xiii, b, 5 Haughwout: Flagellated and Ciliated Protozoa 225 



ascertain the disturbances were caused by the flagellated proto- 

 zoa. They go on to say, however, that cases recovered under 

 antidysenteric treatment with ipecac and its compounds. This 

 appears to be at variance with the experience of other workers, 

 who almost unanimously report unsatisfactory results in the 

 treatment of flagellate infections with ipecac and raises the 

 question of the possibility that the authors might have over- 

 looked Entamoeba histolytica in their examination of the stools. 

 Apparently bacillary dysentery was not absolutely ruled out. 

 The cases they trace to impure water. 



These authors describe the symptoms as consisting of diar- 

 rhoea with colicky pains, watery or slimy blood-stained stools, 

 weakness, dyspnoea, loss of weight, progressive anaemia simulat- 

 ing pernicious anaemia, and the skin appearing yellow with urti- 

 carial or pellagroid eruptions. Later the stools consisted of 

 mucus, blood, pus, and active trichomonads. The blood showed 

 a moderate eosinophilia (6 to 12 per cent). Proctoscopic exam- 

 ination of one of their cases showed the presence of a large shal- 

 low ulcer on the posterior wall of the rectum. The remainder of 

 the rectum was covered with mucus and was congested. The 

 stools of this patient contained blood, pus, and trichomonads. 



A complete description is not given of the organisms seen by 

 these authors; that is to say, the description is not sufficiently 

 complete to leave their identity as Trichomonas beyond ques- 

 tion, and indeed, such is the case with many of the reports that 

 are available to me. This makes it difficult in some instances 

 to decide what flagellate is involved. 



Of interest in connection with this observation is a case I 

 recently saw in consultation with Dr. A. F. Coutant, at St. 

 Luke's Hospital, Manila. The patient was a young American 

 woman, married, who some time previous had suffered an acute 

 attack of intestinal entamoebiasis. She came to the hospital for 

 treatment of a persistent diarrhoea, which, though troublesome, 

 did not prevent her from going about. Repeated examination 

 of the stools of this patient failed to disclose the presence of 

 entamoebas, but the stools contained considerable mucus and 

 an occasional red blood corpuscle. Eventually Trichomonas in- 

 testinalis was found in small numbers. Proctoscopic examina- 

 tion of the patient disclosed a small eroded area on the wall of 

 the rectum. This spot was not ulcerated. A small mass of 

 mucus was carefully removed from this eroded area with a sterile 

 platinum loop. Microscopic examination of this mucus revealed 

 a large number of active trichomonads. Under treatment with 



