IO4 TROPICAL MEDICINE AND HYGIENE 



as the axilla is preferred by some. This cannot be 

 repeated so often as the rectal injections, but must be 

 employed in cases where there are both vomiting and 

 rectal irritability. The great point is to commence the 

 treatment early. If this is done from the onset, fluid by 

 the mouth only will suffice, as the vomiting is to a great 

 extent due to the renal obstruction, and if the latter can be 

 prevented, or only a few tubules are blocked, the vomiting 

 can be controlled. 



If suppression has set in, recovery does not take place, 

 but there is just the possibility that the free supply of 

 fluids may enable a sufficient flushing to take place to 

 dislodge some of the casts and so restore the functional 

 activity of a part of the kidneys. In some cases where 

 a free discharge of urine of very low specific gravity 

 is induced there is no improvement in the condition. 

 Alcoholic stimulants are required in all severe cases, but 

 their use should not be commenced too early ; strychnine 

 also should be given. 



The patient is usually constipated ; but active purga- 

 tion is probably injurious, as it diverts into the intestine 

 the fluid that we wish to pass through the kidneys. 



During convalescence good, easily digested food must 

 be given. The digestive powers are usually good. The 

 bowels should be kept freely open with salines. 



Iron and arsenic may be taken with benefit in the 

 later stages, but there is no advantage in giving them 

 early, as all the actively metabolic organs are at that 

 time overloaded with iron. 



For the secondary fever free purgation seems to be 

 the most effective. Quinine has no beneficial action and 

 may provoke a relapse. Phenacetin and other anti- 

 pyretics are to be avoided ; their action is temporary and 

 the danger of cardiac failure is great. In hyperpyrexia 

 during this stage hot packs, cold packs, or cold baths may 

 be resorted to, but the prognosis is most unfavourable. 



Relapses must be treated in the same way as the 

 primary attack. 



