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. We may note here, before discussing the pathology of dysentery, that no evidence is available at present as to whether the dysentery of the classical writers was bacillary (shigellosis) or amebic.

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 fre quency 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 fleshlike 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 - tenesmoi - 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.

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