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A TREATISE
—OIT-
Malarial Fevers,  for Domestic Use,

By J. M. LEWIS, M. D.



   MEXIA, TEXAS. 
 
 
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M&IsftRIAIs  FEVE^
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DOMESTIC USE
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J. M. LEWIS, M. D


  MEXIA, TEXAS.

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KUGKNK VON BOKCKMANN, BOOK AND JOB PRINTER, AUSTIN, TEXAS.


          1888. 
       WCF




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Copyright, 1888, by the Author.
 
PEEFAOE.
   This little book on  Malarial Fevers is written in plain
language,  (avoiding all technical terms,) in  order that the
non-professional man may understand how to  manage the
common forms of fevers of the South.
   I do not claim any originality in the ideas set forth, nor
is there anything novel; but having  had much experience
in the treatment of malarial  diseases, and knowing of no
work exclusively on fevers, for domestic use, and moreover
recognizing the fact that fully three-fourths of the sickness
of this country is malarial, and  easily managed when thor-
oughly understood,—for these and other reasons,—I propose
to record all the essential  facts in reference to Malaria and
its influence on  the human  system, its  cause, symptoms,
treatment, and the best mode of prevention. Also describing
the pulse,  temperature, (use of thermometer,) respiration,
etc.,  etc.
  A  chapter is devoted  to the symptoms  and treatment of
convulsions of children, occurring during an attack of fever. 
INTRODUCTORY.
  I would not attempt to delude any one with the idea that
they may become expert  in the treatment of Malarial Fe-
vers, or that  I can make Physicians of all who may read
this work;  but will maintain  that  the  facts herein taught
are true; and have been demonstrated time and time again.
And if you do not learn how to manage an ordinary case of
Malarial Fever after reading and studying closely this little
book, the fault will be with you.
  To country people, who live many miles from a physician,
this book will be valuable during the sickly season—July,
August and September, in the South—as  often they cannot
obtain the services of a physician; then a correct knowledge
of how, skillfully, to manage the  sick, is invaluable.  The
life of  the patient is in danger, and whatever is adminis-
tered, should be done intelligently.
  The nurse should have some idea of  what the disease is,
and what to accomplish by the remedies.
  Many intelligent country people know well  how to treat
an ordinary case of Malarial Fever—observation has taught
them, and they seldom call a physician for such a case.
  In this book each type  of the disease will be  considered
in a separate chapter.   This is done for convenience.  First;
we can best  study the disease in types, then  as a whole. 
MALARIAL FEVERS.                  5
 Second, in cases of emergency, the reader can refer  to any
 chapter at once.
   This book is  not written to injure, in any manner, my
 professional brethren, and I hope none will think that it is
 unprofessional in me to write it.
   The fact is, we often visit patients when it is plain that if
 the  family had properly understood the case, a  life could
 have been saved, and the remedies administered should not
 have been given.
   In such cases the thoughtful  M. D. says nothing,  avoids
 all comments, because  he does not wish the family and
 friends to think,  that by neglect or ignorance on their part,
 the patient died.  This is more often the case in malarial
 sickness,  than any other; for in some instances  it assumes
 great violence; yet is generally controllable by proper treat-
 ment, if administered early.
   That the views set forth  in this book,  are not  in  accord
 with those held by many physicians, I well know; especially
 is this true of the oft-used remedy, calomel.   In condemning
 its use in the  acute stage of Malarial Fevers, I feel confident,
 after many years experience, that I am correct, and that its
 use entails much suffering and debility; thereby prolonging
 convalescence.  This is also the opinion of some of the best
 authorities on Malarial Fevers, as I will show  further on.
   In a  book  of this  kind, I cannot  argue this  point  at
 length, going into  details as  to  its action,  nor is it neces-
sary ; thinking it can be safely said that  the use of calomel
in malarial sickness zvill soon be a thing of the past, as is 
6
MALARIAL  FEVERS.
bleeding and other spoilative treatment, which came into
use when the disease was regarded as inflammatory, and
only holds its place now on account of its supposed (?) action
on the liver. 
MALARIAL  FEVERS.
7
FEVER THERMOMETER.
   To properly  understand fevers, and  to  be accurate in
 noting its phases, it is necessary to use a fever thermometer.
   There is no mystery in its use; it is simple and easily un-
 derstood, and while one may understand  the case,  often,
 without it, yet with accuracy much better with its aid.
   The day is not far distant when every family in the coun-
 try will be supplied with a fever thermometer, and it is well
 they should, for it  certainly is one  of the  most valuable
 auxiliaries we have for diagnosing disease.
   I will try to explain fully, how to  use the thermometer.
   To the physician it  is indispensable, and all well-informed
 doctors use them ;  indeed, we cannot find an intelligent M.
 D. in the country without one in his pocket.
   There are several kinds of these instruments in the mar-
 ket.   All druggists and instrument makers keep them.
   The best, or rather the one I prefer, is the small, straight,
 self-registering,  in rubber case.  This one  is convenient to
 carry, and generally accurate.
   Some thermometers  are curved and some do not have  the
 self-register.  This latter (without a self-register) kind is
 not reliable, and one is likely to be deceived by  it,  for in
 taking the thermometer from the  arm-pit,  (the part of the
body to which it is  usually applied,) it  may fall a degree or 
8                  MALARIAL FEVERS.

so before you notice it; especially is this true if the weather
is cool.
  The main point in purchasing  a  thermometer,  is  to  be
sure it is correct.
  Always ask, if it has been tested.  Should it be incorrect,
of course, it would mislead you.
  Have your physician or some  one test it with one that
has been used and known to be accurate.
  Have no fear in commencing the use of the thermometer,
that you will not understand it.   You will soon  recognize
its great value and simplicity.
  The normal (natural) temperature of the body  is 98y2°-
The heat of the body varies to some extent in different per-
sons, as it does in our own bodies, but from 98^° to 98^°
is the average normal temperature of the  human  body, in
health.
  Most of the thermometers have a "star" on them at 98^°,
thus marking it as the normal temperature of the body.
  In using a self-registering thermometer, always bring the
mercury down to the ' 'star'' before inserting in the arm-pit.
Jarring the thermometer, which is readily done by holding
the same in the fingers and then  striking the knee with the
hand, (as you perhaps have seen physicians do.)
  Be careful not to jar the mercury below  the point 98}^°,
as it may descend into the bulb [and become useless, for if
the register ever passes into the bulb,  the register is ruined.
  When the register is at the correct  place  (98^°),  insert
the bulb (or mercury part) in the arm-pit  (axilla), exercis- 
                   MALARIAL FEVERS.                  9

 ing care that the mercury part is well  covered  with flesh,
 (otherwise you may be taking the temperature of the cloth-
 ing, and not the body), which can be done  by  placing the
 fore-arm across the breast.
   After adjusting the thermometer  well, let it remain at
 least five (5) minutes ; then note the height of the mercury
 in the column.
   It is always best to write down the hour and  the degree
 of fever; by doing this you can compare the fever  one  day
 with another.
   This is all very easy and simple  to  execute, nevertheless
 very important.
                    RECAPITULATION.
   1.  Procure a good, reliable, self-registering thermometer.
   2.  See that the point of register is at 98^° (star), before
 inserting in the arm-pit.
   3.  Be sure that the bulb is well-covered with  flesh.
   4.  Eet the thermometer remain at least five  minutes in
 the  arm-pit.
  5.  Mark the hour taken and the height of the fever.
  A little practice will soon make perfect in its use. I know
 many ladies, who understand the use  of the thermometer
 well;  acquired the knowledge from attending  one case of
 fever.
  In attending the sick learn to be systematic and accurate;
 they must be administered to correctly,  or not at  all.
  By keeping  a correct  register, noting the  temperature
every three or four hours, the nurse  will soon observe when 
IO
MALARIAL  FEVERS.
 the  fever cools,  and also  the  effect of the remedies given,
 etc.; can also compare the  temperature of the body, one
 day with the next.
   I do not think it well, every  time, to inform  the patient
 as to the amount of  fever they may have, for in protracted
 cases they are liable to  become discouraged.  The patient
 can be informed, if they inquire as to how much fever they
 have, by an evasive answer, stating, your  fever is about the
 same as  a certain time yesterday, or, not  so much as a few
 days since, or less, as the case may be.   If the  nurse finds
 the patient watching the course of their fever, it is well not
 to use the thermometer often.   Always deal truthfully with
 a patient, but often their minds should be diverted from
self, and kept as cheerful as possible.
                        PULSE.

  Will now consider the pulse, for  the  pulse, temperature
and respiration are  the  A B C's in the treatment of fevers.
  The pulse is, as most people  know, the radial artery, and
can be felt with the finger, near the wrist.
                 COUNTING THE PULSE.
  To count it accurately, open your  watch,  at the same
time placing the index  finger on the artery, then wait until
the second hand of watch is  opposite  either of the figures
10,  20,  30, 40, 50, or 60, (which  divides  the  minutes into
six parts), then count the pulsations that take  qlace before 
MALARIAL FEVERS.
II
the second hand reaches the next figure, multiplying these
pulsations by  six, and you have the number per minute.
Some physicians hold the pulse  and count for one minute;
but this is often tiresome to the patient, and by all means
do not worry  one when sick.   Consequently, I think the
above plan the best.
   Often it is best to place only one finger on the artery;  fox
if you place two, the pulsations may confuse you.    Do not
press hard, just enough to get the impulse.
   The average rate of pulse in  health, is  about (68)  sixty-
eight for the adult, though this varies much in different in-
dividuals,  and with  age and sex—faster in females than
males.
   Usually the pulse beat will  increase about five to ten
beats for each degree of fever.   Case with normal  pulse o
sixty-eight (68), when attack with fever, and temperature
of body  1020, pulse will usually be from 100 to 105.  With
temperature of 103, pulse will be from  1080 to 1130, and so
on, though this will vary greatly in each individual.
   When in good health, the beating of pulse should be full
and regular; no intermissions.   If any intermissions  (stop-
ping), it is proof that the heart is involved.
   Physicians are accustomed to describing the character of
pulse, but in a work  of this kind, perhaps it is best not to
enter  into details, as the subject is too scientific, and re-
quires much study and investigation to properly understand.
   Note on your paper the hour and rate of the pulsations, 
12
MALARIAL FEVERS.
 as by this means the pulse rate can  be compared  one day
 with another.
  It is well to count the  pulse and take the temperature of
 body at the same time.
                    RECAPITULATION.
  i.  Have the patient as quiet as possible when you count
 the pulse; let the arm rest easy (in easy position).
  2.  Open the watch, and, with the finger  on the pulse,
 commence to count when the second  hand  is opposite one
 of the figures, as directed.
  3.  Note if  there is any intermission—missing  of  pul-
 sations.
  4.  Make a record of the  hour and rate of pulse, as  well
 as temperature.
  N. B.—The artery is not always found in the usual posi-
tion near the wrist, it will vary  in  some.  The anatomy of
all are not alike.
                    RESPIRATION.

  The normal  respiration  (breathing), is  about seventeen
(17) per minute.
  Some authorities give 3^,  others 4 times the respiration
for  the pulse rate.  That is,  if a man breathes seventeen
respirations to the minute, his pulse will be four times that,
to-wit : sixty-eight.
  There  can  be no universal rule in  these cases, but in a
large majority,  I think  the rate given above, is  correct, 
MALARIAL  FEVERS.
13
 ?'.  e., that there  will be four beats of the pulse to each
 respiration; this is when the heart and lungs  are acting in
 harmony (health)
    In counting the respirations, it is always best to do so,
 unobserved by the patient,  for if the patient  notices that
 his  breathing is being counted, it will interfere with  the
 same, and he will often force the respirations.   The most
 favorable time to count the breathing is when the patient is
 asleep.
    Observe  the same directions  in  counting the respirations,
 as directed for pulse, to-wit:  Open the watch and note when
 the second-hand is opposite a given figure, then  count each
 inhalation, until the same reaches the next figure, then mul-
 tiply, etc.,  (see directions for counting pulse).
   Do not count the exhalation, as the exhalations and in-
 halations constitute one respiration.
 .  In malarial forms the breathing is usually not much  in-
 creased.  Much is owing to  the  degree  of restlessness and
 nervousness of the patient.   In ordinary  cases one  to two
 respirations for each degree  of fever.  In congestive forms
 of  fever the breathing is  often rapid  and sighing,  and in
 some cases  labored (forced).
                    RECAPITULATION.
  1.  The average normal respiration in an  adult is seven-
teen (17), faster in females, and more rapid in children.
  2.  Count the  respirations unobserved (when  possible),
by the patient.  When asleep is the best time. 
H
MALARIAL  FEVERS.
  3.  Count by the watch as  directed for pulse, and only
count inhalations.
  4.  In ordinary  cases of Malarial Fevers the respiration
is usually increased one to two respirations for each degree
of fever ;  in congestive more rapid.
                GENERAL REMARKS.

  Before commencing the  study of Malarial Fever, it is
proper to discuss how and when to administer medicine.
  In administering remedies to the sick, we should have  a
definite object in view.
  There is no such thing  in  the practice of medicine as
specifics, that is,  a given remedy  for  each disease.  Nature,
or the  natural^workings of the system, affects the cure.
  All the physician  can  do, is to rightly  interpret nature,
and assist in the work.
  Some people,  (and I fear  some physicians also,) seem to
think that their remedies effect  the cure.   Not so.   Then
always  be  sure  you do not  retard nature's work, instead of
assisting it.
  As s.iid in the first of this  book, try and be accurate.  Mark
on  a  paper the amount and  kind of medicine given, also
note the effect.   This is very important,  for in your excite-
ment, you may forget.   By all means, avoid excitement in
the sick room.   Be as calm and cool as possible.
  Often the[physician  is told, on entering a room, in reply
to the question,  "what have you given?"   "Oh! we have 
MALARIAL FEVERS.
15
 given everything we know of,  and the patient continuing to
 get worse, have sent for you."
   This  is no  information to  the physician.  He wants to
 know exactly what has  been done, so always state exactly.
 Tell him you  gave opium at  a certain hour, quinine at a
 certain time, pills, etc., just as the facts may be.
   If the nurse has been  careful, and noted all this on paper,
 just hand him the sheet, and at once  he knows your line of
 treatment.
   To show how easy it is to make a  chart, the following is
 an example of how a record should be kept.   It is not hard
 to learn, and any one that adopts it  will soon acquire sys-
 tem.  There is nothing  like systematic work in any kind of
 business, and  this  holds good in the practice of medicine
 also:
                   John Smith, (sick.)
 Day.      Hoitr.    Temperature.     Pulse.   Respiration.
 Oct. 1,    8 a. m.       100           100        20
          12 m.         102^          115         23
           3 p. m.       104           130         25
           9 p. m.       100           100        20
          12 p. m.       98^            68         17
   This is a form of chart, and  shows  at a glance the condi-
tion of John Smith for October  1st, one day.
   Now,  on another paper, note the time and kind of medi-
cine given, with any remarks, as follows:
  John Smith was taken sick  October 1st.   8 a. m. gave a
dose of compound cathartic pills.  At 12 m. gave a dose of 
i6
MALARIAL FEVERS.
 salts.  At 3 p. m. gave a dose of bromide potassa.  At 9 p.
 m. commenced giving quinine, in five grain doses, and have
 repeated every three hours.
   Remarks.—Bowels acted well two or three times.  Sweat-
 ing freely at 6 p. m.  Bowels acted  again at 10 p, m., etc.,
 etc.  Under the head of remarks, note anything about the
 patient; if restless, how much he slept, and kind of sleep,
 etc., etc.
   Do not make your notes  in  the  sick room.   If patient is
 very sick, it is well to write what he may say.    Especially
 is this true of cases wounded, as it may be used as evidence
 in  the courts of the  country.  I will  remark incidentally,
 that statements made by wounded persons are not good evi-
 dence, unless they have been informed, or state that they
 are going to die.   The  dying statement then  is  good evi-
dence.
   By the use of such  a  record (chart) as I have given, it is
 an easy matter to see just what the patient  has taken, and
 the record of fever can be compared, one day with the  next,
 etc.
   Always ask your doctor to write  his  directions plainly,
 and let you know just what he is giving.
   The old idea that the  patient or nurse must not know the
"kind or quantity of the medicine,  is  exploded.   Let the
physician state what the remedy is, and what he expects  to
accomplish from its use.
   If a record was kept of every dose and the quantity, (as I
suggested,) some people are forced to take  during a spell  of 
MALARIAL  FEVERS.
l7
sickness, it would be surprising that  they ever  recovered.
Then there can be no question, but that often there is more
drugs used than is necessary.   Every day the profession are
using less medicine, and often now cases are treated without
the aid of so much drugs.   But the people seem determined
to poison their system, and the patent medicines are bought
and consumed in this country by the car load.
  The large majority of medicine sold  are foreign to  the
system, and should be administered with care.
                       MALARIA.

  Definition.—"An unknown  poison of telluric  origin,
the cause of the periodic fevers."—(Sternberg.)
  It is impossible to say just what malaria is :  as no chem-
ist or microscopist has ever been able to demonstrate it; yet
we know from its effect, and from places known to be mala-
rial that it is a poison—and the difinition above given is  a
very good one—"The cause of the periodic fevers."
  In this country all the fevers that come and go, (periodic)
we ascribe to malaria.
  ' 'A poison which is known only by its effects is necessari-
ly a hypothetical substance, and yet there are not wanting
those who deny altogether the existence of such  an  entity
as malaria, and who would account for the disease common-
ly ascribed to the action of this poison, by the supposition
that they are due to immaterial causes,  such as refrigera-
tion, electricity, etc., etc." 
i8
MALARIAL  FEVERS.
   This manner is not satisfactory,  and  the belief in  the
 poison as the cause has foundation, and one who has studied
 the subject closely must  believe that a poison is under cer-
 tain circumstances generated, which substance,  for want of
 a better name, we call malaria.
   While we are ignorant of its true character, we are  con-
 versant with its effects.  The general  belief is that it is
 atmospheric (a gas).
   Men  are slow to  confess  ignorance  on  any  subject,  but
 candor  compels us to admit that  malaria, or  the  substance
 that enters the human system and causes our periodic fevers,
 has never  been  seen  nor  demonstrated.   Yet the  almost
 universal  belief  is that  it is a material agent, and all mala-
 rial fevers are classed as  infectious and due to  a  specific
 cause—i.  e., a poison introduced into the system from with-
 out.
   Much time and close labor has been spent in  trying to
 solve the question, but so far all the skill of the chemist
 and microscopist have been in vain.
   Malaria, then,  is undoubtedly a poison, a real substance,
 generated by a due mixture of heat  and moisture,  intensi-
 fied by vegetable decomposition, which, entering the human
 system, causes periodic fevers.
           CAUSES—WHICH PRODUCE MALARIA.
  In a work of this kind it will not be expected that I will
 be very elaborate in  treating under this head.
  As stated in the  chapter  on malaria—the  cause  is  un-
doubted heat and moisture, with  vegetable decomposition. 
MALARIAL  FEVERS.
19
 Usually, if we know the cause of the sickness, it leads to a
 correct knowledge of the treatment, but in malarial sickness,
 as the cause is atmospheric—or rather the poison is in the
 atmosphere—it will be a difficult matter to remove the cause;
 so we are forced many times to remove the patient to a more
 congenial climate.
   We have several forms  of malarial fevers,  and  yet  all
 caused from the same poison, i. e. malaria.
   Why the one and same substance will produce a  chill add
fever in one, remittent fever in another, and congestion in an-
 other, is a question the profession can not answer.  Yet  we
 know from experience that such  is the  case.   I need not
 state the reason for this conclusion, but state it as  a  well-
 known fact.  We cannot see or  handle malaria, yet it un-
 doubtedly is atmospheric and enters  the  system at night.
 When we are asleep the system becomes relaxed and  then
 poison enters ; during  sleep, the powers of life  being to
 some extent dormant, and resistant at its lowest ebb.
   This poison, which we call malaria, arises from the ground
 at night,  in marshy places,  it being more intense ; when
 the  sun arises in the  morning it is dispelled.   Consequently
 there  is no danger  from exposure,  in a malarious district,
 during the day.
   Prof. Flint makes the following statement in  reference to
 the  causation of  malaria :
   1.  It affects, by preference, low and moist localities.
   2.  It is almost never developed at a lower  temperature
 than 6o° Fahr. 
20
MALARIAL FEVERS.
  3.  Its evolution or active agency  is checked by a tem-
perature of 320 Fahr.
  4.  It is most abundant and most virulent as we approach
the equator and the sea coast.
  5.  It has an affinity for  dense foliage,  which  has the
power of accumulating it,  when laying  in the course  of
winds blowing  from malarious localities.
  6.  Forests or even woods have the power of obstructing
and preventing its transmission under these circumstances.
  7.  By atmospheric currents it is capable of being trans-
ported  to  considerable distances, probably as far as five
miles.
  8.  It may be developed in previously healthy places by
turning up of the soil, as in making excavations for the foun-
dations of houses, tracts for railroads and beds for canals.
  9.  In certain cases it seems to be attracted and absorbed
by bodies of water lying in  the  course  of such winds  as
wafts it from the miasmatic source.
  10.  Experience alone can enable us to decide as to the
presence or absence of  malaria in any given locality.
  11.  In proportion as countries, previously malarious, are
cleared  up  and thickly settled, periodic fevers disappear,
in many instances to be replaced  by typhoid fever.
  I have quoted at length  from  Professor Flint's work, be-
cause these propositions are plain, and convey the idea  so
truthfully that  malaria is a poison, generated  by heat and
moisture at a certain temperature (not less than 6o° Fahr.),
and  the same  is destroyed by cold (320  Fahr.), though in 
MALARIAL  FEVERS.
21
 our Southern States we  undoubtedly have  some  malaria
 during almost every month of the year.   In this connection,
 I will state that  I  believe the pneumonias of this  country
 are effects, or often caused by malaria, and often relieved by
 the anti-malarial treatment.
  It is a fact, that families who seem to have most malar iai
 fevers during the summer and fall, have pneumonias during
 the winter.   Quite a number of articles have appeared in
 medical journals, written  to prove that it is one  and the
 same poison that causes malarial fevers and pneumonias.
  It is hard to convince some of my old  Texas friends that
 the  night air is unhealthy, and that sleeping exposed to
 same (when malaria abounds),  will result  in an attack of
 malarial fever.   They contend that they were accustomed to
 sleeping in the open prairie  (at night) for years, and never
 enjoyed better health.   This is true; but it was before the
 country was settled, and while the prairies were  covered
 with grass.   The soil had not been turned up, and exposed
 to the rays of the sun.
  Formerly,  in  this country, the only places known  to be
 malarious were  those near the swamps, low, marshy lands
 and washouts.
  It is claimed by  some, and no doubt true, that one of the
fruitful causes of malarial  attacks is  the water drank.  Es-
pecially is  this  the case  with springs, shallow wells  and
tanks, while those who use pure cistern water escape.
  This is positively denied by others.  I  am not  positive
myself, and cannot say  whether the water drank is the 
22
MALARIAL  FEVERS.
cause of malarial attacks or not—whether it  is due  to  the
presence of the poison in the atmoshpere, or in the water.
As  there is doubt upon the subject, I certainly think  the
patient should have the benefit, and cistern water, which is
recognized (in this country,)  as the purest drinking water,
should be procured  for one  sick with malarial fever.  Im-
pure water, no doubt, debilitates the system, thus  lowering
the vitality, and in  this way may make the subject more
susceptible to malarial influences.
  Professor Joseph Jones, in his "Memoirs," says:  "The
waters of low,  swampy lands and rice fields are impregnated
with organic matters, which, in certain  seasons of  the year,
and  under certain conditions, exert most deleterious in-
fluence upon the health of the inhabitants.  The great mor-
tality upon rice places, many of which decrease instead of
increasing,  is due to  the character of the waters, which in-
duce bowel affections, and degrayment of the blood, and low
grades of fever.''   [I suspect he means increase where he
has written decrease above, and vice versa.—L-]
  Professor Jones  recommends cistern water  for  well and
spring water. 
MALARIAL FEVERS.                 23
SYMPTOMS AND COURSE OF CHILL AND FEVER.
   Names:  Intermittent Fever, Chill and Fever, Ague.
   Symptoms:   In all well marked cases there is no difficulty
in  forming an opinion- as  to Ague; most people 'in this
country are familiar with the symptoms.
   It  is  characterized  by  paroxysms  of  fever,  running
through certain definite stages, and occurring at more or less
regular intervals, with intermediate periods of rest.
   In discussing the symptoms of Intermittent Fever,  we will
describe the three stages in the order in which they  usually
occur:
   First—Cold Stage.— The cold stage is generally ushered in
by yawning and stretching; often the patient recognises the
fact that he is going to have a  chill.  Yet,  in a large ma-
jority of cases, the attack is sudden, the patient suffering
with pain in  head and bones.  Yawning,  loss of appetite
general sense of illness.   This may be followed by fever, and
have no decided chill, or cold stage,  and often the patient is
mislead  as to the  true  nature of  his disease.   This is
especially true of the first paroxysm, but generally the sec-
ond is more decided.
   In the first paroxysm  (attack) there may be no  aching,
and not much fever follow.   The patient does not take his
bed, continuing his business, or work; but on the following 
24
MALARIAL  FEVERS.
 day, about the same  hour, or earlier, he  experiences a de-
 dided chill,  followed with fever of several  hours duration.
   When he has a decided chill, he  is cold,  (yet the ther-
 mometer  in armpit  may show heat of body,) has pain in
 bones, headache, cold waves  up and  down the spine, shiv-
 ering,  the teeth chattering, skin looks rough, the patient
 is in a rigor, and shakes.  This is what we call the "Arkan-
 saw Shake."
   The pulse is usually small,  and anxiety depicted on his
 countenance,  in  some instances  lividity,  lips and fingers
 blue.
   He wants plenty of cover on his body, and yet the cold
 waves continue.  This cold  stage may  last only a few
 minutes or an hour, generally about forty  minutes, then fol-
 lows the hot stage, one passing into the  other gradually.
 Often the duration and intensity of the cold stage, indicates
 its severity.
   When there is much lividity of the surface, and  the tips
 and fingers blue, vomiting, with some pain in  the chest and
 head, it indicates congestion.   When these symptoms occur
 with children, they are liable to have convulsions.
   In the congestive form,  death may take place soon after
 the patient is taken with the chill.   I have known death to
 occur in two hours after the first symptom  of the  chill,  his
 body rapidly becoming cold and livid.  He soon passes into
a deep comatose condition, from which he cannot be aroused.
No reaction  taking place, death soon closes the scene.
  I have seen this occur so often, that I  always  try to im- 
MALARIAL FEVERS.
25
 press upon my patients the importance of taking remedies
 early,  in order to avoid the second paroxysm; for generally
 we do not have a congestive  one at the first paroxysm, nor
 is there anything to warn us that the  second or third is
 liable  to be a congestive chill.
   Usually, in this country, the most cases of congestion oc-
 cur early in the season, among the first  cases of fever, and
 many  deaths occur from neglecting to take proper remedies
 in time.  So always try to check a  chill and fever as soon
 as possible, for fear of congestion;  for every  chill and fever
 the patient has  racks  his system, producing changes in the
 blood and organs of the body, making it more difficult to
 treat.
   Some people seem to have no fears of chills and fevers,
 and will not  try to check the same, expecting to wear them
 out.
   I have made it a rule for years, when a patient applies to
 me for treatment for ague, to stop  the  paroxysm at  once,
 fearing the next may  be a congestive chill, and  knowing
 the damage done the system by repeated attacks even of the
 ordinary ones.
          HOT  STAGE--OF INTERMITTENT FEVER.
   The cold stage passes gradually into  the  hot, the  pulse
 becomes quick, the chilly sensations cease and the body  be-
comes  warm, the head and bones ache ; in fact, the patient
will inform you that he aches from the  top  of his  head  to
his heels.
  The thermometer,  applied to axilla, will  show,  perhaps, 
26                 MALARIAL  FEVERS.
 about io2° of fever, which continues to rise until it  reaches
 104 or 1050.
   The urine becomes scanty, water is drank freely, and often
 as soon as it becomes warm in the stomach, is ejected.
   The eyes are injected and sparkling, the face flushed, de-
 lirium often accompanies this stage,  and with children con-
 vulsions often occur.   The child will often sleep, and when
 aroused seem frightened and always  very nervous.
   Fever affects no two alike—some will lie quiet  and  sleep
 the fever off;  with others only a  moderate fever, 1020, will
 cause delirium and the patient will be difficult  to  control,
 talking rapidly, and often it will be difficult to keep  him in
 bed.
   The practice of former years was not to allow water dur-
 ing the hot stage, but the modern  and correct practice is to
 allow water drank freely.
   I always give my patients water or lemonade, with a small
 allowance of ice.   (I think  harm may be done by using the
 drinks too cold.)
   Even if the patient vomits the same it cools the stomach
 and produces free perspiration.
   The fever, |or hot stage, usually lasts about four hours, but
 in some instances more than twice that time.
   With children there is always danger of convulsions, un-
 til the fever commences to cool.
   When the fever is subsiding the skin  becomes  moist and
cool, the pulse soft, and the thirst is not so great.
   In some instances, when the fever is high,  the  skin is 
MALARIAL  FEVERS.
27
 moist, but always hot under the moisture ; but, usually, the
 surface is hot and dry during the paroxysm of fever.
       SWEATING STAGE—OF INTERMITTENT FEVER.
   Now comes the calm after the storm—as the fever begins
 to subside,  the skin becomes moist and  the surface  cool,
 sweating breaks out about the forehead, gradually extend-
 ing over the whole body, and soon the patient is bathed  in
 a profuse prespiration.
   The head-ache disappears, the thirst is abated, and the pa-
 tient feels easy  but weak, usually falls into a quiet sleep ;
 with this ends the paroxysm.
   In young children the cold and sweating  stages are not
 so distinctly marked as in the adult.
   The above finishes the  discription  of an  ordinary chill
 and fever.   Most of us in this country have experienced the
 same.  After a rest of twelve (12) to twenty-four (24) hours
 the chill and fever may and most certainly will (unless ap-
 propriate treatment be instituted) return with force, and per-
 haps more intense than the first one.
          TREATMENT—(OF CHILL AND FEVER).
   First—l,et the nurse be satisfied of the nature of the case,
 i. e.,  that  the patient  has ague.   Most people in  this
 country are so familiar with  the symptoms that there is of-
 ten no doubt in their minds as  to the illness, and they sel-
 dom make a mistake.
   Cold Stage—There is  no  special treatment  to be given
during the cold stage, and often none necessary, as it cannot
be cut short. 
28                MALARIAL FEVERS.
  Placing the patient in  bed, applying bottles of hot water
to body, bathing the feet and legs in hot water and mustard,
usually moderate the symptoms to some extent.
  Hot drinks are not admissible; they  usually do more
harm than good.   A dose  of Hydrate of Chloral, (15 to 20
grains,) is often given to an adult.  This is a good remedy,
and will relieve the head and back ache,  and to some extent
stop the rigors; but chloral is not a safe  remedy  in  the
hands of the people.
  Chloroform, administered internally,  (one-half teaspoon-
ful, well diluted,) will  lessen the rigors, and relieve all the
disagreeable  symptoms,  but chloroform is  another one of
those remedies that should  be  administered  with care,  and
generally only by a physician.
  In  a work  of this kind, (written for the people,)  during
the cold stage of Intermittent Fever,  I recommend only the
common domestic remedies.
  The room should  be well ventilated,  apply  hot  applica-
tions to the body, plenty of cover to  the patient, with hot
water and mustard to feet and legs.
  If patient complains of pain in stomach, and it is loaded,
(chill just after a meal,) it  is well to  administer an emetic—
a glass of warm water and  salt, or warm  water and mustard.
After the  stomach is well emptied,  if nausea  should  con-
tinue, small doses of morphine  (1-16 gr.)  will  relieve the
same.  In fact, morphine,  while it quiets the stomach, will
also relieve the nervous system, and afford great relief,  often 
MALARIAL FEVERS.
29
shortening the chill and lessening the duration of the hot
stage.
  Should the cold stage continue, and the patient become
prostrated, his skin  blue and  cold,  restless and vomiting
congestion has taken place, and it will be well to use whis-
ke}', or brandy, and quinine freely,  giving a wine glass  of
whiskey, or  brandy, with five grains quinine, and repeat in
one-half an hour,  if  necessary.  If the stomach will  not re-
tain it, inject in the bowels.   This dose should be repeated
every half hour, with mustard to the stomach and bowels,
until the chill, or cold stage, ceases, and the hot stage com-
mences.  Often the patient will die in this cold stage (con-
gestion,) in two or three hours, unless active means are used
to bring about reaction, such as mustard to the surface,
whiskey and quinine internally, with small portions of mor-
phine to relieve nausea and restlessness.
   If  bowels  are constipated, I usually administer either
saline  cathartics, or use the syringe, with warm water and
soap—in some instances doing both, using the syringe to
hasten the action of the saline cathartics.
   The best salines are either epsom salts or seidlitz powders.
If bowels are hard to act on, compound  carthartic pills (im-
proved) are better,  (dose 2  to  3).  They are a  splendid
cathartic pill, and contain no calomel.
   I have now fully stated  what may be necessary to do,  un-
der certain circumstances,  in the cold stage; yet in the large
majority of cases there is no necessity of any treatment  for 
30                 MALARIAL FEVERS.
 the patient, as the cold stage only lasts a short time, and
 causes no great amount of suffering.
   Hot Stage—{Fever)—The chill,  (as stated), usually lasts
 but a short time,  an*d then follows the fever.
   If the patient's stomach is quiet, and can retain quinine,
 I usually give one capsule, containing  five (5) grains,  and
 repeat every three or  four hours, using about fifteen grains
 of bromide potassa with each dose.
   Bromide Potassa is  a  safe and simple remedy, one that
 can be used without any danger.  It prevents the  quinine
 from affecting the head.  Bromide Potassa is a remedy I
 always use in the  treatment of malarial  fevers, in the dose
 of 10 to 15 grs., repeated every three or  four hours during
 the hot stage.
   Give the patient cold drinks—either lemonade or ice wa-
 ter—using care not to  take too large quantities at  a  time ;
 small sips  to  quench  the thirst;  large  draughts chill the
 stomach, and are liable  to  do much  harm, while  small
 quantities of cold water or cold lemonade  allay the thirst,
 and act on the skin and kidneys.
  Many physicians do  not use an}- quinine  during the  hot
stage of an intermittent fever,  but wait until the  fever sub-
 sides and the patient commences to perspire freely,  but my
 practice has always been to give quinine (when the stomach
 will retain it) during the hot  stage, ■ and I have seen  no
 cause to regret it
  Applying cloths with cold  water  to  the head,  is  very
grateful.  Protecting the bed with an oil cloth and  laying 
MALARIAL  FEVERS.
31
the patient's head on same, then pouring the water over the
head, will often relieve the pain in the head and is very re-
refreshing.
   Sponging the body well and  using saline  cathartics (if
necessary to move the bowels) will lessen the fever.
   There is no necessity for preparing the system for quinine.
   It is well to open the bowels,  especially if they be  con-
sticated, and in doing so it relieves the portal system, liver,
spleen and kidneys ;  this,  according to my judgment, is best
done by saline cathartics.
   I always give quinine to children in the hot  stage; when
they are very nervous use  large doses of bromide potassa at
the same time.
   If they  are  threatened  with spasm, give  either chloral
with the bromide potassa or use bromidia.
   Flint, in his excellent work on practice, recommends wait-
ing until the fever subsides and  the  sweating  commences,
before using quinine.  He then gives it  in large  doses ; to
an adult 15 to 20 grs., but I prefer smaller doses, repeated
as above suggested.   The  quinine is the sine qua non in the
treatment of chill and fevers; this is conceded by all author-
ities.
   The bromide potassium should always be given to child-
ren to prevent convulsion.
   Sweating Stage.—When the fever  subsides,  the  patient
begins to sweat freel}', his  skin is cool,  pulse  soft—all  the
aches and pains disappearing ; he feels weak and will often
sleep.   This stage requires no special treatment, but  an ef- 
32                MALARIAL FEVERS.
fort must be made to prevent a recurrence of the paroxysm.
  While it is the practice of many physicians to administer
large doses of quinine in this stage,  I  much prefer 5 grain
doses (for an adult, children in proportion) every two or three
hours,  until the  patient is thoroughly  cinchonised, then
make the  doses  less  frequent, 5 grains every 5 or 6 hours
and continue this for four or five days.
  If the appetite is poor, using a tonic  of iron and quinine
(see  general remarks on the treatment of malarial fever).
  The bowels should be kept open, at least one action from
same a day, avoiding any  remedy that will debilitate  the
system.
  The patient will require  sustaining  remedies, for  chills
and fever always debilitate and tend to break down the sys-
tem, consequently we must build up, using no remedjr that
will weaken him.  Keep in view the fact that the patient is
poisoned with malaria, and that quinine is the antidote.
  If the sweating is profuse and the patient weak from  the
same, give a stimulant, either whisky or brandy.
  Note.—Care should be exercised in administering qui-
nine to a lady, when pregnant,  as large doses may cause her
to miscarry.  Quinine will do this in some cases.  The best
plan is to give in doses of  two or three grains and  repeat
every three or four hours, and if any pain is excited  in  the
womb, give either laudanam (15 drop  doses)  or morphine
{yi to % grs.)
  Much care must be exercised in treating such cases with
quinine. Some physicians doubt quinine possessing oxytoxic 
MALARIAL FEVERS.
35
power, but I am firmly  convinced it  has, especially  when
given in large doses.
  Period of Intermission.—This is the time to thoroughly
saturate the system with quinine.   Do not  let the patient
overload his stomach with food, for in some cases the  appe-
tite is ravenous.
  Watermelons, apples, peaches and such articles are  injur-
ious and should not be  allowed.  A bland nourishing diet
is all that is necessary.  Keep the bowels open.  If any
diarrhoea, it should have appropriate treatment.
REMITTENT FEVER.
                 SYMPTOMS AND COURSE.
  Name.—Remittent Fever—Bilious Fever.
  Definition. — "A  paroxysmal  fever  of  malarial  origin,
which differs from malarial intermittent fever mainly in the
fact that the hot stage is more prolonged, and is not followed
by an interval of complete absence of fever; and that the
cold stage is commonly ill defined or entirely absent, except
at the  outset.   In severe cases gastric irritability and bilious
vomiting are common symptoms."—(Sternberg.)
  They are a  class of malarial  fevers  characterized by re-
missions and exacerbations, but without intermissions.  ■
  The name remittent alludes to the remission or cessation of
the febrile  symptoms.
  There is not that distinct intermission  as in  intermittent 
34                 MALARIAL  FEVERS.
 fever, but a remission or diminution of the febrile symptoms.
   Often a chill and fever, if allowed to run their course un-
 checked, may assume the remittent form.
   The attack  in remittent form  is  usually gradual,  com-
 mencing with aching of the head, back and  bones, a feeling
 of illness ; this  will sometimes amount  to a rigor,  with
 chilly sensations, soon  followed by flashes of heat of the
 surface.
   The thermometer applied at any time (even during the
 rigor) will show an elevation of temperature.
   The pulse is small and generally accelerated, the breath-
 ing irregular  and sighing,  the patient often restless ;  vomit-
 ing soon sets in.
   As to these symptons, they vary much, as much depends
 upon the patient; fever affecting no two  alike ; some will
 lie quiet and sleep when they have fever,  while others are
 restless and somewhat delirious.
   The tongue is usually coated with a white fur,  the mar-
 gin is red and  often indented by the teeth.   Some physicians
 regard this indentation by the teeth as a sure test for mala-
 rial  fevers.
   While I do  not lay as much stress  on this  symptom as
 others, yet I freely admit that it is a good indication of ma-
 laria in the system.  There is a mawkish  taste—appetite
gone—water and cold drinks being alone craved.
   The fever usually runs its course from ten (10) to twenty-
four (24) hours ; then comes a remission.
  That is, the fever subsides to perhaps 99^ or 1000, the 
MALARIAL FEVERS.
35
 skin becoming moist, but unless appropriate treatment is
 adopted, the fever will soon return and will be more intense)
 so we have almost a continued fever.
   Sometimes it is difficult, espcially at  the commencement
 of an attack, to know whether the  fever is malarial remit-
 tent or typhoid.
   In typhoid fever the temperature is usually 100 to ioi° in
 the morning, and seldom over 102 to 102^ ° in the afternoon.
   In remittent fever, during the remission, the fever  may
 be  as  low  as  99)4°, or even  normal;  it  soon  rises,
 however, to 104 or 1050.  In  remittent  fever the fever is
 more intense, with aching of head,  back and bones, while
 in typhoid fever, usually,  there is no pain.
   In remittent fever the bowels are generally constipated,—
 in typhoid, the bowels are tender and loose.
   In remittent fever there is often a  sense  of oppression in
 the stomach, and usually  vomiting ;  yellowness of skin is
 also common, which, with a coated tongue, often leads phy-
 sicians to say that  the liver is  the cause of the fever  and
 that the patient is bilious.
   True,  the  liver is affected, but not more so than the stom-
 ach, heart, spleen,  brain, or, in fact, any other organ of  the
 body.
   The poison (malaria) that causes remittent  fever, affects
 the  blood,  and, as a matter of course,  every organ in   the
 body suffers.
   If the temperature reaches 1050, the case  must be treated
energetically, and with children convulsions will  often  oc- 
36
MALARIAL FEVERS.
cur, unless under the influence of some remedy to prevent
them.
  When in any doubt as to whether the fever is typhoid or
malarial, I usualiy test the same  by using  quinine freely.
If malarial, the fever will subside when the  patient is fully
under the influence of the same ; but if typhoid, the symp-
toms will all remain and no harm result, only the disagree
able symptom of cinchonism, which will soon pass away, if
the quinine is withheld.  However,  if the  quinine should
be given in large doses (13 to 30 grains), there will be some
reduction of the temperature, but only for a short time.
  In remittent fever there may be two remissions in twenty-
four (24) hours, and again it may be forty-eight (48) hours
without any.
  In some cases this is owing to the treatment that the  pa-
tient has received.
  After the remissions occur a few times, if the patient takes
no anti-malarial medicine, the remissions may cease to oc-
cur, and then the fever becomes continuous, assuming often
a low form, simulating typhoid; yet it is not a true  typhoid>
but simply a low form of malarial fever.

                   RECAPITULATION.
  The following is a  very good description  of the symp-
toms of remittent  fever,  and  cover what  I have written
above so well that  I quote :
  "There are generally premonitory signs,  but the attack
may be sudden. 
MALARIAL  FEVERS.
37
   "Gastric irritation is usually first noted,  there being  a
sense of uneasiness or oppression at the epegastrium, nausea,
and anorexia, with headache, general pains and a feeling of
languor.
   ' 'Some chilliness  or rigors may be experienced, but there
is no cold stage of any duration,  and the  temperature  rises
immediately.
   "The hot stage becomes very intense,  the skin burning
and dry; the face flushed, the eyes  injected,  with intense
headache, giddiness, restlessness,  sleeplessness,  and often
delirium, which is sometimes violent.  Vomiting and nausea
are commonly present, the vomited matters  consisting first
of food, then of a watery fluid, and  finally  of biliary  mat-
ters ;  they may become black or brown.
   "A sense of  great oppression and  weight is felt  in  the
epigastrium; the tongue is furred and  tends to dryness, the
lips are parched and there is intense thirst,
   "The pulse is frequent, and either full or  small and com-
pressible.  The symptoms abate  generally in from  six to
twelve hours, but may continue for twenty-four, thirty-six,
or forty-eight hours, or longer.
   "Some perspiration usually breaks  out as  improvement
takes place.
   "The remission is of variable duration, and this  is  fol-
lowed by an exacerbation which is of greater intensity than
the first paroxysm."—(Encyclopedia of  Medicine and Sur-
gery.) 
38                MALARIAL FEVERS.
           TREATMENT OF  REMITTENT  FEVER.
   Being satisfied that the case is one  of remittent  fever,
 then the treatment is easy.
   Quinine is the sine qua non—the remedy of all  remedies,
 in the treatment of this disease.
   If there is such a thing (?) in medicine as a  specific, then
 quinine is for malarial fevers in all their forms.
   There is no need  of  preparatory treatment  (getting  the
 system right for the quinine), nor is there any  need of wait-
 ing  for a remission; give the quinine at once ! in doses of five
 (5)  grs. (for an adult) every two hours, is the dose I usually
 employ.
   Give the quinine in a capsule,  and it will be retained, on
 the stomach, better.
   If there is much nausea and vomiting, a small portion of
 morphine will often quiet the stomach.   Mint water or one
 drop of creosote (well diluted) with bismuth will settle  the
 stomach.
   Morphine in my hands  has always  acted well when  all
 other remedies failed.
  If the bowels  are constipated, give epsom salts in broken
 closes;  one teaspoonful of salts dissolved in a small  quantity
 of water, repeating this dose  every  two  (2)  or three  (3)
 hours until the bowels act well.
  Give bromide  potassa, in doses of from  fifteen to twenty
grains, to relieve the pain in  the head and back.  In  fact, I
sometimes  think bromide  potassa has some specific  effect on 
MALARIAL  FEVERS.                 39
 malarial poison,—at any rate it is a good remedy to use with
 the quinine.
   Continue the quinine and bromide potassa every  two (2)
 hours until the skin becomes moist, the pulse soft, and the
 thermometer shows the remission of the fever has occurred;
 then, if the patient is fully under the influence  of quinine,
 make the intervals longer—every four or five hours instead of
 two.
   When the patient is thoroughly cinchonised, roaring in the
 ear and some deafness will be the result.  Most people  in
 this country are familiar with the use of quinine, and know
 when a patient is under its influence,
   The danger in treating remittent fever is in  not  giving
 enough quinine, and very few are likely to give too much.
   Cloths wet in cold water and  applied to  the head, are
 grateful;  or pouring cold water over the head ; cold  drinks
 of water or lemonade may be given to gratify thirst, but not
 too profusely,  as large draughts will often  cause vomiting.
   If the quinine can not be retained  on the stomach,  then
 double the dose and inject in the  bowels.  The best plan of
 using quinine  by the bowels,  is to first  give  the patient  a
 large injection of warm water and soap,  thus washing out
 the lower bowel well,  then give the quinine  in as  small  a
 quantity of water  as  possible,  after the large injection  of
warm water and soap has passed ; then  the  patient will be
more likely to retain the quinine injection, and the same
will be absorbed by the bowels more readily. 
40                 MALARIAL FEVERS.
   The injection of quinine should be  repeated every  three
 or four hours.
   The best plan to prepare  the quinine  for  injection  is  to
 dissolve the same  in a few drops of elixir of vitriol and then
 add a small quantity of water, as quinine don't dissolve well
 in water alone.  One drop  of the vitriol to each  grain  of
 quinine will make a clean solution  and pass through the
 syringe more readily.
   The plan of rubbing quinine on the skin, is of not much
 service,—the skin is throwing off in fevers,—and it is very
 questionable as to the amount that is absorbed in any  case.
   However, in children, when it cannot be retained by the
stomach or rectum, the practice of rubbing  on  the surface
 should  be resorted to—one teaspoonful of  quinine mixed
 with one half teaspoonful of lard, and  this  spread over the
chest and under the arms, or the quinine can be dissolved  in
 whiskey and applied in like manner.
   Time, precious time, must not be lost in these cases.   Get
the patient under the influence of quinine as quick as pos-
sible.
   Children with remittent fever often have convulsions when
the fever is high, and I respectfully refer to  the chapter on
convulsions for the appropriate treatment.
   Chloral hydrate  and bromide  potassa,  of each  about fif-
teen grains, diluted, will relieve the  pain in the head and
back so much complained of in remittent fever.   It is also
the dose to give when the patient is  delirious and  restless.
Bromidia is also an excellent remedy  in  such cases,  as  it 
MALARIAL  FEVERS.                 41
contains chloral hydrate, bromida potassa, Indian hemp and
hyosciamus, a good combination,  and  one that generally
acts well.  Dose, one teaspoonful (for an adult),well diluted.
If the patient has an irritable stomach, the chloral  hydrate
and bromide potassa will be more likely  to be retained than
bromidia.
   If symptoms of congestion  occur,  increase the  dose of
quinine, using brandy or  whisky also.
   Emetics  and  mercurial  cathartics  are  not necessary.
Under  the head of general treatment this subject is dis-
cussed  at some length.
   After the patient has had fever for some days and seems
prostrated,  then  supporting remedies  will be necessary;  a
moderate amount of brandy or whisky, and a good diet of
soup, etc.,  etc.
   It will be necessary to  use  the same precaution  in treat-
ing women in family-way (pregnant)  with  remittent fever,
as described in the note in intermittent fever.
   Warberg's tincture is an excellent  remedy in remittent
fever, and much used by the profession.  It contains a large
amount of quinine and cinchonidia,  rather costly ; but I
have  thought best  to  recommend  quinine alone, as the
people generally  know the dose and  are familiar  with its
use.
              •      RECAPITULATION.
   1.—Keep in view the fact that the patient's system  must
be saturated  with quinine, and that as soan as possible.
If the stomach will not tolerate it, give  it  by the  rectum, 
42
MALARIAL  FEVERS.
and if not retained, apply to the surface of the bod}'.
  2.—If nausea and vomiting, check by creosote and bis-
muth, mint water, or small doses of morphine, also apply
mustard to stomach.
  3.—Open the bowels  (if constipated)  with salts  ; small
doses, repeated every three or four hours ; at the same time
using large injections of warm water and soap in rectum.
  4.—Apply cold water (not ice water) to head, using small
quantity of ice water or lefnonade to gratify the thirst.
  5.—For severe pain in head and bones and convulsions in
children use  chloral  hydrate  and  bromide  potassa,  or
bromidia.
  6.—When the patient is convalescing  use a tonic.
        HEMORRHAGIC MALARIAL FEVER.

                 SYMPTOMS AND COURSE.
  Name.—Hemorrhagic   Malarial   Fevers,  Intermittent
Haematuria,  Black Jaundice,  Malarial Haematuria.    (In
Texas, this fever is known as Black Jaundice.)
  Definition.—"This affection  is characterized  by the oc-
casional, and generally periodic, discharge of albuminous
urine, more or less deeply tinged with  the coloring matter
of the blood,  and frequently  containing blood, and casts of
the uriniferous tubules.  It occurs most frequently in mala-
rious regions, and in individuals who have suffered repeated
attacks of malarial fevers; and the discharge of bloody urine 
MALARIAL  FEVERS.                 43
is  often, but  not  always,  attended with symptoms which
characterize  an  attack  of ague,  and with  jaundice."—
(Sternberg.)
  This is one of the graver forms of malarial fever, and the
mortality is great.
  My  experience  is,  that  this form of (hemorrhagic mala-
rial) fever, always occurs in one whose system  is broken
down from repeated attacks of malarial fevers, (either ague
or bilious).
  The symptoms are  the same as  in  either ague or remit-
tent fever, except that the urine is  bloody,  and in some in-
stances blood passes from the bowels, and is vomited. That
from the stomach is usually dark, resembling coffee grounds
in appearance.  The  skin  becomes jaundiced, and later on
appears blue, and from this symptom many in this country
call the fever the "black jaundice."
  There is generally no difficulty in forming  an  opinion as
to the disease.
  The attacks axe periodical, as in ague;  or there  is a remis-
sion, as in bilious fevers.  The skin is first yellow, after-
wards dark  (or blue).  As said  above,  this  symptom ac-
counts  for the name given to this disease by some.
   I object to this name, for the reason that the jaundice  is
only one of the symptoms,  and carries no true idea as to the
nature  (pathology) of the disease.    Hemorrhagic malarial
fever,  or'malarial fever with hemorrhages,  describes the
disease more fully.
  These cases are always serious,  and  the patient should 
44                 MALARIAL FEVERS.
have the counsel of a  physician, if possible, without delay.
   The urine  varies in color,  from a smokey hue to pure
arterial (red) blood.   "The bloody urine may appear during
a paroxysm of intermittent fever, which has  been preceded
by one or more paroxysms unaccompanied by  this symp-
tom; or it may appear suddenly in one who has been sub-
ject to malarial attacks, but who has  not experienced one
for some time.  In this case,  it is  commonly produced by
exposure  to  damp and  cold.  After  such  exposure,  the
patient gets up in  the morning feeling languid, and indis-
posed  to  take  food or to exert himself.  Later on, he may
have slight'chilly sensations, or a distinct chill, followed by
more or less fever,  then he discovers  his urine, which was
perfectly clear when he first arose, has suddenly assumed a
bright or dark  red color,  or it may be the color of porter.
Upon standing, it deposits a  copious  reddish  brown sed-
iment,
   Two or three discharges of this character may take place,
and then the urine suddenly, or gradually assume its normal
appearance.
   The discharges of bloody urine are sometimes preceded
by a sense of fullness,  or of pain, in the  region of the kid-
neys; and this, with a feeling of weariness, may be the only
symptom  attending the attack, other than the hemorrhage.
   The periodic character is manifested by a recurrence of
the attack every day,  or every  second  or third day, at the
same hour.   The paroxysms may occur at longer intervals, 
MALARIAL  FEVERS.
45
 and without any very decided regularity  as to the date of
 recurrence.
   In some cases, the symptoms of hemorrhagic malarial fever
 resemble  yellow  fever, and  the  fever is called by  some
 Malarious Yellow Fever,  a  name liable to mistake.
   Yellow fever is a disease of one  paroxysm, and intensely
 contagious, while malarial hemorrhagic fever has an inter-
 mission, or remission, in the fever,  and is not contagious.
   There  can be  no  doubt as  to  malaria being the prime
 cause of this form of fever: all authorities, I think, agree on
 this point.
   The people, in  this country, have a  great dread of this
 disease, and regard the same  as  almost always fatal; yet I
 am satisfied, if the facts  were known, most of the cases re-
 cover.
   I  know this  is true in the practice of the physicians in
 this part  of the South, who seldom lose a case, unless it is
 one in which the disease has been allowed to run its course
 for some  time, without  treatment, or  in  a patient whose
 system has been badly wrecked  (broken down) by repeated
 attacks of malaria, and who lives in an intensely malarial
 region.
   A writer in Dr. Jones' Memoirs, says: "I find that every
 patient I have had  or  seen  (with hemorrhagic fever) has
 had previous attacks of chills and fever, and in consequence
 the spleen is very much enlarged.   So invariably is this the
case, that when my friends enquire of me how to avoid this
 disease, I tell them to break  up their chills promptly, and 
46                 MALARIAL  FEVERS.
 not to let their blood be poisoned by the long continuance
 of them."  This is from the pen of a physician in  Louisiana,
 and is good advice.
   Another  Louisiana physician says, (speaking  of  hem-
 orrhagic malarial fever,) "I have never seen a case of serious
 or grave import, but in connection with  indubitable  proof
 of chronic and intense malarial toxaemia''   *  ' *  This con-
 firms what was said in the first part of this book, i. e., "to
 break the chills at once."  Every attack  racks  the system
 to some extent.
   Many observers contend that the urine is not bloody, but
 stained  with  the coloring matter of the blood.  On this
 point, the evidence is very conflicting; but  be  that  as  it
 may, surely the passages from the rectum, and in some rare
 instances from the stomach, is pure blood.  Professor Tyson
 says,  "In this form of disease  especially, it  often  happens
 that the coloring matter only, and the debris of blood disks,
 are found in the urine, very  few, and often  no entire  ones
 being discernible"---.  Ferand asserts that the presence
 of blood in the urine is exceptional, and that the  nidanuria
 (black urine) is due to bile pigments.   He says,  "The very
 remarkable color of the urine in nulamisic bilious fever has
 caused the vulgar to believe,  and for a long time the doctors
 also, that the liquid contains a large proportion of blood;
 and I confess that for my part, I have  been very much
 struck with it.   At first view, it seemed very difficult to be-
 lieve that the color which I had before my eyes was not due
to blood, and even to  very  pure blood, but my opinion has 
MALARIAL FEVERS.                 47
been modified          *    I examined more than  twenty
different specimens  of melanuric urine, by means of the
microscope, without ever discovering a single blood globule,
      *    Not wishing to trust to my personal examina-
tions, I have had numerous examinations made by medical
officers under my orders, several of whom  had  ample ex-
perience in the use of the microscope,  but no one among
them was more successful than myself."
   Dr.  Joseph Jones, of New Orleans, finds  blood  in the
urine in these cases.
   Dr.  Sternberg says,  "While we  must admit that the
presence of blood has been established in numerous cases,
yet it is beyond question that bile-pigments are also  present
in large quantities, and perhaps more uniform than blood.
The disease is essentially a bilious fever,  and aside from the
presence of blood in the urine, has no decided hemorrhagic
tendency."
     TREATMENT OF HEMORRHAGIC MALARIAL FEVER.
   In no form of malarial diseases are the profession so di-
vided in their treatment, as in this.
   While the large majority  agree  that quinine  should be
administered, others argue stoutly against its use, claiming
that quinine aggravates the kidneys and increases the flow
of blood.
   My own experience is decidedly in favor of its  use.
   Dr. Druett says, (in  writing of the treatment of this form
of malarial disease), "Of medicine deserving the name  there
is but one, and that is  quinine in full doses." 
48                 MALARIAL FEVERS.
  "Prof. Tyson says:   ' 'The  treatment  is distinctly that of
malarial disease, and I have seldom seen more brilliant and
satisfactory results than have followed the use of quinine, in
a case accurately determined, although such results are not
invariable, and I have known the disease to resist for a long
time the most thorough and judicious  use of anti-malarial
remedies.''
  Quite a variety of remedies have been used to  check the
flow of the bloody urine, such as vegetable  acids, sulphate
iron, sugar of lead, catechu, chlorate potassa, etc., etc.  The
benefit derived  from any of them has been questionable.
  I would  recommend in every case (until a physician can
be consulted) that the bowels be  opened with an injection
of warm water  and soap, and quinine be used freely ; dose,
five to ten  grs., (for an adult,) every two or three hours  ;
with bromide potassa  to quiet nervousness.
  Warburg's Tincture is the best remedy that can be used,
in this form of malarial disease.   It has been much used of
late, and is regarded by all as  one of the very best.   For-
merly it was a patent  remedy, but its formula is now known
to the profession.
  The formula  is printed on the bottle, with the directions,
and I can safely recommend it, in these cases.  The dose for an
adult is one teaspoonful, diluted.   Repeat every two hours,
until the patient is fully under the influence  of same,  Dr.
McLean says,  "It acts as a powerful diaphoretic, the most
powerful with which I am  acquainted." In this way, it may
relieve  the kidneys of  extra work  (by  acting on the skin 
MALARIAL  FEVERS.
49
freely), as well as by  destroying the malaria in the system.
   My  plan of treating hemorrhagic malarial  fever,  is the
same as the graver forms of ague and remittent fevers, ex-
cept that opiates,  in  all forms, should be avoided (if pos-
sible).
   This form of malarial  fever seldom occurs, except in sub-
jects whose systems are broken down by repeated attacks of
malarial fevers;  consequently the system should be  toned
up.  After the paroxysm is over, the  patient should by all
means be moved out of the malarious atmosphere.
   It is astonishing that a sensible person will live in a place
known to be intensely malarious, and be subject to repeat-
ed attacks of hemorrhagic malarial  fever,  when perhaps  a
few miles travel would remove him from the malaria.
   I can speak from experience, that the case subject to such
attacks, and continuing to reside in such malarious locality,
will soon succumb to the  disease.
   We cannot remove the cause, because it is atmospheric,
but we can certainly move the patient.
   Remove him (after the paroxysm  has passed,) from the
malarious place, give  him quinine and  iron, with a good,
generous diet, and he will soon regain his health.
   In speaking of these cases,  I  often use  the following
homely illustration:  Suppose  a  man  is bitten  by a snake.
We  administer  antidotes, and  relieve him.  He recovers,
but is considerably debilitated.   Immediately  he lets  the
snake  bite him again.  How long can his system  stand
these repeated injections of poison?   Just so with malaria. 
go                MALARIAL FEVERS.

We administer remedies to neutralize the poison (malaria) in
the system, but the patient immediately  is exposed,  and
again takes  in  the poison  (by staying in the malarious
region), consequently it is only a question of time as to how
long his system will bear these repeated attacks.
  I have  no experience  with turpentine in these cases.
While free  action from the  kidneys is desirable, it is per-
haps best  to obtain that result by using water freely.
  A writer,  Dr.  Thompson  (ex-Cenfederate Surgeon),  and
whose field of practice is  in the malarious regions of White
River, Arkansas,  says,  "Cure the malarial malady,  and-
you can cure the hsematuria"  (bloody urine).   He regards
' 'quinine as the sheet anchor in the treatment.''
  There is a great diversity of opinions among authorities,
as to the treatment of this grave form  of malarial sickness.
My own experience is in favor of the quinine treatment.  It
is well  to  state,  in some of the graver forms, no remedy
seems to avail, and the patient dies.
  Some physicians give a mercurial (calomel) purge (10 to
15 grains) first, and then follow with quinine.
  If calomel is admissible in any form of malarial disease,
it is  in   this,  from the  fact  that  radical changes have
taken place in  some  of  the organs, and the kidneys are
certainly irritated, if not inflamed.  Calomel will sometimes
quiet the  stomach, check vomiting,  and unload  the  liver
and bowels.
  I do not think there can be any question but that calomel,
when administered, passes out of the system by the kidneys, 
MALARIAL  FEVERS.
51
 as well as by the bowels, and may do good in this manner;
 yet I think the same results can often be accomplished by
 less irritating  and debilitating  remedies, rhubarb, salts  or
 oil, or the remedy so much in use in this country, Simmon's
 Liver Regulator.   I am averse to recommending a patent
 nostrum, but this one  is  so  universally used,  that  nearly
 every family in this country keeps  a supply on hand.
   In detailing my experience with malarial hemorrhagic fever,
 I must confess that the country that I have practiced in is
 not  so  intensely  malarious  as some parts of this State,
 Louisiana and Mississippi,  and perhaps it has  been the
 milder  forms that I have had to contend with.   Many of
 these physicians are positively opposed to the use of quinine
 in this form of malarial disease, some  using  none,  others
 waiting until the paroxysm subsides and the urine becomes
 clear, then administering quinine.
  A few writers believe that quinine will cause the urine  to
 become bloody again.   Below are a few extracts from some
 who hold these views:  Says a Louisiana physician,  "I
 persistently used quinine for a long time, and lost my cases.
 Now that I have  rejected it altogether,  the mortality  is
 much less."
  It will be unnecessary for me to quote at length from men
 who hold such views, as this book is supposed to reflect my
own, and I must say still, that my confidence is in quinine.
  It is the great anti-periodic remedy.   After examining all
the latest authorities on this subject, the preponderance of
evidence is in its favor. 
52                 MALARIAL FEVERS.
  Saline cathartics, with warm water  and soap injections;
mustard to stomach and chest, Warburg's tincture  or qui-
nine, and bromide potassa to quiet nervousness.
  Dr. Webb, of Alabama, who seems to have had much ex-
perience with this form of fever, says:
  '' Quinine will undoubtedly, in a certain number of these
cases,  increase the hematuria (bloody urine),  and some-
times even seem to cause it.  Seeing this, the timid admin-
istrator stops his quinine, and  his patient dies, with quinine
under the ban of killing him;  whereas, with a bolder hand,
directed by a proper idea of the true cause of this  symptom
(a disturbance of the  vaso-motor system under malarial in-
fluences),  he would have unhesitatingly  continued it,  and
his patient might have had a good chance to live.  Remove
the cause of the disease, and the  haematuria  (blood}' urine)
will cease.   I have seen quite a number of  cases to which
this remark applies, some in which the quinine, given at the
expiration  of the second hebdominal period, as a prophylac-
tic measure, (a measure familiar to all physicians in mala-
rial regions,) caused a return of a decided hematuria, with-
out fever.   In these cases, I  have not hesitated to repeat
the quinine next day, with the best results.
  Again I  advise that a physician be called to these cases,
at once, as this is one of the grave forms of malarial disease,
and requires much skill to treat.  By all means,  (as scon as
possible,) remove the patient  out of  the  malarious  atmos-
phere. 
MALARIAL  FEVERS.
53
GENERAL REMARKS  ON THE  TREATMENT  OF
                 MALARIAL FEVER.

   Having discussed the various types  of fever, their cause
and treatment, I propose, under this head, to discuss at some
length, the treatment recommended, quoting  from authori-
ties to sustain the theory set forth in this work.
   There is no such thing known in medicine as an infallible
remedy, specifics—here is the disease and there the  remedy.
   Nature is the great worker.  It is the natural working of
the system that effects the  cure in any case, and all we  can
do with medicine is to assist nature in  its work.   This is a
fact that is too often lost sight of, and many times physi-
cians give more than is necessary.  Most of the remedies
used as a medicine are for eign to the system.
   In a work of this kind I cannot enter into details and ex-
plain how the various medicines are supposed to act in  the
system, nor do I think it essential; suffice it to say that the
"great majority of medicines must  obtain  entry into  the
blood, or internal fluids of the body,  before their action
can be manifested."
   I have explained the symptons,  course and treatment of
malarial fevers, in as condensed a manner as possible,  and
tried to impress the fact that malaria is undoubtedly a poison,
that enters the system, causing periodic fevers, and that ex- 
54
MALARIAL  FEVERS.
  perience demonstrated the fact that quinine is the remedy of
  all remedies,—the grand old medicine that has  safely car-
  ried us through many trying cases of malarial sickness.
    Quinine, when early and freely used,—before any changes
  are produced in any of the vital organs by repeated attacks,
  will stop or cut short any attack  of malarial fever.
    Let me emphasize the fact that the system  needs no pre-
  paration ;  the preparatory  treatment generally used is worse
  than useless.   It hurts the system and consequently does
  harm.   Calomel,  the  remedy  usually  administered,  was
  given years ago, under the impression that all fevers were
  inflammatory,  and like all ideas that obtain a  hold on the
  minds of the people, it is hard to eradicate ; although it has
  been proven (often) to be er r oneous, for calomel is positively
  hurtful in  malarial fevers.
    For ten years I have abandoned its use in the  treatment
  of malarial fevers, and have found no cause to regret it.
    Often physicians speak of its action on the liver and claim
  to administer it for its effect on that organ.  It is very ques-
  tionable whether it has any effect on the  liver.   The dark
*  and offensive  discharges that  follow its  administration are
  said to be due to a decomposition of mercury in the system.
  The discharges have been examined time and time again and
  no bile found, but the color shown to be due to the mercury.
  The same actions will follow if calomel is administered to a
  man in perfect health.
    Doctors (I fear) are like  other people,  that  is—it  is the 
MALARIAL FEVERS.                 55,
 fashion (custom) to use certain remedies ,and they use them
 without questioning the utility of their action.
   The old practice to commence with calomel and blue mass.
 and then use quinine, has had its day, for most  intelligent
 people dread calomel, and  are  asking :  Is there  not some
 way to avoid its use ?  / answer,  it is unnecessary.
   Sternberg  (one  of the  very best authorities on malarial
 fevers) says:
   '' Formerly the opinion prevailed that a certain course of
 preparatory  treatment was necessary,  in order that quinine
 might favorably influence  the  course of the fever.  This
 idea no longer controls the practice of intelligent  physicians
 in malarious regions."
   A distinguished  teacher, Dr.  Morehead, says :
   " The practice, at  one time too common,  of administer-
 ing calomel, in doses of four or five grains,  three  or four
 times in the  course of the  day,  without  any very  definite
 object, and continuing it for a succession of days, cannot be
 too strongly condemned ; not only is it unnecessary, but for
 the following reasons positively injurious.  :
   1.   "In watching  the progress of cases  thus treated, it is
 not difficult to detect a train of symptoms fairly  attributa-
 ble to  the treatment (calomel) than the disease, because it is
 in cases thus tested that it has been chiefly observed.  The
symptoms alluded to are uneasy feelings, sometimes amount-
ing to  pain with  a sense of oppression or  "sinking"  at  the
epigastrium (stomach), and occasionally griping of the  ab- 
56
MALARIAL FEVERS.
domen, for which leeches are not unfrequently applied and
purgatives given.
  2.  "The frequent  repetition of the calomel 'keeps up a
furred state  of the tongue,' with 'nausea'  and  'irritabili-
ty'  of stomach, aggravates the febrile excitement and pro-
duces an irritable state of the bowels, indicated by frequent
watery discharges.
  3.  "The convalescence of cases thus treated  is always
'tedious,' and frequently complicated with  diarrhoea and
clay-colored discharges.
  "Not only is the practice unsound  in theory  and  of no
value, but is contrary to ratidnal theory  and very injurious.
If it be true that prostration of the vital actions and a dete-
riorated state of the blood are  very unfavorable conditions
in remittent fever, and that mercury deteriorates  the  blood
and favors prostration,  on what principle of reasoning can
it be maintained that mercurial  influences  induced by the
physician can have any other  than  an 'injurious effect in
remittent fevers.'
  '' I have on several occasions pointed out the tendency of
malarious fevers to produce a cachectic (broken down) state
of the system,  and have endavored to inculcate  the impor-
tance of guarding against the increase of this  unfavorable
diathesis of medical treatment.   To all who within the past
twenty years have had an opportunity of extensively ob.
serving disease in  India in the various classes of European
society,—asthenia, dyspepsia, injured teeth,  pains in side
and loins, palpitation, habitually 'foul tongue,' constipated 
MALARIAL  FEVERS.                 57
bowels, pale alvine evacuations, depressed spirits and a sense
of sinking at the  epigastrium (stomach), all traceable  to
the abuse of mercury—must be familiar facts.
   "Such, then, are the reasons drawn from my own sphere
of observations, which have led me to the conclusion  that
the induction of mercurial influence  in the  treatment  of
malarial fevers has been a  'great and  grievous  error'  in
therapeutics.''
   I heartily endorse every word said  by  this  distinguished
physician, and can verify the facts by daily observation.
   Dr. J,  Forsythe Meigs  says (in speaking  of the use of
mercury in malarial sickness) :
   '' To say the least they  (forms of mercury)  are  unneces-
sary, and any one who has seen the  gastric  distress, intes-
tinal irritation,  or the  constitutional poisoning, which  mer-
cury  not unfrequently iuduces, will be glad  to know  that
he may, with a good conscience, dispense with  its  use  in
so severe and dangerous a disease  as  this of  malarial fever
often is."
   Dr. Austin  Flint,  (one of the ablest physicians America
has ever produced,) in his work on the practice,  speaking
of malarial fevers, says :
   " There is no need of preparatory treatment.  This posi-
tion was taken by the author in an article published more
than thirty  years  ago.  An  experience  embracing  many
hundred cases, in different climates, since the date of that
publication,  has abundantly confirmed the  correctness of
this position." 
58                 MALARIAL FEVERS.
   Again he says : '' The pathological views (nature of the
 disease) which formerly led practitioners to employ mercury
 freely in this disease, are not tenable, and it may fairly be
 doubted if clinical observation affords any ground for regard-
 ing this remedy specially indicated."
   Again he says : '' Time need not  in any case  be  lost in
 order to resort to cathartics or other measures preparatory
 to the exhibition of an anti-periodic (quinine) remedy."
   Headland, in his work on the action of medicine says :
   '' Mercury disintegrates or decomposes the  blood and thus
 wastes the body."  "This is the systematic  action of mer-
 cury, on which too much stress cannot  possibly be  laid."
 "It is an agent of terrible  activity,  and  we may well be
 cautious how we handle it."   "When the skin cannot carry
 off the poison (mercury) in sufficient quantity—when the
 solvent  powers of the urine is  exhausted—when the  bowels
 are prevented by opium from eliminating the  mercury, then,
 as a last recourse, the salivary glands step in  and in the sal-
 iva the metal finds an exit, (salivation)."
                        QUININE.
  There can be no question but this is the  remedy  of all
remedies in the treatment of all malarial  fevers.   It has
stood the test for years and its use is no  longer  an experi-
ment.   It is the battle axe with which to do  effective work
in treating malaria in all its forms.
  Dr. Flint says: "It is a specific, if any remedy is entitled
to this appellation." 
MALARIAL  FEVERS.
59
  So  much confidence have I in the remedy that  when
called to a patient in the first attack,  I  feel confident that
he will not have another, if he takes the remedy freely.
  How it acts on the poison in the  system no  one, so  far,
has been able  to demonstrate, but that it will cut short  the
disease, there  can be no question.
  Really, malarial troubles are not, properly speaking,  dis-
eases, until after the poison has effected some change  in the
system.   At first it is a poison that racks the whole body—
every organ suffers, and the patien is in pain from  head to
feet; but, usually, as he is under the influence of quinine,
all these symptoms vanish.  The  patient is some  weaker,
but in a short time will regain his health.   But let the par-
oxysm return and continue—soon the constitution becomes
surcharged with malaria, the  spleen and liver enlarged, the
blood weakened, and in addition to all this calomel in the
bones ;  and what a picture !
  People are slow to change preconceived opinions, and all
reforms are gradual; but when reaction does come, it sweeps
clean.
  Sooner or later mercury  will be  banished from the list of
remedies in malarial diseases.  There is danger however, in
extremes going too far, for mercury is a good  remedy in
certain  cases, especially in inflammatory diseases, indeed,
one of the best in pneumonia, acute rheumatism, etc.,  etc.
When the patient is stout, and  we  wish  to lower the vital
powers,  it is one of the best substitutes for blood letting.  I
mention this fact here, to show I have no prejudice against 
6o
MALARIAL  FEVERS.
the proper use  of calomel.  It is a  remedy  of force  and
power, and a good  one when judiciously used; but I hold
there is no  necessity  for it in the treatment of malarial
fevers.
   Bleeding is an old remedy, and a good one in some cases
of pneumonia, or in fact any acute inflammations; but med-
icine has its  fashion,  and bleeding is now "one of the lost
arts."   It  was  formerly  the  custom to  bleed in malarial
fevers, but that practice has long since ceased.
   Professor McLean says, "I have  been  led to take a view
of malarial fevers generally, and remittent fevers in particu-
lar, different from that laid down by many authors.
   "It appears to me that the so-called anti-phlogistic [calo-
mel] treatment,  so  much insisted on by many writers, is
based on the belief that the  phenomena observed in a case
of remittent fever are consequent on  a process of inflamma-
tion.  It is only on such a belief that anti-phlogistic treat-
ment can be justified."
   During the exacerbation of a  remittent fever there is vio-
lent disturbance both of the vascular and nervous system.
Almost every organ, almost every function suffers. The gas"
trie intestinal membrane is affected, the liver and spleen suffer,
the brain is involved,  for rending headache and delirium
are often present.  Is it rational to  suppose that an  inflam-
matory process can  be going on,  at  one and the same time,
in all these various  organs?   Do  the appearances  observed
post mortem (after death) give any support to such  a doc-
trine? 
MALARIAL  FEVERS.                  6r
  If not, on what principle can spoliative treatment be justi-
fied?  Is it not rather the case  that this terrible disturbance
of so many organs is due  to  the  presence  in the blood of a
subtle poison acting on them all?  If so, surely the guiding-
principle of the physician in his treatment should  be to
counteract this poison, to neutralize it, or to expel it from the
system, and so prevent a recurrence of the exacerbations.
  This is the principle on  which  I have long acted, and I
am satisfied that it is  at once a safe and successful one.  In
quinine we have such an  antidote,  a therapeutic agent of
unrivaled efficacy, which, if  skillfully used, will rarely dis-
appoint the practitioner.
   It  is  always, of course,  advisable to have  the  bowels
thoroughly evacuated, and if the patient is seen when the
stomach is loaded (soon  after a  meal), it will  be necessary
to evacuate its contents by an emetic.  In ardent remittents,
however, there is generally  little call for this, as obstinate
vomiting is almost always a  troublesome symptom.
   This done,  the period of remission must be watched for,
and the moment it arrives quinine in a full dose should be
given—not less than fifteen grains in the case  of an adult.
   If the irritability of the stomach be  so urgent that  the
remedy  is  rejected, means  must be  adopted  to allay it.
Time, precious time,  should not  be  lost.   Quinine should
be given by the rectum, in a full and efficient dose.
   By mouth or by rectum, or by both, quinine in quantities
sufficient to induce some of the symptoms of saturation (tin- 
'62                 MALARIAL FEVERS.
chonism) should be given before  the time of expected ex-
acerbation.
  In closing these general remarks, I feel that if this book
should cause a general inquiry  in reference to the abuse of
calomel in the treatment  of malarial fevers, and  a revolu-
tion in the treatment, as now generally adopted through
this country, it will save the people much unnecessary suf-
fering, and I will be repaid for  my  trouble in bringing the
matter to their attention.
CONVULSIONS.
                 SYMPTOMS AND COURSE.
  Children  have spasms from  a variety of causes, but I
shall only describe the symptoms, course and treatment of
convulsions occurring during an attack of either intermit-
tent or remittent fever.
  Some children, with large brains  and a highly developed
nervous system,  will have spasms from very slight fever
(102^2), as it takes  only a moderate  amount of fever  to
make them very nervous  and much excited.
  Fever  affects  no  two  alike.  While some children  are
drowsy, and will sleep during  an attack of fever, others are
wild, and often delirious.
  By watching a case of fever, in a child, closely,  an attack
of spasm can usually be foretold. 
MALARIAL FEVERS.
63
  Just before the spasm, the little  patient usually becomes
very nervous and  highly  excited; the least noise arousing
from  sleep,  the child seems  easily  frightened, excited,
scared, trembling,  afraid something will happen to it, cling-
ing close to  the mother or nurse.
  These symptoms, when  the  fever is  high, should always
be taken as  a warning that the child will have a convulsion
soon, if no remedy be given to prevent.
  Sometimes, however, there is  no warning  symptom, the
spasm coming on suddenly.
  When the convulsion  comes on, the child will usually
cry  out, and ever}-  muscle  become  contracted, the head
drawn back, the  eyeballs roll to one side, and seem fixed
(staring), the jaws either  locked or working rapidly, often
biting the tongue, unless  some substance (cork is  best) is
placed between the teeth to prevent.   Consciousness is lost,
the arms and legs  drawn and violently jerking, the toes and
fingers contracted, the angles of the  mouth  drawn to one
side,  the teeth grate, upon the lips often appears a white
froth or foam.
  The whole body  is twitching by the spasmodic contrac- ,
tions of the  muscles, and often, in  severe cases, the back of
head and feet are the only parts of the body  that touch the
bed.
  This state of affairs (spasm) may only last a few minutes,
or it may continue  for hours,  and the child die in the con-
vulsion.
  Usually, in a few  minutes  the paroxysm begins  to sub- 
64
MALARIAL FEVERS.
 side, the  patient  takes a  deep inspiration  and  becomes
 quiet, and  if not disturbed will fall into a sleep; but the
 fingers and toes  are  not relaxed.   In such  cases, usually
 the  attack will soon return,  with all the force and violence
 of the first.
  The bowels and  bladder are often evacuated uncon-
 sciously.
  Convulsions occurring during fever, should always be re-
 garded as serious; for while a large majority  recover, yet
 every case  should  be treated energetically and promptly,
 and  an effort made to prevent a return of the paroxysm.
  It is easier  to  prevent a convulsion than  to check one,
 consequently  the warning should  be closely watched for,
 i. e., twitching of muscles, restlessness, excitement or  roll-
 ing the eyeballs, etc., etc.
  During the convulsive attack blood may be extravesated
 on the brain, and after the patient recovers from the fever
 and  convulsion, paralysis result from this pressure.
  I saw a case a short time since, (little girl of eight years,)
 who was unable to speak (talk) for three weeks  after the re-
 covery from the fever,  because  of blood  pressing on the
 brain, producing paralysis  of tongue.  (She had convul-
 sions during the attack of fever.)   At first  her  articulation
 was  poor, but soon recovered.
  In another case, after a violent convulsion, the child lost
all consciousness, and for three weeks lay in a stupid condi-
tion, ate and drank mechanically, just as  food was given 
MALARIAL  FEVERS.
65
 her.   She finally recovered, but partially paralyzed in one
 half her body.
   Children  do not  always lose consciousness when they
 have a spasm, for although the body is jerking and muscles
 contracted, they seem to be aware of their condition,  and
 will try to take any water, food or medicine given them
 during an attack.
   There certainly can be no. mistake as to a convulsion, the
 symptoms  are  usually  so  plainly marked, as  so  fully de-
 scribed before.
   These convulsive  attacks vary in intensity from slight
 jerking and twitching, with restlessness,  without  any  loss
 of consciousness, to violent  attacks, which toss the whole
 body about, drawing the face, fixing  the eyes, contracting
 arms and legs, often  causing death during the first convul-
 sion.  In fatal cases  the respiration and circulation is  em-
 barrassed,   and death  takes place  as .a result of cerebral
 (brain) congestion.  When the violent convulsive action
 (in such cases)  cease, the little patient lies quiet, but it is
 often the sleep of death.   The feet and legs  become cold,
 and there is no return of consciousness—the  whole system
 seems to succumb to  the violence of the attack.
   In other cases, the child has one convulsion  after another
 at intervals, during which the stupor is gradually becoming
 more and more profound, the little one becoming unable to
 swallow or be aroused, till finally there is total loss of con-
 sciousness  and sensation.  This is the most frequent mode
of death in convulsions. 
66
MALARIAL  FEVERS.
  Convulsions do not affect the whole body every time, but
in some instances seem  to be confined to one  side of the
body, or one arm and side of face; at other times the eyes
and face, or the lower extremeties; yet this is rare. Usually
the whole body is convulsed,  and much contracted;  but in
the commencement of the attack, only one side may  seem
to be involved.
  While I do not think  there generally will be any difficulty
in diagnosing convulsions, yet I will  insert the  graphic de-
scription  of spasm by Dr. J. Lewis Smith.  In describing
the symptoms, he says:
  "Eclampsia (spasm) is general or partial.  If general, the
muscles of the face, eyes, eyelids, and all the limbs are in a
state of rigid involuntary contraction, alternating with re-
laxation..  The  features lose their natural expression, and
are distorted; the mouth is drawn out of shape, often to one
side, by the violent muscular action;  the  teeth are pressed
together by tonic contraction of the muscles of jaws, and
may be violently  struck together, so as to lacerate the
tongue, if it protrude, or are ground upon each other.  Un-
less the attack is of short duration, frothy saliva, perhaps
tinged with blood from  the injured tongue, collects between
the lips.  The eyelids are usually open, though sometimes
      *    *     they are closed.  In severe cases, the eyes
are turned up, so that  the pupils are lost under the upper
eyelids, or the muscles of the eyes are involved  in the spas-
modic  movements,  so that the  eyeballs are forcibly drawn
from side to side.  Occasionally strabismus [squinting] oc- 
MALARIAL  FEVERS.
67
 curs.   While  the features are thus  distorted, the head is
 forcibly retracted, or is turned to one side; the forearms are
 alternately pronated and supinated;  the thumbs and fingers
 are convulsively flexed, so that the thumbs lie across the
 palms, and are covered by  the fingers; the great toe is ad-
 ducted, the other toes flexed; and the toes, as well as legs,
 participate more or less in the spasmodic movements.
   "In general convulsions, consciousness is usually lost.
 The head is hot previous  to, and during the attack,    *
       *     and  the face flushed.    *    *   *    The
 sphincters are  relaxed during the convulsive attack, so that
 in many cases  the urine and stool are passed involuntarily.
   '' P irtial eclampsia (spasm)  is more common than the
 general form, and it occurs in the muscles  of the face, in-
 cluding those of the eye, of the face, and of one or  both up-
 per extremeties,  or of the face  and extremeties on one side.
 The  spasmodic  movements may  be even limited to the
 muscles of the  eyes, and  they often occur only  in these
 muscles and  those of the  face.   Rarely, if ever,   does
 eclampsia affect the legs,  without affecting also the muscles
 of the arms and face.  In partial convulsive attacks, sensa-
 tion and consciousness are in some not entirely lost, but in
 others they are not manifested if present.
    The duration of an attack of eclampsia varies somewhat
 in different cases, from a few minutes to several hours.  The
 average is not  more than from five  to fifteen minutes.  It
does not often continue  longer than  three or four  hours in
the severest cases.   It is sometimes  said  to  last  a much 
68
MALARIAL  FEVERS.
 longer time, even for days, but there are in these cases in-
 termissions.  Violent attacks are usually short.
   When  the convulsion  ends favorably,  the spasmodic
 movements become less and  less strong,  and finally cease.
 The child then takes a  deep inspiration,  after which it lies
 quiet, and the respiration  remains regular,  or moderately
 accelerated.   Some  fully recover in a few  minutes, if the
 eclampsia has been light and the fever not excessive."

                 TREATMENT  OF  SPASMS.

   The old  maxim  "An ounce of prevention is  worth a
 pound of cure,"  is  certainly applicable  to  convulsions  of
 children, occurring during an attack of malarial fever.
   When there is  any doubt whether the child is threatened
 with  convulsions, it  is the safest and best plan to  give the
 little  one the benefit of the doubt.   Place (at once) the feet
 and legs in hot water and mustard  (or  put the child  in a
 warm bath), apply cold water (not ice water)  to head,  and
 give a full dose of bromide potassa or a dose of bromidia.
   If the child is very restless,  much excited  and nervous,
 give a full dose of bromide potassa and quinine, but if there
 is any jerking of  muscles, it will be  best  to  use bromidia,
 or chloral hydrate, with the bromide potassa and quinine.
   Bromidia  is composed of bromide potassa, chloral hydrate,
 hyoscyamus and Indian hemp.   It is an  excellent  remedy,
 but one that requires some care in  its administration, while
the bromide of potassa alone  is a simple  remedy,  and  one 
MALARIAL FEVERS.
69
that is in very general use in this country as a  domestic
remedy for nervous headache, etc.
  It is well to use the syringe with injections of warm water
and soap, in order to  unload  the bowels.   If no syringe is
convenient, give a dose of castor oil or salts.
  Unload the bowels, washing out all the foecal matter,—this
prepares the way for administering medicine by the rectum—
provided it cannot be given by the mouth.
  Anticipating the spasm, give a  full dose of bromide po-
tassa,—using injections of warm water and soap, in bowels,
—placing the feet and legs in hot water and mustard,—cold
applications to head.
  Bromide potassa is a nerve sedative, and will do no harm.
It is a  good remedy to use in treating malarial fevers, as it
prevents the quinine from causing nervousness and  lessens
the disagreeable roaring in ears, etc.

  Should the convulsion occur, as  it will  often do, during
the height of the fever, the same directions as above should
be adopted, to-wit: place  the patient in a warm bath, or the
feet and legs in hot water and mustard, applying cold to the
head ;  give bromide potassa,  two  grs.  to  a babe one year
old, adding one grain for each year, and repeat every hour,
if necessary to quiet; at the  same time, if the stomach will
tolerate it,  give quinine, in dose  of one grain to babe one
year old, adding one-half grain for each year.
  It is well to remember that quinine, in a full dose with 
7o
MALARIAL  FEVERS.
bromide potassa, will lessen the amount  of fever,  and  al-
ways administer both when the stomach will tolerate it.
  If unable to administer quinine  by the  mouth, inject in
the rectum.   A few drops of elixir vitriol will make a ready
solution of quinine, and it will then pass  through the syr-
inge more readily.
  Before injecting the quinine in the bowels,  it is well to
wash out all the fcecal matter first.   This can  be done  by
using a large injection of  warm  water and  soap ; after the
patient has passed this,  then dissolve the quinine in a small
quantity of  water, with the aid of one drop of elixir vitriol
for  each grain of quinine, and inject the same.
  Washing  out the lower  bowels first with a large injection
of warm water and soap, not only  prepares the  bowels  to
absorb the quinine, but  draws the blood from the head, and
in that manner may lessen the intensity of the spasm.
  Care should be exercised, in attending the little  one,  to
avoid all excitement; this, in many instances, is difficult to
do,  for the family and friends are always  greatly  alarmed,
but if the remedies are intelligently administered some one
must have a cool head to do it, or harm may result.
  Among your domestic medicines it is  well to  have a mix-
ture of bromide potassa or the crude salt.   The  usual solu-
tion or bromide is fifteen grains to the teaspoonful of water,
which is the average  dose for an adult.  Also  chloral hy-
drate,  this keeps better in a weil stoppered (glass)  bottle.
If kept in solution, fifteen grains to the teaspoonful of water 
MALARIAL  FEVERS.
71
 is the average dose for an adult.   Also a bottle of quinine,
 and a lot of assorted sizes  capsules.  Capsules are the best
 and most frequent mode of administering!quinine.
   Bromidia can be used in lieu of chloral hydrate and bro-
 mide potassa. The dose of bromidia is one drop for an  in-
 fant, increasing the dose one drop for each year, and repeat
 every hour, if necessary to relieve patient.
   Generally there is no need of an  emetic,  as vomiting is
 frequently a distressing symptom of the fever  cases];  how-
 ever, if the stomach is loaded with food, and  no  vomiting
 takes place, it would be well to produce vomiting sufficient
 to unload the same; this can be readily  done  by one tea-
 spoonful of syrup ipecac to a young child, and repeat in one
 half an hour, if necessary.

                    RECAPITULATION.

   1.   If the spasm occur during the fever  (or hot stage)  of
 a chill and fever, or remittent fever, place the feet and legs
 in  hot water and  mustard,  (one tablespoonful of  ground
 mustard to bowl of hot water ; apply cold water  to the
head ; place a cork (or soft substance) between the teeth (if
necessary to prevent injury  to the  tongue) ; give bromide
potassa and quinine by the mouth ; if not able to  admin-
ister by the mouth,  inject  in  the  rectum.  If spasms are
severe add chloral hydrate or bromidia, either by the mouth
or rectum.
  Repeat the bromide  potassa and chloral  hydrate every 
72
MALARIAL  FEVERS.
 hour until the patient becomes quiet and the  convulsions
 cease ; at the same time give quinine by the  rectum every
 hour, until the patient begins to sweat freely  and the  skin
 becomes cool.
   In most cases the bromide potassa and quinine by mouth
 and rectum will soon lessen the amount of fever, and the
 convulsions cease, but if the spasms are severe  with much
 jerking,  it is always well to give chloral hydrate  with the
 bromide  potassa.
   The following can be , prepared and kept  ready  for use
 during the sickly season :
     R     Potassa Bromide,
           Chloral Hydrate, a a grs, xxxii
           Water, oz. ii
     M
   Dose (for a child one year old): one teaspoonful, repeated
 every hour until the spasm cease.  The dose can be increased
 one-half  (}4) teaspoonful  for each  year.  The  contents of
 the bottle is the dose for an adult.
   The dose of quinine is about one grain  for a child  one
 year of age, and increase one-half grain  for each year.  If
 injected  into the  bowels, double  the dose,   i.  e.   two
 grains for one year old babe, and about one-half grain for
 each additional year.   A child two years old two and one-
half grains (by injection) ; three years old three grains, and
so on.
  To an adult, with a high fever and  severe  headache, in- 
MALARIAL  FEVERS.
73
 ject in rectum fifteen to twenty grains.   The  dose should
 always be much larger by the rectum than by the mouth.
   Remedies are often given hypodermically (under the skin)
 by physicians, but I do not think this safe in the hands of
 the people, consequently will not refer to it in this  book.
 None but a physician should ever use a hypodermic syringe.
   Chloroform is often used in relaxing  and mitigating the
 convulsive movements, but it is not a safe remedy in the
 hands of non-professionals.  If used at all, in no case should
 it be given after the convulsive movements cease,  but  in-
 haled only during the spasm.  Fifteen to twenty drops on a
 pocket handkerchief and placed in about three or four inches
 of the nose ; "never place against the nose or mouth, as the
 patient must have pure air with the chloroform."
   Chloroform should always be given with great care, as it
 is a remedy of much power.
   In  convulsions of children with  malarial fever  there is
 seldom need  of administering an  emetic, as  most of the
 cases are attended with obstinate vomiting.
   When the child cannot retain the quinine by mouth  or
 rectum, it will be well to apply to the skin.  Mix one tea-
 spoonful of quinine with a small portion of lard, or  dissolve
 in whisky and apply to the chest and under the arms.
   I have very  little confidence  in this  manner of  using
quinine, but in some instances it  will not be  retained by
mouth or rectum.
  When the warm bath  can be used, it is preferable  to bath- 
74
MALARIAL FEVERS.
ing the feet and legs in hot water.  The warm water has a
soothing effect upon the nervous system;  promoting mus-
cular relaxation, and draws the blood  from the head,  etc.
The warm bath (with cold water to head)  can be repeated
every two or three hours, as may be necessary.
  If quinine is applied to the surface, just after each bath,
will be the most appropriate time. 
MALARIAL FEVERS.
75
MALARIAL  TOXAEMIA,  MALARIAL  CACHEXIA,
    CHRONIC  MALARIAL   POISONING,   OR,
          CHRONIC CHILLS  AND  FEVER.
                SYMPTOMS AND  COURSE.
   This condition is caused from repeated attacks of chills
and fever, or remittent fever.
   The patient is weak without energy, feels debilitated, his
spleen and  liver are enlarged, tongue coated  white, and
shows indentations (on sides) of teeth, no appetite, dyspeptic
symptoms, bowels deranged, clay colored discharges, often
diarrhoea, the skin is jaundiced and flabby.
   There can be no mistaking these  cases, they  are familiar
to most people in this country.
   Often they have a chill and fever every other day, or they
may have the fever without any decided chill.
   These cases usually go the rounds, and are prescribed for
by different  physicians, really not treated by any one,  or
some  may, and often do undertake their  own case, relying
on calomel and patent medicines, claiming  that they can
find no remedy to break the " ague."
   Nothing is more appalling than to see these cases, whose
systems are saturated with  malarial poison, (broken down),
and they continually adding mercurial poison,  thus under- 
76
MALARIAL  FEVERS.
  mining nature's forces; mercury in  such cases (malarial
  toxaemia), is an absolute poison—simply adding fuel to the
  fire.
    These cases of malarial  sickness, are no longer simply
  poisoned with  malaria, but the  malaria has produced or-
  ganic changes in the blood, liver, spleen, stomach, kidneys,
  and indeed the whole system is deranged.
    Parties  thus afflicted often try every remedy  they can
  hear or read of, buy patent medicines, and  after a while con-
.  elude there is no virtue in medicine, for the cure of their
  chronic chills and fever; nothing relieves  them, and often
  they become desponding.
    Just such  cases as these are liable  to  attacks  of malarial
  hemorrhagic fever, and in  some few cases  dropsy develops.
    While the abdomen in nearly all cases is enlarged, yet
  the outline of the enlarged liver  and spleen can be very
  rarely felt.
    The jaundiced and pale,  flabby condition of the  skin, in
  these cases of chronic chills and fever,  shows the great de-
  struction of  the red corpuscles of the blood, and the increase
  of the white.
    The destruction of red blood corpuscles do not take place
  equally in all parts of the body during an attack of malarial
  fever, but seem to  spend its force principally in the liver
  and spleen.   If the blood  suffers in this manner,  as  a mat-
  ter of course every organ in the body must.
    Sternberg says :
    '' The most frequent result of repeated  attacks of inter- 
MALARIAL FEVERS.
77
mittent,  or the  continued action of malaria  not attended
with febrile manifestations is that condition known as ma-
larial  cachexia  (Toxaemia.)   This  is  characterized  by
anaemia, feeble circulation, impaired digestion, debility and
an enlarged spleen.
   "In addition  to  this there  is  often  enlargement and
functional  inactivity  of  the  liver,  dropsical  effusions,
mental torpor and in some cases albuminuria.   The anaemia
is often profound : the patient has a blanched appearance,
the conjunctivae (mucous membrane of the eye),  have a
pearly lustre, the lips are pallid, and the slightest exertion
causes dyspnoea (short breath), and palpitation of the heart.
Sometimes the  skin has  a  bronzed or icteric (jaundiced)
hue.''
TREATMENT OF MALARIAL TOXAEMIA, OR CHRONIC CHILLS
                       AND  FEVER.
   All remedies administered should be tonic  in character;
to build  up the broken down system, is the grand object:
   The blood is  loaded with white corpuscles,  when  red
should predominate; iron, in some form, is the best remedy
for this.   Pepsin and muriatic acid to  assist in digesting
the food.
   The policy is to administer remedies to assist in digesting
and in restoring to the system what is wanting : by which
means we build up and strengthen the body.
   Anti-malarial  remedies  alone will not accomplish  the
work in these cases.   For  the system is  damaged by  re- 
78
MALARIAL  FEVERS.
peated attacks of malarial  fevers,  and we must restore the
vital organs to health as well  as rid the system of malaria.
Organic changes have taken place in the liver, spleen, kid-
neys, and the blood is loaded  with impure matter:  to some
extent every organ in the body is affected.
  With a patient in this condition, is it possible by any plan
of treatment to restore him to health ?
  Almost impossible to do  so,  and let the patient  remain in
the same atmosphere, the remedies administered will often
be of no avail—unless the  patient  can be removed from the
malarial place.
  When the patient continues to reside in the  malarious at-
mosphere  (where  he  contracted the disease),  it is almost
impossible to cure  him; we administer  remedies during the
day, and[when night comes,  his  system  takes  on a fresh
supply.  His vital powers are  at such a low ebb,  he cannot
resist the poison.
  I have used the  illustration of a man bitten  by a snake,
and the antidotes  given, etc.,  he allowing the snake to bite
him again and again, etc.,  etc, this applies here, for he is in
just that condition, suffering from repeated attacks.
  He may have taken  anti-malarious  remedies  or not, but
continues to reside in a malarious region, and is continually
being poisoned with malaria; suppose he does take quinine
to neutralize the malaria, and remains in the same locality'
the struggle is kept up.  Soon quinine will have no effect;
these organic changes have taken  place  in the various or- 
MALARIAL  FEVERS.
79
gans of the body, and the blood is loaded with effete matter,
and is no longer good to sustain the system.
  It is often difficult to convince  these half dead people,
that their systems are being  poisoned  with  malaria—they
will  ascribe their chills to the enlarged liver or spleen; want
something  to cure the " ague cake."
  If they should eat some article  of food which disagrees
with them, they can recognize  this, but when we talk of
malaria entering the system,  and  causing chills and fever,
or remittent fever, they will  not believe it.   They usually
want something to act on their livers  and cure the spleen,
and often  resort to  some patent liver  regulator,  or  take
calomel, which invariably does them more harm than good.
  So by all means the  first thing  is to  remove the patient
from the malarious region.   If he can afford it, send him to
some healthy watering place.  But usually these  cases are
among the very poorest class; but if only be  moved  five or
six  miles,  will  suffice in some instances.   If living in the
swamps go to the hills, or some high elevated place.
  Take a tonic—the following  will suffice; it being a com-
bination of quinine and iron:
       R       Quinine Sulph.,  grs. lx.
               Fowler's Solution,  3 iss.
               Liq : Oxide Iron, 3 iii.
               Water,   q. s.,   3 iv.
       M
  DOSE: (for an adult.) One teaspoonful three times a  day
(dilute) before meals and through a quill. 
:8o                 MALARIAL FEVERS.
  If the patient suffers with any dyspeptic symptoms, take
the following :
      R       Pepsin,  3* ss.
               Acid Muriatic, (c. p.) 3 ij.
               Glycerine,   3 i
               Water,   q. s.,  3* iv.
      M
  Dose :  (for an adult.)  One teaspoonful just after eating.
  The following is a cheap tonic and a very good one:
      R       Quinine Sulph.,  grs. xxx.
               Tr. Iron, § i.
      M
  Dose :  (for an adult.)  Thirty drops  three  times a day
before meals, dilute and through a quill.
  The patient should have a generous diet as he can afford:
beef, eggs, milk,  and a glass of wine after dinner,  and fail
not to practice bathing  the  body well, at least once a day,
in tepid water,  adding a teaspoonful of  soda  to  the  bath,
rubbing the skin well, which opens the pores, and assists in
carrying the poison out of the body.
  Nitro-Muriatic Acid is a good tonic in these cases,  after
using the Iron  tonic for some  time; the dose (for  an adult),
five drops well  diluted,  three times a day.
  After using the Iron  tonic, or  acid, till the  appetite is
fully restored, jaundice disappears.   If  any enlargement of
the liver and spleen remains,  use a mixture of 
MALARIAL  FEVERS.                  81
       R       Potassa Iodide,  grs. xxx.
               Syrup Iodide Iron,  3 i.
       M
   Dose :  (for an adult.)  Fifteen drops three  times a day,
dilute, through a quill.
   Using an ointment,  well rubbed  over the  liver (of Bin-
Iodide Mercury) once a day, or paint  the surface with Tr.
Iodine.
   If the patient has any fever or chills, continue to give
quinine freely, as recommended in the treatment  of chills
and fever.   Dose, five  grains every three or four hours, until
he is  thoroughly cinchonised, then give fifteen  grains daily,
after he misses the chill, for several days,  using the iron
tonic also.
   All or most of  the patent medicines placed on the market
for the cure of chronic chills and  fever,  have quinine, or
some  of its alkaloids as their base.
   Some advertise, " no quinine, " and  often it is true, but
the nostrum is saturated with another  extract  of Peruvian
bark—Cinchonidia, and really there is very  little difference
between sulp :  quinine and sulp : Cinchonidia, so far as ef-
fect on malarial poison extends.
   Quinine, in many cases, makes the patient more nervous,
while cinchonidia produces a fullness in the  head.
   The author makes no war on the patent medicine men,
for all of them, so far as he knows, are too smart to put any
calomel, or any other form of mercury in their compounds—
and this is a long step in  the right direction.     However, it 
82
MALARIAL  FEVERS.
 is to be hoped, that the Congress of the United States will
 some day pass a law forcing patent medicine men to print On
 the label their formula.  At the same time  they can be pro-
 tected  in their compounds, but if people  will  use  patent
 medicines, let them know what they are taking.
   Some may object to the arsenic in the tonic R prescribed
 on another page, yet arsenic in  the  dose  there given, is a
 good tonic in these chronic  cases of malarial fever; while in
 large doses it is a well known poison.   No fear need be en-
 tertained of its use, in the  dose  given,  even though the
 tonic should be used for at least sixty days.
   Usually in these  cases diarrhoea is the rule, but if consti-
 pation exists, the same should  be overcome by using cascara
 cordial, salts  or imp. comp. cathartic pills,  syrup rhubarb,
 etc.  Use as little purgative medicine as possible ; try and
 regulate the bowels by having  a certain hour every day to
 attend to that duty, and when  the hour arrives do not neg-
 lect it.  There is nothing more conducive   to  good health
 than a regular condition of the bowels.  They should  act
 at least once every  twenty-four  hours.  We  cannot  have
 good health without being regular  in our habits.
  If diarrhoea be present, use the pepsin recipe, with black-
 berry cordial or brandy, and, if necessary, give paregoric, etc.
  The following is from a standard  work on the practice of
 medicine (Aitken.)   It confirms the position taken on  this
subject, and is in keeping with the views of the leading men
 in the profession:
  " Chronic malarial toxaemia is best treated by a combina- 
MALARIAL  FEVERS.
83
tion of the chlorides of iron, quinine and arsenic, diuretics,
mild saline cathartics,  *     *    *   a nourishing mixed
diet, including milk, meat, vegetables and fruits,  *  *   *
and change of climate.  Great attention should be  paid  to
the skin ; frequent tepid baths should be taken,  or the sur-
face sponged daily   *    *     *    jf there  is  derange-
ment of the chylopoietic viscera  (vessels and viscera which
are connected with the formation of chyli)  muriate of am-
monia alone, or combined with chloride potassa and colchi-
cum, should be given.    *     *    *
   "Under no circumstances should any preparation of mer-
cury be permitted.     *    *     *
   "In the treatment of malarial toxaemia it is  of first im-
portance to keep the sluices of the system  (the kidneys and
intestinal canal) open, unless  there  are  contra-indications ;
and  this is best done by the frequent use of the  mild saline
cathartics before named.
   "Chronic enlargement of the spleen frequently subsides  as
the toxic symptoms abate, and with the  general improve-
ment of health.  The special  treatment is by  bromide  of
potassium and  the application of iodine paint.    *   *   *
Also the officinal  ointment  of  biniodide of mercury.   A
piece, the size of a nutmeg, is rubbed over the affected or-
gan.     *    *    *     The patient is then directed to sit
before the fire until there is a good deal of smarting ; about
half the quantity is again applied over  the  tender surface.
Some blistering follows, which is to be dressed simply. The
process is repeated in about three weeks,   *          *   " 
84
MALARIAL FEVERS.
                    RECAPITULATION.
   i.  One of the most important things (in the treatment of
chronic chills) is to remove the patient, if possible, from the
malarious atmosphere.
   2.  If having fever or  chills,  give a  dose of purgative
medicine, if bowels are  constipated,  Give quinine  freely ;
dose (for an adult)  : five grains every three  or four hours,
until the chill or fever is checked, and the patient thorough-
ly chinconised, then continue the quinine in five grain doses
three or four times  a day.
   3.  Use the iron  tonic as soon as the fever ceases.  The
tonic of liq. oxide iron,  quinine and arsenic, is  one of the
best for chronic chills.  If eye-lids become puffed from  its
use, discontinue the arsenic,  and use the quinine and  iron.
   4.  If bowels are irregular,  try,  as  suggested, to  have
them act at least once  every twenty-four hours.  Use cas-
cara cordial or salts for constipation.   If any diarrhoea  or
dyspepsia, use the pepsin mixture.
   5.  After the system  is rid of all  malaria  and  the chills
checked by the treatment,  the liver and spleen should con-
tinue hard and enlarged, give the iodide  potassa and  iron
recipe with the biniodide  of  mercury or iodine,  externally,
as directed, or use the bath of warm  water, and  soda,  with
nitro-muriatic acid,  internally.
  6.  Give as good and rich  a diet as the patient can afford,
for good food makes rich blood. 
MALARIAL  FEVERS.
85
PREVENTION OF MALARIAL FEVER.
   At no time in the history of medicine has sanitary science
attracted so much attention as now.
   The question is, how to prevent disease?  and certainly he
is a more  scientific and commendable physician that  will
protect his  patients  from disease,  than one who merely
cures them.
   People are slow to act, and it is a hard struggle to con-
vince  the  masses of the importance of hygiene measures.
Often not until disease and death have done their fatal work
among them, can a community see the error of their way.
   As this  book treats exclusively of malarial fevers, I will
confine my paper strictly to the  subject, i. e., the "preven-
tion of malarial fevers.''
   Again, it will be necessary  to review  at some length the
cause  of malaria, because we  cannot understand how  to
avoid unless we, become familiar with its abode, and how
generated.   Malaria undoubtedly arises from  the earh, at
night,  as  it is  more  intense  near low,  marshy places.
Surgeon Chas.  Smart,  U. S. N., in Ref. Med. Sciences,
says:   "In  temperate  climates marshes, swamps,  ditches
and low grounds subject to overflow by rivers, lakes, ponds,
etc., afford  that conjunction  of  the  factors that is  most
favorable for the evolution of the malarial influence.   *  * 
86
MALARIAL FEVERS.
   "The  malarial  miasm  is assumed  to  arise during  the
retrogression of organic matter to the inorganic state, under
favorable conditions as to  moisture and heat.  When  the
moisture is in excess, as when the ground is wholly covered
with water, there is  no malaria.  The rainy season in  the
tropics is not the sickly season, but its ■ commencement is,
when the showers are of short duration, and fall upon a dry
and parched earth; and also its termination, when the earth
remains soaked, and covered with  a dying and decaying
vegetation.
   "Fever and ague prevail, not during the period of an inun-
dation, but during the  subsequent  period  of draining  and
drying  up.     *    *    *    All grounds  that are  al-
ternately submerged and exposed, are malarious.
   '' The artificial  draining of ponds,  and the  accidental
breaking of dams, have occasioned disease in their vicinity.
*     *     *    Shallow  mill dams that uncover a portion
of their  storage during the use of the water, are more dan-
gerous than those that have depth enough  to  keep the land
submerged.     *    *    *
   '' When a steady wind prevails during  the sickly season,
people living on the windward side  may be unaffected, and
even those to the leeward may be protected by the interpo-
sition of a strip of forest land.  Malaria is  diffused into  the
atmosphere with some difficulty.
   "According to Watson,  it loves the ground:   'In an un-
healthy  location  it  is  more dangerous  to sleep on   the
ground,  or on the ground floor, than on the upper floor of a 
MALARIAL  FEVERS.
87
house.   It  is  often  associated with watery vapor  in  the
form of mists, or fogs, which hanging low over the exhalent
surface, may be  floated into  neighboring valleys, and up-
ward along the  rising grounds.'  Monfalcon put the dis-
tance to which malaria could  be  thus transported, at from
fourteen hundred to  sixteen hundred feet of elevation, and
from six to ten  hundred feet longitudinally   Hertz says:
 ' We may  admit the agency  of  the wind  as  a carrier of
miasm for a short distance, but when it  comes to stretches
of many miles, it is no  longer to be  taken into account.'
But the floating cloud of watery vapor and malaria is known
to  be intercepted by belts of trees.   It was remarked by
Pliny that  'trees destroy or consume the malarial vapors/
There are many instances on record where the planting of a
belt of trees between  a pestilent marsh and a settlement has
protected the latter from disease;  and conversely, where the
removal of a screen of trees has been followed by an invasion
of malaria from neighboring swamps.   Not trees only, but
all  solid substances  appear to attract the malarial poison.
*     #      *     Practically, malarial diseases  may  be  re-
garded as non-contagious.
   "Besides  acting as a screen, trees are generally credited
with exercising a beneficial influence in malarial localaties.
*     *      *
  '' Drainage, however, which removes excess of moisture,
increases salubrity, while promoting  rather than interfering
with  the  productive  husbandry.   Drainage has,  therefore,
from the most  ancient  times, been recognised  as the chief 
88
MALARIAL  FEVERS.
method of improving a malarious soil.  Malarial fevers have
been rendered a clinical  curiosity  in  England by means of
drainage and systematic  cultivation.    *     *    * -   It
is to be noted, however, that the first efforts at improve-
ment are almost invariably  followed by an increased viru-
lence and prevalence of the  malarial influence, which sub-
sides only after a period  of continued cultivation.
   "The history of  agriculture, in this country, furnishes
many  illustrations of febrile outbreaks consequent  on  the
drainage, clearing and upturning of the soil; but ~z these
districts attain a high state of cultivation, they become pro-
gressively free from  the paroxysmal fevers.    *          *
In fact, it may be said that any marked interference with
the natural  vegetation of a  soil is likely to  induce an  en-
demic of malarial diseases, if the soil  presents the concur-
rence of the three factors considered essential  to the emana-
tion of malaria, viz:  heat, moisture and organic matter.
   '' The evolution of malaria is known by the experience
of ages to be most active in warm climates  and in warm
seasons, hence the  singularity of the  fact that the warm
period of the  day corresponds in no locality with the great-
est diurnal  activity of the  poisonous  influence.   On   the
contrary, it  is well known that in  temperate  climates there
is no danger on marshes that are  notorious for their fevers,
provided the individual be not exposed  after night-fall;  and
in tropical climates, jungles and  other pestilential regions
may be penetrated with impunity  when the sun is high in
the heavens.   It may be granted that the resisting power of 
MALARIAL FEVERS.
89
the individual is  diminished during  an exposure at night,
particularly during sleep, and that the  depressing influence
of a chilly atmosphere may contribute to still further reduce
the energy of the ' Vis conservatrix natures.''    >:<     *
But notwithstanding these considerations, it appears singu-
lar that  the  period which should by analogy be that of
greatest exhalation should be that of diminished manifesta-
tion.    The  known association  of  malaria with  aqueous
vapors suggests a coincidence in the exhalation of both from
the soil; and as the absorption of the latter into the atmos-
phere is greatest  during the heated period, it would seem
that malarial developments should be  corresponding  prev-
alent and intense at that time.   In explanation, it has been
said that  when the air becomes  chilly,  after sunset, the dif-
ference between its temperature and that of the soil, heated
by the absorption of the sun's rays during  the day,  is at its
maximum, as in consequence the  ascensional tendency of
the air immediately in  contact with  the soil, but radiation
soon cools the soil to the point where the tendency is to de-
position of watery vapor rather than to  its evaporation,
while  the malarial influences continue as pernicious as
when the  ascensional force was greater.  To explain this, it
has been suggested that during  the  day the surface of the
malarious soil becoming  heated in the rays of the sun,
evaporation takes place with rapidity, and  the noxious ex-
halations  carried  upward by  the ascensional tendency, are
•diluted and dissipated in  the higher regions of the atmos-
phere.  There  are,  therefore, no malarial developments in 
90                MALARIAL  FEVERS.
the locality.   At night, when the direct heat  of the sun
ceases to be felt, the soil speedily evolves its heat by radia-
tion, the stratum of air in contact with it becomes colder
than that overlying it,  and such exhalations as issue from
the soil are stayed in their upward  course in the stagnant
layers of cold and moist air which first receive them; hence,
although emanation is more active during  the  day than at
night, the  state  of  condensation of  the miasm is so much
greater during the latter period, that pernicious effects are
only then attributed to  it.
   "The utility  of large fires in dissipating malaria,  or in
protecting  from its evil  consequences, has been  long a set-
tled belief.    Hippocrates  considered that  protection  was
thus attained, and in  modern  times troops  operating in
unhealthy  sections have resorted to  this as  an agreeable
preventive  measure.
   "The generally accepted theory of malarial evolution calls
for the concurrence  of an organic soil, a certain degree  of
heat, and a certain proportion of  moisture."
   In the further  discussion of this  subject—prevention of
malarial fevers—I will quote at some  length from the works
of Prof. Joseph Jones,  of  New  Orleans,  one  of the  best
authorities on the subject of malaria,  etc., etc.—a man who
has spent a lifetime in the close  study and investigation  of
the diseases of the South, and has given us a work that will
remain long  after he is dead, as a monument  of a useful
and well spent life.  The  labor  expended  by Dr. Jones  is 
MALARIAL FEVERS.
9r
immense, and every Southern physician should have a copy
of his works.  He says :
   "No subject is of greater  importance  to  the  inhabitants
of the tropical and temperate regions of the earth than the
destruction or  removal of the cause or  causes  of malaria.
The following propositions should be considered in the dis-
cussion of the measures which may be proposed for  the de-
struction or removal of causes of malaria :
  First.   "Malaria inflicts a vast amount of  disease and suf-
fering upon the human race, and directly and indirectly causes
a considerable portion of the mortality in  the  tropics and
temperate climates.  The star of empire, which has  been
steadily  passing from the east to  the west, has halted in its
progress in the great valley of the Mississippi, where it will
remain as the center  of political power, physical develop-
ment and scientific advancement.  In those regions in which
the earth gives malaria, she also bestows her most bounteous
gifts:  golden grain,  lucious fruits, and every  variety of
animal and vegetable  food.   Thus  the  baneful effects of
malaria are counter-balanced, to a large extent, by the mild
and genial climate, and the bounteous products of field and
forest, river,  lake and  ocean."
  Second.  '' The  labors  of man in  clearing  the  forest,
opening  and  deepening the channels of rivers, draining and
tilling the land, have altered the climate and changed the
character of the diseases  of large  portions of the earth's
surface.   The  malarious belt  of the earth has  been thus
progressively circumscribed by the labors  of the  agricul- 
92                MALARIAL FEVERS.
turist.   In the present century the removal of the causes of
malarial fevers has been greatly facilitated by extensive in-
troduction of improved implements and machinery, and the
use  of steam.   The  drainage  of lagoons, swamps  and
marshes, as well as the land generally, has removed certain
conditions  favorable to  the development of simple con-
structed  organisms and morbific ferments.  With the in-
crease of the human race and the advancement of agricul-
ture and the  mechanical arts, there will be a progressive
diminution of the empire of malaria."  *  *  *
   Third.   " Centuries must elapse before the low grounds,
marshes, ponds,  lagoons and swamps of the United States
of America, and more especially of the  great valley of the
Mississippi,  will be thoroughly drained  and under  cul-
tivation."
  Fourth.  "Substitute  cistern water for well or  spring
water.''
  There can  be no doubt that many cases of malarial fevers
are caused from the drinking of water from shallow wells,
springs, or cisterns that leak.   Look well to the supply of
water used for drinking purposes.
  Fifth.   '' Never commence work upon an empty stomach.''
" Avoid as far as possible,   the  dews of the morning and
nights."
   " Avoid wet clothes as far as'possible."
  In reference to building houses, care should  be exercised
in selecting the location.
  In this State (Texas), it  is well to always  build on the 
MALARIAL  FEVERS.
93
south side of the river, lake or low marshy places, as the gulf
breeze which is always  from the south, will carry the ma-
laria away from the residence.
  The question is often asked why does Mr.  A's family es-
cape fevers, while B's,  living in the  same neighborhood, is
always sick ? Many times it can be accounted  for in the lo-
cation of the residence.   One on the north, and one on the
south of a malarious place, or it may be one has a screen of
timber intervening.
  Many farmers in this country build their tenant houses in
the fields and cultivate the land close to the building. This
is wrong.   Cotton is an unhealthy plant; especially is this
true, if it has been attacked  by worms,  or has  shed  the
leaves freely.  Chills and fevers will certainly attack any
one who resides in a cotton  field,  when  this  is  the case.
Heat, moisture and vegetable decomposition are there, and
these are all that is necessary to produce  malaria.
  Allowing weeds and  rank vegetation  to grow in close
proximity to the building, cutting the same down and per-
mitting it to decay,  will cause malaria.  If cut, it should be
destroyed by fire.
  Two-story houses are much better than the low buildings,
if the upper story be occupied at night, for the poison hov-
ers  near the ground, as has been shown.  When the weather
will permit, close the doors and windows after 10 p. m., but
often in this country the weather is so hot  that  we  cannot
bear the placing of ourselves in  a hot box by closing  the 
94
MALARIAL FEVERS.
 doors and windows at  night.  Nor is this  advisable when
 several persons occupy the same room.
   As a preventive,  quinine is the best of all known  drugs.
 I do not think whisky or strong drink is of any benefit,  as
 many seem  to think  in  this country.  There is certainly
 more virtue in ten  grains  of quinine than in one gallon of
 whisky to prevent an attack of malarial fever.
   There is no doubt in the minds of the very best authori-
 ties in this country as to the power of qunine to ward off an
 attack of ma-laria.   One says : "Of the prophylactic virtues
 of quinine against malarial impressions, it may be asserted
 with confidence that,  fortified with  this  wonderful drug,
 none need fear venturing at any time into the  heart  of our
 hostile low-lands  in summer, inhaling  with  impunity  its
 deadly miasma."
  I am inclined to  think  this language is too strong, yet
 there is much truth in it, for quinine is the great anti-mala-
 rial drug.  Let the  system be kept under its influence while
 in a malarial region.
  When possible, have a screen of green timber between the
 dwelling and the place supposed to be malarious, and by no
 means  allow the same destroyed.
  Often I have known a healthy place made malarious by
 the cutting away of a skirt of timber between the house and
 the swamp.
  In this country, on the prairies, I do not think it  well  to
have too many shade trees in  close proximity to the  house ; 
MALARIAL FEVERS.
95
 they keep the ground too damp and are always full of mos-
 quitoes.
   Occassionally burning the trash and  refuse  about the
 place prevents malaria as well as other sickness, as the fires
 not only destroy the garbage, trash, etc., but purify the air.
                    RECAPITULATION.
   i.   We must build  our houses,  when possible, on the
 south side of these creeks, ponds and malarious places, and
 on as high an elevation as can be secured.   They should be
 far enough above the ground to admit the air to pass  freely
 under them.   When the party  building can  bear the ex-
 pense, an upper story should always be added, and" occupied
 as a sleeping appartment during the time that malaria pre-
 vails.
   2.  Avoid building  in the fields where the house will be
 surrounded by rank vegetation, and the land  cultivated in
 close proximity  to same.
   3.  If possible keep a screen of green timber between the
 house and the low malarial places, and if no forest exists, it
 will pay to plant trees.
   4.  When the weather will permit, close the windows and
 doors after 10 p. m.
   5.  Avoid sleeping in  the night air or exposing the per-
son early in the  morning dews,  etc.
  6.  Use pure cistern water when possible, which should
 by all means be  caught during the winter.   It seems it will
be many years before the people of this State will learn the 
96                MALARIAL  FEVERS.
value of good and pure water,  and how  essential it  is  to
health.  Often they find water so full of chemicals and so bad
that an animal will not drink  it;  they build a  hotel and
establish a health resort, advertising the  wonderful proper-
ties of the springs or wells.
  7.  Take from three to five grs. of quinine at  least once
a day, and if any lassitude,  aching of  bones, excitement  of
pulse, with flashes of heat, are felt, take three grs. three  or
four times a day.   "An  ounce of prevention is worth  a
pound of cure,"—ten grs. of quinine is better to ward off
an attack than thirty grs. given to cure.   If the bowels are
constipated, take salts or cascara cordial to act on same.
  8.  Occasionally have the yard and premises cleaned and
all the trash and filth burned, and do not  forget that an oc-
casional bath is necessary to make the  skin act well, for  it
has been well said that  "Cleanliness is next to godliness."' 

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