40

with serum; so that the figures given are well within the actual limits of
safety.

    Quinine alkaloid in doses up to .03 gramme per kilogramme of animal
weight, dissolved in 33 per cent. alcohol (in normal saline) was injected intra-
venously in rabbits without any ill-effects being observed to follow. A dose
of .03 gramme per kilogramme of animal weight would correspond to a
close of 2.1 grammes (32½ grains) of Quinine alkaloid to man. The injec-
tions, moreover, were not made slowly but as quickly as with any other
solution. Quinine alkaloid is no doubt precipitated as it enters the vein, but
it is in such a fine state of sub-division that, even if it could reach capillaries.
before being re-dissolved in the blood-serum, it could cause no obstruction.

    In passing, it may be noted that, by first dissolving Quinine alkaloid in
a minute amount of absolute alcohol and then adding normal saline to make a
dilution of 1 of Quinine alkaloid in 2,000 or 5,000, a rapid and easy solution
of the alkaloid is obtained for intravenous infusion. To dissolve Quinine
alkaloid directly in water or saline is a very slow and laborious process.

Rectal Administration of Quinine.

    Quinine enemata.—Quinine enemata are probably used as often for
amœbic dysentery as for malaria. In the former case, absorption is not
desired; in the latter, absorption is our object. The chief drawback to Quinine
rectal injections is that Quinine salts, and particularly the more soluble salts,
are so irritating to the mucous membrane that they are generally quickly
returned. Prolonged retention is necessary for the efficient action of these
injections whether they be given for amœbic dysentery or for malaria. In
order to get sufficiently long retention, it is always necessary to add opium,
belladonna or cocaine to the injections. Yet these substances, although they
prolong retention, are apt to retard absorption. It is necessary, of course, before
giving a Quinine enema to clear out the bowels with a simple enema.
According to the National Dispensatory, ¹⁰an enema of Quinine hydrochloride.
in the same dose as by the mouth has nearly the same therapeutic effect as when
given by the mouth, provided the Quinine salt in the enema is given in watery
solution. This view of Quinine enemata appears to be too optimistic, Kleine^12,22
after giving an enema consisting of two grammes of Quinine hydrochloride in
100 cubic centimetres of water found the average Quinine elimination in the
urine to be 17.5 per cent., maximum elimination occurring between the
fourth and tenth hours. He concluded that elimination and probably absorp-
tion from an enema containing a soluble Quinine salt are considerably smaller
than those which take place when Quinine is given by the mouth; and
that with a Quinine preparation which is not easily soluble absorption must be