mainder of the foot may be saved by amputation of the affected part, and the toes removed at the same time. Should the point of the toe be saved and the part behind removed, the portion left would most probably be useless; although a very different procedure is advocated for disease of the metacarpal bone of the fingers and the thumb.

No set rules can, however, be laid down for any of these operations on the tarsus and metatarsus, and everything must depend upon the nature of the wound; and the anatomical knowledge of the surgeon can generally devise some means for the removal of the injured or diseased part, instead of the last resource of amputation.

CHAPTER XX.

THE NUMBER THAT ARE WOUNDED, AND THE PROPORTION THAT SURVIVE UNDER THE DIFFERENT CLASSES OF GUNSHOT WOUNDS.

Ir is curious to remark the numbers that are wounded, and the proportion that survive under the different classes of gunshot wounds. Take, for example, the total number of cases that arrived from India under wounds of the three large cavities, up to March 31st, 1858:

Head, 15, or 2.48 per cent. of the total that arrived, viz., 603. Chest, 19, or 3.16 per cent. Abdomen, 8, or 1·15 per

cent.

The numbers from India do not represent the frequency or the mortality of gunshot wounds in those different regions; but from April 1st, 1855, to the end of the Crimean war,* the total wounded was 7153. Of these, in the

Head, 851 treated, or 11.9 per cent. of the entire wounded; 170 died, or 20 per cent. of those treated. Chest, 420 treated, or 5.8 per cent. of the entire wounded; 118 died, or 28.1 per cent. of those treated. Abdomen, 235 treated, or 3.28 per cent. of the entire wounded; 131 died, or 55.7 per cent. of those treated.

From this it would appear that gunshot wounds of the head (in siege operations, at least) are twice as frequent as those of the chest, and more than three times compared to the abdomen; while wounds of the chest are more than 8 per cent. more fatal than the same injury in the head, and gunshot wounds of the abdomen are 27 per cent. more fatal compared to those of the chest.

* Vide Report.

On comparing the frequency among the cases from India of— Gunshot wounds of the superior extremity, 159, or 26.36 per cent. of the total that arrived. Amputation of the superior extremity, 127, or 21.22 per cent. Total, 286, or 47.42 per cent.

Gunshot wounds of inferior extremity, 162, or 27-03 per cent. Amputation of the inferior extremity, 34, or 5.80 per cent. Total, 196, or 30.84 per cent.

From this it is seen that there is only an excess of 3 in the wounds of the lower than that of the upper extremity; but the proportion of successful amputations is very much in favour of the superior extremity, there being 83 more than in the lower extremity. The number of amputations of the arm are 46, and of the thigh 11. This difference is to be attributed to the greater mortality in amputation of the thigh over that in the The amputations of the forearm and leg are very nearly the same, being 19 of the former and 18 of the latter. There are 53 amputations of the fingers and thumbs, while there are only 2 of the toes; still, these minor operations raise the proportion of the total number of successful amputations of the superior over the inferior extremity.

arm.

In the Crimean war there were

Gunshot wounds of the superior extremity, 2083 treated, or 30.2 per cent. of the entire wounded; 47 died, or 2.9 per cent. of those treated. Gunshot wounds of the lower extremity, 2198 treated, or 31.76 per cent. of the entire wounded; 166 died, or 8.3 per cent. of those treated.

Had the result of the operations performed been added, the difference would have been increased in a very material degree.

The number of cases that occurred under the remainder of the classes is very small, as the following extract from the return of the India cases will show:

Gunshot wounds of the face, 22, or 3.64 per cent. of the entire wounded.

Ditto, neck, 7, or 1.15 per cent.

Ditto, back and spine, 9, or 1.49 per cent.

Ditto, perineum, genital and urinary organs, 3, or 0.49 per

cent.

Ditto, with direct penetration of the larger joints, 8, or 1:32 per cent.

Ditto, with direct injury of the large arteries, not being at the same time cases of compound fracture, 0.

Ditto, with direct injury of the larger nerves, not being at the same time cases of compound fracture, 6, or 0.99 per cent. Sword and lance wounds, 12, or 1.99 per cent.

Bayonet wounds, 2, or 0.33 per cent.

Miscellaneous injuries received in action, 9, or 1.49 per cent. On referring to the "Return of the Wounded from the Crimean War," nearly the same proportion under these classes is found to hold good:

Gunshot wounds of the face, 533 treated, or 7.45 per cent. of the entire wounded; 14 died, or 2.60 per cent. of those treated.

Neck, 128 treated, or 1.79 per cent. of the entire wounded; 4 died, or 3.12 per cent. of those treated.

Back and spine, 326 treated, or 4.55 per cent. of the entire wounded; 45 died, or 13.49 per cent. of those treated.

Perineum, genital and urinary organs, 55 treated, or 0.76 per cent. of the entire wounded; 17 died, or 30-96 per cent. of those treated.

With direct penetration or perforation of the larger joints, 121 treated, or 1.65 per cent. of the entire wounded; 25 died, or 20-66 per cent. of those treated.

With direct injury of the larger arteries, 12 treated, or 0·16 per cent. of the total wounded; 8 died, or 66-66 per cent. of those treated.

With direct injury of the larger nerves, 22 treated, or 0.30 per cent. of the total wounded; 8 died, or 36.36 per cent. of those treated.

Sword and lance wounds, 7 treated, or 0.09 per cent. of the total wounded; 1 died, or 14.28 per cent. of those treated. Bayonet wounds, 36 treated, or 0.50 per cent. of the total wounded; 4 died, or 11.11 per cent. of those treated.

Miscellaneous wounds received in action, 126 treated, or 1.62 per cent. of the total wounded; 6 died, or 476 per cent. of those treated.

CHAPTER XXI.

TRANSPORTATION OF SICK AND WOUNDED.

THIS is a subject demanding the attention of every military surgeon; although not exclusively of a professional nature, still it ought to be one of his special care. It is a matter of the greatest importance during an action, and is one of the chief difficulties in the operations of all armies, not only affecting the wounded themselves, but also the whole army. Numbers of men fall out under the pretence of attending to a wounded comrade or officer, when they ought to remain in the ranks doing their duty.

There is now an Army Hospital Corps, to attend upon the sick and wounded in field and general hospitals, &c.

The Military Train has in charge a fixed amount of the wheel and other means of transport, which now ought to do away with the colouring pretext under which some men formerly left the field during action.

It appears to me that it would be of advantage to have an Ambulance Corps, and a certain number of men, under a permanent military officer, belonging to the Military Train, and appointed specially for this particular duty, so that he might be held responsible for the proper equipment of every description of conveyance for the sick and wounded under all circumstances.

The horses used for ordinary purposes in the waggons of the Military Train will not remain quiet under litières and cacalets; and further, the horses for conveyances of this description should be trained daily to carry some such load; as not one horse in a hundred, in anything like good condition, would carry a litière swinging on its back. Still, it may be remarked that horses during a campaign are not generally so very fresh as in the time of peace.