154 TROPICAL MEDICINE AND HYGIENE 



complete recovery. Tonics, iron and arsenic are advan- 

 tageous and probably expedite recovery. 



It will be seen that the treatment is drastic, and that 

 the prolonged deprivation of food and purgatives must 

 involve some risks in advanced cases. In these the 

 attempt may be made to remove the worms by shortening 

 the period of deprivation of food, but is not often suc- 

 cessful, or the treatment must be postponed. Some cases 

 are hopeless. Thymol is occasionally dangerous and may 

 cause collapse, cardiac failure, or delirium. The risk is 

 greater if it is given in solution, and therefore solvents of 

 thymol, such as alcohol and oils, must not be used, nor 

 must they be given to the patient while he is taking the 

 thymol. Chloroform and eucalyptus oil seem to be 

 almost as effective and the mixture is less dangerous and 

 not so unpleasant to take. 



Nursing. Very careful nursing is required in advanced 

 cases of ankylostomiasis and even in mild cases during 

 the active stages of the treatment. The great danger is 

 cardiac failure. No unusual exertion must be allowed in 

 bad cases, or in any whilst under anthelmintic treatment. 

 The patient must not be allowed to leave his bed or sit up. 

 The bowels must be kept regular and the motions should 

 be semi-solid. The patient must not be allowed to strain 

 forcibly. Mild aperients or enemata should be used. 



In a cold climate warmth must be maintained by the 

 regular use of hot bottles as well as of warm blankets. 

 The foot of the bed should be raised, and in bad cases the 

 legs should be wrapped in cotton-wool, and bandaged 

 firmly and evenly from below upwards. As in other cases 

 of extreme anaemia alcoholic stimulants are of little value 

 and must not on any account be given after or shortly 

 before the administration of the thymol. Cardiac tonics 

 such as digitalis and strychnia are useful. Opium, best 

 given hypodermically in tonic doses only, is often of con- 

 siderable value ; T V or ^ gr. of morphia will often relieve 

 the restlessness, improve the pulse and induce sleep. 



Food must be light and nutritious, and must be given 

 regularly at short intervals. 



