THE DYSENTERIES— AMCEBIC 41 



teen per diem. The condition may persist for years, resulting in 

 marl-ced emaciation. 



Large offensive sloughs may be passed at any time. 



The cysts are responsible for the spread of infection, hence carriers 

 are a danger to a community. Certain carriers manifest no symptoms. 



Before a naked-eye examination of the stools they should always 

 be Avashed. Errors in diet can be more readily detected and corrected 

 by this means. 



The Amoeba minuta lives on the surface of the mucous membrane, 

 but is capable of maintaining the infection. After an acute attack 

 caused by A. tetragena the A. minuta may lead to a relapse of the acute 

 condition, but by itself alone it is doubtful if it causes any symptoms. 



One must not forget that the amoebse are not confined to the bowel. 



Urinary amocbiasis is not infrequent in Indians and other Asiatic 

 races. 



Because of the possible widespread distribution of the amoebae in 

 the human body some have used the term Amoebiasis in preference to 

 Amoebic Dysentery. 



The stools should always be washed under the tap when one is 

 searching for cysts, and in all dysenteric cases it should be done 

 systematically with every stool. The washing should be continued 

 until all traces of faecal matter have disappeared. This method enables 

 the physician to differentiate the sloughs and mucus. The diet can 

 also be controlled and any undesirable ingested foods detected. 



It is often necessary to concentrate the cysts in doubtful cases. 



The method is as follows : — 



(i) Shake up for half an hour about one gram of faces with 300 c.c. 

 of normal saline until the fa?cal mass is disintegrated and an emulsion 

 is formed. 



(2) Pour it into a separating funnel, and shake for half a minute 

 with one-twentieth of its volume of ether or methylated spirits. The 

 facal matter absorbs ether and becomes lighter than the water. Cysts 

 are not aft'ected by the ether and remain at the bottom in the saline. 



(3) Draw off the saline from the separating funnel and centrifuge 

 it for several minutes. The bottom of the tube should contain the cysts 

 in about fifteen times more concentration than the ordinary faeces 

 (Cropper and Row). 



Colonel Wenyon has shown that the mobile stage of the pathogenic 

 amoeba is not infectious by the mouth. Indeed, "the cystic phase is 

 the sole cause of transmission," and these cysts are able, under favour- 

 able circumstances, to live for at least a month outside the body. 



COMPLICATIONS. 



Hepatitis, liver abscess, gangrene of bowel, peritonitis, haemorrhage, 

 stenosis of sigmoid, abscesses in other parts. 



