Remarks on the nature and treatment of acute tropical dysentery / by Robert Lewins.

  • Robert Lewins
Date:
[1841]
Catalogue details

Licence: Public Domain Mark

Credit: Remarks on the nature and treatment of acute tropical dysentery / by Robert Lewins. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    pends upon the immediate cause of death. If the patients die soon, from the direct effects of the acute inflammation, the intes- tines will be found in a state of contraction; if, on the contrary, hectic fever supervene, they will be found dilated. Scybala are never discovered in the colon, though worms, which are extreme- ly common in hot climates, are often present. Ecchymosed spots are sometimes seen beneath the mucous membrane, but this will be the case to a greater degree when dysentery is complicated with scorbutus. The mucous membrane of the small intestine is vascular, and in the ileum the follicles are enlarged, though never so much so as in the first stage of typhus abdominalis, and are of a browner colour. The second stage of typhoid fever, when the mucous membrane over the follicle is in a state of gangrene, and commencing to slough, is liable in some cases to be mistaken for the ulceration of dysentery. When no history of the phenomena during life has been obtained, by attention to the situation of the morbid ap- pearances, the al3sence of vascularity in the vicinity of the ulcer, and the different stages in which we have always an opportunity of seeing the typhoid ulcerations, ^ will in all instances suffice to distinguish it from dysentery, were even only a few inches of the intestine examined. With regard to the morbid appearances connected with the intractable vomiting, often seen in the dysen- tery of the West Indies, I had an opportunity at Vienna of exa- mining the bodies of several who had this symptom in different diseases, medical and surgical. The pathological appearances were pointed out by the prosector, Dr Kolletska, and all present had an opportunity of convincing themselves by ocular demon- stration, that the source of this inauspicious discharge has been overlooked. In most of these cases, I am convinced numerous minute abrasions would be found scattered over the mucous mem- brane of the stomach. These ulcerations are very small, but per- fectly distinct, of a somewhat triangular shape, with well defined margins, but we are unable to detect them, unless the surface of the mucous membrane be perfectly well cleansed, which may ac- count for the fact of their having as yet been overlooked by ob- servers. I have little doubt that in the malignant fevers of hot climates, where the black vomit supervenes, this lesion is also present. ' ' German pathologists are accustomed to divide the morbid appearances observed in typhus abdominalis into four stages,each of which presents physical characters pecu- liar to itself, and differing widely from each other. The first stage, or that of infil- tration, is marked by the enlargement and induration of the mucous follicle. The second stage is that of gangrene of the membrane of the follicle (Schorf. bildung,) by which an eschar is formed. The thii'd stage is termed ulceration, when the eschar has separated, by which the muscular coat of the intestine is exposed, as if cleanly dissect- ed. The fourth stage is that of cicatrization, where the ulcer is closed, ))y the ])ucker- ing in and adhesion of the mucous coat, or when it is covered by the formation of a false membrane.