PART III. TREATMENT 117 



Tables X and XI were given a chicken diet, and were not kept in 

 bed during treatment. The acute cases in these two groups were, 

 however, given dysentery diet and kept in bed. It is difficult to 

 state whether there would have been fewer relapses amongst the 

 carriers in these groups if rest in bed and special milk diet or dysentery 

 diet had been enforced. Kest in bed and milk diet were ordered 

 for the cases appearing in Table XII, and here all the carrier cases 

 were cured. The difference in the result, however, is more probably 

 due to the extra dose of emetin which the latter received. That 

 very bad cases can be cured without any rest in bed is well 

 illustrated by case Spiers, who had, as already mentioned, a very 

 bad history of dysentery and repeated emetin treatments. He was 

 treated whilst he still carried on his usual office occupation, and 

 confined himself to an ordinary light chicken diet. He received 

 during twelve days an injection of a grain of emetin a day, which 

 did not rid him of the infection. This was followed by a course 

 of emetin (5^ grains) by the mouth which permanently cured 

 the patient. This very satisfactory result was obtained without 

 any special rest or diet. Two other carriers (Cox and Badham) 

 were treated by twelve one-grain emetin injections, while they 

 continued on duty and took full diet. One of these was cured 

 and the other relapsed. Another case (Ball) had already had an 

 attack of acute amoebic dysentery, for which he had been treated in 

 bed by oral administration of emetin. He relapsed into the carrier 

 condition and was then treated while still on duty by twelve daily 

 one-grain emetin injections. He relapsed again after the second 

 course. Thus, of the four cases treated out of hospital two were 

 cured and two relapsed. It does not seem advisable, however, to 

 treat patients with emetin while still on duty, though this may have 

 to be done in special cases. 



When patients are in hospital, and especially when they are in 

 bed, they do not need a full diet, and for this reason it is sufficient to 

 give them milk or other light diet alone. When emetin is being 

 taken by the mouth, and possibly comes into contact with the 

 amoebae by way of the intestinal tract, an overloaded intestine 

 would be a disadvantage in that the available emetin would be 

 reduced. Furthermore, the tendency to vomit would be greater 

 if too much food were taken. This, of course, does not apply to 

 emetin administered by injection only, as this seems to produce 

 very little, if any, tendency to vomiting. Case Healy, who had 

 proved most refractory to treatment and who had had twelve 

 one-grain injections, a course of emetin (eight grains) by the mouth 



