coarse, monotonous, or unsound, there, especially in tropical and sub-tropical climates, dysentery is or becomes endemic, and may become epidemic.
Amongst tropical diseases the group of morbid conditions included under the general term " dysentery " ranks in importance next to malaria. Unfortunately, our knowledge is not in proportion to the importance of the subject. Until recent years the word " dysentery " was supposed to indicate a single well-defined disease; writers described its etiology, symptoms, pathology, morbid anatomy, and treatment with precision. Lately we have begun to get beyond this stage of confident ignorance. We may know something about the symptoms and morbid anatomy of dysenteric disease, and we are beginning to get some insight into the germ causes of the leading types, but we are obliged to confess that even in these respects our knowledge is not even approximately complete. Anything approaching a scientific description of dysentery is as yet impossible. I am obliged, therefore, in describing the clinical features of dysentery to adopt an arbitrary and unscientific classification; and to deal with effects before discussing possible causes, symptoms before etiology.
Symptoms.— In ordinary cases the leading symptoms of dysentery are those of inflammation of the great intestine namely, griping, tenesmus, and the passage of frequent, loose, scanty, muco-sanguineous stools. The illness commences in various ways insidiously or suddenly; with high fever, with moderate fever, or without any material rise of temperature. Or the symptoms of colitis may be grafted on to some general affection, such as scurvy or malaria, or on to some chronic disease of the alimentary canal, such as sprue. They may assume acute characters; or from the outset the symptoms may be subdued and of little urgency. As a rule, the symptoms are proportioned to the extent of the disease, but they are not necessarily so. In certain cases they may be extremely urgent and in apparent disproportion to the area of bowel affected; or they may be, in comparison to the extent and the degree of the anatomical
