692 Dysentery 



esophageal bougie, it was possible to bring about diarrhea and 

 death with lesion's similar to those described by Vaillard and Dapterr 



In these experiments it was found that rapid passage through 

 animals greatly increased the virulence of the bacilli, and it was 

 also observed that though 0.0005 ^c. of a virulent culture intro- 

 duced into the peritoneal cavity would cause fatal infection, to 

 produce infection by the mouth as above stated required the en- 

 tire mass of organisms grown in five whole culture- tubes. 



The virulent organisms are infectious for guinea-pigs and other 

 laboratory animals, and cause fatal generalized infection without 

 intestinal lesions. 



Lesions. — The lesions found in human dysentery are usually 

 fairly destructive. They consist of a severe catarrhal and pseudo- 

 membranous colitis, which later passes into a stage of marked 

 ulceration. There is great thickening of the submucosa and the 

 whole of the intestinal linmg is corrugated. For the most part the 

 ulcerations are more superficial than those of the amebic dysentery, 

 and the edges of the ulcerations show less tumefaction and less 

 undermining. Abscess of the liver does' not occur in bacillary 

 dysentery. 



Diagnosis. — The blood-serum of those suffering from epidemic 

 dysentery or from those recently recovered from it causes a well- 

 marked agglutinative reaction. This agglutination was first care- 

 fully studied by Flexner, and is peculiar in that the serums pre- 

 pared from the different varieties of the bacillus, while they exert 

 some action upon all varieties of the organism, exert a much more 

 powerful influence upon the particular variety used in their prepa- 

 ration. The same is true of the patient's serum, hence, in making 

 use of the agglutination reaction for the diagnosis of the disease, 

 the blood of the patient should be tested by contact with all of 

 the different cultures. 



Some experience with the serum employed is necessary for identi- 

 fying supposed dysentery baciUi, or with the bacilli employed when 

 diagnosticating the supposed disease. Normal serums sometimes 

 agglutinate in dilutions as low as i : 10, hence dilutions as high as 

 1 : 20, 1 : 50 or even i : 100 should be compared. 



Serum Therapy. — By the progressive immunization of horses 

 to an immunizing fluid, the basis of which is a twenty-four-hour- 

 old agar-agar culture dried in vacuo, Shiga prepared an antitoxic 

 serum with which, in 1898, in the Laboratory Hospital 65 cases 

 were treated, with a death-rate of 9 per cent.; in 1899, in the Labor- 

 atory Hospital, 91 cases, with a death-rate of 8 per cent.; in 1899, 

 in the Hirowo Hospital, no cases, with a death-rate of 12 per 

 cent. These results are very significant, as the death-rate in 

 2736 cases simultaneously treated without the serum averaged 

 34.7 per cent., and in consideration of the frequency and high death- 

 rate of the disease, Japan alone, between the years 1878 and 1899, 



