A practical treatise on tropical dysentery, more particularly as it occurs in the East Indies : ... to which is added, a practical treatise on scorbutic dysentery, with some facts and observations relative to scurvy

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Preface

The motives^ that roused the author to undertake an investigation of the formidable and destructive diseases treated of in the following pages, were, to avert a miserable dissolution from those entrusted to his charge; to protect them from these scourges of our fleets and armies, by acquiring a more successful practice ; and to relieve the mental anxieties their mortality occasioned.

He tried the practice of the learned lecturers and authors on tropical dysentery, more especially of the East Indies, which was the principal theatre of his professional experience ; yet, while every other acute disease of intertropical regions submitted to the control of a decisive practice and unwearied attention, this alone too often defied his knowledge, baffled his skill, eluded his vigilance, mocked his hopes, and either quickly precipitated his patients to the

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PREFACE.

grave, or consigned them to chronic disease replete with suffering and danger. Still his faith clung to the belief, that dysentery was one of those acute diseases whose desolating influence could be bounded, and fatal career arrested by the healing art, and that its mortal ravages arose more from an ignorance of a successful practice, than from its incontrouiablv fatal nature: and while he availed himself of the advantao-es that past experience of the remedies employed conferred, it seemed a laudable resolution to endeavour to establish a treatment, founded on such inferences, as should be fairly deduced from a mature consideration of all the symptoms and appearances on dissection, and should be sanctioned by sound principles of pathology and physiology.

The means of information were ample ; for the prevalence of this disease among. 500 Europeans of all ages under his medical care, during several years, daily presented to observation both its acute and chronic forms, and he enjoyed eas}^ acce.ss to the hospitals at the Presidencies of India- Tiie .symptoms and ti’eatrnent of every case were minutely and faithfully recorded twice a day, and of tiie interesting ones oftener, while

PREFACE.

Ill the importance of dissections was never forgotten or omitted when opportunities offered, which, happily, at last became very rare : from those cases, and their results, the general observations have arisen, the deductions have been drawn, and the practical treatment inculcated ; and if they vary from other authors, the difference has not grown out of an unbecoming spirit of cavil, but has arisen from the force of circumstances, a respect to truth, a candid avowal of opinion, and a deference to conclusions from facts. — What he has seen and believes, that he has boldly advanced, and faithfully recorded.

The characteristic symptoms of the order of phlegmasiae are so clear and plain, their application to the detection of visceral inflammation is so easy and gratifying,, and their treatment so rational and successful ; that although he could not at once break the fetters that fastened on him the errors of authorative doctrines, nor dissipate the mist ot medical prejudice that obscured the bright clime of India, nor divest himself of the deference paid to the old and confirmed usages of its practitioners ; still the symptoms and events of cases soon convinced, as far as reasoning and redectioD, without demonstration.

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could impress conviction, that the dangerous symptoms and fatal terminations of idiopathic dysentery were those of inflammation, which could not be subdued and averted without the aid of bleeding.

An extended and prudent use of general and topical bleeding, associated with purgatives, sudorifics and mercurials, obtained such happy success, that the Author and his assistant ceased to dread the combat with this once alarming and fearful malady ; and even the insidiously concealed or openly marked hepatic derangement, its occasional associate, was forced to yield to a persevering use of mercury, until salivation was moderately excited, in those cases that resisted its more limited administration.

The great and almost invariable success of his matured and improved practice compared Avith the results of his early mode of treatment, is the principal pretension for presuming its communication will be useful to the tropical practitioner, and beneficial to his fellow creatures; should it prove so, then will his labour not be in vain.

The manuscripts have not received any large

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V accession of facts, since the Author’s arrival from tlie East Indies, in the autumn of 181 1, at which time he was prevented from publishing them, bj being directly recalled into public service, by ill health, and from a hope of enlarging his sphere of observation and field of experience, which, indeed, occurred in 1814, when he was sent to the West Indies, the only intertropical part of the world he had not visited.

The Treatise on scorbutic dysentery must depend on its intrinsic merits for the favorable opinion of the public, as there is not any other extant, known to the author, by which it may be judged of by comparison

When the first part of this volume was printed off’ a friend kindly directed the Author’s attention to the energetic observations of Dr. A. Robertson, on the New Orleans Dysentery,* and the publisher was so obliging as to send, as soon as it was printed, Mr. Ballingall’s “ Practical Observations on the East India Dysentery,” &c Mr. Ballingall concurs in a statement advanced

See Mr. J. Johnson’s 2d edition of The Jiifluence of Tropical Climates, &c.” p. 425 , et seq.

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I vi PREFACE.

in this work, which receives strong proofs from his table of dissections, that hepatic inflammation and dysentery are not so frequently co-existent in India, as has been commonly stated and believed.'^ Of thirtv-livc dissections de-

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scribed in his valuable table, four only disclosed hepatic abscess, and in these, death cannot be so rationally attributed to this cause-, as to the diseased slate of the canal, for in Campbeirs, Christiaifs, and Foran\s cases, the intestine was mortified,’^ and, in Donaldson s, “ the colon appeared livid externally,'' and displayed “ extensive ulcerations." Of twenty-five cases he has recorded, genuine symptoms of hepatitis, during life, were evident in only two. — In the Author’s practice, the co-existence of hepatitis with the inflammatory form of dysentery occurred in about one case in ten ; w ith the severe variety^ much less frequently ; in the mild variety not at all ; and he has seen the livei perfectly sound, where its disease had been predieted by^ several, before death, to be the cause of the fatal symiptoms. Cystitis, peritonitis, and hiflamination of the omentum, w^ere associated with dysentery less frequently than hepatitis,

* P. 56-T of Mr. B.’s Obsei valious, and p. 27, of this Treatise.

and it is but rarely that any otlier structural derangenient ot tiie liver lias been disclosed? suflicient to produce death, except what is occasioned bv its inflammation. Dr. R's dissectioiis, at new Orleans, exposed ‘‘ no morbid intestinal appearances sullicient to account for death,’' which was generally caused l)y hepatic abscess, “ without pain being felt in the right hypochondrium throughout the disease, either on inspiration, or strong pressure under the false ribs.”'^ These peculiarities, it is apprehended, cannot be very satisfactorily explained : but it may be observed of the climate of New Orleans, at the winter period, when this disease prevailed, that the thermometer fell 6 or 7 degrees below the freezing point at night, and rose no higher during the day than to 30 or 38 degrees, and seldom above 50,” and it consequently resembled the frigid, rather than the torriil, zone, and could hardly be said to present cases of tropical dysentery. It may be further remarked, that the men sustained a trandtion •in about 15 days from Jamaica to a climate, ‘‘ where the weather was cold and rainy, with freipjent sharp frosts,”]* and that a suppression ot the cuticular discharges (so recently

* P. 438 of Mr. J.’s work already quoted, f Ditto, p. 427.

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overflowing at Jamaica,) from exposure to extremely cold"^ weather, might more generally and frequently excite inflammation of tw^o of the abdominal viscera at once, than is commonly observed in the Tropics; as in this year in England, visceral inflammations have been more severe and frequent after the very hot summer.

It is to be regretted that Mr. Ballingall ‘‘ should have been restrained from using the lancet in some cases even in his Appendix, from either of the two circumstances"’ he mentions ; “ a deference to the opinion of the older practitioners,” or from a visionary notion, (the author has endeavoured to combat in his sect: on bleeding, and hopes to see banished to its airy habitation,) that the constitutions of the older residents in India and the Tropics will not bear bleeding ; a consideration, which, with much estimable candor and love of truth. Dr. R. informs the author, deterred him from bleeding in some of his fatal cases theriy but would not in future ; as he considers “ the danger of exhaustion from depletion would be less than the direct danger of the disease,” and Avhich experience and reason have long since taught the author to disregard ; for he employed it as successfully among the old residents of

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IX twenty years, with proper caution, as among the newly arrived, and in the last years of his residence in the Tropics more than the first, from having learnt, by experience, to appreciate its value : and had Mr. Ball ingall asserted the dignity of reason, and adopted “ a practice of which he expresses a very favorable opinion,^' the author feels convinced he would not have dissected 100 subjects dead from this disease and witnessed many more. Indeed, when convinced of the inflammatory nature of one form of dysentery, in the Tropics, which noother author had clearly pointed out, and of its fatal tendency to speed suppuration and mortification, reflection taught him thus to reason ; — if a human being be assailed by acute and active inflammation of an internal organ — whether he be shaking on the icy shores of Greenland or burning beneath the -dEquinox — whethei he be a white or an .Tlthiopian — young or old, male or female, of a firm tone or relaxed, in the hot or cold season — what do these considerations avail ? Is there any remedy so indispensibly efficacious inits subduction as bleeding ? Is there one so uniformly

See p. 58 and 67 of Mr. Ballirtgall’s work already quoted — Drummond’s, Davis’s, and Foran’s cases in the Appendix, in which

the sj^raptoms seem to indicate existing phlogosis and consequently bleeding.

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PREFACE* iitampecl with the venerable sanction of the wisest physicians of all ages and climates ; that is inculcated by every author, respectable for learning and accurate observation; and to which the medical world is so much indebted, for being the providential instruments of saving life ? The answer must be — certainly not ; and if a human being, whatever or wherever he be, should be so affected, let it be an axiom, that, under a judicious modification, he will endure bleeding for its cure.

The work is committed to a candid and enlio’htened public, with an assurance, that cases were annexed in the manuscript illustrative of every opinion and observation offered ; to sustain every practical statement made and deduction drawn ; and to confirm every fact ; the subjects of which would have been mentioned,, had the author not been dissuaded from it, aS being unnecessary, by his respected friend Mr. A. Copland Hutchison, whose zeal for the advancement of professional knowledge is only equalled by the benevolence and judgment, with which he exercises his profession.

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TROPICAL DYSENTERY.

CHAPTER I. SECTION the nosology of the disease

T?HE generic cliaracter of Dr. Cullen, and his subdivision of dysentery itito species and varieties, are not applicable to the disease as it occurs in the East Indies and the Tropics : for contagious

pyrexia’'* does not there form a characteristic symptom ; he does not describe chronic dysentery, either as a species, or a sequela to the acute stage ; and the varieties of tropical dysentery and its sequela, that actually occur in practice, distinctly differ in symptoms and character from those, which he and other nosologists have noticed and described.

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* Sec Dr. Cullen’s definition of this genus.

It is thought, that scorbutic dysentery, enrolled by Dr, Cullen among the synonyma of symptomatic dysentery, as the 1 8th species of sauvages, would more properly appertain to the genus scorbutus, and be thus classed according to its proximate cause and its mode of treatment*

I shall then describe the species and varieties, which I have observed in tropical dysentery.

Species 1®"*. — Dysenteria acuta. — Character, — While the faeces are commonly retained, frequent evacuations from the intestines, consisting of mucus, serum, or blood, or a mixture of these, take place, and are preceded and attended by pain in some part of the abdomen, and accompanied and followed by tenesmus ; pyrexia is not often evident, but is sometimes urgent.

It varies in degree.-— (A.) — Dysenteria mitis. — • In which, the stools are not frequent; the quantity of mucus or serum evacuated is small, and rarely tinged with blood ; there is not any fever present ; and the pain of the abdomen is never constant, and is only felt, together with tenesmus, about the periods of evacuation.

(B.) — Dysenteria severa. — In which, the stools are frequent, and recur from twelve to forty-eight times or even oftener in twenty-four hours ; the excretions of mucus, or scrum, and the discharges of blood, or a mixture of these three, are copious ; the tenesmus and tormina about the periods of evacuation are severely felt ; but there is no constant, fixed, and acute pain in any part of the abdomen, or unequivocal synocha.

(C.) — Di/senteria injlammatoTia. — In which, there is a constant, fixed, acute pain of some part of the abdomen or intestinal canal, including the parts contained in the pelvis ; unequivocal inflammatory fever ;* obstinate retention of faices, while there are very frequent and copious dejections of mucus, serum, or blood, or a mixture of these, together with severe tormina and tenesmus. The blood drawn and concreted, exhibits the inflammatory bufi*.

Species — Dyse7iteria chronica. — The acute

is frequently succeeded by chronic dysentery, as a sequela of the varieties B. and C. In chronic dysentery, the feces are not retained ; but frequent, loose, faecal stools, (a state which for brevity 1 shall term Diarrhoea) ensue, mixed with dysenteric excretions, and accompanied with tenesmus and tormina.

* Synocha or inflammatory fever is thus defined by Dr. W. Cullen.- — “ Heat much increased, pulse frequent, strong and hard ; urine high-coloured, the animal functions but little disturbed.” — Nosology, genus iv. — In the inflammatory variety of dysentery, as in enteritis, the pulse is sometimes soft, and in tlie formerj the animal functions are sometimes greatly disturbed.

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Ac ute dysentery is sometimes fo llo wed by diarrhoea^ imcombined with dysenteric excretions, that will be noticed, when we come to the treatment.

Variety (A.) — In which, diarrhoea is accom* panied with an uniform continuance or a frequent recurrence of dysenteric excretions, and of intestinal pains at the periods of evacuation.

( B,)— In which, the dysenteric excretions of the intestines are continued and often evacuated, while the bowels observe regular periods of discharging fajces of natural consistence and color, the same as in health.

(C, ) — In which, the chronic stage of dysentery is protracted by an ulceration or excoriation of the intestines ; the diarrhoea and morbid secretions are maintained ; and pus is observed in the evacuations.

( D. ) — In which, the chronic stage is protracted by a diseased enlargement of the mesenteric glands, and with the following variety, may be considered symptomatic.

(E.) — In which, it is maintained by an abscess formed in one of the abdominal viscera or their membranes, and is generally accompanied by hectic fever.

In this enumeration, many varieties are omitted.

which have been described by Dr. Cullen and other nosologists ; but the omission has been confined to those, which do not require a distinct treatment, or ■svliich have not occurred in tropical practice.

Although Dr. Cullen’s character of the order of profluvia* is applicable only in part to dysentery, for there is very rarely fever, where there is simply an increased excretion of intestinal mucus ; although it does not supply the constant, acute, and fixed pain of the inflammatory variety, which his character of phlegmasiaef does; although even practical good might result from transplanting it to the order of phlegmasiai, for there is extreme danger in treating a severe disease, possessing the character of phlegmasiie, with the mild remedies adapted to the genera of profluvia, and but very little danger in treating a genus of the latter, as you would a mild case of the former : yet, as the character of plilegmasiae does not supply the increased excretions of intestinal mucus, and the frequent dejections, which are characteristic and constant symptoms of all the varieties of dysentery, while febris synocha et dolor topicus only characterize one; I think this part of the nosological arrangement of Dr. Cullen should be retained.

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Section I. Of the symptoms that affect the tongue and

fauces.

In mild cases of this disease, the tongue and fauces deviate so little from the healthy state, that they do not become objects worthy ot much observation ; but if the disease be severe, or assume an inflammatory character, they undergo changes indicative of constitutional derangement; The tongue and fauces then become dry and clammy, and occasion the sensation of thirst ; when fever prevails, the tongue is white and dry, or white and dry at the anterior part, and yellow at the root; or it is covered with a dark fur on the centre, and is white on the edges ; or it exhibits a light yellow fur on the anterior, and is covered with a dark yellow fur on the posterior part this state of the tongue more especially prevails, when there exists an increased secretion of bile ; or, it is sometimes covered entirely with a dry black fur, and at other times with a dry yellow or bilious fur. * The tongue frequently loses its sense

I of taste, or its sense becomes capricious, or is so perverted, that it mistakes bitter for sweet, nauseous tastes for what are apparently pleasant, and vice versa, I have seen the lips and mouth ulcerated in different parts, but this is a rare occurrence in tropical dysentery.

Section II. Of the symptoms that affect the stomach

In mild cases of dysentery, the stomach is sometimes not at all deranged in its functions, or is but simply deprived of its appetite ; in the severe and inflammatory varieties, the powers of digestion and the appetite become considerably diminished and impaired, or are wholly suspended for an uncertain period.

The stomach is frequently affected with nausea, that is constant, and which is occasionally accompanied with vomiting of bile, or of the crapulous contents of the stomach, or of both mixed in different proportions. Indeed, bile moved into the stomach by the_ retrograde action of the duodenum, is, in many instances, the cause of the sickness and vomiting which accompany dysentery, and when these very distressing symptoms are once induced, they in general continue, until the intestines are freely emp-

B 4 tied by the copious evacuation of loose faeces, and a determination of the bile through the course of the intestinal canal is freely established.

There is another state of peculiar irritability of the stomach including nausea and vomiting, which is equally distressing and more dangerous, in which, it is deprived of the capability of retaining any thing which is swallowed in the usual, or in a very moderate quantity, and even the mildest and blandest fluid becomes ejected, if taken in the quantity of a common drink ; this state of the stomach is commonly attended with unceasing thirst, which natu-^ rally inclines the patient to drink copiously. This peculiar irritability or disposition to be excited to inverted action, appears often to depend upon a morbid state of the stomach itself, and to reside either in the nerves or muscular fibres forming a part of it, and not to be caused by any extraneous obnoxious stimulus. The presence of bile or of undigested food is not the cause, for neither is ejected by vomiting. Its own secretions may excite the inverted action, but they cannot be always distinguished from extraneous fluids. Sickness and the action of vomiting sometimes take place, when nothing is ejected ; and consequently no extraneous stimulant, or secretion of the stomach can be the suspected cause. It sometimes originates in sympathy with a diseased portion of intestine or an abdominal viscus. The cause of this irritability cannot always be ascertained ; but it has been observed to accompany those cases, that have terminated in abscess of some of the abdominal viscera or of their coats. Inflammation of the stomach, or of the little omentum, or of the peritonasum situated over the region of the stomach, will necessarily excite a constant, fixed pain about the praecordia, and frequent vomiting, and has been sometimes detected as the cause of both. Frequent and unap^ peasable vomiting and nausea generally succeed the formation of internal abscess.

The bilious vomitings, those from peculiar irritability and other causes, often occasion subsequent pain and soreness about the praecordia, and at the attachments of the diaphragm to the edges of the false ribs, sternum, and lumbar vertebrae, owing to the convulsive actions of that muscle in vomiting, which frequently continue till death.

In the early, as well as in the advanced stages of dysentery, the region of the stomach is frequently affected with transitory pain from the presence of wind, bile, or undigested food, which may be distinguished from tlie pain of inflammation, by its not being constant.

In very severe and inflammatory cases, there often exists such an active stale of sympathetic irritability through tlic whole canal, that any warm fluid or stimulant taken into the stomach, will pro^ pagate a peristaltic motion through the whole intestinal canal, and bring on tormina and tenesmus. A direct sympathy also appears to exist, in dysentery, between the stomach and lower intestines : for it often happens, that, if the stomach be stimuli? ted by wine, warm food, or drink, or aromatic and an Hal medicines, an inclination to evacuate, or actual evacuations from, the lower intestines very quickly follow.

Flatulence is a common symptom in dysenteryj^ but cardialgia is a symytom rarely met with,.

The powers of digestion are seldom diminished by the effects of the mild variety, but in most cases of the other varieties, they remain impaired long after the violence of disease is subdued, and even after its characteristic symptoms have been cured. This loss of function, however, obtains more with the animal than the vegetable part of our diet; for I have repeatedly observed the tough and even tender parts of animal food voided unchanged by the process of digestion, and but very seldom the vege» table part.

Section III, Of the si/rnptonis that affect the intestines

It sometimes happens, that dysentery is preceded by copious diarrhoea, yet, in general, the most obstinate retention of natural faeces takes place in the intestinal canal, accompanied with flatulence, pain, and a sense of fullness of the abdomen. In consequence of this constipation, and perhaps of the stimulus of cathartics on the extremity of the ductus communis choledochus increasing the secretions of the liver, an accumulation of unusual quantities of bile takes place in the duodenum, which meeting with opposition to its ready passage downwards, becomes directed, by retrograde motion, to the . stomach.

In the large intestines, but chiefly in the colon and rectum, an increased and altered action takes place in their secerning arteries and glands ; and instead of the natural healthy mucus secreted in the usual quantity, they throw out serum, mucus, coagulable lymph, or blood, in unnatural quantities, and often considerably vitiated. From the irritation excited by the retention of hardened faiccs, and from the novelty of the stimulus of these fluids on the villous coat of the intestines, now become diseased and possessed of increased sensibility, the muscular coat of the intestines, and the muscles employed in discharging the faices, are frequently stimulated into action to evacuate their contents ; and the effect of the stimulus on the intestine and anus, continuing after the contents are evacuated, produces the muscular movements called tenesmus and tormina; symptoms, which are sometimes extremely severe and distressing, and exhaust the sensorial power so rapidly, as to induce temporary faintnes or actual syncope. Bile being sometimes mixed w ith the morbid excretions of the intestines, increases the force and frequency of tenesmus and tormina; often occasions a sensation of scalding around the verge of the anus, and just within the rectum ; and the verge of the anus is sometimes excoriated, in bad cases, bj^ bile and the morbid secretions. In the mild variety, the constipation readily yields to the action of cathartics, and the pain of tenesmus and tormina is moderate, and confined to the periods of evacuation. In proportion to the degree of severity of the disease, does the constipation become more difficult to remove, and the tenesmus and tormina more frequent and painful. In the inflammatory variety, the constipation is extremely obstinate ; and the tenesmus and tormina are very severe, distressing, exquisitely painful, and leave but short intervals of comparative ease.

The evacuations in dysentery vary in number and quality, and they should be distinguished into fecal, and dysenteric, the latter consisting of any of the morbid excretions of dysentery.

The evacuations are generally numerous, but their frequency is varied by the seveiity of the disease, and the nature of the secretions. In mild caseSj the number of evacuations will not often exceed from six to twelve in twenty-four hours : while in severe cases, in the same time, the number fluctuates from twelve to twenty-four, and by far the greater number of cases may be comprehended in this variety. In the inflammatory variety, and in some very severe cases, when the unequivocal symptoms of inflammation are not present, the frequency of dysenteric evacuations admits of considerable variation ; I have known them to occur as often as four times in an hour, while in other cases they have not exceeded thirty-six or forty-eight times in twenty-four hours ; and again in others, the patient has almost constantly confined himself to the bed-pan. In two cases I have known the blood and excretions flow constantly from the rectum, as the patient lay in his bed. In fatal and advanced stages, the evacuations are often passed involuntarily from a paralysis of the sphincter ani.

It may be applied to all the varieties, as a general observation, that the evacuations are more frequent in the night than in the day time, but more particularly so towards morning and the dawn of day, and, from this circumstance, may possibly be efiected by solar influence. At other periods, the frequency of evacuations may be increased by obstinate constipation, by any fluid or food taken into the stomach, and propagating its stimulus by sympathy from it to the bowels. Again, the frequency is increased by the presence of particular collectidns of offensive secretions, or of undigested food, or of wind acting as stimuli to the intestinal canal.

As the number admits of great variation in different cases, so do also the nature and quantity of the evacuations.

In some cases of the mild variety the disease may be properly considered as local, and confined to the secreting vessels of some portion of the large intestines, without affecting the general constitution. The evacuation, in the mild variety, commonly consists of a small quantity of mucus of different degrees of tenacity, opacity, or transparency, or of mucus, mixed with a small quantity of a serous fluid, that is sometimes streaked or tinged with blood.

In cases of the severe variety, the evacuations generally consist of a mixture of a thin mucus, serum, and blood in larger quantities, to which bile is sometimes added ; while occasionally the mucus is nearly as thick and tenacious as jelly, and of different shades of color and opacity.

In the inflammatory variety, and in some very severe cases, in which the unequivocal symptoms of inflammation are not present, these fluids are separated in much larger quantities, and the aggregate of mucus, scrum, and blood, often amounts to sonic pints, discharged in twenty-fours, and often forms a thin, sanious, or ichorous compound, like the washings of raw meat ; or the three fluids are seen in separate proportions; or the blood most abounds, forming an appearance like a fluid mixture of serum and blood ; or bile is temporarily discharged in considerable quantities, for several successive evacuations, and the appearance of bile obtains most ; or pure blood is occasionally discharged in considerable quantities, at distinct periods ; or it flows from the rectum involuntarily, in constant small quantities, so as to form a stream under the bed, as in James Eaton’s case; or in advanced stages, an actual, dangerous, and copious intestinal hjemorrhage supervenes suddenly, when the patient is attempting an evacuation, and induces syncope.

I have occasionally seen evacuations consistinoof a large quantity of thick, white, opake mucus, coagulated blood, and a small quantity of serum, forming a liver-like appearance.

During the progress and continuance of the disease, at ditferent irregular periods, the evacuations undergo various morbid changes that alter their quality and appearance. The mucus sometimes becomes less tenacious, and sometimes is gelatinous, and of an opake, white color ; a white coaffuluin, probably of lymph, and a thick caseous substance

' liave been observed in some discharges: The blood

occasionally becomes clotted. A black fetid substance has been evacuated^ which in some cases • appeared to be coagulated blood, and in others sloughy membrane, or sloughy portions of the villous coat of the intestines.* Pus and a thick sanies are not commonly observed, except they are met with at advanced periods of the disease, when the srut has suffered ulceration.