PART III. TREATMENT 111 



It is important to note that five of the carrier cases which 

 relapsed after treatment in Group I were treated later and cured as 

 in Group III, while one carrier case which did not react at all to 

 the treatment as in Group I was cured later by treatment as in 

 Group II, while case Spiers who resisted the one grain a day by 

 injections was cured by a course of emetin by the mouth immediately 

 after. 



It seems to follow from this that certain cases that prove 

 refractory to one line of treatment or one method of emetin 

 administration may respond to emetin administered in another 

 way. It is possibly this factor which has given the better results 

 with the combined method of treatment. 



(c) Carrier and Acute Cases. It will have been seen from the 

 list given on page 110 that the ordinary carrier cases not showing any 

 or only slight symptoms are much more readily cured than the acute 

 cases. Thus all the six acute cases in Group I relapsed after 

 emetin injections of one grain a day for twelve days. In Group II 

 again, where three acute cases were treated by emetin by the 

 mouth (one grain a day), one case did not even react to the treat- 

 ment, while two relapsed. In the third group there were treated 

 seven acute cases, and of these five relapsed and two were cured. 



It is quite evident, therefore, that the cases which are most 

 difficult to rid of infection are not the carrier cases passing cysts 

 without any symptoms, but the acute cases passing blood and 

 mucus in the stool with active amoebse containing red blood 

 corpuscles. The acute cases have nearly all had a history of 

 recurrent attacks of dysentery and generally previous emetin 

 treatment. Three of these cases, however, were treated at their 

 first attack of dysentery (Bush worth, Wilkinson and Gaskin), yet all 

 of them relapsed. Rushworth, however, was subsequently cured by 

 a course of emetin given by injection and by the mouth (Table XII). 



The action of emetin on the carrier case generally causes the 

 disappearance of cysts from the stool in two or three days, and 

 similarly in the acute cases not only do the amoebae disappear very 

 quickly but the symptoms clear up also and the patient to all 

 intents and purposes has recovered from his dysentery. It is this 

 fact which had led to the idea that emetin in small doses is such a 

 sure specific for amoebic dysentery. It is only by the detailed 

 control of the cases, as in the methods adopted by us in these 

 observations, that the subsequent course of the cases can be followed. 

 It has resulted that in almost every instance relapse has taken 

 place. 



