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trophe, and the highest intelligence of the nation was employed in devising means for ensuring to the French troops a safe transit, and to the French people a safe intercourse. A successful retreat is said to be the most honourable thing after a decisive victory, and the French surgeons certainly retreated from the terrible disease which assailed them in Turkey with a skilful adaptation of means which does them great honour.
But we must no longer desert Dr. Lyons. His chapter On Typhus Fever is a short one, and presents no new feature of interest, and no post mortem examinations are recorded.
In addition to typhus and typhoid fevers, Dr. Lyons describes intermittent, remittent, and relapsing fevers, and what he calls "simple continued fever"—a disease, the description of which is too brief to enable us to pass any opinion on its nature, and of which we personally saw no examples.
The relapsing fever, as described by Dr. Lyons, oecurred dnring the~ summer, and would seem to have presented the characters with which we are familiar here. The early symptoms were severe, and rapidly reached their acme, while on the fifth or sixth day there was sudden subsidenee (crisis), with sweating. This apparent convalescence was followed by return of febrile symptoms after "two, three, four, or more daya" No cases were fatal.
We had not ourselves any opportunity of accurately studying this form of disease, but we have been informed that it was seen in the Secondary Hospitals in the autumn and winter of 1855-6, and presented sometimes three or four relapses. It was probably this fever which was attended so frequently with jaundice, either during or after its course.
Passing from the consideration of fevers, we find that Dr. Lyons discusses at considerable length both cholera and dysentery. Six post-mortem examinations only are given of the former disease, and we observe no new facts which need detain us.
The chapter On Dysentery is written with very great care, and is illustrated with a table containing a summary of fifty post-mortem examinations of acute and chronic dysentery. The morbid anatomy of the Turkish and Crimean dysentery appears to be completely identical with that of the Indian disease. There was great exudation on and among the coats, sloughing, ulceration, commencing sometimes in the follicles, at other times in the membrane, or even, Dr. Lyons thinks, in the exudative layer which had become organized. This last observation (of ulceration commencing, not in the mucous membrane, but in lymph thrown out upon it and organized) is new to us, and we should have been glad to have seen it illustrated by some minute dissections. The implication of the solitary glands is described by Dr. Lyons very exactly, although he does not appear to have traced their chauges beyond the early period of commencing ulceration.
"That the vesicular glandular apparatus of the large intestine often participates immediately in the dysenteric process is not oaly very probable, but we think that such participation is more common than is usually supposed." (p. 17.)
The fact is, however, that. this change in the solitary glands has been considered by some writers as the proper anatomical character of acute dysentery, and as a prior change to that intense hyperaemia and enormous exudation of lymph, which constitutes the better known anatomical characters of the disease. As far as they go, Dr. Lyons' observations support this view.
. Coincident disease of the small intestine appears to have been more common in Turkey than iu the Indian dysentery. The following table, drawn up from Dr. Lyons' summary, illustrates this :—
Uleeration Small intestine
The affection of the small intestines, in the cases of "complex dysentery," consisted in soveral (four certainly, probably six) cases of ulceration of Peyer's patches, and in several other cases these glands were "infarcted." As in Indian dysentery these glands seem never specially attacked, and suffer only where there is general disease of the whole iliac mucous membrane, it must be admitted that Dr. Lyons is quite correct in referring these cases to a complication of dysentery and typhoid fever. But apart from, and making every allowance for, this fact, the disease of the small intestines would appear to have been more common than in India, probably from the presence of special constitutional cachectic conditions, as it is under such circumstances, and especially in scurvy, that the small intestines are engaged, and show, not usually ulceration, but diphtheritic exudation.
The secondary affections of dysentery are treated rather shortly, and w,e are not very clear how closely Dr. Lyons associates them with the primary disease. They consist of changes in the liver, spleen, kidneys, and especially the lungs ("vesicular bronchitis and lobular pneumonia").
Returning from this very interesting section on Dysentery, to the commencement of the Report, we may observe that Dr. Lyons devotes a few pages to "Diarrhoea," a disease which, according to the official returns, is often fatal. On post-mortem examination, however, all the so-called cases of diarrhoea turned out to be typhoid fever, dysentery, tuberculosis, or pneumonia! and Dr. Lyons has never been able to meet with a pure fatal case of diarrhoea. It is quite time, indeed, that this term should disappear from our tables of deaths. The diarrhoea which was so common among the troops, but which was never really fatal, is arranged by Dr. Lyons under three heads—
1. Atonic diarrhoea, or lientery.
2. Bilious diarrhoea.
s - S. Congestive diarrhoea.
The Hentery is described at some length as a disease in which the food appeared to pass through the stomach and intestines with little alteration, as if there were an arrest of "the digestive, assimilative, and absorbent functions." There appears to have been little pain, and, as far as we can gather from Dr. Lyons' account, there was no pouring out into the intestines of bile, or the intestinal fluids which constitute the stools of common diarrhoea. We did not ourselves witness any form of this disease, but a grave affection somewhat corresponding to it, but often very fatal, was seen in the Chinese war of 1840-42, and after death the mucous membrane of the small and large intestines was, we believe, pale and softened. In Turkey it appears to have been extremely slight, and many medical officers denied its existence.
After considering at some length, in the first half of his Report, the various diseases we have now shortly noticed, Dr. Lyons gives us, in a second part, a resume of the pathological anatomy of the various organs. This is an important chapter, and is very well done. We should, however, have been glad to have had a statement of the number of cases from which the general conclusions are drawn. A rather novel feature in it is that the specific gravities, not only of the organs but of membranes, are given. These observations were made by Dr. Aitken, and reflect great credit on him. As a general result, it would appear that exudation into the intestinal mucous membrane, both in typhoid fever and in dysentery, raised the specific gravity of the membrane; and even in atrophy of the membrane, the specific gravity was above the natural standard. The point is sufficiently interesting to induce us to lay before our readers a portion of the table:
Specific Gravity of the Mucous Membranes.
Maximum. Minimum. Mean.
Fever's patches 1-044 ... 1032 ... 1039
(a) Parts with glandular and exu-~) , ~, Q
dative deposit j
(A) Parts in atrophic state . . . 1038 ... 1030 ... 1035
Apparently healthy 1036 ... 1030 ... 1032
(a) Colon with dvsenteric exudation 1-050 ... 1-037 ... 1-043
(4) Kectuiu 1044 ... 1038 ... 1041
Atropine degeneration 1-040 ... 1037 ... 1038
Apparently healthy 1038 ... 1-028 ... 1033
We are not, however, told from how many examinations these figures were derived.
We have now given as much space as we can afford to Dr. Lyons' Report. Our remarks will show the favourable opinion we entertain of much of its contents. It is written extremely well, id clearly expressed, and is in many parts very descriptive. The introduction, which contains a general statement of Dr. Lyons' opinions ou the pathological origin, progress, and treatment of the diseases of the Eastern force, is a very important document, and may probably come again under review on a future occasion.
Yet, with all the6e undoubted merits, we must frankly say that the Report has in some degree disappoiuted us. 'Die absolute number of post-mortem examinations is not great, and they are communicated very briefly, and in many cases very imperfectly. More might surely have been done in this direction ; and, considering that this Report will represent on the Continent the opinions of the most advanced British School of Pathology, no consideration should have prevented the fullest detail of all the morbid appearances. The chemistry of the fluids has been left untouched, and the microscopical notes are short and unsatisfactory. We have looked in vain for even a microscopical examination of the blood; and the absence of these inquiries is not compensated by any researches earned on at the bedside of the patients, for the histories of the diseases are even more meagre than the accounts of the post-mortem examinations.
Much, no doubt, has been done by Dr. Lyons and his assistants, and great were evidently the difficulties they had to encounter. Taking into account the real and great merits of the Report, and the difficulties the Reporters laboured under, some may think our remarks too severe. We can only assure Drs. Lyons, Aitken, and Doyle, that we should have had much greater i)leasure could we have closed our review without any qualification of the favourable opinion we have generally expressed. We can assure them, too, that their Report is a gain to science, and will always be a document of interest and authority for those who study the medical history of the Crimean campaign.
On the Constitutional Treatment of Female Diseases. By Edward Rigby, M.D., Fellow of the Royal College of Physicians, Senior Physician to the General Lying-in Hospital, Examiner in Midwifery at the University of London.—London. 1857. pp. 324.
The appearance of a new work from the pen of so eminent a physicianaccoucheur as Dr. Rigby, cannot fail to interest the profession; for, notwithstanding the abundance of recent publications on obstetric medicine, there is still room for practical information on a subject which is daily gaining in extent and importance. 'Dr. Rigby describes his book as strictly practical, and prepares the reader in his preface for the due appreciation of constitutional treatment in diseases of the female generative organs.
The experience of every observing physician demonstrates the fallacy of attributing much curative power to merely local means of treatment, and proves the utility of embracing large views of general or constitutional management. Abernethy displayed this in vivid colours to the surgeon; and the physician will also reap- an ample reward in the cure of disease, if he devote himself earnestly and peraeveringly to the discovery of those constitutional defects and disorders which, hidden it may be from the sight of superficial observers, so constantly lie at the root of most of those phenomena the local manifestations of which are too often looked upon as the essence of the complaint, and the sole objects of treatment.
We are glad to find that Dr. Rigby has publicly enlisted himself amongst the number of those physicians who place their chief reliance, in the treatment of the diseases peculiar to the female, upon constitutional measures. The first three chapters of the work before us comprise the subjects of amenorrhcea, dysmenorrhea, and monorrhagia; and although we cannot say they contain much that is new either in description or mode of treatment, they well deserve attentive consideration. With regard to amenorrhcea, like other functional derangements of the uteriue system, it is, in fact, a symptom, an effect of general derangement; and, as Dr. Rigby justly observes, it behoves the practitioner to look beyond the mere local affection, and carefully investigate the abnormal or defective actions of the system upon which it essentially depends. It is undoubtedly a great mistake to imagine that the absence of this natural secretion is the cause of the numerous ills that accompany its retardation or suppression, although such is a very prevalent and convenient doctrine. Nothing is easier than to convince an anxious mother that her daughter's deteriorated health and sickly appearance depend upon this irregularity; it is, indeed, so natural to her to think so, that the practitioner needs no other explanation to satisfy her anxious inquiries. Does not this facility of accounting for diseased appearances often lead to an equally superficial method of treatment 1 And does not the young sufferer sometimes fall a sacrifice to the inroads of constitutional and organic diseases, whilst attempts arc vainly being made to excite the appearance- or reappearance of the menstrual discbarge; its absence simply depending upon the demands made by other diseases upon the system, rendering it unable to establish or continue those functions of the uterus which otherwise ought to exist 1 In vain shall we under such circumstances administer savine, borax, cantharides, and other special emmenagogues, as they are called; until the constitutional powers are restored, no good effect will be produced; and thus we find the best emmenagogues are fresh air and exercise, and such medicines as are most calculated to regulate the bowels and improve the general health.
Dr. Rigby says :—
"The two most valuable emmenagogues which wc possess, and which Mert a special Hction on the uterus, are the preparations of iodine, and tke secale cornutum. The iodide of iron is, perhaps, the best form for administering iodine to obtain its emmenagogue effects," and maybe given in "»e form of pill or syrup two or three times daily. The secale cornutum is "Kt given in the fresh powder, suspended in water with a little mucilage."
■Oysmenorrlieea is referred to the following separate heads:
1- It may be connected with derangement of the digestive organs.
2. It occurs in a gouty or rheumatic habit of body.