It must frequently happen in military practice that several operations have to be performed in rapid succession on the same person, from necessity of a speedy removal of the wounded; and, moreover, from the number of cases which are suddenly thrown on the care of the army surgeons after a general engagement, it must frequently occur that the diagnosis of a case is more or less doubtful. In such instances, the use of chloroform, by diminishing pain and preventing shock, and thus giving the opportunity of more accurate examination of parts, becomes particularly valuable in army practice. After the battles of Alma and Inkerman, when orders were given to remove the wounded as speedily as possible, the first-named consideration frequently occurred. The case of Sir T. Trowbridge is quoted by Mr. Guthrie. This officer had both feet completely destroyed by round shot at Inkerman, and it was necessary to amputate, on one side at the ankle-joint, on the other in the leg: the use of chloroform enabled the two operations to be performed within a few minutes of each other with perfect success. The amputations were done by the late Director-General of the Army Medical Department. In illustration of the second casualty, the following, which happened to the writer at Alma, may be named. A man of the Grenadier company of the 19th Regiment had a leg smashed by round shot. It was a question whether the fracture of bone extended into the knee-joint. Two superior staff-surgeons were near; a hasty consultation was held, and it was decided that the probabilities were in favor of the joint being intact. Amputation was performed, and the tibia sawn off close to the tubercle. It was then rendered evident that there was fissured fracture into the joint. As soon as the man had recovered from the state of anesthesia, the necessity of amputation above the knee was explained to him, and he readily assented. This was shortly afterward done, and the man recovered without any unusual symptoms, and was invalided to England. It is not likely, without chloroform, in a doubtful case of this kind, that the chance of saving the knee would have been conceded.
In the British army in the Crimea chloroform was generally applied by simply pouring a little on lint. The chief objection against this in the open air is probably the waste which is likely to be occasioned. Dr. Scrive says it always appeared to him most advantageous to use a special apparatus, as well to measure exactly the doses, as to guarantee a proper amount of mixture of air; and that although he never saw a fatal result, he had several times seen excess of chloroformization from the use of lint rolled up in the shape of a funnel. The instructions which he gave were, never to pass the stage of strict insensibility to pain, never to wait for complete muscular relaxation; and to this direction being carried out he attributes the fact that no death occurred from chloroform in the French army in the Crimea. In an article on anesthetics, in the Medico-Chirurgical Review, October, 1859, Dr. Hayward, of Boston, has strongly advocated the use of sulphuric ether above all other anesthetics. The quantity required to produce anesthesia—from four to eight ounces—would render the use of this agent almost impracticable in extensive army operations in the field.
AFTER-USEFULNESS OF WOUNDED SOLDIERS.
The results of wounds unfit soldiers for military service in many ways, according to the nature of the wound and the region in which it is inflicted; and the pensions consequent on their discharge entail heavy expenses of long duration on the country. It was hoped that the improvements in conservative surgery would have diminished the number of disabled soldiers as compared with former wars; but the corresponding improvements in the power and means of destruction, with other circumstances, have defeated this hope, and the returns do not show such to be the result. Even the cases where resections of the joints have been performed, and fractures united, which previously would have been treated by amputation, have rarely presented such cures as to render the men available for military service, though the preserved limb may still be of use in the work of civil life. Formerly, all men who thus became unfitted to perform any of the duties to which a soldier is liable were removed from the army; but, by an order from the Horse Guards of 1858, wounded soldiers, though rendered unfit for active service in the field, were directed to be retained for modified duty in such employments as they are capable of executing. The results of the increased practice of conservative surgery may, therefore, prove valuable to the public service, now that the opportunity of secondary employment is laid open. The reports from the hospitals in Italy show that during the recent campaign in that country the practice of conservative surgery after gunshot fractures has been very limited, and in the lower extremity has been almost wholly abandoned, early amputation being practiced instead.
It is believed, that should England become again involved in war, a greater amount of systematic scientific observation will be brought to bear upon the subject of gunshot wounds than circumstances have ever previously admitted. Hitherto, the majority of the younger medical officers of the army have found themselves, on the occasion of war, suddenly in possession of a large number of wounded officers and soldiers to treat, with only those general principles of surgery to guide them which they had originally obtained in their studies in civil hospitals and schools; but this knowledge, essential and absolutely necessary above all other as it is, has been long admitted in the first-class powers of the Continent, whose military experience is necessarily greatest, to be incomplete for this purpose. Now that an Army Medical School has been established in England, and that in it the large number of sick and wounded who annually return from all parts of the world—serving to illustrate, among other subjects, the consequences of wounds and of the surgical operations performed for them in all their varieties—will be turned to account, as well as the great collection of preparations in the museum of the Army Medical Department, it is only reasonable to hope that the opportunities of study in these specialties which will be afforded to every medical officer at his entrance into the army will cause each individual, not only to be ready to apply at any moment all the improvements derived from experience and observation, up to the most advanced period, in this branch of the profession of surgery, but will also best prepare the members of the department for extending still further the sphere of usefulness which has been cultivated by their predecessors.
THE END.