Page:Tropical Diseases.djvu/543

XXIX] red hæmorrhages with irregular margins, measuring from 2 to 4 mm. in diameter, or even more. The solitary follicles are generally swollen and raised, and of a bright-red colour. Here and there, scattered among them, bright-red, sharply circumscribed, small purpuric spots may appear. Occasionally the background of the intestine may be described as though covered with a bright-red eruption, but with darker-red hæmorrhagic points scattered over this background. In the acute cases no definite ulceration takes place, but only a superficial coagulation necrosis of the mucosa." The lower end of the ileum may be similarly affected. Mott's description of the lesions in the fulminating form of asylum dysentery, as it occurs in England, agrees practically with the foregoing. He adds: "Acute fatal cases of a little longer duration show the same swelling, but now frequently the mucous lining, although swollen, presents a pale-grey or dirty whitish-grey appearance; the surface is sometimes finely or coarsely granular. This is owing to stasis in the vessels of the submucosa and necrosis of the epithelium, and the formation of a, false membrane, consisting for the most part of leucocytes and disintegrating epithelial cells."

The primary lesion.— Such, briefly, are descriptions of the principal lesions found in the acute stage of fatal dysenteries. There is general agreement among pathologists about these; but there is very great discrepancy of opinion as to the exact nature of the primary and essential lesions. Some maintain that the starting-point of the disease is in the solitary follicles, which, becoming distended by a specific exudation, afterwards slough, and form the starting-point for a spreading ulcer. Other pathologists regard the primary lesion as being altogether independent of the glandular structures of the mucous membrane. They hold that, in consequence of the irritation produced by the specific cause of dysentery, an exudation is thrown out on to and into the mucous membrane itself: a slough is formed of this, the implicated piece of tissue being subsequently got rid of, very much in the same way