After each bowel movement, the anus and the adjoining parts should be cleansed with water, and then powdered or coated with vase line. Medicinal treatment shoUld, whenever possible, begin with an evacuation of the bowels. For this purpose the salines or castor oil is given; of the latter, according to the child's age, a teaspoonful or table spoonful is given every half hour or hour, until a stool follows and the oil appears in the excreta. As castor oil is thick and viscous, the spoon should he heated over a candle. The following emulsion is a favorite: Calomel is apt to provoke tenesmus or increase enormously that already existing and cannot be recommended for dysentery.
Tenesmus may frequently be alleviated by warm compresses ap plied to the perineum, or by an enema of 20 to 50 c.c. of water of the same temperature as the body 2 to 3 times a day, or an amylaceous decoction (1 teaspoonful of starch to 1 litre of water), with later addi tion of tincture of opium—one drop for a two-year-old child; two drops for a three-year-old; three drops for a four-year-old, etc., in the 24 hours.
Often suppositories have to be resorted to and may be introduced twice a day. As anaesthetics may be recommended opium or amesthesin, the latter in doses twice as large as the former.
Local cold applications are also serviceable. One may introduce into the anus a piece of pure ice of the size of a cherry every 5 to 10 minutes for half an hour to one hour.
After the cleaning of the bowel one may give internally subnitrate of bismuth several times a day. For instance, every three hours: Instead of the bismuth salt, the bismuth albumin combination, bismutose, may be given in doses about three times as large.
As internal astringents, tannalbin or tannigen may be used three to four times daily, in closes of 0.3 to 0.5 Gm. (41-7; gr.). Their combi nation with doses of bismuth corresponding to the age of the child is quite beneficial. In persistent fever tannate of quinine renders good
service. Give three to four times a day: Local treatment of the intestinal process with irrigations, although appearing theoretically advantageous, proves usually too irritating at the initial stage of the disease and must therefore be reserved for a later period. One may use enemata containing to 1 per cent. of table salt and the cleansing injection may be followed by the introduction of an astringent, the quantity of which must never exceed 150 to 200 c.c. The astringents used are: 0.5 to 1 per cent. solution of tannic acid.
1 to 2 per cent. solution of liquor aluminum acetate. 0.1 per cent. solution of nitrate of silver.
The last mentioned should always be followed by a second irriga tion with a weak solution of common salt. They should be made daily or every other day. in protracted eases I have found efficacious the injection daily or every other day of an emulsion of bismuth in a muci laginous vehicle.
I to 2 gr. ..subnit rate of bismuth for children two to three years.
3 to 4. .. gr. xlv-3i • ....subnitrate of bismuth for children four to five years.
5 to 8... „gr. of bismuth for children over five years.
Given in 100 Gm. (3 oz.) mucilage, gum arabic, etc. But such an enema should always be preceded by a cleansing injection. Complica tions and sequelfe that were previously mentioned require an individual symptomatic treatment.
Further observations are needed before the specific serum therapy of dysentery as established through animal experimentation by Kruse, Shiga, Rosenthal and Kancl and already clinically tested, can be intro duced into general practice. it is only quite recently that, Li dke has affirmed the favorable effect produced by Kruse's dysentery serum.