PART III. TREATMENT 129 



grains three times a day for twelve days after the course of emetin 

 was finished. 



Beta-naphthol in a dose of fifteen grains three times a day was 

 tried in several cases without any good result. Case Gildel was one 

 of these. The drug did not even cause the parasites to disappear. 



B. naphthol and Bismuth Salicylate. These two drugs in the 

 form of a powder in the proportions just mentioned above have 

 been given to a number of cases of lamblia infection. In all these 

 the infection has disappeared after a varying number of days, 

 sometimes after two days' treatment, at other times after seven or 

 eight days. So constant has been the disappearance of lamblia 

 cysts from the stools of cases that it is difficult to believe that the 

 drug has no action on the infection and that the vanishing of the 

 cysts is the result of the natural course of the infection. Unfortu- 

 nately, however, the cure is only a temporary one, as the infection 

 almost invariably reappears after a week or two of control. Only in 

 the single case mentioned on page 128 under the emetin treatment 

 did it appear that a cure has been effected, but whether this was 

 the result of the emetin or the subsequent treatment cannot be stated. 



Bismuth Salicylate. This drug alone in a dose of twenty grains 

 three times a day was used on several cases. It was found that the 

 action was just as certain as when the beta-naphthol was used with 

 it. Apparently the action of the former mixture was due to the 

 bismuth salicylate rather than to the beta-naphthol. Bismuth sali- 

 cylate will usually cause a lamblia infection to disappear and there- 

 after the diarrhoaa with associated mucus will stop also. One must 

 not forget, however, that the natural course of a lamblia infection 

 is an intermittent one and that the symptoms described above are 

 intermittent also and will subside without any treatment whatever. 

 It is this fact which makes a judgment on the action of a drug so 

 difficult. 



Case Baker is very interesting in this respect. He was a carrier 

 of E. histolytica who was treated by the combined oral and injec- 

 tion administration of emetin. Three days after the course of 

 emetin was completed a lamblia infection, not hitherto evident, 

 made its appearance. The case was controlled for a month and as 

 the E. histolytica infection did not reappear the man was discharged 

 though lamblia cysts were still present in the stool. Five weeks 

 later he was readmitted to hospital for colitis. The stool was 

 examined on several occasions but there were present no lamblia 

 cysts. Whether this was a case of spontaneous cure or whether 

 the case was passing through one of the periods when the lamblia 



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