The Straits Settlements medical report.

  • Straits Settlements. Medical Department.
Date:
[1912]
Catalogue details

Licence: Public Domain Mark

Credit: The Straits Settlements medical report. Source: Wellcome Collection.

    31/184 (page 29)
    7 grains within 3 days without untoward symptoms. The total amount employed per case on an average was 4 grains spread over 4 days : more prolonged administration is undoubtedly necessary however. The effects were sufficiently striking, the dejecta which at first consisted entirely of mucus and blood and were swarming with amoebae became faecal with only traces of mucus after 3 days in 50 per cent of the cases and by the fifth day in over 80 per cent while living amoebae were found after the third day in only three cases. The mechanism of this effect is very obscure, a direct action of the drug on the parasite being difficult to conceive unless on the hypothesis of an elective excretion into the colon. But of its activity there can be no doubt and the too glowing accounts in the papers referred to have not succeeded in producing much disappointment as the result of its trial. With the powdered Ipecacuanha administered as described a similar effect requires on the average 3 days, the stools becoming faecal on the 4th day with great regularity. In three cases only in a large experience have the symptoms persisted and living amoebae continued in the dejecta during the administration of Ipecacuanha root. In only one of these unfortunately was it possible to administer Emetine but in this case with distinctly beneficial effect. It is difficult to account for the unfavourable results obtained by ROGERS with Ipecacuanha root. His figure of days before the stools became normal is belied by all our experience and this with Chinese patients who suffer much more severely and respond much less readily to treatment than natives of India as is indicated by the death-rate and by the average duration in hospital before discharge. The disadvantages of the Ipecacuanha root however are distinct: the sickness and vomiting produced may be most distressing and may even in rare cases quite contra¬ indicate the drug. It has occurred more than once that a coolie prefers absconding unrelieved to repetition of the nauseating dose. Also the amount actually absorbed is always to some extent doubtful when compared with the neat and certain subcutaneous form of administration. Against the use of Emetine the chief argument is its cost. The employment of drugs at 30 cents a dose in the case of coolies cannot be justified from the stand-point of a correct economy where an almost equally efficient though disagreeable alter¬ native exists. As long as coolies can be replaced for $30 a head large employers of labour are bound to regard the loss of these from a possibly inadequate treatment with greater equanimity than they would a heavy expenditure on drugs. It has been thought however that this difficulty might be overcome by employing the crude alkaloids extracted from the root by some process within the power of a competent pharmacist. Dr. Dent, the Government Analyst, has been good enough to interest himself in this and is at the time of writing engaged in simplifying such a process. The uncrystallised mixed alkaloidal salts which he has prepared have been used by subcutaneous injection in 30 cases already and hitherto with excellent results: there have been no disagreeable effects local or general and the specific action appears quite equal to that of the pure crystallised Emetine Hydrochloride. Of the 30 cases four have died : in three a complication was the immediate cause of death, the amoebic ulceration showing at the post-mortem evident signs of healing: the fourth died within 48 hours of admission. On the publication of Dr. Dent’s method then it may be hoped that a cheap efficient and simple mode of treatment of amoebic dysentery will be available and may be recommended to physicians in charge of rubber estates, plantations, etc., where business principles forbid the use of the pure salt at its present inflated price. Relapses.—With both Ipecacuanha Root and Emetine relapses are frequent occurring as a rule within a fortnight to a month after stopping the drug. These have responded favourably to a repetition of the treatment. I consider it important to continue the administration of ipecacuanha for at least a month where possible prefer¬ ably in the form of Dover’s powder. Bacillary Dysentery.—The bacillary variety is treated in this hospital by the routine method of frequent doses of Salines but during the latter part of the year Anti-dysenteric serum has been employed in 12 cases with fairly good results. In 4 early cases with a history of under 1 week the injection, of 25 c.c. of this intravenously acted like a charm, all the symptoms disappearing and the stools becoming faecal within 48 hours. The remaining cases had a history of 10-14 days before admission and were extremely ill. Four of them died within 5 days, the post-mortem showing a complete destruction of the mucosa of the colon and recovery hence practically impossible. In one case 75 c.c. were injected intravenously during the two days after admission: the patient improved