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urine for the establishing of the diagnosis and prognosis are, as it appears, of subordinate value. On account of the difficulty of collecting a large quantity of perspiration in diseases, our investigations are still very deficient. The mere assertions which we possess on the subject still require confirmation by repeated observations. The normal perspiration has constantly an acid reaction; but this free acid increases to an extraordinary degree in some diseases, as for instance, in rheumatism and gout. In these diseases it is found that the perspiration of the forehead, breast, and extremities intensely reddens litmus-paper in a rapid and extraordinary manner. According to Berend in putrid and typhus fever the perspiration not only should lose its acid, but even have an ammoniacal smell; according to Anselmino, in the critical sweat of a person labouring under rheumatic fever albumen should be present. Voigtel will have it that he has observed bloody sweat, and according to others this same thing is observed in putrid fever and typhus icterodes;-that the sweat of patients labouring under calculus, as also of gouty persons, contains uric acid and urate of soda, whereby, after the evaporation of the water, the body becomes covered over with a fine crystalline coating, has been frequently proved. In the sweat of icteric patients, as also of those labouring under the febris putrida biliosa, the colouring matter of the bile has been sometimes found. The red colouring matter, which imparts its colour to the lateritious sediment, has been found by Landerer in the sweat of the axillary glands of a fever patient. Blue sweat has been observed several times. In the colliquative sweats of hectic patients fat also has been found. All these signs are unsatisfactory; they do not appear constant in the various diseases, and for that reason possess far less importance than those derived from the blood or urine. The odour also of the perspiration is of particular importance. It is well known, that many medical men, on entering the sick-chamber, nay, even the sick-house, can infer the disease from the particular scent. The smell of the sweat can be the subject of chemical enquiry in but few cases; one may no doubt infer the presence of acetic acid in perspiration emitting an acid odour, and that of ammonia in sweat with an ammoniacal odour; but in most other cases the chemical examination is unattended with success; in like manner, the physician who possesses quickness of sense for distinguishing various odours, and who has exercised this sense by several years' experience, can be assisted through the sense of smell with tolerable certainty. The sweat of rheumatic and gouty persons has an acid odour; the sweat of putrid-fever patients and of scorbutic patients should have a putrid odour, that of syphilitic patients a sweetish one, that of itchy patients a mouldy smell, that of jaundic patients a musk-like smell, that of scrophulous patients the smell of sour dough, that of ague patients the smell of fresh-baked brown-bread.
The chemical and microscopical examination of the intestinal excretions is sometimes useful for the diagnosis. In disease, the fæcal matters deviate considerably from the normal state, as well in reference to their consistence as also to their mechanical and chemical composition. The deficiency of bile in the stools in cases of jaundice is sufficiently obvious. The great quantity of intestinal mucus floating in the watery dysenteric stools, which
appears to the naked eye sometimes as a whey-like fluid with cheesy-flakes mixed through it, sometimes as a purulent mucus mixed with water, sometimes red-coloured with blood, and sometimes colourless, can be discovered with certainty only by means of the microscope; sometimes we find portions of coagulated exuded lymph, in which by proper management with the microscope we can recognize the fibrous structure of the coagulated fibrinous matter. The typhous stools thus readily dividing themselves into two strata exhibit to view by means of the microscope an extraordinary quantity of prismatic crystals of the triple-magnesian phosphate, besides mucus-corpuscles, and fragments of the epithelium of the intestinal mucous membrane connected together. In like manner, in intestinal typhus, the fluid stools divide themselves into two strata, of which the inferior, purulent-looking, is recognized under the microscope as constituted of mucus and pus-corpuscles; the superior stratum, in which these same corpuscles are still suspended, and sometimes fatty globules may also be discovered, is generally distinguished by a considerable quantity of dissolved albumen. The watery stools in cholera present under the microscope, among other objects, numerous crystals of triple magnesian phosphate; the purple red colour which these stools assume, when they are mixed with nitric acid, seems characteristic.
We may now notice the peculiar qualities of the vomiting which occurs in violent inflammations of the abdominal organs, and in carcinoma of the stomach; in the former case a watery, slightly mucous, green-coloured fluid, often extremely abounding in fat, is vomited forth; the fatty contents of which may be distinguished even with the naked eye, but still better with the microscope; in the second place, the mucous chocolatecoloured discharges contain a dark-coloured amorphous matter, several large yellow-coloured cells, which are filled with a granular mass, which also contains small fatty globules mixed with them. Besides a more or less considerable quantity of fatty drops seems to be peculiar to this vomiting.
REPORT OF THE COMMISSIONERS FOR ENQUIRING INTO NAVAL AND MILITARY PROMOTION AND RETIREMENT. With Appendices. Medical Department of the Army. Presented to both Houses of Parliament by Command of Her Majesty. 1840.
In a recent number we glanced at the rise, progress, and decay of the Army Medical Board in England; and we took occasion to mention, at the same time, some of the acts of the Medical Boards in the East Indies, which, in our estimation, entitled them to a similar fate with their prototype of the mother country.
We believe it will be found with Boards, as with individuals-that they can only be seriously injured in character by their own acts of omission, or of commission; and we anticipate that we shall be admitted, by impartial persons, to have exhibited enough of the one kind, and of the other, justly to entitle both the European and the Asiatic Boards to the doom which necessarily awaited the one, and which as necessarily impends over the others.
The present admirable Director-General of the British Army Medical Department joined what was still called "the Medical Board," in 1815; and, though much the junior officer, continued the influential, and, as may well be supposed, the guiding and ruling member until 1833, when, by the natural removal of the last rags of the old system, he became the sole and responsible head of the Medical Department of the Army-a position to which his character and talents, as well as his long and tried services in the East and West Indies, in Egypt, in Walcheren, and in the Peninsula, during the campaigns of Wellington, so justly entitle him-a position in which, we will venture to say, he has not disappointed the expectations of any good man in the army, whether above or below him in station. This is great praise, we know; and we can assure the distinguished officer under consideration, as well as the public at large, that we make it as advisedly as impartially. We have no motive in stating other than what we believe, and indeed know, to be the truth.
In our former article we adduced sufficient evidence of the crying public evils attending the government of a Medical Board in London; and having done so, we shall not detain our readers with a detail of the feeble, petty bickerings-the vapid, wordy "minutes in dissent"-with which, in their last moments, and when they had lost the power of doing evil, the senior members worried and vexed the kindly-minded and excellent Chief, the Duke of York. Suffice it to say that, though they could never agree amongst themselves on any point, they nevertheless, like other old men, in other parts of the world, objected to everything, however excellent, that came from a junior, or that they could not be made to understand, or of which they could not be expected to see the end ;-and thus expired, as full of age as wanting in public honour, the Army Medical Board of England.
The Report of the Commissioners* occupies but four pages of large print, and need not detain us long.
It affords, indeed, a most emphatic and melancholy instance of the cold and unpardonable indifference with which all matters connected with the medical department of the army are viewed by those even who might be expected, from previous habits of life, if not from feelings of personal gratitude, to look upon them with a friendly and
"We would beg to observe to your Majesty," says the report," that the general impression produced on our minds by the examination of the evidence, both verbal and documentary, which was placed before us, was that the condition of the army medical officers was not unfavourable; that the great advantages of increased pay and increased retired allowances which were given to this class of officers by the regulations of 1830, were well calculated to secure a succession of accomplished medical officers for the military service; and that but few changes in those regulations would be requisite to place that branch of the service in a satisfactory position in relation to other ranks in the army.
"According to the existing establishment of medical officers as laid down in the Warrant of 1830, there are six classes, viz :—
Inspector General of Hospitals,
Deputy Inspector General of Hospitals,
Assistant Surgeon, and the course of promotion is regulated
throughout upon a principle of selection.
"The Assistant Surgeon is eligible for promotion to the rank either of staff surgeon or regimental surgeon upon vacancies in the authorised establishment, while his subsequent advancement from the rank of surgeon, must, under the warrant, be made through the commission of assistant inspector.
"The Deputy Inspector Generals' appointments are filled by selection from the assistant inspectors; and the deputy inspectors furnish the candidates from whom the inspectors general are taken."
The Report then goes on to state that, while in general it approves the existing regulations, they require amendment, for the purpose of rendering more clear the demarcation of the comparative ranks and respective duties of medical officers of the different grades, and also for that of diminishing the time which elapses before they can expect to receive the first step of advancement in their profession.
"The Staff Surgeons ought, we conceive, to be considered a superior appointment to that of regimental surgeon; but this superiority can hardly be said at present to exist, since the assistant surgeon may now be appointed to be a staff surgeon, without having previously gone through the rank of regimental surgeon, while the staff surgeon, who throughout the war was accustomed equally with the physician, whose place is now filled by the assistant inspector of hospitals, to look forward to the rank of deputy inspector, as a step immediately above him, is now required to pass through the rank of assistant inspector, for which the regimental surgeon is not considered less eligible than himself."
In order that each class of officer might bear the name more correctly
describing their respective situations, the Commission recommended to give to those staff assistant surgeons, whom it is proposed to place on a level with the regimental surgeon, the appellation of staff surgeon of the second class.
"The regular course of promotion in the army medical service would then be as follows:
1. Assistant Surgeon (staff or regimental),
2. Surgeon (regimental or staff of the second class),
3. Staff Surgeon,
4. Deputy Inspector,
"The difference of pay between the regimental and the staff surgeon is also insufficient to counterbalance the advantage which the former derives from his mess and other regimental privileges, insomuch that it is practically found that regimental surgeons are frequently unwilling to accept the appointment of staff surgeon. It appears to us also that the nature of the duties which should properly belong to medical officers on the staff does not require that there should be so great a number of different ranks of these officers as at present exists."
For these reasons the Commissioners recommend the substitution of the scale of grades last given, in place of that first quoted, and the abolition consequently of the rank of assistant inspector, while the pay and comparative rank in the army now enjoyed by this class of officers should be conferred upon the staff surgeon; which appointment should be in future considered the intermediate grade between the regimental surgeon and the deputy inspector of hospitals. These suggestions of the Commission
ers have, we believe, been adopted.
The conclusions submitted to Her Majesty's consideration are as follows: "1. That it is not expedient to alter the existing rules with respect to the promotion of the medical officers of the army, for the purpose of facilitating promotion upon half-pay or by brevet.
"2. That to extend the means of promotion upon full-pay, it is expedient to make the following changes:
1st. To abolish the rank of assistant inspector.
2nd. To give to staff-surgeons the pay and half-pay, and the comparative rank with other officers of the army, now enjoyed by assistant inspectors; making also the rank of staff surgeon the regular intermediate step from that of regimental surgeon to that of deputy inspector.
3rd. To divide the assistant staff surgeons into two classes, allowing the first class the rank and pay of regimental surgeons.
"3. That it is expedient to allow medical officers retiring after twenty-five years' service, the advantage of reduced instead of retired scale of pay.
"4. That it be recommended to the military authorities of the army to consider of the means of giving to the medical staff officers attached to an army in the field, the services of a soldier servant, which shall avoid to weaken the ranks of the battalions or regiments of the army in the field.
"5. That when not employed in the field, such medical staff officers should receive, as compensation for the services of a soldier, an allowance not exceeding 18. a day."
We now propose to analyze the evidence of Sir James M'Grigor, and of Mr. Guthrie, as given in the verbal and documentary forms to the Commissioners for inquiry into Naval and Military Promotion and Retirement.