quinine, it may be necessary to have recourse to some of these drugs. Methylene blue in doses of 2 to 3 gr., and pushed until the urine becomes deeply tinged or signs of kidney irritation appear, enjoys a certain reputation in America and in Germany. Anarcotine was at one time, during a quinine famine, extensively and successfully employed in India; the dose is from 1 to 3 gr. Phenocol hydrochloride, in 10-gr. doses, administered five, three, and two hours before the expected paroxysm, has been used with advantage in Italy, and is said to have succeeded in some instances in which quinine had failed. Tannin has been recommended in obstinate cases where quinine had failed or could not be taken. A grain of capsicum with 5 gr. of quinine is said to succeed sometimes where quinine alone fails. I have given this pill, but cannot determine how much the capsicum contributed to the cure. I cannot say I have ever seen an ordinary uncomplicated ague absolutely resist quinine properly given. I have seen cases of obstinately recurring ague apparently permanently cured by a few intramuscular injections of quinine, although the same drug, given in the ordinary way, had proved a comparative failure. There can be little doubt, however, that in rare cases it does fail, and that it is more efficient against the benign tertian and the quartan than against the malignant parasites. It does not always prevent relapse, even in the non-malignant infections.
Treatment of splenic tumour and malarial cachexia.—— The enlarged spleen of malarial cachexia is best treated by counter-irritation (linimentum iodi, or ung. hydrarg. biniodid.) and saline aperients, combined with quinine, arsenic, and iron. The subjects of hepatic enlargement and abdominal congestion arising from malarial disease of long standing generally derive much benefit from a course of Harrogate, of Kissingen, of Carlsbad, or of other aperient mineral water. When these waters cannot be obtained, a morning aperient saline, kept up for two or three weeks, is an efficient substitute. Aperient courses should, as a rule, be com-
