226 TROPICAL MEDICINE AND HYGIENE 



Peritonitis with or without perforation may occur, and 

 the parasites are found not only in the mucosa and in 

 the walls and floor of the ulcers, but in the submucosa 

 and in the blood-vessels. In fatal cases there may be 

 extensive ulceration, but it is most severe near the rectum 

 and diminishes towards the caecum. No specific treat- 

 ment is known. 



Lamblia intestinalis is probably pathogenic. It does 

 not invade the tissues, but lies closely applied by its 

 sucker-like aspect to the mucosa, in the small intestine, 

 and is associated with chronic enteritis of a catarrhal 

 character. It is easily recognized by the paired nucleus 

 and the six pairs of flagella. The two terminal are the 

 largest and work in a longitudinal groove. Where there 

 is no diarrhoea the cysts will be found. In these the 

 two nuclei are situated near one end, but there are no 

 flagella. 



The symptoms are of a chronic recurrent diarrhoea, 

 with abundant discharge of mucus, often bile-stained, and 

 sometimes there is also blood. When there is diarrhoea 

 the parasite may be found in abundance ; at other times 

 the encysted forms only will be found. These are 

 easily recognized by their oval shape and the pair of 

 nuclei situated near one extremity. The treatment is not 

 very satisfactory. Free purgation to remove the mucus, 

 followed by intestinal antiseptics such as kerol, seems the 

 most promising line of treatment. Enemata are used by 

 some, but as the main infection is in the small intestine 

 it is difficult to explain the satisfactory action claimed. 

 Methylene blue in one or two grain doses in some cases 

 has a satisfactory effect. Liquid paraffin in tablespoonful 

 doses twice or three times a day may be used alone or 

 with methylene blue. 



The distribution of the parasite is extensive, but as 

 from some parts of India so many cases seem to come 

 it is one of the possible causes of the local forms of 

 diarrhoea, such as Poona diarrhoea. 



The Amcebina. An order belonging to the Rhizopoda 



