DYSENTERY CAUSED BY BALANTIDIUM COLI. 149 



cut section the lung appears mottled with dark red areas surrounding the bron- 

 chioles and from these areas bloody serum may be expressed and from the 

 bronchioles a creamy fluid. No nodules or calcified areas can be found. The 

 bronchial glands are not enlarged. 



The peritoneum is distinctly thickened and is not glistening. Scattered over 

 the surface are grayish-white patches. 



The spleen is normal in size. The capsule is thickened and fibrous bands of 

 connective tissue attach the spleen to the colon and posteriorly to the abdominal 

 wall. On passing the hand over the spleen surface numerous nodules may be 

 felt from 1 to 3 centimeters in diameter. These project somewhat from the 

 surface. On section, the pulp is friable and congested. The Malpighian bodies 

 are indistinct. The nodular areas extend into the pulp for a distance ap- 

 proximately the same as their diameter on the surface. When a nodule is 

 sectioned the tissue bulges out and is bright red in color. Fibrous bands extend 

 in different directions through the spleen pulp. 



The mesentery is greatly thickened. The mesenteric glands are not enlarged 

 but many of them show some injection. 



The liver is somewhat enlarged and firmly attached to the diaphragm above 

 by fibrous bands, and is adherent below to the gut. Cross section shows a loss 

 of normal structure with areas of congestion scattered here and there. 



T\ie gall bladder is normal and the duct is patent. 



The pancreas appears somewhat smaller than normal and is firmly adherent 

 to the adjacent viscera. The capsules of the kidneys strip with difiiculty. The 

 striations are irregular and the kidney substance pale. 



The stomach appears to be normal, also the duodeniun and small intestine. 

 The colon (see PI. I) in its entirety is one mass of ulcers from which hang tags 

 of necrotic tissue. The description given in the previous report ' exactly covers 

 the condition here present. The ulceration in this case is rather more general 

 than in the one reported before, but perforation . has not taken place. The 

 ulceration is much more severe near the rectum, it gradually becomes less so 

 toward the caecum and in general appears very much like an amoebic infection. 



The uiinary bladder apparently is normal. Scrapings from the intestinal 

 ulcers show numerous Balantidium colt but no other animal organisms; those 

 from the nodules in the spleen, from the wall of the urinary bladder, and from 

 areas of pleuritis were negative. 



Anatomic diagnosis. — ^Broncho-pneumonia ; chronic adhesive pleuritis; chronic 

 adhesive pericarditis; splenic infarction; chronic nephritis; chronic adhesive 

 peritonitis; chronic ulcerative colitis (Balantidium coli) ; perihepatitis; mitral 

 endocarditis ; arteriosclerosis. 



Histologic examination. — The histologic examination of all the tissues will not 

 be given, special reference being made only to those organs which were found 

 interesting pathologically. 



Spleen: — ^Appears normal in parts, but other areas show severe haemorrhage, 

 the sinuses being crowded with blood cells and the normal splenic structure 

 indistinct. Filarial embryos may be seen here and there. lying close together in 

 the sinuses in groups of two or three. (See PI. II, fig. 3.) These are much 

 more numerous near the center of the haemorrhagic areas, gradually decreasing 

 in nmnbers until the normal spleen tissue is reached. 



Colon. — Examination of one of the ulcers of the colon shows some balantidia 



' '. • Loc. cit. 

 101801 4 



