Medical Soldier’s • « » Handbook The Military Service Publishing Co. 100 Telegraph Bldg. Harrisburg, Pa. Copyright 1941 By The Military Service Publishing Co, Harrisburg, Pa. First Edition, June, 1941 All Rights Reserved CSB3eMLB©©S M THE MILITARY SERVICE PUBLISHING CO. iBO TELEGRAPH BLDG- PA. PRINTED IN THE U. S. A. The Telegraph Frees Harrisburg, Pa. You are now a member of the Army of the United States. That Army is made up of free citizens chosen from among a free people. The American people of their own will, and through the men they have elected to represent them in Con- gress, have determined that the free institutions of this coun- try will continue to exist. They have declared that, if nec- essary, we will defend our right to live in our own American way and continue to enjoy the benefits and privileges which are granted to the citizens of no other nation. It is upon you, and the many thousands of your comrades now in the mili- tary service, that our country has placed its confident faith that this defense will succeed should it ever be challenged. In the transition from civil life to the life of a soldier you may, at first, feel somewhat confused. It is the purpose of this handbook to help you over these rough spots as rapidly as possible and to lay the foundations for your successful career as a soldier. Making good as a soldier is no different from making good in civil life. The rule is the same and that is—know your own job and be ready to step into the job of the man ahead of you. Promotion is going to be very rapid in this Army. Be ready for it. You will have little time to learn the duties of a noncommissioned officer after you become one. You will be expected to know those duties and show that you know them. At a moment’s notice you may have to take charge of your squad as a corporal—and in a critical hour. In the same way when you are a sergeant you cannot tell under what conditions and at what hour you may have to take the place of your lieutenant. You want to know what is expected of you and be ready to do it. The things that a trained soldier must know, and the way in which they are done, will be taught you as rapidly as you can absorb them. The basic military information is de- scribed explained irTTihis handbook so that it may be available* constantly to you during the first weeks of your service. By mastering, the contents your future progress will be much more rapid. In making yourself an efficient soldier you are helping to build a defense for our country that nothing can destroy. You are repaying your obligation to the United States for all the benefits of the past and are declaring your faith in our future. If you will make a part of yourself the following characteristics of the good soldier, you will be doing your part in upholding the glorious reputation of the Army of the States: Be obedient.—Obedience means to obey promptly and cheer- fully all orders of your commissioned and noncommissioned oflgcers. At -first you cannot be expected to know, the reason for everything you are ordered to do. As you remain longer in the service and you understand more of the reasons for military trainings yoiT will -find that everything has been FOREWORD figured out as the result of experience in the past. Ways and methods which have been successful in the past are contin- ued until some new way proves to be better, and then the change will be made. Cheerful obedience leads to a better performance of your duties. It makes it easier for all of your comrades to do their part. It means better teamwork. Be loyal.—Loyalty means that you must stand by your or- ganization through thick and thin. Boost your organization at every opportunity. Be loyal and true to your office;?, your noncommissioned officers, and your comrades. In this way you will be loyal to your country. Be determined.—Determination means the bulldog stick-to- it-iveness to win at all costs. During your training keep ever- lastingly at the most difficult tasks and never give up until you have mastered them. Determination to win means suc- cess in battle. Be alert.—Alertness means being always on your guard. A good soldier may be pardoned for failure, but never for being surprised. Should the unexpected happen, use your head and do something, even if it is wrong, rather than “lie down.” Be a member of the team.—Teamwork means that each man in the squad, platoon, company, troop, or battery gives every- thing in his power to make for the success of the whole unit. Success in battle depends on teamwork just as much as suc- cess in a football game depends on the pull-together spirit of the football team. Unless you play your own special part the team may not win. RECORD OF THE SOLDIER Name Army serial No Grade Organization Height Weight Born (Place) (Date) In case of emergency notify (Name) (Address) (Town) (State) Beneficiary (6 months’ pay) ' (Name) (Relation) (Street and number (Town and state) or rural route) Government insurance (Amount) (Policy number) Other insurance (Amount) (Policy number) Bank account (Name of bank) (City and state) Company number Watch Regimental commander’s name Battalion commander’s name Company commander’s name Platoon commander’s name Squad leader’s name TABLE OF CONTENTS Foreword xn Chapter 1. General Information Section I. Responsibilities of group life 1 II. Relationship with noncommissioned officers and officers 1 III. Relations with civilians 3 IV. Military obligations 3 V. The Articles of War 4 VI. Post and station activities 5 Chapter 2. Military Discipline and Courtesy Section 1. Military discipline 7 II. Military courtesy 8 Chapter 3. Insignia Section I. Arms and services 12 II. Officers and noncommissioned officers 15 Chapter 4. Organization IB Chapter 5. Clothing Section I. Allowances 19 II. Care of clothing 19 III. Wearing the uniform 21 Chapter 6. Equipment Section I. The gas mask 22 II. Field equipment 26 III. The medical soldier’s field equipment 33 IV. Packing individual equipment on horse 46 V. Display of equipment 50 Chapter 7. School of the Soldier Without Arms (Dismounted) Section I. Positions 54 II. Steps and marchings 56 Chapter 8. Squad and Platoon Drill, Without Arms Section I. The squad 61 II. The platoon 68 Chapter 9. Interior Guard Duty 74 Chapter 10. Marches, Camps, and Bivouacs Section I. Marches 76 II. Camps and bivouacs 81 Chapter 11. Use of Compasses and Maps Section I. Use of the compass 87 II. Use of maps 88 Page Chapter 12. Security and Protection Section I. General 98 II. Security of individuals 98 III. Security of small units 110 Chapter 13. Military Sanitation 130 Chapter 14. Anatomy and Physiology 13S Chapter 15. First Aid Section I. General 168 II. Treatment of wounds 169 III. Shock 176 IV. Fractures, dislocations, and sprains 177 V. Artificial respiration 182 VI. Gas casualties 184 VII. Injuries due to heat and cold 187 VIII. Poisonous bites and stings 189 IX. Common emergencies 190 X. Transportation of wounded 194 Chapter 16. Organization and Administration of an Army Hospital 200 Chapter 17. Ward Management 207 Chapter 18. Nursing 217 Chapter 19. Materia Medica 241 Chapter 20. Elements of Pharmacy 257 Chapter 21. Attached Medical Personnel 267 Chapter 22. Division Medical Service Section I. Organization 283 II. Collection 293 III. Division ambulances 315 IV. Clearing 323 Chapter 23. Rules of Land Warfare Section I. Laws of war in general 341 II. The Hague Conventions 341 III. Geneva Convention 342 IV. Voluntary aid societies 343 Chapter 24. Clerical Records and Reports 344 Chapter 25. The Ration 351 Chapter 26. Pay and Allowances 354 Chapter 27. Last Will and Testament 356 Appendix. Glossary of Common Military Expressions 357 Index 359 GENERAL INFORMATION Chapter 1 Section I. Responsibilities of group life 1-3 Section II. Relationship with noncommissioned offi- cers and officers 4-11 Section III. Relations with civilians 12-14 Section IV. Military obligations 15-16 Section V. The Articles of War 17-19 Section VI. Post and station activities 20-25 Paragraphs Section I RESPONSIBILITIES OF GROUP LIFE 1. Before you joined the Army you were a member of a family of closely related individuals who had many things in common. The members of your family shared the same dining room, the same bathroom, and the same amusements around the house. All worked together, played together, read the same newspaper, and were largely dependent upon each other for comforts, pleasures, and a living. 2. You learned that to get along well with other members of your family you must have consideration for them, do your part of the work, and share things with the rest of the household. That was your golden rule and the primary law of family relationship and citizenship. 3. You have the same obligations in the Army but instead of the small family group you are one of a much larger group. Several hundred may have to live together in one small area. Large numbers eat in the same mess hall, use the same bath- house or latrine, bunk together, work together, and play together. Your bedding, your uniforms, your equipment, and your personal possessions will frequently be exposed where they can be removed without your knowledge. Living under these conditions you must do your part in respecting the rights and property of others. A soldier who has learned to respect the rights of his comrades has made a big step for- ward in his training as a soldier and as a citizen. RELATIONSHIP WITH NONCOMMISSIONED OFFICERS AND OFFICERS Section II 4. For every business, every game, every group activity, and in every walk of life there is a leader, a “boss,” an executive, or some directing agency. In the Army these group leaders are the officers and the noncommissioned officers. 5. The President of the United States is the Commander in Chief of the Army. He appoints officers, with the con- sent of the Senate, to assist him in the details of running the Army. He gives them certain authority and makes them responsible for certain groups or organizations in accordance with their grade and length of service. 2 MEDICAL SOLDIER’S HANDBOOK 6. You have a commander in charge of your company, bat* tery, or troop, who is responsible for everything your com- pany does or fails to do. He must see that you are properly trained, and that you are fed, clothed, and sheltered. He must look after your health, your comfort, and your amuse- ments. He could not possibly attend to all these details alone. Suppose that your company commander had to go to every individual soldier, give him special instructions, explain what to do and what not to do, draw rations, issue equipment, keep all your records, and do all of the many things which you require. You can see that many things would be neglected and that you would suffer for lack of proper training, food, equipment, and amusements. To assist him in all the details of running the company he asks the regimental commander to appoint noncommissioned officers who are given certain authority and are made responsible for certain things. You are thus a part of a great organiza- tion or business in which the officers and the noncommissioned officers are the executives, the “bosses,” and the foremen. 7. The first thing to appreciate is that you are subject to the orders of officers and noncommissioned officers placed over you. The officers and noncommissioned officers are entitled to be, and they must he obeyed and respected by all soldiers under them. Make it a rule that you will obey them promptly, cheerfully, and carefully. A military order is usually sharp, positive, and brief. If you do not under- stand what is wanted, it is your duty to ask questions, but do not quibble over small details as to your “rights.” The man who is always thinking of his “rights,” rather than his duty, makes a poor soldier. 8. If you believe that you have been given an unlawful order you should obey first and make a report to your commanding officer afterwards. Disobedience or failure to obey a lawful order, which you may believe to be unlawful, may lead to severe consequences. 9. The Articles of War, the soldier’s law, authorize your commanding officer to impose certain punishments for minor offenses. That is, he can withhold certain privileges, restrict you to the area of barracks or camp for a week, or require you to perform extra duty or hard labor for as much as a week. However, he does not delegate this authority to his noncommissioned officers. A noncommissioned officer is not authorized to administer any form of punishment to a mem- ber of his command. A noncommissioned officer may require you to sweep the barracks floor, wash the squad-room win- dows, and the like but he does this by regular detail from all the members of your company, not as a punishment. 10. It is the duty of a noncommissioned officer at all times and under all circumstances, whether on duty or off duty, to check promptly all disputes, quarrels, or disorderly conduct which might bring discredit upon the service. He is required to enforce the orders and regulations governing the conduct of soldiers. In the absence of an officer, a non- commissioned officer may place a soldier under arrest until he can be seen by his company commander. MEDICAL SOLDIER’S HANDBOOK , 3 11. It can be seen that officers and noncommissioned of- ficers must be specially selected. They hold positions of responsibility and honor, but they belong to the same mili- tary organization that you do. The relationship between all military men is one of comradeship, friendliness, and helpfulness. In no walk of life does “comradeship’’ mean so much as in the military service and nowhere are obedi- ence and respect for authority so important as in the Army. As a soldier you must accept constituted authority, which is nothing more than team play. In your relationship with officers and noncommissioned officers you are expected to be loyal and truthful. Always be frank but courteous. By being courteous and respectful to constituted authority you are exhibiting qualities of a good soldier. RELATIONS WITH CIVILIANS Section III 12. In his off-duty activities, whether in peace or war, the good soldier is always careful to be courteous and consid- erate toward civilians. You must realize that your organi- zation and the Army will be judged by the conduct and appearance of its members in public. Any misconduct on your part in a public place will bring discredit not only upon yourself but also on the military service. You must take pains on every occasion to win the respect and con- fidence of all with whom you come in contact. 13. When on duty your relations with civilians are gov- erned primarily by the orders and instructions of your commanding officer. Here also, whether in peace or war, you should treat civilians with all courtesy and consideration consistent with a strict observance of your orders and the accomplishment of your military mission. 14. The American Red Cross acts as the medium of com- munication between the Army and the civil community. This organization has chapters or representatives in all parts of the United States and its foreign possessions. If you should be concerned about the welfare of your family or conditions in your home, explain the situation to your company commander. He will help you in obtaining the assistance of the Red Cross through the Red Cross field director at your station or serving your unit. Section IV MILITARY OBLIGATIONS 15. a. Every man who enters the Army of the United States, whether through voluntary enlistment or operation of the Selective Service Law, accepts certain solemn obliga- tions. These obligations require that he bear true faith and allegiance to the United States of America; that he serve them faithfully against all their enemies; and that he will obey the orders of the President of the United States MEDICAL SOLDIER’S HANDBOOK and the officers appointed over him (the soldier) according to the rules and Articles of War. Your legal status has changed from that of a civilian to that of a soldier. You have become subject to military law and cannot again become a civilian until you receive your dis- charge by proper authority. As a civilian you could quit your job and seek other employment at will. As a soldier you have given up that privilege during the period of your service. During your off-duty hours as a civilian you could go when and where you pleased without asking permission from anyone. As a soldier you must first get permission be- fore leaving your proper station. b. The reasons for these differences in your status as a civil- ian and as a soldier are important but easy to understand. The military organization to which you now belong is a team that must be constantly trained and ready for duty in any emergency. If its members could go and come whenever they cared to there would be no assurance that this military team would be on hand when needed. 16. As a soldier, then, you must keep in mind and faithfully fulfil your obligations. If you do so you will find the service pleasant and profitable, and will leave it as a veteran with a clean record which will entitle you to the benefits accorded by law to an honorably discharged ex-serviceman. Soldiers who constantly fail to fulfil these obligations are likely, sooner or later, to get into trouble, to lose the respect and regard of their comrades, to suffer punishments, and perhaps, finally to return to civil life dishonored and disqualified for any of the benefits with which the Government rewards honorable and faithful service. Section V THE ARTICLES OF WAR 17. The Articles of War are part of the military laws en- acted by Congress to control the conduct of those in military service of the United States. They govern the administration of military justice. They define the offenses for which soldiers may be tried by court-martial, prescribe the composition and procedure of courts-martial, and fix the limits of punishment that may be imposed by these courts. 18. The Articles of War are read to every soldier shortly after he enters the service and at regular intervals there- after, so that no one will be able to excuse himself for a viola- tion of any of them upon the ground of ignorance of their provisions. 19. However, as a good soldier, resolved to observe fully and in good faith the obligations of the oath of enlistment above discussed, you do not need to spend much time studying the detailed provisions of the Articles of War. As a general rule, they prohibit and penalize only such conduct as the person of ordinary intelligence will readily recognize to be wrong. The man who is resolved to do the right thing and carries out that resolution at all times, is very unlikely to violate any of the Articles of War. Should doubt ever arise in your mind as to 5 whether anything you plan to do is improper or a violation of the Articles of War, don’t hestitate to take the question to some more experienced comrade, to your first sergeant, or to your immediate commanding officer. They will be glad to advise you. MEDICAL SOLDIER’S HANDBOOK Section VI POST AND STATION ACTIVITIES 20. Although you have exchanged your civilian community for a military community, you will find many of the same activities on your post or station that you have known in civil life. For example, your own organization will probably have a barber and a tailor. All soldiers are required to have a short haircut known as a “military” haircut. This is done for sanitary reasons and to secure uniformity. Your organi- zation barber is approved by your organization commander, and is required to maintain a sanitary establishment, which is inspected regularly by the post surgeon. Your organization tailor is prepared to clean and press your uniform and make necessary alterations and repairs. Both of these activities are maintained for the service and convenience of the mem- bers of your organization. The prices are fixed by the post commander so that they will be well within your means. You will be given credit by these activities and can pay for what- ever service you have received at the end of each month. 21. The post exchange is the community store, owned jointly by you and all other men on your post. It is operated under the supervision of the commanding officer and the post ex- change officer entirely in your interests. All profits made in this store come back to you and your comrades in the form of recreational activities, the furnishing of your organiza- tion day room, and other similar benefits. No individual shares in these profits, and under Army Regulations, profits may be expended only for the welfare of the soldiers as a whole. The post exchange will probably operate a general store, a shoe repair shop, a barber shop, and a tailor shop. Your organization orderly room will issue you, on credit, a certain amount of post exchange coupons each month, which will be accepted by all post exchange activities. The cost of these coupons will be collected at the pay table at the end of the month. 22. There will also be a motion picture theatre on your post operated by the United States Army Motion Picture Service, at which will be shown one or two shows each night, or as announced from time to time. There will also be occasional free shows. The price of attendance for the regular shows is small, and payment may be made in cash, post exchange coupons, or in theatre coupons. Theatre coupon books may be obtained on credit and paid for at the end of the month in the same manner as post exchange coupon books. 23. A photograph shop will also probably be operated by your post exchange. The photographer will make a specialty of taking photographs of soldiers at a very small cost, for which he will accept either cash or post exchange coupons. 6 At your early convenience, have your photograph taken in your uniform, and send it home to a member of your family. They will be glad to have it and so will you, after you have returned to civil life. 24. There are also a number of other recreational activities on your post in which you are encouraged to participate dur- ing your off-duty hours. These will probably include bowling alleys, shooting galleries, baseball fields, and basketball and volley ball courts. They are provided for your enjoyment, and you should take advantage of them at every opportunity. Your first sergeant will be glad to explain how you can use them and where to obtain the necessary equipment. 25. Your organization has a bulletin board just outside of the orderly room or organization headquarters tent. Make it a practice to read the contents of the bulletin board several times each day. On it will be posted various company and guard details as well as announcements as to the uniform and equipment to be worn on different occasions, the time and place where you will receive your pay, motion picture pro- grams, and other items of interest to you. MEDICAL SOLDIER’S HANDBOOK MILITARY DISCIPLINE AND COURTESY Chapter 2 Paragraphs Section I. Military discipline 26-29 Section II. Military courtesy 30-33 MILITARY DISCIPLINE Section I 26. The average civilian or recruit coming into the Army, often misunderstands the meaning of the words military dis- cipline. He thinks of them as being connected with punish- ments or reprimands which may result from the violation of some military law or regulation. Actually, discipline should not be something new to you for you have been disciplined all of your life. You were being disciplined at home and in school when you were taught obedience to your parents and teachers, and respect for the rights of others. On your baseball or other athletic team you were disciplining yourself when you turned down the chance to be a star performer in order that the team might win; you were acquiring discipline in the shop, or other business, when your loyalty to your employer and your fellow employees was greater than your desire to secure your own advancement. All of this was merely the spirit of team play; that is, you were putting the interests of the “team” above your own in order that the “team” might win. 27. The word “company,” “troop,” or “battery” is merely the military name for a team, and military discipline is nothing more than this same spirit of team play. It is the most im- portant thing in the Army. In civil life lack of discipline in a young man may result in his getting into trouble which will cause his parents and teachers regret or sorrow; it may cause a member of an athletic team to be “sent to the bench,” or cause an employee to lose his job. In the Army it is far more serious. Here lack of discipline in a soldier may not only cost him his life and the life of his comrades, but cause a military undertaking to fail and his team to be defeated. On the other hand a team of a few well-disciplined soldiers is worth many times a much larger number of undisciplined individuals who are nothing more than an armed mob. History repeatedly shows that without discipline no body of troops can hold its own against a well-directed and well-disciplined enemy. 28. In your work in the Army you may wonder why the officers and noncommissioned officers insist on perfection in what appears to be minor details. Why do rifles have to be carried at just the same angle; why do you have to keep ac- curately in line; why must your bed be made in a certain way; why must your uniform and equipment be in a pre- scribed order at all times: why must all officers be saluted with snap and precision? These things are part of your dis- ciplinary training. Their purpose is to teach you obedience, loyalty, team play, personal pride, pride in your organiza- 8 MEDICAL SOLDIER’S HANDBOOK tion, respect for the rights of others, love of the flag, and the will to win. 29. So you see that being disciplined does not mean you are being punished. It means that you are learning to place the task of your unit—your team—above your personal wel- fare; that you are learning to obey promptly and cheerfully the orders of your officers and noncommissioned officers so that even when they are not present you will carry out their orders to the very best of your ability. When you have learned these things and prompt and cheerful obedience has become second nature to you, then you have acquired military dis- cipline—the kind of discipline which will save lives and win battles. Section II 30. In your home and school you were taught to be polite and considerate in your speech and attitude to your parents, your teachers, and your comrades. That was courtesy. Mil- itary courtesy is the same thing except that the military man is so proud of his profession and has such high respect for the men who belong to it that in the Army courtesy is more care- fully observed than in civil life. Military courtesy is a part of military discipline. The disciplined soldier is always cour- teous whether on duty or off, whether to members of the military service or to civilians. To help you in quickly be- coming a well disciplined and efficient member of your team, the following are some of the more common occasions on which you may have an opportunity to demonstrate your military courtesy. The rules are few and simple, but they have an important bearing on your career as a soldier. a. The military salute is the courteous recognition between members of the armed forces of our country. The salute is a privilege enjoyed only by members of the military service in good standing; prisoners do not have the right to salute. b. The salute is given when you meet a person entitled to it. Those entitled to it are all officers of our Army, Navy, Marine Corps, and Coast Guard. It is also customary to salute officers of friendly foreign countries when they* are in uniform. c. The salute should be given when you can easily recog- nize that the person is an officer and entitled to it. Usually this is at a distance of not more than 30 and not less than 6 paces, in order that the officer may have time to recog- nize and return it. d. When you execute the salute turn your head so that you observe the officer and look him straight in the eye. The smartness with which you give it indicates the pride you have in your profession. A careless or half-hearted salute is discourteous. (See fig. 24.) e. In posts, camps, or stations, the salute is always given whenever you recognize an officer, even though one or both of you are in civilian clothes. It is likewise given whether MILITARY COURTESY MEDICAL SOLDIER’S HANDBOOK 9 or not you are wearing a head covering. For rule when out- side post, camp or station see paragraph 31 f. If the officer remains in your immediate vicinity with- out talking to you, no further salute is necessary when he departs. If a conversation takes place however, you should again salute when either you or he leaves. g. (1) If you are one of a group of soldiers, not in forma- tion, call the group to attention as soon as you recognize an officer approaching, unless some other member of the group has already done so. If the group is out of doors, all mem- bers of the group salute; if indoors or in a tent, all remove their head covering and stand at attention unless otherwise directed. (2) If the group is in formation out of doors, it is called to attention by the one in charge and he alone gives the salute. (3) If you meet an officer on a staircase or in a hallway, halt and stand at attention. h. The salute is given only at a halt, or a walk. Either mounted or dismounted, always bring your gait down to a walk before saluting. Except in the field under campaign conditions, always dismount before speaking to or replying to a dismounted officer. i. If you report to an officer in his office, first remove your headdress, unless you are carrying your rifle or side arms, and enter when told to do so. March up to within two paces of the officer’s desk, halt, salute, and state. “Sir, Pri- vate reports to .” (For example, “Sir, Private Jones reports to the Company Commander.”) After re- porting, carry on the conversation in the first and second person. When the conversation is' ended, salute, make an about face, and withdraw. Unless you are carrying your rifle or side arms, always remove your headdress when en- tering a room where an officer is present. j. If you are driving a motor vehicle, salute only when the vehicle is halted. If it is an animal-drawn vehicle, salute only when both hands are not required to control your team. Any other soldier in the vehicle salutes whether the vehicle is at a halt or in motion, unless there are a number of soldiers in the vehicle in charge of an officer or noncommissioned officer. In this case only the officer or noncommissioned officer gives the salute. k. When you are dismounted and not in formation and the National Anthem is played, or “To the Colors,” sounded, at the first note face the music, stand at attention and give the salute. At “Escort of the Color” or “Retreat,” face toward the color or flag. If you are in civilian clothes and wearing a headdress, stand at attention, remove your headdress and hold it over your left breast. If you are in civilian clothes and not wearing a headdress, stand at attention and execute the hand salute. Hold the salute until the last note of the music. If you are mounted and not in formation, halt and give the salute while mounted. Vehicles in motion will be brought to a halt. If you are riding in a passenger vehicle or on a motorcycle, dis- mount and salute. In other types of military vehicles, as for example troop carriers, trucks, and escort wagons, all indi- viduals except the person in charge of the vehicle remain 10 MEDICAL SOLDIER’S HANDBOOK seated or standing (depending on whether they are riding seated or standing) in the vehicle at attention. The person in charge of the vehicle, unless he be a tank commander or the driver of a horse-drawn vehicle, dismounts and renders the salute. Tank commanders salute from their vehicles. Drivers of horse-drawn vehicles remain in their vehicles and salute only if both hands are not required to control their teams. Individuals leading animals or standing to horse stand at attention but do not salute. The same respect is shown the national anthem of any other country when it is played on special occasions. l. If you are passing, or being passed, by an uncased na- tional color render the same honors as when the National Anthem is played. m. Whenever you are present but not in formation while personal honors are being rendered, salute and remain in that position until the completion of the ruffles, flourishes, and march. n. (1) In garrison, if posted as a sentinel with a rifle, you will salute by presenting arms. During the hours when chal- lenging is prescribed, the first salute to an officer is given as soon as he has been recognized and advanced. (2) While posted as a sentinel, if you are talking to an officer, do not interrupt your conversation to salute another officer. However, if the officer to whom you are talking salutes his senior, you will also salute. o. If you are attending a military funeral not as a member of a formation, and whether in uniform or civilian clothes, stand at attention, remove your headdress, and hold it over your left breast at any time the casket is being moved by the casket bearers and during the services at the grave, including the firing of volleys and the sounding of taps. During the prayers, bow your head. If the weather is cold or inclement, keep your headdress on and give the hand salute whenever the casket is being moved by the casket bearers, and during the firing of volleys and sounding of taps. 31. The following situations will assist you in remembering when you do not or need not salute: a. If you are in ranks and not at attention and an officer speaks to you, come to attention, but do not salute. The officer or noncommissioned officer in command of your unit will give the salute for the entire organization to the person entitled to it. b. If an officer enters the mess room or mess tent, you re- main seated, “at ease,” and continue eating unless the officer directs otherwise. If the officer speaks directly to you, remain seated “at attention” until the conversation is ended, unless he directs otherwise. c. Members of details at work do not salute. The officer or noncommissioned officer in charge will salute for the entire detail. d. When actually taking part in games you do not salute. e. When standing to horse or leading a horse do not salute. f. In churches, theatres, or other places of public assem- blage, or in a public conveyance, do not salute. Indoors, salutes are not given except when reporting to an officer. MEDICAL SOLDIER’S HANDBOOK 11 g. Do not salute when carrying articles with both hands or when you are otherwise so occupied as to make saluting impracticable. h. If you are posted as a mounted or dismounted sentinel and are armed with a pistol, do not salute after challenging. Stand at “Raise Pistol” until the officer you have challenged has passed. i. When on a march in campaign, or under simulated cam- paign conditions, do not salute. j. Off duty, and when you are not in a post, camp, or sta- tion, the salute is optional unless you are addressed by an officer. 32. While officers and noncommissioned officers will usually address you by your last name, always use their title in addressing them. The following titles are used in the mili- tary service: a. All general officers are addressed as “General”; lieu- tenant colonels are addressed as “Colonel”; and both first and second lieutenants as “Lieutenant.” b. All chaplains, regardless of grade, are addressed as “Chaplain.” Catholic chaplains may be addressed as “Father.” c. Warrant officers are addressed as “Mister.” d. Members of the Army Nurse Corps are addressed as “Nurse.” e. Noncommissioned officers are addressed as “Sergeant” or “Corporal.” Master sergeants, technical sergeants, and staff sergeants are all addressed as “Sergeant.” 33. As the result of the observance of military courtesy in our Army for many years, certain customs have come into existence which are recognized as our unwritten law of con- duct. Every civilian community, school, or business has its own customs, and a newcomer should learn them as quickly as possible so that he will not be embarrassed. In the same way, you will discover that your own organization probably has its own local customs, many of which date from some event in the organization’s history, and of which it is very proud. You should become familiar with these customs as early as possible. The following are a few of the general customs which are observed throughout our Army, and which you should know. a. If you wish to speak to your company, battery, or troop commander, first obtain permission from your first sergeant. The company commander will always see you, but he may be busy at the time or the first sergeant may be able to answer your question. b. If you wish to deposit some of your money on pay day, notify your first sergeant before reporting to receive your pay. c. When you report to your company commander for pay, halt directly in front of him and salute. After receiving your pay count it quickly, execute a right or left face and depart. d. Do not salute with one hand in your pocket, while smoking, or with your coat unbuttoned or partly unbuttoned. c. If you should be accompanying a dismounted officer waik on his left; if both you and the officer are mounted ride on his left. Chapter 3 INSIGNIA Section I. Arms and services 34-40 Section II. Officers and noncommissioned officers .... 41-44 Paragraphs Section I 34. Insignia. Each of the various arms and services in our Army has a particular “mark” of its own which is worn by all of its members. It serves to distinguish those members from all other soldiers of the Army and is a part of the uni- form. These various marks are called insignia and usually consist of two types: the metal insignia which you will wear on the collar of your shirt or the lapel of your coat, and the colored hat cord which you will wear on your service hat. 35. To assist you in becoming quickly familiar with the various types of insignia and so that you can tell at a glance to which arm or service a soldier may belong, they are shown in figure 1. 36. Hat Cord. At a distance it will be easier to recognize the arm or service to which a soldier belongs by the color of his hat cord. You should be familiar with the following colors and the arm or service which they identify. Where two colors are given, the cord is of the first color and the acorns and keeper are the color of the piping. a. Air Corps—Ultramarine blue piped with golden orange. b. Cavalry—Yellow. c. Chemical Warfare Service—Cobalt blue piped with golden orange. d. Coast Artillery Corps—Scarlet. e. Corps of Engineers—Scarlet piped with white. /. Field Artillery—Scarlet. g. Finance Department—Silver-grey piped with golden yellow. h. Infantry and Tanks—Blue. i. Medical Department—Maroon piped with white. j. Military police—Yellow piped with green. k. Ordnance Department—Crimson piped with yellow. l. Quartermaster Corps—Buff, m. Signal Corps—Orange piped with white. 37. Arm Band. In addition to the identification marks de- scribed above, sometimes you will see certain soldiers wearing arm bands to show the particular type of work they are doing. These arm bands are called “brassards” and are worn on the left sleeve above the elbow. You will want to know the fol- lowing brassards and what they mean— a. Blue, with the letters “MP” in white—Military Police. b. Red, with the word “Fire” in white—Members of fire departments. c. White, with red cross in center—Geneva Convention Red Cross. d. White with green cross in center—Veterinary Green Cross. ARMS AND SERVICES MEDICAL SOLDIER’S HANDBOOK 13 REGULAR ARMY (Not assigned to regiment-) & ORGANIZED reserve (v/ith reqimenfal number) /NATIONAL GUARD (flof- assigned ■to regiment") (With reqimentol number ) Arm or Service' DislincKvc AIR CORPS CAVALRY CHEM, WARFARE •SERVICE COAST ART. CORPS CORPS OP ENGINEERS FIELD ARTILLERY FI/MANCE DEPARTMENT INFANTRY MEDICAL DEPARTMENT NAT. GUARD BUREAU ORDNANCE DEPARTMENT QUARTERMASTER CORPS SIGNAL CORPS DETACHED ENLISTED MEM Figure 1. Collar Insignia for Enlisted Men. 14 38. Service Stripe. Each enlisted man who has served honorably in the military service for three years wears the service stripe. This stripe is worn 4 inches from the end of the left sleeve of the service coat. For each additional period of 3 years, another service stripe is worn. MEDICAL SOLDIER’S HANDBOOK shoulder sleeve insignia ( Divisions, ehz.) SERVICE STRIPES CHEVRON5. 'OP GRADE WOUND* OVERSEAS ■SERVICE WOUND CHEVRONS OVERSEAS CHEVRONS RIGHT LEFT Figure 2. Wearing of Sleeve Insignia 39. Wound and war service chevrons are worn only by those entitled to them. They are worn only on the woolen service coat, with the wound chevrons on the right sleeve and the service chevrons on the left sleeve. They are worn point EXPERT SHARP-SHOOTER jg CLASS GUNNER MARKSMAN 2.C1P CLASS GUINMER Figure 3. Badges for Qualification in Use of Weapons. Other bars to be attached to basic badges are as follows: MACHINE RIFLE AUTO. RIFLE SMALL BORE RIFLE BAYONET PISTOL-D PISTOL-M SMALL BORE PISTOL MECHANIZED VEHICLE WEAPONS INF. HOWITZER MACHINE GUN SMALL BORE M. G. SUBMACHINE GUN GRENADE COAST ARTY. FIELD ARTY. C. W. S. WEAPONS MINES AERIAL GUNNER AERIAL BOMBER ANTIAIRCRAFT WEAPONS MEDICAL SOLDIER’S HANDBOOK 15 down. When service stripes are worn the war service chevron is above the uppermost service stripe. (See flg. 2.) 40. Badge. Soldiers are classified according to the quali- fications attained in the use of weapons. The different classi- fications are: expert, sharpshooter or 1st class gunner, and marksman or 2d class gunner. Should you attain one of these classifications you will be entitled to wear a badge (fig. 3) which is issued by the War Department. A bar, at- tached to the bottom of the badge, shows the weapon with which you have qualified. Should you qualify with more than one weapon, you will be entitled to wear an additional bar for each weapon. Section II OFFICERS AND NONCOMMISSIONED OFFICERS 41. Commissioned officers and noncommissioned officers also wear the insignia of the arm or service to which they belong and in addition certain other distinguishing marks which show their grade or authority in the Army. The insig- nia of grade worn by all officers on each shoulder loop of the coat, overcoat, or olive-drab shirt when worn without the coat, are shown in figure 4. 42. A general officer wears two bands of black braid just COLONEL LT. COL. MAJOR CAPTAIN 1ST LIEUT. 2— LIEUT (Silver) (Silver) (Gold) (Silver) (Silver) (Gold) Figure 4. Insignia of Rank for Officers (Worn on Shoulder Loops) master i&r. (Itr Grade) TECHNICAL SQT (21? Grade) I »r SQT (2. ESP Grade) staff sgt (55? Grade) .SERGEANT (4li? Grade) corporal private 1st class (5 li) Grade) (6 Grade) Figure 5. Chevrons (Insignia of Grade) for Noncommissioned Offl cers and Privates, First Class (Worn on Sleeves). above the lower edge of each sleeve of the overcoat. 43. Officers of the General Staff Corps wear a band of black braid 3 inches from the end of each sleeve of the service coat. All other officers wear a similar band of brown braid. All warrant officers and enlisted men who served honorably as officers in the World War wear a similar band of forest green braid. 44. Noncommissioned officers wear chevrons of olive-drab material on a dark blue background. They are worn on the sleeve between the elbow and the shoulder of the olive-drab shirt, the coat, the overcoat, and the fatigue uniform. The chevrons for the different grades are shown in figure 5. 16 MEDICAL SOLDIER’S HANDBOOK Chapter 4 ORGANIZATION 45. You are going to hear the word “organization” used constantly in your military service and it will help you to have an early understanding of just what the word means in the Army. If you think about it for a moment you will realize that, actually, organization is nothing new, for you have probably been familiar with its meaning for a long time in civil life. In your factory, shop, or office you remember how men were grouped according to the ma- chine they operated or the type of work they did. The same thing was true in school where students were grouped by classes according to their progress and the number that each teacher could instruct. You are familiar with the way in which your local police and fire departments are divided into precincts or districts located in different parts of the city with one particular man in charge of each station. 46. All of this grouping and arranging is for just one pur- pose—to get things done in the best way possible and without waste of time or effort. If every shop or office worker did only the things he wanted to do, and in his own way, his business would soon fail for he could not turn out his orders on time. If every student studied only the things he was interested in and only when he felt like it, we would soon be a nation of poorly educated people. If each time a fire occurred, the fire chief had to telephone the different firemen and tell them what to do, there would be little chance of saving many build- ings. So, in order to direct the business workers, students, and firemen in their efforts, and to produce efficiency instead of confusion, they are divided into groups of a size which experi- ence has shown one man can control. In charge of these groups are the foremen, chief clerks, teachers, or other group leaders you remember in civil life. 47. The same arrangement exists in the Army and for the same purpose. You have been assigned to a company, troop, or battery of a certain regiment. In charge of your company, troop, or battery is an officer who is responsible for feeding, clothing, and training you and your comrades, and, finally, leading you to victory on the battlefield. He is your team captain. Your company, troop, or battery has in it from 100 to 200 men. If it were always going to be on the drill field, or MEDICAL SOLDIER’S HANDBOOK 17 in the barracks, the company commander could probably control it with his voice. But your team may not always remain in an area where the company commander can di- rectly control it. It is training for the time when, if called upon, it will meet and defeat the enemy on the battlefield. There the distances and noise will make it impossible for the company commander to control directly more than a few men. So, to make sure that all the members of the team are exerting their efforts toward the same end, your company, troop, or battery is divided into a number of smaller groups called squads, sections, and platoons. 48. a. In the Infantry and Cavalry the squad is the largest unit that can be effectively controlled by the voice and signals of its leader—the corporal or sergeant. In size it will vary from 4 to 16 members, depending upon the kind of squad it is. It takes its name from the principal weapon within the squad. For example, in a “rifle squad” the members are armed with the rifle; in a “machine-gun squad” the principal weapon is the machine gun which members of the squad serve, and in a “mortar squad” the principal weapon is the mortar. The squad is small enough so that the leader can directly control all of its members. b. In the Field Artillery and Coast Artillery Corps the section is the smallest fighting unit. In these arms, squads are sometimes used for purposes of drill or administration. For combat, however, the members of the section are usually close enough to the gun they serve so that their leader, the sergeant, can control them. 49. Next above the squad or section is the platoon, which is commanded by a lieutenant. A platoon includes several squads, or two sections, and has a strength of 40 or 50 soldiers. By the time we have reached a unit of this size you can see how difficult it would be for the lieutenant to control directly the actions of all members of the platoon while they are scattered over a large area in combat. He can easily control them, however, through his orders to his section or squad leaders. 50. a. Finally we come to your company, troop, or battery. It usually consists of 3 or 4 platoons and is commanded by a captain. Because of the way your company is “organized” it is possible for the company commander to control and direct efficiently the company as a whole through his orders to the platoon, section, and squad leaders and still have time to plan for the future care and welfare of the company. It would not be possible for him, to do this if he did not have such an “organization,” but had to spend his time constantly running back and forth, issuing orders to 200 individuals. b. The organization of your company which has been dis- cussed above deals with it as a fighting team. But to be able to fight effectively, it must be fed, clothed, and supplied with the necessary equipment. To assist the company com- mander in doing this, he has a company headquarters, whose principal noncommissioned officers are the first sergeant, the mess sergeant, and the supply sergeant. The first sergeant corresponds to the executive, or chief clerk, in a civilian office. He handles all of the administrative details of the company 18 MEDICAL SOLDIER’S HANDBOOK and publishes the orders of the company commander. The mess sergeant with his cooks secures and prepares the food you eat, and the supply sergeant issues you your clothing and equipment and exchanges it when it has become worn out or damaged. Your company is a carefully organized business with the various jobs so distributed that the largest possible number of men can be made available for its principal job of fighting. 51. The same considerations followed in the organization of your company, troop, or battery are carried on upward to your regiment. In the Infantry, Field Artillery, and Coast Artillery Corps, usually 4 companies or batteries are grouped to form a battalion, but there may be only 2 or 3. Similarly, in the Cavalry, troops are grouped as squadrons. These larger units, battalions or squadrons, are commanded by a major or lieutenant colonel. The regiment is composed of 2 or more—generally 3—battalions or squadrons and is commanded by a colonel. So you see how each unit from the 4-man squad up to the 500- or 1000-man battalion fits into a definite place in the big regimental team. Each unit is so organized that one man will be able to control and direct it so that the full power of the team will be directed toward a common purpose. 52. In certain arms of the Army you may find that one or more of the various units described above are not included in the organization for combat of that arm. In the Air Corps you will not find the squad, section, or platoon as fight- ing teams but only organized temporarily for drill and ad- ministrative purposes. The unit to which you will be as- signed is a squadron, commanded by a major. The squad- ron, however, will be divided into sections which are named for the duties the members of that section perform. For example, the administrative section handles the squadron headquarters, mess, and transportation; the technical sec- tion does the engineering, supply, communication, photogra- phy, and repairs; and the flight section operates and main- tains the aircraft of the squadron. 53. In the same way, in certain armored units the small- est organization will be the crew of a scout or combat car, which will consist of 4 men, one of whom will be an officer or noncommissioned officer. Also certain infantry units such as tank, antitank, and military police organizations will vary in size and numbers. But you will not be confused, in what- ever organization you may be, if you will remember the pur- pose for which the Army is organized in every arm or service. It is necessary to secure the efficient control of all members of the team for success in battle. CHAPTER 5 CLOTHING Paragraphs Section I. Allowances 54-55 Section II. Care of clothing 56-58 Section III. Wearing the uniform 59 Section I 54. When you enlisted or were inducted into the Army, you made a contract with your Government. Your part of the contract was to serve faithfully the United States of America against all their enemies. It was an obligation you were glad to assume in return for the many privileges you and your family have received as citizens of a free nation. As its part of the contract the Government agreed to pay, feed, clothe, and give you medical care during the time you were in the military service. 55. You will be issued, without charge, all the articles of clothing necessary for the duties you will be required to per- form. Whenever any item of this clothing is no longer serv- iceable, you may turn it in to your supply sergeant, who will replace it without charge. You must remember, however, that these articles of clothing are the property of the United States and are issued for your use while you are in the mili- tary service. If they are lost, damaged by your neglect, or unlawfully disposed of, the Government will require you to pay for them. ALLOWANCES Section II CARE OF CLOTHING 56. Always remember that your uniform is more than a mere suit of clothes that is worn to cover and protect your body. It is the symbol of the honor, the tradition, and the achievements of our Army. The civilian or soldier who is care- less in his dress and appearance is probably careless in every- thing else. You owe it to your comrades, your organization, and your Army to be neat and careful in your appearance, for officers and men of other organizations will judge your com- pany by the impression you make. 57. By being careful of your uniform, you have many ad- vantages over a careless soldier. Your clothing will last longer, you will be neater and better dressed, and you will make a better impression on your comrades and officers. 58. The following information will assist you in the care of your clothing: a. Whenever you wear the uniform, either on or off duty, be sure that it is complete and that it conforms to the instruc- tions of your post, camp, or station. Have your shirt, coat, and overcoat buttoned throughout. Keep your uniform clean, neat, and in good repair. 19 20 MEDICAL SOLDIER’S HANDBOOK b. Dandruff, dust, or cigarette ashes on a uniform give a bad impression. If possible, keep a whisk broom in barracks for brushing your uniform. Promptly replace missing buttons and insignia. c. Keep your woolen uniforms pressed. This not only im- proves the appearance of clothing, but actually increases its life. d. Clothing not in use should be hung in wall lockers when- ever available. If there are no wall lockers, fold your clothing carefully and put it away where it will not accumulate dust. Uniforms that have become wet or damp should not be folded until they are dry. It is also a good idea to inspect clothing before putting it away. Missing buttons and rips should be attended to as soon as you take off your clothing instead of waiting until it is again needed. e. Grease spots on uniforms are unsightly and unmilitary. The sooner a grease spot is removed, the easier. Usually it helps to place a folded clean towel under the soiled part of the cloth during the cleaning. The cleaning should be done by dampening a clean white cloth with a good commercial clean- ing fluid and rubbing gently back and forth in a straight line over a larger area than the spot until dry. This usually pre- vents leaving a ring on the fabric. Turpentine will remove paint spots from clothing if used promptly, before the paint gets dry. j. Insignia and buttons having a gold finish should be cleaned with ammonia and water. Don’t use an abrasive, as it will remove the gold plating. Rubber bands, manila paper, or any material containing sulfur, if near medals, insignia, or buttons, will tarnish them. g. Keep and wear your service hat in the shape in which it is issued. Brush it frequently to remove dust. Be sure that the hat cord is sewed on. h. (1)* In cleaning your boots or shoes, first remove all dirt or mud by scraping with a dull instrument such as a sliver of wood. Do not use a piece of glass or a knife. Next, wash them with a sponge saturated with a heavy lather of castile soap. Never use hot water or allow the leather to soak in water. Wipe off the lather with the wet sponge and rub the leather thoroughly and vigorously with a clean cloth until nearly dry. Drying by exposure to the sun, fire, or strong heat will cause the leather to stiffen and crack and is forbidden. Stuffing the toes with crumpled paper helps in the drying and tends to hold them in shape. After boots or garrison or dress shoes have dried, a good polish should be applied, provided that it has been authorized by the garrison or unit commander. In the case of work shoes an application of dubbing should be well rubbed in. (2) For other articles of leather equipment, clean as de- scribed above. In the case of unfinished leather, while it is still moist give it a very light coat of neat’s-foot oil by rubbing with a soft cloth moistened with the oil. Any oil not absorbed by the leather should be wiped off. If more than a light coat of oil is given, the leather will be greatly darkened and will soil your clothing. If the leather is to be polished it should be cleaned as described above and then polished with a good grade of polish in the proper color. MEDICAL SOLDIER’S HANDBOOK Section III 21 WEARING THE UNIFORM 59. The manner in which your uniform should be worn is shown in figure 6. Figure 6. Uniforms for Enlisted Men. ® Field service. ® Garrison service, mounted. (D Garrison service, dismounted. ® Overcoat. Chapter 6 EQUIPMENT Paragraphs Section I. The gas mask 60-66 Section II. Field equipment 67-74 Section HI. The medical soldier’s field equipment ... 75-76 Section IV. Packing individual equipment on horse .. 77-78 Section V. Display of equipment 79 Section I THE GAS MASK 60. The American Army service gas mask which is issued to you is the best all around military gas mask known. It is the main device for protecting your face, eyes, lungs, and throat from the effects of gases, smokes, fumes, dusts, and chemical fogs, and is made to take care of all the known chemical warfare agents. However, it will not protect against carbon monoxide or ammonia gas and is not suitable for use in fighting fires or in industrial accidents where ammonia gas •is present. FACE PIECE AIR DEFLECTED AGAINST EYEPIECES BEFORE INHALATION- DEFLECTOR AIR EXPELLED HERE HOSE AIR PASSAGE- MECHANICAL v/FILTER CARRIER - CHARCOAL AND SODA LIME CANISTER 'AIR ENTERS HERE Figure 7. How Your Gas Mask Works. 22 MEDICAL SOLDIER’S HANDBOOK 23 [ GAS CHANNEL EYE PIECES NOT CENTERED NOT LEVEL ® Faulty—front view EYE PIECES ARE LEVEL (D Correct—front view. Figure 8. Mask Adjustment. 24 MEDICAL SOLDIER’S HANDBOOK HEAD PAD NOT CENTERED GAS S CHANNEL STRAPS NOT ADJUSTED , EVENLY ® Faulty—rear view. HEAD PAD CENTERED WELL DOWN 'Ttabs EQUALLY ADJUSTED Figure 8. Mask Adjustment—Continued. ® Correct—rear view. MEDICAL SOLDIER’S HANDBOOK 25 61. a. The gas mask consists essentially of a facepiece, a hose, and a can containing a filter. This can, called the can- ister, is connected by the hose to the facepiece, which fits tightly to your face. Air is drawn in through the canister, where the objectionable gases, vapors, fogs, dusts, or smokes are removed, either mechanically or by chemical action. The cleaned air then passes on to the facepiece where it is breathed and then expelled through a valve. The drawing (Figure 7) illustrates how your gas mask works. b. The facepiece is made of rubber or a similar fabric and is held to your face by means of an elastic head harness. These materials may easily be damaged by carelessness and improper use. For example, if a facepiece is not properly placed in the carrier, or if it is distorted, a crease might be formed which would prevent a positive seal between the face- piece and your face. Unless the rim of the facepiece fits snugly to your face, gas-laden air may leak in. The elastic straps may also become damaged by excessive stretching. 62. Inexperienced persons often make the mistake of pull- ing up the head harness too tight, or of pulling up one strap more than its mate. If you adjust the harness too tightly, you will soon get a headache. If you adjust the head harness unevenly, a channel and consequent leak between the face- piece and your face is often formed. (Fig. 8.) This also often happens if you put the facepiece on carelessly. 63. The canister is the most important part of your mask, for it is here that the air is cleaned and made safe for breath- ing. It contains chemicals which will be damaged if water gets inside. You must always guard your gas mask canister from excess moisture. 64. You should always be careful of your gas mask. Never use it as a seat or pillow. Although it is pretty strong and rugged, it will not stand abuse. You should never carry any- thing but the gas mask and antidim can in the carrier. Socks, tobacco, apples, or other objects may choke up the mask, or otherwise injure it. Such objects also prevent quick removal of the facepiece from the carrier. The wise soldier quickly learns how to inspect his gas mask and makes a daily inspection of it as a matter of habit. 65. Before you become accustomed to it you may find your gas mask uncomfortable. But as you become more used to wearing it, and as you habitually train yourself to work and exercise with it properly adjusted, such discomfort disap- pears. It is only by wearing the mask daily and performing some sort of work, or drill, while masked that you can train your chest and lung muscles to the unaccustomed extra work and strain. You also become accustomed to your decreased ability to move and see. When adjusting the gas mask at the command gas, care in putting it on is more important than great speed. However, with practice, you should be able to stop breathing for 30 seconds, and in this time the mask can be securely and carefully adjusted to your face. 66. An enemy will try to attack troops who are known to be inexperienced or careless in gas mask drill and gas dis- cipline. If he suspects that your battalion as a whole is Med. Sol. Hb. MEDICAL SOLDIER’S HANDBOOK 26 liable to go out without gas masks, or that it cannot do a reasonable amount of work while masked, or that it fails to post gas sentries, he will very likely make a gas attack. To beat him, you should always keep your gas mask with you, keep it in good condition, and not abuse it. You should know how to put it on, and be able to wear it for several hours at a stretch while fighting or working, and, finally, you should always be on the lookout for a gas attack. Section II 67. The articles of field equipment issued to you have been developed and manufactured after careful study and experi- ment by the War Department. You must keep them in proper condition for field service and not remove or change the finish of any article. If it becomes necessary to renew any worn surfaces your company, troop, or battery commander will explain how it is to be done and supervise the work. By following the instructions given below you will find that your equipment will always be in first class condition for inspec- tions and field service. 68. All cloth equipment should be well brushed frequently with a stiff-bristled brush. A dry scrub brush will serve this purpose. During ordinary garrison duty it should seldom be necessary to wash the equipment. Soiled spots can usually be removed by a light local washing. During field service, equipment becomes soiled much more rapidly. Dirty equip- ment should be given a thorough washing, otherwise it will become insanitary and liable to rot. 69. A white soap is issued for the washing of cloth equip- ment, but any good grade of white laundry soap will serve the purpose. Strong soap, such as yellow kitchen soap, should never be used for washing equipment because it usually con- tains a large amount of free alkali and it will fade or bleach the material. a. Before being washed, the equipment should be thoroughly brushed to remove all dust and mud. b. Spread the belt, haversack, pack carrier, or other article on a clean board or rock and apply the soap solution with a scrub brush. After working up a good lather, wash off with clear water. A bad grease spot can ordinarily be removed by the direct application of soap with the brush, followed by a good scrubbing. c. Always dry washed equipment in the shade. The bleach- ing action of the sun on damp fabric is strong. Equipment wet from a march in the rain should also be dried in the shade if practicable. Excessive fading of equipment can thus be reduced. 70. Such articles as the canteen and the different parts of the mess outfit should be kept clean. Water and food should not be kept in them longer than necessary. Aluminumware should be cleaned with soap and water, although a little sand will sometimes assist in the cleaning of canteens. Some- FIELD EQUIPMENT times small white particles will be found in canteens which have been filled with hard water. These particles are harm- less. When not actually in use. the canteen should be emptied and the cup left off to dry. 71. The knife blade is made of tempered steel and when put away for long periods should be covered with a light film of oil to prevent rust. 72. Bits, curb chains, and all metal parts issued unpainted will be oiled lightly when not in use. When in use they will be kept clean and free from rust. Removing paint from metal parts which are issued painted is prohibited except under the direction of your company, troop, or battery commander. 73. a. Leather equipment is expensive, and its proper care is important because of its value and the fact that if neg- lected it soon becomes unserviceable. b. Two agents are necessary to the proper care of leather equipment—a cleaning agent and an oiling agent. The cleaning agent issued is castile or similar type soap; the oiling agents are neat’s-foot oil substitute, saddle soap, and harness soap. c. Neat’s-foot oil is the most satisfactory oiling agent for leather. It penetrates the pores and saturates the fibers, making them pliable and elastic. Dry leather is brittle, but leather oiled excessively will soil the clothing and accumu- late dirt. d. Leather should be treated with enough oil to make it soft and pliable, but should not be given so much oil that it will squeeze out. c. When leather is washed with any soap, some of the surface oil is always removed. This leaves the surface, after drying, hard and liable to crack. If this surface oil is re- placed by direct application of neat’s-foot oil, it is very dif- ficult not to apply too much. This has led to the develop- ment of saddle soaps, which contain a small amount of neat’s-foot oil, so that the surface of the leather after wash- ing is not deprived of its oil. f. Leather equipment in use should be wiped off daily with a damp cloth to remove mud, dust, or other dirt. Under no con- ditions should it be cleansed by immersion in water or in tun- ning water. This daily care is necessary to maintain the ap- pearance of the equipment, but is insufficient alone to pre- serve it properly. At intervals of from 1 to 4 weeks, depending upon circumstances, it is essential that the equipment be thoroughly cleaned in accordance with the following instruc- tions: (1) Separate all parts, unbuckle straps, remove all buckles, loops, etc., where possible. (2) Wipe off all surface dust and mud with a damp (not wet) sponge. Rinse out the sponge and make a lather by rubbing it vigorously on white soap. The sponge must not contain an excess of water if a thick lather is desired. When a creamy lather is obtained, clean each piece of equipment, taking care that no part is neglected. Each strap should be drawn its entire length through the lathered sponge to remove the dirt and sweat from the leather. MEDICAL SOLDIER’S HANDBOOK 27 (3) Rinse the sponge again and make a thick lather with saddle soap; go over each separate piece with the same care as before. (4) Allow the leather to become partially dry and then rub it vigorously with a soft cloth. The equipment should now have a neat, healthy appearance. g. If the foregoing instructions have been carefully fol- lowed, the leather should now be soft and pliable and no further treatment should be necessary. At certain intervals, however, it is necessary to apply a small amount of neat’s- foot oil. No general rule in regard to the frequency of oiling can be given because different conditions of climate and service have to be taken into consideration. Experience has shown that during the first few months of use a set of new equipment should be given at least two applications of neat’s- foot oil per month. Thereafter need for oiling is indicated by the appearance and pliability of the leather. Frequent light applications of oil are much better than infrequent heavy applications. h. New leather equipment should always be given a light application of neat’s-foot oil before it is put into use; clean- ing with soap is unnecessary because the equipment is clean. i. Whenever leather becomes wet from any cause what- ever, it should be slowly dried in the shade. Leather should never be dried in the sun or close to a radiator, fire, or other heat. 74. Soon after your equipment is issued to you, you will receive instructions from your officers and noncommissioned officers as to how the different parts should be assembled so that it can be carried or worn. The following table will help you in remembering the different items of your equipment and how they will be carried. This table includes the basic equipment common to the greater portion of our military service. Should special equipment be issued to you for par- ticular conditions, or should you belong to an arm or service which has its own special equipment, you will receive instruc- tions as to how it will be carried. 28 MEDICAL SOLDIER’S HANDBOOK MEDICAL SOLDIER’S HANDBOOK Field equipment, enlisted men (other than clothing worn on person) Article Dismounted Mounted on horse (artillery drivers, see next column) Driver, horse (ar- tillery only) Driver, vehicle Men mounted in vehicle* Bag, canvas, field, with carrying strap. Bags, feed and grain Belt, p i s tlo 1, re- volver, cartridge, or magazine. Blankets, wool .... Canteen, cup and cover. Glasses, field .... Handkerchiefs .... On right side, slung by a strap passing over left shoulder to right side. On right side, slung by a strap pass- ing over left shoulder to right side or in'on ve- hicle. On right side, slung by a strap pass- ing over left shoulder to right side or in/on ve- hicle. On pommel under raincoat. On seat of saddle, off horse, or on limber. Worn Worn Worn Worn. In pack carrier or in blanket roll. Carried on back or in/on vehicle. On belt, left rear or in/on vehicle. On right side, slung by strap passing over left shoulder. In blanket roll. On back, attached to belt. Attached to haver- sack, or bag, can- vas, field. In pack carrier. Carried on back or in cargo ve- hicle. On belt, left rear On right side, slung by strap passing over left shoulder. In blanket roll .. On back, attached In cantle or blanket roll. Slung from off (right) cantle ring, and attached to off saddlebag. On right side, slung by strap passing over left shoul- der. Near (left) saddle- bag. In cantle or blanket roll. Slung from near (left) cantle ring, off horse and at- tached to saddle- bag. In pack carrier or in blanket roll. Carried on back or in/on vehicle. On belt, left rear or in/on vehicle. Near (left) saddle- bag, off horse. In blanket roll, or in saddlebag. On back, attached to belt. Attached to bag, canvas, field, near saddlebag, or to rear of haversack. Helmet, steel to belt. Attached to rear of haversack. Attached to near (left) saddlebag. Attached to off (right) saddle- bag, off horse. MEDICAL SOLDIER’S HANDBOOK Field equipment, enlisted men—Continued Article Dismounted Mounted on horse (artillery drivers, see next column) Driver, horse (ar- tillery only) Driver, vehicle Men mounted in vehicle* Holster, pistol .... Horseshoes, 2 extra, with naiis. Intrenching tool (machete or bolo). Kit, grooming, com- plete, and saddle soap and sponge. Kit, mess, complete Laces, shoe, extra.. Attached to belt, opposite right hip. Attached to belt, opposite right hip. In off (right) sad- dlebag. Attached to belt, opposite right hip. In off (right) sad- dlebag, off horse. Attached to belt, opposite right hip. Attached to belt, opposite right hip. Attached to rear Attached to rear of haversack. of haversack. In off (right) sad- dlebag. In near (left) sad- dlebag. In near (left) sad- dlebag. Strapped to halter under throat latch. Slung under left arm by strap passing over right shoulder. Strapped to pom- mel over feed bajr. Left front of belt.. Right rear of belt In off (right) sad- dlebag, off horse. In near (left) sad- dlebag, off horse. In near (left) sad- dlebag, off horse. Strapped to halter under throat latch. Slung under left arm by strap passing over right shoulder. Strapped across seat of saddle, off horse. Left front of belt.. Right rear of belt In haversack .... In haversack .... In bag, canvas, field, in haver- sack, or in sad- dlebag. In bag, canvas, field, in haver- sack, or in left saddlebag. In haversack or in bag, canvas, field. In haversack or in bag, canvas, field. Mask, gas, sendee., Slung under left arm by strap passing over right shoulder. Slung under left arm by strap passing over right shoulder. Attached to haver- sack, to bag, can- vas, field, or in/ on vehicle. Left front of belt.. Right rear of belt Slung under left arm by strap passing' over right shoulder. Pocket, magazine, web, double. Pouch, first-aid packet. sack. Left front of belt Right rear of belt sack, to bag, can- vas, field, or in/ on vehicle. Left front of belt. Right rear of belt. ♦Alternative methods for carrying equipment of men mounted in vehicles are prescribed for the reason that types of vehicles, nature and lengths of march, etc., vary so greatly that the description of only one method for one vehicle will not suffice. Field equipment, enlisted men—Continued Article Dismounted Mounted on horse (artillery drivers, see next column) Driver, horse (ar- tillery only) Driver, vehicle Men mounted in vehicle* Raincoat In haversack .... In haversack .... Attached to pom- mel over feed bag. Distributed b e- Strapped across seat of saddle, off horse. Distributed b e- In haversack, in bag, canvas, field, or in/on vehicle. In haversack, in bag, canvas, field, or in/on vehicle. In haversack or in Saddlebags, pair .. tween the two saddlebags to bal- ance load. On bars of saddle tween the two saddlebags of horse to balance load. Across seat off sad- bag, canvas, field, or in saddlebags. Motorcyclists—in bag, canvas, field. Scabbard, bayonet Attached to left side of haver- sack. in rear of cantle. die or on bars of saddle in rear of cantle, off horse. rear of seat. Attached to near (left) side of sad- dle, under skirt. In near (left) sad- dlebag. In near (left) sad- dlebag. In off (right) sad- dlebag, or over saddle blanket. Attached to belt .. Around neck, un- der shirt. Covering (ipol, e, rope, and pins within) blanket roll, on cantle or in/on vehicle. Attached to vehicle In blanket roll or in saddlebag. In blanket roll or in saddlebag. side of haver- sack. Set, toilet Socks, pair Surcingle In haversack .... In blanket roll .. In near (left) sad- dlebag, off horse. In near (left) sad- dlebag, off horse. Attached, one to each saddlebag, off horse. Attached to belt.. Around neck, un- der shirt. Covering (pole, rope, and pins within) blanket roll, carried on seat of saddle, off horse or on lim- ber. In blanket roll. In blanket roll. Suspenders Tag. identification, with tape Tent, shelter half, complete with pole, rope, and pins. Around neck, un- der shirt. In pack carrier, carried on back, or in vehicle. Around neck, un- der shirt. Covering (pole, rope, and pins within) blanket roll, carried in/on vehicle. Around neck, under shirt. Covering (pole, rope, and pins within) blanket roll, carried on back or in/on ve- hicle. ♦Alternative methods for carrying equipment of men mounted in vehicles are prescribed for the reason that types of vehicles, nature and lengths of march, etc., vary so greatly that the description of only one method for one vehicle will not suffice. MEDICAL SOLDIER’S HANDBOOK 31 Field equipment, enlisted men—Continued Article Dismounted Mounted on horse (artillery drivers, see next column) Driver, horse (ar- tillery only) Driver, vehicle Men mounted in vehicle* Towel, face In haversack .... Suspended o n right side by strap passing over l|e f t shoulder. In blanket roll. Carried on back or in cargo ve- hicle. In near (left) sad- dlebag. Suspended on right side by strap passing over left shoulder. In near (left) sad- dlebag, or blanket roll. In near (left) sad- dlebag, off horse. In haversack, in bag, canvas, field, or in saddlebag. In haversack or in bag, canvas, field. Suspended on right side by strap passing over left shoulder. In blanket roll. Carried on back or in cargo ve- hicle. Underclothing .... In near (left) sad- dlebag. off horse, or in blanket roll. In blanket roll. In bag, canvas, field, or in saddlebag. Whistle (challn, hooked to left shoulder loop buttonhole). In left pocket, shirt or coat. In left pocket, shirt or coat. In left pocket, shirt or coat. In left pocket, shirt or coat. In left pocket, shirt or coat. ♦Alternative vehicles, nature will not suffice. methods for carrying equipment of men mounted in vehicles are prescribed for the reason that types of and lengths of march, etc., vary so greatly that the description of only one method for one vehicle MEDICAL SOLDIER’S HANDBOOK MEDICAL SOLDIER’S HANDBOOK Section III 33 THE MEDICAL SOLDIER’S FIELD EQUIPMENT 75. Method of Assembling: Haversack and Pack Carrier. B. To adjust the pistol belt. Take the belt and adjust it so that it fits loosely around the waist and when buckled rests well down over the hip bones and below the pit of the abdomen. The belt is put on with the male buckle on the right. Place the belt on the ground in front of you, inner side down and male buckle to your right. (1) To attach first aid vouch. Attach the first aid pouch by engaging the double hook attachment in 5th and 6th eyelets from your right. Insert hooks from under side. Place the first aid packet in the pouch with the tab or ring down and secure the flaps. Figure 9. Pistol Belt. Figure 10. Haversack Without Pack Carrier. (2) To attach canteen cover. Attach the canteen cover by engaging the double hook attachment in the 5th and 6th eyelets from your left. Insert hooks from under side. Place the canteen and cup into the canteen cover with concave side down and secure the flaps. Place the assembled belt on the ground on your right. b. To attach pack carrier to haversack. (1) Spread the haversack on the ground in front of you, inner side down, outer flap and meat can pouch to the front. Place button- MEDICAL SOLDIER’S HANDBOOK 34 MEAT CAH POUCH SH*F HOOK SNAP HOOK FRONT PACK SUSPENDER -J FRONT RACK SUSPENDER UPPER RINDING STRAP MIDDLE BINDING STRAP LOOP FOR RATONET SCABBARD LOWER BINDING STRAP REA* BELT 5USRENDER BUTTON HOLED EDGE they are in camp; when quartered in temporary structures, especially constructed for military purposes, they are in can- tonment. 142. Camp Sites. The ideal camp site should have plenty of pure water, tough grass turf, and access to a good road. It should be of ample size and provide concealment from enemy airplanes. It should avoid dusty, polluted, or damp soil, stag- nant water, and dry stream beds. In hot weather a shady area free of underbrush is desirable. In war, battle needs may force the use of poor camp sites. 143. Personal Care and Comfort, a. (1) The shelter tent is a small tent capable of providing shelter for two men. (See fig. 32.) (2) It may be pitched singly or two tents may be pitched together known as a double shelter tent. (See fig. 33.) Use of double shelter tents conserves space and, being occupied by four men, they are warmer. (3) (a) The platoon having been formed for shelter tent pitching as described in paragraph 125 (platoon drill), at the command, pitch tents, each man (if armed with the rifle) steps off obliquely with the right foot a full pace to the right front, lays his rifle on the ground, muzzle to the front, barrel to the left, butt near the toe of his right foot. He then steps back into place. All men then unsling equipment and place 82 MEDICAL SOLDIER’S HANDBOOK Figure 32. Shelter Tents. MEDICAL SOLDIER’S HANDBOOK 83 Figure 33. Double Shelter Tents. 84 MEDICAL SOLDIER’S HANDBOOK their packs (or rolls) on the ground in front of them, haver- sacks (saddlebags or field canvas bags) up and to the front, the packs two paces in front of their positions. They then open their packs and remove their shelter halves, poles and pins. Each odd-numbered man, when not armed with a bayonet, places a pin in the ground on the spot which he previously marked with his left heel. The men of each pair spread their shelter halves on the ground which the tent is to occupy, triangle to the rear, buttons to the center, the even-numbered man’s half on the left. (b) They then button the halves together. The odd- numbered man adjusts his pole through the eyelets in the front of the tent and holds the pole upright in position be- side the bayonet (or pin). The even-numbered man pins down the front corners of the tent in line with the bayonets (or pins). He then drives the front guy pin a rifle length in front of the front pole. If he is not armed with the rifle, he measures this distance with his tent rope by taking the distance from the base of the front tent pole to one of the front tent pins. He places the loop of the guy rope over the front guy pin and runs the other end of the rope through the loops of the shelter halves and ties it, making sure that the pole is vertical when the rope is taut. The even-num- bered man then adjusts the rear tent pole through the eye- lets in the rear of the tent. The odd-numbered man pins down the rear of the tent and drives the rear guy pin so that it is a bayonet length in rear of the rear pin of the triangle. If he is not armed with the bayonet, he drives the rear guy pin two and a half tent pin lengths from the rear triangle pin. He then adjusts the guy rope. The even-num- bered man then drives the remaining pins on the left of the shelter tent and the odd-numbered man drives them on the right. (c) On maneuvers and in active operations you and your tentmate will norfnally pitch your tent where you will be concealed from enemy observation. The principles of tent pitching given in (a) and (b) above will apply, but there may be no attempt to aline the tents of your organization. (4) If possible, pick a dry place on high ground for your tent. As soon as your tent is pitched, ditch it, even though you expect to be there only one night. Dig a ditch about 3 inches deep along each side, with a drainage ditch leading off at the lowest side. If it looks as though water may come from higher ground, dig a ditch to divert the water before it can reach your tent. In cold or windy weather the dirt should be banked around the tent. If it rains, loosen the guy ropes to prevent the tent pegs from pulling out. Be sure your tent pegs are securely driven in. If the weather is cold, pitch the closed end of the tent into the wind. (5) Figure 22 shows you in detail how to display your equipment, if it is required. b. Take time to make a good bed; it will mean better sleep- ing. First, level the ground. Then place straw, leaves, or branches on the ground. Place your raincoat over this bed- ding to keep out the damp. In cold weather you need some- MEDICAL SOLDIER’S HANDBOOK 85 thing warm under you as well as over you. A newspaper be- tween blankets and clothing, or straw around the feet, will help. Don’t lie down directly on wet ground. Another means for protection against cold is to fold the blanket in such a manner as to form a sleeping bag. Large horse-blanket safety pins or any large safety pins are neces- sary to keep the folds in position. c. Take off any wet clothes as soon as you can after reach- ing camp. Put on dry clothes, or, if that is impossible, dry your clothes before a fire and then put them back on. If you cannot do this, wring them out. Dry your shoes by placing warm, not hot, pebbles inside the shoes. Do not place the shoes next to a fire. It is a good idea to oil the shoes while they are dry to make them waterproof and pliable. d. (1) As soon as possible after reaching camp wash your feet with soap and water. Dry them carefully, especially be- tween the toes. Until your feet are hardened, dust them with foot powder, which you can get from your corporal or the noncommissioned officer in charge of your unit. Put on a clean pair of socks and the extra pair of shoes. (2) If blisters have appeared on your feet they should be painted with iodine and emptied by pricking them at the lower edge with a pin which has been passed through a flame. Do not remove the skin. The blister should then be covered with zinc oxide plaster which can be obtained at the aid station. If you have serious abrasions on your feet, corns, bunions, or ingrowing nails, have your name put on the sick report and report to the aid station for treatment. (3) See that your toenails are short and clean. Cut them straight across and not on a curve. This prevents ingrowing nails. e. Before building a fire, clear away all dry leaves or grass, leaving a bare spot. Dead branches from trees are more apt to burn than wood gathered off the ground. Stones heated red hot and then placed under a bucket in your tent make a good stove. A canteen filled with hot water makes a good hot water bottle for very cold feet. f. Read instructions for camp sanitation in chapter 13. 144. Camps and Bivouacs for Mounted Organizations, a. In campaign your organization will probably be scattered over a large area to take advantage of cover from ground and air. It will often be necessary to tie horse's individually to trees or bushes. Soldiers are grouped together by squads or sec- tions, and bivouac close to their mounts to care for them and be able to leave at short notice, or in the dark. Provide good, dry standing ground for your horse, clear of rocks and stub- ble, and bed him down well. Guard against the possibility of his becoming entangled in the halter rope or picket line. b. In severe weather protect your horse from cold winds. If woods with heavy undergrowth are not available, protec- tion may be obtained by using the branches of trees. Avoid stream beds in rainy seasons, as a freshet upstream might cause trouble. c. By taking the precautions mentioned above it will not normally be necessary to use the saddle blanket as a horse cover because the weather is severe. Horses in good condi- 86 MEDICAL SOLDIER’S HANDBOOK tion can withstand severe weather very well. If your horse becomes ill from exhaustion or other causes, even in hot weather, it may be necessary to keep him warm and the saddle blanket is useful for this purpose. You will be well repaid for the care and attention you give your mount. d. Vehicles should stand on hard ground and be grouped for ease of servicing and to prevent hostile observation by the use of natural cover or camouflage. Space is required for turn-arounds and at least two exits from the bivouac area are desirable. Chapter 11 USE OF COMPASSES AND MAPS Section I. Use of the compass 145-149 Section II. Use of maps 150-158 Paragraphs Section I USE OF THE COMPASS 145. As a soldier, you must be thoroughly familiar with the compass and know how to use it by day and by night. 146. Of the several types of compasses issued to the Army, the prismatic compass (see figs. 34 and 35) is the one most generally used. The compass is an instrument which, by means of a magnetized dial-needle, indicates magnetic north. The dial-needle b is graduated into 360 equal subdivisions called degrees, commencing with 0 (zero), or magnetic north, and reading clockwise around the entire circle until 0 (or 360°) is reached again. You will note that with the com- Figure 34. Prismatic Compass, Showing Compass Open and in Posi- tion for Measuring Azimuth in Daylight. pass dial-needle at rest the 0 is to the north, the 90° gradua- tion is east, 180° is south, 270° is west. Instead of using the directions north, east, south, and west, we may use the terms magnetic-azimuth 0°; magnetic-azimuth 180°, etc. The mag- netic-azimuth of any object is merely the compass reading, expressed in degrees, of a line extending out from the center of the compass toward the object. 147. If a line is drawn from the center of the dial-needle to any object in your view you can find its azimuth by de- 88 MEDICAL SOLDIER’S HANDBOOK termining which number, or degree of graduation, this line crosses on the compass dial. It is done in this manner: Raise the eyepiece a and the cover d and move the clamp at g releasing the dial (b) so that it swings freely. Hold the compass as shown in figure 34. Turn about slowly and carefully until the object, the azimuth of which you want, is lined up by the slit on eyepiece a and by the hair-line f on the glass cover. Allow the dial-needle b to come to rest. ITien read the azimuth through the eyepiece a. 148. At night you may often depend on your compass almost entirely to keep on a required direction. Assume you are to march at night on a magnetic azimuth of 55°. By daylight, or at night by light in a sheltered place, release the compass box glass by unscrewing the screw at h. Move the radiolite marker c on the movable index ring to 55, the grad- uation halfway between the figure 5(50) and 6(60) on the graduated circle around the outside of the compass case. Then clamp the movable ring with the screw at h. Now hold the compass horizontally and carefully turn about until the dial-needle points to the radiolite marker c on the mov- able index ring. The magnetic-azimuth course of 55° is now indicated by the radiolite markers j. On a dark night it may be necessary for another soldier to move forward to the limit of visibility while from the rear you use the compass to direct his movement to the right or left in the proper direction. While still in sight of you your comrade halts, waits for you to come abreast, and then repeats as necessary. 149. The compass may be used in a number of ways, all of which can be practiced by you until you are thoroughly pro- ficient in its use. USE OF MAPS Section II 150. The ability to read a map quickly and accurately is of great importance to you as a soldier. With this ability, and a map in your possession, you will always be able to locate yourself in unfamiliar country. You will be able to accom- plish your mission without wasting valuable time in search- ing for your destination, and you will be able to return to your commander in time for the information you have ob- tained to be of value to him. 151. Map reading is not difficult. It is nothing more than the ability to get a clear idea of what the ground looks like from seeing a map of that ground. You will probably receive further instruction from your officers in map reading, but if you have a good grasp of the following simple facts you can feel confident that you know how to understand and use military maps. 152. a. A map represents a part of the earth’s surface shown on paper. Maps are drawn to scale. This means that a cer- tain distance on a map always represents on that map a cer- tain distance on the ground. For example; suppose the scale of a map is 1 inch equals 1 mile. This means that if, with a ruler, MEDICAL SOLDIER’S HANDBOOK 89 you find that on the map, the distance between two towns, A and B, is 1 inch, you would actually travel 1 mile if you walked in a straight line from A to B on the ground. If the distance between towns C and D on this map is 2 inches then we immediately know that actually these two towns are twice as far apart on the ground as A and B. Figure 35. Prismatic Compass, Showing Compass Open for Measure ment of Azimuth at Night by Means of Radiolite Marker. b. Scales are usually shown on a map in one of three ways, as follows: (1) They may be shown by a single or double line, divided into parts. Each part is marked with the distance which it represents on the ground and may be expressed in feet, yards, or miles. This is the way the scale is shown on automobile road maps, with which you are familiar (fig. 36A). (2) The scale may be stated in words or figures, as 3 inches=l mile. As explained above, this means that 3 inches on the map equals 1 mile on the ground (fig. 36B). (3) The scale may be expressed as a “representative frac- tion” (called RF), which is merely a fraction in which the numerator (above the line) is a certain distance on the map, and the denominator (below the line) is the corresponding distance on the ground. Suppose the scale of our map is 1 inch . 1 inch equals 1 mile. We could write the fraction . For con- Med. Sol. Hb. 90 MEDICAL SOLDIER’S HANDBOOK venience, however, we always write RF with both the numer- ator and denominator in the same unit. Since we know there 1 inch are 63,360 inches in a mile, we can write RF gg ggp jn-ches~ and, by omitting the word “inches,” we have — gg ggQ—. So when 1 we see a map with the RF "ggggQ-> or written as a ratio 1:63,360, we know that 1 inch on the map equals 1 mile on the ground (fig. 360. In the same way, if we have a map with 1 6 the RF we can change the fraction to 'gg'ggg and 1 we see at once that the RF yb 560~ *s the same thing as though it were written 6 inches equal 1 mile. 30 miles A GRAPHIC SCALE 3 INCHES = I MILE §. WORDS & FIGURES 0R "63*360 0. REPRESENTATIVE FRACTION (R.F.) Figure 36. Scales. 153. On practically all military maps which you will handle, the north is at the top of the map. On many maps the north is also shown by an arrow, which points in that direction. Sometimes two arrows are used. The arrow with a full barb, or a star at the end, points toward the north pole or true north. The arrow with a half barb points toward what is MEDICAL SOLDIER’S HANDBOOK 91 known as the magnetic pole which attracts the compass needle. 154. a. Your map is said to be “oriented” when the north and south arrow on the map points north on the ground. This makes all lines on the map parallel to corresponding lines on the ground. Your map should always be oriented whenever you use it. It is just as awkward to attempt to use an un- oriented map as to read a book with the pages turned upside down or sideways. b. There are two simple and easy ways of orienting your map— (1) Suppose there are two points on the ground that you can also locate on the map. Draw a line on the map between these two points which we will call X and Y. Stand at point X. Sight along the line X-Y on the map and turn the map until the line of sight points exactly at Y on the ground. Your map is then oriented. (2) You may also orient your map by compass. Turn the lid back and down and place the hair-line along the mag- netic north-and-south line of the map, the lid lying to the north. Turn both the map and compass, keeping the hair- line over the magnetic north-and-south line on the map, until the compass needle points in exactly the same direction as both lines. Your map is then oriented (fig. 37). 155. You are said to be oriented when you know your own position on an oriented map and the directions on the ground. Suppose you have been proceeding on a mission over unfa- miliar ground and you are not now sure of your location on the map. Orient your map. Select a feature of the terrain, such as a hill, and from that feature draw a line on the map toward yourself. Now do the same with reference to another terrain feature. The point where these lines cross or inter- sect will be your location on the map. 156. a. One of the most important features of map reading will be your ability to determine quickly and accurately the positions of various features on the map. A simple and easily understood method is used in our Army which will help you to do this. It is known as the system of rectangular coordi- nates or the “grid system.” A series of parallel east-and-west and north-and-south lines are placed on the map and divided into a number of squares. This series of lines is called a “grid.” The interval between these lines is usually 1,000 yards, that is, each square is 1,000 yards on a side. (See fig. 38.) b. Beginning at the lower left hand, or southwest corner, the lines of the grid are numbered. The lines running north and south are numbered in order from left to right, that is, from west to east. In the same way, the lines running east and west are numbered from bottom to top, that is, from south to north. These numbers are placed on the margins of the map. c. Now it is very easy to designate any square on the map by giving the numbers of the lines which intersect at its lower left hand corner. For example, the square containing the point B would be designated by giving first the north- south line and next the east-west line, with a dash between them and inclosed in parentheses, thus (152-267). But since, MEDICAL SOLDIER’S HANDBOOK • PLACE HAIRLINE OF COMPASS LID ON MAGNETIC NORTH LINE. Figure 37. Orientation by Compass. on this particular map, all the north-south lines start with 15, and all the east-west lines with 26, we can omit the 15 and the 26 and designate the square containing the letter B as (2-7). This expression (2-7) is called the rectangular coordinate of the square containing the letter B. The prin- cipal thing for you to remember is that you read first the number of squares to the right of the southwest comer of the map and next the number of squares up. A simple rule is: Read right up. MEDICAL SOLDIER’S HANDBOOK 93 Figure 38. Rectangular Coordinates. d. But suppose we wish to designate the point B more closely than by just giving the coordinates of the square in which it lies. Divide the sides of the square into ten equal parts as shown by the dots in figure 38. Now we see that B is three subdivisions east of the line 152 and four subdivi- sions north of the line 267. Therefore, the coordinates of B are (152.3-267.4) or (2.S-7.4). Become familiar with the sys- tem of reading and designating map features by means of coordinates as rapidly as possible. 157. a. You will probably remember the maps contained in your school geographies, as well as the common automobile road maps. On these maps certain signs, such as dots, are used to represent cities; other signs, such as wavy lines, repre- 94 MEDICAL SOLDIER’S HANDBOOK 300D ROADS. POOR ROADS TRAIL RAILROAD DOUBLE TRACK R.R. NARROW GAGE R.R. TELEGRAPH AND TELEPHONE LINES ELECTRIC POWER TRANSMISSION LINES BRIDGE FERRIES (RIVERS AND STREAMS ARE BLUE IN COLORED MAPS.) FORDS. DAM BUILDINGS CHURCH HOSPITAI SCHOOL CEMETERY- GRASSLAND (GREEN IN COLORED MAPS ) MARSH (BLUE IN COLORED MABS) wnnns (GREEN IN COLORED MAPS) Figure 39. Conventional Signs, MEDICAL SOLDIER’S HANDBOOK 95 Automatic Rifle Caliber .30 machine gun (arrow points IN MAIN DIRECTION OF FIRE) Antiaircraft machine gun Xa so k Caliber .50 antitank machine gun 37-mm 37-mm GUN 81-mm 81-mm MORTAR ■60 mm 60-mm MORTAR Machine gun, showing sector of fire AND DANGER SPACE (SHADED PORTION) Message center. Road block (IN RED) Gassed area (to be avoided) ..Observation post ..Trench and dugout Tank trap Infantry unit Armored force unit Air corps unit Artillery unit (field artillery and COAST ARTILLERY OTHER THAN ANTIAIRCRAFT) Cavalry unit. Chemical warfare unit. Coast artillery antiaircraft unit. Engineer unit. Figure 40. Military Symbols. MEDICAL SOLDIER’S HANDBOOK .Military Police unit. Medical unit. .Veterinary unit. .Ordnance unit. .Quartermaster unit. .Signal Corps unit .One squad. Company A, 48th Infantry. .1st Platoon, Company A, 48th Infantry. , Light Machine-Gun section, Company A, 48th Infantry. Machine-Gun Platoon, caliber .so. Company D, 48th Infantry. Troop A, 16th Cavalry. .Special Weapons Troop, 16th Cavalry. Machine-Gun Troop, caliber .so 16th Cavalry. Company A, 1st Armored Regiment (L). Battery B, 5th Field Artillery. Battery B, 104th Coast Artillery (A A). Battery B, 68th Field Artillery(Armoreo). 2d Battalion, 48th Infantry. ,7th Observation Squadron. 6th Quartermaster Regiment, Command Post, 8th Field Artillery. Medical unit in operation. Area occupied by Company A, 48th Infantry. Figure 40. Military Symbols—Continued. sent rivers and the boundaries of states or counties. Signs of this kind which are used to represent cities, rivers, boundaries, mountain ranges, and similar features are known as “con- ventional signs.” Military maps are usually of larger scale and contain many more details than those commonly met with in civil life. Therefore, to represent all the information set forth on them, it is necessary to use many more con- ventional signs than you knew in your school geography. Some of the most common conventional signs you will find on military maps represent roads, bridges, houses, fences, crops, and form lines. b. Thetee form lines are called “contours” and represent the variations of the earth’s surface caused by hills, ridges, valleys, and the like. The exact shape and condition of the ground have a great influence on all military operations. The map, therefore, must give the person who uses it a clear picture of the shape of the ground. Since the map is flat, special conventional signs are necessary to show these dif- ferent shapes. A contour line represents an imaginary line on the ground, every part of which is at the same height above sea level. If you walk along a contour line you neither go uphill nor downhill but always stay on a level. c. You should be able to identify at any time the conven- tional signs shown in figure 39. 158. It often becomes necessary to put on a map either the location of various bodies of troops, such as companies, battalions, or regiments; or command posts, observation posts, trenches, machine guns, boundaries, or other important data. To do this a special list of conventional signs has been pre- pared called military symbols. When put on a map, blue is used to designate our own forces and red the enemy. A few of the commonest are shown in figure 40. MEDICAL SOLDIER’S HANDBOOK 97 Chapter 12 SECURITY AND PROTECTION Paragraphs Section I. General 159-162 Section II. Security of individuals 163-170 Section III. Security of small units 171-178 Section I GENERAL 159. Most of the people you know in civil life probably make an effort at some time or other to save money. They may do this in various ways, such as putting it in the bank, investing in stocks or real estate, or buying different kinds of insurance. With money in the bank and insurance against accident, fire, or death they are relieved of worry as to what will happen to them or their families in case they should lose their jobs or suffer other misfortune. Their savings, in- vestments, or insurance are their protection against the uncertainties of the future. 160. You are also familiar with the police and fire depart- ments in your city or town. They are provided to protect you and your fellow citizens from the dangers of fire or the acts of dishonest persons. In many homes or farms that are beyond the city limits, watch dogs serve the same purpose. 161. All of these things give you, your family, and friends a feeling of safety. They relieve you of anxiety or worry and make you feel secure in the knowledge that misfortune can- not take you by surprise, for you are prepared to meet it. 162. Security in the Army is exactly the same thing except that instead of protection against fire, theft, or loss of a job we protect ourselves against the actions of the enemy. Each individual soldier and each organization take measures to prevent the enemy from taking them by surprise. No matter how thorough these measures seem to be, however, no indi- vidual or organization can ever afford to dismiss completely the possibility of unforeseen action by the enemy. On the other hand, if the security measures have been as carefully planned as possible, we are relieved of a great deal of anxiety and worry. We feel confident that we will be warned in sufficient time to take the necessary action before the enemy can seriously annoy us or interfere with our movements. Thus we are able to give the greater part of our efforts to the main job. When we can do this we are providing for our “freedom of action.” Section II 163. a. The first thing for you to remember is that in a campaign security is always necessary. This is true whether you are resting, marching, or actually fighting. You must always be on the alert for the movements or actions of the enemy, for the sooner you see them and give a warning the SECURITY OF INDIVIDUALS MEDICAL SOLDIER’S HANDBOOK 99 LEFT BANK I ABRUPT SLOPE RIGHT BANK BLUFF CLIFF LAST THING VISIBLE IS SKY LINE OR HORIZON Figure 41, Military Features of Terrain. CREST ' OF RIDGE ROAD FORK I RAVINE ROAD JUNCTION ' SADDLE i ROAD CENTER CULVERT DRAW PEAK, CUT GENTLE SLOPE CROSS ROAD CLEARING VALLEY 100 better chance you and your commander will have to protect yourselves and retain your freedom of action. b. During combat you may be required to serve as a scout, observer, sentinel, listener, sniper, messenger, or a member of a patrol. You may have to move about on the battlefield and work your way close to the enemy both by daylight and by darkness. In order to follow directions and report what you see, you must be able to recognize and use the military terms for different features of the terrain, such as valley, gentle slope, ravine, cut, and others. The terms which you will use most often are shown in figure 41. c. Before you can be expected to help provide security for your organization, however, you must first know how to pro- vide for your own security and protection. There are two ways in which you do this: the first is by learning how to move and remain concealed, or protected, from enemy obser- vation and fire by making use of the ground; the second way is by the proper use of your weapons and equipment. 164. Conduct of Individuals, a. In whatever arm or service you may be you must have a knowledge of the proper use of cover and concealment. You can never know when you may find yourself in a situation where you will have to apply this knowledge in order to save your life. In the military sense, to be “concealed” means to be hidden from view, but not nec- essarily protected from enemy fire. Concealment affords protection only when the enemy does not know that the terrain feature is occupied. “Cover,” on the other hand, means that you are both concealed and protected against enemy fire. b. Concealment may be provided by a bush or tall grass; cover may be a trench, fox hole, a building, an air-raid shelter, an armored vehicle, or the side of a hill away from the enemy. c. You are provided with an olive-drab uniform because that color blends in with the colors of nature and is difficult to see even at a short distance. If there is not sufficient natural concealment at hand, you can still further increase the concealment which your uniform affords you by using leaves, grass, nets, sacking, or other material which may be at hand. No piece of your equipment should glisten in the sun. When the ground is covered with snow concealment may be provided by wearing a cape or jacket of white sheeting. d. In observing, take the position which will most reduce your exposure to enemy view. Whenever possible this should be the prone position. Keep off the skyline and avoid taking cover behind single trees and bushes which stand out against the skyline or are in sharp contrast to the surrounding ter- rain. When observing from woods or a building, keep back in the shadows (figs. 42 and 43). You should look and fire around the right side of trees or other concealment. e. When in the open, lie motionless with your body stretched out flat against the ground. To observe, lift your head slowly and steadily. Hostile eyes may see abrupt and quick move- ments. f. If you must move to a new position for better observation, MEDICAL SOLDIER’S HANDBOOK MEDICAL SOLDIER’S HANDBOOK 101 CORRECT OBSERVING POSITION PRONE AROUND RIGHT SIDE OF TREE FROM A DITCH OBSERVE OVER BROKEN EDGE WITH BACKGROUND OBSERVE THRU BUSH IN PRONE POSITION OBSERVE PRONE UNDER CROSS BAR OF FENCE OBSERVE PRONE AROUND RIGHT SIDE OF ROCK OBSERVE OVER A CREST AT A POINT WHERE IT IS BROKEN OR GRASSY Figure 42. Correct Use of Cover. 102 MEDICAL SOLDIER’S HANDBOOK select your route carefully before you start. If your route car- ries you over open ground, spring up, run at top speed with body bent low to your next cover, and remain motionless (fig. 44). g. If a wall or hedge is available, move behind it, keeping well out of sight. If you have a slight rise of ground between you and the enemy, crawl with all parts of your body close to the ground. TREES CHOOSE A TREE WITH A BACKGROWND AND WITH THE TRUNK SCREENED FROM OBSERVATION THUS AVOIDING EXPOSURE WHILE CLIMBING HUG TRUNK WHILE OBSERVING IN OBSERVING FROM A DOOR OR WINDOW STAY WELL BACK IN SHADOWS OF THE ROOM Figure 43. Observing Positions, showing Correct Occupation. h. Before starting toward a new position, pick out those places around you where the enemy may be located and then move as though you were being watched from these places. Observe the new position closely to see that an enemy is not concealed there. In searching an area look first at the ground nearest you. Look carefully at every place that may afford an enemy concealment. Search a narrow strip close to you from right to left parallel to your front. Then search a second strip a little farther away but overlapping the first. Keep this up until the entire area is carefully covered (fig. 45). i. Know where you are at all times and do not become lost or confused as to the direction of your own troops. Remember all that you see, and report exactly what you have seen when you rejoin your organization. j. If your duties require you to move close to the enemy MEDICAL SOLDIER’S HANDBOOK 103 lines at night make sure that no piece of your equipment will glisten in the light of a flare, or make a jingle or other telltale noise when you move. Cover the luminous dial of your watch. k. In movement at night it is just as important as in the daytime to keep off the skyline and make use of shadows. If you are able to creep, crawl, and cross wire silently you will FROM A PLACE OF CONCEALMENT THE SCOUT OBSERVES POSITION FOR SIGNS OF HOSTILE OCCUPATION THEN HE APPROACHES IT BY A COVERED ROUTE Figure 44. Method of Approaching an Observing Position. make good progress at night, as you will be unseen. You must learn to distinguish different types of noises such as men dig- ging with shovels, cutting wire, and walking. Also the sounds made by helmets and equipment when struck by wire and brush. Stop often and listen. I. If you hear the sound of a flare, drop to the ground and remain motionless before the flare bursts. If you look at a bursting flare you will be blinded momentarily. If possible, 104 MEDICAL SOLDIER’S HANDBOOK inspect by day the area you will move over at night. Select your route out and back, and carefully note all features of the terrain that will assist in guiding you at night. Take ad- vantage of any sound, such as firing or wind, to cover the noise of your movement and move boldly. Consider all people or sounds beyond your own lines as hostile. Figure 45. Method of Searching Ground. m. During combat if you should be wounded and able to walk, report to your commander, turn over your ammunition, and leave the battlefield alone. Unless you have been de- tailed for that purpose, do not carry wounded men to the rear without a written order from an officer. That duty will be performed by medical or specially detailed personnel. n. If you become separated from your own unit, report to MEDICAL SOLDIER’S HANDBOOK 105 the commander of the nearest organization and fight with it until the action is over. Then ask for a written statement that you were present with the organization and present it to your unit commander when you rejoin. o. If you should be made a prisoner remember that by the international rules of warfare you are required to give only your name, grade, and serial number. Answer no other ques- tions and do not allow yourself to be frightened by threats into giving any information. Any facts about our troops or equipment may be of great interest to the enemy and result in defeat to the Army and death to your comrades. Do not give false answers to questions, as they are dangerous; merely refuse to answer. p. Do not take into combat letters, diaries, or other written papers. If maps or documents have been given to you, de- stroy them if it appears that you cannot escape capture. q. Remember that acts of violence against peaceful civilians and the damaging or looting of property are forbidden. They are punishable by trial before a military court. Prisoners and enemy wounded are not to be mistreated nor is their property to be taken from them. If civilians adopt hostile acts against you, force may be used to resist them. 165. Sentinels, a. A sentinel may be posted by a unit to insure its safety or readiness for action, or he may be a part of a security detachment sent out to protect a larger body. If you should be posted as a sentinel, you must be on the job every minute you are on post. You should have the follow- ing information, obtained from the person who posted you: (1) Direction and probable route of approach of the enemy. (2) Sector you are required to watch. (3) Names of terrain features of military importance within sight (villages, roads, streams). (4) Location of the nearest security detachments on the flanks and the means of communicating with them; number and location of your own outguard or security detachment, its support, and the routes to them. (5) Whether patrols or other friendly troops are operat- ing to your front. If so, any signs or signals of recognition or other means by which you can identify them, especially at night. (6) Other special signals. (7) Instructions concerning challenging. (8) What you will do in case of attack. b. If practicable, you will be provided with field glasses and a means of signaling. You should place yourself where you can see your assigned sector at all times and not be seen by the enemy. If possible, in the daytime you should also be able to see the sentinels on your flanks. A position in a tree may be just what you want. If you see signs of the enemy, notify your commander at once. In the daytime you should let pass only officers, noncommissioned officers, and detach- ments that you recognize. Stop all you do not recognize and call your commander, who will make the necessary examina- tion of their passes. At night when persons approach your post halt them and call your commander. When halting MEDICAL SOLDIER’S HANDBOOK Figure 46. Sentinel on Duty. anyone keep him covered. If a person fails to stop at your third command to halt, or attempts to escape or attack you, shoot him. If the enemy attacks or there is other great danger, give the alarm by firing rapidly. You do not need to challenge if you are certain you have recognized the enemy. If deserters or a small hostile party displaying a white flag approach, make them lay down their arms; call your com- mander. Pass on to the sentinel who relieves you all infor- mation and instructions relating to your post. (Fig. 46.) 166. Messengers. At any time during active operations you may be called upon to deliver a message. It is your duty to deliver it in the shortest time possible. If you should delay, it may mean the defeat or capture of your unit. Before start- ing out repeat back the message, if it is an oral one, to the per- son who gave it to you in order to fix it firmly in your mind. Ask questions about any points that are not clear and be sure that you thoroughly understand what is expected of you. Next, locate yourself on the ground and map, if you have one, and select land marks to help you find your way. In order to ac- complish your mission it will generally be necessary for you to take full advantage of the concealment afforded by the ground, as has been explained in paragraph 164. Be especially careful not to make careless movements which would enable the enemy to locate the station sending the message or the one receiving it. By using different routes in entering and leaving message centers and command posts you will avoid marking out paths which can easily be seen from the air. If necessary, ask any troops you pass the whereabouts of the person or headquarters for whom your message is intended. If you should be delayed or lost, show or explain your message to an officer and ask his advice. Any information of importance you may have obtained along your route should be reported to the person to whom you are delivering the message. Be sure that you explain to him what you have seen and heard yourself and what has been told you by someone else. After delivering your message and before returning, ask if there are any messages or orders to be taken back. Upon your return to the place from which you started report that you have accomplished your mission. 167. Connecting File. Connection between the different parts of a marching column or between the detachments of a unit is maintained by connecting files. In a marching column a connecting file usually consists of two men. One keeps in touch with the element in front, the other with the rear. They halt only when the element in front halts or upon signals from the rear. They repeat signals from front to rear. The distance between connecting files is usually about 100 yards by day. At night, or when there is poor visibility, the distance is decreased to the limit of visibility. If you are a connecting file the principal thing to remember is to regulate your movements so that you can always see the other connecting file as well as the groups ahead or in rear of you. You should see that the element following takes the correct road. This will require especial care in turning off a road in forests, towns, or villages, and in darkness or fog. MEDICAL SOLDIER’S HANDBOOK 107 108 MEDICAL SOLDIER’S HANDBOOK 168. Antiaircraft Security and Protection, a. As long as the enemy has any combat aircraft which will fly, our troops may expect to be attacked from the air. To provide security against such attacks each ground unit establishes antiaircraft lookouts to watch for enemy airplanes and warn the troops. These lookouts are provided on the march, in shelter, and in combat. They may remain at one post, march abreast of the marching unit, or move from one post to another by motor vehicles. If you are detailed on this duty you should observe in every direction, and especially that from which attacks are to be expected. The direction of the sun, or of hills, woods, or other cover which might screen low-flying attacks until they are close to your unit is particularly dangerous. Antiaircraft lookouts usually work in pairs and relieve each other at in- tervals of not more than 15 minutes. They are equipped with field glasses and sun glasses and instructed as to the alarm signal to be used. They are trained to recognize hostile as well as friendly airplanes. The alarm is given as soon as low-flying airplanes are seen which are not positively iden- tified as friendly. Observers stationed at our antiaircraft weapons and at command and observation posts will be on the watch for signals from the antiaircraft lookouts. b. In case of a daylight air attack, never attempt to escape by running. The plane probably has not seen you. before but is sure to see you when you run. Your best protection is to lie flat on the ground. A ditch, shellhole, depression, or shadows along the road will give you good protection. When attacked from low altitudes, unless you have received definite orders not to fire, every soldier should fire on the enemy planes with rifle, automatic rifle, and machine guns. This will cause the enemy airplanes to keep above the range of small arms fire. c. Dense woods provide complete concealment from aircraft and it is doubtful that you will be seen even in sparse woods provided you do not move around. If you are to be in the open for some time you can conceal yourself by pulling branches or bushes over you, which will blend with the land- scape, and by lying still. d. At night enemy airplanes may drop flares to light up the ground. When a flare is first dropped, it glows for about a second and then burns brightly. When you see that a flare has been dropped, stop where you are and remain motionless until it has burned out. 169, Antitank Security and Protection, a. To give warn- ing of the approach of enemy tanks or armored vehicles, anti- tank lookouts are provided. Sometimes the same lookouts will watch for enemy aircraft as well as tanks and armored ve- hicles. Prearranged sound and visual signals are used to warn our troops. The approach of tanks may be suspected by the noise of their motors and tracks or by unusual columns of dust. When your unit is at a distance from where the enemy is known to be, the probable approach of tanks or armored vehicles will be over roads. When you are close to the enemy, however, the entire area to your front must be watched. b. For the same reason that you should not run from an airplane attack do not run from an attack by enemy tanks or armored vehicles. You can’t run fast enough to get away MEDICAL SOLDIER’S HANDBOOK 109 from them and they are sure to see you and have a much better shot at you than if you remained still. If you are with your unit, upon seeing or hearing the antitank warning signal, await orders from your commander. c. If you are alone, your best protection from vehicles of this kind is to take advantage of natural obstacles that they cannot cross. These are deep streams, canals, or other bodies of water, marshes or boggy ground, deep ditches or ravines, thick, heavy woods, stump land, and ground littered with good sized boulders. d. You will also be safe from these vehicles in a trench or “fox hole” if you get down below the surface of the ground and allow the tank to pass over you. If you get a chance to shoot at the tank, aim at the vision slots or other openings but withhold your fire until the vehicle is at close range. If the belly of the tank is exposed you have a good chance of shooting through it with your .30 caliber armor piercing am- munition. Hand grenades have been used to good effect against armored vehicles, as well as bottles of gasoline which will break on the vehicle and set it afire. Above all, remem- ber that armored vehicles can be stopped and destroyed, so don't be panicky when they approach your position. 170. Protection Against Gas. a. Gas is another weapon which the enemy may use on the battlefield to gain surprise. Your security against being surprised is to learn to know when gas attacks are being made and how to use your gas mask. If you can do this, act promptly and keep cool, you have nothing to fear from a gas attack. b. The enemy may use gas in one of the following ways: (1) From candles and cylinders. You can tell these by the hissing sound of the escaping gas and during daylight by the cloud of gas itself. (2) From gas projectors and artillery ahd mortar shells. Projector attacks make a big explosion, a brilliant flash, and a large cloud of smoke and dust. Artillery and mortar shells filled with gas sound almost like duds when they explode. Usually a thin haze or mist surrounds the burst for a few moments. (3) From airplanes and tanks. The airplane bomb filled with gas also sounds like a dud when it explodes. If the gas is sprayed from the airplane or tank it can usually be seen. (4) From bulk containers and chemical land mines, placed in position and exploded by electricity or by contact fuze, c. You should remember the following rules as your security against gas: (1) Carry nothing in your gas mask carrier but your mask. (2) Prevent damage to your gas mask by handling it carefully. (3) Keep your gas mask. You may need it at any time, and it may save your life. (4) Give a gas alarm only when gas is present. (5) Hold your breath after the gas alarm is given until you are sure that your mask is well adjusted to your face and that you have cleared the face piece of gas by blowing vigorously into it while holding the outlet valve. MEDICAL SOLDIER’S HANDBOOK (6) Keep your gas mask on until permission to remove it is given by an officer or a gas noncommissioned officer. (7) Do not enter a dugout during or immediately after a gas attack. (8) During or immediately after a gas attack keep your mask on, even if in a gasproof dugout. (9) Remain quiet and avoid unnecessary moving around during a gas attack. (10) Keep cool, and remember your protective equipment will save you if properly used. (11) Remember that the enemy uses many different kinds of gases, sometimes one kind at a time, and sometimes mixed with other chemical agents, smoke, or high explosive. (12) Remember that clothing which has been in contact with mustard gas should be removed as soon as possible. (13) Use gloves to remove another man’s clothing or to handle equipment that has come in contact with mustard gas. (14) Remember that mustard gas remains in an area for days. (15) Avoid all areas in which there has been mustard gas. If your duties require you to go into such an area, remain as short a time as possible even though you are wearing protective clothing and a gas mask. (16) Remember that the best conditions for a gas attack are during a calm, in foggy or cloudy weather, a drizzling rain, and at night. Be on the alert. (17) Avoid drinking water or eating food that has been subjected to a gas attack. (18) Remember that all gas cases require: first, rest; sec- ond, warmth; third, fresh air. (19) If gassed, do not talk, walk, or move about. (20) Do not bandage the eyes of a gassed case. It is harm- ful and may result in blindness. SECURITY OF SMALL UNITS Section III 171. For your commander to use his troops successfully he must first know where the enemy is and what he is doing. Without this information your commander is like a man try- ing to feel his way in the dark. He cannot know how to plan his attack to defeat the enemy, for he does not know where he will meet him. Nor does he know at what moment, or from what direction, the enemy may attack him and take him by surprise. 172. You may be detailed as a member of a detachment sent out to provide security for a larger body of troops. These de- tachments have different names which indicate whether the main body is resting, marching, or fighting and what the se- curity detachment is doing. No matter what they are called, always remember that the principal mission of every security detachment is to prevent the main body from being surprised. They do this by finding out where the enemy is and what MEDICAL SOLDIER’S HANDBOOK he is doing, by giving warning of the enemy’s approach, and by delaying him so that the main force can get ready to fight. They are the eyes and ears of the commander. They get back to him the information he needs to know so quickly that he will have plenty of time to make or change his plans. Another important thing to remember is, no matter how small the unit may be it always provides for its own security even though this security may consist of only one or two men. 173. Scouts, a. The smallest security detachment is the scout. The scout is a soldier whose duty it is to see what the enemy is doing without being seen, and to hear the enemy without being heard. The scout must be intelligent, have a strong body, great endurance, keen eyesight, delicate hearing, and an excellent memory. b. As a scout your commander may use you in all types of combat operations. When your organization is in camp or bivouac, scouts are sent out from the outpost to gain informa- tion of the enemy, to prevent his scouts from gaining infor- mation of your organization, or both. When your organiza- tion is on the march, scouts perform important duties with the advance, flank, and rear guards by discovering hostile troops and promptly sending this information back so that your own commander will not be surprised. In movement by night or in dense woods, scouts serve as guides. c. As your unit moves forward to the attack, scouts precede it and keep the proper direction for it to follow; they investi- gate danger areas before the unit crosses them, and select locations where it will be protected from enemy fire. During the progress of the attack they also protect your unit from surprise fire or counterattack by the enemy; they select and occupy firing positions and point out enemy targets. d. When their organization is on the defense, scouts serve as lookouts, observers, listeners, and snipers. They may serve as members of patrols to enter the enemy lines, both by day and night, to get information of the enemy. They drive off enemy scouts and patrols who are trying to do the same thing. e. A trained scout will be able to see and hear things that the average soldier does not. You must be able to pick up in- distinct and motionless objects as well as moving ones. Long periods of painstaking search are often required before the position of a hostile soldier is located. As a scout you will conceal yourself as has been described in the preceding section, but as you will be “on your own” you will have greater freedom of movement. f. Scouts usually work in pairs, with each scout having the utmost confidence in the ability of his fellow scout. Train with your partner and make a buddy of him so that each of you know what the other will do under any circumstances. Scouts always work in pairs when scouting in front of their organization in the advance. They move ahead of their or- ganization as ordered by the commander. Here their duty will be to cause hostile riflemen and machine gunners to open fire and disclose their position, and to overcome re- sistance from small hostile outposts and patrols (fig. 47). 112 MEDICAL SOLDIER’S HANDBOOK RUNNERS CONNECTING UP THE SCOUTS WITH K THE PLATOON LEADER A Figure 47. Position of Scouts in Advance. g. As you scout in front of your advancing unit, pick out probable positions that may conceal enemy machine guns or rifle groups. When you signal that these positions are clear your unit will advance by bounds and you should move forward for further reconnaissance. h. Your distance in front of your organization varies with the ground and position of the enemy. In approaching houses, woods, and villages, one scout of each pair covers while one reconnoiters (fig. 48). i. When the enemy opens fire, stop, seek cover, and deter- mine where the fire is coming from. Scouts open fire with tracer ammunition to show to their leader the position of the enemy. j. Scouts must be alert for intervals or gaps in the enemy line. When you discover them, push in, take up position from which flanking fire may be brought to bear on the hostile position, then either you or your fellow scout notify your leader at once. k. You can see that if you are appointed a scout a great deal will depend upon how well you perform your duties. You must always remember why the commander sent you out and what he wants you to do. That is your “mission.” Some- times this will require a great deal of courage on your part and you may have to try out several different plans until one of them works. You will be “on your own” and often will find yourself in a situation which neither you nor your commander could have thought of in advance. But if you remember your “mission” at this time, and just what infor- mation your commander is anxiously waiting to receive from you, you will succeed. 174. Patrols, a. General. The squad or a part of a squad often acts as a patrol. Patrols are assigned either recon- naissance or security as their primary mission. (1) Reconnaissance patrols are used primarily to get in- formation, maintain contact with the enemy, or observe points or areas. They do not fight unless they must in order to accomplish their task. They move so as best to do their job; they are not bound by either position or distance to the unit from which they were sent out. (2) Security patrols provide security for a larger force. Their mission often will require them to fight. They must regulate their movements on the force or unit they are protecting. (3) Patrols executing missions which will probably call for combat are given the means and the strength to enable them to engage in combat. b. Reconnaissance patrols. (1) Reconnaissance patrols are usually small, consisting of a leader and two or three men. They avoid unnecessary combat and accomplish their mis- sions by stealth. (2) The patrol leader is given the enemy situation and our own situation insofar as he needs to know them. He is given a definite job to do; he is told the general routes to be followed, the friendly troops through which he will pass, MEDICAL SOLDIER’S HANDBOOK 113 114 MEDICAL SOLDIER’S HANDBOOK WITH PLATOON IN WOODS SCOUTS REACH OPEN AND SEE HOUSE AHEAD. THEY SIGNAL HALT. PLATOON SHOULD NOT ADVANCE BEYOND THIS POINT. RECONNAISSANCE SHOWS HOUSE TO BE CLEAR, SCOUTS SIGNAL FORWARD AND PROCEED CROSSING OPEN SPACE SCOUT SEES POSITION FROM WHICH MACHINE GUN MAY SWEEP THIS AREA. HE SIGNALS DOUBLE TIME AND POINTS TO THE MG POSITION, MEANING THIS AREA IN DANGER. FROM THAT POINT PLATOON SHOULD HURRY ACROSS SCOUT RECONNOlTERS FOR A SHORT DISTANCE INTO WOODS, FINDING EDGE OF WOODS TO BE UNOCCUPIED. A SCOUT RETURNS TO EDGE OF WOODS AND SIGNALS" FORWARD'', THEN BOTH ENTER WOODS AND WAIT FOR PLATOON TO CLOSE UP Figure 48. Conduct of Scouts During Advance. MEDICAL SOLDIER’S HANDBOOK 115 the time of return, and the place where messages are to be sent or the patrol is to report. (3) Before starting out the patrol leader studies the map and the terrain and selects a suitable route. He appoints alternate leaders, gives the other members of the patrol care- Figure 49. Distribution of Patrol Halted in Observation. ful instructions about the task the patrol has to perform, assigns individual tasks, points out the route on the map and on the ground, arranges special signals, and designates an assembly point if the patrol is forced to separate. He makes sure that all members of the patrol know their jobs and checks to see that the arms and equipment are so carried MEDICAL SOLDIER’S HANDBOOK 116 ONE MAN APPROACHES UNDER COVER, OTHERS ARE IN POSITION READY TO OPEN FIRE IF NECESSARY THE PATROL CROSSES ONE MAN AT A TIME. OTHERS ARE IN POSITION READY TO OPEN FIRE IF NECESSARY Figure 50. Method of Approaching House; of Crossing Stream. MEDICAL SOLDIER’S HANDBOOK 117 that they will not glisten or rattle. The members of the patrol do not carry written matter which might be of value to the enemy if they are captured. (4) All must clearly understand that in event of a fight wounded comrades are not abandoned but brought in with the patrol, whenever possible. (5) All patrols provide for a point, flank protection, and a get-away man, who must always be able to return to his commander no matter what may happen to the remainder of the patrol. When a patrol is at a halt for any reason it must provide itself with all around protection (fig. 49). (6) When moving in open country near the enemy, the patrol should pick its next stopping place before each ad- vance. Moves should be made by one man at a time and at top speed. Before crossing a skyline one man should go to a point where the skyline is broken and observe, the rest of the patrol covering his advance. When he signals “forward” the way is clear and the remainder of the patrol comes up (fig. 50). (7) Patrols should avoid enclosures and villages if possi- ble. If it is necessary to pass through villages or to patrol them, great care must be taken, as each house or cellar may conceal an enemy. Watch windows, doors, and tops of houses closely. Advance slowly and cautiously (fig. 51), (8) If a patrol is attacked and must fight, the man who first notes the danger calls out “Front,” “Right,” “Left,” or “Rear.” All members face toward the man attacked. The men on the flanks advance a short distance straight ahead and then close on the enemy from the flanks. The patrol leader and the men with him rush the enemy. During the combat, the members of the patrol repeat their recognition signals. If necessary, the leader designates a man near him to stay out of the fight. (9) The patrol leader decides whether information gained will be sent back at once by messenger or reported on the return of the patrol. He alone is authorized to talk to, or arrest civilians or to seize telegrams and mail matter. Patrols do not allow civilians to pass through or precede them. (10) An example of a message which you, as a patrol leader, might send back is shown in figure 52. After writ- ing the message you would point out to the messenger who will carry it the location of the stone fence, woods, and machine guns and tell him your intentions. The sketch can be made quickly and requires no special ability. It con- tains all the information that is needed but no unnecessary information. If the commanding officer of Company A wants to know what you are going to do, he will ask the messenger. The advantage of this lies in the fact that, should the messenger and the message be captured by an enemy patrol, there is nothing in the message to tell them where Corporal Jones is now. To write “squad will remain at B” invites capture. (11) A soldier who is a good individual scout will ordi- narily be a good member of a patrol. However, it must be remembered that as a member of a patrol you must 118 MEDICAL SOLDIER’S HANDBOOK Figure 51. Formation of Patrol Passing Through Village. MEDICAL SOLDIER’S HANDBOOK 119 obey the signals or commands of the designated leader in- stantly and without fail. You are not then scouting “on your own.” (12) Since many night patrols are for the purpose of cap- turing prisoners and executing tasks which may require combat, the patrol should rehearse plans for night combat and laying ambushes until it reaches a high state of effi- ciency. Only through repeated rehearsals and training will each member of the patrol learn to do his part unhesitat- ingly and correctly, and thus gain confidence in the ability of the patrol as a unit (fig. 53). Failure to do this will sooner or later result in heavy losses in the patrols. These spaces for message center only Time Filed MSGCEN NO How Sent MESSAGE No 2 Dote 20 Cue 40 To J.Qj&.A. stone fence /. Enemy machine gun firing near stone fence. See one gun at MG noods 2. Patrol now at B. 3. Runner wit! report my future movements wheat field Leader Patrol No! 9 >20 A official designation of sender Jones. Gorp’t. [TIME SIGNED Signature and Grade of writer Figure 52. Example of Message c. Security patrols. (1) A squad or a part of a squad may act as a point (of the advance guard or rear guard) or as a flank patrol of a force on the march or in combat. (2) Point of advance guard. The point of an advance guard is a security patrol. It moves along the route of march and prevents an enemy on or near the route of march from opening surprise fire on the troops in rear. Behind the point comes the advance party. The distance 120 MEDICAL SOLDIER’S HANDBOOK between them will vary with the kind of terrain and whether it is day or night, but usually the point will not precede the advance party by more than 300 yards. As a member of the point you will find that it is so arranged as best to let the leader control it, to make it a poor target for enemy fire, and to permit all members to fire quickly to the front or either flank. It frequently marches on both sides of the road. It fires on all hostile forces within effective range. When unable to drive off the enemy, it holds its position and covers the action of the advance party. The presence of a distant enemy beyond effective rifle range is reported by signal. The point observes toward the front and flanks but does not reconnoiter on the flanks of the route of march. When the column halts, the point sends forward one or more observers. (3) Point of rear guard. As a member of a rear point you are assisting in protecting the rear of your marching column. The formation of the rear point is similar to that of the point of an advance guard. However, as a member of a rear point you stop to fire only when the enemy threatens to interfere with the march. No other troops will move to your assistance, but when the enemy presses closely, other troops will take up firing positions in rear to cover you. When you are forced back, withdraw to a flank so that the troops behind you can fire into the enemy. (4) Flank patrol, (a) A flank patrol is a security patrol. Flank patrols operate in one of two ways; either they go to a designated place, remain there for a specified time, and there rejoin the column, or they march along a designated route. They report, by signal or messenger, enemy forces they observe. (b) A flank patrol of a column on the march moves so that it can protect the column against hostile small-arms fire at mid ranges (300 to 600 yards). (c) In combat the flank of the unit to which you be- long may become exposed. In such a situation flank security patrols are sent out to protect the exposed flank. Not only do these patrols report' observed hostile forces and their movements but they also report the movements of friendly forces which they can see. 175. Security at Halt. a. Detachments of troops detailed to protect a body of troops at rest or not on the march are called outposts. The general purposes of an outpost are to get information, to observe places where the enemy might sneak up on the main body, and to fight off enemy troops coming toward your position. In particular the outpost must protect the main body so the troops can rest, or work undis- turbed, and in case of attack hold the enemy off long enough so that the main body can get ready to fight. If you are a sentinel on outpost duty you must be on the job every minute you are on post, but you must avoid unnecessarily alarming the command. b. For an organization the size of a company, troop, or battery the outpost need be only a few sentinels and patrols. In a larger organization a larger and more elaborate outpost MEDICAL SOLDIER’S HANDBOOK 121 PAIRS OF SCOUTS ATTACK PREVIOUSLY DESIGNATED MEMBERS OF THE ENEMY PATROL BY RUNNING IN UPON THEM FROM BEH1NCL A PAIR OF MEN WITH BROWNING AUTOMATIC RIFLES ARE PLACED ON EACH FLANK NEAR END OF AMBUSH SO THAT THEY CAN COVER ITS FLANKS. Figure 53. Night Ambush. Med. Sol. Hb. 122 MEDICAL SOLDIER’S HANDBOOK will be needed. On account of the presence of motorized and armored forces in all modern armies, outposts must give all around protection to their commands. The part of the outpost nearest the enemy is an observation group called an outguard. Behind the outguard are more troops in detach- ments called supports (figs. 54 and 55). Direction or the enemy OUTQUARD No. 2 Outquaud No. I OUTOUARD NO. S Support Main body c. If you are a member of an outguard, no fires will be built or smoking permitted unless you are told you can do so. You should avoid loud talking or making other noise. The position of each outguard may be entrenched and will be concealed. You keep your weapons at hand all the time, and do not remove your equipment. Your duties as a sentinel are described in the preceding section. Figure 54. Outpost of Small Force. MEDICAL SOLDIER’S HANDBOOK 123 OimsuiED Me 1 'TO 5UIW&T OX 6.1GBT Figure 55. Several Outguards on Duty. ourauAtto M2 TO SUtr06,T ON LEFT oiroum «»3 124 d. You may be called upon to perform outpost patrol duty. Outpost patrols operate either within our lines or beyond our lines. Some patrols operate beyond our lines to reconnoiter in the direction of the enemy. Other patrols operate within our lines in order to keep in touch with the parts of the outpost and check up on the performance of duty on the line of outguards. Outpost patrols have at least two men and a good leader who, on important tasks, may be an officer. The patrols get information of the ground and of where the enemy is and what he is doing. Any ground near the line of outguards that might give concealment for hostile troops is searched frequently by patrols if the enemy could get to it without being seen. When you are on patrol duty you fire only in self defense or to give the alarm. Patrols and reliefs should not move in the open in vicinity of the out- guards and so give away the location of the sentinels and outguards. c. If you have to establish a cavalry outguard, remember that your horses must be kept as near at hand as practi- cable. This will require careful planning so that they can be fed and watered and still be protected from enemy ob- servation and fire. 176. Security on the March, a. An advance guard is a detachment of a body of troops that goes ahead of and pro- tects the main body on the march. The chief job of an ad- vance guard is to protect the main body against surprise attack and drive back small detachments of the enemy. Par- ticularly its duties are— (1) To guard against surprise and get information by patrolling. (2) To push back small detachments of the enemy and prevent them from observing, firing on, or delaying the main body. (3) To remove obstacles and make repairs to the road to help the steady advance of the column. (4) To delay the enemy’s advance in force long enough to let the main body get ready to fight. (5) When the enemy is found on the defensive to take a good position, locate his lines, and protect the main body during its preparation for action. b. An advance guard provides for its own security and gets information by putting out smaller detachments to the front and flank. The most advanced part of the advance guard is called the point. (Figs. 56 and 57.) The point is usually a squad, or part of a squad. It is really a patrol with a fixed mission. c. Your part in an advance guard may be as a part of the point or one of the other patrols sent out to make sure that the enemy does not ambush the main body. d. If the point of an advance guard is fired upon, it should deploy and try to continue to advance fighting. Thfe is done in order that small enemy detachments will not succeed in delaying the advance of the main body. Flank patrols assist in this, and if the enemy does not fall back they try to locate MEDICAL SOLDIER’S HANDBOOK his flanks. If necessary, each part of the advance guard goes into action to clear the way for the main body. e. A rear guard is a detachment whose job is to protect the main body from an attack from the rear. In a retreat it fires on and delays in every possible way enemy pursuing troops, so that the main body can gain distance from the MEDICAL SOLDIER’S HANDBOOK 125 ADVANCE GUARD FLANK GUARD FLANK GUARD DIRECTION OF MARCH MAIN BODY REAR GUARD Figure 56. Relation of Security Detachments on March to Main Body. enemy. The formation of a rear guard is like that of an advance guard, reversed. That is, the various parts follow the main body instead of going ahead of it. Also the rear party follows the support, and the rear point follows the rear party. The rear guard makes the most of opportunities to block the road and takes up good positions from which it can fire on the enemy and make him deploy. The fight is not kept up so long that the rear guard will not be able to fall back to other positions. (Fig. 58.) f. A flank guard is a detachment whose job is to cover the flank of a column exposed to enemy attack. It may be placed in position to cover the march of the main body or it may march generally opposite the main body to protect it. The object of the flank guard is to prevent attack of the main body or, if this cannot be done, then to delay the enemy long enough so that the main body can get ready to fight. The flank guard must keep contact with the main body. A flank guard must provide its own protection and if neces- sary have its own advance guard or rear guard and flank patrols (fig. 56). 126 MEDICAL SOLDIER’S HANDBOOK POINT ADVANCE PARTY SUPPORT DIRECTION OF MARCH MAIN BODY Figure 57. Advance Guard of Small Force. MAIN BODY SUPPORT DIRECTION OF MARCH REAR PARTY REAR POINT Figure 58. Rear Guard of Small Force. MEDICAL SOLDIER’S HANDBOOK 127 g. (1) When a march is made near the enemy, special meas- ures are taken during halts for protection against surprise or attack. When the halt is only for a short time (less than a half hour), the advance party and support rest along the route of march. The point and flank patrols move to positions where they can keep a good lookout. If necessary more patrols will be sent out from the advance party and support. Antiaircraft and antitank lookouts are detailed to watch out for the ap- proach of enemy airplanes and tanks or armored vehicles. (2) If the halt is longer than a half hour, a march outpost will probably be formed. Outguards are sent out to the front and flanks, and unless friendly troops are close in the rear they will be put out to protect the rear also. The out- guards to the front and flanks are furnished by units of the advance guard. Outguards to the rear, when necessary, will be taken from the rear guard. When the march is to be resumed, the various outguards are signalled to close in, and when all are back in their march formations the march is resumed. March outposts watch particularly roads and routes of approach leading to the main body for the approach of enemy mechanized and motorized detachments. March outposts work like other outposts in protecting the main force. h. All arms of the service follow the same general plan for providing security for themselves. In the cavalry, ar- mored, or motorized units, however, the distances between the security detachments and the main body are greater than with foot troops because of the greater speed which cavalry, armored, and motorized units have. Security elements of these rapidly moving forces sometimes advance by bounds, much as a scout will do in advancing toward the enemy. That is, the point of the advance guard will move rapidly forward to some ridge or other favorable terrain feature from which it can observe toward the enemy and, if all-looks well, it signals for the next larger unit to come forward. The leader of the point then selects another favorable terrain feature and repeats his advance, taking advantage of cover. While the point is doing this the next larger detachment in rear is prepared to defend the point by firing on any hostile element which might seek to stop the advance of the point. Sometimes, however, when the advance of the main body is very rapid, or during darkness or fog, movements by bounds will not be made but a steady rate maintained. 177. Security While Defending, a. When your organization is defending, security against a surprise attack is provided by sentinels, patrols, outguards, outposts, a warning sys- tem, and natural and artificial obstacles. The natural obstacles which provide some protection by making it difficult for the enemy to attack are rivers, canals, lakes, marshes or boggy ground, ravines, steep mountains, and other difficult parts of the terrain. They can all be crossed, however, and must be watched and defended. b. The artificial obstacles which provide protection are trenches and dugouts, barbed wire entanglements, road blocks, road craters, traps, and mines. Just as with the natural obsta- cles, the enemy can remove or cross artificial obstacles if he is 128 not interfered with. The thing to remember is that after a natural or artificial obstacle has been selected or put in place it should be covered with the fire of your weapons, espe- cially machine guns. The obstacles will slow the enemy up. When he attempts to remove or cross them your fire will stop him. c. (1) There are specially organized units in the Army to provide protection against aircraft and armored vehicles. If you are assigned to one of these units, you will be given special instruction in the use of the weapons. If you are not a member of such a unit, however, you should make every effort to provide your own security with the weapons and other means available to you. As was explained before, your best protection against low-flying aircraft is concealment, remaining quietly in place, and firing on the airplane with all weapons unless you have received orders not to fire. (2) Even where natural obstacles exist, additional secur- ity should be provided against armored vehicles by an all around protection of artificial obstacles. Tank traps and mines can be set out, although this will usually be done by engineers or larger troop units. Road blocks are especially effective in stopping armored vehicles or slowing them up and making them go across country. These may be easily constructed by deepening and enlarging shell holes on the road, by felling trees or telephone poles, or by putting old automobiles or trucks crosswise on the road where the armored vehicles cannot get off the road because of steep banks or ditches. The value of these obstacles is increased by covering them with fire, which will interfere with the enemy’s attempts to remove the obstacles. (3) You must be on the alert to prevent enemy sympa- thizers or parachute troops which have been landed behind our lines from removing these obstacles. If you are detailed to guard an obstacle, never allow any persons to tamper with it or remove it unless you are sure of their authority to do so. If there is any doubt in your mind, hold them under guard until one of your officers or noncommissioned officers arrives. If they attempt to attack you or to escape, shoot them. 178. Security While Attacking, a. As your unit approaches the actual or probable location of the enemy, security is provided by covering its advance with scouts. These scouts go in advance of the larger units and “comb” the ground thoroughly. Their action will make the enemy disclose his position by opening fire before the larger elements of your organization have come within his range. As your unit comes closer to the enemy’s position additional security will be provided by breaking up into smaller units, known as squad or platoon columns, or by deploying as skirmishers. This increases the readiness for action of your unit by putting it into formation from which it can move in any direction and cannot be surprised by any action of the enemy. Addi- tional security is provided by the fire of machine guns and other weapons which keep down the enemy’s fire until your organization can reach his position and drive him out of it. b. If your organization halts during the attack, one or more MEDICAL SOLDIER’S HANDBOOK combat outposts are immediately sent out to the front where they can screen and protect your organization until it is ready to continue the attack. A combat outpost usually operates from several alternate positions. If the enemy advances the combat outpost opens fire at long range. Upon close approach of the attacking troops the combat outpost withdraws. Routes of withdrawal are used which will not interfere with your own organization in rear firing at the enemy. c. If the battle is interrupted by darkness, combat outposts will be promptly established. At night they will be closer to your organization than in the daytime. The combat outpost will establish listening posts to warn the front line organiza- tions of the approach of hostile raiding or attacking parties. It will maintain a vigorous reconnaissance during the night in order to discover any change in the hostile dispositions, in- tentions, or situation. d. During battle it may happen that a flank of your organ- ization may be exposed. That means that there are no friendly troops close to that flank. When this happens a flank 'patrol must be sent out to that flank. Its duties are to prevent the enemy from working his way around and attacking your exposed flank or rear, or to give due warning of such an intention. Such a patrol regulates its own movements on that of the unit it is protecting. It may remain in one position or, if your organization is advancing, it will move rapidly from one position to another. When the patrol occupies a position each member selects two locations, one from which he can fire to the front or flank and another from which he can fire to the flank or rear. The patrol must be in constant communication with the unit it is protecting. One man is selected who must always be able to escape and get back to your organization in case the patrol is captured. Information of enemy activities or of friendly troops which may appear on that flank are reported back to your com- mander as he directs. MEDICAL SOLDIER'S HANDBOOK 129 Chapter 13 MILITARY SANITATION 179. Before you entered the Army, you were given a thorough physical examination to see that you had no dis- ease. Now that you have been accepted in the military serv- ice it is your duty to our country and yourself to keep well and ready for any service. If you will remember and follow the few simple rules given below, you will find yourself re- paid many times. Following these rules, in connection with the daily exercise of your military training, will keep you in excellent physical condition, and you will return to civil life with a better and stronger body than when you entered the Army. 180. If at any time you do not feel perfectly well, or be- lieve that you have any disease, go at once to your first ser- geant, or the noncommissioned officer in charge of quarters, who will send you to a medical officer for examination. Never try to treat yourself, as you may not only seriously harm yourself, but may also become a source of danger to your comrades. The danger of giving a disease to another man is usually greatest when the illness is just starting, and often before you feel really sick. If you have a cold, a head- ache. diarrhea, sore eyes, a rash on your body, or feel feverish, you must be examined by a medical officer as soon as possible. Many catching diseases begin with these symptoms, so you must not wait until you have exposed your comrades before seeing a medical officer. You will also usually have a less severe illness yourself if you report for a treatment as early as possible. 181. Stay away from any person having a disease unless it is your duty to take care of him. 182. An unclean body may be the cause of disease. Take a bath at frequent, regular intervals and at least twice a week. Pay particular attention to your armpits, the parts between the legs, the feet, and under the foreskin. Always wash your hands thoroughly before eating and after using the toilet, as you may have gotten some disease germs on your hands which will get on the food you eat and into your sys- tem. You are especially likely to get such germs on your hands when going to the toilet. If bathing facilities are not available, scrub your body frequently with a wet cloth, pay- ing particular attention to your armpits, crotch, and feet. 183. Have your underwear, shirts, and socks washed fre- quently and change them at least twice a week. If water is not available, crumple up your clothing, shake it well, and hang it in the sunlight for at least 2 hours. Be on the look- out for body lice and crab lice. If you have a continued itch- ing on your body or head, report to a medical officer at once. 184. When your clothing or shoes get wet. change them as soon as possible. Sitting around in wet clothes or with wet feet is almost certain to give you a cold or other serious illness. 185. Keep your mouth clean by thoroughly brushing your teeth at least twice a day; one brushing should always be 130 before going to bed. Brush your teeth on the inside and out- side, away from the gums and toward the cutting surfaces of the teeth. If particles of food remain between the teeth, they should be promptly removed, care being taken not to injure the gums. If your teeth are bad, or ache, report to the dental officer. 186. Get into the habit of having your bowels move regu- larly once each day at as nearly the same time as possible. Always go to the toilet to urinate, or when your bowels move. Using the ground for this purpose is a source of great danger to everyone. Flies or other insects may alight where you have relieved yourself, pick up germs, and later deposit them on food. These germs may also be carried by rain, or drain- age, into wells or a stream which serves as a water supply for some city or your own camp or post. 187. Drink plenty of water at intervals during the day but do not drink a large amount at one time, especially when you are overheated after exertion. Drink from your own glass or cup, or from a bubbling fountain. Never use a cup which is used by others, as someone may have left live germs on it from his mouth or hands, and you may catch a disease when drinking from it. For the same reason do not exchange pipes, cigars, musical instruments played by the mouth, hand- kerchiefs, towels, or shaving outfits. 188. Be sure to use your mosquito bar when mosquitoes are present. See that it is well tucked in and that it has no holes in it. 189. Flies and cockroaches frequently carry disease germs and leave them on food and other articles over which they walk. Get rid of flies in every way. Whenever you see a fly in barracks, kill it. Be sure that screens in windows and doors are kept tightly closed. Food containers and garbage cans must be kept tightly closed. Scraps of food, fruit skins, and manure should never be left on the ground about the post or camp. 190. Keep your barracks and squad room clean. If you find bedbugs in your bed, or in the barracks, report that fact to your company commander. 191. Keep your hair cut short and your fingernails clean. This is especially important if you are detailed as a cook, baker, or in other positions in which you handle food. 192. a. Avoid venereal diseases. These diseases are almost always caught by sexual intercourse with an infected woman. If you have had sexual intercourse, report at once for “prophy- laxis.” The prophylactic treatment must be carried out thor- oughly and the directions followed exactly. The sooner you report for this treatment, and at least within 2 hours after exposure, the more certain you are of avoiding disease. b. If you should feel that you have caught a venereal dis- ease, report to the medical officer at once and do exactly as he tells you. Any venereal disease can be cured much more quickly if proper treatment is begun early. Above all, do not try to treat yourself or go to an advertising quack doctor. Doing either of those things may result in serious dam^es MEDICAL SOLDIER’S HANDBOOK 131 132 to your body and health which will remain with you the rest of your life. 193. While all of the rules given above are of the same im- portance in the field as they are in your post or cantonment, the following are of especial importance in your field service: a. Be more careful of the water you drink. Never drink any water from a stream, spring, well, or faucet until it has been passed as pure by a medical officer and a sign posted that the water is safe to drink. When orders have been issued that all drinking water must be boiled, be sure that the water you drink has actually been boiled for 20 minutes and not merely heated a little. Often water will be provided for drinking which has been purified in a sterilizing bag known as a Lyster bag. These bags are usually placed in your company street or near the company kitchen. When this is done drink only the water from the bag. Do not mind the peculiar taste; it will not hurt you in the least and comes from a powder issued by the Quartermaster Corps to purify the water. Water puri- fied in this way may make your urine sting a little but this means nothing harmful. Let the water run from the faucet of the bag into your own cup. Do not dip a cup into the bag and do not drink by putting your lips to the faucet. b. Be especially careful not to relieve yourself except in the latrine, or the night urine can, provided in your company street. c. Be sure that your mess kit and knife, fork, and spoon are thoroughly washed in hot, soapy water and rinsed in boiling water after they are used. Unless this is done in boiling water your mess gear may pick up disease germs from the men who used the water before you and you may contract disease. d. Use the mosquito bar whenever there are mosquitoes, or when directed by your company commander. e. Get a bath whenever possible. Watch for lice or other vermin on your body and clothing and, if found, report im- mediately to the medical officer. f. Do not sit or lie directly on the damp ground. When you are hot or perspiring, or when your clothes are damp, do not remain where a draft can strike you. If you do, you will get chilled and as a result may contract a cold, rheumatism, or pneumonia. g. Every day, if possible, hang your blankets and clothing out to air in the sun and shake or beat them with a stick. Wash your shirts, underwear, and socks frequently. When- ever possible, roll up your tent so the air and sun can get in it. Keep it ventilated at night. h. Ditch your tent as soon as you can after it is put up, even if your camp is only for one night. If you do not, a little rain may spoil a whole night’s rest. i. Always prepare your bed before dark. If you have no cot, level off the ground and scrape out a little hollow for your hips. Use some straw, dry grass, leaves, or small branches. Sleep on your raincoat. This keeps the dampness from coming up from the ground and chilling your body. 194. The most important thing in your marching ability as a soldier is the care of your feet. You will find instructions on this matter in section II of chapter 10. MEDICAL SOLDIER’S HANDBOOK Chapter 14 “Ye are fearfully and wonderfully made.”—psalms 139-14. 195. Introduction. To intelligently perform his duties in the care of sick and injured, the medical soldier must have a practiced knowledge of the structure of the human body. He must also know the functions of the various parts of the human mechanism because many procedures in the treatment of disease alter the normal function to meet a temporary need. The structure and the function of an organ are so closely related that it is well to study their relationship within one chapter. The information contained in this chapter is in no means complete; but it comprises those essentials necessary for the medical soldier’s duties, and it will provide a background for further study in textbooks devoted en- tirely to anatomy and physiology. 196. Definition. Human anatomy is the study of the structure of the body and the relation of its parts, one to another. The body consists of a bony framework to which softer tissues are attached. Each part is made up of a num- ber of cells of various sizes and shapes. For example, bone is made up of bone cells, muscle of muscle cells, a nerve of nerve cells, fat of fat cells, and skin of skin cells. Anatomy, therefore, includes the study of the smallest cells to the complete body which these cells form. Physiology is the study of the activities and functions of the various structures and organs of the living body. It in- cludes the study of the activities of the smallest cells to the complete, human body. For example, muscle cells are long and have the power to contract; bone cells form the hardest and most enduring tissue in the body; nerve cells have long processes or fibres which carry impulses from one part of the body to another; fat cells store heat and energy; and cells of the skin protect the softer tissues underneath them. 197. Development of the Human Body. The human body develops from the union of a single female cell with a male cell. This union normally takes place within the womb of the female. The female cell is called the ovum; the male cell, a spermatazoon. After this union, which is known as fertilization, the female cell continues to divide and subdivide as it grows. The cells finally arrange themselves into three layers: the outer layer, the middle layer, and the inner layer. These three layers of cells, later in the act of development, assume different sizes and shapes, forming the various kinds of cells found in the body. For example, cells of the outer layer become the skin and nerve cells; cells of the middle layer, the muscle cells; and the cells of the inner layer, the cells lining the intestine. Combinations of one or more of the layers form the various body structures and organs. The tissues formed possess the characteristics of the cells which compose it. It is a wonderful feat of nature which, upon completion within the womb of the female, becomes a living being. At birth this new individual is separated from the mother, birth being that stage in which the newly-formed body is capable of independent body functions. ANATOMY AND PHYSIOLOGY 133 134 198. The Skeleton. The bony structure of the body is known as the skeleton. It is the framework of the body and may be compared to the chassis of an automobile, to which many parts are added to make a complete, operating machine. The skeleton consists of 206 different bones. The four main functions of bone are: To support the body. All other tissues are attached to or supported by it. MEDICAL SOLDIER’S HANDBOOK \ SKULL —.PAJIPAL — OCCIPUT SCAPULA CERVICAL VERTEBRAE CLAVICLE tIM |— STERNUM — HUMERUS thoracic (dorsal) VERTURAl VERTEMAE ULNA - PELVIS - SACRUM - RADIUS V-COCCYX VCARPAL LUMIAft •'> VERTEIRAE - m-lvts - SAORUM V PHALANGES v metacarpal ■ONES FfMUR - patella HIULA - TAtUS ; CALCANEOUS (OS CAICISI TARSAL •ONES MCTATARSAL •ONES PHALANGES © Front view. Figure 59. The Skeleton (D Back view To afford protection to certain organs and structures which might easily be injured. To furnish a system of levers which when acted upon by the muscles causes the body to move. To give shape to the entire body. The skull. The skull includes the bones of the head. The cranium is that portion of the skull which encloses and pro- tects the brain. It contains 8 bones. There are 14 bones in MEDICAL SOLDIER’S HANDBOOK 135 / PARIETAL - SUTURE FRONTAL NASAL SPHENOID LACRIMAL rrsomatic MAWLLARY MANOJKf (LOWER MAXILLARY) FRONTAL PARIETAL (LIFT) , WIN© Of SPHENOID TEMPORAL NASAL ZTSOMATIC UPPER MAXILLARY TEETH (ADULT| MANOIILE MASTOID PROCESS Of THE TEMPORAL \ RONE ' AN«l« OP THE JAW Side view. Figure 60. The Skull. Front view. ATLAS (•*♦» AXIS (2d) CERVICAL VERTEBRAE CERVICAL VERTEBRAE THORACIC VERTEBRAE THORACIC VERTEBRAE A VERTEBRAL BODY A POSTERIOR PROCESS , A POSTERIOR PROCBtS LUMBAR VERTEBRA! ~ , A TRANSVERSE PROCESS LUMBAR VERTEBRAE SACRUM — SACROVERTEBRAL JOINT COCCYX SACRUM COCCYX ® Side view (normal curvature). @ Back view (dorsal) Figure 61. The Spinal (Vertebral) Column 136 MEDICAL SOLDIER’S HANDBOOK that portion of the skull forming the face. In addition the normal adult has 32 teeth. The spine. The spine or vertebral column consists of 26 irregularly-shaped bones. Each vertebra has a flattened body at the back of which is an arch that encloses and protects the spinal cord. The vetebral column may be divided into five segments, the vertebrae being somewhat different in structure for each segment. They are as follows: cervical, thoracic, lumbar, sacral, and coccygeal. The chest wall. The chest wall consists of the sternum (breastbone), 12 ribs on either side, and the vertebral col- umn at the back. The upper 7 pairs of true ribs are joined by means of cartilage to the breastbone. The next lowermost 3 pairs of ribs have their cartilages attached to the rib above. The remaining 2 pairs have no attachment in front. The lowermost 5 pairs of ribs are known as the false ribs. The ribs protect vital tissues and organs in the chest. The chest and its contents are known as the thorax. COSTAL CARTILAGES MANUBRIUM (HANDLE) OF THE STERNUM —^ GLADIOLUS (BODY) OF THE STERNUM - TRUE RIBS (COSTAE) ENSIFORM (XIPHOID PROCESS) OF THE STERNUM FALSE RIBS * FLOATING RIBS Figure 62. The Thorax (Front View). The shoulder hones. The shoulder bones are the scapula or shoulder blade, and the clavicle or collar bone. The scapula lies within muscles which are outside the rib cage. In the upper and outermost portion of the scapula is the socket for the shoulder joint. The collar bone serves to keep the shoulder blade in place and protects the large blood vessels and nerves beneath it. The pelvic hones. The pelvic girdle consists of the hip bone, on either side, and the wedge-shaped base of the spinal col- umn, known as the sacrum, which is at the back. Each hip bone possesses a deep, round socket into which the head of MEDICAL SOLDIER’S HANDBOOK 137 the thigh bone (femur) fits and rotates. The hip bone is composed of three separate bones—the ilium, the ischium, and the pubic bone. The pelvic bones furnish protection to the vital organs and structures within the pelvis. Bones of the extremities. In anatomy the arms or upper limbs are classified as the upper extremities, and the legs or lower limbs are classified as the lower extremities. They are discussed together for the purpose of comparison; each contains ACROMIAL END STERNAL END ® The left clavicle or collar bone (upper surface) SPINE OF THE SCAPULA CORACOID PROCESS ACROMION PROCESS GLENOID CAVITY (D The right scapular or shoulder blade. Figure 63. The Clavicle and the Scapula. 30 bones, and the arrangement in each is similar. The differences in structure are due to the principal functions required of each—the upper limbs for holding, grasping, and manipulating movements; the lower limbs for locomotion and weight bearing. For that reason the bones of the lower extremities are larger and heavier. The upper extremities must have more freedom of action in order to give flexibility. The round head of the arm bone (humerus) is shallow and fits into the socket of the scapula (shoulder blade). This arrangement, together with the looseness of the attachment of the muscles of the shoulder, permits a wide range of movement at the shoulder. The flexion (bending) and extension (straightening) of the forearm is permitted by the hinge joint at the lower end (elbow) of the humerus. 138 MEDICAL SOLDIER’S HANDBOOK The rotation of the forearm (pronation and supination) is possible because there are two bones in the forearm; only the ulna takes part in the hinge joint at the elbow and only the radius at the wrist. Therefore the relationship of the radium and ulna (bones of the forearm) may change at the wrist joint upon turning the hand. There are 8 small bones (carpal bones) in the wrist. They are loosely con- nected by ligaments which give them considerable freedom of movement. Distal (farther away from the body) to the ILIUM ILIUM ANTERIOR SUPERIOR ILIAC SPINE ' ANTERIOR INFERIOR ILIAC SPINE T" ACETABULUM PUBIC BONE > SACRUM - COCCYX - ACETABULUM PUBIC BONE OBTURATOR FORAMEN ISCHIUM " SYMPHYSIS PUBIS ISCHIUM - Figure 64. The Male Pelvis (Front View). - PUBIC ARCH ANATOMICAL NECK " • OLECRANON SUft&CAL. NECK - HEAD" Carpal bones (»l SHAFT - RADIUS - . metaCarpalS (S| - FIRST PHALANX — SECOND PHALANX (— THIRD PHALANX CONDYLES TROCHLEA STYLOiO " PROCESS (D The humerus (right). ® Bones of the i forearm (right). ® Bones of the right hand. Figure 65. Bones of the Upper Extremity (Right). wrist bones are the five metacarpals or bones of the hand. Each metacarpal is joined to a finger bone (phalanx) by a hinge joint. Collectively the bones of the fingers (and the toes) are called the phalanges. The thumb is so situated that it may be pressed against any portion of the other fingers. This permits the hand to grasp and manipulate objects readily. MEDICAL SOLDIER’S HANDBOOK 139 The lower extremities do not require as much flexibility as the upper limbs. The hip muscles, unlike the muscles of the shoulder, are more firmly fixed; the socket of the hip bone into which the thigh bone (femur) fits is much deeper than the socket of the scapula. Consequently, while there is less flexibility at the hip joint, there is also less chance of dislocation. In the knee there is little forward motion. Because the fibula (outer leg bone), the more slender of the two leg bones, is attached firmly to the upper end of the tibia (inner leg bone), rotation is lacking in the leg. The bones of the ankle and the foot correspond to the bones of the wrist and the hand. They are, however, closely bound together by ligaments and do not possess a similar degree of freedom of motion. In order that there be elasticity to permit springiness in the step to avoid jarring, the bones of the foot are arranged in arch formation. This explains what is meant by “fallen arches” or flat feet, which often make walking very painful. The bones of the toes (phal- anges) are much shorter than those of the fingers. They are less flexible, and the great toe as compared to the thumb cannot oppose any of the other digits (toes). Therefore the foot lacks the power to hold and grasp. X- HEAD - NECK LESSER TROCHANTER TARSAL •ONES CALCANEOUS — TALUS .—- CUIOIO NAVICULAR T CUNEIFORMS GREATER / TROCHANTER PIBULA — TIBIA SHAFT — — METATARSALS , lit PHALANX ■ 24 PHALANX . 3d PHALANX EXTERNAL MALLEOLUS PHAIANSK CONDYLES INTERNAL - MALLEOLUS ® The femur (right front view). ® Bones of the lower right leg. ® Bones of the right foot. Figure 66. Bones of the Lower Extremity (Right) 199. Development of Bone. When a child is born the bones of the body, although formed, are not continuous masses of bony tissue. Each is partly composed of cartilage, a sub- stance more flexible and not as hard as bone. The process of bone formation is complicated and begins in these areas of cartilage from small points or centers of ossification (bone formation). These centers finally enlarge and continue to enlarge until adult life is reached, when all of the cartila- ginous tissue has been replaced by bone. The mineral con- tent of the bone is increased and the animal matter is decreased as the individual grows older, the bone becoming more brittle and more apt to break (fracture). 140 MEDICAL SOLDIER’S HANDBOOK The thin tissue, a sheet-like membrane which covers the bone, is called the periosteum. This is an important mem- brane because it is necessary for bone growth and nutrition. The bone surgeon will always take care to preserve the periosteum when bone repair requires surgery. The blood vessels are imbedded in this membrane and through it pass to the holes (nutrient foramen) in the hard part of the bone through which they enter into the hollow portion (medullary cavity). This cavity or canal contains the bone marrow. 80NE EXTREMITY ARTICULAR CARTILAGE SHAFT MEDULLARY CAVITY CORTEX (COMPACT SUBSTANCE) PERIOSTEUM BONE EXTREMITY CANCELLOUS OR SPONGY SUBSTANCE Figure 67. Longitudinal Section of a Long Bone. 200. Joints. Where two bones of the skeleton come together (apposition) they form a joint or articulation. Some joints permit no motion while others permit motion in many direc- tions. The bones are held together by ligaments, and the joining surfaces of each bone are covered by a smooth, thick, tough cartilage that is lubricated by a secretion (syno- vial fluid) produced by cells lining the inside of the joint space. The principal kinds of joints are classified as follows: Fixed joints. Fixed joints are those which permit no motion of the involved bones. They are also called sutures and may best be illustrated by the union between the bones of the skull. Ball-and-socket joints. In a ball-and-socket joint the rounded end of one bone fits into the hollowed surface of another. Its characteristic is that a greater degree of motion is permitted than in other joints. The hip joint and the shoulder joint are examples. Each of these joints permits the limb to be moved in practically every direction. Hinge joints. Hinge joints permit movement in one plane and may be compared to the hinge on a door. The knee joint is one of the best examples of this type of joint. The leg may be moved backward (flexed) onto the back of the thigh, but it cannot be moved forward or to either side. When the leg moves sideward it is due to the freedom per- mitted by the hip joint. Pivot joints. In a pivot joint one bone rotates around another which remains stationary. The best example of this type of joint is between the first and second vertebrae of the spine. Because of this arrangement the head may be rotated from one side to the other. MEDICAL SOLDIER’S HANDBOOK 141 PERIOSTEUM FIBROUS LIGAMENT JOINT CAVITY SYNOVIAL FOLD ARTICULAR (HYALINE) CARTILAGE BONE SYNOVIAL MEMBRANE BONE Figure 68. A Movable Joint (Schematic). Figure 68. A Movable Joint (Schematic) Gliding joints. In a gliding joint, little motion is per- mitted except that provided by one of the bones sliding a short distance over the surface of the other. Examples of this type of joint are those between the bones of the wrist. 201. The Muscles. The muscles perform one of the im- portant functions of the body, which is motion; the ability to move from one place to another; the movements of breath- ing; the beating of the heart; the activities of the stomach and intestines; and many other actions. These actions are accomplished by forcible contraction of muscle tissue. It must be remembered that muscular activity is dependent upon the skeleton, the nervous, the circulatory, and digestive system in order to maintain and control this action. The appearance of human muscular tissue is roughly com- parable to the lean butcher’s meat and comprises about 50 per cent of the body weight. Muscle cells are of three distinct kinds, and therefore we have three types of muscular tissue: striped, smooth, and cardiac. Voluntary muscles. Voluntary muscles are those muscles which are under our control and may be moved at will. They make up the mass of skeletal muscles and because of their striped appearance under the microscope are sometimes called striped or striated muscle. Involuntary muscles. Involuntary muscles are not under our control and may not be moved at will. They are not fixed to the skeleton but largely surround cavities or tubes within the body. They appear smooth under the microscope. In comparison to the voluntary striated muscle, they are called the nonstriated muscle. The muscles of the stomach and the intestines are good examples of involuntary muscle. Cardiac (heart) muscle. Heart muscle is involuntary muscle but differs somewhat from other involuntary muscle tissue when examined under the microscope. It more closely re- sembles the striated muscle. 142 MEDICAL SOLDIER’S HANDBOOK -■ANNULAR LIGAMENT -*NF*».SMNAU* EXTENSORS _-OCCIWtOf«ONT*US (D Back view. ItNOON ACMIlllS-^ VASTUS lateralis' @ Side view. Figure 69. Muscles of the Human Body. PLEXORS*"" EXTENSORS - TEMPORAl — ORBICULARIS RALREIRUM ORBICULARIS ORIS . MASSETER _ TENSORS — BICEPS FEMORIS - QUADRICEPS EXTENSOR - TRAPEZIUS r— DELTOID - 8ICEPS TRICEPS — GLUTEI MUSCLES — GASTROCNEMIUS — REROnEUS — EXTENSORS SOI f US TENDON aCmili.ES • STERNO-CLElOO MASTOID OILlOUUS - EXTERNUS / RfCTORALtS MAJOR RtCTORALlS MINOR ® Front view. DELTOID - SERRaTUS MAGNUS BICEPS TRICEPS — QUADRICEPS EXTENSOR- SARTORIOS- ELEXORS-— SUflMATO* LONGUS — FLEXORS — RECTOS ABOOMINALIS MEDICAL SOLDIER’S HANDBOOK 143 Muscular movements. Muscles are attached by means of tendons or heavy fibers to the bones of the body. By their contraction, parts of the body are forced to move. The point where one portion of the muscle is attached to the bone is called the origin of the muscle; where the opposite end of the muscle is attached is called the insertion. The origin is usually in that part of the skeleton which is less freely movable than the part to which the insertion is attached. It must be remembered that muscles are of various sizes and shapes and may have attachment to the bone only at one end or along one side, depending on the function of the muscle, the other end being attached to another muscle or structure of the body. (T) Voluntary muscle (striated). (0 Involuntary muscle (nonstiiated). Cardiac muscle. Figure 70. Muscular Tissue When skeletal muscles serve to move bones they act as levers. When we send a nervous impulse to a voluntary muscle, that muscle moves either rapidly or slowly as we will it to. For example, the biceps (large muscle in the front part of the arm) contracts, and the forearm is flexed at the elbow. When the triceps (large muscle in the back part of the arm) contracts, the arm is extended. The nervous system coordinates this action so one muscle will relax while the other contracts; otherwise the action of one would oppose the action of the other. However, involuntary muscle acts without any direction sent to it by our will and may contract at varying intervals. The muscles of the stomach and intestine will contract continuously while there is food within the alimentary tract. Muscles and posture. Correct posture is the term applied to that position of the body in which there is the least possible strain or friction, no matter what the amount of physical labor. It is a position of equilibrium of the body, such as standing, sitting, or lying, which can be maintained for some time. The term, “the position of the soldier,” used in the Army, is the normal standing position of the well-developed and healthy individual. When the body is held in a certain posture, there is always a slight, sustained contraction of the muscles to prevent the joints from bending. If the position is held for any considerable length of time a certain amount of fatigue is produced. Should the muscles not be in a healthy condition this fatigue is produced earlier. The 144 MEDICAL SOLDIER’S HANDBOOK result of this fatigue causes the muscles to relax, and the posture becomes improper. When a person, not well de- veloped, stands at attention (erect) for a long period the muscular relaxation causes him to slump. Exercise of muscles. Good food, pure air, and a proper functioning of the body activities are necessary for the healthy operation of the body. In addition to these, the muscles must be exercised in order to get the proper nourish- ment. Each muscle acts as sort of a chemical engine. Con- traction and relaxation are required frequently in order to throw off waste products and take in new fuel from the surrounding body fluids (blood and lymph). LEFT SUBCLAVIAN ARTERY LEFT COMMON CARTOID ARTERY INNOMINATE ARTERY SUPERIOR VENA CAVA LEFT AURICLE LEFT CORONARY VESSELS RIGHT AURICLE LEFT VENTRICLE RIGHT CORONARY VESSELS RIGHT VENTRICLE APEX OF THE HEART Figure 71. The Heart. When a muscle is not used at all it becomes much smaller and wastes away. This is called atrophy of the muscle. When any muscle or group of muscles are used in excess of normal the muscles become larger or undergo what is known as hypertrophy. The calf muscles of the legs of track men are examples of hypertrophy. The muscle cells become larger but do not increase in number. Tendons. Tendons are white, glistening cords made up of closely packed, parallel bundles of nonelastic, dense fibrous tissue. Their great strength and lack of bulk make their presence about the joints desirable because joint movements may be accomplished more easily. They serve as attachments of the muscle to the bony structure of the body. When a MEDICAL SOLDIER’S HANDBOOK 145 tendon serves as a strong connecting fiber between muscles it is called an aponeurosis. 202. The Circulatory System. The heart and the blood vessels form the cardio-vascular system. This system con- sists of a series of closed tubes of various sizes through which the blood circulates. Circulation of the blood is maintained by the forced contractions of a muscular pump, the heart. The heart and this system of vessels bring blood to and from the tissues in all parts of the body. PULMONARY ARTERY LUNG LUN* RIGHT AURICLE PULMONARY VEINS LEFT \ AURICLE ’ TRICUSPID VALVE MITRAL (BICUSPID) VALVE HEART PORTAL CIRCULATION ■LEFT VENTRICLE GASTRIC AND INTESTINAL VESSELS RENAL CIRCULATION Figure 72. The Circulation of the Blood (Schematic). SYSTEMIC CAPILLARIES The heart. The heart is a large, hollow, cone-shaped mus- cular organ about the size of the fist. It is enclosed in a tough, fibrous sac, known as the pericardium (meaning around the heart), and is located between the lungs near the front part of the chest. The larger portion of the heart is on the left side of the mid-line. It is protected by the rib cage. 146 MEDICAL SOLDIER’S HANDBOOK Because of its function, the heart is divided vertically into two separate halves without any direct opening between them so that each side of the heart operates independently. Each half has two cavities, an auricle above and a ventricle below. The auricles are smaller and have thinner walls. The right side of the heart is called the venous side as it receives into its auricle the impure blood collected by the veins. From the right auricle the blood passes down to the right ventricle, then via the pulmonary artery to the lungs where it is purified. When purified (oxygenated) it is returned via the pulmonary vein to the left auricle of the heart. The blood now passes down to the left ventricle, which contracts forcefully and pushes the blood out through the systemic arteries to the various parts of the body. There are two circulatory systems connected with the heart. The circulation of the blood from the right ventricle of the heart to and through the lungs and back to the left auricle of the heart is the pulmonary circulation. The circu- lation going from the left ventricle of the heart through the body, exclusive of the lungs, and back to the right auricle of the heart is the systemic circulation. The circulation of that portion of the blood within th* systemic circulation which goes to the stomach, spleen, and intestines, and on its return to the right auricle of the heart goes through the portal vein and capillaries of the liver and is known as the portal circulation. That portion going to the kidneys is known as the renal circulation. It is important in that it brings food material from the digestive system to the liver to be acted upon by that organ and either placed in the circulation or stored for future use. Blood vessels. The tubes which carry the blood away from the heart are called arteries; those which carry the blood to the heart are called veins. Connecting the arteries and veins in the different tissues are small, hair-like vessels known as capillaries. Except within the pulmonary circulation, the arteries contain purified blood and the veins the blood containing waste products. Because of the thin walls and dense network of the capillaries the blood within them comes into close relationship with the tissues of the body. The blood gives up food and oxygen to the tissues and takes away their waste products, which are carried to a point where they can be excreted by the kidneys and lungs. Blood. The total quantity of blood for the average adult is estimated to be one-twelfth of his body weight. The aver- age man may be considered to have 1% gallons of blood. The color of the blood when purified by its oxygen content is bright red. Therefore it is bright red in the arteries. In the abscence of oxygen, it is dark red and is so found in the veins. It is composed of blood cells (corpuscles) transported in a liquid known as the plasma. Plasma is composed of fibrin and a true liquid called serum. The fibrin is the substance which causes the blood to clot or coagulate when bleeding occurs. The serum, which is the plasma without the fibrin, contains the nutritive (food) elements of the blood. MEDICAL SOLDIER’S HANDBOOK 147 ARTERIES VEINS TEMPORAL TEMPORAL — FACIAL — EXTERNAL CARTOID COMMON CARTOID INTERNAL JUGULAR INTERNAL INNOMINATE SUBCLAVIAN — AXILLARY _ -SUBCLAVIAN ARCH OF THE AORTA SUPERIOR VENA CAVA- — AXILLARY — HEART DESCENDING AORTA BRACHIAL INFERIOR VENA CAVA- BASILIC CEPHALIC MEDIAN CEPHALIC- MEDIAN BASILIC" MESENTERIC VESSELS CEPHALIC — RADIAL COMMON ILIAC - EXTERNAL ILIAC - HYPOGASTRIC ILIAC \ VOLAR ARCH BASILIC -— FEMORAL - —FEMORAL INTERNAL SAPHENOUS- — POPLITEAL — POSTERIOR Tl BlAL — ANTERIOR Tl Bl AL SMALLER SAPHENOUS (POSTERIOR) ' GREAT SAPHENOUS _ (ANTERIOR) LEGEND ARTERIES = VEINS -PERONEAL DORSALIS PEDIS Figure 73. Principal Arteries and Veins of the Body. 148 MEDICAL SOLDIER’S HANDBOOK The blood cells or corpuscles are of three types: the red cells or erythrocytes, the white cells or leucocytes, and the blood platelets. The red cells are flattened discs, slightly concave (indented) on each side, and contain hemoglobin. Hemoglobin is a sub- stance containing iron, which has the ability to carry large amounts of oxygen. There are five million red corpuscles per cubic millimeter of blood in the healthy male. ® Blood platelets. (D Bed ceils. SMALL LYMPHOCYTE - POtYMORPHONUCLEA# EOSINOPHIU MONOCYTE- - LARGE LYMPHOCYTE POLYMORPHONUCLEAR NEUTROPHILE Figure 74. Types of Blood Cells. ® White cells. The white cells are spherical and slightly larger than the red cells. In the healthy human adult there are between 5000 to 7000 white cells per cubic millimeter of blood. These cells are able to change their form and pass through the walls of the blood vessels and destroy disease-producing organisms. They form the first line of defense against in- fection and poisons. Consequently, in most infectious dis- eases the number of these cells greatly increase. The blood platelets are small, almost colorless cells. Their average number is approximately 300,000 per cubic millimeter of blood. It is believed that the function of the platelets is to assist in the clotting of blood and to maintain immunity against certain diseases. The study of blood is known as hematology. MEDICAL SOLDIER’S HANDBOOK 149 203. The Lymphatic System. The lymphatic system is similar to the blood circulatory system except that the lymph fluid is clear and the lymph circulates between the cells of the body and the capillaries of the blood circulatory system. The lymph fluid is similar in composition to the blood plasma. The lymph vessels begin in the small spaces between the in- dividual cells of the body tissues; they unite to form larger vessels and empty into the venous blood system by way of a large lymph vessel, the thoracic duct. The thoracic duct is located in front of the bodies of the vertebrae, beginning in front of the second lumbar vertebra, and extends upward, gradually inclining to the left until on the level with the seventh cervical vertebra where it empties into the innominate vein beneath the left collar bone. LYMPH VESSELS (LARGE) — AXILLARY NODES LYMPH NODE EPICONDYLAR NODE I.YMPH VESSELS (SMALL) - LYMPH VESSELS - PALMAR PLEXUS ® A lymph gland, showing In- coming and outgoing vessels. @ Lymphatic network of the right arm. Figure 75. Lymphatic System of the Upper Right Extremity. The lymphatic system includes lymph nodes, which are bean-shaped glandular bodies along the course of the larger lymph vessels. The lymph passes through the substance of the node, thereby being filtered and purified. In case of in- 150 MEDICAL SOLDIER’S HANDBOOK — NASAL CAVITY - HARO PALATE NOSE — NARES — LIPS TONGUE — ORAL CAVITY (MOUTH) -POSTERIOR NASOPHARYNX SOFT PALATE TEETH- - PHARYNX “EPIGLOTTIS LOCATION OF VOCAL CORDS - LARYNX TRACHEA ® Upper respiratory tract. - SUPERIOR HORN - LARYNX — THYROID CARTILAGE — CRICOID-THYROID MEMBRANE — INFERIOR HORN — CRICOID CARTILAGE TRACHEA. BRONCHIAL TUBES RIGHT BRONCHUS LEFT BRONCHUS BRONCHIOLES RIGHT LUNG - LEFT LUNG © The larynx, trachea, bronchi, and lungs. Figure 76. The Respiratory System. MEDICAL SOLDIER’S HANDBOOK 151 fection these nodes become inflamed and enlarged. They are of importance because they aid in localizing and controlling infections, so the blood stream does not become infected. 204. The Respiratory System. The respiratory system con- sists of the structures and organs involved in the act of respiration. The term respiration means the function of gaseous interchange between the air taken into the lungs and the blood. Air reaches the lungs through the air passages: the nose, pharnyx, larynx (voice box), and trachea (windpipe). It enters from outside the body through the nose under ordinary conditions, although it may be taken in through the mouth. The nose is divided into two nasal passages by a partition called the septum. The inside of the nose is so shaped that the cooler, outside air is slightly warmed and certain foreign materials, such as dust particles, are removed before the air reaches the lungs. Near the nasal passages are irregularly- shaped cavities called the sinuses. Their inner surfaces are lined by a moist membrane similar to that found within the nose. Inflammation of this membrane is called sinusitis and may arise from an extension of an ordinary cold in the nose. Secretions of the sinuses drain into the nasal cavity. The pharynx. The pharynx is the large passageway back of the mouth. It is a common channel for food and air, since both the mouth and nasal cavity open into it. The pharynx extends downward to the opening of the larynx in front and to the opening of the gullet, or esophagus, in the rear. At the base of the tongue there is a small triangular- shaped flap covering the opening into the larynx; it prevents food from entering the larynx because when food is swallowed this flap, called the epiglottis, closes. The larynx. The voice box, or larynx, connects the pharynx and the trachea (windpipe). It is composed of circular car- tilages, muscular tissue, and connective tissues and contains the vocal cords. When the vocal cords are in a certain posi- tion and air is driven past them, their vibration makes a certain sound. The size of the opening made by the vocal cords controls the pitch of the sound, and the force of the air through the opening determines the loudness. The re- sonance of the sound and other alterations necessary to pro- duce the desired sound are also dependent upon the pharynx, the mouth, sinuses, nasal cavity, and the movements of the tongue, cheeks, throat, and lips. The trachea. The windpipe, or trachea, is a tube of circular rings of cartilages extending from the lower part of the larynx to the lungs. About four inches below the larynx it divides into two tubes, the bronchi, one of which goes to each lung. The lungs. There are two lungs, the right lung and the left lung. The bronchi continue into the lungs, their walls becoming thinner and thinner, dividing and redividing until they end in tiny air sacs. The thin wall formed by a single layer of cells in the air sacs, with the thin-walled capillaries surrounding them, permits the inhaled air to release oxygen to the blood and remove the carbon dioxide from it. 152 MEDICAL SOLDIER’S HANDBOOK Covering the lungs is a thin membrane called the pleura. The arteries, veins, and bronchi enter at the roots of the lungs. The chest cavity is a cone-shaped cavity with the narrow portion under the collar bone. It is surrounded by the ribs, breastbone, spinal column, and the diaphragm. The chest also contains the heart, trachea, and esophagus. It is lined on the inside by the same kind of membrane that covers the lung, the pleura, and is continuous with it. The space be- tween is known as the pleural cavity. Respiration is a voluntary movement to a certain extent, as one can breathe rapidly or slowly or take a deep or shallow breath. However, ordinary breathing goes on unconsciously. When impure blood reaches the lungs in increased quantities, there is a greater demand for more pure air. This condition stimulates, through the brain center, a need for increased speed and depth in breathing. This action takes place in- voluntarily. When one inhales, the chest increases in size, the ribs are pulled outward, and the diaphragm contracts and flattens, pulling in the air by increasing the length of the chest cavity. This is known as inspiration. Expiration requires little muscle action as the diaphragm and intercostal muscles relax, per- mitting the chest to return to a resting position. The lung capacity varies in different individuals, but in an average man, even after forced expiration, the lungs contain about 1000 cubic centimeters of air. This air is known as residual air. Under normal conditions we do not make forced expirations, and there are usually about 3000 cubic centi- meters of air remaining in the lungs after expiration. Deep breathing is of value in that it opens all the air sacs and per- mits a complete ventilation of all the air passages. Correct posture facilitates good breathing. 205. The Digestive System. The digestive system is made up of the food passageway (alimentary canal) and the various organs and glands attached to it. The function of the diges- tive system is to so prepare the food eaten that it can be ab- sorbed and used by the various tissues of the living body. In addition to the various food substances—carbohydrates, fats, proteins, minerals, and vitamins—the body requires water, since a large portion of the body is composed of water. In order that the above food elements may be used by the body, certain substances, called enzymes, present in the se- cretions of the alimentary canal, reduce these foods into simple solutions so they can be absorbed and transported to the various tissues where they are needed. Some of the alimentary secretions contain more than one enzyme. There are certain enzymes for the different types of food. For instance, some split carbohydrates into simple sugars; others, fats into fatty acid and glycerine; and still others, proteins into acids. After the food has been reduced by these digestive juices, it is absorbed by the blood, or lymph, circulating in the walls of the alimentary canal. Most of the absorption takes place in the small intestines. Food absorbed by the lymph vessels surrounding the alimentary canal is collected into, and later MEDICAL SOLDIER’S HANDBOOK 153 discharged from, the thoracic duct (a large lymph vessel) into the blood stream. The blood gives up the food substances to the various tissue cells through the lymph, nearby the capil- laries. The lymph, in turn, passes the food on to the tissue cells by the same process. This entire procedure is called assimilation and is brought about by means of an interchange -ESOPHAGUS LIVER &all\ LOCATION Of pancreas below - STOMACH ASCENDING COLON DESCENDING COLON - SIGMOID COLON APPENDIX >V'S* ANUS NOTE—The Liver end Gell Bledder have been lifted up. See dotted line for normal position in front of stomach and transverse colon. Figure 77. The Digestive System. of fluids governed by osmotic pressure. Osmotic pressure Is the passing of the more dense fluid to the less dense, and vice versa, through a thin membrane. The complete process, in- cluding the oxygen and food intake and the means by which they are utilized by the living tissue, is known as metabolism. The mouth. The mouth is the first organ taking in the digestion of food for absorption. After food is taken into the mouth, it is chewed by the teeth and mixed with a substance called saliva. Glands in the cheeks, under the tongue, aijd in the lower jaw secrete saliva through small ducts opening Med. Sol. Hb. 154 MEDICAL SOLDIER’S HANDBOOK into the mouth. Saliva contains an enzyme known as ptyalin, which acts on starches and reduces them to a sugar called maltose. If one chews a soda cracker for a prolonged period before swallowing, he will notice that it has a sweet taste. After the food becomes semi-liquid, it is swallowed and passes down the esophagus to the stomach. The stomach. The stomach is a hollow, sac-like, muscular organ which lies just below the diaphragm and is lined on the inside with cells that secrete the gastric juice. This acid liquid contains pepsin, an enzyme that breaks certain proteins up into simpler compounds. At the entrance to and the outlet from the stomach there are rings of muscular tissue which keep the food in the stomach until the proper digestion has been completed. Then the muscle fibers contract and force the food into the small intestine. The small intestine. The small intestine is a tube about 22 feet long which lies in coils within the abdominal cavity. In it digestion begun in the mouth and stomach is completed, and the majority of the food is absorbed by the blood and lymph through the walls of the intestinal villi. CAPILLARIES COLUMNAR NETWORK SMALL ARTERY LACTEAL VESSEL (LYMPH TRUNK) Figure 78. An Intestinal Villus. There are small openings into the intestine through which secretions of the pancreas and liver are received. The pancreas, which is a long, narrow gland located back of and below the stomach, secretes pancreatic juice. This juice re- duces further the proteins and starches, a process already started in the stomach, and, in addition, acts upon the fats. The liver. The liver secretes bile which aids the pancreatic juice in its action upon fats. The liver is the largest gland in the body and is situated on the right side of the abdomen, just beneath the diaphragm. The bile is formed by the liver cells and is collected in small ducts which unite to form the hepatic duct. Some of the excess bile passes up to the gall bladder, which is a bile reservoir, where it is stored for future use as required. When the gall bladder contracts, the stored bile is forced through the cystic duct. The cystic duct joins the hepatic duct to form the common bile duct which empties into the small intestine. Cells of the small intestine also secrete an intestinal juice which completes the breaking down of the proteins and starches. Undigested food and other waste products pass on to the large intestine. The large intestine. The large intestine, or colon, is three to four feet long and is much larger in diameter than the small intestine. It begins in the lower, right part of the abdomen where the small intestine empties into it through the ileo- cecal junction. From there it extends upward (ascending colon) to the under surface of the liver, then across the upper abdomen (transverse colon) to the spleen, and thence down the left side (descending colon) to the anus. Most of the food substances are absorbed in the small intestine. The contents discharged into the large intestine are liquid. Whatever re- mains of food value and the majority of the liquid contents are absorbed in the colon. The remaining material then con- sists of undigested substances, waste products, and unab- sorbed fluids, all of which are passed as fecal material. The sigmoid and the rectum are the lower portions of the large intestine. This portion of the bowel permits retention of the feces so that defecation is voluntary. MEDICAL SOLDIER’S HANDBOOK 155 SWEAT PORE SHAFT OF HAIR EPIDERMIS PAPILLA SEBACEOUS GLAND SWEAT GLAND DUCT - ARRECTOR MUSCLE - HAIR FOLLICLE DERMA ICORIUM] SWEAT (SUDORIFEROUS) GLAND ROOT OF HAIR - ADIPOSE (FAT) — SUBCUTANEOUS (AREOLAR) TISSUE Figure 79. A Section of the Skin. 206. The Excretory System. Waste products of the body are disposed of by means of the skin, lungs, urinary system, and the large intestine. The liver also acts as an accessory ex- cretory organ because it separates waste material from the portal circulation, makes certain harmful (toxic) excretory substances harmless, and returns them to the blood for ex- cretion through the skin and the kidneys. The skin has other functions in addition to providing a protective covering for the subcutaneous tissues. The skin consists of two layers, the cuticle, or epidermis, and the true 156 MEDICAL SOLDIER’S HANDBOOK — CEREBRUM BRAIN -CEREBELLUM SPINAL CORD SPINAL NERVES Figure 80. The Brain. Spinal Cord, and Spinal Nerves. MEDICAL SOLDIER’S HANDBOOK 157 sylvian fissure ~ MID-BRAIN 'SUPERIOR PEDUNCLE - INFERIOR PEDUNCLE MEDULLA OBLONGATA - SPINAL CORO Side view. Figure 81. The Brain OLFACTORY NERVE OPTIC NERVE , OPTIC CHIASMA OCULOMOTOR r NERVE \ TROCHLEAR i -j-NERVE OPTIC TRACTS \ TRIGEMINAL f- NERVE ABDUCENT " NERVE CEREBELLUM " MEDULLA OBLONGATA sylvian fissure T> Under surface, frontal lobe- GLOSSOPHARYNGEAL NERVE VAGUS NERVE—— SPINAL ACCESSORY NERVE' HYPOGLOSSAL NERVE — (AUDITORY) NERVES- INFUNDIBULUM — TEMPORAL LOBE - FACIAL NERVE ACOUSTIC 158 skin. Located in the true skin are numerous, tiny sweat glands. They secrete sweat, the quantity of which varies, depending on the temperature and the activity and physical condition of the individual. By this action, the skin is a body heat-regulator. The perspiration contains waste prod- ucts similar to those contained in the urine. In this manner, the skin has an excretory function. The lungs, urinary system, and large intestine are dis- cussed elsewhere in this chapter. 207. The Nervous System. The nervous system of the living body can be compared to the operation of a telephone sys- tem—the brain being the telephone center, the large nerves the trunk lines, and the small nerves the individual telephone lines. It is the most complex system of the body. Just like a big business concern, some of the problems may be taken care of by branch offices without complete knowledge of the home office, so there are various nerve centers which can take care of local needs without conscious participation of the highest center, which is the brain. Involuntary ac- tions, such as heart action and movements of the stomach and intestines, are automatic and are made unconsciously. They are handled by the sympathetic nervous system. Vol- untary actions are controlled by the cerebrospinal nervous system. The sympathetic nervous system consists of two rows of central ganglia (mass of nerve cells) lying along the front of the vertebral column These ganglia are united with each other by strands of nerve fibers and connected by means of sympathetic nerves to the various parts of the body. The cerebrospinal system is made up of the brain and spinal cord and the nerves given off by these organs, namely, the cranial and the spinal nerves. The brain. The brain, a complex mass of nervous tissue, lies within and well-protected by the skull. It consists of a large cerebrum, a much smaller cerebellum, the mid-brain, the medulla oblongata, and the pons. The average weight of the brain in the adult is about forty-eight ounces (three pounds). The cerebrum is egg-shaped and fills the entire upper portion of the skull. It is the seat of intelligence, and, if removed, all power of voluntary action and all sensations of light, taste, smell, touch, and hearing are lost. Here decisions are made and messages are sent to the muscles, telling them what to do. Mental exercise keeps the cerebrum active and capable of development. Certain portions of the cerebrum have definite tasks, and for that reason it is divided into lobes as follows: the frontal lobes, the parietal lobes, the temporal lobes, the occipital lobes, and the insula (Island of Reil). These lobes are separated by fissures (crevices), and each has ridges called convolutions. The large fissure which almost separates the two halves, or hemispheres, and extends from the back to the front of the cerebrum is the longitudinal cerebral fissure. The two hemispheres are joined in the center by a broad, transverse band of nerve fibers called the corpus callosum. Separating the cerebrum and the cere- bellum is a horizontal fissure called the transverse fissure. MEDICAL SOLDIER’S HANDBOOK Within each of the halves there is a longitudinal cavity containing cerebrospinal fluid known as a lateral ventricle. A third ventricle is situated behind and connects the two lateral ventricles. A fourth ventricle is in the upper portion of the spinal cord and connects the third ventricle with the central canal of the spinal cord. Openings between these cavities permit the cerebrospinal fluid to circulate from the ventricles to the central canal of the spinal cord. This fact is of considerable importance in the diagnosis and treatment of diseases of the nervous system. The cerebellum, which is oval shaped and slightly con- stricted in the center, lies in the lower and back part of the cranium. It is below the posterior portion of the cerebrum, connected to the cerebrum by the superior peduncles, to the pons by the middle peduncles, and to the medulla oblongata (upper portion of the spinal cord) by the inferior peduncles. Peduncles are bundles of nerve fibers, comparable to the large trunk lines between power houses and substations. The cerebellum is the chief center of muscular coordination and sense of equilibrium. It causes all the muscles to keep the proper amount of contraction and causes them to relax and contract so they will not interfere with the action of other muscles in performing a desired movement. Lack of this coordination may indicate some lack of development, disease, or injury involving the cerebellum, or the pathways leading to and from it. The mid-brain is a short, constricted portion connecting the pons and the cerebellum with the hemispheres of the cere- brum. The medulla oblongata is continuous with the spinal cord, which, upon entering the cranial cavity through the foramen magnum (opening in the base of the skull), widens into a pyramidal-shaped form, the broad end of which joins with the pons. Within the medulla oblongata are the roots of many of the cranial nerves and nerve fibers which pass to the cerebellum, to the cerebrum, and to the sympa- thetic nervous system. Many nerve fibers also arrive there, re- laying messages from all parts of the body. It is a large traffic control for incoming and outgoing messages. The medulla oblongata is also the seat of vital and reflex centers, regulating the action of the involuntary organs in compliance with the conditions made known through incoming messages (sensations) from the various listening posts (nerve endings). In this respect, its most important function is the control of the heart and respiration. The pons (Varolii) is located between the mid-brain and the medulla oblongata in front of the cerebellum. It is a bridge between the two halves of the cerebellum and also a bridge between the medulla oblongata and the cerebrum. Several of the cranial nerves leave the brain for their des- tination from the pons. The spinal cord. The spinal cord is a continuation of the nervous tissue of the brain which extends from the brain down through the spinal canal in the vertebral column. The upper portion where it is attached to the brain is widened MEDICAL SOLDIER’S HANDBOOK 159 160 MEDICAL SOLDIER’S HANDBOOK out to form the medulla oblongata. It is a large bundle of nerve fibers which carry nervous impulses to and from the various parts of the body—a large trunk line, carrying im- pulses in both directions. Meninges. Covering and enclosing the brain and spinal cord are three membranes known as the meninges. They are designated from within outward: the pia mater, the arach- noid, and the dura mater. The pia mater is a delicate mem- brane containing blood and lymph vessels and is closely adherent to the entire surface of the spinal cord and brain. The arachnoid is also a delicate membrane between the pia mater and the dura mater. Between the pia mater and the arachnoid membrane is a space containing cerebrospinal fluid. The arachnoid does not adhere or dip down into the fissures (exception is in the longitudinal fissure) but sur- rounds the brain and spinal cord loosely. The dura mater is a dense, stronger membrane containing a great many blood vessels. It has two layers within the cranium, the outer forming the inner periosteum for the bones of the cranium; the inner and thinner layer continues down into the spinal canal and encloses the spinal cord. The cerebrospinal fluid, found in the sub-arachnoid space and ventricles, acts as a nutritive fluid for nerve cells and as a buffer for protection of the delicate nerve tissue of the brain and spinal cord. It is a clear fluid, containing traces of proteins and other organic substances. Certain diseases may increase, decrease, or alter the cerebrospinal fluid in various ways. It is formed in the ventricles of the brain by tufts of blood vessels. Nerves are a continuation of the nervous tissue fibers into the various parts of the body. Cranial nerves are those emanating from the cranial portion of the nervous system; spinal nerves are those from the spinal cord. Nerves have a sensory or motor function, the sensory (afferent) nerve fibers carrying the incoming messages and the motor (efferent) nerve fibers carrying the outgoing messages. Through this intricate system of nervous tissue, the living body is pro- vided with a coordinated operation of all its organs and structures. The activity of one organ is often dependent upon the action of another. The necessary teamwork for normal body activities and maintenance of health is de- pendent upon this communication system and the result of the decisions and coordination from the brain. The senses. The special senses are seeing, smelling, hearing, tasting, and feeling Through them the activities of the body are, to a large degree, determined. These senses are made possible by the peculiar development and structure of the sensory nerve endings in various parts of the body. The sensory nerves of taste are all located in the taste buds of the tongue. Those of smell are in the membrane within the nose. The sense of sight is made possible because of the retina of the eye, which interprets and makes images of the light waves. Sound sensations are transmitted to the brain by the organs of corti within the inner ear. The sense of feeling is more generally distributed over the body surface. In some places, as in the finger tips, the sensory nerve end- ings are close together and the sense of feeling is more acute. The sensation of feeling may have any one or more of four qualities: pressure, cold, heat, and pain. The eye is like a small camera which is constantly in operation, taking pictures and sending them to the brain. The eyes are located in the bony cavities (orbits), which are hollow sockets in the front part of and outside the skull. Their only exposed side is to the front, and this surface is protected by the eyelids, eyebrows, and eyelashes. The inner surface of the eyelids and the exposed surface of the eye are kept moist by the secretion of the tear (lachrimal) glands in the eyelids. At the inner and lower corner of each eye is the opening of the lachrimal duct which drains the tears from the eye to the nasal cavity. MEDICAL SOLDIER’S HANDBOOK 161 SUPERIOR RECTUS MUSCLE -SCLERA SUSPENSORY LIGAMENT CILIARY PROCESS ZONULE OF ZINN CORNEA ANTERIOR CHAMBER CRYSTALLINE LENS ■PUPIL IRIS POSTERIOR CHAMBER ■CILIARY MUSCLE RETINA CHOROID INFERIOR RECTUS MUSCLE CHOROID RETINA - MACULA LUTEA VITREOUS BODY OPTIC NERVE- Figure 82. Diagrammatic Section of the Left Eye. The eyeball is spherical in shape and is composed of two hollow segments, the anterior and the posterior. The anterior chamber comprises about one-sixth of the eyeball and con- tains a gelatinous material, the aqueous humor. The posterior segment contains vitreous humor. The eyeball has three coats (tunics). From without inward, they are: a thick protective membrane (the sclera), which is continuous with the clear cornea in front but otherwise white; a middle coat, which contains blood vessels, a small muscle (ciliary muscle) and, in front, the iris (which contains color cells and forms the pupil); and the inner coat, the retina, which contains the light-sensitive cells of the optic nerve. The crystalline lens is placed directly behind the pupil and is held in place by the ciliary muscle (muscle of ac- commodation because it shortens or lengthens the lens) In comparison with the camera, the rays of light enter the front of the eye through the pupil (shutter), pass through the lens, and are registered on the retina, which corresponds MEDICAL SOLDIER’S HANDBOOK 162 to a color-sensitive film. The regulation of the light is con- trolled by the iris, which produces a small opening in bright light and a larger one in dull light. Adjustment for distance is made by means of the crystalline lens, which is auto- matically made thicker or thinner by the ciliary muscle so the light rays will fall properly upon the retina. The image falling upon the retina stimulates the light sensory cells therein, and the sensation is conveyed by the optic nerve to the brain where perception takes place. In the normal eye, the optical center of the refractive sys- tem is 15.5 millimeters from the retina. However, in many individuals the distance is greater or less. If this is the case, the images on the retina are not distinct. Correction must be made by the use of glasses containing lenses which re- turn the focus of light rays in a relation to the retina so as to make the image distinct. CONCH* (EXTERNAL EAR) external auditory CANAL -AUDITORY NERVE SEMICIRCULAR CANAL ■ BONY LABYRINTH - COCHLEA * VESTIBULE . EUSTACHIAN TUBE MIDDLE EAR EXTERNAL MEATUS ' MALLEUS INCUS STAPES TYMPANIC MEMBRANE (EAR DRUM) Figure 83. Cross Section Through the Right Ear (Front View) The ear. The hearing apparatus consists of an external ear, a middle ear, and an internal ear. The external ear collects the sound waves and directs them through a canal to the middle ear. This canal is called the external auditory canal and is a tube about an inch long, somewhat curved and lined with skin containing a few hairs. These hairs and the waxy substance secreted by a few glands in the skin of the canal tend to prevent entrance of foreign particles. At the inner end of the auditory canal is the ear drum (tympanic mem- brane) which separates it from the middle ear. Sound waves are directed against this shiny, taut membrane. The middle ear is a small, irregular body cavity in the skull, separated from the external ear by the tympanic membrane and from the inner ear by a thin, bony wall with two small openings. Inside the middle ear and stretched across the gap from the ear drum to one of the openings into the in- ternal ear are three small, movable bones called the hammer (malleus), the anvil (incus), and the stirrup (stapes). The middle ear is connected to the pharynx by the auditory (Eustachian) tube. Ordinarily, this tube is closed by the pressure of the tissue of the throat, but, upon swallowing, it opens and allows air to enter the middle ear. In so doing, equal air pressure is maintained between the inside and outside of the ear. The internal ear is a bony labyrinth (peculiar-shaped cavity) in the temporal bone containing a communicating MEDICAL SOLDIER’S HANDBOOK HILUM CALYX - PYRAMIDS - CORTEX (CORTICAL SUBSTANCE) •"MEDULLA (MEDULLARY SUBSTANCE) RENAL ARTERY - PELVIS URETER 'URINARY > bladder URETERAL OPENINGS - OPENING TO URETHRA (INTERNAL URINARY MEATUS) — OPENINGS OF THE EJACULATORY DUCTS PROSTATIC URETHRA BULBOUS URETHRA OPENINGS OF THE DUCTS OF COWPER S GLANDS - PENIS - URETHRA VAS DEPERENS EPIDIDYMIS — TESTICLE — EXTERNAL URINARY MEATUS Figure 84. The Male Urinary System. vestibule or passage to the middle ear, the cochlea (a snail- like shell spiral tube of two and three-fourths turns), and the semicircular canals (bony channels). The organ of Corti is located on a membrane in the cochlea. The mechanism of hearing is as follows: The sound waves are collected by the external ear and passed through the external auditory canal to the ear drum. These impulses are transmitted across the middle ear by the three small bones 164 MEDICAL SOLDIER’S HANDBOOK to the internal ear. Impulses received set in motion the fluid filling the cochlea and stimulate, through the vibrating fluid, the sensory cells of the Organ of Corti. These sensa- tions are conducted to the brain through the auditory nerve. 208. The Control of Balance. The slighest movement of the head changes the distribution of pressure created within the semicircular canals. This change is transmitted by the vestibular nerve to the brain, which interprets the position of the body and brings about the necessary changes to main- tain equilibrium, or balance. 209. The Male Genito-Urinary System. This system includes the urinary system and the reproductive (male genital) system. The urinary system. The urinary system includes the fol- lowing organs: the two kidneys which make urine from the waste products removed from the blood; the two ureters— small ducts that convey the urine away from the funnel (pelvis) of the kidney; the bladder—a reservoir for urine; and the urethra—a tube through which the urine passes from the bladder to the meatus (tip) of the penis where it is expelled from the body. The kidneys are two bean-shaped organs between four and five inches in length, one on each side of the spinal column in the back of the abdomen. The concave (indented) side is turned toward the spine. Near the center of the concave side is a fissure called the hilum, which contains the pelvis, ureter, blood vessels, lymph vessels, and nerves going to and from the kidney. Here the ureter, which takes away the urine, has its origin. There is one ureter for each kidney. They are small tubes which carry the urine from the kidneys to the bladder. The urinary bladder is a hollow muscular organ lying in the lower portion of the abdomen just behind the pubic bone. The ureters enter by separate openings at the lower posterior portion of the bladder. As the kidneys secrete the urine, it passes on to the bladder where it is stored to be emptied voluntarily at intervals. The opening of the urethra is in the anterior lower portion of the bladder. The urethra is the tube through which the urine passes from the bladder when the individual urinates. It passes through the prostrate gland and through the penis. Normal urine is a transparent, yellowish liquid with a characteristic odor and a specific gravity of 1.020 (weight of 1 cc). The quantity of urine may be increased by drinking a large amount of liquid, decreased perspiration, nervousness, and certain diseases. The presence of abnormal constituents in the urine, such as albumin, glucose, indican, acetone, casts, calculi, pus, and blood, is an indication of some disease or injury of the body. The male genital system. The male organs of reproduction are the two testicles and their accessory organs, the two vasa deferentia, the two seminal vesicles, two ejacula- tory ducts, two spermatic cords, the prostrate, and the penis and urethra. The testicles are two ovoid glandular organs which lie in MEDICAL SOLDIER’S HANDBOOK 165 a pouch of skin, the scrotum. They are covered with a thin membrane that doubles back on itself to line the scrotum. The testicles before birth develop in the abdominal cavity and descend into the scrotum, usually just before birth. The passageway closes up in the majority of cases, but some- times it remains open or the closure is so weak that the intestines may descend along the inquinal cord, causing a hernia (rupture), A hernia is not the result of venereal disease. The testicles have two important functions—the formation of the male cells (spermatazoa) and the secretion of the substance (a hormone) necessary for the development of sexual characteristics in the male. INTERNAL URINARY MEATUS x URINARY BLADDER COWPEK S GLAND AND DUCT RECTUM [ANUS. PENIS CORPUS CAVERNOSA CORPUS SPONGIOSUM GLANDS OF LITTRE PENIS . FORESKIN (PREPUCE) - EXTERNAL URINARY MEATUS SCROTUM - TESTICLE Figure 85. The Male Genital System, When the spermatazoa are formed, they pass into a long, coiled tubule on the back of the testicle known as the epididymis. This tube measures about 20 feet in length, but is coiled up so that it takes up little space. The tube of the epididymis is continued in a more direct channel as the vas deferens to a membranous pouch, the seminal vesicle (one on each side) lying between the base of the bladder and the rectum. These vesicles act as a reservoir for the fluid containing the spermatazoa, to which they add another secretion. They discharge the fluid through the small ejacula- tory ducts into the back part of the urethra. At the same place where these ducts empty into the urethra, the prostrate gland empties a secretion which facilitates mobility of the spermatazoa. The prostrate gland is shaped like a chestnut and surrounds the urethra just as it leaves the bladder. The penis is a muscular organ containing relatively large 166 MEDICAL SOLDIER’S HANDBOOK veins and attached to the lower part of the abdomen. It is suspended in front of the scrotum. At the end of the penis is a' slight enlargement known as the glans penis in which the urethral opening (meatus) is located. During sexual intercourse the seminal fluid is discharged through the urethra and directed into the female genital organ by the penis which is turgid because of distension due to an in- creased amount of blood in its venous spaces. spermatic artery - SPERMATIC cord (Co«***n d«*e'e"». *pe'm*t.c irtiritl *"<1 *♦•**». lympKatiC. ne'*ei muide and connect;** *issw*). HEAD OF EPIDIDYMIS VAS DEFERENS TAIL OF epididymis Figure 86. The Testicle, Semen is the fluid produced as a result of secretions from various sexual glands in the male. The reproductive elements in the semen are the male cells produced in the testicle; the other constitutents are derived from the seminal vesicles’ prostrate gland, and Cowper’s glands. Cowper’s glands are two small bodies about the size of a pea, situated one on each side of the prostrate gland. They secrete a viscid fluid which empties into the urethra. The endocrine system. The endocrine system is that group of organs and tissues which produce internal secretions. Some of these glands are ductless, and their secretions are ab- sorbed directly into the blood, or lymph. The active sub- stances contained in their secretions are called hormones. Hormones influence such functions as growth, reproduction, and metabolism. The most important of the ductless glands are: the thyroid, the parathyroids, the thymus, the suprarenal glands (adrenals), the pituitary body, the pineal body, the gonads (testicles and ovaries), and the spleen. Special cells in the pancreas, liver, stomach, and intestines also furnish internal secretions. The thyroid gland, in the neck, is one of the largest duct- less glands. Overactivity of this gland causes nervousness, loss of weight, rapid heart action, and many other symptoms. Insufficient secretion of this gland causes mental dullness, re- tardation of growth of the long bones, coarse hair, rough dry skin, and other symptoms. The above is cited to show that proper function of the endocrine glands has an im- portant bearing on the good health of the individual. The disfunction of one may create either an increased or de- creased function of another ductless gland in the endocrine system. MEDICAL SOLDIER’S HANDBOOK 167 Chapter 15 FIRST AID Paragraphs Section L General 210-211 Section II. Treatment of wounds 212-214 Section III. Shock 215 Section IV. Fractures, dislocations, and sprains ... 216-217 Section V. Artificial respiration 218-220 Section VI. Gas casualties 221-222 Section VII. Injuries due to heat and cold 223-225 Section VIII. Poisonous bites and stings 226-228 Section IX. Common emergencies 229-236 Section X. Transportation of wounded 237-238 GENERAL Section I 210. General. First aid consists of the temporary emer- gency treatment given in a case of sudden illness or accident before the services of a medical officer can be secured. This temporary care if intelligently given will often save a life. In all cases first aid, properly administered, will reduce men- tal and physical suffering and thereby place the patient in the medical officers hands in a better condition to receive further treatment. Very often the only first-aid care that is necessary is to prevent further injury to the patient by well-meaning but ignorant meddlers. Unit commanders are responsible that members of their units receive adequate training in first aid. 211. General Directions. The following precautions ap- ply to the application of first aid in any situation: a. Do not move the patient until the extent of the injury is determined. Keep the patient lying in a comfortable posi- tion, with the head level with the body. Many types of in- juries require skilled preparation before they can be safely transported to a hospital. Hurried transportation by un- skilled persons may aggravate injuries or even prove fatal to the patient. b. Keep cool; do not handle the patient hurriedly or roughly; keep bystanders away from the injured. c. Keep the patient warm; be sure he is covered and is not being chilled from contact with the ground. d. Do not give liquids to an unconscious patient; they may enter the windpipe and strangle him. e. Do not try to do too much; if the injury appears to be a serious one, bring medical assistance to the patient rather than transporting the patient to a hospital. MEDICAL SOLDIER’S HANDBOOK 169 Section II TREATMENT OF WOUNDS 212. General, a. A wound is a break in the skin or in the mucous membrane of one of the body cavities. Incised wounds are made by sharp cutting instruments such as knives, razors, and broken glass. Lacerated wounds are ir- regular and torn. They are caused by contact with angular surfaces such as shell fragments or by machinery. Puncture or stab wounds are caused by penetrating objects such as nails, wire, or bullets. Figure 87. First-Aid Treatment. b. Infection and severe bleeding are the principal dangers from any type of wound. Rapid bleeding requires immediate attention. In most cases bleeding is readily controlled if fundamentals are known and applied. Infection can incur whenever the skin surface is broken. The size or location of the wound is not related to the possibility of infection; a skin puncture with an ordinary pin may become infected. A wound should never be touched with anything except sterile dressings or instruments. The contact of unclean hands, bandages, or instruments may infect a wound that otherwise is relatively clean. 213. Application of First-aid Treatment, a. Steps in treat- ment: (1) Expose the wound completely by removing, cutting, or ripping the clothing or footwear. (2) If an antiseptic such as iodine is available, apply it to the wound and to the skin for 1 inch around the wound. If no antiseptic is available, this step is omitted. 170 (3) Apply a sterile dressing to the wound, preferably one from a first-aid packet. (4) Take additional steps to control bleeding if necessary. (5) Try to prevent shock by keeping patient warm and quiet. (6) Have the wound re-dressed by a medical officer as soon as possible. Special surgical treatment or the use of sera against tetanus and gas gangrene may be necessary. b. Precautions. In order to avoid infection or aggravation of the injury, the following precautions should be observed: (1) Do not touch the wound with the hands, mouth, cloth- ing, or other unclean object. (2) Do not wash the wound with any solutions such as soap and water. (3) Do not massage or squeeze the wound. This might start severe bleeding and certainly will injure the tissues. (4) Do not attempt to explore the wound or remove blood clots. (5) Never use iodine in or around the eyes, or in a body cavity. c. Use of the first-aid packet. (1) The first-aid dressing is carried by all military personnel. It is contained in a sealed metal container, whose seal must be broken to remove the dressing. The dressing consists essentially of a thick pad of absorbent material to which are attached two double-tailed rolls of bandage. When removing the wrapper and applying the dressing, the hands should touch only the bandage and the papered side of the dressing. The paper is colored to aid in its recognition. (2) The unpapered side of the dressing is applied to the wound. The bandage is then snugly secured about the limb or part by tying or pinning the ends. If a missile has gone com- pletely through an arm or leg, a dressing should be applied to one of the wounds without unrolling its bandage. A second dressing is then applied to the other wound, and its bandage used to secure both dressings. (3) It may be necessary to use the contents of several packets to cover very large wounds. 214. Hemorrhage, a. Varieties. There are three varieties of hemorrhage (bleeding) as follows: (1) Arterial. An arterial hemorrhage is bleeding from an artery. The loss of blood may be very rapid. The blood spurts from the wound with each pulsation of the heart beat and is bright red in color. (2) Venous. A venous hemorrhage is bleeding from the veins. The flow of blood is steady and the color is dark red. (3) Capillary. A capillary hemorrhage means bleeding from very small blood vessels and is manifested by oozing of blood from the wound. It is ordinarily not severe. b. Control of hemorrhage. Most mild hemorrhages will cease by natural means. This results from a blood clot form- ing in the wound, preventing the further escape of blood. More severe hemorrhages, particularly arterial and venous ones, usually require one or more of the following artificial measures for control: MEDICAL SOLDIER’S HANDBOOK MEDICAL SOLDIER’S HANDBOOK 171 (1) Elevation. Elevating a wounded extremity will aid in the control of hemorrhage by decreasing the volume of blood in the injured part and thereby encouraging the natural tendency to cessation of bleeding. (2) Pressure, (a) Direct pressure. Direct pressure is the most common and safest method for the control of bleeding. If sterile gauze or bandage material is available, it can be Temporal— Subc/avian Brach/a -Facia/ -Caro fid -Axillary -A or fa Grachia/ • (A/bend of e/bow) -Rad/a/ —U/nar Femora/- 1 Pop/ifea/ (Attack of knee) Figure 88. Course of Arteries and Pressure Points used for direct pressure on the wound and held in place until a dressing is applied or a tourniquet adjusted. The dressing itself can be adjusted so as to exert some pressure. (b) Pressure with the fingers. 1. When direct pressure on the wound does not control the bleeding, pressure upon the blood vessel between the heart and the wound is necessary. At certain places in the 172 MEDICAL SOLDIER’S HANDBOOK body, large arteries lie near bones and may be compressed to decrease the flow through them. Pressure may be ap- plied with the fingers until a tourniquet can be applied. 2. The following are the principal pressure points: (a) Scalp. Apply pressure with the tips of the fingers in front of the ear just above where the lower jaw can be felt working in its socket. A branch of the temporal Figure 89. Course of Arteries and Pressure Points—Head and Neck, Figure 90. Course of Arteries and Pressure Points—Upper Extremity, artery crosses the temple on the line between the upper border of the ear and the upper border of the eyebrow. (b) Neck and head. Press the thumb and fingers deeply into the neck in front of the strongly marked muscle which reaches from behind the ear to the upper part of the breastbone. (c) Shoulder and armpit. Press the thumb deeply into the hollow behind the middle of the collar bone. This compresses the large subclavian artery. (d) Arm or hand. Press outward against the bone just behind the inner border of the large muscle (biceps) of the arm. This compresses the brachial artery. MEDICAL SOLDIER’S HANDBOOK 173 Figure 91. Course of Arteries and Pressure Points, Lower Extremity: A, front view; B, back view. (e) Thigh, leg, or foot. Press strongly with the thumbs at the upper part of the inside of the thigh where the large artery passes over the bone. This compresses the femoral artery. (c) Tourniquet. 1. The use of a tourniquet is a dangerous procedure. One should not be employed if bleeding can be stopped by any other means. A tourniquet consists of a pad which is pressed against an artery, and a strap which is used to obtain 174 MEDICAL SOLDIER’S HANDBOOK Figure 92. Pressure Points; A, Temporal Pressure Point; B, Carotid Pressure Point; C, Brachial Pressure Point; D, Femoral Pressure Point. Figure 93. Use of Tourniquet Application. MEDICAL SOLDIER’S HANDBOOK 175 pressure on the pad. Medical Department personnel carry issue tourniquets as part of their equipment, but satisfactory ones can be improvised. The pad may consist of a roll of bandage, a stone wrapped in a handkerchief, or any other hard, smooth object. The strap may consist of a bandage, a cravat, a belt, or a handkerchief. The strap should be at least 1 inch wide so that it will not cut into the skin. Figure 94. Application of Tourniquet to Thigh. 2. For the arm and hand the tourniquet pad is applied about a hand’s breadth below the armpit. For the thigh and leg it is applied about a hand’s breadth below the groin. After tying the strap loosely around the limb, the required degree of pressure is made by passing a stick or bayonet under the hand but opposite the pad, and twisting it so that the pad is pressed down firmly. The stick is anchored with a bandage. The pressure exerted should be as light as will stop the hemorrhage. 3. Since a tourniquet cuts off the entire blood supply to the injured part, precautions must be taken that the tourniquet is not left on too long or the limb will die (gan- grene). It should be loosened at least every 20 or 30 minutes. It should not be covered with a bandage or splint or it may be forgotten. Some sort of tag should be attached to the man marked “tourniquet” and giving the date and hour when applied. MEDICAL SOLDIER’S HANDBOOK 176 Section III SHOCK 215. Shock, a. General. Shock is a profound depression of all physical and mental processes. This condition usually results from injury, but it may be caused by exposure, bleed- ing, fatigue, hunger, or extreme emotion. Some degree of shock follows all injuries; it may be slight, lasting only a few minutes, or it may be prolonged and end fatally. Where an injury is severe it can safely be assumed that a corresponding degree of shock will be present. Even if evidence of shock has not appeared after severe injury, it is well to anticipate it and to help prevent it by instituting shock treatment. b. Symptoms of shock. Part or all of the following symptoms may be present: (1) The patient feels weak, faint, and cold, and may feel nauseated. (2) The face is pale and pinched, and has an anxious and frightened appearance. (3) There is listlessness and possibly a general loss of sensation with beginning stupor. (4) The skin is cold and clammy. (5) The breathing is irregular and sighing. (6) The pulse is weak and rapid. c. Treatment of shock. (1) Place the patient flat on his back with the head low. (2) Control the hemorrhage if any is present. (3) Loosen all constricting clothing. (4) Avoid unnecessary movement of the injured part or of the patient; pain will result and shock will increase. Move patient no more than absolutely necessary before medical assistance arrives. If movement is necessary, apply the other shock treatment measures before moving the patient. (5) Apply heat to the body. This is the most important factor in preventing and treating shock. Additional clothing and blankets may be used. External heat may be applied by means of bottles or canteens filled with hot water, hot stones, or hot bricks. These hot objects may be placed between the legs, under the armpits, and beside the waist. They should not be placed directly against the bare skin or against very thin clothing as a burn may result. Care should be taken not to expose the patient to chilling while he is being examined and treated. (6) Stimulants given by mouth are valuable but cannot be used in all cases. They should never be given to unconscious patients, patients who are bleeding, or patients with skull fracture, apoplexy, sunstroke, or a wound of the abdomen. The best stimulants are hot drinks such as water, coffee, tea, or chocolate. A teaspoonful of aromatic spirits of ammonia in water is also valuable. (7) Treatment of shock must be continued for a consider- able period of time. The patient should be watched con- stantly until evidence of shock has disappeared. MEDICAL SOLDIERS HANDBOOK 177 Section IV FRACTURES. DISLOCATIONS, AND SPRAINS 216. Fractures, a. General. (1) A fracture is a break in a bone. A simple fracture is one in which there is no wound extending from the broken bone through the skin. A com- pound fracture is one in which the wound extends from the broken bone through the skin and therefore is exposed to the dangers of infection from the outside. A complicated frac- ture is one where there is damage to adjoining large vessels, nerves, or muscles which is a contributing factor in causing shock. (2) In no injury is the ultimate outcome more influenced by the character of first-aid treatment than in fractures. Improper handling or immediate transportation prior to im- mobilization of the limb may produce or aggravate shock and deprive the patient of a chance for recovery. All fractures or suspected fracture cases should be handled gently. It is equally as important to know what not to do as to know what to do. In splinting, two mechanical principles are in- volved: (a) Fixation to obtain rest for the injured parts, to retain them in proper alinement, and to favor their union. (b) Traction to obtain muscular relaxation with the object of diminishing pain and overcoming muscular contrac- tion which might result in faulty position of the injured parts, to secure proper alinement by a pull in the direction of normal anatomical lines, and to prevent the displacement of bony fragments with consequent injury to nearby nerves, muscles, and blood vessels. (3) In certain cases, immediate movement of the patient is very detrimental. The first-aid treatment should be admin- istered where the patient lies; medical assistance should be brought to the patient rather than the patient transported to the medical officer. This is especially true of fractures of the thigh, pelvis, or back and in all cases when there is evidence of shock. In any event, depending on the severity and nature of the case, one or more of the general first-aid measures are usually indicated. b. Signs and symptoms of fracture. Part or all of the fol- lowing signs and symptoms may be present: (1) Pain and tenderness at the point of fracture. (2) Partial or complete loss of motion. (3) Deformity. (4) Swelling and later, discoloration. (5) Crepitus or grating may be felt, but no attempt should be made to produce this sensation. c. First-aid treatment. (1) General. Splint the patient where he is. Do not transport or move him about until some type of splint is in position. Except where the bone is pro- truding, straighten the limb by pulling gently but steadily upon the lower end of the extremity. Maintain this steady traction and support the limb on either side of the fracture until a splint is applied. A splint should be as wide as the limb, and long enough to immobilize the next joint in either 178 MEDICAL SOLDIER’S HANDBOOK direction from the fracture If no issue splints are available, temporary splints may be improvised from many common materials such as shingles, pieces of board, bayonets or scab- bards, pieces of tin, mesh wire, bundles of twigs, rifles, folded blankets, pillows, or any other rigid or semirigid materials. It is important that splints be well padded on the side toward the skin, and that they be securely bound by bandaging or tying them at several points above and below the fracture but not over the fracture. Caution must be exercised that they are not so tightly bound as to cut off the circulation as swelling of the limb occurs. The splint and limb should be examined at least every 30 minutes to be sure the circulation is not cut off. Figure 95. Sling Made From Ordinary Bandages. (2) Treatment of fractures with wounds. In fractures with wounds or hemorrhage, the wound should be dressed and hemorrhage controlled before a splint is applied. Even if bleeding is slight, it is a safe precaution to place a tourni- quet loosely about the part so that, if bleeding should start, it can be quickly controlled. If the bone is protruding through the skin, it should not be pushed back with the hands. Apply iodine to the exposed bone and to the wound. Place a sterile dressing over the wound. Then apply traction to the extremity. (3) Slings. Fractures of the upper extremities should be supported by a sling after splinting. A triangular bandage makes the best sling. However, arm slings may be made from ordinary bandages, or may be improvised from the ordinary clothing by using safety pins to fasten the coat sleeve to the MEDICAL SOLDIER’S HANDBOOK 179 Figure 96. Sling Made From Ordinary Clothing. front of the coat to support the arm. The coat flap may be used for the same purpose by pinning it, or by punching a hole through the lower edge of the flap and buttoning this to a coat button. (4) Application of splints, (a) Fracture of the forearm. With the forearm flexed to a right angle, thumb up, apply a splint to the inner surface, extending to the tips of the fin- gers, and another to the outer surface, extending to the wrist. (b) Fracture of the upper arm. Apply two splints from the shoulder to the elbow, one in front and the other behind, if the lower part of the bone is broken; apply to the inner and outer sides, if the fracture is in the middle or upper part; support by a sling. (c) Fracture of the collar hone. Flex the forearm to a right angle in front of the body and place in a sling. (d) Fracture of the leg or ankle. Apply two splints, one 180 MEDICAL SOLDIER’S HANDBOOK Figure 97. Splints for Forearm. Figure 98. Splints for Leg or Ankle. on the outside, the other on the inside of the limb, extending from the knee to beyond the foot. (e) Fracture of the thigh. Administration of first-aid treatment where the patient lies is the method of choice. Splinting should not be attempted by the inexperienced unless unusual circumstances make it necessary that the patient be moved some distance at once. Proper traction ap- plied to the limb below the fracture is absolutely essential to provide effective first-aid treatment which will permit trans- portation without danger of producing further injury and shock. To do this requires a special splint applied by one experienced in its application. If the patient must be moved, carry gently as possible, paying special attention to the sup- port of the injured limb in the extended position. MEDICAL SOLDIER’S HANDBOOK 181 Figure 99. Splints for Hip or Pelvis. (f) Fracture of the hip or pelvis. The patient should be prepared for transportation by a medical officer. If abso- lutely necessary to move him, a splint should be applied, ex- tending from the armpit to the foot. This should be securely anchored at several points. (g) Fracture of neck or back. The patient should not under any circumstance be moved except by skilled medical personnel. In fracture of the neck the head should be gently straightened and steadied by the hands or by pads on either side of the neck. In fracture of the back it is best to lay the patient flat on his stomach. 217. Dislocations and Sprains, a. General. When a bone gets out of place at a joint, the condition is called a dis- location. When the ligaments about a joint are torn or bruised, the condition is called a sprain. In these conditions the pain is usually severe, marked swelling rapidly occurs, and shock may be present. It is often impossible to dis- 182 tinguish a sprain or dislocation from a fracture without an X-ray examination. b. Treatment. (1) Elevate the part. If this is an upper extremity, elevate by means of a sling. If it is the lower extremity, have the patient in the prone position with pillows, coats, or other support under the raised leg. (2) Apply cold applications to the site of injury early to retard swelling. If the injury is over 2 hours’ old, hot ap- plications are more valuable. Plain hot water is as efficient as any solution for this purpose. (3) Keep the patient warm. If shock is present, treat it. (4) When in doubt, treat the case as a fracture and apply splints, especially if the patient must be transported. (5) Never attempt to reduce a dislocation as permanent damage may be done. MEDICAL SOLDIER’S HANDBOOK Section V ARTIFICIAL RESPIRATION 218. General. Asphyxia, suffocation, or cessation of breath- ing occurs most frequently in drowning, electrical shock, and gas poisoning. The safest and most effective method of ap- plying artificial respiration is the prone pressure or Schaefer method. Oxygen respirators, which are available at many bathing beaches and military stations, are very efficient in trained hands but, for unskilled personnel, are less satisfactory than the Schaefer method. 219. Drowning, a. General. Being under water for over 5 minutes is usually fatal, but an effort to revive the ap- parently drowned should always be made unless it is known that the body has been under water for a long time. It is very important that artificial respiration be started at the earliest possible moment after the patient has been removed from the water. b. Technique of resuscitation. (1) Lay the patient face down, force his mouth open, pull the tongue forward, and remove false teeth, juice, vomitus, or debris from his mouth and throat. (2) Raise him by the hips in order to drain the water from his lungs. (3) Lay him on his belly, preferably at a spot where his head will be lower than his feet. One of his arms should be extended over his head, the other bent at the elbow so that his face can be turned to the side and rest on the hand. (4) Kneel astride the patient’s thighs, with your knees placed at such a distance from his hips as will allow you to exert the pressure on his lower ribs as described below. Place the palms of your hands on the small of his back with your fingers on his lower ribs, your little fingers just touching his lowest rib, with your thumbs and fingers in natural position and the tips of your fingers out of sight just around the sides of his chest wall. The heels of the hands should be placed as far from the backbone as possible without slipping off. (5) With your arms held straight, swing forward slowly so MEDICAL SOLDIER’S HANDBOOK 183 that the weight of your body is gradually brought to bear upon the patient. Do not bend your elbows. This operation should take about 2 seconds. (6) Now immediately swing backward so as to remove all pressure completely and suddenly. Leave the hands in place if possible. (7) After about 2 seconds repeat the operation. The cycle of compression and release should take about 4 or 5 seconds and should be repeated at the rate of 12 to 15 times per minute. Figure 100. Artificial Respiration, First Position. (8) Continue the operation without interruption until nat- ural breathing is restored, or until the subject is unquestion- ably dead. Remember, many patients have died because arti- ficial respiration has been stopped too soon. Always continue the operation for 2 hours or longer. (9) Aside from the resuscitation, the most valuable aid that can be rendered is keeping the patient warm. After artificial respiration has been started, have an assistant loosen the clothing and wrap the patient in any clothing that is available. Use hot brick, pads, heaters, or similar means, but be sure the person is not burned by your treatment. (10) When the patient revives he should be kept lying down and not allowed to stand or sit up; this will prevent undue strain on the heart. Stimulants such as hot tea or coffee, or aromatic spirits of ammonia, can be given as soon as the patient is perfectly conscious. (11) At times a patient, after temporary recovery of res- piration, stops breathing again; artificial respiration should be resumed at once. (12) Due to the length of time this operation may be kept up, one, two, or more operators may be necessary. A change 184 MEDICAL SOLDIER’S HANDBOOK of operators can be made without loss of rhythm of respira- tion. If this point is remembered no confusion will result when the change occurs and the respiratory count will be kept even. The great danger is stopping artificial respira- tion prematurely. In many cases, breathing has been estab- lished after 3 or 4 hours of artificial respiration, and there are instances where normal breathing has been reestablished after 8 hours. The ordinary and general tests for death should not be accepted; a medical officer should make several careful examinations at various intervals before the proce- dure is allowed to be stopped. Figure 101. Artificial Respiration, Second Position. 220. Electrical Shock. The rescue of the victim from a live wire is always dangerous. If the switch is near, turn the current off, but lose no time in looking for the switch. Use a dry stick, dry clothing, dry rope, or some other dry non- conductor in removing the victim from the wire. Start arti- ficial respiration immediately. Do not regard early stiffening as a sign of death; always keep up the artificial respiration for several hours. Section VI GAS CASUALTIES 221. Peacetime Gases. The chief poisonous gases encoun- tered in civil life are illuminating gas, carbon monoxide (motor exhausts), charcoal, and mine gases. The first thing to do in all of these gases is to get the patient into fresh air. The fresh air of a warm room is preferable to extremely cold air. If breathing is weak or irregular or has stopped, artificial MEDICAL SOLDIER’S HANDBOOK 185 respiration should be started and continued until normal respiration has been established. A medical officer should always be called, since the patient may die even after breath- ing is apparently normal. 222. Gases in Warfare, a. General. Prompt and proper first-aid treatment for gas casualties is of vital importance. Proper treatment will minimize the effects of the gas and will often prove the deciding factor in the outcome of the case. There are certain simple rules which all individuals must know. Unit commanders are responsible for the training of members of their commands in first aid for gas casualties. They are also responsible for the intelligent early handling of gas casualties prior to evacuation. b. First-aid rules. The detailed protection against and treatment for the various gases used in warfare are given in FM 21-40. The following simple general rules should be understood by all individuals: (1) Wear mask and gloves when handling a gassed man. If gloves are not worn, wash hands thoroughly with soap and water, or rub them with dry lime, after handling such cases. (2) Remove the casualty or the suspected casualty from the contaminated area as quickly as possible. (3) Remove the patient’s clothing and equipment unless undue exposure to cold will result, but leave his mask on until certain that the air is free from gas. (4) If possible, remove all gassed cases from woods or low ground to knolls or hillsides. Do not carry them into dugouts or cellars, since most war gasses are heavier than air. (5) Do not allow cases affected by lung-irritant gasses to walk or talk. The apparent mildness of these cases is often misleading. (6) Remember that the clothing, equipment, or bodies of cases gassed with vesicants may contaminate anything with which they come in contact. Thus blankets, litters, or areas on the ground occupied by such cases should be avoided by ungassed persons. (7) Prevent patients with vesicant-gas injuries from rub- bing their eyes, mouths, or genitals. Do not bandage the eyes. c. Special measures. See FM 21-40. (1) Lacrimators. Men who are lacrimated do not require evacuation as casualties. They only need to leave the con- taminated atmosphere and face the wind, allowing it to blow into their eyes. They should not rub their eyes; their clothing and equipment should be loosened so as to get rid of en- trapped gas. Bathing the eyes in cold water or with a weak boric acid or sodium bicarbonate solution will aid. (2) Irritant gases (sternutators). These agents, such as DM, are not lethal in field concentrations. They may, how- ever, cause such disability as to require evacuation. (a) Remove patient from the contaminated atmosphere, keep away from heat, and remove outer clothing. Flush the nose and throat with a weak solution of sodium bicarbonate (baking soda) or of ordinary salt. (h) Breathing chlorine in low concentrations tends to alleviate the irritation. In lieu of other facilities, this may Med. Sol. Hb. 186 MEDICAL SOLDIER’S HANDBOOK be accomplished by breathing from a bottle containing bleaching powder (chloride of lime), or from a mixture of alcohol, chloroform, and ether. The exposed surface of the body should be washed with soap and water. (3) Lung irritants. In order to reduce his oxygen re- quirements to the minimum possible, a lung irritant casualty should be made to lie down and not allowed to walk to an aid station even though he insists that he is able to do so. He should, as soon as possible, be removed from the con- taminated atmosphere, his equipment removed, his clothing loosened, and he should be kept warm. In addition to wrap- ping him in blankets, nonalcoholic stimulants such as hot coffee or tea should be given; and he should be evacuated as soon as possible as an absolute litter case. (4) Vesicants. All of the agents classed as “vesicants” have also a powerful lung irritant action. (a) Mustard gas. The casualty should be immediately taken out of the contaminated atmosphere or area and his contaminated clothing removed. Should only portions of the clothing be splashed with liquid mustard, these can be cut away. If the face has been exposed, wash the eyes and rinse the nose and throat with a saturated boric acid, weak sodium bicarbonate, or common salt solution. If the vapor has been breathed, the individual should be treated and handled as a lung irritant casualty. First aid must be prompt for little can be done later than 30 minutes after exposure. Vapor burns on the skin may be lessened or even prevented by thorough cleansing with soap and water (preferably hot) immediately after exposure. Cleansing the exposed parts with gasoline or kerosene prior to the use of soap and water will facilitate the removal of all traces of the gas. Mustard burns or skin areas wet with liquid mustard should be immediately and repeatedly swabbed with a solvent such as kerosene, gasoline, any oil, alcohol, or carbon tetra- chloride (pyrene). Fresh cloths should be used and the spreading of the con- tamination should be avoided. After cleansing with the solvent, the affected parts should be thoroughly washed with soap and hot water. Cloths used in removing the liquid mustard will be contaminated and should be burned or buried after use. A weak, freshly prepared solution of chloride of lime in water may be used in place of the oily solvent; this solution is itself very irritating to the skin and must, there- fore, be removed by subsequent washing with soap and water. Fresh, uncontaminated clothing must be supplied where necessary. All casualties should be evacuated as soon as possible. (b) Lewisite. To be of any value against lewisite, first aid measures must be instituted almost immediately. The treatment is similar to that for mustard. In lewisite burns, whether from vapor or liquid, the danger of poisoning from absorbed arsenic far overshadows the effect of the actual burn; it is, therefore, imperative to neutralize, if possible, any arsenic present and not yet absorbed. This may be accomplished by the immediate application of some hydrolyzing agent. A 5 per cent aqueous solution of sodium hydroxide (caustic soda) has been found very efficient if applied soon enough. Following this, or in the absence of the hydroxide solu- tion, vapor burns should be thoroughly cleansed with soap and water and then dressed with a ferric hydrate paste. The paste should be spread on thickly, covered with gauze, and allowed to remain for 24 hours. Following the hydroxide solution and cleansing with soap and water, liquid burns should be repeatedly swabbed with some oily solvent as sug- gested for mustard, again washed with soap and water, and dressed. Fresh, uncontaminated clothing must be supplied where necessary. All casualties should be evacuated as soon as possible. (5) Incendiaries, (a) For burns from incendiaries other than white phosphorus, treatment and handling are the same as for ordinary heat or fire burns. (b) For phosphorus burns, immerse the affected part in water to stop the burning of the phosphorus and pick out the solid particles from the flesh. Wet cloths, mud, or damp earth may serve the purpose if immersion in water is not possible. As phosphorus melts at approximately 111° F., if hot water is used, the melted particles may be removed with a cloth or sponge. The prompt application of an approximately 2- or 3-per cent solution of copper sulphate in water will form a thin coating of copper phosphides on the phosphorus particles, which will stop their burning at once. The coated particles can then be picked out from the flesh. The copper sulphate solution should be applied by soaking a pledget of cotton, a sponge, or a piece of cloth in the solution and then placing it on the phosphorus. A minute or two is sufficient time for the formation of the metallic covering coat. After removal of the phosphorus, the burns should be dressed. All severe cases should be evacuated. MEDICAL SOLDIER’S HANDBOOK 187 Section VII INJURIES DUE TO HEAT AND COLD 223. Burns, a. General. Burns may be caused by dry or moist heat, electricity, and chemicals. They are classified in degree according to the depth to which the tissues are in- jured. Shock and infection are to be feared in dry burns. (1) First degree. The skin is reddened but there is no blister. (2) Second degree. The skin is blistered. (3) Third degree. The skin is destroyed or charred, as from contact with flames. b. Treatment of burns. (1) General rules. The following general rules apply to the first-aid treatment of all burns: (a) Do not pull the clothing from the burned part; snip or cut it off. (b) Do not break or prick blisters if present. (c) Treat shock early in all severe burns. 188 (d) When possible, protect the burn quickly with a sterile dressing, applying medication as indicated in (2) to (5) below. (2) First-degree hums. The treatment is directed toward the relief of pain since the skin is unbroken and there is no danger from infection. Any substance that will relieve the pain is satisfactory. An oily substance such as petrolatum (vaseline), olive oil, or castor oil is usable. Cold water or soda in water is soothing when immediately applied. It must be remembered that if the burn is at all serious, such as en- countered in second- or third-degree burns, oily substances are not to be applied. (3) Second-degree burns. Here the injury must be re- garded as an open wound; only material that is known to be clean can be used. Remove the loose clothing, but do not try to remove material that adheres to the skin. The application of sterile gauze soaked in a solution of Epsom salts (2 table- spoonfuls to a pint of boiled water) is very good. The dress- ing should be kept moist and warm until further aid is obtained. The best treatment is application of gauze satu- rated with 2-per cent picric acid solution applied securely but not tightly. A 5-per cent tannic acid solution similarly ap- plied is of equal value. Never apply iodine or similar sub- stances to a burn, and never apply absorbent cotton to a burned surface. Shock is always present to some degree in every case. (4) Third-degree burns. These are always serious and re- quire medical attention promptly. The first-aid treatment consists chiefly of keeping the patient warm and treating shock. If medical attention can be obtained promptly it is best merely to lay a sterile dressing lightly on the wound. If over 30 minutes will elapse before help can be obtained, one of the dressings used for second-degree burns should be applied. (5) Chemical burns. Burns caused by acids or alkalies should be washed with large quantities of water, preferably lukewarm, until the chemical is thoroughly removed. All clothing should be cut away with scissors. Apply a salve dressing after the chemical is completely removed, and secure a medical officer’s services. Phenol or carbolic acid burns should first be washed with alcohol if available. Eye burns require careful attention. The best first-aid treatment is to flush the eye thoroughly with clean olive oil, mineral oil, or castor oil. If these are not available use water; a drinking fountain that throws a stream is excellent for this purpose. After washing, the eye should be covered with a moist dress- ing and further medical aid secured. 224. Sunstroke and Heat Exhaustion. Both these condi- tions are caused by excessive heat, but they differ entirely in their symptoms and treatment. a. Sunstroke. (1) General. Sunstroke is a very dangerous condition usually caused by direct exposure to the rays of the sun, especially when the air is moist. The symptoms are headache, dizziness, oppression, and sometimes vomiting; the skin is hot and dry, and the face flushed; the pulse is rapid MEDICAL SOLDIER’S HANDBOOK and full; the temperature is high, often ranging between 107° and 110°. Unconsciousness usually occurs and the body be- comes relaxed; however, convulsions may occur. (2) Treatment. Remove the person to a shady, cool place if possible and loosen or remove the clothing. Lay the pa- tient on his back with shoulders elevated. Apply cold to the head by means of wet cloths, ice bags, or ice. The brain can- not withstand the effects of high temperatures. Cool the body by giving cold baths for 20 minutes at a time combined with brisk massage of the limbs and trunk. Cold wet cloths or ice bags may be used. Wrapping the body in a sheet and pouring on cold water every few minutes is very effective. Do not overdo any of these procedures. Stop every few minutes to observe the effects on the patient. If the skin again gets hot repeat the treatment. Give no stimulant by mouth while unconsciousness lasts. b. Heat exhaustion is caused by exposure to high tempera- ture as encountered in boiler rooms, foundries, bakeries, and similar places. The first signs of heat exhaustion are dizzi- ness, nausea, and uncertain gait. The face is pale, the body is covered with a profuse perspiration, and the skin is cold and clammy. Breathing is shallow, the pulse is weak, and the temperature may be normal or somewhat elevated. Fainting may occur, or prostration may become severe. Remove the patient to circulating cool air, place him in a supine position, and let him drink freely of cool salt water (1 teaspoonful of table salt in a pint of water). Call a medical officer if the patient does not recover promptly. 225. Freezing, a. Frostbite. (1) The symptoms of frost- bite are cold in the part, then pain, and finally, loss of sen- sation. The affected part becomes white or bluish white. (2) Slowly thaw the frozen part by using extra clothing, applying it to another part of the body, or wrapping it in cloths soaked in cool water. Do not expose frozen tissues to a hot stove or radiator. Do not rub the frozen part either with the bare hands or with snow; the tissues will be bruised and torn, and gangrene may result. Medical attention is usually necessary after frostbite. b. Unconsciousness. When a man becomes unconscious from cold, if possible, carry him into a cool room, cover him well with blankets, and move his arms and legs gently but steadily. When consciousness returns, give him warm drinks and let him lie quietly. MEDICAL SOLDIER’S HANDBOOK 189 POISONOUS BITES AND STINGS Section VIII 226. Snake Bite. Treatment for snake bite should start immediately. The main effort is to prevent the poison enter- ing the general blood circulation. If on a limb, a tourniquet should be tied around the limb just above the bite to increase the bleeding. A necktie, handkerchief, or bandage can be used as a tourniquet. It should be tight enough to prevent the blood flowing back through the veins, but not tight enough to prevent the blood flow in the arteries. In any event it should 190 not be left on for a period greater than 1 hour. Whether or not the bite is on a part of the body where a tourniquet can be used, a cross incision, Vz by V2 inch, should be made over each fang mark, and preferably one to connect the two fang punctures. The cut must be deep enough, V\ to Vz inch, to insure free bleeding. Suction must then be applied for short intervals during at least Vz hour. This may be applied by the mouth, glass breast pump, or by heating a bottle and applying its mouth tightly over the wound. The cooling of the bottle will produce considerable suction. Snakes’ venom is harmless in the mouth unless there are cracks or wounds of the lips or inside of the mouth. The patient should be kept quiet and medical attention obtained as quickly as possible. Anti- venom may be given him, but the free bleeding produced by incision and suction is of far greater value. Whisky is not only useless in the treatment of snake bite but it is distinctly harmful because of its depressing effect. Cauterization of the wound and the use of various drugs, such as potassium permanganate, are also useless. 227. Insect Bites and Stings, a. The proper removal of the stinger is important. This should be done by grasping the stinger with a pair of small forceps and removing it in its entirety. A paste made of baking soda, or a cold, moist dressing, using a dilute solution of salt, soda, or ammonia, is helpful. b. Poisonous spider and insect bites should be treated in a manner similar to snake bites. A cross incision should be made and a loose tourniquet applied. Cauterization of the wound with a mild acid or with a hot implement is recom- mended. Shock, if present, should be treated and a medical officer called. c. For the itching of mosquito or chigger bites, calamine lotion is very soothing. For extreme irritation 2 per cent phenol may be added to the lotion. These preparations can be obtained at most dispensaries. 228. Animal Bites. The first-aid treatment is the same as that for ordinary wounds. However, medical advice should be sought even if the wound seems trivial, since animal bites are commonly infected, unless dressed properly. If possible, the animal should be captured and examined to be certain that it does not have rabies. MEDICAL SOLDIER’S HANDBOOK Section IX COMMON EMERGENCIES 229. Poisons, a. General. The two principal points to remembered in the treatment of poisoning are: (1) Poisons when diluted are not absorbed in as great quantities as when they are in a concentrated form. (2) The stomach can be cleaned out by causing vomiting or by washing. Washing the stomach with a stomach tube should be attempted only by experienced personnel. b. Treatment. (1) Vomiting is the first step in treatment. The following fluids are useful in producing vomiting. From four to seven glassfuls should be given, preferably lukewarm. Tickling the throat with the finger will then usually induce vomiting: (a) Soap suds from any type of soap. (b) Salt water or soda water. (c) Lukewarm water. (d) 1 tablespoonful of mustard in warm water. (2) Additional first-aid treatment for specific poisons is as follows: (a) For carbolic acid (phenol) poisoning, give soap suds or milk. (b) For the corrosive poisons such as bichloride of mer- cury, give milk or the whites of eggs. (c) For iodine poisoning, give starch in water. (d) For strychnine poisoning, keep the patient quiet and call a medical officer. (e) For overdoses of sedatives, keep the patient on his feet and make him walk. Give strong coffee and get him to medical attention. (/) For wood alcohol, shoe dye, or like poisons, induce vomiting and get medical attention. (g) For acute alcoholism (drunkenness) treatment is usually unsatisfactory and unnecessary. Inducing vomiting and giving strong coffee will speed recovery. Cold baths are dangerous and without value. 230. Removal of Foreign Bodies, a. Foreign bodies in the eye. (1) Close the eye and allow the tears to accumulate. Do not rub the eye. After a few minutes open it again and the foreign body may be washed out by the tears. If the foreign body is under the lower lid, pull the lid down and have the patient roll the eye up and the foreign body may be easily brushed out by the corner of a clean handkerchief or a small swab made by wrapping a little cotton around the end of a match. (2) If, as usual, the foreign body lies under the upper lid, grasp the eyelashes of the upper lid with the index finger and thumb of the left hand; place a match or pencil held in the right hand over the middle of the upper lid; then turn the lid over the match and the foreign body may be seen and removed. The corner of a clean handkerchief may be used, or the eye may be irrigated with clean water, using a small sterile syringe. (3) If the object is embedded in the eyeball or eyelid, close the eye, apply a bandage lightly, and consult a medical officer. Never attempt to use a knife, toothpick, or pin to remove a foreign body. (4‘) When acid is splashed into the eye an alkaline prepa- ration made from soda, magnesia, chalk, or lime should be used. (5) When strong alkalies get into the eye, weak acid solu- tions such as diluted vinegar or lemon juice are employed. b. Foreign bodies in the ear. The only safe method is to syringe the ear canal with lukewarm water. If the object does not come out, consult a medical officer. Never use pins MEDICAL SOLDIER'S HANDBOOK 191 192 or wire to dislodge these objects, as there is great danger of seriously injuring the eardrum. Insects in the ear can usually be killed by dropping in a little oil, and then washing the ear canal with a syringe. c. Foreign bodies in the nose. These usually present no immediate danger. Gentle blowing of the nose may be tried: if unsuccessful, drop in a little olive or mineral oil and con- sult a medical officer. Any attempt to remove the object with forceps or wire usually causes more swelling and lodges the foreign body more securely. d. Foreign bodies in the throat. (1) As the result of sud- den interference with the breathing, the person clutches at his throat and gasps for air. There may be violent coughing or attempts to vomit, the face becomes blue, and the eyes stick out of their sockets. (2) If another person is at hand, have him go or telephone for the nearest medical officer, notifying him of the nature of the accident so that he may bring the proper appliances. In the meantime attempt to dislodge the foreign body by slapping the back violently between the shoulder blades. If this is not successful, hold the patient by his feet with the head down and have someone slap his back between the shoulder blades. (3) If a foreign body such as a safetypin or a dental bridge has been swallowed, the patient should be promptly but gently transported to a hospital. 231. Pain in the Abdomen. Pain in the abdomen may be due to a variety of causes, many of which may be serious. In any case where there is nausea and vomiting, accompanying or following pain over all or any part of the abdomen and with pain and tenderness in the lower right part of the abdomen, appendicitis should be suspected. Appendicitis may also occur without nausea. Always put suspected cases to bed and call a medical officer. As a general working rule, never give cases with abdominal pain or tenderness food, water, a laxative, or an enema unless ordered by a medical officer. 232. Unconsciousness, a. General. Unconsciousness may be complete or partial. Frequently it is impossible to deter- mine the cause, and treatment must be along general lines. An unconscious person with an odor of alcohol on his breath should not always be considered drunk. An intoxi- cated person may not have an alcoholic breath. It is always wise to consider the possibility of apoplexy and skull fracture in every case of unconsciousness. In examining an uncon- scious patient, look carefully for the cessation of breathing and for symptoms of poisoning, bleeding, or sunstroke, as special treatment for these must be given at once. b. Treatment. Lay the patient on his back with the head and shoulders slightly raised. Apply cold cloths or an ice pack to the head. Insist on absolute quiet; do not move the patient unless urgent and then do so very carefully. Have sufficient cover to keep him warm. Use no stimulants until the patient is awake and some cause for the condition is found. Call a medical officer. MEDICAL SOLDIER’S HANDBOOK 233. Fainting. Usually allow the patient to lie where he falls if he can be made comfortable. Lower the head and shoulders by elevating the hips. Loosen the tight clothing. Sprinkling the face with cold water and inhalations of am- monia or smelling salts are beneficial. 234. Convulsions or Fits. a. General. Convulsions may be due to a variety of causes, among them being epilepsy, hysteria, poisoning of various kinds, and various illnesses. The diagnosis is often difficult. A medical officer should be called promptly. The first aid treatment of convulsions consists essentially in loosening the patient’s clothing, avoiding vio- lent restraint, and protecting him from biting his tongue or doing himself bodily injury by threshing about. b. Epilepsy. (1) Epileptic fits may consist merely of mo- mentary unconsciousness with slight muscular twitching, or they may be very serious. In the severe form, with or with- out premonitary sign, the subject usually utters a peculiar cry and falls into a convulsion. At first the entire body is rigid; then there is generalized jerking of limbs, contortions of the face, and foaming at the mouth. The eyeballs roll upward, and the pupils of the eyes are dilated (enlarged). The patient may bite his tongue and may have involuntary evacuation of his bowels and bladder. After a few minutes the convulsions are followed by profound stupor, and this generally merges into deep sleep. During the attack the patient usually is insensible to pain. (2) The patient should be placed flat on his back, prefer- ably on a mattress or other soft material, so that he cannot injure himself in tossing about. Force a rolled handkerchief or towel between his teeth to prevent his biting or swallow- ing his tongue. Do not use any more force than absolutely necessary to keep him from injuring himself. “Epileptic fits” are sometimes feigned. The feigned attack usually occurs at night when no one can see the patient. The man does not fall so as to hurt himself and does not bite his tongue. He flinches when the eyeball is pressed. 235. Head Injuries, a. General. (1) Comparatively mild blows on the head may cause concussion of the brain. This means actual bruising of the brain itself. This is the con- dition present when we say a man has been “knocked out” or “stunned.” The usual symptoms are unconsciousness, pal- lor of the face, and quick and shallow breathing. The pupils of the eyes are of equal size and are usually small. The de- gree of insensibility varies. Sometimes the patient can be aroused but is irritable and lapses again into unconscious- ness. The duration of symptoms is dependent largely on the severity of the injury. (2) More severe blows or falls on the head may cause fracture of the skull, hemorrhage within the skull, or com- pression of the brain. In these more severe injuries the patient cannot be roused. There may be bleeding from the nose or ears. The breathing is deep and snoring. There may be paralysis of part of the body. b. Treatment. It is often impossible to determine the severity of head injuries early. Therefore extreme caution MEDICAL SOLDIER’S HANDBOOK 193 194 should be observed. The patient should be laid flat, with the head slightly raised. He should be kept warm. No violent efforts to rouse him should be made. Shaking his head or slapping his face and neck are very dangerous procedures, since they may increase the injury. A medical officer should be called promptly. No stimulants should be given by mouth, but in the milder injuries aromatic spirits of ammonia may be inhaled with benefit. 236. Apoplexy. Apoplexy is a condition due to sudden rupture or blocking of one or more blood vessels within the brain. It is most common in persons past 50 years of age, but may be seen in younger persons. The onset is sudden. Consciousness is usually lost. The face is flushed, one or both pupils dilated, the breathing is abnormal, and the cheeks puff out with each expiration. There is usually paralysis of one side of the body; this may be determined by lifting up the hands and legs and allowing them to fall slowly to the side. The one that is paralyzed will be cold and lifeless and will drop like a dead weight. The first-aid treatment is essen- tially the same as that for head injuries, rest and quiet. MEDICAL SOLDIER’S HANDBOOK Section X 237. Transportation With Litters, a. Service litter. The service litter is the most satisfactory means of transporting patients over difficult terrain. It may be carried by two or four men, or may be attached to a wheeled field carrier. b. Improvised litters. Many objects and materials may be used to construct improvised litters: (1) Camp cots, window shutters, doors, benches, and lad- ders, properly padded. (2) Litters may be made with sacks, bags, or bedticks, by ripping the bottoms or snipping off the corners, passing two poles through them and tying crosspieces to the poles to keep them apart. (3) A shelter half, a blanket, a piece of matting, or carpet may be fastened to poles by tacks or twine. (4) Hay, straw, or leafy twigs over a framework of poles and cross sticks make an efficient litter. (5) Rope, wire, or rawhide may be woven between poles and this network covered with a blanket. (6) The usual military improvisation is with blankets or shelter tents, and poles about 7 feet long. The blanket is spread on the ground. One pole is laid across the center of the blanket which is then folded over it. The second pole is placed across the center of the new fold and the blanket is folded over the second pole as over the first and the free end of the blanket fixed. (7) A litter also may be prepared by turning two or three blouses inside out and buttoning them up, sleeves in, TRANSPORTATION OF WOUNDED x 1 For complete information on transportation of the sick and wounded, see FM 8-35. MEDICAL SOLDIER’S HANDBOOK 195 Figure 102. Service Litter. Figure 103. Litter Improvised With Blankets. 196 MEDICAL SOLDIER’S HANDBOOK then passing poles through the sleeves, the backs of the blouses forming the bed. 238. Methods of Removing Wounded Without Litter, a. Rifle coat seat. A good seat may be made by running the barrel of a rifle through each sleeve of an overcoat, turned inside out and buttoned up, sleeves inside, so that the coat is back up, collar to the rear. The front bearer rolls the tail of the coat tightly around the barrels and takes his grasp over them; the rear bearer holds the rifles by the butts, trigger guards up. Figure 104. Rifle Coat Seat. b. Rifle blanket seat. First a blanket is folded once from side to side, and a rifle laid transversely upon it across its center so that the butt and muzzle project beyond the edges. Next one end of the blanket is folded upon the other end and a second rifle laid upon the new center in the same manner as before. The free end of the blanket is then folded upon the end containing the first rifle so as to project a couple of inches beyond the first rifle. The seat so formed is raised from the ground with trigger guards up. c. One bearer. A single bearer may support a slightly injured man, or carry a patient in his arms, or on his back, MEDICAL SOLDIER’S HANDBOOK 197 or across his shoulders. If the patient is helpless, the last method is best. This is effected as follows; (1) The bearer, turning the patient on his face, steps astride his body, facing toward the patient’s head and, with hands under his armpits, lifts him to his knees. Then, clasp- ing hands over the abdomen, he lifts the patient to his feet. Next he seizes the right wrist of the patient with his left Figure 105. Patient Carried on Back. hand and draws the arm over his own head and down upon his left shoulder. He now shifts himself in front of the patient, stoops, and passes his right arm between the legs and grasps the patient’s right wrist. Lastly, with his left hand he grasps the patient’s left hand and steadies it against his side as he rises. (2) In lowering the patient, the motions are reversed. Should the patient be wounded in such a manner as to re- quire these motions to be conducted from the right side instead of the left, as described, the change of method is simply one of hands, the motions occurring as directed, sub- stituting right for left and vice versa. d. Two hearers. The bearers take their positions with one man between the patient’s legs and the other at his head, MEDICAL SOLDIER’S HANDBOOK 198 both facing toward his feet. The rear bearer, having raised the patient to a sitting posture, clasps him from behind around the body under the arms; the front bearer passes his hands from the outside under the flexed knees; then both raise the patient to the carrying position. This method re- quires no effort on the part of the patient. It should not be used in severe injuries of the extremities. Figure 106. Patient Carried in Arms. e. Horseback. (1) The assistance required to place a dis- abled man on a mount will depend upon the site and nature of his injury; in many cases he will be able to help himself materially. The horse, blindfolded if necessary, is held by an attendant. (2) Once mounted, the patient should be made as safe and comfortable as possible. A comrade may be mounted behind him to guide the horse. A lean-back may be provided, made of a blanket roll, a pillow, or a bag filled with leaves or grass. If the patient is very weak, the lean-back may be made of a sapling bent into an arch over the cantle of the saddle, with its ends securely fastened thereto. MEDICAL SOLDIER’S HANDBOOK 199 Figure 107. Patient Carried Across Shoulders. Chapter 16 ORGANIZATION AND ADMINISTRATION OF AN ARMY HOSPITAL 239. Military Hospital Defined. A military hospital is an institution provided by the government for the treatment of military personnel while they are sick or injured. Army hospitals are established primarily for the care of Army per- sonnel. 240. Military Hospitals in War. In time of war, mobile hospitals form a constituent part of the mobile forces. These hospitals are established in the combat zone and comprise evacuation hospitals, surgical hospitals, convalescent hospitals, and the clearing stations (emergency and in camp) operated by the clearing companies of medical regiments, medical bat- talions, or medical squadrons. These field medical installa- tions are discussed in Chapter 22. The fixed or non-mobile military hospitals are identical in time of war or peace and serve the same general purposes. They are established in the zone of the interior and in the communications zone. Whenever practicable three or more general hospitals may be grouped at one place into an ad- ministrative and clinical organization known as a “hospital center.” A convalescent camp constitutes a part of the hos- pital center. The administration of these fixed hospitals is similar to that of the fixed hospitals of peace time. 241. Military Hospitals in Peace. Military hospitals in time of peace are of two general types: station hospitals and gen- eral hospitals. Station hospitals. These hospitals are provided for the hospitalization of the sick and wounded of local commands. They function under local commanders. For example, the station hospital at Fort Sheridan is conducted by the surgeon at Fort Sheridan, who functions under the commanding of- ficer, Fort Sheridan. Station hospitals ordinarily have facil- ities to hospitalize 5 per cent or more of the local command. General and department hospitals. These hospitals are provided for the hospitalization of the sick and wounded of larger areas and for the care of special cases for which the authorized facilities of general hospitals are more adequate. During peace time the general hospitals function under the immediate direction of the Surgeon General. The department hospitals in Honolulu and Manila serve the same purposes as general hospitals but are under local departmental control. The permanent general and department hospitals of the Army are: Army and Navy General Hospital, Hot Springs, Arkansas. Fitzsimons General Hospital, Denver, Colorado. Letterman General Hospital, San Francisco, California. Sternberg General Hospital, Manila, Philippine Islands. Tripler General Hospital, Honolulu, Hawaii. Walter Reed General Hospital, Washington, District of Columbia. William Beaumont General Hospital, El Paso, Texas. MEDICAL SOLDIER’S HANDBOOK UtiSUAft TftA)NIN6 OfHCM C *•«.<» I -i 0.* .1 j «tC«lAl»ON Of MCI* marshal r KECI'VING A EVAC. OEEICEI _w,.d h~ i-l.fc-.-, L,.,. . AMERICAN • 10 ciost L'--' _ _| AOMINISIlATIVt J I DIVISION I 'cootf* r- MISS OfMCt* r * Lo _ COMMANDING OfMCU MIO OfT I O.UtW«*«l r ** U.. Cxr.c.. La.m.. <. L-™r OUARKIMASIU .M«'v ’ OK** fOST IKCMANGI 0»HCM f in o*... Figure 108. Organization of an Army Hospital. •* j + I CM _J 0.I W«i i -i MCOICAI SUWlf r r A Ik-.-, L Ct*pU I COMMANDING QMICf | 1 — 1 HOSHTAi r »NSficTo« rCk-t* N«'u I N«>m, •-< r a.*», h—, >A»4*« M««Ji ” S*c SURGICAL SOviCC ■'wr.,lo,'“l MOftSS'ONAl OMiCit Of fHt PM S*'4« r H i i U .t 0*»k«p«d.t G..** MEDICAL SERVICE £•'•0^1, CooUq».i I raofUsiONAL |_ | DIVISION I W,»,M S.C*.0~ C.'d.. V.,(,U, r Lr- i,, w,,^ _i>»o»ATo«r sitvici IeuiMi MtUkolitm Off c«f dental SERVICE I Ope»«»i»« F S«c>t*n I P.o.tK.tu r Section r OUT-PATIENT SERVICE (oott-cy M.J O««.l .Of*.....-, -Wu-m.t, 202 MEDICAL SOLDIER’S HANDBOOK 242. Army Dispensaries. In order to provide medical attention for groups of military personnel not located at Army stations, or where there is an excessive amount of out-patient clinic service, general dispensaries staffed with Medical De- partment officers and enlisted men are established at these centers of military activity. At large posts a dispensary is established, in addition to the station hospital, to facilitate the out-patient service. Sick call and physical examinations are held there. Sick call. Sick call is a military formation held daily at an hour designated by the commanding officer. At this time all sick or injured are conducted by a noncommissioned of- ficer to the surgeon at the hospital, dispensary, or other place for holding sick call to determine whether they can continue their regular duties or whether they should be admitted to hospital or quarters. Those able to do “duty” are so marked on the daily sick report, given the necessary treatment, and returned to their organization. Should further treatment be required they will return to sick call daily until informed otherwise by the surgeon. Those requiring hospitalization for more adequate treatment are sent to the hospital after sick call. In case of emergency, sick or injured may be admitted to the hospital at any hour. However, the unit commander should be informed as soon as practicable so that the soldier’s name and proper notations can be made on the company sick report. 243. Hospital Regulations. In so far as is practicable, the provisions of Army Regulations 40-590 govern the adminis- tration of Army hospitals established for the care and treat- ment of personnel. In general, they cover chiefly the ad- ministration of general hospitals and the larger station hos- pitals, but in so far as applicable and practicable they govern the administration of all fixed hospitals regardless of their type of capacity. See Army Regulations 40-245, 40-580, 40-600, 40-605, and 40-610. For records and reports, see Chapter 24. 244. Hospital Organization. The hospital is organized so as to provide the best professional care of the sick and in- jured. The general organization of the hospital is in gen- eral conformity with Army Regulations 40-590. The organ- ization consists of two major divisions; administrative and professional (fig. 108). The administrative division. The administrative division of a fixed hospital includes such personnel and activities as the commanding officer of the hospital may prescribe for the efficient administration of the hospital. The personnel and activities which belong to the administrative division are shown in fig. 108. In smaller hospitals several activities may be placed in charge of one officer. Professional division. For convenience of administration, and in the interest of professional efficiency, the command- ing officer of each Army hospital organizes the professional activities of his hospital into services after the manner of well-organized hospitals in civil communities. He prescribes the number of services for his hospital, the lines of control over them, and their relationship to each other. The usual services are shown in fig. 108. MEDICAL SOLDIER’S HANDBOOK 203 245. Titles of Medical Personnel, The following nomencla- ture is observed in designating the official position of Medical Department personnel performing the more important admin- istrative and clinical duties at a hospital: Duty Title Commanding hospital Commanding Officer. In charge of a service Chief of Service. Commissioned assistant on a service .. Assistant Service. Officer in charge of records of sick and wounded Registrar. Officer in charge of a ward Ward officer. Commissioned assistant in a ward Assistant ward officer. Nurse in charge of a ward Head nurse. Principal enlisted assistant in a ward.. Ward master. Other enlisted assistant in a ward .. Ward attendant. 246. Commanding Officer of the Hospital. The senior medi- cal officer of the hospital staff is the commanding officer of the hospital. He is known as the “station surgeon” if the hospital is located at an Army station. This distinguishes him from the commanding officer of the post. The surgeon is responsible for the proper administration of the hospital, which includes the care and treatment of patients and the rendering of all necessary reports connected therewith. 247. Medical Officer of the Day. A medical officer of the day is detailed daily by roster to serve for 24 hours. His functions are both administrative and professional, although in large hospitals the duties may be apportioned among sev- eral individuals. During his period of duty he holds himself available for emergency professional service, particularly during hours when other medical officers are off duty. He is in charge of the hospital at night, makes inspections at stated intervals, inspects the mess at each meal, and represents the commanding officer of the hospital in the latter’s absence. 248. The Commanding Officer of the Medical Detachment. The commanding officer of the hospital or one of his com- missioned assistants commands the enlisted personnel as “de- tachment commander.” He has essentially the same duties as the commander of a company. He assigns the enlisted per- sonnel to appropriate duties and prescribes and enforces reg- ulations as to the sanitary, disciplinary, and other require- ments. 249. Hospital Rules. (Paragraph 22, AR 40-590.) The com- manding officer of the hospital is responsible for the formula- tion and enforcement of such hospital rules as are necessary for the guidance of patients and duty personnel. Rules should be kept posted in appropriate places so as to be easily seen and read by those persons to whom they are applicable. The rules below have in the past been instrumental in promoting the administrative efficiency and are published herein as a guide for drawing up detailed rules for a hospital. Each officer in charge of public property will keep an accurate account of the same and of its place of distribution. Each person in charge of a department of the hospital is respon- sible for the public property in his department. The responsible person will keep a list of property and will assure himself of its presence by frequent inventories (at least once a month). All public property in the possession of enlisted men must be kept in good order and missing or damaged articles accounted for. MEDICAL SOLDIER’S HANDBOOK 204 A person, upon his assignment to a department of the hospital, will become familiar with the special orders and rules governing it, and all must familiarize themselves with the standing orders of the hospital. All noncommissioned officers and privates of the detachment will be present at all formations unless specially excused. All men on duty in the kitchen and mess hall will arise at least one hour before reveille; all other members of the detachment, unless specially excused, will arise at or before first call for reveille. Immediately after reveille each man will arrange his bed and personal belongings in a neat and orderly manner. All clean under- clothing will be uniformly packed in his locker; other clothing will be brushed and hung in the lockers or in a designated place. Soiled clothing will be kept in the barrack bags. Shoes will be polished and neatly arranged in the lockers or under the sides of the beds. All beds will be overhauled and cleaned each week, and, weather permitting, the bedding and mattresses will be well shaken and hung out to air for at least two hours each week. Mattress covers will be changed immediately before each monthly inspection and oftener if necessary. Sheets and pillowcases will be changed at least once each week. A card bearing the name of the soldier will be attached to the foot of his bed, and his accouterments will be hung, neatly and uniformly arranged, on the foot end-iron of his bunk. The squad room will always be kept clean, neat, and orderly. The men will pay the utmost attention to personal cleanliness; each man will bathe at least once weekly, his hair must be kept short, face shaved, and underclothing frequently changed. Members of the detachment will wear the prescribed uniform at all times when present at the station. While on fatigue they may wear the fatigue clothing. While on duty in wards, pharmacy, operating room, mess room, or kitchen they will wear the white uniform. No member of the detachment will leave the hospital bounds except by permission of proper authority or in case of emergency in the execution of duty. Immediately after breakfast the hospital will be thoroughly policed in every department. It must be ready for inspection at the hour designated by the commanding officer and always kept scrupulously clean. No member of the hospital personnel will borrow money or have financial dealing with any patient. A noncommissioned officer in charge of quarters will be detailed by roster from noncommissioned officers on duty with the detach- ment; an emergency squad will always be designated. The noncommissioned officer in charge of quarters will make an inspection of all wards and quarters at such times as the com- manding officer of the hospital may direct; he will report all unauthorized absentees to the noncommissioned officer in charge of the detachment and will see that no unauthorized lights are burning. In case of fire he will give the alarm and proceed as ordered in fire regulations. He will be responsible for the efficient performance of duty by the guards. The guards (sometimes called “emergency detail”) will be under the immediate orders of the noncommissioned officer in charge of quarters. The guard on duty will patrol the hospital grounds at least once every three hours and will be constantly on the alert for fire, unauthorized lights, and unauthorized persons in or about the hospital. The guard will report at once to the non- commissioned officer in charge of quarters all unusual occurrences and violations of existing orders which come under his observa- tion. 250. The Registrar. In the military service the office of registrar is peculiar to the Medical Department. The reg- istrar has charge of all medical and surgical records and sees that careful and accurate clinical histories, statistical tables and charts, and all prescribed sick and wounded records are kept. He prepares all reports and returns pertaining to the sick and wounded. If the commanding officer does not as- MEDICAL SOLDIER’S HANDBOOK 205 sume direct command, he commands the detachment of patients and has charge of all records, accounts, and returns pertaining thereto. He is custodian of the money and valu- ables of patients in the hospital. He performs such other duties as may be prescribed by proper authority. 251. The Clinical Record (Form 55a, M.D., and Accompany- ing Lettered Forms). The Clinical record when completed is a complete history of the patient during his stay in the hos- pital. Therefore it is essential that all important data and information be entered on the appropriate lettered forms. A clinical record of each patient is kept at all times at fixed hospitals excepting those which are located in a theater of operations. The clinical record of each patient is started as soon as practicable after admission, using such lettered forms of M.D. Form 55 as the importance and nature of the case demands. They should show an accurate, concise record of the patient’s previous history, condition on admission, daily treatment and condition while in the hospital, and his condition upon dis- charge from the hospital. Upon the transfer of a patient from one ward of the hospital to another, the clinical record is sent with him to the new ward, the fact of transfer being noted thereon. Upon the departure of a patient from the hospital, all of the sheets of the clinical record will be ar- ranged in their proper order, all entries completed, fastened together at the top, and signed by the ward officer. It is then sent to the registrar’s office with the next morning report of the ward. The clinical records of all completed cases are immediately filed in the sequence of the registra- tion number which is the number given to the patient’s clinical record upon admittance and placed on his register index card (Form 52a, M.D.) upon discharge. The index cards are filed in alphabetical order according to the surnames of the patients. If the patient re-enters the hospital the new register number will be entered on the same index card. For further information regarding records of sick and wounded, consult AR 40-1025, AR 40-1030, AR 40-1040, AR 40-1045, AR 40-1050, AR 40-1055, AR 40-1060, AR 40-1065, and AR 40-1075. 252. Procedure in Admitting Patients to an Army Hospital. Admitting a patient to an Army hospital includes specific measures so as to secure correct identity of the patient, proper care of his valuables and personal belongings, and completion of the necessary records pertaining thereto. Patients who are seriously sick are not held for examination or preparation of routine records but are admitted directly to the correct ward. For such cases an attendant should accompany the patient and obtain the necessary data at the ward for the preparation of Form 55a, M.D. Identification. Each patient must be inspected upon arrival at the hospital and every effort made to establish his un- questioned identity by name, rank, or grade, serial number, and military organization. Except in emergency no civilians are admitted to the hospital except those entitled to treatment without specific authority from the commanding officer or surgeon. Admission records. The most important admission record is the initiation of clinical record Form 55a, M.D., which will 206 MEDICAL SOLDIER’S HANDBOOK include the status of military and civilian patients and which will be sent to the ward with the patient. Notation is made of any unusual circumstances connected with the admission of the patient. Also, at the time of admission the patient’s clothing and property record must be completed. 253. Patient’s Personal Belongings. When a patient is ad- mitted he must be advised to deposit his money and other valuables with the “registrar” for safekeeping. If he elects to take them to the ward he does so at his own risk. Money and valuables. A triplicate list of money and valu- ables deposited is signed by the patient and the admitting officer. The triplicate copy is given to the patient as his receipt. The original and duplicate are delivered to the “registrar,” who signs the duplicate and returns it to the admitting officer as his receipt. If the patient is unconscious he is searched by the admitting officer. When money or valuables are found they must be listed and deposited with the “registrar.” Patients’ clothing and property. Patients’ clothing and property are delivered to the baggage room and the receipt countersigned by the attendant in charge. Patients are to be informed that the contents of grips, trunks, and other bag- gage must be listed; otherwise, the surgeon will not assume responsibility for any loss. When received, articles of patients’ effects will be carefully labeled with the name, rank, and organization of the owner, and their contents noted. These data are entered on a property record card (Form 75, M.D.) for the property of each person. The duplicate card is given to the owner of the property as a receipt, and the original retained in the “live file.” The clothing worn by patients at the time of their admission and their hand baggage will be kept in the room for patients’ effects. Patients going on pass. A patient who has been authorized to leave the hospital on pass presents his card and an order from the ward officer for his clothing to the attendant on duty in the patients’ clothing room. The patient must be accom- panied to the clothing room by a ward attendant. The re- tained card, receipted by the patient, is held (suspended) un- til he returns. Upon disposition of patients. When a patient returns to duty, is furloughed, or is discharged from the service and leaves the hospital, his effects are restored to him. The patient, accompanied by the ward master, presents his prop- erty receipt card to the attendant in charge of the “patients’ effects room” together with an order (certifies discharge) for his clothing signed by the ward officer. The patient signs an acknowledgement that his clothing and effects have been re- turned on the retained card which is then returned to the file. When a patient dies or deserts, his effects will be disposed of as indicated in AR 600-550 and 615-300, respectively. When a patient is to be transferred to another hospital his effects will be restored to and receipted for by him if he is able to take care of them. When he is unable to take care of them they will be intrusted to the senior officer or enlisted man in whose charge the patient is being transferred. He in turn will secure a receipt for the patient’s effects from the proper authorities of the receiving hospital. Chapter 17 WARD MANAGEMENT 254. Ward Defined. A ward is a large hospital room pre- pared for the care and comfort of a number of patients. The furnishings of a hospital ward are usually plain, substantial, durable, free from decorations, and smooth so they can be easily cleaned with soap and water. The color of the walls and floors is plain, free from patterns, and cool and restful to the patients’ eyes. Everything is so planned that simplicity and neatness are the keynote which will help to impress the patients that it is a place of perfect order, giving them a feel- ing of confidence. Most of the wards in an Army hospital are built similarly. The ward offices, lavatory, utility room, linen room, and ward kitchen are usually connected to the ward and are conveniently arranged to facilitate the ward work. 255. Ward Management Defined. Ward management is the term applied to the control of all activities which should properly take place within the hospital ward. It includes supervision of nursing care of the patients; the cleaning and policing of the ward and adjacent rooms; completing all orders and treatments prescribed for the patients therein; completion of all records pertaining to patients; preservation of instruments, equipment, and property charged to the ward; provision of adequate supplies and economy in their use; and giving instruction to those employed in the ward. 256. Responsibility for Ward Management. In Army hos- pitals the ward surgeon has direct supervision over the ward. The head nurse or ward master in charge of the ward is re- sponsible for the care and nursing of the patients and the management of the ward as stated in the paragraph above. In their absence the senior enlisted man assumes charge of the ward. 257. Ward Personnel. The assignment of personnel to a ward of about 20 patients normally includes a ward surgeon, a head nurse or a ward master, and enlisted attendants (as- sistant nurses) as required. The ward surgeon may have other duties extending beyond the particular ward, and in his absence the nurse or ward master takes charge of the ward. He accompanies the ward surgeon on his rounds, making notes as to the orders for each patient and such other directions as the ward surgeon may give so that later he may execute these orders or have them carried out by others. One nurse is ordinarily sufficient for a ward of 20 patients, providing all attendants are capable assistants. The ward master or nurse should assign specific duties to the enlisted assistants based upon a well-arranged schedule of the ward work; this includes the police of the ward and the nursing or bedside care of patients. He should assign the more responsible duties to the attendants having the most experience and the simplest duties to those having the least experience. However, to help the new attendants attain proficiency the ward master should have them assist the more 208 MEDICAL SOLDIER’S HANDBOOK experienced men in the care of the sick. Contact with the sick person deepens the sense of responsibility and helps attendants to develop a serious attitude toward their work. It is desirable that the duties be so divided that one at- tendant regularly looks after the same patients; the latter should be grouped together in order to save time and increase convenience. The schedule should provide a fair and equal distribution of work in accordance with the number or per- sons assigned for duty in the ward. This policy reduces chance for friction and greatly helps to maintain the spirit of cooperation so necessary between the medical officer, the nurse or ward master, the enlisted assistants, and the patients. Such considerations in duty assignments will help to obtain a cheerful atmosphere and efficient operation of the ward. 258. Ward Rules. Ward rules which apply to all ward personnel are as follows (AR 40-590): The head nurse On wards in which Army nurses are not assigned, the ward master) of each ward is directly responsible to the ward officer. This person is in charge of the ward and the enlisted assistants and patients within it and will be obeyed and respected accordingly. The head nurse (in wards in which Army nurses are ndt assigned, the ward master) is responsible for the cleanliness and order of the ward, for the public property therein, and for the effects of the patients until they have been turned over to the proper custodian, and is responsible for the prompt delivery of prescriptions to the pharmacy, of medicines to the ward, and of the diet cards to the mess office. In wards to which Army nurses are not assigned, the ward master is responsible for the administration of medlclitgs and other treat- ment prescribed, the keeping of records, and all other duties that may be assigned to him by the ward officer. No enlisted men, except those authorized in writing by the responsible medical officer to do so, will administer medicine to a patient in hospital and then only as directed by the responsible medical officer and under such limitations as his written authorization prescribes. Phenol, bichloride of mercury, other active poisons, alcohol, and alcoholic liquors, when necessarily on hand in the ward, will be kept under lock and key and every precaution taken to their improper use. Disinfectants such as formalin, cresol, etc., and medicines for external use only, will not be kept on the same shelf or in the same medicine cabinet as medicines for Internal administration. On the death of a patient the ward master will notify the ward officer or in his absence the medical officer of the day. He will not remove the body from the ward until after it has been examined by a medical officer. The ward master will see that patients are acquainted with ward rules. The rules should be rea'i and explained to them. Before leaving the ward at the end of his daily tour of duty, the ward master will turn over to his relief all orders of the ward officer, accompanied by such explanation and instruction as may be necessary. Upon reaching the ward, natients will be promptly bathed, clothed in clean hospital clothing, and i5ut to bed, unless their condition indicates otherwise or a specific order forbids. Money and valuables found on patients wUl be turned over to the commissioned officer who is custodian of such articles. Patient* will be given receipts for their articles. Upon presentation of the receipt on discharge from the hospital, the patient’s pfTorts wil1 be restored to him. The commanding officer Is not responsible for money or valuables of patients not turned over for deposit in the hospital safe. A clinical record (Form 55a and accompanying lettered forms) will be carefully kept for each patient. Upon final disposition of the case this record will be completed arid signed by the ward officer and turned in to the record office. No information regarding the diseases or conditions of patients under treatment will be given to anyone except those authorized under the regulations to receive it. Visitors will be allowed to see friends in the ward at a specified time, when their presence will in no way disturb other patients. Bed linen will be changed on occupied beds at least twice weekly and oftener if necessary to insure cleanliness. Whenever a bed is to be occupied by a new patient, clean linen will be furnished. All bedding and clothing used by infectious cases will be promptly disinfected when removed from the beds. Patients will not oc- cupy their beds when dressed in other than hospital clothing. Loud noises, boisterous actions, the use of profane languar"' and gambling are forbidden in the wards, and no food, Intoxicants, or other articles of food or drink, except as prescribed or author- ized, will be brought into the wards. Patients are forbidden to use towels, basins, toilet articles, eating utensils, or articles of clothing pertaining to another patient. 259. Instructions for Patients. The head nurse or the ward master is responsible that each patient understands the ward rules as stated in par. 258. The bed patients should have the ward rules read or explained to them as soon after their arrival as their condition will permit. Walking patients should be shown where the ward rules are posted and be instructed to read them carefully. In addition to the ward rules there are other instructions which the patient should be given. These include; that no food, intoxicants, narcotic drugs, or other articles of drink will be brought or used in the ward; that bed patients will be served their meals on a bed tray; that if they mess in the main mess hall they will remain in the ward until notified the meal is ready to be served; that they must remain in the ward unless authorized to leave same by the ward officer and, if permitted to do so, they must report to the head nurse or ward master upon departure and return; that their personal mail will be delivered to them daily by the ward master; that when they are able they will be required to keep their own bed and surroundings clean and orderly at all times; that any violations of the ward rules are punishable by disciplinary action in the case of enlisted men or, in the case of civilians, by dismissal from the hos- pital; and that all complaints should be made in person to the head nurse or ward master, who will bring them to the attention of the ward officer. 260. Ward Records. The commonly used ward records are; the patient’s clinical record (Form 55a, M.D., and accompany- ing lettered forms); diet cards (Form 73, M.D.); the treatment book; and the temperature book. All will be made out in ink in so far as practicable and kept up to date. Except for the diet cards they are preserved as a permanent record of the ward. When no longer needed they are sent to the regis- trar for file. The clinical record is the complete story of the patient while in the hospital, and all treatments, medicines, and records or events pertaining to his condition are recorded therein. In case patients are sent to appear before boards or to other de- partments of the hospital for examination or treatment, the clinical record is sent to the officer concerned. Under no condition are patients to be allowed to handle clinical records or other ward records. In the case of transfer of a patient from one ward to another his clinical record is completed to MEDICAL SOLDIER’S HANDBOOK 209 210 MEDICAL SOLDIER’S HANDBOOK date, noting the exact time of transfer, the ward to which transferred, and the condition of the patient. The clinical record accompanies the patient and his attendant to the ward to which he is transferred. The day preceding the departure of the patient to duty status the clinical record is completed, arranged in proper sequence, fastened together, signed by the ward officer, and delivered to the sick and wounded office (record office). A diet card covering the requirements of the ward patients for the next 24 hours is completed and sent to the mess office in sufficient time for the preparation of the day’s meals. Additional cards for newly-admitted patients or newly-arrived personnel are made out when necessary. The diet cards are destroyed after they have served their purpose. The treatment book is a record used by the ward officer for writing his orders for each patient. All orders for treat- ment should be in writing and should be signed by the ward officer. The treatment book is kept in the ward office at all times. The temperature book is a record in which the temperature, pulse rate, and respiration rate of patients are listed. These recordings are transferred to the respective patient’s clinical records. Other records of the ward are dependent on the local regu- lations of the hospital as to form and method of use. Such records may include pass books, transfer cards, ward reports, list of ward patients, roster of ward personnel and their assignment of duties, and property records. 261. Ward Office. The ward office is the administrative center of the ward. It is usually a small room situated adja- cent to the ward. It contains the ward officer’s desk, the desk for the head nurse or ward master, the ward medicine cabinet, and the files for ward records. Only those specifically re- quired by their duties should be allowed to enter the ward office. Except when interviewed by the medical officer or the head nurse, patients are not permitted in the ward office. 262. Ward Property and Linen. Constant attention must be given to preserve in good condition all instruments, equip- ment, linen, or other property in the ward. Those in charge should see that it is not abused and that necessary repairs are made promptly. A record of the property with which the ward is charged should be kept and the property inventoried at least once a month to determine if there has been a loss. Property will not be transferred without prior approval of the commanding officer. Linen should receive special attention, and an inventory should be taken weekly. Soiled linen should be counted before going to the linen exchange room and the clean linen counted before leaving the linen exchange room. Linen closets should be kept locked, and the nurse or ward master should carry the keys. Damages to linen should be avoided by the use of protective pads, rubber sheeting, and by care in giving and removing bed pans and urinals. For cases requiring treatment which will stain, such as genito-urinary cases, burns, scabies, etc., old, repaired linen should be used. MEDICAL SOLDIER’S HANDBOOK 211 There should be a designated time for the issue of clean linen in wards. Patients who are able to be up and about should be required to bring their soiled linen to the linen closet to be exchanged for clean linen. 263. Ward Utility Room or Closet. The utility room or closet contains the brooms, mops, dust cloths, rags, and other cleaning material for the police of the ward; shelves and hooks for the storing of these articles; the bed pan sterilizer; the rack for bed pans and urinals; and a sink with hot and cold running water for cleaning these articles. All articles removed from the utility room or closet should be returned promptly when no longer needed, cleaned thoroughly, and replaced in their proper storage place. The utility closet should be scrubbed and policed at least twice daily. 264. Police of the Ward. It is important that the ward be kept clean because dust and dirt favor the growth of bacteria. This cleaning should disturb the comfort of the patients as little as possible and must not interfere with their care and treatment. The work should be equally distributed so that each ward attendant will know exactly the cleaning duties required of him. Patients who are able to work may be assigned to help. In addition to the daily routine cleaning, plans should be made so that each day of the week some special cleaning, such as walls, windows, woodwork, beds, and furniture, will be attended to. Dusting should be done daily and systematically. Use a damp cloth, rinsing it frequently in clean, warm water. Floors should be swept frequently, at least three times daily. Unpolished floors must be scrubbed with brush, hot water, and soap as often as necessary. Change the water frequently when scrubbing, as dirty water will not clean the floor and will leave the surface streaked. Metal should be cleaned with a suitable metal polish. Por- celain tubs and sinks should be scoured with special cleansing materials and then rinsed with hot water. Bedpans, urinals, irrigating cans, and other similar utensils must be kept clean at all times. Rubber articles and sheets should be cleaned with warm water and soap, rinsed well, wiped with a disinfectant solution, and hung in a cool place to dry. Dishes and silverware should be thoroughly washed and sterilized after use. Special attention should be given to dishes used by a patient having a contagious disease. Wash these dishes separately and keep them separated from dishes used by other patients. Refrigerators and coolers should be cleaned with hot water and soap before the arrival of the ice and fresh supplies. Shelves should be removed and cleaned separately. The water cooler should be taken apart when cleaned. Tables and dish cabinets should be scrubbed and aired daily. Do not use paper shelving as it provides a hiding place for roaches and for the collection of food crumbs. Cleaning equipment and materials should be returned to their proper place in the utility closet or room as soon as 212 work is completed. They should be washed with soap and water frequently and then aired in the sun. Be careful when using lye as a cleaning material as it may produce severe burns to the hands. Be sure it is well and clearly labeled. Dissolve lye in water before applying it to an area to be cleaned. Prior to an inspection, make a complete check of the ward cleanliness. As the inspector proceeds, open all drawers, cabinets, medicine closets, and lockers, closing them , imme- diately after they have been examined. Police of the ward includes an orderly arrangement of the furnishings of the ward. All articles of furniture should be arranged uniformly so that beds, tables, chairs, and stands are in straight lines, if practicable. Keep each article in its proper place. Do not permit the patients to accumulate articles on their beds, chairs, and tables or to tuck them under pillows or on the window sills and radiators. Ward attendants must be constantly on the alert to keep the ward in perfect order. 265. Ventilation, Heating, and Lighting. General care of the ward includes the maintenance of the correct standard of ventilation, heating, and lighting. Most hospitals are constructed with the necessary provisions for the correct adjustment of all three. Proper ventilation is provided by the inlet of pure air without causing a draft. When windows are opened they should all be raised or lowered a uniform distance. Exposure of the patients should be avoided by having them sufficiently covered when the windows are opened for the purpose of airing the ward. The average ward temperature should be 68 degrees Fahr- enheit during the day and 65 degrees Fahrenheit during the night. Treatment and bath rooms should be kept at 72 degrees Fahrenheit. Patients with chronic diseases, poor circulation, or anemia, or those who have just returned from surgery under general anesthesia, require a warmer temperature than other patients. Ward attendants should check the room tem- perature by looking at the ward thermometer occasionally. The effect of sunlight in a ward is beneficial as the direct rays of the sun are the best air purifiers and germ destroyers. A ward should have as much sunlight as possible. Artificial lighting should be by indirect means; when this method is not used, shades and screens may be employed or the posi- tion of the patient’s bed changed to protect his eyes from glaring lights. 266. Daily Ward Duties. In the morning before breakfast the night attendant should see that all patients have their faces and hands washed, their mouths cleansed, their teeth brushed. He should take the temperature, pulse, and res- piration of all patients and record them in the temperature book. Before he goes off duty all medicines and treatment ordered to be given before breakfast should be completed: all specimens for laboratory examination should be collected and taken or sent to the laboratory; and all necessary pre- operative routine for surgical patients completed. MEDICAL SOLDIER’S HANDBOOK The day attendants serve breakfast. They feed patients too sick to feed themselves or secure the assistance of other patients who can aid them. Breakfast dishes are collected and returned to the kitchen as promptly as possible so as not to delay the day’s routine work. After breakfast the beds are made up, bed-baths given, the ward aired, swept, and dusted, the furnishings arranged, and everything made ready for the ward officer’s inspection and morning rounds. The head nurse or ward master, on arrival in the morning, should visit all patients and become thoroughly acquainted with the condition of each, especially those who are seriously or critically ill. Records should be brought up to date, laboratory reports attached, and made ready for the ward officer and the chief of the service. The morning report of patients will be completed and submitted to the registrar, after the roster of patients has been checked to see that all patients are in the ward. Requisitions for ward supplies will be prepared and submitted to the proper author- ities. Mail for the patients is distributed. Attention will be given to dressings, medicines, temperatures, and diets be- tween 10 a.m. and the serving of the noon meal. After dinner the patients are allowed to rest while the attendants keep the ward policed and carry on the necessary work of the ward. When visiting hours are over visitors who have not departed will be told politely that it is time for them to leave the ward. The patients are then prepared for the evening meal. About one hour after the evening meal the evening toilet of patients begins. Medicines and treatments as ordered are given, and the ward records are brought up to date. The wards and adjacent rooms are policed and left in a clean condition. Sufficient supplies of medicines, dressings, ice, and food are secured for the routine night care and for the special diets for breakfast. Later in the evening, after visiting hours, bed patients are prepared for sleep. The bed clothes are straightened, brushed free of crumbs, and bed patients given their alcohol back-rubs. All patients are checked to see that they have the things they need throughout the night; absentees are reported to the medical officer of the day; and all ward lights, except night lights, are turned out at the required time set by the hospital rules. During the night special vigilance is given to the seriously and critically ill. They should be located near the ward office so as not to disturb other patients while attending them. Routine night medicines and treatments are given as ordered. Medicines, treatment, and the condition of the patients during the night will be recorded. All unusual occurrences are re- ported promptly to the medical officer of the day. At 6 o’clock the morning cycle of duties begins again. 267. Admission of the Patient to the Ward. The actual nursing care of a patient begins on his admission to the ward. He should receive immediate attention, be greeted with an air of friendliness, and action taken to make him feel comfortable and at ease with his new surroundings. MEDICAL SOLDIER’S HANDBOOK 213 214 MEDICAL SOLDIER’S HANDBOOK If he is a walking patient he should be assigned a bed at mce, the admitting records completed, and the routine temperature, pulse, and respiration taken and recorded. He should be supplied with a pajama suit, towels, and soap, be shown the bath and toilet rooms, and be instructed to take a tub or shower bath before going to bed. He should be instructed by the head nurse or ward master in the rules for patients as applicable to him. The acutely ill patient must be put to bed immediately and all data and information taken at his bedside, after which, if it is permissible, he should be given a bed-bath. At the time of bathing, careful observation should be made for the presence of vermin or any contagious disease eruptions of the skin. The ward officer or the medical officer of the day should be notified of the arrival of a new patient. Laboratory specimens of a routine nature for newly-admitted patients are secured and sent to the laboratory as soon as practicable. The patient is prepared for the medical officer’s examination in accordance with the latter’s wishes and requirements. The conscious patient should be told something of the examination which is to be made and what will be required of him. If he is nervous he should be reassured and made as com- fortable as possible. When the examination is over, he should again be made comfortable. 268. Visitors. Visitors are allowed to see friends in the ward at a specified time, when their presence will in no way disturb other patients. When relatives or friends come from a distance to visit patients, in case of emergency or other unusual circumstances, they may be authorized by the commanding officer or the medical officer of the day to visit during a time other than the regularly designated visit- ing hours. Such visitors should be escorted by the head nurse or ward master to the patient concerned. 269. Ward Telephones. During the day telephones are to be used only for official business. Patients are not permitted to use the telephone unless specifically authorized to do so by the ward officer. 270. Disposition of Patients from the Ward. Disposition includes “discharge to duty,” “discharge to quarters,” “dis- charge on certificate of disability,” “transfer to another hos- pital.” or “transfer to another ward.” “discharge from the Army” for other causes than disability, death, or desertion. When a patient in hospital has recovered sufficiently from his disability to enable him to perform full duty, the ward officer through the commanding officer of the hospital will send such a patient back to his organization. Notice of dis- position will be given to the head nurse or ward master at least 24 hours in advance. The patient’s clinical record will then be completed and disposed of as described in par. 260. Any government property in his possession will be returned to the proper authorities. Upon departure he will be dropped from the ward list of patients, and his time of departure and condition will be noted on his clinical record. An attendant from the ward will accompany him to the room containing his personal effects. He will then be given his clothing, money, MEDICAL SOLDIER’S HANDBOOK 215 and valuables. If he has complaints the ward officer will be notified and the patient returned to him for questioning or such action as the ward officer specifies. In case of transfer to another ward, an attendant from the ward accompanies the patient to his new ward. Other dis- positions (except death) are handled similarly under direct supervision of the ward officer. A dying patient should be separated from other patients in the ward, preferably by removing him to a quiet room. Otherwise screens should be placed around his bed. Unneces- sary conversation should not be carried on in his vicinity. The attendant should be attentive and sympathetic, both to the patient and his relatives. In case of the death of the patient the ward master will comply with ward rules as stated in par. 258. 271. Special Requirements for a Detention Ward. The detention ward is a ward used for the treatment of prisoners or insane persons requiring hospitalization. In addition to the rules of the ordinary hospital ward the following re- quirements should be followed in the management of a deten- tion ward. No patient will be admitted to, nor any prisoner confined in, the detention ward except on the authority of a medical officer. No persons except medical officers, nurses, and attendants on duty in the hospital will be allowed to enter the detention ward. Nurses and attendants will not permit loitering of unauthorized persons in the vicinity of the ward. Each patient in the detention ward will be seen by the enlisted attendant once every hour and at such other times as deemed necessary by the medical officer. A daily search, including all possible hiding places, for any property or dangerous implements that any patient may have con- cealed will be made each morning by the ward attendant. All attendants are forbidden to strike or maltreat patients. Any attendant using force upon a patient shall be punished or bear the burden of proving that his action was necessary in defense of life or in preventing the escape of the prisoner. When a sentry is posted in a ward by direction of the command- ing officer, the ward master will turn his ward door key over to the sentry. When the sentry is no longer required to be posted the ward master will obtain the return of his key from the last sentry. In the case of escape of a prisoner the ward officer, the prison officer, and the officer of the day will be notified at once. A written report to the surgeon, explaining all the circumstances relative to the escape, will be made. 272. Special Requirements for a Contagious Ward. Since communicable diseases may appear unexpectedly in regular hospital wards all medical personnel should be constantly on the alert to detect them. A ward especially prepared for the nursing care of contagious diseases is known as the “contagious” or “isolation” ward. Separate rooms or cubicles are provided for the segregation of patients having any one or more of the various communicable diseases. Enlisted attendants should be especially qualified in the nursing care of contagious disease. In addition to the requirements of nursing and ward management which are usually observed, the following requirements must be observed in the con- tagious ward. Wear a cap and gown, and rubber gloves If necessary, while In the ward. 216 MEDICAL SOLDIER’S HANDBOOK Thoroughly scrub the hands in running water before entering and leaving the ward and before meals. In addition, make a prac- tice of keeping the hands away from the face. Scrub the hands with soap and water and then immerse then in an antiseptic solution after doing anything for the patient or handling contaminated articles. Wear glasses and a gauze mask over the nose and mouth when taking care of a contagious patient, being careful to avoid contact with secretions from the patient’s body, especially the spray pro- duced by sneezing and coughing. Gowns should never be worn away from the immediate vicinity of the ward. When gowns are removed, turn them inside out and hang them up. Wash and scrub the hands again after their re- moval. When working in a contagious ward, maintain the strictest per- sonal hygiene, both off and on duty. Be certain that it includes plenty of sleep, nutritious food, and exercise in the open air. Avoid visiting other patients in the hospital. All furniture in the ward should be wiped daily with a cloth dampened with a weak solution of phenol (1 to 40 solution). Patients must not be permitted to violate any quarantine re- strictions. Do not tolerate carelessness by anyone, as it will prove dangerous. Charter 18 NURSING 273. Nursing: Defined. Nursing means caring for the sick and injured under the direction of a medical officer. It includes the care of the patient and his surroundings, and the administration of diets, drugs, and treatment, as well as other tasks prescribed by the medical officer. 275. The Medical Soldier as a Nurse. In the Army the medical soldier must be prepared to perform nursing duties. Some medical installations operate without the services of members of the Army Nurse Corps; in others, the number of professional nurses is inadequate. Since nursing is im- portant to the recovery of patients the medical soldier who is employed as such must be trained to perform the duty or assist in its performance. 275. Qualifications of a Soldier Nurse. The soldier nurse must demonstrate higij physical, mental, and moral standards because all soldiers are not fitted for the task. He must be interested in the duty, for otherwise he may find it easy to neglect certain requirements which require the utmost tact and understanding. He must be strong physically because, at times, the hours are long and the work severe. Strength will help him to ward off many diseases with which he will come in contact. He must be intelligent and mentally alert, for the medical officer will entrust him with instructions which must be followed with exactness. He must have the quality of “common sense” because many problems will arise which require the exercise of good judg- ment. All in all, the soldier nurse must be drawn from the finest soldiers of the Army in order that the group include only those who are willing to serve and are able to serve intelligently. 276. Relationship Between the Medical Officer and the Nurse. The nurse and the medical officer constitute a trained team. The medical officer is responsible for the proper treatment of his patients. Therefore, the nurse must demonstrate to the medical officer by faithful performance of duty his strict adherence to the principles of good nursing so that the medical officer can place confidence in his ability. Then and only then can he entrust patients to his care. The doctor relies on the nurse to observe, interpret, report, and record the symptoms and signs which will inform him of the patient’s condition. He expects the nurse to do everything within his power to bring about the patient’s recovery and to make him comfortable. While the medical officer is present the nurse is his assist- ant. The nurse provides the necessary records, instruments, materials, and other articles requested by the medical officer. The highly-trained and efficient nurse will anticipate the medical officer’s needs. Confidence in one another and smooth and intelligent operation will result in the best possible treat- ment for the patients and bring success to each member of this professional team. 277. Importance of the Nurse to the Patient. The patient Med. Sol. Mb. 218 depends on the nurse to give him continuous attention during his illness. Skillful nursing will conserve the patient’s strength and assist him in returning to mental and physical health. By means of various nursing procedures in conform- ity to the condition of the patient, the nurse can improve the comfort of mind and body. Cheerful and willing attention to the patient’s wants and needs, and a tolerance to his abnormal desires due to his illness, will inspire the patient with confidence such as will encourage and help him. This type of service will soon secure the patient’s cooperation, and he will, when able, assume more responsibility in caring for himself. Quite frequently the nursing care is more im- portant to the successful recovery of the patient than the brief professional attention required from the medical officer. Time and nature are the healers, the doctor and the nurse their assistants. . 278. Making an Empty Hospital Bed. The correct prepara- tion of the hospital bed envolves making it look neat, com- fortable for the patient, and protection of the mattress against soiling or moisture. Articles necessary. One mattress, 1 mattress cover, 3 sheets, 1 single blanket, 1 bed spread, 1 pillowcase, 1 pillow, 1 rubber draw sheet, and a bed. Have all articles on hand before beginning to work. Procedure. Place a chair at the foot of the bed with the linens piled in the order they are to be used. Turn the mat- tress over, head to foot. Remaining on the near side of the bed, proceed as fol- lows: Place the mattress cover on the mattress. Place a large sheet evenly, the “right” side (surface of the sheet having the smooth hem) up, the narrow hem even with the upper edge of the foot of the mattress. Be sure that the sheet is straight and that the center fold is in the center of the bed. Tuck the upper end under the head of the mattress and miter (square) the corner. Tuck the sheet smoothly under the mattress as far as it will go along the side of the bed. Rubber sheet: Place the rubber sheet in the center of the bed, with the upper edge 18 inches from the upper edge of the mattress. Draw sheet: Fold a second sheet crosswise with the upper edges of the hems together, the “right” side up, and the hems toward the foot of the bed, and covering the rubber sheet. Tuck the ends of the sheet and rubber sheet under the mattress along the side. Place the wide hem of a third sheet at the top of the mattress, “wrong” side (the surface of the sheet containing the fold of the hem) up, and the center crease in the center of the bed. Tuck it smoothly under at the bottom, miter the corner, then tuck it smoothly under along the side of the bed. Blanket: Place the top of the blanket 8 inches from the top of the mattress. Tuck it smoothly under at the bottom. Miter the corner and tuck the blanket in smoothly along one side of the bed. If a double blanket is used, place the folded edge at the top, tuck one layer under the foot of the MEDICAL SOLDIER’S HANDBOOK mattress, and fold the other layer evenly with the upper edge of the foot of the mattress. Miter the corner and tuck the blanket smoothly under the mattress along the side of the bed. Spread: Place one end of the bed spread even with the top of the mattress and tuck it in at the foot of the bed, miter the corner, making it smooth and square. Let the sides of the spread hang down. Pull the spread tight and smooth it out. Go to the opposite side of the bed and proceed as follows: Fold all the bedding back from the head to the foot, then re- peat the procedure of tucking in the sheets, blankets, and spread along the side and th*e foot of the bed as was done on the other side of the bed. Be sure that all wrinkles are re- moved by tucking the bedding in tightly and that the corners are square and neat. Pillow: Slip the pillow into the pillowcase so that the corners will fit well. Press and smooth out the pillow, then place it at the head of the bed covering the upper edge of the spread. If the bed is to be occupied soon, fold the bedclothes neatly down to 8 inches from the upper edge of the draw sheet. 279. Making a Bed Occupied by a Patient. It is necessary at times to make a bed which is occupied by a patient. Pro- ceed as follows: Remove the upper bedding except one blanket. The patient should not be left without covering even in warm weather. Fold the bed spread and place all clothing removed on a chair. Remove the pillows. Loosen the lower bed linen. Air the patient’s gown, shaking out all refuse, or change it if it is damp or soiled. Turn the patient on one side near and facing the edge of the bed. The lower soiled sheet is folded or rolled close to the patient’s back; the clean sheet is rolled lengthwise to its middle and placed close up to the soiled sheet. Turn the patient on his opposite side upon the clean sheet and remove the soiled sheet. If a draw sheet is used the new draw sheet and draw sheet cover can be inserted at the same time as the clean bottom sheet. With an assistant on the opposite side support the patient at the shoulders and the hips and draw the bottom sheet tight, freeing it from all wrinkles. Proceed with the replacement of the upper bedding as for the hospital bed. 280. Making an Operative Bed. An operative or ether bed is a hosptial bed made up to receive a patient following an operation. The bed must be ready when needed so there will be no delay; the bed clothing must be warm and protected from emesis (vomited material). Articles necessary. Linen as for making an empty bed; 1 ad- ditional pillow and pillowcase; 1 small rubber sheet; 1 bath towel; 5 safety pins; mouth wipes (small pieces of gauze or toilet tissue); a paper bag; 2 emesis basins; 2 filled hot water bottles and hot water bottle covers with water at 125 degrees Fahrenheit; roller bandage; basin of ice water; 1 compress (use clean wash cloth); 2 tongue blades; pad and pencil; shock blocks and side boards (ask ward surgeon if they are to be used); chest protector; rubberized or protected pillow cover; scultetus binder for abdominal cases. MEDICAL SOLDIER’S HANDBOOK 219 220 MEDICAL SOLDIER’S HANDBOOK Procedure. Strip the bed and turn the mattress. Make the base as for a closed bed. Place a small rubber sheet at the head of the bed. Cover the rubber sheet with a towel and pin the four corners, placing the pins under the corners of the towel. Put on the top covers, tucking them in at the foot and on one side as for an open bed. Leave the side of the bed open for entrance of the patient. Make an 8-inch fold of the top covers on the side to be opened. Place one pillow between the head of the bed and the mattress. Hold the pillow in place with two strips of roller bandage. Put on neatly and tie each at the back. Place at least two hot water bags in the bed. Pin the paper bag to the side of the mattress at the upper front edge of the bed, so as to be convenient for the disposal of used mouth wipes. On the bedside-stand place 2 emesis basins, the mouth wipes, 2 tongue blades, a basin with ice water and a compress, the paper pad and pencil. Cover the second pillow with a rubberized pillow cover and pillowcase and place it on the chair. Place the chest-pack (protector) and scultetus binder on the chair. Place the shock blocks (used to elevate the foot of the bed) near the foot of the bed. Have the side boards (used to keep unconscious patient from rolling out of bed) conveniently placed nearby. They are used only when an attendant is not available continuously at the bedside of a patient who has had a general anesthetic. When patient returns. Remove the hot water bags. Roll back the upper bedding. Transfer the patient to the bed. Cover the patient’s shoulders. Tuck in the bedding at the foot and the side in the usual manner. Adjust the side boards and shock blocks. Apply the chest protector to the chest. Apply the scultetus binder if the patient is an abdominal case of surgery and if it is so ordered. Make the patient as comfortable as possible. Precautions. Be sure that the mattress and pillows are well protected. Warm the bed thoroughly. Have all articles neces- sary for emergency near at hand. For any patient who has had a general anesthetic, side boards must be used unless he has a special nurse. For spinal anesthetic cases be sure that the foot of the bed is well elevated and do not use a pillow. Get authority from the medical officer before removing the shock blocks. 281. Moving a Patient. Never attempt to move a helpless patient unaided. Make all necessary preparation for the move before disturbing the patient. To turn the patient on one side. Place one hand under the shoulder and one hand under the buttocks on the opposite side of the patient. Then turn him toward you by pulling. To lift a patient up in the bed. This requires two attend- ants, one on each side of the bed. Place hands under shoulders and under the thighs. Have the patient pass an arm behind each attendant. In unison, the attendants draw or slide the patient up in the bed to the desired location. To set a patient up in the bed. Have the back-rest and pillows ready. Draw the patient well up in the bed. Raise him to a sitting position, supporting his back and shoulders. Arrange the back-rest and pillows. Protect the shoulders with covers, if necessary. For cardiac cases place pillows under the arms and inflated rubber rings under the buttocks. Provide a stand if available so that he may lean forward and rest his arms and head on it. To place a bed-patient in a chair. Place two pillows in the chair, one over the back and one over the seat. Cover both pillows with a blanket. Place the chair so that no unneces- sary steps or turns need to be taken. Raise the patient to a sitting position and put on his robe. Fold the bedding to the foot of his bed. Put on his socks and slippers. Swing the patient to the side of the bed and place his feet on the floor. Wait a short time to let the patient rest. Assist him to stand, turn him slowly, and place him carefully in the chair. If he is unable to stand the patient must be lifted in a sitting posi- tion from the edge of the bed into the chair. Lifting a patient from a stretcher to a bed. To lift a patient from a stretcher to a bed or to transfer him from one bed to another, try to avoid all possible discomfort and strain to the patient Requirements. Three attendants, a stretcher with the patient wrapped in blankets, and an open bed. If the transfer is from one bed to another, place the bed containing the patient in the same relative position as stated below for the stretcher. If the transfer is from the bed to the stretcher, reverse the process. Procedure. Have the bed properly prepared to receive the patient. Bring the stretcher to the bed, placing the head of the stretcher at the foot of the bed at an angle of about 135 degrees. The three attendants come to the side of the stretcher toward the head of the bed. One attendant places his hands under the patient’s head and shoulders. Another attendant places one arm under the patient’s back and the other under his buttocks. He should be the tallest of the three attendants. The remaining attend- ant places one arm under the patient’s thighs and the other arm under his ankles. , The attendants then lift the patient in unison, holding him so that he rests against their chests. Together they walk in step along the stretcher and the bed to the correct place alongside the bed. They lower the patient gradually to the bed. One attendant covers the patient and removes the stretcher blanket. Others remove the stretcher. 282. Temperature, Pulse, and Respiration. The nurse deter- mines and records the temperature, pulse rate, and respiration rate of the patient as directed by the medical officer. Articles necessary. Watch with second hand; thermometer tray containing alcohol, 70 per cent; clean cotton; cresol solu- tion in a basin; and a sterile clinical thermometer. Taking temperature by mouth. Remove the thermometer from the receptacle containing disinfecting solution. Wipe it with a cotton pledget saturated with 70 per cent alcohol from MEDICAL SOLDIER’S HANDBOOK 221 222 the bulb upwards. Wipe it again with a dry cotton pledget. Carry the thermometer in a cotton pledget to the bedside. Shake down the mercury column in the thermometer. Place the thermometer in the patient’s mouth, with the bulb end under the side of the patient’s tongue. Instruct the patient to keep his lips closed. At the same time take the pulse rate and respiration rate. After two minutes, remove the thermometer and read the height of the mercury column on the scale. Wipe off the thermometer with a clean pledget dipped in 70 per cent alcohol; wipe from the top toward the bulb. Replace the thermometer in the disinfecting solution. Record the temperature, pulse rate, and respiration rate on the patient’s chart. Taking temperature in the rectum. Taking the temperature in the rectum is the most accurate method. Turn the patient on his side. Wipe a rectal thermometer. Shake the mercury to 95 degrees Fahrenheit on the scale. Lubricate the bulb with vaseline. Insert the bulb into the rectum until it slips past the internal sphincter (about IV2 inches). Let it remain in position for two minutes, steadying it if it tends to slip out. Meanwhile, take the pulse rate and rate of respiration. Re- move the thermometer, read it, and wipe and clean it thor- oughly. Precautions: Do not place the rectal thermometer in the tube containing the mouth thermometer. Do not take the rectal temperature of a patient after he has had rectal surgery or rectal disease. Do not allow the patient to insert the thermometer himself. Taking temperature in the axilla (armpit). Pull a sleeve away from the armpit. Place the clinical thermometer deep in the axilla. Have the patient drop his arm to the side, holding it snugly to his chest with his hand across the opposite side of his chest. Leave the thermometer in the axilla for five minutes. Meanwhile take his pulse rate and rate of respiration. Remove the thermometer, read it, and cleanse it. This method is used in cases of extreme restless- ness or when other methods cannot be employed. Care of the clinical thermometer. Clinical thermometers should not be left in the sun or near a radiator or electric light. Do not wash them in hot water. Do not leave a ther- mometer on the bedside table of a patient. When handling the clinical thermometer be sure the hands are dry, as the thermometer will slip out of grasp easily. To shake down the mercury, grasp the thermometer se- curely by the upper end (never hold it by the bulb), bend (flex) the hand, and give a quick sudden movement of the wrist as when cracking a whip. Always read the thermometer just before placing it in the patient’s mouth to be sure that the mercury has been shaken down. General instructions on taking temperature, pulse rate, and rate of respiration. The temperature of surgical patients should be taken at four-hour intervals until sutures or skin clips are removed and as long as there is any drainage. Then, if the temperature is normal, change to twice a day. MEDICAL SOLDIER’S HANDBOOK MEDICAL SOLDIER’S HANDBOOK 223 Patients able to walk should be seated while temperatures are taken. Patients are not to be awakened for taking of temperature unless it is so ordered by the ward officer. A suitable set of schedules for taking temperature is shown below: If taken twice a day—8:00 a.m. and 4:00 p.m. If taken every 4 hours—8:00 a.m., 12:00 noon, 4:00 p.m., and 8:00 p.m. If taken every 2 hours—8:00 a.m., 10:00 a.m., 12:00 noon, 2:00 p.m. 4:00 p.m., 6:00 p.m., 8:00 p.m., and 10:00 p.m. If a patient develops a sudden rise or fall in temperature, read it each two hours. Temperatures are to be taken every half hour during a chill until the temperature begins to fall, then every two hours until ordered discontinued. In case any temperature reads unexpectedly low, or shows a sudden elevation, verify it at once with a different thermometer, keeping it in the mouth 5 minutes, or take the temperature by rectum. Record the temperature thus taken. In all cases the pulse yate and the rate of respiration must be counted for a full minute. Do not take temperature by mouth for 20 minutes after a hot or cold drink. Do not take temperature by mouth of a mouth breather. Do not take temperature by mouth of restless, delirious, un- conscious, or insane patient. 283. Rules for Charting. Charting includes the recording of all important events, symptoms, signs, treatment, and general condition of the patient on each patient’s clinical record (Form 55a, M.D., and accompanying lettered forms). Nothing of importance should escape the notice of the nurse as it may be of great value to the patient and to the doctor. Subjective symptoms (those complained of by the patient) and objective symptoms (those noted by the observer) should be recorded promptly and accurately. The patient’s clinical record (Form 55a, M.D., and accom- panying lettered forms) should be filled in, in so far as practicable, at the time they are assembled and whenever a new form is added. All insertions should be written clearly and correctly in black ink, except the night recordings be- tween 7:00 p.m. and 7:00 a.m., which are written in red ink. Records should be accessible only to ward officers and such military personnel as authorized by them. Nurses and ward attendants are responsible for strict com- pliance with written orders. Records should be printed, not written. Spelling and composition should be correct. Use periods at the ends of statements. Notations recorded should be accurate, concise, and neatly printed. Always record the exact time of an occurrence. Notations are to be made immediately after service is ren- dered. Only authorized abbreviations are allowed. Do not use chemical formula—write it out. 224 Ditto marks should not be used. Use all the space needed to make the record clear. Use additional blank forms. When medication is administered, other than by mouth, the channel of administration must be indicated. Example: “Per rectum,” etc. Liquids taken by mouth are recorded in cubic centimeters (c.c.) rather than in ounces. To indicate the separation of one day from the other on the patient’s clinical record, midnight lines are used. They are lines formed by drawing two parallel lines in red ink across the page and writing in the new day and date between the lines. For surgical cases, record should be made between the midnight line of the post-operative day, using Roman numerals to indicate the day. For example: “Tuesday, March 24, 1941. Ill Post-operative Day.” (Written in red ink). All medicines, treatment, preparations, etc., are to be char- ted by the nurse who administers them. Chart the change of surgical dressings, by whom made, and the amount and character of drainage. In charting stools and urination the number of stools are indicated by Roman numerals; the urine is indicated by Arabic numerals and is recorded in cubic centimeters. 284. To Give and Remove a Bed Pan. The articles neces- sary for this procedure are a bed pan. bed pan cover, toilet paper, and screens. Procedure. Screen the bed from view. See that the bed pan is clean, dry, warm, and covered with a bed pan cover. Take the bed pan to the patient’s bedside. Place the bed pap cover between the foot of the mattress and the foot of the bed. Instruct the patient to flex his knees. Place one hand under the small of the back to help raise and steady the patient. Slip the bed pan under his buttocks with the other hand. The patient may assist, if he is able, by pressing both heels and shoulder on the bed and raising the middle of his body. Remove the bed pan in the same manner. Always leave the patient dry, clean, comfortable, and his bed in order. Rinse the pan with cold water, using a brush if necessary. Unless the hospital has a bed pan sterilizer, cleanse it with cresol solution and rinse it with hot water. Dry it and put it away. When charting, describe the defecation according to amount (large, medium, small), character (soft, liquid, well-formed), color (brown, yellow, clay-colored, etc.) and any abnormalities such as worms, blood, pus, mucus, etc. Measure and chart the amount of urine. 285. The Enema. The object of an enema is to introduce fluid into the colon by way of the rectum for the purpose of cleansing the intestinal tract, relieving distention and gas (flatus), acting as a local remedial application, and to admin- ister medication or nourishment for general systemic effect. Articles necessary. If a large quantity of fluid is to be given, secure a clean tray containing an enema can, clamp, glass connector, rubber tube, a short colon tube (if used), and an enema tip; a warm bed pan and several large pieces of MEDICAL SOLDIER’S HANDBOOK newspaper; a suitable lubricant; the solution as ordered; and an irrigating standard (high frame with hooks for holding bedside apparatus. If a small quantity of fluid is to be given, secure a clean tray containing a funnel and colon tube; a pitcher of the solution as ordered; the desired lubricant; a warm bed pan; several large pieces of newspaper. Procedure. Screen the bed from view. Have the patient lie on his left side or on his back. Protect the bed with the newspapers. Make the patient comfortable. Unclamp the tubing and expel the air and cold water into the bed pan. Lubricate the rectal tip. Introduce the tip gently into the anus. The colon tube should not be intro- duced more than 6 inches. Guard the patient from all un- necessary exertion, discomfort, and exposure. Release the clamp and permit the solution to enter the colon slowly until the desired amount is given. Place the patient on the bed pan and protect the lower part of the bed. Report to the head nurse or ward surgeon if the patient is unable to expel the solution. At the conclusion of the treatment, turn the patient on his side and cleanse the buttocks carefully with toilet tissue. Leave the patient clean, dry, and comfortable. Inspect the contents of the pan. Preserve any specimen of diagnostic value until viewed by the medical officer. Chart the time of treatment, giving the amount, kind, and tempera- ture of solution used. Describe as to amount, color, consist- ency, and flatus expelled. 286. Catheterization. The object of catheterization is to withdraw urine from the bladder by artificial means. It is done when the patient is unable to urinate, when ah uncon- taminated specimen of urine is required, before operation (if ordered by the medical officer) to make sure the bladder is quite empty, and in cases where there is involuntary urination or dribbling for an overdistended bladder. Articles necessary. Enamel tray, sterile towel, 1 sterile basin for urine, sterile receptacle containing catheters, sterile receptacle containing green soap and one containing boric acid or argyrol solution, if necessary, 6 sterile cotton pledgets, newspaper for water, sterile forceps, and lubricating jelly (sterile). Procedure. Wash the hands well, using a brush and soap. Have the patient lie on his back with his legs slightly separ- ated. Place a newspaper under his hips and thighs for pro- tection of the bed. Stand on the right side of the patient with the catheterization tray on your right if you are right- handed. Place a sterile towel, unfolded, on the thigh. With the left hand pick up the penis and with the right hand wash it well from the tip back, using a sterile pledget soaked in green soap. Then rinse the penis well with sterile water or mild boric acid solution or the solution prescribed by the ward officer as standard. With the right hand pull the sterile towel on the thighs upward by the corners so that the penis can rest on it. With a sterile forcep place sterile catheter on the towel. MEDICAL SOLDIER’S HANDBOOK 225 226 Place some lubricant on the towel over the catheter tip. Hold the penis with the left hand. With the sterile forcep pick up the tip of the catheter and introduce it gently into the urethra. Do not touch the catheter at any time until it is in the bladder. Have a receptacle ready to receive the urine. When the bladder is empty remove the catheter slowly with the right hand. Hold a piece of gauze under the tip of the penis so as to catch the urine remaining in the catheter. Wipe off the penis with a clean gauze. Remove all the apparatus and make the patient comfortable. 287. Bladder Irrigation. The object of bladder irrigation is to relieve pain, inflammation, and congestion. Articles necessary. The same articles are required as for catheterization plus the following: a sterile pitcher containing sterile solution (as ordered for the irrigation) at about 105 degrees Fahrenheit; a sterile basin for return solution; and a sterile glass urethral syringe. Procedure. Proceed to empty the bladder as in catheter- ization. When the bladder is nearly empty, attach the syringe and pour into it 2 to 4 ounces of sterile irrigating solution. Allow solution to run in by gravity unless otherwise ordered. Before the syringe is entirely empty detach the syringe and allow the solution to flow into the enamel basin. Before the return flow from the bladder ceases, introduce more solution and continue until the prescribed amount of solution has been used. Finish as in catheterization. Chart the time of treatment, the amount and kind of solution used, and the character of the return flow. Precautions. Always use a rubber catheter. Keep the patient’s feet and body warm. Genito-urinary diseases react unfavorably to cold. 288. Bladder Instillation. The object of bladder instillation is to introduce into the bladder some antiseptic solution which is to remain and act as an application to the mucous membrane. Articles necessary. Same as for catheterization and irriga- tion. Procedure. Proceed as for catheterization. When the bladder is nearly empty or after the bladder has been irri- gated, attach the syringe to the catheter and inject the fluid into the bladder. Detach the syringe and complete the procedure as in catheterization. Chart the time, the amount of urine withdrawn, the treat- ment (“bladder instillation”) with the amount and strength of the drug used, and any symptoms of distress caused by the instillation. 289. Laboratory Specimens. The general rules for collection of specimens are the following; Always have the correct receptacle for the specimen to be collected. The receptacle must be perfectly clean. All specimens must be accompanied by appropriate laboratory request blank, completely filled out. MEDICAL SOLDIER’S HANDBOOK MEDICAL SOLDIER’S HANDBOOK 227 To collect routine urine specimen. Use routine specimen bottle, marked with routine label filled out completely. Col- lect specimen in clean bed pan or urinal. Measure and pour about 4 ounces into specimen bottle. If the patient is to col- lect the specimen, explain carefully what is to be done. To collect sterile urine specimen. Catheterize the patient and collect the urine in a sterile bottle covered with a sterile 4" x 4" gauze. To collect a 24-hour urine specimen. Select a large bottle (gallon), mark with the date, the ward, and the name and register number of patient, and the hour started. Start at 6:00 a.m. if possible. Have the patient void on the hour of starting. Thereafter save all urine voided until the same hour is reached 24 hours later. Have the patient void on the hour of completion and include in the specimen. The entire specimen is well shaken and the entire amount measured. Pour about 4 ounces of the composite specimen into a specimen bottle and send to the laboratory. The total amount of urine saved in 24 hours must be marked on the laboratory slip and on the patient’s clinical record (Form 55a, M.D.). Precautions. It is important to have all urine voided until the 24 hours are completed. Do not spill any, do not allow the patient to defecate when voiding, and do not mix speci- mens of different patients. Keep the specimen in a cool place. Example: March 23, 6:00 a.m.—Have the patient void, throw away the urine. Save all urine during the day and night. March 24. 6:00 a.m.—Have the patient void; save the urine. To collect a stool specimen. Immediately after defecation, take from the bed pan a specimen of the feces about the size of a walnut. Use a tongue blade for this purpose. Place the specimen in the feces cup and cover it with a paper lid. Fill out the laboratory slip (Form 55n, M.D.), noting the hour the specimen was passed, and send it with the specimen to the laboratory. To collect a stool series. Collect one single specimen of feces in every 24-hour period. The medical officer orders the number of days, usually 3 to 6 days. Take each specimen to the laboratory while warm. Indicate day of stool series on the laboratory blank. No oil is given for catharsis during this interval. Usually, bile salts or saline cathartics are used. To collect a sputum specimen. Instruct the patient to ex- pectorate material coughed (not nasal) into sputum cup. Label the specimen cup, fill out Form 55c, M.D., and send both to the laboratory. 290. Baths. There are many reasons for giving baths, and there are many different kinds of baths. Ordinarily they are given to promote cleanliness, but in the hospital other types of baths are used to stimulate circulation, to produce sweat- ing, to quiet the nervous system, or to reduce the patient’s temperature. The bath may be general or limited to a por- tion of the body. Variations in temperature are used, and chemicals may be added to the bathing solution to secure the desired effect of the bath. Soldiers employed in physio- therapy departments should study textbooks devoted to 228 MEDICAL SOLDIER’S HANDBOOK therapy by physical measures, the most important of which is water treatment. For the medical soldier employed in the hospital ward, the most common bath administered is the cleansing sponge bath. 291. Cleansing Sponge Bath. The objects of a cleansing sponge bath are: to refresh the patient; for cleanliness and to free the body from odors; to stimulate the superficial cir- culation. Articles necessary. Two basins of hot water; alcohol and powder for back rub; clean face towel, bath towel, and wash cloth; bath towel and wash cloth on stand that were used the day before; clean gown when needed; soap dish and soap; and comb and nail file. Preparation of the surroundings. Close the windows. The room temperature should be between 70 and 75 degrees Fahrenheit. Place a screen around the patient’s bed. Clear off the bedside table and place it so articles used for bathing may be placed on it. Arrange extra pillows neatly on the chair at the foot of the bed. Remove the bed spread. Fold and place it over the back of the chair. Place the clean linen on the chair. Remove the pillow from under the patient’s head. Put on clean pillow case and place it on the chair. Use the soiled pillow case as a container for the soiled linen. Loosen the upper bedding, all the way around the bed. Give the patient the bed pan and encourage him to use it. Remove the patient’s gown and place it over the back of the chair. Procedure. Wipe the perspiration from the patient with a clean towel. Protect the bed with patient’s towel that he has used previously. Use the patient’s wash cloth with cleansing soap and use a clean wash cloth for rinsing. Wash in sequence: face, front of neck and ears, upper extremities, chest, abdomen, lower extremities, back and genitalia. Dry each part or area thoroughly before proceeding to the next. Cleanse the mouth and brush the teeth. Then wash the face and dry. Upper extremities: Expose the arm nearest to you. Protect the bed with a towel under the arm. Bathe the arm and forearm. Give special attention to the armpit and dry it thoroughly. Place a basin of soapy water on the towel so the patient may place his hand in the basin. Wash the hand and dry it thoroughly. Repeat on the other arm and hand. Clean and cut the fingernails. Chest: Loosen the chest pack (protector) and expose the chest. Bathe and dry thoroughly. Abdomen: Cover the chest with a bath towel and turn down the blanket, being careful of any surgical dressings. Loosen and remove the abdominal binder if any is present and if it is permissible to do so. Bathe and dry thoroughly. Lower extremities: Protect the bed. Drape the extremity carefully, leaving the nearest limb exposed. Wash the thigh and leg thoroughly, then dry them thoroughly. Place a basin of soapy water on a towel near the foot of the bed. Allow the. patient to place his foot in the basin. Wash it. Support and move his foot from the basin and place it on a bath towel. Dry it, paying special attention to the heels, ankles, MEDICAL SOLDIER'S HANDBOOK 229 and the areas between the toes. Clean and cut the toe nails. Repeat the procedure on the other thigh, leg, and foot. Back: Turn the patient so his back will be toward you. Protect the bed. Examine those parts especially subjected to bed sores. Expose the back and bathe it. Dry it thoroughly. Rub the back with alcohol, paying particular attention to bony prominences and reddened areas. Place the abdominal binder (if any) in position. Turn the patient carefully on his back. Genitalia: If the patient is able, instruct him to finish his bath. This will include bathing of the genital area. Provide him with a soapy wash cloth. Place the bath water so it is convenient for him and give him a bath towel. If the patient is unable to proceed, the attendant completes the bath. Be cer- tain that the area is dried thoroughly. To finish: Put a clean gown on the patient. Comb his hair. Remove all bathing equipment, dirty linen, etc. Make up the patient’s bed neatly. 292. Care of the Hair. It will be necessary to comb the patient’s hair several times daily. Place a towel over the pillow under the patient’s head. Raise his head on one side and brush and comb the hair. Then turn his head and brush and comb the hair on the other side. Raise his head and comb the hair on the back of his head. To give a shampoo to a bed-patient. The object of the shampoo is to cleanse the hair and to stimulate and clean the scalp. Articles necessary. Three bath towels; 1 face towel; 1 large rubber draw sheet; newspapers for the floor; 1 small rubber sheet or rubber pillowcase; 2 large pitchers of water at 105 degrees Fahrenheit; 1 small pitcher of soap solution; 1 small pitcher;* and cotton pledgets. Procedure. Carry all articles to be used to the bedside. Remove the spread and loosen the upper bedding. Bring an extra chair to the side of the bed. Protect the floor and chair with newspapers. Remove the pillows and replace them with a small rubber sheet covered with a bath towel. Slip the patient’s gown low about his neck and pin a bath towel snugly around it. Place pillows under the patient’s knees. Make a pad of a bath towel and a large rubber sheet; roll the towel lengthwise; roll the edge of the rubber sheet over it; shape them into a horseshoe roll and place under the patient’s head, putting the free end so it will drop into the foot tub. Place the foot tub on a chair under the drainage pad. Bring the patient well over to the side of the bed. Place some cotton in his ears. ’Wet the hair by pouring warm water over it, using the small pitcher. Apply the soap to his hair and rub it into the hair. Repeat, adding soap solution until there is a good lather. Rub the scalp well. Rinse the hair thoroughly. Repeat the soaping and rinsing. Dry the hair with a bath towel. Re- move the rubber sheet and place it in the foot tub. When the hair is thoroughly dried, comb it. Precautions. Do not wash a patient’s hair without orders 230 MEDICAL SOLDIER’S HANDBOOK from the medical officer. Be sure that all the soap is rinsed off. 293. Care of the Back. Proper care of the back will prevent bed sores (decubitis). The symptoms of a bed sore are heat, redness, tepderness, and discomfort. Preventive treatment against bed sores is the responsibility of the nurse. Protect the bony prominences by relieving pressure on them. The following mechanical devices are used for this purpose: rubber rings, cotton rings, cradles, and back rests. The following bedside care will assist in prevent- ing bed sores: change the position of the patient frequently; keep his skin clean and dry; keep his bed free from wrinkles and crumbs; handle him carefully, especially when giving him the bed pan; rub his back with alcohol and powder; rub extremely dry skin with oil; paint reddened areas with com- pound tincture of benzoin. The treatment of bed sores is as follows: Report reddened spots and abrasions to the head nurse or ward officer. Chart the time and method used in dressing abrasions. For redness and slight abrasion of the skin, keep the skin clean, apply castor oil and bismuth, antiseptic powders, ichthyol ointment, or compound tincture of benzoin. Apply sterile dressings. 294. Care of the Mouth and Teeth. The object of dental hygiene is to keep the teeth in good condition and to prevent the formation of sores. General instructions. Always wash your hands before and after cleansing a patient’s mouth. Use fresh solution and clean applicators for each cleansing. Never dip the applicators in the mouth wash a second time. Routine care for bed patients who are able to brush their own teeth. At the time of the morning toilet and again in the afternoon, provide the patient with a toothbrush, mouth wash (2 ounces), a glass of water, and an emesis basin. Protect the patient’s bed garments and bed with a towel and place the other articles within his reach. Routine care for patients who are helpless. Wash your hands. Place the towel slightly under the patient’s head and over his shoulder. Place the emesis basin near his mouth. Pour some solution over the brush. Have the patient open his mouth. Brush with a slow, sweeping motion. Rinse the brush frequently. If the patient has a coated tongue, cleanse his tongue with a gauze dipped in a mixture of one dram of glycerine and a few drops of lemon juice. Special care is given to very sick patients, patients with high fever, unconscious patients, and surgical patients just before going to surgery. 295. Feeding the Patient. Food is.essential to the mainte- nance of life. When a person is sick he must have food, other- wise he cannot be returned to health. Since sickness disturbs the normal processes of digestion and interrupts the normal desire for food, the act of feeding a patient must be intelli- gently planned and painstakingly accomplished. Rules for feeding patients. Arrange the patient’s bedding so he will be comfortable. Place the table and tray in a convenient position. Have the room or ward in proper order so there are no disturbing sights which oppose the enjoyment MEDICAL SOLDIERS HANDBOOK 231 of the food. Prevent serving meals immediately following treatments, application of dressings, departure of visitors, or the medical officer’s inspections, as the patients may be some- what restless. Avoid all excitement and have the patient alone and unobserved by others. Do not discuss food with the patient and do not ask the patient to decide what he will have. Be strict in giving food in accordance with the medical officer’s orders. Never give anything to the patient, either to drink or eat, without being fully aware of what the patient is permitted to have. Arrange the tray as nicely as possible, making it attractive to the patient. Avoid dropping or spilling the food dishes. Place it before him in an attractive condition. If it is to be hot, serve it hot; if it is to be served cold, serve it cold. Do not hurry the patient and give him all necessary assistance. Remove dirty dishes promptly. Note how much the patient has eaten, what he has eaten, and what he has not eaten. In feeding liquids to a patient use drinking cups or glasses; cup, saucers, and spoon; medicine dropper; glass drinking tubes; or straws, depending upon his condition. Never use glass tubes for small children or delirious patients. Give liquids slowly, watching the patient’s color so that you may be certain it is not going into his windpipe. The time spent in feeding the patient correctly is never wasted. Often it is of greater importance than the medical measures devoted to the treatment of the disease. 296. Drugs and Their Administration. Drugs may be given by various methods. The channels of administration com- monly employed in the hospital ward are as follows; By mouth. To produce local effect in the gastro-intestinal tract and absorption into the blood stream. By rectum. Enemas and suppositories. By inhalation. For infections in the respiratory tract and absorption into the blood stream. By inunction. Applications of ointments to the skin by rubbing them in. By injection. Subcutaneously—under the skin; intracu- taneously—into the skin; intramuscularly—into a muscle; in- travenously—into a vein; intraspinally—into the spinal canal. When normal saline is given into the deep subcutaneous tissues (upper inner thigh, under the nipple area, or anterior abdomen) it is known as hypodermoclysis. The saline may contain some other substance such as glucose (5 per cent). 297. Administration of Medicines by Mouth, The majority of medicines are given by mouth (orally). Articles necessary. Tray covered with X-ray film or similar material; medicine glasses; and medicine tickets (small Wi- inch square cards for each patient, showing medicine to be given and dosage). Procedure. Arrange the medicine glasses on the tray so that each medicine ticket has a glass to accompany it. Make out the tickets for new medicines ordered since last issue of medicines. When dispensing the medicine from the medicine cabinet proceed as follows: Read the label and take the bottle of medicine from the shelf. Uncork. Read the label again. Hold the medicine glass or minim glass in the left hand and 232 on a level with the eye. Always shake the bottle before pouring out its contents. Pour out the exact amount from the side of the bottle opposite the label. Give your undivided attention to pouring medicine. Place the medicine glass on the ticket on the tray. Wipe off the neck and base of the bottle with a damp cloth. Recork and again read the label as the bottle is replaced on the cabinet shelf. Read the patient’s name on the medicine ticket, verify it with the name tag on the foot of his bed, and call the patient by name. Stay with the patient until the medicine is taken. Cleanse the tray and leave it in readiness for future use. Precautions. Have the ward officer’s order for all medica- tions. Do not give medicines poured by another person. Do not leave medicines or medicine glasses on a patient’s table. Keep all the medicine bottles marked plainly. Never give medicine from an unmarked bottle. Give medicine at the time prescribed. Order only a small amount of medicine from the pharmacy, as it deteriorates with age. Use the minim glass for measuring minims and the medicine dropper for drops. Use the medicine glass for measuring drams and ounces. Use a teaspoon for measuring teaspoon- fuls. Give all syrupy cough medicines without water unless otherwise ordered. Dilute saline cathartics with small amount of water unless otherwise ordered. Give the following well diluted and through drinking tube: acids, iodides, arsenic, and iron. Keep all narcotics in a locked cupboard. Narcotics must be given out by the head nurse in a labeled envelope. Know the action expected from the drug. Know how to administer the drug. Watch for signs of cumulative poisoning. Make medication as attractive as possible, especially oils, bitters, etc. Watch for individual idiosyncrasies (peculiar reactions ex- hibited by some patients to certain drugs). Do not tell the patient what kind of medicine he is taking. 298. Hypodermic Injection. A hypodermic injection is given to obtain prompt action from a drug, to prevent irritation of the mucous lining of the stomach, and to administer a drug when a patient is unable to swallow. Articles necessary. A tray covered with a paper towel; alcohol lamp and spoon, a box of matches; a glass container with syringes in alcohol; needles (hypodermic) in a glass container; cotton pledgets; and 4 bottles in a rack containing alcohol for cleansing the skin, ether, alcohol for forceps, and distilled water. Procedure for subcutaneous injection. The hypodermic needle to be used is boiled in distilled water in a spoon for one minute. Be especially careful in handling the needle to avoid blunting the point. The needle is taken out of the spoon with forceps which have been disinfected with alcohol. Place the needle on a syringe and rinse the syringe out with a portion of the boiled water in the spoon. Pick up the tablet desired from the medicine envelope by touching the tablet with the dampened end of the syringe MEDICAL SOLDIER’S HANDBOOK MEDICAL SOLDIER’S HANDBOOK 233 plunger. Draw up sufficient water from the spoon to dis- solve the tablet—8 to 10 minims. Place a cotton pledget saturated with alcohol over the needle. Carry the syringe thus prepared to the patient. Select an area, preferably the outer surface of the arm or thigh, and cleanse the skin with the cotton pledget saturated with alcohol; pinch up the flesh of the cleansed area with the forefinger and thumb and quickly insert the needle into the subcutaneous tissue. Press the piston of the syringe slowly and gently until the solution is expelled. Then withdraw the needle and wipe the skin area with the pledget. Massage around the site of the puncture but not directly over it. To administer a medicine put up in ampules or rubber- capped vials. In giving a hypodermic from solutions con- tained in ampules or in rubbercapped vials, always cleanse the ampules or rubber caps with an alcohol sponge. Withdraw the plunger in the syringe to the desired point. Hold the hilt of the needle when withdrawing it. It is sometimes convenient to force a little air into the vial before drawing up the solu- tion—as for insulin. Charting. Chart the hour, drug and amount, and patient’s reaction. Also reason for giving narcotics—such as pain or restlessness. Hypodermoclysis. Hypodermoclysis, the injection of sterile normal saline fluid into the body, is given in the same man- ner as other subcutaneous injections except more fluid is given (200 to 1500 cubic centimeters). The flask containing the saline is connected to the large subcutaneous needle or needles by a sterile rubber tubing. Procedure for intramuscular injection. The technic is the same as that for giving a subcutaneous hypodermic, but a longer needle is used and the needle is inserted straight into the muscle. Stretch the skin tightly over the part, pressing on it in one direction with the thumb and in the other with the first finger of the left hand. Large, heavy muscles are chosen, such as those of the thigh and the gluteal muscles of the buttocks. Precautions. Use aseptic technic; the drug must not be boiled in the water; care must be observed to prevent break- ing the needle in the flesh; care must be taken to expel the air from the barrel before inserting the needle into the skin. Insert the needle in the direction of the heart and in the fleshy parts of the body, such as the outer surfaces of the arms and legs and thighs, never over bony prominences. When giving an intramuscular injection it is good policy to withdraw the plunger slightly after its insertion into the flesh to make certain the needle is not in a blood vessel. If blood appears in the bottom of the syringe, redraw the needle and reinsert in a new area. Fractional dosage. Occasionally it may be necessary to give a fractional part of a medicine tablet instead of the actual dosage of the tablet as prepared. For instance, it may be desirable to give %2 grain of morphine sulphate, and the smallest grain tablet of morphine sulphate on hand is y8 grain. First it is necessary to determine how much of the % grain 234 MEDICAL SOLDIER’S HANDBOOK tablet will be needed. Divide Vi2 grain (desired dose) by i/g (dose of tablet on hand) or Vi2 times 8/1 = 8/12 (portion of Vs tablet which should be used). Since it is difficult to proportion a tablet, the tablet is dissolved in sterile water, using the number of drops as in- dicated by the denominator of the above fraction %2 or -2 drops. The 12 drops now contain the original dosage of Vs grain which was in the prepared tablet. Draw 8 drops (numer- ator of the fraction 8/12) of the 12 into a syringe, and the syringe contains 8/12 of the 1ls grain which was dissolved or the desired dose, y12 grain. Do not dissolve the tablet in less than 10 drops of water. 299. Intravenous Infusion. The objects of an intravenous infusion are to replace fluid after a hemorrhage, to stimulate the heart action, to assist in eliminating toxic materials, to fill the blood vessels and maintain the blood pressure, and to provide nourishment. Articles necessary. Enamel tray covered with paper towel, vein set (obtain in surgery when getting solution), and sterile vein-needle in a container. Have the doctor select the needle, tourniquet, iodine and alcohol, adhesive plaster, 4 sterile cotton pledgets, 1 clean 4" x 4" gauze, small rubber sheet and towel, bandage scissors, irrigation standard and 2 extra vein- needles. Procedure. If a large quantity of fluid is to be given the solution is placed in a sterile flask and connected to a syringe. When smaller quantities are given, the amount can be given with suitable syringe containing the solution. Using the flask: Warm the solution in hot water. Do not allow hot water to run over the flask. Do not boil or set over a flame. Test the heat of the flask against forearm. Connect the flask, vein-set, and needle. Run the solution through the tubing to expel any air. Place on a tray with the needle in a cotton pledget saturated with alcohol. Carry everything to the bedside table and assist the medical officer. Place a rubber sheet and towel under the patient’s elbow. An area about 3 inches in diameter around the site of punc- ture is then disinfected with iodine and alcohol. The medical officer again allows some solution to run through the needle to see that the air is expelled from the tubing and that the solution is warm before inserting the needle into the vein. Fasten the tubing in place with adhesive tape. Place a 4" x 4" sterile gauze near the hilt of the needle between the tubing and the forearm. Watch the solution as it runs in. After the correct amount has been given, clamp the tubing; then remove the needle. Wipe the site of puncture with a cotton pledget saturated with alcohol. Apply either a col- lodion dressing or have the patient hold the pledget over the site of the puncture. Make the patient comfortable. Clear away the used articles and return vein-set and flask to the operating room. Draw ether through the needle. Chart: time begun and ended, amount given, per cent and kind of solution used, and the patient’s pulse rate before and after infusion. MEDICAL SOLDIER’S HANDBOOK 235 Using a syringe. Use a Luer syringe, 2, 10, 20, or 50 cubic centimeter, according to the amount of medication to be given. Select or have the medical officer select the vein-needle. Draw the solution into the syringe. Cover the needle with a sterile cotton pledget. Have iodine, alcohol, tourniquet, and sterile cotton pledgets on the tray. Precautions. Use aseptic precautions with all materials which come in contact with the solution or the skin. Take the pulse rate before and after the treatment. Expel the air from the tube and needle (or syringe) before inserting needle. Do not allow the solution to become cold. If the patient is restless, a nurse must be in attendance during the proced- ure, especially if glucose 10 per cent is being given. 300. General Preparation of Patients for Surgery. Liquid or soft diet the night before; encourage the swallowing of fluids until four hours before surgery if not vomiting; shave and prepare the operative skin area; normal saline enema at 5:00 or 6:00 a.m.; lavage (if ordered) stomach cases; and take the temperature, pulse rate, and rate of respiration. Give hypodermic medication at the exact time ordered. (Morphine sulphate grains 1/6 and atropine sulphate grains 1/150 are usually given % hour before operation). Have the patient void just before going to surgery. Meas- ure the urine and chart. Report to the nurse or ward officer if the patient is unable to void. Catheterize if ordered. Dress the patient in a- clean gown and surgical leggins. Comb the patient’s hair. Put on his surgical cap. All arti- ficial parts must be removed; this includes false teeth and dentures. Remove all jewelry and turn it over to the re- sponsible officer. Fill out receipt and have the patient sign, then return with valuables to the responsible officer for safe keeping. Chart “Ready for surgery” and the time ready on patient’s clinical record (Form 55, M.D.). When the patient leaves the surgery, chart the exact time that he leaves. Also chart the time patient returns from surgery. 301. Surgical Preparations. The object of pre-operative care is to prepare the patient for his operation. Articles necessary for the preparation tray. Tray covered with a paper towel; razor and blades; toilet paper; bowl for water and a cake of soap; 3 cotton balls for lather; bowl for sterile water; forceps; solution as follows: green soap, ether, iodized alcohol (98 cubic centimeters of 70 per cent alcohol and 2 cubic centimeters of tincture of iodine); a preparation package in paper wrapper containing seven 4" x 4" gauze pieces and 3 applicators; newspaper for waste; and a drop light. Routine preparation. Shave the area well. Do not cut or scratch the patient. Use soap to make lather. Surgical enema: Take the patient to the enema room, if practicable. Give him a normal saline enema. Repeat at 6:30 a.m. the following day. Give sufficient water to get good results. Start the preparation for bath while the patient is expelling his enema. Tub bath: Cleanse the bath tub well. Assist the patient in and out of the tub and as much as necessary. If the patient 236 MEDICAL SOLDIER’S HANDBOOK has had a bath just before admission, get permission from the nurse or ward officer not to give a bath. When the patient has returned to his bed or in some cases to the operating room, paint the prepared field as follows. Painting the prepared field (area of skin). Green soap: Use applicator to clean the umbilicus (navel). Use forceps and one 4" x 4" gauze. Use up-and-down strokes from the median line to the bedline (line of the patient’s body next to the bed). Lather three times, which will take about five minutes. Cleanse the area with sterile water. Use two pieces of 4" x 4" gauze, then dry well with two pieces of 4" x 4" gauze. Ether; Use applicator to clean the umbilicus. Use forceps and one 4" x 4" gauze. Scrub with up-and-down strokes from median line to the bedline, alternating strokes on the right and left sides. Iodized alcohol: Use applicator for the umbilicus. Use forceps and one 4" x 4" gauze. Paint with overlapping up- and-down strokes from median line to the bedline, alter- nating the strokes on the right and left side. Orthopedic preparation (two-day preparation). First day: Same as the standard surgical preparation except scrub with green soap solution for 10 minutes; scrub with ether 3' min- utes; paint with 3% per cent iodine; remove all iodine with 90 per cent alcohol; cover the area with a double sterile cover (leggins or pillowcases may be used). Second day: Omit shaving and green soap scrub; proceed as on the first day. When through, report to the ward of- ficer and have him inspect the preparation. Emergency preparation. Using a sharp blade, shave the area without using soap and water. Clean the umbilicus with an ap- plicator. Scrub operative area with ether until sponges re- main clean. Do not bathe unless ordered to do so. Do not give an enema unless ordered. When finished, report to the head nurse or ward officer and have the preparation inspected. Areas prepared for operations are: Abdominal: (appendectomy, cholecystectomy, gastric work, hernia, and any abdominal operation). Shave from the nipple line downward over genitalia, perineum, and anus. Shave from the median line out to the bedline, being careful of the hip bones. Bone surgery: Operation on the wrist or area of the hand; shave the arm and hand from the fingertips to the elbow. Operation on the elbow or area below: shave the arm from the wrist to the shoulder; include the armpit (axilla). Operation above the elbow including shoulder: shave from the lower jaw to the waistline and from the spine to the anterior midline of the chest. Shave the shoulder and the arm down to the elbow, including the armpit. Operation below the knee: shave from the knee downward, including the toes. Operation on the knee: shave from the hip to the ankle. Operation on the hip: shave from the waistline on affected side downward over the genitalia, perineum, and anus, and from the anterior midline to spine on the affected side. Shave the hip and the thigh downward to the knee. MEDICAL SOLDIER'S HANDBOOK 237 Mastoid operations. On the affected side, part hair and clip with scissors, then shave an area six inches in diameter all around the ear and down the affected side of the neck to the clavicle (collar bone) in front and to the scapula (shoulder blade) in rear from the median line in front to the median line in back. Wash the ear carefully and swab the external canal with a soft applicator. Perineal operations. Shave the genitalia and perineum and around the anus. Shave the thighs for several inches. Rectal operations. Shave the genitalia and perineum and around the anus. Shave an area six inches in diameter around the anus. Neck operations (thyroidectomy). Shave entirely around the neck from the lower jaw line and shoulders down to the nipple line in front. 302. Post-operative Care. Post-operative care begins when the patient returns from the operating room. Place him im- mediately in a well-warmed operative bed in a warm room with good ventilation but without draft. Do not leave him alone until he regains complete consciousness. Watch him so that he does not swallow his tongue, choke on aspirated mucus, or become chilled. If it is absolutely necessary to leave the room, place the side boards on the bed; preferably get some other attendant to take the duty. Take the pulse rate and rate of respiration every 15 minutes for the first 2 hours, then every 30 minutes for 2 hours, and then every 2 hours for 4 hours. Record them as taken, noting the time. When vomiting occurs, raise the head slightly and tilt it to the side. Place a kidney-shaped emesis basin under the jaw. Support the patient’s head with one arm and hand and with the other hand wipe his mouth and face. Remove all mucus from his mouth, using squares of gauze. Dry the face frequently during excessive perspiration. Also dry the skin and replace damp linen when it is safe to dis- turb the patient to that extent. Avoid exposing the body surface any more than actually necessary. Do not give anything by mouth until ordered to do so by the medical officer in charge of the case. If fluids have been ordered by other methods check them to see that the ap- paratus is working. The nurse should not give intravenous infusions or hypodermoclysis. See par. 296 for description of drug administration. 303. Complications. When any of the following complica- tions occur after surgery, report it promptly to the head nurse and ward officer: Hemorrhage; collapse; excessive restlessness; drawn, anx- ious expression; gasping for air; blood-stained dressings or blood in stools, urine, or vomitus; cold clammy skin; weak pulse; unconsciousness: distension of the abdomen; and ab- normal changes in the patient’s temperature. The medical officer will wish to prescribe a treatment and control the care of these patients closely. 304. Surgical Dressings. There are various kinds of surgical dressings. The simplest is a dry dressing consisting of a 238 MEDICAL SOLDIER’S HANDBOOK sterile gauze applied to the wound and held in place either by a roller bandage or adhesive plaster. Wet dressings consist of gauze moistened with a prescribed solution and covered with a protective material to retain moisture and prevent wetting the bed and the patient. Hot, wet dressings are commonly used for local infections. They are applied in the form of sterile cotton pads wrapped with roller bandage and then covered with an oiled silk or rubber wrapping. Hot water bags are applied to maintain the heat. These are important dressings and to apply them correctly requires experience and training. There are many other minor yet important surgical pro- cedures that the trained nurse will know. The medical soldier should be constantly on the alert to learn new procedures in order that he may profit from the experience. All days are not alike in the surgical ward; therefore the nurse must be prepared for the care of emergencies at all times. Extra dressings, sterile instruments, clean linen, fresh beds, and in- dividual rooms should be available at all times. Surgical dressings will usually be applied by the medical officer, assisted by the nurse. In the dressing of surgical wounds have all necessary equipment on the dressing tray. Most hospitals have a sur- gical cart on which dressings and equipment are kept. It is moved from one bedside to another and placed conveniently on the side the medical officer is working. Dress all clean cases before dressing the patients having drainage (infectious cases). Remove adherent adhesive plaster with ether or benzine. If the gauze dressing is sticking to the skin, moisten it with a sterile solution of water. Where possible, remove all dressings with a forceps. Use clean, sterile forceps to replace the new dressings. Be certain that no contamination takes place. When there is doubt use an- other dressing. When there is profuse drainage from a wound, the dressing should be changed frequently to prevent spread of the in- fection, uncleanliness, unpleasant odors, and discomfort to the patient and other patients. Apply sterile vaseline to the skin adjacent to the wound. Before starting dressings, the attendant should always scrub his hands thoroughly and rinse them with a disinfectant. He should do likewise upon completing this duty. 305. Asepsis and Aseptic Technique. It was not until 1850 that any great attention was paid to the cleansing of wounds, the discovery of the cause of infection, and how to treat in- fection. Bacteria. Not all germs or bacteria are disease producers, but every precaution should be taken to destroy all germs, thus destroying the ones that might cause infection. Bacteria are abundant in all parts and places of the earth. The air, the soil, the water, and every living animal have many millions of these small organisms. Fortunately, not all are disease producers and not all produce the same disease. But precautions must be taken in order that some diseases will not be produced when such overwhelming numbers of bacteria are present. Individual bacteria cannot be seen by MEDICAL SOLDIER’S HANDBOOK 239 the human eye. It is known that bacteria can be collected in some of the most spotless of rooms and places, and they can be grown in great numbers under suitable environment. The mouth, nose, teeth, and fingernails contain millions of bacteria, some of which will cause infection if allowed to break through the skin or protective surface. Breathing into an open wound or sore may cause it to become infected. Picking the skin with fingernails may distribute germs from the nails to the skin wound. It is known that germs cause infections on the surface of the body as well as inside of the body. Discussion here is limited to wound infections outside the body. It is these wounds that can be cared for and treated in a simple manner. A simple illustration of what takes place when infection of the skin is encountered follows: First, the outside protec- tive layers of the skin are torn away (denuded) by a scratch. If the area denuded is deep enough the wound may bleed, or it may ooze serum if it is superficial. Bacteria present in the air, in the dirt, or bacteria already present on the skin invade this serum or blood and start multiplying. The blood and serum make good culture media (food) for most bacteria. Body resistance tries to kill these rapidly-forming bacteria, but if they are not killed the infection spreads and causes a more extensive area of disease. If the wound is properly treated in the earlier stages, the bacteria will be killed, or at least not allowed to multiply, and little or no infection will develop. There are bacteria on all exposed objects, the skin of the body, in the mouth, and elsewhere. Obviously, the utmost care must be taken to remove the bacteria from the skin about a wound and then not introduce any thereafter. In surgery, the surgeons scrub their hands and forearms with soap and water for ten minutes by the clock. Then they dip their hands in iodine and sponge them off with alcohol. Even then the nails might contain bacteria, so rubber gloves are worn to insure further safety. Every precaution is taken to destroy the organism. The surgeon also wears a clean mask over his nose and mouth, a clean cap, and a sterile gown. The area or field of surgery to be operated is shaved beforehand to remove hiding places for bacteria and to make further cleansing easier. Ether is applied to the skin to re- move oily substances, and then is followed by iodine and alcohol. Sterile drapes are applied around the operative area. The sheets of cloth (drapes) have beforehand been auto- claved, that is, heated to a high temperature, under pressure, in a tight oven (autoclave). The instruments to be used are rendered sterile (germ free) by boiling. Then during the operation the surgeon and his assistants do not touch any- thing but the sterile drapes, instruments, and the wound. Thus, surrounding bacteria have been previously killed, and no bacteria are brought into the wound. In this way all precautions are taken to guard against sepsis (infection). It is known that from 50 to 70 per cent of all wounds will become infected (to more or less extent) if nothing is done to prevent infection. If every wound were to be cared for as soon as possible after it is caused, far fewer infections 240 would develop. Many severe infections have occurred from small, simple skin wounds that were overlooked or in which no attention or aid was given. Numerous arms and legs could have been saved if only the small wounds had been cared for at the start. On encountering a wound the local facilities will vary the treatment. When in the field and aseptic technique is practicable, the wound should be bathed with plenty of water (and soap if available) and then some antiseptic applied. Every soldier and officer has a sealed metal packet con- taining a sterile dressing (first aid packet). On opening this dressing, handle it as little as possible and bind it with the gauze tails provided. Tuck in the edges to pre- vent the entry of perspiration and dirt from other parts of the body. Where ample facilities are available the process is the same, except when washing the wound a sterile gauze held by a sterile forcep is gently rubbed over the wound. The antiseptic is applied with a sterile piece of cotton on a sterile applicator (or stick). The gauze is handled with a sterile forcep. Dirty hands or even the ordinary washed hands should never come in contact with a wound. Infected wounds are caused by bacteria. If every precau- tion can be used in the killing of these bacteria, or even the hindrance of their growth, the wound will heal properly and promptly. The secret is: start early to combat infection; treat every wound as potentially infected by thorough cleanliness and apply aseptic (the absence of germs or disease) technique. MEDICAL SOLDIER’S HANDBOOK MATERIA MEDICA Chapter 19 306. Materia Medica Defined. Materia medica is the science which treats of the medicinal materials used for the cure or the prevention of disease. The particular part of this science which relates to the properties of medicinal substances and the application of remedial agents in the treatment of dis- ease is known as therapeutics. These substances are usually spoken of as medicines or drugs. In studying them it is necessary to consider their source, composition, physical characteristics, chemical properties, preparation and admin- istration, and physiological and toxicological action. In ad- dition to the use of drugs as therapeutic agents, water, serums, vaccines, electricity, light rays, heat, physical, me- chanical and operative measures, and hygienic agents are employed for the cure and prevention of disease. 307. Derivation of Drugs. Medicinal substances for the treatment of disease and the restoring or the preserving of health are derived from the animal, vegetable, and mineral kingdoms of nature. Samples of each are shown below: Animal. Adeps (lard); Adeps lanae (wool fat); Gelatinum (gelatin); Thyroideum (thyroid); Pepsinum (pepsin); Diph- thenicum (antitoxinum). Vegetable. Amylum (starch); Acacia (gum arabic); Linum (linseed); Prunus virginiana (wild cherry). Mineral. Sodii chloridum (sodium chloride); Sodii bicar- bonas (sodium bicarbonate); Magnesii sulfas (Epsom salts); Magma magnesii (milk of magnesia). Medicinal substances obtained from the animal or vegetable kingdoms are called organic dnigs. They contain compounds of carbon used in medicine. Medicinal substances obtained from the mineral kingdom are called inorganic drugs. 308. Administration of Medicines. The normal adult dose of medicine is based upon the condition that the individual be 24 years of age and weigh approximately 150 pounds. Per- sons under 24 or over 60 years of age require proportionately smaller doses. To compute the dose for persons under 24 years of age, the following rules are applicable. Young’s rule: Take the age of the person as the numerator of the fraction and the age plus 12 as the denominator. Thus for a child 4 years old, 4 would be the numerator and 4 plus 4 12, or 16, the denominator, or — % of the adult dose. X 5 grains = 1% grains. Cowling’s rule: Take the age at the next birthday of the individual as the numerator of the fraction and 24 (the age of the adult) as the denominator of the fraction. Thus for a child 11 years old, 12 would be the numerator and 24 the denominator, and the dose would be Vz of the average adult dose. X 5 grains = 2Vz grains. When the “dose” of a drug is designated, the meaning of 242 MEDICAL SOLDIER’S HANDBOOK the term is the amount necessary to produce the desired therapeutic effect. The doses shown in the Pharmacopoeia and the National Formulary are the average therapeutic doses. The lethal dose is the smallest dose of the substance that will produce death. When giving medicines many factors affect the size of the dose, the method of administration, and the frequency of doses. Some of these factors are; Age. Children and aged adults as a rule require less than the normal adult dose. Sex. Females require smaller doses than males. Race. Negroes usually require larger and Asiatics smaller doses than white people. Physical condition. Strong, sturdy patients require larger doses than weak patients. Climate. People in warm climates, as a rule, require smaller doses of purgatives. Occupation. Men working out of doors at hard labor re- quire larger doses than those who sit at a desk during the working day. Habitual use. If the individual has become a habitue, this modifies the dose by lessening the therapeutic effect of the drug, and the dose of the drug must be increased greatly to obtain the proper effect. This is especially true of narcotics. Idiosyncrasy. People react differently to drugs if they happen to have a peculiarity of constitution, and occasionally these individuals are encountered. Patients will usually in- form medical authorities of difficulties encountered when the drug was administered previously. Form of the drug. All drugs must be reduced to a solution before they enter the blood circulation. The form of the drug will control largely the rate of absorption. Time of administration. Drugs given before a meal are more quickly absorbed than those given upon a full stomach. Mode of administration. As a rule, drugs administered hypodermically are used in much smaller quantities. Drugs may be introduced into the circulation by any one of the following methods: By mouth. Most common of all methods and is usually the most desirable except when rapid action is required. Subcutaneously. Drugs are injected under the skin. This method is frequently used when rapid action is desired or when the stomach juices will destroy the principal action of the drug if given by mouth. By rectum. Introducing the drug into the rectum either by suppository or by means of a solution, when it is impossible to administer drugs by mouth because of vomiting, semi- consciousness or unconsciousness, delirium, or certain diseases of the gastrointestinal tract. By inunction. This method consists of applying ointments or oily combinations to the skin and rubbing them into it. Intravenously. By this means preparations of drugs are introduced directly into a vein. It is used when rapid action is desired. Inhalation. By this method medicated vapors or drugs, such as ether or chloroform, are inhaled. Hypodermoclysis. Hypodermoclysis is the introduction of MEDICAL SOLDIER’S HANDBOOK 243 solutions of saline into the loose tissues about the breasts, abdomen, and certain other portions of the body. Intramuscularly. By this method sterile preparations of drugs which are readily absorbable are injected directly into the muscle tissue. Further information as to administration of medicines is given in Chapter 18. 309. Classification of Drugs. Drugs are classified according to their physiological actions and effects on the body or its organs and tissues. If a drug (therapeutic agent) increases the functional activity of the body or of any organ or tissue, it is a stimulant; if it lessens or reduces the functional activity, it is a sedative. Below is a list of some of the common terms classifying drugs according to their actions and effects. Examples of remedial agents are shown for each. A drug may have more than one action or effect and will therefore be included in corresponding classes. For the description and average dose of common individual drugs, see par. 310. Alteratives. Substances used to modify processes of nutri- tion, expecially in chronic diseases. Examples: Donovan’s solution, arsenic and mercuric iodides, calomel, sodium cacodylate, hydriodic acid diluted, arsenic trioxide, tincture of iodine. Analgesics or anodynes. Used to allay pain. Examples: acetylsalicylic acid (aspirin), paragoric, acetophenetidin, acetanilid, ammonium salicylate, antipyrine. Anesthetics. Used to produce local or general insensi- bility. Examples: ether, chloroform, nitrous oxide, ethylene, ethyl chloride, cocaine, novacaine, butyn, phenol. Anaphrodisiacs. Used to depress the sexual appetite and function. Examples: potassium nitrate (saltpetre), potassium iodide. Antacids. Used to neutralize acid in the stomach and intes- tine. Examples; sodium bicarbonate, bismuth subcarbonate, magnesium phosphate, magnesium oxide, magnesium car- bonate, calcium carbonate, potassium bicarbonate. Anthelmintics. Used to destroy or expel intestinal worms. Examples: santonin, carbon tetrachloride, tetrachlorethylene, thymol, oil of chenopodium. Antidotes. Act upon poisons in such a manner as to alter their composition, rendering them less poisonous and so pre- venting their toxic (poisonous) action from being exerted upon the body. Examples: tannic acid (abundant in tea) to most of the vegetable poisons; milk and albumen of egg to mineral poisons. Antipyretics. Used in the reduction of body temperature in fevers. Examples: antipyrine, acetanilid, phenacetine, amidopyrine, acetylsalicylic acid (aspirin), quinine sulphate. Antiseptics. Have the power of preventing the growth and development of bacteria. Examples: alcohol, phenol, potas- sium permanganate, free chlorine (such as from fresh Dakin’s solution), sodium perborate, hydrogen peroxide, silver nitrate, boric acid, tincture of iodine, mercurochrome, mercury bichlo- ride, sulphur, sodium thiosulphate, formaldehyde, iodoform. Antispasmodics. Used for the relief of nervous irritability 244 and minor spasms. Examples: atropine sulphate, camphor, valeriana, asafetida. Antisyphilitics. Used in the treatment of syphilis. Ex- amples: arsphenamine, neoarsphenamine, tryparsamide, sulph- arsphenamine, bismuth subsalicylate, mercurial ointment, mercury salicylate, potassium iodide. Astringents. Produce shrinkage of the mucous membranes or raw tissues, decreasing the amount of exudation from them. Examples: tannic acid, silver nitrate, ferric chloride, ferric subsulfate, potassium permanganate, bismuth subcar- bonate, alum, boric acid, bismuth subgallate, resorcinol, cal- cium hydroxide. Cardiac stimulants. Used to increase the force and frequency of the heart action. Examples: digitalis, adrenalin, ephedrine, strophantin, metrazol, caffeine. Carminatives. Aid in the expulsion of gas from the stomach and intestine by increasing peristalsis, stimulating circulation, etc. Examples: anise, asafetida, capsicum, cardamon, cloves, ginger nutmeg, peppermint, pimenta, sassafras, spearmint, oil of turpentine. Cathartics. Increase or hasten the evacuation of the intes- tine. They are classified according to their power, as follows: laxatives or aperients, simple purgatives, drastic purgatives, saline purgatives, hydrogogues, cholagogues. Examples re- spectively are cascara sagrada, castor oil, croton oil, magnes- ium sulphate, resin jalap, and bile salts. Caustics. Destroy the tissue to which they are applied and produce a slough. Examples: silver nitrate, trichloroacetic acid, monochloroacetic acid, nitric acid, chromium trioxide, copper sulfate, zinc chloride, trioxymethylene. Correctives. Used to correct or render more pleasant the action of other remedies, especially purgatives. Examples; fruit extracts, soda bicarbonate, oils of anise, caraway, cloves, and peppermint. Demulcents. Allay irritation and soothe and protect the parts to which they are applied. Examples; flaxseed, acacia, tragacanth, slippery elm, marshmallow, glycyrrhiza (licorice root), almond, starch, glycerin. Deodorants. Destroy or hide foul odors. Examples: formal- dehyde, sulphur dioxide, creosote, naphthalin, lime, zinc chloride, potassium permanganate, charcoal, bromine, chlorine, phenol, blue or green vitriol. Diaphoretics. Produce increased excretion of sweat. Ex- amples: pilocarpine, eserine, muscarine, ammonium salts, picrotoxin camphor. Disinfectants. Have the power of destroying germs. Ex- amples: heat in various forms, light in various forms, phenol, alcohol 70 per cent, formaldehyde, mercuric chloride, chlorine, creosote solutions, acriflavine, metaphin, silver nitrate. Diuretics. Increase the secretion of the urine. Examples: caffeine, oil of juniper, sweet spirit of nitre. Emetics. Produce vomiting. Exampes: apomorphine and ipecac. Haemostatics. Arrest hemorrhages (usually applied to in- ternal bleeding). Examples: tannin, epinephrine, pitutitrin, chromium trioxide. MEDICAL SOLDIER’S HANDBOOK 245 Hypnotics. In the proper doses, produce sleep without narcotic or deliriant effects. Examples: phenobarbital, sulph- onal, bromides. Irritants. When applied to the skin, produce more or less vascular excitement. When employed to excite a reflex in- fluence on a part remote from the place of application they are called counter-irritants. Rubefacients, the mildest of this group, cause redness (congestion) of the skin. Vesicants or blistering agents produce decided inflammation of the skin and the accumulation of serum between the epidermis and the derma. Examples: rubefaicients—mustard,, dapsicum, camphor, ammonia, arnica, alcohol, ether, chloroform, tincture of iodine, oil of turpentine, menthol. Vesicants—cantharides, iodine, ammonia, mustard oil in alcohol, boiling water, glacial acetic acid, formic acid in water. Mydriatics. Cause dilation of the pupil. Examples; atropine sulfate, homatropine hydrobromide, cocaine, gelsemium. Myotics. Cause contraction of the pupil. Examples: eserine salicylate, pilocarpine nitrate. Narcotics. Used to depress the central nervous system. Narcotics are more powerful than soporifics and produce a more profound depression from which one cannot be aroused. If the dose is sufficient they produce coma, insensibility, and death by paralysis of the nerve centers which control organic life. Examples: morphine sulphate, codeine sulphate, chloral hydrate, opium, dilaudid hydrochloride. Nutrients. Give nourishment to the system. Examples: glucose, lactose, viosterol and other vitamin containing sub- stances, olive oil, oil of almond. Parasiticides. Destroy the various animal and vegetable parasites. Examples: mercury oxide (red), mercury bichlo- ride, ammoniated mercury ointment, mercury salicylate, sulfurous acid, betanaphthol, chrysarobin, sulphur, hydro- cyanic acid, oil of tar. Prophylactics. Prevent the taking or the development of disease. Examples: serums, vaccines, protein silver. Pulmonary sedatives. Relieve cough and dyspnoea (difficult breathing) by lessening the irritability of either the respira- tory center or the nerves of respiration. Examples: codeine sulphate, morphine sulphate, papaverine hydrochloride, paraldehyde, terpin hydrate. Purgatives. Produce free evacuation of the bowels. See cathartics. Respiratory stimulants. Intensify the function of the res- piratory center in the medulla oblongata, quickening and deepening the breathing. Examples: alpha lobelin, caffeine, atropine in large doses, metrazol, strychnine. Soporifics. Sleep producing but less powerful than narcotics. Examples: sodium bromide, potassium bromide, phenobarbital, barbital, Dover’s powder, dilaudid hydrochloride in small doses. Specifics. Have a direct curative influence on certain diseases. Examples: insulin for diabetes mellitus, thiamine hydrochloride (Vitamin Bj) for beriberi, nicotinic acid for pellagra. MEDICAL SOLDIER’S HANDBOOK 246 MEDICAL SOLDIER’S HANDBOOK Styptics. Control minor hemorrhages by local hemostasis. Examples: stypticin, alum, tannic acid, iron sulphate, zinc sulphate. Tonics. Augment gradually and permanently the strength and vital activity of the body or its organs, increasing the vigor of the entire system. Examples: iron carbonate, nux vomica, cod liver oil, quinine, rhubarb, syrup of iron iodide. Vermifuges. Cause the expulsion of intestinal worms. See anthelmintics. 310. Description of Commonly-Used Drugs. For immediate reference to some of the drugs used commonly in the Army hospital, a brief description of the source, composition, phy- sical characteristics, chemical properties, preparation and administration (average dose), and physiological and toxico- logical (poisonous) action of each of them is included in alphabetical order below. The soldier engaged in active pharmacy will have need to seek more complete description of these and other drugs as found in the United States Pharmacopoeia. Acetylsalicylic acid (aspirin), U.S.P. The acetyl derivative of salicylic acid. Preserve it in well-closed containers. Properties: It Is a white crystalline powder or colorless crystals, odorless, and stable in dry air. It is sparingly soluble in water and freely soluble in alcohol. In moist air gradually hydrollzes into acetic and salicylic acids. It is decomposed by alkalies. Action and uses: It is used extensively as an antipyretic and antirheumatic. It is an excellent headache remedy. It must be used with caution because some individuals are easily poisoned by it, due probably to an Idiosyncrasy. It should not be dispensed in solution because its aqueous solution slowly decomposes on standing Average dose: 0.3 gram or 5 grains. Alcohols. Alcohols are compounds formed by the renlacement of one or more hydrogen atoms of a paraffin hydrocarbon with an equal number of hydroxyl (OH) groups. If one hydroxyl group is substituted for one hydrogen atom in methane (CH4) an alcohol known as methanol (CHaOH) (methyl or wood alcohol) results; if one hydroxyl group is substituted for one hydrogen atom in ethane (C2H-0 an alcohol known as ethanol (C2H5OH) (ethyl or grain alcohol) Is obtained; if three hydroxyl groups are substituted for three hydrogen atoms In propane (CsHs) an alcohol known as glycerol (CaHsfOHs) (glyceric alcohol or glycerin) occurs. When acted upon by an acid they form a salt (ester) and water which is analogous to the reaction that takes place when an acid acts on a base (hydroxide). They have a neutral reaction to litmus if pure. Ammonia water, stronger U.S.P. An aqueous solution of ammonia (NHs) containing not less than 27 per cent nor more than 29 per cent by weight of NHs. This solution deteriorates rapidly in open containers. Preserve it in a cool place in glass-stoppered or rubber- stoppered bottles made of hard glass, free from lead. Great caution should be used in handling this liquid because of its caustic and irritating properties, and it must never be tasted or smelled unless greatly diluted. Properties: It has an excessively pungent, characteristic odor and a caustic and alkaline taste. In its chemical properties it closely resembles the solutions of potassium or sodium hydroxide, being a strong, caustic alkali. If kept in a warm place, ammonia (NHs) is liberated and held in the upper part of the bottle; there- fore, great care should be exercised in opening the bottle to see if the stopper has been secure and has not allowed the gas to escape. There is danger of the sudden escape of a large amount of gas, which might cause injury to the eyes or mucous membranes of the nose and throat by inhalation. Preparation: Ammonia is a by-product in the manufacture of illuminating gas. When coal Is subjected to destructive distilla- tion, ammonia is one of the products formed. The gases formed are nassed through an acid solution (sulfuric or hydrochloric) and an ammonium salt Is formed (ammonium sulfate or chloride, ac- MEDICAL SOLDIER’S HANDBOOK 247 cording to the acid used). This salt then is heated with lime, ammonia (NHs) is set free, and after passing it through quicklime it is passed into water until a saturated solution is formed. Action and uses: Stronger ammonia water is never given inter- nally. It is used- in making the weaker solution of ammonia, known as ammonia water. Ammonia water is an aqueous solu- tion of ammonia (NHs) containing not less than 9.0 grams nor more than 10.0 grams of NHs in each 100 cc. This solution is used in making aromatic spirit of ammonia and ammonia liniment. The antidote for ammonia water is weak acids, the same as for other alkaline hydroxides. Inhalations of ammonia gas stimulate the heart and respiratory center. Oedema of the glottis, resulting in obstructed breathing, might result in giving inhalations of con- centrated ammonia gas; therefore, care should be exercised in giving inhalations to an unconscious patient. Aromatic spirit of ammonia, U.S.P. It contains, in each 100 cc., not less than 1.7 grams and not more than 2,1 grams of total NHs; and ammonium carbonate, corresponding to riot less than 3.5 grams and not more than 4.5 grams as (NHOzCOs. (ammonium carbonate) Preserve it in glass stoppered bottles, in a cool place and protected from light. Description; A nearly colorless liquid when freshly prepared but gradually acquiring a yellow color on standing. It has the taste of ammonia and an aromatic and pungent odor. Action and uses: It is used as a reflex stimulant to prevent fainting, and to relieve nausea or sick headache caused by hyper- acidity of the gastric juice. It should be given well diluted with water. It contains from 62 to 68 per cent of alcohol. Average dose: 2 cc. or 30 minims. Arsphenamine, U.S.P. Also known as salvarsan, 606, arsenobenzol, and arsaminol. Contains not less than 30 per cent of arsenic (As). Its manufacture is under the control of the U. S. Public Health Service. Properties: A light yellow, hygroscopic powder, unstable in air, and put up in sealed ampules. Action and uses: A specific remedy for syphilis in all stages, but it is more efficient the more recent the infection; also useful in various spirillum diseases, such as relapsing fever, Vincent’s angina, etc. Average dose: 0.3 to 0.6 gram or 5 to 9 grains, administered intravenously. Atropine sulfate, U.S.P. The sulfate of the alkaloid atropine. Properties: It occurs as a white, crystalline powder or colorless crystals efflorescent in dry air. Great caution should be used In tasting it and then only in very dilute solution. It is soluble In 0.4 part of water, and 5 parts of alcohol. Action and uses: It is used in 0.5 per cent solution to dilate the pupil of the eye. Caution: It is an extremely poisonous drug. Average dose: 0.0005 gram or 1/120 grain. Barbital (diethylbarbituric acid), U.S.P. Properties; Colorless or white crystals, or a white crystalline powder, odorless, with a slightly bitter taste, and stable in the air. It is soluble in 130 parts of water, and in 14 parts of alcohol. A saturated solution in water is acid to litmus paper. Action and uses: It induces sleep and is a relatively safe hypnotic A large number of deaths have resulted from its use, due to a single overdose or continuous administrations of small doses. Average dose: 0.3 gram or 5 grains. Bismuth subcarbonate (basic bismuth carbonate), U.S.P. It is a basic salt, which, when dried to constant weight at 100° C., yields upon Ignition not less than 90 per cent of BiaOs. Protect It from the light in well-closed containers. Properties: A white or pale yellowish-white powder. It is odor- less and tasteless and is stable in the air. It is insoluble in water and in alcohol. Action and uses: It is protective, slightly antiseptic, astringent, and antacid. It is used in the treatment of hyperacidity of the stomach and in the treatment of ulcers of the stomach and in- testine. It is used in making X-ray pictures of the intestinal tract. It is less toxic than the subnitrate and may be given in larger doses with greater safety. It is used as an antiseptic and protective application in the treatment of skin diseases, old ulcers, MEDICAL SOLDIER’S HANDBOOK 248 ami suppurating wounds. Its external application to the broken skin must be watched for possible toxic symptoms due to absorp- tion of the drug. Average dose; 1 gram or 15 grains. Boric acid (boracic acid), HsBOs, U.S.P. Boric acid contains not less than 99.5 per cent of HsBOs. Preserve it in well-closed con- tainers. Properties: Colorless scales of a pearly luster, or crystals, or a white powder, slightly unctuous to the touch. It is odorless and is stable in the air. One gram is soluble in 18 cc. of water, and In 18 cc. of alcohol, and in 4 cc. of glycerin. An aqueous solution is slightly acid to litmus paper. Action and uses: Boric acid is a mild antiseptic. Externally it is used as a dusting powder either alone or with diluents such as starch or talcum. An aqueous solution containing from 2 to 4 per cent is used as an eye lotion. Boric acid solution has caused death in infants when given internally by mistake. Average dose: 0.5 gram or 8 grains. Cascara sagrada aromatic fluid extract, U.S.P. Made by extracting the active principles of cascara sagrada with boiling water. The bitter taste is removed from the cascara by maceration and percola- tion while it is mixed with magnesium oxide. It is aromatized and sweetened with purse extract of glycyrrhlza, saccharin, oil of anise, oil of coriander, and methyl salicylate. It contains from 17 to 19 per cent alcohol. Action and uses: It is preferred as a laxative over the other preparation of cascara because of its pleasant taste. Average dose: 2 cc. or 30 minims. Castor oil, U.S.P. A fixed oil obtained from the seeds of Ricinus communis. Preserve it in well-closed containers. Properties: It is a pale-yellowish or almost colorless, transparent, viscid liquid, having a faint, mild odor and a bland, afterwards slightly acrid and generally nauseating taste. It is almost in- soluble in water and is soluble in equal parts of alcohol and in one and one-half times its volume of liquid petrolatum. Action and uses: It is used extensively as a simple purgative. It increases the intestinal secretions and stimulates the peristaltic movements of the intestine. Its disagreeable taste may be dis- guised partially by administering it between a layer of peppermint water below and a layer of compound tincture of cardamon above the oil. Average dose: 15 cc. or 4 fluid drams. Codeine sulfate, U.S.P. The sulfate of the alkaloid codeine. Pre- serve it in well-closed containers, protected from light. Properties; It occurs in colorless crystals, usually needlelike, or as a white crystalline power, efflorescent in the air. It is soluble in 30 parts of water and slightly soluble in alcohol. Actions and uses: Sedation, narcotic, especially- in respiratory diseases. Average dose; 0.03 gram or V2 grain. Cod liver oil, U.S.P. The partially destearinated fixed oil ob- tained from the fresh livers of Gadus morrhua (codfish) and other species of the family Gadidoe. Cold liver oil contains in each gram at least 600 U.S.P. units of vitamin A and at least 85 U.S.P. units of vitamin D. Preserve it in a cool place in well-closed containers which have been thoroughly dried before filling. Properties: It is a thin, oily liquid, having a peculiar, slightly fishy, but not rancid odor, and a fishy taste. It is almost insoluble in water but is slightly soluble in alcohol. Preparation: The oil is obtained from the fresh fish livers by boiling them with water and skimming off the separated oil. Action and uses: It is used as a tonic in the treatment of wast- ing diseases. The ease with which it is assimilated makes it an excellent food. Its beneficial effects are due principally to the presence of large amounts of vitamin A and vitamin D. Cod liver oil is also used as a local application to promote healing of burns on the body. Average dose: 10 cc. or 2l/2 fluid drams. Digitalis (foxglove), U.S.P. The dried leaf of Digitalis purpurea. The potency of digitalis shall be such that 0.1 gram of it, when assayed as directed, shall possess an activity equivalent to not MEDICAL SOLDIER’S HANDBOOK 249 less than 1 U.S.P. digitalis unit. One United States Pharmacopoelal Digitalis Unit is Identical in potency with the International Digitalis Unit, as adopted in 1928 by the Permanent Commission on Biological Standardization of the Health Organization of the League of Nations. One International Digitalis Unit represents the activity of 0.1 gram of the “International Standard Digitalis Powder.” Digitalis contains a number of glucoeldes, those of the greatest Importance being dlgitalln, digltonin, digitalein, and digitoxin. There are many proprietary preparations of digitalis on the market, but the U.S.P. recognizes only two, powdered digitalis and tincture of digitalis. Tincture of digitalis is on the Supply Table. The potency of powdered digitalis is the same as digitalis; when digitalis is prescribed, powdered digitalis should be dispensed. Digitalis should be stored in waterproof and airtight containers and be protected from light. Action and uses: It is used as a cardiac tonic and stimulant, slowing and strengthening the heart beat. Digitalis is cumulative in the system. Evidence of accumulation is shown by headache, giddiness, sickness, and a marked slowing of the pulse. The active principles of digitalis are irritating to the gastric mucous membranes and may cause nausea and vomiting. In case of mild poisoning or overdosing administer atropine sulfate hypodermically. The diuretic effect of digitalis is due to improved circulation. Average dose; 0.1 gram or IV2 grains. Ephedrine, U.S.P. An alkaloid obtained from Ephedra equisetina. Ephedra sinica, and other species of Ephedra. It was first ob- tained from a Chinese herb. It is closely related to epinephrine structurally but is more stable. Properties: An unctuous, almost colorless solid, or white to colorless crystals or granules. It is soluble in water, in alcohol, in chloroform, in ether, and in liquid petrolatum, the latter being turbid if the ephedrine is not dry. Solutions of ephedrine are strongly alkaline to moistened red litmus paper. Action and uses; Ephedrine produces effects similar to those produced by epinephrine (adrenalin). It increases blood pressure and causes dilation of the bronchi and of the pupils of the eyes. It is used for shrinking congested nasal mucous membranes in rhinitis and sinusitis. It is also given in the treatment of asthma and hay fever. It may be given by mouth, hypodermically, or intramuscularly. The base (ephedrine) is used in ephedrine oil inhalant (usually 1 to 3 per cent in liquid petrolatum). The hydrochloride and sulfate are used in water solution. The sulfate is used in ephedrine jelly and in ephedrln6 syrup. The salts are not soluble in liquid petrolatum and cannot be used in the prepara- tion of the oil inhalants. Average dose; 0.025 gram or % grain. Ethers. Ethers may be defined as oxides of hydrocarbon radicals. There are simple ethers and mixed ethers. Simple ethers are formed by the union of two like hydrocarbon radicals with one oxygen atom; compound ethers are formed by the union of two unlike hydrocarbon radicals with one oxygen atom. Ethers in organic chemistry are analogous to oxides in Inorganic chemistry. The term often is applied erroneously to esters. It should be understood clearly that ethers and esters are two different and distinct classes of organic compounds. Ethers are organic oxides, while esters are organic salts. Glucose (syrupy glucose, liquid glucose, corn syrup), U.S.P. A product obtained by the incomplete hydrolysis of starch. The syrupy glucose obtained by one process of manufacture consists of 30 to 40 per cent of dextrose, 30 to 40 per cent of dextrin, and small amounts of other carbohydrates, notably maltose, and water. Properties: A colorless or yellowish, thick, syrupy liquid, odor- less or nearly so, and having a sweet taste. It is soluble in water but only sparingly soluble in alcohol. It is the principal source of dextrose, U.S.P. The term “glucose” is frequently applied in- correctly to dextrose but should never be used when reference to dextrose is intended. Action and uses: Glucose is given per rectum as a food when feeding by stomach is impossible, and it may be used to combat various types of shock. In pharmacy it is used as a diluent in pllular extracts and has replaced glycerin in the commercial manu- facture of many pharmaceutical preparations. If the U.S.P. prep- Med. Sol. Hb. MEDICAL SOLDIER’S HANDBOOK 250 aration of glucose is not available, ordinary commercial corn syrup is a satisfactory substitute. Glucose should not be given intravenously, intramuscularly, or intra-abdominally, as it contains substances not suitable for In- troduction into the body in those ways. It should not be used if dextrose is obtainable. Hydrochloric acid, HC1, U.S.P. An aqueous solution containing not less than 35 per cent nor more than 37 per cent of HC1. Pre- serve it in glass-stoppered bottles. It should be noted that about 64 per cent of the liquid is water and only 36 per cent (by weight) is hydrochloric acid (gas). Absolute HC1 is a gas, and this prep- aration is a solution of HC1 gas in water. Preparation: It is made by acting on sodium chloride (common salt) with sulfuric acid. Neoarsphenamine (neosalvarsan), U.S.P. The name applied to a mixture, sodiumdiamlnodlhydroxyarsenobenzenemethanolsulfoxylate with inert, inorganic salts. It contains not less than 19 nor more than 22 per cent of arsenic (As) and complies with the require- ments of the National Institute of Health, U. S. Public Health Service. Preserve it in sealed tubes of colorless glass, from which the air has been excluded either by the production of a vacuum or hy displacment with a nonoxidizing gas, in a cool place, prefer- ably not above 10° C. Properties: A yellow powder, unstable in air. Action and uses: Essentially the same as those of arsphenamlne, although many observers claim better results. It differs from arsphenamlne in that it dissolves readily in sterile water, making a neutral solution which can at once be injected. Water not warmer than from 20° to 22° C. (68° to 71.6° F) should be used in dissolving the drug, and the injections should be made at once, as it oxidizes rapidly and becomes toxic. The solution should not be shaken, and it must not be administered subcutaneously. Average dose: 0.6 to 0.9 gram or 9 to 14 grains. Camphorated tincture of opium (paregoric), U.S.P. It is made of 40 cc. of tincture of opium, 4 cc. of oil of anise, 4 gm. of benzoic acid, and 4 gm. of camphor dissolved in 900 cc. of diluted alcohol to which 40 cc. of glycerin and sufficient diluted alcohol are added to make the finished product measure 1000 cc. It is the weakest and one of the most used of the opium preparations and yields, from each 100 cc., not less than 0.035 gram and not more than 0.045 gram of anhydrous morphine. Action and uses: It possesses analgesic and carminative proper- ties. It is one of the ingredients in Brown’s Mixture (checks cough). It is used to relieve abdominal pain due to flatus (gas in the intestine), to check diarrhoea, etc. Average dose: 4 cc. or 1 fluid dram. Petrolatum (petroleum jelly), U.S.P. A purified mixture of semi- solid hydrocarbons, obtained from petroleum. Properties: It is an unctuous mass, yellowish to light amber in color, transparent in thin layers, and free from odor and taste. It is insoluble in water, almost insoluble in alcohol, soluble in ether, chloroform, oil of turpentine, benzine, or in most fixed or volatile oils. It melts between 38° and 54° C. Chemically It is very stable and does not turn rancid like vegetable oils and animal fats. It remains unchanged when brought in contact with strong acids or alkalies. Preparation; It is an intermediate product in the distillation of crude petroleum. It comprises a part of the residue left after distillation of the lighter substances. Action and uses: It is used as a bland, neutral, protective dress- ing and as a base for ointments. The absorption and rapidity of action of drugs are retarded when incorporated with petrolatum; therefore, it should not be used alone as an ointment base when absorption of a drug is desired. Given internally it is not absorbed from the Intestinal tract; it acts as a lubricant and may be used in gastrointestinal irritation. White petrolatum, U.S.P., is petrolatum that has been decolorized. Phenobarbital (luminal), U.S.P. This compound Is closely re- lated chemically to barbital in that it represents barbital with an ethyl group replaced by a phenyl group. Properties: White, glistening, small crystals or a white crystal- line powder, odorless, and stable in the air. It Is soluble in 1000 parts of water, and In 8 parts of alcohol. A saturated aqueous solution is acid to litmus paper. Action and uses: It is used as a sedative and hypnotic. The action is similar to that of barbital but more powerful. It is poisonous in large doses. Average dose: 0.03 gram or V2 grain. Phenol (carbolic acid), C H:.OH, U.S.P. It is obtained from coal tar or made synthetically. It contains not less than 98 per cent of CeHsOH. Preserve it in well-closed containers, protected from light. Properties: It occurs as colorless, Interlaced or separate needle- shaped crystals, or as a white, crystalline mass, sometimes acquir- ing a red tint, having a characteristic, somewhat aromatic odor. When undiluted It cauterizes and whitens the skin and mucous membrane. It Is soluble In 15 parts of water; soluble in alcohol, glycerin, chloroform, ether, and in fixed or volatile oils. When heated It melts, forming a highly refractive liquid. It also is liquified by the addition of about 8 per cent of water. Preparation: It Is obtained from coal tar by fractional distilla- tion and subsequent purification. It also is made synthetically. Action and uses: Liquified phenol is used as: antiseptic, germ- icide. disinfectant, caustic or local anesthetic. Potassium permanganate, KMnCb, U.S.P. It contains, when dried to constant weight in a desiccator over sulfuric acid, not less than 99 per cent of KMnO*. Preserve it in glass-stoppered bottles. Potassium permanganate when in solution or in the dry condition must not be brought into contact with organic or other readily oxldlzable substances, as dangerous explosions are liable to occur. Properties: It occurs as slender prisms, of a dark purple color, odorless and having a disagreeable astringent taste. It Is stable In the air. It Is soluble in 14.2 parts of water. An alcoholic solu- tion cannot be made because It is decomposed by alcohol. It is a powerful oxidizing agent, two molecules In acid solution yielding five atoms of oxygen. When it comes in contact with organic matter it is decomposed with the liberation of oxygen. This prop- erty makes it a valuable antiseptic and disinfectant. Preparation: It may be made bv fusing together a mixture of potassium hydroxide, manganese dioxide, and potassium chlorate, forming potassium manganate. When the potassium manganate Is boiled with water, potassium permanganate is formed. Action and uses: It is used as an antiseptic astringent irrigating fluid, especially for the urethra and bladder, in strengths of from 1-4000 to 1-10.000, It seldom Is used externally, largely on account of the objectionable stain which It leaves. A 5 per cent solution is used in the treatment of poisoning bv venomous snakes bv injection into the wound. It also is used in the treatment of morphine poisoning. It has been used w'th formaldehyde solut'on to volatilize formaldehyde gas in disinfection of rooms, but it has been displaced for this purpose by barium dioxide, a cheaper sub- stance. Average dose: 0.06 gram or 1 grain. Insulin, N. N. R. (new and nonofficial remedies). An aqueous solution of an active principle from the pancreas which affects sugar metabolism. The strength of Insulin Is expressed In “units.” The unit Is equivalent to 0.125 milligrams of the International Standard Preparation of Dry Insulin Hydrochloride prepared by the Medical Council of Great Britain. One milligram of this standard preparation contains 8 insulin units, as provisionally defined by the Insulin Commission of the University of Toronto, Canada. Action and uses: It Is used in the treatment of diabetes. If a suitable dose of insulin Is administered at suitable Intervals to a person suffering from diabetes melUtus. the blood sugar is main- tained at or near a normal level and the urine remains free from sugar. In case of overdosing with insulin the patient complains of weakness and fatigue and a feeling of nervousness and tre- mulousness, followed by profuse sweating. This condition Is re- lieved by giving orange Juice by mouth, or dextrose Intravenously if the patient Is comatose. Insulin is administered by injection into the loose subcutaneous tissue of the body about 30 minutes before meals. There Is no average dose for insulin; each case must be studied individually. The dose of insu’ln should always be ex- pressed In units rather than by cubic centimeters. MEDICAL SOLDIER’S HANDBOOK 251 252 Iodine, I, U.S.P. Iodine contains not less than 99.5 per cent of I. Preserve iodine in glass bottles closed with stoppers resistant to corrosion, and in a cool place, protected from light. Properties: Heavy, grayish-black, brittle plates, having a metallic luster and a characteristic odor. One gram is jsolub e in 2950 cc. of water, in 12.5 cc. of alcohol, in 80 cc. of glycerin, and in 4 cc. of carbon disulfide. It is freely soluble in chloroform, in carbon tetrachloride, and in ether, and is dissolved by aqueous solutions of iodides. Iodine unites actively with iron and other metals. In weighing iodine use a bone or rubber spatula, and paraffined paper on the scale pans. With starch paste, iodine gives a deep blue color. Iodine stains may be removed from linen by the application of a solution of sodium thiosulfate. Source; Iodine is now obtained principally from the mother liquors obtained in the purification of crude Chili saltpeter (sodium nitrate). Some iodine is obtained from the ashes obtained by burning seaweeds. A new source of iodine is the brine issuing from the oil in petroleum oilwells. In Chili saltpeter, iodine oc- curs as sodium lodate mixed with sodium nitrate. Action and uses: See tinctures of iodine. The antidote is starch paste. Average dose: 0.01 gram or 1/6 grain. Lard, U.S.P. The purified internal fat of the abdomen of the hog. Preserve it in a cool place in well-closed containers which are impervious to fat. Adeps benzoinatus (benzolnated lard), U.S.P., is a lard that has been treated with Siam benzoin to prevent It from turning rancid. In the preparation of benzolnated lard for use in warm climates the Pharmacopoeia states that 50 grams of white wax (or more if necessary) may replace an equal amount of the lard in order to raise its melting point. Supply Table lard contains 12 per cent of white wax. Properties: Lard is a soft, unctuous mass having a faint odor and a bland taste, and free from rancidity. It melts between 36° and 42° C., is insoluble in water, slightly soluble in alcohol, and readily soluble in ether, chloroform, and petroleum benzine. Action and uses: Benzolnated lard Is used principally as an ointment base. Magnesium sulfate (epsom salts), MgSOi, U.S.P. It contains, when rendered anhydrous by ignition, not less than 99.5 per cent of MgSCU. It contains not less than 45 per cent and not more than 52 per cent of water. Preserve it in well-closed containers. Properties: It occurs as small, colorless needle-Lke prisms, with- out odor, and having a cooling, saline, and bitter Taste. It is soluble In 0.8 part of water, almost Insoluble in alcohol, and Is slowly efflorescent in warm, dry air. Preparation: One of the methods of making magnesium sulfate is by the action of sulfuric acid on magnesium carbonate (mineral magnesite). Action and uses: It is an extensively used saline cathartic. It should be given before breakfast in a saturated aqueous so1utlon. It acts both by preventing absorption of fluid from the bowel and by drawing more fluid from the blood into the intestine. Applied externally in saturated solution on lint to swol’en joints in acute arthritis, to swollen testicles in orchitis, and to bolls, it relieves pain and congestion by extracting fluid from these parts. It is the chemical antidote for poisoning by lead acetate, producing an insoluble lead sulfate, and is also used in ph°nol po'soning. Magnesium sulfate can be made more pleasant to take by mixing it with sodium bicarbonate, citric acid, and tartaric acid. This mixture is known as Effervescent Salt of Magnesium Sulfate. N. F. (National Formulary). Average dose: 15 grams or 4 drams. Morphine sulfate, U.S.P. The sulfate of the alka’oid morphine. Preserve it In well-closed containers, protected from light. Properties: It occurs In white, featherv. sllkv crystals, or cubical masses of crystals, or a white crystalline powder, odorless, and permanent in the air. It Is soluble in 15.5 parts of water and In 565 parts of alcohol. Action and uses: It Is a powerful narcot'c. It is depressant to the central nervous system, relieves p'dn, produces sleep, and tends to cause constipation. It Is a dangerous habit-forming drug and should never be prescribed In repeated doses except by a MEDICAL SOLDIER’S HANDBOOK MEDICAL SOLDIER’S HANDBOOK 253 doctor. In case of acute poisoning by morphine, wash out the stomach with potassium permanganate solution and give stimu- lants. Average dose: 0.008 gram or Vs grain. Quinine sulfate, U.S.P. The sulfate of the alkaloid quinine. Pre- serve it in well-closed containers, protected from light. Properties: It occurs in white, fine, needle-like crystals, usually iusterless, making a light and easily compressible mass; odorless and having a persistent, bitter taste. It is soluble in 810 parts of water and in 120 parts of alcohol. It is freely* soluble in water to which has been added a small amount of diluted hydrochloric or sulfuric acid. Action and uses: It is antimalarial, antipyretic, and a bitter tonic. It is used principally in the treatment of malaria for which it is specific. It should be noted that quinine' sulfate is practically insoluble in water. If an aqueous solution is desired, it may be made by adding to the quinine sulfate mixed with the water in a graduate, diluted sulfuric or hydrochloric acid drop by drop until a solution is produced. An acid salt is formed in solution which is soluble in water. Average dose: Tonic, 0.1 gram or IV2 grains; antimalarial, at least 1 gram or 15 grains daily. Santonin, U.S.P. The inner anhydride of santoninic acid, ob- tained from several species of Artemisia. Preserve it in well-closed containers, protected from light. Properties; It occurs in colorless crystals, usually tubular, or as a white, crystalline powder; odorless and nearly tasteless at first but afterwards developing a bitter taste; stable in the air but becoming yellow on exposure to light. It is slightly soluble in water and soluble in 43 parts of alcohol. Action and uses: It is used principally as an anthelmintic for the removal of Ascaris lumbricoides ground worms) from the in- testine. It makes objects appear to the patient as if viewed through a yellow glass (xanthopsia). Average dose: 0.06 gram or 1 grain. (It is on the Supply Table in one-half grain tablets.) Silver nitrate, AgNOs U.S.P. It contains, when powdered and dried to constant weight in a desiccator over sulfuric acid, in the dark, not less than 99.8 per cent of AgNO. Preserve it in dark amber-colored, glass-stoppered vials, protected from light. Properties: Occurs in colorless, transparent, tubular, rhombic crystals, becoming gray or grayish black on exposure to light or in the presence of organic matter; odorless, and having a bitter, caustic, and strongly metallic taste. Soluble in 0.4 part of water and in 30 parts of alcohol. An aqueous solution is clear, colorless, and neutral to litmus paper. Preparation: It is made by dissolving silver in nitric acid with the aid of heat. Action and uses: Solutions of silver n’trate should be made with distilled water. Weak solutions are astringent and antiseptic to mucous membranes, and strong solutions are caustic. The mucous membrane should always be cleaned before applying solu- tions of silver nitrate. A 1 per cent solut on is Instilled Into the eyes of the newborn Immediately after delivery to prevent gonor- rheal conjunctivitis. The action of silver nitrate c?n be immedi- ately stopped by the application of sodium chloride (salt) solu- tion, and this is. often done when it is desired to limit the action of local application to the eye or throat. Silver nitrate forms on tissue a dei\se film of coagulated albumin. This film prevents deeper action of the silver nitrate. The film is at first white but soon becomes black, due to the reduction of the silver A 4 per cent solution Is used for application to the mucous membrane of the throat, mouth, or nose. Average dose: 0.01 gram or 1/6 grain. Sodium bicarbonate (bicarbonate of soda, baking soda), NaHCOa. U.S.P. It contains, when dried to constant weight in a desiccator over sulfuric acid, not less than 99 per cent of NaHCOs. Preserve it in well-closed containers in a cool place. Properties: It is a white, crystalline powder, odorless and having a cooling, mildly alkaline taste. It is stable in dry air but slowly decomposes in moist air. When its aqueous solution is heated. 254 even mildly, it loses carbon dioxide and is converted into sodium carbonate. It is fhirly soluble in water and is insoluble in alcohol. Its aqueous solution is alkaline to litmus, and the alkalinity in- creases as the solution stands, or as it is agitated or heated. When treated with acids it effervesces (the same thing occurs when any carbonate is treated with an acid). Preparation: It is made by the Solvay process (ammonia soda process). A concentrated solution of sodium chloride is mixed with ammonia water; carbon dioxide under pressure is forced into this mixture, resulting in the formation of sodium b'carbonate and ammonium chloride. Sodium bicarbonate is precipitated (being less soluble), and the ammonium chloride remains in solution. This process also may be used in making sodium carbonate. Alter making the bicarbonate this may be heated, driving off carbon dioxide and water, leaving behind sod um carbonate. Action and uses: A valuable and popular antacid. It is given frequently for hyperacidity of the stomach (heartburn), but it must be remembered that while it neutralizes the acid contained in the stomach it also causes increased secretion of more acid and may defeat the purpose for which it is given if administered over a long period. When used for heartburn it usua.ly is combined with ammonium carbonate and oil of peppermint and given in tablet form (soda-mint tablets). It is used externally in saturated aqueous) solution for the treatment of burns and poisoning by poison ivy. It may be used in the preparation of other compounds of sodium. It is the principal ingredient in baking powder. In making bread this substance, when acted upon by either alum or cream of tartar, liberates carbon dioxide, which becomes entangled in the dough and causes it to rise. The term “soda” often is applied to this compound, taut “soda” is an incorrect te”m and might mean sodium carbonate or caustic soda. A solution for Intravenous sodium bicarbonate should be colorless with phenolph- thalien. Average dose: 1 gram or 15 grains. Sodium perborate, U.S.P. It contains not less than 9 per cent of available oxygen, corresponding to about 86.5 per cent of NaBOs 4H2O. Preserve it in well-closed containers. Properties: It occurs as white, crystalline granules or as a white powder. It is odorless and has a saline taste. It is stable in cool, dry air but is decomposed with the evolution of oxygen in warm or in moist air. One gram is soluble in 40 cc. of water. In acqueous solution sodium perborate is decomposed into sodium metaborate and hydrogen peroxide, the solution gradually evolving oxygen. Oxygen is evolved more rapidly if the solution is warm. A saturated aqueous solution is alkaline to litmus naper. Action and uses: It is used as a cleansing mouth antiseptic. It is used in tooth pastes, tooth powders, and mouth washes. Solutions of sodium perborate should be prepared fresh as they easily decompose on standing. Average dose; 0.06 gram or 1 grain. Sublimed sulfur (flowers of sulfur), S, U.S.P. It contains 99.5 per cent S. Properties: A fine, yellow, crystalline powder having a faint odor and taste. It is insoluble in water and nearly insoluble in alcohol. It is soluble in carbon disulfide, ether, and in olive oil. It burns in air to form sulfur dioxide gas. Action and uses: Sublimed sulfur is not given internally. It is used in the preparation of washed sulfur. Sulfanilamide, U.S.P. (aminobenzenesulfonamide). White, odor- less crystals or crystalline powder soluble in water, alcohol, gly- cerin, or hydrochloric acid; insoluble in ether, chloroform, or ben- zene. Renders blood, spinal fluids, urine, and other tissue fluids unfavorable as mediums for supporting the active multiplication of susceptible bacteria. Uses: It is used extensively for infections produced by certain strains of hemolytic streptococci, meningococcic infections, gono- coccic infections, and certain urinary infections. Average dose: 3 grams or 45 grains. Sulfapyridine (2—sulfanilylamlnopyridine). White, odorless, prac- tically tasteless crystals or crystalline powder, soluble in water, alcohol. MEDICAL SOLDIER’S HANDBOOK Actions and uses: Antipneumococcic and antigonococcic. Used in pneumococcic pneumonia and other pneumococclc Infections, and gonorrhea Average dose: 5 grams or 75 grains. Sulfathiazole. A white, crystalline powder, soluble in water and alcohol. Saturated aqueous solution has pH of 6.0. Uses; Certain staphylococcic infections, pneumococcic pneu- monia, and gonococcic Infections. Average dose: 4 grams or 60 grains. Tannic acid (tannin, gallotannic acid), U.S.P. A tannin usually obtained from nutgall. Preserve it in well-closed containers in a cool place, protected from light. Properties: It is a yellowish-white to light brown, amorphous powder, glistening scales, or spongy masses, nearly odorless, and having a strong astringent taste. It is soluble in 1 part of glycerin and is very soluble in water or alcohol. Action and uses: It Is an astringent, and haemostatic. It is used in the form of an ointment for the treatment of haemorrhoids and in an aqueous solution as an astringent mouth wash and gargle. It is an alkaloidal precipitant and may be used as a chemi- cal antidote in certain cases of alkaloidal poisoning. It is used extensively in the treatment of burns in the form of an aqueous solution or a jelly. It acts as an astringent, hinders the growth of bacteria, and “tans” the tissues in the burned areas, forming a crust over them which prevents the escape of fluids from the body. Tincture of ferric chloride (tincture of iron), U.S.P. A hydro- alcoholic solution containing, in each 100 cc„ about 13 per cent of ferric chloride (FeCls), corresponding to not less than 4.5 per cent of Fe. Protect tincture of ferric chloride from light and keep it in a cool place, in glass-stoppered bottles. Properties: A bright, amber-colored liquid, having a slightly ethereal odor, a very astringent, styptic taste, and an acid reaction Preparation: It is made by diluting 350 cc. of solution of ferric chloride with sufficient alcohol to make 1000 cc. Action and uses; It should be administered well diluted with water and taken through a glass tube. The mouth should be thoroughly rinsed to avoid injury to the teeth. It is a valuable chalybeate (iron) tonic and styptic. It also has slight diuretic properties. It is used in making solution of iron and ammonium acetate (Basham’s Mixture), N. F. (National Formulary). Average dose: 0.5 to 2 cc. or 8 to 30 minims. Mild tincture of iodine, U.S.P. Mild tincture of iodine contains, in each 100 cc., not less than 1.8 grams and not more than 2.2 grams of I and not less than 2.1 grams nor more than 2.5 grams of Nal (sodium iodide) dissolved in 50 per cent alcohol. Preserve it in the same manner as tincture of iodine. Action and uses: This weak tincture is actively antiseptic and when applied to the abraded surface is not so painful as the strong tincture. The presence of iodides in both the strong and the weak tinctures improves their stability and Increases their pene- trability. With acetone iodine it forms an Irritating compound. A solution containing 1 cc. of mild tincture of iodine to 100 cc. of 70 per cent alcohol is used as a local application in the treat- ment of trichophytosis (athlete’s foot). Tincture of iodine, U.S.P. An alcoholic solution of iodine and potassium iodide. One hundred cc. contains not less than 6.5 grams nor more than 7.5 grams of I, and not less than 4.5 grams nor more than 5.5 grams of KI. Preserve it in glass bottles, closed with stoppers resistant to corrosion, and in a cool place, protected from light. Preparation: See U.S.P. Action and uses: It is applied externally as a counter-irritant, disinfectant, and parasiticide. It may be applied to any part of the body externally except the eye. An alcoholic solution (half strength) containing equal parts of the tincture and alcohol is employed in the disinfection of the skin before operations. It penetrates Into the pores and acts as a powerful germicide. It should never be painted over a surface that previously has been washed with bichloride of mercury solution because in the presence of the bichloride new compounds are formed which are intensely MEDICAL SOLDIER’S HANDBOOK 255 MEDICAL SOLDIER’S HANDBOOK 256 irritating, especially under a dressing, and blistering of the skin is liable to occur. To get the best germicidal results from tincture of iodine, it should not be applied to a surface wet with water Internally, tincture of iodine is used as an alterative. It acts as an irritating poison in large doses. The antidote is starch paste or starchy foods, such as bread and mashed potatoes. Iodine stains can be removed from linen with a solution of sodium thiosulfate. Averts© closoi 0.1 cc. or minims (7 REGTLHQ SEC (b) l£ UNIT £ MED SUP SEC 2 9 RE6TLM REP SEC I 10 UNIT SUP GP 1(d) 5 MED SUP GP 1(6) A (a) Regt’l hq. C O (also div surg). Ex O. S-3. Adj. Asst S-3. (b) For duty with regt’l hq. (c) Unit sup O, Med O and Regt’l S-4. (d) Asst unit sup officer. (e) Asst med sup officer. Fig. 112. Functional Organization of the Headquarters and Head- quarters and Service Company, Medical Regiment. T/O 8-22, Nov 1, 1940. (c) Headquarters and service company. This is the administrative and supply unit of the regiment. It com- prises: 1. The enlisted overhead for the regimental and three battalion headquarters; 2. The organization for the general and medical sup- ply of the regiment; 3. The organization for the medical supply of the en- tire division; MED BN (a) 34- 4-76 DIV SUHG OFFICE MED INSP DIV DENT OFFICER DIV VET OFFICE EX «J BN HQ. A- HQDIT 3 AS CO A (COLL) 5 101 CO D (COLL) 5 101 CO c (CO Li) 5 101 CO D (CLRj 12 128 (a) One medical battalion per infantry division, “triangular.” One medical battalion per type corps. Division surgeon commands medical battalion in infantry division. Division surgeon’s office replaced by corps surgeon’s office when serving as corps medical battalion. Figure 113. Functional Organization of the Medical Battalion, Infantry Division, Triangular. T/O 8-65, Oct. 1, 1940. HQDET (MED BN) _7 45 ON HQ SEC (3) 4L3 DET HQ Kb) U UNIT fy MED SUP SEC HO U M-MAINT SEC I 7 UN IT SUP GP MED SUP G»P (a) Bn hq. i———« C O (Also div surg). Ex O. S-3. AdJ. (b) Unit sup O, Med sup O and Bn S-4. (c) Asst unit sup O and Asst med sup O. Figure 114. Functional Organization of the Headquarters Detachment, Medical Battalion, Infantry Division, Trian- gular. T/O 8-66, Oct. 1, 1940. MEDICAL SOLDIER’S HANDBOOK foiv SURG OFFIC? 4 DIVSURG I MED IN5P I I DIV DENTO , DIV VET 1 I OFFICE EX | L? 8J 287 MED SQ. (CAV DIV) (£1) 24- 328 sq NQ A HQDET 2 34- COLLTR 7 137 CLR.TR. 7 93 VET TR. A QA Division surgeon commands medical squadron, (a) One medical squadron per cavalry division Figure 115. Functional Organization of the Medical Squadron Cavalry Division. T/O 8-85, Nov. 1. 1940. MQfrHQDET (MED SQJ 6 34 SQ HQ (3) 4. SQ HQ DET lb) 10^ DET MQ ICO 12 SUPSEC 1(d) 8 MAI NT SEC 4- UNIT SUP GP MEDSUP GP (a) Sq hq. C O (Also div surg). Ex O and S-3. Ch. Adj. (b) For duty with sq hq. (c) Unit sup O, med sup O and sq. S-4. (d) Asst unit sup O and asst med sup O Figure 116. Functional Organization of the Headquarters and Headquarters Detachment, Medical Squadron. T/O 8-86, Nov. 1, 1940. 288 MEDICAL SOLDIER’S HANDBOOK 4. The regimental motor repair section. It has no functions directly connected with the care or evacu- ation of casualties. (d) First battalion. The first battalion is composed of a headquarters and three collecting companies. 1. The headquarters consists of the battalion com- mander and one commissioned assistant; the enlisted force for the battalion headquarters is furnished by the head- quarters and service company. For further details, see T/O 8-25. 2. Collecting company. The three collecting com- panies are designated A, B, and C, respectively. Each con- sists of a company headquarters and three platoons. The first platoon comprises a collecting station section and a liaison section; the second and third platoons are litter bearer platoons. (e) Second battalion. The second battalion is composed of a headquarters and three motor ambulance companies. 1. The headquarters is organized like that of the first battalion ((d) above). For further details, see T/O 8-35. 2. Motor ambulance company. The three companies of this battalion are designated D, E, and F, respectively. Each consists of a company headquarters and two platoons of motor ambulances. (/) Third battalion. The third battalion is composed of a headquarters and three clearing companies. 1. The headquarters is organized like that of the First Battalion ((d) above). For further details, see T/O 8-45. 2. Clearing company. The three companies of this battalion are designated G, H, and I, respectively. Each consists of a company headquarters and three platoons. The first platoon is the technical platoon, the second is the ward platoon, and the third is the transportation platoon. (2) Medical battalion (triangular division). The organi- zations of the medical battalion of a triangular division com- prise a headquarters, detachment medical battalion, three collecting companies, and one clearing company. For further details, see T/O 8-65. (a) Headquarters detachment, medical battalion. The headquarters detachment is made up of the following sections; 1. Battalion headquarters section. 2. Detachment headquarters. 3. General and medical supply sections. 4. Motor maintenance section. (b) Collecting companies. The medical battalion has three collecting companies. Each consists of a company head- quarters, a collecting station platoon, and a collecting pla- toon. The collecting platoon is subdivided into bearer and ambulance sections. The bearer section consists of a pla- toon headquarters, which includes the liaison agents, and three bearer sections. Each ambulance section is furnished twelve ambulances. (c) Clearing company. The clearing company consists of a company headquarters and two clearing platoons. (3) Medical squadron. The medical squadron of a cavalry division consists of a headquarters, a headquarters and serv- ice detachment, a collecting troop, a clearing troop, and a veterinary troop. For details, see T/O 8-85. (a) Headquarters. The headquarters consists of the squadron commander, who is also the division surgeon, and his staff. Enlisted personnel are furnished by the headquarters and service detachment. (b) Headquarters detachment. This detachment consists of three sections: a headquarters section which furnishes the enlisted overhead for the squadron headquarters, a general and medical supply section, and a motor maintenance sec- tion. (c) Collecting troop. The collecting troop consists of a headquarters and two collecting platoons. Each platoon is organized into a collecting station section, a bearer section, and an ambulance section. (d) Clearing troop. The clearing troop consists of a headquarters and two clearing platoons. Each clearing pla- toon is organized into a technical section, a ward section, and a transportation section. (e) Veterinary troop. The veterinary troop consists of a headquarters, a clearing platoon, and two collecting pla- toons. (4) Medical battalion, armored division. The medical bat- talion of an armored division consists of a headquarters, a headquarters detachment, a collecting company, and a clear- ing company. For details, see T/O 8-75. (a) Headquarters. The headquarters consists of the bat- talion commander, who is also the division surgeon, and his staff. Since the division surgeon’s office is an administrative office distinct from the medical battalion and located at di- vision headquarters, enlisted personnel therefor is provided by the armored division headquarters. (See T/O 17-1.) (b) Medical headquarters and headquarters detachment. This detachment consists of four sections; a headquarters sec- tion to furnish the enlisted overhead for the battalion head- quarters, a battalion headquarters section, a supply section, and a maintenance section. (c) Collecting company. The collecting company con- sists of a headquarters and two collecting platoons. Each pla- toon is organized into a platoon headquarters, an ambulance section, and a litter bearer section. (d) Clearing company. The clearing company consists of a headquarters and two clearing platoons. Each clearing platoon comprises a platoon headquarters, a technical sec- tion, a ward section, and a transportation section. 346. Equipment, a. Classification. The equipment of an MEDICAL SOLDIER’S HANDBOOK 289 290 MEDICAL SOLDIER’S HANDBOOK FRONT LINE REAR Boundary (Not drawn to scale. Note that one collecting company and one ambulance company is supporting each brigade combat team, and that the clearing unlt(s) is (are) supporting the entire division.) Figure 117. Schematic Representation of Medical Service of Infantry Division (Square) in Combat. organization is divided into individual equipment and or- ganizational equipment. b. Individual equipment. All officers of the Medical, Dental, and Veterinary Corps, and all enlisted men of the Medical Department, carry on their persons special equip- ment for the first aid treatment of sick and injured men or animals. This equipment is specialized to meet the needs of medical, dental, and veterinary service. Corresponding with the degrees of technical training, the individual equip- ment of officers is more elaborate than that of noncommis- sioned officers; and that of the latter is more elaborate than the individual equipment of privates. c. Organizational equipment. The equipment of an or- ganization is both general and special. The general equip- ment is that used in the general functions common to all military organizations, and the special equipment is that provided for the special functions of the unit. (1) Headquarters companies. The battalion headquarters companies and headquarters and service companies have no medical equipment. Their functions are administrative rather than concerned with the care of patients. The divi- sion medical supply sections of these companies carry a small rolling reserve of medical supplies for the entire division. The companies are equipped with motor transport and with special equipment required for its maintenance. (2) Collecting companies. The special equipment of a collecting company consists of a limited amount of tentage for the shelter of casualties; chests of instruments, medicines, dressings, blankets, and simple foods for the emergency care and treatment of the sick and injured; and litters upon which to transport those unable to walk. While this equipment is designated only for simple technical procedures, it is ample enough for the company to initiate combat and to furnish replacements of dressings to battalion aid stations in its front until the division medical supply system can be placed in operation. The company has the necessary motor vehicles to transport its equipment. (3) Ambulance companies and platoons. Ambulance units have a supply of litters, blankets, and splints solely for prop- erty exchange. They have no unit medical equipment for their own use. Their special equipment consists largely of ambulances. (4) Clearing companies and platoons. The special equip- ment of clearing units includes tentage, cots, and chests of instruments, medicines, dressings, blankets, and foods for the temporary care and emergency treatment of the sick and injured. While the medical equipment of these units is somewhat more elaborate than that of collecting units, it is sufficiently simple to be readily transportable and too limited to provide for involved technical procedures. Motor trans- port is provided for personnel and equipment. 347. Installations. When a medical unit establishes its temporary installation for combat and is ready to function, it is said to be at station. The installation is designated generi- cally as a station, and specifically by the function it performs; MEDICAL SOLDIER’S HANDBOOK 291 292 e. g,, aid station, established by sections of medical detach- ments; collecting station, ambulance station, and desiring sta- tion. A service station is established by the supply sections of the headquarters, or headquarters and service, company of the division medical unit. 348. Division Surgeon, a. General. The senior officer of the Medical Corps assigned to a division is the division sur- geon. The fact that this same officer is also the commander of the division medical unit must not be permitted to obscure the sharp distinction between his functions in the two capaci- ties. As division surgeon he is a special staff officer of the division commander, and all his duties and responsibilities are staff functions. As commander of the division medical unit, his functions are exclusively those of command. MEDICAL SOLDIER’S HANDBOOK Section II COLLECTION 349. Definitions, a. Collection is the operation of removing casualties from aid stations, or directly from the field when necessary, to a collecting station and there preparing them for further evacuation. It should be noted that this prepara- tion for further evacuation is an essential feature of collection. b. A collecting station is a complete establishment of a col- lecting unit—complete in the sense of availability of all the normal facilities of a collecting station. Certain collecting units have duplicate sets of equipment permitting them to establish two complete stations. In the latter case the per- sonnel available to operate each station is proportionately reduced. c. A collecting post is a limited establishment operated by a detachment of a collecting unit and contains the necessary elements to prepare casualties for further evacuation, but with less elaborate degree than a collecting station. 350. Collecting Units, a. Functions. A collecting unit has the following functions: (1) Combat function. The combat function of a collect- ing unit is to provide direct support of the attached medical personnel in its front. This support consists of the collection of casualties, their sorting, emergency treatment, and transfer at the collecting station or post to the ambulance unit in support. In the case of collecting units which include ambulance platoons, this transfer of responsibility is made at the clearing station. (2) Supervision of sanitation. When not confronted with actual or impending combat functions, collecting units pro- vide the personnel to assist in sanitary administration in the manner prescribed in paragraphs 5 and 6, AR 40-205. b. Functional organization. Each collecting unit is organized into a unit headquarters, collecting station section, liaison agents, and litter bearers. An ambulance subunit is included in certain collecting units. (1) Unit headquarters consists of such commissioned and enlisted personnel as are required for the command and ad- ministration of the unit as a whole. It maintains at all times a small office for the administration and maintenance of the unit including the preparation of reports, returns, requisitions, and correspondence. (2) Each collecting station section is charged with the establishment and operation of a collecting station. When at station this section is reenforced as necessary. (3) Liaison sections are charged with the establishment and maintenance of liaison (contact) with the medical de- tachments attached to combat units in the zone of action covered by the collecting unit. (4) Litter bearers carry litter cases to the collecting station from the aid station and, when necessary, from the field in rear of the battalion aid stations in their zones of action. They operate the unit’s wheeled litter carriers when- ever their use is practicable. They perform such first aid for casualties handled by them as may be necessary. 294 351. Collecting Unit Commander, a. General. The senior officer of the Medical Corps present for duty with a collecting unit commands it. Collecting units are the critical elements of the division medical service; and commanders of these units must be able, alert, resourceful, courageous, and indus- trious. MEDICAL SOLDIER’S HANDBOOK I ST bn (COLL) J7 38l_ ON HQ 2 <5 CO A (COLL) 5 125 CO B (COLL) 5 125 CO c (coll; 5 12 S 2dPLAT LITTER DEARER I AO 3d PLAT LITTER. BEARER. i (aUo CO HQ I 23 1 ST PLAT 2 22 COLLSTA SEC 2 15 LN SEC 7 I ST SEC 2d SEC (a) Same as 2d plat. Figure 118. Functional Organization of the 1st Battalion (Collecting), Medical Regiment. T/O 8-25, Nov. 1, 1940. c. Relations with other units. (1) Within the division medical service. In combat there must be close and har- monious cooperation between the collecting unit and the am- bulance unit directly supporting it. The ambulance unit, however, must adapt its operations to those of the collecting unit except that the collecting unit must establish its stations near points accessible to ambulances. (2) Without division medical service. The collecting unit must base its dispositions and operations upon those of the combat elements in its front. Normally it removes casualties from aid stations; but, when attached medical personnel for any reason have been unable to remove all wounded from the field, the collecting unit must search and clear the field. MEDICAL SOLDIER’S HANDBOOK 295 352. Message Center, a. General. The message center is the nerve center of the unit. All official messages to and from the unit pass through the message center and are made of record. It is located at the unit CP, and marked with a conspicuous sign. The message center clerk is in direct charge of operation. COLL CO ( MED ON) 5 JOI CO HQ I IG STA PIAT 2 17 BEARER. PLAT I A\ A MB PLAT (a) I 27 COLL STA SEC 2 12 2d SEC LN SEC 5 1ST SEC 1ST SEC 2d SEC (a) 12 Amb, cross country. Figure 119. Functional Organization of a Collecting Company, Medical Battalion, Triangular Division. T/O 8-67, Oct. 1, 1940. b. Equipment. The essential equipment of a unit message center consists of; (1) A small table and stool. (2) Blank delivery lists. (3) Field message blanks. (4) Carbon paper, pencils. (5) Registration stamp and ink pad. (6) Blank message center registers (W. D., S. C. Form No. 1150). (7) Flashlight, lantern. (8) Time piece. (9) Message center case (for equipment). (10) Message center directing sign. (11) A simple file for communications, delivery lists, and message center register sheets. c. Special combat functions. Message center personnel MEDICAL SOLDIER’S HANDBOOK 296 meet incoming litter bearers and walking wounded from the front, and ambulances from the rear, and ascertain by direct questions whether or not they are bearers of messages. Mes- sages for the collecting unit are retained; those for units in front or in the rear are forwarded by the proper agencies. d. Records. The records of the message center should be complete. (See FM 101-10.) 353, Locating Collecting Station, a. General. The site of a collecting station is selected from a study of the terrain, COLL TR* (MEOSQ) 7 137 TR. HQ I 19 2d PLAT (a) 3 59 1ST plat 3 59 COLLSTA SEC I 13 LITTER BEARER SEC I 20 AMBSfcC (b) I 26 (a) Same as 1st plat. (b) 12 Amb. cross country Figure 120. Functional Organization of the Collecting Troop, Medical Squadron, Cavalry Division. T/O 8-87, Nov. 1, 1940. roads, friendly and hostile troop dispositions, and the capabil- ities of the enemy. The governing element is the mission of a collecting unit: the preparation of casualties for ambulance transportation to the clearing station. Many patients arrive at a collecting station who have not been given adequate emergency treatment; but none should ever leave a collecting station with an inadequate dressing, a poorly splinted frac- ture, or lacking sufficient blankets to protect him from the weather. These functions cannot be discharged unless some degree of protection from enemy action is afforded; this con- sideration points to a site well to the rear. However, the difficulties in transporting patients on litters carried by hand, MEDICAL SOLDIER’S HANDBOOK 297 and the suffering of walking wounded, point to a site near the front. Selection of the site, then, becomes a compromise be- tween these divergent considerations. The most important factor in determining the location for a collecting station is the position of the several aid stations supported by the unit. This requires a map study or reconnaissance of the belt of terrain some 500 yards to the rear of the line of departure or the main line of resistance in order to determine the loca- tion of aid stations and a knowledge of probable or actual battalion boundaries. (See fig. 117.) The latter information frequently can be obtained in advance in the case of a pre- pared attack or a prepared defensive position. In a meeting engagement, such advance information of combat elements may not be available but usually fairly accurate deductions may be made. In such situations, it may be advisable to order the collecting unit to a position in readiness initially, from which it can be rapidly advanced to the best position after the tactical situation has developed and the aid stations have been located. b. Site requirements. (1) The station should be located so as to obtain sufficient defilade from elevations of terrain for protection from direct small arms fire and from flat trajectory artillery fire. A distance beyond the effective range of hostile artillery fire renders the station useless. Properly located buildings, particularly those of brick, concrete, or stone con- struction, should be utilized. Cellars provide protection, and in stabilized situations dugouts may be constructed. Protec- tion may also be obtained by concealment. Positions in woods or other localities which are not under direct enemy observa- tion should be sought. A location in close proximity to bridges, fords, important crossroads, ammunition distributing points, battery positions, or other points likely to draw hostile artillery fire should be avoided. (2) Every effort must be made to reduce to a minimum the distance of litter carry. The average should not be more than 1500 yards, and each 100 yards that this average dis- tance is reduced adds to the efficiency of casualty collection. A position somewhere near the center of a zone of action or sector will equalize the distances from the several aid stations and is desirable unless there are urgent reasons to the contrary. (3) The site selected must be accessible to ambulances, although the station is not necessarily accessible at all times. Demolitions, other traffic, and enemy fire may prevent am- bulances from reaching the station for varying periods, and, in extreme situations, ambulances may be able to evacuate the station only at night. (4) The site must be of sufficient size to permit systematic organization of the station and for the movement of ambu- lances and trucks. Considerable accumulations of wounded may occur for various reasons and there should be sufficient shelter and cover available while they are awaiting evacua- tion. The ground must be firm. (5) A point which intercepts the greatest number of natural lines of drift of wounded is desirable. 298 MEDICAL SOLDIER’S HANDBOOK (6) Probable areas of casualty density must be considered. (7) The collecting station should not be located so far for- ward as to become involved in minor fluctuations of the line. (8) An adequate water supply is desirable. c. Average location. The location of a collecting station will depend in each situation upon the terrain, road net, na- ture of the operation (attack, defense, etc.), and enemy capa- bilities. No fixed rule can he laid down; but the following approximations may be regarded as general guides: (1) It should rarely be nearer than 1200 yards to the front line. (2) It should rarely be farther than 3500 yards from the front line. (3) Other things being equal, it should be near the center of its zone of action in a lateral direction. (4) It should be on or near a road leading to the rear. d. Reconnaissance. (1) Depending upon the situation, the general area in which a collecting station is to be established may be prescribed by the commander of the division medical unit or by the commander of the collecting battalion; or the collecting unit may be given a mission in order to support a specified combat element, in which case the unit commander may exercise full discretion. Before the collecting unit ar- rives in the general area, a reconnaissance should be made by the unit commander, whenever possible, to select the exact location of the collecting station. (2) Upon arriving at his decision, the unit commander may send a messenger to guide the unit into position, or he may return and lead it in. In either case he should have a detailed plan for the lay-out of the station and the employ- ment of the other elements of his unit by the time it arrives at the site selected. (3) Whenever practicable, this reconnaissance is made jointly with the supporting ambulance unit commander. The views of the latter must be considered carefully, but the deci- sion rests with the collecting unit commander. 354. Establishing a Collecting Station, a. Approach march. (1) General. The advance of a collecting unit to its combat position will depend upon the nature of the operation, enemy capabilities, and the location of the unit at the time it re- ceives its mission. Intervening, ordinarily, between the unit and its combat position is the bulk of the combat troops and their trains. These must have priority of movement. Thus an early and uninterrupted advance of a collecting unit to its combat position is not always assured. However, when early entry of collecting units into combat is imperative, this source of delay should be obviated by placing them in such positions prior to combat that their subsequent movements will not interfere with combat troops. In planned operations of large units, however, several hours are allotted for reconnaissances of commanders and staffs and for other necessary prelimi- naries to combat. During this period a collecting unit usually will be able to make its preparations and advance to its posi- tion without interfering with other elements. (2) Advance into position. The personnel of a collecting unit are moved into position whenever practicable by the MEDICAL SOLDIER S HANDBOOK 299 ambulance unit designated to support. The train of the col- lecting unit follows in the column. The ambulances trans- port the collecting personnel to the site of the station, or as near thereto as the convoy may proceed in relative safety. Except when the ambulance unit is a subordinate element of the collecting unit, this movement is controlled by the am- bulance unit commander. Collecting personnel are trans- ported in ambulances both to save time and to start them off in their arduous duties in the best physical condition possible. The combat order for a collecting unit will prescribe the time of movement, the route, the ambulance unit (if any) to trans- port the personnel, entrucking, and (when known) detrucking points, the hour at which the collecting station will open, if necessary, and such other information as may be required. b. Setting up the station. (1) Organization. The station is organized into the following departments: receiving, litter wounded, walking wounded, gas cases (when indicated), rec- ords, forwarding, kitchen, and the morgue. For a diagram of the organization and layout, see figure 121. (2) Allotment of tasks, (a) General. All departments are established simultaneously. The platoon leader is in gen- eral charge; he is assisted by the platoon sergeant. (b) Kitchen. Mess sergeant, cooks, and cooks helpers. (c) Message center. Message center clerk. (d) Latrines. Truck chauffeurs may be used to dig latrines. (3) Procedure, (a) If the unit has been transported to the site by ambulances, it detrucks and forms. The packs of the men, except those in the litter platoons, are unslung and laid aside. The unit commander points out the posi- tions for the headquarters and message center, the receiving, litter wounded, walking wounded, and forwarding depart- ments of the station, the kitchen, morgue, motor park, la- trines, and direction of water point; and indicates where the liaison personnel will report to him for orders, if its mem- bers have not already reported to the regimental and bat- talion surgeons. (b) The officers and noncommissioned officers then take charge of their respective platoons, sections, and details, and establish the station. (c) The trucks are driven to points most convenient for unloading and placing equipment. (d) The litter bearers are marched to a nearby point affording some concealment and cover. Packs are unslung; and all equipment in excess of stripped packs is removed from the packs. Stripped packs with medical belts or pouches are then slung. The excess personal equipment is stacked. Lit- ters are procured and stacked. The litter bearers fall out and remain in the immediate vicinity of the stacked litters. (e) Under the immediate direction of the platoon ser- geant, the reinforced collecting station section unloads the station equipment from the trucks. The litters are unloaded first and placed to one side convenient for use by the litter bearers. This detail may pitch the tents for litter and walk- ing wounded. Each tent is then equipped by the enlisted personnel on duty therein, under the supervision of the 300 MEDICAL SOLDIER’S HANDBOOK TO FRONT PROPERTY EXCHANGE MESSAGE GENTEEL RECEIVING ❖ •SORTING (IF NECESSARY) UTTER. WALKING 'WOUNDED WOUNDED &AS SECTION LEGEND / LR - UTTER RACK S - STERILIZER. § - SPLINTS BD - BOX OF DRESSINGS SL- SHOCK UTTER. DL - DRESSED UTTER B - BLANKETS X- UTTER STACK * NO PERSONNEL FOR GAS SECTION PROVIDED BY T/O CLERK. RCCORDi OF FAT IB NTS Forwarding [ PROPERTY EXCHANGE^ AMBULANCES Figure 121. One Arrangement of Collecting Station. Arrangements Vary With Characteristics of Site. platoon sergeant. Each man arranges and prepares for im- mediate use the equipment and supplies in accordance with his duty assignment. (f) After they are unloaded, the platoon sergeant directs the distribution of blankets, litters, and splints to the receiving, litter wounded, and walking wounded depart- ments. (g) Personnel in the litter and walking wounded de- partments prepare for the reception of patients. (h) The forwarding department is established. (i) The clerk, recorder of patients, takes position prepared to make the necessary record of patients passing through the station. (j) As soon as the platoon sergeant has personally inspected all departments of the station and ascertained that equipment and preparations are complete and satisfactory, he takes his post in the receiving department. (fc) Under the direction of the mess sergeant, the cooks and cooks helpers unload the equipment and supplies of the station kitchen, pitch the kitchen fly, and start the prepa- ration of hot foods and drinks for patients. This kitchen does not feed the duty personnel. The unit kitchen should be located near but not in the collecting station. (l) The message center clerk establishes the message center at a designated point, places the proper signs, and takes his post. (m) As soon as trucks are unloaded, they are driven to a concealed park in the vicinity of the station. in) After the trucks are parked, the chauffeurs dig the latrines. As soon as they are finished, they return to the park and await further orders. (4) Improvements. If the station remains in one position several days, its organization, protection, and facilities are improved. c. Directing signs. Upon the establishment of a collecting station, plainly visible directing signs are posted at suitable points to mark the location of the station and the routes thereto. The area forward is adequately posted along the litter-bearer routes as far as the line of the aid stations. A large sign is prominently displayed in the vicinity of the station. The posting and removal of the station sign are the responsibility of the platoon sergeant. The posting and subsequent recovery of the Red Cross directing signs are the responsibility of the sergeant of the bearer element in whose zone of action these signs are posted. 355. Operating Collecting Station, a. General. The ma- terial in this paragraph is to be construed merely as a general guide to the operation of a collecting station. The functions discussed herein must be discharged in every situation; but circumstances may require some modification of the manner in which they are discharged. b. Receiving department. All cases enter the station through this department. A supply of blankets, litters, and splints is maintained for exchange with litter bearers. Each patient is examined and classified either as a walking wounded or a litter wounded. Experience has shown that roughly 50 per MEDICAL SOLDIER’S HANDBOOK 301 302 cent of all cases received will fall into each of these classes. If gas is used, a further classification must be made to sepa- rate gassed patients from all others. As soon as a patient is classified in this department, he is sent to the proper depart- ment for emergency treatment and preparation for further evacuation. c. Litter wounded department. (1) In general, litter v/ounded will require more attention than walking wounded, although a relatively slight injury to a foot may prevent a patient from walking and this department is organized ac- cordingly. If the personnel is available, this department should be manned by two medical officers and six enlisted men. Of the latter, there is one noncommissioned officer in general charge; one enlisted man in charge of sterilization and the administration of hypodermic medication, including sera; one enlisted man in charge of shock litters; one in charge of dressed litters; and two (technicians) to assist the medical officers. (2) Two dressing tables are operated, one by each medical MEDICAL SOLDIER’S HANDBOOK ANY VISIBLE COLOR (This sign may be painted on a suitable panel with the additional legend “To Collecting Station’’ or “To Clearing Station,’’ or whatever the installation may be, and mounted on a post or tree or other object.) Figure 122. For Signs Pointing Way to Medical Installations. officer and his assistant. Dressings and splints are placed conveniently. Only the simplest and most necessary opera- tive procedures are undertaken. Tourniquets must be re- moved and hemorrhage stopped if possible before the patient is evacuated. (3) A section of the litter wounded department is devoted to the treatment of traumatic shock. A shock litter is pre- pared by placing an ordinary litter on a litter rack with blankets so arranged as to inclose the space beneath the litter, in which are placed lanterns. When lighted, these lanterns provide heat to a patient placed on the litter. Additional heat may be provided with blankets and the judicious use of hot water bottles. (4) Working to the rear of the dressing tables is an en- listed man charged with sterilizing instruments and admin- istering hypodermic medication. An important duty of this man is to examine the emergency medical tag of each patient and, if the administration of any serum is routine, to deter- mine whether or not it has been administered previously: and, if it has not already been administered, to give the pa- tient the prescribed dose, making a proper notation of his action. He administers other hypodermic medication at the MEDICAL SOLDIER’S HANDBOOK 303 direction of a medical officer and makes the proper notations of such action. (5) Several litters are dressed with blankets to be avail- able without delay when needed. For the method of dressing a litter, see FM 8-35. d. Walking wounded department. This department is op- erated similarly to the litter wounded department except that no provisions are made for the treatment of shock and no dressed litters are maintained. One medical officer with enlisted assistants usually operates this department. e. Gas department. If gas is used by the enemy, special provision must be made at the collecting station for gassed cases. They must not be mixed with other patients, and they usually require special treatment. While these cases must receive treatment at the collecting station, the meager equip- ment and limited personnel will not permit of more than the minimum of ameliorative measures being taken. Degassing of mustard cases and suspected mustard cases is undertaken when practicable. In good weather, this department should be operated in the open. Personnel must observe protective measures. If gas casualties are numerous, collecting units must be reinforced to afford proper care to such cases. Spe- cially trained personnel and suitable equipment should be provided. f. Record department. A clerk, recorder of patients, keeps a numerical record of all patients received at the collecting station, classified as indicated in FM 8-45. A report is sub- mitted through the message center to the next higher head- quarters at such intervals as may be directed, usually every 4, 6, or 12 hours, depending upon the situation. g. Forwarding department. (1) As soon as the treatment of each patient is completed, he is removed to the forwarding department. Although not separated by any great distance, to facilitate the loading of ambulances, walking wounded are kept apart from litter wounded in this department. While awaiting evacuation, patients, especially the seriously sick and injured, must be provided with some shelter if the wea- ther is cold or inclement. (2) The enlisted man in charge of the forwarding depart- ment directs the loading of ambulances, checks the exchange of property, and separates the patients into those who are to be evacuated and those who are to be returned to their or- ganizations. The latter he turns over to the military police, or disposes of in accordance with special instructions. The former he classifies as shown below, and sees that ambulances are loaded accordingly: (a) Those who must be transported in a recumbent position. These are not to be confused with litter wounded, since certain litter wounded may be transportable in a sitting position. (b) Those who may be transported in a sitting position. (c) Those who must be transported apart from others, such as gassed patients and those with contagious diseases. (3) The equipment of evacuees may accompany them, or may be disposed of at a salvage dump established at the col- 304 MEDICAL SOLDIER’S HANDBOOK lecting station. This is determined by policies established by the division commander. (4) The loading of ambulances is controlled by the collect- ing unit. All ambulances are loaded to capacity when evacu- ation is heavy. Except in emergencies, ambulances are held at the forwarding department until a full load is assembled. h. Kitchen. When the station is opened, the cooks imme- diately prepare an adequate supply of hot coffee, cocoa, or soups for cases awaiting treatment or evacuation. i. Morgue. This is merely a place, out of the sight of the wounded, where those who die at the station are placed until they can be properly disposed of by the agency responsible for burial. 356. Liaison Section, a. Responsibility for liaison. In the medical service the responsibility for maintaining contact be- tween two medical units lies with the unit to the rear. Al- though regimental and battalion surgeons have a duty in this connection, the responsibility for establishing and maintain- ing contact between attached medical personnel and the collecting unit in support lies with the latter. To discharge this duty there is, in each collecting unit, a liaison section composed of contact agents. b. Duties of contact agents. The basic functions of contact agents (e below) are: (1) To locate all infantry aid stations in the collecting company’s assigned area of responsibility. Contact agents are not usually assigned to artillery units. (2) To return to the collecting station and guide the litter bearers forward to the aid stations. (3) Afterward, to remain at their respective aid stations and there act as contact or liaison agents for their unit, send- ing back to the unit commander all the useful information they can obtain. c. Establishing contact. Contact is established in one of two different ways: (1) Collecting station to aid station. The contact agents remain with the collecting unit until the site for the collecting station has been fixed. Then, while the station is being estab- lished, the contact agents are sent forward to locate the aid stations. (2) Aid station to collecting station. The contact agents are sent to locate the aid stations before the establishment of the collecting station has been started. This may be done either by attaching a contact agent to each battalion medical section before it enters combat, so that the contact agent ac- companies it into position, or by dispatching the contact agents forward after the battalion sections are in position but while the collecting unit is still in a position in readiness. When this method is employed contact agents must be in- formed of the general area in which the collecting station will be located. The choice of methods will depend upon the sit- uation; elimination of delay is the guiding consideration. d. Instructions to contact agents. When contact agents are not attached to battalion sections prior to combat, but are dispatched forward by the collecting unit commander, their instructions must include the following; (1) Direction of the enemy. (2) Boundaries of the zone of responsibility of the collect- ing unit, shown both on the ground and on the map. (3) Designation of the unit, or units, to which the contact agent is being sent. (4) Location of such unit, or units, if known. (5) General route to be followed. (6) Any information to be transmitted to the regimental or battalion surgeon to whom the contact agent will report, such as the location of the collecting station and when litter squads may be expected to arrive at the aid station. e. Local distribution of contact agents. When two or more contact agents are being dispatched to a combat regiment, all should report initially to the regimental surgeon so that he may distribute them according to the plans for the employ- ment of the regiment. f. Failure of a contact agent to report. If a contact agent sent to locate an aid station does not report back to the col- lecting station at the proper time, another contact agent or other soldier capable of performing the duty must be sent. Liaison must be established and maintained. g. Contact agents at aid stations. Contact agents must not only be intelligent and highly trained but must exhibit initia- tive and have a keen sense of the importance of their duties and the responsibilities of their position if they are to be of any value to their commanding officer and to the medical service. They are there to obtain early and reliable informa- tion, and they must get it and transmit it. Their duties are to keep the collecting unit commander constantly in- formed of: (1) A change or contemplated change in the location of the aid station. (2) The prevailing type of wounds or gas casualties. (3) The number of wounded and whether increasing or decreasing. (4) The progress of the regiment or battalion to which attached. (5) Enemy counterattacks of new infantry units engaged or about to engage as communicated to the contact agent by the regimental or battalion surgeon, and any other infor- mation pertinent to the military situation if it concerns the collecting unit. h. Agencies for transmitting information. (1) The agen- cies available to contact agents for transmitting their infor- mation to the collecting station are usually limited to return- ing litter bearers, walking wounded (unreliable, but used when necessary), ambulances arriving at the aid station or a nearby loading post, and the telephone, when available. (2) Messages of special importance are sent in duplicate by two different agents. One message is marked “Duplicate.” (3) Sketches are sent when they supplement a written message or better explain a certain situation than does a message. MEDICAL SOLDIER’S HANDBOOK (4) Each contact agent is provided with a field message book and pencils. 357. Litter Bearers, a. Task. The assembling of litter wounded at a collecting station is a slow operation. The time required to evacuate aid stations of their litter wounded is a function of three variables: the number of litter wounded, the number of litter bearers, and the time required to make the trip between the aid station and the collecting station. Dis- tance is no accurate index of this time, since difficulties may alter the usual relationship between time and space. b. Factors tending to retard collection rate. (1) Poorly trained or ill-disciplined litter bearers. (2) Night collection. (See g below). (3') Casualties scattered over field instead of being assem- bled at aid stations. (See f(l) below.) (4) Inclement weather; difficult terrain, such as mud, rough undergrowth, etc. (5) Enemy fire and gas. (6) Enemy counterattacks. (7) Long litter carriage. (8) Fatigue of litter bearers. During hard fighting, fresh litter bearers can be expected to work the first 20 to 24 hours with but little rest. Thereafter they should be relieved and rested every 12 hours. (9) Casualties sustained by litter bearers. c. Measures for increasing the rate of collection. (1) Use of wheeled litter carriers. A wheeled litter carrier is a light collapsible, two-wheeled, rubber-tired, hand-propelled vehicle which will transport one patient on a litter. Each carrier is operated by two bearers. Each collecting unit is equipped with wheeled litter carriers. They should be allotted to bearer elements according to numbers of patients to be transported, distances to be traversed, and .suitability of terrain. By es- tablishing relay posts, carriers may be used for parts of the distance, substituting carriage by hand over stretches not suited to their use. (2) Forward displacement of the collecting station. An aid station is not located for convenience to the collecting station. The location of the latter must conform to the movements of the former. While it is true that the move- ment of a completely established collecting station entails considerable effort and is to be avoided unless necessary, the reduction in capacity of litter bearers may outweigh the advantages of retaining a collecting station site. When this point is reached the station should be moved forward to de- crease the distances that patients must be transported by bearers. (3) Use of advanced ambulance loading posts. Advanced ambulance loading posts should be used whenever practicable and the situation permits. In some situations they may be used during the hours of darkness when their daytime use is impossible. An advanced ambulance loading post is estab- lished by the ambulance unit upon the request of the collect- ing unit. In the event that the ambulance unit commander disagrees as to the practicability of operating ambulances in advance of the collecting station, the decision is made by the MEDICAL SOLDIER’S HANDBOOK MEDICAL SOLDIER’S HANDBOOK 307 next higher echelon commander, normally the commander of the division medical unit. (4) Reinforcement with personnel from collecting unit in reserve. If there be in reserve a collecting unit whose em- ployment in the near future is not contemplated, individual personnel or subordinate elements may be detached therefrom to reinforce a collecting unit in action. The relative expedi- ency of this course and that discussed in (5) below must be carefully considered. It may be advantageous to relieve an exhausted company with a fresh one, placing the former in reserve to recuperate. (5) Leapfrogging with another collecting unit. This pro- cedure consists in placing an unengaged unit in action to establish a new collecting station farther forward, closing the old station when the new is in operation. Though not always practicable, this procedure is most useful in certain situations. A typical situation in which its use is indicated is to be found in a successful attack by combat teams in column. d. Litter squads in extended order. For a detailed discus- sion of extended order see FM 22-5. The bulk of the work of litter squads is not done in formation, but formations are necessary in the advance to aid stations and in clearing areas of wounded that have not been taken to aid stations. Such formations reduce casualties in litter squads, promote control, and insure a thorough search of the field. All distances and intervals shown in figure 120 are approximate and are in- tended only as guides. (1) Column of litter squads. This formation facilitates control or change of direction and presents the smallest pos- sible frontage to direct enemy fire. It is most frequently used in advancing to a definite objective, usually an aid station, over terrain subject to hostile observation and fire, or in fol- lowing a concealed route, as a draw or ravine. A distance of 50 yards between litter squads in the column is usually ade- quate. The platoon sergeant marches at the head of the column. The section leaders march where they can best control their sections. (2) Line of litter squads. This formation finds its greatest usefulness in searching and clearing the field of wounded after combat. At night, in close, rough, and wooded country, the interval between litter squads must be less than on open and flat terrain. The platoon sergeant marches well in ad- vance of the center of the platoon so that he may be the first to arrive in new territory, make his decisions, and trans- mit his orders to his section leaders. (3) Line of section columns. This formation is sometimes useful in crossing dangerous areas or in approaching woods in order to provide quick concealment and at the same time present an inconspicuous target. A distance of 50 yards be- tween litter squads in the column is usually adequate. e. Advance to and clearing of aid stations. (1) Prior to advance. Litter bearers are usually not dispatched until the locations of the aid stations are definitely known. While awaiting the return of the contact agents, the situation so far as known is carefully explained to the platoon sergeants and section leaders. As the exact locations of aid stations are 308 MEDICAL SOLDIER’S HANDBOOK FIRST SECTION SECOND SECTION DIRECTION MOVEMENT D/ZECT/OA/ SECOND f SECTION FIRST SECTION LEGEND PLATOON SGT SECTION LEADER UTTER BEARER UTTER BEARER PLATOON ADVANCING IN COLUMN OP LITTER SQUADS I UTTER SQUAD UTTER BEARER PLATOON ADVANCING IN DEPLOYED LINE OF UTTER SQUADS Figure 123. Extended Order Formations of Litter Bearers. learned, they are plotted on maps or sketches. Apparent loss of time, occasioned by holding the bearer platoons at the col- lecting station until positive information of aid station posi- tions is obtained, is fully repaid in diminished loss of person- nel, fewer chances of going astray, and in a better organiza- tion of the bearer service. Although the platoon or section may be accompanied by the contact agent, the platoon ser- geant or section leader must understand where he is going MEDICAL SOLDIER’S HANDBOOK 309 and how he is going to get there before being permitted to start. (2) Advance. Over favorable terrain, it is usually feasible to leave the collecting station personnel in column of litter squads closed up. This formation is retained as long as it is safe, but as dangerous areas are approached the distance be- tween litter squads is increased as may be necessary in order to avoid unnecessary losses. Actively shelled areas are avoided whenever practicable. Advantage is taken of terrain features to secure cover from fire, and particularly concealment from hostile observation. If the litter carry is 1000 yards or more, a litter relay post is established at a selected point, and the necessary number of squads left to man it. (See h below.) (3) Evacuation. When the aid station is reached, evacua- tion begins at once, all litter cases being carried back to a litter relay post, the collecting station, or an advanced ambu- lance loading post. With occasional rests, the litter bearers ply continuously back and forth between these points and the aid stations until all wounded have been evacuated, or until the bearers have been relieved. It is essential that aid stations be cleared as rapidly as possible, not only that the wounded may reach a place of definite treatment with the least practicable delay but, from a broader point of view, it is essential that the wounded be removed from the sight of the combatant troops. It occasionally happens that the wounded lying to the rear of the aid stations must be temporarily neg- lected in order that the steady flow of wounded from the aid stations be not interrupted. /. Clearing field of wounded. (1) When, in addition to re- moving the wounded from aid stations, the bearer platoons must also search and clear certain areas, their task is greatly increased and collection is thereby retarded. If casualties be numerous, reinforcement may be necessary. Such a situa- tion may arise when combat troops have advanced some dis- tance, necessitating corresponding advance and successive re- establishment of aid stations. It may occur in hard fighting without advance of the aid stations, the medical detachments being unable to cope with their tasks. Or it may arise in an interval between attack and counterattack when the oppor- tunity must be seized to remove all wounded. (2) When the field is to be cleared by the bearer platoons, they are assigned zones of action. Boundaries are designated by conspicuous landmarks, such as buildings, roads, streams, fences, isolated trees, or woods. The platoon or section forms in a deployed line of litter squads, using such intervals as may be indicated by the nature of the terrain and system- atically searching all the ground as it advances. The effec- tiveness of the search is increased in each squad by having the numbers 1 and 4 move 10 to 25 yards on each side of the litter. Upon finding a wounded man, he is removed to the central axis and the search is resumed where he was found. The central axis should be a well marked, easily distinguish- able feature, such as a road or fence. This central axis is finally cleared to the collecting station by ambulance if prac- ticable; otherwise by litter or wheeled litter carrier. It is 310 MEDICAL SOLDIER’S HANDBOOK sometimes desirable to evacuate wounded as found to a litter relay post. g. Clearing field of wounded at night. (1) This is fre- quently necessary, and in dark nights on strange terrain is at- tended by great difficulties, the most serious of which are; (a) Loss of control of litter bearers. (b) Inability to find all wounded, especially the most seriously wounded, or uncertainty whether all wounded have been found. (c) Difficulty in resuming search where last patient was found. (d) Difficulty in maintaining proper direction of search. (2) Measures which facilitate night collection are as follows: (a) If possible the clearing of the field should be initiated before it has become quite dark. If this cannot be done, a reconnaissance of the area to be searched by the officers and noncommissioned officers who are to direct the work of the bearers is advisable even though hasty. Promi- nent and easily recognized and followed landmarks are to be noted in this reconnaissance. (b) Disciplined bearer units thoroughly trained in night exercises, and the use of the luminous compass. (c) Detailed organization of the bearer service, and a carefully worked out plan for the assigned task. (d) Avoidance of dispersion of bearers until area to be cleared has been reached. (e) Assignment of limited zones of action to subunits marked by easily recognized boundaries, such as roads, build- ings, fences, streams, railroads, edges of woods. (/) Material reduction of intervals depending on the character of the terrain and the degree of darkness. (g) Reduction of distances with reference to litter relay posts, central axes to which patients are carried, and advanced ambulance loading posts. (h) Close contact and control by section sergeants in- cluding periodical reporting of bearers at local command posts. (i) A white band (wide bandage) around each bearer. (j) One member of each squad to remain at the point where the last patient was found to mark the place. (k) Assignment of guides to bearer platoons brought up from the rear after dark. (3) The evacuation of aid stations at night is less difficult after the stations have been located. The best evacuation routes to the collecting station are selected. Frequently, de- sirable routes can be taken at night, the use of which in the daytime is impossible. Distances between litter relay posts may be somewhat reduced. (4) If the military situation permits of lights being used, the problem of night evacuation of wounded is simplified. h. Litter relay posts. (1) Litter relay posts are established as required, usually about every 600 yards. Over good terrain the distance between relay posts can be increased several hundred yards. The relay posts are on the litter bearer routes which extend from the aid station back to the collecting sta- 311 tion or any other point at which wheeled litter carriers, light railway, or ambulances can take over the patient. It is un- economical and unnecessary to locate wheeled litter-carrier relay posts as close together as are litter relay posts. In fa- vorable situations, it may be practicable to cover the entire distance between an aid station and the collecting station with wheeled litter carriers. In other instances their use will be more restricted, forming only a link in one or more evacuation routes. (2) Points selected. So far as practicable, litter relay posts are so spaced that all bearers in the chain of evacuation are kept approximately equally occupied. The relay posts should be definitely organized, affording shelter during incle- ment weather, some security from hostile fire, a small reserve of blankets, litters and splints, and a place for storing food. Frequently shell holes, dugouts, or trenches can be used. (3) Personnel. The strength of a relay post will vary. Occasionally as many as 24 bearers are assigned. (4) Operation. The operation is simple. Posts are num- bered from front to rear. A bearer squad with patient arrives from an aid station at post No. 1; turns its patient over to a bearer squad at post No. 1 without removing him from the litter; takes a litter from the stack and returns at once to the aid station. In the meantime, a bearer squad from post No. 1 carries the patient to relay post No. 2 or to the collect- ing station as the case may be. The organization of the relay post system varies according to the situation. One line of relay posts may be established to each aid station being evacuated, all converging at the collecting station; or, as is more frequently the case, especially if the front be not wide, the chain may run forward to No. 1 post which is centrally located in the rear of and close to the aid stations, and all wounded are evacuated from the aid stations to No. 1 relay post, and thence back through the relay route. Each situation must be studied with a view to the simplest, most rapid and economical removal of litter patients from the aid stations to the collecting station. i. Officer commanding litter-bearer platoons. An officer under the company commander is responsible for organizing and operating the litter bearer service during combat. When necessary, he leads the bearer platoons forward and makes the initial dispositions. He establishes his command post normally at the collecting station or at a litter relay post from which he can best control and coordinate collection in the company zone of action. He goes, however, wherever his services may be required. He informs the platoon sergeants of his position and keeps in communication with them. He keeps the company commander constantly informed of the situation and makes timely requests for reinforcements or relief of his bearer platoons. j. Platoon sergeant. The platoon sergeant receives his or- ders during combat from the officer commanding the litter bearers. He goes forward with his sections and personally sees that they reach the aid station or stations, or other ob- jective, and gets evacuation under way at once. He organizes litter relay posts as directed and supervises the work of his MEDICAL SOLDIER’S HANDBOOK 312 platoon. He takes post at a point from which he can best control the functioning of his platoon. This may be at a relay post or a point where the evacuation routes of his two sections converge. He maintains close contact with the sec- tion leaders at all times and keeps his commanding officer constantly informed of the situation in his platoon and zone of action. k. Collection of artillery casualties. Collecting units rarely establish contact with the aid stations of artillery units for the following reasons: casualties among artillery personnel are normally less than in infantry units, and the attached medical personnel of artillery units are able to prepare their casualties for evacuation to the clearing station; ambulances ordinarily can reach artillery aid stations with safety; and the medical detachments of almost every artillery unit are equipped organically with ambulances. Consequently, artil- lery casualties normally are evacuated directly from aid sta- tions, either upon request to the division ambulance unit operating in the area or by the organic ambulances of their own medical detachments. 358. Closing Collecting Stations. The procedure of clos- ing the collecting station is practically the reverse of its establishment, except that in closing the station the bearer platoons do not participate. a. All patients are evacuated. b. The personnel of each department packs its own equip- ment. c. The truck drivers bring their trucks to the designated loading positions. d. The collecting station personnel strike and fold the tents. e. The collecting station personnel load the station’s equip- ment trucks. f. Directed by the mess sergeant, the cooks and their helpers load the kitchen supplies. g. The loaded trucks take their march position. h. The unit forms in skirmish line and polices the area it has occupied. Upon the completion of this duty the unit falls in (with bearer platoons if they are to move with the com- pany) and, if shelter tents were pitched, strikes them, slings equipment, and forms for route march. i. Latrines are closed and marked by the truck drivers. j. The commanding officer makes a personal inspection of the area. 359. Forward Displacement of Collecting Station, a. When warranted by the tactical situation, the forward displacement of a collecting unit at station by bringing the station closer to the majority of wounded and shortening litter carriage is an effective means of facilitating casualty collection. The collecting unit must keep .close, effective contact with the front line troops in its zone of action or sector, the station being located close enough to the line of aid stations to make litter carriage as short as possible but not so exposed that the work of the station cannot be carried on. It must be recognized that litter bearers may properly be exposed to enemy fire to a greater extent than is practicable for the sta- MEDICAL SOLDIER’S HANDBOOK 313 tion itself. When in the opinion of the unit commander the station should be advanced, he makes the recommendation to the proper authority. The station is advanced only on orders of competent authority. b. Forward displacement is indicated: (1) During a successful attack, when the litter carry has become unduly long. (2) When the enemy has abandoned the field, and the number of casualties and their distribution warrant a re- establishment of the collecting station. c. Forward displacement is not indicated: (1) When the advance is only a temporary fluctuation in the course of the battle. (2) When the station in a more advanced position would be rendered useless by the enemy fire. d. Important obstacles in effecting forward displacements are: (1) Enemy artillery fire. (2) Destroyed or impassable roads. (3) Congested roads or roads reserved for the advance or relief of combatant troops. (4) Darkness. e. Procedure. (1) The collecting unit commander, accom- panied if possible by the ambulance unit commander con- cerned, makes a reconnaissance of the route or routes forward and of the vicinity in which the collecting station is to be reopened. (2) The officer directing the litter bearer service is in- formed of the new location for the station and the hour at which the movement of patients thereto is to start. He re- groups his bearer service to meet the new situation. (3) Medical supplies are replenished as necessary. (4) Aid stations are notified by field messages of the location of the new station and when it will open. (5) The station is cleared of any accumulation of wounded. (6) Equipment and supplies are packed and loaded. (7) The advance to the new site is made at the hour and by the route prescribed in the order from the battalion. (8) The proper authority is informed as soon as the new station is opened. (9) Ordinarily one truck and the equipment and person- nel of the walking wounded department should remain at the old site until everyone concerned has been notified of the movement forward and the establishment of the new station. 360. Dividing Collecting Unit for Tactical Employment, a. The collecting station equipment is so made up and carried that the company can be divided into two approximately equal parts, each one of which is able to function on a limited scale as a collecting unit in combat. b. Occasions which may make such a division of the com- pany desirable or necessary are: (1) When a force on a detached mission does not require a complete collecting company, or for which a complete com- pany cannot be spared. (2) When a force is fighting on an extended front against MEDICAL SOLDIER’S HANDBOOK Med. Sol. Hb. 314 a weak enemy, in a delaying action, or is holding defensively a wide front. (3) When one or more terrain features divides the zone of action into two areas more or less inaccessible to each other, (4) When only part of a collecting company is required for an advance, flank, or rear guard, c. The company is so divided that each half contains its proportionate share of officers, equipment, and the function- ing subunits of the company. 361. Relief of Collecting Unit at Station, a. When a collect- ing unit at station is to be relieved, orders are issued desig- nating the organization for the relief, the date and hour the relief is to be completed, route by which the relieving unit will approach the station, and the elements of the old unit to remain in the area for the guidance of the new. Guides are detailed to meet the new unit. This is especially necessary in night reliefs. b. Upon receipt of the order, the commander of the re- lieving unit or an officer designated by him proceeds to the unit he is to relieve for arrangement of details and a thorough reconnaissance of the entire area covered by the unit he is relieving. He takes over all maps of the sector and all property which is to be exchanged. He familiarizes him- self with all sector orders. He must note especially the fol- lowing important points: (1) Location of all aid stations and the routes thereto. (2) Location of each relay post and advanced ambulance loading posts (if any). (3) Wheeled litter-carrier routes. (4) Location of the ambulance station. (5) Source of water supply and purity of the water. (6) Source of fuel. (7) Characteristics of enemy fire and his habits relative to the use of gas. (8) Areas which come under enemy observation. c. The relief of the litter bearers conforms to the methods governing such operations. No relief should be carried out without leaving important elements of each section being relieved in position to aid the incoming litter bearers during the first few hours. The men so left are used in giving in- formation of the area and in guiding groups from place to place until the new personnel are thoroughly familiar with the terrain and the peculiarities of the enemy artillery on this portion of the front. MEDICAL SOLDIER’S HANDBOOK Section III 362. Functions, a. General. The ambulances of the di- vision medical unit furnish the transportation, described below, within the division area. They are not employed normally to evacuate casualties from the division; this is a function of ambulance units of higher echelons. Nor must the ambulances of the division medical unit be confused with those assigned to the medical detachments of certain other elements of the division, notably artillery. b. In other than combat situations. The transportation of evacuees from dispensaries to the agency designated to re- ceive the patients of the division. c. In combat. (1) Primary, (a) The transportation of evacuees from collecting stations (and occasionally certain aid stations) to the clearing station. (b) The transportation of litter wounded from ad- vanced ambulance loading posts to collecting stations. (c) Emergency care and treatment of sick and injured en route. (2) Secondary, (a) The transmission of messages from one medical unit to another along the assigned routes of evacuation. (b) The transportation of medical supplies from the division medical dump to units farther forward. (c) The transportation of medical personnel, partic- ularly of collecting units, to and from battle stations. 363. Control, a. General. In one type of division medical unit, ambulances are controlled by ambulance unit command- ers. In the other type, they are controlled by collecting unit commanders. In either case each major ambulance element is commanded by an officer of the Medical Corps, and the gen- eral principles of control and operation are the same. b. Orders to ambulance elements may specify the exact route or routes to be used, or they may list certain available routes and leave the final selection to the discretion of the ambulance commander. In either event the ambulance com- mander must be informed of all traffic restrictions that may affect his operations. c. Reconnaissance. Whenever practicable, ambulance com- manders should reconnoiter all routes available or likely to become available within their zones of operation. Such re- connaissance is not alone for the purpose of selecting or familiarizing themselves with initial routes, but also for secur- ing information of alternate routes in the event that changes in the situation may indicate or require the abandonment of the initial route. d. The ambulance plan should include: (1) The initial ambulance route and possible alternate routes. (2) Locations of the ambulance station, of relay posts, of traffic posts, and of advanced ambulance loading posts. (3) Distribution of ambulances among tasks and among the several posts. (4) Provisions for supply and maintenance of vehicles. DIVISION AMBULANCES 316 MEDICAL SOLDIER’S HANDBOOK (5) Provisions for relief and messing of personnel. 364. Ambulance Routes. The following considerations gov- ern the selection of ambulance routes: a. Availability. h. Physical characteristics, such as the surface, width, and grades of roads, and the practicability of cross-country routes, c. Other traffic on same routes or portions thereof. 2Ld DN(AMDj II 213 BN HQ 2 223 Battalion aid station 274 Battalion surgeon 274 Battalions, medical, organization of 28^ Battalions, separate, medical detachments with 2»2 Beds, making hospital 218> 24® Bed pan, to give and remove 224 Belligerents, definition of 341 Belt, pistol, to adjust 32 Billet, definition of 21 Bivouacs: Definition of For mounted organizations 85 Personal care and comfort in 81 Bladder instillation 226 Bladder irrigation 226 Blanket, to fold the 36 Blanket roll, to assemble and pack the 46 Blood 146 Blood platelets 148 Blood vessels 146 Body, development of the 133 Bone, development of ., 139 Bones of tlie extremities 137 Brain 158 Bulletin board, organization 6 Burial expenses 355 Burning, definition of 261 Burns, first aid for 187 Camps: Definition of 81 For mounted organizations 85 Personal care and comfort in 81 Sites for 81 Canteen cover, to attach 33 Cantle roll, to assemble and pack the 46 Cantonment, definition of 81 Capacity, systems of 259 Capillaries 146 Carbonization, definition of 261 Cardiac stimulants 244 Cardio-vascular system 145 Care of sick and wounded 342 Carminatives 244 Cathartics 244 Catheterization 225 Caustics v 244 Cavalry, medical detachments with 278 Cerebellum 159 Cerebrospinal fluid 160 Cerebrum 158 Charting, rules for 223 Chest cavity 152 Chest wall 136 Chevrons 15 Circulatory system 145 Cleansing sponge bath 228 Clearing station: Closing a 333 Establishing a 325 Operating a 330 INDEX 361 Page Clearing unit commander 324 Clearing units 323 Clerical records and reports 344 Clinical record 205 Close interval formation: Platoons 70 Squads , 66 Clothing: Allowances 19 Care of 19 Wearing of 21 Colation 262 Collar insignia 13 Collecting station: Closing a 312 Establishing a 298 Forward displacement of a 312 Location of a 296 Operating a 301 Collecting unit commander 294 Collecting units 293 Column of twos, formation: Platoons 72 Squads 67 From single file 67 Commanding officer: Of the hospital 203 Of the medical detachment 203 Company aid men 272 Compass, use of 87 Complications after surgery 237 Compounding, definition of 257 Connecting file 107 Contact agents 304,305 Contagious ward 215 Control of ambulances 315 Conventional signs 94 Convulsions, first aid for 193 Coordinates, rectangular 93 Cord, hat 12 Cornea 161 Corpus callosum 158 Correctives 244 Corti, organ of 163 Counting off, squads 61 Cowling’s rule 241 Cowper’s glands 166 Courtesy, jpilitary 8 Crystallization 263 Decantation 262 Declaration of war * 341 Decorations, pay for 354 Deductions 355 Defense, security in 127 Demulcents 244 Dental department, clearing station 332 Dental service 275 Deodorants 244 Department hospitals 200 Deposits, soldiers’ 355 Description of commonly-used drugs 246 Dessication, definition of 261 Detachments, medical 267 Detention ward 215 Diaphoretics 244 Digestion 263 Digestive system 152 362 INDEX Page Discipline, military 1 Disinfectants 244 Dislocations, first aid for 181 Dispensaries 202, 269 Dispensing, definition of 257 Displacement 263 Display of equipment 50 Diuretics 244 Division ambulances 315 Division medical service: Clearing 323 Collection 293 Division ambulances 315 Organization 283 Division surgeon Domestic measures 280 Double time 57 Drivers, artillery Drowning, first aid for 182 Drugs: Administration of 261 Classification of 243 Derivation of 241 Description of 246 Mechanical subdivision of 261 Dura mater 160 Ear: Removal of foreign bodies in 191 Structure of 162 Electrical shock, first aid for 184 Elements of pharmacy 257 Emblem, medical service 342 Emetics 244 Employment, division medical service 283 Endocrine system 167 Enema, to give an 224 Engineers, medical detachments with 281 Epiglottis 151 Epilepsy, first aid for 193 Equipment: Display of 50 Field 26 Gas mask 22 Individual 291 Medical soldier’s field 33 Organizational 291 Packing individual equipment on horse 46 Erythrocytes 148 Eustachian tube 162 Evacuation of wounded 309,332 Evaporation, definition of 261 Exchange, post 5 Excretory system 155 Expiration 152 Extension 137 Extraction 263 Eye: Removal of foreign bodies in : 191 Structure of 161 “Eyes right” or “eyes left” 54 Facing; In marching 58 Positions 55 Fainting, first aid for 193 Feed bag 47 Feeding the patient 230 INDEX 363 Feeling, sense of 160 Fibrin 146 Field Artillery, medical detachments with 279 Field ration 351 File, connecting 107 Filtration 282 Fire for cooking 353 First aid: Artificial respiration 182 Common emergencies 19° Fractures, dislocations, and sprains 177 Gas casualties 7 184 General 168 Injuries due to heat and gold 187 Poisonous bites and stings 189 Shock 176 Transportation of wounded 194 Treatment of wounds 169 Fits, first aid for 193 Fixation 177 Fixed hospitals 200 Flank guard 125 Flexion 137 Foramen magnum 159 Formations: Platoons 68 Squads 61 Forwarding department, collecting station 303 Fractures, first aid for ' 177 Freezing, first aid for 189 Frostbite, first aid for 189 Furlough allowance 354 Fusion, definition of 261 Garrison ration 351 Gas, protection against 109 Gas casualties, first aid for 184 Gas department, collecting station 303 Gas mask 22 General hospitals 1 200 Geneva Convention 342 Genital system J64 Genito-urinary system 164 Glossary, common military expressions 357 Government insurance . V 355 Grain 258 Grain bag 47 Group life, responsibilities of 1 Guard duty: Importance 75 Orders * - 74 General 75 Personnel 74 Tour of 74 Haemostatics 244 Hague Conventions 341 Hair, care of the 229 Half step 58 Halt, security at 120 Halting 57 Haversack, assembling the 33 Head injuries, first aid for 193 Hearing: Mechanism of 163 Sense of 160 Heart 145 Heat exhaustion, first aid for 189 364 INDEX Page Helmet, to attach the 42 Hematology 148 Hemoglobin 148 Hemorrhage, types and control of 170 Hilum, the 164 Horseback, moving wounded on 198 Hospitals, military 200 Hypertrophy of the muscle 144 Hypnotics . 245 Hypodermic injection 232 Hypodermoclysis 233 Identification of patients 205 Ignition, definition of 261 Incendiaries 187 Incompatability, definition of 265 Individual medical equipment 44 Infantry, medical detachments with 278 Infusion 263 Insect bites, first aid for 190 Insignia: Arms and services . 12 Officers and noncommissioned officers 15 Inspiration 152 Installations, division medical service 291 Insurance, government 355 Interior guard duty 74 Intestine: Large 155 Small 154 Intravenous infusion 234 Irritant gases 185 Irritants (drugs) 245 Joints 140 Kidneys 164 Kitchen, collecting station 303 Laboratory specimens 226 Lacrimators 185 Large intestine ; 155 Larynx 151 Lateral ventricle 159 Laws of war 341 Lethal dose 242 Leucocytes 148 Lewisite 186 Liaison section 304 Liquids, separation of solids and 262 Litter bearers 306 Litter relay posts 310 Litter squads 272 Litter wounded department: Clearing station 331 Collecting station 302 Litters, transportation with 194 Liver 154 Longitudinal gerebral fissure 158 Lookouts, antiaircraft 108 Lungs 151 Lymphatic system 149 Maceration 263 Maintenance of ambulances 322 Page Maps: Direction 90 Importance 88 Orientation 91 Reading 91 Grid system 91 Scale, application 88 Symbols, military 97 Use 88 Marches: Conduct on 77 Falling in for 77 Preparation for 76 Road discipline for 78 Security on 124 Marchings: By the flank 59,66 Double time 57 Facing 58 Halting 57 Marking time 57 Other than at attention 60 Platoons 70 Changing direction 71 Close interval 70 Normal interval 70 Toward flank 71 Quick time 57 Squads: By the flank 66 Changing direction 66 Oblique 66 Toward flank 66 Steps: Back 58 Changing 59 Half 58 Side 58 Mark time 57 Mask, gas 22 Materia medica 241 Measures, weights and 258 Medical officer of the day 203 Medical personnel, titles of 203 Medical service emblem 342 Medical soldier as a nurse • 217 Medical soldier’s field equipment; Assembling haversack and pack carrier 33 Assembling medical private’s kit 44 Medicines, administration of 241 Medulla oblongata 159 Melting, definition of 261 Meninges 160 Menstruum, definition of 262 Message center 295 Messengers 107 Metacarpal bones 138 Meter 258 Metric system 259 Metric weight 258 Metrology 258 Mid-brain 159 Military courtesy 8 Military discipline 7 Military obligations 3 Mobile hospitals 200 Morgue, collecting station 304 Motorized units, medical detachments with 281 INDEX 366 Page Mouth: Care of the , 23® Functions of the 153 Moving a patient “20 Muscles 141 Mustard gas 1°® Mydriatics 24" Myotics 245 Narcotics 245 National Formulary 257 Nerves 1®® Nervous system 1"® Nonbelligerents, definition of * 341 Nose, foreign bodies in 19- Nursing 217 Nutrients 245 Obligations, military 3 Oblique march, squads 210 Office, ward 210 Officer of the day, medical 203 Officers: Addressing 11 Appointment of 1 Insignia for 15 Soldier’s relation to 1 Operations of ambulance units Operative bed 219 Orders: Guard duty 74 General 75 Obedience to 2 Organization: Army 16 Division medical service 284 Hospital 202 Medical detachments 267 Orientation, map 91 Osmotic pressure 153 Overcoat, to fold and attach the 42,47 Pack carrier, assembling the 33 Packet, first aid 170 Packing equipment on horse 46 Parasiticides 245 Patients: Admission to hospital 205 Admission to ward 213 Disposition of personal belongings 206 Disposition from ward 214 Feeding the 230 Importance of nurse to 217 Instructions for 209 Moving 220 Post-operative care 237 Preparation for surgery 235 Patrols 113 Pay and allowances , 354 Pelvic bones 136 Penis 165 Percentage solution 263 Percolation 263 Pericardium 145 Periosteum 140 Phalanges 138 Pharmaceutical arithmetic 260 INDEX 367 Page Pharmaceutical preparations 263 Pharmacy management 257 Pharynx 151 Photograph shop 5 Physiology, anatomy and 133 Pia mater 160 Plasma 146 Platelets, blood 148 Platoon: Composition 68 Dismissing 70 Formation 68 Close: Interval 70 Ranks 71 Columns of twos 72 Line to the front 71 Normal interval 70 Open ranks 71 For shelter tents 71 Single file , 72 Individuals, position of 68 Marching: Changing direction 71 Close interval 70 Guide in 70 Normal interval 70 Toward flanks 71 Organization 17 Reforming 72 Pleural cavity 152 Point of advance guard 124 Poisons, first aid for 190 Pons 159 Portal circulation 146 Positions: Attention 54 “Eyes right” or “eyes left” 54 Facings 55 Rests 54 Salute, hand 55 Post-operative care 237 Post exchange 5 Post and station activities 5 Pouch, first aid, to attach 33 Precipitation _ 262 Prescription, definition of 265 Prescription files 258 Prisoners of war 342 Professional division, Army hospital 202 Pronation 138 Prophylactics 245 Protection of medical troops and property 342 Pulmonary circulation 146 Pulmonary sedatives 245 Pulse 221 Purgatives 245 Quarters for medical detachments 277 Quick time 57 Radius bone 138 Raincoat, to fold and attach the 40,47 Rate of pay 354 Rations: Army 351 For medical detachments 277 Rear guard 125 INDEX 368 INDEX Page Receiving department, collecting station 301 Record department, collecting station 303 Records: Alcoholics and narcotics 258 Clerical 344 Ward 209 Recreational activities, post 6 Regimental aid station . 270 Regimental surgeon 273 Regiments, medical, organization of ; 284 Registrar, duties of ... 204 Regulations, hospital 202 Relations: With civilians 3 Medical officer and nurse 217 With officers and noncommissioned officers 1 Relief of collecting unit at station 314 Renal circulation 146 Respiration: Artificial 182 Process of 152 Rate of 222 Respiratory stimulants 245 Respiratory system . 151 Responsibilities of group life 1 Rest positions 54 Resuscitation, technique of 182 Retina 161 Rifle blanket seat 196 Rifle coat seat 196 Roll, to make tfte 36 Rules: For charting 223 Hospital 203 Of land warfare 341 Ward 208 Saddle, to pack the 47,49 Salute, hand 55 Sanitation, military 130 Saturated solution, definition of 262 Scales, military map 88 Scouts in security Ill Security: Antiaircraft 108 Antitank 108 In the Army 98 On campaign: Individual 98 Lookouts: Antiaircraft 108 Antitank 108 Sentinels 105 Unit HO At halt 120 Detachments HO On march 124 Patrols 118 Scouts HI While attacking 128 While defending 127 Sedative 243 Sedimentation 262 Semen 166 Senses, the 160 Sentinels in security 105 Septum 151 Serum 146 Page Shelter tent pitching 81 Forming platoon for 71 Shock, first aid for 176.184 Shoulder bones 136 Shuttles, ambulance 317 Sick; Abandonment of 342 Care of 342 Side step 58 Siphoning 262 Sight, nerves of 160 Signs, conventional 94 Skeleton 134 Skull 134 Sleeve insignia 14 Slings, use of 179 Small intestine 154 Smell, nerves of ■ 160 Snake bite, first aid for 189 Solids and liquids, separation of 262 Solute, definition of 262 Solution, definition of 262 Solvent, definition of 262 Soporifics 245 Specialists’ pay 354 Specifics 245 Specimens, laboratory 226 Spinal cord 159 Spine 136 Splints, application of 179 Sprains, first aid for 181 Squadrons, medical, organization of 284 Squads: Dismissing 61 Formation ' 61 Alinernent 64 Assembling 67 Close intervals 66 Column of twos 67 From, and to, single file 67 Instructions for .' 61 Taking interval 67 Litter 272 Marching: By the flank 66 Changing direction 66 Oblique 66 Organization 17 Toward flank 66 Standards of weights and measures , 258 Station hospitals 200 Steps, marching: Back 58 Changing 59 Double time 57 Half 58 Mark time 57 Quick time i 57 Side 58 Stemutators 185 Stimulant 243 Stings, first aid for 190 Stomach , 154 Straining 262 Stripe, service 14 Styptics 246 Sublimation, definition of 261 Sunstroke, first aid for 188 Supination 138 INDEX 369 370 Page Supply of medical detachments 269 Surgeon: Battalion 274 Division 292 Regimental . 273 Surgical dressings 237 Surgical preparations 235 Symbols, military 95 Systemic circulation . 146 System of capacity 259 Tailor, organization 5 Taste, nerves of 160 Teeth, care of the 230 Telephones, ward 214 Temperature, determining 221 Tendons .' 144 Tent pitching: Heavy 334 Shelter 81 Platoon, formation for 71 Testament, will gnd 356 Testicles 164 Theatres, motion picture 5 Thoracic duct 149 Throat, foreign bodies in 192 Titles of medical personnel 203 Tonics 246 Tourniquet, use of 173 Toxicology . J 266 Trachea 151 Traction 177 Training of medical detachments 277 Transportation of wounded ,..... 194 Transverse fissure 158 Travel pay 355 Trituration 261 Troy weight 258 Ulna bone 138 Unconsciousness, first aid for 192 Uniform, wearing the 21 United States Pharmacopoeia 257 Urethra 164 Urinary system 164 Urinary bladder 164 Urine 164 Vaporization, definition of 261 Veins 146 Ventricle 146 Vermtfuges 246 Vesicants 186 Veterinary aid station 271 Veterinary service 275 Visitors, ward 214 Vitreous humor 161 Volume, weight and 259 Voluntary aid societies 343 Walking wounded department: Clearing station 331 Collecting station 303 Ward management: Admission of patient to ward 213 Contagious ward 215 INDEX INDEX 371 Page Daily duties Definitions Detention ward ~l" Disposition of patients “£* Instructions for patients 200 Office 210 Personnel “Y ‘ Police of the ward "1* Property and linen 210 Records 200 Responsibility for 207 Rules 208 Telephones 214 Utility room or closet 211 Ventilation, heating, and lighting Visitors 214 Weights and measures 258 Will and testament 356 Wounded: Abandonment of 3’2 Care of 342 Clearing field of 309.310 Transportation of 194 Wounds, treatment of I®9 Young’s rule 241 MEDICAL SOLDIER’S HANDBOOK