Page:Malarial fever; its cause, prevention and treatment; containing full details for the use of travellers, sportsmen, soldiers, and residents in malarious places (IA malarialfeverits00rossuoft).pdf/80

62 2. Try to get a doctor. 3. Give only the softest foods-milk if possible; or milk puddings; and broth and soft bread, or boiled rice.

If in spite of treatment the fever continues with- out a break for a fortnight, the case is almost certainly not malarial, and may be typhoid, or undulant, or hyperpyrexial fever. Reduce the quinine to five or ten grains a day; give soft food, and do your best to get a medical man.

XXVIII. TREATMENT OF OLD CASES

The reader may be called upon to treat a patient who has had several previous attacks, and now has a relapse (section II). Whether he has taken quinine or not, the treatment is practically the same. He must have the parasites in his blood, and they must be ex- terminated. Put him through a three or four months' course of quinine.

It is, however, necessary to use one precaution. Do not commence suddenly with twenty-grain doses of quinine daily. Begin with only five grains daily for a week; then increase this to ten and twenty grains for the second and third weeks, and afterwards proceed as in other cases. This is for fear lest sudden large doses should bring on blackwater fever.

If the case is a very old one, if the patient has been having fever on and off for months, it will, perhaps, suffice to work up daily doses of only fifteen or even ten grains. But the medicine must be continued for months.

If the patient is very sallow and anaemic and has a large spleen, five grains of quinine daily, with an occasional dose of aperient mineral water, and plenty of fresh milk or other good diet are called for. Such cases