REVIEW — TROPICAL MEDICINE, ETC. 115 



A very useful general paper which, in many ways applies to the conditions prevalent in Malaria — 

 the Sudan, is that by Howard,' on " Malarial Prophylaxis in Small Communities in British continued 



Central Africa." Special attention may be directed to what is said regarding the selection of 

 sites for posts and mission stations. Anyone who has seen the posts on the Upper White Nile 

 must agree that, however convenient from the point of view of trade and general 

 communication, they are as a rule badly placed from a sanitary standpoint. The problem 

 is frequently one of much difficulty, but one has often wondered why Kodok remains a seat 

 of Government, when both for it and for Taufikia the site occupied by Malakal would have 

 been infinitely more preferable. Melut, however, is well placed. Of course one is here 

 looking at the question solely from the outlook of a sanitarian, and there may be good and 

 weighty reasons for retaining stations alongside khors, which at certain seasons teem with 

 the larvae of anophelines. The Shilluk villages are, as a rule, situated a considerable 

 distance from the Nile, doubtless to secure freedom from the winged hosts which are apt to 

 render life unendurable. 



Darker,^ of Southern Nigeria, has a paper on what he calls intracellular injections of 

 quinine in malaria. In place of a mixture of quinine sulphate and vaseline, which he was 

 wont to employ in the case of negro children, he now injects a warm dense solution 

 of quinine hydrochloride (neutral salt). 



Ten drops of water are placed in a test-tube and 15 grains of quinine hydrochloride 

 crystals are added. Shake. Heat till solution is complete. Boil. Cover tube with sterile 

 cover till the end containing the fluid is " just warm " to the hand. Inject in the usual way 

 either into the cellular tissue under the skin of the anterior abdominal wall in the case of a 

 child able to walk, or into the deep tissues of the outer side of the thigh in the case of 

 a baby in arms. Close needle puncture with a saturated solution of gum mastiche in 

 rectified spirit and apply a piece of lint. The quinine solidifies (so it is said) in the tissues, 

 and is absorbed in about two mouths, during which time the child's general appearance 

 greatly improves. 



When a number of children are to be treated, the test-tubes containing the solution can 

 be kept in readiness in a water bath at 100" F. The temperature of the fluid in the syringe 

 must not fall much below 100" F., or solidification will occur and re-heating and washing 

 out be required. 



In a similar way euquinine dissolved in rectified spirit may be employed, but the 

 asepsis is more difficult. 



Darker also remarks that dense solutions of the acid salts of quinine (those used for 

 intramuscular injection in cases of malignant malaria) disorganise the tissues when they 

 are injected and so are not absorbed as quickly as may be desired. Hence he suggests that, 

 in pernicious cases, the quinine should be in dilute solution, say 1 grain in 10 drops of water, 

 several injections being made at the same time if necessary. 



Several letters on the hypodermic use of quinine in malaria appeared recently in the 

 Indian Medical Gazette. Some are very practical and useful, and may be quoted from with 

 advantage. Thus, Scott^ says : — 



The form in which quinine is most usually given hypodermically or rather intramuscularly is, I suppose, 

 the quininffi hydrochloridum acidum of the B.P. dissolved in distilled water to the strength of 1 in 1 or 1 in 2. 



I use the former strength, i.e. equal parts of quinine and water. My usual dose of gr. x can then be 

 contained in the full bsirrel of an ordinary •20-minim hypodermic syringe. 



I have also used quinine sulphate extensively for injection and found it perfectly satisfactory. I have 

 thought that it caused more after-pain than the acid hydrochloride, but could not be sure of this. I dissolve it 

 with tartaric acid. By warming in a test-tube gr. s of quiuine sulph. can be dissolved by gr. iii of tartaric acid ill 

 m. 20 of water. Grains 5 of tartaric acid should be used if the solution is to be kept at all, otherwise the quinine 

 will be precipitated. The solution will not keep so long as that of the acid hydrochloride anyhow. Of the 

 sulphate, I always use a 1 in 3 solution, and fill the barrel of the syringe twice without removing the needle from 

 the gluteal muscles. 



Several cases of tetanus have occurred fi-om injection of quinine, and absolute asepsis is essential. A boon to 

 tropical practitioners would be a small pocket case on the lines of B. W. & Co.'s urine-testing pocket-case, 

 containing a spirit lamp, a small vessel for heating oil on a stand over the lamp and just large enough to take an 

 intramuscular needle. Another small vessel with a handle and flat bottom for boiling the quinine solution, a 

 hypodermic sj-ringe (all metal), a pair of forceps for taking the needle out of the hot oil, and three bottles to 



1 Howard, E. (January 1st, 1908), " Malarial Prophylaxis in small Communities in British Central Africa." 

 Journal of Tropical Medicine niul Hijijiaic, p. 1, Vol. XI. 



' Darker, Q. P. (December 1st, 1906), " Intracellular Injections of Quinine in Malaria." British Medical 

 Journal, p. 1577. Vol. II. 



° Scott, L. B. (March, 1907), "The Hypodermic Use of Quinine." Indian Medical Gazette, p. 114. 



