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82 their elastic areolæ holding an amorphous granulo-molecular substance, which has or has not imbedded in it irregular nuclear- looking particles, variously sized, solid, fat granules, and shrivelled cells. The second condition is that in which there is a slightly tenacious granulo-molecular basis substance, with minute portions of fibre, and having imbedded in it shrivelled cells, irregular nuclear particles and fat granules. The portions of fibre are abundant, look like comminuted elastic tissue, and are proved to be such by chemical reagents. The third condi- tion is that in which minute, opaque specks are scattered through the expectoration, sometimes of the size and shape of air-vesicles, sometimes not. These portions transmit the light feebly, are of a pale grey colour, and exhibit a slightly coherent granulo-molecular basis substance, a few shrivelled and disin- tegrating cells, numerous irregular, angular, compressed, and eroded nuclear particles, resisting the action of acetic acid, fat and oil granules, together with undeterminate débris. True pus globules are often but not always associated with these elements. They are not, however, mingled with the tubercular elements, but surround the minute tubercular masses. Your reviewer has not accepted my proposal ; and there are weighty reasons why I should not accept his, in the way in which he has put it. A little reflection will show that it is not quite a fair one. Tubercular matter is not always to be found in the sputum; and there are sources of fallacy in the proposal of your reviewer which could not be avoided without personal superintendence. In such a trial the lot might fall to him or to me, and the matter be decided accordingly, and perhaps wrongly. We are each of us, it is to be hoped, seeking for truth, not triumph; and it would be as unjustifiable as it would be unwise, for the sake of any personal satisfaction, to risk the recognition of a truth upon a plausible but most fallacious ex, periment. Though I cannot agree to have this matter decided by an experiment of the kind proposed, I shall most gladly examine and report upon any specimens of sputum forwarded by your reviewer or by any of my professional brethren, and I am well assured that he and others will more surely reach the truth in this way than any other. Dr. Theophilus Thompson, who is well known as a careful and conscientious practical observer, has examined many of my preparations, and holds, in the main, the same opinions on this matter as myself. I took exception to your reviewer’s assertion of the impossi- hility of recognising tubercular matter in the sputum of early phthisis. I hold that exception to be founded in fact, and to be justified by my preparations. The further development of this matter must be determined by observation, not argument, and I shall not be the last to assent to the results of collective experience, even if they convict me of having erred. I am, Sir, your humble servant, Montague-place, Russell-square, 1855. ANDREW CLARK. SURGERY OF THE WAR. THERE was a time, and that not a year ago, perhaps, when the smallest of the dread events now daily chronicled in the Crimea, would have arrested, if not entirely paralyzed, public attention. Our sick troops dying by hundreds a week, from the inclemencies of a Russian winter; hospital gangrene, dysentery, and tetanus, still numbering their daily victims amongst the wounded. If there be for us a bright spot, it is gratifying to find that we have only been anticipating the zvel deserved eulogy passed on our army surgeons generally by Thl Times. Like the bravery of our soldiers at Inkermann and Alma, in the midst of much want of proper administration, "nothing," says the leading journal, "could exceed the per sonal activity of the medical staff at the hospitals at Scutari. They are so over-worked, they might well be patients them selves. The operations have been skilfully performed, and we have often had opportunities of observing, on the part of par ticular surgeons, acts of no common kindness to their patients. All did their best, and that under difficulties scarcely to be conceived." We thought it necessary last week, it will b( remembered, to defend our younger surgeons from the asper sions cast upon them by amateur writers, who ascribed hos pital gangrene and dysentery to the want of skill displayed but the possibility of checking the latter may be conceived, from the thousand hardships to which the troops have been exposed, such as want of clothing, want of proper food, bad diet, raw pork and biscuits, inducing scurvy, wet and cold in their hundred forms by night and day, completely setting medical aid at defiance. Ship-loads, it is said, of dysentery and diar- rhœa patients were sent to Scutari without even opium on board. In one week, indeed, ending January 3rd, we find in these long lists that to sadden the brighter glimpses of the war, 274 deaths at Scutari ; and of these, 179 from diarrhcea, and dysentery alone. The other parts of these tables, at pre- sent, are of no use, so completely has dysentery swept, and still sweeps, we regret to say, like a devastating pestilence through all the regiments; so completely now have scurvy, dysentery, and hospital fever overwhelmed the troops and hos. pitals with dead and dying. The first week of the present month, in addition to this mortality, finds us with 3984 sick and wounded at Scutari; 1000 more waiting in ships, four of which had been set apart for receiving the sick and wounded; besides new hospitals at Rhodes, Gibraltar, Malta, &c. The condition of the sick and wounded still remains very melancholy; the nurses and hos. pital orderlies, in many instances, having fallen victims to the pestilence. Dysentery, it is discovered, has assumed an epi. demic and bad form, resisting all treatment. The greater the want of these invalided sick hospital orderlies and nurses, it is found, the greater the impediment to move the sick; and, as may be tOOJreadily conceived, the greater the fatality of this disease. The hospitals at Balaklava, removed from the ad- vantages belonging to Constantinople, are also described, at present, as in a frightful condition, the sick lying in all varieties of neglect and filth. Much of this, no doubt, is inse- parable from the horrors of war; yet, we believe, still much good will be done, more especially among medical men at home, whose advice will be more or less taken on these subjects that the worst should be known. The want of sufficient organiza. tion may be conceived, when it is stated that, in the Peninsular War, with 70,000 men, we had twenty-one hospital purveyors, with twenty-one clerks; while, before Sebastopol and at Scu- tari, it is said, we have never had but one hospital purveyor and three clerks, amongst whom have already been deaths We are now in a stranger and more inhospitable country than the Peninsula-scorbutic dysentery, from want of vegetables, as we all along feared, carrying off men by dozens every day, surgeons crying out in vain for lime-juice and fresh vegetables, not raw coffee, salt pork, biscuits, &c. Fresh meat, we need scarcely say, is not a specific for scurvy, as popularly believed; but fresh meat, with fresh vegetables, we trust, may yet bring the army into an efficient condition, if sufficient attention can be directed to these points. The transport service, we are gratified to learn, is better arranged, a departmental order having been just issued of some interest, showing us that all organization is not at an end. After naming four ships (the Melbo2crrze, Australian, Sydney, and Brandon) for the conveyance of the sick from Balaklava to Scutari, the surgeons (Messrs. Rutherford, Lane Sheehy, Moorhead, and Ancell, for the first two ships; Donnell and Hooper, Wishart and Paliologus, for the latter) are directed to see that the sick are properly put up, their food of good quality and properly cooked, and that they receive the medi- cines, &c., ordered for them; that they pay attention also to the cleanliness of the ship. These surgeons, however, are further embarrassed, we would say, with medical journals- printed monthly and weekly forms; No. 1 and No. 2 for medical comforts; which will be carefully examined, it is noted, on the arrival of each vessel, to see that the expenditure corre. sponds with the entries of the medical journals. Each staff- surgeon (2nd class) to provide himself with a case of operating instruments-his own property; but a medicine-chest, and such other medical and surgical appliances, to be supplied from the apothecaries’ store. Each transport to be visited at Balaklava and Scutari by a staff-surgeon (lst class); this officer to report to head-quarters. Mr. Macgrigor, surgeon, until further orders, attends to this only. All this appears a move in the right direction, and one in some measure due to the agitation of the subject in the medical and daily press in England. We trust that our younger army surgeons, so hard. worked, will not be forgotten in the promotions going forward. One sergeant from each regiment in the Crimea is to be made ensign or cornet, and our staff officers have had heaped upon them very undeserved promotions. We trust Dr. A. Smith will avoid this universal subject of dissatisfaction, and, in pro- moting the really active men, afford the best commentary on Lord Raglan’s previous false estimate of their services.
