1856 



THE DYSENTERIES 



As a rule the serum treatment should not be continued for more than four 

 or five days, and it should not be repeated later on, or symptoms of 

 anaphylaxis may develop. 



The serum has often a marked effect upon the disease, hastening 

 the cure, ameliorating the symptoms, and reducing the mortality, 

 but it must be admitted that in certain cases it has practically no 

 action whatever. 



When the serum treatment cannot be carried out, the saline 

 treatment is, in our experience, the most useful. Two drachms 

 of magnesium sulphate and 2 drachms of sodium sulphate, dis- 

 solved in an ounce of water, chloroform water, or peppermint water, 

 should be administered, and then i drachm of each should be given 

 every two hours, or half doses every hour, until the motions become 

 fseculent. 



There is generally considerable pain in these more acute cases, 

 and therefore a fomentation sprinkled with laudanum should be 

 applied to the abdomen, and the tenesmus should be relieved by 

 suppositories of morphia or of cocaine. If these remedies fail, 

 then hypodermic injections of morphia or opium (gr. \) by the 

 mouth must be given, for it is a most important factor in the treat- 

 ment that the patient should not suffer more than can possibly be 

 avoided from this distressing symptom. If prolapse of the anus 

 or rectum occurs, it is important that this should be reduced and re- 

 lieved by an astringent ointment, such as hazeline or gall and opium. 



Rectal injections may be given, as described above, but in sensi- 

 tive cases it is as well to pass in a second tube alongside the enema- 

 tube, so that, instead of the inflamed bowel being distended by the 

 injection, it may be simply washed by the irrigation of the boric 

 lotion. 



During the treatment of the severe acute forms a great danger 

 is to stop the saline treatment too quickly, and to allow constipa- 

 tion to occur, by which is meant that, though the patient may 

 be having fifty to a hundred motions per diem, still, fseculent matter 

 is being retained. On the other hand, there is danger in continuing 

 the saline treatment too long, for in our experience this should be 

 stopped on the third day if there is no improvement, and also when 

 the motions become serous. 



After the acute stage is over it may be found useful to employ 

 some astringent drugs, such as tannalbin, 15 grains every two hours, 

 or large doses of bismuth subnitrate (gr. xv. to xxx., with or without 

 salol (gr, V. to x.), every two hours, in cachets or emulsion, and an 

 enema of boracic or tannic acid (J to i per cent.) per rectum may be 

 administered. 



If there is a tendency to chronicity, fresh Bael fruit may be 

 given. It must, however, be both fresh and ripe, and should be 

 prepared by being boiled, and then shredded with a fork into 

 warm milk, pressed and strained, and then a little sugar added. 

 A tumblerful of the milk extract of Bael fruit may be taken 

 twice daily. 



