a month or longer, regarding it as a specific which should be persisted with as we would when giving quinine, iodide of potassium, or mercury. In view of its many manifest advantages, emetine intramuscularly, where available, should now be substituted in most cases for the crude ipecacuanha. Better than either is the recently introduced emetine bismuth iodide preparation. This should be given in freshly prepared pill form or in powder in a nightly dose of 3 gr. and kept up for ten days or a fortnight. Like most preparations of ipecacuanha, after a few doses it is apt to induce diarrhœa. It is said to be the most efficient drug in getting rid of encysted amœbæ and, therefore, in effecting a radical cure and in obviating the risk of spreading infection. Several courses of the drug may have to be prescribed before complete sterilization is effected.
These measures failing, recourse may be had to some of the following:
Nitrate-of-silver injections.— The most effective treatment of certain types of chronic dysentery is undoubtedly that by injections of large quantities of nitrate-of-silver solution of a strength of ½ to 1 gr. to the ounce of distilled water. There is a right and there is a wrong way of using this splendid remedy. If employed in the wrong way, it is useless —perhaps worse than useless. It must never be applied when acute symptoms are present. These must first be got rid of by ipecacuanha, by emetine, by the sulphates, by calomel, by castor oil, and by rest and diet. The patient should be prepared for a week at least in this way. Then the bowel is to be cleared by a small dose of castor oil, followed by a large enema of 3 or 4 pints of warm water to which 2 or 3 teaspoonfuls of carbonate of soda have been added. The whole of this injection having escaped, and when the bowel is quite empty, 2 to 3 pints of the nitrate-of-silver solution are thrown in by means of a- long tube passed slowly and carefully into the bowel as far as it will go without kinking. It is better to fill the bowel by gravitation, using a funnel and tube, rather than by a syringe. If it
