=Complications.=—In addition to the arthritis there may be neuritis, which, in severe cases, may go on to muscular atrophy. In the arthritis the knee joint is that most frequently involved. This complication appears late in the course of the attack. Arthritis may be frequent in one epidemic and absent in another. The joint swelling usually clears up completely. Some of the reported joint involvements are undoubtedly serum reactions from antidysenteric serum treatment. Rarely in Shiga infections we may have an irido-cyclitis. Subnormal temperature may follow severe attacks. In some epidemics of dysentery gangrenous manifestations have been common. This is a very fatal type and is recognized by the passage of dark-brown serous discharges containing ashy gray to black sloughs or even tubules of gangrenous mucosa, the stool having a putrid odor. The general symptoms are pronounced, there being a dry glazed tongue, and low muttering delirium with a thready pulse. It is the typhoid state. It is usual to consider bacillary dysentery as a self-limited disease, running on to convalescence within ten days or two weeks. Rogers has called attention to the importance of bearing in mind a chronic condition as well as the acute one. In these chronic cases the ulcerations are usually located in the descending colon, sigmoid flexure or rectum and give rise to frequent stools containing blood and mucus and causing a progressive loss of strength and weight. There is marked digestive disorder and the patient becomes weak, anaemic and neurasthenic. DIAGNOSIS In the presence of the dysenteric syndrome of tormina, tenesmus, frequent scanty stools of muco-purulent or muco-sanguinolent character, one must keep in mind the various conditions which may give rise to such manifestations of dysentery and not diagnose a bacillary dysentery until we have excluded tuberculous, cancerous and syphilitic processes as well as those connected with schistosome or other helminthic infections. =Clinical Diagnosis.=—Amoebic dysentery is differentiated clinically from bacillary dysentery by the usual absence of manifestations of toxaemia and by its insidious onset and chronic course. It is important however to remember that either bacillary or amoebic dysentery may show gangrenous manifestations and in such cases the clinical picture of the typhoid state is the same whether the process is amoebic or bacillary. Fulminant bacillary dysenteries may greatly resemble cholera in its algid stage. Tropical liver abscess is a complication exclusively occurring in the amoebic form of dysentery while joint manifestations and evidences of multiple neuritis may be noted in some epidemics of bacillary dysentery. Again, the toxins of the dysentery bacilli have a tendency to damage the myocardium. At present we consider the good effects of the administration of emetine as important in the diagnosis of amoebic dysentery.