CORNELL UNIVERSITY LIBRARY THE MONAGHAN COLLECTION The Gift of Frank Monaghan Cornell 1927 Cornell University Library UH500 .E92 History and description of an ambulance olin 3 1924 030 749 968 Cornell University Library The original of this book is in the Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/details/cu31924030749968 HISTORY AND DESCRIPTION OP AW AMBULANCE WAGON COMSTRTJCTED IN ACCORDANCE WITH PLANS FURNISHED BY THE "WRITER. BY THOMAS W. EVANS, M.D. Author of " La Commission Sanitaire, son Origine et ses R^sultats," "Les Institutions sanitaires pendant le Gonflit austro-prussien-itallen," etc. Officer of the Legion of Honour, etc., etc. PARIS: PRINTED BY E. BRIERE, 257, Rue Saint-HonorS, 257. 1868. THE EVANS' AMBIJLANOE WAGOK At the recent Exposition Universelle, espe- cially through the efforts of the different So- cUtis de Secours aux Blesses, the materiel employed in the Sanitary service of European and American armies was very fully repre- sented; particularly was this true of the prin- cipal means and appliances intended for the transportation of the sick and wounded. Field Ambulance Wagons had been sent from Eng- land, Prussia, and Switzerland; while France, Austria, Italy, and the United States, exhibited each several wagons or models. A very hasty inspection however of the different models exhibited, was sufficient to show that, what- ever might be the special merits of each, no one entirely fulfilled some of the most impor- tant conditions to be observed in Ambulance construction. A committee was consequently appointed by the Socielis de Secours, to inves- tigate the subject of Ambulance Wagons j to formulate rules for their construction, an-d if possible to select some type or model as the best practical embodiment of the same. Unable to be personally present at the con- ferences of this committee, which were conti- nued for several weeks during the summer, I prepared an Essay on Ambulance Wagons, pubhshed as an appendix to " Les Institutions Sanitaires pendant le conflit Austro-Prussien- Italien," in which I gave a summary expression to views which I have long entertained on this subject, and which had been only confirmed by an examination of the different models at the Exhibition. The principles then announced, differing in some details from those subsequently presented by a majority of the committee, are in most respects the same, and I regard them as of such considerable importance that I shall re- produce an abstract of them, preliminary to th description in detail of the Ambulance Wagon which I caused to be constructed, as a more ])erfectand conclusive illustration of their prac- tical value. This wagon, which has unques- tionably been regarded with more favor than any other Ambulance Wagon exhibited in the Champ-de-Mars, has been the subject of so many personal inquiries, that I have felt that some concise yet clear exposition of the objects to be attained in Ambulance construction, with the means which [ propose to that end, was required, not only on account of the general importance of the subject, but, in my own behalf, as some acknowledgement for the favors which have been shown me, — for the special interest which has already been taken in the wagon I have constructed. The great question to decide, is, how the sick and wounded of armies can bebest transported, most humanely and comfortably to themselves, as well as most conveniently and economically to the administration. For the system which shall clearly contribute in the largest degree to the special interest of the individual, and at the same time, to the more general interests of the army and the Government, must be accepted as the best attainable good however imperfect it may seem. To this end, in the construction of an Ambu- lance Wagon, the first requisite is lightness. Ihis is so important a consideration, that every thing superfluous to the comfort of the wounded, or not absolutely necessary for their security or the security of the carriage itself, should be unhesitatingly dispensed with. An Ambulance Wagon should be so light as to be easily and rapidly drawn by two horses any where it is possible for a carriage to pene- trate; across meadows and fields as well as on macadamised roads. The Ambulance should be so constructed as to turn easily and safely within a circle whose diameter should be but little greater than the length of the wagon. Not only ought it to be well ventilated, but it should be so arranged as to be capable of being readily opened to the light and air. The Ambulance should be so made as to carry men either recumbent or sitting. It may be arranged lo carry ten or twelve persons sitting, besides the driver ; a full load should seldom however exceed eight persons sitting. It should be arranged for carrying two re- cumbent; but with a provision for carrying four persons recumbent, should it af any lime be desirable to do so. The best form must as a rule be that with four wheels. Means should be taken to secure the severely sick or wounded from shocks and concussions, to the iargest extent practicable; by the employ- ment of stretcher mattresses furnished with springs, or by fixed springs upon which the mattresses may rest. The interior construction should admit the ready loading and unloading of the carriage, both as regards the patients and the attendants. 8 The severely wounded should never without a special reason be removed from the litter (stretcher) employed in carrying them to the Ambulance, but the interior of the vehicle should be so arranged that the litter may be placed readily within it, and be as readily with- drawn whenever necessary. A place should be reserved for a water- tank, and for a few indispensable sanitary supplies, as also for two or three supplementary stretchers or hand litters. An Ambulance should be simple in construc- tion, and all its parts and fittings capable of being easily repaired or replaced in the field. These general principles I do not propose to rediscuss here. Nearly all are now accepted by the best authorities, as more or less indis- pensable in the construction of carriages in- tended for the transportation of the sick and wounded of armies in active service. They are necessarily general principles, sub- ject to the control of circumstances, and to the modifications rendered necessary by topogra- phical, climatic, and other local conditions. The carrying capacity, however, is not only of such great importance, but is so essential a peculiarity of the Ambulance which I have constructed, and whatever of merit or demerit it may possess is so largely dependent upon this feature, Ihat I feel compelled to explain more fully my opinion upon that subject. 1 believe eight persons seated — with the driver nine — are a load quite sufficient for a two-horse carriage, for any moderate distance. Yet by the common arrangement, where the interior seats are at the sides, longitudinal, asin omnibuses, there is at once a capacity for eight persons seated, while the driver's seat, trans- verse, will accommodate three more, making in all eleven, with the driver. This is the arrange- ment which I have adopted, and get there are two seats (places) more than 1 regard as general- ly necessary. In fact, I have still added two more (exterior folding) seats. The reason for this will be obvious on a moment's reflection. Two 10 recumbent persons will take up the whole in- terior floor space, — the space generally reserved for eight persons sitting. If, therefore, we would be able to utilise on all occasions our power of transportation, seats must be reserved with the driver, or elsewhere, in excess of the number generally required. In the wagon which I have constructed, when the floor is occupied by two lying down, by means of my super- numerary seats, I am still able to transport six persons, besides the driver, and when the in- terior is fully charged with four recumbent, I am able to transport eight persons, besides the driver, — the number I have already proposed as a sufficient load. With reference to the number of persons a two horse ambulance should carry recumbent, opinions difter considerably^,,, I do not know a single Government in Europe which now tran- sports two sick soldiers recumbent in a four- wheeled wagon, without employing for that purpose even more than two horses. The disadvantages resulting, from such a 11 system, — Irom the limited capacity of the am- bulance trains, in view of their great magnitude, and the reserves of men, horses, and forage which are always necessary to maintain them, together with the impediment which from their uiiyieldy bulk, they, in common with the trains of supply, are always offering to the free move- ments of an army, are perfectly understood by all military men. In the United States, a careful and practical study of this subject has led to the adoption by the Medical Bureau of that country of the system, known as Ruckers, by which four men are carried recumbent in carriages drawn by two horses. In Europe, at different times, various unsuccessful efforts have been made to introduce some similar system. More recently, Locati of Turin has even pro- posed to carry live persons lying down. His am- bulance, however, drawn nominally by two hor- ses, actually requires four. What is gained in one direction is thus lost in another. Indeed, wagons carrying more than two recumbent, and requiring more than two horses, are quite out 12 of the question. They are open to all the ob- jections, which can be urged against the two horse wagons thus arranged, without possessing anyof their merits. So important an end, that of increasing, at times doubling, the capacity of transportation, or, in other words, that of greatly diminishing the cost of an expensive branch of military ser- vice, is at least an object worth securing, if practicable. Not only may the cost of maintaining this service be reduced, but the effectiveness of the service itself at the same lime largely increased by adopting the system I propose. The light- ness of the wagons, permitting Ihem to move rapidly from point lo point, with their power ofdoublingat will their transporting capacity, are qualities which will be appreciated by who- ever has had but a few hours to clear a field of its wounded, or has been forced to pick up the same, during the march of a rapidly advan- cing or retreating column. Much if not all the prejudice against wagons 13 carrying more than two lying down has arisen from the disposition of the interior of such car- riages. The mechanical adaptation has al- most always interfered with the proper ac- complishment of the more general uses of the wagon. In actual service, an ambulance wagon is charged with but one recumbent more fre- (}uently than with two, and the occasions when it will be desirable to send more than two re- cumbent sick or wounded at the same time, will always be relatively few. To therefore, con- stantly encumber the interior of a carriage with permanent fixtures, with folding shelves, and suspended mattresses, for the possible transport of several recumbent, i ce rlainly inexpedient, as the positive disadvantage — the every day in- conveniences — occasioned by such fixtures, will be found to be more than an equivalent for any however great advantages, to be only obtained at irregular and uncertain intervals. I presume this general statement is quite sufficient to ac- count for the prejudice alluded to, independent- ly of objections which may be raised against 14 any particular system which may have been previously proposed, for the purpose of increas- ing the carrying capacity of ambulance wagons. That it is desirable, however, not only to re- duce the number of the horses employed, but also to increase the carrying capacity, could this be done without detriment to the ordinary uses of such wagons, can scarcely be a subject of discussion. This is what I propose to do. If I have failed, I shall at least have the satisfaction of feeling that the great importance of the subject fully justifies all the efforts I have made to devise some system for transporting the sick and wounded more humanely, and at the same lime more economically, than this service is now fulfilled in any of the armies of Europe. As will be inferred from previous observa- tions, my ambulance has been constructed with the intention of uniting a possible capacity for four persons recumbent, with lightness, easiness, and safety of movement, facility of loading and unloading, and simplicity. 15 The Ambulance is a four-wheeled carriage, is intended to be drawn by two horses, weighs about 1,300lbs., and in its general external appearance resembles one of the well known American two horse ambulance wagons. (See Plates I, II, III, IV.) The Wheels, — are light and strong. The rear wheels have a diameter of 4 feet 5 inches, and a distance from each other from tire to tire of 4 feet 8 inches. The forward wheels have a diameter of 3 feet 1/2 inch, and turn readily beneath the body of the carriage. The width of the tire is 1 7/8 inches, and the thickness of the felloe, 2 3/4 inches. The axle-trees are of iron, or of wood and iron combined. The wheels are furnished with a break, which can be applied by a lever, to be operated by the driver's hand or foot. The Body,— of the wagon is supported upon eUiptical or platform springs, 3 feet 3 inches from the ground, and has a length, not includ- ing the driver's step, of 8 feet 21 i/2 inches, a 16 breadth of 3 feet 111/3 inches, and a height in the centre of 5 feet. The interior length, from the tail board to the driver's seat, is 7 feet and 5/8 of an inch. The sides areof woodinpannel, to the height of 2G 3/4 inches. From these sides, and framed into the floor, spring six wooden bows, supporting an enamelled cloth or cotton duck covering, the side curtains of which can be opened or closed at will. The rear of the car- riage can also be closed by an end curtain of the same material. The second (from the front) and rear bows, are made strong; the reason for this will be subsequently apparent. The inner and superior surfaces of the panneling are padded, a width of six inches, and form the backs of the seats which are attached to each side longitudinally (see Plate IV.) Two sliding ventilators, are placed in each side, to be used, if necessary, when the carriage is charged with four recumbent. A broad wooden step, length 3 feel 3 inches, facihtates admission at the rear ; two iron steps are in front, one on each side of the driver's step, 17 for the same purpose, and one at eacfi side of the carriage between the wheels, to enable the attendants more conveniently to reach the patients whenever necessary. That nothing may be lacking as regards facility of ingress and egress, the driver's seat in front, transverse, has a height and width of but 13 and 3/4 inches, the back being formed by a broad leather band, free at one extremity to be either hooked or unhooked. This arrangement per- mits a free passage through the wagon from end to end, particularly desirable in loading, as the attendant who lifts the end of a stretcher on to the floor of the carriage, is himself able to enter the carriage , adjust properly the stretcher, and stepping over the low driver's seat, descend to the ground from the front of the ambulance. The driver's step projects, or has a length of, 21 and 3/4 inches, the floor- level— H and 3/4 inches, the foot-board — in- clined at an angle of 30" — 1 inches. The tail-board (Plate IV, k) is hinged, to be opened or closed at will. 18 The Seats. — The lateral seats are so construct- ed that they may be readily detached from the sides, and used as Mattresses upon the floor of the wagon. The framework of each is made in two longitudinal sections of strong light wood; the sections are hinged, and each well padded or cushioned. Fig. 1 , Plate VI, will give a general idea of a seat; the superior, shaded section, is attached to two pivots, screwed into a piece of the framework of the side of the carriage, 1 and 3/4 inches from the floor; the light section rests perpendicularly upon the floor of the carriage. The seats have an extreme length of 6 feet 8 inches, the superior section, a width of 12 and 1/2 inches, the perpendicular section, a width of i 1 inches, and when mounted are about 13 3/4 inches high. The driver's seat has already been described; cushioned, it furnishes a conifortable place for two persons, besides the driver. The supernumerary "exterior folding" seats, to which I have referred, are placed at the rear of the wagon, outside, and on each side. These 19 seats are hinged, and, when not in use, fold beneath the floor. When to be used, they are opened outwards, and secured by a sliding iron rod which passes beneath. The broad rear step of the ambulance supports the feet of those using these seats. They are in- tended to be used most frequently by the at- tendants. Plate III shows a folding seat thus occupied. Fig. 2, plate VI, shows an interior lateral seat, arranged as a mattress ; cccc, are the handles, and, d e, Ihe head-rest, one section of which, d, is raised. Fig. 3, which re- presents the inferior surface of the mattress, shows the sliding handles to better advan- tage; they are made of inch gas pipe, can be drawn out about seven inches, and are se- cured by strong iron sockets, FF. The hinges, which hold together the sections of the mat- tress, are indicated by the letters, aaaa. The letters, bbbb, show the position of iron wheels^ having a diameter of three inches; dd, are hooks, by means of which the mattress when 20 it is used as a seat, is secured to the pivots in the sides of the wagon. It will be observed that these seats may be used not only as mattresses in the ambulance, but that, whenever circumstances require it, they may be used as hand litters for the" direct transportation of the patient to the ambulance, where, once lifted to a level with the floor, he is rolled easily and quietly within. The func- tion of the wheels will however be more fully explained elsewhere. Many objections can doubtless be offered to a combination of seats, mattresses, and stretchers. "They are heavy, liable to get out of order, etc. " Still the principle has very ge- nerally been adopted more or less completely both in Europe and America. In the Wheel- ing ambulance, the seats form also the mat- tresses. In the Rucker, they are used both as mattresses and litters ; while in most Euro- pean ambulances they are arranged for men both seated and recumbent. It is so very im- portant that the severely wounded should not 21 be removed from the litters or mattresses upon which they are lying more often than is impe- ratively necessary, that I believe no mat- tress should be used which cannot be employed as a litter as well. It being an accepted principle of ambulance construction, that the litters or mattresses em- ployed should possess some elasticity indepen- dent of the springs upon the axle-trees, I have proposed to give that elasticity by means of special springs. These springs, eight in num- ber, and sunk in the floor of the wagon, flush with its surface, are placed in pairs correspon- ding with the wheels of the mattresses which they are intended to support. They may vary in form and material, but a generalidea of their purpose may be derived from Fig. 2, plate V, which gives a sectional view of a mattress wheel, a, resting upon a spring, bb, between the double floor, c cc c. These springs, made of stiff steel, yield from an inch to an inch and a half, which is practically sufficient. Indeed, too much elasticity is to be avoided. The ad- 22 vantages of placing the springs beneath the floor are; first, they are thus comparatively secure against all accidents ; this is not the case when they are placed in the body of the ambulance, as in Howard's or Mundy's, and es- pecially when they are attached to the mattresses or litters, as is more generally done; se- condly, they are entirely out of the way. The importance of this last circumstance will be fully appreciated by examining the cumber- some mechanism which Howard, the construc- tor of probably the best Ambulance Wagon hitherto made, has employed to give elas- ticity to his mattresses. Floor.— The floor of the wagon, as before observed, is double. To guide the wheels of the mattresses unerringly to the springs, a sort of grooved tramway (See Fig. 1, Plate V, cc) has been cut in the upper floor on each side of the wagon for the lateral pairs of wheels. Iron plates protect the openings through which the wheels pass from destructive abrasion. Fig. 1 , Plate V, shows very well these plates, 23 bbbbbbbb, as also the springs beneath, aaaaaaaa. Water tank, and Supply Drawer. — Beneath the driver's seat are two compartments ; one upon the right, is taken up by a water tank, having a capacity of about twenty-five htres. A robinet outside communicates with the tank; its interior extremity rests upon a small ice box. The compartment upon the left is occupied by a drawer, reserved for a few needful sanitary sup- plies, stimulants, bandages, etc., such as each medical officer in charge may consider as most suitable for the occasion. Litters.— The ambulance is provided with three common field litters; two, open, are carried in the top of the carriage, quite over the heads of those sitting within (See Plate 1), and one, folded, is carried in a small rack on the side of the wagon (See Plate III). Lanterns. — Two lanterns are carried in front on each side; they can be readily detached and carried in the hands of attendants, if needed elsewhere. 24 It may be remarked that no place has been provided for guns, knapsacks, and other miUtary accoutrements. This is naturally a service so entirely secondary that 1 have ques- tioned very much the necessity of making any special provision for it. Practically there will always be found in the wagon a place for such of these things as it may be necessary to carry, either upon the floor by the side of those recumbent, upon the driver's box, or elsewhere, and that without discomfort to any one. Having explained the means to be ordinarily employed for the transportation of men either sitting or recumbent,— having described an am- bulance wagon in itself complete and equal to the general requirements of the sanitary service ; it now remains for me to indicate how the ca- pacity of Ihis ambulance may be increased, and four persons transported lying down, both comfortably and safely. This is effected by the use of caoutchouc rings or loops, which are arranged in such a 25 manner as to receive the handles of two com- mon field litters, which are thus suspended, as a second tier, above the mattresses which oc- cupy the floor of the carriage. A very good general idea of the plan pro- posed may be obtained from Plate IV. Two loops are attached, on each side of the wagon, to the second and rear'^bows, 2 feet 9 iuches from the floor, two loops to an upright post in the centre of the carriage, immediately behind the seat of the driver, and two loops to a jointed hook fastened to the centre of the rear bow. These loops, equally distant from the floor, are arranged in pairs corresponding with the handles of the litters. The mode of adjusting the handles is shown in Plate V, Fig. 3. As elsewhere stated the second and rear bows are made strong; particularly is this true of the rear bow, which supports not only two side loops, but the jointed hook. This hook is ge- nerally turned up against the top of the car- 26 riage, and is quite concealed behind the two litters which may be suspended there. In preparing an ambulance for the immediate transport of four persons recumbent, all that is to be done, is to remove from the wagon the lateral seats, unstrap and take out the re- served litters, and drop the jointed hook ; the whole interior of the "carriage is now free. Two attendants will place a patient upon one ofthe litters, when he is taken up and brought to the carriage, the attendant in advance resting the handles of the litter which he holds upon the floor of the wagon. Enter- ing the carriage he again lifts the end he- was carrying, and is followed by his compa- nion, adjusting the handles to the loops cor- responding, in the manner shown in Plate V, he steps to the ground from the front of the carriage, while his companion adjusts the rings in the rear. The second htter is placed in position similarly ; while the seat mattresses having been charged, are rolled into their 27 places as previously described, and rest in position as shown in Plate IV. The work of loading is not only rapidly but easily effected by two attendants. Plate IV represents very well the two litters suspended, as also the two seats, arranged as mattresses upon the floor of the wagon. In Plate III, the litters are seen charged. By arranging for the suspension of litters in the manner proposed— aside from the capacity for transporting four recumbent, an advantage is secured of such very great moment, as to alone warrant the introduction of the plan proposed. I refer to the constant ability thus gained to transport two men lying down, and at the same time, several others sitting, within the carriage itself. This can very readily be ef- fected, by placing the recumbent upon one side of the wagon — reserving the other side for those sitting. The seat of the right side of the ambulance, for instance, is placed upon the floor, and a litter is suspended immediately 28 over it— here are two places for men lying down. The seat opposite will accommodate four sitting. This disposition is very well indicated in Plate II. In the construction of my first ambulance, I employed suspension loops of India rubber, and found them to answer the purpose for which they were intended very well. These loops were about 5 inches long, 3 broad, and 5/8 thick; they were strong, elastic, yet not too elastic, and could be readily adjusted to the common field litters. Further experience however, has led me to employ, at least in most cases, leather straps in preference to the india rubber loops ; first, because the elasticity of the caoutchouc, that which determined ihe selection of this material, is not essential, the elasticity of the shaft of the suspended litter being quite sufficient to ensure the comfort of the patient transported; secondly, because straps furnished with buckles can be adjusted to any litter, whether longer or shorter, extem- 29 poraneously without loss of time; thirdly, because leather straps if lost or broken can be easily replaced or repaired in the field. Fig. 3, d, Plate V, shows one of these straps. The straps to be used at the rear of the ambulance can if wished be made some thing longer, as shown also in Fig. 3, Plate V. It will be seen from this statement that the whole mechanism necessary for converting a wagon which carries two men recumbent inio a wagon which can carry four, in fact, consists simply of eight leather straps, costing but a few shillings, weighing but a few ounces, never in the way, yet always ready for service. Indeed the apparatus employed is so simple as scarcely to attract observation unless special attention is directed to it, and yet it seems to me, not only as a matter of theory but also of practice, a means entirely sufficient for the accom- plishment of the end proposed. It is a device which obviates the employment of encumbering fixtures, and at the same time, gives to the 30 common hand litters used in all armies, a new function, which must add immensely to their value. The features peculiar to the ambulance which I have made, those which distinguish it from all other ambulancewagons previously constructed are; the floor springs, the attendants' seats, and the suspension loops or straps. These three peculiarities, with certain complementary and minor arrangements, such as the iron wheels of the mattresses, the moveable leather back of the driver's seat, the form of the driver's step, the two side steps, the supply drawer, etc., etc., are new. The wagon, however, is decidedly American in type, from the lightness of the wheels and body, as well as from the ge- neral form of the body and its covering. In one respect it is European (continental), the forward wheels are low and turn under the body. Several dispositions, such as the arrange- ment of the water tank, the side ventilators, the mode of carrying the litters, etc., are, with perhaps slight modifications, those which have 31 been previously employed in some one of the well known ambulances. 1 may observe that I attach but small impor- tance to most of the mere details of construc- tion. It can make but little difference whether the distance between the wheels is 4 feet 8 inches, or an inchortwo more or less, whether the top is covered with enamelled cloth or some other impermeable stuft', whether a break or a sabot is attached, whether the water tank is placed beneath the driver's seat, or under the wagon, whether the litters are suspended over head, or are carried somewhere else, whether a place is reserved for ice, or not, etc. Many of these details must be determined by topo- graphical or other local considerations ; while with reference to others there will always be differences of opinion as regards their relative importance; even admilting them to be of equal importance, as regards the comfort of the patient, or the convenience of the attendant, many must be renounced if we would not have our system too complicated for general service. 32 Simplicity is a condition indispensable in the construction of all material intended for field use. An important consideration is cost. At what price can an ambulance wagon such as 1 have described be furnished ? The cost of construction will naturally vary in different cities and countries, and every where largely with the number ordered. In Paris a single wagon can be made for about 2,000 francs, and in quantity they can be con- structed at a cost for each scarcely exceeding half that sum. In a word, these ambulances can be furnished as cheaply, — if not more cheaply than any other four-wheeled ambulance wagons now known. Requiring under no circumstances more than two horses, and permitting a reduced attend- ance, these wagons can transport as many men sitting as the heavy European four-horse ambu- lance wagons. They can transport two men lying down, much more comfortably than the heavy four-horse wagons, and can double this 33 capacity whenever necessary; while at the same time they are always able to accomplish their work with much greater rapidity. In fact, whether viewed from a humane, an economical, or an administrative point of view, as a means of reducing the impedimenta of the ambulance service to the smallest terms possible, the sys- tem I propose would seem equally to commend itself. In presence of the immense improvements which have recently been effected in the mate- rial of war, not more striking in the increased perfection of fire-arms, than in the remarkable rapidity with which troops and supplies are now concentrated or dispersed, it becomes in the highest degree important that a corresponding vigor and efficiency should be imparted to the ambulance service. Its deficiencies are glaring, — are evident to every body. The difficulty ot finding practical remedies is only fully known to those who have most carefully and conscien- tiously studied the subject. To point out faults either real or apparent is alWfiys easy. To 34 substitute the perfect for the imperfect is alwp.ys hard. That the system which 1 propose for the transport of the wounded is itself faultless, I do not claim; that it is a step forward, that it is an improvement upon any other known system, I fully believe, and in this belief ■ I confidently submit it to the intelligent shd liberal criticism of those most interested inlhe sanitary service of armies. Paris.— Printod by E. Driere Z")", rua Saint Honor6. m p % H g ^ <1 f !l ' UMhJ ' ll' II 'I iHl .'iii'ii'iiilPiliiliSiiiilillf'iiii Si'iiilifl ! I iiir i IP ' 1 illi' I! ' M mt > im \ V*. • «!pl» i. I Ir"''''' Jiiiiiifiiilllli^^^^^^ ^j/; ii e I i\M -■^vv l/^^k ^'V:^^lli^!^^^^ 1^ V'-:h!ii:| „. h '^ 1-1 -- - -I vv w 1 'S'Ji i^ k M 1 l\ 1 "^ k K 1 1^^ 1 ^^ mL 11 ' (ian— ■- ^: iilii I I 11/ ii ™ m,,,|„ ,„i ,| ilifli'i(ii|!|!l1|linil'ii ill i I, i """'"''iliiilili|i?if!|ii;i mmm, id'' liiMf hi I i I fit ill '■'''■ '' 'i'l' 111'',* ill I" W.Jllli '\i 3 J, " C I I a w ^ yi 2 ff I PLATE VI. Fig. i.—Ji Utanl Stat XrX V,M