
Species Determined.
Entamoeba histolytica Schaudinn.
Cysts of this protozoan were observed in the stools from 15 individuals, and trophozoites were found in three fresh samples. These 18 records were equally divided between the faulty and the normal groups, the incidence being 20.5 per cent. in the former and 16.2 per cent. in the latter, with a total incidence of 18 per cent. Matthews and Smith (1919) recorded E. histolytica in 9.7 per cent. of 207 patients in an English mental hospital; Boeck and Stiles (1923), 6.1 per cent. in 1182 individuals examined on an average of 3.2 times each, and 15 per cent. in 505 individuals examined six times each, all inmates of a mental hospital in the District of Columbia; Bach (1932), 14.83 per cent. in a mental hospital in north-west Germany; and Reardon has recently (1941) recorded as high as 44 per cent. infestation with E. histolytica in a small group of the inmates of the State Hospital, Georgia, U.S.A. Fortunately it appears that strains of E. histolytica in mental hospitals are in general of low virulence, and the presence of this species is of minor significance excepting in the case of the occasional individual of low tolerance, or of the entry of a strain of E. histolytica of higher than usual virulence. Barcelos (1940) has given an account of the tragic possibilities of the latter occurrence in the case of a children's institution. In the present study, infestations with E. histolytica were found in all age-groups and in individuals of long-standing as well as of recent admission to the hospital community. Two individuals examined within a fortnight of their admission showed infestations of a chronic nature. The cysts observed ranged in size from 8 microns to 12 microns in diameter, were typical in appearance, and many examples showed clearly the nuclear morphology characteristic of the species.
Entamoeba coli (Lösch).
This very common entozoan of man was identified by the presence of cysts in 16 stools (36.2 per cent.) from faulty individuals, and in 18 stools (32.2 per cent.) from the group of individuals normal in their habits. The incidence of 34 per cent. for the entire group studied ranks this as the most common species encountered. The incidence is nevertheless lower than that recorded by Young and Ham (1941), who determined an infestation of 48 per cent. in a selected group of 142 mental cases at the South Carolina State Hospital; or Miller (1939), who recorded an infestation of 45 per cent. of the inmates of a children's institution in midwestern Canada. It is similar to that recorded by Boeck and Stiles

(1923) of 35.5 per cent. for their series of 1182 mental hospital inmates, but lower than their figure of 61 per cent. in their series of 505 cases. The species was recorded in all age-groups, and as in the case of E. histolytica was found in recent admissions as well as in inmates of long standing in the community. The cysts observed ranged in diameter from 14 microns to 22 microns, were generally spheroidal, although in several stools up to 50 per cent. of the cysts observed were ovoidal, and in one case two sub-cylindrical cysts were found. The majority of infestations were of the medium and large races, ranging from 16 microns to 22 microns. In one stool, both the large and the small races of E. coli were present along with an infestation by the medium race of E. histolytica. E. coli was found commonly in the stools of individuals admitted more than 12 months before examination.
Endolimax nana (Wenyon and O'Connor)
Characteristic cysts of this common commensal amoeboid protozoan were found in stools of two individuals of the faulty group. This total incidence of only 2 per cent. is undoubtedly correlated with the nature of the routine technique employed. The cysts of this species are small, usually only 8 microns to 10 microns in diameter and differentiate poorly with simple iodine preparation. Faust and his associates (1939) have shown that the examination of haematoxylin stained films will reveal 60 per cent. more positives for this species than any other technique; but such films prepared from formalinised material are too variable for consistent results, and we could not make this a routine part of our technique. The actual incidence might normally be anticipated to be between 17 per cent. and 24 per cent.
Iodamoeba butschli (Prowazek).
Cysts of this species were observed in one stool (2.25 per cent.) of the faulty group, and three stools (5.35 per cent.) of individuals of the normal group. This total incidence of 4 per cent. is similar to that of 5.4 per cent. determined as the incidence among 1182 mental hospital cases by Boeck and Stiles (1923), and to that of 6 per cent. recorded by Miller (1939) among the inmates of a children's institute. It is almost half the incidence of 9 per cent. determined by Young and Ham (1941) for their selected group of 142 mental hospital inmates of untidy habits. Few cysts were observed in any of the positive preparations. The cysts were subspherical to ovoidal in shape, ranging from 9 microns to 15 microns on the longer axis, but showed clearly in all cases the peculiar nuclear morphology characteristic of the species. It is quite possible that formalin preservation is not favorable for the cysts of this species, as the present records are with one exception from stools examined fresh.
Giardia intestinalis (Lambl).
Infestations with this flagellate were found in five cases, in three individuals (6.8 per cent.) of the faulty group, and two (3.57 per cent.) of the normal group. The former were young, less than twenty years of age; the latter were in their third and fifth decades. One individual had been admitted less than two months before

examination. In the individuals of the faulty group, large numbers of cysts were being passed. There is a marked age correlation for the determined incidence of this species (Meleney, Bishop, and Leathers, 1932). The incidence of infestation rises to a peak of 25 per cent. between the ages of two and seven years, falls to a minimum of 2.5 per cent. at thirty years, and is maintained near this level in the subsequent age-groups. Miller's (1939) figure of 19 per cent. is high and related to the lower average age of the group he studied. Matthews and Smith (1919) determined an incidence of 3.4 per cent. in mental hospital patients, a figure similar to that of Boeck and Stiles (1923), who record an incidence of 3.1 per cent. for their entire group and of 15.4 per cent. in their group of 505 patients examined six times each. Young and Ham (1941) record an incidence of 6 per cent. in the select group examined by them. The incidence of 5 per cent. recorded here for the whole group agrees well with that of studies elsewhere, and the incidence of 6.8 per cent. for individuals of the faulty group agrees well with that determined by Young and Ham. The cysts observed showed little variation, being mostly 10 microns to 12 microns in length and 6 microns to 8 microns in width. The axostyles and parabasal bodies characteristic of this species in stools from humans were clearly evident.
Trichomonas hominis (Davaine).
The absence of cyst-formation from the life-history of this species limits the detection of Trichomonas infestations to the examination of fresh stools. Many of the fresh specimens examined by us were dry, indurated and unsuitable from the view point of the detection of this species, however in three cases—two of the faulty group (4.5 per cent.), one of the normal group (1.78 per cent.)—this species was observed. The total incidence of 3 per cent. is similar to that of other studies carried out in the present manner; but from the limiting factor mentioned above it is obvious that the results are generally lower than the actual incidence in any group studied.
Chilomastix mesnili (Wenyon).
This species is recorded here on the basis of cysts observed in the stool from one individual of the faulty group. The incidence is exceptionally low and we have no explanation of this since the cysts of this species preserve well and differentiate readily with iodine.
Enterobius vermicularis (Linn.).
Pinworm infestations were recorded in five (11.18 per cent.) of the individuals of faulty habits, and two (3.57 per cent.) of the individuals of normal habits. This total incidence of 7 per cent. is close to that determined by Boeck and Stiles (1923) for their entire group of 1182 inmates of a mental hospital in the District of Columbia, viz., 5.8 per cent. on the basis of an average of 3.2 examinations per person. It contrasts with the negative findings reported for this species by Young and Ham (1941). Reardon (1941) reports 69 per cent. infestation with E. vermicularis in the small group which she examined, but this is the result of examinations by N. I. H. swabs. The present records and those of earlier

surveys are based entirely on simple stool examinations which as is well recognised do not reveal the actual incidence of the species (Sawitz, et al., J. Parasit. Suppl., 1938, No. 9); but for our purposes the results of such survey work are comparable.
Trichuris trichiura (Linn.).
In the group reported on, the whipworm ranks second to E. coli in frequency having in this series a total incidence of 27 per cent. Infestations were recorded in 20 individuals (45.5 per cent.) of the faulty group and seven (12.5 per cent.) of the normal group. Boeck and Stiles (1923) using practically the present technique revealed 50 per cent. of the actual incidence of T. trichiura by the examination of a single stool of each of the individuals in their series of 505 cases ultimately examined six times each. On this basis our figure for the observed incidence of this species in the faulty group indicates a situation approximating to that of the 78 per cent. incidence determined by Young and Ham (1941) in their selected group of 142 patients of untidy habits, and the probable incidence of 54 per cent. for the entire group approximates to the incidence of 61 per cent. to 65 per cent. recorded by Reardon (1941); but in view of the warning given by Svensson and Linders (1934), it is inadvisable to use calculated demonstrabilities in estimating actually existing infestations. In the present study, T. trichiura infestations were detected in all age-groups. The eggs observed fall within the limits of this species, and none were found which might have been assigned to T. ovis or to the other species of the genus which are common in the domesticated animals of this country.
