BLACKWATER FEVER 105 



In the exceptional cases where an attack of malaria 

 follows blackwater fever, quinine should be given in 

 small but gradually increasing doses, commencing with 

 ^-gr. doses. 



Nursing. During the first day of the illness the main 

 precaution to be taken is to administer fluid frequently, 

 so that a considerable quantity, at least equal to that of 

 the urine passed, is taken. Ten ounces every hour by 

 the mouth, or 5 to 6 oz. per rectum every hour are 

 usually sufficient. As there is always a tendency to 

 vomiting, water must be given in small quantities, i to 

 2 oz. at a time. Though there is thirst, the amount of 

 water that must be taken is in excess of -that which the 

 patient desires. The urine should be measured after 

 each act of micturition, as it is of the utmost importance 

 to obtain information as to any diminution in the rate 

 of secretion. As nearly as possible secretion at the 

 rate of at least 4 oz. every hour is the result desired. 

 Any drop to a lower rate than this calls for rectal or 

 subcutaneous administration of fluid or of both. Tepid 

 sponging after the perspirations is required, and great 

 care must be taken to avoid a chill. 



This treatment must be continued throughout the 

 attack, but after the first day, though the muscular 

 strength may be considerable, the patient must not be 

 allowed to leave his bed or even raise himself in it 

 without assistance. Any necessary movement must be 

 made very slowly. These precautions become more and 

 more necessary, not only whilst the blackwater persists, 

 but for several days after. The vomiting must be 

 checked ; if not restrained by sinapisms or hot applica- 

 tions to the epigastrium, hypodermic injections of 

 morphia should be administered and all fluid given in 

 teaspoonfuls if necessary. Painting the skin over the 

 course of the pnetimogastric nerves in the neck with 

 blistering fluid sometimes succeeds when other methods 

 have failed. 



Patients must never be worried to pass urine ; they all 



