should be somewhat delayed, than the safety of the patient risked.

RULE 13. In crossing a ditch, dike, or hollow, the stretcher should be first laid on the ground near its edge. The first bearer then descends. The stretcher, with the patient upon it, is afterwards advanced, the first bearer in the ditch supporting the front of the stretcher while its other end rests on the edge of the ground above. While it is thus supported, the second bearer descends. The two bearers now lift the stretcher to the opposite side, and the fore part being now made to rest on the edge of the ground, while the rear part is supported by the second bearer in the ditch, the first bearer is left free to climb up. The stretcher is now pushed or lifted forward on the ground above, and rests there, while the second bearer climbs up. The two bearers then carry on the stretcher.

RULE 14. If several loaded stretchers carried by two bearers are moving together, or if a stretcher is being borne by four bearers, other methods of executing the movements referred to under Rules 12 and 13 can be advantageously adopted. If several stretchers are in progress, each with two bearers only, one may be laid on the ground while the two bearers quit it to give temporary aid to the bearers who have to carry the first stretcher across the obstruction. If it be a hedge or fence which has to be crossed, one of the bearers first gets across, and the stretcher, supported by three others, two on its opposite sides in advance and one in rear, is raised sufficiently high for the front handles to be passed clear of the obstacle, and over it, so that they can be taken by the bearer who is on the other side. The two side bearers then quit the stretcher-poles which they were holding, cross over the hedge or fence, and are at once ready to maintain the stretcher firm until the rear bearer can also cross. The stretcher being then laid on the ground, the other stretchers can be got across in a similar manner. Each stretcher can now be taken charge of by the two bearers who were previously carrying it, and the march resumed. The passage of a broad dike can be effected in a very similar manner, and with safety to patients, under corresponding circumstances.

RULE 15. On no account should a stretcher be permitted to be carried on the shoulders of four men. The evil of such a proceeding is not only that it is unlikely the four men will be of precisely the same height, so that a level position may be secured, but also that the wounded person, if he should happen to fall from such a height, owing to the helpless condition in which such a patient usually is, is not unlikely to sustain a serious aggravation of the injuries he may already be suffering from. General Stonewall Jackson of the Confederate States army, during the war of the rebellion, apparently owed his death to neglect of this rule.

He was being removed, wounded, from the field of action on a stretcher, which was carried on the shoulders of four bearers. One of the bearers, while engaged in this duty, was shot and fell, and the General was immediately thrown off the stretcher. The suddenness of the event, and the height from which he fell, caused General Jackson to come into contact with the ground with such force that the character of his wound, which was by no means a mortal one, was aggravated by the blow, and the General sustained, in addition, a severe concussion of the chest, which was followed by inflammation, and appeared to be the immediate cause of the fatal termination which ensued. The same cause led to a deplorably serious wound happening to Colonel Unett, who commanded the 19th Regiment during the Crimean war. He had sustained a very serious gunshot fracture of the thigh at the final assault of the Redan, and was being carried up to camp on a stretcher, which was unhappily placed on the shoulders of four of his men. One of them stumbled on the way, and the jerk by some means caused the discharge of the man's loaded rifle. It was being carried bandoleer fashion at the time, and the bullet in its course passed through the neck of Colonel Unett and shattered his right clavicle. I attended my unfortunate commanding officer until his death, which occurred a few days afterwards from the effects of his multiple wounds. Moreover, one of the bearers of a stretcher ought always to have a patient suffering from a grave wound in view, so as to be aware of hemorrhage, fainting, or other change requiring attention, taking place; and this cannot be done when the patient is carried on the shoulders. The height, too, is calculated to cause the patient uneasiness and fear of falling off, which it is also desirable to avoid. For all these reasons, notwithstanding that untaught soldiers will often attempt to carry a patient on a stretcher upon their shoulders, from the weight being borne more easily in that position, or with a view of relieving a fatigued condition of the arms, the proceeding should be strictly forbidden.

RULE 16. If the wounded man lying upon a stretcher have to be transferred into an ambulance waggon, a third bearer must be employed to assist in the transfer. This is already provided for if three bearers accompany the stretcher. On the arrival of the stretcher at the waggon, the bearer near the part which is first to be inserted should be ready to move round the end of the pole in his left hand, retaining, while he does so, the support of this pole only. Before he makes this move, however, the third bearer must grasp the right-hand pole; the hold of the other pole should on no account be given up by the first bearer until he has quite ascertained that the right-hand pole is fully supported by the third bearer. When this is known to be accomplished, the first bearer turns round, supporting the left pole at the side as he does so, and then, acting in concert with the third bearer, the two

together raise the ends of the poles, which are now free, into the compartment of the waggon which is destined to receive them. The bearer at the head of the stretcher at the same time takes care to maintain it level, and assists in effecting its entrance into the waggon by pushing it forward. By adopting this method the admission of the stretcher is effected with ease, rapidity, and perfect security; while two bearers can only accomplish the object with difficulty, and not without risk of accident to the patient.

(B.) Wheeled Stretchers.

General remarks on wheeled stretchers.--Stretchers supported and moved on wheels are articles of ambulance transport of comparatively modern invention. They were employed for the first time as military means of transport in the German war against Denmark in 1864; and the experience then gained led to very warm expressions regarding their utility by both Prussian and Austrian army surgeons. Wheeled stretcher supports have only formed part of the regular ambulance equipment of the British service since the report of the Committee on Ambulance Conveyances in the year 1872.

Wheeled supports for stretchers have been designed with a view to supply means of making up for the deficiency of bearers which has always been experienced when wounded men in large numbers have had to be carried by hand stretchers, as well as to diminish the labour and fatigue entailed upon the bearers who are engaged in their removal. Under particular circumstances, when the nature of the ground is favourable for their employment, they offer other important advantages; especially that of effecting the removal of the wounded more rapidly than it can be accomplished when the stretchers are carried by hand-thus saving them from prolonged exposure, and affording them an opportunity of more early surgical assistance.

The experience of the war between Germany and France in 1870-71 did not tend to confirm the good opinions which had been previously held regarding wheeled stretchers as conveyances for wounded men near the scene of conflict. A certain number of them were taken into the field with the German sanitary detachments, but it was found that they could very rarely be used with advantage between the fighting lines and the field hospitals. In consequence, in Germany, it has since been determined to discontinue them among the articles of equipment of the sanitäts detachements, and to retain them for use only with intermediate and stationary hospitals, and in garrisons. These appear to be the more practicable spheres for their employment in time of war; at the same time, they can always be made use of with advantage wherever level roads exist, when sufficient ambulance waggons are

not available, and it is a matter of importance to save the time and labour which would otherwise have to be expended in the carriage of sick or wounded men by hand. They orald doubtless be turned to very useful account in the home country in case of an invasion. Various forms of these conveyances are in constant use in civil life.

A wheeled stretcher consists of two distinct parts the stretcher and the wheeled support. In respect to the stretcher, the adaptation of the same one which is used for hand conveyance to the wheeled support presents so many obvious advantages that it has been adopted as a principle in the construction of the wheeled

stretcher of the British service. There are other points of importance to be attended to in the construction of a contrivance of this kind for military purposes. It must be made capable of being easily taken to pieces for stowage, and of being easily put together again when required for use. It must be strong enough to stand rough usage, but must be light enough to be lifted by two men over a ditch, bank, or low wall in case of need. The mode of connection between the stretcher and the wheeled support must be simple, so that the stretcher with a patient lying on it may be placed on the support or taken off it with ease and celerity. The

position of the stretcher on the support must be so arranged, and the weight adjusted, that the whole may be readily either drawn or pushed by a single bearer, at the same time that the wounded man upon it has as much security and ease as practicable. These principles have all been kept in view in the construction of the British service pattern.

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Wheeled stretcher of the British army.-The stretcher' is the regulation field stretcher described at page 631. The stretcher shown in the drawing (fig. 67) is the one which was introduced by the Hospital Conveyance Committee in 1872; the service stretcher which is in present use, with rollers for feet, is equally

adapted to this mode of carriage. The wheeled support' is composed of steel and iron throughout, and is therefore not liable to deterioration from long storage. It consists of an axletree, a pair of wheels, a pair of elliptical steel springs with crutches on their upper surfaces to receive the stretcher-poles, and a pair of folding legs. The axletree is made of -inch square steel, with a metal cap at each shoulder. The wheels are 3 feet in diameter. Each consists of eight steel spokes, deeply hollowed on opposite sides, screwed into a wrought-iron nave, and riveted to a T-iron tire 1 inch in width. The nave is made to secure the wheel on the axletree arm. The springs are made from 14 by inch springsteel, and are each two leaves in thickness. On the top of each