calm and collected state of mind and self-reliance, arising from an acquaintance, at least, with the principles of action in the case before him! And how can this be secured but by study and experience? It becomes imperative, then, upon every member of our profession, to acquaint himself at once with the best authors on military surgery within his reach. The works of Hunter, Hennen, Guthrie, Mann and Larrey, should be carefully studied, Guerin's Chirurgie Operatoire, Gibson or Erichsen carefully reviewed at least, such parts of them as relate to wounds, incised, punctured, or contused, to gun-shot wounds, fractures and dislocations- and no opportunity to cut down, on the dead body, for the main arteries, or for the performance of such operations as circumstances may permit, should be allowed to pass unimproved. Most fortunately, by the kindness of friends in this city, many of us have enjoyed the pleasure and profit of listening to the instruction of the distinguished Professor of Surgery in the Medical School of Harvard University, and of witnessing his neat operations upon dead and living bodies. For such opportunities, we beg him and them to accept our most hearty thanks. To such as have not recently enjoyed these privileges, let me say, drilling, to the inexperienced surgeon on the eve of battle, is no less necessary than to the young recruit. The former, no less than the latter, should see to it that his arms are in order, and that he knows how to use them. The character of wounds should be as readily recognized by the surgeon, as the foe by the soldier; and the principles of their treatment should

be as familiar to the one as are military evolutions and tactics to the other. To these principles, as drawn from the best authors, we invite attention, with the double object in view, of refreshing our own memory and inducing others to do the same, and to supply any deficiency and correct any error that may be discovered in the speaker. To those who listened to Dr. Bigelow's lectures, a portion of my address may serve as an imperfect review or résumé, for which I crave their indulgence; while to those who were not thus favored, I trust my remarks may serve as a substitute, so far as principles are concerned, and as incentives to study and to action.

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Before entering upon the treatment of wounds,

may be well to make a few general observations upon the nature of gun-shot wounds, and their effects upon the constitutional powers. The only wounds which the surgeon in civil practice sees, that in any way resemble those witnessed by the military surgeon, are the wounds presented by the accidents upon our railroads. The action of a cannon ball, on coming in contact with our limbs, deadens not only the parts impinged upon, but diminishes, if it does not actually destroy, the vitality or normal condition of adjacent parts; so that, in the performance of amputations, care should be taken to operate in such a manner as to preclude the necessity of any secondary operation. Our incisions, if possible, should be made above any part in danger of sloughing; and for the same reason, the artery should be secured as high as possible, and the bones sawed

off above all local injury. The bullet deadens the part in the neighborhood of the wound, but it is by no means true that its entire track must slough. The Minié ball appears to be peculiarly destructive to the bony parts, fracturing and comminuting them to an extent, and in a manner, truly surprising. Before proceeding to any operation involving the removal of a member, a thorough knowledge of all the wounds which the patient may have sustained, demands the most careful attention; for it has so happened in military surgery, as appears from Hennen, that a limb has been removed and dressed before it was discovered that the patient had, beside, a wound through the body, which must of necessity prove fatal.

The state of collapse consequent upon a trifling, no less than a severe wound, should receive attention. Hence Hennen recommends that the surgeon should always have about his person a canteen of wine, to revive the fainting spirit of his patient. "This tremor," he says, "which has been so much talked of, and which to an inexperienced eye is really terrifying, is soon relieved by a mouthful of wine or spirits, or by an opiate, but above all by the tenderness and sympathizing manner of the surgeon, and his assurance of the patient's safety."

The continuance of this alarm or shock ought to excite fears for the result, especially when wounds have been received in such a situation as to cause us to suspect the injury of vital organs.

The necessity of immediate action on the part of the surgeon is too often imperative; it may be in

the height and tumult of the battle. The weight of his duties must, of course, depend upon the number of his associates and assistants, as well as upon the number of the wounded.

All wounds accompanied with much arterial hæmorrhage demand immediate attention, either by compression or by ligature. The former cannot safely be continued for any length of time, and the latter cannot safely be postponed very long. When the wounded or bleeding artery can be reached, immediately ligating with a single thread of dentist's silk, one or both ends, if possible, may prevent a secondary and fatal hæmorrhage - which, when it occurs, usually takes place from the eighth to the twentieth day. If such secondary hæmorrhage should occur, or circumstances prevent securing the artery at the place of the wound, if incised, it may be secured above, and future hæmorrhage be prevented by pressure from below and up to the wound. In gun-shot wounds, this compression could not be endured, and amputation would be required.

When the hæmorrhage is venous and from an extremity, a sponge tent, or compression, properly applied, may be sufficient; or if not, the vein may be tied. Compressions alone may succeed in staying hæmorrhage from wounds of the scalp, the hands or the feet; but if it does not, in the case of the hand, if the radial and ulnar cannot be tied, we may apply the ligature to the humeral artery. If compression on wounds of the arteries of the scalp is insufficient, the artery may be divided.

Should the hæmorrhage arise from the wound of

an internal organ, as the lungs, the liver, or the spleen, venesection from a large orifice, which may be repeated if needed, is our most effectual means of relief- remembering always that young recruits and the inhabitants of cities tolerate bleeding less amply than the inured soldier and the hardy yeoman; and that venesection, except in severe inflammations of the serous membranes, congestion of the lungs and brain, and in the early stage of pneumonia, has been in a great measure abandoned.

Next to controlling hæmorrhages, the surgeon should be careful to remove, either by the wound or counter-openings, all foreign bodies, whether in the fleshy or bony parts. This, Hennen says, we should lay down as a rule never to be deviated from, so far as can possibly be accomplished with safety to the arteries, cavities and joints; "but," he continues, "those who best know the field of battle will easiest admit how often it is impossible to do all in this respect that they could wish."

"In all our examinations," says Guthrie, "the surgeon should never forget to make a counter-pressure to the fingers with which he is searching for the ball. This is most essential in the extremities, where counter-pressure will often bring an extraneous body within the reach of the finger or probe."

In searching for foreign bodies, we should always remember that we are never to probe the abdomen or chest with any other instrument than the finger; if the foreign bodies are readily found, they may be extracted; but we are never to persist in exploring for them. The body thus wounded should be so

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