PART III. TREATMENT 125 



indicating a more extensive involvement of the large intestine, 

 indicate a bad prognosis as regards emetin treatment. 



Exceptions to this rule occur, however, for case Spiers, so 

 frequently referred to in this paper, had a very bad history of 

 recurrent dysentery, yet he was completely cured by emetin. 



(m) Effect of Previous Emetin Treatment. The possibility of 

 previous emetin treatment having produced a resistant or emetin- 

 fast strain of E. histolytica has been discussed above. It will be 

 seen from the table of thirty-seven cases treated by one-grain 

 injections (Table X) that six of the carriers who were cured had 

 had previous emetin treatment for dysentery. Of ten that relapsed, 

 only one had had a previous course of emetin. Of five cases which 

 did not react, two had had previous emetin treatment on many 

 occasions, but these (Healy and Spiers), though in a carrier 

 condition when first seen by us, had just recovered from acute 

 attacks and ought rather to be classed with the actual acute cases. 

 Practically all the acute cases had had repeated attacks of dysentery, 

 and this has meant repeated though less numerous courses of emetin. 

 The three acute cases (Rushforth, Wilkinson, and Gaskin) who had 

 had no previous dysentery and consequently no previous emetin 

 treatment, all relapsed after the first course of emetin ; Rushforth 

 and Gaskin were given a second course and the former of these was 

 cured. It would appear, therefore, that a previous course of emetin 

 in itself does not affect the subsequent treatment. The symptoms 

 of dysentery cleared up just as quickly in those previously treated 

 as in those who had had no treatment before. 



(n) Delayed Action of Emetin. When emetin is administered 

 subcutaneously, on its rate of absorption depends its action on 

 the amoebae. When a course of injections is given, if absorption 

 does not take place very quickly it is evident that the drug will go 

 on acting on the amoebae for some time after the treatment has 

 been stopped. Thus with case Greenwood amoebae were still 

 present in large numbers the day after the course of treatment 

 was completed, but they had completely disappeared at the next 

 examination and they remained absent till a relapse occurred 

 some time later. We do not yet know how quickly the emetin is 

 excreted from the body, but a delayed cure like the one just quoted 

 seems to indicate that the emetin may not reach the amoebae in 

 its maximum concentration till a day or more after injection. 



(o) Best Method of Emetin Administration. From what has 

 already been said regarding the cases we have treated it is clear 

 that the best results have been obtained by the employment 



