given to reduce temperature by such rapidly acting measures as the cold bath, or ice applied in various ways to the head and body. Antipyretic drugs are of very little service, even if, in consequence of their depressing action on the heart, they be not actually dangerous; in all serious cases of siriasis such drugs must be carefully avoided. Chandler, speaking from an experience of 197 cases in which the mortality amounted only to 12, gives some excellent rules for the management of hyperpyrexial cases. He directs that the patient be placed undressed on a stretcher, the head end of which is raised slightly so as to facilitate the escape of involuntary evacuations and to provide for drainage. A thermometer is kept in the rectum. The body is covered with a sheet upon which are laid numerous small pieces of ice, larger pieces being closely packed about the head. Iced water is then allowed to drip for thirty or forty minutes on the patient from drippers hung at an elevation of from five to ten feet. A fine stream of iced water poured on the forehead from an elevation will act as a stimulant and rouser; this is a very powerful measure, and must not be kept up for longer than one or two minutes. A hypodermic injection of 40 minims of tincture of digitalis is given as soon as possible, its administration being preceded, in the case of plethoric patients showing much arterial tension (but not otherwise), by a small bleeding. The application of cold should be at once discontinued so soon as the thermometer in the rectum has sunk to 104° F., or, in cases of simple thermic fever in which the temperature has not exceeded 106°, when it has fallen to 102°. If these powerful antipyretic measures are carried beyond this point the fall of temperature may continue below the normal, even to as low as 91°, and dangerous collapse ensue.
On discontinuance of the iced sheet the patient should be wrapped in a blanket, and hot bottles applied to limbs and trunk. Very likely perspiration, a very favourable sign, will then set in. Stimulants may now be necessary. Strychnine, owing to the marked tendency to convulsions that is
