1854 



THE DYSENTERIES 



We wish to emphasize the fact that simple agglutination is not sufficient 

 to diagnose that a certain bacillus is a dysentery bacillus . As shown by Levi 

 della Vida, by one of us, and other observers, it is not at all rare to isolate, 

 from dysentery patients bacilli which aire extremely well agglutinated, say, 

 by Shiga serum, but which produce gas in glucose. Notwithstanding the 

 opinion of a few authorities, such germs cannot be considered to be true 

 dysentery bacilli, they are nosoparasites or secondary invaders. Hence the 

 importance of carrying out fermentation tests in addition to serological tests. 



To the bacteriological diagnosis of bacterial dysentery rnay be applied also 

 Castellani's polyserum method as used for the diagnosis of cholera. A large 

 number oi the white colonies from MacConkey plates are inoculated in a tube 

 of peptone water containing a few drops of lactose non-fermenters agglutinating 

 polyserum (excepting the dysentery group). In theory all non-lactose fer- 

 menters, apart from the dysentery bacilli, will be agglutinated, while the 

 dysentery bacilli will grow diffusely; in practice, however, many difficulties 

 are met with, owing to the great difficulty in producing an efficient 

 polyserum. 



Finally, we wish to call attention to the necessity of carrying out 

 the bd,cteriological examination for dysentery on stools absolutely 

 fresh, as soon as evacuated, plates being made at the bedside and 

 then sent to the laboratory. If this precaution is not carried out, 

 a very large number of cases will give negative results. 



Prognosis. — In the milder forms of acute dysentery, the prognosis 

 is good, recovery being the rule, but the death-rate of severe acute 

 dysentery is high, while the prognosis in gangrenous dysentery is 

 very bad. As an average, the mortality of the various forms 

 may perhaps range from 12 to 25 per cent., for there is no doubt 

 that in Ceylon and other tropical countries dysentery is a more 

 potent factor in the death-rate than malaria, though the latter 

 may cause more illness. 



The site of the disease is also a factor in determining the prognosis, 

 being as a rule better if it is situate low down, and worse if high up 

 in the bowel. According to Kruse, Shiga, Duval, Dopter, and our 

 own experience, early serum treatment lessens the mortality 

 and therefore improves the prognosis. 



As regards age and sex, the prognosis is better for adults than 

 for children, and for men than for women. The European or 

 new-comer into the tropics suffers more severely than the 

 native resident race, but this racial difference is merely relative. 



Treatment. — ^In all cases, however mild, the patient should be 

 kept at rest in bed, and the urine-bottle and bed-pan must be used. 

 The latter should preferably be slightly warmed before being used, 

 especially in cool climates. Damp cotton-wool should be sub- 

 stituted for sanitary paper, in order to prevent irritation of the 

 region of the anus. 



All motions should be disinfected, after having been seen by the 

 physician, with Jeyes' fluid or carbolic acid, and they should also 

 be protected from flies. It is, however, most necessary that the 

 motions should be saved for the physician to see, because they are 

 extremely important in judging the progress of the case. 



In very mild cases the bowels should be cleansed by an initial 

 dose of one tablespoonful of castor oil, which may be administered 



