In survival scenarios, many believe that trauma from gunfights at the OK corral will cause the most deaths. The truth, however, is that many avoidable losses will occur due to more basic issues, such as dehydration from infectious diarrheal diseases. These most often occur from failure to assure the sterilization of water, proper preparation of food, and safe disposal of human waste. One of the many duties of the medic in austere settings is to supervise these activities.
I’ve written about some of these diseases before, such as Cholera, but I haven’t discussed dysentery in much detail. The World Health Organization (WHO) defines dysentery as diarrhea in which blood is present in loose, watery bowel movements. Unlike Cholera, dysentery is a diarrheal disease that can be caused by several different organisms. It can be spread from human to human or, less commonly, from animals to humans.
Most cases of diarrhea are mild and easily treated with fluids and avoidance of certain food products, like dairy. Dysentery, however, is a more serious form where inflammation of the large intestine causes watery stools mixed with blood, pus, and mucus.
There are two types of dysentery:
Bacillary: Most often caused by several variants of the bacteria family Shigella, but E. Coli, Salmonella, and Campylobacter may also be involved.
Amoebic: A parasite, Entamoeba Histolytica, is more commonly seen in tropical and subtropical climates.
Dysentery was the cause of death of many soldiers in the Civil War. In total, infectious diseases like Cholera, Typhoid, and others killed more men than bullets or shrapnel.
SIGNS AND SYMPTOMS OF DYSENTERY
About 2-10 days after infection, the patient will begin to show symptoms. Some will experience mild effects but others will progress to more severe disease. Beside frequent watery stools mixed with blood and mucus (sometimes 20-30 times a day!), you may see:
· high fevers
· abdominal pain and bloating
· Excessive gas
· Loss of appetite
· Weakness and fatigue
· Urgent need to evacuate
All of the above leads to significant dehydration, which is complicated in severe bacillary dysentery by erosion of the lining of the gut, leading to ulcers that cause bleeding from the rectum. Combined with the effect of bacterial toxins, death may occur quickly without antibiotic therapy and IV fluids. Amoebic dysentery may follow a similar course or be more prolonged in nature, leading to a weakened system and the formation of pockets of pus in the liver.
As you can imagine, any form of this disease will greatly decrease the chance for survival off the grid. As the well-prepared medic can intervene early with certain medicines, a high index of suspicion will decrease avoidable deaths.
For bacillary dysentery like that caused by Shigella, antibiotics like ciprofloxacin (Fish-Flox) or azithromycin (Aquatic Azithromycin) are used as treatment. Amoebic dysentery can be treated with an anti-parasitic drug such as metronidazole (Fish-Zole). Dosing can be found in our book “The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way” or in various articles at doomandbloom.net. Loperamide (Imodium) and Pepto-Bismol (Bismuth Subsalicylate) are additional items that will be useful tools in the medical woodshed.
Of course, it’s especially important to rehydrate victims aggressively. Oral rehydration salts contain electrolytes that will more effectively aid recovery. These can be purchased commercially or improvised using the following formula:
To one liter of water (2 liters for children), add:
· 6-8 teaspoons of sugar
· ½-3/4 teaspoons of salt
· ¼-1/2 teaspoons of salt substitute (used by people who can’t use regular salt. This item has potassium, an important electrolyte, and can be found wherever regular salt is found.)
· A pinch of baking soda for bicarbonate
Prevention of dysentery requires understanding of how it’s spread. Transmission often occurs by infected individuals who handle food without washing first or use unsterilized water. Some people may carry the organisms and show no symptoms, at least for a time. As contamination with human feces is a big factor, the medic has to closely supervise the building and use of latrines and other facilities.
Dysentery is just one of the issues that can cause headaches and heartaches for the survival medic. With some knowledge and supplies, you’ll have a better chance to keep your family safe in times of trouble.
Joe Alton, MD
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