and may, by choking off a threatening fever, avert suffering and anxiety, not to mention danger.
Form, in which to administer quinine.—— Quinine is best given in solution, and probably the hydrochloride, as containing a larger proportion of the alkaloid than the sulphate, is the best salt. Some, under the impression that hydrobromic acid prevents the singing in the ears attending the free use of the drug, prefer this to dilute sulphuric acid as a solvent for the ordinary sulphate. When the tongue is fairly clean and digestion not .altogether in abeyance, the quinine may be given in freshly prepared pill, in tabloid form, in cachet, or enclosed in cigarette paper; but in serious cases, particularly where the tongue is foul and digestion enfeebled, pills and tabloids are not to be trusted to. In these circumstances they are apt to pass through the bowels and to appear in the bedpan unaltered. In grave cases this occurrence must not be risked.
Euquinine or euchinine, the ethyl carbonate of quinine, quinine tannate, and aristoquinine—— a diquinine carbonic ester—— have the advantage of being almost tasteless, an important property in the case of fever in children or fanciful patients.
Milk as a menstruum for quinine.—— If the taste of the ordinary salts of quinine be very much objected to, and if euquinine is not available, a good plan is to give quinine in powder in a tablespoonful of milk after the patient has previously lubricated the mouth with a morsel of bread and butter. Given in this way the bitter taste of the drug is not perceived.
Injection of quinine.—— In any type of fever, if vomiting is persistent, if the brain is affected, or if the patient is insensible and cannot or will not swallow, recourse must be had to rectal, or intramuscular, or intravenous injection of quinine. In all cases in which life is in imminent danger, and in which the earliest possible action of the drug is of importance, it must be so administered. The intramuscular method is sometimes a painful one, and may be attended with some risk of abscess; in the circumstances, such possibilities count for little.
