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The after course of the case will be seen from the chart (No. 2.) by the 10th the temperature had fallen to normal, and fish diet was now given, it took the patient some time to regain his strength. On the 12th full diet and the following medicine was prescribed.

R. Eastonii Syrupi, 3ss. Aq. ad 3i. tdsam.

He was discharged cured on the 20th September.

REMARKS. The first attack was evidently one of intermittent fever, the second being of the remittent type. In these severe cases I am firmly of opinion that the only way to combat the fever is by the application of external cold and administering quinine hypodermically as soon as the tem- perature falls, it being useless to give it by the mouth as the stomach will not retain anything.

II-CASE OF REMITTENT FEVER. HIGH TEMPERATURE. DEATH.

H. P. cet. 23, Scotch, Police Constable.

Admitted to Hospital at 8 P.M.

following medicine was ordered :

11th August, 1889. Temperature on admission 102-8° F., the

R. Antipyrin, grs. X.

Aq. ad. 3i. 2 horis sdm.

Temperature fell during the night and at 8 A.M. on the 12th was 99-8°, 5 grains of quinine were now ordered every hour, at midday the temperature was 100-2° F. One dose of antipyrin was substituted for the quinine and at 2 PM. the temperature was 99°, in the afternoon the temperature had risen to 99.4°, and at 8 P.M. it was 102° F., at 9 P.M. it had risen to 106 2° F., notwithstanding the adminis- tration of antipyrin, Dr. TooGOOD now saw the patient and ordered the following medicine :-

R. Antipyrin, grs. XX.

Tr. Jaborandi m. xxx. Mist. Diaphoret ad. ži.

to be given at once and another dose in an hour's time as the skin was very dry and hot, at 9.45 P.M. the temperature had risen to 107·6° he was now placed in a bath temperature 98° F. this was cooled down by ice to 76° F. in 10 minutes his pulse began to intermit and became weaker in strength, he was removed from the bath and Zi. brandy was given; his temperature was now 101·4° F.

At 11 P.M. it had risen to 105-6o, at 11.30 P.M. it was 106° F., at 12.25 A.M. (13th) 107-4° and at 12.45 A.M. 108-6° F. ice-packing was at once commenced; at 1 A.M. temperature was 107-6° twenty grains of quinine were now given. At 1.23 A.M. it was 107°, as the temperature did not seem to fall notwithstanding the wet-packing another twelve grains of quinine were given. At 1.33 A.M. tem- perature was 105-2° F. at 2.15 A.M. 104.8°, at 3.05 A.M. 101·4° F. and at 3.35 A.M. it registered 100-8° all during this time the pulse was quick and weak, small doses of iced champagne were frequently administered. Ice-packing was now discontinued; at 3.45 A.M. after he had been placed in bed sixty minims of the hydrobromate solution of quinine were injected hypodermically and 5 grains of quinine were ordered every hour in the form of a pill. At 5 A.M. it had however risen to 101.7° half an ounce of Warburg's Tincture was now given, at 6.30 A.M. it had risen to 104-2° F. and at 7 a.m. 105°. At 7.45 a.m. 105-8° F. was registered-wet packing was again commenced and con- tinued to 10 A.M. when it was 102.2° this was now discontinued ten minims of the hypodermic solution of quinine were administered, the temperature however steadily rose again and at 4.45 P.M. was 106.6° F., wet packing was again used and continued to 7.30 P.M. when the temperature had fallen to 99-8° F. Quinine was given as before, but notwithstanding that this was persevered with every hour the temperature steadily arose again and at 4 A.M. on the 14th registered 108° F. Recourse was again had to wet packing and the temperature by this means was lowered seven degrees by 7 A.M.

As will be seem from the chart (No. 3.) the temperature rose twice again that day to over 105° F. when the same treatment was used, this last time at 12 midnight the temperature fell in half an hour three-and-a-half degrees. It arose again steadily that day (15th) until 6.45 A.M. when it was 105.2° F. wet packing was again commenced, and continued until 8.45 A.M. when temperature was 100-6° F.

In the evening (7.30 P.M.) as the temperature had again risen to 105 8° and the skin was very dry two- thirds of a grain of pilocarpin was injected hypodermically and although in few minutes it produced profuse perspiration this was only temporary. The temperature fell in 20 minutes to 105-4° the skin how- ever soon became dry again and at 9.55 P.M. registered 108° F., wet packing was again commenced and notwithstanding this at 10.10 P.M., the temperature was 108.8°, at 10.25 P.M. it had fallen to 106.8°, as he was now in a state of collapse, pulse almost imperceptible, he was placed back in bed a hypodermic of brandy was now given, his temperature soon rose again, at 11.20 P.M. it was 108° and at 11.35 P.M. the patient died, shortly after death the temperature (per rectum) was 110° F.

REMARKS. This was one of those peculiarly malignant cases of remittent fever in which qui- nine seems to have no effect.