36 



stages of the disease with resulting localized or general peritonitis, 

 retroperitoneal abscess, etc. 



The healing of small lesions may take place with complete repair, 

 or of large lesions with the formation of scar tissue and with sub- 

 sequent contractions. Peritonitis may result in the formation of 

 adhesions. Complete cure may be the eventual outcome, or a con- 

 dition of chronic atrophic enteritis or chronic catarrhal enteritis 

 may result. 



Generally, and probably always in active cases, the intestine is 

 thickened. This increase may be due to edema of all the layers, 

 but chiefly to that of the submucosa. It may also be caused by the 

 presence of the abscesses and sinuses which are so common in that 

 layer. In very active cases the subperitoneal coat may be verj' much 

 thickened, mostly from oedema. The mucous membrane between 

 the ulcers in uncomplicated cases usually appears normal. 



Distribution of the lesions. — There seems to be only a partial unanimity 

 regarding the extent and localization of the lesions in the disease. To 

 quote recent remarks on the subject, Futcher {Journal of the American 

 Medical Association, 1904) says the rectum in a majority of cases is 

 not involved or is so, only to a slight extent. Harris (loc. cit. ) remarks 

 that in fully half the cases the lesions do not extend above the beginning 

 of the transverse colon, and Rodgers (loc. cit.) writes that almost invariably 

 the lesions are more marked in the caecum and ascending colon and fre- 

 quently limited to these areas. 



In considering the presence of lesions above the ileoesecal valve, Futcher 

 says that in two of 119 cases slight superficial ulceration was present in 

 the last few centimeters of the small intestine. Rodgers concludes that 

 "the process never invades the ileum, which is contrary to frequent results 

 in other forms of dysentery." JIany writers speak of the more or less fre- 

 quent involvement of the appendix. Such observations taken from literature 

 might be multiplied many times, but these serve to show how different are 

 the results of careful and accurate observations based upon studies carried 

 out in different countries and even in different parts of the same country. 



Our statistics are based upon two series of cases, each of which 

 comprehends 100. 



Series A : Composed of cases that received either unsystematic 

 treatment by enemas or none at all. This series is one in which 

 the cases were received in the pathological service of Dr. R. P. 

 Strong at the Pirst Reserve Hospital and Army Pathological Labo- 

 ratory, and in which the necropsies were performed by Drs. Strong 

 and Musgrave. Dr. Strong kindly turned over to us the autopsy 

 records for examination and study. 



Series B : Composed of eases treated by rectal injections. 



