SARCODINA 1055 



dysentery, it will be remembered, is a disease with a short incuba- 

 tion period and an acute onset; after two or three days' illness the 

 bacillary ease is confined to bed, is pale, weak, emaciated and 

 presents every evidence of profound toxemia ; an amoebic case, sick 

 the same length of time, will be up and about and perhaps will not 

 have applied for treatment. 



Complications. A common and most dangerous complication is 

 abscess of the liver. The amoebae travel from the ulcers in the colon 

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

 necrosis of the parenchyma. The liquefied portion contains a red- 

 dish or chocolate-colored fluid, which is not pus 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 multiple, and at times the whole liver may be 

 riddled with large and small abscess cavities; both right and left 

 lobes may be involved. If surgical 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. 

 A few cases of amoebic abscess of the brain have been reported. 

 (Kartulis, 1904.) 



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 

 solitary 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 characterized by irregular margins and undermined edges. 

 Fresh smears made at autopsy will show vegetative amoebae. 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 amoebic 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 Baltimore and Washington, and cases are not very infre- 

 quent in the northern tier of states; hence one must examine the 

 stools for amoebae in dysenteric cases regardless of the location of 

 the patient's home. 



