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ACUTE BACILLARY DYSENTERY1

HISTORICAL ASPECTS1

Bacillary Dysentery as a Disease of Wars，Ancient and Modern1

Clinical Concepts of Bacillary Dysentery among the Ancients10

Bacillary Dysentery in the Seventeenth Century11

Interpretations of Hippocrates＇ and Sydenham＇s Clinical Descriptions12

EPIDEMIOLOGY14

Incidence and Mortality from Intestinal Infections in the United States15

Incidence of Bacillary Dysentery outside the United States32

Dysentery Carriers45

Bacillary Dysentery in Animals51

Transmission of Bacillary Dysentery by Flies52

Seasonal Incidence of Bacillary Dysentery53

Milk as a Vehicle of Transmission of Bacillary Dysentery55

Water as a Vehicle of Transmission of Bacillary Dysentery56

Other Foods as a Source of Bacillary Dysentery58

The Survival of B．Dysenteriae in Soil59

Hospital and Institutional Outbreaks of Bacillary Dysentery60

Bacillary Dysentery in Summer Camps64

Hotels，Restaurants and Bacillary Dysentery66

Travel and the Dysentery Problem71

Ship Dysentery72

Planes，Trains and Dysentery74

A Seven Point Program for the Control of the Infectious Diarrheas75

The Gastric Barrier in Bacillary Dysentery75

CLINICAL ASPECTS78

Clinical Forms79

Incubation Period80

Age Incidence81

Acute Bacillary Dysentery in the Newborn83

Mode of Onset of Acute Bacillary Dysentery88

Systemic and Focal Intestinal Manifestations89

The Typical Clinical Picture in Acute Bacillary Dysentery90

Diarrhea91

Abdominal Pain94

Pyrexia95

Atypical Clinical Forms of Acute Bacillary Dysentery96

Appendicular Form with Acute Distal Ileitis98

Meningitic Type105

Pneumonic Type107

Agranulocytoid Type110

Asymptomatic Type112

Afebrile Type114

Constipated Type114

Other Clinical Features of Bacillary Dysentery115

Varying Degrees of Severity in the Same Household or Outbreak115

Rapid or Sudden Fatalities115

Respiratory Symptoms116

The Relationship of Specific Dysentery Strains to Severity of Clinical Infections116

Multiple Infections117

Complications in Acute Bacillary Dysentery119

Arthritis119

Vitamin Deficiency States122

Edema123

Parotitis124

Perforation124

Ocular Complications125

Urinary Tract Infections with B．Dysenteriae126

Otitis132

Urethritis132

Vaginitis132

Adrenal Insufficiency132

Intussusception133

Appendicitis133

Cardiac Complications133

Complications Involving the Nervous System133

Mortality Incidence in Acute Bacillary Dysentery134

Relapse and Reinfection136

Enteritis，Gastro-enteritis，Ileocolitis and Bacillary Dysentery137

Differential Diagnosis of Acute Bacillary Dysentery140

BACTERIOLOGY OF ACUTE BACILLARY DYSENTERY146

Historical Review146

Classification of the Dysentery Bacilli154

Antigenic Structure of the Dysentery Bacilli157

Smooth and Rough Variants172

Relationship of Positive Fecal Cultures to Day of the Disease174

The Dysentery Toxins180

Pathogenicity of B．Dysenteriae for Animals185

Multiple Infections with Members of the Dysentery Group187

Positive Blood Cultures in Bacillary Dysentery189

Dysentery Bacteriophage189

SEROLOGICAL ASPECTS OF BACILLARY DYSENTERY197

Effect of Vaccination on Agglutination Titers209

PATHOLOGICAL LESIONS IN ACUTE BACILLARY DYSENTERY222

THERAPY OF ACUTE BACILLARY DYSENTERY239

Curative and Supportive Therapy240

Elimination of the Causative Organism240

Catharsis240

Sulfonamide Drug241

Bacteriophage Therapy253

Bacterial Antagonists258

Specific Neutralization of Absorbed Toxins259

Anti-dysentery Serum259

Diet263

Palliative Drug Therapy269

Prophylaxis272

Vaccination272

The Prophylactic Value of Antidysentery Serum277

Vaccination of Human Subjects279

General Methods of Prophylaxis286

Fly Control287

Prophylaxis and Treatment in Combat Areas288

CHRONIC ULCERATIVE COLITIS AND CHRONIC DISTAL ILEITIS290

CHRONIC BACILLARY DYSENTERY290

Historical Aspects290

Pathogenesis292

Epidemiological Aspects297

Supplementary Clinical and Bacteriological Observations309

Serological Considerations320

Pathology324

Roentgenographic Data in Cases of Chronic Ulcerative Colitis and Ileitis337

Concepts as to the Etiology of Chronic Ulcerative Colitis338

Bacteria338

Protozoa340

Fungi340

Virus341

Allergy342

Deficiency States342

Psychogenic Theory343

Intestinal Spasm343

Miscellaneous Theories343

Concepts of the Etiology of Chronic Distal(Regional)Ileitis344

Infection of Uncertain Origin344

Tuberculosis344

Streptococcal Infection345

Bacterial Allergy345

Sarcoidosis of Boeck345

Lymphogranuloma Inguinale345

Mechanical Theory345

Intussusception345

Miscellaneous Theories345

Summary of Data on Common Pathogenesis of Bacillary Dysentery，Chronic Ulcerative Colitis and Distal Ileitis347

CLINICAL，PATHOLOGICAL AND ROENTGENOLOGICAL CONSIDERATIONS OF CHRONIC ULCERATIVE COLITIS AND DISTAL(REGIONAL)ILEITIS349

Chronic Ulcerative Colitis349

Incidence349

Age and Sex349

Symptomatology349

Complications and Sequels354

Polyposis354

Rectal Stricture and Intestinal Stenosis354

Abscess Formation355

Perforation356

Arthritis357

Vitamin Deficiency States358

Skin Lesions360

Hemorrhage367

Roentgenographic Changes370

Diagnosis374

Differential Diagnosis of Amebiasis376

Differential Diagnosis of Intestinal Polyposis378

ETIOLOGY380

PATHOLOGY383

ROENTGENOGRAPHIC DIAGNOSIS395

CLINICAL DIAGNOSIS397

SIGMOIDOSCOPIC DIAGNOSIS398

SUMMARY399

Treatment of Chronic Ulcerative Colitis399

MEDICAL TREATMENT399

SURGICAL TREATMENT410

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

Historical Aspects422

Incidence423

Age and Sex423

Sites of Involvement424

Symptomatology426

Roentgenological Aspects434

Diagnosis438

Complications441

Pathology and Pathogenesis442

Treatment450

APPENDIX465

TECHNICAL METHODS USED IN THE DIAGNOSIS OK BACILLARY DYSENTERY465

Cultural Studies465

The Culture Specimen465

Differential Plating Media467

Fermentation Tests468

Composition of Differential Media468

Other Biochemical Tests474

Litmus Milk474

Indole Production474

Methyl Red Test(M．R．)474

Voges-Proskauer Test(V．P．)475

Nitrate Reduction475

Ammonia Production476

Hydrogen Sulfide Production476

Reduction of Methylene Blue476

Catalase Test476

Agglutination Tests for Determining Serological Titer477

Microscopic Method477

Macroscopic Method477

Serological Identification of Dysentery Strains478

The Use of Antisera478

Agglutinin Absorption480

Polysaccharide Precipitin Typing481

Diagnostic Sera481

Dysentery Bacteriophage482

Classification of the Dysentery Bacilli484

THE HOSPITAL EPIDEMIOLOGIST494

Selecting the Hospital Epidemiologist495

Methods of Control of Communicable Diseases in Hospitals495

THE PREVENTION AND CONTROL OF BACILLARY DYSENTERY AND OTHER INFECTIOUS DIARRHEAS AMONG MILITARY FORCES497

Drinking Water500

Food and Foodhandlers501

Bacteriological Diagnosis of Infectious Diarrheas501

Clinical Aspects503

Therapy504

EDUCATIONAL PROGRAM FOR THE PREVENTION AND CONTROL OF BACILLARY DYSENTERY506

The Physician507

Public Health Officials508

Nurses509

Lawmakers509

Teachers510

Hospital and Institutional Administration510

Laymen511

Military Forces511

BIBLIOGRAPHY513

INDEX609