THE DYSENTERIES 



of leucocytes. Where ulcers occur, the amount of exudate covering 

 the muscular coat may be thin, while in other places it may be 

 thick. The peritoneum is also generally infiltrated by a coagulated 

 exudate. 



Symptomatology. — ^The different appearances presented by the 

 bacillary dysenteries may be grouped into: — 



1. The acute type. 



2. The gangrenous type. 



3. The entero-dy sent eric type. 



4. Choleraic dysentery. 



5. Chronic dysentery. 



6. Dysenteric diarrhoea. 



7. Dysenteric infantile diarrhoea. 



I. AcuteBacterial Dysentery. — ^The incubation varies from twenty- 

 four hours to three or four days, and is not well known in natural 

 infections. Usually after an incubation of a few days, during which 

 the patient may not feel quite well, and may complain of constipa- 

 tion or diarrhoea, with loss of appetite and malaise, the disease 

 begins with an attack of pain in the lower part of the abdomen, 

 and an urgent desire to defaecate, which results in the passage of 

 perhaps an ordinary formed faeculent motion, which temporarily 

 relieves the pain. Soon, however, another attack of pain is felt, 

 generally in the region of the umbilicus, from which it radiates to 

 any part of the large intestine, and this is again associated with a 

 desire to defaecate and the passage of a motion which is composed 

 of faecal matter, but may now be soft. The pain increases, and th^ 

 desire to defaecate becomes more and more frequent, until almost 

 constantly present, while any nourishment, however bland and un- 

 irritating, at once produces a desire to defaecate. After a time 

 the patient sits almost continuously upon the commode, straining 

 violently, and passing at first motions of faeculent matter mixed with 

 blood and mucus, and then blood and mucus mixed with a little 

 faeculent matter, and finally nothing but a little blood and mucus. 

 As a result of the straining and the passage of numerous motions, 

 the anus becomes inflamed and very painful, and prolapse of the 

 bowel is not uncommon, and adds greatly to the distress of the 

 patient. The urine diminishes in quantity, and therefore may show 

 an increased quantity of urea, and at times may contain a trace 

 of albumen. Pain is often complained of in the region of the bladder 

 during and after straining at the commode. In slight cases the 

 number of motions may be only about one every hour, but in more 

 severe cases they number from fifty upwards, until they are passed 

 almost continuously. This constant pain and desire to defaecate 

 naturally weakens and exhausts the patient very quickly, for it 

 prevents sleep and rest. 



In ordinary cases the tongue is moist and coated with a white 

 fur, and usually the patient is thirsty, but not markedly so, except 

 in bad cases. Nausea is often present, and there is no desire for 



