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WESTERN MEDICAL AND SURGICAL SOCIETY.
lungs, tumultuous action of the heart, and great restlessness of the French and Sardinian medical officers. We have to-day the body. In the second class, the difficulty of respiration medical officers of three great nations, whose union has phyarose from obstruction of the windpipe-i.e., from pure aphna, sically been already nobly cemented by heroic deeds. May we the chest could not be filled with air, and there was pulmonary not hope that mentally the same union may produce a vast congestion, a feeble but not tumultuous action of the heart, amomit of benefit ? I believe that in no profession can more occasional fits of convulsions, a dark hue of the surface of the good be produced or truth eliminated than in ours, by the inbody, and marked turgescence of the veins. In the third class terchange of thought, comparison of practice, and statement of of cases, the symptoms were of a mixed kind. Tracheotomy facts, tending to elicit truth, and drive away empiricism; and the presence here of our allies evinces a wish on their parts to was advisable in those cases only where the symptoms were solely attributable to obstruction in the air-passages; and it join us heartily in our endeavours. The proceedings of the previous meeting were then read, and was probably in these cases that M. Trousseau had operated with so much success. The above diagnostic signs were always several medical officers were elected honorary members. sufficiently clear to settle the point whether or not the opeDr. BOWEN (Coldstream Guards) then read the report of ration might be performed with the chance of success. A CASE
OF FROST-BITE, and exhibited the morbid specimens of the hands affected. The had been on sentry for two hours, holding a bayonet, WESTERN MEDICAL AND SURGICAL SOCIETY. patient without gloves, on the night of the 19th December, 1855, when the thermometer fell to 4° below zero. There was complete FRIDAY, FEBRUARY 1ST, 1856. death of the fingers; gangrene set in, and the phalanges of the DR. BARCLAY, VICE-PRESIDENT, IN THE CHAIR. right hand were removed, and the left amputated at the wrist. The case was brought forward in consequence of a difference of Dr. RICHARDSON read a paper opinion amongst the medical officers of the regiment-first, as to operating at all; and secondly, as to the extent of the ON THE UNITY OF SANATIVE AND CURATIVE MEDICINE. Dr. Bowen was strongly of opinion limb to be removed. The author commenced by remarking that, since the revival of the system of preventive medicine, after a slumber of some that, as the patient’s health wza,s sinking, and he was suffering seventeen hundred years, it had been an absurd practice to from diarrhoea, the operation was called for, and the state of look upon prevention and cure as rival systems ; not, perhaps, the parts rendered it necessary to operate where it was done. The patient is now doing well. as absolutely antagonistic, but as systems requiring for their Dr. WYATT, in reply, stated that the question resolved The advancement distinct orders of mind and education. three general issues—1st, the nature and patholoperiods of time in which the two systems had stood out in itself into their isolated forms indicated those when civilization was in logical condition of frost-bite; 2nd, the different primary and local effects produced; and 3rd, the treatment necesvery different phasis. The existence of a preventive system secondary indicated a high phase of mental progress, while that of abso- sary to be employed. Extreme cold, long applied, destroys lute trust in a system exclusively curative showed a lower vitality without the precedence of inflammatory action; but it violent inflammatory reaction phase. This position the author proved by an extended predisposes to gangrene when of vitality. The pathological effects reference to different epochs of history. He then passed on to precedes the of cold have not yet been properly elucidated. His opinion, prove that in reality the two systems were one, and that it founded on experience, is that gangrene after frost-bite is allied was mischievous to the profession and to the public to divide the humid or the dry form of sphacelus, according as it has them, or to place them respectively in the hands of different to sects. He argued out this point on the three following grounds, been produced by direct application of cold, or from secondary action. In mortification from cold, the effect being produced, the bearing on the subject of the treatment of disease. 1st.—That every disease arising from an external and pre- removal of the cause is impossible, and he (Dr. Wyatt) is therefore ventible cause cannot, as a general rule, be cured until such of opinion that the line of demarcation should be awaited, and ulcerative action between the dead and the living parts be fully cause be ascertained and removed. 2nd.-That in the majority of diseases arising from external developed, and that we should then assist Nature. There was between the disease this and last-winter, from the causes, there is ultimately established in the system a series of great difference constitutional debility of the patients. He considered general molecular changes, which continue even when the cause is should be avoided, but when they were neremoved, and which require distinct treatment of a curative that amputations cessary we should injure the living portions as little as possible. kind, based on pathology and therapeutics. 3rd.-That in instances where the body itself is the simple In referring to the case, it was of importance to know that the that seat of the disease-i. e. ,where the cause is internal, the exter- man suffered much pain at night, showing, he thought, " nal chemical and physical influences to which the sufferer is Nature was" resisting the injury, and setting up disjunctive The question, therefore, for the Society was, subjected may materially modify the case in regard to its pro- ulceration. whether sufficient time had been given after the line of demarits and treatment. gress, symptoms, In supporting these arguments, Dr. Richardson went cation had set in, and, amputation being decided on, whether more of the structures of the hand might not have been saved*. minutely into the subject of the effects of heat and moisture He (Dr. Wyatt) then exhibited sketches of the present appearon the body ; and the effects of poisons, especially those of an ance of the hands, and of what he considered they might have out the differences the first between organic kinds, he traced influence of these agents on the body and the after results. In been. Dr. WILLIAMS said it should be remembered that conservaconclusion, he proved the importance of combining the two tive and operative surgery were very different branches; of in the ab. systems prevention and cure, by showing that, he was a strong advocate for conservative surgery. The sence of such combination, the difficulties connected with the knowledge and practice of conservative surgery was never so of the could never be of diseases overcome. study origin far advanced as it has been in this army. With reference to Dr. Bowen’s remark, that he should not operate in cases of frost-bite when the patient was also suffering from dysentery, he (Dr. Williams) was of opinion that we should. Dr. SALL had served in Newfoundland, and had had much experience of frost-bites. The practice there, and in which he agreed, was to leave as much as possible to Nature. Dr. TAYLOR alluded to the distinctions existing in the cases MILITARY MEDICAL AND SURGICAL SOCIETY, of gelatio met with this winter, and those occurring last winter, FIRST DIVISION, BRITISH ARMY, CRIMEA. when they arose from wet and long-applied cold, whilst the men at the same time were suffering from fever and dysentery ; THURSDAY, JAN. 17TH, 1856. and he mentioned some severe cases he had seen. The case related by Dr. Bowen was a peculiar one. He (Dr. Taylor) THE third meeting was held this day, when there were was of opinion that we should wait until the line of separation twenty-six medical officers present. is fully established, and then assist Nature in removing the Dr. WILLIAMS, having been called to the chair, said—Gen- dead parts only. tlemen, I am much obliged for the honour you have done me, Dr. BOWEN considered that Mr. Guthrie and Mr. Fergusson and wish I was better fitted to fill the position you have placed had been wrongly quoted, and mentioned the opinions of Baron me in. It is most gratifying to see so many strangers here to- Larrey and Mr. Lawrence, that severe frost-bites (in Poland) day, and still more to have the pleasure of meeting our allies. generally occurred when the temperature was changing from
deprivation
The Crimea.
,
183
,
OF FROST-BITE, and exhibited the morbid specimens of the hands affected. The had been on sentry for two hours, holding a bayonet, WESTERN MEDICAL AND SURGICAL SOCIETY. patient without gloves, on the night of the 19th December, 1855, when the thermometer fell to 4° below zero. There was complete FRIDAY, FEBRUARY 1ST, 1856. death of the fingers; gangrene set in, and the phalanges of the DR. BARCLAY, VICE-PRESIDENT, IN THE CHAIR. right hand were removed, and the left amputated at the wrist. The case was brought forward in consequence of a difference of Dr. RICHARDSON read a paper opinion amongst the medical officers of the regiment-first, as to operating at all; and secondly, as to the extent of the ON THE UNITY OF SANATIVE AND CURATIVE MEDICINE. Dr. Bowen was strongly of opinion limb to be removed. The author commenced by remarking that, since the revival of the system of preventive medicine, after a slumber of some that, as the patient’s health wza,s sinking, and he was suffering seventeen hundred years, it had been an absurd practice to from diarrhoea, the operation was called for, and the state of look upon prevention and cure as rival systems ; not, perhaps, the parts rendered it necessary to operate where it was done. The patient is now doing well. as absolutely antagonistic, but as systems requiring for their Dr. WYATT, in reply, stated that the question resolved The advancement distinct orders of mind and education. three general issues—1st, the nature and patholoperiods of time in which the two systems had stood out in itself into their isolated forms indicated those when civilization was in logical condition of frost-bite; 2nd, the different primary and local effects produced; and 3rd, the treatment necesvery different phasis. The existence of a preventive system secondary indicated a high phase of mental progress, while that of abso- sary to be employed. Extreme cold, long applied, destroys lute trust in a system exclusively curative showed a lower vitality without the precedence of inflammatory action; but it violent inflammatory reaction phase. This position the author proved by an extended predisposes to gangrene when of vitality. The pathological effects reference to different epochs of history. He then passed on to precedes the of cold have not yet been properly elucidated. His opinion, prove that in reality the two systems were one, and that it founded on experience, is that gangrene after frost-bite is allied was mischievous to the profession and to the public to divide the humid or the dry form of sphacelus, according as it has them, or to place them respectively in the hands of different to sects. He argued out this point on the three following grounds, been produced by direct application of cold, or from secondary action. In mortification from cold, the effect being produced, the bearing on the subject of the treatment of disease. 1st.—That every disease arising from an external and pre- removal of the cause is impossible, and he (Dr. Wyatt) is therefore ventible cause cannot, as a general rule, be cured until such of opinion that the line of demarcation should be awaited, and ulcerative action between the dead and the living parts be fully cause be ascertained and removed. 2nd.-That in the majority of diseases arising from external developed, and that we should then assist Nature. There was between the disease this and last-winter, from the causes, there is ultimately established in the system a series of great difference constitutional debility of the patients. He considered general molecular changes, which continue even when the cause is should be avoided, but when they were neremoved, and which require distinct treatment of a curative that amputations cessary we should injure the living portions as little as possible. kind, based on pathology and therapeutics. 3rd.-That in instances where the body itself is the simple In referring to the case, it was of importance to know that the that seat of the disease-i. e. ,where the cause is internal, the exter- man suffered much pain at night, showing, he thought, " nal chemical and physical influences to which the sufferer is Nature was" resisting the injury, and setting up disjunctive The question, therefore, for the Society was, subjected may materially modify the case in regard to its pro- ulceration. whether sufficient time had been given after the line of demarits and treatment. gress, symptoms, In supporting these arguments, Dr. Richardson went cation had set in, and, amputation being decided on, whether more of the structures of the hand might not have been saved*. minutely into the subject of the effects of heat and moisture He (Dr. Wyatt) then exhibited sketches of the present appearon the body ; and the effects of poisons, especially those of an ance of the hands, and of what he considered they might have out the differences the first between organic kinds, he traced influence of these agents on the body and the after results. In been. Dr. WILLIAMS said it should be remembered that conservaconclusion, he proved the importance of combining the two tive and operative surgery were very different branches; of in the ab. systems prevention and cure, by showing that, he was a strong advocate for conservative surgery. The sence of such combination, the difficulties connected with the knowledge and practice of conservative surgery was never so of the could never be of diseases overcome. study origin far advanced as it has been in this army. With reference to Dr. Bowen’s remark, that he should not operate in cases of frost-bite when the patient was also suffering from dysentery, he (Dr. Williams) was of opinion that we should. Dr. SALL had served in Newfoundland, and had had much experience of frost-bites. The practice there, and in which he agreed, was to leave as much as possible to Nature. Dr. TAYLOR alluded to the distinctions existing in the cases MILITARY MEDICAL AND SURGICAL SOCIETY, of gelatio met with this winter, and those occurring last winter, FIRST DIVISION, BRITISH ARMY, CRIMEA. when they arose from wet and long-applied cold, whilst the men at the same time were suffering from fever and dysentery ; THURSDAY, JAN. 17TH, 1856. and he mentioned some severe cases he had seen. The case related by Dr. Bowen was a peculiar one. He (Dr. Taylor) THE third meeting was held this day, when there were was of opinion that we should wait until the line of separation twenty-six medical officers present. is fully established, and then assist Nature in removing the Dr. WILLIAMS, having been called to the chair, said—Gen- dead parts only. tlemen, I am much obliged for the honour you have done me, Dr. BOWEN considered that Mr. Guthrie and Mr. Fergusson and wish I was better fitted to fill the position you have placed had been wrongly quoted, and mentioned the opinions of Baron me in. It is most gratifying to see so many strangers here to- Larrey and Mr. Lawrence, that severe frost-bites (in Poland) day, and still more to have the pleasure of meeting our allies. generally occurred when the temperature was changing from
deprivation
The Crimea.
,
183
,