^RMY MEDICAL ORGANISATION IN THE FIELD.

(Continued from page 449.)

with the 19 The corps chief surgeon, approval of the Commanding, exercises direct and immediate Mntor-General of the control overthe medicaljervico corps, 8ul,ject to in- from the army chief surgeon or the burgeon-General. Suctions to their Ho nwifiis all medical officers respective duties in order so that, on the march or in battle, they may ffnnrlin! at all times without know and take their posts confusion. are to the field Tho most skilful operators assigned hospitals. with the division TTr determines after consultation chief the assent of the General surgeons (and with Commanding) the"best sites for field hospitals. One of his chief responsibih- ? an + during and immediately after engagement will be to several divisions and ascertain the needs of his transfer mprliral help from one to the other, should it become urgently nof^essarv He should call for reports of sick and wounded, often as circumstances personnel and material, as permit. division should The chief surgeon of the make himself and thoroughly acquainted with his personnel means of trans- portation and make the best possible use of them. On the battlefield he must see where the needs are most pressing and tirovide for them. As soon as a medical officer has completed he should be his special duties at one place, ordered to other will be wanted at work All spare officers the field hospital after "the close of an engagement. The number of medical officers required for the service of thp division, front and rear, should never be less than 40, or 30 for the front 4 to every 1000 men, namely, and 10 for the the medical officers will be rear. In the service of the front, as follows: chief 1 lieutenant-colonel, division surgeon. the held major, commanding hospital. commanding the ambulance corps. major' one o m?i0rs and 4 captains, hospital surgeons; captain "SS executive otficcr of the hospital. the ambulance and ?? commanding companies captains, station. for duty at the ambulance surgeons, for 17 and lieutenants, regimental duty captains and the fiont. at the dressing stations not above the of first lieu- iQ Two line officers, grade in the medical service of each x + be detailed tenant, snoui?hnuld quartermasters and commissaries, field the other with the fnv "vitli tlie hospital, ; ? a U should have mounted sergeant as ambulanceilli rorns Each fficers have but little aptitude for this from their more wor^ and cannot be spared important professional duties. 488 THE INDIAN MEDICAL GAZETTE. [Dec. 1902,

14. The ambulance corps and field hospital (exclusive of The importance of litters in the service of the front can- be one officers) of an infantry division will be constituted as not be over-estimated, and it should of the cardinal follows :? principles of our sanitary service that every measure must be AMBULANCE CORPS. taken to provide an abundant supply of them.

. f Hospital Stewards .. ... 9") Ambulance. g, Acting Stewards ... 27 Hospital 17. The various kinds of ambulances until used in '$ Buglers ...... 3 lately our service were intended for two recumbent O Ambulance Drivers...... 36 mostly patients and otherwise defective. The last however, is a dis- "3 Ambulance attendants ... 36 J- pattern, -J 3031 tinct and far the best field ambulance ever Packers ...... 6 improvement by constructed in this Without to the Nurses and cooks ...... 42 country. adding weight, it the inestimable and of carry- Orderlies ...... 24 possesses indispensable quality and four recumbent and of .. patients ^Litter Bearers ... 120 j ! ing safely comfortably tliem on their own thus time and ... litters, fFarrier ...... 1^ f admitting saving handling in down both seats 5 ? I Blacksmith...... 1 dangerous loading. By letting or one, it carries men or four and O-w I Wheelwright ...... 1 only eight sitting sitting two recumbent. Outside are two brackets upon which litters ^ o Saddler ...... 1 J are these brackets should be to car- .-g ; Drivers of? f 13 j carried; sufficiently large two litters on each side. In front is a socket for the am- ?*= I Subsistence ... 3 ry wagons 238 A. ... bulance flag (Par. It.). I Baggage, &c., wagons 6| Besides the regular baggage wagons, I also believe that the Medical Department should have subsistence wagons and FIELD HOSPITAL. surgical wagons, constructed for their own special purposes, so their contents be in g f ^ that respective conveniently grouped ... in- i. | Hospital Stewards ... 7 I sufficient quantities, each class in its appointed place and ... accessible. 8 I Acting Hospital Stewards 21 ! 1fin stantly & | Nurses and Cooks ...... 66 f j' Other Means of Transport. Pack Mules for Dressing Orderlies ...... 6 g | | Stations. Hospital Material. K I J ? or a! f Blacksmith...... 1^| 18. In the absence of ambulances, for places where I Wheelwright ...... II they cannot go, various means of animal transport have ? S Saddler ...... 1 124 been devised. The best known in armies is the o | | j- European Drivers of? 24 mule used in France and it consists of _ ? j J- | litter, chiefly England; one j Surgical Wagons ... 3 a pair of couches, on each side of a mule ; seats (cacolets) "2,2 Subsistence Wagons .. 6 can be carried in the same manner, or a couch on one side and ? S I Baggage, &c., Wagons ... 12, a cacolet on the other. This means of transport requires bh i. J strong and specially trained mules, and, on account of its breadth, is inadmissible on many trails ; it has never been Total ... 440 looked upon with favour in this country. The two-mule litter, or litter suspended between two mules Leaving the 4 mechanics of the ambulance corps out of in tandem, has been successfully used on the western plains, each ambulance :? account, company will consist of but requires many animals and a straight road.

...... on Hospital Stewards ... 3 The single-mule litter, laid lengthwise the back of Acting Hospital Stewards ...... 9 the animal, lias also been recommended, but is condemned ...... severe Ambulance drivers ... 12 by the jolting to which the patient is mercilessly Ambulance attendants ...... 12 exposed. Packers ...... 2 The Indian travois, as improved by Greenleaf and otliei's, Nurses and cooks ...... 14 is probably, in the absence of wheeled vehicles, our best Orderlies ...... S means of animal transportation, but, in my opinion, should Litter bearers ...... 40 be further perfected by making the rear ends of the poles rest

...... a narrow Bugler ... 1 upon two-wheeled truck instead of dragging upon ... such a Wagon drivers ...... 3 the ground ; truck would be greatly to the advantage of the patient and his assistants ; it can be so constructed as Total ... 104 to admit of being carried on pack animals. Two travois should be provided for each regiment in the field, to be car- 15. Each furnishes the necessary and company personnel ried to the front on pack mules in case no ambulances are material to the brigade to which it is attached. The men availabe. to their so that should be permanently assigned duties, they 19. Ambulances should be allowed in the ratio of one to assume them at time without or disorder. may any delay each battalion or squadron, one to each two batteries of ar- of the station will as near- The personnel dressing consist, tillery, one to division head-quarters. The number of horses as officers ly possible, of 6 regimental medical (two for each for the ambulances to orderlies and mount- 2 6 stewards and 16 required (2 each), regiment), stewards, acting privates ed stewards of the division will be 90, exclusive of officers, orderlies and If there be two stations to (nurses, packers). who their own mounts. The number of mules re- the this is divided as be needful. provide brigade, personnel may for wagons (4 to and as animals will be 130. The of the ambulance station will consist quired each) pack personnel of 20. Ambulances, if at all able to reach dressing stations, the in of the ambulance the 3 major charge corps, captains can only do so late in the action and therefore the 1 3 stewards and comparatively commanding companies, steward, acting cannot be depended upon for the large supply of dressings 8 and If of the privates (nurses orderlies). any portion needful there from the For this purpose, light or stations are beginning. hospital personnel is available (Para. 24) con- two-wlieeled carts are used in Europe following each battalion these details can be increased solidated, accordingly. men) or regiment (3,000 men). In our service, such The six stewards are in (1,000 remaining acting placed charge of carts could seldom proceed far enough to the front; they the litter two for each ambulance bearers, company. should be by pack mules, which can follow the soldier The ambulance and field distinct replaced corps hospital, although wherever he goes. Such pack mules will doubtless be the so far as their administration is organizations concerned, best and often the only means of transport near the battle- are must interdependent and mutually helpful. They keep each animal two chests.* These chests should so of the field, carrying in touch with each other, that part personnel, when contain chiefly the simple dressings and other few articles an be transferred from one emergency requires it, may easily needed at the front: first-aid packets, bandages, gauze, cot- to the other. ton compresses, diagnosis tags, MATERIAL. splints, tourniquets, antisep- tics, stimulants and restoratives ; but there should be enough Hand Litter. of these for at least 200 patients. One or two mules should be to each 16. The regulation hand litter of our service is the result thus assigned brigade. 21. One subsistence and two of much intelligent study and and, in my opini- wagon baggage wagons experience, be allowed to each ambulance The subsist- on, the best in the world for field work. should company. general Although carries mess and food doubtless still of further it com- ence wagon cooking utensils, chests, susceptible improvement, the sick The bines the qualities of lightness, simplicity, portability, stores for and rations. baggage wagons carry 3 wall tents for the shelter tents of the corps strength and safety to a not equalled by that of any officers, hospital degree 2 tents and 2 common tents for the ambulance other army. Wheeled litters have been recommended and men, hospital a field utensils, tools, &c. are more or less used in all European armies, but they are station, desk, baggage, forage, only possible on hard smooth roads and therefore of doubtful value on or near the battlefield. The litter laid on a frame * The aparejo, although doubtless the best device for loading pack resting upon a bicycle wheel has also been tried but with mules, is too complicated for the purposes of the Medical Department indifferent success. and should be replaced by a pad or blanket and a plain pack saddle. Dec. 1902.1 FIELD MEDICAL ORGANISATION IN THE AMERICAN ARMY. 439

tals the ; if necessary, part of the field is set -2. The field train by way hospital hospital wagon consists of 3 surgicaland left behind for this purpose. ?wagons, 6 subsistence wagons, 12 lip baggage wagons and 1 field?26. In a camp, each should have on The contain permanent regiment surgical wagons operating tables and all with it two medical officers, at least two stewards and six Jorge.the instruments, sterilizers, duty medicines, dressings aonliancesH. C. and be provided with an ambulance and team. &c., required at the field their privates, hospital; contents are so ar'There is no hospital; each regiment has one in chests or as to regimental ?ranged, otherwise, be quickly got out The canvas (i wall tents and 3 comprises common tents for the re- manent the shelter tents of the staff, hospital corps men and for each section of the 1 brigade hospital; hospital or conical as the division is closely united, the division hospital tent as 1 for subsistence 1 long kitchen, stores, for medipil answers all and remains consolidated; if the line be and 20 tents for purposes hospital wards, dispensary and operatingmuch extended, the hospital may be divided into its several room. This canvas for 4 to 5 provides per cent, of the com" each in convenient to its re- mand sick or sections, being placed proximity dangerously wounded, and for more if the flies and ambulance company. be to spective brigade used extend wards. There should be on hand cots or The field hospital may occupy suitable buildings, if any hospital train must carry administration and mess tents ; or else a the officers i field dispensing, forming personal baggage, desk, axes, picks and with the above tents inside of it. for and triangle ?spades pitching trenching tents, dic-cdna-' sink*" hnw The ambulance corps, if nnited, is camped, in the ing the dead, &c., and forage for horses vicinity and mules of the hospital. If, as will be generally the case, the com- The field hospital should also be in the most supplied with an appa-panies are separated, each is camped suitable place ratus for drinking the on one boiling water; Waterhouse-Forbesin rear of its the officers and men side of the sterilizer to be the most brigade, appears satisfactory so far devised line, the ambul mees and wagons on the other. for in the field.f A small picket troops acetylene plant for the 27. The rules which should control the estab- of the and sanitary lighting operating administration tents is likewiselishment of a cunp, so as to prevent the produc- desirable and An permanent practicable. X-ray machine would be use-tion and of disease, are of the highest importance Jess and in the at the field propagation way hospital where only immedi-and worthy of the best efforts of medical officers. More lives necessary are ately operations performed (par. 39). can be saved by their intelligent application than by the observance of the most approved methods of treatment, oil ON THE MARCH AND IN CAMP. the battlefield, and an experienced liygienist will often be 23. On the march, the ambulance an corps (personnel and of much greater benefit to army than the most skilful is in the immediate rear of the material) division. The men surgeon. of march is the three companies together in column of fours fol The first and most important rule that very large bodies lowed ambulances, enc by pack mules, surgical, subsistence 'and of men should not be imped together unless required by of or baggage wagons. stern military necessity. A division 10,00!) 11,00!) men Whenever a located on brigade operates independently, or at some should be the largest command any one site, and so distance from its as for c in be division, instance in vaivmard or re- that no part of it polluted by the of connaissance its ambulance disposed drainage duty, company follows it other part. The water must be strictly guarded the any against Only junior regimental surgeons march with their each in rear with regiments, riding his orderly. One ambu in of an lance, charge acting hospital steward, also follows each two H. C. privates march ? but one which must be regiment; in front of it one solved if'the of them rides on the rear step when it is^troublesomeproblem. fever and carries patients n-imn soourees, typhoid dysentery, are to be who cannot find room should be Any patient his regimental am- nrevented The sinks carefully disinfected with bulance is a jn times a given diagnosis tag which is also a nermit tn or ashes three day, and every man for the earth quicklime wait by the roadside ambulances of use them A much better his brid? le com who fails to severely punished. sys- pany. is the removal of tem whenever practicable all f;eces from 24. The Chief of the Surgeon division is with the General disinfected latrine troughs by means of odorless excavators The in Commanding. Captains command of the ambulance nnri their burial as far away as possible, or incineration in are with their companies respective companies under th*. ri; ^-nmatories. The part played by the mosquito in the propa- rection of the the fever must in Major commanding ambulance corns The of malarial and yellow be borne mind train of Ihe ambulance and gation corps, immediately behind it i? and action taken accordingly wherever these diseases are ap- charge of a lie,,to.ant of the line, acting prehended. All fever cases of a suspicious nature should be niastei. (Jrai? i?i)? SiSfqiaJter isolated until a definite diagnosis is made. The train should be at the promptly hospital head of the light bag- be train of the division. It is also [To concluded.) gage in charge of a Lieute of the assistant nant line, acting quarter-master (Par 13 ) With it marches the hospital personnel But if a battle is including the'two mechanics. impending the r!nm mo ?ri in ~ Officer of the hospital, hisesecutive officefand't Ins men follow m rear of the ?oTee??n?'o? directly .ambulance so as locate and corps, to be able to prepare the site for the the arrival of the train. If the hospita pend- ing latter be or assist the long delayed, gone astray, they ambulance corps 25. At the end of the day's march, each company, with its ambulances and wagons, will bivouac as near its respect- ive as convenient; the brigade necessary tents are and under the pitched every arrangement possible circumstances is made for the comfort and of the security sick and wounded The will wagons of the ambulance corps generally be sufficient tn immediate so that the supply wants, hospital need not be until a more or less tmhl brought up permanent camp is reached. As soon as after the possible division goes into camp call is sounded i? each Surgeons regiment; the sick and -wounded more than temporarily unfitted fordntvu-pfnmioV. ed with sent to diagnosis tags and the company It is for the ambulances.' unnecessary regimental ambulances to their from rejoin respective companies, which t.hev mav he fir VI;? taut at the end of each day's march, if they are Ybl or otherwise procure, grain and forage for tho-.n.-mnioAocar% The officers, stewards and privates detacher remain with it in but wSi, regiment camp, may mess with the respective companies if conveniently near. J Every effort should be made by the chief all serious cases to the rear or leave them in local hoTpi- * If all the baggage cannot find room m the hospital waa-ons the most the necessary articles are carried along: others are left at the base or some depot on the line of communication and sent for later if needed t Sterilization of water for troops in the field with description' of apparatus. By Major W. Reed, U. S. A. Pro. Mil. S?^fl899