1846 



THE DYSENTERIES 



leucocytes, and the peritoneal coat may be oedematous. The 

 micro-organisms destroy the fibrinous false membrane, which may 

 separate off in flakes, thus causing ulcers, which are at first super- 

 ficial, but later become deep and extensive. After treatment these 

 ulcers heal with the formation of connective tissue, thus producing 

 a scar in the mucous membrane, which in due course becomes 

 pigmented from the sulphuretted hydrogen of the bowel acting on 

 the iron of the blood. The other toxin may attack the nervous 

 system, causing peripheral neuritis. 



Very rarely do the bacilli enter the blood stream, and cause 

 true septicaemia, though such cases have been recorded by Rosen- 

 thal and Markwald, the latter observer stating that he found the 

 bacilli in the blood and intestinal contents of a foetus which had 

 been prematurely expelled from the uterus of a mother who was 

 suffering from bacillary dysentery. Darling has actually grown the 

 bacillus from the blood of cases of bacterial dysentery. Occasionally 

 the bacilli affect the joints and very rarely the conjunctiva. 



Morbid Anatomy. — On opening the abdomen, the peritoneum is 

 found in general to be normal, but the bloodvessels of the large 

 bowel are seen to be injected, and the mesocolons may be infil- 

 trated with lymph, or firm and fibrinous. There may be adhesions 

 of the sigmoid colon to the omentum, pelvis, bladder, or small 

 intestines, while the splenic flexure may be adherent to the spleen 

 and surrounding parts, and the hepatic flexure to the liver. The 

 caecum may show adhesions to the omentum, and more rarely there 

 may be pericaecal abscess. Signs of a general peritonitis may be . 

 met with, and will generally be associated with a gangrenous or 

 perforated condition of the intestine. 



The small bowel is usually normal, but may be hyperaemic or, 

 much more rarely, ecchymotic. The walls of the large intestine 

 are usually considerably thickened and hyperaemic, and may at 

 times be found to be gangrenous along a great or lesser extent of 

 their course. On opening the large bowel, the mucosa will be seen 

 to be covered with a coagulated exudate in the form of a false 

 membrane, which is more evident on the summits of the folds, 

 and is especially well marked in the sigmoid colon, the caecum, and 

 the ampulla of the rectum. Around the areas covered by the false 

 membrane the mucosa is seen to be hyperaemic and oedematous. 

 As a rule, numerous ulcers are also to be seen, with clean surfaces, 

 elevated edges, and a base formed by the submucosa. These 

 ulcers may be very extensive, leading to the separation of large 

 sloughs, or may extend deeply into the coats of the bowel, causing 

 perforation and peritonitis, or in less serious cases induce the 

 exudation of much lymph into the peritoneum coat, which subse- 

 quently causes adhesions. 



In post-mortem examinations of cases which have died from 

 some other complaint it is not unusual to find the intestines matted 

 together in the pelvis, the omentum adherent to the colon, and the 

 colon to the bladder, etc. On opening such a colon it will be found 



