88 PROTOZOAN PARASITISM 



tine hydrochloride. One grain of the alkaloid is 

 given hypodermically in the morning and one-half 

 grain in a keratin coated tablet at night by mouth, 

 both every day for twelve consecutive days. James 

 and Decks (1924) recommend the use of emetine hy- 

 podermically with concurrent administration of bis- 

 muth by mouth. A routine in active amoebic colitis 

 is as follows : 



Give a preliminary dose of castor oil. Put the 

 patient to bed and limit the diet to liquids, prefera- 

 bly milk. If tenesmus and griping pains are severe 

 give a hypodermic of morphine and atrophine as in- 

 dicated. Emetine hydrochloride hypodermically in 

 1/2 grain doses twice daily or 1 grain doses daily for 

 9 to 10 days. Bismuth subnitrate, a heaping tea- 

 spoonful (180-200 grs.) is mechanically mixed in a 

 glass of water and taken every 3 to 4 hours. When 

 the stools begin to form the bismuth is decreased to 

 three times daily and a generous diet is gradually in- 

 stituted. 



Rectal irrigations of quinine, silver salts, iodine 

 and other agents are unnecessary, according to Decks, 

 as are surgical measures for irrigating purposes. 



These courses of treatment for active cases of 

 amoebiasis take into account the stubborn nature of 

 the infection and, particularly that of James and 

 Decks, the pathologic state of the intestine. It is not 

 to be expected that the intestinal ulcers are to be 

 healed in the periods of time covered by these thera- 

 peutic courses. One has only to picture the condition 



