A few hours afterwards, the limb would be greatly swollen, the skin tense and white, and marked along its surface by prominent blue veins. The cut edges of the stump looked like pork. Acute pain was felt. The constitution, by this time, had begun to sympathize. A cold sweat covered the body, the stomach was irritable, and the pulse weak and frequent. The respiration became short and hurried, giving evidence of the great oppression of which the patient so much complained. The heart's action gradually and surely got weaker, till from fourteen to sixteen hours from the first bad symptom, death relieved his sufferings. All local and constitutional remedies which could be thought of were equally powerless, nothing could relieve the system from the weight which seemed to crush it, or enable it to support the severe burden.
Strong stimulants were the only remedies which appeared to retard the issue for a moment. Postmortem examination, instituted shortly after death, showed the tissues of the limbs, and in many cases those of the internal organs also, to be filled with gas, and loaded with serous fluid. The vessels leading from the stump were healthy, and in only one case had there been any actual mortification previous to death. The intestines, in two of the four cases, were much diseased. Was the cause which gave rise to this affection referable to " weakness or defective powers of action," arising from the patients' bad state of general health, or " excessive irritability or disposition to act," from their being of intemperate habits? or was it " excessive irritation or excitement to act," arising from the severity of the injury sustained *?
After the taking of the city in September, the same form of disease again appeared, especially among the Russians who had been: and was so deadly, that in no case, which iid recovery Erytiptlcu was latterly rarely seen in our ral eases which appeared in my own wards readily 1 1 to treatment. At Scutari there were a good many cases, at the time when the men were most de-ed by their hardships; but it was seldom virulent. The troops suffered greatly, during the first winter which they passed in the Crimea, fromfrost-bite. Death not nnfivqiu'iitly followed on the injuries it occasioned. The severity which marked these lesions did not arise from the degree of cold, as the temperature was never so low as of itself to cause the severe results produced, but rather from the depressed vital power of the soldiers, who could not resist the effects of a degree of cold which would little injured them it' they had been in rude health.
The practice, which was nearly universal, of sleeping in tlu-ir wet boots, aided greatly in causing the life This custom arose from the tear, that it' the boots were put oil', they could not be drawn on again.;uid thus the feet kept for a long at a l-.w temperature, with the circulation retarded. at length lost their vitality slowly, but all the more surdy on that account. I'r. I, report on th. 1 1 n--,riment, to which interesting has been already made, says: " It is to be observed, as i-in lying dormant for some days, or of a fomites of the disease hanging about the clothing of the men, that wounded men discharged fit to rejoin th
The scorbutic poison, too, with which the men wen drenched, predisposed strongly to the action of the cold, and it was even at times difficult to say how much of the destructive result was due to the one cause or the other. During the first winter the frost-bites were much more severe than during the second, and much more difficult to manage, from the more depressed vitality of the patients. I referred in a previous chapter to that peculiar effect caused in the feet by the union of scurvy and frost-bite, to which it is so difficult to give a name. Tetanic symptoms resulted in a few cases from frostbite injuries of the feet. The French suffered more than we did.
In their hospitals a limb might be seen sphacelated half way to the knee. Uncontrollable diarrhoea was a common complication in such cases, and invariably, according to M. Legoust, caused death. Scrive (Mem. de Med. et de Chir. Milit, vol. xvii.) tells us that on the 21st January, 1855, with the thermometer at 5, they had 2,500 cases of frost-bite admitted into their ambulances, of whom 800 died, and that at that period no operation succeeded, so that " it was necessary to abstain from operating." M. Legoust says he found, in treating his cases at Constantinople, that a solution of sulphate of iron formed the best dressing, but of its use I had no experience. To obtain the separation of the scars, and regulate the subsequent granulation on general principles, was what had chiefly to be attended to.