The diagnostics and treatment of tropical diseasesStitt, E. R. (Edward Rhodes)
Science
The diagnostics and treatment of tropical diseases
Stitt, E. R. (Edward Rhodes)
Tropical medicine
Very favorable reports have come from the use of emetine bismuthous
iodide. This drug is given by mouth in doses not exceeding 3 grains
in a day. It is put up in gelatine capsules and a course of treatment
is one 3 grain capsule each night for 12 nights. It is supposed that
there is no action on the drug in the stomach as it is insoluble in
dilute acid but as a matter of fact nausea and vomiting frequently
occur and slight purging is common after its administration. During
the twelve-day course of treatment the patient should remain in bed
and be given a milk diet.
We have recently had success with the administration of ipecac by the
duodenal tube and it might be that bismuthous emetine iodide could be
given in the same way.
Ross thinks that the flushing action of salines, thus washing away
amoebae and necrotic material, is of advantage in amoebic as well as
in bacillary dysentery. He also thinks liquid petrolatum of value.
Some advise the bismuth treatment recommended by Deeks of giving a
large teaspoonful of bismuth subnitrate, in a glass of water, 3 or 4
times during the day.
A decoction made by boiling for 15 minutes one teaspoonful of
powdered chaparro in 8 ounces of water and given one-half hour before
each meal has been reported on favorably. The powdered roots, stems
and leaves of “Chaparro amargosa” are used. This is a plant of Texas
and is named _Castela nicholsoni_. A decoction of about one-half
strength of that taken by mouth is recommended for enemata. Simaruba
bark is recommended by some practitioners. Its action is similar to
chaparro. Benzyl benzoate is recommended for the pains and tenesmus
of amoebic dysentery as well as bacillary dysentery. Twenty drops of
the 20% alcoholic solution are given three times daily.
Many drugs have been recommended for colon irrigation of which the
favorite is probably quinine muriate in dilution of 1 to 1000 or 1
to 2500. Inject 2 or 3 pints slowly by gravity. Protargol in 1 to
500 solution is better than silver nitrate in 1 to 2000. Emetine
enemata do not seem to be of much value.
In very serious cases, particularly when gangrenous change in
the mucosa may be present, the operation of appendicostomy seems
indicated, following which a catheter is inserted and the large
intestine irrigated with a 1% solution of bicarbonate of soda to wash
away the mucus and later with a boracic acid solution of 1 to 125 or
1 to 10,000 of potassium permanganate.
In a discussion as to certain surgical considerations in connection
with appendicostomy Muller notes that the right rectus incision
is to be avoided on account of danger of gangrene from pressure
of rectus on the stitched-up appendix. He also thinks that
appendicostomy is much safer than caecostomy on account of the
frequent thinning of the walls of the caecum. For irrigation he
prefers a 1 to 500 solution of collargol.
In treating dysentery cases rest in bed and the use of a
nonirritating diet are advisable.
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