18

force it through the catheter into the stomach. The sequence of events is
given in the accompanying table alongside that in the case of suicide—

Table IV.

Time after
ingestion.		 GUINEA-PIGS, MINIMUM-LETHAL OR SUB -
LETHAL DOSE OF QUININE BI-HYDROCHLOR-
IDE 1-30 BY MOUTH.		 Case of suicide. Quinine
4 drachms + 2 lemons
swallowed.
After meal. Fasting (24 hours).
2½ hrs. ... Giddiness
(unsteadiness).		 Giddiness and pallor.
3      „ Giddiness
(unsteadiness).		 ...... ......
3½   „ ... Twitchings ......
4      „ Twitchings ...... Unconsciousness and convulsions.
4½   „ ... Convulsions Convulsions.
6      „ ... Convulsions Convulsions and death.
6½   „ Convulsions Death if lethal dose;
  signs of recovery if
  sub-lethal.		  

        There is therefore reason to believe that, under ordinary circumstances,
most of the Quinine administered by the mouth is absorbed from the small
intestine; a small amount possibly from the stomach, especially if adminis-
tered while fasting and in the form of a salt easily soluble in water; and also
a relatively small amount from the large intestine. As already mentioned, the
absorption of Quinine is normally very complete, very little being passed with
the fæces after medium doses.

FACTORS INFLUENCING ABSORPTION FROM THE GASTRO-INTESTINAL TRACT.

       1. Food contents of the gastro-intestinal tract.—There seems no doubt
that, if Quinine is administered with or soon after a meal, absorption and elimi-
nation are retarded (Kleine,22 Mariani,13 Giemsa and Schaumann5). When ad-
ministered with a meal, Giemsa and Schaumann found traces of Quinine in
the urine only after two hours; when given fasting, they could detect traces in
20 to 30 minutes. Regarding total Quinine elimination see under (4) below.

       2. Affections of the gastro-intestinal tract.—The frequency with which
purgatives (not necessarily cholagogue) are administered before Quinine is
evidence that experience has taught physicians that a sluggish or loaded bowel
is not favourable to Quinine absorption. Marshall6 reports that in diseased
conditions of the heart or kidney absorption is delayed: this no doubt is due