44 HUMAN INTESTINAL PROTOZOA IN THE NEAR EAST 



E. liistolytica appeared in the stool, and later still the patient was 

 readmitted to hospital with amoebic dysentery. Of course, in this 

 case the diagnosis was made on the occurrence of red blood 

 corpuscles in the amoebae, and the correctness of this was proved by 

 the subsequent relapse with the passage of E. histolytica cysts. 



The greatest difficulty is likely to occur when persons infected 

 with E. coli or carriers of E. histolytica suffer from bacillary or 

 other forms of dysentery. The encysted amoebae are not generally 

 present unless the case is seen very early and it may at times be 

 impossible to diagnose accurately the amoebae, though the absence 

 of included red blood corpuscles is a very strong argument in favour 

 of their being E. coli, for infections with this amoebae are so much 

 commoner in healthy or apparently healthy men. The question 

 is, are all such cases to be treated as if they were amoebic 

 dysentery? If so, we are neglecting the possible bacillary element, 

 so that logically such cases would have to be treated as mixed 

 infections and given both emetin and serum or other bacillary 

 dysentery treatment. One may have to adopt this course in certain 

 cases but a guide to treatment can be obtained in other directions. 

 In the first place, the case may be clinically bacillary rather than 

 amoebic dysentery, and though amoebse are present, i.e., amoebae 

 without included red blood corpuscles and unassociated with cysts 

 of E. liistolytica, it should be treated as bacillary dysentery, for as 

 the symptoms subside cysts of the amoebae will almost certainly 

 appear and the species be identified. Again, much can be gathered 

 from the character of the stool, and it cannot be too strongly 

 emphasized that it is the duty of every medical officer who has 

 charge of dysentery cases to make arrangements whereby he can 

 see the entire stool of his cases. It is not sufficient either for him 

 or for the person entrusted with the microscopical examination to 

 rely on the patient's statement or to be content with the examina- 

 tion of only a small sample. In many cases this may be sufficient, 

 but, as will be explained below, the picture of the entire stool is so 

 characteristic that a diagnosis can often be made at a glance. 

 Again, the microscopic appearance of the stool apart from the 

 amoebae is of considerable help. In the examination of a dysenteric 

 stool it is important to examine both the faecal and mucus parts if 

 both are present, for amoebae alone may occur in the latter and 

 cysts with or without amoebae in the former, though this condition 

 of affairs exists only when a carrier case is relapsing into one of 

 acute amoebic dysentery. Case Ball is of interest in this connection ; 

 he was on the staff of the hospital and reported sick with the 



