066 A M B U I. A N C E defects which were then made manifest. Since that time a trained army hospital corps has been constituted, and much of the ambulance equipment has been revised. One serious impediment to perfecting an ambulance system is the costliness of maintaining, in time of peace, establishments which will only be required for use in time of war. All that can be done is to form a nucleus which can be expanded according to need when war breaks out. But even in Continental armies, with frequent wars pressing upon them, the urgency of giving close attention to the subject, and in countries where the existence of conscrip tion furnishes a greater supply of men at less cost than in England, the deficiencies of the ambulance establishments have hitherto been so great in respect to the numbers and necessities of the wounded on occasions of great battles, that an extensive volunteer organisation, with national societies in every country of Europe, has sprang up for giving additional assistance. This is not the place to dis cuss the advantages of such volunteer aid; but, if accepted, all who have considered the subject well have admitted the necessity for its being placed under military authority, and under distinct regulations, in order to secure maintenance of order and discipline. It is also generally admitted that volunteer aid to wounded soldiers is out of place in the ambulances, and can best be employed in the fixed hospitals, by which means some of the regular military personnel may be set free for work in the field. One important step, taken a few years since, towards the amelioration of the condition of the wounded of armies in the field must be just mentioned. This was the Euro pean Convention signed at Geneva in 1864, by the terms of which, subject to certain regulations, not only the wounded themselves, but the official staff of ambulances and their equipment have been rendered neutral; the former, therefore, not being liable to be retained as prisoners of war, nor the latter to be taken as prize of war. This convention has greatly favoured the develop ment of ambulance establishments. The conditions of modern warfare have led to the need of army ambulances being arranged on principles different from what were applicable only a few years ago. The immensely increased range of rifles and artillery in the present day, the consequent extension of the area over which fire is maintained, the suddenness with which armies can be brought into the field from increased facilities of locomotion, the rapidity of their movements, the shortened duration of campaigns, the large numbers of wounded which have to be dealt with, not merely from the destructive qualities of the fire-arms, but from the vast forces collected on occasions of important battles, the increased proportion of severe wounds, are all circum stances which have entailed need for revision of am bulances and their administration. The ambulances must be so organised as to be able to keep up with the troops, and so disposed as in no way to interfere with their movements. They must be capable of meeting the wants of a partial or general engagement at any moment, and if the troops advance, must be prepared to accompany them, so as to be ready to meet future wants. Whatever the details of organisation may be when an important battle is fought, the ambulance system must admit of three help stations at least being established in rear of the combatants. There must be a station of limited character immediately in rear of the troops for attention to such wounds as entail speedy loss of life if no assistance be rendered ; a second station, more remote, where tem porary assistance of a more general nature can be afforded ; a third, where more thorough attention can be given, and where the wounded can receive food and protection until there are means of sending them away. Recently, in some armies, the ambulance arrangements have been calculated for furnishing aid at four stations ; and, indeed, owing to the increased range of fire, and the consequent distance between the help stations when only three are formed, the fatigue thrown on the bearers is so great, and the time the wounded are left without help so long, that the division of the ambulances into four stations has become almost essential. If this arrangement be followed, there will be 1st, the field station, for help of prime urgency; 2d, the transfer station, where the wounded will be transferred from the hand conveyances to wheeled vehicles ; 3d, the dressing station, where the provisional dressings will be applied ; and 4th, the field liospital station, where defini tive treatment will be adopted. The disposition and distances of these four ambulance sections must vary according to the nature of the battle, the configuration of the terrain, and other circumstances, but in a general way will be as follows : 1st, the field station, in the immediate rear of the troops, moving with them, and therefore under fire; 2d, the transfer station, clear of the enemy s rifle fire, but not too far for the bearers, and at a place practicable for waggons, from 800 to 900 yards behind the troops engaged ; 3d, the dressing station, beyond range of artillery fire, at a spot easily reached by the ambulance waggons, and on the way to the fourth station, with a running stream or well at hand if possible, from 800 to 1000 yards in rear of No. 2; and 4th, the field hospital station, at a place free from risk of being brought within the sphere of fighting, from 2 to 4 miles in rear of the combatants. This last station may be at a farm or country house, or in a village, but should not be in a place of strategical importance, or in one likely to be blocked by the general transport of the army. "When the four stations are in working order, as men fall badly wounded, those within reach will be placed on stretchers by the men told off for duty as bearers, and, after hasty inspec tion by the field surgeon, and, as far as practicable, receiv ing such help as is of vital importance, they will be borne to the second or transfer station, and placed in ambulance waggons, or on wheeled stretchers if they are in use. The bearers, then taking vacant stretchers, will return to the field station for more Avounded. The wounded who have been transferred to the wheeled conveyances will be driven by the men of the ambulance train to the third or dressing station, and there receive whatever provisional dressing may be necessary before being sent on to the fourth or field hospital station, where definitive treatment will be adopted, and any surgical operations performed that may be re quired. It is obvious that such a system of help can only be carried out, with any approach to regularity and requisite speed, with ambulance establishments proportionate to the number of troops in the field, each ambulance being well organised, provided with a sufficient staff and complete equipment, and acting under the general supervision of an experienced director, whose duty it is to watch the varying events of the contest while it is in progress, and to order changes in the ambulance arrangements according as the troops advance, retire, or otherwise change position. Even with these advantages, the difficulties of adequately meeting the wants of the wounded must always be very great, owing to the rapid manoeuvres of the troops, the varying features of the ground over which battles are extended, and the rapidity with which the wounded fall ; but without a proper organisation arranged beforehand, the difficulties are insuperable, and no help of much value can be afforded until all fighting has ceased. Ambulance arrangements have to be modified to suit par ticular military operations, such as when troops disembark
on a hostile shore, on occasion of sieges, &c.
