Chronic Bacillary Dysentery

THE investigation of chronic diarrhlea forms an important part of the examination of patients invalided from overseas commands, particularly from the tropics. This involves adequate laboratory examination for intestinal protozoa, flagellates, and dysentery organisms. During the course of the laboratory investigations on seven hundred of such patients with a history of chronic diarrhoea, dysentery organisms were isolated from forty, and it is felt that the presentation of the laboratory findings in this small group may prove of some general interest and serve as a guide to other workers in this field. This group of cases forms a fairly average sample of the types of case returning to this country with a previous history of repeated or relapsing amoebic and bacillary infection. The history needs to be carefully retaken and previous diagnoses, unsupported by laboratory confirmation, not unduly stressed. Many cases with repeated attacks of diarrhoea are, in the tropics, diagnosedl as ameebiasis, and treated on quite "a priori" grounds with courses of ameebicidal drugs. Therefore, previous clinical diagnoses of intestinal'amebiasis should be treated with some reserve. Of the forty cases under review, only seventeen gave a clear-cut clinical history of acute bacillary dysentery; twelve were diagnosed as intestinal amoebiasis; three were unequivocal cases of sprue, andl the remainder undiagnosed diarrhoea. The previous treatment varied with the previous clinical diagnosis. Only nineteen had some form of sulpha-drug therapy, and the sulpha-drug was not always administered during the initial attack. This in some cases was due to the exigencies of war. For example, two of the cases were members of an air crew who were forced to bail out over enemy territory, where they developed bacillary dysentery, which remained untreated until they regained Allied lines. Twenty of the cases had a full course of amcebicidal therapy.