THE PRIMARY SURGERY 
OF 
GEN. SHERMAN’S CAMPAIGNS. 
BY E. ANDREWS, M.D., 
PROF. OF SURGERY iN CHICAGO MEDICAL COLLEGE, 
AND 
J. M. WOODWORTH, M.D., 
LATE .MEDICAL DIRECTOR OF THE ARMY OF THE TENNESSEE. 
GEORGE H. FERGUS, BOOK AND JOB PRINTER, 
12 & 14 CLARK STREET. the PRitttirSTrom 
OF 
GEN. SHERMAN’S CAMPAIGNS. 
By E. ANDREWS, M.D., Prof, of Surgery in Chicago Medical College, and 
J. M. WOODWORTH, M.D., Late Medical Director of the Army 
of the Tennessee. 
A perfect record of the primary surgery of a military cam- 
paign is a desideratum seldom obtained. Owing to the hurry 
of battle and the movements of troops, records on the spot are 
too often neglected, and any perfect estimate of the value of 
the various surgical operations rendered impossible. The au- 
thors of this article, who were both under the command of Gen. 
Sherman, viewed with great regret the almost total loss of sur- 
gical statistics which occurred in the first half of the war, and 
resolved on making a strong effort to preserve reliable records 
of the army in which they served. For this purpose, they 
made systematic preparations before any similar system was 
established by the War Department, and succeeded in obtaining 
a large mass of valuable information which has never reached 
the Surgeon-General’s office. At a later period, the surgical 
records of the army underwent a reform, and furnished the 
means of obtaining still larger collections of material. 
The subjoined tables contain almost the entire primary sur- 
gery of Gen. Sherman’s army, during the campaigns in Geor- 
gia, leading to the capture of Atlanta, the famous “March to 
the Sea,” the siege of Savannah, and the operations in South 2 
Primary Surgery of Gen. Sherman s Campaigns. 
and North Carolina to the close of the war. With this is com- 
bined a complete record of the battle of Chickasaw Bayou, 
near Vicksburg, a portion of the other engagements in that 
region, and a large number of facts, gathered from Shiloh, 
Corinth, and other Western battles. The death or recovery of 
each patient is given, so far as obtainable, and if unknown is 
so stated. 
Gen. Sherman’s troops were always remarkable for the im- 
mense marches which they undertook. They were kept in the 
lightest possible moving order, and, to a great extent, dispensed 
with the use of tents, except when stationary. Their history 
is briefly this:— 
After the battle of Shiloh, they moved on Corinth and con- 
stituted the extreme right at the capture of that place. They 
then moved leisurely to Memphis, fortified that place, and occu- 
pied the surrounding region, engaging in many small skirmishes, 
but meeting no large body of the enemy. Thence, they moved 
by water to Vicksburg, where they engaged in the battles of 
Chickasaw Bayou, Arkansas Post, siege of Vicksburg, and 
the other important operations in that region. At the close of 
this campaign, they returned by water to Memphis, and thence 
undertook that prodigious march from the City of Memphis 
almost to Knoxville, and thence back again to Chattanooga. 
In this region were fought the battles of Mission Bidge, Resaca, 
Allatoona Pass, Kenesaw Mountain, Jonesboro, etc., etc., re- 
sulting in the capture of Atlanta, after a most magnificent cam- 
paign. After making proper arrangements, Gen. Sherman 
sent to the rear all his sick, wounded, and enfeebled men, and, 
with a force of over 65,000 seasoned and hardy troops, com- 
menced his renowned “March to the Sea.” On this march 
there occurred some sharp fighting, but, owing to the splendid 
arrangements of Med. Director Moore, all the wounded were 
carried through, not a man being left behind. There was an 
opportunity here to observe the effects of land transportation 
upon wounded men, and to compare them with the results pre- 
viously seen on the hospital steamers of the Mississippi River. 
The results were calculated to overthrow some of the received Primary Surgery of Gen. Shermans Campaigns. 
3 
opinions on this subject. These wounded, though carried in 
ambulances an immense distance, suffered a much less mortality 
than the average of the hospital steamers, and even of many 
of the general hospitals. We infer from this, not that wheel 
transportation is free from all injurious effects, but that the 
pure air of an open ambulance, in spite of its shaking, renders 
it a safer place for a wounded man than the foul air of many 
general hospitals and hospital steamers, notwithstanding their 
quietness, their good food, and their soft cots. Where a por- 
tion of the wounded of a battle are taken in ambulances to a 
general hospital at some distance, and another portion are kept 
in the field, it is uniformly found that those who are treated in 
the hospital do worst. This is often attributed to the shaking 
received on the route from the ambulance. The experience of 
the “March to the Sea” shows, however, that wounded men 
carried in ambulances from the day of battle to the termination 
of the case, do better than in most general hospitals. The prime 
necessity of a wounded man is pure air, and compared with 
this, all questions of diet, beds, and even shelter and repose 
seem to be secondary. This great truth was difficult to learn, 
and, to many of us, hard to believe, until it was taught by the 
stern experience of war, and proved by observations covering 
many thousand cases. 
At the close of the war, marked by the surrender of John- 
son's army in North Carolina, Sherman’s forces marched to 
Washington. During this movement, an illustration of the evils 
of forced marches was displayed on a large scale. The troops 
were in the highest exhilaration of spirits, at their magnificent 
conquests and at the prospect of a speedy return home. Acting 
under this natural impulse, the 15th and 17th Army Corps 
virtually ran a footrace of several days duration, to see who 
should reach Richmond first. From 15 to 17 miles is a wood 
O 
day’s march for infantry, and very few generals can get large 
bodies of men over as great an average distance as that, when 
moving day after day for a considerable time. On the 1st of 
May, these two corps marched 20 miles; on the 2d, 25 miles; 
on the 3d, 13 miles; on the 4th, 241 miles; on the 5th, 18 Primary Surgery of G-en. Shermans Campaigns. 
miles; and on the 6th, 26 miles, when they halted near Peters- 
burg. As the result of this enormous footrace of six days dura- 
tion, 1630 men were found disabled from lameness and exhaus- 
tion, and had to be sent to Washington by steamers. 
The total number of wounded on our records, is 6122. Of 
these, 1042 are simply entered as wounded, with no additional 
information respecting them. 
THE NUMBER OF THE WOUNDED. 
CAUSES OF WOUNDS. 
The cause of the wounds is recorded in 4480 cases, as shown 
in the following table:— 
Bullets, (nearly always conical,) 3980 
Shells, 384 
Buckshot, 25 
Grape and Canister, N- 24 
Torpedoes, 14 
Pistol Shots, 12 
Solid Shot, 11 
Accidental Explosions, 8 
Bayonets, 7 
Splinters, 6 
Stones, 3 
Gun Caps, 3 
Strippings of Cannon Shot, 3 
Sabres, 0 
Total, 4480 
It will be seen at a glance, that the musket is manifold the 
most destructive agent used in war, causing seven-eighths of all 
the wounds. This, however, is owing purely to the numerical 
preponderance of the infantry. If we examine the table, it 
will be seen that 431 wounds were caused by artillery, which 
is about 10 per cent of the whole number. Now it is not prob- 
able that the enemy’s artillery exceeded 7 per cent of his entire 
force, which shows that, in proportion to the men engaged, ar- 
tillery is more destructive than infantry and cavalry. It is 
seen, also, that almost the whole effect of artillery is produced Primary Surgery of Gen. Sherman s Campaigns. 
5 
by shells, the wounds of which were 384 in number, while the 
solid shot, grape, canister, splinters, stones, and strippings of 
shot, altogether, only injured 47 men. 
The buckshot are mostly from shotguns, in the earlier half 
of the war, when that weapon was extensively carried by the 
rebels. The remainder are from the old-fashioned round mus- 
ket ball cartridge, also much used by the enemy. The useless- 
ness of the buskshot is shown by the few wounds produced by 
them. The gun cap wounds were in the eye, and were caused 
by the bursting of the percussion cap on the nipple of the gun. 
Only 7 bayonet wounds are recorded, and a part of these 
were accidental. It will be remembered that though bayonet 
charges are often made, men seldom cross these weapons in 
close fight. One party or the other gives way before the col- 
lision occurs. 
The 14 torpedo wounds were all received in the storming of 
Fort McAllister, near Savannah, from torpedoes planted in the 
earth to assist in the defence. The pistol wounds were almost 
all received in the same assault, in consequence, doubtless, of 
the rebel officers using their pistols to increase the amount of 
fire from the walls. 
Not a single sabre wound is recorded, though these weapons 
were carried by all the cavalry and many of the artillery. The 
rebels, at the beginning of the Avar, had high expectations for 
their cavalry, owing to the great prevalence of habits of saddle 
travel in that region; but this, like many other mistakes, arose 
from not considering all their circumstances. The fact is, the 
nature of the country is such, that extensive cavalry operations, 
in the European sense of the term, are impossible. Almost 
every battle Avas either in the forest, or among such crags, 
ravines, or marshes that an opportunity for a regular charge 
by mounted men could scarcely ever be found. A body of 
highly-trained European cavalry placed in our Southern States 
Avould have been the most helpless piece of lumber that ever 
encumbered an army—incapable of defence, and useless for 
attack. Both sides, therefore armed their mounted forces Avith 
carbines, and sabres rusted idly in their scabbards. 6 
Primary Surgery of Gren. Sherman's Campaigns. 
DISTRIBUTION OF THE INJURIES. 
The following table shows the nature and position of injuries, 
with their results, so far as traced:— 
Wound. 
Recov’d. 
Died. 
Result Unk’n. 
Flesh wounds of head, 
146 
10 
69 
Non-penetrating flesh wounds of trunk, 
214 
7 
87 
Penetrating wounds of thorax, - — 
26 
127 
76 
u “ abdomen, - 
7 
109 
31 
“ “ pelvic viscera,- 
4 
Flesh wounds of superior extremity,-- 
221 
2 
78 
“ “ inferior “ 
425 
•9 
81 
Wounds of large arteries,- -- — -- 
5 
3 
2 
Contusions, - - - -- 
102 
4 
34 
Concussions, — -- - -- 
6 
2 
2 
Fractures of cranium, not penetrating 
the brain, 
15 
9 
7 
Penetrating fractures of cranium,-- - 
54 
7 
Comp, fractures of facial bones, -- 
45 
8 
15 
Fractures of spine,- 
2 
21 
3 
Compound fracture of scapula, 
10 
5 
“ “ clavicle, 
1 
3 
“ “ shoulder-joint,— 
63 
20 
17 
“ “ humerus, 
101 
24 
55 
“ “ elbow-joint, 
29 
7 
17 
“ “ forearm, - - 
88 
8 
50 
“ “ wrist, -- -- 
13 
8 
“ “ hand & fingers,- 
124 
2 
“ “ pelvis, 
7 
10 
11 
“ “ hip-joint, 
9 
1 
“ “ femur, - - 
78 
125 
57 
“ “ knee-joint, - -- 
24 
45 
41 
“ “ leg, 
91 
45 
73 
“ “ ankle-joint, 
14 
1 
8 
“ “ foot, - -- - 
53 
3 
23 
Wounds not described, mostly flesh- 
wounds which usually recovered,- 
2683 
1910 
671 
3541 
In looking Over the above list, it will be seen that it is impos- 
sible to determine the absolute ratio of mortality, owing to the 
great number of cases in which the results are unascertained. Primary Surgery of Gen. Sherman s Campaigns. 
7 
As the greater part of the deaths occur within 20 days of the 
injury, it is to be presumed that the deaths were much fewer 
among the cases which went to the rear and were lost sight of, 
than among those of which the result was ascertained. As a 
test of relative mortality, however, the table is valuable. 
FLESH WOUNDS. 
Simple flesh wounds, not involving large vessels, nerves, nor 
important cavities, produce very little danger. Of 1034 flesh 
wounds whose results were ascertained, only 28 died, or a little 
over 2 per cent. 
PENETRATING WOUNDS OF THE CHEST. 
The danger of this class of injuries is in striking contrast to 
the safety of the preceding. Of 153 cases, whose results were 
ascertained, 127 died, and only 26 recovered, being a mortality 
of about 83 per cent. As there were 76 cases Avliose termina- 
tion was not ascertained, it is probable that a larger portion of 
them recovered, which would reduce the rate somewhat. The 
Surgeon-General, from a list of 1272 cases, reports a mortality 
of 73 per cent. 
These are still more fatal than those of the chest. Out of 
116 cases 109 died, making a mortality of 94 per cent, while 
only 31 cases remained in doubt. The Surg.-Gen.’s statistics 
differ widely from these. In a list of 543 cases he reports a 
mortality of only 74 per cent, which is only a trifle greater 
than that of the chest wTounds. As this is contrary to all our 
personal observation, we are compelled to believe that the 
Surg.-Gen.’s statistics must be vitiated by cases of mere flesh 
wounds of the parietes, falsely reported by careless and hurried 
surgeons as penetrating wounds. This is the more likely, as 
the diagnosis is not always easy, and conjectures are often put 
into official reports instead of knowdedge, in the hurry of field 
duty. Certainly there must be a great error somewhere in 
figures which make penetrating wounds of the abdomen scarcely 
more dangerous than those of the chest. 
PENETRATING WOUNDS OF THE ABDOMEN. 8 
Primarg Surgery of Gren. Sherman s Campaigns. 
We found the proportion of deaths so great that we seriously 
contemplated the heroic experiment of opening the abdominal 
cavity, washing it out, and stitching the wounded intestine to 
the external orifice, as a desperate resort for a desperate in- 
jury; but not finding any authority to justify us, we did not 
finally venture on it. We deem the suggestion, however, wor- 
thy of serious consideration. Wounds of the large intestine 
appear, for some reason, to be more hopeful than those of the 
small bowel. 
WOUNDS OF THE PELVIC VISCERA. 
These were few in number and uniformly fatal, in our re- 
corded cases. We learned, however, of cases that recovered in 
other departments. 
FRACTURES OF THE CRANIUM. 
These fractures should he considered in two classes, viz.:— 
the penetrating, and the non-penetrating. Those in which a 
bullet, or even a buckshot, penetrates the brain are the worst 
of all wounds. Out of 61 cases on our list, 54 are known to 
have died, not a single one was ascertained to have recovered, 
and only 7 remained in doubt. The cases, however, in which 
the bullet only fractured the bone and lodged or glanced off 
without penetrating the brain were widely different in their re- 
sults. Out of 24 cases only 9 died. The Surg.-Gen.’s reports 
mix both these classes together, so that it is impossible to com- 
pare his results with our observations. In two of the non-pene- 
trating fractures, epilepsy is ascertained to have ensued. 
FRACTURES OF THE SPINE. 
Out of 26 cases 21 died, only 2 recovered, and 3 were unas- 
certained. Entirely similar to this is the official record of the 
Surg.-Gen., who has a list of 187 cases, out of which 180 died. 
FRACTURES OF THE SCAPULA AND CLAVICLE. 
Fractures of the scapula gave us no ascertained case of 
death, but out of 4 fractures of the clavicle 3 died; but the 
fatal result in these cases was owing to penetration of the lung, 
and other complications. Primary Surgery of (Jen. Sherman's Campaigns. 
These, are not very dangerous, and generally do well under 
conservative treatment. The table shows that the danger dimin- 
ishes as the location of the injury recedes from the shoulder. 
FRACTURES OF THE SUPERIOR EXTREMITY. 
FRACTURES OF TIIE IIIP-JOINT. 
Of 9 ascertained cases, not one recovered. The statistics at 
Washington show similar results. Of 82 cases, only 2 survived. 
FRACTURES OF THE FEMUR. 
These are a most dangerous class of injuries. The brittle, 
ivory like tissue of the shaft of the femur is often comminuted 
by the force of a bullet into a hundred fragments, which are 
spread out into the muscular tissue of the thigh with all the 
force of an explosion. The shock, therefore, is tremendous, 
and a large portion of the patients sink without reaction. 
Great efforts have been made to improve this result, by new 
modes of treatment, but still the fact remains that the majority 
of gunshot fractures of the femur are fatal. Our table shows 
78 recoveries and 125 deaths. The report of the Surg.-Gen., 
in like manner, shows 462 recoveries and 689 deaths, which 
gives nearly the same ratio. 
FRACTURES OF THE KNEE-JOINT. 
These also are fearful injuries. Out of G9 ascertained cases, 
we lost 45, which is a mortality of 65 per cent. The tables of 
the Surg.-Gen. are much less favorable. They show 598 deaths 
out of 770 cases, which is a mortality of nearly 78 per cent. 
This result is mainly attributable to the fact that almost all 
our cases were treated by primary amputation, while many of 
the Surg.-Gen.’s cases were treated conservatively, which in 
this injury is synonymous with destructively. 
The following table shows the cases of amputation in which 
the results were ascertained:— 
AMPUTATIONS. 10 
Primary Surgery of Gen. Sherman's Campaigns. 
Recovered. 
Died. 
Per cent 
of Deaths. 
Primary amputation at Shoulder-joint,— 11 
2 
15 
Secondary “ “ — 2 
1 
33 
Primary u Arm, - --- - 55 
5 
8 
Secondary “ “ - - 4 
1 
20 
Primary “ Forearm, _ - 21 
2 
9 
Secondary “ “ 
1 
Amputation at Hand,-- - 4 
1 
20 
“ Fingers, -- 60 
1 
u 
Primary amputation, Upper 3d of Femur, 5 
13 
72 
Secondary “ “ “ 
2 
Primary “ Middle 3d “ 11 
14 
56 
Secondary “ Middle 3d of Femur, 2 
o 
50 
Primary “ Lower “ “ 37 
24 
40 
Secondary “ “ “ “ 24 
12 
33 
Primary “ Leg, ----- 60 
24 
29 
Secondary “ “ 7 
4 
36 
Amputation at Ankle-joint, 3 
Pirrogoff’s amputation, — - --- 2 
1 
25 
1 
33 
Syme’s “ - 
1 
Chopart’s “ ------ 2 
Amp. at other parts of Foot and Toes,— 18 
1 
5 
The following figures, extracted from Circular No. 6, of the 
War Department, will serve as a basis of comparison with the 
above:— 
Amp. of Fingers and parts of Hand, 
Recovered. Died. 
—- 1778 29 
Ter cent 
of Deaths. 
1.60 
“ at Elbow,-- -- 
“ Forearm, - - - - - 
—- 19 
—- 500 
99 
16.52 
“ Arm, -- - 
—- 1535 
414 
21.24 
“ Shoulder-joint, - --- 
—- 144 
93 
39.24 
“ Toes,-- — -- ----- 
—- 784 
6 
.75 
Partial amp. of Foot, 
—- 108 
11 
9.24 
Amp. at Ankle-joint, 
—- 58 
9 
13.43 
“ Leg, 
-— 1737 
611 
26.02 
“ Knee-joint,- - -_ - 
—- 52 
64 
55.17 
“ Thigh, 
-— 568 
1029 
64.43 
“ Hip-joint, - - 
3 
18 
85.71 
The following list of amputations is compiled from the re- 
cords of Surgeon-General Chisholm, of the Confederate Army: Primary Surgery of (Jen. Sherman s Campaigns. 
11 
Per cent of 
riace of Amputation 
Recovered. 
Died. Mortality. 
Primary am 
iputation Sliouldcr-joint, 
— 54 
25 
31 
Secondary 
a 
u 
8 
20 
71 
Primary 
u 
Arm, 
252 
42 
14 
Secondary 
u 
— 87 
53 
37 
Primary 
u 
Elbow-joint, - - 
3 
1 
25 
Secondary 
u 
U 
— 23 
6 
26 
Primary 
u 
Forearm, — . 
61 
8 
12 
Secondary 
u 
U 
35 
10 
22 
Primary 
a 
Hip-joint, 
1 
2 
Secondary 
u 
1 
1 
Primary 
u 
Thigh,- 
— 213 
132 
38 
Secondary 
u 
— 43 
119 
73 
Primary am 
putation Leg, - - 
219 
95 
30 
Secondary 
U 
u 
76 
74 
49 
Primary 
U 
Chopart’s, - — - 
13 
3 
Secondary 
u 
U 
7 
1 
Primary 
u 
Syme’s, — 
2 
Secondary 
u 
___ 4 
Primary 
u 
Pirrogoff’s, - 
2 
2 
AMPUTATIONS AT THE SHOULDER-JOINT. 
For this operation we find the following rates of mortality:— 
In Sherman’s Army, prim, and sec., 23 per cent. 
U.S. Surg.-Gen.’s tables, “ 39 “ 
Confederate Army, primary, 31 “ 
British wars with Napoleon “ (Guthrie) 28 “ 
Mortality in Sherman’s Army, prim, and sec. 10 per cent. 
“ Surgeon-General’s tables “ 21 “ “ 
“ Confederate Army, primary 21 “ “ 
“ European Armies, (Guthrie) 23 “ “ 
AMPUTATIONS OF TIIE ARM. 
We saw no cases of amputation at the elbow\ 
AMPUTATIONS OF THE FOREARM. 
Mortality in Sherman’s Army, prim, and sec. 12 per cent. 
“ Surgeon-General’s tables “ 17 “ “ 
“ Confederate Army, primary 19 “ 12 
Primary Surgery of (Jen. Sherman s Campaigns. 
AMPUTATIONS AT THE IIIP-JOINT. 
This operation was not resorted to in any instance, conse- 
quently we can add nothing to the general stock of knowledge 
on that point. The Surgeon-General reports 21 cases, 18 of 
which died. 
Mortality. 
Primary Amp. 
in Sherman’s Army - 
49 per cent. 
Secondary “ 
U U 
61 “ “ 
Primary “ 
Confederate “ - ■ 
38 “ “ 
Secondary “ 
U U 
73 “ “ 
AMPUTATIONS OF THE TIIIGII 
The Surgeon-General does not distinguish between primary 
and secondary cases, and, therefore, his statement is not en- 
tered here for comparison. 
The death-rate varied very much, according to the distance 
from the body, as the following statement shows:— 
Mortality of Prim. Amp. in Upper 3d of Thigh 72 per cent. 
“ “ “ Middle “ “ 56 “ “ 
u “ “ Lower “ “ 40 “ “ 
AMPUTATIONS AT THE ANKLE-JOINT, 
These are few in number, but, so for as they go, confirm the 
superior safety of Syme’s operation, as compared with Pirro- 
goff’s. Adding our own figures to those of the rebel army, 
we find the following result:— 
Recovered. 
Died. 
Syme’s Amputation- - - 
6 
1 
Pirrogoff’s “ 
4 
3 
Pirkogoff, himself, is said to have abandoned his operation, 
on account of* the frequent necrosis of the stump of the os calcis. 
Certainly, the military record is* against it, and yet we have 
found it in civil practice a very useful and comparatively safe 
operation. 
It will be noticed above, that there is, apparently, a much 
less mortality in our statistics of amputation than in those of 
our Surgeon-General, or those of the Confederate Army. This Primary Surgery of Gen. Sherman's Campaigns. 
13 
arises, partly, from the fact that our cases are nearly all pri- 
mary, our observations being mostly confined to field service, 
while the records of the Surgeon-Generals of both armies con- 
tain an excess of secondary operations, from the fact that the 
general hospital cases were all faithfully reported to them, but 
the field cases were not so fully recorded. Their tabular 
results are, therefore, affected by the greater mortality which 
always belongs to secondary operations. The U.S. Surgeon- 
General has not stated separately the primary and secondary 
cases, so that we are unable to compare Sherman’s army in 
this matter with the rest of the Union forces. The Confed- 
erate statistics, however, are distinguished into primary and 
secondary, and still show a greater mortality than Sherman’s 
in most of the amputations. 
RESECTIONS. 
The following table gives a view of all the resections whose 
results were determined:— 
Per cent 
Operation. Recovered. 
Died. 
of Deaths. 
Prim. 
Resection of Shoulder-joint 
18 
8 
31 
Sec. 
U U 
23 
5 
18 
Prim. 
“ in continuity of the Humerus- 
7 
1 
12 
Sec. 
a u u a 
5 
Prim. 
“ of Elbow- -- - --- -- 
6 
2 
25 
Sec. 
u u 
1 
1 
Prim. 
“ in continuity of Forearm - 
19 
1 
5 
U 
“ “ Femur 
4 
100 
Sec. 
u u a 
4 
4 
50 
Prim. 
“ of Knee-- — --- — --- 
1 
1 
Sec. 
a u 
1 
Resections in continuity of Tibia- -- — 
5 
a 
“ Fibula - 
3 
u 
“ Clavicle — 
1 
4 
80 
Resections in Sherman s Army. 
Operation. 
Recovered. 
Died. 
Per cent 
of Deaths. 
Prim, llesection of Shoulder-joint - - 
160 
50 
23 
Sec. “ “ 
183 
115 
39 
Resections reported by the U.S. Surgeon-General. 14 
Primary Surgery of Glen. Sherman s Campaigns. 
Resection of continuity of the Humerus-- 133 
42 
24 
U 
the Elbow 224 
62 
22 
U 
in the continuity of Forearm— 217 
32 
13 
u 
of the Hip-joint -- - 4 
26 
87 
4; 
in the continuity of the Femur- 6 
32 
84 
u 
of the Knee -- - -- 2 
9 
84 
u 
in the continuity of the Tibia-- 48 
11 
19 
u 
“ “ “ Fibula- 60 
15 
20 
Resections in the Confederate Army. 
Operation. 
Recovered. 
Died. 
Per cent 
of Deaths. 
Prim. Shoulder-joint 
28 
13 
27 
Sec. “ - 
19 
7 
21 
Prim. Elbow-joint- -- 
22 
3 
12 
Sec. “ -- 
23 
6 
24 
Ilip-joint - -- -- - --- 
1 
1 
Knee-joint 
2 
2 
From an examination of these tables, it will be seen that 
resections do not follow the law of amputations in respect to 
primary and secondary operations. In Sherman’s army, pri- 
mary resections were generally more fatal than secondary, 
though the reports from other parts of the army do not fully 
conform to the same rule. 
From comparison of the various tables, it will be seen that 
resection of the shoulder is preferable, on the score of safety, 
to amputation, and, accordingly, it was generally given the 
preference by surgeons, wherever the choice presented itself. 
In addition to the greater safety of the operation, there is the 
important consideration of the usefulness of the limb, which, in 
spite of the loss of bone, is very valuable. The same remarks 
are applicable to resections of the elbow and wrist. In short, 
the military surgeon may, in respect to resections of the supe- 
rior extremity, guide himself by the rules of civil surgery. 
The writers of- this article had no experience with military 
resections of the hip-joint, as we deemed that the patient’s 
chance was better without the operation than with it. The 
Surgeon-General’s tables give it a mortality of 87 per cent. 
For similar reasons, we abstained from resections of the 
knee-joint. The impossibility of transporting such patients in Primary Surgery of Gen. Sherman s Campaigns. 
15 
an ambulance is obvious at a glance. Wounds of the knee- 
joint were, therefore, generally treated by amputation at the 
lower 3d of the thigh. Of three such resections which fell 
under our notice, two died. The Washington statistics give a 
mortality of 84 per cent to resection of the knee, while the 
primary amputation in the lower 3d of the thigh only gave, in 
Sherman’s army, a mortality of 40 per cent. 
RESECTION IN TIIE CONTINUITY OF BONES. 
This class of resections is seen in the above tables to be con- 
siderably more fatal than amputations of the same parts, a fact 
which is well proved, but difficult to explain. Primary resec- 
tions in the continuity of the humerus had, among us, a mor- 
tality of 12 per cent, and amputations of only 8 per cent. In 
attempting the same resection on the shaft of the femur, 66 per 
cent died, which is 10 per cent worse than our experience in 
primary amputations in the middle of the thigh. Still, in the 
superior extremity, the use of the hand is so important that the 
operation may be risked, even on the humerus, in favorable 
cases, and in the inferior extremities, it is quite proper on the 
fibula and metatarsals. In the femur, the tibia, and the clavi- 
cle it is very fatal, and should not be performed, except in sec- 
ondary cases accompanied by necrosis. 
CONSERVATIVE SURGERY. 
The question whether to operate or trust to nature is often a 
difficult one, which can only he decided by knowing what the risk 
is in cases not operated upon. The following tables throw a 
good deal of light upon this subject:— 
QUNSIIOT FRACTURES TREATED WITHOUT OPERATION. 
Pr ct. Mort. 
Pr ct. Mort. 
Prct. M. 
Fracture. 
Recov’d. 
Died. 
Sh’rm’n’a Ar. 
Sur.-Gen. Rep. 
Reb. Ar. 
Shoulder-joint -- 
35 
7 
17 
35 
Humerus 
33 
7 
17 
Elbow-joint 
9 
3 
25 
11 
Forearm - 
43 
1 
o 
Wrist-joint 
5 
7 
Ilip-joint 
4 
10 
71 
100 
100 16 
Primary Surgery of Gen. Sherman s Campaigns. 
Femur— -- — 
64 
68 
51 
63 
Knee-joint - -- _ 
. 25 
42 
63 
84 
51 
Leg 
33 
17 
34 
Ankle-joint - - 
. 9 
1 
10 
20 
Foot - - - - - 
21 
1 
5 
. (penetrat’g) 
Cranium y 
5 
13 
78 
non-pen) 
Face-- - — — 
15 
1 
6 
Table of Wounded Joints, treated in the Confederate Army 
■without amputation (from Surg.-Gen. Chisholm’s Report):— 
Joint Wounded. 
Recovered. 
Died. Joint Anchylosed. Pr ct. of Deaths. 
Shoulder 
11 
6 
3 
35 
Elbow 
50 
5 
22 
11 
Wrist 
26 
2 
7 
7 
Hip 
8 
100 
Knee _ _ _ 
50 
53 
21 
51 
Ankle 
23 
6 
1 
20 
There is something inexplicable in the Confederate statistics, 
as given in this table. That out of 103 wounds of the knee- 
joint, only 21 should become anchylosed, and only 53 died 
under conservative treatment, is, certainly, contrary to the 
experience of the rest of the world, and suggests the possibility 
either of typographical error, or else that some cases of wounds 
about the knee are included which did not penetrate the cavity 
of the joint. 
The following conclusions are, on the whole, warranted by 
the figures:— 
Conservative treatment of wounds of the shoulder-joint ap- 
pears, at first glance, to be more successful than either resection 
or amputation. It is to be remembered, however, that the milder 
cases were saved and the worse ones operated upon, so that the 
comparison cannot be pressed. The impression made upon us by 
our experience, is this:—Cases where the joint is simply opened, 
or slightly fractured, should be treated without operation. 
Where the joint is much comminuted, resection should be pre- 
ferred, and where the comminution is accompanied with destruc- 
tion of the great axillary nerves and vessels, amputation is 
imperative. Primary Surgery of Gen. Sherman s Campaigns. 
17 
In the elbow-joint, the mortality of the conservative treat- 
ment with us was 25 per cent, that of primary resections, 25 per 
cent, that of primary and secondary resections together, 33 per 
cent, and of primary amputation above the elbow, only 8 per 
cent, showing that amputation is the safest, resection the next, 
and conservative the most destructive treatment of wounds of the 
elbow-joint. Our figures for primary amputations above the 
elbow are more favorable than the experience of the rest of the 
world bears out. The mortality for primary and secondary am- 
putations of the arm together in the U.S. Surgeon General’s 
report, is 21 per cent, but even this is better than treatment with- 
out operation. On the whole, we prefer resection in all gunshot 
fractures of the elbow-joint in which the principal nerves are 
intact, but in case of destruction of these, amputation is the 
best. Conservative treatment will do in very slight fractures. 
Compound fractures of the hip-joint were, in our experience, 
treated conservatively, with a mortality of 71 per cent. The 
U.S. Surgeon-General, however, as well as the Rebel statistics, 
gives a mortality of 100 per cent for such treatment. These 
fractures are not always easily distinguished from extra capsu- 
lar fractures of the neck of the femur, and it is possible that 
our results are made too battering, by the inclusion of some of 
the latter in the list. The subject is one which needs further 
investigation. . 
Fracture of the femur between the articular extremities is 
a very fatal accident. A large portion of the patients die of 
shock during the first three days, under any treatment which 
may be adopted. In comparing conservative treatment with 
amputation, it must be remembered that fracture of the shaft 
of a femur, if amputated, requires the operation at the middle 
or upper third; hence, amputations at the lower third are 
excluded from the comparison. 
Our results are, as follows:— 
Mortality of cases treated without operation,— 51 per cent. 
“ “ “ by resection in con- 
tinuity of the shaft, 6(3 “ 
Mortality of amputa. at Middle and Upper 3d, 63 “ 18 
Primary Surgery of Gen. Sherman s Campaigns. 
showing an advantage of 10 or 15 per cent of treatment by 
splints and extension over operative procedures. We, therefore, 
were led to discourage amputation for fractures of the femur, 
except when necessitated by destruction of the nerves and 
vessels. 
Great interest has been excited by the question whether 
amputation should be performed for penetrating wounds of the 
knee-joint. Our figures give for primary amputations just 
above the knee a mortality of 40 per cent; and for treatment 
of perforated knees, without operation, a death-rate of 63 per 
cent; giving a balance of 23 per cent in favor of primary am 
putation. 
The Surg.-Genera! recommends primary amputation at the 
knee-joint, and gives its statistical mortality in our army as 
35 per cent. This operation was not practiced under our obser- 
vation, but the evidence in its favor has become so strong that 
in future wars it will probably be preferred in most cases of 
perforated knee-joints. 
Treatment of fractures of the leg, without operation, give 
about the same risk as amputation below the knee. This 
method, therefore, should be adopted wherever there is hope of 
preserving a useful limb. 
TREPHINING. 
Only six cases of trephining were traced to their results. Of 
these, three were for wounds penetrating the brain, and all died. 
The other three were for depressed fractures not penetrating 
the brain, and all recovered. The statements of the Surgeon- 
General absurdly class the penetrating and non-penetrating 
fractures together, which renders it impossible to collate his 
figures with ours. The opinion which we have arrived at is, 
that non-penetrating gunshot fractures of the cranium require 
trephining in military as well as in civil practice, when the 
fragments are depressed, but that cases in which the bullet has 
passed into the brain arc not benefited by the operation, 
though as they all died alike, we can scarcely say that any 
harm was done. In penetrating fractures, the chief mischief 
is too deep to be helped by the trephine. Primary Surgery of Gen. Sherman s Campaigns. 
19 
ANAESTHETICS. 
The anaesthetic used was almost exclusively chloroform. This 
agent was administered in about 3000 cases, and produced two 
deaths. The first death was that of Private J. W. Whitlock, 
Co. II, 111th 111. Inf., wounded in the elbow-joint. On post 
mortem examination, the pericardium was found adherent and 
the lungs consolidated, showing prior disease of both organs: 
The second case showed nothing on post mortem examination 
to account for the fatal result. 
We have endeavored in these pages, to give a condensed and 
truthful statement of the materials in our hands, in order that 
impressions and facts, now fresh and valuable, may not be lost 
to the world. In conclusion, we wish to put on record an opin- 
ion impressed upon us by very large and varied observation, 
but which it is impossible to put in a tabular form, and it is 
this:—A very great error has been committed in the anxiety of 
Medical Directors to gather the wounded into large general 
hospitals, where cots, white sheets and pillow-cases, and luxuri- 
ous diet shall contribute to the comfort of the soldier, and where 
the general air of compactness and good order, and the fine ap- 
pearance of the buildings shall favorably impress the public. It 
often happens that those ver}’’ hospitals, which by their show of 
cots, sheets, clean floors, and well-cooked meals, extort praise 
from visitors, newspaper reporters, and even Medical Inspec- 
tors, are hothouses of death to the inmates, in consequence of 
the impossibility of perfect ventilation in the interior. Our ex- 
perience shows, that in many of these fine hospitals soldiers die 
in large numbers, who would have recovered had their wounds 
been treated under a tent or a tree, on their blankets, by their 
regimental surgeons. 
The very first necessity of a wounded soldier is absolutely 
pure air, such as cannot be had in most of the buildings selected 
for general hospitals, but when this requirement is fully met, it 
is astonishing what vigor the system often shows in repairing 
its injuries. The next great improvement needed in Military 
Surgery is a system of general hospitals which shall furnish air 20 
Primary Surgery of Gen. Sherman s Campaigns. 
as pure as that of the open fields. When such a system shall 
be devised and put in operation, war will be stripped of a large 
percentage of the mortality at present following in its train. 
Note. — The Confederate statistics given are derived from the Richmond 
Medical Journal and from a work issued by the Confederate Surgeon-General, 
for the instruction of his medical officers.