APPENDIX 



181 



NOTE. On his arrival in England, the patient was seen by Dr. A. C. Stevonson and Dr. G. C. Low, who undertook the further 

 atinent. A course of bismuth emetin iodide (3 grains a day for 12 days) was s ivei1 . witu f ne result that the E. histolytica 

 afection entirely disappeared, and did not recur during a control of 10J months with 38 examinations. A tetramitus infection 

 -*iich had developed did not yield to the treatment. 



CASE KETTLEWELL, aged 24. Patient, who had not been abroad before, left England 

 June, 1915, and went direct to Gallipoli. He was there for seven weeks but had dysentery 

 fter having been there two weeks. He remained on duty, however, till he was compelled 

 report sick in September. He was invalided to Malta, where he remained one month and 

 suffered from jaundice. Thence he returned to England and was in hospital a few days till 

 he was discharged. He was given six weeks leave, but was ill part of the time with dysenteric 

 symptoms. He was back on duty (A class) in December, 1915, and returned to the 

 Mediterranean Egypt in February. Since the beginning of his illness patient had had diarrhoea 

 or dysentery continuously till December, when there was some improvement. He was never 

 treated with emetin. On March 1 and 3, owing to continued looseness of the bowels, patient's 

 stool was examined and he was found to have a large E. histolytica infection, together with 

 tetramitus and E. coli. Patient was taken into hospital and given a course of emetin injections 

 of one grain a day for 12 days. The E. histolytica infection was not abolished by this treatment, 

 during which patient was not kept in bed and was on chicken diet. It was accordingly decided 

 to keep patient in bed, give him daily a rigid dysentery diet (tea with milk, arrowroot, jelly, and 

 a little custard), and institute a course of emetin by the mouth. Patient was given in this 

 way emetin in tine, opii 1| grains a day for four days, followed by one grain a day for eight 

 days. There was no vomiting. The E. histolytica quickly disappeared, as also did the 

 tetramitus and E. coli. There was no return of the E. histolytica infection during a control of 

 one month after treatment. The other infections, however, recurred. When patient got 

 up after the second course of emetin he felt very weak and suffered from marked shortness of 

 breath and irregular action of the heart on slight exertion. This condition continued for about 

 one month and gradually disappeared, the patient finally returning to duty. In this case 

 it appeared as if the emetin administered had had some bad effect upon the heart. 



