NOTES ON MILITARY MEDICINE IN EUROPE. 
BY BREVET LIEUTENANT-COLONEL JOHN S. BILLINGS, 
Surgeon U. S. Army. 
During the summer of 1881 it was the good fortune of 
the writer to have the opportunity of being present at the 
great International Medical Congress, which met in London 
at the beginning of August, and subsequently of making a 
rapid trip on the Continent, in the course of which he 
visited, among other places, Berlin, St. Petersburgh, and 
Vienna, and had occasion to see something of the condition 
and working of the Medical Departments of the armies of 
the several countries. It has been suggested that some of 
the points which attracted his attention may be of interest 
to others, and the purpose of the present article is to give 
brief notes of some of these subjects, divested, as far as 
possible, of medical technicalities, and having no particular 
moral in view. 
The Congress referred to was the seventh meeting of 
the kind which has been held in Europe, and was much 
larger and more important than any of its predecessors. 
Over three* thousand physicians and surgeons were present, 
representing every civilized country and government of the 
earth, and including a decided majority of all the celebrated 
medical writers, teachers, and practitioners of the old world. 
I have elsewhere sketched some of the general aspects of 
this assemblage (“International Review,” January, 1882),and 
shall here only refer to those which relate to military medicine. 
All the preceding medical congresses had divided into 
sections, for convenience ; one section being devoted to 
medicine, a second to surgery, a third to diseases of the MILITARY MEDICINE IN EUROPE. 
235 
eye, etc.; but the London Congress was the first which has 
had a section especially set apart for military medicine and 
surgery. And when the members of the Section came 
together in the large, bare room allotted to it in the Uni- 
versity of London, they certainly formed a striking assem- 
blage to one who had some knowledge of the persons 
present, and of their history and work. 
There were men who had been through the Indian 
Mutiny, the Crimean War, and New Zealand and African 
campaigns. There also were surgeons who won fame during 
the Austro-Prussian and Franco-Prussian wars, and others 
who had followed the Russian eagles to the walls of Con- 
stantinople. Scattered about the room were some of the 
old India surgeons, whose duties have been often rather civil 
and administrative than military or medical, but who have 
never lost their interest in the studies of their youth, and 
whose contributions to the literature of their profession are 
among the most valuable which we possess. As the repre- 
sentatives from different nations rose in turn and contrib- 
uted each his best knowledge as to the particular point 
under discussion, stating what apparatus or device had been 
found useful in his own service, one could not help thinking 
how different their policy was from that of other army de- 
partments. The President of the Section, Surgeon-General 
Longmore, alluded to this very happily in his opening ad- 
dress. Said he : “ Although belonging to all nations, we 
have the advantage of being able to meet together without 
national jealousy, and with no other rivalry than that of 
vieing with each other in endeavors to discover what may 
most benefit the sick and wounded. It is not with our 
province of thought and action, as it is in some measure 
with those other parts of military science and practice, on 
which national safety or superiority in power may depend. 
A certain amount of reticence in regard to them is justified 
by national self-interest. We can speak quite openly of all 
our professional plans and arrangements. If they contain 236 
MILITARY MEDICINE IN EUROPE. 
any features better than those belonging to our neighbors of 
other countries, we have no fear of imparting them. We 
hope, indeed, if they are really better, that they may be 
adopted and turned to account; for if practically applied, 
our own people may possibly be among those who will be 
benefited by their adoption. Even in time of war ‘ there 
are no enemies within our sphere of action.’ It is true that 
this last statement must sometimes be taken as indicating 
that which ought to be rather than that which is, as was 
shown by a statement made by Don Nicario de Landa y 
Alvarez, of the Spanish Army, who, in speaking of the 
recent war in Cuba, said that both the wounded and the 
surgeons were killed when they fell into the hands of the 
insurgents, and' that seven medical officers were thus lost; 
nevertheless, the feeling which such a statement arouses 
proves that such conduct is exceptional, and that the rule 
is that given by Professor Longmore, “ There are no 
enemies within our sphere of action.” 
Among the various subjects brought before the Section the one which 
received the greatest amount of attention was the care of the wounded dur- 
ing active service of an army in the field, and especially the means for 
their transportation. 
Surgeon-General Longmore devoted the greater part of his opening 
address to this subject, and pointed out that it is the impossibility of 
securing trained animals which makes the majority of appliances devised 
for this purpose useless in uncivilized and savage warfare. Where ambu- 
lances can be used, it was agreed by all that the American patterns are 
the best. The matter was summed up by Surgeon-General Roth, of the 
German Army, in the statement that the experiences of the last great 
wars, particularly the Franco-German and Russo-Turkish ones, have 
proved that the difference in the means of transport in different armies 
are of comparatively small importance. For large numbers of wounded 
we have to rely on stretchers, railroads, and boats, because ambulances 
can scarcely ever be collected in sufficient number at the places of most 
importance. He quoted approvingly the remarks of Pirogoff, that after 
all, the fate of the wounded soldier depends more on the Administration 
than upon the medical man, and agreed with Longmore that the most 
important point is the personnel of the army hospital corps. “ For 
the inauguration of such an organization we are indebted to America, MILITARY MEDICINE IN EUROPE. 
237 
from whence issued a model sanitary service formerly unknown in 
Europe. A well-drilled ambulance or bearer corps will make the best of 
whatever material is available, and the object should be the organization 
and training of such a corps, which should be at the disposal of the Army 
Medical Department.” 
In the course of the discussion on the transport of wounded, Pro- 
fessor Gori of Amsterdam paid a high compliment to the late Surgeon 
George A. Otis, of the United States Army, declaring that his writings 
are the glory of the army to which he belonged, and that the army sur- 
geons of all countries unite in deploring his loss. At the close of his 
remarks Professor Longmore arose, and in his peculiarly grave and courtly 
manner, but with a voice which trembled with emotion as he went on, 
spoke as follows : 
“In the course of the observations which have just been brought to 
our notice by Dr. Gori of Amsterdam, that gentleman has made refer- 
ence to a calamity about which there can be no discussion. I allude to 
the eloquent tribute which Dr. Gori just now paid to the services and 
untimely death of that learned and most distinguished American sur- 
geon, Dr. Otis. All of us military surgeons who are in this room, to 
whatever nation we may belong—and every leading nation is represented 
here at this moment—all of us have greatly benefited, and so long as we 
are able to pursue our profession, must still be benefited by those grand, 
impartial, and comprehensive volumes of the surgical history of the great 
War of the Rebellion in the United States, which Dr. Otis was spared to 
complete, and which the Government of the United States have so largely 
and so liberally distributed among military surgeons in Europe. This 
seems to be a very fitting occasion, representatives as we are of the 
science and practice of military surgery in all countries, for us to express 
our profound regret at Surgeon Otis having been taken away from us 
before he was able to complete the greatest of all his many valuable pro- 
fessional works, as he had hoped to do ; and it seems also to be a fitting 
opportunity to convey to Surgeon-General Barnes, and through him, to all 
the medical officers of the United States Army, our heartfelt sympathy 
with them on the great loss their medical service in particular, and, at the 
same time, military surgical science in all parts of the world, has sus- 
tained in the death of their great colleague. I say these few words in the 
presence of an eminent friend and fellow-laborer of Dr. Otis—Dr. Bil- 
lings—who occupies an important post in the Surgeon-General’s Office at 
Washington ; and I beg to propose to the meeting that Dr. Billings be 
asked kindly to allow himself to be made the medium of communicating 
this, I may truly say, international expression of feeling—for I see 
plainly that you all share with me the sentiments which I have tried to 
express—to the distinguished chief at the head of his department and 
to his colleagues on his return to Washington.” 238 
MILITARY MEDICINE IN EUROPE. 
This tribute of Surgeon-General Longmore to the merits of my friend 
and colleague was as unexpected as it was gratifying, and the scene was 
so impressive that it was with difficulty I could find words to return 
thanks and to express in behalf of the Medical Department a proper appre- 
ciation of the eulogy thus made. I could only promise to convey the 
message, and while this has long ago been done to the circle of his imme- 
diate personal friends, I am glad to have this opportunity to make it 
known also to the much wider circle of thdse who appreciated and 
admired him, although knowing him only through his works. 
The most marked improvements in military surgery which have 
occurred since our own war consist in the methodical use of antiseptics 
and of Esmarch’s bandage for the prevention of hemorrhage. 
Even yet there has been but little experience of the results of the 
application of antiseptic methods to the treatment of wounds upon the 
battle-field ; but these results as reported are so superior to those 
obtained by the old methods, that all military surgeons are bound to fol- 
low the new plan as far as possible. This, however, does not necessarily 
imply that all the details of what is known as Listerism, and more espe- 
cially the antiseptic spray, are essential features of the method. Professor 
Longmore pointed out that the methodical use of the spray in operations 
on the battle-field is almost impossible, while, if this can be dispensed 
with, the question becomes a comparatively simple one, since there is no 
special difficulty in supplying antiseptic dressings under such circum- 
stances. 
The evidence of the Russian and German surgeons was all in favor of 
the antiseptic treatment of wounds in war, but it also went to show how 
difficult it is to carry out the method as practised in civil hospitals. The 
water available is often muddy—there is no time to boil or filter it—the 
spray producers become choked and useless, and there are other diffi- 
culties which it is unnecessary to specify ; but it is satisfactory to learn 
that however much the completeness of applying details is interfered 
with, when applied at all it always confers benefits. Dr. Melladen’s con- 
clusion was : “ Follow it as much as possible, for any part of it, however 
small, is better than none.” 
There is a great deal of truth in the statement of Professor Esmarch, 
that a great number of the most severe gunshot wounds remain free from 
septic trouble if not touched or examined by dirty fingers or instruments. 
And if the essential principle of antiseptic treatment be kept in view, it is 
easy to see why this may be so. The antiseptic treatment is designed to 
prevent decomposition of the fluids in the wound. This decomposition in 
the immense majority of cases, if not in all, is due to the coming in con- 
tact with these fluids of extremely minute particles of organic matter, 
such as are found in all ordinary river or pond water, and in the air of all MILITARY MEDICINE IN EUROPE. 
239 
habitations, in the mouths and alimentary canal of all animals, and where- 
ever there is decomposing organic matter ; in other words, which are 
almost ubiquitous : these minute particles are, for the most part, living 
organisms, capable of rapid growth and multiplication in the presence of 
moisture, warmth and organic matter, all of which conditions are present 
in a wound. The result of their action upon a wound is to produce 
irritation, suppuration and sometimes a peculiar poison which passes into 
the blood and produces pyaemia or septicaemia, erysipelas, and other 
complications. Precisely how they do this, need not here be discussed ; 
it is sufficient to know that the power of these particles to produce 
these results is suspended or destroyed by bringing them in contact with 
certain substances known as antiseptics—that is, substances capable of 
preventing fermentation or putrefaction. The antiseptic which is most 
used in the treatment of wounds is carbolic acid, and when properly 
employed, it is capable of entirely destroying the power of these particles 
or organisms to produce decomposition of organic fluids. The object 
of the use of antiseptics in surgery then is, as far as possible, to put a 
wound in the condition which it would be in if the skin had not 
been broken, the skin being a perfect barrier against the entrance of these 
particles or germs. Where the surgeon makes the wound himself, it is 
evidently possible for him to do it with instruments wet with the anti- 
septic solution, and in a cloud of antiseptic spray, which prevents any 
germ from entering the wound before it has been, so to speak, poisoned 
by the vapor through which it must pass. The true value of the anti- 
septic spray in an operation evidently depends on the number and 
character of these particles in the surrounding air. In an old hospital 
they are numerous and virulent, in any closed room they are dangerous in 
proportion to the number of inmates, the want of ventilation and the 
quantity of filth present ; but on broad, open plains, and especially on 
mountains and high table lands, remote from human habitations, the 
danger from them is much less, so far as the air is concerned—the chief 
risk being from dirty fingers, and from clothing and water. It follows 
that on the field the least possible disturbance should be given to the 
wound, it should not be probed or explored with the finger, but simply 
covered with an antiseptic dressing, held in place with a bandage, and left 
until it can be handled with antiseptic precautions in all details. 
This is the advice of Esmarch, who would have every soldier carry 
on his person a small parcel containing the materials for a simple anti- 
septic first dressing of a wound. 
These packages, however, soon lose their antiseptic qualities if car- 
ried about the soldier’s person, and for this reason it is better that they 
should not be distributed until just before battle. 
Esmarch’s bandage for the suppression of hemorrhage consists of a 240 
MILITARY MEDICINE IN EUROPE. 
simple stout elastic tube applied while extended two or three times around 
the wounded limb. Its use requires no special anatomical knowledge, as 
does the tourniquet, it is not interfered with by transport, and if the ends 
are properly secured, it cannot slip. Of course it should remain no 
longer than is necessary, and the wounded vessel should be ligated with 
antiseptic precautions as soon as possible. Professor Esmarch suggested 
that as india rubber gradually loses its elasticity and becomes brittle, 
suitable bands and tubing cannot be kept on hand for years, and in 
the event of a great war, at least in Germany, manufacturers could ixOt 
supply them rapidly. To meet this difficulty he suggested that the 
soldiers be supplied with rubber suspenders or braces, so made that in 
case of need they can be used as an elastic bandage. Such braces would 
not cost more than others, and would be useful not only in cases of 
hemorrhage, but to prevent absorption from poisoned wounds, such as 
snake bites, and for other purposes. The limits of this paper do not 
admit of further notice of the proceedings of the Congress, and I will 
only add that after its close a majority of the medical officers of foreign 
armies visited Aldershot Camp to see a drill of the Army Hospital Corps 
in stretcher and cacolet exercise—removal of the wounded, applications 
of first dressings, etc.—all of which was admirably done, and showed 
careful and intelligent training. 
Probably the features of the English Army Medical Department which 
would be of the most interest to the readers of this Journal, is the Army 
Medical School at Netley Hospital, near Southampton. This hospital 
consists of an immense three-story brick building, picturesquely situated 
on rolling ground, facing an arm of the sea, and to it are brought the 
invalids of the British Army from all quarters of the world. Is there a 
campaign on the Cold Coast or at the Cape—soon after, some of the in- 
evitable results in the shape of convalescents, cripples and chronics make 
their appearance by the ship-load in Southampton Water, and pass on to 
Netley on their way to furlough, discharge, or the grave. 
The great variety of cases thus presented led to the selection of this 
hospital as a Medical School, at which those graduates in medicine who 
have passed the Army Examining Board, remain a year for special train- 
ing in military hygiene, medicine and surgery. I shall have occasion to 
speak presently of other Military Medical Schools in Europe, but with 
none of them are our medical officers so familiar as with Netley. The 
names of its professors are household words in our Post Hospitals, in 
every one of which will be found the works of Parkes, Longmore, and 
Aitken, while Maclean and De Chammant are almost equally well known 
to all of us. 
The school does not receive the attention and support which it merits. 
It ought to have as complete a set of laboratories, including all forms of MILITARY MEDICINE IN EUROPE. 
241 
apparatus, chemical, physiological, pathological and sanitary, as could be 
provided—and a library to match—but the funds allowed it are ridicu- 
lously insufficient, and its library, museum, and much of its apparatus are 
in the main contributed by the officers themselves, and speaks well for 
their interest in the school and in their work. 
Nevertheless, Netley has done, and is doing, thoroughly good work, 
and it is to be hoped that the time is not far off when its needs will be 
better appreciated by those in power than they now seem to be. Until 
quite recently the young medical officers of the British Navy also received 
their training here, but they are now sent to a school of their own in con- 
nection with the great Haslm Hospital, at Portsmouth, a change of which 
the expediency seems extremely doubtful. 
Of all European cities, the one in which the military element is most 
prominent is undoubtedly Berlin. Officers and soldiers—but especially 
officers—are met with everywhere, and in every possible variety of uni- 
form, and regiments daily traverse the streets on their way between the 
scattered barracks, and the great drill and parade-ground of the Tempel- 
hof. Just beyond the parade-ground is the best permanent military 
hospital in the world, the second Garrison Hospital of Berlin, completed 
about three years ago. This hospital contains 500 beds, and is con- 
nected with all the barracks of the city by means of a branch of the 
general system of street railroads, or tramways, as they are called abroad. 
The hospital has an ambulance car, neatly fitted up, and by its means 
patients can be brought from barracks several miles away, and quite on 
the other side of the city, with the least possible jarring or trouble of any 
kind. The buildings are of brick, and the wards are on the pavilion plan 
—one group being connected with each other and with the kitchen, by 
means of a corridor, while a second group consists of buildings which are 
entirely isolated. 
The details of drainage, heating and ventilation, etc., have been most 
carefully worked out regardless of expense, and the results obtained are 
excellent. One of the buildings of this hospital is a large fire-proof 
storehouse, containing a complete outfit for a large field hospital, all 
ready for immediate use. It will be understood that this hospital of the 
Tempelhof is what we would call a depot hospital, and is unique in its 
way. The great majority of the military hospitals pertain to regiments, 
and each regiment has also its own hospital outfit for field work. 
On the opposite side of the city is a hospital belonging to the city, and 
known as the Moabit Barrack Hospital. This was built in the spring of 
1872, and is of the cheapest possible construction, the general plan of the 
buildings being that of our temporary hospitals during the late war. It 
consists of 15 isolated barrack buildings, each containing from 30 to 40 
beds, and is now the only large municipal hospital upon this plan. It 242 
MILITARY MEDICINE IN EUROPE. 
forms the strongest possible contrast to the two other great city hospitals, 
namely, the Charite, which is very old, and badly planned, and the Fried- 
richsheim, which is a model of a permanent hospital, having been built 
under the supervision of the same architects who planned the Tempelhof 
Hospital, and upon the same general plan. 
Near the Charite is an institution of great interest to army surgeons, 
—namely, the Friedrich Wilhelm’s Institute, better known during the 
first half of this century as the “ Pepiniere,” which may be roughly trans- 
lated as the “ digesting establishment.” It is not, however, material, but 
mental food which is to be digested there. This institution owed its 
origin to the very great difficulty which all governments in Northern 
and Western Europe experienced about a century ago, in their attempt 
to secure an adequate supply of skilled medical attendance for their 
armies. This difficulty became so pressing, that in Austria, Saxony, 
Prussia, and France, it was decided to establish schools whose main pur- 
pose was to educate medical officers. The first step in this direction 
was taken in Prussia, by the formation of a Medico Chirurgical College at 
Berlin, which still exists under the title of the Friedrich Wilhelm’s Insti- 
tute. This was connected with the Charite Hospital, and the junior 
army surgeons were sent there for instruction. The supply, however, 
remained insufficient. 
Frederic, in his Silesian Campaigns, was in great need of surgeons, 
and was obliged to bring a number from France. He also sent some of 
the younger Prussian medical officers to Paris and Strasbourg to com- 
plete their education, and to fit themselves to instruct others. In those 
days surgery was considered to be distinct from, and subordinate to, 
medicine, and those destined for surgery were usually apprenticed to 
barbers, and were men of an inferior class, having little or no education. 
Finally, in 1795, as the result of urgent appeals from Gorcke, the Sur- 
geon-General of the Prussian Army, setting forth the absolute necessity of 
providing better medical attendance for the troops, the Pepiniere was re- 
organized under its present name, and made to include both medicine 
and surgery in its curriculum. 
The Medicinish Chirurgisch Joseph’s Academie at Vienna was founded 
by the Emperor Joseph II., in 1786, and placed under the direction of 
Surgeon Brambilla, of the Austrian Army, the object being the same as 
that of the Berlin institution. In 1820 the scope of the teaching of this 
Academy was enlarged to that of a medical faculty of a university, and 
it was given power to confer degrees. At the same time it was made a 
sort of a medical advisory council for the army. There were two courses 
of study. The higher included all branches of medicine, and occupied 
about six years; the lower was less comprehensive, and lasted only three 
years; those who took the highest course, entered the army as full sur- MILITARY MEDICINE IN EUROPE. 
243 
geons, with a prospect of promotion to higher grades, while those who 
graduated from the lower course could not rise above the rank of assist- 
ant surgeon. 
In Dresden a Medico-Chirurgical College was established in 1748, 
having the double purpose of educating practitioners of a lower grade for 
the rural districts, and of training army medical officers. In 1814 this 
was changed into a Military Medico-Chirurgical Academy, with a full 
course of instruction. 
In France the Revolution destroyed all medical schools. The evil 
results of this were brought to the attention of the National Convention 
by the fact that properly qualified medical officers could not be found to 
replace those who died in the service of the armies of the Republic. By 
direction of the Convention, the celebrated chemist Fourcroy prepared a 
plan for organizing medical schools to meet this want, and this plan was 
carried out by the law of 1794, which established schools at Paris, Mont- 
pellier, and Strasburg. The method adopted to secure students for 
these schools was peculiar and effectual. From each district in France a 
young man between 17 and 26 years of age, whose name had not been 
drawn in the first conscription, was selected by the Government authori- 
ties, and was forwarded at the expense of the State to one of the three 
schools referred to, 300 being allotted to Paris, 150 to Montpellier, and 
100 to Strasburg. Three years were allowed for their instruction, and 
as soon as they were qualified, they were given the title of Officiers de 
Sante and sent to join the troops. These were really, then, military medi- 
cal schools; they did not confer the Doctorate, and had for their object 
the manufacture of medical officers as soon as possible. This brief his- 
torical sketch may aid in understanding the condition of some European 
army medical departments of the present day. 
At present there are five military medical schools in Europe, viz : the 
school connected with the Netley Hospital, already described ; a military 
medical school at Dresden, which is a recent creation due to the energy 
of the present Surgeon-General of the Saxon Army, Dr. Roth ; a French 
school in connection with the Hospital of Val de Grace ; the German 
school of the Friedrich Wilhelm’s Institute ; and the Medico-Chirurgical 
Academy at St. Petersburg. The Dresden school is modelled somewhat 
upon that of Netley, but its work does not consist so much in supple- 
menting the teachings of the ordinary medical schools as in giving instruc- 
tion in special branches to the younger medical officers of the army, who 
are sent there in turn, and also in teaching them how to teach. The Mil- 
itary Medical School of France, located at the Hospital Val de Grace, 
furnishes special training to about three-fourths of the medical officers 
entering the army, the other fourth being selected by competitive ex- 
amination. The organization of this school preceded that of Netley, and 244 
MILITARY MEDICINE IN EUROPE. 
is in many respects analogous to the special school for engineers at Metz, 
and the General Staff School in Paris. The work of the Friedrich Wil- 
helm’s Institution at Berlin is in the main auxiliary to that of the medi- 
cal department of the University of Berlin. It has one of the best 
medical libraries in Europe, and has undoubtedly exercised a strong influ- 
ence for good upon the medical department of the Prussian Army. 
The only one of all these military medical schools which is not 
dependent upon other medical schools for its material, but gives a com- 
plete course of instruction from the beginning, is the Medico-Chirurgical 
Academy at St. Petersburg. This academy has a large hospital, fine 
laboratories, a splendid museum, and the largest distinct medical library 
in Europe. The course of instruction is well arranged, being essentially 
that of the German universities, and it is evident that good scientific, as 
well as educational work, is being accomplished. The only other medical 
educational institution in St. Petersburg is for the education of women, 
the most important resources of the city being destined for army sur- 
geons, and every graduate of this school must serve in the army for a 
certain length of time. At other universities in Russia, at Moscow, 
Dorpat, etc., this rule does not prevail, the graduates of the medical 
school being in the same position as in other countries in Europe ; but at 
St. Petersburg it seems to be the purpose of the Government to throw the 
weight of its influence in favor of the education of women for civil prac- 
titioners, reserving the men for military service. A large and valuable 
medical journal in the Russian language is published by the Medical 
Department, through which the members of the corps are kept well 
informed as to the most recent discoveries and improvements in other 
countries. 
Allusion has been made to the large and valuable medical libraries of 
the Friedrich Wilhelm’s Institute of Berlin, and of the Medico-Chirurgical 
Academy of St. Petersburg. These were especially interesting to me, as 
being among the five or six largest and best arranged medical libraries 
in Europe, and as being, like our own libraries of the same kind, under the 
direction of Army Medical Departments. The Russian includes a large 
number of works on natural history as well as medicine, and is a matter 
of just pride to those having it in charge. 
The hospitals of St. Petersburg are large and numerous, and they need 
to be to accommodate the great number of sick poor who must be con- 
stantly present in the city. The majority of them are large three-storied 
structures of the old pattern, and are overcrowded and badly ventilated. 
It is in some of these old hospitals that the benefits of the antiseptic 
treatment of wounds, heretofore referred to, are most strikingly apparent. 
Before the introduction of this method almost every operation was fol- 
lowed by(erysipelas or septicsemic troubles of some kind ; even the ampu- MILITARY MEDICINE IN EUROPE. 
245 
tation of a finger was a dangerous matter, and the graver operations were 
so fatal that the surgeons in these hospitals were very reluctant to under- 
take them. Now such sequelae of wounds are rare, and although the 
effects of overcrowding and impure air are seen in the lowered vitality 
and delayed convalescence of the patients, yet the results obtained are 
on the whole very good. There are, however, some excellent hospitals 
in St. Petersburg, and one of the most interesting of these is the 
Roschderstnensky City Hospital, which contains the first barrack pavil- 
lion wards erected in Russia. Two of these were opened in 1871, and ' 
the results obtained in them were so satisfactory that several others have 
been added. It was considered very doubtful as to whether a simple 
one-story wooden barrack hospital, having windows on the opposite 
sides, could be so constructed as to secure comfort to its inmates during 
the intense cold of the Russian winter, but experience has shown that 
there is no difficulty in doing this. One of these barrack pavilions 
measures about 95 by 32 feet, the height of the ward being 15 feet, and 
contains beds for 21 patients. The walls are hollow, and have a double 
air space, the whole being about 40 inches in thickness. The building 
has seven double-sashed windows on each side. The ceiling of the ward 
is arranged like that of a Pullman car, giving free ridge ventilation in 
summer. The heating is effected by a large German porcelain stove, 
about 14 feet long, 5 feet wide, and a little over 6 feet high, standing 
in the centre of the ward. Although I have spoken of this as a stove, it 
is in reality the top of a furnace, which is placed in the basement below, 
and in which all the fuel is introduced. Through this stove pass eight 
apertures, which are connected with the external air, and through which 
the fresh air supply of the ward is introduced. Originally this air was 
taken directly from the basement, but this was found to be unsatisfactory, 
and it is now brought from the exterior. The foul air is removed by 
tubes, which open at the floor near the side walls between the beds, and 
then passing downwards, converge to the furnace below, which they 
enter, a prolongation of the smoke flue. 
Besides the central stove, there are other similar ones connected with 
the service-rooms of the ward, one being devoted exclusively to the 
closets. The total amount of fresh air supplied is about 3,200 cubic feet 
per hour per patient. When the temperature is about the freezing-point, 
and not lower than 240 Fahrenheit, the large central stove is heated up 
but once, viz., in the morning. When the temperature falls to 50 
Fahrenheit it is heated twice, and when it falls below zero four firings 
become necessary daily. 
These results will not be considered surprising by those officers of 
our army who have served in the Northwestern Territories, but they 
were something quite new in Russian experience, and in consideration 246 
MILITARY MEDICINE IN EUROPE. 
of the large amount of air supply which is furnished, giving complete 
ventilation even in the coldest weather, I do not know that the results 
have been surpassed anywhere. 
Of course a large amount of fuel is required for heating such an immense 
quantity of air, from zero to 62° Fahrenheit, which is about the tempera- 
ture maintained. The best hospitals in St. Petersburg are devoted to the 
care of women and children, and one or two of these are not surpassed 
anywhere in the perfection of their arrangements for preventing the 
spread of contagious disease within the hospital. 
Although my visit to St. Petersburg was at the end of August, 
when every one who can manage to do so has left the city, when all 
schools are closed, and neither scientific work nor entertainment of any 
kind is going on, I found it nevertheless a most interesting and 
instructive place, which was largely due to the fact that I saw it under 
the guidance of a medical officer of the Russian Army, Dr. Weljaminoff, 
whose knowledge of what ought to be seen there by an army surgeon was 
only excelled by the courtesy with which he made this knowledge 
available for my benefit. St. Petersburg is a very unhealthy city, owing 
in part to its low situation in the swamps of the Neva, rendering it so 
difficult to supply it with proper drainage and sewerage that the problem 
has not yet been solved, and in part to the habits of the lower classes of 
the population, they being huddled together in huge tenement houses, 
where they are poisoned by their own filth. 
At the time of my visit spotted fever, relapsing fever and diphtheria 
were prevailing in the city, and I found in my room at the hotel a signifi- 
cant notice, printed in French, German and Russian, warning strangers 
not to drink of the ordinary water supply, which comes from the Neva. 
My visit to Vienna was so timed as to enable me to be present at the 
meeting of the German Public Health Association. A feature of this 
meeting was the number of army medical officers present, including the 
Surgeon-Generals of the Austrian and the Saxon armies, the latter being 
practically an army corps of the German Army. The prevention of 
disease is being more and more a subject of special interest and study 
among the medical men of European armies, more so, probably, than 
among physicians in civil life, and it is easy to see why this should be so. 
It is distinctly to the interest of the army surgeon that the men under his 
charge should be kept in good health as far as possible, and his attention 
is daily called to the subject by the sick report. This is true even in 
our little garrisons containing from 50 to 100 men, while in Europe, 
where in a barrack or garrison there is never less than a regiment, the 
effects of preventable causes of disease become so magnified as to render 
them promptly apparent. 
The importance of preserving the health of the soldier simply as a MILITARY MEDICINE IN EUROPE. 
247 
matter of economy is also more urgently felt in Europe than with us. 
Modern military hygiene may be said to date from the close of the 
Crimean War, the most important steps being the publication of the re- 
ports of the English Barrack and Hospital Commission, the issue of 
“ Parkes’ Military Hygiene,” and the publication of our own experience 
during the late war. 
The Royal Commission appointed in 1857 to investigate and report 
upon the sanitary condition of the British Army, besides examining bar- 
racks and hospitals, and making recommendations with regard to them, 
considered also the duties of the army medical officer, and in the new 
system of regulations prepared under the direction of this Commission, 
the army surgeon was made a sanitary official as well as a medical atten- 
dant. The systematic teaching of medical hygiene at Netley by Dr. 
Parkes, soon acquired such reputation that medical officers from European 
armies would visit the school for the purpose of taking advantage of this 
instruction, and the issue of his work on military hygiene exerted a 
strong influence in the minds of medical officers of all armies. The pos- 
sibilities as to what might be done by very simple means, for securing 
fresh air for the sick and wounded of large armies, and the results of so 
doing were strongly manifested in the results of our own war, more 
especially as regards the results obtained in the simple, cheap one-story 
barracks or the tent hospitals which were so largely used. This same 
organization was found of equal advantage by the Germans, in the 
Franco-German War. 
Military hygiene is, however, not only of importance to armies, but it 
is of the greatest interest and value to the community at large. The 
reason for this is that in the army, the facilities for observing the effects 
of changes in the environments upon the health of man, are far greater 
than in civic life. The test of the effect of a certain set of conditions 
upon the health of those subjected to them is the amount of sickness pro- 
duced. This can be ascertained in a garrison, but not as a rule in a 
town or city in which the best that can be done is to learn the number of 
deaths. 
I find, however, that I am not only exceeding the space which is 
allowed to this paper, but am getting rapidly near the point where a 
moral would come in, and this moral it was promised should not be 
inflicted. Clearly, therefore, it is time to stop.