120 HUMAN INTESTINAL PROTOZOA IN THE NEAR EAST 



by a desire to vomit, the later doses can be taken with impunity. 

 Case Healy, who took the 1^ grains for twelve days, found this most 

 marked, and felt that finally he could have continued without any 

 ill effect in this direction. 



Emetin administered by the mouth, as already explained, tends 

 to produce looseness of the bowels, so that if the drug is being 

 administered in this way it is unnecessary to give salines. We have 

 not noted any tendency to diarrhoea as a result of emetin adminis- 

 tered subcutaneously alone, nor has the emetin produced any 

 haemorrhage from the bowel, as it is supposed to do sometimes by 

 causing some change in the vessels about the ulcerated areas. 



Local The subcutaneous injection of emetin has produced 

 very little local effect. The only cases which have complained of 

 any local trouble have been nervous, highly sensitive individuals 

 who have stated that the injection of emetin was followed by pain 

 at the site of injection. The majority of cases, however, have taken 

 the injections without any complaint. In one case, in which twelve 

 one-grain injections were given into the right arm, the last injection, 

 the only one given in the forearm, produced a tingling in the hand 

 and elbow. It is probable that in this case a nerve was accidentally 

 injured. 



General. In certain cases the emetin seerns to produce a feeling 

 of stiffness and weakness in all the limbs and a general lassitude. 

 Case Spiers, who had the twelve-grain course of emetin while he 

 carried on his regular office work, noted this weakness especially in 

 the legs. 



Heart. The possible deleterious action of emetin on the heart 

 is of great importance. It has been reported from time to time 

 that emetin has caused not only derangement of the heart's action 

 but even death in some instances. Dale has noted that in cats 

 there is definite evidence that emetin in large doses is cumulative 

 in its action, so that care has to be exercised in its administration. 

 On this account we have paid very special attention to this point 

 in the treatment of our cases, the pulse-rate and temperature 

 having been kept regularly. We can say that in only two instances 

 were any signs of heart trouble noted. In one case (Kettlewell) 

 there had been given twelve one-grain injections of emetin, and 

 as this had not abolished the infection the patient was placed on 

 dysentery diet, kept in bed and given 1^ grains of emetin by the 

 mouth for four days, followed by one grain for eight days. When 

 he got up after the treatment he felt weak, a condition which must 

 have resulted not only from the emetin he had had, but also from 



