11 



hours of his death, which occurred on the following morning. 

 There were no more hemorrhages or bowel movements. 



At autopsy there was a large abscess measuring about 14 centi- 

 meters in diameter situated in the right lobe of the liver. The left 

 lobe contained a small abscess measuring about 7 centimeters in 

 diameter. The liver tissue was very fatty. The gall bladder and 

 ducts were normal. The large intestine contained many shallow 

 ulcerations, some of which were in the healing stage. The large 

 bowel contained some dark clotted blood. After a careful search 

 I was unable to locate any specific point from which the hemorrhage 

 had occurred. Scrapings from the intestinal ulcers and from the 

 walls of the abscess showed many motile amoebae, some containing 

 red blood cells. 



The question suggests itself of why severe intestinal hemorrhage 

 is not of more frequent occurrence in amoebic dysentery, particularly 

 when one considers the extensive lesions of the submucosa which are 

 present in most of the advanced cases. However, the additional 

 points in the pathology of the infection which would tend to prevent 

 hemorrhage must be recalled, viz, the thrombosed condition of the 

 blood vessels in the zone of infiltration and cedema which surrounds 

 the ulcers, the infiltration of the walls of the arteries, and the more 

 or less marked evidence of endarteritis as the progress is rapid or 

 slow. In chronic cases one may see at times the lumina of tlie 

 arteries entirely occluded by this process. 



On the other hand, the frequent occurrence of smaller amounts of 

 blood in the stools may be explained from the fact that the walls 

 of the veins are early infiltrated with round cells, followed by soften- 

 ing and complete disorganization; also from the fact that amoebae 

 may penetrate the wall of a vein. However, thrombosis of the 

 veins is not infrequent. 



As a rule the blood in the stools in amoebic dysentery probably 

 arises not from one but from many ulcers about wliich the capillaries 

 are usually considerably distended, frequently forming a network 

 at the bases and margins of healing ulcers. At post-mortem, 

 when one removes the upper layer of the mucosa in the vicinity 

 of an ulcer, one frequently finds small hemorrhages in the upper 

 portion of the submucosa. When the overlying mucosa becomes 

 necrosed and sloughs, the blood from these vessels finds its way into 

 the lumen of the intestine and appears later in the stools. How- 

 ever, in the cases which we have mentioned above tlie liemorrhage 

 probably arose from a single ulcer involving a blood vessel. 



