1 16 PRACTICE OF MEDICINE. 



flammation of the mucous and sub-mucous coats of the large intes- 

 tine. Hence traces and effects of inflammatory action in various 

 degrees are found in the rectum and colon. The mucous coat is 

 more or less injected in several points, and certain portions of the 

 cjECum and colon are either ulcerated or entirely disorganized, the 

 membranes hanging by shreds into the interior of the bowel. The 

 ulcers are sometimes small and numerous; at other times they are 

 elevated, hardened, and covered with sloughy or fungous granula- 

 tions. Some parts of the great intestine may be in a state of sphacelus ; 

 and more or less coagulable lymph, mixed with shreds of disor- 

 ganized cellular tissue, adheres to different points of its surface. 



Treatment. — The treatment of acute dysentery must be regulated 

 by the form in which the disease presents itself; but as in this 

 country the sthenic form usually prevails, the following remarks are 

 applicable to it only. The chief remedial means then, in the begin- 

 ning of the disease, are, local or general bleeding, with fomentations 

 to the hypogastrium ; — calomel and Dover's powder at night, and 

 castor oil with laudanum in the morning ; and starch enemata, so 

 as to clear out all irritating foecal matters, and soothe the bowels. 

 Some physicians, however, place more reliance on calomel and 

 opium, and very extraordinary doses of the former medicine have 

 been administered with the best effects, especially in warm climates. 

 When the inflammatory symptoms have been completely subdued, 

 and there are no longer any tenesmus and tormina, if the patient 

 remain feeble, gentle tonics, such as infusions of cinchona or columba, 

 with rhubarb, may be administered. The state of the bowels should 

 be carefully regulated during convalescence. 



CHRONIC DYSENTERY. 



Chronic dysentery may either succeed the acute form or it may 

 commence with diarrhoea, and gradually assume the character of 

 dysentery. The symptoms are the same as those of the acute form, 

 merely differing in intensity. The alvine discharges are more co- 

 pious, but less frequent ; they contain less blood, and less fibrinous 

 matter. There is not much abdominal pain ; the pulse is commonly 

 natural during the day, and symptoms of general excitement only 

 occur on aggravation of the local disease. 



Treatment. — As long as there is any reason to believe that sub- 

 acute inflammation exists in the intestinal canal, local depletion, 

 aided by counter-irritants and diaphoretics, must be cautiously em- 

 ployed ; but the disease often persists after the subsidence of all 

 inflammatory symptoms. In such cases, a great variety of remedies 

 has been recommended. Some place their chief reliance on small 

 and frequently repeated doses of ipecacuanha ; others advise the ad- 

 ministration of astringents, such as the infusion of catechu, the sul- 

 phates of zinc or copper, and the superacetate of lead. The last is 

 frequently employed in combination with opium and ipecacuanha. 



