246 THE TREATMENT OF DISEASES. 



Several different varieties of dysentery are spoken of, but they in reality pass by 

 such insensible gradations the one into the other, that it will be sufficient for our 

 purpose to describe an ordinary simple acute case. The patient, in all probability, 

 gets chilled by careless exposure to the cold night air in an aguish district. The 

 chill is succeeded by slight heat of skin, loss of appetite, and a feeling of nausea. 

 These are followed by griping pains in the belly, irregular in their position and 

 periods of return, but attended with discharges from the bowels, by which they are 

 partially relieved. The action of the bowels is accompanied by most distressing 

 straining, which quickly becomes one of the prominent features of the case. From 

 the first the stools are very offensive, the smell, which has been described as " the 

 most offensive of all organic effluvia," being characteristic of the disease now under 

 consideration. After a time the calls to stool become more urgent and frequent ; 

 the patient is hardly in bed ere he desires to rise again, each time convinced that he 

 is about to pass something which will relieve him. At last he can hardly be induced 

 to leave the stool : he remains on it, and strains involuntarily. After the first few 

 evacuations, which may have the appearance of ordinary motion, the stools are very 

 small, and consist of transparent or whitish mucus, or of mucus mixed with blood, 

 and sometimes even of almost pure blood. "With these are little shreds or patches 

 of membrane. As the disease progresses, the patient becomes irritable and depressed, 

 and the countenance indicates suffering and despondency. If no improvement takes 

 place, the stools become of a brownish colour and very copious, causing the most 

 terrible exhaustion. The distressing straining and griping cease, and the patient, 

 misled by the absence of pain, often thinks that he is on the high road to recovery. 

 By-and-by his mind begins to wander, and, as if in some degree to compensate for 

 |>ast sufferings, his delirium takes pleasing forms, and he dies exhausted, without 

 liore pain. In more favourable cases, treatment steps in and averts the fatal 

 termination, or the disease takes a favourable turn, and the patient recovers. 



Sometimes, however, the patient neither dies nor completely recovers, for the 

 disease becomes chronic. The discharges still maintain somewhat of their offensive 

 odour, are for the most part fluid, and mixed with blood and slime. Sometimes they 

 are pale and frothy, and are voided with considerable force. The general health is 

 poor, night sweats are frequent, the hair drops off, boils are common on all parts 

 of the body, and the patient ages rapidly. 



There is seldom any difficulty in distinguishing dysentery from ordinary diarrhosa. 

 The excessive griping and straining, the presence of blood and slime in the stools, 

 and, above all, their peculiar odour, serve as distinctive characters. 



Fortunately, dysentery is a disease for which we have a remedy, which is almost 

 a specific, and that remedy is ipecacuanha given in large doses. The earlier tho 

 patient is submitted to treatment the more likely are we to succeed in our efforts to 

 check the progress of the disease. In tropical climates, more especially, it is impos- 

 sible to over-estimate the importance of prompt treatment. The patient should be 

 at once put to bed, and brought under the influence of the drug. From twenty-five 

 to thirty or even sixty grains of powdered ipecacuanha should be at once adminis- 

 tered in as little fluid as possible. It may be thought that so large a dose would 

 produce vomiting, but if the patient keeps perfectly quiet, and takes neither food nor 



