The best place for an a intramuscular quinine injection is the gluteus maximus muscle at a point somewhere from 2 to 3 in. below the crest of the ilium. After the injection is made the part should be gently massaged so as to diffuse the solution, and the little wound sealed with collodion. Quinine ought never to be injected into the neighbourhood of large nerves or blood-vessels, and never into the subcutaneous connective tissue, as in the case of morphia and other alkaloids. I have long been in the habit of using intramuscular injections of quinine, both in hospital and in private practice, and, so far, without mishap. My belief is that abscess, indurations, and similar accidents are for the most part attributable to imperfect methods and carelessness.
Intramuscular injections of bihydrochloride of quinine, 7 to 10 gr. in 10 to 20 minims of water daily for a week, is the best way of checking obstinately relapsing malarial attacks.* [1]
Precautions.—— It may be well to mention—— not with the idea of deterring the practitioner from using the drug in this way, but to impress upon him the necessity for sterilizing the patient's skin at the place selected for injection, and for care in keeping instruments and solutions aseptic—— that not only abscess, sloughing, and chronic painful indurations have sometimes followed the hypodermic injection of quinine, but also tetanus. In these latter unfortunate cases it was not, of course, the quinine that directly caused the tetanus; it was the tetanus bacillus, and this tetanus bacillus was introduced either on a dirty needle or in a fouled solution. Further, as Semple has pointed out and emphasized, the tetanus bacillus may be present in the body without giving rise to symptoms, provided the vitality of the tissues is not seriously impaired by injury or irritant. Unlike morphia, or emetine, quinine is a powerful irritant, and, when
- ↑ * Quinine when lodged in a muscle is not invariably immediately absorbed. It may be precipitated and thereafter slowly absorbed, thus ensuring the continuous presence of the drug in the blood. To this and to the consequent continuity of action on the parasite has been attributed the undoubted efficacy of this method of administering quinine in obstinate cases of malarial infection.
