DISLOCATIONS OF THE TARSUS AND METATARSUS. - These dislocations re semble those of the carpus and meta. carpus (q. v.). The external cuneiform alone has not been dislocated individu ally.
DYSENTERY.—Gr.,,)v;-, difficult, and intestine.
Definition.—An acute or chronic in flammatory disease, which -usually affects the large, but sometimes the small, in testine. The structures implicated are the solitary and more rarely the agmi nated nodules, and the general enteric mucous membrane. Under this name are described several different forms of intestinal flux, which in the acute stage are characterized by feyer and accom panied by tormina and tenesmus.
Varieties.—Several different forms of dysentery are distinguished partly upon anatomical and partly upon clinical and etiological grounds. A. division into endemic, epidemic, and sporadic has been made. It is probable that the endemic, or tropical, form owes its origin to a definite species of micro-organism, the amceba coli. The epidemic and spo radic varieties are of uncertain etiology. For clinical purposes a separation into catarrhal, diphtheritic, and aincebic dys entery' may be made.
General Symptoms.—The first symp toms of dysentery usually set in without prodromata. A natural movement is fol lowed by seYeral diarrhwic stools with out either pain or tenesmus. The size of the movements gradually diminish, they become admixed with mucus and blood, and are accompanied by colic, bor borygrni, and tenesmus. It sometimes happens that tbe disease is ushered in with bloody and mucous stools, pain, and tenesmus. In light grades constitu tional symptoms are scarcely present; in severe ones the disease begins with chill, fever, loss of appetite, nausea, and faint ness. The eyacnations remain diarrliceic and contain only mucus, when we have to deal with a mild catarrhal inflamma tion, or they become admixed with blood, pure bloody, psendomembranons, or pur ulent, indicating more seyere lesions.
The several kinds of dysentery present ' different stages. The epidemic and spo radic forms may be separated into ca- I tarrhal, diphtheritic, and ulcerative stages. The endemic form, and espe cially the amcebic variety, appears in the ulcerative stage almost exclusively. The last also shows a greater tendency to be come chronic and to relapse.
—(A) Cdtarrhal Dysentery.—In this form prodromata, except dyspepsia and slight abdominal pains, are rare. Diarrlicea is the most
constant initial symptom and at first it is not painful. The characteristic feat ures of the disease—colicky and griping abdominal pain, frequent stools, and straining—are usually developed within the first thirty-six hours. The consti tutional symptoms are, as a rule, insig nificant; the temperature is little ele vated; the pulse rarely exceeds 100; the tongue is, at first, furred and moist, but later becomes red and glazed; nausea and vomiting may be present. The ab donien may be flat and hard and the thirst excessive. There is constant de sire to go to stool. The stools present the following characters: During the first twenty-four or forty-eight hours they consist of more or less clear mucus and blood, with small, scybalous masses. Under strict regimen, as early as the second day, they may be composed en tirely of mucus and blood, and their con sistence may be so viscid that the bed pan may be turned upside down in many cases without spilling the contents. The number of stools in twenty-four hours varies from 15 to 200. This condition may persist for one or two weeks, the mucus becoming gradually more opaque, of a grayish-white color, the blood pro gressively diminishing in quantity, and a little gray, green, or brown pultaceous detritus, or fluid fiecal matter, appear ing in the stools. As the disease sub sides, ffecal matter again makes its ap pearance, increasing in amount until fully-formed ftvces are passed, showing neither mucus nor blood. In the more prolonged cases wholly pultaceous, yel low-brown or gTeenish (spinach) evacua tions may intervene between the bloody, mucoid stools and the passage of formed faTes. Microscopical examination of the stools shows in the first bloody, glairy discharges a predominance of red blood corpuscles. With these are associated leucocytes and cylindrical epithelial cells in small numbers, and constantly large round or oval epithelioid cells. In later stages the stools contain fewer red cor puscles and more leucocytes; in the taceous material cellular elements are scarce. Bacteria are more abundant in the later stages; amceb are absent; casionally the Cercomonas intestinalis is seen in large numbers. The duration of the disease is variable; according to Flint, the milder cases terminate in about eight days; severe ones may last as long as a month. The disease rarely becomes chronic.