through Vienna, take away Venice and all of Italy which remained in Austrian hands, and chase the Bourbons from Italy. Having pacified the continent, he would return to the ocean and work anew at a maritime peace.

As the fleet never came, Napoleon was compelled to give up his plans of the invasion of England and to turn his attention to other matters. He left Boulogne for the last time on September second, 1805, and was soon followed by all troops except three regiments and a few other men who stayed to protect the boats and stores which were abandoned. As a final note to the history of the expedition, it is interesting that Fulton came to Boulogne in 1805 and attempted to convince Napoleon that the army should be sent across the channel by steamboat. Inasmuch as the "Clermont" moved upstream on the Hudson River two years later, it is probable that the necessary machinery was nearly perfect when offered to the French, and that the idea was not so ridiculous as it first seemed.

As might be expected with such a large military project on hand and with such genius for detail as Napoleon always showed, his plan of medical administration for the Boulogne camp was remarkably complete and had been logically evolved.

MILITARY SURGEONS IN THE 16th Century

Up to the end of the sixteenth century military surgeons were unheard of in France, possibly owing to the lack of organized armies. The different seigneurs paid private surgeons to accompany them on campaigns. These surgeons treated such men as needed care more or less at haphazard, and when the campaign was over returned to their villages to resume civil practice. Many of the wounded who had been abandoned on the wayside were treated by charlatans following the army, and were eventually left to the mercy of friendly peasants or monasteries.

Ambroise Paré (1509-1590) is properly considered the first military surgeon in France. King Henry IV (1589-1610) was instrumental in developing surgeons as an integral part of the army, and his adviser Sully (1560-1641) was the first to organize hospitals for the wounded. He introduced the "ambulance," which was a mobile hospital where early treatment could be given; stationary hospitals were placed well back of the lines for later treatment. Richelieu (1585-1642) created regimental surgeons, and after 1731, when the Académie royale de Chirurgie was founded, all French surgeons of repute went through a certain amount of military training.

EARLY MILITARY AMBULANCES

The French Army Medical Corps, or "Service de Santé," was developed further during the reign of Louis XV (1715-1774). Army medical schools were established at which army officers were taught. There were seventy military hospitals to which "ambulances" were attached and to which were allied charity civilian hospitals. In times of war a mobile hospital received the wounded and evacuated them as quickly as their condition allowed to a stationary military hospital somewhere near the front. These hospitals in turn evacuated their cases to the nearest charity civilian hospital in the interior.

The ambulance wagons used for the mobile hospitals were heavy vehicles which carried an immense amount of equipment. Each one was drawn by forty horses and had a personnel of 134 men. Of these, 41 were surgeons, and 31 were supposedly trained nurses. Each mobile hospital was detailed to look after 20,000 men. The great objection was that it was unwieldy in bad roads and that it had to stay at least three miles behind the fighting. The wounded remained on the field until the day's battle was over when they were collected in a group. The ambulance approached at its

convenience, which was often twenty-four hours later. Many of the wounded died through lack of immediate care and were abandoned in case of a retreat.

Napoleon had two remarkable surgeons in his command who made notable progress in the systematization of military surgery. Larrey (1762-1842) realized the necessity of helping the wounded on the field of battle and of removing them under fire. He formed the legion of mobile ambulances (Légion de l'ambulance volante). Each legion consisted of three units under the command of a major with two aids, twelve junior surgeons, and an administrative and working force of 340 men. Each unit operated twelve light ambulances and four heavier ones. The light carriages were drawn by two horses and carried two stretcher cases. The heavier ones were drawn by four horses and held four stretcher cases. The wagons were well ventilated and were so constructed that a wounded man could be put inside on a stretcher in horizontal position. Bandages and instruments were part of the equipment. An officer or nurse could drive anywhere for the wounded, dress them on the field when necessary, place them in the ambulance, and gallop off at top speed to a mobile hospital outside the battle zone. Percy (1754-1825) modified Larrey's system by sending out trained stretcher-bearers to render first aid to the wounded and to collect and carry them back.

NAPOLEON'S MEDICAL ORGANIZATION

Thus when the camp at Boulogne was established, Napoleon's medical organization was somewhat as follows: Trained stretcher-bearers collected the wounded on the battlefield, applying dressings on the spot if necessary, and carried the patients to rapidly moving ambulance wagons. These, in time, took the men to the advanced mobile hospital, where further care was given. Finally, the wounded were sent

back to permanent stationary hospitals outside the battle area for treatment until they recovered.

The most modern touch to this system was added in Boulogne by Napoleon himself. In 1803 he wrote a letter to the commanding general of the Saint Omer Camp, recommending that all the sick should be retained in hospitals in the town. He felt that there was nothing worse for sick soldiers than travel. Furthermore, men once sent away from their own units were lost as effective soldiers for long periods of time.

In order to prevent overfilling the hospitals in the area, he ordered the establishment of a convalescent camp big enough to contain a thousand men. All patients on discharge from the hospital were to be sent to this camp for one or several weeks, after which time they were to be returned to their own units for duty. The men in the convalescent camp were to be properly fed and exercised, were to be given a daily ration of wine and the necessary medicines. The medical care of the men was to be undertaken by regimental medical officers or doctors from the hospitals. The military side of the camp was to be in charge of a senior officer with a sufficient number of junior captains and lieutenants.

HOSPITAL TREATMENT AT BOULOGNE

IN 1805

On the whole, the organization of the French camp at Boulogne in 1803-1805 was remarkably comparable to that of the British camp there in 1914-1918. Both armies turned the city into a military centre and took for army purposes various civilian buildings making them into storehouses, offices, and hospitals. Both armies had numbers of men under canvas on the plateaux at the mouth of the Liane and at Wimereux and Étaples. In 1805 the wound

ed were collected and dressed on the battlefield, were taken quickly to advanced mobile hospitals, and were later evacuated

to permanent hospitals outside of the battle area. Suitable cases were sent to a convalescent camp in order to be returned to their proper units for duty and so that a man with a minor wound or ailment should not be lost for military purposes. In 1918, the wounded were treated in much the same fashion.

Whether or not Napoleon's proposed invasion of England was feasible as a military project is a debatable question. The history of the Boulogne camp is worth remembering in any event, for it was associated with American development and

helps to illustrate the close fashion in which American, British, and French interests have combined or conflicted during the last two centuries.

REFERENCES

"Histoire du Premier Empire." Hamel. "Histoire du Consulat et de l'Empire." Thiers. "Correspondance du Napoleon Ier."

"Les Militaires Blessés et Invalides." De Riencourt.

"Dominique Larrey et les Campagnes de la Révolution et de l'Empire." Duruy.

"Napoleon: A Short Biography." Johnston. "History of the United States." Hawthorne. "A Student's History of the United States." Channing.

THE eruption of the Small-pox is preceded by a continuous fever, pain in the back. itching in the nose, and terrors in sleep, These are the more peculiar symptoms of its approach, especially a pain in the back, with fever; then also a prickling which the patient feels all over his body; a fullness of face, which at times goes and comes; an inflamed colour, and vehement redness in both the cheeks; a redness of both the eyes; a heaviness of the whole body; a great uneasiness, the symptoms of which are stretching and yawning; a pain in the throat and chest, with a slight difficulty in breathing, and cough; a dryness of the mouth, thick spittle, and hoarseness of the voice; pain and heaviness in the head; inquietude, distress of mind, nausea and anxiety (with this difference, that the inquietude, nausea and anxiety are more frequent in the measles than in the smallpox; while, on the other hand, the pain in the back is more peculiar to the small-pox than to measles); heat of the whole body, an inflamed colour and shining redness, and

especially an intense redness of the gums.

There is a bad and fatal sort of the white and large pustules, viz., those which become confluent and spread, so that many of them unite and occupy large spaces of the body or become like broad circles, and in colour resemble fat. As to those white pustules which are very small, close to each other, hard, warty, and containing no fluid, they are of a bad kind, and their badness is in proportion to the degree of difficulty in ripening. And if the patient be not relieved upon their eruption, but his condition continues unfavorable after it is finished, it is a mortal sign. And as to those which are of a greenish, or violet or black colour, they are all of a bad and fatal kind; and when, besides, a swooning and palpitation of the heart comes on, they are worse and still more fatal. And when the fever increases after the appearance of the pustules, it is a bad sign; but if it is lessened on their appearance, that is a good sign.

RHAZES. "De variolis et morbillis.”

(Greenhill's translation).

W

HATEVER may be said of Sir William Osler in days to come, of his high position in medicine, of his gifts and versatility, to his contemporaries, love of his fellow-man, utter unselfishness, and an extraordinary capacity for friendship will always remain the characteristics which overshadow all else. Few so eminent and so industrious come in return to be so widely beloved for their own sake. Most of us do well with what Stevenson advises-a few friends and those without capitulation -but Osler had the God-given quality not only of being a friend with all, high or low, child or grown-up, professor or pupil, don or scholar, but what is more, of holding such friendships with an unforgetting tenacity— a scribbled line of remembrance with a playful twist to it, a note of congratulation to some delighted youngster on his first publication, the gift of an unexpected book, an unsolicited donation for some worthy cause (and giving promptly he gave doubly), a telegram to bring cheer or consolation, an article to help a struggling journal to get a footing, a cable such as his last on the day of his operation to his old Hopkins friends, which was given by them to the press for the benefit of countless others who shared their own anxiety-all this was characteristic of the man, whose first thoughts were invariably for others.

He gave much of himself to all, and everyone fortunate enough to have been brought in contact with him shared from the beginning in the universal feeling of devotion all had for him. This was true of his patients, as might be expected, and he was sought far and wide not only because of his wide knowledge of medicine and great wisdom, but because of his generosity, sympathy and great personal charm. It was

true also-and this is more rare-of the members of his profession, for whom, high or low, he showed a spirit of brotherly helpfulness untinctured by those petty jealousies which sometimes mar these relationships. "Never believe what a patient may tell you to the detriment of another physician" was one of his sayings to students, and then he would add with a characteristic twist"even though you may fear it is true"; and he was preeminently the physician to physicians and their families, and would go out of his way unsolicited and unsparingly to help them when he learned that they were ill or in distress of any kind. And no one could administer encouragement, the essential factor in the art of psychotherapy in which he was past master, or could "soothe the heartache of any pessimistic brother," so effectively and with so little expenditure of time as could he.

During one of his flying trips to America some years ago, as always with engagements innumerable, he took time to go from Baltimore to Boston for the single purpose of seeing a surgical friend with literary tastes who for some months had been bed-fast with a decompensated heart; and James Mumford, for it was he, always said that this unannounced visit was what put him on his feet again. I knew of his doing the same thing for an Edinburgh physician of whose illness he heard by chance just as he was leaving the steamer, in Liverpool. He was due for an address before the British Medical Association in Oxford, but without hesitation he took the first train to the north and managed to get back to Oxford just in time for the address, blithe and gay as though he had not spent two nights on a train. Indeed he was invariably punctual and somewhat intolerant of tardiness in others. "Punctuality is the prime essential

of a physician-if invariably on time he will succeed even in the face of professional mediocrity."

The universal devotion he engendered was no less true of those with whom he came in contact outside his profession, and his points of contact through his varied interests were innumerable. Man, woman or child-and in children especially he delighted as they did in him-felt from the first moment of meeting a rare fascination in his personality. In a poem, "Books and the Man," dedicated to Osler and read before the Charaka Club, March 4, 1905, Weir Mitchell recalls in these three verses their first meeting in London twenty years before.

Do you perchance recall when first we metAnd gaily winged with thought the flying night And won with ease the friendship of the mind,I like to call it friendship at first sight.

And then you found with us a second home,
And, in the practice of life's happiest art
You little guessed how readily you won
The added friendship of the open heart.

And now a score of years has fled away
In noble service of life's highest ends,
And my glad capture of a London night
Disputes with me a continent of friends.

On Osler's seventieth birthday, just passed, the medical world set out to do him honor-unknown to him, for he was one to elude public testimonials and did not suffer adulation gladly, quick as he was to give praise to others. For this occasion many of his former pupils and colleagues in Baltimore wrote a number of papers containing the sort of things rarely said or written about a man or his work until after his death. Among these papers is one by his present successor there, on "Osler the Teacher" which deserves quoting in full, but which after an enunciation of his traits. ends with this picture of the man as his hospital associates and students remember him.

If you can practice consistently all this, . . and then, if you can bring into corridor and ward a light, springing step, a kindly glance, a bright word to everyone you meet, arm passed within arm or thrown over the shoulder of the happy student or colleague; a quick, droll, epigrammatic question, observation or appellation that puts the patient at his ease or brings a pleased blush to the face of the nurse; an apprehension that grasps in a minute the kernel of the situation, and a memory teeming with instances and examples that throw light on the question; an unusual power of succinct statement and picturesque expression, exercised quietly, modestly and wholly without sensation; if you can bring into the lecture-room an air of perfect simplicity and directness, and, behind it all, have an ever-ready store of the mostapt and sometimes surprising interjections that so light up and emphasize that which you are setting forth that no one in the room can forget it; if you can enter the sick-room with a song and an epigram, an air of gaiety, an atmosphere that lifts the invalid instantly out of his ills, that produces in the waiting hypochondriac so pleasing a confusion of thought that the written list of questions and complaints, carefully complied and treasured for the moment of the visit, is almost invariably forgotten; if the joy of your visit can make half a ward forget the symptoms that it fancied were important, until you are gone; if you can truly love your fellow and, having said evil of no man, be loved by all; if you can select a wife with a heart as big as your own, whose generous welcome makes your tea-table a Mecca; . . . if you can do all this, you may begin to be to others the teacher that "the chief" is to us.

Little wonder that he was idolized by the students. This was natural enough, but he in turn took pains to know them by name, gave up an evening in each week to successive groups of them at his home, learned them as individuals and never forgot them. And it was the same with his hospital juniors, whether they happened to be members of his own staff or not. Preserved among some papers I find this characteristic undated note of circa 1898, concerning an early effort which had been submitted to him. It is scribbled in pencil on a bit of paper.

A. A. 1. report! I have added a brief note about the diagnoses. I would mention in the medical re