730 



ACUTE INFECTIOUS DISEASES. 



benefit from the application of leeches to the abdomen (in adults ten 

 to twenty), and allowing the bites to bleed for a time under the poul- 

 tices. Internally we may give an emulsion, and at evening a moderate 

 dose of opium. This treatment is enough for many cases of mild dys- 

 entery ; but in others, in spite of it, the passages increase in number, 

 the tormina and tenesmus are more severe, and the fever augments 

 greatly. In such cases, as well as in the higher grades of dysentery 

 where local abstraction of blood is almost always indicated, the ad- 

 ministration of calomel with opium is the most trustworthy treatment. 

 It is customary to give one grain of calomel with a quarter of a grain 

 of opium every two hours ; and I think this treatment, especially when 

 combined with five to ten grains of Dover's powder at bed-time, de- 

 serves the preference over large doses (gr. x) of calomel, which have 

 also been recommended. If salivation result from the continued use 

 of calomel, we must stop it, and continue the opium alone, then it is 

 best to give the tincture in mucilage, or in a weak infusion of ipecac. 

 In just such cases a combination of opium and acetate of lead is highly 

 spoken of. But I always consider it best, besides the small doses of 

 opium given during the day, to give a full dose at night. If this treat- 

 ment also fail, we have still less to expect from the internal adminis- 

 tration of nitrate of silver and the vegetable astringents, especially 

 tannin. According to my experience, the employment of the latter 

 remedy in the form of enema, which is praised by many authors, is 

 objectionable on account of the difficulty of giving a clyster when the 

 tenesmus is so great, and on account of the increase of the tenesmus 

 caused by the most careful injection as well as by the medicament 

 itself. Moreover, if the remedy is to come in contact with the whole 

 of the diseased surface, the enema must be very large ; the contents 

 of a simple enema syringe do not pass much above the rectum. In 

 the highest grades of dysentery, treatment is almost always with- 

 out benefit. The great prostration of the patient, the threatening 

 paralysis forbid the abstraction of blood as well as the administration 

 of calomel and opium, and we must limit ourselves to maintaining the 

 strength of the patient as well as possible, and preventing general 

 paralysis, by the administration of tonics and stimulants. In chronic 

 dysentery, especially when the tenesmus has abated, enemata of solu- 

 tions of nitrate of silver or sulphate of zinc deserve most confidence. 

 If there be no collection of faeces above the seat of disease, or if the 

 muco-purulent and bloody masses are accompanied by the passage of 

 thin faecal matter, we may give astringents internally also, and in such 

 cases I prefer catechu ( 3 ij to v j water and ss gum-arabic, a table- 

 spoonful every two hours) to tannin and nitrate of silver, as it is 

 doubtful if the latter reach the intestines in a very efficient form. If 



