[ 43 ] 
as typical and in which the Amoebae are always to be found are mite 
to the large intestine which is usually involved in its whole extent but wit 
more advanced or extensive lesions in the caecum and sometimes in the 
^'"The^neral mucous membrane is little affected, but the ulcers are deep 
and have' 5 a yellow adherent slough attached and a surrounding intensely 
fn ec ed edge y The ulcers in the transverse colon are discrete and vary in 
size from iStle more than a pin point to one inch in diameter and a 
in various stages. In the caecum and sigmoid flexure several of these ulcer 
often coalesced that in these parts a large shaggy adherent sloughy suiface is 
presented The pus from these ulcers or sloughs is distinctly mucoid. T 
amoebae are found in this pus and in the sloughs, but most abundantly in 
crranillfTS from the floOI of the clbsCCSS. • i 
P Mixed cases occur in which the intervening mucous membrane is also 
ulcerated or intensely congested. Tubercular ulcers in cases of tuberculosis 
may also be met with in conjunction with this Amcebic fotm of dysen ery. 
In other cases in which Amoebae may or may not be f°" nd . f ° f °'^ 
nlrprs heal in o' ulcers and submucous abscesses m which the mucosa is 
undermined and more or less extensive collections o f Pus commumcatmo 
with the lumen of the intestine by a mere pm point occur. This pus usually, 
but by no means invariably, is free from Amoebae. Balantidium cob is 
sometimes met with in pus from such situations. . , 
Hepatic abscesses were found in i per cent, of the Chinese examined 
This proportion is about the same as in British Guiana. In each case 
ulceration of the colon, usually markedly of the Amoebic type, was present, 
and in all cases Amoebae were found both in the liver abscess and m the 
intestinal ulcers or their discharges. 
Another marked type of dysentery is the so-called diphtheritic form. 
In the pure cases of this type the disease is not limited to the large intestine 
but a variS>Slength of the ileum and rarely also of the jejunum is involved. 
The lesions iS the small intestine may simply lie extreme congestion 
most marked at the summits of the rugae. More common v in ® r , 
part of the ileum there is a granular adherent superficial slouch 
adherent to the summits of the ruga;. This condition may “tend up 
jejunum, but is always most marked in the last few inches of the ileum where 
the superficial slough may completely cover the mucous membrane. Beyers 
patches and the solitary glands are not swollen or specially in '° lverf - 
In the caecum the congestion is intense, the slough is deeper am 
forcible removal leaves an ulcerated surface. I he whole extent of the 
large intestine is usually involved, but towards the rectum at the time of 
death there may be ulceration and little of the sloughs are left. Nine 
cases were of this type uncomplicated by other lesions. 
In a typical case with these lesions Amoebae are not found, and 1 
most of the mixed cases in which this form of dysentery can still be 
recognised Amoeba; are absent, but the two types Amoebic and Dipthentic 
are occasionally present together. . . • , 
It is strictly speaking an Entero-Colitis, and though the lesions in the 
majority of cases are most marked in the caecum and large intestines in 
occasional rare cases the main seat of disease is in the lower part ot the 
ileum. 
