52 REVIEW — TROPICAL MEDICINE, ETC. 



Dysentery— character where the stools consist of blackish-red or blackish fluid, with a horribly 

 continued putrescent odour, and of bits of gangrenous tissue. 



Dopter* records three cases of amoebic dysentery, in which all ordinary methods of 

 treatment failed, but which were speedily cured by lavage with a 1 in 100 creosote wash. 

 He suggests that the creosote does not merely act locally, but, being absorbed, reaches and 

 acts upon the Amceha dysenferica in the tissues and in localities where it cannot be affected 

 by other medicaments. 



Vincent-* believes that in water-borne epidemics the amoeba is more frequently the 

 cause than the bacillus. He investigated the length of life of B. (hjsenteriie in various 

 waters and the action of antagonistic saprophytes, and concludes that water is not a 

 suitable medium for the bacillus. At the same time, it lives a long time in frozen water 

 with light excluded, which perhaps explains the outbreaks and frequency of epidemics in 

 cold countries. 



Billet^* has described a special form of Trichomonas which he terms T. dysenterix as 

 distinct from T. intestinalis, and which he believes plays a jjart in the production of 

 tropical dysentery. 



So far as Khartoum is concerned there can be little doubt that polluted surface soil 

 played an important part in the only dysentery epidemic — a slight one — which has visited the 

 town. Eeference to this and other points with relation to dysentery in the Sudan will be 

 found under " Sanitary Notes" (Third Report). 



As regards the treatment of dysentery, one must distinguish between measures suitable 

 for bacterial dysenteries and those useful in amoebic cases. The treatment for the former 

 class has been revolutionised by the introduction of appropriate sera, and considerable 

 literature has accumulated on this most important subject. 



Blackham'' in the first place gives a table for the differential diagnosis of Amoebic and 

 Bacillary Dysentery : — 



Amccbic Bacillary 



1. Always chronic in its course. 1. Acute in onset and running a rapid 



course in nearly all cases. 



2. Pyrexia rare. 2. Pyrexia common. 



3. Toxic symptoms not present except where 3. Toxic symptoms usually present. 



there is liver abscess. 



4. Liver abscess occurs in about 16 per cent. 4. Liver abscess never occurs. 



of cases (Curry). 



5. Small intestine frequently attacked. 5. Disease confined to large intestine. 



6. According to Krause and Kartulis, under- 6. Ulcers usually found on surface folds 



mined ulcers present. of intestine. 



Personally I very much doubt if bacillary dysentery is always confined to the large 

 intestine. In the Second Eeport of these Laboratories I recorded a rapidly fatal case of a 

 disease exactly like dysentery where, post mortem, all that was found was a comparatively 

 small area of the small intestine acutely inflamed and presenting an appearance like a 

 measles rash. I had no opportunity of examining this case baoteriologically, but it was 

 either bacillary dysentery or some hitherto unrecognised, infective, inflammatory process. 



The main points brought out by Blackham as regards treatment are : (1) Value of opium 

 in doses of gr. ^ to gr. J of morphine hypodermically. (2) Clear soups are better than milk ; 

 and weak chicken broth, whey and egg albumen may be given till the tongue cleans. 

 (3) Stimulants rarely necessary ; when required try a teaspoonful of brandy in a tablespoonful 

 of coffee. (4) Value of preliminary dose of castor oil with or without 15 or 20 minims of 

 Liquor Opii Sedativus. (5) Medicinal treatment lies between use of sodium sulphate or of 

 calomel The latter is given in gr. | doses every hour for twelve hours during the day, 

 stopped at night, and repeated in the same way during the second and third days. Bismuth 

 should be given after the calomel for 3 or 4 weeks. (6) The specific serum treatment is 

 valuable and should be tried. (7) In sub-acute and chronic cases in the tropics, where good 



" Dopter, C. (February 12th, 1908), "Traitement de la Dysenteric Amibienne par la Creosote." £ull. dc la 

 Soc. Path. Exot. 



« Vincent, H. (June, 190G). ricnic d'Hygiine, t. XXVIII, No. 7. 



= Billet, A. La Gaducie, August 17th, 1907. 



■• Blackham, R. J. (Pebruarv, 1908), "The Treatment of Dvsentery." Journal of the Royal Institute of 

 Public Health, p. 77, Vol. XXIV." 



• Article not consulted in the original. 



