[from the "Boston Medicai and Surgical Journal" ofOctober 9,1862.] Abuse of Army Ambülances.—In the interesting communication of Dr. Bowditch, on the subject of the want of system in the ambulance arrangements of the United States Army, published by us two weeks since, several details of the recklessness of the drivers, as mentioned by him at the meeting of the Society for Medicai Improvement, were omitted. In our opinion these facts should be known, as furnishing additional evidence of the need of thorough reform in this depart- ment. Dr. Bowditch particularly dwelt upon the malicious pleasure which the drunken drivers took in doing ali the damage they could to the valuable vehicles entrusted to them, by the most unnecessary col- lisions. One special source of amusement to them was to try to drive the pole of the ambulance into the back of the one in front, and it was a particularly gratifying evidence of skill, if the driver succeeded in striking the head of the cask -plaeed beneath the seats and pro- jecting slightly at the back of the vehicle, and intended to hold watcr for the use of the wounded. This triumphant tilt was run by the man in charge of the ambulance in which Dr. Bowditchvtvas rid- ing, with the successful result of knocking it from its attachments into the road, where it was left, as none of the men would take the trouble to replace it. We say casks intended to hold water. In the present instance, it happened that not one in the whole traia would do this ; they had ali been allowed to dry until they were as leaky as so many sieves; so that their loss was not a matter of such moment as it might have been. Mentioning the circumstance a few days since to a friend who had been in the army, he remarked, that he never saw an ambu- lance cask yet that would hold water. Dr. Bowditch also referred to the extreme danger, incurred by the sleepy and drunken drivers, of running their vehicles off the precipi- tous banks on either side of the road, and said that the leader of the train informed him tha,t, a short time before, he barely had time to turn aside the horses attached to an ambulance, full of wounded,. from the brink of a precipice twenty feet high,, over which the whole would have gone the next moment. The driver was asleep ! Trüly who can doubt the need of a thorough reform of such outrageous abuses ? Thus much had we written, when we received the following com- munication from Dr. Bowditch, to which we gladly give place.—Ed. It is painful, yet it ought not to surprise us, to see how many mis- takes have necessarily arisen, during this terrible rebellion, owing, first, to the utter disbelief on the part of the North in the really revo- lutionary views of the Southern leaders; second, to our own igno- 2 Army lAwhulances. rance of the arts of war, and oí the means of alleviating the sufíerings incident thereto ; and third, tu the fact that, in very many instances, we still endeavor to manage an army of more than half a million of men by rules of war established for a few thousands. In nothing, per- haps, have we suífered more, from the last two causes, than in the whole arrangements for the transportation and care of the sick and wounded on and from the battle-field. It would, a priori, seem natu- ral that the first thought of a truly paternal government, after having made arrangements to strike a decisive blow against an enemy, would be to make most ample provision to alleviate the sufferings of those of its children who would necessarily be doomed to endure much, even under the best system that could be devised. No extra sufifering, and every alleviation of absolute misery, should be the watchword on such an occasion. I regret extremely to feel that, judged by this rule, our government has heretofore totally failed in one department, at least, of its service, viz., the ambulance system, or no system, as it may more properly be called. The extraordinary statements by Dr. Coolidge, Medicai Director at Centreville, that the drivers of the ambulances broke into the hospital stores, drank the liquors and would not help the wounded until whis- key was given ; my own account (see this Journal, Sept. 25) of the abominable misdeeds of these^sàme or similar miscreants, duriug our excursion to relieve the starving and wounded at Chantilly, near Centreville ; and finally, numerous individual statements (Neto York Times and also Medicai Times), confirmatory of the saine fact of gross misconduct, and of the essentially degraded character of most of these drivers ; ali these things are my reason for bringing .the subject again before the readers of the Journal. Some change must be effected. I am thankful to see that correspondents in different journals in thiscity and New York, are discussing various plans, and as the great object we now ought to have in view is to have some plaji» ins^ad of chãos, as at present, I write the following brief abstract of what foreign governments and our own have done in the premises, and will finish with giving what I know to be the carefully thought-out suggestions of the present humane and able Surgeon-General Hammond. On the 2d of April, 1855—only six years ago—Jefferson Davis is- sued his instructions to Majors Delafield and Mordecai, and Capt. G-. B. McClellan, to visit Europe for the purpose of learning everything possible, relative to modern systems of warfare. The Crimean war was then in full operation, and Sebastopol was besieged. Every sub- ject connected with the carrying on of war was carefully suggested v for investigation in the instructions given to the Committee. One item among them was as follows :—" The kind of ambulances or other means used for transporting the sick and wounded." Capt. (now United States Major-General) McClellan, makes no allu- sion to the subject in his " Armies of Europe." Of Major Mordecai's opiuion, I know nothing. But the following, from Major Delafield's report (Senate Document, June, 1860), becomes important in consider- ing the question of what we should do, in the present emergency. Major D. says, page 68, that " never before was so much attention paid to this branch of the military service " as during this celebrated siege, and in front of Sebastopol. And in this connection he pays a Army Ambulances. 3 high tribute to that remarkable womaa, Plorence Nightingale, "as the foundation of power, from which ali the new arrangements and ap- pliances emanated." It seems that several kinds of carriages were used among the allied and Russian arraies, according to the ideas of those having the control of each. The smaller ones, those capable ot ©assing and repassing any where, were the best. Wrought-iron chairs or liiters, two hung like pack-saddles upon mules' backs, were of great service. One hundred and sixteen chairs or litters were in use at the bloody battle of Inkermann, and sufficed to transport ali the menm a very short time after the action terminated ; " proving," says Major D., " that they combined greater advantages than any previous ar- rangement." The English organized a "brigade for hospital conveyance "—(Ee- port, p. 15), which was new in personnel and materiel. Its train con- sisted of twenty carts, five store wagons, one forge cart, and one cart for stoves and portable forge." The carts were for two, the wagons for four horses. The whole were for twelve regiments. The plan was contrived so that where a gun could go, a carriage could follow. The following extract (p. T6), I desire to bring to the notice of the reader. Jefferson Davis undoubtedly took counsel from the whole ot this valuable report, in plotting his treason. Our government seem to have lost sight of its valuable suggestions, in one instance, at least, as is now well proved:—" The whole of this train was under the Staff-Surgeon of the division ; none of the wagons, carts or drivers be- ing subject to the orders of any other department, except with the authority of the General of Division, who best knew when to break up or sacrifice any part of his entire means of transport. This provision is worthy ôf our attention. The details and requirements of this part of the service should not constitute a part of the general transport service of the army, as heretofore has been the case in our service. No per son can so well preserve the efficiency of the surgical and medicai apparatus, as he who best knows its uses." The italics are my own, and I would simply add that there never was a more striking exemplification of the truth of these remarks by Major Delafield, than what I saw, in striking contrast to them, during my recent ambulance journey to Centreville. Among other things, at that time, I observed that of the small casks intended for water, and two of which were prepared for each wagon, not one seemed to contain water ; and I was informed by the army surgeon in command that they ali leaked ! What does the Quartermaster care for them .' The absolute need of water for the thirsty, wounded or dying soldiers, would never be dreamed of by that officer. It is the Surgeon alone who sees, and as it were feels, the agony the wounded soldier suffers, when deprived of this luxury. The personnel of this English train consists of one Sergeant Major, four other non-commissioned officers, and sixty-nine drivers—total, seventy-four persons to twenty-seven carriages, or scarcely three to each carriage ; "which," adds Major D. (p. 76), " gives the small- est admissible number of supernumerary drivers." Ali the nations of Europe " have their own ambulance and hospital store wagons, each possessing its peculiar merit, adapting them to their respective armies." 4 Ar mifxAmbulances. In addition to these, the Stajf Surgeon, while on the march, ha» a mule with " capital instruments " attached to his immediate service. What ought we to do ? Certainly we ought to adopt ali the good which past experience has shown to exist in any of these ambulance corps, or modify them to suit the peculiar conditions of our army. A plan has been devised" by the Surgeon-General of the United States Army, and months ago was urged upon Secretary Stanton, and declined by him and General Halleck. Since the terrible sufferings, lately endured by our soldiers, and foretold in a great degree by Surgeon Hammond, that gentleman has again urgedon the government the necessity of some action. The government still delaye, or if it has acted officially, it is only within the past week or two, and, so far as my knowledge extends, nothing has yet been publicly done in the matter. I well know that reports come to us through the public prints, that General McClellan is doing something about it. I have, from official sources, learned that the plans of General McClellan are, as it is thought, " insufficient. lst, Beeause the drivers, &c. are simply sol- diers detached for the purpose ; and, 2d, the plan ie not sufficiently comprehensive." What the Surgeon-General wants, "is a corps composed of men especially enlisted for Hospital and Ambulance service, with officers commissioned purposely to command them, and who shall have the entire charge, under the medicai officers, of the ambulance wagons, transport-carts, &c, and ali the many departments of hospitais ; a corps upon the basis of two men to each company of one hundred men, a hospital Captain, two hospital Lieutenants, and five hospital Sergeants, to be drilled, uniformed and equipped according to certain regulations. The whole should be commanded by a Hospital Commander. This is substantially the plan followed in the European armies." Will not our government allow this, or some other beneficent pla% to be followed out ? Henry I. Bowditch. 20th Congress, [ftep. No. 215.] Ho. of Reps> lst Session. VARIOLOID, OR SMALL POX, IN WASHINGTON. MARCH 27, 1828. Read, and laid upon the table Mr. Alexander, from the Committee for the Distrtct of Columbia., to which the subject had been referred, made the following BEPORT: The Committee for the District of Columbia, to whicli was referred a resolution instructing them to inquire into the propriety of taking effi* cient measures for checking the further progress of a contagious dis- ease, known to exist within the precincts of the Corporation of Wash- ington, and whether this disease be, as it is somttimes ealkd, vario- UM, or real small pox, report: That, by an act of Congress, full power has been vested in the Cor- poration of Washington to establish a Board of Health, and makc ali regulations that may be necessary to prevent the introduction of con- tagious diseases, and for the preservaiion of health, generally. In pur- suance of this power, a Board of Health has been constituted, with competent authority over the subject; to whom, as well as the ÍVÍayor of the City, the Committee directed their inquiries. It appears, from the information received, that lhe disease which has shewn itself, is the varioloid, or modified form of small pox, milder in its character, - and. consequently, less dangerous than the natural small pox, though equally contagious. The existing cases are seven in number, and reported to be not of a malignant kind. One of them is in the City, whose situation did not admit of a removal $ but every necessary pre- caution has been taken to guard against the infection. The others have been placed in a temporary hospital without the limits, or are so entirely insulated, as to leave no fears about the farther spread of the disease. In addition to the measures already adopted, a general course of vaccination has been recommcnded and pursued, as well calculated to prevent its contagious influence. The committee are of opinion that the city authorities are suflieient- ly competent to do ali that may be required of them on the oceasion, and are assured that no exertions on their part will be wanting to check the progress of the disease. For greater security, however, they would recommend an entire separation of the persons infected from the populous part of the city, which is believed to be their inten- tion; and preparations are making with that view. Seeing the neces- 2 [Rep. No. 215.] sity of the case, and the ill provided means of the District to arrest diseases of this character, the committee will tãke this onportunity of drawing the attention of the House to a bill now before it, proposine to establish a Lazaretto for the District of Columbia : a measure that recommends itself to the consideration of Congress, by every regard for their own safety, as well as that of the citizens, against infectious or contagious diseases ; and. if adopted, would, in a great degree, re- move the alarm and uneasiness that must necessarily be felt on such occasions. The Committee submit the information communicated by the President of the Board of Health, and the Mayor ; and ask to be discharged from the further consideration of the subject Ho use of Representatives, March 25, 1828. Sm : I am instructed by the Committee for the District of Colum- bia, to request that you will inform them of the character of the dis- ease (said to be contagious) that has lately made its appearance in Washington, its extent, and what measures, if any, have been adopt- ed, by removal of the patients or otherwise, to check its progress. I am, with respect, Your obedient servant, __, , M. ALEXANDER. To the President of the Board of Health, Washington City. Washington, March 25, 1828. Sir : There are seven cases of varioloid disease in this city ; two situated in a small building near the Penitentiary; one in E street, near the Telegraph Office ; and four in hospital, in the north part of the city. remote from population. The Board of Health have prohibited ali intercourse with the in- fected, except by persons important to the comforts of the sick ; and those are not permitted to mingle with the citizens, with the excep- tion of the attending physicians. A general vaccination is practised, and every other precaution used to prevent its progress. The varioloid disease is a modificd form of small pox, and arises in persons whose constitutions have been imperfectly influenced by the small pox or cow pock. It is more mild and more superficial than the small pox, and, thercfore, less dangerous. I have the honor to be, With high respect, &c. Your obedient servant, HENRY IIUNTT, Pres9t Board of Health. Hon. M. Alexander, Vhairman Com. for the District qf Columbia. [Rep. No. 215.] 3 Mayor^ Office, Washington, March 26, 1828. Sir : I have'the honor to state, ih reply to your inquiry as to what measures have been adopted by the City Authorities for pre- Veuíing the spread of the varioloid disease within our limits, that a hospital has been established, in the out-skirts of the city, remote from the inhabited part of it. to which?the patients at the Poor House, (itself distam, from the populated part of the city) have been reipoved, and to which ali other cases will be removed, should any occur, ex- cept such as are already sufficiently isolated ; that ali intercourse with the sick, except by the nurses and medicai attendants, has been strictly forbidden, under adequaté penalties, whetber at the Hospital or else- where ; that ali new cases are reported at the Mayor's Office; and that. according to my present information, the number of cases, out of our whole population of nearly twenty thousand souls, does not ex- ceed eight. I feel confident that the measures which have been taken, together with the very general vaccination which has been resorted to, will not only check the disease for the present, but will also prove important guarda against its invasions hereafter. <**■ Should the disease, however, not be immediately rooted out. I beg leave to assure the committee that every exertion will be made to cairy into effect any further measures whatever, which may be recommended by the intelligent physicians and other responsible citizens who com- pose the Board of Health. With great respect, I have the honur to be, Your most ob't serv*t, J O GA LE S, Jr. Mayor. Hon. Mark Aiexander, Chairman Committteefor Üie District Columbia.