TREATMENT OF AMEBIC DYSENTERY 135 



Treatment and Prevention. — One of the greatest discoveries 

 in the field of medical treatment since the production of salvar- 

 san by Ehrlich is the discovery of emetin as a specific poison for 

 amebffi. Emetin is an alkaloid substance prepared from ipecac, 

 the extract of the roots of a Brazilian herb. It was long known 

 that ipecac sometimes had a very marked effect on dysentery, 

 but since amebic dysentery has only recently been differentiated 

 from other forms very variable results were obtained from its 

 use. Ipecac has a decided disadvantage in that it causes violent 

 vomiting, but its alkaloid, emetin, in the form of emetin hydro- 

 chloride, while possessing all the amebicidal properties of ipecac, 

 can be used in the form of injections into the veins, and therefore 

 does not cause vomiting. Experiments with cultural species of 

 amebse showed that emetin (emetin hydrochloride) is destructive 

 to amebse when diluted 500,000 times, and the intestinal amebse 

 on a microscope slide become round and motionless and ap- 

 parently dead when subjected to this very dilute solution. 



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. It is probable that 

 self-infection from the remaining cysts is the cause of the fre- 

 quent cases of recurrence of amebic dysentery after inadequate 

 treatment. Under continued treatment the cysts gradually dis- 

 appear 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 the healing of the lesions, and also as an 

 amebicide. Another aid to the efficiency of emetin is a daily 

 enema of saline salt solution, since this tends to eliminate the bac- 

 teria which are apparently necessary for the welfare of the amebse. 



Another preparation of emetin, alcresta ipecac, is effective 



