576

America, the voluntary associations were restricted to the limits within which only they can be useful. For my part, I do not believe that voluntary associations can ever be substituted for a medical staff in countries that have standing armies. European nations maintain at great expense numerous soldiers, because they know that armies are not to be created in a few days. Now, a medical staff composed of specially trained men, is much harder to organize than a regiment. It should exist long before it is called on in war, and a government is culpable that calls on its soldiers to march against an enemy without making sure provision that if a man is wounded he will receive the care to which he is doubly entitled as a soldier and a citizen. To trust to private enterprise, unorganized, without official responsibility, to provide requisite assistance, appears to me to be yielding to a deception so very serious in its results that I consider it useless even to discuss the visionary plan of replacing by voluntary associations the duties of army surgeons.

"These associations, having their ambulances, their staff of surgeons and nurses, their stretchers and supplies, can they go on the battle-field, and work on the same footing as the army surgeons co-operating with them? Most of the delegates at the Geneva Congress thought they could; but I believe that the question should be answered most emphatically in the negative.

"MM. Moynier and Appia, in their book entitled 'War and Charity,' depict a battle-field, on which the staff of the aid-societies shall figure as follows:

surgeon. I have often heard it maintained that there should be no special army medical staff-that medicine and surgery are alike everywhere, and that a civilian can take care of wounded soldiers as well as a military surgeon. A very little practical experience disproves this hypothesis.

without experience. To know soldiers, their habits "The duties of a military surgeon are not to be learned and prejudices, to be familiar with military regulations, to be cool under fire, are attainments that require training. The military surgeon, accustomed to the usages of armies and of war, must ever remain the real battlefield doctor, to whom pertains, by right of his special experience, the organization and administration of the field service. Voluntary associations cannot then be substituted for a military medical staff; they cannot even co-operate with the latter under all circumstances; but, if admission to the field should be denied to such societies during the battle, they may still render great surgeons at liberty to devote themselves exclusively to service at the base hospitals, thus leaving the military field surgery

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The

takes the field; its medical staff is complete; cach regi"What happens inevitably in war time? An army ment has its surgeon and assistants. Presently a battle is fought. The surgeons at headquarters, and at the tend the wounded, and send those who can be moved to division hospitals, aided by the regimental surgeon, atthe nearest hospitals. Then the army moves on. surgeons behind with the wounded of the first battle, medical staff, sufficiently numerous at first, has to leave and at the next engagement the number of medical men is insufficient. If the campaign is protracted, the army has the alternative of being accompanied by an inadequate medical staff, or of leaving its wounded without suitable attendance, unless the regular medical staff calls to its aid either the civil practitioners of the country in which the war is carried on, or obtains auxiliaries from its own country. than two hundred Italian physicians co-operated in the Thus in the Italian campaign, more dria, Brescia, and Genoa; while, nevertheless, it was care of our wounded in the hospitals of Milan, Alexanstill necessary to call upon a large number of French medical students as dressers and assistants to reinforce the medical staff."

experienced physicians and not raw medical students at the base hospitals, Dr. Lefort continues:

"The stretcher-bearers (of the regular ambulance corps) have bravely confronted the hostile cannon to remove the wounded; the surgeons are at their posts, to apply the first dressings. But the battle goes on. The bearers have gone a mile or a mile and a half from the line of battle to the first field hospital station. Their strength begins to flag! How shall they continue in their laborious duty? Behold! a crowd of young, vigorous, modest young volunteers, fired by a generous enthusiasm, and by a few noble chiefs, who inspire a most chivalric courage! They are not soldiers nor retainers of the medical staff. Let us assist you, they cry; let there be no distinction between official and unofficial; or, if you wish to see our commission, we are the brevetted official delegates of humanity, we are voluntary Samaritans! Officers, surgeons, stand aside!' "Doubtless this is ingeniously put, and written in a gards as the appropriate functions of aid-societies, and After describing at considerable length what he relively style, but if we come down to the level of prac-dwelling upon the indispensable necessity of having tical common sense, I presume that no one of military experience would recommend the admission on a battlefield of a corps, not wanting in bravery certainly—that is a cheap commodity-but deficient in that coolness which characterizes the trained soldier, and which is imparted by a sort of wholesome contagion to the young recruit at his elbow. Excited by the sound of battle, the volunteer is intoxicated with courage; but this feverish excitement is absent, and it is imperatively necessary that it should be absent, in the military surgeon, who must maintain coolness and composure in the execution of his difficult mission. Fancy the ambulances of the voluntary associations inadvertently exposed to fire by some retrograde manoeuvre! Are we quite sure that the volunteer nurses would not create a panic, a disaster common to all armies? What security would there be that the volunteer ambulances would not block the road of the batteries, and caissons, and ammunition trains? Along the line of battle, during the combat, the military surgeons have ever proved equal to their noble, laborious, and perilous mission. fight that their overwhelming labors begin. A civilian But it is after the surgeon, however skilful and experienced he may be, lacks some of the indispensable qualities of the military

How is a numerous efficient auxiliary medical staff to "Here comes the most difficult part of the problem. be had? The answer is simple; it may be considered almost brutal. Such assistance is to be had by paying for it, and paying dearly; that is to say, at its real value. In questions of this sort, it is well to dismiss illusions and avoid sentimentalism. and to humanity is not a money question; but a capable doctor of medicine, however patriotic, cannot afford Devotion to the country to leave his family and his employers, unless adequately indemnified pecuniarily for the sacrifice he makes. If one's own country is invaded, he may indeed volunteer; but it is a different thing in foreign wars. proper occasion to remember that money is the sine w of war. Here is a

making appeals to the patriotism, charity, and purses of
The aid-societies are admirably fitted for
citizens, and such appeals would be responded to,
doubtless, in France, as they have been in Germany
and America.

of surgeons, students, and nurses.
"But it is not enough to have a sufficient personnel
are requisite. And here we approach a most im-
Adequate supplies

portant question, for I believe that we must completely so much ingenuity on ambulance-springs and elastic revolutionize our field hospital service and ambulance beds, when it is much easier to carry in any vehicle on organization. wheels a tent that will hold thirty men, than to trans port thirty men to any distance to a shelter.

"When a battle takes place, it is customary to send the wounded as soon as their condition will allow, and frequently sooner, to the nearest town provided with hospitals, or with transportation into hospitals. These structures are presently filled. Two or three times the number of patients they ought to contain are crammed into them, and when the terrible results of overcrowding are manifested, those who can be transported are moved on to more distant depots. The revolution which should be brought about, would bring the hospitals, illustrating his lecture by the experience in the pital to the patient, and not, at all hazards, to take the patient to the hospital; and this is not only desirable and possible, but easy.

days' notice to set ambulance trains in motion, to assemble a multitude of surgeons, and large hospital supplies; for nothing would be ready. If civil practitioners, through patriotism, might be willing to place themselves temporarily under the orders of the military intendants, of men who by long experience have learned a little of what military surgeons alone can know thoroughly, they will never consent to receive their instructions from these directors of voluntary associations. Men animated by the best motives no doubt, but utterly incapable of learning what a military medical staff is and should be."

While literally translating we have still greatly abbreviated M. Lefort's commentaries, which are elaborated at great length. His eulogies on the American system of army medical organization are simply a reproduction of what has already been pronounced by the ablest European authorities. In France, M. Didiot, writing under the inspiration of Baron Larrey, has devoted a volume to the subject, and has translated the reports in Circular No. 6, for the benefit of his brother surgeons. In Russia, the chief surgeon of the navy, Baron Haurowitz, has published a voluminous account of his inspection of our army medical department, and recommended that the Russian medical staff should be reorganized in conformity with our system. The head surgeon of the unhappy Maximilian, Dr. Neüdorfer, chief medical officer of the 8th Austrian Army Corps, has equally praised the American organization in his journal surgical treatise, and Staff Surgeon Münich, of Prussia, Staff Surgeon Nicholaysen, of Norway, and Inspector-General Muir, of the British army, have urged, in their reports to their respective governments of their examination of the medical organization of the United States army, the adoption of the system which worked so admirably in our colossal struggle. A. B. C.

"HUMAN EYES." 29*

TO THE EDITOR OF THE MEDICAL RECORD.

Upon the slightest consultation of any of the text-books of comparative anatomy, Dr. Smith would have found that his opening statement was incorrect-the eyes of insects, for instance, being anatomically adapted to the law of the radiation of light, and the eyes of higher animals being anatomically adapted to the law of the refraction of light. In the next paragraph we are told that "such is the constitution of the organ that the rays of light in crossing each other while passing through the beautiful magnifying glass at the anterior part of the globe present the image bottom upward." The reader would naturally infer that the eye was wonderfully constituted, till perhaps he happens to find that his simple burning-glass does the same, as every convex lens. Telescopes," says the author, "are made with a second convex lens, to take the rays on leaving the first, and recrossing them. That simple contrivance gives a natural aspect to the image, and thus the astronomer sces the bodies he is contemplating in celestial regions precisely as they are, and not topsy-turvy, as they would appear with only one convex lens in the instrument." This ought to satisfy any intelligent reader why his spy-glass has more than the lens in the end, because it is so simple and easily understood. Moreover, it will be a warning to him when purchasing a telescope to assure himself that the optician has put in the second convex glass. If, however, the seller of the instrument takes it apart and shows him more than two glasses, he can readily add up the number, divide it by two in his head, and if it comes out even, depart with the assurance that with that telescope there will be no danger of his seeing things "topsy-turvy" because the even numbered lenses correct the odd ones.

"Various theories," says Dr. S., "have been proposed in explanation of the fact that we see things right side up, although the image is not so; but none of them are satisfactory." The reader must however be satisfied with Dr. Smith's, which is: "Probably the mind takes cognizance of the object on which the eye rests, with regard to the impinged image which happens to be made, because the fabric of the retina is actually a reflecting mirror. Yet without an image there is no vision." I have vainly attempted to comprehend this lucid explanation, and trust the general reader obtained some distinct idea of it. If the author would study the theory of projection he might possibly find it more "satisfactory than his own, and I am confident the general reader would.

SIR. When any of the laity write articles on medical subjects and publish them in the popular periodicals, no matter what misstatements or untruths they may contain, I am always indisposed to take notice of them, because those reading them will naturally refer to some professional person for explanation, and so learn their incorrectness. It is somewhat different, however, when those to whose names M.D. is attached, publish in the periodicals articles which exhibit utter ignorance of We are next gravely told that "the eye is no more anatomy and physiology, and particularly when, in conscious of the presence of light in its interior, than is addition, advice and recommendation are given of a a spy-glass. Both receive the light and transmit it to character to do harm to persons who might follow it, the nervous pulp of the optic nerve, which is spread misled by the idea that because M.D. was appended out in an extremely delicate tissue, like a cup." This to the author's name, therefore what he says in print is really unpardonable anatomical ignorance. If the must be true. My attention has been called to, and I author does not, he will find that many of the laity have been requested to notice, an article headed" Human even, do know, that the retina is a very distinct organ, Eyes," in the October (1868) number of a popular alone perceiving light which does not affect the optic monthly of New York called Hours at Home. The nerve; this latter, where it enters the eye being the cause piece is only some four or five pages in length, written of the "blind spot" in our field of vision. by Dr. J. V. C. Smith, formerly editor of the Boston Medical and Surgical Journal, and Mayor of Boston. The title of M.D. and having filled these two positions, might naturally give some weight to his statements.

The article exhibits such profound ignorance of anatomy and physiology, and all the recognized laws of optics, that it is a little difficult to deal with it properly. The opening sentence is curious and startling. "All land-seeing eyes are constructed anatomically upon the same plan." As the author afterward speaks of the "water-seeing" eye, we may conclude that he means the one is to see in the air, the other in the water.

Read before the Suffolk District Medical Society.

Again we are told that, "in the night-seeing animals, and in fishes, there is a remarkable modification of the apparatus, apparently extremely simple in its mechanical aspect. But there is a vital endowment superadded which no artist can imitate, and no philosopher elucidate, that gives the individual a capacity for distinct,views and an unmistakable apprehension of outlines, distances, and colors in darkness. A cat's eyes appear quite phosphorescent, when met in a dark corner. She sees by a very few rays from a feeble illuminating source, which striking the tapetum-a sort of metallic-looking portion of the retina-they are thrown back, and finally conducted from one angle to another, in conformity to a

law in optics, operating on the principle of a dark lantern, which concentrates the light on the object in front, while she is unseen by the rat or mouse, as the case may be, on which she is resolved to pounce. Her little victims have night-vision precisely like her own, but her dark-lantern being the largest, confuses them by the effulgence and brilliancy of its volume of reflected light."

After carefully reading this over I am quite at a loss to know whether Dr. Smith believes, or would have his readers believe, the utter nonsense that the eyes of animals can under any circumstances emit light, or do anything but reflect incident rays.

Next we have the "water-seeing eye," the external tunics of which vary in different species of fishes with reference to their habits, and the functions they are to perform in fresh or salt water, in shallow basins, turbid streams, or in the profound depths of the restless ocean." If Dr. S. can tell a fresh, salt, or muddy-water fish by the sclerotic coat, he must be possessed of some data in comparative anatomy which ought no longer to be kept in the dark. Some anatomical notice of two huge monsters," namely the white shark and horsemackerel, I will pass over, to call upon all to admit, with the author, a "creative intelligence" from "having seen the effect from the beginning, and therefore adjusted the changing focal axes, and protected its inimitable chromatic adjustments within, to meet the exigencies of shark-life in the one, and horse-mackerel peregrination in the other, in their descendants through millions of generations." Will Dr. Smith give to the profession a description of these "chromatic adjustments" in the "water-seeing eye?" I think it is generally conceded that the human visual organ is the most perfect; and certainly with regard to it,physiologists are unable to definitely decide whether it is achromatic, or whether achromatism is necessary for distinct vision. In the next paragraph we are told that the eyes of insects are covered externally with a kind of protecting network, analogous to a wire screen over a cellar-window-each opening between the meshes corresponds with a facet or cornea that transmits light independently of all others on the same hemispheric prominence directly to the optic nerve."

disposition of the people, especially in cities, to have some sort of artificial aid to the eye, we assume it as a lamentable misfortune that spectacles are so easily procured. Were they $500.00 a pair, and only attainable by persons of wealth instead of being within the reach of aping multitudes at fifty cents, there would be more quiet eyes, and far less occupation for oculists-a profession that came into existence with eye-glasses.' Dr. Smith says he "shall not argue the case logically, because it would take too much time, and too much space, and become a book to provoke criticism. But the man who has not yet put on glasses never need Our ears, sense of feeling, sense of taste and smell, last to the last day of our life, under ordinary circumstances. Why should not vision? Our eyes should last as long as our fingers and toes, and to the day of death, were it a century from birth, and correspond in vigor and susceptibility to impressions, like the other special senses. Incidental injuries, diseases, accidents which produce blindness, etc., are not brought under consideration in this connection."

do so.

All this is on a par with the complete ignorance of anatomy and physiology which preceded it. This is a "spectacle age I grant; for thanks to the researches of Helmholz, Donders, and a host of other great minds, we now know how to ascertain the errors of refraction and accommodation, and correct them by proper glasses. If Dr. Smith will study the Sydenham Society's translation of Donders on the Anomalies of Refraction and Accommodation, he may possibly learn something. It is certainly too bad for any one with an M.D. attached to his name publishing such statements, at a time when ophthalmic surgeons are just commencing to enlighten the community as to the necessity of proper examination of all eyes where vision does not seem normal, and the possibility of restoring useful if not perfect sight by appropriate glasses. If the author knows what hypermetropia, myopia, and astigmatism are, and still writes like this, then it is unpardonable; if he does not know of them, the sooner he learns the better. The mistaking cause for effect, as to oculists and eye-glasses, is of course simply amusing. For him to tell the laity that their senses last to the last day of their life, seems unnecessary, because they know better; and although they will admit that their eyes do last "as long as their fingers and toes," they know very well that the power of use and control over all these does not last, but grows less and less with advancing age.

In the dragon-fly, we are told that "the eye is pierced, or rather, presents eight thousand orifices, equivalent to eight thousand eyes, since each one gives a distinct, independent impression." The slight inaccuracy in reference to the number of the orifices," in The following paragraph, however, conclusively proves reality computed at about one-half as many more, I the author's entire ignorance of the anatomy and physiolwill not discuss, but simply call attention to the fact ogy of vision. I quote it entire. "With most persons, that the author seems totally ignorant of the anatomical there is an epoch in life when the eyes become slightly relation of these eyes to the law of the radiation of light, flattened. It arises, probably, from a diminished acas distinguished from all eyes constructed on the prin- tivity of the secreting vessels. The consequence is, ciple of the camera obscura. Again I must recommend that the globe is not kept quite as completely distended a perusal of the common text-books on comparative with fluids as in youth and middle age. There is thus an anatomy. Now I have quoted and commented upon elongated axis of vision. A book is held further off to these few points in order to show the degree of knowl- be read. Finally becoming more flattened by the same edge of the author who, after this extraordinary ex-inactivity within, the difficulty is met by putting on hibition of ignorance, coolly goes on to say: These convex glasses. This is the waning vision of age. If, preliminary observations open the way to some prac- however, when that advancing imperfection is first retical reflections on the philosophy of vision, which, if alized, the individual persists in the attempt to keep the regarded as they should be, simply as contributions to book in the old form of vision-even if he reads under the current fund of useful knowledge, may prove of perplexing disadvantages, never relaxing, but perseverinestimable service to those whose eyes are more im-ingly proceeds just as he did when his eyes were in the portant to them than they have supposed. This is a meridian of their perfection-the slack vessels will at spectacle age; that is, there is a fashionable proneness last come up to his assistance, and the original focal to look through glasses of some sort. A majority of all distance will be re-established." pedestrians on the street, have lunettes dangling at the end of a ribbon. Young misses, whose eyes are as bright as Golconda diamonds, use eye-glasses, and so the mania pervades all communities. With this well-known

Under almost any other circumstances I should be inclined simply to reply to this in the words of our comic friend at Selwyn's, "So glad;" but it is to be remembered that all this is published in a "Popular

Monthly of Instruction and Recreation" in New York, by an M. D., who once held such positions in Boston as would, in the eyes of his readers perhaps, entitle him to be believed. Again, I would refer Dr. Smith to the ordinary text-books on the eye, and he will there find that the eyeball does not change its shape, and he will likewise hear of accommodation and its causes, of which he seems now to be entirely ignorant. The idea of the elongated axis of vision," and the "slack vessels," to account for it, has done some good, since it has afforded others as well as myself cause for a hearty laugh. Dr. Smith goes on to say, "This statement will unquestionably be combated, energetically, by those who use glasses. But it will be a waste of forensic power, because the fact is established beyond cavil." I, however, doubt if those who wear glasses will take the trouble to do more than from curiosity read the author's statement by their help, without which they never could have done so. His statement may do harm nevertheless, from some parent in consequence taking away from his hyper-publishing of the paper is quite sufficient evidence that metropic child already commencing to squint, the convex glass an ophthalmic surgeon has ordered. The author's speaking of old people (introducing Cicero, Humboldt and John Quincy Adams as proofs) being able to see without glasses, and therefore that everybody else should, certainly reveals a fund of ignorance in reference to the anatomy and physiology of vision ample for him to draw upon for all future time. He finishes by cautioning his readers not to furnish glasses to "weak-eyed boys' cr "fashionably-inclined daughters," but graciously accords them the liberty, if they do not believe in his theory, "of buying glasses like the Vicar of Wakefield's son."

this sorrow; any of us can readily count them upon our fingers. As to its getting into the secular papers, I can only say that it, no doubt, took the same course that the Rules for the Management of Infants did, and the Doctor, no doubt, knows what that was. I beg the liberty of suggesting that any irregularity that may attach to the appearance of these productions in the daily papers be referred to the Committees on Ethics. The next point relates to the resolution of thanks for the publication of my paper, introduced by myself at the meeting, and adopted by the Society, and found at the above reference. I am glad that he has given me the opportunity to say that, besides so doing, I prepared the resolutions. I did it for the purpose of ascertaining if the New York County Medical Society, after voting the paper printed, in order to give each member an opportunity to study it, and having so studied, if it, upon mature reflection, still approved its original action; the unanimous vote of the Society thanking me for the this "unworthy" document was acceptable. I would simply state, in the matter he discusses at the bottom of the last column on page 464, that whether I spent minutes or months in obtaining information relating to the Infant Hospital, I am willing to leave the decision upon the truth or untruth of my statements to any responsible tribunal. Let ten per cent, a week of mortality among these helpless infants, over whose condition he labored and contemplated so long, respond. It is much easier, as well as shorter, to tell the truth, even though distasteful, than to devise a method how not to tell it. I find nothing more calling for my attention till I reach the top of the last column of page 465, where I am charged with an unwillingness to teach my fellow physicians philosophy. It seems hardly necessary, and yet this charge makes it so, to again remind him that the very character of the audience rendered more than a simple allusion to well-known facts, not only unnecessary, but tiresome. The educated mind requires no elaboration of first principles. "A word to the wise is sufficient." And I will here venture the remark, that the habits of public teachers too often lead them into didactic dilatation upon subjects quite as well known to their auditors as to themselves, and indeed sometimes much better. As to the variety of subjects which I ventured to mention in my paper, which is regarded by him as quite startling (vide page 464, December 15), I am satisfied with the decisive vote of the Society, that as a report on public health, it had a right to call attention to any subject relating to the health and life of the community, and that it touched no other one. Had I presumed to discourse upon rudimentary physiology before that audience, I should have been careful not to make such groundless statements as that in a temperature of 104, animals, unless they are given water and SIR-Dr. Jacobi having concluded his comments on food, will die within two to four hours." (Vide page my paper, in compliance only with the expectations of 465.) Were that statement true, how many of the many medical friends, I beg you to allow me to make horses would have been left alive at the close of many a few remarks. These friends admit, however, that he days last summer, who were driven about our streets has presented but few things which call for more than for six and eight hours with neither food nor water, in an expression of thanks from me. As I regard the a temperature varying from 110° to 140°. It is a matwhole subject of the health and life of our infants one ter of established record, that when the temperature in too sacred to be trifled with, I shall for most obvious the shade, away from reflection, rises to 90° and upreasons disregard the mass of his communication, and ward, it will rise to 130° and upward in the sun's touch upon such parts as may have a scientific interest, rays. I should also have been very careful not to state or may require an explanatory remark, leaving the that, in atmospheres of high temperature, the temperabalance to the care of an appreciative profession. The ture of the animal is "apt to rise beyond the external first notable point I find at the bottom of page 464, temperature," for that is only true where the temperaRECORD, December 15, relating to the sorrow of the ture of the atmosphere rises to about 110° as applied to philanthropists that my paper should have been pub-man. I am surprised that Berger and Delaroche should lished; especially in the secular papers. I have no reason to name the persons who are bowed down with

To those of my hearers who may consider that such nonsense had better be passed over in dignified silence, I would reply, that except they are at work in my specialty, they can have no idea of the sort of morbid interest with which people with ophthalmic troubles read or have read to them all they find in print; and from the assumed position of superior knowledge on the part of Dr. Smith in this article, many readers of it might be induced to act upon his advice, and thereby cause themselves irreparable trouble. My advice to Dr. Smith, when about to write another article on the human eye, is that of Mr. Punch to those about to marry, simply, "Don't."

BOSTON, Dec. 1868.

B. JOY JEFFRIES, M.D.

THE NEGLECTED CAUSES OF INFANT
MORTALITY IN NEW YORK.
REPLY TO PROF. A. JACOBI.

TO THE EDITOR OF THE MEDICAL RECord.

be quoted in support of any such random statements as these. It is very well known that these experimenters