60 TROPICAL MEDICINE AND HYGIENE 



Blankets and clothing require changing after the sweat- 

 ing stage, and both must be kept thoroughly dry and 

 warm. 



Warm sponging after the sweating stage is comforting 

 and cleanly. 



During the stage of rigor hot bottles are appreciated, 

 but are not necessary. Some protection to the bed is 

 necessary, as the perspiration is frequently sufficient to 

 soak through the blanket, and mattresses thus acquire a 

 peculiar, unpleasant, musty smell. 



To protect the bed fine native grass mats placed under 

 the blanket are serviceable : they are usually cheap and 

 can be washed and sunned. In hot weather these mats 

 will be found very cool and pleasant to lie on. Water- 

 proof sheets, such as are used in England, perish rapidly 

 in the Tropics and are expensive. 



If there is much vomiting sinapisms should be applied 

 to the epigastrium. Drinks should then be given hot, 

 or iced, and in small quantities at a time. 



In the severe forms of fever more attention is required. 

 Any tendency to a lethargic condition must be noted, 

 as this often precedes coma or hyperpyrexia ; and the 

 temperature must be taken at once, and every half hour 

 afterwards, if this tendency is observed, till the symptoms 

 subside, even if the temperature is very little above 

 normal. 



If coma supervenes, hot packs are by many considered 

 to be of great value. These may be given on the bed, 

 but the packs are more readily and rapidly changed if 

 the bedding and patient are placed on the floor. Either 

 a blanket or sheet may be used. The blanket retains the 

 heat longer, but the sheet is more readily arranged. The 

 sheet or blanket must be placed in water of a temperature 

 ten degrees higher than the pack is meant to be applied. 

 This is the safest rule, but in emergencies, or when an 

 exceedingly hot pack is required, it is better to use nearly 

 boiling water and wait until, as tested by the elbow, the- 

 temperature is such that it can just be borne. This will 

 be about 108 to 112 F. 





