23. How To USE THE CLINICAL THERMOMETER 24. FUNDAMENTAL PRINCIPLE OF TREATMENT. 25. HOW TO TAKE QUININE 26. DETAILS OF TREATMENTS THE FIRST WEEK 52 54 55 56 27. TREATMENT AFTER THE FIRST WEEK 58 61 31. PREVENTION AND TREATMENT OF BLACKWATER FEVER 65 68 Malarial Fever Its Cause, Prevention, and Treatment CHAPTER I MALARIA I. WHERE THE DISEASE PREVAILS Malarial fever is known under many other names. It has been called ague, paludism, marsh fever, jungle fever, and telluric fever. It also possesses many local names, such as African fever, Burma fever, Roman fever, and the like. All these denote the same thing. There are two varieties of malarial fever, called intermittent fever and remittent fever. Malarial cachexia is the name given to the condition sometimes produced by very severe or prolonged malarial fever. The disease is chiefly one of hot climates, but it often exists in the summer in temperate climates, and was once common enough in England, and even in Scotland. It is very prevalent in the tropics, where more than half the native children are sometimes found to be infected by it. During many centuries, men have observed a curious fact about the disease, namely, that it is usually most common in the vicinity of stagnant water. As a consequence of this law, it is also most prevalent in localities where stagnant water most tends to collect, as on flat plains, in mountain valleys, in the neighbourhood of estuaries, and so on. For the same reason, the most malarious time of the year is generally the rainy season. Sometimes, however, fever is common in tracts which appear to be quite parched and waterless. But few countries are entirely without water, and it is to be observed that, in the driest places, human habitations are apt to exist just where there is some water. Owing to this undoubted relation between stagnant water and malarial fever, the idea has taken root that the disease is caused by poisonous exhalations rising from the soil-especially from damp soil. Hence the terms malaria (bad air) and telluric (appertaining to the earth), which have been so frequently used. So strong has this fancy become, that people have even described outbreaks of fever as resulting from digging the soil, as if the telluric poison comes rushing out of the ground when its surface is disturbed. As a matter of fact, no proof of this idea has ever been given; and, indeed, we now possess the true explanation of the connexion between malarial disease and stagnant water. It was formerly thought, too, that it is not a catching complaint, but we now know that it is so, provided that both persons—namely, the person who catches the disease and the person from whom it is caught—are living under suitable conditions. Thus, a man who enters a house or village where there have been many cases of malarial fever is very apt to acquire the infection there from the natives. II. THE SYMPTOMS Let us suppose that a person arrives in a malarious locality direct from England; then he will be subject to infection at any moment after his arrival. If he is a careless person, he may become infected the very first night he spends in the locality, but if he takes due precautions he may postpone the evil moment for years, or even altogether. Let us suppose, however, that he does become infected, and then let us trace in him the progress of the disease. For a period of from about three to twenty days after infection, or even longer, he may remain apparently quite well. This is the incubation period, during which the poison is incubating in his blood. At the end of this time the illness commences—generally with a headache and feeling of being 'out of sorts,' followed by a sudden chill accompanied by fever. The chill may sometimes be entirely absent, but at other times may be so severe as to cause a violent fit of shivering, called a rigor. Even when it is present the clinical thermometer shows that the patient's temperature is rising. In a few hours the temperature reaches 103-5° F., and the sick man complains of burning fever, and often of severe headache, nausea, or vomiting. This fever, varied by attacks of shivering or profuse sweating, may continue without intermission from a few hours to a week or more. The temperature then falls to normal (98.4° F.), or still lower (96-7° F.), and the patient feels much better; but the improvement is only temporary, for the fever now generally comes back with all its old violence, and attack follows attack, sometimes for weeks. At the beginning of the illness the fever is generally continued for days, and is then called remittent fever, |