pass through all the intermediate degrees, between the extreme limits of contraction and extension." (p. 455.)

Several

In all cases of catalepsy, without exception, there has been suspension of voice and speech as long as the patient has been left to himself. This feature has not been included in the definition, as it is implied in the general immovability of the muscular system. Those instances in which cataleptic patients have been said to reply to questions during paroxysms, have been complicated with somnambulism. authors have regarded insensibility as a constant characteristic, but erroneously; for while, in general, there is at least an apparent extinction of sensibility, this in some cases is increased. All that can be said is, that there is a disturbed state of the sensitive functions. The vagueness of the expression represents exactly the actual state of our knowledge upon the subject, and it is equally applicable to the modifications experienced by the sensorial and intellectual functions.

We have no intention of following M. Puel in his elaborate exhibition of the symptoms of the disease as they influence the various functions of the economy. Its diagnosis, he observes, is easy, as the pathognomic sign is always present:

"Take in your hand either the arm or the leg of a patient supposed to be the subject of catalepsy. Displace this limb, and then leave it to itself. If it remain in the position in which you have placed it, and the patient is in nowise able to change such position, you may affirm that catalepsy is present. I should observe, however, that when the result of the first experiment remains negative, it should be repeated several times, either on different limbs, the trunk, or the neck-in a word, upon the various mobile parts of the body: for, as we have seen, the contraction of certain muscles being sometimes excited with difficulty, the catalepsy may seem to be partial, and not be at once evident in all parts of the body. In certain diseases, when the pathognomic character is wanting, we seek our diagnosis in the ensemble of the symptoms observable. Here, however, this sign is indispensable, and in its absence catalepsy cannot be said to exist. We must place in the category of doubtful cases all those in which it has not been explicitly mentioned, excepting in the case of some of the observations made by the ancient authors, when analysis in the study of disease was not carried so far as at the present time." (p. 488.)

The non-existence of this symptom renders it easy to distinguish this disease from others which in some respects may resemble it—as hysteria, tetanus, lethargy, ecstasy, &c.

Predisposing Causes.-Analysing the 150 cases he has collected, M. Puel finds nothing decisive in regard to climate, seasons, locality, or hereditary influence. The age has been indicated in 94 cases only. From these it results that it is much more common below thirty, when 74 cases occurred, than above forty, when only 24 occurred there being no cases between thirty and forty. The period from twenty-one to thirty comprised more than a third of the whole number. Sex.-The statement which is true at present that females are more liable to catalepsy than males, has not always been correct. The sex is indicated in 148 of the cases. Of 21 cases, however, occurring in or prior to the sixteenth century, 15 were males, and 6 only females. To the end of the seventeenth century, 43 cases were furnished by 29 males and 14 females; and at the end of the eighteenth century 50 males

and 38 females constituted the 88 cases. The same male predominance was observable until 1841; and of the 130 first cases, arranged chronologically in the author's table, 65 are males and 65 females. Since 1841 females have predominated—so that we now have in the 148, 80 females to 68 males. Occupations.— These have been very various, and in several cases are not stated. Members of religious orders, students, and military persons have furnished numerous examples. Many of the cases have belonged to the upper classes of society, living a life of ease.

The duration of catalepsy is very variable, lasting in some cases but for a few minutes, and in others for several years. But details upon this point are wanting in many of the cases. The duration of the paroxysms themselves may also vary from a minute or two to a very long period. In the case given by Sarlandière it lasted from September 23rd, 1815, to March 28th, 1816, with the exception of a short recovery of consciousness Nov. 29th, 1815. As the usual result of the disease is a return to health, its prognosis must be regarded as favourable, except when it becomes excessively prolonged or complicated with incurable diseases, as mania. Almost every article of the materia medica has been enlisted in the treatment of this disease; and the most competent authors avow how little can be done. The treatment must be, in fact, eclectic; for in a disease of the actual pathology of which we know little or nothing, we must content ourselves with ministering to each special indication as it arises.

REVIEW VIII.

1. Report to the Right Honourable Lord Panmure, G.C.B., &c., of the Proceedings of the Sanitary Commission dispatched to the Seat of War in the East, 1855-56. Presented to both Houses of Parliament by command of Her Majesty, March, 1857.

2. Observations on the Report of the Sanitary Commissioners in the Crimea. By Sir JOHN HALL, M.D., K.C.B., Inspector-General of Hospitals.-London, 1857.

3. Une Mission Médicale à l'Armée d'Orient. Par M. BAUDENS, Médecin-Inspecteur. Revue des Deux Mondes,' livraisons pour Février, Avril, Juin,-Paris, 1857.

A Medical Mission to the Army of the East. By M. BAUDENS, Physician-General.-Paris, 1857.

4. England and France before Sebastopol, looked at from a Medical Point of View. By CHARLES BRYCE, M.D., attached, on special service, to Scutari Hospitals.-London, 1857.

FOR the last three years almost every number of this publication has made use of some valid personal knowledge or published records to keep its readers acquainted with all that belongs to the medical literature of the late war. True, we have had to express regret at the rarity and incompleteness of these materials-still, we looked hopefully to the future. It was impossible to doubt that our army medical staff, with the ability to instruct, would always withhold

from the public the fruits of their professional experience gained so hardly and honourably during the Crimean campaign, and continue silent on the true causes of the terrible mortality which befel the army in the winter of 1854-55. Indeed, self-respect, as well as the interests of humanity and science, impose on this military department the duty of such-like publication. No one has forgotten the blame cast on the competency of the medical staff of the British expeditionary army for a large share of its losses from disease. Their numerical inadequacy to succour and save the wounded was not more roughly denounced to popular censure, than was their professional skill in the proper treatment of camp sickness. And to make this popular censure more credible and poignant, comparisons were drawn, now, between the sanitary state of the Allied armies in the field, and again, between the hospital practice of English, French, and Constantinople surgeons. However painful it is to read these disparaging estimates, and with whatever mistrust the authority for making them was looked at, nevertheless, till very recently, we were without any official statements whereby to gainsay their truth. Even now, we do not possess official documents regarding the two chief points of this comparison, namely (1) The medical organization and administration of the English and French armies respectively, influencing the general hygiene of each; and (2) the professional knowledge of the regimental and staff surgeons, as tested by statistical results of medical practice in camp and hospital. The injustice done the British service, at home and abroad, with regard to the former of these two points of comparison, can be established, we think satisfactorily, by evidence drawn from the writings now selected for review. It was our wish to have embraced the latter particular also, but the means still fail us.

There is on the eve of being issued from Whitehall-yard a voluminous medical and surgical report, which, besides furnishing tabular returns of the number of regimental sick daily in hospital, the classification and details of camp diseases and of external injuries, with the issue of every case borne on the sick list, will likewise present approved dissertations on etiology, pathology, and therapeutics founded on the collated and collective observations of the whole army medical staff employed in Turkey and the Crimea. If this work prove in execution what the Director-General designs it to be, from the time, labour, and cost bestowed on its preparation, Dr. Smith will have taken a noble revenge on detractors of himself and his department in 1855. Disappointed in obtaining the promised publication for present use, we are constrained to narrow the bounds of the preceding comparison to the single question of the relative merits and demerits of British and French military administrative regulations in preserving and restoring the efficient health of soldiers in the field.

We have, indeed, long coveted an opportunity and the means to discuss this question fully. The books set forth for review, the names and designations of the respective writers, with the avowed purpose of their pages and the opportuneness of their revelations, supply these. And being the first contributions to the medical literature of the war which enable us to obtain a clear insight, if not complete knowledge,

of the sanitary administration of the English and French services, it may be useful to premise what follows by some words personal to the authors.

Sir John Hall, as principal medical officer in the East, after the landing of the Allies in the Crimea, was directly answerable, so far as his power extended, for the hygiene of the British army. In all that concerned enforcement of available appliances against camp diseases resulting from accumulated filth, overcrowding of tents and hospital marquees, insufficient nutriment, and defective medical resources, it was his duty to advise, report, or order. And we are only chroniclers of the now unanimous judgment of the British army in stating, that his experience, industry, and wisdom, with exemplary self-respect, augmented his military rank. His weekly official reports and returns are models of exactness and instruction. No chief of a department was less envied than Dr. Hall for the honorary reward conferred by his Sovereign for eminent services in the field.

M. Baudens arrived in the Crimea only towards the close of active hostilities, but not before his high military rank and distinguished medical abilities were needed for the salvation of an army. It has rarely been our good fortune to witness a more dexterous surgical operator, or listen to a more eloquent expositor of medical ethics. While he proved himself indefatigable in personal labours, and daring in counsel for the due fulfilment of his "mission," his high-bred courtesy to the subordinate officers of his department insured the obedience of respect as much as that of command—si sic omnes. The election of a literary and political journal of Orleanist tendencies for the publication of his Eastern experience, does not in our estimation detract from his patriotism or professional dignity, however strange the circumstance must seem to English notions of military reserve.

To Dr. Bryce belongs, it would appear, the credit of having been selected by the Director-General to investigate at Scutari hospitals, and report directly on the comparative merits of the English and Constantinople methods of treating sick soldiers from the Crimea; for which service a former residence in Turkey, and certain published writings, were supposed to qualify him peculiarly. This investigation, we may remark, originated in a newspaper preference given to the Perate medication of fever and dysentery over that generally pursued by our surgeons in like cases. On completion of this special duty, Dr. Bryce proceeded to the Crimea for the purpose of observing the sanitary state and hospital means of the Allied armies; and, at a later period, he visited and closely inspected the French hospitals on the Bosphorus. The facts then and thus ascertained he embodied in official reports for the information of those whom the knowledge concerned. These reports constitute a considerable part of his present volume, the publication of which he probably considered well timed to remove some of the popular injustice continually done our military system in the conduct of the war, and restore, here and elsewhere, the just repute of English medical administration compared with that of the French, for prolonged service of troops in the field.

These preliminary observations on the personnel of the authors named point to the use of their writings and the value of their testimony in relation to the following questions:

a. What was the general sanitary state of the English and Freuch Crimean armies respectively throughout the war?

b. In what respects does the military organization of the medical department of each exercise a controlling influence over the management of sick soldiers?

c. To what extent did experience in the medical administration of both services prove the superiority of either for remedial resources available in camp and hospital, at periods of great sickness?

d. And what was the actual fighting strength, measured by a health standard, possessed by the Allied combatants before Sebastopol immediately prior to the signature of peace? (30th March, 1856.)

These are questions we have been long desirous to elucidate in these pages on authentic data. Let us see if we can do so by making contributory to the attempt the records which we have put at the head of this article. For this end, we now propose to invite attention, first, to the facts of the case as they stand in evidence; and, next, to the medical, military, and national bearings of these facts: and the directest plan whereby to accomplish the object in view is to strictly scrutinize the pages of Dr. Bryce, as the latest and most specific of the three works on the subject.

First, then, what was the sanitary state of the English and French Crimean armies throughout the war?

On application, the Director-General supplied the author with the subjoined

"Abstract of the number of Non-commissioned Officers and Men sent to the East dering the late War, with the Deaths from Wounds and Diseases respectively; also, the Number Invalided to England.

"These numbers may be cast into another form for sake of uniformity with

the French return of casualties which follows. Thus:

These numbers are supplied from a parliamentary return quoted in the United Service

Magazine. 41-XXI.

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