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On the Effects of Injections of Quinine into the Tissues of Man and Animals

Published online by Cambridge University Press:  15 May 2009

Leonard S. Dudgeon
Leonard S. Dudgeon
Affiliation:
Colonel A.M.S., Consulting Bacteriologist B.S.F., and Member of the Advisory Committee to the War Office for Infectious Diseases and Sanitation, Eastern Mediterranean.
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In December 1917, Lieut.-Col. MacGilchrist of the Indian Medical Service published a paper on the necrosis produced by intra-muscular injections of strong solutions of quinine salts. It might be an advantage to quote the first few lines of this communication: “Advocates of intra-muscular injections of strong solutions of quinine salts for the treatment of malaria seldom omit to state that no local ill-effects are produced”. He records a case of tissue necrosis following on the intra-muscular injection of eleven grains of quinine bi-hydrochloride in thirty-four minims of water. Death supervened thirteen hours later. MacGilchrist especially noted, owing to rapid tissue necrosis, that the track of the needle remained patent. He regards as an established fact that most of the quinine injected is precipitated and probably chemically combined with serum proteins in the necrosed tissues and for this reason intramuscular injections of concentrated solutions of quinine salts are not to be recommended for cases of emergency. Very dilute solutions of quinine salts are, in his opinion, rapidly and completely absorbed whether employed subcutaneously or by the intra-muscular route. If the views which MacGilchrist puts forward in this and other communications are to be accepted without reserve then intra-muscular injections of strong solutions of quinine should no longer be employed. It was for this reason that Major-General Sir M. P. C. Holt, K.C.B., K.C.M.G., D.M.S., B.S.F., asked me to carry out an experimental enquiry on animals as to the effects produced by intra-muscular injections of strong solutions of quinine.

Type
Research Article
Information
Journal of Hygiene , Volume 18 , Issue 3 , October 1919 , pp. 317 - 336
Copyright
Copyright © Cambridge University Press 1919

References

page 317 note 1 Indian Med. Gaz. lii. No. 12.Google Scholar

page 318 note 1 Only three experiments were made with this salt as it was found to excite more intense necrosis than the other preparations which were employed.

page 322 note 1 The oral method of administration of quinine is greatly neglected by some medical officers who are placed in charge of cases of malarial fever.

page 335 note 1 The gluteal regions, obtained from a man who had daily intra-muscular injections of quinine, nine in all, were shown at the British Medical Association meeting in London, 1919. As a result of the injections wide tracts of muscle were necrosed and only fragments of healthy tissue remained.