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348 Ourrent Literature retained, and the scheme of the book remains the same. A section dealing with the "Terms used in Prescriptions in Latin and English" has, however, been added. The favourable opinion expressed in the review of the third edition can be fully endorsed, and this book will be found most useful to all medical officers as a ready and accurate means of reference. O. L. R .

•

The Biological Diagnosis of Gonorrhrea.-80mmer (Archiv f. Derrn. u. Syph. Originale, November, 1913, p. 583) gives an epitome of the literature of serum, skin, and vaccination reactions in' gonorrhma, and appends a bibliography of ninety-four references. Wildbolz and Barmen stated that the serum of gonorrhma patients agglutinates the gonococcus, but subsequent observers have obtained negative results only. Moreover, the serum of an animal that has been Protected by copyright. immunized with the gonococcus is not specific in its effects: it clumps staphylococci and streptococci as well as gonococci, though it does Dot agglutinate the meningococcus. On the other hand, an anti-meningo- coccic serum clumps the gonococcus. , Much work has been done on the complement deviation test in gO,norrhma. Dembska examined 100 patients and found that the serum of cases of more than a fortnight's duration deflected the complement, and in a manner especially marked if complications were present. Gardner and Glowes investigated 106 cases, and concluded that the reaction gives valuable information in gynrecology. Schwarz and McNeil find that the test is positive in all gonococcic infections, except when they are localized to the anterior urethra. The reaction is obtained usually

not before the fourth week, and frequently persists seven or eight weeks http://militaryhealth.bmj.com/ or more. Of 165 cases, 13 per cent gave a positive response eight months after recovery. The complement deviation test is specific, but a negative result does not exclude gonorrhma. The intensity of the reaction generally runs parallel with the degree and severity of the infection. v. Pirquet's reaction, in which an emulsion of dead gonococci takes the place of tuberculin, has been employed by many investigators, but the method is uncertain and of no value in the diagnosis of gonorrhma. The intradermic reaction in which vaccine is injected into the substance of the skin, and the ophthalmo-reaction in which it is instilled into the conjunctival sac, also fail to be specific in their results. Some observers consider that tbe local reaction produced at the site

of inoculation after a subcutaneous or intramuscular injection of vaccine on October 2, 2021 by guest. is suggestive of infection, but Sommer finds that no difference exists in the reactions seen in the infected or non-infected. On the other hand, a marked reaction of the implicated part after an injection of gonococcic vaccine is evidence in favour of the disease being due to gonococci. The reports of many investigators show that the pains in epididymitis and J R Army Med Corps: first published as 10.1136/jramc-22-03-16 on 1 March 1914. Downloaded from

Ourrent Literatu1'e 349 gonorrhrnal rheumatism are often temporarily aggravated after a dose of vaccine, or the urethral discharge is increased. Nevertheless, these reactions are not of universal occurrence; therefore, their absence does not exclude gonorrhrna. Such provocative reactions are of service in disclosing gonorrhrna which has been latent for long periods. Erlacher has reported instances in which he discovered gonococci by this method after being absent for months or years. The occurrence of constitutional symptoms with pyrexia after inocula­ tion with gonococcic vaccine often indicates gonorrhrna, but the absence of such a general reaction has no significance. Sommer experimented with intravenous injections of arthigon, a gonococcic vaccine prepared by Schering, and ascertained that they are of more value than subcutaneous or intramuscular inoculations. An elevation of 1.50 C. in the temperature after an intravenous dose of 0·1 c.c. arthigon usually denotes gonorrhrna; a rise of 2'50 C. and a saddle-back course of the pyrexia are almost certainly diagnostic of the disease or of its complications. Provocative reactions are more frequent after intravenous administra­ tion of gonococcal vaccine than after subcutaneous or intramuscular. No bad effects are caused by intravenous injections of gonococci. For women and children the dose of arthigon for intravenous administration must be less than 0·1 c.c. Protected by copyright. Sommer is of opinion that people contemplating marriage, who believe that they have recovered from gonorrhrna, should submit to an intravenous injection of arthigon. Such a course may prevent keen disappoint­ ment in the future, and may be the means of checking much married unhappiness. C. B.

Antityphoid Vaccination in the French Army.-Medecin-principal Vincent (Archiv. Med. Pharm. mil., November, 1913) published an interesting report on antityphoid vaccination in the French army during the year 1912. He employs a polyvalent vaccine, sterilized by contact with ether, and without the addition of any antiseptic to preserve it; each cubic centimetre contains 400 million bacilli. During the year 1912 30,325 men were vaccinated in France and 22,832 abroad. In very few http://militaryhealth.bmj.com/ cases was there any local reaction, and in healthy subjects pyrexia was only observed in 0·8 to 1·5 per cent of those vaccinated. During the year 1912 the strength of non-vaccinated men serving in France was 447,159; the incidence of enteric fever among these was 2·22 per 1,000, with a death-rate of 0'3 per 1,000 of strength. At the same time there were 30.325 vaccinated men, among whom there was not a single case of enteric fever. . In Algeria and Tunisia there were 41,514 non-vaccinated men, among whom the incidence of enteric fever was 12'14, with a death-rate of 1,88 per 1,000. Among 10,031 vaccinated men living under precisely the

sa.me conditions the incidence of enteric fever was 0'9 and mortality on October 2, 2021 by guest. nil per 1,000. In Eastern Morocco the strength of non-vaccinated men was 5,807, among whom there were 222 cases of enteric fever with 32 deaths, the ratio per 1,000 being 38'22 and 5'51 respectively. In contrast to this there was not a single case among 962 vaccinated men. J R Army Med Corps: first published as 10.1136/jramc-22-03-16 on 1 March 1914. Downloaded from

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In Western Morocco 6,293 non-vaccinated men had an incidence rate of 168'44 and a death-rate of 21·13 per 1,000 of strength;· while among 10,794 vaccinated men the corresponding ratios were 0'18 and 0'09 respectively. In an official communication sent to La France Militaire, on April 4, 1913, it was estimated that antityphoid vaccination has prevented about 2,100 cases of enteric fever, with probably 266 deaths, during the year 1912. J. V. F,

Intravenous Injections of Concentrated Solutions of Salvarsan and Neo-Salvarsan.-Ravaut (Presse Medicale, April 3, 1913, p. 262) finding that 0·45 to 0·6 grm. of neo-salvarsan dissolved ih 10 C.c. of distilled water caused no hrnmolysis of human red corpuscles in vitro, has given without mishap 420 intravenous injections of such a solution. It is necessary to filter it through sterile gauze. Duhot (Munch. med. Woch., May 20, 1913, p. 1088) also reports that he has administered intra­ venously without untoward results on 750 occasions neo-salvarsan in quantities up to 0'75 grm. dissolved in 10 C.c. of water. Katz (Munch. rned. Woch., October 21, 1913, p. 2337) finds that the curative effects of 0·3 to 0'6 grm. of neo-salvarsan are enhanced by dissolving it in 10 c.c. of water only. Twenty-four hours after administration no spirochrntes Protected by copyright. are found. His experience extends to 130 injections. Alexandrescu Dersca (Munch. med. Woch, July 23, 1913, p. 1601) has given 40 intra­ venous injections of 0'39 to 0'6 grm. of neo-salvarsan dissolved in 1 to 2 C.c. of water only. He states that no after-effects were observed. Fruhwald (Munch. med. Woch., November 11, 1913, p. 2513) has tested Dersca's method, and has noted no bad consequences. Great care, however, must be taken to prevent these concentrated solutions escaping into the connective tissue. He also has given 259 doses of 0'6 grm. of neo-salvarsan dissolved in 10 C.c. of water, and finds that they act promptly on the treponemata. If three injections are administered in the course of ten days the patient loses all signs of the disease in a fortnight. In about two-thirds of his cases fever, headache or vomiting

were observed, most frequently after the first dose. http://militaryhealth.bmj.com/ Strong solutions of salvarsan have been employed by Stern, who dissolved 0'3 grm. in 10 C.c. of water for intravenous use. Zimmern (Munch. med. Woch., May 20, 1913, p. 1087) has given 147 intravenous injections of a 5 per cent solution of salvarsan. Fever occurred twenty­ seven times, and vomiting followed on thirty-nine occasions. Very painful infiltrations also were caused by inadvertently injecting a few drops of the fluid into the tissues surrounding the vein. He has dis­ carded the use of such strong solutions, although he states that the salvarsan is retained in the body for a longer period when administered in concentrated form. Dreyfus (Milnch. med. Woch., October 21, 1913, p. 2333), using instead of a 5 per cent solution of salvarsan one of

1·25 per cent 01' less, has found in his experience of 320 intravenous on October 2, 2021 by guest. injections that the after-symptoms are fewer than when the. salvarsan is more highly diluted. Vomiting occurred ten times only. A complete course of salvarsan consists of 12 to 15 doses distributed over several weeks. Saalfeld (Milnch. med. Woch., October 21, 1913, p. 2339) has treated with good results 250 cases of syphilis with intravenous injections J R Army Med Corps: first published as 10.1136/jramc-22-03-16 on 1 March 1914. Downloaded from

Ourrent Literature 351 of 0·3 grm. salvarsan dissolved in 40 C.c. of saline fluid. In a few instances infiltrations appeared at the site of puncture which subsided in three weeks' time or less. It appears that neo-salvarsan can be employed in higher concentration than salvarsan. If nephritis is present, both substances must be freely diluted C. B.

The Re-organization of the Swiss Medical Service. (Reviewed In Beiheft 148 zur internationalen Revue uber die gesamten Armeen und Flotten).- The direction of the entire military medical service in peace and war is in the hands of the chief surgeon of the army (Oberfeldarzt). On mobilization he is the D.M.S. on the general staff, and in technical matters gives orders to the director of the territorial medical service (Territorialchefarzt). He is the technical adviser of the War Office on all questions relating to the medical services. His office is at Berne, and he is an official of the Legislative Assembly (Bund) on a fixed salary. The medical corps (Sanitatstruppe) consists of:- (1) Medical officers (Sanitatsoffiziere) : Military surgeons, apothecaries, and quartermasters (the latter are appointed from the Quartermaster­ General's Department (Heeresverwaltung). (2) Medical personnel: N.C.Os., lance-corporals, and orderlies (Kranken wart er). Protected by copyright. Commissions are given only to doctors and apothecaries holding Swiss diplomas. Their position in the army is that of responsible advisers to the combatant troops, and they are under the orders of officers com­ manding troops. Medical officers have military and medical command of medical units. The training of the personnel is carried out at the Rekrutenschule and in the Instruktionskorps. Military instruction is given in the training corps by regular medical officers assisted by officers of other arms. The training ground of all medical units is at Basle. At the head of the training corps is the Oberfeldarzt with a staff officer (Kommandant der Sanitatsschulen). Present establishment: 5 staff officers. 3 captains and subalterns.

4 assistant N.C.Os. , http://militaryhealth.bmj.com/ 'rhese officials are paid by the State, they get extra pay, according to rank, for special services, and also certain allowances (e.g., for uniform, horse, &c.). The recruit goes first to the Rekrutenschule for sixty days; he gets the ordinary military education and is trained as a stretcher-bearer. A new manual of instruction is about to be published, the indexed outline of which appears to be on the customary lines. All medical students and apothecaries join this Rekrutenschule, and, if physically fit, are trained as officers later on. . Conditions for joining the medical corps :- Minimum height 5 ft. 2t in.; V = D 0'4 with the better eye; strong constitution; knowledge of reading and writing; if possible volunteers. on October 2, 2021 by guest. There is an inspection by a staff officer at the end of the course. Officers and N.C.Os. are also trained here. Medical students and the more educated soldiers have a more elaborate training to fit them for the duties of lance-corporal and N .C.O. This is done at the N .C.Os'. school; the course lasts twenty days. J R Army Med Corps: first published as 10.1136/jramc-22-03-16 on 1 March 1914. Downloaded from

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To be graded as an ofhcer a candidate must pass the State examination, and then go through a special officer's training course, which lasts forty­ five days. He is then graded as a lieutenant, and mayor may not be employed with the army. The further education of the medical orderly consists of training in a civil hospital at Geneva or Bale for thirty days. He wears uniform and lives in barracks. N.O.Os. who have passed the Swiss State examination in medicine may be selected for study in the officers' training school by tbe D.M.S. The course here lasts forty-five days. The syllabus of instruc­ tion includes riding, instruction in regulations, accounts, rendering of reports, and practical acquaintance with the field equipment. The pay of mounted officers under instruction is 5 francs per diem, a travelling allowance of 5 cents per kilometre, and also a subsistence allowance Every year there is a refresher course in different areas, lasting two weeks; this is attended by all available ranks of the regular army. It is practical training for war, and great stress is laid on its importance. The necessary transport, &c., is supplied to make' the training as complete and realistic as possible. There is a central school at Thun for officers of all arms, at which all military subjects are dealt with, including 'practical field work and staff

rides. A certain number of medical officers attend some of these classes. Protected by copyright. There are special classes for medical officers which are called taktisch­ klinischen Kurse. These are attended by twenty-five to thirty subaltern medical officers at a time, before promotion to captain. The instruction includes theoretical and practical military surgery, and a more elaborate study of the regulations. Medical staff rides lasting several days are carried out. A senior infantry staff officer assists in the instruction on tactics and the writing of orders. The commandant is a medical officer assisted by two others. , Mounted officers going through the course receive 7 francs per diem, travelling allowance of 10 cents per kilometre, and the regular subsistence allowance. There is another course in tactics for senior or administrative medical officers lasting eight days; it is meant in particular for those who are about to hold important appointments during the manreuvres. http://militaryhealth.bmj.com/ There is also a course on the duties in the home area and lines of communication, which is also attended by officers of other arms. Strength of the medical service ;- For 1912 the strength of the medical service, including the landwebr, but not including voluntary aid (Hilfstruppen), wa,s calculated at about 950 officers and 6,750 N.O.Os. and men. The real numbers required by law are about 1,000 officers and 8,000 N.O.Os. and men. The number of recruits for 1912 for the medical service was about 850 to 900. This was below the number required and the deficiency has been to some extent . made good by training 12 to 15 bandsmen per battalion in medical aid. Mention is made of a special arrangement in the Swiss medical ,service with regard to the employment of civil surgeons. A certain number of on October 2, 2021 by guest. medical men residing near military centres are engaged as stopgaps when for one reason or another there is shortage of military medical officers. A medical man so employed is called a Platzarzt. He is called upon to perform duties by the D.M.S., which also include sanitary supervision. J R Army Med Corps: first published as 10.1136/jramc-22-03-16 on 1 March 1914. Downloaded from

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He usually performs his duties in mufti and is not required to go to mess. He receives 10 francs for each day he is employed. J. V. F. Reorganization of the Swiss Army Medical Establishments.--

NOTES ON ORGANIZATION. An infantry battalion has 2 mounted ]\1:.0s. ( if on L. of C.). 2 medical N.C.Os. 5 lance-corporals (Gefreiter). 13 medical orderlies. In addition, each company has its own medical lance-corporal. There is a regimental medical wagon. Mountain battalions have more medical personnel, viz. :- Per company: 1 M.O. (one captain mounted per battalion, the either three are subalterns and unmounted). 1 medical N.C.O. 1 lance-corporal. 5 " orderlies. Regimental staff:. 1 mounted M.O. (captain or major) with medical lance-corporal. Brigade transport column: 1 mounted M.O. (subaltern) with medical lance- corporal. companies and mitrailleur companies have each a medical lance-corporal. Mountain mitrailleur companies with 8 guns have a mounted M.O., 1 to 2 lance­ corporals, and 4 to 5 men.

Mountain mitrailleur companies with 4 to 6 guns have 1 to 2 lance-corporals and Protected by copyright. 1 to 2 men. The infantry mitralleur detachment has a mounted M.O. Squadrons, mounted mitrailJeur companies, and guide detachments have each a mounted N.C.O., and a mounted M.O. with the regiment. Artillery brigade 2 mounted M.Os. Artillery battery 1 lance-corporal, 2 orderlies. Howitzer brigade 1 mounted M.O. Howitzer battery 1 lance-corporal, 2 Fort artillery brigade 2 mounted M.Os. Fort artillery battery 1 lance.corporal, 2 Mountain battery .. 1 mounted M.O. 1 4 Infantry park company 1 1 corpor~i. Artillery park company 1 1 Howitzer park company 1 1 Mountain park company 1 1 " " Pack ammunition column 2 mounted M.Os. 1

Pack supply colurim 2 1 http://militaryhealth.bmj.com/ Engineers :- Sapper company 1 lauce-corporal, 2 orderlies. Pontoon company 1 2 Telegraph pioneer company 1 2 Mountain sapper company 1 mounted M.O. 1 2 Sapper battalion 2 mounted M.Os. Pontoon battalion .. 2 00 {DiViSional bridging train .. 1 lance-corporal. g. Signal pioneer company .. 1 2 Helio pioneer company .. 1 -:: Telegraph pioneer company 1 ~ Balloon pioneer company.. 1 mounted M.O. 1 2 orderlies. ~ Sapper company . . . . 1 1 orderly.

1'1 Mountain supply company 1 1 on October 2, 2021 by guest. ~ Sapper battalion .. ., 1 mounted M.O. " Supply company 1 lance-corporal, 1 Baker company 1 Supply column 1 M.O. Fortress train company 1 " I medical staff Divisional staff officer { 2 subaltern M.Os. 1 lance corporal. J R Army Med Corps: first published as 10.1136/jramc-22-03-16 on 1 March 1914. Downloaded from

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Extracts from para. 78 of the Swiss medical regulations:- Before an engagement, stretcher-bearers of the infantry, Jager and schiitzen, four per company, assemble in rear of the battalion and then march to the infantry medical wagon. They wear the brassard. The musicians of the above as well as of foot artillery and pioneers are to be used as far as possible as supplementary stretcher-bearers. From machine guns, divisional cavalry, field and foot artillery, the extent to which men trained in first aid are to be employed as additional stretcher­ bearers rests with officers commanding. If so employed they wear brassards. The most important change in the Swiss medical organization is that in the bearer company (Sanitatskompagnie). The companies are numbered I to VI per division; V and VI com­ panies in the 1st, 3rd, 5th, and 6th Divisions are organized and equipped for mountain service. Composition of a company :- Personnel: 4 l1'LOs. (0.0. is a captain, mounted). 1 apothecary. 13 N.C.Os. 15 lance-corporals.

44 privates. Protected by copyright. 8 trausport privates (including 1 N.C.O., mounted). Transport: 7 wagons. 2 medical fourgons, A and B. 3 wagons. 1 supply and baggage wagon. 1 travelling kitchen. Horses: 13 draught horses. Mountain bearer company :- Personnel: 4 officers, as in ordinary bearer company. 14 N.C.Os. 15 lance-corporals. 72 privates. 20 pack-animal conductors (including RC.O.). Transport: 20 pack animals with saddles complete. Two mountain bearer companies form a division (Abteilung), Nos. 1, 3, 5, 6, with a staff of:- 1 staff officer. http://militaryhealth.bmj.com/ 1 quartermaster. l Mounted. 1 0.0. pack animals. J 1 shoeing smith. 4 transport privates. 3 pack-animal conductors." 1 medical fourgon, G,} With 8 draught horses and 3 mounted fourgons, 2 equipped pack animals. Four ordinary bearer companies constitute a division, Nos. 1, 2, 3, 4, 5, 6, with a staff of:- 1 staff officer. 1 adjutant. 1 quartermaster. Mounted. 1 transport officer.

1 apothecary_ on October 2, 2021 by guest. 2 chaplains. 2 medical N.C.Os. 1 transport serjeant. 2 shoeing smiths. 7 transport privates. 1 postal orderly. 1 officer's orderly. J R Army Med Corps: first published as 10.1136/jramc-22-03-16 on 1 March 1914. Downloaded from

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Transport: 1 medical fourgon, O. 1 staff fourgon. 2 supply wagons .. 10 draught horses. If the mountain bearer company acts independently, as often happens, it comes under the orders of the mountain brigade staff. The new arrangements dealt with so far are designated the first and second echelons of medical aid (Sanitatshilfslinie). The first echelon is the medical service with the troops, the second the bearer company. The third echelon of medical assistance is composed of :­ (1) Field hospitals (Feldlazaretten). (2) Hospitals on L. of O. (Etappensanitatsanstalten). (3) Hospitals in home territory (Territorialsanitatsanstalten). The last two are frequently civil hospitals. A field hospital is composed of :- 2 Landwehr- .. designated Nos I and H. Attached are: 2 Bearer columns .. "IH " IV. and 2 Red Oross columns " V " VI. One such formation goes to each division, and they are numbered 11 to 16. The mountain ambulances Nos. 25 to 28, are allotted to the fortress troops at St. Maurice and at the St. Gothard. Each Landwehr infantry Protected by copyright. brigade possesses a Landwehr ambulance, Nos. 19 to 24. Landwehr ambulances, Nos. 1 and 2:- Detail of personnel: 6 medical officers. 1 apothecary. 1 accountant. 6 medical N.O.Os. 1 transport N.O.O. 34 privates (which include 12 to 15 Ltnce-corporals and 8 transport privates). Transport: 2 medical fourgons, A and B. 3 ambnlance wagons. 1 supply wagon. 1 travelling kitchen. 2 saddle horses. 13 draught horses.

In the Landwehr mountain ambulance the subordinate personnel is http://militaryhealth.bmj.com/ slightly increased. Transport: 2 medical fourgons, E and F. 3 ambUlance wagons. 1 supply wagon. 1 travelling kitchen. The equipment of a mountain bearer company is also included. The horses and pack animals required are found by the fortress train companies. Field hospitals, Nos. 11 to 16, have the following staff:- 1 staff officer, mounted. 1 adjutant.

1 apothecary. on October 2, 2021 by guest. 1 quartermaster. 2 chaplains. 4 transport privates. 1 postman. 1 officer's orderly. Transport: 2 medical fourgons, O. 1 requisitioned motor wagon with 2 chauffeurs._ J R Army Med Corps: first published as 10.1136/jramc-22-03-16 on 1 March 1914. Downloaded from

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Bearer column, Nos. III and IV:- Personnel: 3 medical officers, mounted. 1 transport officer, mounted. 1 accountant. 2 medical N.O.Os. 2 tran~port N.O.Os., mounted. 30 medical privates. 1 shoeing smith. 30 transport privates. Transport: 24 hired wagons for sick. 2 travelling kitchens. 1 hired baggage wagon. 1 hired supply wagon. 54 draugM horses. Red Cross column, Nos. V and VI, provided by the Red Cross Society:- Personnel: 2 medical officers, mounted. 40 to 60 volunteer privates. Transport: 1 to 2 fourgons. 2 travelling kitchens. 24 hired wagons for sick. 1 hired baggage wagon. 1 hired supply wagon.

The commandant, line of communication, provides the necessary Protected by copyright. draught animals. These new arrangements were tested for the first time at the autum'n manamvres in 1912, in the 5th and 6th Divisions, and the reports are said to have been very satisfactory. ; There are in addition, for duty on the line of communication and in the home territory, Landwehr ambulance trains :- Personnel: 3 officers. 1 accountant. 2 N.O.Os. 29 lance-corporals and privates. Transport: 20 railway carriages with the necessary fittings. Equipment for line of communication, fortress, and territorial hospitals

(Anstalten) is mostly found by the Red Cross Society. J. V. F. http://militaryhealth.bmj.com/

Japanese Army Medical Service - Bearer Battalions (from materials supplied by Captain A. A. McNeight, Indian Medical Service). Each division has one bearer battalion. This battalion is composed of two bearer companies, two transport companies (sharyochiitai), and a headquarter (dressing station) party. The battalion is commanded by a major or lieutenant-colonel of infantry or transport corps, and each bearer company, consisting of two bearer sections commanded by sub­ alterns, by a captain of infantry or transport corps. It is organized for command and interior economy as a company of infantry. The personnel of the bearer companies consists of infantry reservists, who have been trained while with the colours as auxiliary stretcher­ on October 2, 2021 by guest. bearers in stretcher drill and first aid to the wounded. Each transport company is commanded by a captain of the transport corps, and consists of a transport section and an auxiliary bearer section, each commanded by a subaltern of the transport corps. J R Army Med Corps: first published as 10.1136/jramc-22-03-16 on 1 March 1914. Downloaded from

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The personnel of a transport company consists of transport reservists, who are employed (1) as drivers of ambulance wagons and (2) as bearers of the auxiliary bearer section. The latter have undergone a course of stretcher drill, and are in the proportion of two men to each stretcher. The headquarters section of the battalion consists of the commanding officer, an adjutant, an apothecary, and an accountant officer, and a dressing station party under the command of the senior medical officer. The senior medical officer is a third-class principal surgeon (major), the second senior a captain, and the remainder subalterns belonging to the active army or the reserve. The equipment consists of a number of panniers, boxes containing operating tables, field stretchers, some tents, and a proportion of ambulance wagons. All the equipment is carried on light, one-horse, two-wheeled . Three panniers are loaded on to each . They and their drivers or grooms are supplied by the transport battalion and remain with the bearer battalion during the operations. A bearer battalion is divisible into two identical half battalions, called No. 1 half battalion and No. 2 half battalion. The panniers are in two identical sets for the purpose of division. There are two operating tables. All the personnel of a bearer battalion, infantry, medical, or transport corps, wear the Geneva Convention brassard. The auxiliary stretcher­ bearers of combatant units do not wear this brassard; they wear instead a white band on the right sleeve. Protected by copyright. During work in the field, the bearer companies carry the wounded from the fighting line to the dressing station, in the admission section of which they deposit them, taking from there empty stretchers to carry back to the fighting line. The carriage of the wounded from one section of the dressing station to another is done by men of the medical service. The wounded are removed to the field hospitals by the ambulance wagons of the transport section and bearers of the auxiliary bearer section. The stretchers used by the auxiliary bearer section differ from those carried by the men of the bearer companies in that they are fitted with a detach­ able canvas hood, and with a carrying pole and detachable iron supports, which enable the bearers to carry the stretcher from the shoulders, as is done with the Indian doolie. The dressing station party opens a dressing station (two, if the battalion is divided) about 1,000 yards behind the fighting line. A http://militaryhealth.bmj.com/ dressing station opens in four sections: (1) An admission section, (2) a treatment section, (3) an apothecary's section for the issue of materials, &c., and (4) a discharge section. These sections are partitioned off from one another by ropes, and are distinguished respectively by white, red, green, and black placards by day, and paper lanterns of the same colours by night, except that the one for the apothecary's section is white with broad bars of black. Severe cases have red, and light cases green diagnosis tallies attached to them either by their hattalion medical o,fficer or in the dressing station. When orders are given for a whole battalion to open a dressing station,

only one-half of the panniers, &c., are unloa'ded at first, the other half on October 2, 2021 by guest. being left on the carts, so that if the dressing station should be ordered to close and re-open elsewhere, one-half of the equipment can be sent on at once to the new position. If, however, the number of wounded requires it, the second half can be unloaded and taken into use on the spot. J R Army Med Corps: first published as 10.1136/jramc-22-03-16 on 1 March 1914. Downloaded from

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The Intendance Department is responsible for the cooking and latrine arrangements, this work lying outside the sphere of the bearer battalion. J. V. F. The Results of Treatment of the Wounded in the Russo-Japanese War.-Summary of an article in the Kaikosha Kiji, of October, 1912. Total killed and wounded 200,057 Proportion of killed in action 22'8 per cent

OLASSIFICATION OF WOUNDS. Bullet wounds .. .. 149,040=79'7 per cent Shell wounds .. 31,495=16'9 Explosive wounds 4,720= 2'5 Cold steel wounds . . . . 1,673= 0'9 Proportion of wounded who died after receipt of treatment by members of the army medical service = 6,6

DEATHS AFTER TREATMENT, FROM BULLET "WOUNDS. Wounds of brain 67'3 per cent of cases Wounds of chest 13'5 Wounds of abdomen.. .. 65'5 Wounds of limbs 1'9

Amputations were performed in 1'1 per cent of the total number of Protected by copyright. wounded. Infection of wounds (resulting in erysipelas, tetanus, ulcers, septic­ remia, or pyremia) occurred in O'S per cent of total wounded. The proportion of men invalided from the service as the result of wounds, to the total wounded, was 13'3 per cent. J. V. F.

Some Medical Aspects of Aviation.-Hermann von Schrotter has published a paper in the Oesterreichische Sanitatswesen (Nos. 43 and 44, 1913), entitled "Gesichtspunkte zur Hygiene und Prophylaxe der Luftfahrt: Aeronautik und Aviatik," in which he goes into some detail with regard to the physical requirements of aviators, their clothing and also into various technical matters in connexion with construction. The

writer has had some per~onal experience of flying and has made various http://militaryhealth.bmj.com/ interesting observations on others before and immediately after flight with regard to both temperature, pulse rate and respiration. He has also endeavoured to collect facts with regard to the altitude at which the inhalation of oxygen becomes necessary. He got passengers to keep notes during flights with regard to temperature, &c., at various heights, and gives some interesting notes on their handwriting which, above a certain height (3,000 m.) becomes shaky and less legible. The cold atmosphere was in part responsible for this, but he attributes it also partly to nervous disturbances. He is of opinion that flying men should be periodically examined to see if any organic changes are taking place. He suggests that a medical

specialist should be attached to aviation commissions to deal with the on October 2, 2021 by guest. many medical questions which are likely to crop up. There are points in connexion with causation of accidents in aviation which have 11 medical aspect. This is a new field of work which might wi,th advantage be taken up 1, J R Army Med Corps: first published as 10.1136/jramc-22-03-16 on 1 March 1914. Downloaded from

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by our physical training experts, and to obtain practical results, as in recent years they have done with marching, a practical course of aeronautics would appear to be indicated. J. V.F.

Wounds Inflicted by Falling Bullets.-Professor Wieting Pascha of the Turkish Medical School, Gulhane (Deutsch. Militiiriirzt. Zeit., No. 15, 1909) has described some unusual cases of bullet wounds. During the Revolution in Constantinople the Turkish soldiers, to show their sympathy, fired off some 300,000 rounds of ball cartridge, mostly directly upwards into the air. Many of the bullets fell in the streets and inflicted a variety of wounds on persons there. Wieting discusses the possibility of these wounds having been caused by shots fired into the streets from houses, but does not believe that they could have been so caused. The following cases were treated by him at the Gulhane hospital :­ (1) A man, aged 30, suddenly collapsed while in the street. On admission he was found to have a wound of entrance over the right parietal bone, 1 inch from the middle line, and a wound of exit over the

right malar bone. He was unconscious and showed signs of cerebral Protected by copyright. compression. The wound was enlarged, many splinters of bone were removed and a plug inserted to control the hffimorrhage. At the post­ mortem examination little fissuring of the skull was found; the middle meningeal artery was divided and there was a ploughed-up track through the brain substance. . (2) A boy, aged 12, suddenly collapsed while playing in the streets. He was found to have received a wound of entrance over the left parietal bone with a wound of exit just to the left of the nose. He was un· conscious for several days with right-sided paresis. At the end of three weeks he was discharged cured. (3) and (4) Two other men received wounds of the head which proved fatal immediately; no post-mortem examination was permitted. (5) Without any warning a man was suddenlY struck at the upper part of the left shoulder blade; the bullet, a Mauser one, was found http://militaryhealth.bmj.com/ under the skin over the left breast. There were no lung symptoms. (6) An officer was hit in the deltoid region. The bullet, a Mauser, was found lying against the humerus. (7) A 14-year-old boy was suddenly hit near the acromial end of the clavicle. The bullet was felt near the lower end of the ensiform process. He was unconscious and collapsed; death took place in a quarter of an hour. At the post-mortem examination the bullet track was found to have traversed the lung, pericardium, stomach, liver, small intestine and colon, and to have lodged in the right rectus muscle. (8) A woman, aged 40, was wounded in the soft parts near the elbow

joint. Judging by the shape of the wound, the bullet must have been on October 2, 2021 by guest. a Martini-Henry or a Mauser which struck broadside on. (9) A boy, aged 4, was playing in the open when he suddenly collapsed with a scream. The wound of entrance was just under the twelfth rib to the right of the spine, the wound of exit was at the top of the thigh close to the perineaUold on the right side. The parents picked up the bullet, an unaltered Martini-Henry one, from the ground where the boy fell. 25 J R Army Med Corps: first published as 10.1136/jramc-22-03-16 on 1 March 1914. Downloaded from

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There were some abdominal symptoms, but the boy recovered completely in eighteen days. Wieting discusses the question of ballistics in regard to the possible momentum which a bullet shot vertically into the air might be expected to possess when it again reached the earth, but has not found any satis­ factory answer. He points out that all the wounds resembled in character those inflicted at long ranges. J. V. F. Anti-malaria Campaign in the Adriatic Provinces of Austria.­ Dr. V. Celebrini (Wien. med. Woch., No. 49, 1913) describes the anti. malaria measures carried out by direction of the Austrian Government iu Dalmatia. The local conditions were such that it appeared to be wisest to direct the main effort to eliminating parasites from the blood of their human hosts and so break the cycle of infection. To accomplish this the whole adult popUlation of the affected areas received a daily dose of 0'4 grm. of quinine from June 1 to the end of October; children according to tbeir age received a smaller dose. Frequent blood examinations carried out during a period of several years convinced the authorities that it is

only by means of a daily dose of quinine that the peripheral blood can be Protected by copyright. kept free from parasites. To ensure that everyone got a daily dose of quinine required very careful administrative arrangements, as many people objected to taking quinine when not suffering from fever. Some difficulty was experienced in getting children to take quinine, but latterly a lozenge made of cocoa and containing tannate of quinine has been found to be very satisfactory. In many cases it has been found that quinine treatment merely has the effect of banishing the parasites from the peripheral blood, but does not eradicate them. In districts in which there were few anopheles, two years' prophylactic treatment with quinine almost banished malaria, but where anopheles were plentiful the results of the quinine prophylactic treatment were very disappointing. Weakly, underfed persons did not tolerate quinine well, but in well­ to-do individuals it appeared to have a decided tonic effect. http://militaryhealth.bmj.com/ In making a malaria survey the only reliable index was found to be an examination of the blood; malaria parasites were frequently found in children with a normal spleen. Malignant tertian parasites wer:e most commonly found during the late summer. During the winter the houses in infected districts were freely fumigated, bu.t with little result as it was found that many anopheles hibernated in shelters out of doors. All school teachers have received a course of instruction on malaria and its prevention; it is hoped that they will impart this knowledge to the inhabitants, especially to those in remote villages. J. V. F. on October 2, 2021 by guest. Report on the Health of the Russian Army for 1910 j issued by the Army Medical Headquarters at St. Petersburg in 1912.-The following extracts are taken from a review on this work which appeared in the Deutsch. Militararzt. Zeit., for December, 1913. (1) Strength of the Army Medical Establishment on January 1, 1911 ;- J R Army Med Corps: first published as 10.1136/jramc-22-03-16 on 1 March 1914. Downloaded from

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Medical ~Iedic"l and Pharmacists pharmacist Company officers Feldschers .Feldschers Authorized establishment 3,738 269 5,848 4,427 Actual establishment 3,428 265 4,919 3,958 The strength of the medical service to the rest of the army was as follows:- 1 medical officer to 358 men. 1 pharmacist to 4,631 men. 1 Feldscher to 138 men. On January 1, 1911, there were in the reserve :- 5,033 medical officers. 568 pharmacists. 48 Feldscher officials. 14,900 medical and pharmacist Feldshers. 12,337 company Feldschers. (2) The health of the army:- The average death-rate for the preceding fifteen years was 4'15 per 1,000. The death-rate was highest in Omsk, Turkestan and Warshau. Amongst officers the sick-rate was: 478·9 per 1,000 and the death-rate from sickness 6'9 per 1,000; from accidents, 0·63 per 1,000; and from suicide, 1'41 per 1,000. With regard to the men, 542,410 cases of sickness occurred, exclusive Protected by copyright. of cases treated outside. Of these 31,887 were treated in regimental hospitals and 510,523 in other hospitals. In addition there were 4,608,332 outside cases treated in various institutions, necessitating 8,841,225 professional visits. These cases amount to 3,755 per 1,000 of the total strength of the army. The total strength of the army amounted to 50,755 officers and 1,227,100 men. The average constantly sick in hospital was 28'& per 1,000. There was an average of 10·5 days in hospital for each man and the average number of days under treatment· for each case was 23'8 days. The following groups of diseases accounted for the largest figures in the returns, viz:- http://militaryhealth.bmj.com/ General infectious diseases 87,354 Venereal diseases .. 56,454 Lung diseases 60,829 Diseases of the digesti ve system 55,481 Influenza, 33·5 per 1,000, and intermittent fever, 27'1 per 1,000, head the list of diseases. Deaths occurred chiefly in the following groups :- General infectious diseases 2,658 Diseases of the digestive system 374 " " respiratory system 274 " " ear 243 118 " " brain on October 2, 2021 by guest. The death-rate was highest in typhoid fever, tubercle, and croupous pneumonia. The engineer troops had the highest disease incidence, and the infantry the highest death· rate. J R Army Med Corps: first published as 10.1136/jramc-22-03-16 on 1 March 1914. Downloaded from

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(3) Of particular diseases the following figures are of interest :­ Smallpox, 2lO cases, with 29 deaths. Measles, 182 cases. Death-rate 50 per ce~t. Infection was conveyed by Caucasian recruits. . Influenza is much on the increase, but would appear also to be a convenient diagnostic term for many obscure cases. Typhoid fever: Incidence 5·2 per 1,000, death-rate 0·75 per 1,000, invalided 1·7 per 1,000. The incidence in Turkestan was 18·2 per 1,000 and in the Caucasus n·9 per 1,000. The causation of this disease in epidemic form was attributed to bad water supply, soil infection, primi­ tive latrines and prevalence of the disease amongst civilians. There were 520 cases of cholera. The Caucasus, Kasan and Omsk districts had the most cases. Most cases occurred in July and August. Tubercle of lung: 2,449 cases occurred, 649 died, 1,642 older soldiers and 848 recruits were invalided. There was a considerable diminution in venereal disease, but the incidence is still high, viz., 47·5 per 1,000, of which 15·1 per 1,000 is due to syphilis. The incidence in intermittent fevers and malarial cachexia shows marked improvement. While in the period 1888-1892 it stood as high as 106·5 per 1,000, it dropped to 32·4 per 1,000 in the quinquenium 1903- 1907, and in the year under consideration, 1910, it stood at 28·8 per Protected by copyright. 1,000. Amongst the accidental deaths the following figures are quoted: 32 men were killed by criminals, 26 were shot by accident, and 23 were run over; 21 died of alcoholic poisoning; 16 from carbon monoxide fumes; 12 from frost bite; 133 by drowning, of these 60 per cent were drowned while bathing, and 7·5 per cent whilst horses. The list of suicides is rather interesting. By shooting: 66 officers, 135 men. By hanging: 1 officer, 55 men. The cause of suicide was attributed amongst the officers in 16 cases to mental disturbance, and in 8 cases to alcoholism, and amongst the men in 21 cases to hopeless love affairs, in 16 to alcoholism and in 15 cases to fear of pUD,ishment. Invaliding.-Thirty-three per 1,000 of older soldiers and 23·2-per 1,000

of recruits were invaljded. http://militaryhealth.bmj.com/ Amongst the older soldiers 31 per cent were invalided for anremia and debility. Amongst the recruits the chief causes of invaliding were anremia, bronchial trouble!" heart disease, and joint and bone affections. Recrniting.-According to the regUlations of 1909, 10·3 per cent of recruits called up were examined, of these 43·8 per cent were passed fit, 55·8 per cent unfit, and 0·4 per cent died. Of the unfits, 32'2 per cent were remanded and 67·8 per cent were permanently dismissed. J. V.F.

• on October 2, 2021 by guest.