his bodily organs, no one of them being left untouched.

There is no vital action in the organism which is not changed. In this we only meet the fact equally true of all other diseases, and which, ever in it and them, declares in language from the Divine Power, the language of facts, that there is in the world no such thing as a merely local disease. Hence the views… of all who… have limited the action of the disease to the localized affection of the great intestine are completely negatived at the very outset. They never have shown, and it never can be shown, that the inflammation and ulceration of this part is more an essential part of dysentery than is the loss of muscular force, the changed morale of the patient, of the universal change in the functions of the various secreting glands.

Bacillary dysentery has always rightfully been looked upon as a major hazard of military life. If…invasion of the bowel by the bacilli of dysentery is considered to be the first stage of what is approximately a year’s time becomes the fully established disease of chronic ulcerative colitis or regional ileitis, the early recognition of the organism in all cases of diarrhoea assume even greater importance.–JOSEPH FELSON, M.D., Recent Advances in Bacillary Dysentery, N. Y. State J. Med., April 15, 1942, excerpted in Modern Medicine, August 1942, p. 40.

The second fact which arrests our attention is that as a central point in this general affection there is a group of phenomena which gives character to it among diseases, and without which no one of them is ever called dysentery. This is the group which characterizes the genus, and gives it its place in the circle of those families of morbid processes which constitute the sum total of human diseases. In the practical relations of facts, this group has shown its chief significance and importance, when it has decided that it is dysentery with which we have to do. Hence it is only the defining or generic, group of facts or symptoms of the case.

We say facts or symptoms, because all facts are symptoms, and all the symptoms are facts; the terms are strictly interchangeable. So that when we, as a school of medical practice, are accused in our practical consideration of disease of dealing only with its symptoms, we accept the accusation as a truth. We deal, as we profess, with its facts, and with nothing else. This has been by ignorance cast at us as a reproach. We accept it as an honor. In return we only inquire of the opposer what it may be with which he deals, seeing he is so dissatisfied with facts.

This central group has its origin in a localization, not of the disease, but of one of its elements, or of one of the processes of which it is composed. The localization is in the large intestine. The process is an inflammation of that organ. The group of symptoms as there originating is made up of frequent, and for the most part, small discharges of blood, or of bloody mucus, from the rectum, with pain, tenesmus, and fever. This has often been regarded as expressing the whole of the disease. It is only its generic or defining groups of symptoms. In our practical endeavors to cure, this group has a much less important place than other and far less obtrusive facts. It simply determines the diagnosis and then leaves the prescriber where he was before, as to all knowledge of means for a cure.

In his comments on bacillary dysentery, and the necessity for prompt diagnosis, as quoted above, Dr. Felsen outlines the chronic tendency in uncured cases. But here, as elsewhere,the allopathic physician rests his whole hope of assistance upon the diagnosis–in this case as in many present-day medical problems through serum therapy–without considering of the treatment of the patient upon the facts of the case, as Dr. Wells has pointed out, and certainly without consideration for the facts of the individual case and his own constitutional and individual reaction, either in the acute or chronic stages.–H.A.R.

These (means for a cure) are discovered chiefly by a careful consideration of the.

Third fact, which is present to our observation, viz., That there is a peripheral group of symptoms gathered around this central and localized one, which declares, not that we are dealing with dysentery, which has already been decided, but which goes beyond this, and declares the kind of dysentery, which is before us. The importance of this peripheral group does not cease here. It extends far beyond, it being the group which contains the indices which point to the curative agencies, through the Law of Similars, on which, we have learned, we can safely depend.

It is the group to which we are to find the similimum, in the effects of some member of the materia medica on the living organism, as recorded in its pathogenesis, the Law of Cure demanding the similarity of these two classes of facts, of the drug and the disease. It is made up far more numerous elements than the central, defining group, embracing as it does all those facts of any case not essential to constitute it a member of its class, but which belong to it as an individual member of that class.

In other words, the group embraces all the specific symptoms of the case, while it includes none which are generic. As we have remarked, many of these are gathered around the generic group, and are found as concomitants of its members, or as circumstances or conditions by which they are excited, aggravated, or alleviated. To those are added those modifications of the functions of other organs which ever make up a very important part of the case, and are so ever varying, in their character or circumstances, as to constitute a large part of the elements which compose the characteristics of the case, which are our chief guides in the selection of the specific remedy.

Let us look first at those elements of this principal, or specific, group, which attach to and give character to those of the generic, viz., the evacuations, the pains, the tenesmus, and the fever.

The discharge vary in their character. They may be, at first, feces mixed with mucus, or mucus and blood, or blood only. Later in the attack the feces are absent. The mucus may be yellow, green (light or dark), or brown. The blood may be bright or dark colored, mixed with other matters or in separation from them. It may be fluid or coagulated, in streaks or specks. The voided mass may be odorless or offensive. The offensive odors are various in character. It may like that of spoiled eggs, or of putrid flesh, or it may be of a penetrating, disgusting, indescribable character. Or the discharge may be watery, ichorous, or purulent, brown, green, gray, yellow, mottled, blackish, sticky, tar-like, or mixed with yellowish flocks, or patches of membranous quantity, and of frequent occurrence, vary much in different cases, in both particulars.

The concomitant symptoms of the evacuations are very different in different cases. There may be before the evacuations thirst, nausea, vomiting, anxiety, restlessness of body and mind, faintness, perspiration, partial or general, which may be hot or cold. There may be any of these symptoms present with the evacuation or after it.

Disposition to evacuation may be excited by the ingestion of the smallest quantity of food or drink, and also by any, even the slightest, movements of the body.

The greatest sense of exhaustion may attend or follow the discharges. These may also be preceded, attended or followed by shudderings, chills, heat or sweating.

The pain is very various in its character, as cutting, pinching, constricting. It varies in location, as in the hypogastrium, or the region of the navel. It may extend from the intestine to other near or remote parts, as the urinary parts, as the urinary bladder, the loins, the sacral region, or the thighs. It may be present in its greatest severity before and during the evacuation, and cease, for the time, immediately after. Or it may be continued after with equal, or nearly equal, severity. It may be relieved by particular positions of the body or limbs, by external warmth, and in some cases by a moderate external pressure. It may be renewed or intensified by food and drink of whatever kind.

The tenesmus is present in different degrees of severity, with accompanying pains in the anus of different character. There may be a sense of this part being torn out or constricted. Or there may be burning, cutting, stabbing, shooting, throbbing, in the part accompanying the tenesmus. This symptom may be found to cease with the accomplishment of the evacuation, or to continue after it.

The fever is also various in its intensity, and accompaniment. In some cases it is developed in a slight chill or shuddering followed by a similar slight reaction of heat of the surface and acceleration of the pulse, which disappears after the first day or two of the attack. At other times these elements are more positive and persistent in their character. In other cases the elements of fever are developed later in the case, and are indicative of and spring from important changes in the condition of the part where the diseased process is more especially localized.

The two forms of fever are quite different in importance and significance. The mildness or severity of the first is no measure of the danger of the patient. Neither is its cessation evidence of convalescence, or even that the worst of the attack has passed. On the contrary, the second is always indicative of grave and important changes, and its cessation may unhesitatingly be regarded as a favorable indication in the case.

The elements of the fever in this as in other diseases have their particular characteristics. The chill may be a general sense of coldness, with shuddering, varying in its duration in different cases, or there may be only slight creeping chilliness, confined to the back or limbs. Or it may be in the form of chilliness of the upper or lower extremities, or either side. The heat may be general or partial, extreme or moderate in degree, with great or slight restlessness, and with thirst intense, slight or not at all present. The perspiration, if there be any, any may vary in its character, and also be general or partial, hot, warm, or cool.

The general symptoms also belong to this group, such as debility, exhaustion, emaciation, faintness or fainting, either in connection with the evacuations or independent of them. Coldness of surface, which is dry or covered with perspiration. Heat of surface, dry or sweating. Color of general surface, as pale, red, or bluish. Painful sensibility of the general surface to touch or pressure. Sensation of being generally bruised. Cramps in the limbs. General restlessness, with or without tossing about in bed. Sense of paralytic weakness in the limbs. to the open air, even though it be warm. Sensibility to external cold. The position in bed.

So do also the functional symptoms of other organs than that more especially affected by the localized process in the large intestine. Of the skin, there is to be noted temperature, perspiration, its general or local character, its smell, if any, and the stain it leaves on the clothing, if any. The color of the face, as pale, red or bluish,. Is the face turgid and full as if bloated, or shrunken and the features sharpened? The state of the lips-are they pale or red, dry and cracked, or smooth? Is the mouth dry, or covered with mucus, the tongue dry or moist, clear or coated?

Modifications of taste are also to be noted, as is also the odor of the breath, if this be offensive. Apthae in the mouth. Loss of appetite, thirst, or repugnance to or desire for particular forms of food and drink, difficulties of swallowing and hiccough, nausea, and if there be vomiting, the character of the ejected substances. Distension of the abdomen, with or without sensibility to external pressure. If sensitive, the quality of the pain produced, as of cutting, excoriation, stabbing, shooting, etc. Prolapsus of the rectum with the evacuations. Tenesmus of the urinary bladder.

The character of the urine voided. Sleeplessness. Coma. Anxiety. Delirium. The state of the pulse and the like.

These are the phenomena which gather around the central, localized process of the disease, and declare its specific character; and in so doing, point at the same time to be specific remedy which cures. Hence it is these, in our practical duties, that chiefly engage our attention. In the two aspects in which as practical physicians we are compelled to view diseases, first as facts in science, second as objects of our practical duties, this peripheral group of symptoms belong by eminent importance to the latter. Though its members belong to the disease, and are as rally integral parts of it, as are the generic symptoms in its scientific existence and relations, still they have their highest importance in their office of guides to the selection of specific remedies. They are seldom or never all present in any one case, oftener there are but few of them, but these few are no less the guides to our choice because they are few.

Whether few or many, they are our only guides to a safe and sure practice. The enlightened and conscientious physician will give no less heed to them in this case, and never, for this reason, turn from them to any, whatever, of routine resort, because Dr. This-or-That declares that he “cures all his cases by it.” By this he simply proves that he does not know what a cure really is.

But there are other facts which pertain to dysentery in it scientific character and relations… The disease is found in every climate, though it is more frequent and severe in warm, and especially in tropical, lands. Its production seems to be favored by sudden and great variations of temperature. The effects of this cause are increased by such exposures as chilling the body, or by which it and its clothing are made wet. And this is still further affected by continuing to wear wet clothing.

The production of the disease is still further favored if to these causes are added either deficient or improper diet. When prevailing as an epidemic, it attacks by preference those who are suffering from an exhausted state of the vital forces, from whatever cause. Of these, debility from the action of other diseases, excesses of any kind, protracted watching and attendance on the sick, are among the most potent predisposing causes of dysentery. While this is true, it is equally true that dysentery gives immunity to no age, sex, condition or race,though females are less frequently attacked than males.

These predisposing causes of dysentery are integral parts of the individual case. They are definitely related to it in time and circumstance, and in repertorial consideration of the case– whether in the mental review which the physician gives to each similar remedy or in his study of the case, with repertory in hand–they often prove of inestimable value in discarding the less similar remedies. For the verifications of our remedies have demonstrated, time and again, that certain dispositions to development are essential elements of certain remedies. Dulcamara, for instance, is peculiarly adapted for cases of this kind which occur in the autumn when there is a wide range between hot day temperatures and the chill nights.

Arsenicum, Nux vomica and Rhus tox. are among the sufferers from becoming cold, Rhus particularly when damp, Nux particularly when sitting on a cold stone. These are by no means the only remedies with a peculiar suitability to predisposing circumstances, nor are the predisposing circumstances here mentioned the only ones that may be pertinent to the case. Consider the list of predisposing circumstances noted by Wells, and we will find that there are few mentioned by him that do not appear in our standard repertories, to be sought for when the need may arise.–H.A.R.

Many others, in different ages, have noticed the fact that…. where… intermittent fevers are most prevalent and severe, there dysenteries are most frequent and violent…Dysentery, like intermittent fever, is in its favorite abode on southern coasts, shores of lakes, and the banks and deltas of rivers, and in countries which abound in marshes. In such localities, especially in tropical countries, the disease is found in greatest frequency, and in its most violent form. The extreme in these respects is likely to be developed in the hottest months of the year, and when the change of temperature from day to night is great. In all countries, this last is a potent disposing cause of the disease. This is true especially in the autumn of the year when hot days are followed by cold nights…

P P Wells