162 The Philippine Journal of Science 1917 



subnormal to above normal. The absence of eosinophilia in both 

 of these cases seems to support the belief that eosinophiles may or 

 may not be, found in all intestinal disturbances. Since the ba- 

 lantidia are found penetrating both the mucosa and submucosa 

 without any surrounding cellular infiltration, it may be safely 

 concluded that they are capable of penetrating apparently healthy 

 mucosa. Here they may produce sterile abscesses which may 

 in time become secondarily infected by the rupture of the mu- 

 cosa covering them and thus form ulcers. Macroscopically the 

 lesions produced by Balantidium coli cannot be differentiated 

 from those of Entamoeba histolytica. Microscopically the lesions 

 show a similar cellular reaction, but are easily differentiated 

 by finding the organisms. Many of the balantidia examined in 

 the wall of the colon did not show the typical nuclei, but con^ 

 tained numerous small masses of nuclear-staining material, which 

 resemble chromidia formation, while those examined on the 

 surface of the mucosa show the typical nuclear structures. 



As suggested by Dr. B. C. Crowell, the question of the essen- 

 tial pathogenicity of balantidia is an important one, and one 

 which cannot yet be considered to be absolutely settled. It is 

 necessary to determine the invasive powers of the balantidia, 

 that is, whether they may or may not of themselves penetrate 

 the intact mucosa, and if so, whether they pass through the 

 epithelial cells or between the cells. Reasoning from analogy 

 with known facts concerning the action of entamoebse, and from 

 the known tissue changes described in balantidiasis, it seems 

 necessary to believe that these organisms are essentially patho- 

 genic and that their action is in all ways similar to the action 

 of the entamoebae. Doctor Crowell expressed the theory that 

 it seems reasonable to conclude that some substance (toxin?) 

 originating from the balantidia is able to produce necrosis of 

 the tissues, and the inflammatory phenomena that occur later 

 are the result of the action of the accompanying bacteria. Also 

 that one could imagine that this hypothetical toxic substance 

 from the balantidia produces a cytolysis of the epithelial cells 

 of the mucosa with which they come in contact and so forms 

 a portal of entrance to the deeper tissues for the organisms. 



SUMMARY 



1. Two cases of balantidiiasis with clinical histories and 

 autopsy reports have been added to the five previously published 

 autopsy cases from the Philippines. 



2. In one case there was a history of dysentery for approx- 

 imately two months before death; in the other the intestinal 



