DYSENTERY. 367 



ever, thus far been impossible, even under the most favor- 

 able conditions of preservation, to keep them alive for more 

 than twenty-four hours. Efforts at cultivation of the 

 amebae upon any nutrient medium have, likewise, thus far 

 been unsuccessful. Even when they were inoculated in 

 pure culture no growth developed. (See Liver-abscess, 

 p. 370.) Kartulis has reported successful cultivation of 

 dysentery-amebae in infusions of hay. His observations 

 have, however, turned out to be incorrect, as the supposed 

 dysentery-amebae were hay-amebae, which always develop 

 abundantly in infusions of hay not sufficiently sterilized. 



It may yet be mentioned that the amebae are rather in- 

 different to the action of tannic acid (0.3 per cent.) and of 

 boric acid (i per cent), while quinin, in a solution of I : 

 5000, speedily causes their death. 



With regard to staining the amebae, reference may be made 

 to the sections dealing with the intestinal changes below 

 and with examination of the stools for amebae (p. 371). 



Occurrence of Amebae in the Stools of Dysenteric 

 Patients. The amebae described are regularly present in 

 the stools in cases of tropical dysentery, and especially in 

 the mucous elements thereof. They vary in number. In 

 the albuminoid masses of mucus, often streaked with blood, 

 found in recent cases, they are present actually in hordes ; 

 in older cases, sometimes only in small number. Medicinal 

 treatment may reduce the number materially, and eventually 

 cause their temporary disappearance. The amebae can be 

 demonstrated only when the fresh stool is examined. Ac- 

 cordingly, a negative result in a single examination of the 

 stools can not be accepted as evidence of the absence of the 

 amebae. Only continuous and repeated examination of all 

 the intestinal evacuations, especially at the beginning of the 

 disease, will yield definite information as to the presence or 

 the absence of the amebae. 



The Intestinal Alterations of Dysentery. The clinical 

 symptoms of dysentery are those of hemorrhagic catarrh of 

 the large bowel. The pathologic-anatomic conditions in 

 the intestine include the presence of the dysenteric ulcer, 

 with elevated, wall-like, undermined borders. The ulcera- 

 tive process responsible for these alterations originates pri- 

 marily in the submucosa, which undergoes a peculiar 

 necrotic transformation. If a section of the intestinal wall, 

 after hardening in absolute alcohol, is stained with Loffler's 



