i85i THE DYSENTERIES 



developing in people convalescent from dysentery. Conjunctivitis 

 and iritis have been recorded. 



Sequela*. — One of the most important sequels of dysentery, to 

 which Cantlie has drawn attention, is stenosis of the large bowel, 

 and more particularly of the sigmoid flexure, due to cicatricial 

 contraction of the healing ulcers. The symptoms are the onset 

 of an insidious constipation, associated in due course with a sensa- 

 tion of distension in the abdomen, loss of appetite, and nausea. 

 The constipation is apt to alternate with attacks of diarrhoea. 

 In due course the constipation becomes severe, and is accompanied 

 with recurrent attacks of colic, in which the pain may be localized 

 or radiating, and sooner or later vomiting occurs. On inspecting 

 the abdomen a swollen region may be observed, and the attacks of 

 colic may be seen to be associated with visible peristaltic move- 

 ments, while more or less meteorism occurs. Succussion sounds 

 may be heard over the dilated bowel. This condition is serious, 

 and must be energetically treated. 



According to some authors, ' sprue ' is a sequel to dysentery, and 

 we have, in fact, seen several cases of sprue developing in patients 

 who have been suffering from chronic dysentery. We believe, 

 however, the two diseases to be of different aetiology. 



Diagnosis. — It may be of advantage to say a few words, first, 

 on the diagnosis of dysentery in general. In presence of a patient 

 suffering from abdominal pains, with frequent stools containing 

 blood and mucus, the practitioner is, as a rule, justified in making the 

 generic diagnosis ' dysentery.' 



Next the specific diagnosis must be made — viz., what type of 

 dysentery is the patient suffering from. For practical purposes it 

 is sufficient in the enormous majority of cases to keep in mind the 

 following types : amoebic dysentery, cihar dysentery, bacterial 

 dysentery. A particle of the muco-pus, immediately after evacua- 

 tion, should be examined microscopically, and this examination can 

 be carried out with great advantage at the bedside by means of 

 a portable microscope. If the microscopical examination shows 

 presence of amoebae of the histolytica type, especially if containing 

 red blood cells, the diagnosis will be amcehic dysentery. If amoebae 

 of the histolytica type are absent, and cihates of the balantidium 

 type are present, the diagnosis v/ill be ciliar dysentery. If on pro- 

 longed and repeated examination, amoebae and ciliates are absent, the 

 diagnosis of probability will be bacterial dysentery. A probable diag- 

 nosis of bacterial dysentery can be made also by the practitioner who 

 is not in position to carry out microscopical examinations, if emetine 

 does not make the dysenteric symptoms disappear within three days 



The diagnosis of bacillary dysentery has to be made with special reference 

 to pseudo-dysentery and amoebic dysentery, especially when there is blood 

 and mucus in the motions, and from the various forms of diarrhoea when these 

 signs are absent. 



With regard to pseudo-dysentery, cancer and syphilis of the rectum and 

 inflamed haemorrhoids may give rise to tenesmus and the passage of blood 

 and mucus, but can be differentiated by the history and by an examination 



