BLACKWATER FEVER 103 



can have no good effect. Water has been withheld in 

 order to stop the loss, and this practice is responsible 

 for much of the mortality. Stimulating diuretics, such 

 as turpentine, have been employed, but the haemo- 

 globin in itself acts as so powerful a diuretic that it is 

 unnecessary to employ any additional one. Large doses 

 of calomel are recommended by some authorities on the 

 assumption that the disease is in some way due to some 

 toxin absorbed from the bowel. This method of treat- 

 ment is not recommended. Quinine should not be given 

 unless parasites of malaria are found, and even then 

 must be given very cautiously. Quinine in large doses 

 usually has no effect at all. Patients may recover whilst 

 taking 60 gr. a day, but it does not shorten the dura- 

 tion of the disease. In these doses it may increase the 

 tendency to vomiting, and as in some cases it actually 

 causes further haemoglobinuria it should not be given. 



Good results are claimed for the frequent adminis- 

 tration of boracic acid in solution, and of carbonate of 

 soda in moderate closes, with perchloride of mercury in 

 minute doses frequently repeated. They all have the 

 advantage of increasing the amount of fluid taken by the 

 patient, and the mixture of perchloride of mercury and 

 carbonate of soda, given as in yellow fever, seems to check 

 the vomiting and also acts in the late stages as a bland 

 diuretic. This treatment has been practised by Hearsey 

 with excellent results. 



Carbonate of soda ... ... ... ... ... 5 gr. 



Perchloride of mercury ... ... ... ... -^ gr. 



Water ... ... ... ... ... ... 2 oz. 



This dose should be given every hour till the urine clears. 



The most uniformly successful treatment consists in 

 giving frequent rectal enemata, 6 to 8 oz. at a time, of 

 normal saline solution ; water alone is not retained. 

 These must be repeated every hour, or every half-hour, 

 according to the severity of the case, till the hcemo- 

 globinuria ceases. The injection of large quantities of 

 sterilized normal saline into loose cellular spaces such 



