Am.  Jour.  Pharm. 
June,  1920. 
Effects  of  Quinine  on  Tissues. 
421 
half  a  century  the  substance  has  been  regarded  by  toxicologists  as 
a  protoplasmic  poison  capable  of  destroying  various  forms  of  animal 
and  vegetable  cells.  The  suggestion  has  at  times  been  made  that, 
because  of  the  observed  tissue  damage  following  intramuscular  in- 
jections, this  mode  of  administration  should  be  abandoned.  A 
recent  experimental  inquiry  by  Colonel  Dudgeon^  of  the  British 
Army  Medical  Service,  on  the  effects  of  injections  of  quinine  into 
the  tissues  throws  new  light  on  the  actual  conditions  developed  by 
the  procedure.  It  has  been  suggested  that  in  order  to  avoid  the 
untoward  results,  intramuscular  medication  should  be  <:;arried  out 
only  with  dilute  solutions.  Dudgeon  points  out,  however,  that 
injection  of  quinine  in  solutions  so  dilute  as  to  avoid  edema  and 
tissue  necrosis  is  not  of  practical  utility  in  man.  Concentrated 
preparations  of  quinine  produce  more  intense  necrosis  than  do  dilute 
ones;  but  when  the  latter  are  such  as  to  be  of  therapeutic  value, 
they  also  excite  the  tissue  changes  at  the  site  of  infection. 
A  concentrated  solution  of  quinine  is  absorbed  rapidly  from  the 
tissues  even  in  patients  who  are  moribund.  Dudgeon  insists  on 
the  necessity  of  realizing  that  tissue  necrosis — spreading  edema  and 
local  blood  destruction— are  produced  by  the  solvents  frequently 
employed  for  quinine  administration ;  and  the  effects  are  only  slightly 
inferior  to  those  excited  by  the  quinine  salts  and  the  alkaloid.  No 
advantage  was  gained  by  the  addition  of  oil  or  by  injecting  the 
alkaloid  dissolved  in  alcohol  or  ether.  Necrosis  of  blood  vessels  in 
the  area  of  injection  is  a  common  result.  This  leads,  according  to 
Dudgeon,  to  hemorrhages  into  the  tissues.  Extensive  damage  of 
these  sorts  in  the  neighborhood  of  an  important  nerve  trunk  may 
result  in  nerve  palsy. 
It  may  be  that  a  choice  between  disadvantages  will  dictate  the 
continuance  of  intramuscular  injections  of  quinine.  If  so,  the  lim- 
itations and  dangers  of  their  use  in  practice  need  to  be  appreciated 
clearly  and  specifically.  Daily  doses  administered  for  periods  of  a 
week  and  more  in  the  glutal  region — a  favorite  site  for  injection — ■ 
are  not  unknown.  Such  cases  have  been  found,  further,  to  retain 
only  fragments  of  healthy  tissues  in  the  muscular  tracts  involved. 
Hence  one  can  appreciate  the  force  of  Dudgeon's  warning  that  re- 
peated intramuscular  injections  of  quinine  should  not  be  given  into 
the  same  area  of  muscle  or  tissue  directly  adjacent,  because  other- 
wise permanent  injury  of  muscle  or  nerves  may  result. 
1  Dudgeon,  L.  S. :  "On  the  Effects  of  Injections  of  Quinine  into  the  Tissues 
of  Man  and  Animals,"  /.  Hyg.,  18:  137  (Oct.),  1919. 
