Dysentery and Colitis

This is an ever-recurrent subject of considerable contemporary importance and it is one which, in view of therapeutic advances, calls for a periodic review. As a result of the recent war large numbers of ex-Service personnel who have served in India, Burma and in the Far East are. still suffering from and will continue to exhibit recurring symptoms of these disorders for some time to come. Of the bacillary dysenteries there is fortunately little to be said. In the acute dysenteries of bacillary origin a great therapeutic victory has been won by the introduction of the special sulphonamides-sulphaguanidine and sulphasuccidine. Not only has this disease been robbed of its terrors, but its sequelae, which loomed so large some 25-30 years ago, have almost completely disappeared. No longer do we encounter those alterations in the lumen * of the large intestine, those peritoneal adhesions and that peculiarly intractable ulceration formerly known as chronic bacillary dysentery. Even the granular inflammation of the lower rectum, or ' granular proctitis,' the unhealed remnant of bacillary necrosis of the mucosa, is rarely seen nowadays. These sulphonamides have amply proved their worth, of that there can be no question. And probably also they are not only of curative, but also of prophylactic value, because it appears to have been established that by taking sulphaguanidine in daily gramme doses the onset of these dysenteries may be effectually prevented. It is due to these measures that the incidence of bacillary dysentery in the Eastern theatres of war sank, during 1945, to insignificant proportions and that the mortality rate declined to less than I in 5,000. These are indeed remarkable figures. Though sulphaguanidine and sulphasuccidine are especially valuable in the more toxic bacillary infections caused by Shiga and Flexner bacilli, they appear to be less effective in Sonne dysentery, which is so prevalent in this country at present. There is, however, some evidence that the more recently introduced compound, phthalystatin, possesses greater bacteriostatic powers in this infection. However, there is some comfort in the contemplation that Sonne dysentery produces considerably less damage to the bowel surface than the other organisms of this group.