Page:Tropical Diseases.djvu/612

566 as a residence; but during the cold winter and spring months some milder, drier, and more sunny climate must be sought out.

Drugs in sprue.— Experience soon teaches one to distrust medicines in sprue. Occasionally a gentle aperient or, if diarrhœa is watery and excessive, a few drops of laudanum are of service; but active drugging of all sorts is, as a rule, in the highest degree prejudicial. If the mouth is very painful, cocaine— 5 gr. to the ounce— brushed on before eating will deaden sensibility and, for a time at all events, relieve suffering. Flatulence and diarrhœa of acid stools are best relieved by full doses of sodium bicarbonate. Constipation must be carefully avoided, and a simple enema used if necessary. I think it right to state that two methods of drug treatment seem, in some cases, to have been followed by good results. One, advocated by Dr. Begg, late of Hankow, consists " in the administration of repeated doses of yellow santonin. He recommends one or two doses of castor oil to commence with, and, thereafter, 5 gr. of santonin in a teaspoonful of olive oil once or twice a day for a week, diet being at the same time attended to. The other method has gained for an irregular practitioner in Shanghai some reputation. It consists in the repeated administration of purgatives, alternately with or before the exhibition of large quantities— two teaspoonfuls at a time —of some form of carbonate of lime, believed to be powdered cuttlefish bone or powdered crabs' eyes. I have tried the santonin treatment without benefit to patients. I have also used cuttlefish bone; in one case with the result of permanently stopping the diarrhœa but not of arresting the progress of the disease. In this case, although diarrhœa was most effectively checked, yet massive solid stools continued to pass. After a few weeks the patient died from asthenia, notwithstanding a liberal diet, which apparently was digested but not absorbed.

Of late I have been in the habit of using intramuscular injections of very minute doses of arseniate of iron. In some instances the benefit from these