OF THE ALIMENTARY TRACT 75 



Although attacks of diarrhoea or even dysentery, 

 alternating with periods of constipation, may be dis- 

 covered in the personal history, they may not be 

 more conspicuous than in other people of similar ail- 

 ments. Constipation appears to be the rule of the 

 intestinal dysfunctions. \^ague abdominal pains, 

 heaviness, minor tenderness over the colon, especially 

 the caecum, flatulence, gaseous eructation, are the 

 common abdominal complaints. Generally there is a 

 condition of under weight, a ''tired feeling", a lack 

 of energy. There are headaches and possibly joint 

 aches. The state of ''neurasthenia" is the type, with 

 subnormal temperature, low tension, cardiac irregu- 

 larity, etc. 



All of which furnishes a picture which is very com- 

 mon to the practicing physician. 



The state is thought to be one of "toxemia" and 

 Craig's complement fixation is an evidence of hu- 

 moral absorption and antibody production. 



Diagnosis is to be made by finding the amoeba in 

 the stool, possibly only by repeated examination. 



The pathologic state in this condition is supposed 

 to be that of the small mucosal ulcer previously de- 

 scribed. It appears that these ulcers may be only 

 of microscopic proportions or, at least, barely visible 

 on careful search. Presumably they develop slowly, 

 heal, and develop elsewhere. These flask shaped 

 ulcers may have the neck occluded by debris or mucus 

 and may appear as yellowish nodules in the mucosa. 



James thinks there is also a shallow surface ulcera- 



