bined with moderate doses of quinine, and be followed by courses of iron and arsenic. Cachectics should leave the malarial centre where they are being poisoned, and spend at least one year in Europe. They must be careful to clothe warmly, especially on first entering colder latitudes; to keep lightly employed both in body and mind; to avoid over-fatigue, constipation, exposure to a very hot sun, high winds, rain; to live temperately, and generally to follow the dictates of common sense. Residence in a dry, cool, sunny climate, or a sea -voyage, is an admirable restorative in malarial cachexia.
Malarial cachectics must exercise great caution about exposing themselves to the fresh sea-breezes on the return voyage to Europe. Neglect of this is nearly sure to be punished with an attack of fever, sometimes of fatal blackwater fever. Many such fatalities occur yearly in cachectics from West Africa during the voyage to Europe. Return to Europe in the winter season should, if possible, be avoided, the colder months being spent in the Canaries, Egypt, or the Riviera. If quinine is being taken when the patient leaves for Europe, its use, in the accustomed dose, should be systematically continued during the voyage and for several months, at least three, after arrival. I find that malarial cachectics are often allowed to start on the voyage to Europe inadequately instructed on these important points.
Food and drink in malaria.—— The food in malarial fevers ought to be light and principally fluid. Effervescing mixture often helps to clean the tongue and settle the stomach. Lemon decoction (made by boiling for half an hour a sliced lemon, including skin and seeds, in a pint and a half of water, straining, diluting, and sweetening) is much relished in remittents, and may be taken systematically by all malarials with advantage. Fresh lemonade, fresh lime juice, weak cold tea, and iced water sipped are all of them much appreciated by these patients. During convalescence the quality of the food should be gradually improved and, if necessary, supplemented by a light wine or bitter ale.
