Peripheral Neuritis Following Emetin Treatment of Amebic Dysentery

A. R. Kilgore
1916 Boston Medical and Surgical Journal  
orrhage. Kunkel (quoted in A. M. A., Nov. 13, 1915, p. 1730) recalls an earlier belief that emetin caused anemia of the lungs and therefore tended to relieve hemoptysis and to have, a beneficial effect on pulmonary tuberculosis. He traces this belief to the observation that the pulmonary vessels of animals killed by emetin were empty, a condition really attributable to splanchnic dilatation and drainage of the blood •from the lungs. This explanation of the effect of emetin on hemoptysis thus
more » ... hemoptysis thus calls in the lowered blood pressure of emetin, but goes on to claim pulmonary anemia as beneficial, when the opposite is now recognized, as, for instance, the rare association of pulmonary tuberculosis with a leaking left heart. The idea of emetin as a remedy for hemoptysis originated apparently in France. Flandin and Joltrain, for example, made a report in the Presse Médicale, in April, 1913, regarding the value of emetin in tuberculosis. Raeburn, in the British Medical Journal in the following year (p. 703), followed with an enthusiastic report which speaks for itself. He divides his cases for emetin treatment into three groups: 1. Bronchitis, where no tuberculosis could be demonstrated. If the heart was in good condition, these cases usually showed improvement, which generally continued after the emetin was stopped. This is surely far from conclusive, as the natural rejoinder is that if ipecac had been used in the place of emetin, improvement might well have been still faster. 2. Cases of clinical tuberculosis with no tubercle bacilli in the sputum. Raeburn here admits that improvement might, have been charged to diet and hygiene, but thinks there was a really beneficial action in the congestive stage. 3. Cases with tubercle bacilli in the sputum. Here his results were much less regular, and he draws no conclusion of specific improvement. One may conclude justly that the emetin showed its only beneficial effect in the cases of bronchitis and in tuberculosis where the bronchitic symptoms were prominent, and that it was the expectorant action of emetin which aided, and not any direct influence on the tuberculous disease. In some twelve cases of hemoptysis in which emetin was administered, all in advanced pulmonary tuberculosis, I have failed to see any faorable effect which could not be explained by other factors more plausibly than by the emetin. To summarize, then, in so far as emetin has a beneficial action in tuberculosis, it would seem to be due to its expectorant properties, and if so, other preparations are preferable. In so far as emetin has a beneficial action in hemorrhage, it would seem to be due to the indirect result of decreasing blood pressure, and if so, other drugs would be more effective, in that they would produce a similar result more safely and without the specific action of emetin on coagulation. Constipation. Levy and Rowntree make the suggestion, which can hardly be taken seriously from the clinical point of view, that emetin enemata would subserve a useful purpose in the treatment of constipation. Such cncinata havo an undoubted value when properly used for the sake of the amebicidal action of the drug, but their use as here suggested docs not seem well advised. Other Conditions. Like all new and widely noted remedies, emetin has been tried and commended in a great, variety of diseases. But it will hardly replace Leonard Rogers' hypertonic infusion in Asiatic cholera. And few of its other applications will bear the test of careful expérimentation. It has proved serviceable in the treatment of certain other diseases caused by animal parasites, especially protozoons, but the major uses have been described under its amebicidal action. PERIPHERAL
doi:10.1056/nejm191609141751104 fatcat:hizeetdigremrekhrzsdjgxvky