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XXIX] seems to be doing good, this injection may be used every few days and kept up for some time. Improvement in suitable cases generally sets in at once. The nitrate, or any other form of enema, must not be persevered with if it causes marked irritation or increase of symptoms. In the mild chronic dysenteries which are seen in Great Britain, and which originally had been contracted in the tropics, and also in the more acute relapses of tropical dysenteries, ipecacuanha or emetine should always be tried in the way recommended. Bayma reports favourably on the treatment of amœbic dysentery (both acute and chronic) and also of liver abscess by adrenalin— 20 to 30 drops of the Parke-Davis solution, 1 in 1,000, every six hours. He sometimes combines this with emetine treatment. Other methods of treating chronic dysentery which succeed at times are the systematic washing out of the bowel daily with warm boric water, with linseed infusion, with milk (a very valuable remedy), with mangosteen rind decoctions, with weak solutions of alum, sulphate of copper, or tannin, with hypochloride-of-soda solution 1 per cent., with creosote and water or milk— a teaspoonful to the quart; systematic daily dosing with small quantities of castor oil, with or without opium— 1 to 2 drachms of castor oil with 4 to 10 drops of laudanum three times a day; 10 to 20 drops of turpentine three times a day; small doses of hydrarg. c. cretâ; the daily consumption of some preparation of fresh bael fruit; a course of Carlsbad, of Kissingen, or of Vichy water; rectal douching as practised at Plombières; a diet of grapes only, of milk only, or of beef only; cold-water compresses to the abdomen.

Surgical treatment of chronic dysentery.— When less heroic methods fail and the patient's condition is slowly but progressively deteriorating, right inguinal colotomy or appendicostomy should be offered as affording a reasonable chance. Some time ago I had a colotomy performed in such circumstances with excellent results. If so serious an operation is declined, appendicostomy might be urged. This is