February, 1916.] Annual Address. 



11 



some earlier physicians such as McClean and Norman Chevei* 

 although their work had been largely forgotten. By also dis- 

 covering the blood changes which allowed of the recognition with 

 certainty of the early stages of hepatitis in the presuppurative 

 stage and treating it with large doses of ipecacuanha, I es- 

 tablished a simple method of preventing tropical liver abscess, 

 which has now made that disease as rare among patients 

 coming early under skilled treatment as it was formerly com- 

 mon only eight years ago, so that it may now be considered 

 an almost absolutely preventable disease. The administration 

 of the large doses of ipecacuanha by the mouth, which are 

 necessary for its successful use in these diseases, is a trouble- 

 some and unpleasant experience and the greatest advance 

 was still to come. An American physician, Dr Vedder, work- 

 ing in the Philippine Islands, recorded in 1911 some experi- 

 ments showing that the solublen salts of Emetine, one of th< 

 alkaloids of ipecacuanha, would kill water amoebae in dilutions 

 of 1 in 100-000, but curiously enough he did not realize the 

 importance of his observations, and only suggested that it was 

 advisable to analyse samples of ipecacuanha to see that they 

 contained a good quantity of this alkaloid. The mixed alka- 

 loids of ipecacuanha had been discovered as long ago as 1817 by 

 the French chemist Pelletier, who had also assisted in the 

 first isolation of quinine. 



In 1891 Surgeon-Major Warden, I.M.S., working in the 

 chemical laboratory of the Calcutta Medical College, prepared 

 from ipecacuanha emetine mercuric iodide, which Surgeon-Major 

 Tull-Walsh, I.M.S., administered by the mouth in the General 

 Hospital in cases of dysentery, but; he did not recommend it 

 above other drugs, and concluded that it did not matter one 

 straw what drugs were used or how they were given in dysen- 

 tery, so it is not surprising that his paper led to no advance. 

 When I first read of Vedder experiments on the harmless 

 water amoebae with emetine I also failed to grasp their value. 

 I had indeed some years previously attempted some unrecorded 

 experiments with watery effusions of ipecacuanha on dysentery 

 amoebae, but without obtaining any striking results, doubtless 

 owing to the alkaloids being present in a relatively insoluble 

 form. Late in 1911, while on a voyage back to India, I took 

 advantage of the leisure to tabulate and analyse the notes 

 of the amoebic dysentery cases I had treated during the pre- 

 vious two years in the isolation wards of the Medical College 

 Hospital, which had been placed under my charge at my 

 request in connection with my researches on cholera by Sir 



nsely 



tnese opportunities of carryi 

 lines. I was then struck bv 



proved 



amoebic in nature by microscopical examination, I had lost 

 ovfer twenty per cent in spite of very full doses of ipecacuanha, 



