UNUSUAL CASE OF AMOEBIC DYSENTERY. 305 



nodular elevations from various parts of the large intestine. The appear- 

 ances were nearly uniform in all of the cases. The mucosa between the 

 nodules showed many crypts in which the epithelial lining was entirely 

 converted into goblet cells. In a large number of cases the epithelium 

 was lost entirely, leaving only the interstitial tissue. Here and there an 

 entire crypt was converted into a granular mass, taking a deep nuclear 

 stain. In no case were amoehce found in the crypts, however. Here and 

 there one or two adjoining crypts had become converted into granular 

 masses and were surrounded by masses of small round cells, with numer- 

 ous red blood corpuscles among them. Along either the side or the top 

 of the elevations it was common to find that the tips of the tissue projec- 

 tions between the crypts were densely packed with extravasated red blood 

 corpuscles. Close to these areas of hasmorrhage there often occurred a 

 small bright red mass of thready fibrin mixed with detritus containing 

 tissue cells, blood and other debris, continuous with necrotic epithelium. 

 The necrotic mass extended as a core into the center of the nodule, in 

 some cases reaching no further but in other cases spreading in the sub- 

 mueosa. Surrounding the central core of necrotic material was a dense 

 mass of cells and red blood corpuscles, the corpuscles being often so 

 abundant as completely to fill the tissue. Passing away from the necrotic 

 area along the submucosa the red blood corpuscles rapidly diminished in 

 numbers, while the cellular infiltration extended further, gradually giving 

 way to oedema. In several places the infiltration from one nodule ex- 

 tended directly into that from an adjoining one. The muscular layers 

 were practically free from involvement except along the course of the 

 vessels where there was usually some evidence of small round-cell infiltra- 

 tion. A few small collections were also found in the subserosa. The cells 

 around the necrotic mass and extending through the submucosa were for 

 the most part hrmphocytes. In many cases cells with small, densely 

 staining nuclei were found possessing a greater amount of cytoplasm 

 which took a slightly basic stain. Considerable numbers of cells oc- 

 curred with a slightly vesicular nucleus and clear cytoplasm about two 

 or three times the diameter of a red corpuscle in size. A moderate 

 number of mononuclear eosinophiles were also found. These were more 

 numerous along the outer margins of the areas of infiltration than 

 toward the center. Great numbers of large, pale grayish, cloudy cells, 

 evidently amaibw, were found in the spaces and occasionally in the veins, 

 especially in the advancing margin of necrosis. Often these amccha' 

 contained either blood pigment or fragments of corpuscles. In addition 

 to the changes above noted, the connective tissue cells in the walls of 

 some of the ulcers were swollen, with large vesicular nuclei, and there 

 was swelling and vacuolization of the endothelial cells lining the tis.*uo 

 spaces and veins. In one section there was apparently a new growth of 

 capillaries beginning near the edge of the ulcer. 



