106 TROPICAL MEDICINE AND HYGIENE 



know the danger of suppression, and any concern shown 

 by the attendant as to this will still further increase 

 their anxiety. The danger is suppression, and if no 

 urine is in the bladder it can do no good for the patient 

 to attempt to micturate. Retention does occur occasion- 

 ally, so that if there is undue delay in micturition the 

 abdomen above the pubes should be examined to make 

 sure that the bladder is not distended. 



If the vomiting cannot be checked, or sufficient water 

 cannot be administered by the mouth, rectal injections 

 of normal saline solution, 0*87 per cent., should be given 

 hourly. 



As the frequent administration of such enemata 

 leads to an irritable condition of the rectum, great care 

 is required. The enemata should be given very slowly 

 and should be at blood heat. 



The blankets and clothing must be replaced by warm, 

 dry clothing as often as is required. If the tendency to 

 syncope becomes marked, the lower end of the bed must 

 be raised, hot-water bottles applied to the axilla, and the 

 legs bandaged from the feet upwards, and stimulants given 

 freely by. the mouth, rectum, or by hypodermic injections. 

 Transfusion into the veins has not been successful. 



Hyperpyrexia may occur either whilst haemoglobinuria 

 is present or afterwards during the secondary fever. The 

 temperature should be taken frequently, hourly, or even 

 half-hourly, when it is above 103 F. The hyperpyrexia 

 after the urine has cleared is the more dangerous. 



When the patient is so situated that there is no skilled 

 nursing available, the danger is greatly increased. Atten- 

 tion to the general principles will be of service, and if 

 the patient has to leave the bed his movements must be 

 as slow as possible and the head held low. He must 

 crawl, not walk, and never hold himself upright under 

 any circumstances. Any expressions of despondency 

 must be discouraged. It is useless to attempt to minimize 

 the danger, but the patient's courage must be sustained 

 as much as possible. 



