HYPODERMIC INJECTION OF
By
Assistant
Surgeon
F.
QUININE.
Odevainb, Bhopal Battalion.
from the Annual Report of the Bhopal Battalion. (Printed, by permission of the Inspector-General of Hospitals,
Extracted
Indian Medical
Department.)
In the Medical Times and Gazette for August 1862, Dr. McCraith, of the British Seaman's Hospital at Smyrna, a brief account of the employment by Dr. Chasseaud and himself of an alcoholic solution of quinine injected under
James .rives
the skin in cases of malarious fevers, occurring amongst a large body of workmen in their neighbourhood. Seeing this after its publication, and, like the above medical paper shortly gentlemen, having a minimum of quinine with a maximum
THE INDIAN MEDICAL GAZETTE. of fever cases, I was obliged to solve the problem of curing the latter with the smallest expenditure of the former. For the last seven years I have very frequently used a solution of quinine and have tried many solvents for this alkaloid, with a view of obtaining the most un-irritating
hypoderinically,
one possible, and after several experiments I have come to the conclusion that citric acid is the safest. In obstinate cases of fever, or where ordinary doses fail or
are
the stomach, I use the quinine subcutaneously. carefully dissolved in fifty drops of water, with the aid of a minimum of citric acid (about three grains;) this quantity is injected, with an ordinary hypodermic syringe,
rejected by
Pour grains
are
into the cellular tifsue on the outer side of the arm, avoiding any veins. Should the syringe not hold fifty drops, it would be necessary to unscrew it from the needle, fill it with the remainder of the solution, and use it as before. My in
object
much water is to prevent the solution from being too concentrated, and consequently irritating. The general results of the treatment of malarious fevers by the above
using
so
I have no hesitation in stating this manner acts more powerof gastric irritation, in which the
method have been
satisfactory. antiperiodie given in
that the
fully ; and, of course, in cases remedy cannot be kept down, its administration hypodermically becomes of the utmost value, as entirely checking or mitigating the ensuing paroxysm. In the remittent form of the disease I have frequently used quinine as above described, with very beneficial results; and am confident I have saved several lives by the employment of quinine subcutaneously; and can unhesitatingly say that I have thus economised the expenditure of this invaluable drug. From a good deal of practical experience in a large number of cases in which I have used quinine as thus mentioned, I cannot laud the practice as quite an unfailing one ; for in
some instances I have known the fever return within two hours after the injection; and though I have great faith in the use of quinine hypodermically, I think it only right to
state that the following objections against its this manner should be mentioned :?
(a.) (?.) (c.)
That it is The
a
tedious mode of is
employment
administering
the
in
drug.
less painful to the patient, If the acid used as a solvent be in excess, or the solu? tion bo too concentrated, it is liable to cause considerable irritation, abscess, or even sloughing of the skin at the site of the operation.
injection
more or
Tetanus is stated to have
originated from the employ quinine subcutaneously. Unfortunately a case of this sort occurred to me lately. A sepoy had been treated for fever, by quinine administered in the usual way, but this not having the desired effect, an injection was given over the deltoid muscle. The fever stopped, and he was discharged, but some day3 after was re-admitted with tetanic symptoms, which rapidly advanced and ended fatally. The only wound was a small ulcer, abont the size of a fouranna bit, which had formed at the site of injection, and to this I fear must be attributed the supervention of tetanus. It is true that this one case should not deter us from employ? ing a remedy giving such good results, but the above reasons of quinine hypoderare sufficient to prevent the exclusive use mically ; and, until this alkaloid can be dissolved by means of in this some perfectly un-irritating substance, its employment (cl.)
ment
r
of
manner
can
never
become universal.
In
one
and the
same
intervals injected a watery solution of morphia, upwards of a hundred times, without the smallest
ease
I have at short
irritation resulting at the site of the punctures, which were often repeated in the same place ; this could never have been done with a drug, requiring for its solution a direct irritant,
such
as a
mineral or
vegetable
free acid,
or
pure alcohol.
[April 1,
1871.
By
Assistant
Surgeon
F.
QUININE.
Odevainb, Bhopal Battalion.
from the Annual Report of the Bhopal Battalion. (Printed, by permission of the Inspector-General of Hospitals,
Extracted
Indian Medical
Department.)
In the Medical Times and Gazette for August 1862, Dr. McCraith, of the British Seaman's Hospital at Smyrna, a brief account of the employment by Dr. Chasseaud and himself of an alcoholic solution of quinine injected under
James .rives
the skin in cases of malarious fevers, occurring amongst a large body of workmen in their neighbourhood. Seeing this after its publication, and, like the above medical paper shortly gentlemen, having a minimum of quinine with a maximum
THE INDIAN MEDICAL GAZETTE. of fever cases, I was obliged to solve the problem of curing the latter with the smallest expenditure of the former. For the last seven years I have very frequently used a solution of quinine and have tried many solvents for this alkaloid, with a view of obtaining the most un-irritating
hypoderinically,
one possible, and after several experiments I have come to the conclusion that citric acid is the safest. In obstinate cases of fever, or where ordinary doses fail or
are
the stomach, I use the quinine subcutaneously. carefully dissolved in fifty drops of water, with the aid of a minimum of citric acid (about three grains;) this quantity is injected, with an ordinary hypodermic syringe,
rejected by
Pour grains
are
into the cellular tifsue on the outer side of the arm, avoiding any veins. Should the syringe not hold fifty drops, it would be necessary to unscrew it from the needle, fill it with the remainder of the solution, and use it as before. My in
object
much water is to prevent the solution from being too concentrated, and consequently irritating. The general results of the treatment of malarious fevers by the above
using
so
I have no hesitation in stating this manner acts more powerof gastric irritation, in which the
method have been
satisfactory. antiperiodie given in
that the
fully ; and, of course, in cases remedy cannot be kept down, its administration hypodermically becomes of the utmost value, as entirely checking or mitigating the ensuing paroxysm. In the remittent form of the disease I have frequently used quinine as above described, with very beneficial results; and am confident I have saved several lives by the employment of quinine subcutaneously; and can unhesitatingly say that I have thus economised the expenditure of this invaluable drug. From a good deal of practical experience in a large number of cases in which I have used quinine as thus mentioned, I cannot laud the practice as quite an unfailing one ; for in
some instances I have known the fever return within two hours after the injection; and though I have great faith in the use of quinine hypodermically, I think it only right to
state that the following objections against its this manner should be mentioned :?
(a.) (?.) (c.)
That it is The
a
tedious mode of is
employment
administering
the
in
drug.
less painful to the patient, If the acid used as a solvent be in excess, or the solu? tion bo too concentrated, it is liable to cause considerable irritation, abscess, or even sloughing of the skin at the site of the operation.
injection
more or
Tetanus is stated to have
originated from the employ quinine subcutaneously. Unfortunately a case of this sort occurred to me lately. A sepoy had been treated for fever, by quinine administered in the usual way, but this not having the desired effect, an injection was given over the deltoid muscle. The fever stopped, and he was discharged, but some day3 after was re-admitted with tetanic symptoms, which rapidly advanced and ended fatally. The only wound was a small ulcer, abont the size of a fouranna bit, which had formed at the site of injection, and to this I fear must be attributed the supervention of tetanus. It is true that this one case should not deter us from employ? ing a remedy giving such good results, but the above reasons of quinine hypoderare sufficient to prevent the exclusive use mically ; and, until this alkaloid can be dissolved by means of in this some perfectly un-irritating substance, its employment (cl.)
ment
r
of
manner
can
never
become universal.
In
one
and the
same
intervals injected a watery solution of morphia, upwards of a hundred times, without the smallest
ease
I have at short
irritation resulting at the site of the punctures, which were often repeated in the same place ; this could never have been done with a drug, requiring for its solution a direct irritant,
such
as a
mineral or
vegetable
free acid,
or
pure alcohol.
[April 1,
1871.
