Hints to Travellers, Scientific and General, Vol. 2 / Tenth edition, revised and corrected

by Royal Geographical Society

Prophylaxis.—Only those preventive measures which can be put into operation by the individual will be here considered. This may be called personal prophylaxis. By far the most important means of avoiding malaria is the proper use of an efficient mosquito net. The oblong type is best, and it should contain sixteen meshes to the linear inch. Round the foot of it should be sewn a stout layer of calico 2 feet in depth. This will permit of a foot of the material being tucked under the mattress while the upper foot remains in the form of a belt or zone round the bed. It is necessary, because in its absence the sleeper is very liable to be bitten through the mosquito-net mesh, with which his arms or legs are apt to come in contact. Care must be taken to see that the net is kept in good repair—a most important matter—and in very malarious countries it is advisable to provide every member of an expedition, native or otherwise, with a good mosquito net. In what may be called the dry tropics, the top of the net may be of mesh; in the moist tropics, it is best made of calico in order to keep off the heavy dews. The traveller often sleeps out on the deck of river steamers, and then it is certainly advantageous to have the roof of the net composed of stout calico, as sparks from the funnel are very apt to alight upon it, and naturally holes will be burnt much more readily in mesh than in thick cotton. It is foolish to sleep even for one night in a malarious locality unprotected by a net.

The net is for use during the period of sleep, but one is very apt to be bitten by infected mosquitoes just after sunset, and hence it is well to make use of some form of mosquito canopy. A good type is the so-called mosquito umbrella tent. Such a canopy may be arranged so that the evening meal can be taken in it. One servant will be inside the canopy and receive the dishes through a guarded opening from the attendant outside.

Other methods of protection exist in the shape of mosquito boots or buskins. The best type of mosquito boot is the form which reaches right up the thigh. They may be made of untanned leather or of stout khaki cloth. All mosquito boots and buskins should be provided with soles to protect the feet from wet and damp. In the absence of boots it is well to know that a mosquito will not bite through two pairs of stockings, one super-imposed over the other. This is a way in which women can protect their legs and ankles, or they can employ the buskin, leggings, gaiters, or puttees.

Mosquito veils have been mentioned, the best type being the “Mosquinette” hood.

Mosquitoes are apt to bite through chairs with cane seats or with perforated seats, and these should be guarded by a layer of brown paper, newspaper, or a cushion.

Repellent substances may be used, smeared on the skin. They contain essential oils, such as oil of cassia or eucalyptus oil. These repellents are effective only for a short time, but lessen in some degree the liability to infection.

The prophylactic use of quinine has recently fallen somewhat into disrepute, owing to its comparative failure in many of the war areas, but there can be no doubt that under conditions of civil life it is a valuable auxiliary method, if properly employed. One of the troubles about it is that quinine is rapidly excreted from the body, and hence after a dose it remains in the blood only a comparatively short time; for example, if the dose be taken at 6 p.m. it is very doubtful if enough quinine will be left in the blood at 2 o’clock in the morning to kill any malarial spores which may be introduced into it by an infected mosquito. The ideal method of taking quinine prophylactically would be to take a dose of 5 or 6 grains with the evening meal shortly before sunset. This will protect until it is time to get under the mosquito net. If for any reason it is impossible to employ the latter, then a second dose of quinine should be taken at midnight. This is difficult to accomplish, and hence something may be gained by taking a larger dose of quinine at night on the chance that some of it may remain in the blood for a longer period than would the smaller quantity. As much as 10 grains may therefore be taken under these conditions. Some persons, however, cannot stand 10 grains of quinine daily for a long period of time.

It is clear from what has been said that prophylactic quinine should never be taken in the morning, and also that it is merely an auxiliary method, and does not do away with the necessity of using the mosquito net. Sugar-coated tablets should be avoided, and care must be taken to see that the products or tablets which may be used are readily soluble. It is a good plan to crack the products before swallowing them. A good salt of quinine is the bisulphate, which is soluble and comparatively cheap. When the drug is given in powder, tablet, or pill form, it should be followed by a wine-glassful of water, and it is advisable to acidify the latter by a few drops of hydrochloric acid. There is no doubt that as a general rule quinine is best taken in solution, but in the case of persons travelling about this is not always easy to arrange, and if the above precautions be taken the solid form will generally be found effective. It is better to take prophylactic quinine in daily doses, because if an interval is allowed to elapse between doses one is apt to forget to take the drug at the proper time. Hence it is well to make it a kind of ritual to take the quinine along with the evening meal, for it is certainly an advantage to do so on a full stomach. It should be remembered that persons who take their quinine regularly do not suffer from blackwater fever, while the irregular taking of quinine certainly appears to favour the occurrence of the latter. It is better not to take prophylactic quinine at all than to take it in a haphazard and irregular manner.

Treatment.—The three great principles of treatment are: (1) To open the bowels; (2) to produce perspiration; (3) to give quinine. The routine to be adopted is as follows. Put the patient to bed in flannel pyjamas, and covered up well with blankets; in all cases, save where there is diarrhœa, give an aperient, such as four grains of calomel, or two tabloids of Cathartic Co, or two Livingstone’s Rousers, and if this does not act, repeat the dose in about four hours. If free evacuation is not produced, a warm-water enema should be given. A hot-water bottle in bed is useful. Sponging with warm water often gives relief at the beginning of a fever, and tends to shorten the cold stage. At the same time hot drinks should be given, such as weak tea, in order to promote perspiration and cut short the hot stage, and at this stage, i.e., at the outset of the fever, 10 grains of Antipyrin, or 10 grains of Phenacetin, may be found useful for inducing perspiration, or four tablets of Warburg’s Tincture, which contains some quinine, may be substituted for them. Antipyrin and Phenacetin should not be given except in the earliest stages of the fever.

During the hot stage cold applications, such as cloths wrung out of cold or iced water and sprinkled with eau de cologne, vinegar or spirit may be applied to the forehead and behind the ears. The bed-clothes should be lightened and drink freely supplied, unless it seems to promote vomiting. If the temperature shows signs of getting above 105° F. sponge the patient with warm water or cradle the bed-clothes, as it is called—that is, remove them from contact with the body by some simple means. In the sweating stage strip off the soaked pyjamas and sheets and get the patient into warm, well-aired night-clothes and bed-clothes. If there is any tendency to collapse a little stimulant may be given—say, a dessertspoonful of brandy. In most cases alcohol is better avoided. If vomiting is bad withhold all food, and give bits of ice to suck if it can be obtained.