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In asking this question, I believe I may assume that largenumbers of wounded persons (chiefly with injuries of bones andjoints) will constantly be arriving in England, with a viewto various measures of surgical treatment not applicable in thefirst periods of injury. The large resources of this hospital,and its immediate proximity to the railroads by which suchpersons would reach the metropolis, might render St. Thomas’speculiarly convenient for the purpose suggested.Perhaps I ought further to state, that my object in troubling

you with this question bears reference to the possible establish-ment of a department of military surgery in our medical school;and that, for this educational purpose, it would be important(both for our own students and eventually for the public service)that military casualties should be seen under treatment, so far,at least, as this can be done away from the field of battle.

I have the honour to be your obedient servant,R. G. WHITFIELD,

Resident Medical Officer,To the Right Hon. Sidney Herbert,

Secretary-at-War, &c. &e.

CHLOROFORM.

[MR. WORLD ON ITS ADMINISTRATION.]To the Editor of THE LANCET.

SIR,—From some of the remarks made by Mr. Syme, in hilecture upon " Chloroform," all his pupils, and many of hisreaders, will imagine that Edinburgh alone is the place wherechloroform is administered according to principle.Now, it is hard of the learned professor to say that all his

brethren in this large town " have not been so fortunate as toget into the right way in the first instance." Let me assureMr. Syme that not all of his London brethren who administerchloroform require a grim assistant-physician, with watch inhand, to take charge of the pulse. Being one amongst thebrethren mentioned, will you allow me to state the result ofmy experience in the administration of chloroform?

I have constantly used this anaesthetic agent during the lastseven years, in upwards of four thousand cases, indiscrimi-nately, without regard to the age or condition of the patients:to infants less than a week old, to a man upwards of ninety-two years of age: to patients suffering from every form oforganic disease-from fatty degeneration and valvular diseaseof the heart, aneurism of the aorta, and indeed from almostevery disease involving the circulation and respiration. Duringthis time, and amongst this number of cases, I have not hadone death from the administration of chloroform. " I havebeen guided as to the effect produced" by the respiration,having paid little or no attention to the circulation, this being" only affected secondarily, in consequence of the failure ofrespiration." I have, however, frequently found the state ofthe eye to be an invaluable sign of the patient being under thefull influence of the chloroform, the total insensibility of theeye to the touch and to light fully indicating a state of com-plete anaæthesia—invaluable, inasmuch as by this sign I haveoften been enabled to diminish the quantity, or discontinuethe use, of the chloroform before stertorous breathing has com-menced.

I consider the free admixture of air with the vapour ofchloroform very essential to the safe administration of thisagent. I do not, however, consider that it is necessary, oreven desirable, on this account to put aside the apparatuswhich I have used for some years, and by which I can withgreat facility regulate this admixture. Does not this verydilution, however, render the chloroform more slow in opera-tion ?

It appears that Mr. Syme attaches but little importance tothe quality of the chloroform. I consider this to be a mostimportant point. Many excellent things I own come fromEdinburgh, but may I ask, is all the chloroform therefron:necessarily good ?

T remain Sir your obedient servant

Jan. 1855. R. R. WORLD.

MEDICAL PRACTICE IN THE CAMP BEFORESEBASTOPOL.

To the Editor of THE LANCET.SIR,—An incident took place in our camp yesterday, which,

while it may amuse your readers, shows what a Crimean prac-titioner may have to do in the course of his numerous andvarious duties.

Corporal B-, of ours, came about noon yesterday to reportto me that his wife was very much griped, and wished to seeme. This enterprising lady had, in spite of remonstrance and

reproof, struggled up to the camp from Balaklava, about threeweeks ago, along the canal of mud which is called the road..I proceeded to visit her in the hole that her mate hadprepared for her. This was an excavation six feet long, threebroad, and two deep. To cover it in, a small pyramidal ten’swas placed over the opening ; a slit in one side formed thedoor, from-which a steep and, to me, difficilis descensus ledabruptly to the interior of the establishment. Brushing awaya foot or two of the snow that almost buried the interestinghabitation, I stooped, and wrignied my head and shoulderswithin the door. One look was sufficient to show how mattersstood. She was far advanced in labour; a smiling, thoughoccasionally distorted, countenance evinced that she suffered butlittle pain. Our parturient females of the expedition appearto be retrograding towards the nomadic immunity from severeand long-continued labour pains. The pains had been felt buthalf H/n bnur-

With some misgivings as to my equilibrium, and some diffi-culty in choosing my ground, I found, on getting inside, thatthe child’s head was rapidly descending. Slipping over twoturns of the funis, that I found about Miss B ’s neck, I re-ceived, in a single pain, the young lady and all the et cœterasin my hand. From the rapidity of the execution, I was obligedto tie the funis with the mother’s apron-string, and sever itwith my clasp-knife, as no more appropriate instrument couldbe procured at the moment. The happy mother, the only

female in the camp save her child, at once proceeded, with thehelp of her anxious husband, to wash and dress their littledaughter, which looks most lively and blooming to-day, though,thanks to the booming of the Russian guns, it made its appear-ance two months sooner than it ought. Owing to the individualinterest and kindness of our Brigadier (Major-General Codring-ton), the mother and child want for nothing, and are com-paratively comfortable.

I am, Sir, vour obedient servant.Lines before Sebastopol,

Jan. 14th, 1855.JOHN OGILVY, M.B.,

Assistant-Surgeon, 33rd Regiment.

SURGERY OF THE WAR.

WE propose at present to speak of the purely surgical aspectof the army in the East, though the medical or hygienic con-dition of the troops finds them, we fear, in February as badlyoff as in December or January. The men who fought bravelyat Inkermann and Alma, true to the horrors of the Easternlegend, have sunk and yielded to climate ; the mighty Thor,with his crown of ice, conquering all alike, English, French,and Russians. A writer on the 13th ult. says, whole Englishregiments are eating raw food for want of fuel. The poor men,too, are seized with frost-bitten limbs while asleep. The

and free from scrofula; our men too often are either tuberculous,scrofulous, or, what is now equally bad, dysenteric or scorbutic.The 46th Regiment, which left England 850 strong, now(Jan. 10th) musters only 70 available men; another regiment,which landed in the Crimea 1000 strong, is now reduced toless than 100 bayonets. Lint and chloroform, opium and castoroil, are sadly wanted. The greatest evil at present s a want

of commissariat, or carriage for medical necessaries.We prefer at present noting the result of amputations, asthey are already known, some facts of very great value having

reached us as to operation at Therapia and Scutari. At theformer place, about 1’0 of those most seriously woundedby shot and shell, consisting of frightful lacerations of limbs,severe compound fractures, &c., requiring amputation, werereceived; the returns up to the present have quite confirmedwhat we have so often alluded to-the necessity of all amputa-tions being primary. Of 17 primary amputations on soldiers,including two severe operations on the thigh, only 3 haddied; whilst of 12 secondary amputations, 5 had died. OneRussian had his hip-joint taken out, and recovered. The

primary amputations were thus by far the most favour-. able, 4 even of these cases having been complicated with

compound fractures of other limbs besides those operated on.Of the secondary amputations, five had died, and the othersall but died, from gangrene and purulent absorption. The

i general impression of the naval and army surgeons who had

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seen the cases was, that operation had been of no nse; indeed, mount importance in a military point of view. The morbidin private practice, or where the wounded could be attended conditions requiring operation in these cases were: extensiveto. operation would be totally inadmissible. - laceration; evulsion and crushing of limbs by machinery, differ-

It is to be feared we shall have numerous returns of this ing little from wounds by cannot-shot in battle, the fatalitydescription. We have now five thousand sick and wounded. assisted by gangrene; burns from melted metal, &c., unknownThe men’s health has suffered, too, most disastrously from in military warfare. We have here, in fact, a war of ma-the use of salt meat rations, so that scurvy has made many chinery; but scientific surgery, with Mr. Pott in the as-

of the wounds impossible to heal, and rendered fractures cendant.from shot or splinters quite unmanageable. At Scutari, Such lessons should not be lost on military surgeons. Halfthe result amongst the wounded will, ive fear, be quite an army may be lost as readily by bad surgery as bad general-terrific. A somewhat remarkable circumstance is mentioned ship. Our whole force might, perhaps, even still be secured;in our later letters-viz., that some navy surgeons who went but with our deaths from dysentery alone (quite a preventibleon shore pointed out all the worst cases amongst the soldiers disease), carrying off something like two regiments a month,as suffering from scurvy-a disease not known or suspected by hospital gangrene after secondary amputations threatening tothe younger military surgeons. Dysentery, also, of a very bad take another, we have not much to hope. The cold was sokind was carrying off hundreds of men, originating in a dissolved severe last month, that an officer writing 12th January says,condition of the blood and scurvy, but more generally, perhaps, forty men the previous night had lost their toes : 5300 werein the ordinary causes of this terrible disease-viz., vicissitudes sent, in one month, sick from the trenches, on board ship f9rof climate and bad food and clothing, from which, it is un- Scutari.necessary for us to say, the troops had suffered in no ordinary In the Crimea now the 63rd Regiment has only seven men !manner. In the last half-weekly return at Scutari, from the the Fusiliers, out of 1562, only 210. In the Peninsula, there10th to the 15th of January, of 207 deaths, 168 were from were 66,373 men, of whom, as we have often said, 10,000 weredysentery and diarrhœa. It is feared also that there is still a lost from wounds; but we have lost more in proportion fromlack of castor oil, calomel, and opium, so indispensable in the preventible illness. The necessity of a reserve medical force intreatment of these cases, and turpentine, so valuable externally the army has been well shown. Even the lint sent out was nowhen the disease has gone to ulceration of the colon and rectum. use from want of organization and surgeons. We have nowPerhaps we may here say, that sulphate of copper and opium, eight English hospitals, which we should have had two monthsstrychnine in pills, and acetate of lead, are also of vast utility. ago.We should hope that in Turkey, the land of opium, this drug Our French friends draw a broad and well-marked line ofwould be easily obtained; sulphate of copper (the cheapest of distinction between primary and secondary amputations, feed-all pharmaceuticals) must also be readily accessible. We ing the wounded and starving them; between conservativewould again and again, in the most earnest manner, press upon surgery, cutting out bullets and injured parts at once, or leav-the authorities at home the necessity of sending such medicines ing them, in Prussian fashion, to the chapter of accidents.- about half a dozen in number-not balsam copaiba, which, The Turks and French are taught military surgery almost fromnotwithstanding denial in a contemporary, we hear still was the first lecture at medical schools, as we have shown elsewhere.sent, but by mistake. Are not many of our lamentable pro- Pyasmia, of a bad kind, is almost certain to follow secondaryceeclings, mistakes, and the parliamentary division this week, amputations; pneumonia is also a not unfrequent disease.an emphatic commentary on the medical management of the These are accordingly drilled into them. French surgeons, wewar, and mistakes, as the French say, ert permaraerece ? We think, look at the worst of everything, with a keen, philo-should not dwell on such small matters, but the present is a sophic eye. We rather slur over the danger, and look at every-moment when all the information at the public disposal should thing couleur de rose, satisfied with the surgery of the yearbe combined to save our army. All our science is of no avail 1811.if such simple remedies are forgotten-if such common-place At Batgtche Serai, one of the French hospitals, a Frenchmatters as opium, lemon-juice, quinine, with the remedies we surgeon gives a somewhat lively account of their proceedingshave just indicated, are forgotten, while we are looking up last month. This, it seems, is one of the fairy palaces of theprecedents for their use. Indeed, already it has been said, of Turkish empire, as sung by the Tennyson of those climates-thirty amputations under the care of one surgeon at Scutari, otherwise, the great poet Pauschkine. Here, it seems, aretwenty-two had died from want of medical comforts and wine many of the galleries and scenes of the real Thousand and Onealone. Nights, where that famous Scheherzarade, in whom we allThe subject of primary and secondary amputations, though delighted in our school-boy days, told such splendid stories of

at present likely to be forgotten in the large number of those pepper-tarts, and Sindbad the sailor.dying from exposure to cold in the batteries at Sebastopol and " Arabian nights, indeed," says our French friend, " fromdysentery, is one still of very great moment, lying at the base four in the morning till eleven at night we tried to get throughof all our military surgery. We have had, we need hardly our primary amputations : of 300 wounded sent here one day,say, all varieties and much clashing of opinion on the matter. I had to amputate 135. We have had every kind of wound,Dionis told Louis IV., in France, that the limbs of the wounded from simple bayonet wound to complete destruction of limbswere in greater jeopardy from primary amputations and young by grape and cannon shot. We have avoided pyaemia bysurgeons than the bullets of the enemy. Mr. Pott, however, the cleanliness of the " Arabian Nights’" apartments, andhonestly explained it by saying, "It was better to live with more than anything, by avoiding secondary amputations.three limbs than die with four." Another great military sur- Operate early, and feed your patients, if you wish to savegeon for his time, Bilguer, was so horrified at the result of life; operate late, and starve them, if you wish for suppu-large granulating stumps and actual cautery, in what were in ration, unhealed stumps, pyaemia, dysentery, or death. It ishis pupil days secondary amputations, that he issued an order a problem worth working out, but not yet begun in our Eng-against amputating at all. Accordingly, of six thousand lish army.wounded Prussians, he did not allow one to have a limb am-putated. One half died at once on the field, the remainderwere left cripples for life. "To cut off a limb after a bad NAVAL MEDICAL OFFICERS.—The following gentlemen,wound, what is it," he usually asked, " but to add wound to serving as assistant-surgeons, have just received their promo-wound ?" As a splendidtriumph, he gave 11 out of 6000 tion as full surgeons :-Messrs. William Hoggan, 1842, Croco-cured by Nature—a sad and unusual feat for even the ris dile; John Jeffcott, 1842, Waterloo; Mark Hamilton. 1842,medicatrix. Let us contrast this with an unpretending, but Naval Hospital; John Andrews (b), 1843, Naval Hospital;most valuable, report of the Glasgow Infirmary just pub- Richard Percy Chapman, 1843, Britannia; Cecil Crandell,lished: of 461 amputations of both kinds at this institution, 1843, Royal William: William Smith, 1843, Co2i?vay,- Johnwe find 177 deaths, 284 recoveries; and when we come to Gray (e), 1844, Trincomalee; George Everest, 1844, Algiers;analyze the figures more closely, we discover 197 primary J. Trail Urquhart Bremmer, 1844, Sanspareil; Charles

amputations (including 19 of the shoulder and 32 of the thigh, M’Shane, 1844, Caradoc; James Dennies Cronin, 1844, Vul-the crushed state of these parts by machinery being quite ter- ture William Thomas Billings, 1845, Fisgard; Edmund Law-rific,) yet only 61 deaths, or about 1 in 3; while in secondary less, 1845, Conway; John Turner Caddy, 1545, Monarch;amputations, with all the skill this splendid hospital affords, William Newman Brake, 1845, Dolphin John Sole, 1845,we have 264 secondary amputations of legs and arms, and 116 Express; William F. Nooth, 1845, Neptune; Charles Roberts,deaths, or about half. Five cases of excision of the head of the 1845, Naval Hospital; William Ross (b), 1845, Virago; Johnhumerus, all successful, have been done also, some for bullets Gun, 1846, ImpérieuseJ. Frederick William Blake, 1846,in the bone; 10 of excision of the elbow, from similar causes, Leander. Richard King, 1846, Victory; James Wicher, 1846,7 completely successful, 3 partially so - all facts of para- L’elleisle; and John V’ard (b), 1846, Vengeance.