108 HUMAN INTESTINAL PROTOZOA IN THE NEAR EAST 



was that for the first three nights vomiting occurred within a short 

 time of taking the drug, though there had been no vomiting pre- 

 viously. This illustrates very clearly the difference as regards the 

 property of producing nausea and vomiting between the two drugs, 

 methyl emetin sulphate and emetin hydrochloride. 



From the results it seems clear that with acute cases the methyl 

 emetin in the dose employed has not the same power of ridding an 

 individual of infection as the emetin hydrochloride. In two of the 

 cases the infection did not even disappear, while in the third it 

 vanished only to return soon after the completion of the course. 

 It must be remembered that the dose employed (two grains a day) 

 was larger than the largest dose of emetin hydrochloride used by 

 us (1^ grains a day). The single carrier case, however, cleared up, 

 and no relapse occurred, so that it is clear the drug has an action 

 on the parasite but is not as potent as the usually employed hydro- 

 chloride of emetin. It is possible that in larger doses a better result 

 could be obtained. An important feature of the drug is that the 

 nausea and vomiting which so often follow the oral administration of 

 emetin hydrochloride are absent. The patients who had taken the 

 emetin hydrochloride by mouth and who had experienced the nausea 

 following it, stated that they could go on taking the methyl emetin 

 quite easily, and this when double the dose was being given. 



It may be stated safely, therefore, that methyl emetin sulphate 

 has not such a marked action on E. liistolytica as emetin hydro- 

 chloride, but that it causes much less vomiting and feeling of nausea 

 than the latter drug. 



(c) Treatment by Thymol. Owing to a view which had been 

 expressed that thymol as an intestinal disinfectant was a very 

 powerful agent this drug was tried in one case. This was Healy, 

 who had a very large infection of E. liistolytica (cysts and free 

 forms), and who had resisted a course of one-grain emetin injections, 

 a course of emetin by the mouth and a course of pulv. ipecac. 

 Thymol, ten grains three times a day, was given, but it was abso- 

 lutely without action on the infection. 



(d) Treatment by Pulv. Ipecac. The same case, Healy, after 

 having resisted the course of emetin injections and emetin orally, 

 was placed on a course of pulv. ipecac. He was given to start with 

 thirty grains a day, and this was reduced by five grains daily, till a 

 dose of ten grains was reached. This dose was then kept up for 

 eight days, and for the last three days an injection of i grain of 

 emetin was given also. The treatment merely had the effect of 

 temporarily diminishing the infection. 



