SURGERY, MILITARY. The best civil have proved the best military surgeons, as is shown by the great names in surgical history, Ambroise Pare, Larrey, Pirogoff, Von Bergman, Von Es march, T3illroth, and Lister. Not until the discov ery of asepsis and antisepsis was the true foun dation laid for the modern treatment of gun shot wounds. This discovery so radically changed all former methods of treatment as to lead to the now thoroughly established maxim formulated by Senn in the recent war between the United States and Spain, "The fate of the wounded rests in the hands of the one who applies the first dressing." The lesson has only recently been learned that bullet wounds must never be touched on the field—much less explored by probing or otherwise—before the first aid (antiseptic) dressing is applied. Operative interference is justifiable on the battlefield only in cases of ex treme urgency, where extensive hemorrhage ex ists, or where the .wound is in the region of the throat and suffocation is imminent. As a rule gunshot wounds are bloodless. Primary hemor rhage, unless resulting from the very rare acci dent of cutting some large vessel, is usually ab sent altogether, or can readily be controlled by a compress or first aid bandage. Especially in wounds of the abdomen the law of non-interfer ence applies with double force. In the Spanish American War 50 per cent. of all the cases of abdominal wounds unoperated upon recovered, while all operated upon (lied. In the Russo-Tur kish War, that great apostle of conservatism in military surgery, Von Bergman, by the use of occlusive dressings, immobilization of the limb, and antiseptic precautions, saved thirteen out of fourteen cases of severe gunshot wounds of the knee-joint complicated with extensive comminu tion of the bone, while of similar cases treated by the old method of exploration without anti septic precaution 95 per cent. died.
Observations during the recent Spanish-Ameri can War and the Boer War have led to the following deductions: (1) Small-calibre bullet wounds are usually aseptic and heal promptly. (2) Jagged and extensive wounds, poisoned by such missiles, are due to the detachment of the jacket, the introduction into the bullet of for eign particles (such as cloth, buttons, etc.), lat eral impingement of the bullet, or ricochet. (3)
Owing to the small diameter of the bullet and its great velocity, the orifices at entrance and exit are minute, and it is almost impossible to dis tinguish one from the other. (4) The cardinal principle has been established that manipulation of such wounds and probing on the field (except in the rarest instances) is surgical malpractice.
To Esmarch is really due the latest conception of the axiom 'laisser; oiler,' and his first aid pack age is a memorial to his practical grasp of the principles of wound infection. The first aid package has been modified by Senn, of Chicago, who emphasizes his conclusions as follows: (1) First aid packages are indispensable on the bat tlefield in modern warfare. (2) The first aid dressing must be sufficiently compact and light to he carried in the skirt of the uniform, or on the inner surface of the cartridge or sword belt, to he of no inconvenience to the soldier or in con flict with military regulations. (3) The Esmarch triangular bandage is of great value in the school of instruction, but as a component part of the first aid package it is inferior to the gauze band age. (4) The first aid package must contain in a waxed aseptic envelope an antiseptic powder, such as boro-salicylie powder; two strips of aseptic Entine, each 2 X 4 inches; a lar piece of gauze, the diagonal half of a square yard; sterilized pins wrapped in tin foil, and be tween this package and the outside impermeable cover, two strips of adhesive plaster an inch wide and eight inches long. (5) The first aid dressing must be applied as soon as possible after the re ceipt of the injury, a part of the field service which can be safely intrusted to competent hospi tal corps men. (6) The first aid dressing, if em ployed on the firing line, should be applied with out removal of the clothing over the injured part, and fastened to the surface of the skin with strips of rubber adhesive plaster, the bandage being ap plied over and not under the clothing. (7) The first aid dressing must be dry and should remain so by dispensing with an impermeable cover of any kind over it, so as not to interfere with free evaporation of the wound secretion. (8) The first aid dressing should not be disturbed un necessarily, but any defects should be corrected at the first dressing station.