116 HUMAN INTESTINAL PROTOZOA IN THE NEAR EAST 



cases we have noted that, though most usually the infections show 

 a majority of cysts with four nuclei, with a smaller number of one 

 and two-nuclear cysts, at times infections are encountered where 

 nearly every cyst present has only one nucleus. This has appeared 

 also in our control of individual cases in hospital, and it seems 

 evident that the forms which actually appear in the stool are 

 dependent on the rate of emptying of the large intestine rather 

 than on any peculiar action treatment may be having on the 

 amoebae which are there. 



(/) Influence of other Infections on the Treatment. A glance 

 at the tables of the three main groups of cases treated shows that 

 the majority of cases had some other protozoal infection besides the 

 E. histolytica. These coincident infections have been arranged in 

 two columns according as to whether they were discovered before 

 or after the completion of the course of emetin treatment. Many 

 of these only appeared and were detected after several days' observa- 

 tion of the case. Without entering into any details it seems quite 

 clear from the tables that amongst the carriers which were cured 

 there were just as many extra infections, which were just as varied 

 as amongst the carriers which relapsed, so that the presence of 

 flagellates or E. coli did not in any way prejudice the case against 

 a successful emetin treatment. Amongst the acute cases again 

 extra infections were the rule, but as practically all the cases 

 relapsed it is not possible to judge if the result was in any way due 

 to their presence. Generally speaking our results seem to indicate 

 that the action of emetin on E. histolytica is not affected by the 

 presence of other protozoa, and we can find no evidence in support 

 of the view expressed by Dr. Barlow (New York Med. Journ., 1915), 

 that the cases most difficult to treat are those complicated by 

 flagellate infections. In cases treated with emetin by the mouth 

 it was the rule for all the coincident infections to disappear, but in 

 nearly every instance they reappeared later during the period of 

 control. 



If one looks at the protocols of the cases treated by the 

 combined method of orally and subcutaneously administered 

 emetin it will be seen how all the infections disappear soon after 

 treatment is commenced. This is illustrated by the occurrence of 

 a complete blank on the charts corresponding to the course of 

 emetin. After the course is completed the columns begin to fill up 

 as the infections reappear. 



(g) Influence of Diet and Rest in Bed on the Treatment. It 

 has already been explained that the carrier cases appearing in 



