118 HUMAN INTESTINAL PROTOZOA IN THE NEAR EAST 



and a full course of treatment by pulv. ipecac, without his infection 

 disappearing, was finally treated on what was almost a starvation 

 diet. He was kept in bed and given the diet of an acute dysenteric 

 (barley water, arrowroot water, jelly, tea with a little milk and 

 custard). This diet was started two days before a course of emetin 

 (!TJ grains a day) by the mouth was commenced, and was continued 

 during the twelve-day course of treatment. The infection dis- 

 appeared, but three days later there were present as many cysts 

 and amoebae as before. A second case, Kettlewell, who had resisted 

 the twelve one-grain injections, was treated in a similar manner, 

 but with less emetin (fourteen grains during twelve days). The 

 result in this case was a cure without subsequent relapse. It seems, 

 however, that in most cases where there are no actual dysenteric 

 symptoms such a rigid diet is hardly necessary and may possibly do 

 harm in weakening the patient and rendering him more susceptible 

 to the possible action of emetin on the heart. Case Kettlewell was 

 one of the two cases mentioned below in which some irregularity 

 in the heart's action was noted after treatment. In most instances 

 for carrier cases in bed a milk diet with eggs, bread and butter and 

 milk puddings is quite suitable. Those with actual dysentery with 

 blood and mucus in the stool may require a more rigid diet. 



(h) Influence of Salines on the Treatment. All the cases in 

 Group I were given a mixture containing sodium sulphate one 

 dram four or more times a day, with a view to flushing out the 

 gut. The cases in the second group were not given the mixture so 

 regularly, while in the third group they seldom had it. As already 

 mentioned, emetin by the mouth itself tends to keep the bowels 

 loose, so that salines are not needed so frequently for this purpose. 

 With the acute cases the bowels are generally quite loose without 

 any salines. From the cases we have treated it does not seem that 

 the salines have influenced the result in any way. In fact, the 

 regular administration of salines does not tend to produce such a 

 constant washing out of the large intestine as is often supposed. 

 We have noted that patients who take sodium sulphate mixture 

 regularly so many times a day may pass watery stools for the first 

 two days, but that the effect of the saline seems to pass off. A 

 better result would probably be obtained by giving a single large 

 dose of saline each morning. Barlow (New York Med. Journ., 

 October, 1915) has recently expressed the opinion that emetin has 

 a better chance of action on the amosbae if there is not too much 

 flushing of the gut, and he advocates the administration of a saline 

 every five or six days only to clear out the large intestine. 



