Page:Tropical Diseases.djvu/539

XXIX] Intussusception.— Intussusception is also an occasional occurrence, especially in children. It is not always readily recognized. A sudden increase of pain, increased straining, entire absence of fæcal matter from the stools, vomiting, and perhaps the presence of a tumour in the rectum, might lead one to suspect and examine for this accident. Tenderness; thickening.— The abdomen is tender in most cases of acute dysentery. If the disease be of some standing a certain amount of thickening may be felt along the track of the colon, particularly over the sigmoid flexure. Appendicitis.— Symptoms suggesting inflammation of the appendix due to ulceration of that organ are often met with in amoebic dysentery, and probably account in part for the number of appendicectomies performed in tropical countries. Hepatitis.— In acute cases the liver is usually distinctly enlarged, and may be tender. It sometimes happens that attacks of hepatitis seem to alternate with attacks of dysentery; or, rather, that hepatitis increasing, dysenteric symptoms decrease, and vice versa. These are always very anxious cases, and too often eventuate, unless energetically and properly treated, in the formation of an abscess or multiple abscesses in the liver; in the latter event they almost necessarily prove fatal. Sequelœ.— Apart from chronic intestinal troubles, dysentery may be followed, as is the case in so many other infections, by peripheral neuritis. A condition resembling gonorrhœal rheumatism has frequently been noted as a sequel, and several epidemics have been recorded in which a large proportion of the cases became affected in this way. Conjunctivitis and iritis have also been noted as occasional sequelæ. Abscess of the liver is the most important of the sequelæ of dysentery; it will be treated of separately, and need not be further alluded to here. Mortality.— Although every now and again cases are met with which prove directly fatal, from an overwhelming initial dose of virus, or from the shock of an extensive and intense lesion, or from rapid