io6 DISEASES DUE TO PROTOZOA 



scar resulting from a subcutaneous injection of quinine the size of 

 half-a-crown tliat he will carry to the grave. The necrotic ulcer 

 required four months to heal. 



Intramuscular injections are useful when there are gastric disturb- 

 ances and serious subtertian attacks. Painful spots may remain for 

 months at the point of each injection. I have seen a case of wrist 

 drop following an injection of quinine in the upper arm, the needle 

 having penetrated the musculo-spirial nerve, not to mention the 

 consequent necrosis caused by the quinine itself. One of my patients 

 had been previously treated by quinine injections in both buttocks 

 (even when there had not been any vomiting), and had been partially 

 paralysed in both legs owing to permanent damage having been done 

 to both sciatic nerves. 



For intramuscular injections the bihvdrochloride should be dissolved 

 in normal sterile saline solution, lo grm. of quinine in lo grm. of 

 saline, given i-ioth at a time (Bacelli). 



Giemsa's formula is not supposed to be painful in administration. 



Hermetically sealed vials can be purchased readv for use. 



The gluteal region is chosen usually for the injection along a line 

 drawn from the posterior-iliac spine to the ischial tuberosity. 



It is doubtful if intramuscular injections are sufficiently rapid in 

 their action for severe and acute cases. There is always some local 

 damage done and absorption would be slow in consequence, during 

 the process of which the patient might die. 



(4) In the vein. 



In pernicious cases no time can be lost, hence the intravenous 

 method has its uses. 



An injection of ether should precede that of the quinine if the pulse 

 is bad. A superficial vein about the elbow should be chosen. 15 grains 

 (roo grm.) should be given at a time, well diluted in 20 c.c. of saline, 

 and injected slowly. It should be repeated if necessary, but after the 

 first injection there may be sufficient recovery to continue quinine 

 treatment by the mouth. 



Quinine should be given with care in pregnancy as it may cause 

 abortion, but untreated malarial attacks are more likely to produce it. 



The administration of Cjuinine may precipitate an attack of 

 haemoglobinuria. 5 grains has caused this (Sandwith). 



Fever cases, during the acute attack, must have — 



Rest in bed, light diet, blankets for cold stage, hot bottles, hot 



