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meeting their professional responsibilities by real and honest practical study, and by having made themselves acquainted with all the details of the surgical appliances at their disposal; just as it is the time when those who have not done so will feel most keenly the painful situation in which they have become placed from their previous neglect. Shortly after a battle has commenced, surgeons usually find themselves surrounded by so many wounded men, all of whom urgently require assistance, and many of them serious surgical operations, that it is impossible for them to do what they have to do as quickly as is desirable, however unceasing may be their exertions, much less to find time for deliberating on what ought to be done. Self-possession and decision without delay, grounded upon professional knowledge, are essential for the adequate performance of the onerous and responsible duties which devolve upon surgeons on the occurrence of such an event as a hostile engagement in the field on any large scale.

The situations where help is directed to be afforded to the wounded during the progress of an action and subsequently to it, and the arrangements ordered for ensuring that this help shall be systematically and speedily afforded, have been already sufficiently indicated in describing the system of surgical administration for general service in the field.

Administrative arrangements during siege operations.-In considering the circumstances of siege operations, whether with reference to the duties of the medical staff within a besieged town or fortress, or to those of the staff with the besieging force outside, the study of the means of preventing sickness again assumes the place of first importance. The higher the state of health that can be maintained among the troops, the more successful will be the results of the treatment of the wounded. Within the besieged place, these preventive measures chiefly consist in providing the necessary stores and varieties of food, and in economising their distribution, but particularly in the most strict and regular attention to sanitary regulations; among the besiegers, preventive measures must be chiefly directed to counteracting the injurious effects of the harassing duties, hard labour, miasmatic exhalations, loss of rest at night, and exposure to damp and chills, to which the troops are subjected in the trenches. To describe the best mode of accomplishing these desirable results is the province of works on military hygiene. The remarks which follow will be limited to points connected with the special administrative arrangements for the hospital service, and for the treatment of the wounded on occasions of sieges.

Arrangements inside a besieged place. The provision of supplies for the hospitals should be specially considered. If the state of siege is likely to be of long duration, in addition to the usual hospital comforts, a stock of such articles as are likely to

prove serviceable in warding off scorbutic and allied conditions of body should be laid in freely. Sufficient stores of the remedies required for extensive burns, likely to result from explosions, or buildings set on fire by incendiary projectiles, should not be forgotten. If there is likely to be a want of water, the medical department should try and get a well sunk in the vicinity of the principal hospital while the men are strong and able; at the same time all means of collecting and storing rain water at the hospital should be carefully guarded.

In calculating the amount of medical and surgical stores which may be required under such circumstances, it is not enough to consider only the wants of the troops forming the garrison: the possible additional demands from a relieving force, should one get into the besieged place, must also be provided for. When the relieving forces of Generals Outram and Havelock made their way into Lucknow in September 1857, most of the regiments lost their medicines and surgical instruments during the advance through the hostile part of the city. They subsequently became almost wholly dependent on the stores of one regiment, the 32nd, for these important articles, and the stock of this regiment had become greatly reduced previously to the date named. The instruments were blunt and hardly fit to be used, the chloroform was expended, and the materials for dressing the wounded were exceedingly scanty. It should not be forgotten, also, when apportioning the medical staff to the troops in a place about to be besieged, that there will not be the means of replacing those who may fall sick, or who may die from disease or injury. An increase, proportional to the probable average number of casualties, should therefore be provided.

As soon as the siege has commenced, a regular roster of all the medical officers should be kept for garrison duty, so as to distribute the surgical labour as evenly as possible. Two medical officers should always be on duty together, for mutual aid, and in case of accident to either. A dressing-station should be fixed in some central position. Some of the inhabitants should be prepared for helping the men of the Medical Staff Corps and bearers in bringing the wounded to the dressing-stations.

When the storming of a breach is expected, the medical officers, with men of the Medical Staff Corps and bearers, should assemble in any suitable place near at hand, ready to give assistance. If the storming be successful, they must fall back upon the hospital. If the attack be repulsed, a truce will probably be agreed to, when some of the medical officers should get down to the ditch, to superintend the removal of the wounded from it and from the glacis. No time should be lost in removing the wounded from their wretched position about the ditch and its vicinity. Lanterns should be used, if necessary, for continuing

the search at night. The wounded of the besiegers who may be lying about the works should be given over to their own surgeons, to avoid encumbering the hospitals within the besieged place; if once brought inside, it is not likely that the commandant will allow them to return to their own force, lest they should give information injurious to the interests of the besieged.

Surgical arrangements with a besieging army. When a besieging force is carrying on a regular siege-not merely investing the place with the intention of starving it into capitulation -the labours of the medical officers are always very severe and incessant. Notwithstanding that its communications are open, so that supplies of all kinds may be brought to the army, its sick and wounded quickly removed, and reinforcements brought up, the average amount of disease and mortality in a besieging force is usually greater than it is in the force besieged. This depends particularly on the unhygienic conditions to which besieging troops are usually exposed; and a most important part of the work of the medical department is to counteract the effects of this exposure as far as practicable.

The steps to be taken for the surgical care and treatment of the wounded will be much the same as those already described for an army engaged in action in the open field. Similar arrangements are required for giving primary attention to the patients in the trenches, for their removal from them, for the provisional treatment of their injuries, and for their conveyance to the field hospitals. As the field hospitals are, however, less likely to change their positions, it is only as they become encumbered with many occupants, or when they are ordered to be cleared in anticipation of a sudden increase in the number of wounded from an intended attack, that the same urgent necessity exists of evacuating them upon the hospitals in rear as is experienced in open warfare.

Some primary attention is usually given by a surgeon in as sheltered a part of the trenches as he can obtain, and the wounded men are then carried away under the shelter of the parapets on stretchers to dressing-stations if the field hospitals are far from the works. Some have expressed doubt whether the exposure of surgeons in the trenches is compensated by any good they can do to the wounded in such hazardous positions. Dr. Millingen, whose extended experience during the Peninsular sieges gave, at the time he wrote, great value to his opinions, stated that the surgeons were of little, or rather of no service in this dangerous situation; 16 and that it would be better for bearers to be stationed with their stretchers at such points of the parallels as the engineers might consider safest, and to carry off the wounded men without delay to the field hospitals for treatment. But there can be no doubt, from experience during the siege of Sebastopol,

that the surgeons in the trenches during that prolonged siege were of essential service to the wounded; and if shot-proof protection be constructed in an appropriate part of the works for the medical officers, as was then done, and should always be done when practicable, no less for the preservation of the surgeons than for that of the wounded to whom they have to attend, as well as to admit of a light being used at night, their presence must prove of great service. The surgeon's position should be as near to the most exposed troops as engineering convenience will admit, but not so near as to be liable to be surrounded in case of a sortie and of the enemy getting within the works. It should also be as central as possible, to facilitate the approach of the bearers from both sides of the trenches.

When the assault has been determined upon, a proportion of medical officers should follow the troops, but should not quit the most advanced parallel of the works while the attack is proceeding. There will be ample occupation for them in attending to the wounded who are able to make their way back from the open ground in front, without needlessly exposing themselves to the severe fire to which the assaulting columns will probably be subjected. But if the storming be successful, they should hasten forward to the breach, or the parts of the enemy's works which have been escaladed, as soon as the firing has ceased; for the numerous wounded lying there, probably heaped one upon another, will most urgently require assistance. They should be accompanied by as many bearers as can be got with stretchers, and every effort should be made to get the wounded removed as quickly as possible to places where they can obtain shelter and surgical attention. If the assault be unsuccessful, then, as before mentioned when referring to the arrangements with the troops besieged, it must be hoped that a truce will be mutually agreed upon for the removal of the wounded, as well as for the burial of the dead.

Administrative arrangements in case of an attempted invasion. The general principles on which the wounded would have to be dealt with in case of an enemy making a successful descent on a part of the home country will be much the same as those already described for a general action. A considerable amount of uncertainty must exist as to the place on the coast where the enemy will try to secure a footing. Still, certain parts of the kingdom are more likely to be selected for such a purpose than others, and it is important that the means of carrying all necessary surgical assistance to the neighbourhood of those points where it might be expected an action would be fought should be well considered and arranged beforehand. The positions of the fixed and temporary hospitals relatively to any part of the coast where an enemy would probably attempt to effect a landing, and the

means of conveying the wounded to them, ought to be thoroughly determined. The organisation of the bearer companies ought to enable them to meet the first wants of the wounded, and also those connected with their removal by road or railway to the hospitals. The field hospital establishments should well answer the purposes of either primary or secondary hospitals in any places suitable for placing them. Specific instructions should be prepared, and kept ready for issue, on all points connected with these duties. The directions given on these heads should be marked with the greatest precision, for a misunderstanding might lead to clashing with other military arrangements, and even to disaster as regards the wounded. It is not to be forgotten that, in resisting an invasion, not only regular troops would be engaged, but militia forces and volunteers, who, while conferring great advantages in point of numerical assistance, cannot be expected to be familiar with many of the details and rules of military service. The interests of the wounded require that there should be equal precision in the administrative arrangements and orders of the medical department of the army as there usually is in those of the combatant branch for directing the movements of troops and of war matériel. The medical arrangements for the disposal of the men who are disabled can only be made with the approval of the combatant authorities, and in complete harmony with the general arrangements of the military service.

CHAPTER III

HOSPITAL EQUIPMENT

Preliminary remarks. The equipment required for the care and treatment of the wounded in time of war consists of (a) the surgical, medical, ward, cooking, and table equipment-the whole being included under the general term 'hospital equipment;' and (b) the 'transport equipment' this latter comprehending the store-transport vehicles and the sick-transport conveyances. The principal articles composing the different descriptions of hospital equipment in the British service, and the vehicles or other means by which they are conveyed, will be mentioned in the present chapter; the sick-transport equipment will be separately considered in the one succeeding. It is not intended to do more in this work than explain the general characters of the equipment; for the regulated methods by which medical officers are to obtain it when bodies of troops are preparing to take the field, and for particular details concerning many of the articles of the

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