injected, may suffice to render the implicated area a suitable culture ground for the bacillus and the elaboration in lethal quantities of tetanus toxin.
Tetanus is an exceedingly common disease in some tropical countries. In Western Africa, for example, a large proportion of wounds, no matter how trifling as wounds they may be, if they are fouled by earth or dirt result in tetanus. The French in Senegambia have found this to their cost. A gentleman "who had travelled much in Congoland told me that certain tribes poison their arrows by simply dipping the tips in a particular kind of mud. A wound from these arrows is nearly sure to cause tetanus. In many tropical countries, so general and so extensive is the distribution of the tetanus bacillus that trismus neonatorum is a principal cause of the excessive infant mortality. Every precaution must therefore be taken to ensure that the little instrument which is so potent in saving life may not by carelessness be turned into an instrument of death. The systematic use of tetanus antitoxin in quinine injection treatment has been advocated; but, it seems to me, this is hardly practicable under ordinary tropical conditions.
It is scarcely necessary to add that the intramuscular injection of quinine must not be practised without good reason, or as the routine treatment of ordinary malarial attacks.
Quinine by enema.—— Quinine may also be given by enema. It is readily absorbed if the bowel be not too irritable. The dose should be a large one. Thirty gr. given in this way and repeated in an hour or two in malarial comatose fever has sometimes a rapid effect. It is the most effective method of exhibiting the drug in such attacks in children. Five gr. in warm solution, repeated hourly, retention being ensured by the attendant keeping the patient's buttocks together, is strongly recommended by Daniels.
Intravenous injection of quinine.—— In cases of pernicious comatose remittent, in which it is of importance to obtain a rapid and powerful action of the drug, Bacelli recommends the intravenous injection
