availnliU' oiitsuk' of tlic iiativi' lialiitat of the tiou siiu-o thv 

 sap undoigoi's rapid fcriiu'iitatioii ami becomes very uiipalata 

 ble at ordinary temperatures. Kffort is being made to preserve 

 the material in a way whieli will jiermit of its transportation 

 and storage. Fiein, the proteolytic enzyme isolated from the 

 sap by Robbins. cannot be used safely in man because of its 

 marked jiroperty of digesting the mucosa of the gastro-intesti- 

 nal tract in the presence of abrasions. 



TKK.VTIIK.NT FOR STRONG YLOIBES STERCORjUjlS INFECTION' 



Kwa Tjaon Sioe (1928) and de Langen (1928) introduced 

 gentian violet for the treatment of infectious with this para- 

 site and the treatment was further developed by Faust (l!t30). 

 For adults, Faust recommends a dose of 1 grain (04 mgm.) 

 three times a day before meals over a period of 10% days or a 

 total dose of CO grains. For children, the drug ma.v be given 

 at the rate of 1/0 grain (10 mgm.) per day for each year 

 of apparent age or approximately V2 grain (32 mgm.) for each 

 3 years of apparent age, given over a similar period of time. 

 Gentian violet is procurable in % grain and 3/20 grain enteric- 

 coated or water soluble coated tablets. 



Some Sirongyloidcs cases are refractory to oral therapy with 

 gentian violet and for such cases Faust recommends the duo 

 deual intubation of 2."i cc. of a 1 percent solution of the dye. 

 The patient should remain quietly in bed after this treatment 

 as nausea and vomiting are apt to ensue. 



About one-third of the patients treated with gentian violet 

 experience reactions consisting of one or more of the follow- 

 ing symptoms: Nausea, vomiting, diarrhea, headache, dizziness 

 and abdominal pain. These reactions are usually not of a seri- 

 ous character and can be controlled by reducing the dosage 

 for a short time or discontinuing treatment for a day or two. 



Contraindications for gentian violet are not clearly defined 

 but as a precautionary measure the drug should not be given 

 to patients suffering from gastroenteritis, moderate to severe 

 cardiac, hepatic or renal disease and concomitant infections 

 with Asearis liimbricoidcs. Pregnant women are apt to be 

 markedly nauseated by the treatment. The consumption of 

 alcohol should be prohibited during the period of treatment. 



TREATMENT TOR ENTEROBIUS VERMICULARIS INFECTION 



The ease with which many individuals become constantly re- 

 infected with pinworms makes eradication of the parasite an 

 extremely difficult matter. The failure in many cases to achieve 

 control by the rigid application of hygienic measures calls 

 for supplementing such measures in most cases with suitable 

 therapeutic procedures. 



It is probable that man3' of the failures to control pinworm 

 infection are attendant on the fact that treatment is usually 

 administered only to those persons in the household who show 

 clinical symptoms. Frequently, other members of the family 

 may be infected without being aware of the fact. Under such 

 circumstances, these persons serve as reservoirs of infection 

 which is again acquired by the treated individuals. Wright and 

 Cram (1937) have emphasized tlu> importance of carr.ying out 

 adequate diagnostic tests on all members of a household and 

 treating all infected individuals simultaneously with the view 

 of eliminating at one time all sources of infection within tin- 

 home. 



The literature probably contains a greater array of drugs 

 recommended for the removal of pinworms than for any other 

 parasite. Single dose treatments are not well adapted for 

 combating this parasite. Tetrachlorethylene, probably the best 

 of these, is less than .50 percent effective. In general, better 

 results follow the employment of repeated doses of drugs over 

 a period of time sufficient to allow for desiccation of ova in 

 the patient's surroundings and thus reduce opportunities for 

 reinfection. 



Santonin in repeated doses as for Asearis has been used fre- 

 quently, although its efficacy is somewhat less than 50 percent. 

 Enemas, medicated or non-medicated, are of value particularly 

 in young children but they must be carried over a period of 

 time sufficient to care for the possibilities of reinfection. 



Brown (1932) obtained good results in a small series of pa- 

 tients with hexylresorcinol enemas administered at varying 

 intervals and supplemented by oral therapy with Caprokol 

 pills. Wright, Brady and Bozicevicli (1!I39) treated 27 patients 

 without oral therapy and found 18 negative on post-treatment 

 swabs, although some of the negative patients failed to fur- 

 nish an adequate number of such swabs. A preliminary soap- 

 suds enema was given at bedtime followed immediately after 

 its expulsion by an enema consisting of a 1:2000 solution of 

 hexylresorcinol in water. The above-mentioned workers found 

 that satisfactory results in most cases required the administra- 

 tion of at least 10 such enemas over a period of 3 weeks. No 

 doubt more consistent results would follow more prolonged 



treatment, it is possible that Caprokol orally once or twice- 

 during the jjcriod of treatment would add to the efficacy of 

 the regimen, although the preparation in single doses is not 

 effective in eradicating the worms. 



It would appear that the drug coming closest to fulfilling 

 the requirements for a satisfactory treatment for oxyuriasis is 

 gentian violet as reported by Wright, Brady and Bozicevich 

 (1938) and Wright and Brady (l!i40). These investigators 

 completed experimental treatment on 224 individuals, of whom 

 84 percent were negative for pinworm ova on 7 consecutive 

 daily anal swab examinations taken at various intervals after 

 the end of the treatment. 



The dosage for gentian violet is the same as that used for 

 the treatment of strongyloidosis. However, the regimen of 

 treatment is somewhat different, the patient being given the 

 drug over a period of 8 days, foUow-ed by a rest period of one 

 week and then another course of treatment for 8 days. The 

 contraindications and precautions are the same as those out 

 lined under therapy for strongyloidosis. 



Recently Manson Bahr (1940) reported good results in the 

 treatment of pinwoi-m infection with phenothiazine. Of 6 chil- 

 dren and 3 adults, clinical cures were said to have been ob- 

 tained in all cases, although 3 individuals required a second 

 course of treatment. The following dosage was recommended: 

 For children under 8 years of age, 2 grams daily'for 7 days; 

 for children under 4 years of age, one half of the above-men- 

 tioned dose; and for adults, 8 grams daily for at least 5 days. 

 In the cases in question, results of treatment were not checked 

 by swab technique or other methods to determine disappear- 

 ance of infection. Nothing is said in Manson-Bahr 's paper con- 

 cerning the dangers of blood dyscrasias from the use of pheno- 

 thiazine, although DeEds, Stockton and Thomas (1939) re- 

 ported the occurrence of secondary anemia in 3 of 49 patients 

 given phenothiazine as a urinary antiseptic. The maximum to- 

 tal dose recommended by Manson-Bahr is greatly in excess of 

 that specified by DeEds, Stockton and Thomas as being with 

 in the limits of safety. It would seem that this treatment 

 should he used with considerable caution. 



TREATMENT FOR WUCHERERIA BANCROFTI INFECTION 



There is no specific medication for this condition. Various 

 drugs have been reported as being of value for the destruc- 

 tion of the microfilariae or preventing their appearance in the 

 peripheral circulation. However, evidence for the efficiency of 

 such drugs is meager as in many cases the larvae reappear later. 

 There is no known drug effective for the destruction of the 

 adult worms. 



Chopra and Sundar Rao (1939) have reported on tests ex- 

 tending over 10 years with patients treated with a large num- 

 ber of different drugs at the Calcutta School of Tropical Medi- 

 cine. None of the compounds employed was of value in effect 

 ing the destruction of adult or larval worms. Soamin, an ar- 

 senical preparation, reduced the number of febrile and in- 

 flammatory attacks. Fouadin had a temporary sterilizing ef 

 feet on the parasite but microfilariae reappeared in the blood 

 after several days. However, the drug was said to be very 

 useful in controlling inflammation and fever over comparatively 

 long periods of time. In a few cases, chyluria disappeared even 

 after a single dose. Prontosil and its derivatives were found 

 of value in the treatment of secondary infection. 



Roentgen ray therapy has been advocated as being of value 

 in filariasis but Golden and O'Connor (1934) were unable 

 to obtain consistently promising results. 



In filarial lymphangitis and elephantiasis, surgical interven- 

 tion by means of the Auchincloss technique or one of its modifi- 

 cations will bring some temporary relief. Knott (1938) has 

 advocated prolonged tight bandaging. The use of the method 

 on 105 unselected patients in his series indicated apparently 

 that it is of value for the gradual removal of the lymphoedema 

 and in the prevention of the recurrent attacks of lymphangitis. 



Anti-streptococcal vaccines have been reported to be effec- 

 tive in some cases but O'Connor (1932) pointed out that the 

 relief is only temporary and that any serum or vaccine produces 

 similar relief, indicating probably that temporary cure is due 

 to protein shock rather than to specific anti-bacterial action. 



Anthelmintic Medication for Nematode Parasites of 

 Dogs, Cats and Related Carnivores 



TREATMENT FOB ASCAKID INFECTIONS 



Tetrachlorethylene. This drug in a dose of 0.2 cc. per 

 kilogram (2.2 pounds) of body weight is effective for the re- 

 moval of dog ascarids. In using chlorinated hydrocarbons in 

 the presence of heavy ascarid infections, particularly in pup- 

 pies and young dogs, it is advisable to follow the anthelmintic 

 in 3 or 4 hours by an adequate dose of castor oil, or to give 



339 



