QUININE 



cent.) saline solution, and carefully sterilized. Baccelli's formula 

 is 10 grammes of quinine and 0*075 gramme (i^ grain) of salt 

 dissolved in 10 grammes (2^ drachms) of water, one-tenth of which 

 is used for an injection; but the greatest care must be taken that 

 this solution is properly sterile. A good formula for a solution 

 which does not cause pain is Gaglio's or Giemsa's: Quinine hydro- 

 chloride, 10 grammes; aquae destillatae, 18 grammes; ethylurethane, 

 5 grammes, of which one-twenty-fifth portion is used for an injec- 

 tion (1-5 c.c. of the solution contains 0*5 gramme of quinine). 



If, however, the solution is to be prepared and sterilized while 

 the patient is waiting for treatment, much time is lost. We there- 

 fore recommend the tropical practitioner to purchase and keep by 

 him the sterilettes, which are little hermetically sealed vials con- 

 taining a gramme (15 grains) of quinine in solution. These steri- 

 lettes may be purchased from Squire and Sons, or Martindale, of 

 London; Burroughs Wellcome and Co.; or Molteni, of Florence. 

 Giemsa's solution may be obtained in similar sterile vials. 



The technique is simple: First cleanse the skin of the patient 

 carefully with i in 40 carbolic lotion; then break off the glass seal 

 of the vial at the nick in the neck, and pass the open mouth of the 

 vial through a flame; then draw up the contained fluid into a 

 sterilized all-glass syringe provided with a platinum iridium needle. 

 Plunge the hypodermic needle deeply into the deltoid or gluteus 

 maximus, and make the injection. Withdraw the needle, and place 

 a little pad of wool, wrung out in i in 40 carbolic lotion, on the site 

 of the injection. Performed carefully in the above manner, there 

 need be no fear of tetanus or abscess formation, and the injection 

 can be repeated at will. If necessary, a stimulant or an injection 

 of ether may be given in the old and feeble before this intramuscular 

 injection. After repeated injections of quinine, even if adminis- 

 tered antiseptically, hard swellings may appear at the seat of the 

 injections. In such cases the hypodermics should be stopped for 

 a few days, and an ice-bag may be applied to the painful part. 



Notwithstanding the objections to this method brought forward by 

 some authorities, we still strongly recommend it, as we have found it to 

 be most successful in intractable cases, and have never so far seen any un- 

 toward symptoms. We advise that the hypodermic syringe and needle 

 should be sterilized by rinsing with i in 20 carbolic acid after boiling, as the 

 carbolic acid does not interfere with the action of the quinine, and has an 

 unfavourable influence upon any tetanus spores which may by any chance 

 be present. Care should be taken that not too much carboHc lotion is left 

 in the syringe and needle; otherwise a precipitate will form. 



Intravenous Injection. — In cases of pernicious infection with sub- 

 tertian parasites, no delay should be made in giving the patient an 

 intravenous injection, but the effect of quinine on the circulation 

 must be remembered, and if the pulse is bad, it is advisable to give 

 an intramuscular inj ection of ether as a preliminary. The same vials 

 and apparatus should be used in the intravenous as in the intra- 

 muscular injection. 



The injection should be made, using a 5 c.c. or 10 c.c. syringe. 



