Samuel D. (Samuel David) Gross.

A manual of military surgery, or, Hints on the emergencies of field, camp and hospital practice online

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BY S. D. (JROSS, M.D.,



"L'oecasion est urgente, le jugement difficile."

"For want of timely care, millions have died of medicable wounds."




TO 1 51




I / *

;.., ... j

Entered, according to Act of Congress, in the year 1861. by


In the Clerk's Office of the District Court of the United States for the
Eastern District of Pennsylvania.


And one of the Editors of the North American Medieo-Chirurgical Review,










THE sole object which prompts me to publish this
little book is an ardent desire to be useful to the
young physicians who have so hurriedly entered the
volunteer service, perhaps not always with a full
knowledge of the weighty responsibilities of their
position. It treats, very succinctly, of various mat-
ters not generally discussed, except in large and
ponderous volumes, inaccessible in the camp and on
the battle-field. It is essentially a book for emergen-
cies; portable, easy of reference, always at hand.
The substance of it was originally intended as an
article for the July number of the NORTH AMERICAN
MEDICO-CHIRURGICAL REVIEW, and it was not until
I had made considerable progress in its composition
that the idea suggested itself to my mind that it
might, if published separately, be of service to a
part of my profession at this particular juncture in
our public affairs.

I pray the young men into whose hands this
Manual may happen to fall, to be careful of the



health and lives of the poor soldiers committed to
their professional keeping. I exhort them to per-
form their duty as skillful surgeons and physicians,
as men of courage, and as Christians, in order that,
when they return to their homes and their friends,
after the tumult and perils of war shall be over if
war there should unfortunately be they may be able
to render a good account of their stewardship, and
so entitle themselves to their country's benediction.

I would also exhort them, in a special manner, to
take good care, not only of the lives of their coun-
trymen, but also of their limbs, mutilated in battle.
Conservative surgery has, at the present day, claims
of paramount importance upon the attention of every
military practitioner; for, in the language of good
old George Herbert,

Man is all symmetrie,
Full of proportion, one limbe to another,
And all to all the world besides ;
Each part calls the furthest brother;
For head with foot hath private amitie ;
And both with moons and tides.







Historical Sketch of Military Surgery 9

Importance of Military Surgery .... 18

Qualifications and Duties of Military Surgeons 21

Medical Equipments, Stores and Hospitals 27

Wounds and other Injuries 45

Amputations and Resections 74

Ill Consequences of Wounds and Operations ',)0




Injuries of the Head, Chest, and Abdomen 98

Diseases Incident to Troops 112

Military Hygiene 139

Disqualifying Diseases 151

Feigned Diseases 155

Medical, Surgical, and Dietetic Formulae 165




Historical Sketch of Military Surgery.

THE duties and requirements of military
are essentially similar to those of civil sur-
gery. It is founded upon the same knowl-
edge of anatomy, medicine, and the associate
sciences; it demands the same qualifications,
physical, moral, and intellectual. The differ-
ence consists in the application of our knowl-
edge rather than in its range or depth. The
civil surgeon remains at home ; the military
follows the army, examines recruits for the
public service, and superintends the health
of the troops. If the former is well educated,
he will be quite as competent, at any time, as


^ th'e latter* to [perform these duties ; for the
\ t emfefj^ejicjesjof civil 'are' $>f ten not less trying

* fhari tlio's'e oT military practice, although they
may not be on so large a scale.

The best civil have often also been the best
military surgeons. In proof of this asser-
tion it is necessary only to refer to the names
of Par, Wiseman, Schmucker, Kern, Larrey,
Guthrie, Charles Bell, Alcock, Thomson, Bal-
lingall, and Macleod, of Europe ; or to those
of Rush, Jones, Thacher, Mann, and Horner
of our own country.

Military surgery occupies, at the present
day, a deservedly high rank in the estimation
both of the profession and of the public. The
war in the Crimea, the mutiny in India,
and the recent convulsions in Italy, all at-
tended with so much waste of blood and life,
have attracted to it the universal attention of
the profession ; and the revolutionary move-
ments now in progress in our own country
invest it with a new and a fearful interest to
every American physician. Its praises have
been sung by Homer, and, in all ages of the
world, governments have extended to it a
fostering hand. As a distinct branch, how-
ever, of the healing art, it dates back no fur-


ther than the early part of the sixteenth cen-
tury, when it was inaugurated by Ambrose
Par, by the publication of his treatise on
" Gunshot Wounds," the fruits of his observa-
tions in the French army in Italy. This man,
who was surgeon to four successive kings, was
an eye-witness of the numerous French cam-
paigns, from 1536 down to the battle of
Moncontour, in 1569, a period of thirty-
three years. His popularity, both as a civil
and military surgeon, was, up to that time,
without a parallel. The soldiers worshiped
him ; and the success of more than one siege,
as well of one battle, was due almost exclu-
sively to the wonderful influence of his pres-
ence. His treatise on "Gunshot Wounds"
appeared toward the middle of the sixteenth
century, and, after having passed through
various editions, was ultimately incorporated
in his surgical writings, published nearly a
quarter of a century later.

In England, the earliest work on military
surgery was that of Thomas Gale, entitled a
"Treatise on Gunshot Wounds," designed
chiefly to confute the errors of some of his
contemporaries, respecting the supposed pois-
onous nature of these lesions. Gale was born


in 1507, and after having served in the army
of King Henry VIII., at Montrieul, and also
in that of King Philip, at St. Quintin, finally
settled at London, where he acquired great
distinction in his profession. In 1639 ap-
peared the work of J. Woodall," The Surgeon's
Mate; or, Military and Domestic Surgery."
He was surgeon under Queen Elizabeth, by
whom he was sent to France, along with the
troops that were dispatched to the assistance
of Henry IV. and Lord Willoughby. In
1676, Richard Wiseman, sergeant-surgeon to
King Charles II., published his famous "Chi-
rurgical Treatises," one of which was ex-
pressly devoted to the consideration of gun-
shot wounds. Two years after this a treatise
on gunshot wounds was published at London,
by John Brown, also surgeon to Charles. He
was a man of eminence, and served with much
credit in the Dutch war of 1665. The next
English work on military surgery appeared
in 1744, from the pen of John Ranby, ser-
geant-surgeon to George II., under the title of
" The Method of Treating Gunshot Wounds."
After Ranby came the imperishable work of
John Hunter, familiar to every reader of Eng-
lish surgical literature. The part relating to


gunshot wounds was founded upon his observ-
ations made while serving as staff-surgeon at
Belleisle and in Portugal, and is one of the
most precious legacies of the last century,
near the close of which it appeared.

The present century has supplied quite a
number of works on military surgery, as is
shown by the valuable publications of Larrey,
Hennen, Hecker, Augustin, Guthrie, Thom-
son, Hutchinson, Ballingall, Baudens, and
others, which have contributed so much to the
elevation of this department of the healing art.
Some of these works have been reissued in this
country, and have acquired a wide celebrity.

We must not forget, in this rapid enumer-
ation of works on military surgery, the
"Manuel de Chirurgien d'ArmeV' of Baron
Percy, published at the commencement of the
revolutionary war in France. It is a model
of what such a treatise ought to be.

The only work on this department of sci-
ence yet furnished in this country, is that of
the late Dr. James Mann, published at Ded-
ham, Massachusetts, in 1816. It is entitled
"Medical Sketches of the Campaigns of
1812, '13, and '14," and forms a closely-


printed volume of upwards of three hundred
octavo pages.

The latest treatise on this subject in the
English language is that of Dr. George H.
B. Macleod, now Professor of Surgery at
Glasgow, entitled " Notes on the Surgery of
the War in the Crimea ; with Remarks on the
Treatment of Gunshot Wounds." It is a
work of intense interest, written with great
ability by an accurate and diligent observer,
and is worthy of a place in every medical
library. To this work frequent reference will
be made in the following pages.

To Dr. Lewis Stromeyer, Physician of the
Royal Hanoverian Army, we are indebted
for the most recent German work on military
surgery. It was issued in 1858, under the
title of " Maximen der Kriegsheilkunst," in
two duodecimo volumes, to which a Supple-
ment was added in the early part of the pres-
ent year. A more valuable contribution to
this department of surgery could hardly be

Besides the above more recent works, the
reader should carefully study the "Principles
of Military Surgery," by the late Dr. John
Hennen, one of the most zealous and distin-


guished military surgeons that Great Britain
has yet produced; a man of vast experience,
and of the most enlightened views upon every-
thing which he has touched with his pen.

Perhaps the most systematic work on the
subject in the English language is that of Sir
George Ballingall, entitled " Outlines of Mil-
itary Surgery/' the last edition of which,
the fourth, appeared only recently at Edin-
burgh, where the author held for many years
the chair of military surgery, for a long time,
we believe, the only one in Great Britain.
It is a production of much merit, and is des-
tined to maintain a very high rank in this
species of literature.

The works of the late Mr. George Guthrie
also deserve attentive study ; they are written
with great clearness and ability, and embody
the results of an immense experience, acquired
during many years of arduous and faithful
labor and observation in the British army. I
have always regarded the works of this great
man as among the most valuable contributions,
not only to military surgery, but to surgery
in general, in the English language.

With these works before him, the student
of military surgery cannot fail to make him-


self in a short time perfectly familiar with
everything pertaining to the subjects of which
they treat. He should also provide himself
with a copy of the excellent little volume en-
titled " Hints on the Medical Examination of
Recruits for the Army," by the late Dr.
Thomas Henderson, formerly Professor of
Medicine in Columbia College, Washington
City. A new edition of it was published a
few years ago by Dr. Richard H. Coolidge,
of the United States army.

Although we have long had one of the most
respectable and thoroughly organized army
and naval medical staffs in the world, our coun-
try has, nevertheless, not produced one great
military surgeon ; simply, it may be presumed,
because no opportunity has occurred since the
establishment of our government, in which the
men in the public service could distinguish
themselves. Their aid has been required in
the duello and in skirmishes rather than in
great battles, such as have so often charac-
terized the movements of the armies of the
Old World. We make no exception in this
remark in favor even of the battles that were
fought during the Revolution, and during our
Late War, as it has usually been designated,


with Great Britain. Those engagements
were, for the most part, comparatively blood-
less. Happily living under a flag which,
until recently, commanded alike the respect
and the admiration of all nations, belonging
to a government which was at peace with all
foreign powers, the medical and surgical staffs
of the public service had little else to do than
to prescribe for such diseases as are incident
to civil practice. America has never wit-
nessed, and we trust in God she never may
witness, such carnage as that which attended
the footsteps of Napoleon at the Bridge of
Lodi, at Leipzig, at Dresden, and at Water-
loo ; or which, more recently, characterized
the exploits of the English, French, and
Russian forces in the Crimea; or of the
French, Italian, and Austrian armies in Italy ;
or of the English soldiers during the late re-
bellion in India. Nor has she ever been
engaged in one great naval battle similar to
that of La Hogue, Toulon, Trafalgar, or
Aboukir. A number of highly respectable
physicians accompanied our army to Mexico,
but they returned without any special laurels,
and without any substantial contributions to
military medicine and surgery.


Importance of Military Surgery.

IT is impossible for any civilized nation to
place too high an estimate upon this branch
of the public service. Without the aid of a
properly organized medical staff, no army,
however well disciplined, could successfully
carry on any war, even when it is one, as that
which is now impending over us, of a civil
character. No men of any sober reflection
would enlist in the service of their country,
if they were not positively certain that com-
petent physicians and surgeons would accom-
pany them in their marches and on the field
of battle, ready to attend to their diseases
and accidents. Hence military surgery, or,
more correctly speaking, military medicine
and surgery, has always occupied a deservedly
high rank in public estimation.

Dionis, a surgeon far in advance of his
age, in referring to the value of medical ser-
vices to soldiers, exclaims, with a burst of
eloquence: "We must then allow the neces-


sity of chirurgery, which daily raises many
persons from the brink of the grave. How
many men has it cured in the army ! How
many great commanders would have died of
their ghastly wounds without its assistance !
Chirurgery triumphs in armies and in sieges.
'Tis true that its empire is owned: 'tis there
that its effects, and not words, express its

The confidence reposed by soldiers in the
skill and humanity of their surgeon has often
been of signal service in supporting them,
when exhausted by hunger and fatigue, in
their struggles to repel the advancing foe, or
in successfully maintaining a siege when the
prospect of speedy surrender was at hand.
Who that is versed in the history of our art
does not remember with what enthusiasm and
resolve Ambrose Par, the father of French
surgery, inspired the souls of the half-starved
and desponding garrison at Metz, in 1552,
when besieged by 100,000 men under the
personal command of Charles V.? Sent
thither by his sovereign, he was introduced
into the city during the night by an Italian
captain; and the next morning, when he


showed himself upon the breach, he was
received with shouts of welcome. "We shall
not die," the soldiers exclaimed, "even though
wounded; Par is among us." The defense
from this time was conducted with renewed
vigor, and the French army ultimately com-
pletely triumphed, through the sole influence
of this illustrious surgeon.

No man in the French army under Napo-
leon rendered so many and such important
services to the French nation as Larrey, the
illustrious surgeon who accompanied that
mighty warrior in his various campaigns,
everywhere animating the troops and doing
all in his power to save them from the de-
structive effects of disease and injury. His
humanity and tenderness were sublime ; and
so highly was his conduct, as an honest, brave,
and skillful surgeon, appreciated by Napoleon,
that he bequeathed him a large sum, with the
remark that "Larrey was the most virtuous
man he had ever known."



Qualifications and Duties of Military Surgeons.

IT is of paramount importance that none
but men of the best talent and of the highest
education should be received into the public
service. Rigid as the examinations of the
army and naval medical boards already are,
there is need of increased rigor, in order that
none may be admitted who are not thoroughly
prepared for the discharge of their responsi-
ble duties. Equal vigilance should be exer-
cised in regard to the introduction of physi-
cians and surgeons into the volunteer service.
Every regiment should be provided with an
able medical head, a man ready for every
emergency, however trying or unexpected;
a man skilled in the diagnosis and treatment
of diseases, and competent to perform any
operation, whether small or large, on the spur
of the moment. To do this, he must be more
than a mere physician ; he must be both phy-
sician and surgeon, in the true sense of the
terms, otherwise he will be unfit, totally un-


fit, for his position* He must have been
educated in the modern schools ; be of un-
doubted courage, prompt to act, willing to
assume responsibility, humane and sympa-
thizing, urbane and courteous in his manners;
in short, a medical gentleman, as well as a
medical philosopher, not hesitating, if need
be, to perform the most menial services, and
to do all he can to preserve the health and
the lives of the soldiers committed to his care.
The white-gloved gentry, such as figured in
some of the regiments that went to Mexico,
have no business in the service; their time
can be much better spent in the discharge of
their domestic duties, in the practice of their
neighborhood, and in the contemplation, at a
distance, of the miseries of war.

It is much to be feared that, from the rapid
manner in which our volunteers have been hur-
ried together, many medical men, old as well
as young, have already been admitted into the
service utterly unfit for the office. If this be
the case, let our authorities, warned by the
past, be more circumspect in regard to the
future. Above all, let them see that the
medical staffs of the brave volunteers of the
country be not defiled by charlatans and un-


worthy men, between whom and the regular
practitioners there cannot possibly be any
professional, much less social intercourse,
either in civil or military practice. The me-
dical men should be on the best possible terms
with each other; all causes of discord and
bickering among themselves should be stu-
diously obviated, and speedily suppressed, if,
unfortunately, they should arise. Concert of
action on the part of the medical corps is in-
dispensable to the success of the medical
operations of an army.

Every regimental surgeon should have at
least two assistants in time of peace, or
during the inactivity of the troops under his
charge; when on active duty, on the con-
trary, the number should at least be double,
especially in the face of an anticipated bloody
engagement. These assistants should be se-
lected solely with reference to their compe-
tency; they should, like the principal, be
eminently intelligent, and ready, in case of
emergency, to perform any operation that
occasion may demand. Every brigade should
have its brigade surgeon, who should exercise
a supervisory control over the regimental
surgeons, principals as well as assistants, as


every State should have its surgeon-general,
or medical-director, whose duty it should be to
superintend the whole medical arrangements,
seeing that the candidates for the medical de-
partment of the service be subjected to a rigid
examination, attending to the purchase of
medicines and instruments, providing suitable
nurses, inspecting the quarters, stores, and pro-
visions,' that nothing of an unwholesome char-
acter may find its way into the ranks, pointing
out the proper location of camps, and the con-
struction of hospitals, and giving general in-
structions in regard to military hygiene, or the
best means of avoiding disease and accident.
Prior to every engagement at all likely to
be severe or serious, a proper number of men
should be detailed for the purpose of render-
ing prompt assistance to the wounded, and
carrying them off the field of battle to the
hospitals or tents erected for their accommo-
dation and treatment. Unless this be done
as a preliminary step, much suffering will in-
evitably be the consequence, if not great con-
fusion, highly prejudicial to the issue of the
combat. So fully aware are the leaders and
sub-commanders of our armies of this fact
that they never permit any man to fall out


of the ranks, during an engagement, to per-
form this service.

While the battle is progressing it is the duty
of the surgeon and of his assistants to remain
in the rear of the combatants, as much as pos-
sible out of harm's way, but at the same time
ready and on the watch to render the promptest
possible aid. They must be Argus-eyed, and
in the full possession of their wits. One of
the leading differences between military and
civil practice is the instantaneous action so
often demanded by the one, and the delay so
frequently admitted by the other.

The first duty of every surgeon is to the
officers and men of his own corps; but on
the field of battle, or soon after the battle is
over, he is often brought in contact with the
members of other regiments, or even with the
wounded of the enemy ; and under such cir-
cumstances the dictates of humanity, not less
than the usages of war, demand that he should
render his services wherever they may be
likely to be useful. The medical officers, of
the contending parties sometimes meet upon
such occasions, and, when this is the case,
their conduct should invariably be char act er-


ized by the courtesy of the gentleman, not the
asperity of the enemy. They should not for-
get that they are brethren of the same noble
profession, acting in the capacity of minister-
ing angels to the sick and the dying. Coun-
try and cause alike should be forgotten in gene-
rous deeds.

By the usages of war in all civilized coun-
tries, the surgeons are always respected by
the enemy if, during an engagement, they
happen to fall accidentally into their hands.
Their lives are regarded as sacred, the more
so, as they are comparatively defenseless.
They are not, however, during the rage and
smoke of the battle-field, always easily distin-
guishable from the other officers, or even the
common soldiers. The green sash, their dis-
tinctive badge of office, does not always afford
them immunity, because it is not always re-
cognized; and it is worthy of consideration
whether, as an additional safeguard, the word
" surgeon" should not be embroidered in legi-
ble characters upon a piece of cloth, to be
thrown across the chest in time of battle.
The significance of such a badge could not be
mistaken by friend or foe, and would be the
means of saving many valuable lives.


Medical Equipments, Stores, and Hospitals,

EVERY 'regiment, or body of military men,
should be amply provided, in time of war,
with the means of conveying the wounded
and disabled from the field of battle. For
this purpose suitable carriages and litters
should constantly be in readiness. The car-
riages should be built in the form of light

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Online LibrarySamuel D. (Samuel David) GrossA manual of military surgery, or, Hints on the emergencies of field, camp and hospital practice → online text (page 1 of 10)