Page:Tropical Diseases.djvu/161

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VIII]
TREATMENT
129

necessary. In such circumstances, antipyrin and similar antipyretics are worse than useless. Good rules are to prepare to give the cold bath, or cold pack, if the axillary temperature reach 106° F., and to remove from the bath when rectal temperature has fallen to 102° F. Although the temperature has been reduced by this means, thermometrical observations must be continued at short intervals, say every two hours; directly it begins to rise again, say to 102-103 F., the patient should be replaced in the bath: this must be repeated as often as necessary. Patients who have suffered from a hyperpyrexial attack should be invalided home.

Treatment of algide and dysenteric attacks.—— Algide and dysenteric attacks demand quinine combined with a little opium. If dysenteric symptoms persist, emetine, or ipecacuanha, or the aperient sulphates in full doses, and opium, according to the nature of the dysentery, must also be given.

Other drugs in malaria.—— During the continuation of a fever I have never seen much, if any, good from arsenic. The place of arsenic is not as a substitute for quinine during fever, but as a blood restorer after fever. I have heard of cases of obstinate ague cured by ½-drachm doses of liquor arsenicalis; I have never myself ventured on these heroic doses. Recent experiments show that although salvarsan and neo-salvarsan have some effect on the quartan and tertian parasites, they have little if any on the subtertian. A strong infusion of "the hairs that grow between the grain and the outer leaves of the mealie cob " (dose, 3 tablespoonfuls) has recently been recommended as a cure for malaria; I have no experience of it. I have never seen benefit, in any way approaching that derived from quinine, from methylene blue, carbolic acid, iodine, anarcotine, analgen, phenocol, parthenium, ailanthus, chiretta, eucalyptus, or any of the many drugs which from time to time have, on very limited experience, been recommended in malaria. In those cases, however, in which from some idiosyncrasy the patient is unable to take F