THE DYSENTERIES 



is of advantage to give the patient a saline purge, and then one of 

 the so-called enrichment methods of Cropper and others may be 

 used : about i gramme of faecal matter is mixed with 30 c.c. of salt 

 solution in a conical glass, and ether added in the amount of about 

 10 to 20 per cent. The cysts are generally found in the supernatant 

 fluid, and may be collected by centrifuging it. 



Cysts maintain all their morphological characters for a very long 

 period in faecal matter mixed with a formalin solution (2 per cent.). 



The presence in dysenteric stools of Charcot-Leyden crystals, as emphasized 

 by Acton, points to the condition being of amoebic origin rather than bacterial, 

 especially if there is scanty cellular exudate with preponderance of mono- 

 nuclears. 



Prognosis. — The prognosis in a case of amoebic dysentery must 

 always be guarded, as there is the possibility of hepatic abscess 

 as sequela of the mildest case, and the cure induced by emetine and 

 ipecacuanha, though striking, is often merely clinical, complete 

 sterilization not being attained. The prognosis is worst in the 

 gangrenous cases, better in the acute, and still better in the mild 

 chronic cases, but the danger of latency after an apparent cure 

 must be remembered. In the acute type hiccough is an un- 

 favourable sign, often indicating the approach of exhaustion and 

 death. 



Treatment. — It is of the utmost importance that the patient 

 should be placed at rest in bed. For the same purpose the urine 

 bottle and the bed-pan must be used. It is advisable to relieve the 

 severe griping and straining by either a hypodermic injection of 

 morphia or by small enemata of 40 minims of laudanum in i ounce 

 of mucilage of starch, or by using a morphia (gr. J), or codeine 

 (gr. J) suppository. 



At first the bowels should be swept clean by a dose of castor oil 

 (3iv. to 5vi.),with or without a few minims of liquor opii sedativus, 

 or a few doses of saline may be given during the first twenty-four 

 hours (see Bacillary Dysentery). After the castor oil has acted, or 

 simultaneously, the emetine treatment should be begun. One-third 

 to half a grain of emetine hydrochloride, dissolved in sterile normal 

 saline solution, should be administered as a hypodermic injection 

 two or three times a day for several days. Emetine hydrobromide 

 may also be used in the same dosage, but it is not quite so soluble. 

 These drugs may be obtained in sterile tubes ready for injection. 

 We have never seen any bad effects on the heart from the adminis- 

 tration of emetine, but we have met with cases of dermatitis prob- 

 ably due thereto, while Dale and Low have noted diarrhoea after 

 prolonged administration. 



A combined subcutaneous and oral administration of emetine as recom- 

 mended by Wenyon and O'Connor (one grain emetin by injection in the 

 morning and a ^ grain emetine tablet at night) answers well, especially in 

 subacute and chronic cases, and in carriers. 



If emetine cannot be obtained, then ipecacuanha should be administered 

 in 5-grain doses every three or six hours, or in larger doses (gr. x. to xx.) twice 



