15ALANTIDIUM COLI INFECTION. 419 



owe their origin to other organisms, for example to tubercle bacilli or to 

 amoeba;. 



The early ulcerations of the intestine are shown in Plate I. 



Case II. — Male Filipino, who entered the tropical medical service 

 of Doctor Strong with the following complaint : Severe diarrhoea, fever, 

 cough^ general weakness. 



The patient on admission was in such a weak condition that all 

 questions as to previous history, illness, habits, etc., were answered very 

 unsatisfactorily. The following extracts are taken from the author's 

 clinical history : The patient is very pale and somewhat emaciated. 

 Glands of the groin somewhat enlarged, the other superficial lymphatic 

 structures normal. Muscular power greatly diminished. The tongue is 

 heavily furred and the breath is foul. He has no appetite. He ex- 

 pectorates large quantities of mucus semifluid sputum. 



The pulse is weak, varying from 120 to 150 per minute, the tension 

 is very low. On examination of the heart the apical impulse can not 

 be seen or felt. The precordial area is hyperresonant and the heart's 

 boundaries can not be sharply determined. On ausculation the heart 

 sounds are weak and distant, but clear. 



The respirations are shallow and rapid. Deep inspiration causes pain 

 on both sides of the chest. The thorax on both sides generally is 

 hyperresonant and on ausculation a few coarse rales may be heard at 

 the bases of both lungs posteriorly. 



The liver is not enlarged and the spleen can not be palpated. The 

 abdomen is tense, and pressure, particularly over the region of the 

 colon, causes severe pain. 



During the time he remained in the hospital, diarrhoea was present, 

 but at no time was it very acute; the number of bowel movements 

 varied usually between five and ten in twenty-four hours. The stools, 

 however, were always semifluid and contained much mucus and blood. 

 The latter occasionally was passed in the form of clots. The temperature 

 was usually normal in the morning, rising to 38° or 39° C. in the 

 evening. 



Twice during the course of his illness severe hsemorrhages from the 

 bowels occurred. Immediately after the second hemorrhage, the patient 

 sank into a state of collapse, and died shortly afterwards. 



Laboratory examinations: A blood smear showed no malaiial para- 

 sites and a Widal test and blood culture also proved negative. The 

 counts of the red blood corpuscles varied from 3,500.000 to 2.500,000. 

 The leucocytes averaged 9,500. A differential count showed a moderate 

 increase in the mononuclear elements and 8 per cent of eosinophiles. 



The sputum was negative for tubercle bacilli and for parasites. 



The microscopic examination of the fseces showed the presence of 

 the ova of Ascaris Inmbriroidcs, Uncinaria diiodcnalc and large numbers 



