INTESTINAL AMCEBIASIS WITHOUT DIARRHOEA. 231 



doses of the usual cathartics may be brought to the attention of the 

 physician, or in other instances the action of these drugs may be un- 

 usually severe and prolonged. Loss of weight occasionally becomes a 

 noticeable sjonptom, but in many instances the nutrition remains good 

 and the patients may even increase in weight. Interference with the 

 appetite is usually first shown by lack of desire for breakfast and this 

 may be accomjDanied by morning nausea and the accumulation of con- 

 siderable mucus in the mouth and throat during the night. Active 

 indigestion or dyspepsia are not very common symptoms, but do occur 

 in a certain percentage of the cases. 



Excessive perspiration, particularly of the palmar and plantar sur- 

 faces, is very frequent, and in many instances the physician is first 

 consulted because of this complaint. The whole chain of symptoms of 

 so-called "Philippinitis" or tropical neurasthenia, characterized by dull- 

 ness, headache, loss of memory, weakness, desire for sleep, etc., is a 

 rather common condition encountered in these infections, but it is also 

 particularly prevalent in the absence of such parasitic invasion. 



Diagnosis. — When we come to study the clinical phenomena shown by 

 this class of cases, it is seen that there is nothing specific or definite in 

 any one, or in all the findings, except the one of the presence of amoeba; 

 in the stools. The patients are of the class sometimes reported as 

 "healthy people with amoebae in the stools," and, as alluded to in one 

 of my previous papers, it is erroneous to report all of such cases as being 

 healthy or as those "suffering from diseases other than dysentery." 



This brings us to the important point which of itself is sufficient 

 excuse for this paper, namely, How are we to diagnose amoebic infec- 

 tion of the bowel during life? Ten years' continuous experience with 

 this disease clinically, in the laboratory and at autopsy, has convinced 

 me that its diagnosis is not possible except through information secured 

 by a microscopic examination of the faeces. Looseness of the bowels in 

 the form of dysentery or diarrhoea has long been the strong diagnostic 

 point, but the facts show it also to be a very unreliable one. 



The sygmoidoscope gives valuable and positive evidence of infection 

 in patients with ulceration in the lower part of the bowel, but does not 

 furnish aid in the large percentage of early infections in which the 

 lesions are above the range of this instrument. As a result of careful 

 application of all known diagnostic methods in the infection we have 

 but one constant finding, and that is the presence of amoebae in the bowel 

 discharge. ,The question whether the presence of amoeba? in the stools 

 of patients should be considered sufficient evidence of infection for the 

 institution of treatment is still a disputed one. A number of authors 

 agree with the late Professor Schaudinn that there are two easily differ- 

 entiated species of amoebae encountered in stools, one a pathogenic parasite 

 and the other a harmless commensal. 



I have already discussed this subject fully in other publications. 



