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Dysentery (UK pronunciation: , US: ), historically known as the bloody flux, is a type of gastroenteritis that results in
blood Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the cells, and transports metabolic waste products away from those same cells. Blood in the cir ...
y
diarrhea Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin w ...
. Other symptoms may include
fever Fever, also referred to as pyrexia, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using val ...
, abdominal pain, and a feeling of incomplete defecation. Complications may include
dehydration In physiology, dehydration is a lack of total body water, with an accompanying disruption of metabolic processes. It occurs when free water loss exceeds free water intake, usually due to exercise, disease, or high environmental temperature. Mil ...
. The cause of dysentery is usually the bacteria from
genus Genus ( plural genera ) is a taxonomic rank used in the biological classification of living and fossil organisms as well as viruses. In the hierarchy of biological classification, genus comes above species and below family. In binomial nom ...
''
Shigella ''Shigella'' is a genus of bacteria that is Gram-negative, facultative anaerobic, non-spore-forming, nonmotile, rod-shaped, and genetically closely related to '' E. coli''. The genus is named after Kiyoshi Shiga, who first discovered it in ...
'', in which case it is known as
shigellosis Shigellosis is an infection of the intestines caused by '' Shigella'' bacteria. Symptoms generally start one to two days after exposure and include diarrhea, fever, abdominal pain, and feeling the need to pass stools even when the bowels are ...
, or the amoeba '' Entamoeba histolytica''; then it is called amoebiasis. Other causes may include certain chemicals, other bacteria, other protozoa, or parasitic worms. It may spread between people. Risk factors include contamination of food and water with feces due to poor
sanitation Sanitation refers to public health conditions related to clean drinking water and treatment and disposal of human excreta and sewage. Preventing human contact with feces is part of sanitation, as is hand washing with soap. Sanitation syste ...
. The underlying mechanism involves inflammation of the intestine, especially of the colon. Efforts to prevent dysentery include hand washing and food safety measures while traveling in areas of high risk. While the condition generally resolves on its own within a week, drinking sufficient fluids such as oral rehydration solution is important. Antibiotics such as azithromycin may be used to treat cases associated with travelling in the developing world. While medications used to decrease diarrhea such as loperamide are not recommended on their own, they may be used together with antibiotics. ''Shigella'' results in about 165 million cases of diarrhea and 1.1 million deaths a year with nearly all cases in the developing world. In areas with poor sanitation nearly half of cases of diarrhea are due to ''Entamoeba histolytica''. ''Entamoeba histolytica'' affects millions of people and results in greater than 55,000 deaths a year. It commonly occurs in less developed areas of Central and South America, Africa, and Asia. Dysentery has been described at least since the time of
Hippocrates Hippocrates of Kos (; grc-gre, Ἱπποκράτης ὁ Κῷος, Hippokrátēs ho Kôios; ), also known as Hippocrates II, was a Greek physician of the classical period who is considered one of the most outstanding figures in the history o ...
.


Signs and symptoms

The most common form of dysentery is bacillary dysentery, which is typically a mild sickness, causing symptoms normally consisting of mild gut pains and frequent passage of stool or diarrhea. Symptoms normally present themselves after 1–3 days, and are usually no longer present after a week. The frequency of urges to defecate, the large volume of liquid feces ejected, and the presence of blood, mucus, or pus depends on the
pathogen In biology, a pathogen ( el, πάθος, "suffering", "passion" and , "producer of") in the oldest and broadest sense, is any organism or agent that can produce disease. A pathogen may also be referred to as an infectious agent, or simply a g ...
causing the disease. Temporary lactose intolerance can occur, as well. In some caustic occasions, severe abdominal cramps,
fever Fever, also referred to as pyrexia, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using val ...
,
shock Shock may refer to: Common uses Collective noun *Shock, a historic commercial term for a group of 60, see English numerals#Special names * Stook, or shock of grain, stacked sheaves Healthcare * Shock (circulatory), circulatory medical emerge ...
, and delirium can all be symptoms. In extreme cases, people may pass more than one liter of fluid per hour. More often, individuals will complain of
diarrhea Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin w ...
with
blood Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the cells, and transports metabolic waste products away from those same cells. Blood in the cir ...
, accompanied by extreme abdominal pain,
rectal pain Rectal pain is the symptom of pain in the area of the rectum. A number of different causes (68) have been documented. Differential diagnosis Anal fissures One of the most common causes of rectal pain is an anal fissure. It involves a tear in th ...
and a low-grade
fever Fever, also referred to as pyrexia, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using val ...
. Rapid weight loss and muscle aches sometimes also accompany dysentery, while
nausea Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. While not painful, it can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of th ...
and
vomiting Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can be the result of ailments like food poisoning, gastroenter ...
are rare. In many cases there can be cascading cramps that affect the muscles surrounding the entire upper intestine; sometimes severe enough to cause the lining of the intestine to separate from the wall, leading to systemic infection. On rare occasions, the amoebic parasite will invade the body through the bloodstream and spread beyond the intestines. In such cases, it may more seriously infect other organs such as the
brain A brain is an organ (biology), organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It is located in the head, usually close to the sensory organs for senses such as Visual perception, vision. I ...
,
lungs The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either si ...
, and most commonly the
liver The liver is a major organ only found in vertebrates which performs many essential biological functions such as detoxification of the organism, and the synthesis of proteins and biochemicals necessary for digestion and growth. In humans, it i ...
.


Cause

Dysentery results from
bacteria Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria were am ...
l, or parasitic infections. Viruses do not generally cause the disease. These pathogens typically reach the large intestine after entering orally, through ingestion of contaminated food or water, oral contact with contaminated objects or hands, and so on. Each specific pathogen has its own mechanism or pathogenesis, but in general, the result is damage to the intestinal linings, leading to the inflammatory immune responses. This can cause elevated physical temperature, painful spasms of the intestinal muscles ( cramping), swelling due to fluid leaking from capillaries of the intestine ( edema) and further tissue damage by the body's immune cells and the chemicals, called
cytokine Cytokines are a broad and loose category of small proteins (~5–25 kDa) important in cell signaling. Cytokines are peptides and cannot cross the lipid bilayer of cells to enter the cytoplasm. Cytokines have been shown to be involved in au ...
s, which are released to fight the infection. The result can be impaired nutrient absorption, excessive water and mineral loss through the stools due to breakdown of the control mechanisms in the intestinal tissue that normally remove water from the stools, and in severe cases, the entry of pathogenic organisms into the bloodstream.
Anemia Anemia or anaemia (British English) is a blood disorder in which the blood has a reduced ability to carry oxygen due to a lower than normal number of red blood cells, or a reduction in the amount of hemoglobin. When anemia comes on slowly, t ...
may also arise due to the blood loss through diarrhea. Bacterial infections that cause bloody diarrhea are typically classified as being either invasive or toxogenic. Invasive species cause damage directly by invading into the mucosa. The toxogenic species do not invade, but cause cellular damage by secreting toxins, resulting in bloody diarrhea. This is also in contrast to toxins that cause watery diarrhea, which usually do not cause cellular damage, but rather they take over cellular machinery for a portion of life of the cell. Some microorganisms – for example, bacteria of the genus ''
Shigella ''Shigella'' is a genus of bacteria that is Gram-negative, facultative anaerobic, non-spore-forming, nonmotile, rod-shaped, and genetically closely related to '' E. coli''. The genus is named after Kiyoshi Shiga, who first discovered it in ...
'' – secrete substances known as cytotoxins, which kill and damage intestinal tissue on contact. Shigella is thought to cause bleeding due to invasion rather than toxin, because even non-toxogenic strains can cause dysentery, but E. coli with shiga-like toxins do not invade the intestinal mucosa, and are therefore toxin dependent. Definitions of dysentery can vary by region and by medical specialty. The U. S. Centers for Disease Control and Prevention (CDC) limits its definition to "diarrhea with visible blood". Others define the term more broadly. These differences in definition must be taken into account when defining mechanisms. For example, using the CDC definition requires that intestinal tissue be so severely damaged that blood vessels have ruptured, allowing visible quantities of blood to be lost with defecation. Other definitions require less specific damage.


Amoebic dysentery

Amoebiasis, also known as amoebic dysentery, is caused by an infection from the amoeba '' Entamoeba histolytica'', which is found mainly in tropical areas. Proper treatment of the underlying infection of amoebic dysentery is important; insufficiently treated amoebiasis can lie dormant for years and subsequently lead to severe, potentially fatal, complications. When amoebae inside the bowel of an infected person are ready to leave the body, they group together and form a shell that surrounds and protects them. This group of amoebae is known as a cyst, which is then passed out of the person's body in the feces and can survive outside the body. If hygiene standards are poor – for example, if the person does not dispose of the feces hygienically – then it can contaminate the surroundings, such as nearby food and water. If another person then eats or drinks food or water that has been contaminated with feces containing the cyst, that person will also become infected with the amoebae. Amoebic dysentery is particularly common in parts of the world where human feces are used as fertilizer. After entering the person's body through the mouth, the cyst travels down into the stomach. The amoebae inside the cyst are protected from the stomach's digestive acid. From the stomach, the cyst travels to the intestines, where it breaks open and releases the amoebae, causing the infection. The amoebae can burrow into the walls of the intestines and cause small abscesses and ulcers to form. The cycle then begins again.


Bacillary dysentery

Dysentery may also be caused by
shigellosis Shigellosis is an infection of the intestines caused by '' Shigella'' bacteria. Symptoms generally start one to two days after exposure and include diarrhea, fever, abdominal pain, and feeling the need to pass stools even when the bowels are ...
, an infection by
bacteria Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria were am ...
of the genus ''Shigella'', and is then known as bacillary dysentery (or Marlow syndrome). The term ''bacillary dysentery'' etymologically might seem to refer to any dysentery caused by any
bacilliform A bacillus (), also called a bacilliform bacterium or often just a rod (when the context makes the sense clear), is a rod-shaped bacterium or archaeon. Bacilli are found in many different taxonomic groups of bacteria. However, the name ''Bacillu ...
bacteria, but its meaning is restricted by convention to ''Shigella'' dysentery.


Other bacteria

Some strains of ''
Escherichia coli ''Escherichia coli'' (),Wells, J. C. (2000) Longman Pronunciation Dictionary. Harlow ngland Pearson Education Ltd. also known as ''E. coli'' (), is a Gram-negative, facultative anaerobic, rod-shaped, coliform bacterium of the genus '' Esc ...
'' cause bloody diarrhea. The typical culprits are enterohemorrhagic ''Escherichia coli'', of which O157:H7 is the best known.


Diagnosis

A diagnosis may be made by taking a history and doing a brief examination. Dysentery should not be confused with hematochezia, which is the passage of fresh blood through the anus, usually in or with stools.


Physical exam

The mouth, skin, and lips may appear dry due to dehydration. Lower abdominal tenderness may also be present.


Stool and blood tests

Cultures of stool samples are examined to identify the organism causing dysentery. Usually, several samples must be obtained due to the number of amoebae, which changes daily. Blood tests can be used to measure abnormalities in the levels of essential minerals and salts.


Prevention

Efforts to prevent dysentery include hand washing and food safety measures while traveling in areas of high risk.


Vaccine

Although there is currently no vaccine that protects against ''Shigella'' infection, several are in development. Vaccination may eventually become a part of the strategy to reduce the incidence and severity of diarrhea, particularly among children in low-resource settings. For example, ''Shigella'' is a longstanding World Health Organization (WHO) target for vaccine development, and sharp declines in age-specific diarrhea/dysentery attack rates for this pathogen indicate that natural immunity does develop following exposure; thus, vaccination to prevent this disease should be feasible. The development of vaccines against these types of infection has been hampered by technical constraints, insufficient support for coordination, and a lack of market forces for research and development. Most vaccine development efforts are taking place in the public sector or as research programs within biotechnology companies.


Treatment

Dysentery is managed by maintaining fluids using oral rehydration therapy. If this treatment cannot be adequately maintained due to vomiting or the profuseness of diarrhea, hospital admission may be required for intravenous fluid replacement. In ideal situations, no antimicrobial therapy should be administered until microbiological microscopy and culture studies have established the specific infection involved. When laboratory services are not available, it may be necessary to administer a combination of drugs, including an amoebicidal drug to kill the
parasite Parasitism is a close relationship between species, where one organism, the parasite, lives on or inside another organism, the host, causing it some harm, and is adapted structurally to this way of life. The entomologist E. O. Wilson h ...
, and an antibiotic to treat any associated bacterial infection. If shigellosis is suspected and it is not too severe, letting it run its course may be reasonable – usually less than a week. If the case is severe, antibiotics such as
ciprofloxacin Ciprofloxacin is a fluoroquinolone antibiotic used to treat a number of bacterial infections. This includes bone and joint infections, intra abdominal infections, certain types of infectious diarrhea, respiratory tract infections, skin i ...
or TMP-SMX may be useful. However, many strains of ''Shigella'' are becoming resistant to common antibiotics, and effective medications are often in short supply in developing countries. If necessary, a doctor may have to reserve antibiotics for those at highest risk for death, including young children, people over 50, and anyone suffering from dehydration or malnutrition. Amoebic dysentery is often treated with two antimicrobial drugs such as
metronidazole Metronidazole, sold under the brand name Flagyl among others, is an antibiotic and antiprotozoal medication. It is used either alone or with other antibiotics to treat pelvic inflammatory disease, endocarditis, and bacterial vaginosis. It is ...
and
paromomycin Paromomycin is an antimicrobial used to treat a number of parasitic infections including amebiasis, giardiasis, leishmaniasis, and tapeworm infection. It is a first-line treatment for amebiasis or giardiasis during pregnancy. Otherwise it is gen ...
or iodoquinol.


Prognosis

With correct treatment, most cases of amoebic and bacterial dysentery subside within 10 days, and most individuals achieve a full recovery within two to four weeks after beginning proper treatment. If the disease is left untreated, the prognosis varies with the immune status of the individual patient and the severity of disease. Extreme dehydration can delay recovery and significantly raises the risk for serious complications.


Epidemiology

Insufficient data exists, but ''Shigella'' is estimated to have caused the death of 34,000 children under the age of five in 2013, and 40,000 deaths in people over five years of age. Amoebiasis infects over 50 million people each year, of whom 50,000 die (one per thousand).


History

The seed, leaves, and bark of the kapok tree have been used in traditional medicine by indigenous peoples of the rainforest regions in the Americas, west-central Africa, and Southeast Asia in this disease. In 1915, Australian
bacteriologist A bacteriologist is a microbiologist, or similarly trained professional, in bacteriology -- a subdivision of microbiology that studies bacteria, typically pathogenic ones. Bacteriologists are interested in studying and learning about bacteria, ...
Fannie Eleanor Williams was serving as a medic in Greece with the Australian Imperial Force, receiving casualties directly from Gallipoli. In Gallipoli, dysentery was severely affecting soldiers and causing significant loss of manpower. Williams carried out serological investigations into dysentery, co-authoring several groundbreaking papers with Sir Charles Martin, director of the Lister Institute. The result of their work into dysentery was increased demand for specific diagnostics and curative sera. '' Bacillus subtilis'' was marketed throughout America and Europe from 1946 as an immunostimulatory aid in the treatment of gut and urinary tract diseases such as rotavirus and ''Shigella'', but declined in popularity after the introduction of consumer antibiotics.


Notable cases

* 685 – Constantine IV, the Byzantine emperor, died of dysentery in September 685. * 1183 –
Henry the Young King Henry the Young King (28 February 1155 – 11 June 1183) was the eldest son of Henry II of England and Eleanor of Aquitaine to survive childhood. Beginning in 1170, he was titular King of England, Duke of Normandy, Count of Anjou and Mai ...
died of dysentery at the castle of
Martel Martel may refer to: People * Andre Martel (1946–2016), American politician and businessman * Anne-Marie Martel (1644–1673), founder of what is now the Congrégation des Sœurs de l’Enfant-Jésus. * James B. Aguayo-Martel, ophthalmologis ...
on 11 June 1183. * 1216 – John, King of England died of dysentery at Newark Castle on 19 October 1216. * 1270 –
Louis IX Louis IX (25 April 1214 – 25 August 1270), commonly known as Saint Louis or Louis the Saint, was King of France from 1226 to 1270, and the most illustrious of the House of Capet, Direct Capetians. He was Coronation of the French monarch, c ...
of France died of dysentery in Tunis while commanding his troops for the
Eighth Crusade The Eighth Crusade was the second Crusade launched by Louis IX of France, this one against the Hafsid dynasty in Tunisia in 1270. It is also known as the Crusade of Louis IX against Tunis or the Second Crusade of Louis. The Crusade did not see an ...
on 25 August 1270. * 1307 –
Edward I of England Edward I (17/18 June 1239 – 7 July 1307), also known as Edward Longshanks and the Hammer of the Scots, was King of England and Lord of Ireland from 1272 to 1307. Concurrently, he ruled the duchies of Aquitaine and Gascony as a va ...
caught dysentery on his way to the Scottish border and died in his servants' arms on 7 July 1307. * 1322 – Philip V of France died of dysentery at the Abbey of Longchamp (site of the present hippodrome in the Bois de Boulogne) in Paris while visiting his daughter, Booty, who had taken her vows as a nun there in 1322. He died on 3 January 1322. * 1376 – Edward the Black Prince son of Edward III of England and heir to the English throne. Died of apparent dysentery in June, after a months-long period of illness during which he predicted his own imminent death, in his 46th year. * 1422 – King Henry V of England died suddenly on 31 August 1422 at the Château de Vincennes, apparently from dysentery, which he had contracted during the siege of Meaux. He was 35 years old and had reigned for nine years. * 1536 –
Erasmus Desiderius Erasmus Roterodamus (; ; English: Erasmus of Rotterdam or Erasmus;''Erasmus'' was his baptismal name, given after St. Erasmus of Formiae. ''Desiderius'' was an adopted additional name, which he used from 1496. The ''Roterodamus'' w ...
, Dutch renaissance humanist and theologian. At
Basel , french: link=no, Bâlois(e), it, Basilese , neighboring_municipalities= Allschwil (BL), Hégenheim (FR-68), Binningen (BL), Birsfelden (BL), Bottmingen (BL), Huningue (FR-68), Münchenstein (BL), Muttenz (BL), Reinach (BL), Riehen (B ...
. * 1596 – Sir Francis Drake, vice admiral, died of dysentery on 28 January 1596 whilst anchored off the coast of Portobelo. * 1605 – Akbar, ruler of the Mughal Empire of South Asia, died of dysentery. On 3 October 1605, he fell ill with an attack of dysentery, from which he never recovered. He is believed to have died on or about 27 October 1605, after which his body was buried at a mausoleum in
Agra Agra (, ) is a city on the banks of the Yamuna river in the Indian state of Uttar Pradesh, about south-east of the national capital New Delhi and 330 km west of the state capital Lucknow. With a population of roughly 1.6 million, Agra ...
, present-day
India India, officially the Republic of India (Hindi: ), is a country in South Asia. It is the List of countries and dependencies by area, seventh-largest country by area, the List of countries and dependencies by population, second-most populous ...
. * 1675 –
Jacques Marquette Jacques Marquette S.J. (June 1, 1637 – May 18, 1675), sometimes known as Père Marquette or James Marquette, was a French Jesuit missionary who founded Michigan's first European settlement, Sault Sainte Marie, and later founded Saint Ign ...
died of dysentery on his way north from what is today Chicago, traveling to the mission where he intended to spend the rest of his life. * 1676 – Nathaniel Bacon died of dysentery after taking control of Virginia following Bacon's Rebellion. He is believed to have died in October 1676, allowing Virginia's ruling elite to regain control. * 1680 -
Shivaji Shivaji Bhonsale I (; 19 February 1630 – 3 April 1680), also referred to as Chhatrapati Shivaji Maharaj, was an Indian ruler and a member of the Bhonsle Maratha clan. Shivaji carved out his own independent kingdom from the declining Adil ...
, founder and ruler of the Maratha Empire of South Asia, died of dysentery on 3 April 1680. In 1680, Shivaji fell ill with fever and dysentery, dying around 3–5 April 1680 at the age of 52 on the eve of Hanuman Jayanti. He was cremated at Raigad Fort, where his
Samadhi ''Samadhi'' ( Pali and sa, समाधि), in Buddhism, Hinduism, Jainism, Sikhism and yogic schools, is a state of meditative consciousness. In Buddhism, it is the last of the eight elements of the Noble Eightfold Path. In the Ashtanga Yo ...
is built in Mahad, Raigad district of
Maharashtra Maharashtra (; , abbr. MH or Maha) is a state in the western peninsular region of India occupying a substantial portion of the Deccan Plateau. Maharashtra is the second-most populous state in India and the second-most populous country subdi ...
,
India India, officially the Republic of India (Hindi: ), is a country in South Asia. It is the List of countries and dependencies by area, seventh-largest country by area, the List of countries and dependencies by population, second-most populous ...
. * 1827 – Queen Nandi kaBhebhe, (mother of Shaka Zulu) died of dysentery on 10 October 1827. * 1873 –
David Livingstone David Livingstone (; 19 March 1813 – 1 May 1873) was a Scottish physician, Congregationalist, and pioneer Christian missionary with the London Missionary Society, an explorer in Africa, and one of the most popular British heroes of t ...
, died of dysentery on 1 May 1873. * 1896 –
Phan Đình Phùng Phan Đình Phùng (; 1847January 21, 1896) was a Vietnamese revolutionary who led rebel armies against French colonial forces in Vietnam. He was the most prominent of the Confucian court scholars involved in anti-French military campaigns ...
, a Vietnamese revolutionary who led rebel armies against French colonial forces in Vietnam, died of dysentery as the French surrounded his forces on 21 January 1896. * 1910 – Luo Yixiu, first wife of
Mao Zedong Mao Zedong pronounced ; also Romanization of Chinese, romanised traditionally as Mao Tse-tung. (26 December 1893 – 9 September 1976), also known as Chairman Mao, was a Chinese communist revolutionary who was the List of national founde ...
died of dysentery on 11 February 1910. She was 20 years old. * 1930 – The French explorer and writer, Michel Vieuchange, died of dysentery in Agadir on 30 November 1930, on his return from the "forbidden city" of Smara. He was nursed by his brother, Doctor Jean Vieuchange, who was unable to save him. The notebooks and photographs, edited by Jean Vieuchange, went on to become bestsellers. * 1942 – The Selarang Barracks incident in the summer of 1942 during
World War II World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the World War II by country, vast majority of the world's countries—including all of the great power ...
involved the forced crowding of 17,000 Anglo-
Australia Australia, officially the Commonwealth of Australia, is a sovereign country comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands. With an area of , Australia is the largest country by ...
n prisoners-of-war (POWs) by their Japanese captors in the areas around the barracks square for nearly five days with little water and no sanitation after the Selarang Barracks POWs refused to sign a pledge not to escape. The incident ended with the surrender of the Australian commanders due to the spreading of dysentery among their men.


See also

* Cholera


References


External links

{{Authority control Intestinal infectious diseases Diarrhea Waterborne diseases Conditions diagnosed by stool test Wikipedia medicine articles ready to translate