to any diversity in the nature of the wounds inflicted in the field, nor in that of the treatment adopted in the hospitals, for the fire-arms and their projectiles were alike, and the same surgeons were in attendance; it was obviously attributable to the fact that the field hospitals in the Crimea were close to the places where the wounds were received, while in the Italian war they were mostly situated at a considerable distance from them. In the Crimea the patients were received into the ambulances shortly after their wounds had been inflicted; in Italy, owing to the largeness of the number of wounded resulting from the principal battles, the difficulties of transport, and the distance of the hospitals, many of the severer cases did not live long enough to come under treatment-they died on the field of action itself. The chest wounds among the 'killed in action' in Italy were increased in number; the deaths among those treated in hospital were, in proportion, lessened in number. The absolute mortality of the wounds of the chest was probably similar in both the Italian and Crimean wars. Ratios of mortality in abdominal wounds.-The wounds most directly fatal in the field have generally been wounds of the head and chest. Penetrating wounds of the abdomen, even with visceral complications, are not so quickly fatal as a very large proportion of penetrating wounds of the two regions just named. A considerable number of penetrating wounds of the abdomen usually prove fatal, however, within twenty-four hours, or, at most, within a couple of days after their infliction. When, therefore, we find a large proportion of wounds of the abdomen among the dead on a field of battle and few in the hospitals, we may infer that there has been delay from some cause or other in removing the wounded; when we find a large ratio of mortality among wounds of the abdomen in the field hospitals, we may equally infer that the wounded have been removed to them without much delay. In the Crimean war the percentage of mortality in wounds of the abdomen among the British officers treated in the field hospitals was the highest of any regional wounds, viz., 51.5 per cent., and of the non-commissioned officers and men equally the highest of any regional wounds among them, viz., 557 per cent. This fact alone shows that no long time elapsed before the wounded officers and men referred to were placed under hospital care. In the French hospitals in the Crimea, also, wounds of the abdomen gave rise to a higher percentage of mortality than any other regional wounds, viz., 42.62 per cent.; while in the French hospitals in the Italian war of 1859 the mortality among them was only 26-64 per cent. These facts point to early removal to hospitals in the former instance, comparatively late removal in the latter. Ratios of mortality according to the situation of hospitals. -It has often been noticed that the wounds of those who have been treated in the villages and towns nearest to battle-fields have been followed by a larger ratio of mortality than those of the wounded treated in distant hospitals. Several reasons may be given for these different results. In the first place, the most gravely wounded, and from this cause the most unfit to be removed to distant hospitals-in many instances soldiers whose wounds are inevitably mortal-are retained in the nearest field hospitals; in the second place, the hospital arrangements in these situations are usually the most make-shift in character, the surgical appliances the most defective, and the hygienic conditions, within the hospitals and around them, not unfrequently very inferior. Opposite conditions have usually existed in the hospitals to which wounded soldiers have been sent at a distance from the scene of action. In these the slightly wounded have mostly been received, together with those who have partly recovered from their injuries, or from the surgical operations consequent on them—in short, all those who have been likely to undergo the fatigues and exposure of the transport with impunity; while the hospitals in such situations, being for the most part fixed establishments, have been provided with all the necessary means for the treatment of their inmates, and have had a more complete professional and nursing staff. The statistics of wounds, and of the different results of their treatment, in different places, will often lead to wrong conclusions, unless such facts are borne in mind. The Regional fatality of wounds on the field of action itself.— There are not many data for estimating the relative mortality of wounds of different regions on the field of battle itself. pressure on the time of surgeons in attending to the living wounded rarely permits the opportunity of examining the nature, or even the mere situation, of the wounds of those who have been killed outright. It could not possibly be done after large battles. The observation has been made to a partial extent on several occasions. During the New Zealand war of 1863-65, the region of the body wounded in 118 men who were killed on the scene of action itself was noted, and is recorded in the official report of the war. The following table shows the number of wounds in each region on this occasion, and the percentages of their occurrence :— It is stated in the Surgical History of the U. S. War of the Rebellion, that out of the 44,238 soldiers killed in action, according to the adjutant-general's returns, the records in the surgeongeneral's office only show the seat of injury in 1173 of the number. Of these, 487 were wounded in the head and neck, 603 in the chest and abdomen, 30 in the upper, and 53 in the lower extremities.4 46 These figures show the relative regional fatality to have been 41.51 per cent. in the head and neck, 51.41 in the trunk, 2.56 in the upper extremities, and 4-52 in the lower extremities, among 1173 wounds which led to immediate death in the field itself. Regional fatality of wounds within forty-eight hours.—Dr. Loeffler, in his account of the Danish war of 1864, has recorded the regional distribution of the wounds of 387 Prussians who were killed directly on the field of action (33 killed, the situations of whose wounds were not noted, being excluded), as well as of 82 others who died during the first forty-eight hours from their injuries.47 On calculating the percentages derived from these figures, the order of mortality of the regional wounds is not found to differ, as appears in the adjoining table, very materially from that in the one preceding. It will be seen by these figures that the order of fatality according to regions is only slightly changed by adding those who succumbed during the first forty-eight hours, from what it is among those who were killed on the field itself. The numbers of deaths differ considerably in the two lists; but the order of regional fatality in those who were killed on the spot is but little altered by the addition of those who may be regarded as having been in a dying state at the time they were removed from the field to the field hospitals. The deaths among men wounded in the trunk and head, doubtless with lesions of the internal organs, are largely increased in number in the course of forty-eight hours. Regional fatality of wounds among patients in military hospitals. It will be readily understood that when those who are killed on the field itself, and those who die within forty-eight hours after an action, are excluded, the regional order of fatality among those who remain under treatment may become materially changed. The severe wounds of those regions, the wounds of which are attended with the most speedily fatal results, have in a large proportion disappeared from the hospital lists, and the less serious wounds among them only remain for treatment. It is especially among these that more favourable results may be hoped for in the future from improved modes of treatment than have been experienced in the past. There are so many sources of fallacy when the percentages of mortality are derived from limited numbers of cases in particular hospitals (some of the causes of which have been already explained), that I have preferred to select a few examples in which the number of wounded treated throughout a whole war, or resulting from an entire battle, could be obtained, and the number of deaths among them shown. As these figures must include the results of treatment both in the near and distant hospitals, and under all conditions, a closer approximation to the truth may be hoped for than could be attained by selecting disjointed results. The only exception I have introduced has been the partial experience gained in the hospitals at Sedan and Balan by Sir Wm. MacCormac and Dr. Frank. As this experience was gained in hospitals on the field of action itself, to which the wounded were brought indiscriminately from the conflict, and where circumstances allowed the patients to remain for a considerable time, the figures may perhaps be fairly taken as a sample of what would have been the experience if the statistics of the whole of the wounds inflicted in the great and decisive battle of Sedan could have been ascertained. The campaigns or battles respecting which sufficient information has been found to exist for basing the calculations just mentioned upon are the following: Crimean and Italian wars, French; Crimean war, British; New Zealand war, British; war of 1864, Prussians and Danes; Ashanti war, British; and the campaign. between Prussia and Hanover in 1866. Calculations founded on Sir Wm. MacCormac's observations at Sedan have also been added, as already mentioned. Regional fatality of wounds among French soldiers during the Crimean war. The following tables show the order of fatality of the wounds and surgical operations necessitated by them, among the cases treated in the ambulances and hospitals of the French army during the Crimean war, and the subsequent Italian campaign of 1859.48 Owing to the manner in which the wounds are classified in Dr. Chenu's very valuable histories of these wars, the regions cannot be arranged, or the percentages calculated, in exactly the same manner as they are in the British tables. Wounds penetrating the articulations, for example, are not separated from those affecting the parts simply surrounding the articulations. Other differences in details exist, which interfere with exact comparison between the French and British returns. Crimean War, 1854-56.-French. Italian Campaign, 1859.-French Regional fatality of wounds in the British hospitals during the Crimean war.-The next table shows the order of fatality of the wounds according to regions, firstly among the officers, and secondly among the non-commissioned officers and privates, treated in the British hospitals during the Crimean war. The wounds of the officers are quoted for the whole of the war; of the rank and file, from April the 1st, 1855, to the end of the war.51 3 Joints 123410009 5 Head Back and Spine 7 Lower Extremity. 8 Upper Extremity. 19 2 10.5 29 3 10:3 200 10 5.0 4 0 0-0 Region. Number Treated. Number Died. Percentage of Mortality. Abdomen 2 Perineum and' 235 131 55.7 55 17 30-9 3456789 10 Upper Extremity 2100 55 2.6 |