Treatment During the Paroxysm

The dry pack is also the best measure to diminish the severity of the chill during the paroxysm. Care should be taken not to keep the patient heated up too long, as otherwise the fever may be greatly increased in intensity. In one case, which we had under observation, the patient fell asleep in the chill, and the nurse neglected to remove the hot bricks by which he was surrounded, so that when he was aroused, after a short time, it was discovered that he had become delirious. The withdrawal of the hot bricks, and employment of cold applications to the head, and cold sponging, soon reduced the heat and relieved the delirium, however, and the patient made a good recovery.

After the fever is fully established, so that the patient has ceased to complain of chilly sensations, the amount of covering should be gradually diminished; and when the fever has reached its height, tepid sponge baths or a wet-hand rubbing should be repeated every few minutes while the head is kept cool by cloths wrung out of cold or ice water. Care should be taken not to begin sponging too soon, or to cool the patient too rapidly, as the chill may return. During the sweating stage the patient should be wiped off with dry flannels; and at its conclusion, the wet clothing should be exchanged for clean and dry garments, and a tepid sponge bath should be administered

Cold affusions and the application of ice to the spine has been recommended as a means of interrupting the chill. We consider these as harsh measures, and never employ them. In fact, about all the treatment that is of any benefit during the paroxysm is such as will render the patient more comfortable at the time. Nausea may be relieved by hot drinks during the cold stage, and sips of cold water, or bits of ice, during the hot stage. If the patient has eaten a meal just before the beginning of the chill, it is generally best, when there is very much nausea, to assist him to empty his stomach by giving a warm water emetic.

The diet of an ague patient should be very plain and simple. Butter, meat, sugar, rich sauces, and all kinds of pastry, should be entirely avoided. The diet should consist almost entirely of such food as oatmeal gruel, graham or Indian-meal gruel, rice, baked apples, stewed prunes, figs, and grapes. This diet should be continued until the tongue clears off, and then the patient should return to his usual diet very slowly. The free use of lemons is generally advantageous though, as a general rule, patients become tired of them after using them freely for three or four days. As before remarked, the disease may be successfully treated without the use of quinine or any other drug, yet many cases occur in which small doses of quinine, chinoidine, or some other preparation of Peruvian bark, may be advantageously employed. We have no faith in the popular notion that it is better to allow the disease to "wear itself out." In many cases the patient becomes worn out instead of the disease. Consumption and various other constitutional disorders may arise from the long continuance of ague or any other severe malarial affection. If the disease does not yield within a week to the measures before described, it will invariably yield to a very small dose of quinine, or double the quantity of chinoidine. We rarely find it necessary to use more than four to six grains of either. After the patient has had a weeks course of treatment, as before described, the remedy should be taken during the sweating stage at the conclusion of the paroxysm, or four or five hours before the time the next paroxysm is expected. Although we think it best that the use of quinine should be avoided so far as it can be, on account of its disturbing effect upon the digestive organs, we do not think there is ground for the popular belief that it injures the bones or very frequently gives rise to permanent or serious injury of any sort. There is, however, some ground for the belief that cases of deafness are occasionally produced by its use in large doses.

Whenever its employment is thought necessary to interrupt the paroxysms of ague, it should not be relied upon as a curative measure, but should be followed by thorough eliminative treatment, such as packs, full baths, hot-air baths, and fomentations over the liver and spleen. Daily fomentations over the liver should be continued for several weeks, if necessary. In case the spleen and liver are considerably congested and enlarged, as indicated by pain and tenderness on pressure in the region of these organs, local hot and cold applications should be employed daily until the symptoms disappear, and the patient should wear for several weeks a moist abdominal bandage at night, replacing it by a dry flannel during the day. In bad cases, the moist bandage should be worn night and day, being discontinued during the daytime as soon as evidences of irritation of the skin make their appearance.