A complete handbook for the hospital corps of the U. S. army and navy and state military forces

Front matter

.906

.0 rine t is nn NOT CIRCULATE

A COMPLETE HANDBOOK

CHAPTER II. In the Field 8

Regimental detachment. Field hospital and ambulance company. Service of the front. Sendee in camp. On the march. During and after a battle; regimental aid; dressing station; ambulance station; field hospital. Service of the rear. Permanent camp.

Part II. Anatomy And Physiology

CHAPTER I.

Bone. Cartilage. Classification of bones. The vertebral column. Joints. The pelvis. Lower extremity. Thorax. Upper extremity. Skull. Teeth.

CHAPTER II.

The Muscles, Cellular Tissue, and the Skin 32

Muscles, voluntary and involuntary. Action of muscles; the sterno-mastoid, biceps, diaphragm. The cellular tissue; fat. The skin and its appendages. Functions of the skin.

Chapter I

How to act in emergencies; removal of clothing. Contusions; shock and its treatment; treatment of contusions. Wounds, incised, lacerated, contused, punctured, poisoned, gunshot. Wound infection; septicemia and pyemia. Treatment of wounds; first-aid packets. Wounds of the skull, of the chest, of the abdomen, of the bladder. Bites of insects, of tarantulas, scorpions, and centipedes; bites of snakes, of rabid animals. Tetanus; anthrax. Poisoned arrows, etc.

CHAPTER II. Hemorrhage 80

Capillary bleeding; nose-bleeding, bleeding from a tooth socket. Venous bleeding. Arterial bleeding, primary, intermediate, and secondary. Treatment of arterial bleeding; compression with the fingers; with the tourniquet; the Spanish windlass. Bleeding from special arteries; in the upper extremity, the lower extremity, the neck, the tongue, the lips, the face, the scalp. Bleeding from the lungs, the stomach, the bowels.

CONTENTS. ix

Chapter III. Page

Sprains and Dislocations S7

Dislocations, definition of ; symptoms, diagnosis from fracture and

sprain; treatment. Special dislocations; shoulder, lower jaw, fingers,

knee-cap.

Sprains; definition; symptoms, treatment. Sprained ankle.

CHAPTER IV. Fractures 92

Fractures, definition of; compound, simple, comminuted, complicated, impacted, green-stick; causes of; symptoms. Treatment; of simple fractures; setting, splinting; of compound fractures. Healing of fractures. Splints. Special fractures; of the skull, spinal column, ribs, pelvis, nasal bones, lower jaw, clavicle, arm, forearm, metacarpals, fingers, thigh, knee-cap, leg, foot.

CHAPTER IX. Poisoning 121

Caustic acids. Caustic alkalies. General management of cases of poisoning. Emetics, antidotes, combating the tendency to death.

Special poisons; phenol, wood-alcohol, food-poisoning, "knock-out drops" (chloral), corrosive sublimate, nitrate of silver, phosphorus, strychnine.

Skin poisons; poison-ivy, poison oak, poison sumach.

x CONTENTS.

CHAPTER VIII. Symptoms and Clinical Record 163

Symptoms; subjective, objective, feigned; the attitude and expression; mental condition; the eyes; the hearing; the skin; the tongue, mouth, and

CONTENTS. xi

PAGE

teeth; cough; the appetite; vomiting; suppression, retention, and incontinence of urine; hiccough; sleep; hallucinations and delirium. Clinical records; history, treatment, charts.

CHAPTER IX. Bandaging 169

The triangular bandage and its application to various parts of the body; the slings. The roller bandage; sizes; method of rolling; rules for applying; the figure of eight; the spica; the knotted turn; recurrent of the head; recurrent of a stump; application to various parts of the body. Flannel and rubber bandages. Fixed bandages.

CHAPTER X. Infection and Disinfection 184

Definition. Disinfectants; dry heat, flowing steam; boiling water, corrosive sublimate, phenol, cresol, quick-lime, chlorinated lime, formalin, sulphur. Disinfection of sputum, feces, infected clothing, bedding, vessels, beds, rooms, tentage.

CHAPTER XI. Instruments and Appliances 190

Description of the ordinary instruments and appliances. Special appliances and apparatus of the medical department of the army; compressed air apparatus; electric batteries; restraint apparatus; steam sterilizing apparatus; case, aspirating; case, emergency. Field equipment; desk; food chest; bedding, tent unit; bath-tub sets; commode chest; acetylene chest; detached service chest; mess chest, etc.

CHAPTER XII. The Operating-Room and Surgical Nursing 214

The bacteria of surgical infection. Toxemia, septicemia, and pyemia. Preparation of the patient for operation; after care; dressing.

Preparation in the operating-room. Sterilization of instruments, trays, dressings, sutures, and ligatures; metal and glass syringes; rubber goods; webbing catheters; water. Normal saline solution. Drains. Disinfection of the hands and field of operation. Care of instruments, etc., after the operation. Operations in the field.

Part VII

HYGIENE. POST AND CAMP SANITATION.

CHAPTER I.

Water 295

Daily allowance. Surface and ground waters. Purification of water; the Forbes sterilizer; filtration methods. Water-borne diseases. Collection of samples.

CHAPTER II.

Composition of air; impurities. Ventilation; natural and mechanical. Floor space and cubic air space. Heating by stoves, furnace, hot water, steam.

Part XI. Minor Surgery

CHAPTER I.

Anesthesia, General and Local 409

General anesthesia; preparation for; ether; chloroform. Anesthesia in the tropics. Local anesthesia; ethyl chloride; cocaine; eucaine; Schleich's method.

CHAPTER II.

Assisting at Operations. Minor Operations 415

Preparation for operation. Handing instruments. Sponging. Incised wounds; suturing. Contused and lacerated wounds. Boils. Carbuncles. Felons. Abscesses. Gum-boils. Ulcers. Piles.

Chapter III

Subcutaneous saline infusions. Antitoxin injections. Mercury injections for syphilis. Use of the stomach tube. Forced feeding. Introduction of metallic catheters and sounds into the bladder. Hernia and trusses. Toothache and tooth extraction. Electric batteries.

CHAPTER IV. Adhesive Plaster Straps and Strapping 427

To retain splints. Extension in fracture of the thigh. Strapping for fracture of the ribs. Sayre's strapping for fractured clavicle. Strapping a swollen testicle. To draw wound edges together. Removal of adhesive plaster.

Part XII. Hospital Corps Drill Regulations

Hospital Corps Drill Regulations

Definitions. General principles. Signals. School of the soldier. Equipment. Manual of the saber for officers. School of the detachment. Litter drill. Methods of removing wounded without litters. Travois. The ambulance. Use of ordinary wagons to transport wounded. Inspection and muster. Tent drill. Position of the medical department on march and in camp. Drill for transportation of wounded on shipboard.

A COMPLETE HANDBOOK

FOR THE

OF THE

U. S. ARMY AND NAVY

AND

STATE MILITARY FORCES

Chapter I. The Hospital Corps In Post

The medical department is composed of medical officers, contract surgeons and contract dental surgeons, the hospital corps, and the nurse corps (female).

The hospital corps consists of sergeants first class, sergeants, corporals, lance corporals, privates first class, and privates. The sergeants first class, and sergeants correspond to the former hospital stewards and acting hospital stewards; the number of the former is at present limited by law to 300; the number in the other grades is a matter of regulation; at present there are allowed 300 sergeants and 20 corporals; the total number of privates first class must bear a relation to the number of privates, not exceeding two to one. All original enlistments are in the grade of private.

Enlisted men may be transferred from the line to the hospital corps as privates. Married men are not accepted as recruits, nor transferred from the line for service in the corps. Candidates for enlistment should apply to a post medical officer or to a recruiting officer. Applicants who have graduated in pharmacy, or who have had training as nurses in civil hospitals, should present certificates of their special qualifications. Slight physical defects which, under existing orders, would disqualify for the line, do not disqualify for enlistment in the corps, provided they are not of such a character as wrould interfere with the full performance of the duties of a sanitary soldier in garrison or in the field. If a candidate is accepted he is forwarded to a company or detachment of the corps for instruction in: 1. Discipline and the duties of a soldier; 2. Care of animals and equitation; 3. Drill and field work ; 4. Anatomy and physiology ; 5. First aid; 6.

Nursing; 7. Army Regulations; 8. Cooking; 9. Materia medica and pharmacy; 10. Elementary hygiene; n. Clerical work. All privates are instructed in the first seven subjects, and those who show special aptitude take the complete course.

Companies of instruction are established at such points as may be directed by the Secretary of War. At present there are companies at Washington Barracks, D. C, and the Presidio of San Francisco, California. The course prescribed by the Surgeon- General is both theoretical and practical and covers a period of four months.

The object of the detachments of instruction is to provide an emergency reserve of hospital corps men under the immediate direction of the department commander and chief surgeon; there is at least one in each military department, usually at the largest and most conveniently located post.

When the theoretical education of the recruit is considered complete he is assigned to duty at some post where his services are utilized as nurse, cook, or attendant, according to his special qualifications.

Privates first class or privates of the hospital corps who have shown special proficiency may be recommended for promotion by the surgeon. To test their capacity for performing the duties of a noncommissioned officer, they may be first detailed as lance corporals. Before being appointed sergeants they must pass an examination as to physical condition, character and habits, and general aptitude, and in the principles of arithmetic, in orthography and penmanship, in materia medica and pharmacy, care of sick and ward management, minor surgery and first aid, elementary hygiene, cooking and mess management, Army Regulations, clerical work and hospital corps drill.

Sergeants who have served a year as such, or enlisted men of the hospital corps who served as hospital stewards of volunteers or acted in that capacity for more than six months during and since the Spanish- American war, may be appointed sergeants first class upon the recommendation of the Surgeon-General, provided they have successfully passed a more extensive and detailed examination in the above subjects than is required for promotion to the grade of sergeant. A reexamination before his first reenlistment may not be required if the surgeon certifies that the candidate has performed

THE HOSPITAL CORPS IN POST. 5

his duties efficiently ; but a reexamination is called for before a second reenlistment, after which no further examination is ordinarily required.

Army Regulations provide for at least one noncommissioned officer and four privates at each permanent military post, with an additional noncommissioned officer for every additional four privates ; six privates when the garrison is two hundred, and two privates additional for every additional one hundred of strength.

The uniform of the hospital corps for ordinary wear is the same as that of the line except that the facings are of maroon-colored cloth and that the caduceus is the emblem of the corps. Privates first class are distinguished from privates by wearing a caduceus upon the sleeves of the blouse above the elbow. For duty in the wards, kitchen, dispensary, and operating-room a uniform of white cotton duck is worn. The hospital corps man's equipment is detailed in the Drill Regulations.

The duties of the hospital corps in time of peace are largely confined to the hospital service; that they are many, varied, and important may be gathered from the scope of the scheme of instruction detailed in the following pages.

The peace hospitals of the army are of two kinds, post Jwspitals and general hospitals; they are distinguished from each other by the fact that the former usually receive only the sick of the post to which they belong, while the general hospitals receive the sick from widely separated commands. Some of the general hospitals are of a special nature, such as that at Fort Bayard for the treatment of tuberculosis, and the general hospital at Hot Springs, Arkansas, for the treatment of cases requiring a course of bathing.

The duties of noncommissioned officers are, under the direction of the surgeon, to look after and distribute hospital stores and supplies ; to care for hospital property ; to compound and administer medicines ; to supervise the preparation and serving of food; to maintain discipline in the hospital and watch over its general police; to prepare the hospital reports and returns ; to supervise the duties of the hospital corps in hospital and in the field ; to assist the medical officers in their sanitary duties and to perform such other duties connected with their positions as may, by proper authority, be required of them.

The senior noncommissioned officer must be an efficient disciplinarian, expert clerk, accurate arithmetician, and a trustworthy pharmacist, with as much knowledge of materia medica, therapeutics, and minor surgery as will enable him to give sound advice and suitable treatment in the minor ailments and accidents which in civil life are dependent on the resources of domestic medicine or the knowledge of the nearest pharmacist; in addition, he must have that higher knowledge, for use in the wards, which enables the experienced nurse to appreciate the condition of those who are seriously ill, that their improvement may be fostered and all harmful influences excluded. At small posts, during the temporary absence of the surgeon, the unforeseen casualties and even many of the exigencies of military life impose duties upon him the satisfactory performance of which may be of the first importance to the individuals concerned.

The daily routine of the service of a post hospital begins at reveille, when, after roll call, the wards are tidied up and breakfast is served and cleared away before sick-call is sounded. Promptly on this call a noncommissioned officer from each company brings his sick to the place designated for their inspection; usually the hospital or a dispensary. The surgeon examines each man, indicating in the company sick report book those who are to be treated in hospital and those who are to be excused from duty or portions thereof as sick in quarters, etc. Morning reports are then sent to the adjutant's office for the information of the commanding officer. Prescriptions for those in quarters are now filled, and the register of sick and wounded is brought up to date by the careful entry of the morning's changes. After breakfast the wards are visited and the prescription and diet orders recorded. After this the kitchen, dining-room, and other parts of the hospital are inspected, and the regulation visit is at an end. Emergency calls bring the medical officer to the hospital at any hour, and generally, when serious cases are on hand, he may be expected before retreat or tattoo. After the morning visit he attends to his patients in the families of officers, married soldiers, laundresses, and other attaches of the garrison, and his prescriptions reach the dispensary from time to time during the forenoon. By the time these are filled the senior noncommissioned officer has posted the records, supplied the wards with needful articles of bedding, etc., given directions for the diet of the day, and provided the required supplies from his sub-

THE HOSPITAL CORPS IN POST. 7

sistence stores and special diet fund and hospital fund purchases. The afternoon may be devoted to instruction, exercises, or amusements, in the absence of special call for its occupation otherwise, and the evening to study, or, at certain periods, to the preparation of official reports and papers. The studies of the members of the corps are naturally such as will fit them to act intelligently in all matters relating to the management of the hospital and the sick and wounded. Every surgeon supervises the instruction of his men and the higher education of his noncommissioned officers; the latter guide and perform similar offices to those who serve under them. The medical officer is required by regulations to devote at least five hours each week to instructing the men of the corps in their various duties. These duties will eventually lead every capable member of the corps to the position of a noncommissioned officer; but besides this personal influence they serve a higher end by preparing the corps for a sudden expansion in time of war. When every sergeant is qualified to undertake the duties of a sergeant first class, and ever}7 private ready to step into a higher position, the expansion of the command can be effected by merely recruiting for the lowest grade.

The surgeon is responsible for the timely and accurate rendition of the reports and papers required in the service of a post hospital; but the work, except in the case of special and professional reports, is usually performed by a member of the corps, to whom the clerical work has been assigned. For all routine reports blank forms are provided by the War Department, and full instructions are printed on each of these to insure accuracy, the said instructions having the force of Army Regulations.

Chapter II. In The Field

The duties of the hospital corps in the field are even more varied and important than in time of peace and are apt to be more clearly defined. Thus some men will be assigned as litter-bearers, others as nurses, orderlies, cooks, operating-room assistants, etc. It is necessary that even privates should understand something of the field organization of the medical department.

Each regiment has a detachment of the hospital corps consisting of three noncommissioned officers and nine privates, with proportionate quota for similar organizations; for each division of about 18,000 men there are four field hospitals, each divisible into a hospital section and an ambulance company section.

" The service of the medical department in the field is divided into:

11 Service of the front, comprising all medical department formations which march with troops.

11 Service of the rear, comprising all medical department formations which belong to the army but do not march with it." F. S. R., 632, 1904.

"The lines of medical assistance for an army traced from front to base are as follows :

"Front: Regimental aid. Field hospitals, including ambulance company sections. Advanced medical supply depots.

" Rear: Stationary hospitals and rest stations on the fines of communications. Base or general hospitals at base of operations. Convalescent camps. Base medical supply depots " (Fig. 1). F. S. R., 633, 1904.

Service in camp: "In camp, regiments brigaded will establish regimental infirmaries and not regimental hospitals. These infirmaries will care for emergency cases and for those slightly sick or injured. All serious cases will be promptly transferred to field hospitals, which will be located by division surgeons.

"Regiments operating independently, or at such great distances

IN THE FIELD.

from field hospitals that it is impracticable to transfer serious cases to them, will under authority of the division surgeon, establish regi-

Fig. i.— The Lines of Medical Assistance in Battle.

THE HOSPITAL CORPS IN POST AND FIELD.

mental hospitals. These hospitals should have their full personnel and equipment which should always accompany regiments changing base, except in the operations of an active campaign, when the personnel will be assigned and the equipment stored under direction of the division surgeon" (Fig. 2). F. S. R., 644, 1904.

CONSTRUCTING PLAN OF A 12--BED

REGIMENTAL HOSPITAL

FCR OFFICERS OF THE MEOICAL CEFARTIV.ENT OF THE U.S. ARMY AND NATIONAL GUARD

AT THE

*RMY MEDICAL SCHOOL

WASHINGTON D.C

PLAN OF

WINTER QUARTERS

FOR HOSP. CORPS m

SHED

I OF REGIMENTAL HOSPITAL REGIMENTAL HOSP^ FOR WARM CLIMATES

FOR COLO CLIMATES

Fig. 2.

The ambulance company sections camp near the field hospitals to which they belong, so as to render all necessary aid. The field hospitals are located at convenient points. Each has a capacity of 108 patients in 18 tents.

The advanced medical supply depots are located at convenient points.

"When the command moves forward the sanitary personnel of the troops should be promptly relieved by corresponding units from the 'service of the rear.' In case of retreat the necessary personnel remains with the immobile sick and wounded under protection of the Geneva Convention." F. S. R., 646, 1904.

On the march: Camp is usually broken up soon after reveille. Ambulance drivers and teamsters groom, feed, and water their animals; litter-bearers pack up their shelters and blankets, and fill the ambulance kegs with fresh water, while nurses and cooks attend to their respective duties. After breakfast the sick are examined and medicines prescribed and provided for their use during the day. They are then transferred to the ambulances, while the hospital tents and bedding, kitchen utensils, and other property are packed up and stowed away in the heavy wagons, which have by this time reported for their loads.

" The regimental medical officers will habitually accompany their regiment, the senior with the commander at the head, one junior with the ambulance at the rear, the other at the rear of the leading battalion." F. S. R., 647, 1904.

On ordinary marches the field hospitals will march in rear of the last regiment of the division.

Usually when an engagement is in prospect the personnel for a dressing station, with pack transportation to carry the equipment, will march at the rear of each brigade, except the first which will be followed by an ambulance company. The field hospitals will ordinarily march at the rear of the division; but when there are several divisions in one column one field hospital from each division would usually be held in reserve and march with the "second line" of ammunition columns and trains, that is, a short day's march in rear.

The regimental ambulances will rejoin the ambulance company before an engagement.

" Sick and wounded falling out in line of march will be be placed in the regimental ambulance; when this is filled diagnosis tags will be given as passes to the ambulance train and other transportation, or the weak and foot-sore may be relieved of their equipment and permitted to march in rear of the regimental ambulance." F. S. R., 649, 1904.

The arms, equipments, and clothing of soldiers who fall out will be carried with them in the ambulances.

" Upon arrival at the day's destination all but the trivial cases will be transferred to the field hospital. Those unable to march next morning will be transferred to stationary hospitals, or they may be left under shelter — in houses if practicable — with the necessary attendance until taken charge of by the medical service of the line of communications, the chief of which should be duly notified" (Fig. 3). F. S. R., 650, 1904.

^— r^rs~ Lii

SECTION THKOUSH.A.B. 5H0WIN6 CENER»IT070GIAPMY

Fig. 3.— Plan for Field Hospital.

As soon as the baggage train arrives, as many hospital tents as will accommodate the sick are unloaded, pitched, and provided with such bedding and other articles as may be needful, after which the litter-bearers transfer the sick from the ambulance wagons. The tents of the officers are then pitched. Meanwhile, the cooks provide a refreshment of tea, coffee, or consomme. Later in the evening dinner is served. Pending its preparation the ambulances and baggage wagons are parked, and the horses and mules fed, watered, and groomed, while the litter-bearers pitch their shelters in the designated place and trench around the wards to keep their floors dry

IN THE FIELD.

in case of rain. With dinner the labors of the day are at an end, save for the wagon guard, the hospital guard, if the season requires one to attend to the fires, and the special work of medical officers and nurses in particular cases. In the establishment of this camp each man, by drill and experience, knows his particular duty, and by doing it well enables the whole to be accomplished with ease and

O-

CONSTRUCTING H-AN OF AN

AMBULANCE COMPANY CAMP

FOR

OFFICERS OF THE MED. DEP'T. OF THE U.S. ARMY

AND

NATIONAL GUARD

THE

ARMY MEDICAL SCHOOL

WASHINGTON D.C

- 30- — ■♦

O-

Mi

GUARD ■[ TENT

BASE UNE ill

■bf I

MM

ft < K- —

KITCHEN FVf

'X 5 K «0 FT. TO SINK

OFFICERS QUARTERS

Fig. 4.

rapidity. Less than an hour will suffice to transform a deserted field into a hospital settlement as orderly and as perfect in its field appointments as if it had been in existence for many days (Fig. 4). During and after a battle: " At the beginning of an engagement, while the troops are deploying, the wounded will be cared for by the regimental surgeons. Those able to walk will be directed to the rear, the others will be taken to sheltered places out of the way of advancing troops.

" As the troops take battle formation the officers and men of the regimental sanitary personnel, previously equipped, accompany their organizations." F. S. R., 652, 1904.

" Each officer and man will carefully retain the first-aid packet issued by the regimental surgeon at the beginning of the campaign and, when wounded, will apply the bandage himself or with the assistance of a comrade." F. S. R., 653, 1904.

" The distribution and work of the regimental hospital corps men will be under the direction of the senior medical officer with the regiment. The band will be utilized as directed by the regimental commander- The wounded will be placed under cover from fire if possible. They will not be taken to the rear at this stage as the regimental personnel must remain in touch with their units.

" Diagnosis tags will be attached to all wounded at this or a later stage, whichever may be practicable." F. S. R., 654, 1904.

If the wounded man is able to walk, both colored borders of the tag are torn off; if he must be carried, only the blue border is left; if he is not able to stand moving, the blue border is torn off leaving the red ; if the case is urgent, one of the urgent tags is also attachea. The purpose of the tag is to show at a glance what has been done and what is necessary to be done so as to avoid undue handling and interference.

" The following stations will be established for the care of the wounded: 1. Dressing stations; 2. Ambulance stations ; 3. Field hospitals." F. S. R., 655, 1904.

As soon as the advance ceases, dressing stations will be established by dressing-station parties from the ambulance company, under the direction of the brigade surgeon, at the nearest points in rear of the line of battle where the wounded will be sheltered from fire. The point selected should be near roads leading to the rear, or in proximity to open country over which ambulances may be driven. An abundant supply of water should be at hand to satisfy the thirst of the wounded and also for use in connection with dressings. If the men are fighting behind breastworks, the best protection may be on the line itself; otherwise, advantage is taken of some superficial depression, gully, ravine, fence, wall or building, about half a mile in rear. Here two of the medical officers of the ambulance company with the thirty-six bearers and an appropriate number of noncommissioned officers take station and make ready for the reception of the wounded.

The ground is policed, underbrush cleared away, and the dressings and other appliances which have been brought forward on pack mules made ready. Meantime the litter squads are sent out to bring the wounded to the station. These squads should take advantage of cover in making their way to the front and rear so as to give themselves and the wounded all practicable protection.

The amount of surgical work performed here is greatly affected by circumstances. If the cases are numerous or the station exposed, many may be permitted to pass to the ambulance after a glance at their condition and a caution to permit no unauthorized handling of the wound, while the attention is mainly devoted to arresting bleeding, removing shock, and supporting fractures in slings or light splints for ease in transportation. But if casualties are infrequent and the station well protected, flesh wounds may be thoroughly cleaned with boiled water, the first-aid dressing applied, and the patient tagged to intimate that further interference is unnecessary. Dressing stations are distinguished during the day by red cross flags, and at night by red lanterns.

Ambulance stations at the rate of one to a brigade will be established by the brigade surgeon at places affording protection from fire. Here the senior medical officer of the company, with such others as may be assigned, takes station.

The ambulances are drawn up facing the rear to receive patients, and the cook at once starts a fire and prepares restoratives such as coffee, hot bouillon, etc., for those wounded requiring stimulation.

The medical officers clean and place protective dressings on wounds that escaped attention at the first dressing stations, marking such as require no further investigation and also such as seem to call for immediate operative procedure. They superintend the loading of the ambulances, and see that every case is in the best possible condition to undertake the journey to the hospital. The topographical features of the battlefield are often such that the first dressing stations and ambulance stations may be consolidated. When the ambulances can get close up, there is no need of an intermediate halt in the removal of the wounded ; and when the roads and the ground permit of it, ambulance stations may be established at more than one point in rear of a brigade, in order to shorten the distance over which the wounded have to be assisted or carried. In the event of an advance or a yielding of the line of battle, a corresponding change of position of the dressing and ambulance stations must be effected. In the former case, a few of the ambulances follow up the advancing ■ line, leaving the greater part to clear the field before participating in the forward movement. In the latter case positions are assumed in rear of the reformed line, except when the hospital becomes exposed, in which case special or-ders from the chief surgeon determine the further movements.

Helpless wounded brought in during the engagement will be removed to the field hospital, but the principal work of the ambulances begins at the end of the battle and consists in the evacuation of the dressing stations.

Such field hospitals as may be required will be established by the division surgeon, after consultation with the division commander if practicable. The site should be at least three miles from the front, near a by-road, and on a stream when feasible. An ample supply of water is necessary, and suitable buildings are of great advantage.

In order to avoid confusion and loss of time, all the wounded are brought to the receiving section where the medical officer in charge examines and distributes them to the operating section, the dressing section, or directly to the wards as the case may require.

Generally, some time before the first ambulance load of wounded arrives from the front, the surgeons on duty at the hospital are engaged in receiving, dressing, or operating on, injuries of the hand and flesh wounds attended with little hemorrhage or shock. These cases probably left the field stations without waiting for attention and made the journey unaided and on foot. Each is assigned to a specified ward, the wardmaster of which is thereafter responsible for his comfort. Shelter tents may be pitched at regular intervals near the hospital tents to form the ward for these lighter cases. Hospital corps or band men attend to this work, trenching the ground, weatherguarding the open ends of the shelters, and providing some material, as hay, straw, freshly cut grass, leafy twigs, wood-shavings, etc., for bedding. If no suitable material can be found in the immediate vicinity, one of the now empty transport wagons may be despatched to some point where a supply may be obtained. During inclement weather these lighter cases may be housed in the as yet unoccupied hospital tents until their special camp is prepared. When thus systematically camped, their wants are not overlooked, as each wardmaster has his duties aggregated and defined.