recommended, the short duration of this stage of the paroxysm can scarcely be supposed to admit of such an application of them, as is calculated to effect any very useful purpose.

Sweating stage.-All that is required at this period is to avoid premature exposure, and administer tepid diluent drinks, should the patient complain of thirst. If much languor prevail, there may be added to these drinks, a little wine or spice.

Treatment during the Intermission.

The object of the treatment during the intermission, is to prevent the recurrence of the paroxysms, or, in other words, to cure the disease. This is to be effected by the administration of certain medicines, which, generally speaking, rank under the class of tonics. The principal of these is the cinchona, or Peruvian bark, which is commonly exhibited either in the form of powder or of the sulphate of quinine. There are two modes in which the cinchona has been recommended to be given; either in divided doses during the entire intermission, or in one large dose immediately before the expected paroxysm and at that time only. But, although the latter mode is said, when successful, to effect a cure with the least expenditure of the drug, experience has shown that it often fails in putting a permanent stop to the disease, and that patients so treated are much more susceptible of a relapse than when treated according to the former plan. It is only therefore when we are particularly anxious to prevent the recurrence of a paroxysm, and especially when that recurrence is close at hand, that this practice ought to be preferred. Under such circumstances, however, eight, ten, or twelve grains of the sulphate of quinine may be given at once, either in solution

in a vehicle acidulated with sulphuric acid, such as the compound infusion of roses; or, in the form of pills or a bolus. Some have given half an ounce of the powdered bark for the purpose, but it is much more liable to offend the stomach and disgust the patient than the less bulky sulphate of quinine.

By far the best and most effectual method of combating the disease, is to administer our remedies in divided doses during the entire intermission. A dram of the powdered cinchona, or what is much better, about three grains of the sulphate of quinine, may be given every two hours in a quotidian; every three hours in a tertian; or every four hours in a quartan; increasing either the frequency or the quantity of the dose, should our first efforts fail in preventing, or at least considerably mitigating, the violence of the next expected paroxysm.

Another remedy, rivalling if not actually surpassing the cinchona in power, is the arsenious acid, commonly called white oxide of arsenic, or simply arsenic. This is commonly exhibited in the form of arsenite of potash, as we find it in Fowler's mineral solution, the liquor arsenicalis of our Pharmacopoeia. Four, five, or six minims may be given three or four times a day, combined with as many minims of laudanum to prevent the nausea and pains in the stomach and bowels to which it frequently gives rise. The vehicle may be an ounce or ounce and half of distilled water, or of any aromatic distilled water, or of the infusion of cascarilla.

Several other medicines of the tonic class, although of greatly inferior power to those already mentioned, have been given with success. Of these, perhaps, the most efficacious is the willow bark, which may be administered in the form of powder, in doses of a dram; or, in the form of its proximate principle, salicine, made into pills, in doses

of five or six grains. Many astringents and bitters have also, either alone or in combination, proved adequate to the cure of Ague. The principle of these are the gentian, chamomile, cusparia, sweet-scented flag, oak bark, and tormentil root. From the mineral kingdom, the chalybeates and the sulphates of zinc and copper have now and then been successful. Besides these, it is only necessary to mention, that sulphur, the snuff of a candle, coffee, and the web of the black spider, have each had their advocates in

some cases.

Treatment of Complicated Ague.

The treatment of Irregular, is the same as that of regular Ague; and as it regards complicated Ague, the modification of treatment applicable, will of course depend upon the nature and degree of the complication.

It has already been observed, that a mere residence in an aguish district will often suffice to derange the functions and even the structure of the abdominal viscera ; and it has also been shown, that the repetitions of the paroxysms have a similar tendency; it is therefore a good and safe practice in every form of Ague to commence our treatment by unloading the bowels, and endeavouring to promote the flow of the abdominal secretions. This is to be done by mercurial purgatives and mercurial alteratives. Four or five grains of calomel, followed in a few hours by a smart dose of compound infusion of senna and Epsom salts; or ten grains of the compound extract of colocynth and three of calomel; or a grain of calomel or five grains of mercurial pill every hour for four hours, followed after the last dose if necessary by the senna and salts, or an ounce of castor oil may be given immediately. Any of these

forms of mercurial purge may be repeated every two or three days during the whole of the subsequent treatment. In other instances, especially if the patient have been long exposed to the miasmata, or if the disease be of long standing, a grain of calomel, or five grains of mercurial pill, may be given every night, or night and morning, with only an occasional dose of senna and salts or castor oil, at the same time that we are administering the cinchona or other medicine to prevent the recurrence of the paroxysm.

Should a purging be present, which is not unfrequently the case, especially in autumn, it will in general be necessary to moderate or remove it before having recourse to the usual remedies for putting a stop to the paroxysms. The alvine discharges will commonly be found, under such circumstances, of a bilious or unhealthy character. The bowels, therefore, should be well freed from their irritating contents, by a scruple of powdered rhubarb, or by two or three drachms of castor oil, or by emollient enemata; after which, attempts should be made to correct the secretions by means of the mildest mercurials, combined with some form of opium, or with chalk, or with both. Three grains of the hydrargyrum cum cretâ with four of the pulv. ipecac. comp. or eight or ten of the confect. opii, or a scruple of cret. ppt. may be given twice a day with very great advantage in such cases, regulating the doses, however, according to the effects produced. So great is the influence of the deranged condition of the abdominal viscera, that in many instances, all our ordinary remedies entirely fail, until it has been thus mitigated or removed; whilst, even if apparently successful, relapses are frequently experienced from comparatively slight causes. It is probably owing to these circumstances that mercury has been by some regarded as capable of curing ague; but, although mercury will often,

by correcting the state of the abdominal viscera, or by removing some other local disease, enable remedies to cure an ague, when they had previously failed to do so; and although after trying ordinary remedies in vain for some time, mercury alone has appeared to cure the disease, certain it is, that the specific action of mercury on the system, is by no means incompatible with the continuance of an ague.

Should local pain, or other symptoms, indicate the existence of congestion or inflammation in the liver, or the spleen, or within the head, it will be prudent and often quite necessary, to subdue these local affections before having recourse to the remedies usually applicable during the intermission. For this purpose, venesection, cupping, leeching, and blistering must be employed, according to the age and constitution of the patient, and other circumstances of the case: depletion being followed by mercurials and other means suited to these respective complications. As soon as these local affections have been overcome, we may proceed to put a stop to the paroxysms. It is in such cases that the cinchona occasionally proves too exciting and irritating, and in which the liq. arsenicalis will in general be found to answer the purpose better.

The treatment that has been found most successful in removing the enlargement of the spleen or ague cake, consists in the application of cupping-glasses and leeches, blisters, poultices, mercurial inunction or mercurial plaster to the region of the spleen, mild diet, gentle laxatives, and the internal and external use of iodine and hydriodate of potash, and occasionally quinine.

The dysenteries and dropsies which occasionally result from ague, or from long-continued exposure to miasmata, must, of course, be treated according to the principles, which will be pointed out in another part of this work.