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RIFLE-BULLET, SHRAPNEL, AND SHELL WOUNDS IN THE RUSSO-JAPANESE WAR AND COMPARATIVE CASUALTIES.
1340 Conan Doyle received at the Chefalrat.
same
time the Order of the!
very wide.
Such
gaping
wounds
were
found in the fore-.
head, temple, and in the extremities. Small wounds of’ this category usually healed by cicatrising but the larger THE Master and Wardens of the Society of ApothecariesI ones healed only after a second bandaging in most cases. Where suppuration was present in the three categories will entertain guests at dinner in the Hall of the Society above described it was mostly in cases of imbedded bullets, "to meet the Lord Mayor" on Tuesday, Nov. 19th. sometimes in case of torn wounds, and least of all in cases of ____
through-and-through perforations. In the cases of throughand-through perforation the suppuration appeared to result. from bleeding deep in the wound. Most of the instancesRIFLE-BULLET, SHRAPNEL, AND SHELL of suppuration in blind perforations occurred where the WOUNDS IN THE RUSSO-JAPANESE bullet was present, particularly if disfigured through ricochet or other cause. It is interesting to observe that often, almost WAR AND COMPARATIVE next the bullets found in the tissue under the immediately CASUALTIES. skin when extracted, suppuration was found even after both the opening of the wound and the perforation had well A REPORT read by M. I. Glagolieff before the Society of cicatrised. Medical Men of Krementchug appears in the Ohirurgia of M. Glagolieff concluded his observations on rifle-bullet Moscow. It deals specially with wounds in the soft parts wounds by remarking the very unfavourable course followed of the extremities as well as in the head, neck, and trunk by most of the wounds in the soft parts of the wrists, arms, that were treated in the Fourteenth Kharbin Collecting feet, and fingers. Wounds in these parts were often irregular Hospital which began its operations at Lyaoyan in July, 1905. with rough edges. These wounds frequently ran a bad From Lyaoyan it was transferred to Kharbin and thence to course, accompanied by suppuration and inflammation which, Vladivostok. It dealt with 5956 cases of sick and wounded, affected even uninjured parts. Lymphangitis was frequent. of which 2290 were wounded. Of these, 2273 were the In all the cases that came under his observation he did not victims of firearms and 17 only (0 ’ 7 per cent.) of cold steel. find one in which the bullet carried part of the victim’s The wounds were distributed as follows :clothing into the wound, which was so common with the old, 616 (26’9 per cent.) Lower extremities large bullet. It was, however, far otherwise with the 606 (26-4 per cent. Upper shrapnel-bullet wounds that he describes. He attributes ) 71-3 ) 412 (18-0 Joints 25 per cent. of all the wounds to shrapnel. He attaches Thorax 177 ( 7-7 ) importance to this note, as he thinks the chief military 122 ( 53 Head medical department failed to establish the relative import) ance of rifle-bullet and shrapnel wounds in the statistics (of which 32 were with fractured skull) 100 (4’3 per cent.) Face published after the war-at least, they are not indicated in 84 Pelvis ......
......
"
...............
...............
II
...............
"
..................
(3-6
) ) ) )
the charts. He continues that the late Russo-Turkish war showed only 4 per cent. of wounds from shells. But now this " is all changed. Besides through-and-through perforations, II blind perforations, and surface wounds all as in the case of the rifle bullet, the shrapnel also made irregular wounds with The total number of deaths in the hospital was 18, of torn edges. The form of the blind perforations was thewhich eight were cases of wounds, or 0’35 per cent. Most prevailing shrapnel wound. The more frequent imbedding of the wounds resulted from rifle fire, then shrapnel, and of the shrapnel bullet in the body is very striking. The size lastly splinters of shells. The rifle-bullet wounds took the of the entry and exit of the bullet into and out of the body form of through-and-through perforations or canals, blind respectively was from 1’1 1 to 5’ 2 centimetres diameter, perforations or canals, or of open wounds with rough or in some cases the entry being larger than the exit; whilst,. smooth edges. The through-and-through perforation was the again, the former would in some cases be fairly round most frequent. Of 100 cases of wounds in the extremities and the latter longer and wider. The blow of the shrapnel taken without selection nine were surface wounds, three bullet generally made a wound 5, 7, or 10 centimetres long blind perforations, and 87 were through-and- and 2, 3, or 5 centimetres wide. Wounds from shrapnel in were through perforations. After further detailing the classi- the hands, feet, and fingers were usually irregular with fication of wounds, M. Glagolieff made the observation that broken edges. For the scab to form and the wound to heal according to the hospital reports in cases of wounds from at the first bandaging was rare. These wounds took longer distances of about a verst and over the entry and exit to cicatrise than wounds from rifle bullets and they supopenings differed but little, whilst the entry was more fre- purated also in more cases, no matter what the kind of quently the larger. At short distances the exit orifice was wound. They also more frequently gave rise to swelling and more frequently the larger. These openings were usually subcutaneous effusion of blood. The causes of these aggrainsignificant and were mostly of a diameter of (or even less vations must be supposed to be the more frequent imbedding than) the bullet. The exceptions were cases where the of the bullet in the body, the greater tearing of the tissue, bullet did not hit diametrically, such as ricochets. There &c., the more extensive bleeding, and finally the frewas no sign of injury round the openings of the typical quency with which the larger shrapnel bullet took bits of wounds except just at the edges. shirt, uniform, &c., into the wound. He remarks in conFresh wounds were never seen ; there was always an clusion, with respect to shrapnel bullets, that often as interval of from three to seven days between the infliction they were extracted in no case did they show any material of the wound and the arrival of the patient in hospital. deformation. Patients arrived usually straight from the battlefield with There were very few cases of wounds from shell splinters. their wounds, generally speaking, in one of the three follow- When extracted from the wounds they were seldom larger ing conditions : (1) both orifices cicatrised ; (2) one only so, than shrapnel bullets. They were pieces of dark metal, very with the other like a clean wound; and (3) one orifice irregular in shape, and often with several sharp points. The cicatrised or like a clean wound and the other suppurating. wounds which they caused were mostly irregular, approaching Nos. 1 and 2 conditions usually required from two to three to roundness and varying in size from 0’5byO’75 centimetre and a half weeks to heal. No. 3 class would take about three to 1’1 1 by 5 2 centimetres. The hospital had no cases of weeks to heal. The suppuration was easily arrested and very large wounds of this class. The wounds were usually otherwise the healing was as easy as in Nos. 1 and 2. blind perforations of varying depths. Through-and-through The cases of wounds consisting of blind perforations were perforations were rare. Where the muscles were torn the few and resulted usually from bullets either spent or wounds gaped wide. The peculiarity of these wounds was interrupted in their course by hard objects, such as stones, their multiplicity. Some of the patients would be struck in and the consequent disfiguration in the bullet produced a ten or more places, but generally the wounds were small correspondingly irregular wound. In a very few cases the and were not deep. The small wounds cicatrised readily bullets were not found but these wounds also healed easily, enough but most of the large ones suppurated-particularly where the flesh was much torn-and healed slowly. especially where there were no bullets. Surface bullet wounds, chiefly in the head, were more M. Glagolieff then turns to wounds of the soft parts comcommon. They varied from 1 to 10 centimetres long and plicated with injury to the large blood-vessels. The remarkfrom 0-5 to 0-3 centimetre wide. Sometimes when the able feature of war subsequently to the adoption of smallbullet struck the muscle diametrically the wound would be calibre arms has been the rarity of bleeding after the wounds ...............
Vertebra and Back...... Neck Abdomen Post operation wounds ...
...............
............
66 (28 8 44 (1-9 44 (1’9 19
"
"
1341 ;and the formation of traumatic aneurysms which has been observed by many authorities who witnessed the first bandaging of the wounded at the front. The wounds quickly close up and get choked with blood, so that if a blood-vessel is It percolates into the broken the blood cannot escape. surrounding tissue till the exterior pressure is equal to the interior, and with partial injury to the wall of the vessel in -casean opening is made, the blood flows to the tissue nearest the rent and gradually pushes it to one side. Here a hsematoma is formed. The blood coagulates at its periphery and remains liquid in the middle and thus an arterial traumatic aneurysm is formed. Such cases should be subjected to primary bandaging on the field of battle, says Professor von Manteuffel. M. Glagolieff then relates a number of such cases that reached the hospital in the rear. In all cases of arterial aneurysm the wounds healed with the first bandaging. In some cases the swelling gradually increased, ’ then pain followed and became worse till it was unbearable, I probably because of the pressure of the ba3matoma on the nerves. In two cases this led to a successful operation, but in a third case, after ligaturing the deep artery of the hip, the feet and knees became benumbed, and on the seventeenth day after the operation amputation at the lower third of the thigh was resorted to. The patient recovered. There were very few cases of injury to the great nerves. These are quoted without comment. There were only two or three cases of erysipelas and only five of tetanus. The most difficult operations were those on the aneurysm involving the ligaturing of the injured vessel and the removal of the hasmatoma. M. Glagolieff concludes as follow : ’’ Most of the rifle-shot wounds were aseptic and the blood in the perforations thickened so that a scab soon formed and excluded contagion. The shrapnel wounds greatly resembled those of the old large leaden bullets, including the tendency to carry bits of textile (clothing) into the wounds. Experience shows that wounds probed at the first-aid stations and sanitary wagons and from which bullets were extracted on the spot frequently suppurated ; hence it may be concluded that excepting the application of aseptic protective bandages the wounds should not be treated either at the front or in sanitary wagons. The treatment of cicatrised and clean vounds should be aseptic. The best bandage for cicatrised wounds is the collodion bandage. Iodoform preferably, as sterilised iodoform muslin, may be applied to inflamed and suppurating wounds." All the lint, wool, and muslin supplied to the hospitals seem to have been satisfactory. Collodion and spirit were both of great service. It appears that the hospital inventory requires to be augmented by such items as sterilisers for material and operating linen and for instruments, lamps or heaters for sterilisers, and enamelled basins for holding used bandaging material. A subsequent issue of the Oki’l’1f.’rgia contains a report by P. Ph. Koltchin on the cases treated in the lst Barracks of the Ninth Kharbin Collecting Hospital, the statistics of which make an interesting comparison with those of the Fourteenth Kharbin Collecting Hospital with respect to the relative casualty-producing power of the various arms. Out of a total of 832 cases 634 (76 -2 per cent.) were rifle-bullet wounds, 140 (16’88 per cent.) were shrapnel wounds, 45 (5’4per cent.) were wounds from exploded shells, and 7 (0’ 8 per cent.) were from cold steel. The negligible balance was from contusions or from unknown causes. Again, 679 (81’6per cent.) were through-and through wounds and 153 (18 .per cent.) were blind. As many as 633 (76 - 08 per cent.) healed without suppuration and 199 (23’99 per cent.) with suppuration. 12 patients (1’4 per cent.) died.
Germany, Switzerland, and France are rich in and in our patronage of them we are apt to forget that there are admirable health resorts within the British Isles. Bath and Buxton, Cheltenham and Harrogate, Leamington and Woodhall in England, and Strathpeffer, Dunblane, Pitcaithly, and Bridge of Allan north of the border, all possess climatic and balneological advantages of a very high order and have the additional advantage of lying much nearer the patient’s home than the continental spas. Notices of some of these places have appeared from time to time in the leading medical journals and on this occasion I would call attention to the advantages enjoyed by that beautiful little Stirlingshire town, Bridge of Allan. Situated on the picturesque river of the same name and on the main Caledonian railway line from Glasgow to Perth and Aberdeen, it is readily accessible both from Edinburgh and Glasgow, as well as from the south. It lies under the shelter of a spur of the Ochils, which effectually protects it from the winds of the north and east, while the ground, sloping gently towards the south, widens out into the strath of the Forth and affords a splendid exposure for sunshine. The climate is mild and equable, and with its moderate rainfall possesses the freshness of the west of Scotland blended with that of the east. The slope of the ground permits of the ready drainage of moisture, and the air is singularly free from mist and fog. The real value of Bridge of Allan as a health resort lies, however, in its abundant supply of natural mineral waters. These have been known for many years but have only received detailed attention within recent years. Their source consists of six springs, tapped at a depth of 116 feet. These springs are not uniform in composition, four being very rich in saline constituents, the remaining two less so. The springs mix together at the bottom of the shaft from which they are pumped up. and it is this mixed A recent analysis (April, 1907) of water that is used. this water showed it to have the following composition :resorted to. such
spot?,
An analysis for results :-
dissolved gases
gave the
following
at our request sent us a sample of the of the analysis made in THE LANCET Laboratory practically coincide with those given above. They as follows :-
[Our correspondent
water and the results
were
NOTES UPON HEALTH RESORTS. BRIDGE OF ALLAN. A CORRESPONDENT writes: The beneficial results obtained in the treatment of disease, especially in its more chronic phases, by residence at watering-places, health resorts, and the like, have been appreciated by the profession since the earliest dawn of medicine, and this form of treatment has received the approval of schools of therapeutics differing very widely in other respects. The result is that many places possessing special climatic advantages or yielding waters endowed with medicinal qualities have become known both to the prefer ion and to the laity and are largely
temperature of about being drunk. It is therefore a non-gaseous, non-thermal spring, and a true natural mineral water, comparable to the best-known continental spas, some of which it closely resembles. For example, it is not unlike the Kissingen water which is also a cold spring of nearly the same strength (657 grains per gallon, Rakoczi spring). The latter, however, is gaseous The water reaches the surface at
a
450 F. and is warmed to 133° F. before
same
time the Order of the!
very wide.
Such
gaping
wounds
were
found in the fore-.
head, temple, and in the extremities. Small wounds of’ this category usually healed by cicatrising but the larger THE Master and Wardens of the Society of ApothecariesI ones healed only after a second bandaging in most cases. Where suppuration was present in the three categories will entertain guests at dinner in the Hall of the Society above described it was mostly in cases of imbedded bullets, "to meet the Lord Mayor" on Tuesday, Nov. 19th. sometimes in case of torn wounds, and least of all in cases of ____
through-and-through perforations. In the cases of throughand-through perforation the suppuration appeared to result. from bleeding deep in the wound. Most of the instancesRIFLE-BULLET, SHRAPNEL, AND SHELL of suppuration in blind perforations occurred where the WOUNDS IN THE RUSSO-JAPANESE bullet was present, particularly if disfigured through ricochet or other cause. It is interesting to observe that often, almost WAR AND COMPARATIVE next the bullets found in the tissue under the immediately CASUALTIES. skin when extracted, suppuration was found even after both the opening of the wound and the perforation had well A REPORT read by M. I. Glagolieff before the Society of cicatrised. Medical Men of Krementchug appears in the Ohirurgia of M. Glagolieff concluded his observations on rifle-bullet Moscow. It deals specially with wounds in the soft parts wounds by remarking the very unfavourable course followed of the extremities as well as in the head, neck, and trunk by most of the wounds in the soft parts of the wrists, arms, that were treated in the Fourteenth Kharbin Collecting feet, and fingers. Wounds in these parts were often irregular Hospital which began its operations at Lyaoyan in July, 1905. with rough edges. These wounds frequently ran a bad From Lyaoyan it was transferred to Kharbin and thence to course, accompanied by suppuration and inflammation which, Vladivostok. It dealt with 5956 cases of sick and wounded, affected even uninjured parts. Lymphangitis was frequent. of which 2290 were wounded. Of these, 2273 were the In all the cases that came under his observation he did not victims of firearms and 17 only (0 ’ 7 per cent.) of cold steel. find one in which the bullet carried part of the victim’s The wounds were distributed as follows :clothing into the wound, which was so common with the old, 616 (26’9 per cent.) Lower extremities large bullet. It was, however, far otherwise with the 606 (26-4 per cent. Upper shrapnel-bullet wounds that he describes. He attributes ) 71-3 ) 412 (18-0 Joints 25 per cent. of all the wounds to shrapnel. He attaches Thorax 177 ( 7-7 ) importance to this note, as he thinks the chief military 122 ( 53 Head medical department failed to establish the relative import) ance of rifle-bullet and shrapnel wounds in the statistics (of which 32 were with fractured skull) 100 (4’3 per cent.) Face published after the war-at least, they are not indicated in 84 Pelvis ......
......
"
...............
...............
II
...............
"
..................
(3-6
) ) ) )
the charts. He continues that the late Russo-Turkish war showed only 4 per cent. of wounds from shells. But now this " is all changed. Besides through-and-through perforations, II blind perforations, and surface wounds all as in the case of the rifle bullet, the shrapnel also made irregular wounds with The total number of deaths in the hospital was 18, of torn edges. The form of the blind perforations was thewhich eight were cases of wounds, or 0’35 per cent. Most prevailing shrapnel wound. The more frequent imbedding of the wounds resulted from rifle fire, then shrapnel, and of the shrapnel bullet in the body is very striking. The size lastly splinters of shells. The rifle-bullet wounds took the of the entry and exit of the bullet into and out of the body form of through-and-through perforations or canals, blind respectively was from 1’1 1 to 5’ 2 centimetres diameter, perforations or canals, or of open wounds with rough or in some cases the entry being larger than the exit; whilst,. smooth edges. The through-and-through perforation was the again, the former would in some cases be fairly round most frequent. Of 100 cases of wounds in the extremities and the latter longer and wider. The blow of the shrapnel taken without selection nine were surface wounds, three bullet generally made a wound 5, 7, or 10 centimetres long blind perforations, and 87 were through-and- and 2, 3, or 5 centimetres wide. Wounds from shrapnel in were through perforations. After further detailing the classi- the hands, feet, and fingers were usually irregular with fication of wounds, M. Glagolieff made the observation that broken edges. For the scab to form and the wound to heal according to the hospital reports in cases of wounds from at the first bandaging was rare. These wounds took longer distances of about a verst and over the entry and exit to cicatrise than wounds from rifle bullets and they supopenings differed but little, whilst the entry was more fre- purated also in more cases, no matter what the kind of quently the larger. At short distances the exit orifice was wound. They also more frequently gave rise to swelling and more frequently the larger. These openings were usually subcutaneous effusion of blood. The causes of these aggrainsignificant and were mostly of a diameter of (or even less vations must be supposed to be the more frequent imbedding than) the bullet. The exceptions were cases where the of the bullet in the body, the greater tearing of the tissue, bullet did not hit diametrically, such as ricochets. There &c., the more extensive bleeding, and finally the frewas no sign of injury round the openings of the typical quency with which the larger shrapnel bullet took bits of wounds except just at the edges. shirt, uniform, &c., into the wound. He remarks in conFresh wounds were never seen ; there was always an clusion, with respect to shrapnel bullets, that often as interval of from three to seven days between the infliction they were extracted in no case did they show any material of the wound and the arrival of the patient in hospital. deformation. Patients arrived usually straight from the battlefield with There were very few cases of wounds from shell splinters. their wounds, generally speaking, in one of the three follow- When extracted from the wounds they were seldom larger ing conditions : (1) both orifices cicatrised ; (2) one only so, than shrapnel bullets. They were pieces of dark metal, very with the other like a clean wound; and (3) one orifice irregular in shape, and often with several sharp points. The cicatrised or like a clean wound and the other suppurating. wounds which they caused were mostly irregular, approaching Nos. 1 and 2 conditions usually required from two to three to roundness and varying in size from 0’5byO’75 centimetre and a half weeks to heal. No. 3 class would take about three to 1’1 1 by 5 2 centimetres. The hospital had no cases of weeks to heal. The suppuration was easily arrested and very large wounds of this class. The wounds were usually otherwise the healing was as easy as in Nos. 1 and 2. blind perforations of varying depths. Through-and-through The cases of wounds consisting of blind perforations were perforations were rare. Where the muscles were torn the few and resulted usually from bullets either spent or wounds gaped wide. The peculiarity of these wounds was interrupted in their course by hard objects, such as stones, their multiplicity. Some of the patients would be struck in and the consequent disfiguration in the bullet produced a ten or more places, but generally the wounds were small correspondingly irregular wound. In a very few cases the and were not deep. The small wounds cicatrised readily bullets were not found but these wounds also healed easily, enough but most of the large ones suppurated-particularly where the flesh was much torn-and healed slowly. especially where there were no bullets. Surface bullet wounds, chiefly in the head, were more M. Glagolieff then turns to wounds of the soft parts comcommon. They varied from 1 to 10 centimetres long and plicated with injury to the large blood-vessels. The remarkfrom 0-5 to 0-3 centimetre wide. Sometimes when the able feature of war subsequently to the adoption of smallbullet struck the muscle diametrically the wound would be calibre arms has been the rarity of bleeding after the wounds ...............
Vertebra and Back...... Neck Abdomen Post operation wounds ...
...............
............
66 (28 8 44 (1-9 44 (1’9 19
"
"
1341 ;and the formation of traumatic aneurysms which has been observed by many authorities who witnessed the first bandaging of the wounded at the front. The wounds quickly close up and get choked with blood, so that if a blood-vessel is It percolates into the broken the blood cannot escape. surrounding tissue till the exterior pressure is equal to the interior, and with partial injury to the wall of the vessel in -casean opening is made, the blood flows to the tissue nearest the rent and gradually pushes it to one side. Here a hsematoma is formed. The blood coagulates at its periphery and remains liquid in the middle and thus an arterial traumatic aneurysm is formed. Such cases should be subjected to primary bandaging on the field of battle, says Professor von Manteuffel. M. Glagolieff then relates a number of such cases that reached the hospital in the rear. In all cases of arterial aneurysm the wounds healed with the first bandaging. In some cases the swelling gradually increased, ’ then pain followed and became worse till it was unbearable, I probably because of the pressure of the ba3matoma on the nerves. In two cases this led to a successful operation, but in a third case, after ligaturing the deep artery of the hip, the feet and knees became benumbed, and on the seventeenth day after the operation amputation at the lower third of the thigh was resorted to. The patient recovered. There were very few cases of injury to the great nerves. These are quoted without comment. There were only two or three cases of erysipelas and only five of tetanus. The most difficult operations were those on the aneurysm involving the ligaturing of the injured vessel and the removal of the hasmatoma. M. Glagolieff concludes as follow : ’’ Most of the rifle-shot wounds were aseptic and the blood in the perforations thickened so that a scab soon formed and excluded contagion. The shrapnel wounds greatly resembled those of the old large leaden bullets, including the tendency to carry bits of textile (clothing) into the wounds. Experience shows that wounds probed at the first-aid stations and sanitary wagons and from which bullets were extracted on the spot frequently suppurated ; hence it may be concluded that excepting the application of aseptic protective bandages the wounds should not be treated either at the front or in sanitary wagons. The treatment of cicatrised and clean vounds should be aseptic. The best bandage for cicatrised wounds is the collodion bandage. Iodoform preferably, as sterilised iodoform muslin, may be applied to inflamed and suppurating wounds." All the lint, wool, and muslin supplied to the hospitals seem to have been satisfactory. Collodion and spirit were both of great service. It appears that the hospital inventory requires to be augmented by such items as sterilisers for material and operating linen and for instruments, lamps or heaters for sterilisers, and enamelled basins for holding used bandaging material. A subsequent issue of the Oki’l’1f.’rgia contains a report by P. Ph. Koltchin on the cases treated in the lst Barracks of the Ninth Kharbin Collecting Hospital, the statistics of which make an interesting comparison with those of the Fourteenth Kharbin Collecting Hospital with respect to the relative casualty-producing power of the various arms. Out of a total of 832 cases 634 (76 -2 per cent.) were rifle-bullet wounds, 140 (16’88 per cent.) were shrapnel wounds, 45 (5’4per cent.) were wounds from exploded shells, and 7 (0’ 8 per cent.) were from cold steel. The negligible balance was from contusions or from unknown causes. Again, 679 (81’6per cent.) were through-and through wounds and 153 (18 .per cent.) were blind. As many as 633 (76 - 08 per cent.) healed without suppuration and 199 (23’99 per cent.) with suppuration. 12 patients (1’4 per cent.) died.
Germany, Switzerland, and France are rich in and in our patronage of them we are apt to forget that there are admirable health resorts within the British Isles. Bath and Buxton, Cheltenham and Harrogate, Leamington and Woodhall in England, and Strathpeffer, Dunblane, Pitcaithly, and Bridge of Allan north of the border, all possess climatic and balneological advantages of a very high order and have the additional advantage of lying much nearer the patient’s home than the continental spas. Notices of some of these places have appeared from time to time in the leading medical journals and on this occasion I would call attention to the advantages enjoyed by that beautiful little Stirlingshire town, Bridge of Allan. Situated on the picturesque river of the same name and on the main Caledonian railway line from Glasgow to Perth and Aberdeen, it is readily accessible both from Edinburgh and Glasgow, as well as from the south. It lies under the shelter of a spur of the Ochils, which effectually protects it from the winds of the north and east, while the ground, sloping gently towards the south, widens out into the strath of the Forth and affords a splendid exposure for sunshine. The climate is mild and equable, and with its moderate rainfall possesses the freshness of the west of Scotland blended with that of the east. The slope of the ground permits of the ready drainage of moisture, and the air is singularly free from mist and fog. The real value of Bridge of Allan as a health resort lies, however, in its abundant supply of natural mineral waters. These have been known for many years but have only received detailed attention within recent years. Their source consists of six springs, tapped at a depth of 116 feet. These springs are not uniform in composition, four being very rich in saline constituents, the remaining two less so. The springs mix together at the bottom of the shaft from which they are pumped up. and it is this mixed A recent analysis (April, 1907) of water that is used. this water showed it to have the following composition :resorted to. such
spot?,
An analysis for results :-
dissolved gases
gave the
following
at our request sent us a sample of the of the analysis made in THE LANCET Laboratory practically coincide with those given above. They as follows :-
[Our correspondent
water and the results
were
NOTES UPON HEALTH RESORTS. BRIDGE OF ALLAN. A CORRESPONDENT writes: The beneficial results obtained in the treatment of disease, especially in its more chronic phases, by residence at watering-places, health resorts, and the like, have been appreciated by the profession since the earliest dawn of medicine, and this form of treatment has received the approval of schools of therapeutics differing very widely in other respects. The result is that many places possessing special climatic advantages or yielding waters endowed with medicinal qualities have become known both to the prefer ion and to the laity and are largely
temperature of about being drunk. It is therefore a non-gaseous, non-thermal spring, and a true natural mineral water, comparable to the best-known continental spas, some of which it closely resembles. For example, it is not unlike the Kissingen water which is also a cold spring of nearly the same strength (657 grains per gallon, Rakoczi spring). The latter, however, is gaseous The water reaches the surface at
a
450 F. and is warmed to 133° F. before