SYMPTOM A TOLOGY 



those of diarrhoea, associated at times with abdominal pain and the 

 passage of faeculent motions mixed with mucus and sometimes 

 streaked with blood, while in the intervals between these exacerba- 

 tions there may be constipation. An exacerbation is usually 

 ushered in by pain in the abdomen, slight fever, griping, and 

 tenesmus, and passage of blood and mucus in the motions, while 

 the faeces contain small greyish masses, in which the amoebae may 

 be found. The number of motions per diem is not excessive, and 

 may be only twelve to fourteen. Usually they are passed somewhat 

 more frequently at night than in the day. Gangrenous complica- 

 tions may, however, occur at any time in the course of an exacerba- 

 tion, or, indeed, during any stage of this type, when large sloughs, 

 smelling offensively, may be passed with the motions. Chronic 

 dysentery may persist for years, and cause the patient to slowly 

 emaciate. The blood, as shown by Chalmers and Archibald, often 

 shows an increase in the large mononuclears. 



T/ME iMlflMk m| 



EMrMEMrMEMrMEMCMEMCMEMEMEMCMEMCMeMEMEMEnEME 



•58' ? 



3&' 



* ipecacuanhei Treafmenf begun. + Rise due to Vaccination. i Pafieni Convalescent 



Fig. 763. — Temperature Chart of a Case of Amcebic Dysentery 

 complicated by hepatitis. 



3. Latent Type. — We have several times met with cases in which, 

 though dysenteric symptoms were absent, still, amoebae were present 

 in the motions, and others in which dysenteric ulcers were only dis- 

 covered accidentally on post-mortem examination, the death being 

 due to other causes. This latent condition is important, as it can 

 easily lead to an acute attack or to liver abscess, and no doubt these 

 * entamoebic carriers,' as has been noted by Martini, Vincent, and 

 others, are a source of the dissemination of the infection. 



4. Mixed Type. — These are cases in which there is a mixed in- 

 fection of Loeschia histolytica and the Shiga-Kruse bacillus. 

 Usually in these cases the motions are numerous from the first, and 

 there is considerable fever, nausea, vomiting, and great constitu- 

 tional disturbance. The motions are apt to be very offensive, and 

 to contain sloughs, indicating a gangrenous condition of the bowel. 

 Exhaustion may come on early, and the patient may die delirious 

 or comatose, or, more rarely, from peritonitis, with or without per- 

 foration. More rarely improvement set s in, and the disease becomes 

 chronic. 



