726 



ACUTE INFECTIOUS DISEASES. 



they finally come in contact, if the loss has not been too great. Then, 

 as in cicatrizing ulcers of the stomach, there is sometimes stiicture, 

 sometimes not. If, on the other hand, the opening be very large, its 

 edges do not come together, and we find more or less extensive patches 

 of the inner surface covered, not by mucous membrane, but by callous 

 connective tissue. According to Rokitanskifs apt description, this 

 tissue not unfrequently forms " fibrous bands and striae, which project 

 in the shape of seams into the intestine, cross each other in various 

 directions, and often form valvular or ring-shaped duplicatures in the 

 intestine, thus inducing a very peculiar stricture of the colon." If, on 

 the other hand, the intestinal disease takes a chronic course or tends 

 to recovery, the losses of substance become chronic ulcers, and those 

 changes occur in the intestine which we described as follicular ulcera- 

 tion. In the thickened, strongly pigmented, mucous membrane, the 

 inflamed follicles become ulcers, at first round, afterward irregular; 

 occasionally, also, in the thickened submucous tissue, abscesses and 

 fistulous passages form, and subsequently perforate the muscular coat 

 and induce peritonitis or abscesses about the rectum. 



SYMPTOMS AND COURSE, Occasionally, premonitory symptoms 

 precede the actual outbreak of the disease for several days; these 

 consist in an undefined constitutional disturbance and irregularity of 

 digestion, especially loss of appetite, thirst, slight colicky pains, and 

 inclination to diarrhoea. The commencement of the disease is rarely 

 characterized by a chill, and not often by rigors even, or other symp- 

 toms of fever. But in most cases dysentery begins with an apparently 

 innocent diarrhoea, during which the faeces passed are not suspicious- 

 looking, which is preceded by very moderate colicky pain, and is ac- 

 companied by very little, if any, of the tenesmus which afterward be- 

 comes so painful. But the more frequently the passages succeed each 

 other, the more severe and continued become the colicky pains (tor- 

 mina ventris) which begin some time before each evacuation, and 

 shortly before its occurrence attain great severity. The evacuations 

 are accompanied by a very torturing and painful bearing down of the 

 rectum, to which is often added strangury. In spite of the severe and 

 long-continued straining, proportionately slight, non-feculent, mucous, 

 gray-colored masses (dysenteria alba) or muco-bloody masses (dysen- 

 teria rubra), and occasionally pure blood, are evacuated. In some 

 cases a few hard scybala are from time to time passed with the mucous 

 or muco-bloody masses. Immediately after an evacuation the patient 

 feels relieved, and usually has pain only on hard pressure against the 

 abdomen, especially in the region of the colon ; but soon, often even 

 in a few minutes, the tormina begin again ; the patient writhes and 

 groans, and, when the pains have attained the highest grade, tenesmus 



