XII. B. 3 Manlove: BcUantidial Colitis 157 



in apposition to the ulcers is oedematous and slightly infiltrated, 

 while the serosa opposite the extensive ulcers is covered with 

 a fibrinohemorrhagic material, which shows some cellular in- 

 filtration. 



Balantidia are found within blood vessels of the muscle, also 

 in the subserous tissue, where they are both within blood vessels 

 and lying free. They are found in varying numbers in the 

 necrotic material covering the bases of the ulcers, where there 

 is cellular infiltration about them, while the organisms found 

 in the muscle and subserous tissue are free from any surround- 

 ing cellular infiltration. 



Summary of first case. — A 16-year-old Filipino was in hospital 

 for seven and a half days before death. He had bloody diarrhoea 

 for a few days two months before death, followed by intermittent 

 diarrhoea and constipation. There was a daily chill and fever 

 during the last month. For sixteen days before death there 

 were frequent bloody diarrhoea, moderate fever, abdominal pain, 

 and malaise. Physical examination one week before death 

 revealed emaciation, weakness, slight tachycardia, changes in 

 temperature varying from 36° to 38.5° C, albuminuria, and 

 slight leucocytosis. The faeces were thin, watery, and blood- 

 stained and contained at all times large numbers of balantidia, 

 blood cells, mucus, and ova of Trichuris. Autopsy revealed a 

 colitis with bronchopneumonia and degenerative lesions of the 

 viscera. 



CASE II 



History. — The second case was a Filipina, age 51 years, who 

 was first admitted to the hospital August 28, 1916, and a diag- 

 nosis was made of mixed tumor of the parotid and epithelioma 

 of the cheek. She was discharged September 1, 1916, as incur- 

 able. At this time there was no record of intestinal trouble. 

 The patient was again admitted to the hospital September 21, 

 1916, complaining that one week previously she had become too 

 weak to walk. She was very poorly nourished, with little or 

 no appetite, and was constipated. On the forehead were three 

 small superficial lacerated v»'ounds. On the left side of the neck 

 just below the ear was an irregular swelling with a sinus about 

 1 centimeter in diameter discharging a moderate amount of 

 pus. The left corner of the mouth was indurated, and this 

 induration was continuous with an induration and ulceration 

 on the inner surface of the cheek, the tongue, and the gums in 

 the region of the lower molars. On the right forearm just above 

 the wrist was an ulcer at the base of which the ulna was exposed. 

 On the buttocks there were numerous scars and one ulcer with 



