122 HUMAN INTESTINAL PROTOZOA IN THE NEAR EAST 



of treatment or because only free amoebae were present, which could 

 not be distinguished from E. coli which were present also. 



Of thirty-five carrier cases which received one grain of emetin 

 subcutaneously for twelve days and which did not relapse, the 

 infection persisted on an average for four days before disappearing, 

 while of ten carrier cases which were treated in the same way and 

 which relapsed later, the figure is 4'5 days. On the other hand, 

 for twenty-seven carrier cases treated and cured by the combined 

 subcutaneous and oral method (! grains a day) the average is only 

 two days. Amongst the carriers treated in this way there were 

 no relapses. The cases which were treated by one grain of ernetin 

 by the mouth alone occupy an intermediate position. 



It is evident that as regards the rapidity of disappearance of 

 the infection the combined treatment gives the best results. 



If we take into consideration the degree of infection as shown 

 in the columns in the tables it will be found that for the carriers 

 who did not relapse and who were treated with one-grain injections 

 the + + + infections gave an average time of disappearance of 

 3'5 days, the + + infections an average of 4'3 days and the + 

 infection 3'5. With the carrier cases treated by the combined 

 method the figures are 2'3, 1'5, and 2'3 respectively. 



It thus appears that the intensity of the infection as judged by 

 the appearances in the stool has very little to do with the rate of 

 disappearance of amoebae or cysts. It is significant, however, that 

 the cases which did not react to the injection of one grain of 

 emetin for twelve days all had large infections, and this is true 

 also to a great extent of the cases which were cured but which 

 relapsed later. 



As regards the acute cases, in the majority the infection rapidly 

 disappeared in one or two days, but in a few it persisted for a longer 

 period and in one case as long as the last day of treatment. It is 

 important to note that with all the acute cases the clinical signs of 

 dysentery disappeared very rapidly and this in spite of the fact that 

 practically all relapsed later. Most of these acute cases had 

 already been treated with emetin in other hospitals and had been 

 discharged as cured. The remarkable feature of the emetin 

 treatment is not that in some cases, such as Healy with a + -1- + 

 infection, there should be a failure to bring about a disappearance of 

 the infection, but that in certain cases, such as Carr, for instance, 

 who had a simply overwhelming infection, the largest we have 

 encountered, the first day of treatment was sufficient to abolish it. 

 It has already been mentioned that the cysts which Carr was 



