1858 



THE DYSENTERIES 



calomel (gr. J) or grey powder (gr. J), every hour until six doses 

 are given in a child of two years of age. The dosage may be 

 decreased or increased according to age. Afterwards astringents 

 such as tannigen (gr. iii.) or tannalbin (gr. v.) may be given every 

 two to four hours. 



In severe cases, due to the Shiga-Kruse or the Flexner bacillus, 

 serum treatment is the best, 5 to 10 c.c. being injected twice daily. 

 The diet should be altered from milk to albumen water, whey, 

 diluted meat-juice, or clear soup. 



Pain must be combated by hot fomentations, and convulsions 

 by bromides given in gr. xv. as enemata, or in small doses by the 

 mouth in albumen water. Chloroform may require to be adminis- 

 tered, while some authors recommend minute doses of morphia. 



Treatment of Chronic Dysentery. — ^The treatment of chronic 

 dysentery varies, for sometimes the malady is easily amenable 

 to the treatment laid down for mild cases of acute dysentery, 

 while at other times many remedies may be tried without success. 

 After an initial dose of castor oil, tannigen, in 3 to 8 grain, or 

 tannalbin in 10 to 20 grain doses, in cachets, may be tried three 

 to six times a day. In old-standing cases pilula plumbi cum 

 opio should be given twice a day. Serum treatment should also 

 be tried during the exacerbations, as indicated above. Bael fruit, 

 the rind of the mangosteen, simaruba bark, etc., are all useful in 

 this condition, and the lavage treatment is more useful than in acute 

 cases. Rectal irrigations should always begin with 2 pints of 

 I per cent, solution of bicarbonate of soda to remove the adherent 

 mucus, and then the medicated enema may be administered, and 

 may consist of boracic acid (i per cent.), followed by an enema 

 containing bismuth subnitrate and sodium salicylate suspended in 

 a pint or less of mucilage, silver nitrate (^ to i grain to the ounce), 

 copper sulphate (2 grains, with 5 minims of tincture of opium to the 

 ounce of water), tannin (0-2 to 0-5 per cent.), resorcin (i to 2 per 

 cent.), creolin (i drachm to the pint), lysol (i per cent.), or formalin 

 (i in 5,000), may all be used. Silver nitrate, however, gives the 

 best results, gr. x. to the pint. Albargin (i in 500, i in 1,000) has 

 also been recommended. Perchloride of mercury (i in 20,000) 

 should not be used as a rectal enema, as it is dangerous, and may 

 increase the symptoms instead of diminishing them. In chronic 

 or subacute obstinate cases the vaccine treatment first introduced 

 for dysentery by Castellani and Greig may be tried, using vaccines 

 prepared from the dysenteric bacilli isolated from the stools of the 

 patient. Forster has tried this treatment also in acute cases. In 

 our experience it gives good results in several cases of the chronic 

 type, but in acute dysentery is much inferior to the serum and saline 

 treatment. If all these methods of treatment fail, app end ic ostomy 

 should be tried. 



Diet. — ^There is no point in the treatment of dysentery of greater 

 importance than the diet. The bowel requires physiological rest, 

 and therefore, in very severe cases, the diet must be restricted 



