198 DISEASES DUE TO BACTERIA 



SYMPTOMATOLOGY. 



There is an endless variety in character, urgency and significance. 



The nearer the lesion to the rectum the more urgent is the tenesmus. 



The nearer the caecum the more griping. There is never liver 

 abscess. 



We will group them thus : — 



Acute, Chronic, and Infantile. 



(i) Acute bacterial dysentery . 



Incubation twenty-four hours to six days. 



Onset. — Sudden, abdominal pain about the umbilical region first. 



Incessant call to stool, griping, tenesmus, very small stools of slimy 

 mucus, and later blood-stained. 50-200 in twenty-four hours. Passage 

 of a stool gives no relief. 



Slight or moderate fever, 99°-io3° F. Great thirst, foul tongue, 

 dry skin. Anus becomes painful, prolapse not uncommon. Blood in 

 stools, rapid exhaustion, sleeplessness, restlessness. 



Vomiting is not common. There may be constipation of the upper 

 bowel with diarrhoea of the lower, recognized bv distension. 



The typical dysenteric motions have no faecal odour. 



The pulse is quickened, especially if much blood is passed per 

 rectum, and may become irregular. 



Bad signs are : — 



Irregular and rapid pulse, subnormal temperature, hiccough, 

 diminished number of stools in midst of attack during the second or 

 third week. 



Good signs are : — 



Motions more faeculent, less numerous, disappearance of blood and 

 mucus, less pain and tenesmus. 



Cases have been known to improve much, and then with a slight 

 faeculent diarrhoea the patient has died wiiliin a few hours from 

 gangrenous dysentery, or with the latter type there mav be thin, 

 watery, dirty, foul stools, with sloughs of every shape and colour. 



Profuse hc-emorrhage is always possible. 



Others may commence with rigors, and the temperature may keep 

 high, 1030-105° F., with mental symptoms as stupidity, sleeplessness, 

 delirium, abscesses, carbuncles and bed-sores, simulating somewhat 

 enteric fever. Death may ensue in a few days from exhaustion, 

 toxaemia or hyperpyrexia. 



The stools. 



In an average case they consist of odourless gelatinous blood and 

 extremely tenacious mucus Avhich adheres to the pan. 



In three to four days they become of a more purulent nature, vellow 

 in colour, and contain less blood. Later bile is seen, which indicates 



