39 



cells; and whenever this, perhaps a sign of incipient coagulative 

 necrosis, is visible, there is usually some distortion of the glands 

 beneath the surface. Such changes are most frequently seen in the 

 very early stages. In many cases the cells lining the glands are 

 separated from the basement membrane and lie singly or in clumps 

 in the lumen. Under such circumstances it is not uncommon to 

 see amcebas in the glands, lying among the desquamated cells or 

 forcing their way between the epithelia and the basement membrane. 



The most marked feature of the early lesions is congestion, often 

 combined with capillary hemorrhages which are most noticeable 

 immediately beneath the mucosa. This congestion may extend 

 even to the submucosa, in which layer there is also a certain degree 

 of thickening, chiefly due to oedema. Together with congestion, 

 there is an increase of cellular elements of the lymphoid type in the 

 interglandular tissue. The muscularis mucosa at this stage of 

 the disease may show no changes or only a slight oedema. 



The most interesting feature of this early process lies in the dis- 

 tribution of the amoebae. ISTot only may they be seen in the 

 glands, as described above, but they may also be present, sometimes 

 in large numbers, in the interglandular tissues and blood vessels, 

 in the muscularis mucosa, and in the dilated veins of 'the submucosa, 

 and this, with changes scarcely perceptible, if only the low powers 

 of the microscope are used. In such lesions bacteria are very few 

 in number and often can not be found even after prolonged search, 

 and none can be demonstrated in the amoebae. The latter, even in 

 the blood vessels, show the peculiar rod-shaped or crystalline bodies 

 which stain intensely with magenta and hematoxylin, the radiate 

 structure of the ectoplasm and ingested cells. 



In sections from lesions slightly more advanced and showing a 

 more extensive, though still superficial necrosis, the glands imme- 

 diately surrounding them are hypertrophied and the cells show 

 mucoid degeneration. There is the same lymphoid infiltration, 

 with, if anything, a greater congestion. In the congested area each 

 gland mouth seems to be surrounded by a zone of hemorrhages. 

 The cells of the necrotic mucous membrane are incorporated, with 

 occasional leucocytes, granular detritus, amceb®, and bacteria, into 

 a more or less well-formed membrane. There is a more extensive 

 separation of the glandular cells, and in such glands amoebae can 

 usually be seen either in the lumens or between the cells and the 

 basement membrane. Within the interglandular connective tissue 



