dency being manifested in the large ration of sick constantly present, and in its effects in the wounded upon recovery, it has been marked in its evidence in operations, by diminution of the fibrin, an increase of the watery elements of the blood, and in the blood vessels a relaxation of the muscular cots and a patulous condition of the minuter branches, requiring a larger number of ligature than usual, and with free and sometimes very troublesome venous hemorrhage.
Gangrene has scarcely appeared. In only one hospital has it been developed, in a few cases not readily accounted for, occurring, as it did in some of the cases, in the healthiest and most robust subjects and readily yielding to the milder escharotic with tonics.
Primary operation have been the rule, and careful observation justifies the opinion that "shock" to the extent of forbidding surgical interference, ever in cases of considerable gravity, is much less common than generally taught. In the field also, when few of the appliance of conservative surgery can be had and fewer employed, and frequent transportation for considerable distances is unavoidable, operations are frequently necessary, where at least an attempt might be made to save the limb in general hospitals. This is especially true of compound fractures of the femur from gunshot wounds. Several cases considered the most promising from general good health, squareness of fracture, with little combination of bone or laceration of soft parts, have been dressed with Smith's anterior splints and sent at once to the rear; but all cases from which any report has been received have died from apparent destruction of vital force consequent on the gravity of the injury, or from rapidly exhaustive suppuration. Cases of injury of large arteries or nerves uncomplicated with fracture have been exceedingly rare; only two cases have been reported, both of the branchial artery. No cases of secondary hemorrhage have been recorded. Not a single case of punctured wound from sword or bayonet has been observed as received in battle; a singular fact, in view of the large number of injuries under observation, but owing probably to the character of fire-arm being of so destructive a nature as to compel one side or the other to give way before advancing to a close hand conflict.
Resections of joints and in the continuity of bones have received careful attention, and the most experienced and thoughtful surgeons of the staff have found it necessary to exercise a careful discrimination in the selection of cases, and refuse now to operate in many instances which early in the campaign seemed to favor conservation.
The small mortality after operations is gratifying. The tabular form bears but three deaths in field hospital after operations. These statistics apply only to primary mortality, as some cases proved fatal after removal to the rear. The statistical table appended affords some items of interests, and other comment is unnecessary regarding diseases, wounds, and operations. The table compiled from the hospital report does not embrace the sick in hospital or sent to the rear up to the 1st of June, as these records for the time previous were not entered on the hospital register and are lost.
The medical officers all have rendered efficient service. Surg. S. K. Crawford, Fiftieth Ohio Volunteer Infantry, deserves especial mention for the faithful performance of duty as surgeon in charge of division hospital. The organization and celebration of details are due mainly to him. Surg. C. D. Moore, Thirteenth Kentucky Volunteer Infantry, as an able and skillful operator and for sound