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ACUTE BACILLARY DYSENTERY 1

HISTORICAL ASPECTS 1

Bacillary Dysentery as a Disease of Wars，Ancient and Modern 1

Clinical Concepts of Bacillary Dysentery among the Ancients 10

Bacillary Dysentery in the Seventeenth Century 11

Interpretations of Hippocrates＇ and Sydenham＇s Clinical Descriptions 12

EPIDEMIOLOGY 14

Incidence and Mortality from Intestinal Infections in the United States 15

Incidence of Bacillary Dysentery outside the United States 32

Dysentery Carriers 45

Bacillary Dysentery in Animals 51

Transmission of Bacillary Dysentery by Flies 52

Seasonal Incidence of Bacillary Dysentery 53

Milk as a Vehicle of Transmission of Bacillary Dysentery 55

Water as a Vehicle of Transmission of Bacillary Dysentery 56

Other Foods as a Source of Bacillary Dysentery 58

The Survival of B．Dysenteriae in Soil 59

Hospital and Institutional Outbreaks of Bacillary Dysentery 60

Bacillary Dysentery in Summer Camps 64

Hotels，Restaurants and Bacillary Dysentery 66

Travel and the Dysentery Problem 71

Ship Dysentery 72

Planes，Trains and Dysentery 74

A Seven Point Program for the Control of the Infectious Diarrheas 75

The Gastric Barrier in Bacillary Dysentery 75

CLINICAL ASPECTS 78

Clinical Forms 79

Incubation Period 80

Age Incidence 81

Acute Bacillary Dysentery in the Newborn 83

Mode of Onset of Acute Bacillary Dysentery 88

Systemic and Focal Intestinal Manifestations 89

The Typical Clinical Picture in Acute Bacillary Dysentery 90

Diarrhea 91

Abdominal Pain 94

Pyrexia 95

Atypical Clinical Forms of Acute Bacillary Dysentery 96

Appendicular Form with Acute Distal Ileitis 98

Meningitic Type 105

Pneumonic Type 107

Agranulocytoid Type 110

Asymptomatic Type 112

Afebrile Type 114

Constipated Type 114

Other Clinical Features of Bacillary Dysentery 115

Varying Degrees of Severity in the Same Household or Outbreak 115

Rapid or Sudden Fatalities 115

Respiratory Symptoms 116

The Relationship of Specific Dysentery Strains to Severity of Clinical Infections 116

Multiple Infections 117

Complications in Acute Bacillary Dysentery 119

Arthritis 119

Vitamin Deficiency States 122

Edema 123

Parotitis 124

Perforation 124

Ocular Complications 125

Urinary Tract Infections with B．Dysenteriae 126

Otitis 132

Urethritis 132

Vaginitis 132

Adrenal Insufficiency 132

Intussusception 133

Appendicitis 133

Cardiac Complications 133

Complications Involving the Nervous System 133

Mortality Incidence in Acute Bacillary Dysentery 134

Relapse and Reinfection 136

Enteritis，Gastro-enteritis，Ileocolitis and Bacillary Dysentery 137

Differential Diagnosis of Acute Bacillary Dysentery 140

BACTERIOLOGY OF ACUTE BACILLARY DYSENTERY 146

Historical Review 146

Classification of the Dysentery Bacilli 154

Antigenic Structure of the Dysentery Bacilli 157

Smooth and Rough Variants 172

Relationship of Positive Fecal Cultures to Day of the Disease 174

The Dysentery Toxins 180

Pathogenicity of B．Dysenteriae for Animals 185

Multiple Infections with Members of the Dysentery Group 187

Positive Blood Cultures in Bacillary Dysentery 189

Dysentery Bacteriophage 189

SEROLOGICAL ASPECTS OF BACILLARY DYSENTERY 197

Effect of Vaccination on Agglutination Titers 209

PATHOLOGICAL LESIONS IN ACUTE BACILLARY DYSENTERY 222

THERAPY OF ACUTE BACILLARY DYSENTERY 239

Curative and Supportive Therapy 240

Elimination of the Causative Organism 240

Catharsis 240

Sulfonamide Drug 241

Bacteriophage Therapy 253

Bacterial Antagonists 258

Specific Neutralization of Absorbed Toxins 259

Anti-dysentery Serum 259

Diet 263

Palliative Drug Therapy 269

Prophylaxis 272

Vaccination 272

The Prophylactic Value of Antidysentery Serum 277

Vaccination of Human Subjects 279

General Methods of Prophylaxis 286

Fly Control 287

Prophylaxis and Treatment in Combat Areas 288

CHRONIC ULCERATIVE COLITIS AND CHRONIC DISTAL ILEITIS 290

CHRONIC BACILLARY DYSENTERY 290

Historical Aspects 290

Pathogenesis 292

Epidemiological Aspects 297

Supplementary Clinical and Bacteriological Observations 309

Serological Considerations 320

Pathology 324

Roentgenographic Data in Cases of Chronic Ulcerative Colitis and Ileitis 337

Concepts as to the Etiology of Chronic Ulcerative Colitis 338

Bacteria 338

Protozoa 340

Fungi 340

Virus 341

Allergy 342

Deficiency States 342

Psychogenic Theory 343

Intestinal Spasm 343

Miscellaneous Theories 343

Concepts of the Etiology of Chronic Distal(Regional)Ileitis 344

Infection of Uncertain Origin 344

Tuberculosis 344

Streptococcal Infection 345

Bacterial Allergy 345

Sarcoidosis of Boeck 345

Lymphogranuloma Inguinale 345

Mechanical Theory 345

Intussusception 345

Miscellaneous Theories 345

Summary of Data on Common Pathogenesis of Bacillary Dysentery，Chronic Ulcerative Colitis and Distal Ileitis 347

CLINICAL，PATHOLOGICAL AND ROENTGENOLOGICAL CONSIDERATIONS OF CHRONIC ULCERATIVE COLITIS AND DISTAL(REGIONAL)ILEITIS 349

Chronic Ulcerative Colitis 349

Incidence 349

Age and Sex 349

Symptomatology 349

Complications and Sequels 354

Polyposis 354

Rectal Stricture and Intestinal Stenosis 354

Abscess Formation 355

Perforation 356

Arthritis 357

Vitamin Deficiency States 358

Skin Lesions 360

Hemorrhage 367

Roentgenographic Changes 370

Diagnosis 374

Differential Diagnosis of Amebiasis 376

Differential Diagnosis of Intestinal Polyposis 378

ETIOLOGY 380

PATHOLOGY 383

ROENTGENOGRAPHIC DIAGNOSIS 395

CLINICAL DIAGNOSIS 397

SIGMOIDOSCOPIC DIAGNOSIS 398

SUMMARY 399

Treatment of Chronic Ulcerative Colitis 399

MEDICAL TREATMENT 399

SURGICAL TREATMENT 410

Chronic Distal Ileitis．(Regional Ileitis，Regional Enteritis) 422

Historical Aspects 422

Incidence 423

Age and Sex 423

Sites of Involvement 424

Symptomatology 426

Roentgenological Aspects 434

Diagnosis 438

Complications 441

Pathology and Pathogenesis 442

Treatment 450

APPENDIX 465

TECHNICAL METHODS USED IN THE DIAGNOSIS OK BACILLARY DYSENTERY 465

Cultural Studies 465

The Culture Specimen 465

Differential Plating Media 467

Fermentation Tests 468

Composition of Differential Media 468

Other Biochemical Tests 474

Litmus Milk 474

Indole Production 474

Methyl Red Test(M．R．) 474

Voges-Proskauer Test(V．P．) 475

Nitrate Reduction 475

Ammonia Production 476

Hydrogen Sulfide Production 476

Reduction of Methylene Blue 476

Catalase Test 476

Agglutination Tests for Determining Serological Titer 477

Microscopic Method 477

Macroscopic Method 477

Serological Identification of Dysentery Strains 478

The Use of Antisera 478

Agglutinin Absorption 480

Polysaccharide Precipitin Typing 481

Diagnostic Sera 481

Dysentery Bacteriophage 482

Classification of the Dysentery Bacilli 484

THE HOSPITAL EPIDEMIOLOGIST 494

Selecting the Hospital Epidemiologist 495

Methods of Control of Communicable Diseases in Hospitals 495

THE PREVENTION AND CONTROL OF BACILLARY DYSENTERY AND OTHER INFECTIOUS DIARRHEAS AMONG MILITARY FORCES 497

Drinking Water 500

Food and Foodhandlers 501

Bacteriological Diagnosis of Infectious Diarrheas 501

Clinical Aspects 503

Therapy 504

EDUCATIONAL PROGRAM FOR THE PREVENTION AND CONTROL OF BACILLARY DYSENTERY 506

The Physician 507

Public Health Officials 508

Nurses 509

Lawmakers 509

Teachers 510

Hospital and Institutional Administration 510

Laymen 511

Military Forces 511

BIBLIOGRAPHY 513

INDEX 609