SARCODINA 727 



way of the lymphatics to the liver and there set up a liquefying ne- 

 crosis of the parenchyma. The liquefied portion contains a reddish or 

 chocolate-colored fluid, which is not pur, in the ordinary sense, although 

 it may become a pus-containing abscess if secondary bacterial infection 

 occurs. Liver abscesses may be single, but are much more often mul- 

 tiple, and at times the whole liver may be riddled with large and small 

 abscess cavities; both right and left lobes may be involved. If sur- 

 gical interference be withheld, the abscess increases in size, approaches 

 the surface, and finally ruptures into the lung through the diaphragm 

 or into the peritoneal cavity. 



At autopsy the lesions are found in the colon, principally at the 

 sigmoid flexure and in the cecum, though in chronic cases the whole 

 colon is involved, showing ulcers with undermined edges, swollen soli- 

 tary follicles and a hemorrhagic-catarrhal inflammation of the mucous 

 membrane. The ulcers, readily differentiated from those caused by 

 the tubercle bacillus, are of all sizes, shallow or deep, and are charac- 

 terized by irregular margins and undermined edges. Fresh smears 

 made at autopsy will show vegetative amebae. In chronic cases, the 

 colon is a mass of scars and ulcers and acutely inflamed, swollen and 

 thickened mucous membrane resting on a hypertrophied submucosa. 

 The severe and chronic forms of the disease are now as rare as they 

 were formerly common as a result of the present specific treatment 

 with emetin. 



Geographical Distribution. Although amebic dysentery is classed 

 among the tropical diseases, it is by no means confined to the tropics. 

 In the United States, for example, it is endemic as far north as Balti- 

 more and "Washington, and cases are not very infrequent in the north- 

 ern tier of states; hence one must examine the stools for ameba? in 

 dysenteric cases regardless of the location of the patient's home. 



Diagnosis. While the history of the case may suggest amebic infec- 

 tion, the diagnosis can onTy be made with certainty by microscopic 

 examination of the stool. For this purpose the examination should be 

 made as soon after the stool is passed as possible; and in this disease 

 it is usually practicable to have the patient come to the hospital, clinic 

 or office and pass a stool there. It may then be examined imme- 

 diately. If this is impracticable, the stool may be kept warm and sent 

 to the laboratory in a small glass jar inside a tin pail partly filled 

 with water at body heat; a little cloth or absorbent cotton will hold 

 the hot water and prevent splashing during transit. The stool will 

 show bloody mucous masses, and small drops of this are placed on 



