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CONSOLIDATED  STATEMENT
GUNSHOT   WOUNDS.
CIRCULAR  No. 9.
                            Surgeon General's Office, July 1, 1863.
  The accompanying tables have been compiled by Surgeon J. H. Brinton,
U. S. V., from the various reports received at this office, for the periods to which
the tables refer.
  They are believed to  possess great statistical valué, and are now published
for the information of the medical officers of the army, and of the profession at
large, in a sepárate form,  in  advance  of more  extended details illustrative
thereof.
  The Surgeon General desires to expresa bis gratification at the promptness
exhibited by the maj'ority  of medical officers in making the valuable reports
embodied in these tables.
  Covering, themselves, a period of only four months, they are to be considered,
in addition to their intrinsic valué, as an earnest for the future of still larger and
more valuable contributions to the literature of surgery.
                                             W. A. HAMMOND,
                                                     Surgeon General. 
2
/X YO                           Surgeon General's Office,
                                           Washington City, D C,
                                                           July 1, 1863.
  General: In obedience to your instructions, I have the honor to submit the
following  tables of gunshot injuries treated in the U.  S. A.  General  Hospitals
during the months of  September, October,  November, and December, 1862.
These figures are obtained by the aggregation of the Consolidated tabular state-
ments of nearly all of the army general hospitals in the United  States for the
months  specified.  The number of hospitals represented in the tablea is one
hundred and sixty-seven.   Reports from others, obviously inaccurate, have been
excluded as unreliable.
  The statistical results thus collated are  founded on the exhibit of the  first
edition of the "tabular statement of gunshot wounds," adopted by the Medical
Department in September last.   Previous  to  that month, the surgical statistics
of the war are absolutely worthless.   The  only information  procurable is such
as can be  derived from an  examination of  a  mass of reports, all  of which  pre-
sent merely certain figures, under the vague  and unsatisfactory heading " Vulnus
Sclopeticum."   The adoption of the new "report of sick and  wounded" was an
experiment; and although as first issued,  it  was somewhat imperfect, it is be-
lieved that the results already arrived  at possess considerable professional in-
terest.
  In  the  statements now presented I would  direct  your attention to  the exist-
ence  of certain  unavoidable  deficiencies.   I  would also  state that steps have
been instituted to correct these; and I  can confidently assert that if medical
officers will hereafter devote more care to  the preparation of  their reports,
future consolidations will prove  of far greater valué to surgical  science than those
now submitted.  It has  been found impossible, in the present tables, to account
in every  detail  for the entire  number of  cases  (20,930)  of gunshot injuries
treated.   I have therefore arranged sepárate tables, each  of  which is  complete
in itself.   Thus, in table number 2,ffifteen  hundred and forty-five)amputations//>
have  been reported, whilst in table number 4 I have  been able  fo account for
but 1,342; but these are accounted for fully and correctly.  The same remark
will apply to the statement of excisions.
  Ñor have I been able in the present exhibits  to sepárate the  results of the
primary and secondary  operations; the necessary data for this   purpose were
not heretofore in the possession of the Medical Department.   Such alterationa
have,  however, been made in the form  of the blank issued to medical officers
as will, it is hoped, correct this  omission for the future.
  The results  of the injuries of the different  thirds of the thigh were not  ob-
tained by the issue of the first edition of  the sick report.  This omission has
been  already suppljed for the year 1863, and also for  all cases   in the present
tables remaining under  treatment on the first of January last.
  The constant  transfer of patients from one  hospital  to  another  has been one
of the greatest difficulties encountered in the preparation of these tables, and the
utmost caution  has been necessary to avoid  duplication of  cases.  I believe,
however, that this obstacle has  been overeóme,  and I do not think that any im-
portan t errors exist in the results now offered to you.
  As  the  subject of gunshot fractures of the fémur is one of such great practical
importance, 1 have extracted from the April reports, now in process of compila-
tion, the statistics  of these injuries for the first  quarter of  1863.   These I have
appended in a foot note to the  first table.   I Avould also state that all cásea re-
ported as  " remaining under treatment January 1, 1863,"  have  been  taken up
and accounted for in the  reports of the quarter ending  March  31, 1863,  now
being  compiled. 
  Fuller information as to the comparative results of operative and conservative
surgery will, it ia believed, be obtained from  the working of the recently adopted
"Medical Descriptive  List"  system.   Tabular statements containing  only
figures must unavoidably fail to accomplish  thia important end.
     I have the honor to be, very respectfully, your obedient servant,
                                                JOHN H.  BRINTON,
                                                         Surgeon U. S.  V.
  Brigadier General Wm. A. Hammond,
                   Surgeon General  U. S. A.
                                   No. 1.

Tabular statement of gunshot wounds treated in the U. S. A. General Hospitals
  during  the. months of September, October, November, and December, 18^2 ;
  showing the number returned to duty; furloughed, deserted, discharged, died,
  and remaining under treatment January 1, 1863.
GUNSHOT WOUNDS—SEAT AND
        CHARACTER.
         Flesh wounds.

Of head.......................
Of neck.......................
Of trunk......................
Of external genitals............
Of upper  extremities...........
Of lower extremities............

       Wounds of cavities.

Of brain.....................
Of lungs..................---
Other wounds of thoracic cavity..
Of stomach....................
Of intestines...................
Of bladder..................
Other wounds of abdominal cavity

       Gunshot fractures.

Of cranium....................
Of facial bones................
Of clavicle....................
Of scapula....................
Of humeras...................
Of forearm....................
Of fémur......................
Of leg........................
Of ribs........................
1,090
  459
2,190
  163
4,972
3,817
 44
495
114
 19
 72
 31
104
176
405
132
199
575
728
749
967
113
  396
  166
  686
   49
1,750
1,338
 72
 17
 37
 38
101
  9
 61
 14
 37
 15
 76
  5
186
241
 9
19
 2
 4
36
40
13
29
 6
 29
  6
 50
  2
144
 37
107
 45
220
 24
594
248
  3
112
 46
  6
  4
  6
 36
 43
 72
 27
 24
177
]60
113
156
 25
30
21
91
 9
63
78
 32
192
 18
  5
 43
 16
 15
 59
 27
  7
  7
 69
 18
238
140
 11
O i-I

8 rt

 '"3



II
  487
  200
1,055
   74
2,219
1,875
  7
163
 45
  7
 14
  7
 49
 65
212
 71
127
243
398
372
572
 56 
4*
No. 1.—Tabular  statement,  Sfc—Oontinued.
GUNSHOT WOUNDS—SEAT AND CHARACTER.	O M Sí d «o 2 ® d CO w O "es "o H	i o d d "S M	na Oí rd bD d o d	a) S P	13 b£ í-l s	H3	T3 "b¡> -s a> X S-4 0J d O ce P><	Remaining under treatment Jan. 1, 1863.
	48 997 269 241 161 146 427 282 161 532 52	1 204 19 173 18	2 35 12 6 7 3 13 8 8 4 7	18 8 7 1 1 5 7 12	7 202 61 78 48 14 54 82 58 28 17	22 48 41 21 11 56 166 37 2 8 6	10 6 12	16
								490
Wounds of joints.								137
								123
								94
								72
								189
Oí anide ....................								148
								74
Contusions and injuries by spent								295
								4
								
Total....................	20,930	5,149	856	374	2,897	1,607	87	9,960
								
Gunshot fractures of fémur treattd in the U.  S. A.  General Hospüals during the months of January,
                               February, and March,  1863.
	i o O I-I <D .O a ¡3 a o	Treatment.				"3 O O e	-o ■a s o fe	» tu Ui CS tí 5	13 a 3	gen
		d .2 ti "5 1 <	0 .2	B ■8 s 53	c3-55 Oí 03 P					OH a-c be P. .so ¡a *> '3 S S a
Upper third--- Middle third___ Lower third---	103 143 137	22 46 35	2 1 3	53 83 85	26 13 14	1	1 2 9	25 41 38	24 26 25	53 73 65
Total.......	383	103	6	221	53	1	12	104	75	191
  Note.—Of the 383 cases included in this table, 75 were received into hospital during 1862, and are embraced
in table No. 1, under the caption "remaining under treatment January 1, 1863." 
5
No. 2.
47S
Tabular statement exhibiting the Treatment of the gunshot wounds received in
  the U. S.  A.  General  Hospitals during the months of September, October,
  November, and December, 1862.
Seat and character.
tí 8
	
d	
o	to
c3	d o
d	55
PU	
a	w
<	W
GUNSHOT WOUNDS.
Flesh wounds.
Of bead............
Of neck............
Of trunk...........
Of external genitals.
Of upper extremities
Of lower extremities
                Wounds of cavities.

Of brain.........................
Of lungs.........................
Other wounds of thoracic cavity.....
Of stomach.......................
Of intestines.....................
Of bladder.......................
Other wounds of abdominal cavity—
Gunshot fractures.
Of cranium---
Of facial bones
Of clavicle___
Qf scapula---
Of humeras ...
Of forearm —.
Of fémur......
Of leg........
Of ribs .*.....
Of vertebras...
Of other bones.
Wounds of joints.
Of shoulder-joint....................
Of elbow ..........................
Of wrist...........................
Of bip.............................
Of knee............................
Of ankle...........................
Of other joints.....................
Contusions and injuries by spent balls.
Miscellaneous......................
Total.
1,045
  455
2,178
  159
4,972
3,806
 33
495
 71
 11
 67
 28
 99
163
374
128
191
568
722
749
949
 93
 40
952
   266
   240
   158
   155
   242
   349
   164
   484
    23

20,429
132
 11
198
120
269
299
312
23
34
23
  104
   52
   39
    5
    5

1,626
38
35
39
14
 8
11
 8
 5
381 
6
4/6'
No. 3.
Tabular statement exhibiting  the  character of the Missiles in cases of gunshot
  wounds treated in the  U. 8. A.  General Hospitals during the months oj Sep-
  tember, October, November, and December, 1862.
Seat and character,
          GUNSHOT WOUNDS.

            Flesh wounds.

Of head...........................
Of neck...........................
Of trunk.........................
Of external genitals................
Of upper extremities...............
Of lower extremities................

           Wounds of cavities.

Of brain..........................
Of lungs..........................
Other wounds of thoracic cavity......
Of stomach.......................
Of intestines......................
Of bladder........................
Other wounds of abdominal cavity---

           Gunshot fractures.

Of cranium........................
Of facial bones....................
Of clavicle........................
Of scapula........................
Of humeras.......................
Of forearm........................
Of fémur..........................
Of leg............................
Of ribs...........................
Of vertebrae.......................
Of other bones.....................

           Wounds of joints.

Of shoulder-joint...................
Of elbow.........................
Of wrist..........................
Of hip............................
Of knee...........................
Of ankle..........................
Of other joints.....................
Contusions  and injuries by spent balls
Miscellaneous.....................

        Total.....................
1,049	367
435	194
2,072	633
152	51
4,636	1,621
3,461	878
 32
394
 69
 13
 47
 20
 81
148
353
119
181
529
661
539
767
102
 39
910
208
229
156
124
144
271
140
440
 33
153
 30
  7
 20
  6
 25
 30
115
 31
 51
110
169
107
205
 25
 16
259
18,554
5,554
^
e) H
  453
  205
1,189
   89
2,566
2,307
 22
227
 35
  6
 24
 14
 50
 79
197
 69
105
371
447
378
442
 66
 21
524
109
142
102
 87
 78
164
 88
124
 18
10,798
165
 24
186
  4
307
229
25
22
 9
18
28
33
38
80
 6
 1
56
 19
 13
  6
  5
  6
 12
  9
141
  6
1,463 
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										^-^								H	w	
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CO		v-ii-i tO 00 CS tO i-i 10 i-i to								)-i to «b. 00 Os <» On									Gunshot wounds.	Bl
<J		^HtO^CD<(t0O5t0								COC-^CS^J^ÍGCCO										U
																				
																			Other causes.	— ■?
		^			to		00				-3		<l				co			P ^
																				2 *
CO			t-i «b- tO On								l-i OO i-i Oí								Primary operat'ns.	2 w
		oo	00 00 O >-■ i-i en tO								to <( oo i-i >b- >b- to									fs £
																				^ N
00																			Secondary opera-	
en		lU OD co to tn I-i toooto >b. to																	tions.	
üi		oototoi-icni-ioo<ícococo©ooosoD>b.o																		
i—i		i_i i-i to w oo																	Total.	
ib-		OO OS tO i-i to to to ib. 00 -4 «*í <l																		
to		(OtOib.cOCOtO>b.tOCn00<K100VJ^lOD>-i																		
1-1 o																	1 oo		Returned to duty.	
o		oo									! os		: to		! *~'		! 0°			
to en		M			! r-1						KH		! w		: toi-ics				Furloughed.	
I—"		!			: ;						;				: :				Deserted.	
I—"							r-1				l—l h-l ¡				¡ ; t-i <i					ts
																				
8			1 w l_l				! **			' l—> i-i i-i oo oo o tO On on to i-i On tO OÍ									Discharged.	H ai
o		o	; wc*>				; OOOn													
																				
																				ce
co																			Died.	
to		ib. OSOS l-i^									' 1-1 ib. 1-1									
os		OOtOOncntOvb.'d'ente									; i-i oo o to o						! te			
																			Second operation	
co o			■ 1—1 ¡ r-1 te O				; oocoi-i					' * 1 M )_1			H-1		! N>		necessary.	
en																			Remaining under ta	•eatment,
		h-1	1 i-i on oo o i-" to >u to on																January 1, 18	63.
os		On	; *>• 00 CO oo on tO OO l-i OO 00 OÍ ib-CO iU to																	
1 |			! ! !!!!!!!!!!!!																Secondary operatio	n neces-
	*»			'•	M	co	■	■	■	■	■	.	■	■	■	■	■	■	sary; result not	jiven.
9¿/y 
No. 5
*
Tabular statement of Excisions performed in the U. S. A. General Hospitals, and their  results, during the months of September,'^
                                         October,  November, and December, 1862.                                          \J
														^r
	SIDE OF BODY.		FOR WHAT		PERIOD OF					RESULTS.				os
			PERFORMED.		OPERATION.		"3 "o						i	a oseo
LIST OF OPERATIONS.	3 bu	¿d	té d d o tE O 02 d d	to 0) d c3 U Sh	có ja H ¡M OS dn O r*> ¡1 a3 a	¿ Si OS Ph O si a o o		d nd o as 0)	n3 as ■a d jd d	tí cu !-. as •si as	nd as CSC <3 rd O to	as	d .2 as s-a, o3 OS rrt O	£ GO !h T—l os . T-Jl-l §b d B •d rt d c3 a os
	«	V-l	O	6	Ck	OQ	H	M	Ph	M	Q	Q	W	M
EXCISIONS.		<•												
Wrist .........................................	14 25 26	7 20 25	21 45 51		3 5 8	18 40 41	21 45 51		2 1	"T 1	4 12 14			J5
												8 10	1	23
														26
	8 5 4 7 102	8 3 5 9 53	16 8 9 16 111	i	3 1 1 2 17	12 6 9 13 131	16 8 9 16 155		1	1	3 1			11
Ankle												2 8 9 18	1 1	5
														1
Hip .............................														7
								6	1	1	25			104
	26	24	49	i	7	43	50		2	1	10	1		36
														
Total....................................	217	154	326	2	47	313	371	6	7	5	69	56	3	228
														
 
No.  6.
Extraction ofbwls during the months of September,  October,  November, and December, 1862.
LIST OF OPF.R ATÍONí
Extraction of balls and other foreign bodies

      Total.....................
						i							-	
SIDE OF	BODV.	FOR WIIAT I'KRFOR.MKI).		PFRIOD O].' OPERATION.					RESULTS.				d 3 "S có	
													¿ ao	
				co d	es		íA					d o	sh	
							d						TU <-l	
		d		s-.			rd					S £	s k	
	as h-!	c CO d d	as CO 5 o 3 rd 6	o b g	r~- d " 2 d J2	o	O nd <a d d as «	ra as rd bC d o d fe	rd as "tí as CO a> Q	rd as bC CJ co 0	13 5	Oh* O « as IT) CJ O as W	Remaining v Januai	OS d O CO '£ di
35]	253	604		86	451		312	18	1	69	n	2	179	14
351	253	604		8G	451	604	312	18	1	69	n	2	179	14
No.  7.
Tabular  statement  exhibiting the results of thirtyfve cases of  Trephining, performed in  the U.  S. A. General Hospitals, fr,
                                                 September, 1862,  to March 31, 1863.
OPERATION.	FOR WIIAT PERFORMED. PERIOD OF OPERATION.			RESULTS.		
	Number i of cases. Gunshot Other causes. Primary wounds. operations.		Secondary operations.	Rccovered.	Died.	Under treat-ment April 1, 1863.
Trephining.........................	35 \ 30	5 3	32	5	28	2
						
zo
ÑOTfc.—In the five cases which recovered, the operation of trephining was performed nfter gunshot injuries.  Four of the operations were secondary, and one was prii
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