214 RESEARCH IN PROTOZOOLOGY 



his descriptions are based on the study of tissues fixed and stained 

 by approved methods, they form a good foundation for the study 

 of the appearances seen in the bowel discharges. 



SUGGESTIONS FOR THE STUDY OF UNSOLVED PROBLEMS IN DIAGNOSIS 



The foregoing comprises a brief review of what the writer 

 considers to be the outstanding problems in the laboratory diag- 

 nosis of dysentery. With settlement of the etiology of amoebic, 

 balantidial and bacillary dysenteries, attention is becoming focused 

 on the more obscure aspects of the general problem, which conse- 

 quently begin to emerge as essential features of the broader pic- 

 ture. We shall now proceed to an equally brief consideration of 

 viewpoint and method involved in their possible solution. Con- 

 sidering only the work that has led us astray and raised false 

 problems, it would seem that in the past too much solitary, non- 

 correlated work has been undertaken. Moreover, there has been 

 lack of attention to many of the less obtrusive details which were 

 submerged during the developmental period of the work on dysen- 

 tery. Accordingly, the investigator who wishes to inquire into any 

 of the conditions we have been discussing will, if he would make 

 his study effective, establish an entente with capable (and, I might 

 add, interested) clinicians. He also will seek the cooperation of 

 men in pathology and bacteriology on whose knowledge and inter- 

 est he can rely. 



The selection of clinical material upon which to base a series of 

 studies of any of these problems should be made with the most 

 scrupulous care and thoroughness. Failure to do this may under- 

 mine the whole project. If the problem at hand seems to have 

 many ramifications, it will be well to be persuaded in the beginning 

 that all of them must be thoroughly explored. Of course, it may 

 take years to do this which, unfortunately, is not in harmony 

 with the prevailing ambition to achieve quick results and early 

 publication. 



The first essential is a thorough and searching physical examina- 

 tion and a careful inquiry into the medical history of the subjects. 

 Particular attention must be paid to the anal and rectal regions 

 and the abdominal wall should be carefully palpated with a view 

 to discovering regions of tenderness and other abnormalities. In 

 work of this kind it often is necessary to make inquiries of other 

 institutions and former medical attendants. However, data secured 



