Dysentery

The word dysentery (Latin dysenteria) derives from the Greek dys (bad) plus enteria (intestine), thereby indicating the system involved, though not, of course, the causative agent.

Although explicit references are not common, it is probable that dysentery was widespread in antiq­uity. Some evidence is provided by a series of four aphorisms in Hippocrates, as well as the explicit statement that dysentery was common in the sum­mer and autumn. Elsewhere, in an attempt to estab­lish the disease pattern and age incidence, it is writ­ten that men (beyond the age of young men, i.e., 30 years and older) commonly suffer from 11 diseases, 2 of which are chronic diarrhea and dysentery. This fits the pattern of men of military age and the condi­tions of crowding and lack of proper sanitation facili­tating local outbreaks, if not small epidemics.

Various philosophical and medical theories were advanced to explain the sudden outbreak, its spread, and the distinctions, not always clear, between acute and chronic dysentery, on the one hand, and between dysentery and diarrhea, on the other. Roughly, there were two different kinds of etiologic proposals, each of which had its adherents, some of whom tried to combine the salient features of the two competing theories. Whether the humoral explanation came earlier is difficult to judge; at any rate, Hippocrates seems to have been the earliest exponent of the theory that one of the humors, in this case black bile, was the causative agent. Other writers (e.g., Plato, Timaeus, and Cassius Felix) selected other humors as the causative agent. The other theory, equally reasonable at that stage of medical inquiry, was that unconcocted or undigested food, not necessarily “bad” food, was the cause. This theory is represented by Aristotle and Aretaeus. At the end of the classical period, Paul of Aegina suggested that the mucus found in the feces indicated undigested food, al­though he opted for black bile as the principal cause.

The literature on the signs and symptoms of dysen­tery corroborate the belief that dysentery was both widespread and common. All authorities are in agree­ment that a compelling need to defecate, the fre­quency of which is proportionate to severity, quickly becomes unproductive and that the production of well-formed stools, within 48 to 72 hours, changes to the production of watery stools. Such watery stools, from ones tinged reddish to ones highly colored with blood, were often thought to contain Aeshlike shreds of undigested food (i.e., mucus or pus). In addition, the gripings in the lower abdomen, so ran the prevailing theory, led to typical straining - tenesτnoi - that both physically evacuated the inadequately concocted food products and dehydrated and physically enervated the victims.

There was less agreement regarding other signs. Celsus, for example, asked whether the patient was always fevered, and Alexander of Tralles tried to determine the extent to which the liver was in­volved. Galen has left us the best account of the typical ulcerated lower intestine. Finally, Hippo­crates seems to have regarded dysentery following an enlarged spleen (perhaps of malarial origin) as a favorable condition, doubtless with the thought in mind that a natural catharsis would help to reduce a swollen organ by removing impurities.