— eS 
i 
568 
ACUTE, GENERAL PERITONITIS usually follows perforation of an ulcer in 
the colon, or of a liver abscess, but this complication does occur without 
any perforation whatever and, on the other hand, perforations of the ulcers 
in the colon may be walled off without general peritonitis. In rare in- 
stances, the rupture of a liver abscess into the peritoneal cavity may take 
place without producing general peritonitis. In 100 carefully examined, 
fatal cases of amoebiasis, acute general peritonitis occurred 26 times; 4 
times from ruptured liver abscesses; 20 times -from perforation in the 
large bowel; once from a perforated appendix, and once without any 
perforation. Of the colon perforations, 8 were in the sigmoid flexure and 
descending colon; 2 in the transverse colon and 9 in the ascending 
colon and cecum. In the case of peritonitis without perforation there 
was a combination of acute and amcebic dysentery. These statistics are, 
of course, from extreme cases and in no way represent the prevalence of 
peritonitis in any other class. It is comparatively a rare occurrence in 
patients who are satisfactorily treated and even in an average series of 
fatal cases it will be found much less frequently than it is in the statistics 
quoted above. The symptomatology and treatment of this complication 
needs no comment here. 
CHRONIC, LOCALIZED ADHESIVE PERITONITIS is one of the most frequent 
complications of the amoebic infection and is found in more than 80 per 
cent of the fatal cases. It may be very slight or very extensive and may 
give rise to all varieties of adhesions which may occur in the abdominal 
cavity. Some of the most important of these adhesions are of the 
omentum to the various other adjacent structures, such as to the abdominal 
wall, the surfaces of the intestines, the appendix, and particularly to the 
cecum; of the surfaces of the intestine to each other, to the abdominal 
wall, the appendix, stomach, gall-bladder, liver, spleen, ete.; and the 
adhesions between the liver and diaphragm, abdominal wall, colon, and 
even appendix. Many other varieties and combinations are encountered. 
The principal symptoms of these various conditions are abdominal pain 
and soreness. They may be so slight as not to be noticed, and, again, may 
be overshadowed by pains of other origin during the active stages of the 
intestinal disease. ‘The most annoying manifestation of these adhesions 
develop as an after effect in this disease, and these conditions will be 
further considered when that part of the subject is discussed. 
PHLEBITIS, EMBOLI, VENUS THROMBOSIS, AND INFARCTIONS have been 
reported and infarcts in the liver, spleen, and intestine are sometimes 
seen. Within the last few days multiple, white infarcts of both kidneys 
were found at autopsy in a case of intestinal amoebiasis combined with 
mesenteric and intestinal tuberculosis. 
PERNICIOUS ANMIA has but rarely been noted as a complication 
in amoebic disease. I have seen two cases in which the association was 
intimate and an apparent interdependence continued during the course 
of the disease. Both were patients who had contracted their maladies in 
