148 BOWMAN. 



thready, although regular. The apical impulse is normally situated and the 

 heart is not enlarged. Pulse rate, 95 per minute. 



Breathing is rapid; vocal fremitus somewhat intensified in the base of the 

 left lung, and this area is also somewhat dull on percussion. In the bases of 

 both lungs and up toward the axillae, coarse rales may be heard and also an occa- 

 sional friction rub. 



The spleen can not be palpated. The liver is normal in size. The abdomen 

 is slightly prominent and this is particularly apparent in the left flank, where 

 there is distinct bulging. The entire abdomen is tender on palpation, but this 

 is particularly noticeable in the colon area on both sides and in the epigastrium. 

 There is great general muscular weakness. The patient lies for the greater part 

 of the time with the legs flexed. 



The bowels move frequently and the motion is accompanied by tenesmus. 

 The stool is very thin and sanguineous. During the past week there has been 

 much blood present, more than at any time during the course of the illness. 



Microscopic examination of the fseces shows many balantidia present (30 

 or 40 in one cover-glass specimen) also much blood and mucus. 



Blood examination. — The blood is very pale and coagulates slowly. Haemog- 

 lobin, 70 per cent; white blood cells, 4,000. Differential counts show no eosi- 

 nophilia to be present and the blood picture is practically normal. Urine, some 

 albumin and a few casts present. 



August 31: The patient is much weaker and can not be roused. Heart very 

 feeble. He is still hiccoughing. The abdomen is very tender, but no other signs 

 of peritonitis are observed. 



The patient died on September 1 at 4.45 a. m. Many methods of treatment 

 were used without any definite effect being produced. Enemata of quinine, silver 

 nitrate and thymol were given, also ipecac by mouth in large doses. 



Protozoa other than Balantidium coli were never found during the course of 

 the disease, although the faeces were examined daily. The autopsy was performed 

 by me four hours after death. 



The protocol follows: 



Autopsy. — The body is that of a well-nourished Filipino. Rigor mortis is 

 present. The pupils are equal and dilated. The superficial glands are not pal- 

 pable. There is a fair amount of subcutaneous fat and the muscles of the abdomen 

 and chest are fairly well developed and of good color. 



On opening the thoracic cavity the sternum is raised with great difficulty 

 because of fibrous adhesions. The pericardial cavity contains a fair amount of 

 straw-colored fluid. Some fibrous bands may be seen between the visceral and 

 parietal pericardium toward the apex of the heart. A few "milky patches'' 

 occur on the anterior portion of the heart, some having tags of tissue attached 

 to them. 



A layer of yellow fat surrounds the heart. The coronary arteries are somewhat 

 hard and tortuous. On cut section, the heart muscle is of good color. The wall 

 of the right ventricle is thickened. The valves of the heart apparently are normal 

 with the exception of the mitral leaves, which are thickened and apparently 

 incompetent. 



The aorta is thickened near the ventricle and is only slightly elastic. 



The lungs, both right and left, are firmly attached throughout to the chest 

 wall by fibrous adhesions and can only be removed by rupturing the lung tissue. 



Both lungs are crepitant in parts, less so in the apices than in the bases. On 



