Ziegler described small bacilli in the crypts of Lieberkuhn and the underly ing mucous membrane. Madan and Lion cultivated from the mesenteric glands, pericardial fluid, and heart's blood of two cases the bacillus coli communis. Babes has cultivated the streptococcus, proteus vulgaris, and other organisms from dysenteric cases. Maggiori studied, in 1891, an epidemic which occurred in Italy. He found in the mucous stools of all cases the bacillus coli communis, in association with proteus vulgaris. More rarely pyococci, bacillus fluores cens, and pyocyaneus were obtained. 0g,ata investigated an epidemic which prevailed in Japan. IIe found small ba cilli, which lay in the protoplasm of cells; they were present in the base of the ulcers. Cultures from fifteen cases gave a short, non-pathogenic, liquefying ba cillus. From eleven cases Ogata culti vated a bacillus which also liquefied gelatin, but was pathogenic. Guinea pigs, inoculated subcutaneously, develop hTmorrhages and ulcers in the intestine. Rectal injections produced more pro nounced results. Condorelli, Alaugieri and Aradas describe a bacillus which they obtained from an epidemic and also iso lated from the drinking-water; Bertrand and Muncher studied an epidemic at Cherbourg and isolated several different bacteria, none of which appear to be spe cific. Silvestri described diplococci which caused diarrhcea in dogs. CoIli and Fi occo found that in the dejections of dys enteric persons the bacillus coli com munis is always present; with it is often associated a typhoid-like bacillus; more rarely the streptococcus and protons ba cillus. The introduction of this bacillus coli, either alone or in association with the other bacteria, by means of the mouth or rectum, into cats, gives rise to dysen tery. According to these writers, the association of the bacillus coli communis with the other bacteria mentioned leads to its conversion into the bacillus coli dysenterie. Celli has more recently ex pressed the idea that the primary in jury to the intestine is produced by the toxin of the bacillus dysenterie, which is followed by the injurious action of pyo aenic cocci contained within the intes tine. Ciechanowski and Norrak have failed to confirm this view by experi ments, although they found large num bers of streptococci in the stools of eases of sporadic dysentery. The bacillus pyo cyaneus, according to Blumer and Larti gan, may be associated with epidemics of dysentery in this country.
Treatment.—The hygienic rules which are observed in the prevention of other infectious diseases and especially of cholera have been employed with excel lent effect in controlling epidemics of dysentery. The employment of filtered and boiled water has reduced the num bers of cases and the spread of the dis ease in the tropics. The same principles are applicable to the treatment of articles of food (vegetables, fruits, etc.) which come into contact with water. Other prophylactic measures consist in the use of suitable clothing which obviates the injurious influence of rapid changes in temperature and humidity of the air and the proper disposition of the dejecta from the sick.
In armies in the field intemperance and all forms of excess should be severely repressed. For the purification of water every available method should be used, but the most practical and certain is boiling, Soldiers willingly adopt these precautions if tea or coffee is served out to them for use with the water. As the sanitary service is not adequate to cope with the necessary work of disinfecting hospitals and the sanitation of battle fields, there should be organized in time of peace a special service for those pur poses which should be in a condition to set to work from the very beginning of mobilization. A service of this kind was
tried with success by the Russians. in 1877. Antony (Thirteenth Inter. 31ed. Congress; Brit. Med. Jour., Sept. 8, I900).
The direct treatment is, in part, di etetic , in part therapeutic. In acute cases the diet is to be restricted to milk, whey, and broths, and during convales cence great care is to be exercised in pro viding only the most digestible articles of food. In the use of a diet of milk, which often will be the chief article, the appearance of curds in the stools is the indication to dilute or partially peptonize the milk before it is administered. Di luted egg-albumin may supplement milk or even take its place for a few days if there is much intolerance to the latter. Sometimes milk is made more acceptable by dilution with lime or Vichy water. The quantity of milk, for an adult, ad ministered in twenty-four hours .should be from 2 to 2 V, quarts. Whatever the food, it is advisable to give it in small quantities and at frequent intervals.
The patient even in chronic cases should be confined to bed; in acute cases no especial persuasion will be required. For the relief of the abdominal pain, the external application of fomentations or turpentine stupes will sometimes suffice; but the internal use of opiates may be demanded. When the pain is low down in the bowel then enemata of opium or suppositories containing some form of this drug or of cocaine may be resorted to.
When a ease is seen early, especially if there has been constipation, a purge should be administered. This can be either eastor-oil or, what is preferable, a saline. By this means the fmcal contents of the large intestine, which tend to pass continuously over the inflamed area, should be effectually removed. The saline selected should be given in suf ficient doses to promptly produce abun dant dejections, and it is then to be dis continued. There may be a marked dim inution in the frequency of the dysen teric evacuations, and great relief of the tormina and tenesmus following the operations of the purgative. The use of a saline is contra-indicated by feebleness of the patient; in such cases castor-oil is to be preferred.
Ninety-five cases treated at Hydera bad, India, by sulphate-of-magnesium method. The number of days under this treatment before the dysenteric symp toms disappeared was never more than 5, and in many eases 1 or 2 only. Leahy (Lancet, Oct. 4, '90).
[Saturated solutions of magnesium sulphate urged by many observers: To an ounce of saturated solution of mag nesium sulphate 10 drops of dilute sul phuric acid are added; this is given every hour or two until it operates freely and the stools have become feculent, free from blood and mucus, and the pain and tenesmus are relieved. W. W. Jolts STON, Assoc. lid., Annual, '91.] Mortality reduced from 5 to 10 per cent. to practically nit, by avoiding all irritants and stimulants; rendering the intestinal canal aseptic by- preventing the decomposition of contents; by counter acting acidity of the blood by alkalies and thus quieting the abnormal action of the intestinal glands. Diet restricted to arrowroot-milk and trinitrate of bis muth, Dover's powder, and soda inter nally. Bahadurji (Brit. Med. Jour., Oct. 24, '91).