The military surgeon must have an acquaint ance with many medical problems: The condi tions developing diarrhoea and dysentry, the exposure to heat and cold, causing sunstroke and frostbite, all of which he must be familiar with; the condition and treatment of the vari ous classification of burns that occur from fire and from the materials used in some of the high explosives, also the care of the soldier who suffers so seriously from multiple wounds made by the explosion of the so-called °mud shell;' the particles penetrating the clothing, and where there are often 50 to 100 abrasions that are very painful. A responsibility of grave importance is the selection of the camp site, and which is usually entrusted I., the medical officer, as it should be.
When the United States entered into the European War the surgeon-general's office, en dorsed by the War Department, organized schools of instruction. The splendid response made by the members of the medical profession to comply with the government's request that they have a few months' preparation for army service has enabled thousands of doctors to better fit themselves for looking after the sick and wounded soldiers than in any of our previ ous wars. It was said by United States army surgeons, when this war began, in August 1914, that, in many respects, it would be the most humane ever waged; that it would be settled in a much shorter period of time than most persons believed possible; however, this proph ecy came far short of the real result. To day dressing stations, evacuation and base hos pitals are terms with which we have become very familiar. It was stated, and this has proved true, that the mortality list from dis ease would be very small. The control of ty phoid, typhus and malarial fevers has been very perfect. Alas! that the epidemic of in fluenza and septic pneumonia has presented so many serious conditions hitherto unknown, causing a death rate that, while not large, yet was unexpected.
While it was believed that the rapid-firing rifle, with its smaller metal cap bullets, would disable men quickly, the results would not be so fatal in the loss of life, and would not cause so great a number of seriously injured as when the slow-firing, larger bullets, such as was the Minie ball, used during the Civil War. This, to a great extent, has proved true. The breaking of bones, the tearing of blood vessels, the injuries to nerve trunks, in proportion to the number of wounded, has not been as great in this war as some of our recent conflicts.
Much important experience had accumulated during the Russo-Japanese and some of value during the Spanish-American War. To-day, as a whole, wounds have not been so fatal, but the prediction that there would be a less num ber of infective wounds and injurious com plications has not proved to be true. The knowledge of preventive methods, and important sanitary precautions, has helped decidedly in the saving of life, as they have been so vigor ously investigated and carried out. The sad lesson of the Spanish-American War had served to warn our medical officers and they have made a noble success of all that has been placed at their disposal for the care of the soldier. One can enumerate but a few of the many aids that have come to the medical and surgical departments of the American army, in this war, such as the Red Cross, the Y. M. C. A., the Y. W. C. A., the Knights of Colum bus, the Salvation Army, the establishment of canteen huts, stations at the front for dressing of wounds, the evacuation hospitals, base hos pitals, methods of transportation, which have never been equalled, and when the statistics are finally compiled, it will be greatly to the credit of our surgeons that they did all that was possible for the sick and wounded soldiers.
When war begins suffering and pain enter, and the surgeon, having everything in readiness, endeavors to relieve his patient as promptly as possible. The use of anaesthetics has passed through a very thorough analysis, resulting in the positive doing away with all mixtures of ether, chloroform and alcohol, for they have met with little endorsement in military opera tions. The same experience has come to many surgeons in civil life as the unequal evapora tion makes their use somewhat uncertain. The administration of ether, or chloroform, sepa rately, with plenty of air, has resulted very favorably. It is to be observed that many of the writers on the subject have endorsed plac ing the patient under a minimum narcosis, then watching them very carefully, and the after effects have been excellent. Local anesthesia seems to have inspired a good deal of confi dence, particularly among those who are work ing in the evacuation and base hospitals, as well as rest homes.