TREATMENT IN MALARIAL FEVER 55 



bihydrochloride contains 72 per cent, of quinine ; it should 

 alway be used for intramuscular and intravascular injec- 

 tions as it is soluble in one part of water. It is also best 

 for rectal injections. 



Quinine may be given (i) by the mouth ; (2) by the 

 rectum ; (3) by intramuscular injection ; (4) by intra- 

 venous injection. 



(1) By the mouth is on the whole the most convenient 

 method, and it suffices in the vast majority of cases. 

 The quinine should be given in solution dissolved in 

 water with the addition of an acid when a rapid effect is 

 desired and in all cases for treatment of the acute 

 conditions ; hydrochloric or hydrobromic is the best, but 

 sulphuric or tartaric acid may be used. Lime juice, either 

 fresh or preserved, sherry and other acid solutions may 

 also be used as solvents. When given in solution it is 

 certainly and rapidly absorbed, but the taste to many 

 people is nauseating. 



Freshly made pills, made by the addition to quinine 

 sulphate or hydrochlorate of a small crystal of tartaric 

 acid and a drop of water, have no disadvantage. 



Sugar-coated pills, tabloids, or tablets or old pills must 

 not be used, as they are frequently passed undissolved. 

 Compressed uncoated tablets are occasionally, but rarely, 

 passed in this way under ordinary circumstances. They 

 may be used for prophylaxis, during convalescence, and 

 in mild attacks, if the tongue be clean and there are no 

 symptoms of dyspepsia, but should not be relied upon in 

 severe attacks. They are convenient when travelling as 

 they can be readily broken up and dissolved if required. 

 Before using tablets in cases of fever, typhoid fever must 

 be excluded. Fatal haemorrhage has occurred in cases of 

 typhoid where quinine tablets have been given. Quinine 

 is sometimes taken in cigarette papers, but it is not certain 

 that taken in this way the quinine will be absorbed, and 

 in many places gelatine capsules are used, but the gelatine 

 often becomes hard and is not dissolved in the stomach. 



(2) Administration by the rectum results in very rapid 



