and bind it to neighbouring organs. Dilatation above the seat of cicatricial stricture is liable to ensue. In chronic dysentery large patches of the bowel, and even the ulcers themselves, may be pale and anæmic, whilst at the same time other patches of the gut are congested. Some parts may be thickened and contracted; others, again, may be thinned and dilated, the glandular structures being atrophied. Lesions of the appendix are often found in amœbic dysentery. Symptoms of appendicitis occurring in countries where appendicitis and consequently appendicectomy are common should incite the tropical practitioner to examine the stools for amœbæ and to apply the appropriate treatment.
Polypoid growth.— Some time ago I attended a case of chronic relapsing dysentery in which the mucous membrane, at all events of the rectum and descending colon, was covered with enormous numbers of polypoid growths of considerable magnitude, some of them at their free ends being as large as the tip of the little finger. The growths had pedicles 1-2 in. in length. During life these polypoid bodies appeared in the stools, often in great number, looking like so many mucilaginous seeds. Similar cases are occasionally met with.
Liver; mesenteric glands.— In by far the majority of cases of acute dysentery the liver is hyperæmic and swollen. In about one-fifth of the cases of Indian dysentery which come to the post-mortem table the liver is the seat of single or multiple abscesses. In chronic dysentery this organ may be atrophied; very generally it is the subject of fatty degeneration.
In acute cases the mesenteric glands are enlarged, soft and congested, or even hæmorrhagic; in chronic cases they are enlarged, hard, and pale. None of the other viscera is characteristically affected. Abscess is sometimes discovered about the rectum. If perforation has occurred, there may be signs of commencing peritonitis.
Etiology.— From a study of the natural history of the various types of the disease we are forced to the conclusion that at least three factors are concerned in the production of the clinical condition called dysentery, namely, (1) influences that weaken the natural
