DYSENTERY. 72 f 



recommences, and again a small quantity of dysenteric dejections of a 

 sickening odor is passed. Sometimes this scene is repeated twenty 01 

 thirty times in twenty-four hours. If at first absent, febrile symptoms 

 always come on in the course of the disease. Where the intestinal le- 

 sion is moderately intense, the fever has an erethetic or synochal char- 

 acter ; the pulse is moderately frequent, full, and hard. But in the high- 

 est grades of the disease the fever acquires an asthenic character very 

 early ; the pulse becomes small, and very frequent. According to the 

 character of the fever, dysentery has been divided into inflammatory, 

 adynamic, and putrid, or typhous. This classification corresponds very 

 nearly with the different grades that we described above. Even in 

 the mildest grades, and when the fever is moderate, the patients are 

 greatly run down by the loss of albumen, the pain, and the loss of 

 sleep ; they become pale ; the pulse, at first full, grows small ; there 

 is great mental depression ; the dulness and want of spirits are very 

 marked. If we filter the dejections, and add nitric acid to the filtrate, 

 we shall find that the albumen in it is sufficient to stiffen almost the 

 whole contents of the reagent-glass, even where the dejections scarcely 

 have a reddish tinge, and only solitary blood-corpuscles are found un- 

 der the microscope. This great loss of albumen also explains why, in 

 favorable cases where, after four to eight days, the tormina and tenes- 

 mus grow less and gradually disappear, and where, often by the end 

 of the first, or the beginning of the second week, the masses passed 

 again become feculent the convalescence is almost always slow. The 

 character of the blood of a convalescent from dysentery is, as Schmidt 

 aptly remarks, very similar to that of a person with Brightfs disease ; 

 and I can confirm, from my own experience, the observation that gen- 

 eral dropsy follows slight cases of dysentery far more frequently than 

 it does other diseases of equally short duration. 



In the higher grades of dysentery, the evacuations succeed each 

 other at very short intervals, the colicky pains scarcely cease, and oc- 

 casionally become unbearable ; the abdomen is sensitive to even a 

 light pressure. The tenesmus also is more continued and severe than 

 in the milder forms. The dejections contain a great deal of blood, nu- 

 merous flocculi and shreds, and occasionally large membranous masses. 

 In many cases large quantities of pure blood are evacuated. At first 

 the pulse is more frequent and full ; later it becomes very frequent, 

 while its fulness usually diminishes rapidly. There are also great con- 

 stitutional disturbance, loss of appetite, dry tongue, deep physical and 

 mental depression, and frequently dulness of the mind and slight delir- 

 ium. If the disease runs a favorable course, the symptoms gradually 

 subside, the intervals between the evacuations become longer, the 

 dejections again grow brownish and feculent ; the epithelial and exu- 

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