454 The Philippine Journal of Science 1921 
to feel better, and his color and general appearance showed im- 
provement. He had gained no weight. 
I saw the patient for the last time on the night of April 10, 
at which time he furnished me another stool specimen. This 
was a seemingly normal, formed stool, light yellow in color. 
Examination of it on the following morning showed. that he still 
retained his infection, for a few cysts in the sporoblast stage 
were found on examination of the first preparation. 
The following day the patient sailed for the United States. 
His condition had improved, and he stated that he felt much 
better. I referred him to Prof. Charles A. Kofoid, of the — 
University of California, in order that the state of his infection 
might be determined on his arrival in California. 
To summarize the clinical side of the case: 
It seems likely that the patient contracted his infection in 
the United States. The population of the camp at Nitro was 
such that it is not improbable that it may have numbered in- 
fected persons hailing either from the eastern Mediterranean 
zone or from the trenches in France. That is to say, the patient’s 
contacts in other places were much more unlikely to have been 
infected with Isospora. Moreover, during a residence of seven 
years in the Philippine Islands, I have studied thousands of 
stools of healthy persons and of persons suffering from intestinal 
disorders, who have hailed from nearly all portions of the 
Islands; and, until I ran across this case, I never encountered 
a case of human coccidiosis, notwithstanding I have had the 
possibility in mind ever since the first cases were reported 
abroad in 1915 and 1916. 
Apparently the onset of the trouble came about February 9. 
This would not necessarily mean that the patient must have 
contracted his infection only a short time previously. It is not 
improbable that some digestive disturbance may have occurred 
at this time, that was quite separate from the coccidial infection. 
With a light initial infection it is conceivable that a fairly long 
period might elapse before involvement of the intestinal mucosa 
became extensive. It is to be doubted if every merozoite dis- 
charged at schizogony finds its host cell. On the contrary, 4 
large proportion of them, particularly those formed in cells 
which do not lie deep in the crypts, must be caught in the flow 
of the intestinal contents and swept on to perish for lack of 
suitable food. This is probably just what happens in the early 
stages of the infection, and it is only later that the organisms 
work up into the crypts where they are more or less secure. 
