Report to the London School of Tropical Medicine on investigations on dysentery in Fiji during the year 1910 / by P.H. Bahr.

  • Manson-Bahr, Sir Philip Heinrich, 1881-1966.
Date:
1912
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Licence: In copyright

Credit: Report to the London School of Tropical Medicine on investigations on dysentery in Fiji during the year 1910 / by P.H. Bahr. Source: Wellcome Collection.

Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.

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    (6) Indian male, aet. 40, was admitted in a very wretched condition, very emaciated and anaemic (haemoglobin 40 per cent.) ; there was marked oedema of both ankles. His temperature was irregular, varying from 99° F. to 101° F., but his tongue was fairly clean. There was a large bulging swelling on the right side of the thorax, which was very painful on pressure. The liver was enlarged upwards to the fourth rib in the nipple line, and downwards two finger-breadths into the abdomen. Definite consolidation at the base of the right lung was found. The heart's apex beat was displaced two inches external to the nipple line. On examination of the blood the red cells numbered 2,300,000 per cubic millimetre, and there was a polymorphonuclear leucocytosis of 13,000 (poly- morphs 80 per cent.). His serum did not agglutinate a culture of Shiga's or Flexner's bacilli. The abscess was explored; liver pus, which was sterile on culture, was obtained. Before an operation could be performed the patient absconded, but was brought back ten days after in an almost moribund condition. The liver dulness now extended up to the third rib in the nipple line. At operation two ribs were resected and four pints of thick curdy liver pus evacuated. The cavity in the right lobe, which was a large one, appeared to extend into the left lobe as well. He was passing six to eight stools a day, containing a quantity of mucus and blood, in which numbers of amoebae were found. The nuclei of these amoebae were not visible in the unstained specimens. Ova of Ankylostoma duodenale were also present in the stools in great numbers. The second day after operation, amoebae bearing the same morphological characters were also found in the liver pus. On continuous doses of ipecacu- anha (5 to 30 grs.) the stools became rapidly normal. To prevent vomiting, the powder was given in pill form, coated with salol, with good results. The after-history of this man is most interesting. He developed a pyo- pneumonothorax on the right side, which caused a marked displacement of the hea,rt ; there was great respiratory distress, the abscess cavity in the liver became septic, and he almost died from septic absorption. Another abscess then developed in the left lobe of the liver ; this was opened under local anaes- thesia. Eventually, however, the patient recovered entirely and returned to India, though, naturally, the pneumonothorax still persisted. (7) Indian male, aet. 45, admitted with a history of dysentery of nine weeks' duration. His temperature was normal, and was never raised during his whole stay in hospital. The stools were frequent, twelve to fourteen a day; they consisted of semi-solid faecal matter coated with mucus and blood. For the first week in hospital he was treated with frequent doses of sodium sulphate, but without any marked improvement in the number and nature of the stools, which still contained quantities of blood and mucus. He was very emaciated and anaemic (haemoglobin 50 per cent.) and his tongue was furred. Ova of Ankylostoma duodenale were numerous in the stools ; active amoebae were found also in great numbers ; these measured 15 to 22 in diameter; their nuclei could not be distinguished in the fresh specimens, nor was the endoplasm markedly granular. They were so numerous that twenty or more could be found in one field of the microscope with a high-power lens. Some small cysts, probably of some intestinal flagellate, were also present in great numbers. There was no abdominal tenderness and the liver was not enlarged. His serum did not agglutinate cultures of Shiga's or Flexner's bacilli. Pulv. ipecac, (grs. 5 to 30) was given over a period of ten days with great benefit; the patient rapidly put on flesh, the stools became normal and averaged