found in cases of Dysentery from the Mediterranean 187 
or oval cysts, containing four nuclei and the remains of the 
axostyles, may be found in the faeces of diarrhoeic patients. In 
Indo-China, many cases of lamblial dysentery have been described 
by French investigators. In 1879 Grassi observed this flagellate 
in mice and subsequently in man in Italy. By experiment on 
himself he proved that infection took place by ingestion of the 
cysts. Cereal foodstuffs, contaminated with Lamblia cysts from 
the vermin of the locality, such as rats and mice, serve to convey 
the infection to man. Mathis (1914) in Tonkin found infected 
rats and mice in the houses of patients. He also discovered 
healthy carriers of Lamblia cysts. 
The much-discussed Cercomonas hominis has also been found 
by us in the stools of dysenteric patients from Gallipoli. 
Notes on Geographical Distribution and Recent Treatment of 
Flagellate Dysenteries. 
‘Escomel (1913) recommends the use of essence of turpentine 
for Trichomonas dysentery. Derrien and Raynaud (1914) found 
this treatment effective in cases in Algeria. Other cases have 
occurred in the Southern United States and were treated with 
thymol and calomel at night, followed by Carlsbad salts in the 
morning. Escomel, Smithies and others have found the flagel- 
lates in water reservoirs and in unfiltered surface waters which 
were in use for drinking purposes. In Peru, after the cleaning 
of the reservoirs and consequent removal of the flagellates, the 
cases of dysentery ceased. As Stiles points out, when flagellates 
or amoebae are found in 10 to 40 per cent. or more of the 
members of a community, means should be taken to improve 
the methods for the disposal of dejecta in order to safeguard the 
food supply against faecal contamination. Such contamination 
may occur by the agency of rodents, flies, and water. 
Dysentery due to the allied flagellate, Chilomastiw (Tetra- 
mitus) mesnil, has been recorded within the last three years by 
Brumpt from France, by Nattan-Larrier from the Ivory Coast, 
by Marques da Cunha and Torres from Brazil, by Gabel from 
Tunis, and we have seen cases from Gallipoli. Methylene blue 
has been recommended for the treatment of such cases. 
Giardia (Lamblia) intestinalis has been studied recently in 
Tonkin by Mathis (1914), who pointed out that the patients’ 
homes were infested with rats and mice. According to Noe, 
Lamblia may be water-borne, while healthy carriers of cysts are 
known. Emetine hydrochloride may be useful in killing the 
flagellate forms, but apparently has little action on the cysts. 
Magnesium sulphate has been recommended, also milk diet with 
VOL. XVIII. PT. IV. 13 
