562 
by fibrous bands following localized peritonitis deserves special attention 
because it is not so infrequent and because it has previously received but 
slight consideration. Rogers mentions a case of strangulation of the small 
intestine from such a cause, and I have observed several cases, post- 
mortem, in which such bands were placed in a manner in which they 
must materially have interfered with the function of the organ. ‘These 
conditions may exist in any portion of the colon, but they are most 
common. below the splenic flexure; one case has been encountered where 
an hourglass contraction of the cecum was due to such a cause. The 
omentum is a factor in the majority of these cases because it is the 
important agent in the localized peritonitis which is very frequent in the 
disease. Many of the fibrous bands are formed principally about the 
omental-intestinal adhesions. Except in very rare instances, these con- 
tractions do not produce results which contribute materially toward a 
fatal termination of the disease, but, on the other hand, they are the 
cause of certain symptoms, both during the course of the disease and 
afterwards, in patients who recover. The symptoms usually are not 
of such a nature as to allow of a definite diagnosis of the condition, nor 
are they of very great importance, excepting where some other condition 
is to be excluded. 
Intestinal hemorrhage is a comparatively rare complication of amcebic 
infection, as is to be expected from the histologic picture which is 
produced, such as the well-known thrombosed condition of the blood 
vessels within and closely surrounding the lesions, and the more or less 
well-marked endarteritis which is usually present. Hemorrhage has 
been noted in a general way by several writers, but its importance as a 
factor to be reckoned with in the prognosis and treatment of the disease 
has not, until recently, received very much consideration. Attention 
had been called to it, in dysentery, by Woodward, Scheube, Manson, 
Sodre, Osler, Lafleur, Ranaud, and others, but its special importance in 
relation to amcebic dysentery has been emphasized by Lafleur, Haasler and 
Strong. The association of these hemorrhages with liver abscess has 
also been noted by Woodward, Haasler, Strong, and Mugliston and Freer. 
Haasler ° briefly reported three cases of severe intestinal hemorrhage in amebic 
dysentery, in two of which the hemorrhage was considered to be the cause of 
death. The author notes particularly that in both of these cases there was liver 
abscess and in one, with death after a loss of over 4 liters of blood, a thrombosed 
vessel was found in one of the ulcers. Strong* again emphasized the occurrence 
of severe intestinal hemorrhage as a fatal complication of ameebie dysentery, and 
reported to the Manila Medical Society November 2, 1902, two cases of amoebic 
dysentery and liver abscess in which severe hemorrhage was the cause of death. 
One of the patients lost more than 2 liters of blood in repeated hemorrhages during 
the three days preceding the end. At necropsy the source of hemorrhage was 
’> Haasler: Deutsche Medicin. Wochenschr. (1902), 28, 26 and 47. 
®Strong: Publications Biological Laboratory, Bureau of Government Labora- 
tories (1905), 32, 1. 
