234 



TROPICAL MEDICINE AND HYGIENE 



leucocytes is increased. The dysenteric symptoms at 

 or before the hepatic troubles may be very slight and 

 even escape the notice of the patient. In fatal cases 

 ulceration of the colon is nearly always present. Even 

 when there are no symptoms of dysentery encysted 

 amoebae, E. tetragena, may often be found in the stools. 

 Ipecacuanha is again coming into favour in cases of 

 amoebic hepatitis when there is no evidence of the forma- 

 tion of pus. 



The parasitic amoebae die if left in the faeces as soon as 

 putrefaction occurs. Reproduction takes place by simple 



I / | 10 I It) I Z(J ; <L\ i dd ^3 i 2t 25 dt> Z7 2 

 M E [M E M E M EM EM E 'M E M E !M E M E M E M 



FIG. 67. Pyrexia due to Entamceba. x indicates when Ipecacuhana 

 was administered. 



division, whilst they are parasitic, but transference from 

 one host to another is believed to be by the encysted 

 forms. In these the organism becomes spherical, is 

 covered with a thickened cyst wall, and the contents 

 are divided into four or eight. 



Sometimes localized cedema may be found and more 

 frequently local tenderness. Either of these are valuable 

 localizing symptoms of the abscess. If an abscess has 

 formed it must be localized by exploratory punctures 

 with an exploring needle and freely opened and drained. 

 If no abscess is found the symptoms may be due to 

 hepatitis, and if that be due to amoebic infection a 

 course of ipecacuanha or a series of intramuscular injec- 

 tions of emetin hydrochloride J to ^ a grain daily will 

 bring down the temperature and relieve the symptoms. 



