lb 



PRACTICE OF MEDICINE. 



use ; hot foot-baths ; warm bed ; frictions of the spine. During the 

 hot stage, cool drinks; and after the sweating, let the skin be rubbed 

 dry with warm towels. 



When the fit is over, begin with some antiperiodic remedy, to 

 prevent its recurrence. The best is quinine, of which from two to 

 four grains should be given every four hours, in solution with a few 

 drops of dilute sulphuric acid, tincture of orange-peel, and water. 

 Under some circumstances, it may be necessary to administer the 

 whole dose, either immediately before or after the paroxysm ; as, 

 for instance, when the apyrexia is exceedingly short, as in the quo- 

 tidian. Upon the whole, however, it is best, if possible, to introduce 

 it into the system gradually. 



The remedy should be continued in gradually decreasing doses, 

 for ten days or a fortnight after the last fit, as the complaint is very 

 apt to return. 



If the quinine is rejected by an irritable stomach, it may be in- 

 jected into the rectum in solution in distilled water, with a drop or 

 two of laudanum; or a blister be applied to the epigastrium, and the 

 surface be dressed with a strong solution. 



If the quinia cannot be procured, or if it does not produce good 

 effects, the next best remedy is liquor arsenicalis, in doses of V(X v. — 

 X. ter die. Other remedies are, willow bark, piperine, sulphate of 

 zinc, ammonia, sulphate of copper, and all the vegetable bitters and 

 astringents; but they are much inferior in virtue to the quinine. 



Opium given in a full dose sometimes puts ofiT the fit, if given 

 just before it is expected ; and it is also of great use to shorten the 

 hot stage; but not of much service in the cold. 



Bloodletting, in the cold stage, was recommended by Dr. Macin- 

 tosh, but in ordinary cases is now repudiated by most physicians. 

 It may, however, be necessary in the violent agues of hot climates, 

 when there is great intei'nal congestion, or delirium and cerebral 

 excitement. 



The great congestion in the abdominal veins which occurs during 

 the cold stage, is very apt to produce enlargements and induration 

 of the liver, and especially of the spleen, the tumour formed by 

 which is commonly called ague cake; and the obstruction to the 

 venous circulation caused by these is liable to induce dropsy. 



REMITTENT FEVERS. 



Syn. — Bilious fever . — Bilious remittent fever. 



In this form of fever, the febrile phenomena evince striking ex- 

 acerbations and remissions, one paroxysm occurring in the twenty- 

 four hours. It is caused by some atmospheric poison. It is most 

 common in the middle and southern sections of the United States, 

 although it occurs in all parts lying between the northern lakes and 



