MILITAEY SURGERY AND MEDICINE. 



FIG. 9. 



541 



leaves a large and ragged cavity in its last rest- 

 ing-place. The wounds made by fragments of 

 shell are still more severe, mangling the unfor- 

 tunate subject most cruelly, and producing de- 

 structive fractures and sloughing wounds. 



The treatment of these gunshot wounds 

 must necessarily be different in many respects 

 from those of the musket-ball, treated of by the 

 older surgical writers. The extraction of the 

 ball is, as a general principle, the first work of 

 the surgeon, the hemorrhage from the wound 

 having been previously checked. This is often 

 a matter of considerable difficulty, though from 

 the frequency with which the Minie bullet 

 approaches the surface on the opposite side 

 from that which it entered, it may often be 

 reached speedily. Dr. Frank H. Hamilton, late 

 Medical Director in the TJ. S. Army, has in- 

 vented a probe (Jig. 11) and two pair of forceps, 

 one of which is shown \nfig. 10, for extracting 

 the bullets when lodged in the soft tissues, the 

 other when impacted in the bony structures, 

 which prove very serviceable for this purpose. 

 Surgeon Isaac Moses, of the army, also invented 

 a somewhat complicated instrument working 

 in a canula, through which are forced three 

 hooks to seize the ball when the instrument 

 strikes it (Jig. 12). This is also said to prove 

 serviceable. George Tiemann & Co. have in- 

 vented a pair of forceps (Jig. 13) with two 

 teeth set obliquely forward, like the incisors 

 of a mouse, which proves admirable for remov- 

 ing buckshot, light balls, or fragments of lead, 



but does not answer for the removal of frag- 

 ments cf harder metals. Nelaton's probe (Jig. 

 14), which has a small ball of unpolished porce- 

 lain on the end, is invaluable for discovering the 

 presence of a billet by the marks of the lead 

 on the ball. 



The military surgeon in the field at the pres- 

 ent day rejects all those medicaments and pro- 

 cesses formerly deemed essential in the pri- 

 mary treatment of gunshot wounds; and having 

 removed if possible not only the missile which 

 caused the wound, but any fragments of cloth- 

 ing, bone, or other foreign substance in the 

 track of the wound, confines himself to the use 

 of water as a dressing for the wound, as the 

 simplest, most convenient, and most efficacious 

 application which can be made. The water is 

 generally applied cool or at its ordinary tem- 

 perature, but of course becomes tepid speedily. 

 When inflammation sets in the temperature 

 should be lowered, and this is effected best by 

 the method of irrigation, by means which the 

 ingenious surgeon or nurse readily devises even 

 in the rudest or most poorly supplied hospital 

 tent. 



The part which is wounded, and several inches 

 of the integument beyond the margin of the 

 wound, being covered with a piece of patent 

 lint, or in default of this woollen or flanne. 

 cloth, the water is suspended over the limb, or 

 placed on a table beside the bed, and from it is 

 conducted either by a syphon tube filled with 

 candle-wicking or thread", or in default of any 





