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

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.