PART III. TREATMENT 107 



(b) Treatment by Methyl Emetin Sulphate. Methyl emetin in 

 the form of the sulphate was tried on four cases. This drug 

 prepared by Dr. Pyman of the Wellcome Bureau of Scientific 

 Kesearch is a stable compound which is soluble in water and not 

 decomposed by boiling. As methyl emetin, according to experi- 

 ments made by one of us (C. M. W. 1915), is equal in amcebicidal 

 power to the emetin hydrochloride, and as it is much less toxic to 

 animals on injection, it was decided to give the drug a trial in 

 amoebic affections in man. Dr. Low had previously tried another 

 salt of methyl emetin on a case of rather doubtful nature at the 

 Albert Dock Hospital, but the investigation was not carried very 

 far and no attempt was made to test its action in comparison with 

 the usually employed emetin hydrochloride. 



We have tested methyl emetin sulphate on four cases. Three 

 of these were acute cases of amoebic dysentery, while one was a 

 carrier. The carrier case (Percival) had a + + + infection of E. 

 histolytica and a smaller E. coli infection. The patient was given 

 for twelve days an injection of the drug each morning (one grain in 

 one cubic centimetre of distilled water) and one grain in keratin- 

 coated tabloids by the mouth each night. The E. histolytica 

 infection disappeared after the seventh day of treatment and did 

 not recur during a subsequent control of over one month. During 

 the treatment the patient was kept in bed on milk diet. 



Of the acute cases one (Smith)* had already relapsed after two 

 courses of emetin hydrochloride (Tables X and XII). He was 

 given the same treatment as the preceding case. The course of 

 methyl emetin apparently had no action on the infection, for 

 free forms of E. histolytica, sometimes with included red blood 

 corpuscles, were passed during the whole course.' The second 

 acute case treated was liussell who had also relapsed after a 

 course of emetin hydrochloride (H grains a day subcutaneously 

 and orally : Table XII). The same treatment with methyl 

 emetin sulphate as was used in the other cases was adopted. On 

 this occasion the infection disappeared after the fourth day of 

 treatment, but reappeared three days after the completion of the 

 course. The third acute case (Blair) was given the same dose, but 

 it did not even bring about a disappearance of the infection. 

 Accordingly at the end of the twelve-day course of methyl emetin 

 sulphate the treatment was changed to one grain of emetin hydro- 

 chloride in keratin-coated tabloid at night. This alteration of the 

 emetin was made without the patient's knowledge. The result 



* Sec note on case, page 1H7. 



