vni. B, 1 Walker: Balantidicidal Activity 11 



and the readiness with which the compound is reduced to metallic 

 silver probably play a part in the process. Among these silver 

 compounds several, especially ichtargan and actol, look prom- 

 ising for the treatment of balantidiasis. These compounds are 

 relatively nontoxic ; while they are precipitated by albumin, they 

 are said to form soluble compounds; and they possess a balan- 

 tidicidal activity which is as great, in proportion to the silver 

 contained, as silver nitrate. 



In the application of the organic compounds of silver to the 

 treatment of balantidiasis, there are four ways in which they 

 might be employed, namely : first, by subcutaneous or intravenous 

 injections; second, by high rectal enemata; third, by mouth; 

 and, fourth, by appendicostomy and colon irrigations. The 

 first of these methods, by subcutaneous or intraveneous injec- 

 tions, has a precedent in Roger's treatment of entamoebic dysen- 

 tery by subcutaneous injections of the soluble salts of emetine. 

 In such treatment, 1 part of the silver compound to the number 

 of parts of the body weight which are equivalent to the highest 

 efficient balantidicidal dilution of the compound would have to 

 be administered. Whether such a dose could be safely given 

 would have to be determined experimentally. It is noteworthy in 

 this connection that for several of these compounds such a dose 

 has been experimentally determined to be harmless for guinea 

 pigs (Table II). The chief objection to rectal enemata is that 

 they cannot be made high enough to reach all of the infected gut. 

 Nevertheless, it is one of the most convenient methods of treat- 

 ment, and, if the large intestine be first emptied of faecal matter 

 as completely as possible, should be efficient so far as the infected 

 areas can be reached. For this method of treatment, solutions 

 of the compounds of silver of a strength at least equivalent 

 to the highest efficient balantidicidal dilution should be employed. 

 Capsules coated with creatin, salol, or other substance that would 

 be dissolved only just before discharge into the large intestine 

 would probably be an efficient method of treatment, since by 

 this means the whole length of the large intestine could be 

 reached with the balantidicidal agent. In cases of balantidial 

 infection in which dysenteric symptoms are established and 

 which yield to none of the other methods of treatment, appendi- 

 costomy and the flushing out of the whole large intestine with 

 the balantidicidal solution would undoubtedly be the most efficient 

 method of treatment and would under the circumstances be 

 advisable. 



