306 MARSHALL. 



In sections stained with thionin, the amoebae failed to take the distinc- 

 tive stain, but the tissue was old at the time of staining. In sections 

 stained by Gram's method, no bacteria were found in the necrotic areas. 

 The anicebcB were conspicuous in these sections. The mesenteric lymph 

 glands showed little change in the cell nests and cell columns, except 

 that the structure was less dense. The sinuses were moderately distended 

 and contained many cells, (small and large mononuclears) and a few 

 red blood corpuscles. 



Anatomical diagnosis. — Amoebic dysentery; haemorrhage into large 

 bowel ; acute anaemia ; focal necrosis of liver ; cloudy swelling of kidneys ; 

 ecch_ymoses in skin and epicardium; scar from old liver abscess. Unci- 

 naria and Ascaris infection. 



In this case the acute course of the disease with the abundant 

 haemorrhages and the peculiar nodular form of ulceration shown in the 

 accompanying illustrations were unusual. On looking through the liter- 

 ature I find, however, that this lesion has been described as characteristic 

 of the earlier stage of amoebic dysentery. Councilman and Lafleur - 

 note in one case, in addition to irregular undermined ulcers, "numerous 

 round elevations often communicating with the lesions of the bowels 

 by a small opening. Others apparently have no opening." In their 

 summary they speak of "sharply circumscribed projecting nodular thicken- 

 ings, in which were small cavities filled with gelatinous looking pus." 



The most detailed description is given by Dopter,^ who cites an illus- 

 tration of a nodule similar to one of these, and describes its development 

 from the first stage of oedema and congestion with minute superficial 

 erosions through a stage with elevations which he speaks of as "verruco- 

 sities" which vary from the size of a millet seed to that of a pea. He 

 describes the false membrane and the necrosis ; the destruction of entire 

 glands and the reaction in the submucous tissues. The amount of 

 haemorrhage in his case was much less than in the one under discussion. 

 He also descriljes the fusion of adjacent areas and a subsequent sloughing 

 off of areas of mucosa leading to the characteristic sinus form of 

 ulceration. 



Kartulis ■* makes very little mention of such a form as the one under 

 consideration. He describes one stage as follows: "In the case of still 

 incomplete ulceration the plug (of necrotic tissue) is wedged in the tissue 

 and the picture is like a furuncle with a small opening in the mucosa and 

 the base in the submucosa." Davidson ^ refers to the occurrence of 

 such nodules at an early stage of amoebic dysentery, and apparently a 



^ Johns Hopkins Hosp. Rep. (1891), II, 45 L 



^ Anat. Patli. Dysenterie Aniibienne Arch, de Med. exp. et d'Anat. Patli. Paris 

 (1907), 19, 505-.54L 



* KoUe u. Wasseiniann : Handbuch der pathogenen Mikroorganism, Erganzungs- 

 band. 1907. 



' Allbutt and Rolleston : A System of Medicine by Many Writers. London. 

 ( 1907 ) 11, Part 2, .527-542. 



