Studies of the Acute Diarrheal Diseases: XIV. Clinical Observations

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Abstract
A series of 1,247 cases of acute diarrheal diseases was accumulated through case-finding procedures designed to avoid selection by degree of severity. Observations on 555 cases culturally positive for Shigella are compared with those on 692 cases from which these organisms were not isolated. Significant predisposing factors were not discovered. The illnesses generally appeared suddenly in persons previously in good health. There was a very wide range in the gravity of specific manifestations, as in the disease as a whole. The enteric disorder in positive as in negative cases was usually a "simple watery diarrhea," though gross blood was observed in more of the former than in the latter. Classical dysenteric stools were unusual even in proved Shigella infections. The associated symptoms and findings did not reveal any prominent differences between the culturally positive and negative series. 16% of the nonfatal positive cases had one or more recurrences of illness, though a portion of these were found to be successive infections with different vars. of Shigella. Recurrences were not as frequent in the negative cases. Deaths in positive cases were limited to infants under 2 yrs. of age and were more frequent than in the negative series. The observed case-fatality in the positive series varied from 15.5% in New Mexico (1937) to no deaths in New York City, and in the negative series, from 7.1% in New Mexico (1937) to 1% in New York City and no deaths in Georgia. Compared with the findings on cases in the general population, the observations on institutional inmates strongly emphasized that "simple diarrhea" rather than classical dysentery was the usual manifestation of Shigella infections.

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