It was found by Baermann and Heinemann that subcutaneous injections of from 2 to 2½ grains daily caused indisposition and anorexia. The subcutaneous injections are less painful than the intramuscular ones.
Rogers has used emetine intravenously in doses of 1 grain without bad effect.
Vedder calls attention to the fact that the minimal fatal dose of emetine is several times less when administered to rabbits intravenously than when given subcutaneously, so that after seeing rabbits die with what was apparently centric paralysis immediately after intravenous doses of comparatively small amounts of emetine hydrochloride he would hesitate before administering 1 grain intravenously in a human case.
Levy and Rowntree think emetine should not be given intravenously except in extreme cases. Among ill effects of emetine they note peripheral neuritis. Kilgore has reported such cases where even wrist-drop was seen.
Low has treated cases successfully with keratin-coated tabloids of emetine hydrochloride, giving ½ grain every night. Vedder has not obtained satisfactory results with the drug by mouth.
Rogers considers that 15 grains of emetine is the fatal dose for an adult man and as there is possibly a cumulative action it would seem safer to continue the drug only for ten days and then later repeat the course of hypodermics. Of course emetine cannot cure the ulcerative lesions of amoebic colitis and as bacillary infections are apt to set in when damaged tissues are present and, as such infections do not yield to emetine, one must be prepared for failure in treatment of symptoms in such cases.
Recognizing the great importance of immediate treatment to prevent extension of the ulcerative process, as well as against abscess, the rule was adopted in the medical care of the English forces, in the Mediterranean, to give emetine so soon as a case of dysentery was seen, not waiting for a determination of etiology. The treatment ordered was 1 grain of emetine, hypodermically, every day for ten days, or ½ grain morning and evening for ten days. There must not be any intermission of a single day.
Before the introduction of emetine the usual treatment was with ipecac.
It was customary to give 20 to 50 grains of powdered ipecac in capsule, cachet or keratin-coated pills to a patient with an empty stomach and who had had a dose of morphine or laudanum about 20 minutes before the time for giving the ipecac. The salol-coated ipecac pills are generally used in America. The patient should be in bed and should try to yield to the soporific influences of the opiate. Any flow of saliva should be removed with gauze as its swallowing would provoke nausea. Some use a mustard poultice to the epigastrium. It is remarkable the change which this treatment will effect in the number and character of the stools.
Many now think it advisable to give emetine hypodermically to reach the amoebae deeply seated and, at the same time, to give ipecac by mouth to destroy more superficially situated ones, or those in the lumen of the gut. Alcresta ipecac has been recommended as a good method of giving ipecac by mouth.