230 MTJSGRAVE. 



Many more could be added to this group of cases in which diarrhoea 

 developed only a few days before death, and then this symptom was often 

 due to intercurrent disease, such as cholera, which caused the exitus. 

 Still another group which might well be classed here includes those 

 patients in which diarrhcea or clinical dysentery developed a few days 

 before death and in which, at autopsy, advanced amoebic lesions were 

 found. However, as these cases did show some symptoms of diarrhcea, 

 they are not here considered. In the 50 instances which form the 

 subject of this paper, looseness of the bowels, except from cathartic 

 medicine, was not at any time a symptom. Indeed, in several constipa- 

 tion was a noticeable and constant feature of the disease up to the time 

 of death. 



Pathology. — Characteristic amoebic lesions were present at autopsy in 

 all of the 50 cases. These lesions varied in type from those which 

 were just beginning to those showing ulcers having the characteristic 

 extensive destruction of the mucous membrane of the bowel so often seen 

 in cases of amcebiasis of long standing. The lesions were distributed as 

 follows : 



Not recorded, 5 cases ; confined to ca?cum and ascending colon ( including 3 

 of the appendix), 27; entire large bowel (except sigmoid and rectum), 9; rectum, 

 0; descending colon and sigmoid flexure (alone), 2; transverse colon (including 

 splenic flexure), 2; ciecum, hepatic and splenic flexures, 5. 



Other parasites, such as monads, trichuris, hookworms and asearis 

 were present in several of these patients; the lesions of other diseases 

 have been mentioned above. The duration of the infection, judging from 

 the autopsy findings, varied, but in most instances the lesions indicated 

 processes of long standing. 



Symptoms. — The occurrence of general symptoms in these patients 

 varied considerably, and if we except those due to the intercurrent disease 

 were entirely absent in some of them. In others there were present one 

 or more clinical manifestations which I have described elsewhere as 

 occurring in latent and masked types of amoebic dysentery. While none 

 of these symptoms may be said to be pathognomonic of amoebic infection, 

 yet when several are present in the same patient, in the absence of any 

 other satisfactory cause, they are strongly suggestive of amoebic infection, 

 especially in zones where this disease is endemic. 



Abdominal "aching," usually more or less general, worse at night and 

 early in the morning, and often accompanied by flatulence and occasion- 

 ally by constipation, is one of the most frequent of the symptoms, but 

 unfortunately this is extremely common among a large class of patients 

 with mild forms of indigestion who are not suffering from amoebic in- 

 fection. Distension of the abdomen and the discomforts of flatulence 

 are of frequent occurrence. Constipation is a particularly common 

 complaint. In this class of patients the lack of result from ordinary 



