565 
Morbid anatomy.—The lesions of the amoebic process in the appendix 
resemble those found in the bowel, but they are usually smaller and more 
superficial. Microscopically, the same general picture including throm- 
bosis of the vessels, is seen. As in the colon, the ulcers are rarely along 
the meso-border but they sometimes may extend entirely around the 
mucosa. ‘The appendix is most often patulous, with a rather large lumen, 
and concretions are exceptional. External evidences of inflammation are 
not very marked; as a rule, they consist of moderate engorgement and 
injection of the vessels. 
Symptoms and diagnosis——There is not very. much to add to the 
general symptomatology as given in a previous communication. The 
clinical manifestations in general resemble those in appendicitis from 
other causes, but are as a rule less severe. There is less rigidity of the 
abdominal muscles, the tumor mass is not so sharply circumscribed, and 
the fever and general prostration are less marked. However, cases may 
be of a fulminating type and are then not to be distinguished clinically 
from other types of appendicitis, but then these, like very acute intestinal 
symptoms, are due more to secondary invaders than to the ameebic 
infection. Appendicitis, in no way caused by amoebe, may occur in a 
patient suffering from ameebic dysentery. The leucocyte count is not 
of as much value in ameebic appendicitis as it is in other types, because 
the intestinal infection plays too uncertain a part in the variation of 
the number of the white cells. The following pathologic changes found 
in intestinal ameebiasis may give clinical symptoms closely resembling 
appendicitis and must be taken into account in a consideration of the 
subject: 
(1) Severe amoebic infection of the colon or cecum and ascending 
colon. 
(2) Infection of the lower ileum with the caecum. . 
(3) Acute, localized peritonitis about the cecum, ascending colon, or 
hepatic flexure. 
(4) Periczecal ameebic abscesses. 
(5) Neuralgia, gaseous distention, and fecal accumulation in the 
caecum. 
(6) Acute catarrhal appendicitis. 
(7) Chronic recurrent appendicitis. 
(8) Chronic recurrent appendicitis with secondary amcebic infection. 
(9) Ameebic appendicitis. 
(10) Any combination of the above conditions. 
The first of these conditions is a very frequent one in Manila and super- 
ficially at least, it closely resembles appendicitis. The differentiation, 
however, is not, as a rule, difficult upon careful clinical examination by one 
familiar with all the conditions. The fever, leucocyte count, nausea, and 
® Loe. cit. 
