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diffusible agent thus admitted into the blood, the author can give no definite explanation ; every one, however, will agree with him in assuming that it is of different quality in different conditions ; thus it appears inaccurate to speak of putrid infection (septicæmia or septhæmia) in those cases in which the symptoms become manifest before any putrefaction or suppuration can have taken place, as in some miasmatic and endemic affections.
“Here we have to deal neither with pus nor the common products of putrefaction, but with specific fluids, which are, no doubt, in a state of transmutation, which originate in the lymphatic fluids, under the influence of miasmatic or epidemnic influences, and may infect not only the patient's own body, but also that of others. The chemical quality, by which the humours are altered, is unknown to us; we can, therefore, not use it for the appellation of the altered crasis of the blood. But vitiated the humours are which become admixed to the blood: we can, on that account, without hesitation, select a name from this circumstance; I propose, therefore, to call the condition ichorrhania, as already the ancients understood by ichor, corrupted humours.” (p. 702.)
Virchow's ichorrhæmia differs therefore from septicæmia, or septbæmia by the absence of the really putrid elements; both have that in common, that they are caused merely by infected fluids. The ichorrhæmia is further distinguished by being combined with a larger amount of colourless blood-globules and fibrin, thus approaching, in this respect, the inflammatory crasis (phlogæmia). Finally, the author agrees with Rokitansky in the view that there does not exist a condition which deserves the name pycemia. The ichorrhæmia, which is to supplant the pyæmia in many instances, possesses, as was just mentioned, the same inflammatory diathesis which had been ascribed to the old pyæmia. In the concluding part of this chapter Virchow gives a résumé on some points connected with embolia, on which, however, we are unable to enter. In the same manner we are obliged, for the present, to pass over the remaining sections, which contain contributions to Gynaekology, to the pathology of new-born children, to the pathology of the cranium and brain, and an essay on cancroid and papillary tumours.
All these essays will amply repay a careful perusal, which will not only convince the reader of the extended and varied knowledge of the author, but will also show him that Virchow's method of investigation is a truly philosophical one, combining observation, experiment, and induction, in a manner which we rarely meet with, but which must necessarily tend to the real advancement of science. We may, therefore, express our confident hope that the author will make good use of his present influential position as Professor of Pathological Anatomy at the University of Berlin, with clinical wards in the Charité, and a chemical laboratory at his disposal ; he is the right man to show the way to the study of the phenomena of disease, as well during life as after death, without over-valuing the one or under-rating the other; from him, we trust, his pupils will also learn not to depreciate the action of therapeutics, but to consider the art of healing as the last and highest aim of our profession.
REVIEW III. 1. Report on the Pathology of the Diseases of the Army in the East.
By Drs. Lyons and AITKEN. (Blue Book,' 1856.) 2. Discussion sur le Typhus observé dans les Armées pendant la guerre
d'Orient. (Societé Impériale de Médecine de Constantinople.')—
Constantinople, 1856. Discussion on the Typhus observed in the Armies during the War in the
East. ('Imperial Society of Medicine of Constantinople.") We observed in our Number of July, 1856, that it would be desiratle to delay the consideration of Dr. Luyons' Report until all the documents which may be published on the Diseases of the War are before us. But, as it is probable that the official publications which have yet to appear may deal with portions of the medical history of the campaign different from that which is discussed in Dr. Lyons' Report, and therefore will require special and particular consideration, we deem it advisable not to delay any longer our notice of the only pathological report which we are likely to receive. The second work, the title of which heads this review, is the first publication of a Society founded at Constantinople during the war, and which included among its members several of the most distinguished Surgeons of the French and English services. The appearance of this publication, and the interest attaching to the subject discussed by the Society, will lead us in this review to select especially for comment that portion of Dr. Lyons' Report which refers to the Fevers of the Eastern Force.
Dr. Lyons was sent out in April, 1855, with instructions from Lord Panmure to investigate the pathological anatomy of the diseases among the troops. A very able letter of instructions was drawn up for his guidance, and has already appeared in our pages. * Drs. Aitken and Doyle were sent out under him, and a very complete and efficient apparatus was provided.
The advantage of sending out to Turkey men experienced in morbid anatomy, who might institute a regular and systematic investigation, is so evident that it would be an insult to our readers to insist on the point. For want of such men during the winter of 1854-55 at Scutari and in the Crimea, we have lost the opportunity of acquiring a perfect medical history of the campaign. That several thousand men died,—that certain causes produced their deaths,—is the limit of our information. The precise structural lesions which were the immediate causes of death we do not, and shall never, know. We shall receive, no doubt, tables of the diseases to which these deaths are officially referred ; but this meagre information is not equal to what the scientific precision of the day demands.
We cannot blame the medical officers of the army for not investigating the morbid anatomy of the diseases prevalent among the army in 1854–55. The labours of these gentlemen were overpowering and incessant, and they naturally threw aside that portion of their duty which could best be spared. Much better is it to have lost all the interest which the examination of those dead men would have given us, than to have taken from the living one moment of time, or one attention which might have aided in preserving a life dear and necessary to the country. The omission was inevitable, and must be inevitable in every campaign attended with unusual sickness, unless, as was done in the spring of 1855, and as is to be done for the approaching Chinese war, gentlemen are sent out for the single and exclusive object of examining the bodies of the dead, and of investigating the causes and the effects of diseases, instead of being occupied in treating them.
* Vol. xviii. p. 279.
Unfortunately, however, in the Eastern campaign, the period of greatest mortality was allowed to pass by before the pathological inquirers were set to work, and their report is therefore by no means equal to what it would have been had their inquiries commenced simultaneously with the sickness. In April, 1855, when Dr. Lyons arrived at Scutari, the mortality of all the large hospitals aggregated there had fallen to four or five a-day, and soon fell even below this; and the types of disease had lost not only the intensity, but the characters which they had displayed in the winter. Subsequently, the diseases of the expeditionary force presented nothing specially remarkable or unusual; and in the English army in particular, various favouring circumstances combined to keep the health of the soldiers during the summer, autumn, and winter of 1855–56 in a condition unparalleled either in ancient or modern warfare. The French and Russians, indeed, as is well known, suffered greatly at the time when the English were most singularly healthy. “The English army,” said one of the French surgeons, in the discussion of the Society at Constantinople, " is to the French what a rich family is to one less endowed with fortune's gifts;" and certainly no men were ever more zealously guarded from all sources of disease than were the survivors and successors of that heroic band whose sufferings and destruction will fill the saddest page of our military history.
After the arrival of Dr. Lyons and his assistants, the chief diseases among the English were typhus and typhoid fevers; and during the summer and autumn of 1855, it would seem clear that the latter disease constituted the great bulk of the cases, though in the previous winter and early spring there can be as little doubt that exanthematic typhus was much more prevalent. Scurvy had almost entirely disappeared, and though in the following winter it was again seen, it was in an extremely slight form, was easily checked by treatment, and did not influence in any great degree the progress of other diseases occurring in persons with this slight scorbutic taint.
The typhoid fever presented the deposits and ulcerations of the Peyerian glands, and deposits in the mesenteric glands, in the form so well known in Western Europe; Dr. Lyons says, “the enteric lesions were all but universally attendant upon it;" but he does not narrate the exceptional cases, in which, with all the other symptoms of typhoid fever, he found no ulceration of Peyer's patches. At p. 60
he gives a table of the chief morbid appearances in 50 cases of typhoid fever. In 31 of these cases there was ulceration of Peyer's patches; in 9 there was deposit in them, but the softened and ulcerative stage had not commenced; in 1 case only (No. 10 Pte. Hugh Love) Peyer's patches were unaffected; but this case was evidently one of double pneumonia, and not typhoid fever, * although it happened to be returned as “ Febris Continua Communis." We have been unable to find any other evidence bearing out the inference to be drawn from Dr. Lyons' expression—viz., that the Peyerian glands were not invariably diseased.
The symptoms presented by the typhoid fever in the Crimea presented nothing unusual. Dr. Lyons refers to the frequent latency of its course; but this was not different from what occurs in a certain percentage of cases in France and England. Few things are more surprising than that practitioners will still look for strongly-marked febrile symptoms in every case of typhoid fever; these may or may not exist in a high degree; and there will always be a certain number of cases in which the febrile symptoms are extremely slight; a little elevation of temperature by 1° or 20 of Fahr., a moderate increase in the fulness and quickness of the pulse towards the evening, a little headache during the first five or six days of the disease, and scanty urine, may be the only symptoms of a case which is to terminate at a later date by hæmorrhage or perforation. Whether these cases were comparatively more numerous in the Crimea can only be known by proper statistics, and these are unfortunately not attainable.
It would appear from Dr. Lyons observations that fatal cases at an advanced period were not uncommon, from continual progress of the intestinal lesion; and that frequently men returned to duty while this local affection was steadily advancing. This form of disease is a very interesting one, as it is comparatively seldom seen in civil life. At a certain period in typhoid fever, the specific disease of Peyer's patches ends, the mesenteric glands begin to lessen in size, and the nutrition of the body returns to its physiological condition. Under ordinary circumstances the intestinal ulcers rapidly heal; but from errors in diet, or from constitutional conditions unknown to us, they occasionally continue to spread in the mucous membrane of the ileum, just as dysenteric ulcers will do in the colon. Eventually the patient dies with obstinate diarrhea and emaciation, or, much more rarely, by perforation. It can be well understood that this class of cases may have been very numerous in the Crimea ; according to our observation, there was very little malingering among the men; there was almost always a great desire to return to duty, and this led many to report themselves as stronger than they really were; on discharge, therefore, from hospital with ulcers only partly healed, the coarse food and the exposure soon produced an increase of the intestinal ulceration; often, too, ulceration attacked also the colonic mucous membrane, and the case would have been termed “Dysentery following typhoid
* « The left lung was condensed throughout, and was of a bright red colour on section, and non-crepitant, except a small portion of the apex. The lower and posterior parts of the inferior lobe (of the right luvg ?) were in a similar condition, and the texture of both was friable." (p. 64.)
fever.” Cases of this sort ended sometimes three or four months after the original attacks, and the men were out and in hospital two or three times during this time.
In addition to dysentery following typhoid fever, many cases were seen in which typhoid fever had followed dysentery. We had not ourselves much opportunity of seeing this, but a very competent observer, now unfortunately dead, informed us that the association of rather old, healed, dysenteric ulcers, with recent typhoid fever, was too frequent to allow him to suppose the coincidence was accidental. Dysentery, it is true, prevailed in the army, and a certain number of dysenteric persons would necessarily be afterwards attacked with typhoid fever, but during the summer, autumn, and winter of 1855–56, the dysentery and the typhoid fever were not so common as to lead one to suppose they would very frequently be found in the same person. It is possible, then, either that the same persons had a constitutional tendency to both dysentery and typhoid fever, or that the dysentery predisposed to the last-named disease.
Dysentery also accompanied the febrile stage of typhoid fever more commonly than it does in England and France, so that the affection of the large intestine, before, during, and after typhoid fever, may be considered to have been decidedly more pronounced in the Crimea than we are accustomed to see it here.
General tuberculosis occasionally followed the Crimean, as it will do the English, typhoid fever.
The so-called “Crimean fever" was simply the typhoid fever. There was no special and distinguishable Crimean fever, there were intermittent, remittent, and relapsing fevers (probably), and typhus and typhoid fevers, but there was no disease to which, scientifically, the term Crimean fever should be applied.
The mortality of the typhoid fever cannot be known, as the correct diagnosis was frequently not made, and as in the army returns there is only one general beading of Continued Fever. Not infrequently cases of typhoid fever appear to have been returned as diarrhæa. At page 3, Dr. Lyons gives a table of 16 cases, which were returned as being fatal from " diarrhea." These cases were really
Among Dr. Lyons' 50 fatal cases (pleurisy, pericarditis, meningitis, peritonitis), we notice only 2 cases of perforation. We conceive there is no disease which the army medical officer should study more carefully than typhoid fever. Its frequently insidious course, its duration, and its sequela, render it a most difficult disease to treat, unless the diagnosis is made early. Then all becomes clear, and the patient has