ledge? If so, shut the book, and if a student, go to the hospital, the lectureroom, and the dissecting-room, for information, rather than to Galen and Paulus Ægineta. If you are in actual practice, study diseases for yourself at the bedside of sickness, and keep up to the level of the swelling tide of knowledge that every where flows around you. If, however, you prefer the imperfect-too often absurd, doctrines and practices of the Arabian, Greek, and Roman physicians, you will study their writings by day and by night, till you have earned for yourself the reputation of being a learned. veteran of THE OLD SCHOOL.

OUTLINES OF MILITARY SURGERY. By Sir George Ballingall, M.D. F.R.S.E. Third Edition. 1844.

RECUEIL DE MEMOIRES DE MEDICINE, DE CHIRURGIE, ET DE
PHARMACIE MILITAIRES. Vol. 56, Paris, 1844.

A Collection of Memoirs on Military Surgery, Medicine and
Pharmacy. Vol. 56.

A MEDICAL Work reaching its third edition can require little notice or recommendation upon the part of the Reviewer; but we may observe that, we think its value would have been enhanced if the first division, relating to what may be termed Military Hygiene, had formed a larger proportionate share of its contents. This, however, could only be accomplished by much enlarging the size of the book, or by trenching upon the purely surgical portion, which the author considers as specially demanding his attention.

"So long as this course stands alone, the only one of its kind delivered in the medical schools of the united kingdom, so long it can only be patronized and encouraged as a substitute for part of the surgical attendance enjoined by the several colleges and hence I feel myself bound, in justice to my pupils, to enlarge upon the surgical department. Again, I find that this is the department of the course which proves most interesting to that important part of my audience consisting of gentlemen returning from foreign service, to refresh their memories, or to renovate their knowledge at the schools of medicine.

Without at all underrating the importance of those diseases more strictly within the province of the physician, I cannot avoid expressing my fears, that in a period of long protracted peace, there is some risk of the medical officers of the army overlooking the importance of the surgical department of their profession."

That the army or naval medical officer should be made fully acquainted with every surgical duty which he, beyond any of the profession, is most likely to be called upon to fulfil, is too obvious to require farther remark; but it is no less true that this forms but a portion, and even a limited portion, of what should be expected from him, and is by far the most easy of attainment at the ordinary courses of surgical instruction at our schools. Such knowledge will, indeed, prove invaluable upon the field of battle: and it is a matter of sincere congratulation that the gross ignorance which dis graced the lower ranks of medical officers of both the French and British No. 09.

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armies at the commencement of the late wars, can never be again witnessed. But do not the histories of all campaigns and naval expeditions, and the defective health and large mortality of our soldiers and seamen even during a period of profound peace, too truly indicate that sources of destruction far more potent and more constant in their operation than the battle-field are in existence? Formidable as these evils are, they are still very much diminished, for even the condition of the warrior has participated in the general progress of improvement. But such improvement has only arisen from the diffusion of more sound principles of hygienic treatment, and can only be augmented by their still farther dissemination. Where is the young medical officer to seek for the necessary information upon this subject, if not at the hands of his experienced teachers of military medicine? for it is obvious that, at the ordinary courses of the schools, none such can be supplied. It is true that we possess a great number of works which incidentally convey most valuable information upon this head, and much of modern improvement is due to their publication: but we have no work treating Military Hygiene as a substantive subject, although, from its great national importance, it is worthy of the employment of the highest talent and most extensive experience. We sincerely hope the Head of the Army Medical Department has not abandoned the intention the author states he once entertained of producing such a one.

In truth there is no member of society, placed above destitution, whose condition is more worthy of consideration and commiseration than that of the common soldier. Frequently entrapped into the service of the public at an unwary moment, he discovers, when too late, that he has contracted an interminable bondage with a hard task-master. Neither emancipation nor advancement stimulates and rewards good conduct, while the smallest delinquencies are visited by punishments determined by an arbitrary system of laws, and too often inflicted with most injudicious severity. It might be expected that the complete abrogation of the moral judgment, and the conversion of the man into an intelligent machine, which military discipline exacts, would, at least, be compensated for by a due provision for every physical comfort, as is seen to be the case in some of the other more avowed forms of slavery. With the soldier it is not so; for, whether we regard his clothing, his diet, his abodes, his recreations, his nightly rest, the due alternations of moderate employments with proper intervals of repose, or a variety of other circumstances, we see cause to acknowledge the necessity of great meliorations before his hygienic condition can be considered satisfactory. Many of the inconveniences of a military life are indeed inseparable from it during the period of war, although even then susceptible of great mitigation: but the extent to which they are allowed to continue during peace is lamentable. What are the results of the conjoined operation of the various circumstances unfavourably influencing the condition of the soldier? A large proportion of premature deaths and suicides, frequent attempts at desertion, an addiction beyond all other classes to intoxicating liquors, and the generation of such a host of fictitious maladies, that no small share of the duties of the military surgeon, aided by a now distinct branch of medical literature, consists in their detection.

We proceed to notice a few of the observations made by Sir George Ballingall upon this subject.

Diet.-The importance of a wholesome and abundant diet, as a means of preservation of the health of the soldier, is now almost universally acknowledged. Dr. Jackson, however, believes that a frugal fare has usually been that of the conqueror, and a rich and luxurious one that of the conquered.

"In his last work, on the Formation, Discipline, and Economy of Armies,' Dr. Jackson has adduced much ingenious argument in support of his views of this subject; and he concludes by observing, that luxurious living places the military character on the brink of destruction; for,' says he, if there be anything like correct observation among men, it may be confidently asserted, that, if high living be the life of the gentleman, it is the death of the soldier.' It is obvious, however, that such observations as the foregoing apply only to the luxuries occasionally indulged in by the higher ranks. They can only be addressed with propriety to the officers-to the educated and reflecting part of the army-and habits of abstinence are so little congenial to the disposition of the English soldier, that he will never practise them when he can do otherwise. My views of the disadvantages of an insufficient diet are, I find, fully borne out by the recent experience of Mr. Alcock of the British Legion, who, in a letter to me, observes that his men, at Vittoria, were literally starved upon their rations, nominally a pound and a half of bread, and a pound of meat; but this, when served to the soldier, after the peculations, and diminutions from bone and skin, was often not more than four or six ounces of solid meat. This,' says

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he, is not sufficient, and formed a very prominent cause of a startling mortality.'" 37.

Where practicable, daily rations are to be preferred as preventing the waste and gluttony which sometimes are present when several days' are delivered out at once. In a letter to Sir James M'Grigor, the Duke of Wellington states that rations were invariably delivered daily in the Peninsula; and that the British soldier carried but three days' bread, while the Portuguese carried six, and the French fifteen days'. Almost all observers agree in the importance they attach to the introduction of tea or coffee for the soldiers' breakfast. Their use seems often prophylactic in cases of exposure to malaria, night air, &c. The benefits resulting from substituting these drinks for spirits in both Army and Navy are acknowledged on all hands. "Coffee," says M. Finot, in an article to which we shall presently advert, "now received in the berry and ground as wanted, forms the best of drinks for the French soldier in Africa. The advantages which have attended its replacing the former distributions of brandy, are, we believe, now definitively agreed upon.'

Clothing. We do not think the author has sufficiently exposed the defective character of this. To us it seems that it would be difficult to contrive more unsuitable habiliments than those of the soldier, which reştrain by their tightness free muscular action, rendering the occasional active exercises painful and dangerous, and by their flimsy texture afford an insufficient protection against the inclemencies of the weather. White trousers may look very nice upon parade, and please the eye of the commanding officer, but, in this and other cold and inclement climates, should

never be employed, especially when it is considered that it is impossible for the soldier to keep them sufficiently clean without the use of wet pipe-clay. Under-clothing of every description, both waistcoats and drawers, is also far too much neglected, although instances of the prevention and removal of disease by its adoption are exceedingly numerous. When we consider the vicissitudes of weather a soldier is exposed to, his alternations of active exercise and perfect inactivity, and the broken description of rest he obtains, it seems evident that he is very insufficiently clad, and that above all things he should be furnished with a better supply of flannel.

Exercises. The author thinks that these require great attention to be paid to them by the officers, agreeing with Sir John Pringle, that "although a soldier is occasionally liable to great fatigue, the most frequent error of people of that class, if left to themselves, would be on the side of rest. The most eligible rate for marching in all climates is from three to three and a half miles per hour.

"I have been much pleased to find my own views on this point strongly confirmed by a recent authority, Dr. Kennedy, of the Bombay army, who, in his interesting Campaign of the Army of the Indus,' observes, that when the soldier has from 50 to 60 pounds weight to carry, a distance of 12 or 14 miles to march, and a solar temperature above 100° to bake in, the shorter the time he is about it, the better. It is in my opinion an erroneous practice, as was the custom during my service in India, from fear of exposure to the sun, to move off the troops from the ground at two or three o'clock in the morning, sometimes even earlier. Their sleep was thus broken; and the march, accomplished in the dark, frequently over bad roads or no roads at all, was necessarily protracted, was attended with great additional fatigue, and not without risk to the limbs of individuals. An hour's more sleep, and an hour's more daylight, even at the expense of an hour's more sun, was the maxim which I endeavoured to inculcate." 46.

Accommodation of Troops.-We cannot compress the few remarks the author makes upon the construction of camps. He particularly insists that, when these prove unhealthy, other localities should at once be chosen, rather than attempts be made, which usually fail, at remedying the evil. In the construction and regulation of barracks, means for thorough ventilation and perfect cleanliness should be carefully provided for. "The class of society from which soldiers and their wives are taken have an incorrigible aversion to the free circulation of air, a circulation which is rendered more necessary for them than for the higher ranks, in consequence of their less minute attention to personal cleanliness." Dr. Reid's Illustrations of Ventilation, noticed in a recent number, supply us with numerous examples of the defective condition of shipping as regards ventilation. Sir George Ballingall describes an easy and effectual mode of ventilating barracks, by which the currents of air so detrimental to health and comfort are avoided. Dry-scrubbing the floors has been advantageously substi tuted in numerous instances for the former too frequent washings. This cannot always be done.

"In warm climates, where vermin, and particularly fleas, are abundant, frequent washing is perhaps a necessary resource. Mr. Alcock tells me, that in

the large hospital at San Telmo, containing 600 beds, he had each division scrubbed with water every morning at day-break during the summer months, to the manifest comfort of the patients, who were thus kept free from vermin, greater coolness and cleanliness were obtained, and no bad result was observed. By the general introduction of iron bedsteads into barracks, cleanliness has been essentially promoted, and ventilation improved; for those cumbersome wooden bedsteads formerly in use, not only obstructed the circulation of air, but even materially diminished the cubical bulk of it contained in a room."

The importance of whitewashing hospitals and other crowded receptacles is now generally acknowledged, and the author deplores the unne. cessary obstacles and delays which often prevent its execution, as well as the imperfect manner in which it is usually performed. We have often regretted the remissness of parochial authorities in applying this useful preventive of infection to our wretched alleys and courts; but the neglect in the case of barracks, military hospitals, &c., where all the appliances and plenty of hands may be easily furnished, is far more culpable.

Proportion of Sick in Armies.-This may be much diminished by careful attention to the various circumstances mentioned. As already observed, those who fall in battle constitute but a small portion of the total mortality. Sir D. Stewart states, "that the 92d regiment lost more officers and men in four months from the climate of Jamaica, than by the hand of an enemy in an active war of 22 years, in the progress of which it was 26 times in battle." After alluding to the large proportion of sick reported by Pringle, in the campaigns of the Low Countries, the author observes

"To compare this with what has recently happened in another quarter of the world, I may notice the statement made regarding the sickness in the Bombay division of the Army of the Indus. From 1st Nov. 1838 to 31st Dec. 1839, the number treated was, Europeans and Natives, 11,689, and the deaths 408, which, compared with the strength, sufficiently indicates the hardships endured, and the efficiency of the hospital establishments. From Col. Tulloch's statistical statements it is inferred that soldiers in the United Kingdom are under medical treatment once in 13 months; in the West Indies twice within that period. In this country 1 case in 67 proves fatal, and in the West Indies 1 in 24."

Mr. Edmonds states, from returns in the Adjutant-General's Office, that in the Peninsular Army, averaging 64,227, the annual ratio of mortality, in the years 1810-13, was 10 per cent. officers, 16 per cent. men, and that during this period there were constantly 224 per cent. sick. Vaidy, in his article "Hygiene Militaire" in the "Dictionnaire des Sciences Medicales," states that, under the most favourable circumstances, an army will furnish about 5 per cent. of sick. During a campaign, not less than 10 per cent. must be calculated; and in the event of reverses or other untoward circumstances, this becomes immensely increased. As an example of what may be effected by able medical superintendence, the author cites the following incident of the Peninsular war.

"During the ten months from the siege of Burgos to the battle of Vittoria, inclusive, the total number of sick and wounded which passed through the hospitals was 95,348. By the unremitting exertions of Sir J. M.Grigor and the medical staff under his orders, the army took the field, preparatory to the battle