64 HUMAN INTESTINAL PROTOZOA IN THE NEAR EAST 



" probably bacillary dysentery " if it is present, and the cases are 

 treated accordingly. From the point of view of the patient this is 

 most important, for bacteriological examination cannot give an 

 answer quickly enough. Theoretically it may be possible to isolate 

 and diagnose the bacillus in thirty-six to forty-eight hours, or 

 occasionally in eighteen hours, but this is the critical period for 

 the patient and it is during this period that active anti-dysenteric 

 treatment should be adopted. As a matter of fact, in practice the 

 bacteriological diagnosis takes longer than forty-eight hours on an 

 average, so that frequently all signs of dysentery have vanished 

 before the report is obtained. It is obvious therefore that bacterio- 

 logical diagnosis is too slow to be of use in assisting at the early 

 treatment and one must have recourse to other methods viz., 

 a consideration of the clinical characters of the case, the macro- 

 scopic appearance of the stool and the microscopic appearance of 

 the exudate. While the type of stool described above is typical 

 of the bacillary dysenteric attack at one period of its development, 

 it must not be forgotten that before and after this the stools may 

 be very different. Often a patient does not report sick till the 

 blood and mucus appear, and by the time that he is in hospital it 

 may have vanished. The character of the stools after the blood 

 and mucus stage depends largely on x the type of diet the patient has 

 had. As a rule he has been too ill to want much food. Often at 

 this stage one sees what we have called the brown liquid stool 

 which differs macroscopically in no way from the stool which 

 would result from a saline purge. Microscopically, however, one 

 may find all the cells present which one finds in the typical 

 bacillary dysentery mucus. They are, however, uniformly dis- 

 tributed through the liquid faecal matter, though patches of cell 

 agglomerations may occur here and there. This appearance 

 probably indicates a bacillary dysentery which has passed the 

 mucus stage, or a case which will not develop the mucus stage 

 at all. In reporting on these cases, however, much greater caution 

 is needed, for a stool of this kind may be produced by chronic 

 amoebic conditions or by the ulceration of the large intestine which 

 is left after the amoebic infection has disappeared after treatment. 

 A case illustrating this point is described below. At other times 

 in bacillary dysentery one sees a stool like the rice water stool 

 of cholera, and here again there is an abundance of pus, mono- 

 nuclear cells and large macrophages. As the dysenteric condition 

 passes off the cellular elements diminish till finally the microscope 

 fails to yield any information. 



