Notes on clinical findings, mode of transmission and prevention of Dysentery

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Definition:

It is a term characterized by frequent motions, with blood and mucus in the stools, painful straining and general constitutional disturbance. It may be acute of short dura­tion or chronic lasting for months. True dysentery is caused due to an infection of the intestine either by a specific bacillus when it is known as bacillary dysentery or by a microscopic unicellular animalcule called Amoeba in which case it is known as Amoebic dysentery.

Mode of Transmission:

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In almost every part of the world the bacillary vari­ety occurs, but it is more, common in the tropical countries, and sub-tropical countries. It is more prevalent during the rainy season. The chief source of infection is the faces of the dysenteric patient.

Flies are mostly responsible for carrying it from faces to food. Contaminated water is also believed to play a major role in the ‘transmission of the disease. Vegetables from fields irrigated with polluted “water are liable to carry infection.

Infected food handlers can spread infection through their unhygienic habits and practices. Viable cysts have been found on the hands and under the finger-nails of these persons.

Incubation Period:

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The incubation period of the bacillary variety is con­fined to 2 to 7 days, while in the case of amoebic variety it is about 3 to 4 weeks In the face of massive infection, the incubation period may be shorter.

Clinical Features:

At the time of attack of bacillary dysentery, the stools become very frequent, blood and mucus or pus appear in the stools with abdominal pain and painful straining, loss of appetite and prostration. There may be headache, vomiting, drowsiness and the temperature rises to 101 to 102 degrees.

During 24 hours, the frequency of stools may rise to 15 or more and become scanty with hardly any fecal matter in them. The duration of the disease is usually from a few days to 3 to 4 weeks. But it becomes chronic and lasts for years if it is not treated properly or if any discretion in diet is committed. The onset of amoebic dysentery may be sudden or gradual like the bacillary variety and the symptoms are very much like it. Without proper treatment it reappears at irregular intervals.

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Prevention:

The measures aimed at primary prevention are;

(i) Sanitary disposal of human excreta;

(ii) Provision of safe adequate drinking water boiling of drinking water is a safe preventive measure;

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(iii) Hygienic kitchen practices;

(iv) Thorough washing or disinfection of uncooked fruits and vegetables;

(v) Protection of food against flies;

(vi) Periodic examination of food handlers, and

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(vii) Health education of the people in matters of personal hygiene, proper toilet habits such as hand washing after defalcation, cleaning and protecting vegetables and fruits and controlling insect. The secondary prevention is based on early detection of cases and their proper treatment.

At the time of dyse­ntery liquid food such as barley, sago, arrowroot, glucose etc. should be given instead of solid food. Frequent hot foliations should be given in order to relieve the pain it is discomfort in the abdomen. A thorough evacuation of bowels is advisable at the very beginning. The advent of Flaky has revolutionized the treatment of amoebic dysentery. With proper medical treatment, diet, rest etc. the disease can be got rid of within two weeks. A very amp and useful remedy used in India for chronic dysentery is Bell fruit. A liquid extract of the fruit 2 ounces four times a day should be given. Another cheap and equally effective remedy is the infusion of Karachi bark, which is made by infusing 2 ounces of the crusted bark in one pint of boiling water for 8 hours.

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