BACILLARY DYSENTERY 199 



that the contraction of the lower part of the large gut has passed off. 

 Faecal matter may then be passed. A stool of glairy mucus, like 

 sputum, is usually a catarrhal inflammation due to the Y bacillus. 



In the most acute fulminating varieties the stools contain much 

 blood, and have been compared to "meat washings." 



When necrosis of the mucous membrane has taken place the stools 

 may be choleraic, but may contain dark green sloughs of mucosa 

 (Bahr). 



(2) Chronic bacterial dysentery. 



Insidious onset or may ensue after an acute attack. The bowel is 

 not healthy, and any dietetic error, chill, fatigue, or indulgence will 

 cause the symptoms to appear. 



The stools are loose, five to ten per diem, partly faecal, much mucus, 

 rarely blood, like " frog's spawn " or "boiled sago." The tongue is 

 glazed red, anaemia and emaciation are progressive, cachexia is 

 apparent. 



The digestion is impaired, all functions are beloAv par resulting 

 from anemia and toxaemia. Fermentation produces much intestinal 

 gas. 



These symptoms may subside and recur at intervals. 



The disease may continue until death from exhaustion or some 

 intercurrent disease, or it may clear up spontaneously. 



If no blood is passed it is commonly dysenteric diarrhoea. 



(3) Dysenteric infantile diarrhoea. 



This is an extremely common disease in the tropics. 



Flexner's bacillus commonly, and Shiga's bacillus rarely, are 

 believed to be the exciting agents. 



The symptoms resemble those of the enteric type of chronic 

 dysentery. It begins by vomiting and a temperature of io3°-io5° F. 



The abdomen is distended and tender. 



The stools are facal, but often green w-ith blood and mucus. 



The fever is remittent. There may be repeated attacks. 



Death may be from exhaustion or convulsions. 



Recovery may take place, but the convalescence is always slow. 



COMPLICATIONS. 



Peritonitis with or without perforation (rare). 

 Pleurisy, pericarditis, endocarditis. 



Arthritis, tenosinovitis, j^erhaps the result of secondary infection. 

 Ana?mia and dropsy. 



Peripheral neuritis, frequent in mild forms; one nerve only may be 

 involved. 



Iritis, toxaemia, yields to atropine. 



