200 TROPICAL MEDICINE AND HYGIENE 



exert little effect upon it, and should be avoided on 

 account of their depressing action upon the heart. Tepid 

 or cold sponging may, however, be beneficial, the choice 

 depending upon the height of the fever. 



Thirst and vomiting may both be relieved by the 

 frequent administration of small quantities of cold but 

 not iced water. It is further important to let the patient 

 have plenty of water or other cooling drinks, provided 

 that they do not cause vomiting. The vomiting may 

 require the application of a mustard plaster or other 

 counter-irritant to the epigastrium, this also relieving the 

 tenderness of the liver and spleen. 



In view of the tendency to relapse, and thus to con- 

 siderable duration of the disease, it is very necessary to 

 see that the patient is properly fed. During the febrile 

 period fluids only should be given. The best is milk 

 diluted with soda-water, or with lime or barley water. 

 During the apyrexial period, should there be no intestinal 

 complications, easily digestible solid food may be given. 



The constipation of the early stage is best treated by a 

 mild aperient, but in view of the tendency to diarrhoea 

 at the crisis, it is important to avoid violent measures. 

 For the headache and insomnia, cold applications to the 

 head and small doses of bromide and chloral are the 

 best remedies. The treatment of other symptoms and of 

 complications should be conducted on general principles 

 and does not call for special remedies. 



Preventive Treatment. From what has been said with 

 regard to the etiology of relapsing fever it would appear 

 that cleanliness of the persons' clothes and dwelling 

 and the destruction of vermin are the best safeguards 

 against the disease. From an administrative point of 

 view the condition to be prevented or overcome is that 

 of overcrowding, for it is only under this condition, 

 whether it be in city or camp, that epidemics occur. 

 Should it be impossible to avoid overcrowding, it is 

 important, in view of the probability of the transmis- 

 sion of infection by means of pediculi, bugs or similar 



