728 ACUTE INFECTIOUS DISEASES. 



dation masses, as well as the blood, which long continues to be mixed 

 with them, diminish ; the pulse rises, the tongue grows moist, the mind 

 clearer ; but convalescence is always slow, and, in the most favorable 

 cases, weeks elapse before the patient can leave his bed. If the dis- 

 ease is to prove fatal, the pulse becomes smaller, the apathy increases, 

 consciousness is lost, the complaints of pain and tenesmus cease, the 

 evacuations are involuntary, and the patient dies, as in other rapidly- 

 exhausting diseases, of general paralysis. If the disease pass from the 

 acute to the chronic form, as is very often the case in the higher grades, 

 the fever disappears, and we have the symptoms of follicular ulcera- 

 tion of the intestines. Diarrhoea generally alternates with constipa- 

 tion ; occasionally normal faeces, with muco-bloody masses clinging to 

 them, at other times only a puriform fluid from the ulcerating mucous 

 membranfc, is evacuated ; the patients become very much emaciated, 

 and, after languishing for months, usually die of marasmus and dropsy. 

 If the losses of intestinal mucous membrane heal, leaving a cicatricial 

 stricture, the symptoms of protracted dysentery of high grade are fol- 

 lowed by those of stricture of the intestine. For the rest of his life 

 the patient suffers from habitual constipation, and the various incon- 

 veniences accompanying this state. On carefully inquiring into the 

 causes of chronic abdominal diseases, we can frequently trace them to 

 a dysentery that existed several years previously. 



In the highest forms of dysentery, the putrid or septic forms of 

 authors, after the disease begins as above described, the passages as- 

 sume a discolored, brownish-red or blackish color, and a carrion-like 

 odor ; and large, black, sloughy shreds of mucous membrane are not 

 unfrequently mixed with them. The pulse soon becomes small and 

 very frequent, the extremities cool, and the body burning ; the patients 

 are collapsed, the countenance distorted, the tongue and gums are cov- 

 ered with dry sordes, and the mind is very dull. Tormina and tenes- 

 mus cease very early in the disease ; the discolored, thin, fetid passages 

 are passed involuntarily, owing to the relaxation of the sphincter, and 

 they excoriate the parts with which they come in contact. In such 

 cases, to the symptoms of adynamia are often added those of an acute 

 haemorrhagic diathesis, bleeding from the nose, petechia, etc. During 

 the first days even, the patient may die of septic dysentery ; and re- 

 covery is very rare in this form of the malady, which occurs chiefly in 

 camps, besieged towns, or under other unfavorable conditions. Dysen- 

 tery patients with the higher and highest forms of the affection do not 

 often die of peritonitis or pyaemia ; in the tropics not a few probably 

 die later from the hepatic abscesses which develop during the disease. 



TREATMEOT. Prophylaxis demands that the circumstances which 

 experience shows to favor the development and propagation of dyson- 



