(The following suggestions are intended for the necessarily limited possibilities of a mountain camp.)
Treatment.
Malaria.—So long as his temperature is above normal, the sick man should, if possible, be kept in bed. Give 3 grains of calomel followed by a dose of Epsom salts to clear the liver and bowels. Continue to give three doses of 5 grains each of quinine bihydrochloride every day that the fever lasts; but do not give the quinine while the temperature is raised. When the attack has ceased give 10 grains daily for a week, and afterwards continue with the regular daily dose of 5 grains. At the same time it is very important to make sure of a regular action of the bowels. If, while the attack lasts, headache is very severe and persistent, 5 or 10 grains of phenacetin may be given; but this drug is greatly abused and is often of little or no use. Sweating may be stimulated by giving copious draughts of hot tea; when the sweating stage is at an end, the pyjamas should be immediately changed.
Diarrhœa is a very common trouble, particularly when no fresh food is obtainable. It is usually sufficient to take a dose of castor oil and to eat as little as possible for 24 hours. If this treatment is not effective, give 10 grains of bismuth subnitrate three times daily, and a diet of milk and arrowroot or Horlick’s malted milk. If the diarrhœa ceases, but there is still discomfort in the bowels, 10 drops of chlorodyne may be given, but in most cases it is better to avoid the use of this drug.
Dysentery.—Rest in bed, warmth, a diet of milk and water and arrowroot, and a preliminary dose of castor oil are the first essentials of the treatment. Severe cases may be well treated by the use of emetine hydrochloride, in keratin-coated cachets, containing one ½-grain dose. One dose should be taken each day, and the treatment should be continued until he has taken altogether 8 grains. As an after-treatment it may be good practice to take 2 drams of liquid paraffin every night. There are some who advocate the regular use of this every day as a preventative of intestinal disease, but such a thing will be hardly practicable on a mountain expedition with limited transport. The treatment by ipecacuanha cannot be recommended for camp use. Less severe types of dysentery may be treated by giving small doses (1 dram) of sulphate of magnesia every two or three hours to ensure a free watery purgation, which may be continued until the pain has ceased. If the disease proves to be intractable, the sick man should be removed to the nearest place of civilization as soon as possible.
Constipation is not a very common trouble in tropical mountain expeditions. It may generally be avoided by eating a daily plate of porridge and, if they can be carried, by eating prunes and figs. If the camp arrangements make bread-making possible, it is a good plan to mix with the white flour some whole meal, or, in countries where it is grown, the meal made from millet. If none of these measures ensures a daily action of the bowels, a dose of sulphate of magnesia (½ to 1 ounce) may be taken early in the morning, or one ‘Livingstone Rouser’ or cascara sagrada or two vegetable laxatives (Burroughs & Wellcome) may be taken over-night.
Sunstroke is not at all likely to occur, but if a serious case should happen, and the temperature rise to 105 or 106, the patient should be stripped and wrapped in cold wet blankets until the temperature falls to 103, after which he should be placed in bed in the darkest and coolest place possible; the bowels must be kept open and a liquid diet given for some days.
Coughs and Colds are sometimes exceedingly troublesome. They may often be cured at the outset by taking a hot bath (if that be practicable) with mustard in it, followed by bed with many blankets and a dose (10 to 15 grains) of Dover’s powder. A sore throat may be treated by frequent gargles of weak solution of potassium permanganate (Condy’s fluid) and by sucking tabloids of chlorate of potash. Nasal catarrh may sometimes be cured by sniffing the vapour arising from the open mouth of a bottle of formalin.
Toothache is one of the most frequent and most distressing troubles of a mountain expedition, and it ought, as far as possible, to be avoided by visiting a dentist before leaving civilization. If the pain is in a decayed tooth, it is sometimes sufficient, after clearing away the debris, to put into the cavity some powdered carbonate of soda; it is more efficacious to put in very carefully a small drop of pure carbolic acid on a plug of cotton wool. Pain at the root of a tooth may be relieved by painting the gum with tincture of iodine, but the cheek should be held away from the jaw until the tincture has dried. Some forms of toothache can only be treated by extraction, and no expedition ought to make a long journey without three or four forceps. The sufferer will probably prefer extraction at the hands of an amateur to the horrors of prolonged toothache.
Sleeplessness is often a very serious trouble, not less at high altitudes than in the sweltering heat of the foothills. Sleep may sometimes be induced by drinking a cup of hot cocoa shortly before going to bed; it is also a good plan to have biscuits within reach during the night. If the insomnia is very persistent, it may become necessary to give up smoking and to reduce as far as possible the consumption of tea. The use of powerful sleeping-draughts is strongly to be deprecated, except in extreme cases.