On the pathology and treatment of dysentery : being the Gulstonian lectures delivered at the College of Physicians, in February 1847 / by William Baly.

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[1847]
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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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    LECTURE II. Character of the intestinal lesion in the dysentery of Euro2>e, and in tropical dysentery—Have two diseases been con- founded under the one term “ Dysen- tery ” ?—Morbid appearances in other ]}arts of the body than the large intestines. —Inconstancy of hepatic abscess as a complication of dysentery—Malaria does not prevent the developement of tubercular disease, and the existence of phthisis does not prevent the attacks of dysentery—Typhus or typhoid feiier is often combined toith dysentery— Symptoms of dysentery—Accuracy of Sydenham’s description—Complete ab- sence of feverishness in some cases— Sthenic character of the symptomatic fever in the two less severe degrees of the disease—Symptoms indicating the part of the intestines affected—Symp- toms indicating the degree of severity of the inflammation—Sources of the bloody, mucous, and puriform discharges— The third and most severe degree of the disease attended by symptoms which indicate that the blood has undergone a morbid change—Nervous affections as- sociated with dysentery at the Millbank Penitentiary—Their anomalous character —They have not been observed elsewhere. In my former lecture I described the lesions which have presented themselves in the large intestines of persons who have died in the Millbank Prison while suffering from dysentery. It will not be necessary that I should occupy much time in showing that the more prominent of those morbid appear- ances have been generally observed in fatal cases of the dysentery of Europe. The best accounts of the morbid anatomy of the disease, from observations made in these islands, are those of Dr. Cheyne* and Dr. Abercrombie.f Both of these physi- cians describe the redness and roughness of the inflamed mucous membrane, the small round ulcers, the sphacelated state of the rug®, the more e.\tensive sloughs, and the ulcers of various forms which must have been left by the separation of such sloughs ; and Dr. Abercrombie, the truthfulness of whose descriptions gives to his medical * Dublin llospit.al Reports, vol. iii. p. 1.75. «<'I’racticnl Uesearclies on th T“ o‘''e>',y'sccra of the Abdomen, ,Sr edition. London, 1837, p. 204-00. works a classical value, mentions also small firm tubercles, which were evidently en- larged solitary glands. Sir John Pringle* and M. Broussaisf found the same lesions in the fatal cases of camp dysentery observed by them in many campaigns on the con- tinent of Europe. And I may mention that M. Broussais, in his remarkable work on chronic inflammations, asserts his belief that the ulcers of the large intestine have their origin in the solitary glands.J Again, the dysentery associated with the fevers from which the British troops suffered so severely in the disastrous Walcheren expe- dition, has been well described by Dr Davis. § And from his account it is obvious that this Walcheren dysentery was, in its anatomical characters, identical with the disease from time to time observed at Millbank. The same result is afforded by an exami- nation of the works of more recent French dnd German authors who have observed and described the disease. We may therefore at once proceed to the inquiry, whether any peculiar characters of the changes in the large intestine essentially distinguish the dysentery of tropical coun- tries from the disease known by the same name in this climate 1 . Dr. Abercrombie, admitting the identity of the two diseases as to their nature, concluded that the dysentery of British systematic writers and tropical dysentery differed in the extent of intestine affected ; the disease being confined to the rectum or the lower part of the colon in the former, and extending in the latter through the whole course of the colon, and often affecting also a considerable part of the small intestines. But though the cases in which the whole length of the large intestines is affected are comparatively rare in this coun- try and frequent in India, yet cases do occur in this climate where the extent of the dis- ease is as great as in the dysentery of the tropics. From the extent of the disease, therefore, no constant distinctive character can be drawn. The^orw and nature of the anatomical changes in the large intestine, * Diseases of the Army, fifth edition. London, 1765, p. 237-248. + Uistoire dcs Pblegmasies, fourth edition. Puns, 1826, t. ii. p. 517-642. t Ibid. t. iii. p. 76 et seq. §View of the Lever of Walcheren, by J. It. Davis, M.D. London, 1810, p. 155-182 and' p. iai-104.