XII, B, 3 Manlove: Balantidial Colitis 161 



places. The liver cuts readily, showing a smooth, moist, glisten- 

 ing surface, which has a reddish brown mottled appearance. 

 The lobules are plainly visible and show a reddish center and 

 a pale periphery. The bile ducts are surrounded in places with 

 considerable fibrous tissue, and they have a yellowish tinge 

 throughout. The common bile duct measures about 1 centi- 

 meter in diameter and contains four or five dead ascarides. 



The gall bladder was removed intact for bacteriological ex- 

 amination. 



Histologically the changes in the colon are confined to the 

 mucosa. The mucosa shows catarrhal inflammation and some 

 desquamation of the superficial epithelium, and the tubules are 

 filled with mucus. The mucosa is frequently folded in such a 

 manner that the shape of an ulcer is produced with undermined 

 edges. These areas are completely lined with epithelium, but 

 may contain fsecal material within which balantidia are embedded. 

 The balantidia are found only on the surface of the mucosa, 

 where they are embedded in faecal material. The tumor in the 

 moiith proved to be an epithelioma. 



Summary of second case.— A 51-year-old Filipina was under 

 observation about seven weeks. She sought hospital treatment 

 on account of epithelioma of the cheek and a mixed parotid 

 tumor. Weakness was a marked symptom. She was consti- 

 pated until ten days before death, when intermittent attacks 

 of diarrhoea occurred. She was emaciated and had no appe- 

 tite, and there were subnormal temperature, normal pulse, nor- 

 mal respiration, and albuminuria. The intestinal condition only 

 assumed importance after examination of the faeces and the 

 finding of balantidia. Autopsy showed a colitis as a complica- 

 tion of the other more important disease. 



DISCUSSION 



In the first case I was particularly careful to exclude the 

 possibility of balantidiasis of the left lung and pleural sac. It 

 is of interest to note that cultures made from the pleural sac 

 remained sterile. The histological examination of the lung and 

 pus did not reveal any balantidia. In view of the fact that the 

 sections of colon show balantidia in blood vessels, there must 

 be a continual entrance of balantidia into the general circulation. 

 However, it is rare to find them producing lesions outside of the 

 intestines, although they have been reported in sputum from a case 

 of supposed lung involvement. In my cases the physical findings 

 cannot be said to be distinctive of balantidiasis. The tempera- 

 ture was one of the most variable features, as it fluctuated from 



