TREATMENT 153 



only after repeated attempts. Oil of male fern, /3-naphthol, 

 thymol, oil of eucalyptus and chloroform are the best to 

 use, and of these the last two are most to be relied upon. 



Preliminary treatment is required to remove the mucus 

 which covers and protects the worms. This consists of 

 semi-starvation and purgation. The patient must be kept 

 in bed on low diet for two or three days, and the bowels 

 kept freely open. No food is to be given after 6 p.m. 

 on the night before the administration of the anthel- 

 mintic. In the early morning a purgative dose of salts 

 or castor-oil should be given. Some prefer calomel, but 

 it is risky with anaemia, though small doses, T ^ to J gr- 

 three times a day for two or three days before, may be 

 given in cases where there is no pyorrhoea alveolaris. If 

 thymol be used, 15, 20, or 30 gr., in cachet or wrapped 

 in cigarette paper, should be given and the same dose 

 repeated one or two hours later. 



Eucalyptus and chloroform are employed by many : 



Eucalyptus oil or eucalyptol ... ... ... nixxx. 



Chloroform ... ... ... ... ... ... n\xlv. 



Ol. ricini ... ... ... ... ... ... 5 X - 



This should be divided into two doses ; the second dose 

 should be given half to one hour after the first. 



In any case a brisk purge, preferably saline, should 

 be given an hour later. The patient can be allowed to 

 take food after the action of the purgative. All the stools 

 for that and the next day should be saved, strained, 

 and examined for the worms. Some worms will always 

 be found, but even if they are numerous the stools must 

 be examined for eggs for some weeks. Usually they are 

 found in about a week, and if found the treatment must 

 be repeated. It is common for it to be necessary to 

 repeat either form of treatment three or four times or 

 more at intervals of one week before the great majority of 

 the worms are expelled. To remove all the worms, even 

 with repeated treatment, is difficult. 



When this has happened, good, nourishing, easily 

 digested food, and rest are all that is essential for 



