126 HUMAN INTESTINAL PROTOZOA IN THE NEAR EAST 



of the combined method of emetin treatment. This has con- 

 sisted in the administration of one grain of emetin hydrochloride 

 subcutaneously each morning, and J grain in keratin-coated 

 tabloid orally each night, the course of emetin extending over 

 twelve days. During the course the patient should stay in bed 

 and be kept on light diet, which must be a strict dysentery diet 

 if blood and mucus are present in the stool. It is not necessary 

 to give salines regularly, but they must be employed if there is 

 the slightest tendency towards constipation. This treatment has 

 given us the best results. All the carrier cases treated in this 

 way have been cured, and two, possibly three, out of eight acute 

 cases with definite dysentery. This treatment can, therefore, be 

 safely employed for all cases of E. histolytica infection, though 

 the results with acute cases, especially those who have had long 

 histories of repeated dysenteric attacks, will be far from satis- 

 factory when compared with the results obtained in the case of 

 a carrier. The treatment has the effect of almost immediately 

 clearing up the dysentery, while the amoebae disappear from the 

 stool. In most of the acute dysentery cases, however, relapse 

 occurs later. For this reason we feel that it would be well to 

 treat cases of this nature during long periods as one would treat 

 chronic malaria infections. The initial course of emetin as 

 explained above can be given, and this might be followed by a 

 long course of emetin, say T 1 grain, or even grain, taken orally 

 in keratin-coated tabloid each night. A tolerance, as regards 

 nausea, would be quickly acquired, and it is very probable that 

 the daily exhibition of the small dose during two or three months 

 after the initial course of emetin would prevent relapse occur- 

 ring. We have had no opportunity of testing this method, but 

 from what we know of malaria and quinine there seems to be 

 every prospect of success. Such a small dose as T x o or -| grain, 

 or even \ grain, is hardly likely to affect the patient's health, for 

 we know of several cases who have taken much larger doses over 

 long periods without any untoward symptoms developing. We 

 would advise that carrier cases of E. histolytica be treated with 

 1J grains of emetin as explained above, and that cases with actual 

 dysentery with blood and mucus be treated in the same manner, 

 though with a stricter dysentery diet. If these dysenteric cases 

 show any tendency to relapse, as they frequently do, the emetin 

 course can be repeated and be followed by a long course of emetin 

 by the mouth in small doses as is done with quinine in cases of 

 chronic malaria. 



