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NOTES AND RECOLLECTIONS 
 
 OF AN 
 
 AMBULANCE SURGEON. 
 
//X 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Digitized by the Internet Archive 
 in 2017 with funding from 
 Duke University Libraries 
 
 
 https://archive.org/details/notesrecollectio01macc_0 
 
NOTES AND RECOLLECTIONS 
 
 OF AN 
 
 AMBULANCE SURGEON, 
 
 BEING AN ACCOUNT OF WORK DONE UNDER THE 
 RED CROSS DURING THE CAMPAIGN OF 1870. 
 
 BY 
 
 WILLIAM MAC CORMAC, 
 
 F.R.C.S., M.A., M.R.I.A. 
 
 ASSISTANT-SURGEON TO ST. THOMAS’S HOSPITAL, CONSULTING SURGEON TO THE GENERAL 
 HOSPITAL, BELFAST, AND MEMBER OF SENATE OF THE QUEEN’S UNIVERSITY. 
 
 LONDON: 
 
 J. & A. CHURCHILL, NEW BURLINGTON STREET. 
 
 1871. 
 
LONDON I PARDON AND SON, PRINTERS, PATERNOSTER ROW 
 
$P s, ft u a t i 0 it. 
 
 TO MY 
 
 COLLEAGUES OF THE ANGLO-AMEKICAN AMBULANCE 
 
 I DEDICATE 
 
 THIS RECORD OF OUR JOINT LABOURS 
 
 AS A 
 
 TOKEN OF MY AFFECTIONATE RECOLLECTION. 
 
 WILLIAM MAC COEMAC. 
 
 a 2 
 
Ni/ actum repntans si quid superesset agendum. 
 
PREFACE. 
 
 A considerable portion of this little work con¬ 
 sists of communications which have recently 
 been made to the British Medical Journal , to 
 whose Editor, when he saw him abroad, the 
 Author had promised to give some account 
 of his surgical experiences at the seat of war. 
 These papers are now reprinted with several 
 additions, along with a few plates representing 
 some examples of gun-shot fractures of the 
 bones. 
 
 The author does not purpose to give any 
 systematic account of gun-shot wounds, but 
 simply a record of his personal experience, 
 and the impressions he derived from the rather 
 novel circumstances in which lie found himself 
 placed. The form in which it is published is 
 somewhat that of a diary, since he has repeated 
 as closely as possible the expressions which are 
 
Vlll 
 
 PREFACE. 
 
 entered in the note-book lie kept at the time. 
 It cannot be truly said that there is much that 
 is mysterious or unknown to the exoteric surgical 
 world, in either the principles or practice of 
 military surgery, further than this, that the 
 greatest care and tact are oftentimes needed for 
 the accurate diagnosis and prognosis of gun-shot 
 injuries. The external appearances often bear so 
 little relation to the amount of internal injury, 
 that it is sometimes difficult to estimate the ac¬ 
 tual gravity of a gun-shot wound. Very careful 
 and complete examinations become, therefore, of 
 the greatest importance. Unfortunately, the ex¬ 
 cellent rules of conservative surgery are largely 
 inapplicable. The author is satisfied that errors 
 may be committed by being too exclusively 
 guided by the experience gained in civil 
 hospitals. 
 
 The writer admits having himself fallen into 
 this error. Had he another opportunity, similar 
 to the last, of practising military surgery, he 
 would not yield so often as he did to the tempt¬ 
 ation of trying to save limbs, the bones of 
 which were seriously damaged by conoidal bullets. 
 It has been said, “’Tis better for a man to live 
 with three limbs than to die with four.” If 
 this be true, without a doubt it is also equally 
 true, that the lives of many were lost through 
 
PREFACE. 
 
 IX 
 
 an attempt being made to save their limbs. The 
 author fears that, however reluctantly, he must 
 come to the conclusion that Radical and not 
 Conservative surgery is the general principle 
 of treatment to carry out for severe cases of 
 gun-shot wounds which must be cared for 
 on or near the field. Much will, of course, 
 depend upon the special conditions obtaining 
 in each campaign, such as the general physique 
 and morale of the soldiers, the previous hard¬ 
 ships which they may have incurred, and the 
 means that are available for the efficient treat¬ 
 ment of their wounds. 
 
 The writer can unhesitatingly say that, but 
 for the volunteer aid furnished not merely by the 
 belligerents but by the large-hearted liberality 
 of neutral powers and especially England, the 
 sufferings and misery of this terrible war would 
 have been augmented tenfold. Those who say 
 such aid should be withheld, that the large sums 
 which England in her generosity so freely gave 
 have been mis-spent, and that it but assisted 
 the belligerents to prolong the fight, base their 
 conclusions, I cannot but think, on somewhat 
 harsh and narrow-minded premisses,* premisses 
 which the sterner logic of the appalling suffer¬ 
 ing on the actual scene of battle, could they 
 only realize it, would soon cause to melt away. 
 
X 
 
 PEEFACE. 
 
 The National Aid Societies have supplied a 
 most pressing want, and their assistance will 
 be eagerly sought after in all future wars. No 
 one imagines that nations will offer battle to 
 each other more readily because such organiza¬ 
 tions exist, and it is just as far from the fact 
 that their operations can in any appreciable 
 manner affect the duration of a campaign. 
 The experience gained during this war can 
 only serve to increase their usefulness, as it 
 must tend to remove any imperfections that 
 may have been observed in the working of 
 National Societies for affording Succour to the 
 Sick and Wounded. 
 
 The plates at the end of the book are executed 
 by a new method called Heliotype, which com¬ 
 bines the absolute accuracy of a photograph 
 with the durability, and almost the cheapness, 
 of ordinary printing in ink. The fidelity and 
 beauty of these illustrations speak sufficiently 
 for themselves, as well as for the skill and ability 
 displayed by Mr. Ernest Edwards, inventor of 
 the process by which they have been carried out. 
 
 13, Harley Street, London, W., 
 April, 1871. 
 
 THE AUTHOR. 
 
C 0 N T E N T S. 
 
 CHAPTER I. 
 
 PAGE 
 
 Account of a Visit to Metz before the Investment . . . 1 
 
 CHAPTER H. 
 
 Formation of the Anglo-American Ambulance—Its Journey 
 to Sedan — Its Installation in the Caserne d’Asfeld— 
 Proper Constitution of an Ambulance . . . .18 
 
 CHAPTER III. 
 
 Arrival of the Wounded—Visit to Balan to attend the Wounded 
 the Evening of the Battle of the 31st—Battle of Septem¬ 
 ber 1st—Account of Work done that day in Sedan . . 33 
 
 CHAPTER IV. 
 
 Account of Injuries of the Face and Neck— Description of 
 the Prussian Entry — Infirmiers — Details of Surgical 
 Procedure .47 
 
 CHAPTER V. 
 
 Note-taking—Organization of the Hospital Service—Expe¬ 
 dition to Bouillon—Excursion over the Battle-field — 
 Injuries of the Head—Account of our Ambulance at 
 Balan and Bazeilles—Wounds of Chest, Abdomen, and 
 Pelvis . 59 
 
Xll CONTENTS. 
 
 CHAPTER VI. 
 
 The Prisoners’ Camp—Disarticulation of the Hip-joint— 
 Wounds of the Spine and of the Buttock—Secondary 
 Haemorrhage—Arrival of Aid and Supplies from the 
 English Society’s Depot at Arlon —Eau de Zouaves 
 
 CHAPTER VII. 
 
 Condition of the new Patients sent from the College Ambu¬ 
 lance — Violation of the Geneva Convention — Altered 
 Sanitary Condition of the Hospital—Deaths from Py¬ 
 aemia—Table of Wounds and Operations in the Upper 
 Extremity—Stromeyer’s Treatment of Fracture of the 
 Humerus—Instance of Sang Froid .... 
 
 CHAPTER VIII. 
 
 Resections of Shoulder and Elbow—Esmarch’s Splint for 
 Resection of the Wrist-joint—Case of double Resection 
 of Elbow and Shoulder-joints . 
 
 CHAPTER IX. 
 
 Various Operations performed—One of our Staff Shot at— 
 Ligature of the Subclavian Artery—The Etappen System 
 —Visit to Bouillon — Injuries and Operations in the 
 Lower Extremities — Stromeyer’s Statistics at Floing 
 —The Feld-Lazareth at Floing ..... 
 
 CHAPTER X. 
 
 Complete Tables of the Injuries treated at the Caserne 
 d’Asfeld, and the Operations that were performed— 
 Differences characteristic of Wounded Germans and 
 French—Wounds of the Ankle-joint—Esmarch’s Ap¬ 
 paratus—Gunshot Fracture of the Femur — Conclusion 
 of the Work of the Anglo-American Ambulance at 
 Sedan . ... 
 
 Description of the Plates .. 
 
 PAGE) 
 
 76 
 
 88 
 
 101 
 
 111 
 
 126 
 
 141 
 
NOTES AND EECOLLECTIONS 
 
 OF AN 
 
 AMBULANCE SURGEON. 
 
 CHAPTER I. 
 
 Being anxious to see what military surgery 
 was like, I started from home, for Paris, almost 
 immediately after the declaration of war, not 
 knowing exactly what I might be able to do, or 
 whether my services would be accepted or not. 
 
 My first visit in Paris was to the Palais de 
 l’lndustrie, in the Champs Elysees, erected as 
 a symbol of universal peace, but now having 
 its large area filled, partly with cannon, and 
 partly with immense stores and supplies of all 
 kinds for the wounded. The French National 
 Society for Aid to the Wounded had established 
 itself here, under the presidency of the Comte de 
 Flavigny, along with M. Chenu, so well known 
 as a writer on military surgery and hygiene, as 
 its medical director. 
 
 The first intelligence I here received was, 
 
 b 
 
2 
 
 NOTES AND RECOLLECTIONS OF 
 
 that no foreign surgeons would be permitted 
 to serve. Some days afterwards, however, 
 Nelaton returned from head-quarters at Metz, 
 bringing back with him the Emperor’s express 
 sanction and welcome to such English and 
 American surgeons as might offer their aid. 
 But after that, time was required to settle 
 where the applicants were to go, and it was 
 not for several days that I received my feuille 
 de route for Metz, with orders to serve in the 
 hospitals there, and to report myself to Dr. 
 Isnard, Surgeon in Chief. 
 
 Accordingly, I left Paris this evening, August 
 9th, at ten minutes to eight, for Metz. We 
 had many stoppages on the way, and did not 
 arrive in Metz till seven o’clock on the morning 
 of the 10th. At short intervals, all along the 
 road, we passed long trains containing horses, 
 cattle, vivres of all descriptions, and, on arriving 
 at Metz, we were stopped about a mile outside 
 the town. Several trains were in front. After 
 waiting nearly an hour, and seeing no hope of 
 progress, I got down, and, taking my bag in 
 my hand, walked into the town. Along the 
 line were heaped up boxes of comestibles, bales 
 of hay, bags of oats, artillery ammunition, all 
 sorts of supplies. On the meadows outside were 
 encamped masses of troops, both infantry and 
 cavalry. Close to the station were the hand- 
 
AN AMBULANCE SURGEON. 
 
 .'3 
 
 some carriages of the Imperial train. After 
 leaving the railway, I soon reached the forti¬ 
 fications, which are of immense strength, and 
 surrounded by two deep ditches, over which 
 we crossed by drawbridges, and were then in 
 the enceinte of the strongest fortified town in 
 France. Metz has several times been besieged, 
 but never taken. It is now stronger than ever; 
 and all round its walls, as well as in the sur¬ 
 rounding forts, of which there are many, are 
 placed the very largest and most powerful guns. 
 There is little probability that the Prussians will 
 besiege the place, but if they do, they will find 
 it a hard nut to break .* 
 
 Metz , August 10 th, 1870. — In front, about 
 fifteen kilometres distant, is the corps cVarmee 
 of Marshal Bazaine, which contains at least 
 130,000 men, of whom 50,000 have not yet 
 been in action. They await the Prussian 
 assault, and, as it will be the first time the 
 French and Prussian soldiers have met in any- 
 
 * In my diary I have written, “ The fortifications of Metz are of 
 the most stupendous kind. It seems, to look at them, that it 
 would be perfectly impossible for any enemy to gain an entrance, 
 even with the new weapons of attack. There are three lines of 
 earthworks, with deep broad ditches between, and the Moselle 
 flows in and around the town in such a way as to give it most 
 efficient protection as well. It might be starved out, but coixld 
 not be taken. It has, in effect, never been taken, and goes by the 
 proud name of Metz la Pucelle.” It can boast this name no longer now. 
 
4 
 
 NOTES AND RECOLLECTIONS OF 
 
 thing' like equal numbers, the result is awaited 
 with much interest, and, apparently, but little 
 anxiety. Everyone here is sanguine. Indeed, 
 the contrast between the tone of this place and 
 that of the capital is remarkable. I left Paris on 
 the eve of the assembling of the Corps Legislatif. 
 The previous three days had been spent in a state 
 of the most feverish excitement. All along the 
 boulevards, dense crowds were assembled. The 
 air was surcharged, as it were, with electricity, 
 and one awaited, every moment, an explosion. 
 Yesterday afternoon the Place de la Concorde 
 and the Pont Poyal, in front of the Palais du 
 Corps Legislatif, were filled with people, and it 
 was difficult to imagine what might ensue. In 
 fact, the military had to be called upon to pre¬ 
 serve the peace. Crowds also besieged the Min- 
 istere de l’Interieur, asking for news, demanding 
 arms. In short, there seemed to be more danger 
 to the French Government from the condition of 
 Paris, than from the enemy in front. On that 
 day, indeed, the Ollivier ministry, which pro¬ 
 mised so much, and did so little, for France, 
 resigned, and Count Palikao formed a new 
 Government. 
 
 Here, in the great frontier fortress, all appears 
 different. I am staying in the Hotel de l’Europe, 
 amidst a crowd of soldiers, marshals and gene¬ 
 rals covered with bullion lace and numerous 
 
AN AMBULANCE SUJiOEON. 
 
 6 
 
 orders, and officers of every grade beneath. No 
 disquietude prevails. All that the French sol¬ 
 diers desire, say the officers, is an opportunity 
 of fighting with the enemy on something like 
 equal terms. An engagement was expected 
 to-day, but there has been none. I did not 
 notice any tall talk, but a sincere conviction was 
 found to exist, without being noisily expressed, 
 that the French arms would ultimately be vic¬ 
 torious. It must be remembered that these 
 were the real soldiers of the French army, most 
 of whom knew what fighting was. 
 
 With the recommendation of M. le Dr. Chenu, 
 Directeur de la Society de Secours aux Blesses, 
 I went to M. Isnard, medecin militaire, Medecin 
 en chef des Hopitaux de Metz. 
 
 He was most kind and courteous, entered 
 willingly into my views, and promised me a 
 place beside himself, in charge of one of the 
 pavilions of the large temporary hospital which 
 was in course of construction on the artillery 
 practice ground, just outside the fortifications of 
 Metz. It is constructed on the plan of the 
 General Hospital at Lincoln, U.S. 
 
 Destined to accommodate 2,000 sick, and ar¬ 
 ranged in a triangular fashion, it consists of 
 pavilions containing fifty beds each. The offices 
 and the operating theatre are in the centre, 
 while a covered way goes all round. The pavi- 
 
NOTES AND RECOLLECTIONS OF 
 
 6 
 
 lions themselves are one story high, and raised 
 some few feet from the ground. 
 
 Besides this vast hospital, there are others, 
 civil and military, and in all 5,000 beds are 
 arranged here for the reception of the sick and 
 wounded. 
 
 After leaving Dr. Isnard, and by his advice, I 
 went to the Mairie, when M. le Maire, an ancien 
 medecin , gave me a formal written permission to 
 dwell in Metz, and a very necessary permission this 
 proved. All strangers had been absolutely turned 
 out. A gentleman from a London hospital, who 
 came as representative of a medical paper, told 
 me, very indignantly, that he had arrived only 
 that morning, had been twice put under arrest, 
 and finally ordered by the provost-marshal to 
 quit the place immediately. He left this very 
 evening, the day of his arrival. All the English 
 and French journalists have been turned out. It 
 is said they are gone to Nancy. 
 
 So far only about five hundred wounded have 
 arrived here, but if the great battle be fought 
 which is expected, the place may become imme¬ 
 diately filled up. 
 
 Dr. Isnard was in command of an ambulance 
 corps during the Italian campaign, and has had 
 a very large experience of military surgery. 
 He explained to me an ingenious means of 
 treating gunshot fracture of the thigh, whereby. 
 
AN AMBULANCE SURGEON. 
 
 lie alleges, shortening can be almost entirely 
 obviated, besides other surgical contrivances. 
 
 Such are a few of the incidents which I have 
 thought worth noting on this the day of my arrival 
 at the seat of war. “It is curious,” I have written, 
 “ to watch the soldiers here on the eve of battle, 
 carrying their life in their hands. They talk seri¬ 
 ously together for the most part. They evidently 
 feel the drama is not one to laugh at, and yet 
 they seem cpiite confident, in spite of the serious 
 reverses which the French arms have sustained. 
 I feel not a doubt but that French soldiers, if 
 properly officered and fed—and there it is that the 
 want has been—will retrieve all their lost glory, if 
 they have lost any. To sustain a long fight against 
 overwhelming numbers, even until their ammu¬ 
 nition became exhausted, is no great or irretriev¬ 
 able defeat. The French soldiers at Weissenburg 
 and Worth fought like lions, but they were beaten 
 in detail. Adequate generalship was sorely want¬ 
 ing. That may now perhaps be changed. Marshal 
 Bazaine, of Mexican renown, commands. Will 
 he lead his troops to victory ? Nous verrons 
 
 These words were written at the time in the 
 fortress of Metz itself, and when, had the right 
 man appeared to command the soldiers of France, 
 the future campaign might have proved very 
 different. Intimate relations with the French 
 during some three months of the war have served 
 
8 
 
 NOTES AND RECOLLECTIONS OF 
 
 to convince me that the French are very brave. 
 Everything that has since happened only tends 
 further to establish this opinion. But when men 
 are neither officered nor fed, but led half starving 
 to a shambles, it is hard for them to win. The 
 mismanagement and incompetence, coupled with 
 downright ignorance, which prevailed in high 
 places in the French army, were something 
 extraordinary. 
 
 Metz, August 11 th, 1870.—This morning, be¬ 
 tween seven and eight o’clock, I went to visit the 
 military hospital of Metz. It is an immense 
 building in separate blocks, calculated in time of 
 peace to accommodate 800 patients, but the num¬ 
 ber is now reduced to 630 beds. The wards are 
 large, each accommodating from fifty to eighty 
 beds. In the larger wards there are four rows of 
 beds between the windows. There were there 
 about 250 wounded from Forbach and Saarbriick. 
 I also visited the tobacco manufactory, which is 
 at present utilised for a hospital. In it there 
 are 600 beds, and about 200 wounded. The 
 men with the slighter wounds are sent off as 
 fast as they can be transported to Paris, and to 
 hospitals in the interior, in order to have as 
 much room as possible for a sudden accession 
 of wounded. 
 
 A great battle is expected every moment, most 
 
AN AMBULANCE SURGEON. 
 
 9 
 
 probably to-morrow, between this and Thionville, 
 and both the Prussian and French armies are 
 collected in great force at this point, about fifteen 
 or sixteen kilometres distant. All the troops are 
 in excellent spirits, and are eager to meet the 
 enemy. They appear not in the slightest degree 
 disheartened by the disastrous encounters of 
 Weissenburg and Forbach, the results of which 
 are alone attributed to the overwhelming forces of 
 the enemy. The idea seems now to be to allow 
 the Prussian troops to advance into French 
 territory, to surround them, and not to allow a 
 man to escape. A French captain of scouts told 
 me the Prussians were very badly off in the com¬ 
 missariat department, and that the tactics of the 
 French generals were to prolong the war as much 
 as possible, since the enemy could not continue 
 the struggle for very long. It was this system 
 of self-deception, and the habit of trying to 
 deceive every one else as well, that has aided 
 so effectively in producing the most complete 
 military collapse ever witnessed in the world. 
 
 I became acquainted with M. Hermann, 
 Mddecin en chef de l’Hopital Militaire de Metz, 
 lie invited me to accompany him in his hospital 
 visit, which is from six a.m. till ten a.m., and 
 also from three p.m. till four p.m., to see any 
 new arrivals. 
 
 The military hospital has two surgeons of the 
 
10 
 
 NOTES AND RECOLLECTIONS OF 
 
 first class, M. Hermann and M. Hanard. I there 
 saw a large number of wounded. For the most 
 part, however, the injiu'ies were not serious. It 
 was extraordinary to see how balls would traverse 
 limbs from one side to the other, and yet not 
 injure either the bones, the important vessels, or 
 the nerves. I saw several wounds en pleine poitrine , 
 and yet the ball had not penetrated the chest. In 
 many cases there was a long’ tract as if burnt by a 
 hot iron, a black and contused channel. I saw one, 
 for example, extending beneath both clavicles 
 from one side of the chest to the other. I saw 
 two or three similar channels running along the 
 back, many inches in length, and grooving the sur¬ 
 face for three-quarters of an inch deep. In several 
 other cases, the ball ran beneath the skin en seton , 
 for various lengths. What surprised me was the 
 complete absence of serious wounds, although the 
 distance required to transport the wounded was 
 but trifling, and the means of transport ample. 
 One man had been struck by a ball which passed 
 through both buttocks, making four large open¬ 
 ings. Another was shot in the foot, the ball 
 traversed the shoe and passed between the tendon 
 Achilles and the back of the astragalus and ankle 
 joint. I was astonished at the number of soldiers 
 who had got the end of their forefinger shot off. 
 I suppose there were nearly two dozen. Mostly 
 it was the forefinger of the left hand. 
 
AN AMBULANCE SURGEON. 
 
 11 
 
 The number of these wounds was so great as 
 almost to suggest the explanation that some of 
 them were self-made. But be that as it may, the 
 fact remains the same that there they were. 
 
 As to the surgical treatment, it was of the 
 simplest kind. A mass of cliarpie was applied to 
 the wound, and a bandage. M. Hermann makes 
 considerable use of Vacide plienique. All the 
 water he employs in bathing the sores is plienique, 
 and, on the whole, they looked very well. There 
 was hardly any inflammation or general fever 
 to be seen in any of the patients. 
 
 M. Isnard has received no wounded as yet, but 
 if the engagement, which is expected to-morrow, 
 take place, there will be employment for every 
 one. You may be sure I was in a state of anxiety 
 for work. Metz itself is in great excitement. It 
 is, of course, in a state of siege, and M. le General 
 St. Sauveur is Prevot-Marechal. The utmost 
 suspicion prevails in respect of everybody. 
 Prussian spies have already obtained great ad¬ 
 vantages for the enemy by their cleverness, and 
 anybody may be arrested at any moment. An 
 artillery officer, an inhabitant of Metz, was 
 arrested yesterday. The captain of scouts, of 
 whom I spoke just now, was required to prove 
 who he was, while sitting at my side in the court¬ 
 yard of the hotel. The proprietor of the hotel 
 also was arrested, and an unlucky contretemps 
 
12 
 
 NOTES AND RECOLLECTIONS OF 
 
 happened to myself. I was so unfortunate as to 
 speak a casual word to an American sitting near 
 me at the table d’hote last night, and this morning 
 I was requested to attend at the Prevot’s office. 
 Fortunately, my papers were in every way satis¬ 
 factory, and M. Leon le Fort, chief surgeon of 
 one of the ambulances, who came in, assured them 
 it was all right, but he gave me the advice at the 
 same time to leave Metz by the first train, an 
 advice which was endorsed by the officers of the 
 Prevot in such a way as to be equivalent to an 
 order. Unless you go, they said, you will be 
 exposed to all sorts of inconvenience, perhaps to 
 something worse. In fact, they said, we cannot 
 have foreigners here, no matter in what capacity. 
 I must add, that so soon as I proved who I was, 
 these gentlemen were very polite, and said, 
 with many excuses, they were obliged to take the 
 excessive precautions they did. The circumstance 
 of speaking to this stranger had made so slight 
 an impression on me, that I was unable to recol¬ 
 lect it, and it must have been by the merest 
 accident. But it appears this man was strongly 
 suspected of something or other bad. The gates 
 of Metz will probably be closed to-morrow, and no 
 one afterwards permitted to leave. I had lost 
 any great desire to remain in a place where I 
 had received such scant welcome, after coming 
 solely to aid the sick and wounded. Under the 
 
AN AMBULANCE SURGEON. 
 
 13 
 
 circumstances, the accident was perhaps fortunate 
 which enabled me to go away just in time. As 
 it is, no one is allowed to enter Metz who does 
 not bring forty days’ provisions with him, and 
 the condition of the people arriving from the 
 villages in the neighbourhood of the battle¬ 
 grounds is terrible. They have come near the 
 walls of Metz to be under the shelter of its guns, 
 and line the roads all about. They have no 
 money, and little or no food, they are turned 
 out of house and home, they are not allowed to 
 enter the city, the weather is fearfully bad, and 
 it rains in torrents night and day. Without 
 food, without cover, in a state of most fearful 
 anxiety and distress, what is to become of these 
 poor villagers ? Such are some of the horrors of 
 war, of a war, too, only just commenced. If it 
 last, ruin and misery must spread everywhere. 
 
 The Emperor is still at Metz, and so was the 
 Prince Imperial, yesterday at least, although it 
 was announced everywhere that he had returned 
 to Paris. Everything is pretty quiet, no demon¬ 
 stration, talk, or noise such as that which fol¬ 
 lowed the small affair of Saarbriick. The soldiers 
 evidently mean to accomplish great things, if 
 possible, and the officers as evidently entertain 
 no doubt of their ultimate and decided success. 
 
 I was yet loth to leave, although angry at 
 being treated as I had been. Plenty of work was 
 
14 
 
 NOTES ANI) RECOLLECTIONS OF 
 
 expected, and there were far too few to do it. 
 M. Isnard was indignant, but there was no help 
 for it, go I must. So accordingly I left Metz the 
 same evening. The train should have started at 
 seven o’clock, but it did not get under way for 
 three-quarters of an hour after, an augury of what 
 was to follow. We slowly steamed away, past 
 the men encamped under their tentes d’abri, out 
 through the fortifications, and passing for miles 
 on either side of the main rails long lines of rail¬ 
 way waggons and carriages in sidings. Many of 
 these were afterwards converted into hospitals, 
 and served the purpose very well. All the way 
 from Metz to Chalons, which we did not reach 
 until two o’clock next day, long trains, slowly 
 drawn by two and three engines, passed us at 
 intervals. I counted some of them, and the 
 number of carriages was forty-five and fifty. 
 These trains brought troops, horses, cattle, muni¬ 
 tions of war, and artillery of all sizes, to the front. 
 In fact, the amount of war materiel passing us 
 was almost incredible. Our journey was a 
 long and tedious one. We had to stop about 
 three hours at Frouard, the junction to Nancy, 
 and four hours were consumed outside the 
 station at Bar-le-Duc. Our own train was a 
 very long one, being composed of thirty-seven 
 carriages, drawn by two huge engines. The 
 only incidents of the journey were a demand 
 
AN AMBULANCE BURGEON. 
 
 15 
 
 to see my papers, wliich were churlishly ad¬ 
 mitted to be satisfactory, and the arrest of 
 two persons supposed to be spies. One of them 
 was habited as a cure , the other was a queer- 
 looking' man who came into our compartment 
 at the off-side twice, as he alleged, by mistake, 
 whilst the guards of the train were looking at 
 tickets. It was supposed he was trying to 
 avoid inspection, but he ultimately failed. 
 
 Generally the delay was caused by other trains 
 in advance, as many as three often stretch¬ 
 ing along the line in front of ours, and there 
 were other trains behind us. The stoppages 
 were continual, and the loud whistling kept up 
 by the two engines, as if in rivalry one of the 
 other, was something surprising. To make a 
 long story short, we only reached Paris at nine 
 o’clock in the evening, twenty-six hours after 
 the time of starting, and sixteen hours late, 
 the journey being usually one of but ten hours 
 at the most. 
 
 Amongst our compagnons-dc-vo>jage was an un¬ 
 fortunate lady, the wife of the colonel of the 8th 
 regiment of infantry. She had heard, by mere 
 accident, that her husband had been wounded 
 at Forbach, and she had come to Metz to try to 
 discover him, but could get no news whatever, 
 and was now returning to Paris, travel-worn 
 and exhausted, intending to get into Bel- 
 
16 NOTES AND RECOLLECTIONS OF 
 
 gium, and thence obtain a passport for Prussia, 
 in the hope of finding her husband amongst 
 the prisoners. Another fellow-traveller was a 
 doctor who, after being four days in the saddle, 
 getting no food or comfort of any kind, and 
 exposed to bad weather, broke down, and was re¬ 
 turning to Paris invalided. He had been at the 
 affairs of Worth and Weissenburg, and said the 
 havoc on both sides was fearful, but the number 
 wounded and killed on the Prussian side he 
 estimated at three times the number of those on 
 the French. It was probably exaggerated, but 
 the mitrailleuse, he said, u faisait tomber les 
 hommes comme des mouches.” He watched them, 
 he told us, through his glass. A poor Zouave 
 who spoke to us was nearly crying, all his 
 comrades, he said, were gone, not half-a-dozen 
 remained. Many of the missing may, doubtless, 
 afterwards turn up, but the carnage was terrible. 
 We saw a corporal of the 60th Infantry march¬ 
 ing lightly along to Chalons. He told us he 
 was one of 312 out of a regiment of 3,000 
 strong. Yet he was marching manfully along 
 to await the reconstruction of his corps at 
 Chalons, just as if nothing very remarkable 
 had occurred. The day after I left, as I believe, 
 in the last train, Metz was cut off, and the 
 communications with Paris were at an end, 
 the fortress was invested, and the Emperor had 
 
AN AMBULANCE SURGEON. 
 
 17 
 
 left for Verdun, the first stage of his disastrous 
 series of retreats. 
 
 The mental effect produced on one by the 
 exaggerated dread of spies on the part of the 
 French was most unpleasant, nay demoralizing. 
 In spite of yourself you experienced a sort of con¬ 
 scious guilty air. You felt as if at each moment 
 some one might demand fresh explanations, and 
 you became afraid even to address or look at 
 anybody. The vaguest suspicion is considered 
 tantamount to proof that you are in the service 
 of the enemy, and a mistake once made may be 
 difficult afterwards to rectify. The only con¬ 
 solation I received was when I subsequently 
 learnt that the Prevot-Marechal himself had been 
 arrested by one of his own gendarmes, and 
 brought in triumph to the Prefecture as a spy. 
 
 Thus terminated, through no fault of my own, 
 an effort to serve the French in their need at 
 Metz. How great that need proved, how fearful 
 were the sufferings entailed by the siege, are 
 things now only too well known. 
 
 c 
 
18 
 
 NOTES AND RECOLLECTIONS OF 
 
 CHAPTER II. 
 
 I was unwilling to relinquish the struggle with¬ 
 out some further effort, and had an opportunity 
 of making another trial through the kindness 
 of my friend, Dr. Marion Sims, who had been 
 invited by the Americans in Paris to place 
 himself at the head of an ambulance corps, 
 consisting of Americans, for service in the field. 
 
 Through a difference of opinion as to where 
 the staff of this corps could render most efficient 
 service, considerable delay ensued, and in the 
 end the American surgeons were unable to take 
 with them to the field a collection of the most 
 complete kind, in stores, tents, and surgical 
 appliances, which the generosity of the Ameri¬ 
 can citizens in Paris had provided. Just at 
 this juncture Dr. Frank arrived as a plenipo¬ 
 tentiary from the English Society, with plenty 
 of money, and stores in profusion. The tide 
 of war was rolling on, our staff was chafing 
 at the inaction to which they were reluctantly 
 condemned. A joint meeting of English and 
 
4.N AMBULANCE SURGEON. 
 
 19 
 
 American surgeons was held, and it was then 
 and there unanimously determined to start at 
 the earliest moment for the seat of war. 
 
 I cannot, perhaps, do better than quote some 
 passages from Dr. Sims’s able Report, addressed 
 to Colonel Lindsay, which bear on this and some 
 other points : — 
 
 “ Sedan, September 25th, 1870. 
 
 “ Colonel Loyd-Lindsay, 
 
 u Sir,—Wishing to return to New York early 
 in October, I have resigned my position as 
 Surgeon-in-Chief of the Anglo-American Ambu¬ 
 lance into the hands of Dr. MacCormac. I, 
 therefore, feel it to be my duty to make you a 
 statement of our doings at Sedan and its neigh¬ 
 bourhood. I shall confine myself to our internal 
 organization and general hygienic condition, 
 leaving the special surgical report to our prin¬ 
 cipal surgeon, Dr. MacCormac, who performed 
 most of the operations. He will, in due time, 
 furnish such a report as will, I am sure, do credit 
 to himself, to the profession, and to the Anglo- 
 American Ambulance. 
 
 “ The Anglo-American Ambulance has a little 
 history of its own. The Americans in Paris 
 appointed a Committee at the beginning of the 
 war to organize an ambulance. This Committee 
 invited me to select a staff of American surgeons 
 
 c 2 
 
20 
 
 NOTES AND RECOLLECTIONS OF 
 
 for this purpose. I accepted the invitation, and 
 organized the staff. When we reported ourselves 
 ready to go forward to the seat of war, the 
 Committee suggested that we should set up our 
 tents in Paris, and await the coming of the 
 Prussians. The surgeons unanimously opposed 
 this proposition, insisting that our organization 
 was for the purpose of giving aid and succour to 
 the sick and wounded on or near the field of battle. 
 The Committee was obstinate, the surgeons were 
 no less determined. Hence arose a split, and the 
 American surgeons dissolved their relations with 
 the American Committee, and formed a union 
 with Dr. MacCormac, Dr. Frank, Dr. Webb, 
 and other English friends, under the title of the 
 Anglo-American Ambulance. We then went to 
 the French Soci^te de Secours aux Blesses, in the 
 Champs Elysees, where our services were at once 
 accepted. The English surgeons had £2,000 
 sterling, and a lot of stores. The French gave 
 us 15,000 francs, horses, waggons, tents, and, 
 indeed, everything we asked for. Both parties 
 promised us all the money and all the stores we 
 might need for the future. The French gave us 
 7,000 francs more at Sedan, and they have fur¬ 
 nished us with rations ever since we entered the 
 service, and will continue to give us money and 
 rations. You know how generous and opportune 
 has been the assistance from your side. 
 
AN AMBULANCE BURGEON. 
 
 21 
 
 u Our organization was completely French, but 
 composed only of English and Americans. We 
 studiously, and I can now say wisely, excluded 
 all other nationalities. We were half-and-half, 
 eight Englishmen and eight Americans. 
 
 The English are— 
 
 Dr. William MacCormac, 
 
 Dr. Frank, 
 
 Dr. Webb, 
 
 Dr. Blewitt, 
 
 Dr. Wyman, 
 
 Mr. Hewitt, 
 
 Mr. Scott, 
 
 Mr. Ryan. 
 
 u The Americans are— 
 
 Dr. Marion Sims, 
 
 Dr. Pratt, 
 
 Dr. May, 
 
 Dr. Tilghman, 
 
 Dr. Nicoll, 
 
 Mr. Hayden, 
 
 Mr. Wallis, 
 
 Mr. Harry Sims. 
 
 11 1 was made Surgeon-in-Chief, and Dr. Mac¬ 
 Cormac was placed next in command. Dr. Webb 
 was comp table, which includes the functions of 
 Commissary and Paymaster. Thus organized, 
 we left Paris on Sunday night, the 28th August, 
 with orders to report at Mezieres. We arrived 
 
22 
 
 NOTES AND RECOLLECTIONS OF 
 
 there oil Monday night, and on Tuesday, the 
 30th, we came to Sedan, where we found the 
 Caserne d’Asfeld already converted into a hos¬ 
 pital, which the authorities gladly turned over to 
 our use, and we took possession of it on the 31st. 
 We had hardly entered its grounds when the 
 roar of cannon announced the battle of that date. 
 At night, most of us repaired to the battle-field. 
 Many of the wounded were transported to our 
 hospital at Sedan, but many more, too severely 
 wounded to be transported, were housed in the 
 village of Balan. Several urgent operations were 
 performed that night by MacCormac and Frank. 
 
 11 Besides those sent to the hospital at Sedan, 
 and those attended by MacCormac and Frank, our 
 staff visited and ministered to the wants of more 
 than a hundred others. Drs. Frank and Blewitt 
 remained all night at Balan, the others returning 
 at midnight to Sedan. Early next morning, the 
 1st Sept., began the great battle of Sedan. Dr. 
 Frank’s hospital was in the midst of it at Balan, 
 and he was busy all day receiving and dressing 
 the wounded that fell in sight of his door. The 
 house that he occupied, the Mairie, bears the 
 marks of many bullets, and he was at one time, 
 for self-preservation, compelled to lie down by 
 the side of his wounded and dying. Dr. Frank 
 being thus accidentally, or I should rather say 
 providentially separated from us, established a 
 
AN AMBULANCE SURGEON. 
 
 23 
 
 branch of the Anglo-American Ambulance at 
 Balan, while we remained at Sedan. On the 
 night of the 31st August, we received at Sedan 
 thirty-six wounded, and on the 1st and 2nd Sept, 
 every bed was occupied. During the whole day 
 of the 1st Sept., the seriously wounded were 
 brought on brancards or stretchers to the hospital 
 in a continuous stream. Dr. Webb, Dr. Wyman, 
 Mr. Ryan, Mr. Hayden, Mr. Wallis, and Harry 
 Sims were busily occupied at the door dressing 
 the slightly wounded and such as could walk. 
 Dr. May, Mr. Hewitt, and Mr. Scott were sent to 
 the Mairie, bursting bombs falling on all sides, to 
 attend the wounded there, and in the adjacent 
 houses. Dr. MacCormac, Dr. Pratt, Dr. Tilgli- 
 man, and Dr. Nicoll, others assisting as they 
 could, devoted themselves to the operating-room. 
 They stood nearly all day and a good part of the 
 night at the operating-table, and MacCormac per¬ 
 formed a great number and variety of operations.” 
 
 After some valuable remarks on the importance 
 of small ambulances in contrast to the cumbrous 
 organization of those of the French Society, Dr. 
 Sims concludes his report as follows :—• 
 
 “Now, sir,” Dr. Sims continues, “in taking 
 leave, allow me to thank you for the promptitude 
 and liberality with which you have supplied all 
 our wants, and to tell you that I have only 
 
NOTES AND RECOLLECTIONS OF 
 
 words of praise for every member, male and 
 female, of the Anglo-American Ambulance. To 
 Dr. MacCormac, as Co-surgeon in chief with me 
 at the Caserne d’Asfeld; to Dr. Frank, as chief 
 at Balan; to Dr. Webb, as comptable for both 
 establishments; to Father Bayonne, the Catholic 
 priest; and to the Rev. Mr. Monod, the Pro¬ 
 testant minister, I am under the greatest obliga¬ 
 tions. And to each and every member of the 
 Anglo-American Ambulance, I beg leave to tender 
 my most grateful acknowledgments. We have 
 worked together cheerfully, heroically, each 
 vying with the other in doing his duty. 
 
 “ The English and Americans affiliate natu¬ 
 rally. Of the same origin, with the same lan¬ 
 guage, having a common literature, the same laws 
 and religion, even the same liberty under Govern¬ 
 ment, how could it well be otherwise ? In truth, 
 the English and Americans are full of genuine 
 human nature. When a common cause unites them 
 they are as a band of brothers. But when political 
 views differ and selfish interests clash, they hate 
 as only brothers do under opposing circumstances. 
 If the two peoples could always be as kindly 
 united in sentiment and action as are their repre¬ 
 sentatives in the Anglo-American Ambulance, 
 there would be no more Alabama claims to settle. 
 
 “ Believe me, Sir, yours, &c., 
 
 “J. Marion Sims, 
 
 “ Stirgeon-in-Chief of the Anglo-American Ambulance 
 
AN AMBULANCE SURGEON. 
 
 25 
 
 I should wish, however, to add a name or two 
 to those thus mentioned by Dr. Sims. To Dr. 
 Duplessy I would here acknowledge my thanks 
 and appreciation of his high-minded conduct on 
 all occasions, and our best thanks for the grati¬ 
 tude he was pleased to evince for, and the esti¬ 
 mation in which he was good enough to hold 
 our services. To M. Billotte, our French Officier 
 (VAdministration, I would here also wish to record 
 the very high credit that is due for the prompt 
 and efficient aid he rendered to us in so 
 many ways, and the great value we set upon his 
 cordial co-operation. 
 
 Everything in war time is a Vimprevu , for 
 one can never tell beforehand what is about to 
 befall. So it was even with us from our first 
 start from Paris on the 28th of August last. 
 Through a number of accidental circumstances, 
 foreseen by none of us, we joined together, a 
 band of English and American surgeons, anxious 
 to give our aid to the sick and wounded as accru¬ 
 ing from this bloody war. We were sixteen in 
 all, eight Americans and eight English, with Dr. 
 Sims and myself at the head. 
 
 We received our stores, as already mentioned, 
 at the Palais de 1’Industrie, in the Champs 
 Elysees, then a vast receptacle for medical sup¬ 
 plies of all kinds, and, with two waggon-loads 
 of medical comforts, surgical instruments and 
 
2(3 
 
 NOTES AND RECOLLECTIONS OF 
 
 appliances, some saddle-horses, and a troop of 
 infirmicrs , or male nurses, we formed a procession 
 along the Boulevards, on Sunday, August 28th. 
 In due time we reached the railway station, and 
 started for the purpose of reaching MacMahon’s 
 head-quarters, and the field of battle wherever it 
 then might be. 
 
 I may here say a word as to the organization ot 
 the French voluntary ambulance corps. The gene¬ 
 rality of them were monstrously cumbrous. There 
 were too many surgeons, too much material to 
 transport, and too many infirmiers. Too often these 
 were taken from a class of men who enlisted in this 
 service to escape being called upon to fight in the 
 army. In some of the ambulances there were as 
 many as forty medical men, and a dozen heavy 
 waggons, with horses in corresponding numbers. 
 Some of these ambulances spent most of their 
 time in marching and countermarching, never 
 reaching, in time to be of use, the actual scene ot 
 operations. Their waggons would often stick fast 
 in some country by-road, or in a field, and then 
 they would have to be abandoned. There were 
 ten such ambulances. As a system or organi¬ 
 zation, the French Society for Aid to the 
 Wounded has to a certain extent failed in its 
 mission. No doubt it has done much good, but 
 not proportionate to its resources, which have long 
 since been completely used up. In my opinion, 
 
AN AMBULANCE BURGEON. 
 
 27 
 
 a field ambulance should be constituted of not 
 more than four or five surgeons, and as many 
 assistant-surgeons, who would act as competent 
 dressers, and who had been trained to dress 
 severe wounds. Skill as a dresser is almost as 
 much required on the battle-field as skill as an 
 operative surgeon, and there is ample scope for 
 the employment of carefully educated young 
 surgeons in this capacity. I look upon this point 
 as of the first importance. All the cases, whether 
 they be operated upon or not, require careful 
 dressing, and too often this has to be entrusted to 
 inexperienced hands. For a moving ambulance, 
 the smaller the quantity of stores taken the 
 better, and these without exception should be 
 carried on horses or mules. The waggons are 
 a serious impediment, and very often, as I have 
 said before, must be abandoned, with their valu¬ 
 able contents, altogether. What is most needed 
 are a few cases of surgical instruments and ap¬ 
 pliances, some medicines, chloroform and carbolic 
 acid, one moderate-sized tent, and half a dozen 
 stretchers of the simplest construction, to carry 
 the wounded and to serve as beds. These, and 
 some tins of preserved food and biscuits, are all 
 that need be carried about. For whatever else 
 may be required, one must trust to the supplies 
 of the place in which one may happen to be. If 
 the French ambulances had been constructed 
 
28 
 
 NOTES AND RECOLLECTIONS OF 
 
 upon this system, and multiplied in number, they 
 would have been much less costly, and, I venture 
 to add, would have done much more good. Of 
 course these remarks apply only to field ambu¬ 
 lances which follow closely, or are supposed to 
 do so, the movements of the troops. For more 
 extensive organizations which go to a certain 
 spot, and there establish a complete hospital, the 
 case is different. But the great difficulty for 
 these is to secure patients. In moving troops 
 about, and taking up a position from which to 
 offer battle to the enemy, I fear that as yet 
 generals are not much actuated in coming to 
 a decision, by any consideration, as to where 
 may happen to be placed the largest and best 
 hospitals, or indeed any hospitals at all. No 
 doubt if the scene of battle could be foretold, 
 it would be quite right to send thither before¬ 
 hand the amplest medical provision possible. 
 But as that can never be, the less complete 
 but more manageable organization of an ambu¬ 
 lance volante must be relied upon to furnish that 
 immediate succour so much needed on, or close 
 to, the battle-field itself. 
 
 In accordance with our instructions on leaving 
 Paris, we tried, after arriving at Sedan, to reach 
 MacMahon’s head-quarters and the front. The 
 Yicomte de Chezelles, Courier des Ambulances, 
 acted as our guide. We heard that hard fighting 
 
AN AMBULANCE SURGEON. 
 
 29 
 
 had been going on all that day at Carignan, 
 and we were told of a French success, and that the 
 field was won. We designed to reach the nearest 
 battle-ground and set at once to work. Through 
 a combination of circumstances we were delayed 
 that evening, the 30th August, at the railway 
 station near Sedan, and we saw the Emperor, 
 MacMahon, and the whole Etat Major, arriving 
 during the night. It was a striking sight to 
 witness the flying Emperor surrounded by his 
 marshals and generals, arriving in such a manner. 
 They walked silently a couple of hundred yards 
 from the railway station to the walls. In a 
 moment or two the drawbridge was let down, 
 and the whole party disappeared inside. The 
 drawbridge was as rapidly raised, and the night 
 became silent as before. And this was the result 
 of the reported French victory, of which we had 
 been hearing all day. 
 
 In place, therefore, of our going to the front, 
 the front came to us. Then were the negotiations 
 completed with Dr. Duplessy, Medecin en Chef 
 des H6pitaux Militaires de Sedan, which placed 
 us in possession of a large hospital of 384 beds 
 on the battle-field of Sedan. This j)iece of 
 exceptional good fortune, namely, getting into a 
 first-rate position, and into working order, just 
 on the eve of a great battle, enabled the Anglo- 
 American ambulance to render services such as 
 
'30 NOTES AND RECOLLECTIONS OF 
 
 no other ambulance in either army has, I believe, 
 been in a position to perform during this war. 
 
 Of course, during the first ten days or a fort¬ 
 night we were shorthanded, and overworked. 
 Such a result appears inevitable after all great 
 battles. I find, from the diary which I kept, that 
 we have sometimes been working for twenty hours 
 at a time, performing operations, noting cases, 
 and making dressings. I have heard of surgeons 
 working for much longer spells after battles. 
 But it is questionable if work done under like cir¬ 
 cumstances can be of advantage to the wounded. 
 Not only does one suffer from physical fatigue, 
 but one must lose, more or less, that clear in¬ 
 telligence which the urgency and severity of the 
 cases necessarily demand. Some conception of 
 the amount of work required at the hands of the 
 surgeons after the Battle of Sedan, may be gleaned 
 from the fact, that there were of French wounded 
 alone, exclusive of the dead, 12,500. What the 
 German losses may have been I do not know, but 
 they also were large. The building of which we 
 got possession was an infantry barrack, situated 
 on the ramparts of Sedan, at the place to which 
 the Prussians afterwards gave the appropriate 
 enough name of Kronwerk Asfeld. 
 
 The Caserne d’Asfeld, of which a good view is 
 given in the frontispiece, was so named after a 
 French marshal who belonged to the town, famous 
 
AN AMBULANCE SURGEON. 
 
 31 
 
 also, before it gained its present notoriety, as the 
 birth-place of Turenne. The barrack is on a 
 plateau in the fortifications, about 70 feet above 
 the level of the Meuse, which meanders through 
 the valley. It is a two-story building, about 
 240 ft. long, and contains nine large rooms and 
 four smaller ones on each floor. The large wards 
 are 17 ft. 3 in. broad, 53 ft. 6 in. long, and 
 10 ft. 5 in. high. If an average of twenty beds 
 be allowed for each ward, it would give for each 
 patient a cubic space of 450 feet, but at first 
 there were twenty-four occupied beds in each 
 ward. 
 
 When we reflect that in a civil hospital, with 
 cases much less serious, four times that amount 
 of cubic space per bed is considered not too 
 much, it is no wonder that we dreaded an out¬ 
 break of pyaemia, hospital gangrene, or erysipelas. 
 The wards, which ran pretty nearly north and 
 south, had large windows at each end, and the 
 intercommunicating doors were at the middle of 
 each side. 
 
 The smaller rooms were used as sleeping apart¬ 
 ments for the members of the Staff. One or two 
 of them were used as separation wards for parti¬ 
 cular cases, for stores, and for an apothecary’s 
 shop. We had the advantage of the services of 
 a very intelligent French Pharmacien whom we 
 procured from the town. 
 
32 
 
 NOTES AND EECOLLECTIONS OF 
 
 All tliat could be done to obviate the effects of 
 overcrowding was done. The windows, fine 
 weather or foul, we constantly kept wide open, 
 the asphalte floors were washed twice daily with 
 a solution of carbolic acid, and all once-used 
 bandages and dressings were burned. 
 
AN AMBULANCE SURGEON. 
 
 33 
 
 CHAPTER III. 
 
 On the afternoon, then, of the 31st of August, 
 we were installed in medical charge of the 
 Caserne d’Asfeld, and awaiting the arrival 
 of the wounded. Nor had we long to pause. 
 The fact of there being an English ambulance 
 in occupation of the barrack must have been 
 speedily made known, as wounded men almost 
 immediately began to arrive. Severe fighting 
 had been going on all day in the direction of 
 Pont Maugis and Bazeilles, about three miles 
 distant, which we were able to see very dis¬ 
 tinctly from our elevated position. We had 
 scarcely, indeed, unpacked our waggons and 
 brought our stores inside, when bearers arrived 
 with stretchers, carrying a number of severely 
 injured soldiers. Others came on foot as best 
 they could, having in many instances marched 
 long distances with wounds in different parts 
 of the body. 
 
 Ur. Webb, with two or three assistants, re- 
 
 D 
 
34 NOTES AND RECOLLECTIONS OF 
 
 mained in charge of the door, examining the 
 wounds of those who arrived, a large proportion 
 of which had received attention on the field, 
 and were enveloped in temporary dressings. All 
 who were lightly wounded had their wounds 
 re-dressed, and were then at once sent away, a 
 biscuit or two being given to each of them. 
 Those who appeared to demand further care 
 were passed into the house. Dr. Webb’s was 
 no easy task, for everyone who applied was 
 desirous of admission, often in the inverse ratio 
 of the gravity of his injury. However, the 
 Doctor was most firm and judicious, and exer¬ 
 cised in every instance a wise discretion. About 
 130 poor fellows passed through our hands that 
 afternoon. 
 
 At six o’clock, when we were getting our 
 affairs into somewhat better order, a gentle¬ 
 man rode up in hot haste to inform us that 
 at the village of Balan, near which there had 
 been fighting all day, there were upwards of 
 two hundred wounded, with no one to look 
 after them. He told us the place was about 
 two kilometres, or a little over a mile, distant. 
 Dr. Sims had our ambulance-cart got ready, 
 into which we put surgical instruments, dressings 
 of all kinds, chloroform, carbolic acid, and some 
 provisions, such as Liebig’s extract of meat, and 
 biscuits, and he, Dr. Frank, and myself, with 
 
AN AMBULANCE SURGEON. 
 
 35 
 
 Messrs. Blewitt, Wyman, and Hewitt, started for 
 Balan. Just at the entrance to the village we 
 found a number of wounded in the various 
 houses, and also two carts, each containing three 
 or four wounded soldiers, standing in the road¬ 
 way. I stopped there with a portion of our sup¬ 
 plies, and, with the aid of Mr. Hewitt, set 
 about attending to the poor fellows as well as we 
 could. Dr. Wyman, who also stayed with us for 
 a time, was shortly taken away to see another set 
 of wounded, and did not return again to me that 
 night. The rest went on, and spent several hours 
 upon the battle-field, giving all the succour they 
 could to some hundred poor soldiers lying there 
 untended. 
 
 I found about thirty cases to look after. In 
 the first place, I took possession of an exceed¬ 
 ingly nice empty house, and, with the aid of the 
 neighbouring people of the village, arranged 
 some beds upon the floor, and extemporised an 
 operating-table in one of the rooms. All this 
 took some time, and it was now quite dark. 
 The first poor fellow whom I examined had his 
 left tibia smashed by a bullet. It was too plainly 
 a case for amputation. He was a soldier of the 
 marines. Mr. Hewitt administered chloroform, 
 and then compressed the artery for me. One 
 indigenous volunteer held a candle, whilst another 
 provided a basin and sponge, and, under these 
 
 d 2 
 
36 
 
 NOTES AND RECOLLECTIONS OF 
 
 difficult circumstances, I removed the leg in 
 the upper third. The next was an artilleryman, 
 whose left leg was very extensively shattered by 
 a shell explosion. Both the bone and the soft 
 parts were much injured. There was great mus¬ 
 cular development of the calf. I amputated this 
 leg just as I did the other, by oval skin-flaps and 
 circular division of the muscles. For some days 
 these men received very little attention, but both 
 recovered admirably under the care more par¬ 
 ticularly of Mr. Blewitt, who stayed with Dr. 
 Frank at Balan that night, and subsequently 
 remained there permanently as one of our Balan 
 division. I often saw these two patients when I 
 rode out to visit Frank. They got on without a 
 single drawback, and both recovered perfectly. 
 
 There were several other important cases ; 
 for instance, that of a soldier of the marines, who 
 was shot through the middle of the left deltoid 
 muscle, the ball passing directly into the chest 
 through the head of the humerus. There was 
 no wound of exit, and the probe passed in an 
 indefinite distance. The symptoms present 
 were short cough, difficult respiration, and 
 bloody expectoration. It was clearly a case of 
 penetrating wound of the chest with lodged 
 bullet. The man subsequently died. 
 
 Schyltee, another marine, was lying insensible 
 with extensive fracture of the skull from a shell. 
 
AN AMBULANCE SURGEON. 
 
 37 
 
 The brain was a good deal lacerated and exposed. 
 For neither of the poor fellows could anything 
 be done. 
 
 In another artilleryman, an immense fragment 
 of shell penetrating the calf had become wedged 
 between the tibia and fibula. It was very 
 difficult to remove. These and other cases 
 having been attended to, we prepared to return 
 to Sedan, as it was very late, and we were all 
 tired. Amongst us, we must have attended to 
 two hundred and sixty wounded men that after¬ 
 noon and night. We all slept the sleep of 
 fatigue, but our quarters were none of the most 
 comfortable. We took possession for ourselves of 
 two rooms on the first floor, each containing eight 
 beds. These were the same as those in the 
 wards, very narrow, covered with the soldiers’ 
 bedding, and filled with bugs, which disturbed 
 our slumbers fearfully. There were no washing 
 utensils, or other conveniences of any kind. 
 Such a thing as a chair was not to be found 
 in the whole establishment. 
 
 In spite of our fatigues, we were awakened very 
 early the next morning, September 1st, by the 
 sound of heavy cannonading. Towards five 
 o’clock, when it became light, we perceived that 
 everything was enveloped in a dense fog. The 
 troops could not have seen each other, yet the 
 firing commenced between three and four in the 
 
38 
 
 NOTES AND RECOLLECTIONS OF 
 
 morning. It went on crescendo , and after the fog 
 lifted, spread all along the lines, which were some 
 four miles in extent. At each end, Floing and 
 Donchery on the north-west, and Bazeilles 
 and Balan on the south-east, the infantry and 
 cavalry came into collision,—while on the rising 
 ground in front of us, about a mile and a half 
 distant, we had a fine view of the Prussian bat¬ 
 teries of artillery, which, from ten o’clock in the 
 morning until four in the afternoon, literally 
 rained shells upon the French positions just in 
 the rear of the hospital. The French, of course, 
 replied, and there was in consequence a storm of 
 projectiles flying close over our heads in both 
 directions all this time. The heavy guns of the 
 citadel just alongside of us were also firing ; and 
 all these, together with the incessant hurr-r-r of 
 the mitrailleuse and the musketry fusillade, made 
 us feel as if our quarters were exceedingly hot. 
 Several times the Prussian shells struck the 
 building, and some of them burst in the en¬ 
 closure, killing and wounding several persons— 
 amongst the rest, two of our male nurses or 
 mfirmiers, and a number of soldiers. About four 
 in the afternoon, the German fire was turned in 
 another direction, and the feeling of relief which 
 we all experienced was as agreeable as it was 
 great. By six o’clock, the cannonading and 
 fighting had stopped altogether. 
 
AN AMBULANCE SU11GEON. 3 ( J 
 
 During 1 the entire day the wounded were 
 arriving, some hobbling along on foot, others 
 carried upon stretchers. Our guards at the door 
 had no easy task, for, besides the wounded, 
 numbers of demoralized soldiers demanded ad¬ 
 mission, seeking shelter and protection. In the 
 barrack square not less than 4,000 men of all 
 arms had accumulated, and, as night came on, 
 they lay stretched side by side upon the ground, 
 their arms piled beside them, and so closely as 
 to render it almost impossible even to pick one’s 
 way amongst them without trampling on some¬ 
 body. The camp fires flickering here and there 
 added to the strangeness of the scene. 
 
 During all that day I was busy examining 
 the wounded carried into the hospital, and per¬ 
 forming operations on those who needed them. 
 These last were done at one of the ward windows 
 in order to get a good light, and we were unable 
 wholly to divest ourselves of the unpleasant con¬ 
 viction that at any moment a shell might burst 
 in our midst, dealing destruction to all around. 
 I suppose one might perhaps become accustomed 
 to it in time, but, at first, operating in the direct 
 lino of fire, as we were, with the shells con¬ 
 tinually whizzing in our ears, and hitting the 
 building from time to time, has a somewhat 
 disquieting influence. One of our party while 
 on duty at the door saw a shell explode a few 
 
40 
 
 NOTES AND RECOLLECTIONS OF 
 
 paces off, killing and wounding several of the 
 soldiers. 
 
 I did not succeed in keeping a record of all the 
 work that was done that day. Indeed, I only 
 wonder I kept any record at all. I find, how¬ 
 ever, that I performed several amputations of the 
 leg, the thigh, the forearm, and the arm, that I 
 excised the shoulder and the elbow joints, and 
 also performed partial resections of the upper and 
 lower maxillae, and of nearly the whole ulna. 
 The number of bullets and pieces of shell that 
 were extracted from various parts of the body are 
 too numerous to reckon. Thus came to an end, 
 late on in the night, our second day’s work. 
 
 As closely as I have been able to calculate, we 
 received, during the course of that day, 274 
 patients into the hospital, and dressed and other¬ 
 wise attended to, at the door, 250 more, at the 
 very lowest calculation. It was very hard to 
 turn many of these wretched, hungry men away, 
 but we could not help it. We should otherwise 
 have been overrun. Towards the end of the day 
 our discipline, to a certain extent, relaxed, and 
 we allowed a number to get a night’s rest 
 and food, which they took lying about on the 
 staircases and in the passages of the hospital, 
 which were thus everywhere crowded. 
 
 We were all by this time pretty well ex¬ 
 hausted, and, although there were many whose 
 
AN AMBULANCE SURGEON. 
 
 41 
 
 cases demanded interference, we felt it necessary 
 to take some hours’ rest. All within the house 
 had been attended to more or less, temporary 
 dressings had been applied to the wounds, opiates 
 were administered to all those suffering pain, and 
 some food was given to the hungry. Nearly all 
 the men were tired out with fatigue and suffer¬ 
 ing. Outside, all was quiet. The soldiers in the 
 barrack square lay stretched in profound sleep by 
 their expiring camp-fires. But looking over the 
 town and country we saw the flames of houses 
 burning in several places, and a loud continuous 
 hum of thousands of voices rose in the night air 
 from the caged soldiers in the town. In parti¬ 
 cular, I noticed the masses of flame and smoke 
 which rose from burning Bazeilles. We went to 
 bed all uncertain as to what might happen on 
 the morrow, and wondering if the bombardment 
 would recommence. Rumours of the most vary¬ 
 ing kinds reached us, but the prevailing opinion 
 was that all had been lost, that regiments had 
 given themselves up en masse, that even generals 
 had fled. A Colonel who had been at Weissen- 
 burg, Worth, and Forbach, whose eagles had 
 been decorated, told how, when he could fight no 
 longer, he had burnt his colours, and buried the 
 eagles along with his decorations, that they might 
 not fall into the enemy’s hands. He and other 
 officers declared, with tears in their eyes, that 
 
42 
 
 NOTES AND RECOLLECTIONS OF 
 
 their country had been dishonoured, betrayed, 
 and lost by incompetence of the grossest kind. 
 
 Next morning, the 2nd of September, the 
 sun shone out bright and beautiful over the wreck 
 and ruin of the previous day. We rose early. 
 From the ramparts, we saw the dead soldiers 
 strewn all about. A little farther off we saw 
 Prussian burying parties busily engaged in¬ 
 terring the killed, an office which was not 
 wholly completed for nearly a week. Our own 
 dead during the first few days, and they were 
 not a few, were interred in a trench some 
 little distance from the hospital. After the 
 affairs of the town became again somewhat en 
 regie , the civil authorities took charge of the 
 burials, and relieved us from further trouble. 
 
 We commenced as soon as possible to attend to 
 those cases which had not been thoroughly ex¬ 
 amined the day before. I may here repeat what 
 has been insisted upon elsewhere, and by none 
 better or more forcibly than Professor Longmore, 
 that it is of the very last importance to make a 
 complete examination of gunshot wounds during 
 the primary stage, that is, as soon as possible 
 after the receipt of injury, and before inflam¬ 
 mation sets in, and that no probes and no 
 apparatus will adequately subserve the use of 
 the finger. If necessary, too, the wound may 
 be somewhat enlarged. It is but of small con- 
 
AN AMBULANCE SURGEON. 
 
 43 
 
 sequence to do so in comparison with leaving 
 the extent of comminution in an injured bone 
 undiscovered, or a lodged bullet unextracted. 
 It is more difficult than might be supposed to 
 estimate the gravity of a gunshot injury, or to 
 ascertain, by means of a probe, the existence of 
 a bullet in a wound, more especially if it be 
 a wound of bone, as, for instance, a bullet lodged 
 in the spine. The extraction of bullets also 
 requires both skill and patience. Much injury 
 may be inflicted on surrounding parts by the 
 incautious use of the bullet-forceps. 
 
 The mortality consequent upon primary am¬ 
 putations is so very much smaller than that 
 attendant upon those called secondary, that this 
 point cannot be too strongly insisted upon. 
 Quite a large number of poor fellows were sent 
 to us from other ambulances, ten days or more 
 after the battle, whose limbs should have been 
 removed in the first field-hospital they reached. 
 We were obliged to amputate them, but the 
 mortality was distressingly great. Again, it 
 may not perhaps be sometimes of vital import¬ 
 ance to remove a lodged bullet, but were it only 
 for the mental solace afforded to a soldier by 
 the extraction of the ball, it would prove a 
 sufficient reason to do so if possible. A soldier 
 seems generally to imagine that his life almost 
 depends on the extraction of the missile that has 
 
44 
 
 NOTES AND RECOLLECTIONS OF 
 
 injured him, and his joy is proportionately great 
 when it has been successfully removed, while 
 he never appears comfortable, either in mind 
 or body, so long as it remains in the wound. Of 
 course the great difficulty consists in there being 
 neither hands nor time sufficient after a great 
 battle to make these examinations so fully and 
 so completely as the occasion demands. The 
 bullet-forceps I preferred was one with claw 
 points, at a right angle with the handle, and 
 slightly overlapping, so as to admit of easy 
 ingress. When these catch the bullet, they 
 rarely let it slip. All that is required is to 
 ascertain beforehand the exact position of the 
 foreign body, and then to pass the forceps 
 gently down to it. I must confess, in spite of 
 high authority to the contrary, I did not like 
 Coxeter’s ingenious bullet extractor. I think 
 there are some objections to, and few advantages 
 in, its use. 
 
 Meanwhile, the day wore on, and the fighting 
 did not recommence. The batteries on the hill- 
 slopes opposite did not reopen their deadly fire. 
 We saw heavy columns of Prussian infantry 
 posted inactive in the fields. First came to us 
 the report of an armistice of forty-eight hours, to 
 bury the dead, then the stupendous news that 
 an army of 100,000 men, 400 pieces of artillery, 
 70 mitrailleuses, and an Emperor to boot, had 
 
AN AMBULANCE SURGEON. 
 
 45 
 
 capitulated without being able to strike another 
 blow for their country or their liberty. 
 
 Once in Sedan, there was no way out of it. 
 The French army had become transformed into a 
 disorganized mob. The officers knew not where 
 their men were, the soldiers knew nothing of 
 their regiments or their officers. Men of all 
 arms were mixed up together in irremediable 
 confusion. Some were cooking horseflesh, some 
 were eating it even raw. Many were lying about 
 the streets in the deep sleep of fatigue. Every¬ 
 thing and everybody looked utterly wretched 
 and miserable. At each corner were the bloody 
 skeletons and entrails of horses, from off which 
 every scrap of flesh had been cut, but bread 
 was not to be had for love or money. In the 
 hospital enceinte the same thing was going on. 
 Four thousand men had been collected there, and 
 the debris they left behind required the hard work 
 of relays of men, during several days, to remove. 
 All the 2nd of September, like the 1st, we were 
 engaged performing amputations, excisions, and 
 in removing deeply lodged balls and pieces of 
 shell, only interrupted, from time to time, by 
 calls to see some fresh arrival. 
 
 In the evening, after a hard day’s work, we 
 got a summons to say that in the town were 
 large numbers of wounded still untended. A 
 party of us went down. In every second house, 
 
46 
 
 NOTES AND RECOLLECTIONS OF 
 
 almost, there were wounded men. The theatre 
 was full of them, the church was full of them, 
 other public buildings were equally full. Some 
 we had transported to our own hospital, while 
 to others we administered what comfort we 
 could. Subsequently, aid arrived from other 
 ambulances, and from the military medical 
 officers, but for the first few days the encombre- 
 ment des malades , as the French call it, was 
 almost enough to make one give up in despair. 
 
 That evening, to my great relief, I heard from 
 Dr. Frank, and that he was safe. When I saw 
 the village in which he was in flames, and knew 
 that it had been the scene of a desperate fight, 
 I feared we might never again see him alive. 
 Indeed, at one time, and with only too much 
 reason, he had given himself up for lost. All 
 by himself, he tied the carotid artery for a 
 wound of the face, and performed other opera¬ 
 tions, but he had not had sufficient help. There 
 were two cases, he afterwards told me, where 
 amputation should have been performed at the 
 hip-joint, but this had to be left undone for 
 want of assistance. 
 
AN AMBULANCE SURGEON. 
 
 47 
 
 CHAPTER IV. 
 
 There were many cases which came under our 
 care on that day, September 2nd, of deep in¬ 
 terest. Amongst the rest were two in which I was 
 afterwards compelled to tie the common carotid 
 for secondary haemorrhage. 
 
 Case I. was that of a French Colonel, who had been wounded 
 near Balan on September 1st. The ball had entered the right 
 cheek, passed downwards through the horizontal ramus of the 
 inferior maxilla, comminuting it extensively, and then lodged 
 deeply beneath the right sterno-mastoid muscle, where it was 
 with great difficulty detected. On the day following I removed it 
 through a veiy deep incision along the posterior edge of the 
 muscle, at a point level with the angle of the jaw. The ball 
 was much altered in shape, and a piece of the bone was 
 firmly impacted in it. We thought the Colonel was quite con¬ 
 valescent, he was walking about, his wounds were healing fast, 
 when, on September 10th, he had a severe attack of haemor¬ 
 rhage both from the mouth and from the wound made for 
 the extraction of the ball. This was checked. He had a 
 second attack, which was also arrested, then, all on the same 
 day, a third, and more profuse than the others, took place. 
 At midnight, I cut down upon and tied the common carotid. 
 No return of the bleeding took place. The ligature fell in 
 
X"TE> AXD EECOLLECTIOXS OF 
 
 4s 
 
 fourteen ours. I brought the colonel away -with me when I 
 left Sedan, and he is now staying in Brussels, his wounds all 
 but healed. His father, also a colonel, was shot almost in the 
 same manner at bVaterloo. and recovered, like his son. 
 
 Case EL.—My other case, similar in many respects to that 
 just narrated, was not so fortunate in its issue. Jacob ISTebek. 
 a Prus si a n , aged id. was wounded on September 1st. The ball 
 entered just beneath, and slightly external to, the left ala of 
 the nose. It then ripped np the whole of the hard and soft 
 palates in the central line, with the exception of the alveolar 
 ridge. Three days afterwards, the bullet was extracted through 
 a deep incision opposite the middle of the posterior border of the 
 right stemo- mastoid. This patient made good progress until 
 the afternoon of September 11th. He was, like the Colonel, 
 apparently convalescent, and able to walk about. On that day 
 very profuse bleeding took place. The blood poured down 
 through the wound in the roof of the month so fast as almost to 
 choke him. and free bleeding also occurred from the incision 
 behind the sfcemo-jnasboid. The difncnlty was to ascertain 
 whence the haemorrhage came. Pressure exerted alternately on 
 each carotid failed to afford the clue, as no decided effect was 
 thus produced. There was no time to hesitate, the man was 
 rapidly bleeding to death. I decided that, although the mouth- 
 wound was mesial, the bullet had. in traversing the right side 
 of the neck, probably injured some branch of the right external 
 carotid. I tied the right common carotid, and, to my great 
 relief, the bleeding was permanently arrested. Otherwise one 
 might have had. the nndesired opportunity of witnessing the 
 effects of simultaneous ligation of both carotids, for I would 
 have tied the opposite external carotid, had the first ligature 
 failed to stop the bleeding, hbeder. for five days, progressed 
 favourably, acute double pneumonia then set in, and he died. 
 
 The Chassepot bullet which caused the injury 
 is represented in the accompanying wood-cut. It 
 
zfrV AMBULANC'E SURGEON. 
 
 49 
 
 has been greatly altered in shape during its pas¬ 
 sage through the bone. 
 
 Fig. 1. 
 
 Case III.—A third case, very similar to these two, except 
 that there was no secondaiy haemorrhage, was that of an 
 infantry soldier named Chableboi, aged 27. He was wounded 
 on September 1st. The ball entered one inch and a half 
 external to the left commissure of the lips, and emerged behind 
 the middle of the right stemo-mastoid muscle. The lower jaw 
 was fractured at its angle on the left side. This man died 
 exhausted eight days afterwards. 
 
 Cases IT. and "V .—We had two singular cases, in each of 
 which a piece of shell traversed horizontally across the face, 
 passing beneath the bridge of the nose, but leaving the bridge 
 complete, and the nose but little altered in form. In each case 
 one eye was destroyed, and the lids of the other grazed. Both 
 patients were in a short time discharged convalescent. There 
 were three other cases in which one eye was destroyed, and a 
 remarkable example of temporary loss of vision from a shell- 
 explosion close by, which caused no further injury. 
 
 There were several other eases of wound of 
 the neck and face admitted on the 1st and 2nd 
 of September, of some of which I may furnish 
 a few details. 
 
 Case VI.—I only recollect one example of extensive injurv 
 to the upper maxilla. A man came in during the heat of the 
 fighting on September 1st, with his left cheek partially tom 
 
 E 
 
50 
 
 NOTES AND RECOLLECTIONS OF 
 
 away by a shell. The bone was a good deal comminuted, and 
 the antrum of Highmore laid open. The soft parts were lace¬ 
 rated and contused throughout a length of four inches, and the 
 greater portion of the masseter muscle was torn off. I removed 
 all loose pieces of bone and shreds of flesh, sutured the wound, 
 and applied carbolic dressings. I never saw this man again, 
 nor heard of him. I believe he left the hospital after getting 
 his wounds dressed. 
 
 Case VII.—About the same time of the day Captain Bera 
 came to us with a large portion of the body of the lower maxilla 
 carried away by a shell. Fortunately, the alveolar ridge was 
 intact. I removed all loose portions of bone, and adjusted the 
 soft parts. He recovered with scarcely any deformity. He 
 was a very handsome young man, and was chiefly anxious that 
 his good looks should be preserved to him. 
 
 Case VIII.—An infantry soldier, named Mathie, was shot 
 through the face the same day. The ball entered just beneath 
 the zygoma, rather less than an inch in front of the left ear. 
 It then crossed the nasal fossae, and emerged through the right 
 cheek, fracturing the right malar bone. This man did not 
 appear to be even inconvenienced by his wound, and soon left 
 the hospital quite convalescent. 
 
 Case IX. is very like the preceding. Bulion, 1st Zouaves, 
 was also shot across the face. The ball entered under the left 
 malar bone, immediately in front of the edge of the masseter 
 muscle. It ripped up the hard palate on the left side, and 
 then, being diverted upwards, emerged beneath the right zygo¬ 
 matic arch, three-quarters of an inch in front of the ear. After 
 a fortnight’s treatment, this man left the hospital convalescent. 
 
 Case X.— Navel, 4th Regiment of Marines, was wounded by 
 a ball, which entered beneath the centre of the left zygomatic 
 arch, and made its exit exactly at the tip of the right ear. The 
 last molars of the upper jaw on the right side, half of the soft 
 palate, and the uvula, were torn away. This man also recovered. 
 
AN AMBULANCE SURGEON. 
 
 51 
 
 Case XI.—Private Fays received a ball on September 1st, 
 which entered the left cheek close in front of the masseter 
 muscle, and emerged just over the vertebra prominens. The 
 front of the chest was ecchyinosed. There were no symptoms of 
 serious injury, and in three weeks he was discharged con¬ 
 valescent. The wound, however, remained fistulous. 
 
 Case XII.— Galliard, Chasseur a Pied, was struck on the 
 1st of September by a ball, which entered beneath the left eye, 
 and after smashing the left malar and palate bones, emerged 
 below the right ear, to re-enter the anterior border of the 
 trapezius, then passing downward and backward, it made its 
 final exit over the inferior costa of the scapula. This man 
 quite recovered in a short time. 
 
 Case XIII.— Antoine, 53rd Regiment of the Line, was also 
 wounded on the 1st, en battant la retraite. The ball entered just 
 to the left of the sixth cervical vertebra, and emerged through 
 the right cheek, in front of the insertion of the masseter 
 muscle in the lower jaw. The wound of entrance, with its 
 bruised and inverted edges, was much larger than the wound of 
 exit, whose edges were as if cut and everted. For a fortnight, 
 Antoine did well. He then took typhoid fever, and died. 
 
 Case XIV.—This is a case almost identical, except in 
 result, with the last. Fritz, a soldier of the 89th Regiment of 
 the Line, was also wounded en battant la retraite. The ball 
 entered a little below and to the left side of the vertebra pro¬ 
 minens, and emerged through the middle of the left sterno- 
 mastoid muscle. The wound of entrance was much larger than 
 the wound of exit. He recovered without any symptom of 
 importance. 
 
 Case XV.— Bernard, 5th Regiment of the Line, was struck 
 by a ball, which entered one inch externally to the left com¬ 
 missure of the lips, fractured the left ramus of the lower jaw, 
 and emerged through the central point of the fold where the 
 chin joins the neck. The same ball, passing downwards, again 
 
 E 2 
 
52 
 
 NOTES AND RECOLLECTIONS OF 
 
 entered just below and outside the right sterno-clavicular 
 articulation, and, after fracturing a couple of ribs, was cut out 
 on a level with the nipple, but four inches external to it. For 
 a time, this patient did well, but he ultimately died of pleuro¬ 
 pneumonia excited by the fractured ribs. 
 
 Case XVI.— Renan, wounded, like most of the others, on 
 September 1st, was a soldier of the Marines. The ball 
 entered just below the left ala of the nose, passed through the 
 upper lip, knocked away the two left incisors, also the canine 
 and first bicuspid teeth, grooved deeply the dorsum of the 
 tongue, left the cavity of the mouth by piercing the right pos¬ 
 terior pillar of the fauces, and finally emerged behind the right 
 sterno-mastoid muscle. This man was discharged convalescent 
 in a fortnight, having only suffered the veiy smallest possible 
 amount of inconvenience. 
 
 These cases are chiefly remarkable on account 
 of forming a series very similar to each other in 
 most important particulars, and in none more 
 than the marked smallness of the mortality, or the 
 absence, indeed, of any serious consequences what¬ 
 ever. The great majority convalesced rapidly. 
 The same fact has been observed in other wars 
 with regard to wounds of the face and neck, which 
 appear, as a rule, to be readily recovered from. 
 
 We had, besides, a large number of gunshot 
 wounds traversing the neck in various directions, 
 also without injuring important parts. In one 
 case only was the trachea wounded. 
 
 Case XVII.— Farjonel was struck by a ball which entered 
 in front of the left sterno-mastoid muscle, and emerged just 
 above the centre of the right clavicle, wounding the trachea in 
 
AN AMBULANCE SU11GE0N. 
 
 53 
 
 its passage across the neck. During respiration, the air flowed 
 freely out of each aperture. He made, nevertheless, a good 
 recovery. 
 
 There must occur many instances of com¬ 
 batants with wounds of the great vessels of the 
 neck, who die immediately, and are never carried 
 off the field at all, but the surgeon has his hands 
 too much occupied with the living wounded to 
 have much time to examine the injuries received 
 by the dead. 
 
 Coming down a little lower in the body, there 
 were under our care five cases in which the 
 clavicle was smashed by a ball, which afterwards 
 wounded the lung. In two of these I found it 
 necessary to excise at least one-third of the 
 clavicle. In a third, the ball was cut out 
 from the back, having traversed the lung with 
 a piece of the clavicle sticking in it. Four of 
 these patients died. The fifth recovered. In 
 this last, the ball, besides fracturing the clavicle, 
 had passed out through the infra-spinous fossa 
 of the scapula, starring it. In all of them there 
 was profuse haemoptysis. 
 
 The longest day must come sometime to an 
 end, and so did the 2nd of September. It was 
 only in the evening that we learnt authori¬ 
 tatively what our position really was. General 
 De Wimpffen, who had succeeded in com¬ 
 mand of the army, when MacMahon was shot 
 
54 
 
 NOTES AND RECOLLECTIONS OE 
 
 through the hip, posted a proclamation in 
 Sedan, in which he announced that he felt 
 constrained to capitulate in order to avoid a 
 useless massacre, that the whole army could have 
 been destroyed, without being even able to reply 
 to the enemy’s tire, and that, further, when on 
 the evening before he had appealed to the 
 courage and devotion of liis troops to make a 
 sortie and cut tlieir way out through the Ger¬ 
 man lines, only two thousand men could be 
 found willing to rally round his standard. 
 
 September 3rd .—It has been raining heavily all 
 night, and the unfortunate soldiers must have 
 found it difficult to keep then’ fires alight. They 
 could not have slept much, as nearly all night 
 through we heard the confused noises which 
 masses of men so crowded together are sine to 
 make. In the morning they presented a sad 
 and sorry plight. Outside the town we saw the 
 German troops being paraded, and could hear dis¬ 
 tinctly the huzzas and cheering with which they 
 received the news of their wonderful success when 
 the king passed them in review. About nine in 
 the morning, to the strains of splendid music, 
 the Prussians marched into Sedan, occupying 
 as their head-quarters the Sous-Prefecture, which 
 the unfortunate Emperor and his staff had only 
 left a few hours before. I was particularly struck 
 
AN AMBULANCE SURGEON. 
 
 55 
 
 by the fine appearance of both men and officers, 
 and especially of their horses. They looked 
 more as if they had just left the parade-ground 
 in Berlin than like troops who had been for two 
 months campaigning in the heart of an enemy’s 
 country. During the day a somewhat exciting 
 little episode took place. A patrol of soldiers 
 came up to take possession of the barrack. 
 Chezelles and I went to the gate to meet them, 
 on which they levelled arms at us. We ex¬ 
 plained that we had no soldiers amongst us, but 
 only wounded men, both French and German, 
 in the barrack. Immediately after receiving our 
 explanations they retired, expressing themselves 
 as perfectly satisfied, and from that time forward 
 we were in no wise interfered with by either the 
 Prussian medical or military authorities, except 
 in one particular, which is a matter requiring 
 some explanation, which I shall now endeavour 
 to make. 
 
 For the first fortnight we had for the nursing 
 of our patients to depend exclusively upon the 
 service of military infirmiers , or male nurses. 
 Several of these men were most excellent 
 fellows. Some were quite invaluable, [having 
 received a thorough training in nursing the sick 
 and in dressing wounds at the great French 
 Military Medical School of Val-de-Grace. Others, 
 again, were as bad as the first were good, 
 
56 
 
 NOTES AND RECOLLECTIONS OF 
 
 There is a regular service of infirmiers in the 
 army, and these men are held to be inviolable, 
 just as the sick themselves, or the surgeons are, 
 according to the terms of the Geneva Conven¬ 
 tion, to which both French and Germans had 
 agreed. Under such circumstances we were 
 naturally made very indignant when, on two 
 occasions, a large number of our infirmiers were 
 marched off and sent prisoners to Prussia. The 
 first abstraction took place on September 10th. 
 We then got fresh supplies, with the assurance 
 that these should be left to us. And yet, on 
 September 15th, a large proportion of these also 
 were removed, after we had both times had all 
 the trouble of training them, as well as they 
 could be trained, to their work. The annoy¬ 
 ance, and inconvenience, and loss in every way, 
 both to ourselves and to our patients, can, per¬ 
 haps, be imagined, but scarcely described. Be¬ 
 sides, it seemed to be so direct a violation of the 
 Geneva Convention. What, however, I did not 
 discover till afterwards was, that only those men 
 not regularly inscribed as infirmiers were re¬ 
 moved. The staff of infirmiers , properly so- 
 called, was never interfered with. This statement 
 I make on the authority of the French Ofiicier 
 d?Administration, M. Billotte, with whom we 
 were associated, and whose valuable assistance 
 on all occasions I wish to acknowledge in the 
 
AN AMBULANCE SURGEON. 
 
 57 
 
 strongest manner. The Prussian authorities were 
 distinctly dans leurs droit in seizing upon those 
 quasi-infirmiers. But their action did not on that 
 account embarrass us the less, and when the 
 vast number of wounded French soldiers accruing 
 from the battles around Sedan is considered, 
 one cannot help wishing that the Prussian Com¬ 
 mandant might have been a little less exigeant. 
 
 We received only twenty-two fresh cases this 
 day, Sept. 3rd, and there were comparatively 
 few out-patients to look after, but, if so, of work 
 inside the Hospital there was no slackness. 
 There were still several cases requiring opera¬ 
 tion, and many amputations were performed. 
 It is unnecessary to go into many details about 
 these at present, further than to say that in every 
 instance chloroform was employed, that, during 
 the operation, bleeding was controlled by digital 
 pressure, the tourniquet being never used, and 
 that the arteries were twisted, not tied, with the 
 exception of the first few cases. Unlimited torsion 
 was the method employed. The amputations 
 were performed by long anterior and shorter 
 posterior flaps, the first cut from without in¬ 
 wards, never formed by transfixion and em¬ 
 bracing only the skin and its subcutaneous con¬ 
 nections, or sometimes a thin layer of muscle, 
 but the general mass of muscles was divided by 
 a circular sweep of the knife. The short posterior 
 
58 
 
 NOTES AND RECOLLECTIONS OF 
 
 flap was usually formed by transfixion. Wire 
 stitches were frequently employed to unite the 
 edges of the flaps, leaving' usually a portion 
 unclosed to allow the easy escape of the dis¬ 
 charges. The dressing's were simple, consisting* 
 of a few strips of lint dipped in carbolic lotion, 
 and a turn or two of bandage to keep them in 
 their place. 
 
 The resections of the elbow and shoulder were 
 done through a single straight incision, in the 
 former case behind the joint, in the latter in 
 front, unless when the scapula was injured, and 
 then the incision was made behind. The knee- 
 joint resection was performed through an oval 
 incision in front. 
 
AN AMBULANCE SURGEON. 
 
 59 
 
 CHAPTER V. 
 
 September 4^.—Not many fresh cases were ad¬ 
 mitted, and on this and the next few days we 
 enjoyed a respite to a certain extent. Most of 
 the fatally injured had by this time died, 
 and we were able to discharge several, amongst 
 whom were some malingerers, fellows with trivial 
 wounds of the hand and foot, who had contrived 
 to elude our vigilance at the door. In conse¬ 
 quence of this, the wards were not quite so over¬ 
 crowded. We found time to number the beds 
 and wards, to assign them to different surgeons, 
 to organise our nursing staff better, and to put 
 our commissariat into good order. Some of our 
 surgeons had forty-eight beds to look after, some 
 had fifty-eight, and some so many as seventy-two. 
 I devoted all the leisure time I could spare to 
 taking short notes of the cases. These notes, 
 of course, are very imperfect. It was very 
 difficult to take them at all, on account of the 
 little available tune there was, and the difficulty 
 
GO 
 
 NOTES AND RECOLLECTIONS OF 
 
 was frequently increased by the patients being 
 moved from one part of the building to another. 
 My notes, too, do not comprise the cases of some 
 patients who died during the first two days, 
 when it was all but impossible for any record 
 to be taken, as everyone was fully occupied with 
 other and more pressing work. Such as they 
 are, however, the brief histories which I was 
 able to take of our patients and of the nature 
 of their injuries, are all that there is to form the 
 basis of a surgical report of our work at Asfeld, 
 and become, therefore, a valuable record. 
 
 We tried to-day, for the first time, to get some 
 letters conveyed to Belgium, in order that our 
 friends might hear of our safety, and we sent off 
 two of our corps to the Belgian frontier in order 
 to get to Bouillon, the nearest post-town, where 
 they were to post our letters and procure as many 
 eggs and fowls, as much butter and vegetables, 
 and other food, as they could. One of the 
 gentlemen spoke French and German, the other, 
 neither. Not knowing the route, in place of 
 going to Bouillon, they strayed into the road 
 to Mezieres, and soon fell in with Prussian 
 patrols, who considered it very strange that, 
 while purposing to go to Bouillon for supplies 
 for an ambulance, they should be striking 
 straight for Mezieres, a fortress then in the 
 hands of the French. In short, they were 
 
AN AMBULANCE SURGEON. 
 
 61 
 
 looked upon as spies, and taken before the 
 officer commanding. We only learnt on the 
 return of the party, how very great a risk 
 they had run, for it appeared that one of the 
 letters they carried contained matter tending 
 to implicate a person in Paris as a Prussian 
 spy. Just when about to be searched, our 
 messenger recollected this document. He was 
 certainly endowed with much presence of mind, 
 for, immediately feigning sickness and diarrhoea, 
 he begged to see a surgeon, who administered 
 a dose of laudanum. He got thirty drops, 
 though he would not, he said, have hesitated to 
 swallow a hundred, if necessary. He was then 
 permitted to go aside, when he effectually dis¬ 
 posed of what might have been the means of 
 placing his life in very great danger. Our 
 letters were afterwards given to an Englishman, 
 an officer in the Prussian army, who promised 
 to send them for us by an early opportunity, 
 but up to the present time they have never 
 reached their destination, and now, I suppose, 
 they never will. 
 
 During the day I was able to take a walk for the 
 first time. Standing on the ramparts just behind 
 the hospital, we could see over the late French 
 positions for two or three miles. Dead soldiers 
 and dead horses were still lying in great num¬ 
 bers on the field, and we could see a few burying 
 
62 
 
 NOTES AND RECOLLECTIONS OF 
 
 parties at work. In the fosse at our feet and 
 on the glacis the dead were lying in some places 
 quite thick, and the heavy sickening odour that 
 pervaded the air was very shocking and in¬ 
 describably offensive. In the afternoon, Dr. 
 Tilglnnann and I rode over the battle-field. It 
 was a sad, sad sight. For miles the ground was 
 studded over with, dead men and horses. De¬ 
 composition was fast setting in, which rendered 
 the sight still more ghastly. In most instances 
 the men were lying with arms and legs extended, 
 generally on their backs, sometimes on their 
 faces. Several soldiers had died preserving the 
 last attitude they had assumed in life, with 
 their arms raised, and as if holding the gun 
 which they were about to fire. We passed the 
 body of a poor officer who had died in a ditch 
 after having had both legs amputated, and a 
 dog watching by the grave of his dead master. 
 Next day I sent a person to find the dog and 
 bring him to me, but my messenger failed to exe¬ 
 cute his mission, perhaps he never tried. We 
 passed along roads .encumbered with guns and 
 ammunition of all kinds, inspected houses burnt 
 by shells, went through gardens once beauti¬ 
 ful, now scenes of utter ruin, everywhere the 
 same desolation, and no living thing anywhere. 
 The stillness during our ride that bright sunny 
 autumn afternoon was most oppressive, and the 
 
AN AMBULANCE SURGEON. 
 
 63 
 
 beautiful sky overhead formed a contrast to the 
 earth beneath, outraged by human passion and 
 violence, that afforded food for reflection. 
 
 To-day I used the trephine in a case of de¬ 
 pressed fracture with compression of the brain 
 from effusion, of which I may give a few par¬ 
 ticulars. 
 
 Case XYIII.— This man had been struck at the apex of the 
 occipital bone. He became violently delirious, the left pupil 
 was contracted to the size of a pin’s point, the right was 
 normal in size. The left side was completely paralyzed, while 
 the right arm and leg were in constant convulsive motion. 
 After the depressed skull had been elevated, a quantity of 
 grumous blood, mixed with portions of the brain, flowed away, 
 and the patient became quite tranquil. But, as might be ex¬ 
 pected, the result was not satisfactory. 
 
 Of injuries of the head generally we have not 
 had many examples. 
 
 Case XIX. is interesting, as being typical of the uncertainty 
 both in diagnosis and prognosis often found in this class of 
 injuries. Dupre, Captain of the 36th Regiment of Infantry, 
 was struck by a ball which entered the crown of his kepi at one 
 side, and, after making a ricochet off the vertex, came out at 
 the other. There are the two holes in the cap in the flat oval 
 disc which forms its upper eurfacg, quite plain to see, as 
 the cap was preserved. On examining the head, a con¬ 
 tused wound was observed at the middle of the sagittal suture. 
 With the probe, the bone could be felt fractured and somewhat 
 depressed. The patient was perfectly sensible, said he had no 
 headache, and there was absolutely no symptom whatever de¬ 
 manding interference. I thought it likely, from the oblique 
 blow the skull must have received, and from the absence of any 
 symptoms, that the fracture might not be exteusive, probably 
 
64 
 
 NOTES AND RECOLLECTIONS OF 
 
 involving the outer table only, and that it would be wiser to let 
 the patient alone. He got on quite well for ten days, never 
 during that time suffering even from headache. I thought he 
 was going to recover. Then he appeared to become stupid, and 
 persistent hiccough came on. On the 12th of September, I 
 made a crucial incision, through which were removed several 
 loose pieces of the skull which had been pressing on the brain. 
 1 found the dura mater intact. The operation was not fol¬ 
 lowed by any change for the better, and he died on the 18th 
 September. No post-mortem examination was made. Possibly 
 the result might have been otherwise had an operation been 
 performed in the first instance. But in the absence of symp¬ 
 toms it is usually wiser not to meddle. 
 
 Case XX. forms a contrast to the last. It was one of simple 
 scalp-wound, with exposure of the bone, received on September 
 1st. Neither fissure nor fracture could be discovered in it, never¬ 
 theless, the right side of the body was completely paralyzed. 
 On the 10th September, the power of motion had partly re¬ 
 turned to the arm, but the leg still remained paralyzed. The 
 man was discharged on the 22nd with imperfect use of the leg 
 persisting, but otherwise convalescent. 
 
 Case XXI.— Chaumont received a small scalp-wound, ex¬ 
 posing the bone. He died quite pysemic, and with well-marked 
 trismus. I have not notes of any other cases of pysemia fol¬ 
 lowing scalp-wound with injured skull, but it is a very fre¬ 
 quent result in both military and civil practice. 
 
 The principles on which to conduct the treat¬ 
 ment of injuries of the head are so generally 
 recognised as to need little allusion to them 
 here. One point regarding which opinions vary 
 somewhat is respecting the treatment of de¬ 
 pressed fracture, unaccompanied by symptoms, 
 and with an external wound. When there is 
 
AN AMBULANCE SURGEON. 
 
 65 
 
 no wound, he would be a hardy operator who 
 should cut down upon a depression in the skull, 
 in the absence of any symptoms of compression. 
 When there is a wound, however, the case is 
 different; but even here I question much if the 
 surgeon ought to do more than simply remove 
 such loose fragments as can readily be got at. 
 Where depression of the skull and symptoms 
 of brain-injury coexist, it may seem advisable 
 to interfere. As a general rule, however, the 
 largest proportion of good results will obtain 
 amongst those cases where the amount of opera¬ 
 tive surgery has been at a minimum. 
 
 September 5th .—Every morning at six o’clock 
 we hear the lively strains of martial music, to 
 which the unfortunate French prisoners, many 
 of them sick, footsore, and half-starved, are daily 
 marched out of Sedan, on their road to Germany. 
 
 To-day I was annoyed to find that a cut I had 
 received on the finger had become poisoned, and 
 that the lymphatics up the arm were inflamed. I 
 had a smart rigor, and felt very unwell for a day 
 or two, but then I got quit of it, and, although I 
 afterwards repeatedly jagged myself with needles, 
 and had several cuts on my fingers, which were 
 constantly being dabbled in the offensive discharges 
 from wounds, it seemed, strange to say, as if the 
 first inoculation had procured for me future im- 
 
06 
 
 NOTES AND RECOLLECTIONS OF 
 
 munity, for I experienced no further trouble from 
 that cause whatever, although the hospital was for 
 a long time in a very poisonous state. 
 
 On account of the indisposition I felt, I went 
 out for a walk towards Balan, where I first visited 
 my two amputation cases, which I had not seen 
 since the battle. Mr. Blewitt had been taking 
 capital care of them, and they were doing first- 
 rate. I then, with Dr. Frank, saw several of 
 his more interesting cases. He had about one 
 hundred and twenty patients, chiefly Bavarians, 
 under his care, most of them at this time getting 
 on well. They were distributed, part in the 
 Mairie, part in the houses of the village, and it 
 occupied both Dr. Frank’s and Mr. Blewitt’s entire 
 time, for they were alone, to attend to them. 
 They just worked, they told me, quietly all day 
 long, and in that way succeeded in getting over 
 their patients. They were at that date just about 
 to take possession of a beautiful chateau, belonging 
 to the Comte de Fiennes, the chateau of Mont- 
 villet, in a lovely park, with nice old trees, an 
 orangery and aviary, with splendid gardens, and 
 ornamental waters around it. A more lovely spot 
 I never saw. This chateau is at the now famous 
 town of Bazeilles, or rather what was once a town. 
 When I saw Bazeilles, it was a heap of smoking 
 ruins, literally a city of the dead. The sloping 
 lawn of the chateau had been the scene of a fierce 
 
AN AMBULANCE SURGEON. 
 
 67 
 
 fight, and many were the wooden crosses dotted 
 over it. Dr. Frank organized a hospital here, and 
 the wounded soldiers treated in it were in clover 
 during their convalescence. It was beautiful 
 autumn weather a good part of the time, and I 
 often saw them wandering about the orange-trees 
 with their crutches or their bound-up arms or 
 heads, or paddling about the lake in the pleasure- 
 boat. Dr. Frank offered me the use of the place 
 as a convalescent hospital for our secondary opera¬ 
 tions, but we found it impossible to manage it. 
 
 Indeed, the country all about Sedan is very 
 lovely, consisting of undulating hill and dale, 
 with the Argonne mountains in the distance, 
 with the Meuse meandering through the valleys 
 as much as does the Meander itself. The natural 
 beauty of the country serves only to throw out 
 into blacker, more fearful relief, the horrible deso¬ 
 lation of the battle-field. 
 
 Case. XXII. — That evening, before I returned to Asfeld, I 
 assisted Frank to amputate the thigh of a poor chasseur de Vin¬ 
 cennes, named Lyon. He was only just then brought in from the 
 field, having lain in a trench, where he had been wounded, until 
 that very day. He said, I am sure with truth, that for two 
 days before the battle he had not tasted food, and that he had 
 had hardly anything since. He was struck by a Bavarian ball, 
 which flattened itself out against the right femur a little above 
 its middle, shattering the bone extensively. The accompanying 
 wood-cut shows the altered form of the bullet. He told us that 
 for four hours after he fell he was lying under the hail of the 
 mitrailleuses, whose fire passed just over him. The limb was 
 
 F 2 
 
68 
 
 NOTES AND RECOLLECTIONS OF 
 
 greatly swollen and emphysematous in the neighbourhood of 
 the wound; but his pulse was good, his face tranquil, and his 
 courage prodigious. The first thing Lyon demanded was a 
 cigar, and this he continued to smoke until with reluctance 
 he laid it aside in order to inhale chloroform. The operation 
 was most beautifully performed by oval skin-flaps and circular 
 division of the muscles. No blood was lost. And although 
 the amputation was through the upper third of the thigh, the 
 shock was comparatively trifling. The first thing the brave 
 fellow did, on rousing out of his chloroform-sleep, was to 
 demand his cigar, saying that he might as well finish it whilst 
 we were getting ready to amputate his limb. He went quite 
 gaily to bed when assured that all was over, and, puffing his 
 cigar the while, declared that he did not now care how many 
 of his legs we cut off. Such a man should have recovered, 
 and every one was shocked and grieved to find symptoms of 
 tetanus supervene on the fifth day. These increased in 
 violence, and he soon died. No doubt the exposure and 
 privation to which this gallant fellow was subjected, enough, 
 as it were, to kill three men, had been the important antecedents 
 in causing the attack of tetanus. 
 
 I found the ball lying close against the femur. 
 It seemed spread out against the bone somewhat 
 
 Fig. 2. 
 
 as is a pellet of clay when thrown against a wall. 
 The wood-cut represents the surface from the 
 bone, the one next it was smooth and flattened. 
 
AN AMBULANCE SURGEON. 
 
 69 
 
 Dr. Frank had two or three cases of perforating 
 chest-wounds, in which, with marked temporary 
 relief, he made free counter-openings for the 
 escape of fluid accumulated in the pleura. 
 
 We also had at Asfeld a very large number of 
 wounds of the chest, about which there could be 
 no manner of doubt that they were penetrating. 
 As near as may be, half of them died, some from 
 the immediate inflammatory consequences of the 
 wound, some from mere exhaustion, and others 
 from pyaemia. Two bullets were cut out of the 
 back, as is elsewhere mentioned, in one of which 
 a piece of clavicle was imbedded, while a portion 
 of rib was found sticking in the other. The latter 
 is figured in the wood-cut. It is a needle-gun 
 
 Fig. 3. 
 
 bullet which traversed the right lung from before 
 backwards. It was cut out from beneath the 
 skin of the back. 
 
 In four instances, the ball which lodged in the 
 lung had first traversed the centre of the deltoid 
 muscle, and passed straight through the head 
 
70 
 
 NOTES AND RECOLLECTIONS OF 
 
 of the humerus, before piercing the thoracic 
 cavity, just as in the case I saw at Balan the 
 night of the 31st August. Of course, operative 
 interference of any kind was not thought of 
 under these circumstances. It would have been, 
 
 I think, rather reckless surgery. 
 
 In some instances of penetrating lung-wounds, 
 as I have mentioned, the clavicle was fractured, 
 in others, one or more ribs, in several, one of 
 the scapular fossae was perforated. 
 
 Case XXIII.— Reyet, 3rd Chasseurs, was shot through the 
 infra-spinous fossa of the right scapula. The ball passed for¬ 
 wards and upwards, smashing the centre of the right clavicle as 
 it emerged. In spite of so extensive an injury, the man rapidly 
 recovered. 
 
 Case XXIV. illustrates the tenacity with which life clings 
 to some persons. Captain Fournel was shot through the left 
 lung, and through the pelvis on the opposite side, with impli¬ 
 cation of the serous sac of the peritoneum. He was also shot 
 through the forearm. Notwithstanding great difficulty of 
 breathing, and acute peritonitis, along with pneumonia, he lived 
 until September 8th. 
 
 The lung was, however, completely traversed 
 several times, in which the injury appeared to 
 give rise only to the most trivial symptoms after 
 the first day or two. Invariably there had been 
 profuse haemoptysis and difficulty of breathing, 
 lasting often two or three days. 
 
 I am sure the plan so unhesitatingly denounced 
 in the report of the Surgeon-General of the 
 
AN AMBULANCE SURGEON. 
 
 71 
 
 United States Army, is a bad one, and worthy of 
 the censure with which it is there stigmatised— 
 viz., hermetically closing chest wounds. On the 
 contrary, the better practice would be to make 
 free counter-openings, and let the collections of 
 purulent fluid, almost sure to supervene, have 
 the readiest possible means of escape. 
 
 We treated a considerable number both of shell 
 and bullet-wounds which extended around the 
 walls of the chest without penetrating into the 
 pleural cavity. I have seen bullet-tracks ten, 
 and even twelve inches long, not causing pene¬ 
 tration, or even fracturing the ribs whose elas¬ 
 ticity and freedom of motion must, to some 
 extent, protect them. In several instances we 
 had one or more ribs fractured, always producing 
 more or less serious symptoms, and sometimes 
 even death. We had a remarkable case in which 
 a bullet traversed the axilla from behind for¬ 
 wards. The points of entrance and exit were 
 such as to make it seem impossible that the great 
 vessels and nerves could escape. Yet there was 
 no damage done to any important part. 
 
 Of penetrating wounds of the abdomen we saw 
 but few, and the subjects of these died rapidly of 
 peritonitis and shock. We were not tempted, as 
 was suggested by an eminent German professor, 
 to perform an operation, as if for ovariotomy, 
 to find out the perforated stomach, intestines, or 
 
72 
 
 NOTES AND RECOLLECTIONS OF 
 
 liver, as the case might be, sew the wounds up, 
 clean out the cavity of all clots and foreign 
 substances, close the external wound, and then 
 hope for a favourable result. I fear the hope 
 of such a success will have to be deferred for a 
 very long time. 
 
 We treated several instances of wounds of the 
 abdominal parietes without penetration. There 
 was little that was peculiar about them, and it is 
 sufficient to cite one example. 
 
 Case XXV.— Blondel was sent to ns from another ambu¬ 
 lance on the 14th September, having been wounded by a frag¬ 
 ment of shell on the 1st. Dr. Clarke extracted two large 
 pieces of lead-casing, photographed with the other shell frag¬ 
 ments in Plate I., which had lain imbedded in the abdominal 
 muscles all that time, causing very little trouble. The patient 
 soon recovered sufficiently to leave the hospital. It is a little 
 remarkable that such weighty masses of metal could have re¬ 
 mained so long in a superficial wound without falling out. 
 
 In the first of the plates a number of shell 
 fragments have been heliotyped. Those alluded 
 to above lie immediately to the right of the 
 entire shell. 
 
 We observed two or three examples of exten¬ 
 sive subcutaneous ecchymosis of the abdomen and 
 thighs from shell-explosions, which did not cause 
 further mischief. And in one instance, a man was 
 knocked clean over by a bomb bursting near him. 
 He was bruised, but sustained no more serious 
 injury, although the shell must have exploded 
 
AN AMBULANCE SURGEON. 
 
 73 
 
 close at hand. In contrast to an effect so slight, 
 was the injury sustained by two infirnniers , who 
 were killed at the gate during the bombardment 
 of September 1st. They were lying together, a 
 sort of confused heap of scorched and blackened 
 flesh, perfectly shapeless. Their heads were par¬ 
 tially blown away, so were the pelvis and lower 
 extremities in each of them. In fact, they lay a 
 shapeless mass of debris. 
 
 In connection with injuries of the trunk, the 
 following cases of pelvic wound are of consider¬ 
 able interest. 
 
 Case XXVI.— Jean Allary, 5th Regiment of the Line, 
 was wounded on the 1st September. The ball entered the outer 
 side of the left thigh, three inches below the great trochanter, 
 and slightly anterior to it. The wound of exit, much smaller 
 in size, was situated a little to the left of the fourth lumbar 
 vertebra. He was admitted to Asfeld, September 10th, and when 
 the dressings were removed, a large quantity of fluid faeces 
 came away from both wounds, chiefly from the inferior one. 
 The patient himself remarked that all he swallowed flowed the 
 wrong way. When the abdomen, which was neither swollen 
 nor painful, was pressed upon, the bowel contents could be made 
 to jet out through the wound in the thigh. In the course of a 
 fortnight the aperture in the loin closed. In three weeks exactly 
 the faeces ceased for a time to flow by the lower opening. This 
 wound re-opened for a short time, but when the patient left 
 the hospital, on October 8th, the discharge had ceased, and he 
 was quite convalescent. Allary was lying down when he 
 was hit, and the ball must have twice perforated some portion 
 of the descending colon without opening the peritoneal cavity. 
 
 Case XXVII. was also an example of double faecal fistula. 
 
74 
 
 NOTES AND RECOLLECTIONS OF 
 
 The ball entered near the apex of Scarpa’s space on the left 
 side, and emerged through the centre of the right buttock ; 
 feculent matter flowed from both wounds, but the convalescence 
 was rapid. In this example, the rectum must have been 
 traversed. It would be interesting to learn if any constriction 
 followed upon recovery. 
 
 Case XXVIII.— Hautefeuille, a young fellow of twenty- 
 two years of age, a soldier of the 1st Marines, also wounded on 
 the 1st September, was struck by a ball, which entered on the 
 left side of the coccyx, traversed the rectum and bladder, and 
 emerged just above the symphysis pubis. For a considerable 
 time all the feces passed by the posterior opening, while the 
 urine flowed entirely from the anterior wound. He recovered 
 without one single unfavourable symptom. Both wounds had 
 closed by the 18th September, and remained so until his dis¬ 
 charge from hospital on September 25th, when he appeared as 
 well as if nothing had happened to him. 
 
 In a Belgian ambulance I saw two cases of 
 urinary fistula recovering without a bad symp¬ 
 tom. In one the ball had entered just above the 
 pubic symphysis, and as it had not made its 
 way out, the patient will probably have to 
 submit to a future operation for the extraction of 
 the bullet, as was the case with a soldier wounded 
 during the American War, from whose bladder a 
 piece of shell, weighing 898 grains, was suc¬ 
 cessfully removed by the lateral operation. In 
 the second case the ball entered just above the 
 tip of the right trochanter major, passed through 
 the iliac bone, and emerged a little to the left of 
 the symphysis pubis. In both these instances no 
 
AN AMBULANCE SUBGEON. 
 
 75 
 
 untoward symptoms were manifested. I saw, 
 on September 20th, at the Chateau de Bazeilles, 
 under Dr. Junker’s care, in a man who had been 
 wounded on the 1st, another instance of bladder 
 injury. The ball had passed through the body of 
 the pubis, and emerged through the right but¬ 
 tock. The urinary fistula persisted, and some 
 pieces of bone had been extracted by Dr. Junker, 
 but the man was going on well. 
 
 The Chateau de Bazeilles is situated just out¬ 
 side the burnt village, and close to the scene of 
 a hotly contested fight between the Bavarians 
 and the French Marine Infantry. It is an old 
 French chateau, with ornamental gardens, and 
 quaint statues on the terraces. It overlooks the 
 winding Meuse, and belongs to a French general 
 en retraite. It was, during the battle, speedily 
 filled with wounded from garret to cellar, and 
 the old-fashioned ornamented rooms, with their 
 antique furniture, formed a place but very ill- 
 adapted for the reception of wounded men. 
 
 There were some other cases of similar injury 
 which I did not see, but which, I was informed, 
 were doing well. A priori, one would certainly 
 not expect that such serious visceral lesions 
 should produce so little constitutional disturb¬ 
 ance. But when the pelvic fascial layers are 
 intact, wounds of this form usually do well. 
 
76 
 
 NOTES AND RECOLLECTIONS OF 
 
 CHAPTER VI. 
 
 September 6th .—There is nothing very eventful 
 to remark of this day. Some of us paid a visit 
 to the camp of French prisoners, of which so 
 much has been said in the newspapers. At 
 least 100,000 men were confined on an island, 
 formed by a canal and a branch of the Meuse. 
 But few of them had any cover, and food of 
 every kind was exceedingly scarce. It had been 
 raining for several days, and the ground was 
 churned into mud ankle deep. At every step, 
 some of the soldiers, seeing our red crosses, 
 would stop us, say they were very sick, and beg 
 to be taken to hospital. They looked what they 
 said, poor fellows, but we could do nothing. 
 The colonel of the 4th Chasseurs d’Afrique, the 
 Marquis de Galliffet, asked me if I could give 
 him some quinine, as he was then suffering from 
 an accession of African fever. He was out in 
 the drenching rain like the rest, protected only 
 to a certain extent by the hood of a rude char 
 a banc. I gave him the quinine, and he begged 
 
AN AMBULANCE SURGEON. 77 
 
 me in return to accept his Arab horse. It is 
 a beautiful animal, and I brought it home with 
 me. It served me when in Sedan, in place of 
 my own horse, a very good one, which I had 
 brought from Paris, and which was stolen from 
 me. The only difficulty was to feed him, 
 fodder being almost unattainable, so his daily 
 dinner consisted for some time of the fragments 
 of stale bread which had been left uneaten by 
 the patients in the wards. 
 
 September Sth .—I find I have mentioned in my 
 diary that even up till this date large numbers 
 of dead horses lay unburied, and that it would 
 be several days before all could be put under 
 ground. A great many also had to be killed 
 and thrown into the river. There was no food 
 for the unfortunate beasts, many of whom, like 
 their masters, had been severely wounded. 
 To-day, for the first time, we got our boots 
 cleaned, and towels to dry our faces after 
 washing — luxuries to which we were pre¬ 
 viously quite unaccustomed, and which we 
 appreciated accordingly. 
 
 On the 9th, 10th, and 11th of September, 
 102 new patients were sent to us from different 
 other ambulances. All were cases of very serious 
 injury, and some had been previously subjected 
 
78 
 
 NOTES AND RECOLLECTIONS OF 
 
 to amputation on the field. This influx of 
 patients overcrowded us a good deal, and we 
 were most anxious to get tents, into which we 
 could put any cases of fever or of erysipelas 
 which might arise, and those patients threatened 
 with pyaemia, also cases likely otherwise to poison 
 the hospital atmosphere, so as thus to relieve 
 the encombrement of the wards. Of course there 
 were many amongst these new cases on whom 
 operations required to he performed. There 
 were injuries so severe that one could scarcely 
 understand why any attempt whatever had been 
 made to save the limb. I suppose it was every¬ 
 where else the same as it was with ourselves, 
 far too much work for the surgeons to do. 
 
 For instance, it was so in the following 
 example. 
 
 Case XXIX.— Guerieei, 4th Marines, wounded on Septem¬ 
 ber 1st in three places, was admitted to Asfeld on September 
 10th. A ball had traversed the right thigh without injuring 
 the bone. The left tibia was extensively smashed, and so was 
 the upper part of the left femur, close to the trochanters. He 
 was in a very weak exhausted state. It was evident from the 
 moment we first saw him that it was hopeless to attempt to save 
 the limb, but his condition was not such as to warrant immediate 
 interference. He was accordingly carefully tended and fed • 
 and on the 18th, when he had made a considerable rally, it was 
 decided to afford him the only chance he had, that of disarticu¬ 
 lation at the hip-joint. The operation was performed in the 
 usual manner with a long anterior flap, and the femoral and 
 other arteries were twisted. The poor fellow died very shortly 
 afterwards. He never rallied from the effects of the shock, 
 
AN AMBULANCE SURGEON. 
 
 79 
 
 and I think the amount of chloroform he took had a large share 
 in the rapidity of the fatal issue. In no operation, perhaps, 
 does the administration of chloroform demand greater careful¬ 
 ness than in this one. 
 
 Case XXX.—The only other instance of disarticulation at 
 the hip at Asfeld was admitted also on the 10th. The upper 
 and back part of the left thigh, as well as a great portion of the 
 outer side of the limb, had been carried away by a shell- 
 explosion, which tore off a considerable portion of the left 
 buttock as well. As the bone was uninjured, and also the 
 main vessels, an unsuccessful attempt had been made before ad¬ 
 mission to preserve the limb, or at all events to avoid immediate 
 amputation at the joint, a procedure so uniformly fatal. This, 
 however, failed, and the operation became necessary on the 
 15th September. The flap required to be made of unusual 
 length, and was taken from the inner aspect of the limb, as the 
 soft parts on the outer and back part of the thigh were almost 
 completely removed. The femoral was twisted. The after¬ 
 shock was considerable, but the administration of brandy and 
 beef-tea produced, after some time, a good reaction. The man 
 was placed in a tent by himself, with a special attendant, and 
 under the particular charge of Dr. Nicholl, who was most 
 assiduous in bis care of him. On the next day, the patient’s 
 condition was excellent, the pulse 120, and pretty strong; he 
 had slept and eaten well. For five days I felt quite sanguine 
 as to his ultimate recovery. Each day he appeared stronger 
 and better. On making my evening visit on the sixth day, 
 however, I found Liprende, for that was his name, weak and 
 exhausted. He said that the attendant had neglected him all 
 day, and that he had got neither food nor wine. It was, un¬ 
 fortunately, too true. The rascally infirmier, tired of his work, 
 had bolted, leaving his unfortunate patient to take care of him¬ 
 self. He had been seen two or three times during the day, but, 
 as he made no complaint except to myself in the evening, the 
 neglect was not discovered till too late to remedy it. I do not 
 say that the patient would otherwise have eventually recovered, 
 
80 
 
 NOTES AND RECOLLECTIONS OF 
 
 but there was everything about him and his condition to make 
 us hope and expect that he might do so. He died, howevei’, 
 during the course of that night. 
 
 Mr. Blewitt disarticulated tlie hip at Balan, 
 hut with no better success than in our two cases. 
 
 Four cases of resection of the elbow-joint were 
 admitted on the 10th. One of them had been 
 only partial, and proved fatal. In another, 
 amputation had to be immediately performed. 
 The joint had been cut out through a transverse 
 incision across its posterior aspect. There was 
 no attempt at repair, and the wound was a 
 large hole, into which one might almost put 
 a closed fist. The forearm was only attached 
 to the arm by a narrow isthmus of skin and 
 muscle in front. We received some other cases 
 of resection of the elbow, which had been per¬ 
 formed outside in this manner—that is, by a 
 transverse in place of a longitudinal incision. 
 The men told us that they had been operated 
 upon by German surgeons, but the method 
 adopted is one which would find little favour 
 in this country. 
 
 A few cases of injury of the spine were 
 admitted about this date, of one or two of which 
 I may here give particulars. 
 
 Case XXXI.— Jean Pujolle, farrier in the 5th Cuirassiers, 
 was wounded in two places on the 1st September. He had 
 received a flesh-wound, caused by a fragment of shell, in the 
 
AN AMBULANCE BURGEON. 
 
 81 
 
 right arm, and his neck was traversed by a ball, which, enter¬ 
 ing opposite the anterior edge of the left sterno-mastoid, at the 
 mid-point of the muscle, emerged a little to the right side of 
 the fifth cervical vertebra. On his admission, nearly a fortnight 
 after the injury, we found the body almost completely paralyzed, 
 from the chest downwards. The respiration was diaphragm¬ 
 atic, the cheeks were flushed, the countenance was exceedingly 
 anxious, and the bronchial tubes were partially choked with 
 mucus, which was only imperfectly expectorated. The pulse 
 was 110. Both arms were completely paralyzed,—there was 
 not a trace of power of motion in either. The left leg was 
 completely paralyzed, but there was slight power of voluntary 
 motion in the right. We found, however, sensation almost 
 perfect in the left leg, while there was none in the right, 
 and we found complete sensibility to touch in the right arm, 
 while the left was quite ansesthetic. Reflex action could be 
 excited in the paralyzed leg. The patient passed both urine 
 and faeces involuntarily. Frequently he cried out on account 
 of pains in his limbs, and the slightest movement in bed caused 
 him great agony. The temperature was usually very high. In 
 this helpless condition this poor creature lingered on. Each 
 day we hoped death would rid him of his great suffering. Bed¬ 
 sores formed of course, but his general condition remained 
 throughout pretty much as I have described it. I expected 
 before I left to have had an opportunity of performing what 
 must have proved a most interesting autopsy. The patient, 
 however, did not give up the struggle till after I quitted Asfeld. 
 
 I transferred him, with a few others, to the care of the surgeons 
 of a Dutch ambulance just arrived at Sedan, who faithfully 
 promised they would make a post-mortem examination and let 
 me know the result. I regret much it has not been done. I 
 have written on the subject to know, and received a reply in 
 the negative. 
 
 Case XXXII. is somewhat remarkable in consequence of 
 being an example of almost exactly similar injury. Bonnevey, 
 wounded on the 1st, was also admitted on the 10th September - . 
 
 G 
 
82 
 
 NOTES AND RECOLLECTIONS OF 
 
 The ball entered through the upper part of the right sterno- 
 mastoid muscle, and emerged two iuches and a half to the left 
 of the vertebra prominens. The right side was completely 
 paralyzed. He died the following day, and there was no leisure 
 at this time for an y post-mortem examination. 
 
 Case XXXIII. —Pescher was shot in the region of the 
 second lumbar vertebra. He was also one of the later admissions. 
 A careful search was made for the ball, and it was found im¬ 
 pacted in the body of the vertebra, having smashed the trans¬ 
 verse processes. It had become, doubtless, altered a good deal 
 in shape, for, though it could be seized by the forceps, no 
 reasonable efforts sufficed to remove it. A few pieces of cloth 
 were alone pulled out, and a short time after, very profuse 
 haemorrhage occurred. The wound required to be plugged to 
 arrest it, and the patient died the same afternoon, the day, in 
 fact, he was admitted. This case illustrates one of the dangers 
 attendant on meddling with bullets deeply lodged in the spine ; 
 and it shows that in some cases the extraction of a bullet, even 
 with a good hold of it, is no simple task. We had a few other 
 cases of spinal injury, but it is unnecessaiy to mention any 
 details concerning them. 
 
 The great number of buttock-wounds which 
 we had under treatment is sufficiently remark¬ 
 able. They were of all shades of severity— 
 some being slight flesh wounds, caused by the 
 grazing of a shell or piercing of a bullet, while 
 in others, the greater portion, or even the whole, 
 of the glutei muscles of one side had been carried 
 away by the explosion of a shell, and the ilium 
 or sacrum injured at the same time. We had 
 in all about eighteen such cases, and since it 
 is true that the valiant Marechal de MacMahon 
 was wounded in this region, it can be taken as 
 
AN AMBULANCE SURGEON. 
 
 83 
 
 no indication of want of bravery if a soldier 
 should unfortunately be struck there. 
 
 Case XXXIV.— Claude Saunier, artilleryman, was wounded 
 by a piece of shell on September 1st. He was admitted to 
 Asfeld twelve days afterwards. We then ascertained that 
 almost the whole of the left ilium was exposed, as well as the 
 upper part of the sacrum. The glutei muscles were, on the 
 left side, completely stripped off the bone, and torn from their 
 attachments throughout almost the entire length of the crest of 
 the ilium. On the right side of the sacrum, the soft parts 
 were also much injured, and the sacrum itself was fractured. 
 The entire length of the wound was twelve inches, and it was 
 six inches wide at its broadest part. In the bottom, a con¬ 
 siderable portion of the sacrum lay exposed, and almost the 
 whole of the dorsum ilii, which was fissured in several direc¬ 
 tions. A portion of bone seven inches long and five inches 
 wide was exposed, black and dead. The wound around looked 
 healthy, the granulations were springing up at the edges. 
 Some fragments of bone showed signs of beginning to loosen. 
 The patient lay constantly upon his face. His bowels were 
 regular, he passed urine readily, and his appetite was good. He 
 suffered absolutely from nothing. He was twenty-two years of 
 age, and looked a placid, good-tempered fellow. Nothing was 
 done save dressing the wound carefully, until October 6th, 
 when I extracted several inches square of the outer table of 
 the iliac bone, which had become loose. The whole length of 
 the crest itself would in time exfoliate, but, although loosened, it 
 was not as yet ready to come away. I transferred this fellow, 
 in the best possible condition, to the surgeons of the Dutch 
 ambulance, on October 8th, who subsequently removed the 
 loosened crest of the ilium. From first to last the wound 
 seemed to give but very little annoyance. Saunier never com¬ 
 plained, and I never saw in his face an expression in the very 
 smallest degree indicative of suffering. 
 
 In a letter I received from my Dutch friend, 
 
 g 2 
 
84 
 
 NOTES AND RECOLLECTIONS OF 
 
 lie reports that on November 21st Saunier was 
 doing- quite well, a large portion of the crista 
 ilii had been removed, and the wound had filled 
 up so nicely that he was able to go about on 
 crutches. We may therefore fairly assume his 
 final convalescence. 
 
 Case XXXV.— Jean Cabirol, 22nd Regiment of the Pine, 
 was wounded and admitted to hospital the same day as Saunier, 
 and the nature of his wound was very similar, though not quite 
 so extensive. It involved, however, about half of the left 
 buttock, the muscles being torn away, and the bones exposed 
 and fractured, both the ilium and the sacrum. The right 
 buttock was also extensively lacerated, but it did not look by 
 any means so horrible a wound as the last. Until September 
 25th, Cabirol got on pretty well, when he had a rigor, followed 
 by sweating. The left leg began to swell enormously, into 
 a condition of hard oedema, probably from occlusion of the iliac 
 vein, and he died on October 1st with all the symptoms of 
 pyaemia. A post-mortem examination showed well-marked 
 hypostatic congestion all over the front of the body. He 
 had been lying constantly upon his face, like the last man. 
 The left profunda vein was found to be full of pus. There 
 could be no mistake about it. The pus was seen flowing up 
 whenever the part was compressed, after slitting up the femoral 
 vein, which, as well as the iliac, contained a soft red clot. The 
 liver contained numerous abscesses, and in the lungs was a 
 number of large yellow softish masses, like tubercle, which must 
 have been deposits of pus, not yet softened down into ordinary 
 abscesses. 
 
 There were two cases in which buttock-wounds 
 proved fatal from secondary haemorrhage, and it 
 may here be observed that the secondary 
 haemorrhage so frequent in gun-shot wound is 
 one of the most serious of complications. It 
 
AN AMBULANCE SURGEON. 
 
 85 
 
 indicates that the fluids of the organism are 
 vitiated by some poison, pysemic or other. The 
 already weakened forces of the constitution are 
 still further lowered by the losses of blood, diffi¬ 
 cult to check, and ever ready to return, and the 
 result generally is, that the patient yields in the 
 struggle, whether the original injury be very 
 severe or one comparatively slight. The main 
 vessel of the injured part may be ligatured, but 
 too often this serves merely as a temporary check, 
 and if the patient do not succumb previously to 
 the disordered state of his blood, the bleeding 
 will probably recur when the ligature falls. The 
 great frequency of secondary hemorrhage has for 
 its chief causes the absence or faultiness of sani¬ 
 tary conditions, and the debility of the patients 
 reduced by privation from nourishing food, as 
 well as the exhaustion and exposure to which 
 they have been previously subjected. The means 
 calculated to remove or anticipate such evils will, 
 if applied, be of more value than is the ligature 
 in coping with secondary bleeding after gun-shot 
 injury. 
 
 About this date, Sept. 11th, we had a visit from 
 Captain Brackenbury, chief representative on the 
 Continent of the English National Society for Aid 
 to the Sick and Wounded in War. His appear¬ 
 ance was most acceptable. Up to that time we had 
 heard nothing from the outside world. We knew 
 not if Paris were besieged or taken, or if a vie- 
 
86 
 
 NOTES AND RECOLLECTIONS OF 
 
 torious Republic had routed the hitherto irresistible 
 German legions. Soon after his visit, we received 
 stores of all kinds—blankets, bedding, food, and 
 surgical assistance at the hands of several mem¬ 
 bers of the English Society. Amongst others, 
 Dr. Markheim, Mr. Marcus Beck, Dr. Duncan, 
 and Mr. Parker. What we had been up till then 
 relying upon were the stores which we had brought 
 with us from Paris, partly supplied there by the 
 French Society, and in part too by the English. 
 During all the time we were at Sedan, the French 
 Military Intendance supplied us with rations and 
 with wine, and with a staff of hospital servants. 
 Dr. Sims has, in his report, already awarded a 
 just tribute of praise to the lady-nurses, Miss 
 Pearson, Miss Macloughlin, Mrs. Mason, Miss 
 Barclay, and Miss Neligan, who arrived also 
 about this time. I cordially endorse what he has 
 said. I only wish we had had them from the 
 outset. In that case, lives which were sacrificed 
 through want of adequate nursing, or rather 
 through the absence of any proper nursing at all, 
 might have been saved. 
 
 Women are better adapted, both physically and 
 morally, for the charge of the sick than men. 
 They should, however, in order advantageously 
 to fulfil their mission of good, be adequately 
 trained, and then they become simply invaluable. 
 No male nursing is to be compared to woman’s, and 
 
AN AMBULANCE BURGEON. 87 
 
 I am sure both the French and German soldiers, 
 in our hospital at least, very much preferred it. 
 Female aid cannot, perhaps, be rendered avail¬ 
 able on the battle-field itself, but there seems to 
 be no reason why it should not be procurable 
 immediately afterwards. 
 
 To-day we tasted, for the first time since our 
 arrival, a most welcome treat. Some cans of 
 Irish preserved milk, which is most excellent, 
 reached us. This pleasure was, however, more 
 than counterbalanced by a discovery which we 
 made the same day. During - the heat of the 
 bombardment of September 1st, a couple of 
 fugitive Zouaves made their way into an under¬ 
 ground cistern of water which supplied the 
 hospital, all other supply from the town having- 
 been cut off. They went in to escape one form 
 of death, only to meet, poor fellows, with another. 
 They were drowned, and their bodies were not 
 discovered until the water becoming low in the 
 cistern, it was found necessary to descend into it 
 to get the daily supplies for the house. I did not 
 object to eating horseflesh, to which for a day or 
 two we were reduced, although I confess I did not 
 like it, but, when we discovered the nature of the 
 infusion with which we had been washing it 
 down, I admit that I for one, and I believe all the 
 rest also, felt very uncomfortable, and we did 
 not drink any more water for some time. 
 
88 
 
 NOTES AND RECOLLECTIONS OF 
 
 CHAPTER VII. 
 
 September 12th .—All our tents, supplied to us 
 by the Intendance Militaire , were by this time 
 pitched. They were thirty-six in number, and 
 were soldiers’, not hospital tents, calculated to 
 hold eight persons each. We considered four about 
 the proper number. The tents were spread over 
 the hospital enclosure, now made clean, and 
 trenches were dug around them to keep the 
 inside dry. We were busy distributing some of 
 our cases amongst them, when the even tenour 
 of our way was disturbed by the arrival of a 
 message to prepare to receive a number of fresh 
 cases of sick and wounded, and forthwith the 
 patients appeared, borne upon stretchers. The 
 weather was as bad as bad could be, cold 
 and stormy, and the rain came down in tor¬ 
 rents, without a moment’s cessation. The in¬ 
 equalities of the coverlets over the men served 
 but to form receptacles for little pools of water. 
 There were one hundred and thirty of these 
 
AN AMBULANCE SUBGEON. 
 
 89 
 
 poor fellows, all French, sent up to us that 
 fearful day. Some of them were in a truly 
 wretched plight. These patients were transferred 
 to us from the ambulance installed in the fine 
 large building of the College or District Public 
 School, previously occupied by the wounded 
 French, who were removed by the German 
 authorities to make room for their own wounded. 
 And this was done, under the circumstances 
 which I have detailed, in most villainous weather. 
 These patients were not convalescents. There 
 were amongst them two cases of tetanus. One of 
 the patients died on the day of his arrival, two 
 died the following day, several in three or four 
 days afterwards. Some absolute necessity for it, 
 or some adequate explanation, may be forthcoming 
 of what certainly appeared to us at the time, and 
 under the circumstances, a most unwarrantable 
 and cruel act. I, for one, should be delighted to 
 receive an explanation. But, as it stands, the case 
 seems to me to be a distinct violation of the 
 Geneva Convention, since a wounded man becomes 
 ipso facto a neutral, and should cease, so far as the 
 doctors are concerned, to possess any nationality 
 whatever. I would not dwell upon this painful 
 topic, but that it had so direct and unfortunate an 
 influence upon our own well-being. Upon the 
 accession of so many fresh cases, the hospital 
 became at once fearfully overcrowded. One 
 
90 
 
 NOTES AND RECOLLECTIONS OF 
 
 hundred and five of the new-comers had sustained 
 serious injuries, demanding in many instances 
 severe operations. The remaining twenty-five 
 were cases of fever and dysentery. 
 
 Very few days passed until the wounds of 
 our original patients began to alter in appear¬ 
 ance for the worse. Secondary haemorrhage 
 became frequent, and, worst of all, some of 
 our best and most promising cases of operation 
 began to show symptoms of pyaemia. Nearly 
 all the patients, in fact, sickened more or less. 
 The difference was felt even amongst the staff; 
 for one and all of us got attacks of some sort of 
 illness. One had severe diarrhoea, another a 
 feverish attack, a third violent headache, a fourth 
 an attack of vomiting, and so on. Dr. Sims alone 
 amongst us was happily exempt. 
 
 There can be little doubt that the overcrowding 
 which we suffered from at this time was a most 
 potent cause in inducing an increased death-rate. 
 For instance, in thirty-three cases death arose 
 from acute pyaemia, in its most typical form of 
 rigors, followed by drenching sweats, diarrhoea, 
 jaundice, and finally death. The post-mortem 
 examinations revealed multiple abscesses, often 
 in the joints and limbs, but most frequently in 
 the liver and lungs, never in the spleen or 
 kidneys. Without doubt, the agglomeration of 
 bad cases has, whatever else may have, a great 
 
AN AMBULANCE SURGEON. 
 
 91 
 
 deal to say to the production of pyaemia. That 
 many other deaths besides were due to the same 
 cause I am very certain, although it has not 
 been so recorded. 
 
 Amongst the patients admitted during the first 
 two days of September, and those sent in on the 
 9th, 10th, and 12th, the deaths from pyaemia 
 were about equal, namely, seventeen of the one 
 class, and sixteen of the other. It is perhaps 
 noteworthy that of the seventeen deaths from 
 pyaemia, occurring amongst our original patients, 
 twelve took place between the 21st and 27th days 
 of the month, seven of the twelve being on the 
 21st and 22nd September. Again, eight of the 
 sixteen deaths from pyaemia amongst the patients 
 admitted from the 9th September to the 12th 
 September took place also from the 20th to the 
 27th of the month, five of the eight being on the 
 20th, 21st, and 22ud September. Assuming the 
 duration of a case of acute pyaemia to be from 
 ten to fourteen days, this would determine the 
 commencement of the disease as the very time at 
 which we became encumbered with the influx 
 of new cases. 
 
 I am aware it is rather dangerous to draw 
 large deductions from limited premises, but it is 
 a fact well worthy of remark, that so many as 
 twenty of the thirty-three noted deaths from 
 blood-poisoning took place within a very few 
 
92 
 
 NOTES AND RECOLLECTIONS OF 
 
 days of each other, and that twelve of the 
 twenty occurred within a few hours of each 
 other. If the disease run an approximately fixed 
 course as to time, the inference clearly is, that 
 it commenced in these different cases about the 
 same date, and other considerations fix that date 
 as being from the 9tli to the 12th of September, 
 when the large numbers of fresh patients were 
 crowded in upon us. 
 
 In the great majority, pysemia was found to 
 arise only in those cases in which the bone 
 had been injured, or in which amputation 
 had been performed. It was far more fre¬ 
 quent also after secondary than after primary 
 amputations. 
 
 Before proceeding to consider wounds of the 
 extremities, with or without fracture of the bones, 
 necessitating in some cases amputation, in others 
 resection, I should wish to narrate briefly the 
 particulars of some other cases of pelvic gun¬ 
 shot injury. 
 
 Case XXXYI. — Lieutenant Secheras, Chasseur-ct-pied, 
 was struck by a ball on September 1st. The point of entrance 
 was three inches below the tip of the great right trochanter, 
 but a couple of inches anterior to the bone. The point of exit 
 was almost symmetrically placed on the opposite side, being 
 three inches below the tip of the left trochanter. In place, 
 however, of being in front of the femur, it was two inches 
 behind that bone. The urethra was wounded, but not completely 
 divided by the ball in its passage across. There were frequent 
 
AN AMBULANCE SURGEON. 
 
 93 
 
 fits of retention of urine, and the greatest difficulty was experi¬ 
 enced in introducing the catheter. The laceration, which was 
 in the lower wall of the urethra, could be distinctly felt while 
 the instrument was being passed. The particular charge of this 
 case, as well as of the other wounded officers, of whom we had 
 nearly one hundred, was entrusted to Dr. Tilghman, than whom 
 none could be more faithful or intelligent in the discharge of 
 his duties. He conducted this case to a successful issue, and the 
 officer left the hospital quite convalescent, and warned of the 
 necessity for combating the tendency to traumatic stricture 
 which must inevitably ensue after a contused wound of the 
 urethra. 
 
 In two other instances, where the upper part 
 of the thigh was pierced, a large part of the 
 scrotum was torn off. In one case the testicles 
 were injured, and in the other the corpora 
 cavernosa were almost completely divided, the 
 urethra being left intact. Recovery took place 
 in all. 
 
 Case XXXYII.— Colombain, a soldier of the line, was struck 
 by a bullet just over the right anterior superior spine of the 
 ilium. He must have been carrying his watch just at the place 
 where the ball struck, for it was carried bodily into the wound. 
 Dr. Duncan extracted portions of the watch and of cloth from 
 over the sacro-iliac synchondrosis of the same side. Unfortu¬ 
 nately, the watch was not in such a state of preservation as 
 to be of much further use as a time-keeper. The man 
 made a good recovery, and was discharged convalescent from 
 hospital. 
 
 In another case, a Prussian bullet entered 
 external to the anterior superior spine of the 
 ilium, striking the bone obliquely. It lodged 
 
94 
 
 NOTES AND RECOLLECTIONS OF 
 
 in the buttock, whence it was cut out, presenting 
 the ciu'ious flattening shown in the cut. No 
 fracture, or injury of the bone could be detected, 
 and the patient soon perfectly recovered. 
 
 Fig. 4. 
 
 We had altogether 152 cases of injury to the 
 upper extremity, twenty-one of which terminated 
 fatally. These may be analysed and tabulated 
 in the following manner: — 
 
 Cases. Deaths. 
 
 Wounds around the shoulder not penetrating the 
 
 joint . . .. . . . . . . . . 7 0 
 
 Penetrating wounds of the shoulder-joint . . 6 3 
 
 Wound around the elbow-joint not penetrating . . 1 0 
 
 Penetrating wounds of the elbow-joint . . . . 15 6 
 
 Gun-shot wounds of the arm without fracture . . 33 1 
 
 Gun-shot fractures of the humerus . . . . 25 11 
 
 Gun-shot wounds of the forearm without frac¬ 
 ture . . . . .. . . .. .. 22 0 
 
 Gun-shot fractures of one or both bones of the 
 
 forearm .. . . . . . . . . 10 0 
 
 Gun-shot wounds of the hand with and without 
 
 fracture . . . . . . . . . . 33 0 
 
 152 21 
 
AN AMBULANCE SURGEON. 
 
 95 
 
 The operations which these injuries entailed 
 were as follow :— 
 
 Operations. Deaths. 
 
 Prim. 
 
 Sec. 
 
 Tot. 
 
 Prim. 
 
 Sec. 
 
 Tot. 
 
 Disarticulation at shoulder-joint 
 
 1 
 
 1 
 
 2 
 
 1 
 
 1 
 
 2 
 
 „ elbow-joint. . 
 
 0 
 
 2 
 
 2 
 
 0 
 
 2 
 
 2 
 
 „ wrist-joint . . 
 
 2 
 
 0 
 
 o 
 
 sJ 
 
 0 
 
 0 
 
 0 
 
 Amputation of arm 
 
 14 
 
 6 
 
 20 
 
 6 
 
 3 
 
 9 
 
 „ fore-arm 
 
 4 
 
 0 
 
 4 
 
 0 
 
 0 
 
 0 
 
 Partial amputation of hand 
 
 12 
 
 0 
 
 12 
 
 0 
 
 0 
 
 0 
 
 Resection of shoulder-joint 
 
 1 
 
 3 
 
 4 
 
 1 
 
 1 
 
 2 
 
 ,, elbow-joint 
 
 Double resection of shoulder and 
 
 4 
 
 7 
 
 11 
 
 1 
 
 5 
 
 6 
 
 elbow-joints in the same arm 
 
 0 
 
 1 
 
 1 
 
 0 
 
 0 
 
 0 
 
 Resection of three-fourths of ulna 
 
 2 
 
 0 
 
 2 
 
 0 
 
 0 
 
 0 
 
 Total 
 
 40 
 
 20 
 
 60 
 
 9 : 
 
 12 
 
 21 
 
 There were, besides, three instances of double 
 amputation in the upper extremity. In one case, 
 the arm and forearm were removed, in another, 
 amputation of the arm and disarticulation at the 
 shoulder were performed. Both these patients 
 died, but a double forearm amputation which 
 had been performed, recovered. 
 
 On the whole, the recoveries, both after 
 wounds and from operations, in injuries of the 
 upper extremity, are, as might be anticipated, 
 tolerably satisfactory for military practice. The 
 proportion of deaths, both after amputation 
 and resection, was comparatively small, and the 
 patients recovered well, with scarcely any excep¬ 
 tion, from simple flesh-wounds. The proportion 
 
96 
 
 NOTES AND RECOLLECTIONS OF 
 
 of deaths among the fractures of the upper arm 
 seems very high, hut in many of the cases so 
 noted, amputation had to he performed, either 
 primarily or at a subsequent period. 
 
 While on the subject of gun-shot fracture of 
 the upper arm, I should like to notice the 
 triangular cushion used by Strom eyer, that 
 veteran authority in military surgery, for the 
 treatment of such fractures. He has observed, 
 he told me, the excessive danger which exists 
 of producing gangrene, or other unfavourable 
 result, when any constricting apparatus is applied 
 to the fractured upper limb, and he says there is 
 a fatal facility for gangrene to occur if any tight 
 bandaging or splints be applied, and the circula¬ 
 tion is materially interfered with. The. cushion 
 may be described as a right-angled isosceles 
 triangle, four inches thick at the apex, which 
 rests against the chest and supports the elbow, 
 the fore-arm being bent at a right angle with 
 the arm. The cushion gradually thins down till 
 the base is a mere edge, and of the two other 
 angles, one is passed up into the axilla, while 
 the other rests on the chest under the wrist. The 
 cushion is readily fastened in its place by a tape 
 round the neck, and one round the body. When 
 this simple apparatus is applied, the arm rests 
 upon it, beautifully supported, and in excellent 
 position. Whilst lying in bed, nothing beyond the 
 
AN AMBULANCE SURGEON. 
 
 97 
 
 ordinary dressings are required for the wound; 
 and if the patient need to be transported from 
 one place to another, or is fit to walk about, this 
 can be arranged for with the utmost facility, 
 as cushion, arm, and all can be bound by a 
 broad bandage to the body, and thus form an 
 immoveable whole. Stromeyer himself told me, 
 so highly did he estimate the value of this 
 
 Fig. 5. 
 
 Stromeyer's Cushion as applied for Gun shot Fracture of the Humerus. 
 
 cushion, that he considered it the most valuable 
 appliance he had invented during his life, which 
 is very strong language from a man who, like 
 him, has done so much for surgical science. 
 
 I have tried this mode of treatment myself, 
 and found it answer every purpose. The cushions 
 are very readily made, and can be manufactured 
 
 H 
 
98 
 
 NOTES AND RECOLLECTIONS OF 
 
 of different sizes. A very good size is one in 
 which the sides measure about fourteen or fifteen 
 inches in length. 
 
 I may here put upon record one or two of 
 the more interesting cases of injury of the upper 
 extremity which fell under our notice. 
 
 Case XXXVIII.—Roux, a soldier of the Marines, was 
 wounded on the 31st August by a fragment of shell striking 
 the front and outer part of the left shoulder. The greater portion 
 of the pectoralis major was tom away, and part of the deltoid 
 muscle, leaving between the two wounds a species of bridge of skin 
 and other tissue. Most of the deltoid was in fact divided across, 
 and the wound in front was a deep hole five inches in diameter. 
 The shoulder-joint was fully opened, and the head of the 
 humerus somewhat comminuted. The first and second stages 
 of the axillary artery were exposed, and the beating of the 
 great humeral vessel was very distinctly seen. The clavicle 
 and the scapula were not broken. This patient was treated in 
 a very simple manner. All loose pieces of bone were removed, 
 both at first and whenever afterwards they were disposed to 
 exfoliate. The wounds, which were of enormous size, were 
 carefully dressed and attended to by Mr. Hayden, who deserves 
 great credit for the painstaking attention which he bestowed 
 upon this, and indeed upon all the other cases of which he had 
 the care. Pieces of bone from time to time came away, and 
 the wounds began to fill up. Three weeks afterwards, the 
 report states that the patient had been getting on admirably, 
 and was then all but convalescent, and that the expectant mode 
 of treatment had proved most satisfactory. The Dutch surgeon 
 under whose care he was left wrote me a report up to November 
 21st of this and the other cases left behind, and I am sorry to 
 chronicle an unfortunate issue to this man’s history. “ Roux,” 
 he writes, “ died a few days ago. At first he was doing nicely. 
 The caput humeri, and also a large piece of the humerus, became 
 loose, and had been removed; the wounds had been filled up 
 
AN AMBULANCE SURGEON. 
 
 99 
 
 with good granulations, but an attack of fever and diarrhoea 
 soon made an end of him.” His death, therefore, could not 
 at an interval of ten or eleven weeks be attributed, except 
 indirectly, to the injury from which he was then rapidly 
 recovering. 
 
 Case XXXIX.—I mention the following case, not for its 
 surgical so much as for its psychical character. Payen, a pri¬ 
 vate soldier in the 50th Regiment of the Line, received a gun¬ 
 shot wound which traversed the left wrist-joint, shattering the 
 bones so extensively as to render resection of the articulation 
 impracticable. The soft parts were also a good deal injured. 
 I amputated in the middle of the forearm, and the patient 
 was removed to the next ward to bed. The curious part is to 
 follow. 
 
 I should also mention that our operations 
 were performed at the end of one of the wards 
 opposite the large window, and in the presence 
 of a number of the patients. Since all the 
 beds, for a considerable time at least, were full, 
 we could not empty any portion of the hospital 
 to make an operating theatre. The operation 
 was performed on September 1st, and during that 
 entire day we were exposed to the heavy fire 
 of the Prussian batteries just opposite, whose 
 shells often struck, but fortunately never entered, 
 the hospital-building. The constant whizzing of 
 the shells in our ears was anything but re¬ 
 assuring. But, to return to our patient. In about 
 ten minutes after he had been sent to bed, he 
 left his own ward and returned to the operating- 
 
100 
 
 NOTES AND RECOLLECTIONS OF 
 
 ward, whilst we were administering chloroform 
 to a poor fellow whose leg required amputation. 
 We were all amazed at Payen's sang froid. He 
 asked for a cigar, which he commenced to 
 smoke, and chatted to those around him un¬ 
 concernedly. We could not persuade him to 
 return to bed, and as we had not any time to lose, 
 he was permitted to remain. He inspected all the 
 steps of the operation with much interest. He 
 said he could not understand in his own case 
 why he had felt no pain, and he wanted to see 
 how such a feat of magic was accomplished. 
 After he had seen the stump put up, he returned 
 to bed perfectly satisfied. It is perhaps un¬ 
 necessary, though not without interest, to add 
 that this young man rapidly recovered. His 
 wound healed almost by the first intention, and 
 he left the hospital on the 22nd of September, 
 quite well. 
 
 I do not think I have anything to note about 
 amputations of the arm. They were generally 
 performed with oval skin-flaps and circular divi¬ 
 sion of the muscles. In respect of the mortality 
 after this operation, we find, as before stated, 
 that it is very large. The cases of double ampu¬ 
 tation were, with one exception, fatal. In one 
 curious case, the same ball traversed both arms 
 without injuring the trunk. 
 
AN AMBULANCE SURGEON. 
 
 101 
 
 CHAPTER VIII. 
 
 I have now to speak of resections as per¬ 
 formed in the upper extremity. There were but 
 four of the shoulder, eleven of the elbow, and 
 none of the wrist. There was one remarkable 
 case, to be given afterwards in detail, in which 
 I performed resection of both the shoulder and 
 the elbow joints in the right arm. A reference 
 to the table will show the proportion of second¬ 
 ary to primary resections, and the deaths after 
 each, which were much greater in the former 
 than in the latter type of operation. Of the 
 four primary elbow excisions, only one died; 
 while of seven secondary, so many as five 
 perished. Resection was performed whenever it 
 was practicable in injuries of the upper extremity. 
 Amputation was never practised for gun-shot 
 injury of the elbow or shoulder, which would 
 admit of excision of the injured joint. On the 
 whole, the results may be pronounced satis¬ 
 factory. I shall, however, quote the particulars 
 
102 
 
 NOTES AND RECOLLECTIONS OF 
 
 of the case of excision of the shoulder, which 
 proved fatal, as an example of how our very best 
 operations proved fatal under the pysemic in¬ 
 fluences which became so rife amongst us. In 
 a second case a very similar result had nearly 
 ensued. 
 
 Case XL. —Gaugeard, a nice young fellow, a sous-lieutenant 
 in the 53rd Regiment of the Line, was wounded at three o’clock 
 on September 1st, near Balan. The ball passed through the 
 head of the right humerus from before, backwards. The head 
 and two inches of the shaft of the bone were removed 
 by means of a single anterior incision, and carbolic dressings 
 were somewhat carefully applied. On September 3rd, the 
 wound was dressed. It was almost all healed. Some serous 
 fluid flowed from it. There was neither general nor local dis¬ 
 turbance. On September 9th, he was going on extremely well. 
 He had so far no fever nor other untoward symptoms at any time. 
 So runs my brief report. In short, the patient was so far con¬ 
 valescent as to be walking about with his arm in a sling, quite 
 happy and comfortable at the thought of his limb being pre¬ 
 served to him. He was regarded by everyone as quite con¬ 
 valescent, when, on the 14th, we noticed beads of sweat upon 
 his face, he had complained of feeling hot before, there was no 
 distinct rigor, but the sweating became very profuse. The skin 
 soon assumed a sallow tint, and his eyes became sunken. An 
 attack of secondary haemorrhage, the prelude to the fatal issue, 
 took place on September 21st; and, on September 22nd, he 
 died. Thus in a short ten days ended one of our best and most 
 promising cases, and this is but an example of what happened 
 in a dozen similar instances. 
 
 Case XLI.— Gallerand, Mareclial du Logis 7th Artillery 
 Corps, was wounded on September 1st by a ball which entered 
 behind the left shoulder-joint, and, passing directly forwards, 
 smashed the head of the humerus, and emerged in front. He 
 was only sent to Asfeld on September 12th. On September 
 
AN AMBULANCE SURGEON. 
 
 103 
 
 14th, I excised the head of the bone, just as in the last case, by 
 a single anterior incision. Up till September 29th the patient 
 got on famously, and then symptoms threatening pysemia made 
 their appearance. He also had sweatings, but no marked shiver. 
 Fortunately, these unfavourable symptoms soon abated, and 
 Gallerand made an excellent recovery. He left the hospital 
 perfectly convalescent on October 6 th. 
 
 I am very sceptical as to any treatment being 
 of much avail in well-marked pyaemia. Some 
 time ago, I had frequent opportunities of trying 
 Professor Polli’s antizymotic treatment by the 
 bisulphites of soda or magnesia. It always ap¬ 
 peared to me to do a good deal of harm, and 
 never much, if any, good. Diarrhoea was in¬ 
 duced by it, as well as vomiting, the abdomen 
 swelled up with flatulence, and food was soon 
 rejected. Perhaps the internal administration or 
 inhalation of carbolic acid, which in the hands of 
 some would seem to prove an universal panacea, 
 might succeed better. It would be well worth a 
 trial, although I did not feel disposed to accord it 
 one at Asfeld. For myself, I can place but little 
 reliance in anything save quinine and opium, and 
 plenty of fresh air, and not much even in these 
 means, for staying the progress of acute pyaemic 
 poisoning. When once fully developed, it is 
 very rarely checked. 
 
 We had, as before mentioned, no cases of exci¬ 
 sion of the wrist-joint, but I may take this oppor¬ 
 tunity of mentioning the excellent apparatus of 
 
104 
 
 NOTES AND RECOLLECTIONS OF 
 
 Professor Esmarch, who has treated cases of re¬ 
 section of the wrist with great success. The 
 hand and arm are placed in a prone or semi-prone 
 position on the splint (Fig. 6), whose form is such 
 
 Fio. 6. 
 
 Professor Esmarch’s Splint for Resection of the Wrist. 
 
 as to leave the wrist exposed, and easy to he got 
 at for the application of dressings. The whole 
 apparatus en fonction , consisting of a suspending 
 rod, a plaster of Paris, or other form of bandage, 
 and the splint, is represented in Fig. 7, and the 
 
 Fig. 7- 
 
 facility with which the patient can move about 
 in bed, or readjust the position of his arm, is 
 at once perceived. Dr. Patrick Heron Watson’s 
 anterior splint for resection of the knee-joint, 
 
AN AMBULANCE SURGEON. 
 
 105 
 
 and the American anterior fracture-splints, are 
 similar in principle and application. 
 
 A modification of this apparatus might readily 
 be applied in cases of resection of the elbow. 
 But, unless for purposes of transport, it is not 
 often necessary, nor even, I consider, desirable, 
 to apply splints of any kind to excisions of this 
 joint, any more than to those of the shoulder. 
 The after-purpose of the operation is to secure 
 free motion in the new articulation, and the arm 
 and elbow can usually be adequately and well 
 supported by pillows. I myself never used any 
 form of splint after excision of the elbow, and I 
 found that great comfort to the patient, and 
 great facility in applying new dressings, were 
 thereby secured. 
 
 Besides those cases operated upon in hospital, 
 several cases of resection which had been per¬ 
 formed elsewhere were sent to us, and in some of 
 these a very rough-and-ready method had been 
 adopted for entering the wounded joint. The ope¬ 
 rator had cut transversely across the back of the 
 elbow from one side of the limb to the other, sacri¬ 
 ficing the ulnar nerve, of course, and making a 
 huge unsightly wound. Pott’s plan of a single 
 longitudinal incision was the method I adopted in 
 all save one instance, when I used the H-shaped 
 cut, on account of the nature of the wound. The 
 single incision may cause the operation to be 
 
106 
 
 NOTES AND RECOLLECTIONS OF 
 
 perhaps somewhat more tedious, but it gives 
 sufficient room, inflicts less damage on the soft 
 parts, and the cicatrix is more satisfactory than 
 after any other operation. The incision should 
 be made towards the inner border of the olecranon, 
 and, by keeping the edge of the knife close to the 
 bone, the ulnar nerve need be neither exposed 
 nor endangered. I did not consider it expedient 
 to attempt sub-periosteal resection. In several 
 instances, amputation was performed for injuries 
 of the elbow, but then the injuries were so 
 extensive as to preclude the idea of saving the 
 limb, and had ordinarily been produced by the 
 explosion of a shell. 
 
 The n um ber of cases of penetrating wound of 
 the elbow under our care was very considerable. 
 In the great majority, resection was performed 
 at once, as all secondary operations do so very 
 badly. In a few cases of elbow wounds, for one 
 reason or another, expectant surgery received a 
 trial. 
 
 Case XLII. is an example of recovery from penetrating 
 wound of the elbow-joint, without operation. Vivien was 
 wounded by a ball which entered half way between the internal 
 condyle and the olecranon process of the left arm, and emerged 
 in front of the articulation over the head of the radius. The 
 joint was therefore traversed from behind, forwards, outwards, 
 and slightly downwards. An examination revealed but a com¬ 
 paratively small amount of damage. The patient was a healthy 
 young man, and it was decided to give him the chance of getting 
 
AN AMBULANCE SURGEON. 
 
 107 
 
 better without operation. The case turned out in every way 
 satisfactory, and he left the hospital convalescent. 
 
 Case XLIII.— Auguste Soitel, 89th Regiment of the Line, 
 presented another example of penetrating wound of the elbow, 
 in which recovery took place. He was struck on September 
 1st by a ball which entered the posterior surface of the elbow, 
 j ust over the head of the radius, breaking that bone. The ball 
 emerged, after traversing the joint, a little above the internal 
 condyle. No serious symptoms were manifested, and the man 
 soon left hospital convalescent. 
 
 The following may be taken as an example of 
 the cases sent into us from without, in which an 
 operation for excision of the elbow had previously 
 been performed. 
 
 Case XLIV.—Louis DEROYwas wounded on September 1st 
 by a ball in the right elbow-joint. An operation had been per¬ 
 formed in a Prussian field ambulance, on September 3rd, for 
 removal of the injured joint by means of a single transverse 
 incision across the back of the articulation. The patient was 
 admitted to Asfeld on September 5th. The case did not get on 
 well, and, on September 20th, the arm was amputated most 
 skilfully by Dr. Wyman. The patient eventually recovered, 
 leaving hospital on October 6tli. 
 
 Case XLV.— Fauvartel was operated upon by excision of 
 the joint in a manner precisely similar to Deroy, for a shell 
 wound of the elbow, but in his case a fatal result ensued from 
 exhaustion, without further operative interference. 
 
 Case XLV I. deserves especial mention, as it is of unusual 
 interest, and, I believe, unique in operative surgery. Louis St. 
 Aubin belonged to the 3rd Chasseurs d’Afrique, a corps which 
 has distinguished itself for extreme gallantly in every action in 
 which it has been engaged. This young man, only twenty- 
 three years of age, had his horse shot under him, after receiving 
 
108 
 
 NOTES AND RECOLLECTIONS OF 
 
 a bayonet thrust in his left cheek, the only one I saw amongst 
 all the cases that came under my notice. He then got separated 
 from his comrades. They had been in action all day. It was the 
 fatal 1st of September, and the French troops had been routed 
 and were flying towards Sedan. St. Aubin, though wounded 
 and alone, had no notion of turning his back upon the enemy. 
 He provided himself with one of the numerous Chassep6ts lying 
 about, and shortly after fell in with a small party of Marines, 
 a corps who have also proved themselves amongst the very 
 finest troops in the French army. These brave fellows, a mere 
 handful, started forward to meet the enemy. But they had 
 not gone far before the deadly fire from the Prussian batteries 
 laid several of them low, and amongst the rest St. Aubin, who 
 was struck by the fragments of an exploding shell on the right 
 arm, which severely wounded both the shoulder and elbow 
 joints. He came under our care on September 12th, not having 
 in the interval received any special treatment. On examination, 
 we found both the head of the humerus and the elbow-joint 
 extensively shattered. The soft parts were in both regions 
 lacerated and contused. The injuries were so extensive that 
 amputation seemed almost imperative, but I determined to 
 attempt to save the limb if the extent of the deeper-seated 
 injury would at all admit of it. The poor fellow himself would 
 not consent, all we could do, to take chloroform, so much afraid 
 was he we might take advantage of his being asleep to ampu¬ 
 tate his arm, a mutilation which, under any circumstances, he 
 naturally enough refused to hear of. The operation had, there¬ 
 fore, to be undertaken without it, and, on September 14th, I 
 thus proceeded to excise the shoulder-joint. It was only needful 
 to extend the original wound, which had torn the deltoid muscle 
 on its outer and anterior aspect, and through this I removed, in 
 large fragments, nearly three inches of the upper end of the 
 humerus. The operation was necessarily a protracted one, and 
 the brave fellow bore it throughout, including the sawing of the 
 bone, without a single murmur. I never saw such powers of 
 endurance. It was, however, too much for my courage to inflict 
 so much needless suffering, and, after faithfully promising to 
 
AN AMBULANCE BURGEON. 
 
 109 
 
 him that I would not amputate his arm, I succeeded, almost 
 having to use violence, in making him inhale chloroform, before 
 I attacked the elbow. I found the injury was here chiefly con¬ 
 fined to the i-adius and the ulna, which were a good deal split 
 up. I cut off a thin slice of the condyloid end of the humerus, 
 and removed the fractured portions of the bones of the forearm. 
 The original wound was here, also on the back of the joint, in 
 such a position as to admit of its being utilized in making the 
 preliminary incision. The operation completed, the patient was 
 removed to bed, and the injured arm laid carefully on a {Allow. 
 Antiseptic dressings and careful syringing of the wound consti¬ 
 tuted the after treatment. St. Aubin’s courage never flagged 
 He never complained. “ J’ai du courage, moi,” he used to ex¬ 
 claim, and even when he was at the very worst, he would 
 always assert, “ J’en guerirai.” 
 
 Up till September 23rd, he got on well, and then pysemic 
 symptoms declared themselves. His temperature rose very high. 
 His skin became yellow. He had rigors, and was delirious for 
 a time. Then a deep abscess formed high up in the left side of 
 the neck. I thought he was going the road so many others 
 were travelling just about this date. However, he rallied, as 
 such a brave fellow deserved to do. The abscess was opened, 
 and a quantity of unhealthy pus discharged. The wounds began 
 to look extremely well, and his spirits and appetite regained 
 once more their wonted sway. 
 
 On October 8th, he was transferred, with the few other re¬ 
 maining patients of the Caserne d’Asfeld, to a Hutch ambulance 
 just then arrived in Sedan. The Hutch surgeon to whose care 
 he was entrusted, courteously communicated to me the report of 
 his condition up to November 21st. He says : “ St. Aubin 
 does not make much progress. The wound of the shoulder is 
 healing up quite well, but at the elbow large abscesses have 
 formed, which have undermined his constitution considerably. 
 However, during the last few days he was again improving. 
 He is now in the Civil Hospital at Sedan, under the care of Hr. 
 Huplessy, Surgeon in Chief of the Military Hospitals.” 
 
 A short time since, I had the satisfaction of receiving a letter 
 
110 
 
 NOTES AND BECOLLECT1ONS OF 
 
 dictated by tlie poor fellow himself, in which he says, with 
 grateful expressions :—“ J’esperais ecrire moi meme, mais mon 
 bras est plus nialade depuis votre depart. II est tres enfle, 
 de plus il s’est forme au coude quelques abces qui me font 
 souffrir, cependant j’ose vous le dire Monsieur, je ne me laisse 
 pas abattre, j’ai du courage. Si vous etiez la j’en aurais davan- 
 tage. J’ai bon appetit, je n’ai qu’a me louer des soins dont je 
 suis l’objet. Je me trouve bien a Phopital.” 
 
 It is to be hoped, for many reasons, that this 
 brave young Frenchman will completely recover; 
 and it will become an interesting question to 
 learn what amount of usefulness an arm, from 
 which both the elbow and the shoulder joints 
 have been excised, will possess. I trust I shall 
 be in a position, at some future time, satisfactorily 
 to solve the problem. I have given in Plate II., 
 Fig. 2, a lieliotype representation of the portions 
 of bone removed, which will serve, I trust, to 
 enhance the interest attaching to this case. 
 
AN AMBULANCE SURGEON. 
 
 Ill 
 
 CHAPTER IX. 
 
 September 13 th . — Some short extracts from my 
 diary of this date may not be uninteresting. I 
 find it mentioned in this day’s report that, after a 
 busy morning’s work, I walked out to Balan, 
 where I assisted Dr. Frank to disarticulate an arm 
 at the shoulder-joint, and Mr. Blewitt to ampu¬ 
 tate a thigh. I also performed an amputation of 
 the thigh myself. When I returned to Asfeld in 
 the afternoon, I found a poor fellow who had been 
 sent about from one ambulance to another since 
 September 1st, having been wounded in the 
 thigh on that day, and I performed amputation 
 of the thigh in his case also. I heard that 
 19,500 cigars are requisitioned daily from the 
 inhabitants for the troops, and other things in 
 proportion. 
 
 September WtJt .—There were more operations to 
 be performed again to-day, as indeed there were 
 every day. Twelve o’clock was the hour upon 
 
112 
 
 NOTES ANT) RECOLLECTIONS OF 
 
 which we had now fixed as the time for perform¬ 
 ing such operations as were required. At first 
 they used to he done at all hours—indeed, as it 
 were, all day long, hut, for several reasons, it 
 was convenient to fix upon a particular time as 
 soon as we were ahle to do so. To-day I had 
 occasion to excise two shoulder-joints and one 
 elhow-joint, to amputate the thigh, and to per¬ 
 form excision of the knee-joint, the only instance 
 in which I performed that operation. It proved 
 fatal, just as, I believe, have all resections of this 
 joint during the present war. 
 
 September 1 5th .—I excised an elbow-joint, and 
 amputated the thigh for a gun-shot smash of the 
 femur. My thigh amputation of the 13th at 
 Balan proved fatal to-day. My first case of 
 amputation at the hip-joint died also to-day, 
 
 ] laving survived the operation only four days. 
 The femoral artery had been twisted. There 
 was no haemorrhage. I suppose this is perhaps 
 the largest arterial trunk to which torsion has 
 been ever applied. 
 
 We were all put on the alert to-day by the 
 circumstance of double sentries being posted all 
 round the ramparts. The drawbridge, which we 
 had to cross on entering the hospital precinct, 
 was raised in the evening, and some of our staff 
 were shut out that night, as, not being aware of 
 
AN AMBULANCE SURGEON. 
 
 113 
 
 the change, they had remained till rather late 
 in the evening in town. The alert was a false 
 one. Bazaine was reported to have made that 
 sortie from Metz which, in point of fact, he never 
 did make, although opinions may differ as to the 
 possibility of his having been able or willing to 
 do so. From this time forth we were in a certain 
 sort prisoners on parole. The sentries at the 
 gate allowed the members of the Staff to go 
 in and out during the day, but no one else, 
 without special permission, could pass, and at 
 night we were shut in as securely as in any 
 fortress. 
 
 An incident, very unpleasant, and which might 
 have been attended with the most serious conse¬ 
 quences, occurred about this time. One of the 
 junior members of the staff, who had recently 
 joined, went out one evening in the dusk to 
 forage for trophies. He passed into the deep 
 wide ditch outside the ramparts by a covered way 
 beneath them. He had not pursued his innocent 
 avocations very long until the hail of the German 
 sentry from one of the ramparts above recalled 
 him to a sense of the situation. The unfortunate 
 young fellow knew not a word of German, and 
 but little more of French. Not much time, 
 however, was lost in words or attempted explana¬ 
 tions. The German soldier did not understand 
 the nature of the appeal made to him, so he 
 
 1 
 
114 
 
 NOTES AND RECOLLECTIONS OF 
 
 solved liis difficulties by firing. The dusk and a 
 not unnatural acceleration of his pace saved our 
 young friend, who got round the sheltering corner 
 of a bastion, and gained the covered way again 
 in safety. It is perhaps unnecessary to add that 
 this gentleman was very careful in future not to 
 venture much out after dark. Of course we 
 remonstrated about this rather summary treat¬ 
 ment, but were told that the sentries had orders 
 to fire at once on any one found straying out 
 after nine in the evening, who could not give the 
 countersign, or otherwise account for himself. 
 The difficult circumstance in respect of times 
 such as these is, that a mistake, once made, is 
 impossible to rectify. 
 
 September 1 Qth. —To-day I tied the subclavian 
 artery on the right side, for secondary haemorrhage 
 after amputation of the arm. The bleeding was 
 stopped, but the poor fellow ten days afterwards 
 died pyaemic. 
 
 Case XLYII.—Louis Dessoyes, marechal du logis, 2nd 
 Artillery, was wounded on September 1st. His arm was am¬ 
 putated in the upper third on September 3rd, in the Eglise 
 St. Charles of Sedan, and he was transferred to our care on 
 September 9th. He was doing well until September 17th, 
 when serious secondary haemorrhage occurred, and we were 
 obliged to tie the subclavian artery. I cut down upon its third 
 stage in the usual way, and the artery was then occluded by 
 twisting a loop of silver wire round it, instead of tying a piece of 
 
AN AMBULANCE BURGEON. 
 
 115 
 
 silk. Dr. Sims applied the silver wire with the dexterity and 
 address which characterize all his operative procedures. The 
 wound in the neck never gave any trouble. It healed up very 
 kindly, and for some time we thought all would go well with 
 our patient. By the 25th, symptoms of well-marked pyaemia 
 had become fully developed. On the 26th, he was delirious, 
 and on the 27th, he died. We found, at the 'post-mortem 
 examination, abscesses in the left knee, left shoulder, right 
 shoulder, and between the layers of the abdominal muscles. No 
 internal abscess was discovered. The artery at the seat of 
 ligature was carefully examined. A large firm clot occupied 
 the vessel throughout the second stage up to the seat of ligature. 
 In the distal portion of the vessel, hardly any clot was found. 
 Had further haemorrhage occurred in this case, it would have 
 come, as usual, entirely from the distal extremity. 
 
 This mode of occluding a large vessel is not 
 new. Dr. Le Vert, in the American Quarterly 
 Journal of the Medical Sciences , many years ago 
 published the results of a series of experiments in 
 which he applied metallic ligatures to the arteries 
 in dogs, and others of the lower animals. Dr. 
 Stone, of New Orleans, at the instance of Dr. 
 Physick, has tied a wire round the carotid and 
 external iliac in the human subject, and with 
 good results. The question is one which deserves 
 further investigation, although in the present 
 instance the termination proved so unfortunate. 
 
 September 20th. — Six thousand five hundred 
 of the wounded after the battles of August 
 31st and September 1st have up to this date 
 been “evacuated” on Mezieres, for distribution 
 
 i 2 
 
116 NOTES AND RECOLLECTIONS OF 
 
 thence to different parts of France and Ger¬ 
 many. These men were sent either to France 
 or Germany, according to the category in 
 which they had been arranged by the medical 
 officers. Those certified as slightly wounded, 
 and able to serve again in a month, were sent to 
 Germany as ordinary prisoners of war. Those, 
 however, who were classed as being gravely 
 wounded, and, though capable of being trans¬ 
 ported, unable to serve their country for a space 
 of three months, were allowed to return to their 
 French homes without restriction. Doubtless, 
 at this time, just after the disastrous capitula¬ 
 tion of Sedan, the German generals did not 
 anticipate a prolongation of the campaign for 
 so long a period as the subsequent events have 
 shown. The system of speedy “ evacuations,” 
 so thoroughly carried out by the German autho¬ 
 rities by means of their admirable Etappen 
 system, offers many advantages, by disencum¬ 
 bering the neighbourhoods of great battle-fields 
 of the enormous masses of wounded, which the 
 gigantic scale on which some modern battles 
 have been fought too surely produces. There 
 are, however, the countervailing cases of indi¬ 
 vidual hardship and death caused by the 
 transport of men weakened by injury and disease 
 through long distances, more especially when these 
 have to be traversed during inclement weather. 
 
AN AMBULANCE SURGEON. 
 
 117 
 
 The next few days were varied by visiting 
 Balan and Bazeilles, where our detached ambu¬ 
 lances were, in assisting Drs. Frank and Blewitt 
 to do some operations, inspecting some of their 
 more interesting cases, and in paying a visit to 
 Bouillon, in the hope of there getting letters 
 and newspapers. 
 
 The little frontier town of Bouillon, whence 
 the famous Godefroi de Bouillon went to wage his 
 numerous wars, and where his picturesque old 
 chateau still remains, is one of the most beauti¬ 
 fully situated places I ever visited. It lies in 
 a deep valley, surrounded on all sides by the 
 steep slopes of wooded hills, except the narrow 
 gorge through which flows the Samoy, a tribu¬ 
 tary of the Meuse. The view from the donjon 
 of the castle, which overhangs the river and 
 the village, is exquisitely lovely, and I cannot 
 perhaps convey a better idea of the first im¬ 
 pression the place gives, as one descends the 
 long steep hill into the town on reaching it 
 from Sedan, than by saying that it combines 
 the attractions of an Alpine village, with those 
 beauties we are in the habit of admiring in a 
 little town upon the Rhine. 
 
 And now to continue, after this digression, 
 the account of our wounded at Asfeld. I find 
 that in all we had under treatment 284 cases 
 of injury of the lower extremities, of which 66 
 
118 
 
 NOTES AND RECOLLECTIONS OF 
 
 terminated fatally. The following tables give 
 an analysis of these cases, and of the operations 
 that were performed on account of the injuries 
 received :— 
 
 Table op Injuries. 
 
 Penetrating wounds of liip-joint 
 Penetrating wounds of the knee-joint 
 Penetrating wounds of the ankle-joint 
 Wounds around the knee-joint, not penetrating the 
 articulation . . . . . . . . 
 
 Wounds around the ankle-joint, not penetrating 
 the articulation 
 
 Gun-shot wounds of the thigh and buttock, witk- 
 
 Cases. 
 
 3 
 
 12 
 
 7 
 
 21 
 
 Deaths. 
 
 2 
 
 9 
 
 3 
 
 out fracture of bone . . 
 
 . # 
 
 . .100 
 
 13 
 
 Complete avulsion of buttock 
 
 • • 
 
 . . 2 
 
 1 
 
 Gun-shot wounds of the leg, without fracture 
 
 .. 36 
 
 1 
 
 Gun-shot injuries of the foot 
 
 . . 
 
 .. 24 
 
 2 
 
 Gun-shot fracture of femur 
 
 • . 
 
 .. 27 
 
 19 
 
 Gun-shot fracture of tibia or fibula 
 
 • • 
 
 .. 43 
 
 14 
 
 Simple fracture of leg 
 
 
 .. 4 
 
 0 
 
 
 
 284 
 
 66 
 
 Table of Operations. 
 
 Operations. Deaths. 
 
 Prim. Sec. Tot. Prim. Sec. Tot. 
 
 Disarticulation of the hip-joint 0 2 2 0 2 2 
 
 Disarticulation of the knee-joint 0 3 3 0 3 3 
 
 Syme’s amputation . . ..0 2 2 011 
 
 Pesection of knee-joint ..011 011 
 
 Amputation of the thigh .. 5 16 21 4 14 18 
 
 Amputation of the leg . . ..18 6 24 5 5 10 
 
 Partial amputation of the foot 7 0 7 0 0 0 
 
 30 30 60 
 
 9 26 35 
 
 These tables point to some interesting con¬ 
 clusions. The great mortality of wounds of the 
 
AN AMBULANCE SURGEON. 
 
 119 
 
 knee is only too apparent, nine out of twelve 
 dying. In but one case, because it appeared 
 so very suitable, did I attempt resection. And 
 yet a speedily fatal result ensued. Of no rule 
 in military practice can there, I think, be less 
 doubt, than that immediate amputation should 
 always be practised in gun-shot wounds of the 
 knee clearly implicating the articulation. When 
 the operation has, however, been postponed from 
 any cause, the efforts of nature should generally 
 be allowed free scope, since secondary amputa¬ 
 tions of the thigh prove so exceedingly fatal. Of 
 eleven resections performed during the Ameri¬ 
 can war, nine died. One case, in which the 
 operation was performed by Surgeon Bontecou 
 in October, 1862, recovered, while in the eleventh 
 case the alleged recovery was so extraordinary as to 
 suggest doubts as to its authenticity. Excision for 
 wounds of the knee may be successfully performed 
 in civil practice, but is not justifiable in military. 
 Cases where the knee-joint is really opened 
 require to be discriminated from those in which 
 the ball, deflected by the strong fibrous capsule 
 of the articulation, passes more or less completely 
 round it without penetration. We had twenty- 
 one such instances, two only of which proved 
 fatal. Of our twenty-seven cases of gun-shot 
 fracture of the femur, nineteen died. Those in 
 whom amputation was not practised were treated 
 
120 
 
 NOTES AND RECOLLECTIONS OF 
 
 by the application of the long splint to steady 
 the limb, and extension by means of a weight 
 attached to the foot, the weight of the body, and 
 its friction against the bed, affording sufficient 
 counter-extending power. In a few instances, 
 there ensued very considerable deformity and 
 shortening, but in some, on the other hand, the 
 result was as good as could be desired. 
 
 Case XLVIII. affords an example of what I have just 
 stated. Captain Thouvenel, 89th Regiment of Infantry, was 
 wounded on September 1st. The ball entered on the inner 
 side of the right thigh, close to the perinseum, and, after tra¬ 
 versing the femur just beneath the lesser trochanter, emerged 
 on the outer side of the thigh. There were, when first ex¬ 
 amined, two inches of shortening and great deformity. The 
 fracture must have been almost a transverse one, such as those 
 alluded to in the U.S. Surgeon-General’s report, for the bone, 
 after considerable extending force had been applied, went into 
 its place with a jerk, and there remained. He recovered with¬ 
 out a bad symptom, and the most accurate measurements failed, 
 six weeks afterwards, to detect any appreciable amount of 
 shortening. A result such as this is rare after any form of 
 fractured femur, and is even considered by some surgeons as all 
 but impossible. 
 
 Case XLIX.— Edouard Grundler, 2nd Infantry of the 
 Mai'ine, had his right thigh fractured by a ball in the upper 
 third. He recovered perfectly with about two inches shortening. 
 
 Case L.—Louis Denoyer, 37th Line, had his right thigh 
 fractured in the upper third. The shortening in this case 
 amounted to one inch and a half. I have since heard that he 
 has gone home to his friends quite convalescent. 
 
 Case LI.— Jean Goutard sustained a fracture high up in 
 the left thigh. There were great comminution, distortion, and 
 
AN AMBULANCE SURGEON. 
 
 121 
 
 tardy consolidation of the fracture. He was slowly improving 
 when I last heard of him, on November 21st. 
 
 In somewhat strong 1 contrast to our experience 
 is that of Stromeyer in his ambulance at 
 Floing, close by Sedan, where a good deal of 
 hard fighting took place. He treated there 
 thirty-four fractures of the femur, and in twenty- 
 four there was, at the time of the report, a 
 prospect of cure, four were doubtful cases, and 
 only six died. His table of results in fractures 
 of the leg is also very satisfactory. Out of thirty- 
 one fractures of the tibia or fibula, or both, caused 
 by gun-shot injury, only three died, while the 
 result remained doubtful in six instances. Out of 
 thirty-four similar cases at Asfeld, of fractures of 
 the leg, as many as fourteen perished. 
 
 The mortality after operations in the lower 
 limb was very great at Asfeld. I may say that 
 scarcely any recovered but those in which the 
 operation was performed immediately after the re¬ 
 ceipt of injury. Our secondary operations proved 
 nearly all fatal. Previous privation, the exhaust¬ 
 ing influences of the wound itself, added to the 
 unhealthy condition of the hospital at the time 
 when these operations had to be performed, 
 made it difficult for a single one to escape. 
 And, in fact, some 58’20 per cent, of all those 
 operated upon in the lower extremities perished. 
 In contrast to this, also, Stromeyer’s table, as may 
 be seen, displays a marked difference. 
 
122 
 
 NOTES AND RECOLLECTIONS OF 
 
 Feld-Lazareth von Generalstabsarzt Stromeyek. 
 
 Condition of the Sick at Floing, 24//t and 2 6th September, 1870. 
 121 patients—04 German, 57 French. 
 
 Total. 
 
 Prospect 
 of cure. 
 
 Doubt¬ 
 
 ful. 
 
 Deaths. 
 
 Fractures of the skull. . 
 
 2 
 
 2 
 
 0 
 
 0 
 
 Face-wounds 
 
 1 
 
 1 
 
 0 
 
 0 
 
 Penetrating cliest-wounds 
 
 14 
 
 7 
 
 7 
 
 0 
 
 Contusion of the crown 
 
 1 
 
 1 
 
 0 
 
 0 
 
 Fracture of the crown . . 
 
 3 
 
 0 
 
 2 
 
 1 
 
 Wounds of small intestine 
 
 1 
 
 0 
 
 1 
 
 0 
 
 Wounds of liver 
 
 1 
 
 1 
 
 0 
 
 0 
 
 Wounds of soft parts of pelvis . . 
 
 1 
 
 1 
 
 0 
 
 0 
 
 Wounds of bladder 
 
 1 
 
 0 
 
 1 
 
 0 
 
 Wounds of soft parts of shoulder 
 
 2 
 
 2 
 
 0 
 
 0 
 
 Wounds of soft parts of upper 
 arm 
 
 1 
 
 1 
 
 0 
 
 0 
 
 Fracture of collar-bone . , 
 
 1 
 
 0 
 
 1 
 
 0 
 
 Fractures of upper arm 
 
 3 
 
 3 
 
 0 
 
 0 
 
 Wounds of elbow-joint 
 
 2 
 
 2 
 
 0 
 
 0 
 
 Fractures of fore-arm . . 
 
 1 
 
 1 
 
 0 
 
 0 
 
 Wounds of hip . . 
 
 2 
 
 2 
 
 0 
 
 0 
 
 Wounds of soft parts around 
 femur 
 
 5 
 
 5 
 
 0 
 
 0 
 
 Fractures of the femur . . 
 
 34 
 
 24 
 
 0 
 
 0 
 
 Fracture of femur and tibia . . 
 
 1 
 
 1 
 
 4 
 
 6 
 
 Fracture into knee-joint . . 
 
 7 
 
 3 
 
 1 
 
 3 
 
 Injury to the sciatic nerve 
 
 1 
 
 1 
 
 0 
 
 0 
 
 Wounds of soft parts of leg . . 
 
 1 
 
 0 
 
 1 
 
 0 
 
 Fractured leg, not specifying 
 which part was fractured 
 
 7 
 
 6 
 
 1 
 
 0 
 
 Fracture of both bones of leg . . 
 
 18 
 
 11 
 
 4 
 
 3 
 
 Fracture of tibia . . ,. 
 
 5 
 
 3 
 
 2 
 
 0 
 
 Fracture of fibula 
 
 1 
 
 1 
 
 0 
 
 0 
 
 Fracture of tibio-tarsal joint . . 
 
 2 
 
 2 
 
 0 
 
 0 
 
 Foot wounds . . 
 
 1 
 
 1 
 
 0 
 
 0 
 
 120 
 
 82 
 
 25 
 
 13 
 
AN AMBULANCE BURGEON. 
 
 123 
 
 Table of Operations. 
 
 Total. 
 
 1 . Ligature of femoral artery .. 2 
 
 2. Extraction of large splinters 
 
 of shell . . . . . . 6 
 
 3. Resection of elbow-joint .. 1 
 
 Resection of portions of femur 1 
 Resection of portions of tibia 2 
 
 4. Amputations.—Primary . . 10 
 
 Double .. 1 
 
 Secondary.. 14 
 
 5. Disarticulation of the hip-joint 1 
 
 Total . . . . 38 
 
 Prospect Doubt- 
 of cure. fuL 
 
 0 1 
 
 3 1 
 
 1 0 
 
 0 0 
 
 1 0 
 
 9 1 
 
 0 0 
 
 8 4 
 
 0 1 
 
 22 8 
 
 Deaths. 
 
 1 
 
 2 
 
 0 
 
 1 
 
 1 
 
 0 
 
 1 
 
 2 
 
 0 
 
 8 
 
 On September 1st, there were 1,200 wounded in Floing. On Septem¬ 
 ber 5th, the sick numbered 635 patients; 300 German and 335 French. 
 Twenty primary amputations had so far been performed. 
 
 I have published these statistics here, having 
 been given them by the distinguished Surgeon- 
 General himself on the occasion of a visit to 
 him, both on account of their intrinsic interest, 
 and because they serve as a means of comparison 
 with my own tables. I have little doubt that 
 much of the difference in the results may be 
 explained by the circumstance that most of the 
 patients at the ambulance of Floing were treated 
 virtually in the open air. A number of tem¬ 
 porary houses or huts, constructed of shingles or 
 rough boards, were arranged on the lawn of 
 a chateau near the village. There were no 
 windows in them, but the sides opened all the 
 way along by means of large louvres, and, when 
 
124 
 
 NOTES AND RECOLLECTIONS OF 
 
 these were all raised, the entire circumference of 
 the liut was laid open. There was a door at each 
 end, a stove in the centre, and ten extempore 
 wooden beds along each side. These Baraken , 
 as they are termed, form an admirable Fcld- 
 Lazareth. They are only fitted, or intended, for 
 temporary occupation, but for such a purpose 
 are, I think, very suitable, and very much better 
 than tents, which are liable to numerous and 
 great inconveniences. Stromeyer had a large 
 staff of surgeons and assistants under him, and 
 his duties as Generalstabsarzt did not confine 
 him to one ambulance. The great civil surgeons 
 who hold the highest posts in the German armies 
 visit the different field-ambulances at fixed times, 
 when there are regular consultations with the 
 surgeons attached to each on all cases of im- 
 portance, and at these visits the operations are 
 performed, which are decided upon after consult¬ 
 ation as being needful. There can be little 
 doubt that the advantages of such a system, 
 both to the army medical officers themselves, 
 and to the patients under their charge, in having 
 the counsel and assistance, at all times and in 
 all cases of difficulty, of the most matured sur¬ 
 gical advice in the country, are very great. 
 There is no undue interference, however, and I 
 have not heard that any jealousies are excited, or 
 that the system does not work to the immediate 
 
AN AMBULANCE SURGEON. 
 
 125 
 
 benefit of all concerned. Certainly, in the case 
 of Stromeyer, who is beloved and respected 
 by everyone with whom he comes in contact, 
 nothing could be more harmonious than the rela¬ 
 tions which subsisted. On the occasion of my 
 visit to him, he paid me a great compliment by 
 insisting on my performing an amputation of 
 the thigh, which was required for an injury to 
 the knee. We afterwards had a long conver¬ 
 sation together, in the course of which he asked 
 me if I had yet arrived at his conclusion that the 
 practice of military surgery was unsatisfactory 
 in the extreme. He said he was now passing 
 through his third campaign, and that the 
 longer he lived the more deeply was he alive 
 to the seemingly unavoidable evils which attend 
 the practice of surgery during war. 
 
126 
 
 NOTES AND RECOLLECTIONS OF 
 
 CHAPTER X. 
 
 Perhaps I cannot do better in concluding what 
 is after all but a sketch, and, I fear, an im¬ 
 perfect one, of our ambulance work, than by 
 giving in extenso a table of all the cases of injury 
 which were received and treated in Asfeld, and of 
 the operations that were there performed. Some 
 of the operations, however, were not performed 
 at Asfeld, the patients having been sent to us 
 subsequently from other ambulances. The classi¬ 
 fication of the injuries is made mainly according 
 to regions from the head down to the foot, which 
 is, perhaps, the simplest and the best plan. 
 When the injuries have been multiple, they are 
 classed under that one which is likely to prove 
 most dangerous to life. Besides the cases thus 
 recorded, there have been a number where the 
 names were never discovered, and wherein all 
 source of identification is thus lost. There were 
 several, too, whose names are known, but not the 
 forms of injury from which they suffered. All 
 
AN AMBULANCE SURGEON. 
 
 127 
 
 this was unavoidable, the amount of work im¬ 
 posed on us being simply overwhelming for the 
 first few days. 
 
 I have prepared these tables with much care, 
 and after a great deal of trouble. I had my 
 own notes, and, in addition, a general registry 
 of all the cases. By collating these two carefully 
 I think I have been able to exclude any serious 
 error, and to present as correct a resume of our 
 work in a tabular form as it is possible to have. 
 
 Table of Injuries Treated at Asfeld during September 
 and October, 1870. 
 
 Cases. Deaths. 
 
 Scalp wounds . . . . . . . . . . 9 2 
 
 Fractures of the skull . . . . . . . . 8 7 
 
 Gun-shot wounds traversing the face, or the face and 
 
 neck, and in general fracturing the bones . . 24 5 
 
 Wounds of the face destroying the eye . . .. 4 0 
 
 Wounds traversing the neck . . . . .. 5 0 
 
 (In one case the trachea was divided.) 
 
 Wounds of the soft parts around the shoulder-joint 
 
 without penetration of the articulation . . 7 0 
 
 Wounds around the elbow-joint without penetration 1 0 
 
 Wounds of the soft parts of the hip and the buttock 18 G 
 
 Wounds of the buttock and various other parts . . 7 0 
 
 Complete avulsion of the buttock, with fracture of 
 
 the ilium and sacrum . . . . . . . . 2 l 
 
 Wounds around the knee-joint not penetrating the 
 
 articulation .. . . . . . . . . 21 2 
 
 (In one case the popliteal artery was divided by 
 the ball, causing sphacelus.) 
 
 Wounds around the ankle-jointwithout penetration 5 0 
 
 Penetrating wounds of the shoulder-joint . . . . 6 3 
 
 „ „ elbow-joint . . . . 15 6 
 
 „ „ hip-joint . . . . 3 2 
 
128 
 
 NOTES AND RECOLLECTIONS OF 
 
 Table of Injuries— Continued. 
 
 Cases. 
 
 12 
 
 Penetrating wounds of the knee-joint 
 
 „ ,, ankle-joint . . .. 7 
 
 Shell-wound penetrating both the shoulder and the 
 elbow-joint of the same arm . . . . . . 1 
 
 Wounds of the soft parts of the chest 
 without penetration ; sometimes com¬ 
 plicated with fracture of the ribs ..14 2 
 
 Superficial wounds of the chest and abdo¬ 
 men . . . . . . . . 4 0 
 
 Superficial wounds of the chest and 
 
 various other parts . . . . 5 0—23 
 
 Superficial wounds of the back and loins . . . . 15 
 
 Wounds of the back and various other parts .. 2 
 
 Gun-shot wounds of the spine— 
 
 Cervical region . . . . 2 2 
 
 Dorsal region . . .. 1 1 
 
 Lumbar region . . . . 4 3— 7 
 
 Gun-shot wounds of the pelvis . . . . . . 4 
 
 Gun-shot wound of the pelvis with a penetrating 
 wound of the chest also . . . . . . 1 
 
 Gun-shot wounds penetrating the chest— 
 
 Wounds penetrating or traversing, 
 
 chiefly the left lung . . 18 9 
 
 By a ball first traversing the scapula 3 2 
 
 By a ball first traversing the head 
 
 of the humerus . . . . 4 1 
 
 By a ball first smashing the clavicle 5 4 
 
 Shell-wound tearing away the side of 
 the chest and largely exposing the 
 
 lung 
 
 1 
 
 Wounds penetrating the abdomen 
 Wounds of the soft parts of the arm with¬ 
 out fracture . . . . . . 31 
 
 Wounds traversing both arms . . 2 
 
 Wounds of the fore-arm without fracture . . 
 Gun-shot injuries of the hand 
 
 1—31 
 . . 7 
 
 1 
 
 0-33 
 .. 22 
 
 .. 33 
 
 Deaths. 
 
 9 
 
 3 
 
 17 
 
 7 
 
AN AMBULANCE SURGEON. 
 
 129 
 
 Table of Injuries— Continued. 
 
 Cases. Deaths. 
 
 Wounds of the soft parts of the thigh 
 
 without fracture . . . . 63 6 
 
 Gun-shot wounds traversing both thighs 
 Gun-shot wounds of the thigh and various 
 
 3 
 
 0 
 
 
 other parts 
 
 9 
 
 1—75 
 
 7 
 
 Wounds of the soft parts of the leg without fracture 36 
 
 1 
 
 Gun-shot injuries of the foot 
 
 Gun-shot fractures of the femur— 
 
 • 
 
 . . 24 
 
 2 
 
 Upper third 
 
 9 
 
 5 
 
 
 Middle third . . 
 
 8 
 
 4 
 
 
 Lower third . . . . . . 10 
 
 10-27 
 
 19 
 
 Gun-shot fracture of the leg, generally the 
 
 
 
 
 tibia . . . . . . . . 41 
 
 13 
 
 
 Gun-shot fracture of the tibia, with simple 
 
 
 
 
 fracture of the opposite leg . . 
 
 1 
 
 0 
 
 
 Gun-shot wound traversing both legs, 
 
 
 
 
 causing fracture of one tibia, a wound 
 penetrating the opposite ankle-joint, 
 and a wound of the thigh without 
 fracture 
 
 1 
 
 1—43 
 
 14 
 
 Fracture of the femur and tibia in the 
 
 same limb . . . . . . , . . . 1 1 
 
 Simple fracture of the leg . . . . . . . . 4 0 
 
 Gun-shot fracture of the humerus . . . . . . 24 10 
 
 „ „ ,, with wound of the 
 
 thigh and buttock . . . . . . . . 1 1 
 
 Gun-shot fracture of the radius or ulna, or both . . 10 0 
 
 Burns, contusions, and sprains . . • . . . 31 0 
 
 Temporary loss of sight from a shell-explosion . . 1 0 
 
 Total .. . . 610 137 
 
 I have purposely avoided any record of our 
 numerous cases of fever, dysentery, and rheuma- 
 
 K 
 
130 
 
 NOTES AND RECOLLECTIONS OF 
 
 tism, as they only remained for a very short 
 time under treatment. 
 
 Table of Operations Performed. 
 
 Cases. Deaths. 
 
 
 Prim. 
 
 Sec. 
 
 Tot. 
 
 Prim. 
 
 Sec. Tot. 
 
 Disarticulation at hip-joint 
 
 0 
 
 2 
 
 2 
 
 0 
 
 2 
 
 2 
 
 „ „ knee-joint . . 
 
 0 
 
 3 
 
 3 
 
 0 
 
 3 
 
 3 
 
 „ „ shoulder-joint 
 
 1 
 
 1 
 
 2 
 
 1 
 
 1 
 
 2 
 
 „ „ elbow-joint. . 
 
 0 
 
 2 
 
 2 
 
 0 
 
 2 
 
 2 
 
 „ „ wrist-joint . . 
 
 2 
 
 0 
 
 2 
 
 0 
 
 0 
 
 0 
 
 Amputation of the thigh — 
 
 Upper third 
 
 2 
 
 6 
 
 8 
 
 1 
 
 5 
 
 6 
 
 Middle third , . 
 
 1 
 
 9 
 
 10 
 
 1 
 
 8 
 
 9 
 
 Lower third 
 
 2 
 
 1 
 
 3 
 
 2 
 
 1 
 
 3 
 
 Amputation of the leg — 
 
 Upper third 
 
 14 
 
 6 
 
 20 
 
 5 
 
 3 
 
 8 
 
 Middle third 
 
 2 
 
 1 
 
 3 
 
 0 
 
 1 
 
 1 
 
 Lower third 
 
 2 
 
 0 
 
 2 
 
 0 
 
 1 
 
 1 
 
 Double leg amputation 
 
 1 
 
 0 
 
 1 
 
 1 
 
 0 
 
 1 
 
 Syme’s amputation 
 
 0 
 
 2 
 
 2 
 
 1 
 
 0 
 
 1 
 
 Amputation of the arm 
 
 14 
 
 6 
 
 20 
 
 6 
 
 3 
 
 9 
 
 „ „ fore-arm 
 
 4 
 
 0 
 
 4 
 
 0 
 
 0 
 
 0 
 
 „ „ arm & fore-arm 
 
 1 
 
 0 
 
 1 
 
 1 
 
 0 
 
 1 
 
 Disarticulation at the shoulder- 
 
 joint and amputation of the 
 
 fore-arm . . 
 
 1 
 
 0 
 
 1 
 
 1 
 
 0 
 
 1 
 
 Double fore-arm amputation . . 
 
 1 
 
 0 
 
 1 
 
 0 
 
 0 
 
 0 
 
 Excision of the knee-joint 
 
 0 
 
 1 
 
 1 
 
 0 
 
 1 
 
 1 
 
 „ shoulder-joint. . 
 
 1 
 
 3 
 
 4 
 
 1 
 
 1 
 
 2 
 
 „ elbow-joint 
 
 4 
 
 7 
 
 11 
 
 1 
 
 5 
 
 6 
 
 (One case requiring secondary amputation recovered.) 
 Double resection of the shoulder 
 
 and elbow in the same arm 011 000 
 
 Resection of one-third and one- 
 
 half of the clavicle . . 1 1 2 
 
 1 1 2 
 
AN AMBULANCE SURGEON. 
 
 131 
 
 Table op Operations Performed— Continued. 
 
 Cases. 
 
 Prim. Sec. Tot. 
 
 Resection of considerable por¬ 
 tions of the long bones . . 10 0 10 
 
 Extraction of splinters of shells 
 and of bullets, about 150 
 Partial amputation of the hand 12 0 12 
 
 „ „ foot . . 0 7 7 
 
 Resection of the lower maxilla. . 10 1 
 
 Resection of the greater portion 
 
 of the ulna . . . . 2 0 2 
 
 Deaths. 
 
 Prim. Sec. Tot. 
 10 0 0 
 
 0 0 0 
 0 0 0 
 0 0 0 
 
 0 0 0 
 
 Total . . . . 79 59 13S 23 38 61 
 
 Ligatures op Arteries. 
 
 Ligature of the subclavian artery 
 
 (One was almost immediately fatal, the other 
 died pysemic.) 
 
 Ligature of the common carotid 
 
 (Since this report was made out, the other case 
 has proved fatal at Brussels after apparently 
 complete convalescence.) 
 
 Ligature of the femoral (died pysemic) . . 
 
 Ligature of the dorsalis pedis . . 
 
 Cases. Deaths. 
 2 2 
 
 2 1 
 
 1 1 
 1 0 
 
 Total . . 
 
 6 4 
 
 In preparing these tables, I found the left 
 side of the body very much more frequently in¬ 
 jured than the right, certainly in the proportion 
 of not less than three to two. The left lung, 
 for instance, was traversed nearly twice as often 
 as the right. The left hand, fore-arm, and arm, 
 
 k 2 
 
132 
 
 NOTES AND RECOLLECTIONS OF 
 
 much more frequently suffered than the right, 
 and the same was true of wounds of the lower 
 extremities. The ordinary positions assumed by 
 a soldier in firing are such as to expose the 
 left side the most, and it was for that reason 
 much oftener struck. 
 
 I have been repeatedly asked whether I had 
 noticed any difference in the manner in which the 
 French and Germans bore suffering and pain, 
 and recovered after injury. I can only record 
 my own impressions, derived from what I saw, 
 when I state that I failed to observe any marked 
 difference. Differences there may have been, 
 but what struck me most was the resignation, 
 both amongst officers and men, to their too often 
 sad fate. I met with no repining, no fretfulness. 
 The recollection which I bear away with me, 
 and which always presents itself in the foremost 
 place, is the gratitude that these poor fellows 
 showed and expressed for all that we did for 
 them. Flesh and blood have pretty much the same 
 attributes of flesh and blood, no matter on whicli 
 side of the Rhine they may have been developed. 
 And, apart from individual characteristics, I 
 could really detect no difference between the 
 way in which a German or a French wounded 
 soldier, each of whom say had sustained an injury 
 of like severity, comported himself while under 
 treatment. 
 
AN AMBULANCE SURGEON. 
 
 133 
 
 On a reference to the table of injuries, it will 
 be seen that there are recorded seven cases of 
 penetrating wound of the ankle, with three 
 deaths. Two of these deaths followed secondary 
 amputation, the third was from exhaustion. 
 
 Case LI.— Holler, aged 24, a private in the 53rd Regiment 
 of the Line, was wounded on the 1st September by a ball 
 which entered an inch and a half below, and slightly posterior 
 to, the internal malleolus, and emerged a little in front 
 of the external malleolus. For a time, under expectant treat¬ 
 ment, all went well, a number of small pieces of bone were 
 removed, and fair prospects of good recovery were entertained. 
 But on September 17th Syme’s amputation proved needful, and 
 it was performed by Dr. Wyman. The poor fellow died with 
 pysemic symptoms on September 21st. 
 
 Case LII. was also one of penetrating wound of the ankle, 
 but recovery took place after expectant treatment. Sergeant 
 Emile Baudry was wounded on September 1 st, by a ball which 
 opened the ankle-joint just over the instep. The ball was 
 extracted by the wound of entrance. There was a good deal 
 of diffuse inflammation, and matters at one time did not look 
 well, for I have marked in my note-book “ Case for operation,” 
 and even decided on the 26th to excise the joint. I did not 
 do so, however, and recovery eventually took place. We 
 discharged Baudry convalescent on October 8th. 
 
 But for the impossibility of getting anything 
 fixed in the Asfeld ceilings capable of supporting 
 a swinging apparatus, we should more generally 
 have used suspension splints, and I know of 
 nothing better for wounds of the ankle, or for 
 
134 
 
 NOTES AND RECOLLECTIONS OF 
 
 cases in which operations have been performed 
 in that region, than the apparatus of Professor 
 Esmarch, as represented in Fig. 8. 
 
 Fio. 8. 
 
 Professor Esmarch’s Apparatus for Wounds and Excisions of the Ankle-joint. 
 
 Case LIII.— Eugene Gaillot, Sergeant-Major of the 21st 
 Regiment of the Line, was struck by a ball just posterior to, 
 and a little above, the tip of the internal malleolus. There was 
 no wound of exit, nor could the ball be discovered. For some 
 days nothing unusual was witnessed, but then the ankle began 
 to swell and inflame, free counter-openings were made on the 
 opposite side, from one of which the ball, lying almost superfi¬ 
 cially, was readily removed. It was evident that the ankle- 
 joint was now seriously involved. Every care was bestowed 
 on this poor fellow, who was a fine handsome young man of 
 two-and-twenty, but without avail. Fresh abscesses formed 
 up the leg, accompanied with very profuse suppuration, and it 
 became necessary, in order to afford him a chance of life, to 
 amputate the limb. I disarticulated accordingly at the knee- 
 joint, not removing the cartilage of incrustation. The popliteal 
 artery was twisted. For some days the relief experienced was 
 remarkable : he looked a new man, and we expected him to 
 recover. Then he had the fatal rigor, a sweat, his appetite 
 failed ; diarrhoea and vomiting followed, and within a fortnight 
 
AN AMBULANCE SURGEON. 
 
 135 
 
 he died quite pysemic. On account of an attack of secondary 
 haemorrhage the day but one before his decease, I ligatured the 
 femoral artery. This bleeding would, I consider, have taken 
 place just the same had the ligature been applied to arrest the 
 bleeding in place of twisting the vessels. The bullet, which 
 must have been well-nigh spent, since it did not penetrate the 
 skin on the opposite side of the limb, grooved deeply the lower 
 end of the tibia, just above the articulating extremity, and 
 caused, in addition, a spiral fracture, reaching as high in front 
 as the junction of the middle and lower thirds of the bone. 
 The existence of this fracture, but not its extent, had been 
 previously ascertained. 
 
 A representation of this fracture is given in 
 Plate V., Fig. 9 . The groove in the lower end 
 of the tibia is well seen, and also the commence¬ 
 ment of the spiral fracture. 
 
 With reference to fractures of the leg I have 
 not much to say. We had the large number oi 
 forty-three cases with fourteen deaths. The 
 majority of these cases, in consequence of the 
 extensive injury to the bone, were submitted to 
 amputation, but a considerable number were 
 also treated in ordinary splints, with excellent 
 results. After an interval of three or four weeks 
 the limbs were put up in fenestrated gypsum 
 bandages, and then the patients could with 
 perfect safety and great facility be removed. 
 
 The amputations of the leg were among our 
 most successful cases, six only perishing out 01 
 eighteen primary amputations. Of the seven 
 cases of secondary amputation four died, making 
 
136 
 
 NOTES AND RECOLLECTIONS OF 
 
 a total mortality of ten cases in twenty-five 
 operations. The fatal case of amputation in the 
 middle third was one where Teale’s operation 
 had been performed, and the flaps afterwards be¬ 
 came gangrenous. It was the only instance in 
 which recourse was had to this form of operation. 
 The others were made simply by long anterior 
 and short posterior cutaneous flaps, and a circular 
 division of the muscular substance. 
 
 As might be anticipated, the penetrating ab¬ 
 dominal wounds were all fatal. Those in the 
 spine were also very fatal, one man only, who 
 had been wounded low in the lumbar spine, 
 recovering so far as to be able to leave hos¬ 
 pital. The four cases of wounds of the pelvis 
 all recovered, as the abdominal cavity was not 
 implicated. 
 
 With reference to fracture of the femur, it 
 may be observed that all who suffered from it in 
 the lower tim'd perished. In the middle third 
 two survived after amputation in the upper third, 
 and two after treatment for the fracture. In 
 the upper third, conservative treatment was most 
 generally adopted, and with a happy result in 
 the four cases already detailed. Five deaths 
 took place, two after disarticulation at the hip- 
 joint, and three from iDyaemia and exhaustion. 
 
 In the annexed figure is represented a mis¬ 
 shapen Bavarian bullet, which caused a very bad 
 
AN AMBULANCE SURGEON. 
 
 137 
 
 fracture of the thigh, and was extracted, with 
 a portion of the femur firmly impacted in it. 
 
 Perhaps it may not be uninteresting to some 
 readers were I to figure in their original shapes, 
 the bullets which caused these shocking muti- 
 
 Fio. 9. 
 
 lations. The woodcut represents the French, 
 Prussian, and Bavarian bullets, as well as the 
 bullet of the mitrailleuse. The first two weigh 
 
 Fio. 10. 
 
 Chassepot, Needle-gun, Bavarian and Mitrailleuse Bullets, of tho 
 natural form and size. 
 
 respectively 380 and 500 grains, the Bavarian bul¬ 
 let weighs 434 grains, while the mitrailleuse ball 
 is an ounce and three-quarters in weight. 
 
 It is somewhat curious that amongst all our 
 
138 
 
 NOTES AND RECOLLECTIONS OF 
 
 patients there was not one who had been wounded 
 by the mitrailleuse. Either this much-vaunted 
 weapon of offence wounds comparatively few 
 persons, or else it must fatally injure all those 
 whom it wounds. 
 
 There remains now but little more to say. 
 After handing over the dozen remaining patients 
 to the care of our Dutch friends, whose ambu¬ 
 lance was then being installed, I started with 
 those of our party who had remained with me to 
 the end, for Brussels, en route for England, taking 
 with us Colonel Beaudoin, to place him in an 
 ambulance in that city. The colonel bore the 
 journey well, and without fatigue. I parted 
 with him a day or two afterwards with great 
 regret, but in the expectation of seeing him soon 
 again. I was inexpressibly shocked to hear, not 
 much more than a month later, of his unexpected 
 death. He was a brave soldier and a simple- 
 hearted gentleman. He died, as I believe, of 
 a broken heart. And thus terminated our labours 
 at the Caserne of Asfeld. 
 
 Our ambulance was now completely separated. 
 Part of the Staff had previously started in search 
 of further work, under the command of Dr. 
 Pratt, and their well-known and brilliant ser¬ 
 vices at Orleans require no meed of praise at 
 my hands. They were such as to render then- 
 old associates both proud and, it may be, a little 
 envious. At Epernay, at Metz, and still later 
 
AN AMBULANCE SURGEON. 
 
 139 
 
 in Switzerland, amongst the famished and perish¬ 
 ing troops of the brave but beaten Bourbaki, Dr. 
 Frank, Dr. Webb, Mr. Blewitt, and Mr. Wyman 
 rendered services which, if not so brilliant or 
 so exciting as those rendered at Orleans, are 
 certainly not less praiseworthy or valuable. 
 
 The war is now over. Peace has been signed. 
 And I can say without affectation that, through 
 many difficulties and dangers, the Anglo- 
 American Ambulance has successfully pursued 
 its humane mission. I believe it has accom¬ 
 plished much genuine good, that it has brought 
 aid and succour in the hour of great distress, 
 when such aid would otherwise have been 
 wholly wanting, and I for one shall look back, 
 as I believe also can do every other member of 
 the ambulance, not only with unalloyed pleasure, 
 but also a little pardonable pride, to the humane 
 career of the Anglo-American Ambulance. 
 
DESCRIPTION OF PLATES. 
 
 PLATE I. 
 
 The centre figure is a Prussian 15-pounder shell, of the kind the 
 Germans were firing at us from their field-pieces on the 1st of 
 September. This was the only one we found unexploded, and it 
 was picked up while still warm. Its outer leaden casing shows 
 the grooving caused by the rifled bore of the cannon. On each 
 side are a number of the fragments, both of lead and iron, into 
 which such a shell bursts. All of these, with the exception of the 
 largest, were extracted from different parts of the body. Above are 
 the various forms of bullets used, and a few also of those which 
 had been removed from wounds, some of them being considerably 
 altered in shape. A mitrailleuse cartridge is likewise shown. 
 Twenty-five of these deadly missiles are fired at each discharge of 
 the piece. I believe they generally kill in place of disabling 
 the soldiers. The following description of the Prussian artillery, 
 from the Revue des Deux Mondes, is very interesting:— 
 
 “ Tho Prussian pieces belong chiefly to the models styled 6, 12, 
 and 24 rifled breech-loaders. The weight of the percussion shells 
 thrown by these cannons is respectively 7, 14, and 28 kilogrammes. 
 The large Krupp cannons, of which so much has been spoken, are 
 pieces of 48 and 96 (there are some of even still larger calibre), 
 throwing projectiles of 50 and 94 kilogrammes to a distance of 
 8 kilometres. All these projectiles are cylinders terminating in 
 an ogive, solid or hollow. The cylindrical surface is furnished 
 exteriorly with annular projections, destined to retain an envelope 
 or coating of lead surrounding the body of the projectile, which is of 
 
142 
 
 
 cast-iron. The advantage of the envelope of soft metal is to force 
 tho projectile into the grooves of tho piece, to suppress thus the 
 windage or passage of the gas produced by the ignition of tho 
 powder, and as a consequence the jolting of the projectile in the 
 bore of the piece. By this means great tension is given to 
 the course or trajectory followed by the projectile after leaving 
 the cannon. In other words, the range and accuracy are increased, 
 and the penetrating power of the projectile is greater. 
 
 ‘ 1 The ogivo-cylindrical form of the percussion shells sent us by 
 the Prussians is known. These projectiles burst by means of 
 fusees styled percutant. At the moment when the shell strikes 
 the ground, a small metallic stalk, terminating in a point, acts 
 upon a fulminating capsule screwed on the head of the shell, and 
 the powder is ignited. The shell bursts, and the fragments, to 
 the number of a score or so, and of different sizes, are violently 
 scattered, mostly in front, to a distance which often reaches 
 several hundred metres. The sheaf of projection takes a fan-like 
 form, whose centre is precisely the spot touched by the shell. 
 The leaden coating, although strongly laminated, principally on 
 the surface in contact with the inferior part of the bore, is itself 
 violently separated from the shell, at least in many cases, and 
 serves to increase the destructive effects produced by the cast-iron 
 by tearing into the shape of large flakes, sometimes twisted and 
 contorted in a thousand ways. 
 
 ‘ ‘ When the capsule does not go off, as happens when the shell 
 falls on heavy, damp, or porous soil, the projectile makes a large 
 opening in the ground in penetrating, from fifty to sixty centi¬ 
 metres in diameter at the opening, and of variable depth, according 
 to the velocity of the projectile and the nature of the soil traversed, 
 but it may attain even two or three metres. The inclination 
 of the hole is that which the shell had on arriving, and its direc¬ 
 tion that of the lino of fire. Sometimes the shell bursts at the 
 bottom of the chamber which it has made, and then the earth 
 above is lifted up like a dome, and cracked to the surface. When 
 the shell has not burst, it would be very dangerous to try to get 
 at it without some precautions. In all cases it is well to plunge 
 it in a bucket of water, and have the capsule unscrewed by a 
 person of the craft. The powder is then slowly emptied, and the 
 enormous sugarloaf of metal, clothed on all its cylindrical portion 
 with an intact coating of lead, which here and there bears marks 
 of the annular projections of the cast-iron, or the sharp grooves 
 
143 
 
 produced by the rapid passage of the projectile in the bore of the 
 piece, forms a kind of artistic object well calculated to tempt 
 collectors. Towards the eye, or open part of the shell, grooved 
 interiorly to admit of the percussion-fuse being screwed in, is a 
 sort of inclined canal, which traverses the cast-iron from the 
 exterior to the interior. Through this passes a small metallic 
 spit, interposed between the capsule and the percutor. By the 
 rapid rotatory movement made by the projectile on itself on 
 leaving the cannon, this little spit is soon thrown out in virtue of 
 centrifugal force, and at the moment of the shock the percutor 
 can act freely on tho head of the capsule, until then the inter¬ 
 vention of the spit is intended to prevent all danger of a premature 
 explosion. 
 
 “The percussion shell betrays itself on its way by a sort of 
 peculiar whistling. This iEolian-harplike vibration is never for¬ 
 gotten by those who have once heard it. The whistling proceeds 
 from the resistance offered by the air to the passage of the 
 projectile, which possesses a great velocity, about 300 or 400 
 metres per second. As the velocity diminishes in proportion to 
 the distance traversed by the shell, the intensity of the whistling 
 also diminishes; but the noise is heard very far off, often for 
 several seconds, and consequently at a distance of two or three 
 kilometres. The ear easily judges of the direction in which the 
 projectile is going, and the extreme sensitiveness of the organ 
 becomes thus a veritable means of preservation, for the percussion 
 shell passes so rapidly that it is not seen coming, and cannot bo 
 perceived in the air, even at night. One may hear it burst, or 
 even be reached by it, when it is still thought to be far off. The 
 noise produced by the explosion of the percussion shell is quite 
 a special one. It cannot be compared to that of the detonation of 
 a cannon. Heard at a little distance, it is a dead, dull sound, 
 accompanied by the repercussions of the echo, and the vibrations 
 resulting from the striking of the fragments against the walls and 
 soil. At night there is something sinister in all this music, and 
 if one be in the active sphere of the bombardment, that is to say, 
 in the district aimed at and reached, there is little chance of sleep.” 
 

 
 
 
 
 
 
 
 
 
145 
 
 PLATE II. 
 
 Fig. 1. Near the condyles of the fomur tho bullet often makes 
 a cloan round holo through tho cancellated tissue, as is seen in this 
 instance. Tho amount of splintering is, however, enormous. In 
 the plate is shown, a little way above tho internal condyle of tho 
 right femur, the point of entry of the ball. The edges of tho 
 aperture are quite sharp externally, and bevel off inside, just as 
 ono may see them in a pane of plate-glass through which a bullet 
 has been fired. In Plate IV., Fig. 1 b, the posterior view of tho 
 same specimen is given, and there tho very much larger and more 
 irregular aperture of exit may be very distinctly traced, with 
 fragments of bone, somewhat everted, surrounding tho edges. 
 Tho direction of tho bullet may thus bo ascertained without 
 difficulty from the most cursory examination of the specimen. 
 In the sixth circular of the American Surgeon-General, p. 33, 
 an injury of a very similar character is represented. 
 
 Fig. 2. The fragments removed from the shoulder and elbow- 
 joints of the right arm of a Chasseur d’Afrique, Louis St. Aubin, 
 the particulars of whose case, No. XLVI., are narrated on pp. 107 
 to 110. Several small pieces of the elbow-joint have been shot 
 away or lost. 
 
 Fig. 3 shows the effect of a conoidal bullet traversing tho right 
 tibia at a high velocity. Tho hole mado by the missile is small, 
 but the splintering is most extensive. Tho ball has entered on the 
 internal aspect of tho bone, and emerged as shown in Fig. 3 b, 
 Plate III., on the outer side. There is no great difference in tho 
 sizo of theso openings, but tho wedge-like power of the projectile 
 is demonstrated by its having so largely split in several directions 
 the upper half of tho tibia. This specimen is from one of the cases 
 admitted to Asfeld at a late date. An attempt had been mado to 
 preserve tho limb, and a certain amount of new material has been 
 thrown out, but secondary amputation at the knee-joint proved 
 necessary, and the case terminated, like many of the rest, fatally. 
 
 L 
 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
147 
 
 PLATE III. 
 
 Fig. 3 b shows the external surface of the fractured tibia last 
 described and figured in Plate II. 
 
 Fig. 4. In this instance, also, the patient was not admitted 
 under our care until a fortnight after the date of injury, too late 
 to attempt any operation, as he was then in a very weak state, and 
 soon after died exhausted. The fracture is situated at the middle 
 of the right femur, and besides being comminuted and split into 
 large fragments, portions of the bone were driven considerable 
 distances into the surrounding muscles. There was a good deal 
 of deformity and shortening. The specimen shows a certain amount 
 of callus to have been thrown out. No. 1643, in the American 
 Military Museum, photographed in the beautiful series issued by 
 the Surgeon-General, is an example of an injury almost identical 
 in form. 
 
 L 2 
 

 
 
 
 
 
 . 
 
 
 
 

 
 
 
 
 
 
 
 
149 
 
 PLATE IY. 
 
 Pig. 5. This is a very interesting specimen. The patient from 
 whom it was removed was wounded on the 1st Sept., and died 
 exhausted on the 28th of the same month, with all the symptoms 
 of penetrating wound of the chest and none other. The hall, 
 coming from the front, entered the right side of the chest, carrying 
 portions of the ribs into the pleural cavity. It emerged close to the 
 angles of the second and third ribs, fracturing them both. It then, 
 passing obliquely upwards, carried away the spines and portions of 
 the laminae of the 2nd dorsal the 1st dorsal and the 7th cervical 
 vertebrae, and finally emerged through the anterior edge of the left 
 trapezius muscle. The patient was not seen by us until admitted 
 on Sept. 9th to Asfeld, and the exact nature of the injury was not 
 revealed till after the autopsy was made. The spinal canal was 
 largely laid open, and a piece of cloth the size of a florin, found 
 lying in it. The cord and its coverings were not injured. In this 
 way alone may he accounted for the curious fact, that there was 
 not the smallest symptom, traceable to spinal injury, present at 
 any time during the four weeks the man lived, and that ho died 
 simply from tho consequences of the penetrating wound of the 
 chest. 
 
 Fig. 1 b gives the posterior view of Fig. 1, Plate II., already 
 described. 
 

 
 
 
 
 
PLATE V. 
 
 Fig. 6. Left humerus, through the lower portion of which a 
 small fragment of shell had passed. Considerable efforts at repair 
 have been made. The patient died of pya'mia. 
 
 Fig. 7 shows a large irregular tunnel through the internal 
 portion of the head of the left tibia, caused by a Prussian bullet. 
 Secondary amputation was performed, but the patient died of 
 pyaemia. The complete erosion of the cartilage from the articular 
 end of the femur is very perfectly shown. 
 


 
 
 
 
 
 
 
 
 
 
153 
 
 PLATE VI. 
 
 Fig. 8 shows tho almost complete destruction of the lower end of 
 the tibia and fracture of tho fibula by a Prussian ball. A con¬ 
 siderable amount of repair has taken place. Amputation was 
 subsequently successfully performed. 
 
 Fig. 9 is a heliotype of the tibia and fibula removed by 
 secondary amputation at the knee-joint. Tho particulars of tho 
 case No. LIII., are given on p. 134. The ball has simply grooved 
 the lower extremity of the tibia, but in doing so it also caused a 
 spiral fracture, a portion only of which is seen, to extend half-way 
 up tho bone. 
 

 

 
 
 *•. v 
 
 
 
 
 
 4 
 
 ■ 
 
 
 
 4 . 
 
 
 
 * 
 
 
155 
 
 PLATE VII. 
 
 Fig. 10 is taken from the left femur of a man on whom secondary 
 amputation was performed. He was also one of the late arrivals, 
 and it seems strange why amputation was not had recourse to in 
 the first instance. Although gunshot wounds of all the joints, 
 even the knee, may often he obscure, one would think the track 
 of a ball which passed straight through the patella might readily 
 have been traced. It was a Prussian bullet, which, after splitting 
 off the internal condyle, lodged, as here represented, in the lower 
 extremity of the femur. The patella is extensively comminuted. 
 
 Specimen o9, in the series of American photographs before 
 alluded to, is an illustration of a somewhat similar description 
 of injury, except that the patella was not fractured. 
 
 Fig. 11. The man who received this injury must have been 
 kneeling at the time. A Bavarian bullet has grooved very deeply 
 the anterior surface of the lower end of the femur, and after 
 splitting off the external condyle, became impacted, as its velocity 
 diminished, in the shaft of the bone where the more compact 
 tissue commences. The bullet is a good deal altered in shape. 
 
 LONDON : PARDON AND SON, PRINTERS, TATERNOSTER ROW. 
 
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