?(   76    )
is largely used. Experience has now shown that better results would be
obtained if this method of administration were given up in favour  of
administration intramuscularly into the gluteal muscle. (4) Quinine when
given intramuscularly is not absorbed so rapidly as when given by the mouth,
but its absorption extends over a longer period; therefore intramuscular
doses do not act so quickly as those given by the mouth, but their action is
more prolonged. It is this prolongation of action that makes the method so
valuable in chronic relapsing cases. (5) The intensity of action of quinine
when given intramuscularly is probably less than when given by the mouth,
so that, theoretically, intramuscular doses should be larger than doses given
by the mouth. But in practice it is often difficult to give a larger dose than
eight grains intramuscularly, and experience teaches that this dose is usually
effectual. (6) It will be inferred from what has just been said that it is not
always better to give quinine intramuscularly than by the mouth; it is
seldom better to do so. (7) To patients who do not remain in bed during
treatment larger doses of quinine must be given than to those who do so.
(8) Quinine when taken in powder or in the form of compressed tablets
should be followed by a wine-glass of water acidified with three or four
drops of hydrochloric acid.
Pernicious
attacks.
As regards the treatment of pernicious attacks it is not necessary to add
much to what has already been said in the foregoing pages. In cerebral
attacks a smart purge should be given along with the first dose of quinine,
and a dose of at least 10 grains of a soluble salt of quinine should be given
intramuscularly in addition to that which is given by the mouth. Hyper-
pyrexia should be treated by cold baths, rectal injections of iced water and
ice bags to the head-never by the administration of powerful diaphoretic
or depressing drugs, which are very likely to cause profound collapse when
the temperature falls with profuse sweating.
In cases when there is no time to be lost quinine should be
administered intravenously. If the solution of quinine is at the correct
temperature [100°F.), if the quinine is thoroughly dissolved, and if complete
aseptic precautions are taken, there is no danger in this operation. Fifteen
grains of quinine bi-hydrochlorate should be dissolved in 30 or 40 minims of
normal saline solution. The skin over the bend of the elbow should be
rendered aseptic. A rubber tube is wound round the arm on the proximal