548 



MILITARY BUEGERY AND MEDICINE. 



crowding, want of ventilation and cleanliness 

 in hospitals, by dampness, by unfavorable loca- 

 tion, by the bad position of the vaults or latrines 

 of the hospital or ward, and once developed it 

 becomes epidemic, and is propagated both by 

 infection and contagion in the wards of the hos- 

 pital. The scorbutic condition, or the depressed 

 vitality of the patient from excessive hajmor- 

 rhage, may induce it. It is characterized by a 

 phagedenic destruction of the soft tissues, leav- 

 ing the tendons, blood-vessels, and nerves com- 

 pletely dissected, and is attended by a most of- 

 fensive and penetrating odor, and severe gnaw- 

 3Qg and biting pains, and an almost entire loss 

 of appetite. Unless speedily arrested, it termi- 

 nates fatally within a few days. The treatment 

 adopted in the United States general hospitals, 

 has been new, but has proved so successful in 

 arresting the disease, that the mortality from it 

 has been considerably less than five per cent, of 

 the cases attacked. In the Spanish peninsula, 

 in 1813, nearly one-third of those attacked died. 

 The prophylactic and constitutional treatment, 

 though important, possesses little novelty, the 

 effort being to remove promptly all predispos- 

 ing or inducing causes of the disease in and 

 about the hospital, to destroy by burning any 

 thing which could communicate the disease, 

 and to support the patient by stimulants and a 

 most generous diet. The local applications 

 which have proved successful in arresting most 

 promptly this terrible disease, are bromine, ap- 

 plied pure (the surface having first been thor- 

 oughly cleansed by the use of soap and water, 

 the dead and gangrenous tissue carefully re- 

 moved, and carefully dried by the application 

 of lint) to the gangrenous surface, and a solu- 

 tion of a drachm to four ounces of water em- 

 ployed to paint the surrounding tissues. This 

 application is followed immediately by an emol- 

 lient poultice. A single thorough application 

 is usually sufficient to destroy the gangrene and 

 restore the part to a healthy condition, after 

 the evolution of the slough. For the introduc- 

 tion of this remedy, the profession are indebted 

 to Dr. Middleton Goldsmith, Surgeon U. S. V. 



The permanganate of potassa, first introduced 

 by Dr. Hinkle, A. A. Surgeon U. S. A., is per- 

 haps not inferior to bromine as a local applica- 

 tion in this disease. The concentrated solution 

 is applied as an escharotic, and the dilute solu- 

 tion applied on lint as a dressing and repeated 

 every three or four hours. Both this salt and 

 the bromine are powerful disinfectants. Tho 

 use of spirits of turpentine as a local application, 

 as recommended by Dr. Hachenberg A. A. 

 Surg. U. S. A., has proved an efficient and 

 speedy remedy. Leaving no chemical eschar, 

 it is perhaps on that account to be preferred to 

 the others. In default of these remedies, the 

 application of Maunsell's solution of persulphate 

 of iron, pure tincture of iodine, or of nitric acid, 

 will arrest the progress of the gangrene more 

 slowly, though with perhaps equal certainty. 

 In the treatment of scurvy, which has at differ- 

 ent periods prevailed somewhat extensively in 



the army, in addition to the use of potatoes, 

 onions, sauerkraut, oranges, lemons, and lime- 

 juice, which have been considered as the best 

 antiscorbutics, Dr. "William A. Hammond, late 

 Surgeon-General, recommended and introduced, 

 with the best effect, the use of the solution of 

 bitartrate of potassa (cream of tartar), as a 

 beverage among the men. The use of the com- 

 mon dandelion with vinegar, and of sorrel, are 

 also recommended. Both contain salts of po- 

 tassa, which in some form seems to be the most 

 effectual remedy for scurvy. Wine, cider, 

 spruce beer, and vinegar made from apples, are 

 also valuable for the same cause. The vinegar 

 made by the German process in the acetous fer- 

 mentation of alcohol, is worthless in this dis- 

 ease. Dr. Hammond also recommends from 

 his own practice, tincture chloride of iron in 

 doses of thirty drops three times a day. 



The use of anaesthetics in surgical operations 

 during the war, has been far more extensive 

 than in all the previous history of these agents. 

 An experience of their use in probably fully 

 two hundred thousand cases, ought to throw 

 light on the advantages and injuries resulting 

 from them, and to enable the profession to de- 

 termine whether their introduction is, all things 

 considered, a bane or a blessing. Yet, strange 

 as it may seem, the opinions of eminent surgeons 

 are at variance on this subject, and that after 

 extended opportunities of observation Dr. Frank 

 II. Hamilton, after a very large experience in 

 surgical operations both before and since the 

 introduction of anaesthetics, states distinctly, 

 that " his success in capital operations, especial- 

 ly in primary thigh operations, has not been BO 

 good since he began to use these agents as it 

 was before." " Anesthetics," he says, "produce 

 certain effects upon the system which tend to 

 prevent union by the first intention ; and con- 

 sequently they must be regarded as indirectly 

 causes of suppuration, pyaemia, secondary hem- 

 orrhage, erysipelas, and hospital gangrene. 

 Ether, he thinks, ought to be preferred to chlo- 

 roform, being less liable to destroy life imme- 

 diately. 



Mr. Cole, an eminent English surgeon, re- 

 gards chloroform " as a highly pernicious agent," 

 and desires that it should be entirely excluded 

 from field and field-hospital practice." The 

 Director-General of the Medical Department of 

 the British Army states, " that while a majority 

 of the surgeons of that army believe its use 

 desirable in all cases both of slight and severe 

 wounds requiring operations, where no organic 

 disease exists, a large minority object to its use 

 in cases of very severe shock, more especially 

 where much blood has been lost ; and a smaller 

 minority believe its use to be dangerous in sec- 

 ondary operations, where the patient's system 

 has been much reduced by large purulent dis- 

 charges, and more especially when this reduc- 

 tion has taken place with rapidity greater than 

 usual from inordinate amount of discharge, or 

 from the addition of secondary hemorrhage." 

 Dr. Zina Pitcher, of Detroit, a surgeon in the 



