NORTHERN DIVISION OF THE ARMY.
73
hazard, and extending over 40 days, gave only from 80 to 90 grains of nitrogen, and 2,050
grains of carbon as the amount consumed daily. The largest diets were composed of
1.—Rice ... 11 ounces.
2.—Bread.
...
10 ounces.
Bread ... 10
„
Rice
...
10
„
Dhall
...
4
„
Dhall
...
4
„
Ghee
...
2
„
Mutton
...
2
„
Ghee...
1
„
Total solid... 27
„
72
„
These would represent about 145 to 162 grains of nitrogen, and 4,200 to 4,147 grains of
carbon, respectively. The lowest diet consisted only of, perhaps, 4 ounces of rice, or 8 ounces
of milk. Some latitude must necessarily be allowed in calculating the diets, as the actual
weighments of the food could in some cases only be guessed. But the whole question of
diets and temperature was a relative one. The first 75 cases admitted after the beginning
of June gave these results :—
A.
B.
C.
D.
Previous
days of
fever.
Average
temperature
on admission.
Treatment.
Number of
subsequent
attacks.
13 cases (Europeans) ...
...
...
...
...
?
Normal.
Quinine
10—15
grains daily.
None.
3 cases (Natives)
...
......
?
104°8 grains quinine
daily.
None.
14 cases
„
...
. . .
. . .
. . .
. . .
2
102°None.
1—2
5 cases „ • •. ... ... ...
?
1 0 1 . 8
None.
in 3 cases, 4 ;
in 2, 5 times.
18 „
Natives and
?
101.1
15 grains quinine
daily.
3—4
Europeans ...
...
. . .
22 „
Natives
...
...
...
...
...
2.4
101.2
None.
None.
Column A, to be more precise, might be passed over, this allowance being made for
incorrect statements by patients themselves.
Column B, however, renders it evident that (except in the 13 cases of Europeans)
there was a decided state of pyrexia when application for admission was made.
In these cases the expectant treatment seems most favourable, for not only did the 22
cases require no treatment, but the 18 who were treated with quinine had in no one case less
than 3 fever days afterwards. Balancing against this might be shown the 13 cases of Euro-
peans who had no subsequent fever, but here there was, at any rate, some doubt possibly as
to their statements. The cases favourable to quinine were 3 amongst natives, and negatively,
also, the 14 cases which had no quinine, and had a return of fever.
I think there can be no question that, as prescribed by Professor Maclean, quinine, to be
valuable, must be given in large doses. The hypodermic method is far better ; but this method
I did not feel justified in pursuing in the regiment, owing to fatal results apparently following
the use of the syringe, which occurred last year ( vide Lancet, July 1st, 1876). There is also
this to be said, that were I to have given large doses to all admissions for intermittent fever,
as recommended, 30 grains to be taken between the attacks, I should have used more than
2 lbs. weight of quinine since the 1st June. It is, therefore, advisable to see if the attacks of
intermittent fever are amenable to a less expensive treatment. This is, of course, a secondary
consideration, but still a useful one.
The next 50 cases were treated with carbolic acid : internally 12 grains were dissolved in
1 drachm of glycerine, the dose being 15 minims 3 times a day.
Average
temperature
on admission.
Treatment.
Subsequent
attacks
(average).
11 cases (Natives)
...
...
...
...
...
...
101. (nearly) Carbolic acid, grains
iii, three times a
day.
None.
21 „
„ .. ..
.
...
...
...
101.5
Do.
1
12
„
„ ...
...
...
....
...
102.2
D o .
2
6
„ „
...
...
...
...
.,.
...
101.4
Do.
5
B 1 9 6—1 9