F. W. O’Connor 
243 
dysentery, a positive diagnosis of bacillary dysentery from the microscopical 
appearance of the cell-element alone can only be considered unscientific. 
Although in bacillary dysentery the cell element is generally greater in amount 
than is the case in the amoebic disease, yet this is not invariably the case 
(see Case H). 
In amoebic cases the microscopical findings vary according to the portion 
of the specimen examined. In blood and mucus, red blood corpuscles pre¬ 
dominate as a rule, although I have found amoebae containing these red cells 
moving in a medium of degenerated leucocytes and epithelial cells and when 
bacteriological control failed to reveal evidence of double infection. The 
amount of cell-exudate and its character bears some relation to the extent of 
bowel affected and to the acuteness of the particular attack. 
In Lamblia cases even when the free flagellate is present and is matted 
together in large numbers, the cell element is conspicuous by its absence. 
In the foul liquid motions following acute bacillary dysentery, leucocytes 
and epithelial cells in an advanced state of degeneration equivalent to pus, 
with little or no admixture of red cells, is a common feature. 
Cells are not generally found in the cases associated with fungi. 
AMOEBIC DYSENTERY. 
Observations on the parasite of this disease were made from examinations 
of 88 acute cases. Cases were considered acute when red blood cells were 
found within active amoebae. 
In none of the cases was the temperature raised above 99° F. Most of the 
cases gave a history of recurrent attacks of diarrhoea at long intervals dating 
back to the Gallipoli campaign. Five only could be said with reasonable 
certainty to have originated on the Sinai Desert. Cases showing rectal 
symptoms associated with tenesmus, pain, and tenderness in the region of the 
descending colon predominated over those complaining of griping before 
stool and tenderness in the caecal region. 
An account of one case will demonstrate the insidious onset and the sub¬ 
acute course of the disease, with mild symptoms which are sometimes out of 
all proportion to the wholesale destruction of large intestine which may be 
taking place. It will also clearly show the reason for some of the observations 
made in this paper: 
Case Pte. W. II. Admitted to Casualty Clearing Station in a state of collapse, 18. ix. 16. 
Past History. Patient never left England before the war, and gave no history of previous 
serious illness. He arrived in Egypt direct from home on January 19th, 1916. After spending 
two nights in Alexandria with his draft he proceeded to the Sinai Desert, where he had 
served since. 
History of Present Condition. Towards the end of April 1916 patient went sick, complain¬ 
ing of diarrhoea and abdominal pain, principally before defaecation, though tenesmus 
accompanied the act. He was treated in a Field Ambulance for a fortnight and then given 
light duty for a week. He then returned to full duty; from that time onwards he occasionally 
had two or three motions a day and latterly his comrades remarked that he was getting thin. 
