Both sexes are liable. Pregnancy, miscarriage, and the puerperal state are grave complications.
Diagnosis.—Provided reasonable care be exercised, diagnosis, especially in acute cases, is usually easy. In chronic cases the question of seat worms, hæmorrhoids, polypus, stricture, tubercle, malignant and specific disease, proctitis, ulceration, abscess about the rectum, and tumour in the bowel may require to be considered. Diagnosis must never be taken for granted. In every case stools must be inspected; and in every case in which there is any probability of rectal disease some of the methods of digital or specular examination must be carried out.
A diagnosis of dysentery having been arrived at, it becomes necessary, especially in view of treatment, to arrive at a correct conclusion as to the type of the particular case. As the practitioner has principally to deal with either bacillary or amœbic dysenteries (very rarely with other forms) he should at once set about ascertaining to which of these two categories it belongs. The following table enumerates the points to be attended to:—
| Amœbic Dysentery | Bacillary Dysentery |
| Clinical.—Insidious commencement as a rule. No fever in uncomplicated cases. Generally subacute or chronic in type. Prone to recur or relapse. Often associated with hepatitis and liver abscess. | Generally acute in character. Often an initial fever. Runs its course and not prone to relapse; one attack confers a certain degree of immunity. |
| Bacteriological.—No serum reaction. Entamœba histolytica in stools. | Serum agglutinates cultures of B. dysenteriæ, which can be cultured from the stools on Conradi-Drygalski medium. Absence of Entamœba histolytica from the stools. |
| Reaction to treatment.—Rapidly improves on emetine or ipecacuanha treatment. | Not affected by emetine or by ipecacuanha, but reacts to injection of polyvalent antiserum. |
The Entamœba histolytica when present is usually easily found in the stools, and is readily recognized by the technique described at p. 515.
Unfortunately, from the point of view of rapid
