38 



the distribution of the lesions at any period save that immediately 

 preceding death. 



We have selected from our series tvt'enty-five cases in which death 

 occurred from intercurrent disease early in the amoebic process and 

 find that among these there is an increased proportion of cases 

 showing ulceration confined to a portion of the intestine and a 

 coincident decrease in the number showing ulceration throughout 

 the large gut : 



Ulceration confined to the ctecum and ascending colon 11 



Ulceration confined to the descending colon, sigmoid, and rectum 8 



Ulceration throughout the bowel 6 



Total 25 



Lesions of the small intestine, in our experience, have always 

 been confined to the lower ileum and have been the apparent result 

 of direct extension from the caecum, which is usually severely ulcer- 

 ated in these cases. We have had one in which ulceration extended 

 32 centimeters above the ileocgecal valve, but ordinarily the lesions 

 consist of one or a few ulcers immediately above, or within 5 

 centimeters of, the Bauhinian valve. However, when there is a 

 diphtheritis of the caecum, the membranous exudate more often 

 extends above the valve for a longer or shorter distance, but without 

 ulceration. In such cases amoebse have not been demonstrated and 

 conseqiiently they have not been included in our statistics. 



As with the small intestine, so with the appendix, only cases with 

 distinct ulcerative processes, in which amoebae were demonstrated, 

 have been included in our statistics. In many necropsies this 

 organ was found clinically diseased from causes other than amce- 

 biasis and it occasionally showed an acute process which could not 

 be proved to be due to amoebae. All such cases have been excluded 

 from the tables. 



Histology. — In general, it may be said that the mucous mem- 

 brane between the ulcers is but little changed. In many places no 

 deviation from normal can be noted. However, in the immediate 

 neighborhood of the lesions there is a tendency to hypertrophy with 

 mucoid degeneration and even cyst formation. The latter is less 

 common in the cases we have studied than in those reported by 

 Councilman and Lafieur. The most common change in the mucosa 

 is in the immediate vicinity of the lesions and is shown by a ten- 

 dency to more diffuse staining than is seen in normal epithelial 



