This form prevails in the tropical and subtropical countries for
the most part, and is caused by an animal parasite, the _ameba
dysenteriae_. This is constantly found in the stools, the tissue of
the intestine and also in the pus of the liver abscesses, which are
secondary to dysentery. Amebae are sometimes found in the stools of
healthy men, having probably entered the system through the drinking
water or uncooked food.
=Pathologically=, the mucous membrane of part or whole of the large
intestine is swollen. Round or irregular ulcers which undermine the
mucous membrane, especially of cecum, ascending and pelvic colon, are
found. In later stages there is infiltration of the connective tissue
followed by necrosis. In some cases false membranes and sloughs are
formed.
=Symptoms.=—The onset may be either sudden or gradual, with a very
irregular diarrhea, moderate fever, and copious, liquid stools,
abounding with the amebae coli. The straining may be less severe and
persistent than in catarrhal dysentery and may be absent. Sometimes
there is nausea and vomiting.
Abscess of the liver is the most common complication, which may
be single or multiple. When single it usually involves the right
lobe. Multiple abscesses are small. The more recent abscess walls
are necrotic; the older have whitish, smooth, fibrous walls. These
abscesses do not contain pure pus, but a fatty and granular debris
containing the amebae and a few cellular elements. Sometimes they
extend into the lung.
=Diagnosis.=—This depends upon severity of attack and general condition
of the patient. Relapses often occur and the case may become chronic.
Cases have been treated osteopathically with success.
=Treatment.=—In this form of dysentery the treatment is largely
the same as in acute ileo-colitis. The spinal lesions affect the
innervation to the intestine, thus producing a stasis in the
circulation; this condition favoring, and in fact, inviting the
retention of the ameba coli in the system at this point.
The diet is the same as in other forms of dysentery. Rectal injections
and hot applications to the abdomen are useful. In all cases where
strong treatment has been given to the spinal column, a quieting
treatment to the nervous system and an inhibitory treatment to the
heart will be gratefully received by the sufferer. Both of these
effects can be accomplished at the same time by simple inhibition to
the occipital nerves. The stools should be taken care of immediately
and disinfected. Ice water enemas given frequently are reported as
giving good results. For the tenesmus, inhibit strongly at 3d, and 4th,
sacrals.