PART III. TREATMENT 119 



(i) Effect of Emetin on the Patient. Gastro-Intestinal. Emetiii 

 administered by the mouth causes vomiting in many instances. In 

 the Tables XI and XII, showing the various groups of cases treated, 

 the number of times each patient vomited, if at all, is shown in a 

 special column (E). This only occurred after emetin orally adminis- 

 tered, and the patients did not vomit more than once after any 

 single dose. Emetin injections do not produce vomiting, though 

 some complain of a feeling of nausea. At first the drug was given, 

 as explained above, dissolved in tinct. opii, the requisite dose being 

 taken in a cup of tea at night. This caused vomiting very easily, 

 especially in some cases, so that finally this method was abandoned 

 in favour of emetin in the form of keratin-coated tabloids. Even 

 this caused a good deal of vomiting, but usually it was an hour or 

 more after taking the dose. In the group of cases treated both by 

 injection and orally, one case (Pero) vomited almost at once after 

 each tabloid, so that after six nights the ^-grain tabloid by the 

 mouth had to be discontinued. Vomiting so quickly after the 

 tabloid was, however, the exception. One of the cases (Dewhurst) r 

 treated exclusively by emetin by the mouth in the tinct. opii tea 

 mixture, vomited after ten of the twelve doses, as will be seen 

 by the chart of his case. In spite of this the E. liistolytica infec- 

 tion disappeared and there was no recurrence. Case Spiers, who 

 had resisted twelve injections of emetin, was given emetin by the 

 mouth, one grain in keratin-coated capsule. The dose was taken 

 at night before going to sleep, but though the patient made every 

 effort to prevent this, he vomited on two nights, once after two- 

 hours and once after three. Nevertheless, the amoebae disappeared 

 immediately from the stool, though they were present in enormous 

 numbers before. It is thus evident that though the drug may 

 cause vomiting the bulk of the dose taken is retained. As regards 

 the vomiting after the drug, a great deal depends upon the 

 determination of the patient to withstand the inclination. When 

 several patients in one ward are receiving the treatment it often 

 happens that if one of them vomits the others follow suit at once.. 

 One case (Healy), which proved very resistant to emetin, was given- 

 emetin 1^ grains by the mouth for twelve days. There was a 

 strong feeling of nausea, but the patient made heroic efforts and 

 was able to prevent himself from vomiting on every occasion except 

 after the first dose, though this was not till six hours after it was 

 taken. 



It seems that a certain resistance to the nauseating effect can 

 be acquired, and though the first two or three doses may be followed 



