NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
25th May 1909. 6,920,000 20,700 61
34
3 2
28th May 1909.
17,280 63.5 31
4.5 1
1st June 1909
15,200 59
37.5 3.5 0
4th June 1909
13,200
13 H D.
23
M
M Scpoy, 116th Mah.
8 days .
R.
Normal
16th April 1909. 4,560,000
6,700 84
8.5 7.5
—
+
(M & C)
14 H A.
25
M
M Nil
.
.
. 8 days R.
R.
Do
24th April 1909.
6,700 60
28
12
0
—
Mucus and
blood.
+
(C)
15
J
..
F
E Nil
.
.
. 52 days R .
Do
13th June 1909. 1,325,000
7,000 67
30
2.5
5
—
Do.
+
(C)
20th June 1909.
8,760 77
18
3
2
28th June 1909. 2,870,000
7,000
16 K. M.
25
M
H Hawker
.
. 9 days
R.
97 to 99
15th March 1909 5,470,000 12,000 70.9 0.5 19.9 8.7
—
Do.
+
(C)
17 K. R.
22
M
H Shoemaker .
. 7 days
R.
97 to 99 .6
31st March 1909 5,540,000 17,000 85.5 4.5 10
0
— Blood chiefly
+
(C)
18 L.
25
M
E R. E. .
.
. 62 days
R.
102 to 103
17th April 1909.
10,720 66.5 24
7.5 2
—
Blood and
mucus.
+
(C)
24th April 1909.
12,540
11th May 1909.
12,250 67
23.5 6.5 3
21st May 1909. 4,020,000 13,460
15th June 1909. 3,325,000 15,800 67
26
6
1
16th January
11,700
1909.
19 L. C.
42
M
Jap.
3 days .
D.
Continued
fever.
17th May 1909.
10,640 73
23
3.5 0.5
— Blood chiefly
+
(C)
17th June 1909.
18,720 89
8
2
1
20 M. S.
38
M
H Nil
.
.
. 22 days
improved.
,
23rd June 1903. 1,300,000
3,480 15.5 80
4.5 0
—
Loose, trace
of blood.
+
(C)
28th June 1909.
3,980 25
70
5
0
30th June 1909.
3,380 36
61
2.5 0.5
21st July 1909 .
4,160 34.5 61.5 3
1
21 P. K.
36
M
M Sepoy, 116th Mah. . 13 days R .
Normal . 16th April 1909 4,400,000
8,600 64
30.5 5.0 0.5
—
22 P. S.
18
M
H Scpoy, 116th Mah.. 12 days
R.
Do.
. 17th April 1909 4,350,000
9,000 66
27.5 5
1.5
—
Mucus and
blood.
+
(C)
23 P. Gr.
24
M
E R. G. A.
.
. 42 days
R
97 to 100 . 20th April 1909
4,260 56
33
9
2
—
Mucus and
blood.
5th May 1909 .
5,840
10th May 1909 .
4,580 56
37
7
0
33
Serial
No. Name. Age. Sex. Race.
Occupation.
Number
of days in
hospital
and
result.
Temperature. !
Date
of
examination.
R
. B. C. W. B. C.
PERCENTAGES.
Blood.
Malarial
parasite.
STOOLS.
P. N. S. M. L. M. E.
Character. Amœbæ
21st May 1909 . 3,040,000
8,450
24 J.
46
M Goa Cook .
.
•
R.
Normal
. 23rd March 1909 5,460,000 11,860 80
14
0
—
+
(M & C)
25 R. G.
36
M
H P. C. .
.
. 12 days
R.
Do. .
• 24th March 1909 5,270,000
9,200 70
4
22
4
—
Blood and
mucus.
+
(M)
26 R. J.
36
M
E Gym. Instructor . 10 days
R.
Do. .
. 6th February
1909.
12,000 57
33
9.5 0
—
+
(C)
27 S. A.
43
M
E Horn dealer .
. 11 days
R.
Do. .
. 3rd June 1909 .
68
25.5 3
0.5
—
+
(C)
5th June 1909 .
14,160
11th June 1909
11,600
2 8
W. Gr. 3 8
M
E R. G. A.
.
. 25 days R . Do. .
. 21st April 1909
6,800 57
2 9
11
3
—
29
40
M
H Tailor .
.
..
Do. .
. 10th June 1909 1,730,000
7,000
—
+
1,500,000
4,500
(C)
30 S. M.
35
M
M Milkman
.
. 19 days
R.
Do. .
. 29th May 1909
23rd May 1909 4,870,000
13,000
12,140
26th May 1909
10,320
—
Blood and
mucus.
+
1st June 1909
11,400
(C)
6th June 1909 .
10,920
31 S.
34
M
E Spinning work
18 days R .
Do. .
. 24th May 1909 4,125,000
8,000 58
35.5 6
0.5
Loose, trace
of blood.
+
(C)
H=Hindu. M=Mahomedan. E=European. R=Recovered. D =Died. M & C=Microscope and Cultivation.
35
In considering these results the cases may be divided for convenience into
three classes—(1) mild, (2) severe, (3) complicated. The first class, where the symp-
toms are not marked, the lesion being confined to a few small localised ulcers in the
cæcum, may show no increase in the total number of the leucocytes (cases Nos. 5,
13, 28, 31). A case like this may not be recognised and treated as dysentery. This
is a question of considerable importance and urgency both from the point of view
of the community and the individual, because unrecognised cases such as these
may form the foci of epidemics ; further, an extension of the infection from the
bowel may occur and produce the very grave complication of abscess of the liver.
Hence the question of the diagnosis of amœbic dysentery in its earliest stage is
one of great importance and will be dealt with in the next section. It is a
common post mortem observation in cases of abscess of the liver to find on opening
the large intestine a few small ulcers in the cæcum which had given rise to no
symptoms of dysentery. It is interesting in this connection to note that we have
been able to cultivate (page 51) amœbæ similar to those found in dysentery and
abscess of the liver from the stools of cases of abscess of the liver, although no
active symptoms of dysentery existed at the time. In the second class of cases the
signs of dysentery are severe, indicating an involvement of the whole length of the
large intestine, and post mortem evidence bears this observation out, for in such
cases the entire length of the large intestine shows extensive ulceration. A micros-
copic examination of a section of the intestine shows the characteristic appearance
of an amœbic infection, namely, a great thickening of the sub-mucus layer, which
is the portion of the intestinal wall chiefly affected. In this thickened layer
localised areas of cellular exudation may be seen, and at the wall of these small
" abscesses " many amœbæ may be observed (Figure 3, Plate III). Amœbæ are
seen also in the thickened sub-mucus layer which, apart from the above-mentioned
foci, does not show much cellular infiltration. Except at the part actually ulcerated
the layer of tubular glands shows comparatively little alteration. In this class of
cases the lesions are very extensive. The blood count during life in these cases
may show a high degree of leucocytosis, cases 7 and 12. It must, however, be
remembered that some cases of this nature show little or no leucocytosis. How-
ever, that a high leucocytosis may occur in these conditions should not be lost
sight of in making a differential diagnosis between dysentery and dysentery com-
plicated by lesions beyond the large intestine, the most common and serious com-
plication of this nature being that of amœbic infection of the liver, but others, e.g.,
pericæcal abscess, acute peritonitis, etc., may occur also.
The third group of cases is a very important one since it includes the serious
condition of liver abscess. As Rogers1 has shown the early stage of invasion
1 Medico-Chirurgical Trans., Vol. 90, 1908.
F 2
36
of the liver by the amœbæ, before suppuration has occurred, may be recognised by
careful examination of the blood, and if the appropriate treatment is applied at
this period of the infection the very grave complication of abscess of the liver may
be prevented. Hence the extreme importance, as a preventive measure in these
cases, of studying the blood changes which occur. In a case of amœbic dysentery
with very slight symptoms, indicating a limited lesion in the large intestine, or in
cases where there are no active symptoms of dysentery at the time the patient
comes under observation, if it is found that there is a distinct, but not excessive
increase of the total leucocytes, the normal relative proportion being maintained, as
a rule, and the temperature is raised, then there is strong reason to suppose that the
amœbic infection is no longer confined to the large intestine, but has extended
to the liver. At this early stage there may or may not be definite physical signs
indicating involvement of the liver apart from the leucocyte curve. Hence the
urgent necessity of making a careful count, total and relative, of the white blood
corpuscles in such cases, as this gives the earliest information regarding the invasion
of the liver, a matter of great importance in treatment.
(b) THE EFFECTS OF ADMINISTRATION OF IPECACUANAHA.
The administration of ipecacuanha in amœbic dysentery and hepatitis is
closely bound up with the study of the blood changes in these conditions, because
the earliest phase of amœbic invasion of the liver, which is the most favourable for
treatment with this drug, is detected only by a blood examination. When
ipecacuanha is given at this early stage of hepatitis a reduction of the temperature
and leucocytes with amelioration of the symptoms takes place. As these questions
are of very considerable practical importance in the prevention and treatment
of so serious and fatal a disease as liver abscess, the records of several cases bearing
on it are given.
CASES ILLUSTRATING GROUP 3.
Case No. 215. L. D., age 40, Goanese cook.
May 17th, 1909.—Patient was admitted on 12th May complaining of pain in
the right hypochondrum of five days duration. The onset was very sudden with
severe pain in that region, nausea and vomiting. Patient felt feverish, weak, and
ill.
Previous health.—Good, no history of dysentery.
Social condition.—Born in Mangalore has been in Bombay for sixteen years
; returned from leave from Goa ten months ago. Has habitually drunk country
liquor, but does not admit excess.
Present condition.—Patient looks thin and debilitated, conjunctivæ have a
faint yellow tinge. Tongue covered with a thick white fur. Abdomen is slightly
37
retracted and moves freely with respiration, both iliac fossæ free from tenderness,
Colon not palpable. Spleen not palpable. Liver very tender, enlarged; mostly down-
wa r d s i n f r o n t ; a r e a o f d u l l n e s s i n mi d d l e l i n e 3 ¾ i n c h e s , i n n i p p l e l i n e 6 ¼ i n c h e s .
Upper border of dullness cuts the mid line in the 6th interspace and the nipple
line in the 5th interspace. Lungs, bronchitis râles at bases ; otherwise normal.
Liver was punctured in three places in front. A small quantity of sanguineous
fluid only withdrawn, no pus.
May 31st, 1909.—Temperature normal, tongue clean. Liver mid line 3¼
inches. Right nipple 4 inches, upper border at 6th rib. No tenderness.
June 5th 1909.—Discharged.
Treatment—Pulv. ipecac, gr. 30, twice daily.
Cultivation of stools showed presence of amœbæ. An attempt was made to
cultivate amœbæ from the sanguineous fluid withdrawn from the liver by puncture,
but this failed.
The following chart shows the course of the disease and the total number of
W. B. C. per c.m.m. of blood :—
CHART VI.
T O T A L L E U C O C Y T E S . P E R C M M O F B L O O D .T
E M P E R A T U R E .
38
The following table shows the result of the examination of the blood :—
Name
and
occupation.
Age.
Date
of
examination.
R. B. C. W. B. C.
PERCENTAGES.
Para-
sites in
• blood—
malaria.
P. N. S. M. L. M. E.
Desouza, cook
40
17th May 1009
16,880
57
36
4.5
2.5
—
19th May 1909
14,050
62.5
32
4
1.5
21st May 1909
3,990,000
13,320
24th May 1909
11,550
28th May 1909
9,680
2nd June 1909
9,000
56
39
2.5
2.5
R E M A R K S . — T h i s c a s e i s a n i n t e r e s t i n g a n d s u g g e s t i v e o n e . I t i l l u s t r a t e s s e v e r a l i m p o r t a n t p o i n t s . I n t h e f i r s t p l a c e t h e p a t i e n t
gave no definite history of dysentery ; this is not infrequent in cases of hepatitis and liver abscess, the reason being that the lesion of the
bowel produced by the amœba i s, at ti mes, very sl i ght and si tuated i n the cæcum ; thus the symptoms produced are not urgent and no
attention is paid to them, or they may escape notice entirely. The cultivation of the amœba from the stool in this case was of considerable
interest. This patient suddenly developed fever with marked hepatitis and, also, some enlargement. There were no malarial parasites
in the blood, but there was a distinct leucocytosis, the relative proportion of the leucocytes, however, remaining more or less unaltered.
The most important practical point in the case was, that under full doses of ipecacuanha the fever and leucocytosis diminished, and finally
all the symptoms cleared. up and the patient was discharged well. There can be little doubt that this case was an example of amœbic
hepatitis, which if it had not been recognised but had keen left untreated might have passed on to abscess formation. Hence the
importance of a careful blood examination and systematic treatment with ipecacuanha in such cases.
As a control observation the following case is given which is also one of hepatitis
but in which ipecacuanha was not exhibited, another line of treatment being
adopted.
Case No. 78. L., European, age 25.
April 17th, 1909 .—Admitted to hospital complaining of abdominal pain with
passage of blood-stained stools daily, tenesmus and straining. Left Rangoon on
9th, and shortly after noticed blood in the stools with loss of appetite, but was not
severely ill.
Previous health. —Good, no dysentery.
Present condition. —Patient is somewhat pale and thin, but fairly well
nourished. Tongue covered with brown fur. Abdomen normally full, no tenderness
on pressure. Spleen not enlarged. Liver not enlarged..
April 24th, 1909 .—Patient feels better. One or two semi-solid motions daily
without griping ; no blood or mucus.
May 5th, 1909 .—No diarrhœa ; no pain or tenderness.
May 21st, 1909 .—No noteworthy change.
June 15th, 1909 .—Bowels fairly regular. Motions healthy. Complains of pain
i n t h e r i g h t h y p o c h o n d r i u m d u r i n g t h e p a s t w e e k , n o w t e n d i n g t o s h i f t u p w a r d s ,
towards the right shoulder. Liver enlarged downwards in front 1" below costal
margin in right nipple line ; upper border normal.
Examination of the stools showed the presence of amœbæ.
Treatment .—Mag. sulphate one drachm thrice daily and quinine.
39
The following chart shows the course of the disease and the total number of
W. B. C. per c.m.m. of blood :—
CHART VII. —(Continued, p. 40.)
TOTAL LEUCOCYTES.PER CC
M OF BLOOD.
TEMPERATURE.
The following table shows the result of the examination of the blood :—
Name.
Age.
Date
of
examination.
R. B. C.
W. B. C.
PERCENTAGES
Para-
sites in
blood—
malaria.
P. N. S. M. L. M.
E.
L.
.
.
25
17th April 1909
.
10,720
66.5
24
7.5
2
—
24th April 1909
.
12,540
'
11th May 1909
.
12,250
67
23.5
6.5
3
21st May 1909
. 4,020,000
13,400
15th June 1909
.
3,325,000
15,800
67
26
6
1
16th June 1909 .
11,700
REMARKS—In this case we have the mild attack of dysentery, the presence of amœbæ in the stool. The symptoms of dysentery
improve, but the temperature is irregular and there is a distinct leucocytosis. At first there are no hepatic symptoms, but these develop
after he has been about two months in hospital. In this case we have a control observation to the previous one, the morbid condition
was the same in both, but, in the former, ipecacuanha was exhibited with the result that the signs and symptoms disappeared; in the
latter Mag. sulphate was used and the course of the disease was prolonged, and the signs and symptoms d.d not clear up. Such a case
as this may ultimately develop liver abscess.*
* It is interesting to record that this patient actually did develop liver abscess.
40
CHART. VII. (Cont).
The two following cases are given to show the effect of administration of
ipecacuanha on the temperature and leucocytosis in cases of dysentery : —
Case No. 194. B., European Seaman, age 33.
April 30th, 1909.—Admitted on 26th April complaining of griping pains in the
abdomen with looseness of the bowels of a month's duration. Mucus and blood
present in stools. Onset was gradual with ordinary diarrhœa.
Previous health.—Good ; no previous dysentery.
Social condition.—Born in India ; went home first in January 1909. Since
then has done another trip to Falmouth. States that food on board was bad.
Present condition.—Patient fairly well nourished and well developed. Tongue
covered with a yellowish white fur ; abdomen retracted. Slight tenderness on
pressure in right iliac fossa. Spleen and liver not enlarged. Bowels now moved
2-3 times daily ; no straining and tenesmus.
May 7th, 1909. —Dismissed well. Treatment. Pulv. ipecac., gr. 30, twice
daily. Amœba cultivated from stools.
41
The following chart shows the course of the disease and the total number of
W. B. C. per c.m.m. of blood :—
CHART VIII.
The following table shows the result of the examination of the blood :—
Name and occu-
patron.
Age .
Date of examina-
tion.
W. B. C.
PERCENTAGES .
Para-
sites in
blood-
malaria.
P. N.
S. M.
L. M.
E.
J., Seaman.
.
33
27th April 1909
11,650
64
30
5
1
—
6th May 1909
56
35
7
2
REMARKS.—This case shows the rapid fall of temperature and leucocytosis under ipecacuanha. Although there were no direct
physical signs of acute hepatitis yet the occurrence of fever and leucocytosis in the mild case of amœbic dysentery pointed to a
probable early invasion of the liver, and the action of the ipecacuanha confirmed this view.
•
42
Case 204. A. D., Medical Student, age 28.
May 5th, 1909.—Admitted to hospital on 4th May complaining of pains in the
abdomen with frequent motions, composed chiefly of mucus streaked with blood.
Commenced about a week ago with diarrhœa without griping. No previous
history of dysentery, no malaria.
Present condition.—Patient is well nourished and well developed ; does not
appear actully ill. Tongue covered with uniform white coating. Slight tender-
ness in right fossa. Spleen and liver not enlarged.
May 10th, 1909. —Tongue coated with brown glaze ; 4-5 stools in the day. No
pain or tenderness in hepatic region. Temperature rose suddenly to 103.8 to-day,
it was normal in the morning. Abdominal pain and tenderness very slight. Most
tenderness in right iliac fossa, no marked local resistance. Liver and spleen not
palpable or enlarged on percussion.
CHART IX.
43
May 13th, 1909. —Tongue still coated with brown glaze in centre, but
clearing.
May 15th, 1909. —General condition improving.
May 23rd, 1909. —Much improved. Temperature normal.
May 26th, 1909. —Improvement maintained, only 1-2 motions in 24 hours.
June 6th, 1909.—Tongue clean ; one solid motion in 24 hours.
June 7th, 1909. —Dismissed well. Treatment. Pulv. ipecac., gr. 30, twice
daily.
The chart on page 42 shows the course of the disease and the total number
of W. B. C. per c.m.m. of blood.
The following table shows result of the examination of the blood :—
Name.
Age.
Date of examina-
tion.
R. B. C. W. B. C.
PERCENTAGES.
Para-
sites in
blood—
malaria
P. N. S. M. L. M. L.
D. A.
.
.
28 4th May 1909
15,200
50
31
17
2
6th May 1909
22,190
52
31
15.5
1.5
8th May 1909
24,680
10th May 1909
27,670
62.5 26
11
0.5
12th May 1909
16,560
63
33
3
1
13th May 1909
20,570
60.5 33
5.5
1
14th May 1909
6,100,000
19,920
15th May 1909
18,410
51
40
5
4
17th May 1909
15,500 47.5 45.5
4
3
19th May 1909
5,620,000
16,050
58.5 34.5
4.5 2.5
23rd May 1909
15,700
26th May 1909
14,620
28th May 1909
12,900
29th May 1909
10,400
1st June 1909
13,000
4th June 1909
9,280
REMARKS.—In this case, also, during a moderately severe attack of amœbic dysentery leucocytosis developed and the temperature
was elevated. There were no definite signs of enlargement of the liver, although the leucocytosis and fever disappeared under treatment
with large doses of ipecacuanha.
G 2
44
The following illustrates the value of ipecacuanha in a case of liver abscess
which had been opened and drained, and where it was found necessary to open a
second abscess. The temperature and leucocyte count after the second operation
still remained elevated, accordingly the patient was placed on large doses of ipeca-
cuanha with the result that both the temperature and leucocyte curve fell to normal.
Case 85 T., European, age 28.
May 24th, 1909.—Admitted to hospital on 19th May complaining of pains
across the right hypochondrium of two days' duration ; awoke suddenly in the night
with pain, now constant.
Previous health good, no history of dysentery, had never seen mucus in his
stools.
Social condition.—Arrived from Rangoon on 16th April.
May 26th, 1909.—Operation for liver abscess, pus removed. Profuse sweating
at night.
CHART X.
45
May 29th, 1909.—Operation second abscess incised and drained.
June 22nd, 1909. —Patient is now doing well, wound healthy ; temperature
normal.
August 26th, 1909.—Discharged.
Microscopic examination of pus showed the presence of amœbæ and staphy-
lococci. Examination of stools by culture showed the presence of amœbæ.
Treatment. —Operation, temperature remaining high, Pulv. ipecac was com-
menced on June 4th. Dose at first was gr. X, thrice daily, which was increased
to gr. XX, twice daily, and this was finally increased to gr. XXX daily.
The chart on page 44 shows the course of the disease and the total number
of W. B. C. per c.m.m. of blood :
—
The following table shows the result of the examination of the blood :—
Name.
Age. Date of examina-
tion.
W. B. C.
PERCENTAGES.
Para-
sites in
blood—
malaria.
P. N. S. M.
L. M.
E.
T.
.
.
.
..
24th May 1909 .
15,000
84
12
4
0
22nd June 1909 .
9,240
50
39
10
1
REMARKS.—This case illustrates several points of very considerable practical importance in connection with the treatment of liver
abscess. The patient had two abscesses opened one after the other, but in spite of this the temperature remained high. It is noteworthy
that the administration of ipecacuanha in full doses reduced the temperature, and the leucocytic curve fell also. It is probable that this
patient had an extensive amœbic invasion of his liver, as evidenced by the presence of two abscesses, and the action of the ipecacuanha
was to limit the further amœbic extension. It is important, therefore, to bear in mind that ipecacuanha is not only of use before the
formation of the liver abscess, but, also, after the abscess has been opened to prevent the further extension of the amœbic infection.
CASE ILLUSTRATING GROUP 2.
The following cases are given to illustrate the occurrence of a high leucocytosis
in cases of amœbic dysentery :
—
Case No. 208. F. C., European, age 20.
May 17th, 1909. —Admitted to hospital on 8th May complaining of diarrhœa
with pains in the abdomen and straining, stools small, consisting of mucus and blood.
Duration six days. The onset was gradual with ordinary looseness.
Previous health. —Good, no dysentery.
Present condition. —Patient well nourished and well developed. Tongue
covered with a thick yellowish fur extending to tip and edges. Abdomen slightly
retracted, and tenderness on pressure all along course of colon, most marked about
sigmoid and cæcum ; neither liver nor spleen enlarged.
ay 20th, 1909.—Condition improving. Motions 3-6 daily.
June 3rd, 1909.—Temperature rose on 1st June to 102.4, no rigors, 3-4 motions
daily.
June 7th, 1909.—Again improved, one motion daily.
June 19th, 1909 .—Temperature normal ; tongue clean, one motion daily.
He is able to walk about.
June 23rd, 1909.—Temperature normal. Has had slight griping pain occa
-sionally ; has three stools a day, with small amount of mucus and blood.
July 3rd, 1909 .—Patient feels fairly well ; no pain. One motion daily. Looks
pale and debilitated. Sent to England on sick leave. Examination of the stools
by culture showed the presence of amœbæ.
The following chart shows the course of the disease and the total number of
W. B. C. per c.m.m. :
CHART XI.
47
The following table shows the result of the examination of the blood :—
Name.
Age. Date of exa-
mination.
R. B. C.
W. B. C.
PERCENTAGES.
Para-
sites in
blood—
malaria.
P. N. S. M. L. M. E.
C.
.
20
17th May 1909
35,240
86.5 10
2
1.5
—
18th May 1909
33,850
81.5 12
5.5
1
20th May 1909
32,400
22nd May 1909
30,370
26th May 1909
22,130
28th May 1909
17,000
1st June 1909
14,860
80
16
3
1
3rd June 1909
13,480
79
16
5
0
5th June 1909
14,400
7th June 1909
15,920
9th June 1909
14,500
13th June 1909
10,000
57
37.5
3
2.5
17th June 1909
67
29
2.5
1.5
19th June 1909
15,640
51
43
5.5
0.5
21st June 1909
10,400
55
42
2
1
23rd June 1909
12,400
48.5 46.5
3
2
25th June 1909
12,000
49.5 45.5
3.5
1.5
27th June 1909
10,760
47
44
5.5
3.5
1st July 1909 3,625,000
9,640
47
45
5.5 2.5
REMARKS—This was a severe case of dysentery. The whole length of the colon was involved as shown by the tenderness on pressure.
In this case the total leucocytes were greatly increased in number. Therefore when the lesion of the large intestine is extensive and severe
a high degree of leucocytosis may be produced. It is necessary to bear this fact in mind in the differential diagnosis between a severe
dysenteric lesion in the bowel and dysenteric complications outside the large intestine.
Case No. 216 G., Hindu, age 36.
May 21st, 1909. —Admitted on 20th May complaining of griping pains in the
abdomen and frequent small motions, composed of mucus and blood. Duration
ten days.
Previous health. —Good; no history of dysentery.