HUMAN INTESTINAL PROTOZOA IN THE NEAR EAST 



to England in November, 1914, and was then very fit except for the fact that he always had 

 loose motions. About July, 1915, when under canvas in wet weather in England, he experienced 

 another attack of dysentery for which he went into hospital and was given emetin. He came 

 out of hospital but very soon relapsed again. This time he was treated with rectal injections 

 of silver salts. In November, 1915, he left England for the Mediterranean and had an attack 

 on the ship. He came to Egypt and remained fairly well to the end of the year. When 

 on the way to Mudros he was very ill with dysentery. While in Mudros he was constantly 

 ill, and after a fortnight was sent back to Egypt. Up to February 23, 1916, when the stool 

 was first examined microscopically, patient was constantly passing blood and mucus. When 

 examined on this date the stool was found to consist of brown soft faecal matter with some 

 patches of blood and mucus, and contained numerous small amoebae which looked like minuta 

 forms of E. histolytica. A similar condition was observed next day, while on the next day after 

 this, in addition to the small amoebae, there were numerous cysts of E. histolytica. Patient 

 was placed on light diet and given a course of emetin injections, one grain a day from 

 February 25, to March 7. This had practically no effect on the infection. Owing to the 

 good result obtained in another case (Spiers) patient was then given emetin by the mouth. 

 From February 9 he had J grain a day for four days and then one grain a day for six days. 

 As this treatment also gave no result patient was then given a course of pulv. ipecac., 

 commencing with 30 grains. This was decreased daily by five grains till a dose of 10 was 

 reached, when patient continued the 10 grains a day for eight days. As this treatment 

 was in no way reducing the infection, patient was given an injection of emetin one % grain 

 a day along with the 10 grains of pulv. ipecac. As no change in the infection was produced, 

 this double treatment was discontinued after three days. Owing to a suggestion that thymol 

 was toxic to amoebae, this drug in doses of 10 grains t.d.s. was tried for eight days. This drug 

 yielded no better results than the others tried before. During the whole of this time patient 

 was not kept in bed and was mostly on chicken diet. It was accordingly decided to try emetin 

 treatment by the mouth in larger doses, to keep the patient in bed, and to give him a rigid 

 dysentery diet of arrowroot water, jelly, tea with milk, and a little custard. This diet was 

 commenced two days before the emetin was started. Patient then took 1 grains of emetin 

 each night for 12 nights. After three days of this treatment the amoebae disappeared 

 from the stool and patient was allowed towards the end of the course a little extra food in 

 the shape of beef tea, an egg and rusks. The emetin was kept down without vomiting, except 

 on the first occasion, though this necessitated a heroic struggle on the patient's part. Three 

 days after the end of this course of emetin there were as many cysts of E. histolytica in the 

 stool as before treatment. These, with or without minuta forms of E. histolytica, were found 

 regularly till May 13, when patient was invalided home to England. The large quantity of 

 emetin taken by the patient had very little effect on his general health, and any weakness 

 after treatment could be attributed to the restricted diet and stay in bed during the last course 

 of emetin. The patient had a pure infection of E. histolytica uncomplicated by the presence 

 of any other protozoa. 



