PROPHYLAXIS 



1859 



to albumen water and whey, and brandy given only if absolutely 

 necessary. 



In milder cases the diet should consist of milk, which must be 

 diluted with Perrier, soda, Vichy, or barley water, or may be mixed 

 with powders of sodium bicarbonate (gr. vi.), potassium bicarbonate 

 (gr. vi.), sodium chloride (gr. iii.), or sodium citrate (gr. xl.), to the 

 pint of milk, and less in proportion. Arrowroot made with water 

 or milk, at first thin and later thick and flavoured with a little 

 brandy, is most useful. Benger's food and Horlick's malted milk are 

 also useful. Strong meat-essences and alcohol should be avoided. 



In all severe cases the food must be given in small quantities 

 every two hours, about 4 ounces at a time, and must be taken very 

 slowly, and should be neither very warm nor cold. In chronic 

 dysentery this milk diet is of the greatest importance, and may, 

 as already stated, be supplemented by the sour-milk treatment. 



When convalescence begins, chicken-broth and milk-puddings 

 may be added to the diet, and then lightly-boiled eggs and toast; 

 then chicken, cream, and fish; but for a long time only white flesh 

 should be allowed, and not much of this, for the diet should for 

 several weeks consist largely of milk foods. Of especial importance 

 in convalescence is the chewing of the food, and care must be taken 

 not merely that the teeth are in good order, but that the patient 

 is directed not to swallow any tough or very fibrous piece of food. 

 Fruit must be avoided for a long time. 



Prophylaxis. — One of the important prophylactic measures which 

 is at present but little used, owing to practical difficulties, is the 

 isolation of the convalescent until three bacteriological examinations 

 of the faeces give a negative result. Another is the search for dysen- 

 tery carriers in a locality in which the disease is endemic or occa- 

 sionally epidemic. The treatment of a carrier must be the same 

 as for a case of chronic dysentery, but here vaccination will be 

 distinctly useful. The persons to be suspected are those with a 

 history of dysentery, or with a history of having nursed a case of 

 dysentery, and people occupied in the cooking or handling of food 

 materials. 



Another very important measure is the destruction by burning or 

 the disinfection of the dysenteric motion by either crude carbolic 

 acid or by Jeyes' fluid, together with its careful protection against 

 flies before its final disposal. 



The personal prophylaxis consists in drinking only filtered and 

 boiled water, and using the same for cleaning the teeth, in avoiding 

 salads and fresh vegetables and unripe fruit, and in carefully 

 washing the exterior of any fruit. 



With regard to public prophylaxis, a modern method of collecting 

 and disposing of the sewage of towns is necessary everywhere in 

 order to prevent the disease from spreading, and there is no doubt 

 that for this purpose the best method for tropical towns is the 

 Shone or pneumatic system, as introduced into Rangoon, Bombay, 

 and Karachi. 



