244 
intestinal Protozoa of Man 
He did not report sick and took his place on the march with the other men. For three weeks 
before admission, becoming weak, he was posted to duty as batman. Motions had now 
become numerous but he continued on duty. Three days before admission he had to fall 
out on the march through weakness and diarrhoea and he then noticed some blood in his 
motions. He was treated for two days at the Regimental Aid Post and then, as he was 
becoming steadily weaker, he was admitted to the Casualty Clearing Station. 
Condition on Admission. Patient was in a very much collapsed condition. Face thin 
and shrunken. Tongue coated and dry. Pulse rapid and easily compressible. Temperature 
97° F. Abdomen hard and movements restricted; generally tender and resistant to palpa¬ 
tion. The liver dulness was not increased. Ten to twelve motions occurred daily, the 
material passed being thin and watery with flakes of mucus and epithelial tissue and 
sometimes a little blood in streaks. The general condition suggested cholera, and a specimen 
was sent to the laboratory for examination. Owing to the long distance between the 
Casualty Clearing Station and the laboratory the specimen did not arrive for 15 hours. 
Microscopical Examination. Large numbers of degenerated leucocytes and epithelial 
cells, and other large cells which might have been either amoebae or tissue cells were seen. 
No definite amoebae were observed. In these circumstances, and as the comma bacillus 
was not isolated, a provisional diagnosis of bacillary dysentery was given, and a request 
for an early and fresher specimen was made. The patient, however, rapidly sank and died 
next morning. A partial autopsy was made, and the liver, spleen and the large intestine 
were sent by horse to the laboratory. The tissues, which were still warm on arrival, w r ere 
examined by Major A. R. Ferguson, R.A.M.C., and myself. 
The liver was engorged and on section dark, sanguineous fluid flowed out; its texture 
was soft; it was not much enlarged. No abscesses were found. 
The spleen was slightly enlarged and congested. 
The large intestine. From the ileo-caecal valve to just above the anal canal the intestine 
was in a state of advanced ulceration. Only two islands of apparently healthy tissue, each 
about the size of a five-shilling piece, were left: The epithelial lining was almost completely 
destroyed. In many places the submucous coat was extensively ulcerated; in one spot a 
perforation of the peritoneum was seen, but this probably occurred during post mortem 
manipulation as there was no evidence of general peritonitis. The attached mesenteric 
glands were matted together, enlarged and hard, but suppuration had not taken place. 
Material was examined microscopically from the bases of some of the ulcers. Considerable 
numbers of large phagocytic amoebae were found, many of them containing red blood cells. 
The movements of these amoebae were sluggish and consisted in the protrusion of long 
fine tapering processes (Text-fig. 1). This kind of movement was evident in some sixty 
individuals examined, and differed markedly from the sudden bursting and rolling move¬ 
ments seen in amoebae passed in the stools of patients suffering from the disease. The 
nucleus was in every instance E. histolytica in type. Although several experimental cultures 
were made, both from the specimen of the stool and from the tissue sent after death, no 
specific bacillary infection was discovered. 
The following points are worth noting in this case: 
1. The very insidious onset and the subacute course of the disease. 
2. The extensive destruction of large intestine co-existent with the 
patient’s ability and willingness to carry on his duties, always especially 
strenuous on the desert. 
3. The almost sudden collapse which preceded the fatal termination of 
the disease, suggesting the possibility of cholera. 
