62 TROPICAL MEDICINE AND HYGIENE 



water may be further cooled with ice, or a block of 

 smooth ice may be rubbed up and down over the wet 

 towel as it lies on the patient, so as to keep it constantly 

 cold " ice planing." Cold applications, ice-bags, &c. r 

 to the head should also be used. 



Administration of Quinine. This, when given by the 

 mouth, may cause vomiting. The ordinary precautions 

 should be taken, but if the vomiting is uncontrollable 

 hypodermic injections of morphia, ^ gr., should be 

 given, preferably over the epigastrium. It is absolutely 

 necessary that quinine should be absorbed, and if it 

 cannot be readily retained by the stomach it must be 

 administered in some other manner. In giving quinine 

 by the rectum the nozzle of the syringe and the long 

 tube used must be warm, or a funnel and tube may be 

 used. The injection should be given well above the 

 anus, and must be made very slowly. 



The patient is to be kept perfectly still and the buttocks 

 should be pressed together in order to counteract any 

 slight efforts at straining. In children the nurse must 

 maintain this pressure for half an hour, otherwise the 

 injection will not be retained sufficiently long for absorp- 

 tion to take place. 



Superficial hypodermic injections of quinine must not 

 be given as they are painful and often followed by 

 abscesses. If administered by injection the quinine 

 must be introduced into one of the larger muscles, such 

 as the gluteus maximus. Injections into the forearm, or 

 amongst any mass of small muscles, cause a good deal 

 of pain and swelling, and if injected into or close to 

 a nerve trunk may cause permanent paralysis. This 

 accident occurs most frequently if the injections be 

 given in the forearm. The most important point to 

 be remembered about these injections is their liability 

 to cause tetanus or abscesses. Such accidents appear 

 to be due to the injury inflicted by the quinine upon 

 the tissues with which it came in contact, thus facilitating 

 the growth of any organism introduced with it, or, as 



