64 TROPICAL MEDICINE AND HYGIENE 



attack, and there is no object in forcing any on the 

 patient during this period. Thirst is a common symptom, 

 and there is no reason why abundant fluid should not 

 be taken, provided that small quantities only are taken at 

 a time, otherwise vomiting may be provoked. Any fluid 

 taken should be hot ; hot tea is a favourite drink, but 

 must be freshly prepared and not too strong, as tannate 

 of quinine may be formed in the stomach and is very 

 slightly soluble. 



Many of the native remedies, such as lemon-grass tea, 

 are comforting and aid in diaphoresis. In subtertian 

 malaria the fever is long continued and careful feeding 

 is important. Milk, and milk and barley water or other 

 light food is usually retained and digested. 



During convalescence, protection from chill is of great 

 importance. Good food is also required ; it should be 

 light, nutritious and varied, as the appetite is frequently 

 capricious. 



Few men can be persuaded to remain long in bed even 

 after a severe attack of fever, but a minimum of three 

 days should be insisted on. 



Special Cases. In pregnant women the frequency of 

 abortion with or without quinine must be kept in mind. 

 Unless the fever is controlled, abortion will take place 

 in many cases, but quinine, the only reliable drug, 

 undoubtedly has a similar tendency. 



Before treating a case of malaria in a woman, careful 

 inquiries should be made in order to find out if she is 

 pregnant. If so, quinine must be given, but in very small 

 doses, gradually increased till the fever is controlled. 

 The large heroic doses advocated in an ordinary case 

 must only be given in pregnancy if there is urgent danger 

 to life. A pregnant woman should be kept in bed for 

 at least one day before the quinine is given. Drastic 

 purgatives must be avoided, but a fair action of the 

 bowels must be obtained, and the quinine given after the 

 laxative has ceased to act. During the whole course of 

 the treatment the patient must be kept quiet in bed. 



