APPENDIX 



199 



a light brown liquid stool without mucus ; lamblia cysts were present in large numbers, as well 

 as small free amoebae and cysts of E. histolytica. It was in this case that the dividing forms of 

 lamblia described elsewhere were found. The presence of the lamblia in such enormous 

 numbers in the mucus and the fact that E. histolytica were in the " minuta " and encysted 

 stages would suggest that the attack was not one of amoebic dysentery but rather of lamblia 

 irritation. Apparently the case was a carrier of E. histolytica in which symptoms due to over- 

 whelming lamblia infection developed. Patient had not been ill with diarrhoea or dysentery 

 before. He was kept under observation till May 2 and then given a 12-day course of emetin 

 (one grain injection each morning and \ grain in keratin-coated tabloid by the mouth at 

 night). During the treatment he was kept in bed on milk diet. The E. histolytica and lamblia 

 infections disappeared, but infections of E. coli and E. iiana became evident. The E. histolytica 

 infection did not recur during a control of over six weeks, part of which patient spent in 

 convalescent camp on light duty. The lamblia infection recurred soon after the emetin course 

 was finished and persisted till patient developed jaundice, for which he was re-admitted to 

 hospital. Curiously enough, the lamblia diminished in numbers two days before patient was 

 admitted for jaundice and were completely absent when the characteristic jaundice stools were 

 found. During the attack the E. coli and E. nana infections were also absent. The lamblia 

 infection recurred a fortnight after the jaundice had disappeared. The emetin course had no 

 effect on the patient's temperature or pulse-rate. 



