DYSENTERY. 725 



from oedema. This change occurs chiefly, and generally exo.usive,ly, 

 in the large intestine, and it is rare for the dysenteric affection to ex- 

 tend to the lower portion of the small intestine. In higher grades of 

 the disease, more glutinous, or more hard, membranous gray-white 

 layers cover large portions of the interior surface of the intestine ; they 

 are removed with difficulty, and only along with the mucous mem- 

 brane. If they are already detached, the submucous tissue lies exposed. 

 The whole intestinal wall appears thickened by the excessive oedema 

 of the submucous tissue, and of the muscular and serous coats, but cer- 

 tain parts, corresponding to the spots formed by the exudation, are 

 especially swollen, so that they form nodular prominences on the inner 

 surface of the intestine. When dysentery is of this high grade, the 

 serous coat of the intestine usually participates in the inflammation, 

 and is covered with a thin layer of fibrin, which unites it to the sur- 

 rounding parts. The diseased intestine is evidently dilated, and is 

 filled with epithelial masses, shreds of exudation, and with an albumi- 

 nous fluid mixed with more or less blood ; it usually contains no faeces. 

 In the highest grades of dysentery, according to Rokitansky^ " large 

 portions of the mucous membrane are changed to a black, rotten, 

 friable, charred mass, which subsequently is not unfrequently thrown 

 off and passed as tubular pieces ; the submucous tissue either appears 

 infiltrated by charred-looking blood and by a bloody serous fluid, or 

 else pale, and the blood in its vessels is consumed to a black, stiff, 

 powdery mass ; but later, as a result of the throwing off of the dead 

 parts by a reactive inflammation in the deeper layers, it appears infil- 

 trated with pus. Besides a dirty-grayish discoloration and loss of 

 lustre, the peritoneal coat is in some places injected by dilated capil- 

 laries, and covered by a brownish, discolored, ichorous exudation. 

 The foul-smelling intestine, containing a blackish-brown fluid, like 

 coffee-grounds, is either in a state of passive dilatation, or it is collapsed, 

 and, when the process, has lasted a long time, the muscular coat is 

 shrunken, pale, faded, and readily torn." 



The glands of the mesocolon belonging to the diseased portion of 

 intestine are more or less vascular, swollen, and relaxed. The liver is 

 hypersemic, and in the malignant dysentery of the tropics it is not un- 

 frequently the seat of abscesses, which are doubtless due to the intes- 

 tinal veins carrying ichor or emboli from the diseased intestine to the 

 liver. 



If death do not occur at the height of the disease, the dysenteric 

 process either subsides, or a slow inflammation (" chronic dysentery " ) 

 remains, which subsequently carries off not a few of the patients. In 

 the former case, the edges of the loss of substance are approximated, 

 by the contraction of the connective tissue which forms their base, till 



