(   72     )
CHAPTER IV.
Treatment and prevention.
Treatment
before the
diagnosis has
been made.
IN all diseases associated with fever an accurate diagnosis is essential for
successful treatment. During the period which sometimes elapses before
accurate diagnosis of the cause of the fever in a patient who complains of this
symptom can be made the following line of treatment should be adopted. The
patient should be admitted into hospital, sent to bed and given a milk-diet.
His temperature should be taken every four hours. Medicinal treatment
should be directed to the relief of symptoms; a diaphoretic mixture and a
mild purge may be given if indicated, but during this period quinine must on
no account be used.
Routine treat-
ment for
adults.
This line of treatment will be continued  until the diagnosis is assured
when, if necessary, it will be changed to one more likely to cure the disease
which has been recognised as the cause of the fever.    In these notes we have
to consider the treatment of those patients only in whose cases a diagnosis of
malarial fever has been made.     It is well known that quinine is a  true
specific, that is,  an infallible remedy, for this  fever.    Its   administration
should be begun immediately the diagnosis is assured, irrespective of the
stage of the attack or the height of the fever.    A  good routine practice in
the treatment of adult patients is to give a dose of 15 grains of the sulphate
dissolved in two or three  ounces  of  water  (with the aid  of a  sufficient
quantity of  dilute hydrochloric acid) just before the morning meal and a
similar dose before the evening meal, and to continue these doses daily for
five days.    It is a good practice to give a purgative  on  the  day   that  the
treatment is  begun.    If it has been possible  during the first stage, that is
during the days  before  the diagnosis has been made, to ascertain the time of
the day or night at which the paroxysm is to be expected, the times of giving
the doses of quinine should be altered, one dose being given about four hours
before the expected paroxysm and the  other  about  12  hours  later.    Expe-
rience  has shown   that,   provided  the  doses   of quinine   are not vomited or
are not passed through the intestine without being absorbed, there is hardly any
form of true malarial fever  which fails to yield to this treatment within a
few days and if at  the  end   of  five   days, the patient's fever  continues as