60 HUMAN INTESTINAL PROTOZOA IN THE NEAR EAST 



mucus, while between the attacks the stools may approach the 

 normal or, what is more usual, they remain soft and mucoid, being 

 of a peculiar sticky character, due to admixture with mucus in the 

 form of small flakes or streaks. 



(5) Character and Diagnosis of the Dysenteric Stool. 



It has already been stated that much information as to the type 

 of dysentery present can be gathered from the features of the stool. 

 The typical bacillary dysentery stool is so characteristic that with 

 very little experience one can recognize the condition at a glance. 

 The amoebic dysentery stool is also fairly typical but not so much 

 so as that of bacillary dysentery. 



(a) The Character of the Stool in Bacillary Dysentery. 

 Bacillary dysentery sets in with acute diarrhoea, which very soon 

 washes all the faecal matter from the gut, and it is after this that 

 there is found the glairy white or yellowish white mucus streaked 

 or flecked with blood which is very little altered in colour. When 

 seen in the bed-pan this mucus may be sufficiently liquid to pour 

 to and fro or it may be more tenacious and adhere to the bottom of 

 the vessel. It may be the only material present, or there may be 

 a certain amount of faecal matter between patches of mucus. 

 A small portion of this mucus examined under the microscope 

 shows a varying number of red blood corpuscles on a white field 

 composed almost entirely of pus cells, a smaller number of larger 

 round mononuclear cells and a still smaller number of very large 

 cells which remind one of nothing so much as the large hyper- 

 trophied endothelial cells of the blood-vessels. This large type of 

 cell is very commonly found in certain diseases and is generally 

 known as the macrophage. In kala-azar it is the large cell which 

 contains the Leishmania and in malaria it may be found in the 

 peripheral blood. It seems to us that the large cells seen in 

 bacillary dysentery probably have a similar origin. Any of the 

 cells described above may be phagocytic, especially the round mono- 

 nuclear cells and those of the macrophage type. They frequently 

 ingest the polynuclear pus cells and also red blood corpuscles and it 

 is this feature which renders their confusion with amoebae such an 

 easy matter for the uninitiated. The macrophages, however, are 

 non-motile, or practically so, even in the perfectly fresh stool. 

 Another feature of this overwhelming cellular exudate is that the 

 individual cells may appear fairly healthy or they may show exces- 

 sive necrosis, being reduced to nothing more than vesicles, the 

 limits of which are the remains of the cytoplasm or nuclear 



