319. In Dysentery, Acute and Chronic, the Nitrate of Silver has recently been extensively employed, and has obtained a high character as a remedy in these affections. The following is a brief sketch of the mode of treatment strongly advocated by Dr. Hare,¶ of the Bengal Medical Service, and which, in other hands, as in those of Dr. Hare, has been found highly successful in the acute form. He commences his treatment with the use of large enemas thrown into the colon, in the manner first introduced by Dr. O'Beirne. The patient is placed on the left side, and the flexible tube of a stomach-pump is cautiously introduced, per rectum, about six or seven inches, or at any rate till it reaches above the sigmoid flexure of the colon; 3, 4, or even 6 pints of warm water, or milk and water, are then injected, and this on returning per rectum, will, in many instances, be accompanied by large quantities of hardened faeces. Dr. Hare advises that the tube, when first inserted, should be moved up and down, in order to break up and mix with the water the hardened faecal matter. If much does not come away with the first enema, he advises its repetition twice or thrice. It requires to be employed daily. Should the retained faecal matter have given rise solely to irritation, or even inflammation, these will yield to the ordinary antiphlogistic remedies; but should they have been retained such a length of time that ulceration has taken place, then Dr. Hare advises the employment of enemas composed of Argenti Nitras gr. xv. in Oiiss. - Oiij. of distilled water, to be thrown up in the same manner as the previous ones. Dr. Hare observes that it has often been found that, when small injections of the Nitrate with an ordinary glyster-pipe have been employed in cases of dysentery, and the patient has died, the ulcers which had been reached by the Nitrate were perfectly healed, whilst those beyond the reach of the application had gangrened, and death had ensued. From this, Dr. Hare rationally concludes that, if the ulcers of the rectum healed under the application of the Nitrate to their surface, those beyond, which cannot be reached by means of the ordinary injection apparatus, would also heal, if subjected to the same application. He consequently employs the long flexible tube, and by this means applies the Nitrate in solution to the whole surface of the transverse colon, the chief seat of dysenteric ulcerations. Dr. Hare, who has extensively followed this mode of treatment, as well as many other medical officers in India, bear witness to the great success which has followed its adoption. It is perfectly simple and rational, and in every case deserves a fair trial. In conclusion, it should be remembered that it is not always easy or even practicable to introduce the tube as recommended above. The natural sharp fold at the junction of the rectum and colon may cause obstruction, and Mr. Earle has shown that the bowel not unfrequently makes a horizontal curve to the right before descending into the pelvis. Great caution is, therefore, necessary in the introduction of the tube, otherwise the intestine may be perforated or other serious mischief ensue. Dr. Delioux* insists strongly on the superiority of albuminous enemas prepared by adding gr. iij. of the Nitrate and gr. iij. of Common Salt, both in separate solutions, to the white of an egg, diluted with fl. oz. viij. of distilled water. Each enema requires to be freshly prepared at the time required.
* Lib. of Med. vol. iv. p. 83. Therap. vol. i. p. 393. Op. cit.
§ Lect. on Dis of Children, Med. Times, vol. xvii. p. 250.
|| Clinical Lectures, vol. ii p. 228. ¶ Edin. Med. and Surg. Journ. July 1, 1849, and Indian Ann. of Med. Sci. vol. i p. 486.
* Bull. G6n. de Therap. 1851.
320. In Chronic Dysentery, the above treatment, with some modifications, is equally applicable. Dr. M'Gregor,* who has had extensive experience in this disease as it occurs in India, recommends an enema composed of Argent. Nit. gr. xx., in fjij. of Mucilage combined with Opium. This, he states, will in most cases be retained, and greatly relieves the tenesmus. Internally, he gives the following pills: - Opii (Hill) gr. xij., Argent. Nit. gr. ij., Pulv. Ipecac. gr.vj., 01. Caryoph. gutt. vj., M. ft. pil. vj., one to be taken every second hour. He adds that the effect is often wonderful, but the action of such a substance must be carefully watched, particularly on the stomach, though its effects on this organ are less marked than those of the Sulphate of Copper or Acetate of Lead, while its action on the ulcers is much more beneficial. The Nitrate, as a remedy for Dysentery, was employed in the form of Enema by Dr. Osborne, of Dublin, in 1831; and Dr. Hudson states that it has been in common use in Dublin since that date. He adds, that in his own practice as well as in that of others, the best effects have followed its use. In conclusion, I would add my testimony to its efficacy when given internally. I have employed it extensively in the later stages of Acute and in Chronic Dysentery, in doses never exceeding a grain and a half daily, in combination with Dover's Powders; and in almost every instance its administration has been followed by speedy and permanent benefit. Its effects are often very remarkable. I have never seen any ill effects follow its use, although given to children of two years old.
321. In Ulceration of the Stomach, the Nitrate of Silver is a valuable remedy, inducing a healthy action of the mucous mem- < brane, and apparently favouring the process of cicatrization. It may be given in the form recommended in Dyspepsia and Gas-tralgia.