English
Enemata serve to dislodge or to prevent fecal impaction where ulcers have healed and a stenosis has formed in the lower bowel, and for evacuating gas, putre¬ fying matter, toxic discharges and other irritants Avithiu the rectum. An enema is generally given in constipation. And in an enema the fluid administered has to be limited to two to three quarts or it might cause distension, pain, ptosis 111 . 1 N ^ m f^si <0 ??jfr W tvSTT 1 nsjpq sitfjri' u; ti iraiiwi II 244 ANCISNr HIKBTJ MEDICINE or paresis of the intestine and in severe cases even the rupture of its membrane. While in irrigation, there is no limit to the quantity of fluid, for the solution is allowed to flow into and out of the gut through a double or return-flow tube {irrigator) or by making the fluid flow into the bowel by way of an artiflcial opening {appendiceal or cecal) and making it flow out at the anus through a proctoscope or a pipe intro¬ duced for the purpose, thus escaping as fast as the solution enters into the bowel. Therefore irrigation serves by the soothing and antiseptic properties of its content to heal the local ulcerated lesions, prevent the formation of impacted fecal masses, to wash out the sores and to neutralize the toxins, to remove toxins, irrita¬ ting pus, blood, mucus, tissue debris and feces, to dislodge and wash away parasites, and to relieve enterospasm, colics and tenesmus. By vasti is meant to include the functions of an enema and irrigator according to the needs. Improvement invariably follows daily irriga¬ tion of the intestine. But it is not so much due to the medicaments as to the dissolvent and cleansing quality of water and washing away the toxins, so that the organism does not suffer so much from their absorption. Umioubtedly DISEASES 245 antiseptic, deodorant, soothing and stimulating medicaments exert beneficial influence, especially in inflammatory, ulcerative and obstructive lesions of the intestine, but they are only of secondary value. Tlie only thing that is important is to irrigate the intestine as often as possible with body temperature of the solution. Positive good result is obtained by daily irrigation witl warm saline solution, camomile, flax-seed, oak-bark tea, pinas canadensis ( 1 p. c. ), borolyptol, potassium permanganate, glyco- thyinolin or listerin (3 p. c. ), salicylic acid, alum, zinc sulphate or silver nitrate ( 1 p. c.), boric acid or Carlsbad salt ( 2 p. c. ) or thymol (l : 2000 ). In advanced ■ cases of deep-seated ulceration and erosions, it is better to use the above solutions a little stronger or ichtliyol or balsam of Peru ( 2 to 5 p. e. ), salicylate of soda ( 3 to 5 p. c. ) and bisulphate of quinine (I :1000) especially in entamebic and bacillary dysentery. Oils named according to the degree of their proven usefulness, olive, sesame, sweet almond, cotton seed, liquid vaselin and neutralol, either alone or in emulsion with the above-mentioned medicaments, can be used with marked result. Propyhlaxis : As water seems to lie the principal source of infection of cholera asiatica. 246 ANCIENT HINDU MEDICINE typhoids and dysentery, and in water spirillum cholera asiatica, bacillus typhosus and pathoge¬ nic agents of dysentery ( entameba dysenteria, bacillus dysenteria, halantidium coli ) can all live and thrive for a long time, it is essential that all drinking water must he thoroughly boiled and filtered. Milk also must be boiled before it is drunk, as it is often contaminated by water from suspicious sources. All dejecta from the victim of any of these diseases must be dis-in- fected with a five per cent solution of carbolic acid, one per cent of chloride of lime or one- fortieth per cent of corrosive sublimate, so that all the pathogenic microbes be destroyed and they can not enter into the soil, especially if it be saturated with moisture where they can multiply, and retain their vitality and virulence for years. This also applies to urine and sputum. Nor should any vegetable or fruit be eaten raw or not thoroughly cooked which might have grown on the soil or fallen upon it, where there is the least possibility that the soil has been fertilized by human feces. And all coarse vegetables and unripe fruits which might leave a good deal of irritant residue, should be avoided. It is true that these germs have been found living in harmless, inert vegetative state without DISEASES 217 ;yrovoking any lesion in the gastro-intestinal tract where they have been harboured, and the predisposing cause of their development is the malnutrition, fatigue, over-work and exhaustion of the organism. Yet it must he admitted that it is very dangerous to sustain such potential enemies. In the treatment of typhoid and choleraic • diarrhoea^ two fundamentally opposed theories. One is the destruction and removal of the vibrios and to neutralize the toxins by a, powerful antiseptic purgative like calomel ( 3 to 5 grains with 6 to 12 grains of sodium bicarbonate ) and after this initial dose to administer small doses ( one-tenth to one-twen¬ tieth grain ), every half or quarter hour until the symptoms improve or the patient passes into algide stage. Some strongly recommend the administration of castor oil ( half an ounce emulsified with chloroform) before giving calomel. And to inject saline solution (1.25 per cent solution of salt, prepared by dissolv¬ ing 2 drachms of salt in one pint of water) at blood tempei’ature, ten to fifteen ounces every half an hour to counteract the circulatory disturbance through the evacuations. The other theory is to spare the vitality of 248 ANCIENT HINDU MEDICINE the patient which is seriously dissipated by repeated evacuations, and for this purpose a strong astringent like tannic acid ( kino, cateclm^ rhatania are to be preferred to pure tannic acid ) should be introduced into the rectum one to two litters daily in one per cent solution at a little above the body temperature. This seems to have shown good result. And if there are evidences of toxic accumulation and fecal reten¬ tion, calomel is to be given every two hours in doses of 0.03 to 0.05 gram. The patient must be confined to bed’. The body should be kept warm by fomentation. To quench thirst, sterilized water should be given, preferably acidulated with the juice of pomegranate, but any other fruit juice or milk under no circum¬ stances. During convalescence pigeon, dove or chicken broth with rice, with aromatic but non-irritant spices is to be preferred, but all coarse and irritant food should be avoided. In puerperal diarrhoea {sutika) which is usual¬ ly caused hy the invasion of the blood by the streptococci, staphilococci, united with gono¬ cocci, coli bacilli and other micro-organisms through a wound of the uterus at child-birth or in miscarriage by careless, septic handling and. spreading of the germs, treatment should be DISEASES 24a move or less confined to increase tlie resisting, jiower, bacteriolytic and agglutinative functions of the blood by dietary and hygienic regulations. The symptom-complex of septicemia (mtika) commences usually within a Aveek after infection. At the onset there is chilliness Avith low and moderate fever, but which rises and tends to be¬ come of continued type with decided daily remission. If however pyogenic germs have also got admission into the blood, tlie fever sets in with rigor, there is high temperature with steep curve and daily remission witli sweating, like malarial remittent feA'er. However, the fever runs an irregular course. But it may be complicated by previous or post malarial infec¬ tion. As compared Avith septicemia, pyemia exhibits recui’ring chills, deeply remitting fever and sweats, rapid wasting and moderate icterus Arhile in septicemia the chilliness is only felt at the onset of the fever which runs a mild conti¬ nuous type with no sweats and jaundice is much lighter. Heiidache, marked anorexia, nausea and diarrhoea are the usual symptoms of septicemia (ftidikd). Tlie pulse is rapid, small and compressible. The spleen may be palpably SAA'ollen ; petechial spots are not uncommon ; rashes or herps might also appear. Slight toxemic jaundice is alsa •250 ANCIENT HINDU MEDICINE usually seen. The urine usually contains albumin, leucocytes, red-cells and tube casts. The leucocytes are increased and there is an immense destruction of the red-corpuscles of the blood, leading often to bemoglobineraia and hemoglobinuria. Loss of appetite is very pronounced and there is no desire to partake of any kind of food and there is a special disgust to meat. The stool is emptied Avith severe tenesmus and consists of mucus mixed with blood. Often the joints beeome painful and swollen, and the skin of those parts reddish. Respiration is rapid but there is no dyspnea. But there may be complications of bronchitis or jineumonia. Prognosis is not very favorable except in cases whex’e within 6 to 8 weeks the temperature, respiration and jxulse slowly tend to be normal. The treatment should chiefly consist ef hygiene and dietary. The patient must be confined to bed. All movements should be restricted as much as possible, as movement tends to spread the in- fectiot). Even after convalescence has set in, the patient shall remain in bed, at least for four weeks and all physical motion and mental excitement should be forbidden. However it is very desirable that the room is airy, blight and -cheerful, so that there is no oppressive dullness DISEASES 251 ■and monotony.