1226 



THE TROPICAL HEMOGLOBINURIAS 



General Treatment. — In treating the disease, the important 

 features to be remembered are that the patients are often infected 

 with malaria; that they suffer from a great blood destruction, and 

 therefore from great weakness; that, as a result of the blood destruc- 

 tion, a severe strain is thrown on the liver and kidneys, and that the 

 latter are apt to be damaged by the haemoglobin. In fact, some 

 people think that the haemolysis takes place in the kidney, but in 

 any case there is danger of blocking of the renal tubules, of nephritis, 

 anuria, and uraemia. Lastly, the disease is apt to relapse. 



From the very commencement, the patient must be put to rest 

 in bed, and have careful nursing. A most important matter is to 

 flush out the kidneys, and this should be done by introducing water 

 into the body in some way. If the patient can take liquids by the 

 mouth, use soda-water, albumen-water, whey, cold or warm tea, 

 barley-water, or toast -water, in quantity. If vomiting is such that 

 liquids cannot be retained by the stomach, use rectal enemata of 

 warm physiological saline solution (o^g per cent, of common salt 

 in water) or sterile subcutaneous injections (temperature 98*4° F. 

 or 37° C.) of a mixture such as the following : — 



Calcium chloride . . . . . . 4-5 grammes. 



Sodium chloride . . . . . . 10 grammes. 



Distilled water .. .. .. 1,000 c.c. 



One hundred to two hundred cubic centimetres of this mixture, 

 properly sterilized, may be used two or three times a day as a sub- 

 cutaneous injection in bad cases. 



Adam Patrick recommends the intravenous injection of a i per cent, sterile 

 sodium chloride solution. He has injected as much as 3 pints at one time. 

 Bayliss' Solution, containing 6 per cent, gum acacia and 0-9 per cent, sodium 

 chloride, may also be used. 



Diet.— The diet must be fluid, preferably in the form of whey, 

 milk, chicken-broth, albumen-water, and Benger's food; but strong 

 meat-extracts should be avoided. 



If the vomiting is troublesome, and there is no diarrhoea, rectal 

 feeding might be tried. Plenty of aerated water should be allowed. 



The condition of the stomach, liver, and kidneys may counter- 

 indicate stimulants at times, but there is no doubt of the value of 

 champagne and brandy when they can be administered. 



Symptomatic Treatment. — Vomiting may be reheved by sips of 

 iced or cooled soda-water or champagne. If these simple remedies 

 fail, apply a mustard-leaf to the pit of the stomach. Tincture of 

 iodine in a strength of i to 2 drops in an ounce of cinnamon water, 

 and administered orally several times a day, may be useful. If this 

 fails, hypodermics of morphine must be tried, but it must be ad- 

 mitted that we do not like to administer this drug in blackwater fever 

 unless compelled, and prefer to combine atropine with it, and even 

 then to give as little as possible. Constipation may be combated by 

 means of calomel in repeated small doses, helped if necessary by 

 enemata. Diarrhoea should not be too rapidly stopped, but if it is 



