The experience of the host of observers working on the various battle fronts in the great world war has cleared up many doubtful points in the prevention and treatment of this disease. Rational treatment can only be entered upon after an examination of the stools, which will demon strate whether the attack is one of amebic dysentery (Anicebiasis) or of ordinary dysentery.
Preventive or prophylactic measures are practically the same in both types, and are of vita] importance in travelling in the tropics, in war and in the regulation of life in barracks, jails and asylums and in all regions in time of famines or scarcity of food supply and other depressing con ditions. The destruction of the excreta by fire, disinfectants, or deep burying in the soil and the boiling and filtering of all water used for drink ing or washing purposes should be rigidly carried out; fruit should never be eaten till thoroughly cleansed, and the most thorough cleanliness of bed and wearing linen, &c., is important. Flies play an important part in the spread of amoebic dysentery, but the chief agent to be searched for and found out is the presence of the human carrier, whose stools may be loaded with cysts, though he appear to be in perfect health. The remedy for the carrier danger consists in a ten or twelve days' continuous treatment byl gr. Emetine twice daily or a course of Thymol and Calomel. The Lister Institute Serum is prophylactic against bacillary dysentery, and immunity in epidemics has been established by Shiga Vaccine.
As soon as the symptoms indicative of an acute attack of either type of dysentery are observed the patient should be ordered to remain in bed; his food should consist of small quantities frequently administered of a liquid food as barley water, albumin, peptonised milk or light soup, chicken jelly or meat essences.
Notwithstanding the presence of diarrhoea and tenesmus it is a good routine to administer a smart purgative at the beginning of the illness.
Three types of cathartics, each haying their strong advocates, are in ordinary use both at home and in the tropics; these are Castor Oil, Salincs and Calomel. The former is much used and never can do harm. Salines are more speedy in their action of sweeping out the contents of the intestines, and by many authorities the plan of administering Sulphate of Soda or Magnesia in drachm doses 4 or 6 times a day is kept up after the administration of the large initial dose. Calomel in one dose of 5 to to grs. is a favourite drug for starting the treatment.
Bacillary Dysentery.—The best routine consists in the immediate administration of So-too c.c. Antidvsenteric Serum intravenously in all severe cases, followed next day by 4o c.c. hypodermically. Alild cases may be treated by subcutaneous injections of 3o-5o c.c. The administra tion of mild saline purgatives may be safely continued for a few days. In collapse the intravenous injections of Normal or Hypertonic Saline solution with Adrenalin are invaluable. After suspension of saline pur gation, Bismuth in full doses with moderate amounts of Opium and Salol affords the best results.
Chronic Bacillary Dysentery.--Rogers in chronic cases recommends his Vaccine, consisting of sensitised Shiga and Flexner bacilli. The after
treatment consists in the discriminating use of such agents as Bismuth Salicylate, Opiates, and vegetable astringents, alternating with short courses of minute doses of Calomel.
Ipecacuanha or Emetine is not indicated in bacillary dysentery, but as it is practically harmless it may be administered as in the ammhic type till a microscopic examination of the stools demonstrates the absence of amoeba.
The plan of treating chronic forms of the disease by Appendicostomy and washing out the colon with antiseptics is apparently less effective than large rectal injections of Silver Salts, as Albargin dr. in 3o oz. water, recommended by Rogers.
Amcebic Dysentery.—Treatment by Ipecacuanha is firmly established by all recent war experience. Emetine, its active alkaloid, is now the routine in every case where itimulia or cysts are found in the stools; gr. of Emetine should be given subcutaneously every day for io or 12 days. Some authorities recommend .1 gr. daily by the mouth in divided doses during the course of injections. Complete success follows in the great majority of cases before the seventh day. As regards saline purgatives, though rationally indicated, their use retards the action of the Emetine by hastening its elimination, and it is generally advisable to give small doses of Opium during the injections. Dale recommends the double iodide of Emetine and Bismuth in 3-gr. doses by the mouth, but the drug causes vomiting. In severe collapse Saline intravenously should be resorted to, and though the injection of Antidysenteric Serum is rationally indicated only in the bacillary type of the disease, some authorities do not hesitate to inject So-roo c.c. into a vein, and this is clearly justified in grave cases before a diagnosis can be made from the stools.
Flushing of the colon by various antiseptics, Tannin, Quinine, Per manganate, Copper, Mercury, and Silver Salts, has not found much favour. Tenesmus and pain may call for small Enemata of Laudanum or Morphia Suppositories or a large enema of Liquid Paraffin (20-40 oz.).
Emetine treatment certainly seems considerably to reduce the super vention of liver abscess.
Chronic Anurbic Dysentery is often intractable, whether following acute attacks which have been treated by Emetine and have relapsed or in those cases where treatment has been neglected from the first. Emetine should be administered as soon as a chronic case comes under observation, and here again hypodermically rather than by the mouth. Bismuth in large doses, Liquid Paraffin, Salo], the so-called intestinal antiseptics, and every drug useful in colitis, has had its advocates. Quinine is useless either by the mouth or in strong solution as an irrigator of the colon. Ulcers in the lower end of the bowel may be locally reached by caustics through the protoscope, and those higher up by large enemata of Albargin x in ;ou of Nitrate of Silver 5 grs. to r pint. Short courses of minute doses of Calomel ;; gr. thrice daily, alternating with the Bismuth or Salo] treatment and followed by a few days of Saline purgation, may be tried. Appendi costomy and flushing with an antiseptic solution should be a last resort.