26
SKETCH OF THE MEDICAL HISTORY OF THE NATIVE ARMY OF BOMBAY.
success ; but the failure is only due to the breaking of the instruments we were using, and
the inability of the Medical Store Department on each occasion to supply another one with-
out considerable delay.
The hypodermic syringes, though beautiful instruments, are almost necessarily of delicate
structure, and have not been handled by the subordinates with all the caution and care tha
t was required, but which I trust experience will now have taught them, and thus two
instruments have been broken in my hospital.
Their great liability to be broken is very much increased by a fault in their manufacture,
which, if remedied, would render the chances of fracture very much less. This defect lies
in the cement used for fixing on the upper silver cap, which instead of being so strong as to
be untouched by the solutions used, is so easily acted on by the acid of a quinine solution,
that after two or three days it becomes loosened, and the slightest force subsequently applied
in trying to fasten the cap on again breaks the graduated tube.
I have used it altogether in 49 cases, with the following results : Four out of the 49
turned out to be remittent fever, so the treatment was changed. Out of the remaining 45, in
only two instances it is recorded that there was " no effect," in the rest the result was "no
return of fever ; " of these, however, eight were cases of febricula, which may have recovered
without any treatment at all, so I would exclude them from the list. There then remain
37 cases of true intermittent fever, of which 20 were accompanied with ague, 8 were of tertian
type and 9 quotidian, without ague. The number of times hypodermic injection was per
-formed was as follows :—
•
Total number of injections.
24 cases were injected once 24
6 ............................twice 12
2 ............................thrice 6
4 ............................four times 16
1 ............................six times
6
Total... 37
64
(Those requiring the injection repeated several times were generally the tertian.)
The amount of quinine used for injecting was grains 192, (a solution of grains 3 having
always been used for each injection) giving an average of about grains 5 to each man.
I think a rough, but fair comparison, may now be made between this quantity and the
amount of quinine that would in all probability have been taken by the mouth during the
time they were in hospital ; and this, if the comparison be allowed to be a fair one, will show
what is perhaps the most important point of this statement, as it will be the point most in-
teresting to Government, and will lead, I trust before long, to a general adoption of the hy-
podermic plan of' treatment, viz., the great saving in the expenditure of an expensive drug
like quinine.
The aggregate number of days the above 37 men were in hospital, is, I find by the re-
gister, 212, from this I would deduct three days from each man's time, as the average time he
would have been convalescent and would have taken no quinine—the invariable practice in my
hospital. This leaves 140 days to be multiplied by 9 (the usual amount given being 3 grain
doses thrice a day), making a total of 1,260 grains, or an average of about 34 grains to each
man, instead of 5 grains as shown above to be the result of the hypodermic method, or to give
it more strikingly in a money value (the wholesale price of quinine being Rs. 3-12 an
ounce), each man's recovery would have cost about four annas and nine pies, instead of about
seven pies, which it has now cost, or about nine times the amount.