56 TROPICAL MEDICINE AND HYGIENE 



absorption. It is particularly useful when there is much 

 vomiting and when it is desired to give frequent large 

 doses, as in comatose cases or in children with con- 

 vulsions, as it is necessary that large doses should be 

 absorbed, and that these doses should be repeated at 

 short intervals. A preliminary enema is not advisable 

 except when the rectum is loaded with faeces. 



The hydrochloride or bihydrochloride, dissolved in the 

 minimum amount of acid and freely diluted, up to four 

 or six ounces in an adult, should be used and injected 

 very slowly. 



The injection must be given warm, and with a fairly 

 long tube (a No. 8 Jaques catheter fixed on the nozzle of a 

 glass syringe is a convenient instrument to use) to be sure 

 that it is retained. 



In children it is necessary for the nurse to keep the 

 buttocks pressed together to ensure the retention of 

 the quinine solution till it is absorbed. Irritation and 

 inflammation of the rectum are said to follow this 

 method of administration, when the sulphate dissolved 

 in sulphuric acid is given, but even then these results 

 are exceptional. 



(3) Intramuscular injection has many advocates. The 

 results are good but no better, even if as good, in 

 comatose cases than rectal injections. It is assumed 

 that absorption is rapid. The quinine is, however, preci- 

 pitated in the muscle, and is gradually absorbed ; the 

 great advantage of its administration is that it is being 

 continuously absorbed. It is particularly useful in 

 persons with chronic dyspepsia or gastric irritability, and 

 a comparatively small dose (10 gr. daily or on alternate 

 days) of quinine is required. 



Precautions. Unless antiseptic precautions are adopted 

 there is danger of tetanus or formation of abscesses, and 

 the injection must be made into a large muscle. Semple 

 has shown that however strict these precautions may be, if 

 there are any tetanus spores in the body, or introduced 

 shortly after the injection, these will multiply at the site 

 of the quinine injection and tetanus occur. 



