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Prevention of Communicable Disease: Epsom

Preliminary Treatment.-"On Saturday evening give a dose of Epsom salts. The reason is this: The hookworms are surrounded by more or less mucus and partially digested food. Unless this is removed, the thymol may not reach the parasites, but may reach the patient, and this is contrary to what is desired, as thymol is intended for the parasite, not the patient.

Thymol Treatment on Sunday.- "Position of patient: Instruct the patient to lie on his right side immediately before taking the drug and to remain in that position for at least half an hour. The reason for this is that many of these patients have enlarged stomachs, and if they lie on their right side, the drug has the benefit of gravity in passing rapidly from the stomach to the intestine; but if any other position is assumed, the drug may remain in the dilated cardiac portion of the stomach for some hours and result in considerable complaint on the part of the patient and delay of the drug reaching the worms. "Time of dosage: The time of giving and size of dose should be arranged on one of two plans, depending on existing conditions. "The plan usually followed is: At 6 a. m., one-half of the total dose of thymol; at 8 a. m., one-half of the total dose of thymol; at 10 a. m., Epsom salts (never castor oil). "If the case is an especially severe one, or if the patient has, upon the first Sunday's treatment, complained of burning or other effects of thymol, the following plan is adopted: At 6 a. m., one-third of the total dose of thymol; at 7 a. m., one-third of the total dose of thymol; at 8 a. m., one-third of the total dose of thymol (if unpleasant symptoms, as a sensation of severe burning in the stomach, have appeared this third dose should be omitted); at 10 a. m., Epsom salts (never castor oil). "Food: No food is allowed until after the 10 o'clock dose of Epsom salts, but the patient is permitted to take a glass or so of water after the thymol, if he desires. "Thymol: Finely powdered thymol in capsules, preferably in five-grain capsules, should be used. "General rule as to age: In the table of dosage given in the next paragraph, the maximum dose per day to be adopted as a routine is given for various age groups. In determining the dose, however, the rule should be followed of taking the apparent rather than the real age and of not hesitating to cut down the dose even lower in case of unusually severe cardiac symptoms or other unfavorable conditions. Thus for a boy sixteen years old, who appears to be only twelve years old, or in whom the anemia is especially marked, resulting in severe cardiac symptoms, the quantity of thymol should be reduced to the twelve or even the eight-year dose. Some authors give the impression that it is useless to give thymol for this disease unless the full dose is administered. This view is not in harmony with my experience. "Size of dose: The following doses represent the maximum amount to be used during one day's treatment for the age groups in question. It is practically the same table that the Porto Rican Commission has been using:

Grains. 7 15 .. 30 Under 5 years old..

From 5 to 9 years old...

From 10 to 14 years old.

From 15 to 19 years old. 45 From 20 to 59 years old........60 Above 60 years old...30 to 45 Total dose, to be divided as previously indicated.