The specific cause is an organism much Iike the bacillus coli, and which is agglu tinated by the blood of dysenteric pa tients. An antitoxic serum prepared ith which 266 cases were treated, ss-ith a death-rate of 12 per cent., the death rate during the same period under ordi nary treatment in 1736 cases being 34 per cent. Shiga (Report by Surgeon Eldridge to the U. S. Marine-Hosp. Serv ice, 1900).
In Fiji dysentery is endemic and most prevalent in May, June, and July: the season of dry weather and scanty water supply. While under some circumstances the mortality is high,-40 per cent.,—the average death-rate is 7 per cent. C. W. Hirsch (Edinburgh Med. Jour., Jan., 1900).
Among 277,000 cases of malarial dis ease recorded by various writers, 3054 were registered as pernicious fever, and, of the 1317 of those which were more definitely classified, only 8 were consid ered to be as belonging to the pernicious dysenteric class. Kanallis and Carda matis (Progres Med., May 19, 1900).
In Manila dysentery is very common. Investigation has conclusively shown the two types of dysentery: one dependent upon a. specific bacillus said to resemble the bacillus typhosus or the bacillus coli connnunis, the other being the ordi nary anicebic dysentery of the tropics. R. P. Strong and NV. F.. Musgrave (Jour. Amer. Med. Assoc., Aug. 25, 1900).
Analysis of the waters of Landerneau (Brittany) in the midst of an affected region. The nutritive gelatin plates of Ellsner showed colonies of the colon bacillus, the method of Pere also. The bacillus resembled Eberth's bacillus, but was distinguished by the lactose test, which differed from the reaction with Eberth's bacillus. F. Lenoble (La Presse Med., Oct. 27, 1900).
Comparative study of several cultures of bacilli obtained from cases of dysen tery. These organisms were designated Manila cultures, Kruse's bacillus, Shiga's bacillus, cultures of a Porto Rican, and Strong's bacillus. Tbe differences of growth are slight. and probably depend upon purely accidental circumstances. A comparison of the morphology of the bacilli shows only very minor differ ences. Kruse bas not observed motility at any time in his culture; Shiga states bis to have been feebly motile, while those of the author were at first slightly motile, but soon became quiescent in artificial cultivation and did not regain motility. Strong's observations coincide with the author's. Vedder and Duval, under the direetion of the author, have succeeded in demonstrating flagella by Van Ennengheim's method in several vultures. The serum reactions have been of the greatest importance, and are, moreover, unmistakable in signifi cance: they indicate close relationship between the bacilli from Japan, Manila, Porto Rico, and Germany, and they further render probable the identity of the epidemic dysentery of this country with that of the East and Germany. Elexner (Brit. Med. Jour., Sept. 21,
1901).
Shi,ga's bacillus dysenterire is found in the latter half of the first week of the disease in the fresh stools; in the later stages of the disease it is rather difficult to cultivate. It disappears more or less completely as the patient improves. If there is a relapse it again appears in large numbers. One finds the bacilli in almost pure culture in fresh catarrhal or diphtheritic areas in the bowel; in fresh conditions they are found more superficially in the lesions; in the old infection, the colon bacillus and other micro-organisms overgrow them. The bacilli are often found in the mesenteric glands, but the author has never found them in the liver or spleen. He exam ined five eases of parotitis which oc curred in the course of dysentery, and was unable to find the bacilli in ex tirpated portions of the glands or in juices of the gland. The urine, blood, and milk are always sterile. Because of the localized character of the disease one finds in dysentery no tumor of the spleen, no eruption, and no inflamma tory conditions of the bone and bone marrow, etc., such as are found in ty phoid fever. The agglutinative reaction he has tested in hundreds of patients and found it generally parallel in in tensity with the severity of the disease. It appears in some instances in dilution as great as I to 130. and so on down, very mild cases being negative at 1 to 10. He has seen the reaction present as long as eight months after the at tack. It is now, however, of impor tance in diagnosis in ninny instances, because it is very likely to be absent in very mild or doubtful eases. He dis cusses the relation between the typhoid serum reaction and the prognosis, and then states that, after making quan titative investigations on the agglu tinating power of the blood in dysen tery, he found that its intensity is prac tically parallel with the severity of the disease excepting in very grave cases, which are commonly fatal, in which the reaction is usually but slightly marked. Agglutination appears only in tbe sec ond or third week of the disease, and reaches its highest point in convales cence. It sometimes appears as late as the sixth week, a.nd this late appear ance makes it of little importance in diagnosis. The bacteriological diagnosis of a case of dysentery may be made by earrying out the ag{.,clittination test of a culture with immune serum, by culti vating on glucose agar, and in milk. If agglutination occurs at once, if there is no gas-production, and if milk has not .coag,ulated, the dysentery bacilli may be considered to be present. K. Shiga (Deutsche med. Wochen., Oct. 24, 1901).
Dysentery is due to the increase in the virulence of micro-organisms that ordinarily inhabit the intestine. The writer does not consider it due to a specific organism. Bertrand (1Zevue de MCA., July 10, 1002).