SECT. XLII.—ON DYSENTERY.
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.