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SCIENCE 



[N. S. Vol. XLI. No. 1067 



statistics and are all larger than those of 

 the Medical and Surgical History of the 

 War. ' ' The average strength of the Union 

 Armies was 806,755, and the deaths 359,- 

 528, of whom 67,058 were killed in battle 

 and 43,012 died of wounds. This gives a 

 battle death rate of 33 per 1,000 per an- 

 num. The disease death rate was 65 per 

 1,000 per annum. The case death rate 

 from disease was only 3.4 per cent., a very 

 low figure. 



I can testify to the excellent condition 

 of the Civil War hospitals, of which I saw 

 many, but only in the East. When I say 

 "excellent condition" it must be with the 

 reserve that we knew nothing as to bac- 

 teriology, which did not exist, nor of infec- 

 tion, which was utterly unknown as to its 

 causes and prevention. The general sani- 

 tary conditions, and by this I mean shelter, 

 ventilation, cleanliness, good food, as good 

 nursing as intelligent orderlies could give, 

 etc., were all excellent. But the surgical 

 conditions as we now know were simply 

 dreadful. Practically every wound sup- 

 purated, and in summer I have seen many 

 wounds swarming with squirming maggots 

 as large as chestnut worms — disgusting, 

 but, fortunately, not especially dangerous. 

 In my "Surgical Reminiscences of the 

 Civil War"^^ I have given many statistics 

 taken from the official Medical and Surgical 

 History of the War, a few of which I will 

 reproduce that you may see what blessed 

 conditions you "free born" men have in- 

 herited. Pyemia (blood-poisoning) was 

 one of our worst scourges. There were 

 2,818 cases, and of these only 71 recovered, 

 a death rate of 97.4 per cent. Few of you 

 probably have seen even one such case. I 

 have given a matter-of-fact description of 

 it in my "Surgical Reminiscences," but if 

 you wish to see it sketched by a master's 



17 Keen, "Addresses and Other Papers," 1905, 

 p. 420. 



hand read that most touching and beauti- 

 ful of all medical stories I know — "Rab 

 and his Friends," by dear old Dr. John 

 Brown, of Edinburgh. He vividly paints 

 the sudden change in the wound, the pulse, 

 the eye, the mind, on and on, worse and 

 worse, until "that animula, ilandula, vag- 

 ula, hospes comesqiie was about to flee." 

 Tetanus had a mortality of 89.3 per 

 cent. Of amputations at the hip-joint 83.3 

 per cent. died. Trephining had a mortal- 

 ity of 61 per cent. Even of ligations of 

 the femoral artery, 374 in number, 281 

 died, or over 75 per cent. Of 2,235 cases 

 of secondary hemorrhage, 61.7 per cent, 

 died. Hospital gangrene, of which there 

 were several hundred cases, had only a 

 mortality of about 25 per cent, because we 

 early learned the correct though empirical 

 treatment, viz., the application of the ac- 

 tual cautery, pure bromine, strong nitric 

 acid or similar destructive agents which 

 killed the germ, whatever it was, and ar- 

 rested the disease. 



The Franco-Prussian War of 1870-71 

 was marked by notable progress in military 

 sanitation in the German army, yet in spite 

 of this there were 74,205 cases of typhoid 

 fever, almost 10 per cent, of the entire 

 average strength (788,213) and 8,904 

 deaths, a mortality of 11.3 per cent. 



Surgically the results were nothing to 

 boast of. Listerism had as yet made but 

 little progress in the profession. Carbolic 

 acid was used to some extent, but there 

 was no thorough antiseptic system, for the 

 germ theory was as yet neither understood 

 nor accepted. 



Of tetanus there were 294 cases, and 268 

 died, a mortality of 91.1 per cent. 



The total of the four selected amputa- 

 tions was 2,194 with 1,196 deaths, a mor- 

 tality of 54.5 per cent. — over one half. 



Disarticulation at joints showed an aver- 

 age mortality of 56 per cent. Fifteen 



