422 P.OWMAN. 



general peritonitis and death. ^ This case, however, never reached the 

 stage of advanced general peritonitis, for at the time of perforation 

 there occurred a severe haemorrhage, the patient losing a liter or more 

 of blood, and this, with the shock of the perforation, in his weakened 

 condition caused almost immediate death. 



In 1904, Strong* collected from the literature all the cases of Bq,lan- 

 lidium coli infection {127 in number) repoi'ted up to that tiiiK'. In 

 two of these cases death occurred from general peritonitis. 



The presence of Balantidium coli in the mesenteiic lymph glands in 

 the second case reported in the present paper is peculiar to this case 

 and has not been described before. 



In Doctor Strong's series none of the cases showed abscess of the 

 liver and only in one was the parasite reported as present in the sputum 

 from a case with an indefinite diagnosis of abscess of the lung. The 

 parasites are very frequently situated in the lymph spaces and in the 

 blood vessels of the submucosa, but they do not appear to have caused 

 inflammatory conditions elsewhere in the body. As has been stated, 

 some of the mesocolic lymph glands in the second case showed areas of 

 inflammatory change and of necrosis. On account of the size of the 

 Balantidium coli wherever the parasite enters, the intestinal bacteria 

 would also have an opportunity of entering and of causing inflammatory 

 changes. However, bacteria were not definitely discovered in sec- 

 tions of these glands. In this connection it is interesting to note that 

 Glaessner ' in extracts of Balantidium coli in the fseces was able to 

 demonstrate a very active diastase and a fairly strong haemolytic sub- 

 stance, although the extracts were inert with respect to dilute allnimen, 

 peptone solution and to fibrin. 



CONCLUSIONS. 



T. The intestinal lesions in both of these cases seem to have been 

 caused by Balantidium coli. 



II. Death may result from perforation in severe Balantidium coli 

 ulceration. 



III. The presence of the parasite is not always limited to the walls of 

 the intestine. The organism may invade the mesocolic intestinal lym- 

 phatic glands. 



^ Both specimens of the intestine from which these illustrations were prepared 

 are at present in the museum of the Biological Laboratory of this Bureau. 

 *Pm&. p. I. Bur. ScL, Biolog. Lah. (1904), No. 26, 1-77. 

 ' Centrum, f. Bad. Orig. (1909), 47, 3.51. 



