I have seen some things to admire in French hospital organization, and can commend certain facilities for uniformity and despatch, which the system of cahiers and formulated prescriptions, tisans and food, affords; and, indeed, without which it would be utterly impossible for any surgeon to glance at and indicate any particular physic or regimen for his patients, during the two hours to which his morning visit is restricted. But I need not point out how these very facilities, this rapidity of action, and disproportionate clinical investigation, produce, as their least evils, necessarily imperfect diagnosis, empiricism in practice, and mere conjectures as to the efficiency of modes of treatment or the fatality of disease.

This is no fanciful sketch, inopportunely forced on view, when the matter in hand is the treatment of typhus in the French hospitals of Constantinople, the head quarters of its Medical and Intendance Staffs. Neither medical science nor common-sense humanity had fair scope for their exercise under the above circumstances. For this reason it is thought unnecessary to bestow many lines on this part of my subject. From what I observed of the practice, and learnt by discussion of the pathological views of my French colleagues, there are little of novelty, and less of reasoned purpose in their therapeutics, as regards the treatment of typhus. I have heard of general bleeding being employed by one or two surgeons, and leeching of the head by others; but the results have not

alteration of the dinner ordered at the morning visit. This visit closes all the responsibility of the Médecin-traitant for the day. All other ward-duties and casual requirements devolve on the Médecin de garde (orderly officer).

recommended the treatment. Emetics and purgatives are very generally prescribed at the commencement for those seized in the wards, and the large use of calomel is no longer an exclusive English practice. Scruple doses twice or thrice in twenty-four hours, followed by saline purgatives and turpentine enemata, prove, by the generality of the practice, how utterly Broussaism is in desuetude.

Counter-irritation by sinapisms, blisters, and even the actual cautery down the spine, is much in vogue. Quinine in very full doses-twenty to twenty-five grains-and almost in all stages of the disease and state of the patient, is prescribed generally; by some for its alleged tonic properties, by others as a so-called antiseptic, by most for its undoubted febrifuge virtues. More than one practitioner upholds its specific influence in the epidemic.

For the most part, the diet consists of soups and medicated drinks. Wine is sparingly ordered for its stimulating properties. Several of my French colleagues bore willing testimony to the superior efficacy of our English port wine, a generous supply of which was furnished from the Scutari hospital stores on the special recommendation of Dr. Linton. I have to express my personal acknowledgments to Miss Nightingale for the gift of a barrel of this wine, presented more particularly for the use of my own wards at Gulhanéh.

As respects my individual experience and practice, a very few sentences will tell all necessary to be made known at present. Looking upon this fever as essentially a primary disease of function, in the sense in which Dr. Corrigan uses the term, and which lesion of function alike stamped its character and defined its type, I sought

to ascertain the predominant function affected, and, on this discrimination, founded the indications of my treatment. In the decided majority of my Crimean cases the lesion of the circulatory function was shown unequivocally in the state of the pulse, feebleness of the heart's action, petechiæ, and utter prostration of the patient.

In all the orderlies, and most of the convalescents, infected in my wards, I found the fever ushered in by decided cerebro-spinal disturbance. In a few there were pulmonary complications, and these, as before stated, proved least amenable to any treatment. In all the function of nutrition, including assimilation, secretion, and excretion, was compromised. With this variableness of form, though not of essence, there could be no exclusive system of treatment. Neither bark or wine, bleeding or antimony, emetics, purgatives, diuretics, counterstimulants, could be used indiscriminately or invariably at the outset, or during the course of the disease. Hence any specific medication or uniform mode of general treatment must degenerate into sheerest empiricism. For myself, in having recourse par force to French pharmaceutical formulæ, I experienced some difficulty in devising and substituting remedies for those which my older acquaintance with the fever first obviously suggested. Thus the only available preparations of mercury were calomel, corrosive sublimate, and an ioduret. No Dover's powder, though admitted by name into the formulaire militaire; no henbane nor hemlock; no preparation of ammonia, save the acetate as a salt; no brandy; no disposition on the part of the pharmacien to obtain any drug or prepare any medicine which he was without, even though sanctioned

by the above printed authority; nor power on the part of the Médecin-en-Chef to enforce compliance.

In the hospital dietary there was offered sufficient variety, but little substantial nutriment; and the surgeon has no licence to extemporise or substitute extras, otherwise than under the penalty of having the cost of the same deducted from his next monthly pay. I speak here of the regimen of the private soldier. In the case of sick officers there are no restrictions whatever.

On the whole, a wretched administrative parsimony governs and injures medical practice in the wards of French military hospitals. Economy of all kinds abounds throughout, save in human life and suffering.

SCUTARI HOSPITAL, 2nd May, 1856.

NOTE

ON THE HOSPITAL MEANS AND SANITARY STATE OF THE TURKISH AND SARDINIAN ARMIES.

Ir has been suggested to me to append a brief note respecting the sanitary state and hospital provisions of our two other Allies in the Eastern War. In complying, I fear that I shall only seem to make more apparent the exceptional character of the preceding representations. Justice, however, obliges me to say that, during the winter of 1855 and spring of 1856, France stood alone as regards the sufferings and losses from camp diseases experienced by the Crimean armies. I know of no fact that discredits the foresight judgment, and success of Turkey and Sardinia in maintaining the health of their soldiers in the field and of restoring the sick to service. On the contrary, my own professional experience entitles me to speak of the liberal and enlightened measures taken at Constantinople by the Turkish Government for the welfare of their sick and wounded soldiers. There was provided a large hospital staff, consisting of civil practitioners-natives and foreigners,-all selected with care; several, teachers at the Imperial School of Medicine, and many otherwise of creditable repute in private practice. The pay and appointments were above those of similar rank in Continental armies; and their personal position and professional authority in their wards were at least equivalent to what the English medical officer enjoys. The ordinary hospital dietary was excel