PART II. CHARACTERS AND DIAGNOSIS 45 



passage of blood and mucus. The first stool examined consisted of 

 two parts, a faecal part and a patch of dark blood-stained mucus. 

 The former contained cysts of E. histolytica and free amoeba) of the 

 minuta type in large numbers, while the mucus contained many 

 large active amoebae, some of which had ingested red blood 

 corpuscles. The patient was evidently a carrier of E. histolytica 

 relapsing into an attack of acute dysentery. It must also be 

 remembered that any E. histolytica carrier case may suffer from 

 bacillary dysentery though it is very doubtful if in such cases the 

 arnoebse which would be of the minuta form would contain red 

 blood corpuscles. Cysts would only be found at the beginning of 

 such an attack when some faecal matter was still present and 

 probably the flushing action of the dysenteric process would get 

 rid of most of the free amoebae as well. 



Case Morgan affords an illustration of a case of this type. After 

 only fourteen days in Egypt the patient was taken acutely ill with 

 dysenteric symptoms. There was some fever and the clinical 

 picture was that of bacillary dysentery. Examination of the stool 

 showed the characteristic macroscopic appearance of the disease 

 while microscopically the abundance of pus, mononuclear and 

 macrophage cells, intermingled with red blood corpuscles, further 

 supported this view. In addition, however, the stool contained 

 free amoebae, none of which included red blood corpuscles, and a fair 

 number of cysts of E. histolytica. The amoebic infection had 

 probably been contracted in England, where the patient had served 

 for seven months as orderly in a dysentery hospital. The point of 

 interest is the cause of the attack of dysentery. Unfortunately, no 

 dysentery bacilli were isolated from the stool, but the clinical and 

 other features of the case leave little room for doubt that it was 

 actually one of this disease which was the prevailing type of 

 dysentery at that time. The microscopic appearance of the stool 

 corresponded with this view and the fact that the amoebae them- 

 selves did not contain red blood corpuscles and the presence of 

 cysts indicated that the amoebic infection was not of acute amoebic 

 dysentery type. We, therefore, feel justified in describing the case 

 as one of bacillary dysentery in a man who was acting as a carrier 

 of E. histolytica. 



Another case of this type deserves mention. The patient 

 (Gundry) was admitted for dysentery and the microscopic examina- 

 tion of the stool showed the characteristic exudate of bacillary 

 dysentery. The case was reported as probably one of bacillary 

 dysentery in spite of the fact that fairly active amoebae, none of 



