[Bfen«nted from the Boston Medical and Surgical Journal 
of May 12, 1892.] 
THE WOUNDED OF THE WOUNDED KNEE 
BATTLEFIELD, WITH REMARKS ON WOUNDS 
PRODUCED BY LARGE AND SMALL CALIBRE 
BULLETS.1 
BY CHARLES B. EWIN&- 
Captain and Assistant Surgeon, U. S. A. 
The Great Sioux Indian War of 1890 has been 
fought so often that I feel an apology is necessary for 
inflicting it upon you on this occasion, but, while much 
has been said of the combatants, little has been written 
of the casualties of which this paper will treat. 
The causes which led to this sanguinary hostility 
are, in brief, “the failure of the government to fulfil 
its obligations,” and the Messiah delusion, together 
with a determination of the hostile Sioux not to sur- 
render their arms to the government; this latter more 
particularly led to the Wounded Knee affair. 
The theatre of war was located in South Dakota, and 
especially that part known as the Pine Ridge Indian 
(Ogallala Sioux) Reservation, situated in the southern 
part of the State mentioned. I cannot do better than 
to quote from the annual report of that very gallant 
and able soldier, Major-General Nelson A. Miles, re- 
garding his disposition of troops. He says : “ Seven 
companies of the Seventh Infantry, under Colonel 
Merriam, were placed along the Cheyenne .River to 
restrain the Indians of that reservation, and intercept 
those from Standing Rock. In the meantime, a force 
had been gathered at the Rosebud and Pine Ridge 
agencies. Those at the Rosebud, under the command 
of Lieutenant-Colonel Poland, were composed of two 
troops of the Ninth Cavalry and battalions of the 
1 Read before the Association of Military Surgeons of the National 
Guard, U. S., at St. Louis, April 19, 1892. 2 
Eighth and Twenty-First Infantry ; Colonel Shatter, 
with seven companies of the First Infantry controlled 
the country to the south and west of the Rosebud 
agency, with station at Fort Niobrara; those at Pine 
Ridge agency, under the immediate command of Gen- 
eral Brooke, were eight troops of the Seventh Cavalry, 
under Colonel Forsyth; a battalion of the Ninth Cavalry, 
under Major Henry; a battery of the First Artillery, 
under Captain Capron ; a company of the Eighth In- 
fantry and eight companies of the Second Infantry un- 
der Colonel Wheaton. West from Pine Ridge agency 
was stationed a garrison of two companies under 
Colonel Tilford of the Ninth Cavalry ; north of that, 
with headquarters at Oelrichs, was stationed Lieu- 
tenant-Colonel Sanford of the Ninth Cavalry, with 
three troops, one of each from the First, Second, and 
Ninth Cavalry; north of that, on the line of the rail- 
road at Buffalo Gap, Captain Wells, with two troops 
of the Eighth and one troop of the Fifth Cavalry, was 
stationed ; north of that, on the same railroad at Rapid 
City, Colonel Carr of the Sixth Cavalry, with six troops, 
was in command ; along the south fork of the Cheyenne 
River, Lieutenant-Colonel Offley, and seven companies 
of the Seventeenth Infantry; and to the east of the 
latter command, Lieutenant-Colonel Sumner, with 
three troops of the Eighth Cavalry, two companies of 
the Third Infantry, and Lieutenant Robinson’s com- 
pany of scouts. Small garrisons were also stationed 
at Forts Meade, Bennett, and Sully. Most of the 
force was'placed in position between the large hostile 
camp in the Bad Lands, which had gathered under 
Short Bull and Kicking Bear, and the scattered settlers 
endangered by their presence. As the line under 
Colonel Carr was considered the most liable to be 
brought in contact with the hostile force, the division 
commander established his temporary headquarters at 
Rapid City, S. D., where this force was in close com- 3 
munication, and from which their movements could be 
directed with the least delay.” 
This map is drawn on a scale of 360 yards to the inch. The figure 
at the lower left-hand corner of the Cavalry Camp shows the location 
of one-half of A and I troops. The dotted line near the Council rep- 
resents 12 or 15 soldiers at skirmish distance. 
Everything indicated a peaceful settlement of affairs, 
when the well-laid plans of Major-General Miles look- 
ing to an early and amicable adjustment of trouble 4 
were suddenly “ frustrated ” by the lamentable occur- 
rence at Wounded Knee Creek on the morning -of 
December 29th. The opposing forces were the fol- 
lowing: the United States troops were eight troops,' 
Seventh Cavalry; Light Battery E, First Artillefy, 
and Company A, Indian Scouts, making a total of 470 
fighting men, under the command of Colonel Forsyth, 
Seventh United States Cavalry. The Indian war party 
consisted of 106 warriors and 294 women and children, 
all of the Minneconjous Sioux, under Chief Big Foot 
So many descriptions of this unfortunate affair have 
been published that I shall limit myself simply to scf 
much of an account as is to be found in the very brief 
and concise language of my report, made upon request, 
to the department commander, and in so doing, I ask 
pardon for using the personal pronoun to the extent 
that I do, but, inasmuch as a report of my personal 
services was desired, I was obliged to frame it in the 
following terms: 
Office of Attending Surgeon, 
St. Louis, Mo., June 23, 1891„ 
To the Adjutant-General, Division of Missouri, Chifltyo^Ill. 
Sir : — Understanding that a report of my services at 
the battle of Wounded Knee is desired, I have the honor 
to submit the following: \ 
The battle began at 9.30 A. m., December 29>>L'8$0, find 
the troops withdrew from the field about 2 ;p. and 
marched to Pine Ridge agency, reaching that point some- 
time between 9.30 and 10 o’clock that evening. 
Lieutenant Kinzie, Second United States Infantry, Mr. 
James A say, Indian trader at Pine agency,*and 
myself, were seated in an open wagon witlimTgitbr fifteen 
feet of one end of the parallelogram of soldiers sur- 
rounded the Minneconjous Sioux band under Root. 
Colonel Forsyth, Seventh United States Cavalry, was 
writing a communication which one of our ,p"arty was to 
carry to General Brooke, commanding Department of the 
Platte, then at Pine Ridge agency, and while waiting^r 5 
communication, the firing commenced. A volley came in 
our direction, the bullets whistling unpleasantly about us; 
our horses took fright, and, becoming uncontrollable, ran 
right across the line of fire, but were turned, and finally 
stopped near Louis Mossoeu’s store, about three hundred 
yards distant from the field of battle; we alighted, and I 
was then informed by Lieutenant Kinzie that he had been 
shot in the foot; after examination of the same, I imme- 
diately returned to the camp and busied myself in the care 
of the wounded. 
I did not think it a time for ceremony, hence dispensed 
with the formality of reporting for duty, and at once went 
to work. The work consisted principally of what is known 
as first aid to the wounded. The only exception being an 
operation of a plastic nature, when I replaced and stitched 
the severed nose of Mr. Wells, the interpreter, belonging 
to Lieutenant Taylor’s command of Indian scouts. This 
was the only operation, if my memory serves me, that was 
performed on the field. 
This first aid consisted in stopping haemorrhage; apply- 
ing dressings to wounds; putting up fractures; giving 
stimulants; and allaying pain. Later it became necessary 
to redress many of the wounds, as is often the case, the 
first dressing being only temporary. 
I accompanied Captain Edgerly’s troop to a point about 
three miles to the west, where Captain Jackson was re- 
ported to be surrounded by hostile Brules. Truth forbids 
that I place this in the light of a medical service, and I 
freely confess that it was only after arriving at our desti- 
nation that I was aware that I lacked everything in the 
way of dressings to render aid to the wounded in case of 
trouble; of course, much could have been done in that regard 
by using the clothing and equipment of the men. My only 
excuse is that I went very suddenly, so quickly in fact that 
there was no time for obtaining dressings. It was in this 
way: I was standing on the brow of the hill watching the 
firing of the Hotchkiss guns and the barricading of the 
ridge, when Captain Edgerly’s troop galloped past, and 
seeing a horse in the troop without a rider, 1 ran out 
and jumped in the saddle. I had provided myself with 
carbine and ammunition, hence was in good shape. It did 
not take us more than fifteen minutes to ride the three 6 
miles, and we were just in time to see the Indians disap- 
pear in the direction of Pine Ridge agency. After remain- 
ing about fifteen or twenty minutes, I suddenly remembered 
that I had absolutely nothing in the way of dressings, hence 
returned to camp with Lieutenant Brewer for the purpose 
of obtaining some, but learning that the command was to 
return immediately, I found mv services would not be 
needed, hence did not obtain dressings as I intended doing. 
Now, to sum up : I was on the field from 9.30 a. m. to 
about 4 p. M., at which hour we began our march back to 
the agency. Of that six and one-half hours, I am quite sure 
I spent two and one-half to three hours at the dressing sta- 
tion, and the same length of time superintending the re 
moval of a part of the wounded and at least three-fourths 
of the dead, to which must be added about three-quarters 
of an hour taken up in accompanying Captain Edgerly’s 
command and returning as stated above. 
We consumed about five and one-half hours on the march 
to the agency, which was of necessity slow. I rode a horse 
(kindly furnished me by a troop commander), as did also 
Assistant Surgeons Hoff and Glennan. I did not render 
any medical service on the march, and think it quite un- 
likely that such could have been rendered efficiently, as 
darkness came on quickly and lights were not permitted 
in the command. I was not called upon to render any aid 
by the surgeon officially in charge, and I fail to see, under 
the conditions, how the wounded could have been benefited 
further till arrival at division hospital. I would be failing 
in a proper appreciation of the work of my brother sur- 
geons in this connection were I not to mention the very 
efficient and untiring services of Captain Van R. Hoff and 
Lieutenant Glennan, of the Medical Department, who 
labored unceasingly in ministering to the wounded. Upon 
arriving at Pine Ridge agency, the wounded were placed 
in that part of the divisional field hospital of which I was 
in charge. It was my duty to attend and redress some 
twenty of the wounded, which occupied my time till two 
o’clock the following morning. 
Very respectfully, your obedient servant, 
Charles B. Ewing, 
Captain and Assistant Surgeon, U. S. A. 7 
Now, to the consideration of the casualties, which I 
shall separate into the killed and wounded ; of the 
former we had one officer and twenty-nine men, a total 
of thirty. 
The great majority were killed outright, the very 
few surviving a variable time from a few minutes to a 
few hours after the reception of their injuries. Cap- 
tain Wallace, besides the fatal gunshot wound of the 
lower abdomen, received two cuts with a tomahawk or 
hatchet; one across the forehead just above the super- 
ciliary ridges, and the other conforming to the anterior 
two-thirds of the sagittal suture. In neither case did 
these cuts fracture the skull. 
This officer’s death, coming as it did in the heyday 
of his career, was indeed a “ tragedy.” No words of 
mine can portray the love and admiration in which he 
was held by his family, friends and brothers-in-arms. 
“ His life was gentle; and the elements 
So mixed in him, that Nature might stand up 
And say to all the world, * This was a man.’ ” 
The greater portion of the dead I saw had received 
two or more wounds. In order that you may clearly 
appreciate the treatment of the cases to be presented, 
1 shall premise by stating that my knowledge of them 
dates from the battlefield, on the morning of December 
29, 1890, and ended, so far as three-fourths of them are 
concerned, upon their transfer to Fort Riley, Kan., 
January 4, 1891 ; remaining in charge of those whose 
condition could not permit of transfer at that time, till 
a day or two later, on which date I was placed in com- 
mand of a company of the Hospital Corps. 
The wounded consisted of two officers, twenty-nine 
enlisted men, and one civilian interpreter, attached to 
the scouts. I shall classify the above, broadly speak- 
ing, according to the part of the body injured, leaving 
out of detailed consideration twelve cases of gunshot 8 
wounds, mostly of minor import, which did not come 
under my care. 
In brief, then, we have gunshot wounds of the head, 
body, upper and lower extremities. 
We will now consider the wounds as classified, tak- 
ing up those of the Head, three in number: 
Case I. Private H. D., Troop A, Seventh Cavalry. 
Pistol-ball entered right side of face half an inch an- 
terior to lower part of right meatus auditorious exter- 
nus, passing transversely through bones of face and 
obtaining exit two and one-half inches anterior to lower 
part of lobule of left ear. Calibre of pistol not known, 
but from size of wound of entrance, think it about a 38. 
Discharge of blood from both ears, and persistent flow 
of saliva, the latter giving evidence of the wounding 
of Steno’s duct. A violent cellulitis supervened, which 
finally subsided under treatment, and he was in excel- 
lent shape when transferred. 
Case II. Gunshot wound of inferior maxilla. 
Quartermaster-Sergeant C. C., Seventh Cavalry. Ball 
entered left inferior angle of chin, passing transversely 
through body of inferior maxilla, with inclination 
downward, gaining exit at right inferior angle of chin, 
crushing and comminuting bone in its passage. Treat- 
ment consisted of removing broken particles of bone, 
with corresponding teeth; stitching the lacerated in- 
tegument of chin ; applying antiseptic dressings ; felt 
splints and bandages to support chin. This man was 
doing as well as he could under the circumstances 
when transferred. I understand that he has since had 
false teeth and plate made. 
Case III. Incised wound of nose. Mr. W., In- 
dian interpreter attached to Company E, Indian 
Scouts, had all that part of nose anterior to nasal 
bones slashed off with a knife in the hands of an infu- 
riated Indian of Big Foot’s band. The severed part 
was hanging by a mere shred and bleeding profusely. 9 
Fifteen minutes after reception of wound, I replaced 
nose, and held same in place with numerous silk 
stitches. This man immediately after the operation, 
took his Winchester and went at once to the skirmish 
line, and afterwards on our return to Pine Ridge 
agency, took his place in the advance with Lieutenant 
Taylor’s Indian Scouts. I did not see Mr. W. for 
some days after operation, when I found good union, 
and removed stitches. This, if it can be so dignified, 
was the only operation performed on the field. 
I now come to Gunshot Wounds of the Body. Un- 
der this heading we have five cases: 
Case I. Penetrating gunshot wound of chest. Pri- 
vate J. C., trumpeter Troop K, Seventh Cavalry. Ball 
entered two and one-half inches below and one inch 
from left nipple toward median line, passed trans- 
versely in straight line, gaining exit two and one-half 
inches below right nipple. No rise of temperature, 
and patient in good condition when transferred. 
Case II. Sergeant II. H., Troop A, Seventh Cav- 
alry. Ball entered posterior surface of left chest, 
passed forward, coming out just internal to the left 
nipple. Besides the above, Sergeant H. suffered two 
additional gunshot wounds, one above and the other 
below left elbow. Pneumonitis supervened. 
Case III. Sergeant L., Troop I, Seventh Cavalry. 
Ball entered to right of sternum just below clavicle, 
passed backwards and outwards, obtaining exit at axil- 
lary line in the fifth intercostal space, where incision 
was made, and the ball removed, with pieces of blouse 
and fragments of undershirt. Pneumonitis followed. 
In considering the treatment of the cases coming 
under this particular heading of Penetrating Gunshot 
Wounds of the Chest, I should like to mention the 
cases of one officer and two enlisted men, who suffered 
gunshot wounds of like character in an affair with 10 
Chiricahua Apaches at Chevelon’s Forks, Ariz., July 
17, 1882. 
The treatment of all these cases was alike, with re- 
coveries in all of them. It was as follows: thorough 
cleansing of wounds ; application of corrosive subli- 
mate solutions; iodoform powder dusted upon parts; 
antiseptic dressings just sufficient to cover each partic- 
ular wound ; then the application of collodion, sealing 
part “ hermetically ” or by what is known as primary 
occlusion ; finally restraining the muscles of respira- 
tion by circular bandages of chest, and fixing arm of 
side affected. I do not wish to place myself on record 
as treating all penetrating gunshot wounds in this way, 
but simply present my experience to your considera- 
tion for what it is worth. I am quite of the opinion 
that I should modify my treatment by substituting the 
plaster-of-Paris bandage, with the flannel roller, for 
the circular cotton bandages, to restrain the muscles of 
respiration. 
This treatment by primary occlusion may seem very 
radical indeed, when such an authority as Ashhurst 
says, “ The vast majority of penetrating wounds of the 
chest are gunshot injuries, the exceptions incised or 
punctured wounds. Applying the ordinary principles 
of surgery, even to the exceptional group, nothing but 
absolute necessity would justify the complete closure 
of the wound.” And again, “Surely the conditions of 
a wounded lung and thorax are unfitted for the exper- 
ment of closure.” And further, “ Nothing appears 
more repugnant to the principles of surgery than the 
attempt to close a bullet-track which, however it be 
placed, under its ordinary conditions must afford ample 
material to be discharged externally.” I quote the 
above to present the other side of the question as well 
as my own. I think this kind of dressing for chest 
wounds would become very necessary, particularly 
where traumatic pneumonitis has been set up, which 11 
would preclude the constaut change of dressings and 
the consequent exposure of the chest at those times. 
The consensus of opinion among military writers is 
that the least fatal injuries are those in which the pro- 
jectile has passed entirely through the chest, being less 
injurious than those in which the bullet has lodged. 
While my cases are few, the results are certainly very 
satisfactory, when we consider that during the last two 
years of the war, the death from penetrating wounds 
of the chest reached almost per cent. 
Case IV. Gunshot wounds of vertebrae, upper and 
lower extremity. Private , Troop B, Seventh 
Cavalry, suffered four distinct gunshot wounds: one 
passing transversely through lumbar vertebrae from 
left to right, crushing and comminuting vertebrae and 
severely injuring the cord and its membranes, and 
finally lodging in the muscles of the right lumbar re- 
gion ; penetrating gunshot wounds of right and left 
arms below elbow joints ; and the fourth passing 
through left leg just above ankle joint. It would not 
be economizing fact very much to say that this man 
was literally shot to pieces. The bullet which I now 
exhibit, weighing 385 grs., was removed from the right 
lumbar region by simple incision, without anaesthetic, 
immediately after his arrival in the divisional field hos- 
pital at Pine Ridge, and, as Nature had not moulded 
him to resist three ounces of lead in this form and 
method of distribution, he died shortly afterwards. 
The injuries of this soldier were so severe that it was 
hardly expected that he would survive the journey 
from the battlefield to the field hospital, sixteen miles 
distant. 
Case V. Gunshot wound in neighborhood of right 
inguinal region. Lieutenant H. H., Light Battery, 
Second Artillery, received gunshot wound (Winches- 
ter) of right side, ball entering just external to ante- 
rior superior spine of right ilium and passed down- 12 
wards and inwards. This officer was in charge of a 
Hotchkiss gun some six hundred yards distant from 
a party of hostiles that had gained the shelter of a 
ravine, and who were beset upon two sides by the fire 
of carbines and upon the third by Hotchkiss guns. 
The gun in charge of this officer was moved from its 
original position upon an eminence to lower ground, 
so that better range could be obtained, rendering the 
fire more effective. This was so successful that the 
Indians sought to silence this particular piece, resulting 
in the shooting of Lieutenant H. The ball was de- 
flected from its original course, seemingly a fatal one, 
by a watch worn at the time and which was com- 
pletely destroyed. I saw Lieutenant H. when shot on 
the field ; he fell under my care that evening at the 
field hospital; and the same night or the following morn- 
ing I examined and dressed his wounds, at which time 
the course of the ball had not been fully determined. 
Having a great deal of work on my hands, I was glad 
when relieved of this case by another medical officer. 
I understand Lieutenant H. has so far recovered from 
his injury as to be able to perform duty. 
Let us now consider Gunshot Wounds of the Upper 
Extremity. 
Sergeant H. H., Troop I, Seventh Cavalry, was 
admitted to the field hospital, Pine Ridge agency, 
December 29th, from the field where I first saw him. 
Ball entered just external to coracoid process of scap- 
ula, passed through deltoid muscle, finally entering the 
head of humerus. Severe. This man was treated 
upon the expectant principle till his transfer to Fort 
Riley on January 6th, for the following reasons: no 
appreciable rise of temperature; complained very 
little of pain; was able to sit up and walk about to a 
certain extent. Treatment consisted of securing thor- 
ough drainage of wound ; absolute rest by appropriate 
position and posterior splints of felt or plaster-of-Paris 13 
(I have forgotten which) ; antiphlogistic regimen ; hy- 
podermic administration of morphia when necessary. 
I find myself well supported in the above treatment 
by Billroth, who declares against operative procedures, 
under like conditions, as follows: “ As in cases of 
resections, you can have no control as regards the 
prospective functions of the arm, especially when a 
large portion of bone is to be excised, it is always 
better for the patient to escape with an anchylosed 
joint, without resection, than to have a dangling joint 
after resection.” 
Yon Langenbeck says : “ If it be true that anchylo- 
sis of the shoulder-joint enhances the usefulness of the 
rest of the extremity, and especially of the hand, we 
would be obliged, in shot-injuries of the shoulder- 
joint, to constantly strive for the accomplishment of 
anchylosis. The presumption that anchylosis would 
bring about greater usefulness of the arm than could 
be had with a shoulder-joint even with limited motion, 
rests upon a fallacy, occasioned by neglect to take 
into consideration the various degrees of severity of 
shot-wounds of the shoulder-joint.” The same author 
cites nine successful cases of shot-wounds of the 
shoulder-joint treated on the expectant plan, the pa- 
tient in every case recovering “completely with con- 
servation of good motion of the arm.” He further 
says: “ It is certain that the results of the cases of 
conservative treatment of shot-wounds of the shoulder- 
joint above cited challenge greater attention to the 
side of conservative surgery.” 
Two of the cases under this heading were gunshot 
injuries in the neighborhood of the shoulder-joint, one 
of them made by a Winchester 38, and the other by 
a gun of larger calibre. Both cases were given com- 
plete rest by means of splints and position ; drainage 
of wounds; antiphlogistic regimen, and opium in cases 
of pain, which complaint was rare. 14 
No symptoms up to the time of transfer to warrant 
operative interference. I am quite of the opinion, 
however, that if the temperature, pain, etc., had so 
indicated, I should at once have made an exploratory 
incision, and an exsection or amputation, according 
to the conditions in each particular case; but up to 
the time of transfer to Fort Riley, there occurred 
nothing to warrant such procedure. 
Gunshot Wound of Upper Extremity. 
Lieutenant G., Troop G, Seventh Cavalry, re- 
ceived a shot which entered olecranon process of right 
ulna, comminuting that part, passing forwards through 
shaft, and gained exit at the posterior surface of arm, 
at junction of inferior with middle third. Treatment 
consisted of removing portions of bone; applying 
antiseptic dressings, and supporting arm. This case 
was turned over to another surgeon the day following 
his arrival at the field hospital. I have since learned 
that this officer has rejoined his regiment. 
Gunshot Wound of the Right Hand. 
Private F. L., Troop B, Seventh Cavalry. Ball 
entered internal border of wrist, and passing through 
comminuted bones of same, coming out on palmar 
surface at base of thumb. Wounds cleansed, dressed 
antiseptically, and given rest by application of splints. 
This man was transferred in good condition. 
Gunshot Wounds of Lower Extremity, consisting 
of two of thigh, one of knee and two of leg. 
Case 1. Private Wm. H. G., Troop C, Seventh 
Cavalry, while mounted, received a gunshot wound 
which entered middle of posterior surface of left 
thigh, at junction of middle with upper third, ranging 
slightly downward (missed femur), passed forward 
and inward, obtaining exit at about middle of internal 
surface. Wounds were cleansed, dressed antisepti- 
cally, and when transferred patient was about well. 
Cask IT. Private E. S., Troop C, Seventh Cavalry. 15 
Gunshot wounds of right and left thighs. Ball en- 
tered inferior surface of left thigh, ranged upward in 
front of femur, passing out at internal border of ante- 
rior surface at junction of middle with upper third ; 
this ball continuing its course entered internal border 
of posterior surface of right thigh, and ranging trans- 
versely behind femur, passed out at middle of upper 
third of external border of posterior surface. Treat- 
ment consisted of thoroughly cleansing wounds, using 
bichloride of mercury solutions and dressing antisepti- 
cally. This man had about recovered when trans- 
ferred. 
Case IV. Private G. E., Troop K, Seventh Cav- 
alry. Gunshot wound of right leg, middle third. 
This was a very severe compound comminuted fract- 
ure of both tibia and fibula, with much destruction of 
the soft parts, including a division of both anterior 
tibial and peroneal arteries. Am of the opinion that 
this was a case of primary infection. Thirty-six hours 
after entrance into field hospital it was decided to 
amputate limb. I performed the operation, assisted 
by Surgeons Hartsuff and Spencer, United States 
Army, under rather unfavorable auspices. A Sib- 
ley tent with the earth for a floor served as an opera- 
ting-room, which is very unsatisfactory, inasmuch as 
your light passes to you through a mere “chink ” of a 
door, and the tripod which supports the central up- 
right pole of the tent permits very little room for the 
operating table, assistants and tables for antiseptic 
fluids. Then again, you may sprinkle your floor 
assiduously with water, yet those moving about run 
great risk of stirring up clouds of dust. Patient was 
placed under chloroform and a lateral flap amputation 
was performed, four inches below knee-joint, under 
antiseptic conditions so far as they could be obtained. 
Leg was found as described above ; flaps were brought 
together, permitting of the best drainage. Treatment 16 
then consisted in supporting patient, and using per- 
sistent antiseptic irrigation of the stump, but despite 
ail our efforts, the products of the staphylococcus 
pyogenes were formed abundantly, and the patient 
succumbed to pyaemia resulting from a primary infec- 
tion upon the battlefield. 
Now, to sum up, we have reviewed: Gunshot 
wounds of the head, three cases; of the body, eight, 
including the three cases quoted; of the upper ex- 
tremities, six; and of the lower, four; making a total 
of twenty-one cases. 
The difficulties of the situation, as they appeared to 
the medical director of the department, Colonel Bache, 
can be learned by a reference to his own language 
when he says: “ Had that regiment (the Seventh) 
been operating at a distance from support or organized 
assistance instead of having a receiving hospital within 
easy reach, it is not hard to cast the sum of its suffer- 
ing.” In comparison with the difficulties met with in 
this instance, in which there were three (although the 
medical director says two) medical officers, and four 
hundred and ten men to care for, thirty-one wounded, 
1 would like to place for a moment those met with 
and successfully overcome, in an affair in which I 
plaved a part some years since upon another field. 
My memory recalls the battle of Chevelon’s Forks, 
Ariz., the 17th of July, 1882, where the fighting 
strength of the Chiricahua Apaches was about the same 
as that of the actual Indian combatants in this affair 
under consideration ; the opposing forces being two 
troops of the Third and one of the Sixth Cavalry, un- 
der Major Evans and that brilliant cavalryman, Cap- 
tain Chaffee, respectively. These Indians were the 
most warlike in the entire Southern country, and among 
them were the renegade scouts that had turned against 
General Carr’s command at Cibicu Creek, Ariz., the 
year before. The engagement was a sanguinary one, 17 
the Indian foe holding a very inaccessible point in the 
mountains some five or six hundred feet high, with 
precipitous sides except upon the south, which, while 
permitting the approach of our forces, was so strongly 
fortified and the Indians so well armed and such good 
marksmen, that this line of approach was exceedingly 
dangerous. The casualties were two officers and twelve 
men wounded and two men killed. The Indians lost 
fifteen killed (left upon the field), and a number of 
wounded carried off under cover of darkness. The 
Indian camp was captured, and with it two Indian 
squaws and two children ; one of these squaws suffered 
a very severe gunshot wound of the right leg, which 
made amputation necessary. I performed this opera- 
tion at once, upon the field, using as an operating-table 
a box placed upon the ground, which was at that time 
covered with three to four inches of hail, having plenty 
of spectators in the shape of soldiers. This case with 
seven others, we carried by hand on rude litters fash- 
ioned from the branches of the pine tree, for a dis- 
tance of fifteen miles, such was the roughness of the 
country. Upon gaining the table-land of the Mogollon 
Mountains, where a comparatively smooth country was 
found, mule litters were made, upon which the more 
serious cases were placed, and carried ninety miles to 
Whipple Barracks. The lamented Crawford was 
detailed with two troops of cavalry to help me out of 
the mountains with the wounded, and his men acted 
as litter-bearers, relays being necessary every two or 
three hundred yards. This task, from the roughness 
of the country and the rudeness of the litters, was 
found not a very agreeable one. Our base of supply 
in this instance was fifty miles distant, whereas in the 
affair under consideration it was only sixteen. The 
difficulties were really not great, and I can only recall 
one case in which 1 thought the operation of amputa- 
tion of the limb should have taken place on the battle- 18 
field rather than at the field hospital twenty-four to 
forty-eight hours later. 
This unfortunate battle provoked another hostility 
upon the following day, in the 6hape of the White 
Clay Creek affair. Such, however, was the masterly 
manner in which that gallant soldier, General Miles, 
controlled the situation, both by his comprehensive 
knowledge of the art of war as indicated by the disposi- 
tion of troops and his clear insight into the Indian 
character, that he prevented what at one time threat- 
ened to become a serious Indian war. Peace as well 
as safety was again assured the settlers of that sparsely 
populated country, a month after the arrest of Sit- 
ting Bull, by the surrendering of nearly 4,000 Sioux 
Indians at Pine Ridge agency, February 15, 1891. 
The entire sentiment of the country is well voiced by 
no less a personage than the President of the United 
States, in his last annual message, when, in speaking 
of General Miles, he says, “ He is entitled to the credit 
of having given thorough protection to the settlers and 
of bringing the hostiles into subjection with the least 
possible loss of life.” 
It is not surprising that the casualties of the foe, as 
well as ourselves were great, when we remember that 
the fire-arms used were those of largest calibre at close 
range. The Sioux were armed with three different 
kinds of guns, namely, Winchester of pattern 1866 
and calibre 45; Winchester, calibre 38; and the 
Springfield carbine, calibre 45. The principal weapon 
was the Winchester, calibre 38, together with very 
few of the other patterns mentioned. 
The United States troops were armed with Spring- 
field carbines, calibre 45; weight of bullet 400 grs., 
composed of lead and projected by 55 grs. of powder. 
The wounds resulting from the above were sinous and 
irregular, with lacerated edges; and the apertures of 
exit were frequently much larger than those of eu- 19 
trance. Fragments of clothing, splinters and pieces 
of lead were at times left in the wounds by the bullets, 
which, when permitted to remain, frequently led to 
long and obstinate suppurations (as instanced in the 
Indian wounded), often rendering secondary operations 
necessary. These bullets, by reason of the malleabil- 
ity of the metal (lead) of which they are made, are 
expansive; they easily lose their regular form and 
“ mushroom,” readily bursting iuto fragments upon con- 
tact with a hard body. By reason of the above, wounds 
of blood-vessels are more frequent, and attended with 
laceratiou, and the gravest of all dangers to the wounded 
on the battlefield, haemorrhage. These wounds are 
further complicated by the splintering and not infre- 
quently the complete shattering of bones. 
I am of the opinion that three-fourths of the casu- 
alties of the opposing forces were received in what may 
be termed the “ explosive zone ” of the projectiles’ 
trajectories. 
If, then, for the sake of illustration, we divide the 
trajectory of a small-arms projectile into three zones 
of action, indicative of the effects of its penetrating 
power on the human body, we should designate them 
as: (1) a “zone of explosion ”; (2) a “zone of pen- 
etration ” ; (3) a “ zone of contusion.” 
With record of the remaining velocity of the projec- 
tile, at successive stages of its trajectory, which it is 
perfectly possible to have with fair accuracy ; and 
with an assumed value of the work of penetrating the 
average human body, which assumption could be made 
within reasonable limits of error ; and with an assumed 
value of the remaining velocity after penetration, the 
projectile reappearing to leave a wound of the explo- 
sive type, which would be a very vague assumption,— 
accurate calculations of the zones could be made, but 
the result could be no better than the assumed data of 
the problem. Looking to experience, for the zones 20 
of the Springfield rifle, the wounds at the Wounded 
Knee fight, mostly within 100 yards range, were dis- 
tinctly of the explosive type. The wound of Lieuten- 
ant Hawthorne, delivered at 300 to 400 yards, just 
failed of this type. I have seen, at target practice at 
known range, the body of a man perforated by the 
Springfield bullet at 1,000 yards, and my memory re- 
tains no note of the wound of exit being of remarkable 
character; from which 1 infer that this range is well 
within the zone of penetration. I shall therefore es- 
timate these zones, for effective range of 2,400 yards, 
to be as follows: explosion, up to 250 yards; penetra- 
tion, thence to 1,200 yards; contusion, thereafter. 
The discussion of the zones of “explosion,” of 
“ penetration,” and of “contusion,” is a mixed one, 
involving both mechanics and physiology. Its mechan- 
ical features are essentially as follows: a very rapidly 
moving projectile practically shatters and destroys the 
material opposed to it, and makes a clean hole, as a 
pistol-bullet through a pane of glass, or as the enter- 
ing bullet in the familiar type of gunshot wounds. A 
projectile of less velocity tears or breaks the material 
opposed to it, as a bullet thrown from the hand against 
a pane of glass, or as the issuing bullet in the ordinary 
gunshot wound. 
The “ zone of explosion ” for any given piece is that 
part of its range in which the projectile has so great 
velocity that its loss of speed by penetrating the body 
of a man still leaves such velocity as to make the 
wound of exit similar in character to that of entrance ; 
the loss of velocity by the work of penetration is so 
great that this zone is very narrow except for pieces 
of great power. 
The “ zone of penetration ” for any piece is that 
part of its range in which the velocity of its projectile 
is such that it perforates the human body, but the loss 
of velocity in doing so leaves the projectile unable to 21 
make the wound of exit similar to that of entrance. 
This zone makes up the important effective range of 
most fire-arms. 
The “ zone of contusion ” covers the whole range 
from the last to the harmless “spent ball.” Much of 
it is still effective range. 
The penetrating power of the projectile varies di- 
rectly with its weight, directly with the square of its 
velocity. The resistance of the human body may proba- 
bly be taken to be proportionate to the area struck, 
that is, to the square of the calibre. 
In comparing the more modern arms with the 
Springfield rifle, the higher velocity and the less area 
of resistance more than counterbalances the less weight 
of projectile, and the “ zone of explosion ” confined 
to a very short range in our arm, is with them a con- 
siderable part of their effective range. We are 
neither keeping pace with the humanity of nations 
nor increasing the effectiveness of our army, by still 
holdiug on to the antique, single-loading Springfield 
rifle, calibre 45. 
This old-fashioned gun cannot be compared to that 
of France, the weapon of Germany or that of Austria ; 
and while our arm possesses a larger calibre than that, 
I think, of any other civilized nation at this time, it 
cannot be classified with such old calibres as those of 
68 and 72 (the latter known as the Minnie carbine), 
carrying projectiles that weighed as much as 740 grs. 
We find, however, a gradual change for the better, as 
in the last Franco-Prussian war the Germans were 
using an arm with projectile weighing 478 grs.; twenty- 
two grains less than our own. The French, upon the 
other hand, were armed with the Chassepot, calibre 
43, carrying a bullet weighing 385 grs. The Gras, 
which superseded the Chassepot in 1874, did not 
reduce the calibre or weight of bullet. The real 
advance was made, however, in the direction of in- 22 
creased velocity and reduced calibre, when the Lebel 
was adopted. Germany kept pace with France in 
substituting the Mauser model (1888) for that of 1871- 
84; and Austria followed suit by arming her troops 
with the Mannlicher. 
Now, to sum up, from the standpoint of ballistics, 
the modern arms mentioned are superior to ours by 
reason of possessing (1) greater initial velocity, (2) 
flatter trajectory, (3) greater accuracy, (4) greater 
penetration, (5) greater range. 
Added to these qualities, we find the quantity of 
powder lessened, the weight of projectile decreased, 
and from a financial view less cost of the arm as a 
whole. The most interesting phase is presented, how- 
ever, when we consider this matter from a surgical 
aspect. Chavasse and Delorme are of the opinion that 
all wounds received in the space between three hun- 
dred and nine hundred yards, are equally dangerous, 
but this is not concurred in by Chauvel, who contends 
that the explosive effects are as frequent in arms of 
small calibre. Dr. Noel, in the Medical Bulletin of 
February and March, 1891, says, “The disorganiza- 
tion of the soft parts is so extensive and the loss of 
tissue so considerable, that in general all reparation is 
impossible and a considerable sacrifice, is rendered un- 
avoidable.” “ The zone of penetration,” however, 
presents a more marked difference ; here the bullet, as 
a rule, maintains its shape ; the wounds of entrance 
and exit are more equal ; the fluids of the body are 
not thrown violently toward the periphery, as in the 
case of balls of large calibre, and the edges of the 
wounds are not bruised or lacerated, but look as if the 
integument had been “ punched out.” As we have 
stated, the bullet does not change its form, except in 
very rare cases, so that fragments of clothing and for- 
eign bodies are not usually left in the track of the 
wound; hence consequent suppuration is not to be 23 
feared. It is said that union is, as a rule, to be ex- 
pected by first intention; the period of recovery will 
be shortened ; paralysis or extensive shock rare ; gan- 
grene less grave and infrequent. Bones will not suffer 
fracture to the extent heretofore known, as they will 
be pierced in their entirety, and the Assuring and 
splintering will not be so extensive. Blood-vessels 
and nerves will run less risk of being struck propor- 
tionate to the reduced diameter of the projectile, con- 
sequently haemorrhage will not be so frequent, and the 
wounded in better position to await first aid. In 
the “ zone of contusion ” we will find either simple 
contusions or contused wounds, their gravity dimin- 
ishing as the bullet reaches the end of its trajectory, 
thereby losing its force. Periostitis, abscesses and 
exfoliations will ensue at times where bones have been 
struck, but these form the most serious cases, for gen- 
erally we will find mere extravasations of blood into 
the connective tissue. The optimistic picture just 
drawn portrays what is thought by some of the French 
and German writers upon the subject of their respec- 
tive arms; but this is not shared in by Billroth, who 
recently spoke to a question relating to the reorgani- 
zation of the army medical corps of the Austrian 
army. He is of the opinion that the modern small 
arm will aggravate suffering and slaughter in the bat- 
tle of the future, and informs us that as eighty per cent, 
of all wounds result from rifle-balls, fifteen per cent, 
from heavy guns, and five per cent, from cavalry 
weapons, surgical attention must be devoted princi- 
pally to the infantry projectile. Accurate statistics 
of the war of 1870-71 show that comparatively few 
were killed by artillery. 
Speaking of the manoeuvering at a distance which 
the long range of the modern arm will lead to, he 
says : “ A collision must come sometime, and then 
what will the effect of the new rifle be? Bullets 24 
that formerly stopped at the bone will pierce it, and 
perhaps two or three other bones ; the number of the 
severely wounded will be rapidly increased, and the 
armies will dwindle rapidly. 
“In consequence of the greater length of range, the 
wounded must be treated at a longer distance from the 
enemy, say four hundred paces further than hereto- 
fore. Moreover, with the quicker movements of the 
troops comes the necessity for the quicker moving of 
the field hospitals. The number of porters for the 
wounded, already too small in the Austrian army, will 
have to be largely increased; in fact, many wagons 
must be drawn up immediately behind the line of bat- 
tle to carry off the injured.” 
After dwelling upon the increase of the mortality to 
result from the use of smokeless powder, Professor 
Billroth continued to speak very disparagingly of the 
stretcher service in these words : “ At Gravelotte St. 
Privat there were 5,000 dead and 15,000 wounded. 
Two-thirds of the latter were only slightly wounded, 
and were carried off by railway. For the severely 
wounded, when we calculate that two porters with one 
stretcher made the trip of 500, 600 and 700 paces ten 
times during the eight hours of battle, we find that for 
the Germans alone 500 stretchers and 1,000 porters 
were necessary. We have left out of all consideration 
the French, for whose severely wounded the Germans, 
as victors, had to care. This at least doubled the re- 
quirements, so that 2,000 porters and 1,000 stretchers 
were needed. This shows how entirely impossible the 
whole stretcher service is.”