15 



the development of hemorrhage. The relation between hemor- 

 rhage and various other diseases of the liver, such as acute atrophy, 

 syphilis, cancer, and affections of the biliary passages, particularly 

 when jaundice is present, is well known. However, it is true that 

 in typhoid fever severe and fatal intestinal hemorrhage may occur 

 independently of any extensive lesion of the liver, though it has 

 even been claimed that when such a result takes place it depends 

 chiefly upon a diminished coagulability of the blood ^ or to special 

 bacterial activity.- Therefore, while it obviously is probable that 

 more extensive observations will show that fatal intestinal hemor- 

 rhage in amoebic dysentery may occur independently of liver abscess, 

 the cases to which I have referred would seem to point out that 

 at least when hemorrhage occurs in cases complicated with such 

 hepatic disease, it is likely to be very severe and that the bleeding 

 is likely to recur. 



It is also possible that the occurrence of multiple intestinal 

 hemorrhages in amoebic dysentery may occasionally be of some 

 importance in the diagnosis of liver abscess. In my last case 

 as noted above there was no fever and no leucocytosis, and although 

 the liver was slightly enlarged and abscess was suspected, I did 

 not feel by any means certain of such a diagnosis. However, when 

 the intestinal hemorrhages appeared, reasoning from my knowledge 

 of the conditions in the other five cases, I felt confident of the 

 existence of hepatic abscess, a diagnosis which, as already men- 

 tioned, was confirmed at autopsy. In this connection I was 

 recently much interested to find in Woodward's article on dysentery 

 in the Medical History of the War of the RehelUon,, 1879, the state- 

 ment that "hemorrhage from the bowels is another occasional 

 symptom of liver abscess and sometimes is the immediate cause of 

 death." This statement seems to have received no attention in 

 the literature on amoebic dysentery. 



We are about to undertake by Wright's method a study of the 

 coagulability of the blood in our cases of amoebic dysentery, for the 

 purpose of ascertaining if any changes occur either during the course 

 of the uncomplicated disease or in those cases in which liver abscess 

 or hemorrhage develop. 



'Wright and Knapp. Lancet, 1902, Vol. II, pp. 16, 1533. 

 ^Xicholls and Learnionth, ibid., 1901, Vol. I, p. 30.5. 



