Suppurating wounds from small-calibre bullets, having high velocity, heal with comparative promptness. Wounds from such bullets are necessarily more humane and less painful than those from the older missiles; but the relative percentage of deaths to wounded is but slightly reduced. Unless unusual complications call for immediate surgical interference, the injured should be removed as rapidly as possible to a well-equipped base or general hospital for treat ment. Penetrating abdominal and thoracic wounds give a vastly larger percentage of recov eries where non-interference has been observed. Laparotomy, except under the most favorable conditions, such as hold in well-equipped hospi tals, is attended with great peril. The Röntgen ray has been of utility in indicating where surgi cal interference is justified and in many cases has averted infection which would result from probing or similar surgical procedures. It has also thrown light on the pathology of wounds in volving the solid structures, and shown that the severest lesions of bones will progress toward recovery, provided the wound is sterile. It proved an invaluable aid in the Spanish-Ameri can War, in the Boer War, and in the Philip pines, where it was used in general hospitals at the base of operations and on hospital ships; but it is not a practical apparatus near the firing line, where its use in the detection of bullets could only prove an incentive to premature opera tions. The modern jacketed bullet is practically aseptic; there is never urgency for its removal except where aseptic technique is possible, other wise infection of the wound is an inevitable con sequence. The Röntgen ray was also of especial scientific value in gunshot fractures by showing the character of the bone lesions, the form of the fracture, and the amount of bone comminution by small-calibre bullets, fragments of shells or other missiles, conditions that could not have been otherwise determined in the living body, thus also proving an important factor in developing the principle of conservatism in surgery of war.
It is to Pasteur and Lister that military sur gery owes its greatest debt. They have simplified its labors and taught the great lesson of non interference. The soldier who falls on the battle field from the effect of a ball passing through any but a vital part of his anatomy and who has a 'first-aid' dressing promptly applied and is then transported to a general hospital where the Röntgen ray and the principles of asepsis and antisepsis can he utilized, has a far greater chance of recovery than when his wounds are treated on the field. By following these conserva tive methods in the Spanish-American War the percentage of recoveries was 95.1 per cent., while 4.9 per cent. died, a ratio never before attained in the history of warfare.
The medical corps of different armies vary lit tle in their personnel. There is one surgeon-gen eral; a chief surgeon to each separate army corps, division, brigade, and general hospital ; surgeon and two assistants to each regiment; and a single surgeon with each battery or separate detachment. These are all commissioned officers. The hospital corps comprises the hospital stew ards and their assistants, privates often selected to serve as pharmacists, orderlies, nurses, cooks, litter-bearers, and ambulance-drivers, and should equal four per cent. of the fighting force of the
army. In addition to a canteen, the United States Hospital Corps men carry a corps pouch and an orderly pouch. The corps pouch contains aromatic spirits of ammonia, first dressing packets, wire gauze for splints, gauze bandages, rubber band ages, surgical plaster, scissors, pins, forceps, and knife. The orderly pouch contains chloroform, antiseptic tablets, pocket case, ligatures, hypo dermic syringe, etc. Medical and surgical chests used on the march or at the front should contain, as stated by Surgeon-General Forward, United States Army, "surgical material mainly, and very little medicine, which may he for the most part in tablet form. The principal articles are splints and modern wound dressings, including plaster rollers, and rubber plaster for rapid fixation of splints; a light complete operating set, tin trays, basins, and cups in nests; chloro form and inhaler; rubber tubing, needle, and canula; and pure sodie ehlorid for transfusion; mercuric biehlorid, trieresol, iodoform, soda, and green soap; rubber bandage and rubber gloves; hypodermic syringe and full sets of tablets; purgative pills, quinine, and a few other medi cines; concentrated food and stimulants; small ease of 'tools in the handle,' and a lantern. The dressings consist mostly of biehlorid and iodo form gauze, absorbent cotton, and gauze band ages. They should be in small parcels, compressed, and wrapped in strong waterproof paper, to save waste and contamination, and for convenience in transportation, handling, and distribution." The same general directions—relatie;e to ( ) the operating room, covering instruments and dressings; (2) preparation of the patient; (3) preparation of the surgeons; (4) the operation; and (5) after-treatment—that apply in general surgery (as stated in the article SURGERY) apply also to military surgery at the base hospitals, and successful results will follow in exact pro portion as those details are carried out. It is not therefore to any special training in surgical technique that the military surgeon will owe his triumphs. History has shown that more cam paigns have been decided by disease than by the sword. Statistics of wars for the past hundred years, while varying in some particulars, have concurred to establish the fact that for every soldier killed in battle there are five wounded who recover. The introduction of modern wea pons with the compound metal-jacketed small calibre balls of high velocity and great range, has shown no perceptible change in the propor tion of these figures, viz. one killed to five wounded. It is also an established fact that for every man killed in action or who dies from the results of wounds, at least five die of disease that is almost invariably of a preventable char acter. In the American Civil War (180-05) 110,070 were killed, and over 249,458 died from disease. These proportions were higher in the war of the Crimea and also in the Mexican War; and in the Spanish-American War, although ac tual hostilities only lasted for a period of six weeks, the proportion of losses by disease was even higher still.