remain, with the view of presenting the least possible surface capable of infection. I have studiously discontinued the use of sutures and adhesive straps in flaps of amputation, and recommended the wet muslin strap dressing, as advised by McLeod. It is, I am satisfied, a great gain over the old method, and is a saving of time and labor, beside being in the interest of cleanliness and simplicity.
Tetanus has not occurred. Its absence is owing to the speedy removal of the wounded from the field, to the sufficient shelter provided, and to the mildness of the temperature, the purity of the atmosphere, and the prompt and speedy attention which all wounds received at the hands of the surgeons. The care which was taken in securing the blood vessels at the time of operation prevented secondary hemorrhage from stumps, no cases of which are reported.
There was, however, in many cases, a great amount of scorbutic oozing, necessitating the application of numerous ligatures and the free use of styptic. Of secondary hemorrhage from wounds of vessel, two cases are given in full in the subjoined reports. (See J. W. Clark, sergeant Company I, One hundred and twenty-ninth Indiana, amputations of the leg, upper third, case 5; and R. J. Walker, private Twenty-second Indiana Battery, amputations of the leg, middle third, case 2.) The principle of practice enjoined has been ligature above and below in cases of recent wounds, and ligature in continuity on the cardiac side when the probability of securing the ends of the artery was considered doubtful. Surgeons were advised in such cases not to hesitate to use the actual cautery. I arrested by this means, after the battle of Chattanooga, secondary hemorrhage from the brachial artery, which had sloughed, and which could not be secured without a ruinous dissection of the arm. The hemorrhage was arrested and the limb saved. A coincident gangrene was likewise extinguished. Two cases only have required ligature of main trunk, and in these cases the ligature was applied above and below the opening. Several examples have occurred of concussion from the explosion of shells near the head. The phenomena of this class of injuries are of a mixed character, partaking both of concussion and shock. The symptoms are those of acute nervous and cerebral irritation. The most remarkable case which I have seen was that of an officer who was under charge of Surgeon Hiese, a of the One hundredth Illinois Regiment (now of Chicago), at Chattanooga, and has probably been reported by him in full. The symptoms in this class of accidents are those of irritative in depression, and very persistent. They have a tendency to terminate in meningitis, mania, and death, or softening and fatuity, with an equally certain but more protracted fatal result. Hospital gangrene did not appear. A few cases of traumatic gangrene occurred, which showed no tendency to spread. They were readily controlled by creosote, charcoal poultices, and internal stimulants. I take this occasion to record my unqualified preference for bromine in the treatment of gangrene, and to express the opinion that its local and internal use will furnish the remedy for a large class of septic and contagious diseases, hitherto as intractable as was hospital gangrene to the hands of the older military surgeons.
I have placed on file in a former report a case of pyaemia cured by the administration of Bibron's antidote. The diseases of the
a If Dr. Hiese, who is now out of the service, has not reported this case, I would recommend that he be requested to do so.