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however urgently it may be needed. Furthermore, the presence of a mattress, which cannot well
be changed for each patient, causes the carriage to appear less clean than it should do. The
vehicle used in Paris, on the other hand, has glass windows which, if air is wanted, can be
lowered, while the blinds afford a protection from the sun and from the gaze of too inquisitive
persons. The doctor has room to sit beside the patient, or, if necessary, move round him. There
is no mattress and no sheet but only a blanket, which can be used or not. The patient lies on a
stretcher, of which the following is a description—
The stretcher question is a difficult one. Stretchers, as usually constructed, f.re either in
wood and canvas or entirely in wood, and covered by a mattress. In either case the stretcher is
necessarily very large and therefore requires a very large carriage to contain it. Besides, the
canvas becomes brittle, and, like the mattress, is always more or less dirty. Sometimes one or
more stretchers in wood and canvas are suspended from the roof of the carriage. This solution
of the difficulty may be necessary in the case of military ambulances, but it is only a pis-aller, as
it is next to impossible to suspend the patient, who is first placed on the stretcher, without
subjecting him to painful and even dangerous jolts. Moreover, there is still the drawback of
the blood-stained canvas. Our stretcher is made of wickerwork, is constructed in one single
piece, and follows the shape of the human body. The arms and legs rest in hollows, and the
patient, having each part of his body supported, is in a comfortable position, while the apparatus
occupies a minimum amount of space. At the head there is a leathern pad forming a pillow.
It will easily be understood that a stretcher of this shape, built of such a light material and
provided with rollers, can, if care is taken, be put into the carriage almost without any jolting.
The small volume of the stretcher also enables it to pass up narrow staircases and be carried,
either at the hospital or the patient's dwelling, to the very bedside. This is not the case with
wooden stretchers. Another good feature about the wicker stretcher is that it can easily be
cleanued with a sponge.
The necessity of placing the stretcher on the carriage-floor made it essential that the body of
the vehicle should be well-hung. We have succeeded so well in this respect that in the Paris
ambulances it is not at all difficult to write whilst the carriage is going at a fast speed along the
paved streets.
The carriage lamps give light to the inside as well as externally. The ambulance is
provided with splints and everything else that is necessary for a first dressing, as well as with a
medicine chest. The driver can be communicated with from the interior by means of a speakingtube.
A bell, worked by the driver's foot, serves as a warning to clear the road, while a Red
Cross flag floating above the carriage acts as an ocular sign that an ambulance is approaching.
Everybody will agree that, when an accident occurs, it is of prime importance to inform the
ambulance station immediately. It is desirable that I explain how I came to organise this part
of the Paris system, and how, in this as in many other respects, the Paris ambulances are
superior to those of New York. At the latter city the fire-alarm system is also used for notifying
accidents. This has the evident advantage of using one apparatus for two distinct purposes.
There is, however, the drawback that, with an electric fire-alarm, the point at which help is
needed can only be indicated approximately. In the case of a fire this is not of great importance,
because the presence of a crowd, or the presence near the alarm-box of the person who gave
the alarm, is sufficient to direct the firemen to the exact spot. In the case of an accident it is
not the same thing, and in New York the ambulance people have often been in doubt.
It was the habits of the Parisians in cases of accident which led me to a better method.
In Paris, as said above, when an accident occurs the first step is to take the injured
person to the nearest chemist's shop. This was my starting point. I went to all the chemists
within the area which we proposed to serve by means of the Saint-Louis station, and
ascertained from each of them the number of injured persons brought to his shop per week. Out
of about 200 chemists I selected 30, being those who had had the greatest number of accident
cases brought to them, and in each of these 30 shops a telephone was placed, connecting it directly
with the Saint-Louis Hospital. It is impossible to conceive of a more rapid call system. The alarm
apparatus is placed exactly where it is most likely that the injured person will be brought; the
call, " Come to No. , Rue is conveyed electrically, and in an instant the carriage,
equipped with everything needful for affording succour, starts for the place where the injured
person is lying.
Of course, in those neighbourhoods where there is no chemist's shop the call-apparatus can
be placed in the police station, as has been done in Paris.
As to the medical attendants who accompany the ambulances, they are selected from those
students who are in their last year, and they have to pass a special examination as to their fitness
for this duty. It is highly important that the victims of accidents should receive the earliest
possible attention, and this from qualified medical men. The persons life often depends upon the
promptitude with which efficient aid is rendered. In some cases a few moments' delay proves
fatal. The medical profession know well that injured parts which have been in contact with
septic substances, such as earth, coal, dust, &c., need to be disinfected immediately, and it is only
to an ambulance system organised on the lines described that wo can look for rendering this aid
rapidly. A hemorrhage can quickly become dangerous; an ambulance-carriage provided with
the proper appliances may reach the spot in the nick of time to save the person's life. A broken
limb cannot be handled by the first-comer; it is a competent medical student, attached to the
ambulance, who should place the temporary splints and see to it that the patient is not caused
intense pain by being carelessly handled. In a case of poisoning, the use of the stomach-pump
immediately after the absorption of the toxical substance may snatch the patient from certain
death or at least save him from grave injury. We know that many accidents of all kinds occur
daily, such as falls, burns of all degrees of severity, syncopes, cerebral and other forms of
congestion, collapse through hunger, murders, suicides, confinements in public places, sudden
indispositions, injuries caused by vehicles, explosions, fires and by machinery, &c., &c., and they can
only be properly dealt with by means of a system of horse ambulances organised on the lines of
the Paris "Ambulances Urbaines." Vienna, Berlin, St. Petersburg, Moscow, Warsaw, as well
as many provincial towns in France, have followed the lead set by the French capital, and
London, where such a system is perhaps more imperatively needed, is the only great European
city lacking it.