Page:Tropical Diseases.djvu/579

XXIX] result. In cases where hypodermic injection cannot be made the emetine may be given per os in capsules in 1-2-gr. doses without provoking vomiting, and in very acute or chronic cases in solution by rectal enemata. The hypodermic injection is often followed by slight irritation at the site of injection, but as a rule by no more serious symptoms. The intramuscular route is free from this objection. It is advisable to combine the emetine treatment with small doses of some aperient, preferably castor oil. Rogers's discovery was suggested by Vedder's valuable work on the action of ipecacuanha on amœbæ. Working with cultures of S. dysenteriœ, Vedder found that solutions of ipecacuanha had no effect on cultures of that organism, but in cultures of amœbæ he found that a dilution of 1 in 10,000 to 1 in 50,000 was enough to destroy them, though solutions of ipecacuanha sine emetinâ had no deleterious effect. The toxic constituent of the ipecacuanha was thus shown to be the emetine salts; they killed amœbæ in dilutions as high as 1 in 100,000. The physiological action of emetine was ascertained to be negligible; 7.5 gr. failed to produce vomiting when injected into a dog. The use of emetine, especially its abuse, is not altogether free from risk. In a considerable proportion of cases it gives rise to diarrhœa and, in a few, to degrees of peripheral neuritis characterized by feelings of weakness, sometimes amounting to paresis of the extremities, and impairment of deglutition. Barlow remarks that if it be continued in full doses for from two to four weeks the consequent diarrhœa of irritation may aggravate rather than cure a dysentery.

Aperient sulphates.— In bacillary dysentery ipecacuanha is valueless. In this type of the disease the aperient sulphates are indicated, especially sodium sulphate as being less irritating than magnesium sulphate. Either may be given in drachm doses in a little hot water, or in cinnamon water, every quarter of an hour until a purgative effect is produced; or they may be given in a large dose— half an ounce —to begin with, followed up by smaller doses if necessary. These large doses must not be given when the patient is feeble or in any sense collapsed. Buchanan, speaking from a large experience of dys-