In addition to the specific treatment, which is indispensable, opportunities for symptomatic therapy frequently arise on account of tormenting or even threatening individual symptoms. It is not our intention to consider all the possibilities that may occur, since the great majority of them are influenced by the same therapy as in other diseased conditions. We will confine ourselves to certain symptoms peculiar to malaria , the combating of which requires special experience. As a first principle applicable to malaria, as well as other feverish conditions, the patient should remain in bed during the period of the fever. In cases of mild intermittent the patient may be allowed to leave the bed after the termination of the sweating stage, while convalescents from severe infections, with advanced anemia, should remain in bed until strength is sufficiently restored.
During the cold stage warm cloths and hot bottles help but little the subjective complaints; nevertheless, as a rule, we apply them. Of more value at this stage is opium, per os or in suppository. In an especially violent chill a morphin injection may be given. Hot drinks, like tea and lemonade, are allowable only when no nausea exists.
During the hot stage an ice bag to the head, or, better, a Leiter's coil, is beneficial. In case of a continued fever or a hyperpyretic temperature cold packs and baths are to be employed as in other infectious diseases.
In case of subnormal temperature, as in the algid forms, a protracted warm bath with massage is indicated. To the bath may be added mustard or fir wool extract. Other things strongly recommended are frictions with warm cloths, spirits of camphor and other aromatic substances, applications of sinapisms and other counter irritants to the calves, to the back, and to the epigastrium, together with injections of camphor and ether. It is unnecessary to mention also warm drinks.
The sweating stage demands no special treatment. In case of a sudorific pernicious, we may endeavor to control the profuse sweat by washes of acetic acid or other spirituous lotions. Opium, likewise, is of service.
The gastro intestinal tract was and is even yet of considerable importance from the standpoint of symptomatic therapy. The majority of old physicians administered at once, "in order to cleanse the prima via," emetics and purgatives without regard to the manner of the infection or the severity of the attack. We only agree with the experienced physicians of to day when we declare this procedure entirely superfluous and sometimes even harmful. Intestinal activity should be regulated in the same way in malaria as in any other infectious disease. Irrigations and saline purgatives in suitable cases meet these indications fully. Whether it is justifiable to give calomel under all circumstances in bilious remittent, as several modern physicians hold, is questionable. It may be that the polycholia, which in this form, as in hemoglobinuria, is usually marked, demands a more rapid evacuation of the intestine, yet in the majority of cases diarrhea occurs of itself and fulfils the indication.
Torti placed but little reliance on purgatives, and even believed that they might do injury: "Quamobrem ea certitudine qua febris per Chinam Chinam expellit eadem pariter per Cathartica revocatur."
Tropical physicians, especially in India, still adhere to the administration of drastics "in order to relieve the circulation in the liver and spleen." According to Fayrer, there is given, in ordinary intermittent fever in India, a drastic, like colocynth, calomel, or jalap, followed by a saline purgative and 0.20 quinin in a bitter infusion. This is repeated several consecutive days. If gastro intestinal irritation is manifest, instead of the drastic, ipecac, 1.0 to 1.2, is given.
They claim that quinin acts better after this treatment, though we may say that we do not appreciate the rationale of it.
In India malarial patients are given, besides, Aconitum hetero phyllum (there called "Atees"), to fulfil what indication we do not know. In severe vomiting and gastralgia sinapisms to the epigastrium or even the hot iron itself, chloroform water internally (see treatment of blackwater fever), or chloral by clyster, iced drinks, cold irrigation of the intestine, and injections of morphin are serviceable.
Fayrer recommends Warburg's tincture; Range prescribes cocain:
Cocaini muriatici.......................... 0.15
Aqua? laurocerasi.......................... 8.0
To be taken ice cold, a teaspoonful at a time.
The same measures may be employed in singultus. Diarrhea is combated in the usual way..
On the part of the lungs, the dyspnea sometimes requires attention. Inhalations of oxygen or injections of morphin are probably the most useful.
In coma the bowels and bladder should be evacuated. Counter irritation is indicated. In robust individuals leeches may be applied to the mastoid process, especially if there is congestion in the head, f On the west coast of Africa the favorite remedy for relieving the diuresis in blackwater fever is Kinkelibah. This is a plant, the bitter tasting leaves of which are made into an infusion. The dose is 4.0 of the pulv. fol. Kinkelibah in 250 of water, administered cold.
For pain in the splenic region dry cups, or, in the case of robust individuals, several leeches, may be applied; for pain in the liver, cataplasms.
In heart failure subcutaneous injections of caffein, camphor, and ether, and digitalis by clyster or by the mouth, are recommended. Venesection should practically never be done. The very few cases in which it is indicated have been described in the foregoing section.
Transfusion of defibrinated blood in severe exhausting infections is of great utility and deserves trial. It has saved many a life (Ore). Salt infusions (subcutaneously) are also recommended, especially in the algid, choleraic, and hemoglobinuric forms.
The employment of alcohol demands consideration. Experience shows that it is not so well borne as, for instance, in typhoid fever (Marandon cle Montyel). In the tropics it should be administered with great caution. The rule may be laid down to omit alcohol entirely as long as the malaria is not of an asthenic, algid character, when rum, brandy, champagne, etc., are called for.
In case of obstinate relapses of intermittent, as well as after recovery from a pernicious attack, a change of climate is to be insisted upon, since it is the only way in which to protect the individual from new infection and cachexia.
In tropical countries the military occupants have erected sanator iums at highly located points, in which convalescents may recuperate. These sanatoriums are undoubtedly of great value, but they cannot be made to replace repatriation. Another feature of these countries is the ship sanatoriums. Further information in regard to them will be found in Catrin's work on "Chronic Malaria" and in Kohlbrugge's publication. This latter also gives valuable advice in relation to the choice of suitable places for sanatoriums.