the latter substances. In urine containing santonine, this rose colour does not appear, not at least till half-an-hour or an hour has elapsed. With the carbonates of potash and soda, urine containing rhubarb gives promptly a roseate coloration, whilst with santonine, this reaction shows itself only after 15 or 30 minutes have passed. Spectral analysis gives characteristic results. Santonine in moderately concentrated solution, treated with potash, absorbs all the rays of the spectrum except the red and the yellow; in very dilute solution the red and the blue rays pass through, the rest being absorbed.—(Gaz. Hebdom, 16th May, 1879). Lyon Médical, 25th May, 1879. Books, Pamphlets, &c., Received. The Lettsomian Lectures on Bronchial Asthma: its Causes, Pathology, and Treatment. By John C. Thorowgood, M.D. London: Baillière, Tindall & Cox. 1879. Aids to Chemistry: specially designed for Students preparing for Examination. Part III-Organic. By C. E. Armand Semple, B.A., M.D. London Baillière, Tindall & Cox. 1879. The Causes and Results of Pulmonary Hæmorrhage, with remarks on Treatment. By Reginald E. Thompson, M.D. With illustrations. London: Smith, Elder & Co. 1879. Atlas of Histology. By E. Klein, M.D., and E. Noble Smith. Part IV. London: Smith, Elder & Co. 1879. The Nature of Life: an introductory chapter to Pathology. Ralph Richardson, M.D. Second Edition. London: H. K. Lewis. 1879. By The Heart and its Diseases, with their Treatment: including the London: By Alexander 1879. First Lines of Therapeutics, in a series of Lectures. Pott's Disease: its Pathology and Mechanical Treatment, with remarks on Rotary Lateral Curvature. By Newton M. Shaffer, M.D. New York: G. P. Putnam's Sons. 1879. Bulletin de la Société Clinique de Paris, redigé par MM. les docteurs F. Labadie-Lagrave et Henri Huchard.-1878.-Paris: V. Adrien Delahaye et Cie. 1879. THE GLASGOW MEDICAL JOURNAL. No. VIII. AUGUST, 1879. ORIGINAL ARTICLES. SURGICAL EXPERIENCES AND OBSERVATIONS AS AN AMBULANCE SURGEON IN BULGARIA DURING THE RUSSO-TURKISH WAR OF 1877-78. BY ROBERT PINKERTON, M.B., Surgeon, Anderson's College Dispensary. (Read in the Glasgow Medico-Chirurgical Society, 4th April, 1879.) DURING the late Russo-Turkish war, I was sent out by Lord Blantyre, as a surgeon, to assist the Turkish wounded, and in that capacity acted both independently, and attached to Ottoman Red Crescent ambulances, and also, for a short time, took charge for Stafford House Society of their hospitals at Philippopolis. In this work I travelled from Constantinople to within a few miles of Plevna, when I was stopped by the advance of the Russians. I saw some of the active fighting on the Plevna road, and had considerable experience of the wounded from the fighting at Shipka, the hospitals at Philippopolis being the first place to which the Shipka wounded were removed, after treatment by the ambulances stationed there. My time was so much broken up by being hurried about from place to place, and the amount of work, both surgical and medical, was so overpowering, not only from the large numbers of sick and wounded, but also from the very small number of medical men, together with most inadequate assist No. 8. G Vol. XII. ance for dressing the wounded, that any definite or detailed record of my work is rendered quite impossible. Yet I venture to hope, the simple statement of some of my experiences and observations may not be devoid of interest to members of this Society. The first point I would call your attention to is the fact that only very few of the wounded, in modern wars, are wounded by cuts or stabs, so few, indeed, that to one who reads, in newspaper accounts of battles, of desperate charges with the bayonet, of fearful hand to hand fights at the taking of redoubts, and so forth, where the imagination pictures the wounded from bayonet stabs at hundreds or more, the real number must appear absurdly, even incredibly, small. In the late Russo-Turkish war, where I had the opportunity of seeing thousands of wounded men, I am sure I did not see more than half a dozen suffering from sword, or sabre, or lance, or bayonet wounds. And all the enquiries I could make did not enable me to come across any one whose experience differed much from my own. Why is this? I suppose it is due to the recent improvements in the firearms with which troops are armed, especially the introduction of breech loading, by which the rapidity of fire can be so very much increased. In consequence of the ease and rapidity with which a soldier can load and fire his rifle now-a-days, the firing of shot takes place even at close quarters. Even in a regular charge, I believe, it is in great measure only those who fall wounded. who are bayonetted the attacking party and the attacked both trusting more to a rapid fire of small arms than to the bayonet. In the case of an assault, for example, on an earthwork, the holders of the earthwork, if moderately cool and steady, pour in a close and murderous fire up to the very moment the enemy enter the defences, and although there then may be some little hand to hand fighting, it is comparatively trifling, as the defenders of the earthwork, if beaten, either retire precipitately, in which case they are fired upon, and only those who fall wounded are bayonetted by the pursuing enemy, or they retire slowly, showing a steady front and keeping up fire, so that the enemy prefer to answer them in like manner. There is another reason why we see so few wounded by either cuts or stabs, besides the fact that in recent wars cuts or stabs are comparatively rarely given or received. And that is, that I believe the great majority of cases of cuts or stabs prove fatal on the field, and are, therefore, to be numbered among the killed. If you think for a moment of the circumstances of a close hand to hand conflict with the bayonet, a scene where the wildest passion reigns, and a tiger-like ferocity seems to characterise the combatants, where an enemy is not only overthrown, but trampled upon, you will see the reasonableness of allowing that few of those wounded under such circumstances, and with such a weapon, survive the final thrust, and hardly one lives to be taken off the field. Then there is the fact that the bayonet is, after all, a clumsy and inefficient weapon for close quarters. In fact it not unfrequently acts as a sort of trap for its unfortunate employer. It may become fixed in an enemy's body beyond power of withdrawal, in time at least to be a defence; or it may be rendered useless by having a body hurled upon it, as was done with so much success by the Zulus at the recent battle of Isandula. Soldiers, at least Turkish ones, don't like the bayonet as a weapon; they distrust it; and, as a rule, prefer firing their rifle to using the bayonet. A weapon such as the short heavy knife with which our Indian Gurko regiments are armed, or the regulation bowie knife of the Americans, is the deadliest instrument in hand to hand fighting. In a cavalry charge, especially when the weapon of the attacking party is the lance, you can understand many a man laid low by a comparatively slight flesh wound. Indeed, more than one, of the half-dozen I saw wounded by cuts or stabs, were wounded by the lance of a Cossack. The number of wounded in modern wars, from any other and from all other causes than gunshot, is so insignificant, and the injuries of war which the modern military surgeon has brought under his notice, and is called upon to treat are, therefore, so almost exclusively those resulting from gunshot, that practically the entire scope of modern military surgical teaching comes to be the proper treatment of gunshot injuries. The nature of the ground over which fighting has taken place will modify the appearance of bullet wounds, as also it will affect the proportion of wounds in the different parts of the body. If, in inspecting wounded in an hospital in Philippopolis or Adrianople, you found a large number of them suffering from wounds of the upper part of the body, especially of the hands, face, and neck; if you found, moreover, that the wounds of entrance, in most of them, presented a peculiar appearance, being large in size and oblique in direction, and, further, on looking more closely you found that this large size of these wounds of entrance was caused by a superficial furrow or planing off of the integuments leading up to the point where the bullet began to penetrate the deeper structures,—that, in fact, the wound was a combination of "a razing shot" and a penetrating shot, then you might be perfectly certain they were men who had been wounded in the fighting at Shipka. The wounded from Shipka were easily distinguishable by the nature and position of their wounds, which were nearly all in the upper parts of the body, and, in most of them, the bullet appeared to have struck the body in an oblique direction. This is, I think, satisfactorily accounted for by the nature of the ground over which the fighting took place. The ground was steep and rough, being the entrance of one of the Balkan passes; and, while climbing up the slopes, and over the rough and broken ground, the Turkish soldiers had often to do so on hands and knees, all the while exposed to the fire of the enemy above. Under such circumstances the upper parts of the soldier's body were very much more liable to injury from the bullets of the enemy, and especially was this the case with his hands and face. And this same formation of the ground readily accounts for the oblique direction with which many of the bullets would strike, and for the same bullet, especially in the neck, causing first of all a "razing wound," and then penetrating deeply. Generally speaking, you may expect to find in cases of bullet wounds, where the bullet has passed out, that the wound of exit is larger, and with its edges more ragged and torn than the wound of entrance. Of course, besides this, in the wound of entrance the edges are inverted, while in the wound of exit they are everted. But in these Shipka wounds, the wound of entrance was much larger than the wound of exit, owing to the oblique direction in which the bullets must have struck. But this largeness of the wound of entrance, as Mr. Longmore remarks, "is only in seeming, and is owing to the projectile having struck the surface slantingly, so that parts of the skin and subcutaneous areolar tissues have been shaved away, as it were, before the projectile had passed inwards through the superficial fascia." "There is here," Mr. Longmore continues, "strictly speaking, a razing wound on one side of the true wound of entrance; for the true entrance wound is, of course, the commencement of the track of the projectile through the deeper structures." A great deal of fighting in this war took place under cover of earthworks, and here the protection afforded to the lower parts of the body by the earthwork, made it almost impossible for the men to be wounded in any other than the upper parts of the body, and also made it very difficult for them to be hit at all. For example, the farthest point I reached, before being met by the Russians, was a small village called Telis, about six miles from Plevna. Here a camp had been fixed by the Turks, and earthworks thrown up for the protection of the |