and of the intendant, who is charged with financial control, may be summarized as follows:

Medical Director: His authority extends to all parts of the service. He exercises with regard to the personnel and the sick in his charge, the powers of a chief of corps. He rules on all questions relative to administration and to the good functioning of each service. He authorizes purchases, repairs, and the discarding of material; he authorizes, if he thinks proper, inventories. He gives his approval to the different steps involved in legal processes.

Administrative Officer: He is charged, under the authority of the medical director, with the administrative service, with the police, and with discipline. He exercises with regard to the personnel and to the sick in his charge, the powers of a commander of a company of infantry. He is responsible for the funds, for material and supplies, and, in his turn, is responsible to the Court of Accounts.

Intendant: The financial control of the administration of a hospital is exercised by an officer of the intendance. The intendant's control is limited to the facts of administration. He is not concerned with the expediency of facts, or of their causes, but only with regard to their regularity—the authenticity of documents, the verification of receipts and expenditures of money, the inventory of stores and materials.

All the requirements relative to the activities of the personnel, to the organization and to the functioning of the different services of a hospital are contained in the "Regulations", applying to the service of military hospitals, approved by Royal Decree.

COMMUNICATIONS

FIRST QUESTION: PRINCIPLES OF ORGANIZATION AND FUNCTIONING OF MEDICAL SERVICES IN

MOUNTAIN WARFARE

Marinesco (Rumania)

Colonel Nicholas Marinesco of the Army Medical Service of Rumania offered addenda to his address dealing with the selection and sorting of the wounded who could be returned to the fighting forces. He advocated an increase in the means of evacuating the wounded, of stretchers and stretcher-bearers, in order to overcome the difficulties of terrain. He also advocated establishing relay points behind each company to maintain a link between the fighting line and the battalion post, and between the battalion post and the division ambulances. Reisner (Austria)

Oberstabsarzt 1. Kl. Reisner of Austria stated that during mountain warfare the nature of the terrain and the condition of the roads require the division of the troops into different columns which frequently become separate units. That is why, in mountain warfare, the troops should have an independent medical service and be abundantly provided with personnel and all necessary supplies. The number of persons attached to each unit of the medical service ought to be double that provided for warfare in the open country.

Dr. Reisner emphasized the necessity of utilizing to the utmost natives of the mountains as guides and porters. He advocated the adequate provision of two-wheeled wagons drawn by a horse, so that the wounded might be carried lying on their backs. He also advised provision of small, specially constructed automobiles and motors with sidecars.

Chile

The Chilean delegation stressed the importance of separating the wounded from those afflicted with contagious and epidemic diseases and, at the same time, of protecting the effectives from disease due to altitude, cold, the sun, wind, and snow, and to the climate in general.

The training of troops for mountain service ought to be based upon the work and extraordinary conditions to which the soldier must be subject. It requires a slow, progressive, and careful instruction, if he is to develop the capacity and efficiency necessary for his duties.

The development of chemical warfare now demands special attention from the medical service and requires a special organization.

Schickelé (France)

Speaking of the difficulty of transporting the wounded from the firing line in the mountains, General Schickelé of the French Army Medical Service emphasized the promise of the increased use and development of the teleferic car, swung on a cable, as the only modern mechanical means susceptible of facilitating the transport of the wounded. He also spoke of the possible use of the autogyro and helicopter.

Thomann (Switzerland)

Colonel J. Thomann of Switzerland emphasized the necessity of an increased personnel of the medical service and increased means of transport of the wounded. He warmly recommended the study of the works published in the International Red Cross Review, as well as the contribution of General Schickelé to the Archives de medecine et de pharmacie militaires, May 1934.

Czechoslovakia

The medical service in mountain warfare in the Czechoslovak Army is organized upon essentially the same bases as in war upon any other terrain. The only difference is in the amount of material and personnel supplied: Instead of one doctor for a battalion of infantry, two are provided. There is also an increased number of stretcher-bearers. In winter, the mountain ambulances are provided with equipment which permits the use of skis in transporting the wounded.

Baranoff (U. S. S. R.)

General Baranoff of the Union of Socialist Soviet Republics regretted the attitude of certain military writers who take the position that in winter warfare becomes a war of position-an attitude not quite exact, as the World War proved. He said that a war of movement can be carried on in winter even in the mountains.

Secondly, he stated that in several cases the discussion of the question of the operation of the military medical service was limited to mountain regions more or less cultivated; whereas, in mountain country that is uninhabited or desert the functions of the medical service would be very difficult without previous study of the specific conditions prevailing there.

Another important gap in the literature, he thought, was the question of the provision of water in mountain warfare, in all seasons, from the point of view of sanitary and hygienic conditions.

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SECOND QUESTION: DETERMINATION OF FITNESS FOR THE DIFFERENT SPECIALTIES IN ARMIES, NAVIES, AND AIR FORCES

De Block (Belgium)

Lieutenant Colonel Fr. De Block of the Belgian Army Medical Service stated that it would be desirable, if possible, to secure the exact opinion of the Congress upon the following points of theory, which it would be most interesting to establish definitely, if only from the point of view of scientific interest.

1. Should general or specialized recruiting in the army be conducted exclusively by military medical officers, who are specialists? Is it useful, or necessary, that physicians in civil life should intervene in the matter?

2. Are the present accepted criteria of fitness sufficient to meet the present state of our scientific knowledge? Should they be made uniform, standardized, given an international character?

3. Should an imperative character be given to medical decisions? Suppose the designation of one particular service has been made by military authority and is opposed by medical decision.

4. Should the criteria of fitness for service be the same for officers, volunteers, or members of the militia?

Chile

Chile's sea and land forces, in their selection for fitness for service, are subjected to the simple rules of the classical clinical examination. But this old basic system needs to be supplemented by scientific and modern tests, when such questions are involved as stability of nerves and superior qualities of intelligence under rigorous control. For the air service, in the selection of personnel there are serious and complicated problems involved. Our tendency is to give gradually greater and greater importance to the examination of the nervous system, for we believe that "instability" is the major cause of accidents. Vigilence, care, and the psychophysical maintenance of the aviator are our supreme preoccupation, as well as all the effective instruction from our experience which this new branch of the service allows.

Poland

In Poland's communication it was stated that at the Thirteenth Congress of Occulists, in 1929, model rules were drawn up with great care for the candidates for air service. There was included a comparative table of conditions and methods of examination under the different governments. The demands imposed upon the personnel, as well as upon the technical service, are concretely and precisely stated in the bulletins of the C.I.N.A.

It is evident that with the increase of the importance of the candidates' tasks and responsibility, the demands made upon them are constantly becoming more rigorous.

Observations based on experience, as well as practical reasons and purely scientific considerations, have created these rigorous standards, instructions, and rules. And yet, among the pilots who are able to recall the World War, there are individuals who, though they do not meet today's demands, are still good pilots.

Govaerts (Belgium)

Medical Captain A. Govaerts of Belgium believes that the only way to prove the aptitude of an individual is by tests which may be classified under three main categories:

1. Test of physical fitness to give information on strength, endurance, and resistance;

2. Intelligence test to determine if the individual possesses the required degree of intelligence;

3. Professional test to estimate manual aptitude and professional knowledge.

Through this method he believes that the placing of each individual where he can best serve will be facilitated.

THIRD QUESTION: THE POST-TRAUMATIC

ABDOMEN

Chile

For the surgeon in war to be able to operate with the maximum efficacy in the case of abdominal wounds, according to the Chilean Medical Service, it is necessary for the wounded to have as early attention as possible. This presupposes prompt rescue, rapid transportation, a well-equipped medical-service formation at no great distance, and expert surgeons operating under proper conditions, for these operations are long and serious.

Modern warfare is waged in such a way that it is impossible to realize these conditions. The nearness of the enemy's fire, the incessant uproar, the lack of calm and ordered surroundings, the postoperative care that is difficult to supply, the hurried evacuation, all enormously complicate the treatment of abdominal wounds in the field. For these reasons, as was demonstrated in the late World War, the surgical ambulances proved to have the maximum of efficiency, compatible with the situation, to care for abdominal wounds. In the case of a great number of such wounded such ambulances should be reinforced and multiplied.