The microscopical examination of the bloody, mucoid stools shows red blood corpuscles, leucocytes, oval and round epithelioid cells, cylindrical epithelial cells in small numbers, crystals of arn monia-magnesian and earthy phosphates, Charcot's crystals, occasionally blood-pig ment, and amcebm. At later stages the cellular elements are less numerous, the amorphous detritus increased, and elastic tissue may be met with. In the liquid stools of the chronic form few formed elements except amcebre occur. With each exacerbation there is an increase of the cellular elements.
In the grave form the stools are, at first, numerous, twenty to thirty in twenty-four hours; as the disease ad vances they diminish to a dozen or less, and in fatal cases, toward the end may not exceed three or four.
_Abdominal pain and tenesmus are fre quently present at the outset, especially in severe cases, but may be entirely ab sent. Vomiting and nausea are only oc casionally observed. Fever is an incon stant symptom and ranges from 99° to 101° or 102°. With the development of complications (Iiver-abscess, etc.) it is more persistent and tends to become more regularly intermittent. The pulse, in most instances, follows the variations in temperature. In the fatal stage of gangrenous dysentery the pulse becomes rapid,-120 to 140 or more—thready, and compressible; and at the same time the temperature tends to fall below nor mal. Amemia, of greater or less severity, appears in all cases; albuminuria of slight grade is of frequent occurrence, and hyaline casts are sometimes found in the urine.
The examination of the stools for the amcebm coli is very important and should never be omitted. Sometimes a single examination suffices to demonstrate ac tively-moving amoebre. In chronic cases, however, repeated examinations may be required. In cases of liver- and of lung abscess the diag,nosis of the intestinal disorder may be established by finding the amoebm in the aspirated contents of the former or in the sputa derived from the latter. In making the examinations for amcebre it is advised that the stools be passed into a warm bed-pan and kept at the body-temperature during the ob servation. The examination should be made at once or very soon after collect ing the keces, and the most favorable parts should be chosen for the examina tion. A warm stage greatly facilitates the examination.
Special symptoms referable to com plications are apt to arise. Those most commonly met with are in connection with liver- and lung-abscesses, peritonitis with or without perforation of the in testine, and intestinal hmmorrhage.
The duration of the disease in uncom plicated cases varies from six to twelve weeks. Recovery is tedious, relapses are frequent, and there is a constant tend ency to chronicity. In uncomplicated cases recovery may be expected when the fmces become formed and amcebm disap pear from the stools.
Complications. — A local peritonitis may arise by extension, or a diffuse in flammation, which is usually fatal, may follow perforation. A local inflamma tion about the cmcum gives rise to peri typhlitis; if about the rectum, periproc titis. The regional lymphatic glands may be swelled and hypermmic, and rarely do they undergo suppuration. A serious complication is pylephlebitis af fecting the veins of the intestine and mesentery, owing to the danger of em bolic abscess of the liver. The abscesses, in these cases, may be single or multiple. Intestinal stricture is a rare sequence; amyloid degeneration of the viscera and dropsical conditions are uncommon con sequences of chronic dysentery. The dis eases associated with dysentery which have been noted are rheumatic swelling of the joints, malaria, typhoid fever, pleurisy, pericarditis, and endocarditis.
Case of severe dysentery complicated with infectious pseudorheumatism, ar thritis, with sero-purulent effusion of the left knee, necessitating arthrotomy and drainage of the articular cut-de-sacs. J. lirault (Lyon Med., Jan. 27, '95).
The sequelm of the disease as met with in the Philippine Islands a,re the following: Chronicity; chronic gastri tis and indigestion; obstinate constipa tion; paralysis (partial) of the latge intestines, due either to obliteration of the glands and lack of secretion or to lack of innervation and blood-supply; anminia from lack of assimilation of food; association of malarial fever; typhoid fever; neuritis; atrophic cir rhosis of the liver; chronic parenchy matous nephritis; abscess of the liver; metastatic abscesses of other organs, as of the lungs and kidneys; inanition; toxtemia; dilatation of the stomach and intestines. S. M. Long (N. Y. Med. Jour., Mar. 30, 1901).