SYMPTOMATIC TREATMENT 



1227 



a pressing symptom, weakening and disturbing the patient, then 

 tannic acid in 15 grain doses, tannalbin in 15 grain doses, or bismuth 

 subnitrate in 10-20 grain doses, may be administered by the mouth, 

 or enemata of tannic acid given by the rectum if there is also much 

 vomiting. 



The heart's action should be carefully watched, and may require 

 support by hypodermic injections of digitalin or caffeine. Calcium 

 lactate, having a tonic effect upon the heart, and being also useful 

 for other reasons in this disease, may be given in 10 grain doses 

 twice or three times a day, or in the form of the injection mentioned 

 above. Extract of the pituitary gland has been recommended in 

 cases of cardiac failure. 



Malarial parasites, when present in the blood, require treatment by 

 intramuscular injections of quinine hihydro chloride (p. 1188) , preceded 

 by a dose or two of calcium lactate, but the sulphate or bisulphate 

 of quinine are contraindicated, and should not be employed. 



Pain in the back should be treated by hot fomentations, and if 

 these fail and the symptoms be urgent, by morphine given sub- 

 cut aneously. 



Anuria must be met by vapour baths, before which a hypodermic 

 injection of pilocarpine may be given. If this fails, dry or wet 

 cupping of the lumbar renal area must be tried, and must be helped 

 by oxygen inhalations if available and by free purgation. 



Headache may be relieved by cool applications to the head, but 

 special drugs must not be given. 



2. After the Attack. — -If the patient survive the attack of 

 true blackwater fever, which is often fatal, he should be allowed 

 a long convalescence, with a change to a temperate climate if 

 possible. During this time he will require good, wholesome, nourish- 

 ing food and slowly graduated exercise. 



One attack of ' blackwater fever ' per se should not necessarily 

 lead to the permanent invaliding of the patient from the tropics, 

 though he should be warned that he returns thereto at his own risk. 

 If, however, permanent damage to any organ is also present, this 

 should be the deciding factor in stating that a return will be 

 dangerous. 



3. Remarks. — Such is the outline of the treatment which we 

 advise, but other authors have different views, and one or two 

 of these may be briefly mentioned : — 



Dr. O'SuUivan-Beare strongly recommends the decoction or the fluid extract 

 of the root of Cassia beareana Holmes ; the latter can be obtained from 

 T, Christy and Sons, Old Swan Lane, Upper Thames Street, London, and should 

 be administered in i fluid drachm, well diluted with water, every two hours at 

 first, and afterwards at longer intervals. We have no experience of this drug, 

 but its introducer praises it highly, stating that it relieves all the symptoms 

 quickly. Skelton says he has never seen it do any good, but that it does no 

 harm. So well is the disease known in West Africa that several native remedies 

 exist. With regard to other drugs, atoxyl is said to be useless. Cantlie has 

 used turpentine in mild attacks. Nightingale recommends sodium dimethyl- 

 arsenate administered in i -grain doses thrice daily until the temperature is 

 below normal for twenty-four hours. It is stated to soothe the gastric irrita- 



