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 THE 
 
 JFlomer Upterinary ffiibtatji 
 
 FOUNDED BY 
 
 ROSWELL P. FLOWER 
 
 for the use of the 
 
 N. Y. State Veterinary College 
 
 1897 
 
"eports on the extent and nature of the 
 
 3 1924 000 346 373 
 
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 the Cornell University Library. 
 
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CIROTJLA.R No. 6. 
 WAR DEPARTMENT, 
 
 STJEGEON GENERAL'S OFFICE, 
 
 "Wash-ington, ISTovember 1, 1865. 
 
 R E P O E T S 
 
 ON THE 
 
 EXTENT MD NATURE OF THE MATERIALS 
 
 AVAILABLE FOE THE PREPARATION 
 
 OF A 
 
 MEDICAL AND SURGICAL HISTORY 
 
 or 
 
 THE REBELLION. 
 
 PRINTED FOR THE SCROEON QENERAl'S OFFICE 
 BT 
 
 J. B. LIPPINOOTT & CO. 
 
 PHILADELPHIA. 
 
 1865. 
 
Surgeon General's Office, 
 Washington, D. C, 
 
 November 1st, 1865. 
 
 Tlie following Circiilar is publislied for tlie iixforraation of 
 tlie !M!edical Officers of tlie ^rray. 
 
 JOSEPH K. BARNES, 
 
 Surgeon General. 
 
 K R R A T A. 
 
 Page 9, fifth paragraph, fur 604 read 104. 
 
 Page 41, fifth paragraph, for "fractured wounds" read "punctured wounds. 
 
 Page 43, line fifteen, for "internal carotid" read "internal maxillary." 
 
 reports of the medical officers engaged in it, and ot illustrations ol tnese reports m tne 
 shape of pathological specimens, drawings, and models. The documentary data are of 
 three kinds : first, the numerical returns, in which the number alone of the different 
 forms of wounds, accidents, injuries, and surgical diseases is given; secondly, what 
 may be called the nominal returns, in which are furnished the name and military 
 description of each patient, and the particulars of the case, with more or less of detail; 
 and thirdly, the miscellaneous reports. To the first class belong the "classified return 
 of wounds and injuries" which every medical officer has been required to furnish imme- 
 diately after every engagement, the " tabular statement of gunshot wounds," and the 
 portion of the "monthly report of sick and wounded" referring to surgical diseases and 
 accidents. The second class comprises the "quarterly reports of wounded" and the 
 "quarterly reports of surgical operations" required of all general and post hospitals, the 
 quarterly "sanitary reports" of regimental surgeons, the "nominal lists of wounded" 
 forwarded by medical directors after every general engagement, and extracts from 
 "case books." In the third class are included the reports of medical directors of armies 
 
 1 
 
Surgeon General's Office, 
 Washington, D. C, 
 
 November 1st, 1865. 
 
 Tlie folio-wing Circular is piablislied for tlae information of 
 tlie UNd^edioal Officers of tlie ^rmy. 
 
 JOSEPH K. BARNES, 
 
 Surgeon General. 
 
 CIRCULAR NO. 6 
 
 Surgeon General's Office, 
 Washington, D. C , 
 
 October 20th, 1865. 
 BREVET MAJOR GENERAL JOSEPH K. BARNES, 
 
 Surgeon General TJ. S. Army. 
 General: — 
 
 In response to your inquiries relative to the nature, extent, and value of the sur- 
 gical data that have accumulated in the department of your office under my charge, 
 and in regard to the progress that has been made in arranging these materials, I have 
 the honor to make the following report : 
 
 The materials in the office relating to the surgery of the late war consist of the 
 reports of the medical officers engaged in it, and of illustrations of these reports in the 
 shape of pathological specimens, drawings, and models. The documentary data are of 
 three kinds : first, the numerical returns, in which the number alone of the different 
 forms of wounds, accidents, injuries, and surgical diseases is given; secondly, what 
 may be called the nominal returns, in which are furnished the name and military 
 description of each patient, and the particulars of the case, with more or less of detail; 
 and thirdly, the miscellaneous reports. To the first class belong the "classified return 
 of wounds and injuries" which every medical officer has been required to furnish imme- 
 diately after every engagement, the " tabular statement of gunshot wounds," and the 
 portion of the "monthly report of sick and wounded" referring to surgical diseases and 
 accidents. The second class comprises the "quarterly reports of wounded" and the 
 "quarterly reports of surgical operations" required of all general and post hospitals, the 
 quarterly "sanitary reports" of regimental surgeons, the "nominal lists of wounded" 
 forwarded by medical directors after every general engagement, and extracts from 
 "case books." In the third class are included the reports of medical directors of armies 
 
 1 
 
Z INTRODUCTION. 
 
 in regard to the operations of the Medical Department, and the succor given to the 
 wounded; reports and dissertations on new methods and modes of treatment, and 
 modifications of surgical apparatus and appliances ; pathological researches on morbid 
 processes pertaining to surgery, as hospital gangrene, osteomyelitis, pyaemia, and the 
 like; plans for ambulance organization, and the transportation of the wounded by land 
 and water. 
 
 The extent of these hiaterials is simply enormous. The returns are of as huge 
 proportions as the armies that have been engaged in active operations for the last four 
 years. The great body of the medical officers have made the reports required of them 
 with commendable diligence and promptitude, and their zeal is the more deserving of 
 praise when the engrossing nature of their field duties is considered. The result has 
 been the accumulation of a mass of facts and observations in military surgery of 
 unprecedented magnitude. 
 
 It is as yet impracticable to determine with accuracy the number of wounds 
 received in action during the late war, though data for a near approximative estimate 
 are accessible. But a comparison of a portion of the returns with the complete 
 statistics of other armies will sufficiently indicate the vast numbers that are dealt with. 
 
 In the British Army in the Crimea, during the entire war there were 12,094 
 wounded and 2755 killed, or a total of 14,849.* 
 
 In the French Army in the Crimea, of a total effective force of 309,268, according 
 to the report recently made by M. Chenu, there were 39,868 wounded and 8250 killed, 
 or a total of 48,118, although in his report of injuries of different regions M. Chenu 
 records but 26,681 cases.f 
 
 In the late war, the monthly reports from a little more than half the regiments in 
 the field give, for the year ending June 30th, 1862, an aggregate of 17,496 gunshot 
 wounds. The reports from rather more than three-fourths of the regiments, for the 
 year ending June 30th, 1863, give a total of 55,974 gunshot wounds. The battle-field 
 lists of wounded for the years 1864-65 include over 114,000 names. But these returns 
 are to be completed by collating with them the reports of general hospitals, where 
 many wounded were received whose names the recorders of field hospitals or regi- 
 mental medical officers failed to obtain, and by adding the names of those killed in 
 battle. 
 
 In comparing the numbers of cases of some important injury, as, for example, 
 gunshot fractures of the femur, it is found that in the French Crimean Army there 
 were 459 such injuries, and in the English Army 194, while over 5000 such cases 
 have been reported to this office. Or if one of the major operations is selected for 
 comparison, as excision of the head of the humerus, the Crimean returns give 16 of 
 these excisions in the British, and 38 in the French Army, but the registers of this 
 office contain the detailed histories of 575 such operations. 
 
 * Medical and Surgical History of the British Army which served in the Crimea, during the war against Russia, 
 in the years 1854, 1855, 1856. London, 1858. Vol. ii. p. 259. 
 
 t Rapport au Oonseil de Santd des Armefes sur les Rfesultats du Service M6dico-Chirurgical aux Ambulances de 
 Crim6e et aux H8pitaux Militaires FrauQais en Turquie pendant la Campagne d'Orient en 1854, 1855, 1856. Par 
 J. C. Chenu, D.M., M6decin Principal, Bibliotlificaire de 1' cole Imperiale de M§decine Militaire, Officier de la Lfegion 
 d'Honneur, etc. Paris : Victor Masson et Pils, 1865. 
 
INTRODUCTION. O 
 
 The surgical specimens of the Army Medical Museum number 5480; and not only 
 in specimens of recent injuries, but in illustrations of reparative processes after injury, 
 of morbid processes, of the results of operations, and of surgical apparatus and appli- 
 ances, this institution is richer, numerically at least, than the medico-military museums 
 of France or Great Britain. 
 
 The value of these materials has been foreshadowed in referring to their nature 
 and extent. It may be emphatically said that they throw much light on some of the 
 great moot points in surgery; that they comprise on some subjects, as, for example, on 
 the question of the propriety of excising the head of the femur for injury, fuller data 
 than are now extant in the entire range of surgical literature; and that it may be hoped, 
 without temerity, that they include the elements for the solution of many grave 
 surgical problems. 
 
 To render intelligible an account of the progress that has been made in collating 
 and classifying the surgical records of this office, and the collections of the Army 
 Medical Museum, it is requisite to review briefly the measures that have been adopted 
 by the Medical Department to gather and preserve the observations of the medical 
 officers of the Army, and to compile, in an available form, the results of their inquiries 
 and of their vast surgical experience in the late war. 
 
 In 1861, and during the first eight months of 1862, the "case book" and "regis- 
 ter," made obligatory by regulations, the monthly and quarterly reports of sick and 
 wounded, and the sanitary reports required of regimental surgeons, and of the surgeons 
 in charge of hospitals, were the channels through which medical officers communicated 
 such professional facts as they desired to place on record. These sources of informa- 
 tion have been decried in some quarters, and in an official report to this office,* in 
 July, 1863, it was declared that previous to September, 1862, "the surgical statistics 
 of the war were absolutely worthless," and that " the only information procurable 
 is such as can be derived from the examination of a mass of reports, all of which 
 present merely certain figures under the vague and unsatisfactory heading, 'Vulnus 
 sclopeticum.' " 
 
 That the surgical records of a period including the casualties of the first and 
 second battles of Manassas, the battles on the Chickahominy, Ball's Bluff, Cedar 
 Mountain, and Shiloh, and in which the returns from about one-half of the regiments 
 in the field give an aggregate of over thirty thousand cases of gunshot injury, were 
 deserving of such emphatic censure would be a source of grave regret, and it is gratify- 
 ing to be able to state that a careful re-exaraination of these records proves that they 
 contain a large amount of material that is far from valueless. The reports of the 
 Washington, Fort Monroe, Baltimore, and Philadelphia hospitals of the treatment of 
 the wounded from the Peninsular campaign, are replete with interest; the reports of 
 the hospitals at Alexandria give voluminous materials in regard to the wounded from 
 Cedar Mountain and the second Bull Run. The surgical records of the Fort Donelson 
 campaign are very complete. The returns of the casualties incurred in the operations 
 in North Carolina are satisfactory. The extracts from the case books of Surgeons Page 
 and Clements, and Assistant Surgeons Peters and Billings, of the Army, and of Sur- 
 
 * Consolidated Statement of Gunshot Wounds. Washington, July 1, 1863. Octavo, pp. 11. 
 
4 INTRODUCTIOK. 
 
 geons Neill, Bontecou, and Bently, of the Volunteers, give a multitude of observations 
 that throw light on some of the most important subjects in military surgery. 
 
 On May 21st, 1862, it was enjoined upon medical officers, by a circular order from 
 the Surgeon General's Office, to enter upon the monthly reports details in regard to the 
 surgical cases that came under their care, and to forward pathological specimens to the 
 Surgeon General's Office, with the view to the establishment of an Army Medical 
 Museum. 
 
 In June, 1862, a "tabular statement of gunshot wounds" was appended to the 
 monthly report of sick and wounded. A consolidation of these tables for the months 
 of September, October, November, and December, 1862, was published. The tabular 
 statements of the first two quarters of 1863 have been consolidated also, but it has not 
 been deemed expedient to publish them, because materials are on hand in which fewer 
 sources of error exist. 
 
 On March 25th, 1863, Circular No. 4, of the Surgeon General's Office, established 
 the "classified return of killed and wounded in battle." 
 
 On November 4th, 1863, by General Order 355, War Department, medical direc- 
 tors of armies in the field were directed to forward to this office duplicates of their 
 reports of killed and wounded; and, in promulgating this order, you instructed medical 
 directors to detail suitable officers to collate and prepare all obtainable statistics and 
 data in connection with past or future operations in the field that might be useful in 
 the accurate compilation of the medical and surgical history of the war, and you 
 directed the attention of all medical officers to this subject, and urged their co-operation 
 in the work. 
 
 Circular 26, of November 26th, 1863, S. G. 0., called the attention of medical 
 officers in charge of general hospitals to the importance of preserving representations 
 of the results of surgical operations for the Army Medical Museum. 
 
 It was found that the details in regard to wounds, accidents, and injuries, inserted 
 in the monthly and quarterly reports of sick and wounded, were insufficient, and that, 
 although the defects in the reports were supplied by those officers who diligently 
 recorded their cases in the registers and case books, yet such fidelity was not univer- 
 sal, and the histories of many cases were meagre or imperfect, or omitted altogether. 
 It was considered that the register in use was too bulky for field service, and too small 
 for the requirements of general hospitals. A board of medical officers was accordingly 
 directed to recommend a new form of register. The recommendations of the board 
 were approved, and small portable registers were issued to medical officers in the field, 
 while to each general hospital two large folio volumes were distributed, one as a register 
 of sick and wounded, the other as a register of surgical operations. These registers 
 contained minute directions as to the form in which cases should be entered under 
 appropriate headings. The form of the register of sick and wounded is illustrated in 
 the portion of this report that refers to injuries of the head, and the form of the 
 register of surgical operations is given in connection with the subject of excisions of 
 the head of the femur. To assist in the compilation of these registers, a new form of 
 bed-card was adopted. Blank forms of quarterly reports of wounded and of surgical 
 operations corresponding with the registers were prepared, and, on December 26th, 1863, 
 by a special circular from this office, the officers in charge of general hospitals were 
 
INTRODtrCTION. 
 
 5 
 
 required to fill up these forms for the months of October, November, and December, 
 
 1863. In January, 1864, the new registers were introduced in all the general hospitals, 
 the "consolidated statement of gunshot wounds" was discontinued, and a quarterly 
 transcript from the registers of all cases of wounds or of operations was required. 
 
 The new system has been found to work well, and the surgical records of the last 
 quarter of 1863, and for 1864-65, are believed to possess a higher degree of statistical 
 accuracy than has heretofore been attained. 
 
 Early in 1864, the new forms of reports of wounds and operations began to arrive 
 at this office, and the work of transcribing and classifying their contents began. The 
 cases of wounds were recorded in ten books, the new hospital registers being used for 
 this purpose. The classification was as follows: nine volumes of gunshot injuries, viz.: 
 1. Wounds of the Head and Pace. 2. Wounds of the Neck and Chest. 3. Wounds of 
 the Abdomen, Back, and Spine. 4. Wounds of the Perineum and Genito-Urinary 
 Organs. 5. Fractures of the Upper Extremities. 6. Fractures of the Lower Extrem- 
 ities. 7. Flesh Wounds of the Upper Extremities. 8. Flesh Wounds of the Lower 
 Extremities. 9. Wounds of Arteries, Veins, and Nerves; and a tenth volume embrac- 
 ing Sword, Bayonet, and Miscellaneous Wounds. The cases of operations were recorded 
 in five books, viz.: 1. Amputations in the Continuity. 2. Amputations in the Con- 
 tiguity. 3. Excisions. 4. Ligations. 5. Miscellaneous Operations. On September 1st, 
 
 1864, there had been transcribed upon these registers the histories of 30,435 wounds, 
 and of 1179 operations. 
 
 It was objected to this mode of registration, that injuries of the gravest and most 
 trivial nature were confounded, and that the great mass of materials contained in the 
 special reports, which medical officers had been encouraged to forward, was entirely 
 omitted from the records. The least important cases received as much attention as 
 the most serious, or even more, because the patients with trifling wounds were more 
 likely to be transferred from hospital to hospital, and their histories were traced with 
 greater difficulty. Moreover, the registers, though well adapted to the requirements of 
 hospitals, were unsuitable for permanent records, the space being inadequate for the 
 requisite details of important cases, or for summaries of the treatment and results in 
 cases protracted through several quarters. 
 
 It was therefore determined that an efibrt should be made to arrange the reoords 
 in a form more convenient for reference and study. In the first place, the early returns 
 of the war were examined, and cases of the more important injuries were gleaned from 
 them, and tabulated upon the new form of surgical reports. This work was of neces- 
 sity performed by medical officers, or by clerks possessing a competent share of surgical 
 information. In October, 1864, suitable books of record having been procured, the 
 task of revising the surgical records began. It was decided to make numerous sub- 
 divisions, and, while avoiding impracticable refinements, to group together similar 
 classes of injuries. On the new registers were entered, in the first place, the cases 
 extracted from the early reports. Then the registers in use were examined, and the 
 category in which each case should be placed was indicated ; or, if from lack of pre- 
 cision in the report this was impossible, additional information was sought from the 
 source from which the report had originated. Thus the cases recorded in the register 
 of gunshot wounds of the head and face were distributed in six registers, viz.: those 
 
6 
 
 INTRODUCTION. 
 
 of Fractures of the Cranium, of Fractures of the Bones of the Face, of Fractures of the 
 Vertebrae, of Scalp "Wounds, of Flesh Wounds of the Face, and of Flesh Wounds of 
 the Neck. Especial attention was given to collecting all the information on file in the 
 ofl&ce in relation to gunshot wounds of the three great cavities, gunshot fractures of 
 the femur, and the less common surgical operations. The histories of several thousand 
 specimens at the Army Medical Museum, that had been forwarded prior to the adop- 
 tion of the new system of reports, were tabulated upon the proper forms and tran- 
 scribed upon the records; and, on the other hand, the records were found to furnish 
 histories for many later specimens that had been forwarded without memoranda. An 
 endeavor was made to,. co-ordinate and harmonize these data. 
 
 The following classification of wounds and their results and of operations was finally 
 adopted. It is less elaborate than that employed in the British statistics of the surgery 
 in the Crimea, and more detailed than that followed by M. Chenu, in the French sur- 
 gical report of the Crimean war. The appended figures give the number of cases of 
 each class that were revised and corrected upon the new registers on September 30th, 
 1865. 
 
 Classification of Wounds and Injuries, and their Results, 
 followed in the Division of Surgical Records S. G. 0. 
 
 Gunshot Fractures and Injuries of the Cranium.... 
 
 Gunshot Fractures of the Bones of the Face 
 
 Gunshot Fractures of the Spine, not iuTolving the 
 
 Chest or Abdomen 
 
 Gunshot Fractures of the Kibs, without injury of 
 
 the Thoracic or Abdominal Viscera 
 
 Gunshot Fractures of the Pelvis, not involving the 
 
 Peritoneal Cavity 
 
 Gunshot Fractures of the Scapula and Clavicle, 
 
 not implicating the Thoracic Cavity 
 
 Gunshot Fractures of the Humerus 
 
 Gunshot Fractures of the Radius and Ulna 
 
 Gunshot Fractures of the Carpus and Metacarpus. 
 
 Gunshot Fractures of the Femur 
 
 Gunshot Fractures of the Patella and Knee- Joint.. 
 
 Gunshot Fractures of the Tibia and Fibula 
 
 Gunshot Fractures of the Tarsus and Metatarsus... 
 Gunshot Penetrating Wounds of the Chest, and in- 
 juries implicating the Thoracic Viscera 
 
 Gunshot Penetrating Wounds of the Abdomen, and 
 
 injuries involving the Abdominal Viscera 
 
 Gunshot Scalp Wounds 
 
 Gunshot Flesh Wounds of the Face 
 
 Gunshot Wounds of the Neck 
 
 Gunshot Wounds of the Thoracic Parietes 
 
 Gunshot Wounds of the Back 
 
 Gunshot Wounds of the Abdominal Parietes 
 
 Gunshot Wounds of the Genito-Urinary Organs 
 
 Gunshot Wounds of the Upper Extremities 
 
 Gunshot Wounds of the Lower Extremities 
 
 Gunshot Wounds of Arteries 
 
 Gunshot Wounds of Veins 
 
 Gunshot Wounds of Nerves 
 
 Sabre Wounds 
 
 Bayonet Wounds 
 
 Simple Fractures, and Miscellaneous Wounds and 
 
 Injuries 
 
 Cases of Tetanus 
 
 Cases of Secondary Haemorrhage 
 
 Cases of PyEemia 
 
 1108 
 1579 
 
 187 
 
 180 
 
 397 
 
 2408 
 
 785 
 
 790 
 
 1957 
 
 1220 
 
 1056 
 
 629 
 
 2303 
 
 565 
 
 3942 
 
 2588 
 
 1329 
 
 4759 
 
 5195 
 
 2181 
 
 468 
 
 21,248 
 
 25,152 
 
 44 
 
 8 
 
 76 
 
 106 
 
 143 
 
 2883 
 363 
 
 1035 
 754 
 
 Total 87,822 
 
 Classification of Surgical Operations followed in the Division 
 of Surgical Records S. G. 0. 
 
 Amputations of the Fingers 
 
 Amputations at the Wrist-Joint 
 
 Amputations of the Forearm 
 
 Amputalions at the Elbow-Joint 
 
 Amputations of the Arm , 
 
 Amputations at the Shoulder-Joint , 
 
 Amputations of the Toes 
 
 Amputations of the Foot (Partial) 
 
 Amputations at the Ankle-Joint 
 
 Amputations of the Leg 
 
 Amputations at the Knee-Joint 
 
 Amputations of the Thigh 
 
 Amputations at the Hip-Joint 
 
 Excisions of the Head of the Humerus 
 
 Excisions of the Elbow 
 
 Excisions of the Wrist 
 
 Excisions of the Ankle 
 
 Excisions in the Contin- f |^^!' "^ Humerus.. 
 
 uity of the Upper Ex-j ^f^^"^ 
 
 I Radius and Ulna... 
 
 tremities. 
 
 Excisions of the Shafts of [ Z\^^^, 
 
 the Tibia and Fibula i]??^^ "j^i;-;"";""" ^ 
 
 L Tibia and Fibula.. 
 
 Excisions of the Knee 
 
 Excisions of the Shaft of the Femur 
 
 Excisions of the Head of the Femur 
 
 Excisions of Bones of the Face or Trunk 
 
 Trephining 
 
 Ligations of Arteries 
 
 Extractions of Foreign Bodies 
 
 Operations for Surgical Diseases 
 
 Operations not included in other categories .... 
 
 Total. 
 
 1849 
 
 46 
 
 992 
 
 19 
 
 2706 
 
 437 
 
 802 
 
 160 
 
 73 
 
 3014 
 
 132 
 
 2984 
 
 21 
 
 575 
 
 315 
 
 34 
 
 22 
 
 695 
 
 220 
 
 11 
 
 68 
 
 32 
 
 101 
 
 221 
 
 404 
 
 726 
 
 443 
 
 23 
 
 17,125 
 
INTRODUCTION. / 
 
 Some observations on each of these classes will be oflfered in another portion of 
 this report. 
 
 The several circulars requesting medical officers to forward preparations to the 
 Array Medical Museum met with very general and liberal responses, and, in January, 
 
 1863, a numerical list of 1248 surgical specimens was published by this office. Shortly 
 afterwards, a suitable building was procured, and cases were erected in it for the recep- 
 tion of specimens. Several artists were engaged: a colorist to prepare illustrations of 
 surgical pathology and representations of remarkable injuries; a draughtsman to make 
 maps and plans; and two engravers. The requisite workshops were connected with the 
 Museum. A medical officer was detailed to describe and classify the preparations. In 
 short, this branch of the office was rapidly augmenting in importance. At the end of 
 
 1864, the number of specimens had quadrupled. Among the later specimens a large pro- 
 portion of illustrations of reparative and morbid processes and of the results of operations 
 wfere included. A valuable collection of drawings had been accumulated; draughtsmen 
 having been sent to battle-fields and hospitals to portray the effects of recent wounds, 
 or the results of surgery. A photograph gallery was now established at the Museum. 
 Typical specimens were reproduced, and the photographs, accompanied by brief printed 
 histories, were distributed to medical directors, to be shown to the medical officers 
 serving with them, in order that the knowledge to be obtained from a study of these 
 instructive examples might be generally disseminated. Other preparations were pho- 
 tographed for the use of the engravers. Many of them are reproduced in this report. 
 Numerous patients in hospitals were photographed, and the Museum now possesses 
 four quarto volumes, with over a thousand photographic representations of wounded or 
 mutilated men. Meanwhile the work of describing and classifying the collections at 
 the Museum has been steadily pursued, and the descriptive catalogue is now nearly 
 ready for publication. 
 
 To state, then, in brief, what the records of the surgery of the late war are, and 
 what progress has been made in their arrangement, over 40,000 monthly regimental 
 reports of sick and wounded are on file, which furnish, under Class V.,* the total 
 number of wounds, accidents, and injuries in the army, and the' resulting mortality, as 
 ascertained by the regimental medical officers, and which, having served their purpose 
 of informing military commanders, month by month, of the extent of the losses in 
 their commands, by the casualties of war, are now available for estimating the entire 
 losses of the army from diseases and wounds. These reports have been consolidated 
 for the first two years of the war and for the greater portion of the third year. But, 
 as a certain number of regimental medical officers failed to make the required reports, 
 it is necessary to correct these results by other numerical returns. Prior to September, 
 1862, these are only to be sought in special reports and case books of hospitals, and in 
 the reports by medical directors of battles and minor engagements. It is found that 
 these supply the deficiencies of the regimental returns to a satisfactory degree. For 
 the latter part of 1862, and the whole of 1863, the "tabular statements of gunshot 
 wounds" give the number of such injuries, separated according to regions, and the 
 
 * The form of the Report of Sick and Wounded being printed in the accompanying Report on the Medical 
 Statistics of the War, it is not inserted here, 
 
INTRODUCTION. 
 
 number of operations to which they gave rise. These tabular statements have been 
 consolidated for the entire period, and the results for 1862 have been published. After 
 March, 1863, consolidated classified returns of vrounds and injuries were rendered, 
 after every engagement, by the medical directors of armies or detached commands. 
 This series is very complete. It serves as a check upon the monthly reports, and as a 
 basis for estimating the frequencj?^ and fatality of wounds according to regions, and the 
 total losses of the army in killed and wounded for the period covered by the returns. 
 These results are not yet worked out, although satisfactory progress has been made 
 towards their attainment. Throughout the war, many medical directors had trans- 
 mitted to this office nominal lists of the wounded in battle; but after November 4th, 
 1863, this was made obligatory. After October 1st, 1863, all general hospitals 
 reported by name all wounded men received, and gave full details of their injuries. 
 From these two sources nearly complete lists of the wounded for the last two years of 
 the war have been procured; for the names of those who died before reaching the base 
 or general hospitals are found on the battle-field casualty lists. The progress that 
 has been made in classifying and collating these returns has been already indicated. 
 It will appear, hereafter, that the additional information afforded by case books and 
 special reports has not been neglected. 
 
 The formal reports of medical directors of armies give a general view of the oper- 
 ations of the Medical Department. For the Army of the Potomac, the reports of Med- 
 ical Directors Tripler, Letterman, and McParlin furnish a connected narrative of the 
 services rendered by the medical staflf. For the Western armies, the reports of Medical 
 Directors McDougall, Murray, Cooper, Perin, Moore, and Hewit afibrd similar informal 
 tion. These papers will guide the future historiographer of the surgery of the war, 
 and enable him to put in evidence the immensity of the task that devolved on the 
 Medical Department, and to vindicate its achievements, in showing the extent of the 
 succor given to the wounded in despite of almost incredible obstacles. Besides these 
 authoritative documents, there are on file in the office, to serve as supplementary 
 reports, individual narratives of observations in active service from each member of the 
 regular or volunteer medical staff. The remaining papers for reference are the reports 
 of boards on surgical improvements and appliances, or methods of transport for the 
 wounded; 17,000 descriptive lists of surgical cases; 4200 reports from the manu- 
 facturers of artificial limbs of cases of recovery after amputation; and the surgical 
 essays and dissertations that have been contributed. All of these have either been 
 bound, or indexed and filed in a convenient and accessible form. Lastly, the great 
 treasures of the Army Medical Museum, comprising over five thousand illustrations of 
 military surgery, have been so far classified and arranged as to be available for scientific 
 inquiry. 
 
ON SPECIAL WOUNDS AND INJURIES. 
 
 It is now proposed to review briefly the records of special wounds and injuries, of 
 some of their complications, and of the operations which they have rendered necessary. 
 
 GUNSHOT INJURIES OF THE HEAD. 
 
 In this important class of injuries, the utmost pains has been taken to secure com- 
 pleteness and accuracy in the records. The registers have been copied by experienced 
 clerks, and have been supervised by a medical officer. Exclusive reliance has not been 
 placed upon the field and hospital reports; but in a large proportion of cases, specific 
 inquiries in regard to the extent and results of individual injuries have been made by 
 letter. 
 
 All, or nearly all, cases of gunshot injuries of the head that have been reported to 
 the office from the commencement of the war to October 1st, 1864, have been entered 
 in the records. They number 5046, and have been recorded in two classes : first, the 
 gunshot fractures and injuries of the cranium, including the perforating and penetra- 
 ting and depressed fractures, the fractures without known depression, and the contusions 
 of the skull resulting in lesions of the encephalon; and, secondly, the simple contusions 
 and flesh wounds of the scalp. 
 
 It is quite possible now to establish subdivisions in the first class; but to have 
 attempted this heretofore, would have been premature, and likely to produce confusion. 
 
 In the first class 1104 cases are recorded. Of 604 of them, of which the results 
 have been ascertained, 505 died and 199 recovered. In 107 of these terminated cases 
 the operation of trephining was performed, of which 60 died and 47 recovered. In 
 114 cases fragments of bone or of foreign substances were removed by the elevator or 
 forceps, without the use of the trephine; and of these 61 died and 53 recovered. When 
 operative procedures were instituted, the recoveries were 45"3 per cent. But it must 
 be apprehended that this favorable exhibit will be materially modified when a larger 
 number of results are ascertained, and that a great proportion of the field operations of 
 trephining, in which the results are stated to be undetermined, were lost sight of, and 
 terminated fatally. In the 483 cases treated by expectancy, the ratio of recovery is 
 only 20'5 per cent. But the latter group of cases includes nearly all of the penetrating 
 and perforating fractures, and it would be unwise to base on these figures an argument 
 in favor of operative interference. 
 
 The gunshot contusions and wounds of the scalp that have been entered on the 
 records number 3942, of which 103 terminated fatally. It is altogether probable that 
 in all of these fatal cases some undiscovered injury was done to the cranium or its 
 contents; or that the pericranium was removed, and death of bone ensued, with con- 
 secutive lesions of the encephalon. The histories of many of these cases are now under 
 investigation. So far as ascertained, the fatal results have depended upon concussion 
 or compression of the brain, or upon the formation of abscesses in the liver or lungs, in 
 
 2 (9) 
 
10 
 
 ON SPECIAL WOUNDS AND INJURIES. 
 
 Fig. 1. — Section of a cranium, exhibiting five trephine per- 
 foration9 tor tho evacuation of pua, the result of a gun- 
 shot contusion of the right parietal. Slpec. 2000, A. M. M. 
 
 consequence of inflammation in the veins of the diploe. Compression has resulted 
 either from extravasation of blood, or inflammation of the brain or its membranes, or 
 from suppuration. The following is an example of a scalp wound, followed by inflam- 
 mation of bone and meningitis : 
 
 Private Joseph E , Co. E, 151st New York Vols., received, 
 
 in a reconnoissance near the Eapidan, November 27th, 1863, a gunshot 
 wound of the scalp. The nature of the missile was unknown. The 
 patient was removed to Fairfax Seminary General Hospital near Alex- 
 andria. There were no cerebral symptoms at the time of hiS admission, 
 and it was hoped that the pericranium had escaped uninjured. He was 
 up, and apparently well on December 13th, 1863, when he was suddenly 
 seized with convulsions, which were followed by coma. Surgeon D. P. 
 Smith, U. S. Vols., laid bare the calvaria at the seat of injury, and 
 finding the bone diseased, applied the trephine. Matter was found 
 immediately beneath the bone and oozing from the diploe. It was thought 
 expedient to make five perforations with the trephine, in order to remove the diseased bone and to give free exit to 
 pus. Convulsions did not recur, but the comatose condition continued, and the case terminated fatally twelve hours 
 after the operation. The autopsy revealed diffuse inflammation of the arachnoid and of the dura mater. 
 
 The foregoing case illustrates the fallacy of Pott's views in relation to trephining 
 for pus under the skull-cap; and yet, under such circumstances, the best modern 
 authorities advise the use of the trephine as affording the patient the only chance of 
 recovery. The records attest how slight this chance is, and corroborate the observation 
 of Mr. Hewett, that "the successful issue of a case of trephining for matter between 
 the bone and the dura mater is almost unknown to surgeons of our own time."* 
 
 The Army Medical Museum furnishes very ample illustrations of almost every 
 variety of gunshot injury of the skull and its contents. The number of osteological 
 specimens relating to this class of injuries is 246, of wet preparations 22, of drawings, 
 photographs, engravings, and plaster casts 97. 
 
 There are 22 specimens of gunshot contusion of the cranium. In these, either 
 necrosis has taken place, with exfoliation of the external table only, or of the entire 
 thickness of the bone, or else inflammatory suppuration has occurred in the diploe or 
 between the skull and dura mater. 
 
 The Museum possesses eight examples of that rare and interesting variety of 
 
 gunshot fracture of the cranium, in which the external table 
 is unbroken, while the vitreous table is fissured and some- 
 times depressed. One of the most perfect of these specimens 
 (No. 1568, A. M. M.) is figured in No. 94, Photographic 
 Series, S. G. 0. An abstract of the case is subjoined: 
 
 Private David P , Co. C, 3.5th Wisconsin Vols., was wounded at Tupelo, 
 
 Mississippi, July 18th, 1864, by a musket-ball, which struck the skull obliquely, 
 and apparently inflicted a scalp wound merely, between the sagittal suture and 
 the left parietal protuberance. There were no signs of cerebral disturbance. 
 The wound was dressed simply, and the patient was conveyed to Memphis, Ten- 
 nessee, and admitted into the Adams U. S. General Hospital on July 23d. He 
 was then perfectly rational and free from head symptoms. Two days subse- 
 quently, indications of compression of the brain were observed, and on the after- 
 noon of the 25th they had rapidly become aggravated. The pulse was slow, the respiration labored, the pupils dilated, 
 the sphincters relaxed. A very careful exploration of the wound was made, but, of course, no cranial fracture could 
 be detected. The treatment was limited to cold applications to the head, scarified cups to the nucha, and brisk purging. 
 On the 26th, the patient gradually became comatose. The discharges from the bowels and bladder were involuntary. 
 
 Fia. 2. — Section of ekuU-cap, exhibiting a de- 
 preBsed fracturooftlie vitreous table. Spec, 
 1668,A.M.M. 
 
 * A System of Surgery, Theoretical and Practical, in treatises by various authors, edited by T. Holmes, M.A. 
 Cantab. London, 1861. Vol. ii. p. 101. 
 
GUNSHOT INJURIES OF THE HEAD, 
 
 11 
 
 The patient continued to sink on the 27th, and died at 1 a.m. on the 28th of July. At the autopsy the internal table 
 of the left parietal was found to be fractured and depressed at a point corresponding 
 with the wound in the scalp. The dura mater was wounded, and there was a large 
 abscess in the left cerebral hemisphere. 
 
 / 
 
 ?? 
 
 \ 
 
 III 
 
 |i 
 
 \ 
 
 I, 
 
 !| 
 
 )'if 
 
 specimen. ' 
 
 No further particulars of 
 
 Fig. 5. — Exterior view of the fore- 
 going specimen. 
 
 In a specimen which is believed to be unique, without any 
 apparent lesion of the external table, a fragment of the vit- 
 reous plate of the frontal bone was found to be completely 
 detached and depressed upon the dura mater. The history in 
 this case is unfortunately imperfect. 
 
 Private A L , Co. 0, 78th New York Vols., was wounded by a co- 
 
 noidal musket-ball, at the battle of the Wilderness, May 6th, 1864, and entered 
 Armory Square Hospital, at Washington, on May 12th. He was in a comatose 
 condition when admitted, and died on May 24th, eighteen days after receiving the injury, 
 the case could be obtained. At the autopsy a fracture was 
 discovered of the inner table of the frontal bone, near the 
 coronal suture, to the left of the median line. There was no 
 solution of continuity in the outer table; but it was softened 
 where the pericranium was destroyed by the ball. A frag- 
 ment, an inch and a half in length and half an inch broad, 
 was completely detached from the vitreous table. The speci- 
 men was forwarded by Surgeon D. W. Bliss, U. S. Vols. 
 
 In a case which was observed by Sur- 
 geon Bontecou, U. S. V., who had examined 
 the specimens above referred to,' the proba- 
 bility of a depression of the vitreous table 
 was inferred, and the diagnosis was verified, during life, by the 
 application of the trephine. Unhappily, an abscess had formed 
 
 in the brain, and the operation, though performed as soon as evidence of compression 
 
 existed, was too late to save the patient. 
 
 Private D S — — , Co. E, 2d Virginia Cavalry, aged twenty-one, was 
 
 wounded at Appomattox Court House, April 6th, 1865, and admitted to Harewood 
 Hospital, at Washington, on April 19th, with a gunshot wound of the scalp, just 
 below the coronal suture. The bone was denuded of its pericranium, but there 
 was no apparent fracture. Prior to his admission, the patient had chills, which 
 recurred at intervals of twelve hours, until April 25th, quinia having no appre- 
 ciable influence upon the paroxysms. There was no pain in the head nor disturb- 
 ance of the cerebral faculties until April 26th. On the 25th, inflammation of the 
 lower lobe of the right lung was observed, and on the 26th, there was endocarditis. 
 At 10 P.M. of the 26th, the patient became unconscious. Shortly afterwards he was 
 trephined. When the external table was passed, pus exuded from the cells of the 
 diploe. A depressed fracture of the inner table was discovered, and the detached 
 fragments were removed. The patient did not arouse from his comatose state, and died the next morning, April 27th, 
 1865. A photograph of this patient, prior to the operation, was preserved at the Museum. (Photo. Surg. Cases, 
 vol. i. No. 58.) 
 
 Specimens 3639, 3406, 622, 1922, and 646, A. M. M., afford other examples of this 
 rare form of injury, to which S. Cooper,* Guthrie,f Hennen,J Hewett,§ Williamson,|| 
 and Legouest^f allude, illustrating their observations by a case examined by Mr. Dean, 
 of Cambridgeshire, a specimen in the Dupuytren Museum, which is figured in M. 
 Legouest's work, and specimen No. 2893 of the Netley Collection. 
 
 Fig. 4. — Fracture of the vitreous table 
 of the froutal bone, without frac- 
 ture of the external table. «^ec. 
 2313, A. M. M. 
 
 Section of cranium, showing a de- 
 pressed fracture of the vitreous table. 
 There was a contusion only of the out-er 
 table. Spec. 4344, A. M. M. 
 
 * S. Cooper, Dictionary of Practical Surgery. 
 t Hennen, Military Surgery, p. 326, ed. 1829. 
 II Williamson, Military Surgery, pp. 29, 30. 
 J Legonest, Trait6 de Chirurgie d'Arm^e, p. 283. 
 
 t Guthrie, Commentaries, paragraph 262. 
 ? Holmes' System of Surgery, vol. ii. p. 114. 
 
 See^also Compendium de Chirurgie, t. ii. p. 573. 
 
12 
 
 ON SPECIAL WOUNDS AND INJURIES. 
 
 It is believed that this accident results, in most instances, from a small projectile 
 striking the cranium very obliquely, or possibly, in some cases, from a comparatively 
 slight blow from a body with a large plane surface. 
 
 Closely allied, clinically, to the foregoing cases are those in which a ball produces 
 linear fissure of the external table with displacement of the inner table. Specimen 
 No. 24, of the Army Medical Museum, affords an excellent illustration. The following 
 is an abstract of the case : 
 
 Private M L. H , Co. B, 21st Virginia (Rebel) Regiment, aged twenty years, was wounded and taken pris- 
 oner in one of the later engagements prior to the capitulation of the Army of Northern Virginia, and was admitted 
 
 into the Lincoln General Hospital, 
 at Washington, on March 25th, 1865, 
 with a wound over the left supra- 
 orbital ridge, inflicted apparently by 
 a glancing musket-ball. There were 
 no cerebral symptoms when the pa- 
 tient was admitted, and he seemed to 
 be doing well for several days, being 
 quite free from pain or any febrile 
 movement. The pulse was normal 
 and the bowels in good condition. 
 On April 1st, he complained of a dull 
 deep-seated pain over the left eye. Later in the day he was feverish and restless, his countenance was pale, and his 
 pulse slow and weak. On April 2d, he failed rapidly. On the night of the 3d, he was delirious. On the 4th, there was 
 violent raving, which continued until his death, on the afternoon of April 5th, 1865. At the post-mortem examination, 
 a fissure was found extending into the right orbit, and upwards beyond the left frontal prominence. The vitreous 
 
 J- 
 
 m 
 
 Fig. 7. — Section of the frontal bone exhibiting a 
 fissure over the left supra-orbital region. Sgee. 
 24, A. M. M. 
 
 Fio. 8. — I nternal view of the foregoing specimen, show- 
 ing the extensive splintering of the vitreous table. 
 
 table beneath was largely depressed. 
 
 -Gunshot fracture of right temporal. 
 Spas. 183, A. M. M. 
 
 There was a small abscess in the anterior lobe of the left cerebral hemisphere. 
 
 Of fractures without depression, the cases in which 
 the mastoid process is knocked ofi" by a ball afford ex- 
 amples. Specimen 183, A. M. M., is a very perfect 
 illustration of this accident. The mastoid cells were 
 opened. After a fortnight, meningitis supervened. 
 Specimen 3451 was furnished by a fortunate case of 
 recovery after a fracture of the mastoid process. 
 
 Private William F , Co. G, 98th Pennsylvania Vols., was wounded 
 
 near Fort Stevens, Washington, July 12th, 1864, by a glancing shot from 
 a conoidal musket-ball, and was admitted into Mount Pleasant Hospital 
 on the following day. A little above the right auditory meatus was a 
 scalp wound an inch and a half long. A piece of the mastoid process 
 fracture extended into the petrous portion of the temporal. The patient did well with simple 
 dressings and rest and gentle cathartics till the 20th of July, when the wound began 
 to slough. Applications of nitric acid, creosote, etc., failed to arrest the sloughing, 
 which presently gave rise to repeated haemorrhages from branches of the temporal 
 artery. The gangrene continued to spread until August 9th, when the eschars sepa- 
 rated, leaving a space five inches in diameter on the right lateral region of the head, 
 denuded of integument, fascia, and muscles. During this long period, the patient 
 complained of no inconvenience at the seat of fracture, though there was at times 
 acute frontal pain. Early in September, it was evident that the exposed portions of 
 the temporal and parietal bones were necrosed, and on September 6th a fragment of 
 the squamous portion of the temporal was removed. Two days subsequently other 
 fragments were detached and extracted. After this the wound began to cicatrize 
 rapidly, and on December 3d, 1864, the patient was reported to be entirely out of danger, and in fact nearly well. 
 
 Several cases of undepressed fracture are reported in which a ball gouged out a 
 small portion of the external table. A number of instances are recorded in which con- 
 
 was chipped ofi^, and a 
 
 li'IG. 10. — Exfoliation from the rifrht pari- 
 etal and temporal, resulting from gun- 
 shot injury, Sptc. 3451, A. M. M. 
 
GUNSHOT INJURIES OF THE HEAD. 
 
 13 
 
 siderable portions of the calvaria have been removed by explosions of shell, without 
 depression. Very rarely a musket-ball produces the same effect, as in the following 
 remarkable case. The patient is represented in Photograph No. 58, A. M. M. : 
 
 Private Edson D. Bemis, Co. K, 12th Massachusetts Vols., was wounded at Antietam by a musket-ball, which 
 fractured the shaft of his left humerus. The fracture united kindly, with very slight angular displacement and quarter 
 of an inch shortening. Promoted to be corporal, Bemis received. May 6th, 1864, at the battle of the Wilderness, 
 a wound from a musket-ball in the right iliac fossa. He was treated in the Chester Hospital, near Philadelphia. 
 There was extensive sloughing about the wound, but it ultimately healed entirely, leaving a large cicatrix, parallel 
 with Poupart's ligament. Bight months after the injury, Bemis returned to duty with his regiment. On February 
 5th, 1865, Corporal Bemis was again severely wounded at the engagement at Hatcher's Bun, near Petersburg, Vir- 
 ginia. Surgeon A. Vanderveer, 66th New York Vols., reports that the ball entered a little outside of the left frontal 
 protuberance, and passing backwards and upwards, removed a piece of the squamous portion of the temporal bone, 
 with brain substance and membranes. When the patient entered the hospital of the 1st Division of the 2d Corps, 
 brain matter was oozing from the wound. Respiration was slow ; the pulse 40; the right side paralyzed; insensi- 
 bility total. On February 8th, the ball was removed from the substance of the left hemisphere. In a few days paraly- 
 sis disappeared. The patient was transferred to Fort Richmond, New York Harbor. -He recovered perfectly, and on 
 July 15th visited Washington, and was photographed at the Army Medical Museum. The wound in the head was 
 then nearly healed. There was a slight discharge of healthy pus from one point. The pulsations of the brain could 
 be felt through the integument. The mental and sensory faculties were unimpaired. The corporal had been discharged 
 from service, and recommended for a pension.' 
 
 From the numerous instances of fracture with depression of both tables of the 
 skull, a very few are selected. The first is an example of a common class of cases, in 
 which symptoms of compression of the brain depend upon extravasation of blood, or 
 inflammation of the membranes, and come on tardily. 
 
 Private Leonard L , Co. F, 74th New York Vols., was wounded at the battle of Williamsburg, May 5th, 1862, 
 
 and was admitted into Broad and Cherry Streets 
 Hospital, at Philadelphia, May 13th, 1862. A 
 musket-ball had struck near the left parietal emi- 
 nence, and, producing a slight depression of the 
 outer table, had lodged under the scalp, whence it 
 had been removed by a surgeon on the field. The 
 wound had a healthy aspect when the man was ad- 
 mitted, and there was no cerebral disorder. This 
 favorable condition continued unaltered till May 
 20th, when a febrile movement set in, accompanied 
 by nausea and vomiting ; drowsiness and stupor 
 followed, and the patient died comatose on May 
 23d, eighteen days after the injury. At the autopsy, 
 a small clot was found beneath the depressed portion of the vitreous plate ; the dura mater was uninjured ; the arach- 
 noid, near the seat of injury, was opaque, and studded with deposits of lymph ; the gray matter of the brain was 
 softened. 
 
 Private George V , Co. C, 84th New York Vols., was wounded at Chancellorsville, May 3d, 1863, and admitted 
 
 into Carver Hospital, at Washington, D. C, on May 7th, 1863. His injury was supposed to be a simple scalp wound 
 
 from a musket-ball. It was situated over the 
 right parietal protuberance, and, on admission, 
 was granulating kindly. Ten days subsequent^ 
 ly, the patient, after a walk out of doors, had 
 headache and nausea, and the wound gaped, 
 and its edges ulcerated. On the 18th of May, 
 the probe detected denuded bone; but no frac- 
 ture was discovered. There were no febrile or 
 cerebral symptoms. On May 20th, a depres- 
 sion of the outer table of the skull was de- 
 tected. At night there was delirium, and the following day the pulse became feeble and irregular, the stomach irritable, 
 the tongue heavily furred. The patient died on May 22d, 1863, being conscious and rational to the last. At the 
 autopsy, extensive inflammation of the dura mater was observed, and softening of the middle lobe of the right cerebral 
 hemisphere. 
 
 r.|p|r™^^ 
 
 Fig 11 — Portion of left parietal, showing 
 a slightly depressed fracture of the 
 outer table. Spec. 224, A. M. M. 
 
 Pig. 12. — Interior view of the foregoing 
 specimen, exhibiting extensive splinter- 
 ing of the vitreous table. 
 
 FiG.13.—<3unshot fracture of the right pari- 
 etal bone. Spec. 1257, A. M. M. 
 
 Fig. 14. — Iiitniur view of the foregoing 
 specimen. 
 
14 
 
 ON SPECIAL WOUNDS AND INJURIES. 
 
 Fig. 15. — Fracture of the fron- 
 tal bone by a pistol-ball. 
 Spec. 1673, A. M. M. 
 
 Fig. 16. — Interior view of the 
 foregoing specimen. 
 
 The next case is an example of the classical "punctured" gunshot fracture of 
 
 systematic writers. 
 
 Private James K , Co. G, 6th New York Cavalry, was 
 
 wounded at the battle of Gettysburg, July Sd, 1863, by a pistol-ball, 
 which produced a punctured fracture of the os frontis. He was con- 
 veyed to a hospital at Baltimore, and from thence to Carver Hos- 
 pital, at Washington, on July 24th. He stated that, at Baltimore, 
 he walked about and felt no inconvenience from his wound. On 
 July 27th, he had a convulsion. The wound, which was nearly 
 healed, was laid open, and depressed bone being detected, an effort 
 was made to elevate it. Several small necrosed fragments Were re- 
 moved, and a small quantity of fetid pus escaped. The patient had 
 become comatose, and the operation bad no influence in relieving 
 the symptoms. Death took place a few hours subsequently. 
 At the autopsy, the extended depression of the inner table was discovered, and a large abscess of the brain. 
 
 Instances were not uncommon of the splitting of round musket^balls in striking the 
 skull at an acute angle. The following is an example : 
 
 Corporal John N , aged eighteen years, Co. H, 159th New York 
 
 Vols., was struck on the left side of the forehead, on April 14th, 1863, 
 at an engagement at Irish Bend, Louisiana, by a round musket-ball. 
 He was admitted to the University Hospital, at New Orleans, on April 
 17th. The ball had been removed on the field. Several depressed frag- 
 ments of bone were removed, and cold water-dressings were applied. 
 The case progressed without a bad symptom until April 30th, when 
 there were clonic spasms, which, after a few hours, were followed by a 
 semi-comatose condition, which continued until death, on May 2d, 1863. 
 A necroscopic examination revealed extensive meningitis, and a large 
 abscess of the left cerebral hemisphere. The lateral ventricles were 
 filled with sero-purulent matter. The surfaces of the pons Varolii and 
 of the medulla oblongata were covered with lymph. The specimen was 
 forwarded by Assistant Surgeon P. H. Conner, U. S. A. 
 
 Conoidal balls were less liable to split after this fashion, yet such instances were 
 occasionally observed. 
 
 Private C. C. W , Co. I, 6th Wisconsin Vols., aged twenty^one years, was wounded at Spottsylvania, May 
 
 12th, 1864, and was admitted to Douglas Hospital, in Washington, four days subsequently. It was ascertained that 
 
 the cranium was fractured, but the symptoms were not urgent, being 
 limited to slight paralysis of the right upper extremity, and operative 
 interference was deferred. On May 31st, a conoidal musket-ball and 
 several fragments of the left parietal were removed by Assistant Surgeon 
 Wm. P. Norris, TJ. S. A. One large fragment of the vitreous plate was 
 pressing on the dura mater ; this was elevated and removed. The next 
 day symptoms of compression of the brain were manifested. An explo- 
 ration of the wound was made and a quantity of pus evacuated. On June 
 4th, 1864, twenty-three days after the injury, the case terminated fatally. 
 At the autopsy, the arachnoid was found little altered. There was an 
 abscess in the posterior lobe of the left hemisphere near the longitu- 
 dinal sinus, of the size of a walnut. Its walls were of a greenish-yellow 
 color. It communicated with the lateral ventricle. The right ventricle 
 There was a deposition of lymph at the base of the brain, extending from the 
 The specimen and facts connected with it were contributed 
 
 Fig. 17. — Section of ii IroQtal bone, with a split 
 mnsketbaU. Spec. 1293, A. M. M. 
 
 Fig. 18. — Sknll^ap, exhibiting gunshot fracture near the 
 vertex, by a conoidal musket-ball which has split against 
 the lamina of the left parietal. Spec. .3543, A. VL M. 
 
 was filled with sero-sanguinolent fluid. 
 
 medulla oblongata to the bifurcation of the optic nerves. 
 
 by Assistant Surgeon William Thomson, U. S. A. 
 
 The depressed' fractures produced by cannon-balls, or by the explosion of large 
 shells, were commonly attended by frightful comminution and disjunction of the sutures 
 and were almost always immediately fatal, and hence had little surgical interest. A 
 single example is given : 
 
GUNSHOT INJURIES OF THE HEAD. 
 
 15 
 
 Fio. 19, — Cranfdm fractured by the exploeioo 
 of an 11-inch 8heU. Spee. 2871, A. M. M. 
 
 A Confederate soldier was wounded in the demonstration on Washington, 
 July 17th, 1864, by a shell from one of the large guns of Fort Stevens, and was 
 admitted into Lincoln U. S. General Hospital, on that day, and died two hours 
 after admission. Over the anterior superior angle of the left parietal bone there 
 was an extended scalp wound. On reflecting the scalp, multiple depressed frac- 
 tures of the vault of the cranium came into view. The point of greatest depres- 
 sion is an inch to the left of the median line, near the coronal suture. The 
 depressed fragments measure from before backwards two inches, and from right 
 to left three inches, and involve both parietals and the os frontis. A fissure 
 runs through the squamous portion of the left temporal, and all the sutures of 
 this bone are separated. 
 
 There have been a very few extraordinary and excep- 
 tional recoveries after penetrating and perforating fractures of the cranium, and, in rare 
 instances, the fatal termination has been long delayed. In the following curious case, 
 the presence of a ball within the cranial cavity was unsuspected: 
 
 Corporal G. W. S . 12th Massachusetts Vols., aged twenty-nine years, was wounded at the battle of Fred- 
 ericksburg, December 13th, 1862, and was admitted to Camden Street Hospital, Baltimore, six days subsequently. 
 The humors of the right eye had been evacuated by a ball, which had likewise inflicted a slight wound of the lower 
 
 lid. The left eye was observed to be 
 unnaturally prominent, but its func- 
 tions were undisturbed. The patient 
 did not complain of pain or any in- 
 convenience, except a slight head- 
 ache. There were no cerebral symp- 
 toms, and no one suspected that the 
 
 projectile had entered the brain. The ,,„. 2i_Exterior view of the foregoing 
 wound healed kindly, and, after three Bpecimeo. 
 
 weeks, the man walked about the city habitually, with a hospital pass. 
 He appeared to be well, except that he had an occasional pain over the 
 left eye, until February 6th, 1863, when he had a chill, followed by a 
 febrile reaction. No marked cerebral disorder supervened, however, until February 10th, when delirium was noticed 
 at night. On the following day the patient was comatose, and at midnight of February 15th, he died. The autopsy 
 revealed a conoidal musket-ball wedged between the sphenoid and the left orbital plate of the frontal bone, and lying 
 in contact with the dura mater. The orbital plate was pressed inwards and fractured, and a fissure extended through 
 the superciliary ridge. Over the ball, at the base of the anterior lobe of the left hemisphere, was an abscess containing 
 two drachms of pus. The ball was incrusted by callus, and the opening it had made in entering through the walls 
 of the right orbit was greatly diminished by osseous deposition. . 
 
 In the next case, half of the ball had deeply penetrated the brain : 
 
 Sergeant J. N. H , Co. K, 19th Maine Vols., aged thirty-six years, was 
 
 strnck on the right side of the head, by a musket-ball, in a skirmish at Morton's 
 Ford, on the Bappahannock, February 6th, 1864. The ball was smoothly cut in 
 two, one-half lodging nnder the scalp, and the other passing into the brain. The 
 patient was perfectly rational until February 11th, when his mind wandered at 
 times. On the 12th, Surgeon Justin Dwinelle, 101st Pennsylvania Vols., ex- 
 tracted the fragment of the ball which had buried itself in the brain. Its track 
 communicated with the right lateral ventricle. The other portion of the ball 
 had been removed from under the scalp immediately after the injury. When 
 the patient recovered from the influence of the chloroform, he was rational, and 
 continued so for twenty-four hours or more. Coma gradually supervened, and 
 death took plac&«n February 15th. The left ventricle was found filled with pus. 
 
 A very remarkable case of perforating fracture of the skull, with recovery, is rep- 
 resented by No. 16 of the Surgical Series of Drawings, S. G. 0. The ball entered a 
 little to the right of the occiput, and passed out somewhat below and to the left of the 
 vertex. The intervening bridge of bone was about three inches wide. There had 
 been a cerebral hernia at the wound of exit, and, when the drawing was made, four 
 months after the reception of the injury, there was still a small tumor,^ covered by half- 
 
 Pia. 20. — Conoidal ball embedded between the sphenoid 
 and parietal bones. Spec. 11411, A. M. &L 
 
 Fio. 22. — Section of right parietal on which a 
 conoidal musket-ball has split. Sjjtic. 2121, 
 A. M. M. 
 
16 
 
 ON SPECIAL WOUNDS AND INJURIES. 
 
 formed cicatricial tissue. There was a firm depressed cicatrix at the aperture of entry. 
 There were no evidences of impairment of the cerebral faculties. At the time the 
 drawing was made, the man was employed as an orderly. 
 
 The next case illustrates Mr. Erichsen's remark that the greater splintering of the 
 inner table does not depend exclusively upon its greater density and brittleness, bnt 
 partly on the direction of the fracturing force. At the- aperture of exit, the outer table 
 is splintered more than the inner. In the same specimen the bones forming the right 
 orbit are fractured by contre-coup : 
 
 A soldier of Longstreet's Corps was killed in a charge upon a Union 
 battery, in the second battle of Manassas, August 29th, 1862, by a grapeshot 
 at short range. The cranium was picked up a year subsequently by Surgeon 
 P. Wolfe, 39th New York Vols., under an abatis near the stone bridge over 
 Bull Eun. The missile entered the left parietal near the lambdoidal suture, 
 and made its exit through the squamous portion of the temporal. 
 
 According to Mr. Teevan's experimental inquiries,* 
 
 the aperture of exit in gunshot perforations of the cranium 
 
 is always larger than the aperture of entry, because it is 
 
 „ „, „. „ . „.,. , ■ , . ruade by the ball plus the fragments of bone driven out 
 
 FiQ. 23. — Skull, exhibitiDg an extensive fracture J J^ ^ 
 
 bygrapestot. s^e.. 1318, A. M. M. ^^^^ ^j^g proximal table and the diploe. 
 
 While the number of fatal results after trephining are very great, tbe examples of 
 success are yet numerous. The data are not sufficiently complete to admit of fair 
 comparative analysis; still it is difficult to avoid the impression that a larger measure 
 of success has attended this operation in the late war, than the previous experience of 
 military surgeons would have led us to anticipate. Surgeon D. W. Bliss, U. S. Vols., 
 alone has reported eleven successes after the use of the elevator or trephine. Even in 
 those almost hopeless cases in which compression of the brain follows a gunshot injury 
 of the skull at a late date, instances of recovery are reported. 
 
 In the following case it is not likely that suppuration had occurred, a complication 
 that has rarely presented itself prior to the fifteenth day after the injury; but it can 
 hardly be doubted that meningitis was averted or relieved by tbe opportune employ- 
 ment of the trephine : 
 
 Private John McK , Co. H, 105th Pennsylvania Vols., was wounded at Petersburg, Virginia, June 14th, 
 
 1864, by a conoidal musket-ball, which struck the right side of the skull very obliquely, and produced a slightly 
 
 depressed fracture of the right parietal bone. He was admitted to Mount 
 Pleasant General Hospital, Washington, on June 24th, with the report that 
 the progress of the case had been so far eminently satisfactory. After ad- 
 mission, he was found to be insensible, and a few hours subsequently, con- 
 vulsions supervened in rapidly recurring paroxysms. Twelve ounces of 
 blood were taken from the temporal artery without apparent benefit. A 
 trephine was then applied to the seat of fracture, and, upon the removal of 
 a button of bone, a portion of the inner table was found slightly depressed. 
 This was elevated, and the patient soon afterwards regained consciousness. 
 On the 28th of June, the wound in the scalp became erysipelatous, and 
 before the inflammation subsided, there was extensive loss of substance of 
 the integuments and pericranium, denuding a large portion of the parietal 
 bone. Necrosis ensued, and embraced the whole thickness of the bone. In 
 September, 1864, a portion of the parietal, three inches by four, had become so much loosened that it was readily 
 removed. After this, cicatrization went on rapidly, and, at the date of the last report, December 2d, 1864, the wound 
 had contracted to an ulcer less than an inch in diameter. The patient's mental faculties were impaired somewhat, the 
 ward physician thought, but not to a great extent. The specimen was contributed by Assistant Surgeon C. A. McOall, 
 
 Fig. 24. — Exfoliation from the i ight parietal bone. 
 S^ec. 3462, A. M. M. 
 
 * British and Foreign Medico-Chirurgical Review, vol. xxxiv. p. 205. 
 
GUNSHOT INJURIES OF THE HEAD. 17 
 
 U. S. A. A colored drawing was made representing the appearance of the parts prior to the separation of the exfolia- 
 tion. (No. 74, Surgical Series of Drawings, S. G. 0.) 
 
 The occurrence of hernia or fungus cerebri is mentioned in connection with 18 
 
 cases of gunshot fracture of the skull, complicated by lacerations of the dura mater 
 
 and brain. In 4 of these cases, recovery took place without operative interference 
 
 with the protruding fungous mass, which, in these instances, gradually contracted, was 
 
 then covered by granulations, and finally cicatrized. In those cases in which bandaging 
 
 and compression were resorted to, cerebral oppression was soon manifested, and stupor 
 
 and coma eventually supervened. In those in which the tumor was sliced off, as usually 
 
 recommended, at the proper level of the brain, it was commonly speedily reproduced, 
 
 and death from irritation ensued. 
 
 Charles T , Co. H, 63d New York Vols., aged seventeen years, was admitted to Hospital No. 1, Frederick, 
 
 Maryland, on September 28th, 1862, with a fracture of the skull. He was wounded at Antietam, September 17th, 
 1862, by a conoidal musket-ball, which struck at the lower anterior angle of the right parietal, fractured both tables 
 of the cranium, and lodged under the scalp in the occipital region. The scalp was lacerated, and a dark pulsating 
 mass protruded in the wound. The left side of the body was paralyzed. The patient's mental faculties were unim- 
 paired. On September 29th, flaps of integument were reflected by a T-shaped incision. The ball and a number of 
 fragments of bone were removed, some of the latter being embedded in 
 the brain substance. The inner table was found badly splintered, but 
 the fracture of the external table was still more extensive. The pro- i**4 ■ 
 
 trading cerebral mass was shaved off. The rough edges of the frac- _rf-^ ^» ^ 
 
 f.nrAfl hntlA wrprA HTnAn+.lipil \\\r nn+.+ mo. fAPPPnn TVip fnllmffino- Aiw +I1A \^j *tiCf •£. ' 
 
 I 
 
 tured bone were smoothed by cutting forceps. The following day, the 0^ '^^i^ i, 
 
 paralysis was more complete than before the operation. There was | * i 
 
 S'^^. 
 
 Wfw" f 
 
 severe headache. The pulse was slow and weak. On October 3d, the 
 fungus was sprouting and sloughing. The left arm was powerless ; the 
 paralysis of the left leg was less complete. On October 4th, the hernia 
 
 was again sliced off, and gentle compression was applied. There was ^^ . . ^ _^p^- 
 
 great irritability and restlessness. On October 21st, the patient had \^ ^^* "^ 
 
 improved. His appetite was voracious. He was less irritable, and the 
 hemiplegia was much less complete. He was very sensitive to cold. ^o. 26.-Gnn,hot fractuiTT^ght parietal, followed by 
 The temperature of the left side was lower than that of the right. The necrosis. Spec. 3869, a. m. m. 
 
 fungus was of the size of a pigeon's egg. On November 17th, a dilata- 
 tion of the left pupil was first noticed. Sensation in the left leg, and partial control of the muscles had returned. 
 Since the last report the tumor of the brain had continued to grow and slough away, so that it remained of about the 
 same size. On December 7th, the report states that little change had taken place, except a gradual amelioration of 
 the hemiplegia, and improvement in regard to the fretfulness and irritability. On this day there was a severe chill. 
 After this, the patient never regained his accustomed readiness and clearness of mind. The discharge from the 
 wound became watery, unhealthy, and more copious. There was an exacerbation of fever every afternoon. On 
 December 17th, there was a severe convulsion, which lasted half an hour, and was terminated by death. 
 
 At the autopsy, an irregular portion of the right parietal, four inches in diameter, was found to be necrosed and 
 detached. The dura mater was much thickened in the vicinity of the fracture, and was adherent to the margins of 
 the healthy bone. Except in the immediate vicinity of the hernia, the brain matter appeared to be in a healthy state. 
 
 In looking over the registers of gunshot injuries of the head, two general facts are 
 noticed : First, that in the after-treatment of scalp wounds, a multitude of surgeons 
 did not consider spare diet, perfect rest, and antiphlogistic measures as of essential 
 importance; and, secondly, that in the treatment of cranial fractures, the general 
 tendency was to the practice recommended by Guthrie in regard to operative proce- 
 dures, rather than the more expectant plan insisted upon by the majority of modern 
 European writers on military surgery. The interest of the material and the importr 
 ance of the subject alike invite extended comment; but in this brief and cursory review, 
 the motto of Montaigne, je raconte, je ne juge pas, must be rigorously adhered to. A 
 few more cases of gunshot injuries of the head are appended, to illustrate the form of 
 the register of wounds now in use in the army. 
 
 3 
 
18 
 
 ON SPECIAL WOUNDS AND INJURIES. 
 
 Hospital. 
 
 Hygeia Hospi- 
 tal, Old Point 
 Comfort, Va. 
 
 NatioDal Hos- 
 pital, Balti- 
 more, Mary- 
 land. 
 
 Cuyler Hospi- 
 tal, Philadel- 
 phia, Penn. 
 
 Mower Hospi- 
 tal, Philadel- 
 phia, Penn. 
 
 Armory 
 Square Hospi- 
 tal, Washing- 
 ton, D. C. 
 
 Ist Division 
 Hospital, An- 
 napolis, Md. 
 13,254. 
 
 U.S.A. Gene- 
 ral Hospital, 
 Frederick, Md, 
 
 Burd, Charles W. 
 
 Stallman, John 
 
 Stallman, John H 
 
 Stallman, J. H. 
 
 Kennedy, Charles 
 
 Kennedy, Charles 
 
 Grafton Hospi- 
 tal, "West Vir- 
 ginia. 788. 
 
 Rank. 
 
 Co. 
 
 Lieutenant. 
 
 Lieutenant. 
 
 , Charles 
 
 Private. 
 
 Regiment. 
 
 Age. 
 
 4th Maine 
 VolunteerB. 
 
 4th Penn. 
 
 Cavalry. 
 
 4th Penn. 
 Cavalry. 
 
 4th Penn. 
 
 Cavalry. 
 
 28th Penn. 
 VolunteerB. 
 
 28th Penn. 
 Volunteers. 
 
 14th Virginia 
 Infiintry, 
 
 21 
 
 14th Virginia 
 Infantry. 
 
 When 
 
 admitted. 
 
 From what 
 General Hos- 
 pital Trans- 
 ferred. 
 
 Feb. 20, 
 1862. 
 
 Sept. 8, 
 1864. 
 
 Dec. 11, 
 
 1864. 
 
 May 10, 
 
 1865. 
 
 May 7, 
 1863. 
 
 Nov. 14, 
 J.863. 
 
 Sept. 17, 
 1864. 
 
 From 
 what other 
 source ad- 
 mitted. 
 
 From 
 Field, from 
 Field Hos- 
 pital, etc. 
 
 Sandy Hook, 
 Maryland. 
 
 National, 
 Baltimore. 
 
 Cuyler, 
 Phila., Penn. 
 
 Armory 
 Square. 
 
 Prison in 
 Richmond 
 
 Gunshot fracture of both tables of os frontia 
 at left frontal eminence. Penetration of 
 the substance of the brain by a portion of 
 the ball. 
 
 Hospital 
 Transport. 
 
 From 
 furlough. 
 
 DIAGNOSIS. 
 
 In Surgical Caaes, state Seat and Character 
 of Wound or Injury. 
 
 Bull Run, 
 July 21,1861. 
 
 Missile entered at the right temple, and 
 emerged at the opposite side of the head. 
 
 Missile entered the right side of the frontal 
 bone near its superior margin. Evidently 
 passed through the brain, and emerged on 
 the opposite side. 
 
 Ball passed through brain, carrying away 
 anterior portion. 
 
 Missile removed the superior angle of the 
 occipital bone and the dura mater beneath. 
 
 Missile entered the left temporal bone one 
 inch from the meatus auditorius extemus, 
 and penetrated the cavity of the skull, 
 lodging on the side of the sella turcica. 
 
 Nov. 2, 
 1864. 
 
 Frederick, 
 Maryland. 
 
 On what 
 occasion 
 Wounded. 
 
 Date. 
 
 Winchester, 
 Va., July 24, 
 
 1864. 
 
 Winchester, 
 July 24, 1864. 
 
 Winchester, 
 July 24, 1864. 
 
 Chancellors- 
 
 ville, Va., 
 May 2, 1863. 
 
 Berryville, 
 Sept. 3, 1854. 
 
GUNSHOT INJURIES OF THE HEAD. 
 
 19 
 
 IN SURGICAL CASES ONLY. 
 
 Natare of 
 Missile or 
 Weapon. 
 
 Round or 
 (ToDical 
 
 Bullet, 
 Solid Shot 
 Bayonet, 
 
 Sword. 
 
 Treatueni. 
 
 Amputation.. .Date of 
 
 Excision " " 
 
 Other opera- 
 tion " " 
 
 Simple dress- 
 ings ' *' 
 
 RESULT. 
 
 Returned 
 to duty. 
 
 Date. 
 
 Trans- 
 ferred to 
 Veteran 
 Resorve 
 
 Corps. 
 
 Date. 
 
 To other 
 General 
 Hospital. 
 
 State or 
 City. 
 
 Date. 
 
 Fur- 
 loughed. 
 
 Deserted. 
 Date. 
 
 Dis- 
 charged 
 from Sei> 
 
 Tice. 
 
 Date. 
 
 Death. 
 Date. 
 
 Readmit- 
 ted ft-om 
 Furlough 
 or Deser- 
 tion. 
 
 DcOe. 
 
 " REMARKS. 
 
 Here state cause of death, of discharge, or 
 of transfer to Veteran Reserve Coi-ps. 
 
 Musket 
 Ball. 
 
 Musket 
 Ball. 
 
 A portion of the ball 
 was removed^ from 
 under the integu- 
 ment, on the field. 
 Seven months after- 
 
 _ wards the fistulous 
 orifice of the wound 
 was dilated, depres- 
 sed bone was re- 
 moved, and a por- 
 tion of the ball from 
 within the cavity 
 of the cranium. 
 
 Simple dressings. 
 
 March, 
 1863. 
 
 Probably 
 
 a piece of 
 
 shell. 
 
 Conotdal 
 
 Mufiket 
 
 Ball. 
 
 May 7th. Hair shav- 
 en, water-dressings, 
 cathartics, injec- 
 tions and anodynes, 
 leeches to temples 
 and behind the 
 ears. May 13th. A 
 splinter of bone 
 removed. 
 
 Part of ball extracted 
 from under the 
 scalp in the frontal 
 region, by forceps. 
 This fragment was 
 about one-third of 
 the ball. 
 
 Jan'y 12, 
 1864. 
 
 Dec. 10, 
 
 1864, to 
 Cuyler 
 Hospital. 
 
 May 10, 
 1865, to 
 Mower 
 
 Hospital. 
 
 Phila., Pa. 
 
 To Graf- 
 ton, Nov. 2 
 1864. 
 
 June 20, 
 
 1863. 
 
 May 23, 
 
 1865. 
 
 Nov. 6, 
 1864. 
 
 During his imprisonment he suffered from 
 pain in the head, but had no delirium, 
 coma, or paralysis. Was perfectly well 
 when he rejoined his regiment. (Vide 
 Special Report from Surgeon R. B. Bon- 
 tecou, U.S.V. General Index A, No. 59.) 
 
 When admitted, his bowels were consti- 
 pated, and nausea was almost constant. 
 His pulse was slow and feeble. His pupils 
 were constantly dilated. When discharged 
 his -mental operations seemed slow and 
 uncertain, bat there was no aberration 
 of mind, and his memory was unimpaired. 
 (See Report of Assistant Surgeon Schell, 
 U.S.A.) 
 
 On admission, substance of brain protruded 
 about one inch and a half; wound was 
 about two inches long and one inch wide ; 
 pulsation was distinct; total loss of vision ; 
 pulse 60; inclined to sleep but could not ; 
 mind dull; partial paraplegia. May 11th. 
 Rests quietly but cannot sleep; has not 
 slept from date of ii^ury; no alvine evac- 
 uation. May 12th. Not so much pain. 
 May 13th. Had four dejections. May 
 15th. Fungus retracted somewhat, with 
 a healthy granulating surface; vision 
 partially restored. June 16th. Sitting 
 about ward, talking and laughing; fun- 
 gus retracted entirely, but pulsation dis- 
 tinct; vision restored; pulse and bowels 
 regular; sleeps well; intellect perfect; no 
 pain. The wound is represented in Nos. 
 26 and 27 Surgical Series of Drawings, 
 S. G. 0. 
 
 When admitted, patient had paralysis of 
 2d, 3d, 4th. 5th, 6th, and 7th nerves of the 
 left side. No pain in the head. General 
 health of patient was good. His pulse, 
 skin, and bowels were natural. His con- 
 sciousness perfect. His articulation was 
 thick, but improved, and after the extrac- 
 tion of the ball became almost natural. 
 There was a free evacuation of pus after 
 the operation, the pupil of the left eye 
 diminished in size, and vision partially 
 returned. Oct. 10th, 1864. Was so far re- 
 covered as to walk about and assist in 
 nursing in the ward. If, however, he 
 exerted himself too much he suffered from 
 headache. While being transferred to 
 Grafton, Va.,he drank a large quantity 
 of whiskey. The day after his arrival he 
 had a violent chill, followed the next. 
 morning by convulsion, and strabismus 
 of right eye; these continued during the 
 day, and coma succeeded on the following 
 morning, and he died without reaction. 
 
 Post-mortem showed the larger portion of 
 a conoidal musket-ball resting against 
 the sella turcica. The encephalon was 
 extensively disorganized ; the ventricles, 
 and nearly the whole base of the brain, 
 bathed In pus. (Med. Des List, from J. 
 H. Bartholf, A. A. Surg. U.S.A.) 
 
20 ON SPECIAL WOUNDS AND INJURIES. 
 
 GUNSHOT WOUNDS OP THE FACE. 
 
 Of 4167 gunshot wounds of the face transcribed from the reports from the begin- 
 ning of the war to October, 1864, there were 1579 fractures of the facial bones, and 
 2588 flesh wounds. Of the former 891 recovered, 107 died, and the terminations are 
 still to be ascertained in 581 cases. 
 
 Secondary hasmorrhage has been the principal source of fatality in these injuries. 
 It is a frequent complication in gunshot fractures of the facial bones; and the difficulties 
 in securing bleeding vessels in this region are very great. Recourse has often been had 
 to ligations of the carotid, with the result of postponing for a time the fatal event. 
 
 Owing to the great vascularity and vitality of the tissues in this region, gunshot 
 wounds of the face have commonly healed rapidly, and many creditable plastic oper- 
 ations for the relief of deformities following such injuries have been accomplished. 
 Such operations are illustrated at the Army Medical Museum by numerous casts and 
 photographs. An interesting example is the case of Private Rowland Ward, Co. E, 
 4th New York Heavy Artillery. A fragment of shell removed the anterior portion of 
 the lower jaw within one inch of the ramus on both sides, destroyed the genio-hyoglossus 
 and genio-hyoid muscles, and afforded the occasion for a very successful cheiloplastic 
 operation by Surgeon J. C. McKee, U. S. A. (See Photographs of Surgical Cases, 
 S. G. 0., vol. iii. p. 1, et seq.) 
 
 GUNSHOT WOUNDS OP THE NECK. 
 
 Of the 1329 cases of this category that have been entered on the records, the ulti- 
 mate results have been ascertained in 546 cases only. Time has not been found to 
 trace the histories of many of the remaining cases. In the terminated cases, the mor- 
 tality is 14 per cent. 
 
 Several instances are recorded in which large grapeshot, on striking the hyoid 
 bone, were deflected, and buried themselves in the supra-spinous fossa of the scapula, 
 or among the muscles of the back. These patients died from laryngitis or oedema of 
 the glottis, and might have been saved, perhaps, by tracheotomy; but they died sud- 
 denly, when surgical assistance could not be immediately procured. 
 
 Wounds of the neck, with lesions of the vertebras, are classified with fractures of 
 the spine. 
 
 There are eight examples of gunshot perforations of the larynx or trachea among 
 the specimens at the Army Medical Museum. The series of surgical drawings includes 
 several curious illustrations of the escape of the great blood-vessels of the neck from 
 injury, when balls have traversed the neck directly in their course. 
 
 Cases in which the great vessels were injured are classified with wounds of the 
 arteries. 
 
 GUNSHOT WOUNDS OP THE BACK AND SPINE. 
 
 In this class have been included the fractures of the vertebral column which were 
 not complicated by penetrating wounds of the chest or abdominal cavity, and flesh 
 wounds of the region covered by the trapezius, latissimus dorsi, and gluteal muscles. 
 
GUNSHOT WOUNDS OF THE CHEST. 21 
 
 Of 187 recorded cases of gunshot fracture of the vertebrae, all but 7 proved fatal. 
 Six of these were fractures of the transverse or spinous apophyses. The seventh case 
 is that of a soldier wounded at Chickamauga, September 20th, 1863, by a musket-ball, 
 which fractured the spinous process of the fourth lumbar vertebra, and penetrated to 
 the vertebral canal. The ball and fragments of bone were extracted at a Nashville 
 hospital. The patient was transferred to Louisville, thence to Jefferson Barracks, Mis- 
 souri, thence to Madison, Indiana, and finally, on July 26th, 1864, to Quincy, Illinois. 
 The last report states that he was likely to recover. 
 
 Gunshot lesions of the vertebraa and spinal cord are illustrated at the Army 
 Medical Museum by 66 specimens. 
 
 An engraving of one of these is subjoined. 
 
 Private Frederick L , Co. H, 8th New York Vols., aged twenty-six years, 
 
 was wounded at Cold Harbor June 3d, 1864, and admitted into Carver Hospital, at 
 Washington, D. C, June 11th, 1864. A conoidal musket-ball had entered the right 
 side of his back and penetrated the vertebral canal, shattering the transverse and 
 articular processes of the eighth and ninth dorsal vertebrae. The patient stated that, 
 immediately upon the reception of his injury, he lost all sensation and power of mo- 
 tion below the wound. On admission, he was in a very feeble state; his pulse was 
 slow, his respiration labored, his skin cool, clammy, and cyanosed, his excretions in- 
 voluntary. In this wretched condition he lingered till the 27th of June, when symp- 
 toms of extreme gastric irritability supervened, and every form of nourishment was 
 promptly rejected by the stomach. He died July 2d, 1864. At the autopsy, the j,o.26.-EiBhih,mnth, and tenth dor- 
 spinal cord appeared to have been completely severed at the seat of injury, and was sai vertebrse, with a conoidal ban 
 
 / . , , - , , r J J J> .jj j^^ vertebral canal. Spec. 2939, 
 
 disorganized above and below. A. m. m. 
 
 Five thousand one hundred and ninety-five gunshot flesh wounds of the back have 
 been recorded, of which a large proportion are injuries from shell. Troops being often 
 ordered to lie down under a shell fire, this region becomes particularly exposed. 
 
 GUNSHOT WOUNDS OP THE CHEST. 
 
 Of 7062 gunshot wounds of the chest that have been examined and transcribed 
 from the reports belonging to the period prior to July, 1864, there were 2303 that 
 either penetrated the thoracic cavity or were accompanied by lesions of the thoracic 
 viscera. The results have been ascertained in 1272 of these, and were fatal in 930, or 
 73 per cent. The 4759 flesh wounds presented a very small ratio of mortality. It was 
 observed, however, that they were commonly long in healing, in consequence, no doubt, 
 of the mobility of the thoracic parietes. 
 
 The cases of wounds of the lung by the sharp edges of the fractured ribs, or of 
 contusion of the lung by non-penetrating gunshot injuries, have been recorded with the 
 penetrating wounds. 
 
 In the treatment of penetrating wounds of the chest, venesection appears to have 
 been abandoned altogether. Haemorrhage was treated by the application of cold, per- 
 fect rest, and the administration of opium. These measures seem to have proved 
 adequate generally, and no instances are reported of the performance of paracentesis or 
 of the enlargement of wounds for the evacuation of effused blood. Haemorrhage from 
 the vessels of the costal parietes has been exceedingly rare, and, in the few instances 
 recorded, was a secondary accident. Hence the management of bleeding from wounded 
 intercostal arteries has presented theoretical rather than practical difiiculties. 
 
22 ON SPECIAL WOUNDS AND INJURIES. 
 
 It has been the common practice to remove splintered portions of fractured ribs, 
 and to round off sharp edges that were likely to wound the pleura or lung. After this, 
 with the exception of extracting foreign bodies whenever practicable, and performing 
 paracentesis when empyema was developed, it has been usual to leave these cases to 
 the natural process of cure. 
 
 The records of the results of the so-called method of "hermetically sealing" gun- 
 shot penetrating wounds of the chest are sufficiently ample to warrant an unqualified 
 condemnation of the practice. The histories of the cases in which this plan was adopted 
 have been traced, in most instances, to their rapidly fatal conclusion. The following 
 case is the only recorded exception : 
 
 Corporal Peter Welker, Co. A, 1st U. S. Sharpshooters, was admitted July 30th, 1863, into Mount Pleasant Hos- 
 pital, at Washington, having received, at Manassas Gap, July 23d, 1863, a gunshot wound of the chest. The missile 
 entered near the nipple, between the fourth and fifth ribs, traversed the lung, and emerged at the inferior border of 
 the scapula, fracturing the sixth rib. Treatment : Opiates and stimulants, the wound being hermetically sealed. 
 When admitted, the patient had much pain in the chest, and dyspnoea. The latter increased almost to suffocation, 
 and was accompanied by fever. On July 31st, the posterior wound gave way, and a profnse discharge of clotted 
 blood and purulent matter escaped. The next day the anterior wound was opened, and a pint of matter of similar 
 character escaped, after which the patient became much better. He continued to improve until furloughed. On 
 December 13th, 1863, when readmitted, he had entirely recovered. 
 
 Few examples of recovery are recorded where the track of the ball passed near 
 the root of the lung. The cases in which there was a fracture of the rib at the wound 
 of entry were very dangerous. The established opinion, that penetrating wounds with 
 lodgement of the ball are more fatal than perforating wounds, was amply illustrated. But 
 very few recoveries with balls lodged in the lung are recorded, and the histories of such 
 cases are less explicit and complete than could be desired. 
 
 Private John H. Prouty, Co. G, 27th Illinois Vols., was admitted into the Sherman U. S. General Hospital, at 
 Nashville, Tennessee, from the Field Hospital at Chattanooga, Tennessee, with gunshot wound of the thorax. He 
 was struck in the left chest at Dallas, Georgia, May 25th, 1864, by a musket-ball, which lodged in the substance of 
 the left lung, and was not extracted. The case progressed favorably, and on July 14th, 1864, the patient was fur- 
 loughed and went to his home. 
 
 Private Isaac Miller, Co. B, 139th Pennsylvania Vols., was admitted into the Haddington General Hospital, at 
 Philadelphia, on the 3d of August, 1864, from Port Schuyler Hospital, New York Harbor. He was wounded at the 
 battle of the Wilderness, May 5th, 1864, by a musket-ball, which entered at the left shoulder, and passed downwards 
 and inwards, and lodged in the left lung. . He was fairly convalescent when admitted to Haddington Hospital, and 
 ultimately regained his usual health almost, and on May 3d, 1865, was transferred to the Veteran Reserve Corps. 
 
 In the following case the ball was believed to have lodged in the body of one of the 
 upper dorsal vertebrae : 
 
 Private Daniel Rich, Co. B, 55th Pennsylvania Vols., aged twenty-one, was wounded at the battle of Pocotaligo, 
 October 22d, 1862, and was admitted to Hospital No. 1, at Beaufort, South Carolina, on October 24th. The ball had 
 entered at the left sterno-clavicular articulation, traversed the apex of the left lung, and lodged in the vertebral 
 column. Immediately after his injury, he had hasmoptysis. He was able to walk from the field of battle to the 
 hospital steamer, six miles distant. He stated that the wound bled very freely. When admitted to the hospital his 
 face was dusky, his pulse accelerated, and crepitant rales were audible in the left chest. There was partial paralysis 
 of the arms. He was ordered ^th of a grain of tartarized antimony every two hours, low diet, and perfect quiet. On 
 October 25th, there was less vascular excitement and less dyspnoea. The medicine had nauseated and purged the 
 patient. There was great tenderness of the spine in the upper dorsal region, and the vertebral column was perfectly 
 rigid. The patient would allow no one to touch him anywhere but on the head. He was lifted by his head into an 
 upright position, like a stick. The antimony was continued till October 31st. At this date an abscess pointed over 
 the sternum, and was evacuated by a free incision. The wounds were poulticed. On November 13th, he was allowed 
 to sit up a portion of the time, and was much less troubled by a cough in this position. On November 20th, he 
 began to walk about the ward, and the wounds discharged but little. On December 1st, a necrosed bit of the sternum 
 was removed. Cerate dressings were applied to the wounds. On December 20th, erysipelas attacked the wounds 
 
GUNSHOT 'WOUNDS OF THE CHEST. 
 
 23 
 
 Fia. 27, — Portions of the eleventli and 
 twelfth riba of the right side, exhibit- 
 ing gunshot fractures of the shafts with 
 attempts at reparation. Spec. 845, A. 
 M. M. 
 
 and spread over the chest. On December 28th, the patient had recovered from the erysipelas, the wounds were 
 nearly healed, but the immobility of the spine continued. He was this day sent to a Northern hospital, on the 
 steamer " Star of the South.'" He ultimately recovered, and was transferred to the First Battalion of the Veteran 
 Reserve Corps. A photograph of the recent wound is preserved. (See Photographs of Surgical Cases, S. G. 0., 
 vol. i. No. 47.) 
 
 In the next case the ball was extracted. Nature made an effort to repair the 
 fractured ribs, but the wound of the lung was followed by fatal suppuration. 
 
 Private S- B , Co. A, 83d New York Vols., was wounded at the battle 
 
 of Fredericksburg, and was admitted into the Lincoln Hospital, at Washington, 
 December 23d, 1862. He had been struck by a conoidal musket-ball in the back of 
 the right chest, the ball entering over the attachment of the eleventh rib, and passing 
 forwards. The ball was extracted and simple dressings were applied. Pleuro-pneu- 
 monia ensued, and resulted in empyema. On January 3d, 1863, a pint of pus was 
 evacuated from the pleural cavity. The case terminated fatally on January 21st, 
 1863. The specimen was contributed by Surgeon H. Bryant, U. S. Vols., and the 
 particulars of the case were furnished by Surgeon J. Cooper McKee, U. S. A. At 
 the point of fracture, necrosed splinters are seen, attached by large irregular formations of callus. 
 
 A remarkable recovery is recorded, in a case in which the anterior mediastinum 
 was opened. 
 
 Private Charles P. Betts, Co. I, 26th New Jersey Vols., aged twenty-two, was struck by a three-ounce grape- 
 shot, 0* the morning of May 3d, 1863, in a charge upon the heights of Fredericksburg. The ball comminuted the 
 sternum, at the level of the third rib, on the left side, and tore through the costal pleura. It remained in the wound 
 and was removed by the patient. On the following day, Betts entered the hospital of the Second Division of the Sixth 
 Corps. Through the wound the arch of the aorta was distinctly visible, and its pulsations could be counted. The left 
 lung was collapsed. When sitting up there was but slight dyspnoea. Several fragments of the sternum were re- 
 moved, and the wound soon granulated kindly. On May 10th, a colored drawing of the wound was made. (No. 19, 
 Surgical Series of Drawings, S. G. 0.) On July 5th, the patient was transferred to Washington, convalescent. He 
 ultimately recovered perfectly. 
 
 The result was less favorable in the next case. 
 
 Private Patrick H. B , Co. C, 147th Pennsylvania Vols., was wounded at 
 
 Chancellorsville, May 2d, 1863, by a conoidal musket-ball, which entered between 
 the second and third ribs, on the right side, two inches from the median line, frac- 
 tured the sternum, and lodged beneath it. The wound bled profusely, but the 
 haemorrhage was arrested by pressure. The patient was conveyed to Douglas Hos- 
 pital, at Washington, on May 8th, and died the following day. He had haemoptysis 
 and the symptoms of traumatic pneumonia. 
 
 Only four cases are recorded of gunshot wounds of the 
 heart that came under treatment. The specimens from these 
 four cases are preserved in the Army Medical Museum. The 
 patient that lived longest after a gunshot wound of the heart 
 survived twelve hours (Spec. 837, A. M. M.). In this case a 
 small pistol-shot entered the left ventricle and passed out 
 through the right auricle. 
 
 Not a few cases are recorded ot gunshot wounds involving both the thoracic and 
 abdominal cavities. Among them occur the following remarkable instances of recovery 
 from this formidable kind of injury : 
 
 Lieutenant Daniel B , 63d New York Vols., was wounded at Gettysburg, July 2d, 1863, by a conoidal 
 
 musket- ball, which passed through the belly of the biceps of the right arm, entered the chest, traversed the base of the 
 right lung and diaphragm, wounded the intestines, and passed out above the anterior superior spinous process of the 
 left ilium. When admitted to the field hospital, he had dyspnoea and bloody sputa, and there was a faecal discharge 
 from the wound of exit. He was treated by large doses of opium, and, at the end of three weeks, convalescence was 
 fairly established. In the course of a few months his wounds had entirely closed, and he rejoined his regiment for duty. 
 
 -Sternum, showing 
 fracture by a muslcet-ball, 
 shapen, battered baU is attached. 
 1073, A. M. M. 
 
 gunshot 
 
 The mis- 
 
 Spec. 
 
24 ON SPECIAL "WOUNDS AND INJURIES. 
 
 Captain Eobert S , Co. A, 29th New York Yols., was wounded at Ohancellorsville, on the 2d of May, 1863. 
 
 A round musket-ball, fired from a distance of about one hundred and fifty yards, entered the eighth intercostal space 
 of the left side, at a point nine and a half inches to the left of the extremity of the ensiform cartilage, and fractured 
 the ninth rib. Without wounding the lung apparently, the ball passed through the diaphragm, and entered some 
 
 portion of the alimentary canal. Captain S walked a mile and a half to the rear, and entered a field hospital. On 
 
 examining his wound, the surgeons found a protrusion of the lung of the size of a small orange, which they unavail- 
 ingly attempted to reduce. The wound was enlarged, and still it was impracticable to replace the protruded lung. 
 
 On May 3d, the field hospital where Captain S lay was exposed to the enemy's fire. He walked half a mile 
 
 further to the rear, and was there placed in an ambulance, and taken across the Eappahannock, at United States 
 Ford, to one of the base hospitals. Here fruitless efforts were again made to reduce the hernial tumor, after which a 
 ligature was thrown around its base and tightened. A day or two subsequently the patient passed into the hands of 
 Surgeon Tomaine, who removed the ligature from the base of the tumor. A small portion of gangrenous lung sepa- 
 rated and left a clean granulating surface beneath. On May 7th, the ball was voided at stool. On May 8th, the patient 
 was visited by Surgeon John H. Brinton, U. S. Yols., who found him walking about the ward, smoking a cigar. 
 There was an entire absence of general constitutional symptoms ; no cough, no dyspnoea, no abdominal pain ; the 
 bowels were regular and appetite good. The protruding portion of the lung was carnified, and there was a dullness 
 on percussion and absence of the respiratory murmur in a zone an inch and a half in width around the circumfer- 
 ence of the base of the tumor. Surgeon Tomaine stated that the hernia had been gradually diminishing in volume. 
 It was at this date half the size of an egg, and covered with florid granulations. On May 10th, a drawing of the parts 
 
 was executed by Mr. Stauch, artist of the Army Medical Museum. On June 2d, Captain S^ was transferred to 
 
 Washington. There was an elastic partly reducible tumor, over which was an oval granulating surface, an inch and 
 a half by three-quarters of an inch. The vesicular murmur was perfect throughout the lung, except in the immediate 
 
 vicinity of the tumor. Compression of the tumor was advised. After a furlough of sixty days, Captain S was 
 
 again examined. The wound had entirely healed ; the respiratory sounds were normal ; there was still a slight hernia 
 of the lung. The general health of the patient was excellent. At this date a second drawing was executed. 
 
 Private B. S. Sheridan, Co. A, 9th Massachusetts Yols., was wounded at Malvern Hill, July 1 st, 1862, by a 
 musket-ball, which entered the right side between the ninth and tenth ribs, and passed out a little to the right of the 
 xyphoid cartilage. Soon after the reception of the injury, a portion of the lung protruded from the anterior wound, 
 and from the posterior wound there was a constant dripping of bile. On July 4th, Sheridan walked from the ambu- 
 lance station to James Biver, a distance of a mile and a half, with the hope of getting on board of a gunboat. He 
 was disappointed, and was taken prisoner and conveyed to Richmond. No dressings were applied to the hernia of 
 the lung. It was uncovered, and the patient occasionally washed it. He sufiered little pain or dyspnoea, and there 
 was an amazing absence of shock or prostration. On July 25th, the bile had ceased to dribble from the posterior 
 wound, and the hernia of the lung had greatly receded. The imperfect field notes state that the patient ultimately 
 recovered, and was exchanged. 
 
 Private Latimer Whipple, Co. H, 73d New York Yols., was wounded at Bristoe Station, Yirginia, August 27th, 
 1862, and admitted to the First Division Hospital, at Alexandria, on August 31st. A musket-ball struck him on the 
 right side, four inches above the crest of the ilium, and six inches from the spine, passed upwards and inwards, and 
 lodged. On admission, the patient had cough, with bloody expectoration, and crepitant rales in the lower lobe of the left 
 lung. There was a profuse discharge of bile from the wound. There was acute pain and tenderness in the hepatic 
 region, but no evidence of peritonitis. At the end of a week the symptoms of acute inflammation of the lung sub- 
 sided, but a cough, with purulent expectoration, persisted for months. Early in October the discharge of pus and 
 bile from the wound began to diminish, and in November the pain ceased in the hepatic region, and was referred 
 to the immediate vicinity of the orifice of the wound. The patient now began to walk about the ward. Throughout 
 the treatment there was great tendency to constipation, which was obviated by enemata. In the middle of December 
 the cough had nearly disappeared, and there was but a scanty discharge from the wound. On January 12th, 1863, the 
 wound was entirely healed, and the patient was discharged from service. 
 
 GUNSHOT WOUNDS OF THE ABDOMEN. 
 
 Of 2707 gunshot wounds of the abdomen reported from the beginning of the war 
 to July 1st, 1864, there were 2164 flesh wounds, and 543 cases in which the peritoneal 
 cavity was penetrated or the abdominal viscera injured. Among the flesh wounds, 114 
 fatal cases are recorded, which were, in most instances, cases of sloughing from injuries 
 of the abdominal parietes by shells. Of the 543 penetrating wounds, the results have 
 been ascertained in 414, and were fatal in 308, or 74 per cent. The number of re- 
 
GUNSHOT WOUNDS OF THE ABDOMEN. 25 
 
 coveries is unexpectedly large, but includes only cases in which the reports showed, 
 beyond question, that the abdominal cavity had been involved. Abstracts of several 
 such cases are subjoined: 
 
 Private John Barr, Co. B, 76th New York Vols., aged forty- five years, was admitted into Douglas Hospital, at 
 "Washington, May 18th, 1864, with a'penetrating gunshot wound of the abdomen, received on May 9th, at the battle 
 of the Wilderness. A conoidal musket-ball had entered at the junction of the left twelfth rib with its cartilage, and, 
 passing downwards, backwards, and outwards through the ilium, lodged in the gluteal muscles, whence it was removed 
 by incision. On admission, the wound copiously discharged a thin translucent fluid, resembling diluted bile, which 
 evidently came from the small intestine, for, among other reasons, it had no fsecal odor. Were further proof of the 
 origin of the discharge required, it would be furnished by the fact that three ascarides lumbricoides escaped from 
 the wound during the second and third weeks of the treatment. The discharge, for nine days prior to admission, was, 
 according to the patient, similar to that above noted. The patient was kept perfectly quiet in a recumbent posture. 
 The discharge from the wound was facilitated by large masses of charpie being used to absorb it. For several weeks 
 the patient was nourished solely by milk, milk-punch, and beef tea. His appetite was poor, his sleep much disturbed 
 by cough. But there was no abdominal pain or tenderness, and at no time, throughout the treatment, was there any 
 symptom of peritoneal inflammation. On May 22d, a soap and water enema was administered without result. 
 Nothing more was attempted in this direction, as the patient was doing well, and nature seemed competent to meet 
 every indication. On June 3d, the discharge had entirely ceased, and the patient was much improved. On June 6th, 
 he had a large alvine evacuation, the first since May 9th. On June 11th, with the aid of an enema, he had another 
 large dejection. From this time he improved rapidly. On August 16th, a fragment of necrosed bone, that could be 
 recognized as a portion of the ilium, was removed from the wound in the gluteal region. About the same period bits 
 of necrosed cartilage were taken from the fistulous orifices opening near the wound of entrance. The bowels were 
 disposed to costiveness, and flatulence was troublesome. Early in October there was an attack of dysentery, which 
 lasted one week. On May 5th, 1865, a needle-shaped bit of bone escaped from the wound of entrance. On May 8th, 
 both wounds were entirely healed. On July 16th, the patient was photographed at the Army Medical Museum. He 
 was then in good health. 
 
 Private George H. Bowers, 8th Illinois Cavalry, was wounded in a skirmish near Frederick, Maryland, Septem- 
 ber 13th, 1862, by a musket-ball, which entered two inches above the umbilicus, an inch to the left of the linea alba, 
 and made its exit beneath the tenth rib, three inches to the left of the spinous process of the tenth dorsal vertebra. 
 Immediately after he was shot, he vomited blood copiously until syncope supervened. Haeraatemesis recurred fre- 
 quently for seven days, and blood was passed at stool. Acute peritonitis ensued. The medical attendants had no 
 doubt that the stomach was perforated. Liquids taken into the stomach passed freely through the anterior wound. 
 The case was treated by opium in large doses. In May, 1863, the patient was transferred to the hospital at Stewart's 
 Mansion, in Baltimore. The wound had healed, and the digestive organs had resumed their normal action. But the 
 body was bent forward by intra-abdominal adhesions. The patient was subsequently discharged from service. 
 
 In many instances fsecal fistulse were produced. They commonly closed after a 
 time, without operative interference, reopening at intervals, and then healing per- 
 manently. 
 
 Sergeant Lewis E. Morley, Co. F, 61st New York Vols., was wounded at Gettysburg, July 1st, 1863, by a conoidal 
 musket-ball, which entered a little below the umbilicus and to the left of the linea alba, and passed directly through 
 the body, dividing the intestine in its passage. When brought to the field hospital he was in a state of collapse. 
 Faeces escaped from the wound. There was excessive tenderness and pain. Opiates were freely administered, and 
 the symptoms of peritonitis gradually abated. On July 10th, the patient was in a condition t6 be removed to Balti- 
 more. The discharge of faces from the wounds continued until September 28th, when there was an evacuation by 
 the rectum. The wounds soon afterwards closed, and on October 27th, the patient was sent home on furlough. 
 
 Private A. J. Marker, Co. I, 4th Maine Vols., aged eighteen years, was wounded at Oentreville, September 1st, 
 
 1862, by a conoidal musket-ball, which entered the left hypochondriac region, between the eighth and ninth ribs, and 
 lodged under the skin a little to the left of the spinous process of the second lumbar vertebra. He entered Epiphany 
 Hospital, at Washington, on the following day, and the ball was removed by an incision. There was immediately a 
 copious faecal discharge through the incision. It was ascertained that the ninth rib was fractured, and fragments of 
 it were removed. On September 5th, a portion of gangrenous omentum presented at the posterior wound and was 
 excised. A sphacelated portion of the descending colon was also removed. The faecal fistula persisted until May, 
 
 1863, when the discharge from the anterior wound became sero-purulent. A month afterwards both wounds healed 
 up soundly, and the patient was sent to his home in Belfast, Maine. In November, 1863, while the wounds were still 
 discharging stercoraceous matter, a colored drawing was made, which is No. 15 of the Surgical Series of Drawings, 
 S. G. 0. 
 
 Private John Harm, Co. I, 20th Indiana Vols., was wounded at the battle of Fair Oaks, May 31st, 1862, by a 
 
 4 
 
26 
 
 ON SPECIAL WOUNDS AND INJURIES. 
 
 musket-ball, which entered three inches to the right of the spine and one inch above the crest of the ilium, and, pass- 
 ing upwards across the abdominal cavity, made its exit in the left hypochondriac region. He was admitted to Broad 
 and Cherry Streets Hospital, in Philadelphia, on July 29th, 1862. He stated that there was free haemorrhage from 
 the wounds at first, and subsequently a discharge of faeces. At the date of his admission, the wound of exit had 
 closed; but faeces and flatus still escaped by the posterior wound. At the end of October, 1862, this wound also 
 closed; but it reopened a few weeks subsequently, and a fragment of flannel was extracted from it. After this it 
 healed soundly, and the patient was discharged from service. 
 
 Private Franklin Harsh, Co. G, 7th Ohio Vols., was wounded at Ohancellorsville, May 3d, 1863, by a conoidal 
 musket-ball, which entered the abdomen six inches to the right of the umbilicus, and passed out posteriorly, having 
 wounded the ascending colon and the crest of the right ilium. He was admitted to Armory Square Hospital, at 
 Washington, and remained there for a long time with a faecal fistula. On September 13th, 1863, the anterior wound 
 had closed, and the discharge from the posterior wound was much diminished. Ultimately the fistula closed, and the 
 patient was discharged from service. Early in the history of the case, a colored drawing of the patient was made. 
 (Nos. 21 and 22, Surgical Series of Drawings, S. G-. 0.) 
 
 Sergeant Joseph B. Fletcher, Co. D, 8th Connecticut Yols., aged twenty, was struck at the battle of Antietam, 
 September 17th, 1862, by a musket-ball, which entered six inches to the left of the umbilicus, and, passing somewhat 
 downwards, emerged an inch and a half to the left of the spine. The ball opened the descending colon, and when the 
 patient was examined by Surgeon T. H. Squire, 89th New York Vols , there was a profuse faecal discharge from the 
 wound of exit. The ensuing peritonitis was circumscribed, and the patient was transferred to Frederick, a few weeks 
 subsequently, in a satisfactory condition. The fsecal fistula finally closed and the patient recovered. 
 
 Lieutenant G. P. Deichler, Co. I, 69th Pennsylvania Vols., aged twenty-two years, was wounded by a conoidal 
 musket-ball, at Hatcher's Run, Virginia, in March, 1865. The ball entered the right iliac region, and, passing 
 through the ascending colon, made its exit a little to the left of the last dorsal vertebra. The patient was taken to a 
 field hospital, and from thence to Armory Square Hospital, at Washington, where he was admitted on April 1st, in 
 an exhausted condition, with grave symptoms of peritonitis. There was a copious faecal discharge from both 
 wounds. Appropriate dressings were applied, a fourth of a grain of sulphate of morphia was ordered to be given 
 every second hour, and stimulants were directed. On April 7th, sloughs separated from both wounds, and left a 
 clean granulating surface. A large piece of sphacelated omentum was removed from the anterior wound. The 
 opiate treatment was continued till April 27th, when there was a faecal evacuation by the anus, for the first time 
 since the injury. On June 12th, the discharge from the wounds was very slight. The edges of the wounds were 
 now refreshed and approximated by adhesive strips. On August 10th, the anterior wound was firmly healed. 
 There was a small fistulous sinus at the posterior wound, discharging pus scantily. On this day, a photograph 
 was taken at the Army Medical Museum, from which the plate opposite is copied, and the patient left the hospital for 
 his home in excellent general health. 
 
 Private Eobert Brierly, Co. A, 1st Delaware Vols., aged twenty-two, was wounded at the battle of Antietam, 
 by a conoidal musket-ball, which entered a little to the left of the umbilicus, and lodged under the muscles near the 
 anterior superior spinous process of the right ilium. There was great prostration, with nausea and vomiting, which 
 were treated at the field hospital by the administration of opiates. Three weeks subsequently, the patient was trans- 
 ferred to Frederick, Maryland. On October 25th, faeces escaped through the lower wound, which had been for 
 several days in a sloughing state. The artificial anus continued open until November 15th. On November 25th and 
 December 11th, there were attacks of colic, followed by reopening of the faecal fistula. By the end of December, the 
 wounds appeared sound and permanently healed, and the patient was transferred to Baltimore, and subsequently was 
 discharged from service. 
 
 Private James T. Dowdy, 28th Virginia (Eebel) Eegiment, aged twenty-three years, was wounded at the battle 
 of Gettysburg, July 3d, 1863, by a conoidal musket-ball, which entered at the tip of the ensiform cartilage, and 
 remained in the body. He was removed to one of the Gettysburg field hospitals. On July 4th, fourteen hours after 
 he was shot, he passed the ball at stool. There was no general peritonitis, and the wound healed promptly, and the 
 patient was transferred to Baltimore, and thence sent to City Point, Virginia, for exchange. 
 
 Recoveries after wounds of the large intestines have been much more numerous 
 than after wounds of the ileum or jejunum. 
 
 No case has been reported in which it was thought expedient to apply a suture to 
 the intestines after gunshot wounds. 
 
 Gunshot wounds of the liver were usually followed by extravasation into the 
 abdominal cavity and rapidly fatal peritonitis. Of 32 cases in which the diagnosis 
 was unquestionable, all but 4 terminated fatally. Abstracts of two of the fortunate 
 cases are appended : 
 
 Private Fritz Siebel, Co. D, 139th New York Vols., aged twenty-three years, was wounded at Cold Harbor 
 
PERFORATING GUNSHOT WOUND OF THE ABDOMEN. 
 
 CASE OF LIEUTENANT DEICHLER 
 
GUNSHOT WOUNDS OF THE ABDOMEN. 27 
 
 Virginia, June 3d, 1863, by a musket-ball, which entered the right hypochondriac region, below the tenth rib, and 
 passed out posteriorly an inch and a half to the right of the spine. He was admitted to Harewood Hospital, at 
 "Washington, on June 18th, in a very feeble state. There was a fcecal discharge from the wound, mixed with bile. 
 The ball had passed through the colon and the liver. There was great abdominal pain, aa anxious countenance, 
 nausea, and the other symptoms of traumatic peritonitis. A cold water-dressing was applied, and opium was admin- 
 istered in full doses. On July 1st, the pain on pressure was circumscribed, and the general symptoms were less 
 threatening. The discharge from the wound was unaltered. On September 1st, the wound of exit had healed, and 
 the anterior wound discharged only a thin serum. On September 14th, the wound of entrance closed. The patient 
 was furloughed on October 8th, 1863, and on the expiration of his furlough was returned to duty. 
 
 Corporal W. A. C. Biles, Co. K, 25th North Carolina (Eebel) Regiment, was wounded at Gettysburg, July 3d, 
 1863, by a conoidal musket-ball, which passed through the lower portion of the right lobe of the liver. He was 
 treated at one of the field hospitals at Gettysburg, and his case was carefully observed by Surgeon H. Janes, U. S. Vols. 
 There was a free discharge of bile from both the wound of entry and of exit. There was circumscribed pain and 
 tenderness on pressure, but apparently no extra-abdominal extravasation. The wounds continued to discharge bile 
 until August 27th. On November 1st, the patient was transferred to West's Buildings Hospital, at Baltimore, and on 
 November 12th, 1863, he was sent to City Point, Virginia, for exchange, bis wound being entirely healed. 
 
 All the cases of gunshot wounds of the spleen that have been reported, were fatal. 
 No symptoms are mentioned that particularly distinguished these from other gunshot 
 injuries involving the abdominal cavity, and it is quite possible that the list of re- 
 coveries may include cases in which this viscus was injured, though the diagnosis was 
 not made out. 
 
 A case is recorded of a lacerated wound of the abdominal walls, with lesion and 
 protrusion of the pancreas, a portion of which is reported to have been excised. It 
 appears probable that it was rather a portion of the omentum that was removed. 
 Several cases are reported in which it was believed that recovery took place after gun- 
 shot wounds of the kidney : 
 
 Private Groff, Co. D, 61st Pennsylvania Vols., was admitted on June 8th, 1862, to Fifth Street Hospital, in 
 Philadelphia, for wounds received at the battle of Pair Oaks, June 1st, 1862. He had a flesh wound of the left hip, 
 another of the right thigh, and a wound in the left lumbar region, which was considered to be a penetrating wound 
 of the abdomen. Immediately after he was struck, blood passed freely by the urethra. When he entered the hospital, 
 he had hEematuria. His wounds healed, however, kindly, and he left the hospital entirely well. 
 
 Sergeant Galloway, Co. H, 8th Pennsylvania Reserves, was wounded at South Mountain, September 14th, 1862, 
 by a musket-ball, which passed through the abdomen. He was treated at Satterlee Hospital, in Philadelphia. He 
 had haematuria, and pain and tenderness in the region of the left kidney. He ultimately recovered. 
 
 It can hardly be considered that the evidence of gunshot wound of the kidney 
 was, in these cases, unequivocal. 
 
 Gunshot wounds of the bladder, when the projectile entered above the pubes or 
 through the pelvic bones, have proved fatal, so far as the records have been examined. 
 There are many examples of recovery, however, from injuries of the parts of the blad- 
 der uncovered by the peritonaeum. 
 
 Several examples of recovery, after protrusions of the abdominal viscera through 
 gunshot wounds, have been reported. In two cases in which loops of small intestine 
 issued, they were immediately returned and retained by means of adhesive strips and 
 bandages, and the patients recovered with ventral hernia. The escape of omentum, 
 through wounds, would not appear to be a very serious complication, for in many'cases 
 portions of protruding omentum have been excised, and the patients have, nevertheless, 
 recovered promptly. 
 
 In relation -to gunshot wounds of the great vessels of the abdomen, a few words 
 will be said in treating of ligations. 
 
 Penetrating wounds of the abdomen, complicated with fractures of the vertebrae. 
 
28 ON SPECIAL WOUNDS AND INJURIES. 
 
 uniformly proved fatal. A single extract will suffice to show the usual progress of 
 such cases. . j u p 
 
 Corporal John E , Co. M, 14th New York Heavy Artillery, was wounded before 
 
 Petersburg, in July, 1864. He was sent to Washington, and admitted to Douglas Hospital, 
 with peritonitis and complete paraplegia. A musket-ball had entered at the right hypo- 
 chondriac region, passed downwards through the right lobe of the liver and the abdominal 
 cavity, and fractured the second and third lumbar vertebrae. He died on August 3d, 
 1864. 
 
 At the Army Medical Museum are specimens of 18 gunshot 
 
 wounds of the stomach or intestines, 10 of the liver, 8 of the 
 
 ^ „„ ^ , , , „ spleen, 10 of the kidneys, 4 of the bladder, and 6 of the genito- 
 
 FiQ. 29. — Gunshot fracture of the 1 ^ •' " ^ 
 
 second and third lumbar verte- iiv>i-i^nT«Tr r\v*fvn-nc* 
 
 bra. *ec.3683,A.M.M. urmary organs. 
 
 GUNSHOT FRACTURES OP THE PELVIS. 
 
 The records under this head include only the cases in which the abdominal cavity 
 was not penetrated. From the beginning of the war to October 1st, 1864, 359 such 
 cases have been reported. Recovery took place in 97, death in 77, and the result is 
 still to be ascertained in 185. In 256 cases the ilium alone was injured, the ischium 
 alone in 19, the pubes in 12, the sacrum in 32, and in 40 cases the lesions extended to 
 two or more portions of the innominata. 
 
 The gravity of these cases depended upon the location and extent of the fracture. 
 The majority of recoveries were from fracture of the ilium by musket-balls, in which 
 the crest was grooved, or comparatively slight injury was inflicted. Yet there were 
 many examples of perforation of the body of the ilium with ultimate recovery. The 
 following is an abstract of such a case : 
 
 Major H. A. Barnum, 12th New York Vols., was wounded at Malvern Hill, July 1st, 1862, by a conoidal musket- 
 ball, which entered midway between the umbilicus and the anterior superior spinous process of the left ilium, passed 
 through the middle of the ilium, and emerged posteriorly. On July 2d, he was captured and taken to Libby Prison, 
 a distance of eighteen miles, in an express wagon. On July 17th, he was taken to Aikens' Landing in an ambulance, 
 a distance of seventeen miles, and exchanged. He was conveyed by water to Albany, and thence by rail to Syracuse, 
 New York. At no time were any symptoms of peritonitis manifested. On October 1st, Major Barnum went to 
 Albany, where Dr. March dilated the anterior wound by an incision and extracted several fragments of the ilium, and 
 directed that a tent should be worn. Promoted to the command of the 149th New York Vols., Colonel Barnum took 
 the field in January, 1863. He wore the tent about a month, when the anterior wound healed. About the middle of 
 March, a large abscess formed, and evacuated itself at the site of the anterior wound. In April, Dr. March again cut 
 down to the ilium, and introduced a tent. No loose fragments of bone were found. The Colonel resumed his duties, 
 and commanded his regiment at Gettysburg. In January, 1864, another large abscess formed, and discharged pos- 
 teriorly. The orifice was enlarged by Dr. L. A. Sayre, of New York, and a seton of oakum was passed from before 
 backwards through the entire track of the ball. This was worn for several weeks, when Surgeon M. K. Hogan, U. S. 
 Vols., substituted a seton of candle-wick, which was gradually reduced in size, and finally replaced by a single linen 
 thread. A photograph of the patient was taken at the Army Medical Museum in August, 1865. The wound still 
 discharged slightly, and the thread seton was still worn. Promoted to be a brigade commander. General Barnum has 
 been almost continually in the field for the past two years. He participated in the campaigns of Atlanta, Georgia, 
 and Carolina, was shot through the right forearm at Kenesaw Mountain, and received a shell wound of the side at 
 Peach Tree Creek. 
 
 In most cases of injury of the pelvic bones, very tedious suppuration ensued, and 
 surgery could do but little, except to facilitate the escape of pus, and to remove dead 
 bone as it became separated. The returns corroborate the observation of Stromeyer, 
 that there is a great liability to pyaemia in gunshot fractures of the pelvis. 
 
GUNSHOT WOUNDS OF THE UPPER EXTREMITIES. 29 
 
 GUNSHOT WOUNDS OF THE GENITO-URINARY ORGANS. 
 
 In this category are included gunshot wounds of the genitals or urinary organs 
 that are not complicated with fractures of the pelvis, or with penetration of the ab- 
 dominal cavity. To October 1st, 1864, the reports furnish 457 such wounds, of which 
 37 had a fatal result. 
 
 Surgeon S. W. Gross, U. S. Vols., reports the singular history of a soldier of the 
 16th TJ. S. Infantry, struck at Shiloh, on the right side of the penis, by a conoidal 
 musket-ball, which buried itself in the corpus cavernosuin, and became encysted. It 
 gave no pain, and the patient refused to have it extracted. 
 
 The following is an interesting case of gunshot wound of the bladder : 
 
 Private Conrad L , Co. A, 23d Indiana Vols., aged thirty-two years, was wounded at Vicksbnrg, Miss., 
 
 June 23d, 1863, by a fragment of a hand-grenade, which entered the right nates two inches outside of the end of 
 the coccyx, and passed into the bladder, where it lodged. Urine passed 
 by the wound immediately after its reception. The patient was admitted 
 into the General Hospital at Jefferson Barraclts, Missouri, August 5th, 
 1863. His general health was much impaired. The urine passed mainly by 
 the wound, and was largely mixed with pus and blood. The treatment 
 directed comprised warm fomentations, mild diuretics, stimulants, and nu- 
 tritions diet. On February 20th, 1864, a catheter was with much difBcnlty 
 passed by the urethra, and the presence of a foreign body was ascertained. ■^Y^f^fte?^™tract°ed ftom tL'Sde^^^ 
 On March 19th, the general condition was improved, the wound was so far Spec.ss, a. m. m. 
 
 closed as to admit only a large- sized probe. Attempts to pass a catheter or to probe the wound caused chills and febrile 
 irritation. On April 2d, 1864, the lateral operation of lithotomy was performed by Surgeon John P. Randolph, U. S. A., 
 the patient being anaasthetized by equal parts by bulk of chloroform and ether. A rectangular fragment of shell, largely 
 incrusted with earthy phosphates, was extracted. It was two inches in length, seven-eighths of an inch in width, and 
 three-eighths of an inch in thickness. It weighed two ounces and five grains troy. On April 12th, the urine passed 
 by the wound. On April 27th, the wound had healed, and the patient was soon afterwards restored to his ordinary 
 condition of health. The incrusted fragment of shell is preserved in the collection of the Army Medical Museum 
 (Spec. 88). It weighs 898 grains, portions of the phosphatic deposit having crumbled away. 
 
 GUNSHOT WOUNDS OF THE UPPER EXTREMITIES. 
 
 When unaccompanied by lesions of the vessels and nerves, the gunshot flesh 
 wounds of the upper extremity are not very serious injuries. All foreign bodies hav- 
 ing been extracted, they commonly heal, under the use of water-dressings and the 
 lightest bandaging, in a few weeks. The 21,248 cases entered on the registers are all 
 copied from the reports for the last quarter of 1863 and the first two quarters of 1864. 
 
 The gunshot fractures of the upper extremity are recorded in four classes : those 
 of the scapula and clavicle, which are not, at the same time, penetrating wounds of the 
 chest; those of the shaft of the humerus and either of its articular extremities; those 
 of the ulna and radius; and those of the carpus and metacarpus. It is only with the 
 second class that much progress has been made. This comprises 2408 cases of gunshot 
 fractures of the humerus that have been examined and recorded. Recovery followed 
 in 1253 cases, death in 436, and the result is as yet undetermined in 719 cases. In 
 the 1689 completed cases, amputation or excision were practised in 996, and con- 
 servative treatment was adopted in 693, with a ratio of mortality of 21 per cent, in 
 the former and 30 per cent, in the latter. But it is premature to make deductions 
 from statistics which are daily augmenting and tending towards completion. 
 
30 
 
 ON SPECIAL WOUNDS AND INJURIES. 
 
 Gunshot lesions of the upper extremity are illustrated at the Army Medical Mu- 
 seum by 978 specimens, including examples of almost 
 every variety of contusion and fracture, of the repair 
 of fractures, of consecutive diseases of bones, and of 
 excisions, amputations, and their secondary lesions. A 
 few specimens are copied here. 
 
 Private William P , Co. F, 18th Massachusetts Vols., aged 
 
 thirty years, was wounded at the second battle of Bull Eun, August 
 30th, 1862, by a conoidal musket-ball, which entered to 
 the left of the spinal column, and, passing outwards, trav- 
 ersed the body of the scapula and the muscles of the 
 upper part of the arm. The patient was conveyed to 
 Union Chapel Hospital, at Alexandria. On the 3d, and 
 again on the 5th of September, misshapen pieces of ball 
 and a few fragments of bone were extracted through an 
 ^ „, , „ , V ■ V » <• . incision on the outer edge of the scapula. On Septem- 
 
 Fio. 31. — Left scapula, anowmg a gunshot fi-acture, ° . ™ . -c j. j 
 
 nearly parallel with the spine of the scapula, with two ber 19th, Symptoms of purulent infection were maniiested. 
 
 fragments of a conoidal musket-ball. Spec. 809, A. , ,. , , . , !_• ^ t. ... j 
 
 M. M. An active treatment by stimulants, quinia, iron, and am- 
 
 monia, was instituted, but unavailingly, and on September 25th, 1862, the case terminated fatally. 
 At the autopsy, a large collection of extravasated blood was found beneath the scapula, and between 
 the muscles of the shoulder. There was extensive serous effusion in the left pleural cavity, and numer- 
 ous metastatic foci in both lungs. 
 
 A soldier of the 2d Division of the 12th Army Corps had his left arm shattered by an elongated 
 musket-ball, in the attack on the stone wall on the heights at Fredericksburg, December 14th, 1862. 
 Primary amputation at the shoulder-joint was performed, and the patient recovered. The specimen 
 illustrates the ordinary longitudinal splitting produced by a conoidal ball in the shaft of a long bone. 
 
 Private B W , Co. I, 37th New York Vols., aged twenty-two years, was wounded at 
 
 Williamsburg, Virginia, May 5th, 1862, in the right elbow, by a conoidal musket-ball. A simple 
 
 dressing was applied, and he was re- 
 moved to Yorktown, and thence to Phil- 
 adelphia, where he was admitted to Race 
 Street Hospital. No report could be ob- 
 tained of the progress of the case until pio. 32.— LefThu- 
 March 13th, 1863, when the patient was ?>f "'■ <=omminu- 
 
 ^ ted by a conoidal 
 
 Fio. 33.— Necrosis of the shaft of the humerus, following a gunshot wound of transferred tO the McOlellan General muaket-ball.SpM. 
 the elbow. Spec. 2749, A. M. M. tj -4. 1 j. xt- m -ii. x . ''■082, A. M. M. 
 
 j> . , a. m. m.. Hospital, at Nicetown, with extensive 
 
 necrosis of the shaft of the humerus and caries of the elbow-joint. About the joint and arm there were numerous 
 sinuses, through which a profuse purulent discharge escaped, and, occasionally, small fragments of detached bone. 
 Under a supporting treatment, the general condition improved. About the middle of July, it was first noticed that the 
 patient's legs were oedematous. General anasarca ensued, and an examination of the urine showed that it was highly 
 albuminous. The patient became rapidly worse, and on August 12th, an uncontrollable diarrhoea set in, accompanied 
 by vomiting. The case terminated fatally, August 22d, 1863. The characteristic lesions of Bright's disease were 
 revealed by the autopsy. 
 
 GUNSHOT WOUNDS OF THE LOWER EXTREMITIES. 
 
 Of these, 30,014 cases have been recorded, of which 4862 were fractures, and 25,152 
 were flesh wounds. The latter were transcribed from the reports from October 1st, 
 1863, to October 1st, 1864. It has not been practicable as yet to tabulate the flesh 
 wounds of the lower extremities that occurred in the earlier part of the war. 
 
 For gunshot fractures of the femur, two registers have been kept. On one, all 
 cases were entered. On the other, only those in which the histories of the cases had 
 been carefully scrutinized, and in which the locality and extent of the injury were 
 clearly designated in the reports. In the latter register 1823 cases had been entered on 
 September 1st, 1865, or about one-third of the total number that have been reported. 
 
GUNSHOT WOUNDS OF THE LOWER EXTREMITIES. 
 
 31 
 
 Gunshot wounds of the knee-joint, with or without fracture of the patella, or of 
 the epiphyses of the femur or tibia, have been recorded in like manner, to the number, 
 thus far, of 1183. 
 
 Of the 1823 cases of gunshot fracture of the femur that have been entered on the 
 permanent records, the results have been ascertained in 1233. Of the 1183 cases of 
 gunshot wounds of the knee-joint, the results are known in 740. 
 
 While it is deemed premature to discuss these results when it may be reasonably 
 hoped that the completed statistics will definitely settle the important questions that 
 are here involved, it is yet thought expedient to report them, chiefly that the magni- 
 tude of the subject may be put in evidence, and that the absolute necessity for long 
 and patient investigation may be acknowledged. 
 
 The following table exhibits at a glance the results of 2003 cases of gunshot 
 fracture of the femur, or of gunshot wounds of the knee-joint, out of a total of 3106 
 cases hitherto recorded. The fractures of the femur are separated according to regions. 
 The left hand column gives the number of cases belonging to each region of which the 
 ultimate results have been satisfactorily determined. The right hand column gives the 
 total number of cases of injuries of each region that have been recorded. The inter- 
 mediate columns give the comparative results of treatment by amputation, excision, or 
 attempt at conservation of the limb, the number of recoveries and deaths and unfinished 
 cases in each category being mentioned, and the rate of mortality calculated for the 
 finished cases alone. 
 
 Table, exhibiting the Results of 2003 Terminated Gases of Gunshot Fracture of the Femur, or of 
 Gunshot Wounds of the Knee- Joint, out of 3106 Gases that have been entered on the Records. 
 
 
 Total 
 
 TERMIN- 
 ATED. 
 
 Ampctation. 
 
 EXOISION. 
 
 .CONBEKTATIVE MEASUEES. 
 
 Agqre- 
 
 GATE. 
 
 M 
 
 ■a 
 S. 
 P 
 
 •s 
 
 1 
 
 II 
 
 ■fis 
 
 1 
 
 (5 
 
 1 
 S 
 
 1 
 
 II 
 
 1 
 
 i 
 
 13 
 
 a 
 P 
 
 II 
 
 11 
 
 II 
 
 Gunshot Fractures of Femur, impli- 
 
 82 
 887 
 346 
 418 
 770 
 
 
 
 8 
 
 42 
 
 131 
 
 121 
 
 2 
 
 24 
 
 51 
 
 112 
 
 331 
 
 
 
 47 
 117 
 266 
 
 100- 
 75- 
 54-83 
 46-09 
 73-23 
 
 2 
 7 
 2 
 1 
 1 
 
 10 
 18 
 18 
 
 1 
 9 
 
 1 
 
 6 
 
 10 
 
 
 
 1 
 
 83-33 
 
 72- 
 
 86-66 
 
 50- 
 
 90- 
 
 
 
 93 
 
 106 
 
 72 
 
 50 
 
 321 
 
 68 
 237 
 132 
 101 
 258 
 
 796 
 
 14 
 199 
 148 
 137 
 146 
 
 644 
 
 100- 
 71-81 
 55-46 
 57-79 
 83-76 
 
 97 
 
 603 
 
 551 
 
 672 
 
 1183 
 
 Gunshot Fractures of upper third of 
 Femur . 
 
 Gunshot Fractures of middle third of 
 
 Gunshot Fractures of lower third of 
 Femur 
 
 Gunshot Wounds of the Knee-Joint, 
 ■with or without Fracture 
 
 
 2003 
 
 302 
 
 520 
 
 441 
 
 63-26 
 
 13 
 
 51 
 
 18 
 
 79-68 
 
 71-26 
 
 3106 
 
 In examining the above table in detail, it is seen that the results are ascertained 
 in 822 of the 1263 cases treated by amputation, or 65' per cent.; in 64 of the 82 cases 
 treated by excision, or 78 per cent.; and in 1117 of the 1761 cases treated by conser- 
 vative measures, or 63 per cent. 
 
32 ON SPECIAL WOUNDS AND INJURIES. 
 
 The only recorded recoveries after gunshot fracture of the femur involving the 
 hip-joint are those in which excision was practised. In fractures of the upper third, 
 the mortality rate is greatest for the cases treated by amputation. There were 43 of 
 these cases, and in 19 of them the amputation was done at the hip-joint Excision 
 gives 7 recoveries after fractures of the upper third; 2 of these were excisions of the 
 head and a portion of the shaft of the femur, 4 were formal excisions of the continuity, 
 and 1 was a removal of fragments and rounding off of sharp edges of bone, which was 
 admitted among the excisions with some hesitation. Under conservative measures 93 
 cases of fracture of the upper third had survived the injury a year or more, and are 
 reported as recovered. The mortality rate of the completed cases of amputation for 
 gunshot wounds of the knee-joint is large, and will probably be modified when the 
 results of the numerous unfinished cases are recorded. It depends partly, however, 
 upon the excessive mortality of intermediate amputations of knee-joint injuries. With 
 six or eight exceptions, the 50 recoveries without amputation classified with gunshot 
 wounds of the knee-joint were examples of fractures of the patella, in which the 
 evidence that the joint was opened was not unequivocal. 
 
 Comparing in gross the 822 finished cases treated by amputation, with the 1117 
 treated by conservation, the mortality rate of the former has the advantage by 8 per 
 cent.; an advantage that is maintained in the different regions, except in the upper 
 third. It must be remembered that the amputations include most of the bad cases, 
 and those in which preservation of the limb was attempted and abandoned. 
 
 But little progress has been made in the examination and registration of the frac- 
 tures of the tibia and fibula. Only 1056 have been recorded, of which 696 are term- 
 inated cases, chiefly belonging to the earlier periods of tho, war. Of these, 169, or 24 
 per cent., were fatal. 
 
 A similar remark applies to the fractures of the tarsus and metatarsus. But 629 
 cases have as yet been recorded. 
 
 For gunshot fractures of the phalanges, it has been thought superfluous to keep a 
 separate register, as the majority of such cases will appear on the register of amputa- 
 tions of the toes. 
 
 At the Army Medical Museum, the gunshot injuries of the lower extremity are 
 illustrated by 1984 specimens, comprising examples of almost every conceivable form 
 of contusion or fracture, illustrations of secondary lesions, and of reparative attempts 
 in all stages, wet preparations showing the appearances of wounds of entrance and exit, 
 the ravages of hospital gangrene, wounds or consecutive lesions of the great vessels, 
 numerous drawings, casts, and photographs, and, among the latter, representations of 
 over seventy patients, who had so far recovered after gunshot fracture of the femur as to 
 be able to move about. 
 
 The specimens of fractured or diseased bones at the Museum are arranged accord- 
 ing to the regions involved, the primary being separated from the secondary lesions, 
 and the illustrations of operations being classified apart. Kepresentations of a few 
 specimens will be introduced here. 
 
 In Stromeyer's classification of the action of bullets on bone, the fifth division is 
 that in which the ball pierces the bone and forms a canal without causing further 
 splintering. Examples are common in the upper portion of the tibia, but very rare in 
 the upper extremity of the femur. The following is such an instance : 
 
ON SPECIAL WOUNDS AND INJURIES. 
 
 33 
 
 ¥ia. 34.— Upper extremity of left femur 
 perforated by a coDoidal ball. Spec. 
 666, A. M. M. 
 
 Captain James M. L , Co. I, 20th Indiana Vols., was admitted into Colum- 
 bia College Hospital, at Washington, June 29th, 1862, with two gunshot wounds, 
 received a day or two previously in one of the battles before Richmond. The first 
 wound was through the left lumbar muscles. After receiving it the officer fell, and 
 while lying on the field he was again struck by an elongated musket-ball, which 
 entered on the outer side of the left thigh, a little below the great trochanters, and, 
 passing upwards and inwards, lodged. A finger could be readily passed into the per- 
 foration in the femur, but the ball could not be reached. Three formal attempts to 
 ascertain its position and accomplish its removal were made unsuccessfully. The 
 patient died from exhaustion on August 19th, 1862. The near proximity of the ball 
 had not induced any disease of the hip-joint. The specimen and the facts relating to 
 it were contributed by Assistant Surgeon W. M. Notson, U. S. A. 
 
 An illustration of a comminuted gunshot fracture in the 
 
 trochanteric region is given in the section on excisions of the 
 
 head of the femur. Of comminuted fractures of the shaft of 
 
 the femur by the conoidal musket-ball, the following is a fair example : 
 
 1 
 
 Private John Draker, Co. I, 57th Pennsylvania Yols., aged twenty-five years, was wounded 
 while on picket duty on the Eapidan, November 27th, 1863. A conoidal musket-ball passed 
 through the muscles of the right thigh, and, entering the middle of the left thigh at its inner side, 
 flattened itself against the femur, and shattered the bone. The patient was transferred to Alexan- 
 dria by rail, and admitted, December 4th, 1863, to the Second Division U. S. A. General Hospital. 
 P„ _ He died December 13th, 1863. 
 
 1% Just above the condyles, where the cancellated structure of bone 
 
 predominates, musket^balls often make a clean perforation. But the 
 wedge-like action of the elongated musket-ball almost invariably involves 
 ^ IPl longitudinal splintering. The following is a good illustration : 
 
 ^P iiJI Private Samuel S. Kopp, Co. B, 10th Pennsylvania Reserves, was 
 
 ' iS^^H gjiot through the lower third of the right thigh, by a musket-ball, at 
 
 the second battle o'f Bull Run, August 28th, 1862. The ball entered 
 just above the patella, and made its exit in the popliteal space. 
 The patient was taken, after a few days, to Alexandria. On Septem- 
 ber 20th, 1862, his thigh was amputated at the middle. He survived 
 the operation two days. 
 
 The later writers on military surgery have duly 
 insisted upon the different effect upon bones of the 
 impact of round musket-balls and of the cylindro- 
 conical projectiles. The degree of difference in the 
 injuries inflicted has, perhaps, been exaggerated. It 
 is unquestionably true, however, that the round ball 
 usually produces much less longitudinal splintering 
 than the conoidal ball, with its greater weight and 
 immense force of propulsion and wedge-like action. In the case 
 
 Ijj^rjrm which furnished Specimen 3228, A. M. M. 
 //is lb I where a round ball entering the outer condyle 
 ii^P'^lv ii behind, passed upwards, forwards, and inwards through the bone, it 
 was practicable to amputate successfully much nearer the track of the 
 ball than would have been admissible in the case quoted just before. 
 One curious effect, occasionally produced by the heavy conoidal 
 ball in striking the femur, has not been very generally noticed. 
 The bone is fissured and comminuted, though less than is common, 
 5 
 
 Fig. 35. — Fracture of 
 tbeshafc of the left 
 femur by a muBket- 
 ball. Spec. 1907, A. 
 M. M. 
 
 Fio. 36.— Perforation of the right 
 3 femur by a muakot-ball. Spec. 76, 
 
 Fig. 37.— Condyle of left fe- 
 mur nearly perforated by a 
 round muekot-ball. £^ec. 
 3228, A. M. M, 
 
34 
 
 GUNSHOT WOUNDS OF THE LOWER EXTREMITIES. 
 
 at the point at which the ball impinges, while at two or three inches above or below this 
 point, according as the point of impact is below or above the middle 
 of the shaft, a nearly transverse fracture of the shaft is produced. 
 The accompanying figure is an example; but the Museum contains a 
 dozen better illustrations. The best are of cases in which a ball has 
 struck the condyles anteriorly, and the shaft is snapped across two 
 inches above. In several of these specimens, the transverse fracture is 
 not connected by fissures with the comminuted fracture produced by the 
 ball. It appears that these injuries were produced by balls fired at 
 short range. 
 
 When the femur is simply contused by a ball, a limited necrosis 
 
 FM 38-iTactiire of the couimouly eusuBS from the destruction of the periosteum, and inflam- 
 
 Sr'by''a'^conoidIi matloH of the medullary cavity often results, and death from pyaemic 
 
 a.^m.m!'^'' ^'°' ' infection. The records would indicate that gunshot contusions of the 
 
 long bones, a subject ably discussed* of late by Surgeon J. A. Lidell, U. S. Vols., are 
 
 more dangerous accidents than comminuted gunshot fractures even. 
 
 Of gunshot contusions of the femur, there are seventeen specimens 
 
 at the Army Medical Museum. Several of these bones were sawn 
 
 through the long axis, immediately after the death of the patient, 
 
 and colored drawings were prepared, exhibiting the appearances of 
 
 the inflamed or suppurating or gangrenous medulla. 
 
 Cases in which a portion of the shaft of the femur is gouged 
 out, or a part of its cylinder crushed without entire division of the 
 continuity, are also very fatal. The following is an example : 
 
 Private Orson B. Norwood, Co. K, 3d Michigan 
 
 Cavalry, was wounded July 15tli, 1863, in a skirmish 
 
 near Jackson, Tennessee. He was acting as a vidette 
 
 at the time, and was stationed on a bridge. The ball, 
 
 fired from below, produced a long fissure in the lower 
 
 third of the inner aspect of the femur, and was it- 
 self split by the compact lamina of the bone. This 
 
 patient was removed to the General Hospital, at 
 
 La Grange, Tennessee, July 22d, 1868. The thigh 
 was then erysipelatous, and amputation was deemed inadvisable. Septem- 
 ber 27th, 1863, he was removed to the Washington Hospital, at Memphis, 
 where he died of pyaemia, October 2d, 1863. The fragment of the inner sur- 
 face of the femur, though but slightly separated from the diaphysis, was found 
 to be necrosed. 
 
 The series at the Army Medical Museum, illustrating 
 the reparative efibrts of nature after gunshot fractures of the 
 femur, consists of 190 specimens, and is of exceeding interest. 
 A few cases are selected. The first shows the extent of 
 repair ten weeks subsequent to the injury. 
 
 Private E. W. A , Co. G, 5th Florida (Rebel) Regiment, aged eighteen 
 
 years, was wounded July 3d, 1863, at the battle of Gettysburg, by a conoidal 
 
 musket-ball, which shattered the upper third of the left femur. He was first 
 
 treated at a field hospital, but on August 5th, 1863, was admitted to Camp 
 
 Letterman General Hospital. At that date, the patient was reduced by profuse suppuration; he was greatly 
 
 emaciated, and -large bed-sores had formed on his back. On August 12t h, a troublesome diarrhoea set in. He lingered 
 
 * American Journal of Medical Sciences, vol. xlix. p. 17, et seq. 
 
 Eia. 39.— Lower end of right fe- 
 mur, split by a conoidal mus- 
 ket-ball. Spec. 1788, A. M. M. 
 
 Fig. 40. — Lett femur, exhibiting attempts 
 at repair after a gunshot fracture of 
 the upper third. The patient surTived 
 ten weeks. Spec. 1938, A. M. M. 
 
ON SPECIAL WOUNDS AND INJURIES. 
 
 35 
 
 till September 15th, 1863, when he died from exhaustion. The large foliaeeous masses of callus uniting the fragments 
 were extremely delicate aud brittle. 
 
 In the next case, the patient likewise survived ten weeks after a comminuted 
 gunshot fracture of the middle third. 
 
 Corporal H. Burns, Co. H, 31st New York Vols., was struck by a conoidal ball, at 
 the battle of Uhancellorsville, May 3d, 1863. The missile fractured the shaft of the left 
 femur, with the usual longitudinal splintering. On May 8th, the patient was admitted to 
 Douglas Hospital, at Washington, and it was decided to attempt to save the limb. This 
 was first suspended by Smith's anterior splint. Afterwards Hodgen's apparatus was ap- 
 plied, and apparently answered a better purpose; but large abscesses having formed in 
 the thigh, and free incisions becoming requisite, a, long fracture-box, filled with bran, was 
 substituted. On June 16th, 1863, the ball and several fragments of detached bone were 
 removed. The patient died on July 11th, 1863, from exhaustive suppuration. Several days 
 before his death gangrenous patches appeared on the left leg. (Figure 41.) 
 
 In the next case, the patient survived more than four months. 
 
 ^^H Ij' 'l|j|fe Sergeant Sewell T. Douglas, Co. G, 1st Regiment Maine Heavy 
 
 ■ ^11 ' H -A.rtillery, aged twenty-eight years, was wounded at the battle of Spott- 
 
 I ;^lliil sylvania, and was admitted to Emory Hospital, at Washington, May 
 
 I j^JHIH 22d, 1864. A musket-ball entering posteriorly, had fractured the lower 
 
 i **^^^^jBi third of the left femur, and lodged in the medullary cavity. The injured 
 I ^1^^^^^ Umh was placed on a double inclined plane, and moderate extension was 
 I PmSE^^ra ^^^^- Internally, stimulants and tonics were employed. In August, 
 I f I^B^ai 1864, the patient suffered from severe diarrhoea. There was a copious 
 I f jd^^^r ill-conditioned discharge from the wound. The patient died September 
 26th, 1864, from exhaustion, and, at the autopsy, a deposition of callus 
 was found at the seat of injury, enclosing several necrosed splinters and 
 a battered musket-ball. 
 
 In the following case the process of repair had 
 Fro. 42.-partiaiiy con- gouB on for ulue mouths, and union was nearly com- 
 tureof the left femur, pleto, wheu the patieut was carried ou by an intercurrent disease. 
 
 Spec. 3267, A. M. M. •'^ ' ^ •' 
 
 Private Christian Holzworth, Co. B, 20th Indiana Vols., was wounded at the second battle of Manassas, August 
 29th, 1862, by a conoidal musket-ball, which entered on the anterior aspect of the 
 upper third of the left thigh, and lodged against the femur, which was fractured with 
 extensive longitudinal splitting. He was conveyed to Armory Square Hospital, at 
 Washington. No particulars of the treatment employed can be ascertained, but it is 
 reported that in March, 1863, he was able to go about on crutches, and that he was 
 "doing well" until the latter part of May, when an attack of cerebro-spinal taeningitis 
 supervened, and terminated fatally on May 25th, 1863. Upon examiuation of the in- 
 jured limb, the fractured extremities of the femur were found to be united, with great 
 angular deformity, by irregular arches of callus. A fragment of the ball was enclosed 
 between the arches. The specimen was contributed by Assistant Surgeon Byrne, 
 U. S. A. (Figure 43.) 
 
 The next figure represents a specimen in which consolida- 
 tion is quite firm. The patient succumbed to phthisis seven 
 months after the injury. 
 
 Private Luman M. Millius, Co. K, 6th Pennsylvania Reserves, was wounded at 
 Antietam, September 17th, 1862, by a conoidal musket-ball, which entered a little 
 below the great trochanter of the right thigh, shattered the upper third of the femur, 
 and lodged beneath the skin on the inner part of the right thigh, whence it was 
 extracted through an incision. The patient was treated in a field hospital until the 
 middle of October, when he was transferred to the General Hospital, at Smoketown. Although a slender man, with 
 a narrow chest and feeble organization, his condition on admission was not unpromising. During the autumn of 1862, 
 the suppuration was copious, and fragments of necrosed bone were occasionally discharged. Under a nourishing diet, 
 the patient's strength was supported remarkably. On January 21st, 1863, the fracture was firmly consolidated. The 
 
 rio. 41. — PftrtiiiUy conBoli- 
 dated gunshot fracture 
 of the middle third of 
 the left femur. Spec. 
 1643, A. M. M. 
 
 Fio. 43. — Partially consolidated gun- 
 shot fi'acture of the left femur. 
 Spec. 1161, A. M. M. 
 
36 
 
 GUNSHOT WOUNDS OF THE LOWER EXTREMITIES. 
 
 Fra.44 — Upppr half of right fe- 
 mur, exhibiting a consolida- 
 ted gunshot fracture. Spec. 
 1042, A. M. M. 
 
 Fig. 45. — Outer condyle ot 
 right femur, grooved by 
 a musket^ball. Spec. 2134, 
 A. M. M. 
 
 limb was shortened four inches. The wound on the inner side of the thigh had closed. There was a slight fistula, 
 
 with trifling discharge at the wound of entrance. The patient passed several hours 
 daily in the open air, on crutches. .A^bout this time, cough and night-sweats, and other 
 indications of tuberculosis of the lungs, appeared, and confirmed phthisis was soon 
 established. The patient died March 9th, 1863. (Figure 44.) 
 
 Of gunshot injuries of the knee-joint, the Museum possesses 
 355 specimens. A number of illustrations will be given. 
 
 The case that furnished Specimen No. 
 2134 (Private Baldwin, Co. K, 42d Indiana 
 Vols.) was treated by laying open the knee- 
 joint, by free incisions, as soon as suppuration 
 was established. The patient was wounded 
 September 20th, at Murfreesboro', and died 
 December 12th, 1863. The injury to the 
 outer condyle was very slight. The specimen 
 was contributed by Surgeon Israel Moses, U. S. Vols. 
 
 Dr. Bellanger has recorded* five fatal cases of gunshot injuries 
 of the knee-joint treated by free incisions into the articulation, and 
 Surgeon Lidell, U. S. Vols., has published three such cases.f The records contain a 
 score of similar examples. Yet amputations for gunshot injuries of the knee that have 
 reached the secondary period are scarcely less disastrous. 
 
 The next case well illustrates the obscurity of symptoms and 
 difficulty of diagnosis of a serious gunshot injury of an articulation 
 so accessible for examination as the knee. The fracture of the 
 internal condyle was not discovered until after death. The speci- 
 men was contributed by Surgeon J. A. Lidell, U. S. Vols. 
 
 Private Eisner, aged twenty-nine, Co. B, 7th Michigan Cavalry, was wounded June 
 19th, 1863, while on picket at Chantilly, Virginia, by an elongated carbine-ball, which 
 entered in front at the middle of the left thigh. He was admitted to hospital, in Wash- 
 ington, on June 26th, and the ball was cut out from beneath the integument on the inner 
 aspect of the knee. On the next day, there was pain and tender- 
 ness of the joint. Death took place July 18th, 1863. 
 
 In the next case a conoidal ball, fired from 
 a great distance, has crushed the anterior part of 
 the femur just above the condyles, and produced 
 fissures that extend to the joint. The patient 
 that furnished this specimen was wounded at Petersburg, March 
 31st, was amputated at Emory Hospital, April 7th, and died on June 
 24th, 1865. The specimen was contributed by Surgeon N. B. 
 Mosely, U. S. Vols. 
 
 The two following figures exhibit the common appearances of 
 fractures of the bones composing the knee-joint by round musket- 
 balls. 
 
 Private Eichard Williams, 28th Pennsylvania Vols., was wounded September 16th, 1 862, 
 at the battle of South Mountain, by a musket-ball, which entered near the outer hamstring, and 
 lodged between the condyles of the right femur. He was conveyed to Washington, D. 0. 
 
 no. 46.— Gunshot fracture of 
 the internal condyle of the 
 left knee. Spec. 1399, AM. 
 M. 
 
 Fia. 47.— Partial fracture of 
 the left femur by a conoi- 
 dal ball, which has lodged 
 in the cancellated structure. 
 Spec. 4071, A. M. M. 
 
 * American Journal of Medical Sciences, vol. xlvi. p. 42. 
 
 t Ibid., vol. xlix. p. 295. 
 
GUNSHOT WOUNDS OF THE LOWER EXTREMITIES. 
 
 37 
 
 riG. 48.— Lower extremity 01 
 right femur, the outer con- 
 dyle split off by a round 
 muBket-ball. ^ec. 59, A. 
 M. M. 
 
 Fig. 49. — Amputated end of right 
 femur and head of tibia, with a 
 round musket-ball impacted in 
 the latter. Spec. 1481, A. M. M. 
 
 and admitted into Mount Pleasant General Hospital, September 22d, 1862. On September 30th, Ms right thigh was 
 amputated by flap incisions. At this date the limb was excessively swollen ; the discharge 
 of pus was profuse ; abscesses had burrowed in the soft parts, and irritative fever existed 
 to an alarming degree. The case terminated fatally on October 2d, 1862. 
 
 Private , a soldier of the 3d Division of the 1st 
 
 Army Corps, was wounded at Gettysburg, Pennsylvania, on 
 July 1st, 1863, by a musket-ball, which entered through the 
 right popliteal space. Assured the internal condyle of the fe- 
 mur, and lodged in the head of the tibia. He underwent 
 amputation at the lower third of the thigh on July 15th, and 
 died July 17th, 1863. The specimen was contributed by Sur- 
 t^SSSm lB Sa[y geon Quinan, in charge of the Division Hospital. (Figure 49.) 
 
 ^^^''W^^^^ Three patients have been photographed 
 
 at the Army Medical Museum who had recov- 
 ered without amputation after gunshot injuries 
 of the knee-joint. (Photographs Nos. 63, 64, 
 
 LK^H ^""^ '^^■) ^C)ur or five additional cases appear 
 
 \ ilHi upon the records. In scarcely any of these 
 
 \ ™H cases could it be asserted that the danger of consecutive disease 
 
 \mP of the knee-joint was passed. The "curious fact," adverted to by 
 
 Surgeon I. Moses, U. S. Vols.,* "that more men had been discharged 
 the service at that post [Louisville, Kentucky] who had received 
 gunshot wounds of the knee-joint with recovery than when ampu- 
 tation of the thigh had been performed," is directly contradicted by the official reports 
 from that post. 
 
 The following is the most carefully compiled of the abstracts of cases of recovery after 
 gunshot wounds involving the knee. Photograph 63, A. M. M., represents the patient. 
 
 Private Peter Stuck, Oo. E, 116th Pennsylvania Vols., was wounded on May 12th, 
 1864, at the battle of Spottsylvania, and was admitted, on May 18th, to Douglas Hos- 
 pital, in Washington. The projectile, which was probably a conoidal musket-ball, had 
 entered at the inner edge of the right patella, passed directly through the articulation, 
 and made its exit near the centre of the popliteal space. The inner condyle was slightly 
 grooved, but the ball passed mainly through the intercondyloid notch. There was an 
 abundant thin discharge of mingled pus and synovia. The joint was somewhat 
 swollen, but the inflammatory symptoms and constitutional disturbance were moderate. 
 The patient was of a delicate organization. The treatment was limited to rest and 
 water-dressings. On June 9th, there was swelling and pain in the joint, and a febrile 
 reaction. Poultices were applied to the wound of exit, the anterior wound having 
 healed. In a few days the bad symptoms abated. In the latter part of August, 1864, 
 the patient began to walk about on crutches, the leg being flexed at an angle of 135° 
 with the thigh. In October, the limb was bandaged to a movable angular splint, and 
 the flexion was gradually reduced. Almost complete extension was obtained without 
 exciting inflammation in the joint. The patient kept his bed during this period of the 
 treatment. For the following eight months nothing of special interest transpired. 
 There were several attacks of inflammation of the joint; but they were moderate in 
 degree, and were readily subdued by poulticing. On such occasions abscesses some- 
 times formed in the thigh. For the greater part of the time the patient's appetite 
 was fair, his bowels regular, his sleep refreshing. When inflammatory mischief was 
 threatened, poultices, hot fomentations with flannel covered with oiled silk, and appli- 
 cations of tincture of iodine were employed. At other times, cold water-dressings, 
 with charpie to absorb the discharge, were used. Ice was never applied. A photo- 
 graph was taken July 9th, and the patient was discharged from service and the hos- fjo. bo.— Destruction of the left knee by 
 pital July 14th, 1865. The posterior wound was still open, and a probe could be 
 
 a shell explosion. Spm. 709, A. M. M. 
 
 * American Journal of Medical Sciences, vol. xlvii. p. 341. 
 
38 
 
 ON SPECIAL WOUNDS AND INJURIES. 
 
 introduced through it for three inches. There was a large deposit of new bone. The patella was firmly anchylosed 
 to the femur. The facts of the case were forwarded by Assistant Surgeon Wm. F. Norris, U. S. A. 
 
 Two more illustrations, of gunshot injuries of the knee-joint are 
 here introduced: 
 
 The patient who furnished the first (Private B. M , Co. A, 28th Massachusetts Vols.) 
 
 was brought to Washington on December 26th, 1862, his left knee having been shattered by a 
 shell at the battle of Fredericksburg, on December 14th. He died on December 29th. Evidently 
 primary amputation could alone have saved this man, and this was probably impracticable on 
 that disastrous day. (See Figure 50 on the preceding page.) 
 
 In the next case of shell wound involving the knee-joint (Private C. H. M , Co. F, 
 
 1st Maine Heavy Artillery), primary amputation was performed on October 2d, by Surgeon 
 Jamieson, 86th New York Vols. The patient died of exhaustive suppuration on October 27th, 
 1864. (Figure 51.) 
 
 Fin. 51. — Upper portion of 
 
 Of gunshot injuries of the tibia and fibula, two examples are given, 
 by 
 
 If a'fri^renrorthe oue of fracturc by a musket-ball, the other of comminution by solid 
 
 base of a shell, which -, . 
 is attached. Spec. 4121, SUOt : 
 A. M. M. 
 
 A general ofiicer was wounded at the assault on Port Hudson, May 27th, 
 1863, by a conoidal musket-ball, which passed from the inner to the outer 
 aspect of the right leg, and shattered the upper thirds of the tibia and 
 fibula. A staff surgeon extracted a number of detached fragments of bone, 
 and dressed the limb, and, on June 2d, the patient was rernoved to New 
 Orleans. The wounds were opened, and decomposed coagula, pus, and bone 
 splinters in large quantities were evacuated. The constitutional symptoms 
 were of the most aggravated character. About the middle of June, amputa- 
 tion was performed at the lower third of the thigh by Professor Warren 
 Stone, with the very slightest hope of success. The patient, however, 
 struggled through, and ultimately wore an artificial limb with comfort. The 
 specimen and the particulars of the case were contributed by Prof. F. Bacon, 
 of Yale College, formerly Surgeon U. S. Vols. (Figure 52.) 
 
 Major General D. E. Sickles, U. S. Vols., was wounded on the evening 
 of the second day of the battle of Gettysburg, by a twelve-pounder solid 
 shot, which shattered his right leg. General Sickles was on horseback at 
 the time and unattended. He succeeded in quieting his affrighted horse and 
 in dismounting unassisted. Aid arriving promptly, he was removed a short 
 distance to the rear, to a sheltered ravine, and amputation was perfotmed 
 low down in the thigh by Surgeon Thomas Sim, U. S. Vols. The patient 
 was then sent to the. rear, and the following day was transferred to Wash- 
 ington. The stump healed with great rapidity. On July 16th, the patient 
 was able to ride about in a carriage. Early in September, 1863, the stump 
 Fio. 52.— iiight tibia was completely cicatrized, and the general was able again to mount his horse, 
 tured bra miJket- '^^^ Specimen was contributed to the Army Medical Museum by General 
 ball. Spec. 3604, gickles, and the facts of the case by his staff surgeon, Dr. Sim. (Figure 53.) 
 
 Flo. 53. — Right tibia v 
 ula shattered by a c 
 shot. Spec. 1335, A, I 
 
 GUNSHOT WOUNDS OF THE ARTERIES. 
 
 The number of cases reported under this head is extremely small. In the cam- 
 paign of the Army of the Potomac from the Rapidan to the James, in May, June, and 
 July, 1864, of a total of 36,508 gunshot wounds, only 27 belonged to this category. 
 The cases of compound fracture complicated with injuries of the large vessels, the cases 
 in which limbs are carried away by solid shot or shell, and the cases in which all 
 the tissues of a limb are disorganized by contusion from a large projectile and the 
 vitality of the arteries is destroyed, are all returned under other heads. Those only 
 are included in which the canal of a large vessel is primarily opened, and in which this 
 
SABRE AND BAYONET "WOUNDS. 39 
 
 is the principal accident. Such cases are to be sought for among the dead on the bat- 
 tle-field rather than in the field hospitals. Surgeon J. A. Lidell, U. S. Vols., reports 
 that on the morning of March 25th, 1865, he examined 43 bodies of soldiers killed in 
 the combat near Port Steadman, in the lines before Petersburg; 23 were shot in the 
 head, 15 in the chest, and 5 in the abdomen. " The bodies of all those wounded in 
 the abdomen were very much blanched, as if they had died of haemorrhage, and the 
 same remark held true in regard to all but two or three of those wounded in the 
 chest." In the few cases of primary gunshot lesions of the arteries that came under 
 treatment, it was usually found that only a portion of the calibre of the vessel had 
 been carried away, and that retraction had been thus prevented. But 44 cases are 
 entered on the records. In most of them, ligatures were placed above and below the 
 seat of injury; but, in a few instances, the main trunk was tied at a distance, and 
 amputation was practised when the bleeding recurred. Twenty of the 44 cases term- 
 inated fatally. 
 
 A number of drawings at the Army Medical Museum, exhibiting the course of 
 balls directly in the track of the great vessels of the neck or of the limbs, illustrate the 
 fact so well known to military surgeons of the great resiliency of the large arteries. 
 The dread of primary haemorrhage on the battle-field is confined to the inexperienced. 
 It was so exaggerated at the beginning of the war, that it was seriously proposed by 
 several benevolent associations that every soldier should carry a field tourniquet with 
 his equipments. 
 
 GUNSHOT WOUNDS OF YEINS. 
 
 No cases have been reported in which the bleeding could not be controlled by 
 pressure. 
 
 GUNSHOT WOUNDS OF NERVES. 
 
 Only those cases are recorded as yet uJ)on the register that were reported in the 
 last quarter of 1863 and the first quarter of 1864. Numerous and careful observations 
 on this class of injuries have been received from the Christian Street Hospital, in Phil- 
 adelphia, in which wards were especially assigned, in 1863, for the treatment of such 
 cases. 
 
 SABRE AND BAYONET WOUNDS. 
 
 The number of sabre and bayonet wounds that have come under treatment has 
 been comparatively small ; 105 cases of the former, and 143 of the latter comprise 
 nearly all that have been reported for the first three years of the war. Of these 
 wounds, two-thirds were received in action, and the remainder were inflicted by senti- 
 nels or patrols. There are 11 deaths from sword wounds recorded, and 6 from bayonet 
 wounds. At the Army Medical Museum there are 9 specimens of sabre cuts of the 
 cranium,* a specimen of punctured fracture of the skull by a bayonet, and a prepara- 
 tion exhibiting a bayonet thrust through the stomach.f Prom General Sheridan's 
 
 * Specimens 235, 970, 971, 974, 1672, 2623, 3307, 3684, 4206. t Specimen 2258, A. M. M. 
 
40 
 
 ON" SPECIAL WOUNDS AND INJURIES. 
 
 campaign in the Shenandoah Valley, 25 sabre wounds are reported; and from the battle 
 of Jonesborough, in Georgia, 30 bayonet wounds. After the first battle of Bull Run, 
 several of the wounded left upon the field were bayoneted by the insurgents.* A 
 patient, brought afterwards to Georgetown, received no less than fourteen stabs. A 
 
 similar instance occurred after the battle of Fair Oaks.f 
 Later in the war such atrocities were very infrequent. 
 A few abstracts are subjoined of cases of sword and bayo- 
 net wounds: 
 
 Fio. 64.— Three sabre cuts on the left parietal. 
 Spec. 3307, A. M. M. 
 
 Private E H , Oo. 0, 7tli Colored Regiment, U. S. Artillery, 
 
 was wounded at Fort Pillow, Tennessee, April 12tli, 1864, by three sabre 
 cuts on the left side of the head, one of the wounds penetrating the skull. 
 The symptoms are not recorded, but it is stated that the patient died on 
 April 2lBt, 1864, and that the post-mortem examination revealed a large 
 extravasation of blood upon the brain, and a splinter an inch and a half long 
 from the inner table driven through the dura mater. 
 
 Private J. T. B , Co. F, 7th Michigan Cavalry, was captured on July 3d, 1863, at Gettysburg, his horse 
 
 being shot under him. He was hurried to the rear with other prisoners. In the subsequent retreat he was 
 
 unable to keep up with the column, and all efforts to goad him on being 
 unavailing, a confederate lieutenant, in command of the provost guard, cut 
 him down, and left him for dead by the roadside. He was brought in by a 
 
 ^^ -3t= • — /I scouting party, and admitted to the Cavalry Corps Hospital. On the 25th 
 
 f ^^^""'^'^^^^/^ — of July, he was sufficiently rational to give the above account to Surgeon 
 
 ^K _ ai:'MHs»aBB« > Bulison, 9th N ew York Cavalry. He was in a very depressed state at this 
 
 time. His pulse was weak, and beat from 40 to 45 per minute. He was " 
 indisposed to mental exertion ; but when aroused and interested was quite 
 rational. He lingered until August 15th, 1863, the tendency to stupor 
 becoming greater and greater towards the close. The autopsy revealed a 
 sabre cut sis inches long, which had raised an osseous flap, adherent at its 
 base, from the left parietal, and cloven the right parietal, with great splin- 
 tering of the vitreous plate. The sabre had penetrated the dura mater on 
 the left side, and on the right side the meninges were injured by the de- 
 pressed inner table. The posterior lobes of both hemispheres of the brain were extensively disorganized. The speci- 
 men, with the above history, was contributed by Surgeon W. H. Eulison, 9th New York Cavalry, since killed in 
 battle. 
 
 Private John H ., aged twenty-five, of the guard of Lovell General Hospital, Portsmouth Grove, Rhode 
 
 Island, was confined on February 28th, 1863, in a strong box, as a punishment for 
 bringing liquor into camp. When released, he rushed upon the sergeant of the guard 
 and struck him, whereupon the sergeant drew his sword and put himself en garde. In 
 this position the prisoner made a second assault, but the ground being uneven he 
 slipped, and fell heavily upon the point of the sword, and to the ground. When 
 raised, his face was bleeding, and he was insensible. He was examined by the medical 
 officer of the day, who found a slight cut on the ala of the nose, and ascribed the 
 insensibility to intoxication, and to the fall on the head. The prisoner was removed to 
 the guard-house and there spent the night. In the morning, he was still unconscious 
 and breathed stertorously, and had a slow pulse and dilated pupils. He was removed 
 to a ward in the hospital, and the remedies commonly employed in cases of apoplexy 
 were prescribed. There was no return of consciousness, and the case terminated fatally on March 2d, thirty-one hours 
 after the injury. At the autopsy, it was found that the sword had entered at the right nostril, pierced the right 
 superior turbinated bone and the body of the sphenoid, and caused a transverse fracture at the base of the posterior 
 clinoid process. .There was much extravasated blood in the cranial cavity, especially on the surface of the right 
 hemisphere. 
 
 Fig. 55. — Section of the posterior portion of a 
 cranium, showing a sabre cut of both parietals 
 parallel to the lanibdoidal suture. Svec. 1672. 
 A. M. M. 
 
 Fig. 56.— Portion of a sphenoid bone 
 transfixed by a sword. Spec. 1612, 
 A. M. M. 
 
 * Surgeon Joseph R. Smith's Report. 
 
 t Report of Assistant Surgeon H. B. Brown, 70th New York Vols, 
 
TETANUS. 
 
 41 
 
 Private Thomas B , Co. B, 90th Ohio Vols., was admitted into Hospital No. 1, Nashville, Tennessee, 
 
 on November 27th, 1863, with a bayonet wound behind the left parietal protuberance, inflicted by a sentinel, 
 whom the patient, being intoxicated, had refused to obey. For several days 
 after admission he was somnolent and obstinately constipated. Under the 
 use of powerful purgatives this condition was removed, and the wound nearly 
 cicatrized. But, on December 8th, the patient complained of headache, and 
 a probe passed through the small orifice of the wound revealed the presence 
 of denuded and detached bone. A crucial incision was made and the frag- 
 ments of dead bone were removed. On December 11th, there was more 
 headache, and a tendency to stupor ; the pulse was at 48 ; there was intoler- 
 ance of light and sound ; the scalp was tumid ; the wound gaping, and 
 filled with fungous granulations. The incisions in the scalp were extended, 
 an ice-bladder was applied to the head, and purgatives and purgative eneraata 
 were employed. A day or two subsequently cerebral hernia took place; then 
 extended suppuration in the left hemisphere; then delirium and coma, and 
 death on December 23d, 1863. The description and specimen were con- 
 tributed by Assistant Surgeon 0. J. Kipp, U. S. Vols. 
 
 Fig. 57. — Skull-cap, exhibiting a fracture of the left 
 parietal bone by a bayonet. Spec. 2179, A. M. M. 
 
 SIMPLE FRACTURES AND MISCELLANEOUS WOUNDS. 
 
 The number of cases reported is quite large, and the record is still very incom- 
 plete. For the first two years of the war, the monthly reports give of simple fractures 
 alone 2864 cases with 92 deaths. 
 
 The Army Medical Museum possesses comparatively few illustrations of this 
 class of injuries, and it is to be desired that this department of the collection may be 
 augmented. 
 
 Specimen No. 6 presents a good example of a united simple fracture of the femur 
 through the trochanters. It was taken from a man of forty, who 
 died of pneumonia two years after recovery from the local injury. 
 
 The number of incised and fractured wounds received in broils 
 and altercations is quite numerous. The following is an interesting 
 example of this class of cases: 
 
 Private George S , Co. B, 15th New 
 
 York Engineers, was stabbed in the back by a 
 dirk, April 20th, 1863, at Falmouth, Virginia, in 
 an altercation with a comrade. The blade passed 
 between the transverse processes of the fourth 
 and fifth vertebrae, and severed the spinal cord. 
 The man fell instantly, completely paraplegic. 
 He was admitted to Armory Square Hospital, at 
 Washington, April 22d. On April 27th, he began 
 to pass his faeces and urine involuntarily, and 
 bed-sores appeared on the portions of the lower 
 part of the body exposed to pressure. He sank 
 'aorsarTerttbrk, 8awn''Mun(k,fto ex'hibit°a°tok gradually, and died from exhaustion on May 27th, ^"^'felracture o/Toleft'^ 
 
 whicU traversed the spinal canal. Sj,ec. 1160, A. jggg The specimen waS Contributed by Assist- mur': ;§,eo.No.6,A.M.M. 
 
 ant Surgeon 0. 0. Byrne, U. S. A. 
 
 ^f:^pi 
 
 ^^^^f^^S^SBBStv'^'wM 
 
 
 ' 
 
 
 
 »! '' 'f 
 
 
 H'l 'ii|] 
 
 
 TETANUS. 
 
 The 363 cases of traumatic tetanus recorded in the register for that subject are 
 all that have been reported during the war. The proportion to the total number of 
 wounds is not large. In the Schleswick Holstein war, Stromeyer had 6 cases among 
 2000 wounded. In Napoleon's campaign in Egypt, in the Peninsular campaign, and 
 
 6 
 
42 ON SPECIAL WOUNDS AND INJURIES. 
 
 in the revolt in India, the ratio appears to have been larger than this. Among 12,094 
 wounded, the British in the Crimea had 19 cases only. 
 
 The histories of the 363 reported cases of tetanus are generally Satisfactory in 
 their details of symptoms, progress, and treatment: 336 cases terminated fatally. Of the 
 27 recoveries reported, the disease was of a chronic form in 23. In the 4 remaining cases, 
 the symptoms were very grave. In 2, recovery took place under the use of opiates and 
 stimulants J in 2, after amputation of the wounded part. 
 
 The great majority of the cases were treated by the free use of opium, conjoined 
 with stimulants and concentrated nourishment. Chloroform inhalations were very 
 generally employed during the paroxysms of spasmodic contraction. Subcutaneous 
 injections of the salts of morphia and atropia were frequently used. Cathartics, quinia, 
 camphor, cannabis indica, bromide of potassium, strychnia, belladonna, and aconite are 
 mentioned among the remedies employed. Cups, blisters, turpentine stupes, and ice 
 were among the applications made to the spine; and fomentations with opium or to- 
 bacco were, in some cases, applied to the wound. Amputation, the division of nerves, 
 and the extirpation of neuromata in stumps were the surgical measures sometimes 
 employed. The results have not modified the conclusion of Romberg, that "wherever 
 tetanus puts on the acute form, no curative proceeding will avail, while in the milder 
 and more tardy form, the most various remedies have been followed by cure." The 
 value of nicotine, of the Calabar bean, and of curare* as curative agents in tetanus was 
 not tested. 
 
 Autopsies were made in many cases; but with almost negative results. There 
 were no microscopic examinations to corroborate . or disprove the assertions of Roki- 
 tansky and Demme,f that tetanus has a constant anatomical lesion, consisting in a 
 proliferation of the connective tissue of the white medullary substance of the medulla 
 oblongata, of the inferior peduncles of the cerebellum, of the crura cerebri, and of the 
 spinal cord, producing a viscous mass, abounding in nuclei, and never progressing to 
 the formation of fibres. It is frequently mentioned, however, that great congestion of 
 the brain and spinal cord was observed, a condition on which the lesions of the con- 
 nective tissue above described are believed to depend. 
 
 The records abound with, illustrations of the influence of sudden vicissitudes of 
 temperature in producing this fatal affection, and of the effect which unextracted balls 
 and other foreign bodies and matter confined under fasciae appear to exercise upon its 
 development. It seems probable also that the disease occurred in a larger proportion 
 of cases among the troops serving in the more Southern States; but this and other 
 generalizations must be deferred until the records are more minutely examined. 
 
 SECONDARY HAEMORRHAGE. 
 
 On this important subject the records are still very incomplete. There are 1450 
 special reports relating to it yet to be examined, which will furnish a large number of 
 cases to be transcribed upon the register. The cases have been reported in three 
 
 * According to H. Demme, of 22 cases of traumatic tetanus treated by the latter agent, 8 recovered .See Schweiz 
 Zeitschrift fur Heilkunde, ii. 356. " ^ 
 
 t Schmidt's Jahrbncher, vol. cxii. 
 
SECONDARY HEMORRHAGE. — PYEMIA. 43 
 
 classes : bleeding proceeding from a stump, from a gunshot wound, or from an artery 
 previously ligated in its continuity. Cases of the latter series have not been placed on 
 the registers of secondary haemorrhage, but the repetition of the bleeding has been noted 
 in the history of the case in the volume of the registers of surgical operations devoted 
 to ligations.* 
 
 Of the two other classes, 1037 cases have been examined and recorded on the 
 registers of secondary haemorrhage. Of these, 387 were cases of secondary bleeding 
 from a stump, and 650 were cases of secondary haemorrhage from gunshot wounds. 
 Of the first class, 233, or 60 per cent., ended fatally; of the second, the termination 
 was fatal in 330 cases, or 51 per cent. 
 
 In the 1037 recorded cases, the femoral artery was ligated 93 times for bleeding 
 from stumps, and 45 times for bleeding from wounds; the subclavian was tied 5 times 
 for bleeding after amputation at the shoulder-joint, and 6 times for haemorrhage from 
 gunshot wounds of the axilla. The common carotid was ligated 15 times for haemor- 
 rhage from the deep branches of the internal carotid. Amputation was practised 78 
 times for secondary bleeding from gunshot wounds, and reamputation was performed 
 14 times when other means of arresting haemorrhage from stumps had failed. 
 
 The 387 cases of secondary hasmorrhage from stumps were chiefly examples of 
 arterial bleeding. In 95 cases, the haemorrhage was, perhaps, mainly venous, and was 
 checked by elevating the stump, or applying cold water, ice, pressure, or the solution 
 of the persulphate of iron. When the haemorrhage was arterial, the most common 
 practice was to tie the main vessel, at the second bleeding, as near as was prudent to 
 the end of the stump. In a few cases, the artery was successfully tied on the face of 
 the stump. The results of tying the vessel above, according to Anel's method, were 
 very unfortunate. 
 
 In reviewing the 650 recorded cases of secondary haemorrhage from gunshot 
 wounds, it appears that, during the earlier part of the war, there were many surgeons 
 who were not suflBciently impressed by the precepts of Bell and Guthrie, and who fre- 
 quently treated secondary haemorrhage from gunshot wounds by tying the main trunk 
 at a distance from the wound, even when the bleeding occurred at a comparatively 
 early period. Later in the war, however, it was the universal practice to endeavor to 
 secure both ends of the bleeding vessel at the seat of injury, and some brilliant ex- 
 amples are recorded in which this was accomplished in wounds of the posterior tibial 
 or popliteal, when limbs had become infiltrated and swollen, and the difficulties of the 
 operations were immense. 
 
 PYEMIA. 
 
 On this subject 281 reports have been examined, and the individual cases detailed 
 in them have been transcribed upon the registers : 251 special reports on the subject 
 remain to be examined. The histories of 754 cases are recorded in the register, the 
 pos1>mortem observations accompanying a large proportion of the fatal cases. These 
 number 719, or 95'35 per cent. Pyaemia supervened in 377 cases of gunshot injury in 
 which no operation had been performed, and after 295 cases of amputation, of which 
 
 * See page 85 of this Report. 
 
44 SUKGICAL OPERATIONS. 
 
 155 were cases of amputation in the continuity of the femur. The purulent infection 
 was subsequent to excision of the shafts of long bones in 27 cases, and, to excisions of 
 
 joints in 28 cases. 
 
 These figures by no means represent the frequency with which pysemic poisoning 
 has occurred. It has been one of the great sources of mortality after amputations, and 
 its victims are to be counted by thousands. The small number of cases on the register 
 are taken from special reports. Several valuable papers have been contributed on the 
 pathology of this affection, and a number of statistical reports on its treatment. The 
 conclusions of the latter are adverse to the therapeutical utility of the sulphites and 
 hyposulphites in this disease. 
 
 A series of colored drawings, illustrating the embolic phenomena attendant on 
 pysemia, the metastatic dep6ts, etc., have been prepared at the Army Medical Museum. 
 
 SURGICAL OPERATIONS. 
 
 All surgical operations are recorded on the registers of the office, according to the 
 form which will be presented on a subsequent page, in treating of excisions of the head 
 of the femur. The name and military description of the patient are given, the nature 
 and date of his injury, an account of the operation, a notice of the local lesions which 
 made it necessary, and of the constitutional condition of the patient at the period it was 
 performed. A summary of the progress and after-treatment follows, and the result, if 
 ascertained, the name of the operator, and the post-mortem appearances, when known, 
 if the case terminated fatally. If the case furnished a pathological preparation to the 
 Army Medical Museum, a reference is made to the number of the specimen on the 
 catalogue. 
 
 While this plan involves much labor, it effectually precludes the duplication of 
 cases, and ensures, probably, the highest attainable degree of statistical accuracy. The 
 name and military designation of the patient being known in all cases, the ultimate 
 results of operations can be traced, hereafter, and errors may be corrected. 
 
 Operations have been reported in this form from all general hospitals since Oc- 
 tober, 1863. But nearly half of the sixteen thousand operations now recorded were 
 taken from special reports and field returns belonging to an earlier period of the war^ 
 and it was necessary that these should first be transcribed on the proper forms, a task 
 that has been accomplished by clerks who were students of medicine, their work being 
 revised by a medical officer. 
 
AMPUTATIONS. 
 
 45 
 
 AMPUTATIONS. 
 
 The histories of 13,397 amputations for gunshot injury have been examined and 
 recorded, and the final results have been ascertained in 9705 cases. The following 
 table exhibits the number belonging to each region, and includes both primary and 
 secondary cases. It shows the regular increase in the rate of mortality as the trunk is 
 approached. 
 
 Amputations of the Superior Extremities. 
 Fingers and Parts of the Hand 
 
 Recovered. 
 
 Died. 
 
 Total. 
 
 Per cent, of 
 Mortality. 
 
 1778 
 
 34 
 
 19 
 
 500 
 
 1535 
 
 144 
 
 29 
 2 
 
 
 99 
 414 
 
 93 
 
 1807 
 
 36 
 
 19 
 
 599 
 
 1949 
 
 237 
 
 1-60 
 5-55 
 
 16-52 
 21-24 
 39-24 
 
 Wrist 
 
 Elbow 
 
 
 Arm 
 
 
 
 4010 
 
 637 
 
 4647 
 
 13-70 
 
 
 Amputations of the Inferior Extremities. 
 Toes 
 
 784 
 
 108 
 
 58 
 
 1737 
 
 52 
 
 568 
 
 3 
 
 6 
 
 11 
 
 9 
 
 611 
 
 64 
 
 1029 
 
 18 
 
 790 
 
 119 
 
 67 
 
 2348 
 
 116 
 
 1597 
 
 21 
 
 -75 
 9-24 
 13-43 
 26-02 
 55-17 
 64-43 
 85-71 
 
 Partial Amputations of the Foot 
 
 
 liCff 
 
 
 Thigh 
 
 
 Total of Lower Extremity 
 
 3310 
 
 1748 
 
 5058 
 
 34-55 
 
 
 7320 
 
 2385 
 
 9705 
 
 24-57 
 
 
 Amputations of the Fingers and Portions of the Hand. — The cases that have 
 been transcribed on the records form but a small proportion of the total number in- 
 cluded in the reports. In the 1807 terminated cases, the mortality has been compara- 
 tively large. The causes of death in the 29 fatal cases is stated to have been : in 4, 
 pyaemia; in 4, erysipelas; in 2, gangrene; in 1, tetanus; in 18, different intercurrent 
 diseases, as typhoid and malarial fevers, pleurisy, etc. 
 
 Amputations at the Wrist. — The disarticulation at the wrist has been performed 
 in preference to the amputation of the forearm, when the hand was totally disorganized. 
 When practised by the circular method it is a good operation. The results of the cases 
 examined are satisfactory, the mortality being ten per cent, less than in amputation of 
 the forearm. 
 
 Amputations of the Forearm. — Except in those cases in which the wrist or lower 
 extremity of the radius have been shattered by large projectiles, this amputation has 
 commonly been practised secondarily. It has been impracticable to examine all the 
 cases that have been reported. Of the terminated cases that have been transcribed 
 upon the records, 99 died and 500 recovered. Of the latter, 397 have been supplied 
 
46 SURGICAL OPERATIONS. 
 
 with artificial limbs. In the forearm, the amputation by the double flap method has 
 been generally preferred. 
 
 Amputations at the Elbow. — The returns corroborate the conclusions of Dupuy- 
 tren, Malgaigne, and Legouest, who combat the disfavor into which this operation has 
 fallen. It was done infrequently in the late war, but 19 cases having been reported. 
 But in all of these the ultimate results have been ascertained, and were favorable in 
 every instance. The success of Salleron and other French surgeons with this operation 
 in the Crimea is well known. Whenever, then, it is impracticable to amputate the 
 forearm, disarticulation at the elbow should be preferred to amputation of the arm. 
 The oval method answers the purpose best in this locality. 
 
 Amputations of the Arm. — Of 2774 cases of amputation of the arm that have 
 been entered on the registers, the results are ascertained in 1949 cases: 1535 recov- 
 ered, and 1014 of these patients have been furnished with artificial arms. 
 
 Amputations at the Shoulder-Joint. — It is creditable to the surgery of the war 
 that the number of cases of amputation at the shoulder-joint reported is less than the 
 number of cases of excisions of the head of the humerus, and that the latter operation 
 appears to have been adopted in nearly all the cases in which it was admissible. The 
 reported cases of amputation at the shoulder- joint, for the entire period, number 458; 
 of excisions of the head of the humerus, there were 575. Of the 237 terminated 
 cases of amputation, 93 died, a ratio of mortality of 39*2, which is 6"7 per cent, greater 
 than the mortality in excisions. The amputations of the upper extremity for gunshot 
 injuries are illustrated at the Army Medical Museum by 89 examples of diseases of 
 stumps, and by a large number of plaster casts and photographs, exhibiting the suc- 
 cessful results of operations. 
 
 Amputations of the Toes. — Of 784 cases that have been examined, 6 were fatal. 
 Tetanus supervened in one case, and phlegmonous erysipelas invaded the leg in 
 another. In the four remaining cases, the fatal termination was due to causes foreign 
 to the operation. 
 
 Partial Amputations of the Foot. — Of the 160 recorded cases, 119 were termin- 
 ated, with a mortality of 9 24 per cent. The tarso-metatarsal operation of Hey or 
 Lisfrancwas performed 25 times; the medio-tarsal operation of Chopart 45 times. The 
 remaining cases were ablations of toes with one or more of the metatarsals. There are 
 several casts of stumps, made by Chopart's method, at the Army Medical Museum, 
 which exhibit the drawing up of the heel which so frequently occurs after this 
 operation. 
 
 Amputations at the Ankle-Joint. — The record is far from complete. In the 
 terminated cases, Syme's method was employed in 25 cases, Roux's method in 2 cases, 
 and Pirogoflf's in 9 cases. Several casts and photographs of well-rounded stumps, 
 obtained by the latter procedure, are deposited in the Army Medical Museum. But the 
 operation appears to be regarded with but little favor. Baron von Horronitz, Surgeon- 
 in-Chief of the Russian Marine, in his recent visit to this office, mentioned that Pirogoflf 
 had himself abandoned it, finding the segment of the os calcis likely to become necrosed. 
 An abstract of a favorable case, with an illustration, is subjoined : 
 
AMPUTATIONS. 
 
 47 
 
 Lieutenant W. C. W , Co. 1, 5th Michigan Cavalry, was wounded 
 
 April 1st, 1865, at the battle of Five Forks, by a conoidal musket-ball, 
 which passed through his left ankle-joint. He was immediately carried 
 to the hospital at City Point, and amputation at the ankle was per- 
 formed on the same day by Surgeon St. Clair, 5th Michigan Cavalry. 
 The articulating surfaces of the tibia and calcaneum were removed, and 
 the cut surfaces were brought into apposition. On April 16th, 1865, 
 the patient was transferred to Armory Square Hospital, at Washing- 
 ton. On admission, he was in a feeble condition. An erysipelatous 
 blush extended above the knee on the injured side; an abscess had 
 formed in the lower part of the leg; and no union of the flap had taken 
 place. With the employment of stimulants and nutritious diet with 
 emollient applications to the limb, there was a gradual improvement, 
 until April 28th, 1865, when symptoms of pyaemic infection super- 
 vened. Bapidly recurring chills, an icteroid coloration of the skin 
 and conjunctiva, anorexia, and a frequent feeble pulse, suggested the 
 gravest prognosis. Energetic treatment was adopted. An ounce of 
 brandy was given every two hours, and quinia, sesquichloride of iron, and 
 beef tea were freely administered. On May 6th, the grave symptoms 
 began to subside, and, by the end of the month, the patient was fairly 
 convalescent. On June 26th, he was pronounced well. The os calcis 
 had firmly united to the tibia, and there was a good solid stump. A 
 cast in plaster was taken from it (Spec. 2298, A. M. M.), and a few days 
 subsequently a photograph, which is numbered 75 in the Photographic 
 Series of the Army Medical Museum. 
 
 Fio. 60. — stump after a Pirogoff amputation. 
 
 Amputations of the Leg. — Of the 3302 amputations of the leg that have been 
 recorded, the results have been ascertained in 2348. The ratio of mortality was 26"02, 
 which will doubtless be augmented by further examination of the returns. The oper- 
 ation just above the malleoli, sometimes called Lenoir's operation, has not been very 
 largely practised, but it has given some excellent results, and its mortality rate is sur- 
 prisingly small. The majority of the cases were amputations at the middle of the leg 
 and at the place of election. The circular method has been most commonly employed. 
 Larrey's operation through the head of the tibia has been done but little, though an 
 examination of the specimens at the Army Medical Museum leads to the conviction 
 that this procedure might have been substituted, in some instances, for disarticulation 
 at the knee-joint, or amputations at the lower third of the thigh. Of the 1737 patients 
 that recovered after amputation of the leg, 1057 have been furnished with artificial limbs. 
 
 Amputations at the Knee-Joint. — This operation has found numerous advocates 
 during the war, and has been frequently performed. The returns to October, 1864, 
 give 132 cases, of which 52 recovered and 64 died. In 6 cases, amputation of the thigh 
 was subsequently performed, with 3 recoveries and 3 deaths. In 10 cases, the result is 
 undetermined. These figures are encouraging, and if we look at the primary operations 
 alone, the result is still more gratifying. Of 49 cases of primary amputation at the 
 knee-joint, 31 recovered and 16 died; while 2 underwent reamputation, of whom 1 
 recovered, and 1, a tuberculous subject, died. This gives a percentage of mortality in 
 primary amputations at the knee-joint of 34"9. The mortality in primary amputation 
 at the lower third of the thigh is much larger than this : indeed, it has been already 
 indisputably proved by the Crimean statistics, and by M. Malgaigne, that the mortality 
 in amputation augments in exact proportion as the incisions approach the trunk. 
 
 At the Army Medical Museum there is a photograph, accompanying Specimen 
 2778, of the fine, well-rounded stump of Private Nevelling, Co. A, 71st Pennsylvania 
 
48 SURGICAL OPEEATIO]|^. 
 
 Vols., who was wounded at White Oak Swamp, and amputated, at Philadelphia, by Acting 
 Assistant Surgeon T. G. Morton. The objection to amputations at the knee-joint, that 
 the resulting stump is ill adapted to the use of an artificial limb, is set at rest by the 
 results obtained by Hudson and other manufacturers, who distinctly declare that the 
 stumps from the operation at the knee-joint give a base of support far better than any 
 possibly to be gained in thigh-stumps. 
 
 It is well known that M. Legouest emphatically pronounces the disarticulation at 
 the knee "une mauvaise operation, plus grave que Taraputation de la cuisse dans la 
 continuity, et qui doit etre rejet6e de la pratique," basing this assertion on the Crimean 
 returns ; but it is probable that the more extended experience of the late war will lead 
 surgeons to share the convictions of Macleod, Baudens, and Malgaigne, that this oper- 
 ation is altogether preferable to the amputation at the lower third of the thigh. 
 
 Amputations of the Thigh. — In 1597 terminated cases, 568 recovered and 1029 
 died, or 64-43 per cent., which is within a fraction of the mortality after amputations of 
 the thigh in the English army in the Crimea during the latter part of the campaign. 
 In the French army in the Crimea, the whole number of amputations of the thigh for 
 gunshot injuries was 1666, of which 1531, or 91-89 per cent., terminated fatally. 
 
 Of these 1597 amputations, the date of operation is ascertained with precision in 
 1061. Of these, 423 were primary and 638 were intermediate or secondary. The 
 ratio of mortality was 54-13 in the former, and 74-76 in the latter. 
 
 In the 568 recoveries after amputation of the thigh above mentioned, the patients 
 have been supplied with artificial limbs in 254 cases, and reports are on file of 439 
 other cases of recovery after this operation in which artificial limbs have been provided. 
 These cases are not entered on the registers, because the returns exhibiting the deaths 
 for the corresponding periods have not yet been reached. 
 
 Amputations at the Hip-Joint. — At the commencement of the war, the uniform 
 fatality of amputation at the hip-joint in the Crimean war was impressed upon the 
 minds of surgeons, and many believed that the operation should be discarded alto- 
 gether. Still, it has been occasionally performed, and several lives have unquestion- 
 ably been saved by it. A noted case is that of Kelly, whose appearance, after recovery, 
 is represented in the plate opposite. The following is an abstract of the case : 
 
 Private James E. Kelly, Co. B, 56th Pennsylvania Vols., aged twenty-eight years, was wounded at about 9 o'clock 
 of the morning of April 29th, 1863, in a skirmish of the First Division, First Corps, on the Bappahannock, nearly 
 opposite the " Pratt House," below Fredericksburg. A conoidal musket-ball, fired from a distance of about three 
 hundred yards, shattered his left femur. A consultation of the senior surgeons of brigades decided that exarticula- 
 tion of the femur was expedient, and the operation was performed, at four in the afternoon, at the "Pitzhugh 
 House," by Surgeon Edward Shippen, U. S. Vols., Surgeon-in-Chief of the First Division. The single flap method 
 was adopted, and the amputation was accomplished with slight loss of blood. The patient was at first placed in a 
 hospital tent, and was transferred. May 22d, to the Corps Hospital, progressing favorably. By May 28th, all the liga- 
 tures had been removed. On June 15th, 1863, the patient was captured by the enemy, and was removed to the Libby 
 Prison, in Eichmond. Up to this date there had been no bad symptoms. On July 14th, Kelly was exchanged, and 
 was sent to the Annapolis U. S. A. General Hospital. On his admission, he was much exhausted by profuse diar- 
 rhoea. The internal portion of the wound had united, but the external portion was gangrenous. Applications of 
 bromine were made to the sloughing surface without amelioration. A chlorinated soda lotion was substituted, and in 
 the latter part of July, there was a healthy granulating surface. On December 23d, 1863, the wound had entirely 
 healed, and Kelly visited Washington and obtained an honorable discharge from service, and a pension. Kelly then 
 went to his home, near Black Lick P. 0., Indiana County, Pennsylvania. A letter dated January 12th, 1865, was 
 received from him at this office, and represented him as in excellent health and spirits at that time. A year after 
 the operation, a photograph of the stump was obtained. The accompanying plate is copied from it. 
 
en 
 
 -a 
 -o 
 
 CO 
 
 CO 
 
 c 
 
 o 
 m 
 
 CO 
 CO 
 
 > 
 
 -o 
 
 c: 
 
 o 
 
 m 
 
 c_ 
 O 
 
 H 
 
A 
 
 AMPUTATIONS. 49 
 
 A successful primary case, operated upon at Memphis, by Dr. Fenner, is reported 
 by a student of Dr. F. H. Hamilton, late Medical Inspector U. S. A., who saw the sub- 
 ject of it after his complete recovery. 
 
 A successful secondary case, reported by Assistant Surgeon C. Wagner, U. S. A., 
 was a reamputation of a diseased stump. Necrosis of the femur was induced by osteo- 
 myelitis, and the disarticulation was effected at a period when the traumatic phe- 
 nomena had entirely disappeared. The particulars of this case are subjoined : 
 
 Private Eben. B. Smith, Co. A, 11th Maine Vols., aged nineteen years, was wounded at the engagement at Deep 
 Bottom, near Drury's Bluff, Virginia, 
 on August 16th, 1864, by a musket-ball, 
 which fractured the head of the right 
 tibia. He was admitted at the U. S. 
 General Hospital, at Beverly, New Jer- 
 sey, on August 22d, 1864. On admis- 
 sion, the injured knee-joint was swollen 
 and painful, and there was irritative 
 fever of a moderate grade. On Sep- 
 tember 12th, secondary hiEmorrhage oc- 
 curred, and the thigh was amputated by 
 circular incisions at the lower third, by 
 Acting Assistant Surgeon T. M. Mor- 
 ton, U. S. A., the patient being under 
 chloroform. The case progressed favor- ^'°- ei-'iPP^^"™* "f ''""p ti"-^» ■""■"'^ "f'^f s^on^ary amputation at hip joint, 
 
 ably until October 17th, when secondary haemorrhage recurred, and was arrested by ligating the femoral artery in 
 Scarpa's triangle. The stump remained swollen and painful, and furnished a profuse foetid suppuration. Osteo- 
 myelitis supervened ; the end of the femur protruded, and was removed by the chain-saw. Necrosis finally extended 
 as high as the trochanters, and numerous abscesses formed. On January 19th, 1865, amputation at the hip-joint was 
 performed, under chloroform, by Acting Assistant Surgeon J. H. Packard, U. S. A., the antero-posterior flap operation 
 being adopted. On January 27th, there was haemorrhage from the stump, and the external iliac artery was tied. The 
 ligature separated on February 17th, and two days afterwards there was profuse bleeding from the divided artery, 
 which was controlled by pressure for fourteen days. After this the patient rapidly improved. In April he was 
 reported well, and Hospital Steward Baumgras, one of the artists of the Army Medical Museum, was sent to Beverly, 
 and made the drawing from which the engraving was taken. It is numbered 67 in the Surgical Series of Drawings 
 of the Surgeon General's OfBce. On April 12th, 1865. Smith was transferred to White Hall Hospital, near Bristol, 
 Pennsylvania. Assistant Surgeon W. H. Forwood, U. S. A., reports that, on May 27th, 1865, he was discharged 
 from service quite well and strong, the wounds being entirely healed. The necrosed lower portion of the femur is 
 Specimen 3709; the upper portion is Specimen 81, A. M. M. 
 
 Another successful secondary disarticulation of the femur is reported, which was 
 also a case of reamputation, necessitated by disease of the femur. The first amputa- 
 tion was performed at the lower third of the thigh on account of a bayonet wound of 
 the knee-joint. The case is consequently excluded from the tabular statement of am- 
 putations for gunshot injury < The patient is represented in Photograph 113, A. M. M. 
 
 Private Lewis Francis, Co. I, 14th New York Vols., aged forty-three years, was admitted to Ladies' Home 
 U. S. A. General Hospital, New York City, on October 28th, 1863. He had been wounded by a bayonet in the right 
 knee, at the battle of Bull Run, July 21st, 1861, and was taken prisoner, and suffered amputation of the thigh in 
 Kichmond, Virginia, May 28th, 1862. The femur becoming diseased subsequently, its protruding extremity had been 
 sawn off. What remained of the femur was necrosed, when the patient arrived in New York, and, on May 21st, 
 1864, the flaps were laid open, and the necrosed femur was removed by Surgeon Alexander B. Mott, U. S. Vols. No 
 untoward symptoms followed, and the patient recovered, and was discharged from the service, August 12th, 1864. 
 
 A memorandum is subjoined of all amputations at the hip-joint for gunshot injury 
 that have been reported. Nine were primary, and twelve were secondary operations. 
 This is followed by a table exhibiting the results of this operation in previous wars. 
 
 7 
 
50 
 
 SURGICAL OPERATIONS. 
 
 AMPUTATIONS AT 
 
 No. 
 
 Name of Operator. 
 
 10 
 
 11 
 
 12 
 13 
 
 14 
 15 
 16 
 
 17 
 
 18 
 
 19 
 
 20 
 21 
 
 David P. Smith, Surgeon U.S. 
 Vols. 
 
 Prof. Geo. E. Blaekman, Act. 
 Asst. Surgeon U. S. A. 
 
 E. S. Fenner, Surgeon P. A. C. S. 
 
 Edward Shippen, Surgeon U.S. 
 Vols. 
 
 B. Howard, Asst. Surgeon U.S.A. 
 Unknown. 
 
 Prof. J. M. Carnochan, Act. Asst. 
 Surgeon U. S. A. 
 
 Edward Shippen, Surgeon U. S. 
 Vols. 
 
 Edward Shippen, Surgeon U.S. 
 Vols. 
 
 Peter Pineo, Medical Inspector 
 U.S.A. 
 
 Alexander Ingram, Asst. Sur- 
 geon U. S. A. 
 
 H. C. Roberts, Asst. Surgeon 
 U. S. Vols. 
 
 Albert C. Gorgas, Surgeon U. S. 
 
 Navy. 
 
 Edwin Bently, Surgeon U. S. 
 Vols. 
 
 J. C. McKee, Asst. Surgeon 
 U.S.A. 
 
 F. Hassenburg, Act. Asst. Sur- 
 geon U. S. A. 
 
 Dr. Gurdon Buck, New York 
 
 City. 
 
 Edwin Bently, Surgeon U. S. 
 Vols. 
 
 J. H. Packard, Act. ASst. Sur- 
 geon U. S. A. 
 
 C. Wagner, Asst. Surgeon U.S.A. 
 
 E. Griswold, Surgeon U. S. Vols. 
 
 Name and Kank of Patient. 
 
 Private on Hospital Steamer 
 Crescent City. 
 
 Private on Hospital Transport. 
 
 A private of the Confederate 
 Army. 
 
 Private James E. Kelly, aged 28, 
 Co. B, 56th Penn. Vols. 
 
 Private J. Martin, aged 20, Co. I, 
 146th N. Y. Vols. 
 
 Private William Waters, Co. K, 
 123d N. Y. Vols. 
 
 Private of 9th Corps, aged 28. 
 
 Private J. M. Brown, Co. K, 63d 
 Indiana Vols. 
 
 Private of 23d Corps. 
 
 Private P. Johnson, Co. C, 2d 
 Delaware Vols. 
 
 Private Charles Lackey, aged 19, 
 Co. E, 7th Wisconsin Vols. 
 
 Private Levi Eckley, aged 33, 
 Co. I, 67th Ohio Vols. 
 
 Seaman George Cook, aged 21. 
 
 Private Michael O'Neil, aged 19, 
 Co. E, 58th Mass. Vols. 
 
 Private Daniel H. Bowman, aged 
 24, Co. C, 110th Penn. Vols. 
 
 Private Lewis Larry, aged 23, 
 Co. A, 1st New Orleans Vols. 
 
 Lieutenant Charles H. Hawkins, 
 Co. C, 4th N. Y. Cavalry. 
 
 Sergeant Lewis Carroll, aged S3, 
 Co. A, 1st Delaware Vols. 
 
 Private Eben. E. Smith, aged 19, 
 Co. A, 11th Maine Vols. 
 
 Private John Williams, aged 44, 
 Co. F, 13th Ohio Cavalry. 
 
 Private Geo. M. Spencer, aged 17, 
 Co. B, 2d N. Y. Mounted Rifles. 
 
 Nature and Date of Iijury. 
 
 Comminution of the upper half of the femur 
 by canister, April 6th, 1862. 
 
 Gunshot fracture of upper extremity of femur, 
 April 6th, 1862. 
 
 Gunshot fracture of the left femur, March, 
 1862. 
 
 Conoidal ball comminuted upper extremity of 
 left femur, April 29th, 1863. 
 
 Conoidal ball fractured the upper part of left 
 femur, July 13th, 1863. 
 
 Gunshot fracture of left femur, May 15th, 
 1864. 
 
 Left femur shattered by a shell, May 18th, 
 1864. 
 
 Fracture of upper third of right femur by a 
 conoidal musket-ball, June 16th, 1864. 
 
 Conoidal ball shattered head and neck of 
 femur, and involved the hip-joint. 
 
 Fracture of the upper third of the right femur, 
 and wound of the femoral artery, by a co- 
 noidal musket-ball, Dec. 14th, 1862. 
 
 Upper third of right femur fractured by a 
 musket-ball. May 12th, 1864. 
 
 Gunshot fracture of left thigh. May 20th, 
 1864. 6.0- 
 
 Rifle-ball passed through both testicles, and 
 entered left thigh, conlminuting the femur 
 and passing out, Feb. 1st, 1864. 
 
 Gunshot comminuted fracture of right femur, 
 by a conoidal musket-ball, June 3d, 1864. 
 
 Gunshot comminuted fracture of upper third 
 of right femur, July 27th, 1864. 
 
 Amputation of thigh on account of gunshot 
 fracture. Subsequent necrosis of femur. 
 First injury July 17th, 1864. 
 
 Amputation of right thigh, on account of 
 gunshot fracture of femur received June 
 8th, 1862. 
 
 Gunshot fracture of right femur just below 
 lesser trochanter, by a musket-ball, Oct. 
 22d, 1864. 
 
 Amputation of right thigh on account of gun- 
 shot fracture. Subsequent necrosis of femur. 
 First injury Aug. 16th, 1864. 
 
 Gunshot fracture of left femur, Sept. 30th, 
 1864. 
 
 Gunshot fracture of right femur, March 31st, 
 1865. 
 
AMPUTATIONS. 
 
 51 
 
 THE HIP-JOINT. 
 
 Sate of 
 Operation. 
 
 April 8, 
 
 1862. 
 
 April 8, 
 1862. 
 
 March, 
 1862. 
 
 April 29, 
 1863. 
 
 July 14, 
 1863. 
 
 May 15, 
 1864. 
 
 May 18, 
 1864. 
 
 June 16, 
 1864. 
 
 1864. 
 
 Dec. 27, 
 1862. 
 
 May 21, 
 1864. 
 
 May 24, 
 1864. 
 
 1864. 
 
 August 10, 
 1864. 
 
 Sept. 15, 
 1864. 
 
 Sept. 21, 
 1864. 
 
 'Sept. 21, 
 1864. 
 
 Nov. 11, 
 1864. 
 
 January 9, 
 1866. 
 
 Feb. 17, 
 1865. 
 
 April 12, 
 1865. 
 
 KeBult. 
 
 Died in five days. 
 Died in twenty minutes. 
 Recovered. 
 Recovered. 
 
 Died in forty-eight hours. 
 Died May 15th, 1864. 
 Died in ten hours. 
 Died in one hour. 
 Died in less than one hour. 
 Died in a few hours. 
 
 Died in twenty-four hours. 
 Died in four days. 
 
 Died in less than two 
 hours. 
 
 Died in nineteen days. 
 Died in one day. 
 Died in nine days. 
 
 Died in one day. 
 
 Died in eight days. 
 
 Recovered. 
 
 Died in one day. 
 
 Died before removal to 
 the ward. 
 
 Authority. 
 
 Smith's Report, Surgical Records, A, No. 11. 
 J. H. Brinton's Report. 
 
 Surgeon J. H. Brinton's Report. 
 
 Report from Memphis U. S. A. General Hos- 
 pital. 
 
 Shippen's Report. Vanderkieft's Report. 
 Letters from Kelly. 
 
 Report of Surgeon Flandrin, N. Y. Vols. His- 
 tory of Specimen 1379, Army Med. Museum. 
 
 Report of Army of Cumberland, Book ix. 
 p. 355, S. G. 0. 
 
 Letter of Prof. Carnochan of Nov. 7th, 1864. 
 
 Special Report of Surgeon Shippeu, U. S. 
 Vols. 
 
 Special Report of Surgeon Shippen, U. S. 
 Vols. 
 
 Letter from Medical Inspector Pineo. 
 
 Quarterly Report of Surgical Operations 
 from Judiciary Square Hospital. 
 
 Quarterly Report of Chesapeake Hospital. 
 
 Report from U. S. Naval Hospital, Norfolk, 
 Va. 
 
 Quarterly Report from Third Division Gen- 
 eral Hospital, Alexandria, Va. 
 
 Quarterly Report from Lincoln General Hos- 
 pital, Washington, D. C. 
 
 Quarterly Report from University General 
 Hospital, New Orleans, La. 
 
 Report from St. Luke's Civil Hospital, New 
 York City, and letter from Professor Buck. 
 
 Report from Alexandria Hospital. 
 
 Quarterly Report from U. S. A. General Hos- 
 pital, Beverly, New Jersey. 
 
 Quarterly Report from U. S. A. General Hos- 
 pital, Beverly, N. J. 
 
 Quarterly Report from Judiciary Square 
 General Hospital, Washington, D. C. 
 
 Was transferred to a hospital at 
 St. Louis. 
 
 A patient wounded at Shiloh. 
 
 Operation performed twenty-four 
 hours after reception of wound. 
 
 Was quite well in the summer of 
 1865. Spec. 1148, A. M. M. Draw- 
 ings 31 and 72, Surg. Series, S. G. 0. 
 
 See Specimen 1379, Army Medical 
 Museum. 
 
 Done at 9th Corps Hospital, at 
 battle of Spottsylvania. 
 
 A primary operation. 
 
 A primary operation. 
 
 See Specimen 710, Army Medical 
 Museum, and Photographic Series 
 A. M. M., No. 14. 
 
 See Specimen 2773, Army Medical 
 Museum. 
 
 Ligation of external iliac artery. See 
 Spec. 3098, Army Med. Museum. 
 
 Reamputation. 
 
 Reamputation. 
 
 See Specimen 1020, Army Medical 
 Museum. 
 
 Reamputation. See Specimen 81, 
 Army Medical Museum, and Pho- 
 tographic Series A. M. M., No. 29. 
 
 See Specimen 84, Army Medical 
 Museum. 
 
 An excision of the head of the 
 femur was first practised. 
 
52 
 
 SURGICAL OPERATION'S. 
 
 Table, showing the Mortality of Amputations at the Hip-Joint for Gunshot Injury, including Primary, 
 
 Intermediate, and Secondary Cases. 
 
 Larrey's primary cases 
 
 Larrey's intermediate cases 
 
 Guthrie's Ciudad Rodrigo case (intermediate) 
 
 Guthrie's Waterloo case (primary) 
 
 S. Cooper's case 
 
 Blandin's eases (in 1794) 
 
 Hutin (M^m. de i\Kd. Mil., t. xliv.) 
 
 Brownrigg (Elvas, 1811) 
 
 Wedemeyer (Bull, de F^rusac, t. iii. p. 161) 
 
 Letulle (Si^ge d'Anvers) 
 
 Clot Bey (Legouest's table) 
 
 Jubiot (Legouest's table) 
 
 Guy on (Algeria, 1840) 
 
 S^dillot (Annales de la Chir , t. ii. p. 279) 
 
 Richet (JournSes de Juin, 1848) 
 
 Robert (Idem) 
 
 Guersant (Idem) 
 
 Vidal (Idem) .'!.].'."!."!!!.'!! 
 
 Baudens (Traitg des Plaies d'Armes 4 Feu) 
 
 Schleswick Hoist ein cases 
 
 Langenbeck's case (Schleswick Holstein) 
 
 Two operations in the English Army in the Crimea by the Director General 
 
 A soldier of the 33d English Regiment 
 
 Two other oases prior to April, 1855, in the English Army in the Crimea 
 
 Sevenenlistedmen and two officers (Med. and Surg. Hist, of Brit. Army in the Crimea) 
 
 Twelve primary cases in the French Army in the Crimea 
 
 Mounier's case at Dolma Batchi 
 
 Legouest's case (really recovered, and died of cholera) 
 
 Four other secondary cases in the French Crimean hospitals 
 
 Bertherand's case after the engagement at Novara (Campagne d'ltaliede 1859, p. 37). 
 
 Jules Roux's cases at Toulon (all secondary) 
 
 Primary cases in the late war 
 
 Secondary cases in the late war 
 
 Kecovered. 
 
 11 
 
 Died. 
 
 2 
 1 
 2 
 9 
 
 12 
 3 
 1 
 4 
 1 
 2 
 7 
 
 11 
 
 92 
 
 6 
 1 
 1 
 1 
 1 
 3 
 2 
 1 
 2 
 1 
 1 
 3 
 1 
 5 
 1 
 1 
 1 
 1 
 1 
 6 
 1 
 2 
 1 
 2 
 9 
 
 12 
 3 
 1 
 4 
 1 
 6 
 9 
 
 12 
 
 103 
 
 There seem to be but three conditions under which early amputation at the 
 hip-joint is admissible in military surgery, viz., when nearly the entire thigh is caTried 
 away by a large projectile, when the totality of the femur is destroyed by osteomyelitis, 
 and, possibly, when, with comminution of the upper extremity of the femur, the femoral 
 vessels are wounded. 
 
 The experience of M. Jules Eoux, in the Italian war, seems to prove conclusively 
 that secondary amputations at the hip-joint are less dangerous than primary ones. 
 
 As to the method of operating, it may be observed that the anterior single flap 
 procedure has of late been generally preferred.* 
 
 Amputations of the lower extremity are illustrated at the Army Medical Museum 
 by numerous casts, drawings, and photographs, by 9 specimens of shattered femurs 
 removed by amputation at the hip-joint, and by 211 specimens of the diseases of the 
 
 * Since this report was put in print, two additional cases of amputation at the hip-joint have been reported. In 
 the case of Private P. Kelb, Co. H, 7th New York Vols., whose right femur was fractured at Fredericksburg by a 
 musket-ball, in December, 1862, Dr. E. P. Weir amputated at the hip -joint, at St. Luke's Hospital, New York, on 
 June 7th, 1865, on account of necrosis of the entire femur. The stump nearly healed ; but the patient died October 
 4th, 1865, of pulmonary tuberculosis. On October 12th, 1865, Surgeon E. Bently, U. S. Vols., amputated at the hlp- 
 joint m the case of Private Lemon, 6th Maryland Vols., on account of necrosis of the left femur, resulting from a 
 gunshot fracture of the upper third, received at the battle of the Wilderness, May 5lh, 1864. The patient was in a 
 satisfactory condition on November 24th, 1865. (Specimen 4386, A. M. M.) 
 
AMPUTATIONS. 
 
 53 
 
 Via. 62.- 
 
 Necroais of right tibia and fibula after amputa- 
 tion of the leg. Spec. i22b, A. M. M. 
 
 Fra. 63. — HyperostOBiB of the extremities of the right 
 tibia and fibula after amputation. Spec. 2778, 
 A. M.M. 
 
 bone after amputation. Wood-cuts of a few of the latter are subjoined. In regard to 
 Specimen 4225, the following particulars are recorded : 
 
 Private Daniel S. Crawford, Co. A, 47th Pennsylvania Vols., aged 
 twenty-seven, was wounded at Cedar Creek, October 19th, 1864, his right 
 leg being fractured at the middle third. Amputation at the middle of 
 the leg was performed the same day. On October 26th, he was trans- 
 ferred to the National Hospital, at Baltimore, and thence to the Jarvis 
 Hospital, where it was found that the amputated extremities of the 
 tibia and fibula were necrosed. On March 25th, 1865, lateral flaps 
 were reflected and five inches of the diseased bones were resected by 
 Acting Assistant Surgeon W. G. Small, U. S. A. After this the stump 
 
 healed promptly, and the patient was discharged from service May 31st, 1865. (See Surg. Eec. S. G. 0., Amputations, 
 vol. vi. part ii. p. 141.) 
 
 Specimen 2778 presents a remarkable example of the exaggeration of the natural 
 process by which the amputated ends of bones are rounded off. The redundant osseous 
 formation presents the histological characters of ordi- 
 nary callus. In the case which furnished this speci- 
 men, a successful secondary amputation was performed 
 through the knee-joint. 
 
 Cases of myelitis after amputation of the thigh 
 have furnished the Museum with a large number of 
 sequestra comprehending the entire circumference of 
 the bone. The accompanying example is remarkable 
 for the unusual length of the sequestrum, and from the fact that the patient recovered 
 after its removal. It was contributed, with the following narrative, by Assistant Sur- 
 geon W. Thomson, U. S. A.: 
 
 Corporal H. H. Ellis, Co. I, 16th New York Vols., was wounded at Chancellorsville, May 3d, 1863, and admitted 
 into Douglas Hospital, at Washington, May 8th, 1863. A conoidal ball had comminuted the left patella (Spec. 1852, 
 A. M. M.), and the knee-joint was involved. On the 13tb of May, the thigh was amputated at the lower third by the 
 circular method. This patient's health was 
 much impaired by chronic diarrhoea, and after 
 the operation, his condition was unpromis- 
 ing. Secondary haemorrhage occurred on May 
 20th, and recurred on the 21st, when the fem- 
 oral artery was tied in Scarpa's triangle. For 
 many weeks this man clung to life by the slen- 
 derest thread. The thigh stump was greatly 
 swollen and very tender on pressure. The line of incision, however, was not unhealthy in appearance, and the dis- 
 charge was moderate. Prom the inner angle of the stump the necrosed extremity of the femur protruded. August 
 9th, 1863, the sequestrum was found to be loose, and was removed. After its extraction there was considerable 
 haemorrhage ; nevertheless, convalescence now proceeded rapidly. A formation of new bone, replacing the original 
 femur, could be readily felt. The stump was not shorter than at first. It soon closed entirely, was firm, and in every 
 respect satisfactory. The man was discharged from the hospital, and from the service of the United States, October 
 26th, 1863. In December, 1864, he reported himself in good health. 
 
 The next specimen illustrates the numerous class of cases in which pyaemia accom- 
 panies osteomyelitis, and proves fatal before 
 the dead bone is sufficiently detached to be 
 extracted. The involucrum is thin and 
 eroded. The specimen, with the following 
 facts relating to it, was forwarded by Sur- 
 geon E. Bently, U. S. Vols.; 
 
 Fig. 64. — Cylindrical sequestrum from the left femnr after amputation at the lower third of 
 the thigh. I^aec. 1853, A. M. M. 
 
 Fig. 65. — Necrosis of the amputated end of the left femur. 
 A. M. M. 
 
 Spec. 3343 
 
54 SURGICAL OPEKATIONS. 
 
 Private Andrew H— , Oo. B, 6th New Jersey VoIb., was wounded May 6th, 1864, at the battle of the Wilder- 
 ness, by a musket-ball, which entered the left knee-joint, at the upper outer margin of the patella. He was admitted 
 to the 3d Division General Hospital, at Alexandria, Virginia, on May 26th. On July 9th, a large abscess near the 
 elbow was laid open. Others formed along the thigh, and were likewise opened. On July 16th, the thigh was ampu- 
 tated in the lower part of the middle third. The case terminated fatally on July 26th. The autopsy revealed numerous 
 metastatic foci in the lungs ; the liver was fatty; the spleen much enlarged. There were bed-sores on the back, and 
 the body was much emaciated. 
 
 EXCISIONS. 
 
 The number of excisions after gunshot injuries that have been transcribed from 
 the reports is given on page 6 of this report, and indicates that this branch of conserva- 
 tive surgery was largely practised in the late war. It is proposed here to review very 
 briefly the records of the individual excisions. 
 
 Excisions of the Wrist.— The 35 cases included in this category were all examples 
 of partial excision. In 27, the ends of the radius or ulna, or of both, were removed, 
 and, in some instances, shattered fragments of the upper row of carpal bones. In 8, 
 the greater part of the carpus was excised. Death took place once from pyasmia, and 
 twice from exhaustion from protracted suppuration and irritative fever: 26 cases are 
 reported as recovered. In 2 cases, amputation of the forearm became necessairy. The 
 reports are unsatisfactory in relation to the amount of mobility left in the hand, and the 
 cases are now under investigation with reference to this point. 
 
 As the literature of this subject is meagre, a few illustrative cases are appended: 
 
 Private Joseph Hoover, Oo. A, 62d Pennsylvania Vols., aged twenty-six years, was wounded at Spottsylvania, 
 May 12th, 1864, by a musket-ball, which passed through both wrists. He entered Judiciary Square Hospital, at 
 Washington, on May 26th. His right forearm had been amputated on the field. On May 30th, Assistant '►Surgeon 
 A. Ingram, U. S. A., removed nearly all the left carpus, the styloid process of the ulna, and the carpal end of the 
 first metacarpal bone, and made free incisions over the ulna and the dorsum of the hand for the evacuation of pus. 
 The patient recovered, and was discharged from service. The condition of the hand is not reported. 
 
 Surgeon H. Culbertson, TJ. S. Vols., removed the cuneiform and pisiform, and a portion of the os magnum, and 
 extracted fragments of the unciform and semilunare in the case of Private Neal, Oo. D, 3d Wisconsin, who was shot 
 through the carpus, at Dallas, Georgia. The patient recovered with some use of his hand, and entered the Veteran 
 Eeserve Corps, April 1st, 1865. 
 
 Assistant Surgeon 0. Bacon, U. S. A., excised the lower portion of the right radius, the trapezoid, scaphoid, 
 OS magnum, and the second, third, and fourth metacarpals, in the case of Private Bard, Oo. I, 1st Pennsylvania Vols., 
 who was wounded at Antietam. The result is stated to have been favorable. 
 
 Photograph 59 of the Army Medical Museum represents the forearm and hand of Major 0. W. Hobbs, 7th New 
 York Heavy Artillery, who was wounded at Cold Harbor, Virginia, June 3d, 1863, by three musket-balls. One 
 inflicted a flesh wound of the left thigh, passing across the popliteal space, close to the hamstring tendons. A second 
 fractured the third and fourth metacarpal bones of the left hand, and made its exit near the wrist. The third entered 
 the left hand between the distal extremities of the first and second metacarpals, comminuting the second and third 
 metacarpals, the unciform and cuneiform bones, and the lower extremity of the ulna, and made its exit on the outer 
 side of the forearm. Primary excision was performed by Surgeon J. E. Pomfret, 7th New York Heavy Artillery. 
 Two inches of the distal extremity of the ulna were removed, with the fractured bones of the carpus and metacarpus, 
 and three outer fingers. The case progressed without any untoward eomplication, and recovery was complete in two 
 months. The remaining portion of the radio-carpal articulation was not anchylosed, and the movements of the thumb 
 and forefinger were unimpaired. 
 
 Professor Joseph Lister's recent paper,* in which are narrated the successes ob- 
 tained by his method of excising the entire wrist-joint for caries, encourages the hope 
 that the same operation may be hereafter successfully adopted in cases of gunshot 
 wounds of the wrist. 
 
 * Lancet, American edition, July, 1865, p. 306. 
 
EXCISIONS. 
 
 55 
 
 Excisions of the Elbow. — The returns for three-fourths of the entire period give 
 315 cases of excision of the elbow, and the results are ascertained in 286 cases. In 16 
 cases, amputation of the arm became necessary: 62 cases terminated fatally, or 21'67 
 per cent., which is a mortality a fraction greater than that resulting from amputations 
 of the arm. This result is altogether opposed to the Schleswick Holstein and Crimean 
 experience, and will doubtless be modified when the statistics are completed. It may 
 be ascribed partly to the fact that the returns for the earlier part of the war include 
 quite a large proportion of partial excisions, which are far more hazardous than com- 
 plete removal of the articular surfaces. 
 
 The Army Medical Museum possesses 98 specimens of the injured epiphyses re- 
 moved in excisions of the elbow, and a goodly number of photographs of patients in 
 whom the operation has been performed. 
 
 The happy results of this well established operation are so fully known, that it is 
 unnecessary to give more than a single illustrative case : 
 
 Private William D. Riley, Co. D, 86th New York Yols., aged twenty-one years, was accidentally wounded at 
 Brandy Station, Yirginia, November 26th, 1863, by a musket-ball, which shattered the inner condyle of the right 
 hamerus and the olecranon process of the ulna. He was admitted to Mansion House Hospital, at Alexandria, the 
 same day, having bled quite largely on the way. On December 19th, 1863, Surgeon Charles Page, U. S. A., excised the 
 elbow-joint, employing the H- shaped incision. Two and a half inches of the lower extremity of the humerus, an inch 
 of the upper extremity of the ulna, and a small portion of the head of the radius were removed. The case progressed 
 most favorably, and in May, 1864, Biley went to his home, on furlough, with a useful arm. He was subsequently 
 discharged from service. In 1865, he re-enlisted in Oo. K, 5th Regiment, First Army Corps, with the approval of 
 Lieutenant Colonel Dougherty, Medical Director of the Corps. "The man went through the manual before me," 
 Surgeon Dougherty writes, " and stated his readiness to do all the duties of a soldier. He wished it recorded that he 
 was competent and prepared, in order that, duriug the term of his service, he might be held to full duty. The degree 
 of motion was, perhaps, one-third of the normal amount." A photograph of the patient (No. 54, A. M. M.) was taken 
 in June, 1865, at the Army Medical Museum. 
 
 Excisions of the Shoulder-Joint. — Nearly all of the cases that have been reported 
 during the war have been recorded. The results are given in the following table : 
 
 Table, exhibiting the Results of Cases of Excisions of the Shoulder- Joint for Gunshot Injuries. 
 
 Died ; 
 
 Recovered 
 
 Results undetermined 
 
 Aggregate 
 
 252 
 
 Primary 
 Operations. 
 
 Secondary 
 Operations. 
 
 60 
 
 115 
 
 160 
 
 183 
 
 42 
 
 25 
 
 323 
 
 575 
 
 The percentage of mortality is 23"3 in primary cases, 38-59 in secondary cases, or 
 a mean ratio of 32-48. The ratio in amputations at the shoulder-joint is 39-24, a per- 
 centage of 6-76 in favor of excision. Of 36 cases of gunshot fracture of the head of the 
 humerus, selected as favorable cases for the expectant plan and treated without exci- 
 sion or amputation, 16 died, or 44-4 per cent., a ratio in favor of excision of 11-96 per 
 cent. But it is superfluous to ofier further proofs in behalf of this admirable operation. 
 
56 
 
 SURGICAL OPERATIONS. 
 
 riG.66.— Ball impact- 
 ed in the head of 
 the humerus. A 
 tj'pical cage for ex- 
 cision. Spec. 1206, 
 A. M. M. 
 
 Esmarch* makes the curious observation, that resection of the left shoulder gives 
 less favorable results than the operation on the right side. This statement is not con- 
 firmed by the returns. Of 442 terminated cases in which mention is made of the 
 side injured, the right shoulder was involved in 200 and the left in 242. The oper- 
 ation resulted fatally in 72 of the former, or 36 per cent., and in 71 of the latter, or 
 29-3 per cent. The greater frequency of injuries requiring the operation on the left 
 side is doubtless due to the exposed position of the left shoulder in firing. 
 
 Generally the operation has been done in cases in which the head of the bone was 
 alone implicated, and consisted simply in a decapitation of the humerus. Partial ex- 
 cisions have been seldom practised. The method commonly preferred 
 was that by a single vertical incision, though some operators raised a 
 V-shaped flap, and all endeavored to include the wound made by the ball 
 in the incisions. It is frequently mentioned that the long tendon of the 
 biceps was preserved. In 29 cases, portions of the clavicle, or of the 
 coracoid and acromion processes and neck of the scapula, were excised, 
 as well as the head of the humerus. Only 4 of these cases terminated 
 fatally, and the average result in the recovered cases was as satisfactory 
 as the ordinary result in decapitation of the humerus. 
 
 Where the shaft of the humerus has been extensively shattered, our surgeons have 
 not been deterred by the prohibition of Guthrie, but have frequently removed the head 
 with even five and six inches of the diaphysis. It is true, as Stromeyer has clearly 
 shown, that in gunshot fracture of the surgical neck of the humerus, with extensive 
 longitudinal splitting, the fissures rarely implicated the epiphysis ; yet no good purpose 
 
 seems to be answered 
 by leaving the head 
 of the bone in these 
 cases, and excellent 
 results are obtained 
 after excision of the 
 head with very con- 
 siderable portions of 
 the shaft. The fol- 
 lowing case is an ex- \i«. ^kMv h- 
 {IIIIH ample : 
 
 Private John P. Readon, 
 Co. 0, 6th New York Cavalry, 
 aged twenty-two years, was 
 wounded at Culpepper, Vir- ^ 
 ginia, October 11th, 1863, and 
 entered Armory Square U. S. 
 General Hospital, at Wash- 
 ington, on the following day. 
 It was found that his right 
 rict. 67.— Excised head and Bhaft of right hu- humerus had been fractured by a fragment of shell, which was removed from its 
 
 merus, witli tlie fragment of shell that caused t .^ -, -, . -, ■, -, •, ,„ ., 
 
 the fiacttoe. Spec. 1738, A. M. M. lodgement Under the deltoid muscle, and proved to be four inches long and one 
 
 inch broad, and to weigh nine ounces. The head and upper third of the shaft 
 of the humerus were then excised through a straight incision, by Surgeon D. W. Bliss, U. S. Yols. The patient recovered 
 
 Fig. 68. — Appearance of the patient who furnished the foregoing 
 specimen, two years subsequent to the operation. Photographed 
 on wood. 
 
 * Statham's edition of Esmarch, American edition, 1862, p. 57. 
 
EXCISIONS. 57 
 
 without a bad symptom, and with a remarkably useful limb. lie visited the Army Medical Museum nearly two years 
 after the operation, and a photograph was then taken of his arm. The motions of the forearm and hand were unim- 
 paired. The arm could be moved forwards and backwards with considerable freedom. The hand could be readily 
 raised to the mouth, and placed in the position represented in the wood-cut. 
 
 In the remarkable case of Private Cleghorn, 1st New Jersey Cavalry, after an 
 excision of the head and upper third of the humerus, the remainder of the bone became 
 necrosed, and was excised, together with the articular ends of the radius and ulna, 
 and yet a limb was preserved, which, with the aid of ingenious apparatus, is very 
 useful. (Photograph 112, A. M. M.) 
 
 Numerous patients have been photographed at the Army Medical Museum, in 
 whom, after excision, a very satisfactory degree of motion at the shoulder-joint existed. 
 Photograph No. 103, A. M. M., represents the case of Lieutenant Jacobs, who re- 
 tains to a remarkable degree the power of abducting the arm, which, is usually very 
 limited. - The control over the movements of the arm is much augmented by the con- 
 trivance furnished by the makers of surgical apparatus, in which elastic bands supply 
 the diminished power of the deltoid and biceps. 
 
 Sixty-one excised heads of humeri have been contributed to the Museum. 
 
 Excisions of the Ankle-Joint. — Of 22 recorded cases, 8 were excisions of the 
 tibio-tarsal articulation, and the remainder were nearly all ablations of portions of the 
 tarsal bones. Of 18 terminated cases, 12 recovered and 6 died. 
 
 Five of the fatal cases are reported by Surgeon R. B. Bontecou, TJ. S. Vols., the 
 operations being described as "excisions of the ankle-joint" in four cases, and in one 
 as "excision of the lower end of the tibia and head of astragalus." They were all 
 secondary operations, performed on account of perforation of the ankle, with comminu- 
 tion, by musket-balls. They seem to have been formal resections, and not mere goug- 
 ings of necrosed bone. The results are sufficiently discouraging. 
 
 The sixth fatal case is reported by Surgeon J. A. Lidell, U. S. Vols. It was a 
 secondary excision of portions of the calcaneum and astragalus. 
 
 Surgeon Whitehill, U. S. Vols., reports a complete excision of the calcaneum and 
 astragalus in the case of Private Roberts, 7th Wisconsin Battery, with the prospect, 
 two months after the operation, of a useful limb. 
 
 Assistant Surgeon Billings, U. S. A., removed the external malleolus, the entire 
 astragalus, and a portion of the scaphoid, in the case of Private Ludwig Ettinger, 58th 
 New York Vols., and eight months afterwards the patient could walk with the aid 
 of a cane. 
 
 In the case of a negro boy of nineteen, with a ball lodged in the astragalus. Dr. 
 Billings extracted the ball and fragments of the astragalus, and the patient recovered 
 without anchylosis, and was able to walk with no perceptible limp two months after 
 the operation. 
 
 Surgeon J. A. Lidell, U. S. Vols., extracted the shattered fragments of the cuboid 
 and external cuneiform in the case of Private Ganlert, Co. K, 6 th New York Cavalry, 
 with satisfactory results. 
 
 It appears, then, that the judicious use of the gouge and bone forceps is admissi- 
 ble in gunshot wounds of the ankle-joint; but that the formal excisions are rarely 
 successful. 
 
 8 
 
58 SURGICAL OPERATIONS. 
 
 Excisions of the Knee-Joint.— Prior to the present war, there were but seven 
 recorded examples of excision of the knee for gunshot injury. These were, the elder 
 Textor's case* (in 1847) ; the Schleswick Holstein casef (1851), in which Fahle operated 
 by Stromeyer's direction; Mr. Lakin's casej (1855), in the Crimea; the Alumbaugh 
 case§ (1857), in the Indian mutiny; the case of a man in the London hospitals wounded 
 by bird shot|| (1861); a similar case at BirminghamTI (1861); and lastly, Verneuil's 
 case.** 
 
 Yerneuil's case and the Birmingham case were successful. The patients were 
 lads of seventeen and nineteen. 
 
 Modern surgeons have bravely striven to escape the deplorable necessity which 
 has led to the establishment of the imperative rule of amputation in every gunshot 
 fracture involving the knee-joint, and such eminent authorities as Legouest and Mac- 
 leod have advised that excision should be substituted for amputation in cases in which 
 the injury to the epiphyses is inconsiderable, the patient young and robust, and the 
 requisite hygienic and surgical resources for careful after-treatment attainable. Un- 
 happily, in an active campaign in the field, these circumstances are rarely met in 
 conjunction. 
 
 During the late war, complete excision of the knee-joint has been performed eleven 
 times. An abstract of each case is here furnished : 
 
 Private Alexander Eider, Oo. I, 76th Pennsylvania Vols., aged twenty-five, was admitted into Hospital No. 1, 
 Beaufort, South Carolina, October 24th, 1862. He was wounded at Pocotaligo, South Carolina, October 22d, 1862, 
 by a rough lead canister ball, which entered over the front of the external condyle of the right femur, passed through 
 the articulation, and lodged in the popliteal space. October 24th, 1862, Surgeon Reed B. Bontecou, U. S. Vols., 
 removed the ball by an incision, and sawed off the lower portion of the condyles of the femur, and excised a very thin 
 slice from the head of the tibia. An H-shaped incision was employed. The transverse cut was accurately brought 
 
 together by lead-wire sutures. The azygos artery was tied. The circulation and 
 appearance of the limb were good, but there was some swelling of the knee-joint, 
 which was painful on pressure or when moved. At the date of operation the patient 
 was in good health. An ice-bag and lint wet in a solution of morphia were applied 
 to the joint. October 25th, 1862, sulph. magnes. gi. The ice dressing was continued 
 till November 2d. About this time there was a troublesome diarrhoea, which was 
 checked by pills of opium and nitrate of silver. Diet, milk porridge. October 27th, 
 the limb was placed in a trough, stuffed with hay, which afforded much relief. Be- 
 fore this the pain had been excessive. November 8th, no evidence of inflammation 
 Fio. 69.— Condyle of right femur, excised about the knee. Transverse incision healed without suppuration. November 18th, 
 ternaicondyief"^ec!203o"A?M. M?™" has steadily improved. December 1st, the bones had apparently united, and the 
 
 incisions had healed except at a point on either side of the joint, from which a 
 few drops of pus escaped on pressure. December 20th, starch bandage. December 26th, febrile disturbance. An 
 erythematous blush over skin of lower extremity. Bandage removed. December 28th, febrile symptoms gone. The 
 man was this day sent to the North on the steamer " Star of the South." He was seen by Dr. Bontecou in July, 1863, 
 at "Fort Wood" Hospital, New York Harbor. He was not then able to walk, but subsequently did so with the aid 
 of a cane. He was discharged from service August, 1863. In the summer of 1865, he was again heard from by Dr. 
 Bontecou, and was still in good health. 
 
 Corporal Charles Derrell, Co. P, 74th Indiana Vols., aged twenty-seven, was admitted, November 25th, 1863, 
 into Branch No. 6, Field Hospital, Chattanooga, Tennessee, with fracture of the right knee-joint, by a round musket- 
 
 * Puch's Dissertat. 1854 ; and 0. Heyfelder's Trait6 des Resections, par B. Boeckel. Paris, 1863, p. 106. 
 t Priedrich Esmarch, Die Resectionen nach Schusswunden, Eiel, 1851; and Statham's Esmarch, p. 113. 
 t Macleod, Notes on the Surgery of the Crimea, p. 349. 
 ? Edinburgh Medical and Surgical Journal, October, 1860. 
 
 II The Lancet, April 20th, 1861. T[ Medical Times and Gazette, May, 1861. 
 
 ** Gazette Hebdomadaire, Nov. 1862 ; Soc. de Chirurgie de Paris, Seance de 10 Juin, 1863 ; and Legouest, 
 Trait6 de Chirurgie d'Arm^e, p. 750. 
 
EXCISIONS. 59 
 
 ball, received on date of admission, at Mission Ridge. Missile had entered on inner aspect of the joint, fractured 
 the inner condyle of the femur, and passed obliquely downwards and outwards, lodging in the head of the tibia. 
 November 26th, Surgeon James Heller, 38th Ohio Vols., operated. An anterior semicircular incision, including the 
 wound of entrance, being made, and the patella removed, seven-eighths of an inch was sawn from both tibia and 
 femur. Two arteries required torsion, none ligature. The patient was in robust health at the time of the operation. 
 About December 25th, symptoms of exhaustion were manifest. A supporting treatment was adopted, without avail. 
 Death, January I8th, 1864. 
 
 Private Gardiner Lewis, Co. B, 19th Indiana Vols., aged twenty-two, was 
 wounded at the battle of Gettysburg, July 1st, 1863, by a round musket-ball, which 
 lodged in the internal condyle of the right femur. On November 27th, 1863, he was 
 admitted into Jarvia U. S. A. General Hospital, Baltimore, Maryland, the knee being 
 disorganized and discharging a foetid pus. On December 1st, Acting Assistant Sur- 
 geon P. Hinkle, U. S. A., excised the articular ends of the tibia and femur, sawing off 
 an inch of the condyle of the femur, and three-fourths of an inch of the head of the tibia. 
 An H-shaped incision was employed. At the time of the operation the patient was 
 feverish, anxious, without appetite, and sleepless from intense pain. He did well 
 until several days after the operation, when he had a chill. Chills recurred each 
 alternate day, and other symptoms of purulent infection were manifested. On Decem- 
 ber 23d, the case terminated fatally. The autopsy revealed metastatic foci in the 
 lungs, and six ounces of pus in the left pleural cavity. The incisions were healed, Fio. to.— Excised knee-joint. Around 
 and the ends of the bones were found in apposition, but no union had occurred. The fetur" Xeo'^-m^T^.M."' "^'" 
 excised portions of the femur and tibia are preserved in the Army Medical Museum. 
 (Spec. No. 1956.) 
 
 Private Jacob Miller, Co. A, 3d Pennsylvania Cavalry, aged thirty-eight, was admitted December 5th, 1863, into 
 the 3d Division U. S. A. General Hospital, Alexandria, Virginia, with a compound comminuted fracture of the right 
 pat«lla, involving the knee-joint. The injury was received in action, November 27th, 1863, at Mine Run, Virginia. On 
 December 7th, 1863, Surgeon Edwin Bently, U. S. Vols., excised half an inch of the articulating extremities of the 
 femur and tibia, and removed the patella. The parts were considerably swollen at the time of operation, and the 
 patient was prostrated. Profuse suppuration ensued. A stimulating and supporting treatment was adopted ; but 
 the case resulted fatally, from pyaemia, on December 18th, 1863. 
 
 Corporal Jesse Sims, Co. B, 4th Ohio Vols., aged twenty-three, was admitted, December 5th, 1863, into the 3d 
 Division U. S. A. General Hospital, at Alexandria, Virginia, with gunshot fracture opening the right knee-joint, 
 received on the 27th of November, 1863, at Mine Ran, Virginia. On December 8th, an excision of an inch and a 
 half of the tibia and fibula, and an inch of the femur, was made by Surgeon Edwin Bently, U. S. Vols. The parts 
 were much swollen and the patient greatly prostrated and anxious. Simple dressings were applied. Pyaemia was 
 soon developed, and death occurred on the 13th. A post-mortem examination showed no attempt at repair. The 
 wound was sloughing. Metastatic abscesses were formed along the inside of the thigh, and one at the base of the 
 lower lobe of the right lung. (Spec. 1909, A. M. M.) 
 
 Private Thomas Clark, Co. D, 2d New Hampshire Cavalry, was wounded in a skirmish near Alexandria, Louis- 
 iana, on May 4th, 1864, by a musket-ball, which entered the popliteal space, and, passing behind the artery, emerged 
 two inches above the joint on its outer side, having fractured the external condyle. The patient was admitted to the 
 General Hospital, at Alexandria, Louisiana, on the day that he was wounded. Immediate amputation was advised, 
 but the patient objected so strenuously, that excision was substituted. Assistant Surgeon John Horaans, Jr., U. S. A., 
 removed two inches of the condyles of the femur, and half an inch from the head of the tibia, through a straight 
 incision across the joint, the patient being under the influence of chloroform. The limb was put in a fracture-box, 
 the wound being closed by sutures. No great depression followed the operation immediately. The patient took a 
 full anodyne, and rested well. Next morning, his leg was very cold, and no pulsation could be discerned in any of 
 the arteries below the knee. The patient was placed on a transport steamer and sent to New Orleans, where he died 
 a week after the operation. The report adds that no necroscopic examination was made, and no satisfactory expla- 
 nation could be given of the arrest of the circulation in the limb ; but it seems highly probable that the explanation 
 is to be found in the proximity of the track of the ball to the popliteal artery, and the formation of an occluding clot 
 in that vessel. 
 
 Sergeant Henry J. Moore, Co. P, 7th Maine Vols., aged twenty-four, was admitted, May 24th, 1864, into the 3d 
 Division U. S. A. General Hospital, at Alexandria, Virginia, with a wound of the left knee-joint, from a conoidal 
 ball, received May 12th, 1864, in the battle of Spottsylvania, Virginia. An excision had been made by an unknown 
 operator, by a straight incision across the anterior aspect of the joint. On admission, the limb was in a fracture- 
 box, the wound partially closed by sutures, and discharging but very little. The patient was prostrated by the 
 fatigue of transportation to the hospital, and he died of exhaustion on the 26th of May, 1864. 
 
 Corporal George W. Hays, Co. K, 2d Michigan Vols., aged nineteen, was wounded on June 17th, 1864, before 
 the intrenched lines at Petersburg, Virginia, by a musket-ball, which shattered the left knee, and fractured the right 
 
Fig. 71. — Excised knee-joint. 
 
 60 SURGICAL OPERATIONS. 
 
 patella and opened the right knee-joint. Primary amputation at the lower third of the left thigh was performed at 
 the field hospital, and the patient was transferred to Washington, where he was admitted to Harewood Hospital, on 
 June 20th. On admission, the stump was in a satisfactory condition ; the right knee-joint, however, was disorganized. 
 The ball, after fracturing the patella, had passed through the articulation, grooving the head of the tibia. On June 
 24th, the patient was etherized, and Surgeon Bontecou, U. S. Vols., excised two-thirds of the condyles of the femur, 
 the articular surface of the tibia, and the shattered patella. The limb was dressed with the bandage of Scultetus, and 
 supported by bran bags. The case terminaiJed fatally on July 2d, 1864. The specimen is No. 3046, Army Medical 
 Museum. 
 
 Private D. F. E , Co. I, 49th Georgia (Rebel) Regiment, was wounded and taken prisoner at Petersburg, 
 
 Virginia, on April 2d, 1865. A conoidal musket-ball struck his right knee, and fractured 
 the patella and the external condyle of the femur. He was admitted at the General 
 Hospital, at Fort Monroe, on April 13th. The joint was intensely inflamed, and there 
 was great suffering. On April 18th, the patient was placed under the influence of 
 chloroform, and Surgeon D. G. Rush, 101st Pennsylvania Vols., excised the knee-joint, 
 removing an inch from the femur, half an inch from the tibia, and the entire patella. The 
 patient rallied well after the operation ; but the wound began to suppurate freely, and the 
 ' ;§)ec.'42i2°A. irM."'""' case terminated fatally on April 26th, 1865. At the autopsy, it was found that there was 
 no attempt at reparation. 
 
 Of the tenth case it is only known that a complete excision of the knee-joint for 
 gunshot injury was performed at Fairfax Seminary Hospital, in the autumn of 1862, 
 and that the case terminated fatally, but not until the H-shaped incision had nearly 
 healed. The pathological preparation from the case was forwarded to the Army Medi- 
 cal Museum by Acting Assistant Surgeon Bannister, and is numbered Specimen 600, 
 but it is unaccompanied by a history. 
 
 The success claimed in the next case is so extraordinary as to suggest some doubts 
 of its authenticity. It appears on the quarterly report of the General Hospital at 
 Kansas City, Missouri, for the last quarter of 1863. 
 
 Private Samuel Miller, Go. L, 1st Missouri State Militia, was admitted into the General Hospital, at Kansas City, 
 Missouri, April 1st, 1863. He was wounded near Independence, Missouri, on December 28th, 1862, the ball having 
 fractured the outer condyle of the right femur, passed obliquely through the patella, and lodged in the head of 
 the tibia. On April 7th, 1863, Acting Assistant Surgeon Joshua Thome, U. S. A., performed an excision of the outer 
 condyle of the femur, with part of the shaft, removing by an oblique section two and a half inches from the femur, 
 together with the patella and articulating surface of the tibia. No anaesthetic was used. The wound was full of 
 shattered bone, and an extraordinary amount of pus came out of the joint. There was severe pain and extensive 
 inflammation in the leg. The patient was much emaciated from copious diarrhoea. Skin dark and dry, very like 
 parchment. At the time of the operation he was nearly insensible, pulse 120 and feeble. He was greatly prostrated 
 after the operation, but on the next day he revived. Nutritious diet, with porter, was given him, and he continued to 
 improve. Complete bony anchylosis resulted, with the leg bent about ten degrees. On December 8th, 1863, Miller 
 was discharged from service. He was able to walk almost as well as ever. 
 
 Seven partial excisions of the knee-joint for gunshot injury have been reported. 
 Three of these were excisions of the patella. The operators were Surgeon Bontecou, 
 U. S. Vols., Surgeon Mosely, U. S. Vols., and Acting Assistant Surgeon Coale, U. S. A. 
 The patients survived the operations fifteen, eighteen, and twelve days, respectively. 
 
 Surgeon John A. Lidell, U. S. Vols., laid open the knee-joint, and removed the 
 fragments of a patella, shattered by a musketrball. His patient lived ten days. Acting 
 Assistant Surgeon Theo. Siebold, U. S. A., made a free incision into a knee-joint dis- 
 organized by inflammation following a gunshot fracture, extracted fragments of the 
 head of the tibia and of the patella, removed the semilunar cartilages, painted the 
 synovial membrane with tincture of iodine, and scraped the articular cartilages from 
 the end of the condyles. His patient survived twelve days. In two cases the head of 
 the fibula was excised, and portions of the head of the tibia. Both recovered. In 
 these cases, reported by Surgeon Judson, U. S. Vols., and Dr. Bournonville, it does not 
 clearly appear that the articulation was opened. 
 
EXCISIONS. 
 
 61 
 
 Excisions of the Head of the Femur. — In 1861, our information in regard to 
 excisions of the head of the femur for gunshot injury was summed up by Dr. Hodges 
 in his excellent monograph,* and in 1863, by M. Legouestf and M. Boeckel.J 
 
 Dr. Hodges quotes the observations of Oppenheim, Seutin, Schwartz, and Baum, 
 and the six cases given in the Surgical History of the British Army in the Crimea, and 
 with more detail by Macleod. Legouest adds Textor's case, and Boeckel ascribes a 
 case to Guthrie, which is apocryphal. Dr. Esmarch refers to another case operated on 
 by Dr. Ross, and described in the Deutsches Klinih for 1850, No. 41. 
 
 Statistical Table of Excisions of the Head of the Femur for Gunshot Injury prior to the late war. 
 
 No. 
 
 Surgeon. 
 
 Date of 
 operation. 
 
 Kesult. 
 
 Kemarks. 
 
 Authority. 
 
 1 
 
 Oppenheim. 
 
 May 5th, 
 1829. 
 
 Died in 17 days. The fatal 
 event was attributed to 
 true typhus. 
 
 Performed for a gunshot fracture of the head of 
 the femur and rim of the acetabulum. 
 
 Hamburg. Zeitschrift, vol. i. p. 137. 
 
 2 
 
 Seutin. 
 
 1832. 
 
 Died in 8 days. 
 
 Gunshot fracture of the neck of the femur. 
 
 Histoire Chirurgicale du Si6ge d' Anvers, 
 par H. Larrey, M6m. do M6d. Mil. t. 34. 
 
 3 
 
 Textor. 
 
 1847. 
 
 Died in 9 days. 
 
 Gunshot fracture of the trochanters, followed by 
 caries. 
 
 Heyfelder's table. Traits des Resections, 
 p. 68. 
 
 4 
 
 Schwartz. 
 
 May 13th, 
 1849. 
 
 Died on May 20th, 1849. 
 
 Gunshot fracture through the trochanters of the 
 left femur, received April 23d, 1849. 
 
 Esmarch, Am. ed., p. 103. 
 
 5 
 
 Ross. 
 
 1850. 
 
 Fatal. 
 
 Caries of the bead of the femur, resulting from 
 gunshot injury. 
 
 Deutsches Klinik, No. 41. 
 
 6 
 
 Banm. 
 
 1864. 
 
 Died in 22 hours. 
 
 Gunshot fracture of the head of the femur. 
 
 Lohmeyer, Ueber Schusswunden, p. 199. 
 
 7 
 
 Macleod. 
 
 July 6th, 
 1855. 
 
 Died in 1 week, with symp- 
 toms of cholera. 
 
 Fracture of the trochanter and neck of the left 
 femur by a musket-ball, on June 18th, 1865. 
 
 Maoleod's Notes on the Surgery of the 
 Crimean War, p. 338. 
 
 8 
 
 Blenkina. 
 
 1855. 
 
 Died ill the 6th week. 
 
 Fracture by shell of the upper part of right femur. 
 
 Ibid., p. 341. 
 
 9 
 
 Crerar. 
 
 August, 
 1856. 
 
 Died in a fortnight. 
 
 Fracture of the femur high up by shell. 
 
 Guthrie's Commentaries, 5th ed., p. 622. 
 
 10 
 
 O'Leary. 
 
 ^ilT 
 
 Eecovered. 
 
 Fracture of the great trochanter by a shell. 
 
 Med. and Surg. History of the British 
 Army in the Crimea, vol. ii. p. 378. 
 
 11 
 
 Hyde. 
 
 1855. 
 
 Died in 5 days. 
 
 Upper extremity of femur comminuted by a grape- 
 shot. 
 
 Macleod's Notes, p. 344. 
 
 12 
 
 Combe. 
 
 1855. 
 
 Died in a fortnight. 
 
 Gunshot fracture of the neck of the femur. 
 
 Ibid., p. 344. 
 
 There were then on record, previous to the late war, twelve cases of this opera- 
 tion, with one success. This was the case reported by Surgeon O'Leary of the 68th 
 British Infantry, who excised the head and several inches of the shaft of the femur 
 for Private Thomas Mackenena, the great trochanter being shattered by a fragment 
 of shell. 
 
 Experience having demonstrated the uniform fatality of gunshot fractures of the 
 head or neck of the femur when abandoned to the resources of nature, and the exces- 
 sive mortality of amputations at the hip-joint for gunshot injury, the highest authorities 
 in military surgery were then unanimous in advising, under suitable conditions, excision 
 of the head of the femur, until, as Baron Hippolyte Larrey expressed it, the experiments 
 of the future proved more discouraging than the experience of the past.§ 
 
 How far this advice has been acted upon in the late war, may be seen from the 
 following table, which exhibits also the form in which all surgical operations are 
 recorded on the regis#rs of this office. 
 
 * The Excisions of Joints. Boston, 1861, pp. 204. t Op. cit. 
 
 t Trait6 des Bisections, par le Docteur 0. Heyfelder, traduit de I'Allemand, avec additions et notes, par le 
 Docteur Bug. Boeckel. Paris : Baillifere, 1863, pp. 310. 
 
 i Bulletin de I'Acadgmie de M.6decine, Nov. 12th, 1861. 
 
62 
 
 SURGICAL OPERATIONS. 
 
 TABULAR STATEMENT OP THE OPERATIONS OF EXCISIONS OF THE HEAD 
 
 THE SURGEON 
 
 1. B Street 
 Infirmary, 
 Washing- 
 ton, D. C. 
 
 2. Nash- 
 ville, Tenn. 
 
 3. ClifF- 
 burne 
 
 U. S. A. 
 
 General 
 Hospital, 
 Washing- 
 ton, D. C. 
 
 Hospital and 
 Hospital 
 Number. 
 
 Name, Rank, Company, Regi- 
 ment. Age. Date of Admis- 
 sion to Hospital. 
 
 i. National 
 U. S. A. 
 General 
 Hospital, 
 
 Baltimore, 
 Md. 
 
 5. Field 
 Hospital, 
 
 Gaines- 
 ville, Va. 
 
 Timothy Greely, Pri- 
 vate Co. C, 5th Ex- 
 celsior (74th N. Y. 
 Vols.). Age, — . Ad- 
 mitted October 5, 
 1861. 
 
 -, Private. An 
 
 infantry soldier of 
 Gen. Buell's Army. 
 Admitted March 18, 
 1862. 
 
 T. C. Christopher, Pri- 
 vate Co. D, 18th S. C. 
 (Confederate). Age, 
 21. Admitted May 
 17, 1862. A robust 
 and muscular man, 
 but melancholy and 
 despondent. 
 
 John W. Nelling, Pri- 
 vate Co. K, 1st Massa- 
 chusetts Vols. Age, 
 25. Admitted July 
 25, 1864. 
 
 , Private, Gen. 
 
 R. King's Division. 
 Admitted August 28, 
 1862. 
 
 Description and Date of 
 
 Wound or Injury. On what 
 
 Occasion received. 
 
 Bound ball from 
 smooth-bore musket 
 entered near fold of 
 nates, passed through 
 femur, between tro- 
 chanters, opened hip- 
 joint and made its 
 exit anteriorly. 
 
 Fracture of upper ex- 
 tremity of femur by 
 a musket-ball. In a 
 skirmish near Nash- 
 ville, just before the 
 occupation of the city 
 by Gen. Buell. 
 
 Wounded May 5, 1862, 
 by a mini^-ball, which 
 entered two inches 
 below and behind the 
 trochanter major of 
 the left side, and, 
 passing forward, up- 
 ward, and inward, 
 remained in the 
 body. 
 
 A musket-ball entered 
 the right groin and 
 implicated the hip- 
 joint. The patient 
 was taken prisoner, 
 and confined at 
 Richmond for three 
 months. White Oak 
 Swamp, June 30, 
 1862. 
 
 Ball entered over 
 great trochanter of 
 left femur, shattered 
 the trochanter and 
 produced a long fis- 
 sure, running down 
 the shaft to two in- 
 ches below the lesser 
 trochanter; the mis- 
 sile then entered the 
 pelvis. Gainesville, 
 Va., August 28, 1862. 
 
 Date of 
 Operation. 
 
 October, 
 1861. 
 
 March, 
 
 1862, 
 
 a few days 
 
 after the 
 
 injury. 
 
 May 20, 
 1862. 
 
 August 21, 
 1862. 
 
 August 28, 
 1862. 
 
 Operation. 
 
 Excision of the head, 
 neck, and trochan- 
 ters of the femur. 
 
 Excision of the head, 
 neck, and trochanter 
 of the femur. 
 
 A curvilinear incision 
 four inches long was 
 made behind the tro- 
 chanter major, and 
 parallel to the axis 
 of the limb ; through 
 this the shattered 
 fragments of the 
 head and neck were 
 removed; the ball 
 was then found in 
 the obturator fora- 
 men, and removed; 
 the hsemorrhage was 
 slight. Chloroform 
 (pure) used. 
 
 Excision of the head 
 and neck of the right 
 femur, through a 
 straight incision car- 
 ried down to the 
 bone; the head was 
 found stricken off 
 from the neck of the 
 epiphysis, and only 
 retained in the ace- 
 tabulum by the liga- 
 mentum teres. Chlo- 
 roform. 
 
 Excision of the head, 
 neck, trochanters, 
 and two inches of 
 the shaft of the left 
 femur; the extreme 
 length from the tip 
 of the trochanter to 
 the point at '^ich 
 the shaft was sawn, 
 was four and three- 
 fourths inches. 
 
 Condition of injured Parts at 
 Time of Operation. 
 
 A stream of blood, and 
 another of synovia 
 (clear and pellucid), 
 issued from wound 
 of exit. External 
 wonnd small. 
 
 The fracture was lim- 
 ited to the neck and 
 trochanteric region. 
 
 Tissues about joint 
 swollen, and limb 
 shortened and evert- 
 ed ; sanious pus dis- 
 charging from 
 wound; neck of fe- 
 mur comminuted and 
 head split into two 
 pieces ; acetabulum 
 uninjured; the tro- 
 chanter major was 
 intact, and was left 
 so by the operation. 
 
 Ball entered right 
 groin, passed hori- 
 zontally backwards, 
 and escaped poste- 
 riorly. 
 
 Head and neck of the 
 femur were sound ; 
 the great trochanter 
 was split off in five 
 fragments ; from its 
 base a very oblique 
 fracture ran dowji- 
 wards and inwards, 
 and produced a com- 
 plete solution of con- 
 tinuity of the shaft 
 about two inches be- 
 low the lesser tro- 
 chanter. 
 
EXCISIONS. 
 
 63 
 
 OF THE FEMUR FOR GUNSHOT INJURY THAT HAVE BEEN REPORTED TO 
 GENERAL'S OFFICE. 
 
 Consatutional State of Patient at 
 Time of Operation. 
 
 Progress, Treatment, etc. 
 
 Jlcsult. Cause of Death. 
 
 REMAKKS. 
 
 Pulse but slightly depressed ; 
 
 Sank gradually. 
 
 Survived the operation but 
 
 Operator, John W. S. Gouley, 
 
 patient congratulates him- 
 
 
 a few days. 
 
 Asst, Surgeon U. S. A. 
 
 self on slight extent of his 
 
 
 
 Case taken from Sanitary Re- 
 
 injury, as he supposes. 
 
 
 
 port of Surgeon John T. Cal- 
 houn, 5th Excelsior, Decem- 
 ber 31st, 1861. (See paper 
 No. 71.) 
 
 Satisfactory. Surgeon Gold- 
 
 Failed gradually, and died 
 
 Died March, 1862. 
 
 Operator, A. H. Thurston, 
 
 smith thought the case pe- 
 
 within one week. 
 
 
 Surgeon U. S. Vols. 
 
 culiarly well adapted for 
 
 
 
 Case reported verbally by Sur- 
 
 the operation of excision. 
 
 
 
 geon M. Goldsmith, XJ. S. 
 Vols. 
 
 Very fair; pulse 100; rather 
 
 Simple water-dressing was 
 
 Died May 24th, 1862, at 7 
 
 Operator, J. S. Billings, Asst. 
 
 weak. He had complained 
 
 appliedto the wound. The 
 
 P.M., of exhaustion. The 
 
 Surgeon U. S. A. 
 
 of severe pain in the hip 
 
 foot was fastened by strips 
 
 autopsy revealed a clot of 
 
 This may be called a typical 
 
 and knees. He reacted 
 
 of adhesive plaster to a 
 
 blood, about three ounces 
 
 case of a gunshot injury re- 
 
 well from the chloroform, 
 
 strip of wood at the foot of 
 
 in weight, between the pe- 
 
 quiring exsection of the hip- 
 
 and expressed himself as 
 
 the bed, which being eleva- 
 
 ritonaeum and iliacus inter- 
 
 joint. Everything appeared 
 
 feeling much better. 
 
 ted, the weight of the body 
 
 nus of the left side, proba- 
 
 favorable, the patient being 
 
 
 made extension. Brandy, 
 
 bly from the rupture of a 
 
 young, strong, and healthy. 
 
 
 egg-nog, beef essence, etc.. 
 
 small arterial branch. 
 
 and the injury seemingly 
 
 
 given freely. 
 
 
 uncomplicated. Army Med- 
 ical Museum, Specimen No. 
 19. 
 Special Report of Dr. Billings. 
 
 
 
 
 Feeble. 
 
 Patient rallied well from 
 
 Died August 25th, 1862. 
 
 Operator, Robert Bartholow, 
 
 
 operation. Very little blood 
 
 
 Asst. Surgeon U. S. A. 
 
 
 was lost. Limb sustained 
 
 
 Parts much softened and semi- 
 
 
 by anterior splint. Pro- 
 
 
 gangrenous; end of excised 
 
 
 gressed favorably until the 
 
 
 neck denuded of periosteum 
 
 
 afternoon of August 25th, 
 
 
 and necrosed; femoral vein 
 
 
 when a sudden and ex- 
 
 
 melted down, and was not. 
 
 
 tremely profuse gush of 
 
 
 at the point of injury, dis- 
 
 
 dark blood took place from 
 
 
 tinguishable from surround- 
 
 
 the anterior bullet wound 
 
 
 ing tissues; a quantity of 
 
 
 and posterior incision. 
 
 
 dark fluid blood found an- 
 
 
 which caused death in a 
 
 
 teriorly under the integu- 
 
 
 few minutes. 
 
 
 ments. Army Medical Mu- 
 seum, Specimen No. 400. 
 
 The symptoms were grave. 
 
 Internal haemorrhage from 
 
 The man fell into the hands 
 
 Operator, Peter Pineo, Bri- 
 
 and the prognosis unfavor- 
 
 some vessel in the pelvic 
 
 of the enemy. In all prob- 
 
 gade Surgeon U. S. V. 
 
 able. 
 
 cavity. 
 
 ability he survived but a 
 
 Army Medical Museum, Spe- 
 
 
 
 few hours. 
 
 cimen No. 71. The specimen 
 has been photographed, and 
 a wood-cut taken from it. 
 Photographic Series, No. 13. 
 Letter from Lt. Col. Pineo. 
 
64 
 
 Hospital and 
 Hospital 
 Number. 
 
 Name, Rank, Company, Regi- 
 ment. Age. Date of Admis- 
 sion to Hospital. 
 
 6. Cliff- 
 burne 
 
 V. S. A. 
 
 General 
 Hospital, 
 Washing- 
 ton, D. C. 
 
 7. Ware- 
 house Hos- 
 pital, 
 
 George- 
 town, D. C. 
 
 8. College 
 Hospital, 
 George- 
 town, D. C. 
 
 9. No. 3 
 U. S. A. 
 General 
 Hospital, 
 Frederick. 
 Md. 
 
 , Private, Army of 
 
 Virginia. Admitted 
 September 2, 1862. 
 
 F. MacMin, Private 
 Co. — , 11th Penn- 
 sylvania Vols. Age, 
 — . Admitted Sep- 
 tember 8, 1862. 
 
 Charles E. Marston, 
 Private Co. F, 1st 
 Massachusetts Vols. 
 Age, 19. Admitted 
 September 6, 1862. 
 
 Cornelius Callaghan, 
 Private Co. — , Penn- 
 sylvania Vols. Age, 
 — . Admitted Sep- 
 tember 19, 1862. 
 
 SURGICAL OPERATIONS. 
 
 TABULAR STATEMENT OP THE OPERATIONS OF 
 
 Description and Date of 
 
 Wound or Iiynry. On what 
 
 Occasion received. 
 
 Mini^-ball entered the 
 left hip directly over 
 the trochanter maj or, 
 and embedded itself 
 in the neck of the 
 bone. Second Bull 
 Run, August 29, 1862. 
 
 Musket -ball entered 
 the right buttock and 
 emerged an inch and 
 a, half below and 
 within the anterior 
 superior spinous pro- 
 cess of the right ili- 
 um, comminuting the 
 neck of the femur. 
 
 A large bullet wound 
 one inch anterior to 
 and on a level with 
 the right trochanter 
 major; no exit; com- 
 minution of the head 
 and neck of the fe- 
 mur. Second Bull 
 Run, August 30,1862. 
 
 A shell wound of the 
 outer upper portion 
 of left thigh, with 
 fracture of trochan- 
 ter major. 
 
 Date of 
 Operation. 
 
 Sept. 4, 
 1862. 
 
 Sept. 20, 
 1862. 
 
 Sept. 27, 
 1862. 
 
 Sept. 29, 
 1862. 
 
 Operation. 
 
 Straight incision was 
 made over trochanter 
 major, and all frag- 
 ments removed; the 
 head of the femur 
 was then removed, 
 and the shaft of the 
 femur cut off with a 
 chain- saw at the level 
 of trochanter minor. 
 
 Excision of head and 
 neck of right femur ; 
 a straight incision 
 five inches long from 
 a point two inches 
 behind and one inch 
 below the anterior- 
 superior spinous pro- 
 cess to the trochan- 
 teric region; re- 
 moval of neck at 
 junction with tro- 
 chanter, with chain- 
 saw ; exarticulation 
 of head; one small 
 vessel tied. 
 
 Excision of head and 
 neck of the right fe- 
 mur ; a slightly curv- 
 ed incision, five in- 
 ches long, on the out- 
 side of tie thigh, the 
 shot-hole in the mid- 
 dle of the incision; 
 rough end of femur 
 removed by small 
 saw; one small ves- 
 sel tied ; conoidal 
 ball removed. 
 
 An examination under 
 chloroform, recom- 
 mended by Medical 
 Inspector Coolldge 
 and Surgeon Milhau, 
 U. S. A., revealed a 
 fracture through the 
 trochanter and fis- 
 sure extending with- 
 in the capsule ; the 
 incision was extend- 
 ed three inches below 
 the trochanter maj or, 
 and a chain-saw was 
 passed around the 
 shaft of the femur, 
 which was divided 
 just below the seat 
 of fracture ; the head 
 of the bone was then 
 disarticulated ; no 
 vessels required liga- 
 ture. 
 
 Condition of injured Parts at 
 Time of C^eration. 
 
 Trochanter major and 
 neck of femur split 
 and comminuted; 
 head of bone not in- 
 jured; no joint open- 
 ed ; tissues about 
 joint but slightly 
 swollen, and dis- 
 charging healthy 
 pus. 
 
 Neck of femur in frag- 
 ments; head in situ, 
 and not fractured ; 
 shaft uninjured; foot 
 everted; limb short- 
 ened; acetabulum 
 uninjured. 
 
 Limb half as large 
 again as its fellow; 
 neck broken into at 
 least forty small frag- 
 m e n t s ; trochanter 
 uninjured; head 
 shattered. 
 
 The trochanter was 
 entirely separated 
 and detached by mus- 
 cular action. 
 
EXCISIONS. 
 EXCISIONS OF THE HEAD OF THE FEMUR— Continued. 
 
 65 
 
 Constitutional State of Patient at 
 Time of Operation. 
 
 Progreaa, Treatment, etc. . 
 
 Result. Cause of Death. 
 
 BEMARKS. 
 
 This man had suffered great- 
 
 He reacted well after the 
 
 Died September 24th, 1862, 
 
 Operator, J. S. Billings, Asst. 
 
 ly from the journey from 
 
 operation. Was placed on 
 
 of exhaustion caused by 
 
 Surgeon U. S. A. 
 
 the field, and had diar- 
 
 a fracture bed, and exten- 
 
 colliquative diarrhoea. 
 
 No autopsy. "The man died 
 
 rhoea of a malarial type. 
 
 sion made on the leg by 
 
 
 from malarial complications, 
 
 
 means of a weight. Diar- 
 
 
 and not, in my opinion, from 
 
 
 rhoea increased in severity. 
 
 
 the wound or operation." 
 Special report of Dr. Billings. 
 
 Most unfavorable. By care- 
 
 Wound syringed ; rallied 
 
 Died September 21st, 1862. 
 
 Operator, B. A. Clements, Asst. 
 
 ful nursing, and the use of 
 
 after operation; in six 
 
 
 Surgeon U. S. A. 
 
 stimulants, beef essence, 
 
 hours pulse 136; free from 
 
 
 No autopsy. Surgical Series, 
 
 etc., condition so far im- 
 
 pain ; gradually sank. 
 
 
 Army Medical Museum, vol. 
 
 proved that the operation 
 
 
 
 i. page 41, Specimen No. 329. 
 
 was regarded as justifiable. 
 
 
 
 
 Pulse 112; a delicate boy; 
 
 Sand-bags to keep limb in 
 
 Died September 30th, 1862, 
 
 Operator, B. A. Clements, Asst. 
 
 pale ; tongue dryish ; gen- 
 
 position. Pulse quick and 
 
 8 P.M. 
 
 Surgeon U S. A., assisted by 
 
 eral condition bad, but not 
 
 feeble. 
 
 
 staff of hospital and Asst. 
 
 so bad as in Machlin's case. 
 
 
 
 Surgeon Alden, U. S. A. 
 Autopsy showed that lower 
 half of the acetabulum was 
 fractured. Surgical Series, 
 Army Medical Museum, vol. 
 i. p. 43, Specimen No. 328. 
 
 Comparatively favorable. 
 
 September 30th. Patient 
 
 Died October 4th, 1862. 
 
 Operator, J. H. Bill, Asst. 
 
 
 comfortable; pulse 120; 
 
 
 Surgeon U.S.A. 
 
 
 takes full diet; sleeps at 
 
 
 No facilities for autopsy, and 
 
 
 night. Oct. 1st. Thigh 
 
 
 none made. Symptoms, those 
 
 
 swollen ; profuse sweat- 
 
 
 of pyaemia. Army Medical 
 
 
 ing. Oct. 2d. Diarrhoea 
 
 
 Museum, Specimen No. 840. 
 
 
 and fever ; at night, vomit- 
 
 
 
 
 ing and hiccough. 
 
 
 
66 
 
 SURGICAL OPERATIONS. 
 TABULAR STATEMENT OP THE OPERATIONS OF 
 
 Hospital and 
 Hospital 
 Number. 
 
 10. Fairfax 
 
 Seminary 
 
 U. S. A. 
 
 General 
 
 Hospital, 
 
 Va. 
 
 Name, Rank, Company, Regi- 
 ment. Age. Date of Admis- 
 sion to Hospital. 
 
 11. Fred- 
 erick Gen- 
 eral Hos- 
 pital, Md. 
 No. 5. 
 
 12. Field. 
 
 13. 
 
 14. "Stew- 
 art" Con- 
 federate 
 Hospital, 
 Richmond, 
 Va. 
 
 15. Judi- 
 ciary 
 Square 
 U. S. A. 
 General 
 Hospital, 
 "Washing- 
 ton, D. C. 
 7019. 
 
 Joseph Brown, Private 
 Co. I, 3d Michigan 
 Vols. .Age, 38. Ad- 
 mitted September 11, 
 1862. 
 
 Description and Date of 
 
 Wound or Injury. On what 
 
 Occasion received. 
 
 Edward Hunt, Private 
 Co. D, 71st Pennsyl- 
 vania Vols. Age, 24. 
 Admitted January 
 20, 1863. 
 
 James Tallman, Ser- 
 geant Co. H, 18th 
 Wisconsin Vols. 
 
 Private. Confederate. 
 
 Jarratt, Lieuten- 
 ant, 15th North Caro- 
 lina Confederate 
 States Army. 
 
 Charles Cleaver, Pri- 
 vate Co. C, 2d U. S. 
 Infantry. Age, — . 
 Admitted May 18, 
 1864. 
 
 A musket-hall 
 
 through the trochan- 
 ter of the left femur 
 at the second battle 
 of Bull Run. After 
 lying exposed on the 
 battle-field for three 
 days, the patient was 
 taken to Centreville, 
 and thence to Fair- 
 fax Seminary Hos- 
 pital. On two occa- 
 sions fragments of 
 bone were removed 
 from the wound. 
 
 Missile entered two 
 inches above tro- 
 chanter major, and 
 grazed the neck of 
 femur ; passed out at 
 the nates. 
 
 Comminuted fracture 
 of left femur by a co- 
 noidal musket-ball. 
 After Jackson, Miss., 
 May 14, 1863. 
 
 Gunshot fracture of 
 the upper extremity 
 of the femur. 
 
 Comminuted gunshot 
 fracture of the upper 
 extremity of the left 
 femur by a conoidal 
 musket-ball. 
 
 Compound comminu- 
 ted fracture of femur 
 involving the joint 
 and four inches of 
 shaft by minid-ball. 
 Spottsylvania, Va , 
 May 12, 1864. 
 
 Date of 
 Operation. 
 
 March 21, 
 1863. 
 
 Feb. 23, 
 1863. 
 
 May 1.5, 
 1863. 
 
 1863. 
 
 [January 9, 
 1864. 
 
 May 19, 
 1864. 
 
 Operation. 
 
 Condition of injured Parts at 
 Time of Operation. 
 
 A large exploratory 
 incision was made 
 from three inches 
 above to five inches 
 below the trochan- 
 ter ; the femur was 
 divided squarely by 
 powerful bone - cut- 
 ting forceps, six in- 
 ches below the tro- 
 chanter ; the neck 
 of the femur was so 
 much diseased that 
 the head of the bone 
 was then removed. 
 
 Excision of the head 
 of the femur, the 
 neck being divided 
 by the lion -jawed 
 cutting forceps; very 
 little blood Jost. 
 Chloroform. 
 
 Excision of the head 
 and portion of the 
 shaft of the left fe- 
 mur. 
 
 Excision of the head 
 of the femur. Chlo- 
 roform. Secondary 
 operation. 
 
 Excision of the head, 
 trochanters, and sev- 
 eral inches of the 
 shaft of the left fe- 
 mur. Chloroform. 
 
 Excision of head of 
 bone and four and 
 a quarter inches of 
 shaft; incision curv- 
 ed, and six inches in 
 length. 
 
 Early in March the 
 limb began to swell 
 immoderately, and 
 the discharge from 
 the vifound became 
 scanty and foetid ; 
 much callus had been 
 thrown out. A draw- 
 ing of the case repre- 
 sents much burrow- 
 ing of pus amid the 
 muscles of the thigh. 
 
 Profuse suppuration, 
 estimated at a quart 
 in twenty-four hours; 
 abscesses about the 
 hip and upper part of 
 thigh. 
 
 Head of femur commi- 
 nuted, and shaft shat- 
 tered three inches 
 below the surgical 
 neck. 
 
 Extensive laceration 
 of soft parts ; pus, 
 of an ill-conditioned 
 character, burrow- 
 ing in every direc- 
 tion. 
 
 V, 
 
EXCISIONS. 
 
 67 
 
 EXCISIONS OP THE HEAD OF THE FEMTJR— Continued. 
 
 Constitutional State of Patient at 
 Time of Operation. 
 
 ProgresB, Treatment, etc. 
 
 Result. Cause of Death. 
 
 REMARKS. 
 
 Loss of appetite ; pulse small 
 
 Rallied with difficulty from 
 
 April 30th, 1863. Nearly 
 
 Operator, David P. Smith, Sur- 
 
 and frequent. 
 
 the shock of the opeiration. 
 
 well. May 31st, 1863. En- 
 
 geon U. S. Vols. 
 
 
 In forty-eight hours an 
 
 tirely well. August 22d, 
 
 A letter from this man, dated 
 
 
 erysipelatous blush per- 
 
 1863. Successful result. 
 
 Coopersville, March 21st, 
 
 
 vaded the whole thigh, 
 
 
 1864, in which he speaks of 
 
 
 and typhoid, symptoms 
 
 
 himself as being in good 
 
 
 were manifested. A cathe- 
 
 
 health. He walks about and 
 
 
 ter was passed into the 
 
 
 attends to home business. 
 
 
 wound, and maintained 
 
 
 splits and saws a little wood, 
 
 
 there as a drainage tube. 
 
 
 but complains of some pain 
 
 
 The wound was frequently 
 
 
 in the leg and stiffness in the 
 
 
 washed out through this 
 
 
 knee. On the whole, he says. 
 
 
 tube. March 26th. A rigor, 
 
 
 "there is a constant improve- 
 
 * 
 
 apparently caused by haem- 
 
 
 ment, and he is exceedingly 
 
 
 orrhage to the extent of 
 
 
 thankful for the service done 
 
 
 six ounces. After the first 
 
 
 him by his surgeon." An- 
 
 
 few days the limb was 
 
 
 other letter, dated September 
 
 
 supported by the anterior 
 
 
 26th, 1865, states that he con- 
 
 
 splint of Professor Smith, 
 
 
 tinues in good health. Army 
 
 
 and subsequently by a kind 
 
 
 Medical Museum, Specimen 
 
 
 of hammock. Brandy, 
 
 
 No. 1192. Surgical Series of 
 
 
 beef tea, and eggs were 
 
 
 Drawings, S. G. 0., No. 73, 
 
 
 given in large quantities. 
 
 
 represents the appearance of 
 the patient in August, 1863. 
 
 Emaciated, and has night- 
 
 Recovered well from chloro- 
 
 Died February 25th, 1863. 
 
 Operator, H. A. Dubois, Asst. 
 
 sweats. 
 
 form, but never fairly re- 
 
 
 Surgeon U. S. A. 
 
 
 acted from the shock of 
 
 
 Specimen 3907, Army Medi- 
 
 
 the operation. 
 
 
 cal Museum. 
 
 
 Patient removed to a com- 
 
 Died May 19th, 1863. 
 
 Operator, Henry S. Hewit, 
 Surgeon U. S. V. History 
 
 
 fortable hospital in Jack- 
 
 
 son the same day. Gradu- 
 
 
 compiled from his verbal 
 
 
 ally sank. 
 
 
 report. 
 
 
 
 Died. 
 
 Operator, a Confederate Sur- 
 geon. 
 
 
 
 
 
 
 See Confederate States Medi- 
 
 
 
 
 cal and Surgical Journal, 
 
 
 
 
 vol. i. No. 10, p. 155, Octo- 
 
 
 
 
 ber, 1864. 
 
 Satisfactory. 
 
 Very favorable. It was sta- 
 
 The patient so far recovered. 
 
 Operator, J. B. Reed, Surgeon 
 
 
 ted by Dr. Latimer that the 
 
 at the end of six weeks 
 
 Confederate States Army. 
 
 
 patient could ultimately 
 
 from the date of operation. 
 
 The facts in this case were ob- 
 
 
 walk without crutches. 
 
 as to be able to be removed 
 
 tained by Surgeon Otis, U. S. 
 
 
 with the aid of a cane and 
 
 to his home in North Caro- 
 
 Vols., from Dr. Latimer, Asst. 
 
 
 a high-heeled boot. 
 
 lina. He was last heard 
 
 Surgeon C. S. A., who con- 
 
 
 
 from in September, 1864, 
 
 ducted the after-treatment in 
 
 
 
 when all sinuses had heal- 
 
 Lieut Jarratt's case. Army 
 
 
 
 ed, and considerable weight 
 
 Medical Museum, Photogra- 
 
 
 
 could be borne on the in- 
 
 phic Series No. 41. 
 
 
 
 jured limb. 
 
 
 Not good. 
 
 Charpie soaked with per- 
 
 Died May 23d, 1864, of 
 
 Operator, J. H. Thompson, 
 
 
 manganate of potash, ap- 
 
 pyaemia. 
 
 Act. Asst. Surgeon U.S.A. 
 
 
 plied to wound ; tonics and 
 
 
 
 
 stimulants internally. 
 
 
 
68 
 
 SURGICAL OPERATIONS. 
 
 TABULAR STATEMENT OP THE OPERATIONS OP 
 
 I 
 
 Hospital and Name, Rank, Company, Regi- 
 Hospital ment. Age. Date of Admis- 
 
 Number. sion to Hospital. 
 
 16. Judi- 
 ciary 
 Square 
 U. S. A. 
 General 
 Hospital, 
 Washing- 
 ton, D. C. 
 6974. 
 
 17. Stanton 
 
 U. S. A. 
 
 General 
 
 Hospital, 
 
 Wasliing- 
 
 ton, D. C, 
 
 1035. 
 
 "Ward" 
 
 Hospital, 
 
 Newark, 
 
 N.J. 
 
 18. Mt. 
 
 Pleasant 
 
 U. S. A. 
 
 General 
 
 Hospital, 
 
 Wasliing- 
 
 ton, D. C. 
 
 9897. 
 
 19. Jarvis 
 
 U. S. A. 
 
 General 
 
 Hospital, 
 
 Baltimore, 
 
 Md. 
 
 20. Field 
 
 Hospital, 
 
 Ream's 
 
 Station, 
 
 Va. 
 
 Alexander Ewiug, Pri- 
 Tate Co. A, 140tli 
 Pennsylvania Vols. 
 Age, 30. Admitted 
 May 18, 1864. 
 
 Hugh Wright, Private 
 Co. G, 8th New Jer- 
 sey Vols. Age, 28. 
 Admitted May 25, 
 1864. 
 
 John Phelan, Captain 
 Co. A, 73d N.Y. Vols. 
 Age, 22. Admitted 
 May 16, 1864. 
 
 Jason M. Joslyn, Pri- 
 vate Co. I, 7th New 
 York Heavy Artil- 
 lery. Age, 20. Ad- 
 mitted November 28, 
 1864. 
 
 Confederate Private. 
 
 Description and Date of 
 
 Wound or Injury. On what 
 
 Occasion received. 
 
 Compound comminu- 
 ted fracture of upper 
 part of left femur, 
 implicating hip- 
 joint. Wilderness, 
 Va., May 13, 1864. 
 
 A mini^-ball entered 
 the right thigh one 
 inch to the inner side 
 of the femoral artery 
 and about two inches 
 below Poupart's lig- 
 ament, and passed 
 backward and down- 
 ward, shattering the 
 neck and trochanter 
 of the femur. The 
 ball lodged behind 
 the bone. Wilder- 
 ness, Va., May 5, 
 1864. 
 
 Gunshot wound of 
 left thigh, with com- 
 pound comminuted 
 fracture of neck and 
 upper end of femur. 
 Spottsylvania C. H., 
 Va., May 14, 1864. ■ 
 
 Gunshot fracture of 
 head of right femur 
 by a piece of shell, 
 which entered over 
 the great trochanter, 
 fracturing it and the 
 neck of the femur. 
 Cold Harbor, Va , 
 June 3, 1864. 
 
 Compound comminu- 
 ted fracture of the 
 neck of the right fe- 
 mur by a conoidal 
 ball. Ream's Sta- 
 tion, Va., 1864. 
 
 Date of 
 Operation. 
 
 May 19, 
 1864. ■ 
 
 May 27, 
 1864. 
 
 June 3, 
 
 1864. 
 
 June 5, 
 1864. 
 
 June, 
 
 1864. 
 
 Operation. 
 
 Excision of head of 
 bone below trochan- 
 ter ; an incision of 
 about five inches was 
 made over great tro- 
 chanter, taking in 
 the wound of en- 
 trance. 
 
 Resection of head, 
 neck, and both tro- 
 chanters of fe- 
 mur ; made an inci- 
 sion six inches in 
 length over the tro- 
 chanter major down 
 to the bone; extracted 
 the fractured splint- 
 ers, and removed the 
 head and neck of the 
 femur; found the 
 ball, a mini^, lying 
 behind the neck of 
 femur. Sulphuric 
 ether. 
 
 Excision of head, neck, 
 and upper end of fe- 
 mur by T incision 
 of five inches over 
 the trochanter, ex- 
 tending down the 
 line of femur. 
 
 Excision of the head 
 and two inches of 
 shaft of right femur, 
 through an incision 
 eight inches in length 
 on outer side. 
 
 The report from Dale 
 Hospital states that 
 the head and six 
 inches of the shaft 
 were removed. 
 
 Removal of the head, 
 neck, and greater 
 portion of the tro- 
 chanter major of the 
 right femur. 
 
 Condition of injured Parts at 
 Time of Operation. 
 
 There was much in- 
 flammation and swel- 
 ling of soft parts. 
 
 An abscess had form- 
 ed about the seat of 
 fracture ; the bone 
 was mu<Sh comminu- 
 ted, and many of the 
 fractured splinters 
 were detached; the 
 ball had not been 
 extracted. 
 
 All motion of the limb 
 accompanied by se- 
 vere pain. 
 
 Parts very much swol- 
 len. 
 
EXCISIONS. 
 EXCISIONS OF THE HEAD OF THE F'EMJJR—Cofitinued. 
 
 69 
 
 CoDstitutional State of I'atieut at 
 Time of Operatioo. 
 
 Not favorable. 
 
 Fair. 
 
 Constitution naturally good ; 
 Tery much reduced at time 
 of operation; discharge of 
 pus very free; appetite 
 poor; tongue coated ; bow- 
 els moved frequently ; skin 
 moist; pulse 90 to 100. 
 
 Good. 
 
 Progress, Treatment, etc. 
 
 Patient lived but five days; 
 the wound assumed no 
 healthy action; stimulants 
 and ice to wound; but he 
 gradually sank. 
 
 He exhibited a great deal of 
 shock, and reacted slowly. 
 May 28th. Pulse frequent 
 and feeble ; exhibits a good 
 deal of nervous agitation; 
 has some fever; tongue dry 
 and furred in centre. June 
 1st. Condition much im- 
 proved; wound looks well; 
 character of the suppura- 
 tion good. June 30th. Is 
 doing well. 
 
 Simple dressings of cold 
 water and lint; discharge 
 of pus moderate and heal- 
 thy; wound looking well; 
 no pain; nourishing diet; 
 tonics and stimulants given 
 freely. 
 
 Simple dressings; did well. 
 At date of transfer the parts 
 had entirely healed; the 
 limb was six inches shorter 
 than the other, and could 
 be swung forward and 
 backward, but could not 
 be exercised in lateral or 
 rotary motion. 
 
 Smith's anterior splint was 
 applied after operation. 
 
 Besult. Cause of Death. 
 
 Died May 24th, 1864, from 
 exhaustion from surgical 
 fever. 
 
 November 16th, 1864. Re- 
 covered. Discharged from 
 service October 6th, 1864, 
 by reason of expiration of 
 term, but unable to travel. 
 Transferred to General 
 Hospital at Newark, N. J., 
 April 15th, 1865. He was 
 in tolerably good health. 
 The limb disposed to ab- 
 scesses upon any unusual 
 exertion. Left hospital 
 May 6th, 1865. 
 
 Died June 21st, 1864, of as- 
 thenia, consequent from 
 gunshot wound. 
 
 Furloughed Dec. 21st, 1864; 
 readmitted and transfer- 
 red, February 28th, 1865, 
 to Worcester, Mass. March 
 31st, 1865. Patient is in 
 perfect health : parts heal- 
 ed and free from tender- 
 ness ; limb movable in every 
 direction, and perfectly 
 under control of the mus- 
 cles ; while standing erect 
 on tlie left foot, and placing 
 the right on a line with the 
 long axis of the leg, he can 
 touch the floor with his 
 toes; more than two inches 
 of the shaft is apparently 
 gone ; upper end of femur 
 enlarged, apparently by 
 new osseous growth, to 
 almost twice its normal 
 diameter; has a good false 
 joint, and leg can be made 
 useful hereafter when 
 strengthened by artificial 
 appliances. 
 
 Operator, J. H. Thompson, 
 Act. Asst. Surgeon U. S. A. 
 
 The fracture extended into the 
 joint, separating the trochan- 
 ter from neck and splintering 
 the shaft of bone. 
 
 Operator, George A. Mursick, 
 Asst. Surgeon U. S. Vols. 
 
 Army Medical Museum, Spe- 
 cimen No. 3375. 
 
 Operator, M. C. Mulford, Act. 
 Asst. Surgeon U. S. A. 
 
 Army Medical Museum, Speci- 
 men No. 2618. 
 
 Operator, Confederate Sur- 
 geon. 
 
 Transferred from Dale U. S. A. 
 General Hospital to DeCamp 
 U. S. A. General Hospital, 
 August 28th, 1865. 
 
 Asst. Surgeon Warren Web- 
 ster's Report proves conclu- 
 sively that the head of the 
 bone was not removed in this 
 case. The patient is figured 
 in Photographs 106 and 107, 
 A. M. M. 
 
 Report of Asst. Surgeon J. S. 
 Billings, U. S. A., Acting 
 Medical Inspector A. of P. 
 
70 
 
 SURGICAL OPEKATION'S. 
 TABULAR STATEMENT OF THE OPERATIONS OF 
 
 Hospital and 
 Hospital 
 Number. 
 
 21. Hare- 
 wood 
 
 U. S. A. 
 
 General 
 Hospital, 
 Washing- 
 ton, D. C. 
 
 14,050. 
 
 22. Doug- 
 las, Wash- 
 ington, 
 B.C. 
 
 23. Field 
 Hospital, 
 5th Corps. 
 
 24. Field 
 Hospital, 
 5th Corps. 
 
 25. U.S.A. 
 
 General 
 
 Hospital, 
 
 Beverly, 
 
 N.J. 
 
 Name, Rank, Company, Kegi- 
 ment. Age. Date of Admis- 
 BioQ to Hospital. 
 
 Henry Woodworth, 
 Private Co. A, 4th 
 Vermont Volunteers. 
 Age, 18. Admitted 
 May 25, 1864. 
 
 Description and Date of 
 
 Wound or Injury. On what 
 
 Occasion received. 
 
 Gunshot wound of left 
 thigh, ball passing 
 transversely below 
 thetrochantermajor, 
 fracturing upper por- 
 tion of femur and 
 lodging beneath sar- 
 torius muscle. Spott- 
 sylvania C. H., Va., 
 May 12, 1864. 
 
 Peter Boyle, Private Gunshot wound of left 
 Co. D, 59th Massa- hip, fracturing tro- 
 
 chusetts Vols. Age, 
 60. Admitted Au- 
 gust 3, 1864. 
 
 A. McDonald, Private 
 Co. F, 149th Penn- 
 sylvania Vols. Ad- 
 mitted August 20, 
 1864. ■ 
 
 Charles Beard, Private 
 12th Mississippi Re- 
 giment, C. S. A. 
 
 John Zaborowski, Pri- 
 vate Co. H, 7th Con- 
 necticut Vols. Age, 
 33. Admitted Au- 
 gust 22, 1864. 
 
 chanter. Petersburg, 
 Va., July 30, 1864. 
 
 Gunshot fracture of 
 the upper extremity 
 of the femur by a co- 
 noidal musket -ball, 
 which lodged in the 
 head of the bone. 
 Weldon Railroad, 
 Va., August 20, 1864. 
 
 Gunshot fracture of 
 upper extremity of 
 femur by a conoidal 
 musket-ball. 
 
 Gunshot wound of 
 right thigh, fractur- 
 ing head of femur; 
 mini6-ball entered 
 just below the tro- 
 chanter major, pass- 
 ing upward and in- 
 ward, fracturing the 
 neck and injuring 
 the head of the bone. 
 Deep Bottom, Va., 
 August 16, 1864. 
 
 Date of 
 Operation. 
 
 July 1, 
 1864. 
 
 August 5, 
 1864. 
 
 August 20, 
 1864. 
 
 August 20, 
 1864. 
 
 Sept. 2' 
 1864. 
 
 Operation. 
 
 Excision of 
 left femur, 
 ric ether. 
 
 head of 
 Sulphu- 
 
 Excision of the head 
 of the left femur. 
 Ether. 
 
 Excision of the head 
 and neck of the fe- 
 mur, the bone being 
 sawn through the 
 great trochanter; a 
 V-shaped incision 
 was employed. Chlo- 
 roform. 
 
 Excision of head,neck, 
 and trochanters of 
 the femur; the bone 
 was sawn at the level 
 of the trochanter mi- 
 nor; ball removed. 
 Chloroform. 
 
 Resection of the head 
 and a portion of the 
 trochanter major of 
 the right femur, by 
 an incision four and 
 a half inches in 
 length. Chloroform 
 used. Patient react- 
 ed slowly. 
 
 Condition of injured Parts at 
 Time of Operation. 
 
 The ball had commi- 
 nuted the neck of the 
 femur ; fleshy parts 
 healthy. 
 
 Acetabulum uninjur- 
 ed; ball impacted in 
 head of the femur. 
 
 The ball entered in 
 front, badly shatter- 
 ed the neck of the 
 femur, and lodged in 
 the acetabulum, the 
 lower margin of 
 which was broken 
 off, but no communi- 
 cation existed with 
 the interior of the 
 pelvis. 
 
 Parts in a sloughing 
 condition; great sup- 
 purative discharge 
 from wound. 
 
EXCISIONS. 
 
 71 
 
 EXCISIONS OF THE HEAD OP THE F'EMU'R—Coniinued. 
 
 Constitutional State of Patient at 
 Time of Operation. 
 
 ProgrosB, Treatment, etc. 
 
 Result. Cause of Death. 
 
 REMARKS. 
 
 Poor; ansemic; countenance 
 
 Unfavorable; treatment sup- 
 
 Died July 2d, 1864; exhaus- 
 
 Operator, Reed B. Bontecou, 
 
 pale; pulse small. 
 
 porting. Patient did not 
 
 tion. 
 
 Surgeon U. S. Vols. 
 
 
 improve after operation, 
 
 
 Army Medical Museum, Speci- 
 
 
 but rapidly sank. 
 
 
 men No. 3049. 
 
 Patient yery old; 60 years; 
 
 Reacted well after opera- 
 
 Died August 9lh, 1864. 
 
 Operator, Wm. Thomson, Asst. 
 
 condition poor. 
 
 tion, but at night there 
 
 
 Surgeon U. S. A. 
 
 
 was sweating with vomit- 
 
 
 Army Medical Museum, Spe- 
 
 
 ing. Aug. 6th, 1864. Ate 
 
 
 cimen No. 8593. 
 
 
 a good breakfast, but still 
 
 
 
 
 cool sweating skin; pulse 
 128. 
 
 
 
 Satisfactory. 
 
 No bad symptoms followed 
 
 Died in less than four days 
 
 Report of Asst. Surgeon J. S. 
 
 
 the operation for two days, 
 
 after the operation. 
 
 Billings, Acting Medical In- 
 
 
 and on August 23d the 
 
 
 spector A. of P. 
 
 
 patient was sent to the base 
 
 
 Operator, Surgeon Reams, 
 
 
 hospital at City Point. 
 
 
 149th Pennsylvania Vols. 
 Consult also letter of Asst. Sur- 
 geon Chas. K.Winne, U.S.A., 
 of Sept. 20th, 1865. 
 
 Satisfactory. 
 
 Limb dressed in Smith's an- 
 
 Died August 25th, 1864, on 
 
 Report of Asst. Surgeon J. S. 
 
 
 terior splint. Aug. 21st. 
 
 the tifth day after the ope- 
 
 Billings, U. S. A., Acting 
 
 
 A marked rigor occurred 
 
 ration. 
 
 Medical Inspector A. of P. 
 
 
 a short time after the ope- 
 
 
 Consult also letter of Asst. 
 
 
 ration was completed. On 
 
 
 Surgeon Chas. K. Winne, 
 
 
 the following day there 
 
 
 U. S. A., of Sept. 20th, 1865. 
 
 
 was retention of the urine 
 
 
 Operator, Surgeon White, In- 
 
 
 and great irritability of the 
 
 
 diana Vols. 
 
 
 stomach. 
 
 
 At the autopsy the wound was 
 found filled with offensive 
 sanious pus, and the sawn 
 surface of the femur was 
 black. The acetabulum was 
 intensely injected. 
 
 Patient feeble; pulse 140; 
 
 Patient rapidly sinking ; sti- 
 
 Died September 28th, 1864, 
 
 Operator, C. Wagner, Asst. 
 
 appetite wanting ; greatly 
 
 mulants. 
 
 from exhaustion. 
 
 Surgeon U. S. A. 
 
 reduced in strength and 
 
 
 
 Post-mortem revealed nothing 
 
 flesh. 
 
 
 
 worthy of note except slight 
 necrosis of the acetabulum. 
 Army Medical Musuem, Spe- 
 
 > 
 
 
 / 
 
 cimen No. 8716. 
 
72 
 
 SURGICAL OPERATIONS. 
 
 TABULAR STATEMENT OF THE OPERATIONS OF 
 
 Hospital and 
 Hospital 
 Number. 
 
 26. St. 
 
 Louis 
 U. S. A. 
 General 
 Hospital, 
 New Or- 
 leans, La. 
 
 5766. 
 
 27. Mt. 
 Pleasant 
 
 U. S. A. 
 
 General 
 Hospital, 
 Washing- 
 ton, D. C. 
 
 17,236. 
 
 28. Armory 
 Square 
 U. S. A. 
 General 
 Hospital, 
 Washing- 
 ton, D. C. 
 
 29. Douglas 
 General 
 Hospital, 
 Washing- 
 ton, D. C. 
 6829. 
 
 30. Judi- 
 ciary 
 Square 
 General 
 Hospital, 
 Washing- 
 ton, D. 0. 
 9260. 
 
 Name, Kank, Company, Regi- 
 ment. Age. Date of Admis- 
 sion to Hospital. 
 
 Hugh Train, Private 
 Co. G, 31st Massa- 
 chusetts Vols. Age, 
 22. Admitted Febru- 
 ary 13, 1865. 
 
 H. C. Senet, Private 
 Co.F,122dNewYork 
 Vols. Age, 27. Ad- 
 mitted April 2, 1865. 
 
 D. N. Patterson, Lieu- 
 tenant Co. E, 45th 
 Virginia (Rebel) Re- 
 giment. Admitted 
 April 2, 1865. 
 
 Henry Phillips, Pri- 
 vate Co. 1, 146th New 
 York Vols. Age, 34. 
 Admitted April 6, 
 1865. 
 
 George M. Spencer, 
 Private Co. B, 2d 
 New York Mounted 
 Rifles. Age. 17. Ad- 
 mitted April 4, 1865. 
 
 Desciiption and Bate of 
 
 Wound or Injury. On what 
 
 Occasion received. 
 
 Conoidal ball entered 
 anterior surface of 
 middle third of left 
 thigh, ranging up- 
 wards, and making 
 exit above left glu- 
 teus, fracturing neck 
 of femur. Accident- 
 ally, February 1, 
 1865. 
 
 Ball entered midway 
 and on a line with an- 
 terior-superior spi- 
 nous process of left 
 ilium and trochanter 
 major, and lodged in 
 the head of the fe- 
 mur. Petersburg, 
 Va., March 27, 1865. 
 
 Date of 
 Operation. 
 
 Conoidal musket-ball 
 entered behind left 
 trochanter major, 
 comminuted the 
 head, neck, and tro- 
 chanter of femur, 
 and fractured the 
 acetabulum. Boyd- 
 ton Plank Road, near 
 Petersburg, Va., 
 March 27, 1865. 
 
 Gunshot wound over 
 left trochanter, ball 
 lodging in neck of 
 femur. Southside 
 Rail Road, Va., April 
 1, 1865. 
 
 Gunshot fracture of 
 right femur ; ball en- 
 tered at great tro- 
 chanter and caused 
 extensive longitudi- 
 nal splintering of the 
 shaft, which was 
 found subsequently 
 to extend quite to 
 its lower third. Din- 
 widdie C. H., March 
 31, 1865. 
 
 March 24, 
 1865. 
 
 April 4, 
 1865. 
 
 April 3, 
 1865. 
 
 April 8, 
 1865. 
 
 April 12, 
 1865. 
 
 Operation. 
 
 Made an incision four 
 inches in length over 
 the great trochanter; 
 dissected soft parts 
 from bone ; divided 
 bone with chain-saw 
 just below trochan- 
 ter, and removed 
 head of bone without 
 difficulty, teres liga- 
 ment being softened. 
 
 Excision of head of 
 left femur at anatom- 
 ical necli, and ex- 
 traction of ball ; a 
 T incision was made 
 over trochanter ma- 
 jor four by six in- 
 ches. Ether and 
 chloroform. 
 
 Excision of head,neck, 
 and trochanters of 
 left femur; about two 
 inches were removed, 
 and the ball extract- 
 ed. Chloroform. 
 
 Excision of head,neck, 
 and trochanter of left 
 femur. Ether. 
 
 Excision of head,neck, 
 and trochanters of 
 right femur. Chloro- 
 form. 
 
 Condition of injured Parts at 
 Time of Operation. 
 
 Whole thigh dissected 
 with pus ; ulcers in 
 groin ; knee drawn 
 over to right and 
 across ; shortening, 
 with inversion; pus 
 very unhealthy. 
 
 Limb looked very 
 healthy, but on ex- 
 amination it was 
 found that the ball 
 had fractured the 
 head of the femur 
 into three pieces and 
 lodged in it. 
 
 The misshapen and 
 battered ball was 
 buried in the obtu- 
 rator muscles. Back 
 of the acetabulum 
 a splinter of the os 
 pubis was forced in- 
 wards into the pelvic 
 cavity. 
 
 Bone not completely 
 fractured; hip-joint 
 opened. 
 
 The femur extensively 
 shattered; copious 
 suppuration from 
 wound. 
 
EXCISIONS. 
 EXCISIONS OF THE HEAD OP T]Ie YIEMUH— Continued. 
 
 73 
 
 OonBtitutional State of Patient at 
 Time of Operation. 
 
 General health bad; night- 
 sweats; tongue clean and 
 moist; appetite good; bow- 
 els inclined to be costiye. 
 
 Patient feverish and fretful, 
 with furred tongue. 
 
 Very satisfactory. 
 
 Patient was somewhat ex- 
 hausted, and had consider- 
 able fever ; pulse and res- 
 piration nearly normal. 
 
 Irritative fever. 
 
 Progress, Treatment, etc. 
 
 Wound filled with lint ; por- 
 ter, chicken broth, eggs, 
 stimulants, everything to 
 enable him to sustain the 
 drain upon his system. 
 Felt easier for a few days 
 after the operation. 
 
 Singultus came on immedi- 
 ately after operation, but 
 was arrested ; antispasmo- 
 dics. April 5th. Great 
 tympanitis. April 7th. 
 Well-marked signs of peri- 
 tonitis; a chill occurred, 
 and lasted half an hour. 
 
 Did well for two or three 
 days, when hasmorrhage 
 occurred. Hsemorrhage 
 was probably from iliac 
 vein, injured by a sharp 
 splinter of bone. 
 
 April 13th. Wound appears 
 healthy; suppurates well; 
 patient perspires freely ; 
 pulse 120. April 15th. 
 Pulse 118. April 17th. 
 Pulse 120; respiration 32; 
 slight pleurisy of right side; 
 Diarrhoea set in. April 
 18th. Respiration 26; pulse 
 130; much weaker. April 
 20th. Chill. 
 
 It was ascertained that lon- 
 gitudinal splintering of the 
 femur extended far down 
 the shaft, and amputation 
 at the hip-joint was per- 
 formed. 
 
 Reault. Cause of Death. 
 
 BEMABES. 
 
 Died March 30th, 1865. He 
 became very much emaci- 
 ated. 
 
 Died April 8th, 1865; acute 
 peritonitis. 
 
 Died April 7th, 1865. 
 
 Died April 21st, 1865; ex- 
 haustion. 
 
 Died April 12th, 1866. 
 
 Operator, A. McMahon, Sur- 
 geon U. S. Vols. 
 
 When admitted, patient stated 
 positively that the surgeon 
 of his regiment had given 
 him chloroform, and exam- 
 ined his wound, and that the 
 bone was not touched. There 
 was no evidence of fracture 
 on admission. He had walked 
 upon the limb. The ball had 
 injured the neck of the bone, 
 and the subsequent caries 
 had caused its destruction. 
 
 Operator, H. Allen, Asst. Sur- 
 geon U. S. A. 
 
 Autopsy: Lungs healthy; liver 
 greatly hypertrophied; lower 
 fifth of ilium greatly inflam- 
 ed and injected; tissues sur- 
 rounding left hip-joint in a 
 sloughing condition, and in- 
 filtrated with foetid pus, 
 which had burrowed several 
 inches under gluteal mus- 
 cles; also two inches below 
 lesser trochanter ; acetabu- 
 lum denuded and a slight 
 fracture of upper and pos- 
 terior border ; upper two 
 inches of femur denuded of 
 periosteum. Army Medical 
 Museum, Specimen No. 526. 
 
 Operator, D. W. Bliss, Surgeon 
 U. S. Vols. 
 
 Army Medical Museum, Spe- 
 cimen No. 4048. 
 
 Operator, Wm. F. Norris, Asst. 
 Surgeon U. S. A. 
 
 Autopsy. No evidences of py- 
 aemia found, though strongly 
 suspected before death. 
 
 Army Medical Museum, Spe- 
 cimen No. 3235. 
 
 Operator, E. Griswold, Sur- 
 geon U. S. Vols. 
 
 10 
 
74 
 
 SURGICAL OPERATIONS. 
 
 TABULAR STA'^EMENT OF THE OPBRATIOXS OF 
 
 Hospital and 
 
 Name, Rank, Company, Regi- 
 
 Description and Date of 
 
 Date of 
 
 
 Condition of injured Parts at 
 
 Hospital 
 
 ment. Age. Date of Admis- 
 
 Wound or Injury. On what 
 
 Operation. 
 
 Operation. 
 
 Time of Operation. 
 
 Number. 
 
 sion to Hospital. 
 
 Occasion received. 
 
 
 
 31. St. 
 
 T. E. Foulke, Private 
 
 Conoidal ball entered 
 
 April 27, 
 
 Excision of two inches 
 
 Great comminution; 
 
 Louis 
 
 Co. D, 2d Alabama 
 
 posteriorly at middle 
 
 1865. 
 
 of shaft of left femur, 
 
 parts surrounding 
 
 U. S. A. 
 
 (C. S. A.). Age, 17. 
 
 third of left thigh; 
 
 
 including trochan- 
 
 hip-joint filled with 
 
 General 
 
 Admitted April 15, 
 
 extracted above an- 
 
 
 ters, neck, and head. 
 
 unhealthy pus. 
 
 Hospital, 
 
 1865. 
 
 terior superior spi- 
 
 
 Chloroform. 
 
 
 New Or- 
 
 
 nous process of left 
 
 
 
 
 leans, La. 
 
 
 ilium, fracturing up- 
 
 
 
 
 7643. 
 
 
 per third of femur. 
 
 
 
 
 Marine 
 
 Admitted May 26, 
 
 involving trochanter 
 
 
 
 
 General 
 
 1865. 
 
 and neck. Fort 
 
 
 
 
 Hospital, 
 
 
 Blakely, Ala., April 
 
 
 
 
 New Or- 
 
 
 9, 1865. 
 
 
 
 
 leans, La. 
 
 
 
 
 
 
 32. St. 
 
 G. W. Brantley, Pri- 
 
 Conoidal ball entered 
 
 April 28, 
 
 Excision of head,neck. 
 
 Thigh, groin, and sur- 
 
 Louis 
 
 vate Co. C, 2d Ala- 
 
 left groin, passing 
 
 1865. 
 
 and trochanter of left 
 
 rounding parts infil- 
 
 U. S. A. 
 
 bama (C.S. A.). Age, 
 
 through, fracturing 
 
 
 femur; no ligations. 
 
 trated by unhealthy 
 
 General 
 
 18. Admitted April 
 
 neck of left femur. 
 
 
 Chloroform. 
 
 pus. 
 
 Hospital, 
 
 15, 1865. 
 
 emerged posteriorly 
 
 
 
 
 New Or- 
 
 
 from left gluteus ; 
 
 
 
 
 leans, La. 
 
 
 also gunshot frac- 
 
 
 
 
 7641. 
 
 
 ture of external con- 
 dyle of right hume- 
 rus. Fort Blakely, 
 Ala., April 9, 1865. 
 
 
 
 
 A case is reported by Acting Assistant Surgeon Siebold, TJ. S. A., in which only a 
 portion of the head of the femur was removed, a ball being at the same time extracted 
 from the acetabulum. The patient, Private Robb, 188th New York Vols., was treated 
 at Point Lookout Hospital, and died four months after the operation. 
 
 Many other cases occurred in 
 which the operation was admissible, 
 so far as the local lesions were con- 
 cerned. But the requisites for after- 
 treatment were not attainable in 
 the field hospitals, and when the 
 patients reached the base hospitals, 
 their condition forbade operative in- 
 terference. 
 
 The annexed engraving of a 
 Fio. 72.— Conoidal ball embedded in the spccimen (No. 125), taken from a 
 
 head of femur. Spec. 126, A. M. M. '■ . i t i • i -r. 
 
 patient who died m the Patent Of- 
 fice Hospital, in Washington, in September, 1862, illustrates such cases. 
 
 At the Army Medical Museum there are preserved 16 excised heads of femurs, 
 including the specimens from two of the successful cases. 
 
 Specimen 3375 exhibits the extensive comminution of the trochanters in Dr. 
 Mursick's successful case. The black object below the neck represents the battered 
 shapeless ball. 
 
 Fig. 73. — Head of femur excised for gunshot 
 injury, ^ec. 3375, A. M. M. 
 
EXCISIONS. 
 EXCISIONS OF THE HEAD OF THE 'e'EMUR— Concluded. 
 
 75 
 
 Constitutional State of Patient at 
 Time of Operation. 
 
 Progress, Treatment, etc. 
 
 Eesult. Cause of Death. 
 
 EEMAKKS. 
 
 Very much exhausted from 
 
 Nourishing diet; twohottles 
 
 Transferred to Marine Hos- 
 
 Operator, A. McMahon, Sur- 
 
 profuse suppuration. 
 
 of porter daily, eggs, beef 
 
 pital, New Orleans, La., 
 
 geon U. S. Vols. 
 
 
 tea, and everything he de- 
 
 May 26th, 1865; doing 
 
 This case was unfavorable for 
 
 
 sired. 
 
 well. Died June 5th, 1865 ; 
 
 any operation; but as death 
 
 
 
 exhaustion. 
 
 evidently would otherwise 
 result, the only hope for him 
 was in operation. 
 
 Very much exhausted. 
 
 Did not rally well; stimu- 
 
 Died May 2d, 1865; capil- 
 
 Operator, A. McMahon, Sur- 
 
 
 lants very freely adminis- 
 
 lary haemorrhage. 
 
 geon U. S. Vols. 
 
 
 tered. 
 
 
 No operation performed on 
 elbow-joint, as condition of 
 patient would not admit it. 
 
 Fig. 74. — Excised 
 formation below 
 A. M. M. 
 
 shattering 
 the pelvic 
 
 The specimen in Surgeon D. P. 
 Smith's successful case indicates that na- 
 ture had attempted something in the way 
 of reparation. (Specimen 1192.) 
 
 A drawing has been made of the 
 appearance of the limb of the patient 
 who furnished this specimen.* (Surgi- 
 cal Series of Drawings No. 73, A. M. M.) 
 
 In Medical Inspector Pineo's case 
 (Specimen 71, A. M. M.), the ball, after 
 the trochanters and neck of the femur, unhappily entered 
 cavity. 
 
 liead of femur, with callus 
 the trochanters, iSpec.1192, 
 
 Fig. 75.— Excised head ot 
 femur. Spec. 71, A. M. M, 
 
 * The following letter, which is quoted in his own language, has lately been received from Mr. Brown : 
 BvT. Lt. Col. Geokge A. Otis, Coopersville, Michigan, September 26th, 1865. 
 
 Surgeon U. S. Vols. 
 Sir:— 
 
 Yours of the 21st inst. has just come to hand, and I take pleasure in informing you that my general health 
 is good; my leg is improving slowly; the knee remains quite stiff yet, but I think it is better than it was one year 
 ago. I have some control over the movements of the thigh. When standing, can move the leg backwards and 
 forwards, about two and a half feet, and sideways enough to bring the foot across in front of the other foot. 
 Can bear considerable of my weight upon it, but not enough to do away with the use of one crutch yet. Cannot 
 perceive that there is any difference in the length of the limb since I was discharged, as I use the stirrup on 
 the crutch the same as then. There has been no breaking out of abscesses, nor any soreness of any kind since 
 March, 1864, nor since my discharge, to amount to anything. * » * * 
 
 Respectfully yours, .' 
 
 (Signed) JOSEPH BROWN, 
 
 Late of Co. I, 3d Michigan Vols. 
 
76 
 
 SURGICAL OPERATIONS. 
 
 Excisions in the Continuity of the Long Bones of the Extremities. — The great 
 surgeons who have done most towards substituting excision for amputation in gunshot 
 injuries of the joints have almost unanimously condemned excisions of the continuity of 
 the long bones in the treatment of gunshot fractures. The surgical histories of the Cri- 
 mean war, of the Schleswick Holstein campaigns, and of the Indian mutiny, record a 
 few successes in resections of the shafts of the humerus, the tibia, and the bones of the 
 forearm; but this class of operations could scarcely be considered as admitted among the 
 established and approved procedures of surgery. The late war has furnished ample 
 materials for arriving at definite conclusions on this subject, and for determining how 
 far these measures can claim to be included in that true conservatism which has for 
 its first object the saving of life, and refuses to jeopardize lives in order to save limbs. 
 
 These materials are yet to be thoroughly analyzed. So far as examined, their evi- 
 dence is, on the whole, unfavorable to excisions in the continuity. 
 
 A synopsis of the results at present attained is presented in the following table : 
 
 Table, giving the Number of Gases of Excisions for Gunshot Injuries in the Continuity of the Bones of 
 the Extremities, from the Commencement of the War to July, 1864, and the Results as far as 
 ascertained. 
 
 Excisions in the continuity of the Humerus 
 
 Excisions in the continuity of the Kadius 
 
 Excisions in the continuity of the Ulna 
 
 Excisions in the continuity of both Radius and Ulna. 
 
 Excisions of the Metacarpal Bones 
 
 Excisions in the continuity of the Femur 
 
 Excisions in the continuity of the Tibia 
 
 Excisions in the continuity of the Fibula 
 
 Excisions in the continuity of both Tibia and Fibula. 
 Excisions of the Metatarsal Bones 
 
 Totals 
 
 Died. 
 
 42 
 
 11 
 
 16 
 
 5 
 
 2 
 
 32 
 
 11 
 
 15 
 
 1 
 
 5 
 
 140 
 
 Recovered. 
 
 133 
 93 
 
 100 
 24 
 30 
 6 
 48 
 60 
 4 
 26 
 
 524 
 
 Amputa- 
 tions ulti- 
 mately re- 
 quired. 
 
 23 
 
 Result not 
 yet deter- 
 mined. 
 
 79 
 67 
 51 
 10 
 18 
 24 
 20 
 15 
 2 
 2 
 
 288 
 
 261 
 174 
 170 
 40 
 50 
 62 
 84 
 93 
 
 975 
 
 Percentage of 
 Mortality in 
 finished cases. 
 
 24-00 
 10-57 
 13-79 
 17-24 
 6-25 
 84-21 
 18-64 
 20-00 
 25-00 
 19-28 
 
 26-71 
 
 After excisions of portions of the shaft of the humerus for gunshot fractures, a 
 number of patients have certainly obtained very useful limbs. But the mortality 
 after the operation is 3 per cent, greater than after amputation of the arm. The 52 
 preparations at the Army Medical Museum, illustrating this resection, indicate the fre- 
 quency with which it is followed by secondary amputation or a fatal result. 
 
 Excision in the continuity of both bones of the forearm has a larger mortality ratio 
 than amputation of the forearm. 
 
 The specimens at the Museum and the records afford emphatic arguments against 
 formal excisions of the shaft of the femur. With one exception, the few cases that 
 recovered were those in which, after the removal of detached fragments, the least amount 
 of operative interference had been practised. 
 
 The mortality rate after excisions of the tibia and fibula is less than after ampu- 
 tation, as the statistics stand; but the number of cases in which the result is still 
 pending is unusually large. 
 
 There have been a few cases in which portions of the lower jaw, the body of the 
 
EXCISIONS. 
 
 77 
 
 clavicle, the ribs, or the ilium, have been removed by the gouge or the chain-saw after 
 gunshot injuries. The results are given in the following tables : 
 
 Table, exhibiting Results of Cases of Excisions of the Bones of the Face, after Gunshot Fractures. 
 
 Number of deaths 
 
 3 
 23 
 11 
 
 
 Number of cases in which results, as yet, have not been obtained 
 
 
 37 
 
 
 Table, exhibiting Results of Cases of Excisions of the Bones of the Trunk, after Gunshot Fractures. 
 
 Number tff deaths 
 
 Number of recoveries 
 
 Number of cases in which results, as yet, have not been obtained. 
 
 Total number of cases., 
 
 7 
 
 15 
 5 
 
 27 
 
 One of the registers of excisions is devoted to the cases of trephining after gunshot 
 injuries of the cranium. The results of this operation have already been alluded to, 
 and are here recapitulated in a tabular form. 
 
 Table, exhibiting Results of Cases of Gunshot Fractures of the Skull, 
 
 in which Trephining 
 
 was performed. 
 
 
 
 60 
 47 
 14 
 
 
 Number of cases in which as yet, results have not been obtained 
 
 Total number of cases 
 
 121 
 
 
 Table, exhibiting Results of Cases of Gunshot Fractures of the Skull, in which Fragments of Bone were extracted. 
 
 Number of deaths 
 
 Number of recoveries 
 
 Number of cases in which, as yet, results have not been obtained. 
 
 Total number of cases 
 
 61 
 53 
 19 
 
 133 
 
78 
 
 StJEGICAL OPERATIONS. 
 
 LIGATIONS. 
 
 The following table exhibits the number of cases of ligation of the larger arteries, 
 from the beginning of the war to March, 1864 : 
 
 
 Number 
 
 of cases 
 
 recovered. 
 
 Number 
 
 of cases 
 
 died. 
 
 Total. 
 
 Ratio 
 
 of 
 
 Mortality. 
 
 
 12 
 
 "i 
 
 3 
 53 
 12 
 
 9 
 
 "2 
 25 
 1 
 4 
 11 
 13 
 
 ii 
 
 37 
 
 2 
 
 28 
 
 21 
 
 11 
 
 2 
 
 2 
 
 3 
 
 2 
 
 14 
 
 83 
 
 6 
 
 12 
 
 5 
 
 6 
 
 2 
 
 4 
 
 49 
 
 2 
 
 35 
 
 24 
 
 64 
 
 14 
 
 11 
 
 3 
 
 2 
 
 16 
 
 108 
 
 7 
 
 16 
 
 16 
 
 19 
 
 2 
 
 15 
 
 75-71 
 
 100- 
 80- 
 87-50 
 17-18 
 14-28 
 18-18 
 
 100- 
 
 100- 
 87-50 
 76-85 
 85-71 
 75- 
 31-25 
 31-57 
 
 100- 
 26-66 
 
 
 
 
 
 Eadial 
 
 Ulnar 
 
 Common Iliac 
 
 
 
 Femoral 
 
 Profunda.. ... , . . 
 
 
 Anterior Tibial 
 
 Posterior Tibial 
 
 
 
 Ag-crreffate 
 
 163 
 
 240 
 
 403 
 
 
 
 Of the three cases of ligation of the common iliac, one was performed by Surgeon 
 McKee, U. S. A., on account of secondary haemorrhage from a branch of the left in- 
 ternal iliac. The haemorrhage resulted from a gunshot wound of the pelvis, and oc- 
 curred on the fifteenth and again on the twenty-third day. On the second bleeding, 
 the internal iliac was tied; but the hsemorrhage was not controlled, and the main_ trunk 
 was secured. The patient survived two days, and the bleeding did not recur. The 
 appearance of the parts is represented in vol. i. p. 5 of Photographs of Surgical Cases, 
 S. G. 0., and the preparation is preserved as Specimen No. 3464, A. M. M. The second 
 operation was performed by Acting Assistant Surgeon Isham, U. S. A., for a false con- 
 secutive aneurism of the anterior trunk of the right internal iliac, resulting from a 
 bayonet stab through the ischiatic notch. Seven months after the wound was inflicted 
 the rupture of the sac appeared imminent, and the operation was imperative. The 
 patient survived four days. An occluding clot, extending to the bifurcation of the 
 aorta, was found above the ligature. There was no peritonitis. The third operation 
 was done at the Ward Hospital, Newark, New Jersey, for an aneurismal varix, following 
 a stab with a penknife in the left thigh, which opened a communication between the 
 femoral artery and vein. The patient died of peritonitis in five days. The injected 
 vessels constitute Specimen No. 3597, A. M. M., and are represented in Photograph 
 No. 74, A. M. M. 
 
 Two cases are recorded of deligation of the internal iliac for secondary hsemor- 
 rhage after gunshot wounds. Both terminated fatally. 
 
 Of the ligations of the external iliac, 2 recovered. One of them was the case of Pri- 
 vate Smith, already related (p. 49), in which amputation at the hip-joint had been pre- 
 viously performed. The second was the case of Sergeant Ziders, Co. I, 53d Pennsylva- 
 nia Vols., who received a severe flesh wound of the right thigh at Gettysburg, July 3d, 
 
LIGATIONS. 79 
 
 1863, with injury to the femoral artery. There was secondary bleeding, for which the 
 femoral was tied in the wound. Bleeding recurred, and on October 8th, 1863, the ex- 
 ternal iliac was tied by Acting Assistant Surgeon Adinell M. Hewson, U. S. A. The 
 patient recovered, and was discharged from service May 14th, 1864, the movements of 
 his right leg being impaired by contraction of the muscles. 
 
 Of ligations of the subclavian, 35 cases are recorded. In all, the vessel was se- 
 cured outside of the scaleni. In 16 cases, the operation was on the right, and in 14 
 on the left side; in 5 cases, the particular vessel is not mentioned. The operation was 
 performed in 13 cases for secondary hasmorrhage after amputation of the shoulder-joint, 
 with 4 recoveries. In 2 cases, it was done for primary, and in 15 for secondary bleed- 
 ing after gunshot wounds, with injury of the axillary artery, with 2 recoveries. In 2 
 cases, the operation was performed for axillary aneurism. In 2 cases, with one re- 
 covery, it was required by secondary bleeding after excisions of the humerus, and in 1 
 case it was necessitated by a secondary hemorrhage after a gunshot wound with injury 
 of the subclavian. 
 
 The ligations included in the category of "all others" were of the temporal artery 
 in 3 cases, the occipital in 2, the facial in 2, and intercostal in 2; the internal mam- 
 mary, the thoracica longa, the gluteal, the superior profunda of the arm, the posterior 
 circumflex branch of the axillary, the right dorsalis pedis, each in 1 case. 
 
 The two ligations of intercostals were performed by Assistant Surgeon B. Howard, 
 U. S. A., and Assistant Surgeon W. H. Gardner, U. S. A., according to the plan pro- 
 posed by the former, of enclosing the rib in the ligature. Dr. Howard's patient died 
 the day after the operation was performed. The other patient recovered. 
 
 The new haemostatic process* recommended by Professor Simpson was adopted in 
 a few 'cases, with favorable results. 
 
 OTHER SURGICAL OPERATIONS. 
 
 Four additional registers of operations are kept. In one is recorded the histories 
 of 290 cases of gunshot fractures, in which the primary sequestra of Dupuytren, or de- 
 tached fragments of bone, have been extracted. Another register contains the histories 
 of 436 cases, in which balls or other foreign bodies have been extracted. Extraneous 
 matters extracted from gunshot wounds have been of great variety, and comprise bits 
 of clothing and accoutrements, fragments of watches, coins, shoe-nails, teeth, etc. A 
 collection of over 400 such bodies is preserved at the Army Medical Museum. 
 
 The register of operations for surgical diseases contains the histories of 443 cases, 
 many of which are of great interest. For example, 15 cases of tracheotomy or laryn- 
 gotomy are recorded, with six recoveries. The operation was done once, with success, 
 in a case of croupal diphtheritis. 
 
 Finally, in the "register of operations not included in other categories," 23 cases 
 are recorded of the treatment of wounds of the larger joints by free incisions, or of 
 operations for ununited gunshot fractures. 
 
 * Acupressure, a New Method of Arresting Surgical Haemorrhage and of Accelerating the Healing of Wounds. 
 By James Y. Simpson, M.D., F.E.S.B. Edinburgh, 1864. Octavo, pp. xiv., 580. 
 
ON THE MEDICAL STAFF AND THE MATERIA CHIRURGICA. 
 
 THE MEDICAL STAFF. 
 
 After its organization was fairly completed, the medical staff that served in the 
 late war was composed of a surgeon general, one assistant surgeon general, a medical 
 inspector general, 16 medical inspectors, 170 surgeons and assistant surgeons of the 
 regular army, 362 volunteer staff surgeons and assistant surgeons, 3000 regimental 
 surgeons and assistant surgeons of volunteers, 2500 acting assistant surgeons or physi- 
 cians serving under contract, and 6 medical storekeepers. 
 
 The medical service in the field was organized upon the basis of an independent 
 hospital and ambulance establishment for each division of three brigades. The per- 
 sonnel of the division hospital consisted of a surgeon in charge, with an assistant surgeon 
 as executive officer and another assistant surgeon as recorder, an operating staff of three 
 surgeons, aided by three assistant surgeons, and the requisite number of nurses and at- 
 tendants. The division ambulance train was commanded by a first lieutenant, assisted 
 by a second lieutenant from each brigade. The enlisted men detailed for ambulance 
 duty were a sergeant from each regiment, three privates for each ambulance, and one 
 private for each wagon. The ambulance train consisted of from one to three ambulances 
 for each regiment, squadron, or battery, a medicine wagon for each brigade, and two or 
 more supply wagons. The hospital and ambulance train were under the control of the 
 surgeon in chief of division. The division hospitals were usually located just t)ut of 
 range of artillery fire. Sometimes three or more of the division hospitals were consoli- 
 dated under the orders of a corps medical director, who was assisted by his inspector, 
 quartermaster, commissary, and chief ambulance ofiicer. The medical officers not em- 
 ployed at the field hospitals accompanied their regiments, and established temporary 
 depots as near as practicable to the line of battle. How faithfully this perilous duty 
 was performed may be inferred from the fact that, during the war, thirty-six medical 
 officers were either killed, or died from wounds received in battle. As soon as 
 practicable, after every engagement, the wounded were transferred from the division 
 or corps hospitals to the base or general hospitals, which at one time were 205 in num- 
 ber. These were under the charge and command of officers of the regular or volunteer 
 staff, who were assisted by acting assistant surgeons, and by officers of the second bat- 
 talion of the Veteran Reserve Corps. 
 
 The organization of the medical staff in the field and in permanent hospitals is 
 very fully discussed, in papers on file in the office, by Colonel Charles S. Tripler, Dr. 
 Jonathan Letterman, and Colonel T. A. McParlin, successively medical directors of the 
 Army of the Potomac; by Colonel G. E. Cooper, medical director of the Army of the 
 Cumberland; by Lieutenant Colonel J. J. Milhau, medical director of the 5th Army 
 Corps ; by Surgeon L. W. Read, U. S. Vols., surgeon in chief of the 3d Division 5th 
 Army Corps; by Surgeon T. M. Flandreau, 146th New York Vols., surgeon in chief of 
 brigade, and in the reports of the medical inspectors of military departments. 
 (80) 
 
MEANS OF TEANSPOKTATION OF THE WOUNDED. 
 
 81 
 
 . ON MEANS OF TRANSPORTATION OF THE WOUNDED. 
 
 The wounded who were unable to walk were removed beyond the immediate range 
 of musketry on- hand-litters. The details for bearers were usually made from the 
 .musicians of regiments. 
 
 Models of the different patterns of litters that were used are preserved at the Army 
 
 Medical Museum. In the _ _ ^_-^,, ^_„ 
 
 early part of the war, most 
 
 of the regiments were sup- ' " Wk' '- „ ' "'' 'rr^^vT^ "'i 
 
 plied with stretchers of 
 the old regulation pattern. 
 
 It was found that the yoke ^"^ ''^•-Eegnlation handlltter. 
 
 pieces were frequently lost, and that when the canvas stretcher became damp, the 
 litter was put together with difficulty. A light and convenient pattern, known as the 
 "Halstead litter," was subse- 
 quently largely used. Brigadier 
 General Satterlee issued 12,867 
 of these litters from the purvey- 
 
 , , rt -w-r -.--.- ^G- 7^- — Halstead folding hand-litter. 
 
 ing depot of New York alone. 
 
 They were too fragile for the ^^ 
 
 hard usage to which they were '^ '.,^'^\^ 
 
 subjected. = — ^^' r--. ;",'«, 'W^ 
 
 Another pattern, folding up / \ 
 
 lengthwise, in which the poles noTs-smithshand-iitter. 
 
 were separated by folding iron 
 braces, was very generally used during the last two years of the war. Colonel C. 
 McDougall issued 5548 of these from the purveying depot in Philadelphia. 
 
 Fio. 79. — Hand-litter-carrlage. Scale ^ inch to the foot. 
 
 A form of litter on wheels, that had been advantageously employed by the Prus- 
 sians in the war with the Danes,* was introduced too late to test its utility practically. 
 
 * Gnrit, Militar-Chirurgische Fragmente, Berlin, 1865 ; Neudorfer, Handbuch der Kreigs-Chirurgie, Lelpsig, 1864 ; 
 and Neudorfer, Aus dem feld-'eirztlichen Berichter Uber die Verwundeten in Schleswig, Berlin, 1864. 
 
 11 
 
82 
 
 THE MEDICAL STAFF AND THE MATERIA CHIEITRGICA. 
 
 A few cacolets were issued j but they were not regarded with favor by many sur- 
 geons. They were adapted only for men wounded in the upper extremities, and such 
 patients were more comfortably transported in ambulances or baggage wagons. 
 
 Fia. 80.— Caoolet. 
 
 Fia. 81. — ^Wounded men transported by cacolets. 
 
 The horse-litters were also but little used. Altogether, seven or eight hundred of 
 them were supplied to the troops; but they were soon laid aside. 
 
 PiQ. 82.— Transportation of the wounded by the horse-litter. 
 
MEANS OF TRANSPORTATION OF THE WOCINDED. 
 
 83 
 
 At the beginning of the war, the one-horse ambulances, designed by Surgeon Gen- 
 eral Finley and Surgeon Coolidge, and the 
 four-horse ambulances, designed by Surgeon 
 Tripler, were chiefly employed. 
 
 The former were intended to transport 
 two wounded men in a recumbent position. 
 The latter accommodated eight men, lying 
 down. The beds in all of these ambu- 
 lances were movable, and could be used as 
 hand-litters. 
 
 The one-horse ambulances were too frail 
 for the rough roads on which they were 
 
 S'IG. 83. — The "Coolidge" ambalance. 
 
 I'IG. 86.— Side elevation of the Wheeling or Rosecrans ambulance. 
 
84 
 
 THE MEDICAL STAFF AND THE MATERIA CHIRUKGICA. 
 
 employed, and soon fell into disrepute. The four-horse ambulance rendered good service, 
 
 but it was very heavy. What is commonly 
 known as the "Wheeling" ambulance, from 
 having been first constructed at Wheeling,^ 
 Virginia, from a design of General Rose-' 
 crans, soon came, into very general use. It 
 is drawn by two horses, and carries ten or 
 twelve persons sitting, or two or three sit- 
 ting and two lying down. It. combines 
 lightness and strength. 
 
 ■ Towards the close of the war, a still bet 
 ter ambulance was constructed from designs 
 furnished by Brevet Major General D. H. 
 Rucker, of the Quartermaster's Department. 
 It has been recommended, as the regulation 
 ambulance for the U. S. Army. Its plan is 
 exhibited and sufficiently explained in the 
 
 Fio. 87.— Rear elevation of the Wheeling ambulance. aCCOmpaUying plate. 
 
 Throughout the war, the system of rapidly removing the wounded to permanent 
 hospitals, remote from the scene of hostilities, was uniformly adopted. To accomplish 
 this, trains of hospital railway cars were constructed, and steamers were fitted up as 
 hospital transports, or were built expressly for this service. The hospital cars were 
 furnished with movable berths or litters, and in each train one car was provided with 
 facilities for cooking, and with a dispensary. 
 
 31^ la ini ini ^ ini a la a 1^ in Di a la Di ^ n [a ID (^^ 
 
 Fig. 88. — ^U. S. Army Hospital railway car. Side elevation. 
 
 _^J 
 
 
 (9 
 
 m 
 
 V 
 
 Fig. 89. — Hospital railway car. Ground plan. 
 
 Fia. 90. — Hospital railway 
 car, Kear elevation. 
 
 During the siege operations in front of Petersburg, the sick and wounded were con- 
 veyed by rail from the hospitals near the trenches to the central avenue of the great , 
 base hospital at City Point, and unloaded at the doors of the wards. 
 
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EQUIPMENT, DRESSINGS, ETC. 
 
 85 
 
 Plans and descriptions of the hospital railway trains on the lines between Washington 
 and New York, Chattanooga and Nashville, Marietta and Louisville, are filed in this office. 
 
 When the bases of military operations were contiguous to the sea-board or to the 
 great water-courses, the sick and wounded were removed in hospital steamers. The 
 hospital transports on the Atlantic and on the Mississippi and its tributaries formed 
 a large fleet. Ordinary passenger steamers were of necessity employed at first; but 
 ultimately vessels were specially constructed for hospital purposes. The internal ar- 
 rangement of one of the best of the ocean hospital transports is figured in the accom- 
 panying plate. It is a steamer of 1400 tons, 228 feet in length, provided with 477 beds. 
 It was fitted up at New York, under the supervision of Surgeon A. H. Hofi", U. S. Vols. 
 
 EQUIPMENT, DRESSINGS, ETC. 
 
 At the beginning of the war, each regimental surgeon was 'provided with the in- 
 struments, medicines, and dressings enumerated in 
 the Standard Supply Table;* In action, he was 
 accompanied by a hospital orderly, who carried a 
 knapsack containing a limited supply of anaes- 
 thetics, stimulants, anodynes, styptics, and ma- 
 terials for primary dressings. The medicine chest 
 and bulky hospital supplies were transported in 
 wagons of the supply train, and were often inac- 
 cessible when most urgently required. 
 
 To obviate this inconvenience, panniers were 
 provided containing the most necessary medicines, 
 dressings, and surgical appliances.f They were 
 designed to be carried on the backs of pack animals, 
 but they were too heavy to be conveyed in this manner, as were the knapsacks to be 
 borne by men. 
 
 Hospital knapsack of wicker-work, coypred with 
 enamelled cloth. 
 
 Fia. 92. — Qledicine pannier. 
 
 Fia. 94. — Surgeon's field companion. 
 
 * Revised Regulations for the Army of the United States, 1861, p. 304. 
 
 t The contents of the hospital knapsacks, panniers, medicine chests, instrument cases, etc. are enumerated in Cir- 
 cular No. 12, S. G. 0., 186^. 
 
86 
 
 CONCLUDING OBSERVATIONS. 
 
 ijG. 'Jb. — Autenrieth medicine waguu. 
 
 As the organization of the medical staff was perfected, the cumbrous regimental 
 supplies were curtailed. The hospital orderly carried only a light haversack, or "field 
 companion," containing indispensable drugs and dressings. 
 
 But while the regimental hospital supplies were restricted, the brigade supplies 
 
 were augmented. Each brigade 
 was provided with a "medicine 
 wagon," which was furnished not 
 only with drugs, but with an am- 
 ple provision of stores, dressings, 
 furniture, and appliances, an am- 
 putating table, and a limited sup- 
 ply of bedding. The contents of 
 the wagons were continually re- 
 plenished from the stores of the 
 medical purveyor of the army. 
 The medicine wagons construct- 
 ed by Autenrieth and Perot 
 were those chiefly employed in 
 the war. A preferable model, 
 recommended by the Medical De- 
 partment, was adopted during the 
 last year of the war, and was built at the Government workshops. It has been imprac- 
 ticable to prepare an illustration of it in season for this report. 
 
 Models of a variety of hospital knapsacks, panniers, and wagons are preserved at 
 the Army Medical Museum, with the reports of boards on their respective merits or 
 disadvantages. 
 
 CONCLIJDING OBSERVATIONS.' 
 
 In the preparation of a Surgical History of the Rebellion, there are many subjects 
 that would claim attention, which have been scarcely adverted to in the preceding 
 hasty review of the surgical statistics of the office and their illustrations. Among these 
 are the influence of the state of health of the troops upon the result of wounds, the 
 use of anaesthetics, erysipelas, gangrene, the nature of the missiles employed, and the 
 modifications in the character of gunshot injuries produced by modern projectiles. 
 
 The complications of injuries by constitutional diseases, scorbutic, malarial, or ty- 
 phoid, or by a general state of cachexia, in which pathological conditions were combined 
 in unaccustomed synthesis, were elements that unquestionably exerted a vast influence 
 upon the results of the surgical practice of the war. For it cannot be doubted that the 
 frequency of osteomyelitis after amputations, the proneness to suppurative inflammation 
 in wounds of the head and splanchnic cavities, the tendency to the sloughing of flaps, 
 the delay in the union of fractures or the healing of wounds, and the great prevalence 
 of pyaemia, observed at certain periods and localities, were intimately connected with 
 the morbid causes above mentioned, which had led, in many cases, to such an impair- 
 ment of the general vitality of the men as greatly to diminish their ability to resist the 
 effects of severe injuries. In these relations, therefore, such pathological conditions 
 should not be overlooked in the surgical annals of the war. 
 
CONCLUDING OBSERVATIONS. 87 
 
 Anesthetics. — There have been consulted, in regard to the employment of anaes- 
 thetics, the reports of 23,260 surgical operations performed on the field or in general 
 hospitals. Chloroform was used in 60 per cent, of these operations, ether in 30 per 
 cent., and in 10 per cent, of the cases a mixture of the two was administered. At 
 the general hospitals, the greater safety of ether as an anaesthetic was commonly con- 
 ceded. It was often employed, and no fatal accident from its use has been reported. 
 In the field operations, chloroform was almost exclusively used. The returns indicate 
 that it was administered in not less than eighty thousand cases. In seven instances, 
 fatal results have been ascribed with apparent fairness to its use. Detailed reports of 
 these unfortunate cases are on file. The following synopsis is derived from them: 
 
 Case I.— A soldier of a North Carolina regiment, a robust, healthy man, after the battle of Hanover Conrt House, 
 May 29th, 1862, underwent amputation of the thigh. The operation was performed in the open air. He inhaled 
 chloroform very freely. He expired just as the operation was completed. He had lost but little blood. No autopsy 
 was held.— Report of Surgeon Edwin Bently, U. S. Vols. 
 
 Case II.— D. Zebriske, Co. 1, 12th Alabama Eegiment, a prisoner after the battle of Antietam, had a gunshot flesh 
 wound of the hip. A slight incision for the extraction of the ball was made October 19th, 1862, at Hospital No. 5, 
 Frederick, Maryland. Chloroform was carefully administered. The patient expired suddenly. The autopsy threw 
 no light on the cause of death.— Report of Surgeon H. S. Hewit, U. S. Vols. 
 
 Case III.— Corporal Ballou, Co. E, 14th Pennsylvania Cavalry, was placed under the influence of chloroform, to 
 undergo amputation of the right index and middle fingers, at Beverly, West Virginia, October 12th, 1862. He died 
 in the midst of the operation. Slight calcareous deposits were found post-mortem about the valves of the heart. — 
 Report of Surgeon William B. Wynne, \ith Pennsylvania Cavalry. 
 
 Case IV.— Private Thomas Hamilton, Co. A, 1st Maryland Vols., aged thirty-one years, took chloroform Sep- 
 tember 3d, 1864, at Patterson Park Hospital, Baltimore, to undergo an operation for necrosis of the carpal bones. 
 The anaesthetic was given with a large admixture of air. Sudden death ensued. The autopsy revealed fibrinous 
 coagula in the auricles. The thoracic viscera were perfectly normal in appearance. — Report signed by Acting As- 
 sistant Surgeons Fay, Cherbonnier, Kemster, and McLetchen. 
 
 Case V.— Colonel McGilvray, Chief of Artillery of the 10th Army Corps, inhaled two drachms of chloroform, 
 September 4t.h, 1864, for an excision of a phalanx of the left index finger. He expired suddenly before the operation 
 was commenced. There were no pathological appearances found to indicate the cause of death. — Report of Surgeon 
 A. B. Clark, U. S. Vols. 
 
 Case VI. — Private Robert Gormley, Co. I, 7th New York Artillery, died suddenly at McClellan General Hos- 
 pital, November 29th, 1864, having taken chloroform to submit to an incision in the calf of the right leg for the re- 
 moval of a ball. There was no autopsy. — Report signed by Acting Assistant Surgeons Ely and Uhler. 
 
 Case VII. — Private John Johnson, Co. B, 2d Pennsylvania Heavy Artillery, a patient in Mower General Hos- 
 pital, near Philadelphia, expired suddenly on May 13th, 1865, while inhaling chloroform preparatory to undergoing a 
 surgical operation. — Report of Surgeon J. Hopkinson, V. S. Vols. 
 
 Erysipelas. — In the ill-ventilated barracks and private edifices which were some- 
 times of necessity occupied as hospitals during the earlier period of the war, erysipelas 
 was a frequent visitant. Elaborate reports on its prevalence in the hospitals of Louis- 
 ville, Nashville, Memphis, and Madison have been transmitted by Surgeon Goldsmith, 
 TJ. S. Vols., Surgeon "Weeks, U. S. Vols., and Surgeon Culbertson, U. S. Vols. 
 
 Gangrene. — The various forms of sloughing, phagedena, and traumatic gangrene, 
 described in systematic authors, were among the complications of wounds that through- 
 out the war often rendered the skill of surgeons abortive, but the ravages of true con- 
 tagious hospital gangrene were comparatively limited. Voluminous papers on this 
 subject have been contributed. It has been discussed in its clinical relations by Medi- 
 cal Inspector Hamilton, and Surgeons McParlin, Brinton, Goldsmith, Breed, Weeks 
 and Moses, and its pathological anatomy has been investigated by Assistant Surgeons 
 Woodward and Thomson. 
 
88 
 
 CONCLUDING OBSEEVATIONS. 
 
 ri8. 96.— a. V. S. round muslcet-ball, calibre 69, weight 387 
 grains; 6. Springfield rifled mnsket-ball, calibre 68, weight 600 
 grains; c. Enfield rifled musket-ball, weight 450 grains; d. Aus- 
 trian rifle-ball, weight 460 grains. 
 
 Missiles. — The collection at the Army Medical Museum of over five hundred pro- 
 jectiles extracted from wounds, together with the numerous preparations of fractures 
 and wounded viscera in which the missiles that produced the injuries have been pre-, 
 served, afibrd opportunities for the comparison of the various forms of bullets and their 
 effects. During the protracted siege operations in front of Petersburg, an artist of the 
 Museum prepared upon the spot a large number of colored drawings, illustrating with 
 singular fidelity the recent appearance of wounds inflicted at short range by shot and 
 shell. The reports on gunshot wounds have specified the nature of the missile whenever 
 
 it could be ascertained. From these different 
 sources ample materials are available for the 
 study of the modifications in gunshot wounds re- 
 J^^"^"^ mt w iiMiT P 1 mTIi^M suiting from modern improvements in ordnance. 
 
 ' * I^Ii3^ f?^~^~^ t^ — T™ The general employment in the late war of cy- 
 
 ■^L^ ^F La™2 r JH^ I I II 'jfl lindro-conoidal projectiles, moving in low trajec- 
 -^n^^^ ^^^gp, if^^^^ii* oa^^^9 tories, largely increased the proportion of wound- 
 ed to the troops engaged, and the frequency of 
 the occurrence of several wounds in the same 
 individuals. The projectiles for small arms 
 chiefly used were those of the Springfield, Enfield, and Austrian rifled muskets. The 
 rebels also used quite largely, for the Enfield rifle, an elongated bullet without grooves. 
 
 WotrNDED ON THE Battle-field. — Surgcon T. H. Squire, 89th New York Yols., has 
 furnished this office with two instructive reports on the wounded that came under his 
 observation during the battle of Antietam and in the engagements before Petersburg. 
 Similar papers on the wounded at Chickamauga have been contributed by Surgeon 
 John C. Norton, U. S. Vols., and Surgeon J. T. Wood, 99th Ohio Vols., and in relation 
 to the wounded at Chattanooga by Surgeon A. McMahon, 64th Ohio Vols., and Surgeon 
 C. H. Walton, 21st Kentucky Vols. Surgeon H. S. Hewit, U. S. Vols., and Surgeon 
 E. Batwell, 14th Michigan Vols., have communicated valuable reports on the wounded 
 in the engagements of the Atlanta campaign. Recorded observations on the primary 
 attention given to the wounded in battle are, from the nature of things, rare, and these 
 important memoirs therefore merit especial recognition. 
 
 In conclusion, it has been estimated that it will be possible, by judicious condensa- 
 tion, to include in one large quarto volume the statistics of the graver injuries, as frac- 
 tures of the extremities and wounds implicating the joints or great cavities, and of the 
 major surgical operations they have involved, the individual cases, their progress and 
 results, being concisely recorded; while a second quarto volume could comprise numer- 
 ical tables of the less serious injuries, an historical summary, and a discussion of the 
 lessons derived from the statistical records of the war. 
 
 I have the honor to be. General, 
 Very respectfully. 
 
 Your obedient servant, 
 
 aEOKGE A. OTIS, 
 
 Brevet Lieut. Col. and Surgeon IT. S. Vols., 
 In charge of the Division of Surgical Records, S. O. 0. , 
 and Curator of the Army Medical Museum. 
 
Surgeon General's Office, 
 Washington, D. C , 
 
 October 20th, 1865. 
 BREVET MAJOR GENERAL JOSEPH K. BARNES, 
 
 Surgeon General TJ. S. Army. 
 General: — 
 
 In reply to your inquiries as to the nature and extent of the data bearing on the 
 health of the army during the war, which have accumulated in the branch of your office 
 under my charge, and as to how far the labor of digesting this material for publication 
 has advanced, I have the honor to present for your consideration the following state- 
 ments. 
 
 The matter collected is partly statistical, partly pathological. The first category 
 embraces the medical statistics of the several armies and general hospitals. The second 
 consists of a number of memoirs and reports by medical officers on the causes, symptoms, 
 and treatment of the more important camp diseases, of numerous histories of cases and 
 autopsies, of the fine series of medical and microscopical specimens in the Army 
 Medical Museum, and of the results of the pathological studies conducted under my 
 direction on the basis of these collections. In addition, there are a large number of 
 descriptions and plans of general hospitals, of reports on hospital organization, and 
 some other miscellaneous matters. 
 
 The object kept steadily in view has been to collect all the information possible 
 with regard to the sickness and mortality of the army during the war, and especially 
 whatever related to the nature and causes of those affections which were the chief 
 occasion of death and disability. 
 
 The importance of such a study cannot be overestimated. The happy exemption 
 of our army from serious epidemics, an exemption which, under Providence, was the 
 legitimate and necessary consequence of the liberality of our commissariat and of our 
 medical supplies, is continually quoted in terms of the highest self-congratulation. 
 Indeed, so far as can be judged from other recent wars, and from the careful study of 
 such imperfect information as can be collected with regard to the health of troops prior 
 to the nineteenth century, the mortality of our soldiers from disease has been far less 
 than that of any other army in time of war. 
 
 But while our hearts are filled with gratitude at this fortunate result, it should not 
 be forgotten that our losses from disease have, nevertheless, been enormous when con- 
 trasted with the usual mortality of men of military ages in time of peace. Not count- 
 ing those of our soldiers who died while prisoners in the hands of the rebels — not 
 counting those who were discharged for diseases contracted in the service, and who 
 subsequently died at home, — the deaths of our men from disease were far more numer- 
 ous than all the slain in all the battles, and all the wounded who have since died or are 
 likely yet to die of the injuries received in the struggle. Judging from the statistics of 
 the first two years, which have already been compiled, the mortality from disease 
 
 12 (89) 
 
90 REMARKS ON THE STATISTICAL MATERIAL. 
 
 during the war-not counting deaths among prisoners of war or discharged soldiers- 
 was more than five times as great as the mortality of men of the same ages in civil life, 
 and it is not to be disguised that the diseases which produced most mortality were pre- 
 cisely those which are most under the control of hygienic means. 
 
 At the commencement of the present struggle, the only important work which 
 could serve to give correct notions as to the nature of the diseases of armies, and the 
 direction to be given to the activity of those whose duty it is to combat them, was the 
 Official Medico-Chirurgical History of the British Army in the Crimean War, laid be- 
 fore Parliament, in two folio volumes. This work refers to a comparatively small num- 
 ber of troops serving in a climate very different from our own, yet its study was of great 
 value in giving direction to our efforts. What was the direction these efforts took — what 
 were the results attained— why our soldiers died, and how this can be best and most 
 economically prevented in future wars— are questions upon which the experience of 
 the present struggle, as recorded in the official reports and documents, can throw a flood 
 of light. Such a publication, therefore, becomes one of the most important duties of the 
 Medical Department of the army; a duty the evasion or neglect of which would be a 
 grave crime against the army of the United States, and against every American citizen 
 who, in future wars, volunteers in the defence of his country. 
 
 The character and importance of the material available for such a publication, and 
 the labor yet necessary to complete its preparation for the press, can be best appreciated 
 after a brief description of each of the divisions mentioned at the commencement. 
 
 REMARKS ON THE STATISTICAL MATERIAL. 
 
 The statistical material embraces a mass of facts with regard to the several armies 
 and general hospitals. 
 
 Tables are being prepared for each army, showing the monthly number of cases and 
 of deaths from each form of disease or injury. Other tables give the numbers returned to 
 duty, sent to general hospitals, discharged the service for disability, transferred to the 
 Veteran Reserve Corps, died, and remaining at the close of each month. 
 
 The tables referring to the general hospitals show the number admitted into each 
 hospital monthly and the causes of admission, the number of deaths from each disease 
 or class of wounds, the number returned to duty, transferred to the Veteran Reserve 
 Corps, transferred to other hospitals, discharged the service for disability, and remain- 
 ing under treatment at the close of the month. 
 
 The data furnished by these tables render it possible to calculate ratios illustrating 
 many important matters connected with the laws of the sickness and mortality of 
 armies operating in the United States. By such ratios we shall be enabled to form an 
 intelligent judgment as to the success of the means adopted by the government to pre- 
 
REMARKS ON THE STATISTICAL MATERIAL. 91 
 
 serve the health of our troops, and to compare the results attained with those which have 
 occurred in other armies. The comparative prevalence of those diseases which are 
 known to be preventable, or at least greatly under the influence of hygienic control, 
 will indicate the path in which the further exercise of sanitary precautions should be 
 directed. In fact, the medical history of the past four years, as recorded in the official 
 figures, will be found full of meaning and of manifold suggestion for the future. 
 
 It is believed that no one would fail to recognize the importance of medical statis- 
 tics, if confidence were placed in the data from which they are compiled; but it is often 
 insinuated that these data are, from their nature, unreliable in all medical statistics, and 
 that they are especially uncertain in the statistics of armies in time of war. The causes 
 of error are twofold — on the one hand, mistakes in diagnosis; on the other, negligence, 
 omissions, or falsehoods in the reports. 
 
 That errors of both kinds exist, is to be freely admitted. That they are sufficiently 
 numerous and important to rob the medical statistics of our army of their practical value, 
 may be emphatically denied. 
 
 Diagnostic errors can be largely eliminated from medical statistics by grouping 
 together those allied afifections which are most apt to be confounded. There is proba- 
 bly, for example, no army in the world among whose medical officers a sufficient num- 
 ber of men acquainted with the details of ophthalmic science can be found to give 
 authenticity to its statistics of diseases of the eye, if the form required to be filled 
 embraced the modern classification based upon observations with the ophthalmoscope. 
 This fact, however, does not prevent them from being able to report correctly the total 
 number of diseases of the eye, or even, with considerable accuracy, the proportion of 
 these to be included under the designation "ophthalmia;" and these are practically the 
 most important facts. 
 
 Like remarks apply to many similar cases in which there is difficulty in the 
 diagnosis between allied affections; and it becomes therefore one of the most important 
 duties of the medical statistician to group the several diseases together in such a way as 
 to extinguish the greatest possible number of errors of this class. 
 
 But the chief cause which disturbs confidence in medico-military statistics is the 
 belief that medical records are imperfectly and carelessly kept, especially in the case of 
 troops in the field. It has been insinuated that their charge is often intrusted to 
 ignorant subordinates, and even, that in extreme cases, no records were kept, and the 
 monthly reports required by law filled up with no other guide than memory. The 
 objection based upon this supposition has been considerably exaggerated in certain 
 quarters, and it is not for a moment believed that medical officers were generally negli- 
 gent of their duty, or that their reports were not, in the vast majority of instances, based 
 upon records kept according to the best of their abilities. Even daring campaigns, 
 when it was impossible to keep the cumbersome books required by the regulations in 
 force at the beginning of the war, surgeons had their pocket memorandum-books, which 
 perfectly sufficed to preserve reliable data for the simple form of report required 
 monthly. It was a knowledge of this fact that led to the issue of the "pocket register 
 and prescription book" at present used by troops in the field. But the most conclusive 
 answer to every objection of this kind is to be found in the character of the reports 
 themselves as they exist in the official files; they contain internal evidence of the care 
 
92 MORTALITY KATES. 
 
 with which they were prepared, and, it is believed, will compare favorably with any 
 other set of statistical papers in existence. 
 
 It is true, indeed, that the duty of making reports was sometimes neglected, and 
 that sometimes they were missing, from the absence of surgeons, the capture of records 
 by the enemy, or the loss of the papers themselves during transmittal; but the de- 
 ficiencies of this character became progressively less and less numerous and important, 
 and, during the second, third, and fourth years of the war, the number of regiments 
 and detachments not represented was comparatively small. 
 
 Deficiencies of this kind are very much to be deplored, but they in no way diminish 
 the value of the reports received for the troops which they represent; and where the 
 troops represented amount to hundreds of thousands, the results have probably a scien- 
 tific value very nearly as great as would have been possessed by complete reports. 
 
 It has been deemed proper to present these considerations, because much has been 
 said by persons unacquainted with statistical science as to the imperfection of the data 
 which it has been possible to collect, and because it is nevertheless earnestly believed that 
 to neglect the study of these data would be gravely prejudicial to the interests of military 
 medicine and surgery in America. The circumstances interfering with the accuracy and 
 completeness of our reports have operated in the case of all former military statistics in 
 like degree, so that the results are fairly comparable; though it cannot be denied that 
 the immense size of the figures in our case, and the consequent more perfect balancing 
 of errors in opposite directions, lead us, on considerations which flow from the mathe- 
 matical law of probabilities, to place greater confidence in the accuracy and importance 
 of our results than in the figures collected under like circumstances by any other nation. 
 
 The statistical tables necessary to present the data collected in a convenient shape 
 for study can, it is hoped, be compressed into one quarto volume. They are now fully 
 prepared for the first and second years of the war. The work on the third is well 
 advanced; while that on the fourth has but recently been commenced. 
 
 A few general considerations, based upon the manuscript of the tables for the first 
 two years of the war, will here be presented, to give a general idea of the character and 
 scope of the statistics in question. These considerations will have reference to the 
 mortality rates, the prevalence of disease, and the comparative frequency of the several 
 diseases, especially of those which have caused the chief mortality. A few remarks on 
 the character of the latter affections will also be presented. 
 
 MORTALITY RATES. 
 
 The mortality of the armies of the United States from disease alone was 48-7 per 
 1000 of mean strength during the first year of the war, viz., the year ending June 
 30th, 1862, and 65-2 per 1000 during the second year, viz., that ending June 30th, 1863.* 
 
 In obtaining these ratios, the sum of the deaths reported by regiments and detach- 
 ments, and by the general hospitals, is compared with the mean strength given by the 
 
 * The mortality rate here given for the first year of the war differs slightly from that published in Circular No 15 
 Surgeon General's Office, September, 1863, the difference resulting in part from corrections made in completing the 
 discassion of the statistics of that year, in part from the incorporation of material not accessible when the oriKinal 
 computation was made. 
 
MORTALITY RATES. 93 
 
 reports as present in the field, in garrison, and in the hospitals. The sick reports fur- 
 nishing the data employed do not give the deaths among those absent as prisoners of 
 war, on furlough, or deserters; hence the mean strength of those thus absent is not 
 considered in determining the ratios. These absentees may have had a very different 
 mortality rate from that above given. In fact, in the case of those of our men who 
 were absent as prisoners of war, the rate of mortality was terribly greater. An attempt 
 will hereafter be made to estimate this rate on data other than that of the monthly sick 
 reports. Such an attempt, however, would be premature at present. The figures given 
 are therefore to be understood simply as the rate of deaths from disease among that 
 portion of the troops which is represented in the sick reports received at the Surgeon 
 General's Office. How far they may be regarded as applicable to the whole of the army 
 of the United States (excepting always prisoners and absentees), may be inferred from 
 the following considerations : 
 
 The reports for the first year are incomplete, still they represent a large part of the 
 troops in every army and in hospitals throughout the country. The reports from 
 troops in the field and in garrison for the first year represent an average strength con- 
 stantly present during the year of 281,177 men. The reports from the hospitals repre- 
 sent an average strength constantly present of 9759 men. The total strength 
 represented therefore is 290,936 men, among whom there were 14,183 deaths from 
 disease. The average mean strength above given is much smaller than the real 
 average for the year. The number of deaths therefore is less than the real number of 
 deaths; but it is believed that the figures are quite large enough to make it in the 
 highest degree probable that the rate obtained is true, or very nearly true, for the 
 whole army of the United States, excluding always prisoners of war and other 
 absentees. 
 
 The reports for the second year were less incomplete than those of the first. They 
 represent an average mean strength in the field and in garrison of 598,821, and an 
 average strength in hospital of 45,687 men. The total strength represented therefore 
 is 644,508, among whom there were 42,010 deaths from disease. These figures are so 
 large that it is to the last degree improbable that the reports of the comparatively 
 small number of troops not represented would have made any perceptible change in 
 the ratio, had it been possible to collect them. 
 
 The mortality rates thus obtained, and believed to represent accurately the facts 
 of the case, are much smaller than is usual with armies in time of war. Thus, for ex- 
 ample, according to the figures compiled by Assistant Surgeon (now Medical Insj)ector) 
 R. H. Coolidge, the annual mortality of our troops in the Mexican war from disease 
 alone was 103-8 per 1000. For the British army, during the Crimean war, ac- 
 cording to the Parliamentary report, the annual mortality from disease was 232 per 
 1000. The losses of the French army from disease during the Crimean war were, 
 it is probable, proportionately greater than those of the English army. It is difficult, 
 however, to fix them precisely. In the long-expected volume of Chenu,* now just pub- 
 lished, no computed ratios are presented. It is true, monthly statistical tables are given, 
 
 * Rapport au Oonseil de Sant6 des Armfees sur les Resultats du Service Mfedico-Chirurgical aux Ambulances de 
 Criin&e et aux H8pitaux Militaires Pranqais en Turquie, pendant la Campagne d'Orient en 1854, '55, and '56. Par 
 J. (J. Chenu. Paris, 1865. 
 
94 MORTALITY RATES. 
 
 which contain the number of deaths from disease and the mean strength of the army; 
 but unfortunately, after the first few months, these tables, which are headed " Mouve- 
 ment des Ambulances de Crimee," do not include the deaths in the general hospitals 
 established by the French in Turkey. Separate tables for each hospital are given, 
 but these consolidate the deaths from wounds with those from disease, under the 
 general designation "Morts," and do not, therefore, render it possible to complete the 
 computation. If, however, from the total mortality given in the report, the killed in 
 battle and the deaths from wounds, as given in the tables on the several individual 
 injuries, be deducted, it will be seen that the deaths from disease alone cannot be much 
 short of 75,000 during the twenty-eight months, while the strength constantly present 
 was about 100,000; this would indicate an annual ratio of over 300 per 1000 of mean 
 strength. 
 
 It is thus seen that the losses of our troops from disease during the first half of the 
 recent struggle were proportionately much less than those of the allied armies in the 
 Crimea, or of our own army in the Mexican war; and although the present condition 
 of the statistical work progressing under my direction does not permit me to present 
 mortality rates for the third and fourth years of the war, yet, from the examinations 
 I have thus far made, I am inclined to the belief that the proportion of deaths from 
 disease rather diminished than otherwise during that period. 
 
 The mortality of our troops from disease was considerably greater during the second 
 year of the war than during the first. It was also difierent in the different regions in 
 which the troops operated. For the purposes of this comparison, which will also be 
 made in the case of the several diseases, the United States may be regarded as divided 
 into three great regions, designated severally the Atlantic, the Central, and the Pacific 
 regions. 
 
 The Atlantic region will embrace all the slope between the Appalachian range 
 and the sea. It will include the Northeastern and Middle Departments, the Army of 
 the Potomac, the troops in North and South Carolina and in Florida. The Pacific re- 
 gion embraces all that lies west of the Rocky Mountains. It includes California, 
 Oregon, and Washington Territory ; to these. New Mexico* has been added, as more 
 allied to this than to the Central region. The Central region embraces all the great 
 basin of the continent between the Appalachian and the Rocky Mountains. It con- 
 tains the valley of the Mississippi River and its tributaries, and includes the Northern 
 and Northwestern Departments, "Western Virginia, Kentucky, Missouri, Arkansas, the 
 Army of the Tennessee, the Army of the Cumberland, and the Department of the Gulf. 
 
 The exposures of the troops in each of these regions presented certain well-marked 
 characteristics. In the Pacific region, the conditions approached those of peace. The 
 forces were mainly scattered in numerous small posts, and shared few of the active 
 duties of war. In both the Atlantic and the Central regions, on the other hand, cam- 
 paigns were conducted on a grand scale. In the Atlantic region were the several coast 
 expeditions — the Army of the Potomac and its great battles; in the Central, the expe- 
 ditions on the Tennessee and Mississippi Rivers, and conflicts like those of Shiloh and 
 Stone River. One of the chief characteristics of the Central region would appear to 
 
 * In the tables given in Circular No. 15, S. G. 0., above cited (see note to p. 92), New Mexico was included 
 in the Central region. 
 
MORTALITY RATES. 
 
 95 
 
 have been the extent of territory over which the operations extended and the conse- 
 quent embarrassment in the transportation of supplies; in addition, it is to be noted that 
 the malarial miasms, under the influence of which intermittent and other malarial fevers 
 are developed, have for many years been known, from the experience of civil life, to be 
 much more intense in the Central region than on the Atlantic slope. As might be ex- 
 pected, therefore, we find the rates of disease and mortality very different in these three 
 regions. Diflferences also exist between the different parts of each region, which, how- 
 ever, cannot be gone into in a brief paper like the present. 
 
 A comparison of the reports from the troops and hospitals in the three great regions 
 shows the mortality rate of the Central region to be the greatest, and that of the Pacific 
 region the least. In the Pacific region, the mortality from disease alone was about 12 
 per 1000 of mean strength for the first year and 8 for the second, the average for the 
 two years closely corresponding with the rates for young men of military ages in civil 
 life, and with the mortality of the British troops in Great Britain and Ireland, as given 
 in their official reports for 1859, '60, '61, and '62. In the Atlantic region, the rates 
 were nearly 33 for the first year and 41 for the second. In the Central region, 80 for 
 the first year and nearly 90 for the second. 
 
 Tables I. and II. present the monthly mortality in each of these regions. 
 
 TABLE I. 
 
 Monthly Mortality of the Armies of the United States during the year ending June 30th, 1862, expressed 
 
 in ratio per 1000 of mean strength. 
 
 
 1861. 
 
 1862. 
 
 For the 
 year. 
 
 t-3 
 
 1 
 
 -a 
 
 u 
 
 i 
 
 1 
 
 i 
 
 S5 
 
 1 
 1 
 
 a 
 4 
 
 1 
 
 .c 
 
 1 
 
 1 
 
 1 
 
 Atlantic Region 
 
 Central Region 
 
 Pacific Region 
 
 1-96 
 
 •93 
 
 1-72 
 
 2-03 
 2-96 
 1 00 
 
 1-77 
 3-52 
 1-34 
 
 2 02 
 4-63 
 1-43 
 
 2-65 
 6-25 
 1-75 
 
 3-20 
 6-54 
 1-04 
 
 2-88 
 
 8-69 
 
 ■19 
 
 2 -.37 
 
 8-78 
 
 •83 
 
 2-50 
 
 10-06 
 
 •89 
 
 8-04 
 
 6-46 
 
 ■49 
 
 3-12 
 
 7-10 
 
 ■75 
 
 3^35 
 5^90 
 
 •77 
 
 32'54 
 80^18 
 
 TABLE IL 
 
 Monthly Mortality of the Armies of the United States during the year ending June 30th, 1863, expressed 
 
 in ratio per 1000 of mean strength. 
 
 
 1862. 
 
 1863. 
 
 For the 
 year. 
 
 1 
 
 1 
 
 t 
 
 1 
 
 1 
 
 1 
 
 1 
 
 1 
 
 .g 
 
 i 
 
 .1 
 
 S 
 
 Atlantic Region 
 
 Central Region 
 
 Pacific Region 
 
 3 98 
 
 7^69 
 
 ■76 
 
 5^69 
 
 6-11 
 
 ■00 
 
 4-27 
 
 5^72 
 
 ■34 
 
 4'58 
 6-20 
 
 ■77 
 
 4-52 
 
 8-49 
 
 •71 
 
 4^82 
 
 8-30 
 
 ■96 
 
 3-79 
 
 8-68 
 
 •50 
 
 2-96 
 9-93 
 1-01 
 
 2^55 
 
 9^14 
 
 •82 
 
 2^00 
 7;31 
 1-24 
 
 1-25 
 5-46 
 
 ■77 
 
 1^78 
 4-94 
 1^05 
 
 41-40 
 
 89^55 
 
 8 38 
 
96 
 
 GENERAL PREVALENCE OF DISEASE. 
 
 The monthly reports from which the foregoing rates of mortality from disease were 
 computed give also a certain amount of information as to the mortality from wounds 
 and injuries. The deaths from these causes, reported during the first year of the war, 
 were 4857 out of the strength given above, or seventeen (16-7) per 1000 of mean 
 strength; during the second year, 10,142, or sixteen (15-7) per 1000. These rates, 
 however, by no means represent the real losses from wounds and injuries, since they do 
 not include those slain in battle, or those who died of their wounds while prisoners of 
 war or otherwise absent. To form a correct estimate of the total losses from wounds, 
 I must therefore refer to the Surgical History of the War. 
 
 GENERAL PREVALENCE OF DISEASE. 
 
 The directions for making the monthly sick reports in the armies of the United 
 States require every man excused from duty, on account of sickness, to appear on the 
 report. The total number taken sick represents thus slight indispositions as well^ as 
 severe illness, and the figures are therefore much larger than in those armies in which 
 such only are reported as are received into hospital. It follows that the comparative 
 health of the several divisions of our army is to be ascertained rather by considering 
 the monthly number taken sick with serious diseases, such as fever and diarrhoea, than 
 by merely observing the total number of cases reported. 
 
 The statistics show the ratio of cases to have been such, during the first two years 
 of the war, that on the average each soldier must have been taken on sick report 
 several times a year. The figures of the second year show a slight diminution in the 
 number of cases. The ratio for the whole army was 2966 per 1000 of mean 
 strength for the first year, 2694 for the second. In the Atlantic region, the number 
 of cases was 2749 per 1000 of mean strength for the first year, 2563 for the second. 
 In the Central region, 3422 for the first year, 2832 for the second. In the Pacific re- 
 gion, 2168 for the first year, 2123 for the second. Tables III. and IV. give the 
 monthly rates for each of these regions. 
 
 TABLE III. 
 
 Monthly Sickness Rates of the Armies of the United States during the year ending June SOth, 1862, 
 
 expressed in ratio per 1000 of mean strength. 
 
 
 1861. 
 
 1862. 
 
 For the 
 year. 
 
 >> 
 
 S 
 
 i 
 
 Si 
 
 i 
 
 1 
 8 
 
 1 
 1 
 
 1 
 
 
 I 
 
 .c 
 
 'S 
 ^ 
 
 i 
 
 1 
 
 Atlantic Region.... 
 
 Central Region 
 
 Pacific Region 
 
 391-35 
 267-22 
 163-15 
 
 372-18 
 378-81 
 199-67 
 
 298-26 
 336-66 
 197-48 
 
 267-14 
 331-35 
 187-10 
 
 255-90 
 304-11 
 236-80 
 
 230-99 
 313-51 
 153-68 
 
 199-92 
 339-03 
 128-99 
 
 183-33 
 254-19 
 210-57 
 
 167-25 
 257-07 
 198-97 
 
 214-52 
 287-09 
 140-77 
 
 208-45 
 259-43 
 220-84 
 
 239-76 
 233-73 
 187-06 
 
 2748-83 
 3421-93 
 2168-48 
 
CONSTANT SICKNESS BATES. 
 
 97 
 
 TABLE IV. 
 
 Monthly Sickness Bales of the Armies of the United States during the year ending June 30th, 1863, 
 
 expressed by ratio per 1000 of mean strength. 
 
 
 1862. 
 
 1863. 
 
 Por the 
 year. 
 
 if 
 
 
 
 1-s 
 
 1 
 
 1 
 
 1 
 
 1 
 
 »5 
 
 1 
 S 
 
 1 
 
 1- 
 
 JS 
 
 
 1 
 
 s 
 
 Atlantic Region 
 
 Central Region 
 
 Pacific Region 
 
 310-79 
 244-21 
 182-43 
 
 250-21 
 220-26 
 230-73 
 
 242-82 
 263-22 
 211-15 
 
 285-79 
 271-47 
 180-10 
 
 289-11 
 262-23 
 189-35 
 
 229-10 
 244-14 
 166-87 
 
 222-44 
 255-76 
 178-39 
 
 181-51 
 286-18 
 145-68 
 
 180-50 
 239-26 
 152-49 
 
 149-34 
 207-46 
 172-28 
 
 163-43 
 192-60 
 150-60 
 
 159-10 
 219-32 
 183-20 
 
 2563-25 
 283164 
 2122-92 
 
 At first sight it might appear that these figures repres ent an extraordinary amount 
 of disease; but if they be compared with those of the published statistics of the United 
 States army in time of peace, it will be found that the effect of the war on the health 
 of the troops is rather in the increased number of serious diseases and the consequent 
 mortality than in the number taken on sick report. The average number taken on 
 sick report annually in time of peace, from 1840 to 1859, was 2558 per 1000. 
 
 CONSTANT SICKNESS RATES. 
 
 In this connection, the constant sickness rates assume the highest interest, es- 
 pecially to the military authorities. As every regimental sick report contains a sepa- 
 rate statement of the number of sick and wounded under treatment at the close of each 
 month, it might be supposed that the sum of these reports would furnish the number 
 sick in the whole army at the close of each month, and that this would give a fair 
 notion of the constant sickness. But the rates thus deduced give no idea of the number 
 "absent sick," and the proportion of sick "absent" or "present" is not uniform, but 
 varies continually. An army lying in winter quarters generally makes provision for 
 most of its sick with it, while on the march all serious cases are sent to the general 
 hospitals at the base of operations; so that constant sickness rates, which do not in- 
 clude those absent in hospital, are of no value. Now, for the early part of the war, 
 it has not been possible to compute reliable constant sickness rates, because very 
 many of the reports received were the old "quarterly" form, and only show the 
 remaining at the end of each quarter, which would hardly give a just idea of the 
 constant rates; moreover, in these quarterly reports the "remaining" were not dis- 
 criminated into "sick" and "wounded," but given in gross. The figures, therefore, 
 give the constant sickness rates plus the number of wounded under treatment. Sub- 
 sequently to the period named, however, it is possible to compile quite accurate constant 
 sickness rates from the data of the Surgeon General's Office, by taking the number 
 "remaining" in general hospitals into the count and carefully discriminating "sick" 
 from "wounded." 
 
 It might perhaps be hoped that the monthly and tri-monthly returns of the Adju- 
 tant General's Office would supply the missing information for the early part of the war, 
 
 13 
 
98 
 
 COMPARATIVE FREQUENCY OF THE SEVERAL DISEASES. 
 
 but this is not the case. These returns are prepared for military, not for medical pur- 
 poses. The monthly returns represent the number "present sick," but not the number 
 "absent;" and under the head "present sick" (i.e. cm sick report), they include those 
 who are really "present wounded." The tri-monthly returns, indeed, represent the 
 number "absent sick" as well as those "present sick;" but under the term sick, as in 
 the monthly returns, both sick and wounded are included. 
 
 All ratios hitherto comj)iled, and published unofficially, which purport to be 
 based on the returns in the Adjutant General's Office, are open to this objection, that 
 they include the wounded with the sick, and are therefore to be regarded as wholly 
 valueless in forming a notion of the health of the army. The following table of con- 
 stant sickness rates extends only from October 1st, 1862, to June 30th, 1863. It com- 
 pares the health of the troops in the three regions. The figures include only those 
 under treatment for disease, and not those suffering from wounds. 
 
 TABLE V. 
 
 Constant Sickness Rates for apart of the year ending June 30th, 1863, expressed in ratio per 1000 
 
 of mean strength. 
 
 
 Atlantic 
 Region. 
 
 Central 
 Region. 
 
 Pacific 
 Kegiou. 
 
 1862. 
 1863. 
 
 October 
 
 123 
 
 134 
 
 118 
 
 112 
 
 108 
 
 93 
 
 79 
 
 81 
 
 104 
 
 102 
 
 106 
 
 91 
 
 106 
 
 109 
 
 105 
 
 88 
 
 83 
 
 97 
 
 65 
 77 
 66 
 82 
 71 
 67 
 71 
 67 
 62 
 
 November , 
 
 
 January 
 
 February . 
 
 March 
 
 
 May 
 
 June 
 
 Average rate 
 
 106 
 
 98 
 
 70 
 
 
 
 The data from which this table was compiled are not as complete in all respects as 
 could be desired: still the rates presented are believed to be close approximations. It 
 will be observed the Atlantic region has a rate slightly higher than the Central, but 
 that in both the rate is about 10 per cent, of the strength. The rate for the Pacific 
 region, 7 per cent., is in striking contrast with the slight mortality of that region. 
 
 COMPARATIVE FREQUENCY OF THE SEVERAL DISEASES. 
 
 The monthly sick reports of the several regiments, detachments, and garrisons 
 give the number taken sick during the month, and the number of deaths from each of 
 the more important diseases ; the reports of the general hospitals give the number of ad- 
 missions and deaths from each disease. The form employed during the first year of the 
 war differed in arrangement and in some other points from the improved form adopted in 
 the summer of 1862. Among the changes may here especially be mentioned a change in 
 classification and the omission of the designation unclassified— (morbi varii)— the diseases 
 not embraced in the list being directed to be reported as "other diseases," under the 
 
COMPARATIVE FREQUENCY OF THE SEVERAL DISEASES. 99 
 
 heads of the several orders to which they belong. In compiling the statistical tables 
 for the first year of the war, the material contained in the reports has been rearranged 
 to make its classfication correspond with that adopted for the second and subsequent 
 years. 
 
 The classification adopted is, with some slight alterations, that proposed by Dr. 
 Farr, and employed in the reports of the Registrar General of England, and in the an- 
 nual reports of the British army. The chief points of difference are, that "parasitic 
 diseases" have been made a separate class, instead of being included with "zymotic 
 diseases;" that "diseases of the eye" and "of the ear" are made separate orders of 
 "local diseases," instead of being included with "diseases of the nervous system;" 
 that "developmental diseases" are omitted as having no special applicability to army 
 statistics, and that the class of "wounds, accidents, and injuries" is subdivided in a less 
 elaborate manner than in Farr's classification. To these may be added the minor 
 point that Farr includes rheumatism and tonsillitis among miasmatic diseases, instead 
 of which, in our classification, rheumatism is placed among "constitutional diseases," 
 and tonsillitis with diseases of the digestive organs. 
 
 The classification has been adopted as a matter of convenience in grouping the 
 facts, rather than as an expression of any well-considered natural relationship between 
 diseases. Thus, at the very threshold, the question may be raised whether the funda- 
 mental notion which furnished the name "zymotic," is not a mere conjecture; but if, 
 without thereby meaning to insist upon the idea of a ferment, we retain the term to 
 indicate certain grave constitutional disorders determined by dietic errors, by inocula- 
 tion or contagion, by epidemic or endemic influences, or by those groupings of conditions 
 found in camps which act like epidemic influences on many at once, it may be asked 
 whether many of the affections now placed under local diseases ought not to be trans- 
 ferred to this class ? 
 
 Thus, for example, in the tables of Farr, simple coryza and catarrh, as well as 
 epidemic catarrh, are placed in the first order of zymotic diseases; while acute bron- 
 chitis and pneumonia are placed among local diseases. It would appear, however, that 
 all these affections belong in fact to one category, are developed by a like series of con- 
 ditions, acting with different intensities or in constitutions of different resisting powers; 
 that catarrh stands at one end of the scale, pneumonia at the other; and that, regarded 
 as the expression of more or less exposure to unfavorable climatic influences, the proper 
 place for all these affections is with miasmatic diseases. 
 
 Without entering into a further discussion as to the scientific accuracy of the 
 English classification, it may be remarked that one of the arguments most frequently 
 used in its favor is derived from a very different source. It is claimed that the various 
 affections embraced under the class of zymotic diseases are to be regarded as essentially 
 preventable, while diathetic, local, developmental, and violent diseases are more or less 
 inevitable. The classification therefore has this special advantage for military and 
 political purposes, that the amount of disease which, by proper sanitary precautions, 
 might have been avoided, is kept constantly in view; a consideration which must un- 
 doubtedly act as a constant stimulant to sanitary effort. Unfortunately, however, our 
 notions of the causation of disease are not sufiiciently accurate to enable us to draw any 
 sharp boundary between preventable and unavoidable affections; and, indeed, if such q, 
 
100 COMPARATIVE FREQUENCY OF THE SEVERAL DISEASES. 
 
 boundary were attempted, it would certainly not correspond with the classification 
 under consideration; a large proportion of the "local" inflammatory affections being 
 conditioned in frequency and severity at least, if not determined, by want of proper 
 clothing and shelter, unnecessary exposure to cold and moisture, and other causes 
 quite as well understood, and certainly more readily modified by hygienic means, than 
 the causes of diphtheria, of enteric fever, or of epidemic cholera. But notwithstanding 
 these critical objections, the English classification appears to be the most convenient 
 and rational hitherto proposed, and, with the slight modifications above mentioned, it 
 has been thought best to employ it. 
 
 T he following tables give the number of cases and deaths in each of the three 
 great regions for the several classes, orders, and individual diseases during the first and 
 second years of the war. Under the head of "taken sick," in these tables, all cases oc- 
 curring in the field and in garrison are included, but not the "admissions" into general 
 hospitals; because this would have involved a repetition of cases previously reported 
 in the field or in garrison. Under the head of deaths, however, the deaths in general 
 hospitals are included. 
 
 In calculating the ratio of cases to strength in the following tables, then, the 
 strength employed includes only the troops represented in the reports, and this be- 
 cause it was among them only that the cases occurred. In computing the ratio of 
 deaths to strength, however, as already explained under the head of mortality rates, 
 the strength in hospital is included. 
 
 The average annual strengths represented in the reports from which the following 
 tables were compiled, are as follows: 
 
 For the first year — Atlantic region, 177,899 in field and garrison, 4687 in general 
 hospitals; Central region, 96,583 in field and garrison, 5072 in general hospitals; 
 Pacific region, 6695 in field and garrison, — no general hospitals. For the second year 
 — Atlantic region, 283,703 in field and garrison, 27,802 in general hospitals; Central 
 region, 306,405 in field and garrison, 17,885 in general hospitals; Pacific region, 8713 
 in field and garrison, — no general hospitals. 
 
 These strengths are those employed in computing all the ratios given in this paper. 
 The six tables now presented are arranged as follows: Table VI. shows the num- 
 bers taken sick and died for each class of disease in each of the three regions, and for 
 the whole army, during the first year of the war. The ratio of cases and deaths to 
 strength, in each region and for the whole army, is also given. 
 Table VII. contains similar figures for the second year. 
 
 Tables VIII. and IX. are arranged in the same manner, and give the number taken 
 sick and died, and the ratio to strength for each order. 
 
 Tables X. and XI. contain the number taken sick and died from each individual 
 disease and injury for the two years. 
 
 The years spoken of here, and throughout the paper, are congressional fiscal years, 
 beginning on the 1st of July and terminating on the 30th of June following. 
 
COMPARATIVE FREQUENCY OF THE SEVERAL DISEASES. 
 
 101 
 
 TABLE VI 
 
 Summary of Cases and Deaths, by the several Classes of Diseases and Injuries, for the year ending 
 
 June SOth, 1862. 
 
 CLASSES. 
 
 Atlantic Keoiok. 
 
 Centkai, Begiok. 
 
 Pacific Region. 
 
 Total. 
 
 
 1 
 
 a 
 
 1^ 
 
 7! ss 
 
 S o • 
 
 en 
 
 ss 
 
 111 
 
 S 
 
 1 
 
 i 
 
 A 
 
 1^ 
 
 "IS 
 
 Sis' 
 
 o £ 
 
 lit 
 
 1 
 
 IB 
 
 1 
 
 i 
 
 ""I DO jg 
 
 ill 
 
 1" 
 
 iji 
 
 i 
 
 s 
 
 iA 
 
 t 
 
 
 as 
 1=1 
 
 I. Zymotic diseaaeB 
 
 249,120 
 
 35,777 
 
 640 
 
 198,951 
 
 27,862 
 
 4,526 
 
 4,032 
 285 
 
 1,375 
 
 2,410 
 
 262 
 
 1400-34 
 
 20111 
 
 3-60 
 
 1118'34 
 
 156-62 
 
 25-44 
 
 22-08 
 1-56 
 
 7-53 
 13-20 
 1-43 
 
 207,799 
 16,090 
 408 
 106,054 
 15,149 
 2,149 
 
 5,269 
 367 
 
 
 
 2,341 
 
 2,386 
 175 
 
 2151-51 
 
 166-24 
 
 4-22 
 
 1087-71 
 
 156-85 
 
 22-25 
 
 61-73 
 3-61 
 
 23-03 
 23-47 
 1-72 
 
 6,661 
 1,607 
 10 
 5,917 
 1,875 
 423 
 
 32 
 14 
 
 26 
 61 
 
 5 
 
 979-99 
 240-03 
 1-49 
 883-79 
 280-06 
 63-18 
 
 4-78 
 2-09 
 
 3-88 
 9-11 
 0-76 
 
 463,480 
 
 52,474 
 
 1,068 
 
 309,922 
 
 44,886 
 
 7,098 
 
 9,333 
 666 
 
 3,742 
 
 4,857 
 
 442 
 
 1648-36 
 186-62 
 3-76 
 1102-23 
 169-64 
 26-24 
 
 32-08 
 2-29 
 
 12-86 
 16-69 
 1-52 
 
 11. Constitutional diseases 
 
 in. Parasitic diseases 
 
 IV. Local diseases 
 
 V. Wounds and injuries... 
 VI. Unclassified diseases... 
 
 Total 
 
 616,876 
 
 8,364 
 
 2905-45 
 
 45-81 
 
 345,649 
 
 10,538 
 
 3678-78 
 
 103-66 
 
 16,393 
 
 138 
 
 2448-54 
 
 20-61 
 
 878,918 
 
 19,040 
 
 3125-85 
 
 65-44 
 
 
 TABLE VIL 
 
 Summary of Gases and Deaths, by the several Classes of Diseases and Injuries, for the year ending 
 
 June 30th, 1863. 
 
 CLASSES. 
 
 I. Zymotic 
 IT. Constitutional diseases 
 
 m. Parasitic diseases 
 
 IV. Local diseases 
 
 V. Wounds and iiyuries. 
 
 Total 
 
 Atlantic Region. 
 
 428,603 
 62,660 
 3,103 
 
 232,836 
 64,431 
 
 781,633 
 
 9,529 
 
 812 
 
 1 
 
 2,655 
 
 6,344 
 
 18,241 
 
 SS 
 
 o 
 
 ftg = 
 
 ° s 
 
 1510-76 
 220-90 
 10-94 
 820-70 
 191-86 
 
 2765-11 
 
 
 
 30-59 
 2-61 
 0-003 
 8-20 
 
 17-16 
 
 58-66 
 
 CzNTCAL Region. 
 
 686,329 
 
 49,136 
 
 4,218 
 
 227,947 
 41,903 
 
 909,632 
 
 20,158 
 1,736 
 
 7,146 
 
 4,767 
 
 33,797 
 
 "if 
 
 1913-68 
 160-36 
 13-77 
 743-94 
 136-76 
 
 in " ^ 
 
 a a bo 
 
 e- » a 
 
 o^ ® 
 
 ej o a> 
 
 6216 
 5-35 
 
 2204 
 14-87 
 
 Pacific Region. 
 
 10,317 
 1,943 
 33 
 6,204 
 2,141 
 
 20,638 
 
 114 
 
 S.I? 
 
 1184-09 
 223-00 
 3-78 
 712-04 
 245-72 
 
 2368-64 
 
 SS 
 
 0*0 g 
 
 3 O BD 
 
 2-64 
 0-92 
 
 4-82 
 4-71 
 
 1308 
 
 1,026,249 
 
 113,738 
 
 7,364 
 
 466,987 
 
 98,476 
 
 1,711,803 
 
 29,710 
 
 2,656 
 
 1 
 
 9,743 
 
 10,142 
 
 52,152 
 
 g-S 
 
 5 O CD 
 
 1712-11 
 189-94 
 12-28 
 779-84 
 164-48 
 
 £ d fab 
 
 a « a 
 
 46-10 
 3-97 
 0-002 
 15-12 
 15-/4 
 
 2858-62 80-92 
 
 I 
 
102 
 
 COMPARATIVE FREQUENCY OP THE SEVERAL DISEASES. 
 
 TABLE VIII. 
 
 Summary of Oases and Deaths, by the several Orders of Diseases and Injuries, for the year ending 
 
 June SOth, 1862. 
 
 ORDERS. 
 
 Atlantic Region. 
 
 Centeai. Reoion. 
 
 Pacific Region. 
 
 TOTAl. 
 
 1 
 
 1 
 
 1° 
 
 if. 
 
 03 ea ho 
 P, a; p 
 
 i 
 
 1 
 
 ■a 
 
 a) 
 A 
 
 8S 
 
 il O m 
 
 1:- 
 
 i 
 
 d 
 
 
 1:- 
 
 2. £ 
 
 g-2 
 OS 
 
 i 
 1 
 
 1 
 
 Katio per 1000 
 of cases to 
 strength. 
 
 1° 
 
 all 
 
 ■sZS 
 
 I. 1. Miasmatic Diseaaea. 
 
 2. Unthetic Diseases... 
 
 3. Dietic Diseases 
 
 II. 1. Diathetic Diseases... 
 
 2. Tubercular Diseases 
 
 III. Parasitic Diseases 
 
 IV. 1. Diseases of Nervous 
 
 231,671 
 18.604 
 1,945 
 33,689 
 2,088 
 640 
 
 17,970 
 6,563 
 3,263 
 
 2,231 
 
 89,875 
 
 61,216 
 
 2,839 
 359 
 
 15,636 
 
 27,862 
 4,626 
 
 3,989 
 
 5 
 
 38 
 
 38 
 
 247 
 
 232 
 
 68 
 866 
 183 
 
 22 
 
 4 
 
 2,410 
 262 
 
 1302-26 
 
 8715 
 
 10-93 
 
 189-37 
 
 11-74 
 
 3-60 
 
 101-01 
 31-27 
 18-34 
 
 12-54 
 
 605-20 
 
 344-10 
 
 15-96 
 2-02 
 
 87-89 
 
 166-62 
 26-44 
 
 21-85 
 
 -02 
 
 -21 
 
 •21 
 
 1-36 
 
 1-27 
 
 -37 
 4-74 
 1-00 
 
 -12 
 
 -02 
 
 13-20 
 1-43 
 
 201,291 
 
 6,786 
 
 722 
 
 14,094 
 
 996 
 
 408 
 
 8,844 
 4,467 
 1,721 
 
 821 
 
 48,440 
 
 33,496 
 
 1,220 
 188 
 
 6,867 
 
 15,149 
 2,149 
 
 5,216 
 
 8 
 
 45 
 
 62 
 
 305 
 
 233 
 1 
 
 4 
 
 61 
 
 1,797 
 
 225 
 
 8 
 1 
 
 11 
 
 2,386 
 175 
 
 2084-13 
 
 59-91 
 
 7-47 
 
 145-93 
 
 10-31 
 
 4-22 
 
 91-67 
 46-15 
 17-81 
 
 8-50 
 
 501-54 
 
 346-81 
 
 12-63 
 1-95 
 
 60-76 
 
 156-85 
 22-25 
 
 61-31 
 
 •08 
 
 -44 
 
 -61 
 
 3-00 
 
 2-29 
 -01 
 -04 
 
 -60 
 
 17-67 
 
 2-21 
 
 -08 
 •01 
 
 •11 
 
 23-47 
 1-72 
 
 3,755 
 
 2,611 
 
 296 
 
 1,656 
 
 61 
 
 10 
 
 461 
 
 366 
 
 95 
 
 36 
 
 2,058 
 
 2,202 
 
 86 
 7 
 
 618 
 
 1,876 
 423 
 
 30 
 
 "2 
 6 
 8 
 
 9 
 
 4 
 8 
 6 
 
 61 
 5 
 
 560-87 
 375-06 
 44-06 
 23341 
 7-62 
 1-49 
 
 68-86 
 53-17 
 14-19 
 
 6-23 
 
 307-39 
 
 328-90 
 
 12-70 
 1-06 
 
 92-31 
 
 28006 
 63-18 
 
 4-48 
 
 "'-30 
 
 -89 
 
 1-19 
 
 1-34 
 
 •60 
 
 1-19 
 
 •75 
 
 9-11 
 •75 
 
 436.717 
 
 23,801 
 
 2,962 
 
 49,339 
 
 3,136 
 
 1,068 
 
 27,275 
 
 10,376 
 
 5,079 
 
 3,087 
 
 140,373 
 
 96,913 
 
 4,144 
 554 
 
 22,121 
 
 44,886 
 7,098 
 
 9,235 
 
 85 
 108 
 660 
 
 474 
 1 
 4 
 
 133 
 
 2,671 
 
 413 
 
 30 
 1 
 
 15 
 
 4,867 
 442 
 
 1653-17 
 84-65 
 10-53 
 175-47 
 11-15 
 3-76 
 
 97-00 
 36-90 
 18-06 
 
 10-98 
 
 499-23 
 
 344-67 
 
 14-74 
 1-97 
 
 78-67 
 
 169-64 
 25-24 
 
 31-74 
 
 -04 
 
 -30 
 
 -36 
 
 1-92 
 
 1-63 
 •0O3 
 •01 
 
 •46 
 
 918 
 
 1-42 
 
 •10 
 •003 
 
 •06 
 
 1669 
 1-52 
 
 2. Diseases of the Eye.. 
 
 3. Diseases of the Ear.. 
 
 4. Diseases of Organs 
 
 of Circulation 
 
 5. Diseases of Respira- 
 
 6. Diseases of Digestive 
 
 7. Diseaaes of the Uri- 
 nary and Crenital 
 
 8. Diseases of the 
 
 Bones and Joints... 
 
 9. Diseases of the In- 
 
 tegumentary Sys- 
 
 V. Wounds, Accidents and 
 
 TI. UnclasBiBed Diseaaes... 
 Total 
 
 616,876 
 
 8,364 
 
 2905-45 
 
 46-81 
 
 345,649 
 
 
 3578-78 
 
 103-66 
 
 16,393 
 
 138 
 
 2448-54 
 
 20^61 
 
 878,918 
 
 19,040 
 
 3125-86 
 
 65^4^ 
 
 
 
 TABLE IX. 
 
 Summary of Cases and Dealhst by the several Orders of Diseases and Injuries, for the year ending 
 
 June Both, 1863. 
 
 
 Atlantic Region. 
 
 Central Region. 
 
 Pacipic Region. 
 
 TOTAI.. 
 
 
 
 §S 
 
 
 
 
 
 
 
 
 
 ss 
 
 
 OO 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 tls 
 
 ORDERS. 
 
 ^ 
 
 
 ■^fs 
 
 S^f 
 
 ji 
 
 
 :.^ 
 
 ^Sm 
 
 •s 
 
 
 nSA 
 
 r^fl 
 
 4 
 
 
 "^15 
 
 
 ■3 
 
 1 
 
 1 
 
 
 
 •s 
 
 a 
 
 1 
 
 s 
 
 
 
 1 
 
 •d 
 
 n 
 
 
 
 ■a 
 
 d 
 
 S 
 
 •2^1 
 
 g.Jg' 
 
 sZ" 
 
 1°" 
 
 I. 1. Miasmatic Diseases. 
 
 406,433 
 
 9,396 
 
 14.32^60 
 
 30-16 
 
 560,637 
 
 19,968 
 
 1829-72 
 
 61-57 
 
 6,688 
 
 17 
 
 767^69 
 
 1-96 
 
 973,768 
 
 29,380 
 
 162&13 
 
 45-58 
 
 2. Enthetic Diseases... 
 
 17,868 
 
 13 
 
 62-98 
 
 -04 
 
 20,347 
 
 29 
 
 66-41 
 
 •09 
 
 2,798- 
 
 4 
 
 320^56 
 
 •46 
 
 41,008 
 
 46 
 
 68^48 
 
 •07 
 
 3. Dietic Diseases 
 
 4,302 
 
 121 
 
 15-16 
 
 -39 
 
 5,345 
 
 161 
 
 17-44 
 
 •60 
 
 836 
 
 2 
 
 96^96 
 
 •23 
 
 10,483 
 106,890 
 
 284 
 
 17^51 
 
 •44 
 
 II. 1. Diathetic Diseases... 
 
 69,046 
 
 167 
 
 208-13 
 
 -64 
 
 44,983 
 
 301 
 
 146-81 
 
 •93 
 
 1,861 
 
 
 213^59 
 
 
 468 
 
 17&S3 
 
 -73 
 
 2. Tubercular Diseases 
 
 3,614 
 
 646 
 
 12-74 
 
 2-07 
 
 4,152 
 
 1,436 
 
 13-66 
 
 4-43 
 
 82 
 
 8 
 
 9^41 
 
 •92 
 
 7,848 
 
 2,088 
 
 13^11 
 
 3-24 
 
 in. Parasitic Diseases 
 
 3,103 
 
 1 
 
 10-94 
 
 -003 
 
 4,218 
 
 
 13-77 
 
 
 33 
 
 
 3-79 
 
 
 7,354 
 
 12^28 
 
 -002 
 
 IV. 1. Diseases of the Ner- 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 26,147 
 16,294 
 
 917 
 
 85-33 
 53-18 
 
 2^83 
 
 605 
 527 
 
 7 
 
 69-44 
 60-50 
 
 •80 
 
 
 1,491 
 
 
 
 2. Diseases of the Bye. 
 
 7,480 
 
 
 26-37 
 
 
 24 301 
 
 40-58 
 
 
 3. Diseases of the Ear. 
 
 4. Diseases of Organs 
 
 4,611 
 
 2 
 
 16-25 
 
 •006 
 
 6,727 
 
 1 
 
 18-69 
 
 •003 
 
 168 
 
 
 19-28 
 
 
 lu,506 
 
 3 
 
 17-64 
 
 ■006 
 
 of Circulation 
 
 6. Diseases of Respirsr 
 
 6,018 
 
 266 
 
 2V21 
 
 •86 
 
 4,418 
 
 320 
 
 14-42 
 
 •99 
 
 70 
 
 6 
 
 8-03 
 
 •57 
 
 10,606 
 
 691 
 
 17-54 
 
 •92 
 
 
 61,636 
 
 1,188 
 
 217^26 
 
 3^81 
 
 68,761 
 
 4,818 
 
 191-78 
 
 1485 
 
 881 
 
 13 
 
 101-11 
 
 1^49 
 
 121,278 
 
 6,019 
 
 202-53 
 
 9^34 
 
 
 Organs 
 
 7. Diseases of the Uri- 
 
 96,769 
 
 446 
 
 34V09 
 
 1^43 
 
 91,675 
 
 914 
 
 299-20 
 
 2-82 
 
 2,906 
 
 16 
 
 333-62 
 
 1^72 
 
 191,350 
 
 1,374 
 
 319-64 
 
 2-13 
 
 nary and Genital 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 6,862 
 
 63 
 
 20-66 
 
 •20 
 
 6,406 
 
 93 
 
 17-64 
 
 •29 
 
 163 
 
 2 
 
 18-71 
 
 •23 
 
 11,431 
 
 168 
 
 19-09 
 
 •25 
 
 S.Diseases of the 
 
 Bones and Joints... 
 9. Diseases of Integu- 
 
 1,711 
 
 4 
 
 6-03 
 
 •01 
 
 1,351 
 
 26 
 
 4-41 
 
 •08 
 
 27 
 
 
 3-10 
 
 
 3,089 
 
 29 
 
 6-16 
 
 •05 
 
 mentary System.... 
 V. "Wounds, Accidents and 
 
 23,665 
 
 20 
 
 83-41 
 
 •06 
 
 18,168 
 
 68 
 
 59-29 
 
 •18 
 
 857 
 
 
 98-36 
 
 
 42,690 
 
 78 
 
 71-29 
 
 •12 
 
 
 64,431 
 
 6,344 
 
 191-86 
 
 17-16 
 
 41,903 
 
 4,767 
 
 136-76 
 
 14-67 
 
 2,141 
 
 41 
 
 245-72 
 
 4^71 
 
 98,476 
 
 10,142 
 
 164-45 
 
 15-74 
 
 Total 
 
 781,633 
 
 18,241 
 
 2755-11 
 
 68-56 
 
 909,632 
 
 83,797 
 
 2968-40 
 
 104-22 
 
 20,638 
 
 114 
 
 2368-64 
 
 13^08 
 
 1,711,803 
 
 52,152 
 
 2868-62 
 
 80-92 
 
 
COMPARATIVE FREQUENCY OF THE SEVERAL DISEASES. 
 
 103 
 
 TABLE X. 
 
 Showing the Number of Cases and Deaths, by Individual Diseases and Injuries, for the year ending 
 
 June 30ih, 1862. 
 
 LIST OF DISEASES. 
 
 Class I.— Zymotic Diseases, 
 
 Order I. Miasmatic Diseases. 
 
 Typhus Fever 
 
 Yellow Fever 
 
 Typhoid Fever 
 
 Common Continued Fever 
 
 Remittent Fever 
 
 Quotidian Intermittent Fever 
 
 Tertian Intermittent Fever 
 
 Quartan Intermittent Fever 
 
 Congestive Intermittent Fever 
 
 Acute Diarrhoea 
 
 Chronic Diarrhoea 
 
 Acute Dysentery 
 
 Chronic Dysentery 
 
 Asiatic Cholera 
 
 Erysipelas 
 
 Small-pos and Varioloid 
 
 Measles 
 
 Scarlet Fever 
 
 Mumps 
 
 Epidemic Catarrh 
 
 Debility 
 
 Other diseases of this order 
 
 Order II. Enthetic Diseases, 
 
 Syphilis 
 
 Gonorrhoea 
 
 Orchitis 
 
 Stricture of the Urethra 
 
 Serpent-bite 
 
 Other diseases of this order 
 
 Order III. Dietic Diseases, 
 
 Scurvy 
 
 Delirium Tremens 
 
 Inebriation 
 
 Class II,— Constitutional Diseases, 
 
 Order I. Diathetic Diseases. 
 
 Gout 
 
 Acute Rheumatism 
 
 Chronic Rheumatism 
 
 Lumbago 
 
 Anaemia 
 
 General Dropsy 
 
 Cancer 
 
 Tumors 
 
 Other diseases of this order 
 
 Order IF. Tubercular Diseases. 
 
 Consumption 
 
 Scrofula 
 
 Class III.— Parasitic Diseases, 
 Worms 
 
 Carried forward 
 
 Atlantic Region. 
 
 Taken Bick. Died. 
 
 463 
 
 12,616 
 
 7,645 
 
 21,792 
 
 18,145 
 
 13,666 
 
 1,546 
 
 1,500 
 
 90,472 
 
 4,881 
 
 18,392 
 
 1,180 
 
 ' 1,309 
 
 678 
 
 10,055 
 
 93 
 
 4,636 
 
 6,649 
 
 11,670 
 
 4,383 
 
 6,139 
 
 7,416 
 
 1,631 
 
 309 
 
 9 
 
 933 
 426 
 586 
 
 45 
 
 17,686 
 
 10,204 
 
 2,848 
 
 636 
 
 259 
 
 14 
 
 360 
 
 1,637 
 
 1,678 
 410 
 
 640 
 
 285,537 
 
 101 
 
 2,736 
 
 40 
 
 182 
 
 1 
 
 5 
 
 3 
 
 201 
 
 40 
 
 62 
 
 116 
 
 30 
 
 210 
 
 173 
 
 7 
 
 2 
 
 2 
 
 39 
 
 10 
 
 6 
 21 
 11 
 
 243 
 4 
 
 4,317 
 
 Taken sick. Died, 
 
 Central Region. 
 
 859 
 
 9,312 
 
 4,008 
 17,934 
 21,622 
 12,776 
 
 1,855 
 
 727 
 
 72,715 
 
 10,876 
 
 13,472 
 
 1,407 
 
 ' 1,292 
 
 464 
 
 11,558 
 
 40 
 
 6,660 
 
 4,649 
 
 6,529 
 
 3,036 
 
 1,628 
 
 3,185 
 
 906 
 
 56 
 
 11 
 
 321 
 178 
 223 
 
 51 
 
 7,435 
 
 3,701 
 
 1,367 
 
 590 
 
 491 
 
 18 
 
 75 
 
 366 
 
 795 
 201 
 
 408 
 
 223,297 
 
 89 
 
 2,864 
 
 105 
 
 187 
 
 31 
 
 28 
 
 1 
 
 160 
 
 187 
 
 440 
 
 230 
 
 94 
 
 81 
 190 
 377 
 
 116 
 23 
 
 35 
 
 7 
 
 19 
 10 
 
 ■■4 
 
 22 
 4 
 
 299 
 6 
 
 6,636 
 
 Pacific Region. 
 
 Taken 
 
 49 
 118 
 321 
 608 
 308 
 
 50 
 
 7 
 
 1,364 
 
 58 
 373 
 
 24 
 
 51 
 
 168 
 
 63 
 
 26 
 
 16 
 
 125 
 
 30 
 
 1,244 
 
 1,037 
 
 185 
 
 43 
 
 74 
 
 62 
 
 169 
 
 1,136 
 
 311 
 
 74 
 
 3 
 
 8 
 
 1 
 
 12 
 
 11 
 
 85 
 16 
 
 10 
 
 8,178 
 
 Died. 
 
 46 
 
 Taken sick. Died. 
 
 Total. 
 
 824 
 
 21,977 
 
 11,771 
 
 40,047 
 
 40,375 
 
 26,750 
 
 3,451 
 
 2,234 
 
 164,551 
 
 15,815 
 
 82,237 
 
 2,611 
 
 2,652 
 
 1,310 
 
 21,676 
 
 133 
 
 11,216 
 
 11,314 
 
 18,324 
 
 7,449 
 
 9,011 
 
 11,638 
 
 2,722 
 
 408 
 
 20 
 
 2 
 
 1,328 
 666 
 
 978 
 
 96 
 
 26.257 
 
 14,216 
 
 4,289 
 
 1,229 
 
 758 
 
 33 
 
 447 
 
 2,014 
 
 2,608 
 627 
 
 1,058 
 
 617,012 
 
 191 
 
 6,608 
 
 146 
 
 370 
 
 82 
 
 83 
 
 4 
 
 861 
 
 227 
 
 493 
 
 347 
 
 127 
 
 121 
 
 412 
 
 551 
 
 10 
 
 9 
 
 6 
 
 155 
 
 12 
 
 58 
 18 
 
 29 
 19 
 
 2 
 13 
 34 
 
 6 
 
 550 
 10 
 
 9,999 
 
104 
 
 COMPARATIVE FREQUENCY OF THE SEVERAL DISEASES. 
 TABLE X. — Continued. 
 
 LIST OF DISEASES. 
 
 Brought forward.. 
 
 Class IV. — Local Diseases. 
 
 Order I. Diseases of Nervous System. 
 
 Apoplexy 
 
 Headache 
 
 Inflammation of Brain 
 
 St. Vitus Dance 
 
 Epilepsy 
 
 Sun-stroke 
 
 Spinal Irritation 
 
 Insanity 
 
 Melancholy 
 
 Inflammation of Membranes of Brain.... 
 
 Nostalgia 
 
 Neuralgia 
 
 Toothache 
 
 Paralysis 
 
 Other diseases of this order 
 
 Order II. Diseases of Eye. 
 
 Amaurosis 
 
 Cataract 
 
 Inflammation of Iris 
 
 Night Blindness 
 
 Ophthalmia 
 
 Inflammation of Uetina 
 
 Other diseases of this order 
 
 Order III. Di&eases of Ear. 
 
 Earache 
 
 Inflammation of Internal Ear 
 
 Otorrhoea 
 
 Deafness 
 
 Other diseases of this order 
 
 Order IV. Diseases of Organs of Circulation. 
 
 Aneurism 
 
 Angina Pectoris 
 
 Inflammation of Heart 
 
 Inflammation of Endocardium 
 
 Inflammation of Pericardium 
 
 Inflammation of Veins 
 
 Varicocele 
 
 Varicose Veins 
 
 Other diseases of this order 
 
 Order V. Diseases of RespiraUtry Organs. 
 
 Asthma 
 
 Acute Bronchitis 
 
 Chronic Bronchitis 
 
 Catarrh 
 
 Haemorrhage from Nose 
 
 Haemorrhage from Lungs 
 
 Dropsy of Chest 
 
 Inflammation of Larynx 
 
 Inflammation of Pleura 
 
 Inflammation of Lungs 
 
 Other Diseases of this order 
 
 Order VI. Diseases of Digestive Organs. 
 
 Abdominal Dropsy 
 
 Cholera Morbus 
 
 Colic 
 
 Constipation . 
 
 Atlantic Region. 
 
 Taken sick. Died. 
 
 Carried forward . 
 
 285,537 
 
 124 
 
 5,307 
 
 92 
 
 49 
 
 843 
 
 253 
 
 271 
 
 162 
 
 152 
 
 113 
 
 331 
 
 4,418 
 
 4,997 
 
 200 
 
 658 
 
 109 
 52 
 
 205 
 
 97 
 
 4,269 
 
 66 
 
 765 
 
 1,137 
 913 
 926 
 182 
 105 
 
 21 
 167 
 114 
 
 75 
 167 
 
 36 
 726 
 534 
 391 
 
 881 
 
 18,247 
 
 2,588 
 
 53,721 
 
 293 
 
 745 
 
 15 
 
 1,671 
 
 3,023 
 
 4,582 
 
 4,109 
 
 77 
 2,818 
 7,524 
 17,395 
 
 Dyspepsia 4 265 
 
 436,518 
 
 4,317 
 
 60 
 1 
 
 43 
 1 
 
 19 
 7 
 3 
 4 
 1 
 
 58 
 1 
 
 10 
 24 
 
 2 
 
 3 
 
 11 
 
 10 
 
 20 
 
 1 
 
 21 
 
 4 
 48 
 21 
 
 1 
 
 1 
 13 
 
 3 
 
 22 
 
 40 
 
 601 
 
 112 
 
 12 
 3 
 1 
 1 
 
 5,509 
 
 CENTRA!. EESION. 
 
 Taken Bick. Died 
 
 223,297 
 
 68 
 1,711 
 
 67 
 
 28 
 326 
 163 
 281 
 
 55 
 111 
 
 51 
 
 241 
 
 2,945 
 
 2,449 
 
 117 
 
 241 
 
 18 
 66 
 11 
 !,969 
 63 
 297 
 
 600 
 
 504 
 
 479 
 
 71 
 
 67 
 
 13 
 
 55 
 
 30 
 
 34 
 
 55 
 
 37 
 
 258 
 
 286 
 
 103 
 
 288 
 
 7,857 
 
 1,295 
 
 28,455 
 
 112 
 
 294 
 8 
 
 885 
 1,964 
 6,366 
 
 916 
 
 1,464 
 3,695 
 8,631 
 1,719 
 
 303,158 
 
 5,636 
 
 58 
 
 49 
 1 
 
 18 
 9 
 5 
 4 
 2 
 
 47 
 
 11 
 
 28 
 
 10 
 5 
 
 20 
 2 
 
 1 
 17 
 
 7 
 
 54 
 
 15 
 
 4 
 
 2 
 
 9 
 
 2 
 
 11 
 
 42 
 
 1,529 
 
 122 
 
 7 
 
 21 
 
 8 
 
 4 
 
 7,772 
 
 Pacific Keoion. 
 
 Taken 
 Bick. 
 
 8,178 
 
 4 
 
 116 
 
 4 
 
 1 
 
 30 
 
 4 
 
 7 
 
 10 
 
 3 
 
 6 
 
 183 
 
 71 
 
 13 
 
 9 
 
 5 
 
 1 
 
 11 
 
 1 
 
 326 
 
 9 
 
 34 
 
 43 
 
 5 
 
 10 
 
 1 
 
 11 
 
 5 
 
 1 
 
 97 
 
 19 
 
 1,661 
 
 1 
 13 
 
 41 
 
 92 
 
 113 
 
 20 
 
 4 
 
 26 
 
 155 
 
 1,172 
 
 165 
 
 12,705 
 
 46 
 
 Taken sick. 
 
 67 
 
 517,012 
 
 196 
 
 7,134 
 
 153 
 
 78 
 
 1,199 
 
 420 
 
 559 
 
 227 
 
 266 
 
 170 
 
 572 
 
 7,546 
 
 7,517 
 
 330 
 
 908 
 
 147 
 71 
 
 282 
 
 109 
 8,564 
 
 132 
 1,071 
 
 1,771 
 
 1,460 
 
 1,410 
 
 263 
 
 175 
 
 35 
 233 
 149 
 109 
 225 
 
 73 
 988 
 776 
 499 
 
 1,170 
 26,201 
 
 3,902 
 
 83,837 
 
 406 
 
 1,052 
 23 
 
 2,597 
 
 5,079 
 11,061 
 
 5,045 
 
 150 
 
 4,308 
 
 11,374 
 
 27,198 
 
 6,149 
 
 752,381 
 
 Died. 
 
 9,999 
 
 121 
 
 1 
 
 94 
 
 2 
 
 38 
 
 17 
 
 8 
 
 8 
 
 3 
 
 105 
 
 1 
 
 1 
 
 22 
 53 
 
 6 
 
 6 
 
 21 
 
 15 
 
 42 
 3 
 
 i 
 
 89 
 
 11 
 
 102 
 
 36 
 
 5 
 
 4 
 
 22 
 
 5 
 
 34 
 
 84 
 
 2,134 
 
 234 
 
 16 
 33 
 11 
 
 5 
 1 
 
 13,348 
 
COMPARATIVE FEEQUENCY OF THE SEVERAL DISEASES. 
 
 105 
 
 TABLE X.— Concluded. 
 
 LIST OF DISEASES. 
 
 Taken sick. Died. 
 
 Brought forward 
 
 Order VI. Diseases of Digestive Organs — Continued. 
 
 Inflammation of Bowels 
 
 Inflammation of Stomach 
 
 Fistula 
 
 Haemorrhage from Stomach 
 
 Piles 
 
 Acute Inflammation of Liver 
 
 Chronic Inflammation of Liver 
 
 Hernia 
 
 Jaundice 
 
 Prolapsus Aui 
 
 Inflammation of Peritoneum 
 
 Inflammation of Spleen 
 
 Inflammation of Tonsils '. 
 
 Other diseases of this order 
 
 Obder vh. Diseases of Vrinary and Genital Organs. 
 
 Stone and Gravel 
 
 Inflammation of Bladder 
 
 Diabetes 
 
 Incontinence of Urine...., 
 
 Retention and Diflioulty of Urination 
 
 Inflammation of Kidneys 
 
 Hydrocele and Hsematocele 
 
 Saroocele 
 
 Non-Syphilitic Ulcer of Penis 
 
 Other diseases of this order 
 
 Order VHI. Diseases of Bones and Joints. 
 
 Anchylosis 
 
 Exostosis 
 
 White Swelling 
 
 Necrosis 
 
 Order IX. Diseases of the Integumentary Si/stem. 
 
 Abscess 
 
 Carbuncle 
 
 Whitlow 
 
 Boil 
 
 Skin Diseases 
 
 Ulcers 
 
 Other diseases of this order 
 
 Class v.— ■Wounds, Aooidents, and Injuries 
 
 Burns 
 
 Concussion of Brain 
 
 Compression of Brain 
 
 Contusion 
 
 Fracture 
 
 Frost-bite 
 
 Dislocation 
 
 Sprain 
 
 Incised Wounds 
 
 Contused and Lacerated Wounds 
 
 Punctured Wounds 
 
 Gunshot Wounds 
 
 Poisoning 
 
 Suicide 
 
 Others of this class 
 
 TJnclaasified Diseases 
 
 Total 
 
 Atlantic Region. 
 
 436,518 
 
 455 
 
 1,033 
 
 263 
 
 137 
 
 3,861 
 
 1,018 
 
 538 
 
 2,516 
 
 5,110 
 
 219 
 
 161 
 
 98 
 
 7,782 
 
 5,345 
 
 56 
 258 
 
 89 
 136 
 641 
 506 
 194 
 
 91 
 255 
 613 
 
 67 
 
 68 
 
 77 
 
 147 
 
 3,648 
 976 
 944 
 2,752 
 3,111 
 2,878 
 1,327 
 
 656 
 
 81 
 
 25 
 
 4,730 
 
 761 
 
 102 
 
 374 
 
 2,249 
 
 3,178 
 
 3,162 
 
 1,024 
 
 9,270 
 
 183 
 
 "2,067 
 
 4,526 
 
 516,876 
 
 6,509 
 
 43 
 16 
 
 7 
 3 
 9 
 
 44 
 
 "5 
 21 
 
 1 
 
 8 
 
 10 
 
 17 
 
 24 
 
 1 
 
 48 
 19 
 2,206 
 11 
 25 
 36 
 
 262 
 
 8,364 
 
 Taken sick. Died, 
 
 Central Keqion. 
 
 303,158 
 
 695 
 
 868 
 
 99 
 
 40 
 
 1,823 
 
 1,042 
 
 585 
 
 1,269 
 
 5,795 
 
 121 
 
 260 
 
 180 
 
 3,488 
 
 1,663 
 
 34 
 
 136 
 
 36 
 
 33 
 
 239 
 
 410 
 
 99 
 
 35 
 
 66 
 
 134 
 
 56 
 41 
 33 
 58 
 
 1,474 
 198 
 306 
 651 
 1,961 
 1,092 
 186 
 
 292 
 
 48 
 
 34 
 
 1,675 
 
 426 
 
 69 
 
 224 
 
 717 
 
 704 
 
 1,769 
 
 317 
 
 7,837 
 
 2,149 
 
 345,649 
 
 7,772 
 
 48 
 20 
 
 12 
 
 12 
 
 3 
 
 31 
 
 23 
 2 
 3 
 
 26 
 
 6 
 
 7 
 
 24 
 
 3 
 
 1 
 
 11 
 
 64 
 
 16 
 
 2,167 
 
 8 
 15 
 56 
 
 176 
 
 10,538 
 
 Pacifio Resion. 
 
 Taken 
 
 12,706 
 
 4 
 
 56 
 
 13 
 
 10 
 
 89 
 
 19 
 
 16 
 
 34 
 
 24 
 
 4 
 
 4 
 
 3 
 
 197 
 
 209 
 
 16 
 10 
 1 
 16 
 23 
 
 171 
 
 13 
 
 48 
 
 132 
 
 114 
 
 121 
 
 19 
 
 60 
 
 17 
 
 1 
 
 494 
 
 59 
 
 19 
 
 40 
 
 185 
 
 179 
 
 319 
 
 47 
 
 389 
 
 21 
 
 ""55 
 
 423 
 
 16,393 
 
 Died. 
 
 67 
 
 138 
 
 Taken Bick. Died. 
 
 Total. 
 
 752,881 
 
 1,164 
 
 2,556 
 
 375 
 
 187 
 
 5,773 
 
 2,079 
 
 1,138 
 
 3,809 
 
 10,929 
 
 344 
 
 425 
 
 281 
 
 11,467 
 
 7,217 
 
 93 
 401 
 124 
 170 
 888 
 932 
 303 
 127 
 336 
 770 
 
 126 
 111 
 111 
 207 
 
 5,293 
 1,187 
 1,298 
 3,536 
 6,186 
 4,091 
 1,531 
 
 998 
 
 146 
 
 60 
 
 6,899 
 
 1,246 
 
 190 
 
 638 
 
 8,151 
 
 4,061 
 
 5,250 
 
 1,388 
 
 17,496 
 
 293 
 
 8,070 
 
 7,098 
 
 878,918 
 
 13,348 
 
 92 
 35 
 
 21 
 
 21 
 
 6 
 
 40 
 
 68 
 2 
 9 
 
 47 
 
 5 
 2 
 1 
 1 
 10 
 
 11 
 
 2 
 
 18 
 16 
 24 
 49 
 
 4 
 
 1 
 16 
 112 
 37 
 4,421 
 19 
 45 
 
 442 
 
 19,040 
 
 14 
 
106 
 
 COMPARATIVE FREQUENCY OF THE SEVERAL DISEASES. 
 
 TABLE XI. 
 
 Showing the Number of Cases and Deaths, by Individual Diseases and Injuries, for the year ending 
 
 June 30lh, 1863. 
 
 LIST OF DISEASES. 
 
 Class I. — Zymotic Diseases. 
 
 OnDER I. Jt/iasmatic IHseases. 
 
 Typhoid Fever 
 
 Typhus Fever 
 
 Typho-Malarial Fever 
 
 Yellow Fever 
 
 Remittent Fever 
 
 Quotidian Intermittent Fever 
 
 Tertian Intermittent Fever 
 
 Quartan Intermittent Fever 
 
 Congestive Intermittent Fever 
 
 Acute Diarrhoea 
 
 Chronic Diarrhoea 
 
 Acute Dysentery 
 
 Chronic Dysentery 
 
 Asiatic Cholera 
 
 Erysipelas 
 
 Small-pox and Varioloid 
 
 Measles 
 
 Scarlet Fever 
 
 Diphtheria 
 
 Mumps 
 
 Epidemic Catarrh 
 
 Other diseases of this order 
 
 Order II. Enthebic IHseases. 
 
 Syphilis 
 
 Gonorrhoea 
 
 Orchitis 
 
 Stricture of the Urethra 
 
 Purulent Ophthalmia 
 
 Serpent-bite 
 
 Other diseases of this order 
 
 Order III. Dietic IHseases. 
 
 Scurvy 
 
 Purpura 
 
 Delirium Tremens 
 
 Inehriation 
 
 Chronic Alcoholism 
 
 Other diseases of this order 
 
 Class II.— Constitutional Diseases. 
 
 Order I, Diathetic IHseases. 
 
 Gout 
 
 Acute Rheumatism 
 
 Chronic Rheumatism ....'. 
 
 Anaemia 
 
 General Dropsy 
 
 Cancer 
 
 Tumors 
 
 Dry Gangrene 
 
 Other Diseases of this order , 
 
 Order II. Tubercular IHseases. 
 
 Consumption 
 
 Scrofula 
 
 Other diseases of this order 
 
 Class III. — Parasitic Diseases. 
 
 Itch. 
 
 Tape- worm 
 
 Other intestinal worms 
 
 Other diseases of this order.. 
 
 Atlantic Region. 
 
 Taken sick. Died. 
 
 Carried forward.. 
 
 17,050 
 
 469 
 
 12,093 
 
 356 
 
 35,056 
 
 28,968 
 
 22,295 
 
 2,687 
 
 1,098 
 
 175,152 
 
 28,062 
 
 24,597 
 
 8,753 
 
 1,99b 
 
 802 
 
 5,106 
 
 115 
 
 1,046 
 
 3,005 
 
 28,391 
 
 14,336 
 
 6,118 
 
 9,348 
 
 1,537 
 
 441 
 
 222 
 
 9 
 
 193 
 
 8,090 
 85 
 314 
 487 
 101 
 275 
 
 42 
 
 25,723 
 
 26,571 
 
 4,596 
 
 725 
 
 92 
 
 306 
 
 58 
 
 933 
 
 2,666 
 
 957 
 
 91 
 
 2,435 
 
 85 
 
 550 
 
 494,366 
 
 4,356 
 
 ]28 
 
 489 
 
 100 
 
 339 
 
 29 
 
 20 
 
 5 
 
 243 
 
 210 
 
 1,974 
 
 249 
 
 309 
 
 76 
 
 375 
 
 110 
 
 7 
 
 143 
 
 13 
 
 3 
 
 218 
 
 36 
 14 
 40 
 
 n 
 
 3 
 17 
 
 27 
 25 
 59 
 18 
 4 
 2 
 11 
 21 
 
 630 
 9 
 6 
 
 10,342 
 
 Central Kegion. 
 
 Taken sick. Died. 
 
 14,218 
 
 424 
 
 10,426 
 
 48,219 
 
 67,087 
 
 57,380 
 
 6,693 
 
 2,728 
 
 197,089 
 
 34,900 
 
 39,637 
 
 4,941 
 
 4,512 
 
 1,974 
 
 11,217 
 
 89 
 
 1,317 
 
 10,291 
 
 32,915 
 
 14,580 
 
 6,439 
 
 10,982 
 
 1,580 
 
 279 
 
 878 
 
 17 
 
 172 
 
 3,774 
 217 
 385 
 660 
 120 
 289 
 
 78 
 
 18,887 
 
 18,483 
 
 4,746 
 
 1,564 
 
 53 
 
 279 
 
 7 
 
 2,983 
 
 1,075 
 
 94 
 
 3,790 
 
 49 
 
 336 
 
 43 
 
 639,682 
 
 6,106 
 252 
 640 
 
 828 
 
 115 
 
 96 
 
 73 
 
 776 
 
 659 
 
 5,510 
 
 671 
 
 777 
 
 759 
 
 757 
 
 1,203 
 
 19 
 
 136 
 17 
 21 
 
 553 
 
 20 
 6 
 
 57 
 
 40 
 
 106 
 
 27 
 
 5 
 
 1 
 
 13 
 
 52 
 
 ,402 
 23 
 10 
 
 21,894 
 
 Pacific Region. 
 
 "^Ick" I"^^ 
 
 106 
 
 6 
 
 133 
 
 "iii 
 
 608 
 
 378 
 
 54 
 
 21 
 
 1,686 
 
 121 
 
 470 
 
 58 
 
 68 
 
 46 
 
 22 
 
 2 
 
 81 
 
 133 
 
 1,896 
 
 363 
 
 1,224 
 
 1,802 
 
 199 
 
 87 
 
 4 
 
 3 
 
 24 
 
 531 
 
 2 
 
 73 
 
 224 
 5 
 1 
 
 6 
 
 1,067 
 
 704 
 
 17 
 
 5 
 
 5 
 
 23 
 
 1 
 
 33 
 
 50 
 32 
 
 7 
 
 6 
 
 20 
 
 12,293 
 
 31 
 
 31,374 
 
 899 
 
 22,652 
 
 356 
 
 83,716 
 
 96,668 
 
 80,058 
 
 9,434 
 
 8,847 
 
 373,927 
 
 63.083 
 
 64,704 
 
 8,747 
 
 6,576 
 
 2,822 
 
 16,345 
 
 206 
 
 2,444 
 
 13,429 
 
 63,202 
 
 29,279 
 
 18,781 
 
 21.632 
 
 3,316 
 
 757 
 
 1,104 
 
 29 
 
 389 
 
 7,395 
 304 
 772 
 
 1,221 
 226 
 565 
 
 126 
 
 45,677 
 
 45,758 
 
 9,359 
 
 2,294 
 
 150 
 
 608 
 
 66 
 
 1,852 
 
 5,599 
 
 2,064 
 
 185 
 
 6,232 
 140 
 906 
 
 76 
 
 1,146,341 
 
 10,467 
 381 
 
 1,129 
 100 
 
 1,167 
 
 144 
 
 116 
 
 78 
 
 1,020 
 870 
 
 7,488 
 922 
 
 1,086 
 
 835 
 
 1,132 
 
 1,313 
 
 26 
 
 279 
 
 30 
 
 24 
 
 773 
 
 27 
 6 
 8 
 8 
 
 90 
 31 
 111 
 22 
 10 
 20 
 
 84 
 
 65 
 
 165 
 
 45 
 
 24 
 73 
 
 2,040 
 32 
 16 
 
 82,267 
 
COMPARATIVE FREQUENCY OF THE SEVERAL DISEASES. 
 
 107 
 
 TABLE XL— Continued. 
 
 LIST OF DISEASES. 
 
 Brought forward 
 
 Glass IT.— Local Diseases, 
 
 Order I. Diseases of Nervous System. 
 
 Apoplexy 
 
 Epilepsy 
 
 Headache 
 
 Insanity 
 
 Inflammation of Brain 
 
 Inflammation of Membranes of Brain .... 
 
 Inflammation of Spinal Cord 
 
 Nostalgia 
 
 Neuralgia 
 
 Paralysis 
 
 Sun-stroke 
 
 Other diseases of this order 
 
 Ordek II. Diseases of Eye. 
 
 Amaurosis 
 
 Cataract 
 
 Inflammation of Conjunctiva 
 
 Inflammation of Iris 
 
 Night Blindness 
 
 Other diseases of this order 
 
 Order III. Diseases of Ear. 
 
 Earache 
 
 Inflammation of Internal Ear 
 
 Deafness 
 
 Otorrhoea 
 
 Other diseases of this order 
 
 Order IV. Diseases of Organs of Circulation. 
 
 Aneurism 
 
 Valvular Disease of Heart 
 
 Dropsy from Heart Disease 
 
 Dropsy of Pericardium 
 
 Inflammation of Pericardium 
 
 Inflammation of Endocardium 
 
 Inflammation of Veins 
 
 Varicose Veins 
 
 Varicocele 
 
 Other diseases of this order 
 
 Order V. Diseases of Sespiratory Organs. 
 
 Asthma 
 
 Bronchitis Acuta 
 
 Bronchitis Chronica 
 
 Dropsy of Chest 
 
 Haemorrhage from Nose 
 
 Inflammation of Larynx 
 
 Inflammation of Lungs 
 
 Inflammation of Pleura 
 
 Haemorrhage from Lungs 
 
 Other diseases of this order 
 
 Order Vf. Diseases of Digestive Organs. 
 
 Colic 
 
 Constipation 
 
 Cholera Morbus 
 
 Cirrhosis of Liver 
 
 Dropsy from Hepatic Disease 
 
 Dyspepsia 
 
 Diseases of Pancreas 
 
 Diseases of Spleen 
 
 Fistula in Ano 
 
 Hernia 
 
 Haemorrhage from Stomach 
 
 Carried forward 
 
 Atlantic Region, 
 
 Taken sick. Died. 
 
 494,366 
 
 170 
 
 1,386 
 
 11,059 
 
 407 
 
 175 
 
 130 
 
 319 
 
 806 
 
 8,188 
 
 561 
 
 651 
 
 1,232 
 
 280 
 106 
 5,540 
 295 
 691 
 568 
 
 2,454 
 537 
 439 
 
 1,057 
 124 
 
 50 
 789 
 123 
 
 62 
 279 
 122 
 
 68 
 
 2,070 
 
 1,929 
 
 536 
 
 1,987 
 
 29,727 
 
 4,695 
 
 63 
 
 528 
 
 2,822 
 
 5,894 
 
 4,986 
 
 923 
 
 10,011 
 
 12,195 
 
 20,720 
 
 4,010 
 
 46 
 
 569 
 
 7,466 
 
 22 
 
 167 
 
 410 
 
 5,573 
 
 150 
 
 650,523 
 
 10,342 
 
 107 
 44 
 
 137 
 
 69 
 
 10 
 
 5 
 
 2 
 
 42 
 
 15 
 
 128 
 
 10 
 97 
 16 
 14 
 24 
 15 
 4 
 1 
 
 "85 
 
 48 
 
 31 
 
 6 
 
 1 
 
 81 
 
 933 
 
 37 
 
 24 
 
 69 
 
 5 
 
 1 
 42 
 
 3 
 24 
 
 4 
 
 12,456 
 
 Central Kemok. 
 
 Taken sick. Died. 
 
 639,682 
 
 221 
 
 1,166 
 
 9,384 
 
 410 
 
 271 
 
 165 
 
 718 
 
 1,207 
 
 10,060 
 
 584 
 
 547 
 
 1,419 
 
 226 
 192 
 14,490 
 294 
 451 
 641 
 
 3;020 
 
 1,000 
 
 316 
 
 1,310 
 
 81 
 
 48 
 424 
 109 
 
 57 
 263 
 133 
 
 70 
 
 1,270 
 
 1,566 
 
 478 
 
 1,455 
 
 20,815 
 
 4,771 
 
 128 
 
 478 
 
 3,011 
 
 14,450 
 
 5,252 
 
 1,066 
 
 7,335 
 
 12,094 
 
 18,680 
 
 4,558 
 
 67 
 
 897 
 
 5,574 
 
 18 
 
 741 
 
 457 
 
 4,329 
 
 211 
 
 798,600 
 
 21,894 
 
 146 
 01 
 
 12 
 
 807 
 
 189 
 
 82 
 
 7 
 
 6 
 
 57 
 
 42 
 
 108 
 
 10 
 
 .85 
 
 31 
 
 21 
 
 71 
 
 32 1, 
 
 68 
 
 21 
 139 
 170 
 
 24 
 
 2 
 
 121 
 
 4,014 
 
 130 
 
 89 
 158 
 
 11 
 
 5 
 54 
 
 2 
 50 
 
 6 
 
 10 
 5 
 
 15 
 5 
 
 28,113 
 
 Pacific Region. 
 
 Taken 
 sick. 
 
 Died. 
 
 12,293 
 
 81 
 
 7 
 
 2 
 
 33 
 
 
 202 
 
 
 14 
 
 
 4 
 
 2 
 
 2 
 
 
 5 
 
 
 3 
 
 
 285 
 
 
 19 
 
 2 
 
 1 
 
 
 30 
 
 i 
 
 7 
 
 
 8 
 
 ..• 
 
 448 
 
 
 30 
 
 
 5 
 
 
 34 
 
 
 47 
 
 
 54 
 
 
 20 
 
 
 39 
 
 
 8 
 
 
 1 
 
 1 
 
 4 
 
 
 11 
 
 "2 
 
 4 
 
 
 4 
 
 
 4 
 
 
 9 
 
 
 33 
 
 2 
 
 26 
 
 
 257 
 
 
 52 
 
 
 7 
 
 
 86 
 
 
 122 
 
 io 
 
 121 
 
 2 
 
 27 
 
 
 183 
 
 i 
 
 139 
 
 2 
 
 1,408 
 
 
 60 
 
 
 1 
 
 
 1 
 
 1 
 
 191 
 
 1 
 
 15 
 
 
 4 
 
 
 10 
 
 
 75 
 
 1 
 
 7 
 
 
 16,455 
 
 61 
 
 Total. 
 
 Taken sick. 
 
 Died. 
 
 1,146,341 
 
 398 
 
 2,585 
 
 20,645 
 
 831 
 
 450 
 
 297 
 
 1,037 
 
 2,016 
 
 18,533 
 
 1,164 
 
 1,199 
 
 2,681 
 
 513 
 
 801 
 
 20,478 
 
 619 
 
 1,147 
 
 1,248 
 
 5,521 
 1,591 
 
 775 
 2,406 
 
 213 
 
 . 99 
 
 1,217 
 
 232 
 
 119 
 
 553 
 
 259 
 
 132 
 
 8,344 
 
 8,504 
 
 1,047 
 
 3,468 
 50,799 
 
 9,518 
 191 
 
 1,013 
 
 5,919 
 20,466 
 10,359 
 
 2,016 
 17,529 
 
 24,428 
 
 40,758 
 
 8,623 
 
 114 
 
 1,467 
 
 18,231 
 
 65 
 
 912 
 
 877 
 
 9,977 
 
 1,465,578 
 
 32,267 
 
 265 
 105 
 
 "26 
 
 446 
 
 208 
 
 42 
 
 12 
 
 8 
 
 101 
 
 57 
 
 237 
 
 21 
 
 182 
 
 47 
 
 35 
 
 97 
 
 47 
 
 6 
 
 1 
 
 155 
 
 29 
 187 
 201 
 
 30 
 
 3 
 
 152 
 
 4,957 
 
 169 
 
 68 
 228 
 
 18 
 6 
 
 96 
 5 
 
 75 
 
 11 
 
 "12 
 
 6 
 
 23 
 
 40,630 
 
108 
 
 COMPARATIVE FREQUENCY OF THE SEVERAL DISEASES. 
 TABLE XL— Concluded. 
 
 LIST OP DISEASES. 
 
 Brought forward. 
 
 Order TI. Diseases of Digestive Organs— Continnei. 
 
 Hsemorrhage from Bowels 
 
 Inflammation of Tonsils 
 
 Inflammation of Stomach 
 
 Inflammation of Bowels 
 
 Inflammation of Peritoneum 
 
 Acute Inflammation of Liver 
 
 Chronic Inflammation of Liver 
 
 Jaundice 
 
 Piles ....!!!!!....!!! 
 
 Other diseases of this order 
 
 Order VII. Diseases of Urinary and Genital Organs 
 
 Stone and Gravel 
 
 Diabetes 
 
 Bright's Disease 
 
 Diseases of Prostate 
 
 Diseases of Testis 
 
 Inflammation of Kidneys 
 
 Inflammation of Bladder 
 
 Incontinence of Urine 
 
 Hydrocele 
 
 Other diseases of this order 
 
 Order Till. Diseases of Bones and Joints. 
 
 Anchylosis 
 
 Caries 
 
 Inflammation of Joints 
 
 Inflammation of Bones 
 
 Inflammation of Periosteum 
 
 Necrosis 
 
 Other diseases of this order 
 
 Order IX. Diseases of Integumentary System. 
 Abscess 
 
 Boils !!!!!!!!!!"!" 
 
 Carbuncle 
 
 Ulcers 
 
 Whitlow !......"!!.! 
 
 Skin Diseases 
 
 Class v.— Wounds, Accidents, and Injuries. 
 
 Order I. Wounds, Accidents, and Injuries. 
 
 Burns 
 
 Contusions 
 
 Concussion of Brain __[ 
 
 Drowning » 
 
 Dislocation [ 
 
 Simple Fractures "/ 
 
 Compound Fractures 
 
 Gunshot Wounds 
 
 Incised Wounds [\ 
 
 Lacerated Wounds 
 
 Punctured Wounds 
 
 Poisoning 
 
 Asphyxia. 
 
 Sprains 
 
 Other accidents and injuries 
 
 Okdek II. Somicide 
 
 Okder III. Suicide 
 
 Order IV. ^Execution of Sentence.. 
 
 Total... 
 
 Atlantic Region. 
 
 Taken sick. Died. 
 
 650,523 
 
 336 
 
 9,680 
 
 1,532 
 
 859 
 
 147 
 
 1,467 
 
 1,307 
 
 16,853 
 
 10,252 
 
 3,008 
 
 481 
 
 158 
 298 
 39 
 486 
 1,744 
 602 
 859 
 256 
 
 152 
 166 
 756 
 46 
 252 
 223 
 116 
 
 8,665 
 8,101 
 1,096 
 206 
 1,998 
 3,599 
 
 1,510 
 
 5,911 
 109 
 
 "424 
 
 743 
 
 105 
 
 31,165 
 
 3,5'95 
 
 1,591 
 
 803 
 
 401 
 
 8 
 
 5,972 
 
 2,033 
 
 *1 
 
 781,633 
 
 12,456 
 
 13 
 17 
 43 
 92 
 62 
 22 
 15 
 28 
 2 
 60 
 
 18 
 7 
 
 17 
 
 6 
 15 
 22 
 50 
 
 2 
 
 15 
 
 78 
 
 4,782 
 
 6 
 39 
 54 
 10 
 
 4 
 
 204 
 
 12 
 
 39 
 
 6 
 
 18,241 
 
 Centrai Eebion. 
 
 798,600 
 
 407 
 7,751 
 2,141 
 1,292 
 297 
 2,477 
 2,235 
 14,702 
 9,551 
 8,251 
 
 430 
 266 
 197 
 86 
 397 
 1,877 
 544 
 419 
 258 
 932 
 
 179 
 69 
 473 
 42 
 190 
 249 
 149 
 
 7,624 
 5,307 
 1,046 
 
 1,300 
 2,891 
 
 1,122 
 
 4,087 
 
 167 
 
 "'432 
 
 807 
 
 190 
 
 24,599 
 
 1,759 
 
 2,385 
 
 770 
 
 346 
 
 23 
 
 3,780 
 
 1,584 
 
 *2 
 
 909,532 
 
 28,113 
 
 32 
 22 
 185 
 176 
 97 
 58 
 49 
 93 
 20 
 
 6 
 
 11 
 
 19 
 
 1 
 
 3 
 
 34 
 
 9 
 
 2 
 
 1 
 3 
 1 
 3 
 16 
 1 
 
 52 
 
 29 
 
 19 
 
 38 
 
 69 
 
 1 
 
 28 
 
 54 
 
 3,946 
 
 75 
 
 222 
 
 54 
 
 15 
 
 1 
 
 138 
 13 
 
 48 
 7 
 
 33,797 
 
 Pacific Region. 
 
 Tahen 
 sick. 
 
 16,455 
 
 304 
 89 
 26 
 
 102 
 52 
 48 
 85 
 
 229 
 60 
 
 3 
 
 2 
 
 2 
 
 20 
 
 16 
 
 2 
 
 8 
 
 96 
 
 544 
 80 
 24 
 
 "79 
 180 
 
 47 
 
 728 
 
 12 
 
 "35 
 
 68 
 
 "216 
 182 
 821 
 
 47 
 50 
 
 293 
 148 
 
 20,638 
 
 61 
 
 Total. 
 
 27 
 
 114 
 
 Taken sick. 
 
 1,465,578 
 
 743 
 
 17,735 
 
 3,762 
 
 2,177 
 
 546 
 
 8,996 
 
 3,590 
 
 31,640 
 
 20,032 
 
 6,319 
 
 867 
 
 432 
 
 498 
 
 127 
 
 885 
 
 8,641 
 
 1,162 
 
 1,280 
 
 522 
 
 2,017 
 
 236 
 1,236 
 89 
 448 
 475 
 272 
 
 16,883 
 
 18,488 
 
 2,166 
 
 206 
 
 8,877 
 
 6,620 
 
 2,679 
 
 10,726 
 
 288 
 
 891 
 1,618 
 
 295 
 
 55,974 
 
 6,536 
 
 4,247 
 
 1,620 
 
 857 
 
 31 
 
 9,995 
 
 8,715 
 
 *8 
 
 1,711,803 
 
 40,630 
 
 45 
 
 39 
 
 178 
 
 271 
 
 162 
 
 84 
 
 64 
 
 121 
 
 22 
 
 129 
 
 6 
 
 18 
 
 37 
 
 1 
 
 3 
 
 53 
 
 16 
 
 2 
 
 1 
 
 21 
 
 2 
 4 
 1 
 3 
 16 
 
 69 
 
 3 
 
 5 
 
 84 
 
 61 
 
 123 
 
 3 
 
 48 
 
 132 
 
 8,755 
 
 81 
 262 
 109 
 
 25 
 
 847 
 26 
 88 
 13 
 
 52,152 
 
 * Attempted. 
 
CAMP FEVER. 109 
 
 In order to facilitate the appreciation of the foregoing tables, a few considerations, 
 derived partly from the statistical facts, partly from contributed papers and from 
 pathological observations conducted in this branch of the office, are presented with 
 regard to some of the more important affections. 
 
 CAMP FEVER— (TTPHO-MALARIAL FEVER). 
 
 On account of the great mortality resulting from it, camp fever has been, during 
 the two years under consideration, the most important of the diseases of the army. 
 
 Under the general designation of Camp Fever, all those cases are here included 
 which were reported, during the first year of the war, under the heads of Typhus, 
 Typhoid, Common Continued, and Remittent Fevers, and, during the second year, 
 under the heads of Typhus, Typhoid, Typho-Malarial, and Remittent. 
 
 This grouping is by no means intended to express a doubt as to the propriety of 
 regarding typhus, typhoid or enteric and remittent fevers as distinct affections. The 
 enteric lesion characteristic of typhoid fever enables a ready distinction to be effected 
 between it and a genuine typhus or a true remittent, on the autopsy at least. But as the 
 diseases have occurred in our army during the present war, the phenomena of these 
 two affections have continually complicated each other in the same patient: so that, in 
 fact, the enteric fevers have broken out among men campaigning in a malarial region, 
 with constitutions more or less thoroughly impregnated with the malarial poison ; the 
 remittents among soldiers, peculiarly prone by their exposures and mode of life to en- 
 teric disease; and both have occurred, almost without exception, in men whose health 
 has been more or less modified by camp diet, and who were therefore suffering in some 
 degree from a condition best characterized as the scorbutic taint. 
 
 These three modifying conditions or tendencies, each of which, acting alone, might 
 produce simple enteric fever, periodic fever, or scurvy, when acting simultaneously pro- 
 duce mixed types of disease that vary infinitely in accordance with the predominance 
 of one or another of the three sets of determining conditions. For these variable 
 resulting fevers I proposed the general name of Typho-Malarial Fever, which, in June, 
 1862, was, at my suggestion, adopted in the statistical nomenclature of the monthly 
 reports of sick and wounded. 
 
 Typho-malarial fever is then the most important and frequent of the diseases in- 
 cluded here under the head of Camp Fever, and its several varieties embrace the great 
 majority of the continued fevers of the army. Undoubtedly cases of simple enteric 
 and simple remittent fevers did occur, especially among recruits not yet brought 
 under camp influences, and among the attendants in hospitals or others not exposed 
 to them. It would be difficult to state the real frequency of such uncomplicated 
 cases, and when the extreme diversity of opinion existing among physicians on the 
 subject of fevers is considered, it will be understood that the number of cases reported 
 as Typhoid and Remittent Fevers are, to a great extent, to be regarded simply as 
 those in which the typhoid or the paroxysmal phenomena predominated. 
 
 Using then the term Camp Fever in the broad sense above indicated, the follow- 
 ing statistical facts may be presented : 
 
 The whole number of cases during the first year of the war was 74,619, the deaths 
 
110 
 
 CAMP FEYER. 
 
 6315; during the second year, 138,641 cases and 13,144 deaths,— the total for the 
 two years being 213,260 cases and 19,459 deaths. 
 
 The distribution among the several affections included in the statistical reports is 
 
 shown in Table XII. 
 
 TABLE XII. 
 
 Number of Gases and Deaths, from the several forms of Gamp Fever, during the first two years of the war. 
 
 Typhus 
 
 Typhoid 
 
 Typho-Malarial 
 
 Common Continued 
 
 Remittent 
 
 Total. 
 
 Yeae enbino June SO, 1862. 
 
 Taken sick. 
 
 824 
 21,977 
 
 11,771 
 40,047 
 
 74,619 
 
 Died. 
 
 191 
 5,608 
 
 146 
 370 
 
 6,315 
 
 Yeab endiho June 30, 1863. 
 
 31,374 
 22,652 
 
 83,716 
 
 138,641 
 
 Died. 
 
 381 
 
 10,467 
 
 1,129 
 
 1,1G7 
 
 13,144 
 
 The ratio of cases and deaths to strength is very similar for both years. In a 
 general way, it may be said that each year about one-quarter of the men suffered from 
 some form of the fever, and that the deaths amounted to about two per cent, of the 
 strength. The whole number of deaths from these fevers during the first year was 
 nearly one-half the total mortality from disease; during the second year, owing to the 
 increased mortality from other diseases, and especially from diarrhoea and dysentery, 
 only about one-third the total mortality from disease, though still maintaining nearly 
 the same ratio to strength. 
 
 The ratio of cases and deaths to strength for each year, and for the average of the 
 two years, is shown in the following table : 
 
 TABLE XIIL 
 
 Total Number of Cases and Deaths from Gamp Fever for the first two years of the war, with the annual 
 
 ratio per 1000 of mean strength. 
 
 Year ending June 30, 1862 
 
 Year ending June 30, 1868 
 
 For the two years. 
 
 Taken sick. 
 
 74,619 
 138,641 
 
 213,260 
 
 Died. 
 
 6,315 
 13,144 
 
 19,459 
 
 Annual ratio 
 
 of cases per 
 
 lOiX) of mean 
 
 strength. 
 
 265-45 
 231-52 
 
 242-34 
 
 Annual ratio 
 
 of deaths per 
 
 lOOOofmeau 
 
 strength. 
 
 21-71 
 20-39 
 
 20 80 
 
 A comparison of the reports from the three great regions shows camp fever to 
 have been far more frequent in the Atlantic and Central regions than in the Pacific. 
 In the Atlantic region, during both years, the number of cases was somewhat less than 
 one-fourth the strength; the deaths for each year about seventeen per 1000 of strength. 
 
CAMP FEVEE. 
 
 Hi 
 
 In the Central region, the ratio of both cases and deaths was much greater during the 
 first year than the second. During the first, the cases amounted to nearly one-third 
 the strength; the deaths to about thirty-two per 1000 of strength. During the second 
 year, the cases were somewhat less than one-fourth the strength ; the deaths twenty- 
 four per 1000 of strength. In the Pacific region, the cases for each year amounted 
 only to between seventy and eighty per 1000 of strength; the deaths somewhat over 
 one per 1000 during the first year, somewhat less than one per 1000 during the 
 second. These relations are here presented in detail. 
 
 TABLE Xiy. 
 
 Number of Cases and Deaths from Camp Fever in each of the three regions. 
 
 
 Tear ending June 30, 1862. 
 
 Tear ENDiwa Jone 30, 186.S. 
 
 
 Taken sick. 
 
 Died. 
 
 Ratio per 1000 
 
 of mean 
 
 Btrengtti 
 
 taken sick. 
 
 Ratio per 1000 
 
 of mean 
 
 strength 
 
 died. 
 
 Taken sick. 
 
 Died. 
 
 Ratio per 1000 
 
 of mean 
 
 strength 
 
 taken sick. 
 
 Ratio per 1000 
 
 of mean 
 
 etrengtli 
 
 died. 
 
 Atlantic Region 
 
 42,516 
 
 31,613 
 
 490 
 
 3,059 
 
 3,245 
 
 11 
 
 238-99 
 
 327-31 
 
 73-19 
 
 16-75 
 
 31-92 
 
 1-64 
 
 64,668 
 
 73,287 
 
 686 
 
 5,312 
 
 7,826 
 
 6 
 
 227-94 
 
 239-16 
 
 78-74 
 
 17-05 
 
 24-13 
 
 0-69 
 
 Central Region 
 
 Pacific Region 
 
 Total 
 
 74,619 
 
 6,315 
 
 265-38 
 
 21-71 
 
 138,641 
 
 13,144 
 
 231-52 
 
 20-39 
 
 
 The modifying influence of region on the mortality is shown still more strikingly 
 when, instead of comparing the deaths with strength, they are compared with the 
 number of cases. It is then seen that the disease is not only more frequent, but more 
 fatal in proportion to the number of cases, in the Central region than in the Atlantic, 
 and in this more than in the Pacific. In the Central region there was one death to 
 every 9'7 cases for the first year; one for every 9'3 for the second. In the Atlantic 
 region one to 14 cases for the first year; one to 12 for the second. In the Pacific 
 region, as there were but eleven deaths in the first year and six in the second, much 
 importance cannot be attached to its ratios. The relationship of deaths to cases for 
 each year and region is shown in the following table : 
 
 TABLE XV. 
 
 Relation between Cases and Deaihs of Camp Fever. 
 
 Atlantic Region 
 Central Region. 
 Pacific Region.. 
 
 Total 
 
 Tear ensino June 30, 1862. 
 
 Ratio of 
 deatiis per 
 1000 cases. 
 
 7195 
 
 102-65 
 
 22 57 
 
 84-63 
 
 Number of 
 
 cases to each 
 
 death. 
 
 13-90 
 
 9-74 
 
 44-31 
 
 11-82 
 
 Tear endino June 30, 1863. 
 
 Ratio of 
 deaths per 
 1000 cases. 
 
 82-14 
 
 106 79 
 
 8-75 
 
 94-81 
 
 Number of 
 
 cases to each 
 
 death. 
 
 12-17 
 
 9-36 
 
 114-29 
 
 10-55 
 
 Annual Average for the 
 two tears. 
 
 Ratio of 
 deaths per 
 1000 cases. 
 
 78-10 
 
 105-54 
 14-46 
 
 91-25 
 
 Number of 
 
 cases to each 
 
 death. 
 
 12-80 
 
 9-48 
 
 69-16 
 
 10 96 
 
112 
 
 CAMP r£V£R. 
 
 A comparison of the monthly ratios of cases to strength in each region indicates 
 the autumnal character of many of these fevers, and confirms the idea of a malarial 
 element in their causation, as already indicated. In fact, the season wave for camp 
 fever during the first year of the war is similar in many respects to that of the inter- 
 mittent fevers, the malarial origin of which is universally admitted. During the 
 second year, the season wave, which in other respects is similar, is somewhat masked 
 by the large figures for July and August in the Atlantic and Central regions. How far 
 this deviation is due to the character of the campaigns of the great armies in these re- 
 gions and the location in which they operated, is a question the discussion of which 
 must be postponed for the present. 
 
 Tables XVI. and XVII. give the monthly ratio of cases to strength in each of the 
 three regions for the first and second years of the war. 
 
 TABLE XVI. 
 
 Monthly Rates of Gamp Fever in the Armies of the United States during the year ending June SOth, 
 1862, expressed in ratio per 1000 of mean strength. 
 
 
 
 
 1861. 
 
 
 
 1862. 
 
 For the 
 year. 
 
 •-3 
 
 1 
 
 i 
 
 1 
 o 
 
 > 
 
 o 
 
 .a 
 
 1 
 
 1 
 
 .a 
 
 p. 
 
 1 
 
 1 
 
 Atlantic Region 
 
 8-30 
 
 18-78 
 
 25-60 
 
 27-64 
 
 27-88 
 
 19-74 
 
 13-85 
 
 13-81 
 
 10 99 
 
 17-42 
 
 24-88 
 
 27-07 
 
 238-99 
 
 Central Region 
 
 16-87 
 
 38-26 
 
 39-98 
 
 37-60 
 
 36-25 
 
 26-89 
 
 23-28 
 
 18-59 
 
 16-97 
 
 23-96 
 
 29-33 
 
 27-79 
 
 327-31 
 
 Pacific Region 
 
 1-72 
 
 5-31 
 
 5-35 
 
 . 6-67 
 
 4-31 
 
 4-90 
 
 2-15 
 
 3-45 
 
 6-34 
 
 9-19 
 
 20-44 
 
 12-59 
 
 73-19 
 
 TABLE XVII. 
 
 Monthly Sates of Gamp Fever in the Armies of the United States during the year ending June SOth, 
 1863, expressed in ratio per 1000 of mean strength. 
 
 Atlantic Region 
 Central Region . 
 Pacific Region.. 
 
 36-20_ 
 
 28-18 
 
 4-21 
 
 28-59 
 
 27-18 
 
 9-45 
 
 19-54 
 24-81 
 18-92 
 
 I 
 
 27-67 
 
 24-14 
 
 9-83 
 
 21-72 
 
 19-24 
 
 9-19 
 
 18-51 
 
 16-94 
 
 6-74 
 
 17-61 
 
 18-77 
 
 2-29 
 
 1432 
 
 2016 
 
 1-91 
 
 S 
 
 14-06 
 
 19-23 
 
 2-79 
 
 12 29 
 
 16-83 
 
 5-09 
 
 IS 
 
 13-87 
 
 16-74 
 
 4-19 
 
 14-87 
 
 18-76 
 
 5-85 
 
 For the 
 year. 
 
 227-94 
 
 239-18 
 
 78-74 
 
 The upper diagram of the plate facing this page represents the monthly fluctua- 
 tions indicated in these tables. 
 
 Materials for an elaborate discussion of the subject of camp fever have been col- 
 lected, and a careful investigation of its pathological anatomy has been conducted 
 under my direction at the Army Medical Museum. The space to which it has been 
 thought best to limit this paper does not, however, permit the presentation of further 
 
Dicup-/i/n shAH'ina Mo/i^Jihi-dics ol ('(in \j) Fever 
 
 An<infic h'i<ii<iii Cnitriil Jir(poil. I'arHu ]\a)ion. 
 
 
 
 
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CAMP FEVER. 113 
 
 details than the foregoing remarks, and the brief sketch of the pathological specimens 
 of the affection now in the Museum, which will be given in the account of the medical 
 and microscopical sections of that collection. 
 
 Besides the forms of continued fever which may be properly included under the 
 general designation of Camp Fever, three other forms, which have occurred during 
 the war, deserve a brief mention in this place, viz.: True Typhus Fever, Spotted Fever, 
 and Yellow Fever. 
 
 Of typhus fever, 824 cases and 191 deaths are reported during the first year; 899 
 cases and 381 deaths during the second. There is evidence, however, which will be 
 presented in the Medical History of the War, that many of these cases were not 
 true typhus, but rather cases of typho-malarial, or of ordinary enteric fever of an 
 adynamic character, with strongly marked typhous symptoms, or complicated with 
 scurvy; congestive intermittents occurring in scorbutic patients, and perhaps other 
 diseases, were also occasionally diagnosed as typhus. These facts led me for a long 
 while to doubt whether true typhus fever had ever occurred in our army during the 
 rebellion, and inclined me to look upon the few hundred cases above quoted as be- 
 longing chiefly to typho-malarial fever ; they have therefore been included in the fore- 
 going statistics of camp fever. Subsequent facts, however, have been brought to my 
 knowledge, which induce me to admit the occasional occurrence of a limited number of 
 cases of true typhus, in connection with overcrowded and ill-policed camps, and es- 
 pecially in the case of those of our soldiers who were detained as prisoners in the 
 enemy's hands. 
 
 Spotted fever, called also cerebro-spinal meningitis, attracted attention chiefly at a 
 period later than that embraced in the present paper. Large numbers of cases, autop- 
 sies and other interesting materials on this subject have been contributed, with the 
 mere mention of which I must here content myself. 
 
 Yellow fever, from which the army wholly escaped during the first year of the war, 
 made its appearance at Key West, Florida, in July, 1862, and subsequently at Hilton 
 Head, South Carolina. The outbreak was limited to a few hundred cases and the 
 deaths to a hundred. In both places, there was the most decisive evidence that the 
 disease was imported in consequence of the neglect or violation of quarantine regula- 
 tions. The fear that yellow fever would prove a terrible obstacle to the operation of 
 our troops in the Southern States has proved wholly unfounded. It may here be men- 
 tioned that the only subsequent outbreak of importance which has occurred up to the ' 
 date of writing was the epidemic at Newbern, North Carolina, in the summer of 1864. 
 But even here the mortality, so far as our troops were concerned, was limited to a few 
 hundred men. In the case of this outbreak, Surgeon D. W. Hand, U. S. Vols., Medical 
 Director of the Department, expresses the belief that the fever was not imported, but 
 that it originated on the spot in consequence of the neglect of hygienic precaution by 
 the citizens of the place and by the refugees who had made it an asylum. There is 
 now in the possession of this ofiSce a most interesting set of papers, contributed by sur- 
 geons who were eye-witnesses, giving the whole history of the several outbreaks of yellow 
 fever during the war, with descriptions of the disease, of the treatment employed, etc. 
 etc. It is proposed to publish these papers in extenso in the Medical History of the 
 
 War. 
 
 15 
 
114 
 
 INTERMITTENT FEVER. 
 
 INTERMITTENT FEVER. 
 
 The several forms of intermittent fever played a conspicuous part among the dis- 
 eases of the army, as might indeed have been anticipated, from a consideration of the 
 frequency of these affections in the United States. They were not the source of any 
 very great mortality; nevertheless the malarial influence, of which the frequency of 
 these simple manifestations may be regarded as the measure, played a part in so many 
 more serious and more fatal affections, that the rate of the occurrence of intermittents 
 assumes a high significance in the appreciation of the comparative mortality of the 
 several regions. 
 
 Intermittent fevers were reported under the several heads of Quotidian, Tertian, 
 Quartan, and Congestive. The total number of all forms reported was 72,810 during 
 the first year, 189,997 during the second; making a total during the two years of 
 262,807 cases reported. The mortality, however, was extremely small, with the ex- 
 ception of the so-called congestive form — (the Pernicious Fever of Dr. Wood). The 
 whole number of deaths, including this more fatal variety, was 430 during the first 
 year and 1358 during the second, or 1788 during the two years. Excluding the conges- 
 tive cases, the mortality of the other varieties was but 407 deaths for the two years, or 
 one death to every 631 cases. It has not, however, been thought proper to omit these 
 cases, as, after all, in the present state of our knowledge they are to be regarded simply 
 as extremely intense cases of intermittent fever, and are therefore a proper element to 
 be included in considering the mortality of this affection. Embracing them in the 
 computation, it will be found that there was one death to every 147 cases during the 
 two years. It may be remarked, however, that possibly a certain number of cases of 
 spotted fever and of cerebro-spinal meningitis may have been erroneously included 
 under the head of Congestive Fever. 
 
 The following table shows the number of cases and deaths reported from each 
 variety of intermittent fever. It will be seen that, according to the reports. Quotidian 
 was somewhat the most frequent form, next comes the Tertian: the Quartan is com- 
 paratively rare, the Congestive still rarer. 
 
 TABLE XVIII. 
 
 Number of Gases and Deaths from the several forms of Intermittent Fever during the first two years 
 
 of the war. 
 
 Year ending June 30, 1862. 
 
 Taken sick. Died. 
 
 Tear ending Jone 30, 1863. 
 
 Taken sick. Died. 
 
 Quotidian Intermittent . 
 
 Tertian Intermittent 
 
 Quartan Intermittent . .. 
 Congestive Intermittent 
 
 Total 
 
 40,376 
 
 26,750 
 
 3,451 
 
 2,234 
 
 32 
 
 33 
 
 4 
 
 361 
 
 96,603 
 
 80,053 
 
 9,434 
 
 3,847 
 
 144 
 
 116 
 
 78 
 
 1,020 
 
 72,810 
 
 430 
 
 189,997 
 
 1,358 
 
INTERMITTENT FEVER. 
 
 115 
 
 Intermittent fever was more frequent during the second year than the first. In 
 both, however, the total number of cases during the year amounted to considerably 
 more than one-fourth of the strength. The mortality for the first year was a little 
 over one per 1000 of strength, for the second a little over two per 1000. 
 
 TABLE XIX. 
 
 Total Number of Gases and Deaths from Intermittent Fever for the first two years of the war, with the 
 
 annual ratio per 1000 of mean strength. 
 
 Tear ending June 30, 1862 
 
 Tear ending June 30, 1863 
 
 For the two years 
 
 Taken sick. 
 
 72,810 
 189,997 
 
 262,807 
 
 Died. 
 
 430 
 1,358 
 
 1,788 
 
 Annual ratio 
 
 of cases per 
 
 1000 of mean 
 
 strengtti. 
 
 258-95 
 317-29 
 
 298-64 
 
 Annual ratio 
 
 of deaths per 
 
 1000 of mean 
 
 strength. 
 
 1-15 
 2-11 
 
 1-91 
 
 Intermittent fever was more frequent and fatal in the Central than in the Atlan- 
 tic, and in this than in the Pacific region. In the Pacific region, there were no deaths 
 during the first year and but one during the second. In the Atlantic region, the deaths 
 were somewhat over one per 1000 of strength the first year, somewhat less than one 
 per 1000 during the second; while in the Central region, the deaths were somewhat 
 over two per 1000 during the first year, somewhat over three per 1000 during the 
 second. These relations are exhibited in detail in Table XX. 
 
 TABLE XX. 
 Number of Gases and Deaths from Intermittent Fever in each of the three regions. 
 
 
 Teae ekdiso Jose 30, 1862. 
 
 Teas EiroiMa Jdne 30, 1863 . 
 
 Taken sick. 
 
 Died. 
 
 Ratio per 1000 
 
 of mean 
 
 strength 
 
 taken sick. 
 
 Ratio per 1000 
 
 of mean 
 
 strength 
 
 died. 
 
 Taken sick. 
 
 Died. 
 
 Ratio per 1000 
 
 of mean 
 
 strength 
 
 taken sick. 
 
 Ratio per 1000 
 
 of mean 
 
 strength 
 
 died. 
 
 Atlantic Region 
 
 34,857 
 
 36,980 
 
 973 
 
 210 
 220 
 000 
 
 195-94 
 382 88 
 145-33 
 
 115 
 2-16 
 0-00 
 
 55,048 
 
 133,888 
 
 1,061 
 
 297 
 
 1,060 
 
 1 
 
 194-03 
 436-96 
 121-77 
 
 0-95 
 3-27 
 0-11 
 
 Central Region 
 
 Pacific Region 
 
 Total 
 
 72,810 
 
 430 
 
 258-95 
 
 1-48 
 
 189,997 
 
 1,358 
 
 317-29 
 
 2-11 
 
 
 The proportion of deaths to cases was slightly greater in the Central than in the 
 Atlantic region, especially during the second year. In the Pacific region, for the two 
 years, the proportion was over two thousand cases to each death. 
 
116 
 
 INTERMITTENT FEVER. 
 
 TABLE XXI. 
 Relaiion between Cases and Deaths of Intermittent Fever. 
 
 Atlantic Region 6-02 
 
 Annual Average foe • 
 Yeab endino June 30, 1862. Teas ending June 30, 1863. nfo Teaeb. 
 
 Ratio of 
 defltbs per 
 lono cases. 
 
 Central Region . 
 Pacific Region... 
 
 Total . 
 
 6-22 
 000 
 
 5-91 
 
 Number of 
 
 cases to each 
 
 death. 
 
 16611 
 160-77 
 000-00 
 
 169-20 
 
 Katio of 
 deaths per 
 1000 cases. 
 
 5-39 
 
 7-91 
 0-94 
 
 7-20 
 
 Nnmber of 
 
 cases to each 
 
 death. 
 
 185-53 
 
 126-42 
 
 1063-83 
 
 138-89 
 
 Eatio of 
 deaths per 
 1000 cases. 
 
 5 64 
 7-49 
 0-49 
 
 6-80 
 
 Numher of 
 
 cases to each 
 
 death. 
 
 177-30 
 
 133-51 
 
 2040-82 
 
 147-06 
 
 The influence of season on the frequency of the disease is shown in Tables XXII. 
 and XXIII. It will be seen that intermittents occur at all seasons of the year, but 
 that they are most frequent in the latter portion of the summer, and during the autumn 
 months. In the Atlantic region, the maximum was attained in September during the 
 first year, in October during the second; in the Central region, in August and October 
 during the first year, October during the second; in the Pacific region, in August during 
 the first year and September during the second. 
 
 The curve formed by the monthly ratios in each region is an autumnal one, and, 
 on the whole, September and October would appear to be the months of greatest fre- 
 quency. To appreciate fully, however, the effects of season, it would be necessary to 
 study the detailed statistics of the several armies in each region, with their location 
 and exposures, which is out of the question in a brief pamphlet. Full materials for 
 such a comparison are in course of compilation. 
 
 The lower diagram of the plate facing page 112 represents these fluctuations, and 
 may be advantageously compared with the diagram showing the monthly rates of camp 
 fever, which occupies the upper part of the same plate and is constructed on the same 
 scale. 
 
 TABLE XXII. 
 
 Monthly Rates of Intermittent Fever in the Armies of the United States during the year ending June 
 30th, 1862, expressed in ratio per 1000 of mean strength. 
 
 
 1861. 
 
 1862. 
 
 For the 
 year. 
 
 if 
 
 p 
 1^ 
 
 ■? 
 
 1 
 
 i 
 
 1 
 
 1 
 
 A 
 
 P 
 
 1 
 
 1 
 1^ 
 
 1 
 
 1 
 
 i 
 
 1? 
 
 Atlantic Region .... 
 
 10-97 
 
 27-96 
 
 39-32 
 
 84-46 
 
 22-08 
 
 14-08 
 
 7-87 
 
 8-43 
 
 7-00 
 
 12-01 
 
 16-25 
 
 16-88 
 
 195-94 
 
 Central Region 
 
 39-19 
 
 66-93 
 
 56-46 
 
 66-77 
 
 42-13 
 
 80-60 
 
 21-87 
 
 17-37 
 
 19-07 
 
 27-68 
 
 28-09 
 
 26-26 
 
 382-88 
 
 Pacific Region 
 
 6-46 
 
 21-56 
 
 9-36 
 
 17-17 
 
 18-99 
 
 13-54 
 
 7-29 
 
 10-20 
 
 8-87 
 
 1001 
 
 8 72 
 
 12-97 
 
 145-33 
 
DIAERH(EA AND DTSENTERT. 
 
 117 
 
 TABLE XXIII. 
 
 Monthly Bates of Intermittent Fever in the Armies of the United States during the year ending June 
 SOlh, 1863, expressed in ratio per 1000 of mean strength. 
 
 
 1862. 
 
 1863. 
 
 For the 
 year. 
 
 
 ■? 
 
 1 
 
 ■§ 
 
 1 
 1 
 
 1 
 
 1 
 
 I 
 
 .d 
 
 t 
 
 < 
 
 
 i 
 
 Atlantic Begion .... 
 
 20-12 
 
 22-85 
 
 25-40 
 
 30-98 
 
 19-35 
 
 13-67 
 
 11-54 
 
 8-74 
 
 9-39 
 
 10-48 
 
 15-37 
 
 19-16 
 
 194-03 
 
 Central Region 
 
 81-39 
 
 36-33 
 
 56-85 
 
 63-05 
 
 45-59 
 
 33-38 
 
 28-46 
 
 26-93 
 
 29-25 
 
 28-37 
 
 29-20 
 
 44-02 
 
 436-96 
 
 Pacific Region 
 
 11-87 
 
 12-51 
 
 15-86 
 
 13-91 
 
 11-19 
 
 8-67 
 
 8-27 
 
 5-94 
 
 7-39 
 
 8-94 
 
 8-26 
 
 9-90 
 
 121-77 
 
 Before passing from the subject of intermittents, a word may be said with regard to 
 some other manifestations of malarial poisoning, and especially with regard to jaundice. 
 
 Besides developing intermittent fever and complicating other diseases, such as 
 camp fever and diarrhoea, the malarial influence manifests itself with considerable fre- 
 quency among troops exposed to its action by the development of a peculiar form 
 of anasmia, which may be designated Chronic Malarial Poisoning. This condition, 
 attended usually with enlargement of the spleen and frequently with an increase in the 
 number of the white corpuscles of the blood, manifests itself externally by languor, 
 feebleness, and pallor, attended commonly with neuralgic pains, and, as it actually oc- 
 curred among our troops, often complicated by slight scorbutic symptoms. Attacks of 
 fever, pneumonia, or other acute diseases occurring among patients in this condition are 
 peculiarly apt to prove fatal. A yellowish complexion is a frequent phenomenon in the 
 form of anaemia here referred to, and often amounts to decided jaundice. 
 
 Mild epidemics of jaundice, running a course of from two to six or eight weeks, 
 and usually terminating in recovery, have also been of frequent occurrence among our 
 troops in malarial regions. That this form of the affection also stands related to the 
 malarial poison, is shown by the fact that, as a general rule, it was most common in 
 those localities in which intermittents were most frequent. In Tables X. and XI. 
 jaundice will be found reported among diseases of the digestive organs. The number 
 of cases reported during the first year was 10,929, during the second year 31,640, mak- 
 ing in all 42,569 cases. The deaths were only 40 during the first year and 121 during 
 the second, or 161 in all, which is but one death in 264 cases. Of the large number of 
 cases reported, only 24 during the first year and 85 during the second occurred in the 
 Pacific region; none of these cases died. 
 
 DIARRHCEA AND DYSENTERY. 
 
 These disorders were reported under the four heads — Acute Diarrhoea, Chronic Diar- 
 rhoea, Acute Dysentery, and Chronic Dysentery. The words diarrhoea and dysentery 
 were somewhat loosely used during the war. The disease most generally called 
 Chronic Diarrhoea was, in fact, usually an affection of the large intestine, which was 
 thickened, softened, and often ulcerated. The term dysentery would have been more 
 
118 
 
 DIARRHOEA AND DTSENTERT. 
 
 exact, and was bestowed by many surgeons on tbe same affection which others called 
 diarrhoea. Hence it has been thought advisable, in considering the figures, to group 
 together all cases reported under these heads. 
 
 The extreme frequency of diarrhoea and dysentery makes it most important to under- 
 stand these disorders. They constitute more than one-fourth of all the cases of disease 
 reported during the period under consideration. The annual number of cases for the 
 whole array was greater than three-fourths of the mean strength, and next, after camp 
 fever, they were the chief cause of mortality from disease. The total number of cases 
 reported during the first year was 215,214, with 1194 deaths; during the second year 
 510,461 cases and 10,366 deaths— the total, 725,675 cases and 11,560 deaths. It will 
 be seen that the proportionate mortality of the second year is by far the greatest, show- 
 ing the prevalence of cases of a more formidable type. 
 
 The following table presents the number of cases and deaths as actually reported 
 under each of the heads above mentioned: 
 
 TABLE XXIV. 
 
 Number of Gases and Deaths from the several forms of Diarrhoea and Dysentery during the first two 
 
 years of the war. 
 
 Acute Diarrhoea 
 
 Chronic Diarrhoea.. 
 Acute Dysentery.... 
 Chronic Dysentery . 
 
 Total 215,214 
 
 Tear ending June 30, 1862. 
 
 Taken sick. 
 
 164,551 
 
 15,815 
 
 32,237 
 
 2,611 
 
 Hied. 
 
 227 
 493 
 347 
 127 
 
 1,194 
 
 Teae knbing June 30, 1863. 
 
 Taken aick. 
 
 373,927 
 
 63,083 
 
 64,704 
 
 8,747 
 
 510,461 
 
 Died. 
 
 870 
 7,488 
 
 922 
 1,086 
 
 10,366 
 
 Taking the total of these several forms, it will be seen the ratio of cases was 765 
 per 1000 of mean strength during the first year and 852 per 1000 for the second; so 
 that considerably more than three-fourths of the whole strength was attacked each year. 
 The mortality was 4 per 1000 of strength during the first year and 16 during the second; 
 the disease being just four times more fatal during the second year than the first. 
 
 TABLE XXY. 
 
 Total Number of Gases and Deaths from Diarrhoea and Dysentery for the first two years of the war, 
 and the annual ratio per 1000 of mean strength. 
 
 Year ending June 30, 1862. 
 Year ending June 30, 1863 
 
 For the two years.. 
 
 215,214 
 510,461 
 
 725,675 
 
 Died. 
 
 1,194 
 
 10,366 
 
 11,560 
 
 Annual ratio 
 
 of cases per 
 
 1000 of mean 
 
 strength. 
 
 765-40 
 852-44 
 
 824 63 
 
 Annual ratio 
 
 of deaths per 
 
 1000 of mean 
 
 strength. 
 
 4-10 
 16-08 
 
 12-36 
 
DIAREH(EA AND DYSENTERY. 
 
 119 
 
 The greatly increased mortality during the second year will be at once understood 
 if the acute cases of diarrhoea and dysentery, as given in Table XXIV., are added 
 together for each year and their mortality compared with that of the chronic cases. 
 Of acute diarrhoea and dysentery, 196,788 cases and 574 deaths were reported 
 during the first year, 438,631 cases and 1792 deaths during the second; the mortality 
 being one death to every 331 cases in the first year and one to every 245 in the second. 
 It appears, therefore, that the acute forms remained comparatively mild. Of chronic 
 diarrhoea and dysentery, there were 18,426 cases and 620 deaths during the first year, 
 71,830 cases and 8574 deaths during the second; the mortality increasing, therefore, 
 from one death in every 30 cases for the first year to one in every 8 for the second. 
 
 This increased mortality, which shows that the chronic forms assumed a more for- 
 midable type during the second year, becomes at once intelligible on the presumption 
 that a certain length of time is required before the influences to which a soldier is 
 exposed culminate in chronic diarrhoea. Indeed, individual experience shows that the 
 same soldier has frequently, perhaps usually, repeated attacks of acute diarrhoea, which 
 terminate in temporary recovery, and which, of course, are each reported as a separate 
 case, before the more serious and continuous disorder sets in, on which the term "chronic" 
 is usually bestowed. 
 
 Like camp fever and intermittents, diarrhoea and dysentery were most frequent 
 in the Central region; less so in the Atlantic, and least in the Pacific region. In the 
 Central region, the cases were more numerous than the strength during the first 
 year and nearly equal to the strength during the second; in the Atlantic, they were 
 more than half the strength during the first year and more than three-quarters during 
 the second; in the Pacific region, during each year somewhat over one-quarter the 
 strength. The differences between the ratio of mortality to strength in the three re- 
 gions was still more striking: in the Central region, the mortality was 9 per 1000 
 of mean strength during the first year, 23 per 1000 during the second; in the At- 
 lantic, 1 per 1000 during the first year, 9 per 1000 during the second; in the Pacific 
 region, less than 1 per 1000 during each year. 
 
 TABLE XXVI. 
 
 Number of Cases and Deaths from Diarrhoea and Dysentery in each of the three regions. 
 
 
 Tear EjiMNO June 30, 1862. 
 
 Year ending June 30, 1863. 
 
 Taken sick. 
 
 Died. 
 
 Ratio per 1000 
 
 of mean 
 
 Btreogtb 
 
 taken sick. 
 
 Ratio per 1000 
 
 of mean 
 
 strengtli 
 
 died. 
 
 Taken sick. 
 
 Died. 
 
 Ratio per 1000 
 
 ot mean 
 
 strength 
 
 taken sick. 
 
 Ratio per 1000 
 
 of mean 
 
 strengtli 
 
 died. 
 
 
 114,925 
 
 98,470 
 
 1,819 
 
 238 
 
 951 
 
 5 
 
 64601 
 
 1019-54 
 
 27M0 
 
 1-30 
 9-36 
 0-75 
 
 281,564 
 
 276,567 
 
 2,330 
 
 2,742 
 
 7,617 
 
 7 
 
 816-22 
 902-62 
 267-42 
 
 8-80 
 
 23-49 
 
 0-80 
 
 
 Fa^cific Region 
 
 Total 
 
 215,214 
 
 1,194 
 
 765-40 
 
 4-10 
 
 510,461 
 
 10,866 
 
 852-44 
 
 1608 
 
 
/ 
 
 120 DIARRH(EA AND DYSENTERY. 
 
 The ratio of deaths to cases shows the influence of region in a striking manner. 
 
 TABLE XXVII. 
 Relation between Gases and Deaths of Diarrhoea and Dysentery. 
 
 Atlantic Region 
 Central Region 
 Pacific Region.. 
 
 Total... 
 
 Teae ENDINO Jdke 30, 1862. 
 
 Ratio of 
 deaths per 
 1000 cases. 
 
 2-07 
 9-66 
 2-75 
 
 5-55 
 
 Number of 
 
 cases to each 
 
 death. 
 
 483-09 
 103-52 
 363-64 
 
 180-18 
 
 Yeae ending June 30, 1863. 
 
 Ratio of 
 deaths per 
 
 1000 cases. 
 
 11-84 
 
 27-54 
 
 3-00 
 
 20-31 
 
 Number of 
 
 cases to each 
 
 death. 
 
 84-46 
 36-31 
 
 49-24 
 
 Annual Average for the 
 TWO Years. 
 
 Ratio of 
 deaths per 
 1000 cases. 
 
 8-60 
 
 22-85 
 
 2-89 
 
 15-93 
 
 Number of 
 
 cases to each 
 
 . death. 
 
 11628 
 
 43-77 
 
 346-02 
 
 62-77 
 
 If now we consider the influence of season in each of the regions, it will be found 
 that diarrhoea and dysentery were by far most frequent in the summer and autumnal 
 months. In the Atlantic region, the greatest monthly ratio was during July, 1861, after 
 which it diminished through the fall and winter, but again increased from March to 
 June, 1862 ; July, 1862, was the maximum month for the second year. The cases 
 greatly diminished in August— after the Army of the Potomac had withdrawn from the 
 Peninsula to near Washington; but increased in September, and attained a second maxi- 
 mum in October, which is the month in which intermittents were most frequent in this 
 region ; it then diminished steadily till April, 1863, increasing again in May and June, 
 tn the Central region, the maximum month is August, 1861, after which there is a 
 gradual diminution till December; an increase in January, 1862; a falling off in Febru- 
 ary, and a great increase in March and April. The monthly ratio became gradually 
 less during May, June, July, and August, but increased considerably in September, after 
 which it gradually diminished until January, 1863, when it increased again, and made 
 subsequently but slight fluctuations. On the Pacific coast, the disease was most frequent 
 during the summer and autumnal months. The following tables give the rates, and the 
 upper diagram of the plate facing this page represents them to the eye: 
 
 TABLE XXVIII. 
 
 Monthly Bates of Diarrhoea and Dysentery in the Armies of the United States' during the year ending 
 June 3Qth, 1862, expressed in ratio per 1000 of mean strength. 
 
 
 1861. 
 
 1862. 
 
 For the 
 year. 
 
 
 1 
 
 1 
 
 ti 
 
 1 
 1 
 
 1 
 1 
 
 1 
 
 1 
 
 .g 
 
 1 
 
 s 
 
 i 
 
 Atlantic Region .... 
 
 Central Region 
 
 Pacific Region 
 
 168-23 
 93-06 
 28-41 
 
 116-29 
 
 139-99 
 
 40-96 
 
 70-80 
 97-94 
 29-63 
 
 62 66 
 94-68 
 27-03 
 
 46-06 
 70 91 
 30-86 
 
 28-54 
 63-34 
 13-54 
 
 23-20 
 71-87 
 10-74 
 
 22-20 
 55-53 
 16-54 
 
 35 22 
 70-73 
 18-13 
 
 67-20 
 
 107-12 
 
 16-57 
 
 70-92 
 97-99 
 22-98 
 
 87-06 
 83-78 
 35-82 
 
 646 01 
 
 1019-54 
 
 271-70 
 
Diafirdin shcHinH flic Men/ lilr v(t/(s ol' Diairliocd a/ul Dyscn/a-y. 
 
 Allan 1 1 r Beep on 
 
 Cfiiii-dl li'diKni . 
 
 I'(<ri(ir lii<ii(i{i 
 
 
 }'/■<!/■ cnrliiK) .hill, :jf/^'' ini) 
 
 'J . 
 
 
 
 
 iW//- rufh/Kj 
 
 Jiiiir ■Ml"' J863. 
 
 
 
 
 
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 JSO -^ 
 
 1 
 
 ^ 
 
 ■^ 
 
 
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 ^ 
 
 ^ 
 
 n 
 
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 f<^ 
 
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 f-^ 
 
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 J5(> 
 
 
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 JJ-O 
 
 
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 Ji-p 
 
 
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 120 
 
 
 I 
 
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 no 
 
 
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 N^"v 
 
 
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 Bia/irn/n shiwiiu/ liu Ma/i//iJv rti/rs ol' In/hiiniiiohi-v ff/'fcrlions of llir Ji'csfjiniiorv Oiifniis 
 
 if/iinlir /I'ri/iiiii fnifrii/ Mnpori I'ori/ir li'iijioii. 
 
 h'niir nulhiii Jnnf '.iO^!' Hid 
 
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 TSindai-'s Utk. Plidiuldfiik 
 
DIAERHCEA AND DYSENTERY. 
 
 121 
 
 TABLE XXIX. 
 
 Monthly Rates of Diarrhaia and Dysentery in the Armies of the United States during the year ending 
 June BOlh, 1863, expressed in ratio per 1000 of mean strength. 
 
 
 1862. 
 
 1863. 
 
 For tho 
 year. 
 
 1 
 
 1 
 
 1 
 
 1 
 
 8 
 
 1 
 
 1 
 
 1 
 
 a 
 
 1 
 
 1 
 
 
 A 
 -< 
 
 1 
 
 i 
 
 Atlantic Region .... 
 
 Central Region 
 
 Pacific Region 
 
 129-56 
 79-76 
 38-43 
 
 94-40 
 67-6-t 
 36-21 
 
 105-00 
 88-45 
 33-53 
 
 111-22 
 86-93 
 28-38 
 
 73-47 
 60-27 
 26-97 
 
 68-64 
 60-03 
 18-66 
 
 58-50 
 84-54 
 14-65 
 
 45-52 
 
 70-84 
 
 7-55 
 
 38-57 
 76-73 
 12-54 
 
 .31-85 
 67-86 
 18-38 
 
 58-02 
 71-48 
 15-09 
 
 59-96 
 86-36 
 21-16 
 
 816-22 
 902-62 
 267-42 
 
 Much interesting material has been collected bearing on the causes, symptoms, 
 nature and treatment of these formidable affections. This consists, besides detailed sta- 
 tistics, of a number of papers on the subject by medical officers, of numerous histories 
 of cases and accounts of autopsies, of pathological specimens, drawings, and microscopical 
 preparations, and of the records of microscopical investigations in the Army Medical 
 Museum. The subject is one of such general interest that, although it is utterly im- 
 possible to present in this place even an outline of the material collected, it may not be 
 amiss to make a few remarks suggested by these studies. 
 
 The origin of the diarrhoea and dysentery of troops is to be sought in no one con- 
 dition, but in the co-operation of several, each of which should be the subject of hygienic 
 precautions, if the health of an army is to be preserved. Some of the chief of these, but 
 assuredly not the only ones, are the scorbutic taint dependent upon camp diet, the malar 
 rial influences operating in certain seasons and regions, the overcrowding and filth of 
 camps and barracks, the heat of summer, the exhaustion and fatigue of campaigns, and 
 the use of water containing saline or organic impurities. Whether there has ever existed, 
 in addition to these intelligible conditions, any specific causative momentum deserving 
 the designation of epidemic influence, is a grave question which receives no affirmative 
 reply from any experience reported during this war. The causation of chronic diarrhoea 
 and dysentery is to be found in the long-continued action of the influences above men- 
 tioned, and in the consequent frequency and duration of attacks, but not in any specific 
 cause or set of causes different from those which induce the acute form. 
 
 The influence of the scorbutic taint in the production of diarrhoea and dysentery 
 is shown not only by the increased frequency of these disorders whenever supplies of 
 fresh meat and vegetables have been deficient, but also by the presence of readily- 
 recognized scorbutic symptoms in the patients. When, on marches or active campaigns, 
 the diet is reduced to a minimum, often consisting chiefly of hard bread and coffee, with 
 but a scanty supply of salt pork, and of beef on the hoof, the number of acute attacks 
 of a mild form, as also of attacks which become chronic, is always greatly increased. 
 It would be a grave error, however, to suppose, as has been done for example by Dr. 
 J. H. Salisbury, of Ohio,* that this is the efficient cause of the disorder, and to reject the 
 consideration of other momenta. To neglect the influence of climate in the production 
 
 * Annual Report of the Surgeon General of Ohio for the year 1864. 
 
 16 
 
122 DIARRHffiA AND DTSEKTERY. 
 
 of the disease, for example, would be almost as unfortunate as to neglect the considera- 
 tion of diet. 
 
 The influence of climate, in this connection, is abundantly proved by the detailed 
 statistics of individual armies and localities, too voluminous to be presented in this 
 place, but which will appear in the official volumes. It is also worthy of note 
 that the month of the greatest prevalence of diarrhoea and dysentery in any army is 
 often also the month of the greatest prevalence of intermittent fever. But since it is 
 not possible, in campaigning in malarial countries, to avoid exposure to malaria, the chief 
 interest here attaches to the connection of climate with treatment. This connection is 
 of such a nature, that the number of recoveries bears a direct relation to the latitude of 
 the climate in which the patients are treated and to its freedom from malaria. Passing 
 by the figures of the first year of the war, during which the deaths from chronic diarrhoea 
 and dysentery were comparatively few, the second year gives the following results, which 
 are of especial significance. 
 
 During the second year of the war, the proportion of deaths from chronic diarrhoea 
 and chronic dysentery in the general hospitals of New England was one to every forty- 
 nine (48-8) patients admitted for these disorders; in the general hospitals of New York 
 City and State, including the hospital at Newark, New Jersey, one to every nineteen 
 (18-7) cases; in the general hospitals of Philadelphia and at other places in Pennsyl- 
 vania and Delaware, one to every fifteen cases; in the general hospitals of Maryland 
 and the District of Columbia, including those of Washington, Georgetown, Alexandria, 
 Frederick, Baltimore, Annapolis, etc., one to every eleven cases (11"4); in the general 
 hospitals at Fortress Monroe and on the coast of North and South Carolina, one to 
 every seven cases (7'1). 
 
 The mortality was greater in the Central region of the continent, but the relative 
 influence of latitude was still observed. In the general hospitals of Ohio, Indiana, Illi- 
 nois, Iowa, Missouri, Kansas and Kentucky, including those at Cincinnati, Louisville and 
 St. Louis, the mortality was one death to every nine (8'53) cases; in those of Tennessee, 
 Northern Mississippi and Arkansas, including among others the hospitals of Nashville, 
 Memphis and Helena, one in five (5'4); in the hospitals of Louisiana, including New 
 Orleans and Baton Rouge, one in four. 
 
 Nor will a separate consideration of the mortality from these affections in the 
 hospitals of the great cities on the Mississippi Eiver be less instructive. In the hos- 
 pitals of Keokuk, la., the mortality was one in nine cases (9-1); in St. Louis, one in 
 five (5-2); in Cairo, one in four (3-98); in Memphis, one in five (5-4); and at New Or- 
 leans, somewhat less than one in five (4-7). The extreme mortality, it may be noted, 
 is not at the point farthest south, but at Cairo, situated on the alluvial peninsula formed 
 by the junction of the Mississippi and Ohio Rivers, where, as is well known, most 
 intense malarial influences prevail. 
 
 It is impossible to escape the conviction, based upon the foregoing observations, 
 that a change of climate is one of the most important elements in the treatment of 
 these diseases. The value of such a change, familiarly known to those surgeons of 
 our army who had enjoyed the experience of the Mexican war, did not escape the at- 
 tention of the Surgeon General's Office; and throughout the war, patients suffering from 
 the fevers and bowel affections of southern latitudes were, as far as the exigencies of 
 
DIARRHOEA AND DYSENTERY. 128 
 
 the service would permit, transferred to the North. In October, 1863, Surgeon C. 
 McDougall, Medical Director of the Department of the East, recommended the transfer 
 of patients suffering from chronic diarrhoea in the Atlantic region to the hospitals in the 
 State of Vermont, where the freedom from malaria and the fine mountain air would, it 
 was hoped, afford the most favorable results. The experiment was tried, as far as prac- 
 ticable, and with much success. In the West, also, such cases were sent, as far as pos- 
 sible, to hospitals in high northern regions, as at Keokuk, la., Madison, Wis., Chicago, 
 Detroit, etc. etc. It was never possible to give the full benefit of climatic influences to all 
 those patients who needed it; but the Medical Department was fully alive to the advan<> 
 ages to be derived from this source, and availed itself of them as far as, at the time, with 
 a full knowledge of all the circumstances of the case, it was believed to be practicable. 
 
 Papers have been contributed by various surgeons, detailing the history, symptoms, 
 and treatment of numerous cases of diarrhoea and dysentery. These reports, properly 
 elaborated, will be a most important contribution to our knowledge of those diseases. An 
 analysis which should do justice to them is quite out of the question in the present paper; 
 but a few salient points, in connection with the chronic form, will be briefly touched upon. 
 
 The most common and characteristic chronic form, as already intimated, was 
 anatomically a chronic ulcerative colitis, occasionally an entero-colitis. Designated cor- 
 rectly chronic dysentery by many surgeons, it was most generally known as chronic 
 diarrhoea, or chronic camp diarrhoea; and it is to this form that the few remarks here 
 offered are limited. Among its most striking phenomena may be mentioned the 
 usual absence of fever throughout the greater part of its course, the progressive and 
 ultimately often extreme emaciation, the dry, harsh condition of the skin, and the 
 presence of complicating phenomena of malarial and scorbutic nature. The fre- 
 quent complication of the disease with camp fever is also notable. Sometimes the 
 attack of fever begins the disorder, and diarrhoea is left subsequently as a result. 
 Often, however, camp fever occurs in patients who have already long suffered from 
 chronic flux. In fatal cases of either variety, the anatomical lesions characteristic of 
 diarrhoea are found variously combined with those of camp fever, as will be seen in the 
 brief description of the specimens of this sort in the Museum, which is given in a sub- 
 sequent paragraph. 
 
 Chronic flux, unaccompanied by camp fever, may run its course to its own natural 
 termination in extreme emaciation, with death from debility and exhaustion; or, as 
 perhaps happens more frequently, terminate at an e.irlier period, in consequence of 
 the occurrence of some disastrous complication. Often, for example, after the dis- 
 ease has lasted a long time without fever, the stools varying from two or three to 
 twenty or more daily, the patient still walking about and suffering little pain, acute 
 dysenteric symptoms set in with fever, delirium, abdominal tenderness, tormina, tenes- 
 mus, rapid sinking and death in a few days. An autopsy shows the colon, which is 
 more or less ulcerated according to the previous duration and severity of the flux, to 
 be coated with a yellowish or greenish-yellow, sometimes brownish-yellow, pseudo-mem- 
 brane, which often extends also through the small intestines. The nature of this 
 pseudo-membrane has been made the subject of careful investigation in the Museum, 
 and the examination of a large number of cases leaves no doubt on the matter. It is 
 simply the croupous lymph, pseudo-plastic lymph, caco-plastic lymph, or false membrane 
 
124 DIARRHOEA AND DYSENTERY. 
 
 of medical writers. The examination by the microscope of properly prepared sections 
 shows it to be composed of innumerable round cells (lympH' cells, pus cells), held to- 
 gether by an adhesive granular matrix more or less resembling coagulated fibrin. With 
 such sections, there is no difficulty in tracing the origin of this membrane to a rapid 
 multiplication of the epithelial cells and superficial connective tissue corpuscles of the 
 diseased mucous membrane. The condition thus described is not always fatal, tubular 
 casts of false membrane having been found in the stools of patients, with the above- 
 described symptoms, who have subsequently recovered. 
 
 Another grave complication is diphtheria, with the formation of a similar false 
 membrane in the fauces and respiratory passages. The membrane does not differ from 
 that formed in ordinary diphtheria in civil life. The Museum contains several fine 
 specimens. I have made a careful examination of the false membrane in a number of 
 cases of this sort. It is anatomically similar to the false membrane of the intestine, 
 and its origin is as readily traced to the epithelium of the mucous membrane, the con- 
 nective tissue of which is, however, less frequently involved in the cell multiplication. 
 The early stage of the diphtheritic affection, in these cases, is often associated with 
 oedema of the glottis, which sometimes suddenly proves fatal before the formation of 
 the false membrane. It may be mentioned in this place, that oedema of the glottis, 
 with or without the formation of a diphtheritic false membrane, has been a not unfre- 
 quent mode of death in cases of protracted suffering from gunshot wounds. Other fatal 
 complications of common occurrence in chronic diarrhoea are pneumonia, congestion of 
 the lungs, serous apoplexy, Bright's disease of the kidneys, etc. etc. 
 
 An interesting complication which has several times been brought to my notice 
 in autopsies is the formation of metastatic foci, generally in the liver, but sometimes 
 also in the lungs and spleen. These foci precisely resemble those which occur in 
 pyaemia after gunshot wounds. I have met them in the bodies of men dead of 
 diarrhoea, who had received no wound or injury, but who had extensive ulceration 
 of the colon. These are the only cases in which, with propriety, "embolism" can be 
 spoken of as a complication of chronic diarrhoea. The heart clots (death polypi), 
 observed in the autopsies of this disease, difier in no respect from those so frequently 
 occurring in patients dead of the most diverse afiections, and even, under certain cir- 
 cumstances, in animals killed by violence; and all the evidence which careful investi- 
 gation has hitherto accumulated on the subject is in favor of the opinion that they 
 are formed during the death agony — consequences and not causes of the fatal issue. 
 Ordinary abscesses of the liver, sometimes of great size, were not very rare, and a 
 number of illustrative specimens have been received at the Museum. 
 
 Considerable interest attaches to the examination of the faeces in chronic diar- 
 rhoea, and especially to their examination with the microscope. The naked eye at 
 once recognizes as a prominent fact the presence in the stools of undigested portions of 
 the food, the characters of which are often but little altered. This, however, is also fre- 
 quent in ordinary acute diarrhoea, and is simply an expression of diminished digestive 
 power. In the case of soldiers in the field using hard bread as a part of the ration, 
 lumps of this article but little altered by their passage through the alimentary canal 
 are very commonly present. The most various substances derived from the food are 
 frequently observed; the microscopic appearances of some of them being well calcu- 
 
DIARRHEA AND DYSENTERY. 125 
 
 lated to deceive the unwary pathologist, especially if he attempts the microscopical 
 study of the excreta without a prior knowledge of the minute structure of the articles 
 of diet likely to be encountered. Besides such undigested fragments, mucus, blood 
 and pus, in variable quantities, are commonly met, with excess, deficiency, or absence 
 of the products of the intestinal transformation of the hepatic secretions. For the 
 recognition of blood and pus, when they exist in small quantity, the microscope is 
 necessary; in large amounts they can be recognized by the naked eye. Especial 
 significance is to be attached to the presence of pus, which, in moderate quantities, 
 can be recognized in a vast number of cases, probably In all those in which there are 
 ulcers of any size in the colon. Of course, it may happen that though pus exists, 
 its corpuscles have been destroyed by the peculiar form of putrefaction which the in- 
 testinal contents sometimes undergo; for, coincident with the diminished activity of 
 the digestive processes, forms of fermentation and even of putrefaction occur, which are 
 not usually met with in the healthy human body. The frequent occurrence in the 
 stools of torula cells, indicative of the setting up of fermentation among the saccharine 
 and starchy elements of the undigested food, has been mentioned by Dr. Salisbury in 
 the paper before referred to. This quite accords with my own observations; but the 
 account given in his paper of the presence of other "algoid forms," etc. is, I presume, 
 based upon some misinterpretation. 
 
 For a brief statement of some facts as to the pathological anatomy of this disease, 
 see subsequent remarks on the specimens in the Museum. 
 
 The papers above referred to contain also much interesting detail as to the treat- 
 ment of these afiections, which cannot be here introduced on account of its bulk. A 
 few remarks may, however, be made in reference to the chronic variety. In this form, 
 the two most important elements of treatment would appear to be diet and climate. 
 The diet should be antiscorbutic. Fresh meat and broth made from it, eggs, milk, 
 oysters, etc. are of the greatest value; but fresh vegetables also exercise a favor- 
 able influence. If the disease remains obstinate under this diet and suitable medica- 
 tion, the patient should be transported to a non-malarial northern locality. As to 
 medication, the whole range of vegetable and mineral tonics, astringents and altera- 
 tives have been employed with variable success. Among the remedies which have been 
 brought into extensive use in this country for the first time during the present war, I 
 may briefly mention subnitrate of bismuth, strychnia and arsenic. 
 
 Subnitrate of bismuth is perhaps the most generally available of these articles. 
 The first paper published on its use in camp diarrhoea was that of Acting Assistant 
 Surgeon J. B. Trask,* who recommended it in both the acute and chronic forms. Dr. 
 Trask advised the bismuth to be given daily in one large dose of from one to four 
 scruples, which he regarded as more efficacious than its use in divided doses. He was 
 very sanguine as to its success in all cases in which the patient was not actually dying 
 when the treatment was commenced. He says: "In not a case of the two hundred and 
 seventy treated at Finley Hospital during the period named, and by this agent, was 
 there a failure in promptly and radically arresting the disease, when given in the quan- 
 
 * Report on the Treatment of Acute and Chronic Diarrhoea with Subnitrate of Bismuth at Camp Downey, Cali- 
 fornia, and Finley Hospital, Washington, D. C, by J. B. Trask, M.D., Acting Assistant Surgeon U. S. A. San 
 Francisco, 1863. 
 
126 SMALL-POX. 
 
 titles and time as stated." In September, 1863, Surgeon T. Rush Spencer, U. S. Vols., 
 made an official report on the use of the remedy in seventy-six cases, sixty of which 
 were chronic and sixteen acute. Seventy-one of these cases were cured and five still 
 under treatment at the date of his report. The treatment in the successful cases lasted 
 from one to eight days. Influenced by these and other reports, I myself tried the 
 remedy quite extensively, and was cognizant of its use in a large number of cases of 
 both acute and chronic diarrhoea. It generally showed itself a most valuable agent. 
 In a few cases, however, tormina, tenesmus, and other dysenteric phenomena, with an 
 aggravation of all the symptoms, followed its use, and in a very considerable proportion 
 of the severe chronic cases it appeared to be wholly without effect. The subsequent 
 experience of many surgeons in the field and in hospital gave similar results; so that 
 while it must be admitted to be a quite useful remedy, especially when given in large 
 doses, the extravagant expectations which were at first entertained with regard to it by 
 some must be abandoned. 
 
 Strychnia was also extensively used by some surgeons. It was given in the form of 
 sulphate, or as extract of nux vomica. Very generally it was combined with quinine, 
 or with quinine and iron, and proved valuable in many atonic and paralytic conditions 
 of the bowels, but was far from being of general availability in the treatment of severe 
 chronic cases. 
 
 Arsenic in pill, or in the form of Fowler's solution, was more frequently useful? 
 and by some surgeons this remedy was regarded almost as a specific. So far as I have 
 been able to learn, it was chiefly available in cases complicated with chronic malarial 
 poisoning. The utter failure of these, or indeed any therapeutic agents, to command 
 general confidence, or to come into general use, will serve to show how subordinate their 
 effect is to be regarded to that of proper dietic and climatic conditions. 
 
 Asiatic cliolera did not make its appearance during the war, nor was any similar 
 affection of a severe type frequent. The whole number of deaths from cholera morbus 
 was 33 during the first year and 96 during the second. 
 
 SMALL-POX. 
 
 From a very early period in the war the attention of the Medical Bureau was 
 directed to the subject of vaccination, and strenuous efforts were made to render this 
 method of protection universal. That these efforts were to a great extent successful, is 
 shown by the comparatively small number of cases reported: 1310 cases of small-pox 
 and varioloid were reported during the first year and 2822 during the second — making 
 a total of 4132; the deaths were 412 during the first year and 1132 during the second — 
 being 1544 in all. According to these figures, the mortality would be one death to 
 about every three (2-67) cases. Since, however, a certain number of cases of variolous 
 disease originated in the general hospitals themselves, and upon the statistical system 
 employed the deaths from among these cases would be included in the above figures, it is 
 probable that the ratio of deaths to cases thus obtained is somewhat too high. If, how- 
 ever, the experience of some of the larger small-pox hospitals, in which it is known that 
 the cases received were treated to their termination, be compared, it will be found that 
 the mortality shown in their reports closely approximates the above. Thus, in the two 
 
EPIDEMIC MUMPS. 127 
 
 largest establishments of the kind, the Small-pox Hospital at St. Louis, Missouri, and 
 that at Washington, D. C, the total number of cases of small-pox and varioloid treated 
 during the two years was 2319; the number of deaths 597, or one in four (3'88) cases. 
 A considerable amount of material is on file concerning the frequency and fatality 
 of variolous disease among those who have been vaccinated, as compared with the un- 
 protected, and on other matters of interest connected with this subject. Most of this 
 material belongs, however, to a period subsequent to that referred to in this paper. I 
 will only mention here the occurrence in many instances, especially in the Central re- 
 gion, of foul or gangrenous ulcers as an accident attendant upon vaccination. The 
 earliest cases of the sort referred to in the ofl&cial reports occurred in the latter part of 
 1863 in the District of the Frontier, and are reported by Surgeon George H. Hubbard, 
 U. S. Vols., Medical Director of the district. They were supposed to be caused by the 
 accidental admixture of syphilitic matter with the virus employed. Other cases sub- 
 sequently occurred in Missouri, the Northern Department, Kentucky, Tennessee, etc., 
 and were made the subject of careful inquiry by Colonel C. S. Tripler, Medical Director 
 of the Northern Department, and other surgeons. The opinion generally arrived at was, 
 that they were the expression of scorbutic or other cachectic conditions of the patients, 
 and not due to any poisonous admixture with the vaccine virus; and it was frequently 
 observed that the same scab which had produced a number of successful vaccinations 
 would, in other men vaccinated at the same time, produce the ulcers referred to. An 
 exceedingly interesting paper which illustrates this point, as observed in a number of 
 cases among citizens at Horicon, Wisconsin, has been contributed by Surgeon Howard 
 Culbertson, U. S. Vols. The subject is one which deserves a full discussion hereafter. 
 
 CAMP MEASLES. 
 
 Epidemic measles was one of the characteristic afiections of the war. It occurred 
 chiefly in regiments recently raised, and among recruits, and appeared to be due wholly 
 to the incidental exposure of men brought up in rural districts who had hitherto escaped 
 the contagion : 21,676 cases and 551 deaths were reported during the first year of the 
 war, 16,345 cases and 1313 deaths during the second; but there is reason to believe 
 that the actual number of cases was considerably greater, since it is well known that 
 the disease frequently prevailed epidemically in new regiments, after the men began 
 to come together in the State to which they belonged, but before they were mustered 
 into the service of the United States, and therefore before their medical officers began 
 to report to the Surgeon General's Office. The disease resembled ordinary measles in 
 adults, except when aggravated by the effects of crowd poisoning or other depressing 
 infiuences. The direct mortality was not great, being only one death to every twenty 
 cases, but tedious catarrh, pneumonia, and pleuro-pneumonia were frequent sequelae; 
 and a part of the mortality from these affections was due indirectly to measles. 
 
 EPIDEMIC MUMPS. 
 
 Another affection, which prevailed extensively, was Epidemic Mumps (parotitis). 
 It occurred both as an independent affection and as a complication of other diseases. It 
 was seldom fatal. During the first year 11,216 cases and 9 deaths were reported; during 
 
128 
 
 INFLAMMATORY DISEASES OF THE RESPIRATORY ORGANS. 
 
 the second 13,429 cases and 30 deaths. The inflammation of the gland seldom termin- 
 ated in abscess, except in those cases which occurred as complications of camp fever. 
 Metastasis to the testicle was not unfrequent. The disease appeared to spread by 
 contagion, affecting almost exclusively those who had never previously suffered. 
 
 INFLAMMATORY DISEASES OF THE RESPIRATORY ORGANS. ' 
 
 The last of the miasmatic group of zymotic affections on which remarks will here 
 be made is Epidemic Catarrh, of which 11,314 cases and 5 deaths were reported during 
 the first year, and 63,202 cases and 24 .deaths during the second. Considerable confusion, 
 however, appears to have existed as to the precise signification and limits of the terms 
 Catarrh, Epidemic Catarrh, and Acute Bronchitis; precisely similar cases being reported 
 by different surgeons under each of these heads. It appears probable, moreover, that 
 the causes determining inflammatory affections of the several portions of the respi- 
 ratory apparatus are intimately allied, the total number of cases representing the effect 
 of exposure to unfavorable climatic influences, such as cold, dampness, etc.; while the 
 mortality is determined partly by the intensity of the cause, partly by the hygienic 
 surroundings and constitutional condition of the patients. Influenced by these and 
 other reasons, it has been considered advisable to bring together into a single group all 
 the disorders of this class. This group will be designated Inflammatory Diseases of the 
 Respiratory Organs, and will include all the cases reported as Epidemic Catarrh, Catarrh, 
 Acute and Chronic Bronchitis, Laryngitis, Pleurisy, and Pneumonia. 
 
 The whole number of the cases of this group reported during the first year of the 
 war was 143,991 cases and 2400 deaths; during the second year, 160,263 cases and 
 5690 deaths — making a total for the two years of 304,254 cases and 8090 deaths. 
 These cases were distributed among the several affections included in the group, as 
 shown in the following table : 
 
 TABLE XXX. 
 
 Number of Gases and Deaths from Inflammatory Diseases of the Respiratory Organs during the first 
 
 two years of the war. 
 
 Catarrh 
 
 Epidemic Catarrh . 
 
 Laryngitis 
 
 Acute Bronchitis... 
 Chronic Bronchitis 
 
 Pleurisy 
 
 Pneumonia 
 
 Total spoken of as Inflammatory Diseases of the Respiratory Organs. 
 
 Tear ending June 30, 1862. Year ending June 30, 1863, 
 
 83,837 
 
 11, 3U 
 2,597 
 
 26,201 
 3,902 
 5,079 
 
 11,061 
 
 143,991 
 
 5 
 
 5 
 
 34 
 
 102 
 
 36 
 
 84 
 
 2,134 
 
 2,400 
 
 63,202 
 5,919 
 
 50,799 
 9,518 
 
 10,359 
 
 20,466 
 
 160,268 
 
 24 
 152 
 187 
 201 
 169 
 4,957 
 
 5,690 
 
 The total number of cases during the first year amounted to more than one-half the 
 mean strength; during the second year, however, to not much more than one-quarter of 
 the strength. The deaths were between 8 and 9 per 1000 of strength during each year. 
 
INFLAMMATORY DISEASES OF THE RESPIRATORY ORGANS. 
 
 129 
 
 TABLE XXXI. 
 
 Total Number of Gases and Deaths from Inflammatory Diseases of the Respiratory Organs for the first 
 two years of the war, with the annual ratio per 1000 of mean strength. 
 
 
 Taken sick. 
 
 Died. 
 
 Annual ratio 
 
 of cases per 
 
 1000 of mean 
 
 strength. 
 
 Annual ratio 
 
 of deaths per 
 
 1000 of moan 
 
 strength. 
 
 Tear ending June 30, 1862 
 
 143,991 
 160,263 
 
 2,400 
 5,690 
 
 512-10 
 267-63 
 
 8-25 
 8-83 
 
 Year ending June 30, 1863 
 
 For the two years 
 
 804,254 
 
 8,090 
 
 345-74 
 
 8-65 
 
 
 It will thus be seen that the ratio of cases to strength during the, second year is 
 only about one-half that during the first while the ratio of deaths to strength is about 
 the same; so that while the proportionate number of cases greatly diminished during 
 the second year, their comparative fatality increased and the proportion of mortality 
 to strength remained about the same. The greater prevalence of slight cases during 
 the first year thus indicated is probably to be attributed, to a certain extent at least, to 
 the large number of men taken suddenly, during the fall and winter, from the shelter 
 and comforts of civil life and subjected to the exposure of camps. The greater number 
 of cases of measles during the first year is also undoubtedly connected with the greater 
 prevalence of catarrhal cases. 
 
 Unlike camp fever and diarrhoea, the inflammatory affections of the respiratory 
 organs occurred with nearly equal frequency in the three regions, the only exception 
 being in the case of the Pacific region, which suffered somewhat less than the others 
 during the first year, somewhat more during the second. The proportion of mortality 
 to strength, however, followed the same general law as the other important camp dis- 
 eases, being most frequent in the Central and least so in the Pacific region. In the 
 Central region it was 16 per 1000 of strength during the first year, 14 during the 
 second; in the Atlantic about 4 per 1000 of strength during both years; in the Pacific 
 about 1 per 1000 during both. Table XXXII. gives the details. 
 
 TABLE XXXIL 
 
 Number of Gases and Deaths from Inflammatory Diseases of the Respiratory Organs in each of the 
 
 three regions. 
 
 
 Teae ending June 30,1862. 
 
 Year ending Jdne 30, 1863. 
 
 Taken sick. 
 
 Died. 
 
 Eatio per 1000 
 
 of mean 
 
 strength 
 
 taken sick. 
 
 Ratio per 1000 
 
 of mean 
 
 strength 
 
 died. 
 
 Taken sick. 
 
 Died. 
 
 Eatio per 1000 
 
 of mean 
 
 strength 
 
 taken sick. 
 
 Eatio per 1000 
 of mean 
 strength 
 
 
 90,481 
 
 61,471 
 
 2,089 
 
 735 
 
 1,658 
 
 7 
 
 508-61 
 582-92 
 304-56 
 
 4-03 
 
 16-31 
 
 1-04 
 
 76,515 
 
 81,214 
 
 2,534 
 
 1,083 
 
 4,595 
 
 12 
 
 269-67 
 265-05 
 290-83 
 
 3-48 
 
 14-17 
 
 1-38 
 
 Central Reffion 
 
 Pacific Resrion 
 
 Total 
 
 143,991 
 
 2,400 
 
 512-10 
 
 8-25 
 
 160,263 
 
 5,690 
 
 267-63 
 
 8-83 
 
 « 
 
 
 
 
 17 
 
 
 
 
 
 
130 
 
 INFLAMMATORY DISEASES OF THE RESPIRATORY ORGANS. 
 
 The proportion of deaths to cases was likewise greater in the Central than in the 
 
 Atlantic, and in this than in the Pacific region, and, as already intimated, it was greater 
 
 during the second year than during the first. In the Atlantic region there was one death 
 
 to every 123 cases during the first year, one to every 71 during the second; in the Central 
 
 region one to every 31 cases during the first year, one to every 18 during the second; 
 
 in the Pacific region one to every 291 cases during the first year, one to every 211 
 
 during the second. The average for all regions and both years was one death to every 
 
 38 cases. 
 
 TABLE XXXIII. 
 
 Belation between Gases and Deaths of Inflammatory Diseases of the Respiratory Organs. 
 
 
 Thar enbins June 30, 1862. 
 
 YfiAB ENDIHG JUNE 30, 1863. 
 
 Annual Average for the 
 TWO Years. 
 
 Ratio of 
 deaths per 
 1000 cases. 
 
 Number of 
 
 cases to each 
 
 death. 
 
 Ratio of 
 deaths per 
 1000 cases. 
 
 Number of 
 
 cases to each 
 
 death. 
 
 Ratio of 
 deaths per 
 1000 cases. 
 
 Number of 
 
 cases to each 
 
 death. 
 
 
 8-15 
 
 32-21 
 
 3-44 
 
 122-70 
 
 31-05 
 
 290-70 
 
 14-15 
 
 56-58 
 
 4-74 
 
 70-67 
 
 17-67 
 
 210-97 
 
 10-91 
 
 47-13 
 
 4-15 
 
 91-66 
 
 21-22 
 
 240-96 
 
 Central Region 
 
 
 Total 
 
 16-70 
 
 59-88 
 
 35-60 
 
 28-17 
 
 26-62 
 
 37-57 
 
 
 The efiect of season on the development of these diseases is indicated, as might be 
 expected, by the occurrence of the greatest number of cases during the winter. On the 
 Atlantic coast the number of cases taken sick each month gradually increased from 
 July, 1861, to January, 1862, after which it diminished to August, 1862, increased till 
 December, and then diminished through 1863 till the close of the fiscal year in June, 
 with the exception of an irregular increase in March. In the Central region the dis- 
 ease pursued an essentially parallel wave, and this was the case during the second year 
 in the Pacific region. In the Pacific region during the first year, however, the wave 
 was less regular. The following tables exhibit these relationships in detail : 
 
 TABLE XXXIV. 
 
 Monthly Rates of Inflammatory Diseases of the Respiratory Organs in the Armies of the United States 
 during the year ending June 30th, 1862, expressed in ratio per 1000 of mean strength* 
 
 
 1861. 
 
 1862. 
 
 For the 
 year. 
 
 >> 
 
 1 
 1 
 
 
 1 
 
 t 
 
 1 
 
 15 
 
 1 
 
 1 
 
 1 
 
 1 
 
 1 
 
 1 
 
 1 
 
 Atlantic Region 
 
 Central Region 
 
 Pacific Region 
 
 27-06 
 
 16-83 
 
 7-53 
 
 29-17 
 
 21-41 
 
 1-01 
 
 28-82 
 30-45 
 22-18 
 
 35-75 
 35-37 
 21-46 
 
 52-95 
 53-40 
 32-73 
 
 64-32 
 75-89 
 23-86 
 
 67-17 
 98-29 
 24-38 
 
 59-64 
 62-92 
 56-80 
 
 44-51 
 63-37 
 40-44 
 
 32-73 
 38-37 
 15-76 
 
 17-86 
 19-87 
 17-46 
 
 13-27 
 15-88 
 12-19 
 
 506-86 
 532-92 
 304-56 
 
 * The Table of Catarrhal Affections published for this year in the Circular of September 8, 1863, before alluded 
 to, did not include Pneumonia or Pleurisy, and hence differs considerably from the above. 
 
INFLAMMATORY DISEASES OF THE RESPIRATORY ORGANS. 
 
 131 
 
 TABLE XXXV. 
 
 Monthly Bates of Inflammatory Affections of the Respiratory Organs in the Armies of the United States 
 during the year ending June 30th, 1863, expressed in ratio per 1000 of mean strength. 
 
 
 1862. 
 
 1863. 
 
 Tor the 
 year. 
 
 1 
 
 
 1 
 
 S 
 1 
 
 1 
 1 
 
 1 
 1 
 
 i 
 n 
 
 1 
 
 1 
 
 1 
 
 
 
 i 
 4 
 
 Atlantic Region .... 
 
 Central Region 
 
 Pacific Region 
 
 13-46 
 12-01 
 12-63 
 
 9-37 
 10-03 
 13-18 
 
 10-34 
 10-14 
 16-65 
 
 13-87 
 17-07 
 18-66 
 
 24-55 
 33-10 
 
 27-67 
 
 32-82 
 35-03 
 32-99 
 
 33-12 
 30-75 
 35-38 
 
 28-13 
 32-34 
 31-10 
 
 35-19 
 28-30 
 22-72 
 
 24-51 
 20-49 
 32-66 
 
 12-44 
 11-29 
 25-78 
 
 7-21 
 
 8-28 
 
 18-00 
 
 269-70 
 265-05 
 290-83 
 
 The rates contained in the foregoing tables are presented also in the lower diagram 
 of the plate opposite page 120, where they may be instructively contrasted with the 
 course of diarrhoea and dysentery. 
 
 A reference to Table XXX. will show that by far the greatest number of deaths 
 from the inflammatory affections of the respiratory organs were reported under the 
 head of Pneumonia. Out of a total of 8090 deaths from respiratory affections, 7091 are 
 reported as due to this cause. It might perhaps be claimed that this mortality is too 
 great, on account of a certain number of cases of fatal pleurisy and bronchitis having 
 been erroneously included. But the same deficient knowledge of auscultation and per- 
 cussion which would lead to this error, would produce also an error in the opposite 
 direction, and cause the slight cases of pneumonia to be reported as bronchitis. While 
 then it is possible that the ratio of deaths from pneumonia to strength is somewhat too 
 great, the probabilities are in favor of the approximative correctness of the proportion 
 of deaths to cases; and this proportion is so great, as compared with the results in 
 modern civil hospitals, as to direct attention to the general want of success which ap- 
 pears to have attended the treatment of this disorder. The experience of the two 
 years gives a mortality of one death to every seven (6 "8) cases in the Atlantic region 
 and one to every four (3-8) in the Central, as is shown in the following table: 
 
 TABLE XXXYI. 
 
 Batio of Deaths from Pneumonia to Gases in the three regions. 
 
 
 FmsT Tear. 
 
 Second Yeae. 
 
 Foe 
 
 THE TWO YeAES. 
 
 Cases. 
 
 Deaths. 
 
 Number of 
 
 cases to 
 each death. 
 
 Cases. 
 
 Deaths. 
 
 Number of 
 
 cases to 
 each death. 
 
 Cases. 
 
 Deaths. 
 
 Number of 
 
 cases to 
 each death. 
 
 
 4,582 
 
 6,366 
 
 113 
 
 11,061 
 
 601 
 
 1,529 
 
 4 
 
 7-6 
 
 4-2 
 
 28-8 
 
 5,894 
 
 14,450 
 
 122 
 
 933 
 
 4,014 
 10 
 
 6-3 
 
 3-6 
 
 12-2 
 
 10,476 
 
 20,816 
 
 235 
 
 1,534 
 
 5,543 
 
 14 
 
 6-8 
 
 3-8 
 
 16-8 
 
 
 Pacific Region 
 
 Total 
 
 2,134 
 
 5-1 
 
 20,466 
 
 4,957 
 
 4-1 
 
 31,527 
 
 7,091 
 
 4-4 
 
 
132 CERTAIN OTHER DISEASES. 
 
 The great proportion of deaths to cases thus indicated was undoubtedly connected 
 to a certain extent with the character of the disorder. The two chief types to which, 
 as far as can be learned, the majority of the cases belonged, were Typhoid Pneumonia 
 and Adynamic Pleuro-Pneumonia; the first characterized in fatal cases by the condi- 
 tion of the lung designated Splenization, the second, besides the lung lesion, by the 
 presence on the pleura of considerable masses of yellow opaque lymph, with fluid in 
 the pleural cavity. 
 
 Both these forms occurred in a large number of cases as sequelge to measles, or 
 intercurrent affections in the course of chronic diarrhoea and chronic malarial poisoning. 
 In many instances, moreover, what was called pneumonia proved, on the autopsy, to be 
 camp fever, in which the usual intestinal lesions were associated with congestion of the 
 lungs, with capillary bronchitis, or with pneumonia: of course these circumstances 
 would lead to the expectation of a greater mortality than is found among uncompli- 
 cated cases occurring in civil practice. The mortality from pneumonia in the British 
 army in the Crimea was still greater than our own figures, being one death to every 
 3 "6 cases. 
 
 A considerable amount of valuable material has been contributed on the symp- 
 toms, post-mortem appearances, and treatment of this disorder, a careful analysis of 
 which will be presented at the proper time. With regard to treatment, it may be 
 stated that the use of alcoholic stimulants, supporting diet, quinine in large doses, and 
 the expectant plan found numerous advocates, as well as opium, ipecacuanha, veratrum 
 viride, antimony, cupping, and mercurials. The attempt to appreciate these methods 
 must, be postponed for the present. 
 
 CERTAIN OTHER DISEASES, 
 
 The most important affections reported under the head of Entlietic Diseases were 
 the several forms of venereal. The reports give separate figures for syphilis, gonorrhoea, 
 orchitis, and stricture of the urethra. The latter two affections being gonorrhoeal 
 sequelae, may be grouped under the head of Gonorrhoea. Of syphilis, there were 9011 
 cases and 12 deaths during the first year; 13,781 cases and 27 deaths during the 
 second — total, 22,792 cases and 39 deaths. Of gonorrhoea and its sequelge, 14,768 cases 
 and no deaths during the first year; 25,705 cases and 12 deaths during the second — 
 total, 40,473 cases and 12 deaths. The number of cases of all kinds of venereal was 
 23,779 for the first year arid 39,486 for the second, being 85 cases per 1000 of strength 
 for the first year and 66 per 1000 for the second. The ratio of venereal to the total 
 amount of disease was one case of venereal to every 35 taken sick during the first year; 
 one to every 41 taken sick during the second. 
 
 If these figures be compared with the experience of other armies, we cannot fail to 
 congratulate ourselves on the comparative exemption of our troops from these loathsome 
 affections. The published statistics of the English army, for example, show that in 
 1859 there were 422 admissions to hospital for venereal among every 1000 men serving 
 in the United Kingdom; in 1860, 369 per 1000; in 1861, 354, and in 1862, 330— 
 being thus between one-third and one-half the whole number of admissions to hospital. 
 It may be thought, perhaps, that the active occupations of a war carried on in an ex- 
 
CERTAIN OTHER DISEASES. 
 
 133 
 
 tensive and comparatively thinly-populated country will account for this difference in 
 our favor; but the published statistics of the United States army from 1840 to 1859 
 give a mean annual rate of only 99 cases of venereal per 1000 of mean strength during 
 that period; and this, though larger than the rates above given for the first two years 
 of the war, is less than one-third of the most favorable rate above quoted from the 
 English statistics. 
 
 When the frequency of venereal among the troops of the three regions is made 
 the subject of comparison, it is found that in the Atlantic region the rate was 87 cases 
 per 1000 of strength for the first year, 61 for the second; in the Central region, 60 per 
 1000 for the first year, 68 for the second; in the Pacific region rates are, however, 
 attained which closely approximate those of the English army, viz.: 375 per 1000 for 
 the first year and 317 for the second. 
 
 TABLE XXXVII. 
 
 Prevalence of Syphilis and Oonorrhoea in (he several regions. 
 
 
 Tear ending June 30, 1862. 
 
 Year ending June 30, 1863. 
 
 ATLANTIC 
 REGION. 
 
 CEKTRAX 
 BEOION. 
 
 PACIFIC 
 REGION. 
 
 TOTAL. 
 
 ATLANTIC 
 REGION. 
 
 CENTRAL 
 REOION. 
 
 PACIFIC 
 REQION. 
 
 TOTAL. 
 
 1 
 
 la 
 
 O bo 
 
 it 
 
 1 
 
 <*-■ 
 
 it 
 
 ii 
 
 
 S4 
 
 1 
 
 It 
 
 1 
 
 It 
 SB 
 
 1 
 
 il 
 
 l! 
 
 
 gt 
 
 1 
 
 Is 
 
 o M 
 
 il 
 
 it 
 
 Syphilis 
 
 6,139 
 9,366 
 
 34-61 
 
 62-59 
 
 1,628 
 . 4,147 
 
 16-86 
 42-94 
 
 1,244 
 1,266 
 
 186-81 
 188-95 
 
 9,011 
 14,768 
 
 32-05 
 52-52 
 
 6,118 
 11,326 
 
 21-66 
 39-92 
 
 6,439 
 12,841 
 
 21-01 
 41-91 
 
 1,224 
 1,538 
 
 140-48 
 176-62 
 
 13,781 
 25,706 
 
 23-03 
 42-93 
 
 Gonorrhoea and its sequelse..... 
 Total 
 
 15,496 
 
 87-10 
 
 6,775 
 
 59-79 
 
 2,509 
 
 374-76 
 
 23,779 
 
 84-57 
 
 17,444 
 
 61-49 
 
 19,280 
 
 62-92 
 
 2,762 
 
 317-00 
 
 39,486 
 
 66-94 
 
 
 The annual rate of venereal in the Pacific region, as given in this table, is greater 
 than that deducible from the published statistics of eighteen years of peace. But even 
 during that period it was about twice as great as in the rest of the army. 
 
 Among the documents connected with syphilis which have been received for pub- 
 lication, may be mentioned certain interesting papers with regard to the attempts 
 made by the military authorities in the Cities of Nashville and Memphis to limit the 
 spread of syphilis among the troops stationed near those places, by regulating prostitu- 
 tion after the plan practised by the French government in Paris — a plan which is re- 
 ported to have produced the most salutary results in both places. 
 
 Under the head of Dietic Diseases, the chief affections included are scurvy and the 
 abuse of alcohol. As to the latter of these causes of disease, the activity of the cam- 
 paigns, and the stringent regulations very generally enforced with regard to sutlers, 
 reduced the frequency of intoxication to a comparatively low figure in the large armies 
 of the Atlantic and Central regions. 
 
 During the first year, 656 cases of delirium tremens and 978 cases of drunkenness 
 (ebrietas) are reported — drunkenness here including only those cases in which, in con- 
 sequence of the debauch, the man was obliged to go on sick report; during the second 
 year, 772 cases of delirium tremens, 1221 of drunkenness, and 226 of chronic alcohol- 
 
134 CERTAIN OTHER DISEASES. 
 
 ism were reported. This would give a ratio of 6 cases of all kinds per 1000 of mean 
 strength for the first year; 4 per 1000 for the second. It is worthy of remark that the 
 proportional number of cases was much greater on the Pacific coast, where the condi- 
 tions of peace being more nearly approximated to, the men must of course have had 
 more opportunity and more leisure for debauch. In the Atlantic region, the ratio of 
 cases from the abuse of alcohol was 6 per 1000 of mean strength for the first year of 
 the war; 3 for the second. In the Central region, 4 per 1000 for both years; while in 
 the Pacific region it was 33 per 1000 for the first year and 35 for the second. 
 
 The amount of Scurvy reported was comparatively small: 1328 cases and 9 deaths 
 for the first year; 7395 cases and 90 deaths for the second. To this may probably 
 be added the greater part of the 304 cases and -31 deaths of purpura reported during 
 the second year. This extremely small number of cases of scurvy is unparalleled in 
 the history of armies, being but 5 per 1000 of mean strength for the first year and 13 
 for the second. It undoubtedly stands related to the quantity and comparatively good 
 quality of the army ration, — to the immense supplies of antiscorbutics, of medical 
 stores and comforts issued to the men by the Government, and to the large pay of the 
 private soldier, which is very many times greater than in any other army in the world, 
 and which, in part at least, was often spent at the sutler's on pickles, apples, pies con- 
 taining dried fruit, etc. From all these sources, ours have undoubtedly been the best- 
 fed soldiers in the world; and besides all this, they received at various times and 
 localities, stores collected and distributed by several benevolent and patriotic asso- 
 ciations, whose supplies, though of course comparatively small when contrasted with 
 those of the Government, were yet of considerable value in aiding to form the sum 
 total of the soldiers' resources. 
 
 Still it is not claimed that the alimentation of our troops was all that could 
 have been desired; for recognizable scurvy existed to a limited extent, and a scorbutic 
 taint, more or less pronounced, was a prominent phenomenon in most of the diseases of 
 the war. The open question of the army ration, and of its possible economical im- 
 provement, is one of great importance, which will not be here discussed. That some 
 alteration is needed, cannot be denied. 
 
 The scorbutic taint manifested itself very generally in the form of rheumatic pains 
 in the back and limbs, associated with the scorbutic clay-like appearance of the skin, 
 sometimes even with sponginess of the gums, much more rarely with petechige, scorbutic 
 discolorations about the flexure of the knee, etc. 
 
 Most of the physicians called upon to treat these cases, having had in their pre- 
 vious private practice little experience with scurvy, reported them as rheumatism, 
 lumbago, or neuralgia. It is by no means insinuated that all the cases reported under 
 these heads were of a scorbutic nature. Many of malarial neuralgia and many of 
 malingering were thus reported. Undoubtedly also a great deal of true rheumatism 
 existed; certainly, however, the latter affection formed but a small part of the enor- 
 mous number of rheumatic cases reported. During the first year of the war 26,257 
 cases of acute rheumatism, 14,216 of chronic, and 4289 of lumbago were reported, 
 making a tota] of 44,762 rheumatic cases; during the second year 45,677 cases of acute 
 rheumatism, 45,758 of chronic, making 91,435 rheumatic cases; of neuralgia, 7546 
 during the first year, 18,533 during the second. The sum is 162,276 cases of rheuma- 
 
DISCHARGES ON SURGEON'S CERTIFICATE OF DISABILITY. 135 
 
 tism and neuralgia for the two years, being 186 per 1000 of mean strength for the first 
 year; 184 for the second. How many of these were rightly named? What proportion 
 of them were in fact, as a vast number unquestionably were, simply the outward mani- 
 festation of incipient scurvy? What proportion of malingerers was there among those 
 lame backs which were so common? These are questions which, unfortunately, cannot 
 be answered with any approach to precision from our statistics, but in connection with 
 which there exists some valuable material for future discussion. 
 
 Under the head of Tubercular Disease, the most important is pulmonary consump- 
 tion, the number of cases of which, however, was not great: 2508 cases and 550 deaths 
 are reported during the first year; 5599 cases and 2040 deaths during the second — 
 being 8-9 cases per 1000 of mean strength for the first year; 9-3 for the second. The 
 deaths were one to every 4-5 cases during the first year; one to every 2-7 during the 
 second. In the British troops in the United Kingdom, the number of cases of pul- 
 monary consumption reported in 1861 was 9 per 1000 of mean strength; in 1862, 10 
 per 1000 ; the deaths for both years, one in every three cases. 
 
 Space does not permit further or more extended comments in this direction. It 
 is trusted, however, that enough has been said to give an idea of the scope and charac- 
 ter of the statistical work in progress. The figures hitherto presented refer wholly to 
 the white troops of our army. Separate statistical tables are projected for our colored 
 troops and for the prisoners of war in our military prisons. Good data for these tables 
 are on file. Elaborate tables are also being prepared on the subject of discharges from 
 service mi surgeons certificate of disability; these are reported by name to the Surgeon 
 General's Office, with the cause specified in each case, so that data exist for a complete 
 and trustworthy discussion of the subject. 
 
 DISCHARGES ON SURGEON'S CERTIFICATE OF DISABILITY. 
 
 The monthly reports of sick and wounded from hospitals, garrisons, and troops in 
 the field contain in the general summary a statement of the number of soldiers dis- 
 charged the service during the month on surgeon's certificate of disability. On the 
 reverse of the report, a nominal list is given setting forth, precisely as in the case of 
 deaths, the name, company, regiment, date of discharge, and nature of disability in 
 each case. From these nominal lists, the number of discharges for disability and the 
 nature of the disabilities can be computed with great accuracy. 
 
 The various duties devolving upon this branch of the office during the progress of 
 the war were such that it was not possible, until a few months since, to attempt the re- 
 duction of this voluminous material; and although the work is now fairly under way, the 
 figures for the second year of the war could not be completed in time for the present 
 publication. The statistical tables here oflFered, therefore, are limited to the first year. 
 The total number of men reported to the Surgeon General's Ofiice as having been dis- 
 charged the service on surgeon's certificate of disability during the year ending June 
 30th, 1862, was 28,620, or 98-3 per 1000 of mean strength. Of this number, 1937 
 were discharged for wounds and injuries, and 26,683, or 91-7 per 1000, for disease. 
 These discharges were apportioned as follows among the several States: 
 
136 
 
 DISCHARGES ON SURGEON'S CERTIFICATE OF DISABILITY. 
 
 TABLE XXXVIII. 
 
 Showing the Number of Men discharged the Service for Diseases and Wounds, during the year ending 
 
 June 30th, 1862, for each State. 
 
 Maine 
 
 New Hampshire 
 
 Vermont 
 
 Massachusetts 
 
 Connecticut 
 
 Rhode Island 
 
 New York 
 
 New Jersey 
 
 Pennsylvania 
 
 Delaware 
 
 Maryland 
 
 District of Columbia .. , 
 
 Virginia 
 
 Ohio 
 
 Indiana 
 
 Illinois 
 
 Michigan 
 
 Carried forward 
 
 Discharged 
 
 Discharged for 
 
 for disease. 
 
 injuries. 
 
 1,119 
 
 59 
 
 509 
 
 27 
 
 370 
 
 27 
 
 1,825 
 
 143 
 
 387 
 
 16 
 
 194 
 
 13 
 
 7,051 
 
 441 
 
 401 
 
 46 
 
 3,160 
 
 169 
 
 73 
 
 4 
 
 85 
 
 1 
 
 6 
 
 1 
 
 125 
 
 10 
 
 2,317 ' 
 
 142 
 
 1,688 
 
 166 
 
 1,719 
 
 182 
 
 1,185 
 
 58 
 
 22,164 
 
 1,500 
 
 State. 
 
 Brought forward 
 
 Wisconsin 
 
 Iowa 
 
 Minnesota 
 
 Missouri 
 
 Kentucky 
 
 Arkansas 
 
 Kansas 
 
 Nebraska 
 
 Colorado 
 
 New Mexico 
 
 California 
 
 Oregon 
 
 Washington Territory.. 
 
 Regulars 
 
 Miscellaneous 
 
 Total 
 
 Discharged 
 for disease. 
 
 22,164 
 
 1,095 
 
 1,050 
 
 179 
 
 796 
 
 330 
 
 1 
 
 115 
 
 59 
 
 4 
 
 4 
 
 33 
 
 3 
 
 2 
 
 754 
 
 94 
 
 26,683 
 
 Discharged for 
 
 wounds and 
 
 injuries. 
 
 1,500 
 
 59 
 111 
 30 
 62 
 14 
 
 32 
 4 
 1 
 3 
 1 
 
 114 
 6 
 
 1,937 
 
 It will be extremely interesting to compute the ratio of disctarges per 1000 of 
 strength actually in service from each State, but the above table has been too re- 
 cently constructed to afford time for the necessary comparisons, which, moreover, will 
 be still more instructive when the tables for the remaining years of the war are 
 completed. 
 
 The following tables show the number of discharges from the several classes, 
 orders, and individual diseases and injuries. They may be instructively compared 
 with Tables VI. VIII. and X., the last columns of which give the total taken sick and 
 died for the same year. In making the comparison it must be remembered that the 
 column "taken sick" in the tables referred to does not include secondary affections or 
 sequelae. 
 
 TABLE XXXIX. 
 
 Showing the Number of Discharges for Disability by Glasses of Diseases and Injuries, for the year 
 
 ending June SOth, 1862. 
 
 Glass. 
 
 
 Number 
 discharged. 
 
 I. 
 
 II. 
 III. 
 IV. 
 
 V. 
 VI. 
 
 Zymotic Diseases ,- . . 
 
 5,194 
 7,298 
 
 000 
 9,904 
 1,937 
 
 678 
 3,609 
 
 Constitutional Diseases 
 
 Parasitic Diseases 
 
 Local Diseases 
 
 Wounds, Accidents, and Injuries 
 
 Developmental Diseases 
 
 Unclassiiied and cause not stated 
 
 Total 
 
 28,620 
 
 
DISCHARGES ON SURGEONS CERTIFICATE OF DISABILITY. 
 
 137 
 
 TABLE XL. 
 
 Showing the Number of Discharges for Disability by Orders of Diseases and Injuries, for the year 
 
 ending June 30th, 1862. 
 
 Class, 
 
 I. 
 
 II. 
 
 IV. 
 
 V. 
 
 VI. 
 
 Miasmatic Diseases 
 
 Enthetic Diseases 
 
 Dietio Diseases , 
 
 Diatlietic Diseases , 
 
 Tubercular Diseases 
 
 Diseases of the Nervous System 
 
 Diseases of tlie Eye 
 
 Diseases of the Ear 
 
 Diseases of tlie Organs of Circulation 
 
 Diseases of the Respiratory Organs 
 
 Diseases of the DigestiTe Organs 
 
 Diseases of the Urinary and Genital Organs 
 
 Diseases of the Bones and Joints 
 
 Diseases of the Integumentary System , 
 
 Wounds, Accidents, and Injuries , 
 
 Developmental Diseases 
 
 Unclassitied andNsause not stated 
 
 Total 
 
 Number 
 discharged. 
 
 4,64.5 
 
 518 
 
 31 
 
 3,960 
 
 3,338 
 
 1,480 
 
 529 
 
 319 
 
 1,410 
 
 1,764 
 
 3,011 
 
 377 
 
 660 
 
 354 
 
 1,937 
 
 678 
 
 3,609 
 
 28,620 
 
 TABLE XLI. 
 
 Showing the Number of Discharges for Disability by Individual Diseases, during the year ending 
 
 June 30th, 1862. 
 
 LIST or DISEASES. 
 
 Class I.— Zymotic Diseases. 
 
 Obseb I. Miasmatic Diseases. 
 
 Typhoid Fever 
 
 Remittent Fever 
 
 Intermittent Fever 
 
 Diarrhcea 
 
 Dysentery 
 
 Erysipelas 
 
 Small-pox 
 
 Varioloid 
 
 Measles 
 
 Diphtheria 
 
 Debility 
 
 Other diseases of this order 
 
 Order II. Enihetic Diseases. 
 
 Syphilis 
 
 Gonorrhoea 
 
 Orchitis 
 
 Stricture of the Urethra 
 
 Other diseases of this order 
 
 Order III. Dietic Diseases. 
 
 Scurvy 
 
 Delirium Tremens 
 
 Inebriation 
 
 Carried forward 
 
 Nnmber 
 discharged. 
 
 268 
 
 70 
 
 56 
 
 865 
 
 118 
 
 17 
 
 12 
 
 13 
 
 81 
 
 4 
 
 3,139 
 
 12 
 
 49 
 
 60 
 
 1 
 
 7 
 
 4 
 
 20 
 
 5,194 
 
 LIST OF DISEASES. 
 
 Brought forward . 
 
 Class II.— Constitutional Diseases. 
 
 Order I. Diathetic Diseases. 
 
 Gout 
 
 Rheumatism 
 
 Ansemia 
 
 Cancer 
 
 Tumors 
 
 Obesity 
 
 Marasmus 
 
 Dropsy 
 
 Other diseases of this order. 
 
 Order II. Tubercular Diseases. 
 
 Consumption., 
 Scrofula 
 
 Class lY. — Local Diseases. 
 
 Order I. Diseases of Nervous System. 
 
 Apoplexy 
 
 Epilepsy 
 
 Headache 
 
 Insanity 
 
 Inflammation of the Brain. 
 
 Carried forward 13,441 
 
 Number 
 discharged. 
 
 5,194 
 
 4 
 
 3,585 
 
 42 
 
 5 
 
 40 
 
 2 
 
 6 
 
 237 
 
 3,161 
 177 
 
 1 
 
 669 
 
 8 
 
 246 
 
 25 
 
 18 
 
138 
 
 DISCHARGES ON SURGEON'S CERTIFICATE OF DISABILITY. 
 
 TABLE XLL— Concluded. 
 
 LIST OF DISEASES. 
 
 Brought forward 
 
 Order I. Diseases of Nervous System — Continued. 
 
 Nostalgia 
 
 Neuralgia 
 
 Paralysis 
 
 Sun-stroke 
 
 Chorea 
 
 Other diseases of this order 
 
 Order II. Diseases of Bye. 
 
 Amaurosis 
 
 Ophthalmia 
 
 Other diseases of this order 
 
 Order III. Diseases of Ear. 
 
 Deafness 
 
 Otalgia 
 
 Otorrhoea 
 
 Other diseases of this order 
 
 Order IV. Diseases of Organs of Circulation. 
 
 Heart Diseases 
 
 Varicose Veins 
 
 Varicocele 
 
 Order V. Diseases of Mespiratory Organs. 
 
 Asthma 
 
 Bronchitis 
 
 Aphonia 
 
 Inflammation of the Larynx 
 
 Inflammation of the Lungs 
 
 Inflammation of the Pleura 
 
 Haamorrhage from the Lungs 
 
 Other diseases of this order 
 
 Order VI. Diseases of Digestive Organs. 
 
 Colic 
 
 Constipation 
 
 Dyspepsia 
 
 Diseases of the Spleen 
 
 Fistula in Ano 
 
 Hernia 
 
 Prolapsus ani 
 
 Hcemorrhage from the Bowels 
 
 Inflammation of the Tonsils 
 
 Inflammation of the Stomach 
 
 Inflammation of the Bowels 
 
 Inflammation of the Peritoneum 
 
 Inflammation of the Liver 
 
 Jaundice 
 
 Piles 
 
 Loss of Teeth 
 
 Other diseases of this order 
 
 Carried forward 
 
 Number 
 discharged. 
 
 13,441 
 
 39 
 
 252 
 
 21 
 
 18 
 
 193 
 
 109 
 139 
 281 
 
 260 
 
 3 
 
 1 
 
 55 
 
 824 
 299 
 287 
 
 244 
 
 803 
 
 42 
 
 27 
 
 253 
 
 97 
 
 151 
 
 147 
 
 13 
 
 82 
 
 2,300 
 
 38 
 
 2 
 
 1 
 
 87 
 
 21 
 
 14 
 
 136 
 
 17 
 
 215 
 
 37 
 
 24 
 
 21,005 
 
 LIST OP DISEASES. 
 
 Brought forward 
 
 Order VIT. Diseases of Urinary and Genital Organs. 
 
 Diabetes 
 
 Diseases of Testis 
 
 Gravel 
 
 Inflammation of the Kidneys 
 
 Inflammation of the Bladder 
 
 Incontinence of Urine 
 
 Bright's Disease 
 
 Other diseases of this order 
 
 Order VIII. Diseases of Bones and Joints. 
 
 Anchylosis 
 
 Caries 
 
 Inflammation of Joints 
 
 Inflammation of Bones 
 
 Inflammation of Periosteum 
 
 Necrosis 
 
 Exostosis 
 
 Diseases of Spine 
 
 Other diseases of this order 
 
 Order IX. Diseases of Integumenta7-y System. 
 
 Abscess 
 
 Ulcers 
 
 Skin Diseases 
 
 Other diseases of this order 
 
 Class Y.— VoBnds, Accidents, and Injuries. 
 
 Burns and Scalds 
 
 Contusions 
 
 Concussion of the Brain 
 
 Sprains 
 
 Dislocations 
 
 Frost-bite 
 
 Fractures 
 
 Gunshot Wounds 
 
 Incised Wounds 
 
 Lacerated Wounds 
 
 Wounds (unspecified) 
 
 Amputations 
 
 Other accidents and injuries 
 
 Class VI.— Developmental Diseases. 
 
 Atrophy 
 
 Hypertrophy . 
 Deformities ... 
 
 Old Age 
 
 Under Age.... 
 Feebleness.... 
 
 Unclassified and cause not stated- 
 
 Total 28,620 
 
 Number 
 discliarged. 
 
 21,005 
 
 13 
 
 7 
 
 8 
 
 112 
 
 5 
 
 36 
 
 33 
 
 163 
 
 199 
 
 25 
 
 93 
 
 1 
 
 20 
 
 161 
 22 
 39 
 
 100 
 
 39 
 
 268 
 
 35 
 
 12 
 
 69 
 2 
 
 57 
 103 
 
 10 
 277 
 825 
 
 37 
 
 3 
 
 179 
 
 85 
 287 
 
 25 
 
 9 
 
 238 
 
 274 
 
 128 
 
 4 
 
 1,609 
 
 An inspection of Table XLI. shows that the diseases from which the greatest 
 number of discharges were reported were: Rheumatism, 3585; Consumption, 3161; 
 Debility, 3139; Hernia, 2300; Diarrhoea, 865; Heart Diseases, 824; Bronchitis, '803; 
 and Epilepsy, 669. It will be perceived that the discharges reported under these 
 headings constitute pver two-thirds of those discharges ■ for disease the causes of which 
 are specified in the reports. The large proportion of discharges indicated by these 
 
ARMY MEDICAL MUSEUM. — MEDICAL SERIES. 139 
 
 figures would appear to justify some of the criticisms that have been made on the man- 
 ner in which recruits were examined and discharges granted during the early part of 
 the war. It certainly cannot be denied that these criticisms had a certain foundation, 
 and that many men found their way into the service who were either physically disquali- 
 fied at the time, or whose constitutions were so feeble from youth, age, or predisposition to 
 disease, that they soon broke down under the labors and exposures of actual campaigns. 
 But when it is considered with what haste it was necessary to organize those large 
 armies, this fact ceases to be surprising, and it becomes rather a matter of wonder that 
 the discharges for disease should be represented by a figure no greater than nine per 
 cent, of the strength. It is also to be remarked that it is well known that numbers of 
 those who were discharged for curable diseases recovered and re-enlisted; so that while 
 the humane policy of releasing promptly from military restraint those who were not 
 likely to recover if they continued in service was doubtless the means of saving thou- 
 sands of lives, it is probable that the army rather gained than lost in actual strength 
 by this liberality. 
 
 The statistics of the several drafts and of the Veteran Reserve Corps belong to the 
 Bureau of the Provost Marshal General.* 
 
 ARMY MEDICAL MUSEUM. 
 
 Besides the statistical material and the documents accompanying it, such as the 
 reports of medical directors of armies, etc. etc., much valuable material of a strictly 
 pathological nature has been collected. To this category belong numerous valuable 
 memoirs on subjects connected with the leading diseases of the troops, histories of cases, 
 autopsies, etc., and the work done in connection with the Army Medical Museum. The 
 portions of this institution under my charge are the medical and microscopical col- 
 lections. 
 
 The Medical Series of the Museum, which is still growing, consists at present of about 
 700 specimens, chiefly wet preparations preserved in alcohol. Each preparation, after 
 careful dissection, in order that the lesion to be exhibited may be as clearly displayed 
 as possible, is suspended in alcohol from a glass hook in the stopper of a fine glass jar. 
 The jar has tied on its neck a parchment label, with the number of the preparation, 
 and the name of the lesion shown. Besides a number of miscellaneous pathological 
 preparations, the Museum contains good collections on valvular disease of the heart, 
 
 * For interesting information on this subject, reference may be made to the published reports of the Provost 
 Marshal General for 1864 and 1865. 
 
140 AKMY MEDICAL MUSEUM. — MEDICAL SERIES. 
 
 diphtheria, pleurisy and pleuro-pneumonia, camp fever, and camp diarrhoea and dysen- 
 tery. A collection illustrating the diseases of the freedmen has lately been commenced, 
 and promises to be of considerable interest. The manuscript catalogue, containing the 
 description of these specimens and the histories of the cases, occupies 350 pages folio. 
 
 A few words may be said with reference to the specimens illustrative of fever and 
 diarrhoea. The series illustrative of camp fever consists of about 160 specimens, chiefly 
 preparations exhibiting the condition of the intestine in this form of disease. The 
 pieces have been mounted upon frames of glass rod, and suspended in alcohol, so that 
 they can be viewed by either reflected or transmitted light. The specimens in this 
 series are arranged in several groups. 
 
 In the first, the characteristic lesion is enlargement of the solitary follicles of the 
 small intestine, and especially of the ileum. Thickening of Peyer's patches may be 
 quite absent, or may be present to a variable extent. All degrees of enlargement have 
 been noticed, from the slightest change to cases in which the follicle attains the size of 
 a pea. The most characteristic specimens may be thus described : In the fresh intestine, 
 as received at the Museum, the ileum presents patches of deep congestion of variable 
 extent; the solitary follicles, enlarged to the size of large pin-heads, are frequently black 
 with pigment deposits. The Peyer's patches, sometimes quite healthy, are more gen- 
 erally the seat of pigment deposits in the individual follicles composing the patch, which 
 appears of a gray color, dotted over with blackish points, presenting a resemblance to the 
 freshly-shaven chin. The name "shaven-beard appearance" has been quite currently 
 bestowed upon this condition. In other cases, the Peyer's patches are somewhat thick- 
 ened, and occasionally as much so as in ordinary cases of enteric fever. In the 
 preparations, as preserved in the Museum, the color of the piece, including that of 
 the pigment deposit, gradually disappears. The enlarged solitary follicles, and the 
 alterations in the Peyer's patches, are, however, well preserved. The solitary fol- 
 licles are not ulcerated in these cases, except rarely some of the largest, which 
 may present a minute point of ulceration on the apex. The form of fever from 
 which these specimens are obtained is that which attracted attention in 1862, under 
 the designation of Chickahominy Fever, but which, before and since, has prevailed 
 whenever our armies have operated in malarial regions. It is a continued fever, which 
 presents also a more or less decidedly remittent type, at the beginning at least. It is 
 accompanied by diarrhoea and abdominal tenderness, but usually without tympanites. 
 Cerebral and pulmonary complications are common, as in ordinary enteric fever. En- 
 largement of the spleen is frequent, and often excessive. The fever usually lasts from 
 three to five weeks, and terminates in a lingering and protracted convalescence. This 
 variety I have proposed to designate as the Malarial form of Typho-Malarial Fever. 
 
 The second group of specimens are less numerous, and represents, so far as I have 
 been able to learn, a rarer form of disease. As first received at the Museum, the ileum 
 presents intense reddish-black patches of congestion, which sometimes extend through- 
 out its whole length. The patches of Peyer are converted into livid, blackish, pulp-like 
 sloughs, which are often remarkable for their size and fungoid appearance. Petechia- 
 like blotches in the mucous membrane of the colon, the small intestine, and the stomach 
 are of frequent occurrence. Similar discolorations are at times observed in other organs. 
 The cadaver often presents petechise on the external surface of the body and scorbutic 
 
ARMY MEDICAL MUSEUM. — MEDICAL SERIES. 141 
 
 alterations of the mouth. During life, these cases are marked by the extremely ady- 
 namic character of the symptoms, by petechige, at times even by the characteristic scor- 
 butic lesions of the mouth, by haemorrhage from the bowels, and other haemorrhages 
 which complicate the disorder and often prove fatal. The specimens preserved in 
 the Museum, although they have lost their color, show satisfactorily the pulpy slough-like 
 transformation of Peyer's patches. This variety I have proposed to designate the 
 Scorbutic form of Typho-Malarial Fever. It occurred chiefly at times when other 
 scorbutic diseases were prevailing among the troops. 
 
 Specimens of the third group are quite identical with those obtained from the 
 typhoid or enteric fever of civil life, and the cases in many instances are undoubtedly 
 that affection in its ordinary form. As it occurred among the troops, however, the 
 course of the disease was so generally more or less modified by the influence on the 
 soldier of malaria, or of the scorbutic taint, or both, that 1 have proposed to indicate 
 such cases as the Enteric variety of Typho-Malarial Fever. 
 
 Besides these groups, there is a fine series of preparations showing the several 
 forms of ulceration left by the softening and destruction of the patches and solitary 
 glands in each of the varieties, the different methods of perforation, of cicatriza- 
 tion, etc. 
 
 A few brief abstracts of cases, selected from the foregoing series, are here presented 
 in illustration, especial prominence being given to the conditions observed in the 
 autopsies : 
 
 Private C , 6] st New York Vols., was admitted to Satterlee Hospital, West Philadelphia, Pa., July 10th, 1862, 
 
 from the Army of the Potomac, then on the Peninsula. His disease was registered Typhoid Fever. He died August 
 24th, 1862. Autopsy, August 25th : Organs generally healthy, except that the solitary glands were thickened, and 
 both these and Peyer's glands of a black color, resembling the bluish-black of tattooing. The surrounding parts of 
 the mucous membrane were pale and devoid of anything like congestion. No. 270, Medical Series, is a piece of the 
 ileum, showing numerous solitary glands the size of large pin-heads, and a Peyer's patch, which is not perceptibly 
 diseased. The whole ileum was received at the Museum in alcohol, and none of the Peyer's patches were prominent 
 Contributed by Prof. J. Leidy, then Acting Asst. Surgeon U. S. A. 
 
 Private D , 17th U. S. Infantry, was admitted to Satterlee Hospital, West Philadelphia, Pa., August 10th, 
 
 1862, from the Army of the Potomac. His disease was registered Typhus Fever. He died August 22d. Autopsy : 
 Age about twenty-two ; body moderately emaciated ; ecchymoses on the surface of the trunk. There were a number of 
 minute ulcers in the lesser curvature of the stomach ; the ileum was congested in patches ; most of Peyer's glands were 
 healthy, a few of thera slightly thickened, but none ulcerated ; the solitary glands were enlarged ; the colon was slate- 
 colored, with patches of congestion, a number of spots of ecchymosis, and in the descending portion a few small ulcers. 
 Nos. 273 to 276, Medical Series, are successive portions of the ileum, showing the enlarged solitary follicles and a few 
 slightly-thickened Peyer's patches No. 272 is the stomach, with minute ulcers in the lesser curvature. Contributed 
 by Prof. J. Leidy. 
 
 Private B , 7th Maine Vols., was admitted to Satterlee Hospital, West Philadelphia, August 10th, 1862, 
 
 from the Army of the Potomac. His disease was registered Diarrhoea. He died October 8th. Autopsy : Age about 
 twenty-seven years ; body much emaciated ; skin ecchymosed. There was continuous congestion throughout the small 
 intestine, which was most intense in its lower part ; the ileum was of a deep maroon color ; Peyer's glands were not 
 perceptibly altered; the solitary glands numerous and conspicuous from enlargement; the ascending colon was also 
 congested, and presented a few spots of ecchymosis with pigment in some of its solitary follicles. Nos. 237 and 238, 
 Medical Series, are successive portions of the ileum of this patient; each presents a normal Peyer's patch and a 
 number of enlarged solitary follicles. Contributed by Prof. J. Leidy. 
 
 Private W , 20th Michigan Vols., was admitted to Satterlee Hospital, West Philadelphia, December 13th, 
 
 1862, from the Army of the Potomac. His disease was registered Diarrhoea. He died December 26th, 1862. Au- 
 topsy, December 27th: Age about twenty-two years. Body rather emaciated; spots of purpura on the trunk; recent 
 pleurisy on both sides, most marked on the right ; pneumonia in the lower lobes of both lungs ; bronchitis; liver and 
 spleen enlarged ; moderate congestion diffused throughout ileum and colon ; enlargement of the solitary glands in 
 lower part of ileum ; Peyer's glands reddened ; slight enlargement of the solitary follicles of large intestine. Nos. 
 107 and 108, Medical Series, are successive portions of ileum, No. 108 taken from just above the ileo-coecal valve; 
 
142 ARMY MEDICAL MUSEUM. — MEDICAL SERIES. 
 
 both exhibit well-marked enlargement of the solitary follicles, many of which are as large as bird-shot. Each piece 
 exhibits a Peyer's patch, in which, in the alcoholic specimens, nothing abnormal is visible. No. 109, Medical Series, 
 is the enlarged spleen of this patient, 7| inches long, 5 wide by 3 thick. Contributed by Prof. J. Leidy. 
 
 Corporal S , 9th Wisconsin Vols., was admitted to Satterlee Hospital, West Philadelphia, December 16th, 
 
 1862, from the Army of the Potomac. His disease was registered Diarrhoea. He died December 24th. Autopsy 
 the same afternoon : Age about thirty years ; cadaver rather emaciated ; spots of purpura on chest and abdomen ; lobular 
 pneumonia in lower lobes of both lungs ; the inflamed portions numerous, from the size of a marble to that of a 
 walnut, and in a state of gray hepatization ; bronchitis ; stomach much contracted ; patches of congestion in small 
 intestines ; Peyer's patches congested and dark red in color, with, however, only the slightest degree of thickening in 
 some of the lowest of them ; the solitary glands looked like yellow mustard-seeds sprinkled on a red ground ; large 
 intestine streaked with ash color and dark red, and with purpura-like spots of eoohymosis. Nos. 93 to 98, Medi- 
 cal Series, are successive ponjtions of the ileum of this patient. As preserved in the Museum, Peyer's patches 
 are not perceptibly diseased, except the large patch in No. 98, which was taken from just above the ileo-coecal valve, 
 and which is slightly thickened. The solitary follicles in all the pieces are enlarged to the size of mustard-seeds. 
 Contributed by Prof J. Leidy. 
 
 Private D , 100th Pennsylvania Vols., aged eighteen, was admitted to Carver Hospital, Washington, D. C, 
 
 July 5th, 1864, from hospital at City Point, Va. He was considerably emaciated ; his tongue thickly coated ; pulse rapid 
 and feeble; there was headache, anorexia, and diarrhoea; the left parotid gland was swollen and painful. July 15th. 
 The parotitis has terminated in suppuration; the abscess was opened to-day; the febrile symptoms continue; there 
 are distinct remissions during the forenoon of each day; persistent diarrhoea. July 22d. Patient has grown gradually 
 worse ; the integument over the parotid has sloughed ; diarrhoea continues ; there is deafness and low delirium, espe- 
 cially at night; the remissions have not been so distinct for the last few days ; died this evening. Autopsy: Emacia- 
 tion; lungs congested; heart pale and flabby; Peyer's patches congested, but not thickened; the solitary follicles of 
 the ileum considerably enlarged ; several very minute ulcers in the vermiform appendix and the ascending colon. 
 Nos. 385, 386, and 387, Medical Series, are successive portions of the ileum, showing marked enlargement of the 
 solitary follicles. Peyer's patches are not perceptibly diseased. Contributed by Acting Assistant Surgeon 0. P. 
 Sweet. 
 
 Private V , 126th Ohio Vols., was admitted to Carver Hospital, Washington, D. C, from Field Hos- 
 pital, Army of the Potomac, July 4th, 1864. He was much emaciated, and suffering from symptoms resembling 
 typhoid fever. Tongue coated with thick, dry, brown fur, teeth with dark sordes ; tympanites ; petechiae on abdo- 
 men and chest; the diarrhoea was severe, but the stools feculent; the patient at first improved, but July 25th the 
 diarrhoea began to grow worse and delirium set in ; death July 30th. Autopsy : Old pleuritic adhesions on both 
 sides ; two ounces of serum in pericardium ; liver large and pale ; spleen large and firm ; the solitary follicles of small 
 intestine enlarged to the size of large pin-heads ; Peyer's patches congested, but not thickened ; the colon thin, pre- 
 senting a number of ulcers, which, in the descending colon, were large and irregular. No. 416, Medical Series, is a 
 portion of the ileum of this patient, taken from just above the ileo-coecal valve, showing pin-head enlargement of the 
 solitary follicles. The whole ileum (preserved in alcohol) was received at the Museum. No disease of Peyer's 
 patches was visible. Nos. 417 and 418, Medical Series, are from the transverse and descending colon, and present a 
 number of irregular ulcers. Contributed by Acting Assistant Surgeon 0. P. Sweet. 
 
 Private W , 7th Western Virginia Vol. Oav., aged nineteen, was admitted to Carver Hospital, Washington, 
 
 D. C, from the Army of Western Virginia, August 21st, 1864. He was considerably emaciated, and had been sick 
 for some time with fever, diarrhoea, and vomiting. When admitted, he appeared exhausted ; his pulse was frequent 
 and feeble ; he had slight diarrhoea and incessant vomiting ; under treatment, the vomiting disappeared, and the 
 diarrhoea greatly improved, but he remained in a typhoid condition, and died August 25th. Autopsy: Hypostatic 
 congestion of posterior part of lungs ; the right side of heart contained a large fibrinous clot ; the ileum presented 
 patches of congestion, with enlargement of the solitary follicles ; there were numerous ulcers of Peyer's patches, 
 which, however, presented this peculiarity, that three, four, or more small oval ulcers, a few lines in diameter, were 
 seated in each patch, but the remaining portions were nearly normal. This condition is well shown in the portions 
 preserved in the Museum, Nos. 407 and 408, Medical Series. In the colon, the solitary follicles were the seat of 
 pigment deposits. Contributed by Acting Assistant Surgeon 0. P. Sweet. 
 
 Private C was admitted to Hospital No. 3, Alexandria, Va., from the Field Hospital at City Point, November 
 
 30th, 1864. He was in an extremely typhoid condition, with sordes about the mouth, muttering delirium, petechial 
 spots on the surface, and ha3morrhage from the nostrils and bowels. He died December 3d. Autopsy: Peyer's 
 patches converted into black, pultaceous sloughs ; the solitary follicles enlarged, near the ileo-coecal valve some of 
 them ulcerated ; a few small ulcers in the coecum. No. 468, Medical Series, is the lower part of the ileum, which well 
 exhibits the sloughs described. After nearly a year's immersion in alcohol, they have not yet lost their dark color. 
 Contributed by Acting Assistant Surgeon W. Miner. 
 
 Private F ; 42d Massachusetts Vols., was admitted to Hospital No. 3, Alexandria, Va., October 29th, 1864. 
 
 He was taken sick about a, week before with a decided chill, followed by hot skin, severe headache, thirst, and diar- 
 rhoea ; has had no epistaxis or tympanites ; is wakeful, with hot skin, pulse 120, thirst, scanty urine, coated dry 
 
ARMY MEDICAL MUSEUM. — MEDICAL SERIES. 143 
 
 tongue, and some bronchial irritation. November 12th. Improved under treatment until this morning ; his respiration 
 IS now hurried; there is a renewal of all the febrile symptoms, more cough, and dark flashed cheeks, but none of the 
 physical signs of pneumonia. November 15th. Better. November 16th. Feeble, skin cool. November 17th. Bilious 
 vomiting several times last night ; some pain in the epio:astric region ; no tympanites ; pulse feeble ; the stomach 
 continues irritable, with frequent vomiting, the matters vomited resembling coffee-grounds towards the last ; death at 
 8 p.m. Autopsy: Not much emaciation ; intestines glued together with pasty yellow lymph ; abdominal cavity con- 
 tained two pints of yellow turbid fluid, with fiscal odor ; a perforation about i of an inch in diameter near middle of 
 ileum ; Peyer's glands much enlarged ; spleen enlarged and softened. No. 4,39, Medical Series, is a piece of the 
 ileum of this patient, presenting two deep typhoid ulcers quite like those encountered in ordinary enteric fever. One 
 of the ulcers has perforated, and the peritoneal surface of the piece is coated with pseudo-membrane. Contributed by 
 Surgeon E. Bentley, U. S. Vols. 
 
 The series illustrative of diarrhoea and dysentery consists of over 200 specimens, 
 grouped as follows: 
 
 The first group embraces the examples of follicular ulceration of the colon. The 
 specimens present all the transition forms of simple enlargement of the solitary follicles 
 of the colon, the rupture of the same, and the formation of punched-out ulcers of mod- 
 erate size. The colon is usually more or less thickened, the thickening, in some cases, 
 amounting to a quarter of an inch. The ulcers are usually rounded or oval, extending 
 nearly or quite to the muscular coat, and looking much as if they had been cut out with 
 a punch; when received fresh at the Museum, the appearances varied with the stage of 
 the process. In the few cases in which the solitary follicles were simply enlarged, with- 
 out ulceration, the intestine was seldom thickened. It was often normal in color; soi»e- 
 times, however, slate or ash colored; sometimes it presented patches of congestion. 
 The enlarged solitary follicles were often the seat of pigment deposits; sometimes also 
 an areola of pigment, deposited in and among the glands of Lieberkiihn, surrounded the 
 enlarged and blackened solitary follicles. These patients had generally died of some 
 other disease, as of camp fever supervening upon the diarrhoea, with lesions of the small 
 intestine — of gunshot wounds, etc. In the more serious cases of diarrhoea, the colon was 
 more or less thickened, and presented punched-out ulcers which had originated in the 
 solitary follicles. The colon was then seldom normal in its color. Sometimes it was 
 red, reddish brown, or reddish black; at other times greenish, slate, or ash colored; at 
 others, again, unnaturally pale. Its texture, when cut into, was sometimes tough and 
 lardaceous; sometimes it was softened. The ulcers usually presented a grayish or 
 yellowish-gray base. They were sometimes filled with mucus, at other times con- 
 tained pus. In the majority of the cases of this class, the small intestine was not 
 involved, unless camp fever had existed as a complication. 
 
 In the second group of cases, the follicular ulcers have extended until, in extreme 
 instances, the greater part of the mucous membrane of the colon is destroyed by the 
 vast erosions thus produced. The follicular ulcers usually extend by burrowing in 
 the submucous connective tissue; in this way, in some of the specimens, several of these 
 ulcers communicate with each other in the submucous tissue, though still retaining dis- 
 tinct orifices. The mucous layer containing the glands of Lieberkiihn, undermined by 
 the extension of the ulcer, not unfrequently hangs in shreds like a fringe from its edge; 
 the undermined portion being occasionally destroyed by ulceration, but more frequently 
 perishing by sloughing. In such specimens, when received fresh at the Museum, the 
 mucous membrane was generally of a dark-red, brownish, greenish-brown, or slate color. 
 The ulcers presented yellowish-brown or yellowish bases, often with blackish or brown 
 
144 ARMY MEDICAL MUSEUM. — MEDICAL SERIES. 
 
 sloughs adhering to their surface or edges. It would appear that this second group of cases 
 represents simply a more advanced stage of the disease shown in the first group; and 
 that the conditions determining the degree of ulceration are the duration of the disorder 
 on the one hand, on the other, the constitutional condition of the patients; those who 
 labored under the scorbutic taint, or who were otherwise brought to an extremely 
 adynamic condition, presenting the most extensive ulcers. 
 
 In the third group, the cases present more or less ulceration of the bowel, similar 
 to that seen in the first and second group ; but, in addition, the surface of the gut is 
 more or less coated ^ith a yellowish or greenish-yellow pseudo-membranous layer, 
 like that observed in the air-passages in diphtheria. This condition is generally the 
 result of an acute dysenteric process supervening upon a previous diarrhoea of long 
 standing. The appearances of the gut, when fresh, are masked by the plastered layer 
 of greenish-yellow or yellowish pseudo-membrane which coats its surface. 
 
 The fourth group includes those cases in which the small intestine is diseased 
 as well as the large. Most of these are examples of the complications of diarrhoea 
 with camp fever, and the lesions in the small intestine are therefore similar to the 
 lesions already described as existing in fever cases. In some instances the history of 
 the case shows fever to have been the primary disorder, from which, however, the 
 patient never wholly convalesced, but finally succumbed to the diarrhoea which super- 
 vCTied. In other cases, the fever occurred after the patient had suffered from diarrhoea 
 for months. The character of the lesions in the small intestine and colon usually 
 corresponds to this history. 
 
 But besides these cases, in which the affection of the small intestine is evidently 
 the result of fever, the Museum contains several specimens in which, from the charac- 
 ter of the lesion, it must be inferred that the affection of the small intestine is simply 
 an extension of the disease upwards from the colon. In these cases, the ileum is more 
 or less thickened, — the thickening being greatest near the ileo-ccecal valve. The thick- 
 ened ileum presents ulcers of variable size, which appear, as a rule, to have their origin 
 in the solitary follicles, and not in the patches of Peyer. 
 
 The fifth group embraces tubercular ulceration of the bowels. The ulcers are 
 more characteristic in the small intestine than in the large; but both small and 
 large intestines are usually affected. The patients have tubercles in the lungs; 
 cheesy transformation of the mesenteric glands; at times, other tubercular lesions. 
 In the small intestine, Peyer's patches appear to determine the position of the ulcers, 
 which are usually irregular ovals, with their long diameter transverse to the gut, as 
 has been observed in tubercular ulceration of the bowels in civil practice. Frequently 
 also small tubercles can be seen on the peritoneal surface of the piece opposite the 
 ulcers. Of this condition, fine specimens exist in the Museum. With this lesion of 
 the small intestine, thickening and ulceration of the colon are associated. The ulcers 
 are quite similar always to some one of the forms above described. Usually they are 
 extensive and deep, the colon being much thickened. I have not been able to satisfy 
 myself that they originate in tubercular deposits. On the contrary, they seem quite 
 like the colon ulcers of other patients from the same command who have no tubercular 
 disease whatever. Besides the foregoing groups, there are specimens of perforating 
 ulcers of the colon, cicatrices of colon ulcers, etc. etc. 
 
ARMY MEDICAL MITSEUM. MEDICAL SERIES. 145 
 
 Abstracts of a few cases are here very briefly presented in illustration of the fore- 
 going series : 
 
 Private E , 4th Iowa Cavalry, was admitted to Hospital No. 3, Vicksbnrg, Miss., October 10th, 1863. He 
 
 had suffered from diarrhoea for nine months previous to his decease. The attack began as dysentery, with frequent 
 bloody stools, which, in a day or two, greatly diminished in number, becoming mucoid and gelatinous. After five 
 weeks, the disease assumed the characters of chronic diarrhoea, which continued till his admission ; the dysenteric 
 symptoms, however, recurring from time to time. He died November 17th. Autopsy: A few calcareous tubercles 
 and cicatrices at the apex of each lung ; patches of congestion in small intestine ; at the lower end of the ileum a 
 few of Peyer's glands were slightly prominent; coecum of a deep red color, its mucous coat softened; the rest of the 
 colon much thickened, cutting like cartilage, pale, with livid spots or stains, and presenting great numbers of small 
 pnnched-out follicular ulcers ; spleen small. Nos. 119 to 123, Medical Series, are suc(fessive portions of the colon, 
 which show very well its thickness and the follicular ulcers. Contributed by Surgeon George F. French, U. S. Vols. 
 
 Private B , 5th Illinois Cavalry, aged twenty-one, was admitted to Hospital No. 3, Vicksbnrg, Miss., October 
 
 10th, 1863. Has been sick eight months. His disease began with an attack of intermittent fever, which was suc- 
 ceeded by dysentery for a few days, when the stools became watery, and the complaint assumed the character of 
 chronic diarrhcea, which it retained, with occasional dysenteric symptoms, until the date of his admission. Death, 
 November 19th. Autopsy: Old pleuritic adhesions; patches of congestion in small intestine; solitary glands en- 
 larged to the size of small shot ; Peyer's glands healthy ; coecum inflamed ; descending colon and rectum extensively 
 ulcerated. No. 145, Medical Series, is a piece of the ileum, with enlarged solitary follicles. No. 146, of the ulcerated 
 colon. Contributed by Surgeon George F. French, U. S. Vols. 
 
 Private C , 2d Battalion, Veteran Reserve Corps, on duty at the Fairfax Seminary Hospital, near Alexandria, 
 
 Va., applied for treatment August 6th, 1864. He stated that he had suffered from frequent attacks of diarrhoea 
 during the previous six months. He was pale and sallow, with furred tongue, quick pulse, and dry skin. The stools 
 were from ten to fifteen daily, consisting of thin frothy mucus mixed with blood. He died November 25th. Autopsy: 
 Small intestine normal ; colon extensively ulcerated, and coated with a dark-colored pseudo-membrane, which hung in 
 shreds from the edges of the ulcers. Nos. 383 and 384, Medical Series, are successive portions of the colon, exhibiting 
 the conditions described. Contributed by Assistant Surgeon H. Allen, U. S. A. 
 
 Private M , 108th New York Vols., was admitted to Douglas Hospital, Washington, D. C, February 13th, 
 
 1863. Had been taken sick in the Army of the Potomac, and was brought from Aquia Creek in a very feeble con- 
 dition. He was greatly emaciated, pulse 110, tongue red, stools frequent and liquid. He gradually sank, the abdomen 
 became tender and tympanitic, and he died March 20th. Autopsy: Pleuritic adhesions of lower lobe of right lung; 
 nutmeg liver ; patches of inflammatory congestion in small intestine ; the colon thickened, with numerous large ulcers ; 
 the remainder of its mucous surface plastered with pseudo-membrane. Nos. 288 and 289, Medical Series, are succes - 
 sive portions of the colon in this case. Contributed by Assistant Surgeon William Thomson, IT. S. A . 
 
 Private McD , 39th Massachusetts Vols., was admitted to Douglas Hospital, Washington, D. C, from the 
 
 Army of the Potomac, September 9th, 1864. He had suffered from frequent attacks of diarrhoea during the summer, 
 and had also had intermittent fever. For three weeks prior to his admission, he had been in field hospital. Oa admission, 
 he was emaciated and feeble ; conjunctiva yellow ; tongue furred ; pulse 80; abdomen flat and tender, especially over 
 the course of the colon ; frequent stools; slight cough. Death, September 30th. Autopsy: Pleuritic adhesions on 
 both sides; peritonitis; the pelvic cavity filled with thin pus; the viscera coated with patches of yellow lymph; 
 small intestine normal ; large intestine greatly thickened, with extensive irregular ulcers. No. 400, Medical Series, 
 is a portion of the colon of this patient. Contributed by Assistant Surgeon W. F. Norris, U. S. A. 
 
 Private S , 2d New York Heavy Artillery, was admitted to Douglas Hospital, Washington, D. C, from the 
 
 Army of the Potomac, September 9th, 1864, with chronic diarrhcea. At the time of his admission, he was much 
 emaciated, with jaundice and frequent bilious vomiting. Abdomen flat and tender ; stupor ; low delirium ; involun- 
 tary stools; and death on the 17th. Autopsy by Assistant Surgeon B. Curtis, U. S. A.. Emaciation; jaundice; 
 thoracic organs healthy; small intestine normal; mucous membrane of colon greatly thickened, with large irregular 
 ragged ulcers; a perforation the size of a dime in the caput coli; peritoneal adhesions, principally between right lobe 
 of liver and colon ; numerous metastatic foci in liver, especially in right lobe. No. 448, Medical Series, is a piece of 
 the ulcerated colon. No. 449, a section of the liver. The small yellow foci scattered through the liver consisted of 
 granular matter and the debris of normal tissue, but contained no pus. The condition was similar to what is often 
 observed in pyaemia due to gunshot wounds. Contributed by Assistant Surgeon W. F. Norris, U. S. A. 
 
 Corporal C , 160th Pennsylvania Vols., aet. twenty-four, was admitted to Columbian College Hospital, Wash- 
 ington, D. C, October 30th, 1864, for chronic diarrhoea. There was great emaciation, frequent pulse, and five or six 
 loose stools daily. November 11th. Attention was drawn to a dry cough at night, with frequency of respiration. 
 Death, November 18th. Autopsy : A large abscess was found in upper part of right lobe of liver. It had burst 
 through the diaphragm into right pleural cavity, which contained a gallon of sero-pus. The fifth, sixth, and seventh 
 ribs on this side were denuded of periosteum by the burrowing of the pus. The lower parts of the ileum and colon 
 
 19 
 
146 ARMY MEDICAL MUSEUM. — MICROSCOPICAL SERIES. 
 
 were thickened, with follicular ulcers, and coated with patches of pseudo-membrane. The mesenteric glands enlarged. 
 No. 435, Medical Series, is a portion of the liver in this case, exhibiting the abscess cavity. Nob. 436 and 437 are 
 successive portions of the ulcerated colon. No. 434, the collapsed right lung, coated with pseudo-membrane. No. 
 435, the seventh rib of the same side, its inner surface denuded of periosteum, and presenting several new formations 
 of bone. Contributed by Surgeon Thomas Crosby, U. S. Vols. 
 
 Private K , 1st Regt. Veteran Reserve Corps, aged forty-one, was admitted to the Post Hospital, Fort McHenry, 
 
 Md., September 30th, 1865. He had suffered from chronic diarrhoea for several months, and was much emaciated; 
 stools, from eight to ten daily. October 18th. He complained of a violent pain, which appeared to have its seat in the 
 kidneys. Death, October 21st. Autopsy: Hypostatic congestion of the posterior parts of both lungs; four ounces 
 of bloody serum in right pleural cavity ; the right lobe of the liver, adherent to the abdominal walls, presented three 
 abscesses, each containing about four ounces of thick flaky pus; spleen very large and soft; colon ulcerated from 
 one extremity to the other; some of the ulcers very large, and penetrating to the muscular coat. No. 668, Medical 
 Series, is the liver from this case. Contributed by Brevet Major De Witt 0. Peters, Assistant Surgeon U. S. A. 
 
 The arrival of recent specimens at the Museum has afforded good opportunities for 
 making drawings representing the appearance of the preparations immediately after 
 their removal from the body. Accordingly a series of careful water-color drawings has 
 been made, which show most of the typical forms of camp diseases. The drawings are 
 the work of Mr. Hermann Faber, and are faithful to the minutest detail. Some experi- 
 ments have been made which show that they can be reproduced with reasonable fidelity 
 by chromo-lithography. 
 
 The chromo-lithograph here presented will, it is hoped, give an idea of the capa- 
 bilities of this kind of illustration. (See plate opposite.) It represents a portion of 
 intestine, taken from near the middle of the ileum, of a patient who died in the 
 Third Division General Hospital, Alexandria, Virginia, December 11th, 1864. His 
 disease is given in the mortality report of the hospital as typhoid fever. He 
 stated on admission, however, that he had suffered from diarrhoea for several 
 months before the febrile symptoms set in. On the autopsy, the ileum was found 
 to present considerable vascularity, with patches of congestion. The solitary fol- 
 licles were enlarged to the size of pin-heads. The patches of Peyer slightly 
 thickened, with pigment deposits, giving them the shaven-beard appearance. There 
 were a few small ulcers of the solitary follicles near the ileo-coecal valve. The colon 
 was thickened, with numerous follicular ulcers, especially in the coecum and sigmoid 
 flexure. In the transverse colon, several of the ulcers were in the different stages of 
 cicatrization. The portion of ileum here represented is No. 465 in the Medical 
 Series of the Museum. No. 466 is a portion of the transverse colon, showing the 
 cicatrizing ulcers. This case belongs to the class in which typho-malarial fever super- 
 venes in the course of chronic diarrhoea. The drawing here presented is equally 
 characteristic of the uncomplicated cases of the malarial form of this fever. The 
 plate represents the portion of ileum slit up along its mesenteric attachment, and 
 spread out for examination. The blush of congestion in the lower part of the piece, 
 the injected condition of the vessels, the pin-head tumors formed by the enlarged 
 solitary follicles, the shaven-beard appearance of the small Peyer's patch near the top 
 of the piece, and of the larger one near the bottom, are all shown with reasonable 
 accuracy. It is desired to publish in the Medical History of the "War about thirty 
 plates, in this style, to illustrate the most important phases of the anatomical lesions 
 in camp fevers and camp diarrhoea. 
 
 The Microscopical series of the Museum consists already of about 1400 speci- 
 mens, of which 400 have been obtained by purchase and the rest have been prepared 
 
ILEITM m MALABTAL FOUM 
 
 OP 
 
AKMY MEDICAL MUSEUM.— MICROSCOPICAL SERIES. 147 
 
 in the Museum. The Microscopical series grew out of the attempt to conduct 
 exact investigations into the minute anatomical changes characteristic of the several 
 camp diseases, and especially of fever and diarrhoea. The great mortality of these 
 affections has already been intimated, and the vast practical importance of the present 
 study will therefore be at once understood, when it is recollected that no intelligent 
 eflforts to prevent or cure diseases can be made without a reasonable comprehension of 
 their nature, and that this must rest as a basis upon a just knowledge of their patho- 
 logical anatomy. Unfortunately, in the United States, pathological anatomy is but 
 little studied, and especially the application of the microscope to this branch of investi- 
 gation has not received the attention it deserves, so that there appeared little proba- 
 bility that an exact study of the pathological anatomy of our camp diseases would be 
 attempted, if it were not undertaken in the Army Medical Museum, and it became an 
 imperative duty to make an effort in this direction. The result of this effort is the 
 microscopical series, which, although small when contrasted with some of the European 
 collections, is the only considerable micro-pathological collection in the United States. 
 
 The majority of the specimens thus far placed in the cabinet are sections illustra- 
 tive of the normal histology of the intestines, and of the changes they undergo in fever 
 and diarrhoea; but the actual number of specimens preserved indicates only a small 
 part of the work done. Investigations have been continually made into pathological 
 processes, in which want of time and of a sufficient number of assistants have not per- 
 mitted the preservation of specimens. And this branch of the Museum has also been 
 frequently consulted in questions of adulterations, etc. requiring microscopical investi- 
 gation for their solution; a duty of considerable importance, which, of itself alone, 
 would more than repay the trifling cost of the establishment of this branch of the 
 Museum. 
 
 The greater number of the preparations hitherto made in the microscopical branch 
 of the Museum are the work of Brevet Captain Edward Curtis, Assistant Surgeon U.S.A., 
 whose patience and dexterity are deserving of high praise, and to whose intelligent 
 assistance I owe much of the success attained in this direction. In addition. Acting 
 Assistant Surgeon J. C. W. Kennon, who has recently been assigned as an assistant in 
 this branch of the Museum, is preparing a series of very beautiful minute injections, 
 which will form an important part of the collection. It would be wholly impossible 
 to present here a detailed account of the results arrived at by the microscopical work 
 performed. This must be postponed to its appropriate place, in the discussion of the 
 pathological anatomy of our camp diseases in the Medical History of the War. It may, 
 however, be noted, as a matter of interest, that the general results attained are not 
 only of value in connection with camp diseases, but have an important bearing on the 
 general comprehension of normal structure and of morbid action, as must in fact be the 
 case with all studies honestly and earnestly directed to any one series of pathological 
 lesions. In a general way, it may be said that the results of the investigations made 
 in the Museum accord, in many respects, with the ideas of the modern Berlin school of 
 pathological anatomy, are contradictory of the doctrine of exudation, taught so gen- 
 erally in the older medical text-books in use in this country, and at variance also in 
 several particulars with the views of Dr. Lionel Beale, lately so favorably received in 
 England. 
 
148 
 
 ARMY MEDICAL MUSEUM. — MICROSCOPICAL SERIES. 
 
 The best means of making the results of our microscopical studies available for the 
 information of medical men in America has exercised my most serious thought. Much 
 can be done by good drawings executed with the aid of the camera lucida. Some valuable 
 work in this direction has been executed by Mr. H. Faber, the artist before referred to. 
 Such drawings, however, have always attached to them more or less suspicion of being in 
 part at least ideal; and for this reason numerous attempts have already been made, both 
 in Europe and America, to photograph objects as seen with the microscope. Among the 
 experiments in this country, I may especially mention those of Prof. O. N. Rood, of Co- 
 lumbia College, New York, of Mr. L. M. Rutherfurd, of the same city, and of Dr. J. Dean, 
 of Boston. The first two of these gentlemen directed their attention to test objects, and 
 have obtained results which show the practicability of the idea. Dr. Dean has recently 
 published a paper on the anatomy of the spinal cord, illustrated with photo-lithographs 
 from micro-photographs of sections seen with low powers. This is the first attempt 
 made in America to reproduce micro-photographs by photo-lithography, a method 
 which, if successful with high powers, would be highly satisfactory, since no doubt could 
 be entertained as to the fidelity of the picture. It was therefore resolved to attempt 
 the photographic reproduction of the microscopical preparations necessary for the com- 
 prehension of the subjects under consideration, and, after some preliminary experiments 
 made at the Douglas Hospital by Brevet Major W. Thomson, Assistant Surgeon U. S. A., 
 on preparations furnished by the Museum, the necessary apparatus was constructed, and 
 Assistant Surgeon E. Curtis was directed to undertake the labor of preparing the neces- 
 sary illustrations. The task was by no means an easy one. The subject of micro- 
 photography is comparatively new, and the processes still require much improvement. 
 On the whole, however, the results attained by Dr. Curtis have exceeded the expecta- 
 tions formed when the experiment was undertaken, and justify the hope that they will 
 eventuate in the satisfactory preparation of all the illustrations required. 
 
 With low powers, no serious obstacle was encountered in obtaining excellent 
 photographs of properly selected preparations. The higher powers offered difficulties, 
 most of which, however, have been overcome. In experimenting with the higher 
 
 powers, the lined diatomacese were selected as test objects on 
 account of their definite and well-known structure. With 
 these the utmost success has been realized. A photograph of 
 Gyrosigma angulatum (Navicula angulata) has been obtained, 
 for example, magnified about 7000 diameters, in which the 
 hexagons appear of the same size and nearly as distinct as in 
 the cut, which was made by transferring to wood a tracing 
 from the original photograph. In fact, any of the markings 
 ^"'■^" on diatoms that are visible with the microscope can be photo- 
 
 graphed with the utmost clearness and ease, and the time has arrived when the in- 
 ability to photograph alleged markings will throw doubts on the correctness of the 
 observers who have supposed they saw them. 
 
 The plan employed in the photographic work, hitherto executed with high powers, 
 is as follows: The direct rays of the sun, reflected in a constant direction from the 
 mirror of a Silbermann's heliostat (loaned for the purpose by the Coast Survey), are 
 condensed by a large lens upon the plane mirror of the microscope, whence they are 
 
 .tVAV. 
 
 VAVAW 
 
 > # t • # # < ^ ^.< 
 
 ^SV^ 
 
ARMY MEDICAL MUSEUM. MICROSCOPICAL SERIES. 149 
 
 reflected through the achromatic condenser in the usual way. Before reaching the 
 achromatic condenser, however, the rays pass through a cell containing a solution of 
 the ammonio-sulphate of copper of sufficient density to absorb nearly all the rays 
 except those at the violet end of the spectrum.* The light used, therefore, is essen- 
 tially monochromatic, and contains, with enough illumination for agreeable vision, the 
 greater part of the actinic force of the sun's rays. The heating rays being chiefly at 
 the other extremity of the spectrum are of course excluded, and great actinic force is 
 obtained, therefore, without any danger to the preparations or the balsam cementing 
 of the object-glasses. The object-glass employed in the photograph of Gyrosigma 
 above alluded to was a one-eighth of an inch, by W. Wales & Co., of Fort Lee, 
 New Jersey. This glass is so constructed as to bring the actinic rays to a focus. 
 At the bottom of the draw-tube was placed an achromatic concave lens — the am- 
 plifier of Tolles (of Canastota, N. Y.), and an ordinary medium eye-piece com- 
 pleted the optical apparatus. The eye-piece extremity of the microscope was thrust 
 into one end of a long camera box, the connection made light-tight by means of 
 a black silk hood, and the image, received on a piece of plate glass, observed by 
 means of a focussing glass, while the focal adjustments were made. As with the very 
 long camera used, the arm of the observer cannot reach the milled head of the fine ad- 
 justment of the microscope, this head was grooved, and connected by a band with 
 a grooved wheel at the end of a long steel rod, the other extremity of which is near 
 the observer, who, by means of it, can focus accurately with any required length of 
 camera. There is nothing peculiar in the chemicals employed, and, with ordinary 
 collodion, and the high power above spoken of, from thirty to forty seconds' exposure 
 was quite suflScient. 
 
 Of the foregoing devices, most importance is to be attached to the employment of 
 monochromatic light (the violet end of the spectrum), and the use of an object-glass 
 constructed with special reference to the actinic rays. Both these points were suggested 
 to me by Mr. L. W. Rutherfurd, of New York, so well known by his connection with 
 telescopic photography, who has thought much, and made many satisfactory experi- 
 ments in this direction. I believe, however, that the apparatus, as above described, loses 
 some of its advantages by the use of the eye-piece, which I propose to substitute by a 
 lens of proper magnifying power, corrected, like the object-glass, in such a way as to 
 bring to a focus the actinic rays. Such a lens is now in process of construction for 
 further experiment. 
 
 The pathological photographs hitherto satisfactorily executed in the Museum have 
 chiefly been made with moderate magnifying powers, twelve to fifty diameters, though 
 some experiments with higher powers justify me in the belief that with the improve- 
 ments above described, all that is desired in this direction can be attained. Among 
 these experiments, I may particularly mention a view, magnified about four hundred 
 diameters, of the polygonal cells and flat cholesterin tables of a cholesteatoma, which 
 was found on the inner surface of the frontal bone of a soldier who died of epilepsy in 
 the neighborhood of Washington. 
 
 * EinleituDg in die HBhere Optik, von Dr. August Beer. Braunschweig, 1853, p. 48. 
 
150 
 
 ARMY MEDICAL MUSEUM. — MICROSCOPICAL SERIES. 
 
 For the preservation of these photographs for study, glass positives have been 
 printed, and mounted with a piece of ground glass behind them to serve as a back- 
 ground. These are held between the eye and the light, and present, when thus ex- 
 amined, a faithful image of the field of the microscope in every particular except color. 
 
 To render these photographs available for the general illustration of the subjects 
 to which they refer, especially of the minute pathological anatomy of camp diseases, 
 it was attempted to reproduce them by photo-lithography, instead of copying them by 
 any other method of drawing or engraving. After trial, however, I was reluctantly 
 obliged to conclude that, in its present undeveloped condition, photo-lithography is in- 
 adequate to represent the objects in question, which are among the most delicate and 
 beautiful within the range of microscopical observation, and all the details of which are 
 fully preserved in the photographs. Although I much regret this failure, and am not 
 without hopes that, at an early day, improvements in heliographic methods of litho- 
 graphing or engraving will give a process adequate to copying even the most difficult 
 photographs, I regret it the less because I have been fortunate enough to find in Mr. 
 H. Faber, the artist already mentioned, an engraver perfectly competent to make faith- 
 ful copies of the photographs to be reproduced. As an illustration of what may be ex- 
 pected in this direction, I present on the opposite page the reproduction of a photograph 
 of a perpendicular section of ulcerated colon, from the form of Chronic Diarrhoea or 
 Dysentery described on page 143. The blood-vessels were not injected in preparing 
 this section. The picture is not exaggerated, and is a good representation of the orig- 
 inal photograph, which, with the specimen, is preserved in the Army Medical Museum, 
 where both can be seen by any one desirous of comparing them with the engraving. The 
 
 Fia. 2. — Outline of the plate on opposite pflge. A A A A. rollicles of LleberkUliQ. B B. Muscle of Brilcke. C C G. Submacons 
 connective tissue. D D D D. Circular muscle of the colon. G E £. Longitudinal muscle, cut transvtrsely; at 11 H, two ot the 
 longitudinal bands of this layer. F F F. Peritoneal layer. G G Q Q, Points of very active cell multiplication. 1 1. An artery and 
 vein cut through transversely. 1. A deep follicular ulcer, extending to the muscular layer. 2. A small superficial ulcer, which has 
 penetrated to the submucous connective tissue. 3. An ulcer of greater size, psnetrating nearly to the muscular layer, which is 
 covered with grauulations. 
 
 woodcut here introduced gives an outline of the plate opposite, and is lettered for the 
 purposes of description. The section was cut perpendicularly through the colon trans- 
 versely to its length, and presents three points of ulceration, marked 1, 2, 3 in the figure. 
 To render this representation more intelligible, it may be remarked that two forms 
 of ulceration have been observed in the colon in these cases of Chronic Diarrhoea. In 
 the first, the process begins in the closed follicles; in the second, in the intestinal 
 epithelium or the glandular layer. In the first form, the closed follicles enlarge by 
 multiplication of their cellular elements till they project as little tumors above the 
 surface, as shown in Fig. 3, in which ^ is the enlarged solitary follicle. This figure is 
 

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 ARMY MEDICAL MUSEUM. — MICROSCOPICAL SERIES. 151 
 
 an outline transferred to wood from a tracing of the original photograph, which is quite 
 ^ as beautiful and de- 
 
 tailed as that repre- ! 
 
 sented in the plate. ^-^MMMi/^^^^--^ 
 
 It is lettered like ^__Z.^ '^^' ~~~" ^ 
 
 Fig. 2. The tumor, ^ .. .'^'_ ° 
 
 having enlarged to a ° ;:r o 
 
 certain extent, rup- f -" " ^^^^ ^r:^,-."'-"-"".^ 
 
 ^"'' *■ tures, its cellular ele- 
 
 ments escape, and a minute ulcer is formed, as shown in Fig. 4, in which ^ is the ruptured 
 follicle with the minute ulcer; the letters represent the same parts as in the two previous 
 figures. The cells or corpuscles of the connective tissue surrounding the enlarged follicle 
 now multiply, and the ulcer spreads by the superficial cells floating off into the intestinal 
 cavity, while a new base is continually formed by the multiplication of the subjacent 
 cells. 
 
 If the plate be carefully observed (especially with a lens), it will be noticed that the 
 connective tissue layer presents a finely granular aspect, in which each granule corresponds 
 to what, with a higher power, is recognized as a connective tissue cell or corpuscle. In the 
 neighborhood of the edges or base of any of the ulcers, it will be seen that these corpuscles 
 are more numerous, giving the tissue a more granular aspect. Whether the corpuscles 
 in question are true cells, with distinct cell walls, as argued by Virchow and the 
 Berlin school, or mere masses of germinal matter without distinct parietes, as Beale 
 would have us believe, is a question which cannot here be entered upon, on account 
 of the space necessary to explain and justify the views entertained. In either case, 
 it must be admitted that it is through the multiplication of these corpuscles by division 
 that the greater number of elements is produced, and not by the equivocal generation 
 of new cells, as has been so generally held. The Museum contains preparations 
 which illustrate all the stages of this multiplication, and it is believed that these can be 
 satisfactorily photographed for the Medical History of the War. The multiplication of 
 the cells or corpuscles of the submucous connective tissue is accompanied by the marked 
 thickening of the intestine so common in the disease under consideration. The ulcers 
 shown at the right and left of the section represented in the plate (and in Fig. 2, ^ and ^) 
 show diflFerent stages of the excavation thus produced. 
 
 The second form of ulceration begins by an abrasion or denudation of epithelium 
 at some point which does not correspond to the position of a solitary follicle. The 
 follicles of Lieberkiihn are next destroyed, and the ulcer spreads in the connective 
 tissue by the process which has just been described. The central ulcer of the plate 
 (Fig. 2, ^) is of this variety. Such ulcers are much rarer than those of the first kind, 
 and probably are always secondary to them. It is not possible to go into further 
 details in this direction at present, but it is hoped that a careful and fully illustrated 
 account of the minute anatomy of these diseases will be presented to the medical 
 profession in the Medical History of the War. 
 
HOSPITAL ORGANIZATION AND CONSTRUCTION. 
 
 The material bearing on hospital construction, organization, and administration is 
 extremely rich and complete. It consists of numerous reports in connection with the 
 subject, and of plans and descriptions of all the principal hospitals which have been 
 organized during the war, furnished by the surgeons-in-charge to the Surgeon General, 
 or by the medical inspectors to the Medical Inspector General. In addition, the records 
 of the general hospitals in existence during the war have been turned in to the Surgeon 
 General's Office. 
 
 From this lavish material, it will be possible to prepare a complete and faithful 
 history of the hospital system and of its transformations, both as to construction and 
 administration. Such a history will be of inestimable value in future wars, and is 
 full of most important applications to the hospitals of civil life. Never before, in the 
 history of the world, was so vast a system of hospitals brought into existence in so short 
 a time. Never before were such establishments, in time of war, so little crowded or so 
 liberally supplied. They differed, too, from the hospitals of other nations, in being 
 under the command of medical officers. Instead of placing at the head of establish- 
 ments, intended for the treatment of disease and wounds, officers of the line, who, 
 whatever their other accomplishments, could not be expected to understand the require- 
 ments of medical science, and who, with the best intentions in the world, might 
 seriously embarrass the action of the surgeon, as was sadly the case in the Crimean 
 war, and has been since in the English hospitals, our Government, with a wiser discre- 
 tion, made the surgeon the commandant of the hospital, and thus, while holding him 
 responsible for the results of its management, put it into his power to do much to 
 make those results favorable. The medical staff can point with pride to the conse- 
 quences of this liberal course. Never before, in the history of the world, has the mor- 
 tality in military hospitals been so small, and never have such establishments so com- 
 pletely escaped from diseases generated within their walls. 
 
 The hospital buildings used in the beginning, and on occasions of emergency 
 throughout the war, had been erected for other purposes; public buildings, school- 
 houses, churches, hotels, warehouses, factories, and private dwellings being fitted up, as 
 circumstances required. But gradually wooden pavilions, erected for the purpose, 
 came into extensive use, and ultimately the majority of the general hospitals belonged 
 to this class. The introduction of these pavilion hospitals was not the work of any one 
 man. Originally suggested by European experience, they were erected in all parts of 
 the country, under the direction of various medical officers, some by order of the Sur- 
 geon General, others by the authority of local commanders. The necessities of the 
 service and increasing experience suggested numerous alterations from time to time, 
 and it was not until the summer of 1864 that a circular order was issued directing uni- 
 formity in certain essential points. To trace out this gradual evolution of hospital con- 
 struction is, of course, out of the question here; but as the Circular of July 20th, 1864, 
 gives in a few words an idea of the system as fully developed, it is here reproduced • 
 (152) 
 
HOSPITAL ORGANIZATION AND CONSTRUCTION. 
 
 153 
 
 War Department, July 20th, 1864. 
 The following instructions are promulgated for the information of olHcers charged with the construction of gen- 
 eral hospitals, and will be deviated from only in cases of imperative necessity : Buildings will not be taken or occupied 
 for hospital purposes until after full examination and approval by a medical inspector, or other officer of the Medical 
 Corps detailed for this purpose ; and all alterations will be made in accordance with plans submitted by him and 
 
 approved by the Surgeon General. 
 
 Site. — The site of the hospital should be a well-drained plain, 
 with a sub-soil of gravel, and sufficiently extensive to accom- 
 modate the buildings. The situation should be elevated; as 
 remote as possible from marshes or other sources of malaria, and 
 must have a convenient supply of pure water. 
 
 Flan. — General hospitals will be constructed on the prin- 
 ciple of detached pavilions, each ward being in a separate build- 
 ing, with beds for sixty patients. Besides the wards, there will 
 be detached buildings for each of the following purposes : General 
 Administration Building, Dining-Room and Kitchen for Patients, 
 Dining-Room and Kitchen for Officers, Laundry, Commissary and 
 Quartermaster's Store-House, Knapsack-House, Guard-House, 
 Dead-House, Quarters for Female Nurses, Chapel, Operating- 
 Room, and Stable. The wards, administration building, kitchens, 
 dining-rooms, and chapel are to be connected by covered walks 
 which will have floors, but no sides. 
 
 No general plan for the arrangement of the buildings can 
 be directed, as the varying character and dimensions of sites 
 render an uniform adherence to any one impracticable. Wards 
 may be arranged "en echelon" in two converging lines, forming 
 a V, — in this case, the administration building should be at the 
 apex of the V, the other buildings between the wings ; or as radii 
 from the periphery of a circle, ellipse, or rounded oblong, — in this 
 case, the administration building should be one of the radii, the 
 other buildings within the enclosure; or parallel to each other, — 
 in this case, the administration building should be in the centre 
 of the row, the other buildings in the rear. Other plans may 
 be rendered necessary by the special features of the ground. 
 In any case, the important points to be observed are, to place 
 the buildings far enough apart (at least thirty feet should inter- 
 vene between two parallel buildings), and to locate them in such 
 a manner that no one shall interfere with the ventilation of an- 
 other. It is preferable to locate the wards so that the long 
 diameter may run north and south, or nearly so. 
 
 Each ward will be a ridge-ventilated pavilion one hundred 
 and eighty-seven by twenty four (187 X 24) feet. At each ex- 
 tremity, two small rooms nine by eleven (9X11) feet, one on each 
 Bide of a passage, six (6) feet wide, will be partitioned off. The 
 space remaining for patients will be one hundred and sixty-five 
 by twenty-four (165x24) feet (see Figure 5, A), which gives the 
 location of the beds and position of the doors and windows. The 
 small rooms are occupied as follows : Figure 5, a, chief nurse ; 
 6, closet for medicines, etc.; c, bath-room ; d, closet for close 
 stools. Figure 6 is the side elevation. 
 
 The wards will be fourteen (14) feet high from floor to eaves — 
 the pitch of the roof "to vary in accordance to the materials com- 
 posing it. The floor to be elevated at least eighteen (18) inches 
 from the soil, with free ventilation beneath it. A ward thus con- 
 structed will accommodate sixty (60) patients, allowing more than 
 one thousand (1000) cubic feet of air-space to each. The number 
 of wards will be regulated by the number of patients the hospital 
 is intended to accommodate. A hospital of twelve hundred (1200) 
 beds will require twenty (20) wards. 
 
 20 
 
 M. STANTON, 
 Secretary of War. 
 
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154 
 
 HOSPITAL ORGANIZATION AND CONSTETJCTION. 
 
 Administration Building.— ¥or a hospital of six to twelve hundred (600 to 1200) beds, this will be a ridge-venti- 
 lated building-, thirty-eight by one hundred and thirty-two (38X132) feet, and two stories high; the first fourteen (14) 
 and the second twelve (12) feet high in the clear. This building contains the general office, office of surgeon in 
 charge, linen and store rooms, dispensary, chaplain's office, lodging rooms for officers, etc. 
 
 Dining-Room and Kitchen for Patients. — The dining-room will be a ridge-ventilated building, large enough to 
 seat a number equal to two-thirds the number of beds. The most convenient form is a long parallelogram, into which 
 the kitchen opens in the centre of the long side. The kitchen will be divided into two unequal parts — the larger for 
 the preparation of ordinary diet, the smaller for the extra diet — the cooking in both to be done on ranges. Where 
 there is an engine, steam may be advantageously used for boiling. 
 
 Dining. Room and Kitchen for Officers. — A small building for this purpose will be situated near the administra- 
 tion building. 
 
 Laundry. — A building two stories high, with lodging for the laundresses on the second floor. The roof should be 
 flat, with posts for stretching clothes-lines. 
 
 Commissary and Quartermaster Store-Room. — A small two-story building, furnished with boxes and shelves for 
 the various parts of the ration, — having an ice-house connected with it for the preservation of meats and other perish- 
 able articles, and a room for clothing. The second story to contain lodging-rooms for the cooks. 
 
 Knapsach-House. — -A building to receive the effects of the patients while in hospital. It will contain as many 
 pigeon-holes, each two (2) feet square, as there are beds in the hospital. 
 
 Guard-House. — A detached building to lodge the guard, with a guard-room for prisoners. 
 
 Dead-House. — A small building containing two apartments, located so as not to be observed from the wards, and 
 lighted by sky-lights. 
 
 Quarters for Female Nurses. — A detached building containing lodging-rooms, dining-room, and kitchen for the 
 female nurses. 
 
 Ghapel. — A detached building, fitted for the purpose of religious services, so arranged as to be used also as a 
 library and reading-room. 
 
 Fig. 8. Fio. 7. FiQ. 9. 
 
 Operating-Rooms. — Two rooms, each fifteen (15) feet square ; one well lighted by sky-lights, the other by win- 
 dows. The first for surgical operations, the second for discharge-boards, etc. It should be situated near the admin- 
 istration building. / 
 
 Stable. — For ambulance and officers' horses. 
 
 Water Supply. — Where practicable, a large tank will be erected and kept supplied from wells or springs by 
 pumps worked by a steam-engine. The engine, if possible, will be situated near the kitchen and laundry, in which 
 case the steam may be made serviceable in cooking, and the power may be employed in working the washing and 
 mangling machines. 
 
 Sinks. — Where the supply of water is adequate, water-closets may be constructed in one of the small rooms in 
 each ward ; but where this is not the case, privies will be built at a convenient distance from the wards, furnished with 
 water-tight boxes, which must be emptied every night. 
 
 Ventilation. — During warm and mild weather the wards will be ventilated by the ridge (Figure 7), but during 
 
HOSPITAL ORGANIZATION AND C0NSTRUCTi6n. 155 
 
 winter the ridge will be closed (Figure 8), and ventilation by shafts substituted. Four stoves will be allowed to a 
 ward, each partly surrounded by a jacket of zinc or sheet-iron, with an air-box opening beneath it to furnish the sup- 
 ply of fresh air. At eight (8) feet from the stove will be a shaft, properly capped, through which the stove-pipe will 
 ascend. Figure 8 gives a section and Figure 9 a side view of the arrangement. The shaft should be eighteen (18) 
 inches square, and should not come below the tie-beams. 
 
 A conception of the character and extent of the large pavilion hospitals can be 
 perhaps still better obtained from a description of some one of them than from the fore- 
 going circular. A description of the Lincoln Hospital, one of the hospitals of Wash- 
 ington, D. C, is therefore here presented. This hospital was constructed in the latter 
 part of 1862, and first occupied in January, 1863. The original plans for its construc- 
 tion were furnished to the Surgeon General's Office by the writer of this paper. Several 
 modifications and improvements were, however, subsequently made by the successive 
 surgeons in charge. 
 
 The following description was furnished by Brevet Lieutenant Colonel J. C. 
 McKee, Surgeon U. S. A., for a long time surgeon in charge. 
 
 Lincoln Hospital, Washington, D. C, is located about a mile east of the Oapitol Building. Its site is a gently- 
 undulating, uncultivated plain, without shade-trees. East and south of the hospital, the plain declines towards the 
 Eastern Branch of the Potomac, which is about half a mile distant. The soil is a light sandy loam, resting on a 
 deep stratum of gravel. The hospital covers an area of thirty acres of ground, and consists of twenty detached 
 pavilion wards, arranged en echelon in the shape of the letter V, the apex of which looks westwardly. The adminis- 
 tration building is at the apex of the V. The buildings for kitchen, dining-rooms, etc. are in the space between the 
 two sides of the letter. The whole is surrounded by a picket-fence, five feet high, between which and the wards ,is a 
 wide road for ambulances. (See Figure 10 and the plate opposite to it.) 
 
 The Wards are pavilion barracks, built of rough boards, white- washed, with roofs of boards covered with tarred 
 paper ; they are twenty (20) in number, ten on each wing. Each ward is 187 feet by 24, 16 feet to the eaves and 
 20 to the ridge, at which there is the usual ridge-ventilation the whole length of the ward. They are plastered on the 
 inside for about eight feet above the floor. At the west end of each are four rooms, occupying fifteen feet in length. 
 These are used for clothing, baths, nurses, and sinks. Each ward contains thirty-four windows and four doors, one at 
 each end and two in the middle, opposite each other. Pour ventilating gratings, at regular distances in the floor of 
 the ward, communicate by wooden flues under the floor with the air outside, thus giving a full supply of fresh air 
 whenever the weather requires the doors and windows to be closed. VS''ith sixty-two patients, there are 72 square feet 
 of floor and 1447 cubic feet of air-space for each. Thirty-one beds are arranged on each side, with a chair and bed- 
 side table between each pair. An avenue of eleven feet is left between the two rows of beds. The wards are lighted 
 at night by kerosene lamps, and heated by stoves in winter. On the inner side of the two wings of the hospital, and 
 running the whole length of each, is a raised covered walk or corridor, on which is laid a railway track two feet wide 
 and 2156 feet long. Box-cars convey the food from the main and extra kitchens to each ward. 
 
 The Administration Building, at the apex of the triangle, is 184 by 38 feet, 22 feet to the ridge and 16 to the eaves. 
 A hall, 8 feet wide, runs the entire length of the first floor. On the left side of the hall are the following rooms : oflBce 
 of surgeon in charge, 14 by 14; oflice of military assistant, 11 by 14 (employs two clerks); principal ofBce, 56 by 14 
 (employs fourteen clerks); printing-office, 19 by 14 (employs two men); quartermaster's store-room for clothing, etc., 
 44 by 14 (employs two clerks); wardmaster's room, 13^ by 14; bath-room, 4J by 14; post-office, 7 by 14 (employs a 
 postmaster and assistant). On the other side of the hall, and on the right of the entrance door, are the office of the 
 officer of the day, 15 by 14; office of the officer of the guard, 11 by 14 (four clerks); office of surgical records, 11 by 
 14 (one clerk); private office of surgeon in charge, 12^ by 14; office of medical inspector, 11 by 14; linen-room, 66 
 by 14, — all washed clothing and bed-linen is sent from the laundry to this room, and thence distributed to the different 
 wardmasters; one clerk and four women are employed here, the latter in mending, etc. The medical store-room, 
 11 by 14, adjoins the dispensary, and is used for storing supplies. The dispensary, 25 by 14, usually employs four 
 men ; the medicines for the whole hospital are compounded here, under the charge of a hospital steward. Lastly, 
 the laboratory, which adjoins the dispensary, is 22 by 14 feet, used for preparing tinctures, ointments, plasters, etc. 
 
 On the second floor of the Administration Building is the Knapsack-Room, 111 by 37 feet. The effects, accoutre- 
 ments, etc. of the patients coming into hospital are deposited in this room for safe keeping. It employs two men, who 
 receive the articles deposited, issue tickets for the same, credit them to depositors, and deliver them when the patients 
 leave. There are 2184 boxes, arranged in parallel rows, reaching from the floor to the ceiling. Adjoining the Knap- 
 sack-Boom is the extra-duty men's room, 50 by 37 feet, used as a sleeping-room by the men employed on extra duty, 
 and a clerks' room, 25 by 23 feet, used by the clerks of the principal office for the same purpose. 
 
156 
 
 HOSPITAL ORGANIZATION AND CONSTRUCTION. 
 
 Within the triangle, formed by the two wings, and east of the administration building, is the Tank, resting upon a 
 platform 25 feet high, and holding 12,000 gallons of water. It is supplied from a well under the engine-room, and the 
 water forced into it by the engine, which drives the machinery of the laundry. This tank supplies each ward with 
 water by means of pipes. There are four other wells in the enclosure, used for drinking and culinary purposes. 
 
 Tig. 10. — Ground plan of Lincoln General Hospital, Washington, D.C. Scale, 200 feet to the inch. 1. Administration build- 
 ing. 2 2 2 2. Wards. 3 3. Dining-rooms. 4. Kitchen. 5. Laundry. 6. Stewards' quarters. 7. Sisters' quarters. 8. Engine- 
 house. 9. Meat-house. 10. Coal-house. 11. Commissary building. 12. Sutler. 13. Chapel. 14, Stable. 15. Freedmen's 
 quarters. 16. Guard-house. 17. Dead-house. 18. Barraclcs for guard. 19 20. Officers' quarters. 21. Covered way. 22. Tank. 
 The tents shown in the plate are not represented In this plan. 
 
 Twenty yards east of the tank is the Laundry, 61 by 24 feet. The building runs east and west, is two stories high, 
 and has a platform for drying clothes on the roof. Seven men and twelve women are employed in its various depart- 
 ments. The washing is done by steam-power, as is also the drying and ironing. The average wash is 5000 pieces 
 daily — has been pushed to 7000. On the first floor of the laundry is the washing apparatus, consisting of a mangle, 
 steam-boiler, revolving drum for wringing, rinsing-boxes, roller and ironing-table ; on the second floor is the steam 
 drying-room, 36 by 12^ feet. This is in addition to the drying arrangements on the roof. Separated by a partition 
 from the laundry on the first floor, is a sleeping-room for women, 22 by 24 feet; a kitchen for the same, 9J by 17; a 
 dining-room, 9^ by 18. The engine is in a building adjoining the laundry on the east; it is of six-horse power, and 
 
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HOSPITAL ORGANIZATION AND CONSTRUCTION. 157 
 
 employs one engineer and an assistant. It supplies power for the tank as well as for the laundry. The well which 
 supplies the tank is 40 feet deep, with usually 4 feet of water; its diameter is 6 feet. The steam pump can raise 2000 
 gallons of water per hour. 
 
 The building for Sisters' Quarters is 23 by 51 feet, with a wing 16 by 28, forming a letter "L." It is divided into 
 chapel, sitting-room, kitchen, etc. Twenty-eight Sisters of Charity were on duty, and I must bear evidence to their 
 efficiency and superiority as nurses. The extra-diet kitchen is under the care of a sister, and one is detailed by the 
 superior for each ward. They administer medicine, diet, and stimulants, are under the orders of the ward surgeon, and 
 are responsible to him alone. They have been beloved and respected by the men. 
 
 The Stewards' Quarters are 18 feet north of the engine-room, are two stories high— contain dining-room, 
 kitchen, sleeping-rooms, etc. Five stewards generally occupied this building. 
 
 The Operating- Room is 25 feet east of the engine-room. It is 17 feet square, and lighted by a sky-light on the 
 north side of the roof. A revolving-table is in the centre of the room ; also a cupboard for instruments, sponges, 
 microscope, etc., with a sink in the northwest corner. The Examining-Koom adjoining it is 17 feet 7 inches square, 
 and communicates by a door with the operating-room. 
 
 The Extra-Diet Kitchen is under the same roof with the general kitchen. It is 18 by 24 feet— has in it a Harri- 
 son's European range, 8 feet front, 3 feet 6 inches deep. A room 18 by 12 feet adjoins on the south. This kitchen 
 is under the supervision of a sister, who is generally assisted by from four to six men. 
 
 The Main Kitchen is 77 by 24 feet. It contains a cooking-range, 28 feet 10 inches long and 3 feet 2 inches wide; 
 also three of "Peters' and Johnson's bake-ovens or roasters," two boilers for tea and coffee, each with a capacity of 
 120 gallons, five boilers or cauldrons for soup or hash (60 gallons each), and two for heating water (one 60 gallons, 
 the other 22 gallons). Pull diet is prepared here for all the men in the hospital. 
 
 On either side of the kitchen, opening from it north and south, are the Dining-Rooms, each 146 by 24 feet, with 
 three tables running the whole length of each, capable of seating in all 860 men. At the distal end of each room a 
 door opens on a corridor and raised walk, so that the patients are protected from the weather in coming to their 
 meals. Cars, with cans fitted in them, are run around the corridors to the several wards with the food for those 
 unable to come to the dining-room. 
 
 On the northwest corner of the kitchen is a room 30 feet long, 14 feet wide, and 10 feet high, used for washing 
 dishes, roasting cofliee, etc. Prom 40 to 50 men are usually employed in the various departments of the kitchen. 
 
 Opposite the centre of the northern dining-room, and distant to the west 30 feet, is the Fire-Engine and Hose 
 House, 26 by 20 feet— contains one fire-engine, three hose-carriages carrying 1850 feet of hose, 34 ladders, 22 hooks, 
 278 axes, and 300 buckets. 
 
 Thirteen feet south of the kitchen is the Meat-Shop, \^ by 23. In its centre is an ice-box, 3^ by 14J and 4 feet 
 deep, lined with zinc. The allowance of ice per day is one pound for each man. 
 
 East of the kitchen, and connected by a covered way, is the Commissary Building, which is two stories high, — 
 the upper story is used to lodge attendants; the lower story, used for commissary store-room, is 82 by 23J, and is 
 under a commissary steward. In the northeastern corner is the liquor-room, 8J by 13, heavily planked and secured 
 against marauders. All liquor is issued here on the orders of the ward surgeons. The vegetable-room is in the 
 northwestern corner, and is 9 by 13J. An office, 9 by 15J, adjoins the liquor-room. The books and accounts are 
 kept in this office. The store-room is provided with a counter 52^ feet long, and gives employment to one steward, 
 one (jlerk, and two men. At the southern end is the bread-room, 14J by 23, which employs two men cutting bread 
 for the tables. Adjoining, on the east, is the bakery, 14 by 23^. The oven is 10 by 16 feet. 
 
 The Chapel is situated 63 feet east of the commissary building. It is a structure shaped like the letter "T," one 
 story in height, with a cupola on top. The main building is 24 by 78 feet. The northern end is used during the week 
 as a reading-room. The left wing, 18 by 26 feet, is used as a library; it contains 3000 volumes, contributed to the 
 hospital from various sources. The right wing is the same size, and is used as a school for the freedmen employed 
 in the hospital, who are instructed by two female teachers. 
 
 Twenty-four feet south of the chapel is the Sutler's Store, 24 by 68. The Stables, 25 by 101 feet, are 72 east of the 
 sutler's shop.; they contain 18 horses, 3 wagons, 3 ambulances, 3 carts and 1 night-cart. Thirteen men are employed 
 as hostlers, drivers, etc. One hundred and twenty-one feet northeast of the stables is the Guard-House, 15 by 47 and 
 one story high. South of this is the Oil-Room and Freedmen' s Quarters, 29 by 69 feet. The oil and lamp room are in the 
 northern part. Kerosene oil was used in lighting the whole hospital, and all the lamps were filled and trimmed in this 
 room. A corporal and two men were employed. Ninety-one feet southeast of the oil-room is the Dead-House, 15 by 40 
 feet. It is divided into two rooms — the northern one used in making post-mortem examinations, and the southern for 
 plaster-casts, etc. Thirty- two feet south of this room is the Photographic Gallery, 16 by 24 feet. An operator is em- 
 ployed at $100 per month, paid from the slush fund. Surgical cases, pathological specimens, etc. are taken ; also like- 
 nesses of all men discharged on surgeon's certificate of disability, as a guard against fraud. On the base line of the 
 triangle are the Medical Officers' Quarters, 63 by 24 and two stories in height; also, in the same line, the quarters for 
 the Veteran Reserve Corps, a building two stories high, with an outside entrance-stairway to the second fioor. Ninety 
 feet further back, 100 hospital tents are pitched, placed four end to end, on substantial frames, with fioors raised from 
 the ground and a door at each end of the frame. The sides of these tents were always easily raised, and gave the best of 
 
158 
 
 HOSPITAL ORGANIZATION AND CONSTRUCTION. 
 
 ventilation ; hence I selected some of them as gangrene wards, and, I think, with the very best results. In winter, 
 each ward was heated by two stoves, with pipes running to a shaft in the centre. Bach ward of four tents contained 
 20 beds. The length of the fence around the hospital is 1458 yards. The distance of the fence from the tents at the 
 base of the triangle is 124 feet. Sinks were arranged around the whole line of fence. They had movable boxes, which 
 were regularly emptied and limed. Policing was done by a gang of about 20 freedmen. The hospital could accom- 
 modate 1240 patients in the 20 barrack wards. Its total capacity in January, 1865, was 2575 beds, including those in 
 tents and the branch barracks, a short distance off. 
 
 This hospital was opened December 23d, 1862, and closed August 22d, 1865. 
 During this period the movements of patients were as follows : 
 
 
 Admitted. 
 
 ■a 
 
 h 
 
 ■a -a 
 |1 
 
 i 
 1 
 
 Uesdlts. 
 
 1 
 
 1 
 
 1 
 
 w s ■ 
 
 ill 
 
 k 
 
 "(2 
 
 -1. 
 s io 
 
 Us 
 
 1 - 
 5 
 
 1 
 
 a 
 
 White Troops 
 
 12,391 
 
 13 
 
 174 
 
 7,837 
 
 5 
 
 959 
 
 20,228 
 
 18 
 
 1,183 
 
 3,565 
 
 23,793 
 
 18 
 
 1,133 
 
 7,191 
 
 9,411 
 
 18 
 
 924 
 
 4,400 
 
 392 
 
 1,053 
 45 
 
 286 
 8 
 
 1,060 
 161 
 
 
 Prisoners of War 
 
 Total 
 
 12,578 
 
 8,801 
 
 21,379 
 
 3,565 
 
 24,944 
 
 7,191 
 
 10,353 
 
 4,400 
 
 392 
 
 1,098 
 
 289 
 
 1,221 
 
 
 Deducting those sent to general hospital as cases not terminated, and considering 
 that furloughed and deserted amounted to 4686, while only 3565 of these are reported 
 as returned from furlough and desertion, we shall have the following statistics for the 
 terminated cases of white troops treated. 
 
 Total to be accounted for, excluding those sent to other hospitals. 
 
 Returned to duty 
 
 Mustered out of service at the close of the war 
 
 Loss by desertion and failure to return from furlough 
 
 Discharged for disability 
 
 Transferred to Veteran Reserve Corps 
 
 Died 
 
 10,817 
 
 10,817 
 
 6,339 
 852 
 
 1,121 
 
 1,053 
 892 
 
 1,060 
 
 10,817 
 
 These figures represent excellent results, but they are not more favorable than the 
 general statistics of all the hospitals. Making proper corrections for transfers from 
 hospital to hospital, there were over a million of patients treated in the general hos- 
 pitals during the four years of the war, and the mortality, including both that from 
 disease and that from wounds, was but one death to every twelve patients, or about 
 8 per cent. 
 
 Harewood Hospital, Washington, D. C, was constructed on a plan quite similar to 
 that of Lincoln Hospital. The Hampton General Hospital, near Fortress Monroe, was 
 also composed of wards arranged en echelon in the form of a V, but not overlapping 
 
HOSPITAL ORGANIZATION AND OONSTRXTCTION. 
 
 159 
 
 each other, as those of the two foregoing hospitals did. The hospital at Point Lookout, 
 Maryland, at Jeifersonville, Indiana, and the Sedgwick Hospital, at Greenville, near 
 New Orleans, La., may be mentioned as examples of constructions in which the pavilion 
 wards radiated from a circular covered way. An idea of this form of construction can 
 be obtained from the following brief account of the latter hospital, abstracted from the 
 Inspection Report of Medical Inspector E. P. Vollum, U. S. A., dated July 10th, 1865 : 
 
 Sedgwick Hospital is situated at Greenville, La., about seven miles above New Orleans, on the east bank of the 
 Mississippi River. The site is flat, and drains back from the river into the swamp lands lying between the Mississippi 
 River and Lake Pontchartrain. The soil is a rich, black alluvium. The grounds embrace about 30 acres, which have 
 been for many years under cultivation as a plantation. At present, there is a fine vegetable garden sufficient for all 
 the wants of the hospital. A large part of the premises is shaded by splendid groves of live-oak, pecans, and 
 
 Fig. 11. — Grodnd Plan op Sedgwick Qeneral Hospital, Greenville, La. Scale, 120 feet to the inch. 1111. Wards. 2. Administration building. 
 3. Guard-house, knapaack-room, and atore-house. 4 4. Dining-rooms. 5. Kitchen. 6. Ciatern. 7. Covered waya, through which a railway rune 
 with hand-cars for carrying food to the wards. 
 
 oranges, with crape myrtles and the flowerlBg shrubs peculiar to the latitude. The hospital is approached from the river 
 front by a substantial road, and shell-roads and walks connect the several buildings and wind among the groves. The 
 hospital is composed of fifteen one-storied pavilion wards, each 145 by 24 feet, and an administration building, 145 by 
 
160 
 
 HOSPITAL ORGANIZATION AND CONSTRUCTION. 
 
 40, radiating from the periphery of a circular covered way, in the centre of which are the buildings for kitchens, etc. etc. 
 The arrangement is shown in Figure 11, in which the part towards the bottom of the page is that facing the river front. 
 Outside the circle, at convenient distances, are detached buildings for chapel, cooks' and nurses' quarters, 
 laundry, gas-house, bake-house, dead-house, reservoir, and stables. All these buildings are constructed of boards, 
 set upright and battened; the roofs shingled, and open at the ridge for ventilation. They are raised 3 feet above the 
 ground on brick piers. The covered way which connects them is twelve feet wide. The ward pavilions have two small 
 rooms partitioned off at each end, leaving a space in the centre, 115 by 24 feet, available for patients. There are two beds 
 between each pair of windows, as in the plan figured on page 1.53, but the number of beds is less— 40 to each ward. 
 The dimensions allow about 69 square feet of floor and 1200 cubic feet of air-space to each patient. Three of the 
 small rooms mentioned are occupied as sleeping apartments for nurses. The fourth, which is one of those at the 
 outer extremity of each ward, is divided into bath-room and water-closet. The administration building is two stories 
 high, and contains the ofBce, dispensary, officers' reception, lodging, and dining rooms, etc. etc. The hospital kitchen 
 is shown in Figure 12, which explains its arrangement. The building is 80 by 30 feet. There is a patent steam cook- 
 ing apparatus with boilers, etc., and a carving-table, the pans of which are kept warm by steam. There is also one of 
 Myers, Sandford, Winslow & Oo.'s challenge ranges. No. 10, for roasting and cooking extra diet. The railway, on 
 which cars run to distribute food to the wards, passes through the centre of the kitchen. This kitchen is reported 
 by Medical Inspector VoUum as having been "sufficient and in good condition" at the time of his visits. The 
 laundry is situated on the river bank, and is furnished with a steam washing-machine, capable of washing for 1500 
 patients. Water for washing, etc. is obtained from a reservoir on the river bank, capable of holding 320,000 gallons, 
 whence it is carried by pipes through the administration building, wards, kitchen, dining-rooms, and dead-house. For 
 drinking purposes, rain-water is collected in a central cistern, which holds 150,000 gallons, and in smaller cisterns, 
 holding 10,000 gallons each, at the end of each ward. The water for these cisterns is carried from the roofs of the 
 buildings by zinc gutters and pipes. For the purposes of drainage, the grounds are graded from the centre of the 
 circle towards the periphery with a descent of one inch to every 10 feet; the surface water flows at the periphery into 
 brick sewers, which also receive the sewage from the water-closets, kitchen, etc. by pipes. The several sewers unite 
 into a common trunk, by which the sewage is carried far to the rear of the hospital into the swamps which drain into 
 Lake Pontchartrain. The water-closets throughout the hospital are furnished with patent pans, and discharge into 
 brick sinks lined with cement and built up to the floor. These sinks, which are of some size, are connected with the 
 sewers into which all the liquid parts drain. The hospital is heated by coal-stoves, and lighted with gas which is 
 generated on the premises. 
 
 This hospital was opened for the reception of patients April 1st, 1865, and, at the 
 time of writing, is still in existence. On the thirty-first day of October, 1865, which is 
 the date of the last report, there were 97 sick and 8 wounded patients remaining under 
 treatment. Prior to that date, the total number of admissions of white soldiers was 
 2163, of whom 1869 were sick and 474 wounded. The number of patients sent to 
 other general hospitals was 673. Deducting this number and the remaining, we have 
 1385 terminated cases to be accounted for, the results of which were as follows : 
 
 Total to be accounted for, excluding those sent to General Hospitals and the remaining Oct. 31, 1865 
 
 Returned to duty 
 
 Mustered out of service at the close of the war 
 
 Furloughed 
 
 Discharged for disability 
 
 Died 
 
 1385 
 
 1385 
 
 848 
 
 210 
 
 181 
 
 66 
 
 90 
 
 1385 
 
 As one of the most recently constructed hospitals, I may mention the Hicks' Hos- 
 pital, at Baltimore, Md. 
 
 The Hicks' Hospital is situated on the continuation of Townsend Street in the western suburbs of Baltimore 
 near the city boundary. It was opened for the reception of patients June 9th, 1865, and is therefore one of the most 
 recently constructed hospitals. The plan was essentially the circular one already described, but many important 
 improvements and additions were devised by Surgeon Thomas Sim, U. S. Vols., under whose supervision the details 
 of the plan were prepared. The original design contemplated a circular hospital, built on the War Department 
 
HOSPITAL ORGANIZATION AND CONSTRUCTION. 
 
 161 
 
 21 
 
162 
 
 HOSPITAL ORGANIZATION AND CONSTRUCTION. 
 
 plan, with thirty-six radiating pavilion wards, each to accommodate 60 patients. The approach of the end of the 
 war, however, prevented this from being executed, and the hospital, as completed, is a semicircle, in which the wards 
 radiate from a covered way, as in Figure 13. It is, however, both on account of the substantial character of the 
 wooden buildings and the numerous conveniences which have been carefully supplied, one of the most complete of 
 the hospitals built during the war. 
 
 The wards are built and ventilated as directed in the circular from the War Department. The administration build- 
 ing is 132 by 38 feet and two stories high ; the first story contains ofBces for the surgeon in charge, executive officer, 
 quartermaster, commissary and their clerks ; it also contains the hospital library and printing-office. On the second floor 
 are sleeping apartments for officers. This building is flanked on each end by a smaller one, 70 by 28 feet, one of which 
 
 no 
 
 la 
 
 
 20 □ 
 
 Fia. 13. — Groumb Plan OF Hicks' General Hospital, Saltimoee, Md. Scale, 180 feet to the inch. 1 1 1 1. Wards. 2. Administration buildiog. 3. Linen- 
 room, etc. 4, Dispensftry and operating-room. 5. Dining-liall. 6. Kitchen and laundry. 7. Ward for detailed men. 8. Knapsack-room. 9. Commis- 
 sary store-house. 10. Quartermaster's store-hoose, 11. Tank. 12. Quarters for guard. 13. Stable. 14. Wagon-house. 15. Sutler. 16. Stewards' quar- 
 ters. 17 18. Officers' houses (of which, also, there are several not in the figure). 19. Guard-room. 20. Guard-house, near entrance gate. 21. Workshop. 
 22. Contagion ward; this is farther distant than is represented in the figure. The wards, dining-room, and administration building are connected by 
 a covered way, which is indicated by faint lines in the plan. 
 
 contains the linen-room and post-office, with the officers' dining-room, kitchen, and pantry. The other contains the 
 dispensary, medical store-rooms, room of the discharge board, and an operating-room lighted by a sky-light. The 
 dining-room building is 187 by 48 feet, and is two stories high. The dining-room, which is on the first floor, is capa- 
 ble of seating about 1200 patients. The second floor, which is accessible by stairs on the outside, is occupied by the 
 chapel and by dormitories for female nurses. At the end of the dining-room is a T-shaped building for kitchen and 
 laundry. The general kitchen, extra-diet kitchen, and bakery occupy separate apartments ; the former two each con- 
 tain a suitable range and steam fixtures, the latter two bake-ovens. The laundry has a separate room for drying by 
 steam, and immediately adjoins the engine-room, which is at the extremity of the building. There are, besides the 
 foregoing, separate buildings for knapsack-room, quartermaster's store-house, commissary store-house, quarters for 
 
HOSPITAL ORGANIZATION AND CONSTRUCTION. 
 
 163 
 
 detailed men, barracks for guard, workshop, contagion ward, dead-house, stewards' quarters, and quarters for mar- 
 ried officers. The buildings are plastered inside, are lighted by gas, to be warmed in the winter by stoves, and receive 
 their water supply by pipes from the city water-works, besides which there is a tank for the purpose of keeping a 
 stock of water constantly on hand in case of fire. For the purpose of extinguishing fire, there is abundant hose to 
 fit the steam-pump. There are also water-buckets, axes, etc. At the distal end of each ward is a lavatory and bath- 
 room and a water-closet. Bach bath-room has in it a small stove, on which is a boiler for the supply of hot water. 
 In the water-closets the excretions are received in troughs, into which a stream of water runs, and which are emptied 
 by withdrawing a plug several times daily. They discharge into sewers constructed for the purpose, which carry all 
 offensive matters entirely away from the hospital. A very beautiful model of the hospital in holly-wood has been 
 presented to the Army Medical Museum by Surgeon Sim. 
 
 This hospital was opened for patients June 9th, 1865; and the total number of 
 white soldiers received prior to November 30th, 1865, which was the last report up to 
 the date of writing, was 1247, of whom 984 were sick and 263 wounded. Of these, 
 366 were transferred to other general hospitals, and 120 remained under treatment at 
 the date of the last report. The number of terminated cases, therefore, was 761, who 
 are thus accounted for : 
 
 Total to be accounted for, excluding those transferred to other hospitals and those remaining at date of 
 last report 
 
 Returned to duty 
 
 Mustered out of service at the close of the war 
 
 Loss by desertion and failure to return from furlough 
 
 Discharged for disability 
 
 Transferred to Veteran Reserve Corps 
 
 Died 
 
 761 
 
 761 
 
 131 
 
 443 
 
 52 
 
 89 
 
 2 
 
 44 
 
 761 
 
 Besides the above, 280 colored soldiers were admitted, of whom 15 died. 
 
 All the hospitals hitherto described were situated near the base of military opera- 
 tions, and received therefore more severe cases than those at a distance. As an exam- 
 ple of the more distant hospitals, the figures of the Lovell Hospital, at Portsmouth 
 Grove, Narraganset Bay, R. I., may here be given. 
 
 This hospital, which is composed of twenty-eight fine wooden pavilion wards, 
 situated on a tongue of land jutting out into the bay, was opened in July, 1862,. and 
 closed October 10th, 1865. During this period it received 11,696 white soldiers, of 
 whom 8491 were sick and 3205 wounded. Of these, 2461 were transferred to other 
 hospitals, leaving 9235 patients to be accounted for, as follows: 
 
 Total to be accounted for, excluding those sent to other hospitals 
 
 Returned to duty 
 
 Mustered out at the close of the war 
 
 Loss by desertion and failure to return from furlough 
 
 Discharged for disability 
 
 Transferred to Veteran Reserve Corps 
 
 Died , 
 
 9235 
 
 9235 
 
 4386 
 875 
 961 
 
 2021 
 716 
 276 
 
 9235 
 
164 
 
 HOSPITAL ORGANIZATION AND CONSTRUCTION. 
 
 On comparing the statistical reports of the hospitals in various parts of the 
 country, we are struck by the fact that the number returned to duty and the ratio 
 of deaths to terminated cases were greater in those hospitals which were nearest the 
 seat of war. On the other hand, the number discharged the service for disability and 
 transferred to the Veteran Reserve Corps was greater in the more distant ones. These 
 facts, which naturally result from the reception of acute cases into the nearest hospitals 
 and the frequent transfers thence to the more distant ones, must be remembered in all 
 comparisons made between the results of treatment in different institutions. To give an 
 idea of the vast extent of hospital accommodations demanded, the following list of general 
 hospitals in existence in September, 1864, is here presented. The hospital system had at 
 that time attained its maximum extent, there being 202 general hospitals and 136,894 
 beds for patients. The number of beds was gradually reduced till January, 1865, when 
 there were 121,000, and about this number was kept on foot to the close of the war. 
 
 Hospitals in the Atlantic Begion, September, 1864. 
 
 Department of the East. 
 
 David's Island .. 
 Fort Columbus., 
 Ladies' Home.... 
 
 St. Joseph's 
 
 Newark 
 
 Lovell 
 
 Knight 
 
 Brattleboro' 
 
 Marine 
 
 Buffalo 
 
 McDougall 
 
 Augusta 
 
 Grant 
 
 Sloan 
 
 Albany 
 
 Elmira 
 
 Rochester 
 
 OflBcers' 
 
 New York City 
 
 Jews' 
 
 Brooklyn City 
 
 Sisters of Charity.. 
 Readville 
 
 Department of the Sus- 
 quehanna, 
 
 McClellan 
 
 Turner's Lane 
 
 Convalescent 
 
 Satterlee 
 
 Mower 
 
 Cuyler , 
 
 Christian Street 
 
 South Street 
 
 Citizen's Volunteer .. 
 
 Summit House 
 
 York 
 
 Haddington 
 
 Islington 
 
 Officers' 
 
 U.S. General 
 
 Broad StreeJ 
 
 Oieater .' 
 
 Beverly 
 
 White Hall 
 
 Middle Department. 
 
 National Hotel 
 
 Newton University ., 
 
 Convalescent 
 
 Jarvis 
 
 "West's Buildings 
 
 Division No.l 
 
 Division No. 2 
 
 Annapolis JunctioQ .. 
 
 Carried forward.. 
 
 New York Harbor , 
 
 New York Harbor 
 
 New York City , 
 
 Central Park, N. Y , 
 
 Newark, N. J , 
 
 Portsmouth Grove, R. I 
 
 New Haven, Conn 
 
 Brattleboro', Vt , 
 
 Burlington, Vt , 
 
 Boston, Mass 
 
 Buffalo, N.Y 
 
 Fort Schuyler, N. Y. Harbor. 
 
 Augusta, Me , 
 
 "WiUets' Point, N. Y. Harbor. 
 
 Montpelier, Vt 
 
 Albany, N. Y 
 
 Elmira, N.Y , 
 
 Rochester, N. Y 
 
 Bedloe's Island, N. Y. Harbor. 
 
 New York City 
 
 New York City 
 
 Brooklyn City, N. Y 
 
 Buffalo, N.Y 
 
 Readville, Mass 
 
 Philadelphia, Pa. .. 
 Philadelphia, Pa. .. 
 Philadelphia, Pa. „ 
 Philadelphia, Pa. .. 
 Philadelphia, Pa. .. 
 Germantown, Pa... 
 Philadelphia, Pa. .. 
 Philadelphia, Pa. .. 
 Philadelphia, Pa. .. 
 Philadelphia, Pa... 
 
 York, Pa 
 
 Philadelphia, Pa. .. 
 Philadelphia, Pa. .. 
 Camac Woods, Pa. 
 
 Pittsburg, Pa 
 
 Philadelphia, Pa. .. 
 
 Chester, Pa 
 
 Beverly, N. J 
 
 White Hall, Pa 
 
 Baltimore, Md 
 
 Baltimore, Md 
 
 Baltimore, Md 
 
 Baltimore, Md 
 
 Baltimore, Md 
 
 Annapolis, Md 
 
 Annapolis, Md 
 
 Annapolis Junction . 
 
 Beds. 
 
 No. 
 
 3,000 
 
 
 100 
 
 
 400 
 
 
 333 
 
 9 
 
 927 
 
 10 
 
 1,644 
 
 11 
 
 1,121 
 
 12 
 
 1,097 
 
 2/>0 
 
 
 60 
 
 
 160 
 
 
 1,328 
 
 
 1.062 
 
 1 
 
 1,172 
 
 2 
 
 462 
 
 3 
 
 660 
 
 4 
 
 300 
 
 6 
 
 608 
 
 6 
 
 80 
 
 7 
 
 161 
 
 8 
 
 60 
 
 » 
 
 100 
 
 10 
 
 200 
 
 11 
 
 910 
 
 12 
 
 
 13 
 
 
 14 
 
 
 15 
 
 
 Ifi 
 
 
 17 
 
 1.841 
 
 18 
 
 310 
 
 19 
 
 806 
 
 20 
 
 3,519 
 
 21 
 
 3,326 
 
 22 
 
 700 
 
 23 
 
 299 
 
 24 
 
 270 
 
 26 
 
 260 
 
 26 
 
 1,204 
 
 
 2,200 
 
 
 1,225 
 
 
 60 
 
 
 64 
 
 
 723 
 
 1 
 
 627 
 
 2 
 
 1,167 
 
 8 
 
 1,460 
 
 4 
 
 1,373 
 
 b 
 
 400 
 
 1 
 
 200 
 
 2 
 
 1,200 
 
 3 
 
 1,380 
 
 4 
 
 , 426 
 
 .•i 
 
 1,117 
 
 6 
 
 661 
 
 V 
 
 290 
 
 
 43,061 
 
 Brought forward 
 
 Middle Department- 
 Continued. 
 
 Tilton , 
 
 McKim's Mansion . 
 
 Officers' 
 
 Camp Parole 
 
 Department of Wash- 
 ington. 
 
 Armory Square^... 
 
 Augur /. 
 
 Carver 
 
 Campbell , 
 
 Columbian 
 
 Douglas 
 
 Ricord 
 
 1st Division 
 
 2d Division 
 
 3d Division 
 
 Emory 
 
 Finley 
 
 Fairfax Seminary.. 
 
 Harewood 
 
 Judiciary Square... 
 
 Kalorama , 
 
 Lincoln.. 
 
 Mount Pleasant 
 
 Seminary 
 
 Stone 
 
 Freedman , 
 
 Stanton , 
 
 U. S. General 
 
 Louvertnre 
 
 Claremout 
 
 Giesboro' , 
 
 Department of Virginia 
 and North Carolina. 
 
 U.S. General.., 
 
 Balfour 
 
 Foster , 
 
 U.S. General.. 
 Mansfield 
 
 Department of the South. 
 
 Division No. 1.. 
 Division No. 2 . 
 U. S. General.... 
 U.S. General...., 
 
 Ofiicers' 
 
 Conot 
 
 Field 
 
 Total Atlantic Region- 
 
 Wilmington* Del. . 
 Baltimore, Md. ... 
 
 Annapolis, Md 
 
 Annapolis, Md 
 
 Washington, D. C 
 
 Near Alexandria, Ya .. 
 
 Washington, D. C 
 
 Washington, D. C 
 
 Washington, D. G. ...:. 
 
 Washington, D. C 
 
 Washington, D. C 
 
 Alexandria, Va 
 
 Alexandria, Va 
 
 Alexandria, Va 
 
 Washington, D. C 
 
 Washington, D. C 
 
 Virginia 
 
 Washington, D. C 
 
 Washington, D. 
 
 Washington, D. C 
 
 Washington, D. C 
 
 Washington, D. C 
 
 Georgetown, D. C 
 
 Washington, D. C 
 
 Washington, D. C 
 
 Washington, D. C 
 
 Point Lookout, Md 
 
 Alexandria, Ya 
 
 Alexandria, Va 
 
 Giesboro' D. C 
 
 Near Fort Monroe, Ta. . 
 
 Portsmouth, Va 
 
 Newbein, N. C 
 
 Beaufort, N.C 
 
 Morehead City, N. C... 
 
 Beaufort, S.C 
 
 Beaufort, S.C 
 
 Hilton Head, S. C 
 
 Jacksonville, Fla. 
 
 Beaufort, S.C 
 
 St. Augustine, Fla. ... 
 Marietta, Ga 
 
 352 
 
 300 
 
 409 
 
 2,000 
 
 1,000 
 
 671 
 
 1,300 
 
 1,000 
 
 844 
 
 400 
 
 120 
 
 1,295 
 
 1,600 
 
 1,500 
 
 900 
 
 1,061 
 
 936 
 
 2,000 
 
 510 
 
 434 
 
 2,575 
 
 2,000 
 
 123 
 
 170 
 
 98 
 
 420 
 
 1,090 
 
 500 
 
 164 
 
 535 
 
 3,570 
 850 
 475 
 230 
 
 300 
 
 295 
 440 
 600 
 174 
 20 
 133 
 2,115 
 
 78,560 
 
HOSPITAL ORGANIZATION AND CONSTEUCTION. 
 
 165 
 
 Hospitals in the Central Region, September, 1864. 
 
 Name. 
 
 Northern Department. 
 
 SemiDary 
 
 U.S. QeDeral 
 
 TT.S. Oenerol 
 
 Dennison 
 
 West End 
 
 Washington Park.. 
 
 Mai-ine 
 
 U.S. General 
 
 Madison 
 
 U.S. General 
 
 Desmarres 
 
 Marine 
 
 U.S. General 
 
 U. S. General 
 
 St. Mary's 
 
 U.S. General 
 
 Main Street 
 
 Seminary 
 
 Grant, Officers' 
 
 D^artment of the North- 
 
 Harvey 
 
 U. S. General 
 
 U. S. General 
 
 Department of Western 
 Virginia. 
 
 Frederick , 
 
 Cumberland 
 
 Parkersburg 
 
 Grafton 
 
 Department of the Ohio. 
 
 Clay 
 
 Brown 
 
 Eruptive 
 
 U. S. General 
 
 Ohio 
 
 Jefferson 
 
 No. 16 
 
 Nelson , 
 
 Nelson (Eruptive) 
 
 Convalescent 
 
 U. S. General 
 
 U. S. General 
 
 U. S. General 
 
 Corps d'Afrique 
 
 Totten 
 
 Joe Holt 
 
 U. S. General 
 
 OfiBcere' 
 
 Holston 
 
 Officers' 
 
 Branch "A." 
 
 Branch "B." 
 
 Department of the Mis- 
 souri. 
 
 Marine 
 
 Small-pox 
 
 U. S. General . 
 U. S. General . 
 U. S. General . 
 U. S. General . 
 U. S. General . 
 U. S. General . 
 Prison. 
 
 Carried forward.. 
 
 Columbus, Ohio 
 
 Camp Chase, Ohio 
 
 Cleveland, Ohio 
 
 Camp Dennison, Ohio.. 
 
 Cincinnati, Ohio 
 
 Cincinnati, Ohio 
 
 Cincinnati, Ohio 
 
 Evansville, Ind 
 
 Madison, Ind 
 
 Indianapolis, Ind 
 
 Chicago, 111 
 
 Chicago, 111 
 
 Camp Butler,- III 
 
 Quincy, 111 
 
 Detroit, Mich 
 
 Gallipolis, Ohio 
 
 Covington, Ky 
 
 Covington, Ky 
 
 Cincinnati, Ohio 
 
 Madison, Wis. ... 
 Keokuk, Iowa... 
 Davenport, Iowa. 
 
 Frederick, Md 
 
 Cumberland, Md 
 
 Parkersburg, West Ta, 
 Grafton, West Va , 
 
 Louisville, Ky 
 
 Louisville, Ky 
 
 Louisville, Ky 
 
 New Albany, Ind 
 
 New Albany, Ind 
 
 JefFersonville, Ind 
 
 Jeffersonville, Ind 
 
 Camp Nelson, Ky 
 
 Camp Nelson, Ky 
 
 Camp Nelson, Ky 
 
 Lexington, Ky 
 
 Bowling Green, Ky 
 
 Ashland, Ky 
 
 New Albany, Ind 
 
 Louisville, Ky 
 
 Jeifersonville, Ind 
 
 Knoxville, Tenn 
 
 Knoxville, Tenn 
 
 Knoxville, Tenn 
 
 Louisville, Ky 
 
 Bowling Green, Ky 
 
 Bowling Green, Ky 
 
 St. Louis, Mo 
 
 St. Louis, Mo 
 
 Benton Barracks, Mo 
 
 Jefferson Barracks, Mo. 
 
 JelTerson City, Mo , 
 
 Springfield, Mo 
 
 Rolla, Mo 
 
 Kansas City, Mo 
 
 St. Louis, Mo 
 
 214 
 360 
 
 2,600 
 120 
 160 
 122 
 630 
 
 2,095 
 256 
 160 
 110 
 460 
 478 
 460 
 800 
 300 
 218 
 50 
 
 586 
 
 1,350 
 
 200 
 
 1,276 
 
 1,191 
 
 418 
 
 267 
 
 970 
 
 1,000 
 
 348 
 
 1,228 
 
 300 
 
 2,802 
 
 110 
 
 500 
 
 100 
 
 600 
 
 463 
 
 128 
 
 275 
 
 82 
 
 1,160 
 
 1,350 
 
 1,347 
 
 54 
 
 656 
 
 33 
 
 88 
 
 40 
 
 235 
 575 
 1.700 
 134 
 200 
 120 
 100 
 300 
 
 32,170 
 
 Brought forward 
 
 Department of £^ansas. 
 
 U. S. General . 
 U. S. General . 
 
 Department of the Ar- 
 kansas. 
 
 V. 3. General 
 
 U. S. General 
 
 Colored Ward 
 
 Officers' ' 
 
 U. S. General 
 
 Department of the Ten- 
 nessee. 
 
 Overton 
 
 Gayoso 
 
 Adams' 
 
 Officers' 
 
 Old State (Pest) 
 
 Washington 
 
 Webster 
 
 U.S. General 
 
 Peat 
 
 U. S. General No.2 
 
 U. S. General No.3 
 
 U.S. General 
 
 Jackson 
 
 Department of the Cum- 
 berland. 
 
 V. S. General No. 1 
 
 n. S. General No.2 
 
 U. S. General No. 3 
 
 U. S. Genenal No.8 
 
 U. 8. General No. 11 
 
 V. S. General No. 15 
 
 U. S. General No. 16 
 
 U.S. General No. 17 
 
 U. S. General No. 19 
 
 Cumberland 
 
 Field 
 
 U. S. General 
 
 U. S. General 
 
 U. S. General 
 
 U. S. General No. 1 
 
 U. S. General No.2 
 
 Field 
 
 U. S. General No. 14 
 
 Sherman 
 
 U. S. General 
 
 Officers' 
 
 Provisional 
 
 Department of the Gulf. 
 
 St. James 
 
 University , 
 
 Marine 
 
 U. S. Barracks 
 
 St. Louis 
 
 Charity 
 
 U. S. Convalescent . 
 Corps d'Afrique 
 
 Total Central Region.. 
 
 Leavenworth, Kansas .. 
 Fort Scott, Kansas 
 
 Little Hock, Ark. . 
 Fort Smith, Ark. . 
 Little Hock, Ark. . 
 Littlo Eock, Ark. . 
 Helena, Ark 
 
 Memphis, Tenn 
 
 Memphis, Tenn 
 
 Memphis, Tenn 
 
 Memphis, Tenn 
 
 Memphis, Tenn 
 
 Memphis, Tenn 
 
 Memphis, Tenn ; 
 
 Mound City, 111 
 
 Near Vicksburg, Miss. 
 
 Vicksbnrg, Miss. 
 
 Vicksburg, Miss 
 
 Natchez, Miss 
 
 Memphis, Tenn 
 
 Nashville, Tenn 
 
 Nashville, Tenn 
 
 Nashville, Tenn 
 
 Nashville, Tenn 
 
 Nashville, Tenn 
 
 Nashville, Tenn 
 
 Nashville, Tenn 
 
 Nashville, Tenn 
 
 Nashville, Tenn 
 
 Nashville, Tenn 
 
 Bridgeport, Ala 
 
 Gallatin, Tenn 
 
 Murfreesboro', Tenn 
 
 Tullahoma, Tenn 
 
 Chattanooga, Tenn 
 
 Chattanooga, Tenn 
 
 Chattanooga, Tenn 
 
 Nashville, Tenn 
 
 Nashville, Tenn 
 
 Lookout Mountain, Tenn 
 Lookout Mountain, Tenn, 
 Chattanooga, Tenn 
 
 New Orleans, La. . 
 New Orleans, La. . 
 New Orleans, La. . 
 New Orleans, La. . 
 New Orleans, La. . 
 New Orleans, La. . 
 Baton Rouge, La. . 
 New Orleans, La. . 
 
 32,170 
 
 240 
 148 
 
 797 
 326 
 24 
 129 
 100 
 
 450 
 400 
 600 
 100 
 200 
 400 
 600 
 636 
 147 
 290 
 300 
 144 
 300 
 
 900 
 666 
 600 
 640 
 720 
 280 
 176 
 180 
 629 
 2,400 
 408 
 108 
 730 
 100 
 672 
 1,131 
 1,247 
 750 
 430 
 800 
 250 
 100 
 
 300 
 600 
 800 
 
 1,200 
 600 
 660 
 400 
 
 1,700 
 
 Hospitals in the Pacific Region, September, 1864. 
 
 So. 
 
 Name. 
 
 LoOiLITT. 
 
 Beds. 
 
 No. 
 
 Name. 
 
 LOOAUTY. 
 
 Beds. 
 
 1 
 
 Wright .. 
 
 
 
 Presidio, San Francisco, Cal... 
 
 40 
 
 2 
 
 
 
 28 
 
 
 
 
 
 
 
 Atlani 
 Centra 
 Pacific 
 
 RECAPITULATION, 
 ic Region 93 Hospitals. 
 
 78,660 Beds. 
 68,266 " 
 68 " 
 
 
 1 Region 107 " 
 
 Region 2 " 
 
 
 
 Total 202 
 
 136 
 
 894 " 
 
166 CONCLUDING REMARKS. 
 
 In addition to hospital construction, it is important that the system of hospital 
 administration should be faithfully described. The hospital fund and its manage- 
 ment, the slush fund, hospital cooking and diet tables, nurses, the question of female 
 nurses, the hospital records and reports, are all subjects on which there are abundant 
 data for a complete historical investigation. 
 
 In the foregoing remarks, my intention has been simply to give an idea of the 
 nature and extent of the data for a Medical History of the War to be found in the 
 part of the office under my direction. Many matters of interest have not been 
 touched upon, for a full discussion of which abundant material exists; as, for ex- 
 ample, the comparative health of the colored troops, of the prisoners of war held by us, 
 of those of our own men who were unfortunate enough to fall into the hands of the 
 rebels, etc. Moreover, there is much material in other branches of the Surgeon Gen- 
 eral's Office the consideration of which is necessary to a full understanding of the 
 medical administration of the army. 
 
 In conclusion, I may express the opinion that, with the utmost brevity and care, it 
 may be hoped to digest the material above sketched, not including surgical cases, into three 
 quarto volumes, of about the size of the volumes of the Medical Statistics heretofore pub- 
 lished. The prominent subjects in these volumes would be the medical statistics of the 
 several armies, with the principal facts in their medical histories; the medical statistics 
 of the several general hospitals, with descriptions of their construction and administra- 
 tion, illustrated by a sufficient number of ground plans and perspective views to give a 
 just idea of them; and lastly, an account of the causes, history, symptoms, pathology, 
 and treatment of the principal diseases of the troops, based upon statistical facts, con- 
 tributed papers, histories of cases and autopsies, and observations made in the medical 
 and microscopical sections of the Museum. This part of the work it is proposed to 
 illustrate with such colored plates of morbid conditions and representations of the 
 microscopical anatomy of the chief diseases as may be necessary to preserve, for the 
 future study of medical men, a faithful account of the costly experience of the Med- 
 ical Department during the war. Of the subjects thus indicated, about one-half of the 
 statistical matter is compiled, and most of the material required for the remaining por- 
 tion of the work is collected, and can be prepared for the press with reasonable rapidity. 
 Almost all the necessary drawings are made, and ready for the lithographer; a large 
 number of the wood-cuts are actually executed, and the material for the microscopical 
 illustrations is in a forward condition. 
 
 I have the honor to be. 
 
 Very respectfully. 
 
 Your obedient servant, 
 
 J. J. WOODWARD, 
 
 Assistant Surgeon and Brevet Major U. S. A., 
 In charge of the Record and Pension Division, Surgeon General's Office, 
 and of the Medical Section, Army Medical Museum.