In rheumatic hyperpyrexia, where the poison has attacked the central nervous system, salicylates almost always fail.
In the case of white people exposure to heat of itself frequently causes heat-stroke, but probably in almost all cases of heat hyperpyrexia amongst natives the malarial complication is the exciting cause and therefore with them quinine treatment is all-important.
Should a person be infected with latent malaria, heat exposure is very likely to induce an acute malarial attack and the combination is almost certain to lead to hyperpyrexia.
This may occur in syndromes such as malignant hyperpyrexia, tho a metabolic acidosis usually predominates.
The frequent association of heat-stroke with malaria is to be borne in mind in the treatment of heat hyperpyrexia, for, should the temperature of the patient not subside rapidly after treatment with cold sponging in a current of air or cold baths and ice, an intramuscular or intravenous injection of in grains of quinine bihydrochloride should be given without delay.