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■we follo^wed him. On the morning of the
29th, the 2d corps, two divisions of the 3d,
and one of, the 6th corps, all under com-
mand of Gen. Warren, were ordered to the
Plankroad leading to Orange Court House.
We reached Fairmont Church .in the even-
ing, and nioved out before daylight to the
front of the enemy's works.

We remained on their front till December
1st, when we were ordered back to Ctdpep-
per Ford. We crossed the Ford by night,
and re-entered our old camps on Mountain
Eun the follo^wing day. The loss of the
corps during the movement was about five
hundred of all classes. The use and ad-
vantage of the present system of field relief
was more evident to me than ever during
this short campaign. The weather was
most intensely cold, and our supply of
quUts and blankets relieved from suffering,
or, perhaps, preserved the lives of many
wounded. The wounded were all under
tiie charge of Surgeon D-winalle, to whom
many articles were furnished. I made it
my business during the campaign to visit re-
peatedly the field hospitals, which duty was
particularly arduous after our movement to
the right had left me the only representa-
tive of the Commission ■with Warren's large
command. I have the pleasure of reporting
that my stock was adequate to the demand,
and in no case was a proper call denied.
During our movement the wounded were
the major portion of the time in the am.bu-
lance train. I was, therefore, able from my
stores to furnish them daily soft crarkoes,
tea, mOk, stimulants, &c. !|Every evening
milk punch was made by the attendants, and
distributed to those needing it. Through
my observation of my O'wn as ■sy ell as other
corps, and from the expression of medical
officers, it is my impression that the Com-
*mission brought itself most favorably before
the army; and, what is better still, relieved
a mass of suffering which would not have
otherwise been reached, and gave many a
poor fellow another sight of his pweet
northern home who would else have slept-
under the forest trees of the wilderness. On
the 5th we moved our camp to Stevens-
burgh, and on the 7th moved to Shephard's
Grave, where the camp is a ];resent situat-



ed. On the 6th the undersigned was relieved
by Dr. G. E. Holbrook, and on the 10th
returned to Washington. During the past
quarter it has been his endeavor to keep
himself as much as possible under the ^-
rection of the medical staff of his corps, to
whom he is indebted for many kindnesses
and much valua,ble advice. In fact, as a
representative of the Commission, he has
met -with nothing but courtesy from aU the
officers ■with whom his duties have thrp^wn
him; apd his position has been rendered
doubly pleasant from the uniform. kindi;te^
and sympathy of those under whom he has
been acting. He has to return his thanks
for the promptness ■with which all his de-
mands upon their time were met, and for
the amount of good he has been able to
accomplish in his department.

Mr. Kurtz ■writes:

Having just returned from Brandy
Station, I deem it a privilege no less ths^
a duty, to lay before you a few facts ■with
reference to my field experience. Thurs-
day, November 26, 1863, we received the
order to move. It was jcay lot to be con-
nected ■with one of the Field Eelief wagons,
temporarily attached to the Ambulance
train of the 1st Di-vision, 6th Corps. Left
camp, accompanied by Captain Harris,
Assistant Superintendent, and Mr. D. S.
Pope, Eelief Agent, 6th Corps, at 6 o'clock,
A. M. At 2 o'clock, A. M., (November
27th,) the train came to a halt on the plank
road leading to Germania Ford. An hoipr
afterwards we commenced moving agq.in,
coming by 8 o'clock in the morning within
eight miles of the Ford. Though weary
and. fagged out, we still preferred moying
on to an uncertain halt, and felt no little
indignation when hour after hour passed
■without being able to put our teams in
motion. At hist, at 8 o'clock in the even-
ing, the wagon-master concluded to en-
camp for the night, with the inten^iioE of
crossing the pontoon bri4ge at dawn. This
intention ■was carried out at 2 o'clock, A.
M., (Nov. 28th,) and we reached Locust
Grove at seven, where we fed our horses
and breakfasted.

Here the effects of the march upon the
men began to be seen. Many foot-sore,
hungry, sick and weary,lagged behind their
regiments; andhere I had for the irsiticiJ



The Samtary Commission BvUetm.,



139



the satisfaction, as agent to the Sanitary
Commission, to speak words of encourage-
ment to the men,- and to administer to tbe
needs of those who -were suffering from
diarrhoea, &c., on the march. By. 4
o'clock, P. M., the same day, we arrived
at a -spot near the expected battle-field —
moving by way of the Fredericksburg and
Orange Turnpike. Hospitals were im-
mediately extemporized for the various
divisions of the army, and the men wound-
ed in the engagement of the previous day
were removed into them. During our stay
here for two days, I visited frequently the
hospital, 1st Division, 6th Corps, and find
pleasure in stating that we were treated by
the surgeons of the Corps with kindness
and courtesy. Indeed every medical offi-
cer whose acquaintance I made in my
capacity as agent of the Sanitary Commis-
sion, manifested the deepest concern, re-
garding the comfort and needs of the men,
and almost invariably inquired into the
variety and amount of stores placed in my
hands for distribution.

December 1st, we started on our return
to Brandy Station. About midnight the
train stuck in the mud, and hundreds of the
wounded were obliged to remain in the
ambulances during the night. As soon as
the impassibility of the roads was thus
demonstrated, an order was given to camp,
and the surgeons in charge of the wound-
ed inquired with a loud voice for the
agents of the Sanitary Commission. At
once we repaired to the place, and in the
darkness of the night delivered to the
medical officers such stimulants, condensed
milk and crackers as they needed to feed
the wounded soldiers. We were moved to
tears at the sight of the patient heroism of
the sufferers, and our hearts were cheered
■ beyond expression by the knowledge that,
through the aid of the Sanitary Comniis-
sion, the darkness and gloom of the night
was lighted up for these wounded patients.

At 8 o'clock in the morning we resumed
the march. By order of the surgeon,
another halt was made a short distance from
Brandy Station. Here again the assistance
of the Commission was called into requisi-
tion, and the remainder of the beef extract
and crackers in the wagon was distributed.
Aitc r the wounded had been refreshed, we



moved again until we reached the ground
occupied by the division before the march.
During the remainder of our stay with the
army we were gratified at Ijeing able to
furnish the medical officers with socks,
drawers, &c., for the wounded, prior to their
transportation to Washington.

Allow me, in conclusion,, to state that
my experience as pro tempore Field EeUef
Agent of the Sanitary Commission, brief
as it was, has satisfied me that the value of
the Commission is appreciated by both men
and officers ; so that I can well understand
the truth of the remark made by Dr. Clark,
(1st Division, 6th Corps,) after we had
brought him socks and drawers for the
hospital under his chaf ge : " I do not know
what would hwe become of this army had
it not been for the Sanitary Commission. "
This remark simply echoed the sentiments
of many officers and privates expressed to
us at various times. It would be super-
fluous in me to dwell upgn the importance
of the field organization in the Army of the
Potomac, under your successful supervis-
ion. Thousands of sick and wounded
soldiers throughout the land have spread
the fame of the noble and self-denying
worth of your agents in the field, sharing
as they do many of the dangers and all the
privations and inconveniences of camp life;
and the day cannot be far distant when a
grateful* nation, redeemed from the curse
of treason, wiU pronounce the name of the
U. S. Sanitary Commissio;i with a heart
overflowing with gratitude.

D. S. Pope, (Belief Agent, 6th A.rmy
Corps,) speaking in his report of the move-
ment, says, with reference to the 2d of
December: *

We started for Brandy Station, The
roads were in a horrid condition. * * * About
eleven o'clock in the evening we stuck, and
remained thus until moniing. The sick in
the ambulances suffered a great deal. The
hard tack had given out, and also thejj?
beef tea. We issued the crackers from Mr.
Kurtz's wagon, and beef tea, rum and milk
from mine. Captain Harris, our Assistant
Superintendent, made some hot milk punch
for them, which many declared did them
more good than anything they could have
had.

Captain Isaac Harris, referring to the



140



The Samta/py Commission BuUeUn.



same occasion in his report, says: It was
here that the Commission was appreciated.
The men had started with five days' rations,
which were consumed on Monday night;
consequently the sick and wounded in the
ambulances would have been without food,
had it not been that they were supplied
with crackers, beef tea and mUk punch by
the agents. The following morning they
were served with beef-tea and crackers,
and again at noon, when the army had
reached its former camps.



CLASSIFICATION OF WOUNDS.

liETTEB FEOM DEPUTY INSPECTOB-OEN^BBAli T.
LONGMGEE, PEOEESSOE OE MTT.TTABT' BUBGEET
AT THE AEMY MEDICAZi SCHOOL, ENGLAHD, TO
EBEDESICK Iii.W OIjMSTED, ESQ., SECEETAET OS
THE SABITAEY 00MMI33I0N, WASHINGTON.

Netlet, England, November, 1863.
370 the Secretary of the Sanitary Commission, Washington:

SiE — ^Inspector-General Dr. Muir,Princi-
pal Medical Officer to the British forces in
Canada, has forwarded to me copies of the
valuable reports which the Sanitary Com-
mission has issued from time to time,
for the use of the army surgeons in the
field. He has also sent me blank copies of
the returns in use in the United States
Army, among others the form of the
monthly report of sick and wounded, in
which occurs the tabttdab statement of
GUNSHOT WOTTNDS, showLug the "seat and
character" of each wound inflicted, the
"side of the body wounded," "how re-
ceived, " " nature of missile, " " treatment, ' '
and "result," with a column for short re-
marks.

There are some features in this tabular
statement which, it appears to me, are
likely to impair its utility for comparison
with tabular returns of injuries of a Uke
mature in other countries, and believing
the subject to be one of great professional
importance, I am anxious to call the atten-
tion of the Sanitary Commission, and by
its means, that of the surgeons of the
American Army at large, to the classified
form of return, or tabidar statement, of
grunshot wounds which is now adopted in
England. It is one which was arranged
by an English surgeon of great experience
in battle-fields, but who has lately retired



from active service — Inspector-General
Taylor, C. B.

I trust that my professional colleagues
across the Atlantic wUl pardon the liberty
I am taking in sending this letter, for' the
sake of the motive which has prompted me
to write it. This is none other than an
earnest desire that the sufiferings of your
brave soldiers now in the field may, among
other rewards, be attended with this good:
that the additional experience in military
surgery which their injuries are capable of
giving to the stores of information already
accumulated by the members of our noble
profession, may be fuUy gathered, and that
in this way the labors of army surgeons
may be still better enabled to fulfil their
high purpose of saving lives of the utmost
value to their country in its hour of need,
and of generally lessening the unavoidable
miseries of war.

It may appear to some surgeons, at first
view, a matter of no great interest what
kind of arrangement is adopted in army
returns so long as a general nomenclature
is used, and on the whole correctly applied;
experience has, however, taught that so
far from this being the case, the impor-
tance of precision and accuracy in clasifi-
cation is just as great as correctness in
nomenclature, and that the nature of
statistical and professional returns will
bear exact relation to the degree in which
this importance is appreciated. Such
precision, indeed, is especially important in
the army returns, with which military sur-
geons have to deal, and in no department
of the military surgeon's practice in which
detailed returns are called for, is this im-
portance more obvious than in the Depart-
ment of Wounds, and especially of gun-
shot wounds. In time of war these in-
juries usually occur in large numbers to-
gether; the occasions are such that sur-
geons have no time to spare for entering
into detailed reports of each particular
case; and yet the nature of each case must
be defined within fixed limits, if the re-
cords furnished regarding them are to be
turned to any practically useful resultis,
whether as regards their surgical conse-
quences, their ultimate results in disabling
and invaliding soldiers, or in establishing
compari sons betw een the effects of various



The Sanitary Commission Btdletin.



141



modes of treatment. If wounds of different
characters and gravity, -wounds complicated
with serious lesions, and others simple and
uncomplicated, are mixed together under
one heading, then the deductions such as
I have indicated, on being made, must be
open to so many sources of error that no
reliance can be placed upon them.

I feel assured that the members of the
Commission will fully join with me in esti-
mating as extremely important, in a profes-
sional point of view, the condition that,
whatever form of classification be adopted,
whatever form of tabular statement framed
in our returns, these forms should be such-
as will enable surgeons to compare with ex-
actness injuries of like kinds and degrees
of gravity as regards their statistical results,
whether in respect to mortality, or the
effects of operative interference, or other
treatment. They will also agree, that these
means of exact comparison should not be
Umited to the tabular statements derived
from different actions in which one and the
same people may have been engaged, but
should embrafte a far wider range; indeed,
should be capable of being appHed univer-
sally, so that the surgical results of warlike
operations in all parts of the world might
be placed side by side and compared. It
would probably be attended with valuable
practical results if an international congress
of surgeons were formed for the purpose
of agreeing upon a common classification
and form of return of the mjuries of war;
for until such a general arrangement be de-
termined, there must remain a certain
amount of needless imperfection in the
statistical information derived from such
sources.

The tabular statement in the report of
sick and wounde^ divides the seats and
characters of the gunshot wounds into four
principal sections, viz., flesh wounds,
wounds of cavities, fractures of bones, and
wounds of joints. These, again, are sub-
divided into regions, or into particular
bones or joints; but provision is not made
for indicating such wounds as those of the
larger arteries, nerves, organs of special
sense, as the eye, and others. These inju-
ries might be referred to in the accompany-
ing remarks, but they would not be shown
in the niimerical returns. A gunshot frac-



ture of the cranium with depression, but
without penetration of the dura mater, is a
very different injury in its essential features
than another injury with penetration of the
dura mater, and the prospect of success
from elevation or trephining in the one
case as a remedial measure is widely dif-
ferent from what it is in the other. But
such special differences would not appear
in the tabular statement, and without such
limitations in the premises the conclusions
shown in the column of results must neces-
sarily be much impaired in scientific value.
An examination of the tabular statement
wiU. exhibit many other deficiences such as
I- have alluded to: but I wiU not dwell on
these, as they wiU njore readQy suggest
themselves perhaps by an inspection of the
'classification I am forwarding with these
remarks.

Before submitting Inspector-General
Taylor's classification, permit me to take a
brief review of what had been done in this
country in the way of classifying polemical
wounds previously to its appearance, and
also to make a few remarks on the advan-
tages of its arrangement.

Strange as it may appear, until the year
1855, and until several months after the
opening battle of the Alma, there was no
specific classification for gunshot wounds in
this country. These injuries were shown
numerically in the ordinary returns under
the general term of "Vulnera Sclopito-
rum," and a division of them was also made
after each action, according to their sup-
posed gravity, whether slight or danger-
ous. The order which the English sur-
geons received at the commencement of
the Crimean War for the classification of
the killed and wounded among the men of
their regiments, and on which they acted,
was the following:

"As soon after an action as possible,
medical officers in charge of corps will
make out, and transmit to the Inspector-
General of Hospitals, for the information
of the General Commanding in Chief, re-
turns of casualties, made out agreeably to
the following form:"



142



The Sanitary Commission BiMetin.



EETURN OP TnT.T.Tr.T) AND WOUNDED IN
KEST., m ACTION OF



Officers

Non-conunission'd
Officers and Men



Wounded.



s^



No other classified return of gunshot in-
juries was furnished. This was the general
form used during the Peninsular War, and
during the 40 years which succeeded the
closing scene of the Duke of Wellington's
final success at Waterloo, no change in it
was made. Such a form of return was
scarcely in advance of the method of ar-
rangement employed by Hippocrates and
Celsus, into "mortal" and "non-mortal"
wounds, of each class, of which they defined
regular lists ; and scarcely so advanced as
those employed by some of their succes-
sors, who subdivided the mortal wounds
according to the cavses of their fatality —
such as wounds producing death by imped-
ing respiration, by depriving the body of
nutrition, by haemorrhage, and so on.

In addition to the numerical and descrip-
tive return above mentioned, it was ex-
pected by the authorities ,that the histories
of wounds of particular interest would be
furnished in the monthly or annual pro-
fessional reports of corps, but the regula-
tions required nothing more. Sometimes
surgeons of their own accord would tabu-
late the cases which come under their care,
for the sake of conciseness and order; but
from the different views held by different
surgeons, and the tendency that would
naturally occur to put prominently forward
some specially successful results, or features
having a particular attraction for the sur-
geons who reported them, no fair compari-
sons could be instituted between the tables
from different sources. Other zealous sur-
geons, again,-would gather together groups
of cases from a wider field of observation,
for the purpose of investigating special
questions, or illustrating particular doc-
trines; but such summaries could only be
made by an expenditure of much personal
exertion, and they also too often contained



the same elements of error as those I just
now adverted to.

The following is an example of individual
arrangem£nt: The last year in which any
considerable body of soldiers laboring un-
der the effects of polemical injuries came
to England, prior to the Crimean period,
was the year 1848, when the nuUtaTy oper-
ations in India, New Zealand, and the Cape
of Good Hope furnished a number of
cases of this class. The medical officer in
charge 6f the hospital where these invalids
were received, arranged their injuries in a
special return, the first column of which
was intended to show the nature and situa-
tion of the wounds, and the remaining
columns the yarious ways in which the
patients were finally disposed of. On ex-
amining the column of " Situation," in the
first line, wounds of the head and face were
returned together, and I need hardly men-
tion what different considerations are in-
volved in the wounds of these two regions.
Then foUoWed wounds of the thorax:
thirdly, of the abdomen: and fourthly, of
the back; without any subdivisions to show
whether parietes only, or the cavities con-
nected with them, or any other complica-
tions were involved in the injuries. Five
headings then followed for wounds of the
upper extremity, viz: Shoulder, arm, el-
bow, forearm, and hand ; and six for
wounds of the lower extremity, viz : Hip,
thigh, knee, leg, ankle, and foot; without
any indication to point to particular inju-
ries of bones, nerves, or arteries, with which
some of them were doubtless complicated.
. The returns of a corresponding kind
which have been handed down to us from
the Peninsular campaigns, are, for the most
part, of an equally unsatisfactory nature.
Inspector-General Taylor referred to this
fact, in proposing his classification, in the
following remarks: " The necessity," he
writes, "for some such classification as
that now proposed, is obvious, from refer-
ring to the returns drawn up during the
Peninsular War. These will be found
nearly uninteresting and uninstructive, in
consequence of the want of due distinction
amongst wounds of wholly different nature
and quality. In the wounds of the head,
chest and abdomen no distinction is made
between simple flesh wounds of these re>



The Sanitary Commission Bulletin.



143



gions and injuries of the more important
■viscera. The returns do not even distin-
guish between incised and gunshot -wounds,
■which are of such totally different value
even in the same parts ; all kinds of
■wounds seem brought together simply as
'surgical cases,' and in some of the returns
of 'capital operations,' it is not clear
whether fingers and toes have, or have not,
been included under the terms upper and
lower extremities." It is somewhat im-
portant that the fact should be known of
these uncertainties and serious imperfec-
tions existing in the comparatively recent
professional returns referred to, for in al-
most all works of surgery they are quoted
as standards of comparison, with a ■^^ariety
of objects, to show the results of amputa-
tion in dififerent.fegions, for example.

Inspector-General Taylor commenced his
classification of gunshot wounds in India
at the time of the Sutlej campaign; but
completed it in the present shape, while
the principal medical officer at Chatham,
before leaving for the Crimea. He sub-
mitted it when in charge of the 3d Division,
before Sebastopol, to the head of the medi-
cal department in the Crimea, in July, 1855,
and it was then ordered to be adopted for
the army returns in general. A few months
before that time Deputy Inspector-General
Parry had employed it in classifying the
wounded under his charge in the Surgical
Di'vision of the Invalid Hospital at Port
Pitt, duriug the period ending 31st March,
1855 — the time whdn the first series of
wounded invalids from the Crimea arrived
in this country. This maybe safely said
to be the first time that a general classifica-
tion of gunshot wounds at all approaching
to precision was employed in the army
returns of any country. The purpose of
the classification is' so well explained in the
Deputy Inspector's Annual Beport'for the
date just mentioned, that I cannot forbear
quoting a few of his remarks on the sub-
ject.

"With a'vie^w- of forming something sp-
proslching to a correct estimate, "he ■writes,
"of these various wounds and injuries, I
have, in the following table, claSsifiedthem
aecoiding to different regions of the body
in -whidih ■they were situated, and after-
wards subdivided ' these ' under ■ «ach clsSsa



into sevei^l species, according as they were
either confined simply to the soft tissues, ■
or complicated with more or less injury of
the osseous structures and articulations,
or with lesion of important organs, vessels,
or nerves; and these latter, again, according
to the nature and degree of complication.
This classification is framed according to a
form of descriptive return of wounds which
was drawn up by Deputy Inspector-General
Taylor soon after the arrival of wounded



Online LibraryUnited States Sanitary CommissionBulletin → online text (page 26 of 237)