It must, however, be remembered that the rest treatment of pyrexia must not be overdone, and as soon as the temperature has been found to remain permanently normal, graduated exercises should be cautiously commenced. Ai. S. Paterson has demonstrated the importance of these as a curative method in order to induce such a degree of auto-inoculation as will not raise the temperature or lower the opsonic index. When graduated exercises or moderate manual labour is commenced it becomes, therefore, absolutely necessary to determine frequently the rectal tempera ture, and when this is found to rise above too° the patient must be placed in bed again.
Wright also considers that as soon as the antibacterial pressure in the blood has been satisfactorily adjusted by prolonged rest graduated exercises should be commenced, the blood-pressure controlled and the coagulability of the circulating fluid reduced by Citrates so as to irrigate in a methodical manner all the foci of infection with a lymph rich in anti bacterial substances.
This scientific treatment of pyrexia aims at the removal of the exciting cause, and should take the place of the empiric methods of reducing fever by the administration of such agents as the coal-tar products—antipyrine, &c. The thermic centres in tuberculosis are in a condition of most unstable equilibrium, and though the pyrexia can be easily reduced by antipyretic drugs the effect of these speedily passes off, and is liable to be accompanied by great sweating and prostration and to be followed by a greater rise in the temperature. Quinine is not open to the same objec tions, but it often fails entirely to reduce fever heat, though it is a valuable antipyretic drug in the case of children.
The most objectionable and dangerous of all methods of reducing the pyrexia of phthisis is that of applying Guaiacol to the skin under oiled silk, as serious collapse is liable to supervene.
Cold sponging or even the tepid bath may be resorted to when the degce of fever is high and remains refractory to absolute rest. When the pyrexia is due to gastric or intestinal disturbance a saline purge and a return to a. milk diet are clearly indicated.
Heim's Pill is a routine remedy for the control of moderate and persistent fever in phthisis; it contains gr. Digitalis, gr. Ipecac., gr. Opium and gr. Quinine. Niemeyer's Pill has been long used for the same purpose; it contains I gr. Digitalis, f gr. Opium and i gr. Quinine.
Strychnine is valuable in the markedly fluctuating temperature which is due to a toneless state of the thermic centres.
Night-Sweats.—This symptom seldom requires special treatment; the full establishment of the open-air treatment usually effectually meets the condition provided that the bed-clothing be not excessive. In refractory cases the best routine treatment is the following old-fashioned pill: Ext. Belladonna Fir. gr. W. Zinci Oxidi gr. iiss.
Ext. Hyoscyanzi gr. ij. 211isce.
Fiat bilula. 'Witte xij. tales. Sumat unantam hora somni.
Atropine or Belladonna is the most reliable of all drugs for the control of profuse sweating, but after the full dose (, gr. atropine) the dryness of the throat, cardiac excitement and occasional visual disturbances are serious barriers to its usefulness, and sometimes it increases the cough by drying up the sputum. Hyoscine acts in a similar manner, and may be employed when an hypnotic effect is also desired.
Agaricine is free from these objectionable qualities; the dose of this is to .1 gr., and may be given every four hours in rebellious cases. Mus carine acts in the same manner, but it is a body of varying composition, and should not be relied on. Strychnine in small and repeated doses gr.) is often useful, especially in those cases where the temperature keeps fluctuating during the sweating.
Picrotoxin gr.) checks sweating without in any way diminishing the bronchial secretion, by stimulating the respiratory mechanism, as pointed out by Cushny.
Camphoric Acid in doses of io to zo grs. is a favourite anhydrotic with some physicians when given before bed-time.
Dover's Powder in minute doses (I gr.) is sometimes efficacious, but often it aggravates the condition. When given in the form of Heim's Pill, in which it is combined with Quinine, it proves useful both in steady ing the temperature and reducing the sweating, and Niemeyer's Pill acts in the same manner. Quinine by itself may be tried in larger doses when other measures fail; sometimes the combination of this drug in full doses with the Hypophosphites is efficacious, though Yeo recommends the ordinary mixed hypophosphites as the most reliable routine.
Sulphonal in 5-gr. doses often proves valuable in reducing sweating, and the amount may be doubled when a slight degree of insomnia is associated with the profuse perspiration. Chloralose and Chloralamide act in the same manner.
Alone or in association with any of the above methods, sponging the skin with diluted Vinegar or Alcohol, or water containing a small amount