HAVING had the honour of being invited to read before this distiaguished Congress a précis of an essay " On the Best Treatment of the Wounded in Time of War," for which Her Majesty the Queen of Prussia and Empress of Germany was so good as to award me a prize, I felt some hesitation in taking upon myself a duty which embraces so many points for consideration, and which in the time allotted me for addressing you could scarcely be discussed with any degree of minutiæ. However, seeing what good

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... be done in a very short time, and knowing the interest evinced by all classes, professional and otherwise, in everything concerning the relief to wounded in war, I should be neglecting a duty which I owe to humanity were I not to attempt under the circumstances to offer some remarks on a subject which has for me a special interest. To give in detail the method of affording the first' relief to wounded on the battle-fielld, how they are to be transported by the most easy method, how they are to be distributed, and the different plans of treatment recommended for wounds inflicted by special weapons, as well as wounds of different regions of the body, would each require a separate paper which might extend to any length, the subjects being so vast, and requiring in their consideration the opinions of numerous authorities of large experience. I shall therefore not attempt more than some remarks on points connected with the great importance of military surgeons and those engaged in the good work of aiding wounded having a knowledge of the method of constructing extemporaneous appliances, on the duties at the first and second line of surgical assistance, on the distribution and transport of wounded, and on arrangements of field hospitals, especially with reference to cleanliness and proper ventilation. These remarks must necessarily be very brief, but I trust will be found practical. Anyone who has been actually on the battle-field and felt his almost helpless condition when surrounded by wounded in the agonies of death or suffering intense torture, must have wished that by some magic spell he could multiply a thousandfold his means of relief. For it is scarcely possible that any medical department or staff, however well organised, can bring into immediate use on the battle-field medical aid of sufficient strength or material of sufficient quantity to afford relief to the multitude of wounded whom modern implements of warfare give rise to almost simultaneously. It is therefore the duty of such medical officers and their attendants as may have the privilege of being at the front, not to think of the glory and excitement of battle, but to turn their undivided attention to the relief of their fellowcreatures ; and in this, I am convinced, more may be done, by having a knowledge of extemporaneous contrivances and by making the best use of what they have at their disposal, than is generally supposed, and to the utility of which I scarcely think sufficient attention is paid in the preliminary education of surgeons, especially those destined for the public services. Each civilised nation has its special pharmacy-waggon or panniers constructed and supplied with every possible appliance that forethought and experience can suggest for affording relief to wounded as soon as possible after an engagement; but how often do we hear of a breakdown in these, or that they were prevented by some unforeseen accident or block on the road from being in their proper position when required, consequently rendering the surgeon who has no ingenious turn of mind, or who has not been instructed in extemporising, helpless, inasmuch as he has none of the appliances at hand with which he has been i accustomed to dress wounds, or put up fractures in permanent hospitals. I have therefore always suggested that surgeons accompanying troops into action should be * Being a paper read before the Brussels International Congress on Oct. 2nd, 1876. selected, as far as practicable, as worthy of the post from their special aptitude in having resources at hand for all emergencies; that about them they should carry a pocket case of instruments, well-furnished with silk, needles, &c., a small supply of lint, two or three bandages, adhesive plaster, tourniquet, a flask of wine or brandy, and a hypodermic syringe, with a small phial containing two or three drachms of solution of morphia. He should also have a good clasp-knife for removing boots, cutting clothing, and ! shaping splints from such materials as may be available. An orderly or attendant should accompany each surgeon, , who should have a further supply, which may be carried in a field companion, or knapsack adapted for the purpose, ' which should contain flannel and calico bandages, lint charpie, splints such as can be adapted for long or short bones, plaster-of-Paris, a metal spoon, candles, tourniquets, ' tincture of opium or solution of morphia, a drinking-cup, essence of beef, matches, pencil and diagnosing-cards, but, , above all, he should have a large flask of drinking-water. With such a supply, more especially as each soldier now carries a "first dressing," relief may be afforded to any wounded. ' The question is frequently asked -Where are the wounded to be first relieved ? and though many plans are laid down by experienced surgeons which are in theory ex-. cellent, the position will probably be decided for the surgeon by a nucleus being formed wherever he dresses the first man, to which those who can walk will find their way, others being carried. The surgeon accompanying a battalion or battery can scarcely do more in the way of first relief when the forces are moving, than apply temporary dressings and check bsemorrbage, as in the event of his stopping to put up fractures, or tie arteries, &c., he will in all probability be left behind, and his services lost to his . regiment, while his very presence might have a great influence on the minds of his men when a halt takes place. The wounded should then be transported to the bandaging stations, or second line of surgical assistance, for more permanent relief, and at these stations it is necessary to be very careful in selecting a suitable position, as when once wounded begin to arrive they may become too numerous to move without great trouble. The chief points, then, to look for are shelter, fuel, and water, without which wounded cannot be properly attended to. The duties of the surgeon at bandage places are-first, to use means to avert danger, such as checking bsemorrhage , and relieving shock; secondly, to divide the wounded into , those hopelessly injured, those requiring prompt attention, and those fit for transport and slightly wounded. It has been recommended that the wounds should be carefully examined at the bandage stations by the surgeons, and the patients transmitted ticketed with diagnosing cards to prevent all further painful and unnecessary examination ; but I am disposed to disagree with this. especially in penetrating wounds, and quite agree with Prof. Esmarch when he says he sees much less danger in not ascertaining on the battle-field where there are bullets, splinters, or foreign bodies in the wound, than in making an examination which might lead to the introduction of excitants of putrefaction on the finger. Who, in fact, could answer for the surgeons' fingers being clean ? On the contrary, nothing could prevent them from being soiled with blood and other matters, through which septic processes might be excited. Besides, there is the possibility of constitutional syphilis being present, and the result of introducing the blood of a syphilitic patient into another man's wound might be attended by most grave consequences. The importance of the surgeon and his attendants being acquainted with the several methods for extemporising stretchers and other conveyances cannot be over-estimated. As here, at the first and second line of surgical assistance, the regular transport may not be forthcoming, he may be obliged to convert the men's tunics or great coats, with the barrels of rifles lashed together for side poles, into stretchers ; or stretchers may be constructed with hay or straw ropes or ordinary rope, or the straps from two or three soldiers' belts interlaced between two poles. Blankets, sheets, hides, and even knapsacks, form excellent stretchers; and ships' hammocks or cots, if suspended on poles, form convenient modes of conveyance, and were found most comfortable during the recent campaign Q 2