1830 



THE DYSENTERIES 



but may be cirrhotic in chronic cases. The spleen is also usually 

 normal, but may contain an abscess; the kidneys often show 

 signs of parenchymatous inflammation. The heart and lungs are 

 generally normal, but the former may be fatty or show brown 

 atrophy, and the latter, especially the right lung, may show a 

 hepato-pulmonary abscess. 



Symptomatology. — The symptomatology of amoebic dysentery 

 may be classified into: — 



1. Acute Type. 



2. Chronic Type. 



3. Latent Type. 



4. Mixed Type. 



I. Acute Type. — The onset is abrupt, but may occasionally be 

 preceded for a few days by slight diarrhoea, alternating with con- 

 stipation. Pain is felt in the lower part of the abdomen, which 

 may become very severe, while the motions are attended with much 

 griping and straining. These motions, which rarely exceed thirty 

 psr diem, contain blood and mucus, and occasionally greenish 

 material, and when examined by the microscope reveal leucocytes, 

 mucus, Charcot-Leyden crystals, amoebae, bacteria, and at times 

 shreds of tissue. 



The tongue is moist, and often coated with a white fur, and there 

 is usually anorexia, and there may be nausea and vomiting, while 

 digestion is usually much impaired. The abdomen is sunken, the 

 liver and spleen normal, but tenderness is felt on pressure along the 

 whole or a part of the large bowel. 



The examination of the heart and lungs reveals, as a rule, no 

 abnormality, but the pulse and respirations are quickened. The 

 microscopical examination of the blood usually shows that the red 

 cells are diminished, and sometimes that there is leucocytosis 

 (upwards of 20,000 per cubic millimetre), and at times, as first 

 pointed out by Billet, the number of eosinophiles is distinctly 

 increased, even when there is no concomitant helminthiasis. 



The urine is diminished in quantity, and sometimes contains 

 albumen and casts; but the skin is generally normal, though there 

 is often some fever of a remittent type, which, however, may be 

 entirely absent. 



When the temperature falls to normal, and the pain and tenderness 

 abate, these may be favourable signs, or may be merely a prelude 

 to a gangrenous complication or a haemorrhage. If recovery is to 

 take place, the motions become less frequent and more faeculent, and 

 contain less blood and mucus, and gradually improve until normal 

 motions are passed. If death takes place, which usually happens 

 about the end of the first week, and ten days from the commence- 

 ment, it is generally caused by exhaustion, or much more rarely by 

 perforation and peritonitis or haemorrhage. 



2. Chronic Type. — This may follow an acute attack, or, in many 

 cases, may begin quite insidiously, the symptoms being merely 



