obtaining in the Melanesian immigrant vessels at the present day.
Gangrenous dysentery.— What is known as gangrenous dysentery is, symptomatically, merely an aggravated form of acute ulcerative dysentery, or a sequel of the fulminating type. Instead of being inucoid, the stools come to consist of a sort of thin, dirty fluid, like the washings of flesh. On standing they deposit a grumous, coffee-grounds-looking material, and they stink abominably. Now and again sloughs of every shape, size, and colour, from ashgrey to black, are expelled. Sometimes tube-like pieces, evidently rings of mucous membrane which have been cast off en masse, are discharged. In such cases the patient rapidly passes into a state of collapse. He sweats profusely; the features, the extremities, and even the whole body, are cold and pinched as in the algide stage of cholera; he may vomit from time to time, and the belly may become distressingly tympanitic. In this condition there is usually a persistent and worrying hiccough. Low muttering delirium sets in; the pulse becomes small and running, and the patient rapidly sinks. Recovery is extremely improbable. Nevertheless, such cases have recovered, and must not necessarily be despaired of.
Hœmorrhage.— Whenever in dysentery sloughs separate, smart hæmorrhage is always possible. Sudden collapse may occur from this cause, even in otherwise mild cases. As in typhoid, the occurrence of hæmorrhage is more or less of the nature of an accident, depending, as it does, on the position of the sloughing sore in relation to an artery; of course, the more extensive and the deepeV the sloughing, the greater the liability to hæmorrhage.
Perforation.— Another grave, though fortunately rare, accident in the course of dysentery is the occurrence of perforation. Should this unhappily take place, and if the patient survive the shock of an extensive extravasation into the peritoneal cavity, symptoms of peritonitis will supervene and rapidly prove fatal.
