Climate and Health in Hot Countries and the Outlines of Tropical Climatology / A Popular Treatise on Personal Hygiene in the Hotter Parts of the World, and on the Climates That Will Be Met Within Them.

by George Michael James Giles

Dysentery.

We cannot claim to know much definitely as to the exact method in which this disease arises. Four or five vegetable germs and at least two small parasites belonging to the animal kingdom have been found, but none of these are present in all cases, and many of them may be quite commonly discovered in the interior economy of quite healthy persons, so that either the true germ remains to be discovered, or those we know of have only a secondary importance, becoming harmful only when they find themselves in contact with an irritated bowel. As a matter of fact, there are a good many kinds of dysentery, but to enter into their various characteristics would only confuse the lay reader.

The common characteristic is the discharge of frequent scanty motions, with much pain, and an intolerable sensation that more is to come. The material voided is always extremely offensive, of a mucous consistence, and wanting in the natural bilious colour. In severer cases, the mucus becomes streaked with blood, and sometimes little else will be seen, and the actual loss of blood itself may become a serious element of danger.

The disease does not usually occur as an epidemic, though something very like one is not unfrequently to be met with among bodies of men subjected to severe hardships and privations, as for example among soldiers during an arduous campaign in extreme climates. Some predisposing cause capable of causing irritation of the intestine seems to be essential to enable the germs, known or unknown, to take action. This irritant may be mechanical, such as coarsely ground, ill-cleaned grain; or chemical, as in the dysentery that is apt to appear among persons feeding on too newly reaped barley, or from foul or saline water; but the commonest of all causes appears to be the decomposition of the contents of the bowel which almost inevitably occurs when, from any reason, the production of the bile is arrested.

The peculiar yellowish-green secretion of the liver known as the bile appears not only to assist in the solution and digestion of the food, but to act as a natural antiseptic, which checks the too great multiplication of the various germs which are naturally always to be found in the intestine. It is comparatively rarely that the liver itself strikes work, but what does very commonly happen is that a chill, or a mechanical or chemical irritation of the bowel, may extend to the bile duct, and by causing swelling, or spasmodic action of its muscles, prevent the contents of the gall bladder, in which the bile secreted by the liver is stored up, from passing on into the intestine. The chill or irritant that thus stops the flow of the bile necessarily at the same time produces a greater or less amount of catarrh and inflammation of the lower bowel, which, lying as it does next to the wall of the abdomen, is most easily affected by cold; but stoppage of the flow of bile into the intestine seems an essential element in the production of dysentery, as a more or less complete absence of bile from the motions is a universal symptom of the condition, and to restore the action of the liver is, practically speaking, in cases taken sufficiently early, equivalent to curing the disease.

As has been already noticed, dysentery may be caused by a variety of mechanical and chemical irritants, but by far the commonest cause is undoubtedly chill to the surface of the abdomen, and the reason the disease is so common in tropical climates is their peculiarly treacherous feature of the chill that precedes the dawn. The earlier part of the night is often intolerably close and sultry, and it is only with difficulty that the jaded European manages to get off to sleep, and then naturally with next to no covering of the body. As the hours pass, the temperature falls somewhat and he sleeps more easily and deeply, and when the peculiar chill falls that usually precedes a tropical dawn, he is too far off in the land of dreams to be roused by the cold; and the abdomen, bared probably by his restless movements during the earlier part of the night, is left exposed to the treacherous chill.

That there are other ways of getting dysentery I have no doubt, but a tolerably long experience has convinced me that the above is the history of nine cases out of every ten that one meets with, and it follows from this that the all-important safeguard against dysentery is to protect the abdomen from chill. From this it follows that a cardinal measure of precaution in the preservation of health in hot climates is the adequate clothing of this part of the body. It is this fact that accounts for the general consensus of opinion as to the value of the familiar article of clothing known as the “cholera belt,” though I am by no means inclined to regard the said garment as the best, or even a good, method of attaining the object. At best the thickness of material is inadequate, it is generally made too narrow to include the liver above and much of the lower part of the abdomen below within its protection, and it naturally has a strong tendency to “ruck” together so as to form merely a very uncomfortable sort of belt, quite valueless for the purpose for which it is intended. For wear during the day a much more comfortable and efficient garment is the well-known Oriental “kamarband,” a long, narrow scarf of woollen, cotton, or silk, according to taste, folded into a broad band and worn twisted round the waist in place of a waistcoat, over which it possesses the superiority of leaving the upper part of the body free. The elasticity of the folded scarf gives also a comfortable feeling of support, without any of the sensation of constriction inseparable from a belt, and its adaptation to climatic needs is testified by the fact of its being, in one form or another, in use by every tropical race, if we except the Negro, who seems to the manner born, and to want little artificial protection while he keeps within the limits, to meet the conditions of which he evolved. How the Negro gets on with no clothing at all, and the really much civilised Bengali contrives to survive without a hat, are problems which we poor products of centuries of artifice cannot be expected to solve; but the bald fact remains that the Northern European, when translated to the Tropics, must protect his viscera against cold in equatorial climates, even more carefully than in his native north, if he wants to get back there alive.

The cholera belt is especially fallacious at night. Unsupported as it then is by other clothing, it is at no other time so liable to slip down and leave unprotected the very parts that it is most important to keep covered. In the dark hours one wants a protection that is unlikely to be disturbed by forgetfulness, and is more likely to fall back into place than be cast off. This exigency is met by a folded blanket thrown across the trunk, within which are massed the delicate viscera essential to life; the ends of the folds lying on either side on the ground, and folded so that, without too thoroughly rousing oneself, one can spread the rug out a bit, above or below, should the chill of the morning become disagreeable to the chest or the lower limbs.

Provided that the feet, chest and arms are left free, a blanket arranged in this way gives no feeling of oppression; and after a short period of habituation, its deprivation conveys a distinct sensation of discomfort. Lying across the body, with either end on the ground, it is unlikely to be disturbed by the uneasy movements of the body. The fact of the ends resting on the ground makes it difficult to shake it off, and it affords far better protection than any closely-fitting garment, is more comfortable, and less likely to cause prickly heat. Care in this matter, especially during the hours of sleep, is second only in importance to the protection of the head against the sun during the day.

Never let the mildest dysentery, or even diarrhœa, continue unchecked. Taken early, no disease is more tractable, while if allowed to pass on to a chronic condition, no malady is more troublesome; while really severe chronic dysentery is practically incurable. Some knowledge of how to deal with such cases is therefore of special importance, as without embarking on the career of an explorer, any one may find himself a day or two’s distance from competent medical assistance in the countries with which we have to deal.