Annual report on the Medical Department / Sierra Leone.

  • Sierra Leone. Medical Department
Date:
[1916]
Catalogue details

Licence: Public Domain Mark

Credit: Annual report on the Medical Department / Sierra Leone. Source: Wellcome Collection.

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    contain Entamoeba histolytica or its cysts. Since so far no case has been shown by bacteriological methods to be due to Shiga and Flexner’s Bacilli, it may safely be assumed that the dysentery here is spread more or less directly from person to person. (“ Water Supply ” does not include the Freetown wells). Microscopic. 153. A fresh specimen from an acute case of dysentery showed large active amoebae which always appeared to travel in one direction. The ectoplasm was slightly retractile, and they varied in size from 50y—'20y. Bed cells were abundant, and often considerable numbers had been phagocytosed. Some pus cells were present also. As the acute case got better under treatment, the erythrocytes quickly diminished, while the pus cells increased until the lesion had healed, In chronic or recurring cases, or acute cases which were 4-5 days old, specimens showed :— f (i.) Motile amoebic (more sluggish than in acute and fresh cases), and rarely a red cell phagocytosed. (ii.) Few erythrocytes (may explain (i.).) (iii.) Abundant leucocytes and pus cells. 1. or (i.) Encysted amoebic (with 1, 2, 3 or 4 nuclei). (ii.) An occasional or no red cell present. (iii.) Abundant pus cells. 154. The dangerous type of case to the community at large is the “ Cyst Carrier.” He evinces no clinical manifestation of “ dysentery,” but a microscopical examination of his faeces made in the routine examination of his secretions, etc. when he seeks admission to hospital for some incidental ailment, readily reveals the latent nucleated cysts and his potentialities as a dysenteric apostle. In recognising the almost universal local prevalence of helminthic infections, a feature was noted with interest, and indeed was one which might reasonably have been accepted as an index of the progress of a patient towards recovery from dysentery. The presence of the ova of various intestinal worms is almost an invariable quantity in the examination of faeces otherwise regarded as normal. Now, during the stage of acute or sub-acute dysentery these ova were rarely noted, but as soon as a convalescent patient’s faeces reached the stage of containing “ a few pus cells and a little mucus and no erythrocytes and amoebae ” the ova began to re-appear, the presumption being that the morbid condition of the intestinal tract was inimical to the egg-laying function of the parasite. All the amoebic examined have answered to the combined description of histolytica and tetragena as given by Darling, James, Craig, Wenyon and others, and therefore Entamoeba histolytica is the cause of the dysentery as seen in Freetown. (Whether bacillary dysentery exists as such in Freetown cannot yet be stated, because, as far as I am aware, the necessary organisms have not been cultured from dysenteric faeces. Many attempts were made during the latter months of 1916, but only B. coli could be grown. After some practice the amoebic nucleus was seen quite easily in most fresh specimens, being characterised by blocks of chromatin under the nuclear membrane and a centriole. It was always eccentric. Lack of time prevented the more elaborate methods of staining, but dry fixation, staining 1 hour in Leishman’s stain and overnight in Giemsa’s stain and decolorising to the necessary amount in 1 per cent, ammoniated alcohoi, was done in many cases, and the specimens showed the points necessary to diagnose the amoebic as the pathogenic species. Flagellates are often found, but so far do not appear to cause dysentery, though patients who have large numbers thereof frequently suffer from diarrhoea at intervals, with the passage of more or less