TREA TMENT 



1835 



daily, given either in the form of ' membroids ' or as pills coated with salol 

 varnish or keratin. Our experiments in vitro tend to show that membroids 

 and salol varnish do not dissolve freely in peptic juice, while they do so in 

 pancreatic juice. The salol varnish was very efficient, but care must be taken 

 that too thick a coating is not used, as it may not dissolve in pancreatic juice. 

 Martindale's method of stearin-coated pills is good. In this way the 

 nauseating effects of the ipecacuanha are often avoided without diminishing 

 its efficiency, which is the result of using the de-emetized drug. Rarely the 

 membroids and salol varnished pills may be passed unaltered in the motions, 

 and in such cases ipecacuanha may be given in suspension in mucilage and 

 chloroform water or in cachets or pills (gr. x. to xx. twice a day), and should 

 be preceded a quarter of an hour by a dose of 15 minims of tincture of opium, 

 in order to prevent the possible vomiting. 



With regard to ipecacuanha, it is of great importance to use the best Brazilian, 

 which should contain 72 per cent, of emetine (methyl-cephaeline) in its total 

 alkaloids, the other alkaloids being cephaeline 26 per cent., and psychotrine 

 2 per cent.; on the other hand, Carthagena ipecacuanha contains cephaeline 

 57 per cent, and emetine only 40 per cent. The powdered ipecacuanha should 

 have an alkaloidal strength of 2 per cent. 



Emetine and bismuth iodide has been introduced by Dale, and its 

 efficacy has been confirmed by Low and Dobell and numerous 

 other observers, including ourselves. It is especially useful in the 

 treatment of carriers, inducing at times a complete disappearance of 

 the cysts. It is useful also in amoebic hepatitis and general amoebia- 

 sis. It is given in gelatine capsules, one capsule containing gr. iii., 

 at night for two or three weeks, or salol-coated tablets may be 

 used. A shorter course seldom induces a cure. Not rarely the 

 drug produces nausea and at times actual vomiting; in such cases 

 the same precautions may be taken as when giving ipecacuanha. 



When the acute symptoms have passed away, intestinal irriga- 

 tions are useful, and should be administered every other day, or 

 once or twice daily. We generally use a solution of tannic acid 

 (3 to 5 in 1,000), or a solution of the bihydrochloride of quinine in 

 varying strength from i in 5,000 to i in 750. About J to 3 pints 

 should be very slowly injected by gravity from a glass douche 

 vessel by means of a long soft rectal tube well greased with boric 

 vaseline. This injection may be preceded by a cocaine or morphine 

 (gr. J) suppository introduced half an hour previously. 



Other substances used for rectal irrigations are Acetozone (i in 2,000); 

 alphozone (i in 2,000); argentum nitras (i in 2,000 or i in 1,000), useful in 

 some very chronic cases; protargol (i in 500). Creosote is recommended by 

 Zanardini, and may be used by injecting 2 pints of i in 300 or i pint of i in 

 100. The injection, however, may be followed by symptoms of absorption — ■ 

 e.g., dyspnoea and faintness. A solution of sodium hypochlorite may be 

 used, 2 pints of 8 to 12 in 1,000 being recommended by Vincent once or 

 twice a day, which is also useful for amoebic carriers. 



In gangrenous dysentery the only chance of saving the life of the patient 

 is to perform the operation of appendicostomy, and irrigate the whole lower 

 bowel with quinine lotion (i in 1,000) or coUargol (i in 500). The details of 

 this operation are given under the heading Bacterial Dysenteries. 



With regard to the treatment of symptoms, the most important 

 is the relief of pain by hypodermic injections of morphia or by 

 fomentations sprinkled with opium and appHed to the abdomen. 

 As the case progresses favourably, a bismuth mixture or tannalbin 



