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found in a thrombosed vessel occurring in an ulcer situated about 5 centimeters 
below the cecum, In his other case the point of hemorrhage was not located at 
autopsy. He also later reported two more similar cases, again emphasizing the 
presence of liver abscess. In one of these he called attention to the delayed 
coagulation time of the blood. 
Mugliston and Freer’ report two cases of amebiasis with abscess of the liver 
and fatal intestinal hemorrhage. Both of these had septic temperatures and 
in one, jaundice during life was noted. 
I have seen one "ia and four other cases of severe intestinal 
hemorrhage in amoebiasis without liver abscess. In the fatal case, a 
native prisoner, the amebiasis was associated with Banti’s disease and 
the hemorrhage was both gastric and intestinal. One patient, with two 
hemorrhages aggregating about 1,200 cubic centimeters of blood in 
twenty-four hours, also had an ameebic, ischio-rectal abscess. In one, 
with repeated small hemorrhages, there was also tuberculosis of the 
bowel and in the remaining two there was some severe secondary invader 
in the intestine, as was shown by the severity of the symptoms, which 
included fever, tenesmus and depression, conditions which probably do 
not occur in uncomplicated ameebic infections. 
Strong discusses the relations between liver abscess and severe fatal 
hemorrhages and refers first, to the question of whether the destruction 
of such large amounts of liver tissue may not sometimes bring about 
serious functional disturbances in this organ and lead to a condition 
which predisposes to haemorrhage ; second, to the mechanical interference 
caused to the portal circulation; third, to the relation between hemor- 
rhage and various other diseases of the liver, particularly when jaundice 
is present ; fourth, to the diminished coagulability of the blood; and fifth, 
to special bacterial (toxic) activity. He also suggests the occasional pos- 
sible diagnostic importance of such hemorrhages in liver abscesses. 
I am of the opinion that the association between amcebic liver abscess 
and hemorrhage is because of an interdependence upon a common condi- 
tion which is discussed more fully under abscess of the liver. It will be 
noted, in looking over the literature of intestinal hemorrhage‘ in dysen- 
tery, where the records are specific there is often evidence of severe 
infection which can not be attributed to ameebe, and this is particularly 
true in the cases associated with liver abscess. Strong’s and Mugliston’s 
and Freer’s cases had slight jaundice; there was fever and other evidences 
not found in ameebic infection without the presence of some other etio- 
logic agent and which, by their action, might bring about the general 
conditions which favor intestinal hemorrhage in other diseases. In dis- 
cussing the etiology of these hemorrhages we must not lose sight of the 
condition of the intestine, particularly with reference to the nature of 
the secondary invaders which may be present. The majority of the 
cases which have been reported were in infections of a gangrenous or 
*Mugliston and Freer: Jour. Trop. Med. (1905), 8, 113. 
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