200 DISEASES DUE TO BACTERIA 



Parotitis, abscesses, rarely pyaemia. 



Hemorrhage in gangrenous cases. 



Appendicitis may set in. 



T^'phoid is a most serious complication and has occurred. 



SEQUELiE. 



Stenosis of the large bowel due to cicatricial contraction of the 

 healing ulcers. 



Constipation and diarrhoea intermitting result of above condition. 

 Colic and vomiting, meteorism. 



DIAGNOSIS. 



Inflamed haemorrhoids can be seen and felt. 



Syphilis of the rectum can be diagnosed by the Wassermann 

 reaction and excluded by "606" injections. 



Rectal carcinoma can be excluded by the history, examination with 

 finger and microscope. 



Intussusception is very sudden in onset, the abdomen is not tense, 

 a sausage-shaped tumour is felt. Operation will discover and correct it. 



Malarial dysentery parasites will be seen in the spleen by puncture 

 and smear. 



Kala-azar dysentery parasites will be seen in the spleen jjuncture 

 and smear. 



Amoebic and balantidic dysentery by microscopic examination of 

 fasces. 



A bacteriological examination of the fasces should be carried out. 



The agglutination reaction should be tried with the cultures pre- 

 pared from the fasces and other known organisms. 



PROGNOSIS. 



Mild acute attacks; good recovery the rule. 

 Severe acute attacks; poor, mortality high. 

 Gangrenous acute attacks; bad, nearly all die. 

 12-25 ppi' cent, in all classes together die. 

 The lower down the bowel the better the prognosis. 

 The higher up the bowel the worse the prognosis. 

 Early prophylactic serum improves the prognosis. 

 New arrivals in the tropics suffer more than native residents. 

 In Japan, the mortality was reduced from 35 per cent, to 9 per cent, 

 by serotherapy. 



TREATMENT. 



(i) Acute attacks. 

 Rest in bed. Bland diet. 



Use of urine bottle and bed pan. Constipation must be overcome, 

 no matter how long the patient has been passing mucus. Damp 



