128 HUMAN INTESTINAL PROTOZOA IN THE NEAR EAST 



Other Drugs. Various attempts were made to get rid of 

 flagellate infections, and as these were often associated with E. coli 

 it was possible to watch the action of any line of treatment on the 

 amoebae also. Several cases were treated with turpentine (ten 

 minims three times a day) in the form of mist, terebinth. There 

 was no action on E. coli. Similarly E. coli proved refractory 

 to bismuth salicylate twenty grains three times a day alone, and 

 in combination with beta-naphthol fifteen grains three times a day. 

 The latter drug alone likewise had no effect on the E. coli infections. 

 A course of saline purging will do much to get rid of an E. coli 

 infection and a subsequent examination of the stool may give 

 negative results for some days. The absence, however, is only 

 apparent, for the infection invariably reappears later on. Similarly 

 attacks of diarrhoea or dysentery with much purging will mechani- 

 cally wash away the majority of the amoobae, so that an infection 

 may apparently disappear. This is shown very clearly by the 

 number of such cases which we found to be negative at first and 

 which became positive as the stools began to approach normal. On 

 the other hand, certain diarrhoeic conditions favour the multiplica- 

 tion of E. coli as they do other intestinal protozoa, sometimes with 

 the result that a large infection may persist throughout such an 

 attack. In one such case already mentioned the diagnosis was in 

 doubt for some days, for numerous amoebae were passed constantly 

 in a diarrhoeic stool and it was only after the lapse of about ten 

 days that the stools returned to normal and cysts of E. coli became 

 numerous. 



(3) Treatment of Lamblia Infections. 



We have made numerous attempts to rid cases of their lamblia 

 infections, but though many of the drugs tried will abolish an 

 infection as judged by stool examination the infection almost invari- 

 ably reappears. 



Emetin. This drug given in the form of injections of one grain 

 a day for twelve days will sometimes cause a lamblia infection to 

 disappear for a time, but given by the mouth emetin will nearly 

 always produce a temporary clearing up of the infection. Cases 

 Gildel, Amers and Stone, whose charts of infection are given at the 

 end of this paper, illustrate this general rule very well. In practi- 

 cally all these cases the infection returns later. In one case 

 (White), however, the infection disappeared and there was no return 

 during a control of forty days. This case, however, was given a 

 course of beta-naphthol fifteen grains with bismuth salicylate twenty 



