3

    Emaciation.—In fairly advanced cases emaciation is generally present, and
in cases which are proceeding to a fatal termination it is usually extreme.

    Irregular pyrexia. —Fever of an irregular character, reaching to 103° F. or
104° F., or more and showing no definite periodicity, is almost constantly present.
In some cases it shows an undulant character, periods of high fever alternating
with periods in which the rises of temperature are not so high. The temperature
is not influenced by quinine.

    Abdominal symptoms.—Diarrhœa and a dysenteric condition with blood and
mucus in the stools are a constant feature in advanced cases. Death from
peritonitis due to perforation occurred in two out of the three fatal cases which
are referred to in this report. The fæces of two cases in which blood and
mucus were present in the stools were examined for amœbae without success.
The parasites were also searched for in the fæces of these cases but none were
found.

    Oedema of the feet is sometimes, but not constantly, present.

    Pigmentation of the skin is not usually in excess of the normal, and in
two cases seen by me in Eurasians with light skin there was no undue pigment-
ation of the skin or mucous membranes.

2. Post-mortem appearances.

These are as distinctive as the clinical signs. The following are the essen
tial points noted at the post-mortem examinations of three fatal cases :—

Autopsy No. 1.—A male patient. Age about 50. Death from purulent
         peritonitis. The abdominal cavity contained purulent fluid;
         omentum adherent to the intestines; patches of congestion and
         lymph exudation on the small intestine.

Spleen very large, length about 9 inches; of firm consistence and not
         pigmented.

Liver not enlarged; considerable change, which was visible to the
         naked eye, had taken place in the liver substance.

Small intestine.—Patches of congested mucous membrane covered with
         mucus containing worm-shaped clots were scattered over the
         gut. A fair number of anchylostomata were present.

Large intestine.—The mucous membrane was greatly thickened and
         markedly congested. Large ulcers, one of which had perforated
the gut, were present throughout the whole length of this por-
tion of the intestine.