704 Dysentery 



stage of marked ulceration. There is great thickening of the 

 submucosa and the whole of the intestinal lining is corru- 

 gated. For the most part the ulcerations are more superfi- 

 cial than those of the amebic dysentery, and the edges of the 

 ulcerations show less tumefaction and less undermining. 

 Abscess of the liver does not occur in bacillary dysentery. 



Diagnosis. The blood-serum of those suffering from 

 epidemic dysentery or from those recently recovered from it 

 causes a well-marked agglutinative reaction. This agglutina- 

 tion was first carefully studied by Flexner, and is peculiar, 

 in that the serums prepared from the different varieties of 

 the bacillus, while they exert some action upon all varieties 

 of the organism, exert a much more powerful influence upon 

 the particular variety used in their preparation. The same 

 is true of the patient's serum, hence, in making use of the 

 agglutination reaction for the diagnosis of the disease, the 

 blood of the patient should be tested by contact with all of 

 the different cultures. 



Serum Therapy. By the progressive immunization of 

 horses to an immunizing fluid, the basis of which is a twenty- 

 four-hour-old agar-agar culture dried in vacua, Shiga has 

 prepared an antitoxic serum with which, in 1898, in the 

 Laboratory Hospital, 65 cases were treated, with a death-rate 

 of 9 per cent.; in 1899, in the Laboratory Hospital, 91 cases, 

 with a death-rate of 8 per cent.; in 1899, in the Hirowo 

 Hospital, no cases, with a death-rate of 12 per cent. These 

 results are very significant, as the death-rate in 2736 cases 

 simultaneously treated without the serum averaged 34.7 

 per cent., and in consideration of the frequency and high 

 death-rate of the disease, Japan alone, between the years 

 1878 and 1899, furnishing a total of 1,136,096 cases, with 

 275,308 deaths (a total mortality for the entire period of 

 24.23 per cent.).* 



III. BALANTIDIUM DIARRHEA. 

 BALANTIDIUM Cou (MALMSTEN). 



In certain rare cases a severe form of diarrhea, or a mild 



form of dysentery appears to depend neither upon Entamoeba 



histolytica nor Bacillus dysenteriae, but upon an infusorian 



parasite known as Balantidium coli. This organism was 



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



