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A manual of military surgery, by S.D. Gross, MD,1861 Rare Medical Books

1861

A manual of military surgery - Chapter IV: Medicalequipments, stores and hospitals

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MILITARY STJRGEKY. 27

CHAPTER IV.

MEDICAL EQUIPMENTS, STORES AND HOS-

PITALS.

Every regiment, or body of military men,should be amply provided, in time of war,with the means of conveying the woundedand disabled from the field of battle. Forthis purpose suitable carriages and littersshould constantly be in readiness. The car-riages should be built in the form of lightwagons, drawn each by two horses; withlow wheels, easy springs, and a large, widebody, furnished with a soft mattress and pil-lows, and capable of accommodating not lessthan eight or ten persons, while arrangementsmight be made at the side for seating a num-ber more, as in the French voiture. As ameans of protection against the sun and therain, it should have a light cover of oil-clothor canvas.

A great number of litters, or bearers, willbe found described in treatises on military

28 A MANUAL OP

surgery ;but Iam not acquainted with anywhich combine so much simplicity and cheap-ness, with lightness and convenience, as onewhich, after a good deal of reflection,Ihavejust devised, and of which the accompanyingsketch aflbrds a good illustration. Itconsists

of two equal parts, connectedat the ends by stout hinges,the arrangement being such asto permit of their being foldedfor more easy transportationon the field of battle. Eachpart has a side piece of wood,three feet four inches long, bytwo inches in depth, and an

inch and a half in thickness,the free extremity terminatingin a slightly curved handle.The side pieces are united byfour traverses, and the entireframe is covered with ducking,

twenty-four inches in width. Thus constructed,the apparatus is not only very light, so thatany one may easily carry it,or, indeed, eventhree or four at a time, but remarkably con-

29MILITARYSURGERY.

venient both for the transportation of pa-tients, and for lifting them in and out of thewagons, which should always be at handduring an engagement. Moreover, by meansof side straps, provided with buckles, itwillanswer extremely well for a bed-chair, so ne-

cessary in sickness and during convalescence,the angle of flexion of the two pieces thusadmitting of ready regulation. In carryingthe wounded off the field, the labor mayeasily be performed by two men, especiallyif they use shoulder-straps to diffuse theweight of the burden. The body, in hotweather, might be protected with an oil-cloth, while the face might be shielded fromthe sun with a veil or handkerchief. A pil-low for the head can be made with the coatof one of the carriers.

Besides these means, every regiment shouldbe furnished with an ambulance, or, as theterm literallyimplies, amovable hospital, thatis, a place for the temporary accommodationand treatment of the wounded on the field ofbattle. It should be arranged in the form ofa tent, and be provided with all the meansand appliances necessary for the prompt suc-

30 A MANUAL OF

cor of the sufferers. The materials of which itconsists should be as light as possible, possessevery facility for rapid packing and erection,and be conveyed from point to point by a

wagon set apart for this object. The ambu-lance, for the invention and improvement ofwhich we are indebted to two eminent Frenchmilitary surgeons, Percy and Larrey, is in-dispensable in every well-regulated army.

This temporary hospital should be placedin an open space, convenient to water, andupon dry ground, with arrangements for thefree admission of air and light, which, nextto pure air, is one of the most powerful stim-ulants in all cases of accident attended withexcessive prostration. The direct rays of thesun, in hot weather, must of course be ex-cluded, and it may even be necessary, as ininjuries of the head and eye, to wrap thepatient in complete darkness. A properly-regulated temperature is also to be main-tained, a good average being about 68° ofFahrenheit's thermometer.

As engagements are sometimes begun afterdark, or are continued into the night, an ade-quate supply of waxcandles should be provided,

31MILITARY SURGERY.

as they willbe found indispensable both infieldand hospital practice inperforming operationsand dressing wounds and fractures. Torches,too, will frequently be needed, especially incollecting and transporting the wounded.Bed-pans, feeding-cups, spoons, syringes, andother appliances usually found in the sickchamber, will form a necessary part of thefurniture of such an establishment.

The object of the ambulance is, as alreadystated, to afford prompt succor to the wounded.Here their lighter injuries are speedily dressed,and the more grave subjected to the operationsnecessary for their cure. In due time, theformer are sent back to the ranks, while therest are conveyed to suitable lodgings or topermanent hospitals.

As soon as practicable, after the hurry andconfusion attendant upon a combat are over,the surgeon should classify the wounded anddisabled, taking care that those laboring undersimilar lesions are not brought in close con-tact; lest, witnessing each other's sufferings,they should be seized with fatal despondency.

Larrey, in order to meet the exigencies ofthe grand army in Italy, constructed aflying

32 A MANUAL OP

ambulance ;an immense, and, at first sight, avery cumbersome establishment. It consistedof twelve light wagons, on easy springs, forthe transportation of the wounded ;some withtwo, others with four wheels. The frame ofthe former, which were designed for flat, levelcountries, resembled an elongated cube, curvedon the top;ithad two small windows on eachside, with a folding-door in front and behind.The floor of the body, separable and movableon rollers, was covered with a mattress andbolster. Handles were secured to it laterally,through which the sashes of the soldiers werepassed in lifting the sick in and out of thecarriage, when, on account of the weather,their wants could not be relieved on theground. Each vehicle was thirty-two incheswide, and was drawn by two horses ; it couldconveniently accommodate two patients at fulllength, and was furnished with several side-pockets for such articles as might be neededfor the sufferers.

The large carriage, drawn by four horses,and designed for rough and hilly roads, wasconstructed upon the same principle as thesmall; it had four wheels, and could accom-

MILITARY SURGERY. 33

modate four persons. The left side of thebody had two long sliding-doors, extendingalmost its whole length, so as to permit thewounded to be laid in a horizontal position.

These carriages were used for conveying the¦wounded from the field of battle to the hospi-tals of the lines, and combined, it is said,solidity with lightness and elegance.

The number of men attached to the flyingambulance was 113, embracing a soldier'sguard with twelve men on horseback, a

quartermaster-general, a surgeon-major, withhis two assistants and twelve mates, a policeofficer, and a number of servants. The flyingambulance was, in fact, a costly and imposingestablishment, devised by the humanity andingenuity of the great and good Larrey, whocould never do too much for the wounded sol-dier, and whose presence, like that of his illus-trious countryman, Pare", always served toanimate the French troops. At one timethree divisions of the flying ambulance,equipped upon this grand scale, were uponthe field in different parts of Italy.Itis not deemed necessary, in a work like

this, to give an account of the construction of4

34 A MANUAL OF

hospitals, properly so termed; for, with therailroad and steamboat facilities which we nowpossess, there can be little difficultyin obtain-ing comfortable accommodations for the sickand wounded soldiers. Lodgings can almostalways be procured, in nearly every portionof the country where a battle is likely to befought, in houses, churches, and barns. Tem-porary sheds might easily be erected in a fewhours, with such arrangements as would servefor the more pressing wants of the wounded.The chief points to be attended to, in theirconstruction, are sufficient elevation of theground floor for the free circulation of air,windows for light and ventilation, and such aposition of the fire-place as not to annoy theinmates.

The medical stores of the military hospital,whether temporary or permanent, includemedicines, instruments, and various kinds ofapparatus, as bandages, oiled silk,and splints.

It would far transcend my limits wereItoenter fully into all the details connected withthese different topics. A few brief remarksunder each head must suffice for my purpose.

Ist. In regard to medicines, a few articles

MILITARY SURGERY. 35

only, well selected and arranged for readyuse, willbe necessary. Itis bad enough, inall conscience, for a man to be severely shotor stabbed, without physicking him to death.Let him by all means have a chance for hislife, especially when he has already beenprostrated by shock and hemorrhage. Foodand drink, with opium and fresh air, willthen do him more good than anything else.Ishall enumerate the medicines upon which,in my judgment, most reliance is to be placedin this kind of practice, according to theirknown effects upon the system.

1. Anodynes:—

opium, morphia, and blackdrop, or acetated tincture of opium.

2. Purgatives:—

blue mass, calomel, rhu-barb, jalap, compound extract of colocynth,and sulphate of magnesia. Some of thesearticles should be variously combined, andput up inpill form for ready use.

3. Depressants :—tartrate of antimony andpotassa, ipecacuanha, and tincture of vera-trum viride.

4. Diaphoretics:—

antimony, ipecacuanha,nitrate of potassa, morphia, and Dover'spowder.

36 A MANUAL OF

5. Diuretics:—

nitrate and carbonate ofpotassa, and colchicum.

6. Antiperiodics :—

quinine and arsenic.7. Anaesthetics :

—chloroform and ether.

8. Stimulants:—

brandy, gin, wine, andaromatic spirits of ammonia.

9. Astringents :—

acetate of lead, perchlo-ride of iron and alum, tannin, gallic acid, andnitrate of silver.

10. Escharotics:—

nitric acid, acid nitrateof mercury, (Bennett's formula,) and Viennapaste.

2d. The surgical armamentarium should alsobe as simple as possible. It should embracea small pocket case, with a screw catheter; afull amputating case, with at least threetourniquets, two saws of different sizes, andseveral large bone-nippers; and, lastly, a

trephining case. Several silver catheters ofdifferent sizes, a stomach pump, small andlarge syringes, feeding-cups and bed-pansshould also be put up.

3d. Under the head of apparatus may beincluded bandages, lint, linen, adhesive plas-ter, splints, cushions, wadding, and oiled silk.

The bandages, composed of tolerably stout

37MILITARYSURGERY.

muslin, should be free from starch and selvage,well rolled, and, on an average, from twoinches and a quarter to two inches and a halfin width by eight yards in length. Thebandage of Scultetus, very serviceable incompound factures, can easily be made, asoccasion may require, out of pieces of thecommon roller.

Of lint,the patent, or apothecary's, as itistermed, is the best, as it is soft and easilyadapted to the parts to which it is intendedto be applied. Old linen or muslin also an-swers sufficiently well. Charpie is now sel-dom used.

An abundance of adhesive plaster, put upin small cases, should be provided. Collo-dion willnot be necessary.

Splints, of binders or trunk-makers' board,and of light wood, should find a place ineverymedical store, as frequent occasions occur fortheir use. In fractures of the lower ex-tremity special apparatus may be required,which, however, as it is cumbrous and incon-venient to carry, may generally be preparedas itis needed.

Cushions are made of muslin, sewed in the4*

38 A MANUAL OF

form of bags, of variable size and shape, andfilled withcotton, tow,saw-dust or sand. Theyare designed to equalize and ward off pres-sure in the treatment of fractures of the lowerextremities.

Wadding is a most valuable article in sur-gical practice, both for lining splints and mak-ing pads, as wellas in the treatment of burnsand scalds, and cannot be dispensed with.

Oiled silk is a prominent article in thedressings of the present day; it preservesthe heat and moisture of poultices and ofwarm water-dressings, at the same time thatitprotects the bed- and body-clothes of thepatient.

Oil-cloth, soft and smooth, is required inall cases of severe wounds and fractures, at-tended with much discharge.

Air-cushions should be put up in consid-erable numbers, as their use will be indis-pensable in all cases of disease and injuryinvolving protracted confinement.

Bran and saw-dust willbe found of greatvalue in the treatment of compound fractures,ulcers, gangrene, and suppurating wounds, as

MILITARYSURGERY. 39

an easy support for the injured limb and ameans of excluding flies.

Medical case-iooks should be put up alongwith the other articles, for the accurate regis-tration of the names of the sick and wounded,the nature of their lesions, and the results oftreatment. The medical officers should alsokeep a faithful record of the state of theweather, the temperature of the air, the na-ture of the climate, the products of the soil,and the botany of the country through whichthey pass or in which they sojourn, togetherwith such other matters as may be of profes-sional or scientific interest. The knowledgethus acquired should be disseminated aftertheir return for the benefit of their profes-sional brethren.

Finally, inorder to complete hospital equip-ments, well-trained nurses should be provided ;for good nursing is indispensable in everycase of serious disease, whatever may be itscharacter. The importance of this subject,however, is now so well appreciated as not to

require any special comments here.The question as to whether this duty should

be performed bymen or women is of no ma-

40 A MANUAL OP

terial consequence, provided it be welldone. The eligibility of women for thistask was thoroughly tested in the Crimea,through the agency of that noble-heartedfemale, Florence Nightingale; and hundredsof the daughters of our land have alreadytendered their services to the government forthis object. No large and well-regulatedhospital can get on without some male nurses,and they are indispensable in camp and fieldpractice.

Itis not my purpose here to point out thequalities which constitute a good female nurse.Itwill suffice to say that she should be keenlyalive to her duties, and perform them, how-ever menial or distasteful, with promptnessand alacrity. She must be tidy in her ap-pearance, with a cheerful countenance, lightin her step, noiseless, tender and thoughtfulin her manners, perfect mistress of her feel-ings, healthy, able to bear fatigue, and atleast twenty-two years of age. Neither thecrinoline nor the silk dress must enter intoher wardrobe; the former is too cumbrous,while the latter by its rustling is sure to fretthe patient and disturb his sleep. Whisper-

MILITARY SURGERY. 41

ing and walking on tiptoe, as has been trulyobserved by Florence Nightingale, are anabomination in the sick chamber. Finally,a good nurse never fails to anticipate all, ornearly all, the more important wants of thesufferer.

Among the things to be specially attendedto innursing is ventilation. Persons visitingthe sick must at once be struck ¦with the dif-ference of pure air in those chambers wherea proper ventilation exists and those wherethe reverse is the case. To insure this thefresh air should always be admitted from awindow not open directly on the bed, orcausing the patient to be in a draught. Evenin winter it is highly proper that fresh airshould be admitted some time during the daywhen there is a good fire and the patient wellprotected by covering.

The pillows, bedding, and bedclothes shouldbe well aired and often changed, as also theflannel, under-garments, and night-dress. Tofacilitate this, it is well, when the patient isvery illand unable to help himself, to havethe shirt open all the way down in front, andbuttoned up. The patient often escapes great

42 A MANUAL OF

suffering and annoyance by this simple method.Where there is adischarge from sores or whenwater-dressings are applied to a limb, itis ad-visable to place the latter upon a folded sheetwith a thin, soft oil-cloth underneath. Greattenderness and cleanliness should be used indressing wounds or sores. Old linen, muslin,and lint should always be had in readiness forthis purpose.

'Agreat prejudice exists against

the use of muslin, the preference being gener-ally given to linen, but the former is reallyquite as good as the other, ifit is soft and old.

In regard to the cleanliness of a sick-room,itis advisable to use a mop occasionally forthe removal of flue from under the bed;when,however, the patient is in too critical a situa-tion for dampness, a few tea-leaves scatteredover the apartment willabsorb the dust, andcan be quietly taken up with a hand-brush.A frequent change of bed linen is very bene-ficial when practicable, and the clothes mustalways be folded smoothly under the patient.Great cleanliness should be observed in allthe surroundings of the sick-room, and par-ticular attention must be paid to the glassesin which medicine is given, in order to render

43MILITARY SURGERY.

the doses as palatable as possible. The patientshould be washed whenever able, and histeeth and hair well attended to. The bodyseems infused with new vigor after such ablu-tions.

A frequent change of posture is immenselyconducive to the comfort and well-being of asick person, if performed with a careful eyeto his particular condition. Severe pain, lossof sleep, excessive constitutional irritation,and dreadful bed-sores are sure to follow, inall low states of the system, if this precautionbe not duly heeded. No patient must havehis head suddenly raised, or be permitted tolie high, when he is exhausted from shock,hemorrhage, or sickness. Many lives havebeen lost by this indiscretion.

The apartment must be free from noise,the light should neither be too freely admittednor too much excluded, except in head andeye affections, and the temperature must beregulated by the thermometer, from 65° to68° of Fahrenheit being a proper average.

As the patient acquires strength, he maygradually sit up in bed, propped up at firstby pillows, and afterward by a bed-chair.

44 A MANUAL OF

His food and drink, and also, at times, hismedicine, must be given from a feeding-cupduring the height of his disease, and a goodgeneral rule is to administer them with greatregularity, provided this does not interferetoo much with his repose. Ifhe is very weak,and sleeps very long, it will be necessary towake him in order to give him nourishment;but, in general, sleep is more refreshing thanfood, and more beneficial than medicine. Thebed-pan and urinal of course find their appro-priate sphere under such circumstances.

As the appetite and strength increase, thepatient is permitted to resume, though verygradually, his accustomed diet and to exerciseabout the room, ifnot in the open air. Aftersevere accidents and protracted sickness, awise man will not bestir himself too soon ortoo much, but court the fickle goddess ofhealth with becoming caution.

Dying patients should be carefully screenedfrom their neighbors, placed in the easiestposture, have free access of air, and be notdisturbed by noise, loud talking, or the pres-ence of persons not needed for their comfort.As soon as the mortal struggle is over, thebody must be removed.

MILITARY SURGERY. 45

The excretions should be removed as speed-ily as possible from the apartment, and thevessels in which they are received imme-diately well scalded, the air being at the sametime perfectly purified by ventilation, or ven-tilation and disinfectants.

Finally, the nurse must take care of her-self. She must have rest, or she will soonbreak down. If she is obliged to be up allnight, she should be spared in the day.

CHAPTER V.

WOUNDS AND OTHER INJURIES.

The injuries inflicted in war are, in everyrespect, similar to those received in civillife.The most common and important are frac-tures, dislocations, bruises, sprains, burns,and the different kinds of wounds, as the in-cised, punctured, lacerated, and gunshot.With the nature, diagnosis, and mode oftreatment of these lesions every army sur-geon must, of course, be supposed to befamiliar ; and Ishall therefore limit myself,

5