1850 



THE DYSENTERIES 



submucosa. These sloughs may be small or large, and even at 

 times may be tubular. The motions are now exceedingly numerous, 

 and sometimes haemorrhage per anum may take place. The patient 

 becomes extremely exhausted, the pulse small and frequent, the 

 temperature falls to subnormal, and the extremities become cold 

 up to the knees and elbows, while the motions are passed in- 

 voluntarily, and death takes place in some two or three days from 

 exhaustion. Recovery from an attack of gangrenous dysentery is 

 extremely unusual, but when it does occur the pulse slows, the 

 temperature rises, the motions become faeculent again, and the 

 urine, which has been suppressed, reappears. 



3. Enter 0- Dysentery. — ^This variety begins with one or more rigors, 

 and a rise of temperature to 103° F. or more. The temperature 

 keeps high, assuming either a continuous or a high remittent type, 

 and is associated with a dry tongue, and a mouth covered with 

 sordes, foetid breath, headache, malaise, pains in various parts of 

 the body, marked epigastric disturbance, and occasionally with 

 ecchymoses under the skin in various parts of the body. The char- 

 acteristic signs of abdominal pain and tenesmus are absent, and the 



Fig. 768. — Temperature Chart of a Case of Bacillary Dysentery. 



SHOWING THE EFFECT OF SeRUM TREATMENT. 



Chart by Archibald. 



motions, though containing blood and mucus, are mixed with 

 considerable quantities of faeculent matter. The mind is clouded, 

 the patient becoming very stupid, sleepless, and at times delirious. 

 Abscesses may now appear in varying parts of the body, but 

 especially in the parotid or theischio-rectal fossae, while carbuncles, 

 bedsores, and peritonitis may also occur. Death usually ensues 

 after a few days' illness from exhaustion, toxaemia, or hyperpyrexia. 



4. Choleraic Dysentery. — Castellani called attention some years 

 ago in the tropics, and again recently in various war zones, to a 

 type of dysentery or serous diarrhoea which is often mistaken for 

 cholera. The onset is sudden, with rice-water- like or serous motions ; 

 there may be vomiting, and the condition of the patient becomes 

 rapidly very grave. In most cases, however, a motion is passed 

 now and then tinged with blood, and this clears the diagnosis. 



5. Chronic Bacterial Dysentery. — Chronic dysentery appears after 

 an attack of acute dysentery which has apparently been cured, 

 but in which, after a period of quiescence, diarrhoea appears. 

 About five or six motions, composed of watery, evil-smelling, faecu- 



