Has emetine any influence on the schistosomes?

82

H.4S

EMETINE

ANY

INFI,UENCE

ON’

THE

SCHISTOSOMES?

In lMarch, 1~16, I treated an East’ Indian immigrant, who suffered from amoebic dysentery, with emetine. The patient received each day a subcutaneous injection of one grain of emetine hydrochloride on five successive days, with the usual good effect on the dysenteric symptoms. ‘l’he stools of this man had been containing also ova of .S?/?istoso?~cnt tmztmm’, and I was rather astonished when I could not find these eight days afterwards. I repeated the eSamii&icJn 011 Sixteen follOWin g days always with the same negative rewlt. This made me try a .series of five injections of one grain of emetine with other patients shewing the e.ggs in the fzzces, the results of which, together with those of the first patient, are given m the table below. Each time at least t‘hree slides nnd, as a rule, 4-12 were examined either by myself or by trained assistants wLen the eggs could not be found. In several of the cases 1 put a premium on the finding of the eggs, which, as the table shews, I often lost in the end. ‘The results can be summarised aci follo\vs: I. As a rulk the eggs disappear from the slools after about a week. In a few cases they do, not disappear, but they are found I(w frequently (12, I 6, 18), or even this is not obvious (19); but then thc)r may still disappear after a second course of mjections (16, 18). 2. :lfter about two months, sometimes sooner, already the eggs are found again, but can be made to disappear by a second course of injections. Point I can be explained as fo~!ows : It takes about a week for the eggs -to work themselves out of the tissues into the lumen of the Tectum. and no new eggs are laid in the wall of the rectum by the .worms for some reason, e.g., they may be dead or have mc>ved away from the vrins there to the larger veins of the portal system. l%int 2 can be explained by the worms returning to the rectum wall, either the old 011~5 or other worms, c,~., younger worms, which hdd not yet left the portal vein when the injections were given. ‘l’he reappearance of the eggs is too common to be explained by reinfection. Schistosomiasis is not a severe disease in I)utch Guiana, at least not in the very large majority of the cases. Nearly all the patients of the Table shewed no intestinal symptoms at all, and the eggs were only found in the routine examination of the fzces. \Vhen they had intestinal symptoms, dysentery like symptoms, for instance, I very often found amwbze or dysentery bacilli by which they could be explained. 1 believe that the presence of t,lie schistosome:,, probably the passage of the eggs through the mucosa, predisposes to mfections with dysenlerial organisms. On the other hand, I met with cases where no such organisms could l,e found and still there was passage of mucus and blood and abdominal pain. ‘l’he emetine has a beneficial and often a very striking effect on these symptoms. This is readily understood when amcebze are present, but in the other cases there must be some. other action on the diseased mucosa. It is always possible, however, that a small number of amczba \rere at work but not discovered. I

HAS

EMETINE

ANY

INFLUENCE

ON

THE

SCHISTOSOhIES?

83

think one must not too hastily ascribe all sorts of abdominal troubles to the schistosomes, when eggs of .%/asfoso~lcum m~so,kiare found. l’here is no doubt, of course, tha‘t in some cases the worm5 are able to cause serious damage. In Dutch (Guiana, however, this is rare. I never met with a case of death due to schistosomiasis, although in the course of three years more than two hundred cases have entered the hospital ill l’aramaribo, nearly all of them for other diseases. Patient number 4 of the Table had a definite polyposis recti, and a few of the tumours removed by operation contained agreat number of the eggs. It was necessary of course to control the patients during a long time, and it was very difficult to get the fzeces of these people for examination when they had left the hospital. This was one of the reasons why I did not continue these controls. Then 1 did not like the explanation of the disappearance and reappearance of the eggs, because it was SO hypothetical, and I saw no chance to prove or to disprove it. It was desirable to know whether the emetine killed the worms in the rectum wall or not, and this could only be proved by a post-mortem shortly after a course uf injections. I near had such a chance. It would be worth while to know, it’ one could be freed permanently of the eggs in the faxes by an intermittent treatment with emetine. I:ut as the persons that I saw harbouring the worms had not suffered from them for a long time, they tleclined to It is even possil)le that tljrre was no influence on the receive these repeated injectiof,>s. schistosomes at all, and merely on the mucosa tlm~ugh which the eggs have to pass. ‘J’he results obtained, however, can hardlv be ascribed to mere chuncx. DIAMANTIS had son!e results &it11 enletirle in I)ilhaGal hematuria in Egypt (E-up. LG. B&L., Vol. XI . No. 2). MARTIN &IEYBK noticed improvement in a patient aufferiug Cram urinary and inlestinal bilharziasis. and 1,“~~ 1 ROOF in a patient with rectal bilharziasis (Tn$. iAs. Bul/., Vol. XII., No. 3). It was wly arter I had read the results of these authors that I thought it worth while to publisll my own experiences. ‘l’hey leave no doubt that emetine has an influence on the symptoms in rectal schistosomiasis due to SC~~SJ’OSO~U~ mumom’, but I cannot say whether the dru, (r is able to kill off the worms. On the followicg page is a ‘I’able shewing the influence of emetine on the presence of eggs of ScKsfosomum mamom’ in the stools :-

84

HAS

EMETINE

ANY

INFLUENCE

ON

THE

SCHISTOSOMES?

‘~‘AHI,ESHEWINGTHE INFLUENCE OF EMETINE ON THE PRESENCE SCHISTOSOMUM MANSONI IN THE STOOLS. + meanseggsfound.

1 means

eggs

tiot found.

OF

EGGS 01

5 period of emelineinjections.

RAPHAEL

BLANCHARD.