RURAL AMBULANCE SYSTEMS.

It will be easily understood that for country districts an ambulance system can easily be adopted to the present union organization.

Every centre of a union should have a sick-transport carriage for infectious disease, and another for non-infectious disease.

The various outlying parishes should be united to the central office of the union by telephone, and the carriages could then be despatched as needed to the various places.

For accidents and non-infectious cases, stretchers with wheeled appliances should be kept in each village, local police office, local post-office or other place, the stretcher fitting into the central sick-transport waggon, and being exchanged with the patient on it for the stretcher in the waggon, which would be returned to the place from whence the stretcher was taken.

The diagram shows the system on which Lady Brassey, a regular ambulance missionary, has organized the Battle district. The secretary dwells in the Battle centre, and the outlying parishes are organized in connection with it,

and supplied with ambulance matériel. Any day our Poor Law unions could be so organized, but to achieve it we should teach every guardian what a compound fracture Until this is understood, progress cannot come.

means.

TOWN AND VILLAGE AMBULANCE ARRANGEMENTS.

As an example of good work done in towns and villages, we would mention the ambulance organization of Brighouse in Yorkshire. Here a branch of the St. John's Ambulance Association was formed, and, under an active secretary, the local police, firemen, and many inhabitants, have been trained in first aid to injuries. An ambulance institution has been founded, and we find the following matériel available on the spot. One-horse ambulance (sick-transport) carriage for four patients, four two-wheeled Ashford litters, seven stretchers, one police-stretcher for drunken cases, one hamper of appliances for dressing, books, bandages, and diagrams, and a wooden coach house for the ambulance (sick-transport) carriage. Is not this highly creditable? and why should it be an exceptional case?

CIVIL AMBULANCE SOCIETIES.

It is to the St. John's Ambulance Association (chief office, St. John's Gate, Clerkenwell, London, E.C.), that we (we in England a great debt of gratitude for its successful efforts to popularise ambulance and first-aid knowledge amongst the people. It is an offshoot of the Order of St. John of Jerusalem in England, and has for its object the giving of lectures and demonstrations of first-aid to the injured in accident cases, and the provision of ambulance matériel for use in accidents.

Medical men are employed to give a course of lectures in first-aid in accidents, and in nursing. A regular syllabus is laid down; an examiner is sent down to hold examinations, and on his report certificates of first-aid or nursing are issued to the successful candidates.

Ambulance matériel is supplied by this association to many hundred places in England; but truly its important work is the education in the first principles of help it is giving to the people generally in all that concerns the human body. After considerable experience as an examiner, we can safely say that it has spread the first rays of the light of knowledge amongst thousands of people of every class, from the highest to the most humble in the land, and its work has been entirely for good. We feel quite certain that any medical man who takes up these classes in his town or village will be conferring a real benefit upon his district. Laymen of great intelligence and occupying prominent positions have frequently stated, that in any previous mistakes they made in giving help to sufferers, it was entirely their ignorance that was to blame. We have not taught the people enough, and it is to the credit of the St. John's Ambulance Association that they have fought the good fight, and victory is now theirs. To Colonel Duncan, Mr. John Furley, Mr. Barrington Kennett, and the hardworking secretary Captain Perrott, a national debt of gratitude is owing. Any further particulars as to formation of classes, method of work, and supply of ambulance matériel, can be had of the Secretary St. John's Ambulance Association, at St. John's Gate, Clerkenwell, E.C., London.

THE LONDON AMBULANCE SERVICE.

In 1882 a movement to start a "London Ambulance Service" was originated, and is now at work in a small way. H.R.H. the Duke of Cambridge is President of the Committee; Mr. J. H. Crossman, Chairman; and Mr. Haggard, Secretary London Hospital, is Honorary Secretary. It has for its aim the provision of ambulance sick-transport carriages for London by means of public subscriptions. It has already supplied Howard's pattern of sick-transport carriages to Stoke Newington Police Office, to Fulham Police Office, and also to Lambeth Police Station. A hand

ambulance, covered in, and built on Howard's system, has also been supplied to Stepney Parish, and the Vicar informs us it has been of much use. In all cases where these ambulances are supplied, a minimum charge of 5s. is made, increasing with the distance to 10s.

It will be quite evident that the poor are completely unable to pay such a sum, and even many people of that struggling body who form the lower middle class. One would like to see some charitable or municipal funds pay all charges in these cases, so as to lower the cost to that of an ordinary cab-or to abolish it altogether. As far as one can find out, the very existence of the "London Ambulance Service" is unknown to most people, and the London hospitals have not joined in any way in the movement. Further information can be obtained from Mr. Haggard, Secretary London Hospital.

PROVINCIAL AMBULANCE ASSOCIATIONS.

There is an Ambulance Association at Glasgow called the St. Andrew's Ambulance Association. It works an arranging ambulance instruction for the people, and the provision of sick-transport waggons and matériel for the use of the public in cases of accidents or illness. Office, 93, West Regent Street, Glasgow; Mr. W. M. Cunningham, Secretary, who will afford any further information needed. In Edinburgh some steps are being taken to form a similar Association.

CONTINENTAL CIVIL Aid Societies.

a

Professor Esmarch, after studying the St. John's Ambulance Association system in England, has started "Samaritan Society" on the same lines, with Kiel as its centre, from whence the movement is spreading over Germany.

Baron Mundy is the founder of a society on somewhat similar lines at Vienna.

CHAPTER V.

66

PERSONAL FIRST-AID" EQUIPMENT.

The Surgical Havresack-Water Bottles-Field Companions—The Soldier's first Dressing-Means of carrying it-Identification Label -Esmarch Triangular Bandage-Esmarch's Braces.

THE difficulties of transport in war, and the sudden needs of "first-aid," in peace, renders it essential that a certain amount of matériel, in the shape of instruments and bandages, should be carried by the ambulance staff of an army, and by the individual fighting soldier himself in war time, and that in peace readily adopted means of aid should be more generally available. Thus in war, scabbards, bayonets, stirrup-leather, rifles and other articles are used as splints; just as in peace, garden-palings, rolls of paper, and walking-sticks are utilised.

In our army every medical officer carries a case of instruments in a pouch worn over the left shoulder. With every battalion and battery, small portable medicine cases, called "Field Companions," are found. These contain compressed drugs, restoratives, bandages, and the materials needed in first dressings.

With the bearer companies a regular havresac, called the Surgical Havresac," and containing bandages, restoratives, a simple dressing-case, and tourniquets, is found.

This valuable aid is only issued to one-fourth of the number of bearers; but it should be issued to every one of all ranks in the bearer company, and each regimental bearer should likewise have one. They are made by Savory and Moore, of New Bond Street, and cost about £3 each.

Water-bottles are also carried in certain proportions by the bearers; but we would like to see every bearer, without exception, so equipped.