On the Dysenteries of India (With a Chapter on Secondary Streptococcal Infections and Sprue)

The opening chapter deals with morbidity and mortality, seasonal incidence, causation and relative frequencies of the different type? of the disease in this country. Here we are informed that cholera and dysentery are almost equally placed for the third and fourth places in order of importance in the Indian mortality rates and that both are much more important for all India than plague, a fact which is by no means generally appreciated. The seasonal relationships of the disease are shown by a series of All-India charts which demonstrate the all-powerful influence of the rainy season on the incidence of the disease. It should be remembered, however, that such charts represent general conditions' only and cannot be taken as universally applicable; thus in certain areas in, Eastern Bengal, the greatest incidence of the disease corresponds with the height of the cold season. Of greater importance to the clinician, however is the description of the relative frequencies of the different types of dysentery and all the implications it holds with regard to faulty treatment. The authors clearly show that as the result of numerous independent investigations bacillary dysentery is at least five or sixtimes more common than, is amoebic dysentery and that the almost universal use of emetine in treatment in this country is entirely erroneous and may do irreparable damage without alleviating the symptoms. We fully endorse the authors' concluding sentence " We wish that we could bring home to the medical profession in India the much greater prevalence of bacillary than amoebic dysentery, for therapy if it is to be successful?must be based on a correct knowledge of facts." Chapter II gives a very clear, concise and up-to-date description of the etiology, pathology and symptoms of both acute and sub-acute bacillary an$l acute and subacute amoebic dysentery. We arc glad to note that special attention is drawn to the occurrence of mixed infections in which amoebae and the dysenteric bacilli are both found, a fact which has not been generally recognised and the possibility pf which has in fact been denied in some quarters.