THE DYSENTERIES— AMCEBIC 43 



by the mouth per diem in this way. It can also be given inlravenously, 

 o'lo grm. dissolved in lo c.c. of saline daily. 



10-20 per cent, of cases are not cured by emetine. 



Emetine bismuth iodide in gelatine capsules, one grain (o"o6 cm.) 

 thrice daily per os until 36 grains have been given, has now superseded 

 the emetine hydrochloride treatment. It has cured '' emetine-resistant " 

 cases. 



There are several good alternative treatments, e.g., tincture of 

 opium, 15 minims, followed in fifteen minutes by ipecacuanha, 10-20 

 grains in cachet or pill, twice daily. The best Brazilian ipecacuanha 

 should be used, as it contains 72 per cent, of emetine. 



In the chronic stages, use daily intestinal irrigations of quinine 

 bihydrochloride, 1-5,000 to 1-1,000, ^-^l litres slowl}' injected through 

 a well-vaselined rectal rubber tube. 



Tannic acid is good, 5-1,000. Also protagol, 1-500. 



These could be preceded by a morphia suppository half an hour 

 before. Later a bismuth mixture could be given, followed by a tonic. 

 It is a good practice to give small doses of emetine later to prevent 

 relapses. 



There could, of course, be a combined treatment of emetine and 

 ipecacuanha. 



Decks strongly advocates the bismuth-milk treatment as follows : — 



Rest to increase resistance and diminish bowel movement. Generous 

 milk diet — it is absorbed before reaching the large bowel. Saline or 

 water irrigation thrice daily to wash away toxic products. Bismuth 

 subnitrate, grains 180, a heaped teaspoonful, mechanically suspended 

 in a tumbler of water; effervescent, three hourly, day and night in 

 severe cases, reduced as the patient improves. When the stools are 

 few and the tongue clean give it thrice daily. The bismuth salt locks 

 up the free and the nuclear sulphur of the bacteria in the intestine. It 

 destroys certain organisms and influences others. 



Entamoeba show early degenerative changes (James), become 

 vacuolated, swollen and fragmented. The characteristic faecal odour 

 disappears. The entamoeba usually disappear after the fourth day, no 

 matter how serious the condition. 



Too much opium favours retention of toxic products that irritate 

 the normal mucous membrane and interfere \\illi (he production of 

 enzymes and hinder digestion. 



C^costomy in selected cases of emaciation and exhaustion (Herrick) 

 should be done. It prevents food residue from reaching the ulcerated 

 colon, admits of better irrigation of the bowel, and makes possible a 

 more varied and generous diet ; but, on the other hand, convalescence 

 is lengthened and a restorative operation is necessary later. 



