MILITARY MEDICINE CHAMBERLAIN". 243 



so also the practice of military surgery improved coincidently with 

 the progress of surgery in civil life. Intimately associated with the 

 earlier achievements are the names of Pare, John Hunter, and Larrey. 

 The suffering inherent in war was enormously alleviated by the dis- 

 covery of anesthesia. Still the specter of infection remained, and 

 hospital gangrene was the scourge of the wounded in the Civil War. 

 With the development of antisepsis and asepsis a new era dawned 

 for the military as well as for the civil surgeon. At a somewhat 

 later date the introduction of small caliber, steel- jacketed bullets, 

 which usually produced a small, relatively sterile wound, together 

 with the use of sterile first-aid packets, led to a vast number of heal- 

 ings by first intention in the case of gunshot injuries which had been 

 merely dressed aseptically and then left alone. Asepis and conserva- 

 tism were the watchwords, and the saying passed current that the fate 

 of " the wounded man rests with him who applies the first dressing." 

 Much of this optimism has disappeared in the last two years, as a re- 

 sult of the vast European War. The bullet of the latest military rifle 

 is not as humane as that used a dozen years ago. Shrapnel, high 

 explosive shells, hand grenades and bayonets, produce a proportion 

 of wounds far in excels of anything dreamed of in the past. The 

 conditions of trench warfare favor infection, and the great range 

 of modern weapons, and the vast numbers of wounded, have rendered 

 collection of the injured and removal to a place of final treatment 

 far more slow and difficult than ever before. The character of the 

 wounds produced by shell, shrapnel, hand grenades, and spitz bul- 

 lets is such that the first-aid dressing has failed to confer as high a 

 degree of protection as it afforded in the wars of the previous two 

 decades. Asepsis is less in vogue, and in England the cry has been 

 raised, " Back to Lister " — in other words, antisepsis with strong dis- 

 infectants like pure phenol. Extensive opening of wounds with 

 free drainage has replaced expectant and conservative treatment. No 

 longer is it said that the fate of the wounded rests with him who ap- 

 plies the first dressing, but rather that his future depends upon the 

 rapidity of transportation and the possibility of thoroughly treating 

 his wounds as soon as possible by elaborate surgical procedures. 



Turning from the field of surgery and relief organization in bat- 

 tle, Ave find that military medicine, as distinguished from surgery, is 

 intimately associated with, and a decided contributor to, the subject 

 of preventive medicine. Since the days when " The Assyrian came 

 down like a wolf on the fold " armies have been peculiarly the victims 

 of epidemic diseases. Numberless campaigns have failed in whole or 

 in part, because of dysentery, cholera, plague, scurvy, measles, small- 

 pox, yellow fever, malaria, typhus, or typhoid. An interesting re- 

 view might be written dealing with history us influenced by epidemic 

 disease. Up to the time of the Franco-Prussian War in 1870, disease 



