82 HUMAN INTESTINAL PROTOZOA IN THE NEAR EAST 



should occur in some of these. It is, however, obviously illogical 

 to call all such cases of trichomonas diarrhoea, while there is no 

 excuse whatever for the use of the term " trichomonas dysentery." 

 The cases of dysentery in which trichomonas has been present 

 have been cases of bacillary dysentery. 



We are of the opinion, therefore, that while trichomonas may, 

 in some cases, cause diarrhoea, and possibly a diarrhoea persisting 

 over several months, in the vast majority of cases in which it has 

 been found it has in no way been the cause of trouble. Those who 

 are inclined to attribute to the flagellate a pathogenicity must 

 never forget that there are hundreds of cases of diarrhoea both 

 transient and chronic in which no protozoa whatever are to be 

 found for every one in which trichomonas is present. The 

 inclination to attach importance to it as a pathogenic agent is the 

 direct outcome of its size and structure. 



(17) Coccidium (Isospora). 



As we have already mentioned, the isospora which one of us 

 found fifteen times in the examination of 556 cases in London 

 during the latter half of 1915, was found only once amongst the 

 large number of men examined by us in Egypt during the first 

 six months of 1916. It seems probable that the infection came 

 from Gallipoli. 



The single case (Webber) seen by us in Egypt was in an 

 E. histolytica carrier who had been discovered as such in the 

 routine examination of men in Sidi Bishr camp. The man was 

 brought into hospital for treatment of his E. histolytica infection 

 and the first oocysts were seen on the eighth day that the stool was 

 examined and on the day that a course of one-grain emetin injections 

 was commenced. The twelve injections of emetin did not rid the 

 man of the coccidium infection any more than of the E. histolytica 

 infection. The oocysts of the coccidium were few in number during 

 the first few days of the course, but they became more numerous 

 towards the end and were still more numerous after the course was 

 finished. Nine days after the completion of the first emetin course 

 a second course was given. This time the double treatment of 

 injections and orally administered emetin (1^ grains a day) was 

 employed. The oocysts became fewer and were last seen on the 

 sixth day of the course, the E, histolytica having vanished after the 

 second day. The case was most carefully controlled for a month 

 after treatment, several films being frequently examined but no 

 recurrence of the oocysts occurred. The treatment seemed not only 



