TREA TMENT 



Tincture of Mansonia ovata in i-drachm' doses is also recom- 

 mended. Other remedies resembling the above are the roots of 

 Pelargonium tuberosum and P . flahellijolium. 



With regard to individual symptom S; collapse should be treated 

 by the hypodermic injection of saline, hcBmorrhage by calcium 

 lactate. 



Very severe cases, involving the whole of the large bowel, and gangrenous 

 cases may be treated by appendicostomy and washing out of the bowel with 

 a weak permanganate or boric acid solution. 



The simple operation is performed as follows : — The patient is placed un4er 

 chloroform, after the usual antiseptic preparation of the area of the opera- 

 tion. An incision of about 3 inchss in length is made in the usual site for 

 the operation of appendectomy, and, the layers of the abdominal wall having 

 been incised, the peritoneum is carefully opened, and the appendix is searched 

 for and brought forward into the wound, so that about i inch protrudes. 

 Here it is stitched by four stitches to the muscles. The wound is now closed, 

 the appendix being fixed to the skin by a couple of stitches. The wound is 

 now dressed aseptically with a thin layer of wool and covered with collodion. 

 The tip of the appendix is now removed, and a No. 8 or No. 6 catheter inserted. 

 The wound is now dressed antiseptically and left for twenty-four hours, at 

 the end of which time a large tube is placed in the rectum, and the whole 

 bowel is irrigated with i percent, solution of bicarbonate of soda to remove 

 the mucus, and then with a boracic acid lotion, i drachm to the pint. This 

 is repeated daily, but if the case tends to become chronic a solution of silver 

 nitrate (5 to 20 grains to the pint) is used. 



When the cure is effected, the small wound is easily closed. 



Other methods of treatment include the calomel treatment much praised by 

 Scheube and Kartulis, and begun long ago by the Indian physicians, and 

 among the various forms in which it has been applied, Twining's pill of calomel, 

 blue pill, and ipecacuanha used to be very celebrated. Plehn recommends 

 that, after a preliminary dose of castor oil, -| grain of calomel be administered 

 hourly until twelve doses have been taken during the day. The treatment is 

 discontinued during the night, and repeated in the same manner during the 

 second and third days, after which bismuth subnitrate is given in 6-grain 

 doses hourly during the day for a long period of time. 



Yellow santonin, 0*3 gramme in 8 grammes of olive oil, administered three 

 times a day, has been recommended by Drake. Musgrave recommends that 

 acetozone (strength i in 5,000; aerated if necessary) should be freely drunk, 

 so as to prevent fermentation in the stomach and bowels. In all cases a mouth- 

 wash— e.^., glyco-thymoline — ^should be ordered. During convalescence the 

 great point is to prevent chills and indiscretions in diet, which may induce 

 attacks of diarrhoea. Turpentine duotal and styracol, especially in com- 

 bination with castor oil, have been recommended by some. 



Cyllin and other similar disinfectants have been advised, but have not given 

 any very good results in our experience. Bolus alba has been advocated. 



Various colloidal silver preparations have been recommended. 



The sour-milk treatment may be tried in subacute or chronic cases, with 

 sauerin, lacto-bacillin, fermenlactyn, or any other preparation on the market, 

 or by using the ferment as prepared by the natives of the country. Consti- 

 pation is counteracted by small doses of castor oil, liquid paraffin, Carlsbad 

 salts, Hunyadi Janos, Apenta water, or enemata, but if of a marked nature 

 should arouse suspicions of stenosis, especially if the ordinary laxative remedies 

 do not ameliorate the condition. Under these circumstances sigmoidoscopy 

 should be performed, and the stricture dilated by bougies or catheters. 



Treatment of Dysenteric Infantile Diarrhoea. — ^The treatment of 

 infantile diarrhoea and of dysentery in children is best conducted 

 by administering a small dose of castor oil (3i. to 3ii.), followed by 



XI7 



