Sal Ammoniac (326), Sulphate of Iron (177), or Fish Liver Oil (141) internally; and Datura (130), and Mustard (253), or Ginger (157) Poultices locally, are measures which, used conjointly, often prove successful. When periodical, Cinchona Febrifuge (402*).
Fainting.
Generally yields to dashing cold water over the face and neck (386), and applying strong smelling salts to the nostrils; when partially recovered, Omum Water (318) or Asafœtida (35) may be given, or should there be much exhaustion, a dose of Brandy Mixture (426).
Fevers, Ardent or Continued.
In most cases it is advisable to commence with a purgative of Kaladana (187), Castor Oil (83), or Myrobalans (256), or if the patient be a strong adult, a Croton Pill (120); after its operation the Solution of Nitre (264) may be given, and Decoction of Abelmoschus (2), Lemonade (232), or Tamarind Infusion (346), to allay the thirst and cool the system. A very useful and refreshing drink in all fevers, especially if there is irritability of the stomach, is a mixture of equal parts of Milk and Soda Water, with the addition of a piece of ice if procurable. Sucking small pieces of ice also allays thirst and cools the system; for this latter purpose, also, sponging the surface with Water (385) or diluted Vinegar (376) may be employed. The diet should consist chiefly of Rice Conjee (322) and other farinaceous articles, and the apartment should be kept cool and well ventilated. To relieve Headache or great fulness of the head, apply constantly Evaporating Lotion (380) or Nitre Lotion (265), or, if these fail to afford relief, Hot Water Fomentations (393). Leeches to the temples or nape of the neck (209) and Mustard Poultices to the feet (248) may also be necessary in severe cases. For any severe or acute pain arising in the chest or abdomen, Leeches (209) over the seat of pain should be applied, but if these fail try a Blister (349). For Vomiting and Irritability of Stomach give Lime Water (223), or else give Hot Water as a drink (385), and apply Mustard Poultices (251); for Bilious Diarrhœa accompanying use Warm Water Enemas (393). For Sore Throat or Fissures of the Tongue, apply Borax (55) or Alum (29); for Dryness of the Mouth and Fauces sucking sliced limes, or, better still, pineapples, generally suffices. In the advanced stages, when great exhaustion, delirium, &c., are present, give Camphor (74) and Brandy Mixture (426) internally, and apply Turpentine Stupes (363) to the extremities; Turpentine Enemas (364) are also valuable in this condition. For subsequent Debility and during Convalescence give one of the following tonics: Chiretta (98), Atís (42), Bonduc (52), Kariyát (191), Ním Bark (260), Gulancha (352-3), or Cinchona Febrifuge (402). A combination of Chiretta and Sweet Flag Root (12) or Chiretta Wine (99) is perhaps best suited for this purpose. A liberal animal diet should be allowed. N.B.—Throughout the attack it is essential to keep the bowels properly regulated.
Fever, Intermittent or Ague, and Remittent or Jungle Fever.
Commence with an aperient, as in Fever (ante), and should the stomach be foul give an emetic of Country Ipecacuanha (368). In the cold stage, cover the body well up with blankets, give Infusion of Ginger (156), and place bags containing hot sand or hot salt along the spine. In the hot stage, give plentifully of Lemonade (232), Solution of Nitre (264), and adopt generally the other measures advised above in Fever. In the sweating stage, do nothing but protect the surface from cold draughts of air or cold wind. In the intermission or periods between the paroxysms give one of the following: Atís (42), Bonduc Nut (52), Chiretta (98), Sulphate of Iron (175), Ním Bark (260), or Gulancha (352). When one fails another may succeed; when each fails, given singly, they will sometimes prove effectual given in combination. They are all greatly inferior in efficacy to Quinine and Cinchona Febrifuge (401, 403). For these Fevers in Natives, Galls, with Chiretta and Sweet Flag Root (12), have been favourably spoken of. Swelling of left side after Ague, see Spleen, Enlargement of.
In mild, ordinary, uncomplicated cases of Intermittent Fever, all that is required, due attention being paid to the state of the bowels and secretions, is to administer Quinine in doses of from three to five grains, so that 10 or 12 grains be taken in the intermissions between the paroxysms. It is best given in solution, in water or coffee. In the severer forms, or even in ordinary cases, Professor Maclean, of the Netley Hospital, has proposed a treatment which appears very judicious, and which in his hands has for years proved very successful. It consists in administering 30 grains in three equal doses during the period of intermission; the first dose, in solution, should be given towards the close of the sweating stage, and the last about as far as can be calculated, an hour before the next anticipated paroxysm. Should there be much irritability of the stomach, it should be given in enema in doses of 15 grains in place of 10 grains. After the paroxysm has by this means been arrested, a moderate degree of cinchonism, i.e., giddiness, buzzing in the ears, flashing before the eyes, &c., should be maintained for some days, by giving three or four grains in solution every four hours. In cases where the fever returns at the first lunar period, as it is apt to do, the patient a day or two previously should be brought under the influence of Quinine, which should be maintained until the time is past. Should it fail to influence the fever, attention should be directed to the state of the liver and bowels. When from any cause it cannot be given internally, trial may be made with it applied endermically; the experiments of Dr. Guastamacchia and others tending to prove that it becomes absorbed into the system through the skin, and operates as an antiperiodic almost as certainly as when given internally. He dissolved eight grains in half an ounce of spirit, and rubbed first one half, and after the interval of a quarter of an hour, the second half along the spine. When this was done at the commencement of the cold fit, it very often prevented even a single recurrence. Dr. Daunt also bears testimony to this method in the fevers of South America.
In Remittent and Jungle Fever, Quinine is a remedy of the highest value, but its exhibition requires more caution and discrimination than in simple intermittents. Dr. Maclean's treatment appears to be worthy of every attention. After premising, in most cases, a cathartic, immediately on the first signs of remission, he administers a full dose of Quinine, 10 grains, often 15, sometimes 20 grains, never exceeding that dose, and not deterred by the presence of headache or a foul tongue, nor because the remission is slight or imperfectly marked; and this dose he repeats every second hour until 30 or 35 grains have been taken before the hour of the expected exacerbation. Should the stomach be too irritable to bear it, it should be given in enema in large doses (20 grains). As soon as the second remission appears, it must be given as before until full cinchonism or distinct abatement of the disease occurs. During the remission the patient should have mild farinaceous diet, milk, chicken-broth, &c.; as soon as gastric irritability subsides, beef tea should be given, and on the first sign of exhaustion, nourishment and stimulants should be resorted to at short intervals. With regard to the administration of Quinine during exacerbations, Dr. Maclean is of opinion that in the adynamic forms of fever, as met with in some parts of India, and in neglected or mismanaged cases, where depletion has been carried too far, and the fever assumes more of a low continued type, it may be given at any period irrespective of remission. Here it requires to be conjoined with the assiduous use of support and stimulants at short intervals.
As a preventive of Malarious Fever, the power and value of Quinine have been proved beyond a doubt. Every person engaged in forests, swamps, or low, malarious sites, should be provided with a stock of it, and four grains of it in a cup of hot coffee should be taken the first thing in the morning or in a glassful of wine later in the day. Even if it should fail, which it rarely does, no harm can result from its use, and it is essential that it should be continued for at least fourteen days after quitting a malarious locality.