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and will conclude with the excellent advice of Pierre Florio :-" 11 ne convient pas de trop s’en rapporter aux eleves chirurgienspour les soins donner aux malades; le médécill doit lesvisiter lui-meme aussi souvent que possible. Ce n’est qu’àforce de zeie et d’assiduit6 qu’on peut amener la maladie àbonne fin."*Bloomsbury-square, 1855.

ON

MILITARY MEDICAL PRACTICE IN THEEAST.

By GEORGE PYEMONT SMITH, M.D., M.R.C.S.,LECTURER ON MEDICAL JURISPRUDENCE AT THE LEEDS SCHOOL OF MEDICINE.

(Continued from p. 510.)

Gelatio.-The cases of frost-bitten feet admitted into thehospital presented altogether the most wretched and miserableappearance it has ever been my fate to observe. I believethe mortification was not the result of any very intensecold; but from scurvy, deficient food, want of cleanliness,and long-continued exposure, without means of changing ordrying the clothes when they became wet, the general vitalitywas reduced to such a low ebb, that a temperature very littlebelow the freezing point was sufficient to produce mortificationin those parts the furthest removed from the centre of circu-lation. The extent of the mortification of the lower extremitiesvaried from the tips of the toes up to the middle of the leg;and, in two cases that came under my notice, the hands, aswell as the feet, were affected. In the great majority of thesecases the restorative powers of nature appeared altogether ex-hausted ; many died without any attempt at casting off themortified parts ; and others sunk in the course of that process.The treatment resorted to consisted of tonics, opiates, portwine, and porter, with various stimulant local applications;but these were generally unavailing. Out of about fifty casesof frost-bite that came under my notice in one way or another,I do not think there were more than three that survived. Thefollowing is an extract from my diary, January 23red :-" Thereis a patient in the corridor near my quarters, who has bothhis feet frost-bitten above the ankles, the soft parts have sepa-rated, and the dead is now held to the living by the twobones and the tendo - Achillis, the superior surface beingcovered with healthy granulations. This is the only case offrost-bitten feet I have seen that has lived long enough for thisprocess to take place. They are giving him wine and otherstimulants to keep up his strength, and get him ready foroperation." Three or four days after this was written, he wasattacked with dysentery, and died on the 30th of January.On the 30th of January I was requested by one of the divi-

sional medical officers, who was confined to his room by illness,to examine some cases of frost-bitten feet not under my care,and report to him as to their requiring, or being in a fit statefor, operation. The following is a copy of my report :-Hadley.-Right foot: all the toes coming off, and appear

likely to cicatrize without any operation, except perhaps theremoval of the head of the first metatarsal bone. Left foot:all the phalanges have come off; the heads of the metatarsalbones may require removal.

Mullens.-Left foot very slightly frost-bitten. Right foot: Iall the toes implicated, but in too early a stage for operation.Donalds.-Toes of left foot partially affected. All the toes

of the right foot coming offSpalding.-Very weak and emaciated, not likely to live

many days; feet mortifying, but without any line of demarca-tion yet.Sawbey.-Toes partially frost-bitten.Tidcut.-Very feeble, with diarrhoea; both feet dead, with

a line of demarcation about three inches above the ankle-joint,but no discharge yet.Connor.-Very feeble; both feet frost-bitten above ankle-

joint ; no suppuration yet.On the 8th of February, wishing to know how these cases

were proceeding, I paid another visit to the wards, and foundthat Hadley had died that morning ; Mullens was doing well ;Donalds had diarrhoea and bed-sores, and was not likely tolive; Spalding died about the lst of February; Sawbey wasdead; Tidcut died on the lst of February; and Connor aboutthe 5th. These cases were under the care of an intelligent and

a Description de 1’Ophthalmie Purulente, p. 273. Paris, 181.

attentive medical officer, and were, I have no doubt, welltaken care of.On the 8th of February, Dr. MacGrigor performed Dr.

Mackenzie’s modification of Syme’s ankle-joint operation upona case of frost-bitten feet, and on the 9th a similar operationwas performed upon another case by Dr. Cruikshanks; the-second case was not so promising as the other, the patientbeing more debilitated, and there being some ulceration onthe heel. On inquiry the first week in March, I found Dr.MacGrigor’s case doing well, whilst the other was dead.

ebri.s phus.-I,illammation of one or both of the parotidglands was of very common occurrence in the cases of scorbutictyphus; a swelling under the angle of the jaw, increasingrapidly to a large size, without any distinct fluctuation. Thiswas generally accompanied with delirium, great prostration ofstrength, and sometimes sudden death, before the appearanceof any symptoms to lead us to expect so speedy a termination.This was especially the case with a patient that was not undermy care, but who, lying just at my door in the corridor, cameunder my notice. One morning my opinion was asked as tothe advisability of making an incision into the enlarged gland.I found he had been delirious the night before, the tumefactionwas very great, with an indistinct sense of fluctuation; butfinding the breathing quite natural, and that he did not com-plain of any pain in the part, I thought it advisable to wait alittle longer. Hot fomentations, fi,c., were ordered to be

applied. In the afternoon, on going into my quarters, I ob-served him breathing with difficulty, and sent for the surgeonin charge. On his arrival the patient sat up in bed, and an-swered our questions readily. The surgeon went to his quar-ters, about twenty yards off, to fetch a bistoury, leaving thepatient sitting up in bed, and on his return found him dead.A day or two after this, a patient of mine, M——, landed

from Balaklava, on the 8th of January, with diarrhoea andfrost-bitten feet, in a very weak state. On the 10th, I noticeda swelling under the angle of the left jaw, and ordered a poul-tice to it; and on the llth, it was rather larger, but withoutfluctuation; and he did not complain of any pain in it. Onthe evening of the 12th he was delirious, and pulled off thepoultice. On the 13th he appeared much as usual, no diffi-culty of breathing, no fluctuation, or pain; delirious at times;at night slept well for two or three hours; then awoke, haddifficulty of breathing, and died quietly in a few minutes.

Post-,nio2-teiib examination. - On cutting into the parotidgland, and well under the angle of the jaw, there was noescape of matter, but the whole gland and neighbourhood pre-sented a dark-coloured grumous mass, with purulent infiltra-tion, and bloody ichor. In another case of scorbutic typhus,with haemoptysis, both parotids were affected, but without pro.ducing any difficulty of breathing, or sudden dissolution.

Varix.-This man had a large knot of varicose veins in thecalf of the leg, which had been produced instantaneously bythe violent exertion of charging the enemy with the bayonetup the heights on the field of Inkermann.

SIXGULAR GUX-SHOT WOUND.

Walter M——, aged twenty-four, on the 5th of Novemberreceived a gun-shot wound on the inner edge of the left thigh,two inches below the fork. About a month after the injury,when on the close stool, he heard something heavy fall into it,and on examination found the noise had been occasioned bythe fall of a bullet from the anus. For the first three weeksafter the injury, his urine came away entirely by the wound.He then had a catheter passed, after which the urine began toflow partly by the natural passage and partly by the wound.At present (Dec. 16th) the wound is quite healthy and small-about large enough to admit a quill-but the man is much re-duced in health and strength, has a bad cough, and complainsthat the cough forces the urine out through the wound, as,before the cough was so troublesome, the urine had ceased tonow by the false passage.Dec. 23rd.-Has not been so well for the last two or threedays. The urine has begun to fiow more from the wound, andpus and blood from the urethra. After the introduction of acatheter, the urine again passed by the urethra.

Jan. 27th.-Is very ill with pectoral affection and dysentery,and appears likely to sink. He passes urine readily throughthe natural passage, but it is still forced through the woundby coughing.The dysentery increased after the last report, and he died

on the 30th of January.