TREATMENT 



1855 



in neat brandy, with or without a few drops of hquor opii sedativus 

 or tincture of opium, and this should be followed a few hours later 

 by the administration of astringents, such as bismuth salicylate 

 5 grains, and salol 5 grains, made into cachets, and taken every two 

 or four hours at first, and less frequently when the character of the 

 motions improves. In these mild cases tenesmus rarely requires 

 any special treatment, and rectal injections are well borne, and may 

 be administered twice daily, though in most cases they are un- 

 necessary. These injections should consist of either boric acid 

 (i in 100), which is probably the best, salicylic acid (i in 500), tannic 

 acid (i in 500), normal saline solution, or borax and bicarbonate 

 of soda (5 grains of each to the ounce). In administering these 

 enemata, the patient should lie on the left side, with the buttocks 

 elevated on a pillow and the head placed low. A soft rectal tube 

 should be smeared with vaseline and passed as high up the bowel 

 as possible. Two pints of the enema are now run in by gravity 

 from a glass irrigation vessel, and should be warmed to a tempera- 

 ture of about 99° to 100° F. The enema should be retained as long 

 as possible. This treatment, with an appropriate diet, soon gives 

 relief, the pain disappearing, the motions becoming fseculent. 

 During convalescence a tonic of hydrochloric acid, cinchona bark, 

 and gentian is found to be very serviceable. 



In severe cases the serum treatment should be used as soon as 

 possible, though at times it is useful to precede it with a dose of 

 castor oil and associate to it the saline treatment. Kruse's serum, 

 Shiga's serum, the Lister Institute serum (Todd), and that of the 

 Pasteur Institute (Vaillard and Dopter) , are all good. A polyvalent 

 serum, such as that of Shiga, is preferable in those cases in which 

 a complete setiological diagnosis of the malady cannot be made. 



The serum, in our experience, should be given in large doses; thus 

 that from the Pasteur Institute and the Lister Institute should be 

 given in 20 c.c. to 40 c.c. doses twice daily, and in very severe cases 

 four times daily. The inj ection should be made under the skin of the 

 abdomen or flank, using the ordinary aseptic precautions. These 

 injections, as a rule, need not be continued after the second or third 

 day. They may be followed by urticarial-like eruptions and pains 

 in the joints. Calcium chloride or, better, calcium lactate in doses 

 of gr. X. may be administered if these symptoms are severe three or 

 four times daily. When the blood and mucus have disappeared 

 from the stools, salol (gr. x. every four hours) or the ordinary astrin- 

 gents, such as bismuth subnitrate^ or tannalbin (gr. x. to xv. every 

 two hours), should be prescribed. 



Our rules for the administration of the polyvalent serum are:- — 



L In mild cases inject one dose of 20 c.c. 

 11. In cases of medium severity inject two doses daily of 20 c.c. 

 for two days. 



IIL In severe cases inject 40 c.c. twice or thrice a day for two 

 or three or four consecutive days. 



