60 WAGNER and BREVQR 



done by means of heated salt in a small bag, or hot sand or 

 hot mealie meal porridge. 



3. The patient should be made to drink unlimited quantities of 

 fluids, especially boiled water, weak tea or light kaffir beer. 

 As long as there is free urination there is little or no danger. 



4. No quinine or salts to be given but the patient should be 

 made to take a tablespoonful of Mixture No. 1 in water every 

 two hours, for the first twelve hours and then every four 

 hours until the urine is clear ; smaller doses being administered 

 if it produces loosening of the bowels. Small doses of calomel, 

 say '/ 4 grain, should be given two or three times on the first 

 day, or, in place of calomel, vegetable laxative pills may be used. 



5. When the water returns to normal give one tablespoonful 

 thrice daily of Mixture No. 2, and begin to feed the patient 

 gradually on a soft diet of milk pudding or biscuits and toast 

 etc. soaked in weak tea. Soups and Bovril are also good, and 

 if the patient is depressed some whisky should be administered 

 twice a day. Avoid overfeeding and giving meat or anything 

 indigestible. 



6. Unless hot water is available for a bath or sponging do not 

 wash at all either during an attack or for a week after. Cold 

 baths should not be taken for at least two months afterwards. 

 Over-exertion, chills and draughts should be carefully avoided 

 as they are liable to bring on a relapse which is always more 

 difficult to treat than the original attack. 



7. As soon as the patient is convalescent he should be carried 

 out of the district and taken to a non-malarious area. 



Quinine should not be taken for some weeks after Blackwater, 

 but if fever continues take not more than 2 1 / 2 grains daily for 

 some days. If it produces no discolouration of the urine take 

 5 grains daily but no more. If the urine gets dark in colour again 

 stop quinine at once, treat as for original attack of Blackwater 

 and take no more quinine for two months. 



Mixtures Nos. 1 and 2, referred to, are as follows: 

 No. 1. 



Sodium bicarbonate 15 grains. 



Solution perchloride of mercury . 1 dram (60 minims). 



Chloroform water to 1 tablespoonful. 



(Make 12 ounces). 

 No. 2. 



Methyl arsenate of sodium ... 1 grain. 



Water to 1 tablespoonful. 



(Make 8 ounces). 



