418 BOWMAN. 



diai-i-hcea continued, the patient died. The following brief extracts are 

 taken from the protocol : 



Cause of death: Chronic endocarditis and acute purulent pericarditis. 

 Siaphylococciis auretis was isolated from the purulent exudate. The 

 lungs show a number of areas of broncho-pneumonia. The intestine 

 appears normal until the caecum and colon are reached. Very numerous 

 small erosions and ulcers may be observed in the mucosa scattered 

 throughout almost the entire length of the large intestine, but more 

 marked in the region of the caecum and ascending colon. These appear 

 to be of recent origin; none of them measure more than 1.0 centimeter 

 in diameter. Their situation seems to bear no relation to the mesenteric 

 attachment. They are more or less irregular in outline. Some are 

 slightly nndei-mined. There is little indication of acute inflammatory 

 change about their bases or margins which are only slightly reddened. 

 Many are merely erosions extending in depth scarcely through the 

 mucosa; othel's apparently extend into the submucosa. 



Scrapings from these lesions examined microscopically show the 

 presence of the Balantidium coli in large numbers. No other protozoa 

 such as amosbw or flagellata were present. 



The histological examination of sections of these ulcers showed the 

 organisms lying free on the surfaces of the ulcers and invading the 

 adjacent mucosa and muscularis mucosa, and occasionally reaching to 

 the submiicosa, where in a few instances they were observed within the 

 blood vessels. The parasites were sometimes found in the submucosa at 

 considerable distances from the ulcerations, and spaces and sinuses were 

 seen in the tissue which had apparently been made by the passage of 

 the parasites through it. 



This ease is evidently worthy of report for the reason that it has 

 furnished information regarding the production of the very early in- 

 testinal lesions caused by this parasite. As Strong has pointed out in 

 his earlier studies.^ 



"Whether Balantidium coli is capable of producing a primaiy erosion in the 

 intestine has not been conclusively demonstrated. However, if such erosion of 

 the mucosa exists from any cause, the parasite is certainly capable of continuing 

 the process and of modifying and producing in connection with the bacteria which 

 accompany it more or less characteristic pathologic lesions." 



A study of the sections from these early ulcerations gives undoubted 

 proof of this latter fact and from the spaces and sinuses left in the 

 trail of this parasite in the submucosa, its mechanical injury to tlie 

 tissue may be observed. 



This ease also conclusively demonstrates the fact that the Balanti- 

 dium coli is not merely a secondary invader of chronic idcerations which 



-Pvl. P. I. livr. Sci., Biolog. Lah. (1904), No. 26, 1-77. 



