564 
diphtheritic or other very severe type, the lesions in which were clearly 
not due to the action of the ameebe. We know that such agents may 
alter the whole type of an ameebic lesion and bring it histologically nearer 
those in which bleeding is a more common occurrence. 
The symptomatology and treatment of intestinal hemorrhage caused 
by ameebic ulceration is the same as when it is due to other causes and 
need not be entered into here. 
Sloughing of the mucosa is preéminently a complication of this 
disease and in untreated cases is fairly frequent. The sloughs may be 
of any size, from small shreds to casts of the bowel several centimeters 
in length. Sometimes at autopsy, considerable areas are seen completely 
denuded of mucosa. 
AM@BIC APPENDICITIS.—Involvement of the appendix in ameebic in- 
fection of the colon has been noted by several writers. It has already 
become a subject of considerable importance in the Philippine Islands, 
and the larger number of patients returning to the United States 
from Manila and other tropical countries makes it of considerable im- 
portance to the profession at home. In my first report *® of 150 post- 
mortem examinations of fatal cases of intestinal amebiasis, 100 of which 
were from the records of Strong and myself, 6 per cent showed ameebic 
lesions in the appendix and in 7 per cent more there were other lesions of 
this organ and 1 case had ameebic ulceration engrafted on an old, chronic 
appendicitis of other etiology. In a second series of 100 fatal cases 
reported by Woolley and Musgrave * there were 8 with amoebic lesions 
in the appendix and in all, as in the first series, the lesions appeared 
as a continuation of an amoebic process in the cecum; in the last 
series they also appeared in the small intestine, just above the ileo-cecal 
valve. The above and many additional pathological data which have 
been obtained, together with a large amount of clinical material, is the 
basis for the present consideration of the subject. 
Etiology.—The disease is much less frequently met with at autopsy 
than one would suppose, judging from clinical observation. It was for- 
merly more common than it is now in the Philippine Islands. This 
decrease is largely due to the more general early diagnosis and successful 
treatment of the colon infection at the present time. It is nearly or quite 
always an extension of the amoebic process from the cecum and shows 
a specially marked relation to infection on and above the Bauhinian 
valve. It probably does not often develop early in the disease, for 
it was not present in a single one of 25 early cases reported by Wool- 
ley and myself,* in which death was caused by intercurrent diseases. 
It most often attacks an otherwise normal appendix and but rarely one 
already crippled by former disease, and it is very much more frequent in 
severe dysenteric infection, with intercurrent diphtheritis, gangrene, etc. 
® Loc. cit. 
