In order to maintain free action of the kidneys, plenty of fluid should be given, such as barley-water made from Robinson’s prepared barley, flavoured slightly with lime-juice or lemons. Weak tea is useful.
Diuretics which stimulate the kidneys must be avoided. The most effective method of flushing the kidneys is by giving saline injections by the bowel, but these, as a rule, can be administered only by a medical man or by a trained nurse under a doctor’s supervision. It may, however, be stated that the amount usually given is six ounces of physiological salt solution (seven and a half grains of sodium chloride to the ounce of warm water). This is administered every hour, or even oftener, if necessary, in bad cases. In mild cases enemata every four or six hours will suffice. Other measures are the application of poultices or hot fomentations to the loins when suppression threatens, or when there is severe lumbar pain. Diaphoretics, so long as they do not depress the heart, are useful, and so is frequent sponging. Cold applications to the head and especially behind the ears alleviate headache.
The question of giving or of withholding quinine is an important one, but recent work on the subject indicates that in the absence of a medical man who can carry out blood examinations, it is advisable to give quinine as in the case of malaria.
Vomiting is often a serious complication, and the directions for its treatment, given under the head of malaria, should be carefully followed. If it cannot be speedily checked, feeding by the bowel must be carried out. See Nutrient Enema, [p. 259].
So long as plenty of urine is passed and sufficient nourishment is taken there is little cause for anxiety, though wherever possible skilled assistance should be obtained at the earliest opportunity.
After an attack the patient is very weak and anæmic. He requires careful feeding and tonics, especially iron and arsenic. It is advisable that he should be invalided out of the endemic area, and he should be specially warned as to the danger of getting chilled or wet.
Bronchitis, or Inflammation of the Branches of the Windpipe.
Symptoms.—When bronchitis exists, there is a good deal of coughing—at first dry, but afterwards accompanied by frothy expectoration—with a sensation of rawness and tenderness at the upper part of the breastbone.