CHAPTER IX. ON DYSENTERY.
OF the intestines, the upper being thin and bilious (
χολώδεα）
as far as the
cœcum, have got the Greek name
χολώδες. From
these proceed the lower, which are thick and fleshy, as far as
the commencement of the Rectum.
Wherefore ulcers form in all of them; and the varieties of
these ulcers constitute Dysentery: on this account, these diseases
are complex. For some of them erode the intestines
superficially, producing only excoriation; and these are innocuous;
but they are far more innocent if the affections be low
down. Or if the ulcers be yet a little deeper, they are no
longer of a mild character. But ulcers which are deep and
have not stopped spreading, but are of a phagedænic, painful,
spreading, and gangrenous character, are of a fatal nature; for
the small veins get corroded in the course of their spreading,
and there is an oozing of blood in the ulcers. Another larger
species of ulcers: thick edges, rough, unequal, callous, as we
would call a knot in wood: these are difficult to cure, for they
do not readily cicatrise, and the cicatrices are easily dissolved.
The causes of dysentery are manifold; but the principal are,
indigestion, continued cold, the administration of acrid things,
such as
myttôtos,
1 onions by themselves, garlic, food of old
and acrid flesh, by which dyspepsia is produced; also unaccustomed
liquids,
cyceon,
2 or
zythus3 (ale), or any similar
beverage produced in any country as a substitute for wine to
quench thirst. But also a blow, exposure to cold, and cold
drink, create ulcerations.
The dejections and the circumstances attendant on the ulcers
are different in different cases; for, if superficial, when from
above, the discharges are thin, bilious, devoid of odour except
that which they derive from the intestines; those from the
jejunum are rather more coloured, saffron-like, and fetid.
Those dejections which contain the food in a dissolved state
but rough, are sometimes fetid in smell when the ulcers are
gangrenous, and sometimes have the smell as if from scybala.
But in the ulcerations from the parts below, the discharges
are watery, thin, and devoid of smell. But if deeper they are
like ichor, reddish, of the colour of dark wine, or like the
washings of flesh; and these are sometimes by themselves and
sometimes with the fæces, these being dissolved in the surrounding
fluid, devoid of bile and of smell; or they are
evacuated in a consistent and dry state, lubricated with the
surrounding fluid. But if the ulcers be larger and smoother, in
those above they are bilious, and pinch the parts from which
they come and through which they pass (they even pinch the
anus), for the bile is acrid, more especially if from an ulcer;
and the bile is fatty, like grease. In the deeper ulcers below,
a thick clot of blood with phlegm, like flesh not very fat, or
like the scrapings of the bowels: nay, even entire portions are
mixed up with them; they are discharged white, thick, mucous,
like chopped tallow, along with the humour in which
they float: these proceed from the rectum: but sometimes
they are merely mucous, prurient, small, round, pungent,
causing frequent dejections and a desire not without a pleasurable
sensation, but with very scanty evacuations: this complaint
gets the appellation of
tenesmus. But from the colon
there are discharged pieces of flesh, which are red, large, and
have a much larger circumference. If the ulcers become deep,
and the blood thick and feculent, these are more fetid than
the former; but if the ulcers spread and are phagedænic, and
if nothing will stop them, above, in addition to being intensely
bilious, the dejections become saffron-like, frothy, feculent,
blackish, like woad or like leeks, thicker than the former,
fetid like a mortification; food now undigested, as if only
masticated by voracious teeth. But if the under parts are also
corroded, black clots of blood, thick, fleshy, very red, clotted,
sometimes, indeed, black, but at other times of all various
colours, fetid, intolerable; involuntary discharges of fluids.
And sometimes a substance of considerable length, in many
respects not to be distinguished from a sound piece of intestine,
has been discharged, and, to those ignorant of the matter,
has caused apprehension about the intestine: but the fact is
this,--the intestines, like the stomach, consist of two coats,
which lie close to one another in an oblique manner; when,
therefore, the connection between them is dissolved, the inner
coat, being separated to some length, protrudes externally,
while the outer one remains alone, incarnates, and gets cicatrised,
and the patients recover and live unharmed. It is the
lower gut alone which suffers thus, owing to its fleshy nature.
And, if blood be discharged from any vessel, it runs of a bright
red or black colour, pure, and unmixed with food or scybala;
and if a concretion is spread over it like broad spiders' webs,
it coagulates when cold, and no longer would be taken for a
secretion of blood; but being discharged with much flatulence
and noise, it has the appearance of being much larger than its
actual amount. Sometimes, also, a purulent abscess forms in
the colon, nowise different from the other internal ulcers;
for the symptoms, the pus, and the mode of recovery are the
same. But if there be hard secretions of matters resembling
flesh, as if pounded, and like rough bodies, the abscess is not
of a mild nature. Sometimes a copious discharge of water
takes place from the colon in the form of dysentery, which
has freed many patients from dropsy. In a word, such are
the ulcers in the intestines; and their forms and the secretions
from them as I have described.
I will now describe the symptoms accompanying each of
these states of disease, whether the ulcers be mild or malignant.
To speak in general terms, then, if the excoriation is
superficial, whether it be above or below, the patients are free
from pain and from fever, and get better without being confined
to bed, in various ways, by merely some slight changes of diet.
But if ulceration supervene, in the upper bowels there are tormina,
which are pungent, acrid, as if from the presence of a
small amount of hot bile; and occasionally there is suppuration:
indeed, for the most part, there is suppuration, or digestions
imperfectly performed, though there is no want of appetite.
But if the ulcers form in the lower part of the bowels, they are
much less dangerous than in those above, for the bowels there
are of a much more fleshy nature than those above. But if
those above become hollow and phagedænic, there are acute
fevers, of a latent kind, which smoulder in the intestines;
general coldness, loss of appetite, insomnolency, acid eructations,
nausea, vomiting of bile, vertigo: but if the discharge
become copious, and consist of more bilious matters, the tormina
become permanent, and the other pains increase; sometimes
there is prostration of strength, feebleness of the knees;
they have ardent fever, are thirsty, and anxious; black vomiting,
tongue dry, pulse small and feeble. Akin to these are
the fatal symptoms I have stated among those of malignant
ulcers; cardiac affections even to deliquium animi, from which
some never recover, but thus expire. These dangerous symptoms
are common also to erosions of the lower intestines if the
ulcers spread, and the discharge be not checked, only that the
tormina and pains are below the umbilicus where the ulcers
are situated. The forms of the secretions are such as I have
said; but if they be small at first, and there be a postponement
of their spreading for a long time, various changes take
place in the ulcers, some subsiding, and others swelling up,
like waves in the sea. Such is the course of these ulcers. But
if nature stand out, and the physician co-operate, the spreading
may, indeed, be stopped, and a fatal termination is not apprehended,
but the intestines remain hard and callous, and the
recovery of such cases is protracted.
In hemorrhage from the bowels, if it proceed from a large
vein or artery, it is sudden death; for neither is it possible to
introduce the hand so as to reach the ailment, nor to apply any
medicine to the sore. And even if the hemorrhage were
restrained by the medicine, the escape from death would not
be certain; for, in some cases, the falling off of a large eschar
widens the mouth of the vein, and when clots form within,
and remain there, the disease is incurable. It is necessary, then,
to cure hemorrhages in their commencement. Its approach, also,
for the most part is obvious, although not in all cases quite
apparent: anxiety attends, with restlessness, heaviness in the
part where the rupture is to take place, ruddiness of the
countenance if the blood has not yet burst forth. And if the
vein has burst lately, for the most part the symptoms are
alleviated; but if it has been a longer time ago, this takes
place more slowly, and with more difficulty. Such are the
ulcers in the intestines.
They occur in the season of summer; next in autumn; less
in spring; least of all in winter. Diarrhœa attacks children
and adolescents, but dysentery adults and young persons. In
old age convalescence is difficult, and cicatrization protracted.
Corroding sores are unusual in old persons, but yet hemorrhage
is in accordance with old age.
