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XXIX] with normal saline, in addition to other methods of treatment, is advisable.

Relief of pain.— During the early stages of an attack the patient may suffer much from griping and tenesmus. These are generally relieved by hot fomentations, turpentine stupes, or by a hot bath. An excellent application is the Japanese hot-box or hand-warmer a small tin box containing a slowly burning cartridge of powdered charcoal. These hot-boxes, or an imitation under the name of istra, can now be procured in England. Three or four of them may be roughly sewn into a piece of flannel and laid on the abdomen. This application has the advantage of being very light, of not wetting the clothes, and of keeping warm for many hours. Tenesmus and dysuria are best relieved by morphia hypodermically; or by an enema of a wineglassful of thin starch containing 40 or 50 drops of laudanum; or by suppositories of morphia and cocaine. Washing out the rectum with a pint of very hot water, with or without boric acid, is sometimes effectual in removing for a time, or, at all Events, of mitigating, the incessant desire to go to stool and to strain. Two drachms of bismuth with laudanum 30 minims and thin starch 2 oz. is also a good sedative enema. Treatment should be energetic and thorough at the outset of dysentery. Every effort must be made to prevent it from becoming chronic, as in this stage the disease is very difficult to treat successfully, and is prone to issue in permanent invalidism. Treatment of chronic dysentery.— Formerly, as a matter of routine, my personal experience led me to recommend in all cases of chronic amœbic dysentery a preliminary course of ipecacuanha— 30, 25, 20, 15, 10, and 5 gr. on successive evenings— with, of course, rest, and a milk and barley-water diet. There-after I generally prescribed a minute dose of castor oil, with or without opium, three times a day, regulating the dose according to effects. I might also prescribe a mixture of simaruba and cinnamon, or some intestinal antiseptic, as salol or β-naphthol. Sometimes I continued the ipecacuanha in 5-gr. doses for