Intussusception shows marked tenesmus with bloody rather than muco-sanguineous stools.
While dysenteric symptoms may be present in the terminal stages of various chronic diseases, especially tuberculosis and cardiac affections, yet it is in chronic nephritis, leading to uremia, that we may see symptoms of a marked catarrhal or even diphtheritic colitis.
CHAPTER X
AMOEBIC DYSENTERY
History and Geographical Distribution
History.—Lambl, in 1859, was the first one to note the presence of amoebae in man, these being found in the stools of a child affected with diarrhoea. It was Lösch, however, who, in 1875, first accurately described the parasite which he found in the intestinal ulcerations as well as in the stool of a patient with chronic dysentery and was able to produce dysenteric ulcerations in the dog, by injecting amoebae-containing faeces into the dog’s rectum.
In 1879 Grassi noted the encysted forms of amoebae, but as he found them in well people, he denied their pathogenic importance. Cunningham found amoebae in the stools of cholera patients and Perroncito in those of typhoid cases, both of these authorities, however, viewing the question of their pathogenicity as did Grassi.
This was the general attitude of the medical mind until Koch, in 1883, while investigating cholera in Egypt, was impressed with the striking penetration of amoebae in the walls of intestinal ulcers and considered that this fact favored the view that amoebae were pathogenic.
Kartulis continued the work of Koch and in 1886 published his findings in 150 cases of dysentery, noting the presence of amoebae in the stools of all these cases. In 1887 he noted the presence of amoebae in liver abscess. In 1891, Lutz noted that amoebae in dysentery contained red cells. In the same year Councilman and Lafleur came to the conclusion that there were two species of amoebae in man, one harmless and the other, which was found in the submucosa of intestinal ulcers, pathogenic, Casagrandi and others put forward the view that amoebae only acted as carriers for bacteria, but in 1893 Kruse and Pasquale injected all the bacterial species isolated from a dysenteric stool into a cat’s rectum with negative result. Hlava and Kartulis first produced dysenteric lesions in cats by injecting per rectum, amoebic stools. Kruse and Pasquale produced dysentery in cats by injecting per rectum bacteria-free pus from a liver abscess which however contained amoebae.
A stumbling block as to the connection between amoebae and dysentery was the fact that many cases of typical dysentery failed to show amoebae. In 1898 Shiga settled this matter by reporting a group of bacilli which were concerned in the production of dysentery. His findings were confirmed all over the world and the distinction gradually obtained of cases of dysentery from bacillary as well as from amoebic infections.