G.E. Richmond
1901 The Lancet  
SOUTH AFRICA. DURING my experience of the treatment of dysentery i1 seemed that none of the recognised methods were infallible. In giving sulphate of magnesia or sulphate of sodium it was oi the utmost importance that the case should have come undei treatment early in the attack, before much ulceration had taken place, as otherwise the septic absorption continued and in some cases little or no improvement occurred and the patient died in a condition of toxaemia with rapid failing pulse,
more » ... , and profuse diarrhoea, with much painful tenesmas. The cases most suitable for this line of treatment seemed to be young adults of robust constitution. In giving ipecacuanha preceded by tincture of opium it was necessary to keep the patient in bed and almost to starve him whilst the administration of the drug continued to prevent the obstinate retching, which was otherwise certain to follow unless these precautions were taken, and which sometimes occurred despite all the care that was taken to prevent it. In such cases the misery of the patient racked with pain and worried with constant diarrhoea was greatly increased, and in scarcely a single case did the patient allow that his condition was ameliorated under 24 hours from the commencement of the treatment. Then in many cases, but not all, the diarrhoea became less, the tenesmus became much less painful, and the pulse, temperature, and general condition of the patient became much more satisfactory. Personally, before trying sulphur I came to the conclusion that Slr William Gull was correct when he summarised the treatment of dysentery in the three words, "rest, warmth, and ipecacuanha." Tine. Monsonise, combined with tincture of opium, was tried with pleasing results in some cases in which large quantities of blood were being passed and in some other cases where the dysentery had become more or less chronic, whilst in other cases, apparently quite similar, it was absolutely useless. Three minims of izal, combined with 20 grains of subnitrate of bismuth and from five to 10 minims of chlorodyne, was a useful prescription in many cases, and in most chronic cases bismuth and opium were prescribed for long periods with more or less success. Injections with boric acid, copper sulphate, and silver nitrate were frequently given in cases of obstinate ulceration and are undoubtedly of great service if the ulceration is situated in the rectum or the lower part of the colon, but can only be of slight service if the ulceration attacks the cascum, ascending and transverse colon. Instead of izal I found that three minims of carbolic acid substituted in the prescription above were more reliable in action, and although many patients were taking 18 minims of carbolic acid per ' , diem not a single case of carboluria occurred, although the urine was carefully watched in each case for this. As none of these methods seemed perfect and as I was frequently coming across cases where it was desirable to change the treatment even more than once I thought that perhaps sulphur might be as useful in the treatment of dysentery as it had been found in the local treatment of anthrax in the place of ipecacuanha I therefore prescribed 20 grains of sublimed sulphur combined with five grains of Dover's powder to be given four-hourly; the following are two of the cases in which this treatment was tried. CASE l.-Private ——. aged 34 years, was admitted into the Imperial Yeomanry Hospital, Deelfontein, on March 18th with dysentery. On admission the patient had been ill with dysentery for 11 days, having passed blood from the commencement of the attack. At first the amount of blood was slight, but latterly the motions had consisted of nothing but blood and mucus. For the last three or four days before admission he had been up all day and night with diarrhoea., passing nothing but blood and mucus. The bowels had been opened from 20 to 30 times or more in 24 hours. The pain in the abdomen was severe and straining was very distressing. The night before admission the bowels had been moved seven times ; the motions contained no fascal matter but consisted of blood and mucus and were small in amount. The temperature was 100'40 F., the pulse was 96, and the respirations were 20. The abdomen was distended and there was an area of acute pain and tenderness in the left iliac region with less severe pain over the whole of the left side. The abdomen was slightly rigid and did not move well with respiration. Palpation and even the slightest percussion caused acute pain over the iliac region. There was no vomiting but hiccoughs were present. The sulphur powders with Dover's powder were ordered on admission every four hours with belladonna fomentations to the abdomen. The next morning the temperature rose to 1034°, the pulse was 100, and the respirations were normal, but the patient expressed himself as much more comfortable and better in every way. The abdominal condition was about the same as on admission. The bowels had been opened five times during the night and seven times during the day. Blood and mucus were still passed. The tongue was dry and covered with brown fur. On March 20th the abdomen was still very tender, but the pain was much less acute and the area of tenderness had greatly diminished, and palpation and percussion were easily borne. The straining was much less. The temperature fell to 99° at 6 P.M. The pulse was 84. The patient was still passing blood, but the motions were becoming fsecal. The bowels had been opened seven times in the 24 hours. On the 21st there was scarcely any pain in the abdomen and the tenderness had almost gone. The straining was improving. The motions were semi-solid and faaca). No blood or mucus was noticed. The temperature was 982°. The tongue was clean and moist. After this the patient made an uninterrupted recovery. On the 25th the powders were given three times a day, the bowels being opened only twice in the previous 24 hours, and on the 26th one powder was ordered every night. On April 1st the patient was taking convalescent diet ; he had no diarrhoea and was anxious to rejoin his regiment. In this case severe dysentery had existed for 11 days before admission and from the abdominal condition there was evidently severe ulceration present, which no doubt gave rise to the temperature of 1034° on March 19th, the day after admission. Plain milk was given on account of the abdominal condition, although fannaceous food as a rule seems to suit dysentery better than milk. From the very commencement of the treatment the patient became more comfortable, which is not the case with patients who are given sulphate of magnesia or ipecacuanha, who seldom own to any improvement in their general condition under 24 hours. It is also evident that the recovery was a rapid one, as in two days the motions had become faecal and the diarrhoea was reduced to seven times in the 24 hours, and in eight days the patient had to be given an enema and was taking only one powder every night. CASE 2 -Corporalwas admitted to hospital on March 4th. He had been suffering from dysentery for five weeks. The bowels had been opmed three times the previous night and 10 times in the hospital on the morning of admission. He had not passed any blood on the 4th, but was still passing mucus. The motions contained no fascal matter. Tenesmus was troublesome. The abdominal pain was severe. Five grains of Dover's powder and 20 grains of sublimed sulphur every four hours were ordered about noon. On the 5th the bowels had only been opened once since the powders were given. The abdominal pain and tenesmus were much better. The patient felt much better and was much more comfortable. On the 6th the bowels had not been opened at all since the previous morning. The patient said that he felt " firstclass." The powders were ordered three times a day. On the 8th the motions were fsecal and formed and rather constipated. The powders were omitted. On the llth chicken was given and no diarrhoea occurred. On the 13th the patient requested to be sent to his regiment but was retained in hospital to recruit his strength and to see that no relapse occurred. Here a very obstinate case of dysentery, which had lasted for five weeks, was cured immediately by the administration of sulphur and Dover's powders, and after recovery showed no sign of relapsing. In all of the cases that have been treated with sulphur the recovery has been rapid and the patient has seemed to derive relief more speedily from his pain and straining than with other methods of treatment. The cure with sulphur seems to be more certain and stable, as chronic conditions and relapses have not occurred, although with other remedies they have been prone to occur or the case has taken on a chronic condition. Blood and mucus are easily stopped and the motions quickly become
doi:10.1016/s0140-6736(01)89162-5 fatcat:x6pzdxorirbqdjljujeoufc6ka