DIFFERENTIAL DIAGNOSIS OF THE DYSENTERIES 213 



EXUDATES IN MALIGNANT, CHRONIC AND CONVALESCENT CONDI- 

 TIONS, CHOLERA, INTESTINAL ALLERGY AND THOSE RESULTING 

 FROM CHEMICAL AND MECHANICAL IRRITATION 



Much remains to be done in the study of celhilar exudates in 

 maHgnant, chronic and convalescent conditions. I already have de- 

 scribed some of these pictures (1924a and /?), but more study is 

 needed. The papers of Thorlakson (1924) and of Bargan (1924) 

 should be consulted for views concerning primary ulcerative colitis. 

 Low (1920) has written a short paper in which he describes a 

 number of confusing conditions which have been encountered by 

 many microscopists who have had occasion to do diagnostic work 

 in dysentery. These include the appearances presented by syphilis, 

 tuberculosis, malignant disease and various surgical conditions. 

 Occasionally, also, one encounters strange reactions in the intes- 

 tinal tract produced by powerful poisons, such as mercury and 

 arsenic. I have described a case (1922) of violent intestinal irrita- 

 tion produced by the ingestion of uncooked Colocasia esculent imi, 

 a common foodstuff of the tropics.^ 



Allergic reactions in the intestinal tract produced by certain 

 proteins ingested by susceptible persons are described by Duke 

 (1922). They are frequently encountered and are a fruitful source 

 of error in microscopic diagnosis. I have called attention to the 

 type of bowel exudate that occurs in these cases (1924^). It is 

 characterized by the presence of eosinophile leucocytes and plasma 

 or "irritation cells" which make up the bulk of the cellular mass. 

 This is in harmony with the nature of the disturbance and per- 

 mits a differential diagnosis from dysentery. More work should 

 be done on it, however. Zahorsky (1926) has laid stress on the 

 importance of this type of exudate in pediatrics. 



Another line of comparative investigation lies in the thorough 

 study of the bowel discharges in cholera, through all stages of the 

 disease. Maitra, Ganguli and Basu (1925) have written a short 

 paper on their findings in India, but their microscopical methods 

 were faulty and more careful work is needed. Goodpasture (1923) 

 has given a good account of the histopathology of cholera and, as 



^ The fine hairs from the sheath of the bamboo Dcndrocalamus strictus 

 Nees, have been administered in food with homicidal intent. They produce 

 a suppurative condition suggesting a chronic colitis. Powdered glass gives 

 rise to similar effects. 



