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ARMY MEDICAL GRIEVANCES.
497 existing, has reference to the time which should be occupied in will be deeply considered by the Secretary of War, when producing complete insensibility. In several of the communi- making the forthcoming alterations :cations with which I have been favoured, a very slow and 1. They complain that they do not hold the same footing in gradual administration of the vapour is recommended ; but in the army that men of their profession, and in no way superior the Edinburgh school, where the use of pure or undiluted to them in abilities, do in society at large; and hope that, chloroform originated, the practice is still strongly advocated from the improvements of science, the increase of the standard of producing complete intoxication as quickly as is compatible of medical knowledge in surgeons, and the decrease of charlawith a proper supply of air. It may either be thought that a tanism, that an army surgeon may be allowed to hold a rank smaller quantity may thus produce the required effect,-and, equivalent to that which would have been his had he practised certainly, in some interesting experiments lately made by a as a civil practitioner. A tacit allowance that medical men committee of a medical society in Paris, it was observed that are now much higher valued is established by the fact that resuscitation was more speedily effected in animals that had high rank and large pay have lately been given to civilians for been quickly intoxicated by chloroform, than where the agent doing army work; and it at the same time proves that either had been slowly administered,-or it it may be the wish thus the civilian is paid too much, or the army surgeon too little. Civilians receive-Surgeon, Y,2per diem; acting Assistantto "prevent the chance of any excitement," to use the words of Dr. Simpson; or of those "involuntary confidences" and Surgeon, 10s. 6d. Likewise X40 for uniform, and £60 upon emotions lately spoken of by Dr. Stille, in the Philadelphia leaving the service. Medical Journal. ArmySurgeons receive-Surgeon, 1st class, (generally after A slow administration of chloroform, or, which is nearly the eighteen years’ service,) lis. per diem; Surgeon, 2nd class, and Regimental Surgeon, 13s. ; Assistant-Surgeon, 7s. 6d. came thing, an extreme dilution of it with air, would at first They therefore beg that in future medical officers shall rank light appear a safer mode of exhibiting it, but, probably, there - the regimental surgeon as major, instead of captain, as at s no greater difference between the two modes, than between ;he intoxication which is quickly produced by pure brandy, present; the senior assistant-surgeon as captain, instead of md that more slowly produced by brandy -and-water. In the lieutenant, as at present; and the junior assistant-surgeon as recent case of death at the Ophthalmic Hospital, it is stated lieutenant, as at present. They cannot disguise from thembhat the patient was put under the influence of the anaesthetic selves the fact that thousands of lives have been lost by the more slowly than usual, and that especial care was taken, by inability ofmedical men to rectify errors, from the insufficiency rank and power, and hope that the above alteration the use of an inhaler intended for this purpose, that there the recurrence of such an evil. Another induceshould be a large supply of air. In many other fatal cases, the will
of their prevent
of slow administration has been adhered to. ment for the increase is this: that it is not the practice in the An accumulation of facts may show, possibly, that this is a a.rmy of England to give such rewards of merit as the Legion safer practice than that advocated by Dr. Simpson and Mr. of Honour for the disinterestedness which induces a surgeon to Syme; but the assertion which has been made, that it is devoid hazard hislife in alleviating the sufferings of the dying in a or fever pest-house, although other officers obtain of danger, made in the face of so much experimental evidence cholera of the contrary, and in contradiction to the plainest principles medals, appointments, &c., for only equal bravery, but of a of therapeutics, can only influence those who are utterly un- different kind. 2. That the appointment of civil medical practitioners be acquainted with the subject. It is very evident, that by neither plan can the dangers of chloroform be prevented; and that if discontinued, as it is unfair to the army medical officers by this is ever to be accomplished, some much more important stopping their promotion, and creates ill-feeling, which is to the service. change than a mere shortening, or prolongation of the time 3. That in the army the medical profession should arrive at occunied. is reouired in the mode of administering, it. It will, I think, appear from the above observations, that an the acnae of perfection, from the number of opportunities of urgent necessity exists for more information respecting the observation afforded by its vast organization, and the many effects of anaesthetics. If the sixty sudden deaths, and nume- countries through which its parts are scattered. All future rous instances of suspended animation, already recorded as appointments should therefore be given to the Universities, a been be can attributed to chloroform, by produced having any few being left for the best candidates from foreign schools. other cause than its poisonous agency, or if, by an improved Commissions should be only obtained by those who, in addition to the usual qualifications, have a thorough knowlege of at manner of administering it, the fatality hitherto produced can be much diminished, there will be no need for abstaining from least two modern languages, so that a correspondence between its use in those deep operations which cannot otherwise be our surgeons and those of other armies may form a band of rendered completely painless; but if, on the other hand, there science encircling the earth. 4. That an increased staff of surgeons be employed, to should be evidence that the mortality from chloroform is much greater than has been generally supposed, and that this cannot prevent any sudden emergency like the present from re-occurbut be attributed to a noxious agency unavoidable by any mode ring, and placing the health of our army in jeopardy; and for of administering the vapour, it will be clear, that no conscientious the purpose of allowing surgeons leave of absence for at least, surgeon can, in the present state of our knowledge, recommend two months annually, to recruit their health (for the majority more in respect to the prevention of the pain of these operations, of stations are unhealthy, and the atmosphere of an hospital is than that it should be lessened or rendered tolerable by local not the purest in the world); and for the purpose of permitting anaesthetics. Fortunately, the greater number of operations medical officers to proceed to the Continental Universities for of absence somebeing superficial, congelation will, in them, effect all that can study. Whilst other officers can obtain leave be desired with respect to anaesthesia., while it wards off, in a times for months together, their brother officers being willing great degree, the dangers of erysipelas and phlebitis. A per- to do extra work, surgeons cannot, because they have none to« sistence in the use of a dangerous expedient, intended only for relieve them, regiments being generally quartered in detachthe prevention of a temporary short-continued pain, would, ments, and one medical officer with each. 5. That an alteration in the uniform of the medical staff be however convenient it may be in stifling the cries of the patient, and otherwise facilitating the surgeon’s operations, be not only made, to prevent a surgeon being taken for a purveyor’s clerk. opposed to the humanity of the medical profession, but to its or commissariat mule-driver. 6. That a class of non-commissioned officers be appointed to dignity, by inviting an interference from other quarters in matters which should be entirely under its own control. The superintend the delivery of the dinners, expenditure of the exhibition of anæsthetic vapours in operations has been regu- wine, examination of the privies, &c., such duty being derolated by public authority in some parts of the Continent; and gatory to medical officers. chloroform has been expelled from the surgical wards of the 7. That for the prevention of delay, &c., medical officers be Massachusetts General Hospital, by order of the governors of allowed to order or buy such medicines or other requisites for that institution.-I am, Sir, your most obedient servant, the sick as they may think fit, upon their own responsibility, as the lives of their patients, for which they are responsible, are JAMES ARNOTT. York-street, Portman-square, April 26, 1855. surely of more importance than a few ounces of chalk or teaan account of such expenditure being sent to the principal medical officer. ARMY MEDICAL GRIEVANCES. 8. That an apothecary be appointed to each regiment, to act THE To the Editor of LANCET. as dispenser and dresser, as in the Indian army. 9. That a corps of orderlies for the sick be formed, and. SlR,-The army surgeons now engaged with the enemy in the lines of Sebastopol are deeply grieved to find that great properly instructed, of young men enlisted for the special I am, Sir,your obedient servant, injustice is being done them by the authorities at home. I service. CHIRURGUS. hope that the following, which is an epitome of their wishes, Balaklava, April 16th, 1855.
same
principle
tent
detrimental
of their prevent
of slow administration has been adhered to. ment for the increase is this: that it is not the practice in the An accumulation of facts may show, possibly, that this is a a.rmy of England to give such rewards of merit as the Legion safer practice than that advocated by Dr. Simpson and Mr. of Honour for the disinterestedness which induces a surgeon to Syme; but the assertion which has been made, that it is devoid hazard hislife in alleviating the sufferings of the dying in a or fever pest-house, although other officers obtain of danger, made in the face of so much experimental evidence cholera of the contrary, and in contradiction to the plainest principles medals, appointments, &c., for only equal bravery, but of a of therapeutics, can only influence those who are utterly un- different kind. 2. That the appointment of civil medical practitioners be acquainted with the subject. It is very evident, that by neither plan can the dangers of chloroform be prevented; and that if discontinued, as it is unfair to the army medical officers by this is ever to be accomplished, some much more important stopping their promotion, and creates ill-feeling, which is to the service. change than a mere shortening, or prolongation of the time 3. That in the army the medical profession should arrive at occunied. is reouired in the mode of administering, it. It will, I think, appear from the above observations, that an the acnae of perfection, from the number of opportunities of urgent necessity exists for more information respecting the observation afforded by its vast organization, and the many effects of anaesthetics. If the sixty sudden deaths, and nume- countries through which its parts are scattered. All future rous instances of suspended animation, already recorded as appointments should therefore be given to the Universities, a been be can attributed to chloroform, by produced having any few being left for the best candidates from foreign schools. other cause than its poisonous agency, or if, by an improved Commissions should be only obtained by those who, in addition to the usual qualifications, have a thorough knowlege of at manner of administering it, the fatality hitherto produced can be much diminished, there will be no need for abstaining from least two modern languages, so that a correspondence between its use in those deep operations which cannot otherwise be our surgeons and those of other armies may form a band of rendered completely painless; but if, on the other hand, there science encircling the earth. 4. That an increased staff of surgeons be employed, to should be evidence that the mortality from chloroform is much greater than has been generally supposed, and that this cannot prevent any sudden emergency like the present from re-occurbut be attributed to a noxious agency unavoidable by any mode ring, and placing the health of our army in jeopardy; and for of administering the vapour, it will be clear, that no conscientious the purpose of allowing surgeons leave of absence for at least, surgeon can, in the present state of our knowledge, recommend two months annually, to recruit their health (for the majority more in respect to the prevention of the pain of these operations, of stations are unhealthy, and the atmosphere of an hospital is than that it should be lessened or rendered tolerable by local not the purest in the world); and for the purpose of permitting anaesthetics. Fortunately, the greater number of operations medical officers to proceed to the Continental Universities for of absence somebeing superficial, congelation will, in them, effect all that can study. Whilst other officers can obtain leave be desired with respect to anaesthesia., while it wards off, in a times for months together, their brother officers being willing great degree, the dangers of erysipelas and phlebitis. A per- to do extra work, surgeons cannot, because they have none to« sistence in the use of a dangerous expedient, intended only for relieve them, regiments being generally quartered in detachthe prevention of a temporary short-continued pain, would, ments, and one medical officer with each. 5. That an alteration in the uniform of the medical staff be however convenient it may be in stifling the cries of the patient, and otherwise facilitating the surgeon’s operations, be not only made, to prevent a surgeon being taken for a purveyor’s clerk. opposed to the humanity of the medical profession, but to its or commissariat mule-driver. 6. That a class of non-commissioned officers be appointed to dignity, by inviting an interference from other quarters in matters which should be entirely under its own control. The superintend the delivery of the dinners, expenditure of the exhibition of anæsthetic vapours in operations has been regu- wine, examination of the privies, &c., such duty being derolated by public authority in some parts of the Continent; and gatory to medical officers. chloroform has been expelled from the surgical wards of the 7. That for the prevention of delay, &c., medical officers be Massachusetts General Hospital, by order of the governors of allowed to order or buy such medicines or other requisites for that institution.-I am, Sir, your most obedient servant, the sick as they may think fit, upon their own responsibility, as the lives of their patients, for which they are responsible, are JAMES ARNOTT. York-street, Portman-square, April 26, 1855. surely of more importance than a few ounces of chalk or teaan account of such expenditure being sent to the principal medical officer. ARMY MEDICAL GRIEVANCES. 8. That an apothecary be appointed to each regiment, to act THE To the Editor of LANCET. as dispenser and dresser, as in the Indian army. 9. That a corps of orderlies for the sick be formed, and. SlR,-The army surgeons now engaged with the enemy in the lines of Sebastopol are deeply grieved to find that great properly instructed, of young men enlisted for the special I am, Sir,your obedient servant, injustice is being done them by the authorities at home. I service. CHIRURGUS. hope that the following, which is an epitome of their wishes, Balaklava, April 16th, 1855.
same
principle
tent
detrimental