On the pathology and treatment of dysentery : being the Gulstonian lectures delivered at the College of Physicians, in February 1847 / by William Baly.
- Date:
- [1847]
Licence: Public Domain Mark
Credit: On the pathology and treatment of dysentery : being the Gulstonian lectures delivered at the College of Physicians, in February 1847 / by William Baly. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
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![IG often much less extensive in that disease than they are in the colon in dysentery. The other organs which have been the seat of inflammatory disease in cases of dy- sentery are the lungs, the pleura, and the peritoneum. The lungs are the only organs besides the ileum inflammation of which has frequently complicated cases of dysentery. In several cases the dysentery and the pneumonia have commenced at the same time, and have run their course together ; and in one case inflammation, terminating in gangrene of the lung, came on in the course of a dysenteric attack. In the vast majority of cases, however, the dysentery has run its course without being complicated with any pulmonary symptoms. The morbid appearances met with in all the parts of the body I have mentioned attend with equal frequency both forms of lesion in the large intestine. The morbid appearances found after death, therefore, afford no sufficient reason for believing that two distinct dis- eases have been confounded under the term “ dysentery.” When the close relation subsisting between ■ dysentery and suppurative disease of the liver in India is considered, it cannot but appear remarkable that, amongst the many hundreds of cases of dysentery which have cccurred in the Millbank prison during the last seven years, not one has been compli- cated with hepatic abscess. The medical records of the establishment, too, which reach back to the year 1824, afford no grounds for even a suspicion that such cases ever occurred amongst the prisoners. Dr. Budd* has adduced abundant reasons for the belief that, where hepatic abscess is associated with dysentei'y, the former disease is in all or most cases an effect of the dysentery, through the blood conveyed by the portal vein to the liver having been vitiated by morbid or putrid matters absorbed from the ulcerated or gangrenous surface of the large intestines. He has gone further, and has shewn, that, in a large proportion of the cases in which abscess of the liver exists without dysenteric disease of the large intes- tine, there is ulceration of some other of the mucous membranes which return their blood to the liver through the portal vein. But, although ulceration or sphacelus of the in- testinal mucous membrane is capable of exciting abscess of the liver, and is its most frequent cause, yet some special conditions must be present, in order that the effect shall be produced : for the frequency with which ulcers seated in different parts of the gastro-intestinal mucous membrane, or even ulcers in the same parts, but due to different diseases, occasion abscess of the liver, is far * Diseases of the Liver. London, 1815, pp. •49'73. from being the same in all cases. Thus, as Dr. Budd has pointed out, hepatic .abscess is never seen in conjunction with the ul- cerated intestine in typhoid fever, and is very rarely associated with the ulceration of the intestines in phthisis. It has not, how- ever, been owing to the peculiar seat or nature of the intestinal lesion that the dy- sentery of Millbank has been unattended by the hepatic complication ; for in this dysen- tery in the Millbank prison the disease of the mucous surface, both as to its seat and in its nature, has been the same as in the dysentery of India, with which hepatic ab- scess is so frequently associated. The ge- nerally less severe character of the disease at Millbank likewise cannot be the cause of the difference ; for amongst the cases of hepatic abscess with dysentery recorded by ]\Ir. Annesley and by Dr. Parkes, there are several in which the amount of disease in the large intestine was inconsiderable. We must, then, seek some other explanation of the fact that dysentery amongst the prisoners at Millbank has not led to the formation of abscess in the liver ; and in this inquiry we must first notice the important circumstance that the association of hepatic abscess with dysentery has not been equally frequent in all countries. When we examine the nu- merous dissections of fatal cases of dysen- tery in India recorded by Mr. Annesley, Mr. Twining, and Dr. Parkes, we find that hepatic abscess existed in rather more than one-half the cases. In the 51 cases, for example, detailed by Mr. Annesley, there were 26 in which the dysentery was attended with abscess of the liver. On the other hand, M. Broussais, who relates 17 cases, with dissections, of fatal dysentery, does not mention his having found abscess of the liver in any one instance, although he generally notices the condition of that viscus. And Rokitansky,* in his dissections of cases of dysentery, has never found the liver visibly diseased. Again, in China, where dysentery is very fatal to Europeans, the infrequency of hepatic disease is very remarkable. This is testified to by several medical officers of the army and Jiavy who have had oppor- tunities for observing the diseases of our troops both in that country and in India.f It is established, too, by the statistics of the hospital-ship Mindcn, which was stationed at Hong Kong during the military and naval operations in China, and w.as under the superintcndance of Dr. John Wilson. J Amongst 61 fatal cases of dysentery in which the bodies were examined after death, there * Med. Jnhrbucher dcs Ocsterreicli-Staatcs, Bd. XX. 1840, p. 81. t Transactions of the China Ms.-ico-Chiriirgi- cal Society for the year 1845—1816, pp. 14, 25, and 40. if Jledical Notes on Chinn. London, 1846, p. 258 Ct scq.](https://iiif.wellcomecollection.org/image/b21955578_0020.jp2/full/800%2C/0/default.jpg)
