SUPPLEMENT 619 



laudanum in i oz. of mucilage of starch or by using gr. morphia 

 or gr. codeine suppository. A dose of castor oil (5iv to 5vi) with 

 or without a few minims of liquor opii sedativus or a few doses of 

 saline may be given during the first twenty-four hours. After the 

 castor oil has acted or simultaneously, emetine treatment should be 

 commenced ; ^ to gr. of emetine hydrochloride, dissolved in sterile 

 normal salt solution, is injected hypodermically three times a day for 

 two or three days. 



If emetine cannot be obtained, 5 gr. doses of ipecacuanha every 

 three to six hours in the form of membroids, or as pills coated with 

 salol or keratin, can be substituted. 



After acute symptoms have disappeared, intestinal irrigations once 

 or twice daily, on alternate days, are useful. A solution of tannic acid 

 (3 to 5 per 1,000) or of quinine bihydrochloride varying in strength 

 from i in 5,000 to i in 750 is very slowly injected in quantities of 

 \ to 3 pints by means of a long, soft, rectal tube. 



For gangrenous dysentery Castellani and Chalmers state that 

 appendicostomy, with irrigation of the whole lower bowel with 

 quinine lotion (i in 1,000) or collargol (i in 500), is the only chance. 



The use of emetine should be continued in smaller doses after the 

 dysenteric symptoms have ceased, in order to prevent relapses and as 

 a possible safeguard against the development of a liver abscess. 



Recently (July, 1914), Dr. W. E. Decks 1 has given an account of 

 his successful procedure in dealing with the dysenteries in the Ancon 

 Hospital, Panama Canal Zone, of which medical clinic he is the chief. 

 With regard to amoebic dysentery he advocates : (i) Rest, to increase 

 the patient's resistance ; (2) a generous milk diet, which is practically 

 all absorbed before it reaches the large bowel ; (3) saline or plain 

 water irrigations, one to three daily ; (4) the administration of 

 bismuth sub-nitrate in heroic doses ; 180 gr. is given mechanically 

 suspended in about a tumbler of plain or effervescent water every 

 three hours, day and night in severe cases, only lessening the amount 

 when improvement takes place. Mechanical suspension in a large 

 quantity of water is essential. When the stools begin to decrease in 

 number and the tongue becomes clean, the number of doses is reduced 

 to three or four daily. In very chronic cases one or two doses daily 

 for a month after convalescence are recommended. 



In exceptional cases of extreme emaciation and exhaustion, 

 showing marked toxic symptoms, surgical treatment is necessary, 

 and at Ancon a wide, open caecostomy is performed. 



The treatment of dysentery with bismuth sub-nitrate has been in 

 use for some years at Ancon. Latterly, a combined treatment by 

 hypodermic injections of emetine and bismuth sub-nitrate by the 



1 Annals Trap. Med. and Parasitol. , viii, pp. 321, 353. 



39 



