10 



diphtheritis in the large bowel. The mucous membrane between 

 the ulcers was pale in color. The ulcers were clean, and nothing 

 in their appearance suggested a fatal issue for the disease other 

 than that of the one containing the blood clot. The ileum 

 appeared normal. There were no evidences of typhoid fever. 



The second case to which I wish to refer was seen in consultation 

 with Dr. Otto Bartels, of Manila. 



Case No 2. Amcebic Dysentery; Liver Abscess; Multiple Severe 

 Intestinal Hemorrhage ; Death ; Autopsy. 



The patient gave a history of having had several attacks of diar- 

 rhea during the past year, but had not noticed any blood in his 

 stools. Since his entrance to the hospital, one week before, he had 

 been complaining particularly of headache and restlessness. At 

 times he had slight delirium. There was some constipation during 

 this period, and purgatives and enemata were prescribed for him 

 upon several occasions. Amoebae were present in his stools. His 

 temperature for four days previous to the time I first saw him, 

 April 8, had varied between 99.4° and 102.6°. There was no 

 distinct jaundice. Owing to the pain in the right hy])ochondriac 

 region, to the fever, and leucocytosis of 23,000, a diagnosis of liver 

 abscess was made and an operation advised. The patient, however, 

 would not consent to an operation. 



On April 8 there Avas one bowel movement, but none on the 

 following day. On the 10th, 11th, and 12th the bowels moved once 

 each day. The stools contained some mucus, and on microscopical 

 examination, in addition to a few red blood cells, a number of motile 

 amoebas were observed. On April 11 hiccough appeared and 

 persisted for several hours. At 5 p. m. April 13 a hemorrhage 

 occurred from the bowel of about 200 cubic centimeters of fresh 

 blood. The pulse remained good, but the temperature fell from 

 101.5° to 98° two hours later. Early on the following morning 

 the patient complained of pain in the abdomen, and shortly after- 

 wards a large amount of fresh and partially clotted blood was 

 expelled from the intestine. Two hours later there occurred another 

 hemorrhage of about 400 cubic centimeters of bright red blood. The 

 pulse became considerably weaker after the second hemorrhage and 

 the temperature fell nearly four degrees in three hours. The 

 patient suffered from nausea and vomiting at intervals through the 

 day and gradually became weaker. On the following day the pulse 

 became very feeble. The vomiting continued until within a few 



