DYSENTERY is one of the diseases longest known, and may be defined as an infectious disease localized especially in the colon and appearing either endemically or epidemically, the principal clinical symptoms of which are tenesmus, bloody mucus stools, abdominal pain, and early prostration.
Although the clinical picture of the disease has been enlarged by abundant casuistic material, and histological examinations have cleared up the details of the pathologico-anatomical processes in the bowel, yet the etiology was shrouded in obscurity until the last few years. How ever, recent investigations have resulted in commendable success. Thus it has been established by Kartulis, Lutz, Councilman, and others, that tropical dysentery is caused by a parasitic protozoon, the amoeba, and in our latitudes these parasites seem to have an occasional etiological significance, according to Losch, Alva, Kovacs, Quincke, and others. More frequently, however, the infection is caused by the bacillus of dys entery which has been cultivated from the evacuations by Shiga, Kruse, and Flexner in epidemics of dysentery in various localities. According to the investigations made by these authors, and from a considerable number of later investigations—(the literature bearing on this subject has been carefully reviewed by O. Lentz and Leiner)—there exist sev eral varieties of dysentery bacilli, which may be distinguished from each other not only culturally but particularly by serum diagnosis. Further studies must be undertaken to clear up the question touched by many authors as to the relation of follicular enteritis in childhood to infectious dysentery. Children were the material used as a basis for the observations of Leiner and Jehle.
pathologico-anatomical findings depend upon the intensity of the local process as well as the duration of the disease. In the mild cases which recover within a few days there are likely to be circumscribed areas of redness and (edema of the mucous brane of the colon, accompanied by epithelial necrosis, sometimes by shallow ulcerations, while in cases characterized by greater intensity we find flocculent deposits or firmly adherent grayish white or greenish yellow membranes on the mucosa, which is strongly injected and cedema tons, with here and there hremorrhagic infiltration. When these deposits
and exudates have desquamated, there results an ulceration which va ries in size, sometimes isolated, sometimes confluent, or even areas of ulcerations that extend more or less deeply into the intestinal wall and may corrode even the larger blood vessels. The intestinal wall through out is thickened, oedematous, infiltrated, and the solitary follicles are more or less swollen and their surfaces at times ulcerated (see Plate 24). The serosa over the affected intestine appears dull and lustreless, and the regional mesenteric lymph-glands are swollen and frequently infil trated with blood. Besides the colon, the ceeum and even the lower part of the ileum may become the seat of these pathological alterations. The spleen is usually greatly swollen, while the liver and kidneys are acutely degenerated.
disease, as a rule, begins like an intestinal catarrh, with profuse, diarrhceal evacuations. In one or two days later tenesmus occurs during and after the evacuation. Children affected with the disease, moaning, bearing clown and with a painful expression on their faces, usually tarry a long time on the commode and are loath to leave it. The quantity of a single evacuation often amounts only to one or two spoonfuls of at first a glassy mucus, but later on consists of a mucopurulent mass containing small streaks or even small clots of blood, and occasionally dense flocculi or even membranes. The pecu liar odor characterizing the early mucus stools is soon displaced by a carrion-like fetor. The latter is due to the putrefaction of extravasated blood, or it may indicate a severe, even gangrenous inflammation of the bowel. The number of evacuations during twenty-four hours fluctuates between 10, 20 or maybe 50 and even more.