When possible, the patient should remove to a nonmalarious locality. This is particularly important in severe cases, because one attack docs not insure a person against a second, but rather increases the liability. In selecting a residence, care should be taken to avoid settling in a malarious locality. The popular remedy for malarial diseases of all kinds is quinine. The efficacy of this drug in checking the paroxysms of ague is undoubted. When given in sufficient quantity, the disease may be interrupted in almost every case. Unfortunately, however, the drug does not seem to possess the power to neutralize the poison, since the paroxsyms often show an obstinate tendency to return when interrupted in this way without further treatment. In order to effect a permanent cure, it is necessary that the patient should be subjected to thorough eliminative treatment. Packs, hot-water baths, vapor baths, and Turkish and Russian baths, are the best for this purpose. When these are first employed, the paroxysms can be interrupted by the use of a very small dose of quinine, when a very large one would otherwise have been required; and if the eliminative treatment is continued for a time, the disease is much less likely to return.

Although quinine is supposed to be the great specific for malaria and almost indispensable for the successful treatment of the disease, we have repeatedly demonstrated the fact that the disease is curable without it, and in fact without any drug whatever. Our usual plan of treating ague is this: If a patient comes to us suffering with chills every other day, having already passed through his regular paroxysm, we begin treatment with a wet-sheet pack about five or six o'clock in the afternoon. The patient is kept in the pack an hour, and is allowed to sweat profusely. The pack is followed by a wet-sheet rub, after which a thorough fomentation is applied over the liver, spleen, and bowels. A copious enema is administered if the bowels are constipated, and the patient is put to bed with a wet girdle about him. The next day the hot-air or vapor bath is administered about ten o'clock A. M., being followed by another wet-sheet rub and a fomentation over the liver. In the evening, a wet-sheet pack with a fomentation is again administered and the patient is put to bed without the abdominal girdle, well wrapped in woolen sheets and wearing a woolen night-dress. Having ascertained the time at which the next chill will occur, the attendant should be on hand at least two hours before the paroxysm is expected to begin, so as to be ready in case any irregularity should occur. The patient is now carefully observed, his temperature being taken every half-hour with the thermometer. The first indication of the approach of the chill is a slight rise in temperature. Instead of being 98 1/2 it will be 99 or 100; and as the time approaches for the paroxysm to begin, the temperature rises to 100 1/2, 101, or even higher. When the attendant finds his temperature rising, he uses the thermometer every fifteen minutes, and if he finds it rising quite rapidly he knows that the chill may be expected very soon, and at once begins vigorous efforts to forestall it. Having previously got in readiness six or eight bottles filled with hot water, or an equal number of hot bricks, hot sand bags, or other means for applying dry heat, ho promptly brings these into requisition, placing a hot jug or brick at the patient's stomach, two at his back, others at his feet, the sides of the limbs, at the hands, eta The blankets are carefully tucked about his shoulders, extra covering is put on, and he is allowed to drink freely of hot drinks of some kind. We never advise ginger or pepper tea, as they are irritating to the stomach. In nine cases out of ten, the result of this procedure will be to convert the impending chill into a vigorous sweat. This can be accomplished in nearly every case when the patient has had the proper preliminary treatment, and when the treatment is properly managed. It is necessary to exercise some care in its use however. It is important to get the patient sweating at just about the time when the chill would have begun. It is also necessary to use great care that the patient is not kept in the dry pack too long, since there is usually some fever even if the chill is escaped.

As soon as it is apparent that all danger of chilling is past, which will not be for an hour and a half to two hours at least, the patient should be wiped with dry, warm flannels, under the bedclothes, without exposing him to the air, and the hot jugs or bricks should be one by one removed and the extra covering gradually taken off, and thus he should be by degrees cooled off. A very slight exposure at this time, or drinking cold water, will bring on the chill. In some cases, a very slight chill will occur even in spite of these precautions, but one or two repetitions of the dry pack will almost invariably succeed. When we have been able to carry out this plan of treatment thoroughly, we have rarely failed in effecting a cure, even without the use of any other remedies. One fall we treated thirty or forty cases of malarial fever, and succeeded in effecting a cure in every case without other remedies than the eliminative treatment and the dry pack. Treatment must be vigorous and thorough.

The success of this plan of treating the disease depends upon the elimination of the poison from the system through the skin. The method of elimination for which nature manifests a decided preference is indicated by the profuse perspiration to which the disease is subject. If the eliminative treatment is continued until the brown coating disappears from the tongue, the disagreeable taste from the mouth, the dingy hue from the white of the eye, and the peculiar sallowness from the skin the dry pack will be almost certainly successful. In fact, we believe that any measure which will interrupt the paroxysm may be considered as curative after proper eliminative treatment has removed the greater part of the malarial poison from the system.

From observation and careful study of quite a large number of cases, we have come to the conclusion that it is possible for the paroxysm to be fastened upon the system as a habit, so that it may continue long after the poison by which it was first excited has been eliminated from the body. When this is the case, anything which will interrupt the periodicity or regularity of the paroxysm will effect a cure. The same principles are illustrated in the treatment of other diseases; for example, holding the breath to stop hiccough, and practicing gynmas tics to relieve St. Vitus's dance. We have often known persons to be cured of ague by the adoption of some peculiar mode of treatment, such as going down stairs on the hands and knees head foremost, and similar apparently absurd measures. We knew of a case in which a man cured his daughter of ague by burying her in the ground, leaving only the head uncovered, for three hours, at about the time when the chill was expected. Another illustration of the effects of habit upon the system is in the frequency with which relapses occur months, or even years after a person has removed from a malarious district, and has apparently entirely recovered from the effects of malarial poisoning.

These relapses can always be traced to taking cold or some indiscretion which occasions a slight fever, the occurrence of which is sufficient provocation to develop the tendency to periodicity existing in the system. We have long entertained serious doubts whether this form of intermittent fever is really malarial in character except in the sense that it is due to a habit impressed upon the system by previous malarial influences. Cases of this kind are always very mild, and yield promptly to the use of the dry pack.