CLINICAL LECTURES 
ON 
COMPOUND FRACTURES 
OF THE 
EXTREMITIES, 
ON 
EXCISION OF THE HEAD OF THE THIGH-BONE, 
THE 
ARM-BONE AND THE ELBOW-JOINT. 
ON THE 
DISEASES OF THE PENINSULA, 
AND ON 
SEVERAL MISCELLANEOUS SUBJECTS. 
DELIVERED AT THE WESTMINSTER HOSPITAL. 
G. J. GUTHRIE, F. R. S. 
SURGEON TO THE WESTMINSTER HOSPITAL, TO THE ROYAL WESTMINSTER OPHTHALMIC HOSPITAL, 
ETC. ETC. ETC. 
PHILADELPHIA: 
PUBLISHED BY A. WALDIE, NO. 46 CARPENTER STREET. 
1839. These Lectures, now almost reduced in their printed form to 
surgical aphorisms, have been delivered for the last twenty-two 
years to the medical officers of the various branches of the public 
service gratuitously, together with those embracing the whole 
range of surgery. The author’s practice in the two hospitals to 
which he is attached, has been, and is, equally at their service. On 
ceasing to lecture, he may venture to say he has done that privately, 
which ought to be done publicly by the government; which -is 
done so in Edinburgh, and by every sovereign in the great 
capitals of Europe. Young men as well as old ones require, after 
a few years of absence from home, to renew the knowledge they 
once possessed, and which, perhaps, they have in part forgotten; 
and to keep themselves up to the improvements which have taken 
place whilst they have been absent. When they come to London, 
and leave should be given for that purpose, from time to time, this 
opportunity should be given to them by the authorities; they 
ought not to be obliged to go about and pay again their education 
fees, like a parcel of students, if they have not been educated in 
London. 
There is a museum at Chatham of preparations of diseases of 
foreign climates, many of which are unknown in England, and 
which, from its situation, is comparatively of little use. These pre- 
parations ought to be demonstrated, and the diseases duly taught. 
The specimens of natural history are many of them unique, whilst 
others are more splendid than any in the British Museum or else- 
where, but they are comparatively unknown. A government that 
shall appropriate a piece of ground in Downing street, when the 
old houses between it and George street are pulled down, for the 
erection of a museum, with apartments for the conservator, will do 
themselves great honour. Let them attach to this a professor of 
physic and another of surgery, and they will render the country 
an inestimable benefit. The expense need only be the difference 
between the half and the full pay of these officers, and they may be 
otherwise employed in the public service. The saving would be 
that of a great number of lives. 
It is thought proper to employ a gentleman of high character in 
his profession to teach the veterinary surgeons how to cure the 
horses of the army, and surely something of the same kind should 
be done for the men. FIRST CLINICAL LECTURE, 
Delivered at the Westminster Hospital, Saturday, May 21, 1836, 
BY MR. GUTHRIE. 
Three weeks ago you saw me relieve the neck of a poor little 
girl three years of age. who had been burned, and whose lower lip 
was adhering to her breast. I removed the cicatrix: her head is 
kept up by a proper back board and head piece ; and she will get 
well with as little deformity as can be avoided. These cases are 
not common, but coincidences in surgery are not infrequent; and I 
have another of a similar kind at the bend of the arm, which pre- 
vents its being straightened. This girl is 13 years of age, and, 
being the daughter of a person who has seen better days, I have put 
her under the care of the housekeeper of the Ophthalmic Hospital, 
and all of you who choose may be present at the operation on 
Monday. 
You saw me a few weeks ago cut off the thigh of a child, seven 
years of age, by the usual circular incisions. Poor Tommy! I 
tried very hard for weeks to save his leg, and even run it so close 
that I feared it was too late to save his life. The operation did 
however succeed ; but he had a narrow escape. The child whose 
thigh I have just removed is 11 years old ; the disease, ulceration 
of the cartilages of the knee joint, which he has had for months, and 
his mother brought him to me last week for the purpose of having 
it amputated. I did this by the flap operation on each side, so that 
you might have an opportunity of seeing the different methods of 
operating; for instances of this kind occur much too infrequently 
in our hospitals for the advantage of instruction, although quite fre- 
quently enough for the sake of the sufferers. 
It is a proof of the advance surgery is continually making, for one 
operation is not performed now where three were formerly; and in 
many cases in which they were done commonly thirty years ago, 
they are not now even thought of. Sir Astley Cooper observed to 
me the other day, that the last war had given the greatest impulse 
to surgery it had ever received in this country; and there can be 
no doubt of the fact. Those who remained at home were obliged 
to labour and increase their knowledge, that they might be enabled 
to teach; and those who went abroad were obliged to learn, because 
they could not help it. 
I have been and am the historian, or the recorder, of the Surgery 
of the Peninsular part of the war ; and whatever deficiencies there 
may be in the record shall be in time completed. You have lately 
and on this dav seen four of the improvements thus made. 6 
CLINICAL LECTURES. 
1. I did not use a tourniquet, the screwing and unscrewing of 
which always creates some difficulty and annoyance. I never do 
when I have good assistants, but you must have recoure to it when 
alone or when they are ignorant. A very moderate and simple 
pressure suffices to stop the flow of blood through the largest 
artery; and gentlemen who would have trembled forty years ago at 
cutting across the femoral or axillary arteries without an infinity of 
preparation, would now, if they were alive, cut either without the 
slightest hesitation. I never use one, to teach you confidence. I 
learned to do without a tourniquet from necessity, the mother it is 
said of invention, on the field of Vimiera, and I finally abandoned it 
at Albuhera(I beg, gentlemen, you will always spell Albuhera, when 
you have occasion to do so, with an h ; you might as well write 
London without a d.) It was only, however, at the last battle of 
Toulouse the surgery of the British army approached perfection. 
There were even there one or two mistakes. Another campaign in 
the South of France would have made us perfect. 
2. I always divide the skin and fascia by the first circular incision, 
down to the muscles ; they will then retract, with very little assist- 
ance, from the point of the knife at particular spots of adherence, 
instead of the useless and painful dissection of the skin from the 
fascia, which formerly took place. This practice is, I believe, now 
universal. 
3. You will find in books, that in dividing the muscles, you are 
to take particular care that you cut the long and unattached ones 
of a different length from those which are attached to the thigh bone, 
and each muscle according to its power of retraction ; so that they 
must be cut long and short, and of different lengths something 
like the parts composing the compensation pendulum of a clock. I 
have no objection to all this ; but I never saw it done, and have 
long since given up all thoughts of doing it myself; and why? 
because I have seen scores of amputations done by all sorts of 
hackers, hewers, and bunglers, and I invariably found that no 
matter how they were hacked or hewed, whether the muscles were 
cut according to compensation principles or not, they always made 
capital stumps, when another rule was observed, viz. to cut the 
bone, that is to have it well covered by these same muscles and in- 
teguments. It is the golden rule of amputation, and the quicker 
you can do every thing else and come to that, the better for your 
patient. In the flap amputation, where all the parts are divided as 
nearly as possible at once, no attention can be paid to compensation 
cutting, and there is therefore no waste of time. Remember, there- 
fore, always cut your bone short; the stump may by this be one 
inch shorter than you could otherwise make it; but woe there is to 
the man to the end of whose bone the cicatrix adheres, he is 
unhappy for the rest of his life ; he will never forget his doctor. 
4. Saw your bone perpendicularly, and not slantingly, which 
prevents its splintering. 
I read, gentlemen, most of the anecdotes, histories, and criticisms, 
which appear on the subject of the Peninsular war, with great CLINICAL LECTURES. 
7 
interest; sometimes I cannot help smiling at the want of accuracy 
which occurs as to time and place among the critics, and I have 
been half inclined to correct them, but doctors had better mind 
their own work, and I shall only now and then give you a personal 
anecdote of some of my old friends, and after the lapse of so much 
time I may do it perhaps without the charge of vanity or presump- 
tion. You shall now have the first. 
The action of Rolica (by the error of a copying clerk in Lord 
Bathurst’s office miswritten Roleia, and absurdly continued) was 
an eventful day for many ; for none more than for George Lake, 
the lieutenant-colonel commanding the 29th regiment. He fell at 
the moment of victory, and, as far as l know, no one has thought it 
right to record his worth. It is true an attempt has been made by 
Mr. Hamilton, in Cyril Thornton, to portray him as Colonel Grim- 
shaw, and, however estimable he has made him, he was still a 
greater and a better man. In India he. was early distinguished 
when serving with his father the first Lord Lake, by his cool and 
determined bravery, his amenity of manners, his calm and gentle- 
manlike deportment. He joined the 29th regiment immediately 
before their embarkation, in 1807, under General Spencer, for 
Ceuta, and soon won the hearts of all. The officers adored, the 
•soldiers revered, and there were few who would not have laid down 
their lives for him. The evening before the affair at Rolica, there 
was every reason to believe the regiment would be among the first 
troops engaged the next morning, and there were two bad subjects 
under sentence of a court martial for petty plundering. It is to 
this hour the bane of the British army, that there is great difficulty 
in getting rid of men, upon whom neither precept, prayers nor 
punishment have any effect. There were at that time several in 
the regiment who had received from four to eight thousand lashes; 
they were incorrigible on some points, but most gallant soldiers. I 
think I see one of them now, poor Needham, a grenadier of the 
finest order of men, a fellow of the kindest heart, an excellent 
soldier, but he could not resist rum. In America, in Summer or in 
Winter; for heat or cold were nothing to him, he would swim the 
harbour of Halifax on a stormy night, and return to his post with 
as many bladders of rum tied round his neck as he could get money 
to buy. Of course every body got drunk, and poor Needham was 
detected and flogged ; he never disputed the justice of his sentence, 
but readily admitted that he could not possibly refrain from doing 
the same thing again. It was of no use flogging him; neverthe- 
less, I saw him get the last of, I think, 15,000 lashes, without their 
being of the slightest use to him in the way of reformation. Indeed, 
I have seen many scores of thousands of lashes given, without being 
aware of any benefit being derived from them. It is of little con- 
sequence whether a man receives 100 or 300 lashes; my own 
opinion is, that he should receive neither; a brand is not affixed to 
a felon and it should not be to a soldier. Nevertheless the British army 
must be occasionally flogged : it is mercy to the soldier to do it, and 8 
CLINICAL LECTURES. 
no discipline could be maintained before the enemy without it. In 
Great Britain, soldiers should be treated like wayward children, and 
no man in my humble opinion, should receive more than two dozen 
lashes, and that on his bum, in the way schoolboys of 16 sometimes 
get it; and then with their coats turned, they may be made to do 
their duty the same day, the derision of all the children in the town. 
An old culprit cares nothing whether he gets one hundred or five 
hundred lashes. I remember one of these gentlemen (Mr. Dennis 
Reardon by name), who, for some misdemeanor, was sentenced to 
receive 501) lashes. This the general commanding was pleased to 
commute for fourteen day’s garrison black strap; that is, to work, 
(or rather idle) fourteen days at the King’s works, without 7d. a 
day ; but Mr. Dennis declined the favour and took the 500 lashes. 
Poor Needham died in the element he had so often braved with 
impunity. He was carried off the forecastle of a transport by a 
heavy sea in the Bay of Biscay, and was long seen buffeting the 
waves in vain, and without the hope or prospect of relief. He was 
the beau ideal of a grenadier. 
Colonel Lake when he formed his regiment in the evening for 
the punishment of the two culprits, knew full well that every man 
was satisfied they deserved it, but he did not say that. He spoke 
to the hearts of his soldiers ; he told them he floated these men not- 
alone because they deserved it, but that he might deprive them of 
the honour of going into action with their comrades in the morning, 
and that he might not prevent the guard who was stationed over 
them from paticipating in it. The regiment was in much too high 
state of discipline to admit of a word being said, but they were 
repeated all the evening from mouth to mouth ; and the poor 
fellows who were flogged declared to me they would willingly, on 
their knees at his feet if they dared, have begged as the greatest 
favour he could bestow to be allowed to run the risk of being shot 
first, with the certainty of being flogged afterwards if they escaped. 
Early the next day we came up with the French, drawn up in 
line, with the village of Colombeira on the rear of their left, the 
heights of Rolica, Columbeira or Zambugeira, as they are indiffer- 
ently called, behind, and covering the main road which turned the 
right of their position. They were the two battalions of the 
French 70th regiment, and the 29th and 82d advanced in line to 
meet them. A line of two deep, either for attack or defence is 
peculiar to the British ; all other nations attack in column, but 
British disciplined troops can do what none others can do, and 
no day of ordinary parade could appear more beautiful than this. 
We advanced in this manner in perfect order and in ordinary 
time with shouldered arms, until the red tufts, nay, the very 
faces of the French line could be distinguished. Lake and his 
horse seemed both to be prancing with delight. 
I was told my place, on such occasions, was seven paces in the 
rear of the colours (we then knew no better), and he seemed to be 
about as much in front. At this moment he turned round, calling CLINICAL LECTURES. 
9 
out, “Gentlemen display the colours.” The colours flew, the horse 
and he had another prance, when he turned again and addressed 
the line ;—“ Soldiers I shall remain in front of you, and remember 
that the bayonet is the only weapon for a British soldier.” The 
French at this instant retired, and the right of the 29th meeting the 
road, broke into sections and followed through the village of 
Colombeira. One field separates the last houses of the village from 
the foot of the heights which rise almost perpendicularly above it. 
The Light Company under Captain now Colonel Creagh, was 
ordered to the front, when some of the old Grenadiers called out, 
we can do it as well as them, Colonel. His smile was beautiful in 
replying—Never mind, my lads, let the Light Bobs lather them first, 
we will shave them afterwards. A narrow steep ravine seemed the 
only possible accessible part, and up this, Lake, without further 
hesitation, led his grenadiers on horseback. The whole regiment 
followed, with unexampled devotion and heroism, and gained the 
summit, but not without the loss of 300 men in the desperate con- 
flict, which took place almost hand to hand, in the olive grove half 
way up the hill. Broken and overpowered by numbers, Lake fell, 
and his soldiers would have been driven down, if the 9th regiment 
had not rushed up with equal ardour, led by a no less gallant 
soldier, Colonel Stewart. The two regiments formed on the crown 
of the hill, supported on their right by the 5th, which had been less 
opposed, and the French retired, finding that their right was by 
this time turned. Colonel Lake, on horseback, on the top of the 
hill, seemed to have a charmed life. One French officer of the 
name of Bellegarde, said afterwards, that he had fired seven shots 
at him. Once he seemed to stagger as if hit, but it was only at the 
seventh shot he fell. It is probable he was right, for lie was 
wounded in the back of the neck slightly ; but the ball which killed 
him passed quite through from side to side, beneath the arms; I 
think he must have fallen dead. Will you permit me to record the 
end of as brave although an humbler soldier ? The sergeant-major 
Richards, seeing his Colonel fall, stood over him, like another 
Ajax, until he himself fell wounded in thirteen places by shot 
and bayonet. I gave him some water in his dying moments, and 
his last words were, “I should have died happy had our gallant 
colonel been spared;” words that were reiterated by almost every 
wounded man. 
Colonel Stewart, who led the 9th, fell also, He was struck by a 
musket ball in the belly, which lodged ; I saw him a short time 
afterwards lying under a myrtle bush, and he beckoned me to come 
to him. “Our friend Brown,” meaning the surgeon of the 9th, 
“gives me no hope, pray look at me.” I did so, and he saw I had 
none to give either. He thanked me, and begged he might not 
detain me from others to whom he could give relief. He died, poor 
fellow ! a few hours after, with the resignation of a Christian, and 
the firmness of a soldier. 
I have been led to be thus garrulous, from having obtained, only 10 
CLINICAL LECTURES. 
the day before yesterday, the letter addressed by the Duke of 
Wellington, then Sir A. Wellesley, to Sir Richard Borough, who 
had married Colonel Lake’s sister. It is the letter of a soldier an- 
nouncing and regretting the loss of another, for whom he had a 
firm and affectionate regard. I cannot resist reading it to you. It 
is published in the despatches of the Duke, edited by Col. Gurwood. 
Lieutenant-General the Hon. Sir A. Wellesley. K. B., to R. 
Borough, Esq. 
“Lourinha, 18th August, 1808. 
My dear Borough, 
“ I do not recollect the occasion upon which I have written with 
more pain to myself, than I do at present to communicate to you 
the death of your gallant brother-in-law. He fell in the attack of a 
pass in the mountains, at the head of his regiment, the admiration 
of the whole army; and there is nothing to be regretted in his 
death, excepting the untimely moment at which it has afflicted his 
family, and has deprived the public of the services of an officer 
who would have been an ornament to his profession, and an honour 
to his country. 
“ It may at the moment increase the regret of those who lose a 
near and dear relation, to learn that he deserved and enjoyed the 
respect and affections of the world at large, and particularly of the 
profession to which he belonged ; but I am convinced, that however 
acute may be the sensations, which it may at first occasion, it must 
in the end be satisfactory to the family of such a man as Colonel 
Lake, to know that he was respected and loved by the whole army, 
and that he fell alas ! with many others, in the achievement of one 
of the most heroic actions that have been performed by the British 
army. I cannot desire to be remembered to Mrs. Borough, but I 
beg you to believe me, &c. 
“Arthur Wellesley.” 
“To R. Borough, Esq.” 
I know no man of those who are no more, who can be compared 
with Lake, except Sir E. Pakenham. I have always a pleasure in 
bringing them to my recollection. I can fancy them as I last saw 
them before me: alike noble and generous in their natures, as inca- 
capable of fear as of doing a bad action. They were never so 
happy as in doing a good one: equally devoted to the fair sex, they 
were in all situations when they called upon them, their willing 
guardians and protectors: they were the bayards of the British army. 
Sir E. Pakenham was never so animated as before the enemy; the 
sound of a shot seemed to give him the greatest delight; he snorted 
at it like a racer on the course; and, like Lake, he was always the 
first in danger, and the last out of it. Careless of themselves, con- 
siderate for others, wounded on several occasions, they seemed to 
forget that such a thing could again occur. His regard for the CLINICAL LECTURES. 
11 
Duke of Wellington was unbounded. When the British army 
retired before Marshal Marmont, from Fuent Guinaldo, and main- 
tained its ground on the heights near the convent of Sacca Parte, in 
front of Sabugal, he thought the duke, he told me, was needlessly 
exposing himself, and prevailed upon him to fall back a little. He 
had scarcely done so when one cannon shot killed Captain Houghton 
of the 23d Fusiliers close to him, and another struck the ground 
at his feet. The duke merely turned and said, “ Pakenham, this is 
what you call taking care of yourself. In his illness at Madrid, 
his anxiety for the duke and the army at Burgos prevented his 
recovery. I was the chief of my own branch of that army, 
amounting to more than 30,000 men, under my Lord Hill; and 
for ourselves we had no apprehension. We could have beaten 
Marshal Soult any day in four hours, who had about our own 
numbers, but we flattered ourselves of inferior troops; there was, 
however, no advantage to be gained by beating him at Madrid, if 
our communication was cut off at Salamanca. He only began to 
recover his health in the retreat, when there was nothing to think 
of but fighting. 
At a later period, in the fierce conflicts in the front of Yittoria, 
he lost a friend, an officer of his old regiment the Fusiliers, Lieut. 
Col. Despard, who was killed by a ball which lodged in his back 
bone. His widow arrived some time afterwards at St. Ander, with 
four children, from Lisbon, alike wanting in friends, and in a foreign 
country, of means. Sir E. Pakenham sent me a hundred pounds 
for her use, desiring me to say it came from a fund in the regiment, 
to which she was entitled without any sort of favour, on account 
of her children. Spare, he said, at all hazards, her feelings ; they 
will be greatly hurt if it is offered as a present from me, and will be 
refused; and be assured you will not be telling an untruth, for I 
consider every farthing I have to spare as a fund entirely at the 
service of every widow and orphan of that regiment. She does 
not to this hour know that the money came from Sir E. Paken- 
ham. One of these four children was his godson. He has been 
now near fifteen years a lieutenant, and returned two years from 
the West Indies, his health ruined, his constitution almost destroyed. 
He has no prospect but a return there in autumn, unless the pater- 
nal kindness of the commander-in-chief shall relieve him from a 
fate differing from his father’s only in being more untimely and in- 
glorious.1 England, magnificent in her wealth, splendid in her 
extravagancies, deals only with her brave defenders with a niggard 
hand; to all others she is just, if she cannot always be generous. 
I parted with Sir E. Pakenham at Lord Dartmouth’s door, at the 
corner of St. James’s Square, the day he started for his last com- 
mand. On shaking hands, I said, “ We now part for the last time; 
I shall never see you again.” He asked, “Why say so; what 
' Lord Hill has since given to this officer the situation of Adjutant to a 
district. 12 
CLINICAL LECTURES. 
makes you a prophet of evil?” I replied, “I know you so well, that 
I feel confident you will not be able to hear the first shots fired 
without being in the affray ; and you will be killed, I fear, foolishly.” 
He knew the object I had in saying this, the feeling that dictated it, 
and, in pressing my hand more warmly, he said, “ That I shall fall, 
is possible; but if I do, you even shall say I fell as a general com- 
manding in chief, ought to do.” When his aide-de-camp, Colonel 
Wyly, returned to England, he dined with me alone that we might 
talk over the last acts of the life of our departed friend. In the 
front of a regiment which appeared to be failing in its duty, on horse- 
back, with his hat off, he received his first wound. Feeling that 
he could not sit on his horse, he endeavoured to dismount. In the 
act of lifting his right leg over the saddle, a second shot struck him 
a little above the groin, and it was afterwards found, had divided 
the great iliac artery. He fell dead, and he kept his word. 
We will, gentlemen, at some future day, continue our observations 
on the advance of surgery in the war of the Peninsula. SECOND CLINICAL LECTURE, 
ON A PECULIAR AND UNDESCRIBED INJURY OF THE SHOULDER, 
Delivered December 2, 1837. 
I have promised for the last two months to describe to you the 
nature of the accident, as far as circumstances would permit; but 
have not been able to obtain the attendance of the individual to 
whom it happened until this day, and it is of little use describing 
these things unless you can at the time test the value of the 
description. 
J. Cadman, who is now seated before you, is a plasterer by trade, 
and when commencing his daily work felt the ladder turn on which 
he stood, and after some effort to save himself, he fell with it, his 
left elbow striking the ground, whilst his shoulder rested against 
one of the steps of the ladder, in a way he cannot distinctly explain. 
He felt he had sustained a severe injury in the shoulder, and the 
elbow was much grazed. He was brought immediately to the 
hospital; but there was so much swelling that the house-surgeon, 
Mr. Dasent, could not make out the nature of the injury, and sent 
to me. I saw him about three hours after the accident; and the 
most, remarkable and striking appearance was a fold or pucker of 
the skin, the size of the half of half-a-crown, situated over the 
middle of the pectoral muscle, where it forms the anterior fold of 
the arm-pit. A hard substance could be felt below this, and extend- 
ing above it towards the coracoid process, which could not be 
distinguished on account of the swelling, and it had been supposed 
that this hard substance was the coracoid process broken off. The 
head of the humerus could be very distinctly felt on the outer part 
of the glenoid cavity, or something like it. The arm was very 
moveable in every direction, and the elbow could be brought close 
to the side, and made to strike the ribs without difficulty. I decided 
that it was a fracture, and not a dislocation ; but the nature of the 
fracture I did not understand, and hoped it would become apparent 
when the swelling had gone down. The fore-arm was bent, the 
arm brought close to the side on a splint, and leeches and cold 
lotions were applied and repeated until the swelling very slowly 
subsided. I was now satisfied that the humerus had been broken 
at its anatomical neck, and forced through the pectoral muscle, the 
fascia covering which and the skin had offered sufficient resistance 
to prevent its passing through them, and forming a compound frac- 
ture; causing the bone, however, to pass upwards, and puckering 
the skin by carrying it along with it. The arm was shorter, and 
the retraction of the pectoral is major, and probably of the subscapu- 14 
CLINICAL LECTURES. 
laris, had drawn the bone more into the situation the head of the 
humerus usually occupies when dislocated under the pectoral 
muscle. The shape of the broken end of the bone was satisfactory 
as to its being a broken bone; but I was not at all pleased with its 
situation, and as no common ordinary extension moved it down- 
wards, I caused him to be largely bled, and gave him tartar emetic 
at different doses to 12 grains during an hour and a quarter, that I 
placed him under a gentle but gradually increasing extension in 
the pullies. I found I could bring the bone down to its natural 
situation as to length, but I could not make it remain in its proper 
place. There was, therefore, nothing to be done but to allow nature 
to work for herself; and she has certainly worked wonders, for at 
this moment Cadman suffers from one inconvenience only, and that 
is that he cannot touch the ceiling with the hand of the injured 
side, at the same distance that he can with the other; he is obliged 
to be five or six inches nearer to it, from the arm making a greater 
angle with the head, than on the sound side. In all other respects, 
he can do his work just as well as before. When he sits on a chair, 
as he now does, with the fore-arm bent resting on the thigh, the 
hand supine, the prominence of the broken bone is very remarkable, 
and on placing a dry bone by the side of it, it appears to correspond 
to the small tubercle on the inside, and to a part of the great tubercle 
or tuberosity on the outside. The hollow between seems to be that 
for the passage of the long head of the biceps; but whether this 
tendon runs in it I cannot ascertain. The tendon of the subscapu- 
laris appears to be attached to the inner and back part of the small 
tuberosity, and to have drawn it inwards, whilst that of the pecto- 
ralis major, which is well defined, has drawn it inwards and for- 
wards. The portion of the head of the bone, or the whole perhaps 
of the cartilaginous surface, remains attached in situ with a part of 
the great tuberosity; but how far, or how much of the three muscles 
inserted into this process remain with it and the head, I cannot as- 
certain. I should think but little of the teres minor. The arm 
moves with perfect ease in every direction ; when it is rotated out- 
wards and backwards, the broken end of the humerus seems as if it 
were going to come through the skin, it is so prominent, and when 
the arm is raised as high as it can be done, the prominence of bone 
is seen above the shoulder, as it then rides as high as the clavicle. 
I have offered him £50, which he may leave by will, for the dissec- 
tion of his arm, if he dies before me; or my son will give it to his 
heirs, if he survives me, as I should like the accident to be fully 
understood. I have mentioned it to my colleagues of the Court of 
Examiners, but it is not known to any of them. Sir A. Cooper has 
sent me the 21st plate of the last edition of his work on fractures 
and dislocations ; but this only shows a fracture of the anatomical 
neck, with little separation, and that outwardly. Mr. White thinks 
he has seen a case somewhat like it, from there having been the 
same sort of pucker in the skin in front; and Mr. Cusack, of Dublin, 
thinks he has met with one of the same kind, from having also seen CLINICAL LECTURES. 
15 
the same pucker. Both these cases did well, bnt with unseemly 
shoulders. I am of opinion that the elbow came first to the ground, 
but that the step of the ladder struck almost simultaneously against 
the head, or rather across the neck of the bone, and that the effect 
of the first blow, which would have caused a dislocation, was thus 
modified, and gave rise to a fracture. It is not, after all, of any 
consequence to know how the thing happened; but it is of impor- 
tance to know that if nothing is done, nature will right herself so 
as to recover the use of the arm. Surgery is not, however, satisfied 
with this; and my object in a future case of the kind, now that I 
think I understand it, would be to prevent the deformity, which in 
a woman’s arm would be considerable, although much less than I 
expected; for the pucker has disappeared, and the humerus under 
use has resumed so much of its natural direction, that I should never 
have thought of extension by the pullies if it had always been the 
same. The pointed ends of the fracture will yet round off, and form 
a small round extremity of bone, and a kind of false joint with the 
parts around. There is I presume some ligamentous union with 
the head of the humerus. 
In a case of this kind, I should make extension until the bone 
resumed its proper place; but this must be done very carefully, for 
I am not sure it could be done effectively without tearing the skin 
of the pucker or fold I have described, certainly not without great 
risk of doing it, and which would render the accident a very 
dangerous one. If the bone could be brought into its proper place 
(of which, from this and other causes, I have some doubt), it is 
probable it would not be easily retained by padding the axilla, and 
other means which will at the time suggest themselves to you ; and 
if it were, it is possible that bony union in such a situation might be 
more detrimental to the free use of the arm than the mode of cure 
which nature has adopted. I am inclined to believe that the 
capsular ligament of the joint was not torn, or extensively so; but 
this must be matter of conjecture. 
Having thus drawn your attention to this case, I shall hope it will 
soon be thoroughly understood; and in order that no misunder- 
standing may take place on the subject, I shall write, and leave the 
observations I wish you to remember with the house-surgeon, and 
all that please may take a copy of them ; and I shall adopt this 
course in future with any thing I may say which I think it useful 
for you to recollect, or to be able to refer to. 
The poor blind deaf man, with half-a-dozen shot holes in his 
body, I now place before yon, was once a gay and gallant soldier; 
he received these wounds on the heights of Rolica, on ttie 17th 
August 1808; and I bring him forward as an instance of the British 
surgery of the day, in contradistinction to what often followed, and 
as a proof of that which ought to form our rule of practice for the 16 
CLINICAL LECTURES. 
future in the enquiries, I am this day going to notice, viz. those of 
the arm from musket-shot. 
When I revised and completed my work on gun-shot wounds in 
the winter of 1814, I had the support of all the junior medical 
officers of the Peninsular army, the approbation of all the seniors 
under whom I had served, except the Army Medical Board (I was 
too young for them), and the esteem and recommendation of most 
of my equals. I did not like to say I had seen more than many of 
them; I had no desire to say so: I was more willing and more 
happy to divide any credit which might be awarded with my 
brethren, and to take the responsibility of defending what was 
objected to on myself, than to withdraw from the strictures, and 
many of them were sharp ones, which were made on the surgery of 
the campaign of Waterloo, by saying that it was not the same with 
the surgery of the Peninsula. You will naturally ask me why it 
was not? and the answer is a very simple one: that they were not 
the same people, or when they were the same, the ablest had marched 
with the army to Paris, or were solely engaged with the wounded 
officers. The hospitals were principally in charge of others who 
had served but little on the field of battle, and it was the wounded 
under their care that were open to remark. One instance will suffice 
to explain my meaning. After the last battle in the Peninsula, no 
one on the third day could have found a gun-shot fracture of the 
thigh in the bent position on the side; after the battle of Waterloo 
no person could have found one in any other. Here is what was a 
thigh-bone at the battle of Albuhera; the man died at Elvas, and it 
looks something like a ram’s horn. He lay on his back, and the 
thigh on its side. And when this is the case, the thigh is always 
crooked, and the man generally dies. Twenty-two years have passed 
away since the battle of Waterloo ; I have no surgical contemporaries 
of my own standing in London, and I may now tell you the truth 
without the fear of giving offence, or of appearing egotistical. You 
will again ask me perhaps how it was possible that in one short 
year an error of this kind could have been committed? and why 
many surgeons preferred serving at hospital stations to the field of 
battle? and I will have the pleasure of telling you for the benefit of 
those who may be aspirants for military medical honours. 
The first appointment a young man receives at 22 years of age, 
is, that of an hospital assistant, in which situation on service he is 
worse treated than any costermonger’s donkey in Westminster or 
Shoreditch ; for the donkey is occasionally fed, cleaned, and lodged ; 
but the doctor, if he wishes any of these conveniences of life, must 
find them for himself wherever he can catch them, and that is not 
always so easy for a man to do, who has no money in his pockets. 
Suppose him, if you please, at Portsmouth, waiting for a fair wind, 
and spending at the Crown or the Blue Posts the last pound which 
remains of his two months’ pay in advance, which have been very 
improvidently given him; or land him, if you please, at Lisbon or 
at St. Andero, with five pounds in his purse, a foretaste of his 17 
CLINICAL LECTURES. 
prudence. He presents himself to the inspector of hospitals, who 
very politely informs him that he must march to join the army in 
three days, and advises him to buy a mule to carry him and his 
luggage, and to hire a servant, for whom five shillings a week will 
be paid at a future time. He then furnishes him with an order on 
tlie quarter-master-general’s office for a route and on the commissary 
for his rations. 
The quarter-master-general very gravely gives him a route, and 
the commissary-general very agreeably provides him, on his receipt, 
with as much meat, bread, and wine, as ought to last him three days 
on the road, and adds very graciously so much wood to cook the 
meat; but which it may be supposed the young doctor very 
obligingly leaves behind him for the next gentleman in a similar 
situation, and who may be equally unable to carry it. Having no 
money to buy a mule or a jackass, he sends his trunks to the stores, 
where they are soon very cleverly plundered of every thing valuable, 
and starts with a small sack on his back, containing a clean shirt, 
and a new pair of shoes. If he should have a little money in his 
pocket, he ventures to hire some lad who offers himself at the corner 
of the street, or who is recommended by some person about the house 
where he lodges, and who, in all probability, very civilly and quietly 
walks off on the night of the second or third day’s march, with the 
sack and every thing else he can lay his hands upon. If my friend 
has had the good fortune to attract the attention of the inspector, he 
will perhaps direct that he be attached to a party of bullock cars or 
mules going up to the army with stores, and if this should happen, 
he will have a chance of saving his baggage and of getting something 
to eat, but bullock cars travel only two miles an hour on level ground, 
one on a bad road, and oftentimes wait for an hour to take breath, 
so that having ten or twelve miles to travel, he is out for twelve or 
fourteen hours under a burning sun, or in a heavy rain. If he 
escapes after ten or twenty days of this work, it is only on his 
arrival at his station to set off back again on a similar travel, or to 
take charge of a large number of sick, and share the dangers of a 
crowded hospital. The cemetery called English at Ciudad Rodrigo, 
contains all that remains of twenty or thirty-one of these gentlemen, 
the victims of distress and disease. I remember one of these young 
men at Puebla de la Canada, a village on the plain of the Guadiana, 
not far from Merida, who had just come up from Lisbon ; the village 
was full of troops, and as the rank of a hospital mate is the lowest 
of commissioned officers, his lodgings were none of the best; his 
bed being on the ground-floor, at an equal distance between the 
peasant and his wife, and an old sow and a dozen of pigs that had 
grown up to the size of young porkers able to provide for themselves. 
From these he was separated by a partition having a door-way, 
opposite the street entrance, the lower third of which was blocked 
up by a board, in order to prevent the pigs walking into the room 
at pleasure. The doctor finding his position in the night rather 
hot, being in the month of September, shifted his palliass between 18 
the doors for the benefit of the air, which came in under the street 
door. The peasant, who rose at the dawn of day, woke him, and 
having opened the front door, made signs to him to rise. The 
doctor was indignant at being thus disturbed out of a sound sleep, 
and signified that he would not get up. The peasant in his turn 
was more vociferous and urgent with tongue and signs that he 
should shift his position ; he looked, as the doctor afterwards said, 
like a talking sign-post. The matter was however soon adjusted, 
a horn was heard to sound, the peasant tore his hair in despair, out 
jumped the lady pig right on the back of the sleeper, and then 
sprung out of the door, followed by all her family, to join the swine- 
herd who was thus collecting them according to ancient custom, 
at the end of the village, for their day’s pasture in the adjoining 
fields and on the bank of the river. The roaring of the doctor, and 
the cries of the peasant’s wife, brought in some of the neighbours 
and soldiers who were also up, and the poor doctor, on being raised, 
was found to have suffered from only a few bruises. He was 
however a doomed man ; he was only about five feet four high, 
rather good-looking, but like many other people, had remarkably 
short thighs and legs. In the evening &t sun-set, and the evenings 
in autumn in Estremadura after a sultry day are delicious, he 
thought he would stand at the door, and catch the soft but cool 
breeze that is always felt at that hour. He was thinking of home, 
and what could have induced him to leave it, for it was just the 
hour at which he used to steal from the shop where he was appren- 
ticed in Old Gravel Lane, and take a quiet walk down to the bank 
of the Thames, to enjoy the evening breeze, and study the muscles 
on the naked men, who appeared like so many demons emptying 
coals out of the colliers into the coal-barges. His eyes rested on the 
fine blue sky, so common in Spain, and so rarely seen in this 
climate, and he almost thought he yet could be happy for a few 
months in it. At this moment again he heard the sound of the 
swine-herd horn; it reminded him of the irruption of the morning, 
and having most emphatically, with a long-drawn sigh, damned 
those pigs, he continued to meditate and to admire until his attention 
was drawn to sublunary things by a noise which was, alas ! too 
late. On looking down he saw the old lady pig, followed by all 
her family, coming right at him, full tilt, accompanied by all the 
neighbouring pigs who lived beyond him. In an instant she was 
between his legs. Only conceive my little doctor, with an old sow 
near six feet long by two feet wide, in such a position, his fate was 
as inevitable as your’s would be in a similar situation ;—over he 
went, bumped his nose against her tail, and rolled covered with 
blood under the rest of the family, who bolted over him into the 
stye. He was not aware, poor fellow, that the swine-herd dismissed 
his flock by sound of horn as well as collected them, and every pig 
knows that his master or mistress had prepared for him a trough 
well filled with peas, of which the first comer had the best share. 
The pigs, on their arrival at the end of the village, awaited most 
CLINICAL LECTURES. CLINICAL LECTURES. 
19 
patiently the swine-herd’s will ; but the moment the first sound of 
the horn was drawn, every pig took to his heels, and woe to any 
one who stood in their way. The proximity of their dormitories to 
their masters and mistresses rendered them perfectly acquainted; 
and on their way home, if they met their mistresses, who generally 
attend to their food, they would jump upon them like so many 
puppy-dogs. When they got home, if the door was not open, the 
first arrival jumped up and pulled the string of the latch, and let 
himself and the rest in ; there being no locks nor keys in that 
primitive country. 
Circumstances and accidents, such as I have related, rendered it 
very difficult however to procure good qualified surgeons for the 
army, and a curious expedient was resorted to in consequence. 
Political economists say, that when the demand for tea, coffee, 
sugar, cotton, &c. &c. is greater than the supply, the price will in- 
crease, and that human labour ought to be regulated by the same 
rule; the authorities in England thought however otherwise, and 
instead of increasing the price, or smoothing away the difficulties, 
they deteriorated the article, and as surgeons could not be found 
qualified to kill or cure by commission, they thought it right to take 
those of an inferior description, and give them only a warrant, as 
they do to boatswains and gunners on board ship. I do not know 
whether this bright idea originated with the government or the 
army medical board; but when elicited, it seemed to please all 
parties, and a certain number of gentleman thus warranted to do 
business came out to Spain. 1 had some of them at San Andero, 
where I was for a couple of months. One poor fellow having 
called to report his arrival, I desired him to sign a paper descriptive 
of his qualifications. This I found he could scarcely do, the 
letters very much resembling pot-hooks; which he attributed to 
sea-sickness, in which I sympathised with him, my own stomach 
being easily unshipped by a very moderate view of blue salt water. 
I therefore sent him to live at one of the fever hospitals, to do duty 
for a few days, until I might see what he was made of Two days 
after going to this hospital at six in the morning, I found him in 
a little alarm. A soldier had been brought to him, he being the 
officer on duty for the night, riotously drunk; and in order to keep 
him quiet, he had him tied hand and foot to the four corners of the 
first bedstead he could meet with and having thus got the man on 
his back, recollected he was warranted to do something in physic, 
he therefore gave him a good dose of tartar-emetic, believing his 
stomach ought to be emptied ; but never thinking, or not knowing 
that a man could not advantageously vomit on his back, he was 
found suffocated two or three hours afterwards. I met my friend 
some three months after this in charge of 40 men and officers at 
Renteria, going to Passages ill with fever, of which disease he 
knew nothing; he assured me he had been more fortunate than when 
with me. He had been sent in charge of sick to several places; on 
the present occasion he had lost but two; on a former, at Pampeluna 20 
CLINICAL LECTURES. 
three, at, Vittoria five; that he hoped to do better in time, and I 
have little donbt, that if his exploits had been as duly recorded as 
those of Don Giovanni, he might also have boasted by the end of 
the campaign of “ trescientos in hespanha.” 
Perhaps, gentlemen, you may think those doctors who were higher 
in rank fared better. I will give you an example in a bit of my 
own history. Having nearly lost my life through fever, I was sent 
to England, and returned just at the time Marshal Massena broke 
up from before the lines and retreated. I bought a horse and a 
mule, hired a servant on the doubtful recommendation of being as 
good as any one I could get, and set off to follow the army to 
Coimbra. On the fourth day at Rio Myor, the fellow finding I 
kept too sharp a watch to permit him to rob me of all I had, ran 
away with one of my two blankets and my dinner. ] was now in 
a happy state, with a horse and a mule to clean, and nothing to eat. 
An assistant surgeon, who happened to be travelling the same road, 
and had joined me the same day, which in all probability, prevented 
my loosing my horse and mule, had a soldier servant and his mule 
in the same stable with mine, and he kindly allowed him to see 
that they were not stolen. The country was desolate ; dead horses, 
asses, and men lay about in all directions, and there was little to be 
obtained of any kind. My assistant surgeon, whose name I very 
ungratefully forget, also presented me with a blanket he said he 
could spare. It was almost as fatal a gift as the shirt of Nessus. 
From that time I ceased to sleep, my flesh seemed to be creeping 
and crawling all night, I became spotted all over, and wondered 
what could be the matter with me. On arriving at Coimbra, I 
was sent to the house of a padre, the clergyman of the parish ; like 
most of the padres in these countries, he came of a large family, 
at least in the female line, and had a very respectable number of 
nieces, one of whom was so good as to keep house for him. She 
was rather good looking, and about five and thirty years of age, 
which in Portugal constitutes a rather elderly lady. I spoke Por- 
tuguese tolerably well, and was very civil to boot, and they were 
both pleased to delight in me. I could tell them the news, and 
could understand their complaints against the French ; and they 
gave me in return an excellent dinner and a very good bed, in which 
I slept soundly for the first time for four or five days. On mention- 
ing this in the morning to my kind hostess, she assured me by a 
very significant motion of the thumbs, that she knew the cause of 
evil, and begged to have my little stock of bedding delivered over 
to her. On coming home from a morning perambulation of the 
town, she met me in an ecstasy of delight, assured me she had my 
blankets hanging in the sun all day, and that those fleas which had 
not hopped out, her servant had duly destroyed. She further 
assured me they were as long each as her nail. Now as ladies’ 
nails are as long in Portugal as they are in England, and sometimes 
longer, I demurred at this, and she insisted on my assisting her to 
find one, but there was not one to be discovered by our united CLINICAL LECTURES. 
21 
researches, so I cannot vouch for their length ; but from the appear- 
ance of a dead one afterwards produced, I think they may have 
been half as long:. 
In due time I crossed the country, narrowly escaped being 
drowned in the Guadiana at Ju rumen ha, and joined the fourth 
division of infantry near Olivenca. I arrived just after sunset, on 
the flank of the troops, without knowing more than one individual 
of the whole. The general commanding was a mile off, at a house 
I had no chance of finding ; and, by one of the odd arrangements of 
the service, the medical staff-officer is the only one to whom custom 
gives no claim on his hospitality, the other staff-officers all living 
with him. It rained in torrents, with little hope of its termination ; 
there was nothing to be done but to dismount, place one’s back 
against a tree to which the horses were tied, and await patiently, 
dinnerless, the approach of another day. I can assure you I have 
passed pleasanter evenings. Your progenitors, who snored all night 
by the sides of your mothers or grandmothers, and growled all the 
mornings the tax-gatherer paid them a visit, had no idea of the 
comforts we often enjoyed ; and no one who had seen my condition 
in the morning would have pointed me out as the man who, in a 
short few days, was in the field of battle of Albuhera, to be the 
arbiter of the lives and limbs of hundreds of his fellow-creatures. 
The history of that fight has not yet been correctly given : those 
who know, do not tell the whole truth ; and those who do not know, 
cannot tell it. I found myself the chief of my own arm on that 
memorable day, the hardest fought action of the whole war, simply 
because I was the senior and the junior of my rank. The surgical 
history of this battle I will some day tell you, and if no one else will, 
the military history also; suffice it to say, it satisfied me that an 
injury from the wind of a cannon-ball was nonsense. In the middle 
of the contest I dismounted, and had just placed my bridle in the 
hand of the orderly who led the king’s mule, when a cannon-shot 
passed between his head and mine. I could not help asking him 
if his head was on, nor of laughing outright, when, with the most 
soldierlike gravity, he wheeled to the front facing me, touched his 
cap, and hoped also my head was safe. At the battle of Salamanca, 
the fourth division, commanded by Sir Lowry Cole, found itself, as 
usual, under the heaviest fire of the enemy. The troops were 
ordered to lie down under the fire of twelve heavy guns, to which 
we had only six light ones to reply, and I halted a little in the rear 
to make my arrangements. As it was plain we were in for a good 
pelting, the general sent his aid-de-camp, Captain Roverea, to 
ascertain where I had fixed the field hospital, that the wounded 
might be directed upon it. I was at this moment going to the front, 
and saw my friend Roverea approaching, when my horse stopped 
and ducked, a sort of gambol I did not think he Was warranted to 
make from the quantity of corn he had eaten. This motion was 
explained in a moment; a twelve-pound shot, which he had seen, 
but which I. had not, plunged into the loose ploughed field a few 22 
CLINICAL LECTURES. 
feet before him, covered us both with dirt, and hopped calmly, but 
irresistibly, over my shoulder. Roverea was so white in’ the face 
that I thought he must be wounded; he said no he was not, and 
eagerly enquired if I had seen that shot pass. I said I had, and 
nearly felt it too. “ Well,” said he, “it nearly took my nose off.” 
It was impossible to resist laughing at this, for my poor friend, 
although a most excellent, honourable, and upright man, was 
certainly not handsome; he was short, with a large face, having 
high cheek-bones, and as small a proportion of nose as was ever 
allotted to man, so that in profile but very little of it was to be seen. 
I could not for the life of me help saying, “My dear Roverea, it 
might have taken off your head, but I will be hanged if it could 
have taken off your nose.” Not all the sal-volatile in the army could 
have brought the blood more quickly into his face, for he was very 
tenacious on this point, having been caricatured in England, and 
he very indignantly replied, “Sir, you are the only man that would 
have dared to make such a remark.” He had been shot in the head 
at Albuhera; his skull had been fractured, and when delirious, he 
had thrown himself out of bed, and thought he owed his life to my 
kindness. He was, therefore, soon pacified, and willingly forgave 
my joke. He fell honourably, and for his rank gloriously, shot 
through the same side of the head on the heights in front of 
Pampeluna. 
After the battle I found myself without conveyance, without 
stores except those that the panniers of the regimental surgeons 
contained, and encumbered with near 3000 wounded in the village 
of Valverde. The doctors all worked as no men ever worked 
before, the toil was incessant, we thought ourselves happy in the 
improvement of many around us, and that our reward would follow 
in the approbation of the higher authorities; when lo ! to our 
astonishment comes a letter from the adjutant-general, through the 
deputy-inspector of Hospitals, at Elvas, informing him that he had 
been made acquainted by an officer deserving credit, of the neglect, 
<fec., with which the wounded had been treated ; of his great dis- 
approbation, &c. You may conceive our anger, but this is not the 
way to meet an attack of this sort; when a man errs on the wrong 
side of truth, the only way to settle the matter is to convict him. I 
therefore read the letter to the commandant, the late Sir Aretas 
Young, and to all the wounded officers, and then desired them to 
tell the adjutant-general the truth; this 1 forwarded with a request 
that the person who was now shown to be a villifier might be 
brought to justice; but no, the adjutant-general was pleased to 
express in reply, his happiness at finding he had been mistaken 
as to the wounded at Valverde, but thought the word villifier was 
too strong. I entreated the deputy-inspector to go and insist upon 
an apology from the officer, or a reprimand for him from the 
adjutant-general, but it was of no use, the deputy was a worthy 
man, but who would as soon have faced the devil as an adjutant- 
general, and he gravely wrote me word back, we had got remark- CLINICAL LECTURES. 
23 
ably well out of the scrape, and to be quiet. I was not at all 
contented, but I could not move him. He is long since dead, and I 
believe with the most profound dread of both these potentates. 
Well, gentlemen, the matter ended thus : the English papers were 
full of our valour ; our courage, and our difficulties were the theme 
of every tongue, the humanity men were even satisfied: the 
general and statf-officers obtained stars or ribbons, the officers com- 
manding regiments, whether in or out of action received medals, 
many of them were promoted, the regiments inscribed Albuhera on 
their colours in letters of gold; some few persons of inferior note 
who had disappeared and been reported dead, returned to life ; the 
poor doctors alone got nothing. Do you wonder now, gentlemen, 
that a staff surgeon even, might prefer a comfortable bed and a 
good dinner at Santarem or Abrantes, at Portalegre or at Elvas, 
to the field of Albuhera or the trenches of Badajos. I for one 
however got something. I carried away with me a little repu- 
tation, owing more to circumstances than to any merit of my own, 
which with a little more gained in different ways, has enabled me, 
careless of the past, thus freely and laughingly to address you, for 
Ridentem dicere verum 
Quid vetat ? 
“ Mais revenons d nos moutons,” an idiomatic expression often 
used-in France, which signifies when duly translated into English, 
stick to your proper business. THIRD CLINICAL LECTURE, 
ON COMPOUND AND GUN-SHOT FRACTURES OF THE ARM, 
Delivered December 30, 1837. 
The man I now place before you is one of the heroes of Irun, at 
which place he received a musket-ball, which broke the right arm 
nearly midway between the shoulder and the elbow. It does great 
credit to the medical officers engaged on that service, and particu- 
larly to our friend Alcock, (who was educated at this hospital,) and 
proves what a man can do who is attentive to his studies and his 
duties. The arm is a little bent outwards, which has arisen from 
that army not having been supplied with proper splints; and it is 
not sound, from there being still some dead bone to come away. I 
feel it readily with the probe for the space of three inches or more. 
You shall see me remove this. 
It is done, gentlemen, more quickly than lean relate it. I made 
an incision, four inches long, in the line of the ulceration, down to 
the bone on the inner edge of the insertion of the deltoid, and 
downwards on the outer edge of the biceps. By this cut I gained 
but an incision,—a fact you must never forget, as it shows the 
difference between parts in their natural and diseased state. In 
order to expose the bone, the thickened, hardened parts, almost 
resembling cartilage, were separated from it with the knife and 
finger, which being done, I easily removed two pieces of dead 
bone, worm-eaten in appearance, indicating the action of the ab- 
sorbents on them. There does not seem to be any more, and we 
must therefore hope he will soon get quite well, and save an arm, 
and have it equal to useful labour, which would have probably been 
cut off by many surgeons thirty years ago. Let us enquire into 
these cases more fully. 
A compound fracture is, as you all know, a broken bone which 
protrudes, or has protruded, through the skin, causing thereby a 
rent in the integuments, which, when the broken bone is brought 
back to its proper place, may perhaps unite, if the cut edges are 
placed in apposition. If it should do so, the compound fracture 
becomes a simple one, and the cure is effected by a very easy, 
natural process. If it should not unite, the wound remains open, 
and the process of cure is much more complicated. A gun-shot 
fracture must always be a compound fracture, because the shot- 
hole cannot unite or heal by the adhesive inflammatory process : 
but a compound fracture, caused by a heavy cart-wheel going over 
the part, must be a more dangerous injury than any musket-ball 
fracture. The treatment, therefore, in all serious cases, is pretty 
much the same. CLINICAL LECTURES. 
In a gun-shot fracture, the bone or bones may be more or less 
broken, the splinters larger or smaller, or of a greater or less extent. 
Let us now, however, confine ourselves to the upper arm. and sup- 
pose that the ball has done the least possible mischief; it has gone 
through, or remains, having merely broken the bone transversely. 
In the first place, examine the wound at the moment, if you can, 
and in the gentlest manner. The weight of the fore-arm usually 
keeps the lower end of the bone tolerably well in its place, and you 
ascertain the evil by gently feeling the part all round. Your finger 
should then be passed into the shot-hole, and if it will not go in, the 
opening must be enlarged, so as to enable it to enter freely. The 
object is to ascertain the state of the fracture, and to remove the 
splinters, and the extent of the incision must depend on them. 
This is the true principle of what has been called dilatation in 
wounds; for to cut a man because he has been shot is absurd; he 
should only be cut for some good and specific reason. If, for in- 
stance. the ball has merely struck the bone, and has passed out, 
causing a transverse fracture only, there is no necessity for dilating 
such a wound at the moment, although it must be done at a later 
period; it is time enough to do it when necessary, and it is better 
done then ; for if done at first, the cut would have closed up before 
any bone would be ready to come away. This is one of the differ- 
ences between a compound fracture, from a slight accident, and a 
gun-shot fracture. In the accidental fracture, the force being often 
applied to the ends of the bone, no injury is done to the broken part 
by direct collision. It is always done in the simplest gun-shot 
fracture: the bal l grazes and injures the bone, depriving it of a part 
of its periosteum, and a scale or portion will be separated at that 
place ; but this is a process requiring time, and it is to allow of the 
free passage of this exfoliated bone that an incision must be made 
when necessary. If the ball lodges in the soft parts after breaking 
the bone, an incision or incisions are required for its removal ; and 
an incision must also be made if you should fear the lodgment of 
matter, a free vent for which is always of the greatest importance. 
Receive it as a general rule, that whatever may require to be done 
the first few days, had better be done on the first, than on the second, 
for after inflammation has commenced, any handling or examina- 
tion, however gently made, gives much greater pain. Suppose, if 
you please, the bone to be greatly splintered ; an incision sufficiently 
large and deep to enable you to remove the splinters will be neces- 
sary, and they should all be removed if it. can be conveniently 
done. Add to this a wound of the brachial artery, on which you 
must place two ligatures, one above the wound, and the other 
below it. You will now perhaps be able to put your fingers quite 
through the arm, and the wound will look very ugly ; but you may 
yet add a shot through the fore-arm, you may even break a bone of 
it, or knock off a thumb or a finger or two; nevertheless the arm 
must not come off: it is only sixty seconds or so between an arm 26 
CLINICAL LECTURES* 
on, and an arm off; but as a man is not a crab, and cannot repro- 
duce a limb, he must run great risks to keep it. 
The peculiar danger from a gun-shot fracture, and which is not 
so great in a common compound fracture, arises from inflammation 
taking place in the membrane lining the shaft and the cancellated 
structure of the bone. When this inflammation exceeds a certain 
point, it causes the death of the bone which it lines and nourishes, 
and gives rise to a corresponding, but peculiar and different action 
in the membrane or periosteum covering and nourishing the bone 
externally. This swells, thickens, and begins to deposit new bony 
matter, not only in its own structure, but external to it, and induces 
the neighbouring vessels to take on a similar action, to the extent 
often of an inch or more. This ossific deposition begins early. I 
have seen it by the twentieth day, and it begins earlier, and by the 
end of the fourth week it is often very remarkable. When our 
own sick and wounded were in due order, after the battle of Tou- 
louse, in the old convents of the town, I thought it right to make 
the acquaintance of the physicians and surgeons of the Civil 
Hospital. They received me and my principal friends with the 
greatest kindness, and invited us to witness several of their opera- 
tions for different complaints. On my inviting them, in return, to 
see our surgeons amputate three thighs, which was all they had to 
show, the gentlemen I requested to do them, came to me in the 
most mutinously complimentary manner, to beg I would operate 
myself, to which, as I found they were determined not to do it, and 
as their intentions were good, I was obliged to accede. Every leg 
was off in less than eighty seconds ; but tying ten or twelve arteries 
was a more troublesome matter. They were all in the fourth 
week after the injury ; and each vessel nearer than an inch and a 
half to the bone was so surrounded by ossific matter, deposited by 
the action I have alluded to, that the ligatures on being drawn tight, 
sounded as if cutting a chalky substance, and did even in some in- 
stances cut through. The two preparations of the arm bone I now 
show you, once belonged to two gallant soldiers of Waterloo. Mr. 
Morel cut off* one, I amputated the other at York Hospital in 1816. 
They are each twice as thick and as clumsy as an ordinary bone, 
perforated in several places by holes, and containing in many parts 
pieces of the original bone. The new surrounding cases of bone 
is hollow, its walls in some places half an inch thick, of a deep 
brownish yellow colour; the old original bone is white, thin, and as 
if worm-eaten. It is a case of necrosis, with its sequestra, you will 
say; but mark the difference. The five inches of bone I now show 
you, I took out of a young man’s thigh last year in this hospital; 
the new formed bone surrounding it being more than half an inch 
thick. After making a hole in it with the trephine, I was obliged 
to break it down with a mallet and chisel, used even with great 
force, before I could withdraw this dead piece. The dead bone or 
sequestrum is in these cases of natural necrosis in young persons, 
in one piece, even if the whole shaft is implicated, and may in CLINICAL LECTURES. 
27 
general be readily drawn out when sawn through the middle by the 
trephine. The young man got well. 
In a gun-shot fracture, as you see in these preparations, the old 
bone is in several pieces, and could only have been drawn out after 
much chiseling at several places; and the articulating surface of 
the humerus in the joint is diseased, I presume, from the extension 
of inflammation. The danger you have to dread is the shutting 
up of these splinters of bpne by the newly-formed ossific matter ; 
and the subject you ought to have in view is the prevention of the 
extension, if not the establishment of this, which is to a certain 
extent a necessary and consolidating process. This is to be done 
by the suppression of the inflammation in the internal part of the 
shaft of the bone particularly, and of the arm generally. The 
splinters should be removed, if they will admit of it; the arm 
should be placed at perfect rest, if possible, in the bent position, 
duly supported by proper split ts, or otherwise, as the case may 
require. Vascular action must be subdued, by the application of 
cold and by leeches, until cold seems to be disagreeable, when 
warmth is to be substituted. When suppuration is fully esta- 
blished, the remaining splinters may be very gently sought for and 
removed; but if this cannot be done, and time runs on, the firm 
thickening of the arm begins to indicate the deposition of new 
formed bony matter; and after a further lapse of time, a particular 
spot of inflammation at some part implies the formation of an 
abscess in the new bony deposit. It is caused by the irritation of 
a dead splinter; and when the abscess breaks externally, the probe 
will pass through it, and through such a small hole as you see 
several in these two preparations, and rests on the rough dead 
splinter. If you have not found this out before, you have found it 
now, and the dead bone must be removed. The earlier it is done, 
the softer the deposit, which in such cases will cut like Parmesan 
cheese intermingled with lime. Such was the practice of those in 
the Peninsula, who knew what they were about. The great diffi- 
culty I had to encounter was to teaeh, or rather to unteach, the 
young gentlemen who came to us from home. Those that knew 
any thing, were mostly filled with theory not founded on practical 
information; and many of their masters, when they condescended 
to notice us at all, have, when they learned a little better them- 
selves, attributed the mal-practices of their own students to us. 
You may perhaps think, from what you have heard and read, that 
the case I have just shown you from ftolica is an accidental one. 
If you will enquire for Colonel Hodge in the spring, at the United 
Service Club, he will readily show you his arm, broken by gun- 
shot on the same day. It is even a better one. 
During the retreat from Talavera, the wounded who could walk 
over the bridge of Arzobispo were afterwards collected at the con- 
vent of Deleytosa for treatment. Many underwent operations, and 
many lost their lives for want of proper care and conveyance during 28 
CLINICAL LECTURES. 
this short march of half a dozen days. The broken arms were 
mostly amputated. I objected to some few undergoing this opera- 
tion, and saved them for that day ; but I lost a friend thereby, who 
never cordially forgave me even unto his death. 
At the battle of Albuhera, Sir Gregory Way, now a major- 
general, was shot in the left arm, which was broken in the upper 
third, at that place which Baron Larrey and the French surgeons 
of the day say, rendered amputation necessary. I desired that it 
might not be done. I have not examined it since it left my care 
on moving from the village of Valverde, and I believe the shoulder 
is stiff, but the use of the under part of the arm seems perfect. 
The last instance I shall give you, is that of the present master- 
general of the ordnance, Sir Hussey Vivian. He was also shot in 
the left arm, and had it broken before Toulouse. Sir James 
M‘Grigor was with the head-quarters, on the left bank of the 
Garonne, and was pleased to depute me to act as chief on the right, 
where the principle part of the contest lay. The officers under 
whose charge he immediately came, (and they were well taught 
men at home,) decided for amputation ; but knowing I was on the 
field, they deferred for my opinion. On moving into Toulouse, 
after the battle, he had the able assistance of Mr. Gunning, and 
regained as good an arm as he had before. 
I shall finish this part of my lecture with the following very 
general conclusions:— 
1. An upper extremity should not be amputated for almost any 
accident or accidents that can reasonably happen to it from musket- 
shot. Whenever it is done, a special report should be called for by 
the inspector-general of hospitals, and the broken bones and other 
cause for amputation should accompany it. 
2. If the head of the arm-bone entering into the composition of 
the shoulder-joint is broken to pieces, that portion of the bone 
should be sawn off, but the arm must remain. The patient will 
have all the under use of it. 
3. If the elbow-joint is shot through, it is to be cut out, and the 
fore-arm brought into the bent position. The sufferer will have a 
very good and useful arm. 
4. A fore-arm will bear so much fracturing and cutting, at the 
time and afterwards, that it should not be amputated without a 
special report of the reasons, with the broken bones, being sent to 
the inspector. 
5. A thumb and a finger, or two fingers, are v/orth saving; but 
a serious injury to the wrist-joint generally requires amputation. 
6. The treatment of gun-shot fractures of the fore arm must be 
conducted on the same principles as those of the upper arm. The 
fore-arm must be placed in the half-bent position, or at a right 
angle with the arm. The thumb must be uppermost, the hand 
not supported, and two solid splints wider than the arm, and duly 
padded, should be placed one on each side. The arteries, when CLINICAL LECTURES. 
29 
wounded, must be secured at each end, according to the principles 
laid down in my work.1 The danger arising from necrosis is to 
be carefully attended to, and the motions of supination and prona- 
tion must, if possible, by early attention be preserved. 
The splints used for the upper arm should be made of solid 
wood or tin, firm, although light. The anterior one should be 
made at a right angle, which angle should correspond with the 
bend of the arm. The anterior piece, or that for the fore-arm, 
should be hollowed, so as to admit of a very slight degree of pro- 
nation, as it is painful and not necessary that the hand should be 
quite supine. 
7. If the surgeon does not know the anatomy of the parts well, 
he had better cut off the arm. 
I have pointed out to you the miserable and desolate state in 
which the medical officers, not attached to regiments, are situated 
in a campaign ; from which you will perceive how necessary it is 
that some amelioration should take place in their condition; not so 
much on their own account, as on that of the persons committed to 
their care. These poor creatures suffer in a manner it is quite 
deplorable to think of, and which, I must say, is a disgrace to the 
character of the country, and to every man and woman in it 
possessing one spark of the common feelings of humanity. If an 
unhappy wretch of a doctor has to travel two-thirds of a day, 
generally on foot, at the tail of a cart of any kind, shivering and 
wet to the skin, without food, with scarcely a dry change of cloth- 
ing, with no one to help him in the common necessaries of life, 
bow can he attend to his sick and wounded? It is impossible. 
Self preservation is the first law of nature. He must ascertain 
where he is to eat and sleep, how his clothes are to be dried, to 
seek food for himself and his beast, if he has one, and to do every 
thing, if he wishes to live himself, except attend to his professional 
duties. On his arrival at the halting-place, he ought to see his 
people housed, put to bed if possible, and give directions for their 
food, make up their medicines, see them administered, bleed them 
if necessary, or dress their wounds. A rnan worn with his day’s 
labour, or however tired under a burning sun, may do all this for 
two or three hours more, if he has a hope of a tolerably comfortable 
place to rest himself in, or of something to eat, but not otherwise. 
At night he should again visit his sick, and arrange for a move 
shortly after daylight next morning, when all these duties are 
again to be repeated before the march is begun. Under existing 
disabilities, no man, with the enduring strength even of a jackass 
of Malta, or of Old Castille, could do it, and the sick must be 
neglected, and they have been neglected whenever the doctor was 
unequal to the duties. 
Many a brave and gallant soldier lost their lives from the want 
1 On the Diseases and Injuries of the Great”Arteries of the Human Body, 
with the Operations required for their Cure. 1830. 30 
CLINICAL LECTURES. 
of that attention and care I have alluded to. Many a desolate and 
unhappy mother has mourned the loss of a son she need not have 
mourned for; yet England is the greatest nation upon earth, she 
professes to be the most civilised, the most humane, and did give 
twenty millions sterling for the relief of the negroes. It is to be 
hoped, however, that the six hundred and fifty-eight gentlemen 
who hold the purse-strings of the country may learn the truth, and 
I have full confidence that when they do, they will draw them on 
this point liberally, so that its gallant defenders may on no such 
occasions feel that its boasted humanity is not only for the ear. 
There are two ways of proceeding, in order to enable the junior 
medical officers of the army to do their duty to the sick and 
wounded committed to their charge. One is by giving them an 
allowance for a servant, under ordinary circumstances, whether at 
home or abroad, and by granting them a soldier-servant in addition, 
on service, in whom they may repose the confidence of not being 
materially ill-treated unless he deserts. I will hereafter show 
where this servant may come from with advantage to all parties. 
The second mode of proceeding is by much the best, viz. of 
appointing three assistant-surgeons to each regiment on active 
service. A young man taken into the army at twenty-one years of 
age, which I hope will soon be the age at which he can obtain his 
diploma as a surgeon, knows nothing of the management of the 
sick, or of providing for them in any way; nor of the character 
and tricks of the soldier, however good his classical and general 
attainments may be, in addition to his professional knowledge. 
He is called upon to regulate and command upon points which he 
does not understand, and therefore does not do, and he has a great 
part of his duty to learn when he ought to be putting it into 
practice. He is comparatively inefficient. The assistant-surgeon 
of a regiment learns the duty of a soldier in addition to that of a 
doctor, and a military surgeon ought to know one just as well as 
the other. I always found in Spain, that three assistant-surgeons 
of regiments were worth four assistant staff-surgeons or mates who 
had not been attached to regiments. They know how to manage 
the soldier, as well as to physic him ; they go into action with him 
as a point of honour, willingly and cheerfully; they attend him 
kindly and feelingly afterwards. They are equally under the 
control of the head of the medical department; he can and ought 
to be able to rule them as he pleases ; and although he may often 
send them to the rear, their tendency is to return to their homes 
with the regiment in the front. The tendency of the hospital 
mate, or assistant, is, on the contrary, to get away to the rear, 
where he may perhaps find something like a little comfort. The 
expense of each man is the same. 
I once ordered one of the best assistant-surgeons I had, to the 
rear, with a large party of sick ; when I was informed that his com- 
manding officer would not allow him to take his servant with him, 
being one, although a bad way of inflicting a punishment which clinical lectures. 
31 
he perhaps had deserved. I remonstrated, saying it was my sick 
must slitter, and that I would have my duty done; but.I did not 
succeed; and in order to show my feeling on the subject, I sent 
another assistant-surgeon out of his regular tour of duty. The 
general of division would have settled the matter in a second, but I 
did not choose to do it in that way, for it would have made us bad 
friends on a point of duty not strictly medical; and I was on such 
good terms generally with all the commanding officers, that they 
never disputed any thing I desired, when strictly in my own 
province. You will hardly believe, that an hour after daylight, 
when it was quite plain the enemy were quiet in their quarters, I 
have desired one wing of a regiment to take two tartar emetic pills, 
and the other wing two calomel pills, and have seen it done, being 
the best proof I can give you of the confidence of the officers, and 
of the discipline of the troops. You must learn on service to pre- 
vent a fever, as well as cure it, or at all events to be prepared to 
meet it in the best possible manner. A short time after we had a 
small fight, and the commanding officer of the regiment in question, 
a very distinguished soldier, was wounded towards the evening; 
and as a commanding officer, when shot through the body, becomes 
nobody, he was pretty much at the mercy of the doctors, or rather 
at mine, for I took good care his own regimental officers should not 
stir from the regiment. He was not the worse off for being in my 
clutches, as I wished only to read him a gentle practical lesson, 
without almost making him feel it. I removed every body from 
the village except himself, knowing he had no conveyance, and 
allowed all the troops to pass except the rear. It was now late at 
night, and he sent to ask whether I really did mean to let him fall 
into the hands of the enemy. This was all I wanted, as I had 
always intended he should accompany me. I therefore went to 
him, saying I had come for him, as I had arranged; but he had no 
means of moving, so I offered to lend him my horse, by the side of 
which I walked until morning. We never alluded to the old affair; 
but we never had a difference about doctoring afterwards; and he 
has since paid me, in London, the highest compliment in his power, 
viz. lie placed his life in my hands, under circumstances of great 
difficulty, and he escaped. If he should ever serve again, I am 
sure he will cherish well his doctors, if they deserve it, and I care 
nothing for them if they do not. 
I remember a village on the great plain of the Guadiana, near 
Merida, in which three regiments were quartered in the sickly 
season in the autumn, when fever prevails. Three rows of hil- 
locks marked the last resting-place of the dead on earth, and my 
attention was attracted by one row being much shorter than the 
other two. I found, on enquiry, that the regiments were very 
much of the same strength, and quite under the same circum- 
stances. The doctors were equally able; two were men entering 
rather on the middle period of life, the third was a very young 
man, aud perhaps the worst doctor of the three; but the short row CLINICAL LECTURES. 
of tumuli belonged to him. I was very desirous of making this 
out, and after carefully visiting all the hospitals and quarters, I 
ascertained the reason. He was the better soldier, if not the best 
doctor. His hospitals were in better order, the materiel was more 
perfect, the labour bestowed on every part, except in physic, was 
greater, and five per cent, at least of human life was the saving and 
the result. I never saw it otherwise. 
A staff-surgeon, who has not been a regimental officer, has this 
kind of duty to learn ; and if he tries it a little late in life he rarely 
learns it, or at all events rarely practises it, and from five to ten per 
cent, loss of human life is the consequence. It was the custom, at 
the commencement of the last war, to appoint gentlemen who had 
influence at home to the offices of staff-physician and surgeon, 
totally overlooking the merits of those who were serving, and had 
therefrom just claims for those appointments. This error has been 
corrected, but the situation of the staff officer has not been improved 
as it ought to have been ; he now knows his duty, it is true, but has 
not the means of doing it as it ought to be done on service. He is 
gazetted a staff-surgeon, which is stated to be a promotion ; and 
every soldier, on being promoted, knows he attains a step of rank 
even if it be only from corporal to serjeant; but as the medical 
officer can hold no direct military rank or command, a relative 
rank is given him, which is of use only as it regulates his quarters, 
his baggage, his pension for his widow, his prize money, his 
horses, &c., and a regimental surgeon has this rank as a captain. 
When promoted, it is but natural to think he would then gain 
something by such promotion, as all other soldiers do; but no, he 
is still to be a relative captain. He is to have no servant, but is 
allowed five shillings a week to find one, when he can catch either 
the money or the man. In the mean time, he is appointed to a 
duty which in the field he can hardly do well without four animals, 
and certainly with not less than three, and two servants, a propor- 
tion allowed to every staff-officer of the military branch. The 
staff-surgeon should always be promoted or made on account of 
his knowledge of anatomy, medicine, and surgery ; he ought to be 
the ablest of the officers of the corps, and imbued with the zeal and 
spirit of a soldier in all that concerns them and his department. 
He should therefore be promoted for his merit, and should feel that 
he has gained something, at least in rank and privileges, as his 
reward. So far from this being the case, he will find his expenses 
increased, his means rather diminished, his comforts greatly re- 
duced. After years of service, any regimental surgeon can ex- 
change with him on equal terms, and is equally eligible for pro- 
motion ; an arrangement which has been made of late years for the 
sake of economy. It is not then wonderful that few regimental 
surgeons can be found who will take a staff-surgeoncy, unless to 
escape the West Indies for a time; and that few cavalry surgeons 
will even take a deputy-inspectorship of hospitals, unless they can 
be employed as such. The office of staff-surgeon is therefore one CLINICAL LECTURES. 
33 
nobody wishes to have, unless for some particular purpose of his 
own, unconnected with the good of the service; and then those 
gentlemen are generally too old or too idle for any severe and 
active duty. When this occurs, they would rather return to a 
regiment, and thus the promotion of the juniors is arrested. The 
last assistant-surgeon promoted to a surgeoncy with whom I am 
acquainted, was twenty-six years an assistant, the one a little before 
him was twenty-eight years an assistant, and it is not very un- 
charitable to suppose, that at fifty odd years of age he may be 
unequal to the duties he may have to perform. I have no hesita- 
tion in saying, that any such person will be unequal to the duties 
of a regimental surgeon before the enemy, if continued for any 
length of time. I shall not enlarge on this subject, but merely 
remark to you that the medical and surgical duties of the Penin- 
sular war were done, when they were well done, by men from 
twenty to thirty-five years of age. An elderly man must be an 
indifferent operating surgeon, unless he is in the constant practice 
of his profession as such ; and even then he cannot bend his back 
as long and as often as is required; he is like an elderly captain or 
major of infantry, disposed to get a cough, the rheumatism, or the 
gout, to say nothing of a stomach-ache after a night or two’s expo- 
sure to a heavy rain, and to find his way to drier lodgings in the 
rear. If middle-aged men could be found of the iron mind and 
frame of my excellent and kind friend, Lord Lynedoch, my obser- 
vations would be worth nothing; but I am afraid there are, and 
have been, few in the world possessing his ardour and principles. 
Of the senior branches of the medical department, I shall only 
say they are worse treated than the juniors; but my old and able 
friend, Sir James M‘Grigor, understands this subject better than I 
do, and will, I hope, be able to improve their situation. There is 
no man has more love for his profession, more kindness of heart, 
a greater desire to act fairly and honourably to every one, but he 
is without the power of granting promotion except to a very few. 
With assistant-surgeons of twenty-eight years’ standing, and every 
other situation in proportion, a man must be almost an angel to 
please any body, and more than an archangel to please every body. 
His office is one that nobody can envy him under such circum- 
stances. 
Lest it should be supposed that, in the foregoing observations on 
army doctors, I should mean indirectly and covertly to censure 
any particular persons, which is not my object, I shall proceed to 
show you how the legislature has thought fit to treat the civil 
doctors, and I do not think you will find much difference. 
When a convicted felon is found, previously to execution, to 
stand in need of surgical assistance, it is provided by act of parlia- 
ment that he shall be attended by a man possessing the only 
known qualification in the empire in surgery, viz. a diploma from 
one of the three Royal Colleges of Surgeons. Before a gentleman 
can be an assistant-surgeon in the army, he must have the same 34 
CLINICAL LECTURES. 
qualification; and it is also required from a surgeon in the navy. 
By the poor law bill, this qualification, small as it is, is laid aside 
for the poor, thus placing them in a worse situation than a convicted 
felon, or a soldier, or a sailor. It is stated instead of that qualifi- 
cation, that the doctor to attend them shall be a medical man duly 
licensed to practice, for which person the legislature must send to 
Australia, from whence he may come perhaps with the black swans, 
there being: no such man known in Great Britain or Ireland. In these 
countries a man may be either physician by a degree, surgeon by 
diploma, or apothecary by license; but no one qualification embraces 
the others, and the words medical man are just as indefinite as they 
would be found in the law, if the word lawyer were used to describe 
that class of men as fitted for all the higher offices. The misfortune 
however is, that it has pleased the executive to understand, that 
the legislature meant by the words, medical man, an apothecary, 
because he has a license to practice as an apothecary, and the boards 
of guardians, acting under the act of parliament, take an apothecary, 
and make him a surgeon by their own authority, and agree with 
him to do the higher operations of surgery, which he is not qualified 
to perform by any other known authority, at the lowest price they 
can grind him down to; thus placing the poor man when sick, in a 
worse situation than a convicted felon. By this reading of the act 
of parliament, gentlemen, oftentimes illiterate, are enabled to allow 
the most ignorant to compete with the most able, and to make the 
decision depend not on ability, but on the saving of money. An 
act worthy of the lowest state of barbarism in any country, and very 
disgraceful to the parliament which enacted such a law. The only 
excuse for them is, that they did not know what they were about; 
that they took it for granted, the designation of medical man was 
good, and sufficient. If it had been a matter connected with the 
church or the law, the heads or authorities in these professions 
would have been consulted by the person at least who drew the bill; 
but being a matter only of human life as connected with good 
medical treatment, every gentleman thinks himself entitled to dabble 
in it. The chief commissioner, Mr. Frankland Lewis, who possesses 
one of the best and kindest hearts in the world, has done his best to 
remedy the evil, but he cannot give a new reading to the law. There 
are also many places in which persons qualified to act as surgeons 
or even apothecaries cannot be found, and no one can desire impos- 
sibilities ; but even this is the fault of the legislature. Five years 
have elapsed since a bill for the regulation of surgeons and apothe- 
caries in England and Wales, was brought into the House of 
Commons, by the authorities of these two bodies, who agreed in its 
provisions, with one addition, to be afterwards made in committee. 
This would have rendered the public great service, and removed 
various disabilities and vexations under which the prolusion 
labours, and have prevented many of the difficulties which have 
since taken place, and its defects when clearly shown might have 
been amended. It was opposed by Mr. Warburton, and others, and CLINICAL LECTURES. 
35 
turned over on the plea, that a more extensive enquiry was necessary 
before a good and comprehensive bill could be framed, capable of 
removing every grievance. What followed ? Mr. Warburton had 
his committee the year after; it sat, or rather he sat nearly alone, 
as chairman and committee for several months; he published three 
large volumes of evidence, but has made no report; and for five 
years therefore the public has been deprived of the advantages which 
would have been obtained from the rejected bill. This is not all. 
The college of surgeons of London, instead of advancing and 
improving with the times, has stood still, waiting for Mr. Warburton’s 
measures. Instead of increasing its demands on the candidates for 
its diploma, as had been done every two or three years for the last 
fifteen years, and as it would have done long since; instead of 
insisting on a short but sufficient bona fide education, in the place 
of a long, idle, and insufficient one, by which both parents, and the 
public would have been greatly benefited, they have done nothing. 
That they have done so is not my fault. Mr. Warburton cannot 
make a report from his evidence, which shall be founded on fact, 
because a part of that evidence is entirely hearsay matter; many 
parts which refer to facts are not true for the same reason, and on 
one side only was there any cross-examination. A committee of the 
House of Commons, desirous of knowing the truth, and being totally 
unacquainted by education with the subject, ought to have proceeded 
like an election-committee, and have allowed each party implicated, 
whether appellants, or defendants, to have had one such medical 
counsel as they pleased, with fair right of cross examination in the 
usual manner. The committee might then perhaps have made out 
the truth, but as people wickedly say that small evidence will 
sometimes enable even an election-committee to decide a question, 
I fear a committee of the House of Commons, as it is at present 
constituted, is not the best mode of proceeding, in order to elicit it 
in medicine. 
I shall conclude this subject by drawing your attention to the 
fact, that neither the lawyers, nor the churchmen of the three 
kingdoms, have been able to form one code of law, or of religion, 
for them. Nor can any one form one code in medicine, without 
repealing all the acts of parliament, and abrogating all the charters 
which have been granted by various kings for three or four centuries 
past; a proceeding which I do not think the government will 
recommend, or the legislature sanction. You will perhaps ask me 
what can be done under such circumstances? the answer is simple, 
and the mode of proceeding as much so. Let a secretary of state, 
or a chancellor of the exchequer, write to the different universities, 
colleges of surgeons, and societies of apothecaries, desiring them to 
communicate with each other, and with him, on such points as they 
would wish to have settled by act of parliament, for their mutual 
advantage and that of the public. These bodies would, I suspect, 
soon come to a right understanding, as far as their own interests 
were concerned, and I hope those of the public. The colleges of 36 
surgeons of London, Dublin, and Edinburgh, feel their respective 
disabilities too strongly, not to embrace readily any proposition 
which would lead to their final settlement. The other two bodies 
would not, I think, be very intractable. The opponents on all sides 
should even have fair play, and any great functionary would be able 
to settle the matter, both civil and military, to the advantage of all 
parties and of the public, with very little trouble, in less than two 
months. But no functionary, whether whig or tory, can find time 
to trouble himself about it; and the public must continue to suffer, 
until some one shall be found who may have time, and humanity 
enough to undertake it. 
Ttie campaigns of 1793 and 4, followed by that of the Helder in 
1799, seemed to have left little impression on the minds of the medical 
chiefs of the army in 1808, as to the wants of the sick and wounded 
soldier; and very little more on the minds of those whose duty it 
was to attend to the conveyance of troops to the scene of action at 
the commencement of the war. The troops were embarked in 
transports, maintained at a great expense, and commanded by men 
who were oftentimes quite incompetent to the charge committed to 
their care; and the loss of ships, and the loss of lives, which 
frequently occurred, have been usually set down, after formal 
enquiry, to unavoidable accident, when, I have little doubt, they 
really arose from extreme ignorance or negligence. I never hear 
of the loss of a transport having either troops or convicts on board, 
without being very much of that opinion, and for which I will give 
you some of my reasons. I embarked with General Spencer’s force, 
and sailed from Portsmouth in December, 1808. On Christmas- 
day it blew a gale from the southward, against which we contended 
in vain. The men-of-war made a signal, which we afterwards 
discovered to be that for the first rendezvous, viz., Falmouth ; but 
the instructions of the master of the transport had it not. The flag 
was there, but the agent had not taken the trouble to have it painted 
of the regular chequered colour, and this was the case with others, 
so that we did not know it when we saw it. After ten days more 
contention against the elements, and accompanied only by one other 
vessel, we bore up of our own accord for Portsmouth ; and on the 
way met a privateer, who ran under our stern, but, finding us full 
of men, did not like to meddle with us, or we should have found 
our way to France. This misfortune would have been set down to 
the elements, or any thing else, rather than to the negligence of the 
agent of transports, who had not taken the trouble to see that our 
signals and instructions were correct. He had not, I suppose, any 
yellow paint, and could not take the trouble to write against the 
plain flag that its colour was chequered yellow and blue. When 
I came from North America, I kept the ship’s reckoning, and took 
the daily observations with the captain, which indeed 1 had done 
before on going out, and we made the Lizard with the loss of only 
half a day’s sail, and afterwards the Start. From this point we 
took a new departure in the afternoon, and the next morning found 
CLINICAL LECTURES. CLINICAL LECTURES. 
37 
ourselves in a fog, by my reckoning, on the back of the Isle of 
Wight, by the master’s, twenty miles from it. As he would not 
slacken sail, or alter his course, I went forward to look out, and 
soon saw the breakers. He was frightened half out of his life, but 
the ship answered her helm, and when we were fairly about, the 
shore was close under our stern, being St. Catherine’s bay, as we 
learned from a fisherman shortly afterwards, when the fog cleared 
away, leaving a beautiful summer’s day. When the other officers 
laughed at him for being beaten by the doctor, he replied, shaking 
his head, it is true enough, gentlemen, but it all comes of doctoring; 
which he believed was something like magic, and taught every 
thing. General Spencer sailed once more from England, and 
arrived at Gibraltar. Here another accident happened. The St. 
Domingo transport, in which I was, anchored on the bank in the 
bay, and we all went to bed, being in harbour, except the watch and 
the mate. Being a bad sleeper on board-ship, and knowing the 
carelessness of the sailors, I went on deck in the middle of the night, 
and to my astonishment found the ship was drifting. The mate, on 
being awakened from his nap, under the windward bulwarks of the 
vessel, would not believe it, until I showed him the cable nearly 
right up and down. Well, we turned up all hands, got sail on the 
ship, and the moment we tacked, the battery at Algesiras opened 
upon us, (it was before we made friends with the Spaniards,) and 
after some trials, they sent one shot through the accommodation- 
box on the poop. It made such a noise, and such a hole, that a 
harlequin from Drury Lane would have been delighted to have had 
an opportunity of jumping through, if he had been there. We got 
half-a-dozen more shot from Cabrita point on passing, and then beat 
our way back, to the astonishment of the fleet and the garrison, 
who could not conceive what we had been at. If I had not 
happened to go on deck, we should have awakened in the morning 
in Algesiras. My last turn in a transport was from Lisbon to 
Santander, off which port we arrived in the evening, but too late to 
go in without a pilot; so we stood off and on, and at last lay to, 
with a good fine breeze on shore; the tiller lashed a lee, and the 
mate and one sailor to keep watch. At midnight I looked out of 
my port-hole, and saw the ship was making way fast, and approach- 
ing the shore, and there was a very odd noise from time to time on 
deck, as if the tiller was wagging about at its own pleasure. Thither 
I repaired forthwith, and found this to be the case. The tiller had 
got loose, the mate and sailors were asleep, and the vessel was fast 
going into Santona, under the guns of which we should have been 
in another hour. It is therefore with no small satisfaction I have 
seen that the smaller frigates are to be fitted out as troop-ships. I 
have heard it said that some of the smaller line-of-battle ships will 
be equipped in a similar manner ; but not, I hope, to carry troops in 
the beginning of the season, to Canada; for if a 74 should take it 
into her head to manoeuvre against an ice-berg, in April, on the 
coast of Labrador, she will probably bump; or if she tries a pas de 38 
CLINICAL LECTURES. 
deux in the Gut of Canso with another, she will, in all likelihood, 
make the faux pas. 
The army landed in Mondego Bay, under the orders of the Duke 
of Wellington, with the expectation of seeing the enemy forthwith ; 
but no arrangements were made for sick or wounded with the 
regiments. I went on shore with three days’ biscuit in a haversack 
on my back, which contained besides a pair of shoes, two shirts, 
two pairs of stockings, washing and shaving apparatus, and a 
pocket-handkerchief. I was ordered to purchase a mule or an ass 
for the instruments and medicines, by the commanding officer, who 
could not give me the money to buy it, nor was any allowance then 
made for it, as will be seen by the duke’s despatches. I had two 
one-handed men attached to me, whose hands I had cut off after 
maiming themselves in America, and who had hitherto been 
necessary cleaners,—a class of labourers not required in Portugal. 
These fellows could saddle a horse or a mule nearly as quickly and 
as well as if their hands had not been amputated, and having done 
good service until after Talavera, they retired on a pension for the 
loss of their hands in action, no one disputing the fact of their 
having been lost before the enemy. They took care of the jackass 
that carried the physic, and surgical stores in a biscuit bag, which 
I begged from the master of the transport, there being nothing else 
to be had; and thus we set off to fight two or three battles and take 
Lisbon. By his grace’s despatches, l see that two bullock-carts were 
demanded and granted for the medical stores of the army, which, 
his grace further specifies, were to carry 25 bearers, one case of 
utensils, principally, I believe, tin kettles, spitting-pots, and chamber- 
pots, and one medicine-chest; which specification I know to be 
critically correct, as the two carts with the above contents, came 
into my hands at Roli<ja, to be taken on by me to Yimiera. I have 
no doubt there were plenty of stores on board-ship, but it is the 
arrangement, and the utter ignorance of the subject, which is 
ludicrous. Each surgeon should have had a pair of wicker panniers 
covered with bull-hide, and duly filled, of a good form and size, 
slung, and fitted to a proper pack-saddle; and there should have 
been a horse-transport or two, to carry a horse for the field-surgical 
stores of each regiment, and from half-a-dozen to a dozen spare ones, 
similarly accoutred, for extra stores, with a man from each regiment 
who understood the care of a beast. The extra animals, panniers, 
stores, &c., might, on landing, have been distributed, one to each 
brigade in charge of the surgeon best likely to take care of them. 
It was very unwise to trust to an enemy’s country for this supply 
of animals, and a very paltry economy on so large an expedition. 
In our own country, such, for instance, as Canada, the horses are 
the only part of this equipment which ought to be omitted, and they 
should be furnished by the commissary general, as one of the first 
parts of his duty. The allowance made to the surgeon should be 
sufficient to enable him to keep it up, for it should be an animal 
more than equal to its work, and should invariably march before CLINICAL LECTURES. 
39 
the last section of each regiment, and should never be allowed to 
go to the rear. When we marched to surprise the French, on the 
advance to Oporto, an order was given for all the baggage-animals 
to go to the rear. I, however, placed the mule with the physic, and 
the mule with the entrenching tools, in this situation, and walked 
and rode by the side of them. In the middle of the night, the general 
of the division (since dead) passed, and was furiously angry at the 
order having been disobeyed, and desired to know for what reason 
I dared to have two mules there. I very submissively replied, that 
as it was understood we were going to surprise the enemy, it was 
very probable that they might like to fight rather than be taken, 
and that we might thereby have some wounded, when the surgical 
stores would be wanting. He then desired to know what business 
I had with the entrenching tools. Now I dared not say that such 
a thing might happen as the pickaxes being wanted to knock down 
a wall, or for other military purposes, so I very maliciously replied 
that there might be some killed as well as wounded, and it might 
be, I thought, as well to bury them. This only made him the 
more angry, and he ordered them to the rear instanter. In about 
ten minutes the aide-de-camp came back to say the general would 
allow the mules to return. As I was quite sure I was in the right, 
and as events proved it, I told the aide-de-camp that they had been 
gone so long, he had better go and find them, for I could not under- 
take it; and as the poor fellow saw the folly of the proceeding, he 
very quietly went to the rear, and brought them back. In this way 
we began,—how did we finish? When we crossed the Garonne, 
to fight the battle of Toulouse, the left flank company of the fusiliers 
crossed the bridge of boats first, en tirailleur, then the band of the 
fusiliers, playing the British grenadiers, then my two mules, as 
belonging to the chief of the medical staff on that side the water, 
(and they were the only mules allowed to pass except those of the 
regimental surgeons,) followed by Sir E. Pakenham and myself. 
Two French videttes galloped forwards, fired two shots over our 
heads to announce our crossing, and then retired. Times and men 
were altered, and it was well known then that a doctor without his 
apparatus was not much better than a battery of artillery without 
ammunition. In more peaceable times, the medical staff mules may 
march with the general’s baggage, but when there is something to 
be done, they should never be out of the doctor’s sight; he should 
be made to keep them equal to any service which infantry can be 
called upon to do, or mules or horses to perform. 
Under these circumstances we fought the battle of Rolica, the 
surgical part of which, the surgeon of the 9th, Mr. Brown, and I, 
had nearly to ourselves, for the two bullock-carts and the hospital 
staff were a long way in the rear. They came up, however, at 
night, worked with us on the 18th, and relieved me on the morning 
of the 19th, when I started for the army at Yimiera, with the two 
carts, and stores in question. I wished the carts at the devil in the 
first instance, on account of the delay they occasioned; but very 40 
soon took a particular fancy to them; for vve found the French 
cavalry patrolling between Lourinha and Vimiera, to the great alarm 
of both the natives and ourselves. They counted on their fingers 
two patrols of an officer, and twenty men each, one being before, the 
other on one side of us, and told us they would cut us to pieces if 
they caught us. I had some twenty old soldiers with me, all of 
whom I knew well, and two or three subaltern officers of other 
corps, who were taking advantage of the convoy, and whose duty it 
was to fight. I tied the heads of my second bullocks to the tail of 
the cart which preceded them, and thus continued our march across 
the country, which was open, although hilly, and soon satisfied my 
old soldiers that, with their backs against the bullock-carts, they 
were not to be thrashed by a patrol of cavalry. The pots and pans 
arrived safe, ready for the battle of Vimiera on the 21st. The 20th 
was a beautiful day, and I spent it happily with three officers, my 
messmates, who are all since dead. Captain Gauntlett fell, mortally 
wounded, on the hill at Talavera, forming the left of our position. 
He was struck on the side of the head by a ball, which cut his hat, 
and carried away a portion of his skull and brain. It ought not to 
have done this, if his skull had been of any thing like an ordinary 
thickness; it was unfortunately, however, as thin as thick car- 
tridge paper used in packing: it was the thinnest bone I have 
ever seen, and he lost his life in consequence: he died in my arms 
in Talavera. Captain Humfrey was struck on the hip by a cannon- 
shot at Albuhera, which carried away the limbs of two men behind 
him, and died on the spot, encouraging the advance of the regiment, 
for the honour of old Ireland, of which he was a native. The third 
died in bed, Lieutenant-Colonel Stopford, promoted to that rank 
from home, and unattached; he rode with me the whole fight of 
Toulouse. The moment the last redoubt on the enemies’ right was 
taken, we rode up to it, and when all was quiet, and I was giving 
directions about my wounded, the French fired their last shell,—• 
the last, I believe, that was tired in anger against us in France; it 
burst just over his head and mine. When our first fright was over, he 
laughingly said, if that shell had killed us both, which of us would 
have been called the greatest fool ? To which I replied, that he 
would only be called unfortunate, as an amateur soldier, but that I 
should be called the fool. It is quite impossible for a regimental 
surgeon to be out of fire, if he does his duty, and a medical staff- 
officer can scarcely be out of the way of cannon-shot, and the doctors 
are therefore very unjustly treated in being classed with the clergy- 
men and the commissaries. They do not actually fight, it is true; 
but I will venture to say that the surgeons of the fusilier brigade, in 
Spain, have been under more fire, take it all in all, than a large 
proportion of the general officers of the army. I will tell you of the 
unkindness with which one of these gentlemen is now treated, after 
thirty years of active service, if I were not afraid my mention of 
him might do him an injury. 
The morning of the 21st dawned upon us in all its brilliancjr; 
CLINICAL LECTURES. CLINICAL LECTURES. 
41 
distant clouds of dust announced the approaching contest; our 
breakfast of biscuit and water, with a bunch of grapes, was soon 
despatched ; and we at last moved to the high ground on the left of 
the British position. The fight had begun before we got there, 
and the French advance was as usual, valiant. The fire of their 
guns was heavy while it lasted, and it was at this moment I met 
with the wounded officer of the 40th regiment, whose case I have 
alluded to in the third edition of my book,1 whose ball I pulled out 
of his thigh, for three inches, hanging in his shirt, like a shilling at 
the bottom of a purse. Whilst I was doing this, he got a crack 
from a spent ball on his hind quarter, which made him jump, and 
we thought it advisable to retire into a water course which allowed 
our heads to be under cover. Shortly after this Sir H. Burrard 
came on the field, looking remarkably well, as if for a field day in 
Hyde Park. I never saw him before nor since, that I know of, nor 
have I the slightest intention of saying any thing disrespectful of 
his memory, but that one sight of him quite convinced me he was 
unfit to command an army in the field. I am satisfied that his 
head if examined phrenologically, would have responded to the 
best wishes of the Secretary of State who selected him for the 
service, and that he possessed all the talent a commander-in-chief 
ought to possess ; but he outweighed it below: he was too large in 
the waist; and although a good soldier may require a large bump 
or two in the head, he ought not to have them in the belly; and if 
the Government of this country will allow soldiers to gratify their 
military propensities and serve before the enemy, they must take 
care that they first mortify their gastronomic ones. Lord Byron 
says, “I hate a dumpy woman;” although the particular dumpy 
alluded to by him was, I assure you, worth looking at; and I 
equally hate a dumpy soldier; not that they cannot stand fire, but 
because they cannot stand fever, at all events I have never been so 
fortunate as to see one. The Duke of Wellington has several times, 
in his despatches, insisted upon it, that general officers going out to 
Spain should declare upon honour as to their willingness, if not 
capability, to serve the war. The reverse of this should take place 
with inferior officers; and if they have any physical disability, ren- 
dering them less able and less active than a soldier ought to be, 
they should not be permitted to go. They should be allowed, if 
they have deserved it an honourable retirement; and the 658 gen- 
tlemen of the purse-strings should draw them liberally in their 
favour, if they wish the country to be well served. The country 
expects every man, before the enemy, to do his duty; but if men 
are sent, who are physically incapable of doing it as it ought to be 
done, disgrace and disaster can alone be expected. 
General Nightingale’s brigade, to which I belonged, formed in 
1 Treatise on Gun-shot Wounds, on Inflammation Erysipelas and Mortifi- 
cation, on Injuries of Nerves, and on Wounds of the Extremities requiring 
the different Operations of Amputation, &c. &e. 3d, Edit. 1827. • 42 
CNINICAL LECTURES. 
line on the brow of the hill, on the right of the position, of the left 
of the army, with Sir Ronald Furgusson on their left. The French 
made a show of advancing across the valley, and their officers 
gallantly set them the example ; but it would not do; it was only 
a straggle, and they soon retired. Our people were calling for the 
order to advance ; but 1 told them to keep themselves quiet, for I 
had overheard enough of the conversation between Sir H. Burrard 
and the Duke, a little before, to know there was to be no advance. 
I had even heard an officer invited to dinner ; and I therefore set 
about my own immediate duty, sure of not being interrupted. 
If the affair before Rolica had been highly honourable to the few 
troops engaged, this had been glorious to a greater number. They 
were equally important to the advance and improvement of British 
surgery; which seems to have been utterly neglected in the pre- 
vious campaigns of Flanders and the Helder. There was a single 
house in the rear near the front of our position, and I dare say it is 
there still, which I had selected for such wounded as I could collect 
of all parties, having few of our own. I had cut off two or three 
legs with the help of my assistant, when at last in amputating a 
thigh high up, the tourniquet buckle broke and it fell to the ground; 
the bone had just been sawn through, and the limb fell with it; the 
patient was likely to bleed to death. I seized the bleeding end of 
the femoral artery with the finger and thumb of one hand, and 
compressed the artery in the groin against the pubis with the other, 
whilst my assistant, Mr. Curby, put a ligature on the vessel above 
my thumb. I found I had perfect command of it with each hand, 
and when it was secure, and we had time to recover from our alarm, 
I could not help saying ; Why what could Mr. John Bell mean by 
frightening us all so, by saying it was impossible by ordinary press- 
ure to prevent the passage of blood through the femoral artery? 
Thinking however I had met with an exception to the general rule, 
rather than that I had found out the general rule itself, and that 
Mr. J. Bell might still be right, and I in the wrong, I went into the 
village of Yimiera early next morning to try the point on another 
amputation or two. I worked away all day, few people being very 
glutonous of work, and established my fact that I was right, and 
that Mr. J. Bell had given the exception and not the rule. Since 
that, you know I never apply a tourniquet, for various reasons I 
have assigned in my work, except when I have bad assistants; and 
in the latter part of the war, few who knew any thing of their pro- 
fession cared more for any artery in the body than the troops did for 
an equal number of the enemy. Both doctors and soldiers thought 
themselves sure of their opponents. When we came home in 1814, 
several of us thought we had learned a good deal during our cam- 
paign ; but as we had not the vanity to suppose that we knew 
every thing, and that our contemporaries in London were standing 
still ; the best of us deemed it right to revisit the various schools at 
which we had received our early education, and hear what the 
different teachers had to say. With a great deal of highly useful CLINICAL LECTURES. 
43 
information, we were surprised also to find that they knew little or 
nothing of our improvements. In describing the operation of am- 
putation at the shoulder-joint, they could not conceal their alarms ; 
and whilst they were screwing their tourniquets on the shoulders 
of the young gentlemen they produced as objects for observation, 
we were internally laughing with all the complacency, and bon- 
hommie their unvaried kindness deserved. I settled this matter by 
inviting as many gentlemen as pleased to come to the York Hospital 
at Chelsea, where I had two clinical wards. I took an arm off at 
the shoulder-joint without any tourniquet or compression at all; 
and in order that they might be more than convinced, I allowed the 
great axillary artery to throw its jet of blood over two or three of 
them, that they might see how easily and completely it was in the 
power of my finger and thumb. 
Sir C. Bell, in his Institutes lately published, has endeavoured to 
support Mr. J. Bell’s opinion, by saying that if he were wrong with 
regard to the principal artery, he was right in saying that the bleed- 
ing could not be stopped because the collateral vessels would bleed, 
and that a particular compression of the surrounding parts must 
take place to prevent this. But this is merely begging the question ; 
none of these vessels give any trouble, or are worthy of the slightest 
consideration. When I come here, gentlemen, and cut off the tip 
of an old woman’s finger, and a thread of an artery throws out its 
blood, I beg one of you to put your finger on it, that it may not 
spot my shirt-collar, and frighten the lady I may next visit; and I 
should do the same with those small arteries coming from the 
internal iliac in a case of amputation at the hip-joint. They are 
all in recent cases quite unworthy of your further notice, and in 
old cases they deserve but little consideration; in fact, as coming 
from a different source, they have nothing to do with the question. 
The operation of amputation at the hip-joint was not even shown, 
it was declared to be too barbarous to encourage, although we had 
done it often, and my successful case was actually seen in London, 
and was afterwards for years the only one that ever had been seen 
in Paris. An elderly gentleman sent for me at that time, saying, 
without further circumlocution, Sir, 1 have sent for you to know 
whether you can take my thigh out at the hip-joint. Seeing my 
patient was an oddity, I replied, I would do it with the greatest 
possible pleasure, and he desired it might be done at 12 next day. 
To this I demurred, as it was necessary to know the why and 
wherefore, and I begged a consultation with the three surgeons 
whose opinions he had taken. They all declared his case incurable. 
Mr. Cline pronounced the operation of amputation to be inad- 
missible, barbarous, and little less than murder. The second 
surgeon followed his example, and declared he could not counte- 
nance it by being even present. The third, Sir Astley Cooper, 
said, he would assist me if I would do it. It was handsomely and 
generously said, and as gratefully received, although I did not 
stand in need of aid, having my choice at that time of my old 44 
CLINICAL LECTURES. 
Peninsular assistants and friends. Under these forbidding circum- 
stances I thought it right to promise the gentleman only one hour 
to live after his operation was done; that I undertook to guarantee, 
and on these conditions, we did it. When the operation was done, 
I said, sir, I am happy to say your leg is off; to which he calmly 
replied, sir, it was a very unworthy member. I sat by his side for 
an hour, and when the time was out, I said, sir, you have outlived 
the hour, and please God you will recover. Sir, said he, please 
God or the devil, which you like. I believe in neither. My trust 
is alone in you. It was quite clear he was a monomaniac. The 
next morning he satisfied me however he was mad on two points. 
The apothecary, Mr. Stewart, came in, and was going to sit down 
when he begged him to wipe the chair first, and then spit upon it; 
and on giving him a pill, he insisted upon the box being shook 
three times, and spit upon. He was quite sane on all other points, 
and a remarkably well-informed man on most subjects; but he 
never could speak of religion without showing the aberration, nor 
see the apothecary, to whose profession he had an unsurmountable 
aversion, without proving it. I foretold, that this operation would 
nevertheless become too common; that the example we had set 
would be perhaps unnecessarily followed. I have reason to fear 
that this has been the case; that I have been prophetic. 
After I had done the operation at Yimiera, I have described, and 
which led to such particular results, I turned my attention to a 
French officer who was just brought in. He was bleeding much, 
although not dangerously, from a wound in his face, and his white 
waistcoat and trousers were covered with blood. I have alluded to 
this case in my book as one showing, that gun-shot wounds will 
often bleed considerably without any large arteries being injured. 
I spoke to him in French, he immediately pulled out his little book 
of accounts, which every French soldier carries, and returned 
thanks for falling under my care, and gave me his watch and his 
money as a matter of course, and with the view of begging protec- 
tion. At the first fight of Roli(}a, the kit of the dead soldier remained 
on his back untouched, until he was buried, and it is but just to 
say, that the British officers taken under the eye of the French 
General Brennier were not plundered. But our troops were apt 
scholars, and few dead or wounded escaped plundering after that 
day, whether friends or enemies; and the progress we made in arts 
as well as arms, was equally great. The contrast between Roliqa 
and Badajos will be perceived, when I tell you that at day-light 
after the storming of the town, I saw thirteen officers lying dead on 
the great breach, stripped stark naked in the night by their own 
friends or their allies, in such a way does war destroy our noblest 
feelings. 
Two days elapsed before I could find time to seek for my 
wounded French officer, I then found him with several others 
without a sous amongst them; they had been thoroughly well 
cleared out, although otherwise well treated, and they admitted CLINICAL LECTURES. 
45 
they could not have done it better themselves; it was la fortune de 
la guerre, and quite natural. My poor Frenchman came forward 
to renew his acquaintance, for although I had apparently robbed 
him, I had still been kind; and kindness begets kindness. You 
should have seen him open his eyes when I apologised for not 
having found him before to return him his watch and money. 
They did not believe I was serious, but when they saw me place 
the watch and the doubloons in his hand, they could not restrain 
their feelings. I was an ange de dieu, the most beneficent of 
human beings. I assured them it was only a common act of kind- 
ness that every English gentleman would feel himself bound to do. 
This sentiment seemed, however, rather a matter of reproach to 
men who had avowed that plundering was quite a natural pro- 
pensity, and they would not admit of it. I was therefore obliged to 
take my leave, with a full determination to plunder the first French- 
man I came across, in order to satisfy myself, I was but a man. 
The convention, so called, of Cintra followed, and gave us all 
considerable dissatisfaction. A great part of the army never could 
understand the why and wherefore, and officers and men did not 
fail to express themselves in a very disorderly manner in the hear- 
ing of the highest authorities. That they had sold themselves to 
the French, few doubted, although there was not, nor is there the 
slightest foundation for the suspicion. Years have since passed 
away, and the propriety, or the reverse of the proceeding has been 
discussed by various parties, with different political and military 
views and feelings. The two principal of them of late date are 
Colonel Napier, and the author of the critique on him in the 
Quarterly Review ; but neither of them enter into the feelings of the 
army against their superiors as generally expressed at the time. 
The discontented officers and soldiers would never have objected to 
a convention for the evacuation of Portugal, if it had been made 
and ratified the day after the battle ofVimiera, viz. the 22d, before 
they knew that Sir John Moore’s force could land at Maceira and 
be in time to assist; but they did strenuously object to its being 
made on the 28th, when they knew they had that assistance. If 
the armistice had been broken on the 28th the whole British army 
of 25,000 men might have advanced on the 30th. Sir Harry 
Burrard in bringing down Sir John Moore’s force to Maceira did 
better as it turned out, than if he had landed it in Mondego bay; 
he gained several marches by it, and instead of that force only 
reaching Lisbon on the 14th of September, as shown by the com- 
mentators arid critics, it might have been easily there on the 3d. It 
might have done this even if it had gone by the same road, for 
Villa Franca on the Tagus is only two short marches from Torres 
Vedras, and from Villa Franca to Lisbon it is only 21 miles of very 
good road, with a creek to cross at Sacavem, which would have 
been crossed as readily in one case as the other. The Duke of 
Wellington has shown in his despatches that he would have 
marched from Sobral to San Antonio de Tojal; Sir J. Moore’s 46 
CLINICAL LECTURES. 
force taking the road by the Cabe<ja de Montechique, on the 31st; 
and if he had commanded the army and had done so he would 
have been in Lisbon on the 2d of September. We should have 
had a race for it, but the whole French army left unkilled 
would have been prisoners, and they would gladly have com- 
pounded for the surrender of those at Elvas and Almeida. 
That Junot might have crossed one third of his army into the 
Alentejo is possible, but I doubt it. and he must have sacrificed the 
remaining two thirds and all his stores and baggage. That the 
soldiers of the army were right in the opinion they entertained, is 
quite as clear as that they were wrong in the open expression of 
their discontent; but they only asked to do what the Duke of 
Wellington shows he advised, and says he would have done. 
Although many may doubt his judgment on political matters, few 
will express it, or even do so on subjects purely military, and no 
man can be a better judge of what is consistent with the character 
and honour of a British officer. I shall therefore conclude by sup- 
posing that the gentlemen who approve of the convention on the 
28th may probably be in the wrong, and that British history instead 
of defending them may at least admit, that it is possible they erred 
in judgment. 
Having paid a second visit to Cadiz, which only increased my 
admiration for the muchachas muy lindas of the Calle Ancha, the 
fashionable street of that city. I returned in time to accompany 
two regiments on a march to Almeida in support of Sir J. Moore. 
We here performed a piece of animal magnetism, which far exceeds 
any thing the professors of the present day will I believe ever 
attempt to do. When we arrived at Castello Branco we halted a 
day, and therefore had time to prepare our operations. The French 
had somewhat more than two regiments in Alcantara and its 
neighbourhood, and this is the essential point for observation, in 
proof of the superiority of our powers to those enjoyed at present. 
I believe the principal animal magnetisers do now not claim a power 
in intensity or force more than equal to twenty or thirty feet, although 
they can operate on a lady who is duly predisposed at that distance 
through a door two inches thick, but then only when the magnet- 
iser has his whole mind intently engaged in this one object. It so 
happened that the minds of the French were as much engaged 
upon us as we were upon them, and the effect was remarkable, for 
instead of being bounded by 20 or 30 feet, it extended to as many 
miles, with a mountain or two between us, and the Tagus to boot, 
which ought to be as good as a door at any time. Each party 
turned out as nearly as possible on the second day at the same hour 
after dinner, drums beating, colours flying, and all prepared for 
immediate action. No enemy appeared, the uneasiness arising from 
the extraordinary magnetic influence, which were so liberally in- 
fusing into each other, now took complete effect, and both parties 
simultaneously turned round and walked off, being quite unable to 
stand it any longer. The British never stopped until they arrived 
at Abrantes. The French took refuge in Truxillo, (pronounce that CLINICAL LECTURES. 
47 
x as a letter intermediate between it g and h,) and each party only 
felt themselves free from magnetic influence when they were 150 
miles asunder. The day we started, it poured as if the heavens 
had opened all their watery stores upon us, and no poor devils were 
ever in a more wretched state than we were on reaching Cernados, 
one of the most deplorable villages in Portugal. We had intended to 
cross the Tagus at Villa Yelba, but the river had greatly filled in 
the course of the evening and it was not certain we could cross on 
the small flying bridge which existed in those days. Under these 
circumstances we turned short to our left next morning before day- 
light, and took to the mountains by a bridle road or track, and 
never stopped until sunset. The bullock cars could make little of 
this, and half way they were brought to a stand still. What was 
to be done? After due deliberation it was thought desirable to 
burn the carts and the baggage. This consisted principally of 20 
complete sets of bedding packed in four bales in the hardest manner 
and a trunk containing the commanding officer’s best suit of clothes, 
which had no business there. At midnight the conflagration took 
place. I learned afterwards from a French officer that they were 
walking off as fast as they could at the same time, under the mag- 
netic influence we were imparting to them, when they saw the light 
of this fire which they took for a beacon to alarm the country peo- 
ple, in order that they might cut off some of the stragglers. Once 
he said it seemed to blaze up for a minute or two with more than 
ordinary brilliancy, which added to their confusion ; and he asked 
what we had done to cause tjiis effect, and did not seem pleased, 
when I assured him I could only attribute it to the indignant com- 
bustion of the colonel’s best pair of white leather breeches. Animal 
magnetism can, you see, do greater things in Portugal than in 
London. FOURTH CLINICAL LECTURE. 
ON COMPOUND AND GUN-SHOT FRACTURES OF THE THIGH.’ 
Delivered Jan. 6, 1838. 
I approach the subject of compound and gun-shot fractures of 
the thigh with greater diffidence than 1 do any other in surgery, 
not from want of experience, or, 1 trust, of observation on that 
experience, without which it is of no value, but from the unfortu- 
nate nature of the results. Nothing is more easy than to cut this 
difficulty, by saying, cut off the limb; but amputation is scarcely a 
less miserable result, and is at all limes, even when successful, 
which in such cases is very doubtful, an opprobrium to surgery. 
The best thing I can do, I believe, gentlemen, is to read you 
what I have written in my work or gun-shot wounds, &c. &c., and 
then give you the further treatment. 
In accidents in civil life, the bone is in general merely broken 
across, or obliquely, with the point thrust through the soft parts. 
In gun-shot wounds, it is generally the reverse, being much shat- 
tered, and not appearing through the integuments; depending very 
much on the part of the bone injured, and the manner in which it 
has been struck by the ball. 
If a musket ball, in passing through the thigh, merely touch the 
bone, it may fracture it directly across, but it will generally do it 
obliquely, so as to cause some little shortening of the limb when 
cured under the most attentive treatment; but when a ball strikes 
the shaft or body of the femur, it shatters the bone in every direc- 
tion, although it may not pass through: it does not merely break 
off four or five small pieces, which may be taken away by cutting 
down upon the bone, but it breaks it into large pieces, generally 
oblique and very pointed, that retain their attachment to the muscles 
inserted into them. The fractures extend far above and below the 
immediate part struck by the ball; and, as far as depends upon my 
information from the examination of limbs that were amputated, 
further downwards than upwards; so that from a fracture in the 
middle of the thigh, I have often seen fissures extend into the con- 
dyles, and cause ulceration of the cartilages of the knee-joint; but 
they seldom extend upwards as high as the trochanters. Of such 
cases, there can be no doubt as to the propriety of immediate ampu- 
tation ; but if the fracture did not communicate with the joint, when 
the middle of the body of the bone is broken into several large pieces, 
it is better to amputate before the inflammatory symptoms come on, 
than afterwards; for it must then be higher up, or probably cannot 
be done at all. CLINICAL LECTURES. 
49 
The danger and difficulty of cure attendant on fractures of the 
femur from gun-shot wounds, depend much on the part of the 
bone injured; and, in the consideration of these circumstances, it 
will be useful to divide it into five parts. Of these, the head and 
neck included in the capsular ligament may be considered the first, 
the body of the bone, which may be divided into three parts, and 
the spongy portion of the lower end of the bone exterior to the 
capsular ligament, forming the fifth part. Of these, the fractures 
of the first kind are, I believe, always ultimately fatal, although life 
may be prolonged for some time. The upper third of the body of 
the bone, if badly fractured, generally causes death at the end of 
six or eight weeks of acute suffering. I have seen few escape, and 
then not with a useful limb, that had been badly fractured in the 
middle part. Fractures of the lower or fifth division are in the 
next degree dangerous, as they generally affect the joint: and the 
least dangerous are fractures of the lower third of the body of the 
bone. Of these even I do not mean to conceal, that when there is 
much shattered bone, the danger is great; so that a fractured thigh 
by gun-shot, even without particular injury of the soft parts, is one 
of the most dangerous kind of wounds that can occur. 
“ Upon a review of the many cases I have seen I do not believe 
that more than one sixth recovered so as to have useful limbs; 
two thirds of the whole died, either with or without amputation; 
and the limbs of the remaining sixth were not only nearly useless, 
but a cause of much uneasiness to them for the remainder of their 
lives; they were indeed much in the same state as Bilguer’s invalids 
who were incapable of any employment, civil or military. 
“It would be an interesting, and I am sure a useful enquiry, to 
examine the lists, or cause lists to be made, of British soldiers who 
receive pensions on account of incapability for service, from wounds 
with fracture of the thigh bone ; and I am satisfied the number 
would be small, although the accident is not infrequent; and of 
the number thus receiving pensions, I will venture to predict, it will 
be found that in seven eighths the bone was broken below the 
middle of the thigh. 
“ After the battle of Toulouse, forty-three of the best of the frac- 
tures of the thigh were attempted to be saved ; having been carried 
from the field of battle but a very short distance, well accommodated 
in hospital, and attended for the most part with great care, and 
surgical attention : of this number, thirteen died; twelve were am- 
putated secondarily, of whom seven died ; and eighteen retained 
their limbs. Of these eighteen cases, the state, three months after 
the battle was as follows: “Five only can be considered well, or 
as using their limbs. Two more think their limbs more valuable 
(although not very serviceable) than a wooden leg : and the re- 
maining eleven wish they had suffered amputation at first, as they 
are not likely to do well; and if they eventually recover, which in 
many is doubtful, the limb will be distorted and unserviceable.” 
Of two officers with fracture of the femur, one died in the hands 50 
CLINICAL LECTURES. 
of the French surgeons, in whose charge he fell during the action, 
and bv whom he was skilfully treated; the other, with the greatest 
possible attention and care, has preserved a limb, which I think he 
now wishes exchanged for a wooden leg. 
“In the five successful cases, the injury was, in all, at or below 
the middle of the thigh. In the thirteen others, who retained their 
limbs, the injury was not above the middle third; and of those 
who died unamputated, several were near, or in the upper third, 
and either died before the proper period for amputation, or were 
not ultimately in a state to undergo the operation. Of the seven 
amputations that died, two were at the little trochanter by the flap 
operation, and the others, for the most part, unfavourable cases. In 
one case only was the head or neck of the bone fractured by a 
musket ball, which had entered on the outer and back part, and 
went through in front. This man was not pointed out to me for 
some days, and was not at that time, or ever afterwards, in a state 
to render amputation likely to be successful. He lived, however, 
for two months; and, from the dreadful sufferings he endured, I 
always regretted amputation at the hip-joint had not been performed 
at first. 
“After other battles, in which I have had the care of fractures 
of the femur, the success has not been so great, but they were 
generally under less advantageous circumstances; and from the 
sum of knowledge thus acquired on many occasions, I am induced 
to believe, that in this injury amputation ought to be a more fre- 
quent operation than it is at present; and I think I am borne out 
in this supposition by the above statements, and by the general 
opinion of my brethren formed during the Peninsular war. 
“ I think it will also be conceded' by those who are disposed to 
allow the advantage and safety of primary operations, that if the 
thirty-six of the forty-three who died, and have only partially re- 
covered, had been amputated on the first day, the country would 
have had at least twenty-five stout men, able, for the most part, to 
support themselves by their labour, instead of five, or, at most, ten, 
who will not be entirely dependent upon their pensions and parishes 
for their subsistence. 
“As secondary amputation is totally inadequate to produce this 
effect, the patient should be carefully examined, and amputation 
performed, when necessary, on the field of battle. If the heat of 
the weather be great, as in the summer of the Peninsula, Asia, or 
America, the hospital to which the patient must be removed at 
some distance, the means of conveyance bad, or the wounded very 
numerous, it is better to amputate, even in a doubtful case ; and if 
the surgeon, by following this rule, should even cut off a limb that 
might have been saved, he will be amply compensated by the pre- 
servation of a number of lives, that would be lost by delay under 
precisely similar circumstances. 
“ In regard to officers, some little more latitude is to be granted 
than the above suggestions allow; for, as they can often procure CLINICAL LECTURES. 
51 
cool apartments in summer, good conveyance, plentiful attendance, 
and the best professional advice, all of which are occasionally want- 
ing to soldiers, cases of disease and injury will always succeed in 
a greater proportion with them than with private soldiers in 
hospital; but not in so great a degree as to counteract my opinions 
in cases that are really serious. 
“It is a difficult thing to persuade a surgeon unaccustomed to 
the treatment of gun-shot wounds, or the patient himself, when he 
sees but a small wound, that amputation is necessary; and as cases 
of success have been heard of by all, whilst the fatal ones are 
buried in oblivion, many officers will not choose to submit to it; 
they will rather hazard their future health and happiness, and 
undergo the most dreadful sufferings, for months, to save a limb, 
which, when cured, and their wishes are obtained as far as circum- 
stances will permit, they find a useless burthen, and a source of 
inconvenience for the rest of their lives.” 
Wounds from musket-balls, injuring the lower part of the bone, 
without communicating with the joint, do not require primary 
amputation ; they are proper cases for delay, unless there be great 
destruction of parts. 
In order to attempt, with a reasonable hope of success, the man- 
agement of a compound or gun-shot fracture of the thigh, it is de- 
sirable the patient should be placed on a proper bedstead, of 
sufficient height from the ground to render him easy of access, and 
capable of affording him every necessary comfort and accommoda- 
tion without moving. This will be best accomplished by a bed- 
stead and mattrass, invented by the late Mr. Gardiner and myself 
in 1815. The one he died upon in 1817 is now at Mr. Knox’s, 
107 Jermyn street. Mr. Gardiner, if alive, would have been now 
Lord Mountjoy, and I am disposed to call the bedstead by that 
name, to distinguish it from all others. It is so absolutely neces- 
sary in cases of diseased hip and spine, of loss of the use of the 
lower limbs, of injury of the pelvis, as well as in fractures, that one 
or more ought, in my opinion, to be placed in every permanent 
hospital in the British dominions. There is one now in use in the 
Westminster Hospital, and it has been the comfort and happiness, 
as well as the saviour, of more than one person who has lain upon 
it. I am aware of the difficulty of carrying these bedsteads to the 
scene of action in a distant country ; I am equally aware of the 
expense: but Great Britain must give up all her pretensions to 
humanity, if she allows either of these trifling obstacles to prevent 
her brave defenders from having an absolutely necessary assistance 
for their recovery from their injuries, or for the safety of their lives. 
A bedstead, mattrass, &c., complete may be easily bought, packed, 
and conveyed to the most distant of our possessions for ten pounds; 
and six of them may be carried upon any common cart to wherever 
they are wanted. If a second inclined plane and another set of 
bedding are added to the box, it will cost thirteen pounds, and will 
answer for two fractures. The battle of Toulose gave forty-three 52 
CLINICAL LECTURES. 
fractures of the thigh, out of 1242 wounded, which were attempted 
to be saved, and this may be considered as a fair average ; and I 
should say that a corps of 10,000 men ought to be supplied with a 
reserve store of at least twenty of these double bedsteads, at an 
expense, perhaps, of £260. In Spain and France we had nothing 
of the kind; the consequence was, that many suffered intolerable 
torments, that might have been greatly alleviated, and many lost 
their lives. Not only that, many could not be attended to, from 
the delay and the difficulty of assisting them on the ground ; and 
it is only necessary to have seen the horrible sufferings they 
endured, and which might have been relieved, to speak strongly, as 
I do to you. I wish it to be received as a voice from the dead, 
calling upon the gentlemen of England, upon this, and upon all 
other points, to do one of two things—to send their sons forth to 
fight, with every hope and every surety that if they fall wounded 
‘in the service of their country, they will have every attention and 
comfort afforded them that the talent, the capability, and the money 
of the country can bestow ; or not to send them to fight at all. The 
Duke of Wellington, in his despatches (10th vol.), has expressed 
his opinion of the late Medical Board in no measured terms; but 
the present one, with all the knowledge and all the persevering 
labour of its able chief, can do very little better, as far as regards 
the exigences of the sick and wounded soldier, unless assisted by 
the treasury of the country in a very different manner to what has 
hitherto been done. I beg I may not be misunderstood. I do not 
want more pay for the medical officers of the army, the government 
has acted liberally towards them in that respect; but I want almost 
every thing else both for them and for the wounded. The mis- 
fortune is, that things in this country do not go through one 
channel, and unless one or two powerful men, or several smaller 
ones, will take up a question of this kind, it never can meet with 
the consideration it requires and deserves, in all the various 
quarters with which it is connected. 
The position of a fractured femur must be essentially of one 
kind, viz., straight; for it is impossible to keep a man’s thigh in the 
bent position on the side, and himself in the same situation. No 
power that is likely to be employed can prevent his turning on his 
back, and the union, if it takes place at all, must then be at an 
angle. The bent position forwards, or on an inclined plane, is 
defective, inasmuch as the matter, which must necessarily be 
secreted in abundance, will gravitate backwards, in spite of every 
care to prevent it; and in many instances will form abscesses 
towards the pelvis, instead of always running directly outwards by 
a fair and unobstructed passage. When a proper bedstead is used, 
a slightly inclined plane may be tried at a certain later period of 
time, and in some few cases the body of the patient may be raised 
even to the erect position. This must be done however with care; 
the object is to take off the action of the two muscles inserted into 
the little trochanter, which raise the upper end of the fractured bone CLINICAL LECTURES. 
53 
upwards and outwards; which yon will invariably see take place 
after every amputation as high as the middle of the thigh. In 
simple fractures position will do this, and the inclined plane, 
whether by splints or other machinery, will effect it very well; but 
as an inclined plane can be rarely used with advantage in gun-shot 
fractures, the rising end of bone must be kept in its place principally 
by raising the body or by proper and well-directed padding; and 
its inclination outwards must be met by a similar direction of the 
lower part of the limb. The advantages I have alluded to, the 
army never hitherto had, nor any proper splints, nor any thing 
which could be called proper for the treatment of such fractures; 
but they will all, I feel assured, be in future supplied, and you will 
have the opportunity of ascertaining facts upon this point which 
will be of the greatest advantage to mankind. I point out how far 
we have gone before you; it is for you to show by how much you 
can exceed us. 
Aware, from what I have said, of the nature of a gun-shot fracture 
in the arm, you know what you have to expect in the thigh, and 
must endeavour to meet it. First, by the removal of splinters, and 
extraneous bodies. The bone being larger than that of the arm, 
the splinters are often more numerous and larger, upon which 
depends the question of amputation ; but that having been decided 
in the negative, they are to be treated in a similar manner, and the 
splinters, and extraneous bodies must be as far as possible removed. 
It must be borne in mind that they can never (I shall give the 
general rule) be all removed at once, or at the first, or even 
succeeding examinations ; and it follows, that as they cannot come 
away of themselves, except they are small, incisions must be made 
for their removal, and before any quantity of new bone can be 
formed around them. This is a difficult and very interesting point 
of practice, which observation will render more clear to you. It is 
sometimes neglected, from the great thickness of the muscles of the 
thigh, and from the wound having been on the inside, near the 
great vessels, so as to render an incision of sufficient size in some 
degree dangerous. The thickness ot the muscles does not offer a 
sufficient reason for avoiding an incision ; and if the situation of the 
bone on the outside of the thigh be clearly known, a little reflection 
will show that it can be got at easily in that part, if it cannot in 
another. The bone I now show you is the crooked one I have 
alluded to from Albuhera. It has united at an angle, with a deplo- 
rable twist, on account of the wrong position in which the patient 
lay, and from the want of every proper means. That is, however, 
the least part of the evil; for a map can live with a crooked thigh; 
but the new formed bone is also obvious, and in various parts it 
hems in or surrounds several splinters of old bone, which are thin 
and small, although long, and could not get out. They therefore 
kept up an irritation which at last killed the patient at Elvas. The 
best cured fractured thigh I know of from Albuhera is Lord Yentry’s. 
It was broken rather above the middle, but he is lame, and it even 
. — . . * 7_ A 54 
CLINICAL LECTURES. 
now gives him some trouble. The thigh-bone I now show you is 
from Waterloo; it is a much better one, nearly straight, and the 
splinters were nearly all removed ; but it killed the patient never- 
theless. If he had had all the comfort and accommodations he 
would I hope have had by modern appliances, he might have 
recovered. The third thigh-bone I show you has evidently been 
amputated high up. It is one that was cut off after the battle of 
Vitoria. The bones have united by a mass of new formed ossific 
matter, which is hollowed like a scooped out orange rind. There is 
a long splinter of old dead bone locked in by it, and lying across, 
which kept up irritation, and ultimately led to amputation. It 
should have been removed at an early period. Even amputation, 
under these circumstances, does not always give relief, or save life ; 
for, independently of the hazard of this operation high in the thigh, 
to which I have sufficiently alluded, the femur above the injury is 
not always sound. It is suffering from some irritation of its internal 
membrane, and the saw only adds an injury, which causes an 
increase of mischief. The internal membrane dies, and a necrosis 
takes place for several inches upwards, even as high as the small 
trochanter. Here are three specimens of this disease after amputation. 
You see the sawn part quite sharp at its edge, showing that it lost 
its life forthwith, that the absorbents did uot act at all in rounding 
it off, as they do in successful cases. The five or six inches above 
are in the rough worm-eaten state of a sequestrum. It is the old 
bone, which has come out of a new case, formed by the periosteum 
around it. Although this state of evil occurs after gun-shot fractures, 
I am aware that it can also take place after amputation from more 
common causes; and I have therefore warned you against the old 
practice of scraping the periosteum from off the bone at the part 
where you are going to saw it, or of making two or more jags with 
the saw in consequence of its slipping. I have told you that 70 to 
80 seconds is enough of time for cutting off a thigh; but then you 
must know how to do it. Sixteen seconds gain of time to you in 
sawing a bone, may be sixteen months of misery to your patient; 
let time therefore be a secondary consideration. If you think, 
gentlemen, you can saw bones by intuition, you will err; it requires 
practice, like every thing else. If you wish to learn how to saw 
the bones of living men in an artistlike manner, buy a couple of 
broomsticks, and saw them off by inches, under the directions I 
have given for the management of the saw; you will then be qualified 
to try your hands on dead bones, and after that on living ones. 
It is possible to succeed in saving thighs fractured any where 
except at their extremities, by attention to all these things, if you 
have at hand all the necessary appliances of surgery; but if you 
have not, and the sufferer must be kept in a constant state of 
motion and of irritation, you had better cut off his thigh; or, as a 
brave, but unfortunate, French officer said to me at Salamanca— 
pray sir, kill me in any way you please, but do not, in mercy, let 
me die by inches. CLINICAL LECTURES. 
55 
Splints for fractured thighs must be of three kinds, with proper 
pads for all of them, and the material to make the pads should 
accompany them in considerable quantity. 1. Long Dessault 
splints improved. 2. Amesbury’s leg and thigh splints, to be used 
straight for the thigh. 3. Common solid wood and tin splints. 4. 
Ordinary one yard roll-up measures to take the length of the thigh 
and leg from time to time; although, in compound fractures of the 
thigh, extension is of little or no use at any time, and of none after 
the first fortnight or three weeks ; on account of the consolidation, 
and thickening of the soft parts, which after that time do not admit 
of any yielding, although the bones may not be united by ossific 
matter. FIFTH CLINICAL LECTURE. 
ON THE EXCISION OF THE HEAD OF THE THIGH-BONE. 
Delivered January 13th, 1838. 
When the head or neck of the femur have been injured by 
musket balls, the patient has never escaped with life to my know- 
ledge, unless after amputation. He does not die, however, imme- 
diately, but lingers for two, three, or even more months, and at last 
sinks worn out by suffering. The bone I now show you is that I 
removed in my successful amputation at the hip-joint after Waterloo 
at Brussels. The ball struck the neck immediately below the head, 
and went through and out behind; the bone is split nearly perpen- 
dicularly, and is separated from the shaft by a triangular point or 
apex exactly two inches below the small trochanter. The great 
trochanter and the rest of the shaft were not broken. I am not 
sure that, if the head and broken piece had been removed and the 
shaft sawn straight, he might not have recovered; as he can, how- 
ever, walk very well, I suppose he is as well satisfied that he did not 
take the chance. There was one other case at Brussels, in which 
1 wished to do this operation. I urged it on the man, a French 
soldier, for several days, but he refused until finding himself sink- 
ing, when he consented. It was too late; when I gently stated 
this to him, he thanked me, a tear for the moment glistened in his 
eye, he waved his hand once more over his head, and cried out, 
Vive Vempereur. He died a few hours afterwards. 
The bone I now show you is one to which I wish to draw your 
particular attention. The ball entered high up on the thigh near 
the groin, and lodged in the neck of the thigh-bone; it gave rise 
to ulceration of that part, of the head, and of the shaft near it, but it 
did not break or splinter the bone itself; the man however died. 
The removal of the ball alone would not have saved him, but I am 
satisfied the removal of the head and neck of the femur might have 
given him a better chance than he had by doing nothing. 
The third and fourth preparation I now lay before you, show a 
greater degree of mischief, and a larger quantity of new-formed 
bone, indicating that the fracture had extended into the trochanters. 
In the fifth preparation, the fracture is too far below the head and 
neck of the bone to admit of any operation but that of amputation. 
I have been long acquainted with a nobleman, who was sent to 
Lisbon by Mr. Hunter, near fifty years ago, for ulceration of the 
cartilage and head of the thigh-bone, which eventually was drawn 
out of the socket as- the capsular ligament gave way, and has 
formed an attachment with the ilium. The joint is stiff, the leg is CLINICAL LECTURES. 
57 
some three inches shorter, but he walks about on the toes of that 
side with no farther inconvenience than the limp occasions. 
Mr. White, my colleague at this hospital, removed the head and 
neck of the thigh-bone in a young person, by a very simple operation, 
after it had been dislocated by the same disease, because it was 
evidently causing great irritation, instead of forming a false joint as 
in the former case, and would eventually found its way through 
the soft parts. The lad recovered. 
A due consideration of these cases led me to think that if nature 
could, by certain slow processes, arrive at such a happy result, it 
might be possible, in gun-shot fractures of the head and neck of the 
bone, to give her that assistance by art. in effecting a cure which she 
has hitherto seemed unable to obtain without it. This assistance 
is the early removal of the head and neck of the bone by sawing it 
across immediately above the small trochanter in all cases in which 
the nature and extent of the injury will admit of such an operation. 
In the bone I now again show you, and to which I have already 
drawn your particular attention, this might have been done with 
great ease by the surgeon, and I believe with little comparative 
suffering to the patient. 
In order to do this operation with precision, the surgeon must 
make himself well acquainted with the anatomy of the parts by 
dissecting them himself. I have requested the demonstrators of 
anatomy in the school of the hospital, Messrs. Hancock and Hird, to 
prepare two limbs duly injected, to show it to you. One is dissected 
so as to allow every part to be demonstrated and divided in the 
clearest manner. Mr. Hird will have the goodness to divide as I 
name them. Observe, in the first place, two things, the great 
trochanter, and the round head of the bone in its socket, which is 
directly below, and a little internal to the anterior superior spinous 
process of the ilium. When the thigh is bent in the dissected state 
you see it rolling very distinctly; and in order to lay it bare for 
removal, the muscles, &.c. around it must be divided. The first on 
the anterior and outer part is the tensor vaginae femoris; you see 
Mr. Hird now dividing it; outside this the glutasus medius must be 
cut, going to be inserted into the upper and outer part of the top of 
the great trochanter ; deeper and between these two last, you see the 
glutaeus minimus winding forwards to be inserted into the anterior 
portion of the same part. Cut the great glutaeus through backwards 
in a curve, and you see the insertions of four muscles at one part, 
viz. the pit or fossa immediately behind the great trochanter, (I now 
show it to you in the dry bone); these are the pyriformis, the gemelli 
reckoned as one muscle, the obturator exfernus and internus; they 
should all be cut through within half an inch to an inch from their 
insertion. The square muscle you see below them, running lrom 
the ischium to the inter-trochanteric line I now show you is the 
quadratus femoris. It cannot be spared. The thigh-bone now rolls 
in Mr. Hird’s hand easily, and you see the head moving in the 
socket on the back part where the small muscles were divided. He 58 
CLINICAL LECTURES. 
now opens into the joint with the greatest ease at this part, and by 
a little rotation of the knee inwards, the head of the thigh-bone is 
readily dislocated downwards and outwards. The round ligament, 
and the remainder of the capsular ligament, must now be divided, 
keeping the knife close to the bone. You have now every thing 
exposed that I should have wished to remove, and ready for the 
saw, in the particular case I have shown you, and to which I have 
considered this operation so applicable. Let us pause a moment 
before we apply the saw. Two strong muscles are inserted into 
the small trochanter, the iliacus interims and psoas magnus, and I 
am desirous that this insertion should remain unhurt if the fracture 
should not extend below the little trochanter. Tt is not necessary 
to injure them, and they may be of great use afterwards if the 
operation should prove successful. If the neck of the bone is broken 
through, rotating the thigh as I have directed may not assist much 
in dislocating its head; but then, if the separation is complete, the 
separated piece can readily be detached, when the object will be 
easily attained. The sawing is as you see accomplished with the 
greatest ease. The arteries divided are all of small size; they are 
filled with red injection, yet you can scarcely see them, and they 
could not give any trouble, for the wound is so large as to give easy 
access to every part, and to admit of any bleeding vessel being tied 
without any difficulty. The round ligament should be cut off close 
to the socket, and any portion of the capsular ligament which can 
be quickly removed with it, but no time should be lost in trying to 
remove the cartilaginous cavity itself, which will be gradually 
absorbed. The sawn end of the femur should now be brought up 
into the cavity, and kept there if possible with the hope that it may 
become rounded, and adhere by a new-formed ligamentous structure 
in the same manner as the end of the humerus does to the glenoid 
cavity of the scapula, when similarly treated. The edges of the 
wound are then to be brought in apposition, and retained so by two 
or three sutures. The glutaeus magnus slides over the trochanter 
major, having a bursa between them, and this part will not readily 
throw out healthy granulations; I am therefore less solicitous about 
the accuracy of the apposition of the edges at the under part through 
which the discharge will the more easily pass; the outside must 
however be supported by sticking-plaster and a compress to prevent 
any bagging, and to keep all parts in contact. 
Let us now do the operation on the undissected opposite limb. 
The first cut through the skin or integuments and fascita lata should 
be a curved one, beginning just over the inner edge of the tensor 
vaginae fetnoris muscle as you have seen on the other leg, curving 
downwards and outwards, so as to pass across the bone an inch at 
least below the trochanter major ; when it should curve upwards to 
the extent of three inches or more, as the size of the limb may 
require. This first incision should, when complete, divide in addition 
to the integuments, the fascia lata, the tensor vaginae femoris, the 
glutaeus medius and minimus, and the great gluteeus muscle. The CLINICAL LECTURES. 
59 
flap thus formed must be raised or turned up by an assistant to 
enable yon to get at and divide the parts below in the order I have 
named them before. You are not to stop to tie any bleeding vessel 
until the operation is finished, and little or no blood will be lost. 
Let us pause again. You have just done one half the operation 
as to cutting, for removing the whole limb at the joint: and if you 
should now find that the bone is so much shattered in the shaft, 
that you cannot hope to save the limb, there is no difficulty in 
removing it. Place your long knife inside the bone, with the middle 
of its edge resting against the outer edge of the iliacus and psoas 
muscles, and at one firm cut of a strong hand let it cut its way 
inwards, forming an inner flap ; your assistant steadily compressing 
the femoral artery against the bone above. The femoral artery and 
its great profunda will both be divided: you seize them with the 
finger and thumb of your left hand, and place a ligature, or assist 
in placing one on each branch with your right; or, if the trunk of 
the profunda should have been cut very short, you may tie the main 
trunk of the femoral. Let your ligature be a single thread of strong 
dentist’s silk, with which I have successfully tied the common iliac, 
and you need not be afraid of its not holding fast, if you tie it 
reasonably tight. The idea usually entertained, that a great artery 
cannot be closed by the ordinary process of nature under a ligature, 
if a branch is given off near it, is, I believe, erroneous. 1 never 
placed reliance on this opinion, and I now show you the common 
iliac artery of one of the two cases in which I tied it successfully, 
the patient dying a year afterwards, and you may see it is tied about 
an inch from the aorta, and was pervious on each side of the 
ligature, which has closed the vessel to no greater extent than its 
own width, proving all the facts I have mentioned to you so 
frequently on this subject. As to the smaller vessels, they will give 
you no trouble, being easily commanded, each by the point ol a 
finger. 
I have not done this operation on a living man, but yon must do 
it, and I am sure you will in the end succeed. You ought not to 
be allowed to take out a limb at the hip-joint, unless the head and 
neck of the thigh-bone are injured; and you ought not to take it out 
if they are, unless the shaft of the thigh-bone is irreparably impli- 
cated also. In all such cases the inspector-general should see the 
bones, as well as have the other particulars of the case. I give, 
gentlemen, the experience of former times, matured by the practice 
of twenty years in this hospital, and by a due consideration of all 
that has been done by my contemporaries. It is for you to surpass 
us, to show that surgery is never stationary, and to prove that it is 
as much a science as an art. 
The fifth portion of the femur, or that which forms its lower end 
and condyles, entering into the composition of the knee-joint, is the 
least amenable to surgical treatment. In the present state of our 
knowledge, and after "the trials which have been already made in 
vain, I do not recommend the excision of the knee-joint, and ampu- 60 
CLINICAL LECTURES. 
tation is then the sole resource, in cases which are incurable by 
ordinary means. I have endeavoured to bring under your observation 
those cases which generally require amputation when the knee-joint 
is injured, and those in which an attempt ought to be made to save 
the limb. See page 379, et seq. of my work on gun-shot wounds, 
to which I must refer. The lower part of the femur, just above the 
condyles, admits of a particular injury, from its softness, which 
does not occur at any other part. A ball may pass directly through, 
without causing any other injury, or scarcely any longitudinal 
fracture; so that the sufferer walks after it as if the bone had not 
been broken. Captain St. Pol, of the fusiliers, was wounded in 
this manner by a musket-ball at the foot of the great bread], on the 
night of the assault of Badajos. You will find his case, terminating 
in death, page 237 of my work on wounded arteries, to which I 
refer you. The ball struck him in the ham, passed through the 
thigh-bone in the middle, just above and between the condyles, and 
fell into the cavity of the joint, from whence it was removed. The 
hole in the bone was only large enough to allow the ball to pass 
through, and a small fissure extended upwards from it for above 
three inches. He died from mortification, the popliteal artery 
having been also divided. 1 fear he lost his life from excess of 
kindness: for the surgeons of his regiment were much attached to 
him, and I knew him very well, and yielded to their solicitations to 
try and save his limb, or at least give him a chance for a secondary 
amputation. They did this against their better judgment, and so 
did I. It was the last case in the Peninsula in which I did not 
insist on immediate amputation, on the occurrence of gangrene 
after a wounded artery, although I admit it was not the last in the 
army, and that one even of a similar nature occurred at Toulouse, 
but against my express orders. His Majesty Louis Philipe, king of 
the French, when he was in England, during the French revolution, 
studied mathematics it is said, with great success, and taught them 
in a very satisfactory manner. Continual occupation in squaring a 
circle, however, could not but be onerous ; it was “ toujours perdrix 
and his majesty relaxed a little occasionally in other less severe 
studies of nature, his capabilities in which, and in calculating 
nativities, were soon exemplified, it is said, by the appearance of 
poor St. Pol. I do not know whether he was like him, but he was 
a very handsome, agreeable young man, who conducted himself 
always like a gentleman and a soldier, and died much lamented. 
On the subject of fractures of the leg I must refer you once more 
to my work on wounds, begging you to recollect that all I have said 
in these lectures with reference to the arm applies as much in all 
practical points of surgery to the leg. The bones are equally exposed, 
the vessels are equally at command and under control; and a man 
should hazard a great deal before he should lose his leg, if he has a 
good constitution. I do not say to you that you should never 
amputate a man’s leg on account of a musket-shot, which fractures 
the bones, injures the arteries, and does other mischief; but l do say CLINICAL LECTURES. 
61 
that it is a very great extent of mischief alone that authorises such 
a proceeding. You must read the passages I have written on this 
subject, and from page 257 to 261 in my work on wounded arteries, 
and operate as directed from page 384 to 388. I am aware that 
these things are but little taught in London, or, if they are taught, 
they are little attended to; but they are essential, and every man 
ought to know them, and he who does not is not qualified to hold 
her majesty’s commission in the public service of the country. 
When I say these things are little attended to, I do so from finding 
it to be the fact in the examinations at the College of Surgeons.. 
One of the last men I examined on these points was himself what 
is called a grinder, viz., a gentleman who crams others for the 
examiners, as old wives in the country do turkeys before Christmas 
for the cockneys. He knew little about the matter; but as 1 am 
always particularly lenient upon any point which I consider pecu- 
liarly my own, I let him examine me, instead of my examining him. 
It did just as well, and I dare say he will remember it longer. 
When balls impinge with sufficient force to stick in a bone 
without splitting it, or go directly through, a great deal more 
attention should be paid to them than was generally given during 
the Peninsular war. This is one of the weak points on which we 
wanted another campaign in the south of France to perfect us ; and 
it is therefore one to which you, gentlemen, if there should be, and 
when there shall be, another war, must attend to particularly. They 
should always be removed if possible; certainly so if the approach 
to them does not cause more danger than leaving the ball to the 
operations of nature. I have known balls stick in bones, and 
become covered up, and give no trouble; but I have very, very 
much more frequently seen the reverse. When a surgeon is 
acquainted with the anatomy of the parts, he is not afraid of making 
an incision of a sufficient size to enable him to feel, and perhaps to 
see the ball. If it is deeply imbedded, a trephine must be applied 
over it of such size as will include a common ball a little flattened. 
Where it sticks without being imbedded, a small chisel, straight or 
curved at the end, or a hook used as a lever, may often be got under 
it; but the judgment and ingenuity of the surgeon must be exercised 
on such occasions. Suppose a man to have received a ball, which 
sticks in the outside of the lower end of the femur above the joint: 
is it better to leave this to the efforts of nature, or to take it out? If 
left alone, the man will, in all probability, have an open wound for 
years, suffer much occasional pain, have an abscess formed now and 
then, and always have a reminding monitor of his wound along 
with him. If a sufficient incision, on the contrary, be made at first, 
on the day he receives the shot, through the vastus externus, down 
to the bone, and extending upwards far enough so as to allow it to 
be seen, whilst the parts are not adhering, and will separate easily, 
the trephine may be applied without difficulty, or the ball may be 
elevated and removed. The bone will not be diseased, and will 
in general recover from the injury without difficulty, and any 62 
CLINICAL LECTURES. 
apparently splintered or injured parts may be at once removed. 
The man will soon get well, and be less lame than if no operation 
had been dope. 
Suppose the ball had struck the pelvis, or hip, just above the 
acetabulum, and sticks—what ought to be done? Make an incision 
upwards and outwards, not inwards, and of sufficient length to 
enable you to feel it easily, if not to see it. You must then remove 
it by similar processes, recollecting the thickness of the bones of the 
pelvis, and where they are too thin for much use of the trephine. Of 
balls sticking in the bones of the cranium we shall speak in our 
next lecture. 
I cannot conclude this subject of injured bone without drawing 
your attention to three cases now in the hospital, two under Mr. 
White’s care, one under mine. The first was a bad case of ulcer- 
ation of the tibia, which had gone on for three years, and seemed 
likely to go on for ever, unless some more vigorous mode of treatment 
was had recourse to than had hitherto been adopted. Mr. White 
applied one part of the chloride of zinc, mixed with two parts of the 
sulphate of lime, made into a paste with water. The diseased bone 
was in part destroyed by this caustic, and a thick scale, the size of 
the paste, was separated, and came off. The first application was 
made on the 14th of October, and a second was had recourse to on 
the 7th of November, with the same effect, the scale of bone 
separating in fifteen days. The ulcer is nearly healed, and the man 
is almost well. In the second case, the tibia had been diseased for 
31 years ; the mischief was so great that the man begged to have 
his leg cut off. The repeated application of this remedy has been 
so effectual as to leave no doubt in my mind of its great utility in 
similar but less extensive injuries, for although it has rendered him 
a very essential service, I am not quite certain it will be able to effect 
cure, nevertheless,it will prevent, I have no doubt, the necessity for 
amputation. In the third case, which is that of a woman, the injury 
of recent date, and I have applied it solely for the purpose of causing 
the separation of a thicker scale of bone than is exfoliated by the 
unassisted operation of nature, and I recommend it to your attention 
in cases of ulceration of bone, commonly called caries, as one from 
which you will find the greatest advantage. SIXTH CLINICAL LECTURE. 
ON EXCISION OF THE ELBOW-JOINT. 
Delivered February 10, 183S. 
I have pointed out to you so distinctly the manner of excising 
the head of the humerus, that I do not think it necessary to notice 
it here. The excision of the elbow-joint I think it right to demon- 
strate, and to describe to you more clearly, so that you may find 
no difficulty in doing it. 
The cases which require this operation are those in which the 
articulating ends of the humerus, radius and ulna, are wholly or in 
part so much injured, that little or no hope remains of a successful 
result. These cases have been usually submitted to amputation, 
on account of serious injuries of joints being rarely cured. The 
object of excision is to save the fore-arm, or at least to give the 
patient a chance of doing so; and the situation of the shot-hole or 
holes does not signify much as to the manner of operating. The 
principal point regulating the proceeding is to preserve the nerves 
entire; and the most important one likely to be injured is the ulnar. 
To avoid this, which lies between the olecranon and the internal 
condyle, but nearer to the inner condyle to which it may be con- 
sidered to be affixed in passing by ; a common straight, but strong 
pointed knife is to be pushed into the joint, immediately above and 
close to the olecranon process, exactly at its inner edge, near to, 
but at a safe distance from the ulnar nerve. The incision, thus 
begun, is to be carried outwardly to the external part of the 
humerus, dividing thereby the tendinous insertion of the triceps. 
From the end of this transverse incision a cut is to be made per- 
pendicularly upwards and downwards, about an inch and a half 
each way, and the same is to be done at the other end of the 
transverse cut. The whole will now resemble the letter H, and the 
two flaps thus formed must be turned up and down. The olecranon 
may now be readily sawn oft’, with the great sigmoid cavity of the 
ulna, and the coronoid process, which must be separated from its 
connection with the brachialis internus muscle which is inserted 
into it. Before this is done the ulnar nerve must be carefully 
separated from its attachments and turned aside that it may not be 
injured. This exposes the joint effectually ; and the head of the 
radius may now be cut through by the saw, or large scissors in 
cases of old standing disease, and separated from the lateral liga- 64 
CLINICAL LECTURES. 
ment and the humerus, care being taken not to cut, if possible, the 
insertion of the biceps into its tubercle. The articulating extremity 
of the humerus ought now to be pushed through the wound, and 
the broken end sawn off or removed, so as to leave it quite smooth. 
The brachial artery and median nerve are out of all reasonable 
distance for injury, and to prevent the possibility of its occurrence, 
a knife or a spatula may be placed underneath, close to the bone 
and quite across, before the saw is applied ; and any vessel which 
bleeds freely may be tied, although it is probable the hemorrhage 
will cease on the application of cold water. The articulating 
cartilaginous broken ends of the bones having been thus removed, 
and the hemorrhage having ceased, the fore-arm is to be bent, and 
the ends of the radius and ulna are to be brought in apposition 
with the extremity of the humerus. The incisions are to be brought 
together by stitches and sticking-plaster, duly supported by com- 
press and bandage. Mr. Syrne, who has paid great attention to, 
and has earnestly recommended this operation, strongly advises 
that strict attention should be paid to procure union, if possible, of 
the transverse incision, just above the olecranon ; for a broad 
cicatrix interferes with the motion of the joint, a reasonable degree 
of which is always to be expected in a successful case. The arm 
should be duly supported by a proper sling. As the shot-holes 
must remain open, any discharge of blood or serum which takes 
place will readily pass through them. The first dressing should 
be early changed, and the incisions kept in due apposition, so as to 
offer every chance of union; but 1 do not think this of so much 
importance as has been attached to it. Passive motion should be 
early given to the parts, so as to favour the formation of a false 
joint; but this should be carefully and moderately done, lest too 
much excitement should take place, and a new inflammation be 
excited. A fixed or stiff joint is not to be desired, but if it cannot 
be avoided, it must be procured with the fore-arm at a right angle 
with the arm, when it will be most serviceable. The patient is 
best placed on his face on a bed or a table, which renders the steps 
of the operation more convenient to the operator; you must also 
recollect that when the bones are diseased from inflammation 
of any kind, they become soft and are readily cut with the 
strong scissors, but when they are sound, as in cases of gun- 
shot wounds requiring this operation, they retain their natural 
hardness. 
At San Antonio de Tojal, a circumstance occurred which it will 
be useful for those to know who may serve in hot countries. A 
soldier had suffered from bleeding for several days, in considerable 
quantity, from the mouth, which was perpetual; some was spit out 
with a little cough, some was swallowed, and neither medicine nor 
treatment seemed to have any effect upon him. He became greatly 
emaciated, and his death appeared to be inevitably at hand, although 
I could not discover any particular disease about him. On visit- 65 
CLINICAL LECTURES. 
ing the hospital early in the morning, I enquired if he was dead, 
and was astonished at being told he had been quite well for two 
hours, and intended to live, for that he had coughed up a leech, 
which there could be no doubt was the cause of the bleeding, inas- 
much as it had ceased from that moment. The man rapidly re- 
covered. I was quite aware that in warm countries, in which 
leeches prevail, they are readily taken up by men and horses in 
drinking out of puddles, as thirsty animals, whether bipeds or 
quadrupeds, will constantly do. They are usually what are called 
horse-leeches, or of that kind which hold on and suck at one end 
and discharge the blood at the other; but they commonly stick 
about the lips, mouth, and throat, both in men and horses, from 
whence they are readily removed by the fingers or forceps. When 
they get above or behind the palate, they are still usually discovered 
with a little trouble; and when they could not, 1 never before or 
afterwards found much difficulty in dislodging them with strong 
salt and water injected through the nose, which, by its own virtue, 
and that of vomiting, had the desired effect. Whether this leech 
was in that place or not I do not know, but it certainly did all but 
kill the man. 
Dr. Robb gave me the particulars of a case, which was after- 
wards confirmed by Mr. Maling, who said he saw it, which occurred 
in the light division, and nearly killed a man, who had been drink- 
ing out of a puddle, or out of a canteen filled from one, in a more 
extraordinary manner. The man declared he felt something move 
in his stomach the instant he had drunk, and from that moment 
his torments were unceasing, both from pain and from the alarm 
he felt at distinctly perceiving something trotting up and down his 
stomach. The man became pale, wan and miserable, and would 
have died, in spite of all the means employed for his relief, if he 
had not one day, at the end of about three weeks, vomited up a 
living animal, the cause of all his misery. The case is so well 
attested by the medical officers, who saw the animal before it died, 
that it cannot be disputed. They say it had four feet and a long 
tail, and called it a salamander, I presume from no medicine having 
any effect upon it, rather than from its really deserving that name. 
It was so large that it nearly choked the man in coming up, so that 
he was quite satisfied it had grown considerably after he had 
swallowed it, and it was admitted by all who saw it that if it had 
not, it could not have been swallowed without as much difficulty 
as was experienced in bringing it up. 
I have already alluded to a little adventure we had on the road 
to Oporto, when we marched all night to surprise the French at 
Albergaria Nova. This we did, and I got some of the breakfast 
which was preparing for them; but we did not on the whole dis- 
tinguish ourselves much after daylight. The wounded at this 
place, and at Grijon, passed under my observation, but gave nothing 
of importance; and I was not so fortunate as to gain much at the 
taking of Oporto, in professional information. We rather, if any 66 
CLINICAL LECTURES. 
thing, retrograded. The French had collected all the boats on their, 
the nothern side of the river, and apparently considered them so 
secure, as not to think it necessary to place a sufficient guard over 
them. The consequence was, that soon after the British troops 
reached the southern bank of the Douro in Villa Nova, the suburb 
opposite Oporto, one boat was loosened and brought over. The 
soldiers immediately embarked, crossed, and brought back others, 
amidst the shouts and vivas of the natives. Sir J. Sherbrooke 
soon followed, with the whole 29th regiment; and the Portuguese 
boatmen having procured more boats, ferried me over with my 
horse. The alarm was perfect. The French, who appear not to 
have suspected such an accident, fled, leaving horses, mules, and 
baggage in all directions; every one took to his heels, and no one 
thought he could get to Oporto fast enough. 
The inhabitants seemed afraid to touch any thing themselves, 
but called out to us to seize every horse and baggage-mule we saw 
as French. Being the only officer on horseback, I could ride about 
and take my choice of lots of loaded horses and mules, but I was 
much too proud to take possession of three or four mules with 
their baggage. It was not yet considered officer-like to deal in 
baggage, and so I occupied my time looking for some riding horses, 
until I lost the British, and was overtaken by Sir J. Milley Doyle 
at the head of the 16th Portuguese, looking for the English. I 
offered to show him the way, as they were only a little before us, 
and placed myself by his side at the head of his regiment. On 
turning a corner, I showed him the 29th Grenadiers, drawn up in 
line on the rising ground at the end of the road. They as soon 
perceived us, and after a minute or two, I saw Sir J. Sherbrooke 
himself face the Grenadier company towards us, and to my asto- 
nishment, they very quietly made ready as if on parade. Sir John 
and the Portuguese called out it was all over with them, and I 
thought so myself, for, knowing the old grenadiers very well, I took 
it for granted we were as good as dead. We were too far off to be 
heard in time, yet close enough to be shot, and it was quite plain 
they took us for French. I bethought me 1 had a red round jacket 
on under my blue undress coat, and as little time was to be lost, I 
stood up in my stirrups, and opened the blue coat as wide as possi- 
ble, that none of the red one should be lost. The grenadiers at this 
moment came to the present; I thought we were gone; when in 
an instant I saw them irregularly changing to the recover; they 
knew me, and had called out the doctor and the Portuguese. I 
never was so delighted in my life; and galloped up to them forth- 
with. Sir J. Sherbrooke saluted me with, by God, sir, if you had 
not shown that red jacket, I would have sent you all in a second 
more to the devil. I knew Sir John very well, and hoped at all 
events he would have let us gone elsewhere, but he would not hear 
of it. No, sir, said he, I would have sent you to the devil; you 
should have gone there and no where else; and as it was well 
known that Sir John would always do what he said, as far as CLINICAL LECTURES. 
67 
depended on him, there was nothing to be done, but submit. From 
that day the Portuguese never went into action that I saw without 
a white band round the left arm. Shortly after this I accompanied 
the light troops to the front, and had a little skirmish with the 
French runaways, who were making their escape from the end of 
every street. Some of them brought out a gun, but on seeing us, 
and that the road was occupied, as it turned in front of us, 
they dismounted, and left the gun and the four mules that drew it. 
This I went to the left and seized, but what to do with a gun and 
four mules I did not know, more particularly after my failure in 
horse-stealing; so I settled the matter by taking possession of the 
best mule, which I carried off, and it served me very faithfully 
through the Talavera campaign. 
Sir John Sherbrooke was a good-hearted man, although rather 
irascible, and was always willing to do a kind action. If the severity 
of physic and surgery would admit of a little descriptive episode, 
I would give you the appearance of the convents of Alisbaca and 
Batalha when first we saw them. It is better, however, to refer 
you to Mr. Beckford’s book on Portugal, which is quite as charac- 
teristic as it is beautiful. He must have been a gastronome by his 
unbounded admiration of the kitchen at It was, however, 
a good one, and the live fish did swim about in troughs, placed 
from one end to the other on the middle of the table, through 
which the river water constantly flowed; and the gardens were 
beautiful in the extreme. The padre guardien and the monks were 
always hospitable. They were obliged in those days by their 
charter to give a dinner and lodging to every traveller who passed 
and asked it, and about three half pence on parting in the morning, 
and they received us with open arms on all occasions. The dinner 
was most joyous, the monarch and people of the respective nations 
were drunk with enthusiasm. I think I now see the jolly old fellows 
answering to our three times three with a thousand vivas; but 
they were not all old, and the young ones liked wine. On one 
occasion, when Sir J. Sherbrooke dined with them, one of the 
younger ones was also successful in making love ; for the English 
ladies who accompanied the soldiers were not fastidious, and one 
of them could not resist the solicitations of the handsome monk. 
He was caught by the soldiers in a situation unhappily for him pas 
douteuse. They immediately placed him on one shutter and the 
lady on another, and marched them joyously round the cloisters, 
to the great amusement of the populace assembled at the convent 
to see the British. The next morning he had disappeared; his 
trial and punishment were summary; he had been sentenced to a 
slow death on bread and water, in a small stone cell, from which 
he was never to be withdrawn alive. The entreaties of Sir J. 
Sherbrooke prevailed not. The superior honestly admitted, that he 
would have forgiven the offence at the pressing entreaty of the 
English general, if it had not been so publicly manifested; but that 
the character of the order was at stake, and it must be as publicly 68 
CLINICAL LECTURES. 
known that the punishment had been exemplary. Sir John kept 
up a correspondence with the padre, and after the battle of Talavera, 
the old gentlman wrote to congratulate him, in more than the usual 
complimentary terms of the nation. He assured him that he and 
his order, as well as all Portugal, owed every thing to his gallantry, 
and that they must ever bless the day that brought him to Alcobaca. 
Sir John Sherbrooke, with the characteristic feeling of an English 
gentleman, took him at his word, and wrote him back that he 
placed such implicit reliance on all he had said as to his feelings 
towards him, that he could not refrain in reply from asking him fot 
the pardon of the young offending monk as the only, and, at the 
same time, the greatest favour he could do him. Sir John Sher- 
brooke, when he told me this story, declared he had felt that day 
to be one of the happiest of his life, when he received a letter from 
the superior, enclosing one from the young man, thanking him for 
his life, and stating the horrible imprisonment he had undergone, 
and the utter destitution of hope in which he lay, when Sir John’s 
interference and his pardon were announced to him. SEVENTH LECTURE. 
ON THE DISEASES OF THE PENINSULA, TO WHICH THE BRITISH 
TROOPS WERE EXPOSED IN 1811 AND 1812. 
The war in Canada being likely to be brought to a happy ter- 
mination, I need not trouble myself for the present with the remain- 
ing lectures on the injuries of the head, of the chest, and of the 
abdomen, which will, with what I have already written, complete 
the object I have in view,—of leaving you a record of the practice of 
the surgery of the Peninsular war. 
The following document relates to the diseases of a portion of 
time of that period, and may be useful to future generals and 
inspectors of hospitals yet unborn ; embracing, as it does, several 
questions of great interest relating to the health and welfare of an 
army, which are so obvious as to require no comment from me. 
The Duke of Wellington, in the general orders of that army, and 
in his dispatches published by Col. Gurwood, has shown a strong 
preference for general hospitals, amounting almost to a prohibition 
of regimental, or brigade, or divisional hospitals ; and has called 
the attention of general officers on more than one occasion to the 
disobedience of his officers on the subject. His grace mentions in 
other places the extreme difficulty he had to make officers of all 
ranks obey orders on any subject, each being pleased to think for 
himself upon all; so that it was not the doctors alone that incurred 
his displeasure. I am one of those who have reason to be grateful 
to his grace for the good opinion he has expressed of me in his 
dispatches; nevertheless this good opinion was gained by having 
always (at least whenever I could) acted in disobedience to the 
letter, but I believe not the spirit of his grace’s orders on this point, 
as the document fully shows. 1 do not presume to question the 
propriety of his grace’s decisions, but I shall take the liberty of 
enquiring into the grounds of my own disobedience. 
The paper refers to the period from or about which Dr. Frank 
left the medical superintendence of the army, until shortly after its 
assumption at head-quarters at Freneda by Sir James MlGrigor. 
The medical department was during this period in charge of two 
gentlemen in succession; as worthy, honourable, and good men as 
ever lived. They were, however, like several of those military 
officers the duke has alluded to, fit for any ordinary affairs, but quite 
unequal to such extraordinary duty as that in the Peninsula. The 
consequence was that every body did as he pleased. 
The question, however, may be justly divided into two parts;, 
one of necessity, the other of choice. The general commanding • 
can alone decide upon the first, and he may not always choose to 70 
CLINICAL LECTURES. 
give his reasons at the moment. If he is in a situation, for instance, 
in the Alentejo, south of the Tagus, which he knows he intends to 
leave for the country north of that river, and at a considerable dis- 
tance, he may not choose to encumber the troops on marching 
with a number of sick, or to leave the country studded with small 
detachments of them, to misbehave or act as they please. The 
establishment of regimental or brigade hospitals are under such cir- 
cumstances forbidden for more than temporary purposes, or for 
those whose illnesses are not likely to last more than three or four 
days ; the others he sends to the rear, by his return food and forage 
mules, their conveyance thus costing nothing. If the enemy are 
in such strength, and so near as to render an attack, or even a 
retreat, likely or possible, there ought to be no such things as per- 
manent regimental hospitals ; but upon these, and other matters of a 
similar nature, the general commanding can alone judge. Let us 
now suppose, what was a matter of fact at the period to which the 
paper relates, that the army was in cantonments for the greater part 
of the time between the Agueda and the Coa, a small French garri- 
son being in Ciudad Rodrigo, and the bulk of their army at or 
beyond Salamanca. There being no reason, then, to fear a sudden 
attack, and nothing to prevent the formation of temporary regimental 
hospitals for a limited number of men, the only point to be enquired 
into, is, whether it was better for the sick and for the strength of 
the army, that they should be kept with their regiments, or sent to 
the rear? The general hospital for the army at this time was at 
Celorico, from whence some were sent to Viseu, and others to 
Coimbra, from which place they returned very slowly, and some- 
times never came back at all. The inconvenience of sending a 
thousand sick men some forty miles is not great, and they can 
readily come back when well: but when the one thousand becomes 
several thousands, and the first station cannot receive them until 
the preceding sick are removed farther back, the inconvenience 
multiplies in many ways. The advantages of a regimental hospital 
are, that persons who are only slightly ill get well in a few days 
without leaving their regiments; that when they are suddenly 
attacked by serious diseases, they are well attended to from the 
first, and their lives may be saved, although the convalescence may 
be long. 
The disadvantages of a general hospital are, that the sick arrive 
in bad condition, frequently unawares, and when there is no 
accommodation for them; and they suffer accordingly. The 
medical officers generally have no particular interest in any of 
them, know little of the duties, the wants, or the tricks of the soldier, 
and cannot take the same care of them. The town of Celorico 
was a miserable place for a general hospital; although, perhaps, the 
best which could be selected ; and with all the care which could be 
bestowed upon it, it was in my opinion so bad a place, that I 
always considered it an equal chance whether a really sick man 
ever came out of it again or not. The advantages of keeping the 
sick with the regiments at this period were so great, as to be irre- CLINICAL LECTURES. 
71 
sistible ; and I have no hesitation in expressing my opinion, that if 
the regiments I have referred to had not been treated in this 
manner, very few men would have kept the field. A curious proof 
of this was given before a committee of the house of commons. A 
serjeant of the 40th was adduced as an instance of a cure performed 
on a soldier from Spain, who had been rendered useless by the 
Egyptian ophthalmia. He stated that he left the camp near Torre 
del Mauro at the commencement of the period I have noticed ; that 
the general doctor was a hard-hearted man, who would not let other 
poor fellows similarly afflicted go to the rear, and only allowed him 
to go in the place of another non-commissioned officer. I happened 
to be present and heard the story, acknowledged myself to be the 
hard-hearted doctor, and proved to the satisfaction of the committee, 
by the testimony of the general of the divisioti and the surgeon of 
his regiment, that he had only a common inflammation of his eyes, 
that the others all recovered, and that he was the only man who 
had contrived to get away. If I had allowed the others to follow 
him, few would have remained in the field under privations in bad 
weather; and it would have been just the same with other 
complaints. 
My accumulation of sick at last, however, got me into a scrape. 
In February the adjutant-general sent for me to know why I had 
so many sick and wounded, and what I meant to do with them. 
I told him that they were much better with me than at Celorico, 
provided they were not in danger from the enemy ; and he allowed 
me to keep them on my own responsibility for moving them when 
the order for the march to Badajoz should arrive. To do this 
when the order came, I was obliged to give the division in charge 
to the senior regimental surgeon, and to go myself with the last of 
my worst cases to Celorico, in order that I might ensure attention 
to them. I had several days previously warned the principal 
medical officer at that station of the number he had to provide for ; 
but the other divisions had sent their sick before I arrived with the 
last of mine, and there was no room, and less disposition to meet a 
difficulty. My sick were also very ill, and seventeen died in the 
first two days, which was not more than I expected. It sufficed, 
however, for a report which Sir James M'Grigor had received upon 
the back of another, that one of the regiments of my division had 
got the itch, that there was no staff surgeon, and no itch ointment. 
The colonel had reported to the brigadier; he had done the same 
to the general commanding the division ; the general to the com- 
mander of the forces; who signified his displeasure to Sir James 
M‘Grigor, who had to send post to Abrantes and elsewhere for itch 
ointment, in which the regiment rejoiced for three days, having 
halted accordingly. I arrived at Elvas, having laboured and 
traveled as hard again as any body else, just as those gentlemen 
had got fairly out of the itch. You may conceive my astonishment 
when I heard of it, and of the absurdity of the whole affair. I 
bethought me with great regret of the curry-combing I would have 
given them, if they had ventured to have had the itch until it was 72 
CLINICAL LECTURES. 
convenient to me to cure them, if I had been with them. The 
seventeen dead men, in addition to this, was too much ; Sir James 
M'Grigor, whom I had seen but twice in my life before, and hardly 
therefore knew, told me very formally I was the worst officer he 
had, that I was totally unworthy of any trust, and must be sent to 
the rear, where I could do no more mischief. It happened luckily 
for me that there was nobody at hand to put in my place, and I 
was therefore, after due deliberation, informed, that as there was a 
senior at the siege of Badajoz, which had just commenced, I might 
go there, and try to do my duty better. When I arrived in the 
camp, those of the medical officers who had worked with me at the 
two previous sieges of Badajoz and Albuhera, at the affairs of 
Elboden and Saca Parte, and who knew I had lately done half the 
duty of the siege of Ciudad Rodrigo, instead of a quarter, because 
no one else would do it; and had nearly killed them as well as 
myself by pure hard work, during the previous year, fairly laughed 
at me. The assault of Badajoz followed; my division suffered 
most, we lost 1200 men, including the general commanding, Sir C. 
Colville, who was seriously wounded in the thigh. The doctors 
worked this time, however, in a manner that Sir James MGrigor 
was pleased to acknowledge ; and to say that he believed he and I 
must be friends. I was very glad to accept the offer, although I 
knew I had not merited the reproof. I told him I was happy to 
have so far gained his approbation, which I would beg leave to set 
off against the itch ; but that as to the seventeen dead men, I could 
not feel myself at ease until he had the fullest explanation on that 
subject also. The remarks that follow were that explanation ; they 
were forwarded to him the May following from St. Joao de Pes- 
quiera, on the Douro. The return I have already published in my 
first work, will show that regimental hospitals were at least ap- 
proved of by him as much as by me. 
The diseases of Spain and Portugal, on the southern and western 
frontier, in summer and autumn, very much resemble those of hot 
climates in general, and the nearer the approach to the south, the 
greater is the similarity; so much so, that I have frequently seen 
fevers at Gibraltar, Cadiz, and in the plains of the Guadiana, in 
every respect agreeing with the description given of the bilious, 
remittent, and yellow fevers of the West Indies and of the American 
States. As sudden and violent in their attack, as rapid in their pro- 
gress, running the same train of symptoms, and leaving frequently 
the same results. 
The difference of heat between the plains of Castile and of Estre- 
madura is not very great: in the hot months of July, August, and 
September, the rivers and tracks of torrents from the neighbouring 
mountains are nearly dry; and they run generally in valleys or 
low grounds, which were marshes in winter and spring, and afford, 
in the hot and dry months, a large decomposition of vegetable 
matter, which is greatly assisted by the violent, heat of the day and 
the great dews by night. The extreme heat also predisposes much 73 
CLINICAL LECTURES. 
to disease; of which the natives are so much aware, that they 
always, if possible, avoid exposing themselves to a mid-day sun ; 
from whence arises their custom of dining at twelve, and taking 
their siesta, or sleeping for three or four hours afterwards, if their 
circumstances will permit; or they employ that time in various 
household concerns within doors. The British troops, on the con- 
trary, never take the slightest precaution of the kind, or shelter 
themselves from the heat in their private occupations, and the 
necessities of a military life frequently demand their exposure ; 
they, therefore, sutFer much from the diseases prevalent in the 
country, or naturally predominating with the season of the year. 
In the wet and cold months of March and April, in the provinces 
of Portugal and of the western part of Spain, north of the Tagus, 
the obvious diseases are, synochus, inflammatory affections of the 
chest and limbs, and intermittent fevers, for the most part amongst 
those who had suffered in the autumn. These continue with the 
warmer weather of May; but in June, July, August, and Septem- 
ber, the diseases more peculiar to warm climates show themselves 
with the excessive heat. The attack is more sudden, the excite- 
ment greater, and the determination to the head frequently exces- 
sive in the latter months. The effects of heat are combined with 
those of marsh effluvia, the fevers are remittent and intermittent: 
in many, the excitement, which is at first great, is soon, however, 
followed by extreme debility, general yellowishness of skin, exces- 
sive irritability of the stomach, great discharges of vitiated bilious 
matters, petechioe, glassy appearance of the eyes, dilatation of the 
pupil, coma, and death in a very few days : but this aggravation of 
disease is infrequent, or runs a longer course to the north of the 
Tagus. The patient slowly recovers; has probably a paroxysm 
of intermittent from time to time, or only an occasional febrile 
uneasiness ; does not recover the natural complexion, and, even 
when there is every appearance of convalescence, the least exertion 
will cause a relapse. In general, recovery is very protracted: fre- 
quently, after an interval of three and four weeks, the relapse 
would be sudden, and carry off the patient in a few hours; and in 
some instances the malady has been supposed to be apoplectic, yet 
the appearances on dissection did not warrant this conclusion. 
Dysentery, which in particular constitutions is also supposed to 
arise from heat and marsh miasma, is not a formidable disease 
during the summer months, and even in the first weeks of October, 
after the commencement of the occasional rains, nor until the month 
of November, when, with the cold and damp weather, the atiendant 
fever has become typhoid, with great debility: it is then exceedingly 
dangerous, inasmuch as the means of cure, so successfully employed 
when the fever is simple, continued, or even remittent, are contra- 
indicated by the extreme debility experienced in the cases of typhus 
not suffering a decided treatment to be enforced. The relief of the 
febrile symptoms, or means employed to obviate death from debility, 
frequently assisting in establishing a chronic state of dysentery, 
that eventually carries off the patient. 74 
CLINICAL LECTURES. 
The fever, in the greater part of the admissions in the different 
regiments of the division, in the months of November, December, 
and January, was typhus mitior or gravior, depending much on 
the constitution of the patient. In the recruits and relapsed cases 
it was always the latter, and where the interval, or state of conva- 
lescence had been unfavourable, was generally unfortunate. In 
the month of February, with the return of spring, some inflamma- 
tory affections of the chest appeared, but in certain constitutions 
the fever soon became typhoid, and the event fatal. 
The officers during this period suffered equally with the men, 
particularly from June to Christmas. Intermittent and remittent 
fevers, in the worst forms, were observed in several, and consider- 
able subsequent derangement of the abdominal viscera; but, as they 
were all young men, generally of good constitutions, had the 
means of procuring good clothing, sufficiency of food, and shelter 
from the inclemency of the weather, during the siege of Ciudad 
Rodrigo; and in the subsequent month of January, few suffered 
from typhus, and none died. 
The mortality amongst the inhabitants of the different villages, 
in the period alluded to, was greater than that of the troops, espe- 
cially in the summer season, and in places where the soldiers were 
not constantly quartered ; which may be accounted for from the 
wretchedness of their situation, and frequently from the want of 
appropriate remedies. 
From the comparative history of warm climates, and from the 
experience of four years by the British army in Spain and Portugal, 
these diseases are known in autumn to be endemic, and that the 
natives suffer from them as well as the troops. They arise from 
the influence of excessive heat and marsh effluvia, and are to be 
avoided only by non exposure to their exciting causes, more espe- 
cially when the body is predisposed to disease. There are many 
circumstances exclusively connected with a military life that cause 
this predisposition, independent of the susceptibility natural to 
young persons in a foreign country, and in which their manner of 
living is perhaps totally altered. A combination of these causes 
has produced a disease so general amongst a certain number of 
people as to excite an idea of its being contagious, especially when 
it has occurred with troops that have been but a short time in the 
country. It is, however, now generally believed not to be commu- 
nicable from one person to another, whilst it preserves the true re- 
mittent or continued form of fever arising from excessive heat and 
marsh effluvia. At a later period, when the influence of these causes 
has ceased, the body, on the application of other accidental exciting 
causes of fever, being in a state of predisposition for disease from 
the effects of former illness, is soon debilitated ; the assemblage of 
symptoms thus produced denote what is called typhous fever, and 
a disease is formed, capable of reproducing itself by communication, 
as has been well marked here in several instances. In 1809, when 
the army suffered so severely in the plains of the Guadiana from 
remittent fever in September and October, and from dvsentary and 75 
typhus in the three subsequent months, I was in the habit of order- 
ing two fresh orderlies daily, to keep up an establishment of sixteen 
from one regiment only. Every hospital was in the same situation ; 
and, in the present instance, at the same period of disease, the 
troops suffered considerably, not only in men who had been some 
time with the sick, but in others who had come from some little 
distance in an apparent state of health. 
During the spring and summer nonths of 1811, the fourth divi- 
sion was most actively employed, and much exposed to the wet and 
hot weather. In the month of August, during a march of sixteen 
miles, from Frontera to Crato, the heat was excessive, and one day 
so much so as to cause 300 men to fall out of the ranks. In Sep- 
tember, the division was cantoned in the villages in front of Almeida, 
in the vicinity of the Turon and Duas Casas rivers; and it would 
appear, the effects of former fatigue, and the influence of heat and 
marsh effluvia, were great, and particularly observable in the 
seventh regiment, which was quartered on each side of the river; 
203 admissions of fever occurring, of which three died, and 122 
were sent to the rear. 
From the 20th of September to the 20th of October, this corps 
suffered much from fatigue, privation of food, heat, and the occa- 
sional rains, which fell very heavily. During the time they 
bivouacked, 200 fevers were admitted, one died in regimental hos- 
pital, and sixty-three were sent to the rear. 
From the 20th of October to the 20th of November, 156 fevers 
were admitted; six died, twenty-six were sent to the rear. 
From the 20th of November to the 20th December, the division, 
on an advance to Ciudad Rodrigo, to prevent the entrance of a 
convoy, suffered much from every kind of hardship and privation; 
the weather being extremely cold, the easterly winds most piercing, 
and the troops hardly under cover, without proper clothing, and 
with a short allowance of food. Of the seventh regiment, 124 
fevers were admitted ; none died, thirty-two were sent to the rear. 
To the 20th of January, 144 fevers were admitted; seventeen 
died, and twenty-three were sent to the rear. At this period the 
fevers were generally typhous, the debility great, and frequently 
those patients who relapsed from a former fever, after an interme- 
diate state of convalescence, or who were almost in health, died in 
a day or two. In this month, during the seige, the division was 
much exposed, from the insufficiency of the quarters allotted to the 
troops, from the hard weather during the siege, and the heavy rains 
immediately following it. 
To the 20th of February, 105 fevers were admitted; forty-one 
died, and eighteen were sent to the rear. 
To the 20th of March, ninety-one fevers were admitted ; nine 
died, and 158 were sent to the rear: the regimental establishments 
breaking up on the division marching to the south. 
In the six months, there were 1329 admissions from all com- 
plaints: of these, 86 died in regimental hospital, and of which 75 
were recruits; 427 were sent to the general hospital, including 320 
CLINICAL LECTURES. 76 
CLINICAL LECTURES. 
fevers, of which 160 died. Of the 246 dead in the six months, 169 
were recruits, out of 353 landed at Lisbon in June 1811; 77 were 
old soldiers, out of 1145: that is, nearly half of the recruits, and 
one sixth of the old soldiers. 
The fortieth regiment, nearly under the same local circumstances, 
and of the same strength, suffered in a proportion somewhat less; 
having 1189 sick admitted into the regimental hospital from the 
20th of March unto the 20th of September: of these, 869 were 
fevers, of which 446 were sent to the rear. In that period, 24 died 
in regimental hospital, 156 in general hospital. The fortieth regi- 
ment received 400 men from England in July from the second 
battalion, and these also suffered infinitely more than the older 
soldiers, and from the same causes as the seventh regiment; but, 
being a better sort of men in general, the mortality was not so 
great. Of 450 recruits, 102 died; of 1117 old soldiers, seventy- 
eight died in the six months; that is, nearly a fourth of the recruits, 
and a fourteenth of the older soldiers. 
The third battalion of the twenty-seventh, nearly composed of 
Irish and of young men, during this period remained remarkably 
healthy, possessing no advantage over the others in local situation 
until December; and being rather inferior in every respect to the 
seventh and fortieth regiments in point of regimental economy: 
most of these, however, had been two or three years in the country, 
and the draughts they received were Irish boys, more accustomed to 
hardship, and less easily subdued by it. From the 20th of September 
to the 20th of March, there were admitted into the regimental hospital 
altogether 454 sick only; of which, 259 were sent to general hospital, 
eight died in regimental hospital, and fifty in general hospital. 
In December, the twenty-seventh regiment, being nearly naked, 
were sent from the front to Coimbra, and remained away until the 
beginning of February, returning complete in every thing, but 
avoiding thereby the seige of Rodrigo, and the difficulties and 
hardship of the month of January ; which, I think, had a great effect, 
both as to the prevalence of disease and the subsequent mortality. 
From the 20th of September to the 1st of March, no man was 
sent from the division supposed to be in a dangerous state. On 
the 1st, the regimental establishments were broken up. 
The state of the seventh regiment was always an object of con- 
cern and particular attention to the commanding officer, the general 
of division, its medical officers, and myself; and I believe every 
thing our means would permit were tried. They were, as much 
as possible, protected from the weather. Straw and hay mats were 
made, on every change of quarters, for the men to sleep on ; their 
messes, and cleanliness of their houses, were rigidly attended to; 
the night guards and duties were reduced as much as possible; 
they were never allowed to occupy or remain in a house with a 
sick inhabitant. The blankets, as they came up, were given to the 
convalescent men in preference to the usual mode of so many per 
company. No man was put on duty unless perfectly strong. 
During the seige of Ciudad Rodrigo, near one hundred men, mostly CLINICAL LECTURES. 
77 
recruits, who were doing duty with the regiment, were left in their 
old quarters, under proper officers; and an additional sum was 
drawn from their pay to procure them a better mess. The assistant 
quartermaster-general and myself frequently examined their quar- 
ters, and gave more room if we thought they were confined; and 
the general officers of brigade and division frequently inspected 
the hospitals. 
Judging from these circumstances, and the superior attention 
paid to the seventh regiment, they should have been at least as 
healthy as others, where the same strictness was not observed. This 
was, however, not the case; probably from their suffering the 
whole time the more combined operation of all the causes of dis- 
ease ; and which, under the existing circumstances, could not readily 
be avoided. 
A fertile source of disease in this country, and which might 
readily be prevented, arises from the paying oft’ the whole balance 
due to the troops whenever the money can be procured : thus fur- 
nishing them the means of being drunk for the greater part of three 
or four days, instead of purchasing daily or weekly such articles 
of subsistence as could be obtained, and which, in addition to the 
ration, would] secure to them a breakfast in quarters. This fact is 
so notorious, that the surgeons, and even the officers who pay the 
money, generally consider an increase of sickness a matter of 
course.1 
Disease is also greatly aggravated by the mode of conveyance 
from the regiments to the establishments in the rear. This is 
usually effected through the means of the commissariat, either by 
mules or bullock cars, in or upon which the sick are exposed to 
the heat, wet, and indeed all changes of the weather. These 
conveyances even were not given as required, but as they could 
be spared: consequently, the sick can only be removed every 
three or four days; and, when the depot is six or seven leagues 
in the rear, it generally requires two nights on the road, (certainly 
with cars,) and, during these two days and nights, (independently 
of the exposure to the weather,) the attention paid to them 
medically, or to their accomodation at night in quarters, is but 
trifling: so that men who leave their regiment after an illness of a 
couple of days, especially in the autumn, during the prevalence of 
remittent fever, frequently die upon the road, or shortly after 
they reach the place of their destination. If they escape, their 
disease is, for the most part, certainly increased. But if each 
division had a competent conveyance of its own, the journey to the 
first hospital would be accomplished with one halt; and as, 
during the unhealthy season of the year, the troops are nearly 
stationary on one line of march, at that halting place the non-com- 
missioned officer could secure a supply of straw or mats to keep 
them from the ground. The three spring waggons attached to the 
division are, from construction and other causes, independent of 
1 This was shortly afterwards put a stop to. 78 
CLINICAL LECTURES. 
the insufficiency of their number, frequently useless, and a greater 
expense than a well-arranged conveyance would be on different 
principles.1 
The regiments in Portugal are kept up by draughts from the 
battalions at home, and, in obedience to the orders on the subject, 
are as much as possible draughted by complete dies; attention I 
believe, being paid only to reject old men, or those who, from acci- 
dent, are unfit for active service; and not much to the age and 
appearance of the young ones, in consequence of which many are 
sent to this country who are incapable of performing the duties of 
a soldier. This was very evident in the recruits, or draught, sent 
from the second battallion of the seventh regiment to the first, and 
who arrived at Lisbon in June, in number 353: of these, eighty- 
seven never joined the regiment, and (he greater part of those who 
did join were totally unequal to the service required of them. 
They embarked in summer, left Lisbon in August, and reached 
their regiment on the 26th of September, at Fuente Guinaldo: 
having, therefore, been removed to a climate several degrees hotter 
than their own ; marched three weeks with a heavy load they 
were unaccustomed to in the worst season of the year, and which 
they could not have done without injury even in England. The ra- 
tion of a pound of meat, including bone, and a pound and a half of 
bread, or one pound of biscuit, is hardly enough for growing boys, 
if issued regularly; but, when three days’allowance is given at 
once, it is in most instances eaten by the morning of the third day; 
so that, until the next issue, which may not be until the evening of 
the next day, they are without food.2 The recruits of the seventh 
suffered much from this cause; and they unfortunately arrived at 
a time (during the movement from Guinaldo to Sabngal) in which 
provisions were extremely scarce, and issued in small quantity; 
they had a great deal of fatigue, and lay out without blankets 
during some wet weather. Their bodies were naturally at this 
moment predisposed to disease; in many it was already formed; 
and the subsequent season of the year being most unfavourable to 
1 The master-general of the ordinance, Sir Hussey Vivian, has, with the 
consent of Lord Hill, laid the foundation of a corps of hospital conveyance. 
Twenty carts, on Mr. Cherry’s principle, adapted for one or two horses, 
have been already ordered, with such improvements as Sir James M‘Grigor 
and I could suggest. They are well fitted for all the slow work of an army, 
both with respect to the sick and wounded, and even for the conveyance of 
particular stores; but they are not competent to work in action, or immedi- 
ately in front of an active enemy. From the manner in which this subject 
is now taken up by the authorities I have mentioned, I trust the foundation 
of the remaining part of the conveyance will also be laid, when the material 
of the British army will on this point be complete. This corps, when per- 
fect, should furnish the necessary servants for the officers of the hospital 
staff, which it will be able to do without the slightest difficulty; except that 
of altering a bad custom, a matter which I honestly admit is one of great 
difficulty in every official branch in England. 
2 After the siege of Ciudad Rodrigo, the sick eat the bullocks of the 
battering train; and when they furnished 66 pounds of bone out of 96 pounds 
per quarter, I begged to have three quarters as two. CLINICAL LECTURES. 
79 
such subjects, it is reasonable to suppose they must suffer accord- 
ingly. In fact, they never did recover the injury they had sustained, 
were most miserable objects, and were as readily distinguished from 
the older soldiers as if they had belonged to another regiment. 
The great heat in summer renders it desirable to load the soldier 
as little as possible: the blanket, or great coat, is therefore taken 
away; hitherto generally the former, to avoid losing the coat, 
which is only replaced once in three years, whereas new blankets 
are issued yearly, if they can be procured ; but, from the difficulty 
of conveyance to the army on the frontier, the troops do not get 
them at a proper time. In my opinion, a soldier should be complete 
with blanket and coat by the 1st of October, to protect him from 
the cold and damps of the night, which are so great in a warm 
climate. The seventh regiment had not more than one blanket 
between two men in December, and were not complete in January; 
so that relapses could not fail to occur from that cause alone, for 
little assistance could be procured by the soldirs from the inhabit- 
ants; and occasionally, in fact twice during the winter, from the 
incidents of war, the little comforts they could procure were for a 
time taken away, rendering them, of course, more susceptible when 
exposed. 
From a consideration of several draughts sent to this country, and 
particularly the inutility of the greater part of the 353 men sent in 
June to the seventh regiment, I would suggest the necessity of 
selecting men who have been some little time habituated to the 
life of a soldier, for the draughts to Spain and Portugal: or, if the want 
of men will not allow that to be done, of not sending out boys of 
seventeen and eighteen, especially if English, that have been brought 
up in manufacturing towns; as they are generally of weakly constitu- 
tions, have been little accustomed to hardships, do not readily bear 
them, and are, in fact, but a nominal increase of strength. The men 
chosen for this service should be embarked in October, in large 
transports or men-of-war, these being always the most healthy, from 
the greater facility afforded the officers in attending to the men, 
from their having a larger space to move about in, even with an 
equal proportion of tonnage, and from their always having fresh 
air in bad weather, the hatches being open, and a number of men 
upon deck; which cannot be suffered in small brigs of 150 or 180 
tons burden, in which, with every care, they are generally wet, and 
much confined. On their arrival at Lisbon in November, I would 
recommend their being quartered in proper places in the vicinity, 
or within thirty miles, for three or four months, until they become 
a little accustomed to the mode of life they had to undergo, and 
which is very different from that of a soldier at home. They 
should be regularly messed twice a day, and examined daily in fine 
weather, in marching order. In April and May, by short marches, 
and frequent halts of two or three days, they might join their regi- 
ment; the same care being taken of them as to a meal of some 
1 Tents were subsequently supplied. 80 
CLINICAL LECTURES. 
kind in the morning, when possible. They would now have had 
a six months’ trial, and would be better able to support the privations 
and hardships they must experience during the campaign. In 
October their clothing should be completed, the days then being 
frequently hot and dry, the nights cold and damp: from the influence 
of which they should be carefully guarded. If this or some other 
cautious method were adopted, I think the health of the army 
would be much improved, and very many lives saved. In the in- 
stance of the seventh regiment, I have little doubt but that one half, 
or perhaps 21)0, of the original number, would have been effective 
under the plan proposed, instead of forty-two, the number now 
present with the regiment. 
The climate of Portugal is too much valued in England for 
qualities it does not possess: indeed, it appears to have been little 
known beyond the neighbourhood of Lisbon, until within these 
few years. The advantages generally enumerated are taken from 
the vicinity of the capital, and these are very much overrated. 
The whole of the east of Portugal, and the parts occupied by the 
British army north of the Tagus, are more unhealthy than any 
part of England. In July, August 'and September, this occurs 
from the intense heat, and the evaporation and decomposition of 
vegetible matter in the marshy grounds and courses of rivers: in 
November, December, January, February, and March, from the 
heavy rains, cold winds, and frequent changes of weather, which 
are particularly felt, from the houses in general, and especially on 
the frontier, being badly built, possessing neither chimneys nor 
windows, by the aid of which an equal degree of temperature might 
be supported. The unhealthiness of September and October is 
proverbial in Estremadura. April is very changeable: so that, in 
fact, May and June are the only favourable months for invalids: 
and the latter month is frequently very hot. Upon the whole, the 
climate of this part of Portugal is almost always unfavourable for 
the re-establishment of health after fevers; is particularly so after 
chronic or visceral diseases; and, from its frequent and great 
vicissitudes of weather for six months in the year, with the impos- 
sibility of counteracting them by artificial means, is adverse to pul- 
monic and rheumatic complaints. 
Neither consumption nor scrofula are prevailing diseases in Por- 
tugal, particularly in the neighbourhood of Lisbon. Cases of both 
do occasionally occur, but they are by no means so frequent as to 
render them more than accidental, which shows the little predispo- 
sition of the Portuguese for them. They are, however, during the 
great heat in summer, liable to haemoptysis, under any violent 
exertion, but which is usually subdued by mild treatment, and the 
proper functions of the lungs are restored without much difficulty. 
The constitution and mode of living of the Portuguese do not 
dispose them to suffer from inflammatory diseases; and the greater 
clearness of the atmosphere, and the equality of the seasons near 
Lisbon, together with the want of tone of the whole system, render 
inti mmatory affections of the lungs less violent, and more easily CLINICAL LECTURES. 
81 
cured, than in England. There is also little or no heriditary pre- 
disposition for pulmonary disease among them. 
For such information as I can collect from my acquaintances in 
civil life, as well as from my own observation, it would appear that 
persons visiting Portugal from colder climates, with only a predis- 
position of phthisis, or with tubercles in a nearly quiescent state, 
or not in that of suppuration, to receive some benefit from the sea 
voyage and change of air; but, when suppuration and ulceration 
have taken place, which is the case in most persons sent from 
England, the result is almost always fatal in as short a time as if 
the experiment of change of climate had not been tried. I now 
know several cases deteriorating as fast, during the last two months, 
as I conceive they would have done, with due caution, at home. 
Chronic coughs are always benefited by a residence in this 
country.1 
I have shown you that the person called by the soldiers the 
“general doctor,” ought to know something of physic as well as of 
surgery, to do his duty properly; and I will now show you, he 
ought to be able to do other things besides. 
Sir Lowry Cole having returned to the 4th division from England, 
we entered Spain for the Salamanca campaign, during which I had 
no occasion to provide for myself, having experienced the advantage 
of his hospitality and kindness from the battle of Abuhera until we 
afterwards parted at Madrid. I have already told you the medical 
staff officer is the only one of a division or corps-d’armee who 
does not usually live with the general in the field, a custom which 
ought to be abrogated for the good of the service. It is a great 
hardship on a general to be obliged to feed his staff of half a dozen 
persons, as well as himself, out. of the very moderate pittance 
allowed to him; but it is very advantageous for the service of the 
country that he should always have these officers about him, and 
ready for immediate use. It is not only, however, necessary that a 
corps should fight, but that it should be kept in health to fight; 
and the general and the doctor will do this much better together 
than either of them separately. The public should then make the 
general an allowance for every officer of his staff, under the head 
of table money, totally distinct from his pay, when before the enemy 
or in an enemy’s country. A general commanding a corps-d’armee or 
a division, should have at least £400 a year, and a general of brigade 
£200, for this purpose alone, whenever the officers of the staff Jive 
with him. He should, of course, have great weight in the selection 
of the medical officer thus attached to him, and the situation would 
be sought for by the best. It may be supposed that 1 am merely 
seeking for a comfortable situation for a doctor, which is not the 
case; I am trying on this, as on all points, to render the doctor 
capable of doing his duty properly towards the sick and wounded 
soldier. I know too well the misery to which both officers and 
soldiers are often reduced in a campaign, not to do my best to serve 
•The last two paragraphs are taken from a report made from Lisbon, on 
various subjects, in 1803, and published in 1830. 82 
CLINICAL LECTURES. 
them. I wish to have justice done also to the general officer, 
whose pay is totally unequal to the exigencies of his situation 
under these circumstances; and who cannot do his duty to 
his country as it ought to be done, without injury to himself. 
The people of Great Britain never think of these matters. Their 
representatives in parliament only take up the army and navy esti- 
mates, as it appears to me, to enquire how much more reduction 
can be made in them. I see, in the army estimates, a sum charged 
of 8/. 19s. 11 \d. or something like it, for the person who pumps 
the water up at the Tower; but 1 cannot find any estimate for the 
gentleman who pumps at the custom-house, or at the treasury, or in 
any other civil department. I have several times asked my parlia- 
mentary friends both wigs and tories, for the annual estimate or 
account which is, I suppose, laid before parliament, of the manner 
in which the difference between the amount of the next and the 
gross revenue of the country is expended, but I have never been 
able to get it. 1 should like to see the expense of every exciseman 
in the country as fairly stated as that of the pumper at the tower. 
I should like to see the expense of every civil officer and their 
retirements as fairly stated as those of the officers of the army and 
navy; and I should much more like to see the scale equalised. I 
do not think the country would grudge the expense of the printing. 
I and others suffered, or at least we believe we did, for several years, 
a deduction from our pay on account of the fund for widows’ pen- 
sions, on the order of the late kings, whose honour and faith we 
supposed to be pledged to the arrangement. There has, however, 
been no difficulty made about altering it; and now, if a poor unhappy 
widow, entitled to £50 a year pension, should happen to have three 
times that sum, the hard earned savings of a long life, or of her 
own, she is deprived at any time of her pension unless she is a lady 
of title, when an occasional exception can be made. If a pensioner 
on the civil list happens to gain three times his or her pension, no 
mention is made of taking that away. The king’s honour and faith 
are said at once to be their protection; although they cannot protect 
the poor widow of a sailor or a soldier under similar circumstances. 
It is one of the disgraceful pieces of economy, of which the nation 
ought to be ashamed. 
The army advanced from the Tormes to the Duero near Torde- 
sillas with little comparative interruption, when the campaign 
effectually commenced. We saw the French army marching away 
from Tordesillas down the river on their right, as if they meant to 
turn our left, and our order was received to move in the morning. 
We usually breakfasted at half-past three, that is before ordinary 
daylight, so as to be secure of one meal in the day; but the cavalry 
had become so unquiet in our front during the night, that the 
baggage was packed before breakfast, and the infantry had only 
time to get under arms, before Lord Combermere and the cavalry 
came into Castrejon faster than they went out. The infantry, after 
some skirmishing, crossed the Castrillo in their rear, and formed in CLINICAL LECTURES. 
83 
line on the higher ground above ; and when the mist of the morning 
broke and cleared away, the light and fourth divisions found the 
whole French army was upon them; their troops, which had 
apparently marched away to our left in the evening, having coun- 
termarched in the night. This brilliant infantry stood as unmoved 
as if it faced only equal numbers, and checked the French advance; 
whilst V. Alten’s cavalry and the artillery skirmished with them to 
our disadvantage. As the morning advanced the British army 
closed up upon our left, but not in time to prevent the French 
turning the two British divisions so completely as to bring twelve 
guns in their rear to bear on the roads by which they must retire. 
Sir L. Cole placed the six guns of the 4th division in position to 
engage them, and they occupied them so effectively as to allow the 
two divisions to pass under their fire, in parallel but distant lines, 
without injury. I have no knowledge of a single man being hurt 
by this fire, and thus we descended into the plain, crossing the 
Guarena. Distressed by the heat, the troops ranged themselves 
along the bank of the river to drink, and the French brought up 
their guns and formed on the hills immediately above and over- 
looking them. The sun shone as a southern sun alone can shine; 
three divisions of British infantry basked in it, and washed their 
husky throats in the waters rolling almost directly under two and 
twenty guns ready to open upon them at the least sign. Each 
waited a move. The order was at last given ; the British rose, and, 
formed in line, two deep as usual, and then retired; the duke and 
his staff passed at this moment at a canter from left to right, and the 
French artillery opened. I counted every gun of the two and 
twenty. The British infantry having retired in line for some 
distance, moved to their left, and the French artillery ceased firing. 
I had placed myself about a quarter of a mile in the rear with three 
spring wagons, on a rising ground, until the line had moved. The 
whole of the shot of the French artillery passed by and over us en 
ricochet, as the military term it, which means bounding along 
like a cricket ball. If there are only two or three going at the 
same time and on the same line, it is very easy to get out of their 
way, provided you keep your eyes wide open, and are not too much 
frightened. 
As soon as the troops had passed, I trotted down with the spring 
wagons, to pick up the wounded, but there were none to be found. 
The twenty-two guns had done no mischief, as far as we could see, 
on the ploughed ground; and as to the standing corn, it was not 
desirable to loiter too long in that, as there was now nothing 
between us and the French. If there were any poor fellows there, 
unable to move, they died of starvation. They had, however, the 
consolation of thinking, in their last moments, that their country 
would have assisted them if she could; but that she had not the 
means. She could not afford the expense of a conveyance fitted for 
their service, and she left them, unwillingly, to the mercy of her 
enemies, or to the accidental compassion of her friends. The French 
did not fire upon us whilst engaged in this duty, and I was happy 84 
CLINICAL LECTURES. 
in being- able to repay them in the afternoon; when, worn with the 
exertions of a day of protracted labour, under an almost apparently 
vertical sun, which killed several, and particularly Portuguese, the 
French and British fourth divisions of infantry came into contact, 
the latter being supported by two squadrons of General Ponsonby’s 
cavalry. The dragoons went up to each other at last at a walk ; a 
trot or a canter, unless for a few yards, being pretty much out of 
the question ; and in this manner they hacked away without doing 
much mischief. The infantry could hardly drag one leg after the 
other; yet, when nearly worn out, Sir L. Cole advanced in line, 
with the 27th and 40th regiments, to the charge. The French 
stood firm, and it was for a few minutes doubtful which party would 
turn tail and run away. It was at this moment of extreme anxiety, 
that an Irish lad, of the 27th, stooped in the front rank, and, picking 
up a large stone, threw it into the enemy’s line, with a loud “ hurrah, 
my boys.” They were now so close, as to be almost able to cross 
bayonets—a thing so often spoken of, but so seldom done—when 
the French turned, to our great satisfaction, and walked off across 
the river. Our people were quite unable to follow; they had done 
their best in walking up to them, and could go no farther. The 
previous firing had killed several, and wounded many on both sides. 
Some of the French were unable to move, and fell into my hands; 
and, recollecting what had happened in the morning, I went forward, 
and called to them across the stream to send for their wounded 
officers and soldiers, who would be given to them by Sir L. Cole, 
the general commanding. Several officers and men came forward 
immediately, without arms: and you cannot conceive how we 
complimented each other. It was now late in the evening, and I 
had to dispose of all the wounded of the infantry. The doctors 
worked all night; and we got them off for Salamanca before day- 
light. I had just washed myself, and was making a hearty breakfast 
on some bread and water, when Sir James M'Grigor came up to 
enquire if I had received his orders relative to the wounded. I told 
him I had not. He then desired they might go to Salamanca, 
whither they had already been despatched. The cavalry had 
received his orders, he said, but had not obeyed. He now asked if 
I had a spring wagon left. I replied, one; which he said he must 
have for Sir Thomas Picton, who was very ill. I remonstrated, 
saying, it was the only oue I had or could get, and that if we had 
another fight, I could not move a single man. He promised faith- 
fully to bear this in mind, and provide for me accordingly,—which, 
luckily for me, he was not able to do. 
Marshal Marmot) t, very scientifically wheeled us across the 
Tonnes after this, in a manner you will find duly related by the 
military authorities, into the position in which we fought the battle 
of Salamanca. The town was now exposed, and as neither the 
general nor I liked to have our sick taken who were in it, and 
which appeared very likely to happen, I set off in the evening with 
all the mules we could unload of their bread, and corn, and spirits, 
in the division, to take them out of it. It was night when 1 hud 85 
CLINICAL LECTURES. 
effected this, and had crossed the bridge ; the rain came down in 
torrents, the lightning flashed as closely as if it would strike one to 
the earth; my horse would not face it, and I did not know where 
the troops were. The prospect for the night was not very promising, 
when an officer’s servant passed, saying he was going to the baggage, 
which was about three miles off to the rear; and that I had no 
chance of finding the division, although I might perhaps find the 
French. I thought it wiser, therefore, to go with him, and trust to 
the kindnesses of the clergyman and the ladies who sheltered 
themselves under his protection on these occasions. I found them 
all as happy and as thoughtless as possible. The two ladies were 
young, and had got their husbands with them; and our excellent 
clergyman, Mr. Jenkins, received me most kindly into a small tent 
of his own. We all partook of his supper, and parted apparently 
regardless of the morrow. 
The distant sound of a gun, during our early breakfast, banished 
the roses from the cheeks of the ladies, and brought my horse to 
the door. The parting was difficult. The ladies, who were both 
very handsome and agreeable, were the pets of all the officers, 
except the general commanding, who always looked upon them 
with an eye of soldier-like severity. When the hour of difficulty 
came, he could, however, think of them in the kindest manner, as 
if by accident; and a captain and a subaltern were ordered to the' 
rear to see the baggage in a place of safety, whilst the French were 
wheeling us over the plains of Salamanca, until our patience was 
exhausted. These officers were the husbands of the ladies. I 
assured them they were expected to remain until sent for; that I 
had heard the order given. They thought, however, that if I felt 
it necessary to go, they ought, and they followed me in a few 
minutes. I trotted them up to the smaller Arapiles hill, and in 
about two hours one Captain Prescott was killed, and the other, 
Lieut. Leroux, was shot through the body, from which he never 
recovered. 
The general of division, Sir Lowry Cole, was shot through the 
left breast, the ball passing in immediately below the clavicle, and 
out through the shoulder blade. It grazed the subclavian artery, 
and altered the pulse in the arm of that side. There was the six- 
teenth part of an inch or less between him and immediate death. I 
had a Portuguese field officer’s tent, which was given to me by 
General Turner, whose arm I had taken out at the shoulder-joint at 
the first siege of Badajoz; in this I received him; and the whole of 
the wounded officers and soldiers of the division collected around us. 
Many of the worst cases of the stragglers of the army, cavalry, and 
infantry, who were with difficulty moved, were brought to me on 
the second day; and between three and four hundred French, in the 
same desperate state, claimed my assistance. In the army the general- 
in-chief gets in great matters all the credit from the public, and 
bears all the blame, which is fair; but the inferior officers bear 
much of the blame individually when any is deserved in smaller 86 
CLINICAL LECTURES. 
matters, and often obtain but little of the credit. I foresaw I should 
soon be in that predicament unless I exerted myself. I have told you 
that a wounded commanding officer of a regiment is next to nobody 
when away from his regiment; but a wounded general of division 
resembles a sick lion, being very likely to show his teeth and talons 
on a future day, and not to be neglected until he is dead. Presuming 
on his authority, I ordered all the medical officers and all the 
hospital establishments to join me from the division except two ; 
and the commanding officers obeyed without a murmur, which 
they would not perhaps have done at such a moment, if they had 
not known I lived with and wielded the authority of the general on 
all medical points. My wounded were now safe, but the afternoon 
of the second day had arrived, and we were alone on the field of 
battle without even a bit of bread; not a man had stirred, for I had 
kept the slightly wounded to assist the bad cases, and would only 
move as a whole. Sir James M'Grigor could do little beyond 
acquitting me of blame, for the Spaniards promised every thing, 
but as usual did nothing, and he could only speak to them through 
an interpreter. They had given him the St. Domingo convent 
near the bridge, quite empty, and this he delivered over to me, 
with a much more valuable adjunct, viz. permission to badger the 
junta as much as I pleased in his name. The late Dr. Curtis, the 
Roman Catholic Archbishop of Dublin, was one of them, and their 
interpreter, although some of them spoke French; but I could speak 
French better than any of them, and Spanish quite as fast, if not 
as well, and I knew their ways too well to speak English. We 
complimented each other in good Castilian about Spanish honour 
and humanity, British valour and sufferings, until they declared 
there was nothing they would not give me. Every cart in Sala- 
manca should go out forthwith for my wounded, every house should 
find a bed and bedstead until my hospital was completed. These 
promises they had made and repeated frequently during the last two 
days, but they went very little farther than giving the order. I per- 
suaded them, however, at last, to give me over the two police officers 
who were to carry these orders into execution, and when I got them 
safe into the hands of the hospital serjeants, who were waiting 
on the bridge under Assistant-Surgeon Mahoney of the Fusiliers, 
who is now staff-surgeon at Edinburgh, I assured them they 
should never see the inside of their homes again until I got all they 
were ordered to find for me. They first seized every cart that 
came over the bridge from Salamanca, until we had got as many as 
we wanted to carry our wounded, and then I made them furnish the 
convent. In two days mine was the pattern hospital; everybody 
wondered, but nobody found out that this was all done by speaking 
French and Spanish ;—that physic and surgery had nothing to do 
with it. 
My poor Frenchmen were now my care. I had obtained an 
empty convent for them, but the junta would give me nothing but 
promises. The Spanish police-officers had complained loudly of CLINICAL LECTURES. 
87 
me, and I had been forced to give them up. Picture to yourselves 
near three hundred men and officers, desperately wounded, and 
dying by dozens, lying crowded on the bare stone floors, drinking 
and eating all I had to give them out of their shoes, and using these 
same shoes for other more unworthy purposes. Nothing could be 
more horrible; the stench was dreadful ; humanity was never more 
outraged. The junta declared the town was exhausted, that they 
did not see why they should be farther plundered by the French 
than they had been, and that the sooner they died the better. My 
compliments were, I found, no longer of use; so I told them, in the 
best possible Spanish, they should remember that although the 
British army was in their front, things might change; and that, if 
the French came back, they would all be hanged to a certainty for 
their inhumanity. They were quite furious, and I almost thought 
they would murder me. They declared they would write to the 
duke, and have me punished severely. I assured them I hoped 
they would, provided they stated also the reason; for although the 
duke would not permit any impropriety of conduct towards them, 
he would not submit to his prisoners being so ill used ; and that, if 
the French came, I would certainly leave a letter for their general, 
stating how they had treated his wounded. This seemed to make 
some impression, and the matter ended by my once more getting 
the officers to provide for them. It was but badly done ; but these 
poor fellows although little given to praying, assured me they prayed 
for me, and that, if there was a God in heaven, of which some few 
of them seemed to have a doubt, their prayers would be registered 
in my favour. I have great satisfaction in thinking, that if there 
is even one of them now alive, he has me sometimes in his remem- 
brance. One young officer, whose thigh was broken, and who 
heard me cautioning the assistant-surgeon who attended him about 
keeping it of its proper length, begged me to allow it to be an inch 
shorter, as that would ensure his retirement from the service to his 
home and friends. If another war should take place, I trust the 
statement of the horrible sufferings these poor fellows endured, and 
which many others underwent, will induce the highest authorities 
on both sides to agree to some measure, by whjch medical officers, 
purposely left with sick and wounded, shall not be detained as 
prisoners; and that such poor wretches as are rendered unfit for 
service, may be sent home, even without an exchange. Some 
months after the affair of Elboden, in front of Fuente Guinaldo, 1 
rode over the ground, and found the skeletons of those who had 
fallen. I was curious in looking for the death wound in each ; and 
in only one case out of twenty odd, did I fail to see the broken bone 
which had, in all probability, been implicated in it. Some of these 
must, I fear, have died of starvation, to whatever nation they be- 
longed. The sun and rain had bleached the bones the vultures 
had picked clean. 
The battle of Salamanca established the surgery of the British 
army nearly on its present basis. Our previous battles and sieges 88 
had pointed out many faults, and had admitted of many improve- 
ments being made. They were all now tested. Sir James M‘Grigor 
was indefatigable, and all his officers worked well. 
My labours had not been in vain. I found on my arrival at 
Madrid, in October, that he had recommended me to the Duke of 
Wellington for promotion, and that I was now the chief of the army 
under the command of Lord Hill, composed of several divisions of 
infantry and cavalry, with a large and increasing general hospital 
in that town. The force under my charge was larger than that 
under his own immediate superintendence, but he knew it was 
impossible at Burgos to regulate in detail for those to the southward 
of Madrid, and he left me to my own resources, desiring only that 
I would send 500 sets of bedding from thence to Salamanca. 
As the Duke of Wellington’s situation before Burgos became 
desperate, ours at Madrid became critical; we could easily have 
beaten Marshal Soult in open field, but that would have been 
of no use to us, if the Duke was forced to cross the Tormes. It 
would have been as bad as a defeat; we therefore retired from 
Madrid, the French following us closely past the Escurial, and 
across the Guadarama mountains, into the plains of Castile. The 
order for the retreat came suddenly; but, living with Sir E. 
Packenham, who was sick, and commanded in Madrid, it was not 
unexpected by those who had shared his anxieties as to the fate of 
the army at Burgos. Whilst I was pressing our deputy com- 
missary-general, and the Spanish intendant-general, to give sufficient 
conveyance for the removal of the sick to Salamanca, they were 
occupied in filling the Retiro with corn and flour, and with 
establishing in it a large magazine for the army. 
When the order arrived, I found the deputy commissary-general 
on his way to the Retiro, determined to use all the means in his 
power to fill it with provisions. No arguments of mine would he 
attend to, and no more conveyance would he spare. We were now 
within hearing of the sentry, and I begged him to turn his horse 
back with me for a few yards, and then asked him if he knew the 
Retiro was to be blown up that very hour to-morrow. There 
never was a fellow so astonished. I trotted him back with me to 
Sir E. Packenham, who gave him his orders, and desired him to 
furnish mules to move the pontoons to the army. He protested he 
had not a mule ; that he had given me the evening before the last 
40 he had. Sir E. Packenham took them from me with regret, for 
he and I knew the pontoons would not be wanted, as a later despatch 
had informed him the army had altered its march, although it did 
not countermand the movement of the pontoons; the bottoms of 
which were knocked out about a league from Madrid, the next 
morning,—but the mules did not return. 
My situation was more desperate than at Salamanca ; the loss of 
an hospital of several hundred men would have materially injured 
the reputation of the army. What was to be done ? I tried my old 
expedient, of speaking Spanish, only in a more daring way. I armed 
CLINICAL LECTURES. 89 
all the orderlies and convalescents in the hospital, marched them into 
the principal market-place, and seized a dozen fine large four-mule 
wagons in the name of the Spanish government. The drivers pulled 
out their knives at once, and swore they would not go. The mob 
collected around us. 1 showed them several doubloons, and assured 
them the drivers should be paid to the last farthing ; that the British 
army was about to fight for the safety of Madrid, that the hospital 
must be cleared to make room for the wounded ; and I appealed to 
the honour of the Spanish nation. It was not in vain ; the mob at 
last cheered me ; I viva’d in return, and carried off the drivers with 
their wagons, amidst the acclamations of the surrounding populace. 
Two dying and two broken-legged men only were left in the 
hospital at Madrid. 
A British army can march through an enemy’s country without 
doing almost the slightest mischief, but it cannot retreat in a similar 
manner. Every man that falls out becomes in time a maurauder, 
and commits all sorts of mischief. The only thing to be done is to 
prevent their quitting their regiments on any pretext whatever, and 
this is to be affected by the greatest severity of regimental discipline. 
There are three very important personages on such occasions, the 
commanding officer, the doctor, and the drummer, armed with his 
cat-o’-nine-tails. If they do their duty, a retreat may in general be 
conducted in an orderly manner; but without their best exertions 
the thing cannot be done, and particularly if provisions are scarce, 
or are not duly distributed. In the retreat from Madrid, the surgeon 
of each corps marched with the rear of his regiment, and reported 
to me every sick man and every straggler within an hour after his 
arrival at the bivouac. I rode with the last of the infantry, and 
saw that no one was left behind. In this way we drove all the sick 
and all the lazy before us, and had descended the Guadarama pass 
but one day before I knew I had near 2000 of this description on 
their way to the rear, and who would plunder the country before 
them until they arrived at Ciudad Rodrigo. When we arrived 
within a march of Alba de Tormes, I obtained from the deputy- 
adjutant general, Colonel Rooke, since dead, one field and four 
other officers, who were desired to attend to my wishes ; to these were 
added a deputy provost-marshal, and his whippers-in. At day ight 
the officers were at the bridge of Alba, and the provost and I were 
soon occupied in clearing out the town. Before mid-day all the sick 
were on their way to Ciudad Rodrigo in a compact orderly manner ; 
more than a thousand men were added to the strength of the army, 
not one sick man fell into the hands of the enemy, to my know- 
ledge, from Madrid to Salamanca, when my separate duty ceased; 
and I know that during this period the medical officers of the army 
did their duty in a very efficient manner. 
General INapier has three times in his fifth volume commented 
on the officers of the medical department for negligence, and other 
faults of which they as individuals in Spain were not in my opinion 
guilty. If the country cannot give sufficient pay and allowances 
CLINICAL LECTURES. 90 
CLINICAL LECTURES. 
for good and able men, it is not the fault of the doctors. If they 
will not reward them when they do their duty well, who is to 
blame ? if they are refused the same indulgences, the same rewards, 
the same promotion as the rest of the army, how can the public ex- 
pect them to be highly efficient ? There is no one to blame but those 
who have the absurdity to run human life against a paltry economy 
of money. If, in defiance of all the remonstrances of all the doctors, 
there is no, or at best a very insufficient conveyance, in the British 
army on service for sick and wounded men, surely the doctors are 
not to blame; they can only represent. It is with others to act. 
General Napier’s third remark follows his notice of the retreat from 
Madrid to which I have just alluded, and would therefore appear to 
apply to that service. If this should be the intention of it, the mili- 
tary reader has now the opportunity of judging how far it is deserved 
or not. The Duke of Wellington’s opinion was that the doctors 
had done their duty well; and he was, shortly afterwards, in the 
hospital at Lisbon, pleased to express his approbation of it, and to 
declare before all the officers present, that he desired my conduct 
should be considered as worthy the imitation of the whole army. 
I trust, gentlemen, you will see the advantages to be derived from 
attending early to other studies, besides physic and surgery.