On the pathology and treatment of dysentery ; being the Gulstonian Lectures delivered at the College of Physicians, in February 1847 / [William Baly].

William Baly

Date:: [1847]

Credit: On the pathology and treatment of dysentery ; being the Gulstonian Lectures delivered at the College of Physicians, in February 1847 / [William Baly]. Source: Wellcome Collection.

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imprisonment in a state of seclusion induces, for a time at least, an enfeebled, and in consequence highly excitable state of the nervous system. Now both in the year 1823 and in the year 1842, when the nervous disorders as¬ sociated with dysentery occurred in the Penitentiary, the terms of confinement to which the prisoners were subjected were much longer than at present. We may therefore, I think, fairly infer that the ex¬ citability of the nervous system of the prisoners was at those times proportionably great. Can we not now explain the occurrence of the nervous disorders in the Penitentiary ? We have seen that they w-ere associated there with other disorders due to the influence of malaria ; and that in hot and unhealthy climates analogous nervous affections are met wfith, in adults of enfeebled frame, and in infants whose nervous system is naturally sensitive. We have seen too that the ner¬ vous system in prisoners is brought by con¬ finement to a similar sensitive state ; and is it not the natural conclusion from these facts that the peculiar nervous disorders seen in the Penitentiary w7ere due to the action of an atmospheric poison, on persons in whom the nervous system w7as rendered thus excitable ? My account of the dysentery observed at the Millbank Penitentiary would be incom¬ plete if I omitted to notice the remedial measures which have been found most effica¬ cious in the treatment of the disease. 1 have here no novel mode of practice to an¬ nounce. But still, the plans recommended by different authors for the treatment of dysentery being so various, it may be of some interest to the College to learn wdfich of these plans has best answered the vdshes of the physician in an instance where the disease has presented w7ell~marked charac¬ ters, and has prevailed, not in one season merely, but through several years. I shall first speak of those more numei'ous cases in which the disease had, for the most part, the characters of a simple inflamma¬ tion of the larger bowel, this inflammation varying in severity, but being attended by no morbid state of the system at large ex¬ cept symptomatic fever. The chief means I have found successful in these cases, and the means which have rarely failed, where the dystentery was not complicated with some other diseased state, are bloodletting, the administration of calo¬ mel with opium, and gentle aperients. General bloodletting has seldom been re¬ quired, but free local bloodletting by means of leeches has never been omitted when there was well-marked tenderness of the abdomen, or, in the absence of tenderness, when the other symptoms indicated the existence of active inflammation in some part or other of the large intestine. The application of leeches, in the number of twelve or twenty-four, has been repeated several successive times at intervals of some hours, when the symptoms wrere urgent, and were not readily subdued by the means first used. The calomel and opium have generally been administered in doses of two grains of the former, and one-third or half a grain of the latter medicine, every three, four, or six hours, as long as the character of the evacu¬ ations and the state of the local and general symptoms indicated the existence of inflam¬ mation, or until the state of the gums showed that the system was affected by the mercury. In the more severe cases the production of this effect on the system to the full extent was required ; but when the disease was of only moderate severity it was generally subdued so quickly, that the mer- curialization of the system to a further extent than was manifested by a slight swelling and tenderness of the gums was unnecessary. Mild aperients also have been found most useful in perhaps the majority of the cases, but especially in those where the lower part of the large intestines w7as the seat of the disease, and where the feces were retained, so that the evacuations consisted almost en¬ tirely of mucus tinged or mixed with blood. In these cases the administration of one, two, or three drachms of castor oil has pro¬ duced free feculent evacuations, and has afforded great relief to the symptoms. The beneficial effect produced by the action of this mild aperient medicine has often been very remarkable, greater than I know how to explain ; while evil seemed always to re¬ sult from allowing more than twelve hours to pass without obtaining a free feculent evacuation, if the frequent discharge of bloody mucus and other signs still indi¬ cated the persistence of inflammation. In many cases, however, no aperients whatever were required, free discharges of the fecu¬ lent contents of the bowels taking place spontaneously. Indeed, where the caecum and ascending colon were the seat of the disease, the active stage of the inflammation was almost alw7ays attended with copious discharges of liquid feces, and the subsi¬ dence of the inflammation was in great measure evidenced by the less frequent oc¬ currence of these discharges, and their less liquid character. Very rarely indeed was a more active pur¬ gative than castor oil found requisite in the acute stage of dysentery. In some in¬ stances, owing to the irritable state of the stomach, small doses of saline purgatives have been substituted for the castor oil; but

On the pathology and treatment of dysentery ; being the Gulstonian Lectures delivered at the College of Physicians, in February 1847 / [William Baly].

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