SYMPTOM A TOLOGY^COMPLICA TIONS 



lent matter, are passed per diem, and may at times contain blood 

 and mucus, or simply mucus. After a time these symptoms dis- 

 appear, and the motions become normal, or there may be slight 

 constipation. In due course, however, the diarrhoea returns, and 

 these exacerbations recur for months and years, and seriously affect 

 the patient's general health. The appetite becomes bad; the 

 tongue red and smooth, or flabby and coated; digestion is impaired, 

 and fermentative changes cause the bowels to be distended with 

 gas; while haemorrhage, slight or severe, may take place from the 

 nose or under the skin. Profuse sweats may occur at night, and 

 tend to exhaust the patient. Recovery may take place spon- 

 taneously, or after treatment, or the diarrhoea, continuing fitfully, 

 may gradually wear out the patient, who may die of exhaustion 

 or some intercurrent disease. Some authorities believe that chronic 

 dysentery may become sprue. We do not agree with them, although, 

 of course, sprue may develop in a case of chronic dysentery. 



6. Dysenteric Diarrhoea. — ^The term ' dysenteric diarrhoea ' may 

 be applied to the non-bloody diarrhoea of chronic dysentery, and to 

 those cases of diarrhoea which occur during an epidemic of dysentery, 

 and in which the bacillus is either proved to be present in the 

 motions, or the patient's blood agglutinates in high dilution one of 

 the dysenteric bacilli. The attack may in no way differ from an 

 ordinary attack of diarrhoea due to other causes, but is apt to recur 

 and to turn into chronic dysentery. 



7. Dysenteric Infantile Diarrhoea. — ^Diarrhoea is an extremely com- 

 mon disease among infants in the tropics, but has not yet received the 

 attention which it has in the United States, in Europe, and in Japan, 

 where it is called ' ekiri.' It is believed to be due to Flexner's 

 bacillus, or more rarely to Shiga-Kruse's bacillus; while the 

 symptoms resemble entero-dysentery, being characterized by be- 

 ginning with vomiting, and a rise of temperature from 103° to 

 104° F., a dry mouth, coated tongue, distended and tender abdomen, 

 and the passage of motions containing fseculent matter, often green 

 in colour, generally mixed with blood and mucus. The fever is of 

 the remittent type, and as the disease progresses the child wastes, 

 and may become convulsed or comatose and die, or may live for 

 weeks, suffering from repeated attacks of diarrhoea, and finally die 

 from exhaustion. If recovery is to take place, the temperature 

 declines and the diarrhoea ceases, but the child is left in a pale and 

 emaciated condition, from which it takes months to recover. 



. Complications. — ^Peripheral neuritis is not uncommonly met with, 

 generally in a mild form, and often confined to one nerve. Arthritis 

 and polyarthritis are also not uncommon, while inflammation of 

 the tendon-sheaths may also take place. In entero-dysentery 

 parotid buboes are not uncommon, while abscesses in other parts of 

 the body and peritonitis may develop. In gangrenous dysentery 

 haemorrhage may be a serious complication. Typhoid fever may 

 occur at the same time as a dysenteric attack, and is a serious 

 complication. We have met with several cases of appenditicis 



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