136
Extract from the Annual Report of the Medical Specialist, Deccan District, for the
year 1939.
2. That on the whole the doses of the drug given are too small, either the
daily total being too little, or if the initial daily dosage is adequate, it has not
been continued long enough. In this connection it may be permissible to
quote from an article by H. L. Marriot in the B. M. J., dated 11th November
1939, and which appears to be the standard dosage adopted by most autho-
- rities now, and has been advocated by many other authorities in current
literature with very mild modifications. It is necessary in treating Pneumonia
to aim at securing and maintaining a blood concentration of sulphapyridine
of not less than 4 mg. per 100 cm. In adults this level is usually achieved by
a dosage of 2 grammes, followed in 4 hours by 2 grammes followed by one
gramme four hourly. After 2½ days the dosage should be reduced to 0.5
gramme four-hourly for 24 hours and then 0.5 gramme 8 hourly for 32 hours,
i.e., a total of 23 grammes administered on a decreasing scale during 5 days.
The drug should be given in all cases of Pneumonia, however late in starting
it may be, as it helps to prevent such complications as empyema, etc.
* * * * *
They were both British Troops, and were admitted with mild malaise, slight
pyrexia, and discrete erthematous rashes, distributed chiefly on the back,
the chest and the upper arms and legs. In neither case were there any definite
physical signs, and in both cases, all symptoms cleared up completely within
48 hours without any special treatment. It is felt that both these cases are
strongly presumptive of toxic reactions from the sulphonamide group, which
must have been purchased privately as neither patient was on treatment from
any Army source. Tests are being carried out at the British Section Hospital
to see if there is any reliable test for the detection of the drug in the urine,
and if there is, how long after the drug has ceased to be taken it will remain
detectable. If any reliable evidence can be obtained a further report will be-
s u b m i t t e d . [ T h e d e t a i l s o f a s u i t a b l e t e s t h a v e s i n c e t h i s b e e n c i r c u l a t e d ] .
67. Surgery.
As can be seen from the list of operations and surgical treatments surgery
for the Army in India covers a wide scope and provides very considerable
diversity of practice for army surgeons. It is difficult to group descriptions
of cases from the reports of numerous surgical specialists and it is therefore
considered that the best picture can be given by quoting cases of interest.
(i) Fractures of course form a large proportion of military cases. Skeletal
traction by pins and the use of Bohlers unpadded plaster fixation and traction.
using Bohlers special series of metal frames is specially mentioned by several
surgeons. The uniformly successful results with absence of invaliding and
the freedom of the patient are particularly noted.
Two cases of fractured pelvis with intra pelvic rupture of the urethra and
other multiple injuries from riding accidents were successfully treated by
passing and leaving in situ a rubber catheter without any local sutures; plaster
and extension dealt with the fractures. A fractured skull with middle menin
geal rupture and uninterrupted recovery after trephining.
A lorry accident at Abbottabad filled the British wing of the hospital
there with some remarkable cases; a gross rupture of the liver; a severe
wound of the perineum and anum which recovered completely after gas gan
- g e n e i n f e c t i o n a n d a s t o r m y c o n v a l e s c e n c e ; a c o m p o u n d d e p r e s s e d f r a c t u r e
of the front of the skull w th extensive facial and scalp laceration which healed
by first intention and 11 other less serious cases.