42 DISEASES DUE TO PROTOZOA 



DIAGNOSIS. 



From Bacterial Dysentery by its chronic course, rare pyrexia, 

 absence of toxic symptoms, complication of liver abscess and the 

 iinding- of the amcx^bcU in the stools. 



When examining the stools for amoebie a little methylene blue \vill 

 stain the pus and epithelial cells, but not the amoebae, thus facilitating 

 their detection and examination. It is not important in practice to 

 diagnose A. tetragena from A. coli, if one employs the rule that if the 

 symptoms of dysentery are present and amoebae are seen in the stools 

 treat as for amoebic dysentery. 



Wenyon suggests that the stool should be examined \vith a little 

 iodine tincture, so that the nuclei may be well seen with an oil immer- 

 sion and No. 2 eyepiece, the condenser slightly lowered to reduce the 

 light. 



Amcebic Bacillary 



Nearly always chronic in its course Nearly always acute 



Pyrexia rare Pyrexia common 



Toxic symptoms absent or late when no Toxic symptoms usually present 



liver abscess 

 Liver abscess in 15 per cent, of cases Never liver abscess, unless multiple and 



small 

 Small intestine frequently attacked Nearly always confined to the large 



intestine 

 Amoebae found in the stools Dysentery bacilli found in the stools 



From Sub-tertian malarial dysentery hv the absence of malarial 

 parasites the presence of fever and its not yielding to quinine treatment. 



From Ulcerative colitis and Hcemorrhagic typhoid by high fever, 

 prostration, pain, violent delirium and the absence of entamocb^e. The 

 diagnosis is often difficult. 



From Helminthic infectio7is by finding the causative parasites. 



From hitestinal tuberculosis bv marked tenderness in the cascal 

 region rather than over the sigmoid flexure and the absence of parasites. 



From Malignant disease of the sigmoid and rectum by the severe 

 tenesmus, increasing difficulty to pass large-formed stools, the age of 

 the patient and the absence of parasites. 



TREATMENT. 



Absolute rest in bed. 



Relieve griping bv morphia, hypodermically, also by enemata or 

 suppository. Give castor oil half to one ounce (15-30 grm.). 



Emetine hydrochloride is a specific, half a grain (0*03 cm.) dis- 

 solved in normal saline, given twice daily until 12 grains (0*75 cm.) 

 have been given. It can be administered hypodermically : sterile tubes 

 of the drug can be obtained ready for use; it may be given orally as 

 " alcresta " ipecacuanha, ijl grains (D"09 cm.) of emetine can be given 



