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PIROGOFF ON SOME POINTS CONNECTED WITH THE WAR.
196 material of an ordinary cicatrix. He has always taken the whole skin for grafting, and abstains from pronouncing any opinion on Mr. Fiddes’s plan of using epithelial scales only. It is absolutely necessary that the ulcerated surface should be covered with more or less healthy granulations; and it is important, though perhaps not essential to success, that the patient should remain in bed for at least a few days. Here is a concise account of the author’s:modus operai7.di: Flex the arm, then pinch up a small piece of integument with an ordinary pair of forceps, and cut out the piece with either a sharp scalpel or, better still, with a sharp pair of curved scissors. (The author finds the inner side of the arm, about two inches above the elbow, the most convenient spot.) The piece taken out should be about the size of a big pea. This may now be divided, either on the nail, or in any other way, into two, three, four, or even five parts. Make an incision into the surface of the ulcer, or incisions, as may be needed; wait until the bleeding has quite stopped, then put each piece into one of the incisions, taking care to lay the cut surface downwards; then cover it with a piece of Professor Lister’s non-adhesive lac plaster. A small piece about an inch square is what is generally placed over the spot. Keep this in situ with a strap or straps of adhesive ordinary plaster, then a little cotton-wool and a so as to cause bandage, steady pressure. Let the dressing be left untouched for from three to five days, the longer time in many cases being the best. The cotton-wool and the bandage can, however, be removed earlier. Before pronouncing a failure, wait some days, or a week at the outside. After about ten to twelve days a bluish-white point or points will be seen, arising at the spots where the skin was placed. They daily increase until, if planted sufficiently close, they will meet the edges, and the wound or ulcer is healed. We have no space to discuss several points of physiological interest tha are alluded to; but we may say that Mr. Woodman’s notes form a good, practical, unpretending little
highly organised plastic
pamphlet. PIROGOFF ON SOME POINTS CONNECTED WITH THE WAR.
fractures of the femur, and he says that such treatment frequently gave good results in cases where a fatal issue has followed the practice of amputation of the thigh. He attributes the success of expectant treatment to the better transport employed, notwithstanding its many defects, to the greater use of fixed immovable bandages, to the greater care and skill of the surgeons in attending to the position of injured limbs, &c., and to the improved system of hygiene in force. One of the points on which Pirogoff especially dwells is well deserving of attention. According to the Russian system, medical officers go to the front under fire with their men. Advancement and honour attend on a military and not a medical career. Since the commencement of the war seven medical officers have been killed and fifty wounded. The Prussian regulations led to great difficulties in getting medical aid for the wounded. At first, in the German army, not more than ten or twelve important operations were performed on the field of battle, and the wounded did not receive help until they had been conveyed to some distance. After Gravelotte, 10,000 wounded men were conveyed away in country carts, journeying two days and nights without proper surgical help or dressings, and an utterly inadequate number of medical officers to attend on them. Professor Langenbeck had some 3000 wounded brought to him. He was aided by only two assistants. Military ardour is not by any means confined to the Prussian medical service. English surgeons accompany their regiments into action, and, to their credit be it said, do not shirk exposure to danger. Still, there can be no doubt that a doctor’s duty is with the men who have been wounded. There is quite sufficient desire to be "well in to the front" without encouraging it in any way. Pirogoff declares that the organisation of societies for aid to the wounded must be made in time of peace, and not in time of war. England, America, and Holland managed to place hospitals, already organised, at the service of the wounded, accompanied by a full complement of doctors, He considers that sick attendants, necessary matériel, &c. the great aim should be to organise hospitals capable of easy and speedy removal, and he speaks highly of third and fourth class waggons, with pharmacy and cuisine, capable of holding twelve or sixteen persons in each. Pirogoffconsiders that the huts so commonly erected and utilised in Germany for hospital purposes labour under several disadvantages, such as their being fixed, and their light construction rendering them useless for winter and autumn. In the summer tents could be employed. The ventilation in huts is insufficient to preserve the inmates against hospital contagion, as has been demonstrated at Berlin. It ought to be remembered, however, that the huts employed in the war were generally overcrowded. Pirogoff is opposed to large hospitals, but the Russian administration nevertheless continues to construct these of two or three stories. They are difficult of ventilation, and the results obtained in them are unsatisfactory. Single-storied hospitals, with large area for patients, or huts, are to be recommended in
THE Russian military surgeon, Pirogoff, of Sebastopol renown, has lately published some observations in the Journal de St. Petersbourg, in which he recounts the results of his experience during the present war. The French wounded, he says, up to a certain point, were placed under somewhat analogous conditions to those at Sebastopol. At Strasbourg the operations did well when the operations were effected immediately after the wounds, whilst in Germany they did not attain to a tenth of these results. Resections of the foot, which were numerous, were very I, satisfactory; those of the knee were less numerous, and followed, as might be supposed, by very inferior results. Except at Strasbourg, Pirogoff appears to have seen very few wounded that had been struck by large projectiles. There were equally few cases of injuries of the head, and he saw only one example of wound by mitrailleuse. The subjects of these injuries commonly perish on the field of battle. The injury caused by the chassepot is less grave than that by the minie-ball. Chest wounds, where the ribs were not involved in the damage, were often cured. He thinks that limbs have been preserved by conservative surgery which would have been sacrificed in former times. Experience since the Crimean Warhas demonstrated the bad results of thigh and leg amputations-a mortality of from 60 to 90per cent., or 75 per cent. at the least. Pirogoff advocates a simple and expectant treatment in the case of gunshot
I
preference. Pirogoff, on the whole, seems to prefer a very cheap style of hut, that may be entirely adapted to a country so cold as Russia, for instance. They are constructed of the trunks of trees disposed wide apart, with a double coating, outside and in, of clay and chopped straw for the walls. They are thus well defended from cold, and very comfortable, as Pirogoff testifies from personal experience. This will remind military readers of the native huts in India. They would not, in our opinion, prove healthy for hospital purposes in temperate regions.
We have, it is to be feared, exhausted our readers’ but not by any means all the points contained in Professor Pirogoff’s papers. He considers that the chief object of aid societies should be to acquire hospitals in time of peace such as should be easy of transport by rail. He shows how important it is, too, to settle all about the position and discipline of members of volunteer aid societies ; in other words, how to adapt private assistance to official medical administration.
patience,
highly organised plastic
pamphlet. PIROGOFF ON SOME POINTS CONNECTED WITH THE WAR.
fractures of the femur, and he says that such treatment frequently gave good results in cases where a fatal issue has followed the practice of amputation of the thigh. He attributes the success of expectant treatment to the better transport employed, notwithstanding its many defects, to the greater use of fixed immovable bandages, to the greater care and skill of the surgeons in attending to the position of injured limbs, &c., and to the improved system of hygiene in force. One of the points on which Pirogoff especially dwells is well deserving of attention. According to the Russian system, medical officers go to the front under fire with their men. Advancement and honour attend on a military and not a medical career. Since the commencement of the war seven medical officers have been killed and fifty wounded. The Prussian regulations led to great difficulties in getting medical aid for the wounded. At first, in the German army, not more than ten or twelve important operations were performed on the field of battle, and the wounded did not receive help until they had been conveyed to some distance. After Gravelotte, 10,000 wounded men were conveyed away in country carts, journeying two days and nights without proper surgical help or dressings, and an utterly inadequate number of medical officers to attend on them. Professor Langenbeck had some 3000 wounded brought to him. He was aided by only two assistants. Military ardour is not by any means confined to the Prussian medical service. English surgeons accompany their regiments into action, and, to their credit be it said, do not shirk exposure to danger. Still, there can be no doubt that a doctor’s duty is with the men who have been wounded. There is quite sufficient desire to be "well in to the front" without encouraging it in any way. Pirogoff declares that the organisation of societies for aid to the wounded must be made in time of peace, and not in time of war. England, America, and Holland managed to place hospitals, already organised, at the service of the wounded, accompanied by a full complement of doctors, He considers that sick attendants, necessary matériel, &c. the great aim should be to organise hospitals capable of easy and speedy removal, and he speaks highly of third and fourth class waggons, with pharmacy and cuisine, capable of holding twelve or sixteen persons in each. Pirogoffconsiders that the huts so commonly erected and utilised in Germany for hospital purposes labour under several disadvantages, such as their being fixed, and their light construction rendering them useless for winter and autumn. In the summer tents could be employed. The ventilation in huts is insufficient to preserve the inmates against hospital contagion, as has been demonstrated at Berlin. It ought to be remembered, however, that the huts employed in the war were generally overcrowded. Pirogoff is opposed to large hospitals, but the Russian administration nevertheless continues to construct these of two or three stories. They are difficult of ventilation, and the results obtained in them are unsatisfactory. Single-storied hospitals, with large area for patients, or huts, are to be recommended in
THE Russian military surgeon, Pirogoff, of Sebastopol renown, has lately published some observations in the Journal de St. Petersbourg, in which he recounts the results of his experience during the present war. The French wounded, he says, up to a certain point, were placed under somewhat analogous conditions to those at Sebastopol. At Strasbourg the operations did well when the operations were effected immediately after the wounds, whilst in Germany they did not attain to a tenth of these results. Resections of the foot, which were numerous, were very I, satisfactory; those of the knee were less numerous, and followed, as might be supposed, by very inferior results. Except at Strasbourg, Pirogoff appears to have seen very few wounded that had been struck by large projectiles. There were equally few cases of injuries of the head, and he saw only one example of wound by mitrailleuse. The subjects of these injuries commonly perish on the field of battle. The injury caused by the chassepot is less grave than that by the minie-ball. Chest wounds, where the ribs were not involved in the damage, were often cured. He thinks that limbs have been preserved by conservative surgery which would have been sacrificed in former times. Experience since the Crimean Warhas demonstrated the bad results of thigh and leg amputations-a mortality of from 60 to 90per cent., or 75 per cent. at the least. Pirogoff advocates a simple and expectant treatment in the case of gunshot
I
preference. Pirogoff, on the whole, seems to prefer a very cheap style of hut, that may be entirely adapted to a country so cold as Russia, for instance. They are constructed of the trunks of trees disposed wide apart, with a double coating, outside and in, of clay and chopped straw for the walls. They are thus well defended from cold, and very comfortable, as Pirogoff testifies from personal experience. This will remind military readers of the native huts in India. They would not, in our opinion, prove healthy for hospital purposes in temperate regions.
We have, it is to be feared, exhausted our readers’ but not by any means all the points contained in Professor Pirogoff’s papers. He considers that the chief object of aid societies should be to acquire hospitals in time of peace such as should be easy of transport by rail. He shows how important it is, too, to settle all about the position and discipline of members of volunteer aid societies ; in other words, how to adapt private assistance to official medical administration.
patience,