1836 



THE DYSENTERIES 



in cachets (gr. xx. every two to four hours) may be given, while the 

 irrigation may be diminished and stopped, and finally a tonic may 

 be prescribed. 



We are strongly of opinion that the ipecacuanha or the emetine should 

 continue to be given in smaller doses long after the dysenteric symptoms have 

 disappeared, in order to prevent relapses, and possibly also the development 

 of a liver abscess, which is the most dangerous sequel. Among the other 

 drugs which have been recommended in the treatment of amoebic dysentery 

 are Simaruba officinalis and the so-called Kho-sam powder. 



The former is recommended by Manson to be used as a decoction which is 

 prepared by taking simaruba bark, pomegranate fruit -rind, and gum arable, 

 1 5 grammes of each, and placing in a litre of warm water, which is boiled till 

 reduced to half its bulk, and of this decoction i ounce is taken three or four 

 times a day. Shepherd and Lillie have cured, using preparations of chaparro 

 or simaruba, 34 cases out of 80 cases of Loeschial carriers, refractory to emetine. 



Nixon and Sellards and Mclver have had good results by using preparations 

 of Castela, a genus of the Simarubaceae. 



The Kho-sam powder is derived from the berries of Brucia antidys- 

 enterica and B. sumatrana, which grow in Indo-China. It is administered 

 in pill form, i grain being given two to four times a day. Cinnamon has been 

 often used in the past, and the compound extract of garcinia known also by the 

 trade name of amibiasine is praised by several authors. 



If cicatrization of the colon results with stenosis, then sigmoid- 

 oscopy must be performed, and the condition treated as described 

 under Bacterial Dysentery. Liver abscess is considered separately. 

 x\bscesses in other parts of the body — e.g., the spleen — are rarely 

 met with, though it is possible that some of the inexplicable deep- 

 seated abscesses may have their causation in amoebae. 



The diet should be the same as that to be described presently 

 under the heading Bacterial Dysentery. During convalescence the 

 food must be slowly and carefully increased, no acid or very warm 

 substances being allowed. 



Prophylaxis. — The prophylaxis consists in the drinking of only 

 boiled and filtered water, and the avoidance of salads and uncooked 

 vegetables and the prevention of fly infestation of food. 



Stools of dysentery patients and carriers should be disinfected 

 with cresol, i in 10. 



Amoebae, probably non-parasitic, were shown to exist in the 

 drinking-water in Manila, and it was found that copper sulphate 

 and filter-beds were useless. The only safeguard was to sterilize 

 the water by boiling. 



(6) Laveranic Dysentery. 



Definition. — An acute enteritis and colitis caused by Laverania malarics 

 Laveran, and characterized by high fever, associated with the passage of 

 frequent motions containing blood and mucus. 



Symptomatology. — The attack usually begins suddenly, with high fever, 

 great distress, and prostration. The tongue is coated, the abdomen tender, 

 and many motions are passed containing blood and mucus. The spleen may 

 or may not be palpable. Unless correctly treated, the condition becomes 

 serious, and rapidly leads to the death of the patient. 



Diagnosis. — The routine examination of the blood in all cases of tropical 

 disease will prevent mistakes being made, as the presence of numerous sub- 

 tertian parasites in the blood, with absence of amoebae and dysenteric bacilli 

 in the stools, will reveal the nature of the complaint. It should be kept in 



