1838 



THE DYSENTERIES 



appears to enter the mucosa, in which it wanders, causing an in- 

 flammatory reaction and ulceration. 



Morbid Anatomy. — This has been investigated principally by 

 Strong. The intestine may show a diphtheritic false membrane, 

 with often deep burrowing ulcers in the rectum and colon indis- 

 tinguishable from those of amoebic dysentery. On microscopical 

 examination the parasites can be found in the mucosa surrounded 

 by a round-celled infiltration, and several observers have noted a 

 marked eosinophilia of the intestinal wall. 



Symptomatology. — The disease is insidious in its onset, being 

 marked by attacks of diarrhoea, alternating with constipation and 

 vomiting, with anorexia and at times the passage of blood and 

 muco-pus in the motions. CEdema of the face and limbs may set 

 in, and death result from exhaustion. 



In our patient, a little native girl, there was rather high fever, 

 with persistent diarrhoea, great wasting, and severe anaemia. No 

 blood in the motions. The Balantidia, which were abundant, were 

 associated with numerous Trichomonata and Oicomonas ; moreover, 

 the patient harboured various worms, ova of Ancylostoma duodenale, 

 Ascaris lumbricoides, and Trichuris trichiura being present. Some 

 of the symptoms may have been caused by these parasites. 



Complications. — The parasite may enter the liver and form cysts. 

 It may be associated with other parasites — AmcehcB, Trichomonata, 

 Oicomonata, etc. 



Treatment. — The symptomatic treatment laid down for amoebic 

 dysentery may be tried, beginning with castor oil or salines, and 

 followed by intestinal irrigations of tannic and boric acids or 

 quinine. Ipecacuanha and emetine may be administered as de- 

 scribed for amoebic dysentery. Large rectal injections of a solution 

 of methylene blue (i in 3,000), combined with the internal adminis- 

 tration of the same drug in i or 2 grain doses in cachets or pills, may 

 also be tried. Oil of chenopodium has been recommended. 



Some authorities give Salvarsan, by intravenous injection. 



Prophylaxis. — It is not certain that the parasite found in the pig 

 is the same as the human parasite, and, further, the method of in- 

 fection being quite unknown, no useful remarks can be made with 

 regard to prophylaxis. 



(/) Spirochaetic Dysentery. 



This type of dysentery was first described by Le Dantec. It has not been 

 generally accepted, as spirochaetes may be found in cases of typical bacterial 

 and amoebic dysentery and even in normal stools in which Spiroschaudinnia 

 eugyrata Werner, emendavit Fantham, is commonly met with. It is very 

 probable, however, in our opinion, that there may be pathogenic intestinal 

 spirochaetes capable of giving rise to dysenteric symptoms. In a case observed 

 by one of us preparations from the muco-pus were teeming with spirochaetes, 

 while amoebae and ciliates were absent, and the further bacteriological ex- 

 amination showed absence of dysentery bacilli. Emetine and serum treat- 

 ment had no effect, and the patient made a very slow recovery. 



Remarks. — A mistake not rarely made is to recognize as spirochaetes the un- 

 dulating forms of a germ found by Castellani in Ceylon, and described by him 

 in 1910, under the term of Spirillum {Vibrio, Vibrioihrix, Spirobacillus) 



