BACILLI OF THE COLON-TYPHOID-DYSENTERY GROUP 711 



DYSENTERY IN MAN 



The clinical term " dysentery" is a vague one and may signify 

 violent diarrheal disturbances from almost any cause. Technically, 

 the term dysentery should be restricted either to the arncebic variety or 

 the bacillary. Bacterial dysenteries have been attributed to many 

 different organisms besides the true dysentery bacilli, such as some of 

 the paratyphoid bacilli, B. pyocyaneus, the Morgan bacilli, etc. 



Endemic in a large part of the world, especially in the warmer 

 climates, the disease most frequently occurs in epidemics of more or 

 less definite localization, usually under conditions which accompany 

 the massing of a large number of human beings in one place, such as 

 those which occur in the crowded quarters of unsanitary towns, in insti- 

 tutions such as insane asylums, or in military camps. The mortality of 

 such epidemics may be very large. According to Shiga, the disease in 

 Japan frequently shows a mortality of over 20 per cent. 



The disease in human beings usually begins as an acute gastro- 

 enteritis which is accompanied by abdominal pain and diarrhea. As 

 it becomes more severe, the colicky pains and diarrhea increase, the 

 stools lose their fecal character, becoming small in quantity and filled 

 with mucus and flakes of blood. There is often severe tenesmus at 

 this stage, and the bacilli are present in large numbers in the dejecta. 

 Owing to the absorption of toxic products, symptoms referable to the 

 nervous system, such as muscular twitching, may supervene, and if the 

 disease is at all prolonged, there are marked inanition and prostration. 



At autopsy in early stages there may be found only a severe catarrhal 

 inflammation of the mucous membrane of the large intestine. In 

 the later stages there are extensive ulcerations, and the bacteria are 

 found lodged within the depths of the mucosa and submucosa. Occa- 

 sionally they may penetrate to the mesenteric glands, but as far as we 

 know there is no penetration into the general circulation. 



Although this acute disease represents the typical picture of clinical 

 dysentery, it must not be forgotten that bacteria of the dysentery 

 types may cause very much milder intestinal inflammations and even 

 simple diarrheas. "Y" bacilli and Flexner bacilli have often been 

 isolated from such mild conditions, especially during the hot weather. 



Epidemiology and Prevention. Bacillary dysentery is not limited 

 to any particular part of the world. Unlike the ameobic variety, it is 

 probably just as common in temperate climates as it is in the tropical 

 ones, though actual epidemic occurrence is probably a little more fre- 

 quently observed in tropical communities where fly suppression and 



