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1477 and not intermittent epileptiform crises. Clinically, it may be of importance to recognise these cases, be considered-a as surgical intervention could would which hardly be suggested for proceeding



THE USES OF EMETINE. PERHAPS the most important therapeutic advance recent years is the treatment of amoebic dysentery and hepatitis by hypodermic injection We are indebted for it to Professor of emetine. He found that Leonard Rogers, of Calcutta.1 amcebas were rendered inactive and apparently killed by a solution of emetine as weak as 1 in 100,000. The experience of many observers all over the world have shown the great value of this treatment which produces a veritable sterilisation magna, although curiously the phrase has not been used here, but has been applied prematurely to a still more widely known new remedy. Some recent observations, principally French, show that emetine is useful in other diseases than dysentery. In a communication to the Académie de Medecine of Paris on April 14th M. L. E. Bertrand referred to the fact that Dr. Allen Hutchison, a medical missionary in China, had used emetine with most satisfactory results on patients infected with schistosomum japonicum and passing glairy and sanguineous stools. M. Tribondeau has treated three cases of dysentery in which the stools contained spirilla (without amcebae). In two or three days the stools became normal and the spirilla disappeared. He also found the treatment beneficial in mucous colitis. Haemoptysis and gastro-intestinal haemorrhages are now treated in the French hospitals by emetine. Several communications on the uses of emetine have been made at the Société Medicale des Hôpitaux of Paris. At a meeting on Jan. 23rd, M. Louis Renon referred to excellent results which had been obtained in hsemoptysis. He mentioned two cases of cancer of the lung under his own care in which the haemoptysis disappeared under injections of emetine. He also referred to cases of intestinal haemorrhage due to cancer of the lower part of the large intestine and to membranous colitis in which good results were obtained from subcutaneous injections of 4 centigrammes of emetine. M. Renon himself had obtained rapid results in five cases of severe gastro-intestinal hæmorrhage-hæmatemesis and melnena. In two cases the haemorrhage In one a woman was due to hepatic cirrhosis. had the gall-bladder removed for cholecystitis in November, 1912, too late to prevent gradual infection of the biliary passages and hypertrophic cirrhosis of the liver. While undergoing treatment at Carlsbad severe intestinal haemorrhage occurred and did not yield to ordinary treatment. Duodenal ulcer was suspected and laparotomy was proposed. M. Renon was summoned and thought that ruptured intestinal varices were a more probable cause than ulcer of the duodenum. He advised that operation should be postponed and emetine administered. The drug was not given and the patient’s condition became desperate. When M. Renon saw her again four days later she was pale as death and the pulse was uncountable. Under calcium chloride and the application of cold to the abdomen the haemorrhage had diminished, but on the following day it became more abundant. He injected 6 centigrammes of emetine and 10 cubic centimetres of hsemostyl. The effect was most remarkable ; the hæmorrhage nermanentiv ceased and recovery



THE LANCET, Oct. 19th, 1912,

p. 1062.

the three other cases of intestinal due respectively to tuberculous ulceration, uraemic ulceration, and ulcerative enterocolitis, emetine was used alone with equally good result. M. Renon has obtained striking results from injections of 2 centigrammes of emetine once, twice, or thrice daily in desperate cases of bronchopneumonia in the aged. At the following meeting of the society M. O. Josue and M. F. Belloir reported excellent results from the treatment in intestinal hemorrhage in typhoid and paratyphoid fever and alcoholic hepatitis. At the meeting of the society on March 13th M. Félix Ramond and M. Jacques Durand reported good results in acute and chronic bronchitis in consequence of the more fluid character of the expectoration after injection of emetine in daily doses of 4 to 8 centigrammes.







May number of Public Health contains reports on syphilis and public health, by Dr. F. W. Mott, and studies in the epidemiology of pulmonary tuberculosis, by Dr. A. S. M. Macgregor, both of which are well worth attention from those conAn editorial note cerned in practical hygiene. draws attention to the contrast between syphilis and tuberculosis in the nature of the administrative measures needed to reduce the prevalence of the diseases ; it is pointed out that in syphilis we are concerned mainly with the seed, whereas in the case of tuberculous disease we are increasingly learning how large a factor the soil is in determining the incidence of attack. With the knowledge gained in the last few years there is prospect of doing much by well-designed administration to reduce the mischief caused by syphilis; in the case of tuberculosis, where an elaborate machinery for dealing with individual cases has already come into being, the conditions to be much more complex and the combated are underlying principles of action are less easy These observations have special of definition. relation to the studies made by Dr. Macgregor on the incidence of phthisis on the population of Glasgow judged by notifications, deaths, and the social condition of the cases as evidenced by the number of rooms in the tenements which they occupy. Dr. Macgregor has given the results of following cases notified in 1910 into the present year. Among other interesting figures are those which suggest that in the case of Glasgow children of school age stated to suffer from pulmonary tuberculosis a fatal result, if it occurs, nearly always happens within two years, and that the survival of a phthisical child for two or three years after recognition of its disease establishes a strong probability of its The facts as to contacts in eventual arrest. The the houses affected are also noteworthy. incidence of tuberculosis was distinctly more marked among the contact population than in the general population, particularly in the one-roomed tenements, but there was less gradation than might have been expected in the incidence on the contact populations living in two, three, and four rooms. respectively, and the figures once more raise the disputed question as to the real meaning of the occurrence of tuberculosis in the contact. It would be natural to assume, as is now customary in daily practical work elsewhere among such cases, that the excess of tuberculosis among the contacts resulted from their exposure to the known infection, but it still appears possible to explain a.