318 TJie Philippwe Journal of Science wis 



nucleus containing much chromatin. It is for this reason that 

 I have insisted upon stool examinations without the administra- 

 tion of a purgative. In the case of natural diarrhceal stools, 

 diagnosis can usually be made by an experienced protozoologist 

 by a careful study of the stools on successive days; but it is 

 always advisable to endeavor to obtain a. formed stool. Formed 

 stools, when they can be obtained, are always to be preferred 

 for making a laboratory diagnosis of entamoebic infection, 

 because the encysted entamoebse in such stools present the most 

 distinctive morphological characters for the differential diagnosis 

 between Entamoeba histolytica and Entamoeba coli. Finally, it 

 is to be insisted upon that a negative diagnosis should never be 

 made on a single stool examination, since the entamoebse may 

 occasionally be absent from the stools of an infected person; 

 nor upon the identification of Entamoeba coli in a stool, since 

 there may exist a double parasitization with this species and 

 Entamoeba histolytica. In all such cases a diagnosis should be 

 based on several examinations made on different days. 



The treatment of entamoebic dysentery in the Philippines has 

 been based hitherto upon the presence of entamoebse in the stools 

 without regard to the species. With the establishment of a 

 morphological and pathogenic distinction between Entamoeba his- 

 tolytica and Entamoeba coli, and the consequent ability to make 

 a differential diagnosis between the two species, there no longer 

 exists a justification for the indiscriminate treatment of every 

 person showing entamoebse in his stool. Entamoeba coli is a 

 very common commensal of man in the Tropics, but it is usually 

 present in small numbers in the intestine and is harmless. Con- 

 sequently, there is no reason why a patient parasitized with this 

 species should, unless he desired, be subjected to the more or 

 less disagreeable course of treatment. The indiscriminate treat- 

 ment of all persons showing entamoebse in their stools is as in- 

 defensible as would be the treatment with diphtheria antitoxin 

 of every person showing a culture of any bacillus whatsoever 

 from his throat. 



The evidence so far secured in this investigation points to the 

 conclusion that the ordinary routine treatment with ipecac, while 

 efficient in relieving attacks of dysentery and in causing the 

 entamoebse to disappear temporarily from the stools, frequently 

 does not kill all of the entamoebse in the intestine; consequently, 

 the patient is liable to a relapse of the dysentery. This tendency 

 to relapse after chemotherapeutic or drug treatment is, as is well 

 known, characteristic of other protozoan and of spirochsete in- 

 fections. Two acute attacks and 1 relapse of dysentery and 4 



