bowels are very irritable, by intramuscular injection. The presence of scorbutus, of course, indicates fruit juices and fresh unboiled milk, in addition to the usual treatment for dysentery.
Drug treatment.— A dose of castor oil and laudanum is a good preliminary in the treatment of dysentery; indeed, many cases are promptly checked thereby, and require no further treatment beyond rest and dieting for a day or two.
The drugs which have proved of most service in the treatment of severe dysentery are ipecacuanha, or its alkaloid emetine, in amoebic dysentery, and one or other of the aperient sulphates either of magnesium or of sodium, opium, and calomel in bacillary dysentery. In this latter variety subcutaneous or intravenous injections of a polyvalent antiserum (Shiga's or Lister Institute) should be administered, together with aperient salines. Until a microscopical examination of the stools has been made it is difficult to prognosticate in any given case whether ipecacuanha, or its alkaloid, is likely to prove the more effective drug, or whether the sulphates or calomel will answer better. In every case one or the other ought to be exhibited at once; one failing after a fair trial, the other, unless manifestly contraindicated, should get a chance.
Ipecacuanha.— In English practice ipecacuanha, or emetine, is generally the first to be tried. Ipecacuanha must be given on an empty stomach. The best plan is to interdict all food for three hours; then to give 10 or 20 drops of laudanum in a table-spoonful of water and, at the same time, to apply a mustard poultice to the epigastrium. About twenty minutes later, when the patient is coming under the influence of the laudanum, 20 to 30— some give as much as 60— gr. of ipecacuanha in pill, bolus, capsule, or in suspension in about half a wineglassf ul of water, are administered. With a view to prevent vomiting, the patient is directed to lie flat on his back, using a low pillow, and not to eat, drink, speak, or move for at least four hours. Probably he will fall asleep. Should he feel nauseated, he must as much as possible
