KEVIEW — ^TROl'ICAL MEDICINE, ETC. 53 



nursing is available, lavage is valuable. (8) Any morbid condition of the blood must be Dysentery- 

 attacked, i.e. malarial infection by quinine and diminished alkalinity by lactate of sodium. cunUmud 



For amcebic dysentery, ipecacuanha is stated to be the sovereign remedy. Thirty to 

 forty grains, presumably with the usual precautions, are administered at first and the dosage 

 diminished every night. Then castor oil with or without opium is exhibited, very small 

 doses being given. Finally, simaruba with aromatics and an intestinal antiseptic, such as 

 salol or salicylate of bismuth, conclude the cure. 



Vaillard and Dopter^ report most excellent results with the anti-dysenteric serum 

 prepared in the Pasteur Institute, Paris. It was found to greatly lessen mortality, to 

 diminish the severity of the symptoms, and to hasten recovery. They insist on early 

 administration, the giving of sufficient dosage, regulated by the gravity of the case, judged 

 by the numbers of stools in the 24 hours and general symptoms of intoxication. In cases of 

 moderate severity, 20 c.c. suffice. In very severe cases, up to 100 c.c. may be given 

 repeatedly each day till improvement results. 



Sandwith,- in a review of the whole subject, mentions chronic " dysentery carriers," and 

 the rare occurrence of mixed bacillary and amcebic cases. He details the serum rules 

 (Shiga) in Japan. These are (1) in mild cases the serum is injected in one dose of 10 c.c; 



(2) in cases of average severity, a second time after an interval of from six to ten hours ; and 



(3) in severe cases repeated twice daily for two or three days. The serum is derived from 

 horses repeatedly inoculated subcutaneously with an emulsion of Shiga's bacillus in a normal 

 saline solution which has been heated to 60° C. 



By medical treatment alone, patients recover in 40 days or die on the eleventh 

 day ; by the serum treatment, they recover in 25 days or death is postponed till the 

 sixteenth day. 



A polyvalent serum is likely to prove the best, there being so many different strains of 

 dysentery bacilli. Ipecacuanha for amcsbic dysentery was found disappointing in Egypt, 

 and calomel is not recommended, but the fractional method of dosage is not considered. 

 The sulphate of magnesium or sodium treatment gave good results in Egypt. Eules for 

 lavage are mentioned, one pint of fluid increased rapidly to two pints being the quantities 

 usually employed, and the value of this treatment in certain instances before cases have 

 become chronic is emphasised. 



Castellani^* has tried the opsonic treatment in a case of chronic dysentery with 

 marked success. The Kruse-Shiga bacillus isolated from the stools was used in the 

 preparation of the vaccine. 



Drake, ^ writing from Assam, reports very favourable results from the administration of 

 gr. 5 yellow santonin with dr. 2 of olive oil. Unfortunately he does not say what type 

 of dysentery was present. It is quite possible that it may have been the verminous variety, 

 which would explain the beneficial action of an anthelmintic drug. 



Forster^ has a paper on the vaccine-therapy of dysentery. The vaccine employed 

 consists of a dead emulsion of B. Shiga in normal salt solution to which 0-5 per cent, of 

 carbolic acid has been added. The emulsion is prepared from 24-hour agar slope cultures 

 and is killed by heating to 60°-63° C. in a water bath for twenty minutes. 



Stephen" records a case of old-standing dysentery in a British Officer treated with this 

 vaccine. Perfect cure apparently resulted after three inoculations, although the patient had 

 previously been practically incapacitated for work during a period of five years. 



1 Vaillard and Dopter, C. (April 26th, 1907), " La Serotherapie dans le Traitement de la Dysenterie BaciUaire." 

 Aim. de I'Inst. Pastcvr, t. XXI. 



- Sandwith, P. M. (December 7th, 1907), " Hunterian Lectiu-e on the Treatment of Dysentery." Laiicci, 

 p. 1589, Vol. II. 



3 Castellaui, A. (1907). Arc!ai\ fur Si-Mjls uiul Trap. Hyg., Bd. XL, Heft. 3. 



■• Drake, D. J. (November 1st, 1907), "The Treatment of Dysentery by Yellow Santonin." Journal of 

 Tropical Medicine, p. -3.51, Vol. II. 



5 Forster, W. H. C. (June, 1907), " A Preliminary Note on the Application of Vaccine-Therapy to Dysentery." 

 Indian Medical Gazette, p. 201, Vol. XLII. 



« Stephen, L. P. (October, 1907), " Case of Old-Standing Dysentery treated by Vaccine-Ther.ipy." Indian 

 Medical Gazette, p. 375, Vol. XLII. 



* Article not consulted in the original. 



