66 HUMAN INTESTINAL PROTOZOA IN THE NEAR EAST 



were found. The stool was examined on two other occasions with 

 a similar result. The bacteriological examination was also negative. 

 It was assumed to be a case of bacillary dysentery, and as the 

 diarrhoea continued with the passage of blood and pus cells the 

 case was treated with repeated injections of serum. An irregular 

 temperature developed and the patient eventually died. At the 

 post-mortem the upper part of the large intestine showed extensive 

 amoebic ulceration while the lower half was denuded of mucous 

 membrane, save for a few scattered islets here and there. There 

 was also a large abscess of the right lobe of the liver, which formed 

 a mass adherent to lung and diaphragm. Examination of the liver 

 abscess pus showed numerous active E. histolytica, while scrapings 

 from the intestinal ulcers showed no amoebae at all. This case had 

 previously been treated with emetin, so that it is possible the 

 intestinal infection had vanished while the liver infection had 

 remained. The important point of the case is that the microscopic 

 examination of the stool on three occasions failed to give a diagnosis 

 of the true condition, which in this instance could only have been 

 arrived at by clinical methods. The bacteriological and proto- 

 zoological examination may give a definite and conclusive answer 

 in most cases, but the clinician must remember that he must help in 

 the diagnosis to some extent however empirical his methods may be. 



(6) Characters and Diagnosis of Unencysted E. coli. 



Our remarks as to the difficulty of identifying the free unen- 

 cysted forms of E. histolytica apply equally to E. coli. There is a 

 type of amoeba which one sees in non-dysenteric cases which can 

 almost certainly be recognized as E. coli without the presence of 

 the eight nuclear cysts. These are amoebae with a thin rim of pale 

 not highly refractile ectoplasm enclosing an endoplasm which is 

 much vacuolated and which contains bacteria, bacilli, yeasts and 

 other objects, while the rather large nucleus, distinct because of 

 the coarse granules of chromatin on its membrane, can be clearly 

 distinguished. These amoebae move sluggishly as a rule and throw 

 out pale non-refractile pseudopodia. E. coli, however, frequently 

 departs from this type, and as already mentioned we have seen 

 E. coli moving as actively as any E. histolytica does. The character 

 of the amoebae changes also, so that they may resemble certain 

 forms of E. histolytica structurally, and it is possible this change in 

 appearance is dependent in some way upon the character of the 

 stool. E. coli in a dysenteric or a diarrhceic stool never has the same 

 appearance as when it occurs in a normal stool. 



