We do not have now the same confidence in emetine injections that we formerly entertained. In Egypt the combination of emetine injections with ½ grain keratin coated tablets of emetine by mouth seemed to give better results in the more chronic stages of amoebiasis.
Very favorable reports have come from the use of emetine bismuthous iodide. This drug is given by mouth in doses not exceeding 3 grains in a day. It is put up in gelatine capsules and a course of treatment is one 3 grain capsule each night for 12 nights. It is supposed that there is no action on the drug in the stomach as it is insoluble in dilute acid but as a matter of fact nausea and vomiting frequently occur and slight purging is common after its administration. During the twelve-day course of treatment the patient should remain in bed and be given a milk diet.
We have recently had success with the administration of ipecac by the duodenal tube and it might be that bismuthous emetine iodide could be given in the same way.
Ross thinks that the flushing action of salines, thus washing away amoebae and necrotic material, is of advantage in amoebic as well as in bacillary dysentery. He also thinks liquid petrolatum of value. Some advise the bismuth treatment recommended by Deeks of giving a large teaspoonful of bismuth subnitrate, in a glass of water, 3 or 4 times during the day.
A decoction made by boiling for 15 minutes one teaspoonful of powdered chaparro in 8 ounces of water and given one-half hour before each meal has been reported on favorably. The powdered roots, stems and leaves of “Chaparro amargosa” are used. This is a plant of Texas and is named Castela nicholsoni. A decoction of about one-half strength of that taken by mouth is recommended for enemata. Simaruba bark is recommended by some practitioners. Its action is similar to chaparro. Benzyl benzoate is recommended for the pains and tenesmus of amoebic dysentery as well as bacillary dysentery. Twenty drops of the 20% alcoholic solution are given three times daily.
Many drugs have been recommended for colon irrigation of which the favorite is probably quinine muriate in dilution of 1 to 1000 or 1 to 2500. Inject 2 or 3 pints slowly by gravity. Protargol in 1 to 500 solution is better than silver nitrate in 1 to 2000. Emetine enemata do not seem to be of much value.
In very serious cases, particularly when gangrenous change in the mucosa may be present, the operation of appendicostomy seems indicated, following which a catheter is inserted and the large intestine irrigated with a 1% solution of bicarbonate of soda to wash away the mucus and later with a boracic acid solution of 1 to 125 or 1 to 10,000 of potassium permanganate.
In a discussion as to certain surgical considerations in connection with appendicostomy Muller notes that the right rectus incision is to be avoided on account of danger of gangrene from pressure of rectus on the stitched-up appendix. He also thinks that appendicostomy is much safer than caecostomy on account of the frequent thinning of the walls of the caecum. For irrigation he prefers a 1 to 500 solution of collargol.
In treating dysentery cases rest in bed and the use of a nonirritating diet are advisable.
The return of the increase of large mononuclears to normal may be used as an index to cure.