freely and often with salines. A large hot poultice, two feet or more in length by one foot in breadth, should be laid over the region of the liver; such a poultice to be effective should pass from the centre of the back to well over the epigastrium. Dry cupping sometimes gives marked relief. Muriate of ammonia has a certain reputation in these cases; it should be prescribed in 20-gr. doses every six or eight hours. I have often used it, but I cannot vouch for its virtues; it does 110 harm.
When such a hepatitis is associated with dysentery, perhaps latent or antecedent, should it resist these milder measures hypodermic injections of emetine, as in amoebic dysentery, or 30 to 60 gr. of ipecacuanha often give marked relief, and should be repeated every twelve or twenty-four hours for two or three times. When the hepatitis is associated with malarial fever, full doses of quinine, in addition to the purging and the other measures already mentioned, are indicated.
Whether hepatitis, unless associated with dysentery, ever passes on to suppuration is a moot point. Some say that it may ; others resolutely deny that there is such a thing as "tropical abscess" unassociated with dysentery. This subject will be discussed in the following chapter. Malarial hepatitis has already been considered (p. 97).
