of war. It would be impracticable to construct such carriages in sufficient numbers, or, if constructed, to ensure their presence at the particular points where they would be required in case of a landing on our shores being attempted, and a battle ensuing. The chief problem which requires to be solved is how best to convert the existing waggons, such as may be found at any railway station, and especially those which are likely to be used for carrying baggage and stores for an army, into suitable carriages for the removal of wounded men. Such converted waggons must comprise ready accessibility of the patients to surgeons and attendants, proper available supports for them, together with as much freedom from injurious movement as is possible; while, at the same time, due regard should be had to economy in cost, mechanical simplicity, sufficiency of strength, speed of conversion, and to the necessity for so altering the vehicles that they will not be prevented from reverting to their former uses when they are no longer required for hospital purposes. This problem is really only second in importance to that which is known to have received well-judged attention from the military authorities for a long time past, viz., the means of speedily conveying men and guns by railway to any given point, in sufficient force to resist an attempted invasion.

In addition to the ordinary goods waggons which are to be found in large numbers on all railways, there are on some railways specially constructed and fitted sleeping and saloon carriages, which would be especially suited to the necessities of wounded soldiers if they were available at the points where and when they were required. Some officers do not anticipate there would be any real difficulty in obtaining the use of such carriages in case of need. On this point I may quote from the 2nd edition of the Manual of Ambulance Transport an observation by Colonel Findlay of the Engineer and Railway Volunteer Staff Corps, and manager of the London and North-Western Railway. This officer writes: 'I may say, however, that having regard to the large stock of sleeping carriages and invalid carriages, and the ample supplies of bedding of all kinds in the possession of English railway companies, I think there is no reason to doubt that, if ever the emergency should arise, we should be found equal to it, and that we should be able to make up and run suitable ambulance trains for sick and wounded men, with convenient accommodation for doctors, nurses, &c., without any difficulty.' At the same time, it is not to be forgotten that a very large number of railway employés have been trained in the administration of first aid to sick and wounded persons under the auspices of the St. John's Ambulance Association, and that probably the services of a considerable portion of these men could be obtained as attendants on the wounded passengers during their transport.

On one 90CENDI & LETURE TEL WILL which the Tintomas yra tad bet fired was sibiemed to viclent DMG BAort iad: at another time a similar” SILTSTADOS was wwwa lant trait of the bouth-Eamem Ballway, and I found mymil, wale şiq z re of the trenchers, on each occasion subkoka ylu jak cikumate that I had previously supposed th or my sien waone di expension of stretchers in a railway ran wold lave permitted. The necessary anides for carrying the eyeyzers on ulla ejetem are so cheap and simple, and so easily woord, that a wificent quantity can be kept in reserve to meet a sudden exigency without inconvenience or any great expenditure.

The following description and drawing are taken from a pamphlet by General Závodovsky, and sufficiently explain the means by which the stretchers are suspended. Ordinary service stretchers are employed.

Fach set of the appliances will support 4 stretchers in 2 tiers. A single waggon may therefore be adapted to carry either 4 or 8 patients, according to its length. To receive the 4 stretchers, 2 cables (AA) an inch in thickness are suspended across the top of the van, at the requisite distance apart, and secured at each end by iron rings and hooks which are fastened to the side-walls of the van, 24 inches below the roof. To each of the 2 cables is attached, horizontally, at three points (bb b) a pole of any strong springy wood, such as oak, ash, or birch, adapted to the width of the van, but at least 8 feet long. Each pole should be 2 inches thick in the middle and 12 inch at the ends. Four ropes (c c c c) are now attached to each side of the 2 horizontal poles, with knots ( x ) so arranged that they may support the stretchers (DDDD) on a level.

To prevent the stretchers, when the patients are upon them and the train is in motion, from swaying to and fro, or striking against the sides of the van, the supports of the lower tier of stretchers are lashed to three small iron hooks (z z z) or rings screwed into the floor of the van.

When patients are to be inserted, each of the stretchers in succession, with the patient upon it, is carried through the sidedoor of the van, and the bearers, turning round, at once put them in their places. The first stretcher is put in the upper, the next

in the lower loops of the vertical suspending ropes. Each tier of stretchers is then secured by the lashings to the floor of the van. When the patients are to be removed from the van, the lashings that secure one of the sets of stretchers to the floor are first

loosened. The patient on the lowest tier is first carried out, and afterwards the one above him.

The Zavodovsky plan is now systematically taught and practised in the Medical Staff Corps Training School at Aldershot.

The following stores are there supplied for preparing a goods waggon for the transport of eight patients-viz., 4 cables, 16 ropes prepared with loops, 8 large hooks and rings, 32 small ring-bolts, 4 poles of suitable dimensions, and 28 cords for lashings. The 8 stretchers used are service stretchers.

The results of the experience which has been gained regarding railway ambulance transport on the Continent are well worthy of being studied by British surgeons. The construction, organisation, and administration of railway hospital trains have been systematised in Germany for many years past. In Austria a sanitary school train has been long established at Vienna by the Sovereign Order of Maltese Knights, between whom and the Ministry for War an arrangement has been made for the Order taking charge, in case of war, of 12 sanitary railway trains capable of carrying 160 sick or wounded by each train. These sanitary trains will consist of covered goods waggons, temporarily converted into ambulance carriages. To prepare for this undertaking the Order has built at its own expense a sanitary train of 10 ambulance and 4 other waggons, with a view to the practical instruction, in time of peace, of the officers and attendants who will have charge of the trains in time of war. The technical details for the conversion of the goods waggons into sanitary waggons have been carried out in the Railway Carriage Manufactory at Simmering, near Vienna, upon the general recommendations of the late Baron Dr. Mundy, who was the chief surgeon of the Order. All the arrangements are subject to the sanction and approval of the Ministry for War. 31

It is obvious that, in case of England having to take part in Continental warfare, her army must depend upon the railway transport of the country in which the military operations are carried on, should the plan of evacuating any of the field hospitals by railway be adopted in it. Railway vehicles cannot be sent from England with an army, as other wheeled conveyances may be.

The sick and wounded may be sent from the theatre of warfare in ordinary vehicles to the country of an ally, and thence be despatched by railway hospital trains to a coast; or they may be sent by carriages on railways which have been seized in the hostile country itself. In any case, England must depend, so far as railway hospital conveyance abroad is concerned, on the railways and the carriages found in the countries in which the English troops are operating. It is advantageous, therefore, to be acquainted with the nature of the railway ambulance transport, and the system on which it is arranged to be conducted, in different European countries; but it would be foreign to the purpose of this work to pursue the subject further in its pages. 32

SECTION X

ON GUNSHOT INJURIES IN GENERAL NOSOLOGY, AND THEIR CLASSIFICATION IN ARMY STATISTICAL

RETURNS.

CHAPTER I

ON THE GENERAL NOSOLOGICAL CLASSIFICATION OF GUNSHOT

INJURIES

6

Gunshot injuries in general nosological classification.-The army nosological classification which passed away a few years ago, and which was identical with that devised by Dr. Farr, RegistrarGeneral of England, for the mortality returns of the civil population, comprehended a special class of Lesions from violence tending to sudden death,' under the name Thanatici.' The second order of this class, Polemici,' included all lesions resulting from battle; and among them, of course, the particular lesions produced by gunshot, which were at that time designated Vulnera Sclopetaria.' The adjective sclopetarium was taken from the word sclopetum, a gun-a term which appears to have been first employed about the date of the application of gunpowder to destructive weapons. The celebrated surgeon and anatomist of Padua, Fabritius ab Aquâpendente, writes of leaden bullets discharged from fire-arms as 'globuli plumbei à sclopetis emissi,' and of gunshot wounds as 'vulnera è globulis sclopetorum facta.' Analogous phrases are universally met with in the works of the principal surgeons and authors of the sixteenth and seventeenth centuries. The term sclopetum was selected as indicative of the sudden noise produced by the discharge of a gun, and was derived from the Roman sclopus, signifying the explosive report produced by a person quickly striking his two cheeks after they have been distended by holding his breath.1

The Committee appointed by the Royal College of Physicians of London to draw up the Nomenclature of Diseases, which was first published in 1868, and secondly in 1885, have not made use of this term for a gunshot wound; but, going back to a period before fire-arms were invented, have adopted the expression 'Vulnus ex tormentorum pilis,' as the Latin equivalent for a