CHAPTER XXVIII 

 DYSENTERY 



DYSENTERY is an acute, subacute, or chronic, infectious colitis, 

 usually characterized by an acute onset, mild fever, pain in the abdo- 

 men, rectal tenesmus, and the passage of frequent, usually small, 

 mucous and bloody evacuations from the rectum. 



The disease was known to the ancients. It was probably dysen- 

 tery that is meant by " emerods " in describing an epidemic that took 

 place among the people of Israel during the time of the Judges. Hip- 

 pocrates differentiated between diarrhea and dysentery. 



Sporadic cases of the disease occur in almost all countries, the 

 number of such increasing as the equator is approached. In addition 

 to these sporadic cases epidemics not infrequently appear. Though 

 such may break out at any time in towns or cities, they are more apt 

 to occur when unusual activities of the people are in progress. The 

 most frequent of these is military, and armies are apt to be the great- 

 est sufferers. The incidence of dysentery in the Federal Army dur- 

 ing the War of the Rebellion was appalling. Woodward* states 

 that there were 259,071 cases of acute and 28,451 cases of chronic 

 dysentery. 



Endemics also occur from time to time and assume devastating 

 proportions, as in Japan, where between 1878 and 1899 there were 

 1,136,096 cases, with 275,308 deaths a mortality of 25.23 per cent.f 

 Osier quotes Macgregor as saying: "In the tropics dysentery is a 

 destructive giant compared to which strong drink is a mere phantom. 

 It is one of the great camp diseases and has been more destructive 

 to armies than powder and shot." 



The disease early came under the observation of the bacteriolo- 

 gists, and Klebs, Ziegler, Ogata, Grigorjeff, de Silvestri, Maggiora, 

 Arnaud, Celli and Fiocca, Galli-Valerio, Valagussa, Deycke, and 

 others published descriptions of various micro-organisms isolated 

 from dysenteric stools, and looked upon by their discoverers as its 

 cause. The results were, however, so discordant that none of 

 the described micro-organisms could be agreed upon as the excitant 

 of the disease. 



In 1860 LamblJ published a description of an ameba found in the 

 human intestine. No one seemed inclined to believe that it might 

 have any significance until much later. 



In 1875 L6sch described an ameba which he found in great num- 



* " Medical and Surgical History of the War of the Rebellion," Medical, n. 



"Public Health Reports," Jan. 5, 1900, xv, No. i. 

 $ " Aus. d. Franz Joseph Kinderspital zur Prague," 1860, i, 326. 

 "Virchow's Archives," 1875, Bd. LXV. 



631 



