DIFFERENTIAL DIAGNOSIS OF THE DYSENTERIES 211 



that were thought to be malarial. I can say with confidence that I 

 consider every one of these "malarial dysenteries" to have been 

 a perfectly typical bacillary dysentery. Moreover, I believe it is 

 the opinion of the greater number of experienced men in the 

 tropics that all so-called leishmanial and malarial "dysenteries'' 

 can, on a little careful study, be resolved into dysenteries of 

 amoebic or bacillary origin. 



At the same time, definite proof that Plasmodium and Lcish- 

 mania donovani are incapable of giving rise to dysentery has 

 never, so far as I am aware, been adduced. It is well known that 

 these parasites may be found in the blood vessels of the intestine, 

 and many practitioners believe that they may give rise to dysen- 

 teric symptoms. That being the case, we might expect to find a 

 bowel exudate of the amoebic type. Careful search should discover 

 the parasite in the exudate, and trophozoites of Entamoeba Jiis- 

 tolytica or Balaufidiuni coli should be absent. 



Dysentery occurring in subjects known to be infected with 

 Leishmania donovani or Plasmodium should be studied with 

 especial care until sufficient evidence has accumulated to settle the 

 question beyond reasonable doubt. It must be borne in mind that 

 diarrhea, and gastric and intestinal hemorrhage may occur in 

 malaria under circumstances that make it likely they are directly 

 associated with the disease. These usually should cause no con- 

 fusion. Moreover, a simple hemorrhage from the bowel is not 

 dysentery. It is the bloody, mucoid, frankly dysenteric exudates 

 that are most likely to lead to errors in diagnosis. The application 

 of drugs usually employed in malaria and leishmaniosis cannot be 

 expected to be effective against either protozoal or bacillary dysen- 

 tery. It will thus be seen that the settlement of these questions is 

 of real importance. 



Spirochetes are frequently found in feces. They have been re- 

 ported as occurring in a variety of conditions ranging from cholera 

 and dysentery to the so-called post-dysenteric colitides. Several 

 species have been described, but I am not convinced that all of 

 them are valid. There is need of further study of these organisms 

 in their possible relation to dysentery. Students should consult 

 the papers of Thomson and Thomson (1914), Crowell and 

 Haughwout (1918), Taylor (1919) and Hogue (1922), Crow- 

 ell and Haughwout briefly review the literature from 1880 to 

 1916. 



