1828 



THE DYSENTERIES 



probably by passing between the cells lining Lieberkuhn's follicles, 

 and then, entering the lymphatics, make their way through the 

 muscularis mucosae into the submucosa, where they live and feed 

 upon the tissue cells, red cells, and perhaps leucocytes. They, 

 however, invade not merely the tissue of the submucosa, but also 

 the radicles of the portal vein, and at times the branches of the 

 mesenteric arteries, in which they may cause thrombosis. From 

 the radicles of the portal vein they may be carried to the liver, and 

 cause hepatitis and hepatic abscess. 



In the submucosa they induce cellular and oedematous infiltra- 

 tions, which cause the mucosa to project in the form of small 

 elevations, which generally show a minute blackish point or slough 

 at the summit. This slough is cast off, and a small ulcer is formed, 

 which rapidly deepens until it extends into the submucosa. These 

 ulcers become infected with bacteria, and quickly extend by the joint 

 action of the bacteria and the amoebae, forming roundish or oval 

 ulcers with undermined edges; in the latter case the long axis of 

 the ulcer lies transverse to the direction of the bowel. These ulcers 

 may deepen until the muscular and the peritoneal coats are exposed, 

 and even perforated, which, of course, leads to peritonitis or abscess 

 formation, according to the position of the perforation. 



Amoebic dysentery would appear to undergo in many cases no 

 spontaneous cure, but may at times remain quiescent, forming a 

 type of latent amoebic dysentery, which may be found accidentally 

 while performing an autopsy. When the ulcers heal, which they 

 do by the formation of connective tissue, a distinct scar is formed, 

 which is often black in colour from the action of the sulphuretted 

 hydrogen of the bowel upon the iron of the blood. When cica- 

 trization takes place, the lumen of the bowel may be constricted, 

 causing stenosis and obstinate constipation. Peritonitic adhesions 

 are also very common, binding the large bowel to the viscera or 

 walls of the abdomen and pelvis. 



Sometimes, when the infection is severe, the bowel becomes 

 gangrenous; at other times the amoebae may be carried to the liver 

 or other parts of the body, and form abscesses, which, though most 

 commonly met with in the liver, may still occur in the spleen, the 

 salivary glands, and elsewhere. 



Morbid Anatomy. — Usually the body of a person dying from 

 amoebic dysentery is emaciated, and the abdomen is sunken. 

 Rigor mortis begins, and passes off early, and decomposition sets 

 in quickly. On opening the abdomen, it is noticed that the tissues 

 are dry, and that a peculiar odour is perceived; the omentum may 

 be normal or congested, and may or may not be adherent. The coils 

 of the small intestines are usually normal, but may be congested. 

 The large intestine is generally contracted and thickened, but may 

 be gangrenous in places or along its entire length. There may be 

 perforation and purulent peritonitis. The mesocolon may be 

 congested and oedematous, or thin and fibrous, and adhesions to 

 various organs may be noted. The mesocolic glands are usually 



