The abdomen, for the most part, is depressed, so that on palpation the contracted colon may be frequently felt.. In such a case the bowel, either along the whole tract or in circumscribed localities, manifests more or less acute sensitiveness to pressure. The tissue about the anus is usually very much reddened, often excoriated, or even ulcerated, while in the gaping anus may be seen the tensely filled veins and a chap let-like pad of livid, discolored mucous membrane. The constitutional symptoms soon become manifest. The colicky pains that precede and accompany the evacuations with the consequent. tenesmus torment the patient not less than the intense thirst. The sufferer is deprived of sleep, or sleeps only lightly. Even a few days after the disease has set in the patient's face exhibits a painful expression, the eyes are circled with blue, the lips are usually dry and fissured, the tongue dry and thickly coated, the appetite is gone, and often there exist nausea and vomiting.
It is distinctly characteristic of dysentery that within a few days the skin becomes very pale and there is a rapid loss of strength and great emaciation. The urine is usually lessened in amount and may contain albumin and casts. The temperature presents nothing characteristic. It may be normal or subnormal, but in the majority of cases it exhibits an irregular remittent type.
In a microscopical examination of the stools we find, in and around the struetureless mass of mucus, intestinal epithelia, single and grouped leueoeytes, which are usually polynuclear; erythrocytes normally colored or shadowed, often agglutinated, the occasional remnants of vegetable or animal food and remarkably few bacteria. Concerning the bacteria it may be stated that in a cover-glass preparation the presence of a few short, plump, free or endocellular bacilli, negative to Gram's stain with many pus corpuscles may strengthen our suspicion as to an infection by dysentery bacilli. But a further identification of the latter is possible only by means of cultures or finally by serum diagnosis.
The progress and termination of dysentery vary, a complete return to health in a majority of the cases ensuing in a more or less short (1 to 2 weeks) or long time (3 to 4 weeks). But the convalescence of the patients may, without any manifest cause be interrupted by one or more relapses. Cases which are grave or very severe from the outset may terminate fatally within a few days, owing to a collapse or various com plications. Signs of favorable trend are remission of tenesmus, the occurrence of stools of a feculent odor and of flatus, decrease of thirst, refreshing sleep, and return of the appetite.
Cases continuing for several weeks or several months, in which periods of improvement and apparent cure alternate with relapses, are usually designated as chronic dysentery. Not infrequently such cases
occasion a severe marasmus or certain sequelre or complications may lead to death.
The following complications of dysentery have been observed: Se vere thrush, stoniatitis either aphthous or ulcerative, noma, suppura tive parotitis, icterus, liver abscesses, peritonitis, fissures of the anus, prolapse of the anus and rectum, gangrene of the prolapsed anus, bron chitis, bronchopneumonia, pneumonia, atelectasis, pleuritis, pytemia, obstinate tendinous and articular inflammations.
As sequel there have been recorded: chronic colitis, membranous enteritis, stricture of the anus, of the rectum and of the colon, distur bance of the nerves of the lower extremities, antenna and marasmus.
The diagnosis in a majority of cases of infectious dysentery is easy; the intestinal symptoms and the examination of the stools, especially in an endemic or an epidemic of the disease, being sufficient. More difficult, however, is the etiological diagnosis of a sporadic case, as well as the differential diagnosis of severe cases of follicular enteritis which may be caused by infection with highly virulent colon bacteria (Rossi Doria, 1592, Escherieh, 1S95, Finkelstein, 1SOG). In such contingencies an exact etiological diagnosis is possible only by means of culture and serum reaction.
The prognosis depends on the intensity and extent of the local process, the complications, and the constitution •of the patient. The mortality in several epidemics has fluctuated between five and thirty per cent.
With regard to the prophylaxis, the cases of dysentery must be iso lated both in private practice and in the hospitals, the evacuations must be disinfected, and the attendants, both for their own interest and that of those around them, must be scrupulously clean.
to the treatment, the dysentery patient should be confined to bed, even if the disease be only light. Warm compresses, in moist or dry form, applied to the abdomen, are appreciated by most suf ferers. The diet should consist of mucilaginous soups made of oatmeal or flour, and later on may be given gradually, milk, gruel soups, eggs, purées, and minced meat. To relieve thirst, tepid tea, coffee, pure water, or sugared water to which some brandy or a few spoonfuls of red wine have been added, are advisable. In weakness or collapse cognac or medicinal wines (Mavrodaphne, St. Mauna, Sherry, etc.) in large closes, should be administered, and injections of camphor in oil (camphor 1 part in 9 parts of olive oil) may be given several times a day, 1-1 c.c. al 71-15) with a Pravaz syringe. For the same purpose a subcutaneous injection of 150 to 250 c.c. (5 to S oz.) of 0.8 per cent. solution of chloride of sodium can be recommended.