'Handbook of Arabia. Vol II. 1917' [‎368] (372/542)

368
HYGIENE AND DISEASE
containing slime, or slime and blood. The suffering is sometimes
intense. As the disease goes on, the bowel tends to become ulcer
ated. In some cases, dysentery is followed by relapses, or by
chronic dysentery, or by abscess of the liver.
Three principal factors are at work in a case of dysentery;
(1) the preliminary influences—such as chill, bad food, purgatives,
intestinal worms, and intemperance—which lower the natural
resistance of the large intestine to infection ; (2) the actual invasion
of the intestine by the germs of the disease; (3) the subsequent
invasion of the intestine by the ordinary germs of suppuration,
which tend to form ulcers.
There are two chief types or forms of dysentery. In the one,
the intestine is invaded by bacteria ; in the other, by protozoa.
We call the one, bacillary dysentery ; and the other, amoebic
dysentery. The two forms may co-exist in this or that case, as it
were by chance, but the distinction is none the less valid. Bacillary
dysentery is epidemic dysentery ; it occurs in all latitudes. Amoebic
dysentery is endemic rather than epidemic ; it occurs only in warm
climates, or in the warm season of temperate climates.
Amoebic dysentery mostly commences insidiously, without
marked fever ; it is generally subacute or chronic in its course;
it is apt to recur or relapse ; it is often associated with congestion
of the liver, and sometimes causes abscess of the liver. It rapidly
improves under treatment with ipecacuanha, or, better still, with
emetine, which is the alkaloid of ipecacuanha. If emetine is not
available saturated solution of sulphate of magnesia with Tt. opii
n \xv to each ounce is very useful. Dose : one teaspoonful every
half-hour for 2 hours ; then every 2 hours.
Bacillary (epidemic) dysentery is mostly acute in character, often
with initial fever ; it runs its course, and if properly treated is not
apt to relapse. It is cured by emetine ; and good results hafe been
obtained with a specific antitoxin. We owe the discovery of this
antitoxin to Shiga, a Japanese man of science, who also discovered
the most common bacillus, Dysenteria Shiga.
Protection against dysentery mostly consists in securing a pure
water-supply ; in the avoidance of all ' predisposing causes'; in
correcting either constipation or diarrhoea ; in the isolation of
cases and of suspects ; and in careful sanitation, especially regard
ing the disposal of foecal matter and the keeping down of flies,
Where a great number of persons live in close proximity, dysentery
is very readily spread.
Guinea-worm {Dracunculus) is not unknown in Arabian coast
towns. This worm, like many other parasitic worms, has two