In the tropics and in temperate climates where the Shiga type bacillus is the infecting organism the onset is usually rather sudden with malaise, abdominal pain and a diarrhoea, which only temporarily relieves such pain. This initial diarrhoea is soon followed by the characteristic dysentery stool and the pains, which latter tend to centre about the umbilicus and to become continuous. There is usually loss of appetite and slight nausea and the patient may at times show a very slight tendency to flightiness. The mind however is usually clear. Fever of moderate degree is not uncommon and it may be quite marked,—up to 104°F. Ingestion of food or drink or any movement of the body brings on a desire for defecation. The number of stools, which in mild cases number 15 to 30, may become excessive, even more than one hundred in twenty-four hours, and the tenesmus most torturing, so that excoriations around the anus and at times prolapse of the bowel intensify the distressing clinical picture. In acute cases the stool may be almost pure blood with only an admixture of mucus. Vesical tenesmus may be present and the urine may be diminished in amount. There is a toxic effect on the heart so that the pulse tends to become accelerated and weak. Bacillary dysentery may show a moderate leucocytosis with increased polymorphonuclear percentage instead of a large mononuclear one as with amoebic dysentery. At times, however, the lymphocytes may be the leucocytes showing the greatest relative increase. _Collapse Types._—In the most severe types of dysentery we may have an abrupt onset with rigors and vomiting and a high fever. This fever gives way to a subnormal temperature and the patient shows signs of collapse and such a case may die without having passed dysenteric stools. The abdomen is rigid and very tender on palpation. _Entero-dysentery._—In those cases where the process extends to the lower portion of the small intestine the general symptoms are much more severe although the tenesmus is less and the stools less frequent and more voluminous. They contain much blood and mucus mixed with feculent material. Shiga calls such cases entero-dysentery. In severe cases of the more typical dysentery or colodysentery, as designated by Shiga, the stools may change from the mucopurulent mass to a serous discharge which is very rich in albumin and of an albuminous odor. In such cases emaciation of the patient is very rapid. Such cases may show signs of collapse with cold clammy skin and the clinical picture one associates with cholera. It has been suggested that such cases may be due to action of the dysentery toxins on the adrenal. This serous fluid may contain the flesh-like particles which the French liken to gut scrapings. During convalescence there may be an arthritis, which however does not impair the function of the joint.