# Tropical Diseases/Chapter 30

CHAPTER XXX
EPIDEMIC GANGRENOUS RECTITIS
So far as known, this very fatal disease seems to be confined to the natives of the low-lying, hot, damp regions in the north of South America, and, perhaps, to the natives of Fiji and other islands of the South Pacific. In Guiana it is known as " caribi" or "Indian sickness," in Venezuela as " bicho "or " el becho." It is said to be very contagious, and appears to be a form of rapidly spreading phagedæna, which starts from the neighbourhood of the anus. Occasionally it may begin higher up— in the colon. In the latter case it is called the " high " form; in the former, the "low" or rectal form. Animals as well as men are attacked.
I am indebted to Dr. Ackers, of Curacoa, formerly of Venezuela, for the following information on the subject:— " I have only seen cases of the disease in animals, principally fowls, though also in dogs and calves; but I have been told by medical men, who themselves attended the cases, of its occurrence in children of the poorer classes. The disease commences by an itching in the anus, which produces an inclination to frequent defæcation. This stage continues for a few days, when a severe inflammation of the mucous membrane of the rectum sets in, giving rise to symptoms of acute dysentery. There are frequent stools of a mucous, bloody substance, accompanied sometimes by bile or excrement; at the same time there is much straining, with considerable elevation of temperature, anorexia, and great thirst. At this period, if the animal or child is not attended to, the above symptoms become more alarming; a constant flow of a slimy, fetid, semi-liquid substance streaked with blood appears. Sometimes the discharge is of a bright-green colour, such as might be obtained by ​crushing tender stalks of grass. When this occurs the patients refuse all food, but the thirst is still intense. The affected animal remains standing in one place, with drooping head, as if overcome by fever and weakness. For a day or so it continues like this, until at last, unwilling to move, eat, or even drink, it suddenly dies in convulsions. Sometimes, however, this stage is not fatal, but is followed by prolapsus of the rectum, which is in a very inflamed state and ulcerated; rapidly gangrene sets in and is quickly fatal. The Venezuelan peasants state that this disease arises in children from chewing the green tender stalks of unripe maize, of which they are very fond on account of its sweetness. In children prolapsus of the rectum is very frequent; in bad cases they may die, like the animals, in convulsions, though in children convulsions are not necessarily a fatal symptom. The treatment employed by the natives for animals consists in an enema of strong lemon-juice, mixed with a weak dilution of white rum and water (aguardiente), two or three times a day; at the same time the anus is freely dusted with wood ashes, some of which are also introduced into the rectum. A purgative of oil is generally administered also. In some cases I have known this treatment prove very successful. On the other hand, when the disease is far advanced, or when the ulceration of the bowel appears at an early date, it seems to be of little or no avail. Another treatment employed, especially for children, consists in an enema of the juice obtained by crushing the stalks and leaves of Spigelia anthelmintica (pasote). A decoction of the same herb is also given by the mouth three or four times a day. This decoction is very frequently administered by the peasants as an anthelmintic. In cases of children suffering from 'bicho,' one of the quarters of a lemon is roasted and introduced into the rectum as a suppository once or twice a day, and I have heard that it gives very satisfactory results."