the specific pending the action of the aperient. If an aperient be indicated, it should be given along with the quinine. Five or 10 gr. of calomel is the best. Thereafter the quinine, in 5- or 10-gr. doses, should be repeated every three or six hours until fever has subsided. If there be much bilious vomiting, an emetic of ipecacuanha or repeated draughts of hot water will clear the stomach and perhaps, after a time, enable it to retain the quinine. The drug is sometimes more readily retained if given in chloroform water or in effervescing form. Mustard poultices to the epigastrium, small hypodermic injections of morphia, ice pills, sips of very hot water, effervescing mixtures, champagne, 1- or 2- drop doses of tincture of iodine, are each of them, on occasion, aids in stopping vomiting. If these measures fail, and if the vomiting is so frequent and so severe that the dose is immediately rejected, and if there is no diarrhœa, it is advisable to clear out the rectum with an injection of warm water and, when the action of this has concluded, to throw up an enema of 30 gr. of quinine in 3 to 10 oz. of water with a few drops of acid to aid solution; at the same time, 5 or 10 gr. of calomel may be given by the mouth. This failing, or in preference to this, recourse must be had at once to intramuscular injections. So soon as the stomach has quieted down, quinine may be given again by the mouth.
Treatment of hyperpyrexia.—— Hyperpyrexia must be promptly met by prolonged immersion in the cold bath, rectal injections of iced water, ice-bags to the head, etc. At the same time quinine must be injected intramuscularly, or into the rectum or into a vein, in full doses, and repeated every three hours until 30 or 40 gr. or more have been given. Prompt action in these cases is of the first importance, and may save life. If temperature be kept down for three or four hours the quinine gets time to act on the parasites crowding the intracranial vessels; but if temperature be allowed to mount and to remain high the patient is destroyed before the specific has a chance. The cold bath, therefore, is absolutely
