From Journal Military Service Institution. 
THE ( 
Transportation of the Disabled 
WITH SPECIAL REFERENCE 
TO 
CONVEYANCE BY HUMAN BEARERS. 
By JAMES E. PILCHER, PH.D., 
Assistant Surgeon, U. S. Army. 
N EW YORK: 
1888. THE 
Transportation of the Disabled 
WITH SPECIAL REFERENCE 
TO 
CONVEYANCE BY HUMAN BEARERS. 
By JAMES E. PILCHER, PH.D., 
# 
Assistant Surgeon, U. S. Army. 
(From the Journal Military Service Institution.) 
NEW YORK: 
1888. THE TRANSPORTATION OF THE DISABLED, WITH 
SPECIAL REFERENCE TO CONVEYANCE BY 
HUMAN BEARERS* 
By JAMES E. PILCHER, M.D., Ph.D., 
Assistant Surgeon, U. S. Army. 
WITH the growth of the world in civilization, humanity 
has begun to supplant barbarity in the treatment of 
man by his fellow-man. Annihilation of the enemy 
is a characteristic of the savage massacre, while civilized warfare 
attempts only to weaken the enemy to such an extent as to cause 
him to yield the point in dispute. Instead of seeking the death 
of a disabled opponent, the ethics of the time tend toward the 
removal of his disability and the keeping him under such restraint 
as to prevent his engaging in further hostilities. 
An important feature of the new order of things then is the 
removal of the wounded from the field of battle to the most de- 
sirable place for the treatment of their injuries. For the proper 
performance of this duty thoroughly drilled men and suitable 
appliances are essential. During the War of the Rebellion, the 
necessity for organized means of transporting the wounded cul- 
minated in the formation of an ambulance corps, which rendered 
yeoman service during the latter part of that conflict, but in the 
reorganization of the army, after peace had been declared, this 
corps was eliminated. During the long period of peace that has 
* A lecture delivered before the Military Service Institution of the United States, 
at Governor’s Island, March 21, 1888. The lecture was illustrated by the actual per- 
formance of the methods by trained bearers. 
The illustrations of this paper are mainly reproductions of photographs, for which 
the writer wishes to acknowledge his indebtedness to the skill and courtesy of Lieut.- 
Col. Anton Hegar, Surgeon U. S. Army. 4 
TRANSPORTATION OF THE DISABLED. 
since elapsed in our country, European nations have been devel- 
oping the subject of aid to the injured still further, and the ex- 
perience derived from the more recent wars, in which they have 
been engaged, has thrown new light upon the requirments of 
field sanitary service. After many years of effort, the Medical 
Department of the United States Army has succeeded in obtain- 
ing the organization of a Hospital Corps upon a plan so broad 
and liberal as to justify the highest hopes as to the work to be 
accomplished by it. The number of men in the corps is as yet 
unlimited by legislation, and additional to the enlisted strength 
of the Army as prescribed by law, and when it has its full comple- 
ment, according to existing orders, it will number from eight hun- 
dred to a thousand men, including Hospital Stewards and Act- 
ing Hospital Stewards. In addition to this number, four men in 
each battery, troop, and company in the Army are designated as 
Company Bearers, and are to be instructed in litter bearing and 
in first aid in medical and surgical emergencies. Although not 
prescribed in orders, it has been suggested that the members of 
regimental and other bands, whose duties are of a non-combat- 
ant nature, should be utilized in case of an action. When possi- 
ble, then, these men should be drilled in carrying the wounded 
in addition to those already named. The Militia of the various 
States are falling into line, and notably the New York State Na- 
tional Guard, at the suggestion of Major Fowler, Surgeon of the 
Second Brigade, has already organized an ambulance corps, which 
is now under active instruction. 
The material for rendering aid to the sick and wounded hav- 
ing been thus made available, the question as to the best means 
of utilizing it arises. The first point of importance in case of a 
disabled man is to bring him to the point where he can receive 
the attention of the surgeon ; in case of an action, this would be 
the first dressing station near the line of battle. This must of 
necessity be done by hand, with regularly constructed or extem- 
porized litters, or without assisting apparatus. In any case, a 
definite, uniform system of handling the injured should be em- 
ployed. The required movements may be executed in silence 
according to a prescribed rhythm to which the bearers should 
have become habituated. After some considerable observation 
of the soldier, however, I am forced to the conviction that this 
plan is wholly impracticable, particularly for Company Bearers, 
because of the large amount of drill necessary to train them to TRANSPORTATION OF THE DISABLED. 
5 
properly execute the movements without distinct commands, 
and, owing to the limited amount of time allowed for the train- 
ing of these bearers, it would be impossible to drill them suffi- 
ciently to cause them to execute the movements rhythmically 
without verbal orders. 
Then, having arrived at the conclusion that the movements 
must be executed in obedience to certain commands, I have for- 
mulated the following requisites for the proper carriage of the 
disabled : 
1. A system of manipulation of the hand-litter should first be 
established, and the execution of extemporized methods should 
be adapted to it. 
2. The maneuvers should be so arranged as to prevent confu- 
sion and preserve smoothness, and the commands should be so 
expressed as to bring this about. 
3. In this connection the small number of men commonly 
available for drill should be considered, as well as convenience 
for expansion in case of an increase of forces. 
4. The commands should be so expressed as to convey to the 
bearers in the clearest possible manner the idea of the maneuver 
to be executed. Experience in military tactics has shown that 
this is best accomplished by (a) a preparatory command, to give 
the men warning of the impending movement, followed by (b) a 
command of execution to cause the maneuver. 
5. The same command should not be applied to different 
movements in bearer drill. The mention of this point may seem 
rather unnecessary, but the repetition of this error in nearly every 
plan for bearer drill, that I have seen, has impressed its impor- 
tance upon me. 
6. There should be an analogy with the authorized tactics for 
other arms of the service, (a). When the same movement 
occurs in bearer drill and in the drill of other arms of the ser- 
vice, the movement should be executed in the same manner and 
in obedience to the same commands, (b). The same command 
should not be applied to different movements in the authorized 
tactics and in bearer drill, because the use of commands, conflict- 
ing with those of other arms of the service, would be a con- 
stant source of confusion and demoralization to the company- 
bearers who are required to be familiar with both. 
The unit of bearer drill with the litter should be four men, a 
number which experience has shown to be necessary for the 6 
TRANSPORTATION OF THE DISABLED. 
prompt and efficient conveyance of the insensible, to provide 
proper relief for the bearers, and to afford additional assistance 
in certain maneuvers. The unit of the bearer drill of the St. 
John’s Ambulance Association is three men, and under the stress 
of necessity, this may be sufficient for some civilian purposes, but 
it will not answer for military emergencies. Any organization 
for the purpose of litter-bearing then, should consist of multiples 
of four. 
THE FORMATION OF THE BEARER COMPANY. 
These fours should be united into a company for purposes of 
organization. In forming the company, all bearers, regardless of 
corps, should be made by the senior Hospital Steward to fall in 
in single rank without arms, according to height, the tallest at 
the right, and facing to the right. Junior Hospital Stewards and 
Acting Hospital Stewards should act as file-closers and take their 
posts two yards in rear of the line, the senior at the right, the 
junior at the left, and others in order of seniority, from right to 
left. 
The senior Hospital Steward should then command 
i. Left, 2. Face, 
upon which the men face to the left. He then calls the roll, 
after which he commands 
i. Count, 2. Fours, 
in order to divide the company into the proper bearer squads. 
After the squads are thus designated, he commands 
i. Twos left, 2. March, 3. Halt. 
This movement being executed, he commands 
1. Right, 2. Face, 
following it by 
1. Right, 2. Dress, 3. Front, 
all these movements being executed as prescribed in the author- 
ized Infantry Tactics. 
By this means he has obtained a two-rank formation, with the 
odd numbers (1 and 3) of each set of fours in the front rank, and 
the even numbers (2 and 4) of each set of fours in the rear rank. 
The advantage of this arrangement will appear in marching the 
various squads to the litters, when it will be seen that, without 
any confusion and in the simplest manner possible, the bearers near- 
est the same height will be paired. The company then being TRANSPORTATION OF THE DISABLED. 
7 
formed in this manner, the senior Hospital Steward passes down 
the front of the front rank to the center, advances six yards, 
salutes and reports to the medical officer in command, who 
stands twelve yards in front of the center of the line, and who 
then commands 
Take Your Post, 
upon which the senior Steward faces about and returns to a posi- 
tion in and at the extreme right of the front rank. The medical 
officer then assumes command. 
At the conclusion of all drills and ceremonies, the medical 
officer having brought the company back into the position just 
described, addresses to the senior Hospital Steward the com- 
mand : 
Dismiss the Company. 
The Steward then marches the company to the point where it 
is to be dismissed, when he takes his post six yards in front of 
the center and facing it, and dismisses it with the command 
i. Break ranks, 2. March. 
THE MANAGEMENT OF THE HAND-LITTER. 
The medical officer, having assumed command of the company 
formed as prescribed in the preceding section, sees that a number 
of litters corresponding to the 
number of complete sets of fours 
present are placed in a line paral- 
lel to the company, the litters 
perpendicular to the line and 
three yards apart. I believe that 
the Halstead litter now supplied 
by the Medical Department of 
the Army is the most generally 
useful, while it is simple in con- 
struction, thoroughly portable, 
and exceedingly manageable. It 
consists of two ash side-bars eight 
feet in length by two inches in diameter, connected by a strip of 
canvas six feet long and two feet broad. The side-bars are con- 
nected by two flat bars of wrought-iron, hinged in the middle, to 
permit the litter to be folded, while just within the iron bars are 
situated the legs, also arranged so as to fold. 
The medical officer assigns to the hospital stewards and act- 
Fig. i.—Position of bearers just after the 
command : To your posts— march ! 8 
TRANSPORTATION OF THE DISABLED. 
ing hospital stewards such duties in connection with the drill as 
he may consider advisable. If there is an incomplete squad, a 
steward may be assigned to fill a vacancy, or the squad may act 
as injured men in the drill, practice the extemporized methods of 
carrying the wounded described hereafter, or perform such other 
duties as may be considered advisable. 
Each set of fours constitutes a bearer squad and forms a drill 
unit complete in itself, as I have already remarked. Nos. i and 
2 are the bearers proper, and Nos. 3 and 4 are the relief party. 
No. 4 is the chief of squad and gives all the commands to it. If 
No. 4 is absent or disabled, the command devolves upon No. 3, 
and if the bearer squad is reduced to two, the rear bearer is the 
commander. 
The company and litter then being arranged as indicated, the 
medical ofificer commands 
1. Right, 2. Face. 
This command having been executed, he follows with 
1. To your posts, 2. March. 
At march, Nos. 1 and 3 move forward until Nos. 2 and 4 are 
able to fall in directly behind them, as shown in Fig. 1. They 
then march to the left side of the litter and pass, No. 1 com- 
pletely around it, taking his post between the front handles; No. 
3 following to the middle of the 
right side of the litter; No. 2 to 
the rear handles, while No. 4 
stops at the middle of the left side 
of the litter and faces about. 
Now it will be observed that in 
forming the company the men 
were sized from right to left, and 
that consequently Nos. 1 and 2 
are more nearly the same size 
than Nos. 1 and 3 or 1 and 4. In the same way Nos. 3 and 4 
are more nearly the same size than Nos. 1 and 4 or 2 and 4. We 
have then both our bearers proper and our relief party matched 
in size, and this without the least confusion or conflict. This was 
the end sought in devising this formation, which was selected 
from a large number which were subjected to experiment, be- 
cause of its simplicity and ease of execution. 
To bring the company back into the company formation, the 
Fig. 2.—Position of the bearers about the 
litters. TRANSPORTATION OF THE DISABLED. 
9 
litter squads should be made to bring the litters into a line 
parallel with and facing the proposed line of the company and 
three yards from it. The senior Hospital Steward then takes a 
position at the extreme left of the proposed line and on the line 
of the rear rank. The medical officer then commands 
i. hito ranks, 2. MARCH. 
At march, the bearers pass about the litter, marching in the 
reverse of the direction taken in u To your posts; march." No. 4 
of the right-hand squad advances and takes his position in the 
line indicated by the Hospital Steward and facing to the left; No. 
2 follows and takes his place immediately behind No. 4 ; No. 3 fol- 
lows and takes his position at the right of No. 4, and No. 1 
follows and takes his position at the right of No. 2. The other 
squads advance in the same way and simultaneously with the 
right-hand squad, but each forms on No. 2 of the preceding squad 
instead of on the Hospital Steward. The medical officer then 
commands: Right face, in obedience to which the men face to 
the right and the senior Hospital Steward passes in front of the 
line to his place at the right of the line. 
THE MANIPULATION OF THE LITTER. 
The company is now fully formed, and the officer may assign 
parts of it to any distinct duties, or cause them to be dismissed, 
as already prescribed. 
By the order To your posts, march, the company is resolved 
into its component elements, the litter squads. 
The handles of the litter should be held in the hands, carried 
by the side. If a litter is carried upon the bearers’ shoulders, the 
height at which he is carried is a continual source of anxiety to 
the patient. If one of the bearers should stumble or fall it would 
be a positive source of danger. It is a matter of history that 
General Stonewall Jackson died from injuries aggravated by fall- 
ing from a litter borne on the bearers’ shoulders, when one of 
the bearers fell wounded. 
The bearers should take a firm but not springy step, about 
twenty inches in length, with the knees rather bent and the hips 
moved as little as possible. Theoretically, the best step for 
them to take is the “mountain step,” in which the bearers’ feet 
fall upon the ground in succession—a gait similar to that of a 
“ single-foot ” horse. Practically, the soldier is so accustomed to 
keeping step that it would be impracticable to train company 10 
TRANSPORTATION OF THE DISABLED. 
bearers in this step. A disagreeable swinging motion is given to 
the litter if both bearers step off with the same foot, but this can 
be obviated by the “ break-step,” in which the rear bearer steps 
off with his right foot, while the other bearers step off as usual 
with the left foot. Practically, then, this is the best gait for use 
in litter bearing. 
The litter should be held level. This is obtained on level 
ground by having the bearers as nearly as possible of the same 
height, as already mentioned. In passing over uneven ground, 
the bearers should act in concert, so as to still maintain the level, 
the bearer on the higher ground lowering his end and the bearer 
on the lower ground raising his end. If a declivity is so marked 
that it is impossible to keep the litter level, it should be carried 
so that the patient’s head may be higher than his feet, unless he 
is suffering from a fracture of the lower extremity, when the 
reverse order should be adopted. 
The litter should not be carried over a fence or wall, or across 
a ditch or marked depression, except when it is absolutely impos- 
sible for the bearers to pass around them. If this is impractic- 
able, a portion of the fence or wall should be torn down ; the 
ditch should be crossed by lowering the litter on the margin of 
the ditch while the first bearer descends into it; he then draws 
his end of the litter out over the ditch and holds it while the rear 
bearer descends and lifts his end down ; in ascending on the other 
side, the process is reversed. 
The litter should always be carried with the patient’s feet for- 
ward, except in case of a fracture of the lower extremity, and in 
making a marked ascent. It can readily be seen that this will 
conduce greatly to the comfort of the patient. 
The litter-squad having been marched to their posts, the 
sauad is commanded bv No. a, who commands 
i. Lift, 2. Litter. 
At litter, Nos. 3 and 4 
stand fast, while Nos. 1 and 
2 stoop, adjust the straps 
about the neck and shoul- 
ders, and grasp the handles 
of the litter, as in Fig. 3. 
(Two) They gently lift the 
litter by resuming an erect 
posture. 
Fig. 3.—“ Lift Litter,” TRANSPORTATION OF THE DISABLED 
11 
To place the litter upon the ground, No. 4 commands 
1. Lower, 2, Litter. 
At lower, Nos. 3 and 4 face 
inward toward the litter, and 
grasp its legs, as in Fig. 4. 
At litter, all four gently stoop 
until the litter rests upon the 
ground, Nos. 3 and 4 guiding 
the legs, and (Two) resume an 
erect posture, all facing in the 
direction of the litter. 
In marching, it should be remembered that the rear bearer 
steps off with the right foot, the others with the left foot. If it 
be desired to march directly forward, No. 4 commands, 1. For- 
ward, 2. MARCH ; if it is desired to turn at a right angle, the 
direction is changed by the command, 1. Litter I^cft (or Right), 
2. March ; or if it is desired to turn obliquely, the direction is 
changed by the command, 1. Litter Half Left (or Right), 2. 
March. 
When the destination is reached, or when it is desired to rest 
or change bearers, No. 4 commands, 1. Litter, 2. Halt. 
To change bearers, the litter being lowered, No. 4 commands 
1. Change, 2. March, 3. Halt. * 
At change, No. 4 faces to the rear. 
At march, the squad marches about the litter in the direction 
taken when they marched to their posts. When No. 1 reaches 
the place vacated by No. 4, No. 4 that vacated by No. 2, No. 2 
that vacated by No. 3, and No. 3 that vacated by No. 1, the com- 
mand Halt is given. Nos. 3 and 4 then become the bearers, and 
Nos. 1 and 2 the relief party. When it is desired to resume the 
original position, the march is continued in the same direction, 
the command Halt, not being given until the desired position is 
gained. 
THE MANAGEMENT OF THE LITTER AT THE AMBULANCE. 
To load a litter upon an ambulance, the same general line of 
action may be pursued, care being taken to differentiate the 
commands from those of ordinary litter exercises. A litter hav- 
ing been brought with its front handles at the rear of the ambu- 
lance, its long axis in the long axis of the ambulance, No. 4 
commands 
Fig. 4.—“ Lower.” 12 
TRANSPORTATION OP THE DISABLED. 
i. Prepare to Load, 2. MARCH. 
At march, No. i steps to the left side of the litter at the front 
legs, while No. 3 advances to the 
same point on the right side; No. 
2 passes to the right side at the 
rear legs, while No. 4 steps back 
to the same point on the left side. 
No. 4 having ascertained that the 
ambulance is in condition to re- 
ceive the litter, and that the litter 
is in proper condition to be loaded, 
commands 
1. Raise, 2. Litter. 
At raise, the squad face toward the litter; at litter, they stoop, 
and with the palms upward,,grasp the side poles of the litter, 
and (Two) gently raise it to the level of the rollers of the ambu- 
lance, upon which it is to be placed. No 4 then commands 
1. Load, 2. Litter. 
At litter, each bearer folds up the leg adjacent to him, and 
the litter is gently passed forward on to the rear roller, when 
(Two) Nos. 1 and 3 step back to the right and left one yard, while 
Nos. 2 and 4 push the litter gently in, its full length, and (Three) 
step back facing distance, while Nos. 1 and 3 return to their 
places, and face toward the ambulance. 
The squad may now be marched to a new litter, or into ranks. 
In the former case, Nos. 1 and 3 face to the left, and Nos. 2 and 
4 to the right, and march about a central point, falling in in the 
order 1, 3, 2, 4. In the latter case the movement is reversed. 
To unload a litter from an ambulance, a squad should be 
marched to the rear of the ambulance and formed as described in 
the preceding paragraph, Nos. 1 and 3 in the front rank, and Nos. 
4 and 2 in the rear rank. No. 4 then commands 
1. Unload, 2. Litter. 
At litter, Nos. 1 and 3 face inward, and step back one yard 
to the right and left respectively ; (Two) Nos. 2 and 4 step for- 
ward, and grasping the rear handles, draw the litter gently out, 
seizing the litter-poles at the rear legs, with the palms upward. 
(Three) Nos. 1 and 3 advance and grasp the litter poles at the 
front legs, with the palms upward, and (Four) the litter is drawn 
clear of the ambulance. If the ambulance contains four litters, 
Fig. 5.—Position of bearers after tne com- 
mand, Prepare to load. TRANSPORTATION OF THE DISABLED. 
13 
the first should be carried nine yards to the rear before being set 
down ; if it contains two litters, the first should be carried three 
yards to the rear ; if but one, it may be stopped one yard in rear 
of the ambulance. No. 4 then commands 
1. Depress, 2. Litter. 
At litter, the bearers gently stoop and lower the litter to the 
ground, each bearer seeing that the leg adjacent to his hands is 
in proper position, (Two) arise to an erect posture and (Three) 
assume their proper places about the litter. 
In case it becomes necessary for a squad to assume entire 
charge of an ambulance, when the litter has been brought to the 
ambulance No. 3 takes his position as ambulance driver. No. 4 
sees that the ambulance and litter are prepared, and gives the 
commands as before. In this case No. 2 passes forward on the 
right side to the front legs, while No. 4 assumes sole charge of 
the rear end, standing between the handles. The litter is then 
loaded by the same commands as with four bearers, Nos. 1 and 2 
remaining at the sides of the litter' after the front handles have 
been deposited upon the rollers and helping to push it into the 
ambulance. The ambulance is unloaded by three bearers, with 
the same commands as for four, the bearers being assigned to the 
same posts as when loading. 
It not infrequently occurs that the services of litter-bearers 
are demanded when they are under arms or mounted. Maneu- 
vers, by which both horses and arms may be satisfactorily dis- 
posed of or utilized so as not to interfere with the proper per- 
formance of the bearers’ duties, have been devised, but it would 
seem best that the present paper be confined strictly to the 
means of handling the disabled, and not encumbered with acces- 
sory details. 
THE TRANSFER OF A PATIENT TO OR FROM A LITTER. 
Perfect familiarity with the manipulation of an empty litter 
having been obtained, bearers should be taught how to transfer a 
patient to and from the litter. After a considerable number of 
experiments, the following methods have been selected as the 
most satisfactory: 
The patient lying at full length, on his back if the character 
of his injuries will permit, the empty litter should be brought 
with its front handles at his head and its long axis in the direc- 
tion of the patient. No. 4 then commands 14 
TRANSPORTATION OF THE DISABLED. 
i. To the patient, 2. March. 
At march, Nos. i and3 pass on the right of the patient, No. 
i to his knees and No. 3 to his elbow, while No. 2 passes on the 
left to his waist, all facing toward the patient. No. 4 steps to 
the left to permit No. 2 to pass between himself and the litter, 
then he takes charge of the injured part, or supports the head. 
No. 4 then commands 
1. Lift, 2. Patient. 
At patient, all kneel, (Two) No. 1 passes his hands with the 
palms uppermost, the left under the patient’s calves and the right 
under his ankles, the fingers hooking up on the opposite side of 
the patient; No. 2 passes his hands with the palms uppermost, 
the right under the back between the loins and the shoulder- 
blades, and the left under the thighs at their junction with the 
body, the hands, if possible, hooking up on the farther side of the 
patient; No. 3 passes his hands similarly, the left under the 
shoulders and the right under the loins, the hands hooking up, if 
possible, on the opposite side. (Three) All arise, first upon one 
foot and knee, then upon both feet. 
Or, at patient, all kneel upon one knee, (Two) No. 1 passes 
his hands as above, while Nos. 2 and 3 each pass one hand under 
the patient’s thighs at their junction with the body, and the 
other under the back close up,, under the arm- 
pits, the left palm down and the right palm up. 
Each bearer then grasps his companion’s corre- 
sponding wrist and (Three) all arise. The grip 
s shown in Fig. 6, showing a two-handed seat, 
and this grip in the present instance is to be 
taken with both hands. 
The first of these methods is the best adapted 
:ror a perfectly helpless patient, is the more 
comfortable for the patient, and the more easily 
performed in transferring a patient from litter 
to bed, or from bed to litter; while the second 
is the more easily performed in transferring a patient from ground 
to litter, and is rendered still more easy if the patient can help 
himself by placing his hands upon the bearer’s shoulders. 
The patient then being lifted, No. 4 commands 
1. To the litter, 2. March, 3. Halt. 
At march, the bearers move gently with side steps until the 
Fig. 6.—Two-handed 
seat, to show the grip of 
the hands. TRANSPORTATION OF THE DISABLED. 
15 
patient is held over the litter, when, at halt, they stop. No. 4 
then commands 
1. Lower, 2. Patient. 
At patient, the bearers gently stoop until the patient rests 
upon the litter, (Two) withdraw their arms, resume an erect 
posture and (Three) take their proper posts. No. 4 sees that the 
patient and the injured parts are disposed in the most convenient 
and comfortable position possible, and that the head rests easily 
upon a pillow formed by a coat, knapsack, blanket, or other 
similar article. 
In removing a patient from one litter to another, or from a 
litter to a bed, the litter should be placed with the patient’s head 
at the foot of the new litter or the bed and the preceding pro- 
cedure followed. 
EXTEMPORIZED METHODS OF MOVING THE WOUNDED. 
But every old campaigner will remember that it was rather 
the rule than the exception when the supply trains were left 
behind, and he will readily recognize the fact that, as occurred in 
Lord Wolseley’s Soudan expedition, the paraphernalia of the 
ambulance corps may be wanting. Again, small scouting parties 
of from two to ten men will not be burdened with litters. In 
cases such as these a knowledge of extemporized means of trans- 
porting the sick and wounded may be of the greatest advantage. 
Indeed, I am in very serious doubt as to whether it may not be 
of even greater importance than litter exercises themselves. In 
view of these facts, I have been astonished at the slight amount 
of attention that has been devoted to these methods. Thousands 
of pages have been written upon various styles of litters and am- 
bulances, immense sums have been laid out in the construction 
of complicated hospital-ships and hospital-cars for large numbers 
of the sick, but the conveyance of the single man in case of the 
absence or insufficiency of this elaborate paraphernalia seems to 
have been almost entirely neglected. 
In the execution of these methods, as in litter bearing, the 
utmost gentleness and care should be observed. For practice, 
they should be divided into clearly marked steps, each of which 
should be distinctly performed, also, as in litter bearing. 
I have divided these methods into three classes: 
A. Methods by a single bearer ; 
B. Methods by two bearers ; 
C. Methods by three or more bearers. 16 
TRANSPORTATION OF THE DISABLED. 
A. METHODS BY A SINGLE BEARER. 
I consider these methods to be in reality the most important 
of all, both to the soldier and the civilian. The instances where 
a familiarity with these methods may be the means of saving life 
in case of fire and other accidents in towns and cities, will readily 
occur to the reader, while one who has seen frontier service can- 
not fail to remember numerous occasions where they might have 
been of vital service. 
These methods naturally fall into three groups: I. Where the 
patient is carried in the bearer’s arms; II. Where the patient is 
carried on the bearer’s back ; III. Where the patient is carried on 
the bearer’s shoulder. In all these cases the most important 
question is how to lift the patient into a position in which he may 
readily be carried—a matter of no little difficulty when the 
patient is insensible or unable to assist, and particularly if he be 
a heavy adult. A year or two ago I made a large number of ex- 
periments with a view to devising a means of facilitating this 
procedure, and have continued these experiments during the past 
year, until I have finally settled upon the procedures described in 
connection with the following methods: 
I. Where the patient is carried in the bearer s arms.—These 
methods are adapted to carriage for short distances and for those 
cases where it is thought necessary, for any reason, to have the 
patient under the eye of the bearer. There are three of these: 
i. The patient lying on the ground, (i) turn him face down- 
ward, (2) stand astride of him and, with your hands in his arm-pits, 
raise him to a kneeling posture, (3) shift your 
hands about his body and clasp them in front, 
and (4) lift him upon his feet; (5) then, still hold- 
ing him erect, shift yourself so that his right side 
will be against you and your hands under his left 
arm-pit; (6) then, retaining your left hand and 
arm in place, pass your right arm behind his 
thighs and (7) lift him into your arms. By this 
plan, a man can be lifted into the arms who could 
not otherwise be raised twelve inches from the 
the floor. To lay the patient down from this posi- 
tion, (1) keeping the left hand and arm in place 
lower the patient’s inferior extremities by lowering the right arm 
(2) the heels resting on the ground or cot, the left hand should be 
Fig. 7.— Sixth mo- 
tion in lifting patient 
into arms. TRANSPORTATION OF THE DISABLED. 
17 
clasped in situ by the right, and (3) the patient gently lowered 
on to his back. 
2. The patient may be carried with somewhat greater ease by 
taking a sheet, shelter tent or similar article, and tying the two 
opposite corners together, then (1) passing the broad center of the 
sheet under the patients loins and buttocks, and (2) the knot over 
the bearer’s head with his right arm through the loop; then (3) 
slipping the left hand under the patient’s shoulders and the right 
under his thighs, the bearer rises to an erect posture. To lower 
the patient, the bearer simply bends forward until he rest upon 
the ground or cot. 
3. A sort of harness has been devised by Hospital Steward 
Barbers, to be substituted for the sheet in the preceding meth- 
od (2). 
II. Where the patient is carried on the bearer s back.—A patient 
can be carried upon the bearer’s back with much less exertion 
than in his arms. These methods are consequently better adapted 
to carriage for any considerable distance. There are four prin- 
cipal varieties of these methods: 
1. The patient “pick-a-back.”—(a) This is the oldest of these 
methods and is available, without assistance, only when the pa- 
tient is able to assist by clasping his arms about the bearer’s neck. 
It is best performed in the following manner: 
(1) Let the patient, seated upon the ground facing you, clasp 
his arms about your neck (2) with your hands under his arm-pits 
raise him to a kneeling posture, (3) then shift- 
ing the arms about his body raise him to his 
feet; (4) then letting him support himself by 
his arms about your neck and assisting him with 
your hands, face carefully about ; (5) then grasp 
the patient’s thighs on either side, and draw 
them astride of your loins. The patient is 
lowered by reversing the movements of lifting 
him. 
(b) An insensible patient can best be carried 
by the methods to be described presently, but 
if for any reason it is desired to use this method, 
after the patient is gotten upon the back with the help of other 
assistants, he may be kept in place by passing a broad strap—a 
belt for example—about his back under his arms and up over the 
bearer’s forehead or about his chest. 
Fig-. 8.—Fourth motion 
in lifting patient astride 
of back. 18 
TRANSPORTATION OF THE DISABLED. 
(e) A sort of saddle has been devised by Fischer which relieves 
the bearer from supporting the patient’s thighs, and enables him 
to devote his attention to keeping the patient in place with a strap 
passed about his back. 
2. Analogous to Fischer’s method is the plan of carrying the 
patient seated in a chair strapped upon the bearer’s back. 
3. Another method is much advocated by foreign authors, and 
may be of advantage in countries where the people are accus- 
tomed to carrying heavy burdens upon the head. But it is wholly 
unadapted to the American physique, and I only mention it as a 
curiosity and to condemn it. It is as follows: (1) Seat the pa- 
tient with the knees and hips bent, the head resting on the knees; 
(2) then pass a long band—a belt for example—about the patient 
under his knees and arms; (3) then crouching down behind him 
back to back, pass the strap over your forehead and (4) arise. The 
strap should be short enough to bring the weight upon the 
shoulders and the upper part of the back. 
4. The following method is a modification of one recommended 
by Capt. Shaw of the London Fire Department. It is comfort- 
able to the patient and easy for the bearer, and is of particular 
value when the patient is not insensible, but at the same time is 
unable to render any assistance to the bearer. (1) Turn the pa- 
tient face downward ; (2) seize him under each arm-pit and raise 
him to his knees ; (3) shift the arms about his waist, clasp the 
hands, and lift the patient to his feet; (4) then retaining the right 
hand in position grasp the patient’s left hand with your left hand 
and draw his left arm back about your neck, bringing the hand 
down in front of your chest; (5) then, stooping 
slightly, pass your right arm around in front of 
the patient’s right thigh and grasp it, whereupon 
he will fall across your back ; (6) resume the erect 
posture and balance the body on your back. 
III. The patient over the bearer s shoulder.— 
This method is of advantage because of the ease 
with which the patient can be carried, and because 
it leaves one hand free for other purposes. An- 
other important feature is that it enables the 
bearer to thoroughly control the patient, a point 
of great advantage in case of a delirious or refrac- 
tory patient. (1) Turn the patient upon his face; (2) standing at 
the head of the patient, seize him under his arm-pits and lift him 
Fig. 9.—Patient across 
bearer’s back. TRANSPORTATION OF THE DISABLED. 
19 
to his knees, facing you ; (3) shift your arms about his waist and 
raise him to an erect posture, (4) at the same time placing your 
right shoulder at his stomach so that his body falls over upon 
your back; (5) pass your right hand forward between his thighs; 
(6) With your left hand grasp the patient’s 
right hand and draw it under your left arm- 
pit, until you can grasp his left wrist with 
your right hand ; (7) resume the erect pos- 
ture. 
In case of a female, where the skirts 
would make it inconvenient to pass the arm 
between the thighs, if the patient is not too 
large, the right hand can be passed around 
both thighs. 
To lower the patient (1) the bearer drops 
on his knees, (2) bends greatly forward until tne patient rests 
upon his buttocks, and (3) withdraws his hands and resumes an 
erect posture. 
These methods for a single bearer are sufficient to meet any 
emergency which may arise and afford a sufficient variety to give 
to a bearer the rest to be derived from a change of position. 
B. METHODS BY TWO BEARERS. 
While, in many instances, it is really easier for one bearer to 
carry a patient by the methods which I have given, than for two 
to unite in carrying him, yet it is usually rather more comfortable 
for the patient to be carried by two, and for any considerable dis- 
tance it is easier for the bearers. The methods by two bearers 
may be considered in .three groups: I. Where the patient is car- 
ried without assisting apparatus. II. Where the patient is carried 
upon apparatus extemporaneously constructed for the purpose. 
III. Where the patient is carried upon articles diverted to that 
use. 
I. Where the patient is carried without assisting apparatus.— 
In the execution of these methods, the action should be divided 
as in transferring a patient to or from a litter, and be performed 
in obedience to the same commands, substituting Fonvard March 
for To the litter March. 
1. Four-handed seat.—This is the “ lady’s chair ” or “ sedan 
Fig. io.—Patient over bearer’s 
shoulder. 20 
TRANSPORTATION OF THE DISABLED. 
chair" of the children, and makes a very comfortable seat for a 
patient who is able to help himself to some 
extent. To form it, each bearer grasps his 
own left wrist or forearm with his right hand, 
and with his left hand grasps his fellow’s 
right wrist or forearm. The patient, sitting 
upon the seat thus formed, helps to support 
himself by throwing his arms over the shoul- 
ders of the bearers. 
2. Three-handed seat with back.—This is 
recommended by Longmore as being the 
most desirable of these methods, but while 
it is undoubtedly useful, my own observation has taught me that 
it is inferior to the third method. To form 
the three-handed seat, the right hand bearer 
grasps his own left forearm with his right 
hand, and the left forearm of his fellow with 
his left hand ; the left hand bearer grasps 
with his left hand the right forearm, and 
with his right hand, the left shoulder of his 
fellow. 
3. Two-handed seat with back.—This 
method I consider the most comfortable for 
the patient and the least fatiguing for the bearers and in every 
way the most desirable of the methods by two 
bearers. The right hand bearer grasps, with 
his right hand, the left wrist, and with his left 
hand, the right shoulder of his fellow ; the left 
hand bearer grasps, with his left hand the right 
wrist and with his right hand the left shoulder 
of his fellowr. 
4. Bearers at knees and shoulders.—The 
front bearer, taking his position between the 
patient’s thighs, grasps them on either side and, 
on lifting, elevates them to just above his hips ; 
the rear bearer raises the patient’s head until 
its back rests upon his breast, then passes his arms under the pa- 
tient’s arm-pits from behind, and interlocks the fingers of his two 
hands in front. This method is comfortable for the patient, but 
not as easy for the bearers as some of the others. It is well 
adapted to the carriage of exceedingly weak patients. 
Fig. n.—Four-handed seat. 
Fig. 12.—Three-handed seat 
Fig. 13.—Two-handed 
seat. TRANSPORTATION OF THE DISABLED. 
21 
II. Where the patient is carried upon apparatus extemporaneously 
constructed for the piLrpose. — The proce- 
dures under this head maybe grouped into 
three classes. In the first two the patient 
is seated, in the third he is supine. In the 
first two the patient should be gently lifted 
by one bearer while the apparatus is placed 
beneath him; then he should be lifted and 
carried as in transferring a patient to or 
from a litter. In the third class, the pa- 
tient should be transferred to the extem- 
porized litter, and this litter should be 
manipulated in the same way as the regulation hand-litter. 
1. A seat maybe constructed by forming a ring of leather, 
rope, canvas, cloth, etc. The bearers grasp opposite sides of this 
ring while the patient sits upon it. For ordinary purposes this is 
inferior to the two-handed seat already described; when bearers 
are engaged in bearing the sick for a considerable length of 
time, the hands become cramped and fatigued, and in this case, 
the ring is of service. The German trag-sitz or bearing seat is an 
elaboration of this method. 
2. A convenient litter may be constructed from two rifles with 
their gun-slings. To form this, the slings should be let out to 
their greatest length. That of one rifle should be unhooked from 
the ring near the muzzle; the sling of the other rifle should 
then be passed over this one ; the unhooked sling should then be 
made fast again and passed over the other rifle. In the absence 
of gun-slings, the pieces may be connected by belts, straps, knap- 
sacks, and other similar articles. The patient is to be seated upon 
the litter thus formed, leaning upon the rear bearer. 
3. A hand litter may be constructed by taking two poles of 
suitable length and connecting them by coats, the sleeves of which 
are turned inside out and which are buttoned about the poles 
which are thrust through the sleeves. Three blouses used in this 
way form an excellent lit- 
ter. The poles may also 
be connected by a blanket, 
tent fly or shelter tent fas- 
tened about them. They 
may also be connected by 
picket ropes, straps, belts, 
Fig. 14.—Patient carried by bear- 
ers at knees and shoulders. 
Fig. 15.—Litter constructed of two poles thrust through 
the sleeves of three blouses. 
The middle blouse is left open to show the disposition of 
the sleeves. The buttons are to be carried underneath. 22 
TRANSPORTATION OF THE DISABLED. 
etc., and when these are covered by a blanket or something of the 
kind, the result is a very comfortable litter. 
III. Where the patient is carried upon articles diverted to that 
use. — In the execution of these procedures the maneuvers and 
commands prescribed for the hand-litter should be employed. 
This class may be divided into two groups, accordingto the atti- 
tude of the patient. 
1. The patient may be carried between two bearers, seated 
upon a board, a rifle or carbine, or a chair. 
2. The patient may be carried on a litter extemporized from 
a broad board, a door, a shutter, a cot, or other similar articles. 
The use of blankets, tent flies and the like to be carried by their 
four corners, is inconvenient for the bearer’s and uncomfortable 
for the patient. It is difficult to conceive of a case where, in the 
absence of rigid poles or frames, such as are enumerated in this 
paper, it may be necessary to resort to the awkward blanket. 
C. METHODS BY THREE OR MORE BEARERS. 
It is not infrequently the case that the paraphernalia of litter 
bearing is deficient while there is an abundance of men for bear- 
ing. It is, moreover, not infrequently the case that patients are 
so injured, that in the absence of regularly constructed litters, the 
services of three or more bearers are necessary in order to carry 
them comfortably to any distance. If the distance over which 
the patient has to be borne is considerable, it is frequently desir- 
able, in order to prevent fatigue, in the absence of a satisfactory 
litter, to divide the weight of the patient among several bearers. 
1. By three bearers.—In case of a wound of the lower extremi- 
ties, where the patient is carried by two bearers according to the 
methods already described, a third bearer may be employed to 
support the injured limb. 
II. By four bearers.—I. The methods of carrying a patient in 
transferring him to or from a litter fall under this head—Nos. i, 
2 and 3, being the bearers proper, while No. 4 supports the head 
or the injured part—and they may be utilized for bearing a patient 
in the absence of a litter. 
2. A litter may be constructed by forming the poles on either 
side by two rifles lashed together at the muzzle and connecting 
these poles by a blanket, tent fly, coats, or similar articles. The 
bearers being numbered as in hand-litter exercises, Nos. 3 and 4 TRANSPORTATION OF THE DISABLED. 
23 
grasp the poles in carrying at the point where the rifles are lashed, 
and thus support the weak point. 
III. By five bearers.—A patient may be carried by five per- 
sons, one on either side supporting the head and shoulders, one 
on either side supporting the pelvis, and one supporting the legs. 
A greater number of bearers than five can not act conveniently. 
CONCLUSION. 
By proceeding with the discussion of the transportation of the 
wounded upon wheeled or other vehicles, the subject might be 
extended almost indefinitely, but I have purposely limited myself 
to that part of the subject concerned with carriage by human 
bearers, in the belief that less was known of this than of any other 
part, and that consequently such a study would be of particular 
value at the present time. It has been my aim to introduce 
nothing merely theoretical but to present what, after a careful 
winnowing of a large number of experiments, has been shown by 
practical experience to be the best. I trust that further investi- 
gation may still more perfect this fundamental portion of the 
management of the disabled, and that with a more prevalent 
knowledge of this subject the future may be brought into still 
greater contrast with the past. 
The history of war has hitherto been a story of hundreds of 
lives lost by lead and steel, and of thousands of deaths due to 
sheer neglect. The broader humanity of our age is leading us to 
a higher conception of our duties to the fallen, whether comrade 
or adversary. The general of the future will not disregard the 
care of the injured in forming his plans for a coming battle, nor 
will it continue to be said that living men cannot be spared from 
dealing death, even to engage in saving life. Properly trained 
men will be found in every command whose duty it shall be to 
stay imminent death upon the field and, by means such as have 
been described, tenderly bear the wounded to points where sur- 
gical skill shall gather up the half-broken threads of life. The 
death-rate of future campaigns will be diminished, peace will be 
gained at a lower price, and the horrors of war will be vastly 
lessened—and in the attainment of this result the most important 
factor will be the proper transportation of the disabled.