PREVENTION AND TREATMENT OF PYORRHEA 145 



for bacteria to enter and multiply in enormous numbers, and that 

 certain of these bacteria produce poisonous substances which 

 exert a stimulative effect on the thyroid glands, thus causing 

 goitre. The effect of the presence of amebse, indirect as it is, 

 can be fully demonstrated by destroying them with emetin. In 

 18 out of 23 cases of goitre treated with emetin the size of the 

 thyroid mass was obviously reduced. 



Prevention and Treatment. — Ordinary cleanliness of the 

 mouth by frequent brushing of the teeth, rinsing of the mouth, 

 and care of imperfect teeth is the most important factor in keep- 

 ing the gums healthy and free from an injurious degree of amebic 

 infection. In the investigation of school children in New York 

 already mentioned the number of ameba-infected mouths was 

 reduced one-half by ordinary cleanliness and care. Such 

 methods, however, are of little value if the amebae have estab- 

 lished themselves in a pus pocket, since in such situations they 

 cannot be reached by the usual methods of mouth cleansing. In 

 the New York investigation it was found that mouths could almost 

 always be freed of amebae by using a mouth wash with a weak 

 solution of emetin, the latter being a valuable preventive measure. 

 In older people, however, where the amebae have often already 

 succeeded in stowing themselves away in little crevices and 

 pockets where mouth washes cannot reach them, some other 

 method must be employed. The ideal method is to open up and 

 thoroughly clean out any pus pockets which can be found. 

 This should be followed by a hypodermic injection of emetin, 

 repeated on a few successive days to destroy all amebse, wherever 

 situated. All amebse disappear in 90 per cent of cases in from one 

 to three days, while after six days of treatment, amebse disappear 

 in at least 99 per cent of cases. Usually with the death of the 

 parasites the soreness ceases, the pus formation stops, the gums 

 stop bleeding and the general health rapidly improves. Of 

 course it takes time for the injured tissue to heal and the part 

 destroyed is never replaced. There is also constant danger of 

 reinfection and the already eroded pocket forms an excellent 

 place for fresh amebse to take up a claim and begin their destruc- 

 tive work. Furthermore there are cases of pyorrhea which do 

 not respond to treatment with emetin, probably because the 

 work begun by the amebae is continued by bacteria. Emetin, 

 diluted 200 to 400 times in alcohol and applied with a tooth brush, 



