138 AMEB.E 



thought however, that emetin acts rather by its effect on the tissues 

 of the host than by its direct poisonous action on the amebse. 

 Emetin is given in hypodermic injections. Almost without 

 exception the effect of the drug on the disease is certain and rapid. 

 Severe cases which have been running on for years can be cured 

 in four or five days by this simple treatment. One of the chief 

 disadvantages is that the treatment is often discontinued too 

 soon. The dysenteric symptoms disappear as if by magic and 

 the patient is often not willing to be subjected to continued drug 

 injections until every trace of the amebse has disappeared. 

 Emetin is powerless against encysted amebse and an apparently 

 cured patient may continue to harbor and scatter these dangerous 

 microscopic particles of living matter for some time, thus en- 

 dangering other members of the community. Possibly self- 

 infection from the cysts lodged in the tissues of the intestine is 

 the cause of the frequent recurrence of infection after inadequate 

 treatment, but it is more probable that some of the free parasites 

 escape the action of the drug and continue to multiply and de- 

 velop new cysts. Under continued treatment the cysts gradually 

 disappear from the intestine, but their exodus is hastened by purges. 



Bismuth subnitrate has been used with good success in con- 

 junction with emetin, the bismuth acting as a sedative on the 

 intestine and aiding in healing of the lesions, and also as an amebi- 

 cide. A daily enema of saline solution also seems to aid the 

 efficiency of emetin. 



Another preparation of emetin, alcresta ipecac, is effective 

 against dysentery amebse, though not so certain in its action 

 as the hydrochloride. It has an advantage in that it can be 

 taken in the form of tablets when a physician is not available 

 and the apparatus for hypodermic injection is not at hand. 

 Some doctors in southern United States have advocated the 

 use of extract of a common southern plant, Chaparro amargosa, 

 to destroy intestinal amebse. This extract is very cheap and en- 

 tirely devoid of danger in ordinary doses, but its use in place 

 of emetin has not yet been sufficiently justified. 



Walker and Emrich have recently (1917) reported the success- 

 ful use of oil of chenopodium for treatment of mild cases of amebic 

 dysentery, and especially of " carriers." It is pointed out that 

 emetin in its various forms is often inefficient in treatment of 

 carriers on account of its powerlessness against encysted amebse 



