Imatges de pàgina

ments, and many of them part of their dress, to take their pipes and sit under the trees, or rest themselves in other open and exposed situations, where they enjoyed the conversation of their comrades, in some instances probably to a late hour; whilst the men belonging to the company alluded to, being quartered in rather a better description of house, were in the habit of smoking their pipes in a large kitchen, with the servants of the Dutch family; here they were sheltered from the exhalations so prejudicial to health in such climates and under such circumstances, when the constitution was more liable to be acted upon, viz. in a state of inactivity after fatigue or exercise.” p. 343.

“ The interesting observation communicated by the surgeon of the 43d, of the comparative healthy state of the company of the right wing over all the others in that regiment, is highly deserving of attention; more real advantage may be derived from the knowledge of a single fact, so stated, than from volumes written expressly on the subject of military diseases: it shews how much depends on the attention of commanding and medical officers of regiments to all the minutiæ connected with their interior economy.

“ It was to be regretted that the troops were taken out to exercise before sun-rise. The danger of allowing the men to be under arms every morning an hour before day-light, does not appear to have been considered; and it is extraordinary, that after all that had been written upon the subject of preserving the health of soldiers in such unwholesome climates, no precautions seem to have been taken to guard against the fatal consequences of exposure to the damp and noxious exhalations.” p. 345.

Next, in regard to the cure,

“From the appearances which were observed in these dissections, we were led to draw the following conclusions; that the original disorder was of an inflammatory nature, inducing a considerable vascular excitement and determination to particular organs, especially to the liver and spleen, and that the derangements in their functions occasioned those relapses or subsequent returns of fever which took place at distant pe

riods and at lengthened intervals, from the original or prima

ry attack.

“In fact, we found that no radical or perfect cure could be obtained until the congestions which had been formed in those important organs were either lessened or removed; and by keeping in view the connexion that subsists between the bilious remittents of warm climates, and the remitting and intermitting fevers of our own latitudes, in which derangements in the bilious secretions are so remarkable, a correspondent plan of cure was adopted, and was attended with the happiest re- , sult." p. 360.

“The general plan of treatment at first, was to open the body by means of five or six grains of the submuriate of mercury, with an equal quantity of c. ext. of colocynth, followed up by the senna infusion, and sulphate of magnesia, after which the submuriate and antimonial fluid were given every three or four hours in small doses, and continued, either with or without mercurial friction upon the side, according to the state of the patient and the period of the disorder, or until the mouth became slightly affected.

“The warm bath, fomentations, and blisters to the side were also employed, together with an anodyne draught, and occasionally the camphorated mixture, with acetate of ammonia, &c.

“ In the most obstinate cases, it was found necessary to push the mercurial friction to some length, so as to induce ptyalism; and when there was appearance of remission, the bark was given, and not till then, in the form of decoction, with an aromatic; wine was also allowed in small quantities according to the strength of the patient.

“ This was the usual method we followed throughout the month of September; but in October and November we had occasion sometimes to use the lancet; and in the cases of relapse particularly, the best effects seemed to follow the loss of blood.

“As we had reason to suspect that these attacks of fever were connected with abdominal inflammation, cupping-glasses were employed in preference; and after fomenting the parts,

they were applied either to the region of the stomach, liver, or spleen, where the pain was most complained of, and great relief invariably followed from this topical bleeding.” p. 363.

" When Sydenham complained that he knew of no successful method of treating intermittents, as the bark, which had always had the appellation of a specific, rather checked their progress than removed the cause of the disease; those congestions were not suspected which have been shown to exist to a great degree in consequence of the strong determinations to the viscera, which very early take place; and it was not likely that the disorder could be radically cured, until the irritation which they occasion in the system was entirely removed.

“ It is not however by throwing in mercury, and pouring in the bark, that this effect is to be produced; these are terms to be met with in some late writers, and they are not less improper than the indiscriminate and empirical manner in which those invaluable medicines have been employed.

“The smallest quantity of mercury will often as it is well known) affect some constitutions so speedily, that it is impossible to lay down any rule for its administration in these fevers.

“ I have generally found great advantage to result from its being introduced gradually into the habit, and its action to be rendered more certain by being given in small doses, and at distant intervals.” p. 283.

“ In the distribution of the extra diets, or what are termed medical comforts, a discretionary power was given to the medical officer in attendance; but one general principle was admitted by all, and acted upon throughout the establishment; that wine and spirits were not found to be absolutely necessary to the removal of the Walcheren fever, as it was called; and that, during the progress of convalescence, the management and quantity of diet was to be considered of the highest importance in effecting a perfect recovery. A very contrary opinion had long prevailed, and it is the popular one in the army, that the British soldier required more nourishment and more animal food than those of other countries, and hence arose the

profuse and liberal allowance of every article that could be thought of, which tended rather to satiate, than to satisfy the appetites of persons recovering from acute disease.” p. 332.

On Gun-shot Wounds of the Extremities, requiring the differe ent Operations of Amputation, with their After-treatment: establishing the Advantages of Amputation on the field of Battle to the Delay usually recommended, &c. &c. &c. With Four explanatory Plates. By J. G. GUTHRIE, of the Royal College of Surgeons, London; Deputy Inspector of Military Hospitals. 8vo. pp. 384. Longman and Co. London, 1815.

[From the Edinburgh Medical and Surgical Journal, for April 1816.]

Of this book we may with truth say, “ Indocti discant, et

“ ament meminisse periti.” The experienced and intelligent surgeon will have pleasure in acknowledging the interest with which he has perused it; but to the junior and less experienced members of the profession, and especially to the younger military surgeon, this treatise of Mr. Guthrie must prove an invaluable gift. A work of this kind was, in truth, wanted for their instruction; and the desideratum has been most happily supplied, not by an ordinary surgeon, but by one bred in the camp and in the field of battle. The reader, too, is introduced to this great school of military surgery, and becomes accustomed to its horrors, its dangers, and privations. But, amidst the difficulties and privations of active campaigns, it is delightful to observe with what order and precision the medical arrangements have been conducted during the dreadful war of the peninsula; and to learn that our brave troops had the advantage of being succoured by surgeons of first-rate talents and acquirements. Such, indeed, appears to 'have been the zeal and talents of the more experienced surgeons of the staff, that the camp and field were converted into schools for the instruction and training of the younger medical officers, by all the aids of lectures and demonstrations. And, though we know that almost all the medical recruits who were sent out to the army had received what is called a regular and liberal medical education, and had not received their certificates or diploma till after a regular inquisitorial examination, though many had received even the highest honours of medicine, yet the lectures and demonstrations of the camp were necessary to make them actual surgeons, and they soon became excellent.

Military surgery, like military success and glory, is indeed of late date amongst us; and, to judge from the specimen before us, we think we have now no less reason to be proud of the one than of the other.

The practical conclusions of this interesting volume Mr. Guthrie disclaims as exclusively his own; and he wishes them to be considered, in every thing that is useful, as the result of the general experience of the British military surgeons who have served in the late campaigns.

One of the most important questions in the department of military surgery is that so often discussed, with regard to the proper period for amputating—whether, when such operations are necessary, they ought to be performed on the field of battle, immediately or soon after the injury received, or not till after the removal of the wounded into hospital or quarters, and when the first train of supervening accidents have been subdued.

The whole merits of this hitherto disputed point are most ably investigated by our author in his first section; but the question seems now finally determined, by the experience of military surgeons, in favour of early and immediate amputation, when the limb cannot otherwise be saved. Wiseman, Le Dran, and Ranby, who learned their surgery in the field of battle, are all advocates for immediate amputation; and, perhaps, with the exception of Bilguer, the opposite seems to have grown up with, and to have been defended, chiefly by men of

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