PART III. TREATMENT 113 



drug. It is very difficult to obtain precise information on this 

 point, for, as already explained, the failure of emetin to cure may 

 be due to purely mechanical reasons of poor circulation or other 

 causes. Case Spiers is of much interest in this connection. There 

 was a long history of dysentery of three years standing, and there 

 had been in all thirteen courses of emetin, after each of which the 

 patient's symptoms disappeared. The patient himself had also been 

 in the habit of taking one or two ^-grain emetin tabloids for this 

 purpose. Such a case had every chance of developing a resistant 

 strain of amoebae, and when a twelve-day course of one-grain 

 injections failed entirely to influence the infection we were under 

 the impression that the strain of E. histolytica was resistant to 

 emetin. This view was entirely disproved by the fact that a course 

 of emetin by the mouth over nine days (5 grains in all) com- 

 pletely got rid of the infection without any relapse taking place. 

 In this case at any rate it seemed as if the emetin administered 

 by the mouth reached the amoebae more readily than the emetin 

 by injections. Again, case Healy,* who had a still longer history of 

 chronic amoebic dysentery, failed entirely to react to emetin injec- 

 tions. He failed also to react to small doses of emetin by the 

 mouth and also to a course of treatment by pulv. ipecac. Yet a 

 course of emetin by the mouth 1^ grains a day caused the infection 

 to disappear at least for some days. 



It, therefore, seems to us that because an infection does not 

 appear to respond to treatment by emetin injections it does not 

 follow that this failure is due to the presence of a resistant strain, 

 for if the emetin can be made to reach the amoebae by some other 

 method of administration in most cases some response or even cure 

 will be the result. 



The same failure to respond to emetin injections is seen some- 

 times in the case of amoebic abscess of the liver. A case of this 

 kind was seen by one of us (C. M. W.) in London last year, where 

 a draining abscess of the liver continued to discharge active amoebae 

 though a complete course of emetin injections of a grain a day for 

 twelve days was given. A second case of this kind came under 

 our notice a few months ago. We were controlling a case by 

 examinations of the faeces and liver abscess pus for Captain 

 Redmond, E.A.M.C., who was treating the case. The faeces 

 showed no sign of amoebic infection, while the pus from the abscess 

 contained constantly numbers of E. histolytica, and this in spite of 

 the fact that the patient received a full course of emetin injections 



See note on yagc 181. 



