19

A.—4a

The one negative result amongst the Chinese cases was a severe case of dysentery which had the blood taken on the sixth day of the disease, so that probably the agglutinins will develop later. In all the other cases the serum was taken on the twelfth to the sixteenth day —mostly on the twelfth day ; and a positive result was recorded when the agglutination to B. shiga was 1 in 20 or over, and any agglutination to B. flexner that might be present was less than that to B. shiga. Enteric Cases. —All tho enteric cases showed an agglutination in at least a 1. in 320 dilution of the serum to B. typhosus, except one Chinese case which was done on the eighth day and only agglutinated up to a dilution of lin 160, but this case showed no group agglutination at all; the others all agglutinated slightly to B. paratyphosus " A," either 1 in 20 or 1 in 40, but not to B. paratyphosus " B " at all. Conclusion. —l think that the present epidemic of dysentery is entirely caused by the basillus of shiga, and that the enteric fever cases are caused by the bacillus typhosus. John S. Armstrong, M.8., Ch.M., D.T.M. and H. 24th June, 1923. APPENDIX B. Treatment of Bacillary Dysentkry, Samoan Hospital. On admission: 01. Rieini, 1 oz. ; proportionate doses for children. Mist. Sod. Sulph.* : Two-hourly for forty-eight hours ; four-hourly for forty-eight hours ; T.I.D. until the stools become fsecal. Stop all medicines between 10 p.m. and 6 a.m. For the relief of pain : hot applications to tho abdomen ; hot saline irrigation of the colon. For the relief of tenesmus : starch enema after the irrigation. * The dose was 1 drachm in - 1 oz. of water flavoured witii 10 minims of Syrup Aurantii for an adult. Diet. No. 1 : For the first twenty-four hours give albumen-water and barley-water. No. 2 : Add coconut-milk, the water in which mummy-apples have been boiled, tea, vaisalo, water arrowroot, water sago. No. 3 : Add boiled rice, milk and water, arrowroot biscuits, chicken-soup, eggs. No. 4 : Add chicken, bread. No. 5 : Ordinary, excluding the coarser vegetables. APPENDIX C. Treatment of Dysentery, European Hospital. On admission: 01. Ricini, unless patient has had this before admission. Mist. Sod. Sulph * : Every two hours for forty-eight hours ; Every four hours for forty-eight hours ; T.I.D. before the stools become fsecal. Forjthe relief of pain : Hot applications to the abdomen ; colonic irrigation with hot saline. For the reilef of tenesmus: Starch enema after the irrigation. * The dose for an adult was 1 drachm in J oz. of water flavoured with Syrup Aurantii —-minims 10. Diet. No. 1 : Albumen-water, barley-water for twenty-four hours ; also sugar of milk. No. 2 : Add coconut-milk, tea, Brand's essence, jelly, water arrowroot, -chicken soup (clear). No. 3 : Add milk-puddings, milk foods, poached egg, or pounded fish. No. 4 : Add chicken, toast, biscuit. No. 5 : Add potatoes and gravy, bread and butter.