II94 



THE MALARIAL FEVERS 



It is presumed that no doctor would allow his patient to take quinine in a 

 cigarette-paper, though non-medical people are found who have got into the 

 habit of using this method. 



As regards the powder, it is an efficient method of administering 

 the drug to the healthy, if given directly after a meal, but the taste 

 is most unpleasant. It is certainly the cheapest method. 



The acid preparations— for example, the bihydrochloride and 

 bisulphate — may be dissolved in water, but should have some 

 flavouring added to disguise the taste, while the sulphate requires 

 an acid, which may be provided by suspending some of the powder 

 in natural limejuice; but in order to dissolve the sulphate properly 

 a mineral acid should be used, in the strength of i minim to each 

 grain, but more than this will be required if the unpleasant after- 

 taste is to be avoided. 



In hospitals the sulphate must be used, as if is cheap and effective, 

 but it is as well to have it periodically reported upon by an analyst, 

 in order to see what is really being given to the patients. For 

 hospital use it may be dissolved in dilute sulphuric acid, and have 

 some cheap form of flavouring added. 



We have used Warburg's tincture on the West Coast of Africa 

 with apparent success in cases of chronic subtertian infection, 

 which resist the ordinary methods of administering quinine, but 

 care is required, as it may have a depressing effect upon the heart. 



Tabloids, tablets, and pills are pleasant methods of taking quinine 

 for prophylaxis, convalescence, and mild attacks. Moreover, they 

 are extremely useful for journeys, being readily carried, but in order 

 to be successful they must not be old and hard. The hydrochloride 

 or bisulphate should be used and the solubility tested from time to 

 time in water, otherwise the tabloid must be reduced to powder 

 and taken as indicated above. 



Pills and capsules are quite good when fresh, but they are apt 

 to get hard when old, and are then useless, and must be opened 

 and the powder used, if they form the only supply available. 



The quinine tannate chocolates are, of course, only used for 

 prophylaxis in children. 



By the Rectum. — ^This method may be useful in gastric disturbance, 

 but is not to be compared with the intramuscular. Twenty grains 

 of the bihydrochloride are made into a solution in water, and then 

 mixed with an ounce of mucilage of starch solution, and used as an 

 injection. It is advisable to add a few drops of tincture of opium. 



Quinoform suppositories (gr. iii.) have been used in children by Pedro and 

 others . 



Intramuscular Injections. — ^We are not in favour of hypodermic 

 injections of quinine — i.e., of injections simply under the skin — 

 but strongly recommend intramuscular injections in all cases of 

 malarial fever in which there is gastric disturbance, where, for any 

 reason, the quinine is apparently faihng to act, when the disease 

 is becoming chronic, or in serious subtertian infections. For this 

 purpose the bihydrochloride should be dissolved in normal (075 per 



