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498 exhaustion from hæmorrhage, or from perforation; and though some epidemics exhibit a malignancy which, fortunately, is not very common, the direct and immediate mortality from this disease is, under modern methods of treatment, not very high. In India, the case -mortality in dysentery among Europeans ranges from 3 to 22 per cent.; among natives, about 37 per cent. In Egypt, Griesinger stated it as 36 to 40 per cent. In Japan, Scheube places it at 7 per cent. These figures are of little value, as so much depends on the place and the type of the epidemic, and the range of cases covered by the statistics. There was a time when, under a spoliative treatment by bleeding and calomel, dysentery proved a very fatal disease indeed. Even now, in the presence of scorbutus, famine, the stress of war, and similar conditions, whenever dysentery becomes epidemic in a community it is apt to claim a large number of victims.

Sequelœ more dangerous than the disease.— As a rule, under modern treatment, it is the sequelæ of the disease that we have to fear rather than the disease itself. The chronic ulceration, the scarring, thickening, and contractions of the gut are irremediable conditions which too often, after months or years of suffering, lead to intestinal obstruction or, very frequently, to atrophy of the glandular and absorbent system of the entire alimentary tract, general wasting, and fatal asthenia. Such patients hardly ever pass a healthy motion; they are troubled with chronic indigestion; at times they pass their food unaltered; they have recurring attacks of diarrhœa; they are flatulent; their tongues are red, often ulcerated and tender; they develop the condition known as "sprue," and sooner or later almost invariably succumb.

Morbid anatomy. Catarrhal dysentery.— In those cases that subside in a few days, whether spontaneously or in consequence of treatment, it is reasonable to suppose that the pathological condition consists only, or mainly, in congestion or in catarrhal inflammation; that here and there, or throughout its extent, the mucosa and perhaps submucosa of the colon are slightly swollen and congested; and that