APPENDIX 



187 



(one injection a day for eight days). The dysentery cleared up, and he went to Mustapha Camp, 

 where, on April 3, 1916, another attack of dysentery developed, and he was admitted to the 

 15th General Hospital. The stool contained much blood and mucus, and there were present 

 many active free amoebae, none of which contained red blood corpuscles. Two days later, how- 

 ever, many amoebae had included red blood cells. Patient was given a 12-day course of emetin 

 injection (one grain a day). The amoebae disappeared after the first injection, and the dysenteric 

 symptoms subsided, the stool becoming free from blood and mucus. After treatment patient was 

 kept under observation in hospital for three weeks, during which time a stool with blood and 

 mucus and active amoebae were found on one occasion. Free amoebae and cysts of E. coli and 

 tetramitus were found from time to time. The patient went to convalescent camp on May 12, and 

 on May 19 had another attack of dysentery, for which he was admitted to the Orwa-el-Waska 

 Hospital. The stool contained many active amoebae with included red blood corpuscles and 

 tetramitus. Patient was then given a 12-day course of emetin (one grain injection each morning 

 and grain in keratin-coated tabloid each evening). Under this treatment the dysentery again 

 subsided, but a week later active amoebae with included red blood corpuscles were again present 

 in large numbers. Methyl emetin sulphate was then given for 12 days (one grain injection 

 each morning, and one grain in keratin-coated tabloid by the mouth each evening). The patient's 

 symptoms abated, but amoebae, which, on account of included red blood cells, were certainly 

 E. histolytica, did not disappear. During the courses of emetin, the patient was kept in bed, 

 and was given either milk or some stringent dysentery diet. Neither the emetin nor the methyl 

 emetin by the mouth caused any vomiting. 



The patient's temperature and pulse-rate were not altered by the treatment, though there 

 was some fever on one occasion, associated with a kind of bilious attack. This case, which has 

 been treated with emetin from the commencement of the disease, has proved very resistant. 

 An interesting feature of the case is the constant absence of cysts of E. histolytica, though most 

 careful search has been made for them on many occasions. The only cysts seen have been 

 those of E. coli, and one might argue from this that all the amoebae belonged to this species. 

 The irregularity of the tetramitus infection is also worthy of note.* 



* NOTE. The patient, who was invalided to England, suffered from dysentery on the journey home. He wns treated with emetin. 

 At the dysentery depot at Barton a full course of bismuth emetin iodide (3 grains a day for 12 days) was followed by relapse. 

 A second course of this drug gave no better result. A liver abscess developed, and the patient died after operation. During this 

 period free forms of E. histolytita alone were found. Cysts were never seen. Post-mortem findings were, unfortunately, not 

 available. 



