14 



Case No. 4. Amcebic Dysentery; Liver Abscess; Severe Intestinal 

 Hemorrhage; Death; Autopsy. 



The patient, a Spanish sailor, was first seen after an alcoholic debauch. 

 At this time he was dull and stupid. He complained of acute dysentery. 

 A companion stated that he had been bleeding extensively from the rectum 

 during the previous day. At the time of my visit his temperature regis- 

 tered 99°, and the pulse counted 114. No distinct history of previous 

 dysentery could be obtained. The patient refused to enter a hospital. 

 A portion of a bowel movement, consisting of reddisli-brown masses of blood 

 and mucus, was secured, and a microscopical examination showed numerous 

 amoebae and red blood cells, and considerably altered blood pigment. Later 

 in the day a blood count showed 9,000 leucocytes per cubic millimeter. The 

 coagulability of the blood was tested and found to be complete only after 

 nine minutes. The liver dullness was distinctly increased upward in the 

 right axillary line above the fifth rib. The patient complained of slight 

 pains below the right axillary region. The conjunctivae were slightly 

 jaundiced. Morphia, calcium chloride, and absolute rest were prescribed. 

 The patient was seen again on the evening of the same day. At this 

 time his pulse counted in the neighborhood of 150 and was weak and 

 thready. The extremities were cold. He was already unconscious. His 

 companion stated that he had jDassed three or four large hemorrhages from 

 the bowels during the day. The sheet upon which he was lying partially 

 disclosed this fact, being in places soaked with fresh blood. He gradually 

 sank and died during the night. A complete autopsy could not be per- 

 formed, but an incision was made over the right hypochondriac region, 

 the liver drawn down, and the diagnosis of abscess in the right lobe 

 confirmed. 



On recalling the infrequency of fatal hemorrhage in amoebic 

 dysentery it seemed to me that some reason other than the ana- 

 tomical situation of the nicer might exist in the eight cases referred 

 to above and which might account for the persistence of the bleed- 

 ing and for their unfavorable outcome. Since in all of the cases 

 large liver abscess co-existed, the connection between intestinal hem- 

 orrhage and the hepatic condition has suggested itself very strongly 

 to me. The idea that the destruction of such large amounts of 

 liver tissue may sometimes bring about serious functional disturb- 

 ance in this organ and lead to a condition which predisposes to 

 hemorrhage must certainly be considered. James Finlayson,^ as 

 long ago as 1873, in discussing a case of liver abscess in which 

 intestinal hemorrhage had occurred, argued that hepatic abscesses 

 by interfering mechanically with the portal circulation may produce 

 congestion of the mucous membrane of the colon and thus favor 



' Glasgoic Medical Journal, Feb., 1873, p. 171. 



